Background: Insomnia is one of the most prevalent neurological disorders in the United States, affecting up to half of primary care patients and often necessitating psycho-behavioral interventions. Acupuncture, a key component of traditional Chinese and Mongolian medicine, has been increasingly studied as a treatment for insomnia in recent years. Aim: Evaluating the effectiveness of acupuncture for insomnia Materials and Methods: The study was conducted using a randomized controlled clinical trial design. 148 participants, aged 18-65 years, with a diagnosis of Nonorganic Insomnia (F51.0) according to the ICD-10, and Pittsburgh Sleep Quality Index (PSQI) >7, were divided into the transverse acupuncture, conventional acupuncture, and the control group. The results were analyzed using a Cardiopulmonary Coupling - CPC machine before and after treatment in the 3 groups to assess 1. Total sleep (hours), 2. Deep sleep (hours), 3. Light sleep (hours), 4. REM (hours), 5. Wake time (minutes), 6. Time to first fall asleep (minutes), 7. Sleep rate (%), 8. Number of apneas, and sleep quality was assessed using the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) questionnaires. The research approval was reviewed and granted by the Research Ethics Review Committee of the Mongolian National University of Medical Sciences on January 19, 2024 (Approval No. 24/19/01). Results: The mean age of participants was 51.5±10.8 years, with 79.7% (n=118) being female and 20.3% (n=30) male. In the transverse acupuncture group, post-treatment results demonstrated a 53.8% increase in total sleep time, a 102.8% increase in deep sleep time, a 19.8% increase in light sleep time, a 36.1% increase in REM sleep time, and a 22.1% improvement in sleep normalization rate. The mean differences between pre- and post-treatment scores were statistically significant based on a one-sample t-test. In contrast, no statistically significant improvements were observed in the control group, except for sleep quality. Conclusion Both transverse acupuncture and conventional acupuncture significantly improved sleep quality indicators following treatment.

Background: Hearing loss (HL) is one of the most common sensory disorders, affecting over 5-8% of the world's population. Approximately half of HL cases are attributed to genetic factors. In hereditary deafness, about 75-80% is inherited through autosomal recessive inheritance, and common pathogenic genes include GJB2 and SLC26A4. Pathogenic variants in the SLC26A4gene are the leading cause of hereditary hearing loss in humans, second only to the GJB2 gene. Variants in the SLC26A4gene cause hearing loss, which can be non-syndromic autosomal recessive deafness (DFNB4, OMIM #600791) associated with enlarged vestibular aqueduct (EVA) or Pendred syndrome (Pendred, OMIM #605646). DFNB4 is characterized by sensorineural hearing loss combined with EVA or less common cochlear malformation defect. Pendred syndrome is characterized by bilateral sensorineural hearing loss with EVA and an iodine defect that can lead to thyroid goiter. Currently, it is known that EVA is associated with variants in the SLC26A4 gene and is a penetrant feature of SLC26A4-related HL. Predominant mutations in these genes differ significantly across populations. For instance, predominant SLC26A4 mutations differ among populations, including p.T416P and c.1001G>A in Caucasians, p.H723R in Japanese and Koreans, and c.919-2A>G in Han Taiwanese and Han Chinese. On the other hand, there has been no study of hearing loss related to SLC26A4 gene variants among Mongolians, which is the basis of our research. Aim: We aimed to identify the characteristics of the SLC26A4 gene variants in Mongolian people with Enlarged vestibular aqueduct and Mondini malformation. Materials and Methods: In 2022-2024, We included 13 people with hearing loss and enlarged vestibular aqueduct, incomplete cochlea (1.5 turns of the cochlea with cystic apex- incomplete partition type II- Mondini malformation) were examined by CT scan of the temporal bone in our study. WES (Whole exome sequencing) analysis was performed in the Genetics genetic-laboratory of the National Taiwan University Hospital. Results: Genetic analysis revealed 26 confirmed pathogenic variants of bi-allelic SLC26A4 gene of 8 different types in 13 cases, and c.919-2A>G variant was dominant with 46% (12/26) in allele frequency, and c.2027T>A (p.L676Q) variant 19% (5/26), c.1318A>T(p.K440X) variant 11% (3/26), c.1229C>T (p.T410M) variant 8% (2/26) ) , c.716T>A (p.V239D), c.281C>T (p.T94I), c.1546dupC, and c.1975G>C (p.V659L) variants were each 4% (1/26)- revealed. Two male children, 11 years old (SLC26A4: c.919-2A>G) and 7 years old (SLC26A4: c.919-2A>G:, SLC26A4: c.2027T>A (p.L676Q))had history of born normal hearing and progressive hearing loss. Conclusions 1. 26 variants of bi-allelic SLC26A4 gene mutation were detected in Mongolian people with EVA and Mondini malformation, and c.919-2A>G was the most dominant allele variant, and rare variants such as c.1546dupC, c.716T>A (p.V239D) were detected. 2. Our study shows that whole-exome sequencing (WES) can identify gene mutations that are not detected by polymerase chain reaction (PCR) or NGS analysis.

