Background: Osteoporotic fractures remain a major concern for public health and the economy. Osteoporosis is a chronic disease characterized by reduced bone density due to genetic, hormonal, mineral, and lifestyle factors. Although often asymptomatic, its primary complication is fractures, which lead to disability and loss of work capacity, impacting individuals, families, and society. In Mongolia, no long-term study has examined bone density changes and fracture risk factors, which forms the basis of this research. Aim: To assess 10-year changes in bone density and identify risk factors for fractures. Materials and Methods: This prospective cohort study was conducted at the Department of Pathophysiology, School of Biomedicine, MNUMS. We have re-enrolled 133 adults from Ulaanbaatar between November 2023 and January 2024, originally part of the ‘Study of some risk and pathophysiological factors of osteoporosis in the Mongolian population’ funded by the Ministry of Health and the Science and Technology Fund of Mongolia. Data collection included questionnaires, anthropometric measurements, bone mineral density assessments using the ‘Sunlight Mini-Omni’ bone sonometer (Beammed, USA) Results: The mean age of participants was 54.4±9.6 years (N=133), with 33.1% (n=44) male and 66.9% (n=89) female. Among the participants, 51.1% had a history of bone fractures, with forearm fractures comprising 10.5% and other types of fractures accounting for 40.7%. The bone fractures was significantly higher among elderly individuals and those diagnosed with osteoporosis (p<0.05). The T-score was significantly lower in the fracture group than in the non-fracture group (p<0.05). Vitamin D deficiency was identified as a significant risk factor for fractures (p<0.05). Conclusion All participants’ bone density has decreased over the decade. Bone fractures are more common in elderly and people with osteoporosis. Inadequate vitamin D intake is a significant risk factor for bone fractures.

Background: The discovery of insulin over a century ago significantly advanced the treatment of diabetes mellitus (DM). Effective glycemic control in patients on insulin therapy is influenced by a variety of factors. While developed countries have transitioned fully to insulin analogs, abandoning recombinant insulin, Mongolia lacks comprehensive research on how different insulin formulations influence glycemic control. This gap highlights the need for targeted improvements in therapy effectiveness and service quality. Materials and methods: The cross-sectional study was conducted at the Central Hospital of the Mongolian National University of Medical Sciences, including 183 diabetic patients aged 18-65 years. Participants were managed by endocrinologists and participated in a survey consisting of 44 questions alongside physical measurements. Data were 78 analyzed using SPSS version 25, with a significance threshold of p<0.05. Results: The study population had a mean age of 56.7 ± 11.0 years, with 55.2% (n=101) males. The mean duration of diagnosed DM was 12.6 ± 6.33 years, and the mean duration since the initiation of insulin therapy was 6.77 (1-24) years. The mean glycated hemoglobin (HbA1c) was 10.5%, with 87.4% of the participants categorized under poor glycemic control and only 5.5% maintaining optimal levels. Insulin usage was predominantly recombinant (60.7%), with analogue at 32.2%, and mixed regimens at 7.1%. Usage of insulin pens was reported by 43.2% of the participants. The daily insulin dosage ranged from 10 to 71 units, averaging 37.2 ± 13.7 units. Multivariate logistic regression analysis confirmed that inadequate knowledge about insulin therapy is an independent risk factor (OR; 95% CI = 1.48; 1.21 10.32). When adjusting for confounding factors, the average glycated hemoglobin (HbA1c) levels in the group with inadequate knowledge was significantly higher (11.8%) compared to the group with adequate knowledge, where it was significantly lower (10.2%). Conclusion The use of analog insulin among patients with type 2 diabetes undergoing insulin therapy is relatively low (32%), and glycemic control is poor (87%). Therefore, it is necessary to increase the use of analog insulin and improve glycemic control. Inadequate knowledge about insulin therapy negatively affects glycemic control in patients with type 2 diabetes (OR; 95% CI = 1.48; 1.21-10.32). Therefore, it is essential to enhance patients’ knowledge.

