1.RETROSPECTIVE STUDY OF 2014 PRENATAL MORTALITY DATA OF THE FIRST MATERNITY HOSPITAL OF ULAANBAATAR CITY
Innovation 2015;9(3):86-88
In the framework of the implementation of MDGs, Mongolian government aimed to decrease neonatal mortality by one third in 2015 in comparison with 2000. Rapid urbanization could be seen from the number of pregnancies delivered their babies at Urguu Maternal Hospital. We analyzed the 2014 prenatal mortality data by fetal growth and obstetric complications to find common risk factors for stillbirth and neonatal mortality.We retrospectively analyzed the prenatal mortality data of the Urguu Maternity hospital of Ulaanbaatar city in 2014.In 2014, from 16002 mothers delivered their babies at Urguu Maternity hospital had been registered 74 cases of the stillbirths which are equal to 0.46% and 51 cases of neonatal mortality which is 3.1%. In 2014, 21.6% (16 cases) of the stillbirths are happened for nulliparous women, which support their higher risk of stillbirths than multiparous women across all ages. Their mean age were 29.7, among them youngest is 18, and oldest is 32 years old. Also, 29 cases or 39% of the mothers had fourth and subsequent pregnancies and 17 /23%/ had their fourth and more babies. Regarding the baby sex, 42 cases /56.8%/ of babies were female, 2 case / 2.7%/ haven’t specified in the patient history. 17 had very low birth weight (<1500g), among them 8 were in their less than 30 gestational weeks, including one case of twins, 6 cases were in their 31-35 weeks, 2 including one twin cases were in their 36-41 gestational weeks. According the patient history, main obstetric challenges were 2 were caused by placental abruption, pre-eclampsia caused 3, premature rupture of membranes caused 3 and hemorrhage shock caused 1 case. Among the 21 cases with fetal weight between 1500-2500 g, 11 were in their 30-35, 3 were 36-37 gestational weeks and 6 were full term pregnancies with 37-41 gestational weeks. In one case haven’t identified the fetal sex. Obstetric complications were placental abruption in 7, among them 2 had serious late complications, congenital abnormalities in 2, intra- uterine growth restriction in 1, and 1 case of hemorrhage were identified. In the 34 cases with fetal weight above 2550 g, 12 cases had less than 38 gestational weeks, 16 were 38-40 weeks, and 6 were above 40 weeks age. Among them, 2 cases of twins, 1 case had congenital anomalies, 1 case haven’t received any prenatal services, and 1 case had unattended birth in home. Regarding the obstetric complications, placental abruption 3, uterine scar and placental insufficiency 1, weak contractions 1 case was documented. 3 cases from all 74 were delivered their babies in home, unattended births. Among 51 neonatal death cases, 26 or 51% were female. By classifying maternal age, 15 or 29.4% were nulliparous, from which 1/3 or 5 cases had abortions, previously. Also, 7 or 13.7% were delivered four or more babies, which increased their risks.
Regarding the neonatal babies weight, 9 cases had less than 1500 g, with 8 were haven’t reached the 30 gestational weeks. 17 cases with 1500-2500 g weight, 11 were less than 34 weeks and 6 were 34- 38 weeks. For rest 25 cases, 10 were had above 3500 g weight. 94% / 48/ cases of neonatal deaths were happened in their first week. Reasons documented in the patient history were premature birth 7, natural normal birth 2 cases, spontaneous or ectopic birth 6, with 1 case of weak contraction during the labor. Common documented obstetric complications were premature rupture of membranes 9, oligohydramnios 1, polyhydramnios 1, placental abruption 6, placenta praevia 4, late pregnancy complications 12, fetal hypoxia 5, among them 3 were had emergency C-section and with chronic health conditions were in 6 cases. In 2010, there were 9163 mothers delivered 9200 live births, which in 2014 become 16002 mothers delivered 16107 live births at Urguu Maternity hospital. Neonatal morbidity also decreased 8.6%
/795 cases/ in 2010 to the 4% /649 cases/ in 2014. Neonatal mortality was 4.8% /45 cases/ in 2010 and in 2014 counted as 3.1% /51/ at our hospital, from which premature infant mortality were 49% reduced as 39%, showed health care service quality improvement at Urguu maternity hospital. Stillbirth cases decreased from 0.5% /49 cases/ in 2010 to 0.4% /74 cases / in 2014. Single largest risk factor is unrecognized fetal growth restriction which was cause for 34.2% of the all stillbirths’ cases in 2014.
