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Background: Atrial Fibrillation (AF) is one of the commonest arrhythmias with significant morbidity and mortality where there is uncoordinated activation of atrium leading to mechanical dysfunction of heart. Though rheumatic heart disease is very rare in the western world, it is still prevalent in developing country like Nepal. There is increased risk of development of heart failure, transient ischemic attack/stroke with increased rates of hospitalization. Methods: This study was a descriptive cross sectional study done in 70 admitted cases of two tertiary centres of Kathmandu (Bir Hospital and Sahid Gangalal National Heart Centre) from February 2018 to August 2018, presenting with history and clinical examination suggestive of Atrial Fibrillation and diagnosis confirmed by 12 lead ECG. Results: Among 70 cases, female to male ratio was 2.2:1. The mean age of patients was 60.03 ± 19.60 years with dyspnea (91%) followed by palpitation (76%) being commonest presenting symptoms. 15% of cases presented with Stroke. The most common etiology was rheumatic Heart Disease (38.6%) with female predominance. The most common valvular involvement was of mitral valve (71.4%). 8.6% of patients had clots in Left Atrium and majority had LA size >4cm. Conclusion: In contrary to the studies in the western world, the most common etiology of AF is rheumatic Heart Disease with patients of younger age group with female predominance. Majority of the cases had structural abnormalities in echocardiographic study and left atrial enlargement was common finding risking for thrombus formation and embolization.

Background: There is a close correlation between ankylosing spondylitis and uveitis, other less common ocular manifestations being episcleritis and scleritis. Though the prognosis of uveitis is good, prompt treatment is required to prevent long-term complications. This study aimed to estimate the prevalence of uveitis in patients with ankylosing spondylitis who follow outpatient clinic of a tertiary care hospital.Methods: A descriptive cross-sectional study was done in medicine outpatient department of a tertiary care hospital for 6 months. Ethical clearance was obtained from the institutional review board of National Academy of Medical Sciences. Convenient sampling was done. The data collected were entered in Microsoft excel to tabulate the data and analyze the results.Results: Out of 81 participants, 26 patients had a history of uveitis (32%). Most of the patients in this study were of 18-30 years. Uveitis was most common in patients with (axial to be added) spondylarthritis and peripheral inflammatory arthritis (41%) compared to those with just the axial disease (32%). Uveitis was more common among males (32.2%) than females (31.5%).Conclusion: In patients with spondyloarthritis uveitis was present in 32% of the patient with more common in patient with both axial and peripheral arthritis. Timely diagnosis of uveitis in ankylosing spondylitis can prevent the sequelae with prompt treatment. Keywords: Ankylosing spondylitis; spondyloarthritis; uveitis

Toxoplasmosis is an infection caused by the intracellular protozoan Toxoplasma gondii. An acuteinfection caused by the protozoan is usually asymptomatic but some patients may go into a complicated course. Though it is a common pathogen of immunocompromised states as HIV AIDS, rarelyit may present in an immunocompetent host as pneumonia. We report a 38 years old male whopresented with fever with respiratory distress associated with inguinal lymphadenopathy and transaminitis. Toxoplasma pneumonia was diagnosed by clinico-radiological and immunological methods. The patient was treated with a specific antimicrobial agent. A high degree of suspicion for thediagnosis and initiation of specific therapy can be lifesaving to the patient that might be rewardingto the treating physicians.