BACKGROUND: Fifty-eight syphilis cases were notified from Darkhan-Uul Province in the first three months of 2012, which is double that of the same period in 2011. The objective of this investigation was to confirm the existence of the outbreak, examine the risk factors of cases and develop recommendations to prevent further spread.

METHODS: We conducted a descriptive study of cases notified to the national surveillance system diagnosed with syphilis between 1 January and 20 March 2012 in Darkhan-Uul Province. Additional data were collected from doctors’ record books and outpatient cards. We compared outbreak cases to non-outbreak cases notified in Darkhan-Uul Province in 2011.

RESULTS: The total notification rate was 62.3 per 100 000. The notification rate was highest among 20–29 year olds, and 38 (65.5%) were females. More males than females were detected through contact tracing (45% compared with 10.5%). Only 10% of cases reported using condoms during their last sexual encounter, with 65.5% reporting having had casual sex or multiple sex partners. There were no homosexual cases. Compared to the non-outbreak cases, outbreak cases had a significantly higher proportion of detection through contact tracing (22.4% compared with 0.7%) but a lower proportion of detection through prevention (3.5% compared with 26.5%). There was also a higher proportion of primary syphilis in outbreak cases (62.1% compared with 41.7%).

CONCLUSION: The syphilis outbreak in Darkhan-Uul Province was confirmed. We recommended effective contact tracing followed by timely diagnosis and treatment. Health promotion activities targeted to high school, college and university students on syphilis infection and prevention as well as condom usage were recommended for future prevention.

Urine-incontinence is most significant disease in general population its rate between 10-47%. One of the most widespreeding 10 disease’s one is incontinence in USA, In European population 17%, In Russian 16%. Stress incontinence prevalence in Mongolian women, 78.1% was urban population, 21.9% was rural. In already diagnosed population 30% of them were non-treatment group, 32.25% were underwent surgical treatment. Early diagnose, right treatment option choice, value of surgical treatment all of its result is valuable in practice. Urogynecology Division of First Maternity Hospital Of Mongolia patients who underwent urodynamic machine their economic background, etiological factors, symptoms, maternal status, gynecological check up result all of these factors were calculated by PAD- test. Positive patients diagnostic and treatment options were determined by machine. Prospective study were done within 43 women who diagnosed by urodynamic machine. We reassumed pre and post – treatment patient’s incontinence symptoms by machine. 79.3% percent of women diagnosed with stress incontinence had a history of coffee or tea usage. / p<0.01, QR=0.38/. Birth injury such as vaginal or perineal tear showed statistically significant impact on urine incontinency (82%) /p<0.04, QR=0.31/. Among the signs of urine incontinence, dribbling of urine during physical load was a statistically significant sign of stress incontinence. /p<0.04, QR=0.38/ The result of Pad test showed significantly low statistic importance compare to stress incontinence/p<0.01, QR=0.35/. The result of Pad test showed significantly low statistic importance compare to stress incontinence /p<0.01, QR=0.35/. 41/95%/ women showed normal bladder volume while 5% showed low bladder volume which is lower than 300 ml. Residual urine more than 100 ml showed statistically significant relation with stress incontinence /p<0.03, Q=0.32/. The main symptom of stress incontinence in women was urine leakage /p<0.01, Q=0.44/. Stress incontinence prevalence was 44.8% and overactive bladder was 25% in 36-55 age group. Children weight showed no impact on stress incontinence and overactive bladder. 83% of participants had birth number of ≥ 2 showing the statistical significant impact of birth number in urine incontinence (р>0.05, QR=0.8). From all participants, 60% had stress incontinence, 19% had no abnormality, 9% had overactive bladder, 7% had mixed urine incontinence, and 5% had other diseases (urethral atrophy and obstruction). From total 43 participants, 22(51%) had surgical treatment, 4(9%) had chemical treatment, 3(7%) had combined surgical and chemical treatment, and 14 (33%) had physical exercise. From 21 women who received surgical treatment, 16 had improvement and 5 had no improvement. Analyzing the treatment result of urine incontinence by questionnaire and urodynamic test showed improvement in 75 % of patients received surgical and combined surgical chemical treatment and 80% of improvement in patients received chemical and exercise treatment.High number of birth, high usage of coffee and tea, birth injury especially perineal tear are statistically significant factors of stress incontinence development.Pad test is effective test used in diagnosis, treatment planning and monitoring treatment results of urine incontinence.Urine leakage symptom occurs 44% more in women with stress incontinence. 24% of women with stress incontinence were diagnosed without abnormality by urodynamic test. Urodynamic test has a diagnostic importance in treatment planning, individual treatment choice and increase of treatment effect in urine incontinence patients.

