Giant Cell Tumour (GCT) of bone is a benign, locally aggressive neoplasm. GCT of the foot is rare, comprising of about 5% of cases of all GCTs. GCT of Calcaneus is exceedingly rare, comprising of 1.2% of all calcaneal tumours. Due to its uncommon occurrence at this site, diagnosis can be delayed. In this report, we present the case of a Campanacci Grade 3 GCT of calcaneus in a 43-year-old female patient with 8 months history of worsening pain and disability. We treated her successfully by resection of Oscalcis and reconstruction with a femoral head allograft and K-wire fixation, a relatively cheaper and technically lesser challenging method of reconstruction. Three years’ postsurgery, she remains disease free, and her graft has healed. She continues to walk independently and remains disease free clinically and radiologically. We discuss a comparison with other reported cases where surgeons have opted for detailed intra-lesional curettage (DILC) and cementoplasty to fill the defect for a Grade 2 disease, some have even used a sural for soft tissue coverage with a maximum follow-up of two years. While in our patient we went for Calcanues resection and reconstruction with allograft because of a Grade 3 disease that poses greater risk of local recurrence with just DILC. Our patient has a three-year follow-up where she remains disease free

Background: Thrombocytopenia is more commonly observed in neonates compared to other age groups, occurring in 1-5% of healthy newborns. However, the incidence of thrombocytopenia is significantly higher (22%-35%) in sick neonates admitted to the Neonatal Intensive Care Unit (NICU), and numerous researchers have noted that severe thrombocytopenia contributes to neonatal mortality. However, the incidence of thrombocytopenia and mortality risk among patients in the NICU in our country has not yet been studied, which provided the rationale for our research. Aim: To investigate and determine the incidence of thrombocytopenia and the risk of mortality in neonates treated in the intensive care unit. Materials and Methods: Data were collected from the medical histories of infants hospitalized in the Neonatal Intensive Care Unit of the National Center for Maternal and Child Health in 2017-2019, and statistical processing was performed using the STATA 16 program. Results: Of all infants in our study, 56.53% (658) were boys and 43.47% (506) were girls. According to the gestational age of newborns, 34.19% (398) were full-term (>37 weeks), 61% (710) were preterm (28-36 weeks), and 4.81% (56) were extremely preterm (<28 weeks). According to birth weight, 33.65% (386) had low birth weight (2500g-1500g), 20.05% (230) had very low birth weight (1500g-1000g), and 8.81% (101) had extremely low birth weight (<1000g). Among the surveyed newborns, 534 (45.88%) had thrombocytopenia, and the number was 51.55% (200/388) in 2017, 46.15% (162/351) in 2018, and 40.47% (172/425) in 2019. The mean platelet count of newborns with thrombocytopenia was 50.21±43.23. Early (age <72 hours) 23.41% (125), late (age ≥72 hours) 76.59% (409), light platelet count (100-150x109/l) 17.42% (93), medium (50) -99x109/l) was 25.28% (135) and severe (<50x109/l) was 57.3% (306). The duration of thrombocytopenia in these infants was 13.68±10.33 days, and 72.65% (388) of them had thrombocytopenia, 27.15% (145) died without thrombocytopenia, and 0.18% (1) had autoimmune thrombocytopenia was under medical supervision and was discharged from the hospital. A total of 20.5% (239) of the neonates included in the study died, and among them, 76.15% (182) had thrombocytopenia, which showed a statistically significant difference when compared between the deceased and surviving groups (p<0.001). To determine whether neonatal thrombocytopenia is a risk factor for mortality, a univariate logistic regression analysis was performed, showing that thrombocytopenia increases the risk of mortality with an OR of 5.19 (p<0.001, 95% CI: 3.75-7.19). A multivariate logistic regression analysis further confirmed this association, with an OR of 2.46 (p<0.001, 95% CI: 1.65-3.68), indicating that neonatal thrombocytopenia significantly increases the risk of mortality. Conclusion Thrombocytopenia is commonly observed in neonates treated in the neonatal intensive care unit. Neonatal thrombocytopenia increases the risk of neonatal mortality.

