Healthcare is a rapidly growing industry as medical treatments become more sophisticated, more in demand due to increasing incidence of chronic disease and more widely available worldwide. As the amount of healthcare waste continues to increase, there is a need for further research in the field to meet the global demand for proper disposal of healthcare waste. The growing healthcare consumption, driven by various factors, is contributing to the rise in hospital waste, which in turn is putting pressure on current waste management systems.Currently, healthcare institutions manage waste by segregating at the source, safely transporting infectious waste, and disposing of it through incineration, autoclaving, or landfill methods. Both incineration and autoclaving processes have negative environmental and human health impacts. To reduce the amount of healthcare waste generated, it is necessary to train healthcare workers to properly segregate waste according to its type, following established standards.
Governments can take action to improve waste disposal practices, reduce the generation of infectious waste, and ensure that all types of healthcare waste are properly disposed of. This can include:
• Governments should have clear and standardized definitions for both infectious and non infectious healthcare waste, and enhance the regulatory and legal framework to prevent illegal disposal of waste.
• Healthcare institutions should be provided with incentives, financial support, and other measures to reduce hospital waste, with a particular focus on reducing infectious waste in local health institutions.
• Governments should provide research grants to support studies aimed at reducing and managing healthcare waste disposal effectively.
These measures would help improve the overall management and reduction of healthcare waste and ensure a safer and more sustainable approach to waste disposal.

Description: Due to the increased prevalence of penicillin-resistant bacteria in the treatment of staphylococcal infection in 1961 were introduced into clinical practice one of the semi-synthetic drugs resistant to penicillinase which calls methicillin. However immediately after this event has been reported it’s tolerance [1,2,3].
Methicillin-resistant staphylococcus (MRSA/MTSA) has been widely reported in the world and since the 1980s is now considered a highly contagious infection. MTSA infection and mortality rates are twice as high as methicillin-sensitive staphylococcal aureus infections and it caused to increase hospital bed costs [4,5]. Materials and methodology: The study included a sample of all samples submitted to the NCD for bacteriological analysis in 2018, 2019 and 2020.
Bacteriological specimens were obtained from swabs, wounds, urine, and throat swabs to identify and physically identify methicillin-resistant staphylococcus aureus. The research objectives were obtained from the NCD journal including all investigations from January 1 2018 to December 31, 2020 using the Descriptive Research Method. Results: In 2018, a total of 6419 bacteriological tests were performed with the growth of 4693 bacteria, in 2019 out of 7281 bacteriological tests were performed with the growth of 5485 bacteria, and in 2020 out of 8275 bacteriological tests were performed with the growth of 6894 bacteria.
The MTSA positeve tests accounted 269 (4.1%) bacteriological tests in 2018, in 2019 412 (5.6%) and in 2020 were, 781 (9.4%) from total bacteriological tests fot these years. Conclution The need for bacteriological testing is increasing year by year, which indicates an increase in bacterial infections. Also increased cases of MTSA are reported in the NCD during 2018-2020. The MTSA infections are more common in swabs and pustules.

BACKGROUND. The Dahl Concept refers to the relative axial tooth movement that is observed when a localized restorations are placed in supra-occlusion in dental hard tissue worn anterior area and posterior full arch occlusal contacts re-establishes over a period of time irrespective of age and gender. The literature reports that the objectives of the Dahl concept are achieved in the majority of cases (94%-100%). Some minor and transient adverse events, such as initial difficulty with mastication could develop. If dental arch is crowded and some of the teeth are pushed away, they tends to be pushed more even they were visually aligned by a heavy preparation under the ceramic restorations such as crowns and veneers. To avoid these costly and teeth-harmful treatment options for patients with anterior crowding and who wants straighter and beautiful looking teeth, we use a conservative approach of Align+Bleach+Bonding technique. MATEREALS AND METHOD. For tooth alignment we used Inman Aligner, Clear Aligner and Clear Smile Braces (fixed ceramic braces with super elastic Ni-Ti wires) or their combination. After short orthodontics a Dahl concept was applied to improve patients’ functional occlusion and anterior guidance. A “free-hand” and “no-any-drill” composite restoration technique was used to restore worn anterior teeth. For proper orthodontic diagnosis, assessment and treatment planning Spacewise analysis and Digital Caliper measurement were performed using models, their digital scans and intra/extraoral photos. We use Inman Orthodontic Lab in Florida for Inman Aligner fabrication and IAS Laboratory in London for Clear smile braces set up. Clear aligners (Scheu Dental, Germany) are planned and fabricated at the Digital Dental Office’s Clear Aligner certified laboratory. All treatments are start only after thorough diagnostic analysis, case discussion and acceptance from technical experts and orthodontists from UK, USA and Germany and acceptance of planned results from the patients. A course of home bleaching was then performed followed by resin bonding of anterior teeth edges to stabilize anterior guidance. RESULTS. More than 200 cases of upper and lower anterior crowding have been treated in comparably short period of time. From those we are introducing 3 different cases which were treated using above mentioned three appliances as an example. Average orthodontic treatment lasted 8-16 weeks depending on degree of crowding and type of appliances used. The arch crowding were less than 4 mm in all of them. No any teeth were extracted. After orthodontic treatment patients had double retentions (fixed+clear retainers). Dahl concept was performed in patients with anterior attrition and few patients experienced minor difficulty with chewing for their first week only. To control results of molar extrusion we measured space between occlusal surfaces of opposing molars in the SAM 3 articulator positioned in the centric relation. CONCLUSION. In order to get a long term proper stability of dento-facial function with a bonus of beautiful smile the concept of keeping own teeth and its structure became essential in cosmetic and restorative dentistry. The good thing of Dahl technique is its simplicity if it is done properly and its cost effectiveness. And as it was described the edge bonding itself could be a permanent retainer which prevents a future relapse in ortho-aligned teeth. Moreover patients were highly satisfied due to fast alignment, opportunity of keeping their teeth untouched and getting aesthetically pleasant result with a stable function.

