Background: Liver fibrosis is the underlying pathology of chronic liver disease complications, including cirrhosis and hepatocellular carcinoma, and its early detection is essential for preventing mortality and disease progression. Liver biopsy remains the gold standard for diagnosing fibrosis; however, it is invasive, costly, limited in repeatability, and not suitable for population-level screening. Moreover, liver fibrosis is often asymptomatic for a prolonged period, necessitating reliable and accessible methods for early identification of at-risk populations. Therefore, non-invasive approaches based on routine laboratory parameters, particularly the FIB-4 index, have been widely adopted in clinical practice. Aim: To assess liver fibrosis using the FIB-4 index and to identify risk factors associated with indeterminate and high-risk groups among individuals participating in a national early detection program in Mongolia. Materials and Methods: A total of 37,961 adults who met the inclusion and exclusion criteria were selected from 447,409 individuals who participated in the national early detection screening program between 2022 and 2023. The FIB-4 index was calculated using age, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count, and categorized as low (<1.3), indeterminate (1.3–2.67), and high (≥2.67) risk. Body mass index, blood pressure, fasting glucose, triglycerides, and viral hepatitis status were classified according to standard criteria. Statistical analyses were performed using SPSS version 21.0. Continuous variables were expressed as mean±standard deviation, categorical variables were compared using the χ² test, and logistic regression analysis was used to identify risk factors. Results: The mean age of participants was 44.96±11.31 years, with 61.3% (n=23,285) female and 38.7% (n=14,676) male. The mean FIB-4 index was 0.89±1.09. Based on FIB-4, 86.9% were classified as low risk, 11.8% as indeterminate risk, and 1.4% as high risk; overall, 13.1% (n=4,975) were in the indeterminate and high-risk groups. FIB-4 risk increased progressively with age, reaching the highest level in individuals aged ≥60 years. In multivariable logistic regression analysis, male sex (OR=1.45; 95% CI: 1.36–1.56), viral hepatitis (OR=1.85; 95% CI: 1.68–2.03), and increasing age remained independently associated with indeterminate and high risk. Underweight status and very high triglyceride levels were associated with increased risk, whereas overweight, obesity, and central obesity showed an inverse association. Conclusions 1. The FIB-4 index is a simple, cost-effective tool for identifying individuals at risk of liver fibrosis in primary healthcare settings. Male sex, older age, and viral hepatitis were independent risk factors for indeterminate and high-risk groups. 2. Therefore, the FIB-4 index can be implemented as an initial risk stratification tool in national screening programs to identify high-risk populations for further evaluation and management.

Background: Ephedra przewalskii Stapf. is a perennial shrubby plant of the family Ephedraceae, naturally distributed in the dry and cold desert regions of Mongolia. In traditional medicine, the stems and roots of this plant have been used as decoctions for the treatment of gastrointestinal spasms, abdominal distension, urinary retention, and general fatigue. Members of the Ephedraceae family are known to contain sympathomimetic alkaloids such as ephedrine and pseudoephedrine, which exert strong physiological effects on the central nervous system, respiratory tract, and cardiovascular system. However, detailed information on the tissue- and cell-level localization of biologically active compounds and the microstructural characteristics of E. przewalskii remains limited. Aim: This study aimed to investigate the microanatomical structure and histochemical characteristics of the stem and root of Ephedra przewalskii Stapf., with particular emphasis on the localization of biologically active compounds. Materials and Methods: Plant samples were collected in July from Chandmani soum, Govi-Altai province, Mongolia. The collected material was air-dried in the shade and softened using Ostrich and Fleming solution prior to sectioning. Transverse sections of the stem and root were prepared using a hand microtome and examined under an Olympus light microscope. Histochemical analyses were performed using standard reagents to detect alkaloids, phenolic compounds, tannins, essential oils, polysaccharides, and starch. Results: The stem epidermis consisted of thin-walled, quadrangular cells with a surface covered by spherical protuberances. The stomatal apparatus exhibited a tetracytic structure, and photosynthetic activity was primarily localized in the stem chlorenchyma. The vascular bundles were collateral, with phloem located externally and xylem internally. Idioblasts containing reddish-brown crystalline inclusions were observed in the central pith of the stem. The root showed a polyarch central cylinder, with uniformly distributed, rounded parenchymal cells, and idioblasts similar to those observed in the stem. Histochemical analysis revealed the presence of flavonoids, alkaloids, polysaccharides, and tannins in the stem, predominantly localized in parenchymal and chlorenchymal tissues. In the root, polysaccharides, tannins, and starch were detected, whereas alkaloid accumulation was more prominent in the stem parenchyma. Conclusion The microscopic examination of Ephedra przewalskii Stapf. revealed the characteristic structures of the stem epidermis, stomata, chlorenchyma, vascular tissues, and crystal-containing idioblasts, as well as a polyarch central cylinder in the root. Histochemical reactions detected flavonoids, alkaloids, tannins, starch, and polysaccharides in the stem, whereas tannins, starch, and polysaccharides were identified in the root. These findings provide a comprehensive characterization of the anatomical and chemical features of the different plant organs.

