Background: A drug related problem is defined by the Pharmaceutical Care Network Europe Association as an an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes. One critical aspect of preventing such errors is proper dose adjustment, which plays a vital role in the diagnosis and treatment of disease. For instance, adjusting the dose of warfarin based on the patient’s INR level is essential. In a 1995 study conducted in England, clinical pharmacists recommended target doses of angiotensin-converting enzyme (ACE) inhibitors for patients with chronic heart failure. As a result, patients experienced a significant reduction in pulmonary and peripheral edema, along with improved exercise test outcomes. At the Mongolian-Japanese Hospital of the Mongolian Medical University of Science and Technology, it is important to analyze dosage-related issues identified by clinical pharmacists and inform healthcare professionals about common dosage selection errors and associated risks. Aim: We analyzed issues related to medication dosage. Materials and Methods: A retrospective study was conducted to examine problem related to dosage detected through prescription monitoring at the Mongolian Japanese Hospital of the Mongolian National University of Health Sciences from 2023 to 2024. Results: Out of a total of 2340 drug-related problem identified across five inpatient wards during this period, 581 (100%) were related to dosage. Clinical pharmacists performed prescription review on approximately 67% of all inpatients, which was consistent between years. However, medication-related problems tended to decrease from 41.1% (n=1499) in 2023 to 22.3% (n=841) in 2024 (p=0.05). The majority of dose-related problems, 75.6% (n=440), were overdoses. Medication-related problems were most common in the surgical department, with 59.5% (n=346) (p=0.001). The most frequent dosage-related errors involved exceeding the daily dose of diclofenac, administering higher- than-recommended doses of ceftriaxone, failing to adjust cefotaxime for renal function, and using inappropriate doses of metronidazole in patients with impaired liver function. The leading cause of these errors was failure to adhere to guideline-recommended dosing, which accounted for 71.3% (n=415) of cases (p=0.001). When dosage-related recommendations were provided to physicians before of treatment, acceptance rates increased by 14% (p=0.001). These interventions resulted in an estimated cost saving of 1.267.219₮ and a reduction of 363 injections. Conclusion Therefore, clinical pharmacist-led prescription review can help reduce the risk of dosage errors, lower associated healthcare costs, and alleviate the burden on medical staff.

Introduction: In 2020, about 3% of children and 5% of adolescents had metabolic syndrome, with some variation across countries and regions. The prevalence of overweight and obesity among children and adolescents aged 5-19 years has increased sharply from only 8% in 1990 to 20% in 2022. 3-5% of children and adolescents have hypertension, 10% 14% have changes in arterial pressure, and the prevalence has increased from 1.3% -6.0% These risk factors can lead to MetS, and although there are several studies by national researchers in adults, research on risk factors for MetS in childhood is rare. Aim: To evaluate the physical growth of children aged 6-17 and study the risk of metabolic syndrome (MetS) among them. Materials and methods: A family health center-based, cross-sectional survey was conducted in the apartment district and ger district of Ulaanbaatar, using standardised measurement tools. A total of 622 participants aged 6-17 years were included in this study. Body weight, height, waist circumference, arterial blood pressure, and blood glucose of the participants were measured and the results of body measurements were estimated using the growth chart. Results and conclusions Among the participants, 48.2% (n=300) were male, 51.8% (n=322) were female. The rate of overweight and obesity among the study population is 20.26%, and male children are 2 times more obese than female children. 7.23% of the study participants. The prevalence of metabolic syndrome was 1% with 3 risk criteria according to the IDF 78.93% (n=491) have no risk, 19.33% (n=121) have 1 risk, and 0.48% (n=4) have 2 risks. Among the studied risk factors for metabolic syndrome, overweight, obesity, and central obesity were the predominant risk factors among children. One in five children is either overweight or obese, with boys being twice as likely to experience these conditions (p<0.001). In 1% of the study participants, metabolic syndrome with three risk factors was identified. Overweight, obesity, and metabolic syndrome were more prevalent among the 15-17 age group compared to other age groups (p<0.001).

