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Introduction@#About 20-30% of patients with acute pancreatitis have a severe disease and mortality rate among inpatients were 15%. There are many causes of acute pancreatitis (AP), but most common cause of AP is an alcohol. According to some studies in our country, alcohol is the number one cause of acute pancreatitis and the mortality rate is 15.3%. Very important for prognosis of disease optimal choice of treatment tactics, detection of infectious evidence of necrotizing pancreatitis. Therefore, based on the above, there is an urgent need to conduct research to address important issues and to improve the diagnosis and treatment of acute alcohol-induced pancreatic necrosis.@*Goal@#Determine the importance of early diagnostic assessment of alcohol induced severe acute necrotizing pancreatitis.@*Materials and Methods@#Research model and research method. We conducted our research using an observational research model and a factual research method.Sampling of research materials will be carried out by targeted sampling. From November 1, 2008 to January 1, 2020, 122 patients who were hospitalized with alcohol-inducedAP were selected and archival documents or medical histories were selected. Statistical analysis was performed using averages and regression analysis methods to calculate the laboratory parameters in the analysis related to the new evaluation system.@*Results@#The minimum age of patients with ANP was 25 and the maximum was 71, with the majority (87.4%) aged 26 to 60 years. When the Person Correlation method calculates the relationship between alcohol consumption and mortality, it is assumed that the weaker the correlation, the higher the amount of alcohol consumed, the lower the cure and the higher the mortality. Of the 31 deaths reported in the study, 24 (77.4%) were hospitalized more than 72 hours after the onset of the disease. Late hospitalization and late treatment of patients with acute necrotizing pancreatitis (ANP) disease have been shown to adversely affect the prognosis of the disease. In our study, all parameters were significant, but procalcitonin, serum amylase, serum lipase, serum LDG8 C-reactive protein, serum glucose was found to be higher than the value specified in the evaluation system for the variable (in determining pancreatic necrosis). АNOVA analysis test showed that white blood cells, procalcitonin, serum amilza, serum lipaza, serumglucose, serum LDG, C-reactive protein were higher than those specified in the evaluation system, and that the level of significance for the variable (indicating a severe pancreatitis or poor prognosis) was higher than other test results (P <0.01). According to the new evaluation system, 12 out of 122 patients were classified as A class or 0-3, 69 (56.5%) patients were class B or 4-6, and 41 (33.6%) patients were class C or >7 points. Of the total cases, 90.1% were rated as severe form of ANP and pancreatic necrosis by the classification system we developed. When we assessed the prognosis with the new assessment system, we found that 100 percent of patients in category A were cured, 89.8 percent of patients in category B were cured, and 41.5 percent of patients in category C were cured and 58.5 percent died. Statistical calculations using the correlation analysis method for the correlation between the score and the cure of the evaluation system shows negative correlation (P <0.01) other words, the higher the score of the evaluation system, the lower the cure rate and the higher the mortality rate.@*Conclusion@#In Mongolia, relatively young men suffer from alcohol-induced pancreatitis.Factors contributing to the development of necrosis in acute pancreatitis include alcohol abuse, prolonged alcohol use, delayed hospitalization, and delayed treatment.In our study, following clinical signs and laboratory findings are effective in distinguishing severe forms of acute necrotizing pancreatitis, early diagnosis, assessment of prognosis. Laboratorytests include: increase in white blood cells, procalcitonin, serum amylase, serum LDH, serum lipase, C-reactive protein and a decrease in hematocrit, serum calcium.
