1.Study risk factors, genotype and prevalence of HCV infection among the populations in Arkhangai, Mongolia
Amgalan B ; ; Tsolmon Ch ; Myagmarjaltan B ; Naranzul N ; Khurelbaatar N ; Baatarkhuu O
Mongolian Journal of Health Sciences 2025;89(5):18-24
Background:
Hepatitis C virus (HCV) is a blood-borne infectious disease that, if left untreated, can lead to chronic
infection, liver cirrhosis, and hepatocellular carcinoma. In Mongolia, the prevalence of HCV is relatively high, posing
significant public health concerns. In alignment with the global goal to eliminate hepatitis B and C by 2030, this study
aimed to investigate the prevalence, genotype distribution, and associated risk factors of HCV infection among the general
population in Arkhangai province, Mongolia.
Aim:
To determine the prevalence of hepatitis C virus infection among the relatively healthy population of Arkhangai
Province and to study its genotypes and risk factors.
Materials and Methods:
A cross-sectional analytical study was conducted using a two-stage sampling method, enrolling
2,304 individuals aged 0–80 years. Participants completed a structured questionnaire, and blood samples were collected
for anti-HCV and HBsAg testing using enzyme-linked immunosorbent assay (ELISA) at the central laboratory of the
provincial hospital. Serum from anti-HCV positive individuals was preserved at –80°C and transported to Ulaanbaatar
for HCV RNA quantification via real-time polymerase chain reaction (RT-PCR) and genotyping through molecular
diagnostics. Statistical analyses were conducted using SPSS version 26.0.
Results:
A total of 2,304 individuals from the provincial center and 8 soums participated in the study, of whom 57.8%
were female. The overall HCV seroprevalence was 12.0%, with chronic HCV infection confirmed in 7.16%. Among
patients with chronic HCV, genotype 1b was identified in 98.2% of cases. Risk factor analysis revealed statistically
significant associations between HCV infection and undergoing cosmetic procedures, receiving injections in non-medical
settings, cupping therapy, and sharing shaving equipment.
Conclusion
This study HCV seroprevalence of 12.0% among the relatively healthy population in Arkhangai province,
with genotype 1b detected in 98.2% of chronic HCV cases. The following risk factors were found to be independently
associated with HCV infection: undergoing cosmetic procedures (OR: 2.3), cupping therapy (OR: 1.7), receiving nonmedical injections (OR: 2.4), and sharing shaving tools (OR: 1.5) (p<0.001)
2.Clinical Features, Diagnostic Evaluation, and Treatment Outcomes of Chronic Hepatitis C in Mongolia
Amgalan B ; Myagmarjaltsan B ; Munkhjargal Z ; Uzmee S ; Naranzul N ; Khurelbaatar N ; Baatarkhuu O
Mongolian Journal of Health Sciences 2025;89(5):158-167
Background:
Chronic hepatitis C virus (HCV) infection remains a major global health concern. Approximately 55–85%
of individuals with acute HCV infection progress to chronic disease, which is often asymptomatic. Therefore, early
diagnosis and treatment are crucial to prevent long-term complications. This provided the rationale for our study to
evaluate the clinical characteristics, diagnosis, and treatment outcomes of chronic HCV patients using direct-acting
antivirals (DAAs), with comparisons by viral genotype.
Aim:
To compare the clinical features, diagnosis, and treatment outcomes of chronic hepatitis C according to viral
genotypes.
Materials and Methods:
A total of 1203 chronic HCV patients attending the outpatient department of Arkhangai Provincial
General Hospital were included in this prospective and retrospective cohort study. HCV genotyping was performed, and
patients received DAA therapy. Clinical manifestations, laboratory findings, HCV RNA levels, and fibrosis scores (APRI
and FIB-4) were assessed at baseline, at week 4 of treatment, and at 12 weeks post-treatment. Statistical analysis was
conducted using SPSS version 26.0.
Results:
: Among all patients, 6.7% had liver cirrhosis, and 1.4% had previously received interferon-based therapy. Patients
with cirrhosis more frequently reported fatigue, abdominal discomfort, insomnia, right upper quadrant pain and loss of
appetite (p<0.001). Virologic response at week 4 was 98.9%, and sustained virologic response at 12 weeks post-treatment
was 99.3%. The mean APRI score decreased from 0.71±0.67 to 0.31±0.54, and FIB-4 from 1.61±0.41 to 1.16±0.26
(p<0.001). The most common adverse events were fatigue, headache, and nausea.
