Decreased of Alpha-Fetoprotein Level Among Patients with Liver Cirrhosis that Related to HCV Treated with Combination Therapy with Ledipasvir and Sofosbuvir

( Batsukh Dashnyam ),( Bayarmaa Nyamaa ),( Nyam Biziya ),( Oyundelger Munkhtuvshin ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Hepatocellular carcinoma (HCC) is considered one of the most lethal cancers, with most of cases diagnosed at advanced stage. The prevalence of HCC is high in Mongolia with men 116.6 cases and women 74.8 cases per 100,000 person-years. The hepatitis C virus (HCV) infection is one of the major causes of chronic hepatitis and hepatocellular carcinoma (HCC) in Mongolia. Viral infection with HCV can cause fluctuations in AFP that makes it difficult to differentiate between underlying liver disease and the development of HCC. The lack of specificity has limited the role of serum alpha-fetoprotein (AFP) for hepatocellular carcinoma (HCC) screening among patients with cirrhosis related to hepatitis C virus (HCV) infection. Methods: Here we report 25 cases decreased of AFP level in patients with cirrhosis treated 24 weeks combination therapy with ledipasvir and sofosbuvir between 2017 to 2020 were referred to the Liver Unit, Dornod Medical center Mongolia. All patients had been tested for blood chemistries, liver function markers, such as alanine aminotransferase (ALT), total bilirubin, prothrombin, international normalized ratio (INR), creatinine, AFP and HCV-RNA. Results: Of all patients, fifteen were man and ten were woman. The average age of the testimonies was 53 (between 40 and 67 years). All patients had HCV genotype 1b and had HCV-RNA positive. The combination of the therapy with ledipasvir and sofosbuvir had significantly decreased level of HCV-RNA from 2172560 to not detected (P<0.05), ALT from 119.4 to 28.4 (P<0.05), AFP from 42.8 to 12.2 (P<0.05). Conclusions: In conclusion, the combination of the therapy with ledipasvir and sofosbuvir is decreased AFP level and improved liver function tests in HCV related liver Cirrhosis of those patients.

MAGNETIC NANOPARTICLE-INCORPORATED GELATIN-SILOXANE HYBRID SCAFFOLDS FOR BONE TISSUE ENGINEERING

Khandmaa Dashnyam,Roman A.Perez,Rajendra K.Singh,Meeju Kim,Tsendmaa Bold,Hae-Won Kim 대한치과재료학회 2015 대한치과재료학회지 Vol.42 No.S

Vitamin D Deficiency in Chronic Liver Disease patients

( Uranbaigali Dashnyam ),( Bayarjargal Altankhuyag ),( Nyam Biziya ),( Shinebayar Narantuya ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: One of the most nutritional deficiency in the world is the deficiency of 25-hydroxyvitamin D [25(OH)D]. Study assessed that there are more than 1 billion people living in the world that has serum 25(OH)D<20 ng/ml deficiency. Vitamin D deficiency is widespread in individuals irrespective of their age, gender, race and geography. Deficiency of 25(OH)D not only causes children’s arthritis but to a range of common chronic diseases in adulthood such as diabetes, cancer, infectious diseases, cardiovascular disease, and autoimmune disease, this continuous to be a major public health problem in the world. Methods: Study participants were 102 chronic liver disease over the age of 18 from the citizens of “Choibalsan” city, “Dornod” province, who were referred to the outpatient of Dornod Medical center, Dornod, Mongolia. Overnight fasting blood samples were collected. All patients had tests for blood 25(OH)D were measured by ELISA and 28 patients who took 6 questionnaire tests. Results: Of all patients, 66 were men (68.1%) and 34 were women (31.9%). The mean age was 46 (between 18 and 89 years). There were 55 patients with cirrhosis (54%), and were 47 patients with chronic hepatitis B and C in the study group. 94 (92%) participants had 25(OH)D<20 ng/ml deficiency. Age and season had no correlation on the 25(OH)D level. From the results of the questionnaire test we can see that 5 have efficient 25(OH)D, 17 had the possibility of deficiency of 25(OH) D, and 6 had to reapply for the tests but these participants had 25(OH)D<10 ng/ml and this has no relevance on the level 25(OH)D (Pearson r=0.07, P=0.5). Conclusions: In conclusion, our pilot results show that patients as in 92% have 25(OH)D deficiency.

Old Time Mongolian Records Management and the Organization of Archives, Tradition of the Preparation of Cadres

G. Dashnyam 한국기록관리학회 2013 한국기록관리학회지 Vol.13 No.1

This paper introduces the elaboration of official documents, archival organizations, and the tradition of records in Mongolia from 1694 to 1921. Modern records management began in 1912. Back then, Mongolians had special rules to send and receive official documents, and to register the sent and received official documents. Official documents were used to deliver decrees and policies of the Khan and were used to deal with internal affairs. After their independence in 1911, the traditional documents were collected and preserved. Records managers and archivists were trained by decrees in Mongolia.

