Based on registered cases Н1N1 virus Influenza in Mexico, 26 April, 2009, there were done risk assessment of current and future situations in area along railway across Mongolia. In the frame of this work were done organizational work preparation, urgent activities to prevent the infection The result of this risk assessment were passed this situation with less risk and related activities were done by steps.Work of Making Sure of ReadinessBy the order number 22b of Vice Chairperson of the Security Departure of Railway, on 28th of April, based on act number 02 of the National Emergency Department, group of agents had been assigned on UBRW, on 6th of May ‘’Plan to Prevent and Making Sure Quick Response is Ready from H1N1 Virus Influenza Infection’’ had been declared, announcing to manage works to prevent new virus infections, enforcing presence of related laws and regulations as a duty, organized video-selector of railway on 12th of May 2009, by presenting ways to get infected, prevention, UBRW’s all departments, branches and agencies have organized to prevent. On 29th of June 2009, we have processed and announced a guideline to act when a ‘’Passenger that is suspected with Influenza virus’’, and we made sure international and domestic rails are ready. On 29th of July, with the help of National Infectious Disease Center, we have organized a training to ‘’Early Prevention from H1N1 Virus Influenza Infection Counteract and Preparing Readiness’’ with having presenters from hospitals like Central and Branch rails joint clinic, physicians from branches and factory clinics, Wagon Depo in Ulaanbaatar, Passenger Service Ulaanbaatar Central Station, and produced 63 trainers.In Work of Making Sure of Readiness, on 10th of September 2009, by the order number 50 of Chairperson of Railway, solved 43 million tugrugs of Investment to making sure readiness of the medical and passenger service, saved some protection materials and other inventories. During the red alert additionally planned 156 million tugrugs, during whole phase of H1N1 virus infection UBRW had spent 204 million tugrugs. When looking at the spending: Medical equipments: 73781076 tugrugs, sterilizations and disinfectants: 23907969 tugrugs, protection materials: 27230300 tugrugs, vitamins: 62511518 tugrugs, educational advertisements: 10672525 tugrugs, others: 3369620 tugrugs.Conclusion:1. Incidents of H1N1 virus infection of people in covering area of UBRW’s Central Clinic and its branches railway’s joint clinics are less than National, Ulaanbaatar City, and Provinces that have railways.2. Children ages ranging from 0 to 4 and people from 20 to 49 years old with full ability to work are more likely to get infected.3. According to the research H1N1 Influenza virus incidents are higher in Bayangol and Bayanzurkh districts. The most incidents, which are registered from Bayanzurkh district’s sub districts, are I, III, IV are higher than other sub districts. In these sub districts, Ulaanbaatar Central Railway Station, and commercial centers like BARS Food Market and TOSA Market are located. Moreover 49% of the infected people live in apartments in which they don’t have central how water system, which cannot be denied that, had affected the spread of infections. 4. 96.5-99.15 of all infected people had headache, dry coughing, sneezing, discomfort, chest pain; 76.95 of all children had symptoms like diarrhea. Most patient’s chest X-ray diagnosed one of the two lungs have pneumonia. 60% of all the children and adult from 50 and over had a history of pain and diseases. But youths from 20-49 didn’t have any history of pain and diseases.5. It was effective to use medication tactics like immune activator and anti viral medications.6. In UBRW’s range there haven’t recorded any incidents that are more than 2 people from work place, school and family.7. To conclude (didn’t get laboratory test) from the first registered and dead patient first contaminated 1 person, which had treated in National Infectious Disease Center. And 1 person got lightly sick and got treated at home. If the patient got sick seriously and diagnosed positive, the closest 1 to 2 people have a possibility to be very likely to get contaminated.8. The latency stage of infection was 1 to 3 days and the average inpatient days were 10 days.

