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Occupational and residential differences in dairy and calcium intake in Mongolia

Tuul Nyambal ; Khulan Lkhamsuren ; Soninkhishig Tsolmon

Diagnosis.2025;114(3):51-59.

Although dairy is traditional in Mongolia, urbanization and lifestyle changes have produced uneven consumption patterns. We aimed to quantify dairy and calcium intakes across demographic groups and compare them with national recommendations. In a cross-sectional study, we enrolled 142 adults (workers 39, herders 38, students 41, retirees 24). A food frequency questionnaire (11 dairy groups; 250 items) was used to estimate daily intakes. Calcium and fiber were derived from international food composition tables. Group differences were assessed using the Mann–Whitney test, Kruskal– Wallis test with Dunn’s post hoc (Benjamini–Hochberg adjustment), and Spearman correlation. Dairy intake differed markedly by residence: rural participants had a 6.69-fold higher mean (95% CI 4.13–10.51) and a 3.38-fold higher median (95% CI 2.49–5.89) than urban participants (Wilcoxon p<0.001). By occupation, herders had the highest intakes (Kruskal–Wallis χ²(3)=37.4, p=3.8×10⁻⁷); Dunn’s tests showed herders > workers/ students/retirees (adjusted p<0.05 for most pairs). Estimated calcium intake averaged
~600 mg/day in urban participants (below the 800 mg/day target) and
~2700 mg/day in rural participants (approaching the tolerable upper level in some cases). Students had the lowest intakes, and women consumed less than men. A weak inverse association was observed between fiber and dairy intake. Dairy intake varied significantly across occupational subgroups (χ²(3)=37.4, p=3.8×10⁻⁷). Calcium inadequacy was more common in urban groups—especially students and women—whereas very high intakes were observed among rural herders.

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The results of glycemic control among patients undergoing insulin therapy

Enkhtuul B ; Batjargal B ; Narkhajid G ; Ankhlan B ; Anudari B ; Azzaya S ; Altaisaikhan Kh ; Oyunbold B

Diagnosis.2025;114(3):70-78.

Background: The discovery of insulin over a century ago significantly advanced the treatment of diabetes mellitus (DM). Effective glycemic control in patients on insulin therapy is influenced by a variety of factors. While developed countries have transitioned fully to insulin analogs, abandoning recombinant insulin, Mongolia lacks comprehensive research on how different insulin formulations influence glycemic control. This gap highlights the need for targeted improvements in therapy effectiveness and service quality. Materials and methods: The cross-sectional study was conducted at the Central Hospital of the Mongolian National University of Medical Sciences, including 183 diabetic patients aged 18-65 years. Participants were managed by endocrinologists and participated in a survey consisting of 44 questions alongside physical measurements. Data were 78 analyzed using SPSS version 25, with a significance threshold of p<0.05. Results: The study population had a mean age of 56.7 ± 11.0 years, with 55.2% (n=101) males. The mean duration of diagnosed DM was 12.6 ± 6.33 years, and the mean duration since the initiation of insulin therapy was 6.77 (1-24) years. The mean glycated hemoglobin (HbA1c) was 10.5%, with 87.4% of the participants categorized under poor glycemic control and only 5.5% maintaining optimal levels. Insulin usage was predominantly recombinant (60.7%), with analogue at 32.2%, and mixed regimens at 7.1%. Usage of insulin pens was reported by 43.2% of the participants. The daily insulin dosage ranged from 10 to 71 units, averaging 37.2 ± 13.7 units. Multivariate logistic regression analysis confirmed that inadequate knowledge about insulin therapy is an independent risk factor (OR; 95% CI = 1.48; 1.21 10.32). When adjusting for confounding factors, the average glycated hemoglobin (HbA1c) levels in the group with inadequate knowledge was significantly higher (11.8%) compared to the group with adequate knowledge, where it was significantly lower (10.2%). Conclusion The use of analog insulin among patients with type 2 diabetes undergoing insulin therapy is relatively low (32%), and glycemic control is poor (87%). Therefore, it is necessary to increase the use of analog insulin and improve glycemic control. Inadequate knowledge about insulin therapy negatively affects glycemic control in patients with type 2 diabetes (OR; 95% CI = 1.48; 1.21-10.32). Therefore, it is essential to enhance patients’ knowledge.

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Comparative assessment of renal function during long and short treatment regimens for multidrug-resistant tuberculosis

Uyanga Sh ; Gonchigsumlaa S ; Suvdmaa S ; Narantsatsral D

Diagnosis.2025;114(3):79-85.

