Background: Aetiological mechanisms of demyelinating diseases underlie a very heterogeneous clinical course, ranging from relapsing to progressive, with a longer disease duration leading to physical and cognitive disability. Aim: To identify factors in the development of long-term disability in demyelinating diseases. Materials and Methods: A cross-sectional study was conducted among 64 patients with multiple sclerosis and 33 patients with NMO treated at the Third State Central Hospital. We assessed demographic and clinical data, including the Expanded Disability Status Scale (EDSS). Statistical analysis included descriptive statistics, t-tests, chi-square tests, analysis of variance, correlation, and regression. Result: In MS, relapses (≥1) within 1.0 years of MS onset (OR=5.5, 95% CI 1.11-26.69, p=0.037), optic neuritis (OR=4.3, 95% CI 1.02-21.67, p=0.014), relapse frequency (≥3) (OR=6.6, 95% CI 1.39-31.3, p=0.018), myelitis frequency (≥2) (OR=5.5, 95% CI 1.42-21.67, p=0.014), in NMOSD, time from disease onset to diagnosis (≥3 month) (OR=7.9, 95% CI 1.04-60.7, p=0.046), years of diagnosis (≥3 years) (OR=6.3, 95% CI 1.15-34.12, p=0.034) contributed to disabilty worsening outcomes. Conclusion Disability in demyelinating diseases is affected by many factors.

Background: Simultaneous multiple intracerebral haemorrhages (SMICH) is hemorrhage in different arterial territories and are a rare clinical entity. The primary cause of single ICH is hypertension; however, the causes and risk factors of simultaneous multiple ICH are still unknown. Aim: To clarify the aetiology, risk factors and functional outcome of SMICH compared with solitary intracerebral haemorrhages (ICH). Materials and Methods: A total of 718 consecutive patients with spontaneous ICH admitted to our hospital were prospectively studied. Nine SMICH cases were identified, and 19 risk factors, clinical and neuroimaging variables were compared between SMICH and solitary ICH cases using the unpaired t-test, chi-square test, and multiple logistic regression. Result: 709 (98.75%) patients with ICH and 9 (1.25%) patients with SMICH were enrolled in the study. The age, sex distribution, and other associated risk factors were comparable between the groups (all P>0.05). By SMASH-U classification, arterial hypertension was identified in 6 (66.7%), and it was the most common cause in the SMICH group. Bilateral thalamic or putamenal haemorrhages (33.3% versus 33.3%) were the most common combinations of simultaneous bleedings. Age and NIHSS at admission were associated with 90-day mortality in multivariable analyses (OR 1.018; 95% CI, 1.000-1.036; p=0.044; versus OR 1.080; 95% CI, 1.029-1.135; p=0.002), but GCS was not (OR 0.834; 95% CI, 0.734-0.948; p=0.006). Conclusion Patients with SMICH have risk factors and clinical characteristics similar to those of patients with solitary ICH, but they have a much poorer outcome.

Background: Progressive supranuclear palsy (PSP), a rare neurodegenerative disorder, is mainly characterised by supranuclear palsy, trunk imbalance, and cognitive impairment. Its prevalence is believed to be high, although it remains underdiagnosed. Various clinical presentations have been linked to this entity, often making its diagnosis difficult and leading to delays of three to four years before it is established. PSP diagnosis mainly relies on clinical data and can only be confirmed with the neuropathological findings at autopsy. However, recent research indicates that neuroimaging, namely, brain MRI, can aid in earlier diagnosis. Case presentation: We report the case of a 60-something-year-old male with a history of recurrent and unexplained falls over the last few years that had been wrongly attributed to Parkinson’s disease. He initially presented complaining of ataxia and a tendency to recurring falls that got progressively worse, and eventually, he was not able to walk on his own. Concomitantly, there was also a cognitive dysfunction with frontal predominance. An exhaustive physical examination and clinical history revealed indicators consistent with PSP. Conclusion PSP diagnosis demands a high clinical suspicion, and hence, clinicians should have a good understanding of this disease for its early recognition. Although it is a devastating disorder and no medications that can reverse the disease course are currently available, early diagnosis of PSP may contribute to improving the quality of life of the patients and their families and prevent complications. This report highlights the importance of clinical examinations, particularly eye examinations and radiological imaging, in patients with PSP.