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Introduction@#We classify peritonitis as end-stage if it lasts for more than 72 hours or more than three days. At this point, the pleural effusion of the posterior abdominal wall, the pleural layer of the gastrointestinal tract, and the dimples of the esophagus are all scattered with pus. During the first operation, it is very difficult to completely cleanse these abscesses. After the operation, pus will collect in the abdomen and abscesses will form, which will require another operation. If this postoperative complication is not diagnosed in time and operated again (relaparotomy), many other complications can occur and the risk of death is high. 48-hour relaparotomy mortality is higher than early surgery (21.8% -76.8%). Necrotic pancreatitis is chronic peritonitis (an abscess of the lower extremities) in which only non-pancreatic adipose tissue, sebum glands, pericardial effusions, pericardial effusions, and kidney adipose tissue become necrotic.@*Purpose@#Endoscopic surveillance for chronic pleurisy with pancreatic necrosis@*Objectives@#</br> 1. Endoscopic monitoring of the postoperative course of pancreatic necrosis.</br> 2. Calculate the results of washing and cleaning using binoculars.@*Method@#Patients with advanced peritoneal inflammation and necrotizing pancreatitis should be selected for reoperation. After removing the dead pancreatic tissue (necrosectomy), all layers of the abdomen are temporarily closed. A 6 mm short tube with surgical rubber is cut into the small pancreas, inserted 2 cm deep into the standard abdomen and sutured to the skin. Or use a silicone tube 4 - 5 cm long.@*Result@#The study was carried out on 56 patients in 2016-2020. The mean age was 50 (89%) for men, 6 (11%) for women, and 47.5 ± 8.6.@*Conclusion@#</br> 1. Endoscopic follow-up showed 19 (76%) persistent postoperative peritonitis and re-clearance, and 6 (24%) patients were not diagnosed with persistent peritonitis.</br> 2. 25 (50%) cases of persistent peritonitis after surgery were washed 1-3 times. This method has proven to be a safe and easy procedure and can be used in any urban or rural hospital.
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Introduction@#In Mongolia, data on the etiology and risk factors of cardioembolic stroke (CES) is scarce and few clinical studies have been performed to date. Timely identification and control of cardiovascular risk factors are priority objectives for adequate primary and secondary prevention of CES.@*Goal@#The goal of this study was to describe risk factors for CES in our setting. @*Results@#The case-control study enrolled a total of 525 subjects. CES was detected in 63 (35.7%) out of 176 (33.5%) ischemic stroke patients with a predominance in age group of 60-69 and men (33%). The main risk factor of CES was non-valvular atrial fibrillation (AF). AF especially paroxysmal AF increased the risk of CES by 4.6 times (p=<0.0001, OR 4.6, 95% CI 1.4-44.6). The second main cerebrovascular risk factors were hypertension and dyslipidemia.@*Conclusion@#CES accounted for 1/3 of ischemic stroke. The commonest underlying medical conditions were non-valvular atrial fibrillation, hypertension, dyslipidemia, alcohol consumption and obesity. Hence, all patients with hypertension and non-valvular AF should be meticulously screened for prevention of CES.
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Intruduction@#Since 1990, joint surgery techniques and implants have changed dramatically and results have improved. Today knee implants and surgical treatment of knee injuries are commonplace at the National Center for Trauma and Orthopedics.</br> Rehabilitation after knee surgery can help maintain joint range of motion, muscle strength, and daily function. However, inadequate rehabilitation can lead to increased pain, reduced mobility and, in some cases, reoperation.@*Material and Methods@#The study included 90 patients who responded to an AM-34 form using a random sampling method for pain assessment using VAS, daily activity ability using the Barthel index, gait analysis using gait analysis, and muscle strength rating of joint amplitude using by ICF 10.@*Result@#A study was conducted on 90 patients who had postoperative physical surgery in 2016-2019 in the Arthritis Surgery Department of the National Center for Trauma and Orthopedics. The study included patients aged 19 to 45 years with a mean age of 28.98 ± 5.47 years, 58 years for men (64%) and 32 years for women (36%). </br> Rehabilitation and postoperative treatment after knee surgery can help maintain freedom of movement, muscle strength, and daily joint function, while inadequate rehabilitation can lead to increased pain, reduced mobility and, in some cases, reoperation. confirmed by research.</br> Studies have shown that endoscopic surgery is 30 to 40% more effective than open surgery in normalizing joint function in postoperative knee surgery.</br> The sooner you start mobile surgery after knee surgery, the sooner your joint function will be normal. It was effective to do the 6 movement exercises that we used together.
