Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a primary disease of the myocardium characterized by fibro-adipocytic replacement of myocytes, mostly in the right ventricle. The prevalence of ARVC in the general adult population is estimated to be approximately 1 in 2000 to 1 in 5000. ARVC is an important cause of sudden cardiac death (SCD) in young adults, accounting for approximately 11 percent of cases overall. ARVC is caused by mutations in a variety of genes, most of which encode desmosomal proteins, with greater than 30 percent of cases being familial in origin. We present a rare autopsy case of pregnant woman diagnosed with Arrhythmogenic right ventricular cardiomyopathy. Case presentation: We report a case of a 24-year-old woman at 24-25 weeks of gestation who suddenly collapsed at work and was brought to the emergency department in cardiac arrest. Despite prolonged cardiopulmonary resuscitation, she was pronounced dead. Her medical history included recurrent renal surgeries for hydronephrosis. Autopsy revealed cardiomegaly (379.4 g) with marked right ventricular dilatation, thickened and fatty epicardium, and microscopic evidence of fibrofatty replacement of right ventricular myocardium with inflammatory cell infiltration (CD3+, CD68+). Associated findings included bilateral hydronephrosis, chronic pyelonephritis, accessory liver and spleen lobes, and thoracic scoliosis. The cause of death was determined to be heart failure and arrhythmia secondary to arrhythmogenic right ventricular cardiomyopathy. Conclusion This case highlights the rare occurrence of ARVC in pregnancy complicated by multiple congenital anomalies and chronic infection. Pregnancy-related hemodynamic stress may exacerbate underlying myocardial pathology, leading to fatal arrhythmia. Early detection of cardiovascular and systemic abnormalities during prenatal care is essential to identify high-risk pregnancies and prevent sudden maternal death.

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.

Risk factors for severe postpartum hemorrhage: a case-control study Introduction: Postpartum hemorrhage (PPH) is an obstetric emergency. It is one of the top five causes of maternal mortality in both resource-abundant and resource-limited countries. PPH occurs in approximately 1% to 3% of all deliveries and is the leading cause of obstetric morbidity and mortality worldwide, accounting for approximately 8% of maternal deaths in developing countries and 20% of maternal deaths in developed countries. The United States has one of the highest maternal mortality rates at 11% and continues to rise, increasing from 8 to 40 cases per 10,000 deliveries. In Europe, PPH occurs in approximately 13% of deliveries. Uterine atony, the primary cause of PPH, accounts for 70% to 80% of all hemorrhages.Traditionally, PPH is defined as more than 500 mL of estimated blood loss in a vaginal delivery or more than 1000 mL of estimated blood loss during Cesarean delivery. These parameters were redefined in 2017 by the American College of Obstetrics and Gynecology as a cumulative blood loss of more than 1000 mL with signs and symptoms of hypovolemia within 24 hours of the birth process, regardless of the mode of delivery. A loss of an approximate total blood volume of more than 1500 mL will typically cause clinical features of hypovolemia. Materials and methods: The study was conducted using a retrospective, case-control research design. The study population consisted of women who gave birth between January 1 and August 1, 2024 at the Department of Obstetrics and Gynecology at the National Center for Maternal and Child Health and were diagnosed with hemorrhage. The study participants were divided into 2 groups according to the amount of blood loss in the early postpartum period: the control group was less than 1500 ml (n=72), and the case group was women with blood loss of 1500 ml or more (n=26). Research data were collected through a questionnaire with 60 questions in 3 groups pre-designed from medical history. Statistical analysis was performed using IBM SPSS 26 software. Results: The study included 98 women, maternal age was 17-44 which average 30.2±6.7 years. There were no significant differences in age, marital status, mode of delivery, and drug dosage in the case-control group. The risk of major bleeding in the early postpartum period was associated with Preeclampsia, 1.9 (OR: 1.99; 0.71-5.57), cardiovascular disease 11.2 (OR=11.2; 1.1-18.5), placenta accrete spectrum 6.5 (OR=6.5; 2.01- 21.1), increasing anemia during pregnancy 8.05 (OR=8.5; 1.08-12.5). Also, pregnancy with twins and the weight of the fetus increased the amount of postpartum hemorrhage. Also, the amount of blood lost in mothers with other births was positively correlated with the duration of labor (r=0.348). There is a risk of increased bleeding in case of co-occurring causes of bleeding (p=0.042). Conclusions: The risk of major bleeding in the early postpartum period was associated with Preeclampsia, cardiovascular disease, placenta accrete spectrum, increasing anemia during pregnancy. Also, pregnancy with twins and the weight of the fetus increased the amount of postpartum hemorrhage. Also, the amount of blood lost in mothers with other births was positively correlated with the duration of labor. There is a risk of increased bleeding in case of co-occurring causes of bleeding.

