Background: The most common clinical manifestation of HCV infection, which includes both hepatic and extrahepatic manifestations, is mixed cryoglobulinemia, which is characterized by the precipitation of certain proteins in the blood at temperatures below 37°C (in vitro), aggregation, and deposition in the walls of small and medium-sized vessels, causing vasculitis, which is clinically manifested by a triad of joint pain, fatigue, and rash on the soles of the feet. Cryoglobulinemia is commonly diagnosed in people with HCV infection, with a prevalence ranging from 10% to 70%. Vasculitis that occurs when cryoglobulinemia is detected mainly affects the small vessels of the skin, kidneys, and peripheral nerves, causing complications in other organ systems. Aim : To determine the prevalence of cryoglobulinemia in people with HCV infection, study it in relation to the stage of liver fibrosis, and determine its clinical relevance. Materials and Methods : 200 chronic HCV infected individuals were included in the study according to the inclusion and exclusion criteria. After obtaining informed consent from each participant, a questionnaire was used to collect information, perform physical measurements, and collect peripheral blood samples. Complete blood count and biochemical tests (liver and kidney function) were performed. The degree of liver fibrosis was assessed non-invasively (APRI, FIB4). The glomerular filtration rate was calculated electronically using the MDRD GFR Equation. Skin examination was performed to assess the presence of rash, ulcers, and scarring on the shins and ankles of cryoglobulinemia. To determine cryoglobulinemia, 8 ml of blood was collected in a tube without anticoagulant, and the sample was kept motionless for 1 hour at room temperature until clotting was complete. After centrifugation, the samples were separated and stored in a refrigerator at +4°C for 7 days, and then at room temperature for 30 minutes, the precipitate was detected. Results : A total of 200 people participated in the study, of which 71 were men (35.5%), the average age was 53.39±13.0. Cryoglobulinemia protein precipitates were determined in a total of 148 people, of which 50 were men (33.8%), the average age was 52.95±13.0. Cryoglobulinemia protein precipitates were detected in 89 people, or 60.1% of the study participants. Of the total study participants, 176 (88.0%) had chronic hepatitis C (CHC). Of these, 57 people had CHC with cryoglobulinemia. Comparing laboratory parameters, the mean GGT level in the cryoglobulinemia group was statistically significantly higher than in the non-cryoglobulinemia group (p=0.039). However, when laboratory parameters were grouped by increasing or decreasing, AST and ALT levels were significantly higher in the cryoglobulinemia group, indicating more hepatocellular damage (p<0.000). Increased creatinine levels may be associated with the risk of renal dysfunction. The FIB-4 index and APRI index showed a more severe degree of fibrosis in the cryoglobulinemia group (p<0.005; p<0.000). Univariate logistic regression analysis showed that age was associated with the occurrence of cryoglobulinemia (OR=2.48; 95% CI:1.31–4.70; p=0.005). Platelet count had a statistically significant positive effect in multivariate analysis (OR=14.38; 95% CI:1.26–163.89; p=0.032). Conclusion The prevalence of cryoglobulinemia among HCV-infected patients was 60.1%, and older age and decreased platelet count among infected individuals were associated with the occurrence of cryoglobulinemia.