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Background@#An aim of this study was to evaluate the long-term functional outcomes of laparoscopic ureteropyeloplasty compared to that of open surgery at the Urology and Andrology Center of the First Central Hospital of Mongolia. Ureteropelvic junction (UPJ) is the most common site for upper urinary tract obstruction occurring 1 in 750 - 1500 births. Laparoscopic pyeloplasty was first reported in 1993 by Schuessler WW and its technique was dismembered pyeloplasty.@*Material and Methods@#In the period from June 2018 to September 2019, we have operated 91 ureteropyeloplasty cases. Patients were randomized into Group I (45 laparoscopy) operated by the laparoscopic ureteropyeloplasty and Group II (46 open surgery) operated by the open ureteropyeloplasty. All the patients had ureteropelvic junction obstruction and ureteropyeloplasty was performed. Both groups were compared according to the operative time, and recovery duration. We studied restoration of renal function and causes of conditions. Demographic data including age, gender and complications were recorded. Renal diethylenetriamine penta-acetate scintigraphy was respectively performed 6 months after surgery. @*Results@#Mean age was 32±12.05 ranging 16-62 in all the study population. A total of 91 (55 men and 36 women) were participated. Ureteropelvic junction stricture was occurred 75.66% in laparoscopic cases and 84.78% in open cases which leads to hydronephrosis and it was statistically different (p<0.028). Compared to that of open surgery, wound size was 6 time smaller, blood loss and hospital stay less than 2 fold and wound healing is 5 days shorter than open surgery. There was statistical different (p<0.001) between parameters of 2 groups. In laparoscopic and open group respectively, renal function was 41.78±10.02ml/min, 42.15±11.34 ml/min (1.73м2). After intervention, renal function was increased by (46±10.17ml/min, 46.09±11.50ml/min) and there was difference between 2 groups (p<0.003). In laparoscopic group, renal function was more improved than open group (p=0.05).@*Conclusion@#Laparoscopic surgery had less blood, less analgesics usage, fewer hospital stays, and faster wound healing. Renal function was improved 6 months after surgery.
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Introduction@#In 1987 Jerome Ritchie, David Auth and colleagues first introduced rotational atherectomy (rotablation) as a technique for the endovascular treatment of obstructive atherosclerotic disease. Rotational atherectomy covers 3-5% of all procedures in big PCI centers, while <1% in smaller centers. By study of Warth DC et al. in 1994, at early period when it was first introduced, procedure complication of rotablation was about 40%, those with coronary dissection 29%, coronary artery occlusion 11.2%, side branch occlusion 1.8%, distal occlusion 0.9%, no relow phenomenon 6.1%, severe vasospasm 13.8% and vascular perforation 1-2%. </br> By advanced techniques and technologies that kind of complications reduced significantly, it occurs as same as other PCI procedures. </br> In our country PCI procedure was first introduced in Third State Central Hospital in 2000, since then 20 years has passed. During this period coronary intravascular diagnosis and treatment developed progressively performing 14751 PTCA procedures, of those 8355(56,6%) PCI cases. By statistics of 2017, myocardial infarction occurred 1145.6 in 10000 population, showing sharp increase, and cardiovascular mortality became number one cause and has tendency to increase further.</br> To inform first outcome of rotational atherectomy of atherosclerosis that is severely calcified and unavailable to introduce balloon catheter or stent. To conduct atherectomy treatment methods, accustoming professionals, order and get ready the treatment materials for necessity.</br> We successfully performed rotablation in severely calcified mLAD of 56 years of male patient by staged PCI, whose infarct related artery Lcx was revascularized 3 months previously. As a result the patient was fully revascularized, the balloon catheter passed through the narrowing and stent was implanted successfully.
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@#In the 13th century, a wound caused by an arrowhead was healed by scorching the surface of the injury. For instance, in the early 13th century during a battle, Ugudei Khaan was shot in the neck. One of his knights, Borokhul, sucked a blood clot from the wound and carried him on his horse. When Chinggis Khaan saw them, he grieved, wept, and ordered a fire to be made. After scorching Ugudei’s wound, he gave him something to drink and waited to fight their enemies. We came across instances of curing injuries with dairy products in the Secret History of Mongolia. In one case, when he was wounded in the neck, Chinggis Khaan traveled with difficulty and camped in a battle field at sunset. </br> One of Chinggis’ knights, Zelme, nursed him by sucking blood until midnight. He cared for the unconscious Khaan by himself, not trusting others. When midnight passed, Chinggis Khaan woke up and said “blood has dried and I am thirsty.” Zelme took off his hat, boots and deel (dressing-gown), leaving only underwear and entered their enemy’s camp. He searched for eseg (mare’s milk) on carriages of commoners who camped behind the military camp. However, he couldn’t find any eseg because the refugees hadn’t milked their mares. Therefore, he stole a leather sack of tarag (a drink made by fermenting the milk of sheep, goat, or cow) and carried it back to his camp. </br> Nobody saw Zelme, God might have blessed him. Zelme gave Chinggis Khaan the tarag mixing it with water to drink. Chinggis Khaan had the drink and said he felt relieved. At that time it was dawn. One of the achievements of Traditional Mongolian Medicine of that time was curing wounds with the help of surgical means. In the beginning, the Mongolians got much knowledge of animal anatomy by dismembering joints and internal organs of different animals while slaughtering. Afterwards, based on their knowledge of animal anatomy, they set bones and cured wounds. Additionally, they broadened their knowledge by performing autopsies on dead bodies, etc. In 1263, during one of the battles between the Mongolian and South Sun nation troops, which the Sun lost, Zuukhar was hit by 3 arrows. The arrowhead in his left shoulder could not be removed. Hyavtsag opened the wound with the help of two men who were sentenced to death (these people were Sun nation) and examined if the arrow could possibly be removed. Finally, he was able to remove the arrow from Zuukhar’s body. Thence, the Mongolians of that time performed autopsies as well as surgical treatment along with medical treatment. </br> In the mid-13th century, Traditional Mongolian curing methods were rapidly developing. The Mongolian army had special doctors to cure injured soldiers. According to some sources, in the early 13th century, there was a position of “military doctor,” among Chinggis Khaan’s army. When generals or troops got injured, the military doctor was ordered to cure them by a fixed deadline.
