Introduction: Antibiotics are commonly prescribed in paediatrics.¹ Children were 1.3 times more likely to be treated with antibiotics compared to adults.² Especially, antibiotic prescription is higher in children aged under 5 years.³ Purpose: To identify the most widely used antibiotics in the age group of 0-5. Objectives of the study:
1. To identify the most widely used antibiotics and classify them by pharmacological group
2. To analyze the pharmaceutical dosage forms of commonly prescribed antibiotics for infants and toddlers Methods: In our study, we selected 20 pharmacies from 6 districts (Bayanzurkh, Bayangol, Khan-Uul, Songinokhairkhan, Chingeltei, and Sukhbaatar) of Ulaanbaatar city using a single random sampling method. A total of 496 antibiotic prescriptions written for children aged 0-5 years in 20 pharmacies were analyzed. Antibiotic prescription forms for children aged 0-5 years registered in the pharmacies in November, December 2023, and January 2024 were collected. The results were processed using “SPSS 29.0.2” program. Result: Among a total of 496 antibiotic prescriptions written for children, 341 were written in solid dosage form and 155 were in liquid dosage form (suspension). Amoxicillin 250 mg and Amoxiclav 312.5 mg were mostly used from Penicillin group for the treatment of infants and toddlers. Clarithromycin 125mg/5ml from Macrolide group had an important role in treatment. Cefixime 400 mg from the Cephalosporin group was used in some cases such as diarrhea and vomit. Conclusions
1. Amoxicillin, Amoxiclav, Clarithromycin (Penicillin, Macrolide) antibiotics are the most widely used in the treatment of infants and toddlers.
2. It has concluded that antibiotic prescriptions for infants and toddlers mainly include solid and suspension antibiotics.

Introduction: Among the ancient medical books, manuscripts written in clear script, with unique vocabulary and treatment methods, have been found. The vocabulary in this work is very ancient, and the treatment methods are systematic, with few mentions of theoretical concepts. Most of the unfamiliar words were written in the pronunciation of the ancient Oirat Torghut and Dorbet. Some of these words were of Uyghur and Sartuul (Khui Khui) origin. Therefore, we worked to determine when and by whom this book was written, what its content was, and which direction of medicine it belongs to. Objectives: To study an ancient book written in clear script, containing Islamic medical knowledge, found in Mongolia. Results “The Healing Charm of Blue Ram” (Khökh khutsyn uvdis orshivai) records that Genghis Khan ordered Chagatai Khan to send him medical books from his land. He may have been in poor health shortly after the founding of the Chagatai state in 1225. Thus, he ordered Chagatai to send him books containing medical methods. It is reasonable to assume that the books were sent in 1226. At that time, the Chagatai state was highly developed, consisting of many ethnic groups, including Khorezm, Sartuul, and Uyghurs, who practiced Islam. In particular, the medical field was well advanced, resulting in many excellent doctors and medical books. We tried to list and explain a total of 15 words from “The Healing Charm of Blue Ram,” with many more to explore in the future. In general, it is hypothesized that many vocabulary related to medicine have spread to the Mongolian vocabulary through Arabic, Turkic, Uyghur, and Sartuul among the Western Mongolians. Conclusion: The ancient book “The Healing Charm of Blue Ram” found in Mongolia, written in clear Mongolian script, contains Islamic medical knowledge, as well as traditional Mongolian medicine methods, as is clear from the explanations of some vocabulary related to medicine. In the future, it is important to further clarify how Mongolian medicine and Islamic medical knowledge influenced each other and the contribution of Mongol khans to the development of the Ilkhanate and the Chagatai state in the study of the history of Mongolian medicine.

