Introduction: Antibiotics are commonly prescribed in paediatrics.¹ Children were 1.3 times more likely to be treated with antibiotics compared to adults.² Especially, antibiotic prescription is higher in children aged under 5 years.³ Purpose: To identify the most widely used antibiotics in the age group of 0-5. Objectives of the study:
1. To identify the most widely used antibiotics and classify them by pharmacological group
2. To analyze the pharmaceutical dosage forms of commonly prescribed antibiotics for infants and toddlers Methods: In our study, we selected 20 pharmacies from 6 districts (Bayanzurkh, Bayangol, Khan-Uul, Songinokhairkhan, Chingeltei, and Sukhbaatar) of Ulaanbaatar city using a single random sampling method. A total of 496 antibiotic prescriptions written for children aged 0-5 years in 20 pharmacies were analyzed. Antibiotic prescription forms for children aged 0-5 years registered in the pharmacies in November, December 2023, and January 2024 were collected. The results were processed using “SPSS 29.0.2” program. Result: Among a total of 496 antibiotic prescriptions written for children, 341 were written in solid dosage form and 155 were in liquid dosage form (suspension). Amoxicillin 250 mg and Amoxiclav 312.5 mg were mostly used from Penicillin group for the treatment of infants and toddlers. Clarithromycin 125mg/5ml from Macrolide group had an important role in treatment. Cefixime 400 mg from the Cephalosporin group was used in some cases such as diarrhea and vomit. Conclusions
1. Amoxicillin, Amoxiclav, Clarithromycin (Penicillin, Macrolide) antibiotics are the most widely used in the treatment of infants and toddlers.
2. It has concluded that antibiotic prescriptions for infants and toddlers mainly include solid and suspension antibiotics.

Background: Cardiovascular diseases (CVDs) is a third leading cause of non-communicable diseases and a leading cause of mortality in Mongolia. Among these, acute myocardial infarction (AMI), a complication of coronary artery disease (CAD), is a leading cause of cardiovascular mortality. In patients with AMI, both epicardial artery blood flow, observed through coronary angiography, and coronary microcirculatory dysfunction (CMD) play critical roles in the disease’s pathophysiology. Recent advancements have introduced artificial intelligence (AI)-based softwares which are capable of analyzing coronary blood flow from coronary angiography images. The AI based softwares can assess not only epicardial blood flow but also CMD in recent studies. In this review, we discussed the role of CMD in pathophysiology of AMI, diagnostic approaches, the application of AI-based technologies, their clinical significance, and future directions. Aim: This review aims to explore the pathophysiological relationship of coronary microcirculatory dysfunction (CMD) in the context of acute myocardial infarction (AMI), diagnostic methodologies, the application of artificial intelligence (AI)-based technologies, and their clinical significance. Hypotheses: 1. AI-based software allows for highly accurate assessment of coronary microcirculation during AMI. 2. CMD during AMI is associated with structural and functional changes in the heart. 3. CMD during AMI is related to disease prognosis and patient outcomes. Methodology:: This narrative review was compiled using a systematic and logical approach, based on publicly available recent clinical and biomedical research literature addressing the above hypotheses. Conclusion In recent years, AI-based image processing software has been developed to analyze angiographic images obtained during percutaneous coronary intervention (PCI) and treatment procedures. These tools show significant promise for early detection and improved diagnosis of CMD during AMI, as well as for better assessment of short- and long-term patient risk.

Background: Patient safety is a core dimension of healthcare quality and has become a global priority. According to the report by the U.S. Institute of Medicine, between 44,000 and 98,000 deaths occur annually due to medical errors in hospitals. One of the key indicators of patient safety is the Adverse Events (AE), defined as unintended harm to a patient that results from medical care rather than from the underlying disease. The assessment of adverse events is not only a tool for detecting errors but also an active strategy for improving system reliability and safety. Accurate identification of adverse events is therefore essential for enhancing patient safety and serves as a critical performance indicator with financial implications for hospitals. Aim: To determine the incidence of adverse events in referral hospitals and to analyze the relationship between triggers and adverse events. Material and Methods: Data were collected during 2023–2024 from three referral hospitals, the First, Second, and Third State Central Hospitals after obtaining institutional approval. The study was conducted within the framework of the Whole System Measures methodology developed by the Institute for Healthcare Improvement (IHI), which is internationally used for system-wide performance assessment. Data extraction was performed from electronic health records and inpatient departments, and statistical analyses were conducted using SPSS version 25. Results: The study identified 8.3% adverse events per 1,000 patient-days, which is 1.66 times higher than the international reference rate. A statistically significant association was observed between the number of triggers and the occurrence of adverse events, indicating that the use of triggers facilitates the active detection of adverse events. Conclusion The incidence of adverse events in tertiary specialized hospitals was found to be higher than international benchmarks. The application of trigger-based active surveillance proved to be an effective method for identifying adverse events and enhancing patient safety monitoring systems.

