1. Quantitive assessment of bone marrow trephan biopsy
Tsengelmaa J ; Bakhitbol ; Enkhzul E ; Erdenetsogt D ; Enkhtuya SH ; Bayarmaa E
Innovation 2016;10(3):38-41
In United States, person is diagnosed with blood cancer in every 3 minutes. In 2015, there were 1.665.540 total cancer cases and 9.4% of them lymphoma and leukemia . In 2015, there were 95 cases of lymphoma in Mongolia when compared 4 times increase to 2015 from 2010 . Bone marrow examination is an established diagnostic modality in the evaluation of various hematological disorders. BM examination can serve to establish or confirm a primary diagnosis of lymphoma or to determine the extent of disease dissemination for staging purposes. Biopsy is essential for diagnosis in a dry tap or blood tap which occurs when the marrow is fibrotic or densely cellular. Only a biopsy allows a complete assessment of marrow architecture and pattern of distribution of any abnormal infiltrates. In 2015.01-2016.01 fifty five bone marrow biopsies were retrieved from the files of the National First Clinical Hospital-Department of Hematology. These all statistical analysis was performed using by SPSS 17. Bone marrow processing and staining: The hematologist is instructed to place the freshly obtained BMTB specimens directly into buffer substance fixative and transport it immediately to the histopathology department, on the same day as the procedure.The next morning (after 20–24 h), the solution is decanted (with a strainer) and the biopsy specimen is washed in distilled water for 30 min. The biopsy specimens are left to decalcify for about 6 h before being processed and embedded in paraffin wax, with procedures similar as for other specimens.Sections, 1-mm thick (microtome set for 1 mm sections), are cut from the paraffin-wax blocks with the routine rotary microtomes in the laboratoryA total of 55 cases were reviewed from December 2014 to November 2015. The age of the subjects ranged from twenty two years to seventy eigth years with a male predominance (1.7:1). Data of 55 trephine biopsies were reviewed. The percentage of trephine biopsies in different length ranges was calculated. Twenty two biopsieswere of recommended length, i.e., ≥1.5 Cm while remaining 33 were less than the recommended length. The rate of positivity for diagnosis was 95.4% in group-1, 94.1% in group-2, 63.6% in group-3 and 40% in group-4 In all cases in our study 73% (n=40) were satisfactory and 27%(n=15) unsatisfactory slides .Our study showed that 40% trephan biopsies were of revommended length i.e >=1.5cm with 95.4% positive of diagnosis. However biopsies measuring 1-1.4 cm also had comparable result 94.1% .
2.Evaluation on implementation of preventive activities of non-communicable diseases
Enkhzul T ; Sugarmaa M ; Amarsaikhan D ; Delgermaa V
Mongolian Medical Sciences 2013;166(4):44-47
Background: Mongolia is one of the most influenced countries by non-communicable diseases among developing countries. Non-communicable diseases, including cardiovascular diseases, cancers, respiratory diseases, diabetes, and injuries have become the major causes of morbidity and mortality in Mongolia.Goal: To assess impact of preventive intervention activities of non-communicable diseases in framework of the Millennium challenge account (MCA) health projectMethods: We conducted 17 focus group discussions (FGD) from March to April 2013 in primary and secondary health care settings, of which six in urban and eleven in rural areas.We identified themes concerning the current situation of NCD related health services from the perspective of health professionals, and insights into institutional and professional experiences related to management, implementation and coordination of the newly implemented MCA-Mongolia NCD prevention and control project.Results: As a result of the health project, NCD related knowledge and skills of health professionals have improved through progressive training, and development of guidelines and manuals. During the project, availability of equipment supplies has improved. Accordingly, medical equipment and laboratory reagents needed for early detection of NCDs were provided to primary and secondary health care settings, despite some challenges in the implementation of the project. As result of theproject implementation, increased public awareness on NCDs, and attitude change were considered as the biggest changes.Conclusion: The health project was considered as successful to provide knowledge on the best practice in NCD prevention.
