Background: Hemophilia A (HA) and hemophilia B (HB) are monogenic bleeding disorders caused by pathogenic variants in the F8 and F9 genes, respectively, which are located on the X chromosome and result in deficiencies of coagulation factor VIII (FVIII) and factor IX (FIX). The diseases predominantly affect males, while females are usually asymptomatic heterozygous carriers. Identification of female carriers among relatives of affected males is important for preventing bleeding complications associated with surgery and childbirth. Aim: The main aim of this study was to detect carrier and non-carrier women and compare some phenotypes. Materials and Methods: The study included 50 female relatives of 32 male patients diagnosed with hemophilia A and 13 female relatives of 8 male patients diagnosed with hemophilia B, giving a total of 63 female relatives. Molecular genetic testing was performed to identify the pathogenic variants previously detected in the probands and to determine the carrier status of female relatives. Among them, 33 confirmed carriers and 18 non-carriers completed a 28-item questionnaire comprising three sections to assess bleeding-related symptoms. The questionnaire evaluated easy bruising, duration of menstruation, postpartum bleeding, and bleeding following injuries, surgical procedures, and dental procedures. Questionnaire findings were compared between molecularly confirmed carriers and non-carriers. Continuous variables were compared using the Mann–Whitney U test, while categorical variables were analyzed using Fisher’s exact test in R software. In female relatives of patients with hemophilia A, plasma FVIII activity was also measured. Result: Molecular genetic testing was performed in 52 female relatives. Eleven women were excluded from carrier-status analysis because no pathogenic variant was identified in the F8 or F9 gene of their respective probands. Among 43 female relatives of patients with hemophilia A who underwent carrier testing, 26 (60.4%) were identified as carriers and 17 (39.5%) as non-carriers. Among eight male patients with hemophilia B, pathogenic F9 variants were identified in six; among their seven female relatives, six were confirmed carriers and one was a non-carrier. The mean FVIII activity among heterozygous HA carriers was 58.5±20.6 IU/dL (n=17), which was significantly lower than that of non-carriers (101±28.8 IU/dL; p<0.001). Of the nine bleeding-related symptoms assessed, only easy bruising of the skin was significantly more common among carriers (OR=6.8; p=0.0069). Although prolonged menstrual bleeding and bleeding after childbirth, surgery, or dental procedures were reported among some carriers, no statistically significant differences were observed between carriers and non-carriers. Conclusion Among female relatives of males diagnosed with Hemophilia A or B in Mongolia, 32 (64%) of 50 women were identified as carriers and 18 (36%) as non-carriers. Plasma FVIII activity was significantly lower in HA carriers than in non-carriers (58.5±20.6 IU/dL vs. 101±28.8 IU/dL; p<0.001). Easy bruising was significantly more frequent among carriers (OR=6.8; p=0.0069). These findings support the importance of molecular genetic testing for identifying female carriers and recognizing women who may be at increased risk of bleeding, particularly in the context of surgery and childbirth.

Background: Midwives provide essential maternal, neonatal, reproductive and sexual health care and save lives. In our country, in 2017, the job description of midwives was revised and approved by the Minister of Health in accordance with the core competencies established by the International Federation of Midwives by Order A/216. Therefore, it is necessary to study the extent to which midwives are performing the duties included in the revised job description. Aim: To assess of the professional role and performance of midwives in Mongolia five years after the updated midwifery job description was declared. Materials and Methods: There were 1119 midwives working at all levels of the facilities national wide, and 589 respondents were analyzed. Data were collected using a questionnaire, which was developed with input from an obstetrics and midwifery care advisory group, and was distributed online through Google Forms. We developed a questionnaire on the daily professional roles and performances of midwifery services and skills that were part of the job description of midwives in Mongolia. The questionnaire consisted of three parts and were scored based on a Likert scale. This study was approved by the research ethics committee of the School of Nursing (protocol №22/07-b), Mongolian National University of Medical Sciences (MNUMS), and Ministry of Health. Result: 62.3% of the participants had a bachelor’s degree, 34.3% had a professional degree, 93.5% worked as midwives at all levels of health care, 73.4% worked according to their job description, but 21.9% were unable to work according to their main duties; 56% considered that they faced some difficulties in performing their duties at work. Within the scope of maternity care services mentioned in the job description, 71.4% of them often provide monitoring and counseling to normal, low-risk pregnant women according to guidelines (mean 3.07± 0.96); childbirth and postpartum care are occasionally (mean 2.70±1.10) or not regularly provided; and the average ratings of reproductive health, family planning services, and emergency obstetric care interventions are 2.32±1.120 and 2.40±0.040, respectively. According to self-assessment of professional skills, the average score for the ability to provide care during pregnancy was 3.10±0.038, which is sufficient; the ability to provide care during childbirth and postpartum was 2.83±0.037, which is above average; and the ability to provide emergency obstetric care and reproductive health and family planning care was 2.77±0.84 and 2.57±0.890, which is moderate, respectively. Conclusion The education and professional level of midwives working at all levels of the health sector has improved. While midwives frequently provide the pregnancy care outlined in their job descriptions, they only occasionally perform duties related to childbirth, postpartum and reproductive health, family planning, and obstetric emergency care. According to their self-assessments, midwives demonstrate sufficient competence in teamwork and pregnancy care; above-average competence in childbirth and postpartum care; and moderate competence in obstetric emergency care, reproductive health, and family planning services.There is a need to improve the involvement of midwives in certain professional activities.

