Background: Choriocarcinomas after full-term pregnancies are a rare entity. Case presentation: A 34-year-old woman was admitted to the hospital with a seizure in a comatose state. A computed tomography scan revealed an intracerebral haemorrhage in the right parietal region. A chest CT scan showed a single metastatic lesion in the right upper lung field. The patient delivered a viable infant at 39 weeks of gestation, 4 months before the hospitalisation. Her pregnancy course was uncomplicated. Despite receiving intensive treatment, the patient died 1 day later. Choriocarcinoma was diagnosed at the autopsy. Conclusion Metastatic choriocarcinoma should always be in the differential diagnosis for women of childbearing age presenting with unexplained stroke-like symptoms.

Background: Primary central nervous system lymphoma (PCNSL) is a rare form of extranodal non-Hodgkin lymphoma that is confined to the brain, spinal cord, leptomeninges, or eyes. Case: Our patient was a 52-year-old immunocompetent male who presented with progressive ataxia, dizziness, weakness and pain in both legs, imbalance, nausea, bladder/bowel retention and fever for over 18 months. After repetitive brain and spinal MRI, he was diagnosed with encephalomeningomyelitis and received four courses of steroid therapy, but his clinical symptoms continued to worsen. He was unable to undergo brain tissue analysis due to his persistent fever. We present a case of PCNSL based on the history, clinical presentation, repeated brain imaging, cerebrospinal fluid analysis, and clinical treatment. Conclusion Early diagnosis through accurate interpretation of imaging and timely management is crucial for improved outcomes in PCNSL.

Background: Senear-Usher Syndrome, also known as pemphigus erythematosus, is a rare autoimmune blistering skin disease characterized by overlapping clinical, histopathological, and immunological features of both lupus erythematosus and pemphigus foliaceus. Case Presentation: We report the case of a 46-year-old male diagnosed with Senear-Usher Syndrome, who presented to the outpatient clinic of the National Dermatology Center of Mongolia and received inpatient treatment. Diagnosis: The patient exhibited diffuse, thick, pale gray scales and yellowish crusts on the scalp. Multiple brown hyperpigmented macules of various shapes and sizes, vivid erythema, and a few erosions were observed on the nose, cheeks, trunk, and upper and lower extremities. A few pea-sized vesicles containing clear fluid were scattered on the back. Nikolsky's sign was weakly positive, and Besnier-Meshchersky's sign was positive. Histopathology: Histopathological analysis of skin biopsies revealed hyperkeratosis, parakeratosis, and acanthosis in the epidermis. Subcorneal cleft formation with neutrophils within the cleft was noted, along with perivascular infiltration of neutrophils and lymphohistiocytes in the superficial dermis. Treatment: The patient received treatment with hydroxychloroquine, systemic and topical corticosteroids, and symptomatic therapy. Outcome: Following treatment, the patient's general condition improved significantly. The erosions re-epithelialized, and the vesicles resolved, leaving behind brown hyperpigmented macules. The patient is currently under regular follow-up by a dermatologist and a family physician. Conclusion Senear-Usher Syndrome is a rare disease with a high potential for misdiagnosis. Therefore, an accurate diagnosis relies on a comprehensive evaluation of clinical features, histopathological examination, and direct and indirect immunofluorescence studies.

Background: Cutaneous squamous cell carcinoma (cSCC) accounts for approximately 20% of all malignant skin tumors and is the second most common skin cancer worldwide. Although the prognosis is generally favorable when diagnosed at an early stage, large tumors with invasion into surrounding tissues and metastasis to regional lymph nodes tend to exhibit more aggressive behavior. In particular, reconstruction of large tissue defects following wide excision of skin tumors remains a significant clinical challenge. Case presentation: We present a rare case of cSCC in a 69-year-old male patient, located on the left hip. The lesion measured 13x9 cm, with well-demarcated borders from the surrounding normal skin, prominently elevated above the skin surface, and characterized by a bluish-brown color. The central superior portion of the lesion was depressed and ulcerated with infiltrative features. Histopathological examination confirmed a well-differentiated, keratinizing invasive cutaneous squamous cell carcinoma. Computed tomography revealed a soft tissue density mass at the skin surface of the left lower abdomen, along with enlargement of the left inguinal lymph nodes. Treatment: The patient underwent wide local excision of the tumor along with regional lymph node dissection (lymphadenectomy). The resulting large tissue defect was reconstructed using an anterolateral thigh (ALT) free flap. During surgery, indocyanine green (ICG) angiography was performed to assess flap perfusion, and handheld Doppler was used to evaluate vascular flow. Results: The postoperative course was uneventful. The flap survived successfully with adequate perfusion. Histopathological examination confirmed negative surgical margins, and no metastasis was identified in the lymph nodes. The patient remains in stable condition without any complaints or symptoms and is under regular follow-up by an oncologist. Conclusion This case demonstrates that combining wide excision with free flap reconstruction is an effective approach for managing large cSCC. In addition, the use of indocyanine green (ICG) angiography for intraoperative assessment of vascular perfusion enhances flap viability and contributes to improved surgical outcomes.