Background: Demyelinating disorders are a group of chronic immune-mediated diseases affecting myelinated axons in the central nervous system, which lead to life-long disability. In Mongolia, the last regional prevalence study was conducted in 2010. Our study objective is to describe the current prevalence of multiple sclerosis (MS) and other demyelinating disorders in Mongolia. : Aim Materials and Methods: We registered MS, neuromyelitis optica spectrum disease (NMOSD), myelin oligodendrocyte glycoprotein (MOG), and acute disseminated encephalomyelitis (ADEM) cases diagnosed according to the 2017 McDonald criteria, the 2023 NMOSD diagnostic criteria, International MOGAD Panel proposed criteria. Results: The study was conducted in all tertiary, 7 regional, and 20 provincial hospitals across Mongolia and has collected comprehensive data on 965 patients. The prevalence of total demyelinating disorders was estimated to be 27.2, MS 15.6, NMOSD 5.6, MOG 0.06, and ADEM 0.9 per 100,000 total population, respectively. The prevalence of demyelinating disorders between provinces was compared in order of geographical latitude, from lowest to highest, and was statistically significant. Latitude is associated strongly with the prevalence of demyelinating disorders (p=0.006, 95% CI 14.3-22.4, Pearson correlation=0.603) and moderately with the prevalence of MS (p=0.028, 95% CI 9.39-15.6, Pearson correla tion=0.503). Conclusion In Mongolia, the prevalence of MS has significantly increased and can be considered at medium risk, but still much lower than that in Western countries. The prevalence of NMOSD is almost similar to other Asian countries. An obvious latitude gradient for demyelinating disorders was observed in the Mongolian population.

Background: Tick-borne encephalitis is human viral infection involving the nervous system and transmitted by the bite of infected tick. The TBE Virus is distributed in different geographical areas by three widespread subtypes of the virus: The Far East, Europe, and Siberia. The Far East type has a mortality rate was 30-35%, the European type has a mortality rate of 2.2%, and the Siberian type has a mortality rate of 6-8% (A.G. Pletnev, 1998) [2].
In recent years, human cases of tick-borne infections have been reported in 19 European countries and four Asian countries (Mongolia, China, Japan, and South Korea) [3].
Human cases of tick-borne encephalitis, tick-borne rickettsiosis, and tick-borne borreliosis have been registered in Mongolia since 2005. Deaths have been reported year by year [5].
During 2005 to 2021, tick-borne rickettsiosis (71.6%), tick-borne encephalitis (17.3%) and tick-borne borreliosis (52.9%) were confirmed by epidemiological, clinical and laboratory tests at the NCZD.
Tick-borne encephalitis was registered in 63 soums of 15 provinces and 9 districts of the capital city, of which 90% were infected with tick bites in Selenge and Bulgan provinces. The average mortality rate is 4.9% (14), of which 28.6% in Bulgan province and 2.7% in Selenge province.
Tick-borne encephalitis is the leading cause of death in Bugat soum of Bulgan province and more infected men about 40 years of age [7]. Purpose : Collect ticks from selected soums of the provinces, identify tick species, species composition, distribution, tick densities, pathogens of tick-borne diseases, conduct population surveys to assess the risk of tick-borne infections, and identify tick-borne infections. Material and Method: Ticks were collected by flag from birch trees in birch forests and meadows with biotope and overgrown berries, determined morphological analyze and molecular biological investigation for detecting tickborne pathogens.
Questionnaires were collected from selected soum residents according to a specially designed randomized epidemiological and clinical survey card, collected information and forms were submitted to soum hospitals with a history of tick bites (according to clinical criteria). Serological tests were performed to detect IgG-specific antibodies to the collected serum mites. Result and conclusion Collected 121 ticks (120 I. persulcatus and 1 D. nuttalli) and not wound egg, larvae, nymphs. By molecular biological investigation detected 3.5% of I.persulcatus from Khutag-Undur soum of Bulgan province, 3.5% of anaplasmosis, and 14.1% of I.persulcatus mites from Bugat soum. 1.5% borreliosis, 3.1% anaplasmosis.
Detected DNA of 100% tick-borne rickettsiosis from D.nutalli ticks and determined circulation of infection among tick in Bugat and Khutag-Undur soums of Bulgan province.
247 people were surveyed, 56 blood serum from cases. Detected Q fever, erysipelas, and anaplasmosis, tick-borne borreliosis 3 (5.4%), tick-borne rickettsiosis 26 (46.4%), Japanese encephalitis 3 (5.4%), tick-borne encephalitis tick-borne rickettsiosis 6 (13.0%), tick-borne rickettsiosis tick-borne borreliosis 1 (1.8%), tick’s rickettsiosis Japanese encephalitis 1 (1.8%), tick-borne encephalitis tick-borne borreliosis 1 (1.8%).
By investigation, vaccination (88%) and wearing long-sleeved shirts and pants (81%) were the most effective ways to prevent tick bites (81%) [15]. According to our research, the percent of population knowledge in Bulgan province was insufficient (40.9%) which there is a lack of information, training and advertisement among the population in the province.