Background: Cisplatin is a widely used platinum-based chemotherapeutic agent, but its gonadotoxic effects can damage ovarian tissue, oocytes, and developing follicles and may lead to primary ovarian insufficiency (POI). Adipose-derived stem cells (ADSCs) are being investigated as a potential regenerative treatment because of their paracrine, anti-apoptotic, and tissue-repair effects. Aim: To evaluate the effect of ADSC therapy on estrous cyclicity, body weight, and ovarian follicular morphology in a mouse model of cisplatin-induced POI. Materials and Methods: Thirty 6-week-old female BALB/c mice were included. Six mice received saline as controls, while 24 mice received cisplatin 2 mg/kg intraperitoneally once daily for 10 days to induce POI. After POI induction, cisplatin-exposed animals were continued as an untreated POI group (n=15) or an ADSC-treatment group (n=9). The ADSC group received 1×10⁶ cells suspended in 0.2 mL medium via the tail vein. Body weight and vaginal cytology were monitored daily, and estrous stages were classified as proestrus, estrus, metestrus, and diestrus. Ovaries were collected for histologic evaluation at the end of the study. Result: After cisplatin exposure, mean estrous cycle length increased from 3.97 days in controls to 6.4 days in the POI group (p<0.05). During the post-treatment evaluation, mean cycle length was 5.65 days in untreated POI mice (n=4) and 4.5 days in ADSC-treated mice (n=7), representing a statistically significant improvement after ADSC therapy (p=0.013). Cisplatin caused significant body-weight loss, reaching a mean of 18.0 g on day 6 after completion of cisplatin administration (p<0.01). Histologically, untreated POI ovaries showed follicular atrophy and prominent degenerative changes, whereas ADSC-treated ovaries showed more morphologically preserved primary, secondary, and antral follicles and relatively fewer degenerative changes. Exploratory manual counting in three representative whole-ovary sections per group showed total intact/growing follicle counts of 15.00±2.65 in controls, 6.00±2.00 in POI, and 8.67±2.89 in ADSC-treated ovaries. Conclusion ADSC treatment was associated with partial restoration of estrous cyclicity and ovarian follicular development in a cisplatin-induced POI mouse model. These findings support further investigation of ADSC-based regenerative therapy for chemotherapy-associated ovarian injury.