Background: Cardiovascular disease (CVD) is currently the leading cause of morbidity and mortality worldwide. CVD risk increases significantly even in the early stages of chronic kidney disease (CKD) and CVD deaths account for more than half of all known causes of death in patients with end stage renal disease. Cardiovascular risk factors such as hypertension, anemia, hyperphosphatemia, volume overload and uremic toxins usually occur when eGFR is below 60 ml/min/1.73m2, while the subclinical atherosclerosis starts to develop in early stages of CKD. Serum N-terminal pro B type netriuretic peptide (NT-proBNP) is important for predicting subclinical heart failure in patients with CKD. Methods: Plasma NT-proBNP concentrations were measured in 37 patients with CKD (mean age = 54 years, female 48.6%). Renal function was assessed by estimated glomerular filtration rate (eGFR; ml/min/1.73m2) and the subjects were classified into five stages of CKD. Pearson correlation analysis was used to analyze he relationship between renal function and serum NT-proBNP levels. Results: The mean serum NT-proBNP level was in CKD stage I ( <50pg/ml, p<0.0001), CKD stage II (64.86±21.79 pg/ml, p<0.0001), CKD stage III(119.56±158.1pg/ml, p<0.0001), CKD stage IV (5801.8±7213.7 pg/ml, p<0.0001), CKDstage V (6993.1±9029.9 pg/ml l, p<0.0001). Serum NT-proBNP level was inversely correlated significantly with eGFR (r = -0.464, р = 0.004). Conclusion Our findings indicate the circulating levels of NT-proBNP increased with deteriorating kidney function and these values were highest in patients with CKD IV and CKD V stages.

Purpose: To investigate the outcomes of ROP screening of retinopathy of prematurity (ROP). Methods: This was a prospective of prematurity infants screened ROP from 2020 April 13th to April 28th 2020 and from 2020 June 08 th to June 22th 2020 and prospective cohort study of premature infants with treatment-requiring ROP who received intravitreal injections, laser surgery. Demographic factors, diagnosis and clinical course were recorded. Indirect ophthalmoscopy and Retinal imaging was performed using RetCam (Natus Medical, Pleasanton, CA) and images were taken. Each eye was evaluated by the pediatric ophthalmologist and aimag’s ophthalmologist for the presence or absence of ROP, zone of vascularization, stage, plus disease, and aggressive posterior ROP (AP-ROP). The diagnosis and classification of ROP for this current study were determined by examination using indirect ophthalmoscopy, and treatment plans were determined according to the International Classification for ROP and the Early Treatment for ROP Study (ET-ROP).^2,13 Results: A total of 90 premature infants with BW ≤ 2000g and/or GA ≤ 34 weeks were screened for ROP during the study period. 8 (8.8%) of the 90 infants screened required treatment. The 8 infants who received ROP treatment had a mean GA of 28.5 ± 1.7 weeks, mean BW of 1237.5 ± 125.42g, mean PMA of 36 weeks and mean follow-up time of 2 months. Conclusion After treatment, resolution of ROP was noted in approximately 100 % of the patients who had treatment-requiring ROP.

