To study the correlation within psychological and social suffering in palliative care cancer patientsWe provide study within 100 palliative care patients with cancer stage 3-4. Depression was evaluated by San Diego hospice screening method with 3 questions. Anxiety was assessed by Spielberg -Hanin anxiety scale. Spiritual pain was assessed by San Diego hospice questionnaire, which includes main 4 factors of spiritual suffering, like cooperation, meaning of life, hope, forgiveness. Results of study was statistically evaluated by SPSS20 program.19% of patients had depression, 40% had anxiety, 46% patients had insomnia. 18% of patients with depression had spiritual suffering. 33% of patients with anxiety had spiritual pain. 31% of patients with insomnia had spiritual pain. Depression and spiritual suffering had mild correlation (R-0.318), anxiety and spiritual suffering had mild correlation (R-0.330), insomnia and spiritual suffering had very strong correlation (R-0.84). Psychological suffering of palliative care cancer patients increased with spiritual suffering and correlated with spiritual suffering. Especially insomnia had very strong correlation with spiritual suffering (R-0.84).

INTRODUCTION:In connection with request and financial assistance of Swiss Development Agency ‘’Mercury exposureand health impact assessment study among small scale miners in mercury free technology, wasconducted by researchers of Toxicology division of NCPH.GOAL:To determine mercury exposure level in biological samples of local small scale miners from mercury freetechnology introduced area. To reveal chronic mercury intoxicated patients,MATERIALS AND METHODS:Totally 147 artisanal miners from 33 cooperatives for small scale mining from Bayan-Îvoo soum ofBayankhongor, Bornuur sum of Tuv, Bayangol, Mandal and Tunkhel sum of Selenge province areparticipated in this study and the study was performed by cross sectional study methods during April toDecember, 2014.Over all 147 participants were in the first part of study, 60.5% out of 147 (89 participants) were in secondparts, and another 35.4% (52 people) were participated to the third parts of study. The participants wereundergone in to toxicological, dermatological and neurological examinations and the WHO guidance formercury exposure determination was followed in this study.RESULTS:On the results of all testing we revealed that there were 2 cases of chronic mercury intoxicated patientsfrom each Bayangol Bornuur soum, 2 from Mandal soum, and 3 from Bayanovoo soum.Overall 7 patientswere diagnosed as chronic mercury intoxicated and it comprised 4.7%of (n=147) all involved participants.We have observed that average height of total medical examination number was (2.9) in Bornuur soum.It indicated that there will have higher number of patients would exist in Bornuur soum than others.Ourstudy result has shown that neurological symptoms like tremor and imbalance were more diagnosedamong participants from Mandal and Bayngol soums. It implies that the health of the small scale minersfrom this soum more affected and needed to be investigating further.CONCLUSIONS:Mercury is still being used among artisanal gold miners even thoughit is still illegal. Further medicalevaluation and assistance needed to be taken for newly diagnosed 7 patients.

Sleep and wakefulness are physiological processes in our lives that are regulated by circadian rhythms. The level of melatonin, the "sleep hormone", increases with the onset of darkness, and its production slows down in the morning. Exposure to artificial light at night disrupts our circadian rhythm and the processes it controls. Shift work is when an individual works from 9 am to 5 pm. But the night shift refers to the time when a group of workers who work at night in factories and enterprises work in the evening or at night, especially from 4 p.m. to 8 a.m. according to a regular schedule. One in five people in industrialized countries work night shifts, and studies in America and Europe show that between 15 and 30% of adult workers have some form of shift work. Between 10% and 30% of shift workers meet the diagnosis of shift work disorder (SWD). 5-10% of shift workers experience severe shift insomnia and sleepiness. At least ¾ of shift workers suffer from insomnia. Excessive sleepiness usually occurs during shifts (mainly at night) and is associated with impaired cognitive ability due to the need for sleep and reduced alertness, and decreased alertness reduces performance. Job performance is influenced by many workplace environmental factors, including workload, coworker relationships, stress levels, and extended hours. A nurse specialist provides nursing care by monitoring and evaluating 24 hours a day, and by working night shifts, the circadian system of sleep is disturbed, causing sleep problems and insomnia. When examining how night shift work affects nurses' ability to concentrate, the decline in concentration (33.3%) was twice as high as that of day shift nurses (16.7%). found that shift nurses who worked the night shift had higher rates of insomnia and chronic fatigue compared to nurses who stopped working the night shift. Lack of sleep manifests as a decline in cognitive functions such as attention, decision making, and reaction time. These cognitive and functional declines can negatively affect quality of life and lead to impaired job performance. An Australian study by Winwood et al found that fatigue associated with night shifts increases the risk of human error and injury, and negatively affects the quality of patient care. Lack of sleep significantly affects nurses' alertness, concentration, and job performance. This review article discusses the relation between shift work-related sleep and job performance based on international research findings.

