Background: Asthma is a chronic inflammatory disease characterized by bronchoconstriction and breathing difficulties, which can be triggered by both allergic and non-allergic mechanisms. In allergic asthma, a hyperreactivity reaction occurs, leading to an increase in fractional exhaled nitric oxide (FeNO) levels. Therefore, FeNO is used to differentiate allergic and non-allergic types of asthma. In recent years, studies have been conducted to assess FeNO as an indicator of treatment effectiveness and symptom control. Our goal is to introduce FeNO measurement in Mongolia for the first time and utilize it for asthma diagnosis and treatment outcome evaluation. Aim: Study of FeNO levels in Asthma Diagnosis in Relation to Laboratory Findings and Lung Function Materials and Methods: This study included a total of 70 adult patients (18 years and older) with asthma who visited the Outpatient Clinic of Mongolia-Japan Hospital and Shargaljuut Spa Clinic from May to December 2024. Based on their allergic history, total IgE levels, and peripheral blood eosinophil count, participants were classified into allergic (>5%) and non-allergic (<5%) asthma. The study aimed to determine the diagnostic specificity and sensitivity of FeNO levels. Asthma control levels were assessed using the Asthma Control Test (ACT), lung function was evaluated using spirometry, and exercise capacity was measured with the 6-minute walk test. Results: In a single measurement, there were no differences between the allergic and non-allergic groups in parameters other than total IgE, peripheral blood eosinophil count, and FeNO levels. For diagnosing the allergic form of asthma, at a FeNO level of 25 ppb, sensitivity (Se) was 0.68, specificity (Sp) was 0.30 (p=0.008); at 40 ppb, Se was 0.77, Sp was 0.31 (p=0.001); and at 50 ppb, Se was 0.74, Sp was 0.33 (p=0.001). Lung function and exercise capacity were similar in both asthma groups. Conclusion The sensitivity of FeNO in distinguishing between allergic and non-allergic forms of asthma is 67-81%, and its sensitivity tends to increase as the FeNO level rises. By distinguishing the allergic type in which inhaled corticosteroids are more effective, the outcome of asthma treatment can be predicted in advance based on the FeNO level.

Background: Hyperferritinemia, characterized by elevated serum ferritin levels, affects approximately 5–25% of the general population. Given the frequent coexistence of liver iron overload syndrome and metabolic syndrome—both of which significantly contribute to global morbidity and mortality—it is essential to investigate their interconnections. However, there is a lack of sufficient evidence, both in Mongolia and internationally, regarding the relationship between iron storage indicators, metabolic syndrome, and its components. A deeper understanding of iron’s role in disease progression is needed. Aim: This study aims to assess the association between hyperferritinemia and metabolic syndrome parameters. Materials and Methods: A cross-sectional analytical observational study was conducted on 159 male participants who met the inclusion criteria. Data were collected using a standardized questionnaire, and anthropometric measurements were taken. Blood samples were analyzed to determine glucose, triglyceride, total cholesterol, and high-density lipoprotein (HDL) levels using an automated biochemical analyzer. Serum ferritin concentrations were measured via the ELISA method (DRG Instruments GmbH, Germany), with hyperferritinemia defined as a serum ferritin level exceeding 400 ng/ ml. Metabolic syndrome was diagnosed based on the Harmonized criteria. Statistical analyses included the chi-square test and Fisher’s exact test for categorical variables, the Mann-Whitney U test for non-normally distributed data, and Spearman’s correlation test to assess relationships between glycemic levels, lipid parameters, and metabolic syndrome components. Results: The findings indicate that 59 participants (37.1%) had metabolic syndrome, while 33 (20.8%) presented with hyperferritinemia. The presence of metabolic syndrome and hyperglycemia increased the likelihood of developing hyperferritinemia by 3.4 and 3.7 times, respectively, whereas abdominal obesity raised the risk by 2.2 times. Conclusion There was a significant correlation between serum ferritin levels and certain parameters of metabolic syndrome among the male participants in this study.

