Health expenditure towards mental health is only 2% of all other health expenditure allocated to public health. Currently almost 64% of all that fraction xpendituregoesto hospital based care. It means that there is lack of resources or limitation for development of community basedmental health services in this country, where hospital based mental health system is still remain in place. Long term chronic patients occupied most hospital beds are usually homeless, have no caregivers, no family protection or have a families that could not support their mentally ill members. Traditionally National Center for Mental Health has been offering community based rehabilitation scheme in form of developing labor skills but its coverage and accessibility remains short. In other words it is open for those who admitted to an inpatient service only.For last years the center has been forged partnership with international NGO namely AIFO in cooperation to gradually expand its works toward development of community based rehabilitation programs for people with mental health problems. Study basis is a current need for an expansion and coverage of mental health care and services and priority development of community based services over inpatient care.To asses a current situation of long term chronic patients admitted to inpatient service, their inclusion to CBR programs, expansion possibility of mental health servicesTotal 450 cases of history were registered in an inpatient care in 2013. 170 cases of them were belong to long term patients (1 and over years) with 94 male (55.3% )and 76 female (44.7%) patients. From perspective of age: adult (30-49 years old) consists of main percentage (66.4%)of long term patients. 64 (57.1%)of that age group patients have diagnosis of schizophrenia. Age group of 10-19 years old consists of 0.6% with mental retardation diagnosis. Research shows that long term patients mostly have affective disorders, organic psychosis, mental retardation and schizophrenia. Schizophrenic patients consist of most percentage (52.9%) of long termpatients. Inpatient stay duration spans from 1 to 36 years for long term patients and 17 patients of them have been on permanent basis at the center. These inpatient care users usually have been re-admitting after from 2 weeks to 1 month of duration breaks and they all suffer fromschizophrenia.Currently 170 patients out 450 or 1 in 3 admitted to inpatient service department at NCMH are chronic patients. 80.6% of those frequent users consist of labor intensive 20-49 year olds. Need to develop and conduct community based rehabilitation programs at primary, secondaryand tertiary level of public health services, include chronic patients and also need to set up a nursery for chronic mental health patients.

The pathogenesis of chronic obstructive pulmonary disease (COPD) encompasses a number of injurious processes, including an abnormal inflammatory response in the lungs to inhaled particles and gases. Other processes, such as failure to resolve inflammation, abnormal cell repair, apoptosis, abnormal cellular maintenance programs, extracellular matrix destruction (protease/antiprotease imbalance), and oxidative stress (oxidant/antioxidant imbalance) also have a role. The inflammatory responses to the inhalation of active and passive tobacco smoke and urban and rural air pollution are modified by genetic and epigenetic factors. The subsequent chronic inflammatory responses lead to mucus hypersecretion, airway remodeling, and alveolar destruction. This article provides an update on the cellular and molecular mechanisms of these processes in the pathogenesis of COPD. During the past decade a plethora of studies have unravelled the multiple roles of nitric oxide (NO) in airway physiology and pathophysiology. In the respiratory tract, NO is produced by a wide variety of cell types and is generated via oxidation ofL-arginine that is catalyzed by the enzyme NO synthase (NOS). NOS exist in three distinct are forms: neuronal NOS (nNOS), inducible NOS (iNOS), and endothelial NOS (eNOS). NO derived from the constitutive are forms of NOS (nNOS and eNOS) and other NO-adduct molecules (nitrosothiols) have been shown to be modulators of bronchomotor tone. On the other hand, NO derived from iNOS seems to be a proinflammatory mediator with immunomodulatory effects. Finally, the production of NO under oxidative stress conditions secondarily generates strong oxidizing agents (reactive nitrogen species) that may modulate the development of chronic inflammatory airway diseases and/or amplify the inflammatory response.

