INTRODUCTION: Poor controlled hypertension is associated with development of target organ damage and theassessment of target organ damage is important in the evaluation of all hypertensive patients as itprovides important information on the severity of the hypertension, the cardiovascular risk and guidemanagement of individual patient.GOAL: The aim of this study to determine frequency of target organ damage among hypertensiveoutpatients at district hospitals in Ulaanbaatar.MATERIAL AND METHODS:This was a cross-sectional hospital based study. Total 150 hypertensive outpatients aged 40-70years were consecutively recruited into the study at district hospitals in Ulaanbaatar. Standardizedquestionnaires were used to collect socio-demographic characteristics and data about diseasehistory that shows hypertensive complication. Target organ damage was assessed by physicalexamination, urine test, serum total cholesterol test, eye fundoscopy and ECG.RESULTS:Among study participants, 130 (86.7%) patients had at least one of the four hypertensive targetorgan damage studied. The most affected organ was the eye presenting as retinopathy observedin 109 (72.7%), followed by left ventricular hypertrophy 107 (71.3%), stroke 20 (13.3%), andproteinuria in 17 (11.3%) patients. Only 42 (28%) had controlled blood pressure, 108 (72%) of thestudy participants had uncontrolled blood pressure.CONCLUSION:This study showed a high frequency of target organ damage among hypertensive patients attendingmedical outpatient clinic. These findings illustrate the burden of uncontrolled hypertension in oursetting.

BackroundThe goal of the survey was to determine the prevalence of hypertension and common modifiable risk factors which is constantly increases and in highly lead of blood circulating system diseases among the people of Baynkhongor province in recent years, and also to find a reasonable ways to improve preventive actions for long life expectancy of the province residents.GoalThe goal of the survey was to determine the prevalence of hypertension and common modifiable risk factors among the people above 30 years old of Bayankhongor province.Objectives:1. To determine the prevalence of hypertension among the people above 30 years old of Bayankhongor province2. To determine the risk factors for hypertensionMaterials and Method:The cross-sectional survey used WHO STEPS survey methodology adapted to the countrys specifics. A total of 373 randomly selected above 30 year-old residents involved to the survey that all represented by ages, gender etc.Results:The survey result showed that about 41.3% of the target population who involved in the survey has the prevalence of hypertension and with no difference in all regions too. Men had significantly higher prevalence of hypertension compared to women as well (p=0.029), andit would occurs and happens more with the aging. Total of 34.6% of the target population who have the prevalence of hypertension (p=0.0001) have diagnosed and whereas men at risk about 66%. The survey result showed that the consumption of the pernicious habits of the population is high, and average daily serving of fruits and vegetables were (1.64 unit) once 3 more times less than the WHO recommendation. Daily salt intake was 9.8 grams per person (2 more times higher than the WHO recommendation) and nearly one in two persons were at increased risk for physical inactivity.Conclusions:The survey result showed that about 41.3% of the target population who involved in the survey has the prevalence of hypertension. In conclusion, the summary of combined hypertension risk factors demonstrates that 2 in 3 (65.9%) adults have 1-2 risk factors and 1 in 3 (30%) adults have three or more common modifiable risk factors. Twice as many young men (aged 30-49 years) than women have high 3 more risk factors.

