1.Clarifying some theoretical and practical concepts of pulse feeling method
Munguntuya B ; Bold SH ; Bolor B
Mongolian Medical Sciences 2015;172(2):91-95
IntroductionPossessing thorough pulse feeling skill, the main diagnostic method of traditional medicine, makesa direct impact to treatment results. Unfortunately, there has not been much research done ondetermining the scientific nature of the pulse feeling diagnostic method in Mongolia. Therefore, thetopic was selected in order to clarify some issues of history and theory of the pulse feeling method andto prove the method with practical application.Goal and objectivesThe goal of the research is determining some theoretical issues of traditional medical diagnosticmethod, pulse feeling and proving the effectiveness of the method to determine pregnancy and genderof fetus by practical use. The following objectives are defined:1. Conduct research regarding the theoretical concept of pulse feeling and compare it with thesources in Eastern and Western books, literary works and scriptures;2. Determining pregnancies and feeling the pulses of pregnant women admitted to maternityhospital to identify the gender of fetusMaterials and Мethods50 women admitted to “City Palace of Maternity” hospital and 50 mothers who were hospitalized atpre-natal and post-natal division participated in the study.Used following methods:1. Comparison method2. Pulse feeling method for determining gender of a baby and pregnancyResultsWhen feeling the pulse, the index finger is pressed lightly to feel the skin, the middle finger is pressedwith medium pressure to feel the muscle tissue and the ring finger is pressed hard to feel the boneof the doctor is pressed lightly in order to distinguish the twisted blood flow changes overcoming theresistance of sequential pressure. We also identified that the pulse feeling is based on the natureand connection of the wind and blood and their actions in regard to traditional medicine, whereasby modern medical theory; it is based on functioning factors of vascular muscle layers, pulse rate,pressure to vascular wall and condition of vascular wall as well as thickness and thinness of bloodflow.In addition to the method being effective when detecting pregnancy and gender of fetus of patients atthe maternity hospital, it is definite that it can be basis of identifying the characteristic of pulse of warmand cold diseases.
2. The separation of β-lactoglobulin from cow milk
Bolor B ; Munkhtsetseg J ; Javkhlantugs N
Health Laboratory 2013;2(2):14-16
3.Publication Overview of Sumbe Khamba Ishbaljir and Wonder of his Mindset
Oyun-Erdene B ; Bold SH ; Bolor B ; Ankhtsatsral L ; Ankhtuya P
Mongolian Medical Sciences 2014;170(4):68-72
Introduction: It is significant to translate medical texts having a beginning source of Ayurveda and identifyMongolian doctors, maaramba’s works and books on prescription as well as treatment methods that meetour culture, living condition and climate. Especially, we should clarify the new ideas includes innovatedtheories, which became paradigm not only Traditional Mongolian Medicine but also in Tibetan Medicine.Thus, it has become important to introduce and use in the training for students and practitioners the “FourAmbrosia Essences” and “Dictionary of Drug Identification” by Sumbe Khamba Ishbaljir (1704-1788).Goal: The aim of this study is to investigate “Four Ambrosia Essences” and “Dictionary of Drug Identificationby Sumbe Khamba Ishbaljir and to clarify the new idea of theory and treatment methods created by him.Materials and Method: “Source of Spring” (བདདུ ་ར་ིྩ ཆ་ུ རནུྱྒ ), “White Dew of Spring” (བདདུ ་ར་ིྩ ཟལི ་དཀར), “Drop of Spring”(བདདུ ་ར་ིྩ ཐགི ་པ), “Wedding of Spring” (བདདུ ་ར་ིྩ དགའ་སནོྟ ” by the Sumbe Khamba Ishbaljir were the main materials in thisstudy. In addition, we used to take some sort of sources and manuscripts that related to our studies andcomparative historical method, analysis and synthesis method were used in the studies.Results: According to resources we found, Sumbe khamba Ishbaljor detailed a number of new theoreticaland practical concepts which were never or seldom mentioned in The Four Medical Tantras, in his bookRashaany Dusal (“Drop of Spring”). He expanded the list of common diseases from three wind (khii), bile(shar), phlegm (badgan) to 6 (wind, bile, phlegm, blood, yellow fluid (shar us), nyan or khorkhoi (virus andbacteria) and prescribed treatments for each of them. In addition, he established a concept of 10 importantdiseases and gave them satiric names making them easy to read and understand as well as taught theways to treat them.Ishbaljir developed the traditional medicine and made a reform in it by the discovery of three more causesof diseases blood, bile us and bacteria in addition to the existing causes wind, bile and phlegm. His theorywas that disease causes are wind, bile, phlegm, blood, yellow fluid, and bacteria or virus individually and\or combined. Wind, bile, phlegm, blood, yellow fluid, and bacteria or virus called as diseases. Ishbaljir’sconcept of bacteria duplicates that of some Noble Prize laureates. At the beginning of the 20 century, anAustralian scholar Barry J. Marshall and J. Robin Warren won the Noble Prize for their discovery of the“Bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease” in 2005.Conclusions:1. Sumbe Khamba Ishbaljir expanded the list of common diseases from 3 wind (khii), bile (shar), phlegm(badgan) to 6 (wind, bile, phlegm, blood, yellow fluid (shar us), nyan or khorkhoi (virus and bacteria)and prescribed treatments for each of them.2. Sumbe Khamba Ishbaljir established a concept of 10 important diseases and gave them satiric namesmaking them easy to read and understand as well as taught the ways to treat them.3. The Four Medical Tantras did not mention stomach bacteria. It is pity that Sumbe Khamba Ishbaljirfound out the stomach bacteria disease in the 18th century.
