Acceleration of emissions reductions in household coal stoves and modest improvements in other sectors, however, have the potential to considerably lower outdoor pollution and reduce total exposures to about 70% of those today (Scenario 1). Reducing total exposures closer to these international benchmark levels will require moving away from coal and wood as household fuels and even more control on other sources (Scenario 2). The first package of moderate control measures (Scenario 1) considered in this assessment will result in a slow decline in impacts(Figure) and a cumulative health savings over trends in 2013, but leave annual per capita health impacts only about 25% lower than today after ten years. A more aggressive set of control measures (Scenario 2), however, will result in more health protection over the period and reduce annual impacts by approximately 60% from current levels in 2025 . In terms of impact per capita,this would represent nearly a 70% reduction over the period taking population growth into account.

BACKGROUND. Hemophilia B is X-linked recessive genetic disorder, caused by missing or defective factor IX that results in bleeding longer after an injury or surgery, easy bruising, and an increased risk of bleeding inside joints or the brain. The disorder affects approximately one in 30 000 males worldwide and 18 cases were registered in Mongolia according to statistics of Hemophillia Federation of Mongolia. The annual cost of episodic treatment of an adult with severe hemophilia estimated at ≈53000 USD owing to high cost of treatment developing countries has been adopted to prevent and to forecast the risk of inhibitor. Materials and Methods: The objective of this research is to determine F9 mutations in patients with Hemophillia B in Mongolian population and to assess correlation between genotype and phenotype of disease. Characterization of mutations was performed by direct sequencing of genomic DNA using a Sanger sequencing method. Briefly, the exon or part of the exon deletion was checked and amplified by polymerase chain reaction (PCR). Results: We identified four point mutations and one deletion. No large exon deletion was found in PCR amplification result. As expected, the most common mutations responsible for the disease were point mutations. In general, this study revealed 5 different mutations in unrelated 7 proband and there is good correlation between the type of mutation (location in the amino acid position and domain in the protein) and their functional outcome, yielding a predictable clinical severity.

BACKGROUND. Head and neck cancers are related group of cancers that involve the oral cavity, pharynx (oropharynx, nasopharynx, hypopharynx), and larynx. Early-stage tumors of the upper aerodigestive tract can be cured; for late-stage disease, prognosis is poor. Nowadays microvascular free tissue transfer surgery performed at high level. Worldwide, this particular kind of operation in head and neck surgical field has become “golden standard” of treatment. Seemingly, plastic and reconstructive surgeons of developed countries widely perform forearm free flap, anteriolateral thigh free flap, fibula free flap, rectus abdominal free flap, latissimusdorsi free flap. We purpose to report our first 121 cases of Microvascular Free Tissue Transfer which had been performed at the head and neck surgical department, NCC of Mongolia. METHODS. The clinical records of first 121 cases patients who had microvascular reconstruction done between 2011 and 2017 were reviewed. The indications for surgery, choice of flap, duration of surgery and flap survival were noted. RESULTS. Our study were performed on 121 cases, among them 84.3% flaps were survived, most of defects occurred following cancer resection. Anterolateral thigh and radial forearm flaps were performed commonly for our reconstruction surgery. CONCLUSION. 84.3% free flap recorded success rate indicates our early experiences. Although the National Medical University do not have postgraduate reconstructive and plastic surgical training, we believe that meticulous planning, careful vessel selection, close flap monitoring as well as improved infrastructural support can lead us to much better success rates of microvascular reconstruction in our country.