The Jones criteria is a clinical guideline for the diagnosis of rheumatic fever(RF) and carditis. The clinical features were divided into major and minor categories. Major manifestations include carditis, joint symptoms, subcutaneous nodules, erythema marginatum and chorea. The minor manifestations comprised clinical fi ndings(fever, artralgia, cardialgia,abdominal pain, nose bleeding ) and laboratory markers(Leukocytosis, elevated erythrocyte sedimentation rate and C-reactive protein, prolonged PR on ECG). It was proposed that the presence of two major, or one major and two minor manifestations offered reasonable clinical evidence of rheumatic activity.Carditis is the single most important prognostic factor in RF; only valvulitis leads to permanent damage and its presence determines the prophylactic strategy. The clinical diagnosis of carditis in an index attack of RF is based on the presence of signifi cant murmurs (suggestive of mitral and aortic regurgitation), pericardial rub, or unexplained cardiomegaly with congestive heart failure.Myocarditis(alone) in the absence of valvulitis is unlikely to be of rheumatic origin and by itself should not be used as a basis for such a diagnosis. Two dimentional echo-Doppler and colour fl ow Doppler echocardiography are most sensitive for detecting structural abnormality, abnormal blood fl ow and valvular regurgitation. This method can detect all audible valvular regurgitations to be dThe use of 2D echo-Doppler and colour fl ow Doppler echocardiography may prevent the overdaignosis of a functional murmur as a valvular heart disease. Similarly, the overinterpretation of physiological or trivial valvular regurgitation may result in misdiagnosis of iatrogenic valvular disease. Accurate interpretation of the echocardiographic signals is therefore important.

INTRODUCTION: In the modern medical practice of Mongolia, autoimmune diseases have notbeen diagnosed in its early stage. The autoantibodies are useful in the patient’s early diagnosis,prognosing, and treatment of autoimmune diseases.GOAL: The aim of the study was to compare the prevalence and levels of autoantibodies in theserum of patients with autoimmune diseases.MATERIALS AND METHODS: This patient-based descriptive study involved 144 participants, withconfirmed diagnosis of autoimmune disease and glomerulonephritis (GN). Face to face interviewwas used to obtain necessary information followed by the physical examination and autoantibodies(anti-SS-A/Ro, anti-SS-B/La, anti-SCL-70, c/p-ANCA, anti-GBM, anti-Sm) measured by Enzyme-Linked Immunosorbent Assay (ELISA).RESULTS: The prevalence of anti-SS-A/Ro 38.6%, anti-Sm 25.7%, anti-SS-B/La 8.6%, c-ANCA7.14%, anti-SCL-70 1.4% were positive in autoimmune disease group (secondary GN), theprevalence of anti-SS-A/Ro 6.8%, anti-Sm 2.7%, anti-SS-B/La 2.7%, c-ANCA 1.4% were positivein primary GN group. A higher frequency of anti-SS-A/Ro 66.4%, anti-SS-B/La 22.8%, and anti-Sm38.4% was observed in the SLE group.CONCLUSIONS: Patients with autoimmune disease was significantly higherly younger and female.SLE associated with several auto antibodies (anti-SS-A/Ro, anti-SS-B/La, and anti-Sm) and eachof which are very useful in distinguishing patients with SLE from other autoimmune diseases.

Background During the last ten years cardiovascular disease has became one of the priority cause of death in Selenge province, while 23.9 cases in 10.000 population. Studying cause of increasing cardiovascular disease by year and year, connecting with arterial hypertension control and influenced factors is our research work background.GoalTo determine uncontrolled arterial hypertension and evaluate its influenced factors among the population with arterial hypertension in Selenge province.Objectives:1. Research uncontrolled arterial hypertension among the population2. Determine factors that influence uncontrolled arterial hypertensionMaterials and Metods: Research model: Population based moment model of analitic research is used to survey control of population with arterial hypertension. Research coverage and Sampling: Eruu, Zuunburen, and Khutul soums were chosen from 23 soums including center of Selenge province through the random sampling. And then 480 people with arterial hypertension, aged above 18 years were participated in the research. Data was analysed by SPSS 17 program. Collecting information method: Situation of arterial hypertension control is taken by questionnaire method developed by collaboration with WHO and International Association of Arterial Hypertension, and whether follow the drug treatment instruction of physicians is evaluated by MMAS questionnaire method developed by Association of Control Case Managment of America. Arterial hypertension, weight and height of participants were measured. Although people with arterial hypertension under 140-90 mm.Hy are reported “people who are controlling their arterial pressure in normal rate”.ResultsTotally 480 people with arterial hypertension, aged above 18 years were chosen from of Eruu, Zuunburen, and Khutul soums and center of Selenge province. Approximetly, 29.1 percent were male, 70.8 percent were female and average age was 52.43. About 34 percent were high education, 85.8 percent were married and 34.4 percent were retired people. According to the survey, 68 people or 14.1 percent were controlled their arterial pressure/hypertension in normal rate, 412 people or 85.8 percent were uncontrolled their arterial pressure/hypertension in normal rate. Because of the arterial hypertension 59 percent of the participants were under control of physicians. Also there was difference on age and gender with statistical benefit. (p=0.001) People who can control arterial pressure in normal rate were 12.7 percent of people under control of physicians.Conclusions:About 85.8 percent or 412 people with arterial hypertension were uncontrolled, 90 percent were male and 84.1 percent were female. Because of the arterial hypertension, 59 percent of the participants were under control of physicians. But 87.3 percent of them cannot control their arterial pressure/ypertension in normal rate. Physicians control, employment, body mass index and following drug treatment instruction were the factors influence on arterial hypertension control.