Background: Gout is a chronic inflammatory joint disease that damages many joints. Monosodium urate-deposition accumulates in the joints and soft tissues due to long-term untreated condition and leading to loss of function, further reducing the quality of life. It is the most common inflammatory joint disease in the world. Hyperuricemia, sedentary lifestyle including diet, obesity, and the use of certain medications are risk factors for gout. A study published in the Asia Pacific Journal of Nutrition in 2018 found that excessive consumption of meat, alcohol, carbonated beverages, and fructose containing drinks increases serum uric acid levels and the risk of gout. Aim: To investigate certain risk factors associated with gout and asymptomatic hyperuricemia among study participants. Materials and Methods: This study was conducted using an analytical cross-sectional design. Data were coded, error- checked, and analyzed using the SPSS 29.0 software. Results: A total of 145 individuals participated in the study, with an average age of 55.0 ± 13.9 years, and 75.2% were male. Based on diagnostic criteria, 29.7% had gout, 35.2% had asymptomatic hyperuricemia, and 35.2% had normal uric acid levels. The consumption of different food products over the past month was analyzed among study groups, and alcohol intake was found to be statistically significant. A univariate regression analysis showed that obesity was associated with hyperuricemia, male sex was associated with gout, and alcohol consumption was a potential risk factor for both hyperuricemia and gout. Conclusion Among the study participants, 29.7% had gout, and 35.2% had asymptomatic hyperuricemia. Obesity, male sex, and alcohol consumption were identified as risk factors contributing to increased serum uric acid levels and gout development.

Background: Systemic sclerosis-related interstitial lung disease (ILD) is a major cause of mortality among patients with systemic sclerosis. During this disease, when the forced vital capacity (FVC) is <50% on spirometry, the prognosis is considered poor. Although early changes in systemic sclerosis-related ILD can be identified by chest computed tomography (CT), evaluating the spirometry test is essential for monitoring further follow-up and assessing treatment outcomes. This study aimed to highlight the importance of considering the role of the spirometry test among patients with systemic sclerosis. Materials and Methods: We conducted this study using a cross-sectional research design based at a single-center hospital. The study included 40 patients diagnosed with systemic sclerosis who were attending the rheumatology outpatient clinic at the Mongolia-Japan Hospital. The inclusion criteria were patients diagnosed with systemic sclerosis who had undergone chest imaging (chest x-ray, chest CT scan) and spirometry tests. Results: In our study, in 62.5% of patients diagnosed with systemic sclerosis, a chest CT scan revealed abnormalities indicative of SSc-ILD. There were statistically significant differences (p<0.05) in certain parameters of spirometry between the two groups (normal chest CT, abnormal chest CT). The group with abnormal chest CT had a higher usage of mycophenolate mofetil (p<0.05). A negative correlation was found between changes on chest CT scan and FVC (r= -.453, p<0.05). However, no statistically significant correlation was observed between FVC and disease duration or comorbidities. Conclusion Using spirometry to assess pulmonary function in patients with systemic sclerosis-related interstitial lung disease may be an appropriate method for evaluating the progression of the disease and detecting complications.

