Background: Choriocarcinoma 15-20 new cases per year diagnosed at National Cancer Center of Mongolia. Due to insufficient necessary new drugs for choriocarcinoma patients, cancer center cannot provide the most useful treatment EMA/CO so patients were treated MAC or metothrexate, Adriamycin and cyclophosphamide. The outcomes of patients with choriocarcinoma treated with combined chemo drugs never been studied in Mongolia. Goal: To evaluate the results of combined chemotherapy in choriocarcinoma at National Cancer Center of Mongolia. Methods: Retrospective cohort review of 42 patients with choriocarcinoma who treated with MAC combination chemotherapy at NCC of Mongolia during 2004-2007. Based on MAC ppatients charts we evaluated clinical characteristics, level of HCG during treatment cycles, ultrasound changes and other lab tests. Results: We treated 42 patients with choriocarcinoma from 2004 through 2007. All patients were treated with MAC combination chemotherapy at NCC. The number of cases with choriocarcinoma is increasing in each year. 37.5% of these patients were aged between 30-34 years old, so it shows maximum incidence occurs during child bearing years. The most common clinical characteristics were 44% bleeding, 32% lower abdominal quadrant pain related to disease stages, 36% cough, and 28% fever. Out of 42 patients 35% of them had lung metastasis which was significantly different than other gynecological cancer metastasis. Conclusion: MAC combination treatment offers long-term disease-free survival and potential cure in patients with choriocarcinoma. The reported median survival in these group patients is 5 years. Importantly, 56% of patients were lived up to 5 years in remission.

Background: The main principles of pharmacotherapy are to provide pharmaceutical care with right medicine, right doses, in right time. If, the treatment plan can be in evidence based, it will improve treatment efficacy and safety, can prevent from drug related adverse event and reduce the health care costs.Assessing the drug related problems in elderly patients is a main health care and safety issue for the health care system.Ischemic heart disease (IHD) is one of major cause of mortality and one of the main diseases of morbidity in Mongolia and in the Worldwide.Objective: Aim of this study was to conduct a retrospective study on inappropriate prescribing pattern among elderly patients with Ischemic heart disease who were treated in tertiary level hospitals of Ulaanbaatar.Methods: Total of 438 patient’s records who were treated with diagnosis of IHD during the 2011 – 2012, was collected randomly from main three state hospitals of Ulaanbaatar. A retrospective analysis of inappropriate drug prescription was used Beers criteria (2012).Variables of study were patient’s diagnosis, age, sex, names, doses and route of medications.Results: The mean age of the participants was 67.38±0.24 and 54.6% of participants were male and 44.4% were female.The trends of rational use of drug and number of drug and drug cost per patients were different in each tertiary level hospitals of Ulaanbaatar. In I state hospital, number and cost of drug per patients were higher than second and third state hospitals. The result were shown that in all three hospitals, more than 50 percent of total drugs per patients were injection, less than 50 percent of total use drug per patients were from standard therapeutic guideline.The most common inappropriately used drugs were as follows: amiodarone (16% at the I state hospital; 10% at the II state hospital; 3% at the III state hospital), dipyridamole (51% at the I state hospital; 3% at the II state hospital), amitriptyline (29% at the I state hospital; 20% at the III state hospital), nifedipine (33% at the II state hospital).The use of that are inappropriate with certain medical conditions were common in case of IHD patients with peptic ulcer comorbidity. Non-steroid anti-inflammatory drug + acetyl salicylic acid combination were used in 3% of patients at the I state hospital, in 4% of patients at the II state hospital and 1% of patients at the III state hospital.Conclusion: Among the medications used to elderly patients with IHD, 15 medications were listed in potentially inappropriate medication in elderly (Beers criteria) independent of diagnosis. In I and II state hospitals, usage of potentially inappropriate medication were greater than III state hospital.

