Background: Membranous nephropathy (MN) is among the most common causes of nephrotic syndrome in adults. MN is diagnosed in one third of cases of nephrotic syndrome on kidney biopsy. Kidney biopsy is the gold standard for diagnosing MN and plays an important role in determining the severity of the disease and in determining treatment decisions and regimens. Therefore, the lack of research on kidney biopsy in Mongolia is the reason for this study. Aim: The aim of this study was to investigate the pathological features in the kidney tissues of patients with primary membranous nephropathy diagnosed by kidney biopsy. Materials and Methods: A retrospective study was conducted on 51 cases of MN diagnosed in kidney biopsies performed at the First Central Hospital of Mongolia (FCHM) over a period of 12 years. Renal function was calculated using the CKD-EPI (2021) formula and classified into the stage of CKD by eGFR. Histopathological findings were examined using 4 light microscopy (LM) stains (Hematoxylin-Eosin, Masson-Trichrome, PAS, and Methenamine silver staining) and 8 immunofluorescence (IF) microscopy stains (IgG, A, M, complement C3, C4, C1q, and kappa, lambda). The study excluded secondary MN based on viral markers, tumor markers, and serological tests. Statistical analysis was performed using SPSS and STATA 15.0 software, using t-tests, Pearson’s chi-square tests, and multiple group comparisons were performed using ANOVA and Kruskal-Wallis methods. The study design was approved by the Ethics Committee of the MNUMS, Mongolia. (№ 2023/3-07) Results: A total of 305 kidney biopsies performed at the Kidney Center of the FCHM between 2011 and 2023 resulted in the diagnosis of 51 cases of primary MN. The mean age of patients with membranous nephropathy was 40.6±9.3 years, with the oldest age of 65 and the youngest of 22 years, and 36 (70.59%) were male and 15 (29.41%) were female. In the kidney biopsy, the average number of glomeruli was 16.51±7.82 (min-max, 3-54), and by LM, 33.3% showed global sclerosis of glomeruli by hematoxylin-eosin staining, 94.12% showed thickening of the glomerular basement membrane (GBM), 31.2% showed double counter staining of subepithelial immune complexes by methenamine-silver staining, 88.24% showed holes in the GBM, and 54.9% showed spike-like changes by Masson-Trichrome staining. IF showed IgG 3+ in 37.3%, 2+ in 39.2%, 1+ in 13.7%, and trace staining in 9.8%, while 74.5% of the cases were positive for C3, 93.1% for kappa, and 79.5% for lambda. LM showed thickening of the GBM (OR 23.5, 95% CI 0.093-0.53, p value= 0.007) and interstitial fibrosis (95% CI 6.98-31.07, p value= 0.003) contributing to the decrease in eGFR. The mean time from the onset of the first symptoms of kidney disease to the time of kidney biopsy was 35.35±61.54 months. Patients who underwent biopsy later (in months) after the diagnosis of the disease had a higher incidence of interstitial fibrosis (74.6 ± 98.43, 95% CI -90.52-20.68, p value = 0.002). Conclusion The histopathological features of MN confirmed by kidney biopsy showed thickening of the GBM in 94.12%, global sclerosis in 33.3%, and holes in 88.2%. Immunofluorescence microscopy showed 100% IgG staining, while C3, kappa, and lambda were positive in 74.5%, 93.1%, and 79.5%, respectively.

