1.Cervical cancer incidence and mortality in Mongolia
Oyunchimeg D ; Chimedsuren O ; Avirmed D
Mongolian Medical Sciences 2011;168(1):83-91
Introduction. Cervical cancer is one of the most common cancers among women worldwide. Its mortality exemplifies health inequity, as its rates are higher in low & middle income countries (LMICs ), and in low socio-economic groups within countries. Around 80% of global cervical cancer cases are in LMICs. (WHO, 2008 )
Goal. To determine the prevalence, incidence and mortality for cervical cancer among Mongolian population
Objectives:
1. To determine the trends of incidence and mortality for cervical cancer by regions among Mongolian population during 2000-2009
2. To estimate DALYs for cervical cancer in 2009
Materials and Methods: Data for this study were abstracted from Annual Reports of the National Cancer Registry for 2000-2009.I ncidence and mortality rates were calculated as mean annual numbers per 100,000 residents. Age-standardized incidence rates (ASRs) and age-standardized mortality rates (ASMRs) were calculated by the direct method by weighting age-specific incidence and mortality rates to the World Population. The DALY combines in one measure the time lived with disability and the time lost due to premature mortality:
DALY = YLL + YLD
YLL – years of life lost due to premature mortality
YLD – years lived with disability.
Results: last ten years, the trends have been increasing of the prevalence, incidence and mortality rate for cervical cancer in Mongolia. The cervical cancer incidence rates are the highest in Central and Eastern regions than other regions. The average burden of cervical cancer across all regions in 2009 was 2868 DALYs per 100000 population, of which about 30,9% was due to premature death and 69% non-fatal health outcomes.
Conclusion: The incidence of cervical cancer is generally low in China, moderate in Japan and somewhat higher in Korea and Mongolia [11]. Need to estimate the DALYs for common cancers in Mongolia.
2.Adult Diffuse Pharenchymal Lung Diseases (Dplds): Diagnosis and Treatment
Mongolian Medical Sciences 2010;151(1):47-51
The DPLDs are important, accounting for about 15% of respiratory practice. They comprise a very wide spectrum of pathologies, presentations, and outcomes. There is a serious paucity of evidence about the management of DPLDs, but the morbidity of the DPLDs themselves and the treatments available may be high, with potentially serious consequences therefore for mismanagement. There is concern that DPLDs may be poorly recognized and managed by nonspecialists. Respiratory specialists are the only group with appropriate training and skills to deal with the complexity of the diagnosis and management of these conditions. British Thoracic Society (BTS) Standards of Care Committee set up a sub-committee to formulate recommendations on DPLD management. Purpose of the recommendations: to support improved recognition, diagnosis, assessment, and treatment of patients with DPLD, to raise awareness of the importance of DPLDs, to provide an authoritative current literature review of DPLDs management, to provide practical, evidence and consensus based recommendations that will aid the development of clinical services for patients with DPLD. This article contains the summary of diagnosis and assessment of diffuse parenchymal lung disease, based on BTS recommendations on DPLD management.
3.Risk factor for ectopic pregnancy: A comparison of different age groups
Badamkhand T ; Yanjinsuren D ; Oyunchimeg D
Innovation 2019;13(1):50-53
Background:
Ectopic pregnancy accounts for 1-2 percent of all pregnancies and a certain
proportion of maternal death. The incidence of ectopic pregnancies has seen more than
3-fold increase over the last 20 years. In 2004, around 70000 women in the United States were
diagnosed with ectopic pregnancy and it is one for every 250 pregnant women2. Ectopic
pregnancy case in South Korea is 17.3 per 1000 pregnant women9. In Ireland, the prevalence of the ectopic pregnancy increased from 12.8 per 1000 births in 2005 to 17.1 per 1,000 births in 20168. According to the MCHR study in Mongolia, 2.4% of total pregnant women was reported in maternal death. In Ulaanbaatar, 1.3% of the inpatient women were treated due to ectopic pregnancy and 33.7% of gynecologic surgical patients were women with ectopic pregnancy.
In 2005, 171 women were hospitalized for ectopic pregnancy and this increased to 647 in
20157. Incidence of ectopic pregnancy is increasing each year, but this type of comprehensive survey is not enough to provide a basis for selecting the subject. The objective of the study is to study the medical history of inpatient admissions with ectopic pregnancy, retrospectively.
