Background Varicose veins, or chronic venous insufficiency, become visibly noticeable from the second stage when veins start appearing on the surface of the skin. Symptoms include severe itching, pain, swelling, and inflammation. Chronic venous insufficiency is a common condition in countries such as China, South Korea, Japan, Mongolia, and Kazakhstan. Diagnosis of varicose veins relies on blood flow studies, coagulation tests, contrast-enhanced magnetic resonance imaging (MRI), and Doppler ultrasound of the venous system. Patient B, a 43-year-old male, has experienced pain and swelling in the right lower limb vein for the past two years, especially when exposed to heat. Coagulation tests show PT and PT INR within normal range. Doppler ultrasound of the venous system revealed that the perforating vein is dilated to 0.45 cm and has valve insufficiency. In the deep veins, a width of 0.68 cm was measured, while superficial veins ranged between 0.46–0.59 cm. After receiving appropriate treatment from the Department of Fire Acupuncture, the patient’s symptoms have improved.

Background: Globally, gastric cancer accounts for 1,089,000 new cases and 769,000 deaths annually, ranking fifth in overall cancer incidence and third in cancer-related mortality. The aim to determine HER2 expression in patients with gastric cancer and to evaluate its correlation with clinical and immunological biomarkers, as well as the need for further laboratory diagnostics. Aim: To determine HER2 expression in patients with gastric cancer and to evaluate its association with clinical and immunological biomarkers, as well as the potential need for further laboratory diagnostics. Materials and Methods: A retrospective study was conducted using archived materials from patients with gastric cancer at the Clinical Pathology, Molecular Genetics, and Pathology Laboratories of the National Cancer Center of Mongolia, covering the period from 2019 to June 2025. HER2 protein expression in tumor tissue was assessed using immunohistochemistry (IHC), and chromogenic in situ hybridization (CISH-HER2) was employed to confirm gene amplification. Statistical analysis was performed using the Prisma-10 software. Results: In our study, among 210 cases of gastric cancer evaluated by IHC for HER2, 46 (21.9%) were HER2-positive and 164 (78.1%) were HER2-negative. When comparing patients with gastric cancer stratified into HER2 1+ (negative) and HER2 3+ (positive) groups, no statistically significant differences (p < 0.05) were observed in age, sex, tumor location (surgically resected tissue), morphology, or disease stage. However, a higher proportion of males was noted in the HER2 3+ group (80.9%), though this did not reach statistical significance (p = 0.0879). Significant associations were found with tumor markers. Elevated serum CA-72-4 (>5 ng/mL) was more frequent in the HER2 3+ group (58.8%; p = 0.0069). In contrast, elevated CA-19-9 (>35 U/mL) was more common in the HER2 1+ group (93.5%; p = 0.0117), and elevated CEA (>6.9 U/mL) was also predominant in the HER2 1+ group (90.6%; p = 0.002). These findings suggest that HER2 3+ status predominates in cases with elevated CA-72-4, which may influence diagnostic strategies and HER2-targeted therapies (e.g., trastuzumab). Conversely, elevated CA-19-9 and CEA were more associated with HER2 1+ status, indicating a need for further detailed investigation of these markers in relation to HER2 expression. In patients evaluated by CISH for HER2 expression, stratification into HER2-positive and HER2-negative groups revealed no statistically significant differences (p < 0.05) in age, sex, tumor location, morphology, stage, or serum tumor markers (CA-72-4, CA-19-9, CEA). This suggests that HER2 status (positive/negative) may be independent of these variables. Although HER2 positivity was higher in poorly differentiated tumors (48% vs. 30.6% negative; p=0.1414) and in stage IV disease (50% vs. 39.3% negative; p=0.2607), these differences were not statistically significant. Elevated serum markers (CA-72-4, CA-19-9, CEA) were observed but showed no significant correlation with HER2 status. Conclusion Determining the molecular profile of gastric cancer patients can significantly contribute to refining clinical diagnosis, developing treatment strategies, enhancing therapeutic outcomes, and improving patients’ quality of life.

We describe a minimally invasive endovascular approach to treat an arteriovenous fistula of the scalp. We performed a direct puncture of the lesion through the patient’s scalp for liquid embolic agent injection along with external compression of the superficial temporal artery to perform a “manual pressure-cooker technique.” The combination of these minimally invasive techniques resulted in an excellent clinical and radiographic outcome.

