Background: Herpes zoster (shingles) is an acute inflammatory skin disease caused by the reactivation of the Varicel la-zoster virus. International studies show that the disease severely reduces patients’ quality of life, and chronic pain negatively affects daily activities. In clinical practice, bloodletting pricking therapy has been effectively used for herpes zoster, with positive effects including reducing disease symptoms, alleviating skin inflammation, and promoting skin regeneration. Due to the limited research on treating herpes zoster with combined bloodletting pricking therapy and acupuncture, this clinical study was conducted. Aim: To evaluate the effectiveness of combining bloodletting pricking therapy with acupuncture in patients diagnosed with herpes zoster. Materials and Methods: The study was conducted using a non-randomized clinical trial design based at the Internation al School of Mongolian Medicine of MNUMS and the Inner Mongolia International Mongolian Medicine Committee (IMIMC). The study included 70 patients diagnosed with herpes zoster (ICD 10-B02.9) who met the inclusion criteria. The treatment group received bloodletting pricking therapy combined with acupuncture. The control group received Acyclovir 800 mg 5 times daily for 7-10 days and Pregabalin 75 mg twice daily for 14 days. Treatment effectiveness was evaluated using the VAS linear scale for pain assessment, the SF-12 (Short Form-12 health survey) questionnaire for quality of life, and the Athens Insomnia Scale (AIS) to measure sleep quality and evaluate insomnia. The treatment outcome was assessed according to the Mongolian Traditional Medicine Diagnostic and Treatment Standards. Results: The average age of participants was 47.29±11.11 in the treatment group and 44.43±11.63 in the control group, with 34% male and 66% female participants. According to the VAS linear scale, the treatment group showed a statistically significant greater reduction in pain (P<0.001). The quality-of-life assessment using the SF-12 questionnaire showed that the Physical Component Summary (SF-12-PCS) in the treatment group increased from 32.71±7.38 before treatment to 52.99±2.02 after treatment (t=-17.18, p<0.001), while in the control group, it increased from 36.10±7.41 to 51.56±7.9 (SF-12-3.9) (p<0.001). According to the AIS questionnaire, the sleep quality in the treatment group was significantly better than in the control group (P<0.05). According to the Mongolian Traditional Medicine Diagnostic and Treatment Standards, the combined treatment of pricking therapy and acupuncture resulted in a 100% recovery rate. Conclusion 1. The combination of bloodletting pricking therapy and acupuncture in treating herpes zoster effectively reduces pain. 2. For patients diagnosed with herpes zoster, combining bloodletting pricking therapy with acupuncture effectively improves quality of life in terms of sleep quality as well as physical and mental functioning.

Background: Cardiovascular diseases (CVDs) is a third leading cause of non-communicable diseases and a leading cause of mortality in Mongolia. Among these, acute myocardial infarction (AMI), a complication of coronary artery disease (CAD), is a leading cause of cardiovascular mortality. In patients with AMI, both epicardial artery blood flow, observed through coronary angiography, and coronary microcirculatory dysfunction (CMD) play critical roles in the disease’s pathophysiology. Recent advancements have introduced artificial intelligence (AI)-based softwares which are capable of analyzing coronary blood flow from coronary angiography images. The AI based softwares can assess not only epicardial blood flow but also CMD in recent studies. In this review, we discussed the role of CMD in pathophysiology of AMI, diagnostic approaches, the application of AI-based technologies, their clinical significance, and future directions. Aim: This review aims to explore the pathophysiological relationship of coronary microcirculatory dysfunction (CMD) in the context of acute myocardial infarction (AMI), diagnostic methodologies, the application of artificial intelligence (AI)-based technologies, and their clinical significance. Hypotheses: 1. AI-based software allows for highly accurate assessment of coronary microcirculation during AMI. 2. CMD during AMI is associated with structural and functional changes in the heart. 3. CMD during AMI is related to disease prognosis and patient outcomes. Methodology:: This narrative review was compiled using a systematic and logical approach, based on publicly available recent clinical and biomedical research literature addressing the above hypotheses. Conclusion In recent years, AI-based image processing software has been developed to analyze angiographic images obtained during percutaneous coronary intervention (PCI) and treatment procedures. These tools show significant promise for early detection and improved diagnosis of CMD during AMI, as well as for better assessment of short- and long-term patient risk.

