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: Lower respiratory tract infections, specifically pneumonia, are a leading cause of morbidity in children and are predominantly caused by viral and bacterial pathogens. Researchers worldwide have reported that the etiology of pneumonia varies significantly with age, noting an increasing incidence of Mycoplasma pneumoniae pneumonia (MPP) among children over five years of age. In the context of Mongolia, investigating the incidence, clinical presentation, and laboratory and diagnostic imaging characteristics of MPP is essential. Understanding these specific features will facilitate early detection and optimal treatment, preventing potential complications. Furthermore, this research aims to reduce the unnecessary use of antibiotics by ensuring accurate diagnosis, which serves as the primary rationale for this study. Aim: To investigate the clinical characteristics of Mycoplasma pneumoniae pneumonia (MPP) in relation to laboratory findings and diagnostic imaging changes. Materials and Methods: A retrospective study was conducted at the Pediatric Ward of the National Center for Maternal and Child Health-2 (NCMCH-2). Data were collected using quantitative methods. Information from patient questionnaires, physical examinations, and laboratory test results were coded for analysis. Statistical analysis was performed using Microsoft Excel and SPSS version 30.0. Results: Analysis of the pathogens causing pneumonia across different age groups revealed that mixed viral and bacterial co-infections predominated in younger children. Conversely, bacterial infections became the primary cause as age increased, indicating a significant age-dependent variation in pathogen distribution (p=0.00054). Based on PCR testing, Mycoplasma pneumoniae (MP) was the most frequently detected pathogen, identified in 51.8% (55) of cases. The mean age of children positive for MP was 9.4 ± 4.4 years. Among these cases, only 25% (14) presented as MP monoinfection, while 75% (51) involved co-infections with other bacterial and viral pathogens. Conclusions 1. Mycoplasma pneumoniae was identified as the most prevalent bacterial pathogen (51.8%) among children hospitalized with pneumonia, indicating a high incidence of pneumonia caused by this bacterium during the late months of 2024. 2. Mycoplasma pneumoniae infection primarily affects school-aged children (mean age 9.2 years). Despite presenting with abnormal breath sounds upon auscultation requiring hospitalization, children positive for MP exhibited normal oxygen saturation and normal inflammatory markers in the blood compared to the MP-negative group. This highlight the classic «atypical» nature of the pathogen. Furthermore, clinical manifestations vary across age groups; specifically, upper respiratory symptoms such as rhinorrhea predominate in younger children (likely due to viral co-infection), whereas these symptoms significantly decrease in older children, in whom lower respiratory tract symptoms become dominant.

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: Pneumonia caused by COVID-19 tends to be more severe in middle-aged and elderly individuals, often leading to decreased pulmonary ventilation function and negatively impacting quality of life post-recovery. However, studies on this topic are limited in Mongolia. Aim: To evaluate pulmonary ventilation function and exercise tolerance in middle-aged and elderly individuals after COVID-19 pneumonia. Materials and Methods: A hospital-based case-control study was conducted from June 2022 to December 2023 at Gurvan Gal United Hospital and the First Central Hospital of Mongolia. The study group included 65 individuals aged 50- 69 who had recovered from COVID-19 pneumonia, while the control group consisted of 65 age-matched individuals who had not contracted the infection. Participants underwent a questionnaire, spirometry, and a 6-minute walk test (6MWT) to assess lung function and exercise tolerance. Results: A total of 123 participants were included in the study. The study group showed a significant reduction in FEV1 (P=0.015). compared to the control group. However, no statistically significant differences were observed in FVC or the 6MWT results between the two groups (P=0.464). Symptoms such as chest pain, cough, fatigue, and insomnia were significantly more common in the study group than in the control group (P<0.0001). Conclusion Individuals aged 50-69 who had COVID-19 pneumonia exhibited prolonged symptoms such as persistent cough, chest pain, nasal congestion, sore throat, fatigue, and sleep disturbances at a significantly higher rate compared to the control group (P<0.0001). Pulmonary ventilation function showed a mild decline, with FEV1% being lower than in the control group (P=0.015). Additionally, pulmonary fibrosis was significantly more prevalent among the post-COVID-19 group compared to the control group (P=0.026).

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.

