Goal: To conduct mercury-based medical devises used in health care organizations and develop strategy and recommendations on futher activityMaterial and Methods:A cross-sectional study design was used. Totally 578 units of 38 governmental and private health care organizations inUlaanbaatar, Darkhan, Erdenet cities and Uvurkhangai aimags were conducted in the survey. The survey was conductedby means of a questionnaire given to the medical workers and doctors to complete. There were 3 parts of questions. Thefirst part of the questionnaire dealth with the use of mercury-based medical devices, working, transportation and storageconditions, and waste management. The second section was concerned with knowledge, attitude and practice (KAP) ofmedical personals for safety handling, storage and disposal of mercury containing devices. The third part of the questionnairedealth with the dental amalgam.Mercury concentration of dental amalgam samples were detected by portable mercury vapor analyser RP-91, PYRO-915+ in the Poison Information Center of Public Health Institute. Data processing was done by using statistical programSPSS-10.Conclusions:1. Mercury containing devices such as thermometer, blood pressure sphygmomanometer, energy saving fluorescencelamp and termostates were used in urban and rural hospitals. There are not any regulations for safe handling,storage, and transportation and disposal system of mercury containing divices.2. Knowledge on handling, storaging and disposing mercury based devices are not enough among the medical personals.The current situations for inapproiprate disposal system can be posed to increase riskes of environmentalpollution with mercury.3. Knowledge on health impact of spilled mercury from broken mercury based medical devices is not enoughamong the medical workers. Safety manual for handling, storage and disposal of mercury based medical devicesand promotion materials for health adverse effect and prevention methods have not been developed.4. 14.7% of the investigated dental hospitals and cabinets were used dental amalgam for treatment. Of these wasinvolved the fist stage hospitals. Dental amalgams were imported from China and Russia. Any special recommendationsand rules for safe use, storage and disposal of dental amalgam have not developed.

Abstract. This article refers to the management of adults with community acquired pneumonia (CAP) of all ages in the community or in hospital. Details of general investigations for patients managed in the community and for patients admitted to hospital, treatment in community, hospitals and in intensive care unit, follow up planning, empirical antibiotic choice, duration of antibiotic administration, failure to improve, the level of evidence of recommendations are given in the text and are summarized in figures and tables. Severity assessment is recommended as the key to planning appropriate management both in the community and in hospital. Certain adverse prognostic features have been associated with an increased risk of death and should be assessed in all patients. Patients who have two or more “core” adverse prognostic features are at high risk of death and should be managed as having severe pneumonia. Patients who display no adverse prognostic features can be managed as having non-severe pneumonia and may be suitable for outpatient treatment or early hospital discharge.

BACKGROUND:The mouse double minute 2 (MDM2) is a negative regulator of the p53 tumor suppressor protein.Overexpression of MDM2 is associated with poor survival and is a useful predictive factor for poor prognosisin various cancers in human. Studies revealed a genetic polymorphism located in intron 1 of the MDM2gene, MDM2-SNP309, (a change from T to G) is main functional polymorphism and important to developtumors. However, inconsistent associations between the MDM2-SNP309 and the risk or early onset ageof human different cancers have been reported worldwide. These conflicting results may have dependedon different patient subgroups and ethnicities studies. We studied the association of the MDM2-SNP309polymorphism andbladder cancer in Mongolian patients for the first time.OBJECTIVE:To investigate association between MDM2-SNP309 and the risk bladder cancer or early onset age of thecancer in Mongolian patients.MATERIALS AND METHODS:We genotyped MDM2-SNP309 in 44 patients with bladder cancer and 44 age and gender matched healthycontrols among Mongolian people.Genomic DNA was extracted from whole blood samples by the standardmethod of Qiagen mini blood DNA extraction kit (Qiagen Inc., Valencia, CA) and PCR amplification wasperformed using 100 ng genomic DNA template according to manufacturer’s protocol (Invitrogen, Carlsbad,CA). MDM2 SNP309 genotyping was carried out by restriction fragment length polymorphism assay.RESULTS: The allele frequencies of MDM2 SNP309 in the 44 bladder cancer patients were wild-type (T/T) 27.3%,homozygous (G/G) 34.1% and heterozygous (T/G) 38.6% whereas in the control cases were wild-type(T/T) 29.5%, homozygous (G/G) 20.5% and heterozygous (T/G) 50.0%. The proportion of homozygous(G/G) genotype was higher for bladder cancer cases than for healthy controls. Compared to the low-risk(wild type) genotype, an increased risk association with bladder cancer was shown for the GG genotype(OR=2.0, 95% CI=1.03-1.84). There is also a significant difference in median age onset of bladder cancerbetween GG low and high risk genotypes T/T and T/G (p=0,003)( p=0.0001), respectively (Figure2).CONCLUTION: The current sample data suggests that MDM2 SNP309 GG genotype may be associated withthe risk of bladder cancer as well as an earlier age onset in Mongolian patients with bladder cancer.

