Background: Lumbar disc herniation (LDH) is one of the leading causes of lower back pain and disability, significantly impacting public health and socio-economic well-being. International studies have shown that paraspinal muscle size and structure correlate with age, body mass index (BMI), and spinal disorders. However, comprehensive MRI-based research investigating the correlation between LDH and specific morphometric parameters in Mongolia remains limited. Aim: To evaluate lumbar disc herniation using magnetic resonance imaging (MRI) and compare paraspinal muscle volume and subcutaneous fat thickness. Materials and Methods: An observational retrospective study design was conducted between June 2024 and June 2025 at Asraltmed and Orgil hospitals, enrolling 300 cases selected from 2,840 lumbar spine MRI scans based on inclusion and exclusion criteria. Demographic data (age, sex, BMI) were collected alongside MRI metrics. LDH type, size, location, and severity were evaluated using axial, sagittal, and coronal views across T1WI, T2WI, and STIR/T2FS sequences. Paraspinal muscle cross-sectional area (Multifidus, Erector spinae, Psoas) was measured on axial T1WI and T2WI sequences, while subcutaneous fat thickness was measured on sagittal T2WI sequences. LDH parameters were evaluated in relation to paraspinal muscle measurements, subcutaneous fat thickness, and BMI. Disc degeneration was classified using the Pfirrmann grading system, and statistical analysis was performed using IBM SPSS 25.0. Result: The mean age of participants was 45.6±12.3 years. Higher BMI (r=0.41) and increased subcutaneous fat thickness (r=0.46) showed a significant positive correlation with LDH severity (p<0.001). Conversely, paraspinal muscle cross-sectional area (CSA) was negatively correlated with LDH severity (r=0.49, p<0.001). Multivariate regression analysis revealed that age, sex, BMI, subcutaneous fat thickness, and paraspinal muscle CSA were statistically significantly associated with LDH (p<0.01). Subgroup analysis by sex demonstrated similar correlations between paraspinal muscle size, subcutaneous fat thickness, and LDH severity in both male and female groups. Conclusion Lumbar disc herniation severity is associated with increased BMI and subcutaneous fat thickness, as well as decreased paraspinal muscle mass. Normalized muscle parameters reduce sex-related discrepancies and establish an effective MRI-based risk assessment approach.

Background: Respiratory and gastrointestinal infectious diseases are the leading causes of morbidity in children. Numerous international studies have demonstrated that handwashing with soap is one of the most effective and cost-efficient methods for preventing these diseases in children. A previous study conducted in Ulaanbaatar found that only 50.1% of general education school students practiced proper handwashing, which is considered insufficient even in areas with relatively adequate facilities. In Mongolia, 56.1% of the 865 schools lack handwashing facilities and soap, and 25% do not meet the WASH standards. Although knowledge about handwashing increased during the COVID-19 pandemic, sustained behavioral change remained limited, highlighting a gap between knowledge and practice and indicating the need for targeted educational interventions. Furthermore, there is limited research comparing the effectiveness of such interventions across different school environments and urban–rural settings, which provides the rationale for this study. Aim: To evaluate the effectiveness of a handwashing educational intervention among primary school students and determine differences in knowledge change across four schools in urban and rural areas. Materials and Methods: A quasi-experimental study design was used from December 2024 to June 2025. A total of 1,353 students from grades 3–5 in four general education schools (two in Ulaanbaatar and two in rural areas) were included in the study. Preand post-intervention handwashing knowledge scores were analyzed using paired t-tests and one-way ANOVA (α=0.05) with STATA 14.0. Ethical approval was obtained from the Ethics Committee of the Mongolian National University of Medical Sciences. Result: The mean handwashing knowledge score increased significantly from 9.68 (±2.64) before the intervention to 10.30 (±2.74) after the intervention, with a mean difference of +0.63 (p<0.001). The differences in improvement between schools were also statistically significant (ANOVA: F(3,1335)=5.90, p=0.0005). The highest improvement was observed in urban School A (+1.49), while the lowest was observed in School B (+0.16). Rural schools C and D showed moderate and relatively consistent improvements (+0.51 and +0.70, respectively). Conclusion School-based handwashing educational interventions effectively improve knowledge among primary school students. However, environmental factors, such as infrastructure and geographic location, significantly influence the effectiveness of the intervention. Therefore, educational interventions should be implemented alongside infrastructure improvements.

