We present the fi rst 2 cases of cochlear implantation in Mongolia using “SONATA” type implant of “MED-EL” Company, Austria. CASE 1: A six years old, female had been diagnosed with bilateral congenital profound hearing loss and had been fi tted with hearing aids for 5 years and received little benefi t from her hearing aids and developed very poor speech and language, used lip reading and have had vocabulary of approximately 10 words. A radiological evaluation showed normal cochlea and auditory nerve. Cochlear implant team including speech therapists and audiologists based on the informed consent of patient’s parent decided that family able to participate in follow-up, speech habilitation programme. Patient implanted with SONATA of MED-EL on 4 August, 2009. Electrodes were inserted fully. After 10 days of switch on of the speech processor the patient showed signs of initial hearing of loud sounds. After 5 months of Auditory Verbal Therapy the vocabulary increased up to 50 words. Hearing, cognition and responses are increasing simultaneously. CASE 2: A 2 years old female. Congenitally deaf in both ears. Fitted with hearing aid for 3 months before the surgery and there was no benefi t from hearing aid. Physically and mentally healthy. Patient implanted with SONATA of MED-EL on 4 August, 2009. Electrodes were inserted fully. On 25th days of switching on of speech processor the patient showed initial hearing of loud sounds. Currently, after 5months of treatment her vocabulary is 2 short words and can recognize 4 syllabeles. She is very active, repeats actions and has open nature, feels comfortable with CI.

In modern society there is an increasing demand for oral communication in many professions. Professional voice users aren’t limited to teachers, ministers, salesmen, telemarketers, telephone operators, actors, singers, radio/TV announcers and attorneys. Problems reported by professional voice users are varied and may include hoarseness, voice breaks or cracks, voice loss, weak voiceand vocal fatigue. There are no studies done about the professional voice users in Mongolia. The purpose of this research that was to examine loading effect of work and additional loading factors. We were studied about comparison between normal groups and voice changes groups. Ninety seven professional voice users participated in this study. Half had singers group and half were found to haveteachers group. We used to the voice handicap index (VHI ) score and videolaryngoscopy and other general questionnaire.We studies voice change of the 97 professional voice users. We diagnosed voice disoeders by videolaryngoscopy and voice handicap index. We collected the data base in SPSS 22 and Microsoft excel programs.Major risk factor for voice change was use hormonal medicine. From 97 patients were predominantly diagnosed disease 14,4% reflux laryngit, 15.5% vocal fold nodule, 23.7% acute laryngit. Most of the patients had mild levels changes of voice handicap index.Voice disorders are common in professional voice users. So steroid use increase the risk of voice disorder in professional voice users.

Background: According to the report of see in 2016, 90% of adults are using mobile phones and 64% smart phones, and healthcare organizations are beginning to explore the opportunities in which mobile phones can improve and streamline care. In this study involves the risk of pathogenic virus and bacteria of mobile phones used by healthcare workers. That detected common adenovirus and influenza virus as well as streptococci and staphylococci. Material: In this study was carried out in bacteriology laboratory at the "School of Biomedicine MNUMS". The research collected from the random methods and Mongolian National University of Medical Science‟s 80 students are participated and take a test sample that detected bacteria, them using smart phones. After all students from gave them a survey about usages and clean of smart phones. Results: The results revealed 66% of pathogenic bacterial contamination. Our survey was detected in 33 (63,5%) S.aureus, S.pneumoniae-5 (9.4%) E.coli 2 (3.8%) Bacillus, spp-4 (7.6%) Enterococcus-6 (11.5%) Acinetobacter-2 (3.8%). HOW TO CLEAN YOUR CELL PHONE? asked to total participate in this study. They said that they cleaned up their cell phones in 55.9% once every 3-7days, 11.9% once every 10-14 days and 32.2% once a month and more than. Conclution Are participated in this survey sample have been contaminated bacteria 66%. In total samples have been detected 63,5% in S.aureus and 11.5% in Enterococcus. So students‟ mobile phones may become rick high reservoir of microorganism for infections.