3.The detection of trichomonas vaginalis by cytological stained tests
Bayarmaa E ; Bayarhishig CH ; Enkhzul B ; Giimaa N ; Temuulen D ; Kyung Il Im
Mongolian Medical Sciences 2012;161(3):8-10
Background: One of the confronted problems of doctors and medical personnels is sexually transmitted disease has not been decreased in our country up to now. By last 5 years propagation of trichomoniasis was 16.7-9.5% per 10000 population and infected T.vaginalis. In the practice of parasitology of our country metilen is revealed by gram method hasn’t been introduced which is used in up to date histological analyse. This became the background of our research work. Aim of our research is to diagnose trichomoniasis which infects sexually by cytological analyse and to define its specific and sensibility.Materials and Methods: A total 99 smears of 33 females aged 19-39, used cross sectional descriptive method. Finding T.vaginalis on specimens (1) Vaginal wet mount, (2) Gram staining and (3) Pap stain. Result: In our research T.vaginalis leaked out in wet mount smear was 33%, in Gram stain was (21.2%). The sensibility quality of T.vaginalis on Gram stain is 63%, specific quality is 90%, value of kappa coefficient (К=0.58 Р<0.002). In Pap stain T.vaginalis diagnosed 27,2% and sensibility quality of T.vaginalis is 81%, specific quality is 100%, value of kappa coefficient (К=0.87 Р<0.005). In the case when 3 analysis were positive case was 5 or 15.2%, in the case where 2 analysis were positive case was 6 or 18.2%. Conclusions: The Pap stain sensibility quality of T.vaginalis is 81%, specific quality is 100%, value of kappa coefficient (К=0.87 Р<0.005), that shows should be to give effect on diagnosing of sexually transmitted infectious disease.
4.ДУА-ГИЙН ДАВХАРГА БУЮУ ДЕСЦЕМЕТИЙН ӨМНӨХ ДАВХАРГА: Түүний нээлт, эмнэлзүйн онцлог болон хэрэглээ
Undarmaa N ; Enkhzul D ; Enkhtuul S ; Sainbilig D ; Burenjargal P
Innovation 2018;12(3):42-49
Эвэрлэгийн цагаа, эвэрлэгийн бусад эмгэгийн үед төгс эмчилгээний арга нь эвэрлэг шилжүүлэн суулгах юм. Deep Anterior lamellar keratoplasty (DALK) мэс засал нь гэмтсэн эвэрлэгийн стромын давхарга болон эпителийг бүхэлд нь аван эрүүл эндотели болон десцемет давхаргыг нь үлдээн хийдэг хагалгаа юм. DALK мэс заслын үед Мухамед Анварын том бөмбөлгөн (“Big Bubble” technique) техникийг дэлхий дахинд өргөн ашигладаг ба үүнийг өөрөөр десцеметийн давхаргыг ил гаргах техник (Descemet’s baring technique) гэж нэрлэдэг. Энэ техникийн үед агаарыг эвэрлэгийн стромлуу шахаж өгдөг ба тухайн шахсан агаар нь стромыг десцеметийн давхаргаас салган гэмтсэн эдүүдийг эрүүл эдээс тусгаарлана. Сүүлийн хэдэн жил том бөмбөлгөн техникээр Deep Anterior lamellar keratoplasty (DALK) хагалгааг олон удаа хийх явцад Дуа-гийн давхаргыг олж нээсэн. Энэхүү судалгаанд Дуа-гийн давхаргын онцлог шинж чанар, анатомийн байрлал, түүний нотолгоо болон эмнэл зүйн ач холбогдол хэрэглээг судалсан.
5.A study of factors affecting the implementation of the curriculum
Otgonbayar D ; Dashtseren B ; Lkhamdulam B ; Enkhzul T ; Baasanjav N
Mongolian Medical Sciences 2018;185(3):75-79
Introduction:
The curriculum development is important issue, especially stakeholder’s evaluations for the
implementation of the curriculum. Accordingly, this time we conducted this survey to determine the
level of satisfaction of teachers, which is a key factor in implementation of curriculum at the “Ach”
Medical University.
Goal:
To study curriculum implementation assessment by teachers at the Ach Medical University.
Materials and Methods:
Study was conducted descriptive study design using quantitative research methodology. The Likert
scale (1-5) used for the assessment of satisfaction score. Total 77 teachers were included in the
study. Study questionnaire included 7 groups with 53 questionnaires.
Results:
Total n=77 teachers included in the study. The satisfaction level of teachers for the implementation
of curriculum was 73% (n=56) satisfied with satisfaction, 22% moderate satisfaction (n=17), and
medium satisfaction teacher 5% (n=4).
The satisfaction level of teacher workload and job satisfaction is high enough to satisfy the workload
of the trainee, the time to prepare the lesson, and the opportunity to work with the students in the
classroom. 3.6-4.2, while the teacher’s work value or salary the level of satisfaction level is 3.11, the
minimum value is 2.75, the average.
Conclusion
The average satisfaction score was 4.11 above the average but the effectiveness of
the program, the effectiveness of the teacher’s work, study environment and textbooks were below
average.
6.Item analysis of the basic clinical skills assessment
Otgonbayar D ; Khaliun B ; Zol B ; Enkhzul T ; Baasanjav N
Mongolian Medical Sciences 2018;185(3):80-82
Introduction:
The clinical skills training at medical schools provides the opportunity for future medical doctors to
deal with the client with proper care, diagnosis of the disease, first aid, treatment, nursing, treatment,
counseling to address the complexity of the problem solving and the ethical attitude of the doctor.
