Background: A 2024 study by the National Statistical Office of Mongolia indicate an incidence rate of 38.8 per 100 000 population, with a total of 8169 new cancer cases diagnosed, of which 16.2% are gastric cancers. Notably, 64.4% of these diagnoses are made at advanced stages.2 Surgical intervention remains one of the most effective treatments for gastric cancer. Early-stage surgery confers a 5-year survival rate of 60-80%, whereas late-stage diagnosis reduces this to 18-50%.5 This study aims to investigate the causes, types, and contributing factors of postgastrectomy anemia in patients undergoing surgery for gastric cancer in Mongolia, where no prior study has been conducted on this topic. Methods: This retrospective study analyzed all patients who underwent gastric cancer surgery at the National Cancer Center of Mongolia from 2022 to 2024. Data on demographics, lifestyle factors, clinical signs of anemia, and comorbidities were collected from medical records and confirmed by direct examination. Results: A total of 788 patients who underwent surgery for gastric cancer were included in the study, of whom 70.5% were male and 29.5% female, aged 22–70 years (mean age 46 years). Among the total cases, 461 patients underwent total gastrectomy, 128 had distal gastrectomy with gastrojejunal anastomosis, 39 underwent partial gastrectomy, 3 had gastrectomy with duodenal anastomosis, 5 underwent gastrectomy with esophagogastric anastomosis, and 6 underwent bypass procedures. Conclusions Postoperative monitoring after gastric surgery was insufficient, and there was a tendency for anemia to progress.

Background: Infections in respiratory systems have spread throughout the world without any restrictions including living places, public issues, and lifestyle. Three main causes of illnesses for the population of cities and rural areas were gastrointestinal diseases, respiratory diseases, and cardiovascular diseases. After investigated some medicinal herbs including Stelleria Chamaejasme L. and Oxytropis Pseudoglandulosa, it has been reported that they had antiinflammatory, analgesic, and wound healing effects. Lozenge formulation has some advantages for treatment application, such as easily absorbed, good bioavailability and ability of diminishing stomach irritation. In this study, we aimed to obtain a suitable extract from Stelleria Chamaejasme L. and Oxytropis Pseudoglandulosa for further lozenge formulation. Purpose: To obtain a suitable extract from Stelleria Chamaejasme L. and Oxytropis Pseudoglandulosa, and to conduct qualitative and quantitative studies for some biologically active substances Materials and methods: In this study, an aerial part of Stelleria Chamaejasme L. and Oxytropis Pseudoglandulosa were used, and the study was conducted in MUPS. For obtaining a suitable extract, the raw materials were extracted by remaceration, repercolation and circulation methods in 20% and 70% of ethanol and distilled water. The flavonoids and polyphenolic compounds in the extracts were determined by thin layer chromatography. Quantitative analysis for total flavonoids was performed by spectrophotometer. Results: According to the result, a yellow spot-on chromatogram was detected in extracted raw materials (Stelleria Chamaejasme L. and Oxytropis Pseudoglandulosa), indicating that flavonoid contained in the extracted solution.
The result was compared to standards of rutin (Rf=0.2) and quercetin (Rf= 0.94). Also, a black, blue spot-on chromatogram was detected in extracted raw materials (Stelleria Chamaejasme L. and Oxytropis Pseudoglandulosa), indicating that polyphenols contained in the extracted solution. The spots were compared to gallic acid as a standard substance. In the quantitative assay of total flavonoids in raw materials, black-green precipitation was revealed after procedure. From this result, remaceration and circulation techniques were suitable to extract the raw materials. Flavonoid content was 3.35±0.04% after using remaceration technique, which indicated that it was more suitable to extract the raw materials. Conclusions These results showed that the appropriate extracting solution for Stelleria Chamaejasme L. and Oxytropis Pseudoglandulosa was 70% of ethanol. In this case, 3.35±0.04% of flavonoid was extracted by remaceration technique.