Background: The development of accurate and non-invasive diagnostic tools is essential for improving early detection of cancers. Recent studies have shown that serum biomarkers may be useful for early detection of gastric cancer. Aim: We aimed to evaluate the diagnostic accuracy of PGI and PGR biomarkers for detection of the gastric cancer and atrophic gastritis. Materials and Methods: To identify relevant studies, the MEDLINE (PubMed) database was searched using the keywords (((“Gastritis, Atrophic”[Mesh]) OR “Stomach Neoplasms”[Mesh]) AND “Pepsinogen A”[Mesh]) AND “Sensitivity and Specificity”[Mesh]). Based on the inclusion and exclusion criterias, studies were selected according to the PRISMA guidelines. Meta-analysis was performed using Review Manager 5.4.1 and STATA/IC 15.0 (StataCorp LLC, USA, 2017). Results: According to the PRISMA guidelines, we selected a total of 18 studies in this meta-analysis. The meta-analysis results showed that the sensitivity of the PGI for the detection of atrophic gastritis was 58.5% (95% CI, 44.5-71.3), specificity was 90.2% (95% CI, 68.4-97.5), and DOR was 13.0 (95% CI, 2.6-64.6); the sensitivity of the PGR was 69.9% (95% CI, 58.1-79.5), specificity was 80.9% (95% CI, 52.4-94.2), and DOR was 9.8 (95% CI, 2.6-36.9). However, the sensitivity of the PGI biomarkers for detecting gastric cancer was 72.6% (95% CI, 54.7-85.3), specificity was 66.9% (95% CI, 52.5-78.7), DOR was 5.4 (95% CI, 3.1-9.3); PGR sensitivity was 77.8% (95% CI, 64.4-87.4), specificity was 65.0% (95% CI, 53.2-75.1), DOR was 6.6 (95% CI, 3.7-11.7); PGI+PGR sensitivity was 62.3% (95% CI, 51.1-72.2), specificity was 87.6% (95% CI, 78.0-93.3), DOR was 11.6 (95% CI, 6.8-19.8). Conclusion PGI and PGR tests demonstrated high specificity but moderate sensitivity. Although serum pepsinogen cannot replace endoscopy, it is considered to be an additional test and can be used to select high-risk populations.

Background: In 2022, the World Health Organization (WHO) reported that globally, 2.5 billion (43%) of adults aged 18 and older were overweight, with 890 million (16%) of these individuals classified as living with obesity. Some genes such as the FTO gene are strongly associated with obesity and overweigh. The FTO protein is crucial in regulating food consumption, appetite, energy equilibrium, and expenditure. Aim: The identify single nucleotide polymorphisms rs9939609 and rs17817449 of the FTO gene, which are associated with obesity, and to study their correlation with antropometric measurements and some laboratory test parameters. Materials and Methods: According to the inclusion and exclusion criteria, 50 obese (BMI >30 kg/m²) were included in the case group, and 50 relatively healthy and normal weight (BMI 18.5-24.9 kg/m²) were enrolled in the control group, for a total of 100 people matched for age and gender (1:1). We took physical measurements and collected peripheral blood samples after obtaining informed consent from each participant. Laboratory analyses assessed some parameters of lipid and glucose metabolism. We used the PCR-RFLP technique on two genotype SNPs. A p-value below 0.05 was considered a statistically significant result. Results: In this study, including 100 people aged 23 to 75, the mean age was 46.81±11.54 years, with 60% being female. In terms of antropometric measurements, body mass index, waist circumference, and arterial pressure were markedly elevated in the case group compared to the control group (p<0.001). In laboratory measures, fasting blood glucose, cholesterol, and mean LDL mean levels were statistically significantly higher in the case group compared to the control group. On the other hand, HDL cholesterol levels were lower in the case group compared to the control group. The FTO gene rs9939609 single nucleotide polymorphism was identified in 62% of the total study individuals as TT, 35% as AT, and 3% as AA genotypes. Also, FTO gene rs17817449 single nucleotide polymorphism was identified in 62% of the total study individuals as TT, 33% as AT, and 5% as AA genotypes. Conclusion The rs9939609 AT/AA genotype of the FTO gene elevates the risk of obesity and is associated with increased body weight, waist circumference, and BMI.

Background: The craniofacial region is one of the most frequently injured parts of the human body, with mandibular fractures being the most common type of facial skeletal injury. The leading causes of mandibular fractures include traffic accidents, falls, interpersonal violence, and sports-related injuries. In Mongolia, mandibular fractures are prevalent, with a higher incidence among males. However, to date, no national-level analysis of mandibular fractures has been conducted. This study aims to comprehensively examine mandibular fractures in Mongolia by identifying demographic factors and causes of injury. Aim: To determine the incidence and causes of mandibular fractures recorded in Mongolia over the past ten years. Materials and Methods: This study collected data on mandibular fractures recorded in the Health Development Center of Mongolia between 2014 and 2023. Cases were identified using the International Classification of Diseases (ICD-10) code S02.6. Information on patient age, gender, and hospital diagnosis was collected, along with the cause of injury, classified according to ICD-10 codes. Patient age was categorized based on the classification system of the National Statistics Office. Statistical analysis was performed using SPSS 26.00 software, employing the chi-square test for data analysis. Results: During the study period, a total of 2,872 patients were diagnosed with mandibular fractures, with the highest incidence occurring in the 20-40 age group. The average patient age was 31.1±12 years. Males were 5.6 times more likely to sustain mandibular fractures compared to females. The primary causes of injury were interpersonal violence (42%), mechanical trauma (17%), falls (16%), and traffic accidents (15%). Conclusion Between 2014 and 2023, 2,872 cases of mandibular fractures were recorded in Mongolia, with the majority occurring in individuals aged 20-40 years. The leading causes of mandibular fractures were interpersonal violence, mechanical trauma, falls, and traffic accidents. Specialized trauma care services were accessed differently in urban and rural areas.

