Background: Chronic infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) is a major cause of liver cirrhosis and hepatocellular carcinoma worldwide, and is also associated with a wide range of extrahepatic manifestations affecting multiple organ systems. However, comparative studies on the prevalence, risk factors, and clinical associations of these extrahepatic manifestations in Mongolia remain limited. Aim: To comparatively evaluate the risk factors and clinical associations of selected extrahepatic manifestations in patients with chronic HBV and HCV infections. Materials and Methods: This retrospective cohort study included a total of 1.040 participants matched by age and sex. Extrahepatic manifestations were assessed, including hypertension, hyperglycemia, dyslipidemia, and impaired renal function. Results: Extrahepatic manifestations such as hypertension, hyperglycemia, dyslipidemia, and renal dysfunction were significantly more prevalent in the chronic HCV group (p<0.05). In contrast, obesity was more common in the chronic HBV group, particularly among males aged 50-59 years. Increasing age (OR=1.04, 95% CI: 1.02-1.06) and chronic HCV infection (OR=1.65, 95% CI: 1.20-2.26) were associated with a higher risk of extrahepatic manifestations. Liver fibrosis showed similarly high prevalence in both groups (71-72%), with the highest occurrence in the 50-59 age group. A moderate positive correlation was observed between fibrosis stage and renal function impairment (r=0.45). Conclusion Chronic HCV infection is more strongly associated with the presence and risk of extrahepatic manifestations compared to HBV. Age, sex, and metabolic abnormalities are important contributing risk factors. Therefore, regular monitoring of metabolic and renal function, in addition to liver disease, is essential in patients with chronic viral hepatitis to prevent complications.

Background: Cancer incidence and mortality are steadily increasing both globally and in Mongolia. As these rates rise, traditional Mongolian medicine has long utilized herbal formulas for the treatment of gastric and esophageal cancers and precancerous conditions. One such formulation—Hot Natured 3 Herbs (HN3H)—comprises three species from the Ranunculaceae family: Atragene sibirica L., Ranunculus repens L., and Pulsatilla bungeana L.. However, scientific validation of its anti-tumor effects is essential. This study aimed to investigate the effect of HN3H in a tumor-induced animal model. Aim: To identify the biologically active compounds of HN3H and evaluate their effect in an experimentally induced tumor model in animals. Materials and Methods: The three herbs comprising HN3H—Atragene sibirica L., Ranunculus repens L., and Pulsatilla bungeana L.—were collected during their flowering stage (May–June) in Khishig-Undur, Bulgan province, and dried according to official procedures. Extraction was carried out by maceration in 96% ethanol at a 1:10 ratio. The concentrated extract was suspended in water (1:1) and successively fractionated with dichloromethane, ethyl acetate, butanol, chloroform, and n-hexane. The study was approved by the Research Ethics Committee of the Mongolian National University of Medical Sciences (Protocol №2020/03-04). A colorectal cancer model was established by subcutaneous injection of MC-38 cells (Kerafast, USA) into C57BL/6 mice. Immunohistochemistry was performed using CK20, CDX2, Ki67, and p53 antibodies at 1:100 and 1:200 dilutions. Results: The ethanol extract of HN3H contained 2.98±0.04% total phenolics and 2.16±0.05% total flavonoids. Body weight and tumor volume were measured daily with three repetitions. All groups showed a time-dependent increase in body weight. Mice in groups 1A and 1B received ethanol extract at 50 and 100 mg/kg doses; groups 2A and 2B received dichloromethane extract at the same doses. The negative control group was administered 0.5 mg/kg PBS orally, while the positive control group received intraperitoneal injections of 5-fluorouracil (5FU) at 10 mg/kg twice a week. Tumor growth increased in a time-dependent manner across groups. Compared to the negative control, tumor volumes in four treatment groups showed statistically significant reduction (p˂0.05), while no significant difference was observed when compared to the positive control (p=0.08). Histological analysis revealed necrosis in all groups, with variation in extent. Conclusion The ethanol extract of HN3H exhibited moderate levels of phenolic compounds and a high concentration of flavonoids. HN3H extract inhibited tumor progression and activated lymphocyte-predominant inflammation in tumor tissues, indicating potential anti-tumor activity (p˂0.05).

