Background: According to statistics from National Center of Public Health Development of Mongolia morbidity rate of cardiovascular diseases was 501.84 cases per 10000 population in 2006, which demonstrates increase of 2 times compare to 1996 and 50% increase compare to 2000. Goal: To study bio-ecological factors influencing on mortality and morbidity rate of prevalent cardiovascular diseases among Mongolians.Materials and Methods: We have chosen arterial hypertension, acute myocardial infarction, and chronic rheumatoid fever according 10th classification of WHO. Indices of morbidity, mortality of diseases were calculated per 1000 population.Result: Average atmospheric temperature t0С (χф2=1494); atmospheric pressure (χф 2=36.07); precipitation (χф 2=704); and mineralization of rivers (χф 2=532) have statistically significant effect on morbidity rate of arterial hypertension among the population of Uvurkhangai, Gobi-Altai, Darkhan-Uul, Gobisumber aimags and UB city. Average atmospheric temperature t0С (χф 2=241); atmospheric pressure (χф2=88.62); precipitation (χф 2=62.18); and mineralization of rivers (χф2=86.28) have statistically significant effect on morbidity rate of chronic rheumatoid fever among the population of Arkhangai, Bayankhongor, Umnugobi, Gobisumber aimags.Conclusions:1. Geographical distribution of arterial hypertension is prevailed in Uvur-Khangai, Gobi-Altai, Darhan-Uul, Gobi-Sumber aimags and UB city, distribution of acute myocardial infarction is prevailed in Hovd, Hubsgul, Arkhangai, Selenge, Gobi-Sumberaimags and geographical distribution of chronic rheumatoid fever is prevailed in Bayankhongor, Arkhangai, Umnugobi, Gobisumber aimags. 2. Ecological factors have statistically significant (χF 2=23.1-161.1) influence on the distribution of morbidity and mortality of arterial hypertension, acute myocardial infarction and chronic rheumatoid fever. Influencing ecological factors in regions covered with this study, such as temperature, atmospheric pressure, wind speed and mineralization of water sources have weaker and reverse correlations each separately (r=-0.1-0.2) but in combination they have medium and reverse correlations (r =-0.45- 0.52).3. The result of the research study established that morbidity and mortality of cardiovascular diseases (arterial hypertension, acute myocardial infarction and chronic rheumatoid fever) distributed in 3 regions on the territory of Mongolia depending on ecological factors.

Introduction:The traditional lipid and lipoprotein levels in patients with familial combined hyperlipidemia (FCHL) are relatively mildly elevated and do not fully explain the increased risk of cardiovascular disease (CVD). Hypercholesterolemia, hypertriglyceridemia, and elevated levels of apolipoprotein-B (apo-B) characterize FCH. Familial combined hyperlipidemia (FCHL) is a common lipid disorder characterized by elevated levels of plasma cholesterol and triglycerides that is present in 10% to 20% of patients with premature coronary artery disease. The importance of plasma TG as an independent risk factor for CAD was recognized provided support for the earlier observation that plasma TG levels predict relative risk in relatives of FCHL patientsGoal: To study of correlation between of lipid metabolism disorders and coronary atherosclerosisObjectives:- To define correlation of parameters of lipid metabolism in ischemic and control groups- To compare number of injured coronary arteries and parameters of lipid in ischemic menResults:In our study we involved 86 patients who were investigated coronary angiography. Of them 72 (82.7%) patients revealed changes of coronary artery, and one vessel change was 30 (41.6%), two vessels changes were 28 (38.9%), and three vessels 14 (19.4%) respectively. Lipid levels were significantly increased in case group compared with controls. There were no significant difference in number of injured coronary artery and lipid level.Conclusion:In this study found triglyceride was high level than cholesterol, LDL in ischemic disease. Familial combined disorder of metabolism lipid is possible to depend on hyperlipoproteinemia IIB type. Apolipoprotein B (108.5±3.2 mg/dl) was increased compare with control group (89.6±3.4 mg/dl) in ischemic disease.