According to international medical organizations, the use of efferent therapy that COVID-19 convalescent plasma has shown some results.
Convalescent plasma that contains antibodies to severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2. This is being studied for administration to patients with COVID-19. Use of convalescent plasma has been studied in outbreak of other respiratory infections, including the 2003 SARS-CoV-1, the 2009-2010 H1N1 influenza virus, and the 2012 MERS-CoV.
Although promising, convalescent plasma has not yet been shown to be safety and efficacy of COVID-19 convalescent plasma in clinical trials.
Plasmapheresis and membrane plasmapheresis of efferent therapy has been used in clinical toxicology since 1995, in Mongolia.

Introduction: Cancer is a major public health issue both in Asia and in Mongolia. The most prevalent cancer related deaths in Mongolia are registered for the stomach, esophagus and liver. Purpose: We aimed to investigate the incidence of stomach and esophageal cancer in Mongolian population. Materials and Methods: Epidemiologic data were collected from 2009 to 2018 through the oncology cabinet of all hospitals and medical centers from all provinces, soums (the smallest unit of provinces) and major districts of the capital city. The incidence of stomach and esophageal cancer was calculated by appropriate methods and it was presented by ArcGIS Pro 9.2 software. A P-value of less than 0.05 was considered to be statistically significant and based on two side hypotheses. All calculations were performed in the IBM SPSS Statistics software. The study design in concordance with ethical guidelines was approved by the Ethics Committee of Ministry of Health Mongolia. All clinical investigations were conducted according to the principles laid down in the Declaration of Helsinki. Results: The incidence of esophageal cancer in last ten years (2009-2018) was 10.09 in 100000 populations and the highest incidence were registered in Uvs (38.13), Bayan-Ulgii (24.15) and Zavkhan (18.18) provinces, respectively. The incidence of stomach cancer was 20.33 in 100000 populations and the highest incidences were registered in Uvs (53.01), Khovd (46.02) and Darkhan-Uul (40.50) provinces, respectively. Conclusion
1. Incidence rates for esophageal and stomach cancer are high among the Mongolian population. In the last decade, the incidence of esophageal cancer had not decreased significantly, but it’s constant.
In our study, the esophageal cancer incidence was 10.09 per 100’000 people, which includes one of the high incidence rate countries according to the WHO classification. More than 10 aimags incidence rate of esophageal cancer was higher than the National average. Most of them have occurred in the western region of the country. Most of the Western, some of Khangai and Eastern soums have had the highest incidence of esophageal cancer what we have shown on the mapping.
2. The incidence rates of stomach cancer were registered as 20.33 per 100’000 people in the last 10 years at the national level. It has shown that according to the WHO classification, our country is also one of the countries with the highest incidence of stomach cancer. The stomach cancer incidence trend was increased in the last 10 decades. Therefore, some of aimag’s soums has included the highest rate classification. In addition, some soums in the Western, Khangai, and Eastern aimags had have a very high incidence of stomach cancer.
According to results in the above, the nationwide targeted prevention program is needed especially where the highest incidence rates. Also there is a lack of cooperation between national organizations to accurate registration of gastrointestinal cancer and to fight against these harmful cancers.

Background: The effect of lipopolysaccharide (LPS) on valproic acid (VPA)-induced cell death was examined by using mouse RAW 264.7 macrophage cells. Materials and methods, results: LPS inhibited the activation of caspase 3 and poly (ADP-ribose) polymerase (PARP) and prevented VPA-induced apoptosis. LPS inhibited VPA-induced p53 activation and pifithrin-α as a p53 inhibitor as well as LPS prevented VPA-induced apoptosis. LPS abolished the increase of Bax/Bcl-2 ratio, which is a critical indicator of p53-mediated mitochondrial damage, in response to VPA. The nuclear factor (NF)-κB inhibitors, Bay 11-7082 and parthenolide, abolished the preventive action of LPS on VPA-induced apoptosis. A series of toll-like receptor (TLR) ligands, Pam3CSK4, poly I:C, and CpG DNA as well as LPS prevented VPA-induced apoptosis. Conclusion Taken together, LPS was suggested to prevent VPA-induced apoptosis via activation of anti-apoptotic NF-κB and inhibition of pro-apoptotic p53 activation.