Background: Asthma is a chronic inflammatory disease characterized by bronchoconstriction and breathing difficulties, which can be triggered by both allergic and non-allergic mechanisms. In allergic asthma, a hyperreactivity reaction occurs, leading to an increase in fractional exhaled nitric oxide (FeNO) levels. Therefore, FeNO is used to differentiate allergic and non-allergic types of asthma. In recent years, studies have been conducted to assess FeNO as an indicator of treatment effectiveness and symptom control. Our goal is to introduce FeNO measurement in Mongolia for the first time and utilize it for asthma diagnosis and treatment outcome evaluation. Aim: Study of FeNO levels in Asthma Diagnosis in Relation to Laboratory Findings and Lung Function Materials and Methods: This study included a total of 70 adult patients (18 years and older) with asthma who visited the Outpatient Clinic of Mongolia-Japan Hospital and Shargaljuut Spa Clinic from May to December 2024. Based on their allergic history, total IgE levels, and peripheral blood eosinophil count, participants were classified into allergic (>5%) and non-allergic (<5%) asthma. The study aimed to determine the diagnostic specificity and sensitivity of FeNO levels. Asthma control levels were assessed using the Asthma Control Test (ACT), lung function was evaluated using spirometry, and exercise capacity was measured with the 6-minute walk test. Results: In a single measurement, there were no differences between the allergic and non-allergic groups in parameters other than total IgE, peripheral blood eosinophil count, and FeNO levels. For diagnosing the allergic form of asthma, at a FeNO level of 25 ppb, sensitivity (Se) was 0.68, specificity (Sp) was 0.30 (p=0.008); at 40 ppb, Se was 0.77, Sp was 0.31 (p=0.001); and at 50 ppb, Se was 0.74, Sp was 0.33 (p=0.001). Lung function and exercise capacity were similar in both asthma groups. Conclusion The sensitivity of FeNO in distinguishing between allergic and non-allergic forms of asthma is 67-81%, and its sensitivity tends to increase as the FeNO level rises. By distinguishing the allergic type in which inhaled corticosteroids are more effective, the outcome of asthma treatment can be predicted in advance based on the FeNO level.

Background: Asthma management should be individualized, evidence-based, aimed at controlling clinical symptoms, preventing severe exacerbations, and improving quality of life. Studies have shown that inhalation therapy with iodine- bromide saltwater improves lung function in chronic obstructive pulmonary disease (COPD), while radon-containing mineral water inhalation reduces inflammation and oxidative stress in asthma. Several studies have analyzed the composition of the Shargaljuut hot spring, with Oyuntsesteg et al. identifying high levels of Na+-HCO3 - and Na+-SO4. Other studies on mineral water therapies have reported benefits such as thinning bronchial secretions, improving sputum clearance, reducing inflammation and acidity, mitigating oxidative stress, and enhancing quality of life. Aim: To study the effectiveness of combined asthma treatment with inhaled corticosteroids and hot spring inhalation. Materials and Methods: The study included 67 participants diagnosed with asthma who consented to participate and underwent 10 days of combined inhaled corticosteroid therapy and mineral water inhalation at Shargaljuut sanatorium. A total of 57 participants completed the pre- and post-treatment assessments. Treatment result was assessed using Asthma control questionnaire 7, asthma symptom control with Asthma Control Test (ACT), and exercise tolerance by a 6-minute walk test. Chest X-rays were taken for all participants to rule out pneumonia, cancer, or pulmonary fibrosis. Treatment outcomes were evaluated using ACT scores, peripheral blood eosinophil count, total IgE levels in serum, spirometry indices (FEV1, FVC, FEV1/FVC), and the 6-minute walk distance. Results: The average age of participants was 52±12 years, with a predominance of females. The mean asthma control score was 14.2±4.80, indicating poor asthma control. After 10 days of inhaling corticosteroids combined with hot spring inhalation post-treatment quality of life increased by 0.5 points, FEV1 improved by 7.5%, FVC by 4.2%, peripheral blood eosinophil count decreased by 0.3%, and total Ig E levels dropped from 73.3 (22.5; 216) to 73.2 (21.3; 223) u/ml (p=0.000). Conclusion In cases of uncontrolled asthma remission, combining of inhaled corticosteroid therapy with hot spring inhalation at Shargaljuut improved asthma symptoms, quality of life, enhanced lung function, and reduced inflammatory markers (p<0.001).