COVID-19 and pregnancy: a national registry based study Background: According to a cohort study involving 2,130 pregnant women from 16 countries, the impact of COVID-19 on maternal morbidity and mortality was higher in low- and middle-income countries. Other one study found that the coronavirus pandemic increased maternal mortality by 1.37 times. The COVID-19-related mortality risk is 3 times higher in pregnant women than in the general population. In our country, there is a lack of evidence that determine the impact of COVID-19 on maternal mortality based on the national registration system. We aimed to study the relationship between COVID-19 and maternal mortality and complications based on national registry data Materials and methods: The study was conducted between February 20, 2022 and March 1, 2022 based NCMCH. The impact of the coronavirus pandemic on maternal mortality was performed based on the 2020-2021 maternal mortality data of Mongolia through a retrospective and time series analysis. In order to estimated factors that affect the complications of a pregnant women’s COVID-19 infection, it was conducted a retrospective study design based on the database of pregnant women diagnosed with a COVID-19 infection. The study data was collected through a prepared questionnaire. Results: According to analysis, the maternal mortality rate in Mongolia in 2021 was 1.9 times higher than the predicted rate. In 2021, 67.6% of maternal deaths are due to COVID-19. In 2021, the maternal mortality rate due to Covid-19 was 64.2 per 100,000 live births, which is twice as high as maternal mortality due to other diseases. In 2020-2022, 17,789 pregnant women between the ages of 14 and 46 who were infected with the coronavirus were included in the study to determine the factors affecting the complications of COVID-19. The mean age of the participants was 30 ± 5.8 (95% CI 29.7 – 29.9) and their gestational age was 24 ± 10 weeks. Of all participants, 71.6% was diagnosed and treated in Ulaanbaatar. 52.7% of pregnant mothers diagnosed with coronavirus and presenting with complications have not been vaccinated, which is a relatively high rate compared to the group of pregnant mothers without complications. Not being vaccinated against coronavirus had a 70% increased risk of complications (OR = 1.7, 95.0% CI: 1.4–2.0). However, the probability of hospitalization increased by 20% (OR = 1.2, 95.0% CI: 1.0 – 1.4). The COVID-19 severity depends on the age of the maternal and the length of the pregnancy. Conclusion: The COVID-19 pandemic has had a significant impact on maternal mortality, has increased. The maternal mortality rate in Mongolia is low compared to other countries, but it is higher than the recommended level for reducing maternal mortality. COVID-19 vaccination, on the other hand, reduced the complications of pregnant women and had a protective effect. It is important to build evidence by examining the effects of COVID-19 and vaccines on pregnant women.

Assessing children with disabilities using who international classification of functioning (ICF) Background: In 2021, according to the World Health Organization (WHO), over 1 billion people are estimated to experience disability. The number of children with disabilities globally is estimated at almost 240 million, according to a new UNICEF report. There are approximately 43 million children with disabilities in East Asia and the Pacific. In the 2020 population and housing census of Mongolia, a total of 106.4 thousand people with disabilities were counted, of which 7.6 percent or 8.1 thousand children aged 0-14 were counted. People with disabilities lose some of their ability to labor. WHO recommended that assessment of children with disabilities using both ICD and ICF. Thus, we aim to assess children with disabilities who have neurological disease using International Classification of Functioning and evaluate the validity of this classification. Materials and methods: This was a cross sectional analytical study based on NCMCH. Study materials were collected from children and guardians through standard questionnaires. The questionnaire consisted of 2 groups: general information of the participant and indicators of the scope of the D code of the "ICF" to assess the childhood disability. According to the indicators of the D code range, activity limitations and participation restriction, disabilities were evaluated. Each question in the questionnaire was measured on a 5-point Likert scale from 0 to 4. The statistical analysis was performed using R 3.5.1 program. Validity was