Introduction: 5-10% of shift workers experience severe shift insomnia and sleepiness. A nurse specialist stays by the client's side 24 hours a day, assesses and monitors their physical condition, and provides nursing care. In a comparative study on the work activity among shift nurses, night shift nurses were less active (40%) and more fatigued (53.3%) than day shift nurses.
An aspects of chronotype and sleep quality in shift nurses does not established in Mongolia and the data is very rare, and we aimed to conduct this study. Goal: To study shift schedule, sleep quality and individual chronotype of shift nurses. Materials and Methods: This study is a cross-sectional study. The survey was completed between July 1, 2023 and December 31, 2023, and included a total of 117 nurses who met the inclusion and exclusion criteria of the BZDGH, SKDGH, and KUDGH research. In collecting research data, the questionnaires "Insomnia Severity Index", which is a commonly used international standard questionnaire for assessing insomnia, The Munich Chrono Type Questionnaire for assessing individual chronotype, and "Karolinska Sleepiness Scale" were used. The ethical approval: The ethical approval for the study was obtained by a decision of the Ach Medical University-Ethical Committee on Research on June 30, 2023 (2023/02/05). Statistical analysis : Results were calculated using SPSS - 21.0 v program by a descriptive statistic, and the Pearson correlation analysis. Results : The average score of the Insomnia Severity Index (ISI) was 12.60±6.38, which is the sub threshold for clinical insomnia. But the average Karolinska Sleepiness Scale (KSS) score for sleepiness is 4.41±2.50, or moderate alertness during the shift. Workday sleep-wake pattern and non-workday sleep-wake pattern are correlated (r=0.44, p=0.001). Also, individual chronotype is correlated with chronotype of non-working days (r=0.23, p=0.02). Conclusions Nurses' sleep quality levels were pre-clinical insomnia and moderate alertness during shifts for sleepiness. Working and non-working day sleep-wake patterns are different, chronotype is medium early type. The sleep-wake pattern of weekdays and the sleep-wake pattern of non-workdays are related to each other. The chronotype of the individual is related to the chronotype of non-working days.

Purpose: Kidney function assessment method is improving gradually. New biomarkers are studied and started using in clinical practice, such as beta 2 microglobulin. Beta 2 microglobulin is improving diagnostic and prognosis in CKD patients. We aimed to assess convenience usage of B2MG alone and B2MG based eGFR in Mongolian patients. Materials and method: We included 116 patients diagnosed with CKD and 55 donors whom with normal kidney function. We collected participant's blood sample by venipuncture in plain vacutainer. Creatinine, urea, cystatin C, B2MG were tested by Roche Cobas C311 equipment in serum. eGFR was calculated by online calculation from NKF. B2MG based eGFR was calculated by eGFR=133*B2M^-0.852 Result: Assessment of kidney biomarkers and eGFR was significantly correlated in both groups. Measured serum creatinine was 3.37 mg/dl in CKD patients and 0.87 mg/dl in donors. Serum urea was 97.6 mg/dl, 31.1 mg/dl, cystatin C 3.05 mg/L, 1.49mg/L and beta 2 microglobulin 10.65 mg/L, 2.43 mg/L respectively. Estimated GFR was 21.5-28.4 ml/min/1.73m2 in CKD patients and 47.7-103.9 ml/min/1.73m2 in donors. Assessing kidney function by biomarkers (r=0.720-0.918, p<0.05), and eGFR (r=0.495-0.996, p<0.05) were significantly correlated in both groups. Conclusion B2MG can be used in clinical practice in Mongolia. B2MG is optional with creatinine, urea, cystatin C for assessing and improving kidney function.