Rationale: Effective healthcare starts with an accurate diagnosis, and laboratory plays an important role in this. All health laboratories, be it clinical, animal health, food safety, or environmental health laboratory, contribute to health care and public health security. Therefore, many public health programs are conducting laboratory assessments. The assessment findings can be used for identification of areas in which efforts should be directed in order to strengthen the national laboratory system and health laboratories. Goal: The goal of the project was to assess the national laboratory system and health laboratories of Mongolia. Methods and materials: Laboratory assessment tool (LAT) developed by WHO was used for the assessment of two areas: 1. strategic organization at the national level, and 2. specific technical capacities at the laboratories level. The national laboratory system was assessed using LAT System questionnaire with the participation of MOH officers, and the assessment of laboratories was conducted using LAT Facility questionnaire with the involvement of laboratories representing public and private sectors, all three levels of urban and rural health care organizations, and clinical and public health areas of laboratory services. Results: The strongest areas of the national laboratory system at the policy and regulatory level were “Coordination and management” and “Laboratory information system”. The weaker (below 75%) areas were “Structure and organizations”, “Regulations”, “Infrastructure” and “Human resources”. The insufficient infrastructure score was due to the lack of financing. The main problems detected in the area of Human resources were insufficient financial and organizational support of continuous education of laboratory workers, shortage of trained personnel and incomplete national registration system of laboratory professionals. The results of the laboratory capacities showed that the assessed laboratories were strong in “Data and information management”, “Specimen collection and handling” and “Consumables and reagents”. The testing performance of most laboratories was excellent but the external quality assurance was not available in some test disciplines. The weaker areas of the laboratories were “Facilities”, “Public health functions” and “Biorisk management”. The module “Organization and management” showed lower score mainly due to insufficient budget. The same was with “Facilities”. Although the general safety management of laboratories was very good, the biosafety component was not incorporated in it. Conclusions and recommendations: 1.A national regulatory body needs to be established for the registration of all laboratories and laboratory professional staff. 2.Each laboratory should formally designate an appropriately trained Quality manager, 3.Set-up a formal professional development/ continuous education system for laboratory professionals. 4.Develop biosafety policy and implementation plan. 5.Establish a comprehensive national laboratory information management system (LIMS).

IntroductionThe metabolic syndrome is a cluster of the most dangerous heart attack risk factors: diabetes andprediabetes, abdominal obesity, high cholesterol and high blood pressure. Also it is known as acluster of changes associated with resistance to insulin.There is a convincing evidence of important ethnic differences in the prevalence of metabolic syndrome,its components and sequelae. Estimates vary by country, but generally they show higher prevalenceof metabolic syndrome in non-European groups. Based on these findings, we were convinced inthe importance of studying the prevalence of metabolic syndrome and insulin resistance among thepopulation of Mongolia.Materials and MethodsThe main goal of our study was the determination of insulin level and insulin resistance in metabolicsyndrome exposed and non-exposed groups. We included 194 randomly selected people aged 20-60 years old; among them 51 had metabolic syndrome which was identified by the criteria of theInternational Diabetes Federation. All participants underwent general medical examinations andsigned a written consent paper. Fasting blood glucose, triglyceride, HDL, insulin levels were measuredin fasting blood serum and insulin resistance was calculated as a HOMA-IR model.ResultsAverage age of participants was 44,26±8,66 years, of whom 46,4% (n=90) were male, 53,6%(n=104)were female. By IDF criteria, 26,2% (n=51) of the participants had metabolic syndrome. Insulin levelwas 17,23±14,91μIu/mL in MS exposed group which was much higher than in the control group.Insulin, HOMA-IR, had direct correlation with the body mass, BMI and waist circumference andinverse correlation between HDL.Conclusions26.2% of the study participants had metabolic syndrome which was defined by IDF criteria. Insulin levelin the MS exposed group was 17,23±14,91μIu/mL, higher than in the control group by 7,53±2,21μIU/mL. Insulin, HOMA-IR, showed a direct correlation with the body mass, BMI and waist circumferenceand inverse correlation between HDL.

