Background: Megaloblastic anemia is a hyperchromic macrocytic anemia caused by impaired DNA synthesis and delayed cell division, most commonly resulting from deficiencies of cobalamin and folic acid. Vitamin B12 is obtained from animal-derived foods such as meat, fish, eggs, and dairy products. In the stomach, it is released from dietary proteins by gastric acid and subsequently binds to an intrinsic factor, after which it is absorbed in the distal ileum. Therefore, vitamin B12 deficiency may occur following gastric or intestinal resection surgery. Another common cause of vitamin B12 deficiency is pernicious anemia, which results from autoimmune atrophic gastritis leading to decreased secretion of intrinsic factor. Vitamin B12 deficiency is most frequently observed in individuals over 60 years of age, and its clinical manifestations vary depending on the severity of deficiency. Patients with mild to moderate deficiency commonly present with fatigue, general symptoms of anemia, glossitis, and neurological disturbances. In cases of severe deficiency, profound hematological abnormalities, severe neurological manifestations, and cardiac involvement such as cardiomyopathy may be observed. In this report, we present a clinical case of a 46-year-old male who developed severe vitamin B12 deficiency anemia following total gastrectomy, complicated by anemia-induced mild hypokinesia of the anterior and inferior walls of the heart. Conclusion If vitamin B12 deficiency–related anemia is accurately diagnosed, appropriately treated, prevented, and monitored starting from the primary health care level, it can have a positive impact on patients’ quality of life. Given that this condition may present with diverse clinical manifestations, a multidisciplinary team approach involving specialists in hematology, neurology, psychiatry, gastroenterology, cardiology, and nutrition enables early identification and prevention of potential complications, thereby improving overall clinical outcomes.

Background: Sjögren’s syndrome is a chronic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands, particularly the lacrimal and salivary glands, as a result of genetic and environmental factors, and it is mainly manifested by mucosal dryness. Sjögren’s syndrome is a rare disorder with a prevalence of approximately 6 cases per 1,000 population and shows a marked female predominance. It is most commonly diagnosed between the ages of 40 and 60 years. Anemia is observed in about 70% of patients diagnosed with Sjögren’s syndrome; however, autoimmune hemolytic anemia occurs in only approximately 3% of cases. In this report, we present a rare case of Sjögren’s syndrome that manifested with warm autoimmune hemolytic anemia. Conclusion In cases of autoimmune hemolytic anemia of unknown etiology, it is crucial to investigate the underlying causes leading to hemolysis in order to establish the differential diagnosis and to confirm or exclude the condition. Sjögren’s syndrome typically presents initially with sicca symptoms, with chronic anemia developing during the course of the disease and its treatment. In contrast, in our case, persistent manifestations of autoimmune hemolytic anemia over a prolonged period represented the initial clinical presentation that led to the diagnosis of Sjögren’s syndrome. Immunological markers play a key role in the diagnosis of this syndrome, as they are essential for early detection of Sjögren’s syndrome, timely diagnostic confirmation, monitoring of disease progression, and adjustment of therapeutic dosing.

Background: Cancer is not only a physiological disease but also a complex condition that profoundly affects an individual’s psychological well-being and social relationships. Misconceptions about cancer within the public, including its association with death and the tendency to attribute blame to patients as being “personally responsible,” contribute to the development of social stigma among cancer survivors. This stigma negatively impacts patients’ engagement in treatment and their quality of life, highlighting the need to assess societal attitudes based on survivors’ lived experiences. Aim: To examine the everyday lived experiences of cancer survivors, measure perceived social stigma, and identify psychological challenges as well as sources of support. Materials and Methods: A mixed-methods design was employed. In the quantitative component, the Cancer Stigma Scale (CASS) and the Attitudes Toward Cancer Questionnaire (ATCQ) were translated and their content validity was evaluated by an expert panel using the Content Validity Index (CVI), followed by pilot testing to confirm feasibility (FVI). In the qualitative component, focus group discussions were conducted with cancer survivors, and coping ability was assessed using psychological assessment tools. Result: A total of 207 participants (68% female; mean age 33.82±13.7 years) were included in the quantitative study. Participants experienced a moderate level of cancer-related stigma, with negative attitudes most strongly associated with perceptions of disease severity and individual responsibility. Qualitative findings revealed that physician communication and family support played a decisive role in psychological responses at the time of diagnosis disclosure. Excessive sympathy or social distancing increased psychological distress, whereas normal interpersonal interaction and realistic encouragement were identified as the most effective forms of support. Conclusion To improve psychosocial support for cancer survivors, it is essential to enhance healthcare professionals’ communication skills, promote accurate public understanding of cancer, and strengthen the sustainability of survivor support group activities.

