Background: Hemophilia is a congenital bleeding disorder caused by a lack of clotting factor in the blood. Hemophilia A, B, and C are caused by congenital deficiencies of clotting factors VIII, IX, and IX which are involved in thrombin generation of intrinsic coagulation pathway. Hemophilia A and B is a recessive X-linked congenital bleeding disorder but hemophilia C is typically inherited in an autosomal recessive, these are rare inherited coagulation disorders. This study was conducted based on the lack of database on the epidemiology, clinical type and severity in hemophilia in Mongolia. Aim: The aim of this study was to investigate the relationship between clotting factor levels and bleeding severity of hemophilia. Materials and Methods: A cross sectional study included a total of 30 patients with hemophilia who were registered from May to October 2025 at the Comprehensive Hemophilia Center, MNUMS. The study was approved by the Research Ethics Committee of MNUMS. Result: In this study 30 patients with hemophilia mean age was 18.4±15.7 years, and 96.7% were male. When categorized by age group, 13.4% (n=4) were under 4 years, 40% (n=12) were 5–13 years, 10% (n=3) were 14–18 years, 33.3% (n=10) were 19–44 years, and 3.3% (n=1) were over 45 years. Of the total cases, 83.3% (n=25) had Hemophilia A and 16.7% (n=5) had Hemophilia B. Of the total case, 80% of cases were classified as severe and 20% as moderate hemophilia. Additionally, 40% of cases had joint complications. Conclusion Joint bleeding was observed in 41.6% of patients with severe hemophilia and in 33.3% of those with moderate hemophilia. Target joint damage was found in 40% of the study population because 86.6% of patients were not able to receive prophylactic factor replacement therapy. Joint damage, joint deformities, reduced range of motion, and deterioration in quality of life were all adverse outcomes related to the early onset of joint bleeding.

Background: Megaloblastic anemia is a hyperchromic macrocytic anemia caused by impaired DNA synthesis and delayed cell division, most commonly resulting from deficiencies of cobalamin and folic acid. Vitamin B12 is obtained from animal-derived foods such as meat, fish, eggs, and dairy products. In the stomach, it is released from dietary proteins by gastric acid and subsequently binds to an intrinsic factor, after which it is absorbed in the distal ileum. Therefore, vitamin B12 deficiency may occur following gastric or intestinal resection surgery. Another common cause of vitamin B12 deficiency is pernicious anemia, which results from autoimmune atrophic gastritis leading to decreased secretion of intrinsic factor. Vitamin B12 deficiency is most frequently observed in individuals over 60 years of age, and its clinical manifestations vary depending on the severity of deficiency. Patients with mild to moderate deficiency commonly present with fatigue, general symptoms of anemia, glossitis, and neurological disturbances. In cases of severe deficiency, profound hematological abnormalities, severe neurological manifestations, and cardiac involvement such as cardiomyopathy may be observed. In this report, we present a clinical case of a 46-year-old male who developed severe vitamin B12 deficiency anemia following total gastrectomy, complicated by anemia-induced mild hypokinesia of the anterior and inferior walls of the heart. Conclusion If vitamin B12 deficiency–related anemia is accurately diagnosed, appropriately treated, prevented, and monitored starting from the primary health care level, it can have a positive impact on patients’ quality of life. Given that this condition may present with diverse clinical manifestations, a multidisciplinary team approach involving specialists in hematology, neurology, psychiatry, gastroenterology, cardiology, and nutrition enables early identification and prevention of potential complications, thereby improving overall clinical outcomes.

Background: Sjögren’s syndrome is a chronic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands, particularly the lacrimal and salivary glands, as a result of genetic and environmental factors, and it is mainly manifested by mucosal dryness. Sjögren’s syndrome is a rare disorder with a prevalence of approximately 6 cases per 1,000 population and shows a marked female predominance. It is most commonly diagnosed between the ages of 40 and 60 years. Anemia is observed in about 70% of patients diagnosed with Sjögren’s syndrome; however, autoimmune hemolytic anemia occurs in only approximately 3% of cases. In this report, we present a rare case of Sjögren’s syndrome that manifested with warm autoimmune hemolytic anemia. Conclusion In cases of autoimmune hemolytic anemia of unknown etiology, it is crucial to investigate the underlying causes leading to hemolysis in order to establish the differential diagnosis and to confirm or exclude the condition. Sjögren’s syndrome typically presents initially with sicca symptoms, with chronic anemia developing during the course of the disease and its treatment. In contrast, in our case, persistent manifestations of autoimmune hemolytic anemia over a prolonged period represented the initial clinical presentation that led to the diagnosis of Sjögren’s syndrome. Immunological markers play a key role in the diagnosis of this syndrome, as they are essential for early detection of Sjögren’s syndrome, timely diagnostic confirmation, monitoring of disease progression, and adjustment of therapeutic dosing.