Background: Malaria is caused by parasite of the genus Plasmodium and considered one of the biggest public health issues because almost half of the world’s population is at risk of contracting malaria. It causes 2% of the world’s total deaths and millions of clinical infections. In 2022, 94% of cases and 95% of deaths occurred in the WHO African Region. Cerebral malaria the most severe neurological complication of infection with Plasmodium falciparum malaria. It is a clinical syndrome characterized by coma and asexual forms of the parasite on peripheral blood smears. The neurological complication, induced by cerebral malaria is irreversible and lethal, therefore it is of great significance to unravel its exact etiology, which may be beneficial for the effective management of this severe disease. In Mongolia, malaria normally not present unless the disease was contracted abroad. Considerable attention in malaria control and elimination is needed, yet, increasingly, domestic hospitals are unfamiliar with it, and so there is a risk of being overlooked. The following is the second case, to our knowledge, of cerebral malaria in Mongolia. Conclusion Although Mongolia is not a malaria-endemic region and routine malaria testing is not commonly performed, the number of imported cases is increasing due to the growing mobility of the population—travel, study, tourism, and peacekeeping missions to Africa and Southeast Asia. Therefore, neurologists should be aware of the possibility of cerebral malaria when evaluating patients with neurological deficits who have a history of travel to malaria-endemic areas. This case highlights important clinical, imaging, and laboratory considerations for suspecting and diagnosing malaria in such patients.

Background: Adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP) is a rare neurodegenerative disease characterized by cerebral white matter abnormalities, which leads to progressive cognitive and motor dysfunction that usually presents in a middle-age. We present the pedigree, clinical, and imaging findings of familial cases with similar clinical features suggestive of progressive multiple sclerosis. Among our cases, two had died and the remaining one case is still alive, but with clinical symptoms getting worse, such as unable to verbally express themselves, unable to take care of themselves, worsening social relations and work abilities. Conclusion Because the clinical features and neuroimaging findings of inflammatory and neurodegenerative disorders of the nervous system often overlap, the definitive diagnostic test for ALSP (Adult-onset Leukoencephalopathy with Axonal Spheroids and Pigmented Glia) is genetic testing to identify CSF1R gene mutations. Although genetic testing is currently unavailable, it is advisable in clinical practice to apply diagnostic criteria and pay close attention to family history and characteristic neuroimaging findings when evaluating patients with progressive motor, cognitive, and language decline in order to suspect this condition.

Introduction: Globally, 10.5-25.9 million cases of pyelonephritis have been reported, and the nature of the disease is changing over time. In Mongolia, as of 2022 diseases of the genitourinary system has increased from the average of the last 10 years, and account for 9% of all diseases. The incidence rate by age group increased in all age groups in 2022 compared to 2013, with the largest increase in the age group over 65 with 2,104 cases. The basis of this study is to determine the use of PIM drugs based on the Beers criteria for the treatment of patients diagnosed with pyelonephritis in our country. To study the use of drugs by inpatients diagnosed with pyelonephritis (N10), (N11) in referral hospitals and the use of PIM drugs used in the treatment of elderly people. Methods: A retrospective descriptive study was conducted on the medical history of a total of 150 patients diagnosed with pyelonephritis (year 2023) at The State Secondary Central Hospital, The State Third Central Hospital, and Hovd Regional Medical Centers. Among the 150 inpatients who participated in our study, 14.3% (n=18) of 126 types of drugs were used for the treatment of pyelonephritis, and 85.7% (n=108) for the treatment of multimorbidity and supportive treatment. Inpatients used 11 types of PIM drugs according to Beers criteria. Nitrofurantoin 39% was used the most and amitriptyline 9.8% were the most used drugs affecting the central nervous system. Conclusion 11 types of drugs included in the inappropriate category for use in the elderly are risky and should not be selected. Among them, nitrofurantoin 39%, from NSAIDs ketoprofen 19.5%, ibuprofen 7.3% were most used. PIM drugs used for treatment in 2014 are still used in 2024, indicating the need for improved drug monitoring in the elderly