Introduction: While 10 percent of global total population was above the age of 65 in 2022, it tends to rise to 16 percent in 2050. In the case of our country, as of 2021, individuals aged 60 and above comprised 7.7% of the total population, with tendency of an increase to 11.9% by 2030 and 21.1% by 2050. In 2018, a study conducted in Brazil, involving 573 elderly participants, found that 10.3% regularly taking five or more medications. This highlights the necessity of studying polypharmacy among the elderly. Goal: To identify inappropriate medication use among the elderly Materials and Methods: The study was conducted by analytic cross sectional design. Furthermore, the study was conducted during July 1, 2024, to October 1, 2024, in Ulaanbaatar, covering 6 districts. A total of 12 Family Health Centers (FHCs) were selected, including one from an apartment district and one from a ger district in each area. A random sampling method was used to select 238 elderly individuals aged 55 and above for females and 60 and above for males. From each district, 20 participants were selected, maintaining a gender ratio of 1:1. Statistical analysis was performed using Pearson’s Chisquare test and multiple logistic regression analysis. The study was conducted after obtaining approval from the research ethics committee of “Ach” Medical University. Results: Among the 238 participants in the study, the gender distribution was equal, with 119 females (50%) and 119 males (50%). When analyzing the primary conditions requiring for regular medication by organ system, cardiovascular diseases were the most common, accounting for 89.9% (214) of total cases.
Among the elderly patients included in the study, 68% were found to have inappropriate medication use. Elderly females, aged 85 years and older (n=6, 100%) demonstrated a statistically significant higher prevalence of inappropriate medication use compared to other age groups (p =.023). Among those with inappropriate medication use, 54.9% were females and 45.1% were males, a difference that was also statistically significant (p = .026). Inappropriate medication use was significantly associated with the type of medication used for the primary disease (p = .001), dosage (p = .000), duration of use (p = .000), frequency of daily intake (p =.003), use of medications due to comorbidities (p =.000), and whether the medication was prescribed by a physician (p = .001).According to multivariate logistic regression analysis, age (OR 2.31, 95% CI 1.25–4.29, p = .008), gender (OR 0.574, 95% CI 0.356–0.924, p = .022), education level (OR 2.03, 95% CI 1.21–3.58, p = .008), and pension status (OR 1.03, 95% CI 0.586–1.83, p = .904) were found to be influencing factors for inappropriate medication use. Conclutions 1. Inappropriate medication use among the elderly accounts for 68%.

Introduction: According to the World Health Organization (WHO), by 2030, the number of deaths from cancer worldwide is estimated to reach 13.2 million. However, this number is expected to increase to 20.3 million due to population growth. As of 2018, liver cancer is the sixth most commonly diagnosed cancer and the fourth leading cause of cancer-related deaths worldwide. Hepatitis C virus (HCV) is one of the main causes of chronic liver disease, cirrhosis, and liver cancer.
HCV is estimated to infect 175 million people globally, accounting for 2.8–3% of the total population. About 20% of people infected with HCV progress to severe liver disease, sometimes requiring liver transplantation.