Background: Liver transplantation has become an effective treatment option worldwide for a wide range of malignant and non-malignant liver diseases. In Mongolia, the high prevalence of single and co-infections with viral hepatitis is a major contributing factor to the development of liver cirrhosis and primary liver cancer. However, data on the indications, clinical characteristics, and outcomes of liver transplantation in the Mongolian population remain limited. Aim: To evaluate the indications and clinical characteristics of patients undergoing liver transplantation and to determine their survival outcomes. Materials and Methods: This single-center, retrospective cohort study included 238 patients who underwent liver transplantation at the National Cancer Center of Mongolia between 2018 and feb 2026. Patients were categorized into two groups according to the indication for transplantation: malignant and non-malignant liver diseases. Demographic and clinical characteristics were compared between the groups. Overall survival was estimated using the Kaplan–Meier method, and differences in survival were assessed using the log-rank test. A p-value <0.05 was considered statistically significant. Result: The mean age of the liver transplant recipients was 49.0 ± 8.4 years. Relatively older male patients were more likely to undergo liver transplantation for malignant liver diseases, whereas younger female patients predominated among those transplanted for non-malignant conditions (p=0.0001). No statistically significant difference in body mass index was observed between the groups (p>0.05). MELD and Child–Pugh (CPT) scores, reflecting the severity and prognosis of liver disease, differed significantly between the two groups. However, no statistically significant difference in survival was observed between the groups at 1-, 3-, or 5- years after liver transplantation (p=0.974). Conclusion Although age, sex, and liver disease severity as assessed by MELD and Child–Pugh scores differed significantly between patients undergoing liver transplantation for malignant and non-malignant indications, no statistically significant difference was observed in survival at 1-, 3-, or 5- years following liver transplantation.

Introduction: Chronic lymphocytic leukemia (CLL) is a hematologic malignancy characterized by the clonal proliferation and accumulation of mature monoclonal B lymphocytes in the peripheral blood. CLL is relatively common in Europe and North America, with an incidence of approximately 4–6 cases per 100,000 population, whereas it is rare in South Asia, with an incidence of approximately 0.11 cases per 100,000 population. During the course of the disease, neoplastic lymphocytes may infiltrate the bone marrow, lymph nodes, liver, spleen, and, less commonly, other organs and tissues. CLL presenting with marked splenomegaly in the absence of lymphadenopathy is uncommon. Therefore, in patients with unexplained splenomegaly, the differential diagnosis should include CLL and other lymphoproliferative disorders. Case Presentation: We report a case of CLL diagnosed on the basis of clinical findings, laboratory investigations, and additional diagnostic evaluation in a patient who presented to a hematology outpatient clinic with splenomegaly. An 81-year-old man presented with a macular rash involving the thighs, lower legs, chest, and both upper extremities, accompanied by dizziness, unsteadiness, nausea, fatigue, and generalized weakness. Physical examination revealed massive splenomegaly with a smooth surface and blunt edge, palpable approximately 25 cm below the left costal margin. Laboratory investigations demonstrated hyperleukocytosis with lymphocytosis, moderate normocytic normochromic anemia, and severe thrombocytopenia. Contrast-enhanced abdominal computed tomography revealed massive splenomegaly, with the spleen measuring 27.9×20.0×7.9 cm. The patient was treated with cyclophosphamide at a dose of 250 mg/m (400 mg administered) in combination with glucocorticoid therapy. Following treatment, leukocytosis, lymphocytosis, and monocytosis improved, and the spleen decreased substantially in size, becoming palpable approximately 4 cm below the umbilicus on physical examination. Conclusion Hematologic malignancies should be considered in the differential diagnosis of patients presenting with unexplained splenomegaly. In this case, a diagnosis of chronic lymphocytic leukemia was established based on bone marrow examination and the overall clinical and laboratory findings. Following treatment with cyclophosphamide and glucocorticoids, peripheral blood abnormalities improved and splenic enlargement decreased substantially, suggesting a favorable therapeutic response.

