Background: Type 2 diabetes has increased risk of heart failure 2-4 times more than those in non-diabetic subjects. The early detection of asymptomatic ventricular dysfunction by using NT-pro BNP test in diabetic patients is the best strategy for decreasing morbidity and mortality of heart failure. Aim: The aims of this study were to detect asymptomatic cardiac ventricular dysfunction by using NT-pro BNP test in subjects with type 2 diabetes and to define the factors associated with elevated NT-proBNP. Materials and Methods: This cross-sectional study was included diabetic and non diabetic subjects aged from 35- to 64 years, who had no clinical symptoms of heart failure. Cardiovascular risk factors were detected by clinical examinations. NT-pro BNP determination was performed on an immunoassay analyzer (FIA1100, Getein Bio Medical Inc, China), which uses reagent strip to obtain quantitative NT-pro BNP results in plasma. The cut-off point for NT-pro BNP was 300 pg/ml. Results: A total of 536 subjects without clinical symptoms of heart failure were included in the study of which, 150 were diabetic and 386 were non diabetic. The mean age was 52.8 ± 7.8 years and 281 (52.4%) were females. Cardiac ventricular dysfunction was detected in 7.3% of diabetic and 5.2% of non diabetic subjects. Cardiac ventricular dysfunction in diabetic subjects was increased with age and non-significantly higher in females than in males (8.3% vs 6.4%, p>0.05). In the logistic regression analysis, uncontrolled hypertension (OR 3.80, 95% CI 1.07–13.44), long duration of disease (OR 5.30, 95% CI 1.36-20.66), and ageing (OR 5.40, 95% CI 1.29–22.88) were significantly correlated cardiac ventricular dysfunction in subjects with type 2 diabetes. Conclusion Cardiac ventricular dysfunction in subjects with type 2 diabetes was detected 1.4 times more than those in non diabetic subjects. The likelihood of positive NT-pro BNP test in subjects with type 2 diabetes was independently (p<0.05) associated with advanced age, uncontrolled hypertension and long duration of diabetes.

Background: Accreditation of healthcare institutions serves as a fundamental mechanism for ensuring patient safety and validating the quality of medical services provided to the population. At Intermed Hospital, a quality measurement system for healthcare services has been established since 2015, encompassing 126 quality indicators at both institutional and departmental levels. This system facilitates continuous quality improvement efforts. In this context, quality indicators specific to the endoscopy department play a pivotal role in objectively assessing the quality of endoscopic services. Aim: To assess the quality indicators in gastrointestinal endoscopy unit. Materials and Methods: A retrospective single-center study was conducted by collecting data from the Intermed hospital’s electronic information systems which included HIS and PACS and Quality and Safety Department’s Database and the results were processed using the SPSS software. Ethical approval was granted by the Intermed hospital’s Scientific research committee. The quality of endoscopic services in the Intermed hospital was assessed based on: a) the average values of four quality indicators measured monthly; b) sample survey data from five categories of quality indicators. Results : Between 2016 and 2024, the quality indicators of the endoscopy unit measured as the level of early warning score evaluations for patients was 95.97%±3.33, the level of cases where peripheral blood oxygen saturation decreased during sedation was 1.54%±3.78, the level of cases where patients experienced paradoxiical response during sedation was 5.82%±1.75, surveillance culturing level for validation of endoscopy reprocessing was 11.6%. The endoscopic documentation quality by peer review showed 95.7-100%, the colonoscopy quality indicators were followings as adenoma detection rate: 24.5% Cecal intubation rate: 99.1%, 95.2%, Colonoscope withdrawal average time: 13.28±10.62 minutes, Bowel preparation quality (Boston Scale): 89.3% 95.7%), patient discharge from the recovery room, Average discharge time post-procedure: With propofol alone: 30.92 minutes; With propofol and fentanyl combined: 31.52 minutes, The intermediate risk was 0.28% by the TROOPS evaluation during procedural sedation. Conclusion The quality benchmark levels for these endoscopic units, as determined by a single-center study, can be effectively implemented by benchmark endoscopy centers to enhance their quality and safety operations.