Methods:
The present retrospective study was carried out through a retrospective database
analysis. We studied each patient’s history; total of 615 cases of ectopic pregnancy hospitalized
in the Urguu Maternity Hospital, using 5 sections of questionnaires with of 48 questions, between
1 January 2015 and 1 January 2016. We used the Statistical Package for the Social Sciences
(SPSS) 20 for data processing and estimation of survey findings.
Conclusion
As a result of this study, the highest rate of ectopic pregnancy is 3.8/100 and
the highest incidence of ectopic pregnancy was found among women aged 25-35 years,
the youngest patient was 19 and the oldest patient was 49, respectively. A 38.6% of women
who diagnosed with ectopic pregnancies had to have abortions, 13% had miscarriage, 42.1%
had history of vaginal surgery and 32.6% had history of uterine surgery which is most common
causes of ectopic pregnancy.
4.Study on some of the risk factors for cesarean section
Javzanpagma N ; Yanjinsuren D ; Oyunchimeg D
Innovation 2019;13(1):60-63
Background:
The average of cesarean has increased over the last 30 years in developed
as well as in developing countries. During the last decade, cesarean surgery rates increased
by 1 to 2 times. As of 2015, there were 80434 mothers gave birth nationwide. In Ulaanbaatar
city, 267106 births were recorded, from which 14,327 (30.7%) was born with cesarean section.
In 2015, 32.2% of all births born in Ulaanbaatar delivered by cesarean surgery, which is 2.5%
higher than the previous year. The rate of cesarean surgery has increased dramatically,
however, causes and complications are unclear and these subjects are rarely investigated,
thus, we decided to study this important issue.
Material and methods:
The study was carried out through a retrospective design of
descriptive statistics. Using cross-sectional study, we randomly collected data from the history
of total of 5125 births recorded in the Urguu Maternity Hospital, in 2015 and 408 were selected.
Data was collected by using 48 questions in 5 sections. We used the Statistical Package for the
Social Sciences (SPSS) 20 for data processing and estimation of survey findings.
Results:
From the total of 408 women, who given birth by cesarean delivery, 50.2% done under
cesarean surgery for the first time, 33.3% for the second time and 16.5% of them experienced
with cesarean surgery 3 or more times. The impact of cesarean section on abortions was
studied by comparing the rates of cesarean section compared to rates of abortion and we
had revealed that 25.3% of cesarean surgery had an abortion once and 11.2% of them twice
and 7.4% had 3 or more abortions.
Conclusion
Number of chances getting pregnant is age-related (p=0.001). Cases of first
cesarean delivery have increased to 50.2%. The frequency of cesarean section and the
number of pregnancies was statistically significant (p=0.001). According to the retrospective
study of maternity history, 43.9% had abortions. There is an inverse correlation between the
rates of cesarean section and rates of abortion (p=0.004). Combination of disorders of the
organ systems do not affect the rate of the cesarean section (p= 0.941). Vaginal inflammation
does not affect the frequency of cesarean section (p=0.237).
5.Study on the knowledge, attitudes and practices of STI among adults of Dornod aimag
Munkhchimeg T ; Zevgee T ; Oyunchimeg D
Innovation 2019;13(1):54-59
Background:
In 2017, incidence of STI accounted for 54.6% of all communicable diseases.
Syphilis, gonorrhea and trichomoniasis per 10000 populations are higher than the national
average and congenital syphilis has been registered regularly over the past 5 years, which is a
major problem today. Thus the study aims to research the knowledge, attitude and practice
of sexually transmitted diseases in adults of Dornod Aimag.
Methods:
The population of Dornod aimag was divided into 4 clusters and one cluster from
the aimag center and remaining 3 clusters from soums were selected for the study based on
the ratio of population aged between 16-49 years. Random sampling was used to select
participants from aimag center and 13 soums and total of 342 people selected for the study.
Results:
Knowledge of sexually transmitted diseases is insufficient. There is no difference in the
level of knowledge of sexually transmitted infections between men and women (p = 0.352).
There is a difference in the level of knowledge between age groups and the knowledge
level increases with age (p = 0.001). For the question about casual sexual behavior, 21.1% of
respondents had casual sex intercourse 2-5 times. Gender differences were seen in attitudes
toward casual sex, as 27.8% of male and 14.5% of females had casual sex 2-5 times (p=0.000).
