Background: Cerebral cavernous malformations (CCM) present with varied symptoms and are diagnosed only on MRI, which shows characteristic appearances. Genetic factors play a role, with familial cases following an autosomal dominant inheritance pattern. Case: This is the clinical case of a 48-year-old woman with a history of long-standing arterial hypertension. She was admitted to the Stroke Department with headache, nausea, vomiting, right-sided sensory disturbance, and dysarthria. Based on the clinical presentation and MRI, multiple supra- and infratentorial and intraxial lesions with heterogeneous components were identified, exhibiting hypointense rings on T1- and T2-weighted sequences and a “blooming” effect on T2*/GRE sequences, characteristic of cerebral cavernomas, displaying a “popcorn” appearance. Conclusion In CCM, management requires a multidisciplinary approach, with surgical resection the gold standard for symptomatic cases. Accurate determination of familial or sporadic origin is crucial for tailored treatment.

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: Parry-Romberg syndrome (PRS) is a rare acquired neurocutaneous disorder characterised by progressive hemifacial atrophy involving subcutaneous tissue, muscle, and occasionally bone. Linear scleroderma (also known as Mophea en coup de sabre) is a subtype of focal scleroderma, characterised by thickening and hardening of the skin due to excessive collagen deposition in the skin and subcutaneous tissue. Both disorders occur together, although rarely. We present a case of Parry-Romberg Syndrome with Linear Scleroderma, which initially started on the left side of the face but gradually progressed over the years and, in recent years, has spread to the right side of the face and tongue, and is being treated with immunosuppressive therapy. Case Presentation: A woman in her 30s presented with progressive soft-tissue atrophy of the left side of the face, extending from the forehead and parietal region to the cheek and mandible, with associated left frontal pain and facial asymmetry. The condition had begun at approximately 10 years of age with localized alopecia and gradually progressed over several years, later involving the left side of the tongue. Examination revealed marked left-sided facial soft-tissue atrophy, tongue muscle atrophy, enophthalmos, and facial asymmetry. Electroneuromyography demonstrated chronic myogenic changes in muscles innervated by the left trigeminal, facial, and hypoglossal nerves. Brain magnetic resonance imaging showed thinning of the skull and subcutaneous soft tissues in the left frontoparietal region, with associated reduction in the size of the left orbital soft tissues and globe. Based on the clinical and imaging findings, Parry–Romberg syndrome associated with linear scleroderma was diagnosed, and immunosuppressive therapy was initiated with longterm follow-up. Conclusion Parry-Romberg syndrome is a rare, slowly progressive disorder that can involve the skin, subcutaneous tissue, muscles, bone, eyes, and nervous system. In patients presenting with progressive hemifacial atrophy, detailed neurological examination and appropriate imaging studies are important for establishing the diagnosis and identifying associated neurological involvement. This case highlights the clinical importance of recognizing Parry–Romberg syndrome and its association with linear scleroderma.

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.

Abstract Epilepsy, a neurological disorder characterized by recurrent seizures, affects millions of people worldwide. Significant advancements in both diagnostic and therapeutic approaches have greatly improved outcomes, particularly for individuals with drug-resistant epilepsy. Modern neurostimulation techniques such as Responsive Neurostimulation (RNS), Deep Brain Stimulation (DBS), and Vagus Nerve Stimulation (VNS) have demonstrated effectiveness in reducing seizure frequency in these patients. Additionally, emerging technologies like gene therapy and optogenetics are being explored to better understand the underlying mechanisms of epilepsy and hold promise as future treatment modalities.Traditional imaging techniques often fail to detect subtle epileptogenic zones. However, the introduction of ultra high-field 7T MRI scanners represents a major breakthrough. These advanced scanners use eight transmitters to generate higher-resolution images, reducing signal dropout and enabling the identification of previously undetected lesions. In one study involving 31 patients, 58% had their treatment plans modified based on 7T MRI findings, highlighting its potential to inform surgical decision-making. In terms of pharmacological treatment, newer medications such as sultiame, cannabidiol (CBD), and non-pharmacological approaches like the ketogenic diet have emerged as additional therapeutic options for drug-resistant epilepsy. These developments contribute to more effective, personalized management strategies for epilepsy. In summary, the landscape of epilepsy diagnosis and treatment is rapidly evolving. Innovations in imaging and therapeutic interventions are offering new hope for patients with drug-resistant epilepsy. Ongoing research and clinical trials remain essential to further refine these approaches and improve patient outcomes.

