Background: Studies from other countries have identified multiple contributing factors to renal cell carcinoma (RCC). We conducted this study to investigate the relationship between RCC and certain risk factors among the Mongolian population. Aim: To identify the risk factors for renal cell carcinoma in Mongolian individuals. Material and Methods: This case-control study included 88 patients diagnosed with RCC (confirmed by pathological examination) in the case group. The control group consisted of 88 healthy individuals matched by age and gender. A case-control study design was used. Binary logistic regression analysis was conducted on the questionnaire results from both groups to identify risk factors for RCC through both univariate and multivariate regression analysis. Results: A total of 176 participants were included in the study-88 with RCC and 88 without cancer. Statistically significant associations with RCC were found for hypertension, urinary tract diseases, alcohol consumption, and smoking. Although weight gain appeared to increase the risk for RCC, this was not statistically significant. Conclusion Individuals with hypertension, a history of urinary tract diseases, smokers, and alcohol users are at a higher risk of developing renal cell carcinoma.

Background: Among the total healthcare waste generated from health-related activities, 10–20% is considered haz ardous, posing significant threats to both the environment and human health. Approximately 3% of healthcare waste is pharmaceutical waste. In Ulaanbaatar city, an estimated 2.65 tons of healthcare waste is generated daily (0.78 tons of medical waste and 1.87 tons of general waste). With the continuous increase in pharmaceutical consumption, the improper disposal of pharmaceutical waste has emerged as a major environmental concern, adversely affecting nature, animals, and the food chain. Contamination from pharmaceutical waste, such as the development of antibiotic resistance, is closely linked to inadequate public awareness of waste management. Aim: This study aimed to assess the knowledge, skills, and attitudes of pharmacy technicians in community pharmacies regarding pharmaceutical waste management. Materials and Methods: A cross-sectional survey was conducted among pharmacy technicians across Mongolia. As of 2023, there are 4,959 licensed pharmacy professionals in the country. Using a representative sampling method, data were collected from 360 pharmacist and pharmacy technicians. Data were analyzed using MS Excel and SPSS version 26. Results: A total of 360 pharmacists from both urban and rural areas participated in the study. The assessment was based on a 5-point Likert scale, with scores of 1-2 considered negative and 3–5 considered positive. The average scores for knowledge, skills, and attitudes were 3.3, 3.06, and 3.25 respectively. While individual scores were satisfactory, the results of questions targeting social awareness were relatively low. Conclusion The knowledge, skills, and attitudes of pharmacy technicians regarding pharmaceutical waste management were found to be satisfactory. However, to further improve knowledge levels, it is recommended to implement additional training programs related to pharmaceutical waste management among pharmacy technicians.

Background: Community pharmacies are accessible healthcare institutions that offer services without the need for appointments or prepayment. In recent years, the scope of pharmacist responsibilities has expanded from merely dispensing medications and medical devices to providing patient-centered pharmaceutical care, health promotion, and disease prevention. As a result, pharmacists are increasingly confronted with ethical challenges in their daily practice. Aim: To identify the ethical issues faced by pharmacists working in community pharmacies in Ulaanbaatar, Mongolia. Materials and Methods: A cross-sectional survey was conducted between March and September 2024 among pharmacists working in community pharmacies in Ulaanbaatar. Participants included 374 pharmacists who had been working for at least three months, held valid professional licenses, and voluntarily agreed to participate. A structured questionnaire was used to collect data. Descriptive statistics were analyzed using SPSS version 25.0. Results: Among the respondents, 339 (90.4%) were female, 301 (80.48%) were pharmacists, and 230 (61.5%) were under 30 years old. Additionally, 214 (57.2%) had worked in a community pharmacy for less than five years. Open-ended responses were coded into three major categories and 15 subcategories: (1) pharmacy management and organization, (2) compliance with laws and regulations, and (3) professional communication with clients. The most frequently reported ethical issues were: Customers demanding prescription-only medications without a valid prescription (56.6%), Negative or inappropriate client behavior (27.5%), Attempts to use expired or invalid prescriptions (14%) Conclusion 1. A total of 56.1% of pharmacists demonstrated insufficient knowledge of the Code of Ethics for healthcare professionals, which is essential for their professional practice. 2. Among pharmacists, 54.5% showed a negative attitude, and 48.9% exhibited inappropriate practices when faced with certain ethical situations. 3. The most common ethical challenges faced by pharmacists include: Requests from clients to dispense prescription-only medicines without a valid prescription (56.6%), Unethical or inappropriate behavior from clients (27.5%), Attempts to obtain medicines using invalid prescriptions (14%).

