Background: Cardiovascular diseases (CVDs) is a third leading cause of non-communicable diseases and a leading cause of mortality in Mongolia. Among these, acute myocardial infarction (AMI), a complication of coronary artery disease (CAD), is a leading cause of cardiovascular mortality. In patients with AMI, both epicardial artery blood flow, observed through coronary angiography, and coronary microcirculatory dysfunction (CMD) play critical roles in the disease’s pathophysiology. Recent advancements have introduced artificial intelligence (AI)-based softwares which are capable of analyzing coronary blood flow from coronary angiography images. The AI based softwares can assess not only epicardial blood flow but also CMD in recent studies. In this review, we discussed the role of CMD in pathophysiology of AMI, diagnostic approaches, the application of AI-based technologies, their clinical significance, and future directions. Aim: This review aims to explore the pathophysiological relationship of coronary microcirculatory dysfunction (CMD) in the context of acute myocardial infarction (AMI), diagnostic methodologies, the application of artificial intelligence (AI)-based technologies, and their clinical significance. Hypotheses: 1. AI-based software allows for highly accurate assessment of coronary microcirculation during AMI. 2. CMD during AMI is associated with structural and functional changes in the heart. 3. CMD during AMI is related to disease prognosis and patient outcomes. Methodology:: This narrative review was compiled using a systematic and logical approach, based on publicly available recent clinical and biomedical research literature addressing the above hypotheses. Conclusion In recent years, AI-based image processing software has been developed to analyze angiographic images obtained during percutaneous coronary intervention (PCI) and treatment procedures. These tools show significant promise for early detection and improved diagnosis of CMD during AMI, as well as for better assessment of short- and long-term patient risk.

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: Patients with rheumatoid arthritis are at increased risk of developing cardiovascular disease. In Mongolia, the registration of inflammatory diseases is increasing every year, and cardiovascular diseases are the leading cause of death. Aim: We aimed to determine the degree of cardiovascular risk and its correlation in people with rheumatoid arthritis. Materials and Methods: The study was conducted in a cross-sectional study design with 64 patients with rheumatoid arthritis between May and November 2024. Cardiovascular risk was assessed using mSCORE and the World Health Organization (WHO) cardiovascular Risk Table. We received ethical approval to begin the research at the MNUMS meeting on May 17, 2024 (No. 2024/3-05). Results: The average age of the participants was 55.2±9.7 years, and the average duration since being diagnosed with RA was 9.8±8.0 years. Among the participants, 82.8% (n=53) were female, and 17.2% (n=11) were male. The mean WHO risk index was 10.25±11, while the mean mSCORE risk index was 2.9±4 (p=0.001). There was a significant difference in mSCORE scores between the 40-55 and 56-65 age groups (p<0.001). In contrast, the mSCORE risk assessment showed that 15.6% (n=10) had high risk, and 6.3% (n=4) had very high risk. Among the parameters of inflammatory biomarkers, CRP (OR=0.05, r=0.35, 95% CI 0.9-3.2, p=0.004) has a statistically significant difference and positive correlation, and HDL-C (OR=2.3, r=-0.25, 95% CI 2.9- 10.0, p<0.0001) was significantly different and negatively correlated. Conclusion A total of 64 participants participated in our study, and according to the WHO assessment, 17.2% were at high or very high risk of developing cardiovascular disease in the next 10 years, and according to the mSCORE, 21.9% were at high or very high risk of developing cardiovascular disease. Although the degree of disease activity was not significantly associated with cardiovascular risk, the inflammatory biomarker C-reactive protein was statistically significantly different or positively associated with cardiovascular risk assessment.

