Background: Multidrug-induced long QT syndrome is a serious heart rhythm disorder where multiple medications prolong the QT interval on an electrocardiogram, increasing the risk of a potentially fatal arrhythmia. Long QT syndrome is characterised by heart rate corrected QT interval prolongation and life-threatening arrhythmias, such as polymorphic ventricular tachycardia, Torsades de pointes leading to syncope and sudden death. Case: 21-year-old woman required resuscitation from an apparent cardiac arrest that had occurred after status epilepticus. The woman was diagnosed with long QT syndrome, cardiac channelopathy. She had a long history of syncope, seizure and palpitations. Family history was non-contributory. Home medications included levetiracetam 500 milligrams orally twice and fluoxetine 20 milligrams orally once a day which the patient reported non-compliance with. Levetiracetam is a widely used anti-epileptic medication secondary to its favorable safety profile. To our knowledge, there are few other case reports documenting torsades de pointes after levetiracetam administration, and specifically our case report will be the first documenting cardiac arrest after multidrug administration. Long QT syndrome is not often included in the differential diagnosis of epileptic and non-epileptic seizures. Early recognition of the syndrome is very important because of prognostic and therapeutic consequences. Conclusion Although no hereditary cause was confirmed, this case represents Torsades de Pointes triggered by multiple medications—including long-term low-dose carbamazepine, fluoxetine, diazepam, and high-dose levetiracetam—on a background of probable Romano–Ward syndrome or predisposition to QT prolongation. The arrhythmia progressed to cardiac arrest, requiring ICD implantation.

: In enterohepatic recycling, foreign chemicals entering the alimentary tract and gut normal micro flora (<b>ShagjJambal., 1989b>) are absorbed into portal venous blood by enterocytes, removed from blood by uptake into hepatocytes, secreted into the bile, and then deposited back into the intestinal lumen where they may be reabsorbed by intestinal wall cells and available for recycling (compartment model modified by <b>Wang and Reuningb>). This process is called enterohepatic circulation or enterohepatic recycling (<b>Rollins and Klaasen, 1979b>). Some studies have attempted to interrupt the enterohepatic recycling of toxicants such as pesticides and heavy metals and 56 carbon tetrachloride (<b>CCl₄b>). Plant Material The plant Gentiana macrophylla pall. Was collected during july 2017 from the forest region Galt sum, Khuvsgul aimakh, Mongolian. The taxonomical identification of the plant was done by Botanical survey of Ganbold E. (ScD) Mongolian university subsidiary of Ulanbator institute, Ulanbator. The study was based on the New medicine medical university bio-model, pharmacology laboratory and laboratory. ELISA-biochemistry laboratory. Animals: Male C57BL/6 (miceweight 18-22g (n=40)) were obtained from the Mongolian national university of Medical sciences animal house. Experimental procuders were conducted in accordance with the regulations of Animal Ethical committee. Myeloperoxidase (<b>MPOb>) activity was measured according to the technique described by <b>Krawisz et al. (1984) b>. Assay for lipid peroxides in animal tissues by thiobarbituric acid Reaction (<b>Yagi, K. and Ohkova.,1979b>). A significant decrease (P<0.005) in the MDA was observed in the <b>Gentiana macrophyllab>(GM) treated group (0.340±0.031)when compared with the control group (0.521±0.023). Conclusion The results of the study show that Gentiana macrophylla is inhibition of lipid peroxidation, protection of liver cell. From the protonation compounds generate polyphenol compound with rich hydroxyl and alkaloid. These compounds help to lipid peroxidation or antioxidation and membrane protection.The results of the study show that Gentiana macrophylla is inhibition off oxidation ferric molecule in vitro reaction and detoxification of reactive oxygen species release from damaged liver cell by CCL₄.

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.

