Background: A rare angioproliferative condition of the larynx, Kaposhi sarcoma typically affects the skin. Immunosuppressive treatment following organ transplantation and human immunodeficiency virus infection are the causes. Every type of Kaposi sarcoma has human herpesvirus-8. Laryngeal kaposi sarcoma is uncommon in immunocompromised patients; since its initial identification in 1965, 18 cases have been documented globally. A CO2 laser-assisted laryngeal microsurgery is performed through the mouth cavity to remove tumor when kaposi sarcoma of the larynx obstructs the airway. Case report: A 77-year-old woman complained of hoarseness, dry mouth, odynophagia, and dysphagia three months prior when she arrived at the Mongolian-Japan Hospital. Two years ago, she acquired hard, sensitive lumps that were palpable on her right arm, left ankle, and right thigh. At that time, she was diagnosed with Kaposiform hemangiodermatitis and treated at the National Center for Dermatology. HIV test results were negative. Immunohistochemistry: CD31 +/-, CD34 /+/. Using flexible nasopharyngeal endoscopy to get the diagnosis: There was a mass that was about 1.5–2–5 cm in diameter, bluish in color, smooth and movable, and spongy and vascular on the larynx, on the nasopharynx, behind the palatine tonsills, and supraglottic. Surgery: Through the use of Kleinsasser laryngoscopy and a 0-degree endoscope, pathological tissues were extracted under general anesthesia using a laryngeal microsurgical instrument and a laparoscopic bipolar coagulator. The tissues were then sent for histological evaluation, which revealed Kaposi sarcoma, sarcoma grade 1. Results of treatment Pain decreased and quality of life increased following surgery. Upon nasopharyngeal endoscopy, the vocal cord mobility was normal and the surgical incision was clean. Conclusion: Kaposi sarcoma is an extremely uncommon illness. A lower quality of life and further issues can be avoided with an early diagnosis and suitable therapy. It also needs to be continuously monitored because it is a potentially repeatable disease.

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.

Background: Otitis media is an inflammatory disease involving the mucous membrane of the middle ear, including the auditory tube, tympanic cavity, mastoid antrum, and air cells¹. Multiple factors contribute to the development of OM, one of which is adenoid hypertrophy5. However, to date, no study has been conducted in Mongolia to assess the relationship between the degree of adenoid hypertrophy and OM. Aim: To analyze cases of children who underwent adenotonsillectomy. Materials and Methods: The study was conducted using a cross-sectional observational research design. Clinical data from a total of n=215 cases of children who were diagnosed with adenoid and palatine tonsil hypertrophy and underwent surgical treatment at Gurvan Gal Hospital between October 2023 and October 2024 were analyzed. Statistical processing was performed using STATA 14.2, with statistical significance considered at p < 0.05. Results: Clinical data from 215 children were analyzed to evaluate the relationship between the degree of adenoid hypertrophy (AH) and otitis media. The children ranged in age from 2 to 17 years, with a mean age of 7.23 ± 3.4 years. Among them, 128 (59.53%) were male (7.09 ± 3.29 years) and 87 (40.46%) were female (7.45 ± 3.58 years). A statistically significant moderate negative correlation was found between age group and the degree of adenoid hypertrophy (rho = -0.3485, p < 0.001). A significant seasonal variation in otitis media was observed (p = 0.0001). A statistically significant correlation was found between the degree of adenoid hypertrophy and otitis media (p < 0.001). However, no significant correlation was observed between the degree of palatine tonsil hypertrophy and otitis media (p = 0.8762). Conclusion The incidence of adenoid hypertrophy is highest among children aged 6 to 9 years, and there is a moderate negative correlation between age and the degree of adenoid hypertrophy. The occurrence of otitis media varies by season, with the highest number of cases reported during the winter months. As the grade of adenoid hypertrophy increases, the number of otitis media cases also rises.