18.1% of respondents used condoms during casual sex, while 13.5% occasionally used
condoms, and considering the gender of participants, 24.9% of men and 11.6% of women (p
= 0.000) used condom during casual sex.
Conclusion
In Dornod aimag, there is a lack of awareness of STI and risk behaviors.
Furthermore, they have no intention to protect their health due to lack of positive attitude
and commitment to protect their sexual health.
6.Childhood cancer in Mongolia: focusing on trend in incidence from 2008 to 2017
Erdenechimeg S ; Undarmaa T ; Oyunchimeg D
Mongolian Medical Sciences 2019;187(1):23-28
Introduction:
An international study coordinated by the International Agency for Research on Cancer (IARC) and published today in The Lancet Oncology shows that in 2001–2010, childhood cancer was 13% more common than in the 1980s, reaching an annual incidence rate of 140 per million children aged 0–14 years worldwide. Cancer incidence and mortality statistics reported by International Cancer Research Center (2016), over 300,000 children develop cancer worldwide each year, 215000 children aged 0-14 years and 85000 children aged 15-19 years. Internationally comparable data on childhood cancer incidence in the past two decades are scarce. Based on the need for comparison of childhood cancer incidence in Mongolia to the global level, the study aimed to categorize cancer among children aged 0-19 years.
Goal:
To study the insidence rates and trend from childhood cancer last 10 year in Mongolia
Materials and Methods:
The study was conducted in 786 new cases childhood who were cancer diagnosed, between 2008 and 2017 year. Age-standardized incidence rates were calculated by the direct method using age-specific incidence rates and weights based on the age distribution of the standard world population
Results:
Over the past 10 years, childhood cancer accounted for 1.5% of total cancer in Mongolia. By WHO and IARC data, worldwide childhood cancer age standardized rate (ASR) is 106.0, in Mongolia childhood cancer ASR (101.6) is lower than world average.
The most common childhood cancers worldwide are: 1st leukemia, 2nd lymphoma, 3rd central nervous system cancer, 4th retinoblastoma, 5th soft tissue cancer. Over the past 10 years the most common childhood cancers in Mongolia are: 1st leukemia, 2nd central nervous system cancer, 3rd joint bone cancer, 4th lymphoma, 5th soft tissue cancer. Our country’s childhood cancer ASR is below compared to other countries, but expected growth rate is gradually increasing (3.0 per year).
Conclusions
1. Leukemia is the most common childhood cancer in worldwide and also in Mongolia.
2. By sex, childhood cancer incidence is higher in boys than girls.
3. By age group, childhood cancer incidence is the highest in 0-4 age group.
4. By region, childhood cancer incidence is the highest in central region.
5. The overall incidence of childhood cancer (1 million children) in Mongolia is expected to increase by 3.0 over the next 5 years.
7.The results of early detection program of uterine cervical cancer in Ulnaanbaatar
Uyanga G ; Oyunchimeg D ; Undarmaa T ; Enkhtuya SH
Mongolian Medical Sciences 2016;176(2):19-24
GoalTo evaluate the quality, results, and processing of cytology analyses of early detection program ofuterine cervical cancer implemented in Mongolia, which based on Pap test, at Ulaanbaatar city level.Materials and MethodsInformation was collected from the databases of the recalling system of screening program of theCancer registration and information unit of the NCC of Mongolia and districts pathology laboratoreis.Statistical significant level of 1.96 (95% CI) andthe margins of error 0.05 were considered andsample size was calculated by using the information that 10% of unsatisfied results appear onquality assurance of international level. Thus calculations were madefortotal of 1723 (585 positiveand negative 1138) samples, by collecting 287smears from each district.At the district level all the selected slides were reviewed blindly and compared to the previouscytological conclusion. Diagnostic validity was defined by calculating parameters such as specificityand sensitivity, positive and negative predicted values. The Kappa index criteriais used for statisticalcalculation of the cytological diagnosis conclusion matches.ResultsThe target group women coverage of cervical cancer screening program is 40.8%. Out of all positiveresults of early screening cytology, 77% were at an early stage and 23% were at an advanced stage.Thus positive signs were showed with increased detection results in early stage of uterine cervicalcancer (P = 0.05). Positive results of Pap test were follows; ASCUS (53.2%), ASC-H (10.0%), LSIL(19.2%), HSIL (13.4%), CIS (3.4%), and SCC (0, 8%). Out of total slides, 86.7% were as satisfactory.The test results conducted at the district level were90.1% of sensitivity, 88.8% of specificity and9.9% of false negative response. The discrepancy of results of cytology test in districts and repeatedseen is 31.4% (K = 0.749; p = 0.001).ConclusionThe coverage of cervical cancer screening program that has been implementing in our country isnot enough. There are problems at the district level including severe damages of uterine cervix andincomplete diagnosis. The quality of the cytology test is relatively unsatisfied.
