Background. When the coronary atherosclerotic plaque becomes vulnerable, a thrombus develops on that ruptured plaque and then occludes the coronary artery, which causes an acute blood defi ciency in the downstream myocardium. Furthermore oxLDL (oxidized Low Density Lipoprotein) is involved in the coronary atherosclerotic plaque pathogenesis, MMP-9 (Matrix Metalloproteinase-9) enzymes plays role during the plaque rupture and CPR (C Reactive Protein) has a prognostic value in myocardial infarction. Objective. To determine the involvement of oxLDL, MMP-9, CRP markers in the pathogenesis of myocardial infarction, to study their involvement in the injury of the myocardium and to evaluate the complications. Material and Methods. The study was conducted using case-control design. The main inclusion criteria of the 40 case groups are that the patient should have a ruptured coronary atherosclerotic plaque, confi rmed by clinical symptom, ECG, serum troponin I, and coronary angiography. Also 40 patients with coronary stenosis or chronic occlusion without ruptured plague were included in the control group. Serum MMP-9 enzyme and oxLDL titers were determined by ELISA according to the manufacturer’s recommended protocol. Additionally CRP was measured by full-automated analyzater. We used CIIS (cardiac infarction injury score) by ECG and Gensini score system (Coronary Angiographic Scoring System) for assessing the severity of coronary heart disease. Results. Serum MMP-9, oxLDL levels (p<0.001) in the case group (ÌÌÐ-9 0.396±0.155 ng/ml; oxLDL 1.411±0.099 μg/ml) were more than in the control group (ÌÌÐ-9 0.223±0.087 ng/ml; oxLDL 1.332±0.163 μg/ml). The logistic analysis shows that ÌÌÐ-9, oxLDL, CRP (MMP-9 OR=0.985, p<0.001; oxLDLOR=0.011, p<0.05; CRP OR=0.041, p<0.005) may play a role in the pathogenesis of the plaque rupture. Serum MMP-9 enzyme level was directly correlated with Gensini score (r=0.552, p<0.01), CIIS (r=0.340, p<0.01) and CRP (r=0.321, p<0.01) titers. Furthermore, serum MMP-9 enzyme increases with accordance of severity of the myocardium injury with the statistical signifi cance (p<0.01): the borderline abnormality group (CIIS<10, 0.227±0.099 ng/ ml), possible injury (CIIS 10-15, 0.317±0.132 ng/ml), probable injury (CIIS >15, 0.376±0.132 ng/ ml) groups. MMP-9 levels were signifi cantly higher in the probable injury group patients (CIIS >15) compared to the possible injury group patients (CIIS 10-15) (p<0.001). ROC Curve analysis shows that MMP-9 enzyme levels variance (area=0.87, p<0.001) are more than other biomarkers making it a diagnostically benefi cial for the coronary atherosclerotic plaque rupture (CRP area=0,733, p<0.001, oxLDL area=0.635, p<0.05). Conclusion: Serum MMP-9, oxLDL and CRP are signifi cantly involved in the pathogenesis of coronary atherosclerotic plaque rupture in the myocardial infarction.

Cardiovascular diseases (CVD) are the leading cause of death in the World (31% of all deaths)and Mongolia as well. CVD has been the leading cause of death in Mongolia for the last 20 years and consists one of 3 death cases. In its turn 59.6% of CVD mortality caused by Ischemic heart diseases. When the coronary atherosclerotic plaque becomes vulnerable, it will a thrombus develops on that ruptured plaque and then occludes the coronary artery, which causes acute blood deficiency in the downstream myocardium. Some studies indicate that matrix metalloproteinase-9 (MMP-9) plays a key role on pathogenesis of plaque rupture. Aim:To study the involvement of serum MMP-9 enzyme in the pathogenesis during the rupture of the coronary atherosclerosis plaque.The study was conducted using case-control design. The main inclusion criteria of the case group is that the patient should have a ruptured coronary atherosclerotic plaque, confirmed by angiography. The total number of patients is 80, half of them belongs to the case group. MMP-9 was determined in serum by ELISA. We used CIIS (cardiac infarction injury score) by ECG and Gensini score system (Coronary Angiographic Scoring System) for assessing the severity of coronary heart disease.The average level of MMP-9 in case and control groups are 0.396±0.155 ng/ml, 0.223±0.087 ng/ ml respectively with p<0.001 significance which shows MMP-9 (OR=0.001, p<0.001) may plays a role in the pathogenesis of plaque rupture. MMP-9 is correlated with Gensini score and CIIS score, respectively (r=0.552, p<0.01; r=0.340, p<0.01) which shows MMP-9 is being elevated with the increase of the severity of coronary heart disease and the cardiac infarction injury. Serum MMP- 9 increases statistically significantly (p<0.001) with the increase of the severity of the stenosis and the number of the affected arteries: no severe stenosis (<75% stenosis) (0.245±0.086 ng/ ml); 1 vessel severe (>75%) stenosis (0.317±0.132 ng/ml), 2 vessel severe stenosis (0.348±0.157 ng/ml), 3 vessel severe stenosis (0.422±0.112 ng/ml). Furthermore, serum MMP-9 enzyme increases with accordance of severity of the myocardium injury with the statistical significance (p<0.01): the borderline abnormality group (CIIS<10, 0.227±0.099 ng/ml), possible injury (CIIS 10-15, 0.317±0.132 ng/ml), probableinjury (CIIS >15, 0.376±0.132 ng/ml) group. MMP-9 levels were significantly higher in the probable injury (CIIS >15) patients compared to the possible injury (CIIS 10-15) patients (p < 0.001). An increase in serum MMP-9 enzyme levels is a risk factor of the coronary atherosclerotic plaque rupture (OR=0.001, p<0.001). MMP-9 enzyme may be a possible marker of atheromatous plaque rupture in coronary heart disease.

