Introduction: Leading cause of mortality was cardiovascular disease alone last two decade and occurs5500-6000 deaths annually in Mongolia. Familial hypercholesterolemia is the most common inheritedmetabolic disorders and is characterized by severely elevated LDL-cholesterol levels. The prevalenceof the heterozygous state has been estimated at 1 in 200 to 1 in 500 and of the homozygous state from1 in 160,000 to 1 in 1,000, 000.Goal: To identify Heterozygous Familial hypercholesterolemia among the patients with cardiovasculardisease and study clinical features.Materials and Methods: After view medical examination patients with coronary heart disease andcerebral vascular disease, we selected 183 patients among 26 family who possible to have HeterozygousFamilial hypercholesterolemia. We analyzed family history, clinical examination and lipid parameters.And identifi ed Heterozygous Familial hypercholesterolemia by diagnostic criteria of Netherlands.Results: The mean age for males was 42.3±14, for females was 45.8±15 and gender distribution was42.6% (78) male, 57.4% (105) female. Hypertension occurred in 80.9% (148). BMI was increasedwith age in both sexes (P<0.001). The frequency of tendon xanthoma was 26.8% (49) and cornealarcus was 36.6% (67). The level of total cholesterol and LDL-C were signifi cantly elevated in patients.Identity Heterozygous Familial hypercholesterolemia by criteria of Netherlands was certain-36.1%,probable-42.6%, possible-18.6%, unlikely FH-2.7%.Conclusion: Identifi cation of these individuals at an early age and an aggressive treatment of all knownrisk factors are important for reduce mortality of cardiovascular disease. The Netherland’s criteria issuitable for diagnosing Familial hypercholesterolemia in the Mongolian population, although it does notdiagnose the condition at the genetic level.

BackgroundThere are 137 soums of 17 provinces have plague foci in Mongolia. The 51.7% of them is case, 23.4%- low, 9.5% - high, 0.7% - hyper active. Main host of plague foci is marmot in Mongolia. According last20 year’s surveillance study, about 75.5% of Y.pestis was isolated from marmot, marmot carcassesand their flea. Human plague cases has been caused illegal hunting marmot in Mongolia. Even legaldocument which prohibited marmot hunting was appeared since 2005, people has been hunting marmotfor selling marmot meat, skin and other products. It is depends economy crises and other public issues inMongolia. Also influenced increase risk of human plague and being reverse result in plague preventionactivities.Materials and MethodsStudy was used data of rodent for zoonotic diseases suspicious which tested plague in National centerfor zoonotic disease (NCZD) in 2005-2015 and 13 local center for zoonotic diseases in 1988-2015. Datawas kept in NCZD and National archival authority. For mapping we used Arc View 3.2.ResultsTotally 397 event information of suspicious rodents and other animals was received in NCZD from 8 districtsof Ulaanbaatar city in 2002-2015. Most of information was received from Songinokhairkhan-64.2%district and smallest number was from Nalaikh district-0.3%. 92.2% of them were marmot, 0.1% of themwere marmot raw products for treatment purpose. Totally 1285 animal samples were tested by plaguedisease and the result was negative. Five hundred thirty tree marmots were carried to Ulaanbaatar from10 provinces. In that time plague foci were active and Y.pestis was isolated in provinces which marmotwas carried to Ulaanbaatar.In 1988-2015, totally 257 marmots and animals of 515 event information was received in15 provinces.Including 13.2% of them were birds, 84% of them marmot, 1.6% of them were livestock, 1.2% of themother animals. About 216 marmots were tested by plague. 51.2% of them were detected positive results.We develop conclusion based laboratory investigation result even it need high cost to take earlyprevention and response measures.Conclusion1. It is high risk to spread plague by carrying suspicious animal in urban area. Therefore, it is importantto take early response measures even it high cost. In further, increase cost and support rapid test ofhigh technology.2. To organize rational advertisement and increase knowledge of population about not doing illegalhunting, not selling marmot raw products in urban area, not using marmot raw products for treatmentuse and avoid contact with marmot carcasses.3. It is important to cooperate joint response measures with policeman, inspection agency andveterinary and human health sectors in Mongolia.