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@#There are many treatment options for the management of ureteropelvic junction obstruction (UPJO). Open pyeloplasty has a high success rate and has been considered as a gold standard. Minimally invasive surgical techniques are associated with reduced morbidity, improved cosmetic result and better convalescence than open pyeloplasty. For endopyelotomy, these advantages for minimally invasive surgery such as laparoscopic pyeloplasty and robot assisted pyeloplasty have superior success rate than open pyeloplasty. However, the success rate for laparoscopic surgery could potentially be improved by careful selection of patients, using the criteria of stricture <2 cm, renal function >25% and the absence of severe hydronephrosis. Laparoscopic pyeloplasty and robot-assisted pyeloplasty have similar success rates to open pyeloplasty (>90%) and the best outcomes have been reported for robot-assisted pyeloplasty although this treatment option is less readily available than laparoscopic pyeloplasty. Retrograde endopyelotomy is a simple, safe, and effective therapeutic option for primary and secondary symptomatic UPJO. </br> Retrograde endopyelotomy should be considered a viable first-line treatment option for the management of patients with UPJO. These include balloon dilation, antegrade endopyelotomy, retrograde endopyelotomy, Acucise endopyelotomy and laparoscopic pyeloplasty. During last decade, advances in endourological techniques have resulted in significant progress in the development of minimally invasive surgical procedures to treat UPJO. </br> Surgeons described their modification of Kusters dismembered procedure that involved anastomosis of the spatulated ureter to a projection of the lower aspect of the pelvis after a redundant portion was excised. Laparoscopic pyeloplasty was first reported in 1993 both by Schuessler and others and by Kavoussi and Peters, who utilized dismembered pyeloplasty technique. During last decade, advances in endourological techniques have resulted in significant progress in the development of minimally invasive surgical procedures to treat UPJO. The combination of less postoperative morbidity, improved cosmesis, shorter convalescence and comparable operative success rates has lured many patients away from gold standard of open pyeloplasty. Only few retrospective studies have been conducted regarding laparoscopic versus open pyeloplasty. Success rates are comparable for laparoscopic pyeloplasty.</br> The number of minimally invasive surgeries performed by us increased from year to year. Therefore the characteristics and performance of the surgeries should be studied in detail and based on the finding the evidence based medicine should be placed in.
