Justification: Iodine is a micronutrient essential for human health. 92% of the required iodine human organism obtains with food. One of methods to supply the required amount of iodine is the use of iodised salt. The overall goal of our study was to determine the actual consumption of iodised salt by households. Materials and Methods: Samples of salt consumed by 20173 households from five regions (Western, Mountainous, Central, Eastern regions and Ulaanbaatar city) of Mongolia were collected and their iodine contents were determined according to MNS 5168:2002. Results: Out of the total analyzed salt samples, 19.1 % were non-iodised, 2.8% had low iodine content, 77.5% had appropriate level of iodine and 0.6% had high level of iodine.
When the salt iodine contents were evaluated by the country regions, it was revealed that the households in Western (31.4%) and Mountainous (20.57%) regions consumed salt that was not iodised. 84.5% of the Ulaanbaatar city households consumed salt with appropriate level of iodine. Conclusions
1. 19.1 % of the surveyed households consume non-iodised salt, 2.8% consume salt with low iodine content, 77.5% consume salt with appropriate level of iodine and 0.6% consume salt with high level of iodine.
2. The iodine level is appropriate in 84.5% of salt consumed by Ulaanbaatar city households.

This survey had conducted for determining respiratory system disease and mortality trend of Ulaanbaatar city population and for developing evidence based recommendations. In accordance with the methodology we had done meta-analysis and statistical analysis on data 2004-2008. For the data analysis we used SPSS and parametric and non-parametric tests were used for determining disease changes and differences of seasonal, age and gender. In recent 5 years, in Ulaanbaatar, respiratory system disease cases are continuously leading 5 leading causes of disease. In 2008, respiratory system disease cases were 865.0 per 10000 populations and it is compare to 2004 increased by 10-30 percent. Children and women are more tend to attend to hospitals due to diseases cases. The survey also revealed that incidence of pneumonia (116.7-145.8 per 10000 populations) was the most visited case from other ICD10 causes of diseases.The mean age of mortality of respiratory system disease was 36.6±31.8 and the oldest age was 101 and the youngest was under 1 year old during 2004-2008 in Ulaanbaatar. During spring season, acute respiratory system disease, chronic bronchitis pneumonia and others respiratory system disease cases were more admitted from the respiratory system disease. Whereas, during autumn season, emphysema, during winter season bronchitis were the leading causes of respiratory system disease admission (x2=33.779, p=0.013).CONCLUSION: The statistics, 2004-2008 in Ulaanbaatar, were showing respiratory system disease trend constantly and continuously increasing. Age, gender and seasonal characteristics were signifi cantly correlated with the respiratory system disease. During these 5 years, 932 deaths were recorded and mean age of dying was 36.6±31.8.

IntroductionThe metabolic syndrome is a cluster of the most dangerous heart attack risk factors: diabetes andprediabetes, abdominal obesity, high cholesterol and high blood pressure. Also it is known as acluster of changes associated with resistance to insulin.There is a convincing evidence of important ethnic differences in the prevalence of metabolic syndrome,its components and sequelae. Estimates vary by country, but generally they show higher prevalenceof metabolic syndrome in non-European groups. Based on these findings, we were convinced inthe importance of studying the prevalence of metabolic syndrome and insulin resistance among thepopulation of Mongolia.Materials and MethodsThe main goal of our study was the determination of insulin level and insulin resistance in metabolicsyndrome exposed and non-exposed groups. We included 194 randomly selected people aged 20-60 years old; among them 51 had metabolic syndrome which was identified by the criteria of theInternational Diabetes Federation. All participants underwent general medical examinations andsigned a written consent paper. Fasting blood glucose, triglyceride, HDL, insulin levels were measuredin fasting blood serum and insulin resistance was calculated as a HOMA-IR model.ResultsAverage age of participants was 44,26±8,66 years, of whom 46,4% (n=90) were male, 53,6%(n=104)were female. By IDF criteria, 26,2% (n=51) of the participants had metabolic syndrome. Insulin levelwas 17,23±14,91μIu/mL in MS exposed group which was much higher than in the control group.Insulin, HOMA-IR, had direct correlation with the body mass, BMI and waist circumference andinverse correlation between HDL.Conclusions26.2% of the study participants had metabolic syndrome which was defined by IDF criteria. Insulin levelin the MS exposed group was 17,23±14,91μIu/mL, higher than in the control group by 7,53±2,21μIU/mL. Insulin, HOMA-IR, showed a direct correlation with the body mass, BMI and waist circumferenceand inverse correlation between HDL.

