Background: Choriocarcinoma 15-20 new cases per year diagnosed at National Cancer Center of Mongolia. Due to insufficient necessary new drugs for choriocarcinoma patients, cancer center cannot provide the most useful treatment EMA/CO so patients were treated MAC or metothrexate, Adriamycin and cyclophosphamide. The outcomes of patients with choriocarcinoma treated with combined chemo drugs never been studied in Mongolia. Goal: To evaluate the results of combined chemotherapy in choriocarcinoma at National Cancer Center of Mongolia. Methods: Retrospective cohort review of 42 patients with choriocarcinoma who treated with MAC combination chemotherapy at NCC of Mongolia during 2004-2007. Based on MAC ppatients charts we evaluated clinical characteristics, level of HCG during treatment cycles, ultrasound changes and other lab tests. Results: We treated 42 patients with choriocarcinoma from 2004 through 2007. All patients were treated with MAC combination chemotherapy at NCC. The number of cases with choriocarcinoma is increasing in each year. 37.5% of these patients were aged between 30-34 years old, so it shows maximum incidence occurs during child bearing years. The most common clinical characteristics were 44% bleeding, 32% lower abdominal quadrant pain related to disease stages, 36% cough, and 28% fever. Out of 42 patients 35% of them had lung metastasis which was significantly different than other gynecological cancer metastasis. Conclusion: MAC combination treatment offers long-term disease-free survival and potential cure in patients with choriocarcinoma. The reported median survival in these group patients is 5 years. Importantly, 56% of patients were lived up to 5 years in remission.

BACKGROUND. Statewide STIs does not decrease adamantly in last years, especially syphilis rate is amalgamative. Public health precaution cogency-based, assess prevalence of HIV/STI is supposed to encourage and organize intentionally. PURPOSE: assess prevalence of STIs2 among total persons of SBD. METHOD: analysis data based on outpatient department examination intelligences of patients examined in SBD clinic STI department from 2013 to 2016, controlling form and infectious disease activity EMT-304 reports. RESULT: 12.84% of total infectious disease registered in SBD from 2013-2016 is STI. 63% of the total STIs is syphilis. The causes of 68.05 females, 31.95% males of STIs total patients are that the females included more in a preventative inspection and pregnant inspections. Secondary and latent syphilis increasing regularly in every year and decreasing primary syphilis show the high prevalence of syphilis among SBD persons. Gonorrhea and trichomoniasisincreased by 1 promil on 10000 persons in every year. CONCLUSION: SBD STIs does not decrease constantly in last 4 years. Detection of STIs among pregnant improved by implementing ‘on point service’. High rate STI of among young persons caused insufficient information and knowledge about STIs and unhabit preventative of STIs.

Background This study is a multi-centre, open-label, randomised controlled trial that will compare the impact of selective internal radiation therapy (SIRT) using SIR-Spheres® yttrium-90 microspheres versus sorafenib on overall survival in patients with locally advanced hepatocellular carcinoma (HCC). A definitive RCT comparing the 2 most promising therapies in locally-advanced HCC will impact on outcomes in a large number of patients and change clinical practice. This will also pave the way for future trials in combined modality therapies in HCC. Methods The study is structured so that patients with locally advanced HCC, who satisfy the study eligibility criteria, will be randomised to receive either: Treatment Arm A: Oral Sorafenib therapy at a dose of 400 mg b.i.d until disease progression, no further response, complete regression or unacceptable toxicity or Treatment Arm B: A single administration of SIR-Spheres into the liver targeted at HCC in the liver by the trans-arterial route. Results Twenty patients treated with 90Y-RE and nineteen patients received Sorafenib at our institution from 14 March 2011, and 30 June 2016 were included. Data from 39 consecutive patients were analyzed. The majority of patients were Child Pugh class B(90%), Barcelona Clinic liver Cancer(BCLC) stage C(58.5%) and Okuda class I (89.5%). Approximately 71% patients diagnosed in IIIa stage and 70% of patients had HBV infection. In the analysis for best response, three of 20 patients in the SIRT group (15%) achieved a partial response 7 of 19 patients (46%) had stable disease, whereas in Sorafenib group, two of 19 patients in the SIRT group (12%) achieved a partial response 9 of 19 patients (39%) had stable disease. Conclusion This study shows the potential efficacy of SIR-Spheres and sorafenib. In summary, selective internal radiation therapy (SIRT) using SIR-Spheres is a promising treatment for well selected patients with unresectable HCC. Sorafenib is effective for the patients with locally advanced HCC without portal vein thrombosis (PVT).

