Background: Plants of the genus Achillea are widely used in both traditional and modern medicine and are known to be rich in biologically active secondary metabolites. Numerous phytochemical and histochemical studies have been con ducted on Achillea millefolium L.; however, Achillea asiatica Serg., which is widely distributed in Mongolia, remains comparatively underexplored. Therefore, investigating the distribution of biologically active compounds, the content of polyphenolic compounds, and the optimal extraction conditions of this species is of significant scientific and practical importance. Aim: The aim of this study was to identify biologically active compounds in Achillea asiatica Serg. using histochemical methods, to determine the content of polyphenolic compounds and optimal extraction conditions, and to evaluate the total and internal absorption coefficients of the plant raw material. Materials and Methods: The aerial parts of Achillea asiatica Serg. were collected in August 2025 from Erdene soum, Tuv province, Mongolia. Histochemical analysis was performed on transverse stem sections and flower petals using potassium dichromate, ferric chloride (III), methylene blue, Lugol’s iodine, and Dragendorff’s reagent, followed by ob servation under a light microscope. The total polyphenolic content was determined using the Folin–Ciocalteu method and expressed as gallic acid equivalents. Extraction experiments were conducted using powdered plant material sieved to par ticle sizes of 1, 2, and 3 mm and extracted with 20–80% ethanol. In addition, the total and internal absorption coefficients of the plant material were determined according to standard procedures. Results: Histochemical analysis revealed the presence of essential oils, polyphenolic compounds (tannins and flavo noids), and starch, while alkaloids were not detected. Polyphenolic compounds were observed in both stems and flow ers, with more pronounced accumulation in the vascular tissues. The highest total polyphenolic content (0.421%) was obtained from the 1 mm particle-size fraction extracted with 70–80% ethanol. Using 60% ethanol, the total absorption coefficient of the plant material was determined to be 5.74, and the internal absorption coefficient was 1.885. Conclution Achillea asiatica Serg. is rich in polyphenolic compounds, and their anatomical distribution is closely as sociated with the plant’s protective and biological functions. The use of 1 mm particle-size material and 70–80% ethanol was identified as the most suitable condition for extracting polyphenolic compounds. These findings provide a scientific basis for the standardization of Achillea asiatica Serg. as a medicinal and phytopharmaceutical raw material and support its further pharmacognostic and phytochemical investigation.

Background: High-resolution esophageal manometry (HREM) is the reference standard for the assessment of esophageal motor function and classification of esophageal motility disorders. HREM was introduced into clinical practice in Mongolia in 2022; however, the spectrum of manometric diagnoses and factors associated with major esophageal motility disorders in this population have not been systematically characterized. Aim: To characterize major esophageal motility disorders among adults undergoing HREM and to identify clinical factors independently associated with these disorders. Materials and Methods: This retrospective observational study included 1,033 adults who underwent HREM at Intermed Hospital between September 2022 and March 2026. Manometric studies were interpreted according to the Chicago Classification version 4.0 (CCv4.0). Major esophageal motility disorders were defined as achalasia, manometric esophagogastric junction outflow obstruction (EGJOO), distal esophageal spasm, hypercontractile esophagus, and absent contractility. Multivariable logistic regression was used to identify factors independently associated with major motility disorders. Result: Major esophageal motility disorders were identified in 112 patients (11.2%). Compared with patients with normal motility or ineffective esophageal motility, those with major motility disorders had a significantly lower mean body mass index (BMI) (24.7±4.9 vs. 27.5±4.2 kg/m; p<0.001) and a higher prevalence of dysphagia (50.5% vs. 21.3%; p<0.001) and referral for suspected esophageal motility disorders (70.5% vs. 25.2%; p<0.001). In multivariable analysis, older age per 10-year increment (adjusted odds ratio [aOR], 1.35; 95% confidence interval [CI], 1.12–1.61), lower BMI (aOR per 1-kg/m increase, 0.90; 95% CI, 0.85–0.95), dysphagia (aOR, 1.95; 95% CI, 1.20–3.15), and referral for suspected motility disorders (aOR, 5.47; 95% CI, 3.22–9.31) were independently associated with major esophageal motility disorders. Conclusion 1. Major esophageal motility disorders were identified in 11.2% of adults undergoing HREM in this clinical cohort. 2. Referral for suspected motility disorders was the strongest clinical correlate, while older age, lower BMI, and dysphagia were also independently associated with major motility disorders.

