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Hailu Wu,1,2 Ming Wei,2 Nan Li,2 Qin Lu,2 Sachin Mulmi Shrestha,1 Jiacheng Tan,2 Zhenyu Zhang,3 Guoqiu Wu,4,5 Ruihua Shi2 1Medical School of Southeast University, Nanjing 210009, People’s Republic of China; 2Department of Gastroenterology, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, People’s Republic of China; 3Division of Gastroenterology, Department of Medicine, Nanjing Medical University Nanjing First Hospital, Nanjing 210009, People’s Republic of China; 4Center of Clinical Laboratory Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, People’s Republic of China; 5Jiangsu Provincial Key Laboratory of Critical Care Medicine, Nanjing 210009, People’s Republic of ChinaCorrespondence: Ruihua ShiDepartment of Gastroenterology, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, People’s Republic of ChinaTel +86 25 83262833Fax +86 25 83262830Email ruihuashi@126.comGuoqiu WuCenter of Clinical Laboratory Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, People’s Republic of ChinaTel +86-25 83272150Email nationball@163.comAim: Although Clopidogrel is safe in healthy volunteers, it can induce recurrence of gastric ulcers in high-risk patients. Here, we investigated the protective effect of the natural product, stable gastric pentadecapeptide 157 (BPC 157) on Clopidogrel-induced gastric injury.Methods: We used acetic acid to induce gastric ulcer in Sprague Dawley rats. Clopidogrel alone or in combination with BPC 157 or L-NAME (nitric oxide system blockade) were administered after healing of acetic acid-induced ulcer. One percent methylcellulose solution was used as control. Ulcer recurrence rate and the ulcer index were compared between these groups. Gastric mucosal apoptosis rate, microscopic inflammation activity and angiogenesis markers vascular endothelial growth factor A (VEGF-A) and CD34 were examined by TUNEL, histological evaluations (HE) and immunohistochemistry (IHC). Pathways involved, expressions of endoplasmic reticulum (ER) stress apoptosis marker CHOP, angiogenic markers VEGF-A and its receptor VEGFR1, and endothelial NO synthase (eNOS) were all analyzed by Western blot.Results: This study indicated that Clopidogrel significantly induced the gastric ulcers recurrence, severe inflammation and ER stress related apoptosis of the gastric mucosa, suppressed the synthesis of angiogenic markers and eNOS. Furthermore, Clopidrogel intervention resulted in the activation of protein kinase B (AKT) and p38 mitogen-activated protein kinase (p38/MAPK). BPC 157 attenuated the gastric mucosal damage caused by Clopidogrel and reversed these molecular effects. However, NO blockade L-NAME weakened the protective effect and thus the molecular effects of BPC 157 on gastric mucosa.Conclusion: In conclusion, these results suggest that BPC 157 inhibited Clopidogrel-induced gastric mucosa injury partially by inhibition of gastric mucosa cell ER stress-mediated apoptosis and inflammation, and promoting gastric mucosa angiogenesis via VEGF-A/VEGFR1 mediated-AKT/p38/MAPK signaling pathways.Keywords: clopidogrel, BPC 157, angiogenesis, AKT, p38/MAPK

Bijay Khatri,1 Anjana Khadka,2 Archana Amatya,3 Sushan Man Shrestha,4 Rajan Paudel4 1Academic and Research Department, B.P. Eye Foundation, Kathmandu, Nepal; 2Department of Health Services, Ministry of Health, Kathmandu, Nepal; 3Save the Children International, Nepal Country Office, Kathmandu, Nepal; 4Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, NepalCorrespondence: Bijay KhatriAcademic and Research Department, B.P. Eye Foundation, Kathmandu, NepalTel +977 984 146 3005Email bj.khatri@gmail.comPurpose: The copper-T (TCu-380A), an intrauterine contraceptive device (IUCD), is widely available and is highly effective in terms of safety and effectiveness. Despite this fact, there is low utilization of IUCD in Nepal. This paper describes the perception and use of IUCD among married women of reproductive age attending an institutional clinic in Bhaktapur, Nepal.Methods: An institution-based cross-sectional study was conducted among 273 married women attending the institutional clinic of Bhaktapur hospital who were interviewed by trained staff nurses using semi-structured questionnaires. Systematic random sampling method was applied to select the participants. Logistic regression analysis was used to determine the relationship between factors associated with utilization of IUCD.Results: Just below half (48.7%) of the participants had heard about IUCD. Only 7.0% of the potential users were currently using IUCD, and all of them had discussed using it with their husbands. Among women aware of IUCD, nearly a quarter of them (23.8%) did not want to use it because of their husband’s disapproval and their assumed fear of decreased sexual pleasure. There was a significant association between previous abortion and use of IUCD, where the women who had a history of abortion had increased odds of using the IUCD by 5.45-times compared to those who had not (p=0.01). The women who were counseled about IUCD by health workers were 2.83-times more likely to use an IUCD than those who were not. The women who had a good knowledge level about IUCD as a method of modern contraception had 2.85-times increased odds of using the IUCD compared to those who had poor or no knowledge about it.Conclusion: The use of IUCD depends on the support of husbands, knowledge about its safety, efficacy, and counseling.Keywords: husband, abortion, counseling, knowledge

Background: Pneumothorax, pneumomediastinum and subcutaneous emphysema are respiratory complications of Coronavirus disease 2019 occurring with noteworthy frequency in patients especially with severe disease. They can be life-threatening and often complicate patient managment., Methods: This was a retrospective, observational study of patients admitted in Nepal Armed Police Force hospital from 13/05/2020 to 28/12/2021 diagnosed with pneumothorax, pneumomediastinum or subcutaneous emphysema singly or in combination. Data were collected from clinical charts, imaging records and electronic medical records of Severe Acute Respiratory Syndrome Coronavirus-type 2 positive patients 18 years and older. The frequency and type of the defined complications, the inflammatory markers and ventilatory parameters just prior to their diagnosis, the duration of hospitalization and ICU admission and in-hospital mortality rate were studied., Results: Out of 4013 COVID-19 patients admitted in the hospital during the period, a total of 28 patients were observed to develop the complications, the overall incidence being 0.7% among hospitalized patients and 5.6% among ICU patients. The proportion of subcutaneous emphysema (64.3%) was highest followed by pneumomediastinum (46.4%) and then pneumothorax (39.3%) existing singly or in combination among the 28 patients, where four patients developed the complications spontaneously. Mean Positive End Expiratory Pressure of 12.1±2.6 cmH2O and Peak Inspiratory Pressure or Pressure Support of 30.9±10.3 cmH2O were observed for patients under positive pressure ventilation. Most of the patients who developed the complications (78.6%) died during treatment., Conclusions: Pulmonary air leak complications occur frequently in COVID-19 patients treated with or without positive pressure ventilation signifying increased disease severity, risk of ICU admission and high mortality rate. Hence, clinicians should be vigilant of these complications in all patients affected with COVID-19 and institute timely management.