Background: Generation Z students, born after 1995, are characterized by their ability to multitask, low tolerance for traditional learning methods, impatience, short attention span, and preference for working independently rather than collaboratively. They are also considered more vulnerable to mental health challenges compared to previous generations. Aim: To assess the level of academic engagement among Generation Z students studying in the School of Nursing. Materials and Methods: This descriptive, cross-sectional quantitative study was conducted from February 1 to April 1, 2025. A total of 420 students majoring in nursing, midwifery, physical therapy, occupational therapy, and traditional medicine nursing at the School of Nursing, Mongolian National University of Medical Sciences, participated in the study. The Student Course Engagement Questionnaire (Handelsman, 2005) was used to evaluate students’ engagement levels. The reliability of the questionnaire was confirmed with a Cronbach’s α of 0.955. Statistical analysis was performed using SPSS version 25, and results were considered statistically significant at p<0.05. Results: Among the 420 participants, 91.9% were female and 8.1% were male. By major, 57.1% studied nursing, 22.6% midwifery, 8.8% physical therapy, and the remainder were from other disciplines. Student engagement was analyzed across three domains: academic involvement, personal responsibility and effort, and learning attitude and motivation. Pearson correlation analysis revealed strong positive correlations between academic involvement and personal responsibility/ effort (r=0.828), learning attitude and motivation (r=0.825), and between responsibility/effort and learning attitude/ motivation (r=0.903) (p<0.01). Age showed a weak positive correlation with year of study (r=0.381), while major and year of study had a weak negative correlation (r= -0.146) (p<0.01). Year of study and learning motivation also showed a weak negative correlation (r=-0.107, p<0.05). Conclusion The learning motivation and class engagement of Generation Z nursing students were found to be strongly correlated with their sense of responsibility, effort, and learning attitude (r=0.82–0.90, p<0.01). Most students demonstrated consistent participation and motivation to learn, showed less interest in traditional teaching approaches, and preferred practical training.

Background: Karma, a Sanskrit word that roughly translates to “action,” is a core concept in some Oriental religions, including Hinduism and Buddhism. Though its specifics are different depending on the religion, karma generally denotes the cycle of cause and effect - each action a person takes will affect him or her at some time in the future. This rule also applies to a person’s thoughts and speech, and the actions other people take under that individual’s instructions. Therefore, it is important to study the relationship between body, speech, mind and karma. Research results: The Karma denotes our good and bad intentions. These intentions manifest themselves as good or bad actions with our body, our speech and our mind. In turn, our actions bring about effects called “Karma”, namely: the effect, the consequence, the fruit of the actions, the maturation of the actions. Usually, however, the word Karma is used by ordinary people for both the actions and the effects, which is not accurate. The law of karma is a special instance of the law of cause and effect, according to which all our actions of body, speech and mind are causes and all our experiences are their effects. The law of karma explains why each individual has a unique mental disposition, a unique physical appearance and unique experiences. These are the various effects of the countless actions that each individual has performed in the past. Each person has a different individual karma. Some people enjoy good health while others are constantly ill. Some people are seen as very beautiful while others are seen as very ugly. Some people have a happy disposition that is easily pleased while others have a sour disposition and are rarely delighted by anything. Some people easily understand the meaning of spiritual teachings while others find them difficult and obscure. Conclusion We made conclusion choosing information and sources related to body, speech and mind study as well as Karma in antient works, sorting it into time sequence and enriching it with information in other works. Essentially, Karma denotes our good and bad intentions. These intentions manifest themselves as good or bad actions with our body, our speech and our mind.

BACKGROUND: Early physical therapy plays important role in improving functional capacity, activities of daily life, and quality of life after acute myocardial infarction. OBJECTIVE: We aimed to describe effects of 4 weeks physical therapy program after acute myocardial infarction. METHODS: In our study, 20 men participated in physical therapy program for 14 days after PCI surgery. The patients were diagnosed with myocardial infarction and aged 56.45±8.1. Their BMI was 27.39±3.61and waist circumference was 98±9.28. Exercise program was scheduled 3 times a week with each session consisting of 34-70% intensity exercises for 60 minutes. Exercise type is aerobic (warming up for 10 minutes, walking, bicycling and cooling down stretch for 10 minutes). RESULTS: For the 6-minute walking test (p=0.01) there was significant difference between before and after 4 weeks’ exercise program. CONCLUSION: The hospital based 4 weeks exercise program improved the functional capacity for pci patients.