Background: Likert-scale questionnaire data is widely used to evaluate satisfaction; however, in practical applications, both high classification accuracy and model interpretability are essential requirements. Rule-based machine learning methods provide the opportunity to satisfy both criteria simultaneously. Despite the rapid growth of research using machine learning for classification and prediction in recent years, there is a scarcity of studies employing the C5.0 classification algorithm for Likert-scale satisfaction data, which serves as the rationale for this study. Aim: To implement the C5.0 classification algorithm using a 10-fold cross-validation method to predict two levels of satisfaction (High/Medium) and to evaluate the model’s performance and interpretability. Materials and Methods: he study was conducted at the Department of Physics and Informatics, School of Bio-Medicine, MNUMS, utilizing satisfaction survey data from graduates majoring in Health Information Technology. Data consisting of four Likert-scale variables (V1–V4) were used. The C5.0 model was trained using a parametric grid search and evaluated within a 10-fold cross-validation framework using accuracy and a confusion matrix. Furthermore, IF–THEN rules were extracted from the final rule-based model, and the decision logic was visualized in the form of a flowchart. Results: The results indicated that the rule-based C5.0 model was selected as the optimal model, demonstrating stable performance throughout the cross-validation process. The confusion matrix results showed high precision in identifying the “High” satisfaction class. Among the generated rules, it became evident that variables V4 and V2 have the most significant influence on determining satisfaction levels. Conclusion Utilizing the C5.0 algorithm within a cross-validation framework enables effective and intelligible classification of satisfaction based on Likert data. It was confirmed that the rule-based structure offers distinct advantages for model interpretation and decision-support applications.

Background: A child’s physical growth is fundamentally dependent on hormonal regulation, metabolism, and oxygen supply, within which bone mineralization specifically calcium (Ca²⁺) levels acts as a primary factor determining bone mineral density (BMD), muscle function, and hormonal activity. In cardiovascular disease (CVD), multiple physiological processes are disrupted at various levels, including decreased blood circulation and oxygen supply, increased energy expenditure, and reduced absorption of nutrients and micronutrients. In this context, research linking calcium levels in 6–7-year-old children with electrocardiographic (ECG) changes to physical growth has been scarce, which provided the rationale for conducting this study. Aim: To investigate the association between calcium levels and physical growth among 6–7-year-old children with electrocardiographic (ECG) abnormalities detected through early screening. Materials and Methods: This study was conducted using a case-control design. The case group included 143 children aged 6–7 with ECG changes, and the control group included 153 children without ECG changes, totaling 296 voluntary participants. Serum total calcium and albumin levels in both groups were measured using a fully automated biochemical analyzer. Statistical analysis was performed using SPSSv27, applying independent samples t-tests, ANOVA, and correlation analysis to compare means between the two groups. Results: The control group’s serum total calcium was 2.65±0.15 mmol/L, corrected calcium was 2.58±0.13 mmol/L, and the case group’s serum total calcium was 2.64±0.18 mmol/L, corrected calcium was 2.59±0.17 mmol/L, with no statistically significant difference observed between the study groups (p>0.05). When comparing total calcium in case-group children with normal height (2.66±0.20) versus those with stunted growth (2.61±0.13), a statistically significant difference was found (p<0.05). Correlation analysis between total and corrected calcium levels and physical growth indicators across study groups showed no statistically significant association. When height measurements were divided into four quartiles (Q1–Q4) and compared against total and corrected serum calcium, no statistically significant differences were found between the groups. Conclusions Comparison of physical growth and development Z-scores between children with and without ECG abnormalities revealed no statistically significant differences. However, total calcium levels tended to be lower among children with normal growth compared with those with growth retardation in the case group (p < 0.05). No statistically significant differences were observed in serum total or albumin-corrected calcium levels between the study groups (p > 0.05). When height measurements in the study groups were categorized into quartiles, no statistically significant differences in total or albumin-corrected calcium levels were observed between the groups. This suggests that calcium levels alone may not be a decisive determinant of physical growth in children of the same age.