Background: The Incidence of Intracranial haemorrhage (ICH) in childhood compare to adulthood not very common. The multifactorial etiology ICH may involve coagulation disturbance, venousinfarction, infection, heart congenital abnormalities, birth asphyxia and trauma. ICH is a major cause of morbidity and mortality in neonates and it’s related to vitamin K deficiency. The previous studies have shown, that 37.8% of children with Cerebral Palsy and 31.2% of infants with hypoxic-ischemic encephalopathy had ICH and 48.2% of dead premature infants due to ICH. The number of infants with ICH are increasing year by year. Therefore, the aim of this study was to identify and explore influential factors and causes of ICH among infants in own country.Materials and Methods: The present study was conducted atseveral departments such as PICU, neurology, and cardiology of the State Maternal and Child Health Research of Mongolia. Sixty one patient with ICH involved in the case group and one hundred twenty two infants were involved in control group.Statistical methods. The Mann Whitney U and Fisher’sexact tests were used to compare clinical characteristics of thecontrol infants and infants with ICH. Ethics. The present study was approved by the ethics committee of the MoH and MCHRC. Informedparental consent was obtained for each patient before entry into the study.Results: Among children with ICH 95.1% were under one year and just 4.9% were aged 1-5 years. The following causes of ICH in infants aged under one year were identified: hemorrhagic disorder-39.7%; HIE-13.3%, trauma- 10.4%, unknown reason-12.1% and congenital heart abnormality- 3.4% and Intrauterine infection – 3.4%. However, most common cause of ICH among children aged 1-5 years was trauma – 66.7%, and 33.3% were related to infection.Conclusion:1. The incidence of ICH is high among infants.2. The most common cause of ICH among children were hemorrhagic disorder-37.7%; HIE-13.1%; trauma-13.1%; infection-sepsis -14.8%; intrauterine infection- 9.9%; congenital abnormality of the brain- 3.3% and congenital heart defect-3.3%.3. Influential factors of ICH are preeclampsia (OR=8.6), CS (OR=3.4), newborn asphyxia (OR=3.3) and pathological jaundice (OR=6.8).

BackgroundHealth professional licensing was introduced in Mongolia in 1999. Medical school graduates shouldpass the health professional licensing exam (HPLE) to be registered. It was informed that HPLEsuccess rate has been decreased for last few years among graduates who passed final theoreticexam (FTE). There has been no research conducted to explain the reasons of such trend. Thisresearch aims to conduct a comparative assessment of MSQs used for both HPLE and FTE.GoalTo analyze examination and test to identify the level of medical knowledge of students who graduateas medical doctor at “Ach” Medical University during 2011- 2015.Materials and MethodsThis is a cross sectional descriptive study. it employed a statistical analysis of 2950 MSQs (24version) that were used for the HPLE by the Health Development Center of the MOH (N=16)and FTE by the “Ach” Medical University (N=8) between 2011 and 2015. Test sheets of HPLE(N=728) and FTE (N=686) were assessed in order to identify a reliability of tests, difficulty index,discrimination index using QuickSCORE II program of the test reading machine with a mode of“Scantron ES-2010”.ResultsThe success rate was much higher in FTE than it in HPLE between 2011 and 2015. The successrate of HPLE decreased dramatically starting from 2013 (87%) to 2014 (4%) and 2015 (24%) whilethe same rate of FTE was stable and almost 100%.FTE’s reliability coefficient of 2011-2015 years meets requirement when it’s 0.92-0.96. HPLE’sreliability coefficient of 2013 and 2014 years don’t meet requirement.From all of the MCQs that has been used in FTE‘s 97% and in HPLE’s 80% are positive discriminationindex which means possible to identify medical school graduates knowledge.ConclusionOur findings confirmed that the success rates of HPLE among medical school graduates are beingquite low.Reliability coefficient of HPLE tests were less reliable (КР20=0.66-0.86) than FTE (КР20=0,92-0.96) and particularly tests for 2014 and 2015 were more difficult and were with high percentage ofnegative discrimination.Test score between HPLE and FTE of 2011-2015 is direct linear correlation.