Background: Saponins are secondary metabolites in plants that play an important role in defense mechanisms and physiological processes. Since stomatal cells are crucial for gas exchange and water balance in plant tissues, studying the anatomical and biochemical features of stomatal cells in saponin-rich plant species provides insight into the interactions between these compounds and cellular mechanisms. This serves as the basis of our study. Aim: To determine the structure, types, and functions of stomatal cells in saponin-containing medicinal plants Materials and Methods: During June–September 2024, nine species of saponin-containing medicinal plants were collected from Bulgan, Tuv provinces, and “Gorkhi-Terelj National Park” in Mongolia. Prepared microscopic specimens were examined using macroscopic and microscopic techniques to study the structure, position, number, and epidermal features of stomatal cells. Results: The study revealed that Anemone crinita Juz. exhibited the highest stomatal density (107 stomata/mm²) and epidermal cell density (229 cells/mm²), indicating strong adaptation and protective capacity in arid conditions. Vicia baicalensis (Turcz.) B. Fedtsch. showed the highest stomatal index (39.6), highlighting its significant role in regulating transpiration. Stomatal types varied among species: • Anomocytic stomata were observed in Potentilla multifida and Vicia baicalensis. • Anisocytic stomata were found in Delphinium grandiflorum and Ranunculus borealis. • Paracytic stomata were present in Gentiana algida, Adenophora remotiflora, Helianthemum nummularium, Anemone crinita, and Ranunculus acris. Conclution In the study of the structure, form, and number of stomatal cells in saponin-containing plants growing in Mongolia, Anemone crinita Juz. was found to have the highest number of stomatal and epidermal cells, indicating its high efficiency in gas exchange, water regulation, and protection against external stress. Furthermore, Vicia baicalensis (Turcz.) B.Fedtsch. showed the highest stomatal index, confirming its strong capacity for active regulation of gas exchange. The variation in stomatal cell types among plant species was identified as playing an important role in ecological and biological adaptation as well as protective mechanisms.

Background: Plants of the family Gentianaceae in Mongolia are rich in bitter iridoid glycosides, flavonoids, and polyphenolic compounds, and have been traditionally used in Mongolian medicine to promote digestion, protect the liver, and reduce fever. However, standardized information on the micro-morphology and histochemical characteristics of the widely distributed species Gentiana decumbens L.f. is scarce, limiting the assessment of its quality as a medicinal raw material. Aim: To identify the morphological and anatomical characteristics of the aerial and underground parts of Gentiana decumbens and to localize the distribution of starch, polysaccharides, and phenolic compounds using histochemical methods. Materials and Methods: Plant materials were collected in July 2024 from Tsagaan-Uul soum, Khuvsgul province, andshade-dried. Samples were softened in a water–ethanol–glycerol solution (1:1:1) for 24 hours, and transverse and longitudinal sections of stem, leaf, root, and floral parts (anther, petal, receptacle/bract) were prepared using a hand microtome. Sections were cleared with 10% chloral hydrate. Histochemical reagents included potassium dichromate (K2Cr2O7), ferric chloride (FeCl3), Lugol’s iodine (I₂+KI), thymol + concentrated H₂SO₄, and methylene blue. Slides were mounted in glycerin and examined under an Olympus light microscope at 40× and 100× magnifications, and images were recorded using a 12 MP digital camera. Results: Leaf: The leaf exhibits a dorsiventral structure with a dense palisade parenchyma on the adaxial side and a loosely arranged spongy mesophyll on the abaxial side. Stomata are hypostomatic, and collenchyma is well developed around the vascular bundles. Histochemical reactions were negative for starch and phenolic compounds. Stem: The stem consists of an epidermis, a wide cortex, a continuous ring of sclerenchyma, 12–15 collateral vascular bundles, and a broad central parenchyma. Histochemical tests showed a brownish-yellow coloration with potassium dichromate (K2Cr2O7), indicating the presence of polyphenols and lignin, and a brown coloration with Lugol’s iodine, confirming the presence of starch. Reactions with ferric chloride (FeCl₃), methylene blue, and thymol + H2SO4 were mostly negative in cross sections. However, in longitudinal sections, Lugol’s and thymol + H2SO4 showed positive reactions, suggesting the presence of starch and polysaccharides, respectively. Root: The root displays a primary structure with radial xylem and phloem, a distinct endodermis with Casparian strips, and a pericycle layer. Positive reactions were observed with K2Cr2O7 and FeCl₃, indicating phenolic compounds and lignin. Lugol’s iodine showed abundant starch granules in parenchyma cells. Receptacle / Bract: The receptacle is covered by a thick cuticular epidermis with trichomes, and composed of outer and central parenchyma layers containing numerous small closed (amphivasal-type) vascular bundles. Positive reactions were detected with K2Cr2O7 and FeCl₃, indicating polyphenols, flavonoids, and tannins; Lugol’s iodine confirmed the presence of starch; thymol + H2SO4 showed partial positivity for polysaccharides. Stamen (longitudinal section): The stamen structure includes epidermis, endothecium, pollen sacs, and a distinct vascular bundle. Positive staining was observed with K2Cr2O7, Lugol’s iodine, and FeCl3, confirming the presence of polyphenolic compounds, lignified elements, and starch. Conclusion The anatomical features of G. decumbens indicate adaptations to dry, high-light environments through well-developed mechanical strengthening (sclerenchymatous ring), efficient photosynthetic structure (compact palisade mesophyll), and nutrient storage (starch-rich pith and cortex). Histochemical analysis revealed the localization of polyphenolic compounds and starch/polysaccharides mainly in the root, stem, and floral organs, while absent in the leaves, demonstrating organ-specific accumulation patterns. These findings scientifically support the plant’s traditional medicinal uses for digestive stimulation and hepatoprotection.

