Introduction: Enteroaggregative Escherichia coli (EAEC) is an important agent of acute and persistent diarrhea worldwide. Few cases have been reported in healthy children. EAEC strains are characterized by aggregative adherence (AA) to HEp-2 cells, wherein bacteria are seen in “stacked brick” aggregates attaching to HEp-2 cells and usually to the glass surface between cells. Goal: To identify Enteroaggregative Escherihia coli using multiplex polymerase chain reaction (PCR) and HEp-2 adherence assay in Ulaanbaatar, Mongolia Materials and Methods: A total of 329 E. coli strains were isolated from stool with diarrhea in National Center for Communicable Diseases from July 2012 through September 2014. All specimens were processed by routine microbiological and biochemical tests in the bacteriological laboratories to identify Salmonella spp., Shigella spp. All specimens in our study were negative for these bacterial and parasitic pathogens. The biofilm formation was evaluated by the growth rate of E.coli on plastic surface. PCR assays were used to detect genes of five types of diarrheagenic E.coli (DEC). All of the DEC strains showed mannose-resistant adherence to HEp-2 cells, and aggregative adherence was predominant in these isolates. Bacterial susceptibility to antimicrobial agents determined by the Kirby Bauer disk diffusion method on Muller Hinton agar. Results: EAEC (31.9%) was the most prevalent by PCR and HEp-2 assay comparing with others. EAEC by multiplex PCR in samples (11, 3.3%), followed by enteropathogenic E.coli (EPEC) seen in 2.1%. Enterohemorrhagic E.coli (EHEC) and enteroinvasive E.coli (EIEC) were found in 7 (2.1%) and 1 (0.3%) of the samples. Enterotoxigenic E.coli (ETEC) and diffusely adhering E.coli were detected in 2 (0.6%), respectively. The evaluation of bacterial biofilm formation using 96 well plates showed 309 negative (93%), 15 weak biofilm (4.6%) and 8 moderate biofilm (2.4%) formation for E.coli and no strong biofilm forming strain was detected. Above 50% of antibiotic resistance was observed for ampicillin, trimethoprim/sulfamethoxazole, cefuroxime and cephalotin. Also, 95.4% of isolates were resistant to at least three different classes of antimicrobial agents and considered as multidrug resistance. Conclusion: EAEC is most prevalent pathogen among DEC in our samples. It is necessary to implement EAEC identifying method on Hep-2 assay in our laboratory practice.

IntroductionMany factors can contribute to the occurrence of COPD. Recent studies have pointed to the notion thatpolymorphism of candidate genes may also play a signifi cant role in COPD pathogenesis.GoalTo investigate the association of polymorphisms in ADRB2 and TNF-α genes with COPD.Materials and MethodsWe genotyped three SNPs included rs1042713 and rs1042714 in ADRB2, rs1800629 in TNF-α gene,using PCR-RFLP method.ResultsThere is no statistically signifi cant difference was observed for TNF-α rs1800629 between case andcontrol groups. Genotype frequency of the homozygote Gly16 (rs1042713) was more frequent in COPDpatients than controls (OR=3.25; 95%CI, 1.58–6.66, p=0.0037). Also, haplotype frequency of Gly/Gly16+Gln/Glu27 was signifi cant difference among cases and controls (OR=5.03; 95%CI, 1.8–14.2,p<0.01).Conclusion:Overall, ADRB2 rs1042713 and rs1042714 polymorphisms are associated with increased susceptibilityto the development of COPD. Further studies in large groups of patients with COPD are needed toaddress other genetic risk factors.