Background: Blood is an important resource, both for planned treatments and urgent interventions. It can help patients suffering from life-threatening conditions live longer and with a higher quality of life, and supports complex medical and surgical procedures. According to WHO recommendation at least 1% of the population of any country needs to donate their blood to accommodate the basic clinical needs of the country. Accordingly, we aimed to assess existing attitudes of the general population towards on blood donors. Materials and Methods: The survey identified attitude of the population on blood donation and factors influencing them, using quantitative and qualitative methods. The survey covered a population aged 18-60 years. SPSS software version 21 was used for data analysis of the survey. The survey protocol and methodology were reviewed and approved by the Scientific Committee at the NCPH. The Medical Ethical Committee at the MOH reviewed the survey materials and issued an approval (2015/3). Results: The survey covered in total 3,782 people and there are 59.2% of surveyed respondents said they have never thought of becoming a voluntary blood donor. Positive attitude on blood donation is higher with statistical significance among women (59.0%), 18-25 years old (43.7%) and UB residents citizens with higher education. As education level increases the number of respondents who thought about donating blood is also increases. 16.1% of them had a history of blood donation before and 38.2% said they never thought about it. Twenty point four percent of respondents thought blood donation brings some kind of risk. Nevertheless of the education level of surveyed respondents, the percentage of answer blood donation is not risky for a person was the most common answer. But respondent who is only literal and uneducated were don’t know about whether it has a risk or not (385.37=2א, p=0.000001). Also, respondents failed to donate their blood because the family not allowed, afraid, risk of infection, doesn’t want and had a busy schedule. Conclusion There is a high tendency to donate blood populations of young people aged 20-29, women, residents of Ulaanbaatar, and uneducated and highly educated. The majority of respondents agreed that blood donating is charity and a good deed. The leading causes of blood donation is the education, gender, the desire of doing a good deed, peer influence and health condition.

Background: A blood product is any therapeutic substance derived from human blood, including whole blood and other blood components for transfusion, and plasma-derived medicinal products. Medicinal (medical therapeutic) products derived from human donations of blood and plasma play a critical role in health care. Safe, effective and quality-assured blood products contribute to improving and saving millions of lives every year, as they: address child mortality and maternal health, dramatically improve the life expectancy and quality of life of patients suffering from life-threatening inherited disorders, such as haemophilia, thalassaemia and immune deficiency, and acquired conditions such as cancer and traumatic haemorrhage and support complex medical and surgical procedures, including transplantation. An insufficient or unsafe blood supply for transfusion has a negative impact on the effectiveness of key health services and programmes to provide appropriate patient care in numerous acute and chronic conditions. Ensuring access of all patients who require transfusion to safe, effective and quality-assured blood products is a key component of an effective health system and vital for patient safety.
Although the number of blood donors is increasing, there are still insufficient human and financial resources for encouraging the growing demand of blood and blood products and new blood donors. Material and Methods: We collected secondary data by using using the order forms of hospitals that used blood and blood products registered in the National Center for Blood Transfusion Research in 2017-2019 in accordance with the retrospective survey method.
In total 34,119 hospital order information sheet was entered into computer in excel program, and converted into SPSS 23 software, descriptive parameters were calculated and analyzed. Results: Compare to the 2017 (n=9076), the demand of blood product was increased by 21.8%, and 54.8% in 2019. There are 51.9% (95%CI: 51.2-52.5) of total users are male, which is statistically significant. The mean age of blood product users were aged 48.58±21.32, the youngest user was aged 1 and the oldest age was 99. The demand of blood products were increased by growing of the age of users. The product usage of age group of 46-55 was 17.8% and has trend to increase year by year. In total, 11.3% of total blood product was utilized for children and 72.3% of them were aged less than 5 years old. 73.0% of total blood products were utilized in specialized hospitals, 14.6 % of them were used in aimag and district level hospitals and 11.3% of them were used in private clinics. 24.4% of blood products utilization was used for diseases of digestive system (К00-К93), 22.1% of them were used for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism, and 19.5% of them were used for the cancer (C00-C97) disease patient’s treatment. Conclusion Since after new treatment guidance was introduced the blood and blood products usage had been increased.