In our country, the prevalence of chronic hepatitis increased significantly between 2015 and 2019. In 2019, it accounted for 45.3% of the total liver diseases, an increase of 10.3 percentage points since 2015. When analyzing age groups, it is noteworthy that incidence increased by 3.2 times in children aged 0-9 years. Objectives of the study: To determine the level of ferritin in the blood of patients with hepatitis C virus infection and to assess its relationship with fatty liver. Research materials and methods: This study was conducted using a cross- sectional design. The data were collected before the initiation of anti-HCV treatment, and each participant underwent serum biochemical analysis to assess basic iron metabolism indicators such as ferritin and transferrin. Conclusion Of the 115 participants in the study, 27% (31) had elevated ferritin levels, while 73% (84) had normal levels. The mean ferritin level was 336±262 ng/ mL, indicating that a significant number of participants had elevated ferritin levels. This suggests that ferritin levels are increased in cases of liver cell inflammation and injury. Although biopsy-proven fatty liver disease was not present, 97.4% (112) of the participants had elevated blood lipid levels, and 94.6% of these had elevated ferritin levels. However, the chi-square test did not reveal a statistically significant difference (χ² = 0.170, p = 0.681). Additionally, 91.5% of participants with high HDL also had elevated ferritin, but the relationship was not statistically significant (p = 0.117).

Background: In our country, the high prevalence of chronic liver diseases is influenced by factors such as hepatotoxic viruses, excessive alcohol and drug consumption, and a high incidence of obesity among the population. Although the point at which liver fibrosis becomes irreversible remains unclear, some researchers have suggested, based on clinical studies, that fibrosis may still be reversible in the early stages of cirrhosis. Aim: Therefore, in this study, we aimed to evaluate the degree of liver fibrosis using key markers involved in the pathogenesis of hepatic scarring—MMP-1 (matrix metalloproteinase-1), MMP-2 (matrix metalloproteinase-2), and PIIINP (N-terminal propeptide of type III procollagen)—as well as non-invasive serum markers of hepatocyte injury (APRI and FIB-4), and to compare these findings with the results of liver biopsy. Materials and Methods: This analytical case-control study included 50 patients in the State Third Central Hospital. Peripheral blood samples were analyzed for platelet count, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) using a fully automated analyzer, while serum direct markers were measured using ELISA. Non-invasive serum markers (APRI and FIB-4) were calculated using the MD+CALC online system. Liver tissue for histological examination was obtained via biopsy, and the degree of liver fibrosis was assessed according to the METAVIR scoring system. Differences in mean values of quantitative variables between two groups were analyzed using the Mann-Whitney U test was applied. The correlation between METAVIR stages and serum markers was evaluated using Spearman’s correlation. Results: Among the study participants, according to the METAVIR classification, 15 individuals (30%) had no or minimal fibrosis (F0–F1), 26 individuals (52%) had significant fibrosis without cirrhosis (F2–F3), and 9 individuals (18%) had cirrhosis (F4). As the stage of fibrosis increased, the mean levels of AST (r=0.326, p=0.021), ALT (r=0.392, p=0.005), MMP-2 (r=0.393, p=0.005), PIIINP (r=0.472, p=0.001), as well as APRI (r=0.503, p<0.001) and FIB-4 (r=0.482, p<0.001) showed an increasing trend. In contrast, mean platelet count (r=–0.507, p<0.001) and MMP-1 (r=–0.383, p=0.006) decreased with advancing fibrosis stages. Using AUC-ROC analysis to assess the diagnostic performance of both direct and indirect serum markers, the ability to detect significant fibrosis and cirrhosis was estimated as follows: APRI 80%, FIB-4 75%, MMP-1 67.1%, MMP-2 72.2%, and PIIINP 72.3%. Conclusion In our study, the diagnostic performance of both direct and indirect serum markers for predicting liver fibrosis exceeded 65%. Mean levels of AST, ALT, MMP-2, PIIINP, APRI, and FIB-4 increased with advancing fibrosis stages, whereas mean platelet counts and MMP-1 levels decreased.

Introduction: While 10 percent of global total population was above the age of 65 in 2022, it tends to rise to 16 percent in 2050. In the case of our country, as of 2021, individuals aged 60 and above comprised 7.7% of the total population, with tendency of an increase to 11.9% by 2030 and 21.1% by 2050. In 2018, a study conducted in Brazil, involving 573 elderly participants, found that 10.3% regularly taking five or more medications. This highlights the necessity of studying polypharmacy among the elderly. Materials and Methods : The study was conducted by analytic crosssectional design. Furthermore, the study was conducted during July 1, 2024, to October 1, 2024, in Ulaanbaatar, covering 6 districts. A total of 12 Family Health Centers (FHCs) were selected, including one from an apartment district and one from a ger district in each area. A random sampling method was used to select 238 elderly individuals aged 55 and above for females and 60 and above for males. From each district, 20 participants were selected, maintaining a gender ratio of 1:1. Statistical analysis was performed using Pearson’s Chi-square test and multiple logistic regression analysis. The study was conducted after obtaining approval from the research ethics committee of “Ach” Medical University. Results: Among the 238 participants in the study, the gender distribution was equal, with 119 females (50%) and 119 males (50%). When analyzing the primary conditions requiring for regular medication by organ system, cardiovascular diseases were the most common, accounting for 89.9% (214) of total cases. A total of 37 elderly patients (15.5%) were found to be on polypharmacy (taking five or more medications). Males (n=10, 21.3%) had a higher prevalence of polypharmacy compared to females (n=4, 18.2%).