assessed using the Rasch model for each question. Questionnaire reliability was assessed by Cronbach's alpha test. Results: The study included 32 children aged 2-15 years. Male children were 62.5% of participants, the mean age was 8±3.1 years. Correlation between questions was high (r = 0.79) and reliability was adequate (α=0.94). As a result of Rasch analysis, the mean and standard deviation of the 36 selected parameters were not significantly different from the standardized mean. 3 indicators that did not meet the analysis criteria were removed, and a total of 33 indicators were used to measure childhood disabilities. Mean infit MNSQ was 1.06, mean outfit MNSQ was 0.93. MNSQ of all participants were 1.0 – 2.0. As a result of Rasch analysis, the mean of 33 indicators of disability is -1.6, the standard deviation is 1.2, the upper limit of the mean is 3.6, and the lower limit is -3.4, and the indicator of D code was stable enough to measure disability. The mean code scores were 2.45±1.3. The mean score of disability level of children diagnosed with cerebral palsy was 2.9±1.09, and children hospitalized with seizures and meningitis was 0.5±0.3. Also, the total mean score was 2.61±1.2 in the group with disability and receiving care, and 1.8±0.21 in the group not receiving care, which was a statistically significant difference. Conclusions: Inter-indicator correlation was good and reliability of the questionnaire was adequate in field use of the 38 indicators of the activity limitations and participation restriction of the International Classification of Functioning, Children's Version (ICF-CY) code range “D”. When evaluated by Rasch analysis, 33 questions were evaluated as structural and stable. The International Classification of Functioning can be used to assess children's disabilities. Discussions: Niels Ove Illum et al. (2015) found that The World Health Organization International Classification of Functioning, Disability and Health child and youth version d code data can provide a coherent measure of severity of disability in children across various diagnoses, ages, and genders. Results were similar to our study.

Clinical characteristics differences and risk factors of coronavirus disease and influenza in children 0-18 years Background: In worldwide, 176190 children infected with SARS-CoV-2 during April of 2020. According 01/09/2021, 46019 children had diagnosed with COVID-19 in Mongolia, were 19.5% of all cases. During COVID-19 infection, respiratory and digestive symptoms were commonly presented in children. Although the symptoms of coronavirus disease in children and adults are similar, in general, it was relatively mildly than adults, but from clinical observations reported that the infection occurs more severely in children and leads to death. During the coronavirus pandemic, it has been reported that children have Kawasaki syndrome, cardiac myopathy, coronary artery changes, and digestive system problems. Cardiac dysfunction in children may have recovered without sequelae, and further long-term follow-up studies are necessary. We aimed study clinical characteristics differences and risk factors of coronavirus disease and influenza in children 0-18 years. Materials and methods: The study was conducted Children hospital of NCMCH from October 01, 2021 to April 01, 2022, participated 594 inpatients with COVID-19 and influenza, and studied clinical characteristics, laboratory and functional diagnostic changes, treatment, and complications of the coronavirus disease and influenza. Results: The study included 450 children aged 0-18 years with confirmed COVID-19 infection and 144 children with influenza. In social-demographic indicators, the mean age of children is 4±4.8 years, and 58.6% are male. Children age group included 0-4 ages, 5-9 ages, 10-15 ages and over 15 ages (62.4%, 17.5%, 16.2%, and 3.7%), respectively. As for influenza, 39.7% were children aged 0-9. In 8 cases, they received the COVID-19 vaccine but became ill with COVID-19. As for the variants of COVID-19 infection, 231(41.8%) alpha, 219(48.0%) delta, and 144(24.2%) influenza according to the wave period and clinical differentiation. In severity of diseases, 2(0.4%) were mild, 312(69.3%) were moderate, 117(26.0%) were severe, and 17(3.8%) were critical severe. There is a statistically significant difference in the severity of the disease between COVID-19 and influenza. 