Outcomes of retinopathy of prematurity screening Background: Retinopathy of prematurity (ROP) is a potentially blinding eye disorder that primarily affects premature infants weighing about 1250 grams or less that are born before 31 weeks of gestation (a full-term pregnancy has a gestation of 38-42 weeks). The smaller a baby is at birth, the more likely that baby is to develop ROP. This disorder — which usually develops in both eyes — is one of the most common causes of visual loss in childhood and can lead to lifelong vision impairment and blindness. ROP was first diagnosed in 1942. Our goal was to investigate the outcomes of ROP screening of retinopathy of prematurity (ROP). Materials and methods :This was a prospective of prematurity infants screened ROP from 2020 April 13th to April 28th 2020 and from 2020 June 08 th to June 22th 2020 and prospective cohort study of premature infants with treatment-requiring ROP who received intravitreal injections, laser surgery. Diagnosis and clinical course were recorded. Indirect ophthalmoscopy and Retinal imaging was performed using RetCam (Natus Medical, Pleasanton, CA) and images were taken. Each eye was evaluated by the pediatric ophthalmologist and aimag's ophthalmologist for the presence or absence of ROP, zone of vascularization, stage, plus disease, and aggressive posterior ROP (AP-ROP). The diagnosis and classification of ROP for this current study were determined by examination using indirect ophthalmoscopy, and treatment plans were determined according to the International Classification for ROP and the Early Treatment for ROP Study (ET-ROP). Results: A total of 90 premature infants with BW ≤ 2000g and/or GA ≤ 34 weeks were screened for ROP during the study period. 8 (8.8%) of the 90 infants screened required treatment. The 8 infants who received ROP treatment had a mean GA of 28.5 $ 1.7 weeks, mean BW of 1237.5 $ 125.42g, mean PMA of 36 weeks and mean follow-up time of 2 months. Conclusions: After treatment, resolution of ROP was noted in approximately 100 % of the patients who had treatment-requiring ROP

Outcomes of the retinopathy of prematurity screening and treatment in Mongolia Background: Retinopathy of prematurity (ROP) is a disease characterized by abnormal retinal vasculature that can have devastating visual consequences. Despite evidence that early detection and treatment can prevent blindness, ROP remains a leading cause of pediatric blindness worldwide. We aimed at investigating the outcomes of ROP screening, intravitreal anti–vascular endothelial growth factor (VEGF) and laser surgery in the treatment ROP and describe an evidence-based and specific process for identifying birth weight and gestational age screening guidelines in Mongolia utilizing telemedicine. Materials and methods: This was a retrospective of prematurity infants screened ROP from 2012 September to July 2020 and prospective cohort study of premature infants with treatment-requiring ROP who received intravitreal injections, laser surgery and combined therapy from 2015 December 01 to January 31, 2017. Demographic factors, diagnosis and clinical course were recorded in a de-identified manner using REDCap, a secure, web-based platform to collect image and demographic data. The IRB approved the study protocol not requiring parental consent due to the de-identified nature of the data which was used for program monitoring purposes. Indirect ophthalmoscopy and Retinal imaging was performed using RetCam (Natus Medical, Pleasanton, CA) and images were uploaded to the web-based platform which could be accessed by the Mongolian ophthalmologist for reference. Each eye was evaluated by the local Mongolian ophthalmologist for the presence or absence of ROP, zone of vascularization, stage, plus disease, and aggressive posterior ROP (AP-ROP). The diagnosis and classification of ROP for this current study were determined by examination using indirect ophthalmoscopy, and treatment plans were determined according to the International Classification for ROP and the Early Treatment for ROP Study (ET-ROP).2,13 Regression analysis to determine association between BW and GA and the development of ROP. Results: A total of 9126 premature infants with BW ≤ 2500 g and/or GA ≤ 36 weeks were screened for ROP during the study period. 327 (3.5%) of the 9126 infants screened required treatment. The193 infants who received ROP screening had a mean GA of 30.09 ± 1.7 weeks, and mean BW of 1500.3 ± 125.42g. The BW of infants in this study ranged from 750g to 2000g, and the GA at birth ranged from 25 to 35 weeks. The BW of infants in this study ranged from 750g to 2000g, and the GA at birth ranged from 25 to 35 weeks. There were 96 boys (49.7%) and 97 girls (50.3%). Among infants receiving treatment, the highest BW was 2000g (born at 31 weeks GA), and the oldest was 34 weeks (with a BW of 1300g). The distribution of birth weight and gestational age in Mongolia was similar to other low-middle income countries, with higher birth weight and older gestational age. As birth weight and gestational age decreased, relative risk of developing ROP increased. Conclusions: After treatment, resolution of ROP was noted in approximately 90 % of the patients who had treatment-requiring ROP. 10 % of patients treated with IVB, IVR, Laser surgery and combined therapy however, did not respond and progressed to retinal detachment. This prospective study provides information about the development of ROP in preterm infants in the capital city of Mongolia. The distributions of BW and GA among infants developing ROP in Mongolia differ from those found in higher-income countries, and are comparable to other low and middle-income countries. We used a secure, web-based data collection and retrieval system that could be extended to multiple countries, which is now equipped with a telemedicine platform enabling remote grading of fundus images.