2.Biochemical parameters in correlation with nutritional status of hospitalized elderly
Mongolian Medical Sciences 2011;172(2):20-22
Introduction: While the prevalence of malnutrition in the free living elderly population is relatively low, the risk of malnutrition increases dramatically in the hospitalized elderly. Patients who are malnourished when admitted to the hospital tend to have longer hospital stays, experience more complications, and have greater risk of morbidity and mortality than those whose nutritional state is normal.
Goal: To assess the nutritional status among hospitalized elderly in Secondary healthcare systems by the MNA screening tool.
Materials and Methods: To the study were enrolled 411 hospitalized elderly patients in secondary healthcare systems. The study protocol was approved by the Ethics Committee of the HSUM, and written informed consent was obtained from all study participants. We assessed the participants’ nutritional status by the MNA (Mini nutritional assessment) tool and divided into three groups: malnourished, risk of malnutrition and normal nutritional status. We compared the relationship between nutritional status and some biochemical indicates such as total protein, albumin, cholesterol and blood glucose levels. The ANOVA and Pearson correlation tests were used for statistical analysis.
Results: 146 (36.01%) elders were well nourished among our study participants. Serum albumin was significantly low in malnourished elders.
Conclusion: Among the assessed elderly 36.01% had adequate nutritional status; 43.79% were at a risk of malnutrition and 20.19% were malnourished. Serum albumin was significantly low in malnourished elders.
3.Malnutrition risk of hospitalized elderly and their anthropometric indicators
Mongolian Medical Sciences 2011;172(2):23-26
Introduction: With advancing age, the risk of developing nutritional deficiencies increases. Malnutrition can lead to functional dependency, increases morbidity, mortality, and greater use of health care resources.
Goal: The goal of our study was to assess the nutritional risk among recently hospitalized elderly in Secondary healthcare systems by the NSI screening tool and assess indicators of anthropometry assessment in nutritionally different groups.
Materials and Methods: To the study were enrolled 411 hospitalized elderly patients in secondary healthcare systems. The study protocol was approved by the Ethics Committee of the HSUM, and written informed consent was obtained from all study participants. The nutritional status was classified by the NSI (Nutrition Screening Initiative) into: high risk of malnutrition, moderate risk of malnutrition and without malnutrition (adequate).
Results: Among the assessed elderly, 8.03% had adequate nutritional status; 32.85% were at a risk of malnutrition and 59.12% were at a moderate risk of malnutrition. Some anthropometric variables such as weight, abdominal circumference, calf and mid-arm circumference assessed were significantly more deteriorated among the malnourished individuals. Among the NSI variables tooth loss/ mouth pain (21.6%), eating few fruits or vegetables or milk products (14.3%), chronic illness (13.8%), multiple medicines (13.4%) or economic hardship (11.3%) were found as the risk of malnourished elderly.
Conclusion: There is an interrelationship between the nutritional status of the elderly and some anthropometric variables.
4.Pilot study on metabolic syndrome prevalence among aging male
Bolor-Erdene S, Munkhtsetseg J
Mongolian Medical Sciences 2010;152(2):9-11
INTRODUCTION: Main reasons of metabolic syndrome are obesity and overweighing, which are becoming a global
worldwide problem. Obesity is both a prevalent condition worldwide and a well-known, modifiable risk factor for
various diseases, including diabetes. In a recent review article, waist circumference (WC) and body mass index
(BMI) were reported as established risk factors for diabetes.
GOAL: To define the prevalence of metabolic syndrome among Mongolian aging man living in Ulaanbaatar city
MATERIALS AND METHODS: Randomly selected 180 men aged 35-90 years old were involved to this study. All were
informed and written consent was given by each individual. The metabolic syndrome was defined by NCEP
definition: high blood pressure, high waist circumference, higher fasting sugar, triglyceride and HDL-cholesterol.
Anthropometric parameters like waist circumference (WC), weight, height, blood pressure and blood chemical
parameters like glucose, triglyceride (TG), HDL-cholesterol (HDL-Ch) were measured by automatic biochemical
analyzer.
RESULT AND DISCUSSION: Average age of all participants was 56.82±12.55 years and was divided in three age
groups: 35-60 (n=112), 61-74 (n=47), 74-90 (n=17). The characteristics of participants are shown Mongolian men
in 38.8 % (70) of all participants had a metabolic syndrome and in compare to T.Baysgalan’s study, implemented in
2007 was higher. In our opinion it depends on our study participant’s age, because in our study number of elderly
were predominating than mentioned survey. Waist circumference in metabolic syndrome group is higher than in
healthy control group (p<0.05). Triglyceride level does not change with aging, but in our study participants, the TG
level was negatively correlated with aging in metabolic syndrome group (r = -0.307).