1 death (0.4%) occurred in cases of COVID-19. The mean days of inpatients with COVID-19 was 12.4±5.5 and mean days of inpatients with influenza 8.6±3.64. When assess signs of children, fever, cough and food aversion were main signs among both group of alpha and delta varientin COVID-19. Specifically, 67.3% had fever, 63.3% cough, 16.4% runny nose, 8% chest pain, 10.2% headache, 15.5% fatigue, and 0.9% decreased sense of taste and smell. There is a statistically significant difference (p<0.000) in the symptoms of cough, chest pain, general toxication symptoms and decreased sense of taste and smell in the case of COVID-19 and influenza. During influenza, symptoms of chest tightness and respiratory distress were observed in 10 (7.4%) children during severe illness. 0.5% of all cases of COVID-19 with sinus arrhythmia, and atrioventricular block were detected 0.9% of all cases by electrocardiogram analysis. When studying the underlying medical conditions of children in relation to the complications of COVID-19 and influenza, children diagnosed with heart defects, malnutrition, weakness, anemia, cerebral palsy, and other chronic diseases have a greater impact on the severity of the disease of COVID-19 than those with influenza. In the study of the factors affecting the severity of the COVID-19 infection, the child's age and gender did not have an effect, while the presence of a heart defect in the child increased the risk of complications by 5 times (p<0.001). Conclusions: Among 0-4 aged children with COVID-19 are occurred more hospitalization, brightly presented symptoms in children with chronic diseases, are being more severe and hospitalization days are more than in children with influenza. Symptoms of fever, cough, and runny nose are more common in children during flu and influenza, while headache, abdominal pain, dehydration, and reduced sense of taste and smell are significantly more common in the case of COVID-19. On the other hand, symptoms of chest pain, weakness, and fatigue were found in the 2 groups. The comorbidities (congenital cardiac anomalies, malnutrition, weakness, anemia, cerebral palsy, and other chronic diseases) are being risk factors for the severity of coronavirus disease.

Safety and effectiveness of COVID 19 vaccine among pregnant woman Introduction: Major International Organizations such as the World Health Organization (WHO), Centers for Disease and Prevention (CDC), American College of Obstetrics and Gynecology (ACOG) recommend that use of COVID 19 vaccine for people who are pregnant, breastfeeding and trying to get pregnant. Objective: To determine the safety and effectiveness of COVID 19 vaccine among pregnant woman. Materials and methods: In this prospective study, we collected data from pregnant woman who are receiving their antenatal care at the general hospitals of Ulaanbaatar city and National Center for Maternal and Child Health of Mongolia between July 1, 2021 and August 20, 2021. The survey data were collected four categories of questionnaires. An ultrasound scan performed to screening of fetal anomalies and to assess fetal growth at 12, 20, 28, 36 weeks of pregnancy. Results: Among the total of 420 pregnant woman, 193 (46.0%) have received COVID 19 vaccine and 227 (54.0%) were not. (1:1) The most commonly reported adverse events in pregnant participants were injection site pain (63.2%), myalgia (45.2%), headache (44.9%) and fatigue (40%). Furthermore, complications of pregnancy were 11.5% of vaccinated group and 7.8% of the other group and it has shown that pregnancy complications was not statistically significant in differentiating to the study groups (x^2 = 1.62, p = 0.205) Pregnant woman with COVID 19 infections were 73.6% (n=39) of unvaccinated group and 26.4% (n=14) of vaccinated group. Whether to relate between COVID 19 vaccination and COVID 19 infections were statistically significant in differentiating to the study groups. According to the result, COVID 19 vaccine has an effectiveness of 91% for the pregnant woman if they continue to administer the prevention method of COVID 19 infections (same as before the vaccination: wearing a mask, keep a safe distance). The risk of fetal anomalies at first trimester and 20 weeks gestation were not statistically significant in differentiating to the study groups. These results demonstrate that the COVID 19 vaccine does not affects fetus by now. Conclusions: In this study, COVID 19 vaccine does not increase a risk of pregnancy and medical complications. The prevalence of COVID 19 infection was statistically significant in differentiating to the both vaccinated and unvaccinated groups. It shows that COVID19 vaccines have became a crucial tools for reducing the incidence of COVID 19 infection in pregnancy.

