Concussion treatment through Baria zasal: An exploration of Traditional Mongolian Medicine

There is no specific treatment for concussion in modern medicine; existing treatments are limited to resting and restoring cognition. For Mongolians, seeking concussion treatment from a bariachi, an advanced practitioner of the baria zasal traditional massage therapy, is very common. The baria zasal technique has been passed down the generations for millions of years, keeping with the Mongolian nomadic culture and way of life. However, this Mongolian treatment is little known or researched internationally. Due to the lack of literature on this subject, conducting a meta-analysis or systematic review was impossible. We reviewed the literature published in Mongolian about this technique. We also searched articles published from 1 January 1921 to 20 June 2021 in PubMed using "concussion", "baria zasal", and "Bariachi" keywords. Although informal observation indicates this is a commonly sought treatment among patients, there are very few published scientific articles about the practice outside the realm of cultural anthropology. This may be due to a few reasons: the informal, semi-religious setting in which the treatment takes place makes it difficult to conduct scientific field research; concussion is a mild traumatic brain injury, making it impossible to identify changes in the brain as a result of the treatment using imaging methods and therefore difficult to verify; and lastly, baria zasal is generally uncontested as a treatment even by Mongolian medical professionals, therefore it has not been the subject of empirical debate. Moreover, it is not classified under a specific system, each bariachi having its technique. As bariachis do not receive formal training, their treatments often depend on instincts, natural talents, and personal abilities. Therefore, it is recommended to study the techniques of baria zasal of concussion to explain its enduring popularity in Mongolia and to ascertain how it interacts with standard western medical treatment.

The neurobiology of smartphone addiction in emerging adults evaluated using brain morphometry and resting-state functional MRI

The characteristics of smartphone addiction (SPA) can be evaluated by neuroimaging studies. Information on the brain structural alterations, and effects on psychosocial wellbeing, however, have not been concurrently evaluated. The aim of this study was to identify abnormalities in gray matter volume using voxel-based morphometry (VBM) and neuronal functional alterations using resting-state functional MRI (rs-fMRI) in emerging adults with SPA. We correlated the neuroimaging parameters with indices for psychosocial wellbeing such as depression, anxiety, stress, and impulsivity. Forty participants (20 SPA and 20 age-matched healthy controls) were assessed using VBM and rs-fMRI. The smartphone addiction scale – Malay version (SAS-M) questionnaire scores were used to categorize the SPA and healthy control groups. DASS-21 and BIS-11 questionnaires were used to assess for psychosocial wellbeing and impulsivity, respectively. VBM identified the SPA group to have reduced gray matter volume in the insula and precentral gyrus; and increased grey matter volume in the precuneus relative to controls. Moderate correlation was observed between the precuneus volume and the SAS-M scores. Individuals with SPA showed significant rs-fMRI activations in the precuneus, and posterior cingulate cortex (FWE uncorrected, p<0.001). The severity of SPA was correlated with depression. Anxiety score was moderately correlated with reduced GMV at the precentral gyrus. Collectively, these results can be used to postulate that the structural and neuronal functional changes in the insula are linked to the neurobiology of SPA that shares similarities with other behavioural addictions.

Relationship of tooth loss to mild cognitive impairment among middle-aged Mongolians: Mon-Timeline study

Cognitive impairment is common in elderly people, so it is considered an ageing disorder. However, cognitive decline, including dementia, can also occur in middle-aged people. Cognitive impairment is associated with multiple risk factors. We hypothesised that tooth loss might also be a potential risk factor among Mongolians, as oral health problems are one of the significant health issues in Mongolia, especially in middle-aged people. In this cross-sectional study, we used the baseline data from the Mon-Timeline cohort study, including people older than 40 years of age (n=279). The amount of tooth loss was assessed by a trained researcher. Mild cognitive impairment (MCI) was defined as those participants scoring a total of £ 24 points based on the Mini-Mental State Examination (MMSE). Unadjusted analysis showed that having more tooth loss (>10) increased the risk of MCI by an odds ratio of 3.03 (1.49-6.17), as compared with having less tooth loss (£10). Even after adjusting for covariates, the association remained significant, suggesting that tooth loss is associated with MCI risk, independent of age, education, and other socioeconomic factors. There was no significant interaction effect of age in the association between tooth loss and MMSE scores. In conclusion, tooth loss may play a role in developing cognitive decline, especially in the early onset of dementia. Further studies are needed to investigate whether early tooth loss at younger ages is associated with dementia, especially among middle-aged people.

Challenges and perspectives of brain science in Mongolia and Central Asian countries

"What is the origin of the mind?", "What is the organ of intelligence?" The first answers to these questions trace to the scripts of ancient Sumeria and Egypt. It took almost 4000 years to understand that the brain is the main organ that controls other organs. The dawn of modern neuroscience lay in the 1890s when the pioneering works of Camillo Golgi and Ramon Cajal invented the structure of the nervous system using microscope techniques. Cajal's neuron doctrine, which hypothesizes that the functional unit of the brain is the neuron, has become the main concept that explains the mind and body interactions.