To achieve this objective, it is necessary to assess the level of knowledge, skills and attitudes students
have acquired.
Goal:
To analyze assignment of basic clinical skills assessment and to identify the level of кknowledge and skills
students who have graduated second year medical program at “Ach” Medical University during 2016-
2017 academic year.
Materials and Methods:
The study was used as a descriptive model to measure the reliability of the assignment, the difficulty
factor of tasks, and the Hoffsten’s scores based on the tasks and performance of each station and
compared with the indicators.
Results:
Based on Hoffsten’s study on the success rate of examiners at the 5 stations, the Hoffsten’s score
level of clinical examination was 68 percent, the physical examination station was 64 percent, the
station’s diagnostic level was 71 percent, the laboratory was 70 percent and the nursing station was
70 percent.
Conclusion
At each clinical trial, the differential diagnosis of each individual clinical trial, clinical interview, nursing
station and visual diagnostic station (DF> 95), at the laboratory and at the physical examination
station, assess the student with a higher grade of difficulty factor (DF> 80) to the Hoffsten’s score of
the basic clinical skills exam is set to be 70 percent.
7.Result of implantation of scleral-fixated posterior chamber intraocular lenses
Enkhzul D ; Enkhtuul S ; Burenjargal P ; Tuvshintugs B ; Bat-Erdebe B ; Byamvadorj D
Innovation 2021;14(1-Ophthalmology):36-41
Purpose:
The aim of this study was to determine the surgical and visual outcomes of scleral
fixated intraocular lens implantation in eyes with as subluxated and dislocated crystalline lens or
traumatic aphakic eyes.
Methods:
A retrospective and short-term prospective cohort study was carried out in 45 eyes
of 43 individuals who underwent SFIOL implantation surgery in First Central Hospital of Mongolia
between January 2017 and January 2020 and had a minimum follow-up of 3 months. Pre-operative
and post-operative best corrected visual acuity, postoperative outcomes and complications
were summarized. Patients after the implantation of a scleral fixated PCIOL were evaluated for
the disease etiology, pre- and post-operative best corrected visual acuity, and occurrence of
postoperative complications.
Results:
The analysis included 45 eyes from 43 patients. Thirty-two (74.4%) patients were men and
eleven (24.6%) were women . The mean age at implantation was 57.2 ± 20.0. Indications for the
IOL implantation included ocular trauma (48.9%), pseudoexfoliation syndrome (22.2%) and Marfan
syndrome (15.6%). Disease etiology and age group were compared and results were Marfan
syndrome is mostly diagnosed in 20-29 years of age, ocular trauma is usually diagnosed in 30-69
years of age and pseudoexfoliation syndrome is occurred in 70 and above of age. Post-operative
visual acuity was improved in all cases from which 35 of patients (77.77%) visual outcome was 6/12
and above.
The mean preoperative best corrected visual acuity (BCVA) was 0.083 ± 0.088, which improved to
0.569 ± 0.221 (p<0.001) third month postoperatively and these were statistically significant.
The most frequent complication was induced astigmatism, which occurred in 6 eyes which
successfully corrected with glasses. Suture erosion occurred in three eyes which successfully
relocate it. The most serious complications such as vitreous hemorrhage, retinal detachment,
suprachoroidal hemorrhage, endophthalmitis and suture degradation or breakage was not seen.
Conclusion
Ab externo SFIOL implantation is a reasonable technique for the management of
eyes with aphakia or absence of capsular support, with relatively high visual outcomes and few
serious complications.
The most frequent cause of aphakia and absence of capsular support was ocular trauma thus,
pseudoexfoliation and Marfan syndrome were the most common in elderly and in young age,
respectively.
8. RESULT OF KASAI OPERATION, CHILDREN LIVER TRANSPLANTATION IN MONGOLIA
Chuluunkhuu D ; Zorigtbaatar M ; Nurjanar R ; Ganbayr L ; Otgonsuren G ; Dashaa M ; Enkhzul P ; Khandmaa B ; Sergelen O ; Bat-Ireedui B ; Ganzorig B ; Pagaldulam M ; Saruul G ; Tsendjav A
Journal of Surgery 2016;20(2):56-61
Introduction: Biliary Atresia is a fibroobliterativedisorder of the intra andextrahepatic bile ducts in infancy, which isgoing progressively cholestatic liver disease.The failed Kasaiportoenterostomy requiresliver transplantation. The goal of this studyis to show the outcome of Kasai operation,recent improvement and correlation the datato overseas.Methods and Materials: This study wasconducted in the department of generalsurgery of National Center for Maternal andChild Health of Mongolia between 2010 and2016 on a total of 66 infancies with biliaryatresia.Results: Patient diagnosed with biliaryatresia, which performed Kasai operationwithin first 2 months the outcome is verygood early and late post-operation period.There were 3 patients with 10 year survival, 4patients with 5-10 year and 28 patients with5 year survival after Kasai operation. The mostcomport age for liver transplantation is 1 yearlater after Kasai operation in Mongolia. Livertransplantation programme is necessary forMongolian pediatric surgery, and we thoughtour team was assembled.Conclusion: The children with biliary atresiaperform the Kasai operation within 2 monthsthe outcome is very good. Children with biliaryatresia often experience long wait times fortransplant unless exception points are grantedto reflect severity of disease.In Mongolia livertransplantation done in 2 child.
