Background: Arterial hypertension (AH) is a major risk factor for cardiovascular morbidity and mortality, with both genetic and environmental factors contributing to its development. The insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene has been investigated as a potential genetic determinant of hypertension; however, evidence in the Mongolian population remains limited. Aim: To determine the distribution of the ACE gene I/D polymorphism and investigate its association with arterial hypertension and cardiovascular risk factors in a Mongolian population. Materials and Methods: A case-control study was conducted between October 2018 and November 2019. A total of 150 participants aged 20–64 years were included, comprising 100 patients with AH and 50 normotensive controls. AH was defined as blood pressure ≥130/80 mmHg or current use of antihypertensive medication. Cardiovascular risk factors were assessed using questionnaires and physical examination. Genomic DNA was extracted from peripheral blood lymphocytes, and the ACE I/D polymorphism in intron 16 was determined using a two-step polymerase chain reaction (PCR). Associations between ACE genotypes and AH were assessed using the chi-square test and multivariable logistic regression. A p value <0.05 was considered statistically significant. Result: Among the 150 participants, 64 (42.7%) were male, and the mean age was 44.2±11.7 years. The frequencies of the II, ID, and DD genotypes were 44.0%, 39.3%, and 16.7%, respectively. No significant difference in genotype distribution was observed between males and females. The frequencies of ID, DD, and II genotypes in the hypertensive and control groups were 39.0% vs. 40.0% (p=0.906), 14.0% vs. 22.0% (p=0.215), and 47.0% vs. 38.0% (p=0.295), respectively. The D-allele frequency was 0.33 in the hypertensive group and 0.42 in the control group, with no statistically significant difference. Participants with AH were older and had significantly higher body mass index, waist circumference, salt intake, alcohol consumption, and blood pressure compared with controls. Conclusion 1. The I allele of the ACE gene was predominant in the studied Mongolian population. 2. Neither the ACE I/D genotype nor the D allele was significantly associated with arterial hypertension. Traditional cardiovascular risk factors, including older age, excess body weight, abdominal obesity, high salt intake, and inappropriate alcohol consumption, showed stronger associations with hypertension in this population.

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: Helicobacter pylori (H.pylori) infection is highly prevalent worldwide, with an overall infection rate of 50% of the total population. Effective and accurate eradication treatment for H.pylori is considered one of the most important preventative measures against gastric cancer. However, the increasing prevalence of clarithromycin-resistant H. pylori strains has significantly compromised the success rates of standard eradication regimens. In recent years, many countries have adopted molecular diagnostic methods to detect H.pylori infection and assess clarithromycin resistance. These approaches, which are often non-invasive, enhance both diagnostic accuracy and the ability to tailor treatment strategies. Although numerous studies have investigated methods for detecting H. pylori and clarithromycin resistance using gastric tissue specimens, relatively few have focused on the clinical application of stool-based diagnostics, despite their potential advantages in non-invasive testing. Aim: To detect H.pylori infection and clarithromycin resistance using molecular biological methods from both gastric tissue and stool samples, and to comparatively evaluate the diagnostic outcomes. Materials and Methods: The hospital-based cross-sectional study was conducted at the Gastroenterology department of the Mongolia-Japan Hospital. A total of 125 dyspeptic patients aged 18-80 years were enrolled. Eligibility criteria required the H.pylori infection to be confirmed by at least two diagnostic methods. Each participant underwent both invasive (histological examination, gastric biopsy-based real-time PCR) and non-invasive (urea breath test, stool antigen test, stool-based real-time PCR) methods. Gastric biopsies and stool samples were analyzed by real-time PCR to detect H.pylori and identify clarithromycin resistance-associated 23S rRNA point mutations (A2143G, A2142G, A2142C) Results: Among the study participants, 60.0% (n=75) were female and 40.0% (n=50) were male, with a mean age of 39±1 years. Comparative evaluation of the diagnostic methods for H.pylori infection demonstrated that the stool antigen test, performed in 104 individuals, yielded positive results in 91 cases (87.5%), whereas the urea breath test, performed in 51 individuals, was positive in 45 cases (88.2%). Using real-time polymerase chain reaction (PCR), H.pylori was detected in 76 of 101 stool samples (75.2%) collected in ENAT transport medium, and in 43 of 87 raw stool samples (49.4%). The estimated diagnostic sensitivities were 94% for the urea breath test, 91% for the stool antigen test, 78% for real-time PCR using ENAT-preserved stool, and 49% for real-time PCR using raw stool specimens. Clarithromycin resistance was found in 36 participants (28.8%), while 89 participants (71.2%) carried H.pylori strains susceptible to clarithromycin. Clarithromycin resistance was detected in 27.6% of stool samples and 30.5% of gastric biopsy specimens. Among the clarithromycin-resistant isolates identified from gastric tissue, 35 cases (97.2%) carried the A2143G point mutation, while the A2142G mutation was detected in only 1 case (2.8%). All resistant cases detected from stool samples carried the A2143G mutation, whereas the A2142G mutation was not observed. Conclusion Real-time PCR demonstrated high efficacy for the detection of H.pylori infection and clarithromycin resistance in gastric biopsy specimens. While the sensitivity of stool-based real-time PCR was comparatively lower, detection rates improved with the use of ENAT transport medium. These findings highlight the potential of stool-based real-time PCR as a non-invasive diagnostic tool; however, further investigations are warranted to optimize assay performance through rigorous standardization and refinement of sample processing protocols for the accurate detection of clarithromycin-resistant H.pylori.