Purpose: Follow-up examinations in kidney donors is an essential yet necessary process in organ transplantation. In this study, we aimed to evaluate kidney function using biomarkers and biomarker based eGFR in kidney donors within 5 years of organ transplantation. Materials and method: 91 donors enrolled in our study. We measured body weight and blood and urine samples for laboratory tests. eGFR was calculated using 6 estimations. Result: The mean serum creatinine in participants was 0.81±0.22 mg/dL, cystatin C was 1.11±0.19 mg/dL, urea was 31.44±8.02 mg/L. Systolic hypertension in subjects was 130.0±16.5 mmHg while diastolic hypertension was 78.4±10.8 mmHg. In all donors, 15.9% (n=14) had hematuria, 23.6% (n=21) had proteinuria, 24.7% (n=19) had albuminuria. Body weight, creatinine, cystatin C and urea measurements had gradually increased over the years. The average eGFR was 72.9±17.9 to 112.8±34.0 ml/min/1.73m² showing 0.15%-35.22% before donation. Follow – up rate was 28.3-59.2% of total donors.Having health insurance and living far from Ulaanbaatar city influenced follow – up rate. Donor registration data should be updated regularly. Conclusion
1. Serum creatinine, cystatin C, urea was increasing in living kidney donors. Hypertension and microalbuminuria was greater than other donor study results.
2. eGFR decreased 0.15-35.22% in donor. CKD EPI combined equation was best for donor.
3. Health insurance and living far from Ulaanbaatar city were the influencing follow – up rate. Registration data is missing in 25.5%-82.4% of total donors suggesting enhancement in data collection.

Background: A drug related problem is defined by the Pharmaceutical Care Network Europe Association as an an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes. One critical aspect of preventing such errors is proper dose adjustment, which plays a vital role in the diagnosis and treatment of disease. For instance, adjusting the dose of warfarin based on the patient’s INR level is essential. In a 1995 study conducted in England, clinical pharmacists recommended target doses of angiotensin-converting enzyme (ACE) inhibitors for patients with chronic heart failure. As a result, patients experienced a significant reduction in pulmonary and peripheral edema, along with improved exercise test outcomes. At the Mongolian-Japanese Hospital of the Mongolian Medical University of Science and Technology, it is important to analyze dosage-related issues identified by clinical pharmacists and inform healthcare professionals about common dosage selection errors and associated risks. Aim: We analyzed issues related to medication dosage. Materials and Methods: A retrospective study was conducted to examine problem related to dosage detected through prescription monitoring at the Mongolian Japanese Hospital of the Mongolian National University of Health Sciences from 2023 to 2024. Results: Out of a total of 2340 drug-related problem identified across five inpatient wards during this period, 581 (100%) were related to dosage. Clinical pharmacists performed prescription review on approximately 67% of all inpatients, which was consistent between years. However, medication-related problems tended to decrease from 41.1% (n=1499) in 2023 to 22.3% (n=841) in 2024 (p=0.05). The majority of dose-related problems, 75.6% (n=440), were overdoses. Medication-related problems were most common in the surgical department, with 59.5% (n=346) (p=0.001). The most frequent dosage-related errors involved exceeding the daily dose of diclofenac, administering higher- than-recommended doses of ceftriaxone, failing to adjust cefotaxime for renal function, and using inappropriate doses of metronidazole in patients with impaired liver function. The leading cause of these errors was failure to adhere to guideline-recommended dosing, which accounted for 71.3% (n=415) of cases (p=0.001). When dosage-related recommendations were provided to physicians before of treatment, acceptance rates increased by 14% (p=0.001). These interventions resulted in an estimated cost saving of 1.267.219₮ and a reduction of 363 injections. Conclusion Therefore, clinical pharmacist-led prescription review can help reduce the risk of dosage errors, lower associated healthcare costs, and alleviate the burden on medical staff.