8.Prevalence of asymptomatic bacteriuria in hospitalized patients
Tegshjargal T ; Altantsetseg T ; Regzedmaa D ; Oyunchimeg D
Health Laboratory 2021;13(1):5-11
Description:
Asymptomatic bacteriuria is defined as the presence of 1x105 or more bacteria per milliliter of urine, although there are no signs of UTI [1]. Asymptomatic bacteriuria is quite common and occurs in 1-5% of healthy women before menopause. The incidence of asymptomatic bacteriuria increases in the elderly (men and women) to 4-19%. Asymptomatic bacteriuria is observed in 0.7% -27% of patients with diabetes mellitus, in 2-10% of pregnant women and in 23-89% of patients with spinal cord injury. Asymptomatic bacteriuria is rarely observed in young men and always requires differential diagnosis with chronic bacterial prostatitis[2].
Among the elderly, those in institutionalized settings such as long-term care facilities and hospitals have a higher prevalence of asymptomatic bacteriuria than those living in the community. Therefore, interest in asymptomatic bacteriuria has shifted from the general population to these groups of individuals. The prevalence varies from 2% to 10% in pregnancy and from 15% to 50% in the elderly in long-term care facilities.[3,4]
This study was undertaken to determine the prevalence of people asymptomatic bacteriuria in among hospitalized people.
Purpose:
Investigate cases of asymptomatic bacteriuria among hospitalized individuals and determine antibiotic susceptibility by type of pathogen detected in urine.
Materials and methods:
This cross-sectional study in the “I” Hospital of UB city, Mongolia. We conducted into the study 133 patients. After obtaining informed consent, a midstream clean-catch urine sample was collected in the same 24 hour time window and was evaluated for urinalysis using a dipstick test and routine culture. A positive urine culture was defined as a single urine sample with microbal growth of >105 colony- forming units of a single organism. We use 5-10% Blood agar, UTI agar, Mackkong agar and Chroma agar for a bacterial growth. Then we did antibiotic susceptibility of the determined pathogen.
Result:
The average age of the respondents was 55.9±14.6, the youngest was 17 years old and the oldest was 91 years old (CI 95% 53.4-58.5). By age group, 4.5% (n = 6) of people aged 20-30, 21.1% (n = 28) of people aged 31-45, 37.5% (n = 50) of people aged 46-60, and people over 61 years of age 36.8% (n = 49) respectively.Of the respondents, more than 56 or 54.9% (n = 73) were elderly, of which 63.9% (n = 85) were women and 36.1% (n = 48) were men.
A total of 36 (27.1%) leukocytes were detected, and 25 (34.2%) more (P-0.05) were detected in people over 56 years of age. The protein detected in 24 (18.0%) people, all over 56 years of age and more defined in men (P-0.01).
80.5% (n = 107) of those surveyed were diagnosed with the pathogens, and 54.9% were elderly (P-0.031). 82.4% of women and 77.1% of men were diagnosed with urinary pathogens.
Streptococcus 26%, E.coli 19%, Saprophyticus 13%, Enterococcus 11% and Staphylococcus 11% were detected in the analysis, and Streptococcus and E.coli (19%) accounted for a slightly higher rate of infection.
A total of 13 types of pathogens were identified, of which 53.4% were susceptible, 21.7% were moderately sensitive, and 24.9% were non-susceptible.
Discussion:
According to a study conducted by researchers at the University of Taiwan, the prevalence of asymptomatic UTI-s in the general population is 57.8%. E.Coli was also the most common bacterium in the urine [6].
In our study, there are many cases of E. coli.
Study in the United States found that the prevalence of asymptomatic bacteriuria among inpatients was 8.5%, all of them women. The most common pathogens in this study are Enterococcus bacteria. This study found that 1 in 10 people admitted to the hospital may have asymptomatic bacteriuria. [1]
Conclusion
1. Asymptomatic bacteriuria in 80.5% of those surveyed 54.9% were detected in people over 56 years of age.
2. Antibiotic susceptibility of the tested pathogens was determined as 53.4% sensitive, 21.7% moderately sensitive and 24.9% insensitive.
