Backround Peutz–Jeghers (PJ) syndrome is a rare autosomal dominant disorder characterized by a mucocutaneous pigmentationon on oral mucosa and multiple hamartomatous polyps located in the digestive tract except esophagus. PJ syndrome can be diagnosed in early childhood by a characteristic pigmentation and family history of polyposis. However, it is often diagnosed first as a polyp in the small intestine that causes obstruction and intussusception and is often treated with a bowel resection. If diagnosed in young childhood, an effective non-invasive method is to resect the polyps by tying off the blood supply to the polyps, that is the method named ischemic polypectomy, before they grow to the point of obstruction using a endoscopy. PJ syndrome is rare in Mongolia, but in severe cases, small intestine polyps are treated only surgically. Double-balloon-endoscopy (DBE) has been performed at the Mongolian- Japanese Hospital since 2023, making it possible to diagnose and treat the syndrome endoscopically. Our patient, a 15-year-old boy, had a mucocutaneous pigmentation that had been previously undiagnosed and was first diagnosed with intussusception at the age of 13. He had undergone 4 endoscopic procedures for upper and lower gastrointestinal polyps at the National Center for Maternal and Child Health successfully. In our hospital, we found endoscopically multiple hamartomatous polyps of various sizes between 1-3 cm, and a 3 mm diameter tumor that filled 3/4 of the intestinal lumen was treated by ischemic polypectomy. After the procedure, there were no early or late complications related to the procedure. The child's condition improved, the main complaints subsided, and he continues his daily life normally. However, follow-up DBE is required.

Background: Cancer incidence and mortality are steadily increasing both globally and in Mongolia. As these rates rise, traditional Mongolian medicine has long utilized herbal formulas for the treatment of gastric and esophageal cancers and precancerous conditions. One such formulation—Hot Natured 3 Herbs (HN3H)—comprises three species from the Ranunculaceae family: Atragene sibirica L., Ranunculus repens L., and Pulsatilla bungeana L.. However, scientific validation of its anti-tumor effects is essential. This study aimed to investigate the effect of HN3H in a tumor-induced animal model. Aim: To identify the biologically active compounds of HN3H and evaluate their effect in an experimentally induced tumor model in animals. Materials and Methods: The three herbs comprising HN3H—Atragene sibirica L., Ranunculus repens L., and Pulsatilla bungeana L.—were collected during their flowering stage (May–June) in Khishig-Undur, Bulgan province, and dried according to official procedures. Extraction was carried out by maceration in 96% ethanol at a 1:10 ratio. The concentrated extract was suspended in water (1:1) and successively fractionated with dichloromethane, ethyl acetate, butanol, chloroform, and n-hexane. The study was approved by the Research Ethics Committee of the Mongolian National University of Medical Sciences (Protocol №2020/03-04). A colorectal cancer model was established by subcutaneous injection of MC-38 cells (Kerafast, USA) into C57BL/6 mice. Immunohistochemistry was performed using CK20, CDX2, Ki67, and p53 antibodies at 1:100 and 1:200 dilutions. Results: The ethanol extract of HN3H contained 2.98±0.04% total phenolics and 2.16±0.05% total flavonoids. Body weight and tumor volume were measured daily with three repetitions. All groups showed a time-dependent increase in body weight. Mice in groups 1A and 1B received ethanol extract at 50 and 100 mg/kg doses; groups 2A and 2B received dichloromethane extract at the same doses. The negative control group was administered 0.5 mg/kg PBS orally, while the positive control group received intraperitoneal injections of 5-fluorouracil (5FU) at 10 mg/kg twice a week. Tumor growth increased in a time-dependent manner across groups. Compared to the negative control, tumor volumes in four treatment groups showed statistically significant reduction (p˂0.05), while no significant difference was observed when compared to the positive control (p=0.08). Histological analysis revealed necrosis in all groups, with variation in extent. Conclusion The ethanol extract of HN3H exhibited moderate levels of phenolic compounds and a high concentration of flavonoids. HN3H extract inhibited tumor progression and activated lymphocyte-predominant inflammation in tumor tissues, indicating potential anti-tumor activity (p˂0.05).

