Objective Chronic pain is a leading cause of disability in low- and middle-income countries; however, pain assessment tools have generally been developed and validated in high-income countries. This study examines the psychometric properties of a set of translated pain (and distress) questionnaires in Mongolia and documents the characteristics of people seeking treatment for chronic pain in Mongolia, compared with those in New Zealand, which is representative of high-income countries. Design Cross-sectional, observational. Setting Hospital-based pain treatment centers in New Zealand and Mongolia. Subjects People seeking treatment for chronic pain in Mongolia (N = 142) and New Zealand (N = 159). Methods The Brief Pain Inventory, the Depression Anxiety Stress Scale–21, the Pain Catastrophizing Scale, and the Pain Self-Efficacy Questionnaire were translated into Mongolian and administered to patients attending a hospital-based pain service. Questionnaires that were completed by patients in New Zealand were used for comparisons. Internal reliability, convergent validity, and factor structure were assessed in both groups. Results Patients in Mongolia were older and reported lower pain intensity, interference, and distress and higher pain self-efficacy than those in New Zealand. The translated questionnaires had good internal consistencies, and the relationships between pain variables were similar across both groups. The factor structure for the Pain Catastrophizing Scale was consistent across both groups, but this was not the case for the Brief Pain Inventory or the Depression Anxiety Stress Scale–21. Conclusions Findings indicate that some pain outcome measures may be appropriate for use in Mongolia and should be investigated in other low- and middle-income countries.

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Background: Intraoperative blood loss and coagulopathy is a common consequence of pre-existing abnormalities of the hemostatic system in living donor liver transplantation (LDLT). Estimated amount for fluid management and blood transfusion are challenging and unpredictable for recipient. Methods:The patients involved in this study were divided into two groups. In the first group 76 cases underwent LDLT from 2011 to 2019 and in the second group included 85 recipients which operated after 2019. The data such as coagulation factors, blood, blood products and fluid used during LT and compared whether there are any correlations or relationships between two groups. Results: In the first group there is an operation time of 16.4±4.12 hours, Intraoperative fluid replacement measured as 28.56±18.44 liters. In the second group, the average operation time continued 14±3.06 hours and the amount of intraoperative fluid replacement consisted of 19.9±6.4345 L. There is observable reduction in operation time and intraoperative fluid replacement in the second group. There is no significant difference between the groups on transfused blood products and in the second group used slightly more PRBC of 2.56±1.60 L whereas in the first groups was 1.54±1.86 L. Conclusions: This retrospective study shows that the operation time reduced significantly in the second group. Due to frequent surgery performances enhanced and strengthened the surgeons experience and skill which led to reduction of operation time significantly and easened the potential technical difficulties. Monitoring and determining of coagulation factors by using coagulation, point-of-care testing and ROTEM enabled the transfusion of the blood, blood products and fluid at the right time during LDLT that definitely lead to increased success rate of surgery. The reason for the increased usage of PRBC in the second group was due to clinical conditions of patients which major policy change in National Health Insurance gave an opportunity to perform LDLT in more severe cases in Mongolia.

Background: Liver transplantation is a well-accepted treatment of end-stage liver diseases. Seven-eight liver transplants have been performed from 2011 to June of 2019 in First Clinical Hospital of Mongolia. Numerous advances in perioperative management, like expertise in surgical techniques, better preoperative optimization, intraoperative monitoring and management, changes in immunosuppression regime and advances in postoperative management, not only increased the number of this procedure but also the outcome. The role of the anesthesiologist is to provide safe anesthesia and maintain an acceptable hemodynamic performance, ensuring sufficient perfusion to the vital organs. Estimation of the amount of blood products required during liver transplantation can help provision of adequate blood supply, minimize transfusion associated complications and plan for preventive measures in high risk patients. Methods: Our objective is to investigate some factors impact to perioperative blood product transfusion. We used data of patients who underwent liver transplantation between October 2011 and June 2019 at First Clinical Hospital of Mongolia, were reviewed. The all amount of blood product utilized during surgery and some factors, including pretransplant laboratory data, pretransplant clinical data were recorded. Results: We studied 77 patients who underwent liver transplantation. The mean±standard deviation amounts of red blood cells and fresh frozen plasma transfusion during surgery were 1.64±2.36 and 2.22±2.7 liters, respectively. The mean amount of red blood cells and albumin was significantly (P<0.003 and P<0.005) correlated with model for end-stage liver disease (MELD) score of patients. The mean amount of blood products utilized during operation was decreased from 2015 to 2019 except two retransplantation patients. Conclusions: Some preoperative factors may predict blood transfusion requirements in patients undergoing liver transplantation. Therefore, evaluation of patients before operation should be considered to provide adequate blood supply. Understanding preoperative factors associated with rate of transfusion may help us to best utilize the limited available blood resources.