Background: Medical experts in pharmacies are the most accessible health professionals and play a key role in primary health care. They must strike a balance between their autonomy, the objectives of the company, and professional standards, while facing a lot of ethical dilemmas. This phenomenon can impact the quality of pharmaceutical care, as highlighted in several studies. Numerous studies have been carried out internationally to explore the medical ethics knowledge of pharmacists working in community pharmacies, their attitudes towards emerging ethical issues, and identification of their common problems. However, research in this area is scarce in Mongolia, which serves as the basis for conducting this study. Aim: Assessing the knowledge, attitudes, and practices of pharmacists regarding professional ethics in community pharmacies in Ulaanbaatar city. Materials and Methods: This study was conducted using an analytical cross-sectional study design and included 374 pharmacists who had been working in community pharmacies in Ulaanbaatar for more than three months, had a valid professional license, and consented to participate in the study between March and September 2024 (ethical approval number 2024/3-01). To determine the degree of knowledge, attitude, and practice, a questionnaire including 39 closed questions and 4 groups was used to gather survey data. For statistical analysis, SPSS-25 software was utilized. Results: Of those who took part, 301 (80.48%) were pharmacists, 73 (19.52%) were pharmacy technicians, and 339 (90.4%) were women. Additionally, 259 (69.3%) work in secondary pharmacies, and 305 (81.6%) have received ethics training. The study shows that 56.1% of pharmacists had insufficient knowledge of professional ethics, 54.5% had poor attitudes towards ethical issues, and 48.9% had inappropriate practices. When analyzed in relation to their profession, the ethical knowledge of pharmacists did not differ by profession, age, years of experience in community pharmacies, professional degree, and university graduated, but it was statistically significantly correlated with the participants’ self-assessed ethical knowledge (CL 95%, p=0.0001). Conclusions 1. The knowledge of professional ethical principles and standards is insufficient among pharmacists. 2. While handling emerging ethical issues, they have a negative attitudes and inappropriate practices. Consequently, it is compulsory to intensify training on the ethical code of conduct for medical experts s based on the needs of pharmaceutical professionals.

Background: Hospitalization consumes a large proportion of healthcare financing, and reducing avoidable admissions is critical for optimizing resource use. Objective: To determine the level of hospital admissions due to Ambulatory Care Sensitive Conditions (ACSCs) in Mongolia. Methods: Using the list of 19 ACSC groups defined by Purde et al., a quantitative analysis was conducted on 8.1 million hospital admissions recorded in the National Health Management Information System between 2014 and 2023. The main indicators included admission rates per 1,000 population, average length of stay, and average cost per admission. Results: During the study period, 759,500 avoidable admissions were identified, accounting for 13.2% of non-maternity hospitalizations. The rate of avoidable admissions was 2,375.6 per 10,000 population, with an average length of stay of 7.7 days and an average cost of 116,457.5 MNT per admission. Hypertension (42.8%) and pyelonephritis (25.4%) were the leading causes. Higher risks of avoidable admission were observed among women, the elderly, and those with lower educational attainment. Conclusion Avoidable hospitalizations impose a substantial burden on healthcare resources in Mongolia. Developing a nationally tailored ACSC list with expert consensus and implementing policies to monitor and reduce avoidable admissions are essential steps to support ongoing health sector reforms