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: 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: Helicobacter pylori (H. pylori) is a gram-negative, microaerophilic bacterium that colonizes the human gastric mucosa, with an estimated global prevalence exceeding 50%. The increasing resistance of H. pylori to clarithromycin, a key antibiotic in eradication regimens, has led to a decline in the efficacy of standard treatment to below 80%. Consequently, international guidelines advocate for susceptibility-guided therapy to optimize treatment outcomes. Detection of clarithromycin resistance-associated mutations, including A2143G, A2142G, A2142C, and A2144G, is essential for improving therapeutic efficacy and mitigating the propagation of antimicrobial resistance. Aim: To evaluate the efficacy of tailored H. pylori eradication therapy based on clarithromycin resistance profiling. Materials and Methods: A total of 125 treatment-naïve patients diagnosed with H. pylori infection were enrolled in this study. The infection was confirmed through upper gastrointestinal endoscopy with histopathological analysis, the urea breath test, and stool antigen detection. Clarithromycin resistance-associated mutations were identified using polymerase chain reaction (PCR) analysis on gastric biopsy and stool samples. Based on the presence or absence of resistance mutations, patients were stratified into two treatment cohorts and received targeted eradication therapy. Treatment success was assessed 28 days post-therapy using a stool antigen test to confirm H. pylori eradication. Results: Among the 120 patients who met the inclusion criteria and completed treatment, 41.6% (n=50) were male, and 58.4% (n=70) were female, with a mean age of 39±9.1 years. Clarithromycin resistance-associated mutations were detected in 36 patients (30%), with A2143G identified in 35 cases (97.2%) and A2142G in 1 case (2.7%). In the clarithromycin-sensitive cohort, 84 patients underwent eradication therapy, and among the 60 who completed post-treatment assessment, the eradication rate was 91.6%. In the clarithromycin-resistant cohort, 36 patients received treatment, and among the 20 who completed post-treatment assessment, the eradication rate was 80% (p=0.038). Conclusion A substantial prevalence of clarithromycin resistance-associated mutations was observed among the study population. Susceptibility-guided eradication therapy demonstrated superior efficacy, with eradication rates exceeding 90%. These findings underscore the necessity of implementing resistance-based treatment strategies to optimize clinical outcomes and limit the further dissemination of antimicrobial resistance. Future investigations should focus on refining therapeutic approaches for H. pylori strains exhibiting clarithromycin resistance.

Background: Tuberculosis (TB) is a preventable and usually curable disease. Yet in 2022, TB was the world’s second leading cause of death from a single infectious agent, after coronavirus disease (COVID-19)1. Aim: By reviving strains isolated at specific years over a 10-year interval and performing next-generation sequencing, we can analyze their strain genotype, epidemiology, drug resistance, and dynamicsTherefore, this study was conducted to examine the historical trends and dynamics of strain genotype, variants, and drug resistance of tuberculosis preserved in the culture bank. Materials and Methods:: Using a retrospective, laboratory-based research approach, 200 strains were randomly selected from over 1,000 diagnostic isolates preserved in the NTRL culture collection from 2010 and 2020. Whole-genome sequencing (WGS) was performed using GridION from Oxford Nanopore Technologies (ONT, Oxford, UK) to analyze these strains. The FastQ file was submitted to the International Mycobacterial Database. Strain genotypes, subtypes, gene mutations of drug resistance, and resistance profiles were identified using TBprofiler, MTBseq, IQ-Tree (version 1.6.12), and EPI2me software. Results: Of the tuberculosis strains selected for the study, 66.5% were from eight out of nine districts of Ulaanbaatar, while 33.5% were sampled from 16 out of 21 provinces. Out of the strains analyzed, 83.9% (95% CI 78.7–89.1) belonged to lineage 2 or the Beijing genotype, while 16.1% (95% CI 10.9–21.3) were lineage-4 or Euro-American genotype. While the proportion of Beijing lineage strains was slightly higher and the Euro-American lineage strains slightly lower in rural populations compared to urban populations, the difference in strain distribution between urban and rural areas was not statistically significant (p=0.485). Among the Beijing lineage strains, only the modern Beijing sublineage (100%) was identified. In contrast, the Euro-American lineage exhibited various sublineages: 4 (0.5%), 4.5 (1%), 4.1.2.1 (Haarlem, 3%), Latin American-Mediterranean (LAM, 7.5%), mainly T (3.5%), and S type (0.5%). Notably, the proportion of Lineage 2 strains increased from 80% in 2010 to 86% in 2020. The overlap of the confidence intervals for 2010 (72.16%–87.84%) and 2020 (79.20%–92.80%) indicates that there has been no significant change in the distribution of Mycobacterium tuberculosis lineages over time. The study revealed that among the selected Mycobacterium tuberculosis strains, resistance rates to first-line anti-tuberculosis drugs were as follows: isoniazid (39%), rifampicin (21%), ethambutol (19%), and streptomycin (34%). Genotypic analysis indicated that the Beijing lineage was predominantly associated with drug-resistant tuberculosis cases, including multidrug-resistant (MDR), poly-drug-resistant, and mono-drug-resistant TB. Notably, the Beijing lineage accounted for 100% of pre-extensively drug-resistant (pre-XDR) TB cases. Within the Haarlem lineage, 33% were MDR-TB. In the Latin American-Mediterranean (LAM) lineage, 13.3% were MDR-TB, 6.6% were poly-drug-resistant, and 13.3% were mono-drug-resistant. Among the mainly T lineage, 42.8% exhibited mono-drug resistance. These findings suggest that the distribution of M. tuberculosis lineages in the Mongolian population has remained relatively stable over time, with no significant temporal changes. Conclusion The distribution of M. tuberculosis genotypes circulating among the population of Mongolia has remained relatively stable over time, with no significant time-dependent changes. Additionally, no mutations associated with resistance to newly introduced anti-TB drugs were detected.

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.

