Introduction: Aging is a complex process, where all organ systems can be affected at different stages, with different speed. There are many external and internal factors influencing to the aging and some parameters are changing during aging. These parameters are called as biomarkers of aging. One of potential biomarkers is blood red cell count and its indices. Aim of the study: To study the dynamic features of red blood cell indices during aging of Mongolians. Materials and methods: To the study were enrolled 338 healthy people aged 35-88 years. Present research was implemented at HSUM and district health centers geriatric cabinets. The study protocol was approved by the Ethics Committee of the HSUM, and written informed consent was obtained from all study participants. Venous blood was flown in EDTA containing tube, after which hematology indices were analyzed by cell counter Humacount. In this paper we introduced the red cell count, hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration and platelet cell count. Results and discussion: Red blood cell count was higher in man than women, like hemoglobin concentration (150.5535.3g/l for man, 131.4432.58g/l for women). Red blood cell count increases with aging until 65 against hemoglobin concentration which decreases with aging (r=-0.275, =0.001). Mean corpuscular volume of erythrocyte were 85.024.73fL in man, 83.055.2fL in women and it was significantly increasing with aging in both sexes. The main reasons for the increase of hematocrit are increased number of erythrocyte and MCV, but it has sex different features. In man the MCV was strong factor, where erythrocyte count had higher influence on hematocrit increase of female. MCH and MCHC were higher in man, but has stronger inverse correlation with aging (r=-0.556, p=0.000). In discussion were mentioned that the red blood cell indices had specific dynamic features correlated with aging, especially in man, which was explained by testosterone secretion and its decline during aging. Biologically women have higher adaptation capacity during aging due to physiological processes like menstruation, pregnancy and menopause. Platelet number was decreasing in both sexes, which can be a major cause of hemorrhagic syndrome in geriatric practice. Conclusion: Red blood cell indices (RBC count, hemoglobin, hematocrit, MCV, MCH, MCHC and platelet) have an age specific features during aging and results of this study could be an useful information for geriatricians and medical professionals who work or intend to work with elderly.

As Mongolia is one of the countries with a high maternal mortality rate, the main goal of the Ministry of Health is to reduce the maternal mortality rate. According to the 2005 social survey, Mongolias average population growth reached 1.5 percent and 50.4 percent of the population are females including those of reproductive age making up 28.3 percent. Health and sociological surveys conducted in recent years have shown that the number of multiparae and multigravidae is unlikely to fall in the coming years, probably in the next 10 years. The lack of studies of hemostasia and hemodynamic in multiparae who underwent Cesarean sections has served as the grounds for this research. Goal The goal of this research is to develop a method of preventing surgical complications by studying the causes and characteristics of Cesarean sections in multiparae. Objectives: 1. To do a comparative study of changes in hemodynamic and hemostasia before, during, and after Cesarean sections and process the results, 2. To evaluate laboratory test results during Cesarean sections in multiparae. Methodology 1. Research Materials: Analysis materials are the laboratory samples and birth histories of mothers having Cesarean sections. 2. Research Methodology 3. Sampling Frame: The study will involve mothers (approximately 70 mothers) who are hospitalized in Maternal Departments 1 and 2 of the Clinical Maternity Hospital No. 1 and who will be delivered of their children by Cesarean sections. 4. To study the characteristics of Maternal Coagulation System and to do a selective comparison to the result. Results We have made an analysis to determine the indicators of the erythrocytes and coagulation systems before, during, and after sections in order to study the changes taking place in hemodynamic and hemostasia for discovering the changes in the coagulation systems of multiparae. Our research has identifi ed the following indicators of coagulation: clotting time, activated decalcifi cation time, artifi cially activated thromboplastin time, and fi brinogen amount. Each indicator of the test takes part in a particular stage of clotting and indicates failure of clotting factors or dysfunction of particular stages. According to the analysis, the clotting time in multiparae accelerates 1.5 times more than in prima gravidae, creating over clotting of blood. It indicates that the members of this group should be included in a group with a high risk of thromboembolism. The average level of the artifi cially activated thromboplastin time in prima gravidae was 32.24.6 before sections, 32.74.8 during sections, and 383.4 on the second day after sections, while multiparae had 39.73.4 seconds before sections, 37.34.4 seconds during sections, and 35.73.4 seconds on the second day after sections. It shows that these two indicators have no dramatic changes in prima gravidae, but they are shortened in multiparae during all stages of sections, proving a risk of thromboembolism. During normal pregnancy, both fi brinogen and its procoagulant level increase, reaching the maximum level before delivery, and therefore, the protein level is usually high during normal pregnancy. That is to say, changes in the coagulation system are directly dependent (P=0.01). Discussion Some Mongolian researchers who have studied the coagulation system disorders concluded that all indicators of clotting reach their maximum levels at the end of pregnancy and cause over clotting of blood through adaptation mechanisms.Our study has shown that these women have certain infl ammations or clotting disorders, since their pregnancy continues together with obstetrical or system disorders. During our research, the tests for the artifi cially activated thromboplastin time and the activated recalcifi cation time have determined the over clotting of blood, in particular the activity of the internal tract of hemostasia, and identifi ed a risk of thromboembolism. These results are similar to those of the studies conducted by A.Ts. Makatseriya (1997), and Sh.Sh. Rajabova (1997), and other scientists of the Dagestan University. Conclusion 1. Compared to those in the prima gravidae who had Cesarean sections, the artifi cially activated thromboplastin time and the activated recalcifi cation time in the multiparae who have had Cesarean sections fall signifi cantly (P=0.01), and this proves a high risk of thromboembolism. The above mentioned two groups have different fi brinogen levels. The fact that the fi brinogen level in the multiparae increases during and after the sections proves that pregnancy continues together with system or obstetrical disorders. 2. Multiparae belong to a high-risk group. If these women receive antenatal care as early as possible and timely complex measures are taken to reveal and cure system disorders in the mothers and normalize the changes taking place in hemodynamics and hemostasia. It is possible to prevent potential complications during or after sections and reduce maternal and fetal mortality rates.