Abstract: Demographical, social and cultural factors including population health, diagnoses, introduction of new treatment methods, capacity of the health organizations, enhancement of professional skills of medical practitioners, as well as drug efficacy affect the needs of drug. There are many methods used to estimate needs of drug. For example; Essential medicine list, medicines prescribed for specific illnesses and medicines consumed by norms. Moreover, there are two ways to estimate the demand of the essential medicines making basic comparisons of essential drug needs and morbidity indicators of the other countries in compliance with the recommendation of WHO.¹
Actual needs of the essential medicines for most common diseases and other medicines have determined by selecting from the records of inpatients by classification and amount as well as estimating the classification, amount and price of the medicines sold by pharmacy for the given period. This estimation reveals the temptation of the needs of the drug so that the amount of the supply will be determined by upcoming month, season and year. More importantly, It will not only benefit the classification, amount of the necessary medications but also it will estimate the budget for the certain period.
In the recent 9 years, the community acquired pneumonia cases among the 0 to 5 year old children admitted to the hospitals of Ulaanbaatar city have increased by 15.7%.
Therefore, we have studied the needs of drug in the treatment actual consumption of medicine the CAP in children among 0 to 5 year old.
The research was referenced by the method of determining drug needs by consumption and morbidity indicators, other methods developed by scientists such as Hogerzell H.V., Jonathan D.Quick., James R.Rakin., Richard O.Laing., Ronald W.O.Connor., Andrew, Kobzari L.V, Dryomovo N.B, Glembotskaya G. T, Mnushko Z.N. Numerical data has been determined by average and standard deviation as well as maximum or minimum value employing variation analysis method. Result of the study Having determined the average number of CAP in children cases, temp of annual growth, fluctuations, statistical report of the last decade based on the actual medicine consumption for the treatment of CAP in children of all the participants (96 inpatients aged from 0 to 5 year) and disease prognoses; as result, it has been estimated the necessary drug needs for 27591-33869 CAP in children cases which will be treated in the hospitals of Ulaanbaatar city from 2019-2013.
There’s a tendency that approximately 31509 patients aged from 0 to 5 year are going to be hospitalized for CAP in children so that it’s estimated to require 1156848.1 MNT for the treatment.

Abstract: Respiratory diseases are the most common among the population of Mongolia, besides, the data regarding the pneumonia and chronic obstructive lung disease (COLD) among the community acquired pneumonia in children specially 0-5 year old has taken into much consideration when re- viewing the statistical report of 2010-2018 of Mongolia.¹
Looking at the details, as regards 2010-2011 there were 82 CAP case, which increased by 6.8%, but in 2011-2012, 48 cases were registered, which dropped into 3.7%. Again in 2012-2013, jumped by 2.6 % by reporting 33 cases. Then from 2013 to 2014, it has become 406 cases, increased by 31.8% whereas it added up to 848 cases registered in 2014-2015, which fell by 50.4%. 788 cases reported in 2015-2016 , rose by 94.7%. Then the figure decreased by 2.2%, only 36 reported cases in 2016-2017, again it soared up to 14.1% when 224 cases were registered in 2017-2018. In the last 9 years, the community acquired pneumonia among the 0 to 5 year olds in Ulaanbaatar city has increased by 10.4%.
Reviewing the Statistical Report of 2010-2018 of Mongolia, hospitalized cases of the children aged from 0-5 year old for CAP has gradually increased from 2010 to 2014; the total number of the above mentioned cases has become 8603 and the average increase was 13,1%.
In fact, the figure fell by 40% by reporting 8071 cases in 2014-2015 which whereas in 2015- 2016 there were 13073 cases, an increase of 108.3%. Then, in 2016-2017, the number has de- creased by 6.3% with 1604 reported cases. But in 2017-2018, registering 3260 cases, the rated jumped by 13.9%.²
In the recent 9 years, the pneumonia cases among the 0 to 5 year old children admitted to the hospitals of Ulaanbaatar city have increased by 15.7%. Therefore we have studied the actual medicine consumption in the treatment of the CAP among 0 to 5 year old.
The research data was processed by cross-sectional study by employing retrospective analysis is used to randomly select actual drug consumption from the records of the inpatients who diag- nosed as CAP. Result of the study In the last 9 years, the CAP among the 0 to 5 year old children hospitalized in Ulaanbaatar city has increased by 15.7%.
The number of the inpatients diagnosed as the CAP has reached 21535 cases, which is increased by 6.2% in 2014-2018. Furthermore, there is tendency to increase pneumonia cases by 31509; it’s possible to have approximately an increase of 5.1% in the 2019-2023.
We have revealed 30 different types of medicines have been used for the treatment of the CAP after examining prescribed drugs.