Introduction: Extracorporeal shockwave lithotripsy (ESWL) revolutionizedthe treatment of urolithiasis and graduallybecame the favorite treatment option sothat today it is considered to be the first lineof treatment for patients with urolithiasis.The purpose of this study was assessment oftherapeutic efficacy, complications of ESWLin urolithiasis in Mongolia.Material and methods: A total of46 patients harboring renal and ureteralstones underwent ESWL between March2016 and September 2016 at First CentralHospital of Mongolia. Karl Storz ModulithSLK electromagnetic machines were usedto impart shock waves. All collected stonefragments sent for biochemical analysis.Results: A total of 46 patients 23 weremales (50%). Patients were mean age of34. The stone size distribution was 0.5cmto 3.1cm. The average treatment time wasranging from 75-110 minutes. The averagenumber of shock waves per treatmentwas 3172±378 (range 1500-4000). Theoverall success rate was 75.73%. All calculidisintegrated satisfactorily except for 3stones, which is located lower 1/3rd ofureter. Stone composition analysis proved tobe composed entirely or predominantly ofcalcium oxalate monohydrate. These patientsrequired to have ureterolithoextraction. Calculicomposition for remaining patients 12 werecalcium oxalate monohydrate, 17 calciumoxalate dehydrate, 6 uric acid and 1 struvite.Complications were mostly minor and rare.Most of the patients (90.7%) developedmacroscopic hematuria after treatment; fewpatients developed mild bruising at the entryand exit sites of the shockwaves on the bodywall. Severe complications such as renalhematoma and steinstrasse were diagnosedfor one patient each and their managementwas non-surgical.Conclusion: ESWL is therefore the firstline treatment for urolithiasis with stonesize smaller than 2cm. It has an efficiencyrate above 75, low procedure time, highsafety and good tolerability and minimalcomplication.

Objective: In this study it was aimed to demonstrate the hypolipidemic and hypoglycemic potentials of Agrypum extract on alloxan-induced diabetic rats. Materials and methods: Eighteen male Wistar rats of weights between 140 g were used for the study and divided into three groups of six rats each. The rats of the non-diabetic control group were given 1 ml of distilled water daily. Two other groups induced with diabetes using alloxan by a single dose administration of 120 mg/kg body weight (BW); one of these diabetic rat groups were treated with seeds of this plant (Agrypum) extract daily at 1.5 ml/100 g BW for 4 weeks while the other group was left untreated. Blood samples were collected and total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), lowdensity lipoprotein (LDL) and glucose levels were assayed. Results: After four weeks of treatment, data indicated significant reductions in BW, blood glucose, TG, TC and LDL levels of diabetic rats treated with seeds of this plant (Agrypum) extract compared to the non-treated group. The treated diabetic rats also indicated significantly higher HDL levels compared to the non-treated group. Conclusion: Treatment of diabetic rats with the seeds of this plant (Agrypum) extract lowered blood glucose, TG, TC and LDL levels and increased the HDL level. This shows that the extract has both hypoglycemic and hypolipidemic effects.

BackgroundTraditional Mongolian Medicine has a history of over 5000 years. Scientific development of TM hasstarted in 1959. Since 1999 Mongolia was categorized by WHO as a country having an Integrativesystem of TM- officially recognized and incorporated into all areas of health care provision, TMMresearch has been following key objectives of National R&D programs.AimIn order to assess the situation of TMM development we have conducted this study based on last10 years’ research done.Ìaterial and MethodsDocument study- we have selected key TMM’s R&D project implementers’ archive and humanresources documents.Descriptive and Analytic methods- a survey of 32 questions evaluating participation of TMMprofessionals in R&D work were conducted. Also, to clarify the point of view about TMM’s R&D6 focus group meetings with different level participants, such as professional committee, policymakers and research workers as well as health care providers, were organized.ResultsFrom 2004-2013, there are 28 projects implemented on TMM, 43% accomplished by TMMRTC,32.8% of which is resulting in raw materials standardization and technology study, related clinicalstudies standing 20% out of all studies done on TMM matter. These numbers are confirmed bysurvey and focus group interviews, more than 50% of participants willing to conduct a clinical studyand expressing difficulties such as lack of knowledge of methodology, policy support and revenue.Conclusions:1. TMM R&D has a potential growth due to human resources capacity. Practitioners are leastinvolved in R&D, due to lack of knowledge of methodology and revenue.2. There were 28 projects implemented on TMM matter, most of these are basic studies, fewerclinical studies done, resulting in pharmacopeia monographs and technological guidelines.

