Background: Our research team aimed at determining the prevalence of depression and mutual interaction of other diseases among elderly in today’s changing period of morbidity of population due to social and economic transition.Goal: To determine the correlation between depression and other diseases among elderlyObjectives:1. To determine the prevalence of depression among elderly2. To find out the correlation between depression and other diseasesMaterials and method: The research was carried out by cross sectional method. In the research was involved 1207 elderly, who are retired, of which 60 and over for male and 55 and over for female from one cluster of each economic and geographic regions of Mongolia. The depression was evaluated by using Geriatric Depression Scale.Results: In the research was involved 392 (32.5 percent) men, 675 (67.5 percent) women and their mean age was 68.1±8.1 (68.9±6.5 in male and 65.7±8.5 in female) from 4 economic and geographic regions of Mongolia. Among survey involved elderly, 16.5 (199) percent of them were found to have depression. Out of survey involved depressed elderly, 27.6 percent were male and 72.3 percent female. The mean age of depressed elderly was 67.9, in which 67.1 in women and 70.2 in men. Due to depression status among survey involved elderly, the share of elderly, who inclined to affect by depression was 158 (13.1%). Furthermore, 169 (14%) of them were affected by slight depression, while 30 (2.5%) of them were with severe depression.Among survey involved elderly, 24.5 percent of elderly with anxiety were inclined to be affected by depression and 29.2 percent of them were with mildly depression. However, 5.6 percent of elderly with severely level of anxiety were affected by severe depression. It was not found severe depressed elderly among elderly, who did not have anxiety. The depression of elderly and their morbidity has direct correlation. Elderly depression and anxiety has direct medium correlation.Conclusions:1. The prevalence of depression among Mongolian elderly refers 16.5 percent.2. Depression among Mongolian elderly has direct correlation to some investigated somatic diseases.

Background: In our country, the survey on mental condition of Mongolian elderly, in particularly on assessing the cognitive status has not provided yet. Goal: To determine the cognitive status of elderly and find out some factors which affect on it. Objectives:1. Determine the cognitive ability of Mongolian elderly2. Find out some factors which affect the cognitive ability of elderlyMaterials and Methods: In this cross sectional study, we had chosen randomizily 1 cluster from each 4 economic and geographic regions of Mongolia and Ulaanbaatar city, and totally comprised of 1207 elderly, of which 60 and over for male and 55 and over for female. The cognitive status of survey involved elderly was evaluated by mini mental examination test (MMET).Results: The mean age of survey involved elderly was 68.1±8.1 (68.9±6.5 in male and 65.7±8.5 in female). While 60.3(728) percent of elderly people were normal, 39.7(479) percent of them estimated to have cognitive decline. Out of elderly with cognitive decline, 59.5 percent had slight cognitive impairment, 35.1 percent moderate cognitive impairment and rest 5.4 percent had severe cognitive impairment. The cognitive impairment predominantly revealed in female and prevailed more in elderly who live in countryside compared to elderly who live in the city (P<0.001). The cognitive impairment was related to educational background of elderly who had cognitive decline. Along the decline of education estimated higher level of cognitive impairment, as well as 47.5 percent of male and 53.8 percent of female, who had lower education, shared most percentage of cognitive impairment, compared to other educational levels.The cognitive impairment is directly correlated to decline of Activity of daily living and Instrumental activity of daily living of elderly (p<0,0001).Conclusions:1. The decline of cognitive status of elderly is correlated to gender. The educational background, income and family are related to their cognitive impairment.2. Activity of daily living and Instrumental activity of daily living have direct correlation to cognitive impairment of elderly.