9.PRIMARY PHACOEMULSIFICATION WITH INTRAOCULAR LENS IMPLANTATION FOR ACUTE PRIMARY ANGLE-CLOSURE GLAUCOMA
Enkhzul D ; Enkhtuul S ; Burenjargal P ; Tuvshuntugs B ; Gantsooj N ; Bolortungalag P ; Sainbileg D
Innovation 2018;12(3):6-10
BACKGROUND. Acute primary angle-closure glaucoma (PACG) is a severe disease requiring intensive and emergency treatment. Surgical peripheral iridectomy and laser peripheral iridectomy procedures are performed to decrease papillary block and create an opening for the aqueous humor to pass through the eye. However, the intraocular pressure (IOP) cannot be consistently controlled by peripheral iridectomy. Phacoemulsification can widen the anterior chamber angle, position the ciliary processes in eyes with PAC posteriorly and inhibit the acute angle closure. This procedure can control the intraocular pressure sustainably for a long period. The higher incidence of the acute angle closure glaucoma in Mongolia compared to other countries was the rationale of this study.
MATERIAL AND METHODS. Medical records of 9 patients (9 eyes) with acute PACG, who had received phacoemulsification with intraocular lens implantation as initial management for medically uncontrolled high IOP, were analyzed in a retrospective chart review. IOP, visual acuity, anterior chamber depth (ACD) and the number of anti-glaucoma medications used were evaluated.
RESULTS. The postoperative IOP was reduced in 9 eyes (100%). The mean preoperative IOP was 37.9 ± 13.0 mmHg, which decreased postoperatively to 11.0 ± 1.9 mmHg at day 1, 11.1 ± 2.1 mmHg at week 1, 11.1±2.0 mmHg at 2 weeks, 11.8 ± 1.9 mmHg at month 1, and 11.3 ± 1.4 mmHg at 3 months, which showed statistically significance (p < 0.001). The mean visual acuity improved from preoperative average of 0.04±0.03 to postoperative average of 0.17±0.24 at day 1, 0.45±0.26 at week 1, 0.54±0.31 at week 2, 0.56±0.34 at 1 month, and 0.57±0.33 (p = 0.001) at 3-months. There was functional success at month 3.
СONCLUSION. Our outcome indicates that primary phacoemulsification with intraocular lens implantation lowered IOP and improved visual acuity significantly in patients with acute PACG. This is a safe and effective method of IOP control and can be considered a first line treatment option in managing patients with acute PACG and coexisting cataract.
10.OUTCOME OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Tuvshintugs B ; Gantsooj N ; Undarmaa T ; Bolortungalag P ; Sainbileg D ; Enkhtuul S ; Enkhzul D ; Burenjargal P
Innovation 2018;12(3):12-16
BACKGROUND: There are two general types of age-related macular degeneration: dry and wet. During wet or neovascular age-related macular degeneration new abnormal vessels grow and leak in the macula. As anti-vascular endothelial growth factor (anti-VEGF) was invented, it revolutionized the treatment of nAMD by inhibiting the progress of this disease. The incidence of AMD increases as life expectancy grows and there is a growing need to study this disease. We aimed to evaluate the outcome of anti-VEGF therapy for the treatment of nAMD and the incidence of ocular serious adverse events (SAE) after injections.. METHODS: In our retrospective, single-center study, medical records of patients receiving a single dose of anti-VEGF treatment (Bevacizumab) for nAMD between 17th of April, 2016 and October, 2017 were evaluated. Outcome measures were the change in the baseline visual acuity (VA) score at post-injective month one, incidence of ocular SAE and patients’ baseline characteristics affecting VA. Patients, whose treatment were started before April 2016 and had anti-VEGF treatment for the diseases other than nAMD, were excluded.. RESULTS: 15 eyes in 15 patients between 52 and 85 years of age received single dose of anti-VEGF (Bevacizumab/Avastin) injection. The mean baseline VA improved from pre-injective average of 0.21 to post-injective 1-month average of 0.37 by Snellen. Furthermore, there was no vision loss or other severe adverse effects, such as endophthalmitis, vitreous hemorrhage, retinal detachment, traumatic cataract after 4 weeks. CONCLUSION: Anti-vascular endothelial growth factor therapy has promising short-term outcomes on treating neovascular age-related macular degeneration.