4. SOME RESULTS OF STUDY ON SUSTAINABLE QUALITY OF “TUNAMAL” TEA
Bolor B. ; Tugsbileg S. ; Boditsetseg B. ; Enkhjargal D. ; Ulziidulam D.
Mongolian Pharmacy and Pharmacology 2015;7(2):102-103
Tea is a product which contains of natural antioxidants for relaxation, prevention and healing effects, biofl avonoids, isofl avonoids, organic acids, glycoside and other substances. In order to use this valuable natural commodity economically with keeping the ecologicalbalance and provide quality and safety, nowadays, fi ltered tea bags become popularfor producing. The international standards forinfusion substance portion, antioxidants content, and quality and safety specifi cations for this type of tea are the important measures for preventing of fake products. The sustainable quality study is one of the main parameters, indicating the drug quality, safety and effects. The validity and storageconditions of the drug and its active agents are determined by the study.Aim: To determine the validity /expirationperiod/ of liver protection effect “Tunamal” tea by studying the parameters of its sustainable qualityObjective: To defi ne the expiration time by analyzing annually the moisture, ash, infusion substance, essential oil, appearanceof dry substances, ascorbic acid, content ofthe fl avonoids, mixture of heavy metals and microbiological parametersMaterials and methodologyCommodity of the study, which are the creeping thyme and rosehips fruits, were collected from the territory of Erdene county of Central province and Eruu county of Selenge province respectively; and dried in accordance with the standards. The moisture, ash, infusion substance, essential oil, appearance of dry substance, ascorbic acid, content of all fl avonoids wereanalyzed by methods set by Mongolian national pharmacopoeia, radioactive contamination and presence of heavy metals – by atomic absorption spectrometric method, afl atoxin B1 and pesticide residues – by thin-layer chromatography respectively,; and microbial contamination was analyses in the Steward geological laboratory in the culture medium as well as in the drug inspection laboratory of the State professional inspection authority.
5. A retrospecti ve anal ysis of inappropriate prescribing pattern
Erdenetuya М ; Enkhjargal D ; Ariunaa D ; Bolor B ; Tugsbileg S.
Mongolian Pharmacy and Pharmacology 2013;2(1):9-
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
6.THUNDERBEAT IN USE THYROID SURGERY
Tumur-Ochir Ch ; Shim Woo Jeong ; Munkhbat D ; Baasanjav D ; Bayarkhuu A ; Enkhbat G ; Erdene-Bolor B ; Naranbat L
Journal of Surgery 2016;19(1):64-69
Introduction: Last Decades, Date by date
medical developments providing friendly,
high-efficiency treatment equipment and
services in developed countries are working
toward an advanced, as our country medical
services are trying to that country’s technology
has been introduced. In our country every
day there is only surgical care necessary to
endocrine gland disorders, including most
common thyroid surgery. It is open and
robotic assistant endoscopic surgery in the
world. But robotic assistant endoscopic
surgery is too expensive and impossible in
our country. Thus we chose Thunderbeat
for open thyroid surgery in especially huge
enlarged goiter and vascularized goiter to try
prevent bleeding, recurrent laryngeal nerve
palsy and post operation hematoma and
other complications
Thunderbeat is new generation instrument
combines an advanced bipolar clamp to the
existing ultrasonic cutter.
Materials and Methods: M 51-years-oldwoman
was admitted to Mongol Hyundae
hospital because of front of neck pain, multi
nodular goiter, tachycardia, sweaty and not
controlling emotion.