Polypharmacy was significantly more prevalent among individuals aged 76–84 years, with a rate of 22.4% (p=0.006). Statistically significant differences were observed between polypharmacy and factors such as the type of medications taken for primary diseases (p=0.001), medication dosage (p=0.001), and duration of medication use (p=0.005). Additionally, polypharmacy showed a significant association with comorbid disease-related medication use (p=0.002). Elderly individuals with gastrointestinal and musculoskeletal comorbidities exhibited a higher prevalence of polypharmacy.
Other significant factors associated with polypharmacy included the type of medications used for comorbid conditions (p=0.001), daily medication frequency (p=0.020), and adherence to prescribed medications for comorbid conditions (p=0.017). Multivariate regression analysis identified gender (OR 2.98, 95% CI 1.26-6.97, p=0.007), housing type (OR 0.283, 95% CI 0.117-0.685, p=0.002), medication dosage (OR 4.62, 95% CI 1.97 10.81, p=0.001), and duration of medication use (OR 0.249, 95% CI 0.098-0.631, p=0.003) as statistically significant predicting factors of polypharmacy. Conclusion The use of polypharmacy in the elderly of Ulaanbaatar is 15.5%.

Introduction: According to the World Health Organization (WHO) data from 2022, 19.9 million people were diagnosed with cancer globally, and 9.7 million people died from the disease. In recent years, the incidence of colorectal cancer (CRC) has been rapidly increasing, ranking 4th among all cancers with 18.4 cases and 8.1 deaths per 100,000 population. In Mongolia, 826 new cases of CRC have been registered over the past six years, with an incidence rate of 8.2 cases and a mortality rate of 5.03 per 100,000 population. It is projected that by 2030, the incidence will reach 13.28 cases and the mortality rate will rise to 8.72 per 100,000 population. We aimed to comprehensively examine the risk factors for colorectal cancer among the population of Mongolia, establish a scientific basis for early detection and prevention, and strengthen preventive measures. Materials and Methods: A case-control study was conducted from 2022 to 2024. The study enrolled a total of 305 subjects, including 98 patients with colorectal cancer, 101 patients with colon polyps, and 106 healthy subjects. The risk. questionnaire consisted of 50 questions divided into 10 sections. All statistical analysis was performed with SPSS version 23.0 software (SPSS Inc., Chicago, IL, USA) and P value <0.05 was considered statistically significant. categorical data was represented as numbers and percentages. Pearson’s chi-squared and Fisher’s exact test were used to compare categorical variables. Multivariate logistic regression was used to identify the risk factor associated with recurrence. The study protocol was approved by Ethics Review Committee of Ministry of Health of Mongolia on 17 March 2023 (approval number: 23/012). Results: The average age of the participants was 57.1±12.8 years. Among all study participants, 37.6% (115) were male and 62.4% (188) were female. Comparison of colorectal cancer incidence by age and gender revealed no statistically significant differences (p=0.021; p=0.422). Regular physical exercise was found to have a protective effect against colorectal cancer (p=0.076; OR 0.341 95% Cl 0.118-.0986). The frequency of fruit consumption, 4 to 6 times per week (p=0.008, OR 0.08, 95% Cl 0.01-0.45), frequency of vegetable consumption 4 to 6 times per week (p<0.00; OR 0.07, 95% Cl 0.02-0.19), no dining out (0.007, OR 0.3, 95% Cl 0.18-0.68), and meat consumption (p=0.001) are decreased risk of colorectal cancer. Conclusion The patient's age and the presence of colon polyps are risk factors for colorectal cancer, while regular physical activity and a diet rich in fruits and vegetables are protective factors that help reduce the risk of developing colorectal cancer.