Effects of COVID-19 on pregnancy and delivery outcome: systematic review with meta-analysis Introduction: The impact of Coronavirus infection disease (COVID-19) on during pregnancy, maternal outcome, and neonatal health is unclear. We aimed to measure about effect of Coronavirus infection to pregnancy, maternal outcome, and newborn health in systematic review with meta-analysis. Materials and methods: The systematic review and meta-analysis conducted PRISMA guidelines, recommended from Cochrane, based on database of studies and a hypothesis to determine the impact of COVID-19 on pregnancy, maternal, and neonatal outcome. We searched for eligible studies of databases from December 2019 to April 2021. Our dependent variables were preeclampsia, preterm birth and stillbirth. Independent variables were infection of COVID during pregnancy, and outcomes. We measured for primary outcome that are preeclampsia, preterm birth, and secondary stillbirth. The meta-analysis evaluated the quality of the observational study (Newcastle – Ottawa Scale) and included the results. Statistical analysis was performed using Rev Man 5.0 software. The ratio (OR) in meta-analysis was calculated using a meta-regression model (Random effect meta-analysis). The mean difference was measured and weighed 95.0% confidence interval. Results: We included 46 studies involving 459,789 participants. Coronavirus infection maybe associated with increase the risks of preeclampsia in pregnancy (B: 1.21, 95.0% CI: 1.01 - 1.25), premature birth (B: 1.91, 95.0% CI: 1.62–2.15), stillbirth (B: 2.2, 95.0% CI: 2.12–2.31. Conclusions: Coronavirus infection increases the risk of preeclampsia, premature birth and stillbirth. Furthermore, the studies are needed to collect more robust data to validate or substantiate these findings, better understand the impact of COVID on pregnancy in experiment, intervention, and cohort studies with Meta-Analysis.

The study of clinical and epidemiological characteristics of coronavirus infection in children ages 0-18 Introductions: The coronavirus disease (COVID-19) has been spreading in Wuhan, Hebei Province, China since late 2019, and was declared a pandemic by the World Health Organization on March 11, 2020. Since the outbreak of the pandemic, the SARS-CoV-2 virus has been constantly mutating, and several new variants have emerged, dominating the world. These variants are characterized by differences in transmission, toxicity, and pathogenicity. Due to the lack of research on pediatric COVID-19 in Mongolia. Our goal was to study the symptoms and severity of children with COVID-19 and to compare clinical characteristics between Alpha and Delta of SARS-CoV-2 occurred in children. Material and methods: Clinical characteristics, laboratory and diagnostic test results of 450 children aged 0-18 years, confirmed by laboratory tests from March 30, 2021 to December 1, 2022 in the Isolation Department of COVID-19 infected children of the NCMCH, treatment and complications were studied retrospectively. Result: The study involved 450 children aged 0-18 years with laboratory-confirmed COVID-19 infection. According to the demographic variables, 263 (58.4%) boys and 189 (41.6%) girls. In terms of age group, 62.4% were aged 0-4 years, 17.5% were aged 5-9 years, 16.2% were aged 10-15 years, and 3.7% were children over 15 years old. Of these children, 231 (51.3%) were clinically confirm signs of alpha and 219 (48.7%) delta variant. In 8 cases, COVID-19 was vaccinated but became infected. Clinical features of alpha-type physical examination were 117 (51.6%), pale face and paleness (29.6%), and respiratory distress (40.0.0%). Clinical features of delta-variant bruising, pallor, and chest depression were predominant on physical examination. Conclusion: COVID-19 In children with alpha and delta variants, the most common symptoms of respiratory viral infections, such as fever and cough, were respiratory distress in alpha variant and respiratory and circulatory abnormalities signs in delta variant.

