Background: Simulation-based education has become an effective and widely used modern teaching method in health professional education. This approach allows students to apply theoretical knowledge into practice and develop essential skills such as clinical assessment, clinical decision-making, and teamwork in a safe and controlled learning environment. In recent years, international studies have demonstrated that simulation-based training improves students’ clinical skills, confidence, communication abilities, and professional attitudes. However, evidence regarding the effectiveness of simulation-based training remains limited in certain educational settings, particularly in developing countries. Therefore, evaluating the effectiveness of simulation-based training within local educational contexts is necessary. Aim: To evaluate the effectiveness of simulation-based training on students’ knowledge, clinical skills, and professional attitudes. Materials and Methods: This study included 45 third-year medical students from four classes at the Mongolian National University of Medical Sciences using a random sampling method. Participants were divided into two groups according to the training modality: a simulation-based training group (n=20) and a traditional learning control group (n=25). Knowledge was assessed before and after training using an 18-item test covering asthma etiology, pathophysiology, clinical features, diagnosis, and treatment. After the training session, students’ knowledge, clinical skills, and professional attitudes were evaluated using a 21item Likert-scale questionnaire and small-group discussions to identify factors influencing learning outcomes. The reliability of the questionnaire was evaluated using Cronbach’s alpha, which demonstrated high internal consistency (α=0.90). Statistical analysis was performed using SPSS software. Paired samples t-tests were used to compare pre- and post-training knowledge within groups, while independent samples t-tests were used to compare post-training outcomes between groups. Result: After training, mean knowledge scores significantly improved among all participants (pre-training: 9.18±2.33; post-training: 10.47±2.31; p<0.001). In the simulation group, knowledge scores increased from 7.65±2.01 to 9.05±2.46, while in the control group, scores increased from 10.40±1.80 to 11.60±1.41 (p=0.007). Post-training comparisons showed that the simulation group demonstrated higher mean scores in knowledge (36.70±3.73 vs 34.44±4.77) and clinical skills (11.35±1.69 vs 10.92±1.75) than the control group; however, these differences were not statistically significant (p>0.05). Professional attitude scores were significantly higher in the simulation group compared with the control group (43.35±3.60 vs 40.64±4.51, p=0.034). Conclusion Simulation-based training demonstrated positive effects on students’ knowledge and clinical skills and significantly improved professional attitudes. Integrating simulation-based training with traditional teaching methods may serve as an effective educational strategy to enhance the quality of clinical education.

Background: Pulmonary alveolar proteinosis (PAP) is a rare lung disorder characterized by the accumulation of surfactant within the alveoli, leading to impaired gas exchange and respiratory insufficiency. Although the disease is uncommon, it significantly affects patients’ quality of life and requires specific diagnostic and therapeutic approaches. Whole lung lavage (WLL) is considered the standard treatment; however, it has not been widely implemented in Mongolia. We report the first successful case of WLL performed for PAP in Mongolia. Case Presentation: A 56-year-old male presented with dyspnea. Chest computed tomography demonstrated a bilateral “crazy paving” pattern. Bronchoalveolar lavage fluid was positive for periodic acid–Schiff (PAS) staining, and anti–GM-CSF antibodies were detected, confirming the diagnosis of PAP. WLL was performed under general anesthesia using a double-lumen endotracheal tube with bronchoscopic guidance. One lung was ventilated with 100% oxygen while the contralateral lung was sequentially lavaged with 800–1000 mL of warm (37°C) saline per cycle until the effluent became clear. A total of approximately 20 liters of saline was used. Result: The procedure was completed successfully without complications. Following treatment, the patient showed marked clinical improvement with reduced dyspnea and increased exercise tolerance. Oxygen saturation improved from 88% to 93%, and spirometric parameters (FVC, FEV₁) demonstrated improvement. Chest imaging revealed a reduction in pulmonary opacities. Conclusion This case demonstrates the successful implementation of whole lung lavage (WLL) in Mongolia and highlights its importance in improving the diagnostic and therapeutic capacity for rare pulmonary diseases such as pulmonary alveolar proteinosis. The procedure resulted in significant improvement in clinical, functional, and radiological parameters, consistent with findings from international studies. Early diagnosis of PAP and the adoption of standardized protocols in accordance with international guidelines are essential to optimize treatment outcomes and enhance patients’ quality of life.