Background: While the advanced health care settings are struggling hard to handle the sudden surge of COVID-19 cases, resource poor settings in developing countries like Nepal can barely stand to fight the increasing number of severe cases. Easily available cost effective interventions would be great blessing for such settings. This study aimed to study if awake prone positioning can be used as such intervention in COVID 19., Methods: The retrospective study involved 150 patients admitted between November 2020 and January 2021 at Nepal Armed Police Force Hospital and met specific inclusion criteria. Data was obtained at four different time points in relation to prone position and was analysed using International Business Machines Statistical Package for the Social Sciences (SPSS) version 23., Results: It was found that among 150 patients, majority (109; 72.7%) were males and 60(40%) had some comorbidities. The mean oxygen saturation was found to increase significantly from 87.18 %(SD 3.531) to 91.08(SD 2.206) after fifteen minutes of prone positioning. One way ANOVA test showed that there was significant difference in oxygen saturation between at least two time points. (F (3,596) = [180.005], p=0.000). Games Howell Post Hoc test for multiple comparisons showed that the mean value of SPO-2 was significantly different across all four time points, at significance level 0.05., Conclusions: This study found Awake Prone positioning as a promising cost effective and feasible intervention for improving oxygenation in COVID 19 and thus could be a blessing to the resource poor health care settings.

Background: Sexual dysfunctions including erectile dysfunction among men, a widespread sexual health issue, pose challenges to sexual satisfaction. This cross-sectional study aimed to assess the prevalence and determinants of sexual dysfunctions in both diabetic and non-diabetic individuals aged 30-70., Methods: A study at Tribhuvan University Teaching Hospital in Kathmandu, Nepal, surveyed 350 participants (176 men, 174 women), aged 30-70, with 52.6% having diabetes. The structured interviews and validated questionnaires like IIEF-5 for men and FSFI-6 for women to assess the prevalence and factors associated with erectile dysfunction were used. Statistical tools were employed to measure the associations of different variables with Sexual dysfunctions., Results: Overall, the prevalence of sexual dysfunction was 73.7% (95% CI: 72.4- 73.7) with higher rates in men 83.9% (95% CI: 83.1- 84.7) than women 63.6% (95% CI: 62.0 - 65.2). Individuals with diabetes experienced an 81.5% prevalence of sexual dysfunction (95% CI: 80.6-82.4), whereas non-diabetic individuals exhibited a 65.1% prevalence (95% CI: 63.5-66.7). In the diabetic male population, the prevalence of sexual dysfunction was 97.5% (95% CI: 97.4-97.6), while diabetic females had a prevalence of 68.9% (95% CI: 67.5-70.3). Among non-diabetic men, the percentage of erectile dysfunction was 72% (95% CI: 70.7-73.3), and among non-diabetic women, sexual dysfunction remained 56.2% (95% CI: 54.4-58.0). Among individuals with diabetes, those who used tobacco exhibited a sexual dysfunction prevalence of 93.8% (95% CI: 93.5-94.1), while non-tobacco users had a prevalence of 74.8% (95% CI: 73.6-76.0). In non-diabetic individuals, obesity was associated with a higher prevalence of sexual dysfunctions, reaching 84.6% (95% CI: 83.8-84.6). High blood pressure showed a strong association with sexual dysfunctions in both diabetic (83% with 95% CI: 81.9-83.4) and non-diabetic (70% with 95% CI: 67.7-70.1) groups. Individuals with diabetes for more than five years had a higher rate of sexual dysfunction as 87.8% (95% CI: 86.6-89.0) with 100% in men and 79% in women. However, there was no significant difference in the prevalence of sexual dysfunctions related to obesity and alcohol consumption between diabetics and non-diabetics., Conclusions: The research highlights a noteworthy association of sexual dysfunctions with individuals with diabetes, male sex, tobacco use, and hypertension. The observed high prevalence of sexual dysfunctions in both diabetic and non diabetic people is a public health concern, emphasizing the need for culturally tailored approaches to address the sexual health of the affected individuals.

Introduction: Sepsis is a syndrome that starts with an infection, causes organ dysfunction, and leads to death is a global health issue in critically ill patients. While its epidemiology is well-known in high-income countries, it is poorly understood in low- and middle-income countries, including Nepal. This study aimed to find out the prevalence of sepsis among adults admitted to the intensive care unit of a tertiary care centre., Methods: This descriptive cross-sectional study was conducted among adults admitted to the intensive care unit after obtaining ethical approval from the Ethical Review Board. Data was collected from 11 January 2022 and 29 December 2022 from hospital records. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval., Results: Among 195 patients, the prevalence of sepsis was seen in 74 (37.95%) (31.14-44.76, 95% Confidence Interval). Septic patients had a median age of 44 (interquartile range: 33.75±60.25) years. A total of 40 (54.05%) were male. A total of 28 (37.84%) septic patients were identified with ≥2 diagnoses, while 9 (12.16%) had ≥2 comorbidities., Conclusions: The prevalence of sepsis among adult patients admitted to the intensive care unit was higher as compared to other studies done in other international studies., Keywords: intensive care units; prevalence; sepsis.