Introduction: Air pollution is one of the greatest environmental risk to health. Ambient air pollution accounts for an estimated 4.2 million deaths per year due to stroke, heart disease, lung cancer and chronic respiratory diseases. Approximately 46% of the population resides in Ulaanbaatar, and over half of the population living in ger (traditional yurt dwelling) areas consumes raw coal, which leads to an increase in ambient air pollutants. The Government of Mongolia took a series of actions to reduce air pollution; one was the ban on the consumption of raw coal beginning on 15 May 2019. The aim of this study is to describe the Ulaanbaatar air quality related to briquettes usage during cold seasons. Material and Methods: We used ecological research design in this study. Quantitative data about air quality of Ulaanbaatar city during the cold seasons (Oct, Nov, Dec, Jan, Feb, Mar, Apr) in 2018-2020 years were analyzed from Department of air quality. These 5 indicators such as sulfur dioxide, nitrogen dioxide, particles (PM_2.5, PM₁₀) and carbon monoxide were selected for statistical analysis. The SPSS-20 software was used to analyze the data. Ethics: The methodology was approved by the Medical Ethics Sub-Committee of the Ach medical university on 5^th of February, 2021. Results: The average sulfur dioxide, nitrogen dioxide concentrations in the air have increased in October 2019–April 2020 compared to the previous five years. But carbon oxide, particular matter concentrations have decreased in the selected years. Sulfur dioxide (p <0.0001), nitrogen dioxide (p =0.001), PM₁₀(p <0.0001), and PM_2.5 (p <0.0001) are differentiated before and after the use of improved fuels by Wilcoxon signed rank test. However, the CO content did not differ from that of the briquette’s consumption (p =0.412). Conclusions During the cold seasons, the concentration of sulfur dioxide and nitrogen dioxide has increased in air of Ulaanbaatar after used briquettes, while the concentration of particulate matter has decreased during the cold seasons.

Clinical characteristics differences and risk factors of coronavirus disease and influenza in children 0-18 years Background: In worldwide, 176190 children infected with SARS-CoV-2 during April of 2020. According 01/09/2021, 46019 children had diagnosed with COVID-19 in Mongolia, were 19.5% of all cases. During COVID-19 infection, respiratory and digestive symptoms were commonly presented in children. Although the symptoms of coronavirus disease in children and adults are similar, in general, it was relatively mildly than adults, but from clinical observations reported that the infection occurs more severely in children and leads to death. During the coronavirus pandemic, it has been reported that children have Kawasaki syndrome, cardiac myopathy, coronary artery changes, and digestive system problems. Cardiac dysfunction in children may have recovered without sequelae, and further long-term follow-up studies are necessary. We aimed study clinical characteristics differences and risk factors of coronavirus disease and influenza in children 0-18 years. Materials and methods: The study was conducted Children hospital of NCMCH from October 01, 2021 to April 01, 2022, participated 594 inpatients with COVID-19 and influenza, and studied clinical characteristics, laboratory and functional diagnostic changes, treatment, and complications of the coronavirus disease and influenza. Results: The study included 450 children aged 0-18 years with confirmed COVID-19 infection and 144 children with influenza. In social-demographic indicators, the mean age of children is 4±4.8 years, and 58.6% are male. Children age group included 0-4 ages, 5-9 ages, 10-15 ages and over 15 ages (62.4%, 17.5%, 16.2%, and 3.7%), respectively. As for influenza, 39.7% were children aged 0-9. In 8 cases, they received the COVID-19 vaccine but became ill with COVID-19. As for the variants of COVID-19 infection, 231(41.8%) alpha, 219(48.0%) delta, and 144(24.2%) influenza according to the wave period and clinical differentiation. In severity of diseases, 2(0.4%) were mild, 312(69.3%) were moderate, 117(26.0%) were severe, and 17(3.8%) were critical severe. There is a statistically significant difference in the severity of the disease between COVID-19 and influenza. 1 death (0.4%) occurred in cases of COVID-19. The mean days of inpatients with COVID-19 was 12.4±5.5 and mean days of inpatients with influenza 8.6±3.64. When assess signs of children, fever, cough and food aversion were main signs among both group of alpha and delta varientin COVID-19. Specifically, 67.3% had fever, 63.3% cough, 16.4% runny nose, 8% chest pain, 10.2% headache, 15.5% fatigue, and 0.9% decreased sense of taste and smell. There is a statistically significant difference (p<0.000) in the symptoms of cough, chest pain, general toxication symptoms and decreased sense of taste and smell in the case of COVID-19 and influenza. During influenza, symptoms of chest tightness and respiratory distress were observed in 10 (7.4%) children during severe illness. 0.5% of all cases of COVID-19 with sinus arrhythmia, and atrioventricular block were detected 0.9% of all cases by electrocardiogram analysis. When studying the underlying medical conditions of children in relation to the complications of COVID-19 and influenza, children diagnosed with heart defects, malnutrition, weakness, anemia, cerebral palsy, and other chronic diseases have a greater impact on the severity of the disease of COVID-19 than those with influenza. In the study of the factors affecting the severity of the COVID-19 infection, the child's age and gender did not have an effect, while the presence of a heart defect in the child increased the risk of complications by 5 times (p<0.001). Conclusions: Among 0-4 aged children with COVID-19 are occurred more hospitalization, brightly presented symptoms in children with chronic diseases, are being more severe and hospitalization days are more than in children with influenza. Symptoms of fever, cough, and runny nose are more common in children during flu and influenza, while headache, abdominal pain, dehydration, and reduced sense of taste and smell are significantly more common in the case of COVID-19. On the other hand, symptoms of chest pain, weakness, and fatigue were found in the 2 groups. The comorbidities (congenital cardiac anomalies, malnutrition, weakness, anemia, cerebral palsy, and other chronic diseases) are being risk factors for the severity of coronavirus disease.