IndroductionThe short tandem repeats (STR) are rich source of highly polymorphic markers in the human genome. In this study, we used a commercially available multiplex STR typing kit to study 15 STR systems (D3S1358, THO1, D21S11, D18S51, Penta E, D5S818, D13S317, D7S820, D16S539, CSF1PO, Penta D, vWA, D8S1179, TPOX and FGA,) in the Mongolians population, and estimated the allele and genotype frequencies. These 15 STR loci include 2 new pentanucleotide repeat STR loci, Penta E and Penta D, so are not studied in Mongolians.GoalTo determine allele frequency of STR loci D3S1358, THO1,D21S11, D18S51, D5S818, D13S317, D7S820, D16S539, CSF1PO, vWA, D8S1179, TPOX, FGA Penta E, Penta D in Mongolian population.Materials and MethodsThe liquid blood, blood stain and saliva samples were taken from 165 unrelated individuals from Mongolian. Extraction DNA: Genomic DNA was extracted from whole blood samples by the standard method of phenol-chloroform-isoamyl alcohol and Wizard Genomic DNA Purification kit, Promega Corporation [21], from blood stain and saliva samples QIAamp DNA micro kit, Qiagen [25], AccuPrep Genomic DNA Extration kit, Bioneer, Koreans extraction method respectively.PCR: PCR amplification was performed using 10-15 ng genomic DNA template according to manufacturer’s protocol (PowerPlex® 16 and PowerPlex® 16HS kit, Promega Corporation, USA). Typing: DNA typing was performed on the ABI Prism 310 Genetic Analyzer (Applied Biosystems) using the recommended protocol. The results were analyzed by Data Collection (Version 1.1), GeneScan (Version 3.1), and Genotyper (Version 3.1) softwares (AppliedBiosystems).ResultsWe assessed forensic and population genetic studies using 15 STR loci included in s sample of 165 unrelated individuals from Mongolian. Allele frequency were listed in Table 2. Totally 20 alleles /5, 7-25/ were found from microsatellite Penta E locus and allele 11 has most frequent (0.1128). 6-16 alleles were found from Penta D locus and allele 9 has most frequent (0.3262). This result is interesting because allele 6 of Penta D locus was found rarely among other populations. But relatively higher frequency of allele 6 (0.0183) was found in Mongolian population. A population comparison based in genetic distance and genetic diversity calculated from allele frequencies of the 15 STR loci from obtained five different populations is shown the Table 3. Conclusions:1. Penta E locus was highly polymorphic, and 20 alleles were found in this Mongolians population and allele 11 was most frequent.2. Penta D locus was 20 alleles were found in this Mongolians population and allele 9 was most frequent.

Extraintestinal pathogenic Escherichia coli (ExPEC), the specialized strains ofE.coli that cause most extraintestinal infections, represent a major but littleappreciated health threat. Phylogenetic analysis has shown that ExPEC is composedof four main phylogenetic groups (A,B1, B2, and D) and that virulent extraintestinalstrains mainly belong to groups B2 and D.In this study, we aimed to assess therelation between adherence virulence and phylogenetic groups of ExPEC.A total of 161 E.coli samples were collected. Out of these 17 (10.6%) werefrom pus, 66 (41 %) from urine, 78 (48.4%) from cervical swab. The phylogeneticgroups and 6 virulence genes (fimH, papC, papGII, papGIII, fa/draBC,andSfa/focDE) encoding adhesins were identified by triplex PCR. Phylogeneticgroups distribution was as follows: B1 10.5%, A 24.7%, B2 25.3%, and D 38.9%. Virulence genes prevalence was fimH 90.1%, papC 23%, papGII 16.8%, papGIII1.9%, Afa/draBC 11.8%, andSfa/focDE 5.6%. The cell surface protein (curli) wasdetected 50,3% by Congo red agar. In conclusion: The most isolated strainsbelonged to the phylogenetic group B2 and D. The phylogenetic groups weresignificantly associated with some genes encoding adhesins (fimH, papC) and cellsurface protein (curli).

IntroductionKlebsiella spp is a well-known opportunistic pathogen associated with nosocomial infections such asurinary tract, septicaemia and pneumonia number of multi-drug resistant strains and infections causedby Klebsiella has progressively increased, causing treatment limitations.GoalIdentify of phenotype of Klebseilla isolates from ñlinical samplesMaterials and MethodsA total of 112 Klebsiella strains were isolated from clinical samples in State Central First Hospital and StateCentral Third Hospital from July 2015 through December 2015. The bacterial isolates were identifi edaccording to cultural characteristics, biochemical test and API20E. The serum resistance, capsule andhypermucoviscosity, cell surface protein (curly), a-hemolysin and ability to form biofi lm were sought byphenotypic assays. Antimicrobial susceptibility was tested by diffusion method.ResultA total of 112 Klebsiella samples were collected. The bacterial isolates were identifi ed according tocultural characteristics, biochemical test and API20E, the results revealed that 16.1 percent isolateswere identifi ed as K.oxytoca all of them 83.9 percent isolates were belong to K.pneumonia. Therewere observed for ampicillin (99 percent), nitrofurantoin (53.6 percent), cepalotin (50.6 percent) and51 percent of isolates were considered as a multiple drug resistant. Serum resistance properties ofK.pneumoniae was resistance 89.4 percent, intermediately susceptible 4.3 percent, sensitive 6.4percent and for K.oxytoca resistance 88.9 percent, intermediately susceptible 5.6 percent, sensitive 5.6percent. The hemolysin àalpha was detected in 32.2 percent, and gamma, beta in 66.96 percent, 0.9percent respectively. The capsule was observed in 46.5 percent and hypermucoviscosity in 27.7 percentof isolates. The cell surface protein (curly) and biofi lm were detected in 100 percent.Conclusion:Both K.pneumoniae and K.oxytoca isolates from clinical samples have similar virulent properties, andthe a-hemolysin and hypermucoviscosity positive isolates were more resistance to antibiotics.