9. Comparison of CSF analysis by manual counts and automated hematology analyzer Sysmex XN-2000
Bolor A ; Oyunkhand L ; Erdenechimeg D ; Narmandakh G ; Gerel A ; Narantuguldur D ; Oyunchimeg R ; Naran G
Health Laboratory 2016;5(1):12-15
Introduction:When a central nervous system disorder (meningitis, encephalitis, hemorrhage, leukemia infltration and other neoplasma) is present, cerebrospinal fluid (CSF) shows various changes that reflected the condition. Therefore it is essential to test CSF. Different types of CSF tests include cell count; cell differentiation; chemistry; immunology; microbiology and molecular biology. CSF cell count and cell differentiation in particular, are crucial in differentiating diagnosing various CNS disorder needing immediate care and in evaluating the treatment. The patient’s prognosis largely depends on how accurate diagnosis was done and how early treatment was provided. There for CSF test require high precision and accuracy. In Mongolia until now 2st and 3st level hospital using manual method for CSF cell count and cell differentiation test. In this test has 2 actual problems, which is depends on the analytical techniques, skills and sample stability specific problem. But in Japan in 2011 newly designed Sysmex XN Series hematology analyser with body fluid mode (CSF,pleural effusion, peritoneal and synovial fluid). On The First Central Hospital of Mongolia In 2013 frst timeinstalled Sysmex XN-2000 hematology analyser andpossible use of body fluid automatic testing methods.Materials and methods:We evaluated the basic assay performance of the body fluid mode on the automated hematology analyzer XN-2000, which is used for analysis of CSF fluid. We compared between the manual method and XN-2000 analysis for nucleated (WBC), mononuclear (MN) and polymorphonuclear (PMN) cells was also randomly studied using 10 CSF samples of inpatient section our hospital.Results:In CSF samples the coeffcient correlation(r) for WBC/µl, MN%, PMN% were respectively 0.83, 0.95 ба 0.95.Discussion:The correlation for MN%, PMN% were between automate and manual method was good, that is similar to the other researchers. Whereas the correlation for WBC/µl slightly low, this was probably correlation relatively weak or show discrepancies. In introduction inscriptive in analysis accuracy can to affect analytical techniques skills, sample stability and specifc many problems. Therefore scientifc studied and proven ability specifcity, sensitivity, reproducibility, quality, personnel low cost and spend less time, automatically Sysmex XN series hematology analyzer is desirable to domesticate an appropriate level of medical laboratories.
10.Relation between adherence factors and the phylogenetic group of extraintestinal pathogenic Escherichia coli
Munkhdelger Ya ; Nyamaa G ; Undarmaa G ; Oyunchimeg R ; Munguntuul T ; Altantsetseg D ; Munkh-Od Ts ; Sarantuya J
Innovation 2015;9(2):28-31
Extraintestinal pathogenic Escherichia coli (ExPEC), the specialized strains ofE.coli that cause most extraintestinal infections, represent a major but littleappreciated health threat. Phylogenetic analysis has shown that ExPEC is composedof four main phylogenetic groups (A,B1, B2, and D) and that virulent extraintestinalstrains mainly belong to groups B2 and D.In this study, we aimed to assess therelation between adherence virulence and phylogenetic groups of ExPEC.A total of 161 E.coli samples were collected. Out of these 17 (10.6%) werefrom pus, 66 (41 %) from urine, 78 (48.4%) from cervical swab. The phylogeneticgroups and 6 virulence genes (fimH, papC, papGII, papGIII, fa/draBC,andSfa/focDE) encoding adhesins were identified by triplex PCR. Phylogeneticgroups distribution was as follows: B1 10.5%, A 24.7%, B2 25.3%, and D 38.9%. Virulence genes prevalence was fimH 90.1%, papC 23%, papGII 16.8%, papGIII1.9%, Afa/draBC 11.8%, andSfa/focDE 5.6%. The cell surface protein (curli) wasdetected 50,3% by Congo red agar. In conclusion: The most isolated strainsbelonged to the phylogenetic group B2 and D. The phylogenetic groups weresignificantly associated with some genes encoding
adhesins (fimH, papC) and cellsurface protein (curli).