Introduction: The issue of meeting need of rehabilitation care service required to elders is one of determinants which influences in enabling quality of life of elderly people. In our country, we lack of survey on determining current need of long term care and one of its form rehabilitation care service for the elderly, so it became the background of the research. Goal: Reveal some needs of rehabilitation care service through determining the Activities of daily living and Instrumental Activities of daily living of Mongolian elderly people Materials and Method: The research was carried out by cross sectional method. In the research was involved 1207 elderly, who are retired, of which 60 and over for male and 55 and over for female from one cluster of each economic and geographic regions of Mongolia. The research was conducted by using ADL and IADL tests as well as questionnaire to determine the needs of rehabilitation care service. Results: Out of survey involved 1207 elderly, 32.5 percent (392) referred to men, 67.5 percent (815) to women, and their mean age was 68.1±8.1 (68.9±6.5 in male and 65.7±8.5 in female). While 473 elderly were from Ulaanbaatar city, 734 of them were from 4 regions of countryside. Among survey involved elderly, the mean of ADL ability was 87.4 percent, of which, the following abilities were better such as: continence (92.5%), toileting (91.3%), dressing (87.9%), while bathing ability was impaired mostly or 18.2 percent. Subsequently, the mean of IADL ability among survey involved elderly was found to be 29.9 percent. The health needs of elderly were differed. Due to extensive indicator, 24.8 percent of elderly wanted to admit in a hospital, 20.8 percent - home nursing care and 32.6 percent -involvement in rehabilitation care service. In terms of amount, the maximum needs were eight, while most of elderly requested 1-3 kinds of needs. Conclusions: 1. The impairment of Activity of Daily Living was found to be approximately 22.6 percent, while Instrumental Activity of Daily Living was 29.9 percent among Mongolian elderly people. 2. The impairment level of Activities of Daily Living and Instrumental Activities of Daily Living indicated the requirement of occupational and physical therapy in health care service for the elderly.

Introduction: The mental and behavioral diseases affect in loneliness and discrimination of elderly people and mostly reduce the quality of life of elderly people compared to injury and accidence. Wulf Rossler, Switzerland mentioned that all kinds of mental diseases require long term care, especially rehabilitation. In our country, we lack of survey on determining psychosocial rehabilitation needs for the elderly, therefore it became the background of the research. Goal: Determine the psychosocial rehabilitation needs of Mongolian elderly people Method and materials: The research was carried out by cross sectional method. In the research was involved 1207 elderly, who are retired, of which 60 and over for male and 55 and over for female from one cluster of each economic and geographic regions of Mongolia. The research was conducted by using Geriatric depression test, Spielberg Hanin test to reveal anxiety, Mini mental examination test to assess the cognitive status and AUDIT test to evaluate the alcohol usage. The diagnoses were put according to ICD-10 based on geriatric examination. Results: Out of survey involved 1207 elderly, 32.5 percent (392) referred to men, 67.5 percent (815) to women, and their mean age was 68.1±8.1 (68.9±6.5 in male and 65.7±8.5 in female). While 473 elderly were from Ulaanbaatar city, 734 of them were from 4 regions of countryside. In terms of mental and behavioral diseases, anxiety and depression were prevailing among Mongolian elderly. Thirty eight point five percent of survey involved elderly investigated to have depression and 44 percent - anxiety. Moreover, dementia was found 36 and sleep disorder 28 per 1000 elders. Twenty three point six percent of elderly had slight cognitive impairment, 13.9 percent moderate cognitive impairment, while 2.1 percent had severe cognitive impairment. The cognitive impairment is differed in terms of region. The moderate cognitive impairment predominantly revealed in mountainous and eastern regions, while the severe cognitive impairment was prevailing in central and eastern regions. Due to classification of needs of elderly into medical, financial and other needs, found that, 37 percent of elderly required medical, 33 percent financial and 37 percent other needs. In terms of psychosocial needs, 30.4 percent wanted to have a place for spending free time, 23.9 percent to make new friends and 6.1 percent to hire a job. Also 4.4 percent of elderly had a need of having a caregiver. Conclusions: 1. Out of mental and behavioral diseases, anxiety (38.5 percent) and depression (44 percent) were prevailing among elderly. 2. Each Mongolian elderly had need of 1-2 psychosocial needs. 3. All kinds of psychosocial rehabilitation including the medical, adaptation enhancing and social rehabilitation are equally required for the elderly people.