IntroductionThe main principles of pharmacotherapy are to provide pharmaceutical care with right medicine, right doses, in right time. If, the treatment plan can be in evidence based, it will improve treatment efficacy and safety, can prevent from drug related adverse event and reduce drug cost. Ischemic heart disease is one of major cause of mortality and one of the main diseases of morbidity in Mongolia and in the Worldwide.GoalAim of study was to conduct retrospective study on medications used for in-patients with Ischemic heart disease of tertiary level hospitals of Ulaanbaatar.Materials and MethodTotal of 438 patient’s records was collected randomly from 3 state hospitals, which were treated with diagnosis of ICD. Variables of study were patient’s diagnosis, age, sex, names, doses and route of medications.ResultThe trends of rational use of drug and number of drug and drug cost per patients were different in each tertiary level hospitals of Ulaanbaatar. In I national hospital, number and cost of drug per patients were higher than second and third state hospitals. The result were shown that in all three hospitals, more than 50 percent of total drugs per patients were injection, less than 50 percent of total used drug per patients were from standard therapeutic guideline. In second state hospital, anticoagulant and anti-platelet agents were chosen less than first and third state hospitals. In order to decrease cardiac oxygen demand and improve cardiac microcirculation, nitrates were chosen mostly in second and third state hospitals but, beta blockers were chosen mostly in first state hospital.ConclusionThe study results shown the treatment pattern and trends of rational use of drugs in in patients with ischemic heart disease have been different in tertiary level hospitals of Ulaanbaatar.

Background: The main principles of pharmacotherapy are to provide pharmaceutical care with right medicine, right doses, in right time. If the treatment plan can be evidence based, it will improve treatment efficacy andsafety, can prevent from drug related adverse event and reduce the health care costs. Assessing the drug related problems in elderly patients is a main health care and safety issue for the health care system. Ischemic heart disease (IHD) is one of major cause of mortality and one of the main diseases of morbidity in Mongolia and in the Worldwide.Objective: Aim of this study was to conduct aretrospective study on inappropriate prescribingpattern among elderly patients with Ischemic heart disease who were treated in tertiary level hospitals ofUlaanbaatar.Methods: Total of 438 patient’s records who were treated with diagnosis of IHD during the 2011 –2012, was collected randomly from main three state hospitals of Ulaanbaatar. A retrospective analysis of inappropriate drug prescription was used Beers criteria (2012).Variables of study were patient’s diagnosis, age, sex,names, doses and route of medications.Results: The mean age of the participants was67.38±0.24 and 54.6% of participants were male and 44.4% were female. The trends of rational use of drug and number of drug and drug cost per patients were different in each tertiary level hospitals of Ulaanbaatar. In I state hospital, number and cost of drug per patients werehigher than second and third state hospitals. The result were shown that in all three hospitals, more than 50 percent of total drugs per patients were injection, less than 50 percent of total used drug per patients were from standard therapeutic guideline. The most common inappropriately used drugs were as follows: amiodarone (16% at the I state hospital; 10% at the II state hospital; 3% at the III state hospital),dipyridamole (51% at the I state hospital; 3% at the II state hospital), amitriptyline (29% at the I state hospital; 20% at the III state hospital), nifedipine (33% at the II state hospital).The use of that are inappropriate with certain medicalconditions were common in case of IHD patients with peptic ulcer comorbidity. Non-steroid anti-inflammatory drug + acetyl salicylic acid combination were used in 3% of patients at the I state hospital, in 4% of patients at the II state hospital and 1% of patients at the III state hospital.Conclusion: Among the medications used for elderly patients with IHD, 15 medications were listed in potentially inappropriate medication in elderly (Beers criteria) independent of diagnosis. In I and II state hospitals, usage of potentially inappropriate medication were greater than III state hospital.Key words: inappropriate drug, Beers criteria,ischemic heart disease, treatment guideline