Background: The COVID-19 pandemic has profoundly impacted mental health, particularly exacerbating conditions such as depression, anxiety, insomnia, post-traumatic stress disorder (PTSD), and emotional disorders among hospitalized patients. This study examined the prevalence of COVID-19-related mental health issues and risk factors in hospitalized patients affiliated with MNUMS, compared to a control group. Aim: To assess the prevalence of mental health disorders such as depression, anxiety, insomnia, and post-traumatic stress disorder (PTSD), and to identify their associated risk factors. Materials and Methods: The study was conducted at hospitals under MNUMS, including the Mongolian-Japanese Hospital, Central Hospital, and the National Center for Maternal and Child Health. A total of 552 participants (399 case group, 153 control group) who were hospitalized were included. Depression (PHQ-9≥10), anxiety (GAD-7≥10), insomnia (ISI≥15), and PTSD (PCL-5≥33) were assessed using standardized scales. Analysis was performed using chi-square tests and binary logistic regression (crude odds ratio [cOR]/adjusted odds ratio [aOR], 95% confidence interval [CI]), adjusted for group, age, and sex. Results: In the case group, depression (23.1% vs. 13.7%, p=0.015, cOR=1.884 [1.124-3.156]), anxiety (16.8% vs. 11.1%, p=0.096), and any mental disorder (18.0% vs. 13.7%, p=0.225) were higher, while insomnia was lower (19.5% vs. 30.1%, p=0.008). PTSD was low overall (1.8% vs. 0.7%, p=0.333). Risk factors included female sex (p<0.001, cOR=0.362 for depression in males), younger age (p=0.004), unemployment (p=0.017), and prior trauma (p<0.001). COVID-19 symptoms (difficulty breathing) increased the risk of depression (p<0.001, cOR=2.828 [1.708-4.682]). Conclusion Hospitalization for COVID-19 increases the risk of depression and anxiety, modulated by demographic, clinical, and socioeconomic factors. Targeted interventions for vulnerable groups are essential.

Background: Thyroid nodules (TNs) are a common clinical issue, and their prevalence has been increasing over the last 2 decades [1] due to the widespread use of ultrasound (US) imaging. More than 50% of TNs are detected with US examination In the general population, while only 3–7% are detected with palpation [2]. Nodular goiter is the most common cause of thyroid disease in Mongolia, as in other countries. Recent guidelines suggest that a nodule without clinical symptoms should be treated with watchful waiting; however, some patients require treatment because of cosmetic problems or symptoms. There are several treatment options, but neither is perfect. The main treatment of the disease is still the traditional surgical resection. it still carries a 2–10% prevalence of complications, such as neck scarring, hypothyroidism, transient or definitive postoperative hypoparathyroidism, recurrent laryngeal nerve injury, and the recognized risks associated with general anesthesia [3,4]. Minimally invasive alternatives have been explored. Laser ablation, microwave ablation, HIFU, and radiofrequency ablation (RFA) are safe and effective techniques for the treatment of nodular goiter. it is possible to treat small nodules early and enlarge them before surgical intervention is indicated. We have introduced a new method of RFA treatment (2019) in our country. Purpose: To assess the effectiveness of radiofrequency ablation (RFA) for cystic thyroid nodules. Material and Method: This retrospective study was approved by the Research Ethics Committee of the Mongolian National University of Medical Sciences and informed consent was obtained from all patients before RFA. The study was conducted from 9th Jan 2019 to 15th Oct 2021, 485 nodules from 183 patients (M:F=9:174; mean age±SD=46.3±11.4 years) who met the eligibility criteria and provided written informed consent were enrolled at the First Central Hospital of Mongolia. Nodules were assessed pre-treatment and at 1, 3, 6, 12, and 24 months post-treatment. Nodule volume were recorded at each time point.
The primary endpoint was the volume reduction ratio (percentage) at 1, 3, 6, 12, and 24 months follow-up. Results: For the primary outcome of nodule volume reduction, the absolute volume reduction at the 24-month follow-up was 45 (77.6%). Completely destroyed 10 (17.2%), volume increased by 3 (5.2%) (table. 3). The median volume reductions at the 1, 3, 6, 12, and 24-months follow-ups were 34.9%, 61.0%, 74.9%, 83.3% and 74.0% respectively. Median volume statistically decreased by a significant p=0.0001. At 3 months follow up after RFA, the nodules decreased most. All study subjects recovered without sequelae. Therefore, no patient experienced a life-threatening or delayed complication during the follow-up. Conclusion Our study demonstrates that RFA is a safe and effective treatment for cystic thyroid nodules. Advantages of RFA include no surgical scars or general anesthesia, low complication rates, and avoiding lifelong thyroid hormone replacement.