Objective: To clear up of influence of society, economy family and mood of pregnant mother who gave stillbirth.Material and Methods: We chose 50 mother’s who gave stillbirth by case group, 50 mother’s who gave normal birth by control group by randomized method, research was conducted by specially prepared card and descriptive method, we compared placenta of mother’s who gave stillbirth and normal birth by pathologic analyse and working out was done by using SPSS 14.0 programme and difference between index was concluded by X 2 and F criteria.Results: Normal birth of mother’s who participated in the research is 19(16.7%) at the age 11(84.6%), at the age of 40-44 normal birth 1(50.0%), stillbirth 1(50.0%) stillbirth risk is increased under 19 and over 35, it has statistic probability (p=0.026). In 5(17.9%) of mother’s who gave normal birth, 23(82.1%) of mother’s who gave stillbirth. A member of her family smokes, in 45(62.5%) of mothers who gave normal birth, in 27(37.5%) of mothers who gave stillbirth a member of a family does not smoke .Seeing from this smoking of a family member affect to stillbirth and it has statistic probability (p=0.000).18(54.5%) of mothers who live in ger, 12( 35.3%) of mothers who live in a yard and a house, 20( 60.6) mothers who live in a flat gave normal birth. Seeing from this condition of living in a yard or in a house is worse that condition of living in a flat, it influence to stillbirth, it has probability for statistic (p=0.055). Conclusion: When women gives birth to a child under 19 and over 35 increases risk of stillbirth. It has statistic probability (p=0.026). Smoking of family member affects to stillbirth, it has statistic probability (p= 0.000). Condition of living in a yard and house is worse than living in a flat, it affect to stillbirth, it has probability for statistics (p=0.055).

Trough WHO recommendation hysteroscopy is the golden standart technique of uterine cavity evalution. First Maternity Hospital of Mongolia have been implemented gynecological laparoscopic surgery since 2009, then from 2013 we have started diagnostic and operative hysteroscopy. A hysteroscopy may be done to find the cause of abnormal bleeding or bleeding that occurs after a woman has passed menopause. It also may be done to diagnose infertility. Also a hysteroscopy can be used to remove growths in the uterus, such as fibroids or polyps. We evaluated results of gynecological diagnostic and operative hysteroscopy, which was done in First maternity hospital.We took special questionnaires from 39 women and did prospective analyses.39 patients, who were done hysteroscopy were involved our study from November 2013 to January 2015. 51% of participants were reproductive age women. Under 20 years old participants who underwent diagnostic hysteroscopy due to hyperplasia of endometrium were 3%, they were performed biopsy. From all participants 87,2% performed operative hysteroscopy, 12,8% was diagnostic hysteroscopy. After diagnostic and operative hysteroscopy, 97% of patients had no symptoms, but last 3% of patients had lower abdominal pain. If clarify diagnosis which is approved after diagnostic and operative hysteroscopy 51.3% was displaced IUD, 35.9% was endometrial polyp, 2.6% was hyperplasia endometrium, 10.3% was infertility. Complication was 2.6% through postmenopausal participants if compared with premenopausal women. Diagnostic and operative hysteroscopic procedure has benefits for synehia, septum of uterus, endometrial hyperplasia, abnormal uterine bleeding, submucosal myomectomy. From all participants 87,2% performed operative hysteroscopy, 12,8% was diagnostic hysteroscopy. Hysteroscopy was done when displaced IUD (51.3%), polyp of endometrium (35.9%), hyperplasia of endometrium (2.6%), and infertility (10.3%).Complications after hysteroscopy depends from menopause.

