Background: Among the total healthcare waste generated from health-related activities, 10–20% is considered haz ardous, posing significant threats to both the environment and human health. Approximately 3% of healthcare waste is pharmaceutical waste. In Ulaanbaatar city, an estimated 2.65 tons of healthcare waste is generated daily (0.78 tons of medical waste and 1.87 tons of general waste). With the continuous increase in pharmaceutical consumption, the improper disposal of pharmaceutical waste has emerged as a major environmental concern, adversely affecting nature, animals, and the food chain. Contamination from pharmaceutical waste, such as the development of antibiotic resistance, is closely linked to inadequate public awareness of waste management. Aim: This study aimed to assess the knowledge, skills, and attitudes of pharmacy technicians in community pharmacies regarding pharmaceutical waste management. Materials and Methods: A cross-sectional survey was conducted among pharmacy technicians across Mongolia. As of 2023, there are 4,959 licensed pharmacy professionals in the country. Using a representative sampling method, data were collected from 360 pharmacist and pharmacy technicians. Data were analyzed using MS Excel and SPSS version 26. Results: A total of 360 pharmacists from both urban and rural areas participated in the study. The assessment was based on a 5-point Likert scale, with scores of 1-2 considered negative and 3–5 considered positive. The average scores for knowledge, skills, and attitudes were 3.3, 3.06, and 3.25 respectively. While individual scores were satisfactory, the results of questions targeting social awareness were relatively low. Conclusion The knowledge, skills, and attitudes of pharmacy technicians regarding pharmaceutical waste management were found to be satisfactory. However, to further improve knowledge levels, it is recommended to implement additional training programs related to pharmaceutical waste management among pharmacy technicians.

Background: Community pharmacies are accessible healthcare institutions that offer services without the need for appointments or prepayment. In recent years, the scope of pharmacist responsibilities has expanded from merely dispensing medications and medical devices to providing patient-centered pharmaceutical care, health promotion, and disease prevention. As a result, pharmacists are increasingly confronted with ethical challenges in their daily practice. Aim: To identify the ethical issues faced by pharmacists working in community pharmacies in Ulaanbaatar, Mongolia. Materials and Methods: A cross-sectional survey was conducted between March and September 2024 among pharmacists working in community pharmacies in Ulaanbaatar. Participants included 374 pharmacists who had been working for at least three months, held valid professional licenses, and voluntarily agreed to participate. A structured questionnaire was used to collect data. Descriptive statistics were analyzed using SPSS version 25.0. Results: Among the respondents, 339 (90.4%) were female, 301 (80.48%) were pharmacists, and 230 (61.5%) were under 30 years old. Additionally, 214 (57.2%) had worked in a community pharmacy for less than five years. Open-ended responses were coded into three major categories and 15 subcategories: (1) pharmacy management and organization, (2) compliance with laws and regulations, and (3) professional communication with clients. The most frequently reported ethical issues were: Customers demanding prescription-only medications without a valid prescription (56.6%), Negative or inappropriate client behavior (27.5%), Attempts to use expired or invalid prescriptions (14%) Conclusion 1. A total of 56.1% of pharmacists demonstrated insufficient knowledge of the Code of Ethics for healthcare professionals, which is essential for their professional practice. 2. Among pharmacists, 54.5% showed a negative attitude, and 48.9% exhibited inappropriate practices when faced with certain ethical situations. 3. The most common ethical challenges faced by pharmacists include: Requests from clients to dispense prescription-only medicines without a valid prescription (56.6%), Unethical or inappropriate behavior from clients (27.5%), Attempts to obtain medicines using invalid prescriptions (14%).