Introduction: Hepatocellular carcinoma incidence and mortality per 100,000 population in Mongolia is the highest in the world. The individual’s genetic factors and new genetic changes are considered an important effect on the origin and development cancer. We aimed to investigate whether p53R72P polymorphisms were associated with the risk of hepatocellular carcinoma in Mongolian patients. Material and Method: p53R72P polymorphisms were evaluated in 80 controls and 38 HCC cases using a PCRrestriction fragment length polymorphism assay. Results: The mean age was 58.5±13.6 years in the case group and 63.2±8.1 years in the control group. Hepatocellular carcinoma is most common in 50-59 (n=14, 36.8%) and 60-69 (n=14, 36.8%) ages. Of the HCC group, 4 (10.8%) were diagnosed with tumor at stage II, 23 (62.2%) at stage III, and 11 (27%) at stage IV.
The results revealed that the heterozygous (Arg/Pro (PR)) genotype of p53R72P increased statistically significant the risk of hepatocellular carcinoma (OR=4.222, 95% CI 1.669-10.684) compared to the wildtype (R/R) genotype. (p=0.002). Moreover, the homozygous (Pro/Pro (P/P)) genotype of p53R72P increased the risk of carcinoma (OR=1.333, 95% CI 0.414-4.299) but not statistically significant. (p=0.63). Heterozygous (Arg/Pro (PR)) genotype of p53R72P in the tumor tissue was associated with a statistically significant (OR=3.3, 95% CI 1.274-8.57) increase in the risk of HCC (p=0.014). Pro/Pro (PP) genotype increased the risk of the carcinoma by 2.4 times (OR=2.44, 95% CI 0.865-6.908), but it was not significant. (p=0.092). Pro/Pro (PP) genotype of p53R72P in the tumor tissue compared to normal tissue of a case group increased the risk of cancer by 1.8 times (OR=1.833, 95% CI 0.472- 7.126), which was not statistically significant (p=0.382). Conclusion Taken together, Heterozygous (Arg/Pro (PR)) genotype of p53R72P increases the risk of hepatocellular carcinoma in Mongolians. Further studies with larger populations are needed to confirm these results.

Introduction: Gastric cancer is still one of the most leading causes of mortality in the world. The highest mortality rate of gastric cancer is estimated in Mongolia. South Korea and Japan, where leading the incidence of gastric cancer, mortality rates are observed in 51th and 31nd rank respectively. In Mongolia, gastric cancer is the second leading site, after liver cancer. Goal: We aimed to determine the cause of late diagnosis of gastric cancer and to evaluate supply of upper endoscopy devices and human resource for gastric cancer in the general hospital of provinces and districts. Materials and Methods: In this study, 84 patients suffering from gastric cancer (42 patients in III, IV TNM stage; 42 patients in I, II TNM stage)were investigated in National Cancer Center, Mongolia. A survey questionnaire which included age, gender, education, income, risk factors and clinical questions was detected from all patients. And we conducted study of supply of upper endoscopy devices and human resource for gastric cancer in general hospitals of from 21 provinces and general hospitals of 6 districts by questionnaire. Results: Seventy three(86.9%) patients were over 50 years old and the highest rates of gastric cancer were in group of 61-70 years (40.5%). From the results, the reason to visiting hospital was significantly different between two groups. 55.1% of patients suffering from early-stage gastric cancer were voluntarily diagnosed by upper endoscopy. In contrary, 55.8% of patients suffering from late-stage gastric cancer have visited the hospital due to worsening symptoms or dysphagia and vomiting. Factors such as age, gender, education, employment status and income had no significant effect on late diagnosis of gastric cancer. In totally 24(89%)general hospitals out of 27 had upper endoscopy devices and 22 (81.5%) hospitals had endoscopist. Although 75% of total general hospitals conduct annual cancer screening, 64% of them do not perform the endoscopy in annual screening. Conclusion In our country, late diagnosis of gastric cancer is related to the attitudes of patients for preventing and screening disease. Therefore, it is important to improve the health education of the population and to develop healthy, right attitudes and practices. And the study revealed that general hospitals have insufficient for upper endoscopy devices and human resource.

