Oral hygeine status of children with henoch-schonlein purpura (HSP) disease Backround: Henoch-Schonlein Purpura (HSP) disease is an inflammatory disease in which capillaries, venules, and arterioles are dominated by microvessels due to the accumulation of Ig-A immunity in the walls. Eighty percent of children with HSP have chronic infections such as chronic tonsillitis, otitis media, dental caries, and gingivitis.1-8 However, no research has yet been conducted to determine the prevalence and severity of tooth decay in children with Shenlein-Genoch disease, and to assess gingivitis and oral hygiene. Materials and methods: The survey was conducted from 50 children with the HSP from the Department of Cardiovascular Connective Tissue Pathology of Pediatric Consultant Polyclinic of the National Center for Maternal and Child Health and was conducted in using cross-sectional survey accordance with the number 07- 2021/3, Principles of the Research Ethics Review Committee of the Mongolian National University of Medical Sciences and, the results of the study were processed using the statistical software SPSS 25. Results: The prevalence of tooth decay among children with HSP was high at 95% for mixed dentition and 100% for each stage of primary and permanent dentition, while the intensity of tooth decay was 7,304.64 (caries+ fillings+extraction/ tooth) during primary dentition, 7,303.46 (caries+fillings / tooth) + (caries+fillings+extaction / tooth) during mixed dentures and 11,294.13 (caries+fillings+extraction / tooth) during permanent dentition. It is noteworthy that the level is very high at all.In the study of children with gingivitis, 50% of them had gingivitis with primary dentition, 60.9% with mixed dentition, and 58.8% with permanent dentition. The proportion of healthy children without gingivitis was 50% for primary dentition, 39.1% for mixed dentition, and 41.2% for permanent dentition. The proportion of “good” condition in the study was 30% for primary dentition, 39.1% for mixed dentition, 35.3% for permanent dentition. The “mean” rate was highest for 70% for primary dentition, 56.5% for mixed dentition and 58.8% for permanent dentition. The “insufficient” rate was 4.3% for mixed dentition and the lowest for 5.9% for permanent dentition. Conclusions: 1. The prevalence of tooth decay among children with HSP was high at 95% for mixed dentition and 100% for each stage of primary and permanent dentition, while the intensity of tooth decay was 7,304.64 (caries+ fillings+extraction/ tooth) during primary dentition. 7.303.46 (caries+ fillings+extraction/ tooth)+ ( caries+ fillings+extraction/ tooth) during mixed dentition and 11.294.13 (caries+ fillings+extraction/ tooth) for permanent dentition means that all of the level is at high intensity. 2. In the study of children with gingivitis, 50% of them had gingivitis with primary teeth, 60.9% with mixed teeth, and 58.8% with permanent teeth. The proportion of healthy children without gingivitis was 50% for primary dentition, 39.1% for mixed dentition, and 41.2% for permanent dentition. However, there is a statistically significant result (p <0.001) of the more increase in tooth plaque of poor oral hygiene the more increase in gingivitis. 3. The proportion of “good” condition in the study was 30% for primary dentition, 39.1% for mixed dentition, 35.3% for permanent dentition, the “mean” rate was 70% for primary dentition, 56.5% for mixed dentition and 58.8% for permanent dentition. The “insufficient” rate was 4.4% for mixed dentition, or the lowest for 5.9% for permanent dentition. There were no statistically significant differences (p> 0.05) between oral health and the HSP status of the children in the study. According to the results of the survey, it is observed that the oral health status among the respondents is insufficient.

The prevalence and type of congenital cleft of the lip and palate in mongolia, affiliation of the patients Background: The prevalence of congenital cleft lip and palate is different internationally. There are some research papers which identifying the rate of this abnormality in Mongolia, the latest one shown the result that one cleft case for 1072 live births (Ayanga GN et all, 2012). Aim: to determine/update the prevalence and types of congenital cleft lip and palate in Mongolia Materials and methods: we include the data from all cleft patients who were born between 01 of January, 2011-31 of December, 2021 to this survey retrospectively. We used the e-history for cleft patients, which developed by the department of Maxillofacial surgery since 2011. Results: Totally 1308 cleft patients included to our survey. The prevalence is one cleft cases for 652 live births in Mongolia, and 34,1% is cleft of the lip, 41,4% is cleft of the lip and palate, and 24,5% is cleft palate only of all cases. Also the rate was differently among provinces, as one for 429 live births in Khuvsgul province, and one for 1223 live births in Uvs province. Conclusions: the prevalence of cleft lip and palate in Mongolia 1000:1.5 or one for 652 live births. The highest rate established in Khuvsgul province, and the lowest in Uvs province.