Conclusion
Treatment outcomes were 99.5% in patients with genotype 1b, 100% in genotype 1a, and 75% in genotype
2, with statistically significant differences (p<0.001). Both APRI and FIB-4 scores significantly decreased after treatment,
confirming the effectiveness of DAA therapy in improving liver fibrosis (p<0.001).
3.HER2 expression in patients with gastric cancer and Its clinical significance
Oyunchimeg N ; ; Undrakh O ; Naranzul S ; Dolgorsuren P ; Undarmaa T ; Gerelee Kh ; Adilsaikhan M ; Enkhjargal B
Mongolian Journal of Health Sciences 2025;90(6):112-119
Background:
Globally, gastric cancer accounts for 1,089,000 new cases and 769,000 deaths annually, ranking fifth in
overall cancer incidence and third in cancer-related mortality. The aim to determine HER2 expression in patients with
gastric cancer and to evaluate its correlation with clinical and immunological biomarkers, as well as the need for further
laboratory diagnostics.
Aim:
To determine HER2 expression in patients with gastric cancer and to evaluate its association with clinical and immunological
biomarkers, as well as the potential need for further laboratory diagnostics.
Materials and Methods:
A retrospective study was conducted using archived materials from patients with gastric cancer
at the Clinical Pathology, Molecular Genetics, and Pathology Laboratories of the National Cancer Center of Mongolia,
covering the period from 2019 to June 2025. HER2 protein expression in tumor tissue was assessed using immunohistochemistry
(IHC), and chromogenic in situ hybridization (CISH-HER2) was employed to confirm gene amplification.
Statistical analysis was performed using the Prisma-10 software.
Results:
In our study, among 210 cases of gastric cancer evaluated by IHC for HER2, 46 (21.9%) were HER2-positive
and 164 (78.1%) were HER2-negative. When comparing patients with gastric cancer stratified into HER2 1+ (negative)
and HER2 3+ (positive) groups, no statistically significant differences (p < 0.05) were observed in age, sex, tumor location
(surgically resected tissue), morphology, or disease stage. However, a higher proportion of males was noted in the HER2
3+ group (80.9%), though this did not reach statistical significance (p = 0.0879). Significant associations were found with
tumor markers. Elevated serum CA-72-4 (>5 ng/mL) was more frequent in the HER2 3+ group (58.8%; p = 0.0069). In
contrast, elevated CA-19-9 (>35 U/mL) was more common in the HER2 1+ group (93.5%; p = 0.0117), and elevated
CEA (>6.9 U/mL) was also predominant in the HER2 1+ group (90.6%; p = 0.002). These findings suggest that HER2 3+
status predominates in cases with elevated CA-72-4, which may influence diagnostic strategies and HER2-targeted therapies
(e.g., trastuzumab). Conversely, elevated CA-19-9 and CEA were more associated with HER2 1+ status, indicating
a need for further detailed investigation of these markers in relation to HER2 expression. In patients evaluated by CISH
for HER2 expression, stratification into HER2-positive and HER2-negative groups revealed no statistically significant
differences (p < 0.05) in age, sex, tumor location, morphology, stage, or serum tumor markers (CA-72-4, CA-19-9, CEA).
This suggests that HER2 status (positive/negative) may be independent of these variables. Although HER2 positivity was
higher in poorly differentiated tumors (48% vs. 30.6% negative; p=0.1414) and in stage IV disease (50% vs. 39.3% negative;
p=0.2607), these differences were not statistically significant. Elevated serum markers (CA-72-4, CA-19-9, CEA)
were observed but showed no significant correlation with HER2 status.
Conclusion
Determining the molecular profile of gastric cancer patients can significantly contribute to refining clinical
diagnosis, developing treatment strategies, enhancing therapeutic outcomes, and improving patients’ quality of life.
4.Results of a study on the prevalence of pulmonary tuberculosis among people with type 2 diabetes mellitus
Tsetsegtuya B ; ; Oyuntuya T ; ; Narantuya G ; Ulzii-Utas A ; Davaadulam D ; Purevsuren B ; Bolortsetseg G ; Aigul U ; Lkhagvajav N ; Ermek J ; Tsolmon B ; Oyuntugs B ; Naranzul D ; Mitarai S ; Buyankhishig B ; Sarantuya J
Mongolian Journal of Health Sciences 2025;90(6):135-140
Background:
The continuous annual increase in the prevalence of diabetes mellitus (DM) poses significant challenges not
only within our nation but also globally in the control and management of tuberculosis.
Aim:
This study aimed to determine the incidence of pulmonary tuberculosis among individuals with type 2 diabetes
mellitus (T2DM) residing in six central districts of Ulaanbaatar and to investigate associated factors.