Background: Medical experts in pharmacies are the most accessible health professionals and play a key role in primary health care. They must strike a balance between their autonomy, the objectives of the company, and professional standards, while facing a lot of ethical dilemmas. This phenomenon can impact the quality of pharmaceutical care, as highlighted in several studies. Numerous studies have been carried out internationally to explore the medical ethics knowledge of pharmacists working in community pharmacies, their attitudes towards emerging ethical issues, and identification of their common problems. However, research in this area is scarce in Mongolia, which serves as the basis for conducting this study. Aim: Assessing the knowledge, attitudes, and practices of pharmacists regarding professional ethics in community pharmacies in Ulaanbaatar city. Materials and Methods: This study was conducted using an analytical cross-sectional study design and included 374 pharmacists who had been working in community pharmacies in Ulaanbaatar for more than three months, had a valid professional license, and consented to participate in the study between March and September 2024 (ethical approval number 2024/3-01). To determine the degree of knowledge, attitude, and practice, a questionnaire including 39 closed questions and 4 groups was used to gather survey data. For statistical analysis, SPSS-25 software was utilized. Results: Of those who took part, 301 (80.48%) were pharmacists, 73 (19.52%) were pharmacy technicians, and 339 (90.4%) were women. Additionally, 259 (69.3%) work in secondary pharmacies, and 305 (81.6%) have received ethics training. The study shows that 56.1% of pharmacists had insufficient knowledge of professional ethics, 54.5% had poor attitudes towards ethical issues, and 48.9% had inappropriate practices. When analyzed in relation to their profession, the ethical knowledge of pharmacists did not differ by profession, age, years of experience in community pharmacies, professional degree, and university graduated, but it was statistically significantly correlated with the participants’ self-assessed ethical knowledge (CL 95%, p=0.0001). Conclusions 1. The knowledge of professional ethical principles and standards is insufficient among pharmacists. 2. While handling emerging ethical issues, they have a negative attitudes and inappropriate practices. Consequently, it is compulsory to intensify training on the ethical code of conduct for medical experts s based on the needs of pharmaceutical professionals.

Introduction: Coronavirus infection 2019 (Ковид-19) is an infection caused by a novel virus and induces severe ARDS. КОВИД-19 pandemic has rapidly spreaded in 221 countries, 245,373,039 cases and 4,979,421 mortalities have been reported. Pulmonary and renal thrombotic angiopathy occur in patients with complications of ARDS, sepsis, and multi-organ failure. Elevated D-dimer in КОВИД-19 patients has been reported firstly by doctors in Wuhan, China. In addition, many studies have revealed that elevated D-dimer has been associated with the severity of the diseases, an increased rate of poor prognosis. Objective: We aim to determine D-dimer in КОВИД-19 patients, and patient condition a decrease of D-dimer level after administration of anticoagulant therapy. Case report: We introduce a rare case of КОВИД-19. Laboratory test results and the effect of anticoagulant therapy have been evaluated during the infection. 85 aged women were admitted with a diagnosis other than КОВИД-19. PCR for SARS-Cov-2 was negative on the previous day of admission, and Sars-Cov-2 Ag rapid test was also negative on the admission day. However, the D-dimer test result was much higher with 7120 ng/мл and X-ray and CT revealed a similar pattern to the КОВИД-19 patient. Then anti-Sars-Cov-2 test was positive with 4,08 COI. Based on laboratory test results of D-dimer, LDH, CRP, and CT pattern the patient was diagnosed with post-КОВИД-19 pneumonia, and anticoagulant therapy was initiated additionally to prevent hypercoagulation induced by КОВИД-19. D-dimer test taken before administration of anticoagulant therapy increased more to 10910 ng/мл. 3 days later D-dimer level decreased to 8180ng/мл and the patient’s condition was improved. Conclusion The evaluation of D-dimer of the patients with КОВИД-19 is highly significant. Anticoagulant therapy might be necessary for КОВИД-19 patients with high D-dimer level in serum. Further studies are needed to assess the long-term outcome of the illness and mortality.

