Background: In atopic dermatitis, impairment of the skin barrier function leads to increased susceptibility to environ mental particles and pollutants, thereby contributing to disease pathogenesis and complications, as well as to an increased risk of fungal skin infections. In children with atopic dermatitis, infections caused by Candida species exacerbate the dis ease and reduce the effectiveness of treatment. Candida species are common opportunistic pathogens colonizing the skin and mucosal surfaces, and more than 200 species have been described. Among these, Candida albicans, C. glabrata, C. parapsilosis, C. tropicalis, and C. krusei are most frequently isolated from the skin, mucosa, and oral cavity. In Mongolia, studies culturing skin fungi and determining their metabolic activity and virulence factors are limited, which constituted the rationale for the present study. Aim: To determine virulence factors and selected biochemical activities of Candida species. Materials and Methods: In this study, Candida species strains cultured from clinical samples of children with atopic der matitis were used with research approval. The fungal strains preserved at –80°C were revived by culturing on Sabouraud Chloramphenicol Agar and evaluated microscopically after Gram staining. Biofilm-forming activity was determined us ing the microtiter plate method, in which cultures were grown in broth, optical density was measured using a microplate reader, and values were calculated using a standard formula. Phospholipase activity was assessed using egg yolk agar according to the method developed by Price et al. Results: Of the total cultured isolates, 54.1% (n=33) demonstrated weak biofilm-forming activity (≤ODc / ODc < ~ ≤2×ODc), while 32.79% (n=20) showed moderate biofilm-forming activity (2×ODc < ~ ≤4×ODc). Isolates exhibiting strong biofilm-forming activity (>4×ODc) accounted for 13.1% (n =8) Regarding phospholipase activity, 50% of the isolates showed strong activity, 30% showed moderate activity, 10% showed low activity, and 10% exhibited very weak activity. Conclusions 1. Virulent fungal strains capable of attaching to host cells are involved in the pathogenesis of atopic dermatitis. 2. Atopic dermatitis is shown to contain fungal strains that damage host cells and are involved in the process of inva sion.

Background: In recent years, medical education worldwide has undergone a paradigm shift from knowledge-centered training to a competency-based approach. Within the framework of this reform, it has become crucial to systematically evaluate the workplace performance and professional competencies of graduates rather than solely assessing theoretical knowledge. International standards now demand that medical practice be an integrated synthesis of communication, attitude, ethics, and leadership, extending beyond clinical knowledge. Aim: The study aims to evaluate the current state of comprehensive professional competencies by investigating graduate satisfaction regarding the learning outcomes of the “Medical Doctor” program. Materials and Methods: An analytical cross-sectional study was conducted between January 2024 and January 2026. The study involved 114 graduates (2020–2022) of the School of Medicine, MNUMS, currently working in primary healthcare. Data were collected using a 41-item questionnaire comprising demographic characteristics (10 items), CanMEDS competency indicators (29 items), and open-ended questions. Satisfaction was measured using a 5-point Likert scale. Statistical analysis was performed using IBM SPSS Statistics 26, utilizing Cronbach’s Alpha for internal consistency, t-tests and ANOVA for group comparisons, partial eta squared (ηp2) for effect size, and Factor Analysis for item clustering. Result: The participant pool consisted of 86.1% females and 13.9% males, with a mean age of 27.49±1.15. Regarding workplace distribution, 54.8% were employed in urban areas and 45.2% in rural areas. The questionnaire demonstrated high reliability with Cronbach’s α=0.962. The overall mean satisfaction level of graduates was 3.63±0.79. Among the CanMEDS roles, the “Professional” role received the highest rating (3.78±0.77), while the “Medical Expert” role received the lowest (3.49±0.67). However, the “Medical Expert” competency showed a statistically significant increase (p<0.026) from 2020 (3.24) to 2022 (3.68), indicating improved curricular continuity. Specifically, the graduation year had a medium effect size on sub-competencies ME9 (Prevention, p<0.031) and ME10 (Using evidence, p<0.025), with ηp2 values ranging from 0.061 to 0.064. Workplace location did not significantly influence competency assessment (p>0.05). Factor Analysis categorized the 29 items into five main factors, explaining 69.68% of the total variance. The primary factor, “Integrated Clinical and Management Competency,” alone accounted for 49.08% of the variance, reflecting the integrated nature of comprehensive professional competencies. Conclusion 1.Graduate satisfaction with comprehensive professional competencies is at an above-average level (3.63). 2.The high rating for the “Professional” role indicates strong ethical development and professional maturity, while the lower score for the “Medical Expert” role suggests a need for increased focus on refined clinical skills in training. The longitudinal improvement in “Medical Expert” scores reflects the positive impact of curriculum reforms. 3.These findings confirm that clinical and soft skills are inextricably integrated for primary healthcare physicians, providing evidence for future program development based on this holistic integration.