Background: Transitioning HIV care toward a client-centered model is a key strategy for improving treatment outcomes and controlling the spread of HIV infection. Evaluating service accessibility, quality, and client satisfaction is essential for improving strategic planning and strengthening health service delivery. Aim: To assess the accessibility and quality of client-centered health services among people living with HIV. Materials and methods: A facility-based cross-sectional study was conducted. Data were collected using structured questionnaires from 50 clients and 30 health managers who participated voluntarily. The reliability of the questionnaire, measured using Cronbach’s alpha, ranged from 0.673 to 0.783. Data were analyzed using SPSS version 23.0 with both descriptive and analytical statistical methods. Quantitative variables were summarized using means and standard deviations, and statistical significance was determined at p < 0.05. Results: HIV-related services were found to be highly centralized at the NCCD, particularly for blood testing (96.8%) and inpatient care (71.4%). Overall, 84% of clients reported the need to access services outside NCCD, with the highest demand for internal medicine (32%), dental services (14%), and surgical services (14%). Among the barriers to accessing care, 75% were related to stigma and discrimination associated with HIV status, while 18% were linked to healthcare workers’ attitudes. In addition, 56.7% of healthcare facilities had not conducted HIV-related training, and only 40% had dedicated rooms ensuring confidentiality. Client satisfaction was strongly correlated with healthcare providers’ attitudes and communication (R = 0.614) and confidentiality (R = 0.578), both showing significant associations (p = 0.000). Conclusion HIV services remain highly centralized at NCCD, while the readiness of primary and referral healthcare facilities remains insufficient. Strengthening a client-centered care approach requires improving healthcare workers’ attitudes and communication, ensuring confidentiality, and implementing continuous HIV-related training for healthcare providers.

Background: Rosai–Dorfman disease (RDD) is a rare, benign disorder of non-Langerhans cell histiocytic origin with an unknown etiology, which can affect the skin and other organ systems. The incidence in the United States is approximately 1:200,000. In Mongolia, four cases have been registered over the past five years under the ICD-10 code D76.0. Case presentation: A 59-year-old female patient initially presented to the Dermatology Department of the National Center for Dermatology with clustered, elevated lesions on the medial aspect of the right thigh, including papules, plaques, and nodules of round to oval shape. Additionally, multiple erythematous macules and papules were observed on both lower legs. For diagnostic purposes, a histopathological examination was performed, revealing histiocytes with abundant cytoplasm and lymphocytes within the cytoplasm (emperipolesis). The diagnosis was confirmed based on dermoscopic and immunohistochemical findings. Management: The patient was referred to the Mongolian-Japanese Hospital of MNUMS, where the remaining nodular lesions were surgically excised in the surgical department. Further follow-up was referred to a hematologist. Computed tomography (CT) imaging was recommended. Cutaneous-limited RDD may resolve spontaneously in some cases; however, when multiple organ systems are involved or when associated forms are present, referral to hematology and oncology specialists for systemic therapy is required. Conclusion It is important to differentiate this disease from other dermatological conditions presented with macules, papules, and nodules through clinical evaluation, histopathology, immunohistochemistry, and dermoscopic examination.

Background: Infertility is defined as the inability of couples to conceive despite engaging in regular, unprotected sexual intercourse for over a year. Assisted reproductive technology (ART), particularly in vitro fertilization (IVF), has emerged as the most widely utilized solution for infertility. The cause of infertility, a woman’s ovarian reserve, response, egg and sperm quality, the number and quality of embryos, and various other factors influence the outcome of IVF. Despite significant advancements in ART, predicting IVF outcomes remains challenging, especially when tailoring treatment strategies to individual patient factors. Objective: To investigate the clinical indicators, ovarian reserve markers, and stimulation outcomes influencing the success of IVF treatment in Mongolian women. Material and Method: A prospective study was conducted at the Unimed International Hospital IVF Center between October 2023 and August 2024. Clinical and demographic factors, ovarian reserve markers (FSH, AMH, AFC), and ovarian stimulation outcomes were analyzed in 242 women aged 25 44 years undergoing IVF. Logistic regression analysis was performed to identify risk factors and predictors of clinical pregnancy, with a statistical significance threshold set at p<0.05. Results: Among 208 women who underwent embryo transfer, the clinical pregnancy rate was 36.5%, and biochemical pregnancy was observed in 38.4%. Age was a significant predictor, with older age groups (35-39 years: OR=7.11, p=0.004; 40-44 years: OR=12.65, p=0.004) associated with reduced IVF success. Ovarian reserve markers, including AMH (OR=8.92, p<0.001) and AFC (OR=2.78, p<0.001), were significantly correlated with pregnancy outcomes, whereas FSH was not significant (p=0.518). Higher numbers of pre-ovulatory follicles (POF) (OR=1.03, p=0.040) and high-grade embryos (OR=1.26, p=0.045) increased the likelihood of clinical pregnancy. No significant associations were observed between total gonadotrophin dosage, ovarian sensitivity index, and fertilization rate with pregnancy outcomes. Conclusion Age and ovarian reserve markers (AMH, AFC) are critical predictors of IVF success, while pre ovulatory follicle counts and number of high-grade embryos significantly enhance pregnancy likelihood. These findings emphasize the importance of personalized ART protocols tailored to ovarian reserve and age-related factors to optimize IVF outcomes.