IntroductionCurrently there are 31 pharmaceutical manufacturers in Mongolia. The first standard on Goodmanufacturing practice was adopted in 2005 and during these 9 years the Good manufacturing practicestandard was upgraded twice in 2011 and 2014, and the latest version reached to WHO GMP guidelinelevel.Purpose of the studyAccording to the Law of Medicine and medical devices of Mongolia, all pharmaceutical manufacturersshould comply with the Good manufacturing practice standard MNS 5524:2014. The study was aimedto asses GMP implementation level among local pharmaceutical manufacturers and to define mostlyobserved deficiencies in three categories as “critical”, “major” and “minor”.Materials and MethodAll stable operating pharmaceutical manufacturers were asked to be involved in this study accordingto the Helsinki declaration and 11 of them were involved. Direct observation method was used for thisstudy. WHO guideline on Good manufacturing practice: Main principles and on Sterile products wasused as the criteria of the assessment.ResultsAll deficiencies observed during the study were classified into three groups as critical, major and minorand the frequency was defined.Conclusions:The critical deficiencies are related mainly with the design and general layout of the premises and heatingventilation and air conditioning system. It requires investment and proper planning from the manufacturers.The major deficiencies are mainly related to documentation, qualification and validation.The minor deficiencies are with regard of documentation system, technical requirements of equipmentand storage area condition and its management.For taking corrective actions of major and minor deficiencies do not require investment, but it requirestime, training, implementation, monitoring and continuous improvement from the manufacturer.

BACKGROUND:Congenital heart defects (CHD) turn out to be the leading cause of infant mortality in their first yearafter infectious diseases. Per 1,000 infants, born with CHD, about 19-75 failed to survive. It revealsthe fact that CHD is a major cause of childhood mortality in worldwide. Beyond the progress ofmedicine and surgery, the cause of CHD is not fully defined. The majority of studies reveal that CHDis triggered by many factors, such as the genetic and environmental factors.Based on the evidences of the sequence of the human genome and advances in moleculartechnology, genetic factors play a major role. Per 100 newborninfants, they’re found one child, bornwith a CHD is concerned as a highly frequent incident for birth anomaly. Only 0.5% of these congenitaldefects enable to be inherited in accordance with Mendel’s genetic laws, which is associated withthe change and mutation of a single gene. Many found that most congenital anomalies dependupon mutation or change in multiple genes and other relevant factors. As a result of the progressivedevelopment of molecular biology in the past 20 years discovered a range of genes involved in fetusformation, development, growth and control of processes. In our country case, corrective surgeryfor CHD dominates among all cardiovascular surgery in Mongolia. Particularly, for all incidents donesome corrective surgery of congenital heart defects, atrial septal defect operation occupies 42.44%,in other word it is a substantial part of the CHDoperation (D.Tsegeenjav, 2009). Molecular geneticsstudy of infant born with heart defects and simultaneous anomaly of other organ system researchstill has not been done for Mongolian population. In many cases the diagnosis of CHD is delayeduntil their adulthood, which is a research gap to address without further delay and the finding mustbe applied in practice in the near future.GOAL:The aim of the research is to conduct a molecular genetic study of children, born with CHD andcombined abnormalities of other organs and systems, identify gene lesion, location and characteristicsof mutations, pathogenetic mechanism of congenital defects and anomalies among the Mongolianpopulation.RESULT:For this study, there are 118 patients, with congenital heart disease, received surgical treatmentin the cardiovascular department of III central state hospital named P.N. Shastin, involved afterconfirmed diagnosis through objective and instrumental investigations (ECG, Fluoroscopy, EchoKG).The 118 healthy family members of patients sampled as a control group. According to the diagnosisof patients with congenital heart defect, such as atrial septal defects-95 (81.2% ± 3.6), ventricularseptal defects-17 (14.5% ± 3.3), patent ductusarteriosus- 2 (1.7± 0 .0%) have combined severedefects - 4 (3.3% ± 1.0). Out of 118 patients with congenital heart defects, 32.2% (38 patients)was male, whereas women accounted for 67.8% (80 patients) with average age of 22, 3 ± 12.9(minimum 1.0 year, maximum 51 year). These comprised 42.4% in 1-17 years old (average age10 ± 5.27) and 57.6% in 18-51 years old (average age 31 ± 9.54). The 33.9% ± 4.4 (40 patients) of operated patients responded the questionnaire that they have a hereditary heart defect. Shortnessof breath, heart pain, and recurrent pneumonia were the main complaints of patients with CHDthat significantly authentic to statistical probability. From the taken 118 blood samples, 95 werediagnosed ASD, in 7 diagnosed VSD, in 2 diagnosed PDA, in 4 diagnosed combined defects. Forthe 95 samples, we decided to examine the ASD associated GATA4, TBX5gene. It draws attentionto the fact that 81.2% of all congenital heart defects found only ASD. To examine the ASD genes inthe sample, the following changes have occurred. The study found 8 variants of mutations formingASD. It includes on exon 1 Gly 93 Ala (c.278G> C), on exon 1 P163S (c.487C>T).CONCLUSIONS:1. Patients with ASD alone occupy 81,2% of all heart defects in our study.2. For the samples of ASD, the study found 8 different mutations of GATA4.3. In the sample of blood not found TBX5 gene mutation.4. In the samples, one patient with dextrocardiasitusinvertus was combined with congenital heartdefects found E359Xfs (c.1075delG) deletion variation on exon3.