Background: Metabolic dysfunction–associated steatotic liver disease (MASLD) is a major cause of chronic liver disease and is increasingly linked to cardiovascular disease (CVD), the leading cause of mortality globally. Aim: To evaluate individuals participating in early screening using the Hepatic Steatosis Index (HSI) and examine its association with CVD risk levels. Materials and Methods: This population-based retrospective cross-sectional study included 47,542 adults aged 40–70 years who participated in a national screening program between 2023 and 2025. Hepatic steatosis was assessed using the Hepatic Steatosis Index (HSI) and categorized as <30 (no steatosis), 30–36 (indeterminate), and >36 (steatosis). Ten-year CVD risk was estimated using laboratory-based WHO cardiovascular disease risk charts for Central Asia. Associations were evaluated using logistic regression and expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Result: The mean age of participants was 53.18±8.17 years, and 67.1% (31,886) were women. The prevalence of HSI <30, 30–36, and >36 was 8.9% (4,219), 32.1% (15,271), and 59.0% (28,052), respectively. The distribution of low-, moderate-, and high-risk CVD groups was 48.6% (23,115), 41.3% (19,637), and 10.1% (4,790), respectively. The proportion of individuals with high CVD risk was 5.5% in the HSI <30 group and 10.1% in the HSI >36 group. Compared with the reference group, the odds of high CVD risk were increased in the HSI 30–36 group (OR=1.333; 95% CI: 1.152–1.542) and the HSI >36 group (OR=2.401; 95% CI: 2.094–2.753). These associations remained statistically significant after adjustment for age, sex, systolic blood pressure, waist circumference, physical inactivity, and smoking. Conclusion The prevalence of hepatic steatosis in the study population was 59.0%. Individuals with hepatic steatosis had a 1.2-fold higher risk of cardiovascular disease compared with those without steatosis.

Background: Chronic urticaria (CU) is characterized by intense pruritus, wheals, and angioedema. Luteolin (Lut) is a natural flavonoid with anti-inflammatory and anti-allergic activities, however, its bioavailability is limited. Previous studies have shown that forming complexes between flavonoids and metal ions can improve their physicochemical and biological properties and enhance therapeutic efficacy through synergistic effects. Therefore, the luteolin-gadolinium (Lut-Gd) complex provides a theoretical basis for further investigation as a potentially more potent anti-inflammatory agent compared with Lut. Aim: To evaluate the anti-inflammatory effects and safety of the Lut-Gd complex in a mouse model of CU in comparison with Lut. Materials and Methods: A chronic urticaria model was established in C57BL/6 mice using ovalbumin (OVA) and aluminum hydroxide, followed by treatment with Lut or Lut-Gd for 14 days. Scratching behavior and histopathological changes were evaluated. Results: In the model group, scratching behavior was significantly increased, and dermal edema, disruption of collagen structure, and inflammatory cell infiltration were observed in skin tissue. These changes were attenuated after Lut and Lut-Gd treatment, with a statistically significant improvement in the Lut-Gd group. Lut-Gd reduced scratching frequency by 45–50%, which was 20% greater than that in the Lut group. No pathological morphological changes were observed in the lungs, liver, kidneys, or lymph nodes. Conclusion The Lut-Gd complex demonstrated superior efficacy compared with Lut in reducing scratching behavior and cutaneous pathological changes, while showing no adverse effects on major vital organs, indicating a favorable safety profile.