Materials and Methods:
A cross-sectional study design was employed. Participants aged 18 years and older diagnosed
with T2DM and receiving care at endocrinology clinics in six central districts of Ulaanbaatar were selected using systematic random sampling. Presumptive TB cases were identified through a structured questionnaire and chest X-ray. Sputum
specimens were collected and subjected to smear microscopy and Xpert MTB/RIF assay for tuberculosis detection. Cases
confirmed by laboratory diagnosis, currently undergoing tuberculosis treatment and previously treated cases as per questionnaire data were classified as tuberculosis cases, and prevalence was calculated.
Results:
A total of 1,644 individuals with T2DM were enrolled in the study, of whom 836 (50.9%) were female, with
a mean age of 58 years (range 19–89). The overall prevalence of presumptive TB cases was 10.5% (n=172; 95% CI,
9.0–12.0). Among 112 suspected cases from whom sputum samples were obtained, 10 (8.9%; 95% CI, 4.9–15.7) were
laboratory-confirmed for M.tuberculosis. Notably, 7.2% (6 cases; 95% CI, 3.4–14.9) of asymptomatic individuals with
abnormal X-ray findings were diagnosed with tuberculosis. According to questionnaire responses, 9 participants (0.5%;
95% CI, 0.3–1.0) were undergoing tuberculosis treatment, and 53 (3.2%; 95% CI, 2.5–4.2) reported a previously treated
TB cases. The overall prevalence of tuberculosis among individuals with diabetes was 4.4% (n=72; 95% CI, 3.5–5.5).
Stratification by age and sex revealed a significantly higher prevalence among males (5.9%; n=48; 95% CI, 4.5–7.8)
compared to females (2.9%; 95% CI, 1.2–4.2) (p=0.002), indicating a twofold increased risk of tuberculosis in males.
Although no statistically significant differences in tuberculosis prevalence were observed across age groups (p>0.05), a
declining trend in prevalence with older age was noted.
Conclusion
The prevalence of tuberculosis among individuals with type 2 diabetes was 4.4% (n=72; 95% CI, 3.5–5.5),
with a significantly higher rate in males (p=0.002) and a decreasing trend with increasing age. Among asymptomatic
individuals exhibiting radiographic abnormalities, 7.2% were confirmed to have tuberculosis via laboratory testing
5.Occupational risk factor of health care workers of Hepatitis B infection and its prevention
Naranzul N ; Enkhjargal A ; Тumurbat B ; Tselmeg M ; Nandintsetseg Ts ; Tserendavaa E ; Baatarkhuu O ; Burmaajav B
Mongolian Medical Sciences 2020;191(1):87-95
Hepatitis B (HBV) and C (HCV) are viral infections which can cause acute and chronic hepatitis
and are the leading causes for hepatic cirrhosis and cancer, thus creating a significant burden to
healthcare systems due to the high morbidity/mortality and costs of treatment. The risk of HBV
infection in an unvaccinated person from a single HBV-infected needle stick injury ranges from 6–30.
The prevention of HBV infection among HCWs has become a crucial issue. HBV can effectively be
prevented by vaccination. A safe and effective HBV vaccine has been available since the 1980s and
can prevent acute and chronic infection with an estimated effectivity of 95%. In 2017, the São Paulo
Declaration on Hepatitis was launched at the World Hepatitis Summit 2017, calling upon governments
to include hepatitis B vaccines for HCWs in national immunization programs. The vaccine is 95%
effective in preventing infection and its chronic consequences and has an outstanding record of
safety and effectiveness. Data on current hepatitis B vaccine coverage among HCWs in Mongolia
is scarce. According to Azzaya et al, the protection level of the subjects was 67.2% >100 mIU/ml,
18.8%, 11-100 mIU/mL and 14.1%, 0-10 mIU/mL based on antibody titer level respectively among the
vaccinated HCWs at the 2nd Central hospital. Thus, the HBV vaccination among public and private
sector HCWs in Mongolia to inform the health authorities about the HCWs HBV vaccination status
along with associated problems and challenges for further improving vaccination strategy among
HCWs.
6.Gene mutation associated with drug resistance in M.tuberculosis strains isolated from national TB prevalence survey in Mongolia
Tsetsegtuya B ; Baasansuren E ; Oyuntuya T ; Tserelmaa B ; Gundsuren Sh ; Tsolmon B ; Naranbat N ; Tsatsralt-Od B ; Buyankhishig B ; Naranzul D
Mongolian Medical Sciences 2019;187(1):3-10
Background:
According to the First National Tuberculosis (TB) Prevalence Survey in Mongolia the prevalence of
bacteriologically-confirmed pulmonary TB among adults was 559.6 (95% CI: 454.5–664.7) per 100000
population in 2014–2015. This was three times as high as previously estimated. Nationwide anti-tuberculosis (TB) drug resistance survey was conducted in 1999 and 2007 in Mongolia. Share of multidrug resistant TB (MDR-TB) cases among newly notified TB cases increased from 1.0% in 1999 to 1.4% in 2007. Accordingly, we aimed to perform drug susceptibility test on strains isolated from TB Prevalence Survey and to determine the prevalence of drug resistant TB.