BACKGROUND: Toll like receptors (TLRs) are a class of proteins that key role in the innate immune system. TLR7 is expressed on monocytes, macrophages and dendritic cells, T cell, B cell and eosinophiles. TLR7, originally identified as recognizing imidaquinoline, loxibrine, broprimine and ssRNA, ssRNA viruses such as vesicular stomatitis virus, influenza A virus and human immunodefiency virus. It is known that virus ssRNA affects signaling molecule of IFN-y. Objective: To determine gene and protein activation of IFN-y signal transduction by TLR7 ligand in the endothelial cells. MATERIAL: In study we used mouse aortic linear endothelial cell which is cultured (END-D) in 5% heat- inactivated fetal calf serum (FCS), medium (DMEM) containing antibiotic mix(penicillin G, streptomycin, amphotericin B) at 37°C (5% CO2). Endothelial cells treated with synthetic IFN-γ and imiquimodligands, then the NO (nitric oxide) concentration in the supernatant is determined by Griess reagent. Endothelial cells are cultured in 6 well cell culture plate and in each well 2*104cells are expected to be grown for 24 hours of culture. Then, the cells are treated with synthetic IFN-γ and имиквимод ligand for 6 hours and the NO signaling gene activation iNOS mRNA expression which is induced by IFN-γ is determined by RT-qPCR. Endothelial cells are cultured in 12 well cell culture plate and in each well 2*104 cells are expected to be grown for 18 hours of culture. Then, the cells are treated with synthetic IFN-γ and imiquimodligands for 24 hours and the NO signaling protein iNOS expression which is induced by IFN-γ is determined by western blotting. The experiment was conducted as representation mean of at least three test results. The difference between statistical probabilities is determined by the “Students” t test. The p<0.01 value is assumed to be statistically different. RESULTS: TLR7 ligand imiquimodaugmented interferon gamma induced nitric oxide production TLR7 ligand imiquimodincreased interferon gamma induced iNOS mRNA gene expression. TLR7 ilgand imiquimodup-regulated interferon gamma induced iNOS protein expression. CONCLUSIONS: TLR7 ligand imiquimod augments IFN-γ signaling in the endothelial cells. This synergistic effect has revealed in the levels of gene and protein expression.

Introduction: The aim of this research project is to elucidate the crosstalk of innate and adaptive immune reactions against the DNA containing bacteria. : This study held in the Core laboratory, Science Technology Center, Mongolian National University of Medical Sciences (MNUMS). Murine aortal endothelial cells, END-D cultured and the cell viability checked by MTT assay. In addition, the NO production, protein and gene expression studied by Griess Reagent assay, R.T-PCR and immunoblotting, respectively. Results: 0.1µM, 1µM and 10µM of TLR9 ligand exhibited no cytotoxic action against the cells by MTT assay. IFN-ү alone induced NO production in END-D cells. In the other hand, TLR9 ligand at 0.1µM, 1µM and 10µM up-regulated IFN-ү induced NO production in dose dependent manner. RTPCR results exhibit that TLR9 ligand up regulates iNOS mRNA. Immunoblotting analysis showed the enhanced iNOS protein expression and phosphorylation of STAT1 in cells pre-treated with TLR9 ligand. Discussion: We have demonstrated CpG DNA, TLR9 ligand, up-regulates IFN-ү induced NO via enhanced IFN-ү signaling. The result of Western Blotting and RT-PCR support the up-regulation of NO. CpG DNA can be used as agent against virus and bacteria. Further research need to be conducted. Conclusion TLR9 ligand, CpG DNA up-regulates IFN-ү induced NO production in time and dose dependent manner. TLR9 ligand augments the expression of iNOS mRNA and STAT1 phosphorylation in response to IFN-ү.

Introduction: Valproic acid (VPA) has been used in the treatment of seizures and bipolar disorders. In the present study, we examined how VPA affected PI3K-Akt pathway in response to LPS by using mouse RAW 264.7 macrophage cells. Material and methods: Mouse RAW 264.7 macrophage-like cells cultured and the cell viability checked by MTT and TUNEL assay. In addition, protein expression and protein interaction were detected by immune blotting and immune precipitation, respectively. TLR4 expression on cell surface studied by FACS analysis. Results: The MTT and TUNEL assays demonstrated no significant difference between VPA at 2 mM treated and untreated control cells. VPA attenuated LPS-induced phosphorylation of phosphatidylinositol 3-kinase (PI3K) and Akt, but not nuclear factor (NF)-κB and mitogen activated protein kinases (MAPKs). There was no significant difference in the TLR4 expression on the cell surface between cells treated with or without VPA. VPA inhibited LPS-induced PI3K/Akt signal transduction in a dose dependent manner. Conclusion VPA at 2mM exhibits nontoxic effect in the RAW 264.7 cells. VPA down regulates LPS-induced phosphorylation of Akt via inhibition of PI3K activation.