Anamnesis: She diagnosed to
Thyrotoxicosis in 2005 and she took
medicine last ten years but not controlling
that poisoning. Status locals: Huge enlarged
goiter in front of her neck
Treatment plan:
1. Preoperative Preparation
2. Operation: Open total thyroidectomy
3. Medicine
4. Wound dressing
5. Observation
We did operation after day of admission
day, Patient is placed in a Semi erect position
with a folded sheet underneath the shoulders
so that the head is sharply angulated backward
on the multifunctional surgical table under
general anesthesia. We used thunderbeat
from muscular to all procedures, dissection
both thyroid gland and isthmus after Kocher
skin incision and sub skin tissue dissected.
There is no complication while procedure
and post operation days
Result: Nodular hyperplasia of thyroid
gland with focci of micro adenomatous
change
Conclusion: Thunderbeat in use open
thyroid surgery first outcomes blood loss
than 30ml, no injury of recurrent laryngeal
nerve and no penetration ligament of Berry
while procedure, second outcomes no
hematoma, painless, wound healing process
faster and short time hospitalization.
7. THUNDERBEAT IN USE THYROID SURGERY
Tumur-Ochir CH ; Shim Woo Jeong ; Munkhbat D ; Baasanjav D ; Bayarkhuu A ; Enkhbat G ; Erdene-Bolor B ; Naranbat L
Journal of Surgery 2016;19(1):64-69
Introduction: Last Decades, Date by datemedical developments providing friendly,high-efficiency treatment equipment andservices in developed countries are workingtoward an advanced, as our country medicalservices are trying to that country’s technologyhas been introduced. In our country everyday there is only surgical care necessary toendocrine gland disorders, including mostcommon thyroid surgery. It is open androbotic assistant endoscopic surgery in theworld. But robotic assistant endoscopicsurgery is too expensive and impossible inour country. Thus we chose Thunderbeatfor open thyroid surgery in especially hugeenlarged goiter and vascularized goiter to tryprevent bleeding, recurrent laryngeal nervepalsy and post operation hematoma andother complicationsThunderbeat is new generation instrumentcombines an advanced bipolar clamp to theexisting ultrasonic cutter.Materials and Methods: M 51-years-oldwomanwas admitted to Mongol Hyundaehospital because of front of neck pain, multinodular goiter, tachycardia, sweaty and notcontrolling emotion.Anamnesis: She diagnosed toThyrotoxicosis in 2005 and she tookmedicine last ten years but not controllingthat poisoning. Status locals: Huge enlargedgoiter in front of her neckTreatment plan:1. Preoperative Preparation2. Operation: Open total thyroidectomy3. Medicine4. Wound dressing5. ObservationWe did operation after day of admissionday, Patient is placed in a Semi erect positionwith a folded sheet underneath the shouldersso that the head is sharply angulated backwardon the multifunctional surgical table undergeneral anesthesia. We used thunderbeatfrom muscular to all procedures, dissectionboth thyroid gland and isthmus after Kocherskin incision and sub skin tissue dissected.There is no complication while procedureand post operation daysResult: Nodular hyperplasia of thyroidgland with focci of micro adenomatouschangeConclusion: Thunderbeat in use openthyroid surgery first outcomes blood lossthan 30ml, no injury of recurrent laryngealnerve and no penetration ligament of Berrywhile procedure, second outcomes nohematoma, painless, wound healing processfaster and short time hospitalization.
8.First diagnosis of IgA nephropathy by renal biopsy in Mongolia
Baigalmaa S ; Buyan-Od D ; Bolor-Erdene G ; Otgonsuren D, Amartuvshin B ; Otgonchimeg I ; Enkhtamir E ; Galtsog L
Mongolian Medical Sciences 2015;172(2):35-41
BackgroundIgA nephropathy and MPGN are common glomerulonephritis in the world that progresses slowly andrenal function can even remain unchanged for decades. Clinically, it presents by isolated hematuria,proteinuria. Histologically, IgA nephropathy presents with acute glomerular damage, mesangial cellproliferation, endocapillary leucocyte infiltration, and crescent formations, these lesions can undergoresolution with sclerotic healing. Since 2013, renal biopsy has been done at the First Central Hospitalof Mongolia a few times. However, the confirmative diagnosis of IgA nephropathy and MPGN remainunknown in Mongolia by renal biopsy. Therefore, we intended to test renal biopsy techniques andconfirm its diagnosis by renal biopsy at the Second Central Hospital of Mongolia.MethodsUltrasound guided renal biopsy had been done for four patients by nephrologist at the Departmentof Nephrology of the Second Central Hospital of Mongolia. All four specimens were evaluated assatisfactory which show more than 8 glomerulus under the light microscopy. Each renal cortical tissuewas divided into two tips: one piece for routine H&E stain and special stains, including Masson’strichrome, and PAS stain; another piece for immunofluorescence by frozen section, which werestained with IgG, IgM, IgA and complement component 3 (C3). Each case was screened by threepathologists.Results:The case which shows mesengial widening, mesengial hypercellularity under the light microscopyor mesangial granular deposition of IgA and C3 by immunofluorescence was diagnosed as IgAnephropathy. We obtained crescent formation with glomerular adhesion in most cases. In addition, weobserved secondary MPGN in one case, which is caused by hepatitis C virus infection.Conclusion: Probably, it is a new step for developing pathologic diagnosis for nephrology in Mongolia.We needs further study for improving renal biopsy technique and confirming the diagnosis of IgAnephropathy and MPGN using electron microscopy and pathological report by oxford classification forIgA nephropathy.