Background: Approximately, 3.2 millions of children are born with congenital anomalies in worldwide annually which is equal to one case per each 33 live births. As for Mongolia, there are 2.7 congenital anomalies cases for each 1000 live births on average between 2005 and 2007, however, this number is increased up to 5.04 or doubled up for each 1000 live births in 2012 urging us to concern more on this public health issue. Objective: To determine the prevalence and incidence of the congenital anomalies among infants’ with 0-7 days registered in Mongolia. Materials and Methods: This study is conducted through descriptive analyses. Statistical analyses were conducted by using Stata13, MS excel, and ArcGIS software. Results: Total 669,579 women who gave a birth and 2,376 children with congenital anomalies data were used in this study between 2006 and 2016 in Mongolia. In 2006, there were 3.88 cases of congenital anomalies for each 1000 live births and this increased up to 6.44 cases by 2016. Taking into account the incidence of congenital anomalies by the organ systems, abnormality of circulatory systems were 24.5%, cleft lip and palate were 18.1% of the total cases, respectively. By its geographical patterns, the incidence of congenital anomalies were mostly reported in Orkhon, Gobi-Altai, Gobisumber and Tuv provinces while the least cases reported province was Bayan-Ulgii.
Mean maternal age who gave a birth children with congenital anomalies was 28±6.3 which was statistically significant different (p=0.001) than maternal age who gave a normal birth. In addition, there was high incidence of congenital anomalies among the maternal age groups of 35-44 and above 45 years old. Conclusion
1. Between 2006 and 2016, the incidence of congenital anomalies was increased around 1.7 times it is tended to increase steadily. Particularly, cases of congenital anomalies were occurred in cardiovascular, circulatory system, cleft lip and palates, skeletomuscular system, digestive and nervous systems.
2. Orkhon province had the highest incidence of congenital anomalies in our study. There was significant association (12% more than live births with normal weight) between congenital anomalies and child live birth with less than 2500 gr in weights. By gender, congenital anomalies were reported dominantly in boys and it was statistically significant. Case of congenital anomalies increases as the age of mother increases.

Background:Echinococcosis is from animals to humans and cause cestode zoonoses. Genetic variations within of echonoccocus and their genotypes may cause a disease as well as can indicate transmission dynamics to human and pets. At present, there are no available data for the typing of echinococcosis isolated in MongoliaMaterials and Methods:A total of 50 human hydatid samples from collected from State Centre on Maternal and Child Health, Oncology Centre of Mongolia. All samples were examined by PCR using cox1. The PCR products with a molecular size of 578 bp were amplified from human hydatid samples. Also we used RFLP method.Results:Genotype and strains of E. multilocularis and Е. granulosus were identified by RFLP. PCR products were digested using Ssp I, Hind III, Bgl II endonucleases. PCR products were digested by Ssp I endonuclease we found E. multilocularis. PCR products were digested by Bgl II endonuclease. Two major bands were seen in human hydatid sample. The bands have molecular weight of 420 and 158 bp respectively. It was infected by E. granulosus G6. Digestion with Hind III revealed two major bands within samples from human hydatids. These bands have molecular weight of 168, 410 bp respectively. These samples were infected by E. granulosus G1. Most of E. granulosus materials obtained from human patients by surgery confirmed the presence of sheep strain G1 (Bowles and McManus, 1993 a & c). In 24 cases of human hydatid echinococcosis in Mongolia sheep strain was found to be infective to humans.Conclusions:1. Echinococcosis caused by E. granulosus, E. multilocularis in human.2. G1, G6 genotypes of E. granulosus found in human hydatids.

Background: The ichthyosis is a hereditary skin disease and inherited by autosomal dominant, autosomal recessive and X recessive trait separately. The X-linked ichthyosis (XLI) is the most frequent cutaneous disease and general incidence accounts for one in 2000-5000 male births. Molecular pathogenesis of XLI is due to mutations, which are large deletion, missense, frame shift and nonsense in STS gene. The vast majority of mutation frequency is a large deletion, which are found in 85-90% of patients with XLI. An exon deletion of the STS can be detected by Polymerase chain reaction with exon specific primers. An identification of STS gene mutation has various importance such as 1) detection of mutation type; 2) for genetic counselling, 3) disease severity, 4) carrier detection. Methods: In the present study, pedigree analysis was used for type of inheritance, and Polymerase chain reaction was used to detect a deletion in STS gene and normal control used. A deletion was identified in case PCR bands were not visualized in agarose gels. Results: We included one patient, who had typical symptoms of XLI including dark, adherent scales on skin. Mutation analysis of the STS gene showed that the patient had whole gene deletion (del: Exon 1-10), which was demonstrated by the repeated amplification failure of exons. We used a sample of healthy man as a wild type control, which showed normal amplification of STS gene’s exons. Further, the current study will be focused on the screening of heterozygote large deletion of Del: Exon1-10 of STS gene among patient’s female relatives. Conclusion An ichthyosis case enrolled in this study was inherited by X-recessive and we identified whole exon deletion of STS gene in this patient.