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: Among the endocrine, nutritional, and metabolic disease and thyroid disorders occupy a significant place. According to the World Health Organization, 8-18% of the world’s population suffer from thyroid disorders. In our country, no research on the prevalence of the disorders has been conducted before, and this research methodology was discussed by the Scientific committee of the National Center for Public Health and was approved by resolution No.156 of the Ethics Committee of the Ministry of Health on 2020. Materials and Methods: In order to determine the prevalence of thyroid disease in the country, we collected the actual number of thyroid disorders registered in 9 districts of the capital city and 330 soums of 21 aimags for a total of 10 years from 2011 to 2020. The prevalence of thyroid disorders was mapped using Arc view and GIS software. Results Endocrine, nutritional and metabolic disease account for 2.3% of all outpatient cases. Endocrine, nutritional, and metabolic disease accounted for an average of 168.3 per 10000 population over the past 10 years, and thyroid disorders accounted for 45 or 26.7% of endocrine, nutritional, and metabolic diseases. Thyroid disorders are highest in people aged 40-49 years.
Thyroid toxicity is the most common type of thyroid disease in Mongolia, accounting for 56.2%, with an average of 17.2 per 10000 population in 2011-2020. However, iodine deficiency-related thyroid disease accounts for 5.5% of all thyroid disorders, with an average of 2.5 per 10000 population in 2011-2020. In 2011, it decreased by 2.2 per 10000 population, and by 2020, it decreased by 0.2 per thousand to 2.0, but in the last 5 years, it has increased by an average of 2.4 per 10,000 population, and in the last 5 years it has increased by 0.2 per thousand, or 2.6 per 10,000 population. Morbidity is high in the Khangai and Central regions.

Introduction: Mongolia is one of the most vulnerable countries to climate change due to its geographical location, climate conditions, level of development and lifestyle of the population.
The “Impact of Climate Change on Drinking Water, Health and Adaptability” study report has shown that climate change is affecting the quality and composition of drinking water, drying up many rivers and lakes and reducing groundwater levels.
There was a strong positive correlation between precipitation and air temperature and dysentery, diarrhea and salmonellosis, while there was a strong negative correlation between precipitation, air temperature and viral hepatitis. Goal: The goal of the study was to reveal correlation between meteorology parameters and some intestinal infectious diseases and human health in Mongolia. Material and Methods: We evaluated climate and certain morbidity (intestinal infections) indicators for the last 15 years (2005-2019) using descriptive survey methods. The methodology of the survey has developed and discussed at the Scientific Council meeting of NCPH, 12th of Oct, 2020. The methodology of the survey has developed and discussed at Medical Ethics Reviews Committee of MOH on 23rd. of June, 2021. Results: On the other hand, the average air temperature has intensively risen for the last three decades since 1990 with the warmest average temperature between 2001-2010, whereas the coldest average temperature has been observed between 1951-1960. In 2005-2009, the prevalence of intestinal infections per 10.000 population was 0.8 cases of salmonellosis, 11.2 cases of dysentery, 0.2 cases of diarrhea, and 39.0 instances of hepatitis A. Throughout 2015 and 2019, the prevalence of salmonellosis fell by 0.1 per 10.000 population, dysentery by 2.9, diarrhea by 0.1, and hepatitis A by 0.1. Conclusion A seasonal trend in intestinal infections was observed (p<0.001). Strong positive correlation was found between high temperature and some intestinal infections (hepatitis А, dysentery, salmonellosis) respectively.

Introduction: Soum and family health care centers (primary health care centers) provide public health services to reduce the negative effects of air pollution on health. In order to decrease the risk factors due to air pollution, it is crucial for health professionals, who are providing health care services to the public, to have the knowledge, attitude and practice to give an advice for residents on how to protect their health from air pollution. The “Air pollution and child health” report from WHO recommended that responsibility of health professionals must include knowing the latest information on air pollution, doing a research, spreading the knowledge, educating families and community and learning from them as well, proposing solutions, and finding a solution for policy developers and decision makers in other sectors. Therefore, we conducted this survey with purpose to determine the long-term effects of air pollution on population psychology and lifestyle and to evaluate the level of knowledge, attitude, and practice of health professionals on how to protect a health from air pollution. Goal: Evaluate the level of knowledge, attitude, and practice of health professionals on air pollution. Material and Methods: In 2019, this study conducted a cross-sectional design and collected quantitative and qualitative data. 88.4% of (n=532) health professionals from 48 secondary health care centers (SHCC) and 64 family health care centers (FHCC), which are agents that implement UNICEF project, in Bayanzurkh, Songinokhairkhan districts and Bayankhongor aimag were participated in the survey. Results: 97.4% of the participants agreed that air pollution has negative effects on human health. 99.5% of participants did not know the Mongolian standard for the acceptable level of air pollutant particulate matter (PM) and 73.1% of all participants did not receive information about air quality index. 82.1% of participants regularly give prevention advice with the purpose of protecting maternal and child health from air. The participants who worked for more than 21 years and who are older than 51 years old were more likely to give advice (p<0.05). As for the reasons for not giving advice about air pollution for protecting the maternal and child health, 29.2% of participants answered the service time is not enough, and 22.9% mentioned the lack of knowledge and information. 30.5% (162) of participants were not satisfied with their skill to give an advice on how to protect maternal and child health from air pollution. 86.8% of participants indicated that they did not receive proper training on air pollution and prevention from air pollution. Conclusion There is a need to provide training and information on how to protect maternal and child health from air pollution for health professionals.