Background: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, and approximately 5% of new cases are diagnosed with multidrug-resistant tuberculosis (MDR-TB). Since 2019, a shorter treatment regimen comprising 6–7 oral medications has been introduced for MDR-TB management. Although some of the newer drugs used in short regimens are associated with significant side effects, their potential nephrotoxicity has not been fully studied. Estimation of glomerular filtration rate (GFR) is a primary method for evaluating renal function. Objective: Evaluation changes in renal filtration function during the course of short and long treatment regimens for MDR-TB. Goals: To evaluate changes in GFR at different stages of treatment both regimens, and to compare the treatment outcomes between long and short regimens. Materials and Methods: A retrospective chart review was conducted among 103 patients diagnosed with MDR-TB and treated at the TB Dispensary of Bayangol District Health Center between 2017-2024. GFR was calculated using MDRD equation. Data statistically analyzed using SPSS 23.0. Results: Of the study participants, 71 (66.35%) received the long treatment regimen, while 32 (29.90%) received the short regimen. The mean age was 34.81 years for the long-regimen group and 39.59 years for the short-regimen group. In the long-regimen group, the mean eGFR (mL/ min/1.73m²) was 90.016 at the start, 75.82 at the mid-point, and 77.23 at the end of treatment. In the short-regimen group, the respective eGFR values were 68.47, 68.2, and 72.5. Additionally, 54.92% of participants in the long-regimen group received injectable treatment. Conclusion eGFR values were lower in the short treatment regimen group compared to the long regimen group. While the cure rate was higher in the short regimen group, the mortality rate was also significantly higher. Therefore, treatment success cannot be attributed solely to the type of regimen used.

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Comparison of the mean platelet volume (MPV) between different groups of T2DM patients

Baigalmaa E ; Bolorchimeg B ; Narantsatsral D

Diagnosis.2025;114(3):86-91.

Diabetes mellitus type 2 (T2DM) is a globally prevalent metabolic disorder associated with macrovascular and microvascular complications. The number of patients diagnosed with T2DM has exceeded 460 million worldwide and continues to rise. Insulin resistance is a primary pathogenic factor contributing to various systemic complications. Glycated hemoglobin (HbA1c) is a critical biomarker for monitoring glucose control in T2DM patients.
This study aimed to compare the mean platelet volume (MPV) between different groups of T2DM patients to assess the impact of disease progression and glycemic control. A total of 152 patients were categorized based on disease duration and glycemic control. The results showed that patients diagnosed for less than one year had a mean MPV of 9.8±1.0 fl, while those diagnosed for more than five years had a mean MPV of 9.0±0.95 fl. Comparative analysis with international studies indicated that MPV is significantly higher in diabetic patients than in non-diabetic individuals. Furthermore, patients with poor glycemic control exhibited a decrease in platelet count, aligning with findings in metabolic disease research.
The study findings suggest that both disease duration and glycemic control status influence platelet volume and count variations. Monitoring MPV can serve as an early indicator of diabetes-related complications. This research underscores the importance of continuous platelet parameter assessment in diabetic patients to predict and manage potential vascular complications effectively.

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Association between neutrophil-to-lymphocyte ratio and glycemic control in patients with type 2 diabetes mellitus

Bolorchimeg B ; Baigalmaa E ; Narantsatsral D

Diagnosis.2025;114(3):92-97.

This study examines the association between the neutrophil-to-lymphocyte ratio (NLR) and glycemic control in patients with type 2 diabetes mellitus (T2DM). A cross-sectional analysis was conducted on 109 randomly selected T2DM patients, stratified into three groups based on HbA1c levels: good control (14%, HbA1c <7%), moderate control (16%, HbA1c 7–8%), and poor control (70%, HbA1c >8%). Demographic and hematological parameters were analyzed, with NLR calculated from complete blood count data.
Results demonstrated a significant increase in NLR with deteriorating glycemic control (good: 1.8±0.8; moderate: 1.9±0.8; poor: 2.3±1.2; p=0.015). No significant age or gender differences were observed among groups. Patients with longer diabetes duration (>5 years) exhibited higher HbA1c and NLR levels, suggesting a link between chronic hyperglycemia and inflammation. The findings support NLR as a low-cost, accessible inflammatory marker for T2DM progression.
This study highlights NLR’s potential as a clinical biomarker for monitoring glycemic control and systemic inflammation in T2DM. Future research should investigate NLR’s predictive value for diabetes-related complications.

