Background: Vancomycin was first approved by the US Food and Drug Administration (FDA) in 1958. Vancomycin has an active effect on gram-positive microorganisms, such as methicillin- resistant Staphylococcus aureus (MRSA), coagulase-negative staphylococcus, Streptococcus (Enterococcus faecalis), and Clostridia (Clostridium difficile). It is used in the treatment of severe infections such as endocarditis, osteomyelitis, pneumonia, blood and soft tissue infections, other staphylococcal infections, and S. epidermidis with a β-lactam ring structure that is ineffective or allergic to antibiotics and resistant to many drugs. Materials and Methods: To carry out the study, we obtained permission to conduct the study from the National Institute of Health and Welfare, and randomly sampled a total of 274 inpatients who used vancomycin in the hospital in 2023 in order to be representative in terms of age and gender (n=120). Results The one dose of vancomycin was 0.9 mg, the daily dose was 2.4 mg, the total dose was 20.5 mg, and the total daily average was 11.3 days. The daily dose and total dose of vancomycin were inversely proportional to age (r=-0.008), and the total dose is very weakly correlated with BMI and gender (r=0.052). Cefazolin used in combination with vancomycin had statistically significant differences in monocyte counts (p=0.003), cefotaxime in lymphocyte counts (p=0.027), and ceftriaxone in total white blood cell counts (p=0.048). Conclusion: Vancomycin daily dose is inversely related to age, total dose is inversely related to age, and total dose is very weakly correlated with BMI and gender. There is a statistically significant difference in the use of vancomycin with cephalosporin antibiotics

Background: Vancomycin is a glycopeptide antibiotic widely used to treat infections caused by gram-positive bacteria, especially methicillin-resistant Staphylococcus aureus (MRSA). Despite its effectiveness, vancomycin is known to be nephrotoxic, particularly when administered in high doses, for prolonged durations, or in combination with other nephrotoxic agents. This study aims to investigate the incidence and influencing factors of vancomycin associated renal impairment among hospitalized patients in Mongolia. Methods: A retrospective document review was conducted among 120 hospitalized patients who received vancomycin at the First State Central Hospital in 2023. Data on vancomycin dosage, treatment duration, clinical diagnoses, and biochemical parameters were analyzed. Renal function was assessed using the Cockcroft-Gault equation and categorized into five stages. Statistical analysis was performed using chi-square tests and logistic regression with a significance level set at p<0.05. Results: The mean age was 52.3 years, and the average BMI was 26.7. Among participants, 41.5% showed varying degrees of renal impairment. Vancomycin daily dose was significantly associated with the stage of renal impairment (p=0.040), while total dose and treatment duration were not. Co-administration with cefotaxime and metronidazole showed statistically significant changes in creatinine and urea levels, suggesting potential additive nephrotoxicity. Conclusion The findings indicate a substantial rate of renal function decline among vancomycin-treated patients. Higher daily doses and concurrent use of nephrotoxic antibiotics may increase the risk. Regular renal monitoring and dose adjustments are essential to minimize adverse renal outcomes.

Background: The Maternal and Child Health Handbook is a long-term health monitoring tool that records children’s health, immunization, and developmental stages from the prenatal period to age five. By using the MCH handbook together with parents and health workers, it is possible to increase health education for parents and prevent, and detect potential developmental delays in children at an early age. Aim: To detect the knowledge and attitudes toward family use of the MCH handbook Materials and Methods: The study was conducted using an analytical study using cross-sectional design and included a total of 373 parents and caregivers with children aged 1-4 in 4 districts of Ulaanbaatar city. When assessing knowledge, correct answers were scored and grouped. When assessing the attitude, the parents were scored based on whether they were recorded in the MCH handbook. To determine the relationship between influencing factors, a one-way logistic regression analysis was performed, which was considered statistically significant at a 95% confidence interval and p<0.05 and was performed using the SPSS 25 program. Results: The mean age of the study participants was 33.5±6.5. Reading and keeping a handbook completely (p=0.0001) was statistically significantly related to improving knowledge (p=0.0001). In studying the factors affecting handbook records, the following were statistically significant: gestational age (OR=0.956, 95% CI [0.923, 0.990]), number of births (OR=1.206, 95% CI [1.002, 1.452]). Factor influencing knowledge about the notebook is gestational age (OR=0.954, 95% CI [0.918, 0.992]). Conclusions The factor influencing knowledge about the health notebook of children under five years of age were gestational age (p=0.017). The factors influencing the maintenance of the notebook were gestational age (p=0.011), number of births (p=0.048), and whether the notebook was read completely (p=0.008).