Background: Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease of unknown cause that presents with a wide range of clinical symptoms. Renal involvement in SLE often manifests as lupus nephritis and has become a leading cause of death among Asian populations. Proteinuria serves as a key indicator for assessing renal involvement, monitoring disease progression, and evaluating treatment outcomes in patients with SLE. Aim: The aim of this study was to evaluate the correlation between the spot albumin-to-creatinine ratio, protein-to-creatinine ratio, and 24-hour proteinuria in patients with systemic lupus erythematosus. Material and Methods: The study was conducted using a hospital-based retrospective research method and included 41 patients with SLE who attended the rheumatology outpatient clinic at the Mongolian-Japanese Hospital from July 2024 to February 2025. The participants were divided into two groups based on the level of proteinuria in their 24-hour urine sample: Group A (more than 140 mg) and Group B (less than or equal to 140 mg). To prevent errors in the results of the 24-hour urine protein test, participants were provided with instructions on proper specimen collection prior to the test. Statistical analysis was performed using SPSS version 30.0, and correlations were assessed using Spearman’s rank correlation coefficient. Results were considered statistically significant at p<0.001. Results: A total of 41 participants were included in the study: 56.1% (n=23) in Group A and 43.9% (n=18) in Group B. The mean age of the participants was 37±9.74 years, with 92.7% (n=38) being female and 7.3% (n=3) being male. The mean 24-hour urine protein loss was 1883.1±1819.5 mg/24h in Group A and 72.8±29.0 mg/24h in Group B. The normal urine albumin-to-creatinine ratio (ACR) is less than 30 mg/g. In Group A, 8.7% (n=2) had a normal ACR, while 91.3% (n=21) had abnormal results. Normally, the urine protein-to-creatinine ratio (PCR) is less than 0.15 g/g. In Group A, 13% (n=3) had a normal PCR, while 87% (n=20) had abnormal results. In Group B, 94.4% (n=17) had an ACR <30 mg/g, and 5.6% (n=1) had an ACR >30 mg/g, with all participants in this group having a normal PCR. Correlation analysis between 24-hour urine protein and the albumin-to-creatinine ratio (ACR) showed a strong positive correlation (r=0.790, p<0.001). Similarly, the correlation between 24-hour urine protein and the protein-to-creatinine ratio (PCR) demonstrated a high correlation (r=0.829, p<0.001), indicating a statistically significant relationship. Conclusion A total of 41 participants with SLE were included in the study, with 56.1% (n=23) exhibiting proteinuria. We have shown that the spot urine protein-to-creatinine ratio and albumin-to-creatinine ratio are highly correlated with the 24-hour urine protein measurement. Therefore, these tests are suggested as practical adjuncts to the 24-hour urine protein measurement for identifying urinary protein in patients with SLE.

Background: Gout is a chronic inflammatory joint disease that damages many joints. Monosodium urate-deposition accumulates in the joints and soft tissues due to long-term untreated condition and leading to loss of function, further reducing the quality of life. It is the most common inflammatory joint disease in the world. Hyperuricemia, sedentary lifestyle including diet, obesity, and the use of certain medications are risk factors for gout. A study published in the Asia Pacific Journal of Nutrition in 2018 found that excessive consumption of meat, alcohol, carbonated beverages, and fructose containing drinks increases serum uric acid levels and the risk of gout. Aim: To investigate certain risk factors associated with gout and asymptomatic hyperuricemia among study participants. Materials and Methods: This study was conducted using an analytical cross-sectional design. Data were coded, error- checked, and analyzed using the SPSS 29.0 software. Results: A total of 145 individuals participated in the study, with an average age of 55.0 ± 13.9 years, and 75.2% were male. Based on diagnostic criteria, 29.7% had gout, 35.2% had asymptomatic hyperuricemia, and 35.2% had normal uric acid levels. The consumption of different food products over the past month was analyzed among study groups, and alcohol intake was found to be statistically significant. A univariate regression analysis showed that obesity was associated with hyperuricemia, male sex was associated with gout, and alcohol consumption was a potential risk factor for both hyperuricemia and gout. Conclusion Among the study participants, 29.7% had gout, and 35.2% had asymptomatic hyperuricemia. Obesity, male sex, and alcohol consumption were identified as risk factors contributing to increased serum uric acid levels and gout development.

Background: Systemic sclerosis-related interstitial lung disease (ILD) is a major cause of mortality among patients with systemic sclerosis. During this disease, when the forced vital capacity (FVC) is <50% on spirometry, the prognosis is considered poor. Although early changes in systemic sclerosis-related ILD can be identified by chest computed tomography (CT), evaluating the spirometry test is essential for monitoring further follow-up and assessing treatment outcomes. This study aimed to highlight the importance of considering the role of the spirometry test among patients with systemic sclerosis. Materials and Methods: We conducted this study using a cross-sectional research design based at a single-center hospital. The study included 40 patients diagnosed with systemic sclerosis who were attending the rheumatology outpatient clinic at the Mongolia-Japan Hospital. The inclusion criteria were patients diagnosed with systemic sclerosis who had undergone chest imaging (chest x-ray, chest CT scan) and spirometry tests. Results: In our study, in 62.5% of patients diagnosed with systemic sclerosis, a chest CT scan revealed abnormalities indicative of SSc-ILD. There were statistically significant differences (p<0.05) in certain parameters of spirometry between the two groups (normal chest CT, abnormal chest CT). The group with abnormal chest CT had a higher usage of mycophenolate mofetil (p<0.05). A negative correlation was found between changes on chest CT scan and FVC (r= -.453, p<0.05). However, no statistically significant correlation was observed between FVC and disease duration or comorbidities. Conclusion Using spirometry to assess pulmonary function in patients with systemic sclerosis-related interstitial lung disease may be an appropriate method for evaluating the progression of the disease and detecting complications.

