Background. Cardiovascular diseases (CVD) constitute major cause of death in patients with chronic kidney disease (CKD). It is well established that in decreased renal function is associated with an increased risk of arterial stiffness, so patients with end stage renal disease have a very high risk for cardiovascular events. There have been no reports of the assessment of arterial stiffness in patients at different stages of non diabetic CKD in Mongolia.Aim. The purpose of this study was to determine the correlation between an estimated glomerular filtration rate (eGFR) and cardio-ankle vascular index (CAVI) in the CKD patients. Material and Methods. From a hospital-based population, 125 patients with CKD (mean age 40.30±10.82) were recruited. CKD was evaluated by the eGFR using the Cockcroft-Gault formula. CAVI was determined as an index of arterial stiffness.Results. The mean CAVI was in CKD level l ( 6.00±0.81, p 0.0001), ll (6.90±0.77, p 0.0001), lll (7.42±0.65, p 0.0001), lV (7.63±1.22, p 0.0001) and V (8.02±1.27, p 0.0001). CAVI was negatively correlated significantly with eGFR (r=-0.596, p 0.0001) and age (r=0.543, p 0.0001). Linear regression analysis indicated that CAVI was correlated significantly with eGFR (β=-0.466, p 0.0001) and age (β=0.373, p 0.0001).Conclusion. Decreased eGFR is associated with an increased risk of arterial stiffness, and it could be a strong predictor of risk factor for CVD in CKD patients.

Background: The World Health Organization calls hypertension the number one risk factor for death in the world and it’s considered a significant risk for stroke, heart failure, and kidney failure. Hypertension is common in patients with chronic kidney disease (CKD), and high blood pressure (BP) has been associated with a decrease in kidney function. The purpose of this study was to determine the correlation between an estimated glomerular filtration rate (eGFR) and BP in the CKD patients. Methods: From a hospital-based population, 125 patients with CKD (mean age 40.30±10.82) were recruited. CKD was evaluated by the eGFR using the Cockcroft-Gault formula. Cardio-Ankle vascular index (CAVI) was determined as an index of arterial stiffness. BP was measured using a mercury sphygmomanometer after subjects had sat and rested for at least 15 minutes. Pulse pressure was calculated as the difference between systolic BP (SBP) and diastolic BP (DBP). Mean arterial pressure was calculated as DBP plus one-third (SBP-DBP).Results: When BP grows up, renal function (eGFR 113.72±57.85, 78.39±60.96, 60.56±55.71, 28.38±19.96) and arterial stiffness (CAVI 6.51±0.99, 6.90±1.05, 7.22±1.17, and 7.79±1.16) are decreased. Linear regression analysis indicated that eGFR was correlated significantly with SBP (β=-0.480, p< 0.0001) and hypertension time (β=-0.332), p<0.0001). SBP was the strongest risk factors for CKD with each SD increase in systolic blood pressure (1mmHg) associated with > 4% higher risk ( hazard ratio: 1.04; 95% Cl: 1.02-1.07).Conclusion: Increases SBP were significantly associated with CKD.

