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.

Introduction Currently nations throughout the world are studying and disseminating their traditional medicine and Mongolians create new trend and attitude of medical care and service besides resuming their great heritage and culture of traditional medicine. World Health Organization recommends countries to develop their traditional medicine linking with modern science of medicine, based on particular surveys and analyses are conducted. However, the basic concept for developing Mongolian traditional medicine have been developed and implemented twice, “Government policy on Mongolian traditional medicine”, studies plan of united theory of traditional and modern medicines in master plan for developing Mongolian science and technology studies plan, “Master Plan for health sector” – the policy renovation for 2006-2015, “The frame of implementing master plan for health sector” (2006 2010) and other documents have been developing and implementing since 1990s but lack of studies on whether effective influences of traditional medicines to which stages and to which clinical symptom of dominated diseases among population and whether the traditional medical care meets with customers’ demand are considered as burning issues in determining the further development of traditional medicine. As well as, there are lots of issues that have not been studied and determined yet as diagnosis of traditional medicine, clinical and preventive guidelines and standards have not been developed, have not been involved in united system of health information, structural and operational management of institutions that hold traditional medical care and demands of medical care and professional staffs of traditional medicine. Aim of the study: To study and evaluate the current situation of Mongolian traditional medicine as well as determine trends in future. Purposes of the study: 1. To study the historical periods of the development of Mongolian traditional medicine that have been 01/01 developed since 1921 when health sector initiated in Mongolia. 2. To study Mongolian traditional medical service service by health care levels. 3. To study and to determine the human resource demand and capacity of medical care of traditional medicine. 4. To develop the management model of showing medical care of traditional medicine and health systems based on coherences of western and oriental medicines. Materials and methods This study observed the population criteria of patients who were treated in hospitals, hospital service levels, methods of diagnosis and treatment, common diagnose causes, types of treatment and the results of treatment in order to study the implementation of hospital service of Mongolian Traditional Medicine. The study was conducted in 3 different levels of hospitals: as a primary level hospital Umnudelger soum hospital, Khentii aimag /province/ was chosen, as a secondary level hospital we selected Center for Traditional Medicine of Khentii province, as a tertiary level hospital we chose the clinical hospital of Traditional Medicine, Science, Technology and Production Corporation (CHTMCST). We investigated aid and service information of Traditional Medicine obtained from 952 histories of patients who were treated in hospitals in 2006 and 2007. Analysis was made on policy documents by using analyzing and integrating related document. The study data were developed by making descriptive analysis on digital information, raising related hypothesis, checking it with statistical tests and processing in results. Research data was processed by Microsoft Excel 2007, statistical data was performed by SPSS-12.0 program and descriptive analysis was performed in quantitative information. Result By concluding the activities organized and implemented nationally on the field of traditional medicine for the period since 1921 when health system in Mongolia initiated, it could be considered to divide into stages as, beginning period of developing Mongolian traditional medicine in coexistence with modern health science (1921-1930), deprived period of Mongolian traditional medicine from national service (1930-1958), restoring period of developing Mongolian traditional medicine (1959-1999) and the ensured period of Mongolian traditional medicine as a composition of health science system (1999 up now). It was determined that the percentage of female patients is more than twice (2.3) higher (63.7%) in contrast with male patients (30.1) in all three-level hospital aid. It means in each level of three level hospitals female patients were more in number. Surprisingly, 80.9% of the patients’ age was over 35 and from them 44.7% was at their pension age. This age group is rapidly predominant compared with others. In chosen hospitals patients with diseases and disorders of digestive, urinary-genital, nervous and blood circulation systems are cured commonly. In three-level hospitals examining patients using methods of traditional medicine was differed (p=0.01). In doubled number, 401 or 42.1% of doctors combines both modern and traditional methods of treatment (95% trust limit 42.1+0.017). We investigated if types of treatment depend on the level of hospitals in urban and rural areas by x 2 criteria and concluded that it had statistical significance or the percentage of treatment types went up if the level increased (p

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.