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.

BACKGROUND Congenital and acquired hearing loss considered as the most common disability. According to the WHO report, 360 million people worldwide have disabling hearing loss, and 32 million of these are children. Severe to profound sensorineural hearing loss can be treated successfully with cochlear implants. Post implant Auditory Verbal Therapy/ Hearing Implant Rehabilitation is essential for the progress and better outcome. Multidisciplinary team approach, including ENT, audiologist, speech therapy, social worker, coordinator, caregiver /parent is required. The first clinical speech therapy department in Mongolia was established by the School of Dentistry, MNUMS based at the Maxillofacial Surgery Department of the MCNHC in 2006 (G. Ariuntuul, B. Bulgan, U. Azzaya). Where as the very first Cochlear Implanted child in Mongolia was received the surgery and audiology support by A. Ulziibayar, L. Byambasuren, B. Misheel, B. Narantya and the hearing implant rehabilitation treatment successfully conducted by the abovementioned speech team in 2009. Aim: To analyze current situation on speech therapy intervention for patients with hearing loss and deafness. METHODS Retrospective hospital data were collected based on the School of Dentistry, Speech therapy department between January, 2009- February, 2017. In total 70 patients’ information were retrieved for the study. Descriptive method is used for statistical analysis. RESULTS Out of 70 patients, attended speech therapy sessions 38 (54%) were males, 32 (46%) were females; where as 21 (30%) had congenital deafness and 28 (40%) acquired; 21 (30%) patients with hearing loss not known their causes of deafness. From the total of 28 (100%) cases with acquired hearing loss/deafness 11 (39%) patients cause of deafness is due to complication from infectios disease: meningitis.

Background: Data from yearly statistical reports on morbidity and mortality in Mongolia show that young adults account for approximately 20-26% of all stroke patients as opposed to 10-13% in Western countries. Objectives: The aim of this study was to compare characteristics of ischemic stroke between young (20-49 years) and old (50-79 years) patients undergoing investigations and treatment according to one common protocol in a tertiary hospital. Material and Methods: This hospital based prospective study included 110 young and 130 old patients with acute ischemic stroke. Data regarding the etiology of the stroke, diagnostic neuroimaging test results and degree of functional improvement of patients were examined during their observation. Results: The frequency of ischemic stroke at the age of 20-49 years grows from 9.6% to 24.2% and is predominant in the male sex (17.1%), which indicates a young stroke in mongolians is not uncommon. Young adults with ischemic stroke frequently bear both traditional and specific vascular risk factorsthan elderly people (p<0.05). The most common TOAST subtype in the young and old groups was undetermined (26.4% vs.12.3%; p=0.004), other determined cause (22.7% vs. 6.9%; p<0.001), and cardioembolism (20.0% vs. 22.3%) followed by Large-artery atherosclerosis (17.3% vs. 26.2%) and small vessel occlusion (15.6% vs. 33.8%; p<0.001). Partial anterior circulation infarcts were more common among young patients (p<0.001), than in posterior circulation infarcts. Silent brain infarcts and leukoaraiosis are not uncommon brain imaging findings (<0.05) in hypertensive and migraineur patients and should not be overlooked due to their potential prognostic relevance. Outcomes in young adults with hemispheric ischemic stroke can safely be improved with Low- molecular-weight-heparin therapy (OR 1.58; 95% CI, 0.99-2.51; p=0.001).
There were large differences between two groups concerning the 6-month outcome which showed beneficial effect for young stroke patients (mRS:89.1% vs. 66.9%, p=0.002; BI: 84.2% vs.73.1%). Conclusion There are significant differences between young and old patients with ischemic stroke regarding to risk factors, etiological subtypes and improvement of functional deficits associated with the stroke. However, severity of stroke on admittance is similar but six weeks outcome is different among young and old patients with relatively rapid improvement of functional deficit in young stroke patients than old one (mRS: 89.1% vs. 66.9%, p=0.002; BI: 84.2% vs.73.1%).