Material and Methods:
All 242 MTB strains isolated from the survey TB cases were tested GenoTypeMTBDRplus test and conventional 1st line DST on solid medium.
Result:
Conventional DST and GenoTypeMTBDRplus tests done for 93.8% (227/242) of them and 6.2% (15/242) were tested by GenoTypeMTBDRplus only. A 61.6% (95%CI 55.3-67.4) of all cases were susceptible to first line anti-TB drugs, any drug resistance and MDR-TBdetected as 38.4% (95% CI 32.5-44.7)and 9.5% (95% CI 6.4-13.9), respectively. Prevalence of MDR-TB was7.8% (95% CI 4.9-12.4) among new and 17.9% (95% CI 9.0-32.7) among previously treated cases. The 64 strains were identified as a resistant to isoniazid, 32.8% (42/64) and 65.6% (21/64) were katG, and inhAmutation, respectively. One isolate (1.6%) was mutations in both the inhAand katGgenes.The predominant mutations detected in therpoB were S531L (91.3%) among rifampicin resistant isolates and the mutation in inhAwas C–15T (100%) and katG mutation was S315T1 (100%) among isoniazid-resistant isolates.
Conclusion
Prevalence of cases with DR-TB is high among prevalent TB cases, especially prevalence of MDR-TB among new cases. In comparison to previous studies, DR-TB cases seem to be increased. Rifampicin resistant strains have a mutation of the rpoBand resistance to isoniazid is predominantly associated with the inhA mutation.
7.Results of analysis of reporting form of the new registered cases of tuberculosis
Mongolian Medical Sciences 2010;152(2):53-57
BACKGROUND:Tuberculosis is still an important infectious disease today. The resent World Health Organization TB Fact Sheet statesthat it kills approximately 2 million people each year. WHO estimated that between the years 2002 and 2020 inclusive,approximately 1000 million people will be newly infected. According to the fact sheet over the same period, more than150 million people will become infected, and 36 million will be die due to tuberculosis, if control of the diseases is furthernot strengthened.1In 2009, there were registered 4218 tuberculosis new cases in Mongolia. Among them 1809 cases were smear positivepulmonary cases. Mongolia has the 7th highest tuberculosis case rate country in the WHO.WPR.2GOAL: To review “Reporting Form” of the new registered cases of tuberculosis in Mongolia (2007-2009).OBJECTIVES:1. Evaluation how correct fills out of the “Reporting Form”–s of new registered cases tuberculosis.2. Social and professionals status of tuberculosis cases in Mongolia.MATERIALS AND METHODS:We conducted a retrospective study of 10237 Reporting Form of new case of TB. Which are cases reported from 21aimags and 9 districts of Ulaanbaatar city to the Tuberculosis Department of NCCD, between 2007 and 2009.Retrospective analysis for the “line list of tempore office leave’s” among health care works in National Center forCommunicable DiseasesRESULTS:10237 (79%) out of 12802 new TB cases were correct fill out new cases Reporting Forms in 2007-2009In 2007-2009, there were 43.3 %( 4436) unemployed people, 9.7% (994) students, 8.8 %( 901) pupils, 7.0 %( 712)pensionaries of all registered cases. A total cases 18.5 percentage was students.Also 111 health care workers were developed TB throughout country and it is 1.1% of total cases. A total cases of Healthcare workers; 30.6% (34) nurses, 28 %( 31) doctors, 15.3 %( 17) house keepers, nurses are most affected TB fromhealth care workers. Doctor’s who are working in TB and the judicial department, surgeons, dentists, center to recoverthe alcoholic, soum and family practitioners are most affected compared other doctors.CONCLUSION:1. In 2007-2009, there were 43.3% unemployed people, 9.7% students, 8.8% pupils, 7.0% pensionaries, 1.1%health care workers of all registered cases.2. Excepting students TB rate is 18.5% and this rate increasing year by year. We need to more study and analysisof students TB cases and need to planning further intervention among students3. Among health care workers who are working in tuberculosis hospital more risk of get infected tuberculosis.Urgent needs to improve the infection control intervention in the TB hospital and clinics, branch offices, whichhave high risk of infection.
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