Background: Patient safety is a core dimension of healthcare quality and has become a global priority. According to the report by the U.S. Institute of Medicine, between 44,000 and 98,000 deaths occur annually due to medical errors in hospitals. One of the key indicators of patient safety is the Adverse Events (AE), defined as unintended harm to a patient that results from medical care rather than from the underlying disease. The assessment of adverse events is not only a tool for detecting errors but also an active strategy for improving system reliability and safety. Accurate identification of adverse events is therefore essential for enhancing patient safety and serves as a critical performance indicator with financial implications for hospitals. Aim: To determine the incidence of adverse events in referral hospitals and to analyze the relationship between triggers and adverse events. Material and Methods: Data were collected during 2023–2024 from three referral hospitals, the First, Second, and Third State Central Hospitals after obtaining institutional approval. The study was conducted within the framework of the Whole System Measures methodology developed by the Institute for Healthcare Improvement (IHI), which is internationally used for system-wide performance assessment. Data extraction was performed from electronic health records and inpatient departments, and statistical analyses were conducted using SPSS version 25. Results: The study identified 8.3% adverse events per 1,000 patient-days, which is 1.66 times higher than the international reference rate. A statistically significant association was observed between the number of triggers and the occurrence of adverse events, indicating that the use of triggers facilitates the active detection of adverse events. Conclusion The incidence of adverse events in tertiary specialized hospitals was found to be higher than international benchmarks. The application of trigger-based active surveillance proved to be an effective method for identifying adverse events and enhancing patient safety monitoring systems.

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.

BACKGROUND: Bladder cancer is a cancer of significant morbidity and mortality in the worldwide. It is the second most common urological cancer in Mongolia. It is important to understand the risk factors of bladder cancer.We evaluated the association of smoking, alcohol intake, body mass index and other potential risk factors with bladder cancer incidence in Mongolians.MATERIALS AND METHODS: We analyzed data from a case-control study (116 histologically confirmed bladder cancer cases and 300 cancer-free healthy, age, gender-matched controls). All participants signed the consent form andfilled out the structured questionnaire including cigarette smoking, BMI, chronic urinary disease andalcohol drinking etc. Using logistic regression we estimated the covariate-adjusted odds ratio (OR) and95% confidence interval (CI) of the associations.RESULTS: Mean age of the patients with bladder cancer was 56±10.5 years and 79.3% male and 20.7% female.Cigarette smoking, history of urinary tract diseases and body mass index were associated with an increased risk of bladder cancer OR 6, 48 (95% CI 1, 61-1, 70), OR 80 (95% CI 1, 48-1, 93) and OR=9.8 (95% CI 2.32-2.91) respectively but not alcohol drinking OR 0, 26 (95% CI 1, 56-1, 66).CONCLUSIONS: The results suggest that cigarette smoking, history of urinary tract diseases and body mass indexincreased risk of bladder cancer in Mongolian patients.

Introduction: Prevalence of asthma is increasing year by year, especially among children and exposure to high levels of indoor allergens is a very important factor [1]. Cockroaches are an important cause of asthma in many other regions of the world, including Taiwan, Thailand and Singapore in the Pacific Rim, Costa Rica and Puerto Rico in Centrel America, India, South Africa and more recently, Europe [2]. Goal: The aim of this study was determined total protein amounts allergenic proteins and protein bands of сockroach.Material and Methods: The сockroachs were collected in Ulaanbaatar. The allergenic protein components of the сockroach was purified by the method of Hames Richmond. The total protein of extracts was measured by the Bradford method and the protein components of cockroach were determined by the SDS-PAGE.Results: Among the 4000 known species of cockroaches, only 5 commonly inhabit homes and have the potential to contribute to indoor allergens. These include the American (periplaneta americana), German (Blattella germanica), Oriental (Blatta orientals), Smokey brown (Periplaneta fuliginosa), and brownbanded (Supella longipalpis) varieties [3]. We were defined 2,25mg/ml protein amounts (w/v) in extracts of the purified and lyophilized protein of the сockroach. We were used a standard marker 195,7; 104,0; 59,8; 41,6; 27,8; 21,1; 15,2; 6,5kd molecular weight proteins on the 13% separation gel of SDS-PAGE. On column determined protein bands with 82,3; 59,9; 55,2; 44,0; 41,6; 34,4, 22,7, 17,1 kd molecular weights.Conclusions: The сockroach was included 8 allergenic protein components between ranges of 17,1-82,3 kd molecular weights were determined in the extracts of the body Blatella germanica.