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: There is an urgent need to study client satisfaction in assessing the quality and availability of health care. Compliance with the needs of consumers of any care, its accessibility, professional ethics, speed of work, determining customer satisfaction allows for evidence-based decision-making. Therefore, satisfaction surveys should be conducted at short intervals and the results used for decision making. One hundred and fifty million people on the planet pay for their health care every year and face financial hardship. Hundreds of millions of them are living in poverty, according to the World Health Organization’s 2010 year report. Governments must ensure that all people receive health care and are protected from health-related financial risks. We believe that the current state of quality and access to health care in our country does not fully meet the needs of the population. 62.4% of customer satisfaction surveys conducted in 2013 that health care was inadequate. However, customer satisfaction surveys on health insurance coverage are rare. The process of providing discounted medicines through health insurance varies depending on the health needs of consumers and their budgetary capacity. Therefore, it is necessary to take into account the factors that affect customer satisfaction. Methods: In our study, we looked by retrospective at health and health insurance reporting indicators, Satisfaction of customers who bought medicines at pharmacies with health insurance prescriptions was surveyed in a one-moment survey.
We collected information on the satisfaction status of 525 people who used health insurance prescriptions from 36 pharmacies from December 2018 to April 2019 and from January to February 2021 using preprocessed cards. Conclusion
1. The cost of diagnosis from the health insurance fund and the selection of drugs to be included in the list of drug price discounts are related to the prevalence of the disease in Mongolia.
2. Difficulties in accessing drug price reductions from the health insurance fund can lead to dissatisfaction with the approved budget and the availability of drugs on the list.
3. In the case of Ulaanbaatar pharmacies, the satisfaction rate of consumers who use the discounted price of medicines according to the health insurance prescription is 3.634 or 72.688% in the first stage survey and 3.912 ± 0.50 or 78.248% in the second stage survey.

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.

Background: The effect of lipopolysaccharide (LPS) on valproic acid (VPA)-induced cell death was examined by using mouse RAW 264.7 macrophage cells. Materials and methods, results: LPS inhibited the activation of caspase 3 and poly (ADP-ribose) polymerase (PARP) and prevented VPA-induced apoptosis. LPS inhibited VPA-induced p53 activation and pifithrin-α as a p53 inhibitor as well as LPS prevented VPA-induced apoptosis. LPS abolished the increase of Bax/Bcl-2 ratio, which is a critical indicator of p53-mediated mitochondrial damage, in response to VPA. The nuclear factor (NF)-κB inhibitors, Bay 11-7082 and parthenolide, abolished the preventive action of LPS on VPA-induced apoptosis. A series of toll-like receptor (TLR) ligands, Pam3CSK4, poly I:C, and CpG DNA as well as LPS prevented VPA-induced apoptosis. Conclusion Taken together, LPS was suggested to prevent VPA-induced apoptosis via activation of anti-apoptotic NF-κB and inhibition of pro-apoptotic p53 activation.

Introduction: Valproic acid (VPA) has been used in the treatment of seizures and bipolar disorders. In the present study, we examined how VPA affected PI3K-Akt pathway in response to LPS by using mouse RAW 264.7 macrophage cells. Material and methods: Mouse RAW 264.7 macrophage-like cells cultured and the cell viability checked by MTT and TUNEL assay. In addition, protein expression and protein interaction were detected by immune blotting and immune precipitation, respectively. TLR4 expression on cell surface studied by FACS analysis. Results: The MTT and TUNEL assays demonstrated no significant difference between VPA at 2 mM treated and untreated control cells. VPA attenuated LPS-induced phosphorylation of phosphatidylinositol 3-kinase (PI3K) and Akt, but not nuclear factor (NF)-κB and mitogen activated protein kinases (MAPKs). There was no significant difference in the TLR4 expression on the cell surface between cells treated with or without VPA. VPA inhibited LPS-induced PI3K/Akt signal transduction in a dose dependent manner. Conclusion VPA at 2mM exhibits nontoxic effect in the RAW 264.7 cells. VPA down regulates LPS-induced phosphorylation of Akt via inhibition of PI3K activation.

Abstract National Occupational Standards specify standards of performance that people are expected to achieve in their work, and the knowledge and skills they need to perform effectively. The National occupational standards for supporting teaching and learning in schools were developed to help improve the capacity and capability of the school workforce; they can make an important contribution to raising standards in schools.
National Occupational Standards describe best practice by bringing together skills, knowledge and values. They are valuable tools as benchmarks for qualifications as well as for defining roles at work, staff recruitment, supervision and appraisal.
Globally the roles and scope of work for technicians and pharmacy support workforce cadres vary greatly according to country and practice areas within that country. The School of Pharmacy MNUMS and Mongolian Association of Clinical Pharmacist and Association of Pharmaceutical Management has developed 4 phases National Occupational Standards.