Background Diabetes is a metabolic disorder that is characterized by chronic high blood glucose levels that causes complications in the eyes, kidneys, heart, vessels and nerves. Currently diabetic nephropathy is the most significant long-term complications in terms of morbidity and mortality for individual patients with diabetes. Honey bee venom can be considered as a natural remedy for diabetes due to its blood glucose levels lowering and lipid-regulating effect on diabetic rabbits. Aim The aim of this study was to investigate the effect of Mongolian honey bee venom (Apis mellifera) on renal dysfunction in alloxan induced diabetic rabbits. Material and Method Twenty two Chinchilla rabbits were divided into three groups: control (n=6), diabetic (n=8), and bee venom treated (n=8). The diabetic group was injected with 5% solution of Alloxan monohydrate 100 mg/kg intravenously behind the ear for 2 minutes to induce diabetes. The bee venom treated group received a bee sting (a sting contains 0.2-0.5 ml of bee venom) on their hind paw every day after their diagnosis of diabetes. Result Bee venom treatment (BVT) led to the following changes: compared to the diabetic group, the bee venom treated group’s blood glucose levels lowered between 14.9% and 26.5%; the plasma creatinine and urea levels were decreased respectively by 19,8% and 14.8%. Blood urea nitrogen (BUN) levels were reduced by 14.8%. Conclusion: Treatment with Mongolian bee venom lowered the blood glucose levels and prevents the renal dysfunction in alloxan induced diabetic rabbits

Introduction In 19th century, researchers proved at biochemical level the healing properties of bee products such as bee venom, honey, royal jelly, pollen, propolis and wax. The object of our research is the Apis cerena’s venom properties1-2. Asiatic honey bee or Apis cerana is small honey are small honey bees of southern and southeastern Asia, such as China, India, Japan, Malaysia, Nepal, Bangladesh and Papua New Guinea3. This species is also known as the Himalayan hive honeybee. This species is the sister species of Apis koschevnikovi, and both are in the same sub¬genus as the Western (European) honey bee, Apis mellifera4. Goal The purpose of our research is to study property and potential of bee venom and its effect on immune system. Heal¬ing property of Apis cerana was high. This study proves that bee venom therapy stimulates immunity. Materialis and Methods The research was conducted at the Scientific Research Center of “Monos” Institute of Traditional Medicine and in biochemical Laboratory of “Khuljborjigon” Clinic. For the experiment, we used 23 perfectly healthy mice of same sex and size which meets standards of laboratory testing. We put a bee sting to 0.5 ml of 10% red blood cell (RBC) solution and measured time of heamolysis to de¬fine bee venom potential/capability by Shkenderov S., Ivanov Ts., (1985) method. Following Erne (1963), Kovalev I.E.,(1976), Petrov’s (1980) methodology of studying effects on immune system, we have stung bee venom to 23 mice on the acupuncture point of hind paw every other day in total 3 times. On third day of the experiment, we in¬jected into vein 2ml of 10 % sheep’s RBC to stimulate the immunity. On the fifth day, we defined weight of pancreas, number of pancreatic cells, pancreatic index, and haemagglutination titre. Results Potential of bee venom is determined by speed of heamolysis when bee sting is placed in the 0.5 ml of 10% RBC solution. If we place one bee sting into 1ml of RBC solution then the speed of heamolysis is 46 seconds, when two stings are place speed is 38 seconds and when 3 stings placed then time is 30. Compare to usual speed of heamolysis which is 60 seconds, change in time depending on the number of bee stings proves the effectiveness of bee venom (Table 1). In figure 3, the number of spleen cells of control group’s was 142.71±55.51*106/ml. this is 1.2 times lower compare to normal group which is 172.67±135.5*106/ml. BVT group’s number of spleen cells was 329.78±187.78*106/ml and 1.61 times bigger than in control group. In comparison to control group, haemagglutina¬tion titre of BVT group was 1.13 times higher (BVT group 54.86±19.95%; control group 50±8.83%, p<0.05) and this indicates that BV has immunity stimulating effect. Conclusions From our experiment we can conclude the following 1. Apis mellifera’s bee venom has high treating effect. 2. Bee venom therapy has immunity stimulating activity.