Background. Bacterial meningitis is a severe, potentially life-threatening infection that is associated with high rates of morbidity and significant disability in survivors. Overall mortality rates related to bacterial meningitis of around 20% to 25% have been reported by major centers. Our study is to determine the incidence rate and etiology of childhood bacterial meningitis in Ulaanbaatar, Mongolia.Methods. From 2002-2010, a total of CSF 433 and blood 544 samples were obtained from children age 0-5 years old. The following diagnostic criteria for bacterial meningitis in children aged 0-5 years were used: questionnaires, clinical signs and positive CSF culture and/or CSF antigen test results positive N. meningitis serogroups B, A, C, Y, and W-135, Hib or S.pneumonia; and/or positive CSF PCR results; and/or positive blood culture results with CSF pleocytosis (WBC count, >10 cells/uL). Pathogens were identified and serotype or serogroup with standard methods in the reference microbiology laboratory. Detection of bacterial pathogens with a multiplex and real-time PCR assay.Results. From totally 544 suspected cases had been detected bacterial meningitis in 260 (47, 8%) cases and sepsis in 111 [20,4%] cases respectively. The disease in the 83 [27.1 %] etiologically diagnosed patients was due to H.influenza, S. pneumonia was in 71 [36, 4%] cases and N.meningitis in 111 [24, 7%] respectively. Among the positive samples 80.6% (129/160) the specific serogroup and/or serotypes for N.meningitis serogroups A was available in 22(35, 4%) cases, for the Hib 52(96, 3%) and 6(40%) for the S.pneumoniae 7 serotype. The real time PCR assay was more sensitive for detection of meningitis pathogens than conventional methods (culture and latex agglutination), 19% in comparison with latex agglutination (p<0.0026) and by 39% in comparison with culture (p<0.001). Bacterial meningitis was identified 70.0 in 2004 among population, but it reduced until 5.0 in 2009. The incidence of Hib meningitis was 2002-2005y, N.meningitis and S.pneumoniae meningitis were 2006-2008y, S.pneumonia meningitis was more higher 2009-201 Oy comparing with other pathogens.Conclusion. N.meningitidls, S.pneumoniae H.influenzae type b are the leading causative agents of childhood bacterial meningitis in Ulaanbaatar, and the incidence rate is higher than what were reported in other Asian countries.

Extraintestinal pathogenic Escherichia coli (ExPEC), the specialized strains ofE.coli that cause most extraintestinal infections, represent a major but littleappreciated health threat. Phylogenetic analysis has shown that ExPEC is composedof four main phylogenetic groups (A,B1, B2, and D) and that virulent extraintestinalstrains mainly belong to groups B2 and D.In this study, we aimed to assess therelation between adherence virulence and phylogenetic groups of ExPEC.A total of 161 E.coli samples were collected. Out of these 17 (10.6%) werefrom pus, 66 (41 %) from urine, 78 (48.4%) from cervical swab. The phylogeneticgroups and 6 virulence genes (fimH, papC, papGII, papGIII, fa/draBC,andSfa/focDE) encoding adhesins were identified by triplex PCR. Phylogeneticgroups distribution was as follows: B1 10.5%, A 24.7%, B2 25.3%, and D 38.9%. Virulence genes prevalence was fimH 90.1%, papC 23%, papGII 16.8%, papGIII1.9%, Afa/draBC 11.8%, andSfa/focDE 5.6%. The cell surface protein (curli) wasdetected 50,3% by Congo red agar. In conclusion: The most isolated strainsbelonged to the phylogenetic group B2 and D. The phylogenetic groups weresignificantly associated with some genes encodingadhesins (fimH, papC) and cellsurface protein (curli).

