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.

BACKGROUND: According to International osteoporosis foundation report, osteoporosis is a multifactorial condition associated with an increased risk of fracture and is caused by social, behavioral and physiological factors. Overall incidence is increasing in every country due to people’s life style changes, diet and increased life expectancy. OBJECTIVES: To evaluate the some hormonal effects in bone mineral density among Mongolian population. METHODS: Bone density was measured in the distal one third of radius using the Sunlight Omnisense (Sunlight Medical, Rehovot, Israel) and classified into 3 groups according to WHO osteoporosis criteria. Normal participants were selected into control group and osteoporotic participants were selected into control group. We have evaluated PTH, calcitonin, 25-hydroxy vitamin D in case-control group. RESULT: The prevalence of osteoporosis was 25.7% and 25.3% of participants were osteopenic. It was clear that PTH elevated group (>30.3pg/ml) had more risk of osteoporosis. CONCLUSION: The prevalence of osteoporosis was 25.7% and 25.3% of participants were osteopenic. PTH elevation is risk factor in men.

BACKGROUND: Children’s development and childhood disability are a public health issues to their consequences on quality of life and productivity not only for affected children but also for families and populations as a whole. WHO and the World Bank estimate that more than a billion people live with some form of disability, which equates to approximately 15% of the world’s population (1). Citing the Global Burden of Disease study of 2004, the World Report further estimates that amongst those aged 0-14 years, roughly 5.1% of all children (93 million) live with a ‘moderate or severe’ disability and 0.7%, or 13 million children, live with severe difficulties. Many children younger than 5 years in developing countries are exposed to multiple risks, including poverty, malnutrition, poor health, and other risks, which are affect their cognitive, motor, and social emotional development. There are few research result and national statistics on the childhood disabilities of under 5 years children in Mongolia. OBJECTIVES:The objective of the screening was to determine the rate of disabilities in children aged 9 months to 5 years in Ulaanbaatar. MATERIALS AND METHODS: Population based cross-sectional study design used childhood disabilities screening among under 5 years children in Ulaanbaatar. TQ-(ten questions) screening method used to determine childhood disabilities. The structured interview checklist (TQ) and a guide to collect background and risk factors information were administered in a face-to-face interview of the child’s caregivers. The screening covered 8838 children from 6 districts, Ulaanbaatar. RESULTS: The study covered totally 8838 children (50.4 %) were male and 193 (48.4 %) were female. Over 81 % of the persons responding to the questions were mothers of the children, 10 % fathers. 9 % were the child’s relative and child’s sibling. Based on the ‘ten questions’ screen, 1960 out of 8838 children were positive (disabled). CONCLUSIONS: The positive rate of disabilities by TQ was a higher. At the post verification stage there is need to estimate sensitivity, specificity and negative predictive value of TQ. The second step of evaluation among positive cases should take diagnosis by comprehensive evaluation and clinical assessment.

Introduction Coronary TIMI flow gradewas previously demonstrated to be related to outcome after acute myocardial infarction. However, the relationship between coronary flow grade and left ventricular global longitudinal strainin patients with acute myocardial infarction (AMI) treated by primary percutaneous intervention (PCI) were unclear. Goal In this study, we aimed to reveal the relationship between coronary TIMI flow grade and LV GLS in patients with AMI. Materials and Methods We prospectively selected patients with AMI who treated by primary PCI. Based on whether TIMI 3 flow achieved at the end of the procedure patients were divided into two groups. Group I (TIMI 3 flow was achieved, n=367), Group II (TIMI 3 flow was not achieved, n=47). The LV GLS was assessed by 2dimensional speckle-tracking echocardiography (2D STE). Results A total of 413 patients (mean age 60±13, 84% male) were included and TIMI 3 flow was achieved in 367 patients (88%). LV GLS was significantly impaired in patients who had TIMI 3 flow not achieved compared with TIMI 3 flow achieved group (-13.1±4.8% vs. -15.3±3.8%, p<0.001). Multiple linear regression analysis which included age, gender, clinical, biochemical and angiographic variables showed that coronary TIMI flow grade of culprit artery was independently associated with LV GLS. There was negative correlation between coronary TIMI flow grade and LV GLS (Pearson’s r=-0.183, p<0.001). Simple linear regression analysis revealed that coronary TIMI flow grade is directly associated with LV GLS (β=-1.61, p<0.001) and which indicated that every 1 scale increase of final coronary TIMI flow grade resulted -1.61% increase of LV GLS. Conclusion Our study demonstrated the coronary TIMI flow grade of the culprit artery was independently associated with LV GLSin patients with AMI treated by primary PCI.