Sleep and wakefulness are physiological processes in our lives that are regulated by circadian rhythms. The level of melatonin, the "sleep hormone", increases with the onset of darkness, and its production slows down in the morning. Exposure to artificial light at night disrupts our circadian rhythm and the processes it controls. Shift work is when an individual works from 9 am to 5 pm. But the night shift refers to the time when a group of workers who work at night in factories and enterprises work in the evening or at night, especially from 4 p.m. to 8 a.m. according to a regular schedule. One in five people in industrialized countries work night shifts, and studies in America and Europe show that between 15 and 30% of adult workers have some form of shift work. Between 10% and 30% of shift workers meet the diagnosis of shift work disorder (SWD). 5-10% of shift workers experience severe shift insomnia and sleepiness. At least ¾ of shift workers suffer from insomnia. Excessive sleepiness usually occurs during shifts (mainly at night) and is associated with impaired cognitive ability due to the need for sleep and reduced alertness, and decreased alertness reduces performance. Job performance is influenced by many workplace environmental factors, including workload, coworker relationships, stress levels, and extended hours. A nurse specialist provides nursing care by monitoring and evaluating 24 hours a day, and by working night shifts, the circadian system of sleep is disturbed, causing sleep problems and insomnia. When examining how night shift work affects nurses' ability to concentrate, the decline in concentration (33.3%) was twice as high as that of day shift nurses (16.7%). found that shift nurses who worked the night shift had higher rates of insomnia and chronic fatigue compared to nurses who stopped working the night shift. Lack of sleep manifests as a decline in cognitive functions such as attention, decision making, and reaction time. These cognitive and functional declines can negatively affect quality of life and lead to impaired job performance. An Australian study by Winwood et al found that fatigue associated with night shifts increases the risk of human error and injury, and negatively affects the quality of patient care. Lack of sleep significantly affects nurses' alertness, concentration, and job performance. This review article discusses the relation between shift work-related sleep and job performance based on international research findings.

Introduction: 5-10% of shift workers experience severe shift insomnia and sleepiness. A nurse specialist stays by the client's side 24 hours a day, assesses and monitors their physical condition, and provides nursing care. In a comparative study on the work activity among shift nurses, night shift nurses were less active (40%) and more fatigued (53.3%) than day shift nurses.
An aspects of chronotype and sleep quality in shift nurses does not established in Mongolia and the data is very rare, and we aimed to conduct this study. Goal: To study shift schedule, sleep quality and individual chronotype of shift nurses. Materials and Methods: This study is a cross-sectional study. The survey was completed between July 1, 2023 and December 31, 2023, and included a total of 117 nurses who met the inclusion and exclusion criteria of the BZDGH, SKDGH, and KUDGH research. In collecting research data, the questionnaires "Insomnia Severity Index", which is a commonly used international standard questionnaire for assessing insomnia, The Munich Chrono Type Questionnaire for assessing individual chronotype, and "Karolinska Sleepiness Scale" were used. The ethical approval: The ethical approval for the study was obtained by a decision of the Ach Medical University-Ethical Committee on Research on June 30, 2023 (2023/02/05). Statistical analysis : Results were calculated using SPSS - 21.0 v program by a descriptive statistic, and the Pearson correlation analysis. Results : The average score of the Insomnia Severity Index (ISI) was 12.60±6.38, which is the sub threshold for clinical insomnia. But the average Karolinska Sleepiness Scale (KSS) score for sleepiness is 4.41±2.50, or moderate alertness during the shift. Workday sleep-wake pattern and non-workday sleep-wake pattern are correlated (r=0.44, p=0.001). Also, individual chronotype is correlated with chronotype of non-working days (r=0.23, p=0.02). Conclusions Nurses' sleep quality levels were pre-clinical insomnia and moderate alertness during shifts for sleepiness. Working and non-working day sleep-wake patterns are different, chronotype is medium early type. The sleep-wake pattern of weekdays and the sleep-wake pattern of non-workdays are related to each other. The chronotype of the individual is related to the chronotype of non-working days.

Introduction: In 19thcentury, researchers proved at biochemical level the healing properties of bee products such as bee venom, honey,royal jelly, pollen, propolis and wax. The object of our research is the Apis cerena’s venom properties1-2. Asiatic honey bee orApis ceranais small honey are small honey bees of southern andsoutheastern Asia, such as China, India, Japan, Malaysia, Nepal, Bangladesh and Papua New Guinea3. This species is also known as the Himalayan hivehoneybee. This species is the sister species of Apis koschevnikovi, and both are in the same subgenus as the Western (European) honey bee, Apis mellifera4.