In order to determine sleep disorders, especially insomnia due to exam stress in medical students, moreover are there any bad effects on performance of mental abilities and emotional competency, we carried out this research. We used Prospective cohort study design, involving III and IV grade 60 students, once these grades are most overloaded courses. The study performed through 2 stages: 1) Just after Final examination of a block, 2) During regular days, after sleeping well. The aim can be divided into three main categories, including evaluation of sleep disorders, estimation of brain performances and emotional competency. An average sleeping time was 3.67±1.45 hours on final exam day, whereas a main sleeping time during regular day was 7.88±1.19 hours. As totally 70% of students were estimated as having insomnia and according to insomnia severity index, 58.3% of them had subthreshold insomnia, 16.7% of them had moderate insomnia. Furthermore, regarding to Epworth sleepiness scale, 36.7% of all participants were evaluated as having mild daytime sleepiness, 13.3% had moderate, and 10% had severe sleepiness, which was more common in male students. The estimation of emotional competency consists of self-awareness, managing emotions, motivating oneself, empathy, and social skill, which were strongly associated with duration of sleep time, as well as, emotion was more stable in 4th grade students. As comparison between mental performances of sufficient and insufficient sleep time, main difference of speed 3428±1249, memory 2984±1063, attention 2472±31, flexibility 4525±1184, and problem solving 945±193 scores.

There are a lot of influencing factors of facial nerve palsy; experts believe that is most likely caused by a Virus (54%) and Bacterial infections. Noninfectious causes of facial nerve palsy induce tumors (28%) and less commonly influences head trauma (18%). The retrospective analysis of WHO, in 2012. There are some cases of postoperative complication in middle ear surgery is facial nerve palsy and the total recovery outcome of function was not good. From 2013 to 2016 in EMJJ hospital, Mongolia, we enrolled 16 cases with facial nerve damaged in intratympanic canal but we could not recruit some patients with facial palsy over 6 months. Each subject was tested with pure tone test, ABR, Tympanometry. These were performed for the detection of hearing loss after Temporal bone injury. Then we also investigated location of facial nerve damages of patients by MRI and CT before reconstructive surgery. After that surgery, all patients were given corticosteroid treatment (20mg/day) and physical therapy performed such as acupuncture for a week. Study results revealed that 6 cases after 18 days, 2 cases after 30 days, 1 patient after 45 days of reconstructive surgery regained good symmetry. Therefore, we considered that, postoperative treatments like physical therapy with B12, steroid had good benefits for operation result and to shorten the recovery time. There was a patient who had damaged facial nerve in the tympanic segment during Mastoidectomy. In that case, we performed cable nerve grafting using the r.auricularismagnium but we could not recover facial nerve function. Traumatic facial nerve paralysis is the second most common type. We discussed that performing reconstruction surgery within first 3 months after intratemporal facial nerve injury is extremely desirable and more effective. In our opinion, nerve recovery might be not successfully cause of injured myelin sheet of facial nerve during middle ear surgery.

