Medicinal leech /Hirudo medicinalis/ secretes 150 over bioactive substances from savilary gland, which are hirudin, hialuronidasa, bdellin, eglin, destabilasa, lipase, cholesterol esterase. Medicinal leech’s therapeutic effect is anticoagulant, antiplatelet, anti-ischemic, hypotensive, anti-inflammatory, anti-atherosclerotic and thrombolytic. In Mongolia, medicinal leech therapy’s research is rare. The study was designed as selective sampling and clinical trial study. From June 1st between September 1st in 2016, there were enrolled 30 patients with diagnosis of arterial hypertension stage I at “Piyavka” hospital in Hentii province. Patients were used by method of Medicinal leech therapeutic of the Russian Federation in 2011. Blood samples were used SD LipidoCare analyser, Stago Compact automatic coagulation analyzer. Fibrinogen, Activated partial thromboplastin time, Thrombin time, Prothrombin time, International normalized ratio and Blood lipids level were checked before and after treatment. A total of 30 patients were enrolled in the study. 16 were females, 14 were males and the mean age was 59.13±11.62. Activated partial thromboplastin time was before 37.97 ±5.62 sec and after 45.94±6.05 sec therapy of leeches. Thrombin time was before 17.59 ±1.66 sec and after 19.53±1.38 sec therapy of leeches. As patients who was increased from normal lipid level in blood before leech therapy, Total cholesterol was before 220.63±14.51 mg/dl, after 204.63±13.64 mg/ dl therapy of leeches. Triglyceride level was before 253.69±71.99 mg/dl, after 184.12±61.73 mg/ dl therapy of leeches. Mean of Activated partial thromboplastin time, Thrombin time were prolonged with statistically significant after treatment (p=0.0001). As patients who was increased from normal lipid level in blood before leech therapy, Total cholesterol (p=0.031), Triglyceride (p=0.0003) were decreased with statistically significant by therapy of leeches.

BackgroundLeft ventricular hypertrophy (LVH) is associated with a substantially increased risk of cardiac morbidity and mortality [1-4], so its detection is of major importance, especially for individuals with hypertension or other cardiovascular risk factors. There are many criteria for the diagnosis of left ventricular hypertrophy based on the electrocardiogram but specificity and sensitivity are different depending on age, sex, obesity and ethnicity.GoalThe present study was conducted to determine the sensitivity and specificity of Romhilt-Estes point score criteria of ECG for the assessment of left ventricular hypertrophy by comparing it with the gold standard of echocardiography.Materials and Methods154 clinically diagnosed patients with primary arterial hypertension were included in this study. ECG of the patients was recorded and Romhilt-Estes score criteria calculated. This was followed by echocardiography and left ventricular mass and left ventricular mass index was calculated.ResultsIt was found that Romhilt-Estes score criteria had a sensitivity of 34.9% and specificity of 96.7%. The positive predictive value was 97.73 %whereas negative predictive value was 27.27 %.ConclusionsSensitivity of the criterion Romhilt-Estes score criteria was relatively poor for the diagnosis of left ventricular hypertrophy in patients with arterial hypertension. But specificity of Romhilt-Estes score criteria was high.

According to the literature changes in the body mass index, blood pressure and lipid level might be the risk factors for the ischemic heart disease. The aim of this study was to investigate the BMI (body mass index), blood pressure, lipid levels in the blood of the participants.The BMI and blood pressure were measured by World health organization’s standard methods. Low and high density lipoproteins(LDL, HDL), triglyceride, cholesterol, c reactive protein level were examined from the blood.The BMI of the case group was 26.3(±6) kg/m2, whereas in control group it was 24.8(±3.76) kg/m2. Lipid status was almost same between case group and control group. Also both groups was higher than normal level. The case group of 41.6% and control group of 17.3% are increased by all status triglyceride. The triglyceride level of the patients was 2.1(±2)mmol/l and 1.32(±0.88) mmol/l in control group. HDL level was 56.7(±16.38) in the case group and 50.4(±25.1) in control group. Almost same percentage of bough groups (39-40%) showed decreased level of HDL. 36% of ischemic patients and 40% of control group showed increased cholesterol level. The percentage of people ≥30 kg/m2 was significantly higher (p<0.05) in the case group. There were no significant difference in blood pressure, LDL, HDL and c reactive protein level between the groups. The triglyceride level in case group was significantly higher (p<0.05) than in control group.