BackgroundTraditional Mongolian Medicine has a history of over 5000 years. Scientific development of TM hasstarted in 1959. Since 1999 Mongolia was categorized by WHO as a country having an Integrativesystem of TM- officially recognized and incorporated into all areas of health care provision, TMMresearch has been following key objectives of National R&D programs.AimIn order to assess the situation of TMM development we have conducted this study based on last10 years’ research done.Ìaterial and MethodsDocument study- we have selected key TMM’s R&D project implementers’ archive and humanresources documents.Descriptive and Analytic methods- a survey of 32 questions evaluating participation of TMMprofessionals in R&D work were conducted. Also, to clarify the point of view about TMM’s R&D6 focus group meetings with different level participants, such as professional committee, policymakers and research workers as well as health care providers, were organized.ResultsFrom 2004-2013, there are 28 projects implemented on TMM, 43% accomplished by TMMRTC,32.8% of which is resulting in raw materials standardization and technology study, related clinicalstudies standing 20% out of all studies done on TMM matter. These numbers are confirmed bysurvey and focus group interviews, more than 50% of participants willing to conduct a clinical studyand expressing difficulties such as lack of knowledge of methodology, policy support and revenue.Conclusions:1. TMM R&D has a potential growth due to human resources capacity. Practitioners are leastinvolved in R&D, due to lack of knowledge of methodology and revenue.2. There were 28 projects implemented on TMM matter, most of these are basic studies, fewerclinical studies done, resulting in pharmacopeia monographs and technological guidelines.

Background: Karma, a Sanskrit word that roughly translates to “action,” is a core concept in some Oriental religions, including Hinduism and Buddhism. Though its specifics are different depending on the religion, karma generally denotes the cycle of cause and effect - each action a person takes will affect him or her at some time in the future. This rule also applies to a person’s thoughts and speech, and the actions other people take under that individual’s instructions. Therefore, it is important to study the relationship between body, speech, mind and karma. Research results: The Karma denotes our good and bad intentions. These intentions manifest themselves as good or bad actions with our body, our speech and our mind. In turn, our actions bring about effects called “Karma”, namely: the effect, the consequence, the fruit of the actions, the maturation of the actions. Usually, however, the word Karma is used by ordinary people for both the actions and the effects, which is not accurate. The law of karma is a special instance of the law of cause and effect, according to which all our actions of body, speech and mind are causes and all our experiences are their effects. The law of karma explains why each individual has a unique mental disposition, a unique physical appearance and unique experiences. These are the various effects of the countless actions that each individual has performed in the past. Each person has a different individual karma. Some people enjoy good health while others are constantly ill. Some people are seen as very beautiful while others are seen as very ugly. Some people have a happy disposition that is easily pleased while others have a sour disposition and are rarely delighted by anything. Some people easily understand the meaning of spiritual teachings while others find them difficult and obscure. Conclusion We made conclusion choosing information and sources related to body, speech and mind study as well as Karma in antient works, sorting it into time sequence and enriching it with information in other works. Essentially, Karma denotes our good and bad intentions. These intentions manifest themselves as good or bad actions with our body, our speech and our mind.

BackgroundThese study made us to investigate the drug row material of Mongolian traditional medicine such us Tribulus terrestris, Malva neclecta Wall and Eriocheir sinensis compounded preparation named “Malbus”. Investigated us preparations steel using for treatment of kidney and urinetract deseases, it is one of effective in Mongolian traditional drug preparations.Material and MethodsThe experimental protocol was approved by the Ethics Review Committee at the Ministry Health of Mongolia. In research we used 20 healthy mice and 60 Wistar rats. Investigation was based and implemented at scientific research laboratory of Traditional Medical Science Technology and Producttion Corporation and pathological laboratory of Institute Veterinary medicine. Chemically acting substances is steroid saponin content in Malbus compound was detected by using thin layerchromatography (TLC) and its value was determined by UV-spectrophotometry. The acute oral toxicity study was according to the method Prozorovsky (1978). The toxic nephrosis was produced using Gentamicin (80 mg/kg) rats by using Neugarten’s method (1983).ResultsThe ethanolic extract results of the phytochemical investigations showed that conteined in the “Malbus” determined the presence of bioactive substances such as flavonoids, steroid saponins. The ethanolic extract of Malbus was found to be LD50 of 16.3 g/kg. Toxic nephrosis was induced in Wistar rats administered preparation Malbus dose 80 mg/kg, 160 mg/kg, and 240 mg/kg. Blood levels of creatinine, uric acid, and urea were siginificantly reduced by Malbus treatment compared tocontrol. Histological study revealed that Malbus was effective for treatment of nephritis in rats induced by gentamicin.Conclusions:1. The ethanolic extract of “Malbus” compound determined the presence of bioactive substances such as flavonoids, steroid saponins.2. LD50 of Malbus 16.3 g/kg, the preparation is has nephroprotective effect on experimental Gentamicine induced nephrosis in rats.