Background: In 1904, Monkeberg was first described about the coronary calcification which is the degenerative change that occurs with aging process, but the last decades many studies have been confirmed that coronary calcification was an active process same as the signaling pathways with bone mineralization. Coronary calcification increases the risk of myocardial infarction during bypass graft surgery and PCI (СМ СN. Shanahan, 1999). Goal: To evaluate Agatston Coronary Artery Calcium score using contrast enhanced CT-Coronary angiography. Objectives:
1. To assess Agatston Coronary Artery Calcium score
2. Age and gender relationship of coronary calcification Materials and Methods: We evaluated total 215 patients who were admitted to the Reference center of Diagnostic Imaging named after R.Purev State Laureate, People’s physician and Honorary Professor of the Third State Central Hospital awarded with the Red banner of the Labor diagnosed with the coronary calcification by contrast enhanced 64 slice CT (Philips Ingenuity CT 64) between 2020 to 2022. Patient’s age was considered into 6 groups and coronary calcification was assessed by Agatston’s score. The result of our study determined by common statistical averages and errors and probabilities of the indicators were determined by Student’s criteria. Result: When evaluating Agatston coronary artery calcium scoring by CT-coronary angiography, 11-400 Agatston score was predominantly in our study with p value of (P<0.001). Considering relationship of age and gender, coronary calcification occurs 42.3% of patients aged 50-69, male and female ratio was 1.7:1. Conclusions
1. We established Agatston coronary calcification 11-400 was occurred in 66.96% of the patients.
2. Coronary calcification predominantly occurred in 65% patients aged 50-69 years.

Introduction: Left main coronary artery (LMCA) is a large vessel which supplies the majority of left ventricle and critical lesion at the bifurcation of LMCA can lead to life threatening condition. Therefore, percutaneous coronary intervention (PCI) on LMCA bifurcational stenosis is considered as a complex high risk indicated patient and procedure (CHIP). Goal: In this study, we investigated the impact of urgent and elective PCI on outcomes of patients with LMCA bifurcational stenosis. Materials and Methods: Patients who underwent for urgent PCI due to acute myocardial infarction (AMI) or elective PCI due to stable coronary artery disease (CAD) for their LMCA bifurcational stenosis. Any lesion with >50% stenosis on coronary angiography was considered as a critical stenosis. LMCA bifurcational stenosis was evaluated by Medina classification. Difference between urgent and elective PCI group were compared by independent sample t-test and chi-square test. Association between treatment strategy (urgent or elective PCI) and prognosis were evaluated by Cox proportional hazard regression, and survival rate was evaluated by Kaplan-Meier methods. Ethical approval was taken from the ethical committee of the Health Science University of Medical Sciences (№30/1А) in June 12, 2012. Results: A total of 82 patients with LMCA bifurcational stenosis were included (mean age 62±11, male 76.8%) and 14 of them underwent urgent PCI due to AMI and 68 of had elective PCI due to stable CAD. Patients who underwent urgent PCI had significantly higher 30-day mortality (1.5% vs. 21.4%, p<0.05) and all-cause mortality (7.4% vs. 35.7%, p<0.003) compared to the elective PCI group. Urgent PCI for LMCA bifurcational stenosis due to AMI was associated with increased risk of death (HR=3.63, 95% CI 1.02-12.9, p<0.05). Kaplan-Meier estimation showed that patients in the urgent PCI group had significantly lower survival compared to the elective PCI group. Conclusion Unanticipated urgent PCI for patients with LMCA bifurcational stenosis due to AMI is associated with higher risk of short and long-term mortality. Patients who underwent urgent PCI for LMCA bifurcational stenosis had significantly lower survival compared to elective PCI group.