The microbiologist, who aged 44 man has work with glander DNA extraction between January and March at 2022, was developed sumptoms with fever, headache, muscle pain, weakness, cut throat, cough at 4 March, 2022. On March 7, he had tested Covid-19 and the result was negative. He was given 1gr tefazoline by eight-time interval for two days. Despite completing the therapy, episodes of fever and headache increased. A medical evaluation, which included MRI test was no disorder was developed. On March 12, painful with leg and developed muscle pain. He continued to difficulty to walk and cough, fever and weakness. On March 13, he has admitted hospital with diagnoses pneumonia.
He had continued sign with pneumonia in both lung, fever, infiltration with right leg, cough, headache, and glandule node in hospital. By PCR test, glander DNA was detected in sputum in National Center for Zoonotic Diseases laboratory. He recovered 20 days in hospital.
He has 12 days incubation period and infection route was by worked with glander strain and it was pneumonia form with laboratory-acquired human glanders.
Human glander case is rare in Mongolia. Three human glander cases had registered in 1966, 1972, 1977 among prison’s horse herder in Mongolia.

Background: The American Heart Association estimates that more than 1 million people die each year from acute coronary heart disease and half a million from acute coronary syndrome, and that $ 115 billion a year is spent on diagnosing and treating coronary heart disease [Word Health Organization, 2013]. Goal: In this study we aimed to using coronary computed tomography angiography (CCTA) to diagnose unstable plaques in coronary artery disease. Material and methods: From 2018 to 2021, we performed a coronary computed tomography angiography (CCTA) scan with a Philips Ingenuity 64-slice computed tomography (64 MD-CT) device and examined 47 patients diagnosed with unstable coronary artery disease at the Reference centre on Diagnostic Imaging named after R.Purev State Laureate, People’s physician and Honorary professor of the State Third Central Hospital.
Common statistical measurements such as means and standard errors were calculated. Probability of results were checked using Student’s test. Result: In studying signs of coronary computed tomography angiography (CCTA) to diagnose unstable plaques in coronary artery disease that coronary artery diameters more widening to compared healthy artery 16(34.0%±6.9), low density sites clarify in plaque (lower than +30HU)- 14(29.8%±6.7), small calcification detect in plaque 36 (74.5%±6.4), ring liked additional density (lower than +130 HU) sees in edge of plaque (Halo sign)-9(19.2%±5.8), plaque edge roughness, erosion liked changes- 18 (38.3%±7.1), rupture of intima (dissection)- 8(17.0%±5.5). Conclusion We detect that computed tomography angiography (CCTA)’s specific signs of unstable plaque of coronary artery disease are coronary artery diameters widening, low density sites clarify in plaque (lower than +30HU), small calcification detect in plaque, ring liked additional density (lower than +130 HU) sees in edge of plaque (Halo sign), plaque edge roughness, erosion liked changes and rupture of intima.

