Background: The continuous annual increase in the prevalence of diabetes mellitus (DM) poses significant challenges not only within our nation but also globally in the control and management of tuberculosis. Aim: This study aimed to determine the incidence of pulmonary tuberculosis among individuals with type 2 diabetes mellitus (T2DM) residing in six central districts of Ulaanbaatar and to investigate associated factors. Materials and Methods: A cross-sectional study design was employed. Participants aged 18 years and older diagnosed with T2DM and receiving care at endocrinology clinics in six central districts of Ulaanbaatar were selected using systematic random sampling. Presumptive TB cases were identified through a structured questionnaire and chest X-ray. Sputum specimens were collected and subjected to smear microscopy and Xpert MTB/RIF assay for tuberculosis detection. Cases confirmed by laboratory diagnosis, currently undergoing tuberculosis treatment and previously treated cases as per questionnaire data were classified as tuberculosis cases, and prevalence was calculated. Results: A total of 1,644 individuals with T2DM were enrolled in the study, of whom 836 (50.9%) were female, with a mean age of 58 years (range 19–89). The overall prevalence of presumptive TB cases was 10.5% (n=172; 95% CI, 9.0–12.0). Among 112 suspected cases from whom sputum samples were obtained, 10 (8.9%; 95% CI, 4.9–15.7) were laboratory-confirmed for M.tuberculosis. Notably, 7.2% (6 cases; 95% CI, 3.4–14.9) of asymptomatic individuals with abnormal X-ray findings were diagnosed with tuberculosis. According to questionnaire responses, 9 participants (0.5%; 95% CI, 0.3–1.0) were undergoing tuberculosis treatment, and 53 (3.2%; 95% CI, 2.5–4.2) reported a previously treated TB cases. The overall prevalence of tuberculosis among individuals with diabetes was 4.4% (n=72; 95% CI, 3.5–5.5). Stratification by age and sex revealed a significantly higher prevalence among males (5.9%; n=48; 95% CI, 4.5–7.8) compared to females (2.9%; 95% CI, 1.2–4.2) (p=0.002), indicating a twofold increased risk of tuberculosis in males. Although no statistically significant differences in tuberculosis prevalence were observed across age groups (p>0.05), a declining trend in prevalence with older age was noted. Conclusion The prevalence of tuberculosis among individuals with type 2 diabetes was 4.4% (n=72; 95% CI, 3.5–5.5), with a significantly higher rate in males (p=0.002) and a decreasing trend with increasing age. Among asymptomatic individuals exhibiting radiographic abnormalities, 7.2% were confirmed to have tuberculosis via laboratory testing

Background: Pregnancy induces multiple physiological, metabolic, and immunological alterations that increase susceptibility to infections, often necessitating antibiotic therapy. Evaluating the rational use of antibiotics among pregnant women is crucial for optimizing antimicrobial stewardship at the hospital level, improving clinical pharmacy services, and reducing the risk of antimicrobial resistance. Aim: To assess the rational use of antibiotics, including indication, selection, dosage, and treatment duration—among hospitalized pregnant women in the Department of High-Risk Pregnancy and the Department of Preterm Birth at the National Center for Maternal and Child Health. Materials and Methods: A retrospective study was conducted using a specifically designed data collection form to assess antibiotic use among inpatients at the National Center for Maternal and Child Health. Descriptive statistical analyses were performed using SPSS version 29.0. Results: A total of 348 pregnant inpatients were included, with a mean age of 31.6 ± 6.9 years. The mean length of hospital stay was significantly longer in the Department of Preterm Birth (12.5 ± 5.0 days) compared to the Department of High-Risk Pregnancy (5.9 ± 2.0 days; p < 0.001). The indications for antibiotic use were therapeutic in 39.1%, prophylactic in 33.0%, and unspecified in 21.3% of cases. The most frequently prescribed antibiotic regimen was a combination of β-lactams and metronidazole (29%). While the dosing of cefazolin and cefotaxime was largely appropriate, notable dosing discrepancies were observed in the dosing of ampicillin and azithromycin. Based on the U.S. FDA pregnancy risk classification, among a total of 762 antibiotic prescriptions, 87.0% belonged to category B, 8.8% to category C, and 4.2% to category D, with no significant variation across trimesters (p = 0.695). Conclusion The assessment of antibiotic use among hospitalized pregnant women at the National Center for Maternal and Child Health revealed that 39.1% of the prescriptions were therapeutic, 33.0% were prophylactic, and 21.3% lacked a clear indication for use. β-lactam antibiotics were the most commonly used agents, frequently combined with metronidazole. Based on the FDA classification system, 87% of the prescribed antibiotics belonged to category B, 8.8% to category C, and 4.2% to category D. These findings indicate inappropriate antibiotic use and insufficient implementation of antimicrobial susceptibility testing. Therefore, strict adherence to antibiotic stewardship programs and strengthening of clinical pharmacy services are necessary to improve antibiotic use practices.