Introduction. The acute coronary disease (ACD), broadly encompass the clinical states unstable angina (UA) and acute myocardial infarction (AMI), especially affects adults due to cause the impairment of work ability, associates reducement of life quality and high expenses of medical treatment, and induces leading cause of sever complication and death.Materials and Methods. In this study, 44 ACD patients and 33 healthy subjects enrolled into case and control group, respectively. Relationships of primary and intermediate risk factors between cases and healthy subjects were determined by questionnaire research and clinical examinations. Measurements such as C reactive protein (CRP), cholesterol, triglycerides, low-density lipoprotein (LDH), high-density lipoprotein (HDL), trooping I, and mean platelet volume (MPV) were analyzed by clinical laboratory assays. The SPSS12 statistical software was used for all statistical calculations.Results. Statistical significant differences of hypertension and smoking were observed in ACD patients (UA and AMI) (P<0.01) compared with healthy subjects by independent samples T test. Body mass (BM), waist-to-hip ratio (WHR), body mass index (BMI) were significantly different in patients with UA, but WHR, hip were significantly different in patients with AMI. The levels of biochemical measurements such as cholesterol, triglycerides, and glucose were significantly higher in patients with AMI (р<0.01), whereas glucose concentration was significantly higher in patients with UA (р<0.05). However, a kind of inflammatory markers, CRP was a risk factor in the patients with ACD (UA and AMI), whereas MPV was a risk factor for AMI only. In the ANOVA test, which was confirming analysis on the results of independent samples Ttest, overweight (BM), abdominal obesity (WHR, hip) measurements, parameter of glucose metabolism(glucose) and some inflammatory markers (CRP, MPV) were significantly different between study groups. Relationships by determined Pierson`s correlation, were observed between overweight parameters (BM, BMI) and biomarkers of fatty acid metabolism (cholesterol, LDL, HDL, triglycerides). The BM of overweight parameters and the WHR of abdominal obesity measurements were strongly associated with increased level of glucose.Conclusion. Primary risk factors including hypertension and smoking; parameters of the overweight or abdominal obesity such as BM, WHR, BMI and hip; biochemical measurements as cholesterol, triglycerides and glucose; and some inflammatory biomarkers as well as CRP and MPV were risk factors in the ACD.