BackgroundEarly detection of minor strokes and their treatment that aim to prevent from complications into severe strokes is a process of secondary prevention. There is a need to extensively use image diagnostics (CT, MRI) because signs are obscure, at times without focal neurological sign but can have special mental or psychological syndromes. The start of minor stroke studies in Mongolia will enable further deepening of these studies in future and give an impetus to identification of theoreticaland practical aspects together with further improvement of diagnostics, treatment and prevention of minor strokes.GoalTo develop and introduce the diagnostic criteria of ischemic and hemorrhagic minor strokes in accordance to the concepts of minor strokes and to treat minor stokes in order to prevent complications into severe strokes.Materials and MethodCurrently there are no globally accepted diagnostic criteria for minor stroke. We support the 1981 WHO criteria of minor strokes as strokes neurological signs of which disappear in relatively short period of time. There is a general notion that it should mean all light forms of stroke other than severe strokes. In cases of neurological signs of a minor stroke, complete recovery and elimination of the symptoms take up to 3 weeks. Most scholars tend to consider ischemic lacunar strokes (arising from occlusion of arteriole vessels deep in the brain and with size of 0.5-20 mm) as minor strokes. We maintained the concept that characteristic features of these strokes are their limited focal areas and the following neurological symptoms: pure motor, pure sensory, light ataxia, etc. We also duly considered a suggestion (D. German, L. G. Koshchug et al, 2008 ) to define minor hemorrhagic strokes as strokes with diameter less than 2 cm and blood volume less than 5 cm3.We identified 60 patients with minor strokes, involved in monitoring using special research template (with a term of at least 1.5years) and involved in pathogenesis treatment. In the treatment, we maintained a principle of differential diagnosis of ischemic stroke symptoms. Specifically, we differentiated the following: signs related to an atherotromb, cardio-embolic, lacunar, hemodynamic, hemorheologic pathogenesis. To verify the diagnoses, we used MRT and CT image tests. We executed paraclinic tests in order to identify risk factors: Doppler-duplex-sonography, brain angiography, blood lipid fraction, ECG, EchoCG, heart Holter, blood hemorheology test, and identified the most affecting factors (hereditary factors, excess weight, smoking etc).Results: Our study identified the following clinical forms: lacunar stroke, non-lacunar minor stroke, and hemorrhagic minor stroke. Among the minor strokes, the lacunar stroke dominates (48%), the nonlacunar stroke is the next (27.7%), and the hemorrhagic was found to be the least common 25%. From among a host of risk factors, arterial hypertension is dominant (86%) either alone or in combination with such other diseases as diabetes, atherosclerosis etc. Diabetes occurrence was 5 cases (8,3%) which is fewer than in some foreign studies.The clinic of minor stroke also varies. The strength and expression of their symptoms compared with those of severe strokes are unique in the following:- Relatively lighter and recover faster as a result of treatment even in acute forms,- Some are without specific clinical signs (“silent stroke”).- Some minor strokes have micro focal signs, for example, “pure motor”, pure sensory, ataxia etc, in other words, the signs are limited.- In cases of lacunar strokes, predominantly deep brain arterioles are damaged.- Whereas in non-lacun strokes, embolic, ateroma, thrombotic mechanisms are predominant suchas distal branches of big artery. - In cases of hemorrhagic minor strokes, arteriopathy distortions occur not only in depth of brain but also in any small lobar vessels of brain.- Focal lesions have some variations by their pathological locations and minor stroke signs.In non-lacunar strokes (25%), the focal damages predominantly occur in branches of large intra/extra cranial arteries. In cases of lacunars strokes, the focal lesion is not in branches of large intracranial vessels, but is predominantly in basal ganglia, deep white matter, thalamus, pons and in area of deep penetrating arterial vessels. However, focal infarcts in cerebella may occur in any form of minor strokes.ConclusionAccording our study there were identified 3 subtypes of minor stroke. The finding is that lacunars and hemorrhagic minor strokes are more likely to give grounds to severe strokes. From this, it can be concluded that there are specific factors in the population of Mongolia to affect the genesis of minor strokes, namely, arterial hypertension which is directly related with these forms of minor strokes. We appropriate the WHO criteria of minor stroke that is neurological signs of a minor stroke, complete recovery and elimination of the symptoms take up to 3 weeks. In treatment of minor stroke, we suggest that minor strokes should be treating by pathogenetic therapy. Namely, antihypertensive therapy for lacunar infarction, anti-aggregation therapy for nonlacunar infarction and haemostatic and antihypertensive therapy for hemorrhagic minor stroke.