Background: Spinal muscular atrophy (SMA) is a degenerative neuromuscular disease that causes progressive muscle weakness and atrophy due to the loss of the motor neurons. Approximately 95% of patients with SMA are homozygous for the deletion of SMN1 exon 7. With an incidence of 1/10.000 and a carrier frequency of 1/40 to 1/50, SMA is the most common genetic cause of death in infants. Purpose: To detect homozygous deletion of SMN1 exon 7 and to analyse the SMN1 copy number by molecular genetic analysis. Materials and Methods: In this study, 3 SMA patients with SMN1 gene homozygous deletion and 17 people of their relatives were included. Molecular genetic analysis was performed in the Central Scientific Research Laboratory of the Institute of Medical Sciences. DNA was extracted from peripheral blood, and its purity was assessed by spectrophotometer. Homozygous deletion of SMN1 gene was analyzed with allele-specific PCR, and the SMN1 gene copy number was evaluated by real-time PCR. Results: Among the five participants diagnosed with SMA by clinical symptom and electromyographic test, three cases were found to have homozygous deletion of exon 7 of the SMN1 gene, while two cases did not exhibit such mutation by the allele specific PCR analysis.
The mean age of study participants was 27.76±16.07 (ranging from 8 months to 52 years). Six of the 7 relatives of the first proband had 1 copy number of SMN1 (0.75±0.29) or were carriers of SMA, while one had 3 copy numbers (2.99) or no deletion of SMN1 gene. Additionally, 6 of the 7 individuals of the second proband had 1 copy number of the SMN1 gene (0.72±0.14), and 1 person had 2 copy numbers. All 3 relatives of the third proband had 1 copy number of SMN1 gene (0.96±0.37). Conclusion We consider that determination of SMN1 gene homozygous deletion and carrier testing can be performed by the PCR method locally. Further, it is necessary to implement the molecular genetic testing method into practice and to study the requirements and needs of early detection of SMA in the newborn screening program of Mongolia.

Background: Spinal Muscular Atrophy (SMA), an autosomal recessive disorder characterized by lower motor neuron loss, leads to progressive muscle weakness and atrophy. With a neonatal incidence ranging from 1:6000 to 1:11000, individuals affected by SMA face challenges in locomotor function. The advent of newborn screening tests, early diagnostic techniques, and the introduction of gene therapy have, however, shown promise in enabling the acquisition of these motor skills. Objective: This review article seeks to shed a light on current understandings of the epidemiology, clinical presentations, diagnostic methods, and treatments for spinal muscular atrophy, highlighting cutting edge approaches within the discipline. Methods: A thorough search was conducted on PubMed, Cochrane, National Institutes of Health, and Web of Science databases for recent research articles concerning SMA’s incidence, prevalence, clinical manifestations, early detection, genetic testing and contemporary gene therapy. Results: The prevalence of SMA stands at 1-2 cases per 100,000 population, with an incidence of approximately 8 cases per 100,000 live births. Pre-1995 studies exhibited varying prevalence rates due to using non molecular-biological methods, small localized populations, diagnostic errors, and regional characteristics. Diagnosis involving Multiplex ligation-dependent probe amplification (MLPA), quantitative polymerase chain reaction (qPCR), or next-generation sequencing (NGS) analysis to confirm SMN1 and SMN2 gene status aids in identifying carriers and SMA subtypes. Countries implementing newborn screening programs have demonstrated early SMA detection in asymptomatic newborns, contributing to reduced mortality and disability rates. Currently, several types of gene therapy are being used in the treatment of SMA. Conclusion The epidemiology of SMA varies between countries and regions. It is fully possible to confirm the disease, identify carriers and subtypes. The inclusion of SMA in newborn early detection programs is crucial for reducing infant mortality and disability, and several gene therapies have received approval from relevant authorities for SMA treatment. In Mongolia, it is possible to introduce tests to confirm the disease and determine carriers and subtypes.

Introduction : Attention-Deficit/Hyperactivity Disorder (ADHD) is a disorder that occurs during childhood development, which presents with signs of reduced attention and hyperactivity [1]. Necessary nutrients, such as trace minerals, including manganese, iron, zinc, iodine, selenium, copper, and chromium, are associated with changes in neuronal function that can lead to adverse effects on behavior and learning [2]. In addition to these, social, emotional, behavioral problems, and cognitive impairments such as executive dysfunctions are common in ADHD [3]. Goal: To evaluate the hair elements and intelligence quotient in children with ADHD. Materials and Methods: This is a cross-sectional comparative study conducted at elementary schools of Ulaanbaatar city. All in all 60 children of both genders aged between 7-12 years old were included in the study. Children were divided into two groups as children with ADHD group and a control group. Each group had 30 children. For assessment of emotional Intelligence EQ-i:YV - Emotional Quotient Inventory: Youth Version (Bar-On & Parker, 2000; it ad. Sannio Fancello, & Cianchetti, 2012) was used. Scalp hair samples were randomly collected from approximately ten sites around both sides of posterior parietal eminences and external occipital protuberance. Samples were then packed at room temperature and submitted for laboratory analysis. The study was approved by the Research Ethics Committee of Mongolian National University of Medical Sciences (Reg. No. 2018/Д-10). Results: The IQ of children with ADHD group were 85.03±16.86 p<.0001 and the IQ of control group =108.9±21.22, p<.0001. We identified hair minerals such as Mg, Zn, Pb, Se, Mn. We have then compared to each group and normal ranges of ages. ADHD group and the control group had Pb concentration that was slightly higher and inversely Mg concentration was slightly lower (r=-0.502, p=.005). Concentration of Pb, IQ were directly opposite (r=-0.38, p=.03). Conclusion
1. IQ was lower in the ADHD group compared to control group 85.03±16.86 p<.0001, monitored group 108.9±21.22, p<.0001.
2. The group with ADHD had lower Mg, Zn, and higher Pb, Se, Mn (p<.0001). The IQ decreased when there was increased Pb and decreased Mg.