Background: Meniere's disease is a condition caused by disturbances in the auditory and vestibular systems. It is characterized by symptoms such as dizziness, nausea, vomiting, and tinnitus. In the United States, the prevalence of Meniere's disease has been found to be 84 cases per 100,000 women and 56 cases per 100,000 men. Regionally, it is more common in less populated areas, and research has confirmed that the prevalence increases with higher household income. Aim: To evaluate the effectiveness of traditional medicine treatments and therapies for Meniere's disease. Results: The patient is a 43-year-old male, with symptoms of dizziness, vomiting, and tinnitus. Since 2023, he has sought care at the Central Hospital of Mongolian Medicine, where he received traditional medicine treatments including herbal therapy and other traditional therapies on three occasions. As a result, the frequency of dizziness has decreased and other clinical symptoms have improved. Conclusion Traditional medicine treatments have been shown to be effective in managing Meniere's disease by extending the interval between relapses, improving quality of life, and significantly reducing clinical symptoms.

Background: Vitamin E is an oil-soluble compound with antioxidant properties against free radicals. It has been used in cosmetic practice since long time ago. However, it is unstable to light and heat, and even when formulated into pharmaceuticals, it has poor skin penetration, which can reduce the effectiveness of the treatment. Therefore, by encapsulating Vitamin E in liposomes and forming a gel, it is possible to produce a highly therapeutically effective drug form that supports skin homeostasis and provides moisturizing benefits. To this reason, it is necessary to determine the appropriate methods and conditions for encapsulation in liposomes, which is the basis for conducting this study. Aim: The goal of the research is to develop a technology for preparing vitamin E-loaded liposomes and incorporating them into a gel formulation. Materials and Methods: Liposomes were formed using thin film hydration, ethanol injection, and heating methods, each with 5 different concentrations, and liposome formation was determined spectrophotometrically for each sample. The size of the formed liposomes was determined using a Nanophox instrument. Six gel models were prepared and compared for quality parameters. Results: The highest yield was obtained when 75 mg of phospholipids were used in the thin film hydration method, which is 82.3%; the highest yield was obtained when 50 mg of phospholipids were used in the ethanol injection method, which is 86.75%; and the highest yield was obtained when 50 mg of phospholipids were used in the heating method, which is 58.8%. The average size of liposomes prepared by ethanol injection and dissolved in distilled water was 106 nm. The gel bases were prepared using models F1-F6, and the pH values of models F4 and F5 were suitable. Conclusions 1. Among the three methods for liposome formation, the ethanol injection method had the highest yield. 2. The ethanol injection method had the highest encapsulation when prepared with a phospholipid:vitamin E ratio of (1:10). 3. For gel base model F5 was suitable which is carbomer 1.0%, preservative propylparaben 0.02%, pH adjuster sodium hydroxide, and permeability enhancer propylene glycol 10%.

Background: The main risk factors for childhood overweight and obesity include the consumption of sugar-sweetened beverages and other sweetened foods. The sugar content of sugar-sweetened beverages was different from the nutritional information on the packaging. Aim: To determine sugar and brix content in domestic manufactured sugar-sweetened beverages, and compare information on the packaging and regulatory standards. Materials and Methods: The sugar and brix content in sugar-sweetened beverages was determined by laboratory anal ysis, including 150 domestically manufactured sugar-sweetened beverages. Laboratory analysis carried out in the Chemical toxicology laboratory of the National Reference Laboratory for Food Safety, MASM, determined sugar using a saccharometer and brix using refractometry. : Results: The study included 150 Mongolian sugar-sweetened beverages, including 20.7% (n=31) carbonated drinks, 47.3% (n=71) fruit drinks, 16.0% (n=24) tea drinks, 1.3% (n=2) energy drinks, 14.7% (n=22) flavored water. Sugar content 0.0–15.6% in sugar-sweetened beverages. The laboratory analysis results compared with information on the packaging 72.0% (n=108) difference between 0.1–11.3%, 10.7% (n=16) same, do not have sugar content in the nutritional information on the packaging 17.3% (n=26). Brix contained 0.2–13.0% carbonated drinks, 4.9–15.7% fruit drinks, 0.6–9.8% tea drinks, 7.7–16.0% energy drinks, and 0.1–9.7% flavored water. Conclusions 1. Sugar content 0.0–15.6%, brix 0.0–16.0% in Mongolian sugar-sweetened beverages. 2. The laboratory analysis results compared with nutritional information on the packaging 72.0% (n=108) difference between 0.1–11.3%, 10.7% (n=16) same nutritional information on the packaging, do not have sugar content in the nutritional information on the packaging 17.3% (n=26). 3. 37.3% of Mongolian sugar-sweetened beverages are unsatisfied with regulatory standards.