Introduction: Orthopedic surgery is a highrisk of surgical formation of thromboemboliccomplications.Many researchers are exploringprevent surgical complications.Anticoagulanttreatment is the first choice to preventthromboembolic complications.Artificial jointreplacement surgery has been made in 2008,in National First Central Hospitals (NFCH).Wehave not guideline of anticoagulant treatmentafter surgery and have not principle of choisefollow-drug treatment and unclear testingschedule to monitor anticoagulant treatment,that has become the basis for this study. Westudied by comparing a comparative benefitfor anticoagulant treatment of unfractionatedand low molecular weight heparin results.And studied thromboembolic complications,monitoring test of anticoagulant treatment,fatal bleeding, changes hemostasis ofanticoagulant therapy in both groups. Thesurvey results in practice is doing researchaims to introduce and review the results of thelong-term results.Materials and Methods: Included in thesurvey about 1,400 patients, who had kneeand hip replacement surgery in 2008-2016, inJoint Center of NFCH. All patients are dividedin three group. The first group is control group,do not use anticoagulation treatment, in thesecond group used unfractionated heparin andin the third group used low-molecular-weightheparin.Each group studied comparativewhether thromboembolic complications anddeath caused by thromboembolic, fatalbleeding.Between surgical complication andanticoagulant therapy relationship to investigatethe relationship the correlation is likely trueof 95%. Caused by other thromboemboliccomplications detected cases were removedfrom the study.Results: Control groups has not hospitalmortality, but has 3 cases of sudden death ina after discharge.Hemostasis is longer (INR1,3-1,5) in the second group. There hospitalmortality occurred in 1 (cardiac infarction),and thromboembolic complications 1 (arterialthrombosis in the jugular) in the third group.Low molecular weight heparin are no changeshemostasis, it is strongly dependent (r=0,8).Also in this group there is no fatal bleeding.Conclusions: Orthopedic surgery isnecessary for prevention of thromboemboliccomplications are showing from in controlgroup has sudden death.2 groups have not fatalbleeding when used heparin in normal doses.Other countries researchers conclude lowmolecular-weight-heparin is more effectivethan unfractionated heparin, our study is notvisible correlation reliability.When used lowmolecularweight heparin, hemostasis is notchanged is showing a strong dependence.

Introduction: We performed more than1200 arthroplasty surgeries at National FirstCentral Hospitalfrom 2008, so we haveour surgical technique and experiences.Thepurpose of this study is to assess our surgicalresults and complications after surgery forfemoral neck fracture made in Joint Center,National First Central Hospital, and tocomparingsimilar studies in other countries,and to develop the best optionsurgicaltherapy.Materials and Methods: Between 2008-2015, hip replacement surgery accountedatotal of 168 cases, that was 13.9% allof replacement surgery. A retrospectiveanalysis of patient database based onhospital discharge data and medical recordswas performed. The medical records ofthese patients were reviewed to confirmthe presence of a surgical site infection asdescribed by the Centers for Disease Control(CDC)/NNIS guidelines.Results: Between 2008-2015, in theJoint Center,National First Central Hospital,are seeing increasing number of patientswith hip replacement surgery each year.The cause for hip replacement surgery isaseptic necrosis (42%), at second is femoralneck fractures (22%). Joint Center,NationalFirst Central Hospital currently not providedemergency trauma care center. Therefore,younger patient with femoral neck fracturewas not to happen duringresearch. Olderthan 60 year patients with osteoporosis and,in some cases with nonunion, was doneforhip replacement surgery. The averageage of 75.7 (61-87).Bipolar hip arthroplastywas 14 cases all of 36 patients with femoralneck fracture.9 (5,31%), complications ariseall of hip replacement surgery (168 cases).Including: Infection - 1 (0.59%), sliding - 1(0.59%), dislocation - 2 (1.78%), fracture- 2 (1,18%), nerve injury - 2 (1,18%) andpostoperative mortality - 1 (0.59%).Conclusion: Internal Fixation- for patientage under 60 andgood bone quality. Thatoperation complication is femoral headnecrosis, not healing /nonunion/ delivery ofa lot of research that shows focus. Further,most surgery for femoral neck fracture is hipreplacement that is expected to be widelyavailable.

