The Criminal Code of Mongolia, article 22.2 defines that a person who was imputable at the time of committing a crime but lost the ability to realize the socially dangerous nature of his/her act or omission or to control it due to chronic mental illness, temporary mental derangement, mental deficiency or another serious illness during the consideration of the case in court shall not be subject to criminal liability. A court shall apply to such a person compulsory measures of medical character and decide the matter of imposing punishment after his/her recovery.The Mental Health Law of Mongolia, article 3.1.13 also defines that socially endangered actions of persons with mental disorders means actions of persons who lost self control due to mental disorders by causing self harm, endangering safety of others and community. Therefore obvious need to study the causes of socially dangerous nature acts of patients to whom the court applied compulsory measures of medical character has been assessed.1. Study the diagnosis and mental states when the acts were committed.2. Study the ways of socially dangerous nature acts of mental health patients3. Duration of compulsory medical treatmentsStudy of medical history of those patients discharged from compulsory medical treatment shows that their mental illnesses were started from very young ages and continued in lengthy period of time. Patients with organic mental disorders (39.4%), schizophrenia, schizoid personalitydisorders and delusions (36.4%) were committed socially dangerous acts. Ways of socially dangerous acts were homicide, inflictions of bodily injuries to others including family members and hooliganism.30.3% of patients were in compulsory medical treatment for 10-12 months and 50% of them were with organic mental disorders. 18.2% of patients were in compulsory medical treatment for 25 months and over. 66.6% of them were diagnosed with schizophrenia, schizoid personalitydisorder and delusion.

IntroductionIn the total increase in the rate of smoking in the population of Mongolia, the smoking rate among women of the age of 15-24 years old increased up to 4.2% which is higher by 1.9 points against the level of the year 2005. The average age of starting smoking among women decreased by 3 years compared to 2005 evidencing the increase in the prevalence of smoking among the female population. However, there is no study on prevalence of smoking focusing on school age girls. Researches on the prevalence of smoking and KAP of the population shall play an important part in reduction of tobacco consumption, assisting smoking cessation and determining the effective forms of anti-tobacco communications.Materials and MethodsThe study of the tobacco consumption and risk factors among the school age girls of the 6-11th grades is a cross-sectional study covering the school age girls of 6-11th grades of Suhbaatar, Chingeltei, Bayangol and Songinokhairkhan districts of Ulaanbaatar and Uvurkhangai, Khovd, Dornod and Umnugobi aimags. The participants of the study were selected by random sampling. The study used qualitative and quantitative methods. The study involved 1208 school age girls of 6-11th grades. The data of the survey was analyzed with SPSS software.ResultsEvery third or 33.7% of the schoolchildren of 6-11th grades smoke. The rate of smoking is as twice higher in the metropolitan settings as in provincial aimags. The answer that there are smokers in the family given by 64% of the respondents implies that two in three target age school girls are exposed to second-hand smoking. Every fifth of the girls find themselves in tobacco affected areas daily. Of the target age/gender group, 36.5% reported that they buy cigarettes in kiosks, shops and stores and one in each two schools have any form of tobacco selling points within 100 meters which implies a potential impact of the surrounding environment. Around 90% of the participants of the quantitative survey were able to correctly list the health hazards of smoking, however, the qualitative survey results demonstrate that they have confusions on the health hazards of smoking and have insufficient understanding of the long term effects of smoking.Conclusions:1. Girl in the metropolitan settings smoke more than in provincial settings.2. Smoking at schools and public places are common in both metropolitan and provincial areas.3. The smoking behaviors of the girls are influenced by their and peers. insufficient knowledge 4. It was identified by the research that all smoking girls in the capital and in provinces are wishing to quit smoking.5. Though the girls receive information on tobacco from mass media, friends and Health Education subject, the information received through these channels are insufficient to impact their knowledge and change their behavior.6. The number of school children exposed to the impact of tobacco tends to increase by their age.