Introduction: Circular RNAs (CircRNA) have emerged as an interest of research in recent years due to its regulatory role in various kinds of cancers of human body. Esophageal squamous cell carcinoma (ESCC) is one of the major disease subtype in Asian countries, including China. CircRNAs are formed by back-splicing covalently joined 3'- and 5'- ends rather than canonical splicing and are found to have binding affinity with miRNAs that conjointly contribute to oncogenesis., Materials and Methods: 4 pairs of normal, cancer adjacent tissues and cancer tissues were analyzed by high-throughput RNA sequencing and 84 differentially upregulated circRNAs were detected in cancer tissues. hsa_circ_0032746 was silenced by siRNA and lentivirus and then further proliferation, migration and invasion were performed by CCK-8 and transwell assays. Bioinformatic analysis  predicted binding affinity of circRNA/miRNA/mRNA axis., Results: After qPCR validation, we selected a novel upregulated hsa_circ_0032746 to explore its biogenetic functions which showed high expression in cancer tissues but not in cancer adjacent tissues. The clinicopathological relation of hsa_circ_0032746 showed positive correlation with the tumor location (P = 0.026) and gender (P = 0.05). We also predicted that hsa_circ_0032746 could sponge with microRNA. Bioinformatic analysis predicted 11 microRNA response element (MRE) sequences of hsa_circ_0032746 and dual luciferase reporter assay confirmed binding affinity with miR4270 evidencing further study of circRNA/miRNA role. The knockdown of hsa_circ_0032746 by siRNA and lentivirus demonstrated that proliferation, invasion and migration of ESCC were inhibited in vitro and vivo experiments. Bioinformatic analysis further predicted MCM3 as a target of miR-4270 and was found upregulated in ESCC upon validation. miR4270 mimic decreased the level of hsa_circ_0032746 and MCM3 while further rescue experiments demonstrated that hsa_circ_0032746 was dependent on miR4270/MCM3 axis on the development process of ESCC., Conclusion: We revealed for the first time that circ_0032746/mir4270/MCM3 contributes in proliferation, migration and invasion of ESCC and could have potential prognostic and therapeutic significance., (© 2024. The Author(s).)

Optic disc pit maculopathy (ODP-M) is a rare complication of optic disc pit which can cause irreversible visual impairment. The aim of this study is to evaluate the anatomical and functional outcomes and pattern of resolution of ODP-M following vitrectomy with posterior vitreous detachment (PVD) induction and scleral tissue plug for treatment of ODP-M without ILM peeling, laser or use of long term gas/tamponade or head positioning. This retrospective study included 7 patients with ODP-M, meeting the inclusion criteria. Patients were followed up for 6 months. Complete anatomical success was defined as "Total resolution of all the fluid in retinal compartments". All of the patients had complete resolution of the optic pit maculopathy following surgery. The mean duration for complete resolution was 18.3 weeks. Pattern of resolution of ODP-M was found to be resolution of the subretinal fluid (SRF) followed by disappearance of the retinoschitic lesions (RL) and finally disappearance of macular edema (ME). The proposed minimally invasive procedure (MIP) can produce comparably good and equally reliable results for the treatment of ODP-M., (© 2023. Springer Nature Limited.)

Recent researches have uncovered that long non-coding RNAs (lncRNAs) are closely correlated with the development of different diseases, while biological functions and hidden molecular mechanisms of antisense lncRNAs in oesophageal squamous cell carcinoma (OSCC) remain unclear. Here, we identified upregulation of LINC01116 in RNA sequencing data, online database, and in OSCC and intraepithelial neoplasia (IEN) specimens. Functionally, LINC01116 facilitates OSCC advancement and metastasis in vitro and vivo. Mechanistically, elevated expression of LINC01116 in OSCC cells other than tumor stroma and cytoplasmic enables it to activate AGO1 expression via complementary binding with AGO1 mRNA to facilitate EMT process of OSCC., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Frosted branched angiitis (FBA) is characteristic florid translucent retinal perivascular sheathing of both arterioles and venules in association with variable uveitis and vasculitis affecting the entire retina. The vascular sheathing is supposed to be an immune-mediated reaction, possibly due to immune complex deposition in vessel walls secondary to various underlying etiologies. The authors aim to report a case of FBA secondary to herpes simplex virus and Toxoplasma gondii infection causing the diagnostic dilemma. This is the first case report on FBA from Nepal., Case Report: An 18-year-old young boy hospitalized with the diagnosis of acute viral meningo-encephalitis presented with the complaint of diminution of vision and floaters in both eyes for a week. Herpetic infection was confirmed with the cerebro-spinal fluid analysis and was under antiviral drugs. His presenting visual acuity was 20/80 in both eyes and ocular features were suggestive of FBA. The vitreous sample analysis revealed raised toxoplasma titre so intravitreal clindamycin was administered twice. The ocular features resolved in the subsequent follow ups with intravenous antiviral treatment and intravitreal antitoxoplasma treatment., Conclusions: FBA is a very rare clinical syndrome secondary to many immunological or pathological causes. So, possible etiologies must be ruled out for timely management and good visual prognosis., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this article, (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Numerous studies have revealed that long noncoding RNAs (lncRNAs) are closely related to the development of many diseases and carcinogenesis. However, their specific biological function and molecular mechanism in oesophageal squamous cell carcinoma (ESCC) remains unclear., Methods: RNA-Seq was performed to determine the differential expressions of lncRNAs in ESCC, and the level of SNHG16 expression was detected in ESCC and intraepithelial neoplasia (IEN) samples. In vitro and in vivo experiments were performed to explore the role of SNHG16 and the interaction of EIF4A3 and Ras homologue family member U (RhoU) signalling., Results: One hundred and seventy-five upregulated and 134 downregulated lncRNAs were identified by RNA-Seq. SNHG16 was highly expressed in ESCC and intraepithelial neoplasia (IEN) samples, and its expression level was correlated with tumour differentiation and T stage. Overexpression of SNHG16 can facilitate ESCC cell proliferation and metastasis. Mechanistically, we noticed that SNHG16 could bind RNA binding protein (RBP)-eukaryotic translation initiation factor (EIF4A3) and interact with it to form a complex. Importantly, the coalition of SNHG16 and EIF4A3 ultimately regulated Ras homologue family member U (RhoU). SNHG16 modulated RhoU expression by recruiting EIF4A3 to regulate the stability of RhoU mRNA. Knockdown of RhoU further alleviated the effect of the SNHG16 oncogene in ESCC cells., Conclusions: The newly identified SNHG16-EIF4A3-RhoU signalling pathway directly coordinates the response in ESCC pathogenesis and suggests that SNHG16 is a promising target for potential ESCC treatment., (© 2022. The Author(s).)