Background: Current scar treatment modalities, including silicone gel, corticosteroids, laser therapy, and surgical interventions, demonstrate certain clinical benefits; however, their ability to fully restore normal skin architecture remains limited. In recent years, novel regenerative approaches aimed at enhancing scar tissue repair have been increasingly investigated. Among these, autologous fat grafting (AFG) has emerged as a promising modality. AFG contains adiposederived stem cells (ADSCs), stromal vascular fraction (SVF), and various growth factors, which may improve scar quality by promoting angiogenesis, reducing inflammation, and regulating collagen remodeling. Aim: In Mongolia, there are few studies on the effectiveness and safety of AFG, ADSC, and SVF-based treatments for scars, so it is necessary to summarize international evidence. Materials and Methods: This systematic review was conducted in accordance with PRISMA guidelines. A comprehensive literature search was performed using PubMed, Scopus, and Web of Science databases. Of 902 identified studies, 27 met the inclusion criteria and were included for quality assessment and analysis to evaluate the therapeutic effects of AFG, ADSCs, and SVF in scar management. Results: Findings from the 27 included studies demonstrated that AFG, ADSC, and SVF-based therapies had overall beneficial effects on scar morphology, tissue structure, elasticity, pain, and functional outcomes. Various fat-processing techniques were utilized; however, in 15 studies, the Coleman technique was employed, with retrograde injection administered at the dermal-hypodermal junction. Of the included studies, 23 evaluated structural changes in scars and reported improvements in scar color, thickness, elasticity, and contour. Six studies assessing symptoms demonstrated reductions in pain and pruritus, while six studies reported improvements in functional impairment. Histological evaluation in 6 studies revealed improved collagen organization, increased angiogenesis, and reduced fibrosis. Additionally, 3 studies combining AFG with adjunctive therapies such as platelet-rich plasma (PRP), SVF, and fractional laser reported superior outcomes, although results varied depending on scar type, technique, and evaluation methods. Conclusion AFG, ADSC, and SVF therapies promote scar tissue regeneration by enhancing angiogenesis, accelerating collagen remodeling, and reducing fibrosis. These effects contribute to improved elasticity, functional recovery, and overall quality of life in patients. Therefore, these approaches represent a promising novel strategy for scar management in Mongolia and warrant standardization and integration into clinical practice.

Background: Atopic dermatitis (AD) is a common chronic and relapsing inflammatory skin disease in young children, clinically characterized by pruritus and skin rashes. Epidemiological studies have reported that AD affects 5–30% of children and 1-10% of adults worldwide. In recent years, the use of mineral waters for the treatment of chronic skin conditions has become increasingly popular globally. Although mineral waters, particularly from Shargaljuut springs, have been traditionally used in Mongolia for various dermatological conditions, no studies have been conducted on their use in atopic dermatitis, providing the rationale for this study Aim: To evaluate the result of Shargaljuut mineral spray on disease severity, pruritus intensity, and selected physiological parameters of the skin in children with atopic dermatitis. Materials and Methods: This clinical trial study with a placebo-controlled group included children aged 2-16 years with AD. The participants were treated with Shargaljuut spray and the clinical assessment was conducted before and after the treatment, evaluating severity using SCORAD (Severity Scoring of Atopic Dermatitis), itching intensity using VAS (Visual Analog Scale), skin hydration (SCH) and transepidermal water loss (TEWL). Results: Among all participants, 81.7% (n=49) had mild atopic dermatitis based on SCORAD scores, and 18.3% (n=11) had moderate severity. According to the VAS scores, 40% (n=24) of the participants reported mild pruritus. Skin hydration was found to be severely decreased in 96.7% (n=58) of the cases, while TEWL values were within normal limits in 76.7% (n=46). Statistically significant differences were observed between the experimental and control groups at day 30 in terms of disease severity and pruritus intensity, as well as in certain skin physiological parameters (p=0.001, p=0.002). Within the experimental group, statistically significant differences were also detected in disease severity (p=0.001), pruritus intensity (p=0.002), skin hydration (p=0.002), and TEWL (p=0.001) between baseline, day 15, and day 30. A correlation was found between transepidermal water loss (TEWL) and skin hydration (r=0.566, p=0.0001). Conclusions 1. Among the children with atopic dermatitis (AD) included in the study, 81.7% (n=49) had a mild severity score according to SCORAD, 40% (n=24) had mild itching intensity based on the VAS assessment, 96.7% (n=58) had excessively dry skin, and 76.7% (n=46) showed good transepidermal water loss (TEWL) levels. 2. In the experimental group, comparisons of disease severity, itching intensity, skin hydration, and TEWL levels before and after the use of the Shargaljuut spring water spray revealed that skin hydration increased, TEWL decreased, and both disease severity and itching intensity were reduced following treatment