Background: A drug related problem is defined by the Pharmaceutical Care Network Europe Association as an an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes. One critical aspect of preventing such errors is proper dose adjustment, which plays a vital role in the diagnosis and treatment of disease. For instance, adjusting the dose of warfarin based on the patient’s INR level is essential. In a 1995 study conducted in England, clinical pharmacists recommended target doses of angiotensin-converting enzyme (ACE) inhibitors for patients with chronic heart failure. As a result, patients experienced a significant reduction in pulmonary and peripheral edema, along with improved exercise test outcomes. At the Mongolian-Japanese Hospital of the Mongolian Medical University of Science and Technology, it is important to analyze dosage-related issues identified by clinical pharmacists and inform healthcare professionals about common dosage selection errors and associated risks. Aim: We analyzed issues related to medication dosage. Materials and Methods: A retrospective study was conducted to examine problem related to dosage detected through prescription monitoring at the Mongolian Japanese Hospital of the Mongolian National University of Health Sciences from 2023 to 2024. Results: Out of a total of 2340 drug-related problem identified across five inpatient wards during this period, 581 (100%) were related to dosage. Clinical pharmacists performed prescription review on approximately 67% of all inpatients, which was consistent between years. However, medication-related problems tended to decrease from 41.1% (n=1499) in 2023 to 22.3% (n=841) in 2024 (p=0.05). The majority of dose-related problems, 75.6% (n=440), were overdoses. Medication-related problems were most common in the surgical department, with 59.5% (n=346) (p=0.001). The most frequent dosage-related errors involved exceeding the daily dose of diclofenac, administering higher- than-recommended doses of ceftriaxone, failing to adjust cefotaxime for renal function, and using inappropriate doses of metronidazole in patients with impaired liver function. The leading cause of these errors was failure to adhere to guideline-recommended dosing, which accounted for 71.3% (n=415) of cases (p=0.001). When dosage-related recommendations were provided to physicians before of treatment, acceptance rates increased by 14% (p=0.001). These interventions resulted in an estimated cost saving of 1.267.219₮ and a reduction of 363 injections. Conclusion Therefore, clinical pharmacist-led prescription review can help reduce the risk of dosage errors, lower associated healthcare costs, and alleviate the burden on medical staff.

Background: Anemia is still being a population’s challenging issue regardless of high development of countries around the world. According to a study regarding prevalence and etiology of anemia conducted in 187 countries around the world, the anemia rate is 23 176 per 100 000 population. In accordance with the “5th National Nutrition Survey” study conducted in our country in 2017, one of every five women (21.4%), aged 15-49 years, 16.2% of reproductive age women and 3.0% of men are anemic. The current study was conducted due to it is still essential to study and identify the etiology of anemia, determine its prevalence, plan appropriate intervention, and organize future preventive measures, depending on the socio-economic conditions, location, diet, and customs of the Mongolians. Aim: To identify anemia among the adult population, determine the type and severity of anemia. Materials and Methods: The cross sectional study was conducted during between May 2022 and Sep 2023 and adults aged above 18 years were included. Moreover, we identified anemia cases based on the laboratory test results and determined the anemia severity grade. Statistical analysis was performed by using SPSS software. Results: Among the participants, 6.7% of them, 9.9% of females and 2.8% of males are anemic. Prevalence of mild, moderate and severe anemia is 66.7%, 30% and 3.3%, respectively. While the prevalence of anemia among reproductive age women is higher, the prevalence of anemia increases with age. The anemia prevalence in Ulaanbaatar region, Western region, Khangai mountainous region, Central region and Eastern region is 583 (25.6%); 171 (7.5%); 343 (15.1%); 921 (40.4%); and 261 (11.4%), respectively. By regional location, the prevalence is high in the Central region, with varying prevalence in other regions. Conclusion Anemia was detected in 6.7% of the total study population, 9.9% of females, and 2.8% of males were anemic. Of those with anemia, 66.7% had mild anemia, 30% had moderate anemia, and 3.3% had severe anemia. Moderate and severe anemia were more common in females than in males.