Outcomes of the retinopathy of prematurity screening and treatment in Mongolia Background: Retinopathy of prematurity (ROP) is a disease characterized by abnormal retinal vasculature that can have devastating visual consequences. Despite evidence that early detection and treatment can prevent blindness, ROP remains a leading cause of pediatric blindness worldwide. We aimed at investigating the outcomes of ROP screening, intravitreal anti–vascular endothelial growth factor (VEGF) and laser surgery in the treatment ROP and describe an evidence-based and specific process for identifying birth weight and gestational age screening guidelines in Mongolia utilizing telemedicine. Materials and methods: This was a retrospective of prematurity infants screened ROP from 2012 September to July 2020 and prospective cohort study of premature infants with treatment-requiring ROP who received intravitreal injections, laser surgery and combined therapy from 2015 December 01 to January 31, 2017. Demographic factors, diagnosis and clinical course were recorded in a de-identified manner using REDCap, a secure, web-based platform to collect image and demographic data. The IRB approved the study protocol not requiring parental consent due to the de-identified nature of the data which was used for program monitoring purposes. Indirect ophthalmoscopy and Retinal imaging was performed using RetCam (Natus Medical, Pleasanton, CA) and images were uploaded to the web-based platform which could be accessed by the Mongolian ophthalmologist for reference. Each eye was evaluated by the local Mongolian ophthalmologist for the presence or absence of ROP, zone of vascularization, stage, plus disease, and aggressive posterior ROP (AP-ROP). The diagnosis and classification of ROP for this current study were determined by examination using indirect ophthalmoscopy, and treatment plans were determined according to the International Classification for ROP and the Early Treatment for ROP Study (ET-ROP).2,13 Regression analysis to determine association between BW and GA and the development of ROP. Results: A total of 9126 premature infants with BW ≤ 2500 g and/or GA ≤ 36 weeks were screened for ROP during the study period. 327 (3.5%) of the 9126 infants screened required treatment. The193 infants who received ROP screening had a mean GA of 30.09 ± 1.7 weeks, and mean BW of 1500.3 ± 125.42g. The BW of infants in this study ranged from 750g to 2000g, and the GA at birth ranged from 25 to 35 weeks. The BW of infants in this study ranged from 750g to 2000g, and the GA at birth ranged from 25 to 35 weeks. There were 96 boys (49.7%) and 97 girls (50.3%). Among infants receiving treatment, the highest BW was 2000g (born at 31 weeks GA), and the oldest was 34 weeks (with a BW of 1300g). The distribution of birth weight and gestational age in Mongolia was similar to other low-middle income countries, with higher birth weight and older gestational age. As birth weight and gestational age decreased, relative risk of developing ROP increased. Conclusions: After treatment, resolution of ROP was noted in approximately 90 % of the patients who had treatment-requiring ROP. 10 % of patients treated with IVB, IVR, Laser surgery and combined therapy however, did not respond and progressed to retinal detachment. This prospective study provides information about the development of ROP in preterm infants in the capital city of Mongolia. The distributions of BW and GA among infants developing ROP in Mongolia differ from those found in higher-income countries, and are comparable to other low and middle-income countries. We used a secure, web-based data collection and retrieval system that could be extended to multiple countries, which is now equipped with a telemedicine platform enabling remote grading of fundus images.

Abstract Mana-4, an herbal medicine, had been used to treat incomplete-mannered and infection-caused hot disease in Mongolian traditional medicine. It has already reported that Mana-4 acts as an anti-inflammation agent, an activator of T and B cells, an immune-modulator and an inducer of cellular proliferation. Moreover, it enhances the immune system and energy level of human body. It was confirmed that the main active compounds in Mana-4 are inulin and total flavonoids which are effective for many diseases. Drug formulation types are very important to delivery the drugs to the targeted tissues and organs without loss of active ingredients. Total flavonoids in the extract of Mana-4 and granulated Mana-4 was qualitatively evaluated by TLC and yellow-brown spots (Rf was 0.4) were found on TLC plates, indicating that the preparations contained flavonoids. Also, it confirmed that the appropriate extractor of total flavonoids from Mana-4 was 70% of ethanol. In conclusion, the tablet formulation from Mana-4 was successfully prepared and the quality requirements was allowable.