Today, there are 382 million people living with diabetes. A further 316 million with impaired glucose tolerance are at high risk from the disease – an alarming number that is set to reach 471 million by 2035. One of the most overlooked of all serious complications of diabetes is cardiovascular autonomic neuropathy (CAN) which encompasses damage to the autonomic nerve fibers that innervate the heart and blood vessels, resulting in abnormalities in heart rate control and vascular dynamics. The present report discusses the clinical manifestations (eg, resting tachycardia, orthostatic hypotension exercise intolerance, intra operative cardiovascular liability, silent myocardial infarction (MI), and increased risk of mortality) in the presence of CAN. The reported prevalence of CAN varies greatly depending on the criteria used to identify CAN and the population studied. CAN prevalence ranges from as low as 2.5% of the primary prevention cohort in the Diabetes Control and Complications Trial (DCCT) to as high as 90% of patients with long-standing type 1 diabetes who were potential candidates for a pancreas transplantation. Objective: The aim of this study was to evaluate the Cardiac Autonomic Neuropathy (CAN) among diabetic patients.This study included patients with T1 DM and 20 patients with T2 DM total (97 male, 86 female) diabetic patients. The CAN diagnosed by 6 clinical tests: Resting Heart Rate (RHR), Expiration : Inspiration (E:I) ratio, Heart rate response to standing (30:15 ratio), Orthostatic hypotension (OH) and Sustained Hand Grip (SHG) using Cardiac Autonomic Neuropathy System Analyzer CAN-504. CAN was indicated at least two of five tests are abnormal.Diabetic patients’ mean age was 48.74±12.74, diabetes duration 7.55±5.72, systolic blood pressure 136.25±22.76mm Hg, diastolic blood pressure 84.82±11.90 mmHg, cholesterol 5.04±1.04mmol/l, triglyceride 2.20±1.24mmol/l, LDL2.64±0.85mmol/l, HDL 1.12±0.41mmol/l, non-HDL 3.71±1.06, cholesterol/HDL ratio 4.70±1.29, HBA1c 10.08±2.39%. Result of RHR resting heart rate test was normal 92%, borderline 0.5% and abnormal 7.1%,Expiration:inspiration(E:I) ratio was normal 72.7%,borderline 13.7% and abnormal 14%, Heart rate response to standing (30:15ratio) was normal 47%,borderline 13.714% and abnormal 39.3%, Valsalva was normal 97.8%,borderline 2.2% and abnormal 0%, Orthostatic hypotension (OH) was normal 66%,borderline 29% abnormal 6% and Sustained hand grip(SHG) test was normal 4.9%,borderline 9%, and abnormal 87.8%.Number of abnormal cardiac autonomic neuropathy test results <2 (no cardiac autonomic neuropathy) was in 86(47%) and >2 (with cardiac autonomic neuropathy) was in 97(53%) among diabetic patients. Among diabetic patients cardiac autonomic neuropathy (CAN) was 53%.

BackgroundTraditional Mongolian Medicine has a history of over 5000 years. Scientific development of TM hasstarted in 1959. Since 1999 Mongolia was categorized by WHO as a country having an Integrativesystem of TM- officially recognized and incorporated into all areas of health care provision, TMMresearch has been following key objectives of National R&D programs.AimIn order to assess the situation of TMM development we have conducted this study based on last10 years’ research done.Ìaterial and MethodsDocument study- we have selected key TMM’s R&D project implementers’ archive and humanresources documents.Descriptive and Analytic methods- a survey of 32 questions evaluating participation of TMMprofessionals in R&D work were conducted. Also, to clarify the point of view about TMM’s R&D6 focus group meetings with different level participants, such as professional committee, policymakers and research workers as well as health care providers, were organized.ResultsFrom 2004-2013, there are 28 projects implemented on TMM, 43% accomplished by TMMRTC,32.8% of which is resulting in raw materials standardization and technology study, related clinicalstudies standing 20% out of all studies done on TMM matter. These numbers are confirmed bysurvey and focus group interviews, more than 50% of participants willing to conduct a clinical studyand expressing difficulties such as lack of knowledge of methodology, policy support and revenue.Conclusions:1. TMM R&D has a potential growth due to human resources capacity. Practitioners are leastinvolved in R&D, due to lack of knowledge of methodology and revenue.2. There were 28 projects implemented on TMM matter, most of these are basic studies, fewerclinical studies done, resulting in pharmacopeia monographs and technological guidelines.

IntroductionThe main principles of pharmacotherapy are to provide pharmaceutical care with right medicine, right doses, in right time. If, the treatment plan can be in evidence based, it will improve treatment efficacy and safety, can prevent from drug related adverse event and reduce drug cost. Ischemic heart disease is one of major cause of mortality and one of the main diseases of morbidity in Mongolia and in the Worldwide.GoalAim of study was to conduct retrospective study on medications used for in-patients with Ischemic heart disease of tertiary level hospitals of Ulaanbaatar.Materials and MethodTotal of 438 patient’s records was collected randomly from 3 state hospitals, which were treated with diagnosis of ICD. Variables of study were patient’s diagnosis, age, sex, names, doses and route of medications.ResultThe trends of rational use of drug and number of drug and drug cost per patients were different in each tertiary level hospitals of Ulaanbaatar. In I national hospital, number and cost of drug per patients were higher than second and third state hospitals. The result were shown that in all three hospitals, more than 50 percent of total drugs per patients were injection, less than 50 percent of total used drug per patients were from standard therapeutic guideline. In second state hospital, anticoagulant and anti-platelet agents were chosen less than first and third state hospitals. In order to decrease cardiac oxygen demand and improve cardiac microcirculation, nitrates were chosen mostly in second and third state hospitals but, beta blockers were chosen mostly in first state hospital.ConclusionThe study results shown the treatment pattern and trends of rational use of drugs in in patients with ischemic heart disease have been different in tertiary level hospitals of Ulaanbaatar.