Background: Despite the crucial role of public health students in tobacco control, there is a paucity of information regarding tobacco use among this population in Nepal. This study aims to assess the prevalence of tobacco use among undergraduate public health students in Kathmandu valley, Nepal., Methods: A web-based survey was conducted among 386 undergraduate public health students in Kathmandu valley, Nepal, using the Global Health Professions Student Survey (GHPSS) questionnaire. Associated factors were examined using multivariate logistic regression analyses at the level of significance of 0.05., Results: A total of 16.8% of students were current cigarette smokers, 39.9% had ever smoked cigarettes, and 62.2% had smoked their first cigarettes during adolescence. Among the participants, 11.7% currently used other tobacco products. Male students (aOR: 15.4; 95% CI: 4.9-47.8), students with higher age (aOR: 2.4; 95% CI: 1.0-5.4), students belonging to non-Brahmin/Chhetri ethnic group (aOR: 2.3; 95% CI: 1.2-4.4), and those staying without family (aOR: 2.0; 95% CI: 1.1-5.0) had higher odds of being current smoker. Similarly, students with a parental history of tobacco use (aOR: 2.4; 95% CI: 1.3-5.0) and friends with smoking habits (aOR: 7.9; 95% CI: 2.3-27.0) were more likely to be a current smoker., Conclusion: There is a notable prevalence of tobacco use among public health students in Kathmandu valley, Nepal. Concerned stakeholders should work jointly to implement a cessation program to discourage tobacco use among these populations who have a potential role in educating communities about the hazards of tobacco smoking, tobacco use prevention, and control., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Birendra Chand et al.)

Intravitreal steroid implants are the latest trend for uveitis macular oedema treatment. Dexamethasone intravitreal implants are new in our contexts but we report 2 cases of uveitic cystoid macular oedema where this implant proved very useful in the treatment of recalcitrant macular oedema where other treatment modality fails. Two cases of non-infectious uveitis and intermediate uveitis with recalcitrant uveitic macular oedema underwent dexamethasone intravitreal implantation. Their central macular thickness and central macular volume reduced significantly with the implant. With the reduction in macular parameters, the best-corrected visual acuity also improved and visual rehabilitation was achieved. Thus, dexamethasone intravitreal implant helps in sustained drug delivery inside the vitreous leading to resolution of uveitic macular oedema in recalcitrant cases.  Keywords: Macular oedema; ozurdex; steroid; uveitis; vision.

Oesophageal squamous cell carcinoma (OSCC) is a prevalent malignancy with high morbidity and mortality as a result of early metastasis and poor prognosis. Metastasis is a multistep process, involving various signalling pathways. Circular RNAs (circRNAs) are a class of covalently closed noncoding RNAs, the aberrant expression of which is reported to be involved in several biological events, including cell transformation, proliferation, migration, invasion, apoptosis and metastasis. Several studies have reported interactions between circRNAs and metastasis-associated signalling pathways. The abundance, stability and highly specific expression of candidate circRNAs make them potential biomarkers and therapeutic targets in OSCC. In this review article, we comprehensively describe metastasis-related circRNAs and their interactions with epithelial-mesenchymal transition-associated molecules. We also describe the molecular mechanisms and clinical relevance of circRNAs in OSCC progression and metastasis., (© 2021 The Authors. FEBS Open Bio published by John Wiley & Sons Ltd on behalf of Federation of European Biochemical Societies.)

Immune checkpoint inhibitor (ICI) therapy may benefit patients with advanced esophageal squamous cell carcinoma (ESCC); however, novel biomarkers are needed to help predict the response of patients to treatment. Differentially expressed immune-related genes within The Cancer Genome Atlas ESCC dataset were selected using the weighted gene coexpression network and lasso Cox regression analyses. Based on these data, an immune-related gene prognostic index (IRGPI) was constructed. The molecular characteristics of the different IRGPI subgroups were assessed using mutation information and gene set enrichment analysis. Differences in immune cell infiltration and the response to ICI therapy and other drugs were also analyzed. Additionally, tumor and adjacent control tissues were collected from six patients with ESCC and the expression of these genes was verified using real-time quantitative polymerase chain reaction. IRGPI was designed based on CLDN1 , HCAR3 , FNBP1L , and BRCA2 , the expression of which was confirmed in ESCC samples. The prognosis of patients in the high-IRGPI group was poor, as verified using publicly available expression data. KMT2D mutations were more common in the high-IRGPI group. Enrichment analysis revealed an active immune response, and immune infiltration assessment showed that the high-IRGPI group had an increased infiltration degree of CD8 T cells, which contributed to the improved response to ICI treatment. Collectively, these data demonstrate that IRGPI is a robust biomarker for predicting the prognosis and response to therapy of patients with ESCC., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2021 Qinghua Ji et al.)

Background: COVID-19 pandemic hit all age group with different presentations and outcome. This study aimed at exploring the clinical characteristics, investigational findings, hospital outcome along with 90 days follow up of COVID-19 infection in children., Methods: This was longitudinal descriptive study among hospital admitted children with COVID-19 RT-PCR positive during first wave of Pandemic with 90 days telephonic follow up. Demographic and clinical characteristics, comorbidities, SPO2, investigations, need of oxygen , PICU admission, need of ventilator, outcome (improved and discharged, death) and duration of hospital stay were recorded and 90 days telephonic follow up was performed for any illness and hospital admission., Results: Out of 65 children admitted, male 44 (67.7%) and female 21 (32.3%), median age was 23 months ( IQR 6 days -14 years) with 52( 80.0%) without any comorbid conditions. The common signs were Fever 40(61.5%) vomiting 15 (23.1%) and Cough 11(16.9%).Thirteen (20.0%) children has platelets count less than 150000 and 16(24.6%) had C - reactive protein Positive .Mean duration of hospital stay 8 days (Range 1 -44 days), 20( 30.8% ) needed oxygen , 20(30.8%) needed Pediatric intensive care unit (PICU)admission and 6 (9.2%), needed ventilator. Forty seven (72.3%) recovered and discharged with death of 6.2% (n=4). Fifty six children (75.4%) has not experienced any problem after COVID -19 and only 2 children needed hospital admission in 90 days telephone follow up., Conclusions: In the first wave of the pandemic, Respiratory and Gastrointestinal symptoms were common presentation with few Severe and critical cases. Majority had good outcome. Majority has no other related illness till 90 days after discharge.