Introduction. An uncommon complication of radial arterial blood sampling/cannulation is disruption ofthe artery (obstruction by clot), placing the hand at risk of ischemia. Those people who lack the dualsupply are at much greater risk of ischemia. The risk can be reduced by performing Allen’s test beforehand. People who have a single blood supply in one hand often have a dual supply in the other, allowingthe practitioner to take blood from the side with dual supply.The utility of the Allen’s test is questionable,[1] and no direct correlation with reduced ischemiccomplications of radial artery cannulation have ever been proven. In 1983, Slogoff and colleaguesreviewed 1,782 radial artery cannulations and found that 25% of them resulted in complete radial arteryocclusion, without apparent adverse effects.[2] A number of reports have been published in whichpermanent ischemic sequelae occurred even in the presence of a normal Allen’s test.[3, 4] In addition,the results of Allen’s tests do not appear to correlate with distal blood flow as demonstrated by fluorescein dye injections.[5, 6]Goal. Transradial coronary catheterization across the whole spectrum of Allen’s test results was safeand feasible to address the current uncertainty about the predictive capacity of the Allen’s test fortransradial access.Materials and Methods: This type of descriptive research methods. The patients assisted by SSCHand there were between the ages of 54-88, totally 28 patients. The hand is elevated and the patient/person is asked to make a fist for about 30 seconds.Pressure is applied over the ulnar and the radial arteries so as to occlude both of them.Still elevated, the hand is then opened. It should appear blanched (pallor can be observed at the fingernails). Ulnar pressure is released and the color should return in 7 seconds. If color returns as describedabove, the Allen’s test is considered to be “POSITIVE.” If color fails to return, the test is considered“NEGATIVE” and the ulnar artery supply to the hand is not sufficient. The radial artery therefore cannotbe safely pricked/cannulated.ResultPatients with non-normal Allen’s test results 32.1%.There weren’t any correlation of probability between positive Allen’s test and myocardial infarction, postPCI procedure (p value >0.05).There were correlation of probability between positive Allen’s test and dyslipidemia, DM (p value<0.05).Conclusion:1. We need perform Allen’s test indispensably when transradial coronary catheterization, becausethere were positive Allen’s test not small percent.2. There aren’t additional risk with old myocardial infarction and post PCI procedure patients, becausethere weren’t any correlation.3. There were correlation of probability between positive Allen’s test and dyslipidemia, DM. Thereforedoctors should select artery femoralis if patient have dyslipidemia and DM.

IntroductionChronic periodontitis has been associated with cardiovascular diseases (CVD).GoalThe goal of the present study was to investigate the periodontal status of patients with ischemic heart diseases.Materials and ÌethodsWe studied 35 subjects with clinically newly confirmed ischemic heart disease and 64 matched control subjects with no evidence of cardiovascular diseases all receiving a comprehensive periodontal examination.ResultsPatients with ischemic heart disease had significantly lower numbers of natural teeth. The percentage of participants with periodontal pockets (p<0.001) and clinical attachment losses (p<0.001) were higher in the case group. Statistical analysis demonstrated a difference in the proportion of sites with a periodontal probing depth >3.0 mm (26% for case and 3% for control group, p<0.001). The mean periodontal pocket depth was 5.29 mm in the case subjects and 3.3 mm in the control group.ConclusionOur findings suggest that patients who at routine dental visits demonstrate evidence of deep periodontal pockets and clinical attachment losses around several teeth can predictably be identified as being at risk of future cardiovascular diseases, especially ischemic heart disease. Such subjects should be referred for medical and periodontal examinations and treatments.