Background and Aims: Hepatocellular carcinoma (HCC) is a common cause of cancer related death in Mongolia. Early diagnosis is the very important management to increase successful treatment and survival rate. Glypican-3 (GPC3) protein is highly expressed in hepatocellular carcinoma (HCC) tissue and in serum of HCC patients. Recent studies have been conducted and suggested as a diagnostic biomarker for detecting HCC in the early stage. Therefore, we investigated the diagnostic value of the serum GPC3 level and compared it to the alpha-fetoprotein (AFP) level as a diagnostic biomarker of HCC. Methods: We enrolled a total of 90 participants and divided into 3 groups with HCC (30), with liver cirrhosis (LC/30) and healthy (30) as the control group (30). GPC3 and AFP serum (sGPC-3, sAFP) levels were measured using commercially available enzyme-linked immunosorbent assay kits. The diagnostic accuracy was analyzed using the receiver operating characteristics (ROC) curve and estimated sensitivity and specificity of each biomarker. Results: sGPC3 was significantly elevated in the HCC group as compared to liver cirrhosis and healthy subjects (658±138.2 pg/ml, 378±25.5 pg/ml, 356.3±29 pg/ml) respectively. sGPC-3 sensitivity was 96.6% and specificity was 100%. The area under the ROC curve (AUC) for GPC3 was 0.999 (0.996- 1.0).
In comparison, the mean of AFP was significantly higher in HCC (16.9±11.7 ng/ml) than in LC (6.7±7.6 ng/ml) and in healthy subject (3.3±2.1 ng/ml) and AFP sensitivity was 43,3 %, specificity was 95 % with an AUC of 0.808 (0.696- 0.921).
The combination of GPC-3 with AFP achieved the highest sensitivity (97.1%) and specificity (97%). Conclusion Serum GPC3 has a higher sensitivity than AFP for the early diagnosis of HCC. Combination of two markers showed greatest diagnostic accuracy.

Background: Otitis media is an inflammatory disease involving the mucous membrane of the middle ear, including the auditory tube, tympanic cavity, mastoid antrum, and air cells¹. Multiple factors contribute to the development of OM, one of which is adenoid hypertrophy5. However, to date, no study has been conducted in Mongolia to assess the relationship between the degree of adenoid hypertrophy and OM. Aim: To analyze cases of children who underwent adenotonsillectomy. Materials and Methods: The study was conducted using a cross-sectional observational research design. Clinical data from a total of n=215 cases of children who were diagnosed with adenoid and palatine tonsil hypertrophy and underwent surgical treatment at Gurvan Gal Hospital between October 2023 and October 2024 were analyzed. Statistical processing was performed using STATA 14.2, with statistical significance considered at p < 0.05. Results: Clinical data from 215 children were analyzed to evaluate the relationship between the degree of adenoid hypertrophy (AH) and otitis media. The children ranged in age from 2 to 17 years, with a mean age of 7.23 ± 3.4 years. Among them, 128 (59.53%) were male (7.09 ± 3.29 years) and 87 (40.46%) were female (7.45 ± 3.58 years). A statistically significant moderate negative correlation was found between age group and the degree of adenoid hypertrophy (rho = -0.3485, p < 0.001). A significant seasonal variation in otitis media was observed (p = 0.0001). A statistically significant correlation was found between the degree of adenoid hypertrophy and otitis media (p < 0.001). However, no significant correlation was observed between the degree of palatine tonsil hypertrophy and otitis media (p = 0.8762). Conclusion The incidence of adenoid hypertrophy is highest among children aged 6 to 9 years, and there is a moderate negative correlation between age and the degree of adenoid hypertrophy. The occurrence of otitis media varies by season, with the highest number of cases reported during the winter months. As the grade of adenoid hypertrophy increases, the number of otitis media cases also rises.

Introduction: When human body encounters external pathogens primary/innate immunity cells are activated by recognizing them and secondary/adaptive immunity is activated consecutively. Immune cell surface receptors, called Toll-like receptors (TLRs) recognize and bind pathogens. In our previous study, we revealed that there is a synergistic action between TLR9 and IFN-γ signaling in the endothelial cells. Purpose: To determine the role of negative and positive regulatory proteins on the IFN-γ/TLR9 synergistic signaling pathway Materials and Methods: This study was held in the Core Laboratory, Science Technology Center, Mongolian National University of Medical Sciences (MNUMS). In this study, murine endothelial cell (END-D) culture was used. The negative and positive regulator protein expression was detected by Western blotting. Result: Result of immunoblotting assay indicated that CpG DNA enhanced IFN-γ positive regulator protein p38 phosphorylation in the endothelial cells. Treatment by TLR9 ligand CpG DNA and IFN-γ increased p38 activation in 0.5 hour and 1 hour. CpG DNA inhibited IFN-γ negative regulator SOCS1 protein expression in 4 hr and 8 hr. Therefore, TLR9 ligand CpG DNA increased IFN-γ signal transduction in the endothelial cell line. Conclusion TLR9 ligand CpG DNA has decreased IFN-γ negative regulator protein SOCS1 expression. CpG DNA has increased IFN-γ positive regulator protein p38 phosphorylation.