Background: The first confirmed case of COVID-19 in Mongolia was reported on November 11, 2020. In response, the government imposed a nationwide lockdown, which significantly impacted the population’s mental health. Heightened levels of stress, anxiety, loneliness, and depression during the pandemic altered individuals’ psychological stability and behavior. Personality traits—defined as relatively stable patterns of emotion, cognition, and behavior—play a key role in stress responses and emotional regulation under pressure. Emerging evidence suggests that these psychological factors may influence the immune system’s responsiveness, including vaccine-induced antibody production. Aim: To evaluate the association between post-vaccination antibody responses and personality types following two doses of COVID-19 vaccines. Materials and Methods: A total of 738 participants who received two doses of COVID-19 vaccines (AstraZeneca ChAdOx1, n=29; Pfizer-BioNTech, n=119; Sinopharm BBIBP, n=590) and had no prior SARS-CoV-2 infection were enrolled. Serum samples were collected 21–28 days after the second dose, and SARS-CoV-2 RBD (S) IgG antibodies were measured using ELISA (Proteintech Inc., USA). Personality types were assessed using a 56-item temperament questionnaire developed by A. Belov, categorizing individuals into classical temperament types (choleric, phlegmatic, sanguine, melancholic). Logistic regression and ROC analysis were used to examine associations between personality types and antibody response. Results: The presence of an antibody response was significantly higher among individuals with a melancholic temperament, and significantly lower among those with a phlegmatic temperament. Furthermore, antibody titers were higher in participants with melancholic and sanguine temperaments and lower in those with a phlegmatic type. Conclusions 1. During the early period following the second dose of COVID-19 vaccination, the antibody response was higher in individuals with a pure melancholic temperament, while it was lower in those with a phlegmatic temperament. 2. After the second dose of the Sinopharm BBIBP COVID-19 vaccine, antibody titers were higher in individuals with pure melancholic and sanguine temperaments, and lower in those with a phlegmatic temperament.

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: In recent years, work-life balance has become a pressing issue for healthcare workers in many developing countries around the world. An imbalance between work and personal life leads to psychological stress, health problems, loss of self-confidence, job dissatisfaction, and decreased work productivity due to an inability to concentrate. It also results in a decline in the quality of treatment and services. Furthermore, it increases the risk of medical errors and contributes to both physical and mental burnout, ultimately leading to resignation. Aim: The study analyzed the work-life balance and turnover intentions of employees at family health centers. Materials and Methods: The study was conducted using a cross-sectional model and a quantitative survey method. The work-life balance of employees at Family Health Centers was examined using the work-life balance assessment question naire developed by Hayman (2005), and turnover intentions were assessed using the standard questionnaire developed by Auerbach et al. (2014). The research was carried out in 2024. The study included 123 employees from 22 Family Health Centers located in the Bayangol, Bayanzurkh, Sukhbaatar, Songinokhairkhan, Khan-Uul, and Chingeltei districts of Ulaanbaatar. Results: Of the participants, 95.1% were female, with an average age of 35.2±9.5. Among them, 55.3% were doctors, 29.3% were nurses, 9.8% were health social workers, and 5.7% were other non-medical staff. The income of Family Health Center employees was found to be insufficient; 8.9% had incomes below the minimum subsistence level, and their ability to meet basic household needs was very limited. The results show that participants’ work negatively impacted their personal life (WIPL–23.5), and personal life negatively affected their work (PLIW–15), both of which scored high. Meanwhile, the positive interaction between work and personal life (WPLE–10.7) was low, indicating a disruption in their work-life balance. Working overtime was statistically significant in relation to work-life imbalance (p=0.038). As age and years worked at the current organization increased, the negative impact of work on personal life and personal life on work tended to decrease. Conclusion The work-life balance of Family Health Center employees has been disrupted. The level of work negatively affecting personal life and personal life negatively affecting work is high. 65% of Family Health Center employees are considering leaving their current organization, and 41% are considering leaving the healthcare field.