BackgroundHuman vitamin D status primarily depends on skin exposure to the ultraviolet B (UVB) spectrum of the sunlight.Despite the many days of sunshine in Mongolia, the northern latitute means that much of the UVB is filteredout as it passes through the atmosphere. Studies of Mongolian infants, schoolchildren, and pregnant womenreveal prevalent and profound vitamin D deficiency in the winter months in Mongolia. To date, there has notbeen a single study of the vitamin D levels of Mongolian men, and no studies of working age women outside ofUlaanbaatar. The goal of this study is to determine Vitamin D levels among Mongolian working age populationin different geographical areas, in different seasons, and in different work settings.MethodsThis cross-sectional study was conducted among 120 healthy adults, recruited by a multistage clustersampling method in Ulaanbaatar, South Gobi, and Bulgan. Each participant was tested for serum 25(OH)Dconcentrations, twice in winter and summer. Samples were measured by ELISA. The paired sampling (120summer samples/120 winter samples total 240 samples) frame allowed us to compare an individual’s winter25(OH)D levels to their own summer 25(OH)D levels, avoiding any confounding by differences betweenindividuals. A paired T-test (two sided) with unequal variances was used to test for differences in 25(OH)Dlevels among study groups.Results95% of all participants were Vitamin D deficient (<20 ng/ml) in winter, 24% deficient in summer (p < 0.001).The mean winter serum 25(OH)D levels were (±SD) 10.7±5.3 ng/ml, which were doubled in the summer to(±SD) 26.1±8.1 ng/ml. In all three regions, men and women had similar mean 25(OH)D levels. In Ulaanbaatar,office workers had higher winter 25(OH)D levels than urban outdoor workers. Surprisingly, office workersin the Gobi had higher 25(OH)D levels than nomads in both winter and summer. In Bulgan, there were nodifferences between office workers and nomads in any season.ConclusionWe observe that low vitamin D levels are more prevalent in our winter samples of healthy working age adults.The prevalence of vitamin D deficiency is very high amongst the adult population. These data suggest a needto increase vitamin D intake either through improved fortification and/or supplementation.

Introduction: Determining stages of liver fibrosis in chronic liver disease is essential for clinical practice such as decision making on medical treatment, setting the interval of follow-up examination for its complication, screening intervals for hepatocellular carcinoma. Goal: We compared non-invasive fibrosis markers among the patients with chronic hepatitis Delta. Materials and Methods: Totally 70 patients with chronic hepatitis D enrolled into this study. The blood samples were examined for complete blood count, liver function test and serum M2BPGi level. Non-invasive markers such as AAR, APRI, Fib-4 scores were calculated. Those with AAR >1, APRI >0.7, FIB-4 >1.45 were considered with advanced fibrosis. All patients underwent liver stiffness measurement using FibroScan M2 probe. The cutoff values of FibroScan for advanced fibrosis were 9 kPa for patient with normal transaminase level and 11 kPa for patients with elevated transaminase. Results: Advanced fibrosis was observed in 25.7%, 38.6% and 38.6% by AAR, APRI and Fib-4 score, respectively. When cut-off levels of serum M2BPGi for advanced fibrosis was 2.2 COI, 35.7% had advanced fibrosis. FibroScan tests showed 34.4% had advanced fibrosis. The AUROC of M2BPGi were 0.894 and 0.827 for predicting advanced fibrosis and liver cirrhosis. Conclusion Serum M2BPGi and FibroScan would be reliable diagnostic tool for identifying liver fibrosis in Mongolian patients with chronic hepatitis D.

Background: Age-related macular degeneration (AMD) is an eye condition, that occurs people aged above 50, leads to gradual loss of the vision because of a damage in the macula, which is located in the center of the retina. Several polymorphisms in different genes have been proposed as factors that increase the disease susceptibility. Therefore, we investigated the association between rs833061 polymorphism of VEGF-A gene and rs10490924 polymorphism of ARMS2 gene and AMD in order to analyze with other similar studies by meta analysis. Purpose: To investigate the polymorphisms of VEGF-A gene and ARMS2 gene on AMD susceptibility Methods: is case-control study was conducted on 74 AMD patients and 32 unaffected age-and gender-matched control individuals. Genomic DNA was extracted from the peripheral venous blood. The single nucleotide polymorphisms were identified by restriction fragment length polymorphism (RFLP) method and results confirmed by gel electrophoresis. The REVIEW MANAGER 5.2 software and MetaXL was used for meta-analysis Results: We did not find statistically significant differences in С allele and СС genotype frequency of rs833061 polymorphism of VEGF-A gene between patients and controls. However, analysis of rs10490924 polymorphism of ARMS2 gene shows that T allele (OR=2.72, 95% CI, 1.47 – 5.02, p=0.001), TT genotype (OR=4.54, 95% CI, 1.49 – 13.87,p=0.019) were significantly associated with AMD risk. Haplotype analysis of these SNPs showed that C+T haplotype was statistically significantly different (OR=5.23, 95% CI, 1.76-15.54, p=0.002) between patients and controls. Conclusion As shown by results, rs10490924 polymorphism of ARMS2 gene show that T allele, TT genotype and C+T haplotype were significantly associated with AMD risk In meta-analysis, T allele of rs10490924 polymorphism of ARMS2 gene was significantly associated with AMD risk in all ethnicity that include Asian and Caucasian. However, T allele prevalence was higher in Asians.