Background: The autonomic nervous system plays a curical role in the regulation of vital physiological functions, including cardiac rhythm, heart rate, and maintenance of blood pressure homeostasis. Previous studies have reported that autonomic nervous function gradually declines with aging, particularly after the age of 40, with an estimated reduction of 5-8% per decade. Globally, the prevalence of atrial fibrillation is rapidly increasing, and it is estimated that by 2050, approximately 72 million people in Asia will be diagnosed with atrial fibrillation, with nearly 3 million cases expected to develop ischemic stroke as a complication. Several risk factors, including arterial hypertension, obesity, alcohol consumption, and smoking, contribute to the development of atrial fibrillation, partly by disrupting autonomic nervous system regulation. Patients with atrial fibrillation have a 1.5-2-fold higher risk of mortality compared with the general population, and the lifetime risk of developing atrial fibrillation after the age of 40 is estimated to be approximately 25%. Aim: To assess autonomic nervous system dysregulation based on heart rate variability parameters among individuals aged 40 years and older. Materials and Methods: The stady was hospital-based case–control study was conducted among patients who received outpatient care and underwent 24-hour Holter electrocardiography (ECG) at Promedica Cardiology Hospital between October 2025 and February 1, 2026. A total of 70 participants were selected using a random sampling method. Of these, 31 patients diagnosed with paroxysmal atrial fibrillation were included in the case group, based on clinical records and Holter ECG findings. The control group consisted of 39 participants without atrial fibrillation. Autonomic nervous system regulation was evaluated using time-domain HRV parameters (rMSSD, pNN50) and frequency-domain parameters (LF, HF, and LF/HF ratio). Statistical analyses were performed using STATA version 15.0 A p-value of <0.05 was considered statistically significant. Result: Among the study participants, 37.1% (n=26) were male and 62.9% (n=44) were female. The mean age was 56.9±11 years (range: 40–79). Of the total participants, 44.2% (n=31) belonged to the paroxysmal atrial fibrillation group, while 55.8% (n=39) were included in the control group. A statistically significant difference in age and sex distribution was observed between the two groups (p=0.001). A significant association was identified between autonomic nervous system dysregulation and paroxysmal atrial fibrillation (p=0.001). In the paroxysmal atrial fibrillation group, increased pNN50, rMSSD values, and a decreased LF/HF ratio were observed, indicating impaired parasympathetic (vagal) activity. These alterations were associated with an increased risk of atrial fibrillation, with an odds ratio (OR) of 4.90 (95% CI: 1.98-12.14). No statistically significant differences in autonomic nervous system parameters were observed in the control group. Conclusion Autonomic nervous system dysfunction assessed through heart rate variability parameters may play a significant role in the development of atrial fibrillation. Holter ECG–based heart rate variability analysis could therefore be utilized as a clinical tool for early detection of paroxysmal atrial fibrillation, risk assessment, improved monitoring, and optimization of treatment strategies.