Introduction. The safety and effi cacy of fi nished pharmaceutical products depend on its stabilityattribute. Stability requirements were included for fi rst time in Good manufacturing practice standardMNS 5524:2014. The pharmaceutical manufacturer is responsible to conduct stability studies and tosubmit the report as part of marketing authorization documentation.Purpose of the study. The purpose of this study is to conduct ongoing stability study of the mostlyproduced domestic medicine to monitor the product over its shelf-life.Materials and Methods. As a material used 2 locally produced Paracetamol (Acetaminophen INN) 500mg tablets (local manufacturer (LM) 1 with batch number 271110, LM 2 with batch number 441110). Asa method we used shelf-life specifi cation: Mongolian national standard of Paracetamol 500 mg tablets,MNS 4358:2007. Testing frequency was at 0 time (when tablets were produced) and at 12, 24 and 36months (study was covered the shelf-life).Results. In frame of this study we defi ned the most produced product as Paracetamol (AcetaminophenINN) 500 mg tablets. From the LICEMED- medicines registration record we found 8 tablets, containingAcetaminophen in 500 mg. Two of them were produced locally. These two products were involved inongoing stability study. Testing results showed that no any stability issues over the defi ned shelf life.Discussion. The shelf life was defi ned as 36 months, initially by manufacturers before productsregistered. After a marketing authorization has been granted, the stability of the fi nished pharmaceuticalproducts should be monitored according to a continuous appropriate program that should be permittedthe detection of any stability issue associated with the formulation in the container closure system inwhich it is marketed.Conclusions. After 36 months, testing results were in acceptable limits, selected products wereremaining their quality over the shelf-life.

Introduction: Studies demonstrated that the apolipoprotein B/apolipoprotein A-I (Apo B/apo A-I) ratio predicts cardiovascular risk better than any of the cholesterol indexes. Apo B and Apo A-1 are assumed to be superiormarkers for lipoprotein abnormalities [1,2]. The concentrations of Apo B and Apo A-1 are associated with cardiovascular disease more strongly than the corresponding lipoprotein cholesterol fractions, the discriminant value of these apoproteins in absolute terms appears to be less important than of their ratio (the Apo B/Apo A-1 ratio) [3, 5-7]. The Apo B/Apo A-1 ratio reflects the balance of atherogenic and antiatherogenic lipoproteins in plasma [4]. Multiple clinical and epidemiological studies have confirmed that the Apo B/Apo A-1 ratio is a superior marker for cardiovascular disease compared with lipids and lipoproteins or their ratios [8, 9]. Goal: We determined the variation limits of the Apo B/Apo A-1 ratio in healthy participants with normolipidemia and the relationship of this ratio with other lipid parameters. Material and Methods: A total of 146 normolipidemic healthy participants aged 25–60 years were included in the study. Anthropometric measurements (height and weight) and other personal information were obtained during the clinical examination and the interview. Participants were included in the study using the following criteria:
1. body mass index < 30 kg/m2;

