Background: According to classical sources of Traditional Mongolian Medicine, the Mana-4 decoction clears internal heat and fever, alleviates febrile and infectious diseases, resolves pale-brown Badgan disorders, and alleviates severe pneumonia. Chimedragchaa.Ch. et al. (2002) demonstrated that Mana-4 possesses heat-clearing, anti-inflammatory, and immunomodulatory effects. Chronic Fatigue Syndrome (CFS) is a disorder characterized by clinical manifestations including physical exhaustion, low-grade fever, headache, mood fluctuations, cognitive impairment, and sleep disturbances. In recent years, as the pace of modern life and workload have increased, physical, psychological, and mental stress have intensified, leading to dysregulation of the nervous and endocrine systems, impaired immune function, and a rising global prevalence of CFS—a trend that has attracted increasing attention from researchers worldwide. However, the etiology and pathogenesis of CFS remain incompletely understood, and effective, evidence-based treatments continue to be sought. Therefore, we developed Immunoflu soluble granules, derived from the constituents of Mana-4, and this study aimed to investigate its anti-fatigue effects, as no such investigation had previously been conducted. Aim: To evaluate the anti-fatigue effect of Immunoflu, a formulation derived from the traditional Mana-4 decoction widely used in Traditional Mongolian Medicine. Materials and Methods: A chronic-fatigue rat model was established by forced-swimming induction, following the method of Jia Wang et al. (2013). The behavioral effects of Immunoflu were assessed using the open-field test (locomotor activity) and the elevated plus-maze test (anxiety-related behavior). Result: Immunoflu was administered at 100, 200, and 400 mg/kg to evaluate its effects in a chronic-fatigue model. In the open-field test, no significant difference (p>0.05) in central-zone entries was observed between Immunoflu and the model control. However, vertical locomotor activity increased significantly: Immunal 50 mg/kg +80.4% (p=0.024), Immunoflu 100 mg/kg +82.6% (p=0.003), and 200 mg/kg +77.4% (p=0.035). From these findings, Immunoflu at 100 and 200 mg/kg clearly enhanced locomotor activity in rats with chronic fatigue. In the elevated plus-maze test, Immunal 50 mg/kg increased the time spent in the central zone (10×10cm) by 53.3% (p=0.021) and in open arms by 61.4% (p=0.032) compared with the model control. Although Immunoflu produced no significant changes (p>0.05) in central-zone entries or time spent in the central zone, the time spent in the open arms increased by 60.6% at 200 mg/kg (p=0.026), indicating a reduction in anxiety and improved behavioral response to stress. Conclusion In a forced-swimming–induced chronic-fatigue model, Immunoflu increased locomotor activity by 77.4–82.6% at 100 and 200 mg/kg, reduced anxiety by 60.6% at 200 mg/kg, and reduced behavioral despair and fatigue by 35.3% at 100 mg/kg.

Background: Chronic Fatigue Syndrome (CFS) is a poorly understood disorder of unknown etiology, characterized by clinical manifestations including physical exhaustion, low-grade fever, myalgia, dizziness, mood fluctuations, cognitive impairment, and sleep disturbances. CFS is highly prevalent and frequently comorbid with psychiatric conditions, particularly depression and anxiety. Symptoms exacerbate during physical or mental exertion and do not completely resolve with rest. Currently, there is a lack of proven, effective pharmacological treatments for CFS. Therefore, this study aimed to investigate the anti-fatigue effects of Immunoflu. Aim: To evaluate the anti-fatigue effects of Immunoflu, a technologically modernized formulation derived from the traditional Mana-4 decoction. Materials and Methods: A chronic fatigue rat model was established using the forced-swim protocol described by Jia Wang and Chengxin Sun (2013). The pharmacological effects of Immunoflu were evaluated by quantifying serum levels of cytokines (IL-1β, IL-2, IL-5, IL-10, and IL-17a) by ELISA and assessing behavioral despair using the forced swim test (FST). Results: We evaluated how Immunoflu affects the chronic fatigue model at doses of 100, 200, and 400 mg/kg by measuring serum levels of IL-1β, IL-2, IL-5, IL-10, and IL-17a and assessing despair using the “Forced swim test”. In the forced-swimming-induced chronic fatigue model in rats, Immunoflu at a dose of 100 mg/kg increased the serum IL-2 indicator by 23.8%, and Immunal at a dose of 50 mg/kg increased it by 23.3% compared to the model control group, a statistically significant difference (p < 0.05). Furthermore, Immunoflu at 200 mg/kg reduced IL-17a cytokine levels by 23.7% compared with the model control group. When evaluating the swimming state of the animals with the Forced swim test, the group given Immunal 50 mg/kg (52.03±9.3 sec) decreased by 31.6% (*p=0.038), and the group given Immunoflu 100 mg/kg (49.19±8.54 sec) decreased by 35.3% (*p=0.01) respectively compared to the model control group, while no statistically significant difference was observed in other groups. Conclusions 1. Immunoflu at 100 mg/kg demonstrates immunostimulatory effects in a chronic fatigue model by increasing serum IL-2 levels by 23.8%. Additionally, at 200 mg/kg, it exhibits anti-inflammatory properties, reducing IL-17a levels by 23.7%. 2. In the forced-swimming model, Immunoflu at 100 mg/kg effectively reduced behavioral despair and physical fatigue by 35.3%.

