Within the spectrum of diagnostic procedures in hepatology, the procurement of a liver specimen plays an important role. The method has been diversifi ed to encompass not only different needle types for cutting and aspiration but also different routes proceeding transvenously or transcutaneously. Over the subsequent 50 years the technique of obtaining liver biopsy samples has been modifi ed regarding the approach, the needle type, and the combination with diagnostic imaging techniques such as ultrasound, computed tomography, angiography and laparoscopy. Histological analyses are capable of establishing the etiology of a chronic or acute liver disease, are determined the inflammatory activity (Grading), degree of fi brosis/cirrhosis (Staging), are relevant for the prognosis of the patient and for indication for cost-intensive as well as potentially side are effect-prone therapies. In general, the accepted mortality rate from liver biopsy is between 0,1% and 0,01%. Among the most feared complications of liver biopsies are hemorrhage, seeding of cancer cells, infections, and injury to the viscera. The increasing number of liver transplant patients within the hepatological spectrum requires regular, safe, and high quality biopsies and their appropriate.

Effects of industrial noise have been recognized by humanity since mid 19th century and works to study and prevent industrial noises had begun globally. Strong industrial noises damage human internal ear and hair cell of cort-organ rapidly and gradually, which causes deafness; and thousands of people are suffering from health problems. Many noisy industries, where thousands of people work, were built in our country by 1960’s anddeafness has increased due to exposure of industrial noise. Scientific studies to measure the level of industrial noise, to determine the hearing level of people who are working in it, to study the relationship between noise and hearing loss still haven’t been conducted completely. Aim: To measure distribution zone of industrial noise generator which generates noise with more than 85, to study hearing threshold of the people who are constantly affected by it, to prevent noise hearing loss.The plants of “Erdenet Industry” JSC, TPP-4 SOC, “Darkhan TU” SOC, TPP-3 SOC have been chosenwithin scope of the research. Noise level of 42 instruments of these plants which produces noise over85 “Noise distribution zone” where noise level decreases to 85, Chose 480 employees who have beenaffected by it for more than 5 years.Using modern audiometer at 250, 500, 1000, 2000, 4000, 8000 Hz to measure for each bone and air conduction in noise-proof rooms Average hearing thresholds are calculated at dense, medium, pitched noise levelEarplug and headphone were used at shop and assembly line with noise over 85 дБ for more than 24 hours by employees, their satisfaction was studied and it was watched that if they were using the protective equipment regularly.Hearing threshold of employees who constantly work at noisy environment found to be 28.5±3.8 dB atdense noise 31.8±4.4±0.3 at medium noise, 38.2±5.7 dB at pitched noise level for “Erdenet Industry” JSC, 30.9±3.1±0.3 дБ at dense noise, 34.6±3.5 dB at medium noise, 39.5±4.3 dB at pitched noise level for TPP-4 SOC, 31.9±3.6 dB at dense noise, 34.9±3.8 dB at medium noise, 40.9±4.1 dB at pitched noise level for “Darkhan TU” SOC, 28.9±2.6 dB at dense noise, 32.4±2.8 dB at medium noise, 36.4±4.4 dB at pitched noise level for TPP-3 SOC. 95.6% of employees of “Erdenet Industry” JSC, 95.7% of employees of TPP-4 SOC, 96.5 % of employees of “Darkhan TU” SOC, 95.8 % of employees of TPP-3 SOC were satisfied when noise protection tools Ear classic and Bilsom were used at environment with noise level over 85 dB. Average hearing threshold of employees who have worked for more than 5 years in weak industrial noise level (85 – 92.5 dB) found to be 28.4±3.0 dB at dense noise, 32.3±3.2 dB at medium noise, 37.1±4.5 dB at pitched noise level, for medium noise level environment 30.2±3.4±0.3 dB at dense noise, 33.5±4.0 dB at medium noise, 39.2±4.4 dB at pitched noise level, for strong noise environment 34.1±3.6 dB at dense noise, 34.5±3.8±0.4 at medium noise, 34.8±4.5 dB at pitched noise level, or it was reduced from healthy hearing threshold with true possibility when p=0.05.95.6% of employees of “Erdenet Industry” JSC, 95.7% of employees of TPP-4 SOC, 96.5 % of employees of “Darkhan TU” SOC, 95.8 % of employees of TPP-3 SOC were satisfied when noise protection tools Ear classic and Bilsom were used at environment with noise level over 85 dB, which makes these tools reliable protectors from hearing loss due to noise.