Purpose: The aim of this study was to determine the surgical and visual outcomes of scleral fixated intraocular lens implantation in eyes with as subluxated and dislocated crystalline lens or traumatic aphakic eyes. Methods: A retrospective and short-term prospective cohort study was carried out in 45 eyes of 43 individuals who underwent SFIOL implantation surgery in First Central Hospital of Mongolia between January 2017 and January 2020 and had a minimum follow-up of 3 months. Pre-operative and post-operative best corrected visual acuity, postoperative outcomes and complications were summarized. Patients after the implantation of a scleral fixated PCIOL were evaluated for the disease etiology, pre- and post-operative best corrected visual acuity, and occurrence of postoperative complications. Results: The analysis included 45 eyes from 43 patients. Thirty-two (74.4%) patients were men and eleven (24.6%) were women . The mean age at implantation was 57.2 ± 20.0. Indications for the IOL implantation included ocular trauma (48.9%), pseudoexfoliation syndrome (22.2%) and Marfan syndrome (15.6%). Disease etiology and age group were compared and results were Marfan syndrome is mostly diagnosed in 20-29 years of age, ocular trauma is usually diagnosed in 30-69 years of age and pseudoexfoliation syndrome is occurred in 70 and above of age. Post-operative visual acuity was improved in all cases from which 35 of patients (77.77%) visual outcome was 6/12 and above.
The mean preoperative best corrected visual acuity (BCVA) was 0.083 ± 0.088, which improved to 0.569 ± 0.221 (p<0.001) third month postoperatively and these were statistically significant.
The most frequent complication was induced astigmatism, which occurred in 6 eyes which successfully corrected with glasses. Suture erosion occurred in three eyes which successfully relocate it. The most serious complications such as vitreous hemorrhage, retinal detachment, suprachoroidal hemorrhage, endophthalmitis and suture degradation or breakage was not seen. Conclusion Ab externo SFIOL implantation is a reasonable technique for the management of eyes with aphakia or absence of capsular support, with relatively high visual outcomes and few serious complications.
The most frequent cause of aphakia and absence of capsular support was ocular trauma thus, pseudoexfoliation and Marfan syndrome were the most common in elderly and in young age, respectively.