Background: In the treatment of plaque-induced gingivitis, in addition to mechanical plaque control, the use of chemical plaque control such as mouth rinses for a certain period has shown a positive effect on treatment outcomes and prognosis. Aim: To evaluate the efficacy of a probiotic mouthwash in the treatment of plaque-induced gingivitis. Materials and Methods: A randomized controlled clinical trial was designed for a period of 2 weeks on 45 systemically healthy subjects between 20 and 25 years having plaque-induced gingivitis. The study population was divided into three groups. Group 1-15 subjects were advised experimental (probiotic) mouthwash. Group 2-15 subjects were advised positive control (chlorhexidine) mouthwash and Group 3-15 subjects into a negative control group. Oral prophylaxis was done for all groups at baseline. After the proper oral hygiene instructions, groups 1 and 2 were instructed to rinse their mouth with 15 ml of their respective mouthwashes, for 1 min twice daily, 30 min after brushing. Clinical parameters such as Full mouth plaque score (FMPS), Full mouth bleeding score (FMBS) were assessed at baseline, 2 weeks respectively. Results: At baseline, there was no statistically significant difference between the groups in terms of FMBS and FMPS mean values (p=0.174, p=0.887). At day 14, the FMPS, FMBS mean values were significantly reduced by all treatment modalities ranking probiotic and chlorhexidine is greater than negative control group (p<0.001, p<0.001). Conclusion The probiotic mouthwash was effectively used as an adjunct to mechanical plaque control in the treatment of plaque-induced gingivitis.

Background: Infertility is defined as the inability of couples to conceive despite engaging in regular, unprotected sexual intercourse for over a year. Assisted reproductive technology (ART), particularly in vitro fertilization (IVF), has emerged as the most widely utilized solution for infertility. The cause of infertility, a woman's ovarian reserve, response, egg and sperm quality, the number and quality of embryos, and various other factors influence the outcome of IVF. Despite significant advancements in ART, predicting IVF outcomes remains challenging, especially when tailoring treatment strategies to individual patient factors. Aim: To investigate the clinical indicators, ovarian reserve markers, and stimulation outcomes influencing the success of IVF treatment in Mongolian women. Materials and Methods: A prospective study was conducted at the Unimed International Hospital IVF Center between October 2023 and August 2024. Clinical and demographic factors, ovarian reserve markers (FSH, AMH, AFC), and ovarian stimulation outcomes were analyzed in 242 women aged 25-44 years undergoing IVF. Logistic regression analysis was performed to identify risk factors and predictors of clinical pregnancy, with a statistical significance threshold set at p<0.05. Results: Among 208 women who underwent embryo transfer, the clinical pregnancy rate was 36.5%, and biochemical pregnancy was observed in 38.4%. Age was a significant predictor, with older age groups (35-39 years: OR=7.11, p=0.004; 40-44 years: OR=12.65, p=0.004) associated with reduced IVF success. Ovarian reserve markers, including AMH (OR=2.49, p<0.001) and AFC (OR=1.56, p<0.001), were significantly correlated with pregnancy outcomes, whereas FSH was not significant (p=0.518). Higher numbers of pre-ovulatory follicles (POF) (OR=1.03, p=0.040) and high-grade embryos (OR=1.26, p=0.045) increased the likelihood of clinical pregnancy. No significant associations were observed between total gonadotrophin dosage, ovarian sensitivity index, and fertilization rate with pregnancy outcomes. Conclusion Age and ovarian reserve markers (AMH, AFC) are critical predictors of IVF success, while pre-ovulatory follicle counts and number of high-grade embryos significantly enhance pregnancy likelihood. These findings emphasize the importance of personalized ART protocols tailored to ovarian reserve and age-related factors to optimize IVF outcomes.