Background: Respiratory and gastrointestinal infectious diseases are the leading causes of morbidity in children. Numerous international studies have demonstrated that handwashing with soap is one of the most effective and cost-efficient methods for preventing these diseases in children. A previous study conducted in Ulaanbaatar found that only 50.1% of general education school students practiced proper handwashing, which is considered insufficient even in areas with relatively adequate facilities. In Mongolia, 56.1% of the 865 schools lack handwashing facilities and soap, and 25% do not meet the WASH standards. Although knowledge about handwashing increased during the COVID-19 pandemic, sustained behavioral change remained limited, highlighting a gap between knowledge and practice and indicating the need for targeted educational interventions. Furthermore, there is limited research comparing the effectiveness of such interventions across different school environments and urban–rural settings, which provides the rationale for this study. Aim: To evaluate the effectiveness of a handwashing educational intervention among primary school students and determine differences in knowledge change across four schools in urban and rural areas. Materials and Methods: A quasi-experimental study design was used from December 2024 to June 2025. A total of 1,353 students from grades 3–5 in four general education schools (two in Ulaanbaatar and two in rural areas) were included in the study. Preand post-intervention handwashing knowledge scores were analyzed using paired t-tests and one-way ANOVA (α=0.05) with STATA 14.0. Ethical approval was obtained from the Ethics Committee of the Mongolian National University of Medical Sciences. Result: The mean handwashing knowledge score increased significantly from 9.68 (±2.64) before the intervention to 10.30 (±2.74) after the intervention, with a mean difference of +0.63 (p<0.001). The differences in improvement between schools were also statistically significant (ANOVA: F(3,1335)=5.90, p=0.0005). The highest improvement was observed in urban School A (+1.49), while the lowest was observed in School B (+0.16). Rural schools C and D showed moderate and relatively consistent improvements (+0.51 and +0.70, respectively). Conclusion School-based handwashing educational interventions effectively improve knowledge among primary school students. However, environmental factors, such as infrastructure and geographic location, significantly influence the effectiveness of the intervention. Therefore, educational interventions should be implemented alongside infrastructure improvements.

Background: Research on lactic acid bacteria has confirmed how specific strains possess probiotic properties and impart unique sensory characteristics to food products. The use of probiotic lactic acid bacteria in many food products, thus confers various health benefits to humans when they are frequently consumed in adequate amounts. Aim: To determine the effect of lactic acid bacteria on the growth of tomatoes. Materials and Methods: The lactic acid bacteria were cultured using the Lactobacillus medium from whipping cream and Dandelion (Taraxacum mongolicum) and identified using the MALDI-TOF MS automated microbial identification analyzer. A solution was prepared using Lactobacillus delbrueckii isolated from whipping cream and Lactobacillus gasseri isolated from Dandelion (10^7CFU/ml), and sterilized tomato seeds were watered for 10 days with the solution, while sterilized distilled water was used as a control. The germination rate of the seeds and the root length were measured and recorded every day. Results: The solution of L.delbrueckii bacteria isolated from cream germinated 100% of the seeds, which is 4% higher than the control seeds, while the solution of L.gasseri bacteria isolated from Dandelion germinated 100%, supporting 4% higher than the control seeds. Seedlings irrigated with the L.delbrueckii bacterial solution exhibited an average length of 10.3cm, which was 1.3cm longer than the control (P=0.003), indicating a statistically significant difference. Similarly, those treated with the L.gasseri solution had an average length of 11.5cm, 2.5cm longer than the control (P=0.005), also demonstrating statistical significance. Conclusion The application of the lactic acid bacterial solution significantly enhanced both the germination of tomato seeds and the growth of the plants compared to the control solution.