Background: Herpes zoster (shingles) is an acute inflammatory skin disease caused by the reactivation of the Varicel la-zoster virus. International studies show that the disease severely reduces patients’ quality of life, and chronic pain negatively affects daily activities. In clinical practice, bloodletting pricking therapy has been effectively used for herpes zoster, with positive effects including reducing disease symptoms, alleviating skin inflammation, and promoting skin regeneration. Due to the limited research on treating herpes zoster with combined bloodletting pricking therapy and acupuncture, this clinical study was conducted. Aim: To evaluate the effectiveness of combining bloodletting pricking therapy with acupuncture in patients diagnosed with herpes zoster. Materials and Methods: The study was conducted using a non-randomized clinical trial design based at the Internation al School of Mongolian Medicine of MNUMS and the Inner Mongolia International Mongolian Medicine Committee (IMIMC). The study included 70 patients diagnosed with herpes zoster (ICD 10-B02.9) who met the inclusion criteria. The treatment group received bloodletting pricking therapy combined with acupuncture. The control group received Acyclovir 800 mg 5 times daily for 7-10 days and Pregabalin 75 mg twice daily for 14 days. Treatment effectiveness was evaluated using the VAS linear scale for pain assessment, the SF-12 (Short Form-12 health survey) questionnaire for quality of life, and the Athens Insomnia Scale (AIS) to measure sleep quality and evaluate insomnia. The treatment outcome was assessed according to the Mongolian Traditional Medicine Diagnostic and Treatment Standards. Results: The average age of participants was 47.29±11.11 in the treatment group and 44.43±11.63 in the control group, with 34% male and 66% female participants. According to the VAS linear scale, the treatment group showed a statistically significant greater reduction in pain (P<0.001). The quality-of-life assessment using the SF-12 questionnaire showed that the Physical Component Summary (SF-12-PCS) in the treatment group increased from 32.71±7.38 before treatment to 52.99±2.02 after treatment (t=-17.18, p<0.001), while in the control group, it increased from 36.10±7.41 to 51.56±7.9 (SF-12-3.9) (p<0.001). According to the AIS questionnaire, the sleep quality in the treatment group was significantly better than in the control group (P<0.05). According to the Mongolian Traditional Medicine Diagnostic and Treatment Standards, the combined treatment of pricking therapy and acupuncture resulted in a 100% recovery rate. Conclusion 1. The combination of bloodletting pricking therapy and acupuncture in treating herpes zoster effectively reduces pain. 2. For patients diagnosed with herpes zoster, combining bloodletting pricking therapy with acupuncture effectively improves quality of life in terms of sleep quality as well as physical and mental functioning.

Background: Cardiovascular diseases (CVDs) is a third leading cause of non-communicable diseases and a leading cause of mortality in Mongolia. Among these, acute myocardial infarction (AMI), a complication of coronary artery disease (CAD), is a leading cause of cardiovascular mortality. In patients with AMI, both epicardial artery blood flow, observed through coronary angiography, and coronary microcirculatory dysfunction (CMD) play critical roles in the disease’s pathophysiology. Recent advancements have introduced artificial intelligence (AI)-based softwares which are capable of analyzing coronary blood flow from coronary angiography images. The AI based softwares can assess not only epicardial blood flow but also CMD in recent studies. In this review, we discussed the role of CMD in pathophysiology of AMI, diagnostic approaches, the application of AI-based technologies, their clinical significance, and future directions. Aim: This review aims to explore the pathophysiological relationship of coronary microcirculatory dysfunction (CMD) in the context of acute myocardial infarction (AMI), diagnostic methodologies, the application of artificial intelligence (AI)-based technologies, and their clinical significance. Hypotheses: 1. AI-based software allows for highly accurate assessment of coronary microcirculation during AMI. 2. CMD during AMI is associated with structural and functional changes in the heart. 3. CMD during AMI is related to disease prognosis and patient outcomes. Methodology:: This narrative review was compiled using a systematic and logical approach, based on publicly available recent clinical and biomedical research literature addressing the above hypotheses. Conclusion In recent years, AI-based image processing software has been developed to analyze angiographic images obtained during percutaneous coronary intervention (PCI) and treatment procedures. These tools show significant promise for early detection and improved diagnosis of CMD during AMI, as well as for better assessment of short- and long-term patient risk.