Background: The main principles of pharmacotherapy are to provide pharmaceutical care with right medicine, right doses, in right time. If, the treatment plan can be in evidence based, it will improve treatment efficacy and safety, can prevent from drug related adverse event and reduce the health care costs.Assessing the drug related problems in elderly patients is a main health care and safety issue for the health care system.Ischemic heart disease (IHD) is one of major cause of mortality and one of the main diseases of morbidity in Mongolia and in the Worldwide.Objective: Aim of this study was to conduct a retrospective study on inappropriate prescribing pattern among elderly patients with Ischemic heart disease who were treated in tertiary level hospitals of Ulaanbaatar.Methods: Total of 438 patient’s records who were treated with diagnosis of IHD during the 2011 – 2012, was collected randomly from main three state hospitals of Ulaanbaatar. A retrospective analysis of inappropriate drug prescription was used Beers criteria (2012).Variables of study were patient’s diagnosis, age, sex, names, doses and route of medications.Results: The mean age of the participants was 67.38±0.24 and 54.6% of participants were male and 44.4% were female.The trends of rational use of drug and number of drug and drug cost per patients were different in each tertiary level hospitals of Ulaanbaatar. In I state hospital, number and cost of drug per patients were higher than second and third state hospitals. The result were shown that in all three hospitals, more than 50 percent of total drugs per patients were injection, less than 50 percent of total use drug per patients were from standard therapeutic guideline.The most common inappropriately used drugs were as follows: amiodarone (16% at the I state hospital; 10% at the II state hospital; 3% at the III state hospital), dipyridamole (51% at the I state hospital; 3% at the II state hospital), amitriptyline (29% at the I state hospital; 20% at the III state hospital), nifedipine (33% at the II state hospital).The use of that are inappropriate with certain medical conditions were common in case of IHD patients with peptic ulcer comorbidity. Non-steroid anti-inflammatory drug + acetyl salicylic acid combination were used in 3% of patients at the I state hospital, in 4% of patients at the II state hospital and 1% of patients at the III state hospital.Conclusion: Among the medications used to elderly patients with IHD, 15 medications were listed in potentially inappropriate medication in elderly (Beers criteria) independent of diagnosis. In I and II state hospitals, usage of potentially inappropriate medication were greater than III state hospital.

Background. Cardiovascular diseases (CVD) constitute major cause of death in patients with chronic kidney disease (CKD). It is well established that in decreased renal function is associated with an increased risk of arterial stiffness, so patients with end stage renal disease have a very high risk for cardiovascular events. There have been no reports of the assessment of arterial stiffness in patients at different stages of non diabetic CKD in Mongolia.Aim. The purpose of this study was to determine the correlation between an estimated glomerular filtration rate (eGFR) and cardio-ankle vascular index (CAVI) in the CKD patients. Material and Methods. From a hospital-based population, 125 patients with CKD (mean age 40.30±10.82) were recruited. CKD was evaluated by the eGFR using the Cockcroft-Gault formula. CAVI was determined as an index of arterial stiffness.Results. The mean CAVI was in CKD level l ( 6.00±0.81, p 0.0001), ll (6.90±0.77, p 0.0001), lll (7.42±0.65, p 0.0001), lV (7.63±1.22, p 0.0001) and V (8.02±1.27, p 0.0001). CAVI was negatively correlated significantly with eGFR (r=-0.596, p 0.0001) and age (r=0.543, p 0.0001). Linear regression analysis indicated that CAVI was correlated significantly with eGFR (β=-0.466, p 0.0001) and age (β=0.373, p 0.0001).Conclusion. Decreased eGFR is associated with an increased risk of arterial stiffness, and it could be a strong predictor of risk factor for CVD in CKD patients.

Background: The World Health Organization calls hypertension the number one risk factor for death in the world and it’s considered a significant risk for stroke, heart failure, and kidney failure. Hypertension is common in patients with chronic kidney disease (CKD), and high blood pressure (BP) has been associated with a decrease in kidney function. The purpose of this study was to determine the correlation between an estimated glomerular filtration rate (eGFR) and BP in the CKD patients. Methods: From a hospital-based population, 125 patients with CKD (mean age 40.30±10.82) were recruited. CKD was evaluated by the eGFR using the Cockcroft-Gault formula. Cardio-Ankle vascular index (CAVI) was determined as an index of arterial stiffness. BP was measured using a mercury sphygmomanometer after subjects had sat and rested for at least 15 minutes. Pulse pressure was calculated as the difference between systolic BP (SBP) and diastolic BP (DBP). Mean arterial pressure was calculated as DBP plus one-third (SBP-DBP).Results: When BP grows up, renal function (eGFR 113.72±57.85, 78.39±60.96, 60.56±55.71, 28.38±19.96) and arterial stiffness (CAVI 6.51±0.99, 6.90±1.05, 7.22±1.17, and 7.79±1.16) are decreased. Linear regression analysis indicated that eGFR was correlated significantly with SBP (β=-0.480, p< 0.0001) and hypertension time (β=-0.332), p<0.0001). SBP was the strongest risk factors for CKD with each SD increase in systolic blood pressure (1mmHg) associated with > 4% higher risk ( hazard ratio: 1.04; 95% Cl: 1.02-1.07).Conclusion: Increases SBP were significantly associated with CKD.

