Emergency cesarean section risk factors of Robson 1, 2A, 3, 4A Introduction: Cesarean section rates in Mongolia exceed WHO recommendations of 5–15%, reaching 27.6% nationally and 34.1% at the First Maternity Hospital between 2019–2023. C-sections, while life-saving, increase risks of hemorrhage, infection, uterine complications, and reduced maternal quality of life. This study aimed to analyze emergency C-sections by Robson classification and identify associated risk factors in groups 1, 2a, 3, and 4a. Material and methods: A retrospective case-control study was conducted using 886 medical records (443 emergency C-sections and 443 vaginal deliveries) from 2021–2023. Data were analyzed with IBM SPSS 24.0, and binary logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Results: Robson 2a was the most frequent category (43.8%), followed by 4a (25.7%), 1 (20.1%), and 3 (10.4%). Significant risk factors for emergency C-section included maternal age (p<0.001), early cervical dilation (<5 cm) at labor diagnosis (OR 3.54), abnormal CTG, pre-eclampsia, PROM, amniotomy, infertility, and malposition. Multivariate analysis showed PROM (aOR 14.66), amniotomy (aOR 6.85), fetal weight ≥4000 g (aOR 4.07), and maternal age (aOR 1.48) as key predictors. Conclusions: Emergency C-sections were most common in Robson group 2a. Major contributing factors included PROM, amniotomy, maternal age, macrosomia, and abnormal labor patterns. Targeted interventions to manage these risk factors could reduce unnecessary emergency C-sections.

S100 proteins regulate intracellular processes such as cell growth and motility, cell cycle regulation, transcription and differentiation. S100 proteins represent the largest subgroup in the EF-hand Ca²⁺ binding protein family. The S100 protein family consists of 24 members functionally distributed into three main subgroups: those that only exert intracellular regulatory effects, those with intracellular and extracellular functions and those which mainly exert extracellular regulatory effects.
Within cells, S100 proteins are involved in aspects of regulation of proliferation, differentiation, apoptosis, Ca²⁺ homeostasis, energy metabolism, inflammation and migration/invasion through interactions with a variety of target proteins including enzymes, cytoskeletal subunits, receptors, transcription factors and nucleic acids. S100 proteins have received increasing attention due to their close association with several human diseases including cardiomyopathy, neurodegenerative disorders and cancer. They have also been proven to be valuable in the diagnostic of these diseases, as predictive markers of improving clinical management, outcome and survival of patients and are considered having a potential as drug targets to improve therapies.

Background: However kidney transplantation has being performed in Mongolia since 2006, because of pre-transplant sensitization, ABO incompatibility, hepatitis B and C virus activation many patients are taken kidney transplantation in abroad. The transplantation centers use own immunosuppressive regimens. Objective: Our aim was to assess the immunosuppressive regimens efficacy and toxicity in kidney transplant Mongolian recipients. Methods: We analyzed data from 96 adult kidney transplant recipients who had taken kidney transplantation in different transplant centers from August 2006 through January 2014. There were 3 kinds of regimens Group I Simulect induction with standard triple /FK506/CyA+MMF/AZA+steroid/, Group II Campath-1H induction with CNI monotherapy and Group III Campath-1H induction with standard triple /FK506/CyA+MMF/AZA+steroid/. We retrospectively collected the post-transplant first two years serum creatinine. The study was performed in 2014. The questionnaire was taken and blood samples collected for determination of tacrolimus through level and for other laboratory tests. The primary end point was the first two years serum creatinine, the secondary end points included rejection episodes, blood through level of tacrolimus and some laboratory findings. Results: The post-transplant first two years serum creatinine levels were significantly different in 3 groups. Group III showed similar results compared to Group I. There was not enough data of biopsy proven acute rejection episodes however group II said more rejections occurred. However participants said that rejection occurred in 15 (15.6%) biopsy was done only 3 (3.1%) cases. Blood through level of tacrolimus was significantly different in three groups. Some laboratory findings showed different between three groups. Conclusions A regimen of Campath-1H induction with CNI monotherapy (Group II) may be advantageous for short-term renal function and cost effective but there were more rejection complications and increased creatinine. The regimen of Campath-1H induction 11 with standard triple (Group III) may be advantageous for long-term renal function, allograft survival, but there should consider about infection complications and polycythemia. Simulect induction with standard triple could be best choice but transplantations were performed in experienced centers. The study enrolled few cases and cases which were performed at the beginning of transplant program so many things could influence on the result. The study was compared beginner transplant center with experienced centers. Longitudinal cohort study needed in the future.