The Status of Hepatocellular Carcinoma (HCC) in Remote Eastern Mongolia

( Batsukh Dashnyam ),( Nyam Biziya ),( Oyundelger Munkhtuvshin ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: The prevalence of HCC is high in Mongolia with men 116.6 cases and women 74.8 cases per 100,000 person-years. HCC counts for the 46% of leading cancers. Dornod Medical Centre, Choibalsan is the major medical center in the three Eastern Provinces. The HCC patients in the Sukhbaatar and Dornod Province count for 3rd and 4th places in Mongolia. Methods: 160 patients were diagnosed to be HCC at the Dornod Medical Centre by using sonography from 2012 to 2014. 86 of them with available serum AFP levels were enrolled and compared. Less than a-half patients had computed tomography (CT) to confirm the HCC. Magnetic Resonance Imaging, angiography, hepatitis markers and liver biopsy are not available in the Dornod Medical Centre. Results: The age of patients was as 46-55 (25.5%), 56 -65 (29%), 66-75 (20.9%) and the greater numbers were patients age 76 and older (16.2%). 44 (51%) of them were male and 42 (49%) were female. There were detected 18 (20.9%) of liver cancer in size < 3 cm, 28 (32%) sized 3-5 cm and 40 (46.5%) sized > 5 cm across. Conclusions: The prevalence of HCC in Eastern Mongolia is high. The laboratory tests and image studies are limited in this region. Most patients are not able to afford the medical expense. The accurate diagnosis and treatment are difficult. Most patients are referred to the capital Ulaanbaatar 700 km far away. Much more resources are in-needed to help the prevention, diagnosis and treatment of HCC in the Eastern Mongolia.

Severe Indirect Hyperbilirubinemia Patient with NT-211G>A Variant of UGT1A1 Gene

( Baterdene Dashnyam ),( Naran Uyanga ),( Munkhbaatar Tsendsuren ),( Enkhtuya Derem ),( Gantuya Balgan ),( Nyam Biziya ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Hereditary abnormalities of uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) gene is associated with unconjugated hyper- bilirubinemia worldwide. Methods: Here we report one case of rapid onset of severe hemolysis and severe indirect hyperbilirubinemia in patient with nt-211 G>A mutation in UGT1A1 gene during the initial phase of combined interferon and ribavirin therapy for chronic viral hepatitis C. A 23-year-old Mongolian male developed chronic viral hepatitis C three years ago. His baseline laboratory data were hemoglobin 16.1 g/dl, MCV 86.8 fL, prothrombin time INR 1.0, AST 27 IU/L, ALT 27 IU/L, total bilirubin 1.4 mg/dL, direct bilirubin 0.4 mg/dL. His HCV RNA was genotype 1b and viral load was 3,063,289 IU/mL. The analysis of UGT1A1 gene revealed a homogeneous nt-211 G to A mutation. In the second week of the combined Peginterferon alfa-2a 100mcg plus Ribavirin 1200mg therapy, the patient developed increased jaundice with total bilirubin 4.9 mg/dL, direct bilirubin 1.9 mg/dL, hemoglobin 14.0 g/dL. Reducing the dosage of Ribavirin to 1000 mg daily, the total bilirubin went down to 1.9 mg/dL, direct bilirubin 0.9 mg/dL, hemoglobin 11.0 g/dL and HCV RNA became undetectable in the fourth week. The dosage of Ribavirin was further reduced to 800 mg daily. The total bilirubin level remained steady at 1.9 mg/dL, direct bilirubin 0.6 mg/dL and hemoglobin 10.4 g/dL in the eighth week. In the 22nd week, the patient is discontinued from the combination therapy due to severe depression, and the total bilirubin was 1.2 mg/dL, direct bilirubin 0.4 mg/dL and hemoglobin 11.4 g/dL. The patient achieved a sustained virological response despite the early termination of the combination therapy. Results: The hemolysis was improved by reducing dosage of ribavirin. The patient had sustained virological response despised the severe indirect hyperbilirubinemia. Conclusions: UGT1A1 abnormalities should be assessed when hyperbilirubinemia is observed during the initial phase of combined interferon and ribavirin therapy.

Decreased of Alpha-fetoprotein Level Among Patients with Liver Cirrhosis that related to HCV Treated with Combination Therapy with Ledipasvir and Sofosbuvir