Background. Demographic transition is indication of population growth rates which impacted by global environmental changes and development of modern science. Last years, number of elderly people dramatically increasing in the world and this increases also showed up in Mongolia. Therefore, investigating the ageing process, risk factors for ageing and age related changes of the human body is important for diagnosing and decreasing age-related disease, improving the quality of life in elderly and healthy ageing. We aimed to investigate age related changes of antioxidant and prooxidant status among healthy Mongolian adults.Materials and Methods. 384 healthy subjects participated in this research. We measured serum level of antioxidant and prooxidant parameters in all subjects at the Functional diagnostic laboratory and Immunology laboratory of the Health Sciences University of Mongolia.Results. Serum level of malondialdehyde (MDA) that is parameter of prooxidant activity was lower in the 21-30 age groups and highest in upper 70 age groups. There was a significantly positive correlation between age and serum MDA level (r=0.665, p 0.01). Serum antioxidant parameters such as superoxide dismutase (SOD, r=-0.357, p 0.01), glutathione (GSH, r=-0.201, p 0.01) and total antioxidant activity (TAC, r=-0.256, p 0.01) has a negative correlation with age. But glutathione peroxidase (GPx, r=0.635, p 0.01) was significantly increased with age. That means the antioxidant activity is decreasing with the ageing process. Regression analyses showed that MDA, GPx, SOD, GSH, and TAC were significantly related with the ageing process.Conclusion. We concluded that the antioxidant activity is decreasing and oxidation process is increasing with age and oxidative stress is higher in healthy Mongolian adults. Furthermore, the serum lipid level is increasing from age 40and it can be the reason for arterial wall thickness.

IntroductionAH is one of the widest spread diseases, as well as the leading cause of mortality in Mongolia. Even though the AH is well studied throughout the world, with no significant results in health complications caused by AH in different organs and systems, there is a necessity to study the use of other methods in hypertension treatment, such as Mongolian traditional medicine for an adequate management of hypertension, in order to extend the choices of treatments by combining harmless natural multicompound drugs prepared by ancient mongolo-tibetian prescriptions with Chinese acupuncture and other therapy methods such as massage, bloodletting, cupping etc.GoalThe authors have analyzed 260 patient records of hypertension that have been treated only with MTM treatment methods in MONGEM MTM hospital, in order to define: 1) the classification of arterial hypertension according to theory of disease in MTM ;2) the classification of arterial hypertension according to theory of cold and hot in MTM;3) The results of MTM treatments on hypertension.Methods and MaterialsWe have conducted this study by document review and case study by analyzing 260 patient records of “MONGEM” traditional medicine hospital and research center.ResultsAccording to our study almost 80% of arterial hypertension cases start as a hot disease and change into cold disease. Our research results have also shown that 90% of hypertension can be classified into congested, interdependent state of disease and that treatment by MTM methods of combined disease with consideration of changes in hot and cold states is efficient for relieving arterial hypertension.ConclusionOur study has concluded that carefully diagnosed hypertension using MTM disease and disorder classification, and treated with accordingly chosen methods of MTM treatment such as multi-compound drugs, mild and rough techniques, nutrition and behavioral lifestyle changes combined with Chinese acupuncture, gives satisfactory results in healing arterial hypertension, thus providing safe, efficient, affordable and accessible treatment choices for people.