IntroductionPyelonephritis is generally the result of an ascending infection of the urinary tract (reflux is seen in 30- 50% of affected children) most common organism is Escherichia coli (Heiberger R.E., 2006). The bacteria that are most likely to cause pyelonephritis are those that normally occur in the feces. Pathogens isolated from patients with pyelonephritis include both gram positive and gram negative bacteria. R.E.Neiberger reported that of gram negative bacteria E.coli, Klebsielle, Enterobacter, Proteus, Pseudomonas and of gram positive bacteria Enterococcus, Staphylococcus saphrophiticus, group B.Streptococcus were prevalent in children with pyelonephritis. In another study conducted at the Pennsylvania University, USA, 70-95% of causes were related with E.coli, Proteus, Klebsiella, Pseudomonas, Staphylococcus saphrophiticus and Еnterobacter (Sammuel Baron, 2004). In the Indian study E.coli accounted for 88.1%, Pseudomonas aeruginosa for 7.1% and Klebsiella was in 4.8% of cases (Namalwar B.R., Vijayakumar M., Janani Sankar., Ramnath B and Prahlad N., 2004). Serotypes 01; 02; 04; 06; 07 were considered as most prevalent among E.coli causes of UTI (Sammuel Baron, 2004). Escherichia coli causes about 85% of acute bladder and kidney infections in patient with no obstruction or history of surgical procedures. Proteus, Klebsiella, Enterobacter or Pseudomonas are other common causes of infection(Namalwar B.R., Vijayakumar M., Janani Sankar., Ramnath B and Prahlad N., 2004). Once these organisms enter the urinary tract, they cling to the tissues that line the tract and multiply in them (Parveen J Kumar Michael L Clark Clinical medicine. London, 2003). Pyelonephritis is characterized by tubulo-interstitial inflammation, hyperaemia and oedema. Affected patients present with the abrupt onset of fever and chills, constant dull flank pain, and symptoms of cystitis (dysuria, frequency, urgency). Urinalysis usually procedures microabscess. Urine cultures will frequency be negative in the setting of haematogenousinfection (Namalwar B.R., Vijayakumar M., Janani Sankar., Ramnath B and Prahlad N., 2004). Asymptomatic infections of the urinary tract or Asymptomatic bactreuria are common. In childgood, about 1 percent of girls have asymptomatic bacteruria (Namalwar B.R., Vijayakumar M., Janani Sankar., Ramnath B and Prahlad N., 2004). In Mongolia females aged between 20-40 years old accounted for 60.3% of all patients with chronic pyelonephritis. In cases of bacteriuria E.Coli was 74.05%, with highest sensitivity to claforan (91.25%) and ciprofloxacin (90.65%) (B.Selengee, 2003). Last 5 years (2004-2008) 3709 children were treated in Nephrological department of Mathernal and Children’s Scientific Center, but between them 741(19.97%) children were illned by pyelonephritis. However no study was conducted on bacterial causes of pyelonephritis in children in Mongolia. Purpose:The main goal of study was to indicate the etiological and clinical specialaty of children’s pyelonephritis. Especially, to indicate the prevalently occurred type and the etiological bacterial groups also the clinical specialaty of children’s pyelonephritis. To study microbiological spectrum of pathogens causing pyelonephritis in Mongolian children, sensitivity of them to antimicrobial agent, mechanisms of their resistance and to identify genes related with microbial pathogenity.Materials and Мethods:My study covered 254 children wich illned by pyelonephritis, these were treated in Nephrological department of Mathernal and Children’s Scientific Center in last 5 years (2004-2008). From patient’s history we also used the clinical laboratorial analysis results such as biochemical, blood count and urine analysis. We used retrospective and prospective statistical methods for study on pathient’s history of children wich sickned by pyelonephritis and bacteriological method for indicating groups of bacteria. We collected information about patients by questionary chart. During study we also used electro-sonography(echo), Xray, radio-isotope, computer-tomography and reno-vascular angiography methods. Antibiotic susceptibility testing covered total 212 bacterial species to 19 kind of antibiotics by disk diffusion(DD) and minimium inhibitory concentration(MIC) methods. Strains were identified by API tests strip (BioMerieux, France) and antibiotic susceptibility was determined by disk diffusion method according to the ELSI recommendations. Types of the beta lactamase were determined by PCR using the blaTEM, blaSHV and blaCTX-M specific primer. 1080 bp, 400 bp and 570 bp PCR product were interpreted as positive for blaTEM, blaSHV and blaCTX-M genes. WHONET5.1 programm was used for the analysis of susceptibility testing according to the WHO recommendation. Pathogens from 1 month consequent urine culture of patients treated at the pediatric nephrology, urology units and outpatient clinic at the MCHRC and patients from nephrology and urology departments at the CCH were isolated using disk diffusion test and minimum inhibitory concentration. Bacterial resistance and pathogenity related genes were identified using PCR method.Results:There were the girls prevalently sicked by pyelonephritis (n=181 or 71.25%) than boys (n=73 or 28.74%) and the primary (n=155 or 61.02%) and secondary chronic pyelonephritis (n=99 or 38.97%) also was prevalently occurred. During pyelonephritis are occurring following clinical symptoms these are high temperature, edema eyelid, loss of appetite, sludged urinate, skin dryness, womiting and nicthuria. By our study the main clinical symptoms of children’s pyelonephritis are high temperature (58.55%), back pain (51.0%), edema of eyelid (34.42%) and polyuria (25.79%). Also the main influencing factors for inducing children’s pyelonephritis are hyphoplasia (33.3%), hydronephrosis (19.23%), single kidney (15.38%) and vesico-uretheral reflux (6.41%). Study was conducted on 110 positive cultures (E.coli-52, Citrobacter spp.