Introduction: Antibiotics are commonly prescribed in paediatrics.¹ Children were 1.3 times more likely to be treated with antibiotics compared to adults.² Especially, antibiotic prescription is higher in children aged under 5 years.³ Purpose: To identify the most widely used antibiotics in the age group of 0-5. Objectives of the study:
1. To identify the most widely used antibiotics and classify them by pharmacological group
2. To analyze the pharmaceutical dosage forms of commonly prescribed antibiotics for infants and toddlers Methods: In our study, we selected 20 pharmacies from 6 districts (Bayanzurkh, Bayangol, Khan-Uul, Songinokhairkhan, Chingeltei, and Sukhbaatar) of Ulaanbaatar city using a single random sampling method. A total of 496 antibiotic prescriptions written for children aged 0-5 years in 20 pharmacies were analyzed. Antibiotic prescription forms for children aged 0-5 years registered in the pharmacies in November, December 2023, and January 2024 were collected. The results were processed using “SPSS 29.0.2” program. Result: Among a total of 496 antibiotic prescriptions written for children, 341 were written in solid dosage form and 155 were in liquid dosage form (suspension). Amoxicillin 250 mg and Amoxiclav 312.5 mg were mostly used from Penicillin group for the treatment of infants and toddlers. Clarithromycin 125mg/5ml from Macrolide group had an important role in treatment. Cefixime 400 mg from the Cephalosporin group was used in some cases such as diarrhea and vomit. Conclusions
1. Amoxicillin, Amoxiclav, Clarithromycin (Penicillin, Macrolide) antibiotics are the most widely used in the treatment of infants and toddlers.
2. It has concluded that antibiotic prescriptions for infants and toddlers mainly include solid and suspension antibiotics.

Introduction: Among the ancient medical books, manuscripts written in clear script, with unique vocabulary and treatment methods, have been found. The vocabulary in this work is very ancient, and the treatment methods are systematic, with few mentions of theoretical concepts. Most of the unfamiliar words were written in the pronunciation of the ancient Oirat Torghut and Dorbet. Some of these words were of Uyghur and Sartuul (Khui Khui) origin. Therefore, we worked to determine when and by whom this book was written, what its content was, and which direction of medicine it belongs to. Objectives: To study an ancient book written in clear script, containing Islamic medical knowledge, found in Mongolia. Results “The Healing Charm of Blue Ram” (Khökh khutsyn uvdis orshivai) records that Genghis Khan ordered Chagatai Khan to send him medical books from his land. He may have been in poor health shortly after the founding of the Chagatai state in 1225. Thus, he ordered Chagatai to send him books containing medical methods. It is reasonable to assume that the books were sent in 1226. At that time, the Chagatai state was highly developed, consisting of many ethnic groups, including Khorezm, Sartuul, and Uyghurs, who practiced Islam. In particular, the medical field was well advanced, resulting in many excellent doctors and medical books. We tried to list and explain a total of 15 words from “The Healing Charm of Blue Ram,” with many more to explore in the future. In general, it is hypothesized that many vocabulary related to medicine have spread to the Mongolian vocabulary through Arabic, Turkic, Uyghur, and Sartuul among the Western Mongolians. Conclusion: The ancient book “The Healing Charm of Blue Ram” found in Mongolia, written in clear Mongolian script, contains Islamic medical knowledge, as well as traditional Mongolian medicine methods, as is clear from the explanations of some vocabulary related to medicine. In the future, it is important to further clarify how Mongolian medicine and Islamic medical knowledge influenced each other and the contribution of Mongol khans to the development of the Ilkhanate and the Chagatai state in the study of the history of Mongolian medicine.