Background: Liver fibrosis is the underlying pathology of chronic liver disease complications, including cirrhosis and hepatocellular carcinoma, and its early detection is essential for preventing mortality and disease progression. Liver biopsy remains the gold standard for diagnosing fibrosis; however, it is invasive, costly, limited in repeatability, and not suitable for population-level screening. Moreover, liver fibrosis is often asymptomatic for a prolonged period, necessitating reliable and accessible methods for early identification of at-risk populations. Therefore, non-invasive approaches based on routine laboratory parameters, particularly the FIB-4 index, have been widely adopted in clinical practice. Aim: To assess liver fibrosis using the FIB-4 index and to identify risk factors associated with indeterminate and high-risk groups among individuals participating in a national early detection program in Mongolia. Materials and Methods: A total of 37,961 adults who met the inclusion and exclusion criteria were selected from 447,409 individuals who participated in the national early detection screening program between 2022 and 2023. The FIB-4 index was calculated using age, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count, and categorized as low (<1.3), indeterminate (1.3–2.67), and high (≥2.67) risk. Body mass index, blood pressure, fasting glucose, triglycerides, and viral hepatitis status were classified according to standard criteria. Statistical analyses were performed using SPSS version 21.0. Continuous variables were expressed as mean±standard deviation, categorical variables were compared using the χ² test, and logistic regression analysis was used to identify risk factors. Results: The mean age of participants was 44.96±11.31 years, with 61.3% (n=23,285) female and 38.7% (n=14,676) male. The mean FIB-4 index was 0.89±1.09. Based on FIB-4, 86.9% were classified as low risk, 11.8% as indeterminate risk, and 1.4% as high risk; overall, 13.1% (n=4,975) were in the indeterminate and high-risk groups. FIB-4 risk increased progressively with age, reaching the highest level in individuals aged ≥60 years. In multivariable logistic regression analysis, male sex (OR=1.45; 95% CI: 1.36–1.56), viral hepatitis (OR=1.85; 95% CI: 1.68–2.03), and increasing age remained independently associated with indeterminate and high risk. Underweight status and very high triglyceride levels were associated with increased risk, whereas overweight, obesity, and central obesity showed an inverse association. Conclusions 1. The FIB-4 index is a simple, cost-effective tool for identifying individuals at risk of liver fibrosis in primary healthcare settings. Male sex, older age, and viral hepatitis were independent risk factors for indeterminate and high-risk groups. 2. Therefore, the FIB-4 index can be implemented as an initial risk stratification tool in national screening programs to identify high-risk populations for further evaluation and management.

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: Small intestinal bacterial overgrowth (SIBO) is characterized by symptoms such as malabsorption, nutrient deficiencies, bloating, and abdominal pain. It can occur independently or in association with other gastrointestinal disorders. This study aims to determine the prevalence of SIBO in patients with digestive complaints, evaluate diagnostic outcomes, and analyze the composition and types of pathogenic bacteria present in the small intestine. Materials and Methods: A single-center, cross-sectional study was conducted at the Mongolian-Japanese Hospital, enrolling a total of 46 participants. SIBO was diagnosed using the hydrogen breath test (H₂BT) with lactulose/glucose as substrates. Among the 27 diagnosed cases, 5 patients were randomly selected for microbiological analysis of small intestinal contents. Results: SIBO was detected in 58.7% of the study participants. Among the 5 patients who underwent microbiological analysis, 80% (4/5) tested positive for pathogenic bacteria. The identified pathogens included: Gram-positive bacteria: Staphylococcus aureus (S. aureus); Gram-negative bacteria: Klebsiella pneumoniae (K. pneumoniae); Antibiotic-resistant bacteria: Methicillin-resistant Staphylococcus aureus (MRSA); Fungi: Candida albicans (C. albicans). The remaining 20% (1/5) had a baseline H₂BT value exceeding twice the standard threshold despite no detected pathogens. Conclusion SIBO is highly prevalent among patients with digestive complaints and may be associated not only with bacterial infections but also fungal overgrowth. Therefore, a multidisciplinary treatment approach, including antibiotics, dietary modifications, probiotics, and antifungal therapy, is necessary. While the hydrogen breath test is an effective diagnostic tool for SIBO, standardization of diagnostic protocols is required for improved accuracy.

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.