Background: According to the First National Tuberculosis (TB) Prevalence Survey in Mongolia the prevalence of bacteriologically-confirmed pulmonary TB among adults was 559.6 (95% CI: 454.5–664.7) per 100000 population in 2014–2015. This was three times as high as previously estimated. Nationwide anti-tuberculosis (TB) drug resistance survey was conducted in 1999 and 2007 in Mongolia. Share of multidrug resistant TB (MDR-TB) cases among newly notified TB cases increased from 1.0% in 1999 to 1.4% in 2007. Accordingly, we aimed to perform drug susceptibility test on strains isolated from TB Prevalence Survey and to determine the prevalence of drug resistant TB. Material and Methods: All 242 MTB strains isolated from the survey TB cases were tested GenoTypeMTBDRplus test and conventional 1st line DST on solid medium. Result: Conventional DST and GenoTypeMTBDRplus tests done for 93.8% (227/242) of them and 6.2% (15/242) were tested by GenoTypeMTBDRplus only. A 61.6% (95%CI 55.3-67.4) of all cases were susceptible to first line anti-TB drugs, any drug resistance and MDR-TBdetected as 38.4% (95% CI 32.5-44.7)and 9.5% (95% CI 6.4-13.9), respectively. Prevalence of MDR-TB was7.8% (95% CI 4.9-12.4) among new and 17.9% (95% CI 9.0-32.7) among previously treated cases. The 64 strains were identified as a resistant to isoniazid, 32.8% (42/64) and 65.6% (21/64) were katG, and inhAmutation, respectively. One isolate (1.6%) was mutations in both the inhAand katGgenes.The predominant mutations detected in therpoB were S531L (91.3%) among rifampicin resistant isolates and the mutation in inhAwas C–15T (100%) and katG mutation was S315T1 (100%) among isoniazid-resistant isolates. Conclusion Prevalence of cases with DR-TB is high among prevalent TB cases, especially prevalence of MDR-TB among new cases. In comparison to previous studies, DR-TB cases seem to be increased. Rifampicin resistant strains have a mutation of the rpoBand resistance to isoniazid is predominantly associated with the inhA mutation.

BACKGROUND. Hypertension is an increasingly important medical and public-health issue. Recent years complementary and alternative medicine therapies are getting popular and frequently than medical treatment used by patients with hypertension and cardiovascular disease. Aiming to analyze the efficacy of bloodletting to treat impure blood and hypertension and to implement to the clinical practice. METHODS. 14 day before and after loodletting treatment, triglycerides, cholesterol, high- density lipoprotein were analyzed and compared to body type for 30 patients (30- 60 years old ) who have 1st stage arterial hypertension. The LDL was calculated with Fridvalid formula. The participants took traditional prescription ( formula of three seeds) 2gr twice per day for 5 days after bloodletting vena. ( jinshug) RESULTS. The study showed that triglycerides are decreased by 0,4mml/l (P value 0.0047), cholesterol was decreased by 1,54 mml/l (P value 0.00001), LDL was decreased by 1,68 mml/ l (P value 0.00001), and HDL was increased by 0,22 mml/ l (P value 0.0001) after bloodletting treatment. After treatment we observed decreasing hypertension when measured the systolic and diastolic blood pressure for three months. LDL and cholesterol increasing in the blood is risk for cardiovascular disease. But in this study LDL and cholesterol were decreasing after bloodletting treatment which means it is possible to prevent from cardiovascular disease. As well after treatment HDL was increased in the blood that showed prevention from arteriosclerosis. СONCLUSION. Most of patients were shar and badgan type. The badgan type with patients had obesity and high cholesterol compared to other body types. After treatment cholestrol was decreased in all patients, LDL was decreased and HDL was significantly increased in the badgan type patients with hypertension. Systolic and diastolic blood pressure were decreased and stable and kept for long time after bloodletting treatment.

BACKGROUND. To introduce a new electronic technology which is mobile-based ophthalmoscope to the clinical practice for the patients with diabetes and hypertension. MATERIAL AND METHODS. There are 32 participants who were diagnosed with hypertension (blood pressure measured more than 140/90 mm Hg three times a month or for 2 weeks) participated in our study. We selected the patients with type II diabetes and hypertension who were referred to the RTW diabetes center. RESULTS. In the hypertensive group, based on Keith Wagener Barker (KWB) Grades, there are 1st and 2nd degree retinopathy cases are more common and it increases with the age. In the diabetic group, non-proliferative diabetic retinopathy is diagnosed among the patients aged above 60 years old and it correlates with the duration of disease.