Background: Sjögren's syndrome is a chronic autoimmune inflammatory disease characterized by lymphocytic infiltration of exocrine glands, typically presenting with symptoms such as xerostomia (dry mouth) and xerophthalmia (dry eyes). This disease can appear as an isolated condition or in association with other diseases. It is most commonly associated with rheumatologic disorders such as rheumatoid arthritis and systemic lupus erythematosus, but in rare cases, it may also be associated with other autoimmune diseases involving various organ systems. Autoimmune hepatitis is a chronic liver inflammation characterized by elevated serum globulin and antibody levels. The coexistence of Sjögren's syndrome and autoimmune hepatitis is very rare, with some sources indicating an incidence of only 1.7%. In our clinical case report, a rare occurrence was observed in a 52-year-old female who had been diagnosed with Sjögren's syndrome in 2022 and later developed symptoms of hepatitis, leading to a diagnosis of autoimmune hepatitis. When autoimmune hepatitis coexists with other autoimmune diseases, it often presents with mild clinical symptoms, which may delay the diagnosis. Case report: A 52-year-old female patient presented in 2020 with complaints of dry eyes and mouth, blurred vision, decreased saliva production, fatigue, and occasional swelling of the lymph nodes, as reported during her medical history. In December 2022, she was seen by a rheumatologist at the Mongolia-Japan Medical Center. Laboratory tests revealed positive results for anti-SSA52, CENP-B, ANA IgG, and RF, with altered liver function (see Table 1). A Shirmer test was positive, and saliva production was ≤ 0.1 mL/min. According to the ACR-EULAR 2016 diagnostic criteria, she scored 5 points, confirming the diagnosis of Sjögren's syndrome. Treatment was initiated with hydroxychloroquine and corticosteroids, along with medications for gastric protection, liver protection, and prevention of complications. In March 2023, during a follow-up visit, laboratory tests showed altered liver function (see Table 1). Hepatitis B and C antibodies were negative, and Liver-9-line results were normal. Due to the positive clinical dynamics of Sjögren's syndrome, the dose of hydroxychloroquine was reduced, and other treatments were continued. The patient was also advised to see a gastroenterologist for further evaluation. In August 2024, she presented to the gastroenterology department at Intermed Hospital with complaints of left abdominal pain and jaundice. Upon examination, abdominal ultrasound was normal, but laboratory results showed elevated IgG (132 H), ANA (>400 U/L), ALT (119.2 U/L), and AST (132.8 U/L), which raised suspicion of autoimmune hepatitis. Consequently, a liver biopsy was performed. Liver Biopsy (August 2024): The liver tissue shows a portal triad with 13 portal trios, where there is mild infiltration of lymphocytes, eosinophils, and a few neutrophils around the portal triads. Focal macrosteatosis of hepatocytes and bile stasis are observed. In Masson’s trichrome stain: There is fibrosis around the portal triads with connective tissue proliferation (ISHAK-1). In PAS staining: Focal positive staining is observed within the hepatocytes. According to the international autoimmune hepatitis diagnostic criteria, the diagnosis of autoimmune hepatitis was confirmed with a score of 8 (ANA +2, IgG +2, Biopsy +2, HBV HCV negative +2). Liver biopsy confirmed the diagnosis of primary sclerosing cholangitis. Treatment with corticosteroids and choleretic therapy was initiated, and a follow-up visit is planned in one month. In September 2024, upon follow-up, liver function had improved compared to previous tests, and treatment was continued. The patient is now under ongoing monitoring by both a gastroenterologist and a rheumatologist. Conclusion The coexistence of Sjögren's syndrome and autoimmune hepatitis is a rare clinical occurrence, with foreign studies reporting an incidence of less than 1%. However, if autoimmune hepatitis goes undiagnosed, it can lead to complications such as liver cirrhosis and hepatocellular carcinoma. Therefore, it is of critical importance to perform antibody tests and tissue biopsy for early detection and differential diagnosis in patients diagnosed with Sjögren's syndrome who present with liver and biliary symptoms or laboratory findings indicating liver dysfunction. This clinical case emphasizes the need for careful monitoring and early intervention.