Introduction: Hepatitis C virus (HCV) infection has both hepatic and extrahepatic manifestations, and it is one of the leading cause of liver transplantation. There’s limited research on extrahepatic symptoms of chronic HCV in Mongolia, thus we aimed to investigate the relationship between cryoglobulinemia and it’s related factors. Methods: The study included 200 participants with active HCV, collecting blood samples for various tests (biochemical analysis, kidney function, and cryoglobulinemia detection). The degree of liver fibrosis was assessed using APRI and FIB4 scores, and the study evaluated other health conditions through a questionnaire. Statistical analysis was performed using SPSS-26. Results: Out of 200 participants, 148 checked for cryoglobulin precipitation and 89 (60.1%) were positive. There was a statistically significant age difference between those with and without cryoglobulinemia (54.62 vs. 50.44 years). A higher percentage of participants with cryoglobulinemia had significant liver fibrosis (10.8% vs. 4.7% without). Liver fibrosis scores tended to increase with age, especially in men. Conclusion Liver fibrosis scores above 3.25 are associated with older age, lower platelet counts, elevated AST and ALT levels, and the presence of cryoglobulinemia. FIB4 scores were higher in men with active HCV and cryoglobulinemia.

Introduction: The worldwide prevalence of obesity and its metabolic complications have increased substantially in recent decades. According to the World Health Organization (WHO) indicate that in 2016, over 1.9 billion adults were overweight and, of these, over 650 million were obese. Obesity is a major risk factor for heart disease, type 2 diabetes, steatotic liver, chronic liver disease, stroke, and some cancers. The global prevalence of obesity and its associated comorbidities continue to increase on a pandemic scale. Aim: To determine metabolic changes in overweight and obese adults and their related diseases based on some parameters of anthropometric and laboratory tests. Materials and Methods: This study was conducted with a case-control design in 2023–2024. There were 150 participants in the study, 50 in the control group with normal weight, 50 in the overweight (BMI<29.9kg/m2) case group, and 50 in the obesity (BMI>30kg/m²) case group. Subjects of three groups were matched by age (±1) and sex. We estimated anthropometric parameters and biochemical laboratory analysis including glucose, lipid, ferrum, and liver parameters. CBC All statistical analysis was performed using SPSS 23 software. Categorical variables were described by numbers and percentages, and the numerical variables were characterized by the median (min and max) for the normal distribution, and mean± standard deviation for the non-normal distribution. The statistical tests utilized were the Chi-square, Fisher’s exact, student t-test, and Mann–Whitney tests. Ethical approval for the survey was obtained from the Medical Ethics Committee under the Ministry of Health Of Mongolia in January 2023. Results: The participants' average age was 46.73±11.45, with 60% being women (90) and 40% being men (60). The prevalence of central obesity and fat % were 52.3% and 37.2%, respectively. Between study groups, there were significant differences in fat% (p=0.004), central obesity (p<0.001), FBG (p=0.024), cholesterin (p=0.017), LDL (p=0.018), HDL (p=0.003), ferrum (p=0.010), АЛАТ (p=0.020), and GGT (p<0.001). Conclusion In overweight and obesity groups, the body fat, fasting blood glucose, cholesterol, LDL, and ALT levels are increased. These changes often lead to conditions like type 2 diabetes, arterial hypertension, steatotic liver disease, and liver fibrosis. Therefore, it is important to develop plans for prevention, early detection, public awareness, and intervention programs targeting obesity in the general population.