Background: Open globe injury (OGI) is one of the most devastating form of ocular trauma. The aim of the study is to identify the epidemiology and predict visual outcomes in traumatic open globe injuries using ocular trauma score (OTS) and correlate with final visual acuity (VA) at 3 months., Methods: Patients older than 5 years, presenting to B.P. Koirala Lions Centre for Ophthalmic Studies (BPKLCOS) from March 2016- March 2017 with OGI that met inclusion criteria were evaluated. Patient profile, nature and cause of injury, and time to presentation were recorded. Patients were managed accordingly and followed up to 3 months. An OTS score for each patient was calculated and raw scores were categorized accordingly. The VA after 3 months were compared to the predicted OTS values., Results: Seventy-three eyes of 72 patients were examined. 76 % were male, and the mean age was 26.17 years (median, 23.5 years). The mean time from injury to presentation was < 6 hours (30 patients, 41 %). Thirty-seven eyes (51 %) had zone I trauma, followed by twenty eyes (27 %) with zone II, and sixteen eyes (22 %) with zone III trauma. Sixty-five patients (90 %) were managed surgically, and fifty (68 %) received intravitreal antibiotics with steroid. When compared, the projected VA as per OTS were able to predict actual final visual outcomes in 60 % of the eyes with OGI of various zones., Conclusions: OTS can be an accurate predictive tool for final visual acuity even with a short follow up period of 3 months; with poor presenting visual acuity, delayed presentation, posterior zones of injury, need for intravitreal injections, endophthalmitis, and globe rupture associated with poorer prognosis.

Background: Mortality resulting from the metastasis of retinoblastoma is uncommon in the developed world, however it still constitutes a major problem in developing countries like Nepal. The cases of retinoblastoma with increased risk of metastasis even after enucleation can be predicted from the histopathological examination of the enucleated specimen. We conducted this study aiming to assess the frequency and spectrum of high-risk histological features in enucleated specimens of retinoblastoma., Materials and Methods: Forty-two specimens of primary enucleation done for treatment of retinoblastoma received in the Department of Pathology at UCMS from 1st January 2016 to 31st December 2018 were included in the study. All slides were reviewed for high-risk histological features along with tumor differentiation, tumor extension, necrosis, and staging. Correlation of high-risk histological features with age and tumor size was calculated using unpaired t-test and correlation with tumor differentiation, necrosis and staging was done using Pearson Chi square test., Results: The median age at enucleation was 24 months. All patients had endophytic lesion with a mean tumor size of 1.8cm. One or more high-risk histological features were identified in 30.9% (13/42). The most common high-risk histological feature was retrolaminar optic nerve invasion (10/12, 71.4%). Statistically significant correlation of high risk histological features was noted with tumor size (p=0.011) and AJCC stage of tumor (p=0.0001)., Conclusion: Complete histopathological evaluation of retinoblastoma requires searching for high-risk histological features, the presence of which will guide the clinician in timely planning for subsequent neoadjuvant therapy., (© NEPjOPH.)

Background: Thyromental Height Test is a relatively new, easy method considered as a more accurate predictor of difficult laryngoscopy than existing methods. The aim of this study was to evaluate its accuracy in predicting difficult laryngoscopy as compared to commonly used methods., Methods: This hospital based, cross-sectional, observational study was conducted on 246 patients scheduled for surgery under general anesthesia with endotracheal intubation. Airway assessment was done during pre-anesthetic assessment by Thyromental Height Test, Modified Mallampati Test, Thyromental Distance and Sternomental Distance measurements and predicted as 'difficult' or 'easy' laryngoscopy based on accepted cut-off values. Direct laryngoscopic view was assessed after administration of general anesthesia by a laryngoscopist unaware of the pre-anesthetic assessments and recorded as 'actual' difficult or easy laryngoscopy based on Cormack-Lehane grades. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of each clinical test were determined., Results: Thyromental Height Test had the highest sensitivity (71.42%) and negative predictive value (98.9% respectively) but lowest accuracy (77.2%). Maximum specificity was observed with Thyromental Distance and Sternomental Distance (97.49% each). Thyromental Distance had the highest positive predictive value (25%) and accuracy (95.52%)., Conclusions: Thyromental Height Test, with its high sensitivity, is a useful predictor of difficult laryngoscopy. However, due a high number of false positives and relatively low accuracy, it cannot be considered as a sole, reliable and accurate predictor of difficult laryngoscopy.

Background Neonatal mortality rate (NMR) is decreasing in Nepal but at a slower pace than infant and child mortality. In order to improve neonatal outcome, Care of sick children can be done better so as to aid in reducing neonatal mortality rate. Objective The objective was to identify pattern of diseases and outcome admitted to Neonatal Intermediate care Unit (NIMCU). Method A retrospective study was conducted at Neonatal Intermediate care Unit of Kanti Children's hospital from Bhadra 2071 to Shravan 2073 (August 2014 to July 2016). Result Total 1286 neonates were admitted in Neonatal Intermediate care Unit with the highest admission in the months of Bhadra (August-September) 12.52% and the lowest in Push (December-January) 4.82%. Among the admitted cases, 1,028 (80.0%) were full term while 256 (20.0%) were preterm. Among the total admission, 43.6% were less than 7 days old which is the most vulnerable period during the newborn phase. Admission due to neonatal sepsis was 892 (69.36%). Among them, 628 (70.40%) were late onset neonatal sepsis while 264 (29.60%) were early onset. Neonatal jaundice accounted for 12.36% (159) of the cases while Hypoxic Ischemic Encephalopathy accounted for 4.80% (62) of cases. Congenital Heart Disease were 53 (4.12%) and neonatal pustulosis were 27 (2.20%). Meningitis accounted for 45 (3.49%) of cases and UTI 29 (2.22). Death during treatment were 18 (1.39%). 7% of cases deteriorated and referred to NICU while, 3.2 % of cases were referred to other centers and 5.1% of cases were either discharged on request or left against medical advice. Conclusion Neonatal sepsis including both early and late onset, Congenital Heart disease, birth asphyxia and neonatal Jaundice accounted for majority of admission in NICU. Three of four these etiologies are preventable up to some extent.

Background: Cataract is the leading cause of avoidable blindness in the world. Many etiological and risk factors for age related cataract has been documented. The present study is conducted to compare the prevalence of cataract at high altitude and Kathmandu valley.Many etiological and risk factors for age related cataract has been documented., Methods: A cross sectional comparative study was conducted at Jomsom, Kagbeni, Jharkot and Muktinath of Mustang district and Balaju and Jawalakhel of Kathmandu valley of Nepal in 2009 to 2011 . There were 222 participants at Mustang and186 participants at Kathmandu. The prevalence of cataract was studied among the Tibetans and Thakali population at Mustang and Tibetans at Jawalakhel and Thakali population at Balaju of Kathmandu valley., Results: Prevalence of cataract at high altitude was 31.5% and 10.2% at Kathmandu valley. The prevalence of cataract is 4.05 times more at high altitude as compared to Kathmandu valley (p value < 0.001)., Conclusions: The prevalence of cataract was significantly high at high altitude as compared to lower altitude.