In this published case of a male patient B., 53, has some epidemiological specifics. There is transient ischemic attack (TIA) syndrome, particularly while with clear mind there is sudden temporary paralysis of left leg and arm and loss of ability to speak. Temporary refers here to a period of 2-3 minutes after which everything gets back to normal. The incidence occurred again in two days during the medical treatment.MRA test concluded on the presence of obvious stenosis at the beginning part of both sides of a.cerebri media. The mentioned blood vessel pictures were undefined. Hence selected catheter angiography has been done with a purpose to establish the presence of a full occlusion or clogging stenosis in a.cerebri media and to clarify which specific vessels are being mobilized for the collateral supply. This test established that the a.cerebri media had full occlusion on both sides.A duplex sonography conducted in order to clarify characteristics of the clogging (blocking) process concluded the presence of gradual thickening of and blocking in intima (inner wall) of a. carotis interna. Based on these tests we considered that despite the atherosclerosis symptoms (Ischemia in ECG, 20 years of smoking,being male and aged 53, etc), this case had conditions of gradual (slow progressing) arteriopathy. Thus because of the presence in this case simultaneous arteriopathy process (gradually progressing and causing the blocking) in addition to atherosclerosis syndromes we consider it as a Moya-Moya syndrome. The disease of Moya-Moya is mostly found in children and youth and is a unique arteriopathy considered unrelated with atherosclerosis.

Introduction: Extracorporeal shockwave lithotripsy (ESWL) revolutionizedthe treatment of urolithiasis and graduallybecame the favorite treatment option sothat today it is considered to be the first lineof treatment for patients with urolithiasis.The purpose of this study was assessment oftherapeutic efficacy, complications of ESWLin urolithiasis in Mongolia.Material and methods: A total of46 patients harboring renal and ureteralstones underwent ESWL between March2016 and September 2016 at First CentralHospital of Mongolia. Karl Storz ModulithSLK electromagnetic machines were usedto impart shock waves. All collected stonefragments sent for biochemical analysis.Results: A total of 46 patients 23 weremales (50%). Patients were mean age of34. The stone size distribution was 0.5cmto 3.1cm. The average treatment time wasranging from 75-110 minutes. The averagenumber of shock waves per treatmentwas 3172±378 (range 1500-4000). Theoverall success rate was 75.73%. All calculidisintegrated satisfactorily except for 3stones, which is located lower 1/3rd ofureter. Stone composition analysis proved tobe composed entirely or predominantly ofcalcium oxalate monohydrate. These patientsrequired to have ureterolithoextraction. Calculicomposition for remaining patients 12 werecalcium oxalate monohydrate, 17 calciumoxalate dehydrate, 6 uric acid and 1 struvite.Complications were mostly minor and rare.Most of the patients (90.7%) developedmacroscopic hematuria after treatment; fewpatients developed mild bruising at the entryand exit sites of the shockwaves on the bodywall. Severe complications such as renalhematoma and steinstrasse were diagnosedfor one patient each and their managementwas non-surgical.Conclusion: ESWL is therefore the firstline treatment for urolithiasis with stonesize smaller than 2cm. It has an efficiencyrate above 75, low procedure time, highsafety and good tolerability and minimalcomplication.

