Introduction: Chronic lymphocytic leukemia (CLL) is a hematologic malignancy characterized by the clonal proliferation and accumulation of mature monoclonal B lymphocytes in the peripheral blood. CLL is relatively common in Europe and North America, with an incidence of approximately 4–6 cases per 100,000 population, whereas it is rare in South Asia, with an incidence of approximately 0.11 cases per 100,000 population. During the course of the disease, neoplastic lymphocytes may infiltrate the bone marrow, lymph nodes, liver, spleen, and, less commonly, other organs and tissues. CLL presenting with marked splenomegaly in the absence of lymphadenopathy is uncommon. Therefore, in patients with unexplained splenomegaly, the differential diagnosis should include CLL and other lymphoproliferative disorders. Case Presentation: We report a case of CLL diagnosed on the basis of clinical findings, laboratory investigations, and additional diagnostic evaluation in a patient who presented to a hematology outpatient clinic with splenomegaly. An 81-year-old man presented with a macular rash involving the thighs, lower legs, chest, and both upper extremities, accompanied by dizziness, unsteadiness, nausea, fatigue, and generalized weakness. Physical examination revealed massive splenomegaly with a smooth surface and blunt edge, palpable approximately 25 cm below the left costal margin. Laboratory investigations demonstrated hyperleukocytosis with lymphocytosis, moderate normocytic normochromic anemia, and severe thrombocytopenia. Contrast-enhanced abdominal computed tomography revealed massive splenomegaly, with the spleen measuring 27.9×20.0×7.9 cm. The patient was treated with cyclophosphamide at a dose of 250 mg/m (400 mg administered) in combination with glucocorticoid therapy. Following treatment, leukocytosis, lymphocytosis, and monocytosis improved, and the spleen decreased substantially in size, becoming palpable approximately 4 cm below the umbilicus on physical examination. Conclusion Hematologic malignancies should be considered in the differential diagnosis of patients presenting with unexplained splenomegaly. In this case, a diagnosis of chronic lymphocytic leukemia was established based on bone marrow examination and the overall clinical and laboratory findings. Following treatment with cyclophosphamide and glucocorticoids, peripheral blood abnormalities improved and splenic enlargement decreased substantially, suggesting a favorable therapeutic response.

Background: Osteoporosis is a systemic skeletal disease characterized by reduced bone mineral density (BMD) and deterioration of bone microarchitecture, resulting in decreased bone strength and an increased risk of fragility fractures. Early assessment of BMD is essential for identifying skeletal abnormalities and supporting clinical decision-making. Dual-energy X-ray absorptiometry (DXA) is a widely used, non-invasive method for evaluating BMD at clinically relevant skeletal sites. Aim: To assess bone mineral density using DXA and describe the corresponding T-score and Z-score measurements in adult patients. Materials and Methods: This descriptive observational study was conducted from June to October 2026 at the Department of Trauma and Orthopedic Surgery, Mongolia–Japan Hospital, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia. Eight patients aged 18 years or older without fractures were included. According to the study records, participants were selected using a random sampling method. Demographic characteristics, height, weight, body mass index (BMI), and DXA measurements were recorded. BMD, bone mineral content (BMC), T-scores, and Z-scores were assessed at the lumbar spine, hip, and forearm. Continuous variables were summarized as means and standard deviations, and categorical variables as frequencies and percentages. Results: A total of eight patients were included, comprising five males (62.5%) and three females (37.5%). The mean age was 52.65±7.95 years, and the mean BMI was 31.59±6.32 kg/m². The mean lumbar spine (L1–L4) T-score was 0.35±1.49, and the mean Z-score was 0.97± .36. The lowest reported mean T-score was observed at the left forearm (−1.29±4.34), followed by the right forearm (−1.25±3.87). Measurements were also recorded at the left and right hip regions. The findings were descriptive and were not intended to establish population-level prevalence. Conclusions The demographic and anthropometric characteristics of the eight patients included in the study were assessed. The mean age was 52.65±7.95 years, and the mean body mass index (BMI) was 31.59±6.32 kg/m². Of the participants, 5 (62.5%) were male and 3 (37.5%) were female. The mean BMI of the participants fell within the obesity category. Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry (DEXA) at the lumbar spine, both hips, and both forearms. The results showed variations in BMD measurements across the different anatomical sites examined. An analysis of the T-scores and Z-scores for each measurement site revealed a mean T-score of 0.35±1.49 and a mean Z-score of 0.97±1.36 at the lumbar spine. At the left hip, the mean T-score was −0.63±1.29 and the mean Z-score was 0.34±1.52, while at the right hip, the mean T-score was −0.63±1.15 and the mean Z-score was 0.31±1.09. The mean T-scores of the forearm were comparatively lower, at −1.29± 4.34 on the left side and −1.25±3.87 on the right side.

