Background: One-third of people with epilepsy have drug-resistant epilepsy, making surgical treatment necessary. Comprehensive pre-surgical evaluations, including long-term video-electroencephalographic (VEEG) monitoring, magnetic resonance imaging (MRI), and neuropsychological testing, are essential components of epilepsy presurgical evaluation. The Epilepsy Center at the Mongolian-Japanese Hospital of MNUMS was established in September 2022 and introduced long-term video-EEG monitoring in May 2023. This marked the first time in Mongolia that comprehensive evaluation for epilepsy surgery became available. Aim: To evaluate the role and outcomes of long-term video-EEG monitoring in the pre-surgical assessment of epilepsy patients Materials and Methods: A prospective cohort study was conducted at the Epilepsy Center of the Mongolian-Japanese Hospital from May 2023 to March 2025. Patients who underwent VEEG and comprehensive pre-surgical evaluation were included. Data included demographic information, seizure history, imaging findings, and neurophysiological assessments (routine, sleep-deprived, and long-term video EEG). Patients were divided into two groups based on whether they met criteria for epilepsy surgery, and surgical outcomes were compared between these groups. Results: A total of 297 patients (104 children and 193 adults) participated in the study. Of these, 96 (32%) were diagnosed with temporal lobe epilepsy and underwent pre-surgical evaluation. The mean age of this group was 33±9.2 years; male-to-female ratio was 1:1. Age of seizure onset was 20±10.9 years, and the mean duration of epilepsy was 14.8±10.3 years. Etiologies included meningitis (21.7%), febrile seizures (15.2%), birth complications (12.5%), and traumatic brain injury (12.5%). The average duration of VEEG monitoring was 1.45±0.68 days, during which 161 seizures were recorded (average 2.64 per patient). No seizures were captured in 35 patients. Among the 96 patients, 29 met the criteria for surgical intervention, and 11 underwent temporal lobe epilepsy surgery. Surgical outcomes were significantly better compared to the non-surgical group (p<0.05). Conclusion Long-term video-EEG monitoring plays a critical role in precisely localizing the epileptogenic zone, identifying seizure types, establishing differential diagnoses, and optimizing surgical candidacy. It is confirmed as an essential diagnostic tool in the pre-surgical evaluation for epilepsy surgery.

Complete androgen insensitivity syndrome (CAIS), also known as Morris syndrome, is a rare X-linked recessive disorder characterized by a 46XY karyotype and a female external phenotype. We present the case of a 32-year-old patient who presented to Unimed International Hospital in 2024 with primary amenorrhea, infertility, and chronic pelvic pain. Clinical examination, imaging, and laboratory investigations led to the diagnosis of CAIS. Laparoscopic surgery was performed to remove bilateral gonadal structures and a cystic mass on the left side. Histopathological analysis revealed testicular tissue and a serous cystadenoma originating from the left mesonephric remnant. Following gonadectomy, hormone replacement therapy was initiated, resulting in stabilization of hormone levels. This rare case highlights the possibility of mesonephric remnant-derived cystadenoma in CAIS and underscores the diagnostic value of cytogenetic and histological evaluations, especially in distinguishing between ovarian and testicular tissue when imaging findings are inconclusive.