IntroductionThe main principles of pharmacotherapy are to provide pharmaceutical care with right medicine, right doses, in right time. If, the treatment plan can be in evidence based, it will improve treatment efficacy and safety, can prevent from drug related adverse event and reduce drug cost. Ischemic heart disease is one of major cause of mortality and one of the main diseases of morbidity in Mongolia and in the Worldwide.GoalAim of study was to conduct retrospective study on medications used for in-patients with Ischemic heart disease of tertiary level hospitals of Ulaanbaatar.Materials and MethodTotal of 438 patient’s records was collected randomly from 3 state hospitals, which were treated with diagnosis of ICD. Variables of study were patient’s diagnosis, age, sex, names, doses and route of medications.ResultThe trends of rational use of drug and number of drug and drug cost per patients were different in each tertiary level hospitals of Ulaanbaatar. In I national hospital, number and cost of drug per patients were higher than second and third state hospitals. The result were shown that in all three hospitals, more than 50 percent of total drugs per patients were injection, less than 50 percent of total used drug per patients were from standard therapeutic guideline. In second state hospital, anticoagulant and anti-platelet agents were chosen less than first and third state hospitals. In order to decrease cardiac oxygen demand and improve cardiac microcirculation, nitrates were chosen mostly in second and third state hospitals but, beta blockers were chosen mostly in first state hospital.ConclusionThe study results shown the treatment pattern and trends of rational use of drugs in in patients with ischemic heart disease have been different in tertiary level hospitals of Ulaanbaatar.

BackgroundThese study made us to investigate the drug row material of Mongolian traditional medicine such us Tribulus terrestris, Malva neclecta Wall and Eriocheir sinensis compounded preparation named “Malbus”. Investigated us preparations steel using for treatment of kidney and urinetract deseases, it is one of effective in Mongolian traditional drug preparations.Material and MethodsThe experimental protocol was approved by the Ethics Review Committee at the Ministry Health of Mongolia. In research we used 20 healthy mice and 60 Wistar rats. Investigation was based and implemented at scientific research laboratory of Traditional Medical Science Technology and Producttion Corporation and pathological laboratory of Institute Veterinary medicine. Chemically acting substances is steroid saponin content in Malbus compound was detected by using thin layerchromatography (TLC) and its value was determined by UV-spectrophotometry. The acute oral toxicity study was according to the method Prozorovsky (1978). The toxic nephrosis was produced using Gentamicin (80 mg/kg) rats by using Neugarten’s method (1983).ResultsThe ethanolic extract results of the phytochemical investigations showed that conteined in the “Malbus” determined the presence of bioactive substances such as flavonoids, steroid saponins. The ethanolic extract of Malbus was found to be LD50 of 16.3 g/kg. Toxic nephrosis was induced in Wistar rats administered preparation Malbus dose 80 mg/kg, 160 mg/kg, and 240 mg/kg. Blood levels of creatinine, uric acid, and urea were siginificantly reduced by Malbus treatment compared tocontrol. Histological study revealed that Malbus was effective for treatment of nephritis in rats induced by gentamicin.Conclusions:1. The ethanolic extract of “Malbus” compound determined the presence of bioactive substances such as flavonoids, steroid saponins.2. LD50 of Malbus 16.3 g/kg, the preparation is has nephroprotective effect on experimental Gentamicine induced nephrosis in rats.