Background: Gynecological laparoscopic surgery requires pneumoperitoneum(PP) with CO₂ gas insufflation and Trendelenburg position. Pneumoperitoneum and Trendelenburg position may impact intraoperative respiratory mechanics in anesthetic management.The goal of this study was to evaluate the influence of Pneumoperitoneum and Trendelenburg position on respiratory mechanics and ventilation. Methods: Twenty one patients scheduled for elective gynecological laparoscopy were evaluated. The patients had no preexisting lung and heart disease or pathologic lung function. Conventional general anesthesia with thiopental sodium, fentanyl, аtracrium and isoflurane was administered. The peak inspiratory pressure, plateau pressure, and end-tidal CO₂ were compared before after creation of pneumoperitoneum with an intraabdominal pressure of 15 mmH₂O, then after PP10, PP20, PP30 minutes in the 20° Trendelenburg position, and after deflation of pneumoperitoneum. The dynamic lung compliance was calculated. Results: During of pneumoperitoneum, there were a significant increase in peak inspiratory pressure by 6 cmH₂O, plateau pressure by 5 cmH₂O, while dynamic lung compliance decreased by 11 ml/cmH₂O. General, the Trendelenburg position induced no significant hemodynamic and pulmonary changes. Conclusion The effects of pneumoperitoneum significantly reduced dynamic lung compliance and increased peak inspiratory and plateau pressures. The Tredelenburg position did not change these parameters. The end-tidal CO₂ significantly increased after pneumoperitoneum and CO₂ deflation.

BACKGROUND. When the body of musty and changed, a long time in the water can be difficult to identify soft tissue injury. For detecting hemorrhage in changed tissues we are using the method named after German doctor G.Lepchne, born in 1887. The method, based on the peroxidase activity of hemoglobin pigment. It is recommended to stain frozen slices.Erythrocytes and hemoglobin are colored in a dark brown color. Reagent: 2 ml 0.6% benzidine solution, 0.5 perhydrol, 4.5 ml of 70% ethyl alcohol Since 20148 we have been using the method in four cases. The result was useful for detecting injuries.

Introduction: Extracorporeal shockwave lithotripsy (ESWL) revolutionizedthe treatment of urolithiasis and graduallybecame the favorite treatment option sothat today it is considered to be the first lineof treatment for patients with urolithiasis.The purpose of this study was assessment oftherapeutic efficacy, complications of ESWLin urolithiasis in Mongolia.Material and methods: A total of46 patients harboring renal and ureteralstones underwent ESWL between March2016 and September 2016 at First CentralHospital of Mongolia. Karl Storz ModulithSLK electromagnetic machines were usedto impart shock waves. All collected stonefragments sent for biochemical analysis.Results: A total of 46 patients 23 weremales (50%). Patients were mean age of34. The stone size distribution was 0.5cmto 3.1cm. The average treatment time wasranging from 75-110 minutes. The averagenumber of shock waves per treatmentwas 3172±378 (range 1500-4000). Theoverall success rate was 75.73%. All calculidisintegrated satisfactorily except for 3stones, which is located lower 1/3rd ofureter. Stone composition analysis proved tobe composed entirely or predominantly ofcalcium oxalate monohydrate. These patientsrequired to have ureterolithoextraction. Calculicomposition for remaining patients 12 werecalcium oxalate monohydrate, 17 calciumoxalate dehydrate, 6 uric acid and 1 struvite.Complications were mostly minor and rare.Most of the patients (90.7%) developedmacroscopic hematuria after treatment; fewpatients developed mild bruising at the entryand exit sites of the shockwaves on the bodywall. Severe complications such as renalhematoma and steinstrasse were diagnosedfor one patient each and their managementwas non-surgical.Conclusion: ESWL is therefore the firstline treatment for urolithiasis with stonesize smaller than 2cm. It has an efficiencyrate above 75, low procedure time, highsafety and good tolerability and minimalcomplication.

Ilioinguinal (II) and iliohypogastric (IH) nerve blocks are often performed to provide intra- andpostoperative analgesia for hernia repair in children and adults. Several techniques are describedin the literature. Recently an ultrasound guided technique for II and IH nerve blocks were describedin the international journals. The block success rates are variable specially for using anatomicallandmark blind techniques. In the present study, the anatomical variations in course of the II andIH nerves are described. Knowledge of the course of these nerves in the inguinal region, and anunderstanding of variations seen in their topography, can decrease the incidence of postoperativecomplications and adverse effects. Ultrasound guidance of block performance will shorten the time,reduce the number of needle passes and shorten the block onset time. Blocks may be performedusing lower local anesthetic doses.