Background: Liposomes have been widely studied in the field of medicine in recent years for they can reduce side effects and regulate drug release by delivering active ingredients to target tissues and cells through active or passive routes. There are many types of methods for formulating liposomes, and comparing those methods and choosing the most suitable one will allow the delivery of active ingredients and their incorporation into pharmaceutical forms, so this research was carried out. Aim: To compare liposome formation methods. Materials and Methods: The research work was carried out with the support of “Drug Design Laboratory” and “Pharmaceutical Analysis Laboratory” of the School of Pharmacy of MNUMS. To formulate liposomes, 5 different concentrations of samples were prepared using thin-film hydration, ethanol injection, and heating methods. Phospholipid concentration and light absorption were determined by spectrophotometer in each sample. The size of the resulting liposome was determined using a Nanophox. Results: Phosphatidilcholines were dissolved in distilled water at concentrations of 5, 10, 20, 30, 40, and 50 μg/ml and a standard curve was established by spectrophotometry to determine the concentration of phospholipids in liposome samples. The highest formulation was 76.98% when 75 mg of phospholipid was used in the preparation by thin film hydration method, when 50 mg of phospholipid was used in the preparation by ethanol injection method, the highest formulation was 85.17%, and for when 50 mg of phospholipid was used in the preparation by heating method, the highest formulation was 58.45%. The mean liposome size by ethanol injection method was 115 nm. Conclusions 1. Ethanol injection method for liposome formulation is more efficient compared to thin-film hydration method and heating method. 2. Liposome size was 115 nm when prepared by ethanol injection.

Background: Membranous nephropathy (MN) is among the most common causes of nephrotic syndrome in adults. MN is diagnosed in one third of cases of nephrotic syndrome on kidney biopsy. Kidney biopsy is the gold standard for diagnosing MN and plays an important role in determining the severity of the disease and in determining treatment decisions and regimens. Therefore, the lack of research on kidney biopsy in Mongolia is the reason for this study. Aim: The aim of this study was to investigate the pathological features in the kidney tissues of patients with primary membranous nephropathy diagnosed by kidney biopsy. Materials and Methods: A retrospective study was conducted on 51 cases of MN diagnosed in kidney biopsies performed at the First Central Hospital of Mongolia (FCHM) over a period of 12 years. Renal function was calculated using the CKD-EPI (2021) formula and classified into the stage of CKD by eGFR. Histopathological findings were examined using 4 light microscopy (LM) stains (Hematoxylin-Eosin, Masson-Trichrome, PAS, and Methenamine silver staining) and 8 immunofluorescence (IF) microscopy stains (IgG, A, M, complement C3, C4, C1q, and kappa, lambda). The study excluded secondary MN based on viral markers, tumor markers, and serological tests. Statistical analysis was performed using SPSS and STATA 15.0 software, using t-tests, Pearson’s chi-square tests, and multiple group comparisons were performed using ANOVA and Kruskal-Wallis methods. The study design was approved by the Ethics Committee of the MNUMS, Mongolia. (№ 2023/3-07) Results: A total of 305 kidney biopsies performed at the Kidney Center of the FCHM between 2011 and 2023 resulted in the diagnosis of 51 cases of primary MN. The mean age of patients with membranous nephropathy was 40.6±9.3 years, with the oldest age of 65 and the youngest of 22 years, and 36 (70.59%) were male and 15 (29.41%) were female. In the kidney biopsy, the average number of glomeruli was 16.51±7.82 (min-max, 3-54), and by LM, 33.3% showed global sclerosis of glomeruli by hematoxylin-eosin staining, 94.12% showed thickening of the glomerular basement membrane (GBM), 31.2% showed double counter staining of subepithelial immune complexes by methenamine-silver staining, 88.24% showed holes in the GBM, and 54.9% showed spike-like changes by Masson-Trichrome staining. IF showed IgG 3+ in 37.3%, 2+ in 39.2%, 1+ in 13.7%, and trace staining in 9.8%, while 74.5% of the cases were positive for C3, 93.1% for kappa, and 79.5% for lambda. LM showed thickening of the GBM (OR 23.5, 95% CI 0.093-0.53, p value= 0.007) and interstitial fibrosis (95% CI 6.98-31.07, p value= 0.003) contributing to the decrease in eGFR. The mean time from the onset of the first symptoms of kidney disease to the time of kidney biopsy was 35.35±61.54 months. Patients who underwent biopsy later (in months) after the diagnosis of the disease had a higher incidence of interstitial fibrosis (74.6 ± 98.43, 95% CI -90.52-20.68, p value = 0.002). Conclusion The histopathological features of MN confirmed by kidney biopsy showed thickening of the GBM in 94.12%, global sclerosis in 33.3%, and holes in 88.2%. Immunofluorescence microscopy showed 100% IgG staining, while C3, kappa, and lambda were positive in 74.5%, 93.1%, and 79.5%, respectively.