( Batsukh Dashnyam ),( Bayarmaa Nyamaa ),( Nyam Biziya ),( Oyundelger Munkhtuvshin ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Hepatocellular carcinoma (HCC) is considered one of the most lethal cancers, with most of cases diagnosed at advanced stage. The prevalence of HCC is high in Mongolia with men 116.6 cases and women 74.8 cases per 100,000 person-years. The hepatitis C virus (HCV) infection is one of the major causes of chronic hepatitis and hepatocellular carcinoma (HCC) in Mongolia. Viral infection with HCV can cause fluctuations in AFP that makes it difficult to differentiate between underlying liver disease and the development of HCC. The lack of specificity has limited the role of serum alpha-fetoprotein (AFP) for hepatocellular carcinoma (HCC) screening among patients with cirrhosis related to hepatitis C virus (HCV) infection. Methods: Here we report 5 cases decreased of AFP level in patients with cirrhosis treated 24 weeks combination therapy with ledipasvir and sofosbuvir between 2017 to 2018 were referred to the Liver Unit, Dornod Medical center Mongolia. All patients had been tested for blood chemistries, liver function markers, such as alanine aminotransferase (ALT), total bilirubin, prothrombin, international normalized ratio (INR), creatinine, AFP and HCV-RNA. Results: Of all patients, 53 were men (44.9%) and 68 were women (56.1%). The avarage age was 44 (between 16 and 70 years). Anti-HDV was positive in 75% (91/121) and all were checked for HDV RNA and 100% were found positive (91/91) all of the patients. HBV-DNA detected in111 all of the 121 patients. Mean HBV-DNA level was 1590177.877 IU/ml. The mean HBV-DNA level in the anti-HDV-positive patients were significantly lower than in the anti-HDV-negative patients (P<0.001). There were 65 patients with cirrhosis (54%) in the study group. Anti-HDV seroprevalence and HDV RNA presence were higher in those with cirrhosis 42 (64%). HDV-RNA-positive patients had significantly higher ALT (94 U/L) levels when compared to HDV-RNA-negative patients. Conclusions: Our study showed hepatitis delta virus infection in HBsAg positive patients who live in Eastern province Mongolia higher than other province of Mongolia.

Upgraded quadratic inference functions for longitudinal data with type II time-dependent covariates

조교영,Oyunchimeg Dashnyam 한국데이터정보과학회 2014 한국데이터정보과학회지 Vol.25 No.1

Qu et. al. (2000) proposed the quadratic inference functions (QIF) method to marginal model analysis of longitudinal data to improve the generalized estimating equations (GEE). It yields a substantial improvement in efficiency for the estimators of regression parameters when the working correlation is misspecified. But for the longitudinal data with time-dependent covariates, when the implicit full covariates conditional mean (FCCM) assumption is violated, the QIF can not provide more consistent and efficient estimator than GEE (Cho and Dashnyam, 2013). Lai and Small (2007) divided time-dependent covariates into three types and proposed generalized method of moment(GMM) for longitudinal data with time-dependent covariates. They showed that their GMM type II and GMM moment selection methods can be more efficient than GEEwith independence working correlation (GEE-ind) in the case of type II time-dependent covariates. We develop upgraded QIF method for type II time-dependent covariates. We show that this upgraded QIF method can provide substantial gains in efficiency over QIF and GEE-ind in the case of type II time-dependent covariates.

Upgraded quadratic inference functions for longitudinal data with type II time-dependent covariates

Cho, Gyo-Young,Dashnyam, Oyunchimeg The Korean Data and Information Science Society 2014 한국데이터정보과학회지 Vol.25 No.1

Qu et. al. (2000) proposed the quadratic inference functions (QIF) method to marginal model analysis of longitudinal data to improve the generalized estimating equations (GEE). It yields a substantial improvement in efficiency for the estimators of regression parameters when the working correlation is misspecified. But for the longitudinal data with time-dependent covariates, when the implicit full covariates conditional mean (FCCM) assumption is violated, the QIF can not provide more consistent and efficient estimator than GEE (Cho and Dashnyam, 2013). Lai and Small (2007) divided time-dependent covariates into three types and proposed generalized method of moment (GMM) for longitudinal data with time-dependent covariates. They showed that their GMM type II and GMM moment selection methods can be more ecient than GEE with independence working correlation (GEE-ind) in the case of type II time-dependent covariates. We develop upgraded QIF method for type II time-dependent covariates. We show that this upgraded QIF method can provide substantial gains in efficiency over QIF and GEE-ind in the case of type II time-dependent covariates.

Quadratic inference functions in marginal models for longitudinal data with time-varying stochastic covariates

조교영,Oyunchimeg Dashnyam 한국데이터정보과학회 2013 한국데이터정보과학회지 Vol.24 No.3

For the marginal model and generalized estimating equations (GEE) method there is important full covariates conditional mean (FCCM) assumption which is pointed out by Pepe and Anderson (1994). With longitudinal data with time-varying stochastic covariates, this assumption may not necessarily hold. If this assumption is violated, the biased estimates of regression coefficients may result. But if a diagonal working corre-lation matrix is used, irrespective of whether the assumption is violated, the resulting estimates are (nearly) unbiased (Pan et al., 2000).The quadratic inference functions (QIF) method proposed by Qu et al. (2000) is the method based on generalized method of moment (GMM) using GEE. The QIF yields a substantial improvement in efficiency for the estimator of beta when the working correlation is misspecified, and equal efficiency to the GEE when the working correlation is correct (Qu et al., 2000).In this paper, we interest in whether the QIF can improve the results of the GEE method in the case of FCCM is violated. We show that the QIF with exchangeable and AR(1) working correlation matrix cannot be consistent and asymptotically normal in this case. Also it may not be efficient than GEE with independence working correlation. Our simulation studies verify the result.