Background and Purpose Liver disease that caused by iron metabolism failure is called Hemochromatosis (clinically “Bronze diabetes”, “Over spotted liver cirrhosis”). The two types of hemochromatosis are primary and secondary. Primary hemochromatosis is caused by a defect in the genes that control how much iron the human body absorb from food. Secondary hemochromatosis usually is the result of another disease or condition that causes iron overload. According to the study there is a real need to study the clinical reveals of hemachromatosis in Mongolian patients. The purpose of the study to determine the hemachromatosis in patients with liver cirrhosis and cancer.Methods and Materials: The study involved 68 patients with diagnosis Liver cirrhosis and HCC (1st stage) who were hospitalized in Clinic of Gastroenterology of Shastin clinical hospital and “Shagdarsuren” Hepatic hospital from April to July, 2011. All patients were increased blood iron and iron compounded proteins (ferritin, transferrin). DNA analyze have made in Molecular Biological Laboratory of Institute of Biology, Mongolia. Sequencing assay has made in Molecular Biological Laboratory of Humboldt University, Germany.Results. The patient’s age was 25-86, the mid aging – 55.42±1.7. The allele frequencies of the C282Y, H63D, and S65C mutation (which in chromosome 6) were 16/136, 11.7% (heterozygous 7, homozygous 2), 9/136, 6.6% (heterozygous 0, homozygous 9), 3/136, 2.2% (heterozygous 0, homozygous 3), equally 28/136, 20.5% (heterozygous 7, homozygous 14). Conclusions. In conclusion, the occurrence of the C282Y, H63D, and S65C mutation within HFE in this studied cohort of hereditary hemochromatosis. Therefore, these data incline that other factors than the HFE gene may play a role in determining hereditary hemochromatosis in Mongolians.