HDL-cholesterol is abundantly circulating molecule in human plasma and shows anti-atherogenic effect. In our
participants HDL-Ch decreases with aging (r=-0.174).
CONCLUSION: Our pilot study present that metabolic syndrome prevalence reaches 38.8% of total aged, male
participants, and it is leads to implement and provide an investigation in large range, including urban and rural
areas of the country.
5.The study of apolipoprotein a5 gene polymorphisms in relation tolipidslevel in people with metabolic syndrome
Ariunbold Ch ; Buyankhuu T ; Munkhtsetseg J
Mongolian Medical Sciences 2014;170(4):10-13
Background: Epidemiologic studies have shown a higher prevalenceof hypertriglyceridemia among
patients with CHDthan among unaffected populations. Dozens of polymorphisms in different genesthat
could have some effect on plasma TG levels havebeen analyzed.
The most promising results are connected withvariants within the apolipoproteins (APO) APOA1/APOC3/
APOA4 gene cluster. Transgenic mice overexpressing human apolipoprotein A5decreased plasma
triglyceride concentrations to one-third of those in control mice; conversely, knockout mice lacking
APOA5 had four times as much plasma triglycerides as controls.The human APOA5 gene consistsof
4 exons and codes 369 aminoacidprotein, which is expressed almost exclusively in the liver.A minor
allele of APOA5 (1259C, IVS3+476A and 1131C) which was independently associated with high plasma
triglyceride levels in African-American, non Hispanic whites, Hispanic, Caucasians and Japanese were
reported. Four polymorphisms in ApoA5 (1259T>C, IVS3+476G>A, S19W and 1131T>C) has been
correlatedwith high TG levels in diabetic women.
Materials and Methods: 162 people with MS for case group and 144 people for control group were
selected in this study. MS was diagnosed according to IDF criteria and serum triglyceride, total cholesterol
and HDL levels were determined. DNA from both case and control subjects were extracted from blood
samples (20μL) using “G-spin™ Total DNA Extraction Kit”(iNtRON Biotechnology, Inc).The genotypes
for fourpolymorphisms of ApoA5 were determined using a combination of PCR and sequence-specific
oligonucleotide probes.
Results: There were 304 total subjects included males 50.3% (153) and female 49.7% (151) in our study.
The appearance of risk genotypes of 1177C>T, 1259T>C, IVS3+476G>A and 1131T>C polymorphisms
in ApoA5 gene were higher in MS group than control group.Serum levels of triglycerides and total
cholesterol differed significantly (p<0.001, p=0.029) among APOA5-1131T>C genotypes.
Conclusion: TAG and TC level was higher in people with 1131T>C-CC genotype than other genotypes
in both groups (p=0.010, p=0.001). We determined that the odds ratio for the hypertriglyceridemia was
5.98 for ApoA5-1131T>C CC-genotype carriers.
6.The Aging Related Dynamics of Red Blood Cell Indices
Tseregmaa Ts ; Munkhtsetseg J ; Lkhagvasuren Ts
Mongolian Medical Sciences 2009;147(1):21-23
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.