Introduction Coronary TIMI flow gradewas previously demonstrated to be related to outcome after acute myocardial infarction. However, the relationship between coronary flow grade and left ventricular global longitudinal strainin patients with acute myocardial infarction (AMI) treated by primary percutaneous intervention (PCI) were unclear. Goal In this study, we aimed to reveal the relationship between coronary TIMI flow grade and LV GLS in patients with AMI. Materials and Methods We prospectively selected patients with AMI who treated by primary PCI. Based on whether TIMI 3 flow achieved at the end of the procedure patients were divided into two groups. Group I (TIMI 3 flow was achieved, n=367), Group II (TIMI 3 flow was not achieved, n=47). The LV GLS was assessed by 2dimensional speckle-tracking echocardiography (2D STE). Results A total of 413 patients (mean age 60±13, 84% male) were included and TIMI 3 flow was achieved in 367 patients (88%). LV GLS was significantly impaired in patients who had TIMI 3 flow not achieved compared with TIMI 3 flow achieved group (-13.1±4.8% vs. -15.3±3.8%, p<0.001). Multiple linear regression analysis which included age, gender, clinical, biochemical and angiographic variables showed that coronary TIMI flow grade of culprit artery was independently associated with LV GLS. There was negative correlation between coronary TIMI flow grade and LV GLS (Pearson’s r=-0.183, p<0.001). Simple linear regression analysis revealed that coronary TIMI flow grade is directly associated with LV GLS (β=-1.61, p<0.001) and which indicated that every 1 scale increase of final coronary TIMI flow grade resulted -1.61% increase of LV GLS. Conclusion Our study demonstrated the coronary TIMI flow grade of the culprit artery was independently associated with LV GLSin patients with AMI treated by primary PCI.

Introduction: Biological aging is defined as a process or group processes that originate from progressive decrement of viability and increment of vulnerability of the organism with the passage of time. Biological age can be viewed as an objective measure for the assessment of ones biological vigor which is inevitably declined with advancing chronological age. Materials and methods: The individuals biological age scores (BAS) were estimated from 5 variables: forced expiratory volume in 1.0 sec (FEV1), systolic blood pressure (SBP), blood glucose, albumin, other proteins ratio and mean corpuscular hemoglobin (MCH). The study was composed on study design, based on E. Nakamuras developed method. Using above mentioned parameters was calculated biological age score (BAS), by which were assessed the aging rate of each individual. Results: We investigated a trend for the rate of aging changes in adults aged above 35. Variables used as a biomarkers of aging are significantly correlated with aging, where the systolic blood pressure was strongest one. Biological age score was calculated for every individual and it has strong correlation with chronological age (r=0.331, p=0.01). The rate at which ageing process relatively faster were 45-55 and 55-66 age intervals for females, against which aging rate of man was slower than women in above mentioned age groups. Conclusion: Variables used in calculation of BAS had significant cross sectional correlation with age and the aging rate was faster in man than in women in later age groups. In younger and older age groups (35-45 and above 65) individuals of both sexes had similar aging rate.