Background: Asthma is a chronic airway disease, and its prevention involves avoiding risk factors and ensuring proper inhaler techniques to reduce the risk of exacerbation. Aim: To determine the results of refresher training in health education for the control of bronchial asthma. Materials and Methods: A total of 56 asthma patients’ asthma who visited the outpatient department of the Mongolian Japanese Hospital were enrolled in an educational program aimed at improving asthma knowledge. Three months later, 26 of them were re-evaluated, and a comparison was made of their asthma knowledge, quality of life, and pulmonary function. The occupational status was divided into two groups: those working in offices and those working in factories and construction sites. Education was divided into two groups: those with bachelor, less bachelor. The usage levels of relievers and corticosteroids were divided into two groups: reliever usage was 3 canisters up or down per year, while systemic corticosteroid usage was 10 ampules up or down per year. Ethical approval for the study was obtained in accordance with the approval of the Bioethics Committee of the School of Medicine, Mongolian National University of Medical Sciences (approval number: 2019.06.05), and written consent was obtained from the participants. The data analyses are processed using Excel and SPSS 26 software. Results: According to the asthma control test scores, the improvement in control after the training increased from 8% to 12%, and the percentage of those with poor control improved from 15% to 23%. After the training, 27% (7) of participants showed improvement from their baseline control level, 8% (2) showed a decline, and the rest showed no change. Among the participants, 30.8% (n=8) used bronchodilators with a frequency of more than 3 canisters per year, while 46.2% (n=12) used dexamethasone more than 10 ampules per year. Multivariable analysis showed that age had an odds ratio (OR) of 1.1 (95% CI 0.2-8.10), education had an OR of 1.7 (95% CI 0.2-15.8), occupation had an OR of 1.2 (95% CI 0.1-10.9), bronchodilator use had an OR of 3.6 (95% CI 0.3-45.8), and dexamethasone usage had an OR of 2.1 (95% CI 0.3-15.7), all of which were identified as risk factors. Conclusion As a result of the short-term asthma education program, quality of life and lung function improved, and the level of control increased. This suggests that continuous education should be implemented.

Background: In December 2019, SARS-CoV-2 spread rapidly worldwide, leading the World Health Organization (WHO) to declare it a pandemic in March 2020. COVID-19 is an infectious disease with symptoms similar to the flu, varying in severity from mild to critical. Post-COVID-19 syndrome refers to the persistence of certain symptoms after recovery from the acute infection. The most common symptoms, such as fatigue, shortness of breath, coughing, and headaches, negatively affect patients’ daily lives. Aim: To investigate the clinical manifestations of post-COVID-19 syndrome concerning the severity of the initial infection. Materials and Methods: A hospital-based cross-sectional study was conducted between 2022 and 2023 at the Pulmonology and Allergy Center of the National Center for Health. In this study, we included participants who came for follow-up one year after being diagnosed with COVID-19. The severity of COVID-19 was categorized according to Living guidance for clinical management of COVID-19 issued by WHO and the COVID-19 diagnostic and treatment guidelines approved by the Minister of Health (A/549). Post-COVID-19 conditions were assessed using the 6-minute walk test, Borg rating of perceived exertion, and Fatigue Severity Scale (FSS). The Chi-square and Mann-Whitney U tests used on SPSS 26.0, with a p-value of <0.05 considered statistically significant. This study was approved by the Research Ethics Committee of the Mongolian National University of Medical Science (2022/03-06). Results: A total of 185 participants were included, comprising 74 men (40%) and 111 women (60%), with a mean age of 57.15±11.29 years. Among them, 90 (48.6%) had severe COVID-19, while 95 (51.4%) had non-severe cases. Clinical symptoms, including cough, dyspnea, fatigue, headache, and myalgia, were statistically different between the non-severe and severe groups. The median FSS score was 45 in the severe group and 38 in the non-severe group, showing a statistically significant difference (p<0.05). The median of 6-minute walking distance was 265 meters in the severe group and 282 meters in the non-severe group (p<0.05). The median Borg score was 2 in the severe group compared to 1 in the non-severe group (p<0.05). Conclusion Individuals who experienced severe COVID-19 exhibited reduced exercise tolerance, increased breathlessness, and more pronounced fatigue than those with non-severe cases.

