Background: Acute-on-chronic liver failure (ACLF) is a clinical syndrome seen in patients with decompensated cirrhosis, marked by organ failure and high risk of mortality. In Mongolia, liver cirrhosis and chronic liver disease are among the leading causes of death, with mortality rates four times higher than the global average. Despite this, full data on ACLF in the country remains insufficient. Aim : This study aims to determine the prevalence, etiology, and outcomes of ACLF in patients admitted with acute de compensated liver cirrhosis. Materials and Methods : This retrospective registry study analyzed all hospital admissions at the Mongolia-Japan Hos pital from Jan 1, 2022, to Dec 31, 2024. Definitions from the European Association for the Study of the Liver (EASL) and the Chronic Liver Failure Consortium (EASL-CLIF) were used. Organ failure was assessed using the adapted Chronic Liver Failure-Organ Failure (CLIF-OF) score. Patients with malignancies meeting the Milan criteria were excluded. Results : A total of 83 patients were included, of whom 41% (n=34) met the ACLF criteria. Among ACLF patients, 58.8% were male, with a median age of 52 years. The most common underlying cause of cirrhosis was viral hepatitis B and D. The main triggers for ACLF were infection (50%) and alcoholic hepatitis (20.6%). ACLF grades were as follows: 29.4% for Grade 1, 29.4% for Grade 2, and 41.1% for Grade 3. The overall in-hospital mortality rate was 28.9%, but it was significantly higher in the ACLF group (75%) compared to the non-ACLF group (25%). Mortality rates increased with ACLF grade: 20% for Grade 1, 50% for Grade 2, and 78.6% for Grade 3 (p < 0.00001). Conclusion 1. The prevalence of acute-on-chronic liver failure (ACLF) among patients with decompensated cirrhosis was 41%, with a notably high in-hospital mortality rate of 52.9%. 2. Bacterial infections, rather than hepatic insults, were the leading precipitating factors for ACLF, accounting for 50% of the cases.

Background: A rare angioproliferative condition of the larynx, Kaposhi sarcoma typically affects the skin. Immunosuppressive treatment following organ transplantation and human immunodeficiency virus infection are the causes. Every type of Kaposi sarcoma has human herpesvirus-8. Laryngeal kaposi sarcoma is uncommon in immunocompromised patients; since its initial identification in 1965, 18 cases have been documented globally. A CO2 laser-assisted laryngeal microsurgery is performed through the mouth cavity to remove tumor when kaposi sarcoma of the larynx obstructs the airway. Case report: A 77-year-old woman complained of hoarseness, dry mouth, odynophagia, and dysphagia three months prior when she arrived at the Mongolian-Japan Hospital. Two years ago, she acquired hard, sensitive lumps that were palpable on her right arm, left ankle, and right thigh. At that time, she was diagnosed with Kaposiform hemangiodermatitis and treated at the National Center for Dermatology. HIV test results were negative. Immunohistochemistry: CD31 +/-, CD34 /+/. Using flexible nasopharyngeal endoscopy to get the diagnosis: There was a mass that was about 1.5–2–5 cm in diameter, bluish in color, smooth and movable, and spongy and vascular on the larynx, on the nasopharynx, behind the palatine tonsills, and supraglottic. Surgery: Through the use of Kleinsasser laryngoscopy and a 0-degree endoscope, pathological tissues were extracted under general anesthesia using a laryngeal microsurgical instrument and a laparoscopic bipolar coagulator. The tissues were then sent for histological evaluation, which revealed Kaposi sarcoma, sarcoma grade 1. Results of treatment Pain decreased and quality of life increased following surgery. Upon nasopharyngeal endoscopy, the vocal cord mobility was normal and the surgical incision was clean. Conclusion: Kaposi sarcoma is an extremely uncommon illness. A lower quality of life and further issues can be avoided with an early diagnosis and suitable therapy. It also needs to be continuously monitored because it is a potentially repeatable disease.