We present the fi rst 2 cases of cochlear implantation in Mongolia using “SONATA” type implant of “MED-EL” Company, Austria. CASE 1: A six years old, female had been diagnosed with bilateral congenital profound hearing loss and had been fi tted with hearing aids for 5 years and received little benefi t from her hearing aids and developed very poor speech and language, used lip reading and have had vocabulary of approximately 10 words. A radiological evaluation showed normal cochlea and auditory nerve. Cochlear implant team including speech therapists and audiologists based on the informed consent of patient’s parent decided that family able to participate in follow-up, speech habilitation programme. Patient implanted with SONATA of MED-EL on 4 August, 2009. Electrodes were inserted fully. After 10 days of switch on of the speech processor the patient showed signs of initial hearing of loud sounds. After 5 months of Auditory Verbal Therapy the vocabulary increased up to 50 words. Hearing, cognition and responses are increasing simultaneously. CASE 2: A 2 years old female. Congenitally deaf in both ears. Fitted with hearing aid for 3 months before the surgery and there was no benefi t from hearing aid. Physically and mentally healthy. Patient implanted with SONATA of MED-EL on 4 August, 2009. Electrodes were inserted fully. On 25th days of switching on of speech processor the patient showed initial hearing of loud sounds. Currently, after 5months of treatment her vocabulary is 2 short words and can recognize 4 syllabeles. She is very active, repeats actions and has open nature, feels comfortable with CI.

Coronary heart disease is a leading cause of mortality in many countries. Acute coronary syndrome is the basis pathophysiology of coronary heart disease. Complication of coronary atherosclerosis composes rupture of plaque and erosion of vulnerable plaque. Endothelial dysfunction is main influence of coronary plaque erosion. But then recently research oxidative stress and reaction of immunocomplex is leading cause of coronary plaque rupture. So the research background will study markers of endothelial dysfunction, oxidative stress, immune reaction in the complication of coronaryatherosclerosis. Aim: Determine the effect of some marker for causing complication of the coronary atherosclerosis. The research has been conducted using case-control study method. In the case group, patients with complication of the coronary atherosclerosis as determined by coronary angiography (stenosis >85%) as in the control group healthy people with carotid artery stenosis (<0.7mm) has been involved. In the study we defined Anti-oxLDL (anti-oxidized low density lipoprotein) using ELISA Kit (Eucardio Lab, USA) and oxLDL (oxidized low density lipoprotein) titer by ELISA Kit (Mercadio, USA), ADMA (Asymmetric dimethylarginine) titer by ELISA kit (Eucardio Lab, USA) reagents in the enzyme binding reaction. Total antioxidant capacity (TAC) was determined by using spectrophotometer method. The average age of people involved in the research is 57.2±9.72 and for the average age is case group 28 (32%) and 50 (68%) for the control group. ADMA titer level for complication of coronary atherosclerosis or case group is (30.1±1.98 ng/ml) which is (13.2±0.57 ng/ml) greater than the control group. It was statistically significant result (p<0.001). Also titer level for case group is oxLDL (72±2.75 mU/l), anti-oxLDL antibody (766±29.8 mU/ml), which is oxLDL (45.1±2.28 mU/l), anti-oxLDL antibody(603±17.74 mU/ml) greater than the control group. It was statistically significant result (p<0.001). But TAC titer level for control group is (116±2.47 nmol/l) which is (108.3±5.43 nmol/l) greater than the case group. It was not statistically significant result (p=0.098). According to the Binary Logistic Regression test the anti-oxLDL (OR=0.992, p<0.001), ADMA (OR=0.681, p<0.001), TAC (OR=1.017, p=0.105), oxLDL (OR=0.900, p<0.001) levels significantly influence the complication of coronary atherosclerosis. Therefore according to the Binary Logistic Regression test the anti-oxLDL level high significantly influence the complication of coronary atherosclerosis. Anti-oxLDL antibody titer are correlated directly with oxLDL (r=0.413, p<0.01), ADMA (r=0.42, p<0.001) levels. However, correlated negative directly with TAC (r=-0.233, p<0.01) level. Markers of endothelial dysfunction (ADMA OR=0.681, p<0.001) and oxidative stress (oxLDL, OR=0.900, p<0.001), (anti-oxLDL antibody, OR=0.992, p<0.001) high influence causing of complication of coronary atherosclerosis.