BACKGROUND. Since the implementation of Pre-medical curriculum the first students have successfully finished their courses. However, formative and summative evaluation of the curriculum hasn’t been done. The purpose of this study is to analyze the correlation between satisfaction level and knowledge acquisition of the students. MATERIAL AND METHODS. The study was completed at School of Bio-medicine of MNUMS and Division of Education and Policy. We have studied correlation of grade point average (GPA), integrated final exam score, and general admission test/entrance examination test scores (Chemistry and Biology test scores) of total of 395 students’. RESULTS. A total of 395 students’ 4 types of test scores have been used in this study. Out of 395 students, 68 (17%) male, 327 (83%) female and 317 (80%) medical and 78 (20%) health sciences pre-medical students. Results have shown that, both general admission test score and university pre-medical GPA had a direct, average line correlation. In other words, students who have had a higher general admission test score; have scored higher GPA scores at university. The comparison of GPA with the integrated final exam score has shown a direct, average line correlation, which proves the validity of the GPA.The highest factor among was the teacher methodology skills scoring 4.0. The lowest factor was teaching facilities and student lesson load scoring 3.7. CONCLUSION. The satisfaction level is higher the average. The student GPA, general admission test score, both have a direct or average line correlation.

Since 1990s years Evidence-Based Medicine (EBM) was very important in the world, especially in developed countries, as well as, in UK, USA and others. The emergence of evidence-based practice has to be one of the success stories of the 1990s. In the space of more twenty years the movement has had a significant impact on health care and health policy. Especially, in the UK there are centres, amongst others, for evidence-based medicine, evidence-based child services and mental health services. The depth of influence within UK evidence-based medicine has been paralleled by a breadth of expansion internationally. The movement has rapidly become a global phenomenon transcending national boundaries. An international network to support the development of EBM has developed swiftly in the form of the Cochrane Collaboration, which now has centres in the UK and continental Europe, North and South America, Africa, Asia and Australia.
Over the last few years evidence-based medicine’s approaches have been developed in most health fields, including evidence-based therapy, surgery, gynecology, pediatry, dentistry, nursing, public health, physiotherapy and mental health. Progress has not stopped there: uniquely it would appear that an approach originating in medicine is being advocated and adopted in more distant fields of professional activity, including social work, probation, education anf human resource management.
The development of EBM was thus based on three principles: 1) Doctors must be taught how interpret and use research findings. 2) Doctors must be helped to use research to inform practice throughout their careers. 3) Research findings must be disseminated to doctors in more efficient ways.
Evidence-based practice (EBP) is seen as consisting of five explicit steps:
1. First, the clinician, faced with a patient or group of patients, constructs a specific question concerning their care. This could relate to the diagnosis of the problem, the prognosis or likely outcome of the problem, the most effective treatments and their possible side-effects, or the best method of delivering services to meet patients’ needs.
2. The second stage consists of finding, as efficiently as possible, the best evidence to answer the clinical question.
3. Third, the clinician evaluates the evidence for its validity and usefulness.
4. Fourth, the results are applied to the specific parient or group of patients.
5. Finally, the outcome of the intervention is evaluated.
The aim of EBM is to bring into clinical practice and the fourth stage of the process involves applying the research findings to the care and management of individual patients. The application of clinical research to the care of individual patients presents a core challenge for EBP. The process of evaluation is central to evidence-based medicine. Clinicians using EBM are encouraged to evaluate continually their own performance in relation to their use of EBM and are encouraged to evaluate the validity and importance of clinically relevant research.
But introducing evidence-based medicine’s principles has been needed to very long time in the Mongolian health sector. Especially, we have been needed in a special policy for developing EBM.
Also we have need to knowledge and detailed informations about EBM and it’s principles. Because, in our country should be stimulate this activity.

