Background: Polymyositis (PM) is a rare idiopathic inflammatory myopathy characterized by symmetric proximal muscle weakness, elevated muscle enzyme levels, dysphagia, and respiratory muscle weakness. Rhabdomyolysis is a potentially life-threatening condition caused by extensive skeletal muscle breakdown, resulting in myoglobinuria and an increased risk of acute kidney injury and multiorgan complications. The coexistence of rhabdomyolysis in patients with polymyositis is uncommon and may complicate both diagnosis and management. Case Presentation: A 65-year-old man was admitted with fever up to 39°C, generalized skin rash, dysphagia, progressive muscle weakness, dyspnea, decreased urine output, and dark tea-colored urine. Physical examination revealed symmetric proximal muscle weakness, with muscle strength graded 3/5 in both upper extremities and 4/5 in both lower extremities. Neck muscle strength was 4/5. Dysphagia and a generalized skin rash were also present. Laboratory investigations showed markedly elevated creatine kinase (CK) at 9,943.1 U/L, alanine aminotransferase (ALT) at 449.1 U/L, aspartate aminotransferase (AST) at 222.1 U/L, lactate dehydrogenase (LDH) at 1,342.9 U/L, and C-reactive protein (CRP) at 70.6 mg/L. Urinalysis showed blood 3+ and protein 2+, while no erythrocytes were detected on urine sediment microscopy. Electromyography demonstrated myopathic changes, and muscle biopsy revealed inflammatory infiltrates and necrotic muscle fibers. Conclusion Comprehensive assessment of clinical manifestations, laboratory findings, autoantibody testing, electrophysiological studies, and muscle biopsy is essential for the diagnosis of polymyositis complicated by rhabdomyolysis. An integrated diagnostic approach facilitates confirmation of the diagnosis, differentiation from clinically similar disorders, and appropriate treatment selection. Early recognition of rhabdomyolysis and other potentially life-threatening complications is crucial for preventing organ damage and improving patient outcomes.

Background: Acute appendicitis is an inflammatory disease and acommon cause of acute abdominal pain. The application of the sophisticated automated hematology analyzer more precisely define the morphology changes blood cells. According to this diagnose and treatment control issues are solved by easy and not expensive way. Recent studies haveshown that there is a negative correlation between platelet count (PC) and MPV and that theratio of these two values may be more meaningful. The aim of our study was to investigate thediagnostic value of MPV and the MPV/PC ratio in acute appendicitis. Methods: The patients were divided into two groups based on their histopathological findings: the uncomplicated and complicated appendicitis groups. Leukocyte count, PC, MPV and the MPV/PC ratio were compared all groups. Results: Total of 186 patients, including 119 men, were included in the study. The average age of all patients was 10.21±1.22 years. There was statistically significant difference of some parameters in peripheral blood between the uncomplicated and complicated appendicitis groups in terms of all index. (p<0.001). Leukocyte count had a strong discriminatory property based on the area under curve (AUC) 0.714, (p<0.001). MPV, PC and the MPV/PC ratio had weak discriminatory power with AUC values <0.663. Using receiver operating characteristic (ROC) analysis, the sensitivity and specificity of MPV were 81.56and 45.7%, respectively, and 63.78% and 71.06%, respectively, for the MPV/PC ratio. Conclusions In our study, MPV and the MPV/PC ratio were useful in the diagnosis of acute appendicitis.

Investigation of Klinefelter syndrome among infertility men Background: Klinefelter syndrome (KS) is the most common sex chromosomal anomaly, which is estimated to be 1 in 500-1000 male live births and 2.1-28.4 % among infertility men. Klinefelter syndrome is defined as LD50.30 by International Classification of Diseases 11th Revision. So far, KS syndrome has not investigated among Mongolian infertility men. Materials and methods: We recruited participants who were diagnosed in Center of Infertility, Child and Maternal National Center from October 2017 to October 2019. These participants showed azoospermia and the clinical characteristics of KS. Clinical characteristics of KS were as the anthropometric values, testicle size and also gingival cells were checked by Sanderson method to detect Barr body. Cytogenetically, blood lymphocytes were incubated and evaluated by standard method of G-band using “Metasystem” for karyotyping diagnosis. Results: During the research period, we recruited 1636 male participants with infertility and out of them 145 people were shown the azoospermia and nine people had clinical characteristics of KS. We confirmed the diagnosis of KS in five cases out of these nine patients (3,4%). The mean age of these KS cases was 33.5±4.5. Gynecomastia was presented in 100% (n=5), no underarm hair in 80% (n=4) cases, sparse body hair in 20% (n=1) cases, no facial hair in 100% (n=5) cases, female-like pubertal hair was detected in 80% (n=4) cases. Mean size of testicles was as 4±1.25 ml in left and as 4±0.75 ml in the right. We found that karyotyping pattern of the cases was in 80% 47,ХХУ (n=3) and mosaicism in 20% 48,ХХХУ/47,ХХУ (n=1) and 20% 46,ХХ (n=1), and Barr body was detected in all 100% (n=5) cases. Conclusions: Azoosperm was detected in 8.9% among infertility men in our study. Klinefelter syndrome cases were detected in 3.4% among infertility Mongolian men.