Introduction: This article provides areview about techniques and pitfalls of arterialand venous reconstruction during kidneytransplantation. Main reasons of our clinicalstudy are to evaluate vascular variationsof kidney, posttransplantation vascularcomplication incidence and present status ofsurgery outcome.This retrospective researchbased on cross-sectional assessmentofconsecutive 102 kidney transplantation cases,which performed from 2006 to 2015 at theFirst Central Hospital of Mongolia.Materials and methods: Statisticalprocessing andanalysis on posttransplantionpatient history data are made byMicrosoftExcel, SPSS19.0software.Results: Despite rising technicaldifficulties caused by vascular variations,pelvic and inguinal morphology of recipientand the existence of multiple renal arterieskidney transplantation is a safe and highlyefficient procedure.On this article wereexplained 44 kidney transplantation caseswith reconstruction using microvasculartechniques to reconstruct renal arteriesand veins. About 10 different kinds ofreconstructions were done in our practice.Due to investigation of consecutive 102kidney transplanted recipients, 24,51% had avascular anatomical variations. And describedabout 44 vascular reconstructions used inour hospital in case of vascular variations.According to the lit., vascular complicationsranges from 1 to 16%. In our hospital,vascularcomplication of kidney transplantation withmultiple vessels is 4,0-12,0%. Also, incidenceof vascular complication in group with singlevessels from 1.3 to 2.6% and in group withmultiple vessel 4 to 12%.Even it is highcomparing with other international articles;it’s almost in same results. But lymphaticcomplication is higher than others; it showsneeds of careful and accurate dissection ofrecipient site anastomosing vessels.Conclusion: Multiple renal graft’sveselshave been associated with a higher rateof vascular complications, including arterialstenosis and lymphorrhea. It shows needs ofcareful and accurate dissection of recipientsite anastomosing vessels.

However, the use of robots in medicine has only 30 years of history. The application of robots in surgery originates from the need of modern man to achieve two goals: the telepresence and the performance of repetitive and accurate tasks. The first ‘‘robot surgeon’’ used on a human patient was the PUMA 200 in 1985. In the 1990s, scientists developed the concept of ‘‘master–slave’’ robot, which consisted of a robot with remote manipulators controlled by a surgeon at a surgical workstation. Despite the lack of force and tactile feedback, technical advantages of robotic surgery, such as 3D vision, stable and magnified image, Endo Wrist instruments, physiologic tremor filtering, and motion scaling, have been considered fundamental to overcome many of the limitations of the laparoscopic surgery. Since the approval of the da Vinci robot by international agencies, American, European, and Asian surgeons have proved its factibility and safety for the performance of many different robot-assisted surgeries.
Comparative studies of robotic and laparoscopic surgical procedures in general surgery have shown similar results with regard to perioperative, oncological, and functional outcomes. However, higher costs and lack of haptic feedback represent the major limitations of current robotic technology to become the standard technique of minimally invasive surgery worldwide. Therefore, the future of robotic surgery involves cost reduction, development of new platforms and technologies, creation and validation of curriculum and virtual simulators, and conduction of randomized clinical trials to determine the best applications of robotics.

BackgroundHuman-induced climate change will affect the lives of most populations in the next decade and beyond. The impact of meteorological conditions on human health has been reported globally. There is a need to conduct surveys for correlation between climate change and human health.GoalTo study the impact of air temperature on human health in selected aimags and city districts.Materials and MethodsIn order to study how climate change and air quality parameters affect human health we selected Zavhan, Selenge, Dornod, and Umnugobi aimags which represent different climate zones and 2 districts of Ulaanbaatar city during 2009-2011. All data for respiratory system disease J00-J99, circulatory system disease I00-I99, were collected from soum, district’s hospital, and aimag and soum’s Department of health.ResultsDuring the study period, a total number of 8649 incidences of respiratory disease are registered. From them 74.2 percent are influenza and pneumonia (J09-J18), 17.6 percent are other acute lower respiratory infections (J20- J22), and 8.2 percent are asthma (J45-J45.9). For cardiovascular disease 15288 incidences are registered. From them 65.6 percent are hypertensive disease (I10-I15), 23.6 percent are ischemic heart disease, and 10.8 percent are cerebrovascular diseases (I60-I69). The lower the air temperature, higher the incidence of influenza and pneumonia, acute lower respiratory infections, hypertensive, and ischemic heart disease.ConclusionsCold weather is correlated with a higher incidence of respiratory and cardiovascular diseases.