Background: Human papillomavirus (HPV) is the primary cause of cervical cancer, with HPV genotypes 16 and 18 classified as high-risk types. In Mongolia, HPV testing has been increasingly implemented in recent years, alongside updates to the national screening program. These developments highlight the need for additional testing approaches to encourage regular participation in the national screening program, improve diagnostic accuracy, and facilitate timely treatment planning. These considerations provided the rationale for this study. Aim: To detect HPV infection in cervical samples collected by healthcare professionals and vaginal samples self-collected by women, determine the concordance between the test results, and evaluate the feasibility of self-sampling for cervical cancer screening. Materials and Methods: A total of 206 women aged 25–68 years participated in the study. Two types of samples for HPV testing and one sample for PAP smear were collected from the participants. 14 high-risk of HPV genotypes were classified into three groups, and cytological findings were evaluated according to the 2014 Bethesda System. Statistical analyses were performed using SPSS version 30.0. Results: The concordance between the two sampling methods for HPV detection kappa was 0.949. High-risk HPV genotypes were detected in 50 women (35.2%) among the participants with available test results. Cytological abnormalities were identified in 51% of women who tested positive for HPV. Conclusion Self-sampling is a reliable method for HPV detection, demonstrating good concordance with healthcare professional-collected cervical samples. It has considerable potential to increase cervical cancer screening coverage and improve access to screening, particularly in geographically remote areas.

Background: Nuclear factor erythroid 2-related factor 2 (NRF2) is a transcription factor that plays a crucial role in regulating cellular responses to oxidative stress and xenobiotic exposure. However, excessive NRF2 activation can enhance cancer cell survival and contribute to chemoresistance. Therefore, increasing attention has been directed toward naturally occurring flavonoids that may modulate NRF2 activity. Molecular docking provides a computational approach for predicting potential interactions between flavonoids and NRF2 and may help identify candidate compounds for further investigation in cancer therapy. Objective: To evaluate the potential interactions of five naturally occurring flavonoids—daidzin, rutin, luteolin, apigenin, and quercetin—with the Neh1 domain of NRF2 using molecular docking and to identify promising candidates for further investigation based on docking scores and ligand efficiency. Materials and Methods: The potential interactions of five natural flavonoids, namely daidzin, rutin, luteolin, apigenin, and quercetin, with the target region of NRF2 were investigated using molecular docking. Three-dimensional structures of the flavonoids were retrieved from the PubChem database, while the NRF2 protein structure was obtained from the Protein Data Bank (PDB). Molecular docking calculations were performed using the CB-Dock2 web platform, which incorporates the AutoDock Vina algorithm. Results: The docking scores of the selected flavonoids ranged from −64.9 to −77.2. Daidzin exhibited the most favorable docking score (−77.2), followed by apigenin (−72.0) and luteolin (−71.4), whereas rutin showed the least favorable score (−64.9). The calculated RMSD values ranged from 14.766 to 15.344 Å, with relatively small differences among the ligands. Daidzin and apigenin exhibited comparatively lower RMSD values. The reported pose-clustering analysis indicated that all ligands occupied similar binding regions. In terms of ligand efficiency, apigenin (−2.40), luteolin (−2.30), and quercetin (−2.20) showed comparatively favorable values. Although daidzin had the most favorable docking score, its ligand efficiency relative to molecular size was comparatively lower. Conclusion The results suggest that daidzin and apigenin may be candidate compounds for further investigation of potential interactions with the Neh1 domain of NRF2. However, these findings are based solely on computational analysis. Further molecular dynamics simulations and experimental studies are required to validate the predicted interactions and determine their actual effects on NRF2 activity.