Introduction: The development of analytical methods for evaluation of quality standard parameters of drugs and other health prophylactic, diagnostic, and therapeutic products is essential from the beginning in the process to release to the market finished product. Validation of developed analytical methods is one crucial part of the analysis.
Quantitative determination methods of the total main active compounds of the tincture prepared from the root and the herb of Paeonia anomala L. were developed. In order to verify whether the analytical procedure is suitable for its intended purpose parameters – accuracy, reproducibility, intermediate precision, and linearity were validated. Materials and methods: The total phenolics in the tincture were determined by the reaction with Folin Chicolteau reagent and total monoterpene glycosides by the reaction with hydroxylamine in alkaline solution and ferric (III) chloride following spectrophotometric examination, respectively. Based on the achieved results of the developed quantitative methods which were validated according to the accepted and pursued technical documents in our country the Eurachem guide “The Fitness for Purpose of Analytical Methods” and Russian Pharmacopoeia 13 “Validation of analytical methodology”, where parameters as accuracy, precision – reproducibility, intermediate precision, and linearity are involved. Conclusions Statistical analysis of total phenolic compounds and total monoterpene glycosides in the Paeonia anomala tincture demonstrated that the bias calculated was for accuracy 0.674% and 0.703%, relative standard deviations were for reproducibility 0.896% and 0.798%, for inter- mediate precision 0.922% and 0.696%, respectively and the linearity – R²=0.9985 and R²=0.9997. All achieved results validated the appropriateness of the developed quantitative methods for the intended purpose.

Background: In 2011-2020, WHO approved the Global Strategy for Traditional Medicine. The strategy states that "The trend of using traditional medicine and alternative medicine as a source and resource for health care is expanding worldwide."
In this regard, it is important to develop a policy and methodology to develop a proper combination of traditional and modern medicine. Also, there are demands to study and solve the problems of ensuring the safe, effective, quality, availability, and appropriate use of medicines and treatments. Purpose: Finding traditional medicinal recipes containing the herb Veronica incana L from the ancient Mongolian medical books written by famous Mongolian scientists Jambalchoizhidanzanperenlei, Luvsandorj, and Jigmeddanzanjamts. Research materials and methods:
1. Research materials: Jambalchoijidanzanperenlei. gso rig bstan bcos mtha' dag gi snying po rnams phyogs gcig tu bsdus pa man ngag rin chen 'byung gnas bzhugs so. Wooden printing block with Tibetan script. Luvsandorj. sman sbyar tshad kyi skor rnams che long tsam phyogs gcig tu bkod ba kun phan bdud rtsi'i snying bo zhes bya ba bzhugs so). Wooden printing block with Tibetan script. Jigmeddanzanjamts. rgya badmkhas grub du ma'i gzhung lugs dam pa gong ma rnams kyi man ngag zhal shes lag len myong grub gnad don gnyen po ngo sprod mdzub tshugs dmar khrid kyi bkod pa mthong ba don gsal dga' byed snying po'i rnam gsal bzhugs so. Wooden printing block with Tibetan script.
2. Research methods: Methods of textual analysis for ancient books and checklist methods were used in the study. Conclusion Medicinal recipes containing the herb Veronica Incana L were sampled from the ancient medical books surveyed. There are 6 recipes in the book of Jambalchojidanzanperenlei, 3 recipes in the book of Luvsandorj, and 2 in the book of Jigmeddanzanjamts, a total of 11 ingredients. In general, these ancient medical books had a significant impact on the development of traditional Mongolian medicinal prescriptions. Therefore, even today, these works are still important in the theory of pharmaceutical composition and the practice of drug therapy.

Background: Medicinal plant research has been successfully carried out in the field of pharmacy and pharmacology in Mongolia, and dozens of research projects are still being carried out However, there are still fewer studied medicinal plants of practical importance growing in Mongolia. Therefore, there is a need to register and study the ancient medicinal books written by ancient Mongolian doctors about the relatively lilUe-studied Veronica Incana L plant. In addition, taking into account that scientific research on Veronica Incana L. which grows in Mongolia, has not been done in the field of medicine, the topic was selected for research in this field. Purpose: Comparing the information of the ancient medical books written by Mongolian doctors and scientists, who wrote about Veronica Incana L, to clarify the taste, power, and quality Research materials and methods:
1. Research materials: Sumbe khamba Ishoaljir. gso dpyad bdud rtsi 'i chu rgyun gyi cha lag gi nang tshan gyi sman so so'i mngon brjod dang ngos 'dzin shel dkar me long. Wooden printing block with Tibetan schpl. Toin Jambaldorj. gso byed bdud rtsi'i 'khrul med ngos 'dzin bzo rig me long du rnam par shar ba mdzes mtshar mig rgyan zhes bya ba bzhugs so. Wooden printing block with Tibetan script.
2. Research methods: Methods of textual analysis for ancient books and checklist methods were used in the study. Conclusion Gandhabhatra plant is used in traditional Mongolian medicinal practice from ancient times, the plant is called Veronica Incana L in Lalin. Also called Buural gandbadraa in Mongolian. On the other hand, the traditional medical doctors of China's Inner Mongolia and Tibet use Gandbadraa, the Latin name Gnaphalium affine D. Don. The appearance, shape, and color of the flowers of these two plants are different According to the research of the source, the main instruction and usage of the plants are the same: to deslroy benign tumors, lo remove poison, to treat colds, and to stop cough.