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)

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: Pre-procedural mouth rinsing has been shown to reduce pathogenic microorganisms, prevent secondary infections, and shorten healing time prior to periodontal treatment, oral surgeries, and endodontic procedures. In Mongolia, most dental clinics routinely recommend mouth rinsing before treatment. Moreover, since the COVID-19 pandemic, there has been a notable increase in the public’s use of various mouth rinses outside clinical settings. However, there is a lack of comparative clinical studies assessing the efficacy of these commercially available rinses. Aim: To clinically compare the effects of various commonly used mouth rinses with different active ingredients on the oral environment. Materials and Methods: A case-control study was conducted involving 210 participants with mixed dentition, receiving care at the Pediatric and Preventive Dentistry Department of the Central Dental Hospital of Mongolian National University of Medical Sciences. Participants completed a 17-question survey in three groups, followed by clinical examinations. Oral pH, malodor, and bacterial counts were measured using a phase-contrast microscope (OMAX 40X-2500X, USA) after collecting plaque and saliva samples. Ethical approval was obtained from the Research Ethics Committee of the Mongolian National University of Medical Sciences. Data analysis was performed using STATA 14. Results: A total of 210 children participated (mean age 9.04±1.2 year; 52.2% male, 47.8% female). The average DMFT index was 6.3 DMF+df/t (high), and oral hygiene index was 1.53 score (moderate). The baseline oral pH was 6.3±0.5 score. After rinsing with sodium bicarbonate, the pH increased to 7.4±0.4 score, and remained at 6.61±0.31 score after 40 minutes. In contrast, the placebo group showed minimal change (6.06±0.45 to 6.09±0.31 score). Statistically significant differences between groups were observed. Baseline oral malodor averaged 80.8±1.4 ppb. After rinsing with povidone-iodine, it decreased to 76.1±3.4 ppb at 40 minutes, while in the placebo group it decreased from 74.2±4.9 ppb to 66.3±3.8 ppb. Bacterial count prior to rinsing was 18.85±0.77 score. Chlorhexidine gluconate reduced this to 11.06±0.68 score immediately after rinsing and to 8.8±3.8 score after 40 minutes, whereas the placebo group showed minimal reduction (15.21±2.02 to 17.6±2.2 score). Conclusions Pre-procedural mouth rinsing demonstrated a statistically significant positive impact on the oral environ ment, including improvements in breath odor and a reduction in microbial load. The effectiveness of these outcomes was found to vary depending on the specific composition of the mouthwash used. These findings suggest that selecting an appropriate mouthwash based on the clinical setting can enhance treatment efficiency. Nonetheless, all evaluated solutions contributed to maintaining or improving the balance of the oral environment.

Background: Sleep is a complex neuropsychological, biological, and physiological process essential to human health. Obstructive Sleep Apnea (OSA) is a highly prevalent disorder worldwide. In Asian countries, 12–40% of the population, and in the United States, 35.8% of the population are estimated to be at high risk for OSA. In Mongolia, however, there is limited research on the prevalence of OSA, which led to the initiation of this study. Aim: To determine the prevalence and risk level of OSA among the Mongolian population. Materials and Methods: A total of 1,405 individuals aged 18 and older from the clinical Mon-Timeline cohort study were assessed using the Berlin Questionnaire (BQ). The BQ evaluates three categories: snoring and witnessed apneas, daytime sleepiness, and high blood pressure and obesity. Individuals who met criteria in any two of the three categories were classified as being at high risk for OSA. Data on educational attainment and lifestyle behaviors were collected using the Food Frequency Questionnaire and the Global Physical Activity Questionnaire. Statistical analysis was performed using Student’s t-test, Pearson’s chi-square test (χ²), and ANOVA. Results: The mean age of participants was 42 ± 14.3 years, and 42.5% were male. A total of 24.3% (n=341) were found to be at high risk for OSA. The risk increased with age: 6.7% in individuals under 30, 28.3% in those aged 30–50, and 39.4% in those over 50. Participants at high risk for OSA tended to be older and more physically inactive. Additionally, 41.7% of all participants reported snoring, and 39.3% of those stated that their snoring disturbed others. Conclusion A significant portion (24.4%) of the Mongolian population is at high risk for OSA. These individuals are more likely to be older and physically inactive. The high prevalence of snoring and associated disturbances suggests a need for increased awareness, early detection, and age-targeted prevention strategies in Mongolia.