BackgroundClimate change, as defined by the United Nations Convention on Climate Change, is a “Change of climate which is attributed directly or indirectly to human activity that alters the composition of the global atmosphere and is observed over time”. In 2001 an Initial Communication on Climate Change was prepared by the Government as part of its obligations under the UNFCCC. One of its recommendations was for “creating public awareness among a wide range of stakeholders including public, private and community sector organizations”. GoalThe main goal of the study was to develop recommendations and measures on prevention from diseases and adaptation to climate change by assessing knowledge, attitude and practice (KAP) of population towards climate change. Based on the main goal the following objectives were setup. Therefore addressing the different levels of knowledge and types of attitudes and practices people have towards climate change must initially be dealt with at the local level where site specific variations can be accounted for. Once research has been undertaken at the local level it can later inform decisions and policy at the regional, continental and global levels on how to incorporate site specific variations with in the greater context of the global threat.Objectives:1. To determine knowledge and attitude of population towards climate change;2. To determine practice of population on some adverse consequences of climate change;3. To develop recommendations and measures on prevention from and adaptation to climate change;Materials and MethodsThe study was at once carried out by means of questionnaire. In order to assess KAP of population, the data was collected using a card with 38 questions in three chapters which previously produced and ratified. The questionnaire was structured into 4 sections; demographics, knowledge, attitudes and practices. Two sums in an aimag from each climate zone of Mongolia were selected. In total, 2258 respondents aged 15 to 64 were involved from eight sums in four aimags (Zavkhan, Selenge, Dornod and Umnugovi), and two districts in Ulaanbaatar. The study data was input to computer using EPIDATA-3.6 software and statistically analyzed using SPSS-18.0 software.ResultsA total of 2258 individuals were interviewed. 44.1% 44.1% (995) of the participants was residents of Ulaanbaatar city and remained percentages accounted for residents living in the center of aimags and soums. 56.7% (1281) of participants were women and 43.3% (977) were men aged with 35.2±15.1 in average. Most of the study participants had educated with medium level (34.8%) and high level (30.0%). Employment percentage is 47.5% (1073). However, most respondents interpreted the meaning of climate change as “a change in weather,” “a change in normal climate conditions,” or “a change in temperature” – answers that requires more common sense than climate change savvy. Global warming is one of the evident of climate change. To know study participants awareness about climate change we used terminology of global warming. 25.3% (571) of the total participants answered that climate change revealed by the overheating or warming earth surface. 42.4% of the respondents answered the climate change could affect to health, 33.2% to environment and 16.3% to economy. 84.5% (1908) of the study participants agreed with that climate change has been started. Most of them (71.3%, 1824) allowed that people’s improper use of nature tend to global warming. When ranging the protection practices during the strong storm means of timbering the houses or gers accounted for 42.5% (960). Study participants supported the following activities; 41.2% (931) agreed that is it necessary to increase health services and 34.1% (769) suggested that it is better to enhance training and propagation for increasing awareness of population about climate change adaptation procedures and some information on climate changes and protection events. 85.2% (1923) of the study participants answered that they want to get the information on climate change from public TV.ConclusionsAlthough knowledge on global warming as the climate change was poor among the respondents, they agreed the climate change has already been started worldwide as well as in Mongolia. Only half of the respondents have had practice to prevent themselves from natural disaster.

Background and purpose: Liver disease that caused by iron metabolism failure is called Hemochromatosis (clinically "Bronze diabetes", "Over spotted liver cirrhosis"). The two types of hemochromatosis are primary and secondary. Primary hemochromatosis is caused by a defect in the genes that control how much iron the human body absorb from food. Secondary hemochromatosis usually is the result of another disease or condition that causes iron overload. According to the study there is a real need to study the clinical reveals of hemachromatosis in Mongolian patients. The purpose of the study to determine the hemachromatosis in patients with liver cirrhosis and cancer.Materials and Methods: The study involved 50 patients with diagnosis liver cirrhosis and cancer (1st stage) who were hospitalized in Clinic of gastroenterology of Shastin clinical hospital and "Shagdarsuren" hepatic hospital from April to July, 2011. The special questionnaire was used in the study. The biochemical laboratory examinations were taken and analyzed in lab "MED ANALYTIC". Biochemical tests performed on HumaStar 80 fully automatic analyzer. Determination of Iron level was performed by Photometric colorimetric test for iron with lipid clearing factor (normality 37-148ug/dl), transferring level by Turbidimetric monoreagent for the quantitative determination of transferring (normality 170-340ug/dl), glucose level by (GOD-PAP method) Enzymatic colorimetric test for glucose method without Deproteinisation (normality 75-115ug/dl). The ferritin level performed by ELISA analyzer (normality 15-240ng/ml).Results: The patient's age was 25-86, the mid aging-55.42. From all patients (29 male and 21 female) who were participated in the study, the 25 were with diagnosis liver cirrhosis and 18 of them clinically has the Child Pugh "B" cirrhosis, 7 has Child Pugh "A". The other 25 patients were with diagnosis liver cancer first stage.According to biochemical analyzes iron (n=35;70%); ferritin (n=41;82%); transferring (n=27; 54%); sugar (n=21;42%) levels were elevated.During the liver disease caused by iron overloading the following clinical symptoms were observed:- Skin spotting, n=48 (98%)- Hepatomegaly, n=33 (66%)- Splenomegaly, n=28 (56%)- Diabetes mellitus symptoms, n= 30 (60%)- Cardiovascular disease, n=16 (32%)- Respiratory system disorders, n=11 (22%)- Gonadotrophy, n= 2 (4%)The average serum iron level in case of livercirrhosis was 189.84+18.5mg/dl, in liver cancer 160.4±13.91 mg/ dl, ferritin level in case of liver cirrhosis was 407.69+50.08ng/ml, transferrin 375.68±47.38mg/dl, glucose 121.1±7.15mg/dl, ferritin level in liver cancer was 391.67±47.79ng/ml, transferring 388.76±47.38mg/dl, glucose 114.59±5.78mg/dl.