Background: Modern medical education increasingly integrates Outcome- Based Education (OBE) and Problem-Based Learning (PBL) approaches to improve training quality. The Mongolian National University of Medical Sciences (MNUMS) implemented an OBE curriculum in 2013, creating a need to examine student satisfaction as a measure of program effectiveness. Student satisfaction is recognized as a key indicator of educational quality and is linked to outcomes such as graduate retention and institutional reputation. Aim: To assess the level of student satisfaction in the medical doctor (MD) training program and identify factors influencing it, in order to provide a basis for improving training quality. Materials and Methods: A cross-sectional survey was conducted in 2023– 2024 among 1167 students (third- to sixth-year MD students) at MNUMS. Participants had a mean age of 22.2 ± 1.5 years, and 79.9% were female. A questionnaire with 23 questions (including 16 Likert-scale items on satisfaction) was administered; responses were given on a 5-point Likert scale. Data were analyzed using SPSS version 26. Descriptive statistics, independent t-tests, one-way ANOVA, Pearson correlation analysis, exploratory factor analysis, and multiple linear regression were performed. All statistical tests were twotailed, and significance was set at p<0.05. Results: The satisfaction survey demonstrated high internal consistency (Cronbach’s α = 0.927). Overall satisfaction with the training program was moderately high, with a mean score of 3.51 ± 0.84 out of 5. Fourth-year students reported the highest satisfaction with teaching methods (mean 3.97 ± 0.67), whereas third-year students gave the lowest rating for the sufficiency of learning materials (mean 2.98 ± 1.01); these differences were statistically significant (p<0.001). Additionally, satisfaction with clinical training declined by the final year of study, with a mean rating of 3.16 in the sixth year compared to 3.70 in the third year (p<0.001). No significant difference in overall satisfaction was observed between male and female students (p>0.05). Exploratory factor analysis (KMO = 0.950; Bartlett’s test p<0.001) identified two key underlying factors influencing perceived training quality, which together explained 55.83% of the total variance: (1) “Curriculum organization and teaching methodology,” and (2) “Material resources and learning environment.” Correlation and regression analyses further indicated that better course organization and active teacher engagement were associated with higher student satisfaction (p<0.01). Conclusion The study shows that enhancing teaching methods and improving curriculum coherence are needed to further improve the quality of the MD training program. Additionally, strengthening educational resources and updating instructional approaches are crucial for raising satisfaction levels, particularly for senior (sixth-year) students. These findings provide an evidence- based foundation for curriculum and policy improvements to boost student satisfaction and overall educational outcomes.

Background: In Mongolia, the prevalence of non-communicable diseases and their intermediate risk factors has continuously increased in recent years. From results of early detection and prevalence studies of non-communicable diseases in Mongolia, studies linking intermediate risk factors to insulin resistance are scarce. Aim: To identify the prevalence of insulin resistance among the population and study its connection with intermediate risk factors of non-communicable diseases. Materials and Methods: This study was approved by the MNUMS Ethics Committee on February 23, 2024 (2024/3- 02), and was conducted based on the data of participants who took part in the “Population-based Preventive and Early Detection Screening of Infectious and Non-Infectious Diseases” organized by the Mongolian government from 2022 to 2023. Insulin resistance was identified using the triglyceride-glucose index (TyG), calculated by the formula Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL) / 2]. “Ln” refers to the natural logarithm, based on Euler’s number, approximately 2.71828. TyG levels were classified into low risk (<8.5), medium risk (8.5-9.0), and high risk (>9.0). Defined intermediate risk factors for non-communicable diseases according to stages of hypertension and diabetes. Results: The mean age of participants was 44.3±15.2 years, with 39.2% (n=49,270) male and 41.4% (n=49,749) residing in urban areas. Among the participants, 59.1% had overweight or obesity, 23.6% had diabetes or impaired fasting glucose, 61.4% had hypertension, and 19.7% had elevated triglycerides. Analyzing by levels of insulin resistance risk, 62.8% of the population had low risk, 22.5% medium risk, and 14.7% high risk. Comparing systolic blood pressure across levels of insulin resistance risk showed that even without central obesity or diabetes, as the level of insulin resistance increased, the level of systolic blood pressure also increased (low risk group: 117.0±11.7, medium risk group: 121.1±10.9, high risk group: 123.5±16.2 mmHg). Regression analysis of the risk of hypertension by insulin resistance risk level showed that the risk increased with higher levels of insulin resistance (medium risk group OR=1.35, p<0.0001; high risk group OR=1.63, p<0.0001). Conclusion 22.5% of the population is at medium risk and 14.7% at high risk of insulin resistance. The increase in hypertension risk with higher insulin resistance levels is statistically significant, independent of central obesity and diabetes stages.