Background: Anemia is still being a population’s challenging issue regardless of high development of countries around the world. According to a study regarding prevalence and etiology of anemia conducted in 187 countries around the world, the anemia rate is 23 176 per 100 000 population. In accordance with the “5th National Nutrition Survey” study conducted in our country in 2017, one of every five women (21.4%), aged 15-49 years, 16.2% of reproductive age women and 3.0% of men are anemic. The current study was conducted due to it is still essential to study and identify the etiology of anemia, determine its prevalence, plan appropriate intervention, and organize future preventive measures, depending on the socio-economic conditions, location, diet, and customs of the Mongolians. Aim: To identify anemia among the adult population, determine the type and severity of anemia. Materials and Methods: The cross sectional study was conducted during between May 2022 and Sep 2023 and adults aged above 18 years were included. Moreover, we identified anemia cases based on the laboratory test results and determined the anemia severity grade. Statistical analysis was performed by using SPSS software. Results: Among the participants, 6.7% of them, 9.9% of females and 2.8% of males are anemic. Prevalence of mild, moderate and severe anemia is 66.7%, 30% and 3.3%, respectively. While the prevalence of anemia among reproductive age women is higher, the prevalence of anemia increases with age. The anemia prevalence in Ulaanbaatar region, Western region, Khangai mountainous region, Central region and Eastern region is 583 (25.6%); 171 (7.5%); 343 (15.1%); 921 (40.4%); and 261 (11.4%), respectively. By regional location, the prevalence is high in the Central region, with varying prevalence in other regions. Conclusion Anemia was detected in 6.7% of the total study population, 9.9% of females, and 2.8% of males were anemic. Of those with anemia, 66.7% had mild anemia, 30% had moderate anemia, and 3.3% had severe anemia. Moderate and severe anemia were more common in females than in males.

Introduction: 5-10% of shift workers experience severe shift insomnia and sleepiness. A nurse specialist stays by the client's side 24 hours a day, assesses and monitors their physical condition, and provides nursing care. In a comparative study on the work activity among shift nurses, night shift nurses were less active (40%) and more fatigued (53.3%) than day shift nurses.
An aspects of chronotype and sleep quality in shift nurses does not established in Mongolia and the data is very rare, and we aimed to conduct this study. Goal: To study shift schedule, sleep quality and individual chronotype of shift nurses. Materials and Methods: This study is a cross-sectional study. The survey was completed between July 1, 2023 and December 31, 2023, and included a total of 117 nurses who met the inclusion and exclusion criteria of the BZDGH, SKDGH, and KUDGH research. In collecting research data, the questionnaires "Insomnia Severity Index", which is a commonly used international standard questionnaire for assessing insomnia, The Munich Chrono Type Questionnaire for assessing individual chronotype, and "Karolinska Sleepiness Scale" were used. The ethical approval: The ethical approval for the study was obtained by a decision of the Ach Medical University-Ethical Committee on Research on June 30, 2023 (2023/02/05). Statistical analysis : Results were calculated using SPSS - 21.0 v program by a descriptive statistic, and the Pearson correlation analysis. Results : The average score of the Insomnia Severity Index (ISI) was 12.60±6.38, which is the sub threshold for clinical insomnia. But the average Karolinska Sleepiness Scale (KSS) score for sleepiness is 4.41±2.50, or moderate alertness during the shift. Workday sleep-wake pattern and non-workday sleep-wake pattern are correlated (r=0.44, p=0.001). Also, individual chronotype is correlated with chronotype of non-working days (r=0.23, p=0.02). Conclusions Nurses' sleep quality levels were pre-clinical insomnia and moderate alertness during shifts for sleepiness. Working and non-working day sleep-wake patterns are different, chronotype is medium early type. The sleep-wake pattern of weekdays and the sleep-wake pattern of non-workdays are related to each other. The chronotype of the individual is related to the chronotype of non-working days.