7. RETROSPECTIVE STUDY OF 2014 PRENATAL MORTALITY DATA OF THE FIRST MATERNITY HOSPITAL OF ULAANBAATAR CITY
Innovation 2015;9(3):86-88
In the framework of the implementation of MDGs, Mongolian government aimed to decrease neonatal mortality by one third in 2015 in comparison with 2000. Rapid urbanization could be seen from the number of pregnancies delivered their babies at Urguu Maternal Hospital. We analyzed the 2014 prenatal mortality data by fetal growth and obstetric complications to find common risk factors for stillbirth and neonatal mortality.We retrospectively analyzed the prenatal mortality data of the Urguu Maternity hospital of Ulaanbaatar city in 2014.In 2014, from 16002 mothers delivered their babies at Urguu Maternity hospital had been registered 74 cases of the stillbirths which are equal to 0.46% and 51 cases of neonatal mortality which is 3.1%. In 2014, 21.6% (16 cases) of the stillbirths are happened for nulliparous women, which support their higher risk of stillbirths than multiparous women across all ages. Their mean age were 29.7, among them youngest is 18, and oldest is 32 years old. Also, 29 cases or 39% of the mothers had fourth and subsequent pregnancies and 17 /23%/ had their fourth and more babies. Regarding the baby sex, 42 cases /56.8%/ of babies were female, 2 case / 2.7%/ haven’t specified in the patient history. 17 had very low birth weight (<1500g), among them 8 were in their less than 30 gestational weeks, including one case of twins, 6 cases were in their 31-35 weeks, 2 including one twin cases were in their 36-41 gestational weeks. According the patient history, main obstetric challenges were 2 were caused by placental abruption, pre-eclampsia caused 3, premature rupture of membranes caused 3 and hemorrhage shock caused 1 case. Among the 21 cases with fetal weight between 1500-2500 g, 11 were in their 30-35, 3 were 36-37 gestational weeks and 6 were full term pregnancies with 37-41 gestational weeks. In one case haven’t identified the fetal sex. Obstetric complications were placental abruption in 7, among them 2 had serious late complications, congenital abnormalities in 2, intra- uterine growth restriction in 1, and 1 case of hemorrhage were identified. In the 34 cases with fetal weight above 2550 g, 12 cases had less than 38 gestational weeks, 16 were 38-40 weeks, and 6 were above 40 weeks age. Among them, 2 cases of twins, 1 case had congenital anomalies, 1 case haven’t received any prenatal services, and 1 case had unattended birth in home. Regarding the obstetric complications, placental abruption 3, uterine scar and placental insufficiency 1, weak contractions 1 case was documented. 3 cases from all 74 were delivered their babies in home, unattended births. Among 51 neonatal death cases, 26 or 51% were female. By classifying maternal age, 15 or 29.4% were nulliparous, from which 1/3 or 5 cases had abortions, previously. Also, 7 or 13.7% were delivered four or more babies, which increased their risks.Regarding the neonatal babies weight, 9 cases had less than 1500 g, with 8 were haven’t reached the 30 gestational weeks. 17 cases with 1500-2500 g weight, 11 were less than 34 weeks and 6 were 34- 38 weeks. For rest 25 cases, 10 were had above 3500 g weight. 94% / 48/ cases of neonatal deaths were happened in their first week. Reasons documented in the patient history were premature birth 7, natural normal birth 2 cases, spontaneous or ectopic birth 6, with 1 case of weak contraction during the labor. Common documented obstetric complications were premature rupture of membranes 9, oligohydramnios 1, polyhydramnios 1, placental abruption 6, placenta praevia 4, late pregnancy complications 12, fetal hypoxia 5, among them 3 were had emergency C-section and with chronic health conditions were in 6 cases. In 2010, there were 9163 mothers delivered 9200 live births, which in 2014 become 16002 mothers delivered 16107 live births at Urguu Maternity hospital. Neonatal morbidity also decreased 8.6%/795 cases/ in 2010 to the 4% /649 cases/ in 2014. Neonatal mortality was 4.8% /45 cases/ in 2010 and in 2014 counted as 3.1% /51/ at our hospital, from which premature infant mortality were 49% reduced as 39%, showed health care service quality improvement at Urguu maternity hospital. Stillbirth cases decreased from 0.5% /49 cases/ in 2010 to 0.4% /74 cases / in 2014. Single largest risk factor is unrecognized fetal growth restriction which was cause for 34.2% of the all stillbirths’ cases in 2014.
8.Result of the study of oral health knowledge of school children aged 10-12 years old in Khovd province’s
Munkhtsetseg A ; Ouyntsetseg B
Mongolian Medical Sciences 2010;152(2):37-39
Subjects comprising the population of this study were recruited from 6 high schools of Khovd province. Total of 104210-12 aged children were participated in this study. Oral health education knowledge of study population was notenough. This range of age is most healthy period of permanent dentition. Therefore for these children giving informationabout healthy foods for teeth, importance of having good oral health behavior by oral health education program is veryeffective to prevent dental caries. It is necessary constitute oral health education program for children which is simple,cheap, and sufficient. Also for this oral health education program for high school children requires active participation ofschool teachers and parents.