Introduction: Cardiovascular disease-related mortality accounts for 34% globally, 23% in the United States, and 22% in Europe, with Asia representing 35% of total deaths as of 2019. In Asia, ischemic heart disease and stroke are the most common causes of cardiovascular diseases (CVD), and the prevalence of these two types of CVD varies significantly across different regions and countries in Asia. Over the last 10 years, the average number of deaths due to cardiovascular diseases has been 5.7 thousand annually, representing 33.7% of total mortality. Cardiovascular diseases account for 11.1% of all illnesses, and as of 2021, the rate has increased by 128 compared to the average of the past 10 years, reaching 936 per 10.000 population. As cardiovascular disease-related mortality is the leading cause of death worldwide, every country has criteria for calculating the 10-year risk of CVD to reduce cardiovascular morbidity and mortality. These criteria are crucial for predicting the risk of stroke and cardiovascular diseases in individuals with or without diabetes. Purpose: To assess the risk of heart disease in people aged 40-74 years without cardiovascular disease. Material and Methods: A total of 394 individuals aged 40-74 were included in the study. Blood samples were taken to determine lipid profiles and fasting glucose levels. Using the World Health Organization's (2019) revised cardiovascular disease risk assessment model (which considers age, systolic blood pressure, smoking, total cholesterol, LDL and BMI), the 10-year risk of developing cardiovascular disease was calculated using both laboratory-based and non-laboratory based risk assessment criteria. Statistical analysis of the study was performed using SPSS 26 software, with a p-value of less than 0.05 considered statistically significant. Ethics: The methodology was approved by the Medical Ethics Sub-Committee of the Ach medical university on the 30th of June, 2023 (Decision #23/02/03) Result: The average age of the adults included in the study was 49.3±14.7 years. Among those aged 40-74 who participated in the CVD risk assessment criteria, the average age was 53.7±9 years, with men having an average age of 54.6±9.3 (117 participants) and women having an average age of 53±8.7 (223 participants). The total cardiovascular risk of the study participants was 54.8% very low, 15.7% low, 13.2% moderate, 8.1% high, and 8.1% very high according to laboratory-based assessment, while the non-laboratory based assessment showed 49% very low, 20.7% low, 16.8% moderate, 7.7% high and 5.9% very high risk).
Among all participants, the prevalence of cardiovascular risk factors was assessed as follows: 26.9% (95% CI: 22.6–31.6%) were smokers, 60.5% (95% CI: 55.4–65.3%) consumed alcohol, 46.4% (95% CI: 42.4–50.2%) had arterial hypertension, 10.4% (95% CI: 0.76–13.9%) had diabetes mellitus, 75% were obese, 78.4% (95% CI: 74.2–81.6%) had central obesity, 24.4% (95% CI: 18.5–31%) had hyperglycemia, 42.6% (95% CI: 35.6–49.9%) had hypercholesterolemia, 19.3% (95% CI: 14–25.5%) had hypertriglyceridemia, and 11.3% (95% CI: 0.71–16.7%) had elevated low-density lipoprotein levels.
The total cardiovascular risk of the study participants was 54.8% very low, 15.7% low, 13.2% moderate, 8.1% high, and 8.1% very high according to laboratory-based assessment, while the non-laboratory based assessment showed 49% very low, 20.7% low, 16.8% moderate, 7.7% high and 5.9% very high risk.
These distributions showed a statistically significant difference compared to the group without arterial hypertension (p<0.0001). Additionally, comparison of risk between individuals with and without diabetes mellitus using laboratory-based assessment also revealed a statistically significant difference (p<0.0001). The concordance between the two models was 88.8% (95% CI: 83.6–92.9) with a Cohen’s kappa coefficient of κ=0.6, indicating moderate agreement with statistically significant difference (p<0.001). Conclusion 75% of the people surveyed were obese and 78.4% had central obesity, with men at greater risk than women. The cardiovascular risk of having arterial hypertension and diabetes is further increased. The correlation coefficient of the risk estimates showed a strong correlation across gender and age groups. The agreement between the risk estimate models was 88.8%, or a moderate agreement with Cohen's coefficient (k=0.6).