2. TC < 5.2mmol/L;
3. triglycerides (TG) ≤1.7 mmol/L;
4. HDL-C ≥1.03 mmol/L ( woman), ≥ 1.29 mmol/L (male) .
The plasma levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), apo A-I, Apo B and Apo B/Apo A-1 were determined after a 12 h fasting period. The non-HDL-C was calculated as the difference between the TC and HDL-C. Most research data emphasized that the values for the Apo B/Apo A-1 ratio that define a high cardiovascular risk were proposed to be 0.9 for men and 0.8 for women. Statistical Analysis. The statistical analysis was performed using SPSS 21.0 (USA). Differences between the groups were analyzed using the Mann-Whitney test and the chi-squared test. Correlations between the indices were assessed using the Spearman’s rank correlation. A value of < 0.05 was accepted as statistically significant. Results: The relationship of ratio of apolipoprotein (Apo) B/Apo A-1 with other indicators of lipid metabolism in healthy people with normal lipidemia was analyzed. The Apo B/Apo A-1 ratio in the studied normolipidemic subjects was 0.69 ± 0.17. The percentage of subjects with the Apo B/Apo A-1 ratio exceeding 0.9 (the accepted risk value of cardiovascular disease) was 36.3 %.The subjects with Apo B/Apo A-1>0.9 were characterized by higher HDL-C levels and atherogenic Aпo B, Apo B/Apo A-1 but lower values Apo A-1. Conclusion The subjects with normolipidemia the unfavorable Apo B/Apo A-I ratio> 0.9 had more atherogenic lipid profile.

Introduction: Cardiovascular Disease (CVD) is a major cause of morbidity and a leading contributor to mortality in both developed and developing countries. With rapid socioeconomic development, CVD has reached epidemic proportions in developing countries in recent decades. Dyslipidemia, elevated level of plasma cholesterol, together with arterial hipertension, is the main modifiable risk factor atherosclerosis and cardiovascular diseases (CVD) development. Surveys to monitor and measure dyslipidemia burden in a Mongolian population has not been conducted in recent years and the available data on the prevalence, types, and associated factors of dyslipidemia in the general population is relatively insufficient and outdated. Monitoring of lipid profile at populational level is an important instrument of prevention medicine, applied for CVD populational risk assessment. Goal: Evaluate comparisons of adult blood lipid levels in age, gender and location. Material and Methods: In this study, 500 people aged 25-65 were classified into age groups (47.1% for males and 52.9% for females). Blood plasma in total cholesterol (TC), triglyceride (TG), high density (HDL-C) and low density (LDL-C) lipoprotein-cholesterol, apolipoprotein - ApoA1, Apo B and ratio of ApoB / ApoA1 were estimated. Statistical analysis was performed using SPSS 22.0 Results: Mean age of the participants was 48.8±14.2 years old. Mean values for male TC-4.85±0.92 mmol/l, TG-1.58±1.19 mmol/l, LDL-C-3.24±0.98 mmol/l, HLD-C-1.62±0.21, for women- 4.47±0.96 mmol/l, 1.22±0.47 mmol/l, 2.95±1.01 mmol/l, 1.77±0.23 mmol/l respectively. The mean blood TC,TG levels tended to increase with age group in male compared to women. The prevalence of an increased blood LDL-C levels or risks for an increased blood LDL-C was statistically significantly high in male. Conclusion The prevalence of lipid was shown as high, that demands respective prevention and management.