Background: Employee satisfaction in the healthcare sector has a direct impact not only on the quality of medical services, but also on workforce stability and overall organizational performance. High levels of job satisfaction are associated with improved work performance, whereas low satisfaction often leads to negative outcomes such as stress and burnout. Although studies on job satisfaction have been conducted in Mongolia, research specifically targeting healthcare workers—and identifying the key factors influencing their satisfaction—remains relatively limited. This gap provides the rationale for the present study Aim: The objective of this study is to examine job satisfaction among healthcare workers at primary and referral hospitals and to identify key factors influencing it. Materials and Methods: The study was conducted between 2022 and 2024 among 1,883 physicians, nurses, and other healthcare professionals aged 18–65 years from 11 provinces and Ulaanbaatar city, using a quantitative research approach with a cross-sectional design. Job satisfaction was assessed with a questionnaire comprising six subdomains (supportive leadership, opportunities for human resource development, professional ethics, organizational culture, quality of healthcare services, and workplace safety), rated on a three-point Likert scale. Data analysis was performed using IBM SPSS Statistics version 26.0. Results: The overall level of job satisfaction among participants was 77.6%. Among the subdomains, workplace safety and supportive environment scored the lowest at 71.7%, whereas the quality and safety of healthcare services scored the highest at 83.4%. The findings indicated that holding a managerial position in hospitals in Ulaanbaatar and working as a physician in primary-level hospitals were positively associated with job satisfaction (p < 0.05). Age demonstrated a statistically significant association with job satisfaction, while years of work experience showed a negative correlation, with satisfaction decreasing as tenure increased (r = −0.09, p < 0.001). The findings indicate that improving healthcare workers’ job satisfaction requires strengthening and supporting several organizational dimensions, including supportive leadership, opportunities for human resource development, organizational culture, workplace safety, and a supportive work environment Conclusion Workplace safety and support, opportunities for human resource development, and organizational culture were found to be critical determinants of employee job satisfaction. The findings suggest that job satisfaction can be enhanced by optimizing organizational support, ensuring opportunities for professional growth, and strengthening workplace safety