Background: Otitis media is an inflammatory disease involving the mucous membrane of the middle ear, including the auditory tube, tympanic cavity, mastoid antrum, and air cells¹. Multiple factors contribute to the development of OM, one of which is adenoid hypertrophy5. However, to date, no study has been conducted in Mongolia to assess the relationship between the degree of adenoid hypertrophy and OM. Aim: To analyze cases of children who underwent adenotonsillectomy. Materials and Methods: The study was conducted using a cross-sectional observational research design. Clinical data from a total of n=215 cases of children who were diagnosed with adenoid and palatine tonsil hypertrophy and underwent surgical treatment at Gurvan Gal Hospital between October 2023 and October 2024 were analyzed. Statistical processing was performed using STATA 14.2, with statistical significance considered at p < 0.05. Results: Clinical data from 215 children were analyzed to evaluate the relationship between the degree of adenoid hypertrophy (AH) and otitis media. The children ranged in age from 2 to 17 years, with a mean age of 7.23 ± 3.4 years. Among them, 128 (59.53%) were male (7.09 ± 3.29 years) and 87 (40.46%) were female (7.45 ± 3.58 years). A statistically significant moderate negative correlation was found between age group and the degree of adenoid hypertrophy (rho = -0.3485, p < 0.001). A significant seasonal variation in otitis media was observed (p = 0.0001). A statistically significant correlation was found between the degree of adenoid hypertrophy and otitis media (p < 0.001). However, no significant correlation was observed between the degree of palatine tonsil hypertrophy and otitis media (p = 0.8762). Conclusion The incidence of adenoid hypertrophy is highest among children aged 6 to 9 years, and there is a moderate negative correlation between age and the degree of adenoid hypertrophy. The occurrence of otitis media varies by season, with the highest number of cases reported during the winter months. As the grade of adenoid hypertrophy increases, the number of otitis media cases also rises.

Backround Peutz–Jeghers (PJ) syndrome is a rare autosomal dominant disorder characterized by a mucocutaneous pigmentationon on oral mucosa and multiple hamartomatous polyps located in the digestive tract except esophagus. PJ syndrome can be diagnosed in early childhood by a characteristic pigmentation and family history of polyposis. However, it is often diagnosed first as a polyp in the small intestine that causes obstruction and intussusception and is often treated with a bowel resection. If diagnosed in young childhood, an effective non-invasive method is to resect the polyps by tying off the blood supply to the polyps, that is the method named ischemic polypectomy, before they grow to the point of obstruction using a endoscopy. PJ syndrome is rare in Mongolia, but in severe cases, small intestine polyps are treated only surgically. Double-balloon-endoscopy (DBE) has been performed at the Mongolian- Japanese Hospital since 2023, making it possible to diagnose and treat the syndrome endoscopically. Our patient, a 15-year-old boy, had a mucocutaneous pigmentation that had been previously undiagnosed and was first diagnosed with intussusception at the age of 13. He had undergone 4 endoscopic procedures for upper and lower gastrointestinal polyps at the National Center for Maternal and Child Health successfully. In our hospital, we found endoscopically multiple hamartomatous polyps of various sizes between 1-3 cm, and a 3 mm diameter tumor that filled 3/4 of the intestinal lumen was treated by ischemic polypectomy. After the procedure, there were no early or late complications related to the procedure. The child's condition improved, the main complaints subsided, and he continues his daily life normally. However, follow-up DBE is required.

Background: Starting in 2019, the project "To compile and publish 108 volumes of traditional medicine, to protect the heritage of the ancient medical sources, and to open up its commercial opportunities for use" has been implemented.
As a result of this project, 50 volumes of books were published, including books created by Mongolian ancient doctors and maarambas, translated medical books from Chinese, Manchu, and Tibetan, as well as some books written by traditional medicine researchers and scientists between 1990-2020, have been published and made available to the public. During the creation of 108 volumes of traditional medicine, dozens of ancient medical scriptures were newly discovered. Among them, we have found medicinal books written by Indian and Tibetan scholars and monks from the 8th and 13th centuries. One of them is The Third Karmapa, Rangjung Dorje's sutra, "The Ocean of Medicinal Names." Therefore, it is imperative that we first study the biography and works of The Third Karmapa, Rangjung Dorje. Purpose: Clarifying the biography and works of The Third Karmapa, Rangjung Dorje, the author of the book "The Ocean of Medicinal Names". Research methods: Research of source documents (ancient sources), hermeneulic approach, analysis, and synthesis methods were used. Conclusion
1. The Third Karmapa, Rangjung Dorje, who lived between 1284 and 1339, was a prominent Tibetan religious and cultural figure, a famous author of many books who contributed to strengthening the foreign relations between Mongolia and Tibet and increasing the influence of the Garmaa Gaajud tradition in Yuan Dynasty.
2. Although Karmapa. Rangjung Dorje lived at the end of the 13th century and the first half of the 14th century, he was a well-known, active and creative monk. Therefore, his image has been left in many paintings and cast as God's image. In particular, he wrote an interesting book about medicinal raw materials called "The Ocean of Medicinal Names," which has only a few pages but briefly contains the names and potencies of 768 medicinal raw materials.