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

To determine whether adult people with sleep maintenance problems have significantly melatonin levels comparable normal sleepers. The research was carried out by cross sectional and case-control study. Data were collectedbetween May 2014 and September 2014. We studied 203 healthy adults over the age of 20 years who either slept normally or sleep maintenance problems. A decrease in the quality of sleep is believed to cause anxiety andworsen depression. The quality of sleep was scored using the Pittsburgh Sleep Quality Index (PSQI) a questionnaire method. State and trait anxieties, and depression were scored using other questionnaire methods: the State-Trait Anxiety Inventory (STAI) and CES-D (Center for Epidemiologic Studies Depression Scale), respectively. Serum levels of melatonin were measured in the subjects at 02am, 10am. In the research were involved 126 (62percent) women, 77 (37.9 percent) men and their meanage was 52.24±14.67. 53.7% (n=109) of all subjects were normal sleepers and 46.3% (n=94) were sleep maintenanceproblems. 9.9%(n=20) of all subjects were anxiety, 8.3% (n=17) were depression. Night: day melatonin excretory ratios were similarly in people with sleep maintenanceproblems, normal sleepers have difference.

Sleep is a behavioral state that is a natural part of every individual’s life. To determine the role of health status and social support in the relationship between stresses, depression, anxiety and sleep disturbance, for both intermittent and chronic sleep disturbance. The research was carried out by cross sectional and case-control study. Data were collected between May 2014 and September 2014. We studied 203 healthy adults over the age of 20 years who either slept normally or sleep maintenance problems. The quality of sleep was scored using the Pittsburgh Sleep Quality Index (PSQI) a questionnaire method. State and trait anxieties, and depression were scored using other questionnaire methods: the State-Trait Anxiety Inventory (STAI) and CES-D (Center for Epidemiologic Studies Depression Scale), respectively. All results calculated by SPSS 21.0 programs.The average age was 52.2±14.7 years in our study participants. The rate of self-reported poor sleep quality was found in 46.3% (n=94) of patients according to the PSQI global score (≥5) and53.7% (n=109) patients were normal sleepers. 16.3% (n=33) of all subjects were state anxiety, 9.9% (n=20) were trait anxiety, 8.3% (n=17) were depression. Sleep disturbance was significantly associated with an onset in the evening tea and coffee drinking (OR= 7.0, p = 0.012), majordepressive disorder (OR= 4.2, p=0.015), and stress factors (OR=2.6, p=0.009), meals before going to bed (OR=2.1, p=0.049), but daytime sleep (OR=0.5, p=0.025) is conservation impact.Our results shows, that bad living habits (evening tea, coffee, late sleep and meal habits) depress and stress factors was associated with sleep disturbance, daytime sleep is conservation impact.