Background: In contemporary clinical practice, gastroesophageal reflux disease (GERD) is classified into four phenotypes based on upper gastrointestinal endoscopy and 24-hour multichannel intraluminal impedance-pH monitoring: erosive reflux disease (ERD), non-erosive reflux disease (NERD), reflux hypersensitivity (RH), and functional heartburn (FH). Although the prevalence of GERD in Mongolia is high, and certain chronophysiological aspects have been investigated, there remains a significant lack of data regarding GERD phenotypic classification and physiological diagnostic evaluation using impedance-pH monitoring. This knowledge gap provided the rationale for conducting the present study. Aim: To determine the prevalence of GERD phenotypes among adults presenting with heartburn symptoms and to compare selected manometric and pH-impedance parameters among phenotype groups. Materials and Methods: This study analyzed data from 347 adults who presented to Intermed Hospital between 2022 and 2025 with heartburn symptoms and underwent 24-hour multichannel intraluminal impedance-pH monitoring. Statistical analysis was performed using SPSS version 26. Results: Among the study population, 193 patients (55.6%) were diagnosed with ERD, 34 (9.8%) with NERD, 73 (21.0%) with RH, and 47 (13.5%) with FH. Significant differences were observed among the groups in body mass index (BMI), esophageal acid exposure, total reflux episodes, reflux characteristics, and mean nocturnal baseline impedance (MNBI). Type III esophagogastric junction morphology was identified in 78.76% of the ERD group, 64.7% of the NERD group, 56.2% of the RH group, and 42.6% of the FH group, demonstrating statistically significant intergroup differences. Conclusion ERD was the predominant GERD phenotype among adults with heartburn symptoms, followed by RH, FH, and NERD. Significant differences among GERD phenotypes were observed in BMI, total reflux burden, reflux characteristics, esophageal nocturnal baseline impedance, and esophagogastric junction morphology.

Background: Histopathological examination of skin tissue plays an important role in the diagnosis of dermatological diseases; however, data on surgically excised skin specimens remain limited in Mongolia. Aim: To classify benign and malignant tumors based on histopathological findings of surgically excised skin tissue specimens, determine surgical margin status, and evaluate the age and sex distribution of these conditions. Materials and Methods: This retrospective observational study was conducted using data on surgically excised tissue specimens collected in the outpatient department of the National Dermatology Center between January 2023 and March 2026. A total of 361 patients were identified. Four cases with indeterminate histopathological diagnoses were excluded, leaving 357 patients for final analysis. Data on age, sex, diagnosis, and surgical margin status were collected and analyzed on Microsoft Excel programm. Histopathological diagnoses were classified as benign or malignant tumors. Associations between categorical variables were assessed using the chi-square test, with statistical significance set at p < 0.05. Results: Among 357 patients, 135 (37.8%) were male and 222 (62.2%) were female, with a mean age of 41.8 years. The 20–39-year age group accounted for the largest proportion of cases (39.5%). Histopathological examination showed that 326 cases (91.32%) were benign and 31 cases (8.68%) were malignant. Among benign tumors, melanocytic nevus was the most common diagnosis, while basal cell carcinoma was the most common malignant tumor. The frequency of malignant tumors increased significantly with age (p < 0.001). Patients aged ≥60 years had significantly higher odds of malignancy compared with younger patients (OR = 8.19, 95% CI: 3.79–17.69). Malignant lesions were significantly more likely to have positive (involved) surgical margins than benign lesions. Conclusion Most surgically excised skin tissue specimens were benign; however, the likelihood of malignancy increased significantly with age. Surgical margin assessment is clinically important for improving prognosis, reducing the risk of recurrence, and guiding treatment management.