Background: Organ transplantation has been rapidly advancing in Mongolia in recent years. The number of successful kidney, liver, and bone marrow transplants performed in national central hospitals has been increasing annually. While the number of successful kidney transplants is increasing, post-transplant immune monitoring remains insufficiently studied. Aim: To assess post-transplant immune status by analyzing inflammatory cytokine levels in kidney transplant recipients Materials and Methods: A prospective cohort study was conducted at the First Central Hospital of Mongolia. Serum samples from kidney transplant recipients were analyzed using flow cytometry to measure the levels of 13 inflammatory cytokines, including TGF-β1, PAI-1, sTREM-1, PTX3, sCD40L, sCD25 (IL-2Ra), CXCL12 (SDF-1), sST2, sTNF-RI, sTNF-RII, sRAGE, CX3CL1 (Fractalkine), and sCD130 (gp130). Statistical analysis was performed to assess the results. Results: The mean creatinine level significantly decreased on post-transplant days 7 and 30 compared to pre-transplant levels (p<0.001, ANOVA). No statistically significant difference was found in the 13 cytokine levels between the high risk and low-risk groups based on creatinine levels on post-transplant day 30 (p>0.05). However, the levels of TGF-β1, CX3CL1, sTREM-1, and sTNF-RI showed statistically significant differences between post-transplant days 7 and 30 (p<0.05). No significant correlation was found between the measured cytokine levels and CRP (p > 0.05). On post-transplant day 7, sTREM-1 had a weak correlation with TGF-β1 (r=0.40, p=0.02) and sTNF-RI (r=0.36, p=0.05) but showed a strong correlation with CX3CL1 (r=0.65, p=0.0001). On post-transplant day 30, sTREM-1 remained strongly correlated with CX3CL1 (r=0.73, p=0.0001) and moderately correlated with sTNF-RI and TGF-β1 (r=0.45, p=0.01). Conclusions 1. The levels of TGF-β1, CX3CL1, sTREM-1, and sTNF-RI significantly varied between post-transplant days 7 and 30 (p< 0.05, T-test). 2. On post-transplant day 30, these cytokines were not correlated with CRP but were interrelated among themselves.

Background: Obesity, especially central obesity, is a risk factor for non-communicable chronic diseases such as dyslipidemia, type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVD), and metabolic syndrome (MetS). Aim: Study the association between the subcutaneous fat area (SFA) and visceral fat area (VFA) with lipid metabolism parameters in adults with MetS. Materials and Methods: Data from 1511 participants who visited the ‘NURA Mongolia’ Ai Health screening center between September 2023 and February 2024, including general information, DEXA (Dual X-ray Absorptiometry), and biochemical analysis results, were used. Metabolic syndrome (MeS) was assessed based on the harmonizing criteria 2009 (≥3 criteria). VFA and SFA were categorized into four groups using quartiles (Q1-Q4). Statistical analysis was performed using SPSS v26, including T-tests, multiple logistic regression (OR, 95% CI), and ROC (AUC) analysis. Results: The average age of the participants was 30.5±3.9 years, with a BMI of 25.1 kg/m², and 49.5% were male. The group with MetS (n=531) had significantly higher levels of VFA and SFA compared to the group that rated their health as relatively healthy and had no clinical diagnosis (n=979) (control group) (p<0.0001), with males showing higher VFA and females showing higher SFA (p<0.0001). The Q4 group for VFA had a significant association with MetS in males (4.611, 95% CI=2.394–9.591) and females (2.253, 95% CI=1.097-3.912) (p<0.001). Logistic regression analysis showed that increased VFA was more strongly associated with MetS in males (β=0.325, p<0.0001) and females (β=0.338, p<0.003) than BMI. The AUC for predicting MetS was 0.790 (95% CI=0.750-0.831) for VFA and 0.401 (95% CI=0.351-0.451) for SFA, with all results being statistically significant (p<0.001). VFA had a higher predictive value compared to other markers. Conclusion In healthy men with metabolic syndrome, VFA is more prominently defined, while SFA is higher in healthy women. Since VFA is a better predictor of metabolic syndrome than SFA, it increases the risk of diseases such as cardiovascular diseases and type 2 diabetes in men, whereas SFA in women serves as a protective factor.