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@#Thrombosis is a term for a blood clot occurring inside a blood vessel. R. Virchow postulated that abnormalities in blood flow, hypercoagulability of the blood, and injury to the vessel wall are causally related to thrombus formation. Many of the risk factors for deep vein thrombosis aretrauma for 9.3- 18.8%, birth for 16-17.3%, surgery for 14.3-30.3%, infection disease for 9.7-15.9%, cancer for 3.5%, heart disease for 4.6% and 6.9-11.8% of deep vein thrombosis is an indistinct cause. Pain, swelling, warmth, edema and redness in the affected leg are common symptoms.The diagnosis of deep vein thrombosis of the leg can be difficult with clinical findings and history being unreliable. The National Institute of Health and Care Excellence has evidence based recommendations on the prevention and management of a wide range of health conditions. Here: incorporation of a clinical predication score, D-dimer, and venous duplex ultrasound. The D-dimer blood test measures degraded fibrinogen, which is raised in patients with a clot. However, it cannot confirm deep vein thrombosis, as D-dimer can be raised in other conditions including malignancy, infection, pregnancy, post-surgery, inflammation, trauma, disseminated intravascular coagulopathy, and renal impairment. There are two types venous ultrasound as the first line investigation for suspected deep vein thrombosis. The aim of treatment for deep vein thrombosis are: </br> • The prevention of a thrombus progress </br> • Decrease the risk of the pulmonary embolism </br> • The reduction of the thrombus expansion or resolution.</br> • The prevention of the post thrombotic symptoms</br> • Decrease the mortality of vein thrombosis</br> Guidelines from NICE and ACCP recommended direct oral anticoagulants as first line treatment for deep vein thrombosis. Direct oral anticoagulants include direct factor Xa inhibitors apixaban, rivaroxaban, and edoxaban, and a direct thrombin inhibitor dabigatron
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@#History of surgical services in Mongolian medicine began at least from New Stone Ages (Neolithic Era). However, we decided to study usage of surgical instruments in Mongolian medicine from 1578 to the XIX century. Because, the third transmission of Buddhism into Mongolia occurred during the time of the Altan Khan of the Southern branch of Central Mongols, a descendent of Kublai Khan, tried to revive Mongol strength and unification. After that Undur Gegeen Zanabazar was also holding a religious service around his residence. Furthermore, in 1651 he established 7 parts of the Monastery including Financial, Lamasery, Food service, and Personal physician’s divisions based on his attendants, people, and lamas. The Personal physician’s division was one of the basis for the sect of “Four Medical Tantras”. Since that time the sect of “Four Medical Tantras,” had been spread effectively and many medical schools were established near the Buddhist temples in Mongolia. They respected “Four Medical Tantras,” and “Shun,” as the main scripts and focused to base it on their theory and practice. </br> During the research we identified that from the XVII century, Mongolian doctors and scientists wrote many commentary books on “Four Medical Tantras” and renewed some of the content of “Four Medical Tantras.” Especially, Agvanluvsandanbijaltsan and Jambaldorj wrote a medical and medicinal books including surgical instruments. Also Ishbaljir wrote practical book about internal medicine, surgical methods, and services. </br> The major conclusion to this study was that Mongolian nation established their own medical art, comprehensive knowledge, and surgical methods as well as updated surgical instruments during the XVII and XIX Century. Particularly, they could renewed surgical methods and surgical instruments, which came from Indian Ayurveda and Tibetan medicine.
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Introduction@#The curriculum development is important issue, especially sudent’s evaluations for the implementation of the curriculum. Accordingly this time we conducted this survey to determine the level of satisfaction of students, which is a key factor in implementation of curriculum at the “Ach” Medical University.@*Goal@#To determine student’s satisfaction level in the curriculum implementation of “Ach” Medical University@*Materials and Methods@#Study was conducted descriptive study design using quantitative research methodology. The Likert scale (1-5) used for the assessment of satisfaction score. Total 1105 students were included in the study. Study questionnaire included 2 groups with 17questionnaires.@*Results@#Students’ satisfaction level is 3.22 point on average and students gave lowest points 2.77 on the quality of classroom, school environment, training equipment and books and course materials. @*Conclusions@#The average satisfaction score was 3.22 above the average but the some factors including classroom capacity, study environment, training equipment and books and course materials, textbooks were below average.
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Introduction@#The clinical skills training at medical schools provides the opportunity for future medical doctors to deal with the client with proper care, diagnosis of the disease, first aid, treatment, nursing, treatment, counseling to address the complexity of the problem solving and the ethical attitude of the doctor. To achieve this objective, it is necessary to assess the level of knowledge, skills and attitudes students have acquired.@*Goal@#To analyze assignment of basic clinical skills assessment and to identify the level of кknowledge and skills students who have graduated second year medical program at “Ach” Medical University during 2016- 2017 academic year.@*Materials and Methods@#The study was used as a descriptive model to measure the reliability of the assignment, the difficulty factor of tasks, and the Hoffsten’s scores based on the tasks and performance of each station and compared with the indicators.@*Results@#Based on Hoffsten’s study on the success rate of examiners at the 5 stations, the Hoffsten’s score level of clinical examination was 68 percent, the physical examination station was 64 percent, the station’s diagnostic level was 71 percent, the laboratory was 70 percent and the nursing station was 70 percent.@*Conclusion@#At each clinical trial, the differential diagnosis of each individual clinical trial, clinical interview, nursing station and visual diagnostic station (DF> 95), at the laboratory and at the physical examination station, assess the student with a higher grade of difficulty factor (DF> 80) to the Hoffsten’s score of the basic clinical skills exam is set to be 70 percent.