Background: Ventricular tachyarrhythmia (VT/VF) after aortic artery cross clamp release in cardiac surgery is common and the occurrence has been described but the incidence and risk factors are not well defined. This study was designed with the aim to evaluate the prevalence of VT/VF after aortic cross clamp release and to identify risk factors of patients developing such arrhythmias., Methods: A retrospective observational study 1052 patients over a period of 12 months from March 2011 to February 2012 undergoing various cardiac surgeries with aortic cross clamp were monitored for new-onset ventricular tachyarrhythmia intraoperatively., Results: The prevalence of ventricular tachyarrhythmia was 24.4%. We found age above 30 years, increasing body mass index (BMI), valvular surgeries and male gender as risk factors for VT/VF after cross clamp release in cardiac surgeries., Conclusions: Ventricular tachyarrhythmia is common following all cardiac surgeries, especially valvular heart diseases. There is a strong relationship between ventricular arrhythmias and age above 30 years, coronary artery bypass surgery (CABG), high (BMI) and male gender. It is essential for intense monitoring of these patients.

Hepatic vena cava syndrome (HVCS) also known as membranous obstruction of inferior vena cava reported mainly from Asia and Africa is an important cause of hepatic venous outflow obstruction (HVOO) that is complicated by high incidence of liver cirrhosis (LC) and moderate to high incidence of hepatocellular carcinoma (HCC). In the past the disease was considered congenital and was included under Budd-Chiari syndrome (BCS). HVCS is a chronic disease common in developing countries, the onset of which is related to poor hygienic living condition. The initial lesion in the disease is a bacterial infection induced localized thrombophlebitis in hepatic portion of inferior vena cava at the site where hepatic veins open which on resolution transforms into stenosis, membrane or thick obstruction, and is followed by development of cavo-caval collateral anastomosis. The disease is characterized by long asymptomatic period and recurrent acute exacerbations (AE) precipitated by clinical or subclinical bacterial infection. AE is managed with prolonged oral antibiotic. Development of LC and HCC in HVCS is related to the severity and frequency of AEs and not to the duration of the disease or the type or severity of the caval obstruction. HVOO that develops during severe acute stage or AE is a pre-cirrhotic condition. Primary BCS on the other hand is a rare disease related to prothrombotic disorders reported mainly among Caucasians that clinically manifest as acute, subacute disease or as fulminant hepatic failure; and is managed with life-long anticoagulation, porto-systemic shunt/endovascular angioplasty and stent or liver transplantation. As epidemiology, etiology and natural history of HVCS are different from classical BCS, it is here, recognized as a separate disease entity, a third primary cause of HVOO after sinusoidal obstruction syndrome and BCS. Understanding of the natural history has made early diagnosis of HVCS possible. This paper describes epidemiology, natural history and diagnosis of HVCS and discusses the pathogenesis of LC in the disease and mentions distinctive clinical features of HVCS related LC.

Background: Pterygium is a fleshy fibrovascular growth of conjunctiva encroaching upon the superficial cornea towards the visual axis in the interpalpebral fissure. The study aims to compare the prevalence of pterygium at high altitude and Kathmandu., Methods: A cross sectional quantitative study organized by Professional Support Service Nepal was conducted at Mustang and Kathmandu Valley in the Tibetan and Thakali population. The sample size at Mustang is 222 and Kathmandu Valley is 186., Results: At Mustang, pterygium was present in 40 males (38.5%) and 48 females (40.7%) while at Kathmandu, pterygium was present in 6 males (8.8%) and 17 females (14.4%). Pterygium was present in 20.7% (n=12) at the altitude of 2710 meters, 28.8% (n=21) at an altitude of 2900 meters, 56.6% (n=30) at 3500 meters and 65.8% (n=25) at 3800 meters. The prevalence of Pterygium was significantly high with the rise in altitude (p value=0.000). Pterygium was present in 12.4% (n=23) at Kathmandu.The prevalence of pterygium at high altitude as compared with Kathmandu was also statistically significant (p value = 0.000).Pterygium was present in <40years in 40% and =/>40years in 39.5% at high altitude. At Kathmandu,pterygium was present in <40years in 8.2% and=/> 40years in 13.9%.At Mustang, among participants with the duration of stay at high altitude up to 20 years, pterygium was present in 36.1% (n=13) and those with >20years, pterygium was present in 40.3%(n=75)., Conclusions: Pterygium has significantly higher prevalence at high altitude as compared to lower altitude.

Purpose: Hepatic vena cava disease (HVD), a form of Budd-Chiari syndrome, is caused by the obstruction of hepatic portion of the inferior vena cava. It is a chronic disease characterized by the development of liver cirrhosis (LC) and hepatocellular carcinoma (HCC). As HVD occurred in areas with high incidence of hepatitis B virus (HBV) infection and some patients tested HBsAg positive, it was thought to be the cause of LC and HCC. To assess the pathogenesis of LC or HCC in HVD, a long-term follow-up study was done., Method: Fifty-six patients with HVD diagnosed by ultrasound (US) and confirmed by cavography in 31 and liver biopsy in 34 were followed up for an average of 14.8 +/- 9 years. The occurrence of LC was diagnosed by US and/or liver biopsy and that of HCC by US, elevated level of alpha-fetoprotein, and liver biopsy or fine-needle aspiration cytology, or computed tomographic scan. Other risk factors for LC/HCC such as alcohol use and HBV and hepatitis C virus (HCV) infections were assayed., Results: Forty-four (78.5%) and 6 (10.7%) patients developed cirrhosis and HCC, respectively. LC/HCC occurred more frequently among those who had severe or frequent acute exacerbations (P = 0.017), but it was not related to alcohol use or HBV and HCV infections., Conclusion: HVD is independent risk factors for LC and HCC. Severe and/or recurrent loss of hepatocytes caused by hepatic venous outflow obstruction and/or thrombotic obstruction of small radicals of hepatic and portal veins that occurred during acute exacerbations was considered important in the pathogenesis of LC and HCC in HVD.

