Background: Accreditation of healthcare institutions serves as a fundamental mechanism for ensuring patient safety and validating the quality of medical services provided to the population. At Intermed Hospital, a quality measurement system for healthcare services has been established since 2015, encompassing 126 quality indicators at both institutional and departmental levels. This system facilitates continuous quality improvement efforts. In this context, quality indicators specific to the endoscopy department play a pivotal role in objectively assessing the quality of endoscopic services. Aim: To assess the quality indicators in gastrointestinal endoscopy unit. Materials and Methods: A retrospective single-center study was conducted by collecting data from the Intermed hospital’s electronic information systems which included HIS and PACS and Quality and Safety Department’s Database and the results were processed using the SPSS software. Ethical approval was granted by the Intermed hospital’s Scientific research committee. The quality of endoscopic services in the Intermed hospital was assessed based on: a) the average values of four quality indicators measured monthly; b) sample survey data from five categories of quality indicators. Results : Between 2016 and 2024, the quality indicators of the endoscopy unit measured as the level of early warning score evaluations for patients was 95.97%±3.33, the level of cases where peripheral blood oxygen saturation decreased during sedation was 1.54%±3.78, the level of cases where patients experienced paradoxiical response during sedation was 5.82%±1.75, surveillance culturing level for validation of endoscopy reprocessing was 11.6%. The endoscopic documentation quality by peer review showed 95.7-100%, the colonoscopy quality indicators were followings as adenoma detection rate: 24.5% Cecal intubation rate: 99.1%, 95.2%, Colonoscope withdrawal average time: 13.28±10.62 minutes, Bowel preparation quality (Boston Scale): 89.3% 95.7%), patient discharge from the recovery room, Average discharge time post-procedure: With propofol alone: 30.92 minutes; With propofol and fentanyl combined: 31.52 minutes, The intermediate risk was 0.28% by the TROOPS evaluation during procedural sedation. Conclusion The quality benchmark levels for these endoscopic units, as determined by a single-center study, can be effectively implemented by benchmark endoscopy centers to enhance their quality and safety operations.

Background: Saponins are secondary metabolites in plants that play an important role in defense mechanisms and physiological processes. Since stomatal cells are crucial for gas exchange and water balance in plant tissues, studying the anatomical and biochemical features of stomatal cells in saponin-rich plant species provides insight into the interactions between these compounds and cellular mechanisms. This serves as the basis of our study. Aim: To determine the structure, types, and functions of stomatal cells in saponin-containing medicinal plants Materials and Methods: During June–September 2024, nine species of saponin-containing medicinal plants were collected from Bulgan, Tuv provinces, and “Gorkhi-Terelj National Park” in Mongolia. Prepared microscopic specimens were examined using macroscopic and microscopic techniques to study the structure, position, number, and epidermal features of stomatal cells. Results: The study revealed that Anemone crinita Juz. exhibited the highest stomatal density (107 stomata/mm²) and epidermal cell density (229 cells/mm²), indicating strong adaptation and protective capacity in arid conditions. Vicia baicalensis (Turcz.) B. Fedtsch. showed the highest stomatal index (39.6), highlighting its significant role in regulating transpiration. Stomatal types varied among species: • Anomocytic stomata were observed in Potentilla multifida and Vicia baicalensis. • Anisocytic stomata were found in Delphinium grandiflorum and Ranunculus borealis. • Paracytic stomata were present in Gentiana algida, Adenophora remotiflora, Helianthemum nummularium, Anemone crinita, and Ranunculus acris. Conclution In the study of the structure, form, and number of stomatal cells in saponin-containing plants growing in Mongolia, Anemone crinita Juz. was found to have the highest number of stomatal and epidermal cells, indicating its high efficiency in gas exchange, water regulation, and protection against external stress. Furthermore, Vicia baicalensis (Turcz.) B.Fedtsch. showed the highest stomatal index, confirming its strong capacity for active regulation of gas exchange. The variation in stomatal cell types among plant species was identified as playing an important role in ecological and biological adaptation as well as protective mechanisms.