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Introduction@#The curriculum development is important issue, especially stakeholder’s evaluations for the implementation of the curriculum. Accordingly, this time we conducted this survey to determine the level of satisfaction of teachers, which is a key factor in implementation of curriculum at the “Ach” Medical University.@*Goal@#To study curriculum implementation assessment by teachers at the Ach Medical University.@*Materials and Methods@#Study was conducted descriptive study design using quantitative research methodology. The Likert scale (1-5) used for the assessment of satisfaction score. Total 77 teachers were included in the study. Study questionnaire included 7 groups with 53 questionnaires. @*Results@#Total n=77 teachers included in the study. The satisfaction level of teachers for the implementation of curriculum was 73% (n=56) satisfied with satisfaction, 22% moderate satisfaction (n=17), and medium satisfaction teacher 5% (n=4). </br> The satisfaction level of teacher workload and job satisfaction is high enough to satisfy the workload of the trainee, the time to prepare the lesson, and the opportunity to work with the students in the classroom. 3.6-4.2, while the teacher’s work value or salary the level of satisfaction level is 3.11, the minimum value is 2.75, the average.@*Conclusion@#The average satisfaction score was 4.11 above the average but the effectiveness of the program, the effectiveness of the teacher’s work, study environment and textbooks were below average.
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Introduction@#One of the quality assurance measurements for medical schools is the achievement of students who have graduated in the assessment of the knowledge, skills and attitudes they are trained in.@*Goal@#To analyze assignment of theoretical and practical exam and to identify the level of кknowledge students who have graduate at “Ach” Medical University during 2015-2016 academic year.@*Materials and Methods@#The study was conducted on a cross sectional and descriptive study through the based on the task of analyzing the 261 graduate students theoretical and practical exam performance of the bachelor degree in Medicine, Dentistry, Traditional Medicine and Nursing of Ach Medical University of Mongolia /AMU/ and was assessed and to identify a reliability coefficient, difficulty factor, discrimination index, Hoffsten’s score. @*Results@#The reliabiliy coefficient of graduate exam meets requirement when it’s 0.94-0.96. According to the analysis of the 300 test of the each classroom of graduates was 70 percent (n=202) with weak dicrimination index, difficallty factor was more than 50 percent too easy, The Hoffsten’s score to which exam was passed of Medical graduates is 70 percent, traditional medicine is 87 percent, dentistry is 79 percent, the nursing is a Hoffsten’s score was 80 percent.@*Conclusions @#The reliability coefficient the theoretical exam of the graduates’ knowledge is convenient for all occupations, and whole field examines the weak difficulty index (DI≤0) for all field examinations. The Hoffsten’s score is 70% above the medical field. Graduate assignments can not discriminate graduates’ knowledge and skills levels and the difficulty factor graduate examination was very easy.
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Background @#The frequency of tetralogy of Fallot among newborns and infants is 5.6-14.0% of all congenital heart defects [5, 14, 17] The most frequent complication of the early postoperative period is right ventricular failure, which is formed when the anatomy of the right ventricle and the progressive pulmonary regurgitation are disturbed [1, 3, 12]. With the development of new minimally invasive methods of examination and their introduction into clinical practice, the understanding of hemodynamic parameters after surgical correction, pathophysiological mechanisms of development of right ventricular dysfunction has improved. </br> One of these methods is transpulmonary thermodilution and pulse waveform analysis, which allows in the early hours after operation to determine preload, heart function and postload parameters [9, 20]. </br> In the long-term period, many patients after radical correction have right ventricular dysfunction due to many years of massive pulmonary regurgitation. With the introduction of MRI improved understanding of the pathophysiological mechanisms of development of right ventricular dysfunction.. Recent reports indicate that the global functional assessment of the right ventricle after surgical correction does not reflect its present function [7, 10].@*Aim@#The aim of the study was to estimate the early postoperative indices of hemodynamics in different types of the right ventricular output plastics after radical correction of Fallot’s tetralogy and to access the functional state of the right ventricle in the long- term postoperative period.@*Materials and Methods@#On the basis of cardiovascular surgery department of the Shastin P.N. hospital, a prospective cohort study of 52 patients (28 boys, 24 girls), underwent radical correction of Fallot’s tetralogy, was conducted. </br> Patients were divided into 2 groups by the type of reconstruction of the right ventricular outlow tructs: group I included patients with transannular plasty of the output part (group I, 26 patients), group II-patients with preserved fibrous ring of the pulmonary artery (group II, 26 patients). The postoperative hemodynamic status was assessed with transpulmonary thermodilution. The right ventricular function in the long-term period was estimated by means of US and MRI.@*Results@#During the first postoperative hours, hemodynamic indices according transpulmonary thermodilution technique were significantly lower in group I and reliable differed from group II. However, later (12.24,48 hour after), restoration of hemodynamic indices in group I, which did not significantly differ from group II, was observed. In the long-term period, ejection of the right ventricle was reliable higher in group II, while terminal diastolic volume of the right ventricle was significantly higher in group I. Pulmonary regurgitation was also significantly higher in group I-36.7 (32,44) versus 13,2 (3;14) (p<0,01).@*Conclusions@#Preservation of pulmonary artery fibrous ring provides better parameters of hemodynamics in the early postoperative period including systolic and diastolic functions. In the long-term period, this group of patients is less subjected to the right ventricular function.