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: Anterior open bite involving the anterior dentition associated with skeletal Class III malocclusion is a severe dentofacial deformity resulting from discrepancies in vertical and sagittal relationships of the maxilla and mandible. In adult patients, orthodontic treatment alone is insufficient to achieve satisfactory outcomes; therefore, combined orthodontic and orthognathic surgical treatment is required. Case Presentation: A 21-year-9-month-old female patient presented with a chief complaint of mandibular prognathism. Clinical and radiographic examinations revealed anterior open bite involving the anterior dentition associated with skeletal Class III malocclusion. The treatment was carried out in three phases. Presurgical orthodontic treatment was performed to achieve dental decompensation, followed by orthognathic surgery. Le Fort I osteotomy was performed to reduce the vertical height by 3 mm and advance the maxilla by 5 mm, while bilateral sagittal split osteotomy (BSSO) was performed to set back the mandible by 9 mm. Post-surgical orthodontic treatment was performed using temporary anchorage devices (TADs) to provide stable anchorage, allowing precise control of tooth movement, and intermaxillary elastics were used to refine occlusion. As a result, facial profile, skeletal relationships, and occlusion were improved, with stable outcomes achieved. Diagnosis: Extraoral examination revealed a mandibular facial profile, increased height of the lower third of the face, normal facial midline at the nose, and a 1.5 mm leftward deviation at the chin. Lip position was -6 mm for the upper lip and -2 mm for the lower lip relative to the nasolabial angle. The angle between the cheekbones and the lips was 55.5°. Conclusion Combined orthodontic and orthognathic surgical treatment provides effective and stable outcomes in terms of esthetics, function, and occlusal stability in adult patients with anterior open bite associated with skeletal Class III malocclusion.

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: Iron deficiency (ID) and iron deficiency anemia (IDA) are among the most common forms of anemia worldwide. Although the underlying causes of ID may vary depending on a country’s developmental level, lifestyle, and other factors, blood loss remains the principal cause leading to ID and subsequent IDA. In hemophilia, recurrent bleeding due to deficiencies of coagulation factors (FVIII, FIX, FXI) can lead to ID, which may progress to IDA and adversely affect the quality of life in these patients. The absence of studies evaluating the prevalence of ID and IDA among hemophiliac patients in Mongolia provided the impetus for this investigation. Aim: To assess the prevalence of ID and IDA among patients with hemophilia. Materials and Methods: A cross-sectional study was conducted among 45 patients with hemophilia registered at the Hemophilia Comprehensive Center (HCC), Mongolia-Japan Hospital, Mongolian National University of Medical Sciences. All participants underwent laboratory testing, including complete blood count (CBC) and serum ferritin levels—were performed using the SYSMEX XN2000 and COBAS BM6010 analyzers. Data analysis was carried out using SPSS 27.0 and MS Excel 2010. Results: Among the 45 cases, 41 were Hemophilia A and 4 were Hemophilia B. Reduced serum iron levels were found in 33.3% (15), and low ferritin levels were observed in 22.2%. Detailed blood tests revealed microcytic hypochromic changes in 43.9% (18) of Hemophilia A cases and in 100% (4) of Hemophilia B cases. The overall prevalence of ID was 13.3%, while the prevalence of IDA was 22.2%. Among the IDA cases, 90.0% were classified as mild and 10.0% as moderate. Notably, 80.0% of the IDA cases occurred in children under 15 years of age. Conclusion ID and IDA are common among hemophiliac patients. The high prevalence among children under 15 years of age suggests an age-related predisposition, emphasizing the need to improve disease management and to implement preventive measures against anemia in this population.

Background: Hypokalemia is considered when the serum potassium level is less than 3.5 mmol/L. Clinical research indicates that hypokalemia affects 20% of hospitalized patients, and in 24% of these cases, inadequate interventions result in life-threatening complications. At present, there is no research available on the prevalence, management, and outcomes of hypokalemia in hospitalized patients, which justifies the need for this study. Aim: The study aimed to examine the prevalence of hypokalemia and the effectiveness of its management in hospitalized patients within the internal medicine department, in relation to the knowledge of doctors and resident physicians. Materials and Methods: This hospital-based retrospective study included a total of 553 cases of patients hospitalized in the Internal Medicine Department of the Mongolia Japan Hospital between January 2024 and August 2024. Patients with a potassium level of <3.5 mmol/L were diagnosed with hypokalemia, and the effectiveness of potassium replacement therapy was evaluated according to the method of supplementation employed. Results: The prevalence of hypokalemia among hospitalized patients in the Internal Medicine Department was 9.8% (54 cases). Based on the study criteria, 42 cases of hypokalemia were selected for further analysis, and a total of 118 potassium replacements were performed through oral, intravenous, and mixed methods. Following potassium replacement therapy, 37.3% (44) of patients achieved normalized potassium levels, while 62.7% (74) still had persistent hypokalemia. Conclusion According to the study results, the prevalence of hypokalemia among hospitalized patients in the Internal Medicine Department is 9.8%. The method of potassium replacement and the severity of hypokalemia do not impact the normalization of potassium levels, with the critical factor being the proper dosage of supplementation. The knowledge of doctors and resident physicians regarding hypokalemia is insufficient, and there is a need to implement guidelines and protocols for potassium replacement therapy in daily clinical practice.

Introduction: Hepatocellular carcinoma(HCC) is the 6th most common cancer inthe world, but the first most commoncause of cancer death in Mongolia. Thereis no universally accepted consensuspractice guidelines for HCC owing to rapiddevelopments in new treatment modalities,the heterogeneous epidemiology and clinicalpresentation of HCC worldwide.Methods and Materials: This study wasconducted in the department of generalsurgery of Second Central Hospital ofMongolia between 2015 and 2016 on a totalof 36 patients with hepatocellular carcinoma.Results: The average of operationtime is a 132.2 min, the hospital stay 18.2days. Postoperative bleeding was 2.7% (1),encephalopathy 5.4% (2), wound infection5.4% (2), and incisional hernia 8.1% (3).There were not bile leak during 30 dayspostoperative day.Conclusion: Postoperative complicationis a comparable to different researcher.There were no death within first month.