Clinical characteristics differences and risk factors of coronavirus disease and influenza in children 0-18 years Background: In worldwide, 176190 children infected with SARS-CoV-2 during April of 2020. According 01/09/2021, 46019 children had diagnosed with COVID-19 in Mongolia, were 19.5% of all cases. During COVID-19 infection, respiratory and digestive symptoms were commonly presented in children. Although the symptoms of coronavirus disease in children and adults are similar, in general, it was relatively mildly than adults, but from clinical observations reported that the infection occurs more severely in children and leads to death. During the coronavirus pandemic, it has been reported that children have Kawasaki syndrome, cardiac myopathy, coronary artery changes, and digestive system problems. Cardiac dysfunction in children may have recovered without sequelae, and further long-term follow-up studies are necessary. We aimed study clinical characteristics differences and risk factors of coronavirus disease and influenza in children 0-18 years. Materials and methods: The study was conducted Children hospital of NCMCH from October 01, 2021 to April 01, 2022, participated 594 inpatients with COVID-19 and influenza, and studied clinical characteristics, laboratory and functional diagnostic changes, treatment, and complications of the coronavirus disease and influenza. Results: The study included 450 children aged 0-18 years with confirmed COVID-19 infection and 144 children with influenza. In social-demographic indicators, the mean age of children is 4±4.8 years, and 58.6% are male. Children age group included 0-4 ages, 5-9 ages, 10-15 ages and over 15 ages (62.4%, 17.5%, 16.2%, and 3.7%), respectively. As for influenza, 39.7% were children aged 0-9. In 8 cases, they received the COVID-19 vaccine but became ill with COVID-19. As for the variants of COVID-19 infection, 231(41.8%) alpha, 219(48.0%) delta, and 144(24.2%) influenza according to the wave period and clinical differentiation. In severity of diseases, 2(0.4%) were mild, 312(69.3%) were moderate, 117(26.0%) were severe, and 17(3.8%) were critical severe. There is a statistically significant difference in the severity of the disease between COVID-19 and influenza. 1 death (0.4%) occurred in cases of COVID-19. The mean days of inpatients with COVID-19 was 12.4±5.5 and mean days of inpatients with influenza 8.6±3.64. When assess signs of children, fever, cough and food aversion were main signs among both group of alpha and delta varientin COVID-19. Specifically, 67.3% had fever, 63.3% cough, 16.4% runny nose, 8% chest pain, 10.2% headache, 15.5% fatigue, and 0.9% decreased sense of taste and smell. There is a statistically significant difference (p<0.000) in the symptoms of cough, chest pain, general toxication symptoms and decreased sense of taste and smell in the case of COVID-19 and influenza. During influenza, symptoms of chest tightness and respiratory distress were observed in 10 (7.4%) children during severe illness. 0.5% of all cases of COVID-19 with sinus arrhythmia, and atrioventricular block were detected 0.9% of all cases by electrocardiogram analysis. When studying the underlying medical conditions of children in relation to the complications of COVID-19 and influenza, children diagnosed with heart defects, malnutrition, weakness, anemia, cerebral palsy, and other chronic diseases have a greater impact on the severity of the disease of COVID-19 than those with influenza. In the study of the factors affecting the severity of the COVID-19 infection, the child's age and gender did not have an effect, while the presence of a heart defect in the child increased the risk of complications by 5 times (p<0.001). Conclusions: Among 0-4 aged children with COVID-19 are occurred more hospitalization, brightly presented symptoms in children with chronic diseases, are being more severe and hospitalization days are more than in children with influenza. Symptoms of fever, cough, and runny nose are more common in children during flu and influenza, while headache, abdominal pain, dehydration, and reduced sense of taste and smell are significantly more common in the case of COVID-19. On the other hand, symptoms of chest pain, weakness, and fatigue were found in the 2 groups. The comorbidities (congenital cardiac anomalies, malnutrition, weakness, anemia, cerebral palsy, and other chronic diseases) are being risk factors for the severity of coronavirus disease.

The study of clinical and epidemiological characteristics of coronavirus infection in children ages 0-18 Introductions: The coronavirus disease (COVID-19) has been spreading in Wuhan, Hebei Province, China since late 2019, and was declared a pandemic by the World Health Organization on March 11, 2020. Since the outbreak of the pandemic, the SARS-CoV-2 virus has been constantly mutating, and several new variants have emerged, dominating the world. These variants are characterized by differences in transmission, toxicity, and pathogenicity. Due to the lack of research on pediatric COVID-19 in Mongolia. Our goal was to study the symptoms and severity of children with COVID-19 and to compare clinical characteristics between Alpha and Delta of SARS-CoV-2 occurred in children. Material and methods: Clinical characteristics, laboratory and diagnostic test results of 450 children aged 0-18 years, confirmed by laboratory tests from March 30, 2021 to December 1, 2022 in the Isolation Department of COVID-19 infected children of the NCMCH, treatment and complications were studied retrospectively. Result: The study involved 450 children aged 0-18 years with laboratory-confirmed COVID-19 infection. According to the demographic variables, 263 (58.4%) boys and 189 (41.6%) girls. In terms of age group, 62.4% were aged 0-4 years, 17.5% were aged 5-9 years, 16.2% were aged 10-15 years, and 3.7% were children over 15 years old. Of these children, 231 (51.3%) were clinically confirm signs of alpha and 219 (48.7%) delta variant. In 8 cases, COVID-19 was vaccinated but became infected. Clinical features of alpha-type physical examination were 117 (51.6%), pale face and paleness (29.6%), and respiratory distress (40.0.0%). Clinical features of delta-variant bruising, pallor, and chest depression were predominant on physical examination. Conclusion: COVID-19 In children with alpha and delta variants, the most common symptoms of respiratory viral infections, such as fever and cough, were respiratory distress in alpha variant and respiratory and circulatory abnormalities signs in delta variant.