Pleural effusion is not uncommon in developing countries. It is usually considered to be due to tuberculosis and treated with anti-tubercular chemotherapy without much diagnostic workup. Hepatic vena cava disease (HVD), a disease caused by obliterative lesion of the hepatic portion of inferior vena cava induced by bacterial infection is common in developing countries. We report here the occurrence of pleural effusion in 10% of the cases of HVD. Four patients, one with acute and three with chronic HVD that presented with pleural effusion are described. Pleural effusion in HVD responded to treatment with antibiotic and diuretic. In developing countries HVD should be considered in the differential diagnosis of pleural effusion. It is postulated that bacterial infection and sodium retention resulting from acute caval obstruction are important in the pathogenesis of pleural effusion in HVD.

Objective: To determine the visual outcome of laser treatment in diabetic retinopathy., Design: Prospective, non-comparative case series., Materials and Methods: A total of 80 eyes of 50 patients with diabetic retinopathy in different stages were photocoagulated using diode green laser. Focal laser only was given in 46 eyes and pan retinal photocoagulation only was given in 29 eyes while 3 eyes received focal laser and pan retinal photocoagulation. One eye was given grid laser only and one eye received both grid and focal laser. The best corrected visual acuity was noted and fundus examination was carried out prior to laser therapy and at the last follow-up and results were compared., Results: Non- proliferative diabetic retinopathy was present in 76%. Following laser treatment, best corrected visual acuity improved in 52.50%, remained static in 35% and deteriorated in 12.5%. Maculopathy improved in 52%, remained static in 6% and deteriorated in 2% in right eyes while there was no maculopathy in 40% in right eyes. Similarly, maculopathy improved in 38% and remained same in 10% while 52% had no maculopathy in left eyes. After laser treatment, NVD (OD) regressed in 6% and remained unchanged in 4%. Similarly, NVE (OD) regressed in 18% and remained unchanged in 4% and NVE (OS) regressed in 18% and remained unchanged in 2% following laser therapy., Conclusion: Timely and adequate laser treatment helps in saving the vision in patients with diabetic retinopathy.

Hepatitis E is an acute disease caused by hepatitis E virus that usually manifest as acute jaundice. The hallmark of the disease is its high incidence in young adults, and high mortality in pregnant women from acute hepatic failure. It is a waterborne infection and occurs sporadically or as epidemic outbreaks. Kathmandu valley is a hyper-endemic area for hepatitis E, where during last 30 years three large epidemics and many focal outbreaks have occurred. About 50% of the sporadic cases of acute hepatitis in Kathmandu valley are caused by hepatitis E. This paper describes the epidemiology hepatitis E in Nepal, and its clinical features and management.

Purpose: To examine the relationship between age and ovarian perifollicular blood flow (PFBF) in women undergoing IVF., Methods: Serial transvaginal power Doppler ultrasound (PDU) scans to assess ovarian PFBF were performed prospectively throughout the follicular phase of ovarian stimulation in women undergoing IVF. The ultrasound assessment days were categorized according to day of hCG trigger., Results: A total of 1050 ovarian follicles from 34 women undergoing one IVF treatment cycle were used for data analysis. The median age of the women was 38.5 years, ranging from 28 years to 44 years. There was a significant negative correlation between age and ovarian PFBF on the day of hCG trigger or trigger day minus 1, but not beforehand during the follicular phase., Conclusions: There was a significant negative correlation between age and ovarian PFBF in women undergoing IVF which was only observed very late in the follicular phase of ovarian stimulation.

Objective: To determine whether ovarian perifollicular blood flow (PFBF) in the early follicular phase (EFP) was associated with treatment outcome., Design: Retrospective longitudinal cohort study., Setting: Tertiary referral centre/university hospital., Patients: Thirty-four women underwent 37 IVF cycles, which resulted in 35 embryo transfers., Interventions: Serial transvaginal scans using power Doppler ultrasound during the follicular phase. Ovarian PFBF of follicles > or =5 mm was subjectively assessed using a modified grading system (grades 0-4)., Main Outcome Measures: Ovarian PFBF and pregnancy., Results: Treatment cycles were retrospectively divided into two groups: Group 1 (n=20) had cycles with at least one small (5-10 mm) or medium (11-14 mm) size follicle(s) of high grade (2-4) PFBF on cycle day 5 or 6 or 7; and Group 2 (n=17), had cycles that did not. Group 1 had a significantly higher proportion of high grade large follicles in the late follicular phase (35% vs. 21%) (OR 2.0; 95% CI 1.1-3.7) and higher clinical pregnancy rate (47% vs. 12%) (OR 6.3; CI 1.1-35.7) compared to Group 2., Conclusion: High grade ovarian PFBF in the EFP during IVF is associated with both high grade PFBF in the late follicular phase and a higher clinical pregnancy rate.

Objective: To evaluate whether ovarian perifollicular blood flow (PFBF) varies by ultrasound among women with polycystic and normal ovaries undergoing in vitro fertilization (IVF)., Design: Prospective observational cohort study of women undergoing IVF treatment., Setting: Department of reproductive medicine at a university teaching hospital., Patient(s): Thirty four women with regular spontaneous ovulatory menstrual cycles undergoing IVF divided into two groups according to findings on a baseline transvaginal ultrasound scan: group 1 consisted of 20 women with ultrasound-evident normal ovaries (USNO group), and group 2 consisted of 14 women with ultrasound-evident polycystic ovaries (USPCO group)., Intervention(s): Serial transvaginal power Doppler ultrasound assessments throughout the follicular phase of ovarian stimulation., Main Outcome Measure(s): Ovarian PFBF and ovarian stromal artery pulsatility index., Result(s): Women with USPCO had a significantly lower ovarian stromal artery pulsatility index at the time of the first ultrasound assessment before starting the FSH injections compared with USNO women. However, there was no difference in ovarian PFBF between women with USPCO and USNO during the follicular phase of ovarian stimulation for IVF., Conclusion(s): There is no difference in ovarian follicular vascularity between women with polycystic and normal ovaries during ovarian stimulation at IVF treatment.