Introduction: Artificial joint replacementsurgery started in 2008, in Joint centerof National First Central Hospital. Hasexperienced a variety of post-surgicalcomplications.Postoperative infectiouscomplications, prevent and investigate thecauses of the research is carried out todetermine whether the opportunity.Materials and Methods: Facilitiesrandomly selected cases difficult patientswith postoperative septic, and analyzedby descriptive method. In all cases,Bacteriological analysis of the clinicallaboratory department of joint fluidsamples received. We determined artificialjoints causes of postoperative infectiouscomplications and artificial joints determinethe factors of postoperative infectiouscomplications. Calculate the treatment ofinfectious complications.Results: Since 2008, done a total1200 with an artificial joint replacementsurgery. Each year, a surgical number isincreasing. 82% of all cases were kneeartificial joint replacement surgery and18% were hip artificial joint replacementsurgery. There are 20 cases of postoperativeinfectious complications.Most suppurativecomplications (14 cases, 70%) are earlycomplications, that directly related to thesurgery and hospital infections are likelyto be. Pathogenic bacterial samples weredetected 10 cases. An assay blanks dependon laboratory capacity and the number ofsamples. Open surgery is 83,3% effective,when early infectious period. No mortalitydue to infectious complications in our center.Conclusion: The main reason of thepostoperative infectious complications ofartificial joint surgery is S. Aureus (99%).14 cases (70%) of all postoperativecomplications are early complications, thatdirectly related to the surgery and hospitalinfections are likely to be. The main factorsaffecting disinfection of the surgical roomand trauma.

Introduction: The theory that usingmobile bearing (MB) design for total kneereplacementsurgeries can reduce the riskof tibial component loosening compared tofixed-bearing (FB) designs is still unclear.Arthroplastic surgeries developed rapidlywithin recent 10 years, but there is no similarstudy performed yet. This randomized studyinvestigated the impact of prosthesis design toloosening of components at 2 years for totalknee replacement surgeries.Materials and Methods: 479 patientswho underwent total knee arthroplastyin FirstCentral Hospital of Mongolia were allocated toeither FB or MB tibialarticulation.We comparedour results to similar studies which performedabroad due to there is no such a studyperformed before in Mongolia.Results: There is no significant differenceby age, sex, weight, height, body mass index,operation side (right or left) in both groups.Pre- and postoperative range of motionwasalmostsame for MB and FB groups.Butloosening complication was higher for the FBgroup (1.16%) than MB group (0%).Conclusion: Using MB design for total kneearthroplasty has less loosening complicationthan using FB design in Mongolians. Bonemineral density (dual energy absorptiometry)and radiostereometric analysis are necessaryfor widening studies in field of total kneereplacement surgeries in the future.

joints with severe defects of the medialtibia usually progress as varus or valgusdeformities, with daily functional handicapssuch as, limping, aches and instability. Duringthe last seven years, in total 1200 knees ofpatients were treated by both bilateral andunilateral total knee arthroplasty in the Jointcenter of National First Central Hospital. Thisresearch shed a light on patients that weretreated by unilateral total knee arthroplastyto correct large defects of tibia.Materials and Methods: The objectiveof this paper is to compare patients whowere treated with auto bone graft withpatients who were treated without auto bonegraft, in order to assess the effectiveness ofthe auto bone graft technique through theretrospective method.Results: The unilateral total kneearthroplasty was operated on 553 patients,30 (5,42%) of whom were treated withautobone graft and 523(94,58%) of whomwere treated without the auto bone graft.Postoperative complication was observed in3 cases (9,9%) among the first group ofpatients, and in 25 cases (4,5%) amongthe second group of patients. As patients,diagnosed with osteoarthrotic knees withsevere tibial bone defects, were treatedthrough the auto bone graft, it could beconcluded that more complications wereobserved on patients with large tibialbone losses. However, no complicationwas observed in other 27 cases that weretreated with the bone graft during the postoperativefollow-up period ranged fromtwelve to eighty four months.Conclusion: In conclusion, total kneearthroplasty using auto bone graft forpatients with severe tibial bone defects iseconomically as well as clinically effectivetechnique for our country.