Background: Sjögren's syndrome is a chronic autoimmune inflammatory disease characterized by lymphocytic infiltration of exocrine glands, typically presenting with symptoms such as xerostomia (dry mouth) and xerophthalmia (dry eyes). This disease can appear as an isolated condition or in association with other diseases. It is most commonly associated with rheumatologic disorders such as rheumatoid arthritis and systemic lupus erythematosus, but in rare cases, it may also be associated with other autoimmune diseases involving various organ systems. Autoimmune hepatitis is a chronic liver inflammation characterized by elevated serum globulin and antibody levels. The coexistence of Sjögren's syndrome and autoimmune hepatitis is very rare, with some sources indicating an incidence of only 1.7%. In our clinical case report, a rare occurrence was observed in a 52-year-old female who had been diagnosed with Sjögren's syndrome in 2022 and later developed symptoms of hepatitis, leading to a diagnosis of autoimmune hepatitis. When autoimmune hepatitis coexists with other autoimmune diseases, it often presents with mild clinical symptoms, which may delay the diagnosis. Case report: A 52-year-old female patient presented in 2020 with complaints of dry eyes and mouth, blurred vision, decreased saliva production, fatigue, and occasional swelling of the lymph nodes, as reported during her medical history. In December 2022, she was seen by a rheumatologist at the Mongolia-Japan Medical Center. Laboratory tests revealed positive results for anti-SSA52, CENP-B, ANA IgG, and RF, with altered liver function (see Table 1). A Shirmer test was positive, and saliva production was ≤ 0.1 mL/min. According to the ACR-EULAR 2016 diagnostic criteria, she scored 5 points, confirming the diagnosis of Sjögren's syndrome. Treatment was initiated with hydroxychloroquine and corticosteroids, along with medications for gastric protection, liver protection, and prevention of complications. In March 2023, during a follow-up visit, laboratory tests showed altered liver function (see Table 1). Hepatitis B and C antibodies were negative, and Liver-9-line results were normal. Due to the positive clinical dynamics of Sjögren's syndrome, the dose of hydroxychloroquine was reduced, and other treatments were continued. The patient was also advised to see a gastroenterologist for further evaluation. In August 2024, she presented to the gastroenterology department at Intermed Hospital with complaints of left abdominal pain and jaundice. Upon examination, abdominal ultrasound was normal, but laboratory results showed elevated IgG (132 H), ANA (>400 U/L), ALT (119.2 U/L), and AST (132.8 U/L), which raised suspicion of autoimmune hepatitis. Consequently, a liver biopsy was performed. Liver Biopsy (August 2024): The liver tissue shows a portal triad with 13 portal trios, where there is mild infiltration of lymphocytes, eosinophils, and a few neutrophils around the portal triads. Focal macrosteatosis of hepatocytes and bile stasis are observed. In Masson’s trichrome stain: There is fibrosis around the portal triads with connective tissue proliferation (ISHAK-1). In PAS staining: Focal positive staining is observed within the hepatocytes. According to the international autoimmune hepatitis diagnostic criteria, the diagnosis of autoimmune hepatitis was confirmed with a score of 8 (ANA +2, IgG +2, Biopsy +2, HBV HCV negative +2). Liver biopsy confirmed the diagnosis of primary sclerosing cholangitis. Treatment with corticosteroids and choleretic therapy was initiated, and a follow-up visit is planned in one month. In September 2024, upon follow-up, liver function had improved compared to previous tests, and treatment was continued. The patient is now under ongoing monitoring by both a gastroenterologist and a rheumatologist. Conclusion The coexistence of Sjögren's syndrome and autoimmune hepatitis is a rare clinical occurrence, with foreign studies reporting an incidence of less than 1%. However, if autoimmune hepatitis goes undiagnosed, it can lead to complications such as liver cirrhosis and hepatocellular carcinoma. Therefore, it is of critical importance to perform antibody tests and tissue biopsy for early detection and differential diagnosis in patients diagnosed with Sjögren's syndrome who present with liver and biliary symptoms or laboratory findings indicating liver dysfunction. This clinical case emphasizes the need for careful monitoring and early intervention.