BackgroundIn 1988, the Forty-first World Health Assembly adopted a resolution for the Global Polio Eradication.Since the initiative was launched, number of polio cases has fallen by over 99%. Today, only threecountries in the world, Afghanistan, Pakistan and Nigeria - remain polio-endemic. The Polio Eradicationand Endgame Strategic Plan of 2013-2018 calls for the gradual eradication of wild virus strain and thevaccine virus strain at the same time. In order to prevent the border transmission of wild type poliovirus,virus leakage from laboratories, it is required to conduct inventory of laboratories handling poliovirus andpotential infectious materials every 2 year.GoalTo identify laboratories handling poliovirus and potential infectious materialsMethodsSurvey of laboratories handling poliovirus and potential infectious materials was conducted amongstate, private, clinical, biomedical and environmental testing in total of 127 laboratories operating in21 provinces and 9 districts of Ulaanbaatar city by questionnaire. Survey questionnaire consists of 6sections (general, sample storage, laboratory biosafety, staff knowledge, information source, trainingand etc.). Study results were processed using SPSS-19 statistical programme.Results34.7% of 96 biomedical laboratories were analyzed stool samples. These laboratories were analyzedrotavirus (17.0%), intestinal bacteria (67.0%), Helicobacter (14.3%), parasite and other indicators (1.7%)in stool samples. 43.8% of laboratories were stored stool samples for one day and 3.1% up to oneyear. From 31 environmental testing laboratories 73.3% were bacterialdetection test on environmentalsamples. 60% of wastewater samples were collected from rivers, 16% on entrance to wastewatertreatment plant and after biological treatment combined, and 24% from other sources. Soil sampleswere collected near waste disposal and other sources (46.4%), and from unknown sources (53.6%).24.1% of all laboratories were stored environmental samples for 3 days, 3.4% for 45 days. Accordingto results, surveyed laboratories did not store samples for more than 1 year. Also, none of surveyedlaboratories (100%) were not stored poliovirus and potential infectious materials.Conclusion· The investigated laboratories were not stored poliovirus and potential infectious materials.· The biosafety and biosecurity status of laboratories should be improved in near future throughenhancing knowledge of laboratory workers and organizing training related to biosafetyandbiosecurity.

Ectopic pregnancy (EP) is a life – threatening emergency, and a significant cause of maternal morbidity and mortality in Ulan – Bator. The aim of this research was to determine and evaluate the incidence, risk factors and treatment of ectopic pregnancies at The First Maternity Hospital in Ulan – Bator.This was a retrospective, descriptive study of EP’s managed in The First Maternity Hospital during the study period 2013, 2014.The medical records of the patients managed for ectopic pregnancy as well as the total birth record and gynecological admission records during the period under review were retrieved, and data were collected with the aid of data-entry forms designed for this purpose. There were 46.147 gynecological admissions and 28.744 deliveries, with 870 cases of ectopic pregnancies. A total 863 cases were suitable for analysis. The relevant collected data were analyzed with SPSS Version 20.0 for windows.Ectopic pregnancies constituted in 3.9% of all gynecological admissions.Majority of patients were in 25-29years age group (64.1%). The average age of patients was 30 +/- 6 years. In 83.8% of patients had previous abortions, inflammatory disease was the most frequent risk factors.521(60.3%) patients were treated surgically while the 342(39.6%) remain patients received conservative treatment.The incidence of ectopic pregnancy increased by 0.8%, which is comparable between 2013(2.5%), 2014(3.3%). In our study the number percentage of organ preserving treatment, such as tubostomy and conservative – treatment by methotrexate increased significantly.