Background: Sarcopenia is a multifactorial geriatric syndrome characterized by age-related loss of muscle mass, muscle strength, and physical performance. In recent years, neurotrophic and neuromuscular biomarkers have been investigated as potential diagnostic indicators of sarcopenia; however, evidence regarding their sex-specific differences remains limited. Aim: To evaluate the sex-specific associations of serum BDNF, GDNF, and CAF22 levels with sarcopenia and muscle-related parameters among older adults. Materials and Methods: This analytical cross-sectional study included adults aged 60 years and older. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS 2019) criteria. Serum BDNF, GDNF, and CAF22 levels were measured using ELISA. Group differences were analyzed using independent t-tests, correlations were assessed using Pearson correlation analysis, and diagnostic performance for sarcopenia was evaluated using receiver operating characteristic (ROC) analysis. Multivariable logistic regression analysis was also performed. Results: No statistically significant differences were observed in serum BDNF, GDNF, and CAF22 levels between sarcopenic and non-sarcopenic participants in either the male or female groups (all p>0.05). ROC analysis demonstrated AUC values ranging from 0.540 to 0.542 in males and from 0.508 to 0.530 in females for BDNF, GDNF, and CAF22. Multivariable logistic regression analysis revealed that age (OR=1.12, 95% CI: 1.04–1.21, p=0.003) and lower fat-free mass index (OR=0.78, 95% CI: 0.66–0.91, p=0.001) were significantly associated with sarcopenia, whereas BDNF, GDNF, and CAF22 showed no independent association with sarcopenia. Conclusions 1. No statistically significant sex-specific differences were observed in serum BDNF, GDNF, and CAF22 levels between sarcopenic and non-sarcopenic older adults (all p>0.05). 2. CAF22 levels were weakly negatively correlated with muscle mass and fat-free mass index in males (p<0.05), whereas BDNF levels showed weak positive correlations with handgrip strength and fat-free mass index in females (p<0.05). CAF22 levels also demonstrated a weak positive correlation with age (p<0.05). 3. ROC and multivariable logistic regression analyses indicated limited diagnostic utility of BDNF, GDNF, and CAF22 for sarcopenia (AUC=0.508–0.542), and none of these biomarkers showed an independent association with sarcopenia (all p>0.05). In contrast, older age (OR=1.12, p=0.003) and lower fat-free mass index (OR=0.78, p=0.001) were significantly associated with sarcopenia.

Background: Ovarian cancer (OC) ranks first in mortality among gynecological malignancies, and according to the 2024 WHO report, 90–95% of ovarian tumors are diagnosed as high-grade malignant forms. Early identification of ovarian cancer risk factors is of great importance in improving diagnostic and treatment management. Aim: To investigate risk factors influencing malignant and benign ovarian tumors in women. Materials and Methods: The study was conducted using a prospective observational design between 2025 and 2026, based at the Departments of Gynecological Surgery of the National Cancer Center (NCC) and the Mongolian Japanese Teaching Hospital (MJTH). A total of 93 women aged 26–78 years diagnosed with ovarian masses (72% benign, 28% malignant) were enrolled, and data were collected using a 116-item questionnaire. Statistical analysis was performed using binary logistic regression in SPSS 25.0. Results: The mean age of the malignant group (53.45±12.97) was statistically significantly higher than that of the benign group (38.95±12.81) (p<0.0001). Lower educational level (p=0.046) and higher smoking rates (p=0.034) were observed in the malignant group. Regarding symptoms, abdominal distension (p=0.005), urinary difficulty (p=0.016), and weight loss (p=0.002) were predominantly present in the malignant group. Multivariate logistic regression analysis showed that weight loss increased the risk of malignant ovarian tumor by 7.0-fold (OR=7.0; 95% CI: 1.74–28.14; p=0.006), urinary difficulty by 4.05-fold (OR=4.05; 95% CI: 1.23–13.37; p=0.022), and abdominal distension by 3.52-fold (OR=3.52; 95% CI: 1.43–8.67; p=0.006). Additionally, menstrual irregularity, postmenopausal status, and family history of ovarian cancer were statistically significantly associated with malignancy. Conclusion Malignant ovarian tumors predominantly occur in postmenopausal women, with risk increasing with age. Weight loss, urinary difficulty, and abdominal distension are the key clinical symptoms for differentiating malignant tumors, and menstrual irregularity, menopausal status, and family history showed statistically significant associations with malignancy. The use of the HE4 biomarker and the ROMA algorithm is recommended for early detection of ovarian cancer in future practice.

Background: Fitz-Hugh-Curtis syndrome is a rare condition most commonly caused by Chlamydia trachomatis infection. It is associated with pelvic inflammatory disease and inflammation of the liver capsule (perihepatitis). Due to its clinical presentation, early detection and careful differential diagnosis are essential. Case Presentation: We present the case of a 17-year-old female with a prior history of latent syphilis that had been treated. She developed progressively worsening lower abdominal pain and was admitted through the emergency department. Based on computed tomography (CT) findings, she was diagnosed with Fitz-Hugh-Curtis syndrome and received appropriate treatment. Conclusion Fitz-Hugh-Curtis syndrome should be suspected in sexually active women presenting with severe right upper quadrant abdominal pain requiring emergency care, especially when ultrasound findings show no abnormalities of the gallbladder but reveal signs of peritoneal inflammation in the abdominal and pelvic cavities. In such cases, abdominal CT plays a crucial role in diagnosis. Performing dynamic CT imaging, including the arterial phase, may improve diagnostic accuracy.