Background: Hypokalemia is considered when the serum potassium level is less than 3.5 mmol/L. Clinical research indicates that hypokalemia affects 20% of hospitalized patients, and in 24% of these cases, inadequate interventions result in life-threatening complications. At present, there is no research available on the prevalence, management, and outcomes of hypokalemia in hospitalized patients, which justifies the need for this study. Aim: The study aimed to examine the prevalence of hypokalemia and the effectiveness of its management in hospitalized patients within the internal medicine department, in relation to the knowledge of doctors and resident physicians. Materials and Methods: This hospital-based retrospective study included a total of 553 cases of patients hospitalized in the Internal Medicine Department of the Mongolia Japan Hospital between January 2024 and August 2024. Patients with a potassium level of <3.5 mmol/L were diagnosed with hypokalemia, and the effectiveness of potassium replacement therapy was evaluated according to the method of supplementation employed. Results: The prevalence of hypokalemia among hospitalized patients in the Internal Medicine Department was 9.8% (54 cases). Based on the study criteria, 42 cases of hypokalemia were selected for further analysis, and a total of 118 potassium replacements were performed through oral, intravenous, and mixed methods. Following potassium replacement therapy, 37.3% (44) of patients achieved normalized potassium levels, while 62.7% (74) still had persistent hypokalemia. Conclusion According to the study results, the prevalence of hypokalemia among hospitalized patients in the Internal Medicine Department is 9.8%. The method of potassium replacement and the severity of hypokalemia do not impact the normalization of potassium levels, with the critical factor being the proper dosage of supplementation. The knowledge of doctors and resident physicians regarding hypokalemia is insufficient, and there is a need to implement guidelines and protocols for potassium replacement therapy in daily clinical practice.

Background: Patients with rheumatoid arthritis are at increased risk of developing cardiovascular disease. In Mongolia, the registration of inflammatory diseases is increasing every year, and cardiovascular diseases are the leading cause of death. Aim: We aimed to determine the degree of cardiovascular risk and its correlation in people with rheumatoid arthritis. Materials and Methods: The study was conducted in a cross-sectional study design with 64 patients with rheumatoid arthritis between May and November 2024. Cardiovascular risk was assessed using mSCORE and the World Health Organization (WHO) cardiovascular Risk Table. We received ethical approval to begin the research at the MNUMS meeting on May 17, 2024 (No. 2024/3-05). Results: The average age of the participants was 55.2±9.7 years, and the average duration since being diagnosed with RA was 9.8±8.0 years. Among the participants, 82.8% (n=53) were female, and 17.2% (n=11) were male. The mean WHO risk index was 10.25±11, while the mean mSCORE risk index was 2.9±4 (p=0.001). There was a significant difference in mSCORE scores between the 40-55 and 56-65 age groups (p<0.001). In contrast, the mSCORE risk assessment showed that 15.6% (n=10) had high risk, and 6.3% (n=4) had very high risk. Among the parameters of inflammatory biomarkers, CRP (OR=0.05, r=0.35, 95% CI 0.9-3.2, p=0.004) has a statistically significant difference and positive correlation, and HDL-C (OR=2.3, r=-0.25, 95% CI 2.9- 10.0, p<0.0001) was significantly different and negatively correlated. Conclusion A total of 64 participants participated in our study, and according to the WHO assessment, 17.2% were at high or very high risk of developing cardiovascular disease in the next 10 years, and according to the mSCORE, 21.9% were at high or very high risk of developing cardiovascular disease. Although the degree of disease activity was not significantly associated with cardiovascular risk, the inflammatory biomarker C-reactive protein was statistically significantly different or positively associated with cardiovascular risk assessment.