Background:However kidney transplantation has being performed in Mongolia since 2006, because of pre-transplant ensitization, ABO incompatibility, hepatitis B and C virus activation many patients are taken kidney transplantation in abroad. The transplantation centers use own immunosuppressive regimens.Objective:Our aim was to assess the immunosuppressive regimens efficacy and toxicity in kidney transplant Mongolian recipients.Material and Methods:We analyzed data from 96 adult kidney transplant recipients who had taken kidney transplantation in different transplant centers from August 2006 through January 2014. There were 3 kinds of regimens Group I Simulect induction with standard triple /FK506/CyA+MMF/AZA+steroid/, Group II Campath-1H induction with CNI monotherapy and Group III Campath-1H induction with standard triple /FK506/CyA+MMF/AZA+steroid/. We retrospectively collected the post-transplant first two year serum creatinine. The study was performed in 2014. The questionnaire was taken and blood samples collected for determination of tacrolimus through level and for other laboratory tests. The primary end point was the first two years serum creatinine, the secondary end points included rejection episodes, blood through level of tacrolimus and some laboratory findings.Results:The post-transplant first two years serum creatinine levels were significantly different in 3 groups. Group III showed similar results compared to Group I. There was not enough data of biopsy proven acute rejection episodes however group II said more rejections occurred. However participants said that rejection occurred in 15 (15.6%) biopsy was done only 3 (3.1%) cases. Blood through level of tacrolimus was significantly different in three groups. Some laboratory findings showed different between three groups.Conclusion:A regimen of Campath-1H induction with CNI monotherapy (Group II) may be advantageous for short-term renal function and cost effective but there were more rejection complications and increased creatinine. The regimen of Campath-1H induction with standard triple (Group III) may be advantageous for long-term renal function, allograft survival, but there should consider about infection complications and polycythemia. Simulect induction with standard triple could be best choice but transplantations were performed in experienced centers. The study enrolled few cases and cases which were performed at the beginning of transplant program so many things could influence on the result. The study was compared beginner transplant center with experienced centers. Longitudinal cohort study needed in the future.

There are many treatment options for the management of ureteropelvic junction obstruction (UPJO). Open pyeloplasty has a high success rate and has been considered as a gold standard. Minimally invasive surgical techniques are associated with reduced morbidity, improved cosmetic result and better convalescence than open pyeloplasty. For endopyelotomy, these advantages for minimally invasive surgery such as laparoscopic pyeloplasty and robot assisted pyeloplasty have superior success rate than open pyeloplasty. However, the success rate for laparoscopic surgery could potentially be improved by careful selection of patients, using the criteria of stricture <2 cm, renal function >25% and the absence of severe hydronephrosis. Laparoscopic pyeloplasty and robot-assisted pyeloplasty have similar success rates to open pyeloplasty (>90%) and the best outcomes have been reported for robot-assisted pyeloplasty although this treatment option is less readily available than laparoscopic pyeloplasty. Retrograde endopyelotomy is a simple, safe, and effective therapeutic option for primary and secondary symptomatic UPJO.
Retrograde endopyelotomy should be considered a viable first-line treatment option for the management of patients with UPJO. These include balloon dilation, antegrade endopyelotomy, retrograde endopyelotomy, Acucise endopyelotomy and laparoscopic pyeloplasty. During last decade, advances in endourological techniques have resulted in significant progress in the development of minimally invasive surgical procedures to treat UPJO.
Surgeons described their modification of Kusters dismembered procedure that involved anastomosis of the spatulated ureter to a projection of the lower aspect of the pelvis after a redundant portion was excised. Laparoscopic pyeloplasty was first reported in 1993 both by Schuessler and others and by Kavoussi and Peters, who utilized dismembered pyeloplasty technique. During last decade, advances in endourological techniques have resulted in significant progress in the development of minimally invasive surgical procedures to treat UPJO. The combination of less postoperative morbidity, improved cosmesis, shorter convalescence and comparable operative success rates has lured many patients away from gold standard of open pyeloplasty. Only few retrospective studies have been conducted regarding laparoscopic versus open pyeloplasty. Success rates are comparable for laparoscopic pyeloplasty.
The number of minimally invasive surgeries performed by us increased from year to year. Therefore the characteristics and performance of the surgeries should be studied in detail and based on the finding the evidence based medicine should be placed in.

Background: An aim of this study was to evaluate the long-term functional outcomes of laparoscopic ureteropyeloplasty compared to that of open surgery at the Urology and Andrology Center of the First Central Hospital of Mongolia. Ureteropelvic junction (UPJ) is the most common site for upper urinary tract obstruction occurring 1 in 750 - 1500 births. Laparoscopic pyeloplasty was first reported in 1993 by Schuessler WW and its technique was dismembered pyeloplasty. Material and Methods: In the period from June 2018 to September 2019, we have operated 91 ureteropyeloplasty cases. Patients were randomized into Group I (45 laparoscopy) operated by the laparoscopic ureteropyeloplasty and Group II (46 open surgery) operated by the open ureteropyeloplasty. All the patients had ureteropelvic junction obstruction and ureteropyeloplasty was performed. Both groups were compared according to the operative time, and recovery duration. We studied restoration of renal function and causes of conditions. Demographic data including age, gender and complications were recorded. Renal diethylenetriamine penta-acetate scintigraphy was respectively performed 6 months after surgery. Results: Mean age was 32±12.05 ranging 16-62 in all the study population. A total of 91 (55 men and 36 women) were participated. Ureteropelvic junction stricture was occurred 75.66% in laparoscopic cases and 84.78% in open cases which leads to hydronephrosis and it was statistically different (p<0.028). Compared to that of open surgery, wound size was 6 time smaller, blood loss and hospital stay less than 2 fold and wound healing is 5 days shorter than open surgery. There was statistical different (p<0.001) between parameters of 2 groups. In laparoscopic and open group respectively, renal function was 41.78±10.02ml/min, 42.15±11.34 ml/min (1.73м2). After intervention, renal function was increased by (46±10.17ml/min, 46.09±11.50ml/min) and there was difference between 2 groups (p<0.003). In laparoscopic group, renal function was more improved than open group (p=0.05). Conclusion Laparoscopic surgery had less blood, less analgesics usage, fewer hospital stays, and faster wound healing. Renal function was improved 6 months after surgery.