Backround: Urolithiasis has been increasing in Mongolia recent years. The prevalence of urolithiasis is different in the countries of the world, and it was 7.54% in China, 8.8% in North America, and 5-10% in Europe as of 2011. In recent years, the prevalence of stones in western European countries is 5-14%, in Canada 12%, in Britain 7-15%. It is a common disease in most parts of the world, but it is rare in countries such as Greenland and Japan. When studying the recurrence of kidney stones, 10-23% after 1 year, 50% after 5-10 years, and 75% after 20 years were studied. In our country, there is an urgent need to study the prevalence and risk factors related to the increasing incidence of urolithiasis. Materials and Methods: We analyzed 35819 cases of urolithiasis diagnosed between 2011 and 2022, and the incidence per 10000 population. In 2020 years, 3625 cases of urolithiasis were reported, and 371 people were included in the study, assuming that a minimum of 360 healthy participants were needed to estimate at a 95% confidence level, an estimated 1% diagnosis. Also, 456 cases with stones were included in the study and statistical processing was done using SPSS 21 software. Results: The average age of the participants was 46.3 ± 17.6, and 19,356 (54.04%) were female. Since 2011, the total incidence of kidney stones has been distributed as a quadratic function and has been increasing annually. In Mongolia, the incidence rate of urolithiasis increased from 4.6 per 10000 population in 2011 to 17.96 in 2022 a 3.9-fold increase from 10 years ago. However, the new cases per 10000 population tripled from 3.72 in 2011 to 11.36 in 2022. Considering future prospects, it will increase to 19.4 per 10,000 population in 2023, 21.7 in 2024, 24.3 in 2025, 27.1 in 2026, and 30 in 2027. Compared to 2017, 10 years ago, it will increase by 3.6 times by 2027(Yt=6.145-1.735 х t+0.18 x t2). According to the correlation of risk factors for stone formation, people living in urban areas (mOR 14.5) have a higher risk of stone formation than people living in rural areas (mOR 1.21) (p 0.0001). When examining stone structure, 64.6% of all cases studied had calcium oxalate stones. Conclusion The incidence of urolithiasis is increasing every year and will continue to increase. People living in cities have a higher risk factor for stone formation.

Emergency cesarean section risk factors of Robson 1, 2A, 3, 4A Introduction: Cesarean section rates in Mongolia exceed WHO recommendations of 5–15%, reaching 27.6% nationally and 34.1% at the First Maternity Hospital between 2019–2023. C-sections, while life-saving, increase risks of hemorrhage, infection, uterine complications, and reduced maternal quality of life. This study aimed to analyze emergency C-sections by Robson classification and identify associated risk factors in groups 1, 2a, 3, and 4a. Material and methods: A retrospective case-control study was conducted using 886 medical records (443 emergency C-sections and 443 vaginal deliveries) from 2021–2023. Data were analyzed with IBM SPSS 24.0, and binary logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Results: Robson 2a was the most frequent category (43.8%), followed by 4a (25.7%), 1 (20.1%), and 3 (10.4%). Significant risk factors for emergency C-section included maternal age (p<0.001), early cervical dilation (<5 cm) at labor diagnosis (OR 3.54), abnormal CTG, pre-eclampsia, PROM, amniotomy, infertility, and malposition. Multivariate analysis showed PROM (aOR 14.66), amniotomy (aOR 6.85), fetal weight ≥4000 g (aOR 4.07), and maternal age (aOR 1.48) as key predictors. Conclusions: Emergency C-sections were most common in Robson group 2a. Major contributing factors included PROM, amniotomy, maternal age, macrosomia, and abnormal labor patterns. Targeted interventions to manage these risk factors could reduce unnecessary emergency C-sections.

