Background: Although isotretinoin has been confirmed by clinical and experimental studies to be a teratogenic agent that causes fetal developmental abnormalities, its effects on placental development and placental-like extra-embryonic vascularization have not been sufficiently studied. The vascularization of the chorioallantoic membrane is structurally and functionally similar to mammalian placental vascularization, which provided the rationale for conducting this study. Aim: To study the effect of isotretinoin on chorioallantoic membrane vascularization using an in ovo chick embryo model. Materials and Methods: A comparative experimental control study was conducted using fertilized eggs of the same developmental age from Gallus gallus domesticus. At the HH10 embryonic stage, the control group received avian saline, while the experimental group was administered isotretinoin (5 µg/100 µL). Vascularization of the yolk sac and chorioallantoic membrane was evaluated at the macro- and tissue levels at 72 and 120 hours of embryonic development. Vessel branching order, vascular density, and capillary number were compared, and statistical analysis was performed using the Mann-Whitney U test. Result: In the control group, vascularization progressed actively, with abundant formation of third and fourth order vessels, resulting in a dense reticular network. In contrast, the isotretinoin treated group showed delayed vessel branching, a marked reduction in the number of third- and fourth-order vessels, and an overall decrease in vascular density of 40–60%. Histological analysis revealed thinning of the chorioallantoic membrane, loss of tissue layers, and thinning of vascular walls, and the number of capillaries was significantly lower than in the control group (p<0.01). In addition, the development of chorioallantoic membrane vascularization in chick embryos was found to be structurally and developmentally similar to mammalian placental vascularization. Conclusion Isotretinoin was shown to inhibit the development of the chorioallantoic membrane and markedly reduce vascularization and differentiation in an in ovo chick embryo model.

Background: Pulmonary alveolar proteinosis (PAP) is a rare lung disorder characterized by the accumulation of surfactant within the alveoli, leading to impaired gas exchange and respiratory insufficiency. Although the disease is uncommon, it significantly affects patients’ quality of life and requires specific diagnostic and therapeutic approaches. Whole lung lavage (WLL) is considered the standard treatment; however, it has not been widely implemented in Mongolia. We report the first successful case of WLL performed for PAP in Mongolia. Case Presentation: A 56-year-old male presented with dyspnea. Chest computed tomography demonstrated a bilateral “crazy paving” pattern. Bronchoalveolar lavage fluid was positive for periodic acid–Schiff (PAS) staining, and anti–GM-CSF antibodies were detected, confirming the diagnosis of PAP. WLL was performed under general anesthesia using a double-lumen endotracheal tube with bronchoscopic guidance. One lung was ventilated with 100% oxygen while the contralateral lung was sequentially lavaged with 800–1000 mL of warm (37°C) saline per cycle until the effluent became clear. A total of approximately 20 liters of saline was used. Result: The procedure was completed successfully without complications. Following treatment, the patient showed marked clinical improvement with reduced dyspnea and increased exercise tolerance. Oxygen saturation improved from 88% to 93%, and spirometric parameters (FVC, FEV₁) demonstrated improvement. Chest imaging revealed a reduction in pulmonary opacities. Conclusion This case demonstrates the successful implementation of whole lung lavage (WLL) in Mongolia and highlights its importance in improving the diagnostic and therapeutic capacity for rare pulmonary diseases such as pulmonary alveolar proteinosis. The procedure resulted in significant improvement in clinical, functional, and radiological parameters, consistent with findings from international studies. Early diagnosis of PAP and the adoption of standardized protocols in accordance with international guidelines are essential to optimize treatment outcomes and enhance patients’ quality of life.

Background: Acute-on-chronic liver failure (ACLF) is a clinical syndrome seen in patients with decompensated cirrhosis, marked by organ failure and high risk of mortality. In Mongolia, liver cirrhosis and chronic liver disease are among the leading causes of death, with mortality rates four times higher than the global average. Despite this, full data on ACLF in the country remains insufficient. Aim : This study aims to determine the prevalence, etiology, and outcomes of ACLF in patients admitted with acute de compensated liver cirrhosis. Materials and Methods : This retrospective registry study analyzed all hospital admissions at the Mongolia-Japan Hos pital from Jan 1, 2022, to Dec 31, 2024. Definitions from the European Association for the Study of the Liver (EASL) and the Chronic Liver Failure Consortium (EASL-CLIF) were used. Organ failure was assessed using the adapted Chronic Liver Failure-Organ Failure (CLIF-OF) score. Patients with malignancies meeting the Milan criteria were excluded. Results : A total of 83 patients were included, of whom 41% (n=34) met the ACLF criteria. Among ACLF patients, 58.8% were male, with a median age of 52 years. The most common underlying cause of cirrhosis was viral hepatitis B and D. The main triggers for ACLF were infection (50%) and alcoholic hepatitis (20.6%). ACLF grades were as follows: 29.4% for Grade 1, 29.4% for Grade 2, and 41.1% for Grade 3. The overall in-hospital mortality rate was 28.9%, but it was significantly higher in the ACLF group (75%) compared to the non-ACLF group (25%). Mortality rates increased with ACLF grade: 20% for Grade 1, 50% for Grade 2, and 78.6% for Grade 3 (p < 0.00001). Conclusion 1. The prevalence of acute-on-chronic liver failure (ACLF) among patients with decompensated cirrhosis was 41%, with a notably high in-hospital mortality rate of 52.9%. 2. Bacterial infections, rather than hepatic insults, were the leading precipitating factors for ACLF, accounting for 50% of the cases.