Introduction: Determining stages of liver fibrosis in chronic liver disease is essential for clinical practice such as decision making on medical treatment, setting the interval of follow-up examination for its complication, screening intervals for hepatocellular carcinoma. Goal: We compared non-invasive fibrosis markers among the patients with chronic hepatitis Delta. Materials and Methods: Totally 70 patients with chronic hepatitis D enrolled into this study. The blood samples were examined for complete blood count, liver function test and serum M2BPGi level. Non-invasive markers such as AAR, APRI, Fib-4 scores were calculated. Those with AAR >1, APRI >0.7, FIB-4 >1.45 were considered with advanced fibrosis. All patients underwent liver stiffness measurement using FibroScan M2 probe. The cutoff values of FibroScan for advanced fibrosis were 9 kPa for patient with normal transaminase level and 11 kPa for patients with elevated transaminase. Results: Advanced fibrosis was observed in 25.7%, 38.6% and 38.6% by AAR, APRI and Fib-4 score, respectively. When cut-off levels of serum M2BPGi for advanced fibrosis was 2.2 COI, 35.7% had advanced fibrosis. FibroScan tests showed 34.4% had advanced fibrosis. The AUROC of M2BPGi were 0.894 and 0.827 for predicting advanced fibrosis and liver cirrhosis. Conclusion Serum M2BPGi and FibroScan would be reliable diagnostic tool for identifying liver fibrosis in Mongolian patients with chronic hepatitis D.

Introduction: Foodborne diseases are a major public health concern worldwide. The report, which estimates the burden of foodborne diseases – states that each year as many as 600 million, or almost 1 in 10 people in the world, fall ill after consuming contaminated food. Of these, 420 000 people die, including 125 000 children under the age of 5 years. The 20.3% of diarrhea and 27.5% of die caused by contaminated foods are diarrheagenic Escherichia coli (DEC). Aim: To identify of DEC and determine their antibiotic resistance from ready-to-eat salads Material and Methods: A total of 40 bagged salad mix samples were collected from food markets in Ulaanbaatar, Mongolia. Escherichia coli (E.coli) strains were determined on the basis of MNS 6308:2012 standard and confirmed by polymerase chain reaction (PCR) in samples. DEC was identified using multiplex PCR. Bacterial susceptibility to antimicrobial agents determined by the Kirby Bauer disk diffusion method. Results: Our results showed the presence of E. coli in 19 samples (47.5%). DEC isolates identified by multiplex PCR were defined as follows: the presence of eae and bfp for EPEC, the presence of lt for ETEC, the presence of ipaH for EIEC, the presence of stx1 and stx2 for EHEC, the presence of aap and aggR for EAEC, and the presence of daaE for DAEC. The multiplex PCR assays detected EHEC 6 (31.6%), EPEC 5 (26.3%), EIEC 1 (5.3%). EAEC and ETEC were not detected in samples. The E.coli isolates were 73.7% resistant to chloramphenicol as the first choice of treatment of diarrhea and high resistance (68.4-94.7%) to the cephalosporins. In our country, cephalosporins are widely used in medical practice for the treatment of infectious diseases. Conclusion In this study, about half of ready-to-eat salads are contaminated with E. coli. The three types (EHEC, EPEC, EIEC) of DEC pathotypes were identified in the ready-to-eat salads and high prevalent of antimicrobial resistance. Future research is required to track the contamination sources and develop appropriate steps that should be taken by industry and retailers to reduce microbial contamination in ready-to-eat salads.