In this published case of a male patient B., 53, has some epidemiological specifics. There is transient ischemic attack (TIA) syndrome, particularly while with clear mind there is sudden temporary paralysis of left leg and arm and loss of ability to speak. Temporary refers here to a period of 2-3 minutes after which everything gets back to normal. The incidence occurred again in two days during the medical treatment.MRA test concluded on the presence of obvious stenosis at the beginning part of both sides of a.cerebri media. The mentioned blood vessel pictures were undefined. Hence selected catheter angiography has been done with a purpose to establish the presence of a full occlusion or clogging stenosis in a.cerebri media and to clarify which specific vessels are being mobilized for the collateral supply. This test established that the a.cerebri media had full occlusion on both sides.A duplex sonography conducted in order to clarify characteristics of the clogging (blocking) process concluded the presence of gradual thickening of and blocking in intima (inner wall) of a. carotis interna. Based on these tests we considered that despite the atherosclerosis symptoms (Ischemia in ECG, 20 years of smoking,being male and aged 53, etc), this case had conditions of gradual (slow progressing) arteriopathy. Thus because of the presence in this case simultaneous arteriopathy process (gradually progressing and causing the blocking) in addition to atherosclerosis syndromes we consider it as a Moya-Moya syndrome. The disease of Moya-Moya is mostly found in children and youth and is a unique arteriopathy considered unrelated with atherosclerosis.

Coronary heart disease is a leading cause of mortality in many countries. Acute coronary syndrome is the basis pathophysiology of coronary heart disease. Complication of coronary atherosclerosis composes rupture of plaque and erosion of vulnerable plaque. Endothelial dysfunction is main influence of coronary plaque erosion. But then recently research oxidative stress and reaction ofimmunocomplex is leading cause of coronary plaque rupture. So the research background will study markers of endothelial dysfunction, oxidative stress, immune reaction in the complication of coronaryatherosclerosis. Aim: Determine the effect of some marker for causing complication of the coronary atherosclerosis.The research has been conducted using case-control study method. In the case group, patients with complication of the coronary atherosclerosis as determined by coronary angiography (stenosis >85%) as in the control group healthy people with carotid artery stenosis (<0.7mm) has been involved. In the study we defined Anti-oxLDL (anti-oxidized low density lipoprotein) using ELISA Kit (Eucardio Lab, USA) and oxLDL (oxidized low density lipoprotein) titer by ELISA Kit (Mercadio, USA), ADMA (Asymmetric dimethylarginine) titer by ELISA kit (Eucardio Lab, USA) reagents in the enzyme binding reaction. Totalantioxidant capacity (TAC) was determined by using spectrophotometer method. The average age of people involved in the research is 57.2±9.72 and for the average age is case group 28 (32%) and 50 (68%) for the control group. ADMA titer level for complication of coronaryatherosclerosis or case group is (30.1±1.98 ng/ml) which is (13.2±0.57 ng/ml) greater than the control group. It was statistically significant result (p<0.001). Also titer level for case group is oxLDL (72±2.75 mU/l), anti-oxLDL antibody (766±29.8 mU/ml), which is oxLDL (45.1±2.28 mU/l), anti-oxLDL antibody(603±17.74 mU/ml) greater than the control group. It was statistically significant result (p<0.001). But TAC titer level for control group is (116±2.47 nmol/l) which is (108.3±5.43 nmol/l) greater thanthe case group. It was not statistically significant result (p=0.098). According to the Binary LogisticRegression test the anti-oxLDL (OR=0.992, p<0.001), ADMA (OR=0.681, p<0.001), TAC (OR=1.017, p=0.105), oxLDL (OR=0.900, p<0.001) levels significantly influence the complication of coronary atherosclerosis. Therefore according to the Binary Logistic Regression test the anti-oxLDL level high significantly influence the complication of coronary atherosclerosis. Anti-oxLDL antibody titer arecorrelated directly with oxLDL (r=0.413, p<0.01), ADMA (r=0.42, p<0.001) levels. However, correlated negative directly with TAC (r=-0.233, p<0.01) level.Markers of endothelial dysfunction (ADMA OR=0.681, p<0.001) and oxidative stress (oxLDL, OR=0.900, p<0.001), (anti-oxLDL antibody, OR=0.992, p<0.001) high influence causing of complication of coronary atherosclerosis.