Introduction. Stigma and discrimination against patients with mental illness is very common amongst the society. Therefore, this study aims to study the knowledge and understanding of mental illness and attitudes to patient with mental illness, among the general population.Goal. To assess the knowledge and understanding of mental illness and attitude to patient with mental illness among population of Ulaanbaatar city and compare its results with a similar research in carried out in 2002.Methods. The study was conducted in Ulaanbaatar city from February to April, 2008 and included 991 people aged over 18 years. The sample was selected from 30 micro districts of Ulaanbaatar city, The method of sampling was using primary dot in first step, sampling households in mid step and selecting people by using method of Sweden key from household in final step. The study used 30 item standardized questionnaires. Also there were 2 extra cards to read for respondents.Result. Among the respondents, 45% were males and 55 % females. Average age was 37 years. In view of identifying negative attitude of patient with schizophrenia, majority of respondents answered as “loony person” (n=136) and “mad person” (n=83). Conclusion. Although there was stigma amongst the study population, 66% of subjects who were involved in study could give right diagnosis in non professional level and were able to identify symptoms of mental illness suggesting that more than half of the sample studied had some knowledge of mental illness.

BACKGROUND: In the recent years, mesenchymal stem cells have become increasingly utilized in regenerative medicine and tissue engineering applications because of their properties for self-renewal, differentiation and immunoregulation. The use of stem cells of various clinical applications is highly expected and the production of good quality stem cells is very critical for basic studies. In the bone marrow, hematopoietic and mesenchymal stem cells from an unique niche in which the oxygen tension is low. Hypoxia may have a role in maintaining stem cell fate, self renewal and multi-potency. We investigated whether low oxygen culture would be beneficial for hematopoietic stem cell and mesenchymalstemcell. MATERIAL: BMCs from 8-12 week aged, 15 mice were subjected to hypoxic conditioning by culture for 8-10 days in 20%, 3%, 1% oxygen. For culture 1x105cell/ml were seeded in colony forming assay and 2x106cell/ml were seeded in L-glutamin mediain chamber slide. We counted cell colonies under different hypoxic condiontins by Olympus IX71 fluorescence microscope. After cell culture in chamber slide, we stained cells by anti-CD90 and anti-CD105 then counted positive cells by Olympus IX71 fluorescence microscope. RESULTS: Compared to normoxic cells and hypoxic cells well morphologically differentiated and counted by Olympus IX71 microscope. More colonies were observed at 3%, 1% oxygen. Statistical significances were identified with granulocytes and macrophage colony (p<0.05) in hypoxic condition. More anti-CD90 and anti-CD105 markers were observed at 3% oxygen condition. Statistical significances were identified in 3% oxygen condition with cell markers(p<0.001). CONCLUSIONS: Our data suggests low physiological oxygen culture could improve the stemness of macrophage and granulocytes colony and improve the differentiation of mesenchymal cells. Long term culturewith additional cell markers will be necessary to confirm whether low physiological oxygen levels also improve genomic stability