Medical education in Mongolia: Challenges and opportunities.

In the early twentieth century, Mongolia saw the establishment of Western medicine and educational system, supplementing its pre-existing history of eastern medicine. As a lower-middle-income country with vast landmass and low population density, Mongolia's medical education landscape has evolved significantly. The inception of the Mongolian National University of Medical Sciences in 1942 marked a pivotal moment, initiating the modern era of medical sciences and specialized training programs in the country. Initially shaped by Soviet Union-styled medical curriculum, the system has undergone substantial reform since the constitutional shift to a market economy in the 1990s. This transformation aligned the curriculum with international standards and modern educational approach, focusing on producing skilled medical professionals. Presently, over 10 public and private institutions of higher education in Mongolia provide comprehensive undergraduate, graduate and post-graduate training for medical training. These institutions vary in student enrollment, teaching staff, learning environments, and program models, contributing to the diverse landscape of medical education in the country.

An evaluation of the qualitative superiority of the Mongolian medicinal herb hurdan-tsagaan (Platycodi Radix) from five different geographic origins based on anti-inflammatory effects.

ETHNOPHARMACOLOGICAL RELEVANCE: The contents and types of the active compounds in medicinal herbs depend greatly on their extraction methods, sources of origin and the modes of cultivation. Platycodon grandiflorus (Jacq.) A.DC. is an ethnic medicinal herb widely cultivated in China, and its dried root, Platycodi Radix (PR), is an important ingredient in herbal formulae for attenuating lung issues in Mongolian medical practice. However, research evaluating the superiority of PR based on harvesting regions is relatively limited. AIM: This study aimed to evaluate the qualitative superiority of PR from different regions based on anti-inflammatory effect. MATERIALS AND METHODS: A total of three commercial PR samples were obtained from Anguo, Bozhou and Shangluo, and two wild samples were obtained from Chifeng and Hinggan. PR extract (PRE) was prepared by water distillation, and platycodin D content in the extract was examined by HPLC-UVD. An optimal dose of PRE was administered to BALB/c mice with S. pneumoniae pneumonia, and IL-10 and TNF-α levels in lung tissue were examined by ELISA. HepG2 cells were treated with PRE, and an analysis of differentially expressed gene and functional enrichment was performed using an HTS2 assay. RESULTS: The contents of moisture, total ash, crude extract and platycodin D in the raw roots met the quality control requirements outlined in the Chinese Pharmacopoeia (2020 edition). The platycodin D content in the aqueous extract of the roots in descending order was 24.16% in PRE_Shangluo, 22.91% in PRE_Hinggan, 21.41% in PRE_Bozhou, 17.8% in PRE_Chifeng and 15.92% in PRE_Anguo. Furthermore, administration of PREs at an optimal dose of 2.0 g/kg resulted in some anti-inflammatory effect in mice with Streptococcus pneumoniae pneumonia, among which PRE_Shangluo administration exhibited a more obvious anti-inflammatory impact as shown by a significant decrease in the plasma white cell count (p < 0.05) and IL-10 level elevation and TNF-α reduction in lung tissue (p < 0.05) after treatment. In HepG2 cells treated with 100 µg/ml of each PRE, PRE_Hinggan and PRE_Shangluo resulted in significant differential expression of genes such as nuclear factor kappa B subunit 1 (NFKB1) and significant enrichment of pathways involved in the immune system, such as PI3K-Akt, MAPK and NF-kappa B signaling pathways. CONCLUSIONS: In this study, based on the anti-inflammatory effect, the quality of PR of Shangluo origin was superior to that of PR from the other four regions.

Use of Traditional Mongolian Medicine in Children with Concussion.

(1) Background: There is no specific treatment for concussion in modern medicine, and existing treatment is only limited to resting and restoring cognition. For centuries, Mongolians have used traditional Mongolian medicine (TMM) methods to treat a variety of diseases such as Baria zasal. In this study, we aimed to explore the treatment parents and guardians seek when their children have suffered a concussion. (2) Methods: In this study, we used an online questionnaire. The study participants (n = 400) were randomly selected parents and guardians. The definition of bariachi is an advanced practitioner of baria zasal, which covers most of the massage therapy techniques mentioned in this study. (3) Results: In total, 72% of the parents and guardians went to a bariachi when their children suffered a concussion, while only 10.3% chose western medical hospitals. When asked what they did after the initial treatment was not effective, 47.8% of the participants responded that they went to the bariachi. Based on the days of treatment result, 11.8% reported on the beneficial effects of the treatment appearing in one day, and 60.3% in 1−3 days, which shows that the participants suffered a healing effect of the baria zasal shortly after application to their children. In the regression analysis, visiting a Bariachi was independent of age, gender, or even religion. (4) Conclusions: Although Western medicine is highly developed in Mongolia, the baria zasal of TMM has not lost its appeal in treating concussion. This suggests that baria zasal could be a unique method of concussion treatment even today. This also suggests that the techniques of Baria zasal should be further studied, and as in modern medicine.

Assessing the quality of tuberculosis care using routine surveillance data: a process evaluation employing the Zero TB Indicator Framework in Mongolia.