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Development of a normative model for quadruple markers in mongolian women during the second trimester

Azjargal Batdorj ; Urjindelger Tserensambuu ; Erdenetuya Ganbaatar ; Gerelmaa Nansal ; Munkhtsetseg Janlav

Diagnosis.2025;114(3):98-103.

Background: Down syndrome (DS) is a chromosomal disorder and a leading cause of intellectual and physical developmental delay in children. In Mongolia, there is no current national guideline recommending the use of the quadruple biomarker test for prenatal screening of DS. Instead, triple marker testing during the second trimester remains standard practice. However, the quadruple test offers higher specificity and sensitivity. Therefore, this study was conducted to determine gestational age specific normative values for the quadruple markers, adjusted for ethnic characteristics. Currently, multiple of the median (MoM) values for Mongolian women are calculated using reference medians derived from Caucasian populations. This study aims to establish population-specific reference values for Mongolian women. Objective: To determine the normative serum levels of second-trimester quadruple biomarkers — alpha-fetoprotein (AFP), free beta-subunit of human chorionic gonadotropin (β-hCG), unconjugated estriol (uE3), and inhibin A (Inh-A) — in Mongolian pregnant women. Methods: A retrospective study was conducted involving pregnant women between 14 and 21 weeks of gestation. The concentrations of each biomarker were analyzed using multivariable quantile regression models, adjusting for gestational age and maternal weight. Results: MoM values calculated using the Mongolian model differed significantly from those based on the Caucasian model (Wilcoxon signed-rank test; p < 0.001). Specifically, the concentrations and MoM values for AFP and uE3 were significantly lower, while those for β-hCG and Inh-A were notably higher in the Mongolian cohort. Conclusion The serum levels of β-hCG and Inh-A were significantly elevated in Mongolian pregnant women compared to the ethnicity-adjusted Caucasian reference model, highlighting the importance of using population-specific normative data for accurate prenatal screening.

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Evaluation of changes in human salivary amylase enzyme activity

Sarangerel G ; Odmaa T ; Buyankhuu T ; Oyun-Erdene P ; Odgerel Ch ; Tulgaa S ; Otgonjargal Ch ; Munkhtsetseg J ; Nandin-Erdene M

Diagnosis.2025;114(3):104-111.

Background: Saliva as a non-invasive biological sample can be a game-changer in early disease detection and health risk assessment. Objective: To examine the association between participants' dietary patterns and the activity of salivary amylase, along with serum amylase levels in humans. Materials and methods: This study was conducted at the research laboratory of the Department of Biochemistry, School of Biomedicine, MNUMS. A total of 30 students aged 19–22 years participated in the study. Saliva samples were collected three times at one-week intervals, and one blood sample was collected from each participant, alongside a dietary questionnaire. The activity of the amylase enzyme in both saliva and serum samples was determined using the iodine-starch method. Results: When evaluating the amylase enzyme activity based on participants' carbohydrate intake, the result was p > 0.05, indicating no statistically significant difference. Similarly, statistical analysis of the use of mouthwash and vitamin supplements also showed p > 0.05, which means these variables had no statistically significant effect on amylase activity. The correlation between salivary and serum amylase activity was found to be r = 0.365, indicating a weak positive correlation, but the difference was not statistically significant. Conclusion The intake of carbohydrates, vitamins, and mouthwash does not significantly affect the activity level of the salivary amylase enzyme, according to research findings. However, external factors such as stress and air pollution have been shown to exert a measurable influence on its activity. A comparative analysis of enzyme levels in saliva and blood using amylase as a representative marker revealed similar activity levels in both fluids. This suggests that saliva may serve as a viable non invasive sample for detecting various biomarkers and diagnosing diseases. The results underscore the potential of salivary components, particularly amylase, as valuable indicators in diagnostic applications.

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Impact of storage conditions on the antioxidant capacity of food plants

Munkhzul T ; Oyun-Erdene R ; Tulgaa S ; Nandin-Erdene M ; Buyankhuu T ; Munkhtsetseg J ; Odgerel Ch

Diagnosis.2025;114(3):112-118.