Background: Organ transplantation has been rapidly advancing in Mongolia in recent years. The number of successful kidney, liver, and bone marrow transplants performed in national central hospitals has been increasing annually. While the number of successful kidney transplants is increasing, post-transplant immune monitoring remains insufficiently studied. Aim: To assess post-transplant immune status by analyzing inflammatory cytokine levels in kidney transplant recipients Materials and Methods: A prospective cohort study was conducted at the First Central Hospital of Mongolia. Serum samples from kidney transplant recipients were analyzed using flow cytometry to measure the levels of 13 inflammatory cytokines, including TGF-β1, PAI-1, sTREM-1, PTX3, sCD40L, sCD25 (IL-2Ra), CXCL12 (SDF-1), sST2, sTNF-RI, sTNF-RII, sRAGE, CX3CL1 (Fractalkine), and sCD130 (gp130). Statistical analysis was performed to assess the results. Results: The mean creatinine level significantly decreased on post-transplant days 7 and 30 compared to pre-transplant levels (p<0.001, ANOVA). No statistically significant difference was found in the 13 cytokine levels between the high risk and low-risk groups based on creatinine levels on post-transplant day 30 (p>0.05). However, the levels of TGF-β1, CX3CL1, sTREM-1, and sTNF-RI showed statistically significant differences between post-transplant days 7 and 30 (p<0.05). No significant correlation was found between the measured cytokine levels and CRP (p > 0.05). On post-transplant day 7, sTREM-1 had a weak correlation with TGF-β1 (r=0.40, p=0.02) and sTNF-RI (r=0.36, p=0.05) but showed a strong correlation with CX3CL1 (r=0.65, p=0.0001). On post-transplant day 30, sTREM-1 remained strongly correlated with CX3CL1 (r=0.73, p=0.0001) and moderately correlated with sTNF-RI and TGF-β1 (r=0.45, p=0.01). Conclusions 1. The levels of TGF-β1, CX3CL1, sTREM-1, and sTNF-RI significantly varied between post-transplant days 7 and 30 (p< 0.05, T-test). 2. On post-transplant day 30, these cytokines were not correlated with CRP but were interrelated among themselves.

Background: Obesity, especially central obesity, is a risk factor for non-communicable chronic diseases such as dyslipidemia, type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVD), and metabolic syndrome (MetS). Aim: Study the association between the subcutaneous fat area (SFA) and visceral fat area (VFA) with lipid metabolism parameters in adults with MetS. Materials and Methods: Data from 1511 participants who visited the ‘NURA Mongolia’ Ai Health screening center between September 2023 and February 2024, including general information, DEXA (Dual X-ray Absorptiometry), and biochemical analysis results, were used. Metabolic syndrome (MeS) was assessed based on the harmonizing criteria 2009 (≥3 criteria). VFA and SFA were categorized into four groups using quartiles (Q1-Q4). Statistical analysis was performed using SPSS v26, including T-tests, multiple logistic regression (OR, 95% CI), and ROC (AUC) analysis. Results: The average age of the participants was 30.5±3.9 years, with a BMI of 25.1 kg/m², and 49.5% were male. The group with MetS (n=531) had significantly higher levels of VFA and SFA compared to the group that rated their health as relatively healthy and had no clinical diagnosis (n=979) (control group) (p<0.0001), with males showing higher VFA and females showing higher SFA (p<0.0001). The Q4 group for VFA had a significant association with MetS in males (4.611, 95% CI=2.394–9.591) and females (2.253, 95% CI=1.097-3.912) (p<0.001). Logistic regression analysis showed that increased VFA was more strongly associated with MetS in males (β=0.325, p<0.0001) and females (β=0.338, p<0.003) than BMI. The AUC for predicting MetS was 0.790 (95% CI=0.750-0.831) for VFA and 0.401 (95% CI=0.351-0.451) for SFA, with all results being statistically significant (p<0.001). VFA had a higher predictive value compared to other markers. Conclusion In healthy men with metabolic syndrome, VFA is more prominently defined, while SFA is higher in healthy women. Since VFA is a better predictor of metabolic syndrome than SFA, it increases the risk of diseases such as cardiovascular diseases and type 2 diabetes in men, whereas SFA in women serves as a protective factor.

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: Determining refractive errors among general education school students by age and gender Methods: The study was conducted using a cross-sectional model based on the examination records of 5,202 students from School No. 24 and School No. 37 by the ophthalmologist of the Chingeltei District Health Center in Ulaanbaatar. Results were analyzed SPSS. Result: The average age of all students included in the study was 11.37 ± 3.27 years. Among the participants, 62% (n = 3,208) were from School No. 24, and 38% (n = 1,994) were from School No. 37. Of the students from School No. 24, 18.6% (n = 597) had refractive errors. Specifically: Myopia was present in 17.2% (n = 552), with 6.1% male and 11.1% female. Hypermetropia was found in 0.68% (n = 22), with 0.43% male and 0.25% female. Astigmatism was detected in 0.72% (n = 23), with 0.34% male and 0.38% female. From School No. 37, 6.23% (n = 200) of students were diagnosed with refractive errors. Specifically: Myopia affected 5.23% (n = 168), with 1.96% male and 3.27% female. Hypermetropia was found in 0.16% (n = 5), with 0.07% male and 0.09% female. Astigmatism was present in 0.84% (n = 23), with 0.28% male and 0.56% female. There is a very weak negative correlation between myopia and age, as well as between myopia and gender, which is statistically significant. There is also a very weak negative correlation between astigmatism and age, which is statistically significant. Conclusion Our study found that among the types of refractive errors, myopia was the most common, with female students being more susceptible compared to males. The two schools included in the study represent both central (School No. 24) and peripheral (School No. 37) areas of Ulaanbaatar. Refractive errors were found to be more prevalent among students from the central school (School No. 24).