Sleep and wakefulness are physiological processes in our lives that are regulated by circadian rhythms. The level of melatonin, the "sleep hormone", increases with the onset of darkness, and its production slows down in the morning. Exposure to artificial light at night disrupts our circadian rhythm and the processes it controls. Shift work is when an individual works from 9 am to 5 pm. But the night shift refers to the time when a group of workers who work at night in factories and enterprises work in the evening or at night, especially from 4 p.m. to 8 a.m. according to a regular schedule. One in five people in industrialized countries work night shifts, and studies in America and Europe show that between 15 and 30% of adult workers have some form of shift work. Between 10% and 30% of shift workers meet the diagnosis of shift work disorder (SWD). 5-10% of shift workers experience severe shift insomnia and sleepiness. At least ¾ of shift workers suffer from insomnia. Excessive sleepiness usually occurs during shifts (mainly at night) and is associated with impaired cognitive ability due to the need for sleep and reduced alertness, and decreased alertness reduces performance. Job performance is influenced by many workplace environmental factors, including workload, coworker relationships, stress levels, and extended hours. A nurse specialist provides nursing care by monitoring and evaluating 24 hours a day, and by working night shifts, the circadian system of sleep is disturbed, causing sleep problems and insomnia. When examining how night shift work affects nurses' ability to concentrate, the decline in concentration (33.3%) was twice as high as that of day shift nurses (16.7%). found that shift nurses who worked the night shift had higher rates of insomnia and chronic fatigue compared to nurses who stopped working the night shift. Lack of sleep manifests as a decline in cognitive functions such as attention, decision making, and reaction time. These cognitive and functional declines can negatively affect quality of life and lead to impaired job performance. An Australian study by Winwood et al found that fatigue associated with night shifts increases the risk of human error and injury, and negatively affects the quality of patient care. Lack of sleep significantly affects nurses' alertness, concentration, and job performance. This review article discusses the relation between shift work-related sleep and job performance based on international research findings.

Background and Aims: Hepatocellular carcinoma (HCC) is a common cause of cancer related death in Mongolia. Early diagnosis is the very important management to increase successful treatment and survival rate. Glypican-3 (GPC3) protein is highly expressed in hepatocellular carcinoma (HCC) tissue and in serum of HCC patients. Recent studies have been conducted and suggested as a diagnostic biomarker for detecting HCC in the early stage. Therefore, we investigated the diagnostic value of the serum GPC3 level and compared it to the alpha-fetoprotein (AFP) level as a diagnostic biomarker of HCC. Methods: We enrolled a total of 90 participants and divided into 3 groups with HCC (30), with liver cirrhosis (LC/30) and healthy (30) as the control group (30). GPC3 and AFP serum (sGPC-3, sAFP) levels were measured using commercially available enzyme-linked immunosorbent assay kits. The diagnostic accuracy was analyzed using the receiver operating characteristics (ROC) curve and estimated sensitivity and specificity of each biomarker. Results: sGPC3 was significantly elevated in the HCC group as compared to liver cirrhosis and healthy subjects (658±138.2 pg/ml, 378±25.5 pg/ml, 356.3±29 pg/ml) respectively. sGPC-3 sensitivity was 96.6% and specificity was 100%. The area under the ROC curve (AUC) for GPC3 was 0.999 (0.996- 1.0).
In comparison, the mean of AFP was significantly higher in HCC (16.9±11.7 ng/ml) than in LC (6.7±7.6 ng/ml) and in healthy subject (3.3±2.1 ng/ml) and AFP sensitivity was 43,3 %, specificity was 95 % with an AUC of 0.808 (0.696- 0.921).
The combination of GPC-3 with AFP achieved the highest sensitivity (97.1%) and specificity (97%). Conclusion Serum GPC3 has a higher sensitivity than AFP for the early diagnosis of HCC. Combination of two markers showed greatest diagnostic accuracy.

