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%.

Background: The main principles of pharmacotherapy are to provide pharmaceutical care with right medicine, right doses, in right time. If the treatment plan can be evidence based, it will improve treatment efficacy andsafety, can prevent from drug related adverse event and reduce the health care costs. Assessing the drug related problems in elderly patients is a main health care and safety issue for the health care system. Ischemic heart disease (IHD) is one of major cause of mortality and one of the main diseases of morbidity in Mongolia and in the Worldwide.Objective: Aim of this study was to conduct aretrospective study on inappropriate prescribingpattern among elderly patients with Ischemic heart disease who were treated in tertiary level hospitals ofUlaanbaatar.Methods: Total of 438 patient’s records who were treated with diagnosis of IHD during the 2011 –2012, was collected randomly from main three state hospitals of Ulaanbaatar. A retrospective analysis of inappropriate drug prescription was used Beers criteria (2012).Variables of study were patient’s diagnosis, age, sex,names, doses and route of medications.Results: The mean age of the participants was67.38±0.24 and 54.6% of participants were male and 44.4% were female. The 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 state hospital, number and cost of drug per patients werehigher 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. The most common inappropriately used drugs were as follows: amiodarone (16% at the I state hospital; 10% at the II state hospital; 3% at the III state hospital),dipyridamole (51% at the I state hospital; 3% at the II state hospital), amitriptyline (29% at the I state hospital; 20% at the III state hospital), nifedipine (33% at the II state hospital).The use of that are inappropriate with certain medicalconditions were common in case of IHD patients with peptic ulcer comorbidity. Non-steroid anti-inflammatory drug + acetyl salicylic acid combination were used in 3% of patients at the I state hospital, in 4% of patients at the II state hospital and 1% of patients at the III state hospital.Conclusion: Among the medications used for elderly patients with IHD, 15 medications were listed in potentially inappropriate medication in elderly (Beers criteria) independent of diagnosis. In I and II state hospitals, usage of potentially inappropriate medication were greater than III state hospital.Key words: inappropriate drug, Beers criteria,ischemic heart disease, treatment guideline

Background: Karma, a Sanskrit word that roughly translates to “action,” is a core concept in some Oriental religions, including Hinduism and Buddhism. Though its specifics are different depending on the religion, karma generally denotes the cycle of cause and effect - each action a person takes will affect him or her at some time in the future. This rule also applies to a person’s thoughts and speech, and the actions other people take under that individual’s instructions. Therefore, it is important to study the relationship between body, speech, mind and karma. Research results: The Karma denotes our good and bad intentions. These intentions manifest themselves as good or bad actions with our body, our speech and our mind. In turn, our actions bring about effects called “Karma”, namely: the effect, the consequence, the fruit of the actions, the maturation of the actions. Usually, however, the word Karma is used by ordinary people for both the actions and the effects, which is not accurate. The law of karma is a special instance of the law of cause and effect, according to which all our actions of body, speech and mind are causes and all our experiences are their effects. The law of karma explains why each individual has a unique mental disposition, a unique physical appearance and unique experiences. These are the various effects of the countless actions that each individual has performed in the past. Each person has a different individual karma. Some people enjoy good health while others are constantly ill. Some people are seen as very beautiful while others are seen as very ugly. Some people have a happy disposition that is easily pleased while others have a sour disposition and are rarely delighted by anything. Some people easily understand the meaning of spiritual teachings while others find them difficult and obscure. Conclusion We made conclusion choosing information and sources related to body, speech and mind study as well as Karma in antient works, sorting it into time sequence and enriching it with information in other works. Essentially, Karma denotes our good and bad intentions. These intentions manifest themselves as good or bad actions with our body, our speech and our mind.

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.