Introduction: The World Health Organization describes poor adherence as the most important cause of uncontrolled blood pressure and estimates that 50–70% of people do not take their antihypertensive medication as prescribed.Goal was to measure non-adherence to antihypertensive therapy in a representative sample of the hypertensive Mongolian population and to define the factors associated with non-adherence in the studied population.Materials and Methods:This descriptive study was a questionnaire-based cross sectional analysis. A simple random sample of 735 hypertensive patients, aged 35-64 years was selected. The questionnaire included sociodemographic characteristics and awareness about hypertension and anti-hypertensive treatment, and factors that encouraged or discouraged the patient’s drug taking behavior. Adherence was assessed using the Morisky Medication Adherence Scale (MMAS), with a 4-item questionnaire. Blood pressure was measured twice by the physicians using aneroid sphygmomanometers and stethoscopes. Results and Discussion: The study sample consisted of 265 men (36.1%) and 470 women (63.9%). The mean age of participants was 53.8 ± 8.7 years. The non adherence to medical treatment found in the our study was 68.3% of hypertensive patients. We found younger age (35-44), low family income, not having a regular doctor towards hypertension control, behaviour not taking drug regularly, monotherapy and lack of patient’s knowledge to be the significantly factors influencing on non-adherence to anti-hypertensive medication among Mongolian hypertensive population. The non adherence to antihypertensive treatment found in the current study was higher than that of 25.9%-55.8% found in the study done in Malaysia, Pakistan and Egypt and lower than what a study in the Bangladesh , India and Brazil (74.2%-90.0%)population.Conclusion: The level of adherence to treatment among the participants in this study seriously needs to be improved through well designed health promotion and education strategies in order to prevent poor treatment outcomes.

Background According to the report of World Congress of Cardiology in 2007, 1.5 billion people had hypertension and 45% of hypertensive people were unaware of their condition. In our country, some study had provided estimation of risk factors and prevalence of hypertension, but main characteristics presenting the early detection and control of hypertension have not been studied well and information does not exist.The quality of the control, registration and early detection of hypertension will be improved by studying this topic and complications and mortality due to the hypertension could be decreased.GoalThe aim of our study is to evaluate the current situation of the early detection, registration and control of hypertension, and to describe future strategyObjectives:1. To describe the hypertension awareness and risk factors associated with early detection of hypertension2. To evaluate the current situation of registration system of hypertension and to find out the strategies for renewing registration system3. To investigate the rates of the treatment and control of hypertension, and to survey factors associated with the control of hypertensionMaterials and MethodIt was population based, cross sectional, prospective study. Participants of the study were selected by randomized method.In the study, 1103 individuals, 133 physicians and 2 family hospitals located in Bayanzurkh, Songinokhairkhan districts, were surveyed. The study based on questionnaire and BP measurement which aimed to reveal:• Hypertension awareness (%)• Treatment (%)• Control (%)Software program name: Arterial hypertension registration and control Objectives of the program: to evaluate registration of arterial hypertension, to detect earlier, to determine control level of hypertension Users: family hospitals, family doctorsType of morbidity registration: population basedStatistical analysis was performed with SPSS-17 software program. Single- and multi-factorial analysis was explored by using simple and logistic regression and significance.ResultsIn the study, in total, 1103 people aged of ≥18 years living in Bayanzurkh and Songinokharkhan districts of Ulaanbaatar, have been involved. 37% of all participants were male and 63% were female and mean age of all participants was 40.6±16.1. According to our study, 305 individuals of 431 hypertensive participants (70.8%) were aware of their hypertension. This result was different in gender: 58.0% in male, 79.0% in female. Our research team created software program that can integrate all hypertension data to one database. We are planning to determine unawereness; aware and treated; treated and controlled; and uncontrolled levels by using this software and to introduce the program created by us to all primary level physicians in order to use routinely.Conclusions:1. Among hypertensive individuals, awareness of hypertension was 70.8%. Factors such as young age (<35), single people and not measuring BP for the last one year influence negatively on early detection of hypertension (p<0.05).2. Current method of hypertension registration is not proper at the time. Therefore, we concluded that renewing of the arterial hypertension registration database and conversion it into electronic type is convenient to control arterial hypertension and to provide integration.3. Treatment level of arterial hypertension was 39.9%, controlled arterial hypertension among all hypertensive population - 10.2% and among treated population – 25.2%.