Background: A rare angioproliferative condition of the larynx, Kaposhi sarcoma typically affects the skin. Immunosuppressive treatment following organ transplantation and human immunodeficiency virus infection are the causes. Every type of Kaposi sarcoma has human herpesvirus-8. Laryngeal kaposi sarcoma is uncommon in immunocompromised patients; since its initial identification in 1965, 18 cases have been documented globally. A CO2 laser-assisted laryngeal microsurgery is performed through the mouth cavity to remove tumor when kaposi sarcoma of the larynx obstructs the airway. Case report: A 77-year-old woman complained of hoarseness, dry mouth, odynophagia, and dysphagia three months prior when she arrived at the Mongolian-Japan Hospital. Two years ago, she acquired hard, sensitive lumps that were palpable on her right arm, left ankle, and right thigh. At that time, she was diagnosed with Kaposiform hemangiodermatitis and treated at the National Center for Dermatology. HIV test results were negative. Immunohistochemistry: CD31 +/-, CD34 /+/. Using flexible nasopharyngeal endoscopy to get the diagnosis: There was a mass that was about 1.5–2–5 cm in diameter, bluish in color, smooth and movable, and spongy and vascular on the larynx, on the nasopharynx, behind the palatine tonsills, and supraglottic. Surgery: Through the use of Kleinsasser laryngoscopy and a 0-degree endoscope, pathological tissues were extracted under general anesthesia using a laryngeal microsurgical instrument and a laparoscopic bipolar coagulator. The tissues were then sent for histological evaluation, which revealed Kaposi sarcoma, sarcoma grade 1. Results of treatment Pain decreased and quality of life increased following surgery. Upon nasopharyngeal endoscopy, the vocal cord mobility was normal and the surgical incision was clean. Conclusion: Kaposi sarcoma is an extremely uncommon illness. A lower quality of life and further issues can be avoided with an early diagnosis and suitable therapy. It also needs to be continuously monitored because it is a potentially repeatable disease.

Background: Nicotine-containing vaporized liquids—composed of propylene glycol, glycerin, water, flavorings, and the thickening agent vitamin E acetate—have been implicated in the development of EVALI. Under conditions of low liquid levels and overheating, these substances release toxic carbonyl compounds (e.g., formaldehyde, acetaldehyde, acrolein). In a 2019 national survey, 3.5% of adolescents aged 13–15 reported cigarette use, and 10% used e-cigarettes. Aim: To study the changes in the behavior, lung, and hippocampal structures of rats due to the effects of electronic cigarettes and their vapor. Materials and Methods: In this study, nineteen 14-day-old SHR rats were exposed to 1 g/mg/day of nicotine and dry hit vapor (control, nicotine and dry hit groups) for four weeks. Behavioral assessments (Open Field Test, Elevated Plus Maze, Conditioned Place Preference), bronchoalveolar lavage (BAL), and histological analysis of lung and hippocampal tissue were conducted. Results: The dry hit vapor group showed significantly reduced body weight (p=0.034), increased anxiety (p=0.006, p=0.025), and avoidance of the smoky chamber. BAL revealed elevated total cells, neutrophils, and macrophages (p=0.01, p=0.04) in both nicotine and dry hit groups. Lung tissue exhibited alveolar septal thickening, inflammation, and emphysema- like changes. Extensive neuronal death was observed in the hippocampus. Conclusion Anxiety-like behavior was observed in both the burn and control groups. Analysis of BAL in the dry hit group revealed inflammation predominantly characterized by macrophage infiltration. Histological examination of lung tissue from both experimental groups demonstrated a reduction in the number of alveoli, accompanied by acute inflammation and thickening of the interalveolar septa. In the hippocampal region, neuronal loss and a reduction in neuronal density were also observed.

Background: Otitis media is an inflammatory disease involving the mucous membrane of the middle ear, including the auditory tube, tympanic cavity, mastoid antrum, and air cells¹. Multiple factors contribute to the development of OM, one of which is adenoid hypertrophy5. However, to date, no study has been conducted in Mongolia to assess the relationship between the degree of adenoid hypertrophy and OM. Aim: To analyze cases of children who underwent adenotonsillectomy. Materials and Methods: The study was conducted using a cross-sectional observational research design. Clinical data from a total of n=215 cases of children who were diagnosed with adenoid and palatine tonsil hypertrophy and underwent surgical treatment at Gurvan Gal Hospital between October 2023 and October 2024 were analyzed. Statistical processing was performed using STATA 14.2, with statistical significance considered at p < 0.05. Results: Clinical data from 215 children were analyzed to evaluate the relationship between the degree of adenoid hypertrophy (AH) and otitis media. The children ranged in age from 2 to 17 years, with a mean age of 7.23 ± 3.4 years. Among them, 128 (59.53%) were male (7.09 ± 3.29 years) and 87 (40.46%) were female (7.45 ± 3.58 years). A statistically significant moderate negative correlation was found between age group and the degree of adenoid hypertrophy (rho = -0.3485, p < 0.001). A significant seasonal variation in otitis media was observed (p = 0.0001). A statistically significant correlation was found between the degree of adenoid hypertrophy and otitis media (p < 0.001). However, no significant correlation was observed between the degree of palatine tonsil hypertrophy and otitis media (p = 0.8762). Conclusion The incidence of adenoid hypertrophy is highest among children aged 6 to 9 years, and there is a moderate negative correlation between age and the degree of adenoid hypertrophy. The occurrence of otitis media varies by season, with the highest number of cases reported during the winter months. As the grade of adenoid hypertrophy increases, the number of otitis media cases also rises.