Background: Tuberculosis (TB) is a preventable and usually curable disease. Yet in 2022, TB was the world’s second leading cause of death from a single infectious agent, after coronavirus disease (COVID-19)1. Aim: By reviving strains isolated at specific years over a 10-year interval and performing next-generation sequencing, we can analyze their strain genotype, epidemiology, drug resistance, and dynamicsTherefore, this study was conducted to examine the historical trends and dynamics of strain genotype, variants, and drug resistance of tuberculosis preserved in the culture bank. Materials and Methods:: Using a retrospective, laboratory-based research approach, 200 strains were randomly selected from over 1,000 diagnostic isolates preserved in the NTRL culture collection from 2010 and 2020. Whole-genome sequencing (WGS) was performed using GridION from Oxford Nanopore Technologies (ONT, Oxford, UK) to analyze these strains. The FastQ file was submitted to the International Mycobacterial Database. Strain genotypes, subtypes, gene mutations of drug resistance, and resistance profiles were identified using TBprofiler, MTBseq, IQ-Tree (version 1.6.12), and EPI2me software. Results: Of the tuberculosis strains selected for the study, 66.5% were from eight out of nine districts of Ulaanbaatar, while 33.5% were sampled from 16 out of 21 provinces. Out of the strains analyzed, 83.9% (95% CI 78.7–89.1) belonged to lineage 2 or the Beijing genotype, while 16.1% (95% CI 10.9–21.3) were lineage-4 or Euro-American genotype. While the proportion of Beijing lineage strains was slightly higher and the Euro-American lineage strains slightly lower in rural populations compared to urban populations, the difference in strain distribution between urban and rural areas was not statistically significant (p=0.485). Among the Beijing lineage strains, only the modern Beijing sublineage (100%) was identified. In contrast, the Euro-American lineage exhibited various sublineages: 4 (0.5%), 4.5 (1%), 4.1.2.1 (Haarlem, 3%), Latin American-Mediterranean (LAM, 7.5%), mainly T (3.5%), and S type (0.5%). Notably, the proportion of Lineage 2 strains increased from 80% in 2010 to 86% in 2020. The overlap of the confidence intervals for 2010 (72.16%–87.84%) and 2020 (79.20%–92.80%) indicates that there has been no significant change in the distribution of Mycobacterium tuberculosis lineages over time. The study revealed that among the selected Mycobacterium tuberculosis strains, resistance rates to first-line anti-tuberculosis drugs were as follows: isoniazid (39%), rifampicin (21%), ethambutol (19%), and streptomycin (34%). Genotypic analysis indicated that the Beijing lineage was predominantly associated with drug-resistant tuberculosis cases, including multidrug-resistant (MDR), poly-drug-resistant, and mono-drug-resistant TB. Notably, the Beijing lineage accounted for 100% of pre-extensively drug-resistant (pre-XDR) TB cases. Within the Haarlem lineage, 33% were MDR-TB. In the Latin American-Mediterranean (LAM) lineage, 13.3% were MDR-TB, 6.6% were poly-drug-resistant, and 13.3% were mono-drug-resistant. Among the mainly T lineage, 42.8% exhibited mono-drug resistance. These findings suggest that the distribution of M. tuberculosis lineages in the Mongolian population has remained relatively stable over time, with no significant temporal changes. Conclusion The distribution of M. tuberculosis genotypes circulating among the population of Mongolia has remained relatively stable over time, with no significant time-dependent changes. Additionally, no mutations associated with resistance to newly introduced anti-TB drugs were detected.