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@#The study of indices of heart remodeling was performed in children with secondary atrial septal defects (ASDs) after either endovascular or surgical repair of the defects. The data analysis showed that serious ASDs lead to diastolic left ventricular (LV) dysfunction. Recovery of LV function occurred during the first day following endovascular repair or after six months following surgical correction. Maximum reduction of dilatation of the right heart chambers after ASD repair is recorded in the early postoperative period and keeps during follow up, regardless of the method for the defect repair. We found a significant depression in mechanical activity of left atrium after surgical repair with the recovery one year after the procedure.
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Background: Cardiac surgery with cardiopulmonary bypass is grown rapidly in last years. Theapplication of cardiopulmonary bypass using a heart-lung machine to perform open heart surgeryis known to be associated with numerous pathophysiologic changes including injury of cellularcomponents as erythrocyte, platelets, coagulopathy, and fibrinolysis.Objectives: Our study objective is to study on relation of open heart surgery phases and bloodcoagulation parameters.Materials and Methods: Blood samples from 49 patients (28 females and 21 males, aged 18-63 years) who underwent open heart surgery with cardiopulnonary bypass (CPB) were collectedbefore and at several time points during, after surgery and analyzed for coagulation parametersat Shastin Third Central Hospital.Results: To compare long continued cardiopulmonary bypass (over 1 h) surgery with less 1h groups there prothrombin time was found 18.8±5.9 sec, international normalized ratio (INR)2.09±0.9 sec prolonged (p<0.001) in 7 days after surgery. All coagulation parameters weredecreased significantly (p<0.001) in during extracorporeal circulation and after 1 h declampingthan preoperative level and reached near normal value in 48 h after surgery. Our results havereferred to platelet counts reduction to about 53% in during surgery, 46.8% in 48 h after surgeryof the preoperative level 237.4±57.1 with final return to normal levels 228.9±78.6 within 7 days.Conclusions:1. The cardiopulmonary bypass time and patient age in relation to open heart surgery type therewere significant difference (p <0.01).2. The coagulation parameters have revealed significant changes (p <0.01) in relationcardiopulmonary bypass time.3. All coagulation parameters were decreased significantly (p<0.001) in during extracorporealcirculation and after 1 h decamping than preoperative level and reached near normal value in48 h after surgery.4. There was direct and less correlation between platelet level and CPB time (r=0.37, p<0.001).
