Background: Primary acquired nasolacrimal duct obstruction (PANDO) is a common cause of epiphora in adults, standard surgery for blockage of the lacrimal outflow tract is the dacryocystorhinostomy (DCR). The majority of studies have analyzed the lacrimal system of whites anatomically and presented guidelines for endonasal DCR. It has been our experience that DCR procedures for Asians are more difficult than for whites and we reasoned that the difficulty might be attributable to the anatomic differences in the intranasal structures between the races. Before we started doing endoscopic endonasal DCR in Mongolia, there was no hospital doing this surgery and there was lack of study done on anatomy of lacrimal fossa and DCR surgery result among Mongolians are our rationale of study. Goal: To study the effect of anatomical variance of lacrimal sac fossa on dacryocystorhinostomies performed by the endoscopic endonasal approach. Methods: METHODS: A total of 292 consecutive cases of DCR were performed age between 16-75 years old who have primary nasolacrimal obstruction (ICD-H04.559). This study was approved by the Ethics Committee of Mongolian National University of Medical Sciences. A total of 146 EX-DCR and 146 EN-DCR patients were identified. Full success was defined as no symptoms of tearing after surgery and anatomical patency with lacrimal irrigation. Standard Lac-Q questionnaire was used to compare satisfaction of the surgery in both groups. All statistical tests were two-sided, and a p-value of <0.05 was considered to be statistically significant. Statistical analysis was performed using STATA for Windows version 11.2. Results: There was no significant difference in age or gender distribution between the two groups. Frontal process of the maxillary bone is 4.41± 1.96 mm in successful group and 4.97± 1.04 in failed group (p<0.05). The uncinate process was attached to the lacrimal sac fossa in 80.1% of the all cases and 100% in surgery failed group (p<0.05). The variation that agger nasi cell adjacent to the lacrimal sac fossa was in 93.9%. The operculum of the middle turbinate was attached to the lacrimal sac fossa in 94.5% of the cases (p=0.76). Postoperative assessment was performed for 6 months. Patients who underwent endonasal group reported a 11.0-point improvement (IQR, 9.0–16.5). Conclusions A thick frontal process of the maxilla and uncinate process, operculum of the middle turbinate, and ethmoid cells adjusting to lacrimal fossa are dominant in Mongolians. Patients who have these features are prone to have recurrence of nasolacrimal duct obstruction after DCR surgery. The EN-DCR have a high surgical success rate and good result on reduce of symptoms and improvement in quality of life by using the Lac-Q standard questionnaire.

Background: The shapes of the eye and upper eyelid are distinctive facial landmarks. The palpebral fissure is composed of the free edges of upper and lower eyelids the lateral and medial canthus. Many researchers confirmed that the morphometric characteristics of the palpebral fissure, canthal distance and exophthalmometirc value (EV) vary according to race, ethnicity, age and sex and normative values which may serve as a reference in the index population. Knowledge of normal dimensions, the existence of asymmetry of the palpebral fissure is of value in several clinical specialties including ophthalmology, plastic and reconstructive surgery and traumatology, where it plays a part in the patient evaluation, management and outcomes. Methods: This cross-sectional study was conducted in the Ophthalmological Department, Third State Central Hospital between January 2022 and August 2022. We included participants who are above 18 years, no history of congenital or traumatic craniofacial deformities, any orbital fractures, tumors and surgeries. All measured values that represent eyelid shape and EV were calculated by mean and standard deviation for statistical analysis. Results: A total of 103 participants aged 19-86 were included in the study, of which 44 (42.7%) were male and 59 (57.3%) were female. The distance between the lateral and medial canthus ranged from 20 to 35 mm, and the mean of the right and left side was 28.30+3.23 mm and 28.05+2.99 mm, respectively (p=0.561). The palpebral fissure height ranged from 5 to 13 mm, and the mean of the right and left side was 8.85+1.65 mm and 8.80+1.65 mm, respectively (p=0.816). The mean distance between the lateral canthi were 90.39+5.57 (range: 80-105 mm), whereas the mean distance between the medial canthi were 63.75+4.25 (range: 53-73 mm). The orbital height varied between 27-43 mm (33.73+3.72) and 26-44 mm (33.78+3.73) on the right and left sides, while the orbital width varied between 26-47 mm (36.75+4.53) and 27-45 mm (36.72+4.42) on the right and left sides, respectively. When measuring the exophthalmometric value (EV), the axial position of the eyeball, with the Hertel’s exophthalmometer, it ranged from 8 to 20 mm on both sides (mean value 13.68+3.01 and 13.71+3.00 on the right and left sides, respectively), and there was no statistically significant difference in symmetry (p=0.94). Conclusion The results are determined different from the findings of Chinese, Korean, Afro-American and Caucasian population based studies. Thus further evaluation is required to represent the normative value of Mongolian index population, that is highly beneficial for clinical assessment, diagnosis and management.