Background: In traditional medicine, the Shimshin-6 formulation, which consists of Rheum undulatum L., Hippophae rhamnoides L., Zingiber officinalie Roscoe, Saussurea Lappa C.B.Clark, Sal ammoniacum, Tronae veneni, is recommended for women experiencing menstrual retention disorders. In recent years, Shimshin-6 has been widely used to promote postpartum uterine involution for women and our study aimed to evaluate and determine the acute and chronic toxicity effects of Shimshin-6. Aim: To evaluate and substantiate the acute and chronic toxicity effects of Shimshin-6. Materials and Methods: The acute toxicity of Shimshin-6 was evaluated using the rapid method described by V.B. Prozorovsky (1978) by administering intraperitoneal injections of the medicinal extract in white mice to determine the lethal dose. The active dose was determined following the methodology of I.P. Zapadnyuk (1983). Chronic toxicity was evaluated in Wistar rats according to the OECD 407 (2008) guidelines. The test animals were administered Shimshin-6 in tablet form (90 mg/kg and 180 mg/kg) and decoction form (tang) (162 mg/kg) daily for 60 days. At the end of the experiment, biochemical and complete blood analyses were conducted, along with histopathological examination of major organs. The study was conducted with ethical approval granted by the Ethics Committee of the Mongolian National University of Medical Sciences (MNUMS) on October 25, 2024. Results: The LD50 for Shimshin-6 tablets was 4.47 (3.39–5.1) g/kg, indicating low acute toxicity based on the K.K. Sidorov classification. The LD50 for the decoction form was 8.1 (7.1–9.4) g/kg, suggesting it is non-toxic. Regarding chronic toxicity, platelet count was significantly reduced compared to the healthy control group: Shimshin-6 tablet group: 46% reduction at 90 mg/kg and 29.7% reduction at 180 mg/kg. Shimshin-6 decoction group: 60.5% reduction at 162 mg/ kg. Additionally, hemoglobin levels in the decoction group (162 mg/kg) decreased by 15.7% (p<0.05). Biochemical analysis showed a 36.3% reduction in total cholesterol (LDL-C) levels in the tablet group (180 mg/kg) and decoction group (162 mg/kg) compared to the control (p<0.05). Conclusion Shimshin-6 tablets showed low acute toxicity in experimental mice. However, long-term administration may lead to a reduction in platelet count.

Background: Hepatocellular carcinoma (HCC) is a primary liver cancer originating from liver cells, classified as a chronic liver disease. This cancer ranks third in the world in terms of mortality rate. The MELD (Model for End-Stage Liver Disease) and Child-Pugh scoring systems are utilized to assess the prognosis of chronic liver diseases. Based on studies suggesting that certain blood test indicators, particularly red cell distribution width (RDW), could be used to predict the prognosis of liver cancer and other cancers, as well as serve as diagnostic markers, this topic was chosen to evaluate the clinical significance of RDW in hepatocellular carcinoma. Aim: The aim is to study some blood test indicators and compare them with the MELD score and Child-Pugh score systems in order to determine the prognosis of chronic liver diseases. Materials and Methods: A retrospective, single-center, cross-sectional study was conducted at Mongolia-Japan Hospital. Among 322 patients diagnosed with HCC, 24 patients were selected for the case group, and 37 patients with liver cirrhosis were included in the control group. Results: According to the research criteria, 61 patients were selected and divided into 3 groups, and statistical analysis was performed. In the detailed blood test, platelet count and WBC count showed statistically significant differences among the 3 groups (p< 0.024). In the biochemical tests, C-reactive protein (CRP) was p< 0.018, total bilirubin p< 0.001, and the mean albumin level p< 0.015, all showing statistically significant differences among the 3 groups. A statistically significant inverse correlation was observed between RDW-CV and the clinical MELD score (r=-0.356). Conclusion Platelet count, RDW, CRP, total bilirubin, and average albumin levels are significantly different across the studied groups. RDW-CV shows a moderate inverse correlation with MELD scores, suggesting its potential as a prognostic marker in chronic liver diseases. Further research with larger sample sizes is recommended to confirm these findings.