ABSTRACT Helminthosporium leaf blight (HLB), a complex of spot blotch caused by Cochliobolus sativus and of tan spot caused by Pyrenophora tritici-repentis, is a major wheat disease in South Asia. This 2-year study elucidated HLB development and its impact on yield. Symptoms caused by C. sativus and P. tritici-repentis were first observed at the seedling and tillering stages, respectively. The number of airborne conidia and leaves infected by the two pathogens remained low for several weeks under lower temperatures, followed by a sharp rise as temperatures increased. The number of airborne conidia of C. sativus and incidence of infection by C. sativus were higher compared with P. tritici-repentis. The disease complex caused an average 30% reduction in yield, with greater losses under delayed seeding. Delayed seeding increased disease severity even in resistant genotypes and caused higher yield losses. 'Milan/Shanghai-7' was the most resistant among six genotypes evaluated. Despite higher disease severity, 'BL 1473' showed relatively lower yield losses, indicating its tolerance to foliar blight. The findings of this study bear implications for integrated foliar blight management in the warmer areas of South Asia by combining optimum seeding date, seed treatment and foliar spray of fungicides, and resistant wheat genotypes.

Purpose: This longitudinal study aimed to compare ovarian perifollicular and endometrial blood flow (PFBF and EBF, respectively) during the follicular phase in pregnant and non-pregnant IVF cycles., Methods: Serial transvaginal scans were performed in 15 subjects undergoing IVF treatment. Both PFBF and EBF were subjectively graded (grades 0-4 for PFBF and grades 1-3 for EBF). After confirmation of clinical pregnancy, the treatment cycles were grouped into 'Pregnant' and 'Non-pregnant' cycles. Ovarian PFBF and EBF were retrospectively compared between the two groups., Results: In pregnant cycles, the proportion of large (> or = 15 mm) follicles with high (24) grade PFBF increased with time throughout the follicular phase, and the proportion of large follicles with poor (0-1) grade PFBF decreased. In non-pregnant cycles these trends were reversed. There was no difference in EBF between the two groups., Conclusion: The pattern of ovarian PFBF but not EBF may be predictive of treatment outcome.

Complete nucleotide sequences of 19 hepatitis B virus (HBV) isolates of genotype A (HBV/A) were determined and analysed along with those of 20 previously reported HBV/A isolates. Of the 19 HBV/A isolates, six including three from Japan and three from the USA clustered with the 14 HBV/A isolates from Western countries. The remaining 13 isolates including four from The Philippines, two from India, three from Nepal and four from Bangladesh clustered with the six HBV/A isolates reported from The Philippines, South Africa and Malawi. Due to distinct epidemiological distributions, genotype A in the 20 HBV isolates was classified into subtype Ae (e for Europe), and that in the other 19 into subtype Aa (a for Asia and Africa) provisionally. The 19 HBV/Aa isolates had a sequence variation significantly greater than that of the 20 HBV/Ae isolates (2.5+/-0.3 % vs 1.1+/-0.6 %, P<0.0001); they differed by 5.0+/-0.4 % (4.1-6.4 %). The double mutation (T1762/A1764) in the core promoter was significantly more frequent in HBV/Aa isolates than in HBV/Ae isolates (11/19 or 58 % vs 5/20 or 25 %, P<0.01). In the pregenome encapsidation (epsilon) signal, a point mutation from G to A or T at nt 1862 was detected in 16 of the 19 (84 %) HBV/Aa isolates but not in any of the 20 HBV/Ae isolates, which may affect virus replication and translation of hepatitis B e antigen. Subtypes Aa and Ae of genotype A deserve evaluation for any clinical differences between them, with a special reference to hepatocellular carcinoma prevalent in Africa.

To investigate the genetic changes in hepatitis E virus (HEV) strains in the Kathmandu valley of Nepal, we compared the 412 nt sequence within open reading frame 2 of HEV among HEV isolates recovered from 16 patients in 1999, 14 patients in 2000 and 38 patients in 2002, and additional isolates recovered from 48 patients in 1997 whose nucleotide sequences have been previously published. All 116 HEV-viraemic samples were genotyped as 1 and subtyped further as 1a (n=85, 73 %), 1c (n=29, 25 %) and mixed infection of 1a and 1c (n=2, 2 %): subtype 1c was detected only in 1997. Among the 1a isolates, nucleotide sequence identity with the representative 1a isolate of Ne131-1997 was 96.4+/-2.4 % (mean+/-SD) in 1997, 93.9+/-1.7 % in 1999, 92.2+/-1.0 % in 2000 and 91.7+/-0.5 % in 2002, indicating gradual diversification of HEV sequences. When phylogenetic analysis of the 87 subtype 1a isolates was performed, they further segregated into five clusters, with two predominant clusters of 1a-2 and 1a-3: the annual frequency of cluster 1a-2 isolates decreased from 63 % in 1997, to 50 % in 1999, to 7 % in 2000 and no cases in 2002; cluster 1a-3 isolates were observed in all four years and its annual frequency increased from 5 % in 1997 to 95 % in 2002. Of the remaining three clusters, cluster 1a-1 was detectable only in 1997 and clusters 1a-4 and 1a-5 emerged in 2000 and 2002, respectively. These results indicate that genetic changes and take over of HEV strains may contribute to the genetic variability of HEV in the community.

Five isolates of hepatitis C virus (HCV) RNA from patients with chronic liver disease in Nepal were not classifiable into the known genotypes I/1a, II/1b, III/2a, IV/2b or V/3a using PCR with type-specific primers deduced from the HCV core gene. Their nucleotide sequences were determined for the 5'-terminal 1.5 kilobases and 3'-terminal 1.2 kilobases, covering 30% of the entire genome, and compared with each other and with reported sequences of HCV isolates of various genotypes. They were more similar to a reported HCV isolate (NZL1) of genotype V/3a (in 81.6 to 84.1% of their nucleotides and 85.7 to 88.7% of the deduced amino acid sequence) compared with the genotypes I/1a to IV/2b (in 69.3 to 74.7% and 72.3 to 77.4%, respectively). Hence they were considered to be variants of the third major group (group 3). The five HCV isolates shared 81.3 to 85.2% of nucleotide sequence and 85.4 to 89.3% of deduced amino acid sequence. Thus they were substantially different from each other. One of them was classified as genotype VI/3b due to an 88.2% similarity in nucleotide sequence to that of the reported HCV isolates of this genotype, whereas the remaining four were classified into provisional genotypes 3c, 3d, 3e and 3f. These HCV variants have evolved and remained in Nepal, and have not been observed in the other areas of the world.