Background: Membranous nephropathy (MN) is among the most common causes of nephrotic syndrome in adults. MN is diagnosed in one third of cases of nephrotic syndrome on kidney biopsy. Kidney biopsy is the gold standard for diagnosing MN and plays an important role in determining the severity of the disease and in determining treatment decisions and regimens. Therefore, the lack of research on kidney biopsy in Mongolia is the reason for this study. Aim: The aim of this study was to investigate the pathological features in the kidney tissues of patients with primary membranous nephropathy diagnosed by kidney biopsy. Materials and Methods: A retrospective study was conducted on 51 cases of MN diagnosed in kidney biopsies performed at the First Central Hospital of Mongolia (FCHM) over a period of 12 years. Renal function was calculated using the CKD-EPI (2021) formula and classified into the stage of CKD by eGFR. Histopathological findings were examined using 4 light microscopy (LM) stains (Hematoxylin-Eosin, Masson-Trichrome, PAS, and Methenamine silver staining) and 8 immunofluorescence (IF) microscopy stains (IgG, A, M, complement C3, C4, C1q, and kappa, lambda). The study excluded secondary MN based on viral markers, tumor markers, and serological tests. Statistical analysis was performed using SPSS and STATA 15.0 software, using t-tests, Pearson’s chi-square tests, and multiple group comparisons were performed using ANOVA and Kruskal-Wallis methods. The study design was approved by the Ethics Committee of the MNUMS, Mongolia. (№ 2023/3-07) Results: A total of 305 kidney biopsies performed at the Kidney Center of the FCHM between 2011 and 2023 resulted in the diagnosis of 51 cases of primary MN. The mean age of patients with membranous nephropathy was 40.6±9.3 years, with the oldest age of 65 and the youngest of 22 years, and 36 (70.59%) were male and 15 (29.41%) were female. In the kidney biopsy, the average number of glomeruli was 16.51±7.82 (min-max, 3-54), and by LM, 33.3% showed global sclerosis of glomeruli by hematoxylin-eosin staining, 94.12% showed thickening of the glomerular basement membrane (GBM), 31.2% showed double counter staining of subepithelial immune complexes by methenamine-silver staining, 88.24% showed holes in the GBM, and 54.9% showed spike-like changes by Masson-Trichrome staining. IF showed IgG 3+ in 37.3%, 2+ in 39.2%, 1+ in 13.7%, and trace staining in 9.8%, while 74.5% of the cases were positive for C3, 93.1% for kappa, and 79.5% for lambda. LM showed thickening of the GBM (OR 23.5, 95% CI 0.093-0.53, p value= 0.007) and interstitial fibrosis (95% CI 6.98-31.07, p value= 0.003) contributing to the decrease in eGFR. The mean time from the onset of the first symptoms of kidney disease to the time of kidney biopsy was 35.35±61.54 months. Patients who underwent biopsy later (in months) after the diagnosis of the disease had a higher incidence of interstitial fibrosis (74.6 ± 98.43, 95% CI -90.52-20.68, p value = 0.002). Conclusion The histopathological features of MN confirmed by kidney biopsy showed thickening of the GBM in 94.12%, global sclerosis in 33.3%, and holes in 88.2%. Immunofluorescence microscopy showed 100% IgG staining, while C3, kappa, and lambda were positive in 74.5%, 93.1%, and 79.5%, respectively.

Background: Determining refractive errors among general education school students by age and gender Methods: The study was conducted using a cross-sectional model based on the examination records of 5,202 students from School No. 24 and School No. 37 by the ophthalmologist of the Chingeltei District Health Center in Ulaanbaatar. Results were analyzed SPSS. Result: The average age of all students included in the study was 11.37 ± 3.27 years. Among the participants, 62% (n = 3,208) were from School No. 24, and 38% (n = 1,994) were from School No. 37. Of the students from School No. 24, 18.6% (n = 597) had refractive errors. Specifically: Myopia was present in 17.2% (n = 552), with 6.1% male and 11.1% female. Hypermetropia was found in 0.68% (n = 22), with 0.43% male and 0.25% female. Astigmatism was detected in 0.72% (n = 23), with 0.34% male and 0.38% female. From School No. 37, 6.23% (n = 200) of students were diagnosed with refractive errors. Specifically: Myopia affected 5.23% (n = 168), with 1.96% male and 3.27% female. Hypermetropia was found in 0.16% (n = 5), with 0.07% male and 0.09% female. Astigmatism was present in 0.84% (n = 23), with 0.28% male and 0.56% female. There is a very weak negative correlation between myopia and age, as well as between myopia and gender, which is statistically significant. There is also a very weak negative correlation between astigmatism and age, which is statistically significant. Conclusion Our study found that among the types of refractive errors, myopia was the most common, with female students being more susceptible compared to males. The two schools included in the study represent both central (School No. 24) and peripheral (School No. 37) areas of Ulaanbaatar. Refractive errors were found to be more prevalent among students from the central school (School No. 24).