Background: Rosai–Dorfman disease (RDD) is a rare, benign disorder of non-Langerhans cell histiocytic origin with an unknown etiology, which can affect the skin and other organ systems. The incidence in the United States is approximately 1:200,000. In Mongolia, four cases have been registered over the past five years under the ICD-10 code D76.0. Case presentation: A 59-year-old female patient initially presented to the Dermatology Department of the National Center for Dermatology with clustered, elevated lesions on the medial aspect of the right thigh, including papules, plaques, and nodules of round to oval shape. Additionally, multiple erythematous macules and papules were observed on both lower legs. For diagnostic purposes, a histopathological examination was performed, revealing histiocytes with abundant cytoplasm and lymphocytes within the cytoplasm (emperipolesis). The diagnosis was confirmed based on dermoscopic and immunohistochemical findings. Management: The patient was referred to the Mongolian-Japanese Hospital of MNUMS, where the remaining nodular lesions were surgically excised in the surgical department. Further follow-up was referred to a hematologist. Computed tomography (CT) imaging was recommended. Cutaneous-limited RDD may resolve spontaneously in some cases; however, when multiple organ systems are involved or when associated forms are present, referral to hematology and oncology specialists for systemic therapy is required. Conclusion It is important to differentiate this disease from other dermatological conditions presented with macules, papules, and nodules through clinical evaluation, histopathology, immunohistochemistry, and dermoscopic examination.

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: 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: Esophageal cancer ranks as the fourth most prevalent malignancy in Mongolia. Among esophageal disorders, gastroesophageal reflux disease (GERD) accounts for 55% of cases, while esophageal motility disorders constitute 40%. Enhancing the diagnosis and management of esophageal disorders, alongside preventative strategies for esophageal cancer, necessitates a comprehensive understanding and widespread clinical application of esophageal functional assessment. However, epidemiological data and classification of esophageal motility disorders remain scarce in Mongolia, highlighting the necessity of this investigation. Aim: to identify specific risk factors associated with ineffective esophageal motility (IEM) Materials and Methods: This study was performed an analytical case-control design and was conducted at Intermed Hospital. A total of 702 HRM test results from patients attending the Gastroenterology and Endoscopy Center’s outpatient department, Intermed hospital Participants diagnosed with IEM based on HRM findings were assigned to the case group, while individuals with esophageal normal motility disorders were designated as the control group at a 1:2 ratio. Results: A total of 612 participants aged 21–80 years were included in this study of whom 57.8% (n=354) were female and 42.2% (n=258) were male, with a mean age of 51.1±12.7 years. The prevalence of IEM demonstrated a statistically significant increase in the 60–69 and ≥70 age groups compared to the control group (p<0.000). Participants diagnosed with IEM exhibited a mean lower esophageal sphincter (LES) pressure of 329.61±246 mmHg and a mean complete liquid bolus transit rate of 46.88±22.7%, both of which were significantly lower than those observed in the control group (p=0.000). Furthermore, the incidence of IEM was found to increase in correlation with the severity of hiatal hernia, as classified by both endoscopic and manometric criteria, demonstrating statistical significance (p=0.000). Conclusion IEM is more prevalent among elderly individuals and increases in incidence with the progression of hiatal hernia size. In cases of IEM, esophageal bolus transit is significantly delayed, and lower esophageal sphincter pressure is diminished. Further studies are warranted to elucidate additional risk factors contributing to ineffective esophageal motility.

Background: Accreditation of healthcare institutions serves as a fundamental mechanism for ensuring patient safety and validating the quality of medical services provided to the population. At Intermed Hospital, a quality measurement system for healthcare services has been established since 2015, encompassing 126 quality indicators at both institutional and departmental levels. This system facilitates continuous quality improvement efforts. In this context, quality indicators specific to the endoscopy department play a pivotal role in objectively assessing the quality of endoscopic services. Aim: To assess the quality indicators in gastrointestinal endoscopy unit. Materials and Methods: A retrospective single-center study was conducted by collecting data from the Intermed hospital’s electronic information systems which included HIS and PACS and Quality and Safety Department’s Database and the results were processed using the SPSS software. Ethical approval was granted by the Intermed hospital’s Scientific research committee. The quality of endoscopic services in the Intermed hospital was assessed based on: a) the average values of four quality indicators measured monthly; b) sample survey data from five categories of quality indicators. Results : Between 2016 and 2024, the quality indicators of the endoscopy unit measured as the level of early warning score evaluations for patients was 95.97%±3.33, the level of cases where peripheral blood oxygen saturation decreased during sedation was 1.54%±3.78, the level of cases where patients experienced paradoxiical response during sedation was 5.82%±1.75, surveillance culturing level for validation of endoscopy reprocessing was 11.6%. The endoscopic documentation quality by peer review showed 95.7-100%, the colonoscopy quality indicators were followings as adenoma detection rate: 24.5% Cecal intubation rate: 99.1%, 95.2%, Colonoscope withdrawal average time: 13.28±10.62 minutes, Bowel preparation quality (Boston Scale): 89.3% 95.7%), patient discharge from the recovery room, Average discharge time post-procedure: With propofol alone: 30.92 minutes; With propofol and fentanyl combined: 31.52 minutes, The intermediate risk was 0.28% by the TROOPS evaluation during procedural sedation. Conclusion The quality benchmark levels for these endoscopic units, as determined by a single-center study, can be effectively implemented by benchmark endoscopy centers to enhance their quality and safety operations.

