Introduction: Last Decades, Date by date medical developments providing friendly, high-efficiency treatment equipment and services in developed countries are working toward an advanced, as our country medical services are trying to that country’s technology has been introduced. In our country every day there is only surgical care necessary to endocrine gland disorders, including most common thyroid surgery. It is open and robotic assistant endoscopic surgery in the world. But robotic assistant endoscopic surgery is too expensive and impossible in our country. Thus we chose Thunderbeat for open thyroid surgery in especially huge enlarged goiter and vascularized goiter to try prevent bleeding, recurrent laryngeal nerve palsy and post operation hematoma and other complications Thunderbeat is new generation instrument combines an advanced bipolar clamp to the existing ultrasonic cutter. Materials and Methods: M 51-years-oldwoman was admitted to Mongol Hyundae hospital because of front of neck pain, multi nodular goiter, tachycardia, sweaty and not controlling emotion. Anamnesis: She diagnosed to Thyrotoxicosis in 2005 and she took medicine last ten years but not controlling that poisoning. Status locals: Huge enlarged goiter in front of her neck Treatment plan: 1. Preoperative Preparation 2. Operation: Open total thyroidectomy 3. Medicine 4. Wound dressing 5. Observation We did operation after day of admission day, Patient is placed in a Semi erect position with a folded sheet underneath the shoulders so that the head is sharply angulated backward on the multifunctional surgical table under general anesthesia. We used thunderbeat from muscular to all procedures, dissection both thyroid gland and isthmus after Kocher skin incision and sub skin tissue dissected. There is no complication while procedure and post operation days Result: Nodular hyperplasia of thyroid gland with focci of micro adenomatous change Conclusion: Thunderbeat in use open thyroid surgery first outcomes blood loss than 30ml, no injury of recurrent laryngeal nerve and no penetration ligament of Berry while procedure, second outcomes no hematoma, painless, wound healing process faster and short time hospitalization.

Introduction: Last Decades, Date by datemedical developments providing friendly,high-efficiency treatment equipment andservices in developed countries are workingtoward an advanced, as our country medicalservices are trying to that country’s technologyhas been introduced. In our country everyday there is only surgical care necessary toendocrine gland disorders, including mostcommon thyroid surgery. It is open androbotic assistant endoscopic surgery in theworld. But robotic assistant endoscopicsurgery is too expensive and impossible inour country. Thus we chose Thunderbeatfor open thyroid surgery in especially hugeenlarged goiter and vascularized goiter to tryprevent bleeding, recurrent laryngeal nervepalsy and post operation hematoma andother complicationsThunderbeat is new generation instrumentcombines an advanced bipolar clamp to theexisting ultrasonic cutter.Materials and Methods: M 51-years-oldwomanwas admitted to Mongol Hyundaehospital because of front of neck pain, multinodular goiter, tachycardia, sweaty and notcontrolling emotion.Anamnesis: She diagnosed toThyrotoxicosis in 2005 and she tookmedicine last ten years but not controllingthat poisoning. Status locals: Huge enlargedgoiter in front of her neckTreatment plan:1. Preoperative Preparation2. Operation: Open total thyroidectomy3. Medicine4. Wound dressing5. ObservationWe did operation after day of admissionday, Patient is placed in a Semi erect positionwith a folded sheet underneath the shouldersso that the head is sharply angulated backwardon the multifunctional surgical table undergeneral anesthesia. We used thunderbeatfrom muscular to all procedures, dissectionboth thyroid gland and isthmus after Kocherskin incision and sub skin tissue dissected.There is no complication while procedureand post operation daysResult: Nodular hyperplasia of thyroidgland with focci of micro adenomatouschangeConclusion: Thunderbeat in use openthyroid surgery first outcomes blood lossthan 30ml, no injury of recurrent laryngealnerve and no penetration ligament of Berrywhile procedure, second outcomes nohematoma, painless, wound healing processfaster and short time hospitalization.