Background: Cardiac surgery with cardiopulmonary bypass is grown rapidly in last years. The application of cardiopulmonary bypass using a heart-lung machine to perform open heart surgery is known to be associated with numerous pathophysiologic changes including injury of cellular components as erythrocyte, platelets, coagulopathy, and fibrinolysis. Objectives: Our study objective is to study on relation of open heart surgery phases and blood coagulation parameters. Materials and Methods: Blood samples from 49 patients (28 females and 21 males, aged 18- 63 years) who underwent open heart surgery with cardiopulnonary bypass (CPB) were collected before and at several time points during, after surgery and analyzed for coagulation parameters at Shastin Third Central Hospital. Results: To compare long continued cardiopulmonary bypass (over 1 h) surgery with less 1 h groups there prothrombin time was found 18.8±5.9 sec, international normalized ratio (INR) 2.09±0.9 sec prolonged (p<0.001) in 7 days after surgery. All coagulation parameters were decreased significantly (p<0.001) in during extracorporeal circulation and after 1 h declamping than preoperative level and reached near normal value in 48 h after surgery. Our results have referred to platelet counts reduction to about 53% in during surgery, 46.8% in 48 h after surgery of the preoperative level 237.4±57.1 with final return to normal levels 228.9±78.6 within 7 days. Conclusions
1. The cardiopulmonary bypass time and patient age in relation to open heart surgery type there were significant difference (p <0.01).
2. The coagulation parameters have revealed significant changes (p <0.01) in relation cardiopulmonary bypass time.
3. All coagulation parameters were decreased significantly (p<0.001) in during extracorporeal circulation and after 1 h decamping than preoperative level and reached near normal value in 48 h after surgery.
4. There was direct and less correlation between platelet level and CPB time (r=0.37, p<0.001).

Article deals with age-related hypogonadism in men as an interdisciplinary problem. Current definition, prevalence, analyzes the relationship between age and the incidents of hypogonadism were shown. The detailed overview of clinical studies, meta analysis of causal link of androgen deficiency and erectile dysfunction, ischemic heart disease, arterial hypertension, dyslipidemia, and diabetes mellitus was presented. To date was found the relationship between metabolic syndrome and androgen deficiency. Low level of testosterone is closely connected with low libido as well as insulin resistance, abdominal obesity, dyslipidemia. Insulin resistance and hyperinsulinemia are noticed in patients with hypogonadism in comparison with obese and normal-weight patients. Therefore, metabolic risk factors are the connecting link of cardiovascular diseases and androgen deficiency. Meta-analysis of clinical trials of the effects of testosterone replacement therapy and safety of long term use was presented in the article. The article discusses the importance of a unified approach to the diagnosis and treatment of androgen-deficient conditions and cardiovascular disease.

Introduction: Coronary atherosclerosis is the leading cause of morbidity and mortality in the world. Hypogonadism is not considered a traditional risk factor for coronary artery disease (CAD). Higher CVD mortality may be partially attributed to behavioral and physical characteristics of males, including increased smoking, drinking, endocrine and metabolic factor like fat distribution, and low male engagement in preventive care. In the last decades, many studies have suggested that low testosterone levels are associated with increased prevalence of risk factors for CVD, including dyslipidemia and diabetes. For the reason, this research focused on identifying any association between testosterone deficiency and risk factors of coronary heart disease. Goal: This study aimed to identify any association between testosterone deficiency and risk factors of coronary heart disease in Mongolian men. Material and methods: In this case control study, we determined plasma total testosterone, total cholesterol, triglyceride, high density lipoprotein-cholesterol, apolipoprotein – ApoA1, Apo B and glucose in 287 subjects, among them 125 patients with ACS and 162 healthy subjects. Statistical analysis was performed using SPSS 22.0 of IBM. Results: Mean age of the participants was 55.19±6.99 years old. It was found that, mean plasma TT levels in patients with ACS (4.17 ng/ml) was significantly lower than in the healthy subjects (4.70 ng/ml). There was a negative association between plasma TT level and glucose level (r=-0.185; p=0.002) and ApoB/ApoA1 (r=-0.132, p=0.026). Conclusion The results in the present study suggest that low plasma TT level may be a risk factor for CHD in men, which may relate to the influence of plasma lipoprotein and glucose metabolism by endogenous testosterone.