Rationale: Effective healthcare starts with an accurate diagnosis, and laboratory plays an important role in this. All health laboratories, be it clinical, animal health, food safety, or environmental health laboratory, contribute to health care and public health security. Therefore, many public health programs are conducting laboratory assessments. The assessment findings can be used for identification of areas in which efforts should be directed in order to strengthen the national laboratory system and health laboratories.Goal:The goal of the project was to assess the national laboratory system and health laboratories of Mongolia.Methods and materials:Laboratory assessment tool (LAT) developed by WHO was used for the assessment of two areas: 1. strategic organization at the national level, and 2. specific technical capacities at the laboratories level. The national laboratory system was assessed using LAT System questionnaire with the participation of MOH officers, and the assessment of laboratories was conducted using LAT Facility questionnaire with the involvement of laboratories representing public and private sectors, all three levels of urban and rural health care organizations, and clinical and public health areas of laboratory services. Results: The strongest areas of the national laboratory system at the policy and regulatory level were “Coordination and management” and “Laboratory information system”. The weaker (below 75%) areas were “Structure and organizations”, “Regulations”, “Infrastructure” and “Human resources”. The insufficient infrastructure score was due to the lack of financing. The main problems detected in the area of Human resources were insufficient financial and organizational support of continuous education of laboratory workers, shortage of trained personnel and incomplete national registration system of laboratory professionals.The results of the laboratory capacities showed that the assessed laboratories were strong in “Data and information management”, “Specimen collection and handling” and “Consumables and reagents”. The testing performance of most laboratories was excellent but the external quality assurance was not available in some test disciplines. The weaker areas of the laboratories were “Facilities”, “Public health functions” and “Biorisk management”. The module “Organization and management” showed lower score mainly due to insufficient budget. The same was with “Facilities”. Although the general safety management of laboratories was very good, the biosafety component was not incorporated in it.Conclusions and recommendations:1.A national regulatory body needs to be established for the registration of all laboratories and laboratory professional staff.2.Each laboratory should formally designate an appropriately trained Quality manager, 3.Set-up a formal professional development/ continuous education system for laboratory professionals. 4.Develop biosafety policy and implementation plan.5.Establish a comprehensive national laboratory information management system (LIMS).

Background:One of the soil pollution assessment criterions is bacterial contamination. Soil bacterial contamination has negative impact on water, air, food stuff, human health as well as soil biological activity and soil purification process. The soil of populated area is contaminated by animal and human solid and liquid wastes, dead plants and industrial and household drainage water. Soil becomes a source harboring and transmitting pathogens due to the fact that pathogens are transmitted to the soil by the wastes of patients, human and animal corpses (dead bodies) died of infectious diseases, plants and water. Since it is difficult to detect pathogens from outside environment, the level of soil bacterial contamination is determined by the way of detecting medically important group of bacteria such as E.coli, Cl.perfringens, Proteus and thermophilic bacteria. Aim:Our survey objective is to determine level of soil contamination of Ulaanbaatar, Erdenet, Darkhan city’s by using microbiological method. Results and Discussion:1.Microbiological characteristics of soil bacterial quantitative assessment of the cities surveyed in Ulaanbaatar, all soil samples, Darkhan city, 72.2% and Erdenet, 54.5% belong to higher contamination levels. In 2009, Ulaanbaatar the result of E.coli titer 0.004, anaerobic titer 0,001 and thermophilic bacterial number 28,8 x10 c/g revealed.2.Compared to the average Ulaanbaatar, Darkhan city colon E.coli average titer of 1.25 times and anaerobic-titer 2 times and thermophilic bacteria was less than 1.6 times the number of a city for these parameters 1.5 times and 2 times and 1.5 timesis low.