Background: Lower extremity arterial diseases are chronic stenosis of the artery and occlusive arterial diseases, which are commonly caused by atherosclerosis. Prevalence of lower extremity arterial diseases has positive proportional relationship with age of the patients. Furthermore, prevalence of lower extremity arterial disease is 16% among the males over the age of 60, whereas prevalence among same aged woman is 13%. Among the age group of 38 to 59 age, 60 to 69 age and 70-82 age group, prevalence of lower extremity arterial disease was 5.6%, 15.9%, and 33.8%, respectively. Goal: Identifying lower extremity arterial occlusive disease and chronic stenosis of arteries by CTA-TASC classification of aorta-iliac and femoral popliteal lesions. Obiective:
1. To identify age and sex of the patients with lower extremity arterial occlusive disease and chronic stenosis of arteries.
2. To identify lower extremity arterial occlusive disease and chronic stenosis of arteries by CTA-TASC classification of aorta-iliac and femoral popliteal lesions. Material and methods: Study sample consisted of 237 patients, who were diagnosed with lower extremity arterial occlusive disease and chronic stenosis of arteries from 2019 to 2020 at reference centre on Diagnostic Imaging na after R.Purev State Laureate, People’s physician and Honorary professor of the State Third Central Hospital. Computed angiogram images of lower extremity arteries were examined. Contrast agent “Ultravist” was pumped by automatic syringe. Lower extremity arterial occlusive disease and chronic stenosis of arteries are categorized by CTA-TASC classification of аorta-iliac and femoral popliteal lesions. The youngest participant was 20 years old and the oldest participant was 76 years old. Common statistical measurements such as means and standard errors were calculated. Probability of results were checked using Student’s test. Results: We have found following results: 185(78.1%±3.0) cases out of 237 diagnosed patients with lower extremity arterial occlusive disease and chronic stenosis of arteries are males and 52(21.9%±3.0) cases are female. Distribution of lower extremity arterial occlusive disease and chronic stenosis of arteries by the age group of patients are: up to 20 years of age is 3 (1.3%±0.7), 21 to 40 years of age is 14(5.9%±1.5), 41 to 60 years of age is 86(36.3%±3.1) and over the age of 61 is 134(56.5%±3.2). It is statistically highly significant that experiencing lower extremity arterial occlusive disease and chronic stenosis of arteries among the age group of over 61(P<0.001).
The result of lower extremity arterial occlusive disease and chronic stenosis of arteries by the CTA-TASC classification of aorta-iliac and femoral popliteal lesions are: CTA-TASS аorta-iliac lesions A-16(6.8%±1.8), B-8(3.4%±1.2), C-12(5.1%±1.4), D-41(17.3%±2.5), CTA-TASS femoral popliteal A-41(17.29%±2.5), B-53(22.36%±3.6), C-47(19.83%±2.6), D-96(40.5%±3.2), respectively. Conclusions
1. Lower extremity arterial occlusive disease and chronic stenosis of arteries occurs 46.5% over the age of 60 and 78.1% of the patients are males.
2. Following two categories have identified more than the rest, 17.3% CTA-TASC classification of аorta-iliac lesions, type D and 23.3% CTA-TASC classification of femoral popliteal lesions, type D.

Most of the infected patients completely recovered after covid-19 infection. However, a substantial proportion of patients who have been infected with SARS-CoV-2 continue to have symptoms long past the time that they recovered from the initial phases of covid-19 disease. At NICE guideline,
1. Acute covid-19: signs and symptoms of covid-19 for up to 4 weeks,
2. Ongoing symptomatic covid-19: signs and symptoms of covid-19 from 4 to 12 weeks,
3. Post-covid-19 syndrome: signs and symptoms that develop during or after an infection consistent with covid-19, continue for more than 12 weeks and are not explained by an alternative diagnosis.
In addition to the clinical case definitions, ‘long covid’ is commonly used to describe signs and symptoms that continue or develop after acute covid-19. As the pandemic of covid-19 continues, numerous additional symptoms, such as fever, dry cough, shortness of breath, fatigue, myalgias, vomiting or diarrhea, headache and weakness. Other critical and severe complications of covid-19 can include impaired function of the heart, brain, lung, liver, kidney, and coagulation system. Early reports have now emerged on post-acute infectious consequences of covid-19, with studies from the United States, Europe and China reporting outcomes for those who survived hospitalization for acute covid-19. An observational cohort study from 38 hospitals in Michigan, United States evaluated the outcomes of 1,250 patients discharged alive at 60 day. Of 488 patients who completed the telephone survey in this study, 32.6% of patients reported persistent symptoms. Dyspnea while walking up the stairs 22.9% was most commonly reported, while other symptoms included cough 15.4% and persistent loss of taste/smell 13.1%. Post-hospital discharge care of COVID-19 survivors has been recognized as a major research priority by professional organizations.