9.Comparison of Sysmex UF-5000 with urine culture for the diagnosis of urinary tract infections
Otgontungalag D ; Battulga M ; Bolortungalag B ; Munkhzaya D ; Bayanmunkh B ; Erkhembayar O ; Oyuntsetseg D ; Enkhjin B ; Bolor A
Health Laboratory 2020;12(2):5-10
Introduction:
Urinary tract infections (UTI) are at the second place in the frequency of all causes of infection after respiratory ones. The UTI requires appropriate antibiotic treatment. 85% of UTI predictive antibiotic treatment without confirmation by bacteriological analysis. This is one of the major causes of drug resistance, especially in K.coli. Urine bacteriological tests do not show bacterial culture in all cases where the number of bacteria in the urine exceeds the reference level. Therefore, there was a need to establish criteria for urine bacteriology test based on the results of urine sediment analysis.
In 20I7, a new fully automated Sysmex UF-5000 urine sediment analyzer was installed in the laboratory department of Medipas Hospital. The features of this analyzer include counting the number of bacteria in the urine, distinguishing between gram-positive and negative, homogeneous and mixed forms, and counting the formed elements in the urine. This feature made it possible to compare the number of bacteria and leukocytes in the urine with the results of urine bacteriology tests.
Goal:
Determine the relationship between the number of white blood cells and bacteria in the urine measured by the Sysmex UF-5000 urine sediment analyzer and the results of the urinary bacteriological test.
Objectives:
Compare the number of urine bacteriaand leukocyte measured by using the Sysmex UF-5000 urine sediment analyzer with the urine bacterial culture, and calculate the correlation.
Materials and methods:
The study is analytic cross-sectional study, analyzed the results of a total of 159 people who analyzed a urinalysis and urine bacteriological test at the Medipas Hospital Laboratory in 2017-2019 years.Urine samples were collected in a 100 ml, disposable sterile container in accordance with the instructions for taking urine midstream.Urine analysis was performed within 2 hours of sampling with a fully automatic urine sediment analyzer Sysmex UF-5000 Japan. Urine bacteriological analysis was performed on a lul sterile loop of urine specimens, inoculated into 5% blood agar from Hungary's BioLab, Sabouraud agar, and Chromogen agar from Biomerieux France, and incubated for 24 hours in an incubator at 37°C. Bacterial identification and antibiotic susceptibility tests were analyzed using the "Vitek-2" analyzer from the manufacturer Biomerieux France. Bacterial and leukocyte counts data measured by the Sysmex UF-5000 analyzer and urinary bacteriological analysis data were performed using SPSS23 software.
Results:
A total of 159 urine samples were tested for bacteriological analysis, of which 81 (50.9%) were bacteria over 105 CFU/ml or urine positive culture UTIs, 78 (49.1%) were nonsignificant bactcruria and urine negative culture.The average number of bacteria measured in the urine of 81 samples with urine positive culture above 105 CFU/ ml was 46491/ul (1168-100000 BACT/ul).
The average number of bacteria measured by the urine sediment analyzer of 78 samples with urine negative culture was 2645 BACT/ ul (2-57280 BACT/ul). To calculate more accurately estimate the average number of bacteria in 81 urine specimens with positive culture, the average number of bacteria in 17 (21%) samples was 4753 BACT/ul, measured in relatively low bacteria numbers of 1168-9450BACT/ul. The average leukocyte number in the urine of 81 samples with positive culture was 472.2 WBC/ul, and the average leukocyte number in the urine of 78 samples with negative culture was 87.7 WBC/ul.There is a strong correlation between the number of bacteria measured by the urine sediment analyzer and urine bacterial positive culture, which is 0.8 or statistically significant (p<0.001).The correlation coefficient of the number leukocytes measured by the urine sediment analyzer with in the urine positive cultureof bacteriological tests was 0.6 or moderately of statistically significant (p=0.005).There is a statistically significant relationship (p=0.001) between the number of bacteria in the bacterial positive culture population and the number of leukocytes.