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: Cleft lip and palate (CLP) is a congenital anomaly that accounts for approximately 65% of all craniofacial malformations. In Mongolia, the prevalence of CLP is estimated at 0.93 to 1 per 1,000 live births, which is comparable to the global average but slightly higher than the average reported among Asian countries. The incidence is observed to be twice as common in males compared to females. Diagnosis: The patient is a 15-year-old male with a history of congenital unilateral cleft lip and palate. He underwent primary surgical repair of the cleft at the age of 9. As of May 2022, clinical examination revealed maxillary hypoplasia, anterior crowding, and a combination of bilateral posterior and anterior crossbite. Cephalometric analysis demonstrated a skeletal Class III malocclusion with midfacial deficiency. Treatment: Orthodontic treatment was initiated in October 2022 using a non-removable, self-ligating bracket system (MBT 0.022” slot, stainless steel). In the first month, CuNiTi 0.014 archwires were placed, and cross elastics were applied from the maxillary to mandibular canines on the left side for two months. On December 10, 2022, CuNiTi 0.014×0.025 archwires were placed in both arches, accompanied by coil springs to open space. Subsequent phases involved transitioning to stainless steel (SS) and titanium-molybdenum alloy (TMA) archwires for alignment and leveling. Treatment Outcome: At the end of treatment, a Class I molar and canine relationship was achieved. The axial inclinations of the upper and lower incisors reached normative values based on lateral cephalometric analysis. The maxillary arch form was expanded and improved to a more ideal rounded contour. Dental crowding was resolved without extraction, and both transverse and sagittal occlusal relationships were significantly improved. Conclusion This clinical case demonstrates that fixed orthodontic treatment in a patient with unilateral cleft lip and palate can effectively correct dental crowding, normalize occlusal relationships, and significantly improve facial esthetics, phonetics, and overall quality of life. Orthodontic intervention played a vital role in restoring function and supporting psychosocial and physical development.

Background: Individuals requiring liver transplantation began receiving this procedure in Mongolia in 2011, following initial treatments abroad in 2004. As survival rates of post-liver transplant continue to improve, it is imperative to understand the factors influencing the quality of life for patients during these years and to explore modifiable determinants. The interplay between socioeconomic and environmental factors significantly impacts social and personal development, as evidenced by quality of life metrics. Research indicates that 6% of liver transplant recipients are classified as unable to work based on activity and international disability assessments, while 23% to 61% of recipients achieve full employment following liver transplantation treatment. However, there is a notable lack of studies examining the physical, psychological, and social well-being of patients post-liver transplant in Mongolia. This study aims to address this gap and provide insights into the overall health status of these individuals. Aim: Examining quality of life and employment status following liver transplantation treatment Materials and Methods: A descriptive study design and questionnaire method were used to collect data from 144 cases of individuals who underwent liver transplantation. The study was based on the SF-36 Health Survey, categorized into eight domains, with scores calculated according to predefined criteria. Results: Among the 144 cases included in the study, 81 (56.3%) were male and 63 (43.8%) were female. By age group, 120 (83.3%) were between 19 and 60 years old, representing the working-age population, while 24 (16.7%) were over 60 years old. Post-liver transplant employment status revealed significant differences, with 41 (28.5%) employed full-time, 19 (13.2%) parttime, and 84 (58.3%) unemployed or receiving disability benefits (p=0.024). Among these, 62 (43%) expressed a desire to work, 17 (12%) did not wish to work, and 65 (45%) were uncertain, showing no statistically significant differences (p=0.173). When calculating the quality of life assessment, the physical function index was 63.52±25.32 for working patients and 52.90±25.75 for non-working patients (p=0.018), and the psychological status index was 64.94±14.53 for working patients and 53.63±17.87 for non-working patients (p<0.001), and there was a statistically significant difference. Conclusion Health-related quality of life in people who are employed after liver transplantation is high, and overall physical function and overall psychological well-being improve year after year.