One of the important problems in obstetricians science is wound infection following cesarean deliveries.It occurs in 2-10%.In the obstetricians practice these disorders decline associated with the use of antibiotics but the last 10 years all countries of the world puerperal infection increases, obstetric causes sepsis purulent difficulties of 150 thousand women deaths per year. Objective: To identify risk factories for wound infection following cesarean delivery.A population – based study. To comparing women who have and have not developed a wound infection prior to discharge from First maternity hospital, Mother and Child National health Centre of Ulaanbaatar, between 2011-2013.Using a logistic regression model, the following risk factors were identified: Sepsis purulent difficulties were more likely to develop in women who have twin pregnancy (OR=4.5; 95% CI 2.4-8.6) and vaginal exam multiple times (OR=6.7; 95% CI 2.1-22). No significant differences between the 2 group who underwent cesarean delivery for indications such as induction of labor, falled induction of labor, presence of meconium – stained amniotic fluid, nonreassuring fetal heart rate patterns. Sepsis purulent difficulties (p=0.001) occurred more often in women who were older, multiple pregnancy and delivery, pre-eclampsia, emergency cesarean delivery. The risk to develop sepsis purulent difficulties following cesarean delivery is maternal age, pregnancy, recurrent abortion, gestation age, emergency cesarean delivery, premature rupture of membranes, twin pregnancy and labor complication. (p=0.001)

The Cardiovascular disease is leading the cause of mortality and morbidity and constantly increasingevery year for past decades. World wide 32 million people gets acute heart attack and 2.5 million deaths occur every year due to AMI. In Mongolia Cardiovascular disease is also leading the cause of mortality and morbidity. It is dramatically increasing every year, 479.4 per 10,000 population in 2012 was increased to 848.1 per 10,000 population in 2013. Dr.B.Jerardin, Prof.Z.Lkhagvasuren and his junior L.Jargalsaikhan jointly implanted first stent inMongolia in 2010. There is rapid development in interventional treatment skills since then. Since 2000 until 2014, total of 3791 coronary angioraphy, 1841 stent implantations was performed.This study has included the patients of last 5 years. Total of 898 patients who are treated with AMI during October 2010 to October 2014 at Third State Central Hospital were analyzed. 73.7% of the patients had left coronary artery disease and 26.3% had right coronary disease. Thisfinding was same with other local researchers study (Galtsog et al. 1987, D.Narantuya et al. 2001).59.4% of the occlusions were 75-99% stenosis, 23.5% had total occlusion. 62.9% of the LAD occlusionwere stenosis of over 75%. It demonstrated majority of the cases performed were high severe lesions.This also may be demonstrating that patients are receiving treatment in their late stage of the disease. Early stage complication such as mortality, restenosis was 3.5%, complication within following one month of after stent implantation was 9-13.1%. Overall mortality rate has decreased each year, 11.9% in 2010, 7.8% in 2012, 4.6% in 2013 relatively. General achievement is now 88.1%-95.4%, which is comparable to other countries.Implementation of coronary procedures in daily practice was one of the major achievements in thecardiovascular field in Mongolia. Patients from capital city are relatively been able to receive coronaryinterventional treatment within 12 hours of onset. However, patients arriving golden standard timingis not sufficient enough as well there are still major concerns for patients living in distant rural areas.

Background. Puerperal infection following caesarean section remains a major cause of maternalmorbidity and mortality. It is still one of actual problems in Obstetrics and has incidence rate 2-10%. It isestimated 150 000 maternal deaths due to infection worldwide, despite tendency to decline septicemiaafter C-section due to wide usage of antibiotics in the obstetric practice, postpartum infection hasincreased last decade. Post-Caesarean sepsis incidence rate is above 20%. An assortment of pathologicagents may cause puerperal infection including bacteria, virus and parasites. In 30-40s of last centurymain reason of infection was Streptococcus, then in 40-60s major role was played by Staphylococcus,later in 70-80s Gram-Negative Aerobic Bacteria took its place.Objective. To improve prevention and treatment of post-caesarean sepsis by detection of its causes andantibiotic sensitivity. Materials and methods: We reviewed patients admitted to First Maternity Hospitaland National Center for Maternal and Child Health and who had post-caesarean sepsis between 2011-2013. Statistics analysis had been performed by SPSS-17 software programme, whereas statisticsprocess by X2 test, Fisher test, and t-test. Confi rmation rate was 95%. P<0, 05.Results. The clinical course of 361 post-caesarean patients with septicemia was reviewed prospectively.Primary dysfunctional labour (P<0.033), preterm rupture of the membranes (P<0.0001), ineffectivelabour induction (P<0.001) are risk factors for infectious morbidity. Considerations should be given toprophylactic antibiotic therapy by choosing correct medicine at the correct time. E.coli 29,4%, Intestinalbacteria 9,1%, Staphylococcus epidermis’s 8,9%, Staphylococcus aureus 7,2%, Gram-NegativeBacteria 6,6%, Streptococcus 5,3%, Gram-Positive Bacteria 2,8%, Candida albicans 1,4%, Micoplasma1,1% were responsible for bacteremia, respectively.Conclusion. Bacteriology of all patients diagnosed with post-caesarean sepsis in 74, 7% was positivefor pathologic bacterial cultures. Infection caused by 1 bacteria in 141 cases (39, 1%), by 2 bacteria in 56cases (15, 5%), by 3 bacteria in 2 cases (0, 6%), without any detection of bacteria 162 cases (44, 9%).