Background: Over the past 20 years, world wide scale social and economic reforms, technological breakthroughs, and the population growth (increased by 1.64 billion), especially in urban areas, have had a negative impact on human health; changes in living and working conditions (environmental and air pollution), population density, traffic jam, unhealthy lifestyles, workload, and work stress – all contribute to non-communicable diseases – are increasing. According to researchers from Stanford University in the United States, “Stress plays a key role in the development of behavioral disorders such as poor diet, lack of exercise, alcohol and tobacco use, and addiction. Furthermore, these behavioral disorders play a major role in the development of metabolic disorders and cancer, such as hypertension, cardiovascular disease such as myocardial infarction, and diabetes and obesity. “Stress, in particular, depends on the type of workplace, work environment, and occupation in which the person spends most of their life. Materials and Methods: The study is covered 473 nurses from the specialized tertiary level hospitals in Mongolia. We determined their perceived work stress by the WPS (3 parts 57 questions) questionnaire of American scientist Rice. The work stress results were analytically analyzed with the cross-sectional method regarding the nurses’ arterial blood pressure. Results: Totally 473, or 121, 89, 146, and 117 nurses participated from NCTO (1), NCMH (3), NCID (4), and NCC (4). In present study, 34 or 7.2% of 18-24 year olds, 139 or 29.4% of 25-30 year olds, 99 or 20.9% of 31-40 year olds, 169 or 35.7% of 41-50, and 32 or 6.8% over 51 year olds. The study was conducted by collecting an age group similar to the age pyramid of nurses working in the hospital. The participants illustrated low levels of work stress in 7.6%, medium levels in 27.1%, and high levels of work stress in 65.3%, respectively. When we examine whether the level of stress exposure of nurses differs between the groups by high, medium, and low levels of workplace stress, the analysis of one factor variance confirms the statistical real difference (F = 3.071), (p = 0.028). The study results revealed that long lasted accumulated work stress trigger the hypertention. Conclusion The onset of stress in a nurse’s workplace depends on many different social factors, such as age, gender, organizational characteristics, organization, place of work, and years of experiences. In conclusion, we agreed with Spruil Tanya et al., that chroronic stress at work can be the reason for the high blood pressure.

Background: The WHO recommends the ideal rate for cesarean section to be 15% of the total birth, but researchers are still attracting attention to the fact that in recent years this rate has been steadily increasing, and risk is not decreasing worldwide. Incidence of postcesarean section inflammation and infection are 8-10 times higher than vaginal birth. The determination of lactate levels in early diagnosis of sepsis is clinically significant and the higher the lactate level increases the risk of mortality. Objective: The aim of the study is to improve early detection of inflammation and infection and prevention of serious complications by using risk factors of postcesarean section inflammation and infection, and detecting procalcitonin and lactate in maternal blood. Materials and Methods: This research is conducted between 2015-2017 based at the “Urguu” Maternity Hospital, Obstetric Clinic of National Center for Maternal and Child Health of Mongolia. Factors affecting postcesarean section inflammation and infection are calculated based on multifactorial regression analysis. Procalcitonin was determined by enzyme binding assay while lactate, C-reactive protein, and lactate dehydrogenase were determined by “E-311” the fully automated analyzer. Results: According to the results of the study, the probability of inflammatory and infectious complication is 2.4% when the duration of labor increases by one unit, 34.8% when the risk of amniotic fluid increases, 14.6% when the pregnancy process become more complicated. Whereas, excessive fetal weight statistically increases the risk of infection, but its impact is low. The result of the study shows that the procalcitonin sensitivity was 65%, and the specificity was 96%. Lactate resulted in sensitivity of 56%, but with only 67% specificity. C-reactive protein had a sensitivity of 65% and a specificity of 96%. Lactate dehydrogenase resulted in sensitivity of 95%, and specificity of 82% in the diagnosis of sepsis. Conclusion Postterm pregnancy, premature rupture of membranes, multifetal pregnancy, prolonged labor, placenta previa, pyelonephritis, chronic hepatitis, chronic hypertensive disorder, anemia, emergency cesarean section, preeclampsia are risk factors and it is statistically significant at (P<0.0001). The biomarkers have a direct correlation to all stages of inflammation and infections, which are important for the diagnosis.