Palliative medicine deserved to improve quality of life of patients with advanced, incurable diseases. During last 13 years palliative care workers tried to palliate the pain, physical, psychological, spiritual symptoms of suffering, but they never measured the quality of life of palliative care patients. The term quality of life is used to evaluate the general well-being of individuals and societies. 111 countries of the World established Country QOL Index. Quality of life should not be confused with the concept of standard of living, which is based primarily on income, should not be confused with quality of health services, which is based on medical supplies, equipment, quality of medicine, education level of health workers. Health related quality of life (HRQOL) is “The degree to which a person enjoys the important possibilities of his or her life”. Health related quality of life index not established for all medical specialties. Some tools for measuring quality of life established for diabetic patients (DQOL), cancer patients (Ca QOL), HIV patients (HIVQOL), and palliative care patients (Pa QOL). In Mongolia since 2000 started to talk about quality of services and in 2008 started program on quality of health services, but never provided study of health related quality of life of any patientTo provide the study of quality of life index within palliative care patients and compare quality of life index with pain score and score of other physical, psychological, spiritual suffering of palliative care patientsWe provided study of quality of life index within 60 palliative care patients by MISSOULA-VITAS®- 15 quality of life index, pain score by Wong Baker scale, symptoms of suffering by Anderson method, functional activities by Karnofsky performance scale, psychological problems by hospital anxiety scale23.3% of patients were up to 45 years old, 76.6 % were older 45. 70% of palliative care patients in our study were patients with cancer, 30% were palliative care patients with non cancer pathology. The mean Quality of life Index of total palliative care patients was 37.7. They had more common symptoms of suffering, like pain (90%), fatigue (83.3%), weight loss (83.3%), poor appetite (66.6%), thirst (66.6%), nausea (53.3%), constipation (60%)., depression (66.7%) and anxiety (70%). 56.6% of palliative care patients had spiritual suffering because of false hope, lost of meaning, relationship problems, and forgiveness. Increasing the score of symptoms of physical, psychological, spiritual and social suffering correlated to decreasing the quality of life index.We need to develop comprehensive palliative care to improve quality of life palliative care patients.

To study the correlation within psychological and social suffering in palliative care cancer patientsWe provide study within 100 palliative care patients with cancer stage 3-4. Depression was evaluated by San Diego hospice screening method with 3 questions. Anxiety was assessed by Spielberg -Hanin anxiety scale. Spiritual pain was assessed by San Diego hospice questionnaire, which includes main 4 factors of spiritual suffering, like cooperation, meaning of life, hope, forgiveness. Results of study was statistically evaluated by SPSS20 program.19% of patients had depression, 40% had anxiety, 46% patients had insomnia. 18% of patients with depression had spiritual suffering. 33% of patients with anxiety had spiritual pain. 31% of patients with insomnia had spiritual pain. Depression and spiritual suffering had mild correlation (R-0.318), anxiety and spiritual suffering had mild correlation (R-0.330), insomnia and spiritual suffering had very strong correlation (R-0.84). Psychological suffering of palliative care cancer patients increased with spiritual suffering and correlated with spiritual suffering. Especially insomnia had very strong correlation with spiritual suffering (R-0.84).

Background Educating diabetic patients about their diseases encourages their families to learn as much as possible about the latest medical management and approaches, as well as informing healthy lifestyle choices, and supports their responsibility in improving their condition and quality of life through well-managed self-control. Goal To evaluate the outcomes of diabetes education in patients with T2DM. Materials and Methods The cohort survey was conducted at the Diabetes center of the State Central Clinical Hospital (SCCH) and District Health centers in Ulaanbaatar. Participants included 150 newly diagnosed patients with T2DM. Data collection was done by using internationally accepted questionnaire and anthropometric measurements and biomedical outcome measures such as Haemoglobin A1c levels, high density lipid (HDL), low density lipid (LDL), total cholesterol (TCh), triglyceride (TG), fasting blood glucose (FBG), blood pressure (BP), body weight (BW) at baseline and 3rd and 6th months of the follow ups. Statistical analyses were performed with the SPSS16 software. Results Diabetic patient’s knowledge (p=0.029) and self control of blood glucose (5.35±1.81 days in the last week) of newly diagnosed patients with T2DM improved statistically significantly (p=0.046) after 6 months diabetes education. Psychological problem areas in diabetes (PAID) score reduced in educated group 2.86% (95%CI 1.61 to 3.23) p=0.004 and points in illness perception questionnaire (IPQ) increased 8.95% (95%CI 5.31 to 10.1) p=0.001. After 6 months, the group of the newly diagnosed patients receiving diabetes education had decreased numbers in biomedical measurements: Systolic BP decreased 8mmHg (p=0.001), diastolic BP 2 mmHg (p=0.035), some anthropometric measurements including waist circumference (WC) decreased 2cm (p=0.014). Levels of HbA1C were 1.5% lower (p=0.001) in the diabetes educated group, LDL decreased 0.7 mmol/l (p=0.0001), and HDL increased 0.2% (p=0.036). Conclusion: 1. The data on the educated patients’ knowledge about diabetes, self control, psychosocial status, and illness perception are comparatively higher than those in the non-educated group. 2. The decrease in not only the levels of systolic and diastolic BP and WC of newly diagnosed patients with T2DM, but also levels of HbA1C and LDL together with the increase in levels of HDL indicates that the self control improves among educated patients.