Background: Lung cancer is the leading cause of cancer death in both men and women. In the past decade, histopathological classification of lung cancer has become increasingly important in selecting the appropriate treatment. Methods: All cases of lung cancer diagnosed pathologically in the last 2.5-year period were retrospectively identified at National Cancer Center and performed by descriptive case series design. Results: The average age of our participants was 62, of which 82.2% were men. A total of 214 cases of lung cancer were reported, including 142 (66.4%) squamous cell carcinoma (SCC), 34 (16%) adenocarcinoma (AC), 4 (1.7%) NSCLC, 29 (13.6%) small cell carcinoma (SmCC) and 5 (2.3%) cases of other/unspecified type. Based on only morphology, initially 32 (17.7%) cases of NSCLC were diagnosed, whereas after immunohistochemistry (TTF-1 or NAPA positive/p63 negative, and vice versa) staining, this category reduced to 2.2%. Conclusions Among both males and females, SCC which is highly related to smoking was the most common histologic type of lung cancer. Our results showed that an approach of using only a two-antibody panel (p63 and TTF-1) might help in the reduction of diagnostic category of NSCLC-NOS significantly.

Background: Oral candidiasis, which is one of the most common diseases of the mucous membrane, is carried in the mouth of about 17-75% of healthy population. And 51-74% of this healthy population is asymptomatic. However, oral candidiasis is found in 50-65% of the individuals with dentures, is found in 67% of elders over 75 years old and is found in 85% of the patients with oral cancer. The most common causative organism is C.albicans with 43.7%, less commonly C.glabrata and C.tropicalis. According to some researches, the occurrence of the oral candidiasis has been increasing continuously for last 20-30 years, and has strong tendency to consistently increase for the 21st century. Methods: Total 50 patients were participated in this study, including; the patients with full denture from Department of Prosthodontics of The Dental Center of Ulaanbaatar, and patients with evident symptoms of candidiasis from Department of Neck and Head Surgery and Department of Radiation Therapy of National Cancer Center of Mongolia. The study was carried out by descriptive study type, based on the patients’ questionnaire survey, physical examination and laboratory tests. Results: The oral candidiasis causing pathogen Candida was found in 100% of following patients including; the patients with full denture and the patients having head and neck radiation therapy. For the patients with full denture, Candida albicans was the most commonly implicated organism with 53%, Candida tropicalis 21% and Candida krusei 11%. For the patients with radiation therapy for head and neck cancer, most common pathogen was Candida albicans with 64% and Candida tropicalis with 7%. Conclusions Main causative pathogens for the patients with full denture are C.albicans (53%), С.tropicalis (21%), and for the patients with radiotherapy for head and neck cancer is C. albicans (64%). 95% of the participants who were diagnosed with oral candidiasis were resistant to Colistin and 100% sensitive to Nystatin and Miconazole.

Background: Acute appendicitis is an inflammatory disease and acommon cause of acute abdominal pain. The application of the sophisticated automated hematology analyzer more precisely define the morphology changes blood cells. According to this diagnose and treatment control issues are solved by easy and not expensive way. Recent studies haveshown that there is a negative correlation between platelet count (PC) and MPV and that theratio of these two values may be more meaningful. The aim of our study was to investigate thediagnostic value of MPV and the MPV/PC ratio in acute appendicitis. Methods: The patients were divided into two groups based on their histopathological findings: the uncomplicated and complicated appendicitis groups. Leukocyte count, PC, MPV and the MPV/PC ratio were compared all groups. Results: Total of 186 patients, including 119 men, were included in the study. The average age of all patients was 10.21±1.22 years. There was statistically significant difference of some parameters in peripheral blood between the uncomplicated and complicated appendicitis groups in terms of all index. (p<0.001). Leukocyte count had a strong discriminatory property based on the area under curve (AUC) 0.714, (p<0.001). MPV, PC and the MPV/PC ratio had weak discriminatory power with AUC values <0.663. Using receiver operating characteristic (ROC) analysis, the sensitivity and specificity of MPV were 81.56and 45.7%, respectively, and 63.78% and 71.06%, respectively, for the MPV/PC ratio. Conclusions In our study, MPV and the MPV/PC ratio were useful in the diagnosis of acute appendicitis.

