1.Does air pollution affect to the TB incidence?
Nergui M ; Enkhjargal A ; Burmaajav B
Mongolian Medical Sciences 2019;190(4):67-74
Tuberculosis remains a major global health problem with 10.4 million incident cases in 2016. Although
Mycobacterium tuberculosis is the causative agent, many environmental factors play a role in disease
progression. Several respiratory hazards including smoking and indoor air pollution were suggested
to increase the risk of tuberculosis, but only fewer studies has been conducted on the association
between ambient air pollution and tuberculosis.
Mongolia is a one of the seven TB high burden countries in the WHO Western Pacific Region. In
2017, there were 3779 TB cases in Mongolia. Most of them were smear positive pulmonary cases.
Mongolia achieved the regional WHO targets for finding and curing TB. Currently, case detection and
treatment success rates have reached 72% and 84.0%, respectively.
Air pollution is hard to escape no matter how rich an area you live in, it is all around us. Also, air
pillution is incerasingly serious problem in Mongolia. Globally it is estimated that 9 out of 10 breathe
polluted air and about 7 million deaths are attributed to air pollution. It is estimated that 91% of the
world’s population lives in area where the World Health Organization (WHO) Air Quality Guidelines
are not met.
In addition, children are highly affected by air pollution because their lungs are still developing and
the air pollution can interfere with this biological process, their bodies are less able to metabolize,
detoxify and excrete the toxins contained in the air pollution. Many epidemiological and ecological
studies were done in Mongolia toward to air pollution and health. However, it is still not clear how
much indoor and ambient air pollution can cause to TB incidence in Mongolia.
2. Preoperative local staging of colorectal carcinoma in Mongolian patients using computed tomography
Orkhon G ; Nergui B ; Narantsatsralt J ; Gonchigsuren D ; Tuvshinjargal D
Innovation 2015;9(4):34-37
In Europe, colorectal cancer (CRC) is the second most frequent malignancy and the second commonest cause of death from cancer. -The prognosis of CRC patients is dependent on the stage of disease at the time of diagnosis. Contrast-enhanced computed tomography (CT) examinations allows simultaneous assessment of tumor’s local staging, estimation of its possible invasion into neighboring organs, and detection of nodal and distant metastases; which is essential for appropriate treatment planning and estimation of its outcomes. The lack of reports on CT findings in CRC in Mongolia, increase in CRCmorbidity, and significant potential benefits of early detection served as background for this study.We investigated subjects with histologically proven adenocarcinoma who underwent CRC-related operative treatment either at National Cancer Center, First State Central Hospital, or Ulaanbaatar Songdo Hospital (UBSH) in 2009-2012. We retrospectively reviewed and analyzed from the UBSH’ database their preoperative CT, colonoscopy, surgical and pathohistologic reports using PACSPLUS,OCS operation systems. CECT examinations were performed at Siemens Somatom 64 multidetector scanner.Countrywide, 111 patients underwent surgery for colorectal cancer in 2009-2012. Totally, we involved86 subjects, whose age ranged from 25 to 87 years (mean 61.3years ±13.7SD). The F: M= 48 (55.8%) :38 (44.2%).The CECT determined T2 staging in 10/86 (11.6%),T3 in 61/86 (70.9%); T4 in 15/86 (17.4%);a significant difference in T-staging between CECT and histopathological examination (х2=41.28, p=0.00 (p<0.05)) was found. The CECT detected no peritumoral lymphadenopathy (N0) in 39/86 (45.3%), N1 in 18/86 (20.9%) and N2 in 29/86 (33.7%) patients; there was a significant difference in N-staging between CT and histopathological evaluation (х2=17.74, p=0.007(p<0.05)). For T-staging, CECT evaluation yielded sensitivity of 50% in T2 , 83.6% in T3, 71.4% in T4 staging; Diagnostic accuracy of CT for T2 staging was 89.7%, for T3- 78.2%, for T4- 88.7%. For N-staging, CECT had sensitivity of 88.2%, specificity of 64% and accuracy of 73.8%.Preoperative colorectal cancer patients in Mongolia receive initial MDCT in late stage. The similarsensitivity in staging of T-parameter to that of the international comparable studies. Nodal heterogeneity on CECT was more sensitive for nodal metastases than the size.
