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: Non-small cell lung cancer (NSCLC) accounts for the majority of lung cancer cases and remains one of the leading causes of cancer-related mortality worldwide. Advances in molecular oncology have shown that mutations in the epidermal growth factor receptor (EGFR) gene play a crucial role in diagnosis and in guiding targeted therapy with tyrosine kinase inhibitors (TKIs). However, the detection of EGFR mutations is influenced by specimen type and quality, and differences may exist between bronchoscopic and surgical samples. In Mongolia, studies addressing this issue remain limited. Aim: To evaluate the feasibility of detecting EGFR gene mutations in bronchoscopic and surgically obtained tissue samples from patients with non-small cell lung cancer (NSCLC). Materials and Methods: This prospective comparative study included 35 formalin-fixed, paraffin-embedded (FFPE) tissue samples, of which 19 were bronchoscopic and 16 were surgical specimens. Tumor cell content was assessed histologically, and genomic DNA was extracted from each sample. EGFR mutation analysis was performed using the cobas® EGFR Mutation Test v2 with real-time PCR. Statistical analysis was conducted using SPSS version 26.0, and differences between groups were evaluated using Fisher’s exact test. Results: The mean age of the participants was 64.5±10.5 years; 74% were male and 26% were female. Significant differences in tumor cell content and DNA yield were observed between specimen types. Bronchoscopic samples showed a mean tumor cell content of 34%, with sufficient DNA yield in 73.6% of cases, whereas surgical specimens demonstrated a mean tumor cell content of 93%, with adequate DNA yield in all cases. EGFR mutations were detected in 31.3% of surgical specimens (including exon 19 deletion, L858R, and T790M mutations). In bronchoscopic samples, insufficient DNA yield in some cases precluded PCR analysis, thereby limiting mutation detection. A statistically significant difference in EGFR mutation detection rates was observed between the two groups (p=0.045). Conclusions 1. Bronchoscopic samples demonstrated lower tumor cell content and DNA yield, which may limit their suitability for molecular analysis in some cases. 2. Compared to bronchoscopic samples, surgically obtained specimens provided higher-quality tissue and demonstrated a greater feasibility for EGFR mutation detection.

Background: Cardiac surgery with cardiopulmonary bypass is grown rapidly in last years. The application of cardiopulmonary bypass using a heart-lung machine to perform open heart surgery is known to be associated with numerous pathophysiologic changes including injury of cellular components as erythrocyte, platelets, coagulopathy, and fibrinolysis. Objectives: Our study objective is to study on relation of open heart surgery phases and blood coagulation parameters. Materials and Methods: Blood samples from 49 patients (28 females and 21 males, aged 18- 63 years) who underwent open heart surgery with cardiopulnonary bypass (CPB) were collected before and at several time points during, after surgery and analyzed for coagulation parameters at Shastin Third Central Hospital. Results: To compare long continued cardiopulmonary bypass (over 1 h) surgery with less 1 h groups there prothrombin time was found 18.8±5.9 sec, international normalized ratio (INR) 2.09±0.9 sec prolonged (p<0.001) in 7 days after surgery. All coagulation parameters were decreased significantly (p<0.001) in during extracorporeal circulation and after 1 h declamping than preoperative level and reached near normal value in 48 h after surgery. Our results have referred to platelet counts reduction to about 53% in during surgery, 46.8% in 48 h after surgery of the preoperative level 237.4±57.1 with final return to normal levels 228.9±78.6 within 7 days. Conclusions
1. The cardiopulmonary bypass time and patient age in relation to open heart surgery type there were significant difference (p <0.01).
2. The coagulation parameters have revealed significant changes (p <0.01) in relation cardiopulmonary bypass time.
3. All coagulation parameters were decreased significantly (p<0.001) in during extracorporeal circulation and after 1 h decamping than preoperative level and reached near normal value in 48 h after surgery.
4. There was direct and less correlation between platelet level and CPB time (r=0.37, p<0.001).