Background: Several researchers had been previously done the health professional workload study,however, because of the lack of studies of the relationship between physicians’ volume and outcome, wedid not have enough evidence of the resource allocation, the surgery outcome and quality improvementin our country.Goal: The study was aimed to study general surgeon volume and surgery outcome.Materials and Methods: We randomly selected 1147 patients diagnosed with gallbladder disease whounderwent laparoscopic cholecystectomy (LC) and acute appendicitis from 2012-2013 at the First andThird Clinical hospital and Khovd province Regional Diagnostic and Treatment Center were included.Patient demographics and clinical information, such as drug cost, duration of surgery, and name ofsurgeons were derived from patient medical records. Surgeons’ information, such as age, gender,professional and academic degree, and work experience were derived from hospital human resourcedepartment and correlation analysis was performed to examine the association between surgeryduration, surgeon experience and drug cost.Results: Hospitals LC was done 51,3±32,8 minutes with 24900,70 tugriks, appendectomy was done52,7±31,4 minutes with 18361,00 tugriks of drug cost. The Third Clinical hospital surgeons operatedhigher costs (28631,34±16985,86tugriks) and shorter time (39,86±39,54 ìèí) of an appendectomy. Butthe First Clinical hospital surgeons incurred lower cost (8460,82±13231,40 tugriks) of appendectomy.However, there were no significant differences in operation time and drug average cost in appendectomyin terms of positive and weak correlation(r<0.5, p>0.05). Conclusion: General surgeon volume was notassociated with surgery outcome.

Caesarean delivery is frequently complicated by surgical site infections, endometritis and urinary tractinfection. Most surgical site infections occur after discharge from the hospital and increasingly beingused as performance indicators. Worldwide, the rate of caesarean delivery is increasing. Evidencebasedguidelines recommended the use of prophylactic antibiotics before surgical incision. An exceptionis made for caesarean delivery, where narrow-range antibiotics are administered after umbilical cordclamping because of putative neonatal benefit. However, recent evidence supports the use of pre-incision,broad-spectrum antibiotics, which result in a lower rate of maternal morbidity with no disadvantage tothe neonate. The beneficial effect of prophylactic antibiotics in reducing the occurrence of infectiousmorbidity form caesarean section, whether elective or emergency is well established. A single dose offirst-generation cephalosporin is as effective as multiple doses of broad-spectrum agents. Prophylacticantibiotics for caesarean section are commonly used worldwide, and in most institutions a single dose isadministered, generally after clamping of the umbilical cord. However, a recent survey (published in 2011)of maternal and fetal medicine physicians in the USA revealed that 84% of those who responded (theresponse rate was 25%) used preoperative administration. The effectiveness of prophylactic antibioticsdepends on their presence in effective concentrations throughout the operative period. Classen et al.found that administration of prophylactic antibiotics within a 2-hour period preoperatively was associatedwith the lowest surgical wound infection rate. Because of concerns about unnecessary fetal exposure,masking of fetal infection, increases in neonatal septic work-up and the emergence of resistant strainswhen prophylactic antibiotics are given preoperatively, it is a common obstetric practice to administerprophylactic antibiotics after cord clamping.Conclusion:1. Probability for occurring wound infection happens in case of urgent caesarean delivery for patientswho have not administered by preventative antibiotic.2. It has been confirmed that preventative antibiotic administration is proper in special occasions ofcaesarean delivery for women who suffer from anaemia obesity, diabetes, or chronic inflammatorydisease prior to their delivery.3. When preventative antibiotic administration is used 60 minutes before the caesarean delivery,concentration in blood and tissue reaches up to the maximum amount.

Endovascular repair of descending thoracic aortic aneurysm is an attractive approach. Candidates for endovascular repair should have an inner aortic diameter of 23-37 mm adjacent to the aneurysm without signifi cant thrombus or calcifi cation in these so called landing zones. They should have at least 2 cm of normal aorta both proximal and distal to the aneurysm to ensure adequate fi xationof the divece. Endografting of the descending thoracic aorta requires preoperative measurements of the diameter of the proximal and distal necks of the aneurysm, tratment length, and proximal and distal angulation. This information can be obtained from CT-ic angiography using three dimensional reconstruction.