Background: Multidrug-induced long QT syndrome is a serious heart rhythm disorder where multiple medications prolong the QT interval on an electrocardiogram, increasing the risk of a potentially fatal arrhythmia. Long QT syndrome is characterised by heart rate corrected QT interval prolongation and life-threatening arrhythmias, such as polymorphic ventricular tachycardia, Torsades de pointes leading to syncope and sudden death. Case: 21-year-old woman required resuscitation from an apparent cardiac arrest that had occurred after status epilepticus. The woman was diagnosed with long QT syndrome, cardiac channelopathy. She had a long history of syncope, seizure and palpitations. Family history was non-contributory. Home medications included levetiracetam 500 milligrams orally twice and fluoxetine 20 milligrams orally once a day which the patient reported non-compliance with. Levetiracetam is a widely used anti-epileptic medication secondary to its favorable safety profile. To our knowledge, there are few other case reports documenting torsades de pointes after levetiracetam administration, and specifically our case report will be the first documenting cardiac arrest after multidrug administration. Long QT syndrome is not often included in the differential diagnosis of epileptic and non-epileptic seizures. Early recognition of the syndrome is very important because of prognostic and therapeutic consequences. Conclusion Although no hereditary cause was confirmed, this case represents Torsades de Pointes triggered by multiple medications—including long-term low-dose carbamazepine, fluoxetine, diazepam, and high-dose levetiracetam—on a background of probable Romano–Ward syndrome or predisposition to QT prolongation. The arrhythmia progressed to cardiac arrest, requiring ICD implantation.

Introduction: In Mongolia, data on the etiology and risk factors of cardioembolic stroke (CES) is scarce and few clinical studies have been performed to date. Timely identification and control of cardiovascular risk factors are priority objectives for adequate primary and secondary prevention of CES. Goal: The goal of this study was to describe risk factors for CES in our setting. Results: The case-control study enrolled a total of 525 subjects. CES was detected in 63 (35.7%) out of 176 (33.5%) ischemic stroke patients with a predominance in age group of 60-69 and men (33%). The main risk factor of CES was non-valvular atrial fibrillation (AF). AF especially paroxysmal AF increased the risk of CES by 4.6 times (p=<0.0001, OR 4.6, 95% CI 1.4-44.6). The second main cerebrovascular risk factors were hypertension and dyslipidemia. Conclusion CES accounted for 1/3 of ischemic stroke. The commonest underlying medical conditions were non-valvular atrial fibrillation, hypertension, dyslipidemia, alcohol consumption and obesity. Hence, all patients with hypertension and non-valvular AF should be meticulously screened for prevention of CES.

Introduction : Attention-Deficit/Hyperactivity Disorder (ADHD) is a disorder that occurs during childhood development, which presents with signs of reduced attention and hyperactivity [1]. Necessary nutrients, such as trace minerals, including manganese, iron, zinc, iodine, selenium, copper, and chromium, are associated with changes in neuronal function that can lead to adverse effects on behavior and learning [2]. In addition to these, social, emotional, behavioral problems, and cognitive impairments such as executive dysfunctions are common in ADHD [3]. Goal: To evaluate the hair elements and intelligence quotient in children with ADHD. Materials and Methods: This is a cross-sectional comparative study conducted at elementary schools of Ulaanbaatar city. All in all 60 children of both genders aged between 7-12 years old were included in the study. Children were divided into two groups as children with ADHD group and a control group. Each group had 30 children. For assessment of emotional Intelligence EQ-i:YV - Emotional Quotient Inventory: Youth Version (Bar-On & Parker, 2000; it ad. Sannio Fancello, & Cianchetti, 2012) was used. Scalp hair samples were randomly collected from approximately ten sites around both sides of posterior parietal eminences and external occipital protuberance. Samples were then packed at room temperature and submitted for laboratory analysis. The study was approved by the Research Ethics Committee of Mongolian National University of Medical Sciences (Reg. No. 2018/Д-10). Results: The IQ of children with ADHD group were 85.03±16.86 p<.0001 and the IQ of control group =108.9±21.22, p<.0001. We identified hair minerals such as Mg, Zn, Pb, Se, Mn. We have then compared to each group and normal ranges of ages. ADHD group and the control group had Pb concentration that was slightly higher and inversely Mg concentration was slightly lower (r=-0.502, p=.005). Concentration of Pb, IQ were directly opposite (r=-0.38, p=.03). Conclusion
1. IQ was lower in the ADHD group compared to control group 85.03±16.86 p<.0001, monitored group 108.9±21.22, p<.0001.
2. The group with ADHD had lower Mg, Zn, and higher Pb, Se, Mn (p<.0001). The IQ decreased when there was increased Pb and decreased Mg.

BACKGROUND. Over 5% of the world’s population or 466 million people have disabling hearing loss (432 million adults and 34 million children). Profound sensorineural hearing loss and deafness can be treated successfully with a cochlear implant. A cochlear implant (CI) stimulates the auditory nerve, bypassing the defective cochlea, and provides auditory information to the developing brain, thus improving oral language. Children, who receive an early diagnosis of deafness and proper speech rehabilitation, and undergo early cochlear implantation, are able to develop auditory and linguistic skills at par with their hearing peers. METHOD. 6 deaf patients who underwent unilateral Cochlear Implantation at the NCMCH from January 2017 to June 2018 were included in the study. Participants were divided into 3 groups on the basis of age at which participants underwent implantation. RESULTS. Pre-op average MAIS was 1,6/40, Category of Auditory Performance (CAP) - 0,77 and SIR - 0,7/5 in all implanted age groups. Score increased over time to attain average score MAIS -29.6/40, CAP- 3.3/7 SIR-2.7/5 in all implanted groups at one year after implantation. CONCLUSION. There is a need for more research on patient age and gender composition, and outcomes of cochlear implantation and hearing devices in this study population. A robust set of study measures would provide statistical significance. Parent-child relationships affect hearing and speech therapy results, so there’s a need to improve parents’ knowledge regarding these therapies.

Introduction: Biliary Atresia is a fibroobliterativedisorder of the intra andextrahepatic bile ducts in infancy, which isgoing progressively cholestatic liver disease.The failed Kasaiportoenterostomy requiresliver transplantation. The goal of this studyis to show the outcome of Kasai operation,recent improvement and correlation the datato overseas.Methods and Materials: This study wasconducted in the department of generalsurgery of National Center for Maternal andChild Health of Mongolia between 2010 and2016 on a total of 66 infancies with biliaryatresia.Results: Patient diagnosed with biliaryatresia, which performed Kasai operationwithin first 2 months the outcome is verygood early and late post-operation period.There were 3 patients with 10 year survival, 4patients with 5-10 year and 28 patients with5 year survival after Kasai operation. The mostcomport age for liver transplantation is 1 yearlater after Kasai operation in Mongolia. Livertransplantation programme is necessary forMongolian pediatric surgery, and we thoughtour team was assembled.Conclusion: The children with biliary atresiaperform the Kasai operation within 2 monthsthe outcome is very good. Children with biliaryatresia often experience long wait times fortransplant unless exception points are grantedto reflect severity of disease.In Mongolia livertransplantation done in 2 child.