Background: Asthma is a chronic inflammatory disease characterized by bronchoconstriction and breathing difficulties, which can be triggered by both allergic and non-allergic mechanisms. In allergic asthma, a hyperreactivity reaction occurs, leading to an increase in fractional exhaled nitric oxide (FeNO) levels. Therefore, FeNO is used to differentiate allergic and non-allergic types of asthma. In recent years, studies have been conducted to assess FeNO as an indicator of treatment effectiveness and symptom control. Our goal is to introduce FeNO measurement in Mongolia for the first time and utilize it for asthma diagnosis and treatment outcome evaluation. Aim: Study of FeNO levels in Asthma Diagnosis in Relation to Laboratory Findings and Lung Function Materials and Methods: This study included a total of 70 adult patients (18 years and older) with asthma who visited the Outpatient Clinic of Mongolia-Japan Hospital and Shargaljuut Spa Clinic from May to December 2024. Based on their allergic history, total IgE levels, and peripheral blood eosinophil count, participants were classified into allergic (>5%) and non-allergic (<5%) asthma. The study aimed to determine the diagnostic specificity and sensitivity of FeNO levels. Asthma control levels were assessed using the Asthma Control Test (ACT), lung function was evaluated using spirometry, and exercise capacity was measured with the 6-minute walk test. Results: In a single measurement, there were no differences between the allergic and non-allergic groups in parameters other than total IgE, peripheral blood eosinophil count, and FeNO levels. For diagnosing the allergic form of asthma, at a FeNO level of 25 ppb, sensitivity (Se) was 0.68, specificity (Sp) was 0.30 (p=0.008); at 40 ppb, Se was 0.77, Sp was 0.31 (p=0.001); and at 50 ppb, Se was 0.74, Sp was 0.33 (p=0.001). Lung function and exercise capacity were similar in both asthma groups. Conclusion The sensitivity of FeNO in distinguishing between allergic and non-allergic forms of asthma is 67-81%, and its sensitivity tends to increase as the FeNO level rises. By distinguishing the allergic type in which inhaled corticosteroids are more effective, the outcome of asthma treatment can be predicted in advance based on the FeNO level.

Background: Asthma management should be individualized, evidence-based, aimed at controlling clinical symptoms, preventing severe exacerbations, and improving quality of life. Studies have shown that inhalation therapy with iodine- bromide saltwater improves lung function in chronic obstructive pulmonary disease (COPD), while radon-containing mineral water inhalation reduces inflammation and oxidative stress in asthma. Several studies have analyzed the composition of the Shargaljuut hot spring, with Oyuntsesteg et al. identifying high levels of Na+-HCO3 - and Na+-SO4. Other studies on mineral water therapies have reported benefits such as thinning bronchial secretions, improving sputum clearance, reducing inflammation and acidity, mitigating oxidative stress, and enhancing quality of life. Aim: To study the effectiveness of combined asthma treatment with inhaled corticosteroids and hot spring inhalation. Materials and Methods: The study included 67 participants diagnosed with asthma who consented to participate and underwent 10 days of combined inhaled corticosteroid therapy and mineral water inhalation at Shargaljuut sanatorium. A total of 57 participants completed the pre- and post-treatment assessments. Treatment result was assessed using Asthma control questionnaire 7, asthma symptom control with Asthma Control Test (ACT), and exercise tolerance by a 6-minute walk test. Chest X-rays were taken for all participants to rule out pneumonia, cancer, or pulmonary fibrosis. Treatment outcomes were evaluated using ACT scores, peripheral blood eosinophil count, total IgE levels in serum, spirometry indices (FEV1, FVC, FEV1/FVC), and the 6-minute walk distance. Results: The average age of participants was 52±12 years, with a predominance of females. The mean asthma control score was 14.2±4.80, indicating poor asthma control. After 10 days of inhaling corticosteroids combined with hot spring inhalation post-treatment quality of life increased by 0.5 points, FEV1 improved by 7.5%, FVC by 4.2%, peripheral blood eosinophil count decreased by 0.3%, and total Ig E levels dropped from 73.3 (22.5; 216) to 73.2 (21.3; 223) u/ml (p=0.000). Conclusion In cases of uncontrolled asthma remission, combining of inhaled corticosteroid therapy with hot spring inhalation at Shargaljuut improved asthma symptoms, quality of life, enhanced lung function, and reduced inflammatory markers (p<0.001).