In Europe, colorectal cancer (CRC) is the second most frequent malignancy and the second commonest cause of death from cancer. -The prognosis of CRC patients is dependent on the stage of disease at the time of diagnosis. Contrast-enhanced computed tomography (CT) examinations allows simultaneous assessment of tumor’s local staging, estimation of its possible invasion into neighboring organs, and detection of nodal and distant metastases; which is essential for appropriate treatment planning and estimation of its outcomes. The lack of reports on CT findings in CRC in Mongolia, increase in CRCmorbidity, and significant potential benefits of early detection served as background for this study.We investigated subjects with histologically proven adenocarcinoma who underwent CRC-related operative treatment either at National Cancer Center, First State Central Hospital, or Ulaanbaatar Songdo Hospital (UBSH) in 2009-2012. We retrospectively reviewed and analyzed from the UBSH’ database their preoperative CT, colonoscopy, surgical and pathohistologic reports using PACSPLUS,OCS operation systems. CECT examinations were performed at Siemens Somatom 64 multidetector scanner.Countrywide, 111 patients underwent surgery for colorectal cancer in 2009-2012. Totally, we involved86 subjects, whose age ranged from 25 to 87 years (mean 61.3years ±13.7SD). The F: M= 48 (55.8%) :38 (44.2%).The CECT determined T2 staging in 10/86 (11.6%),T3 in 61/86 (70.9%); T4 in 15/86 (17.4%);a significant difference in T-staging between CECT and histopathological examination (х2=41.28, p=0.00 (p<0.05)) was found. The CECT detected no peritumoral lymphadenopathy (N0) in 39/86 (45.3%), N1 in 18/86 (20.9%) and N2 in 29/86 (33.7%) patients; there was a significant difference in N-staging between CT and histopathological evaluation (х2=17.74, p=0.007(p<0.05)). For T-staging, CECT evaluation yielded sensitivity of 50% in T2 , 83.6% in T3, 71.4% in T4 staging; Diagnostic accuracy of CT for T2 staging was 89.7%, for T3- 78.2%, for T4- 88.7%. For N-staging, CECT had sensitivity of 88.2%, specificity of 64% and accuracy of 73.8%.Preoperative colorectal cancer patients in Mongolia receive initial MDCT in late stage. The similarsensitivity in staging of T-parameter to that of the international comparable studies. Nodal heterogeneity on CECT was more sensitive for nodal metastases than the size.

Purpose: To evaluate colorectal cancer localization in preoperative patients in Mongolia using CECTand endoscopyMaterials and Methods: Totally 10575 optic colonoscopy examinations were performed at UlaanbaatarSongdo Hospital between January 2009 and December 2012. From these examinations, colorectal cancerwas detected in 218 cases; from them 175 had CT examinations. From patients with CT examinations,111 underwent surgery at UBSH, National Cancer Center, State Central Hospital. (64MDCT SiemensSomatom). Only 86 patients with colorectal carcinoma proved by endoscopic or operative pathologywere included into this study. We retrospectively reviewed from the UBSH’ database their preoperativeCT, colonoscopy, surgical and pathohistologic reports using PACSPLUS, OCS operation systems. Toclassify colorectal tumor localization, we divided colon into 8 anatomic parts. The size of tumor wasmeasured as longest dimension visible on CT examination.Results: Study population’s age range was 25-87 age (mean 61.3years ±13.7SD). F: M= 48 (55.8%):38 (44.2%). Urban residents composed 58 (67.4%), rural- 27 (31.4%), foreigner- 1 (1.2%). Tumor sizerange on CT was 0-13 ñì (mean 6.5±2.2 ñì) . Colonoscopy and CT detected colorectal cancer in rectumin 30(34.9%) and 31 (36.1%), in sigmoid colon in 21(24.4%)’’’ and 19(22.1%), in hepatic flexure- 9(10.5%) and 9(10.5%), retrospectively. Double (synchronous) colorectal cancer was detected in 1(1.1%)at colonoscopy and in 2 (2.2%) at CT.Conclusions: The 60-69 age group composed the largest group (38.4%) in colorectal cancer patients,with slight predominance of urban residents over rural and higher female predilection. Sigmoid andrectum are shown to have highest incidence in colorectal cancer. To our best knowledge, it is firstpublication on detection of synchronous colorectal cancer in Mongoliaby both CT and colonoscopy.CT examination is less risky and reliable method to evaluate the entire colonic length in patients withcolorectal cancer suspicion, if observers are skilled in detection of CT signs of colorectal cancer.