Background: Medical education has undergone significant changes over the past few decades, with a focus on studentcentered learning, problem-based learning, competency-based learning, and outcome-based education. Among these, internal medicine diagnostics plays a crucial role in preparing students for clinical practice. However, there is limited research on the factors influencing student satisfaction in this course. Studies by Harden et al. (1999) and Irby et al. (2010) have emphasized the importance of continuous evaluation and effective teaching methods in medical education. This study aims to assess student satisfaction with the internal medicine diagnostics course within the “Physician” program at the Mongolian National University of Medical Sciences (MNUMS), aligning with these global trends. Aim: The primary objective of this study is to evaluate student satisfaction with the internal medicine diagnostics course in the Physician program. Specific objectives include: Assessing satisfaction with the diagnostics course in the 2nd year of the basic medical education program, evaluating satisfaction with the internal medicine diagnostics course in the 3rd year, exploring the relationship between these two courses. Materials and Methods: This analytical study was conducted from June 2023 to June 2024, involving 1,167 students enrolled in the “Physician” program at MNUMS. Data were collected using a 34-item questionnaire, including:Demographic information (5 questions),General satisfaction (17 questions),Internal medicine diagnostics-specific satisfaction (12 questions). Satisfaction was measured using a 5-point Likert scale (1=strongly disagree, 5=strongly agree). Data were analyzed using SPSS Statistics 26, employing descriptive statistics, ANOVA, T-tests, and regression analysis. Effect sizes were calculated using Cohen’s d and Partial Eta Squared (η²), with statistical significance set at p<0.05. Results: Overall satisfaction: The average satisfaction score was 3.98±0.73. 2nd-year diagnostics course: Highest satisfaction (4.07±0.90), particularly with “course content” (4.07±0.90). 3rd-year internal medicine diagnostics course: Lowest satisfaction (3.97±0.78), especially with “learning environment” (3.90±0.90). Gender and Year Differences: No significant gender-based differences (p>0.05). Satisfaction with the internal medicine diagnostics course decreased as students progressed to higher years (B=-0.172, p=0.016). Course Relationship: A strong positive correlation was found between the two courses (r=0.818, p<0.001), but the effect size was minimal (η²=0.008). Conclusion The above-average student satisfaction reflects the quality of the curriculum content and the effectiveness of teaching methodologies. The decline in satisfaction with internal medicine courses as students progress may be due to course difficulty and resource limitations. The weak correlation between the two subjects suggests the need for further development of integrated learning.

Background: Obesity and metabolic disorders are significant contributors to hypertension and cardiovascular disease (CVD). While body mass index (BMI) and waist circumference are known to be associated with systolic blood pressure (SBP), the interplay between adiposity, glucose levels, triglycerides, and SBP is not fully understood. This study aims to investigate the relationships between BMI, waist circumference, glucose, triglycerides, and SBP in a large population-based cohort. Methods: A cross-sectional analysis was conducted on [insert total number] participants with complete data on BMI, waist circumference, blood pressure, glucose, and triglycerides. Descriptive statistics, ANOVA, Pearson correlations, mediation analysis, and multiple regression were used to explore the associations between variables. The moderation effect of glucose on the BMI-SBP relationship was examined using an interaction term in the regression model. Results: The mean age of the study population was 44.3 ± 15.2 years. The mean BMI was 26.7 ± 4.9 kg/m², and 22.7% of participants were classified as obese. Central obesity, measured by waist circumference, was prevalent in 55.9% of the population. BMI, waist circumference, glucose, and triglycerides were significantly associated with SBP (p < 0.0001). Mediation analysis showed that waist circumference partially mediated the effect of BMI on SBP. The interaction term for BMI and glucose was significant (β = 0.32, p < 0.05), indicating that glucose levels moderated the relationship between BMI and SBP, with higher glucose levels amplifying the hypertensive effect of BMI. Conclusion This study highlights the complex interplay between BMI, waist circumference, glucose, triglycerides, and SBP. Waist circumference partially mediates the effect of BMI on SBP, and glucose levels moderate this relationship, amplifying the impact of obesity on blood pressure.