Background: Hypokalemia is considered when the serum potassium level is less than 3.5 mmol/L. Clinical research indicates that hypokalemia affects 20% of hospitalized patients, and in 24% of these cases, inadequate interventions result in life-threatening complications. At present, there is no research available on the prevalence, management, and outcomes of hypokalemia in hospitalized patients, which justifies the need for this study. Aim: The study aimed to examine the prevalence of hypokalemia and the effectiveness of its management in hospitalized patients within the internal medicine department, in relation to the knowledge of doctors and resident physicians. Materials and Methods: This hospital-based retrospective study included a total of 553 cases of patients hospitalized in the Internal Medicine Department of the Mongolia Japan Hospital between January 2024 and August 2024. Patients with a potassium level of <3.5 mmol/L were diagnosed with hypokalemia, and the effectiveness of potassium replacement therapy was evaluated according to the method of supplementation employed. Results: The prevalence of hypokalemia among hospitalized patients in the Internal Medicine Department was 9.8% (54 cases). Based on the study criteria, 42 cases of hypokalemia were selected for further analysis, and a total of 118 potassium replacements were performed through oral, intravenous, and mixed methods. Following potassium replacement therapy, 37.3% (44) of patients achieved normalized potassium levels, while 62.7% (74) still had persistent hypokalemia. Conclusion According to the study results, the prevalence of hypokalemia among hospitalized patients in the Internal Medicine Department is 9.8%. The method of potassium replacement and the severity of hypokalemia do not impact the normalization of potassium levels, with the critical factor being the proper dosage of supplementation. The knowledge of doctors and resident physicians regarding hypokalemia is insufficient, and there is a need to implement guidelines and protocols for potassium replacement therapy in daily clinical practice.

Background: Patients with rheumatoid arthritis are at increased risk of developing cardiovascular disease. In Mongolia, the registration of inflammatory diseases is increasing every year, and cardiovascular diseases are the leading cause of death. Aim: We aimed to determine the degree of cardiovascular risk and its correlation in people with rheumatoid arthritis. Materials and Methods: The study was conducted in a cross-sectional study design with 64 patients with rheumatoid arthritis between May and November 2024. Cardiovascular risk was assessed using mSCORE and the World Health Organization (WHO) cardiovascular Risk Table. We received ethical approval to begin the research at the MNUMS meeting on May 17, 2024 (No. 2024/3-05). Results: The average age of the participants was 55.2±9.7 years, and the average duration since being diagnosed with RA was 9.8±8.0 years. Among the participants, 82.8% (n=53) were female, and 17.2% (n=11) were male. The mean WHO risk index was 10.25±11, while the mean mSCORE risk index was 2.9±4 (p=0.001). There was a significant difference in mSCORE scores between the 40-55 and 56-65 age groups (p<0.001). In contrast, the mSCORE risk assessment showed that 15.6% (n=10) had high risk, and 6.3% (n=4) had very high risk. Among the parameters of inflammatory biomarkers, CRP (OR=0.05, r=0.35, 95% CI 0.9-3.2, p=0.004) has a statistically significant difference and positive correlation, and HDL-C (OR=2.3, r=-0.25, 95% CI 2.9- 10.0, p<0.0001) was significantly different and negatively correlated. Conclusion A total of 64 participants participated in our study, and according to the WHO assessment, 17.2% were at high or very high risk of developing cardiovascular disease in the next 10 years, and according to the mSCORE, 21.9% were at high or very high risk of developing cardiovascular disease. Although the degree of disease activity was not significantly associated with cardiovascular risk, the inflammatory biomarker C-reactive protein was statistically significantly different or positively associated with cardiovascular risk assessment.