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Background@#Cardiac surgery with cardiopulmonary bypass is grown rapidly in last years. The application of cardiopulmonary bypass using a heart-lung machine to perform open heart surgery is known to be associated with numerous pathophysiologic changes including injury of cellular components as erythrocyte, platelets, coagulopathy, and fibrinolysis. @*Objectives@#Our study objective is to study on relation of open heart surgery phases and blood coagulation parameters.@*Materials and Methods@#Blood samples from 49 patients (28 females and 21 males, aged 18- 63 years) who underwent open heart surgery with cardiopulnonary bypass (CPB) were collected before and at several time points during, after surgery and analyzed for coagulation parameters at Shastin Third Central Hospital.@*Results@#To compare long continued cardiopulmonary bypass (over 1 h) surgery with less 1 h groups there prothrombin time was found 18.8±5.9 sec, international normalized ratio (INR) 2.09±0.9 sec prolonged (p<0.001) in 7 days after surgery. All coagulation parameters were decreased significantly (p<0.001) in during extracorporeal circulation and after 1 h declamping than preoperative level and reached near normal value in 48 h after surgery. Our results have referred to platelet counts reduction to about 53% in during surgery, 46.8% in 48 h after surgery of the preoperative level 237.4±57.1 with final return to normal levels 228.9±78.6 within 7 days.@*Conclusions@#</br> 1. The cardiopulmonary bypass time and patient age in relation to open heart surgery type there were significant difference (p <0.01). </br>2. The coagulation parameters have revealed significant changes (p <0.01) in relation cardiopulmonary bypass time. </br>3. All coagulation parameters were decreased significantly (p<0.001) in during extracorporeal circulation and after 1 h decamping than preoperative level and reached near normal value in 48 h after surgery. </br>4. There was direct and less correlation between platelet level and CPB time (r=0.37, p<0.001).
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BackgroundHealth professional licensing was introduced in Mongolia in 1999. Medical school graduates shouldpass the health professional licensing exam (HPLE) to be registered. It was informed that HPLEsuccess rate has been decreased for last few years among graduates who passed final theoreticexam (FTE). There has been no research conducted to explain the reasons of such trend. Thisresearch aims to conduct a comparative assessment of MSQs used for both HPLE and FTE.GoalTo analyze examination and test to identify the level of medical knowledge of students who graduateas medical doctor at “Ach” Medical University during 2011- 2015.Materials and MethodsThis is a cross sectional descriptive study. it employed a statistical analysis of 2950 MSQs (24version) that were used for the HPLE by the Health Development Center of the MOH (N=16)and FTE by the “Ach” Medical University (N=8) between 2011 and 2015. Test sheets of HPLE(N=728) and FTE (N=686) were assessed in order to identify a reliability of tests, difficulty index,discrimination index using QuickSCORE II program of the test reading machine with a mode of“Scantron ES-2010”.ResultsThe success rate was much higher in FTE than it in HPLE between 2011 and 2015. The successrate of HPLE decreased dramatically starting from 2013 (87%) to 2014 (4%) and 2015 (24%) whilethe same rate of FTE was stable and almost 100%.FTE’s reliability coefficient of 2011-2015 years meets requirement when it’s 0.92-0.96. HPLE’sreliability coefficient of 2013 and 2014 years don’t meet requirement.From all of the MCQs that has been used in FTE‘s 97% and in HPLE’s 80% are positive discriminationindex which means possible to identify medical school graduates knowledge.ConclusionOur findings confirmed that the success rates of HPLE among medical school graduates are beingquite low.Reliability coefficient of HPLE tests were less reliable (КР20=0.66-0.86) than FTE (КР20=0,92-0.96) and particularly tests for 2014 and 2015 were more difficult and were with high percentage ofnegative discrimination.Test score between HPLE and FTE of 2011-2015 is direct linear correlation.
ABSTRACT
Introduction: In 1814 Irish surgeonAbraham Coll first introduced distal radialbone fracture in clinical practice as a collesfracture. It is one of the most commonfractures account for 10-20% of the totalrespectively fracture. Case of Colles fracturehas being increased in the developed countryyear by year besides the increasing numberof elderly patients. Depending on severitydisplaced of the fracture, managementincludes closed reduction or surgicalprocedure. The aim of study was to studyresult of risk factors that influence theclosed reduction management of the Collesfracture.Materials and Methods: From hospitalbased population 80 patients aged between5-76 years (mean age 47.31 years, male61.25%, female 38.7%) were recruited bycross sectional and randomized method.Participants were divided into displaced andnon-displaced groups which confirmed byrefractive index difference on X-ray.Results: The risk factors that influence thecolles fracture closed reduction managementwas osteoporosis (p=0.38), menopause(r=0.18, p=0.27), calcium supplement intake(r=0.21, p=0.05), received hospital care in24 hour (p=0.39), apply plaster (p=0.64),hand sling immobilizer brace (p=0.5) andphysical therapy (p=0.5).Conclusion: Osteoporosis and menopausewere the risk factors that influenced theclosed reduction management of Collesfracture. The patient cases that not receivingemergency medical care in first 24 hours,not applying plaster, not using the hand slingimmobilizer brace and not receiving physicaltherapy was risk factors for extending theclosed reduction management of the Collesfracture.