Cardiovascular diseases (CVD) are the leading cause of death in the World (31% of all deaths)and Mongolia as well. CVD has been the leading cause of death in Mongolia for the last 20 years and consists one of 3 death cases. In its turn 59.6% of CVD mortality caused by Ischemicheart diseases. When the coronary atherosclerotic plaque becomes vulnerable, it will a thrombus develops on that ruptured plaque and then occludes the coronary artery, which causes acute blood deficiency in the downstream myocardium. Some studies indicate thatmatrix metalloproteinase-9 (MMP-9) plays a key role on pathogenesis of plaque rupture. Aim:To study the involvement of serum MMP-9 enzyme in the pathogenesis during the rupture of the coronary atherosclerosis plaque.The study was conducted using case-control design. The main inclusion criteria of the case group is that the patient should have a ruptured coronary atherosclerotic plaque, confirmed by angiography. The total number of patients is 80, half of them belongs to the case group. MMP-9 was determined in serum by ELISA. We used CIIS (cardiac infarction injury score) by ECG and Gensini score system (Coronary Angiographic Scoring System) for assessing the severity of coronary heart disease.The average level of MMP-9 in case and control groups are 0.396±0.155 ng/ml, 0.223±0.087 ng/ ml respectively with p<0.001 significance which shows MMP-9 (OR=0.001, p<0.001) may plays a role in the pathogenesis of plaque rupture. MMP-9 is correlated with Gensini score and CIIS score, respectively (r=0.552, p<0.01; r=0.340, p<0.01) which shows MMP-9 is being elevated with the increase of the severity of coronary heart disease and the cardiac infarction injury. Serum MMP- 9 increases statistically significantly (p<0.001) with the increase of the severity of the stenosis and the number of the affected arteries: no severe stenosis (<75% stenosis) (0.245±0.086 ng/ ml); 1 vessel severe (>75%) stenosis (0.317±0.132 ng/ml), 2 vessel severe stenosis (0.348±0.157 ng/ml), 3 vessel severe stenosis (0.422±0.112 ng/ml). Furthermore, serum MMP-9 enzyme increases with accordance of severity of the myocardium injury with the statistical significance (p<0.01): the borderline abnormality group (CIIS<10, 0.227±0.099 ng/ml), possible injury (CIIS 10-15, 0.317±0.132 ng/ml), probableinjury (CIIS >15, 0.376±0.132 ng/ml) group. MMP-9 levels were significantly higher in the probable injury (CIIS >15) patients compared to the possible injury (CIIS 10-15) patients (p < 0.001). An increase in serum MMP-9 enzyme levels is a risk factor of the coronary atherosclerotic plaque rupture (OR=0.001, p<0.001). MMP-9 enzyme may be a possible marker of atheromatous plaque rupture in coronary heart disease.

The burden of endocrine disorders, especially thyroid and women reproductive gland dysfunction and its related disease numbers are rapidly increasing for the recent years. Determining prevalence of thyroid disease among population with serum TSH level, primary hypothyroidism is more common than secondary hypothyroidism (1000:1) for all age and gender. In the statistical report of Center for Health Development in 2013, there were 2615 female patients with thyrotoxicosis (E05) registered which more than 531 female patients with hypothyroidism (E00-E02). Therefore, we studied bone mineral density changes due to thyroid dysfunction in female patients. Ovarian dysfunction and irregular menstrual period during hypothyroidism can cause of sexual dysfunction and infertility. Early screening, right diagnosis and treatment for hypothyroidism can prevent from infertility caused by thyroid dysfunction.We used a hospital-based case-control study design. In the study 90 reproductive age (15-49) female patients were participated. 60 of them were evaluated as relatively healthy patients and 30 of them were diagnosed by laboratory test with hypothyroidism. Serum level of TSH, fT3, fT4, estradiol and progesterone (TSH, fT3, fT4, E2, P4 TOSOH Corporation, Tokyo, Japan) were evaluated by ELISA. The ovarian function was evaluated by ultrasound (Hitachi alokа-Prosound alpa F37, Japan) and ovarian follicle numbers were counted at the 3-5th and 10-15th day of menstruation cycle.Total 90 patients ranging 24-46 years old (average age was 33.4±5.7 in control group, 35.5±6.1 in hypothyroid group) were participated. Comparison of fT3 and fT4 average level between control (fT3 2.47±0.34 pg/ml, fT4 1.23±0.19 ng/dL) and hypothyroid group (fT3 2.48±0.31 pg/ml, fT4 1.07±0.14 ng/dL), fT3 wasn’t statistically relevant (p>0.05) but, fT4 was statistically relevant (p<0.05). The average level of TSH in incidental group (4.24±1.55 µIU/ml) was 2.4 times higher than control group (1.79±0.4 µIU/ml) seems subclinical hypothyroidism. Comparison of estradiol and progesterone average level between hypothyroid group (estradiol 41.6±9.9 pg/ml and progesterone 0.32±0.3 pg/ml) and control (estradiol 41.3±9.0 pg/ml and progesterone 0.38±0.2 pg/ml) at the 3rd day of menstrual cycle, in the ovarian follicle phase, there weren’t statistically relevant (p>0.05). Comparison of estradiol and progesterone average level between hypothyroid group (estradiol 185.4±54.7pg/ml and progesterone 0.8±0.6 pg/ml) and control (estradiol 224.6±76.8 pg/ml and progesterone 0.8±0.5 pg/ml) at the 10th day of menstrual cycle, in the ovarian follicle phase, were statistically relevant (p<0.01). For the progesterone hormone, there was no statistical relevance (p>0.05). The ovarian dominant follicle size was 16.2±2.5 mm in the hypothyroid group and 17.6±2.1 mm in the control group. The dominant follicle size have statistical relevance as 2 groups (p<0.01). Comparison of estradiol and progesterone average level between control (estradiol 139.8±42.9 pg/ml and progesterone 15.0±4.1 pg/ml) and hypothyroid group (estradiol 158.9±75.2 pg/ml and progesterone 12.1±5.3 pg/ml) in the lutein body phase, serum progesterone level was decreased during hypothyroidism (p<0.01). The increased serum level of fT4 can expand serum fT3 as well (r=0.218, p=0.039). The increased serum TSH was inversed correlation to fT4 (p<0.01, r= -0.420). The increased serum TSH was inversed correlation to progesterone (P<0.05, r= -0.234). Ovarian follicle size are direct correlation to increased serum estradiol (r=0.507, p<0.01).The serum TSH level were extremely increased during hypothyroidism (p<0.001). Serum female hormone level was decreased depending on the fT3, fT4 and TSH level for patients with hypothyroidism.