Introduction: Delayed or wrong diagnosis in patients with appendicitis can result in perforation and consequently increased morbidity and mortality. Serum total bilirubin may be a useful marker for appendiceal perforation. The aim of this study was to determine and compare pre-operative total bilirubin level and other diagnostic tools (patient age, duration of symptoms, Alvarado score, white blood cell, C-reactive protein, ultrasound and contrast enchanced CT scan) in cases of acute appendicitis in order to improve the clinical decision making. Materialsand methods: We identified 102 patient with acute appendicitis after excluding those with other causes of hyperbilirubinemia among the 180 patients that underwent a laparoscopic or an open appendectomy from June, 2011 to March, 2015 in UB Songdo Private Hospital. These cases were also subjected to liver function tests and clinical diagnosis was confirmed perioperatively and postoperatively by histopathological examination. According to histological results, these cases were classified two groups: positive(acute appendicitis with perforation and/or gangrene) and negative(acute appendicitis without perforation or gangrene). Their clinical and investigative data were compiled and analyzed. Statistical analysis was performed using independent sample t test, Chi square test, and direct logistic regression. The level of significance was set at P< 0.05. Results: Serum total bilirubin was found to be significantly increased(1,5mg/dL) in case of negative group and much higher (3,6mg/dL) in cases of positive group (P <0.001). The level of total bilirubin was higher than 3 mg/dL in cases of gangrenous/ perforated appendicitis while in cases with acute appendicitis it was lower than 3 mg/ dL. Also Alvarado score (P <0.01), C-reactive protein (P <0.001) and contrast enchanced CT scan (P <0.05) were statistically significant diagnostic tools for acute appendicitis. Conclusion: Assessment of preoperative total bilirubin is useful for the differential diagnosis of gangrenous/perforated appendicitis.

Introduction: Delayed or wrong diagnosisin patients with appendicitis can result inperforation and consequently increasedmorbidity and mortality. Serum total bilirubinmay be a useful marker for appendicealperforation. The aim of this study wasto determine and compare pre-operativetotal bilirubin level and other diagnostictools (patient age, duration of symptoms,Alvarado score, white blood cell, C-reactiveprotein, ultrasound and contrast enchancedCT scan) in cases of acute appendicitis inorder to improve the clinical decision making.Materialsand methods: We identified102 patient with acute appendicitis afterexcluding those with other causes ofhyperbilirubinemia among the 180 patientsthat underwent a laparoscopic or an openappendectomy from June, 2011 to March,2015 in UB Songdo Private Hospital.These cases were also subjected toliver function tests and clinical diagnosiswas confirmed perioperatively and postoperativelyby histopathological examination.According to histological results, these caseswere classified two groups: positive(acuteappendicitis with perforation and/organgrene) and negative(acute appendicitiswithout perforation or gangrene). Theirclinical and investigative data were compiledand analyzed. Statistical analysis wasperformed using independent sample t test,Chi square test, and direct logistic regression.The level of significance was set at P< 0.05.Results: Serum total bilirubin was foundto be significantly increased(1,5mg/dL) incase of negative group and much higher(3,6mg/dL) in cases of positive group (P<0.001). The level of total bilirubin washigher than 3 mg/dL in cases of gangrenous/perforated appendicitis while in cases withacute appendicitis it was lower than 3 mg/dL. Also Alvarado score (P <0.01), C-reactiveprotein (P <0.001) and contrast enchanced CTscan (P <0.05) were statistically significantdiagnostic tools for acute appendicitis.Conclusion: Assessment of preoperativetotal bilirubin is useful for the differentialdiagnosis of gangrenous/perforatedappendicitis.

Learning objectives: After reading this article, readers of the journal should be able to:1. Get information about some aspects of the health sector’s structure and it’s management in the world;2. Understand about current situation of Mongolian health policy (fragmentation of national health policy; but steel has absence of policy on primary health care and medical care);3. Get a short information about health strategic objectives of the official documents: “Millenium Development Goals-Based Comprehensive National Development Strategy of Mongolia” (2007-2021); “Master Plan of Mongolian Health Sector” (2006-2015)4. Understand some ideas for improving management of Mongolian Health Sector on implementation of health strategic objectives, defined by the above mentioned official documents.Summary: Now, in our country, as well as in many countries of the world, has been increased a role of improving health policy and management of the health sector for it’s development. Firstly, we have been needed to Integrated National Health Policy; Secondly, we should be given a more attention to realization of health strategic objectives, already defined by the official documents, which approved in high levels (Mongolian Parliament and Government). The author of this article had trying to some own ideas for improving management of national health sector.