Diabetes is known to be directly and indirectly associated with stress. Many researchers have reported that diabetes is actually induced by stress and several hormones includ¬ing cortisol are known to be involved.14 Though tight glycemic control is viewed as a primary indicator of favorable diabetes outcomes metabolic control , medication, and physical activity, contribute to a patient’s success in achieving desirable glycemic control. Our study aimed to evaluate improves depressive state in newly diagnosed patients with type 2 diabetes(T2DM) by education. The cohort survey was conducted in Ulaanbaatar. For the study we 150 patients newly diagnosed T2DM, who have met the inclusion criteria and agreed with informed consent. We have evaluated self-management control, beliefs about illness, depression. We measured anthropometric measurements, blood pressure (BP), levels of HbA1C, lipids and fasting blood glucose (FBG) at the baseline, in 3 and up to 6 months in educated and noneducated groups. Statistical analyses was performed using SPSS 16 software.The study involved newly diagnosed Type 2 diabetes 49,4±8,9 years men 65 (43,6%), women 85(56,7%) and 39,3% of the participants had a family history of diabetes. After 6 months self- control of blood glucose (p=0.046) significantly improved in educated newly diagnosed patients with T2DM. Problem areas in diabetes (PAID) score reduced in educated group -2.86 (95% CI -1.61 -3.23); (p=0.004) and illness perception questionnaire (IPQ) score increased 8.95 (95% CI 5.31-10.1); (p=0.001). Outcome shows positive improvements statistically increased diabetes self-management control IPQ score and decreased score PAID in the educated newly diagnosed patients T2DM.

DM is the long term chronic disease that leads to late stage vascular complications and pathogeneses of chronic complication started 5-10 years ago when the diagnosed diabetes. T2DM can remain asymptomatic for many years, majority associated complications or several chronic diseases. Main risk for people with diabetes, that hyperglycemia in microvascular complications and alteration of dyslipidemia makes macro vascular complications such as foot amputation, disability, cardiovascular disease, kidney disease, blindness and stroke. Our study aimed to evaluate foot care patients of type 2 diabetes (T2DM) and determained risk factors for foot complication in newly diagnosed T2DM. The survey was conducted in Ulaanbaatar. For the study we 188 and 150 patients newly diagnosed T2DM, who have met the inclusion criteria and agreed with informed consent. We have evaluated self care for foot and self-management control. We measured anthropometric measurements, blood pressure (BP), levels of HbA1C, lipids and fasting blood glucose (FBG) at the baseline, in 3 and up to 6 months in educated and noneducated groups. Statistical analyses was performed using SPSS 16 software. The study involved mean age 20-69 years and male 43.1 %, female 56.9 % patients with T2DM who have been controlled by endocrinologists’ in hospitals s of Ulaanbaatar. Also we studied patients newly diagnosed T2DM mean age was 49.4±8.9 male 65(43.6%), female 85(56,7%) and 39.3% of the participants had a family history of diabetes.In last week self reported servey was in male 3.7 % every day foot care, 93.8 % of male without self care in foot, in female 48.5 % every day foot care (p<0.003). There were statistically significant different between BMI, WC, BFP with normal (p<0.05). The weight, BFP were statistically significant different between gender BMI, WC, blood pressure were no significant between male and female (p>0.05) in newly diagnosed T2DM. Participant’s bad glycemic control for diabetic foot risk factors are FBG, HbA1c,LDL were significantly higher than normal of health adults (p<0.05), but there were no significant TG (p>0.05). However, total cholesterol, HDL were normal level. From above results, the TG was statistically different between gender (p<0.05) Poor control in foot care by selt management in patients with newly diagnosed T2DM. Therefore poor glycemic and metabolic control in patients newly diagnosed T2DM.