Introduction The rate of global warming has accelerated over the past 50 years, with 2014 and 2015 being the earth’s warmest years on record. The prevailing scientific view is that increased ambient temperatures are changing rainfall patterns and cause extreme weather conditions. Increasing surface temperature is melting glaciers and raising the sea level. More flooding, droughts, hurricanes, and heat waves are being reported. Accelerated changes in climate are already affecting human health, in part by altering the epidemiology of climate-sensitive pathogens.
Annually, one out of every four deaths worldwide is due to environmental pollution and climate change-related diseases.
Greenhouse gases from human activities are the most significant driver of observed climate change since the mid-20th century.
These warming trends may have profound effects not only on the environment but also on human health directly and indirectly. In fact, climate change has been considered the biggest threat to global health in the 21st century.

Introduction: The curriculum development is important issue, especially stakeholder’s evaluations for the implementation of the curriculum. Accordingly, this time we conducted this survey to determine the level of satisfaction of teachers, which is a key factor in implementation of curriculum at the “Ach” Medical University. Goal: To study curriculum implementation assessment by teachers at the Ach Medical University. Materials and Methods: Study was conducted descriptive study design using quantitative research methodology. The Likert scale (1-5) used for the assessment of satisfaction score. Total 77 teachers were included in the study. Study questionnaire included 7 groups with 53 questionnaires. Results: Total n=77 teachers included in the study. The satisfaction level of teachers for the implementation of curriculum was 73% (n=56) satisfied with satisfaction, 22% moderate satisfaction (n=17), and medium satisfaction teacher 5% (n=4).
The satisfaction level of teacher workload and job satisfaction is high enough to satisfy the workload of the trainee, the time to prepare the lesson, and the opportunity to work with the students in the classroom. 3.6-4.2, while the teacher’s work value or salary the level of satisfaction level is 3.11, the minimum value is 2.75, the average. Conclusion The average satisfaction score was 4.11 above the average but the effectiveness of the program, the effectiveness of the teacher’s work, study environment and textbooks were below average.

Introduction: The clinical skills training at medical schools provides the opportunity for future medical doctors to deal with the client with proper care, diagnosis of the disease, first aid, treatment, nursing, treatment, counseling to address the complexity of the problem solving and the ethical attitude of the doctor. To achieve this objective, it is necessary to assess the level of knowledge, skills and attitudes students have acquired. Goal: To analyze assignment of basic clinical skills assessment and to identify the level of кknowledge and skills students who have graduated second year medical program at “Ach” Medical University during 2016- 2017 academic year. Materials and Methods: The study was used as a descriptive model to measure the reliability of the assignment, the difficulty factor of tasks, and the Hoffsten’s scores based on the tasks and performance of each station and compared with the indicators. Results: Based on Hoffsten’s study on the success rate of examiners at the 5 stations, the Hoffsten’s score level of clinical examination was 68 percent, the physical examination station was 64 percent, the station’s diagnostic level was 71 percent, the laboratory was 70 percent and the nursing station was 70 percent. Conclusion At each clinical trial, the differential diagnosis of each individual clinical trial, clinical interview, nursing station and visual diagnostic station (DF> 95), at the laboratory and at the physical examination station, assess the student with a higher grade of difficulty factor (DF> 80) to the Hoffsten’s score of the basic clinical skills exam is set to be 70 percent.