Background: Lead is known for their neurotoxicity and compared to adults, children are more vulnerable to lead exposure. Varieties of diseases are developed by lead induced damage in children, including decreased intelligent quotient and behavioral changes, such as anxiety. In normal condition lead does not exist in children’s blood and this toxic heavy metal enters into human body through respiratory way and accumulates in blood and bone to harm neurodegenerative and urinary systems. Therefore, the present study aimed to investigate whether the emitted lead from recycling factory for lead acid batteries, which is located in 9 km distance from Khonkhor town and 39 km faraway from Ulaanbaatar city with north-east direction, is affecting the intelligence of the local children. Methods: There are 13 children involved in this study and the participants are divided into two groups, including subjects, who live in areas outside (n=10) and within (n=3) the 1000 m region of the factory zone. The blood sampling was collected according to WHO guidelines and lead level in blood was determined by Leadcare instruments at Environmental health and toxicological laboratory of National Center for Public Health. The intelligence analysis was conducted by Raven’s progressive matrices test. And the statistical analysis was performed by SPSS 21 software to assess correlation of blood lead levels and the intelligence among participated children. Results: It is resulted that average lead level for children’s blood samples is 3.1±1.5 ug/dL and which is found beyond the acceptable range in WHO guidelines. The children’s intelligence was assessed by Raven’s colored Progressive Matrices analysis, which is practically accepted in China, which estimated that average intelligence score of participants were 48.3±13.2. According to correlation analysis of age, sex, intelligence and blood lead level, there was a weak positive correlation was found between children’s age and lead level in blood. In contrast, a weak reverse correlation was observed in regarding with sex and blood lead level and intelligence score was weakly reverse correlated with the lead level in children’s blood samples. Conclusions The determined average lead level was 3.1±1.5 ug/dL for blood samples collected from 13 children who involved in this study and the value is found under the WHO guidance value. Furthermore, their average intelligence score was estimated as 48.3±13.2. The comparative analysis shown that intelligence score of 3 children, who lives within 1000 m region of the recycling factory was lower than those who lives in outside region of the factory and have same age.

Background: To investigate relapse rates after the successful treatment of patients with non-atypical endometrial hyperplasia (EH) either a levonorgestrel impregnated intrauterine system (LNG-IUS; MIRENA®) or two regimens of oral dydrogesterone (DGS) after primary histological response. Currently, the incidence of EH is indistinctly reported to be around 200,000 new EH cases per year in Western countries. Methods: Patients were at their choice assigned to one of the following three treatment arms: LNG-IUS; 10 mg of oral DGS administered for 10 days per cycle for 6 months; or 10 mg of oral DGS administered daily for 6 months. The women were followed for 6 months after ending therapy. [Figure2] Women aged 25-55 years with low or medium risk endometrial hyperplasia met the inclusion criteria, and 35 completed the therapy. Results: Histological relapse was observed in 55/ (41%) women who had an initial complete treatment response. The relapse rates were similar in the three therapy groups (P = 0.66). In our study involved 25-55 (mean 42.2±1.61) aged 35 women. Among them had reproductive aged 31.43% (n= 11) premenopausal women 42.86 % (n= 15) postmenopausal women 25.71% (n= 9). Their mean body mass index had 28.8±1.15 kg/m², and normal weight 34.29% (n=12), overweight 34.29% (n=12), obese 17.14% (n=6), extremely obese 14.29 % (n=5). [Figure3] Types of obesity had normal 37.14% (n=13), android 25.71% (n=9), gynecoid 37.14% (n=13). Mean parity had 1.8±0.19 to nulliparous 14.29% (n=5), primiparous 60% (n=21), multiparous 25.71% (n=9). Smoke 17.14% (n=6). Non combined disease had 65.7% (n=23), diabetes mellitus 17.14% (n=6), PCOS 14.29% (n=5), cardiovascular disease had 2.86% (n=1). [Table1] Mean endometrial thickness of TVUS had ( 16.0±0.91mm). Smoke (p=0.0391), types of obesity (p=0.0436) and myoma of the uterus (p=0.0187) seen affected the endometrial thickness. LNG-IUD group had after treatment’s menstrual period 11.11% heavy 80ml (n=1), 88.89% light 5ml (n=8). DGS (5-25 day) group had after treatment’s menstrual period 9.09% heavy =80ml (n=1), 90.91% light5ml (n=10), DGS (16-25 day) group after treatment menstrual period 40% heavy 80ml (n=6), 46.67% normal 5-80ml (n=7), 13.33% light 5ml (n=2) байв. Therefore between the three treatment groups had no differences. But treatment’s before and after result had statistics probability differences (P= 0.4064). [Figure4] Conclusions Finally, given the long natural history of menorrhagia, study outcomes need to be assessed over a period that is longer than 2 years. In conclusion, our study showed that both the LNG-IUD, oral progestin treatment reduced the adverse effect of menorrhagia on women’s lives over the course of two years. LNG-IUD was the more effective first choice, as assessed impact of bleeding on the women’s quality of life.