Background: Glomerulonephritis (GN) remains a common cause of end stage kidney failure worldwide. The auto antibodies are useful in the patients prognosing, diagnose and treatment of GN. The aim of the study was to compare the prevalence and levels of auto antibodies in the sera of patients with GN in relation to the clinical activity of disease and auto antibodiesMethods: From a hospital-based population, 90 patients with GN (mean age 37.9±12.7) were recruited. Autoantibodies (C/P-ANCA, anti-dsDNA, anti-Sm, anti-SS-A/Ro, anti-SS-B/La, anti-Scl-70, anti-GBM) measured by Enzyme Immuno Assay (Germany, ORGENTEC Diagnostika GmbH). Renal function was evaluated by the eGFR using the Cockcroft-Gault formula.Results: Patients with GN was significantly younger and primary GN was more common in the male, but frequency of LN was 4 times higher among female. The prevalence of cANCA 2.9%, Sm 4.2%, dsDNA 5.7%, SSA 7.1%, SSB 1.4% were positive in primary GN group, the prevalence of Sm 16.7%, dsDNA 8.3%, SSA 25%, SSB 16.7% were positive in secondary GN group. A higher frequency of anti Sm 25%, anti-dsDNA 25%, anti-SS-A/Ro 75%, anti-SS-B/La 25% was observed in the lupus nephritis group. Conclusion: Lupus nephritis associated with several auto antibodies (anti Sm, anti-dsDNA, anti-SS-A/ Ro, anti-SS-B/La) and each of which are very useful in distinguishing patients with lupus nephritis from other secondary GN.

Osteoporosis is a disease in which the density of bone is decreased with consequent increase in bone fragility and susceptibility to fracture risk. Vitamin D deficiency may cause secondary hyperparathyroidism and low bone mineral density. Our study was aimed to assess relation between vitamin D status and parathyroid hormone and bone density in adults. Relatively healthy 369 participants aged between 20-60 were randomly selected from Ulaanbaatar city. Specially designed questionnaire was used in the survey. Bone mass density was diagnosed according to the WHO criteria by the T-score. Respondents serum calcium and phosphorus levels were described by the fully automated analyzer (Cobas Integra 2800, Germany). Serum parathyroid hormone and 25-hydroxivitamin D levels were described by using ELISA kit (Eucardio Laboratory, Inc. USA) at the Molecular biology laboratory of MNUMS.The statistical result was analyzed by SPSS 21 program. The subjects mean age was 47.61±12.92, with a range of 20-83. The mean T-score was -0.60±2.17. Our study showed that negative correlation between bone mass density values at parathyroid hormone (r=-0.58, p<0.05), 25-hydroxyvitamin D (r=-0.48, p<0.05) and serum calcium (r=-0.21, p<0.05). Our study showed increased serum parathyroid hormone led the releasing calcium from bone and decreasing bone mass density.