Today, there are 382 million people living with diabetes. A further 316 million with impaired glucose tolerance are at high risk from the disease – an alarming number that is set to reach 471 million by 2035. One of the most overlooked of all serious complications of diabetes is cardiovascular autonomic neuropathy (CAN) which encompasses damage to the autonomic nerve fibers that innervate the heart and blood vessels, resulting in abnormalities in heart rate control and vascular dynamics. The present report discusses the clinical manifestations (eg, resting tachycardia, orthostatic hypotension exercise intolerance, intra operative cardiovascular liability, silent myocardial infarction (MI), and increased risk of mortality) in the presence of CAN. The reported prevalence of CAN varies greatly depending on the criteria used to identify CAN and the population studied. CAN prevalence ranges from as low as 2.5% of the primary prevention cohort in the Diabetes Control and Complications Trial (DCCT) to as high as 90% of patients with long-standing type 1 diabetes who were potential candidates for a pancreas transplantation. Objective: The aim of this study was to evaluate the Cardiac Autonomic Neuropathy (CAN) among diabetic patients.This study included patients with T1 DM and 20 patients with T2 DM total (97 male, 86 female) diabetic patients. The CAN diagnosed by 6 clinical tests: Resting Heart Rate (RHR), Expiration : Inspiration (E:I) ratio, Heart rate response to standing (30:15 ratio), Orthostatic hypotension (OH) and Sustained Hand Grip (SHG) using Cardiac Autonomic Neuropathy System Analyzer CAN-504. CAN was indicated at least two of five tests are abnormal.Diabetic patients’ mean age was 48.74±12.74, diabetes duration 7.55±5.72, systolic blood pressure 136.25±22.76mm Hg, diastolic blood pressure 84.82±11.90 mmHg, cholesterol 5.04±1.04mmol/l, triglyceride 2.20±1.24mmol/l, LDL2.64±0.85mmol/l, HDL 1.12±0.41mmol/l, non-HDL 3.71±1.06, cholesterol/HDL ratio 4.70±1.29, HBA1c 10.08±2.39%. Result of RHR resting heart rate test was normal 92%, borderline 0.5% and abnormal 7.1%,Expiration:inspiration(E:I) ratio was normal 72.7%,borderline 13.7% and abnormal 14%, Heart rate response to standing (30:15ratio) was normal 47%,borderline 13.714% and abnormal 39.3%, Valsalva was normal 97.8%,borderline 2.2% and abnormal 0%, Orthostatic hypotension (OH) was normal 66%,borderline 29% abnormal 6% and Sustained hand grip(SHG) test was normal 4.9%,borderline 9%, and abnormal 87.8%.Number of abnormal cardiac autonomic neuropathy test results <2 (no cardiac autonomic neuropathy) was in 86(47%) and >2 (with cardiac autonomic neuropathy) was in 97(53%) among diabetic patients. Among diabetic patients cardiac autonomic neuropathy (CAN) was 53%.

BackgroundTraditional Mongolian Medicine has a history of over 5000 years. Scientific development of TM hasstarted in 1959. Since 1999 Mongolia was categorized by WHO as a country having an Integrativesystem of TM- officially recognized and incorporated into all areas of health care provision, TMMresearch has been following key objectives of National R&D programs.AimIn order to assess the situation of TMM development we have conducted this study based on last10 years’ research done.Ìaterial and MethodsDocument study- we have selected key TMM’s R&D project implementers’ archive and humanresources documents.Descriptive and Analytic methods- a survey of 32 questions evaluating participation of TMMprofessionals in R&D work were conducted. Also, to clarify the point of view about TMM’s R&D6 focus group meetings with different level participants, such as professional committee, policymakers and research workers as well as health care providers, were organized.ResultsFrom 2004-2013, there are 28 projects implemented on TMM, 43% accomplished by TMMRTC,32.8% of which is resulting in raw materials standardization and technology study, related clinicalstudies standing 20% out of all studies done on TMM matter. These numbers are confirmed bysurvey and focus group interviews, more than 50% of participants willing to conduct a clinical studyand expressing difficulties such as lack of knowledge of methodology, policy support and revenue.Conclusions:1. TMM R&D has a potential growth due to human resources capacity. Practitioners are leastinvolved in R&D, due to lack of knowledge of methodology and revenue.2. There were 28 projects implemented on TMM matter, most of these are basic studies, fewerclinical studies done, resulting in pharmacopeia monographs and technological guidelines.

