Introduction: Various modalities oftechniques from standard discectomy,microdiscectomy, percutaneous discectomy,and transforaminal endoscopic discectomyhave been in use for lumbar intervertebraldisc prolapse1. The access to spine is keptto a minimum without stripping paraspinalmuscles minimizing muscle damage bytransforaminal endoscopic approach2.Currently in the population of the Mongoliabeen increased of the spinal nerve rootcompression, which are resulting in lumbardisc pathological changes. In other developedcountries has been successfully introducingthe spine endoscopic surgery use for thatpathological changes. In regard to our countryhad not yet implemented for until now asthese high technological surgeries3. Spinesurgery department team of the GrandMedhospital had successfully introduced that thespine endoscopic surgery.Materials and Methods: We performedtransforaminal endoscopic lumbardiscectomy surgeries on patients age of 24,38, 78 on July/23/2016 All patients withsingle nerve root compression due to Lumbardisc herniations, including sequestrated ormigrated and selected central disc at L4-5. All patients had preoperative MRI andpostoperative MRI to check the adequacy ofdecompression. All patients were operatedby 18-mm ports of the S-Gun endoscopicequipments. Procedure had done under localanesthesia. Postoperatively, all patients weremobilized as soon as the pain subsided anddischarged within 24-48 h post-surgery.Patients were followed up at 2, 6 weeks.Results: The mean follow up was 2-6weeks. The average surgical time was 70min (range 25-210 min). Average blood losswas 20-30 ml. Postoperative MRI showedcomplete decompression. All of patients hadgood-to-excellent results and straight raisingleg test (Lasegue) were 90/90 respectively.All patient is preoperatively visual analogyscale was 8±1 and then became to 1±1.Conclusion: Microendoscopic discectomyis minimally invasive procedure fordiscectomy with results of this procedure areacceptable safe and effective. However, forthis technique has required to do accuracyand experienced surgeon.

Background: Diabetes mellitus (DM) is a chronic progressive metabolic disorder. According to International Diabetes Foundation (IDF) estimation in 2019, globally 463 million adults have diabetes among the population aged 20-79. If this trend continues, 700 million of people will have diabetes by 2045, and the larger increases will occur in low- and middle-income countries. In Mongolia, the prevalence of Diabetes 5.4%. Regularly assessing the quality of life (QOL) in the control of patients with diabetes is important to evaluate the effectiveness of management, to plan treatment and thus to improve monitoring. Meaningful. The purpose of our study was to evaluate the Validity and Reliability of the Mongolian Version of the World Health Organization’s Quality of Life Questionnaire (WHOQOLBREF) in patients with Type 2 Diabetes. Methods: The cross sectional survey was conducted in Ulaanbaatar. For the study 150 patients with T2DM were recruited, who have met the inclusion criteria and agreed to the informed consent. In the study, self-management control, beliefs about illness, depression were assessed. Additionally, anthropometric measurements, blood pressure (BP), levels of glucated hemoglobin level (HbA1C), lipids and fasting blood glucose (FBG) at the baseline and after 3 months follow ups were measured. Statistical analyses was performed using SPSS 21 software. Results: The study involved newly diagnosed Type 2 diabetes with mean age of 49,4±8,9 years. 65 men (43,6%), 85 women (56,7%) and 39,3% of the participants had a family history of diabetes. The Cronbach’s alpha for analysis of the reliability of the WHOQOLBREF was a=0.74-0.84. The patient’s fasting blood glucose FBG, HbA1c, and low-density lipoproteins (LDL) were statistically significantly higher (p <0.05) than normal and the triglyceride (TG) was increased, but it was not statistically significant (p> 0.05). The mean TG had statistically significant (p <0.05) increase by sex. There is a need for further study of the specific questionnaire of QOL people with diabetes. Conclusion The Mongolian version of the WHO Quality of Life Questionnaire evaluating diabetes patients, the internal consistency of the questionnaire was reliable and the validity was a = 0.74-0.84.