Background: From the perspective of Mongolian medicine, hemorrhagic disease is a symptom of bleeding from any part of the body. This disease was compared to the immune thrombocytopenia disease of modern medicine. The treatment of this disease using two medical methods and the prevention of complications and relapses are issues facing the healthcare sector. In this regard, we have chosen this topic to clarify and prove the mechanism of action of the Mongolian drug Gurgem-8, which is widely used to treat bleeding disorders. Aim: To evaluate the therapeutic efficacy of Gurgem-8, in haemostatic treatment. Materials and Methods: The study was conducted using a randomized, controlled (active), open label, single centered clinical trial method. The study was conducted in two phases. First, an acute toxicity study of the Gurgem-8, was conducted in accordance with OECD guideline 423 and evaluated according to GHS classification. A chronic toxicity study was also conducted on Wistar rats (n=20) given the Gurgem-8, at doses of 500 mg/kg, 100 mg/kg, and 150 mg/kg daily for 60 days. Second, a clinical study was conducted on a total of 74 patients, who were randomly divided into 2 groups. The treatment group was given 3 grams of the Gurgem-8, daily, and the comparison group was given 4 capsules of Sheng Xue Xiao Ban Jiao Nang 3 times a day. The results were determined by laboratory methods. The study was conducted with the approval of the Research Ethics Committee of Mongolian National University od Medical Sciences (2024.01.19 №2024/3-01). Results: In the acute toxicity study, Turmeric-8 was found to be of low toxicity according to the GHS classification. No mortality was observed in the chronic toxicity test. As a result of the clinical study, there were significant differences in the blood hemoglobin (χ2=73.923, P<0.001), platelet (χ2=62.465, P<0.001), erythrocyte (χ2=77.113, P<0.001) and leukocyte (χ2=14.771, P<0.001) cell counts between the Gurgem-8, drug group and the comparison group. It was also determined that the platelet (χ2=138.3, P<0.001), erythrocyte (χ2=85.405, P<0.001) and leukocyte (χ2=10.961, P=0.027) cell counts were directly related to the treatment period and the group. When determining the effect on immune cells, there was no significant difference in the lymphocyte cell content before and after treatment (CD4+: t=0.233, P=0.817; CD8+: t=-0.264, P=0.793; CD4/CD8:Z=-0.119, P=0.905). However, the CD4/CD8 ratio was statistically significantly increased in each of the Gurgem-8, drug group and the comparison group (P<0.001, P=0.001). Conclusion In immune thrombocytopenia diseases, the Gurgem-8, has the effect of reducing hemoglobin levels in the blood, increasing platelet counts, reducing CD4+ and CD8+ T cell counts, and increasing the CD4/CD8 ratio.

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.