Background: Studying the human embryonic and fetal organ systems development patterns and determining their quantitative indicators is of scientific and practical importance in medicine and health in every nation.
Distortions and pathologies during the development of the embryo are the causes of congenital disabilities. Among the congenital malformations, facial malformations are the 3rd place, including cleft lip and palate in 70% and Srouzon's syndrome in 30%. In addition, abnormalities due to changes in the size, shape, and position of the jaw are also mentioned in the 2021.04.21 issue of Morphology magazine in the study "Morphometric parameters of the bones of the skull and face during the development of newborns and fetuses". In our country, Ariuntuul G (2005) determined that cleft lip and cleft palate occur at 0.76/1000 or 1 in 1314 live births, while Ayanga G (2012) found that it occurs at 1 in 1072 live births or 0.93/1000. Moreover, the eye cup dimensions of Mongolian fetuses aged 16 36 weeks have a positive linear relationship with the gestational age determined using ultrasound by Nandintsetseg B (2015) et al. Compared with the other countries, the eyecup is slightly wider, and the outer edge distance is similar, whereas the inner edge distance is shorter. Purpose: To summarize research work and determine the embryonic development of bones involved in the formation of the face and facial parts, the period of bone formation, the point of ossification, and the period of formation. Methods: During fetal development, human organ systems grow and develop at different rates but in a particular relationship. This feature of growth and development is also clearly observed in the structure of the head and facial bones, and the results of researchers who have studied this aspect are selected in the articles. Results: Embryonic and fetal development of bone are clinically significant not only from the point of view of its morphogenesis but also from the point of view of congenital disabilities. Conclusion In the analysis of the sources, most of the works on the prenatal period of the development of the same body have studied the development of specific structures of the face and facial area, such as the palatine bones and nasal bones, or have generally covered the development of particular systems in the embryo and fetus, and face, there are relatively few works that show the entire dynamics of growth and development of facial bones.

Abstract National Occupational Standards specify standards of performance that people are expected to achieve in their work, and the knowledge and skills they need to perform effectively. The National occupational standards for supporting teaching and learning in schools were developed to help improve the capacity and capability of the school workforce; they can make an important contribution to raising standards in schools.
National Occupational Standards describe best practice by bringing together skills, knowledge and values. They are valuable tools as benchmarks for qualifications as well as for defining roles at work, staff recruitment, supervision and appraisal.
Globally the roles and scope of work for technicians and pharmacy support workforce cadres vary greatly according to country and practice areas within that country. The School of Pharmacy MNUMS and Mongolian Association of Clinical Pharmacist and Association of Pharmaceutical Management has developed 4 phases National Occupational Standards.