BackgroundEarly detection of minor strokes and their treatment that aim to prevent from complications into severe strokes is a process of secondary prevention. There is a need to extensively use image diagnostics (CT, MRI) because signs are obscure, at times without focal neurological sign but can have special mental or psychological syndromes. The start of minor stroke studies in Mongolia will enable further deepening of these studies in future and give an impetus to identification of theoreticaland practical aspects together with further improvement of diagnostics, treatment and prevention of minor strokes.GoalTo develop and introduce the diagnostic criteria of ischemic and hemorrhagic minor strokes in accordance to the concepts of minor strokes and to treat minor stokes in order to prevent complications into severe strokes.Materials and MethodCurrently there are no globally accepted diagnostic criteria for minor stroke. We support the 1981 WHO criteria of minor strokes as strokes neurological signs of which disappear in relatively short period of time. There is a general notion that it should mean all light forms of stroke other than severe strokes. In cases of neurological signs of a minor stroke, complete recovery and elimination of the symptoms take up to 3 weeks. Most scholars tend to consider ischemic lacunar strokes (arising from occlusion of arteriole vessels deep in the brain and with size of 0.5-20 mm) as minor strokes. We maintained the concept that characteristic features of these strokes are their limited focal areas and the following neurological symptoms: pure motor, pure sensory, light ataxia, etc. We also duly considered a suggestion (D. German, L. G. Koshchug et al, 2008 ) to define minor hemorrhagic strokes as strokes with diameter less than 2 cm and blood volume less than 5 cm3.We identified 60 patients with minor strokes, involved in monitoring using special research template (with a term of at least 1.5years) and involved in pathogenesis treatment. In the treatment, we maintained a principle of differential diagnosis of ischemic stroke symptoms. Specifically, we differentiated the following: signs related to an atherotromb, cardio-embolic, lacunar, hemodynamic, hemorheologic pathogenesis. To verify the diagnoses, we used MRT and CT image tests. We executed paraclinic tests in order to identify risk factors: Doppler-duplex-sonography, brain angiography, blood lipid fraction, ECG, EchoCG, heart Holter, blood hemorheology test, and identified the most affecting factors (hereditary factors, excess weight, smoking etc).Results: Our study identified the following clinical forms: lacunar stroke, non-lacunar minor stroke, and hemorrhagic minor stroke. Among the minor strokes, the lacunar stroke dominates (48%), the nonlacunar stroke is the next (27.7%), and the hemorrhagic was found to be the least common 25%. From among a host of risk factors, arterial hypertension is dominant (86%) either alone or in combination with such other diseases as diabetes, atherosclerosis etc. Diabetes occurrence was 5 cases (8,3%) which is fewer than in some foreign studies.The clinic of minor stroke also varies. The strength and expression of their symptoms compared with those of severe strokes are unique in the following:- Relatively lighter and recover faster as a result of treatment even in acute forms,- Some are without specific clinical signs (“silent stroke”).- Some minor strokes have micro focal signs, for example, “pure motor”, pure sensory, ataxia etc, in other words, the signs are limited.- In cases of lacunar strokes, predominantly deep brain arterioles are damaged.- Whereas in non-lacun strokes, embolic, ateroma, thrombotic mechanisms are predominant suchas distal branches of big artery. - In cases of hemorrhagic minor strokes, arteriopathy distortions occur not only in depth of brain but also in any small lobar vessels of brain.- Focal lesions have some variations by their pathological locations and minor stroke signs.In non-lacunar strokes (25%), the focal damages predominantly occur in branches of large intra/extra cranial arteries. In cases of lacunars strokes, the focal lesion is not in branches of large intracranial vessels, but is predominantly in basal ganglia, deep white matter, thalamus, pons and in area of deep penetrating arterial vessels. However, focal infarcts in cerebella may occur in any form of minor strokes.ConclusionAccording our study there were identified 3 subtypes of minor stroke. The finding is that lacunars and hemorrhagic minor strokes are more likely to give grounds to severe strokes. From this, it can be concluded that there are specific factors in the population of Mongolia to affect the genesis of minor strokes, namely, arterial hypertension which is directly related with these forms of minor strokes. We appropriate the WHO criteria of minor stroke that is neurological signs of a minor stroke, complete recovery and elimination of the symptoms take up to 3 weeks. In treatment of minor stroke, we suggest that minor strokes should be treating by pathogenetic therapy. Namely, antihypertensive therapy for lacunar infarction, anti-aggregation therapy for nonlacunar infarction and haemostatic and antihypertensive therapy for hemorrhagic minor stroke.