Abstract. This article refers to the management of adults with community acquired pneumonia (CAP) of all ages in the community or in hospital. Details of general investigations for patients managed in the community and for patients admitted to hospital, treatment in community, hospitals and in intensive care unit, follow up planning, empirical antibiotic choice, duration of antibiotic administration, failure to improve, the level of evidence of recommendations are given in the text and are summarized in figures and tables. Severity assessment is recommended as the key to planning appropriate management both in the community and in hospital. Certain adverse prognostic features have been associated with an increased risk of death and should be assessed in all patients. Patients who have two or more “core” adverse prognostic features are at high risk of death and should be managed as having severe pneumonia. Patients who display no adverse prognostic features can be managed as having non-severe pneumonia and may be suitable for outpatient treatment or early hospital discharge.

Goal: To conduct mercury-based medical devises used in health care organizations and develop strategy and recommendations on futher activityMaterial and Methods:A cross-sectional study design was used. Totally 578 units of 38 governmental and private health care organizations inUlaanbaatar, Darkhan, Erdenet cities and Uvurkhangai aimags were conducted in the survey. The survey was conductedby means of a questionnaire given to the medical workers and doctors to complete. There were 3 parts of questions. Thefirst part of the questionnaire dealth with the use of mercury-based medical devices, working, transportation and storageconditions, and waste management. The second section was concerned with knowledge, attitude and practice (KAP) ofmedical personals for safety handling, storage and disposal of mercury containing devices. The third part of the questionnairedealth with the dental amalgam.Mercury concentration of dental amalgam samples were detected by portable mercury vapor analyser RP-91, PYRO-915+ in the Poison Information Center of Public Health Institute. Data processing was done by using statistical programSPSS-10.Conclusions:1. Mercury containing devices such as thermometer, blood pressure sphygmomanometer, energy saving fluorescencelamp and termostates were used in urban and rural hospitals. There are not any regulations for safe handling,storage, and transportation and disposal system of mercury containing divices.2. Knowledge on handling, storaging and disposing mercury based devices are not enough among the medical personals.The current situations for inapproiprate disposal system can be posed to increase riskes of environmentalpollution with mercury.3. Knowledge on health impact of spilled mercury from broken mercury based medical devices is not enoughamong the medical workers. Safety manual for handling, storage and disposal of mercury based medical devicesand promotion materials for health adverse effect and prevention methods have not been developed.4. 14.7% of the investigated dental hospitals and cabinets were used dental amalgam for treatment. Of these wasinvolved the fist stage hospitals. Dental amalgams were imported from China and Russia. Any special recommendationsand rules for safe use, storage and disposal of dental amalgam have not developed.

Introduction: Electrolyte values are measured by two different analyzers: arterial blood gas (Point of care) and auto-analyzers. Those two has different methods to measure electrolytes and have several pros and cons. We evaluated if there was agreement between whole blood electrolytes measured by a point-of-care device and serum electrolytes measured using indirect ion-selective electrodes. Materials and methods: An observational cohort study was conducted in 50 paired venous samples from patients admitted in Gurvan gal central hospital. Those were analyzed on OPTC blood gas devise and Roche c-501 auto-analyzer. Statistical analyses were performed using paired t-test and persons’ correlation test. Results: Sodium mean range was 138.54 mmol/l (SD=3.69) by blood gas analyser, but by the automated analyser mean range was 140.75 mmol/l (SD=4.45). Mean difference of the normal sodium group was 1.77 (SD=1.65, p=0.039), and hyposodium group was 4.4 (SD=0.33, p=0.007). Pottasium mean range was 3.13 mmol/l (SD=0.53) by blood gas analyser, but by the automated analyser mean range was 4.42 mmol/l (SD=0.45). Mean difference of the normal sodium group was 0.18 (p<0.001), and hypokalemi group was 1.44 (p<0.001). Conclusion Clinicians should be aware of the difference between whole blood and serum electrolytes. A correction factor needs to be determined at each laboratory.

Introduction: Cancer continues to be one of the world’s major health issues, with Mongolia continues to lead Asia in esophageal (100’000: 17.1) and gastric cancer incidence (100’000: 41.0). In the previous decade, 8,137 new cases of gastric cancer were reported in Mongolia. According to TNM staging, eight out of every ten people are diagnosed late, recognizing the need to improve people’s knowledge, attitudes, and practices. Methods: The survey was carried out using a questionnaire. A total of 320 participants between 17- 80 ages from the aimags of Uvs, Khovd, and Zavkhan were chosen at random for the survey, and data was collected through social media. SPSS (v28.0, SPSS Inc., Chicago, IL, USA) software was used for statistical analysis. Results: The survey included 110, 106, and 104 participants from the aimags of Uvs, Zavkhan, and Khovd. A total of 320 participants, with 20.9% (67) and 79.1% (253) being male and female respectively. The average age was 35.56±9.15 years. The participants’ mean knowledges, attitudes and practices scores were 7.54±2.7, 9.6±2.2, and 3.82±1.1 respectively in the first survey. Following the advocacy campaign, the mean knowledge, attitude, and practice scores increased to 9.3±2.7, 10.1±2.2, and 4.00±1.2, respectively. Conclusion The attitudes and practices of the participants were related to their level of knowledge. It is critical to increase health education and advocacy efforts in order to develop the appropriate attitudes and behaviors to reduce cancer-related deaths.