However, the use of robots in medicine has only 30 years of history. The application of robots in surgery originates from the need of modern man to achieve two goals: the telepresence and the performance of repetitive and accurate tasks. The first ‘‘robot surgeon’’ used on a human patient was the PUMA 200 in 1985. In the 1990s, scientists developed the concept of ‘‘master–slave’’ robot, which consisted of a robot with remote manipulators controlled by a surgeon at a surgical workstation. Despite the lack of force and tactile feedback, technical advantages of robotic surgery, such as 3D vision, stable and magnified image, Endo Wrist instruments, physiologic tremor filtering, and motion scaling, have been considered fundamental to overcome many of the limitations of the laparoscopic surgery. Since the approval of the da Vinci robot by international agencies, American, European, and Asian surgeons have proved its factibility and safety for the performance of many different robot-assisted surgeries.
Comparative studies of robotic and laparoscopic surgical procedures in general surgery have shown similar results with regard to perioperative, oncological, and functional outcomes. However, higher costs and lack of haptic feedback represent the major limitations of current robotic technology to become the standard technique of minimally invasive surgery worldwide. Therefore, the future of robotic surgery involves cost reduction, development of new platforms and technologies, creation and validation of curriculum and virtual simulators, and conduction of randomized clinical trials to determine the best applications of robotics.

Background: An aim of this study was to evaluate the long-term functional outcomes of laparoscopic ureteropyeloplasty compared to that of open surgery at the Urology and Andrology Center of the First Central Hospital of Mongolia. Ureteropelvic junction (UPJ) is the most common site for upper urinary tract obstruction occurring 1 in 750 - 1500 births. Laparoscopic pyeloplasty was first reported in 1993 by Schuessler WW and its technique was dismembered pyeloplasty. Material and Methods: In the period from June 2018 to September 2019, we have operated 91 ureteropyeloplasty cases. Patients were randomized into Group I (45 laparoscopy) operated by the laparoscopic ureteropyeloplasty and Group II (46 open surgery) operated by the open ureteropyeloplasty. All the patients had ureteropelvic junction obstruction and ureteropyeloplasty was performed. Both groups were compared according to the operative time, and recovery duration. We studied restoration of renal function and causes of conditions. Demographic data including age, gender and complications were recorded. Renal diethylenetriamine penta-acetate scintigraphy was respectively performed 6 months after surgery. Results: Mean age was 32±12.05 ranging 16-62 in all the study population. A total of 91 (55 men and 36 women) were participated. Ureteropelvic junction stricture was occurred 75.66% in laparoscopic cases and 84.78% in open cases which leads to hydronephrosis and it was statistically different (p<0.028). Compared to that of open surgery, wound size was 6 time smaller, blood loss and hospital stay less than 2 fold and wound healing is 5 days shorter than open surgery. There was statistical different (p<0.001) between parameters of 2 groups. In laparoscopic and open group respectively, renal function was 41.78±10.02ml/min, 42.15±11.34 ml/min (1.73м2). After intervention, renal function was increased by (46±10.17ml/min, 46.09±11.50ml/min) and there was difference between 2 groups (p<0.003). In laparoscopic group, renal function was more improved than open group (p=0.05). Conclusion Laparoscopic surgery had less blood, less analgesics usage, fewer hospital stays, and faster wound healing. Renal function was improved 6 months after surgery.

Purpose: Follow-up examinations in kidney donors is an essential yet necessary process in organ transplantation. In this study, we aimed to evaluate kidney function using biomarkers and biomarker based eGFR in kidney donors within 5 years of organ transplantation. Materials and method: 91 donors enrolled in our study. We measured body weight and blood and urine samples for laboratory tests. eGFR was calculated using 6 estimations. Result: The mean serum creatinine in participants was 0.81±0.22 mg/dL, cystatin C was 1.11±0.19 mg/dL, urea was 31.44±8.02 mg/L. Systolic hypertension in subjects was 130.0±16.5 mmHg while diastolic hypertension was 78.4±10.8 mmHg. In all donors, 15.9% (n=14) had hematuria, 23.6% (n=21) had proteinuria, 24.7% (n=19) had albuminuria. Body weight, creatinine, cystatin C and urea measurements had gradually increased over the years. The average eGFR was 72.9±17.9 to 112.8±34.0 ml/min/1.73m² showing 0.15%-35.22% before donation. Follow – up rate was 28.3-59.2% of total donors.Having health insurance and living far from Ulaanbaatar city influenced follow – up rate. Donor registration data should be updated regularly. Conclusion
1. Serum creatinine, cystatin C, urea was increasing in living kidney donors. Hypertension and microalbuminuria was greater than other donor study results.
2. eGFR decreased 0.15-35.22% in donor. CKD EPI combined equation was best for donor.
3. Health insurance and living far from Ulaanbaatar city were the influencing follow – up rate. Registration data is missing in 25.5%-82.4% of total donors suggesting enhancement in data collection.