Osteoporosis is a disease in which the density of bone is decreased with consequent increase in bone fragility and susceptibility to fracture risk. Vitamin D deficiency may cause secondary hyperparathyroidism and low bone mineral density. Our study was aimed to assess relation between vitamin D status and parathyroid hormone and bone density in adults. Relatively healthy 369 participants aged between 20-60 were randomly selected from Ulaanbaatar city. Specially designed questionnaire was used in the survey. Bone mass density was diagnosed according to the WHO criteria by the T-score. Respondents serum calcium and phosphorus levels were described by the fully automated analyzer (Cobas Integra 2800, Germany). Serum parathyroid hormone and 25-hydroxivitamin D levels were described by using ELISA kit (Eucardio Laboratory, Inc. USA) at the Molecular biology laboratory of MNUMS.The statistical result was analyzed by SPSS 21 program. The subjects mean age was 47.61±12.92, with a range of 20-83. The mean T-score was -0.60±2.17. Our study showed that negative correlation between bone mass density values at parathyroid hormone (r=-0.58, p<0.05), 25-hydroxyvitamin D (r=-0.48, p<0.05) and serum calcium (r=-0.21, p<0.05). Our study showed increased serum parathyroid hormone led the releasing calcium from bone and decreasing bone mass density.

Osteoporosis is a disease in which the density of bone is decreased with consequent increase in bone fragility and susceptibility to fracture risk. Vitamin D deficiency may cause secondary hyperparathyroidism and low bone mineral density. Our study was aimed to assess relation between vitamin D status and parathyroid hormone and bone density in adults.Relatively healthy 369 participants aged between 20-60 were randomly selected from Ulaanbaatar city. Specially designed questionnaire was used in the survey. Bone mass density was diagnosed according to the WHO criteria by the T-score. Respondents serum calcium and phosphorus levels were described by the fully automated analyzer (Cobas Integra 2800, Germany). Serum parathyroid hormone and 25-hydroxivitamin D levels were described by using ELISA kit (Eucardio Laboratory, Inc. USA) at the Molecular biology laboratory of MNUMS.The statistical result was analyzed by SPSS 21 program.The subjects mean age was 47.61±12.92, with a range of 20-83. The mean T-score was -0.60±2.17. Our study showed that negative correlation between bone mass density values at parathyroid hormone (r=-0.58, p<0.05), 25-hydroxyvitamin D (r=-0.48, p<0.05) and serum calcium (r=-0.21, p<0.05).Our study showed increased serum parathyroid hormone led the releasing calcium from bone and decreasing bone mass density.

IntroductionOsteoporosis is becoming an increasingly important economic and public health problem as ourpopulation ages. Different results are reported about osteoporosis rate among various geographicalzones and ethnic groups even in same country. These differences cannot be attributed to hormonalstate or to the dietary intake of calcium, but do accord in general with the living standards of the differentcountries and the degree of physical activity undertaken by the different populations and sexes.GoalTo determine the osteoporosis rate among Mongolian adults and evaluate the geographical distributionsof osteoporosis rateMaterials and MethodsOur study group was 1990 adults who are over 18 years and participated from Uvs, Arkhangai, Dundgovi,Sukhbaatar province and Ulaanbaatar. We have evaluated serum PTH, 25-hydroxyvitamin D level andbone mineral density via bone sonometer (Sunlight Mini-Omni, Beammed, USA). Lifestyle risk factorswere evaluated through a specific questionnaire.ResultsThe osteoporosis rate is 25.5% (n=507) among Mongolian adults and 2 times higher in women thanmen in all age group. SOS was inversely correlated with age in both sexes (men: r=-0.286, p<0.01,women: r=-0.513, p<0.01). Osteoporosis rate was lowest in Ulaanbaatar but highest in Arkhangai(male osteoporosis) and Dundgovi province (female osteoporosis). Of 25-hydroxyvitamin D values 29%were below 20ng/ml (deficient), 39.8% ranged from 20-29.9ng/ml (insufficient) and 31.2% were above30ng/ml (sufficient). In addition, 25-hydroxivitamin D concentrations were not related to bone density.Serum 25-hydroxivitamin D level was highest in Dundgovi province in both sexes. Mean PTH level was26.0±17.7pg/ml and inversely correlated with T-score (r=-0.248, p<0.01) in men.ConclusionOsteoporosis rate among Mongolian adult is lowest in Ulaanbaatar comparing to other rural areas. Andserum 25-hydroxivitamin D deficiency is 68.8% in Mongolian adults.