Background: The first case of COVID-19 was reported in our country on November 11, 2020. As of 2023, a total of 869,385 cases and 2,128 deaths have been recorded nationwide. The World Health Organization (WHO) has recommended that countries use 15 vaccines from 11 manufacturers listed for emergency use. The WHO has advised low-income member states to prioritize vaccinating healthcare workers and other high-risk populations vulnerable to severe illness and death from COVID-19. The main goal of the coronavirus vaccination program is to prevent infection, complications, and death among priority target groups, such as healthcare workers and other populations at high risk of severe illness. The effectiveness of the vaccination is measured by its ability to reduce the risk of illness, hospitalization, and death from COVID-19-related complications among vaccinated individuals. While extensive research is being conducted globally to develop, evaluate, and assess the effectiveness and outcomes of COVID-19 vaccines, there has been limited research focused on these outcomes within our country. This gap highlights the need for and serves as the basis of the present study. Аim: To assess the risk of infection, hospitalization, and associated risk factors among healthcare workers vaccinated against COVID-19, and to examine the factors that influence these risks. Materials and Methods: A This follow-up study was conducted over an 80-week period—at weeks 12, 24, and 48—from February 23, 2021, to December 31, 2022. The study involved healthcare workers from Ulaanbaatar city and the aimags of Bayankhongor, Orkhon, Bulgan, Dundgovi, Darkhan-Uul, and Dornod. The study was conducted over a period of 1.5 years (80 weeks) following the administration of the first two doses of the COVID-19 vaccine. Data were collected from participants at three time points: before vaccination, after the second dose, and after each booster dose. A structured questionnaire comprising 7 sections and 49 questions was used for data collection, and the results were analyzed using SPSS version 26.0. Results: Of the total respondents, 574 (60%) worked in direct contact with infected individuals in the 'red zone,' while 370 (40%) worked in the 'yellow zone.' Additionally, 250 participants (27.1%) were healthcare workers from Ulaanbaatar city, and 674 (72.9%) were from rural areas. In our observational study, the risk of new infections among healthcare workers increased over time, rising from 38.4% at week 24 to 59.6% by week 80. Hospitalizations also increased during the follow-up period: 24 cases (2.6%) were recorded at week 12, 160 (17.3%) at week 24, 202 (21.9%) at week 48, and 204 (22.1%) by week 80. Among frontline workers in rural areas, those in Bayankhongor and Orkhon aimags exhibited a lower risk of infection compared to their counterparts in other aimags. Conclusion In our follow up study, an increase in the duration since primary immunization was associated with a higher risk of new infection among workers, rising from 38.4% at 24 weeks to 59.6% at 80 weeks post-vaccination. Administration of additional (booster) immunizations was associated with a reduced risk of subsequent infection. COVID-19 vaccination was associated with a reduced risk of complications necessitating hospitalization. Employment in rural settings and designated red zones was identified as a risk factor for incident infections, hospitalizations, and reinfections.

Background: The learning outcomes of a program are defined by the knowledge, skills, and attitudes that students are expected to acquire by the end of the curriculum. For occupational therapy professionals, it is essential to successfully implement both pre-graduation and post-graduation programs and to assess the effectiveness of the curriculum by clearly identifying the competencies expected of graduates in society. Aim: To identify the core competencies required for training occupational therapists at both pre-graduation and post-graduation levels. Materials and Methods: A modified Delphi method combined with Nominal Group Technique (NGT) was employed. The study was conducted in three phases from April 2022 to May 2024. In the initial online survey, a total of 83 participants were involved, including occupational therapy students, graduates, and members of the Mongolian Association of Occupational Therapists. A nominal group consisting of four experts held several focus group discussions to review and vote on the proposed competencies, forming a revised list. In the final phase (second-round Delphi), the updated list was distributed online again to collect additional feedback. Results: A total of 136 individuals participated in the online surveys throughout the study. The final list of competencies was synthesized based on three main international standards: the World Federation of Occupational Therapists (WFOT) Minimum Standards for Education (2016), the Canadian Association of Occupational Therapists (CAOT) Profile of Occupational Therapy Practice (2012), and the TUNING Educational Competencies in Europe. Through five rounds of NGT meetings, one online scoring session, and a final Delphi round, a total of 12 program learning outcomes (PLOs), 198 core competencies for the pre-graduation level, and 86 competencies for the post-graduation level were identified. Conclusion By applying consensus techniques, we developed a structured list of core competencies at both the basic and advanced levels aligned with the 12 program learning outcomes (PLOs) of the occupational therapy curriculum. This list can serve as a practical reference framework for future curriculum design and professional training programs in the occupational therapy.