OBJECTIVES: To evaluate the feasibility of the Zero TB Indicator Framework as a tool for assessing the quality of tuberculosis (TB) case-finding, treatment and prevention services in Mongolia. SETTING: Primary health centres, TB dispensaries, and surrounding communities in four districts of Mongolia. DESIGN: Three retrospective cross-sectional cohort studies, and two longitudinal studies each individually nested in one of the cohort studies. PARTICIPANTS: 15 947 community members from high TB-risk populations; 8518 patients screened for TB in primary health centres and referred to dispensaries; 857 patients with index TB and 2352 household contacts. PRIMARY AND SECONDARY OUTCOME MEASURES: 14 indicators of the quality of TB care defined by the Zero TB Indicator Framework and organised into three care cascades, evaluating community-based active case-finding, passive case-finding in health facilities and TB screening and prevention among close contacts; individual and health-system predictors of these indicators. RESULTS: The cumulative proportions of participants receiving guideline-adherent care varied widely, from 96% for community-based active case-finding, to 79% for TB preventive therapy among household contacts, to only 67% for passive case-finding in primary health centres and TB dispensaries (range: 29%-80% across districts). The odds of patients completing active TB treatment decreased substantially with increasing age (aOR: 0.76 per decade, 95% CI: 0.71 to 0.83, p<0.001) and among men (aOR: 0.56, 95% CI: 0.36 to 0.88, p=0.013). Contacts of older index patients also had lower odds of initiating and completing of TB preventive therapy (aOR: 0.60 per decade, 95% CI: 0.38 to 0.93, p=0.022). CONCLUSIONS: The Zero TB Framework provided a feasible and adaptable approach for using routine surveillance data to evaluate the quality of TB care and identify associated individual and health system factors. Future research should evaluate strategies for collecting process indicators more efficiently; gather qualitative data on explanations for low-quality care; and deploy quality improvement interventions.

A Rare Case of 46, XX (SRY+) With Normal Male Stature and Unilateral Absence of the Vas Deferens.

Objective: This study aimed to investigate the cause of primary infertility in a rare case with unilateral absence of vas deferens. Case report : A 35-year-old man was presented to the Infertility Clinic at the National Center of Maternal and Child Health (NCMCH) with an eight-year history of primary infertility. Clinical examination showed a normal intelligence with a coarse facial appearance and small testicles. Hormonal tests detected elevated levels of prolactin (PRL), follicle stimulating hormone (FSH), and luteinizing hormone (LH), and low levels of testosterone. Chromosomal analysis with fluorescence in situ hybridization (FISH) revealed a 46XX with SRY (sex-determining region Y) positive karyotype with translocation of the SRY gene (46XX der(X)t(X:Y)(p11.1:p11.3)(SRY+)). Magnetic resonance imaging (MRI) revealed bilateral seminal vesicles atrophy and agenesis of the vas deferens on the right side, which is rarely found in 46, XX male syndrome. Conclusion: Although 46XX testicular disorder of sexual development (DSD) cases are rare, multiple aspects of the clinical examinations are important to make an accurate diagnosis and to provide proper genetic counseling and guidance to patients in their long-term management.

SARS-CoV-2 seroprevalence in Mongolia: Results from a national population survey.

BACKGROUND: With the global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in early 2020, Mongolia implemented rapid emergency measures and did not report local transmission until November 2020. We conducted a national seroprevalence survey to monitor the burden of SARS-CoV-2 in Mongolia in the months surrounding the first local transmission. METHODS: During October-December 2020, participants were randomly selected using age stratification and invited for interviews and blood samples at local primary health centres. We screened for total SARS-CoV-2 antibodies, followed by two-step quantitative SARS-CoV-2 IgG serology tests for positive samples. Weighted and test-adjusted seroprevalences were estimated. We used chi-square, Fisher's exact and other tests to identify variables associated with seropositivity. FINDINGS: A total of 5000 subjects were enrolled. We detected SARS-CoV-2 IgG antibodies in 72 samples. Crude seroprevalence of SARS-CoV-2 antibodies was 1·44% (95%CI,1·21-1·67). Population weighted and test-adjusted seroprevalences were 1·36% (95%CI,1·11-1·63) and 1·45% (95%CI,1·11-1·63), respectively. Age, sex, geographical, and occupational factors were not associated with seropositivity (p>0·05). Symptoms and signs within past 3 months and seropositivity were not associated at the time of the survey (p>0·05). INTERPRETATION: SARS-CoV-2 seroprevalence in Mongolia was low in the first year of the pandemic potentially due to strong public health measures, including border restrictions, educational facilities closure, earlier adoption of mask-wearing and others. Our findings suggest large-scale community transmission could not have occurred up to November 2020 in Mongolia. Additional serosurveys are needed to monitor the local pandemic dynamic and estimate how far from herd immunity Mongolia will be following-up with vaccination programme in 2021 and 2022. FUNDING: World Health Organisation, WHO UNITY Studies initiative, with funding by the COVID-19 Solidarity Response Fund and the German Federal Ministry of Health (BMG) COVID-19 Research and development. TRANSLATION: Cyrillic and Traditional Mongolian translation of abstract is available on appendix section.