Background: Type 2 diabetes has increased risk of heart failure 2-4 times more than those in non-diabetic subjects. The early detection of asymptomatic ventricular dysfunction by using NT-pro BNP test in diabetic patients is the best strategy for decreasing morbidity and mortality of heart failure. Aim: The aims of this study were to detect asymptomatic cardiac ventricular dysfunction by using NT-pro BNP test in subjects with type 2 diabetes and to define the factors associated with elevated NT-proBNP. Materials and Methods: This cross-sectional study was included diabetic and non diabetic subjects aged from 35- to 64 years, who had no clinical symptoms of heart failure. Cardiovascular risk factors were detected by clinical examinations. NT-pro BNP determination was performed on an immunoassay analyzer (FIA1100, Getein Bio Medical Inc, China), which uses reagent strip to obtain quantitative NT-pro BNP results in plasma. The cut-off point for NT-pro BNP was 300 pg/ml. Results: A total of 536 subjects without clinical symptoms of heart failure were included in the study of which, 150 were diabetic and 386 were non diabetic. The mean age was 52.8 ± 7.8 years and 281 (52.4%) were females. Cardiac ventricular dysfunction was detected in 7.3% of diabetic and 5.2% of non diabetic subjects. Cardiac ventricular dysfunction in diabetic subjects was increased with age and non-significantly higher in females than in males (8.3% vs 6.4%, p>0.05). In the logistic regression analysis, uncontrolled hypertension (OR 3.80, 95% CI 1.07–13.44), long duration of disease (OR 5.30, 95% CI 1.36-20.66), and ageing (OR 5.40, 95% CI 1.29–22.88) were significantly correlated cardiac ventricular dysfunction in subjects with type 2 diabetes. Conclusion Cardiac ventricular dysfunction in subjects with type 2 diabetes was detected 1.4 times more than those in non diabetic subjects. The likelihood of positive NT-pro BNP test in subjects with type 2 diabetes was independently (p<0.05) associated with advanced age, uncontrolled hypertension and long duration of diabetes.

Background: Helicobacter pylori (H. pylori) is a gram-negative, microaerophilic bacterium that colonizes the human gastric mucosa, with an estimated global prevalence exceeding 50%. The increasing resistance of H. pylori to clarithromycin, a key antibiotic in eradication regimens, has led to a decline in the efficacy of standard treatment to below 80%. Consequently, international guidelines advocate for susceptibility-guided therapy to optimize treatment outcomes. Detection of clarithromycin resistance-associated mutations, including A2143G, A2142G, A2142C, and A2144G, is essential for improving therapeutic efficacy and mitigating the propagation of antimicrobial resistance. Aim: To evaluate the efficacy of tailored H. pylori eradication therapy based on clarithromycin resistance profiling. Materials and Methods: A total of 125 treatment-naïve patients diagnosed with H. pylori infection were enrolled in this study. The infection was confirmed through upper gastrointestinal endoscopy with histopathological analysis, the urea breath test, and stool antigen detection. Clarithromycin resistance-associated mutations were identified using polymerase chain reaction (PCR) analysis on gastric biopsy and stool samples. Based on the presence or absence of resistance mutations, patients were stratified into two treatment cohorts and received targeted eradication therapy. Treatment success was assessed 28 days post-therapy using a stool antigen test to confirm H. pylori eradication. Results: Among the 120 patients who met the inclusion criteria and completed treatment, 41.6% (n=50) were male, and 58.4% (n=70) were female, with a mean age of 39±9.1 years. Clarithromycin resistance-associated mutations were detected in 36 patients (30%), with A2143G identified in 35 cases (97.2%) and A2142G in 1 case (2.7%). In the clarithromycin-sensitive cohort, 84 patients underwent eradication therapy, and among the 60 who completed post-treatment assessment, the eradication rate was 91.6%. In the clarithromycin-resistant cohort, 36 patients received treatment, and among the 20 who completed post-treatment assessment, the eradication rate was 80% (p=0.038). Conclusion A substantial prevalence of clarithromycin resistance-associated mutations was observed among the study population. Susceptibility-guided eradication therapy demonstrated superior efficacy, with eradication rates exceeding 90%. These findings underscore the necessity of implementing resistance-based treatment strategies to optimize clinical outcomes and limit the further dissemination of antimicrobial resistance. Future investigations should focus on refining therapeutic approaches for H. pylori strains exhibiting clarithromycin resistance.