BACKGROUND. Congenital Cleft Lip and/or Palate (CL/P) is a common craniofacial birth defect and occurs 1 per 500-700 live births in average. Children with CL/P at a higher risk for speech/language problems due to the anatomical and structural differences in the oral and nasal cavities, Velopharyngeal Insufficiency causing speech disorders with articulation, phonation, and resonance, respectively. It leads to long-lasting adverse outcomes, influencing quality of life and causes obstacles in child’s socialization. Speech in 2007 Therapy team of School of Dentistry ( G. Ariuntuul , B. Bulgan, U. Azzaya, B. Batsukh, M. Bat-Erdene), Mongolian National University of Medical Sciences (MNUMS) (former Health Sciences University of Mongolia) established and successfully conducted a first clinical speech therapy sessions for children with clefts in Mongolia based on the Department of Oral and Maxillofacial Surgery (G. Ayanga et al.) of National Maternal and Children’s Health Center (NMCHC). Since 2012 the speech therapy team of School of Dentistry, officially transferred the equipped operating speech room to NMCHC and speech pathologist B. Bulgan, supervised and trained by Ariuntuul G. recruited by NMCHC for a full time position and working as a member of multidisciplinary team till present. OBJECTIVES. To assess and analyze registry data of children with clefts, visited speech therapy sessions of speech pathology team of School of Dentistry, MNUMS during 2007 through 2012. MATERIAL AND METHODS. Registry based retrospective study was conducted to obtain demographic and speech disorder related data of children with clefts, visited speech therapy sessions between 2012-2017 at the NMCHC. RESULTS. In total 203 participants are attended the speech therapy sessions: 103 male (51%), 100 female (49%). Out of total 203 children 144 (71%) had Cleft Lip and Palate (CLP), 44 had cleft palate only (22%), 15 had cleft lip (7%), respectively. Average age for primary cleft surgery was 1y13m, where as for secondary was 4y22m. CONCLUSION. For speech therapy session for children with clefts boys were dominant compared to girls (1:1.03). By the types of clefts children diagnosed with Cleft Lip and Palate was prevalent to attend treatment classes. There is a need in early CL/P diagnosis, using birth screening and furthermore, traning of speech therapists/pathologists are important for development of multidisciplinary team, surgery outcome and improvement of quality of life of children with clefts.

This study investigates cochlear implant surgical and Audio Verbal Therapy (AVT) practice patterns of patients with hearing loss (HL) based on data of “Aid” ENT Clinic and Speech Therapy Unit of School of Dentistry, Mongolian National University of Medical Sciences (MNUMS) between 2009-2018. Our aim was to describe and collect related data on surgical interventions, using cochlear implant for patients with severe hearing loss and their involvement in the AVT sessions. Hospital based registry data by audiologistwere retrospectively investigated. Descriptive statistics are used to describe the basic features of the data in the study. In total 78 patients had cochlear implantation surgery with chronological age between 2 months and 55 years. From total subjects 46 (54.59%) were male and 32 (33.41%) female. The distribution of etiology for the hearing loss showed that the majority of hearing loss 47 (60%) had due to infectious diseases, other diseases or injury, 25 (32%) congenital and 6 (8%) unknown causes. Documentation and proper registration is essential for better outcome of cochlear implantation surgery, especially teamwork of speech therapist doing AVT and audiologist in charge of fitting. Furthermore, epidemiological studies are important for evaluation and monitoring of interventions by every specialists included in the treatment team.