Introduction: We began treatment of multi drug resistant tuberculosis first from 2003. At that time there was a 1960 cases and most of the cases were from Ulaanbaatar, Darkhan, Selenge, Tuv, Dornod provinces. From all the cases only 62% or 1058 cases were included in treatment. From that 336 patient or 19% deceased, 296 patient or 18% didn’t get a treatment. We did this study because there were never done any research or study of surgical treatment of multi drug resistant tuberculosis in Mongolia. Materials and Methods: We studied cases of patients who undergone lobectomy, since 2007. There were 48 cases of 46 patients, 2 patients surgery were done on both sides. Respondents aged between 14- 45, 25 male (52%), 23 female (48%), all patients got a first - line anti-tuberculosis treatment, such as cat-1, cat-1+cat-2 and 10 variants of these drugs. It was done based on sputum culture test results of NCCD TB surveillance and research department’s laboratory. Results: From the all patients only 77.08% had undergone surgery within the first 3 years. 92% patients were diagnosed with multi drug resistance TB only with the sputum and sputum culture test results, and the rest of the patients were diagnosed using a tissue analyses on the above tests. It was revealed that HR resistant -91.66%, HR+(Z,E,S) -3 drugs resistant -18.78%, HR+(ZSE)-4 or 5 drugs resistant. In the patients TB lesion locations was on the right upper lobe 54%, left upper lobe 31%, on a both upper lobes 85%, cavernous fibrosis tubercles 60%, combined TB lesions 77%, tubercles 21%.87.5% of total patients received a multi - drug resistant TB treatment between 7 - 24 months prior surgery. All 48 patients had a totally 69 surgeries. Surgeries included 9% pneumonectomy, 28% lobectomy, 30% Wedge resection, 23% pleurectomy decortication, 7% Wedge resection on both sides, one bilobectomy. There were no complications during the surgery but 5 of patients had an empyema after surgery. No fatal cases.Three patients out of 5 who had a surgery due to pulmonary hemorrhage developed an empyema after surgery. Drainage tubes were taken after the surgery within 2-3 months.Therewere no complication and escalations in the patients who received a surgical treatment, after the surgery from 6 months to 5 years. Conclusion: In study it shows that surgical treatment is effective to do after 6 months of anti-tuberculosis drug treatment in multi -drug resistant TB patients.Also it shows that combining of medical and surgical treatment is healing up to 98% in the patients who were rightly chosen according to surgical indications.This research result shows that in our country multi - drug resistant TB surgical treatment complication is only 10.41%, which is below in the other countries who have same anti-tuberculosis drug treatment.