Discussion:
Of the 81 cases of urine bacterial positive culture, 78 (96%) were female, indicating a high prevalence of UTI among women. According to the results of the Fabio Manon's study, the number of leukocytes in the urine is 160-340 WBC/uL and the number of bacteria is 15000-30000 BACT/u,L in the case of UTI, which is approximate results compared to the our study results.Based on the results of the urine sediment analysis, indications for a urine bacteriological test should be made.
Based on the results of urinary bacteriological tests, the choice of antibiotic treatment is the best treatment for urinary tract infections and a way to prevent of antibiotic resistance to UTI.
Conclusions
The number of bacteria measured by a Sysmex UF-5000 urine sediment analyzer is directly related to the bacterial culture urine bacteriological test. If the number of bacteria in the urine is measured above 4753 BACT/ul, it can be considered as an indication for urine bacteriological analysis. Although the number of leukocytes in the urine measured by the Sysmex UF-5000 urine analyzer is moderately correlated with bacterial culture in urine bactcriologucal tests, it is a key indicator of the degree of inflammation of the urinary tract.
10.The result of measured household indoor air quality, Ulaanbaatar, 2020
Oyun-Erdene O ; Tsegmed S ; Buuveidulam A ; Bolor B ; Bataa Ch ; Narantuya D ; Suvd B
Mongolian Medical Sciences 2020;194(4):74-83
Introduction:
Beginning 15 May 2019, the consumption of raw coal in Ulaanbaatar has been replaced by the
consumption of briquette fuel for the improvement of air quality according to Governmental Resolution
No.62 adopted in 2018. Since after this resolution has been in placed the number of CO poisoning
has been increased as of 18 December 2019, nine persons were died and 1394 people get a health
care service due to CO poisoning. However, it has been not been assessed briquette affect to the
indoor air quality and its health impact. Thus, it is need urge to define the indoor air quality effect of
briquette and its heath impact.
Goal:
To assess the indoor air quality of the household using the “improved briquette” and identify the
causes of the risk.
Material and Method:
This a cross-sectional survey, conducted from January 31, 2020 to April 31, 2020, data were obtained
by quantitative, qualitative (observation, interview) and direct indoor air quality measurement. The
survey sampling frame was 40 households in central 6 districts of Ulaanbaatar that used improved
fuels (20 households with a history of carbon monoxide poisoning and 20 households that were not
affected), and 14 households in the Nalaikh district that used raw coal, in total of 54 households were
participated. Indoor air quality was measured by PM2.5, PM10, CO, SO2, NO2, and microclimate per
household for 24 hours during a week.
The statistical data analysis was done by the SPSS-23 program and preformed required parametric
and non-parametric tests. The normality of the data was checked by the Kolmogorov-Smirnov test.
The most of data was not normally distributed. So, thus we used median and used relevant non-parametric tests. The average level of microclimate indicators, and air quality indicators were defined
as mean, median and its IQR and standard deviation. The 95% confidence intervals of mean and
frequencies were determined and used to differentiate group differences.
The Ethical permission to start the survey was approved by the 2nd meeting of the Ministry of Health
on February 4, 2020. The committee was reviewed and approved the research methodology based on
whether data collection technique and tools are considered the ethical issues, and whether provided
accurate information for make decisions to enroll to the survey for respondents.
Results:
According to the health statistic, from October 2, 2019 to March 31, 2020, a total of 2,768 people from 837 households were exposed to carbon monoxide poisoning. Of the total reported cases, 10 were
drunk, and 2 were due to other disease complications, and a total of 2,756 cases were confirmed
diagnosis as carbon monoxide poisoning.
Emissions of CO were recorded every 15 seconds and the results were calculated by conducting
continuous measurements per household for 24 hours a week. The level of CO emitted into the
indoor environment of households exposed by carbon monoxide had increased during the following
time from 7 am to 9 am in the morning, from 13 pm to 15 pm, from 18 pm to 20 pm in the evening, and
from 22 pm to 24 pm at night. During this period of time, the indoor air CO level had increased from
the WHO mild poisoning recommendation level.
Conclusion
It has been defined that the carbon monoxide emits to the indoor air households which are using an
improved fuel according to measurement the 30 minutes, 31-60 minutes, and 61-120 minutes after
burning.