Effect of diurnal changes on the auditory working memory in individuals with normal hearing

The human circadian rhythmicity is an internal biological clock mechanism that enables them to effectively perform tasks during a particular time of the day, due to which they exhibit diurnal effects. The morningness-eveningness questionnaire classifies individuals as definitely morning, moderately morning, intermediate, moderately evening, and definitely evening type individuals based on their active performance during different times of the day. Literature show variations in visual, memory, audition, and other cognitive tasks throughout the day in every individual. The current study aimed to document the diurnal effects on auditory working memory, a phenomenon crucial for learning and academic outcomes and holds its role in various clinical and research fields. Thirty-two participants were enrolled (21 females and 11 males) and were classified based on the morningness-eveningness questionnaire. The Auditory Working Memory tests were carried out during the morning and evening for all the participants. Based on a parametric paired t-test, results reveal no significant differences between morning time and evening time across moderately morning, intermediate, and moderately evening groups implying that working memory is a higher-order function that shows no or negligible diurnal effects, unlike other lower-order functions like temporal processing of auditory signals.

Mongolian Neuroscience Society (MNS) - The 8th Annual Meeting of the Mongolian Neuroscience Society and IBRO-APRC Ulaanbaatar Associate School on Fundamental Techniques in Neuroscience 2021

In 2021, the Mongolian Neuroscience Society (MNS), together with the International Brain Research Organization (IBRO) and the Mongolian National University of Medical Sciences (MNUMS), organized two events: The 8th Annual Meeting of the Mongolian Neuroscience Society themed as "Multidisciplinary Brain Science 2021" and the IBRO-APRC Ulaanbaatar Associate School on Fundamental Techniques in Neuroscience. Multidisciplinary Brain Science 2021 aimed to bring together scientists with brain science-related backgrounds under an umbrella meeting consisting of educational lectures and academic connections. It was held with 14 invited lecturers and 20 speakers for two days virtually from August 13 to 14, 2021. The meeting was streamed live on social media, which brought together 2.6K online viewers. The goal of the IBRO-APRC Associate School on Fundamental Techniques in Neuroscience was to enable students to understand the theoretical and practical fundamentals of neuroscience. This virtual school was formed by 20 students and 16 faculty members from 5 countries. The students participated in lectures, technical talks, interactive discussions, and hands-on sessions on responsible conduct of research in neuroscience with a high neuroethical standard during the 6-day program. The events were a great success, offering a unique opportunity for the participants to get updated with current advances in brain science by global and regional experts in neuroscience and facilitate academic collaborations.

Knowledge, attitudes, and practices toward Covid-19 among the Mongolian general population during the period of the Covid-19 pandemic: a nationwide, population-based, randomised, cross-sectional study

Improving knowledge, attitudes, and practices toward COVID-19 is critical to control the infection rate of the pandemic successfully. Mongolia declared a state of emergency in January 2020 but no study was performed on public adherence to centralised measures and awareness of the pandemic in Mongolia. This study aimed to determine knowledge, attitudes, and practices (KAP) toward COVID-19 in the general population, especially regarding the extent to which KAP has contributed to the control measures before local COVID-19 outbreaks. The study was conducted between July and October 2020, when the pandemic was limited to internationally imported cases. We adapted a structured KAP questionnaire that was used to survey residents of Wuhan, China, during the initial outbreak of the pandemic. Participants aged between 13 and 65 years (n=1324, mean age=39.79±14.8), 73.2% were women, and 27.2% held a bachelor's degree or above. The results suggested that 81.9% of the participants had sufficient knowledge about the transmission, symptoms, treatment, and prevention of the disease. In the multiple linear regression, an increase in age and education contributed positively to a high knowledge score (p<0.05, p<0.001, respectively). The majority of the participants (96.2% - 96.5%) had compliance with the measures to control COVID-19 spread with good practices (82.4% - 93.1%) toward COVID-19 prevention. In the binary logistic regression analyses, the COVID-19 knowledge score was associated with a higher likelihood of optimistic attitudes and preventive practices (OR: 0.617 - 0.845). In conclusion, despite the sufficient knowledge toward the COVID-19 pandemic among the general population of Mongolia, a relatively low level of optimistic attitudes and appropriate practices compared to other populations may negatively impact preventing the outbreak in the society. Health education programs aimed at improving COVID-19 knowledge will be helpful to minimise local epidemic growth and the current government measures such as lockdowns, quarantines, and travel restrictions.

