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.

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.

Background: Headache is a common disorder among population. 47% of population of the world suffers from the primary headache. Due to the chronic lasting process of headaches, individuals lose productivity, get depression because of negative impact on people’s quality of life and economic status.
Headache disorders are amongst the top ten causes of disability in Europe [4]. Three of these (migraine, tension-type headache and medication-overuse headache) are important in primary care because they are common and responsible for almost all headache-related burden.
The burden is immense on workers, women and children in terms of missing work and school days. The personal and social burden of primary headache is high. Health, occupational, social, and psychological factors contributing to burden in people with disabling headache have not been fully unraveled. Headache disorders are not perceived by the public as serious since they are mostly episodic, do not cause death, and are not contagious. A large number of people with headache disorders are not diagnosed and treated: worldwide only 40% of those with migraine or tension-type headache (TTH) are professionally diagnosed and only 10% of those with medication-overuse headache (MOH).
There are no studies on the burden and disability assessment in patients with primary headache in our country, therefore a need for conducting this study. Goal: The burden and disability assessment in patients with primary headache in Mongolian adults. Methods and Materials: This cross-sectional study was carried out from June to November of 2017. Participants aged 18-65 years old randomly were selected from four aimags of Mongolia and three districts of Ulaanbaatar city. They were visited by door to door calling and surveyed using the HARDSHIP and Migraine Disability Assessment (MIDAS) questionnaire. The diagnosis of headache was made using the International Classification of Headache Disorders-3 beta. Statistical analysis was performed on SPSS-23 program, and level of depression in headache present patients was determined by odds ratio (OR). Study methodology introduced at Ethical review Committee of “Ach” Medical University and approved in 2017 (№17/3/2). Results: There were 2043 participants 39.7% and 60.3% of them were men and women respectively. The mean age of them was 38.0±13.4 years. 57.4% (n=1173) of participants had headache, and 27.4%, 30.0%, 11.2% and 7.5% of them had migraine, tension-type headache, chronic headache and medication overuse headache respectively. 42% of participants with headache had the median duration of suffering 7 years (IQR=3-13 years). Out of 1173 participants with headache 20.7% had depression. 23% of participants with migraine had depression whereas 68.2 % and 47% of participants with chronic headache and medicine overuse headache had depression respectively. Participants with migraine were 1.85 (OR: 1.85, CI: 95%, 1.39-2.47) times, with chronic headache 3.40 (OR: 3.40, CI: 95%, 2.04-5.67) times and medicine overuse headache 3.31 (OR: 3.31, CI: 95%, 1,50-7.30) times more likely to suffer from depression compare to participants with no headache.
People with migraine loses their productivity 10.6 days/m, with chronic headache 19.7 days/m, with MOH 20.3 days/ m. According the MIDAS (migraine disability assessment) people with migraine has mild disability, while people with chronic headache and MOH had middle score of disability. Conclusion The prevalence of primary headaches is high among Mongolian adults. These headaches cause disability, impair work, study and daily activities, decrease life quality, and brings unrecognized socioeconomic burden.

BackgroundOut of total 209550 cases of cardiovascular diseases in 2011, 66,7% were newly registered cases.Cardiovascular diseases are the number one cause of mortality in Mongolia; an estimated 6291 peopledied from CVDs in 2011, representing 36.7% of all deaths. It shows that CVD mortality level is higherthan in other countries.Materials and MethodsOur survey is a cross sectional study. We have investigated 600 people of the age of 20-40 whowere randomly selected from 6 urban districts of Ulaanbaatar city. With a permission #4 issued bythe Medical Ethics Control Committee of the Ministry of Health on 25th March 2011, our survey wascarried out between the 1st of July 2011 and the 1st of January 2012 based on the Functional DiagnosticLaboratory, Department of Physiology and Pathophysiology, School of Biomedicine, Health SciencesUniversity of Mongolia.ResultsThe CAVI was significantly higher (p<0.001) in 30-40 aged adults (6.68, 95% CI 6.58-6.78) than 20-29 aged adults (6.42, 95% CI 6.32-6.52). Also CAVI has a direct correlation with the cholesterol level(p<0.05, R2=0,011). Serum cholesterol, triglycerides and LDL levels were significantly higher (p<0.05)in men than women. Framingham Heart Score was in the normal range in 99.2% of the participantswith 4 cases having the score of 10% or higher representing a risk score.ConclusionsDislipidemia, overweight and obesity in young adults are the main causes of vascular dysfunctionsleading to cardiovascular diseases. Thus, the findings of the study demonstrate that helping youths todevelop healthy lifestyles including healthy eating and physical activities shall play a critical role for theprevention and intervention programs designed for development of healthy behavior and lifestyle fromchildhood, especially for the male population, are vital for fulfillment of this role.