Background: A midwifery services are recognized as one of essential health care and services. The amplification of trained midwives plays very important role to improve the quality of and access to health care services as highlighted in the global Human Development Report [1]. Obstetric care is the integrated specialized interventions aimed to detect, monitor, manage delivery, treat and prevent illnesses of mothers, fetus and newborns in pregnancy, childbirth and postnatal periods. Every year, 287,000 women die from complications related to pregnancy and childbirth, and 2.9 million newborns die before they reach the age of four weeks worldwide. The majority of the preventable maternal and newborn deaths occur in low-income countries [3]. Goal: This assessment was aimed to review the current situation and legal framework of midwifery services and comprehensive competencies of midwives, and to provide baseline data for the project as well as evidence based recommendations for further improvement of midwifery services in Mongolia. Materials and Methods: In order to assess the current status of midwifery services and integrated competencies of midwives, a range of quantitative and qualitative methods were used. A cross- sectional study for assessing the quality of obstetric care and practice was conducted by using observation checklists, questionnaires and interview guides. Midwives who are providing obstetric care in Mongolia were involved in the assessment. Results: A total of 321 midwives from NCMCH, and 2 maternity hospitals of Ulaanbaatar and 21 aimags were involved in the assessment. Out of them 97.2% were female and the mean age was 37.2±10.1 [95%CI: 36.03-38.21]. The mean of working years in health sector was 14.54±10.9 years and mean of working years with the current institution was 11.7±10.1 years. Minimum work experience was few months and maximum was 38 years. A majority of the assessed midwives hold some abilities sufficiently such as keeping medical documents during pregnancy [4.23; 95%CI: 4.15-4.32], educating and giving advice to the customers about after and before the pregnancy period [4.01; 95%CI: 3.91-4.11]. A majority of the assessed midwives answered holding some abilities as important, such as basic knowledge of mother and child public health care in the fertility system [4.11; 95%CI:4.00-4.21], implementing experiences [4.07; 95%CI:3.97-4.19], and very important documents for the Obstetricians Association to know about midwives’ practical and professional activity [4.05; 95%CI:3.92-4.17]. None of the midwives took “A” or point indicates highest level. 40.5 percent of assessed midwives took “D” or “Able to make a relatively easy content; Lack of general knowledge, skills and practices”. One third of participated midwives took “F” indicating lack of knowledge, skill and practice. Moreover, one fifth of the midwives took “C” indicating average level, understood most of the content, skilled moderately, and prepared enough to practice more in this field. Even though rural midwives got average level (22.0%) score 4.1 functions more than city midwives, it didn’t have any difference in the statistic correlation. 3.3 percent of all participant 7 midwives took “B” indicating above the average level in the knowledge test. The midwives have told training for them hadn’t organized frequently which is shown in the quality assessment. Conclusions Furthermore, it is necessary to increase the skill of midwives who would perform complex care based on clinical evidence to reveal the risks faced to maternal and infant health, prevent from degradation and manage safe birth.

Although all the pharmacy programs (1 public and 2 private) in Mongolia comply with the national standard for pharmacy higher education D 723400 (MNS 5323-126: 2012), competence based learning has not been introduced yet. Also, pharmaceutical public health service needs have not been assessed in community pharmacies of Mongolia. Our goal was to assess the learning needs of pharmacists’ public health competencies and link pharmacy education with the health needs of populations.This cross-sectional, in-pharmacy survey was conducted in a simple random sample of community pharmacies in 6 districts of Ulaanbaatar city central region, which provide price discount on selected drugs through national health insurance. The survey was developed with evidence for reliability and validity and focused on two main needs assessment: pharmaceutical public health (PPH) serviceprovision and PPH competencies learning. Open ended and 3 point scale (1=great benefit; 2=some benefit; 3=no benefit) questions were used to obtain: general information, public health service knowledge, and needs of learning PPH competencies. Descriptive statistics and comparisons using STATA 13 were performed.A total of 248 surveys were obtained (pharmacists n=82; customers n=166). Pharmacist knowledge/skills greatly impacted the public’s decision to use expanded services. The customers reported high levels (75.3%) of needs with pharmacists providing advice on health promotion and healthy life style. 47.6% of the pharmacists replied having knowledge on health promotion and disease prevention is a great benefit to their practice.Our findings indicate that the public is very interested in pharmaceutical public health services and believe they will benefit. Also pharmacists need to be trained ecessary competencies.

Introduction: Mongolian Traditional Medicine development has been rapid in recent years, so we need to pay attention on one part of treatment which is plant parts. It is a drug safety issue to standardize the traditional medicine. It is necessary to investigate biological active substances in plant, animal and mineral origin drug sources for the further evidence based usage of traditional recipe. Purpose: The determination of biological active substances in traditional “Suman mod-4” recipe. Methodology: To determine “Suman mod-4” (consist of Caesalpinia sappan L., Kaempferia galangal L., Daemonorops dracon Bl, Sal-Ammoniac) traditional medicine’s active constituents, by Chinese and Mongolian National Pharmacopeia (2012) were used thin layer chromatography (TLC) and high performance liquid chromatography (HPLC). Result: We developed optimal methodology for the identifying of biological active substances in “Suman mod-4” compound widely used in Mongolian traditional medical practice. And were determined biological active substance measurements in four samples of traditional recipe “Suman mod-4’ from different drug factories in Inner Mongolia. Conclusion: We determined amount of biological active substances in traditional “Suman mod-4” recipe: Bracial Caesalpinia sappan L tissue consist of 2.9847- 3.6716 mg/g, and B Caesalpinia sappan L tissue consist of 2.9214-3.4951 mg/g active ingredients respectively.