Introduction : Water is a vital resource for human existence and is essential for daily food processing, preparation, washing, hygiene, and sanitation. Furthermore, providing the population with safe drinking water is one of the pressing problems of the world and some regions.
In recent years, population density and the scale of commercial and industrial activities, as well as clean and dirty water consumption were increased in the capital city. As a result of these, ground and surface water resources are becoming scarce and polluted.
Therefore, assessment of daily drinking and residential water consumption of Ulaanbaatar should be determined to use drinking water properly in daily life and water loss. This study assessed the actual amount of households’ daily water consumption. Goal: The purpose of this study is to determine the daily consumption of drinking water for households in ger areas and apartments in Ulaanbaatar. Materials and Method: This study covers 30 households in ger areas and 15 apartment households, in Ulaanbaatar. Household members performed 6-10 types of measurements every day, within 7 days. As a result of these measurements, actual consumption of water quantity used for drinking and household purposes was calculated. Statistical analysis was done by SPSS Version 21 to calculate the true probability of difference between parameters. Result: 67.9% of the households in the ger areas were 4-5 family members. The average daily household consumption of drinking and domestic water were 68.3 ± 3.57 L (95% 61.3-75.3), the minimum consumption was 12 L, and the maximum was 227 L. Average of the household water consumption water was 97.6-108.9 liters during the weekends, and water consumption was statistically higher than weekdays (p=0.001; p=0.01).
The water consumption of residential households with 3 family members accounted for the majority (30.8%) in this study. The average daily consumption of drinking and domestic water was 297.67±19.7 liters. There was no statistically significant difference (p=0.96) in week. The average daily water consumption including drinking and residential was 270.3-335.97 L.
The total daily drinking and residential water consumption per person was 15.57 L for households in ger areas and 90 L for apartment households. Calculating the daily water consumption of households in ger areas, 60.3% of it is used for laundry, washing dishes, food preparation, washing face and hands, and clothes, 31% for drinking, and 8.7% for outdoor water use. While apartment households, approximately 94.1%, were used for household and 5.9% for drinking purposes. Research ethics approval : This study was discussed at the meeting of the Academic Council of the National Center for Public Health. In addition, this study was carried out according to the methods and methods discussed and approved at the meeting of the Medical Ethics Control Committee of the Ministry of Health (Resolution No. 08). Conclusion The total daily consumption of drinking and residential water per person were 15.57 litres for the households in the ger areas and 90 litres for the apartment households. It implies that it does not exceed the WHO recommendations