BackgroundEarly detection of minor strokes and their treatment that aim to prevent from complications into severe strokes is a process of secondary prevention. There is a need to extensively use image diagnostics (CT, MRI) because signs are obscure, at times without focal neurological sign but can have special mental or psychological syndromes. The start of minor stroke studies in Mongolia will enable further deepening of these studies in future and give an impetus to identification of theoreticaland practical aspects together with further improvement of diagnostics, treatment and prevention of minor strokes.GoalTo develop and introduce the diagnostic criteria of ischemic and hemorrhagic minor strokes in accordance to the concepts of minor strokes and to treat minor stokes in order to prevent complications into severe strokes.Materials and MethodCurrently there are no globally accepted diagnostic criteria for minor stroke. We support the 1981 WHO criteria of minor strokes as strokes neurological signs of which disappear in relatively short period of time. There is a general notion that it should mean all light forms of stroke other than severe strokes. In cases of neurological signs of a minor stroke, complete recovery and elimination of the symptoms take up to 3 weeks. Most scholars tend to consider ischemic lacunar strokes (arising from occlusion of arteriole vessels deep in the brain and with size of 0.5-20 mm) as minor strokes. We maintained the concept that characteristic features of these strokes are their limited focal areas and the following neurological symptoms: pure motor, pure sensory, light ataxia, etc. We also duly considered a suggestion (D. German, L. G. Koshchug et al, 2008 ) to define minor hemorrhagic strokes as strokes with diameter less than 2 cm and blood volume less than 5 cm3.We identified 60 patients with minor strokes, involved in monitoring using special research template (with a term of at least 1.5years) and involved in pathogenesis treatment. In the treatment, we maintained a principle of differential diagnosis of ischemic stroke symptoms. Specifically, we differentiated the following: signs related to an atherotromb, cardio-embolic, lacunar, hemodynamic, hemorheologic pathogenesis. To verify the diagnoses, we used MRT and CT image tests. We executed paraclinic tests in order to identify risk factors: Doppler-duplex-sonography, brain angiography, blood lipid fraction, ECG, EchoCG, heart Holter, blood hemorheology test, and identified the most affecting factors (hereditary factors, excess weight, smoking etc).Results: Our study identified the following clinical forms: lacunar stroke, non-lacunar minor stroke, and hemorrhagic minor stroke. Among the minor strokes, the lacunar stroke dominates (48%), the nonlacunar stroke is the next (27.7%), and the hemorrhagic was found to be the least common 25%. From among a host of risk factors, arterial hypertension is dominant (86%) either alone or in combination with such other diseases as diabetes, atherosclerosis etc. Diabetes occurrence was 5 cases (8,3%) which is fewer than in some foreign studies.The clinic of minor stroke also varies. The strength and expression of their symptoms compared with those of severe strokes are unique in the following:- Relatively lighter and recover faster as a result of treatment even in acute forms,- Some are without specific clinical signs (“silent stroke”).- Some minor strokes have micro focal signs, for example, “pure motor”, pure sensory, ataxia etc, in other words, the signs are limited.- In cases of lacunar strokes, predominantly deep brain arterioles are damaged.- Whereas in non-lacun strokes, embolic, ateroma, thrombotic mechanisms are predominant suchas distal branches of big artery. - In cases of hemorrhagic minor strokes, arteriopathy distortions occur not only in depth of brain but also in any small lobar vessels of brain.- Focal lesions have some variations by their pathological locations and minor stroke signs.In non-lacunar strokes (25%), the focal damages predominantly occur in branches of large intra/extra cranial arteries. In cases of lacunars strokes, the focal lesion is not in branches of large intracranial vessels, but is predominantly in basal ganglia, deep white matter, thalamus, pons and in area of deep penetrating arterial vessels. However, focal infarcts in cerebella may occur in any form of minor strokes.ConclusionAccording our study there were identified 3 subtypes of minor stroke. The finding is that lacunars and hemorrhagic minor strokes are more likely to give grounds to severe strokes. From this, it can be concluded that there are specific factors in the population of Mongolia to affect the genesis of minor strokes, namely, arterial hypertension which is directly related with these forms of minor strokes. We appropriate the WHO criteria of minor stroke that is neurological signs of a minor stroke, complete recovery and elimination of the symptoms take up to 3 weeks. In treatment of minor stroke, we suggest that minor strokes should be treating by pathogenetic therapy. Namely, antihypertensive therapy for lacunar infarction, anti-aggregation therapy for nonlacunar infarction and haemostatic and antihypertensive therapy for hemorrhagic minor stroke.