Introduction: The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) has increased significantly over the last three decades worldwide, from 17.6% in 1990 to 23.4% in 2019. The development of this disease depends on many risk factors, including genetics, lifestyle, and environment. The PNPLA3 (patatin-like phospholipase domain-containing protein 3) gene is the most relevant genetic factor influencing the risk of metabolic dysfunction-associated steatotic liver disease. The PNPLA3 rs738409 GG genotype impairs adiponutrin function, accumulating triglyceride in liver cells and forming small fat droplets within the liver. Aim: To determine rs738409 and rs2896019 single nucleotide polymorphisms of the PNPLA3 gene in metabolic dysfunction-associated steatotic liver disease and their correlation with some parameters of anthropometric and laboratory tests. Materials and Methods: This study was conducted with a case-control design in 2023–2024. There were 150 participants in the study, 50 in the control group without MASLD, and 100 in the case group with MASLD. The PNPLA3 (rs738409, rs2896019) gene’s single nucleotide polymorphism was identified by the RFLP-PCR technique. All statistical analysis was performed using SPSS 23 software. Categorical variables were described by numbers and percentages, and the numerical variables were characterized by the median (min and max) for the normal distribution, and mean± standard deviation for the non-normal distribution. The statistical tests utilized were the Chi-square test, Fisher’s exact test, student t-test, and Mann–Whitney test. Ethical approval for the survey was obtained from the Medical Ethics Committee under the Ministry of Health Of Mongolia in January 2023. Results: The participants’ average age was 46.73±11.45, with 60% being women (90) and 40% being men (60). Among all patients, the PNPLA3 gene’s single nucleotide polymorphism rs738409 revealed 44.7% (67) CC, 54.7% (82) GC, and 0.7% (1) GG (OR-CG+GG genotype- 2.9, p=0.003). In addition, as a result of determining the PNPLA3 gene rs2896019 single nucleotide polymorphism, the frequency of the TT genotype was significantly higher in the control group than in the case group (48%, 31%, p = 0.042). Conclusion The frequency of CG/GG genotypes rs738409, and rs2896019 of the PNPLA3 gene is higher in the case group, suggesting that they may be more susceptible to MASLD.

Background: Serum natriuretic peptide (NT-proBNP) is a critical biomarker for diagnosing left ventricular dysfunction. Heart failure is the leading cause of mortality in chronic kidney disease (CKD), emphasizing the need for its early detection and prognosis. Objective: This study aimed to determine the serum NT-proBNP levels in participants with CKD and establish a cut-off value for predicting heart failure. Methods: A descriptive cross-sectional study was conducted from April 1 to July 1,2024. This study received approval from the Ethics Committee of the Institute of Medical Sciences (Approval No.24/01). A total of 117 CKD patients hospitalized in the Nephrology and Endocrinology Department of the third state hospital were enrolled based on predefined inclusion and exclusion criteria. Data were collected using questionnaires, laboratory and heart ultrasound test results. Serum NT-proBNP levels were measured using a rapid immunofluorescence quantitative analyzer. Data were analyzed with SPSS 26.0. Results: The mean age of the 117 participants was 57.9 ± 14.7 years, with 51.3% being male. The mean serum NT-proBNP level was 7686 ± 12149 pg/mL. Statistically significant differences were observed in serum creatinine, sodium, calcium, CKD stage, and arterial hypertension between genders (p<0.05). NT-proBNP levels in hemodialysis patients differed significantly between heart failure and non-heart failure groups (p<0.05). Significant differences were also found in hemoglobin, serum albumin, NT-proBNP levels, and CKD stages (p<0.05). NT-proBNP correlated significantly with risk factors such as hemodialysis, diabetes, and decreased systolic blood pressure (p<0.0001). A weak inverse relationship was noted between systolic blood pressure and NT-proBNP (R² = 0.16). The NT-proBNP cut-off value for predicting heart failure was 3027 pg/mL, with an AUC of 61.7% (sensitivity: 74.5%, specificity: 55%). Conclusion Serum NT-proBNP levels are elevated in CKD patients regardless of heart failure. The established cut-off value for NT-proBNP in CKD patients to detect heart failure was 3027 pg/mL, with moderate diagnostic utility (AUC = 61.7%).