Introduction: Over 800,000 people in the world contract HCC each year and approximately 700,000 die from the disease. HCC is the 6th most common cancer in the world. HCC is the 3rd leading cause of cancer deaths in the world. 2/3 of liver cancer deaths are caused by hepatitis. In the U.S, HCV infection is the more common cause of HCC, while in Asia and Africa, HBV is more common. Mongolia ranks first in the world in mortality from liver cancer, indicating the need for early detection and treatment of cirrhosis. Sysmex Corporation has introduced for HISCL series analyser, a new cirrhosis marker M2BPGi of non-invasive, blood-testing. In 2016, the test was introduced at Medipas Hospital in Orkhon province. It is possible to study the advantages and significance of the marker for use in clinical practice. Materials and methods: From a total of 385 patients who underwent M2BPGi marker testing in 2016-2017Medipas hospital laboratory, data from a total of 283 patients tested for hepatitis B and C virus and M2BRGi markers were selected. A comparison of age, sex, and test parameters of a total of HCVab and HBsAg positive 172 patients tested for Total bilirubin, GPT, GOT, GGT, AFP and M2BPGi. HCV Ab, HBsAg, AFP, M2BPGi markers were analyzed by SysmexHISCL-5000 fully automated immunological analyzer, Liver function tests were performed with a fully automatic biochemical analyzer JEOL Biomajesty BM6010/C. Results: Of the M2BPGi marker tested 283 patients 94 (33%) were infected with the C virus, 78 (28%) were with the B virus,11 (4%) were co-infected with B and C viruses, 100 (35%) no any viral infection. Of the 172 patients diagnosed with hepatitis B and C virus infection, 97 (56%) were male, 75 (44%) were female. In terms of age, 72% of the population is over 45 years old.
Of the 172 patients, 115 (67%) had M2BPGi marker abnormal or > 1.0 COI. Of the M2BPGi marker abnormal patients, 47 (41%) were infected with the B virus and 68 (59%) with the C virus. In terms of age, 27.7% of hepatitis B patients and 10.3% of hepatitis C patients were under 45 years of age, 72.3% of hepatitis B patients and 89.7% of hepatitis C virus patients were over 45 years of age.
Hepatitis B and C viruses are slightly more common in men than in women. The majority of patients infected with the hepatitis virus over the age of 45. The majority of patients with hepatitis virus have abnormal liver function. Increased M2BPGi markers in people under the age of 45 with hepatitis B virus infection are relatively higher for hepatitis B virus infection than for C virus infection. Conclusions The M2BPGi marker was abnormal in 67% of hepatitis virus infected patients. It has been observed that the probability of an increase in M2BPGi marker is slightly higher in hepatitis C virus infection than in hepatitis B virus infection.