-8, E.cloacae-10, Proteus spp.-7, K.pneumoniae-7, P.aeruginosae-22 ба A.baumennii-2, S.aureus-1, Enterococci-1). The bacterial sensitivity and resistance to antimicrobial agents differed between various pathogens. From Gram negative oxydase negative Enterobacteriaceae by PCR testing, 19 isolates contained blaTEM types, 11 strains contained blaSHV types and 16 strains contained blaCTX-M type genes. On the study of PCR the virulence gene “aer” were determined 50% of E.coli strains. blaTEM type resistance can divided to 5 groups, from them 2 groups had the resistance to single beta-lactamic antibiotics, but 3 groups had to both beta-lactamic and aminoglycoside antibiotics.blaSHV type resistance had 2 groups antibiotics, these were beta-lactamic and aminoglycoside antibiotics. blaCTX-M type resistance had 2 groups, these were beta-lactamic and aminoglycoside antibiotics. Both the blaTEM and blaSHV type co-resistance had 2 groups, these were CEP and CXA antibiotics. blaTEM and CTX-M type resistance can divided to 4 groups, from them 1 group had the resistance to single beta-lactamic antibiotics, other 3 groups had to aminoglycoside antibiotics. Both the blaSHV and CTX-M type co-resistance had 2 groups, these were lactamic and aminoglycoside antibiotics. blaTEM, SHV and CTX-M type co-resistance can divided to 3 groups, these were also beta-lactamic and aminoglycoside antibiotics. On the study of PCR the virulence “aer (aerobacterin) gene” expression was identified in 50% of E.coli strains.Conclusion:There were the girls (181 cases or 71.25%) prevalently sick by pyelonephritis than boys(73 cases or 28.74%) was prevalently occurred.In Mongllia the primary pyelonephritis(155 cases or 61.02%) was occurred prevalently than secondary chronic pyelonephritis( 99 cases or 38.97%). The gasteroenterological and toxic symptoms prevalently occurred in clinical symptoms, but later kidney and urinary tract symptoms noticed.In Mongolia the main influencing factors for inducing children’s pyelonephritis are hyphoplasia (33.3%), hydronephrosis (19.23%), single kidney (15.38%) and vesico-uretheral reflux (6.41%).The prevalent pathogen causing pyelonephritis in Mongolia is E.coli. Other causes include Enterobacter spp., Klebsilla spp., Proteus spp., P.aeruginosa, Aceinobacter baumenii and S.aureus. The virulence gene “aer” were determined 50% of E.coli strains. The most prevalent resistance was resistance to beta-lactam, aminoglycoside, tetracycline and trimethoprim sulfometohoxazole. Resistance to beta-lactamic antibiotics was related with blaSHV, blaTEM, blaCTX-M gene experessions in 25-40% of cases. blaTEM, blaSHV and bla CTX-M type of the beta-lactamase were determined 25-40% of Gram negative oxidase negativebacilli. Pathogenic “aer” gene was identified in 50% of E.coli in Mongolia.

Background: Accreditation of healthcare institutions serves as a fundamental mechanism for ensuring patient safety and validating the quality of medical services provided to the population. At Intermed Hospital, a quality measurement system for healthcare services has been established since 2015, encompassing 126 quality indicators at both institutional and departmental levels. This system facilitates continuous quality improvement efforts. In this context, quality indicators specific to the endoscopy department play a pivotal role in objectively assessing the quality of endoscopic services. Aim: To assess the quality indicators in gastrointestinal endoscopy unit. Materials and Methods: A retrospective single-center study was conducted by collecting data from the Intermed hospital’s electronic information systems which included HIS and PACS and Quality and Safety Department’s Database and the results were processed using the SPSS software. Ethical approval was granted by the Intermed hospital’s Scientific research committee. The quality of endoscopic services in the Intermed hospital was assessed based on: a) the average values of four quality indicators measured monthly; b) sample survey data from five categories of quality indicators. Results : Between 2016 and 2024, the quality indicators of the endoscopy unit measured as the level of early warning score evaluations for patients was 95.97%±3.33, the level of cases where peripheral blood oxygen saturation decreased during sedation was 1.54%±3.78, the level of cases where patients experienced paradoxiical response during sedation was 5.82%±1.75, surveillance culturing level for validation of endoscopy reprocessing was 11.6%. The endoscopic documentation quality by peer review showed 95.7-100%, the colonoscopy quality indicators were followings as adenoma detection rate: 24.5% Cecal intubation rate: 99.1%, 95.2%, Colonoscope withdrawal average time: 13.28±10.62 minutes, Bowel preparation quality (Boston Scale): 89.3% 95.7%), patient discharge from the recovery room, Average discharge time post-procedure: With propofol alone: 30.92 minutes; With propofol and fentanyl combined: 31.52 minutes, The intermediate risk was 0.28% by the TROOPS evaluation during procedural sedation. Conclusion The quality benchmark levels for these endoscopic units, as determined by a single-center study, can be effectively implemented by benchmark endoscopy centers to enhance their quality and safety operations.