BACKGROUND. The Dahl Concept refers to the relative axial tooth movement that is observed when a localized restorations are placed in supra-occlusion in dental hard tissue worn anterior area and posterior full arch occlusal contacts re-establishes over a period of time irrespective of age and gender. The literature reports that the objectives of the Dahl concept are achieved in the majority of cases (94%-100%). Some minor and transient adverse events, such as initial difficulty with mastication could develop. If dental arch is crowded and some of the teeth are pushed away, they tends to be pushed more even they were visually aligned by a heavy preparation under the ceramic restorations such as crowns and veneers. To avoid these costly and teeth-harmful treatment options for patients with anterior crowding and who wants straighter and beautiful looking teeth, we use a conservative approach of Align+Bleach+Bonding technique. MATEREALS AND METHOD. For tooth alignment we used Inman Aligner, Clear Aligner and Clear Smile Braces (fixed ceramic braces with super elastic Ni-Ti wires) or their combination. After short orthodontics a Dahl concept was applied to improve patients’ functional occlusion and anterior guidance. A “free-hand” and “no-any-drill” composite restoration technique was used to restore worn anterior teeth. For proper orthodontic diagnosis, assessment and treatment planning Spacewise analysis and Digital Caliper measurement were performed using models, their digital scans and intra/extraoral photos. We use Inman Orthodontic Lab in Florida for Inman Aligner fabrication and IAS Laboratory in London for Clear smile braces set up. Clear aligners (Scheu Dental, Germany) are planned and fabricated at the Digital Dental Office’s Clear Aligner certified laboratory. All treatments are start only after thorough diagnostic analysis, case discussion and acceptance from technical experts and orthodontists from UK, USA and Germany and acceptance of planned results from the patients. A course of home bleaching was then performed followed by resin bonding of anterior teeth edges to stabilize anterior guidance. RESULTS. More than 200 cases of upper and lower anterior crowding have been treated in comparably short period of time. From those we are introducing 3 different cases which were treated using above mentioned three appliances as an example. Average orthodontic treatment lasted 8-16 weeks depending on degree of crowding and type of appliances used. The arch crowding were less than 4 mm in all of them. No any teeth were extracted. After orthodontic treatment patients had double retentions (fixed+clear retainers). Dahl concept was performed in patients with anterior attrition and few patients experienced minor difficulty with chewing for their first week only. To control results of molar extrusion we measured space between occlusal surfaces of opposing molars in the SAM 3 articulator positioned in the centric relation. CONCLUSION. In order to get a long term proper stability of dento-facial function with a bonus of beautiful smile the concept of keeping own teeth and its structure became essential in cosmetic and restorative dentistry. The good thing of Dahl technique is its simplicity if it is done properly and its cost effectiveness. And as it was described the edge bonding itself could be a permanent retainer which prevents a future relapse in ortho-aligned teeth. Moreover patients were highly satisfied due to fast alignment, opportunity of keeping their teeth untouched and getting aesthetically pleasant result with a stable function.

Background: Iodine is a micronutrient essential for mental and physical development. One of ways to prevent from iodine deficiency is sufficient intake of iodine with food. The WHO approved method for assessment of the population’s iodine status is measurement of the concentration of iodine in urine. Goal: The goal of the survey was to assess the iodine status in 6-11 years old children and pregnant women. Materials and Method: 1697 children of 6-11 years of age and 900 pregnant women were selected from 21 aimags and Ulaanbaatar city. Concentrations of iodine in their urine were determined using the Sandell-Kolthoff reaction method. Results: The median amount of urinary iodine in 6-11-year-old children was 143.45 µg/L which was within the WHO recommended range (100.0-199.9 µg/L). 31.82% of the surveyed children had their urinary iodine less than 100 µg/L which indicated a risk of iodine deficiency. The highest frequency of children with urinary iodine less than 100 µg/L was observed in western regions (53.9%) and the lowest percentage was observed in eastern regions (17.8%).
The median concentration of urinary iodine in pregnant women was 111.35 100 µg/L which was lower than the WHO recommended value (≥150 µg/L). The median amount of urinary iodine was 127.81 µg/L for the women in Ulaanbaatar city and for those in rural areas was 108 µg/L. The overall percentage of the women with low urinary iodine was 64.1%. Conclusions
1. The median urinary iodine concentration in 6-11 years old children is within the WHO recommended range, whereas the median concentration in pregnant women is lower than the WHO recommended value.
2. 31.8% of the surveyed children and 64.1% of the pregnant women are at risk of iodine deficiency.
3. The frequency of iodine deficiency is highest in western region and is lowest in eastern and central regions.