Early detection of bronchial asthma in children and establishment of a national continuous monitoring system Introduction: Bronchial asthma - a chronic inflammatory disease with recurrent allergic reactions characterized by increased sensitivity of the bronchi to various factors, swelling of the bronchial mucosa, excessive mucus secretion, and narrowing of the airways due to severe muscle contraction. Early detection of bronchial asthma in childhood, its prevalence, and the establishment of a continuous monitoring system to assess the effectiveness of follow-up treatment Materials and methods: It is mild in children, but is ready to be severe. If left untreated for a long time, the structure of the bronchi changes irreversibly and becomes ineffective. There are cases of death due to risk factors for irritability and asthma. In the first objective of the study, the National Center for Maternal and Child Health (NCMCH) Children's Counseling Polyclinic, Respiratory Pathology Department, and the Children's Department of the General Hospital of 21 aimags and 9 districts were used to determine the prevalence of Acute respiratory infections, implemented outpatient (2019-2021). Within the scope of objectives 2 and 3 of the study, a self-controlled case-control study model was used to assess the diagnosis of asthma in the case group based on the GINA-2018 guideline evaluation and clinical and laboratory tests based on the GINA protocol treatment. The parameters were taken, the pre-treatment parameters were recorded and compared in the control group, and the results were calculated. Results: When the prevalence was determined by the Acute respiratory infections level, there were 11 cases per 1,000 children. 80.8% of cases of asthma were caused by asthma 1-5 times a year, and the majority or 96.5% were aged 0-9 years. Allergies include plant (42.9%), food (25.4%), and pet (14.3%) allergies under the age of 4, all types of allergies between the ages of 5-14, and plant allergies 15-19 years, (9%), food (21.4%), pet (14.3%), environmental moisture and mold allergies (14.3%). Among the 89 children treated according to GINA guidelines, 64.0% used spices or allergenic foods, 13.5% used antibiotics, 6.7% used paracetamol, and 13.5% used other drugs. Children with asthma were assessed according to GINA guidelines and monitored and treated for 1 year (0.0001), the number of cases of asthma (p = 0.035) and the number of people receiving emergency care (p = 0.042) decreased statistically. There was a statistically significant difference of 2%, nocturnal cough decreased by 15.2%, and whooping cough decreased by 1.4%. Conclusions: The prevalence of asthma was 11 cases per 1,000 children. The main causes of allergies are plants, food and pets. The number of coughs, hospitalizations and emergency room visits decreased with GINA treatment.

The result of endovascular surgical treatment of congenital heart disease Background: Over the last 10 years the advances in catheter based interventions for congenital heart disease(CHD) include new procedures, devices and almost 25% of all CHD are now can be treated by endovascular surgery. The purpose of this report was to evaluate the outcome and result of endovascular surgeries for congenital heart disease. Materials and methods: The study included all cases of endovascular surgeries at the National Center for Maternal and Child Health the period of 2014-2019. Results: Total 631 cases had intervention procedures and 377 (59.7%) cases had endovascular surgeries for CHD. 268 patients had patent ductus arteriosus device closure successfully while 57 had pulmonary artery valvuloplasty using balloons. Also 76 patients had device closure of atrial septal defect and 4 patients had device closure of ventricular septal defect using new multifunctional occluder. Another 20 patients had severe coarctation of aorta and had balloon dilatation and stenting as a life saving procedure. Conclusions: Endovascular surgery for CHD is a safe and effective alternative to open heart surgery.