BACKGROUND: Early physical therapy plays important role in improving functional capacity, activities of daily life, and quality of life after acute myocardial infarction. OBJECTIVE: We aimed to describe effects of 4 weeks physical therapy program after acute myocardial infarction. METHODS: In our study, 20 men participated in physical therapy program for 14 days after PCI surgery. The patients were diagnosed with myocardial infarction and aged 56.45±8.1. Their BMI was 27.39±3.61and waist circumference was 98±9.28. Exercise program was scheduled 3 times a week with each session consisting of 34-70% intensity exercises for 60 minutes. Exercise type is aerobic (warming up for 10 minutes, walking, bicycling and cooling down stretch for 10 minutes). RESULTS: For the 6-minute walking test (p=0.01) there was significant difference between before and after 4 weeks’ exercise program. CONCLUSION: The hospital based 4 weeks exercise program improved the functional capacity for pci patients.

Introduction: Extracorporeal shockwave lithotripsy (ESWL) revolutionizedthe treatment of urolithiasis and graduallybecame the favorite treatment option sothat today it is considered to be the first lineof treatment for patients with urolithiasis.The purpose of this study was assessment oftherapeutic efficacy, complications of ESWLin urolithiasis in Mongolia.Material and methods: A total of46 patients harboring renal and ureteralstones underwent ESWL between March2016 and September 2016 at First CentralHospital of Mongolia. Karl Storz ModulithSLK electromagnetic machines were usedto impart shock waves. All collected stonefragments sent for biochemical analysis.Results: A total of 46 patients 23 weremales (50%). Patients were mean age of34. The stone size distribution was 0.5cmto 3.1cm. The average treatment time wasranging from 75-110 minutes. The averagenumber of shock waves per treatmentwas 3172±378 (range 1500-4000). Theoverall success rate was 75.73%. All calculidisintegrated satisfactorily except for 3stones, which is located lower 1/3rd ofureter. Stone composition analysis proved tobe composed entirely or predominantly ofcalcium oxalate monohydrate. These patientsrequired to have ureterolithoextraction. Calculicomposition for remaining patients 12 werecalcium oxalate monohydrate, 17 calciumoxalate dehydrate, 6 uric acid and 1 struvite.Complications were mostly minor and rare.Most of the patients (90.7%) developedmacroscopic hematuria after treatment; fewpatients developed mild bruising at the entryand exit sites of the shockwaves on the bodywall. Severe complications such as renalhematoma and steinstrasse were diagnosedfor one patient each and their managementwas non-surgical.Conclusion: ESWL is therefore the firstline treatment for urolithiasis with stonesize smaller than 2cm. It has an efficiencyrate above 75, low procedure time, highsafety and good tolerability and minimalcomplication.

BACKGROUND: According to the World Health Organization (WHO), 10-15% of couples of reproductive age have infertility. According to researcher D. Sukhe (1999), hormonal infertility in the reproductive age of women was 33.6%, which was a large part of the cause of infertility. In recent years, the number of cases of endocrine disorders, including malignancy and sexually transmitted infections, has been increasing year by year. According to WHO reports, thyroid disorders have a prevalence of 49.3% for active reproductive age (30-50). According to the report of the Health Development Center in 2016, since the thyroid disorders are the second most common disease in endocrine gland disease, our study found that the infertility in reproductive age of women can be substantial due to the loss of thyroid gland. METHODS: The study was carried out by the couple of 20-45 year-olds and modeled as an analytical study model. The questionnaire was used for the couple’s interviews and some of the measurement of body and serum use of TOSOH Corporation AIA-360, Tokyo, Japan. On the serum, anti-TPO and аnti-TG carbohydrates are identified by the Cobas e-411 analyzer under the manufacturer’s accompanying protocol. RESULTS: 76.7% of women were diagnosed with infertility euthyroid, 0.7% hyperthyroidism, 22.6% hypothyroidism (3.8% with overt hypothyroidism and 18.8% subclinical hypothyroidism). Prevalence of TAI, in 6.7% isolated positive anti-Tg were found, and 14.3% had isolated positive TPO, In 3.7% of cases, both types of autoantibodies were present. We analysed binary logistic regression for anti-TPO and anti-TG autoantibody in the positive and negative group in past obstetrics history, evidence of positive of anti-TPO and anti-Tg was increased risk of miscarriage 2.2 times (OR = 2.2, p <0.01). CONCLUSIONS: Women with disorders in our study have high percentage of subclinical hypothyroidism and have higher rate of thyroid autobodies in serum which may be a problem for women with infertility and pregnancy complications due to the loss of thyroid gland. There is a need to develop a principle of recovery and treatment.