The purpose of this study was to analyze the epidemiology of oral and maxillofacial surgery patients in Mongolia and advocate guidelines and programs to promote optimal oral health care. A fact-finding epidemiologic study on the patients who visited at Departments of Oral and Maxillofacial Surgery, at National Hospitals at Ulaanbaatar city and Province and other Central hospitals of Mongolian, from Jan to Dec, 2013.Total 12957 patients treated at inpatients care center at the above mentioned national hospitals. From Ulaanbaatar city were 4284 (36%) and from province were 7673 (64%). Patients from province were treated at FCH 69%, NTORC 6.4%, NCC 11.3%, NCMCH 27% and CMAFH 1.8%. Zero to 16 years, 17 to 36 years, 37 to 56 years and 57 or more years old patients were3072 (27.1%), 4224 (34.2%), 3218 (26.9%) and 1412 (11.8%), respectively. Males and females were 6841 (53%), 6090 (47%). Cases of the inpatients were as follows: infectious disease 5971 (49.88), benign tumor 1039 (8.01%), trauma & injury 1799 (15%), salivary gland disease 2.41%, TMJ disease 2.8%, neuralgia and muscle pain 0.8% and others. 5 provinces have no Oral and Maxillofacial Surgeon and patients were referred to other central hospitals or to the Ulaanbaatar city. This study gives a topic of conversation about undergraduate dental education, continuing education and enough specialists in the region.

Background: A rare angioproliferative condition of the larynx, Kaposhi sarcoma typically affects the skin. Immunosuppressive treatment following organ transplantation and human immunodeficiency virus infection are the causes. Every type of Kaposi sarcoma has human herpesvirus-8. Laryngeal kaposi sarcoma is uncommon in immunocompromised patients; since its initial identification in 1965, 18 cases have been documented globally. A CO2 laser-assisted laryngeal microsurgery is performed through the mouth cavity to remove tumor when kaposi sarcoma of the larynx obstructs the airway. Case report: A 77-year-old woman complained of hoarseness, dry mouth, odynophagia, and dysphagia three months prior when she arrived at the Mongolian-Japan Hospital. Two years ago, she acquired hard, sensitive lumps that were palpable on her right arm, left ankle, and right thigh. At that time, she was diagnosed with Kaposiform hemangiodermatitis and treated at the National Center for Dermatology. HIV test results were negative. Immunohistochemistry: CD31 +/-, CD34 /+/. Using flexible nasopharyngeal endoscopy to get the diagnosis: There was a mass that was about 1.5–2–5 cm in diameter, bluish in color, smooth and movable, and spongy and vascular on the larynx, on the nasopharynx, behind the palatine tonsills, and supraglottic. Surgery: Through the use of Kleinsasser laryngoscopy and a 0-degree endoscope, pathological tissues were extracted under general anesthesia using a laryngeal microsurgical instrument and a laparoscopic bipolar coagulator. The tissues were then sent for histological evaluation, which revealed Kaposi sarcoma, sarcoma grade 1. Results of treatment Pain decreased and quality of life increased following surgery. Upon nasopharyngeal endoscopy, the vocal cord mobility was normal and the surgical incision was clean. Conclusion: Kaposi sarcoma is an extremely uncommon illness. A lower quality of life and further issues can be avoided with an early diagnosis and suitable therapy. It also needs to be continuously monitored because it is a potentially repeatable disease.