Background: According to WHO research, there are approximately 24 million people living with schizophrenia worldwide and schizophrenia is characterized by a combination of psychotic and non-psychotic symptoms. Since the cause of the disease is not fully understood, antipsychotic medications are used as symptomatic treatment. According to the 2022 statistics of the NCMH, 718 people with schizophrenia are being treated under active surveillance in Mongolia. The reason for conducting this study is that the manifestation of drug side effects resulting movement disorders in patients with schizophrenia, which has not been studied in Mongolia. Aim: To investigate the relationship between adherence of medication regimen and abnormal involuntary movements in patients with schizophrenia. Materials and Method: The study was conducted using a descriptive method, cross-sectional design, purposive sampling with the questionnaire and standardized tests. Ethical approval for this study was approved by the NCMH (№3/77 30th of January, 2023) and Research Ethics Review Committee of MNUMS (№2023/3-02). Each participant was asked to complete 5 groups of 36 questionnaires, and standard tests were used to assess patients’ adherence to medication regimens (Morisky scale) and abnormal involuntary movement scale (AIMS). The study was conducted between March and August 2023, and the results were summarized and analyzed using STATA 14 software. Results: The study included 209 patients with schizophrenia, aged 18-79 years, of whom 47.4% (n=99) were male and 52.6% (n=110) were female (p=0.21). Of the participants, 28.2% (n=59) had less than secondary education, 76.5% (n=160) were unmarried, and 85.2% (n=178) had a disability due to mental health. 32.5% (n=68) of the patients with schizophrenia in the study used a combination of typical and atypical medications, and the most commonly used antipsychotic drugs were haloperidol (30.6%), chlorpromazine (26.8%), levomepromazine (25.8%), risperidone (24.4%), and quetiapine (21.1%). 1.4% (n=3) of the patients had good, 52.6% (n=110) had moderate, and 45.9% (n=96) had poor adherence to the medication regimen (Cronbach’s α=0.781). However, according to the results of the test for assessing abnormal involuntary that are performed without self-control, 49.76% (n=104) responded that they felt more sensitive to facial and oral movements, and 44.5% (n=93) to limb movements. The patients’ adherence to the medication regimen was statistically significant with facial and oral movements (n=104; p=0.036) and general body movement disorders (n=94; p=0.05). Conclusion 32.5% of patients with schizophrenia were taking typical and atypical antipsychotics, and 45.9% had poor adherence to medication regimens and were more likely to exhibit clinical forms of abnormal involuntary movements, including facial (p=0.036) and general movement disorders (p=0.05).

Background: Hepatitis virus infections are widespread and highly endemic in Mongolia and ranks first in the world for liver cancer mortality per 100,000 population, eight times the world average. The World Health Organization estimates that more than 2 billion people are infected with the hepatitis B virus. Each year, 1 million people die from the infection, 4 million are newly infected, and approximately 350-400 million are chronic carriers. In 2018, 475 cases of viral hepatitis were recorded nationwide, accounting for 1.1 percent of all communicable diseases, a decrease of 59 cases or 0.2 per 10,000 population compared to the previous year. In 2016, 194 WHO member countries joined forces to develop a strategy to reduce viral hepatitis, with the goal of reducing mortality by 65% and new infections by 90% by 2030. In order to achieve this goal, the strategic goal states that each country must conduct a comprehensive public health study and intervention on the spread of infection, risk factors, and early detection. Aim: Study to the coverage of hepatitis B immunization among children aged 0-9 years in urban and rural Mongolia and to determine the influencing factors. Materials and Methods: A Nationwide population based cross-sectional study design was used in this study. Mongolia is geographically divided into the western, Khangai, eastern, and central regions. A total of 14 provinces were selected randomly in addition to Ulaanbaatar city. The appropriate sample size was estimated at 4500 children aged 0-9 years, based on 2019 demographic data from the National Statistics Office. The questionnaire contained closed and semi-closed questions on demographics, socio-economic status, vaccination history and etc. Results: A total of 5027 children aged 0-9 years were enrolled in this study out of which 33.7% (n=1692) and 66.3% (n=3335) were enrolled from capital city Ulaanbaatar and provinces, respectively. Almost half (n=2552) of the study participants were boys whereas the remaining were girls 50.0% (n=2554). According to the history of Hepatitis B vaccination by questionnaire of parents’, 91.2% [91.2-92.0] were vaccinated with Hepatitis B. The proportion was 