Background: A 2023 study by the United Nations University's Institute for Water, Environment and Health concluded that 72 percent of the world's population faces water supply issues, and 8.0 percent are experiencing severe water shortages. Mongolia has received 60 points out of a possible 100 points, and was defined as a country that is unreliable in terms of clean water supply and may face water shortages in the future. A survey of global water security has been conducted. The organization, which has research institutes in 12 countries, compared and ranked 14 indicators of 186 countries, including clean drinking water supply, sanitation, population health, water quality, freshwater resources, water resource sustainability, and governance related to water management. Mongolia scored the highest possible score of 10 out of 14 basic indicators for water availability. However, in terms of water treatment and reuse and water supply sustainability, the indicator of water storage scored the worst, 2 points. Also, Mongolia is weak in terms of governance related to water management, vulnerable to flood risks, and weak against flood disasters in terms of economy and infrastructure. It is concluded that due to the flood disaster, there could be an economic crisis at the national level.
According to WHO statistics in 2019, the mortality rate among the population of Mongolia due to unsafe drinking water and unsanitary facilitation is 3.2 per 100,000 people. It is 15.0 lower than the global average (18.2) and 13.8 percent lower than the average of Asian countries (17.0). According to 2022 Mongolian health statistics, the national average mortality rate due to unsafe drinking water and unsanitary facilities is 16.5 per 100,000 population. Compared to 2014, there was an increase in mortality per 100,000 people at the national and provincial levels. In Ulaanbaatar, which is the center of the total population, the mortality rate increased from 13.3 in 2014 to 16.2 in 2018 and to 23.2 in 2022. In the provinces, as of 2022, it is 10.7, or 12.5 less than Ulaanbaatar. Mongolia has two main types of water supply: centralized and decentralized, 47.9 percent of the total households in Mongolia (n=941,541) live in a fully equipped apartment with centralized and independent utility system. Drinking water service: The WHO-UNICEF Joint Monitoring Program on Water, Sanitation and Hygiene provides international comparisons of progress estimates in the area of WASH and undertakes global monitoring of the associated Sustainable Development Goals. The monitoring program has produced a report based on national and other estimates on the progress made in the water, sanitation and hygiene sector of the countries of the world for 2000-2022. Below are the figures and facts related to Mongolia included in that report. 84.0% of Mongolia's population (n=2,838,017) have access to basic drinking water services as of 2022.
• 39.0% (n=1,334,883) are directly supplied with drinking water from a safe or qualified source of drinking water;
• 44.0% (n=1,503,134) have access to drinking water less than 30 minutes from a basic or qualified source;
• 5.0% of the population (n=173,237) use surface water or water from rivers, lakes and ponds directly for their drinking water needs Sanitary facilities: As of 2022, 66.0% of Mongolia's population have safe sanitation facilities, of which 70.0% of the population in urban areas and 56.0% in rural areas. Although 25% of the rural population used to defecate in the open in 2015, it decreased by 15% in 2022, but 162,972 people still defecate in the open. In 2022, 0.35% meaning 44,066 of the total household population defecate in the open in rural areas. 76.0% of Mongolia's population has access to handwashing soap and water or basic services at home, and 14.0% has limited access to services (limited access to sinks, soap, and water at the household level). 74% of schools in Mongolia are provided with basic drinking water services. 85% of urban schools and 73% in rural areas are provided with drinking water. The study found that 25% of rural educational institutions spend more than 30 minutes getting drinking water from limited or qualified drinking water sources, and 2% have no drinking water. 70% of urban schools and 18% of rural schools have access to basic sanitation facilities. 18% of rural schools have limited services and 24% have no sanitation facilities. 30% of urban schools have limited sanitation facilities.
As of 2010, 43.5% of the households living at home share the toilet with others, 30.7% use it alone, 25.8% do not have their own toilet, 56.5% of the households pour their waste water into the well, and 43.5% of the households that pour it into the open. Solutions for sanitary facilities have been developed and standards for pit toilets and sinks have been developed and approved. The above 4 types of pit toilets are included in the standard. Hygiene 41% of schools in Mongolia have adequate access to basic hand washing facilities. 53.0% of schools in urban areas and 35.0% in rural areas have access to basic hand washing facilities. 41.0% of rural schools have limited access to sinks, soap, or water for students to wash their hands whenever they get dirty, and 24.0% have no hand washing facilities, or schools do not have handwashing sinks or have no water. 13.0% of urban schools do not have hand washing facilities. Before the pandemic (2020) and in 2022, when the epidemic level will decrease in Mongolia, the knowledge, attitudes and practices of the population about the pandemic have been studied. 83.2 percent (95%CI: 81.5-84.9) of participants reported a change in hand washing frequency. Also, 39.1 percent (95%CI: 37.1-41.2) wash their hands in the correct order, 53.2 percent (95%CI: 51.0-55.5) use soap frequently, and 33.5 percent (95%CI: 31.4-35.8) wash their hands 20 times a day. seconds, but about 9.9% (95%CI: 8.5-11.1) answered that there was no change in hand washing practices.

Introduction: The treatment of antibiotic-resistant bacterial infections has become a pressing problem for humanity worldwide, and antibiotic-resistant bacterial infections are likely to be the leading cause of death by 2050.Due to the mutation of infectious disease-causing bacteria and the emergence of bacterial resistance due to the improper use of antibiotics, the time and cost of infectious disease treatment increases, and in some cases, it leads to an increase in mortality, so it is the focus of the health sector in every country, regardless of the income level of the population. In addition, bacterial resistance has a negative impact on public health, food safety, the environment, and the economy.
As of 2015, Mongolia ranks among the countries with the highest consumption of antibiotics in the world, with 64.41 units of antibiotics prescribed per 1,000 people per day. Bacteria resistant to broad spectrum antibiotics have increased dramatically, and among Gram-positive bacteria, drug-resistant Staphylococcus aureus (MRSA) has become one of the most common and dangerous cause Purpose: Determine the external structure of liposome-encapsulated antibiotics and evaluate their antibacterial activity. Materials and Methods: We conducted this study using an experimental research design. Phospholipids were isolated by intermittent evaporation, antibiotic encapsulation by freeze-thaw method, and antibiotic sensitivity was determined using standard strains by disc diffusion andmicro dilution method. Research ethics: Permission to submit the survey was granted by the Ethics Review Committee of the MNUMS. The survey was granted in accordance with the rules and regulations. Results: In liposome-encapsulated antibiotic sensitivity assays, azithromycin and clarithromycin did not form sacred circles, whereas doxycycline hyclate was sensitive by forming a 16 mm circle. Doxycycline hyclate encapsulated in liposomes formed a 16 mm circle with sensitive results, whereas blank liposomes were inactive. When the rabbits were infected with a standard strain of methicillin-resistant Staphylococcus aureus, the infected area was purulent 24 hours later. A cream containing antibiotics was started at this time. A deep wound was recovered after 12 days after the pus was removed. Nevertheless, after 24 days, the wound on the rabbit’s infected part healed and the hair on the scraped part grew back. Conclusion According to the dilution method, liposome-encapsulated doxycycline hyclate inhibited bacterial growth at 2-fold lower doses than pure doxycycline hyclate. In experimental animal models, liposome-based antibiotic ointment has shown antibacterial activity.