Introduction Gastric ulcer is one of the most common disorders considering the gastrointestinal tract, it affects 5% of the population around the world, so its prevention and management are considered very important challenges. Researchers have revealed several causes of gastric ulcer; these include an imbalance between aggressive and intrinsic defensive factors. Gastric ulcer is a very common gastrointestinal disease that may lead to dangerous complications and even death. The aggressive factors include non-steroidal anti- inflammatory drugs(NSAID),alcohol, psychological stress and Helicobacter pylori infection, cytoprotective intrinsic factors include mucosal blood flow, bicarbonate, mucus, cell renewal, growth factors, NO and prostaglandins, NSAID-induced gastric damage is known to be the most common and dangerous side-effect of these drugs and accounts for 25% of gastric ulcer cases.
Indomethacin (INDO) is considered to be the most common NSAID known to induce experimental gastric ulcer and has been documented to have a higher potential to cause gastric injury than other commonly used NSAIDs.
Most of the drugs which are used for wound healing are imported in Mongolia. It is required to develop drug formulation and increase local productions used for the treatment of wound healing. For the purpose of solving the above problems, we aimed to prepare new drug formulation from Cacalia hastata L. for the treatment. of wound healing. Cacalia hastata L. is a medicinal plant, member of the family Asteraceae. Cacalia hastata L. is widely used for the Mongolian traditional medicine to treat wound healing, gastric ulcer, poisoning fever, liver fever, bile fever, oral cavity, and gynecological diseases

Background: Renal impairment (RI) is a frequent complication of liver cirrhosis and is associated with increased mortality and morbidity. Liver transplantation (LT) serves as an effective treatment method for patients with cirrhosis who have impaired renal function. However, renal function often declines after LT, influenced by various factors. This study aimed to investigate the factors contributing to RI following LT in our cases. Methods: We analyzed the demographic data, preoperative and perioperative parameters, and postoperative outcomes of patients who underwent LT at the First Central Hospital of Mongolia from September 2011 to December 2022. Renal function was assessed by measuring the glomerular filtration rate using the Cockcroft-Gault creatinine clearance formula pretransplantation and at 24 hours, 72 hours, 7 days, 14 days, and 28 days post-LT. Results: Several factors increased the risk of RI among recipients. These included female sex (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.58–5.91), Child-TurcottePugh (CTP) scores of B and C (OR, 4.23; 95% CI, 0.92–19.41 and OR, 7.68; 95% CI, 1.67– 35.30, respectively), preoperative continuous renal replacement therapy (CRRT; OR, 5.86;95% CI, 1.1–31.21), and a high graft-to-recipient weight ratio (GRWR; OR, 3.45; 95% CI, 1.23–9.63). Additionally, the survival rates for recipients with RI post-LT were 93.4% at 1 year and 78.1% at 3 years. Conclusions Female sex, a high CTP score, preoperative CRRT, and high GRWR were identified as risk factors for RI after LT in Mongolia.