Background: Cleft lip and palate (CLP) is a congenital anomaly that accounts for approximately 65% of all craniofacial malformations. In Mongolia, the prevalence of CLP is estimated at 0.93 to 1 per 1,000 live births, which is comparable to the global average but slightly higher than the average reported among Asian countries. The incidence is observed to be twice as common in males compared to females. Diagnosis: The patient is a 15-year-old male with a history of congenital unilateral cleft lip and palate. He underwent primary surgical repair of the cleft at the age of 9. As of May 2022, clinical examination revealed maxillary hypoplasia, anterior crowding, and a combination of bilateral posterior and anterior crossbite. Cephalometric analysis demonstrated a skeletal Class III malocclusion with midfacial deficiency. Treatment: Orthodontic treatment was initiated in October 2022 using a non-removable, self-ligating bracket system (MBT 0.022” slot, stainless steel). In the first month, CuNiTi 0.014 archwires were placed, and cross elastics were applied from the maxillary to mandibular canines on the left side for two months. On December 10, 2022, CuNiTi 0.014×0.025 archwires were placed in both arches, accompanied by coil springs to open space. Subsequent phases involved transitioning to stainless steel (SS) and titanium-molybdenum alloy (TMA) archwires for alignment and leveling. Treatment Outcome: At the end of treatment, a Class I molar and canine relationship was achieved. The axial inclinations of the upper and lower incisors reached normative values based on lateral cephalometric analysis. The maxillary arch form was expanded and improved to a more ideal rounded contour. Dental crowding was resolved without extraction, and both transverse and sagittal occlusal relationships were significantly improved. Conclusion This clinical case demonstrates that fixed orthodontic treatment in a patient with unilateral cleft lip and palate can effectively correct dental crowding, normalize occlusal relationships, and significantly improve facial esthetics, phonetics, and overall quality of life. Orthodontic intervention played a vital role in restoring function and supporting psychosocial and physical development.

Background: Children with developmental disabilities benefit from support in motor skills, sensory processing, cognitive development, and social skills. Mongolia has trained occupational therapists for a decade, with 37% specializing in pediatrics, but long-term therapy facilities remain limited. Aim: This study provides a case report on a child with developmental disabilities who received occupational therapy to evaluate improvements in sensory processing, social communication, and daily living skills. Materials and Methods: The study participants were purposively selected from children undergoing occupational therapy at the “Enerel” Child Development Center. Participant A is a 16-year-old male with hearing and speech impairments, as well as an intellectual disability. The initial assessment showed poor sensory processing and behavioral problems and communication difficulties. A tailored program incorporating sensory-based therapies, communication cards, and sign language was developed with caregiver collaboration. Occupational therapy was conducted five times weekly for 11 weeks. Pre and post test assessments included goal attainment scaling (GAS) and Sensory profile 2 (Child). Results: The participant showed improved communication using cards and sign language, better emotional regulation, enhanced sensory processing, and reduced hyperactivity to external stimuli. Goal Achievement (GAS) +2, meaning the goal was achieved better than expected and positive changes were found on the Sensory profile 2, with large effect sizes. Conclusion The study found that sensory- based occupational therapy and sign language training improved occupational performance and goal achievement in children with sensory, behavioral, and communication difficulties.

Background: Organ transplantation has been rapidly advancing in Mongolia in recent years. The number of successful kidney, liver, and bone marrow transplants performed in national central hospitals has been increasing annually. While the number of successful kidney transplants is increasing, post-transplant immune monitoring remains insufficiently studied. Aim: To assess post-transplant immune status by analyzing inflammatory cytokine levels in kidney transplant recipients Materials and Methods: A prospective cohort study was conducted at the First Central Hospital of Mongolia. Serum samples from kidney transplant recipients were analyzed using flow cytometry to measure the levels of 13 inflammatory cytokines, including TGF-β1, PAI-1, sTREM-1, PTX3, sCD40L, sCD25 (IL-2Ra), CXCL12 (SDF-1), sST2, sTNF-RI, sTNF-RII, sRAGE, CX3CL1 (Fractalkine), and sCD130 (gp130). Statistical analysis was performed to assess the results. Results: The mean creatinine level significantly decreased on post-transplant days 7 and 30 compared to pre-transplant levels (p<0.001, ANOVA). No statistically significant difference was found in the 13 cytokine levels between the high risk and low-risk groups based on creatinine levels on post-transplant day 30 (p>0.05). However, the levels of TGF-β1, CX3CL1, sTREM-1, and sTNF-RI showed statistically significant differences between post-transplant days 7 and 30 (p<0.05). No significant correlation was found between the measured cytokine levels and CRP (p > 0.05). On post-transplant day 7, sTREM-1 had a weak correlation with TGF-β1 (r=0.40, p=0.02) and sTNF-RI (r=0.36, p=0.05) but showed a strong correlation with CX3CL1 (r=0.65, p=0.0001). On post-transplant day 30, sTREM-1 remained strongly correlated with CX3CL1 (r=0.73, p=0.0001) and moderately correlated with sTNF-RI and TGF-β1 (r=0.45, p=0.01). Conclusions 1. The levels of TGF-β1, CX3CL1, sTREM-1, and sTNF-RI significantly varied between post-transplant days 7 and 30 (p< 0.05, T-test). 2. On post-transplant day 30, these cytokines were not correlated with CRP but were interrelated among themselves.

