To evaluate the efficacy and safety of bevacizumab monotherapy or combined with laser versus laser monotherapy in Mongolian patients with visual impairment due to diabetic macular edema.Prospective, randomized, single-center, a 12 month, laser-controlled, clinical trial. Participants: One hundred twelve eligible patients, aged ≥18 years, with type 1 or 2 diabetes mellitus and best corrected visual acuity (BCVA) in the study eye of 35 to 69 Early Treatment Diabetic Retinopathy Study (ETDRS)letters at 4 m (Snellen equivalent: ≥6/60 or ≤6/12), with visual impairment due to center-involved diabetic macular edema (DME). Methods: Patients were randomized into three treatment groups:(I) intravitreal bevacizumab monotherapy (n=42), (II) intravitreal bevacizumab combined with laser (n=35), (III) laser monotherapy (n=35). Bevacizumab injections were given for 3 initial monthly doses and then pro re nata (PRN) thereafter based on BCVA stability and DME progression. The primary efficacy endpoints were the mean change in BCVA and central retinal subfield thickness (CRST) from baseline to month 12.Bevacizumab monotherapy or combined with laser were superior to laser monotherapy in improving mean change in BCVA letter score from baseline to month 12 (+8.3 and +11.3 vs +1.1 letters; both p<0.0001). There were significant difference detected between the bevacizumab and bevacizumab combined with laser treatment groups (p=0.004). At month 12, greater proportion of patients gained ≥10 and ≥15 letters and with BCVA letter score >73 (Snellen equivalent: >6/12) with bevacizumab monotherapy (23.8% and 7.1% and 4.8%, respectively) and bevacizumab + laser (57.1% and 28.6% and 14.3%, respectively) versus laser monotherapy. The mean central retinal subfield thickness was significantly reduced from baseline to month 12 with bevacizumab (−124.4 μm) and bevacizumab + laser (−129.0 μm) versus laser (−62.0 μm; both p<0.0001). Conjunctival hemorrhage was the most common ocular events. No endophthalmitis cases occurred.Bevacizumab monotherapy or combined with laser showed superior BCVA improvements over macular laser treatment alone in Mongolian patients with visual impairment due to diabetic macular edema.

Introduction: Bile reflux gastritis is due to an excessive reflux of duodenal contents into the stomach. The increasedenterogastric reflux may provide the basis for increased mucosal injury. In clinical practice the symptoms of bile reflux gastritis are nonspecific than the other gastritis. Only endoscopy and biopsy can confirm the diagnosis. Observation demonstrates that, in practice there is tendency to increase the bile reflux gastritis. However, in Mongolia there are much less research and studies in this area. Goal: Evaluate the endoscopical and histological changes caused by duodenal reflux on the gastricmucosa Materials and Methods: We included in our study 70 patients with bile reflux gastritis admitted in Second General Hospital in Ulaanbaatar. In all cases we performed an upper gastrointestinal endoscopy and at least 4 biopsyspecimens were done from antral mucosa and the histological features were scored in accordance with the Sydney system. Results: The average age of the patients with bile reflux gastritis was 61.64±9, 69 years. Reflux gastritis was noted to 15 males and 55 females. Gastroduodenal reflux after chlocystoectomic surgery was noted in 46 cases (65.71%), and biliarytract disease was noted in 16 cases (22.85%). The average time interval from original operation tothe discovery of the bile reflux gastritis was 9.22 years after chlocystoectomic surgery. The commonest endoscopic alterations were: erythema of the gastric mucosa in 41 cases (58.57%),gastric antral atrophy in 20 cases (28.57%), gastric diffuse atrophy in 27 cases (38.57%), thepresence of bile into the stomach in 70 cases (100%), erosions in 3 cases (4.28%), gastric ulcer in2 cases (2.85%), intestinal metaplasia in 10 cases (14.28%).The histologic alterations observed from tissues collected during endoscopic examination were chronic super facial gastritis in 19 cases (27.14%), chronic atrophic gastritis in 51 cases (72.85%),an intestinal metaplasia in 32 cases (14.28%), gastric erosions and ulcer in 4 cases (5.71%),dysplasia in 1case (1.42%), Helicobacter pylori infection in 14 cases (20%). Conclusions The most frequent risk factors for bile reflux gastritis were chlocystoectomic surgery and biliary tract disease. Histological findings of patients with bile reflux gastritis revealed gastric cancer precursor lesions, therefore follow-up endoscopic examinations and early treatment of bile reflux are essential.

Introduction: Coronavirus infection 2019 (Ковид-19) is an infection caused by a novel virus and induces severe ARDS. КОВИД-19 pandemic has rapidly spreaded in 221 countries, 245,373,039 cases and 4,979,421 mortalities have been reported. Pulmonary and renal thrombotic angiopathy occur in patients with complications of ARDS, sepsis, and multi-organ failure. Elevated D-dimer in КОВИД-19 patients has been reported firstly by doctors in Wuhan, China. In addition, many studies have revealed that elevated D-dimer has been associated with the severity of the diseases, an increased rate of poor prognosis. Objective: We aim to determine D-dimer in КОВИД-19 patients, and patient condition a decrease of D-dimer level after administration of anticoagulant therapy. Case report: We introduce a rare case of КОВИД-19. Laboratory test results and the effect of anticoagulant therapy have been evaluated during the infection. 85 aged women were admitted with a diagnosis other than КОВИД-19. PCR for SARS-Cov-2 was negative on the previous day of admission, and Sars-Cov-2 Ag rapid test was also negative on the admission day. However, the D-dimer test result was much higher with 7120 ng/мл and X-ray and CT revealed a similar pattern to the КОВИД-19 patient. Then anti-Sars-Cov-2 test was positive with 4,08 COI. Based on laboratory test results of D-dimer, LDH, CRP, and CT pattern the patient was diagnosed with post-КОВИД-19 pneumonia, and anticoagulant therapy was initiated additionally to prevent hypercoagulation induced by КОВИД-19. D-dimer test taken before administration of anticoagulant therapy increased more to 10910 ng/мл. 3 days later D-dimer level decreased to 8180ng/мл and the patient’s condition was improved. Conclusion The evaluation of D-dimer of the patients with КОВИД-19 is highly significant. Anticoagulant therapy might be necessary for КОВИД-19 patients with high D-dimer level in serum. Further studies are needed to assess the long-term outcome of the illness and mortality.