Background: Vitamins are nutrients essential for human health. They act as coenzymes that help trigger important chemical reactions necessary for energy production. Reference values for vitamins help physicians evaluate the health status of patients and make clinical decisions. The aim of this study was to determine the mean values and reference intervals for some water-soluble vitamins of Mongolian adults. Materials and Methods: Three hundred and forty healthy adults (170 males and 170 females) of 17 to 69 years of age were selected for the study based on CLSI C28-P3 criteria Defining, establishing & Verifying reference interval in the clinical laboratory; Proposed Guidelines. The study was approved by the Resolution No.76 of 2018 of the Medical Ethics Review Committee of the Ministry of Health. Informed consents were taken from the selected individuals. Morning blood samples of the participants were collected under aseptic conditions. Levels of vitamins B₆, B₉, B₁₂ and vitamin C were measured using a high performance liquid chromatography method. The lower- and upper reference limits were defined as the 2.5th and 97.5th percentiles, respectively. The data were analyzed using SPSS and Excel programs. Results: The mean blood level of vitamin C was 11.88 mg/L (95% CI 10.47-13.29) for men and 9.62 mg/L (95% CI 8.11-11.13) for women. The calculated reference interval for males was 1.40-19.40 mg/L and 1.17-18.04 mg/L for females. The mean concentration of vitamin B₁₂ in the blood of males was 938.45 ng/L (95% CI 747.22-1129.68) and that of females was 864.03 ng/L (95% CI 603.81-1124.25). The reference interval for vitamin B₁₂ was 233.03-1597.00 ng/L in men and 132.45-1623.86 ng/L in women. The mean level of vitamin B₉ was 8.47 ng/mL (95% CI 5.64-11.30) for men and 6.91 ng/mL (95% CI 4.89-8.93) for women. The calculated reference interval for this vitamin in males was 1.04-24.74 ng/mL and that in females was 1.04-21.46 ng/mL. As for vitamin B₆, the mean concentration for men was 44.42 ng/mL (95% CI 37.01-51.83) and for women was 34.67 ng/mL (95% CI 29.97-39.39) with the reference intervals of 5.90-79.02 ng/mL for men and 5.27-61.72 ng/mL for women. Conclusion The reference values for vitamins B₆, B₉, B₁₂ and vitamin C of Mongolian adults do not differ significantly from those observed in other populations. The calculated reference intervals can be used in the practice of health laboratories.

Background: Minerals are important for the proper body functioning. They also play a role in preventing and fighting diseases. Reference values for minerals help physicians evaluate the mineral status of patients and make clinical decisions. The aim of this study was to determine the mean values and reference intervals for some minerals to be used for evaluation of the nutrition status of Mongolians. Materials and Methods: Two hundred and forty healthy adults (120 males and 120 females) of 17 to 70 years of age were selected for the study based on CLSI C28-P3 criteria Defining, establishing & Verifying reference interval in the clinical laboratory; Proposed Guidelines. The study was approved by the ethical committee of the Ministry of Health of Mongolia. Informed consents were taken from the selected individuals. Morning blood samples of the participants were collected under aseptic conditions. Levels of iron (Fe), zinc (Zn) and copper (Cu) were measured by graphite furnace atomic absorption spectrometry. The lower and upper reference limits were defined as the 2.5th and 97.5th percentiles, respectively. The data were analyzed using SPSS and Excel programs. Results: The mean level of blood iron was 30.50 µmol/L (95% CI 29.71-31.29) for men and 30.91 µmol/L (95% CI 30.03-31.79) for women. The calculated reference interval for males was 21.39-37.72 µmol/L and 19.87-39.67 µmol/L for females. The mean concentration of zinc in the blood of males was 11.00 µmol/L (95% CI 10.69-11.31) and that of females was 11.79 µmol/L (95% CI 11.39-12.19). The reference interval for blood zinc was 8.20-14.92 µmol/L in men and 8.52-16.67 µmol/L in women. The mean level of blood copper was 15.28 µmol/L (95% CI 14.64-15.89) for men and 18.08 µmol/L (95% CI 17.30-18.86) for women. The calculated reference interval for copper in males was 9.72-22.34 µmol/L and that in females was 11.18-27.27 µmol/L. Conclusion The reference values for zinc, copper and iron of Mongolian adults do not differ significantly from those observed in other countries. The calculated reference intervals can be used for evaluation of the nutrition status and making clinical decisions.

Background: Reference values are very important for the clinical decisions in laboratory diagnosis and clinical management of patients. Method: A total of 340 adults (apparently healthy individuals) between 18 to 70 years resident in the Ulaanbaatar city were randomly selected and enrolled in this survey. 340 adults made up of 170 males, 170 females were assessed by a clinician to be healthy. About 5 ml of blood was collected with EDTA test tube and analyzed using automated analyser to enumerate the hematological parameters (red blood cell, white blood cell, hemoglobin and haematocrit). Reference values were determined at 2.5^th and 97.5^th percentiles. Results: Reference values estabilished include: red blood cell 4.69-6.04×1012/L, white blood cell 3.98-9.11×109/L, haemoglobin 145-176 g/L, haematocrit 42.6-52.9% for males and red blood cell 4.10-5.20×1012/L, white blood cell 3.50-9.08×109/L, haemoglobin 121.8-148.2 g/L, haematocrit 36-44.7% for females. Conclusion We were determined mean and reference range of haematological parameters (red blood cell, white blood cell, haemoglobin, haemotocrit) which are important for assessing the nutritional status of adults according to the international standard methodology. The international reference range shows that white blood cells counts do not indicate gender and our data (р=0.0964 are statistically insignificant) also offers no significant difference was found between samples for male and female subjects.