3.Preoperativelocalization of colorectal cancer tumor in Mongolian patients using colonoscopy and computed tomography
Orkhon G ; Nergui B ; Gantuya G ; Gonchigsuren D ; Tuvshinjargal D
Mongolian Medical Sciences 2014;170(4):39-41
Purpose: To evaluate colorectal cancer localization in preoperative patients in Mongolia using CECTand endoscopyMaterials and Methods: Totally 10575 optic colonoscopy examinations were performed at UlaanbaatarSongdo Hospital between January 2009 and December 2012. From these examinations, colorectal cancerwas detected in 218 cases; from them 175 had CT examinations. From patients with CT examinations,111 underwent surgery at UBSH, National Cancer Center, State Central Hospital. (64MDCT SiemensSomatom). Only 86 patients with colorectal carcinoma proved by endoscopic or operative pathologywere included into this study. We retrospectively reviewed from the UBSH’ database their preoperativeCT, colonoscopy, surgical and pathohistologic reports using PACSPLUS, OCS operation systems. Toclassify colorectal tumor localization, we divided colon into 8 anatomic parts. The size of tumor wasmeasured as longest dimension visible on CT examination.Results: Study population’s age range was 25-87 age (mean 61.3years ±13.7SD). F: M= 48 (55.8%):38 (44.2%). Urban residents composed 58 (67.4%), rural- 27 (31.4%), foreigner- 1 (1.2%). Tumor sizerange on CT was 0-13 ñì (mean 6.5±2.2 ñì) . Colonoscopy and CT detected colorectal cancer in rectumin 30(34.9%) and 31 (36.1%), in sigmoid colon in 21(24.4%)’’’ and 19(22.1%), in hepatic flexure- 9(10.5%) and 9(10.5%), retrospectively. Double (synchronous) colorectal cancer was detected in 1(1.1%)at colonoscopy and in 2 (2.2%) at CT.Conclusions: The 60-69 age group composed the largest group (38.4%) in colorectal cancer patients,with slight predominance of urban residents over rural and higher female predilection. Sigmoid andrectum are shown to have highest incidence in colorectal cancer. To our best knowledge, it is firstpublication on detection of synchronous colorectal cancer in Mongoliaby both CT and colonoscopy.CT examination is less risky and reliable method to evaluate the entire colonic length in patients withcolorectal cancer suspicion, if observers are skilled in detection of CT signs of colorectal cancer.
4.Practices COVID-19: cross sectional survey among Mongolian residents
Buuveidulam A ; Tuguldur B ; Nergui R ; Suvd B
Mongolian Medical Sciences 2020;194(4):57-63
Introduction:
In 11 March, 2020 WHO made the assessment that COVID-19 can be characterized as a pandemic.
The COVID-19 pandemic demands health care systems and decision-makers around the world to take
effective preventive measures, policies, and decisions. The pandemic continues to affect individual
and social mental health, well-being, lives, relationships, as well as economic stability. Therefore,
we measure individual and social responses in this context 1) by measuring unexpected events
and actions being taken accordingly, and 2) by the effectiveness of the organized responses to the
pandemic. Prevalence of COVID-19 epidemics has a direct relationship with the general population
behavior, therefore preventive measures against the spread of COVID is vital. Estimation of practices
towards COVID-19 in the population will greatly assist in intensifying the government's efforts to
prevent it. Therefore, there is a need to identify the population’s prevention behaviors, attitudes, and
information needs about coronavirus infection (COVID-19), to further improve the responses, risk
communications, and to ensure public preparedness.
Materials and Methods:
This cross-sectional study was conducted among the general population of Mongolia using quantitative
and qualitative (II & FGD and observation) cross-sectional survey method. The study was adapted to
the specifics of the country, using the research tools and guidelines developed by the WHO Regional
Committee for Europe, the COVID-19 readiness and response, and risk information communication
planning.