BACKGROUND. Acute primary angle-closure glaucoma (PACG) is a severe disease requiring intensive and emergency treatment. Surgical peripheral iridectomy and laser peripheral iridectomy procedures are performed to decrease papillary block and create an opening for the aqueous humor to pass through the eye. However, the intraocular pressure (IOP) cannot be consistently controlled by peripheral iridectomy. Phacoemulsification can widen the anterior chamber angle, position the ciliary processes in eyes with PAC posteriorly and inhibit the acute angle closure. This procedure can control the intraocular pressure sustainably for a long period. The higher incidence of the acute angle closure glaucoma in Mongolia compared to other countries was the rationale of this study. MATERIAL AND METHODS. Medical records of 9 patients (9 eyes) with acute PACG, who had received phacoemulsification with intraocular lens implantation as initial management for medically uncontrolled high IOP, were analyzed in a retrospective chart review. IOP, visual acuity, anterior chamber depth (ACD) and the number of anti-glaucoma medications used were evaluated. RESULTS. The postoperative IOP was reduced in 9 eyes (100%). The mean preoperative IOP was 37.9 ± 13.0 mmHg, which decreased postoperatively to 11.0 ± 1.9 mmHg at day 1, 11.1 ± 2.1 mmHg at week 1, 11.1±2.0 mmHg at 2 weeks, 11.8 ± 1.9 mmHg at month 1, and 11.3 ± 1.4 mmHg at 3 months, which showed statistically significance (p < 0.001). The mean visual acuity improved from preoperative average of 0.04±0.03 to postoperative average of 0.17±0.24 at day 1, 0.45±0.26 at week 1, 0.54±0.31 at week 2, 0.56±0.34 at 1 month, and 0.57±0.33 (p = 0.001) at 3-months. There was functional success at month 3. СONCLUSION. Our outcome indicates that primary phacoemulsification with intraocular lens implantation lowered IOP and improved visual acuity significantly in patients with acute PACG. This is a safe and effective method of IOP control and can be considered a first line treatment option in managing patients with acute PACG and coexisting cataract.

BACKGROUND: There are two general types of age-related macular degeneration: dry and wet. During wet or neovascular age-related macular degeneration new abnormal vessels grow and leak in the macula. As anti-vascular endothelial growth factor (anti-VEGF) was invented, it revolutionized the treatment of nAMD by inhibiting the progress of this disease. The incidence of AMD increases as life expectancy grows and there is a growing need to study this disease. We aimed to evaluate the outcome of anti-VEGF therapy for the treatment of nAMD and the incidence of ocular serious adverse events (SAE) after injections.. METHODS: In our retrospective, single-center study, medical records of patients receiving a single dose of anti-VEGF treatment (Bevacizumab) for nAMD between 17th of April, 2016 and October, 2017 were evaluated. Outcome measures were the change in the baseline visual acuity (VA) score at post-injective month one, incidence of ocular SAE and patients’ baseline characteristics affecting VA. Patients, whose treatment were started before April 2016 and had anti-VEGF treatment for the diseases other than nAMD, were excluded.. RESULTS: 15 eyes in 15 patients between 52 and 85 years of age received single dose of anti-VEGF (Bevacizumab/Avastin) injection. The mean baseline VA improved from pre-injective average of 0.21 to post-injective 1-month average of 0.37 by Snellen. Furthermore, there was no vision loss or other severe adverse effects, such as endophthalmitis, vitreous hemorrhage, retinal detachment, traumatic cataract after 4 weeks. CONCLUSION: Anti-vascular endothelial growth factor therapy has promising short-term outcomes on treating neovascular age-related macular degeneration.

BACKGROUND Patient safety has become a matter of interest to healthcare professionals, governments and researchers worldwide. During the last decade, many studies have been conducted to assess the prevalence, severity and causes of a large variety of different types of adverse events in hospitals, as well as the effectiveness of various approaches to enhance safety. In Mongolia, it is also an arguable point, mistakes and errors associated with physicians, hospital staffs and healthcare organizations has been occurring frequently in recent years. Our main aim is to find difference between physicians and nurses’ attitude on patient safety culture. METHODS The study included 3 tertiary hospitals from Ulaanbaatar city, Mongolia with a total of 122 respondents; all hospital staff. The Hospital Survey on Patient Safety Culture (HSOPSC) Questionnaire from AHRQ (Agency for Healthcare Research and Quality) was used. AHRQ methods, Pearson’s Chi-squared test, pairwise proportion test (p≤ 0,05) were used for statistical analysis. RESULTS Patient safety in hospitals was evaluated as positive by 62.3% of healthcare workers. The highest scores were obtained in specific dimensions as teamwork within unit (77.3%), unit’s team learning from occurred adverse events (71%). Per our survey, health care workers considered non-punitive response to error (20.6%) and communication openness (27.7%) as being weak areas. In surveyed hospitals, physicians and nurses had a significantly different outlook at communication, adverse events reporting and management support. Physicians reported fewer errors than nurses. CONCLUSION Doctors rated safety culture less positively than nurses in some dimensions of patient safety culture- feedback and communication about error, transition and handoffs, management support for patient safety and teamwork across units. This result could indicate a need for more intensive interventions in certain areas of patient safety culture and is certainly an area for future research inquiry.