Introduction. The safety and effi cacy of fi nished pharmaceutical products depend on its stabilityattribute. Stability requirements were included for fi rst time in Good manufacturing practice standardMNS 5524:2014. The pharmaceutical manufacturer is responsible to conduct stability studies and tosubmit the report as part of marketing authorization documentation.Purpose of the study. The purpose of this study is to conduct ongoing stability study of the mostlyproduced domestic medicine to monitor the product over its shelf-life.Materials and Methods. As a material used 2 locally produced Paracetamol (Acetaminophen INN) 500mg tablets (local manufacturer (LM) 1 with batch number 271110, LM 2 with batch number 441110). Asa method we used shelf-life specifi cation: Mongolian national standard of Paracetamol 500 mg tablets,MNS 4358:2007. Testing frequency was at 0 time (when tablets were produced) and at 12, 24 and 36months (study was covered the shelf-life).Results. In frame of this study we defi ned the most produced product as Paracetamol (AcetaminophenINN) 500 mg tablets. From the LICEMED- medicines registration record we found 8 tablets, containingAcetaminophen in 500 mg. Two of them were produced locally. These two products were involved inongoing stability study. Testing results showed that no any stability issues over the defi ned shelf life.Discussion. The shelf life was defi ned as 36 months, initially by manufacturers before productsregistered. After a marketing authorization has been granted, the stability of the fi nished pharmaceuticalproducts should be monitored according to a continuous appropriate program that should be permittedthe detection of any stability issue associated with the formulation in the container closure system inwhich it is marketed.Conclusions. After 36 months, testing results were in acceptable limits, selected products wereremaining their quality over the shelf-life.

IntroductionCurrently there are 31 pharmaceutical manufacturers in Mongolia. The first standard on Goodmanufacturing practice was adopted in 2005 and during these 9 years the Good manufacturing practicestandard was upgraded twice in 2011 and 2014, and the latest version reached to WHO GMP guidelinelevel.Purpose of the studyAccording to the Law of Medicine and medical devices of Mongolia, all pharmaceutical manufacturersshould comply with the Good manufacturing practice standard MNS 5524:2014. The study was aimedto asses GMP implementation level among local pharmaceutical manufacturers and to define mostlyobserved deficiencies in three categories as “critical”, “major” and “minor”.Materials and MethodAll stable operating pharmaceutical manufacturers were asked to be involved in this study accordingto the Helsinki declaration and 11 of them were involved. Direct observation method was used for thisstudy. WHO guideline on Good manufacturing practice: Main principles and on Sterile products wasused as the criteria of the assessment.ResultsAll deficiencies observed during the study were classified into three groups as critical, major and minorand the frequency was defined.Conclusions:The critical deficiencies are related mainly with the design and general layout of the premises and heatingventilation and air conditioning system. It requires investment and proper planning from the manufacturers.The major deficiencies are mainly related to documentation, qualification and validation.The minor deficiencies are with regard of documentation system, technical requirements of equipmentand storage area condition and its management.For taking corrective actions of major and minor deficiencies do not require investment, but it requirestime, training, implementation, monitoring and continuous improvement from the manufacturer.

IntroductionThe detection of adverse drug reactions has become increasingly significant because of introduction of a large number of potent toxic chemicals as drugs in the last two or three decades. Adverse drug reaction (ADR) monitoring and reporting activity is in its infancy in Mongolia. The important reason is lack of awareness and lack of interest of healthcare professionals in ADR reporting and documentation.GoalTo evaluate implementation and trends of health care professionals toward adverse drug reaction reporting at first, second and tertiary level hospitals.Materials and MethodA prospective study was carried out in first and second level hospitals of Khentii, Dundgovi, GoviAltai, Selenge and Uvurkhangai provinces, Sukhbaatar, Songinokhairkhan district hospital and First maternaty hospital. From tertiary level hospitals were selected First national hospital, Third national hospital, National center of oncolgy, National center of traumatolgy. The questionnaire survey involved total of 175 doctors and pharmacists.ResultsThe study result have shown that most of health care profeesionals (76 – 80%) of first and tertiary level hospitals have known about legal bases and theie duties for the ADR reporting than health care professionals (69%) of secondary level hospitals. And, pharmacists more activily involve in ADR reporting than doctors. The main reasons of healthcare professionals ADR underreporting were lack of time to report, lack of awarness about ADR and not knowing importance of ADR repoting. The implementetion extent of ADR reporting was in tertiary level hospital better than in secondary level hospitals. Lacking of clinical pharmacists and clinical pharmacologists and unproper activitity of Drug therapeutic committee in secondary level hospitals were the reason of poor implementing and underreporting of ADR.ConclusionThe study result has shown that there is needed to encourage doctors to the adverse drug reporting activity and implementation of drug safety should be strengthen in each level of health care system.