Staphylococcus aureus (S. aureus) is a clinically significant pathogen widely distributed in food production environments. Its ability to form biofilms on food contact surfaces enhances 50 environmental persistence, increases antibiotic resistance 10–1500-fold, and poses serious challenges for food safety and public health. In Mongolia, data on the biofilm-forming ability of S. aureus in meat processing and retail environments are limited. A cross-sectional study was conducted on 437 samples collected from meat supply and retail sites, including raw meat, aprons, counters, trolleys, and workers’ hands. Isolation and confirmation of S. aureus were performed using MNS 6308:2012 and ISO 6888-1:2021 standards, followed by PCR amplification of the species-specific nucA gene (270 bp). Biofilm formation was evaluated using the microtiter plate assay with 0.5% glucose supplemented tryptic soy broth and optical density at 490 nm, and confirmed by scanning electron microscopy (SEM). Statistical analyses were performed using chi-square tests with p< 0.05 considered significant. Of the 437 samples, 14.2% (62/437) were contaminated with S. aureus. Contamination was higher in retail markets (25.9%) than supply sites (9.3%). Among isolates, 40.3% exhibited biofilm-forming ability: 29.0% weak, 9.7% moderate, and 1.6% strong. Biofilm formation did not significantly differ by sampling site or sample type (p>0.05). SEM imaging revealed distinct biofilm architectures with polysaccharide matrices at 80,000× magnification. A considerable proportion of S. aureus isolates from meat processing and retail environments exhibited biofilm forming ability, posing a potential risk for cross-contamination and persistent foodborne transmission. Strengthened hygiene and sanitation measures are essential to control biofilm-associated S. aureus contamination in Mongolia’s meat production and supply chain.

Background: Schizophrenia is a severe psychiatric disorder of endogenous origin, characterized by the coexistence of prominent positive and negative symptoms and a chronic course. It typically begins during adolescence or early adulthood, leading to disturbances in cognition, thought processes, and emotional regulation, which subsequently result in loss of daily functioning and impairment in social adaptation. Aim: The aim of this study was to evaluate the clinical manifestations of schizophrenia using the Positive and Negative Syndrome Scale (PANSS) and to determine the severity levels of positive, negative, and general psychopathological symptoms. Materials and Methods: A cross-sectional study was conducted at the National Center for Mental Health between December 2016 and December 2019. A total of 102 patients with schizophrenia, aged 20 to 66 years, who were under active outpatient follow-up, were included in the study. Clinical symptoms were assessed using the PANSS. Results: Of the 102 participants, 51% (n=129) were female, with a mean age of 40±12 years. The distribution of positive, negative, and general psychopathological symptoms showed that 21–24% were in the mild to moderate range. Notably, 23% of patients presented with severe negative symptoms, such as blunted affect, social withdrawal, and reduced motivation, indicating that these features are particularly prominent in advanced stages of schizophrenia. Positive symptoms were found to be mild to moderate in 15–24% of patients, suggesting that hallucinations and delusions are more pronounced during the early course of the illness but tend to decline as the disease progresses. General psychopathological symptoms were observed in 12–22% of patients, remaining relatively stable across all severity levels. Conclusion In the early stages of schizophrenia, positive symptoms predominate, whereas in the advanced stages negative symptoms become more prominent. General psychopathological symptoms appear consistently across all levels of severity. These findings highlight the importance of evaluating both positive and negative dimensions when assessing the clinical course of schizophrenia.