Background: Systemic lupus erythematosus (SLE) is an unknown systemic autoimmune disease that causes multiple tissue and organ damage. Lupus nephritis (LN) was found to occur in 15-30% of the patients with lupus at the time of initial diagnosis and in 30-50% during disease progression. Accurate diagnosis and active treatment can preserve the kidney function of LN patients and delay the process of kidney fibrosis, thus postponing the occurrence and development of end-stage kidney disease (ESRD). The diagnosis of LN is ideally confirmed by histologic findings in a kidney biopsy. Additionally, serum or urine biomarkers such as serum creatinine, urea, and immune-related molecules, such as anti-double-stranded DNA, anticardiolipin, complement components C3, C4, and anti-C1q antibodies. Aim: The information concerning non-invasive, easy, and accurate biomarkers for diagnosis of lupus nephritis. This study aimed to evaluate the diagnostic significance of cystatin C and complement component 1q antibody for lupus nephritis. Materials and Methods: A study that included 40 patients with systemic lupus erythematosus (SLE) without LN (non-Lupus group), 40 patients with lupus nephritis (Lupus group) was performed in a hospital based cross-sectional study from May 2022 to August 2024. The serum levels of CysC, Anti-C1q, urea, and creatinine were measured, and estimated glomerular filtration rates (eGFRCysC , eGFRcreat , eGFRcomb) were calculated by equations two groups and the CKD-EPI respectively. T-test analysis or Chi-square test was used to compare the differences between the two groups. The receiver operating characteristic (ROC) curve was applied to identify the diagnostic efficiencies of individual or combined multiple indicators. Results: 80 patients were recruited, including 5% men and 95% women with a mean age of 35.15±9.57 years (range 17-56 years). The LN group with a mean age of 35.2±9.44 years, non-LN group with a mean age of 35.1 ±9.38 years. The non-LN group clinical manifestation of 47.5% arthritis, 32.5% hematologic system, 10% interstitial lung disease, 7.5% dermatitis, 2.5% central nervous system. The LN group with SLE disease activity index of 85% severe activity, 2.5% moderate activity, 2.5% mild activity. The non-LN group with SLE disease activity index of 7.5% severe activity, 62.5% moderate activity, 20% mild activity, 10% low activity. Significantly elevated Cystatin C and anti-C1q were observed in the LN groups. Cystatin C, creatinine, urea and antiC1q were increased 60% (n=24), 22.5% (n=9), 32.5% (n=13), and 70% (n=28) respectively (P=0.001). eGFRcreat detected chronic kidney disease (CKD) stage of 63.7% normal, 25% mild, and 11.25% moderate stage. eGFRcyst detected chronic kidney disease (CKD) stage of 47.5% normal, 25% mild, 20% moderate, 7.5% severe stage. Conclusion The separately detected cystatin C(eGFRcyst) and antiC1q were superior to the conventional biomarkers Urea, Creat, and eGFRcreat in the diagnosis of lupus nephritis with SLE.

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.

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.

Introduction: When human body encounters external pathogens primary/innate immunity cells are activated by recognizing them and secondary/adaptive immunity is activated consecutively. Immune cell surface receptors, called Toll-like receptors (TLRs) recognize and bind pathogens. In our previous study, we revealed that there is a synergistic action between TLR9 and IFN-γ signaling in the endothelial cells. Purpose: To determine the role of negative and positive regulatory proteins on the IFN-γ/TLR9 synergistic signaling pathway Materials and Methods: This study was held in the Core Laboratory, Science Technology Center, Mongolian National University of Medical Sciences (MNUMS). In this study, murine endothelial cell (END-D) culture was used. The negative and positive regulator protein expression was detected by Western blotting. Result: Result of immunoblotting assay indicated that CpG DNA enhanced IFN-γ positive regulator protein p38 phosphorylation in the endothelial cells. Treatment by TLR9 ligand CpG DNA and IFN-γ increased p38 activation in 0.5 hour and 1 hour. CpG DNA inhibited IFN-γ negative regulator SOCS1 protein expression in 4 hr and 8 hr. Therefore, TLR9 ligand CpG DNA increased IFN-γ signal transduction in the endothelial cell line. Conclusion TLR9 ligand CpG DNA has decreased IFN-γ negative regulator protein SOCS1 expression. CpG DNA has increased IFN-γ positive regulator protein p38 phosphorylation.

Introduction: Toll like receptors (TLRs) are a class of proteins that key role in the innate immune system. The SOCS1 and SHP2 proteins are negative-feed loop inhibitors of signaling of JAK/STAT and TLRs pathways. Purpose: To determine negative regulator protein activation which is activated through TLR7 ligand/IFN-γ signal transduction in endothelial cells. Methods: We used mouse aortic linear endothelial cell (END-D); protein expressio was detected by western blotting Results: We analyzed a time dependent stimulation effects of negative regulator proteins stimulated by TLR7 ligand/IFN-γ in endothelial cell cultures. Imiquimod of 10 μg/ml treatment of 1 hr was followed by 100 ng/ml IFN-γ stimulation for 1-8hr to analysis of negative regulator SOCS1 and SHP2 protein expression.
In untreated cells, there was low activations of negative regulator SOCS1 and SHP2 proteins. IFN-γ stimulation alone had increased SOCS1 and SHP2 protein expressions, also imiquimod treatment highly elevated SOCS1 and SHP2 expressions. However imiquimod and IFN-γ doubled treatment have decreased activation of negative regulator SOCS1 and SHP2 proteins. These findings suggest SOCS1 and SHP2 proteins are inhibitors in the TLR7 ligand/IFN-γ signaling. Conclusion Negative regulators, SOCS1 and SHP2 strongly suppressed activations of TLR7 ligand/IFN-γ signaling