IntroductionThe main principles of pharmacotherapy are to provide pharmaceutical care with right medicine, right doses, in right time. If, the treatment plan can be in evidence based, it will improve treatment efficacy and safety, can prevent from drug related adverse event and reduce drug cost. Ischemic heart disease is one of major cause of mortality and one of the main diseases of morbidity in Mongolia and in the Worldwide.GoalAim of study was to conduct retrospective study on medications used for in-patients with Ischemic heart disease of tertiary level hospitals of Ulaanbaatar.Materials and MethodTotal of 438 patient’s records was collected randomly from 3 state hospitals, which were treated with diagnosis of ICD. Variables of study were patient’s diagnosis, age, sex, names, doses and route of medications.ResultThe trends of rational use of drug and number of drug and drug cost per patients were different in each tertiary level hospitals of Ulaanbaatar. In I national hospital, number and cost of drug per patients were higher than second and third state hospitals. The result were shown that in all three hospitals, more than 50 percent of total drugs per patients were injection, less than 50 percent of total used drug per patients were from standard therapeutic guideline. In second state hospital, anticoagulant and anti-platelet agents were chosen less than first and third state hospitals. In order to decrease cardiac oxygen demand and improve cardiac microcirculation, nitrates were chosen mostly in second and third state hospitals but, beta blockers were chosen mostly in first state hospital.ConclusionThe study results shown the treatment pattern and trends of rational use of drugs in in patients with ischemic heart disease have been different in tertiary level hospitals of Ulaanbaatar.

Background: The main principles of pharmacotherapy are to provide pharmaceutical care with right medicine, right doses, in right time. If the treatment plan can be evidence based, it will improve treatment efficacy andsafety, can prevent from drug related adverse event and reduce the health care costs. Assessing the drug related problems in elderly patients is a main health care and safety issue for the health care system. Ischemic heart disease (IHD) is one of major cause of mortality and one of the main diseases of morbidity in Mongolia and in the Worldwide.Objective: Aim of this study was to conduct aretrospective study on inappropriate prescribingpattern among elderly patients with Ischemic heart disease who were treated in tertiary level hospitals ofUlaanbaatar.Methods: Total of 438 patient’s records who were treated with diagnosis of IHD during the 2011 –2012, was collected randomly from main three state hospitals of Ulaanbaatar. A retrospective analysis of inappropriate drug prescription was used Beers criteria (2012).Variables of study were patient’s diagnosis, age, sex,names, doses and route of medications.Results: The mean age of the participants was67.38±0.24 and 54.6% of participants were male and 44.4% were female. The trends of rational use of drug and number of drug and drug cost per patients were different in each tertiary level hospitals of Ulaanbaatar. In I state hospital, number and cost of drug per patients werehigher than second and third state hospitals. The result were shown that in all three hospitals, more than 50 percent of total drugs per patients were injection, less than 50 percent of total used drug per patients were from standard therapeutic guideline. The most common inappropriately used drugs were as follows: amiodarone (16% at the I state hospital; 10% at the II state hospital; 3% at the III state hospital),dipyridamole (51% at the I state hospital; 3% at the II state hospital), amitriptyline (29% at the I state hospital; 20% at the III state hospital), nifedipine (33% at the II state hospital).The use of that are inappropriate with certain medicalconditions were common in case of IHD patients with peptic ulcer comorbidity. Non-steroid anti-inflammatory drug + acetyl salicylic acid combination were used in 3% of patients at the I state hospital, in 4% of patients at the II state hospital and 1% of patients at the III state hospital.Conclusion: Among the medications used for elderly patients with IHD, 15 medications were listed in potentially inappropriate medication in elderly (Beers criteria) independent of diagnosis. In I and II state hospitals, usage of potentially inappropriate medication were greater than III state hospital.Key words: inappropriate drug, Beers criteria,ischemic heart disease, treatment guideline