BACKGROUNDProstate cancer is the most frequent malignancy among men nowadays.METHODSImmunohistochemical expression of prostate-specific antigen (PSA) was retrospectively investigated in 10 patients admitted with clinical suspicion of the prostate cancer. Slides were collected from archived biopsiesandthey were stained for PSA.The final reaction product was evaluated as negative (0), weak/moderate positive (1), and intense positive (2).RESULTSGlandular prostate carcinoma was found in 40% (n=4) and undifferentiated carcinoma in 60% (n=6). The immunoreaction for PSA was intense positive in 30% (n=3), weak/moderate positive in 50% (n=5) and negative in 20% (n=2) of total cases.CONCLUSIONSWe concludethat PSA immunoreaction is helpful for the differential diagnosis based on our results.

Background. The main target of this research paper on “Some issues relating to the family healthcenter, family doctors care and health services” is for the young doctors, and specifically family doctorsand to help their daily work routine. This paper focused on giving analyses on the principle of somescholars research paper about the general structure of family health center, and its practical activities.There are many issues related to social medical service, an example is the basic health service fromthe family health center. There must a model or classic form for providing medical service at the statefamily health center, general medical center and the first care of medical center. This research paperalso proposed a number of current issues in order to improve the quality, such as family health centerand its management structure.Goal. The reference of this paper is to define family health center service and financial management,based on the research survey. Moreover, it concludes the idea of improving and refreshing the healthsector from the smallest branch and implementing health care marketing in the public. This researchpaper contains followings: the structure of family health center, health insurance, medical service costper person in the family, training for family health center doctor and nurse, the history of family healthcenter origin and its development, home visit service, foreign countries experience on this sector, andthe system to simplifying II, III level medical service etc.Materials and Methods. In our country Mo.Shagdarsuren has changed section hospitals into familyhealth hospital who is doctor, one of the famous manager of health protection who is firstly managed cityUlaanbaatar to committee and district. In early 1990s doctor Ts.Mukhar organized control system of familyhealth in some sub cities who helps people to get better health program. He organized small hospitalitysystems of each sub cities and moved kids doctors to family health system. Since its establishment,the system was rapidly extending throughout the country. Researches for changing the management ofFamily Health Center (Udval.D, Bat Ochir.D) and for the future development of family hospital (Mukhar.Ts, Orgil.B) are proven to be useful in practical environment.Result. The importance of this advisory article is considering in improving the Family Health Careservice sufficiency and its quality coordinating with the writings or publications written by ourcountryfamous scientists. Health Sector reformation strategy and other materials to clarify the importanceprimary health care importance of the family health care and its doctors and it is necessary to hire thebest and most experienced doctors and social health figure in hospital primary service in modernsociety.Conclusion. In conclusion, the scholars believe that in this society, the doctors who are the best, mostexperienced, well- educated on general and family health center service, and trained well, work fromtheir bottom of heart, number of accident, and disease rate will gradually decrease. Therefore, thefacilities of the health center must be improved such as providing proper workplace with well equippedmedical facilities and medical diagnosing cameras etc.Additionally, known as “The left hand of a physician“ in other words, there is a high demand to preparewell educated, professionally independent and knowledgeable nurses for the family health center

BackgroundRestoring and reestablishing the Hospital Management and Organization Sector in the Institute of Medicine since 2010 was the significant organizational measure in the framework of the social health annual action that is of particular value getting researchers of medical research institutions and physicians and scientists of urban and rural area medical sectors involved in the activities to conduct the compilation survey on general situation of population sickness, its rate and on reducing the noncommunicable diseases rate and death rate making doctors and officials of the medical sector to worry about. Furthermore, the goal and objectives of the Hospital Management and Organization Sector of the Institute of Medicine will be directed to conducting the comparative survey “conjuncture” on the total sickness and statistical report registered at the national polyclinic, medical units and family hospitals of urban and rural area, realizing the innovation issuing recommendation and introduce the result in the practice of medical institutions.Summary and recommendationWriting on principal reasons of non- communicable diseases rate and death rate collecting data from the statistical survey summary in the framework of activities of the Institute of Medicine will be significant work for the activities of all physicians, scientists and researchers of whole health sector in making constant the research work in the future, conducting the complex prophylactic policy and expanding the practical measures of the result from the one hand and in realizing the annual goal and objective of social health from the other. As well as it was very significant in working out the research project regarding the non- communicable diseases rate in higher quality by the Sector for Social Health, Hospital Management and Organization of the Institute of Medicine, making conclusion on whole efficient result meeting the requirement and realizing it in future activities in reality.This time, we conducted the comparative survey on the population’s sickness situation and noncommunicable diseases rate by the compilation method and particularly the comparative survey on principal reasons of the sickness and their structure and submitted to publish. Furthermore, according to the tradition of previous generations, the Hospital Management and Organization Sector of the Institute of Medicine will organize the comparative survey on reducing and preventing the noncommunicable diseases rate and death involving the urban and rural medical institutions in these surveys and widely promote it through the media and theoretical and practical conferences.

