Background: Simulation-based education has become an effective and widely used modern teaching method in health professional education. This approach allows students to apply theoretical knowledge into practice and develop essential skills such as clinical assessment, clinical decision-making, and teamwork in a safe and controlled learning environment. In recent years, international studies have demonstrated that simulation-based training improves students’ clinical skills, confidence, communication abilities, and professional attitudes. However, evidence regarding the effectiveness of simulation-based training remains limited in certain educational settings, particularly in developing countries. Therefore, evaluating the effectiveness of simulation-based training within local educational contexts is necessary. Aim: To evaluate the effectiveness of simulation-based training on students’ knowledge, clinical skills, and professional attitudes. Materials and Methods: This study included 45 third-year medical students from four classes at the Mongolian National University of Medical Sciences using a random sampling method. Participants were divided into two groups according to the training modality: a simulation-based training group (n=20) and a traditional learning control group (n=25). Knowledge was assessed before and after training using an 18-item test covering asthma etiology, pathophysiology, clinical features, diagnosis, and treatment. After the training session, students’ knowledge, clinical skills, and professional attitudes were evaluated using a 21item Likert-scale questionnaire and small-group discussions to identify factors influencing learning outcomes. The reliability of the questionnaire was evaluated using Cronbach’s alpha, which demonstrated high internal consistency (α=0.90). Statistical analysis was performed using SPSS software. Paired samples t-tests were used to compare pre- and post-training knowledge within groups, while independent samples t-tests were used to compare post-training outcomes between groups. Result: After training, mean knowledge scores significantly improved among all participants (pre-training: 9.18±2.33; post-training: 10.47±2.31; p<0.001). In the simulation group, knowledge scores increased from 7.65±2.01 to 9.05±2.46, while in the control group, scores increased from 10.40±1.80 to 11.60±1.41 (p=0.007). Post-training comparisons showed that the simulation group demonstrated higher mean scores in knowledge (36.70±3.73 vs 34.44±4.77) and clinical skills (11.35±1.69 vs 10.92±1.75) than the control group; however, these differences were not statistically significant (p>0.05). Professional attitude scores were significantly higher in the simulation group compared with the control group (43.35±3.60 vs 40.64±4.51, p=0.034). Conclusion Simulation-based training demonstrated positive effects on students’ knowledge and clinical skills and significantly improved professional attitudes. Integrating simulation-based training with traditional teaching methods may serve as an effective educational strategy to enhance the quality of clinical education.

Background: Pulmonary alveolar proteinosis (PAP) is a rare lung disorder characterized by the accumulation of surfactant within the alveoli, leading to impaired gas exchange and respiratory insufficiency. Although the disease is uncommon, it significantly affects patients’ quality of life and requires specific diagnostic and therapeutic approaches. Whole lung lavage (WLL) is considered the standard treatment; however, it has not been widely implemented in Mongolia. We report the first successful case of WLL performed for PAP in Mongolia. Case Presentation: A 56-year-old male presented with dyspnea. Chest computed tomography demonstrated a bilateral “crazy paving” pattern. Bronchoalveolar lavage fluid was positive for periodic acid–Schiff (PAS) staining, and anti–GM-CSF antibodies were detected, confirming the diagnosis of PAP. WLL was performed under general anesthesia using a double-lumen endotracheal tube with bronchoscopic guidance. One lung was ventilated with 100% oxygen while the contralateral lung was sequentially lavaged with 800–1000 mL of warm (37°C) saline per cycle until the effluent became clear. A total of approximately 20 liters of saline was used. Result: The procedure was completed successfully without complications. Following treatment, the patient showed marked clinical improvement with reduced dyspnea and increased exercise tolerance. Oxygen saturation improved from 88% to 93%, and spirometric parameters (FVC, FEV₁) demonstrated improvement. Chest imaging revealed a reduction in pulmonary opacities. Conclusion This case demonstrates the successful implementation of whole lung lavage (WLL) in Mongolia and highlights its importance in improving the diagnostic and therapeutic capacity for rare pulmonary diseases such as pulmonary alveolar proteinosis. The procedure resulted in significant improvement in clinical, functional, and radiological parameters, consistent with findings from international studies. Early diagnosis of PAP and the adoption of standardized protocols in accordance with international guidelines are essential to optimize treatment outcomes and enhance patients’ quality of life.

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).

Background: Asthma is a chronic airway disease, and its prevention involves avoiding risk factors and ensuring proper inhaler techniques to reduce the risk of exacerbation. Aim: To determine the results of refresher training in health education for the control of bronchial asthma. Materials and Methods: A total of 56 asthma patients’ asthma who visited the outpatient department of the Mongolian Japanese Hospital were enrolled in an educational program aimed at improving asthma knowledge. Three months later, 26 of them were re-evaluated, and a comparison was made of their asthma knowledge, quality of life, and pulmonary function. The occupational status was divided into two groups: those working in offices and those working in factories and construction sites. Education was divided into two groups: those with bachelor, less bachelor. The usage levels of relievers and corticosteroids were divided into two groups: reliever usage was 3 canisters up or down per year, while systemic corticosteroid usage was 10 ampules up or down per year. Ethical approval for the study was obtained in accordance with the approval of the Bioethics Committee of the School of Medicine, Mongolian National University of Medical Sciences (approval number: 2019.06.05), and written consent was obtained from the participants. The data analyses are processed using Excel and SPSS 26 software. Results: According to the asthma control test scores, the improvement in control after the training increased from 8% to 12%, and the percentage of those with poor control improved from 15% to 23%. After the training, 27% (7) of participants showed improvement from their baseline control level, 8% (2) showed a decline, and the rest showed no change. Among the participants, 30.8% (n=8) used bronchodilators with a frequency of more than 3 canisters per year, while 46.2% (n=12) used dexamethasone more than 10 ampules per year. Multivariable analysis showed that age had an odds ratio (OR) of 1.1 (95% CI 0.2-8.10), education had an OR of 1.7 (95% CI 0.2-15.8), occupation had an OR of 1.2 (95% CI 0.1-10.9), bronchodilator use had an OR of 3.6 (95% CI 0.3-45.8), and dexamethasone usage had an OR of 2.1 (95% CI 0.3-15.7), all of which were identified as risk factors. Conclusion As a result of the short-term asthma education program, quality of life and lung function improved, and the level of control increased. This suggests that continuous education should be implemented.