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.

Introduction Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) are the principal enzymes involved in catabolism of ethanol in human body. Alcohol is initially metabolized by ADH to acetaldehyde, which is consequently oxidized by ALDH to acetic acid. Individuals with low activity of alcohol-metabolizing enzymes show low tolerance to alcohol and are therefore rapidly intoxicated. Two studies on polymorphism of alcohol metabolizing enzyme genes in Mongolian population have been implemented to the date, but no assessment study of the serum activity of the enzymes have been conducted. Materials and Methods Fasting morning blood samples were collected from 240 adults 25-54 years of age (124 males and 118 females) from all provinces and the capital city of Mongolia. The serum levels of ADH and ALDH were determined using an enzyme-linked immunosorbent assay. Result: The mean serum level of ADH was 17.6 ng/mL and of ALDH was 15.91 ng/mL. The mean levels of the two enzymes of the surveyed from UB city were significantly lower than of those who lived in rural areas (p=0.000 for both ADH and ALDH). When the survey participants were divided into three age groups (25-34 years, 35-44 years and 45-54 years of age) and their mean levels of ADH and ALDH were compared, no significant age-related differences were found (p>0.05).

Goal: To determine average values of serum total cholesterol, triglycerides, high density lipid cholesterol and low density lipid cholesterol of Mongolian adults, and compare the average values by age groups, gender and regions. Materials and Methods: Serum was separated from morning blood samples collected from 1737 individuals 15-64 years of age (707 males and 1030 females) from 21 aimags and Ulaanbaatar city, and stored at-30°C until analysis. Mean levels of cholesterol, triglycerides, HDL and LDL were determined using photometric system. Results: The overall mean serum level of cholesterol was 159.06 mg/dl (95% CI 155.58-162.53), of triglycerides was 121.65 mg/dl (95% CI 116.77-126.53), of HDL was 61.12 mg/dl (95% CI 59.77-62.47), and of LDL was 130.53 mg/dl (95% CI 128.26-132.80). When the survey participants were divided into five age groups (15-24, 25-34, 35-44, 45-54 and 55-64 years of age) and their mean levels of cholesterol, triglycerides, HDL and LDL were compared, no statistically significant differences were observed between age groups. When the mean levels of lipids were compared between sexes, statistically significant differences were observed for cholesterol and triglycerides, and no statistically significant differences were observed for HDl and LDL.

The serum activity levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are important biochemical indicators of changes in the liver and coronary system function. The correct determination of changes in the activity levels of the transferases is essential for differential diagnosis and appropriate treatment of the diseases. Goal: The aim of this study was to determine the mean activity levels of ALT and AST of the Mongolian population. Materials and Methods: Serum was separated from morning blood samples collected from 1732 individuals 15-64 years of age (706 males, 1026 females) from 21 aimags and Ulaanbaatar city, and stored at -30°C until analysis. Ac¬tivity levels of alanine aminotransferase and aspartate aminotransferase were determined using photometric system. Results: The overall mean serum activity level of AST was 25.52 U/L and of ALT was 21.31 U/L. No statistically sig¬nificant differences were observed between the surveyed from Ulaanbaatar and from rural area, but the mean activity level of both enzymes was statistically significantly lower in women than in men (р<0.05 for both ALT and AST). When the survey participants were divided into five age groups (15-24 years, 25-34 years, 35-44 years, 45-54 years and 55-64 years of age) and their mean activity levels of AST and ALT were compared, it was observed that the activity of both enzymes increased with age (p<0.05).

The serum activity levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are important biochemical indicators of changes in the liver and coronary system function. The correct determination of changes in the activity levels of the transferases is essential for differential diagnosis and appropriate treatment of the diseases. Goal: The aim of this study was to determine the mean activity levels of ALT and AST of the Mongolian population. Materials and Methods: Serum was separated from morning blood samples collected from 1732 individuals 15-64 years of age (706 males, 1026 females) from 21 aimags and Ulaanbaatar city, and stored at -30°C until analysis. Activity levels of alanine aminotransferase and aspartate aminotransferase were determined using photometric system. Results: The overall mean serum activity level of AST was 25.52 U/L and of ALT was 22.60 U/L. No statistically significant differences were observed between the surveyed from Ulaanbaatar and from rural area as well as between sexes (p>0.05 for both ALT and AST). When the survey participants were divided into five age groups (15-24 years, 25-34 years, 35-44 years, 45-54 years and 55-64 years of age) and their mean activity levels of AST and ALT were compared, it was observed that the activity of both enzymes increased with age (p<0.05)