Introduction: Urinary tract infections (UTI) are at the second place in the frequency of all causes of infection after respiratory ones. The UTI requires appropriate antibiotic treatment. 85% of UTI predictive antibiotic treatment without confirmation by bacteriological analysis. This is one of the major causes of drug resistance, especially in K.coli. Urine bacteriological tests do not show bacterial culture in all cases where the number of bacteria in the urine exceeds the reference level. Therefore, there was a need to establish criteria for urine bacteriology test based on the results of urine sediment analysis.
In 20I7, a new fully automated Sysmex UF-5000 urine sediment analyzer was installed in the laboratory department of Medipas Hospital. The features of this analyzer include counting the number of bacteria in the urine, distinguishing between gram-positive and negative, homogeneous and mixed forms, and counting the formed elements in the urine. This feature made it possible to compare the number of bacteria and leukocytes in the urine with the results of urine bacteriology tests. Goal: Determine the relationship between the number of white blood cells and bacteria in the urine measured by the Sysmex UF-5000 urine sediment analyzer and the results of the urinary bacteriological test. Objectives: Compare the number of urine bacteriaand leukocyte measured by using the Sysmex UF-5000 urine sediment analyzer with the urine bacterial culture, and calculate the correlation. Materials and methods: The study is analytic cross-sectional study, analyzed the results of a total of 159 people who analyzed a urinalysis and urine bacteriological test at the Medipas Hospital Laboratory in 2017-2019 years.Urine samples were collected in a 100 ml, disposable sterile container in accordance with the instructions for taking urine midstream.Urine analysis was performed within 2 hours of sampling with a fully automatic urine sediment analyzer Sysmex UF-5000 Japan. Urine bacteriological analysis was performed on a lul sterile loop of urine specimens, inoculated into 5% blood agar from Hungary's BioLab, Sabouraud agar, and Chromogen agar from Biomerieux France, and incubated for 24 hours in an incubator at 37°C. Bacterial identification and antibiotic susceptibility tests were analyzed using the "Vitek-2" analyzer from the manufacturer Biomerieux France. Bacterial and leukocyte counts data measured by the Sysmex UF-5000 analyzer and urinary bacteriological analysis data were performed using SPSS23 software. Results: A total of 159 urine samples were tested for bacteriological analysis, of which 81 (50.9%) were bacteria over 105 CFU/ml or urine positive culture UTIs, 78 (49.1%) were nonsignificant bactcruria and urine negative culture.The average number of bacteria measured in the urine of 81 samples with urine positive culture above 105 CFU/ ml was 46491/ul (1168-100000 BACT/ul).
The average number of bacteria measured by the urine sediment analyzer of 78 samples with urine negative culture was 2645 BACT/ ul (2-57280 BACT/ul). To calculate more accurately estimate the average number of bacteria in 81 urine specimens with positive culture, the average number of bacteria in 17 (21%) samples was 4753 BACT/ul, measured in relatively low bacteria numbers of 1168-9450BACT/ul. The average leukocyte number in the urine of 81 samples with positive culture was 472.2 WBC/ul, and the average leukocyte number in the urine of 78 samples with negative culture was 87.7 WBC/ul.There is a strong correlation between the number of bacteria measured by the urine sediment analyzer and urine bacterial positive culture, which is 0.8 or statistically significant (p<0.001).The correlation coefficient of the number leukocytes measured by the urine sediment analyzer with in the urine positive cultureof bacteriological tests was 0.6 or moderately of statistically significant (p=0.005).There is a statistically significant relationship (p=0.001) between the number of bacteria in the bacterial positive culture population and the number of leukocytes. Discussion: Of the 81 cases of urine bacterial positive culture, 78 (96%) were female, indicating a high prevalence of UTI among women. According to the results of the Fabio Manon's study, the number of leukocytes in the urine is 160-340 WBC/uL and the number of bacteria is 15000-30000 BACT/u,L in the case of UTI, which is approximate results compared to the our study results.Based on the results of the urine sediment analysis, indications for a urine bacteriological test should be made.
Based on the results of urinary bacteriological tests, the choice of antibiotic treatment is the best treatment for urinary tract infections and a way to prevent of antibiotic resistance to UTI. Conclusions The number of bacteria measured by a Sysmex UF-5000 urine sediment analyzer is directly related to the bacterial culture urine bacteriological test. If the number of bacteria in the urine is measured above 4753 BACT/ul, it can be considered as an indication for urine bacteriological analysis. Although the number of leukocytes in the urine measured by the Sysmex UF-5000 urine analyzer is moderately correlated with bacterial culture in urine bactcriologucal tests, it is a key indicator of the degree of inflammation of the urinary tract.

Abstract: The basis of the development of traditional medicine in the XXI century is to study the old medical books and scriptures created by ancient Mongolian doctors and scientists of previous generations. For example, it is important to deepen the scientific understanding of “Man ngag rin chen ‘byung” written by Mongolian doctor ‘Jam dpal chos kyi bstan ‘dzin phrin las in Tibetan, and to understand the content and charms of the Man ngag rin chen ‘byung. Purpose: Sampling and analysis of experimental prescriptions in the “Man ngag rin chen ‘byung” written by Mongolian doctor ‘Jam dpal chos kyi bstan ‘dzin phrin las in Tibetan. Research methods: Methodologies of ancient textbook analysis and check list of textbook were used. Conclusion In the concluding remarks of the “Man ngag rin chen ‘byung” written by Mongolian doctor ‘Jam dpal chos kyi bstan ‘dzin phrin las, it was stated that there are many medicinal raw materials in the practice. He mentioned that: “I have summarized the benefits of medical literature written by the ancient doctors of Mongolian medicine to facilitate for people to learn.” An analysis of this sentence reveals that in the current understanding of medical science, it is evidence-based practice (EBP).