BACKGROUND: Acute cholecystitis is defi ned mostly as bacteria from intestinal infl ammation to gallbladder. Sometimes the inflammation can occur when bacteria and viral can fl ow by blood and lymphus. Acute cholecystitis is leading the second place of acute abdomen. (1.2.3.7.8). The acute cholecystitis complication is not decreasing(4.5.6). The mortality is 0.5-0.8%(2.4.5.9). The acute cholecystitis is comparing with cholelith. Foreign scientists are recommending that fi rst 24-48 hours to treat by drugs, and after that if infl ammation is not healing to do cholecystectomy. In our country the acute cholecystitis is taking the place after acute abdomen and appendicitis. And also, acute cholecystitis morbidity is not decreasing and indication of cholecystectomy is not decided yet. OBJECTIVE: The main purpose of this survey is to study changing of acute cholecystitis depending on time Materials and Methods We studied 58 patients who had cholecystectomy in Surgical Department of The Central Clinical Hospital for State Special Clerks between 2005 and 2008. The result analyzed by SPSS-15.0 Program. RESULT AND DISCUSSION: The patients who was studied were 14 men (24.14%) and 44 women (75.86%). For the clinical symptoms of acute cholecystitis, the result has been occurred as following: the epigastria pain is 17 (29.31±5.9), around the right rib arch is 49 (84.48±4.7), the pain spread of the right shoulder blade is 20 (34.48±6.2), and the pain spread of the right shoulder is 33 (56.89±6.5), to have a fever 6 (10.34±3.0), vomit 10 (17.24±4.9), diarrhea 7 (12.06±4.2), thirsty 16 (27.58±5.8). The pain around right rib arch, pain spread right arm and shoulder, and thirsty are the clinical features that close to the features of scientist’s Alperovich B.I., Soloviev M.M., Saveliev V.S. Acute cholecystitis depending on time 0-24 hours catarrhal 5, phlegmonous 2, necrosis 1, 24-48 hours phlegmonous 4, necrosis 10, necrosis hole 2, 48-72 hours phlegmonous 10, necrosis 8, necrosis hole 3, above 72 hours phlegmonous 2, necrosis 5, necrosis hole 6. Acute cholecystitis starts above 24 hours. CONCLUSION: 1. The acute cholecystitis has been occurred 14 for men and 44 for women. Ate the age of 30-39. These cases were determined more then 31 percent. 2. For the clinical symptoms of acute cholesystitis, the result has been occurred as following: - the epigastria pain is 17, (29.31±5.9) - around the right rib arch is 49 (84.48±4.7) - the pain spread of the right shoulder blade is 20 (34.48±6.2), and - the pain spread of the right shoulder is 33 (56.89±6.5). 3. Under the period study of the acute cholecystitis, the pus, necrosis and perforation cases have been excessively occurred specially at 48-72 hours. 4. Under the comparison study between the acute cholecystitis and its period, the acute wall cholecystitis changes have been occurred specially at 24-48 hours.