BACKGROUND: According to the United Nations, drug reports 2016, 250 million people aged 15 to 64 an estimated 29 million of them have used drugs and narcotics. The United nations states that the drug and narcotic manufacturing have increased by three times in east 15 years. Mongolia is located between Russia and China that are the most drug used countries in the world and it can increase the risk of drug usage in Mongolia. OBJECTIVE: Study to knowledge and attitude about drugs and narcotics among the high school, college and universities students in Ulaanbaatar. METHODS: The research was conducted among the school, college and universities students and the analytic research method was used in our research. 176 middle and high school students, 215 university students and 70 college students from morning classes were participated in the survey. The survey research was used method of collecting information and materials about the drug usage and narcotics. SPSS 17 was used for statistical analysis. RESULTS: The highest point was 16 (n=1) and lowest point was 0 (n=16) and the knowledge of drugs among the students was 8.14. Results releated that 7.8% (n=36) of students have enough information about the drugs and narcotics, 62.9% (n=261) of students did not have enough information and 29.3% (n=135) of them have informed moderately. CONCLUSIONS: Exploring the knowledge about drugs and narcotics among the students, 7.8% of them have enough information, 62.9% of them did not have enough information and 29.3% of them have informed moderately

Middle aortic coarctation (MAC), a variantof middle aortic syndrome, is a rare entity withonly ~200 cases described in the literature.It classically presents with early onset andrefractory hypertension, abdominal angina,and lower extremity claudication(1).A 30 years-old woman, Her systolic bloodpressure measures 180-200mm Hg and diastolicpressures measure 70mm Hg in both arms,lower extremity pressures are approximately70mm Hg. Her bilateral femoral pulses andpedal pulses are nonpalpable, but present onDoppler exam and CT-Angiography.We prepared diagnostic of CT-Angiographyand Aortography before operation. Wesuccessful operated abdominal aorticcoarctation by “Silver graft” Aortoaortic bypasson the middle aortic, left nephrectomy.She was discharged home on postoperativeday 7. Post operation is good. We werecontrolled CT-Angiography.

Background: Demyelinating disorders are a group of chronic immune-mediated diseases affecting myelinated axons in the central nervous system, which lead to life-long disability. In Mongolia, the last regional prevalence study was conduct ed in 2010. Our study objective is to describe the current prevalence of multiple sclerosis (MS) and other demyelinating disorders in Mongolia. : Aim Materials and Methods: We registered MS, neuromyelitis optica spectrum disease (NMOSD), myelin oligodendrocyte glycoprotein (MOG), and acute disseminated encephalomyelitis (ADEM) cases diagnosed according to the 2017 McDon ald criteria, the 2023 NMOSD diagnostic criteria, International MOGAD Panel proposed criteria. Results: The study was conducted in all tertiary, 7 regional, and 20 provincial hospitals across Mongolia and has collected comprehensive data on 965 patients. The prevalence of total demyelinating disorders was estimated to be 27.2, MS 15.6, NMOSD 5.6, MOG 0.06, and ADEM 0.9 per 100,000 total population, respectively. The prevalence of demyelinating disorders between provinces was compared in order of geographical latitude, from lowest to highest, and was statistically significant. Latitude is associated strongly with the prevalence of demyelinating disorders (p=0.006, 95% CI 14.3-22.4, Pearson correlation=0.603) and moderately with the prevalence of MS (p=0.028, 95% CI 9.39-15.6, Pearson correla tion=0.503). Conclusion In Mongolia, the prevalence of MS has significantly increased and can be considered at medium risk, but still much lower than that in Western countries. The prevalence of NMOSD is almost similar to other Asian countries. An obvious latitude gradient for demyelinating disorders was observed in the Mongolian population.