Background: Laryngeal papillomatosis is a chronic recurrent benign tumor of the airway caused by infection with human papillomavirus (HPV) types 6 and 11, developing in the epithelial lining of the laryngeal mucosa. According to R. Y. Seedat et al., clinical manifestations of the disease include hoarseness (25.9%), dyspnea (51.9%), and stridor (70.1%). Hyperplasia and keratinization of the mucosa lead to increased numbers of abnormal cells, which invade beyond the basement membrane and induce atypical changes in normal cells, resulting in uncontrolled proliferation. This causes benign tumor growth, and when mucosal integrity is disrupted, viral proteins may reactivate, leading to recurrence. Surgical treatment is required for each recurrence, and impaired vocal fold vibration negatively affects voice quality. In the early stages, the disease may be misdiagnosed as asthma or allergy, and in some cases, can present as acute respiratory distress, posing a life-threatening risk. Patients with juvenile-onset recurrent respiratory papillomatosis (JORRP) require surgery an average of 4.4 times annually and 19.7 times during their lifetime. The goals of surgical treatment are to remove papillomatous lesions, reduce symptoms, secure the airway, preserve vocal function, extend the interval between recurrences, and improve quality of life. However, surgery alone cannot completely prevent recurrence. Currently, traditional cold instruments, microdebriders, and CO₂ lasers (10,600 nm) are widely used, but no standardized guideline exists. Aim: To compare the outcomes of traditional cold instrument surgery with microdebrider-assisted microsurgery in the treatment of laryngeal papillomatosis. Materials and Methods: A hospital-based case–control study was conducted at the Department of Otolaryngology, National Center for Maternal and Child Health. A total of 76 patients diagnosed with laryngeal papillomatosis were included. Clinical records of 52 patients treated with cold instruments between 2018 and 2022 were reviewed as the control group, while 24 patients who underwent microdebrider-assisted microsurgery formed the case group. Disease severity was assessed using the Derkay staging system, and voice outcomes were evaluated with the GRBAS scale and Voice Handicap Index (VHI). Statistical analyses included group comparisons and correlation testing, with significance set at p<0.05. Results: Of the 76 patients, 52 were in the control group and 24 in the case group. The control group included 36 males (69.2%) and 16 females (30.8%) with a mean age of 42.2±15.7 years, while the case group included 15 males (62.5%) and 9 females (37.5%) with a mean age of 44.6±15.9 years. No significant differences in age or Derkay scores were found between groups (p>0.05). The case group had significantly shorter operative times (24.6±17.6 vs. 30.3±7.8 min, p=0.014) and hospital stays (2.8±2.6 vs. 3.3±0.9 days, p<0.001). However, the recurrence interval was longer in the control group (5.7±6.3 vs. 1.5±3.6 months, p=0.001), while the total number of surgeries per patient was higher in the case group (22.8±36.9 vs. 8.7±11.8). Voice outcomes improved more significantly in the case group, with lower GRBAS (5.3±2.3 vs. 8.4±2.9, p<0.01) and VHI scores (36.8±11.7 vs. 66.4±12.4, p<0.001). Positive correlations were observed between Derkay scores and total number of surgeries (ρ=0.35), as well as between GRBAS and VHI scores (ρ=0.37). Conclusion Microdebrider-assisted surgery for laryngeal papillomatosis significantly reduced operative time and hospital stay while improving postoperative voice outcomes compared with cold instrument surgery. However, the shorter recurrence interval and higher surgery frequency in some cases indicate the need for long-term monitoring and further evaluation of this method.

Background: Liver transplantation (LT) recipients frequently develop complication kidney dysfunction (KD), but the predisposing factors and long-term consequences of KD are not well understood. Post-LT complications that lead to graft failure and patient morbidity/mortality can be generally categorized as vascular, biliary, parenchymal and malignant. Main reasons for our study are to identify complications’ rate for early post-transplant KD and to evaluate the post-LT patients and graft survival rate. Aim: Our aim was to evaluate complications in recipients with early post-transplant KD and to investigate the survival rate after LT. Material and Methods: This study retrospectively and prospectively analyzed the demographic characteristics, preoperative and perioperative clinical parameters, as well as postoperative outcomes of patients who underwent liver transplantation (LT) at the First Central Hospital of Mongolia (FCHM) between September 2011 and December 2024. Renal function was evaluated by estimating the glomerular filtration rate (GFR) using the Cockcroft-Gault creatinine clearance formula at baseline (pre-transplantation) and at 24 hours, 72 hours, 7 days, 14 days, and 28 days following LT. Early and late complications following LT were classified according to the international classification. Ethical approval for the study was obtained at a meeting of the Research Ethics Review Board of the Mongolian National University of Medical Sciences (MNUMS). Results: In our study KD rate was 29.7%. Several factors increased the risk of KD among recipients. Post-LT complications’ related risk factors for KD was high MELD score (OR, 1.11; 95%CI, 1.06-1.16), Child-Turcotte-Pugh scores of B and C (OR, 5.57; 95%CI, 1.27-24.52 and OR, 8.21; 95%CI, 1.87–36.54), comorbidities (OR, 1.92; 95%CI, 1.14-3.23), post-LT acute bleeding (OR, 3.22; 95%CI, 1.22-8.46), early relaparotomy for revision (OR, 3.12; 95%CI, 1.34-7.28 respectively. Additionally, the survival rates for recipients with post-LT KD were 90.7% at 1 year and 81.3% at 3 years. Conclusions 1. Variables like a recipient high age (p<0.001), female gender (p<0.001), elevated liver function scores (p<0.002), comorbidities (p=0.013), severe ascites (p=0.001), preop intensive care (p=0.026) are pre-LT risk factors for post- LT KD. 2. Acute bleeding (p=0.013), early revision (p=0.006) are risk factors for post-LT KD. 3. Early KD in recipients who underwent LT affects both patient survival (Log Rank p=0.522; HR 1.3) and graft survival (Log Rank p=0.457; HR 1.26).