Background: Class III malocclusion is considered to be one of the most difficult and complex orthodontic problems to treat. For patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers solution, surgery to realign the jaws or reposition dentoalveolar segments is the only possible treatment option left. Objective: The treatment objectives were to: (1) level and align the dental arches; (2) obtain an ideal overbite and overjet, to establish correct anterior guidance; and (3) improve the facial profile. Results: Excellent facial and occlusal results were achieved with this surgical-orthodontic management, post-treatment results showed a Class I relationship and ideal overjet and overbite. The facial profile became straight type. Conclusions This case report describes the treatment of a female with dental and skeletal class III relationships. Surgical-orthodontic treatment was the best option for achieving an acceptable occlusion and a good esthetic result in this case. An experienced multidisciplinary team approach ensures a satisfactory outcome.

Background: In 716 Mongolian patients who had breast augmentation surgery at Perfect Clinic during 18 years. The purpose of this study evaluates Mongolians predictors of early and late outcome after primary breast augmentation surgery. Aims of study: In this study, we aimed to clarify predictors of early and late outcome after breast augmentation surgery. Methods: We selected patients who underwent breast augmentation implant surgery between 1999 and 2017. Development of hematoma was chosen for measure of early outcome and capsule contracture was chosen for measure of late outcome. Multivariable Cox proportional hazard regression and Kaplan-Meier estimations were used to clarify independent relationship between possible predictors and outcomes. Results: A total of 716 patients were chosen and mean age was 32±7 years old. Hematoma was occurred in 43 patients (6%) and median time to hematoma was 3 days (IQR 1; 7).). According to the univariable analysis, every 1 year experience was associated with 9% decreased risk of hematoma development. (HR=0.91, 95% CI 0.84-0.99, p<0.05). Finally, Kaplan-Meier estimation was showed that hematoma free survival is higher in more experienced years and patients who had subpectoral muscle.(log rank p<0.01 and p<0.001, respectively). Capsule contracture was occurred in 38 patients (5.3%) and median time to capsule contracture was 10 months (IQR 3; 27). According to the univariable analysis, every 1 year increase of surgical experience is related to 9% decreased risk of capsule contracture (HR=0.81, 95% CI 0.75-0.88, p<0.001), and more textured implant type is associated with less capsule contracture (HR=0.47, 95% CI 0.34-0.66, p<0.001).
Multivariable hazard regression was revealed that implant type (HR=0.55, 95% 0.33-0.90, p<0.05) and surgical time (HR=1.00, 95% CI 1.00-1.01, p<0.001) were independently associated with capsule contracture after breast augmentation surgery (Table 4). Kaplan-Meier estimation was determined that capsule contracture free survival is higher in more experienced years and patients who had more textured implant and subpectoral muscle implant (log rank p<0.001, p<0.001 and p<0.001, respectively). Conclusions For breast augmentation surgery, implant type is independent predictor of capsule contracture and surgical experience is predictor for both hematoma and capsule contracture. Therefore, above mentioned predictors should be considered to prevent complications related to breast augmentation implant surgery.

Background: Dacryocystorhinostomy (DCR) is a surgical treatment for site of obstruction in the nasolacrimal duct system [1]. This surgery is performed in cases of congenital nasolacrimal obstruction, partial and complete occlusion of the nasolacrimal duct in adults, chronic tearing disorders, ineffective probing treatment and placement of a silicone tube in the nasolacrimal system [2,3]. the present findings indicate that preservation of lacrimal sac flaps with end-to-end anastomosis to the nasal mucosa using histoacryl has a positive impact on surgical outcome in patients undergoing endonasal endoscopic dacryocystorhinostomy [4]. Histoacryl glue is one of the most commonly surgical materials used recently. The basis of our study is the lack of research on the use of this glue in the practice of oculoplastic and reconstructive surgery. Purpose: The purpose of this study to comparing outcomes of surgical methods of histoacryl glue and silicone tube during endoscopic endonasal dacryocystorhinostomy. Methods: Retrospective, case series study. The study included 83 patients who underwent endonasal endoscopic dacryocystorhinostomy between January 2017 to June 2020. Whole case was divided into two groups. In group 1, an anastomosis was made during surgery by using histoacryl glue to the posterior wall of the lacrimal sac and the wall formed by the nasal mucosa [5]. In group 2, a silicone tube was placed in the nasolacrimal duct during endonasal dacryocystorhinostomy and the results were evaluated in the 1st, 3rd, 6th, and 12th months after surgery. Statistical calculations were performed using SPSS software. Results: The age of the whole cases was between 17 and 82 years. There were no significant difference among the age groups. In terms of gender, n=48 (78.7%) were female and n=13 (21.3%) were male, indicating that dacryocystitis was predominant in women. Study reports no significant difference in intraoperative and postoperative complication. The surgical success rate was significantly higher in histoacryl group 94.9%, than silicone tube group 79.5%. Recurrent cases n=2 (5.1%) in group 1 and n=9 (20.4%) in group 2 respectively. Conclusion Histoacryl glue is highly effective, commodity, inexpensive and easy to apply during endonasal endoscopic dacryocystorhinostomy surgery.