Background: Vitamins are nutrients essential for human health. They act as coenzymes that help trigger important chemical reactions necessary for energy production. Reference values for vitamins help physicians evaluate the health status of patients and make clinical decisions. The aim of this study was to determine the mean values and reference intervals for some water-soluble vitamins of Mongolian adults. Materials and Methods: Three hundred and forty healthy adults (170 males and 170 females) of 17 to 69 years of age were selected for the study based on CLSI C28-P3 criteria Defining, establishing & Verifying reference interval in the clinical laboratory; Proposed Guidelines. The study was approved by the Resolution No.76 of 2018 of the Medical Ethics Review Committee of the Ministry of Health. Informed consents were taken from the selected individuals. Morning blood samples of the participants were collected under aseptic conditions. Levels of vitamins B₆, B₉, B₁₂ and vitamin C were measured using a high performance liquid chromatography method. The lower- and upper reference limits were defined as the 2.5th and 97.5th percentiles, respectively. The data were analyzed using SPSS and Excel programs. Results: The mean blood level of vitamin C was 11.88 mg/L (95% CI 10.47-13.29) for men and 9.62 mg/L (95% CI 8.11-11.13) for women. The calculated reference interval for males was 1.40-19.40 mg/L and 1.17-18.04 mg/L for females. The mean concentration of vitamin B₁₂ in the blood of males was 938.45 ng/L (95% CI 747.22-1129.68) and that of females was 864.03 ng/L (95% CI 603.81-1124.25). The reference interval for vitamin B₁₂ was 233.03-1597.00 ng/L in men and 132.45-1623.86 ng/L in women. The mean level of vitamin B₉ was 8.47 ng/mL (95% CI 5.64-11.30) for men and 6.91 ng/mL (95% CI 4.89-8.93) for women. The calculated reference interval for this vitamin in males was 1.04-24.74 ng/mL and that in females was 1.04-21.46 ng/mL. As for vitamin B₆, the mean concentration for men was 44.42 ng/mL (95% CI 37.01-51.83) and for women was 34.67 ng/mL (95% CI 29.97-39.39) with the reference intervals of 5.90-79.02 ng/mL for men and 5.27-61.72 ng/mL for women. Conclusion The reference values for vitamins B₆, B₉, B₁₂ and vitamin C of Mongolian adults do not differ significantly from those observed in other populations. The calculated reference intervals can be used in the practice of health laboratories.

Introduction: According to CDC guideline, common changes in patient admitted due to pneumonia caused by COVID-19 are lymphopenia (63%), leukocytosis (24-30%), leukopenia (19-25%). Neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), thrombocyte-lymphocyte ratio (PLR) are important to evaluate prognosis of infectious diseases as well as cancer.
Hematological tests are important for diagnosis, treatment and monitoring of patient with COVID-19. Our study objective was to determine the changes of leukocyte, lymphocyte, thrombocyte, NLR, LMR, and PLR in imported cases of COVID-19 into Mongolia. Method: The data such as age, gender, and laboratory test of a total of 249 cases who admitted to National Center forCommuncable Diseases (NCCD) from March 11 to July 20, 2020 was collected from information system of clinical laboratory of NCCD. Peripheral blood tests were conducted by XN 550 which is fully automated hematological analizator of Sysmex corporation, Japan. Statistical analysis such as mean, standard deviation, probability range was done by Microsoft Excel SPSS -25 program. Result: Regarding to gender, 163 (66.5%) were male and 86 (34.5%) were female. Mean age was 26 with range age of 11-80. Statistic analysis on leukocyte (mean 6.38 x 10⁹/L; P <0.000), thrombocyte (mean 283 x 10⁹/L P <0.000), neutrophil (mean 3.33 x 10⁹L; P <0.000), lymphocyte {mean 2.3 x 10⁹/L; P <0.000), NLR (mean 1.6, P <0.000), PLR parameter (mean 141.8 P <0.000> were revealed. Leukopenia (<3.98) were in 17 (6.8%), leukocytosis (>10.0) were in 11 (4.4%) cases. Lymphopenia (<1.18) were in 14 (5.6%), lymphocytosis (>3.74) were in 14 (5.6%) cases. Thrombocytosis (>369) were in 21 (8,4%), thrombocytopenia (<163) were in 4(1.6%) cases. Neutropenia (<1.56) were in 14 (5.6%) neutrophilia (>6.13) were in 15 (6%). The rest 220 (88.3%) cases have been determined no changes. PLR were 141.8 ±88.6, NLR were in 1.29 ±1.26 in 249 cases. Increased NLR and decreased PLR were in 10 (4.0%) and 114 (45.7%); increased PLR and decreased PLR in 31 (12.4%) and 28 (11.2%), respectively. Discussion Our result which is leukocytosis in 4.4%, leukopenia in 6.8%, lymphopenia in 5.6% of all imported eases ol"CO\ 1D-W. are similar to other studies. However, percentage of changes were lower than similar studies due to low rate of severe cases. It suggests, further studies clinical stages and severity of the infection need to be conducted.