Abstract: Numerous researches conducted in Russia, Bulgaria, Japan, and China on B.pubescens, B. pendula, B.rezniczenkoana (Litv) Schischk, B.humilis Schrank, B.mandshurica Rgl Nakai found that birch barks and leaves contain antioxidants and they have anti-cancer, anti-fungi, antibac- terial and anti-inflammatory properties, protect liver and promote bile secretion. Flat leaved birch (B.platyphylla Sukacz) cortex contains betulin and lupeol of triterpenoids and it’s leaves contain flavonoid and polyphenol compounds. The amounts of compounds found in the cortex are smaller than leaves. Specifically, the amount of flavonoid in leaves is more contained than the that of cortex and leaf buds. In any pharmacology study of new medicines, determination and evaluation of toxicity is the first priority. According to scientific evidences that birch leaves are considered to have less toxins. Not many studies have been conducted on determining toxicity of birch leaves in Mongolia. Therefore, the purpose of this research is to study the species of birches, hippolytii birch (B.hippolytii. Sukacz) and flat leaved birch (B.platyphylla. Sukacz), that were noted to have medical properties in traditional medications and identify their acute toxicity using dry extract and determine mortality dosage (LD₅₀) on animals. Research materials and methods: Evaluation of the acute toxicity of birch leaves was conducted in Pharmacology laboratory of Monos group’s Drug Research Institute between June 19, 2020 and August 10. In this research, 150-204 g of WISTAR breed non-linear 44 white rats were used and 20 g of B.Hippolytii’s dry extract and 20 g of B. Platyphylla ‘s dry extract were injected.
The experiments to determine the toxicity of dry extracts of B. hippolytii and B. platyphylla (LD₅₀) were conducted according to Litchfield and Wilcoxon’s method and subcutaneous injects were per formed in the pelvic area of the rats. Results of determining acute toxicity level The experiments to determine the acute toxicity level of the birch’s dry extracts followed Litchfield and Wilcoxon’s method with 2-stage. LD₅₀ level was determined from the first stage of the research using G.N.Pirshen’s method and the toxicity level was identified using K.K.Sidorov’s toxicity categorization.
From the acute toxicity research, no-observed-adverse-effect level (NOAEL), animal daily dosage and human daily dosage (experimental) were determined. LD₅₀ 2950 mg/kg was determined as a result of acute toxicity research of B.hippolytii and B.platyphilla leaves’ dry extract.

Abstract: The birch leaves were used as a substitute for birch bark, buds and chaga of birch in traditional medicine because the birch leaves are considered to be less toxic. Numerous researches conducted in Russia, Bulgaria, Japan, and China on B.pubescens, B. pendula, B.Rezniczenkoana (Litv) Schischk, B.humilis Schrank, and B.mandshurica Rgl Nakai found that birch barks and leaves contain antioxidants and they have anti-cancer, anti-yeast, antibacterial, anti-inflammatory, liver protective and bile secretion induction properties. The studies conducted on animals with diseases showed that the birch leaves had anti-inflammatory properties on the gastric mucosa during acute stress, as well as anti-biliary and giardiasis. The birch leaf phytopreparations experimentations used on animals showed reduced peripheral tissue insulin resistance and lowered blood sugar. Mongolian traditional medicinal journals noted that the birch barks are used to treat inflammatory acute diseases. Therefore, this study was performed to determine the effects of two species of birch leaves on blood sugar and antioxidant activities in diabetes-induced rats. The study materials and methods: The study was conducted in the Pharmacology Research Laboratory of the Monos Group’s Institute of Pharmacology. 40 WISTAR, non-linear white rats weighing 150-204 g were used in the experiments. Dry extract of birch leaves of the two species (Alloxan monohydrate Tokyo Chemical Industry LTD), IGM-100 3A blood glucose meter (Blood glucose test meter, Infopia LTD, Brussels Belgium) and sugar test (Blood glucose test strip only, province, China) were used for the experiment. Lenzen’s (2008) method was used to induce Alloxan diabetes in the rats and the antioxidant properties were determined by the antioxidant activity kit (Rat Malondialchehyche Elisa KIT, cat. № EKRAT- 0266, Jilin). Study Result: The blood glucose level of the control group with diabetes lowered from 31.5 mmol/l to 17.1 mmol/l in 14 days. As for the B.platyphylla Sukacz group, the blood glucose level reduced to 6.3 mmol/l and the B.hippolytii. Sukacz group’s blood glucose level reduced to 6.9 mmol/l in 14 days.
The study results showed that B.hippolytii Sukacz birch leaves and B.platyphilla Sukacz birch leaves’ extracts reduced the maximum level of MDA dilution (4.8 nmol/ml) of B.hippolytii Sukacz and B.platyphilla Sukacz groups by 33.9% and 53.5% respectively. This suggests that the birch leaves had antioxidant effect. Conclusion B.hippolytii Sukacz birch leaves and B. platyphilla (Sukacz) birch leaves lowered the blood glucose level and had antioxidant properties on diabetes.