BACKGROUND Bovine colostrums is the milk secreted by cows during the first few days after parturition. It contains many essential nutrients and bioactive components, including growth factors, immunoglobulins, lactoperoxidase, lactoferrin and cytokines ets. Lactoferrin has been reported for its multifunctional properties such as antifungal, antibacterial, antiviral antioxidant and anticancer activities. The aims of this study focused on the isolation and purification of lactoferrin from Mongolian bovine colostrums. Lactoferrin purified using HiTrap DEAE an ion exchange chromatography. Lactoferrin purification efficiency was about 60.5%. The single band of purified lactoferrin has been observed in SDS-PAGE electrophoresis. METHODS Bovine colostrum was collected at a cow farm in the Darkhan province of Mongolia. At first the cream was separated by centrifugation (10000 xg 20 min at 4oC). In order to separate the whey, the samples were precipitated with 1mol/l to pH 4.6 and centrifuged at 10000 g 20 min again. The samples of whey were stored at -18oC to the analysis. Lactoferrin was purified by HiTrap DEAE an ion exchange chromatography using 0.005 M phosphate buffer (pH 7.7) and linear gradient NaCl from 0.25M, 0.5M, 1M. During chromatography, protein in the eluents was monitored by ultraviolet absorbation at 280 nm with the instrument. Purity test done by using polyacrylamide gel electrophoresis under denaturated condition (SDS-PAGE) method by Laemmli (1970). For HPLC determination of the lactoferrin by Shimadzu Nexera X2 HPLC system with UV/ VIS detector were used. Detection was carried out at the wavelength 280 nm. Separation was performed on a chromatographic column Protein R C18 ,2.2 x 150 mm, 5 μm particle size. Linear gradient and flow rate 0.2 ml/min were used. Mobile phase a consisted of water / acetonitrile/ trifluoroacetic acid ( 95:5:0.1). The column temperature was set at 40oC and injection volume was 10 μl. Data were collected and evaluated by software Lab Solution. An external standard method for quantification analytes was used. RESULTS Purified lactoferrin in the present study had a good concentration and purification efficiency was about 60.5 %. Protein fraction from 1M NaCl gradient delivers sharp and clean peak to HPLC chromatogram that fits intensity and retention time of standard bovine lactoferrin. Ammount of lactoferrin in bovine colostrums was 0.6 mg/ml and it`s molecular weight 80 kDa as a standard sample. The retention time of lactoferrin fraction which is purified by SDS-PAGE gel electrophoresis. The peak of fraction same compared to the standard lactoferrin 5.8 minutes by HPLC analysis. CONCLUSION Ion exchange chromatography shows reliable and easy isolation of lactoferrin from Mongol bovine colostrum.

Introduction: Enteroaggregative Escherichia coli (EAEC) is an important agent of acute and persistent diarrhea worldwide. Few cases have been reported in healthy children. EAEC strains are characterized by aggregative adherence (AA) to HEp-2 cells, wherein bacteria are seen in “stacked brick” aggregates attaching to HEp-2 cells and usually to the glass surface between cells. Goal: To identify Enteroaggregative Escherihia coli using multiplex polymerase chain reaction (PCR) and HEp-2 adherence assay in Ulaanbaatar, Mongolia Materials and Methods: A total of 329 E. coli strains were isolated from stool with diarrhea in National Center for Communicable Diseases from July 2012 through September 2014. All specimens were processed by routine microbiological and biochemical tests in the bacteriological laboratories to identify Salmonella spp., Shigella spp. All specimens in our study were negative for these bacterial and parasitic pathogens. The biofilm formation was evaluated by the growth rate of E.coli on plastic surface. PCR assays were used to detect genes of five types of diarrheagenic E.coli (DEC). All of the DEC strains showed mannose-resistant adherence to HEp-2 cells, and aggregative adherence was predominant in these isolates. Bacterial susceptibility to antimicrobial agents determined by the Kirby Bauer disk diffusion method on Muller Hinton agar. Results: EAEC (31.9%) was the most prevalent by PCR and HEp-2 assay comparing with others. EAEC by multiplex PCR in samples (11, 3.3%), followed by enteropathogenic E.coli (EPEC) seen in 2.1%. Enterohemorrhagic E.coli (EHEC) and enteroinvasive E.coli (EIEC) were found in 7 (2.1%) and 1 (0.3%) of the samples. Enterotoxigenic E.coli (ETEC) and diffusely adhering E.coli were detected in 2 (0.6%), respectively. The evaluation of bacterial biofilm formation using 96 well plates showed 309 negative (93%), 15 weak biofilm (4.6%) and 8 moderate biofilm (2.4%) formation for E.coli and no strong biofilm forming strain was detected. Above 50% of antibiotic resistance was observed for ampicillin, trimethoprim/sulfamethoxazole, cefuroxime and cephalotin. Also, 95.4% of isolates were resistant to at least three different classes of antimicrobial agents and considered as multidrug resistance. Conclusion: EAEC is most prevalent pathogen among DEC in our samples. It is necessary to implement EAEC identifying method on Hep-2 assay in our laboratory practice.