Introduction: Delayed or wrong diagnosis in patients with appendicitis can result in perforation and consequently increased morbidity and mortality. Serum total bilirubin may be a useful marker for appendiceal perforation. The aim of this study was to determine and compare pre-operative total bilirubin level and other diagnostic tools (patient age, duration of symptoms, Alvarado score, white blood cell, C-reactive protein, ultrasound and contrast enchanced CT scan) in cases of acute appendicitis in order to improve the clinical decision making. Materialsand methods: We identified 102 patient with acute appendicitis after excluding those with other causes of hyperbilirubinemia among the 180 patients that underwent a laparoscopic or an open appendectomy from June, 2011 to March, 2015 in UB Songdo Private Hospital. These cases were also subjected to liver function tests and clinical diagnosis was confirmed perioperatively and postoperatively by histopathological examination. According to histological results, these cases were classified two groups: positive(acute appendicitis with perforation and/or gangrene) and negative(acute appendicitis without perforation or gangrene). Their clinical and investigative data were compiled and analyzed. Statistical analysis was performed using independent sample t test, Chi square test, and direct logistic regression. The level of significance was set at P< 0.05. Results: Serum total bilirubin was found to be significantly increased(1,5mg/dL) in case of negative group and much higher (3,6mg/dL) in cases of positive group (P <0.001). The level of total bilirubin was higher than 3 mg/dL in cases of gangrenous/ perforated appendicitis while in cases with acute appendicitis it was lower than 3 mg/ dL. Also Alvarado score (P <0.01), C-reactive protein (P <0.001) and contrast enchanced CT scan (P <0.05) were statistically significant diagnostic tools for acute appendicitis. Conclusion: Assessment of preoperative total bilirubin is useful for the differential diagnosis of gangrenous/perforated appendicitis.

Mental health team includes a psychiatrist, a psychiatric nurse, psychologist and social workers. Mental health workers are more stressful than other sector’s workers. Mental workers are working with mental patients, who have chronic,severe and poor prognosis disorders for long time, and may have Work Burnout Syndrome (WBS). Worldwide, many researches are used Maslach Burnout Inventory (MBI) for assessing WBS. Our goal was to detect risk factors of WBS among mental health workers. We conducted the survey among workers mental (doctors, nurses and assistant nurses) and study design was a descriptive cross-sectional. We are used a questionnaire, is including MBI. Our subjects were 103 workers, who were 27 (26,2%) doctors, 32 (31,1%) nursesand 44 (42,75) nurse- assistant. They were 15 (14,6%) male and 88 (85,4%) female and average age was 38.21 (SD = 8.92). The worker’s average professional working year was 13.09 (SD = 9.76). Most of subjects (n=63 61.2%) were shift-workers and they (n=99 96.1%) have high workload. We determined 3 groups by level of MBS among mental workers, such as the group with EE’s high scale (n = 27; 27%), thegroup with DP’s high scale (n = 23; 22.8%) and the group with PA’s high scale (n = 50; 50.5%).MBS was high among NMHC’s workers. However their work time is low, but theyhave risk factors for MBI such as high workloads, shift work, number of patients. Workers of emergency department had termination burnout syndrome more than other acute departments. This was associated with working condition.

ObjectiveThis study aimed to assess the prevalence of the total aflatoxin in peanuts, and their concentration level.Material and MethodThis cross-sectional survey was conducted in seven district of Ulaanbaatar, the capital city of Mongolia,from March to December 2015.A total of 41 samples of peanuts were randomly collected from the survey area, from March to December2015. An ELISA test was used for detection the total aflatoxins(B1+B2). The relative humidity andtemperatures of the storage areas were measured at the time of sampling the peanut.ResultsThe Frequency statistics analysis showed that 61% of all analyzed peanut samples had detectablelevels of the total aflatoxinat 0.05 μg kg-1. The prevalence of samples contaminated with the totalaflatoxins(B1+B2) were higher among analysed samples of the tree nuts, peanuts imported from China,and canned nuts (P<=0.01). Levels of the total aflatoxins were less than the maximum permissible limitsof 15 μg kg by the regulation of European Union and worldwide. The mean values of the storage relativehumidityat the time of sampling peanuts were higher than the recommended storage relative humidity incorn cereals (<13%). Furthermore, the mean values of the storage temperatures at the time of samplingpeanuts were higher in groundnut peanuts, cedar’s nut and peanuts imported from China than therecommended level of the storage temperature in corn cereals (10°C-21°C).Conclusion:The prevalence of the total aflatoxin in peanuts was higher. The level of the total aflatoxins were less thanthe maximum permissible limits of 15 μg kg-1 by the regulation of European Union and worldwide. Thestorage relative humidity and temperatures of peanuts may encourage the growth of fungi-producingaflatoxins. Thus, a national strategy for the elimination of aflatoxin in foods is needed in Mongolia.