Background: Due to the geographical location, population, and climatic characteristics of Mongolia, ear, nose, and throat diseases have not decreased to a certain extent, and non-communicable diseases, which are the main causes of morbidity and mortality, are increasing year by year in many countries. Urbanization, population density, environmental and air pollution, unhealthy lifestyles, and harsh working conditions have a significant impact on human health and increase the risk of developing non-communicable diseases. In our country, the study of ear, nose, and throat diseases among emergency workers who work continuously in all weather conditions throughout the four seasons of the year is relatively rare, which was the reason for conducting this study. Aim: Emergency services in some aimags and soums in the Central and Khangai regions have been working to identify and diagnose ear, nose, and throat diseases among employees. Materials and Methods: Using an organization-based prospective study method, clinical examinations were conducted from September 25 to October 18, 2024, among employees of the Central and Khangai regions of Orkhon, Selenge (6 soums), Tuv (4 soums), Khuvsgul (5 soums), Arkhangai (2 soums), Darkhan (1 soum), Bulgan (3 soums), 7 aimags, and 21 soums. The diagnosis of ear, nose, and throat diseases was made using ICD codes, and the data was analyzed using EXCEL software. Results: Among the employees and workers of the emergency services of the aimag, soum who participated in the survey (n=984), 139 (14%) were female and 845 (86%) were male, with an average age of 31.7 years and an average number of years of service of 10.3. The frequency of diseases classified by ICD code as a percentage of occurrence was as follows: J34.2: 211 (21%), J35.1: 96 (9.75%), J31.0: 58 (5.89%), H90: 15 (1.5%), H61.2: 14 (1.4%), H72.0: 10 (1.01%), H65.4: 6 (0.6%), J34.89: 5 (0.5%), K21.0: 5 (0.5%), H61.81: 3 (0.3%), D11.0: 2 (0.2%), 119 (12%) with comorbidities, and 426 (43.3%) diagnosed as healthy without ENT diseases. Conclusion 43.3% of the employees of the National Health Insurance Agency of some aimags and soums of the Central and Khangai regions were diagnosed as healthy or without ear, nose and throat diseases, and deviated nasal septum (J34.2), enlarged tonsils (J35.0), chronic rhinitis (J31.0), and conductive and sensorineural hearing loss (H90) were commonly found.

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: Asthma management should be individualized, evidence-based, aimed at controlling clinical symptoms, preventing severe exacerbations, and improving quality of life. Studies have shown that inhalation therapy with iodine- bromide saltwater improves lung function in chronic obstructive pulmonary disease (COPD), while radon-containing mineral water inhalation reduces inflammation and oxidative stress in asthma. Several studies have analyzed the composition of the Shargaljuut hot spring, with Oyuntsesteg et al. identifying high levels of Na+-HCO3 - and Na+-SO4. Other studies on mineral water therapies have reported benefits such as thinning bronchial secretions, improving sputum clearance, reducing inflammation and acidity, mitigating oxidative stress, and enhancing quality of life. Aim: To study the effectiveness of combined asthma treatment with inhaled corticosteroids and hot spring inhalation. Materials and Methods: The study included 67 participants diagnosed with asthma who consented to participate and underwent 10 days of combined inhaled corticosteroid therapy and mineral water inhalation at Shargaljuut sanatorium. A total of 57 participants completed the pre- and post-treatment assessments. Treatment result was assessed using Asthma control questionnaire 7, asthma symptom control with Asthma Control Test (ACT), and exercise tolerance by a 6-minute walk test. Chest X-rays were taken for all participants to rule out pneumonia, cancer, or pulmonary fibrosis. Treatment outcomes were evaluated using ACT scores, peripheral blood eosinophil count, total IgE levels in serum, spirometry indices (FEV1, FVC, FEV1/FVC), and the 6-minute walk distance. Results: The average age of participants was 52±12 years, with a predominance of females. The mean asthma control score was 14.2±4.80, indicating poor asthma control. After 10 days of inhaling corticosteroids combined with hot spring inhalation post-treatment quality of life increased by 0.5 points, FEV1 improved by 7.5%, FVC by 4.2%, peripheral blood eosinophil count decreased by 0.3%, and total Ig E levels dropped from 73.3 (22.5; 216) to 73.2 (21.3; 223) u/ml (p=0.000). Conclusion In cases of uncontrolled asthma remission, combining of inhaled corticosteroid therapy with hot spring inhalation at Shargaljuut improved asthma symptoms, quality of life, enhanced lung function, and reduced inflammatory markers (p<0.001).