The clinical sign of children’s kidney and urinary tract petrification diseases and the result of eswl Background: A substance exchange disorder where stones form in the kidney or urinary tract with a tendency toward inheritance is called urinary tract petrification disease. In many countries throughout the world, the incidence of urinary tract petrification disease is one to fifteen percent. Urinary tract permeability disease affects 7% of people under the age of 17. Due to the unique nature of the habitat, the incidence of urinary tract petrification disease is higher in India, Thailand, Scandinavian countries, and the Caucasian, Ural, Siberia, and Equator areas. However, the incidence of urinary tract petrification disease spread is two to three percent for children, but the reoccurance risk is 6.5–54 percent. In our country’s case, J. Horloo’s 1993 research indicates that 4.1 to 4.7 percent of kidney and urinary tract patients have urinary tract disease. During urinary tract disease, the common symptoms are abdominal pain, macro- and microhematuria, and kidney and renal bacterial infection. But in younger children, those symptoms are quite grim. In the last 15 years, mongolian’s urine’s oxalate stone’s volume increased by 5 times and mixed stones decreased by 2.5 times. The research of G. Erdenetsetseg’s 1990–1998 study on 305 children and the 2001–2003 study on 161 children indicate that the incidence of urinary tract disease is high between ages 1-3, and 65 percent of the stones consist of calcium oxalate. In 1980, German scientists invented the stone crushing technology using electrohydraulic shockwaves, which turned out to be a beneficial treatment for kidney surgery practice. The National Hospital for Maternal and Child Health's kidney surgery team had 17 surgeries in 2015, 19 surgeries in 2016, 24 surgeries in 2017, and 28 surgeries in 2018, and all of those surgeries were done and treated open. In the last 10 years of our country, children’s urinary tract petrification disease has gradually increased, but research on those diseases risks and factors is lacking. Also, the stone crushing method is necessary for our country’s children's treatment. That’s why we decided to do research on the risk factors of urinary tract disease and its relation to the stone crushing method. Aim: Describe the features of children’s kidney and urinary tract petrification disease and study the stone crushing method’s results. Materials and methods: The study was done between December of 2019 and April of 2022, with the assistance of NCMCH's children's kidney surgery team. Within the parameter of the first objective, within the group of cases of kidney and urinary tract disease, there were 13 children under the age of 17. The research study was conducted cross sectional. The research results were processed by the SPSS 25 program. On the seventh meeting of the health ministry, we got the acceptance of a research patent with the assistance of EHEMUT. Results: The research group consisted of 13 children ages 0–17. The average age of participants was 10.6+-4.2.74. 4 percent of it consisted of men. The research of symptoms showed that back pain n = 13 (100), right side abdominal pain n = 13 (100), disurie n = 3 (23.1), mouth drying n = 2 (15.4), nausea n = 3 (23.1), urine with blood n = 10 (76.9), urine with smell n = 9 (69.2). The position of the stone consisted of 8 (61.5) in the kidney cup, 8 in the kidney cradle. Showing it in which kidney showed that 8 (61.5) were in the right kidney, 3 (23.1) in the left kidney, and 2 (15.4) in both kidneys. The density of the stones was n = 265.8+ 41.9 on average. Kidney stone coming out time was measured by Caplan-Myer’s survivability scale. The stones on the right side of the kidney came out within 14 days on average, while the left and both-sided kidney stones came out within 30 days. Conclusions: 1. Showing the number of stones and locations indicates that 8 (61.5) were in the right kidney, 3 (23.1) in the left kidney, and 2 (15.4) in both kidneys. 2. The results of Caplan-Meyer's scale indicate that kidney stones within the right kidney came out within 14 days, and left- or both-sided stones came out within 30 days.