Introduction: Delayed or wrong diagnosisin patients with appendicitis can result inperforation and consequently increasedmorbidity and mortality. Serum total bilirubinmay be a useful marker for appendicealperforation. The aim of this study wasto determine and compare pre-operativetotal bilirubin level and other diagnostictools (patient age, duration of symptoms,Alvarado score, white blood cell, C-reactiveprotein, ultrasound and contrast enchancedCT scan) in cases of acute appendicitis inorder to improve the clinical decision making.Materialsand methods: We identified102 patient with acute appendicitis afterexcluding those with other causes ofhyperbilirubinemia among the 180 patientsthat underwent a laparoscopic or an openappendectomy from June, 2011 to March,2015 in UB Songdo Private Hospital.These cases were also subjected toliver function tests and clinical diagnosiswas confirmed perioperatively and postoperativelyby histopathological examination.According to histological results, these caseswere classified two groups: positive(acuteappendicitis with perforation and/organgrene) and negative(acute appendicitiswithout perforation or gangrene). Theirclinical and investigative data were compiledand analyzed. Statistical analysis wasperformed using independent sample t test,Chi square test, and direct logistic regression.The level of significance was set at P< 0.05.Results: Serum total bilirubin was foundto be significantly increased(1,5mg/dL) incase of negative group and much higher(3,6mg/dL) in cases of positive group (P<0.001). The level of total bilirubin washigher than 3 mg/dL in cases of gangrenous/perforated appendicitis while in cases withacute appendicitis it was lower than 3 mg/dL. Also Alvarado score (P <0.01), C-reactiveprotein (P <0.001) and contrast enchanced CTscan (P <0.05) were statistically significantdiagnostic tools for acute appendicitis.Conclusion: Assessment of preoperativetotal bilirubin is useful for the differentialdiagnosis of gangrenous/perforatedappendicitis.

Aflatoxins are the secondary metabolites of the fungi namely, Aspergillus flavus and A. parasiticus. They can colonize and contaminate grain before harvest or during storage. There are about twenty related secondary forms of aflatoxins, and subtypes B₁, B₂, G₁, G₂. These aflatoxins frequently contaminate the foods and feeds (Yu J et al, 2000, Imanaka BT et al, 2007). Aflatoxin B1, the most toxic, is a potent hepatocarcinogenic and genotoxigenic metabolites that have been classified as group I carcinogens by International Agency of Research on Cancer (International Agency for Research on cancer, 1993). Aflatoxin M1 is found in milk of lactating cows that have consumed feeds contaminated with aflatoxin B₁. Aflatoxin M₁ was originally classified as a Group 2B human carcinogen in 1993, but subsequent evidences of its cytotoxic, genotoxic and carcinogenic effects led to a new categorization of aflaoxin M1 as Group I (International Agency for Research on cancer, 2002). Aflatoxins can affect a wide range of commodities, including crops, cereals, oilseeds, spices, tree nuts, milk, meat, and dried fruit (Wilson DM et al, 1994, Bao L et al, 2010). Mongolia has been imported foods about 60 percent of food demands including wheat, flour, rice, milk, dairy products, peanuts and maize. This situation is required to study aflatoxin contamination in food in Mongolia. Epidemiological studies have found that dietary exposure to aflatoxin and chronic infection with hepatitis B, C virus are three major risk factors for HCC (Viviani et al. 1997; Hall et al. 2003). HCC as a result of chronic aflatoxin exposure has been well documented, presenting most often in persons with chronic hepatitis B virus (HBV) infection (Wild and Gong, 2010). The risk of liver cancer in individuals exposed to chronic HBV infection and aflatoxin is up to 30 times greater than the risk in individuals exposed to aflatoxin (Groopman et al., 2008). According to the WHO, the national liver cancer incidence rates was 54.1 per 100.000 population, the prevalence of HBV and HCV infection in 11.8%, 15.6% were respectively (J.Abarsanaa, 2012). This situation is a serous public health problem in Mongolia. Thus, we aimed to carry out the monitoring surveillance survey on the aflatoxin contamination level in some food.

Afl atoxins are a type of mycotoxin produced by Aspergillus species of fungi, such as A. fl avus andA.parasiticus. Afl atoxins are the most potent hepatocarcinogen and mutagen among mycotoxins.Afl atoxins can effects a wide range of commodities, including crops, cereals, peanuts, maize, beans,and milk and fruits. Thus, we carried out a monitoring surveillance survey on the afl atoxins level in somefood commodities. In early stage of this survey we tested a total of 112 samples of foods including fl our,rice, peanuts, maize, dried fruits, milk, and cereals. According to the preliminary results of this survey,59 (52.7%) samples of foods including fl our, rice, peanuts, maize, dried fruits, milk, and cereals’ sampleswere positive for a total afl atoxins (AFB1+AFB2+AFG1+AFG2). Although levels of total afl atoxins in allsamples were at permissible limits by the commission regulation of EU, the strategies for the preventionand control of mycotoxin are required in Public health system and Agricultural organization in Mongolia.Since afl atoxins is the most well-known mycotoxin ever thoroughly studied and its prevention and controlhas been most successfully practiced in various countries, therefore, this paper will focus on the strategyfor the prevention and control of afl atoxins’s mycotoxin contamination food in Mongolia.