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.

Background: The primary headache disorders are one of the most common complaints among children and adolescents. Migraine and tension-type headache (TTH) are the most frequently types of primary headache, with prevalence of approximately 9.1% for migraine and 10–24% for TTH among children.
The aim of this study was to determine the 1-year prevalence and some risk factors of primary headache disorders in school-aged children. Material and Methods: A cross-sectional, school-based survey consisting of semi-structured questionnaires was administered to randomly select aged 6-11 years using stratified multistage cluster sampling during the period from April to June 2018. The questionnaire of primary headache was based on International Classification of Headache Disorders-III criteria. Statistical analysis was performed by using the SPSS, version 21. Student’s T-test, chi-square test and analysis of variance were used for comparisons when appropriate. The level of statistical significance was set at p<0.05. Results: We surveyed totally 635 participants; the one-year prevalence of all types of headache was 54.6%. Prevalence of migraine and tension-type headache was 3.0% and 5.4%, respectively. Elucidated biometric and socio-demographic risk factors showed statistically significant difference in prevalence of migraine: type of household, life situation and residential quarter. Conclusion Our study found that frequency of prevalence of primary headaches among the school-aged children is relatively high and comparable with other countries.

Background: Data from yearly statistical reports on morbidity and mortality in Mongolia show that young adults account for approximately 20-26% of all stroke patients as opposed to 10-13% in Western countries. Objectives: The aim of this study was to compare characteristics of ischemic stroke between young (20-49 years) and old (50-79 years) patients undergoing investigations and treatment according to one common protocol in a tertiary hospital. Material and Methods: This hospital based prospective study included 110 young and 130 old patients with acute ischemic stroke. Data regarding the etiology of the stroke, diagnostic neuroimaging test results and degree of functional improvement of patients were examined during their observation. Results: The frequency of ischemic stroke at the age of 20-49 years grows from 9.6% to 24.2% and is predominant in the male sex (17.1%), which indicates a young stroke in mongolians is not uncommon. Young adults with ischemic stroke frequently bear both traditional and specific vascular risk factorsthan elderly people (p<0.05). The most common TOAST subtype in the young and old groups was undetermined (26.4% vs.12.3%; p=0.004), other determined cause (22.7% vs. 6.9%; p<0.001), and cardioembolism (20.0% vs. 22.3%) followed by Large-artery atherosclerosis (17.3% vs. 26.2%) and small vessel occlusion (15.6% vs. 33.8%; p<0.001). Partial anterior circulation infarcts were more common among young patients (p<0.001), than in posterior circulation infarcts. Silent brain infarcts and leukoaraiosis are not uncommon brain imaging findings (<0.05) in hypertensive and migraineur patients and should not be overlooked due to their potential prognostic relevance. Outcomes in young adults with hemispheric ischemic stroke can safely be improved with Low- molecular-weight-heparin therapy (OR 1.58; 95% CI, 0.99-2.51; p=0.001).
There were large differences between two groups concerning the 6-month outcome which showed beneficial effect for young stroke patients (mRS:89.1% vs. 66.9%, p=0.002; BI: 84.2% vs.73.1%). Conclusion There are significant differences between young and old patients with ischemic stroke regarding to risk factors, etiological subtypes and improvement of functional deficits associated with the stroke. However, severity of stroke on admittance is similar but six weeks outcome is different among young and old patients with relatively rapid improvement of functional deficit in young stroke patients than old one (mRS: 89.1% vs. 66.9%, p=0.002; BI: 84.2% vs.73.1%).

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.

Abstract Mana-4, an herbal medicine, had been used to treat incomplete-mannered and infection-caused hot disease in Mongolian traditional medicine. It has already reported that Mana-4 acts as an anti-inflammation agent, an activator of T and B cells, an immune-modulator and an inducer of cellular proliferation. Moreover, it enhances the immune system and energy level of human body. It was confirmed that the main active compounds in Mana-4 are inulin and total flavonoids which are effective for many diseases. Drug formulation types are very important to delivery the drugs to the targeted tissues and organs without loss of active ingredients. Total flavonoids in the extract of Mana-4 and granulated Mana-4 was qualitatively evaluated by TLC and yellow-brown spots (Rf was 0.4) were found on TLC plates, indicating that the preparations contained flavonoids. Also, it confirmed that the appropriate extractor of total flavonoids from Mana-4 was 70% of ethanol. In conclusion, the tablet formulation from Mana-4 was successfully prepared and the quality requirements was allowable.