Background: A rare angioproliferative condition of the larynx, Kaposhi sarcoma typically affects the skin. Immunosuppressive treatment following organ transplantation and human immunodeficiency virus infection are the causes. Every type of Kaposi sarcoma has human herpesvirus-8. Laryngeal kaposi sarcoma is uncommon in immunocompromised patients; since its initial identification in 1965, 18 cases have been documented globally. A CO2 laser-assisted laryngeal microsurgery is performed through the mouth cavity to remove tumor when kaposi sarcoma of the larynx obstructs the airway. Case report: A 77-year-old woman complained of hoarseness, dry mouth, odynophagia, and dysphagia three months prior when she arrived at the Mongolian-Japan Hospital. Two years ago, she acquired hard, sensitive lumps that were palpable on her right arm, left ankle, and right thigh. At that time, she was diagnosed with Kaposiform hemangiodermatitis and treated at the National Center for Dermatology. HIV test results were negative. Immunohistochemistry: CD31 +/-, CD34 /+/. Using flexible nasopharyngeal endoscopy to get the diagnosis: There was a mass that was about 1.5–2–5 cm in diameter, bluish in color, smooth and movable, and spongy and vascular on the larynx, on the nasopharynx, behind the palatine tonsills, and supraglottic. Surgery: Through the use of Kleinsasser laryngoscopy and a 0-degree endoscope, pathological tissues were extracted under general anesthesia using a laryngeal microsurgical instrument and a laparoscopic bipolar coagulator. The tissues were then sent for histological evaluation, which revealed Kaposi sarcoma, sarcoma grade 1. Results of treatment Pain decreased and quality of life increased following surgery. Upon nasopharyngeal endoscopy, the vocal cord mobility was normal and the surgical incision was clean. Conclusion: Kaposi sarcoma is an extremely uncommon illness. A lower quality of life and further issues can be avoided with an early diagnosis and suitable therapy. It also needs to be continuously monitored because it is a potentially repeatable disease.

Background: Sepsis is a life-threatening condition caused by a dysregulated host response to infection, leading to tissue and organ damage. Globally, over 19 million people are affected by sepsis each year, with approximately 6 million deaths, making it the third leading cause of mortality (25%). Identifying factors influencing patient outcomes in sepsis and septic shock is therefore of critical importance. Aim: To investigate the factors associated with outcomes in patients admitted to the Intensive Care Unit (ICU) of the Mongolia-Japan Hospital (MJH) with diagnoses of sepsis and septic shock. Materials and Methods: A retrospective study was conducted on patients admitted to the ICU of MJH with sepsis or septic shock during 2023–2024. We analyzed patient data including pre-existing comorbidities, number of infection foci, presence of multiple organ dysfunction, and initial laboratory parameters to determine associations with patient outcomes. Results: Among 430 patients admitted to the ICU during the study period, 136 (31.6%) were diagnosed with sepsis or septic shock. Of these, 94 patients (69.1%) recovered and 42 (30.8%) died. No significant differences were found between survivor and non-survivor groups in terms of comorbidities, white blood cell count, neutrophils, lymphocytes, mature granulocytes, C-reactive protein, or creatinine levels. However, multiple organ dysfunction (p<0.000), infection foci ≥2 (p<0.001), lactate ≥2 mmol/L (p<0.002), and platelet abnormalities (p<0.014) were significantly associated with mortality. The most common sources of infection were intra-abdominal infections (25.7%), pneumonia (25%), skin and soft tissue infections (22.5%), urinary tract infections (16.1%), abscesses (7.35%), tuberculosis (2.2%), and catheter-related bloodstream or neurologically-origin infections (0.73%). Conclusion Intra-abdominal infections and respiratory tract infections were the most common sources of sepsis among ICU patients. Multiple organ dysfunction, having two or more infection foci, elevated lactate levels (≥2 mmol/L), and platelet abnormalities were found to significantly increase the risk of mortality in patients with sepsis and septic shock.