Total of 1740 people aged 15-60 years old participated in the study from 3 bordering provinces (Bayan-Ulgii, Selenge and Dornogovi) and 2 districts of Ulaanbaatar (Songinokhairkhan and Chingeltei).
Data analysis was conducted using SPSS version 23. Deviation values of 95% confidence interval
(95%CI) were used to assess the difference between the measurement of accuracy of the results
(distribution rate) and the groups (age, sex, location).
Results:
According to the results 47.5% (95%CI: 44.9-49.7) participants were from Ulaanbaatar and 56.7%
(95%CI: 50.3-55.1) were from rural areas. The participants' average age was 35. Most of the
participants were married (72.0%, 1252) and women (60.7%, 1057). As for living conditions 34.8%
(95%CI: 32.7-37.1) of the participants live in apartments and 65.2% (95%CI: 62.9-67.3) live in
ger areas. Respondents had answered to an average of 9.23 ± 3.2 (95%CI: 9.09-9.38) out of 14
scored questions for required knowledge of COVID-19. Knowledge score was higher among female
participants (9.43±3.14) than that among male participants (p=0.0001).The score of participants
with incomplete secondary education was 8.13 ± 3.24, however this score has increased to 8.32 ±
3.44 for those with complete secondary education and 10.08 ± 2.71 for those with higher education (p=0.0001). The majority of participants perceived COVID-19 pandemic as very dangerous. 69.8% of
the surveyed population has been able to prevent COVID-19 in the last 14 days.
This suggests that more than half of the population has a practice of preparedness of COVID-19: wearing a mask, keep
distance, and hygiene. 81.6% of the participants said that they use masks when going out, but most
of them use them incorrectly, which is reflected in the decrease in the frequency of people wearing
masks when shopping, public transportation and public transportation. Half of the respondents said
that in places where interpersonal space is regulated, they keeping distance. However, 2 out of 3
people cannot keep distance. According to the survey, 41.6% of the respondents used to wash their
hands regularly, 58% cleaned and disinfected, 67.0% avoided touching their eyes, nose and mouth
with dirty hands, and 76.6% using napkins and elbows when coughing and sneezing. COVID-19
prevention practices in the population were statistically significant in relation to their knowledge of
COVID-19.
Conclusion
Despite to 81.4 percent of the surveyed population reported they wear face masks outdoors,
quantitative and observational studies have shown that people wear face masks indoors relatively
for a long period of time and handle it incorrectly. Two out of three respondents were not following
social distancing guidelines at all. According to the survey result, good hygiene practices towards
COVID-19 prevention was insufficient such as not washing hands properly (58.4%), not possessing
hand sanitizer (42.1%), touching your eyes, nose and mouth with unwashed hands (22.1%), and not
covering your mouth and nose when you cough or sneeze (23.4%).
5.COVID-19 and quarantine
Nergui R ; Oyundari B ; Sainsanaa Kh ; Lkhagvagarav P ; Bayarjargal M ; Unursaikhan S
Mongolian Medical Sciences 2020;194(4):97-102
COVID-19 global pandemic is spreading rapidly between close contacts through respiratory droplets.
The most effective measures to combat and reduce infection outbreaks include social distancing,
movement restrictions, and health sector capacity building, as well as public health. Scientists
emphasize the importance of containing the number of positive cases without exceeding current
doctors and hospital resources. They concluded that quarantine, particularly complete lockdown is
effective in controlling the risk.
Furthermore, the mistakes reported during lockdown enforcement are the only measures to be taken
when the infection rate peaks. In the highest infection rate, the intensive care unit needs to increase
by 10 percent in only 24 hours if there is no lockdown. In China, complete and partial quarantines in
COVID-19 outbreak areas were effective in containing the infection transmission. Mongolia declared
a state of emergency and enforced quarantine on November 10, 2020, since the first positive case
was reported. Without the quarantine, the number of positive cases is estimated to be 3.2 times
higher.