Recently, we had participated in the International Workshop on IT solutions for Health Research Governance and Management, which held in Ha Noi, Viet Nam. The WHO Regional Office for the Western Pacific has led and supported the development and implementation of integrated IT-based health research management systems in Cambodia, Fiji, the Lao People’s Democratic Republic, Mongolia, the Philippines, and Viet Nam. The workshop is proposed for these 6 countries to share experiences and to explore next steps to achieve sustainable IT-based solutions in health research governance and management. During this workshop we – all participants actively discussed about that how IT can facilitate better and more efficient health research and how to improve research governance and management in each country.Depending on challenges in these fields for Mongolia we all, especially all health science organizations and whole researchers should be thinking seriously about next issues: 1) To improve a collaboration between health research organization and medical practical organization; especially to increase a laboratory technical and technological levels and quality of analyses; in this field should be given more attention from two sides (science and practical sides); 2) To give an attention on improvement of theoretical knowledge and research skills for young doctors and young researchers, regularly; 3) To improve a processes related to improvement of research theme, methodology and involvement of researchers to research projects; 4) To give emphasis on problems related to the clinical trials and ethical issues, previously; 5) To give a more attention on detailed planning of any research work and monitoring, auditing it’s implementations; 6) Most important is documentation or reporting and approvals of any health research work’s results; for this to use of IT solutions, widely; 7) For these goals: a) to improve “MongolMed” online system and increase it’s regular using; b) to build “The Mongolian Health Research Portal”, immediately. Because, today throughout have been needed in emerged development of evidence-based medical practice, but in our country has been continued a health research-medical practice gap.

Introduction: The WHO has been recommended to the member countries to develope a national health system based on PHC. Also the WONCA has given emphased on improvement of rural health. There have been limited research studies done in Mongolia on rural health needs and improvement of PHC’ organizations for rural areas. Goal: To study on thinks of rural medical personnel and rural citizens about activity of PHC’ organization and it’s change in the nearest future. Objective: 1) To introduce with current situation of Soum and Inter-Soum hospitals; 2) To study on thinks of rural medical personnel about activity of Soum, Inter-Soum and Aimag hospitals and it’s further changing; 3) To study on satisfaction of rural citizens from activity of primary care organizations. Material and Method: This study was covered 205 rural medical personnel (physicians - 41, feldshers - 43, nurses - 65, laboratory technicians - 11, other personnel - 45) and 210 rural citizens (local government’ personnel – 86, workers of private entities – 41, herdesmen – 40, pensioners – 11, others – 32) from Arkhangai, Gobi-Altai, Dundgobi, Sukhbaatar, and Tuv aimags. Used a questionaire method (Questionaire for rural medical personnel was include 14 questions; for rural citizens – 13 questions). For analysis of collected materials were used biostatistic methods. Results: Among the rural medical personnel – respondents 77,6% were assess positively about current soum hospital activity, which shown that a soum hospital can been implemented own main functions – to delivery PHC to rural people. Also 67,3% of respondents have thinking positively about Bag’ feldsher unit and 74,6% of them have given a more attention to improve working condition for Bag’ feldshers. Most of respondents – rural citizens (62,9%-80,5%) has been satisfied with soum, inter-soum hospitals care and bag’ feldsher unit service. They have suggestions how to improve rural health facilities. Finally, most of respondents (as rural health personnel, as Conclusions: 1. Based on the results of our study (67,3-77,6% of respondents – rural medical personnel and 62,9-80,5% of rural citizens have a satisfaction with Soum and Inter-soum hospital services, and ctr.) we can conclude that rural health facilities in common have been functioned normally. 2. Most of rural health personnel (68,8% of respondents) has been supported to changing current Soum hospital and its improving as Soum health centre (by thinking 62,4% of respondents) in the nearest future. 3. Also most of rural citizens (77,7-83,3% of respondents) has thinking about changing and improving rural health facilities, especially about Soum health centre. It is very important for providing a health reform in Mongolian rural areas, successfull.