First Maternity Hospital in Ulaanbaatar has provided 1890 women, 2508 women and 3728 women in 2012, 2013 and 2014, respectively, for diseases in women. Uterine myoma, ovarian cysts, dysfunctional uterine bleeding, ovariandysfunction and endometriosis are commonly among women. These need to be diagnosed at early stages of the diseases. Endometrial carcinoma is detected in 5% of women under 40 years of age with over amount of hormone estrogen on a base of endometrial hyperplasia.Women with endometrial hyperplasia have 5% possibility to have endometriosis, endometroidcysts, ovarian cancer or uterine myoma and 0.5% possibility to have higher complication of disease. Therefore, we aimed to introduce the practical treatment with cytological analysis as a medical treatment and diagnosis method. The purpose of the research is to highlight the diseases mostly occurring in women, determine cytological changes and differences and improve the differential diagnosis.The research work has been carried out based on reports of cytological analyses undertaken by the National Centre of Pathology for 1310 patients, who were all of patients treated at the Inpatient Care Department in FMH in 2014. This study included in the cytological analyses at the National Centre of Pathology, by using special questinnaries and did retrospective study. 67.7% /888/, 27.8% /365/ and 4.3% /57/ of the above mentioned women were tested with cytological analyses due to surgical diseases, endocrinology diseases and inflammatory diseases, respectively. The average age is 39±58. The uterine myoma, the ovarian cyst and dysfunctional uterine bleeding have been more commonly occurred among the 35 diseases in women as 38.9% /510/, 15.7% /206/ and 16.7%/219/ of the women, respectively. For endometriosis cases, the ovarian endometriosis occurred with 3.7%, the fallopian tube endometriosis occurred 2.4%, the adenomyosis occurred 4.7% and the combined endometriosis occurred 0.5%.Based on the reports of cytological analyses on endometrial hyperplasia, the details show that the simple hyperplasia is 52.4% /178/ and the complex hyperplasia is 47.6% /162/.Compared with women without the HPV, a cervical intraepithelial neoplasia occurs to women with the HPVmore than 20 times. /p<0.001, OR=20.81/. It is statistically important that 2nd stage of adenomyosiscauses atypic cellular changes for 3 times. /p<0.001, OR=3.09/. In women, the uterine myoma, dysfunctional uterine bleeding and ovarian cyst disorders are most common. Average age of women with disease in women is 39.58.Compared with women without the HPV, a cellular change occurs to women with the HPV more than 20 times. /p<0.001, OR=20.81/.The 2nd stage of adenomyosis causes atypic cellular changes for 3 times. /p<0.001, OR=3.09/

Complete seizure control is the single most important determinant of good quality of life for patients with epilepsy and the chronic nature of the disorder requires that antiepileptic drugs (AEDs) be administered for many years, often for a lifetime. Therefore, long-term experience is of particular importance in evaluating the efficacy and safety of an AED. Valproic acid increases γ-aminobutyric acid (GABA) synthesis and release and potentiates GABAergic transmission in specific brain regions and it also has also been found to reduce the release of the excitatory amino acid β-hydroxybutyric acid and to attenuate neuronal excitation mediated by activation of N-methyl-D-aspartate (NMDA) glutamate receptors. In addition to these effects, valproic acid exerts direct actions on excitable membranes, including blockade of voltage-dependent sodium channels. Valproate is generally regarded as a first-choice agent for most forms of idiopathic and symptomatic generalised epilepsies. Many of these syndromes are associated with multiple seizure types, including tonic-clonic, myoclonic and absence seizures, and prescription of a broad-spectrum drug such as valproate has clear advantages in this situation. The elimination half-life is in the order of 9 to 18 hours, but shorter values (5 to 12 hours) are observed in patients comedicated with enzymeinducing agents such as phenytoin, carbamazepine and barbiturates. The most commonly reported adverse effects of valproate include gastrointestinal disturbances, tremor and bodyweight gain. Other notable adverse effects include encephalopathy symptoms (at times associated with hyperammonaemia), platelet disorders, pancreatitis, liver toxicity and teratogenicity. According to the some study results, endocrine manifestations of reproductive system disorders, including polycystic ovary syndrome, may be more common in women treated with valproate than in those treated with other AEDs.