Introduction: According to the World Health Organization (WHO), more than a million cases of sexually transmitted diseases (STDs) are registered in the world every day. Our country is among the countries with a concentrated spread of HIV infection among the population at risk According to the WHO classification. Although Mongolia is one of the countries with a low prevalence of HIV/AIDS, it is considered to a country with a high risk of STD caused from the location in the middle of the two countries where the HIV infection is spreading as fastest, thus it is important to study. Purpose: The aim is to study the epidemiology of sexually transmitted diseases in the population of Ulaanbaatar. Material and Method: The study was conducted using a single-moment descriptive research design. The following information was obtained from the statistics of the Health Development Center. Including as following:
• Annual indicators of the disease: Statistical data of sexually transmitted diseases between 2017- 2021 (Ulaanbaatar city)
• Annual indicators of the disease: 2017-2021 statistical data on the state of sexually transmitted diseases (city average and provincial average) Result: Considering the prevalence rate of sexually transmitted infections per 10,000 population by age group, as of 2017-2021, the population aged 20-39 had the highest rate of infection with 9.4-154.2 cases, and in 2018, the population aged 30-39 had 146.2 cases was the highest. In terms of the source of infection, 83.1 percent of the total cases in 2017-2021 were sexually transmitted.
Comparing the prevalence of sexually transmitted infections in the population of Ulaanbaatar by location and the number of cases per 10,000 population, as of 2017-2021, Bagakhangai district had more cases in 2017 and 2019, and Sukhbaatar district had 221.4 cases in 2018, which was the highest in the 5-year period, Nalaikh district recorded 64.7 cases in 2020 and 48.4 in 2021, which was the district with the highest number of cases in these years.
In terms of education, people with secondary education or below accounted for 94.1 percent of all cases in the 5-year average.
About the marriage status, 35.9 percent of all cases registered in 2017 were never married, and 53.5 percent were married. As of 2018-2021, there has been no significant increase or decrease in this indicator. Conclusion
1. During 2017-2021, the cases of sexually transmitted infections (syphilis, gonorrhea, trichomoniasis) per 10,000 population was in 2018, the incidence of infection decreased by 2.7 cases, in 2019 it increased by 7 cases, and in 2020 it decreased by 2.2 cases, in 2021, it decreased by 18.3 cases from the previous year, and it is believed that sexually transmitted diseases are expected to decrease in the future.
2. The average rate of syphilis infection (2017-2021) per 10,000 population in Ulaanbaatar was 4.4 cases higher than the average of the provinces, the average of 4.1 cases of gonorrhea infection is likely to increase, and the average of trichomoniasis was 13.4 cases or was equal to average of the provinces and Ulaanbaatar. The problem affecting the incidence of sexually transmitted diseases is related to the level of education of the citizens. 9 out of 10 people have completed secondary education or less.

Background: Treatment of adult tibiofibular fractures, especially severely comminuted fractures, is technically challenging due to the lack of reduction markers and difficulty in restoring the alignment. Fixation of the fibula can facilitate reduction of the tibia fracture and restoration of the lower extremity alignment. Methods: Between 2018-2019 we have operated on 50 patients who have lie on the same plane of tibiafibular fractures. Measures of angulation were obtained from radiographs taken immediately after the surgery, a second time 3 months later, and at 3-month follow-up. The analysis was performed with STATA. Results: Fixating fractures of tibia and fibula at same level were not shown to have complications on the development of nonunion including fibular shortening, hindfoot alignment, slow process of nonunion and unstableness. Conclusions We recommend fibular fixation in all 50 distal fractures when both fractures lie on the same plane and the tibial fracture is relatively stabilized.

Asthma is one of the most common and chronic diseases characterized by multidimensional immune responses along with poor prognosis and severity. The heterogeneous nature of asthma may be attributed to a complex interplay between risk factors (either intrinsic or extrinsic) and specific pathogens such as respiratory viruses, and even bacteria. The intrinsic risk factors are highly correlated with asthma exacerbation in host, which may be mediated via genetic polymorphisms, enhanced airway epithelial lysis, apoptosis, and exaggerated viral replication in infected cells, resulting in reduced innate immune response and concomitant reduction of interferon (types I, II, and III) synthesis. The canonical features of allergic asthma include strong Th2-related inflammation, sensitivity to non-steroidal anti-inflammatory drugs (NSAIDs), eosinophilia, enhanced levels of Th2 cytokines, goblet cell hyperplasia, airway hyper-responsiveness, and airway remodeling. However, the NSAID-resistant non-Th2 asthma shows a characteristic neutrophilic influx, Th1/Th17 or even mixed (Th17-Th2) immune response and concurrent cytokine streams. Moreover, inhaled corticosteroid-resistant asthma may be associated with multifactorial innate and adaptive responses. In this review, we will discuss the findings of various in vivo and ex vivo models to establish the critical heterogenic asthmatic etiologies, host-pathogen relationships, humoral and cell-mediated immune responses, and subsequent mechanisms underlying asthma exacerbation triggered by respiratory viral infections.
Adaptive Immunity ; Airway Remodeling ; Apoptosis ; Asthma ; Bacteria ; Chronic Disease ; Cytokines ; Eosinophilia ; Goblet Cells ; Hyperplasia ; Immunity, Innate ; Inflammation ; Interferons ; Neutrophils ; Polymorphism, Genetic ; Prognosis ; Respiratory Hypersensitivity ; Respiratory Tract Infections ; Risk Factors ; Rivers