9.The study of apolipoprotein A5 gene polymorphism in relation to serum triglyceride level in people with metabolic syndrome
Ariunbold Ch ; Khajidaa B ; Buyankhuu T ; Azzaya E ; Munkhtsetseg J
Mongolian Medical Sciences 2014;169(3):4-7
Background. A large number of longitudinal studies indicate significantly increased risk of cardiovascular
events and death in people with the MetSyn and high plasma levels of triglycerides are an independent
risk factor for the development of cardiovascular disease. Apolipoprotein A5 (APOA5) gene, a new
member of the APOA1/C3/A4 gene cluster, was identified by comparative sequencing of human and
mice DNA by Pennacchio and co-workers in 2001. Since this discovery, variants of ApoA5 gene have
been independently assiociated with level of plasma triglyceride in many countries. Human ApoA5 is
expressed in the liver then appears in plasma in association with VLDL and HDL and plays a major role
in TG catabolism. Variant at ApoA5 gene locus, 1177C>T is located in 3’ UTR which often contains
regulatory regions that influence post-transcriptional gene expression. One alteration can be responsible
for the altered expression of many genes.
Materials and Methods. 152 people with MS for case group and 152 people for control group were selected
in this study. MS was diagnosed according to IDF criteria and serum triglyceride levels were determined.
DNA from both case and control subjects were extracted from blood samples (200 ml) using “G-spin™ Total
DNA Extraction Kit”(iNtRON Biotechnology, Inc). To detect the 1177C>T variation of ApoA5 gene, using
High Pure PCR Template Preparation Kits, a forward primer 5’-CTCTGAGCCTCTAGCATGGTTGAGT-
3’ and the mismatch reverse primer 5’-GAGCATTCCCAAATGAGCAC-3’ were used to create the HinfI
restriction site.
Results. There were 304 total subjects included males 50.3% (153) and female 49.7% (151) in our
study. Incident of CC genotype was 71.1% (216), CT genotype was 25% (76) and TT genotype was
3.9%, TAG level was higher in males than females in both groups (p=0.016, ð=0.001) for CC genotype
and also, higher with MS in males for CT genotype (p=). But, TAG level was no significant difference
among three genotypes in group with MS subjects (male p=0.236, female p=0.881).
Conclusion: The TT genotype of the ApoA5 gene 1177C>T polymorphism frequency was 2.9% in control
subjects and 4.9% in subjects with MS. However, TG level was not differ in both groups for TT genotype,
TAG level in males was higher compared with females (p=0.016 in control, p=0.001 in group with MS).
10.Changes luteinizing hormone in aging female
Azjargal B ; Enebish D ; Munkhtsetseg J
Mongolian Medical Sciences 2011;168(1):16-19
Introduction. Luteinizing hormone is slowly increasing in menopausal transition phase, it’s maintain to increase till early post menopause phase (Gore et al. 2004). It is related to steroid hormone’s negative feedback and estradiol’s positive feedback (Rossmanith 1995), and in addition, recently years kisspeptin-10 of hypothalamus [1]. LH is dramatically decreasing at the rather late of post menopause phase (Hall et al. 2000, Gill et al 2002). By the year 2030, more than 1.2 billion women in the world will be at least 50 years old. This increasing proportion of the female population will be experiencing the menopausal transition with its accompanying physiology and pathophysiology [2]. Recently researchers more focused to study the comparative analysis of hormones at the menopause phase in different ethnic groups. This kind of study have not implemented in our country yet.Goal.Determination of serum LH level changes in relation to aging. Materials and Methods. In this study were involved 161 healthy Mongolian women aged above 35 years. Subjects were randomly selected and undergone physical examination by geriatrician. People, who are receiving hormone replacement therapy, using in proper use of alcohol, injured and had survey, were excluded from our study. Blood samples were collected in the morning 8.30-10.30 AM, after a night fasting. Blood was separated immediately by centrifugation, then obtained sera were stored at -20 0C until assayed by ELISA kit from United Biotech CoLTD, USA, which sensitivity is 1mlU/ml. Statistical analyses have been performed by statistical software SPSS 17, using ANOVA, Pearson correlation.Results. Average level of LH was 29.95±3.31mIU/ml, 15.87±5.86mIU/ml at the age 35-45, 33.12±7.1mIU/ml at the age 46-55, 15.87±ImU/ml at the age 56-65, 38.15±6.6mIU/ml at the age 66-75, and 56.42±11.1mlIU/ml over 76 age in the all participants, considering by person correlation coefficient, between age and LH are moderate and direct correlation (r=0.264, ð 0.003).Conclusion. Average level of LH was 29.95±3.31mIU/ml in women aged over 35. Considering by person correlation coefficient, between age and LH are moderate and direct correlation (r=0.264, ð 0.003). LH increases with aging till round 70 and decreases after 70 years.