Background: Systemic lupus erythematosus (SLE) is an unknown systemic autoimmune disease that causes multiple tissue and organ damage. Lupus nephritis (LN) was found to occur in 15-30% of the patients with lupus at the time of initial diagnosis and in 30-50% during disease progression. Accurate diagnosis and active treatment can preserve the kidney function of LN patients and delay the process of kidney fibrosis, thus postponing the occurrence and development of end-stage kidney disease (ESRD). The diagnosis of LN is ideally confirmed by histologic findings in a kidney biopsy. Additionally, serum or urine biomarkers such as serum creatinine, urea, and immune-related molecules, such as anti-double-stranded DNA, anticardiolipin, complement components C3, C4, and anti-C1q antibodies. Aim: The information concerning non-invasive, easy, and accurate biomarkers for diagnosis of lupus nephritis. This study aimed to evaluate the diagnostic significance of cystatin C and complement component 1q antibody for lupus nephritis. Materials and Methods: A study that included 40 patients with systemic lupus erythematosus (SLE) without LN (non-Lupus group), 40 patients with lupus nephritis (Lupus group) was performed in a hospital based cross-sectional study from May 2022 to August 2024. The serum levels of CysC, Anti-C1q, urea, and creatinine were measured, and estimated glomerular filtration rates (eGFRCysC , eGFRcreat , eGFRcomb) were calculated by equations two groups and the CKD-EPI respectively. T-test analysis or Chi-square test was used to compare the differences between the two groups. The receiver operating characteristic (ROC) curve was applied to identify the diagnostic efficiencies of individual or combined multiple indicators. Results: 80 patients were recruited, including 5% men and 95% women with a mean age of 35.15±9.57 years (range 17-56 years). The LN group with a mean age of 35.2±9.44 years, non-LN group with a mean age of 35.1 ±9.38 years. The non-LN group clinical manifestation of 47.5% arthritis, 32.5% hematologic system, 10% interstitial lung disease, 7.5% dermatitis, 2.5% central nervous system. The LN group with SLE disease activity index of 85% severe activity, 2.5% moderate activity, 2.5% mild activity. The non-LN group with SLE disease activity index of 7.5% severe activity, 62.5% moderate activity, 20% mild activity, 10% low activity. Significantly elevated Cystatin C and anti-C1q were observed in the LN groups. Cystatin C, creatinine, urea and antiC1q were increased 60% (n=24), 22.5% (n=9), 32.5% (n=13), and 70% (n=28) respectively (P=0.001). eGFRcreat detected chronic kidney disease (CKD) stage of 63.7% normal, 25% mild, and 11.25% moderate stage. eGFRcyst detected chronic kidney disease (CKD) stage of 47.5% normal, 25% mild, 20% moderate, 7.5% severe stage. Conclusion The separately detected cystatin C(eGFRcyst) and antiC1q were superior to the conventional biomarkers Urea, Creat, and eGFRcreat in the diagnosis of lupus nephritis with SLE.

Background: Patients with rheumatoid arthritis are at increased risk of developing cardiovascular disease. In Mongolia, the registration of inflammatory diseases is increasing every year, and cardiovascular diseases are the leading cause of death. Aim: We aimed to determine the degree of cardiovascular risk and its correlation in people with rheumatoid arthritis. Materials and Methods: The study was conducted in a cross-sectional study design with 64 patients with rheumatoid arthritis between May and November 2024. Cardiovascular risk was assessed using mSCORE and the World Health Organization (WHO) cardiovascular Risk Table. We received ethical approval to begin the research at the MNUMS meeting on May 17, 2024 (No. 2024/3-05). Results: The average age of the participants was 55.2±9.7 years, and the average duration since being diagnosed with RA was 9.8±8.0 years. Among the participants, 82.8% (n=53) were female, and 17.2% (n=11) were male. The mean WHO risk index was 10.25±11, while the mean mSCORE risk index was 2.9±4 (p=0.001). There was a significant difference in mSCORE scores between the 40-55 and 56-65 age groups (p<0.001). In contrast, the mSCORE risk assessment showed that 15.6% (n=10) had high risk, and 6.3% (n=4) had very high risk. Among the parameters of inflammatory biomarkers, CRP (OR=0.05, r=0.35, 95% CI 0.9-3.2, p=0.004) has a statistically significant difference and positive correlation, and HDL-C (OR=2.3, r=-0.25, 95% CI 2.9- 10.0, p<0.0001) was significantly different and negatively correlated. Conclusion A total of 64 participants participated in our study, and according to the WHO assessment, 17.2% were at high or very high risk of developing cardiovascular disease in the next 10 years, and according to the mSCORE, 21.9% were at high or very high risk of developing cardiovascular disease. Although the degree of disease activity was not significantly associated with cardiovascular risk, the inflammatory biomarker C-reactive protein was statistically significantly different or positively associated with cardiovascular risk assessment.