Introduction. Cancer of unknown primary (CUP) is histologically defined as the presence of a metastasis of lymph node without detection of the primary tumor [1]. Approximately 3–15% of all cancers are designated as CUP [3. 4]. The diagnosis, treatment and monitoring of patients with laterocervical metastases of unknown primary involves a wide range of oncologic entities [5]. While we were studying patho-histological examination of cervical lymphadenopathy in Mongolian, werevealed unknown primary tumor. This is a goal of our study. Objectives of study are followings to differentiate whether primary lymphoma or metastatic cancer of cervical lymph node metastasis of unknown primary tumor and to reveal primitive origin of tumor using by basic and additional immunohistochemical markers.Goal.To determine the conclusive diagnosis in cervical lymph node metastasis of unknown primary origin by immunohistochemical techniqueMaterials and Methods. In this study, we examined immunohistochemically 30 cases of outpatient head and neck surgical unit of the National Cancer Center and dentistry and oral maxillofacial surgical unit of the State Central Hospital which were diagnosed as cervical lymphadenopathy. For immunohistochemical study, we applied an immunohistochemical panel in accordance with avidinbiotin- peroxidase complex method and used a basic and additional antibodies represented by CK(pancytokeratin), LCA, synaptophysin, chromogranin and HMB45. Result. In our study, there was 63.3% lymphoma, 36.7% metastatic cancer. Among them, there were 4 of digestive tract adenocarcinoma, 3 of squamous cell carcinoma /2-esophagus, 1-nasopharyngeal/, 2 of neuroendocrine tumor and 1 of melanoma.Distribution by age groups shows that 20-29 years were 4(13.3%), 30-39 years were 10 (33.3%), 40-49 years were 8 (26.7%), 50-59 years were 3 (10%), over60 years were 5 (16.7%). Gender distribution showed an increased incidence of males (56.7%, 17 cases) compared with females (43.3%, 13 cases).Conclusion: In our study, B cell lymphoma and digestive tract adenocarcinoma were the most common. In further, it is necessary to introduce an immunohistochemical method in patho-histological practice.

To evaluate the efficacy and safety of bevacizumab monotherapy or combined with laser versus laser monotherapy in Mongolian patients with visual impairment due to diabetic macular edema.Prospective, randomized, single-center, a 12 month, laser-controlled, clinical trial. Participants: One hundred twelve eligible patients, aged ≥18 years, with type 1 or 2 diabetes mellitus and best corrected visual acuity (BCVA) in the study eye of 35 to 69 Early Treatment Diabetic Retinopathy Study (ETDRS)letters at 4 m (Snellen equivalent: ≥6/60 or ≤6/12), with visual impairment due to center-involved diabetic macular edema (DME). Methods: Patients were randomized into three treatment groups:(I) intravitreal bevacizumab monotherapy (n=42), (II) intravitreal bevacizumab combined with laser (n=35), (III) laser monotherapy (n=35). Bevacizumab injections were given for 3 initial monthly doses and then pro re nata (PRN) thereafter based on BCVA stability and DME progression. The primary efficacy endpoints were the mean change in BCVA and central retinal subfield thickness (CRST) from baseline to month 12.Bevacizumab monotherapy or combined with laser were superior to laser monotherapy in improving mean change in BCVA letter score from baseline to month 12 (+8.3 and +11.3 vs +1.1 letters; both p<0.0001). There were significant difference detected between the bevacizumab and bevacizumab combined with laser treatment groups (p=0.004). At month 12, greater proportion of patients gained ≥10 and ≥15 letters and with BCVA letter score >73 (Snellen equivalent: >6/12) with bevacizumab monotherapy (23.8% and 7.1% and 4.8%, respectively) and bevacizumab + laser (57.1% and 28.6% and 14.3%, respectively) versus laser monotherapy. The mean central retinal subfield thickness was significantly reduced from baseline to month 12 with bevacizumab (−124.4 μm) and bevacizumab + laser (−129.0 μm) versus laser (−62.0 μm; both p<0.0001). Conjunctival hemorrhage was the most common ocular events. No endophthalmitis cases occurred.Bevacizumab monotherapy or combined with laser showed superior BCVA improvements over macular laser treatment alone in Mongolian patients with visual impairment due to diabetic macular edema.

Background: Poor laboratory quality can lead to misdiagnosis and inappropriate treatment of patients. To demonstrate the quality and reliability of their services, medical laboratories seek accreditation to ISO 15189. We have initiated a project to assist laboratories in their efforts to obtain the accreditation. Goal: Conduct a gap analysis of the status of preparedness of medical laboratories for accreditation. Materials and Methods: Six laboratories are selected for participation in the project. In the first phase of the project, a gap analysis of the participant laboratories is conducted using an Excel program based on ISO 15189 requirements. Results: The findings reveal that the participant laboratories are the strongest in Organization and management of laboratory, Quality of examination results, Personnel and facility management and in Laboratory information management. The majority of the laboratories are hospital based, and their organization and management are well established and functional mostly due to centralized administrative guidance. The concept of quality control is effectively adapted in medical laboratories, therefore ensuring the quality of examinations and the data management are usually in line with the requirements. Weaker areas include Evaluation and audits, and Document control. Even though the laboratories do conduct evaluations and control, they do not do it regularly and, most importantly, do not keep records routinely, which cause the higher gap rate. Conclusion Policies to meet ISO 15189 requirements are in place in the participant laboratories, but their documentation and records keeping are insufficient.