Background: Due to Mongolia’s harsh climate and seasonal limitations in fresh food supply, fruits, vegetables, and medicinal plants are often consumed in preserved forms. However, the preservation methods and storage conditions may significantly alter their antioxidant activity, which is crucial for mitigating oxidative stress and preventing chronic diseases. Objective: This study aimed to evaluate the antioxidant activity of 19 commonly consumed vegetables, berries, and dried medicinal plants under different storage conditions including fresh, cold storage (cellar), and frozen (-20°C). Methods: Samples were extracted in 80% methanol and tested using the DPPH radical scavenging assay. Absorbance was measured at 517 nm using a UV-Vis spectrophotometer. IC⁻⁻ values were calculated to compare antioxidant potency. Statistical differences were assessed using paired and unpaired t-tests with SPSS v27 (p<0.05) Results: Cold storage significantly reduced antioxidant activity in root vegetables, with IC⁻⁻ values increasing by 2.4 to 13.5 times (p<0.01), indicating diminished radical scavenging potencial. In contrast, frozen samples showed minimal change (p>0.05). Dried medicinal plants such as Rosa canina and Thymus serpyllum maintained strong activity, with IC⁻⁻<50 μg/mL. Conclusion Cellar storage leads to a notable decline in antioxidant capacity of common vegetables, while freezing is a more effective method for preservation. Dried medicinal herbs remain potent sources of antioxidants and may be recommended for year-round use in Mongolian diets.

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Comparison of international standards for double-lumen tube size selection with body height and sex in the mongolian population

Bilegmaa D ; Tsendmaa G ; Ijilmurun B ; Dolgorsuren E ; Norovsambuu E ; Otgontulga D ; Batzolboo G ; Bazardorj B ; Soyolzul B

Diagnosis.2025;115(4):5-10.

Background: Double-lumen tubes (DLTs) are widely used in thoracic surgery to achieve one-lung ventilation. International recommendations suggest tube size selection based on height and sex (39 41 Fr for males ≥160 cm, 35–37 Fr for females ≥150 cm). However, in Mongolian practice, applying these standards often leads to oversized tube use and related complications. Objective: To compare international standards for DLT size selection with body height and sex in Mongolian patients. 10 Methods: A cross-sectional study was conducted among patients who underwent esophagectomy with left-sided DLT placement at the National Cancer Center of Mongolia between 2018 and 2023. Data included age, sex, height, and DLT size. Statistical analysis was performed using chi-square and t-tests, with p < 0.05 considered significant. Results: A total of 211 patients were analyzed (58.8% male, 41.2% female). Among males, 170 cm patients received 37 Fr in 90% of cases (p < 0.001). Among females, 160 cm patients either 35 Fr or 37 Fr (p < 0.001). Tube size also differed significantly by sex (p < 0.001): 68.5% of males received 37 Fr, while 83.9% of females received 35 Fr. Conclusion In Mongolian clinical practice, DLT sizes are generally chosen smaller than those recommended by international standards, based on sex and height. All patients in the study achieved successful one-lung ventilation and favorable surgical conditions, indicating that international standards may not be fully applicable to the Mongolian population. Moreover, the study highlights that while DLT size selection correlates strongly with height in males, the association is weaker in females. Therefore, reliance solely on height and sex may be insufficient, and additional biometric and anatomical parameters should be considered for optimal tube selection

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Histology of the fetal lungs at the different gestational age

Talalaev A G ; Davidov I S ; Oyungerel S ; Tumenbayar B ; Javzandulam E ; Khulan B ; Altantsetseg B ; Mandakh-Erdene B ; Nyamsuren P ; Chimegsaikhan S

Diagnosis.2025;115(4):11-16.

The study is devoted to the morphological characteristics of the maturation of lung tissue structures in the fetal period. Fetal histology of the lungs presents the intrauterine development of lung tissue in four successive stages: pseudoglandular, canalicular, saccular and alveolar, each has specific morphological criteria. The following morphological features are predetermined: the development of alveolar epithelium, the ratio of mesenchyme towards the area in alveolar spaces, the degree of proliferation and location of vessels of the microcirculatory bed towards prealveolar partitions. During the fetal period the alveolar columnar epithelium is flattened and differentiates into alveolocytes type I lung histology with the demonstration of histological preparations of the lungs at different stages of intrauterine development. Keywords: fetal lungs, prealveolar structures, pseudoglandular stage, canalicular stage, alveolar stage, alveolar capillary membrane, immunohistochemical study. 16 and II, the area of the mesenchyme gradually decreases and by the birth of a full-term newborn kid it is present mainly in the thickness between the alveolar septa, microcirculation vessels, initially laying deep in the thickness of the mesenchymal tissue, gradually proliferate, approach the pre-alveolar epithelium, channeling it with the formation of alveolar capillary membranes. Air exchange in the lung tissue is mainly provided with two factors: the presence of second-order alveolocytes capable of producing surfactant, and a sufficient formation of alveolias well. This work summarizes the basics of fetal lung histology with the demonstration of histological preparations of the lungs at different stages of intrauterine development.

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