Introduction: Air pollution has become one of the major problems in socio-economic and health issues in Mongolia. Among the various hazards of particulate matter (PM) pollutants, microorganisms in PM2.5 and PM10 are thought to be responsible for various allergies and for the spread of respiratory diseases. Recent studies have shown that PM2.5 particles can cause chronic heart failure, heart arrhythmias, and strokes, as well as lung damage, cirrhosis, inflammation, cancer, cardiovascular disease, and metabolic disorders. Furthermore, some studies have concluded that PM2.5 particles in the environment are a risk factor for gastrointestinal, liver, colon, and lung cancer as well as it affects the growth and metastasis of various cancer cells caused by other factors. In our country, the health effects of air pollution and the relationship between the pathogenesis of cancer research are scarce. Therefore, the study of the effects of PM2.5 particles on cancer cell proliferation, migration (metastasis) can provide a significant role for cancer treatment, diagnosis, and prevention. Purpose: Determining the effects of PM2.5 particles on cancer cell proliferation, migration (metastasis) in in-vitro Material and Methods: A human liver cancer cell line (HepG2), human gastric cancer cell line (AGS) were obtained from the central scientific research laboratory in the Institute of medical sciences. HepG2, AGS cells were seeded at a concentration of 1*105 cells/mL in a culture flask and cultured in RPMI-1640 medium supplemented with 10% FBS, 1% antibiotic mix (penicillin, streptomycin) in a humidified atmosphere of 5% CO2 at 37 °C. The cytotoxic effect of PM 2.5 in AGS, HepG2 cells were evaluated by MTT, CCK8 assays. AGS, HepG2 cells were incubated in 96 well plates for 24h then treated with different concentrations (0, 5, 10, 25, 50 and 100 μg ) of Bayankhoshuu, Buhiin urguu, and Zaisan samples for 24h, respectively. Results: Concentrations of 10, 25, and 50 μg/ml of samples collected from the Bukhiin urguu and Zaisan in March increased HepG2 cell growth, while doses of 25, 50 μg/ml of samples collected from Bayankhoshuu in March and December increased HepG2 cell growth. Therefore, concentrations of 25 and 50 μg/ml of samples collected from Bayankhoshuu in March increased AGS cell growth, while concentrations of 25, 100 and μg/ml of samples collected in December increased AGS cell growth. However, no cytotoxic effect was observed in the sample collected from Zaisan in March, whereas the PM2.5 sample enhanced AGS cell growth in dose dependent manner in December.(p <0.05) Conclusion High levels of heavy metals were detected in samples collected in December from Bayankhoshuu, Bukhiin urguu and Zaisan of Ulaanbaatar. Concentration of 25 μg/ml of samples collected from the Bukhiin urguu and Zaisan in March increased HepG2 cell growth. Concentrations of 25 μg/ml of PM2.5 collected from three regions around Ulaanbaatar increased HepG2 and AGS cell migration.

Research of function of vitamin D on immune system has been studying since the study revealed that vitamin D receptor is expressed on the surface of the immune cells. 1,2-dihydroxyvitamin D3 [1,25(OH)2D], physiologically active form, can be generated through hydroxylation of 25-hydroxyvitamin D3 [25(OH)D], inactive form of vitamin D, in a liver, connecting with specific VDR make biological action. Vitamin D make different biological actions depends on connecting with different immunological cells. Some studies indicated that Vitamin D plays pivotal role in antibacterial innate immune responses through regulating reaction of the main cells as macrophages and dendritic cells. Moreover, calcitriol, the active form of vitamin D, is connected with VDRE, modulates the innate immune response through directly inducing expression of catelicithin and β-defensin as antimicrobial peptides, reducing secretion of IL-1b, IL-6, TNF-a, RANKL, COX-2 as proinflammatory cytokines and increasing production of IL-10, an anti-inflammatory cytokine. Vitamin D plays in proliferation and differentiation of T and B cells and regulates the activities of over 500 genes. Vitamin D differently impacts on per se stages of T cells’ proliferation. Vitamin D indirectly mitigates the differentiation from immature B cells to plasma B cells while it directly impacts on regulation of overloaded production of antibodies in plasma B cells. In conclusion, vitamin D modulates the innate- and adaptive immune response through regulation on activation of APCells, proliferation and differentiation of immune cells, secretion of some antibacterial peptides.

Introduction: When human body encounters external pathogens primary/innate immunity cells are activated by recognizing them and secondary/adaptive immunity is activated consecutively. Immune cell surface receptors, called Toll-like receptors (TLRs) recognize and bind pathogens. In our previous study, we revealed that there is a synergistic action between TLR9 and IFN-γ signaling in the endothelial cells. Purpose: To determine the role of negative and positive regulatory proteins on the IFN-γ/TLR9 synergistic signaling pathway Materials and Methods: This study was held in the Core Laboratory, Science Technology Center, Mongolian National University of Medical Sciences (MNUMS). In this study, murine endothelial cell (END-D) culture was used. The negative and positive regulator protein expression was detected by Western blotting. Result: Result of immunoblotting assay indicated that CpG DNA enhanced IFN-γ positive regulator protein p38 phosphorylation in the endothelial cells. Treatment by TLR9 ligand CpG DNA and IFN-γ increased p38 activation in 0.5 hour and 1 hour. CpG DNA inhibited IFN-γ negative regulator SOCS1 protein expression in 4 hr and 8 hr. Therefore, TLR9 ligand CpG DNA increased IFN-γ signal transduction in the endothelial cell line. Conclusion TLR9 ligand CpG DNA has decreased IFN-γ negative regulator protein SOCS1 expression. CpG DNA has increased IFN-γ positive regulator protein p38 phosphorylation.