Hepatitis B (HBV) and C (HCV) are viral infections which can cause acute and chronic hepatitis and are the leading causes for hepatic cirrhosis and cancer, thus creating a significant burden to healthcare systems due to the high morbidity/mortality and costs of treatment. The risk of HBV infection in an unvaccinated person from a single HBV-infected needle stick injury ranges from 6–30. The prevention of HBV infection among HCWs has become a crucial issue. HBV can effectively be prevented by vaccination. A safe and effective HBV vaccine has been available since the 1980s and can prevent acute and chronic infection with an estimated effectivity of 95%. In 2017, the São Paulo Declaration on Hepatitis was launched at the World Hepatitis Summit 2017, calling upon governments to include hepatitis B vaccines for HCWs in national immunization programs. The vaccine is 95% effective in preventing infection and its chronic consequences and has an outstanding record of safety and effectiveness. Data on current hepatitis B vaccine coverage among HCWs in Mongolia is scarce. According to Azzaya et al, the protection level of the subjects was 67.2% >100 mIU/ml, 18.8%, 11-100 mIU/mL and 14.1%, 0-10 mIU/mL based on antibody titer level respectively among the vaccinated HCWs at the 2nd Central hospital. Thus, the HBV vaccination among public and private sector HCWs in Mongolia to inform the health authorities about the HCWs HBV vaccination status along with associated problems and challenges for further improving vaccination strategy among HCWs.

Background: The past decade has seen an increasing involvement of private for-profit medical laboratories in the national healthcare provision. But the majority of patients still use services of public hospital laboratories. Goal: The goal of the survey was to assess the status of private and public medical laboratories based on ISO 15189 requirements. Method: The overall capacity of seven private and seven public laboratories was assessed using a questionnaire based on ten main requirements of ISO 15189. Results In general, the public laboratories scored better that the private laboratories but the difference was not significant (79 points for public laboratories vs. 72 points for private laboratories; p=0.115). The main differences were in the areas of equipment management (82 points for private vs. 92 points for public; p=0.025) and testing performances (77 points for private vs. 91 points for public; p=0.006). Out of the remaining eight assessment sections, the private laboratories scored better, but not significantly, in the areas of laboratory management and laboratory information system.

Background: Poor laboratory quality can lead to misdiagnosis and inappropriate treatment of patients. To demonstrate the quality and reliability of their services, medical laboratories seek accreditation to ISO 15189. We have initiated a project to assist laboratories in their efforts to obtain the accreditation. Goal: Conduct a gap analysis of the status of preparedness of medical laboratories for accreditation. Materials and Methods: Six laboratories are selected for participation in the project. In the first phase of the project, a gap analysis of the participant laboratories is conducted using an Excel program based on ISO 15189 requirements. Results: The findings reveal that the participant laboratories are the strongest in Organization and management of laboratory, Quality of examination results, Personnel and facility management and in Laboratory information management. The majority of the laboratories are hospital based, and their organization and management are well established and functional mostly due to centralized administrative guidance. The concept of quality control is effectively adapted in medical laboratories, therefore ensuring the quality of examinations and the data management are usually in line with the requirements. Weaker areas include Evaluation and audits, and Document control. Even though the laboratories do conduct evaluations and control, they do not do it regularly and, most importantly, do not keep records routinely, which cause the higher gap rate. Conclusion Policies to meet ISO 15189 requirements are in place in the participant laboratories, but their documentation and records keeping are insufficient.