Background. Nowadays more attention is paid to the study of blood supply of the brain in during headache with various causes. Blood supply of the branch is supplied by 2 pairs of carotis and vertebral artery and 2/3 of it in the carotis and 1/3 of it by the vertebral artery. (Farekas et al., 1963) disease with various causes of the vertebral artery in the external part of the cranium or abnormal system have been studied from ancient un the external part of the cranium, lengthening, aplasia and hypoplasia, change of neck vertebra disk affect to dynamic change of back artery blood supply. By scholar maisel fold of vertebral artery is 40%. Stenoses-18%, hypoplasia-10% vertebral artery through c 3-c5 vertebra occurred 12-20%., abnormal system of vertebral artery and location occur more than carotis artery and it has more dependence on external part of the cranium. Study of disease of vertebral artery in the external part of the cranium by the method of angiography hasnt been done in our country. Aim of research work: We aimed at diagnosing disease of vertebral artery in the external part by the method of angiography and studying its form, case, age and sex dependence. Conclusion: 1. Change of vertebral artery revealed 62.3% 2. Fold of vertebral artery in the 6th level 42% in v2, 3 level -9% revealed. 3. Vertebral artery is congenitally narrow (aplasia, hypoplasia)12%., through v3-5, vertebra-13%. 4. 58% of the people with vertebral artery disease occupy females.

Background. In the process of infarction, important mechanism of blood supply deficiency is collateral blood supply. There are a lot of various collaterals which are able to supply in the period of necessity of human brain. Collateral which forms in the level of villas circle (ring) in the cranium is the most important front and back artery cord of brain form villas circle (ligament) as a result of these arteries possibility of forming collateral blood supply in the period of blood insufficiency in vertebral and carotis and between magisterial artery of 2 sides of brain opens. It is rare when the system of villas circle (ring) is complete (full), artery cord is narrow (hypoplasia, aplasia) or none, villas circle(ring) loses its complete and it becomes open on the front and at the back part. By the researchers study hypoplasia of artery cord occurs in 20-40% because it branches off from other artery. By Yu.M. Nixitins study vertebral artery of the brain branches off the form the artery into carotis and it open at back part-was 25%, study of system of villas circle (ring) by angiography hasnt been done. Aim. We aimed at the diagnosing villas circle system by angiographic method and studying its incompleteness, form cause, age and sex dependence. Materials and Methods. We studied material of 595 patients who were done angiography of the brain because of acute and chronic deficiency of blood supply of the brain in 2007-2008 at the third clinical hospital by P.N.Shastin in the cabinet of angiography came from clinic, district and Achtan Elit hospital. We clarified magisterial arteries and villas circles in the cranium by the standard method in 2 sides used polydiagnostic 2 digital subtraction equipment of Philips form of Japan. We evaluated artery system, location, form and size and studied age and sex dependence.75% of verographer solution not more than 80-100ml was injected into the artery. Conclusion: 1. Incompleteness of circle revealed in 31.7 % 2. Open case of villas circle in the front part was in 41.5 % 3. Open case of villas circle at the back revealed in 58.4% 4. Studying villas circle, evaluating collateral blood supply is necessary to blood supply deficiency in particular to define blood deficiency insult.

Background. Disease of vertebralis and insufficiency of blood supply occur not a few, it decreases lab our ability much, complaints such as: headache, to feel giddy, to blur eyes, fatigue heartache, neck becomes stiff and unbalance reveal. By some researches study 25-30% of blood supply insufficiency of cranium occupies artery disease 65% of vertebral artery insufficiency occupies disease of external part of cranium we have introduced duplex sonography method by using medison Pico-ACE apparatus since 2006 and it gave possibility of revealing artery disease of external cranium. The most causes of artery disease occupy congenital and acquired deficiency such as: aplasia, hypoplasia and vertebra skin. Revealing and diagnosing these disease early is the confronted problem of society and health and it attracts attention of doctors and specialists of angioneurological branch. Aim of research work: We aimed at the study of diagnosing disease of artery of vertebral of external part of cranium by the method of duplex-sonography and studying dependence of type, size, form, case, age and sex. Materials and Methods. We did the study on 100 people who was done duplexsonographic diagnose because of blood supply insufficiency of cranium in the centre of diagnose of private structure Best Ema. We did analyse of DSG by using MedisonPicoACE apparatus by the stand and method, divided them into 6 groups in 10 age and studied type, size, location speed of stream, age and sex. Conclusion: 1. By duplex-sonography, in 18% hypoplasia of vertebral artery revealed, in 88.8% of it hemo-dynastic change revealed. 2. In 24% of patients involved in the study artery fold revealed, in 62.5 hemo-dynastic change revealed. 3. The main method of analyze which reveals location, size and dynamic and diagnosis vertebral artery of external part of cranium is DSG.