Varieties of plants and lyophilized bovine bile have been used for increase secretion of bile in traditional systems of medicine of various countries. Following many articles note on the benefi cial effects of lyophilized bovine bile particularly on the wound healing and gastric protection effects, there is paucity of reports in literature on its effects on a bile secretion, a bile bilirubin, bile cholesterol and a plasma cholesterol levels. Sillichol contains lyophilizedbovine bile, liver hydrolisate, yarrow extract and silymarin. The aim of this study was to find out the effect of bile fl ow, bile bilirubin concentration bile cholesterol level and hepatoprotective of Sillichol. Sixteen adult male wistar rats (weighing between 200-250 gr) were used in the study. They were randomly assigned into control and sillichol group comprising 4 in each group. Thereafter, they were weighed and anaesthetized with ketamine (2ml/200gr body weight) muscle leg and quickly pinned to a dissecting board. Laparotomy was performed and liver lobes were defl ected anterolaterally to expose the common bile duct. The common bile duct was cannulated with a portex cannula (0.5 mm diameter) after a semitransection was made on the bile duct. The cannuls was held in place with thread tied over it and around the bile duct.The bile was collected for 8 hours from each rat studied according to method of Rozuet Jousse. The rate of bile fl ow was noted, the volume of bilirubin, bile cholesterol levels were determined in the control and test groups. Moreover, total of 18 wistar rats (200-250 gr) were obtainedfrom laboratory house of Drug research institute and acclimated for 10 days before starting the experiment. Liver toxicity was induced by the subcutaneous injection of carbon tetrachloride (CCL4, 0.4 ml/100gr), 1:1 diluted with paraffi n oil, for four successive days of the experiment (N.P.Scakun et al, 1983). The rats were divided randomly into 3 groups comprising 6 rats in each group and fed the same diet throughout the experimental period. Mean values of bile cholesterol and bilirubinlevels, rate of bile secretion in the control and sillichol group. Bile cholesterol levels were signifi cantly decreased in the sillichol group compared with the control group (60.3±0.88 mg/dl vs 62.6±1.21mg/dl, p<0.05). Rate of bile secretion was signifi cantly increased in the experimental compared with the control group(10.21±0.25 ml/8hr vs 4.18±0.25 ml/8hr, p<0.05). Total bilirubin, conjugated and unconjugatedbilirubin concentrations in both sillichol and control groups were not signifi cantly different (p<0.01). The activities of GOT, GPT and ALP were estimated in serum samples as the liver function biomarkers using biochemical diagnostic test. The CCL4 treatment markedly affected the liverspecifi c enzymes. It was found that a signifi cant (p<0.05) increase in serum GOT, GPT and ALP activities of CCL4 treated rats. After the treats, hepatic biomarkers were elevated in the serum due to release of the enzymes from damaged liver. GOT (69.8±1.5), GPT (103.9±1.2), ALP (23.8±0.2) and Cholesterol (67.7±13.6) andtriglyceride (64.0±3.3) levels weredecreasedsignifi cantly (p<0.05) in the sillichol groupcompared with the control group. Silichol is decreasing concentration of cholesterol and bilirubin’s level in bile, constantly after administration of drug. Also, liverpreparation is increasing bile acid secretion in hepatocytes and a speed of secretion.From the results of pharmacological study concluded that involves CCL4 induced acute toxic hepatitis, liver preparation has hepatoprotective effect by protecting the liver cells from injury, improving the regeneration process and by correcting metabolic functions of the liver.

Shoulder pain is a common complaint in modern societies which affects on functional abilities and quality of life. Long timefor shoulder pain the diagnosis " shoulder joint periarthritis" was explaining all disorders of shoulder. Modern studies of functional anatomy of shoulder area requires new vision of the problem and new attitude of the diagnosis and treatment. In International classification of diseases - 10 there is classification of shoulder disorders in terms of functional anatomy. Later studies of shoulder disorders described it as three groups of disorders as synovial disorders, shoulder girdle disorders and combination diagnosis. There are examination test for identification of shoulder disorder topography. In Mongolia the shoulder pain is not studied enough, there is no guidelines on diagnostics and treatment. Therefore we did this literature review to find out modern tendencies of shoulder disorder diagnostic approaches which could become a basis for shoulder examination guideline.