Background: However kidney transplantation has being performed in Mongolia since 2006, because of pre-transplant sensitization, ABO incompatibility, hepatitis B and C virus activation many patients are taken kidney transplantation in abroad. The transplantation centers use own immunosuppressive regimens. Objective: Our aim was to assess the immunosuppressive regimens efficacy and toxicity in kidney transplant Mongolian recipients. Methods: We analyzed data from 96 adult kidney transplant recipients who had taken kidney transplantation in different transplant centers from August 2006 through January 2014. There were 3 kinds of regimens Group I Simulect induction with standard triple /FK506/CyA+MMF/AZA+steroid/, Group II Campath-1H induction with CNI monotherapy and Group III Campath-1H induction with standard triple /FK506/CyA+MMF/AZA+steroid/. We retrospectively collected the post-transplant first two years serum creatinine. The study was performed in 2014. The questionnaire was taken and blood samples collected for determination of tacrolimus through level and for other laboratory tests. The primary end point was the first two years serum creatinine, the secondary end points included rejection episodes, blood through level of tacrolimus and some laboratory findings. Results: The post-transplant first two years serum creatinine levels were significantly different in 3 groups. Group III showed similar results compared to Group I. There was not enough data of biopsy proven acute rejection episodes however group II said more rejections occurred. However participants said that rejection occurred in 15 (15.6%) biopsy was done only 3 (3.1%) cases. Blood through level of tacrolimus was significantly different in three groups. Some laboratory findings showed different between three groups. Conclusions A regimen of Campath-1H induction with CNI monotherapy (Group II) may be advantageous for short-term renal function and cost effective but there were more rejection complications and increased creatinine. The regimen of Campath-1H induction 11 with standard triple (Group III) may be advantageous for long-term renal function, allograft survival, but there should consider about infection complications and polycythemia. Simulect induction with standard triple could be best choice but transplantations were performed in experienced centers. The study enrolled few cases and cases which were performed at the beginning of transplant program so many things could influence on the result. The study was compared beginner transplant center with experienced centers. Longitudinal cohort study needed in the future.

There are many treatment options for the management of ureteropelvic junction obstruction (UPJO). Open pyeloplasty has a high success rate and has been considered as a gold standard. Minimally invasive surgical techniques are associated with reduced morbidity, improved cosmetic result and better convalescence than open pyeloplasty. For endopyelotomy, these advantages for minimally invasive surgery such as laparoscopic pyeloplasty and robot assisted pyeloplasty have superior success rate than open pyeloplasty. However, the success rate for laparoscopic surgery could potentially be improved by careful selection of patients, using the criteria of stricture <2 cm, renal function >25% and the absence of severe hydronephrosis. Laparoscopic pyeloplasty and robot-assisted pyeloplasty have similar success rates to open pyeloplasty (>90%) and the best outcomes have been reported for robot-assisted pyeloplasty although this treatment option is less readily available than laparoscopic pyeloplasty. Retrograde endopyelotomy is a simple, safe, and effective therapeutic option for primary and secondary symptomatic UPJO.
Retrograde endopyelotomy should be considered a viable first-line treatment option for the management of patients with UPJO. These include balloon dilation, antegrade endopyelotomy, retrograde endopyelotomy, Acucise endopyelotomy and laparoscopic pyeloplasty. During last decade, advances in endourological techniques have resulted in significant progress in the development of minimally invasive surgical procedures to treat UPJO.
Surgeons described their modification of Kusters dismembered procedure that involved anastomosis of the spatulated ureter to a projection of the lower aspect of the pelvis after a redundant portion was excised. Laparoscopic pyeloplasty was first reported in 1993 both by Schuessler and others and by Kavoussi and Peters, who utilized dismembered pyeloplasty technique. During last decade, advances in endourological techniques have resulted in significant progress in the development of minimally invasive surgical procedures to treat UPJO. The combination of less postoperative morbidity, improved cosmesis, shorter convalescence and comparable operative success rates has lured many patients away from gold standard of open pyeloplasty. Only few retrospective studies have been conducted regarding laparoscopic versus open pyeloplasty. Success rates are comparable for laparoscopic pyeloplasty.
The number of minimally invasive surgeries performed by us increased from year to year. Therefore the characteristics and performance of the surgeries should be studied in detail and based on the finding the evidence based medicine should be placed in.

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.