Incidence and clinical feature of Myasthenia gravis: A five-year data analysis in Ulaanbaatar, Mongolia

Myasthenia gravis (MG) is a rare neuromuscular disorder. Till now, there are no studies on the prevalence and incidence of MG in Mongolia. The current study aimed to elucidate the incidence of MG in Ulaanbaatar, the age of onset, and the gender distribution of Mongolian patients with MG. We conducted a cross-sectional, hospital-based study involving MG patients (n=48) all around Ulaanbaatar from 1 January 2015 to 1 January 2020. The clinical diagnosis was assessed with the Myasthenia Gravis Foundation of America (MGFA) classification system. The disease severity was evaluated by using Osserman’s classification. The diagnosis was confirmed with serological and electrophysiological tests. Statistical analysis was performed using SPSS software. A total of 30 patients with MG were registered for the last five years in Ulaanbaatar. The average annual incidence of MG in Ulaanbaatar was 0.65 per 100,000 populations (95%CI 0.26-1.34), 0.60 in males (95%CI 0.25-1.28), and 0.69 in females (95%CI 0.33-1.46). The cumulative incidence in the study period was 3.2 per 100,000 populations. The ratio of males to females was 1:1,3. The median age for onset of MG was 33 years (ranging from 27 to 46 years); 43.3% of patients had ocular and 56.7% generalized symptoms at the disease onset. Only 23.3% of patients remained with purely ocular symptoms (Osserman I stage). The average incidence of MG between 2015 and 2020 was 6,5 per 1.000.000 population, and the annual incidence was relatively stable. Although ocular and generalized symptoms were observed each in about half of the cases, only one-fourth remained with pure ocular signs at the end of the review period.

Non-invasive detection for work stress among the professional medical nurses during COVID-19 in Mongolia

COVID-19 pandemic has created a lot of work stress, especially among medical professionals, namely among nurses. The absence of the non-invasive stress detecting method using salivary alpha-amylase test in Mongolia served us to perform this study. We consider that the nurse immunization could be managed and boosted if the work stress is detected, and it would serve as the prevention method from the infections in the clinical settings. The study aims to investigate the stress level among medical professionals, particularly the nurses, using a self-report questionnaire, work stress profile, and salivary alpha-amylase during the initial period of the COVID pandemic. In the mid of March 2020, 356 professional medical nurses from three national tertiary centres of Mongolia were involved in this study. We employed a Work Stress Profile (WSP), a self-administered questionnaire that assists the personnel to identify their perceived stressors and assessing the stress at work. As the physical stress marker, we measured the saliva alpha-amylase level in these participants. The vital signs, heart rate, glucose and blood pressure were measured. The correlation method was used. There were 344 females and 12 males. The participants' mean age was 38±9.6 years old. The stress among the medical professionals was high by WSP - it was counted 342 or 96.1% of the personnel suffering from the stress at work: the WSP average was 151.49±26.81. However, age, education and work experience could influence stress at a certain level. The salivary alpha-amylase and WSP scores were correlated directly (p<0.01; r=0.187). The pulse, diastolic blood pressure and salivary alpha-amylase were interrelated. As one of the important personnel at the hospital, nurses are at high risk to get stressed in Mongolia. We concluded that the overloading of work leads to work stress among professional medical nurses, especially during the COVID-19 pandemic.

Translation, reliability, and structural validity of the Hospital Anxiety and Depression Scale (HADS) in the general population of Mongolia

Various psychological, biological, and social factors make people vulnerable to mental health problems. These precursory factors as mental distress, are not sufficient alone for diagnosing a mental disorder but are recognised as risks to mental health. There has been no screening tool available in Mongolia that is adequately validated for mental health screening and neuropsychiatric functions of the brain. Therefore, we aimed to translate and validate the hospital anxiety and depression scale (HADS) to identify potential mental distress in healthy people. The HADS is reliable, valid, and practical for identifying the most common psychological disturbances. This nationwide comparative observational study for the validity of a self-reported measure was conducted between June and December 2020. One thousand ninety-four participants were randomly selected, aged 13-75, mean age was 37.7±13.7 years old, 60.9% were females, 63.9% were married. HADS total score was 13.0±5.7, HADS anxiety (HADS-A) score was 6.8±3.6, and HADS depression (HADS-D) score was 6.0±3.1 for the original two-factor model. The external reliability was good in the whole scale, and both subscales using the Intraclass Correlation Coefficient (0.872, 0.837, and 0.801 for the HADS-T, HADS-A, and HADS-D, respectively). Cronbach's alpha value was 0.776, 0.756, and 0.582, respectively, for the HADS-T, HADS-A, and HADS-D, indicating an acceptable internal consistency for the entire scale but marginal reliability for the HADS-D subscale. The reliability of both the two-factor and three-factor structures of the HADS was confirmed using confirmatory factor analysis with a satisfactory model fit on a separate sample. In conclusion, the Mongolian version of the HADS can be considered a valid and reliable measurement tool for various scientific and clinical practices in the general population.