Introduction: Due to social transition and change of many societal activities in Mongolia, there is an increasing need for pharmaceutical drugs to treat anxiety, stress, fatigue and insomnia. It is considered that medicinal plants used in traditional medicine as sedatives, anti-anxiety and anti-depressive activities could be effective. Our study focuses on exploring optimal methods for preparing tinctures from Paeonia L. genus species, a sedative in Mongolian traditional medicine, and studying their phytochemical compositions. Materials and methods: Root and herb of Paeonia anomala L., grown in Mogod soum in Bulgan province, were used for the study.
Prepared herb and root were chopped and sieved into 1 mm, 2 mm, 3 mm, 4 mm and 5 mm sizes. Then from each size of two samples, a set was created with a 1:1 ratio. Finally 40 % ethanol (1:10 ratio with a set) was applied to prepare tincture through a traditional maceration method. The obtained tincture was analyzed for its color, quantity of biologically active compounds, dry residue, and absorption coefficient using an optimal particle size of samples, volume of the extractive liquid and tincture yield.
Tincture from the set of herb and root of Paeonia anomala L. was prepared using 3 methods, namely, by the traditional maceration; intensified maceration using the ultrasonic bath processing with 45 kHz at an ambient temperature; constant shaking in a heat of 30o-40oC. Conclusion The more optimal and effective method for preparing tincture from Paeonia anomala L. has been found to be the ultrasonic bath processing with 45 kHz for 6 h at an ambient temperature. Crude drug mixture of 2 mm sizes with 40% ethanol (where volume absorption coefficient was accounted to be 2.8) was mixed at a ratio of 1:10. In the obtained tincture, total phenols were determined as 0.58±0.003% in gallic acid equivalent and total monoterpene glycosides as 1.96±0.002% in paeoniflorin, which were the highest compared to other methods, indicating the method is the more optimal one.

Introduction: It is important to standardize a tincture prepared from the herb and root of Paeonia anomala L, which is widely used as a sedative in traditional medicine, based on the results of the studies its chemical composition, biological and pharmacological activities. Moreover, there is a need to carry out a quantitative stability testing in order to establish the ability to maintain quality under certain storage condition, shelf-life and to develop suitable packaging information. Materials and methods: Standardization parameters of prepared Paeonia anomala tincture have been evaluated according to WHO guidelines for the determination of crude drug material, plant preparations and finished products technical parameters, along with the Mongolian National Pharma- copoeian (MNP) and Russian XIV Pharmacopoeian methods for tincture. The color of a tincture, dry residue, special density, alcohol content, and microbiological content were determined according to the methods described in MNP. A qualitative analysis of biological active constituents has been evaluated by thin-layer chromatography, the total phenolic compounds were determined by the reaction with Folin Chicalteu reagent and total monoterpene glycosides by the reaction with hydroxylamine in alkaline solution and ferric (III) chloride following spectrophotometric examination, respectively.
The stability testing study was performed according to the “General requirements for the stability testing study of drug-active compounds” MNS-6439-2014 using the real-time methods for the standardization parameters of the tincture. Conclusions The standardized parameters of tincture prepared from the herb and root of Paeonia anomala L. were approved by the National Reference Laboratory for Food Safety analysis. Consequently, the Mongolian pharmacopoeian article on Paeonia anomala tincture was officially permitted under the number ҮФӨ-0327-2017.
The stability study of tincture was carried out according to the MNS-6439-2014 by real-time tests for 24 months which provided that the changes in tincture quality were within the permitted limits. Consequently, it can conclude that the storage condition and shelf-time of Paeonia anomala tincture are 2 years under not above 25°С.

