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Dunser M.W.,Perioperative and General Critical Care Medicine | Dondorp A.,Mahidol University | Kissoon N.,University of British Columbia | Ganbat T.,Ulaanbaatar State University | And 4 more authors.
Intensive Care Medicine | Year: 2012

Purpose: To provide clinicians practicing in resource-limited settings with a framework to improve the diagnosis and treatment of pediatric and adult patients with sepsis. Methods: The medical literature on sepsis management was reviewed. Specific attention was paid to identify clinical evidence on sepsis management from resource-limited settings. Results: Recommendations are grouped into acute and post-acute interventions. Acute interventions include liberal fluid resuscitation to achieve adequate tissue perfusion, normal heart rate and arterial blood pressure, use of epinephrine or dopamine for inadequate tissue perfusion despite fluid resuscitation, frequent measurement of arterial blood pressure in hemodynamically unstable patients, administration of hydrocortisone or prednisolone to patients requiring catecholamines, oxygen administration to achieve an oxygen saturation[90%, semi-recumbent and/or lateral position, non-invasive ventilation for increased work of breathing or hypoxemia despite oxygen therapy, timely administration of adequate antimicrobials, thorough clinical investigation for infectious source identification, fluid/tissue sampling and microbiological workup, removal, drainage or debridement of the infectious source. Post-acute interventions include regular reassessment of antimicrobial therapy, administration of antimicrobials for an adequate but not prolonged duration, avoidance of hypoglycemia, pharmacological or mechanical deep vein thrombosis prophylaxis, resumption of oral food intake after resuscitation and regaining of consciousness, careful use of opioids and sedatives, early mobilization, and active weaning of invasive support. Specific considerations for malaria, puerperal sepsis and HIV/AIDS patients with sepsis are included. Conclusion: Only scarce evidence exists for the management of pediatric and adult sepsis in resourcelimited settings. The presented recommendations may help to improve sepsis management in middle- and low-income countries. © Copyright jointly held by Springer and ESICM 2012.

Brunauer A.,Paracelsus Medical University | Kokofer A.,Paracelsus Medical University | Bataar O.,Ulaanbaatar State University | Gradwohl-Matis I.,Paracelsus Medical University | And 2 more authors.
Critical Care | Year: 2014

Introduction: Liberal and overaggressive use of vasopressors during the initial period of shock resuscitation may compromise organ perfusion and worsen outcome. When transiently applying the concept of permissive hypotension, it would be helpful to know at which arterial blood pressure terminal cardiovascular collapse occurs. Methods: In this retrospective cohort study, we aimed to identify the arterial blood pressure associated with terminal cardiovascular collapse in 140 patients who died in the intensive care unit while being invasively monitored. Demographic data, co-morbid conditions and clinical data at admission and during the 24 hours before and at the time of terminal cardiovascular collapse were collected. The systolic, mean and diastolic arterial blood pressures immediately before terminal cardiovascular collapse were documented. Terminal cardiovascular collapse was defined as an abrupt (<5 minutes) and exponential decrease in heart rate (>50% compared to preceding values) followed by cardiac arrest. Results: The mean±standard deviation (SD) values of the systolic, mean and diastolic arterial blood pressures associated with terminal cardiovascular collapse were 47±12 mmHg, 35±11 mmHg and 29±9 mHg, respectively. Patients with congestive heart failure (39±13 mHg versus 34±10 mmHg; P=0.04), left main stem stenosis (39±11 mHg versus 34±11 mmHg; P=0.03) or acute right heart failure (39±13 mmHg versus 34±10 mmHg; P=0.03) had higher arterial blood pressures than patients without these risk factors. Patients with severe valvular aortic stenosis had the highest arterial blood pressures associated with terminal cardiovascular collapse (systolic, 60±20 mmHg; mean, 46±12 mmHg; diastolic, 36±10 mmHg), but this difference was not significant. Patients with sepsis and patients exposed to sedatives or opioids during the terminal phase exhibited lower arterial blood pressures than patients without sepsis or administration of such drugs. Conclusions: The arterial blood pressure associated with terminal cardiovascular collapse in critically ill patients was very low and varied with individual co-morbid conditions (for example, congestive heart failure, left main stem stenosis, severe valvular aortic stenosis, acute right heart failure), drug exposure (for example, sedatives or opioids) and the type of acute illness (for example, sepsis). © 2014 Brunauer et al.

Sambuu U.,National University of Mongolia | Chuluunbat Z.,Governance Assistance Project | Unurkhaan E.,Ulaanbaatar State University
ACM International Conference Proceeding Series | Year: 2012

This paper tries to address a number of issues, problems and challenges currently facing while implementing ITS COTS solution in the Mongolian Tax Administration (MTA). The paper describes the gap between expectation of MTA towards positive impact of improved Tax Information system through COTS product and the real situation of the implementation of the product as well as serious risks confronting the new Tax Information System that is currently under replacement. Copyright 2012 ACM.