Background: In December 2019, SARS-CoV-2 spread rapidly worldwide, leading the World Health Organization (WHO) to declare it a pandemic in March 2020. COVID-19 is an infectious disease with symptoms similar to the flu, varying in severity from mild to critical. Post-COVID-19 syndrome refers to the persistence of certain symptoms after recovery from the acute infection. The most common symptoms, such as fatigue, shortness of breath, coughing, and headaches, negatively affect patients’ daily lives. Aim: To investigate the clinical manifestations of post-COVID-19 syndrome concerning the severity of the initial infection. Materials and Methods: A hospital-based cross-sectional study was conducted between 2022 and 2023 at the Pulmonology and Allergy Center of the National Center for Health. In this study, we included participants who came for follow-up one year after being diagnosed with COVID-19. The severity of COVID-19 was categorized according to Living guidance for clinical management of COVID-19 issued by WHO and the COVID-19 diagnostic and treatment guidelines approved by the Minister of Health (A/549). Post-COVID-19 conditions were assessed using the 6-minute walk test, Borg rating of perceived exertion, and Fatigue Severity Scale (FSS). The Chi-square and Mann-Whitney U tests used on SPSS 26.0, with a p-value of <0.05 considered statistically significant. This study was approved by the Research Ethics Committee of the Mongolian National University of Medical Science (2022/03-06). Results: A total of 185 participants were included, comprising 74 men (40%) and 111 women (60%), with a mean age of 57.15±11.29 years. Among them, 90 (48.6%) had severe COVID-19, while 95 (51.4%) had non-severe cases. Clinical symptoms, including cough, dyspnea, fatigue, headache, and myalgia, were statistically different between the non-severe and severe groups. The median FSS score was 45 in the severe group and 38 in the non-severe group, showing a statistically significant difference (p<0.05). The median of 6-minute walking distance was 265 meters in the severe group and 282 meters in the non-severe group (p<0.05). The median Borg score was 2 in the severe group compared to 1 in the non-severe group (p<0.05). Conclusion Individuals who experienced severe COVID-19 exhibited reduced exercise tolerance, increased breathlessness, and more pronounced fatigue than those with non-severe cases.

Background: Systemic sclerosis-related interstitial lung disease (ILD) is a major cause of mortality among patients with systemic sclerosis. During this disease, when the forced vital capacity (FVC) is <50% on spirometry, the prognosis is considered poor. Although early changes in systemic sclerosis-related ILD can be identified by chest computed tomography (CT), evaluating the spirometry test is essential for monitoring further follow-up and assessing treatment outcomes. This study aimed to highlight the importance of considering the role of the spirometry test among patients with systemic sclerosis. Materials and Methods: We conducted this study using a cross-sectional research design based at a single-center hospital. The study included 40 patients diagnosed with systemic sclerosis who were attending the rheumatology outpatient clinic at the Mongolia-Japan Hospital. The inclusion criteria were patients diagnosed with systemic sclerosis who had undergone chest imaging (chest x-ray, chest CT scan) and spirometry tests. Results: In our study, in 62.5% of patients diagnosed with systemic sclerosis, a chest CT scan revealed abnormalities indicative of SSc-ILD. There were statistically significant differences (p<0.05) in certain parameters of spirometry between the two groups (normal chest CT, abnormal chest CT). The group with abnormal chest CT had a higher usage of mycophenolate mofetil (p<0.05). A negative correlation was found between changes on chest CT scan and FVC (r= -.453, p<0.05). However, no statistically significant correlation was observed between FVC and disease duration or comorbidities. Conclusion Using spirometry to assess pulmonary function in patients with systemic sclerosis-related interstitial lung disease may be an appropriate method for evaluating the progression of the disease and detecting complications.

Background: Interleukin-33 (IL-33) cytokine plays a crucial role in asthma pathogenesis. Recent studies have established that IL-33 activity was increased in serum, airway smooth muscle and epithelial cells from patients with asthma and this increase positively correlates with asthma severity. We hypothesized that several genetic variations that contributing IL-33 expression and activity, which may risk factor for susceptibility to asthma. In this study, we examined the association between rs16924159 single nucleotide polymorphism (SNP) of IL-33 gene and asthma susceptibility. Methods: 51 asthma patients and 54 healthy volunteers were involved in this case-control study. Blood sample was collected for genomic DNA extraction. rs16924159 SNP genotyping was performed by the allele specific-polymerase chain reaction (AS-PCR) method. Statistical analysis was performed using STATA 13.0 software. Results: The groups were matched for age, gender and body mass index (p>0.05). The distribution of rs16924159 allele and genotypes among patients and controls was found in accordance with those expected by the Hardy-Weinberg equilibrium (p=0.088). Adenine (A) allele frequency of rs16924159 was significantly different between case and control groups (OR = 1.91, 95% CI = 1.04- 3.51, p = 0.037). Also, homozygote A/A (OR=6.53, 95% CI 0.68-62.38, p=0.104) and heterozygote (OR=2.08, 95% CI 0.93-4.62, p=0.073) genotypes were more frequent among asthma patients than in controls. Conclusions From these findings, we conclude the A allele of rs16924159 SNP in IL-33 gene may be contributing to asthma susceptibility, increasing the carrier`s risk to the development of asthma.