BACKGROUND. Congenital Cleft Lip and/or Palate (CL/P) is a common craniofacial birth defect and occurs 1 per 500-700 live births in average. Children with CL/P at a higher risk for speech/language problems due to the anatomical and structural differences in the oral and nasal cavities, Velopharyngeal Insufficiency causing speech disorders with articulation, phonation, and resonance, respectively. It leads to long-lasting adverse outcomes, influencing quality of life and causes obstacles in child’s socialization. Speech in 2007 Therapy team of School of Dentistry ( G. Ariuntuul , B. Bulgan, U. Azzaya, B. Batsukh, M. Bat-Erdene), Mongolian National University of Medical Sciences (MNUMS) (former Health Sciences University of Mongolia) established and successfully conducted a first clinical speech therapy sessions for children with clefts in Mongolia based on the Department of Oral and Maxillofacial Surgery (G. Ayanga et al.) of National Maternal and Children’s Health Center (NMCHC). Since 2012 the speech therapy team of School of Dentistry, officially transferred the equipped operating speech room to NMCHC and speech pathologist B. Bulgan, supervised and trained by Ariuntuul G. recruited by NMCHC for a full time position and working as a member of multidisciplinary team till present. OBJECTIVES. To assess and analyze registry data of children with clefts, visited speech therapy sessions of speech pathology team of School of Dentistry, MNUMS during 2007 through 2012. MATERIAL AND METHODS. Registry based retrospective study was conducted to obtain demographic and speech disorder related data of children with clefts, visited speech therapy sessions between 2012-2017 at the NMCHC. RESULTS. In total 203 participants are attended the speech therapy sessions: 103 male (51%), 100 female (49%). Out of total 203 children 144 (71%) had Cleft Lip and Palate (CLP), 44 had cleft palate only (22%), 15 had cleft lip (7%), respectively. Average age for primary cleft surgery was 1y13m, where as for secondary was 4y22m. CONCLUSION. For speech therapy session for children with clefts boys were dominant compared to girls (1:1.03). By the types of clefts children diagnosed with Cleft Lip and Palate was prevalent to attend treatment classes. There is a need in early CL/P diagnosis, using birth screening and furthermore, traning of speech therapists/pathologists are important for development of multidisciplinary team, surgery outcome and improvement of quality of life of children with clefts.

ABSTRACT. Recurrent aphthous stomatitis, or RAS, is common oral disorder of uncertain etiopathogenesis for which only symptomatic therapy is available. This article reviews the current clinical features of RAS among study patients and the result of therapeutic effects of the herbal preparation Akhizunber. Over the past four years we have treated 61 RAS patients with different clinical forms by herbal preparation Akhizunber or Alumekatin. The distribution of clinical forms RAS RAS among study patients were minor aphthae -75.4%, major aphthae -16.4% and herpetiform ulcers -8.2% respectively. The healing time of treated Akhizunber was in minor aphthae -9.28±4.82 days, major aphthae -14 days and herpetiform ulcers -12 days. Of the total study participants, the patients treated by Akhizunber reported a rapid and complete recovery from RAS during treatment compared with treated patients by Alumekatin. Treatment with herbal preparation Akhizunber can be effective for patients suffering from RAS in any clinic form, regardless of their ulcer number and size.

BACKGROUND The occurrence of facial injuries tends to be high compared to injuries in other parts of the body, because the face is without a protective covering, and the chin mandible is the most prominent bone in this region of the body. According to several studies, mandibular fractures account for 59% of all facial fractures. Mandibular fractures usually occur in 2 or more locations because of the bone’s U shape. This article aims to analyze retrospectively the age, gender, etiology, and anatomic distribution of mandibular fractures. METHODS The data for this study were obtained from the medical records of 1217 cases treated at Department of Oral and Maxillacial Surgery at National First Central Hospital of Mongolia in 2016. Information was collected from the clinical notes of each patients with mandible fractures. The demographic variables such as age, gender and clinical information included diagnosis, etiology, and anatomical distribution of fractures was assessed. RESULTS The total of 229 subjects had mandible fractures, out of which 209 were males and 20 were females. The mean age of the participants was 32,2±10. The major cause of fractures was assault 79% , followed by road traffic accident – 11%, sport injuries – 5%, accidents at work or home – 3%, other – 2%. Mandible fracture incidence were high during in August. By the time referred to a physician from day of injury were 1-5 days 72,1%, 6-10 days 25,7%, delayed more than 10 days were 2,2% of the cases. Unilateral fractures were 77,4%, bilateral fractures 21,7%. Mandible left side were 158 (65,9%) mostly injured. The most common fracture site was angle- 112 (53%), condyle- 58 (27,5%), body- 21 (9,9%), parasymphysis- 16 (7,6%) and at least common site were ramus- 2 (1%) and symphysis - 2 (1%) of mandible. Among multiple fractures most common sites were condyle-parasymphysis which 24 cases and angle – parasymphysis were 21 cases. CONCLUSION The following conclusions have been drawn from the foregoing study. The mandible fractures were more common in males 209 (91,3%) than females 20 (8.7%). Assaults were the most common cause of the fracture. 77,4% fractures were unilateral fractures. The most common site of fracture was mandible angle- 112 (53%) and common multiple fractures were condyle-parasymphysis. By the time referred to a physician from day of injury were 1-5 days 72,1%, 6-10 days 25,7%, delayed more than 10 days were 2,2% of the cases.