Introduction: Beginning 15 May 2019, the consumption of raw coal in Ulaanbaatar has been replaced by the consumption of briquette fuel for the improvement of air quality according to Governmental Resolution No.62 adopted in 2018. Since after this resolution has been in placed the number of CO poisoning has been increased as of 18 December 2019, nine persons were died and 1394 people get a health care service due to CO poisoning. However, it has been not been assessed briquette affect to the indoor air quality and its health impact. Thus, it is need urge to define the indoor air quality effect of briquette and its heath impact. Goal: To assess the indoor air quality of the household using the “improved briquette” and identify the causes of the risk. Material and Method: This a cross-sectional survey, conducted from January 31, 2020 to April 31, 2020, data were obtained by quantitative, qualitative (observation, interview) and direct indoor air quality measurement. The survey sampling frame was 40 households in central 6 districts of Ulaanbaatar that used improved fuels (20 households with a history of carbon monoxide poisoning and 20 households that were not affected), and 14 households in the Nalaikh district that used raw coal, in total of 54 households were participated. Indoor air quality was measured by PM2.5, PM10, CO, SO2, NO2, and microclimate per household for 24 hours during a week.
The statistical data analysis was done by the SPSS-23 program and preformed required parametric and non-parametric tests. The normality of the data was checked by the Kolmogorov-Smirnov test. The most of data was not normally distributed. So, thus we used median and used relevant non-parametric tests. The average level of microclimate indicators, and air quality indicators were defined as mean, median and its IQR and standard deviation. The 95% confidence intervals of mean and frequencies were determined and used to differentiate group differences.
The Ethical permission to start the survey was approved by the 2nd meeting of the Ministry of Health on February 4, 2020. The committee was reviewed and approved the research methodology based on whether data collection technique and tools are considered the ethical issues, and whether provided accurate information for make decisions to enroll to the survey for respondents. Results: According to the health statistic, from October 2, 2019 to March 31, 2020, a total of 2,768 people from 837 households were exposed to carbon monoxide poisoning. Of the total reported cases, 10 were drunk, and 2 were due to other disease complications, and a total of 2,756 cases were confirmed diagnosis as carbon monoxide poisoning.
Emissions of CO were recorded every 15 seconds and the results were calculated by conducting continuous measurements per household for 24 hours a week. The level of CO emitted into the indoor environment of households exposed by carbon monoxide had increased during the following time from 7 am to 9 am in the morning, from 13 pm to 15 pm, from 18 pm to 20 pm in the evening, and from 22 pm to 24 pm at night. During this period of time, the indoor air CO level had increased from the WHO mild poisoning recommendation level. Conclusion It has been defined that the carbon monoxide emits to the indoor air households which are using an improved fuel according to measurement the 30 minutes, 31-60 minutes, and 61-120 minutes after burning.

Introduction: Health care workers of First Central Hospital of Mongolia have vaccinated with three different vaccines against SARS-CoV-2. We detected SARS-CoV-2 N and S-RBD antibodies after 30-90 days of second dose of vaccination. Method: Quantitation of antibodies to the spike protein of SARS-CoV-2 was performed for the detection of adaptive immune response in 291 HCWs vaccinated with Covishield, Sinopharm and Pfizer Biontech. Detection and quantitation of SARS-CoV-2 N and S antibodies were performed by the electrochemiluminesce assay Cobas e411, Roche. Result: SARS-CoV-2-S-RBD IgG titer were negative 0%, weak positive 0.4%, positive 17.5%, strong positive 82.1% of 246 HCWs vaccinated with Covishield and were negative 2.8%, weak positive 8.5%, positive 57.1%, strong positive 31.4% of 35 HCWs vaccinated with Sinopharm.
In all HCWs vaccinated with Pfizer Biontech SARS-CoV-2-S-RBD IgG titers were strong positive. Conclusion Humoral immunity was produced in HCWs after two doses of Covishield vaccine 100%, Sinopharm 97.0%, Pfizer Biontech 100% respectively. Antibody titer was higher among younger age workers.