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

Background: Worldwide, the leading cause of blindness in people over the age of 50 is age-related macular degeneration (AMD), which is a complication of the exudative “wet” and dry type. AMD is a multifactorial neurodegenerative disease relating with a combination of environmental and genetic factors, and a contribution of age effect and smoking also, obesity was investigated to be associated with the disease. Number of previous studies have shown that the polymorphisms in the ARMS2, CFH and VEGF-A genes are associated with AMD. Therefore, we investigated the associations between the five common vascular endothelial growth factor (VEGF) polymorphisms and AMD with its therapeutic results. Materials and Methods: Totally 161 AMD patients and 223 controls were enrolled in this case-control study. A prospective analysis of 66 eyes of 34 patients with neovascular AMD evaluated intravitreal bevacizumab injections. The polymorphisms in CFH, ARMS2 and VEGF-А were detected by using the methods of allele-specific polymerase chain reaction (ASPCR) and PCR based restriction fragment length polymorphism (RFLP). Statistical analyses were performed by SNPalyze software. Results: Results of the study showed that rs1061170, rs1065489, and rs800292 polymorphisms are associated with arterial hypertension. Anti-coagulant intake rs1061170 polymorphism T/C, C/C/C/C risk genotype (OR=5.04, 95% CI, 1.81-14.09, p=0.002, RERI=2.568, AP=0.509, S=2.7302) , combined effect of G/C/C/C/ /G, G/A risk genotype (OR=6.52, 95% CI, 2.88 14.79, p<0.001, RERI=4.187, AP=0.642, S=4.136) are associated with increased risk of AMD. In the study, in 66 eyes of a total of 34 people who received intravitreous injection treatment, the central retinal thickness before and after treatment was 294.59±83.52 before treatment, 262.74±87.02 on the first day after treatment, 259.5±111.83 after one month, 248.98±84.96 after 3 months, and 262.69 after 6 months. ±110.59, after 1 year it decreased to 259.19±112.29 (95% CI, 226.74-291.65), which is a statistically significant difference. A comparative study of polymorphisms in therapeutic and non-therapeutic groups revealed statistically significant differences in the G/G groups of rs2010963 polymorphisms. Also, people with G/G genotype of rs2010963 polymorphism are more effective in treatment than people with other genotypes. Conclusion Individual factors such as not wearing sunglasses and arterial hypertension and using anti coagulant medication have been identified as risk factors for AMD. The result showed that polymorphisms of ARMS2, CFH, VEGF genes can be a genetic risk factor for AMD. The decreased in central retinal thickness and improving VA after anti-VEGF treatment confirm the effectiveness of the treatment. Also, people with G/G genotype of rs2010963 polymorphism are more effective in treatment than people with other genotypes. Identification of genetic markers that affect clinical response may result in optimization of anti-VEGF therapy.

Background: The shapes of the eye and upper eyelid are distinctive facial landmarks. The palpebral fissure is composed of the free edges of upper and lower eyelids the lateral and medial canthus. Many researchers confirmed that the morphometric characteristics of the palpebral fissure, canthal distance and exophthalmometirc value (EV) vary according to race, ethnicity, age and sex and normative values which may serve as a reference in the index population. Knowledge of normal dimensions, the existence of asymmetry of the palpebral fissure is of value in several clinical specialties including ophthalmology, plastic and reconstructive surgery and traumatology, where it plays a part in the patient evaluation, management and outcomes. Methods: This cross-sectional study was conducted in the Ophthalmological Department, Third State Central Hospital between January 2022 and August 2022. We included participants who are above 18 years, no history of congenital or traumatic craniofacial deformities, any orbital fractures, tumors and surgeries. All measured values that represent eyelid shape and EV were calculated by mean and standard deviation for statistical analysis. Results: A total of 103 participants aged 19-86 were included in the study, of which 44 (42.7%) were male and 59 (57.3%) were female. The distance between the lateral and medial canthus ranged from 20 to 35 mm, and the mean of the right and left side was 28.30+3.23 mm and 28.05+2.99 mm, respectively (p=0.561). The palpebral fissure height ranged from 5 to 13 mm, and the mean of the right and left side was 8.85+1.65 mm and 8.80+1.65 mm, respectively (p=0.816). The mean distance between the lateral canthi were 90.39+5.57 (range: 80-105 mm), whereas the mean distance between the medial canthi were 63.75+4.25 (range: 53-73 mm). The orbital height varied between 27-43 mm (33.73+3.72) and 26-44 mm (33.78+3.73) on the right and left sides, while the orbital width varied between 26-47 mm (36.75+4.53) and 27-45 mm (36.72+4.42) on the right and left sides, respectively. When measuring the exophthalmometric value (EV), the axial position of the eyeball, with the Hertel’s exophthalmometer, it ranged from 8 to 20 mm on both sides (mean value 13.68+3.01 and 13.71+3.00 on the right and left sides, respectively), and there was no statistically significant difference in symmetry (p=0.94). Conclusion The results are determined different from the findings of Chinese, Korean, Afro-American and Caucasian population based studies. Thus further evaluation is required to represent the normative value of Mongolian index population, that is highly beneficial for clinical assessment, diagnosis and management.