Introduction: In 2018, the overall colorectal cancer (CRC) incidence rate was 3.6%, according to the National Cancer Center of Mongolia (NCCM), and the incidence of colorectal cancer has increased slightly in recent years. According to cancer stages, late stage cancer has a 5-year survival rate of 51%, while early stage cancer has a 5-year survival rate of 79%. The overall survival rate of colorectal cancer in Mongolia has not been studied in precisely. In Asia, the 5-year survival rate for colorectal cancer was 60%. Therefore, this study investigated the colorectal cancer survival rate and prognostic factors at NCCM. Methods: A total of 108 patients diagnosed with CRC at NCCM’s General Surgery Department from 2013 to 2015 were used in this retrospective cohort study. The Kaplan-Meier method was used to develop the survival graphs, which were then compared using the Log-rank test. Results: The median survival time was 42 months, with a 95% CI (38.55-45.66). A 5-year period, the overall survival rate for CRC was 61.2%. Survival rates at the I, II, III, and IV stages were 100%, 75%, 65.4%, and 13.5%, respectively. There was a significant difference in CRC survival rates across all stages (p=0.0001). There was a statistically significant difference in determining the relationship between adjuvant chemotherapy and survival rate (p=0.0003). Conclusion The outcome of the surgery is determined by the CRC stage. The postoperative survival rate (61.2%) is directly related to tumor stage, peripheral glandular metastasis, distant metastasis, and chemotherapy effects.

Introduction: Cancer is a major public health issue both in Asia and in Mongolia. The most prevalent cancer related deaths in Mongolia are registered for the stomach, esophagus and liver. Purpose: We aimed to investigate the incidence of stomach and esophageal cancer in Mongolian population. Materials and Methods: Epidemiologic data were collected from 2009 to 2018 through the oncology cabinet of all hospitals and medical centers from all provinces, soums (the smallest unit of provinces) and major districts of the capital city. The incidence of stomach and esophageal cancer was calculated by appropriate methods and it was presented by ArcGIS Pro 9.2 software. A P-value of less than 0.05 was considered to be statistically significant and based on two side hypotheses. All calculations were performed in the IBM SPSS Statistics software. The study design in concordance with ethical guidelines was approved by the Ethics Committee of Ministry of Health Mongolia. All clinical investigations were conducted according to the principles laid down in the Declaration of Helsinki. Results: The incidence of esophageal cancer in last ten years (2009-2018) was 10.09 in 100000 populations and the highest incidence were registered in Uvs (38.13), Bayan-Ulgii (24.15) and Zavkhan (18.18) provinces, respectively. The incidence of stomach cancer was 20.33 in 100000 populations and the highest incidences were registered in Uvs (53.01), Khovd (46.02) and Darkhan-Uul (40.50) provinces, respectively. Conclusion
1. Incidence rates for esophageal and stomach cancer are high among the Mongolian population. In the last decade, the incidence of esophageal cancer had not decreased significantly, but it’s constant.
In our study, the esophageal cancer incidence was 10.09 per 100’000 people, which includes one of the high incidence rate countries according to the WHO classification. More than 10 aimags incidence rate of esophageal cancer was higher than the National average. Most of them have occurred in the western region of the country. Most of the Western, some of Khangai and Eastern soums have had the highest incidence of esophageal cancer what we have shown on the mapping.
2. The incidence rates of stomach cancer were registered as 20.33 per 100’000 people in the last 10 years at the national level. It has shown that according to the WHO classification, our country is also one of the countries with the highest incidence of stomach cancer. The stomach cancer incidence trend was increased in the last 10 decades. Therefore, some of aimag’s soums has included the highest rate classification. In addition, some soums in the Western, Khangai, and Eastern aimags had have a very high incidence of stomach cancer.
According to results in the above, the nationwide targeted prevention program is needed especially where the highest incidence rates. Also there is a lack of cooperation between national organizations to accurate registration of gastrointestinal cancer and to fight against these harmful cancers.