BACKGROUND/OBJECTIVES: College students are in transition from adolescence to adulthood, and it has been reported that they show poor dietary habits. This study was conducted to compare body image perception, nutrition knowledge, dietary attitudes, dietary habits, and health-related lifestyles between Korean college students (KCS) and Mongolian college students (MCS). SUBJECTS/METHODS: Subjects were 314 KCS and 280 MCS. The data includes results of self-administered questionnaires; statistical analysis was performed using the SPSS 23.0 program. RESULTS: With regards to body image perception, KCS perceived themselves to be fatter on current body image than ideal body image compared to MCS; 64.0% of KCS and 34.6% of MCS desired to be thinner. Total score of nutrition knowledge in KCS (17.0) was significantly higher compared to MCS (8.4) (P < 0.001), but total score of dietary attitudes in KCS (27.0) was significantly lower compared to MCS (31.2) (P < 0.001). Nutrition knowledge had a significantly positive correlation with dietary attitudes in MCS (P < 0.01). Meal consumption among male and female subjects was 2 and 3 times, respectively, in order in KCS, and 3 and 2 times, respectively, in order in MCS (P < 0.001). Rate of skipping breakfast in both genders was significantly higher in KCS than in MCS (male: P < 0.05, female: P < 0.001). In health-related lifestyles, KCS had a significantly higher rate in frequency of alcohol drinking (P < 0.001), exercise (P < 0.01), and mobile phone usage (P < 0.001), compared to MCS. CONCLUSIONS: This study suggests that development of nutrition education program which is effective and proper is required to improve healthy dietary habits among college students of both countries. Essential contents should include acquirement of nutrition knowledge and a motivation for its application to actual life for KCS, and improvement of healthy dietary habits for MCS.
Adolescent ; Alcohol Drinking ; Body Image* ; Breakfast ; Cell Phones ; Education ; Female ; Food Habits* ; Humans ; Korea ; Life Style ; Male ; Meals ; Mongolia ; Motivation

Herpes simplex virus (HSV) is a common causative agent of genital ulceration and can lead to subsequent neurological disease in some cases. Here, using a genital infection model, we tested the efficacy of vinegar-processed flos of Daphne genkwa (vp-genkwa) to modulate vaginal inflammation caused by HSV-1 infection. Our data revealed that treatment with optimal doses of vp-genkwa after, but not before, HSV-1 infection provided enhanced resistance against HSV-1 infection, as corroborated by reduced mortality and clinical signs. Consistent with these results, treatment with vp-genkwa after HSV-1 infection reduced viral replication in the vaginal tract. Furthermore, somewhat intriguingly, treatment of vp-genkwa after HSV-1 infection increased the frequency and absolute number of CD3-NK1.1+NKp46+ natural killer (NK) cells producing interferon (IFN)-gamma and granyzme B, which indicates that vp-genkwa treatment induces the activation of NK cells. Supportively, secreted IFN-gamma was detected at an increased level in vaginal lavages of mice treated with vp-genkwa after HSV-1 infection. These results indicate that enhanced resistance to HSV-1 infection by treatment with vp-genkwa is associated with NK cell activation. Therefore, our data provide a valuable insight into the use of vp-genkwa to control clinical severity in HSV infection through NK cell activation.
Animals ; Daphne* ; Herpesvirus 1, Human ; Inflammation ; Interferons ; Killer Cells, Natural* ; Mice ; Mortality ; Simplexvirus ; Therapeutic Irrigation ; Ulcer

Herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) are the most common cause of genital ulceration in humans worldwide. Typically, HSV-1 and 2 infections via mucosal route result in a lifelong latent infection after peripheral replication in mucosal tissues, thereby providing potential transmission to neighbor hosts in response to reactivation. To break the transmission cycle, immunoprophylactics and therapeutic strategies must be focused on prevention of infection or reduction of infectivity at mucosal sites. Currently, our understanding of the immune responses against mucosal infection of HSV remains intricate and involves a balance between innate signaling pathways and the adaptive immune responses. Numerous studies have demonstrated that HSV mucosal infection induces type I interferons (IFN) via recognition of Toll-like receptors (TLRs) and activates multiple immune cell populations, including NK cells, conventional dendritic cells (DCs), and plasmacytoid DCs. This innate immune response is required not only for the early control of viral replication at mucosal sites, but also for establishing adaptive immune responses against HSV antigens. Although the contribution of humoral immune response is controversial, CD4+ Th1 T cells producing IFN-gamma are believed to play an important role in eradicating virus from the hosts. In addition, the recent experimental successes of immunoprophylactic and therapeutic compounds that enhance resistance and/or reduce viral burden at mucosal sites have accumulated. This review focuses on attempts to modulate innate and adaptive immunity against HSV mucosal infection for the development of prophylactic and therapeutic strategies. Notably, cells involved in innate immune regulations appear to shape adaptive immune responses. Thus, we summarized the current evidence of various immune mediators in response to mucosal HSV infection, focusing on the importance of innate immune responses.
Adaptive Immunity* ; Dendritic Cells ; Herpesvirus 1, Human ; Humans ; Immunity, Humoral ; Immunity, Innate ; Interferon Type I ; Killer Cells, Natural ; Mucous Membrane ; Simplexvirus* ; Social Control, Formal ; T-Lymphocytes ; Toll-Like Receptors ; Ulcer ; Viral Load

Interleukin-18 (IL-18) has been known to induce interferon-gamma (IFN-gamma) production and promote Th1 immunity. Although mammalian IL-18 has been characterized in great detail, the properties and application of chicken IL-18 remain largely uninvestigated as of yet. In this study, we evaluated the immunomodulatory properties of Salmonella enterica serovar Typhimurium expressing chicken interleukin-18 (chIL-18) on immune responses induced by avian influenza (AI) and Newcastle disease (ND) vaccines. After oral administration of S. enterica serovar Typhimurium expressing chIL-18, chickens were vaccinated intramuscularly with the recommended dose of either inactivated AI H9N2 vaccine or ND (B1 strain) vaccine. Chickens receiving a primary vaccination were boosted using the same protocol 7 days later. Humoral and cell-mediated immune responses were evaluated in terms of HI antibody titers and proliferation and mRNA expression of IFN-gamma and IL-4 of peripheral blood mononuclear cells (PBMC) in response to specific antigen stimulation. According to our results, oral administration of S. enterica serovar Typhimurium expressing chIL-18 induced enhanced humoral and Th1-biased cell-mediated immunity against AI and ND vaccines, compared to that of chickens received S. enterica serovar Typhimurium harboring empty vector. Therefore, we conclude that our proposed vaccination regimen using inactivated AI and ND viruses along with oral administration of S. enterica serovar Typhimurium expressing chIL-18 may provide a novel approach in protecting chicken from currently circulating AI and ND virus strains.
Administration, Oral ; Animals ; Chickens ; Immunity, Cellular ; Influenza in Birds ; Interferon-gamma ; Interleukin-18 ; Interleukin-4 ; Newcastle Disease ; RNA, Messenger ; Salmonella ; Salmonella enterica ; Vaccination ; Vaccines ; Viruses