Background: Since life style of the nation has changed, the prevalence of T2DM has steadily increased. According to T2DM related studies, estimated number of people with diabetes is 80.000 in Mongolia. Despite this, total number of diabetic patients registered in Mongolia is only 7000. Thus, approximately 90% of people with diabetes are undiagnosed and untreated.Objective: to assess anthropometric and laboratory parameters of newly diagnosed patients with T2DM.Materials and Methods: It was cross sectional study included 133 patients with type 2 diabetes newly diagnosed at the district hospital of Ulaanbaatar. We measured height, weight and waist circumference and analyzed body fat by bio-impedance analyzer machine. Fasting blood glucose, HbA1c, triglyceride, HDL-C, LDL-C were determined by methods of laboratory in venous plasma. We defined as subjects with metabolic syndrome used the IDF new definition of 2009.Results: 44.4% of all participants were male and 55.6% were female and mean age of all participants was 49.1±8.5. According to BMI 85.7% of patients was obese and overweight and 84.2% of patients identified central obesity by measuring waist circumference. In analyzing of body composition, 100% of all patients determined high body fat. 27.1% of men and 36.4% of women diagnosed arterial hypertension. According to HbA1c (%) level the 94% of patients determined 7.5 and above. The hypertriglyceridemia was 59.4%, hyper LDL-C was 76.7% and hypo HDL-C was 12% and increased LDL: HDL ratio was 8.1%. The prevalence of metabolic syndrome among the newly diagnosed patients with T2DM was 69.6%, male 66.1% and female 72.9%. Conclusion: Obese is major risk factor for T2DM in Mongolia. The study shows that assessing body fat is major identifying method of obese (p<0.03) and statistically significant association of high body fat mass with WC in diabetic patients (p<0.05). The prevalence of several risk factors of DM complications among newly diagnosed patients with T2DM is higher.

Introduction. The high rate of malnutrition in young Mongolian children is a serious issue. Anemia, stunting and rickets have all been identified as significant problems. Low levels of serum folate have been reported among some young children in two previous surveys. Zinc is a growth-limiting micronutrient that may contribute to the persistent stunting in young Mongolian children. The traditional rice and wheat-based complementary foods used for young child feeding are likely to be inadequate in zinc. Certainly, the overall prevalence of stunting in Mongolia (i.e., 20%) is suggestive of substantial risk of zinc deficiency. It is possible that co-existing low selenium status may exacerbate zinc deficiency, because selenium compounds regulate the delivery of zinc from metallothioneine to zinc enzymes. To date, however, there have been no studies on the selenium and zinc status of the Mongolian population. Study objective. The objective of this study was to assess the biochemical indicators of micronutrient deficiency among 6-36 months old children. Subjects and methods. This cross-sectional study was conducted in four districts of Ulaanbaatar city and in centers of Bulgan, Bayanhongor, Dornod and Khovd aimags and included 243 (122 male and 121 female) apparently healthy children aged 6 to 36 months. Hemoglobin analysis was performed using a hemoglobinometer Hemocue AB, serum ferritin was analyzed by enzyme immunoassay technology, serum retinol by high-pressure liquid chromatography, serum zinc and selenium were analyzed by atomic absorption spectrophotometry and serum 25(OH)D analysis was performed using radioimmuno assay procedure. Results. Mean hemoglobin, serum ferritin, folate, 25(OH)D, retinol, zinc and selenium concentrations in children from Ulaanbaatar city and aimag centers were determined. Age-group differences for the means were significant for hemoglobin, serum ferritin, serum folate (p=0.001)and serum zinc(p=0.01). The differences between Ulaanbaatar and the aimag centers were also significant for hemoglobin, serum ferritin, serum zinc (p=0.05) and serum folate (p=0.001). 24.3% of the children were anemic. The prevalence of anemia was greater among the children in the aimag centers than in Ulaanbaatar city and in younger children than in the oldest age group. The prevalence of iron deficiency anemia was 15.3% and was independent of setting but was lowest in the oldest children aged 24 to 36 months. Of all the surveyed children, only 3.7% had low level of serum folate. The overall prevalence of low serum retinol levels indicative of vitamin A deficiency was 33.7%, with no differences by setting or age group. 74.7% of the children had low serum zinc concentrations. There was no significant difference in the prevalence between children living in Ulaanbaatar city and the aimag centers, or among the three age groups of children in either setting. The overall prevalence of low serum selenium concentrations was 57.7%, with no differences in the prevalence by setting or age-group. The prevalence of low serum levels of 25(OH)D was 61% and was highest among the children aged 6 to 12 months of Ulaanbaatar city. Conclusion: 1. Zinc deficiency had the highest prevalence (74.7%) among the surveyed children, followed by low serum selenium levels (57.7%). 2. 36% of the children were at risk of two and 64% of more than two coexisting micronutrient deficiencies. 3. There is a need for multi-micronutrient programs that take into account the potential interactions of micronutrients instead of the present single micronutrient based interventions on-going in Mongolia.