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: To determine the visual and anatomical outcomes after rhegmatogenous retinal detachment surgery. Methods: Case files of patients who had surgery for rhegmatogenous retinal detachment at the 3rd state central hospital May 2019 and May 2021 were reviewed. Information obtained included age, sex, presenting and post-operative visual acuity, anatomical reattachment, post- operative complications and causes of treatment failure. Results: Risk factors for retinal detachment included myopia in 8 eyes (32%), trauma in 7 eyes (28%), prior cataract surgery in 2 eyes (8%). 22 eyes (88%) presented with macula off while 3 eyes (12%) presented with macula partly or completely attached. Visual acuity at presentation was <0.01 in 15 eyes (60%). Following surgery, retina was attached in 23 eyes (92%) and remained detached 2 eyes (8%). Visual acuity after surgery was 0.1< 17 eyes, 0.4< 7 eyes. Visual acuity improved in 23 eyes (84%), remained the same in 2 eyes (8%). Conclusion Myopia and trauma are important risk factors for Rhegmatogenous Retinal Detachment. Majority of patients in this setting presented late with Rhegmatogenous Retinal Detachment and this was responsible for relatively poor visual outcomes despite good anatomical results after surgery. Proper screening of eyes at risk and education of patients is important for preventing visual loss due to retinal detachment.

Background: Establishment of quantitative reference intervals of white blood cells and its subpopulations using a high accuracy analytic system is essential for clinical medicine, public health, and anthropology. We are unable to identify peer-reviewed literature sources describing white blood cell counts and their subpopulations using monoclonal antibodies to specific surface antigens in healthy Mongolians. This study aimed to measure the counts of white blood cells and their subpopulations in healthy Mongolians using flowcytometry. Materials and Methods: The absolute number (cell/L) of leukocytes (CD45+), granulocytes, monocytes and lymphocytes were measured by Magnetic Activated Cell Sorting Assay (MACSQuant Analyzer 10) in 287 blood donors (158 males and 129 females) 17-64 years of age (mean age 33.1±12.4). Peripheral blood samples were collected at the time of blood donation at the National Center for Transfusion Medicine. Results The mean values of leukocytes and granulocytes were lower in donors over 30 years of age (ANOVA: F=4.408, p=0.002 and F=5.685, p=0.001) and regression analysis demonstrated indirect correlation between counts of these cells and age of donors (r= - 0.198, p=0.001 and r=-0.221, p=0.001, respectively). Gender-related differences in white blood cell counts were not found.
Mean value of lymphocyte count in donors investigated in spring (May and March, n = 87; 2224.6±775.3) was significantly higher than those in winter (December – February, n=180; 1613.2±454.3, p=0.001) and autumn (October, n=20; 1576.1±438.6, p= 0.001).
Comparing of our findings with the data from available literature shown that healthy Mongolians have lower leukocyte count compared with Koreans, Chinese Han population and lower mean value of lymphocyte count comparing with Korean, Chinese Han population, and Arabian (Saudi Arabia) populations.

BACKGROUND: Toll like receptors (TLRs) are a class of proteins that key role in the innate immune system. TLR7 is expressed on monocytes, macrophages and dendritic cells, T cell, B cell and eosinophiles. TLR7, originally identified as recognizing imidaquinoline, loxibrine, broprimine and ssRNA, ssRNA viruses such as vesicular stomatitis virus, influenza A virus and human immunodefiency virus. It is known that virus ssRNA affects signaling molecule of IFN-y. Objective: To determine gene and protein activation of IFN-y signal transduction by TLR7 ligand in the endothelial cells. MATERIAL: In study we used mouse aortic linear endothelial cell which is cultured (END-D) in 5% heat- inactivated fetal calf serum (FCS), medium (DMEM) containing antibiotic mix(penicillin G, streptomycin, amphotericin B) at 37°C (5% CO2). Endothelial cells treated with synthetic IFN-γ and imiquimodligands, then the NO (nitric oxide) concentration in the supernatant is determined by Griess reagent. Endothelial cells are cultured in 6 well cell culture plate and in each well 2*104cells are expected to be grown for 24 hours of culture. Then, the cells are treated with synthetic IFN-γ and имиквимод ligand for 6 hours and the NO signaling gene activation iNOS mRNA expression which is induced by IFN-γ is determined by RT-qPCR. Endothelial cells are cultured in 12 well cell culture plate and in each well 2*104 cells are expected to be grown for 18 hours of culture. Then, the cells are treated with synthetic IFN-γ and imiquimodligands for 24 hours and the NO signaling protein iNOS expression which is induced by IFN-γ is determined by western blotting. The experiment was conducted as representation mean of at least three test results. The difference between statistical probabilities is determined by the “Students” t test. The p<0.01 value is assumed to be statistically different. RESULTS: TLR7 ligand imiquimodaugmented interferon gamma induced nitric oxide production TLR7 ligand imiquimodincreased interferon gamma induced iNOS mRNA gene expression. TLR7 ilgand imiquimodup-regulated interferon gamma induced iNOS protein expression. CONCLUSIONS: TLR7 ligand imiquimod augments IFN-γ signaling in the endothelial cells. This synergistic effect has revealed in the levels of gene and protein expression.