89.7% [89.7-90.8] and 94.1% [94.1-95.2] in rural and urban areas, respectively. Nearly 90% [89.6-90.5] of children were vaccinated in hospitals, 2.3% [2.0-5.0] were vaccinated at home, 8.1% [7.9-10.7] were unaware of the study participants’ location of vaccination. There were no statistically significant differences by urban and rural residences. Vaccination coverage against Hepatitis B was 91.5% (n=2300) and 90.9% (n=2284) among boys and girls, respectively and 89.6% (n=4506) were vaccinated at hospitals. Vaccination coverage were similar by sex. We also used Health Documents /pink book of children/ or vaccination card for each child to determine the coverage. According to the data from the children’s vaccination card and health documents’, 917 (18.2%) children were not vaccinated against hepatitis, 57 (1.1%) children received 1 dose, 235 (4.7%) children received 2 doses, and 3818 (75.9%) children received all 3 doses of hepatitis B vaccine. There was no significant difference by sex, though the coverage varied by age. For instance, proportion of children with no written documentation in the vaccination card was 13.5% among children aged 1 years that increased to 22.5% and 25.3% among children aged 8 and 9 years, respectively. In contrast the coverage rate of 3 doses of hepatitis B vaccination declined from 77.8% to 70.7% among children aged 1 years and 9 years, respectively. Hepatitis B vaccination coverage according to the vaccination card was different by provinces and within the districts of Ulaanbaatar city. Conclusion A total of 5027 children aged 0-9 years were included in the study, of which 917 (18.2%) children were not vaccinated against hepatitis, 57 (1.1%) children were vaccinated against the first dose, 235 (4.7%) children were vaccinated against the second dose, and 3818 (75.9%) children were fully vaccinated against the first-third dose. Although the coverage of the study participants varied depending on age and place of residence, no significant differences were observed in terms of gender. The current rate of children who are not fully vaccinated stands at 18.2%, emphasizing the need to ensure all children receive full vaccinations for hepatitis B and the required five doses as per the schedule. Furthermore, it is essential to mandate booster vaccinations for those with delayed immunizations and improve the accuracy of registration data.

Background: Sleep quality is frequently highlighted in the literature as a key factor for overall health. Poor sleep quality significantly affects both physical and mental health, diminishing quality of life and potentially harming personal finances. While this issue is influenced by various risk factors, no well-studied research has been conducted on it in Mongolia. Aim: The aim of this study was to assess the frequency of poor sleep quality among visitors to the Sleep center in Mongolia and to identify the factors associated with poor sleep quality. Materials and Methods: This study, conducted using a cross-sectional design, included 200 participants aged 18 to 65 years who visited the Sleep Center at the General Hospital for State Special Servants between January and May 2024. Data were collected using a structured questionnaire. Sleep quality was assessed using the Mongolian version of the Pittsburgh Sleep Quality Index, with a global score above 6 indicating poor sleep. Participants were divided into two groups: “Good sleepers” (n=105) and “Poor sleepers” (n=95). Socio-demographic and clinical variables such as age, sex, levels of education were also recorded. The level of depression, anxiety, and stress was assessed using the DASS 21 (Depression Anxiety Stress Scale) criteria. Univariate analysis was performed using the t-test, Mann-Whitney U test for continuous data, the Х2 or Fishers’s exact test for categorical data, and logistic regression for multivariable analysis. A P-value of less than or equal to 0.05 was considered significant. Results: Poor sleep quality, indicated by a PSQI global score above 6, was observed in 52.5% of the total participants. Univariate analtysis’s test results showed that age, being female, having depression, anxiety, BMI ≥ 25, alcoholism, comorbidities, and using concomitant medications were significantly associated with poor sleep quality (all p<0.05). In the multivariate logistic regression analysis, 50 < age (OR 3.133, 95% CI, 1.245-7.884, p<0.05), BMI ≥ 25 (OR 2.084, 1.039-4.179, p<0.05), alcoholism (OR 3.018, 95% CI, 1.495-6.093, p<0.01) and depression (OR 15.957, 95% CI, 1.592-159.922, p<0.05) were identified as significant risk factors for poor sleep quality. Depression and alcoholism were associated with longer sleep latency and decreased daytime activity (p<0.05). Conclusions 1. In our study, more than half of the participants experienced poor sleep quality. 2. Age over fifty, depression, BMI ≥ 25, and alcoholism emerged as independent significant risk factors for sleep disturbance. Alterations in sleep latency, sleep disruption, and impaired daytime functioning may be associated with poor sleep quality.