Introduction Currently nations throughout the world are studying and disseminating their traditional medicine and Mongolians create new trend and attitude of medical care and service besides resuming their great heritage and culture of traditional medicine. World Health Organization recommends countries to develop their traditional medicine linking with modern science of medicine, based on particular surveys and analyses are conducted. However, the basic concept for developing Mongolian traditional medicine have been developed and implemented twice, “Government policy on Mongolian traditional medicine”, studies plan of united theory of traditional and modern medicines in master plan for developing Mongolian science and technology studies plan, “Master Plan for health sector” – the policy renovation for 2006-2015, “The frame of implementing master plan for health sector” (2006 2010) and other documents have been developing and implementing since 1990s but lack of studies on whether effective influences of traditional medicines to which stages and to which clinical symptom of dominated diseases among population and whether the traditional medical care meets with customers’ demand are considered as burning issues in determining the further development of traditional medicine. As well as, there are lots of issues that have not been studied and determined yet as diagnosis of traditional medicine, clinical and preventive guidelines and standards have not been developed, have not been involved in united system of health information, structural and operational management of institutions that hold traditional medical care and demands of medical care and professional staffs of traditional medicine. Aim of the study: To study and evaluate the current situation of Mongolian traditional medicine as well as determine trends in future. Purposes of the study: 1. To study the historical periods of the development of Mongolian traditional medicine that have been 01/01 developed since 1921 when health sector initiated in Mongolia. 2. To study Mongolian traditional medical service service by health care levels. 3. To study and to determine the human resource demand and capacity of medical care of traditional medicine. 4. To develop the management model of showing medical care of traditional medicine and health systems based on coherences of western and oriental medicines. Materials and methods This study observed the population criteria of patients who were treated in hospitals, hospital service levels, methods of diagnosis and treatment, common diagnose causes, types of treatment and the results of treatment in order to study the implementation of hospital service of Mongolian Traditional Medicine. The study was conducted in 3 different levels of hospitals: as a primary level hospital Umnudelger soum hospital, Khentii aimag /province/ was chosen, as a secondary level hospital we selected Center for Traditional Medicine of Khentii province, as a tertiary level hospital we chose the clinical hospital of Traditional Medicine, Science, Technology and Production Corporation (CHTMCST). We investigated aid and service information of Traditional Medicine obtained from 952 histories of patients who were treated in hospitals in 2006 and 2007. Analysis was made on policy documents by using analyzing and integrating related document. The study data were developed by making descriptive analysis on digital information, raising related hypothesis, checking it with statistical tests and processing in results. Research data was processed by Microsoft Excel 2007, statistical data was performed by SPSS-12.0 program and descriptive analysis was performed in quantitative information. Result By concluding the activities organized and implemented nationally on the field of traditional medicine for the period since 1921 when health system in Mongolia initiated, it could be considered to divide into stages as, beginning period of developing Mongolian traditional medicine in coexistence with modern health science (1921-1930), deprived period of Mongolian traditional medicine from national service (1930-1958), restoring period of developing Mongolian traditional medicine (1959-1999) and the ensured period of Mongolian traditional medicine as a composition of health science system (1999 up now). It was determined that the percentage of female patients is more than twice (2.3) higher (63.7%) in contrast with male patients (30.1) in all three-level hospital aid. It means in each level of three level hospitals female patients were more in number. Surprisingly, 80.9% of the patients’ age was over 35 and from them 44.7% was at their pension age. This age group is rapidly predominant compared with others. In chosen hospitals patients with diseases and disorders of digestive, urinary-genital, nervous and blood circulation systems are cured commonly. In three-level hospitals examining patients using methods of traditional medicine was differed (p=0.01). In doubled number, 401 or 42.1% of doctors combines both modern and traditional methods of treatment (95% trust limit 42.1+0.017). We investigated if types of treatment depend on the level of hospitals in urban and rural areas by x 2 criteria and concluded that it had statistical significance or the percentage of treatment types went up if the level increased (p