Background: Diabetes mellitus is a chronic metabolic disorder with an increasing global prevalence. Early detection and risk assessment are essential for preventing disease-related complications. In recent years, machine learning methods have been increasingly investigated for predicting disease status using medical data and supporting clinical decision-making. Aim: This study aimed to develop a predictive model for diabetes status using the Random Forest classification algorithm based on the PIMA Indians Diabetes Database and to evaluate its classification performance. Materials and Methods: The study used the PIMA dataset, comprising 768 observations, eight predictor variables, and one target variable. Zero values in selected measurements that were physiologically implausible were treated as missing values and imputed using the median. The dataset was split into training and test sets at an 80:20 ratio. Hyperparameters of the Random Forest model were optimized using 10-fold cross-validation on the training data. Model performance was evaluated using Accuracy, Sensitivity, Specificity, Balanced Accuracy, Cohen’s Kappa, and the area under the receiver operating characteristic curve (ROC-AUC). Variable importance was also assessed. All statistical analyses and machine learning procedures were performed in the R programming environment. Results: Cross-validation identified mtry=4 as the optimal configuration, achieving an Accuracy of 78.05% and a Cohen’s Kappa of 0.5062. On the test set, the model achieved an Accuracy of 72.55%, Sensitivity of 58.49%, Specificity of 80.00%, Balanced Accuracy of 69.25%, and Cohen’s Kappa of 0.3883. The area under the ROC curve (AUC) was 0.7802, indicating that the model could distinguish between individuals with and without diabetes better than random classification. Variable importance analysis identified blood glucose level as the most influential predictor, followed by body mass index (BMI), age, and number of pregnancies. Conclusion The Random Forest algorithm demonstrated the potential to predict diabetes status using the PIMA dataset; however, its sensitivity on the test set was relatively low. Therefore, the model should be considered a potential tool for preliminary risk assessment and supporting early detection rather than a replacement for clinical diagnosis. Further research is needed to improve sensitivity, compare the model with other machine learning algorithms, and validate its performance using larger and more diverse datasets.

Background: Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by abnormal proliferation of megakaryocytes in the bone marrow, resulting in persistent thrombocytosis in the peripheral blood and clinical manifestations including thrombotic and hemorrhagic complications. Approximately 90% of patients with ET harbor driver mutations in JAK2, CALR, or MPL, with JAK2V617F being the most frequently detected mutation. The JAK2V617F mutation induces constitutive activation of the JAK–STAT signaling pathway, leading to abnormal megakaryocytic proliferation and increased platelet production. Consequently, patients are predisposed to thrombotic complications; however, qualitative platelet dysfunction may also contribute to an increased risk of bleeding. Among large-vessel thrombotic complications, venous thromboembolism is relatively common, whereas pulmonary artery thromboembolism is an uncommon complication. Moreover, thrombotic risk is generally lower in patients with JAK2-negative ET. Case presentation: In this report, we present a rare case of essential thrombocythemia presenting with respiratory failure secondary to pulmonary artery thromboembolism. Conclusion This case demonstrates that essential thrombocythemia may initially manifest with life-threatening thrombotic complications, including pulmonary thromboembolism, even in the absence of the JAK2 V617F mutation. Accordingly, unexplained thrombocytosis warrants evaluation for an underlying myeloproliferative neoplasm, while early assessment of thrombotic risk is essential for guiding appropriate clinical management and reducing the risk of adverse outcomes.

Background: The aging of the world’s population will determine global health trends. According to the 2021 report of the Capital City Health Department, the average life expectancy of the Mongolian population is 71.3 years (male 67.3, female 76.7), the difference between male and female life expectancy is 9.4 years, and elderly people aged 60 and over account for 8.1% of the total population. The report also shows that 6.5% of all outpatient visits are for people aged 60-64, and 9% are for people aged 65 and over, which means that they do not receive adequate health care services. Therefore, it is important to increase the access to and quality of health care services provided to the elderly in order to improve their health and quality of life. Comorbidities that are common among the elderly are one of the pressing issues in the health sector. Aim: We aimed to study the prevalence and risk factors of multi-morbidities among older adults (aged sixty years and over) in urban and rural areas. Materials and Methods: To accomplish our aim, we conducted 156 lifestyle related questionnaires and 18 health related questionnaires among 720 older people in Ulaanbaatar city and rural areas, and created the database. Pearson correlation coefficient was used to determine the relationship between the quantitative influence of factors using single and multi-factor linear (β-coefficient) and binary logistic regression (odds ratio, CI 95%) methods, and p value less than 0.05 was considered statistically significant. The Apriori algorithm in SPSS was used to determine the relationship between multiple chronic diseases in the elderly people. Results: The prevalence of comorbidity was higher in urban areas (48.1%) and rural areas (51.9%), and ageing (urban areas OR: 2.45, 95% CI: 0.9-6.2; rural areas OR: 6.35, 95% CI: 1.47-27.4, P<0.01) was a risk factor of multi-morbidities. Multimorbidity is defined as the presence of 2 or more chronic conditions, and 3, 4, and 5 chronic conditions were co-occurred to older adults with chronic conditions, 28.7% (165). 11 common patterns of relationships in urban areas and 18 common patterns of relationships in rural areas (support (A→B)>3%, confidence (A→B)>30%, lift (A→B)>1) were determined. Conclusion Multimorbidity was different in urban and rural areas, 11 common patterns in urban areas and 18 common patterns in rural areas were determined. It has shown that the prevalence of multimorbidity was different in urban and rural areas.