Research of function of vitamin D on immune system has been studying since the study revealed that vitamin D receptor is expressed on the surface of the immune cells. 1,2-dihydroxyvitamin D3 [1,25(OH)2D], physiologically active form, can be generated through hydroxylation of 25-hydroxyvitamin D3 [25(OH)D], inactive form of vitamin D, in a liver, connecting with specific VDR make biological action. Vitamin D make different biological actions depends on connecting with different immunological cells. Some studies indicated that Vitamin D plays pivotal role in antibacterial innate immune responses through regulating reaction of the main cells as macrophages and dendritic cells. Moreover, calcitriol, the active form of vitamin D, is connected with VDRE, modulates the innate immune response through directly inducing expression of catelicithin and β-defensin as antimicrobial peptides, reducing secretion of IL-1b, IL-6, TNF-a, RANKL, COX-2 as proinflammatory cytokines and increasing production of IL-10, an anti-inflammatory cytokine. Vitamin D plays in proliferation and differentiation of T and B cells and regulates the activities of over 500 genes. Vitamin D differently impacts on per se stages of T cells’ proliferation. Vitamin D indirectly mitigates the differentiation from immature B cells to plasma B cells while it directly impacts on regulation of overloaded production of antibodies in plasma B cells. In conclusion, vitamin D modulates the innate- and adaptive immune response through regulation on activation of APCells, proliferation and differentiation of immune cells, secretion of some antibacterial peptides.

Introduction: When human body encounters external pathogens primary/innate immunity cells are activated by recognizing them and secondary/adaptive immunity is activated consecutively. Immune cell surface receptors, called Toll-like receptors (TLRs) recognize and bind pathogens. In our previous study, we revealed that there is a synergistic action between TLR9 and IFN-γ signaling in the endothelial cells. Purpose: To determine the role of negative and positive regulatory proteins on the IFN-γ/TLR9 synergistic signaling pathway Materials and Methods: This study was held in the Core Laboratory, Science Technology Center, Mongolian National University of Medical Sciences (MNUMS). In this study, murine endothelial cell (END-D) culture was used. The negative and positive regulator protein expression was detected by Western blotting. Result: Result of immunoblotting assay indicated that CpG DNA enhanced IFN-γ positive regulator protein p38 phosphorylation in the endothelial cells. Treatment by TLR9 ligand CpG DNA and IFN-γ increased p38 activation in 0.5 hour and 1 hour. CpG DNA inhibited IFN-γ negative regulator SOCS1 protein expression in 4 hr and 8 hr. Therefore, TLR9 ligand CpG DNA increased IFN-γ signal transduction in the endothelial cell line. Conclusion TLR9 ligand CpG DNA has decreased IFN-γ negative regulator protein SOCS1 expression. CpG DNA has increased IFN-γ positive regulator protein p38 phosphorylation.

Introduction: Toll like receptors (TLRs) are a class of proteins that key role in the innate immune system. The SOCS1 and SHP2 proteins are negative-feed loop inhibitors of signaling of JAK/STAT and TLRs pathways. Purpose: To determine negative regulator protein activation which is activated through TLR7 ligand/IFN-γ signal transduction in endothelial cells. Methods: We used mouse aortic linear endothelial cell (END-D); protein expressio was detected by western blotting Results: We analyzed a time dependent stimulation effects of negative regulator proteins stimulated by TLR7 ligand/IFN-γ in endothelial cell cultures. Imiquimod of 10 μg/ml treatment of 1 hr was followed by 100 ng/ml IFN-γ stimulation for 1-8hr to analysis of negative regulator SOCS1 and SHP2 protein expression.
In untreated cells, there was low activations of negative regulator SOCS1 and SHP2 proteins. IFN-γ stimulation alone had increased SOCS1 and SHP2 protein expressions, also imiquimod treatment highly elevated SOCS1 and SHP2 expressions. However imiquimod and IFN-γ doubled treatment have decreased activation of negative regulator SOCS1 and SHP2 proteins. These findings suggest SOCS1 and SHP2 proteins are inhibitors in the TLR7 ligand/IFN-γ signaling. Conclusion Negative regulators, SOCS1 and SHP2 strongly suppressed activations of TLR7 ligand/IFN-γ signaling