Background: High blood pressure is both a cause and a complication of chronic kidney disease. As complication, high blood pressure may develop early during course of chronic kidney disease and is associated with adverse outcomes, in particular faster loss of kidney function and development of cardiovascular disease. The purpose of this study is early detection of chronic kidney disease in patients with hypertension by defining the prevalence of microalbuminuria.Methods: The study population consisted of 169 subjects with a hypertension. Individuals were considered to have hypertension if the blood pressure measured greater than 140/90 mmHg or if they were taking blood pressure lowering medications. Microalbuminuria was defined as 20 mg/l or greater. Results: We are presenting data on 169 subjects :male 38 (22.5%) female 131 (77.5%), average age 51.6±0.89 At screening, 14.8% of all participants were smokers, 62.1 % engaged in low levels of physical activity, 72.8% - were having tea with salt (table1). Microalbuminuria and renal failure, as GFR<60 ml/ min/1.73 m2, were documented in 34.3% and 16.6% of subjects, respectively. There is positive correlation between MAU and increasing-range of blood pressure (table2). Correlation was found between albuminuria and GFR(r= -0.2 p<0.01) and serum creatinine(r=0.31 p<0.01) the regression result has shown that GFR is associated with MAU and serum creatinine (table 3).Conclusions:1. In 34.3% of patient with hypertension was found nephropathies with MAU2. Microalbuminuria is increased with decline of GFR and raise of systolic blood pressure. GFR decline is with the raise of age and serum. It is important to implement in clinical practice screening of MAU hypertensive patients.3. In 2/3 of all screened subjects was found 1 and more risk factors for CVD.

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.

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.

Introduction. Garidi-5, a traditional medicine composed of 5 herbs including Terminalia chebula Retz., Aconitum Kusnezoffii Reichb., Acorus calamus L., Saussurea lappa L., and musk of Moschus moschiferus, has been used in traditional Mongolian medicine as an analgesic and antibacterial medicine. The present work was undertaken to evaluate the traditional drug Garidi-5 for its analgesic and anti-inflammatory activity.Materials and Methods. The method of Winter et al. was used to study acute inflammation. Rats in groups of five each were treated with vehicle, Garidi-5 (20, 80 and 200 mg/kg, p.o.) and Indometacin (10 mg/kg) one hour prior to Carrageenan injection. 0.1 ml of 1% Carrageenan was injected into the subplantar tissue of left hind paw of each rat. Swelling of carrageenan injected foot was measured at 0, 0.5, 2, 4 h using Plethysmometer (UGO Basile, Italy)). The right hind paw was injected with 0.1 ml of vehicle.Results. The Garidi-5 (20, 80 and 200 mg/kg) significantly (P<0.01) inhibited carrageenan induced rat paw edema as compared to control group. Maximum inhibition of paw edema was observed with Garidi- 5 (80 and 200 mg/kg) at 4 h when compared to the control group (Tab.1). In assay data, the TNF-α, IL-1β and IL-6 secretion in serum were highly elevated by carrageenan induction but administration of Garidi-5 signifi cantly reduced serum secretion of inflammatory mediatorsas compared to vehicle group (Tab. 2).Conclusion. In conclusion, Traditional drug Garidi-5 have anti-in flammatory properties. The potential efficacy of Garidi-5 to treat inflammation is based in a part on the hy pothesis that it will suppress the proinflammatory cytok ines resulting in less oedema.

Introduction. Garidi-5, a traditional medicine composed of 5 herbs including Terminalia chebula Retz. Aconitum Kusnezoffii Reichb., Acorus calamus L., Saussurea lappa L., and musk of Moschus moschiferus, has been used in traditional Mongolian medicine as an analgesic and antibacterial medicine. The present work was undertaken to evaluate the traditional drug Garidi-5 for its analgesic and anti-inflammatory activity.Materials and Methods. The method of Winter et al. was used to study acute inflammation. Rats in groups of five each were treated with vehicle, Garidi-5 (20, 80 and 200 mg/kg, p.o.) and Indometacin (10 mg/kg) one hour prior to Carrageenan injection. 0.1 ml of 1% Carrageenan was injected into the subplantar tissue of left hind paw of each rat. Swelling of carrageenan injected foot was measured at 0, 0.5, 2, 4 h using Plethysmometer (UGO Basile, Italy)). The right hind pawwas injected with 0.1 ml of vehicle.ResultsThe Garidi-5 (20, 80 and 200 mg/kg) significantly (P<0.01) inhibited carrageenan induced rat paw edema as compared to control group. Maximum inhibition of paw edema was observed with Garidi-5 (80 and 200 mg/kg) at 4 h when compared to the control group (Tab.1). In assay data, the TNF-α, IL-1β and IL-6 secretion in serum were highly elevated by carrageenan induction but administration of Garidi-5 signifi cantly reduced serum secretion of inflammatory mediators as compared to vehicle group (Tab. 2). ConclusionIn conclusion, Traditional drug Garidi-5 have anti-in flammatory properties. The potential efficacy of Garidi-5 to treat inflammation is based in a part on the hy pothesis that it will suppress the proinflammatory cytok ines resulting in less oedema.

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.