Background: Worldwide, the leading cause of blindness in people over the age of 50 is age-related macular degeneration (AMD), which is a complication of the exudative “wet” and dry type. AMD is a multifactorial neurodegenerative disease relating with a combination of environmental and genetic factors, and a contribution of age effect and smoking also, obesity was investigated to be associated with the disease. Number of previous studies have shown that the polymorphisms in the ARMS2, CFH and VEGF-A genes are associated with AMD. Therefore, we investigated the associations between the five common vascular endothelial growth factor (VEGF) polymorphisms and AMD with its therapeutic results. Materials and Methods: Totally 161 AMD patients and 223 controls were enrolled in this case-control study. A prospective analysis of 66 eyes of 34 patients with neovascular AMD evaluated intravitreal bevacizumab injections. The polymorphisms in CFH, ARMS2 and VEGF-А were detected by using the methods of allele-specific polymerase chain reaction (ASPCR) and PCR based restriction fragment length polymorphism (RFLP). Statistical analyses were performed by SNPalyze software. Results: Results of the study showed that rs1061170, rs1065489, and rs800292 polymorphisms are associated with arterial hypertension. Anti-coagulant intake rs1061170 polymorphism T/C, C/C/C/C risk genotype (OR=5.04, 95% CI, 1.81-14.09, p=0.002, RERI=2.568, AP=0.509, S=2.7302) , combined effect of G/C/C/C/ /G, G/A risk genotype (OR=6.52, 95% CI, 2.88 14.79, p<0.001, RERI=4.187, AP=0.642, S=4.136) are associated with increased risk of AMD. In the study, in 66 eyes of a total of 34 people who received intravitreous injection treatment, the central retinal thickness before and after treatment was 294.59±83.52 before treatment, 262.74±87.02 on the first day after treatment, 259.5±111.83 after one month, 248.98±84.96 after 3 months, and 262.69 after 6 months. ±110.59, after 1 year it decreased to 259.19±112.29 (95% CI, 226.74-291.65), which is a statistically significant difference. A comparative study of polymorphisms in therapeutic and non-therapeutic groups revealed statistically significant differences in the G/G groups of rs2010963 polymorphisms. Also, people with G/G genotype of rs2010963 polymorphism are more effective in treatment than people with other genotypes. Conclusion Individual factors such as not wearing sunglasses and arterial hypertension and using anti coagulant medication have been identified as risk factors for AMD. The result showed that polymorphisms of ARMS2, CFH, VEGF genes can be a genetic risk factor for AMD. The decreased in central retinal thickness and improving VA after anti-VEGF treatment confirm the effectiveness of the treatment. Also, people with G/G genotype of rs2010963 polymorphism are more effective in treatment than people with other genotypes. Identification of genetic markers that affect clinical response may result in optimization of anti-VEGF therapy.

Background: The shapes of the eye and upper eyelid are distinctive facial landmarks. The palpebral fissure is composed of the free edges of upper and lower eyelids the lateral and medial canthus. Many researchers confirmed that the morphometric characteristics of the palpebral fissure, canthal distance and exophthalmometirc value (EV) vary according to race, ethnicity, age and sex and normative values which may serve as a reference in the index population. Knowledge of normal dimensions, the existence of asymmetry of the palpebral fissure is of value in several clinical specialties including ophthalmology, plastic and reconstructive surgery and traumatology, where it plays a part in the patient evaluation, management and outcomes. Methods: This cross-sectional study was conducted in the Ophthalmological Department, Third State Central Hospital between January 2022 and August 2022. We included participants who are above 18 years, no history of congenital or traumatic craniofacial deformities, any orbital fractures, tumors and surgeries. All measured values that represent eyelid shape and EV were calculated by mean and standard deviation for statistical analysis. Results: A total of 103 participants aged 19-86 were included in the study, of which 44 (42.7%) were male and 59 (57.3%) were female. The distance between the lateral and medial canthus ranged from 20 to 35 mm, and the mean of the right and left side was 28.30+3.23 mm and 28.05+2.99 mm, respectively (p=0.561). The palpebral fissure height ranged from 5 to 13 mm, and the mean of the right and left side was 8.85+1.65 mm and 8.80+1.65 mm, respectively (p=0.816). The mean distance between the lateral canthi were 90.39+5.57 (range: 80-105 mm), whereas the mean distance between the medial canthi were 63.75+4.25 (range: 53-73 mm). The orbital height varied between 27-43 mm (33.73+3.72) and 26-44 mm (33.78+3.73) on the right and left sides, while the orbital width varied between 26-47 mm (36.75+4.53) and 27-45 mm (36.72+4.42) on the right and left sides, respectively. When measuring the exophthalmometric value (EV), the axial position of the eyeball, with the Hertel’s exophthalmometer, it ranged from 8 to 20 mm on both sides (mean value 13.68+3.01 and 13.71+3.00 on the right and left sides, respectively), and there was no statistically significant difference in symmetry (p=0.94). Conclusion The results are determined different from the findings of Chinese, Korean, Afro-American and Caucasian population based studies. Thus further evaluation is required to represent the normative value of Mongolian index population, that is highly beneficial for clinical assessment, diagnosis and management.