Result the subtypes and effectiveness of functional endoscopic sinus surgery(FESS) using a microdebrider Introduction: Chronic rhinitis in children has been on the rise in recent years, and polyps account for the majority of benign nasal cancers in children. Surgery is necessary when drug treatment is ineffective. We use pediatric rhinoplasty. Aimed at calculating the subtypes and effectiveness of Functional endoscopic sinus surgery(FESS) using a microdebrider. Material and methods: The survey was conducted between March and April 2020, based on the Otolaryngology Surgery Department of the National Center for Maternal and Child Health, using the cross-section of analytical design under Objectives 1 and 2 and the longitudinal design under Objective 3. Under Objectives 1 and 2, participants' information was collected from a pre-prepared questionnaire from their medical history. The questionnaire has four chapters that provide general information about the patient, clinical signs, surgical structure, and biopsy results. The pain was assessed by the “Sino-Nasal Outcome Test (SNOT-20)”. A total of 98 patients were included in the statistical analysis of the survey results using the STATA 15.0 program, and the results of the surgery were evaluated by 20 patients. Results: In children with chronic rhinitis, the SNOT20 test showed a statistically significant difference of 1.6 ± 0.6 before surgery and an average of 0.51 ± 0.11 after surgery. Conclusion: In chronic rhinitis, FESS with microdebrider surgery is an effective treatment for children.

Introduction The use of phytochemical preparations is being promoted an supported worldwide. In order to investigate and confirm the usage of phytochemical preparations that are widely used in the traditional medicine, there is an urgent need to complete a chemical, phytochemical and clinical study for those medicinal preparations. Goal To investigate the effects of “Antitoxic preparation” on the test animal with previously developed acute hepatotoxic infection by LPS. Materials and Methods A pathology model of the acute liver infection was developed on a total of 50 Vister rats, weighing between 200 and 250 gr. The test animals were categorized info five five further groups, e.g. healthy, control, comparison and administered with 50 mg/kg and 100 mg/kg of “Antitoxic preparation”. The preparation for each group was individually and orally administeredfor a period of ten days. On day 11, 2nd, 3rd, 4th and 5th groups were administered 5 μg of LPS and 300 mg/kg of GaIN calculated in 2 ml of physiogial solution was injected in the abdomed of the test animal. After 8 hours, AST, ALT, cholesterol, triglycerides, level of MDA, cytokine levels such as TNF-α, IL-1β, IL-6, IL-10 contained in the blood plasma of test animals were analysed. Results A comparison between measurement of “Antitoxic preparation” group and control group has indicated that the AST was 24.9-30.8%, ALT 23.8-27.6%, Poenzyme activation was reduced by 29.1-32.6%, of cholesterol by 13.2-19.9%, of tryglyceride 23.4-30.5%, MDA in plasma 8.8-20.9%, MDA in urine 11.3- 22.9%, also reduction of TNF-α in plasma by 17.5-27.3% and IL-1β17.7-19.8% respectively. Also, it was determined that the cytokines activating the acute liver infection (TNF-α, IL-1β, IL-10) were impacted after administering the preparation and infection process was suppressed. Conclusions: 1. The pathological model for chronic toxic liver infection developed on the test animal indicated that “Antitoxic preparation” had a reducing effect on cholesterol, tryglycerides, inhibitory effect on activation of fat oxidation, choleretic, antioxidant, reducing effect on ALT, AST activation, reducing the destruction of liver cells and followed by hepatoprotective action. 2. “Antitoxic preparation” was effective in impacting the cytokines (TNF-α, IL-1β, IL-10) that activate the acute liver infection and also suppressing effect on infection process.

Antinociceptive effect of Deva-5 (Gentiana decumbens L., Terminalia Chebula Retz., Polygonium bistorta L., Momordica cochinchinensis Lour., Chiazospermum erectum Bernh) used in traditional medicine for treatment of infectious heat disease was examined in both chemically- and temperature-induced pain models of mice. Deva-5 administered orally at 100 and 200 mg/kg significantly reduced the writhings induced by acetic acid from control values of 37.7±6.7 (N = 6) to 24.5±3.9 (N = 6) and 18,8±2,8 (N = 6), respectively (p<0.05). When administered at 100 and 200 mg/kg, Deva-5 reduced the paw licking time for the second phase of the formalin test from the control value of 92.6±12.9 s (N = 6) to 69.8±5.7 s (N = 6) and 70.1±11.7 s (N = 6), respectively (p<0.05). Deva-5 had no significant effect on the first phase of the formalin test. As evaluated by the tail immersion test, Deva-5 at doses of 100 and 200 mg/kg, showed no analgesic activity. These results show that Deva-5 has antinociceptive activity and suggest that this effect is probably an indirect anti-inflammatory effect, which does not involve the central nervous system.