BACKGROUND: Learning success is a success of study process. It reveals by how the individual effort, time management, task complement, self-development and self sdutying skills. The GPA is a measurable outcome of those skills above. A motivation is a behavior and psychological complex that affects the skills. Otherwise, it is a process that motivates person by the intrinsic or extrinsic effect to a particular goal. Every student has his own permanent study manners and learning skill. It depends directly by how he motivates himself. Such study is deficient, actually in medical students in Mongolia. Therefore, we aimed to study how motivation effects in medical students learning success. METHODS: The present study is accomplished among 3-6 grade students who study by a general doctor in Mongolian National University of Medical Science by analytical study method and cross-sectional design. 536 students wer selected randomly. John Biggs’s R-SPQ-2F- Revised study process questionnaire 2 factor and Rein Cornel’s SRQ (Self regulationquistionnaire) and additional 5 questions are used. For the data analysis, IBM SPSS 21.0, SPSS AMOS soft wares are used to evaluate the descriptive and analytic statistics. Statistically significant differences between the groups were defined as p-values less than 0.05. RESULTS: The total number of students in our research were 536, thereform 23.5% were male (126), 76.5% were female (410) students. Highly GPA students engrained their own study technique because the variable of DS (p<0.01) is positively dependent with the GPA. Whereas the slight motivation (SM) is negativele correlated (p<0.001) with the GPA, therefore the variable of SM is less dependent. The Relactive approach motivation (RAM) is direct, positively dependent between good study strategy (GSS) and grade point average (GPA). Also, the positive learning methods (GSS) both are positively dependent for learning-succession. Although, it is enamored that good study strategy (GSS) are highly indication compared to other variables. Otherwise, GSS is more effective for learning-succession than a grade point average (GPA). If the students can own the right learning skill themselves, they will increase the learning-succession. CONCLUSION: Relative Autonomous Motivation is positively affects through good study strategy and learning success. Intrinsic motivation is more effective than other variables..

BACKGROUND. Head and neck cancers are related group of cancers that involve the oral cavity, pharynx (oropharynx, nasopharynx, hypopharynx), and larynx. Early-stage tumors of the upper aerodigestive tract can be cured; for late-stage disease, prognosis is poor. Nowadays microvascular free tissue transfer surgery performed at high level. Worldwide, this particular kind of operation in head and neck surgical field has become “golden standard” of treatment. Seemingly, plastic and reconstructive surgeons of developed countries widely perform forearm free flap, anteriolateral thigh free flap, fibula free flap, rectus abdominal free flap, latissimusdorsi free flap. We purpose to report our first 121 cases of Microvascular Free Tissue Transfer which had been performed at the head and neck surgical department, NCC of Mongolia. METHODS. The clinical records of first 121 cases patients who had microvascular reconstruction done between 2011 and 2017 were reviewed. The indications for surgery, choice of flap, duration of surgery and flap survival were noted. RESULTS. Our study were performed on 121 cases, among them 84.3% flaps were survived, most of defects occurred following cancer resection. Anterolateral thigh and radial forearm flaps were performed commonly for our reconstruction surgery. CONCLUSION. 84.3% free flap recorded success rate indicates our early experiences. Although the National Medical University do not have postgraduate reconstructive and plastic surgical training, we believe that meticulous planning, careful vessel selection, close flap monitoring as well as improved infrastructural support can lead us to much better success rates of microvascular reconstruction in our country.