Buslov M.M.,Novosibirsk State University | Geng H.,University of Hong Kong | Travin A.V.,RAS Institute of Geology and Mineralogy | Otgonbaatar D.,Ulaanbaatar State University | And 8 more authors.
Russian Geology and Geophysics | Year: 2013

Packages of Late Paleozoic tectonic nappes and associated major NE-trending strike-slip faults are widely developed in the Altai-Sayan folded area. Fragments of early deformational phases are preserved within the Late Paleozoic allochthons and autochthons. Caledonian fold-nappe and strike-slip structures, as well as accompanying metamorphism and granitization in the region, are typical of the EW-trending suture-shear zone separating the composite Kazakhstan-Baikal continent and Siberia. In the Gorny Altai region, the Late Paleozoic nappes envelop the autochthon, which contains a fragment of the Vendian-Cambrian Kuznetsk-Altai island arc with accretionary wedges of the Biya-Katun' and Kurai zones. The fold-nappe deformations within the latter zones occurred during the Late Cambrian (Salairian) and can thus be considered Salairian orogenic phases. The Salairian fold-nappe structure is stratigraphically overlain by a thick (up to 15 km) well-stratified rock unit of the Anyui-Chuya zone, which is composed of Middle Cambrian-Early Ordovician fore-arc basin rocks unconformably overlain by Ordovician-Early Devonian carbonate-terrigenous passive-margin sequences. These rocks are crosscut by intrusions and overlain by a volcanosedimentary unit of the Devonian active margin. The top of the section is marked by Famennian-Visean molasse deposits onlapping onto Devonian rocks. The molasse deposits accumulated above a major unconformity reflects a major Late Paleozoic phase of folding, which is most pronounced in deformations at the edges of the autochthon, nearby the Kaim, Charysh-Terekta, and Teletskoe-Kurai fault nappe zones. Upper Carboniferous coal-bearing molasse deposits are preserved as tectonic wedges within the Charysh-Terekta and Teletskoe-Kurai fault nappe zones.Detrital zircon ages from Middle Cambrian-Early Ordovician rocks of the Anyui-Chuya fore-arc zone indicate that they were primarily derived from Upper Neoproterozoic-Cambrian igneous rocks of the Kuznetsk-Altai island arc or, to a lesser extent, from an Ordovician-Early Devonian passive margin. A minor age population is represented by Paleoproterozoic grains, which was probably sourced from the Siberian craton. Zircons from the Late Carboniferous molasse deposits have much wider age spectra, ranging from Middle Devonian-Early Carboniferous to Late Ordovician-Early Silurian, Cambrian-Early Ordovician, Mesoproterozoic, Early-Middle Proterozoic, and early Paleoproterozoic. These ages are consistent with the ages of igneous and metamorphic rocks of the composite Kazakhstan-Baikal continent, which includes the Tuva-Mongolian island arc with accreted Gondwanan blocks, and a Caledonian suture-shear zone in the north. Our results suggest that the Altai-Sayan region is represented by a complex aggregate of units of different geodynamic affinity. On the one hand, these are continental margin rocks of western Siberia, containing only remnants of oceanic crust embedded in accretionary structures. On the other hand, they are represented by the Kazakhstan-Baikal continent composed of fragments of Gondwanan continental blocks. In the Early-Middle Paleozoic, they were separated by the Ob'-Zaisan oceanic basin, whose fragments are preserved in the Caledonian suture-shear zone. The movements during the Late Paleozoic occurred along older, reactivated structures and produced the large intracontinental Central Asian orogen, which is interpreted to be a far-field effect of the colliding East European, Siberian, and Kazakhstan-Baikal continents. © 2013.

Horoldagva B.,Ulaanbaatar State University | Gutman I.,University of Kragujevac
Match | Year: 2011

Let G = (V, E) be a graph, du the degree of its vertex u, and uv the edge connecting the vertices u and v. The atom-bond connectivity index and the sum-connectivity index of G are defined as ABC = ΣuvεE √(du + dv - 2)/(dudv) and Χ = ΣuvεE 1/√du + dv, respectively. Continuing the recent researches on ABC [B. Furtula, A. Graovac, D. Vukičević, Atom-bond connectivity index of trees, Discr. Appl. Math. 157 (2009) 2828-2835] and Χ [B. Zhou, N. Trinajstić, On a novel connectivity index, J. Math. Chem. 46 (2009) 1252-1270] we obtain novel upper bounds on these vertex-degree-based graph invariants.

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