Background: Generation Z students, born after 1995, are characterized by their ability to multitask, low tolerance for traditional learning methods, impatience, short attention span, and preference for working independently rather than collaboratively. They are also considered more vulnerable to mental health challenges compared to previous generations. Aim: To assess the level of academic engagement among Generation Z students studying in the School of Nursing. Materials and Methods: This descriptive, cross-sectional quantitative study was conducted from February 1 to April 1, 2025. A total of 420 students majoring in nursing, midwifery, physical therapy, occupational therapy, and traditional medicine nursing at the School of Nursing, Mongolian National University of Medical Sciences, participated in the study. The Student Course Engagement Questionnaire (Handelsman, 2005) was used to evaluate students’ engagement levels. The reliability of the questionnaire was confirmed with a Cronbach’s α of 0.955. Statistical analysis was performed using SPSS version 25, and results were considered statistically significant at p<0.05. Results: Among the 420 participants, 91.9% were female and 8.1% were male. By major, 57.1% studied nursing, 22.6% midwifery, 8.8% physical therapy, and the remainder were from other disciplines. Student engagement was analyzed across three domains: academic involvement, personal responsibility and effort, and learning attitude and motivation. Pearson correlation analysis revealed strong positive correlations between academic involvement and personal responsibility/ effort (r=0.828), learning attitude and motivation (r=0.825), and between responsibility/effort and learning attitude/ motivation (r=0.903) (p<0.01). Age showed a weak positive correlation with year of study (r=0.381), while major and year of study had a weak negative correlation (r= -0.146) (p<0.01). Year of study and learning motivation also showed a weak negative correlation (r=-0.107, p<0.05). Conclusion The learning motivation and class engagement of Generation Z nursing students were found to be strongly correlated with their sense of responsibility, effort, and learning attitude (r=0.82–0.90, p<0.01). Most students demonstrated consistent participation and motivation to learn, showed less interest in traditional teaching approaches, and preferred practical training.

Background: Renal impairment (RI) is a frequent complication of liver cirrhosis and is associated with increased mortality and morbidity. Liver transplantation (LT) serves as an effective treatment method for patients with cirrhosis who have impaired renal function. However, renal function often declines after LT, influenced by various factors. This study aimed to investigate the factors contributing to RI following LT in our cases. Methods: We analyzed the demographic data, preoperative and perioperative parameters, and postoperative outcomes of patients who underwent LT at the First Central Hospital of Mongolia from September 2011 to December 2022. Renal function was assessed by measuring the glomerular filtration rate using the Cockcroft-Gault creatinine clearance formula pretransplantation and at 24 hours, 72 hours, 7 days, 14 days, and 28 days post-LT. Results: Several factors increased the risk of RI among recipients. These included female sex (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.58–5.91), Child-TurcottePugh (CTP) scores of B and C (OR, 4.23; 95% CI, 0.92–19.41 and OR, 7.68; 95% CI, 1.67– 35.30, respectively), preoperative continuous renal replacement therapy (CRRT; OR, 5.86;95% CI, 1.1–31.21), and a high graft-to-recipient weight ratio (GRWR; OR, 3.45; 95% CI, 1.23–9.63). Additionally, the survival rates for recipients with RI post-LT were 93.4% at 1 year and 78.1% at 3 years. Conclusions Female sex, a high CTP score, preoperative CRRT, and high GRWR were identified as risk factors for RI after LT in Mongolia.