Background: The Shimshin-6 formulation, composed of Rheum undulatum L., Hippophae rhamnoides L., Zingiber officinale Roscoe, Saussurea lappa C.B. Clarke, Sal ammoniacum, and Tronae veneni, has traditionally been used in the management of gynecological disorders such as amenorrhea, abnormal blood clot formation, and pelvic pain. It has also been widely applied in postpartum care to promote uterine contractility and to prevent complications, including hemorrhage and inflammation. However, its therapeutic potential in postpartum uterine involution has not been scientifically validated. Aim: To investigate the effects of the Shimshin-6 herbal formulation on postpartum uterine involution in rats Materials and Methods: This experimental study was conducted at the Research Center of the Institute of Traditional Medicine and Technology, following the methodology described by Zheng ZH et al. (2019). Postpartum rats were randomly assigned to four groups and received daily treatments for five consecutive days with either Shimshin-6 tablets at doses of 180 mg/kg and 90 mg/kg, Shimshin-6 decoction at 163 mg/kg, or physiological saline as a control. Serum concentrations of estrogen, progesterone, TNF-α, TGF-β1, and TGF-β3 were measured using commercially available ELISA kits (Shanghai MLBIO Biotechnology Co. Ltd, China). Following ethical euthanasia, uterine tissues were collected for histological examination, which included evaluation of uterine weight, endometrial thickness, myometrial structure, and glandular morphology. Results: Shimshin-6 treatment significantly reduced the uterine index and serum estrogen levels compared with the control group, while no significant difference was observed in progesterone concentration. The treatment also decreased tumor necrosis factor-α (TNF-α) levels and modulated growth factors in postpartum rats. Histological analysis further revealed that Shimshin-6 promoted uterine recovery, despite the presence of inflammatory cell infiltration and hemorrhagic changes in the uterine wall. Conclusion Shimshin-6 preparation exerts a promotive effect on postpartum uterine involution in rats.

Background: Vulnerable populations at risk of micronutrient deficiencies include children and women, especially pregnant women, lactating mothers, infants and young children. According to WHO guidelines, a population with a micronutrient (vitamin and mineral) deficiency of more than 20% is considered a public health problem.
Although Mongolia has made significant progress in improving the nutritional status of the population, especially children and women, the 2024 VI survey found that micronutrient deficiencies are high among pregnant women.
The MMS (Multi-ingredient Micronutrient Supplement) distributed to pregnant women by soum and household health centers contains all the essential vitamins and minerals for pregnant women, but coverage has remained inadequate for more than 10 years. Goal: To establish the prevalence of micronutrients deficiency in pregnant women Materials and Methods: Totally 2796 pregnant women included in cross-sectional study from urban and rural area. Survey procedures consisted of interview, anthropometric measurements, clinical examinations, and the collection of biological (blood and urine) samples for pregnant women. Micronutrient deficiencies were assessed by tests for hemoglobin, serum, ferritin, soluble transferrin receptor (sTfR), 25-hydroxyvitamin D {25(ОН)D}, spot urine samples for determination of urinary iodine concentration. Statistical processing : The data from the survey questionnaires were entered into a database created in the “EpiData 3.1” software environment. The data created and verified in the EpiData software environment were converted to the “SPSS–25” program, and statistical analysis was also performed using the SPSS-25 program. The results table was prepared using Microsoft Word 2021 and Microsoft Excel 2021 programs. Research ethics: The research methodology was discussed at the meeting of the Medical Ethics Review Committee under the Ministry of Health on 2023.03.27 (23/017), and permission to conduct the study was obtained Result : The prevalence of anemia, as measured by hemoglobin, was 22.3% and the iron deficiency anemia (IDA), as measured by adjusted serum ferritin or soluble transferrin receptor (sTfR) was (39.8%/9.0%). Prevalence of iron deficiency as measured by serum ferritin was also highest in Western 41.9% and lowest in Khangai region 40.2% (P<0.01). The prevalence of vitamin D deficiency among pregnant women was high at 92.5%, and 7.5% of all pregnant women had adequate vitamin D status. The median concentration of 76.4µg/l indicates inadequate iodine status in pregnant women, as the desired range for adequate iodine nutrition in pregnancy 150-249 µg/l. Conclusions 1. 22.3 percent of pregnant women are anemic, and the prevalence of anemia has not decreased from 2017 levels and remains common.
2. The prevalence of iron deficiency (as measured by ferritin levels) was 39.8 μg/L and the soluble transferrin receptor level was 9.0 μg/L, which is higher than previous studies.
3. The prevalence of vitamin D deficiency among pregnant women remains common, with 76.6% having severe or moderate deficiency, and 15.9% having mild deficiency.