Trough WHO recommendation hysteroscopy is the golden standart technique of uterine cavity evalution. First Maternity Hospital of Mongolia have been implemented gynecological laparoscopic surgery since 2009, then from 2013 we have started diagnostic and operative hysteroscopy. A hysteroscopy may be done to find the cause of abnormal bleeding or bleeding that occurs after a woman has passed menopause. It also may be done to diagnose infertility. Also a hysteroscopy can be used to remove growths in the uterus, such as fibroids or polyps. We evaluated results of gynecological diagnostic and operative hysteroscopy, which was done in First maternity hospital.We took special questionnaires from 39 women and did prospective analyses.39 patients, who were done hysteroscopy were involved our study from November 2013 to January 2015. 51% of participants were reproductive age women. Under 20 years old participants who underwent diagnostic hysteroscopy due to hyperplasia of endometrium were 3%, they were performed biopsy. From all participants 87,2% performed operative hysteroscopy, 12,8% was diagnostic hysteroscopy. After diagnostic and operative hysteroscopy, 97% of patients had no symptoms, but last 3% of patients had lower abdominal pain. If clarify diagnosis which is approved after diagnostic and operative hysteroscopy 51.3% was displaced IUD, 35.9% was endometrial polyp, 2.6% was hyperplasia endometrium, 10.3% was infertility. Complication was 2.6% through postmenopausal participants if compared with premenopausal women. Diagnostic and operative hysteroscopic procedure has benefits for synehia, septum of uterus, endometrial hyperplasia, abnormal uterine bleeding, submucosal myomectomy. From all participants 87,2% performed operative hysteroscopy, 12,8% was diagnostic hysteroscopy. Hysteroscopy was done when displaced IUD (51.3%), polyp of endometrium (35.9%), hyperplasia of endometrium (2.6%), and infertility (10.3%).Complications after hysteroscopy depends from menopause.

Introduction: We began treatment ofmulti drug resistant tuberculosis first from2003. At that time there was a 1960 cases andmost of the cases were from Ulaanbaatar,Darkhan, Selenge, Tuv, Dornod provinces.From all the cases only 62% or 1058 caseswere included in treatment. From that 336patient or 19% deceased, 296 patient or 18%didn’t get a treatment. We did this studybecause there were never done any researchor study of surgical treatment of multi drugresistant tuberculosis in Mongolia.Materials and Methods: We studiedcases of patients who undergone lobectomy,since 2007. There were 48 cases of 46patients, 2 patients surgery were done onboth sides. Respondents aged between 14-45, 25 male (52%), 23 female (48%), allpatients got a first - line anti-tuberculosistreatment, such as cat-1, cat-1+cat-2 and 10variants of these drugs. It was done basedon sputum culture test results of NCCDTB surveillance and research department’slaboratory.Results: From the all patients only77.08% had undergone surgery within thefirst 3 years. 92% patients were diagnosedwith multi drug resistance TB only with thesputum and sputum culture test results, andthe rest of the patients were diagnosedusing a tissue analyses on the above tests.It was revealed that HR resistant -91.66%,HR+(Z,E,S) -3 drugs resistant -18.78%,HR+(ZSE)-4 or 5 drugs resistant. In thepatients TB lesion locations was on the rightupper lobe 54%, left upper lobe 31%, ona both upper lobes 85%, cavernous fibrosistubercles 60%, combined TB lesions 77%,tubercles 21%.87.5% of total patientsreceived a multi - drug resistant TB treatmentbetween 7 - 24 months prior surgery.All 48 patients had a totally 69 surgeries.Surgeries included 9% pneumonectomy,28% lobectomy, 30% Wedge resection,23% pleurectomy decortication, 7% Wedgeresection on both sides, one bilobectomy.There were no complications during thesurgery but 5 of patients had an empyemaafter surgery. No fatal cases.Three patientsout of 5 who had a surgery due to pulmonaryhemorrhage developed an empyema aftersurgery. Drainage tubes were taken afterthe surgery within 2-3 months.Therewere nocomplication and escalations in the patientswho received a surgical treatment, after thesurgery from 6 months to 5 years.Conclusion: In study it shows that surgicaltreatment is effective to do after 6 monthsof anti-tuberculosis drug treatment in multi -drug resistant TB patients.Also it shows thatcombining of medical and surgical treatmentis healing up to 98% in the patients whowere rightly chosen according to surgicalindications.This research result shows that inour country multi - drug resistant TB surgicaltreatment complication is only 10.41%,which is below in the other countries whohave same anti-tuberculosis drug treatment.