This cross-sectional survey was conducted in seven district of the capital city Ulaanbaatar ofMongolia, and border post in Zamiin-Uud, and Altanbulag province from March to December 2015.A total of 380 samples including 70 flours, 114 rice’, 41 various peanuts, 15 maize and maizeproducts, 24 milks, 6 yoghurts, 39 beers, 27 dried fruits and 44 herbal teas were randomly collectedfrom supermarkets, hypermarkets, department stores, factories, and bazaars in Ulaanbaatar city,and Zamiin-Uud, and Altanbulag province.HPLC (High performance liquid chromatography), and enzyme-linked immunosorbent assay (ELISA)were used for the total aflatoxins (B1+B2) and aflatoxin M1 detection.The survey found that (148) 38.9% of all analysed food samples were contained aflatoxins (B1+B2),and aflatoxin M1 were ranging from 0.0094 μg kg-1to 2.4μg kg-1. The levels of aflatoxins (B1+B2)were below the maximum tolerance limit in EU and worldwide regulations. Mean concentrationlevel of aflatoxins (B1+B2) was 0.17 μg kg-1 in all positive samples. Mean daily low and high foodintake were respectively, 63 g and 245 g. Based on the daily food consumption data, estimatedexposure dose of aflatoxins (B1+B2) was 0.16734 mg kg-1bw day-1 in individuals with a daily low foodintake, and 0.65078 mg kg-1bw day-1 in individuals with a daily high food intake (95th percentile). Theexposure dose of aflatoxins from daily high food intake exceeds the estimated provisional maximumtolerable daily intakes, 0.4 μg kg-1 body weight day-1 for adults with hepatitis B (Kuiper-Goodman,1998). Furthermore, estimated excess cancer risk values to liver cancer incidence by ingestion ofthese foods for aflatoxins (B1+B2) and aflatoxin M1were calculated to be 0.0448 mg kg-1bw day-1forindividuals negative for hepatitis Band 1.344 mg kg-1bw day-1 for individuals positive for hepatitis B.Thus, the findings of our survey showed that the potential hazard associated with aflatoxin in foodin Mongolia has not been serious. However, most researchers suggested that no level of aflatoxinexposure is considered safe.Conclusion: Currently, the levels of the total aflatoxins and aflatoxin M1 were lower than the maximumpermissible levels in UE and the USFDA, and worldwide regulations. Currently, estimated exposuredose of the total aflatoxins and M1aflatoxin through daily high food intake was risked in populationwith hepatitis B virus. However, in Mongolian population has not been excess liver cancer risk.

Introduction: Nowadays people are restricting their use of chemical drugs as much as possible, creating a growing need for a systematic study of the use of herbal, animal and mineral medicines at a new level through traditional and innovative methods. Based on the study of traditional national technologies, it is important to study and apply in practice the drugs and pharmaceutical ingredients that contain the most modern scientific achievements including cardiovascular drugs, obtained from ancient rare scriptures. Research materials and methods: Data collected from the Clinical Department of Stress-Related Mental Disorders of the National Center for Mental Health was the primary source for this study. Secondary sources included statistics on the hospital’s website, internal reports of the organization, research related to health services, and legal documents. Research method: Serum cortisol levels were determined with a STATFAX-2100 ELISA (450 nm) according to the manufacturer’s specific methodology (www.melsin.com, Human Cortisol, ELISA KIT- CAT. NO:EKHU-0704).
The amount of cortisol in human serum was calculated as a linear quantitative assay by diluting 7.5 ug/L-90 ug/L in a standard working solution. Conclusion “Srog ‘dzin-5” has a clinical effect of reducing serum cortisol by an average of 27.3%. The statistic (p<0.01) is likely to increase this percentage depending on the time taken. Clinical observations have shown that “Srog ‘dzin-5” has pharmacological action against stress, depression and mental illness.