IntroductionThe main principles of pharmacotherapy are to provide pharmaceutical care with right medicine, right doses, in right time. If, the treatment plan can be in evidence based, it will improve treatment efficacy and safety, can prevent from drug related adverse event and reduce drug cost. Ischemic heart disease is one of major cause of mortality and one of the main diseases of morbidity in Mongolia and in the Worldwide.GoalAim of study was to conduct retrospective study on medications used for in-patients with Ischemic heart disease of tertiary level hospitals of Ulaanbaatar.Materials and MethodTotal of 438 patient’s records was collected randomly from 3 state hospitals, which were treated with diagnosis of ICD. Variables of study were patient’s diagnosis, age, sex, names, doses and route of medications.ResultThe trends of rational use of drug and number of drug and drug cost per patients were different in each tertiary level hospitals of Ulaanbaatar. In I national hospital, number and cost of drug per patients were higher than second and third state hospitals. The result were shown that in all three hospitals, more than 50 percent of total drugs per patients were injection, less than 50 percent of total used drug per patients were from standard therapeutic guideline. In second state hospital, anticoagulant and anti-platelet agents were chosen less than first and third state hospitals. In order to decrease cardiac oxygen demand and improve cardiac microcirculation, nitrates were chosen mostly in second and third state hospitals but, beta blockers were chosen mostly in first state hospital.ConclusionThe study results shown the treatment pattern and trends of rational use of drugs in in patients with ischemic heart disease have been different in tertiary level hospitals of Ulaanbaatar.

Background: The main principles of pharmacotherapy are to provide pharmaceutical care with right medicine, right doses, in right time. If the treatment plan can be evidence based, it will improve treatment efficacy andsafety, can prevent from drug related adverse event and reduce the health care costs. Assessing the drug related problems in elderly patients is a main health care and safety issue for the health care system. Ischemic heart disease (IHD) is one of major cause of mortality and one of the main diseases of morbidity in Mongolia and in the Worldwide.Objective: Aim of this study was to conduct aretrospective study on inappropriate prescribingpattern among elderly patients with Ischemic heart disease who were treated in tertiary level hospitals ofUlaanbaatar.Methods: Total of 438 patient’s records who were treated with diagnosis of IHD during the 2011 –2012, was collected randomly from main three state hospitals of Ulaanbaatar. A retrospective analysis of inappropriate drug prescription was used Beers criteria (2012).Variables of study were patient’s diagnosis, age, sex,names, doses and route of medications.Results: The mean age of the participants was67.38±0.24 and 54.6% of participants were male and 44.4% were female. The trends of rational use of drug and number of drug and drug cost per patients were different in each tertiary level hospitals of Ulaanbaatar. In I state hospital, number and cost of drug per patients werehigher than second and third state hospitals. The result were shown that in all three hospitals, more than 50 percent of total drugs per patients were injection, less than 50 percent of total used drug per patients were from standard therapeutic guideline. The most common inappropriately used drugs were as follows: amiodarone (16% at the I state hospital; 10% at the II state hospital; 3% at the III state hospital),dipyridamole (51% at the I state hospital; 3% at the II state hospital), amitriptyline (29% at the I state hospital; 20% at the III state hospital), nifedipine (33% at the II state hospital).The use of that are inappropriate with certain medicalconditions were common in case of IHD patients with peptic ulcer comorbidity. Non-steroid anti-inflammatory drug + acetyl salicylic acid combination were used in 3% of patients at the I state hospital, in 4% of patients at the II state hospital and 1% of patients at the III state hospital.Conclusion: Among the medications used for elderly patients with IHD, 15 medications were listed in potentially inappropriate medication in elderly (Beers criteria) independent of diagnosis. In I and II state hospitals, usage of potentially inappropriate medication were greater than III state hospital.Key words: inappropriate drug, Beers criteria,ischemic heart disease, treatment guideline