Introduction: Shoulder pain is quite common complaint worldwide, studied and described in many trials evaluating the effects of different treatment methods. Generally, shoulder complains managed by general practitioners and as a result of these studies many countries developed guidelines for management of shoulder complaints for general practitioners. In Oriental Traditional Medicine shoulder pain syndromes is a part of "Bi" syndromes and explained as quite common syndrome and one of the oldest afflictions. It is classified, as well as other joint complaints, as Complicated diseases, and many textbooks give the explanations on diagnostics and treatments of joint pain. In our days, when Traditional Oriental treatment methods becoming popular for the treatment of the shoulder complains, there is need to compare diagnostic approaches of two Medicines and try to develop integrated methods, which could be used by oriental medical doctors (OMD) as well as medical doctors. Taking into account the popularity of acupuncture for pain management in Mongolia we made a literature review and wanted to develop integrative understanding of the patho-mechanism of shoulder complaints and diagnostic guidelines for OMD. Diagnosis of the shoulder complaints should be done in combination of modern medicine view and theory of Channels and collaterals. Objectives: To develop the chronic shoulder pain diagnostic principles for OMD, basing on 10th international disease classification, diagnostic methods used in GP practice, and theory of Pathogens, Channels and Collaterals, TCM. Methods: We did a literature review on diagnostic methods of chronic shoulder pain in modern medicine and Oriental medicine. By the shoulder pain we mean pain located in the region of deltoid muscle, the acromioclavicular joint, the superior part of the trapezoid muscle and the scapula. We excluded rheumatic disorders, severe traumas, tumors, shoulder complains due to internal and neurological diseases because it needs different treatment principles. In TCM, the joint problems are caused by invasion of Wind, Cold and Dampness into the body, which leads to obstruction or "Bi" syndrome. No doubt, that there are many other factors, such as weakness of defensive energy or insufficient energy of certain organs, but patho-mechanism describes that, pathogenic factors invade the body and obstructs Channels and Collaterals and lead to insufficient flow of Qi and Blood. There are five painful joint "Bi" syndromes such as Wind, Cold, Damp, Heat, and Bony Painful Obstruction Syndrome. Three of them (Cold, Damp, Bony syndromes) could be classified as chronic conditions, so we emphasized out attention on them. From the modern medicine view we take diagnostic groups according to the 10th International disease classification: adhesive capsulitis of shoulder (frosen shoulder)M75, Rotator cuff syndrome M75.1, Bicipital tendinitis M75.2, Calcific tendinitis of shoulder M75.3, Impingement syndrome of shoulder M75.4, Bursitis of shoulder M75.5, Other shoulder lesions M75.8. Shoulder lesion, unspecified M75.9. These diagnosis could include into three general groups of complains, which has different therapeutic principles: 1) Synovial group - consisting of patients with pain and /or limitation of motion in one or more directions of the range of active or passive motion of the glenohumeral joint. This complains originate from disorders of the subacromial structures, the acromioclavicular joint, the glenohumeral joint or combinations. 2) A shoulder girdle group - the pain and limitation of the range of active motion of the glenohumeral joint are not related to synovial structures. Instead, pain or limitation of one or several directions of the range of motion of the cervical spine, upper thoracic spine or the upper ribs is found. 3) Patients with combinations of synovial and shoulder girdle disorders - patients with pain and sometimes with slight limitations in the active or passive range of motion of the glenohumeral joint together with pain or limitation of the range of motion of the cervical, upper thoracic spine and/or the upper ribs. Both the synovial structures and the structures of the cervical spine, the upper thoracic spine and the upper ribs may cause the complains. For the diagnosis of the diseases which cause the shoulder pain, it is recommended to use examination tests developed by Cyriax, and then modernized by Sobel and Winters. It is useful to examine Dowborn test, Howkins' test, drop-arm test, empty-can test, the cross-body adduction test, and the external rotation tests used for diagnosis of shoulder complains. Conclusion: The mechanism of shoulder pain in TCM could be adopted in Modern medicine diagnosis, as well as guidelines' examination items could be adopted in Traditional medicine. Pathological changes in shoulder joint and shoulder girdle could be integrated into the diagnostic items used in Traditional medicine. It will improve the quality of acupuncture treatment for shoulder pain.