Background: The World Health Organization (WHO) estimates that the number of cancerrelated deaths will increase by 45 percent between 2008 and 2030. Following this estimate, many projects and programs have been implemented to improve cancer prevention, diagnosis, and treatment, but the number of new cancer cases and deaths is increasing worldwide. In 2018, 6073 new cancer cases were registered in Mongolia.² As of 2018, there are 19,427 cancer patients under the supervision of aimag and district oncologists. In our country, 78.8 percent of all cancers are diagnosed in stage 3.4 and are transferred to palliative care. However, in our country, there is a lack of research on the family, caregiver burden and quality of life of patients receiving palliative care. Therefore, we aimed to assess the caregivers of burden and quality of life of family of cancer patients in this study. Methods: The survey was conducted between November 2017 and December 2018 using an analytical instantaneous model. The survey data were collected from caregivers of cancer patients at the National Cancer Center, Ulaanbaatar District Health Center, Green Ger, and Iveel Hospice. Quality of life was assessed using the WHO WHOQOL-BREF method. The caregiver burden of cancer patients receiving palliative care was assessed using the Caregiver burden inventory international standard questionnaire. Results: The study involved 180 caregivers aged 20 to 72 years. 82.8 percent of the total guardians are women and 17.2 percent are men. The quality of life of the caregivers surveyed was 65.0 percent. In terms of the quality of life of caregivers, the environment is 59.9 percent, social relations 69.2 percent, psychological 70.8 percent, and physical 64.0 percent. The quality of life of caregivers was rated 69.8 percent for men and 64.0 percent for women, or relatively low for women. A statistically significant indicator is that the quality of life of caregivers decreases as patients spend more time per day (p = 0.013). The average workload score for caregivers is 32.97±11.8 for men and 40.53±14.9 for women, which is a statistically significant difference. The inverse relationship between caregiver quality of life and workload is a statistically significant indicator. / r = - 0.61 /. Conclusions The quality of life of caregivers participating in the study decreased. In addition, 91.7 percent have a caregiver burden level of 2 and more, which indicates that the caregivers of cancer patients are overworked. According to the results of the linear regression analysis, the quality of life decreases by 0.56 units when the caregiver’s workload increases by 1 unit.

Background: Pressure ulcer is the worldwide problem which does not depend on age group and any patients could suffer from. Nursing human resource, working load, hospital equipment supply, well-organized training, lack of scientific study are influencing the prevention and nursing care for patients with pressure ulcer although the prevention of ulcer’s depends on continuous nursing care. Therefore, we aimed to improve participation of nurses and evaluate knowledge of nurses on pressure ulcer. Methods: Total of 249 nurses who are working in primary and referral level were chosen as study participants. We used cross-sectional study of analytic study and standard questionnaire with Likert scale. Furthermore, we operated evaluative standard questions of Pieper and Mott (PUKT; 1995), standard questions of pressure ulcer evaluation and nurse’s knowledge. All statistics analysis done by using SPSS 21.0 program. Results: 237 (95.2%) were females, 12 (4,8%) were males were participated in the study and 122 (49,0%) had received Diploma, 125 (50,2%) of them had received bachelor degree and 2 (0,8%) had master degrees. Furthermore, 175 of all participants were nurse practitioners and 74 of them were clinical nurse specialists. The knowledge regarding nursing care on pressure ulcer was evaluated as 2,41% were excellent, 20,88% were with average-knowledge and 76,71% were with poor-knowledge. Nurse’s knowledge regarding Evaluation of pressure ulcer were measured as 65,68% were with poor-knowledge, 33,33% were with average, and 0,8% were with excellent knowledge. Finally, knowledge about nursing care on pressure ulcer, 14,86% were evaluated as average, 85,14% were with poor-knowledge. Conclusion Most of nurse’s knowledge regarding prevention and nursing care for pressure ulcer is inadequate. Therefore, there is a need to improve nurse’s knowledge about prevention and nursing care on pressure ulcer.

We conducted cohort study of 170 patients with advanced cancer who admitted to the Palliative care department of NCC, Hope, Green Home and Grace Hospices. Bad news was informed before the hospitalization by Robert Buckman 6 steps. Psychological reactions of patients were observedimmediately after breaking bad news, after 30 minutes, after one day and after a week.Immediate psychological reactions of patients after breaking bad news was different: 25% of patientssat quietly withdraw into themselves and think about something, 24.2% - sighed heavily and stared in disbelief, 21% - cried or had watering eyes, 14.8% - felt mental relief and were thankful for telling truth, 12% - looked very sad and depressed, 9.7%- looked in fear and worrying. Psychological reaction like crying, fear, worrying were more common within female patients, and psychological reactions like withdraw into themselves and think about something were more common for male patients. After 30minutes patients started ask questions, 80% of patients want talk about treatment (asked questions about possibility for treatment abroad, about palliative treatment, and other therapeutic options), 30% of patients asked about prognosis, 29% of patients asked about possible complications, 19% of patients expressed their anger to family members, because they did not tell truth to them, 4 % ofpatients still expressed disbelief to bad news and they told that they are enough strong to fight with disease or they can find other treatment option. After 7 days 85% of patients were psychologicallycomfortable, because they accepted diagnosis and prognosis, 74 % of patients had very good communication with family, and 65% of them experienced psychosocial rehabilitation, 44%- prepared testament, 30% - finished uncompleted job.First several minutes after breaking bad news patients experienced severe psychological reactions, but after several days they came to psychosocial rehabilitation, for this reason we have to inform to patients truth about diagnosis and prognosis.