BackgroundThere are 137 soums of 17 provinces have plague foci in Mongolia. The 51.7% of them is case, 23.4%- low, 9.5% - high, 0.7% - hyper active. Main host of plague foci is marmot in Mongolia. According last20 year’s surveillance study, about 75.5% of Y.pestis was isolated from marmot, marmot carcassesand their flea. Human plague cases has been caused illegal hunting marmot in Mongolia. Even legaldocument which prohibited marmot hunting was appeared since 2005, people has been hunting marmotfor selling marmot meat, skin and other products. It is depends economy crises and other public issues inMongolia. Also influenced increase risk of human plague and being reverse result in plague preventionactivities.Materials and MethodsStudy was used data of rodent for zoonotic diseases suspicious which tested plague in National centerfor zoonotic disease (NCZD) in 2005-2015 and 13 local center for zoonotic diseases in 1988-2015. Datawas kept in NCZD and National archival authority. For mapping we used Arc View 3.2.ResultsTotally 397 event information of suspicious rodents and other animals was received in NCZD from 8 districtsof Ulaanbaatar city in 2002-2015. Most of information was received from Songinokhairkhan-64.2%district and smallest number was from Nalaikh district-0.3%. 92.2% of them were marmot, 0.1% of themwere marmot raw products for treatment purpose. Totally 1285 animal samples were tested by plaguedisease and the result was negative. Five hundred thirty tree marmots were carried to Ulaanbaatar from10 provinces. In that time plague foci were active and Y.pestis was isolated in provinces which marmotwas carried to Ulaanbaatar.In 1988-2015, totally 257 marmots and animals of 515 event information was received in15 provinces.Including 13.2% of them were birds, 84% of them marmot, 1.6% of them were livestock, 1.2% of themother animals. About 216 marmots were tested by plague. 51.2% of them were detected positive results.We develop conclusion based laboratory investigation result even it need high cost to take earlyprevention and response measures.Conclusion1. It is high risk to spread plague by carrying suspicious animal in urban area. Therefore, it is importantto take early response measures even it high cost. In further, increase cost and support rapid test ofhigh technology.2. To organize rational advertisement and increase knowledge of population about not doing illegalhunting, not selling marmot raw products in urban area, not using marmot raw products for treatmentuse and avoid contact with marmot carcasses.3. It is important to cooperate joint response measures with policeman, inspection agency andveterinary and human health sectors in Mongolia.

Thoracic surgery usually used for anesthesia double lumen endotracheal tubes, then ventilated one lung in NCC of Mongolia The clinical records of the 160 cases patients who had double-lumen endotracheal tubes to place in NCC of Mongolia. In patients during one lung anesthesia done 2012- 2014 were reviewed. All cases were performed high level thoracic epidural catheterization and put double lumen tube for jugular internal vena We are reporting 2012- 2014 anesthesia department at National Cancer Center of Mongolia. In our study involved all 160 open thoracic surgery cases with DLT. In study had anesthesia tidal volume 7.77+1.07ml/kg, one lung volume5.87+0.46 ml/kg, the Mongolian women DLT size 35.43+2.25Fr, deep 27.68+2.47 cm, Mongolian man DLT size 37.09+4.69cm, deep 28.43+2.6 cm. During anesthesia monitored average SpO2-95%+ 1.07,in analyzed arterial blood average SaO2- 92.65 %+ 5.69. (p<0.032) One lung anesthesia separating two lungs by double lumen tube (DLT) – the advantages of the method are allowing surgeons to operate safely in collapsed side of lung; there are a few reports of airway damages. The bronchoscope procedure is in need to use during the all operations in Mongolia. Other types of separation tube are required to be (especially in children) introduced. In the future lungs, esophagus, mediastinal tumors and heart, spine and vascular surgery need double lumen tube to global standards anesthesia widely available in Mongolia. The thoracic anesthesia use double lumen tube outside the epidural anesthesia decided that it can be combined with postoperative pain control. Correct technique of placing the double lumen tube one lung anesthesia surgical team and the shortness of time and the surgical risk patients with post-surgical complications and reduce mortality is of high importance in Mongolia. In our study is a dominant decided that it was linked to smoking habits

The aim of this study was to evaluate of analgesic effect of ultrasound guided transversus abdomines plane block in children undergoing open appendectomy surgery and compare to children were used GA alone.Twenty children aged 5-15 years with ASA I-II classification were randomly enrolled in this study.Each group had 10 children and all children were received GA with same techniques. Study group(transversus abdomines plane block group) were assigned to receive ultrasound guided block using 0.3 ml/kg of Bupivacaine 0.25%. Intraoperative hemodynamic changes, postoperative maximum pain score, the time the first analgesic requirement, correllation between inflammatory process, surgical disease complication and pain intensity were studied. Statistic analysis was made in Excel usingdescriptive analysis, correlation and regressive analysis. A p-value<0.05 was considered significant.There was no differencies between the two studied groups regarding demographic and clinicalcharacteristics. Intraoperative systolic blood pressure changes was higher in control group than studygroup (17%), and HR and BP were more stable in the study group. Level of WBC had direct positive relationship with appendix inflammation (r=0.71 (p-утга <0.001) and weak positive correlation (r=0.44 p-утга <0.05) with pain intensity. Postoperative pain score was higher in control group and the first analgesic requirement time was 2h. In the study group had mild to moderate pain and the the firstanalgesic requirement time was 4h.Transversus abdomines plane block under ultrasound guidance was easy, safe, reliable and effective analgesic in children undergoing open appendectomy surgery.