Introduction: According to the report of World Health Organization and International Society of Hypertension, an estimated 17.5 million people died from cardiovascular diseases in 2005 representing 30% of all global deaths, 1.5 billion people had hypertension and 45% of hypertensive people were unaware of their condition in 2007. In our country, prevalence of hypertension and its risk factors are studied, but prevalence of uncontrolled hypertension that is an important criterion of hypertension control, and its influencing factors is not reported yet. Goal: The aim of our study is to evaluate prevalence of uncontrolled hypertension and to determine its some influencing factors.Materials and Methods: It was population based, cross sectional, prospective study. Participants of the study were selected by randomized method. In the study, 1111 individuals that live in Bayanzurkh and Songinokhairkhan districts of Ulaanbaatar city are participated. The study based on questionnaire and BP measurement which aimed to reveal:• Hypertension unawareness• Untreated• Treated and uncontrolledStatistical analysis was performed by using SPSS 17.0 program.Results: In the study, in total 1111 people aged ≥18 years have been involved. Mean age of all participant was 40.58±16.10 and 63.2% of them were female. We estimated that 38.4% of the population had hypertension and 28.3% of those were unaware their hypertension (unawareness). Among aware population, untreated population percent were 42.1%. We determined that age, sex, education level and visiting to physicians can be risk factors of uncontrolled hypertension.Conclusion: Of the estimated 1111 people with hypertension 28.3% were unaware of their hypertension, 29.5% were aware of their condition but were not being treated, 33.7% were being treated but their hypertension remained uncontrolled and only 8.4% were taking medications that controlled their hypertension. Factors such as young age, male gender, and not measuring BP for the last one year influence negatively on uncontrolled hypertension (p<0.005).

Medicinal leech /Hirudo medicinalis/ secretes 150 over bioactive substances from savilary gland, which are hirudin, hialuronidasa, bdellin, eglin, destabilasa, lipase, cholesterol esterase. Medicinal leech’s therapeutic effect is anticoagulant, antiplatelet, anti-ischemic, hypotensive, anti-inflammatory, anti-atherosclerotic and thrombolytic. In Mongolia, medicinal leech therapy’s research is rare.The study was designed as selective sampling and clinical trial study. From June 1st between September 1st in 2016, there were enrolled 30 patients with diagnosis of arterial hypertension stage I at “Piyavka” hospital in Hentii province. Patients were used by method of Medicinal leech therapeutic of the Russian Federation in 2011. Blood samples were used SD LipidoCare analyser, Stago Compact automatic coagulation analyzer. Fibrinogen, Activated partial thromboplastin time, Thrombin time, Prothrombin time, International normalized ratio and Blood lipids level were checked before and after treatment. A total of 30 patients were enrolled in the study. 16 were females, 14 were males and the mean age was 59.13±11.62. Activated partial thromboplastin time was before 37.97 ±5.62 sec and after 45.94±6.05 sec therapy of leeches. Thrombin time was before 17.59 ±1.66 sec and after 19.53±1.38 sec therapy of leeches. As patients who was increased from normal lipid level in blood before leech therapy, Total cholesterol was before 220.63±14.51 mg/dl, after 204.63±13.64 mg/ dl therapy of leeches. Triglyceride level was before 253.69±71.99 mg/dl, after 184.12±61.73 mg/ dl therapy of leeches. Mean of Activated partial thromboplastin time, Thrombin time were prolonged with statistically significant after treatment (p=0.0001). As patients who was increased from normal lipid level in blood before leech therapy, Total cholesterol (p=0.031), Triglyceride (p=0.0003) were decreased with statistically significant by therapy of leeches.

AimThe aim was to study retrospectively the possible changes in practice patterns in the managementof patients with acute myocardial infarction who were admitted to the State Second Central Hospitalduring the last 5 years.Material and MethodThis study conducted at the State Second Central Hospital in September 2014.Patients with acute myocardial infarction were divided into 2 groups: main and control. Main groupincluded 95 patients with myocardial infarction who were treated from 2010 to July 2014. Controlgroup included 102 patients with myocardial infarction who were treated from 2005 to 2009.From 2005 to 2012 patients fulfilled the diagnostic criteria of myocardial infarction based on WHOcriteria. From 2013 to 2014 patients fulfilled the diagnostic criteria of myocardial infarction based onnational guideline’s criteria. Differences in proportions in the groups were tested with the chi squaretest. P value of <0.05 was considered significant.ResultsA total 197 patients (mean age 71.2±6.1, 62% man, and 38% women) with acute myocardial infarctionwere enrolled. More than half had a history of arterial hypertension. Atypical forms of myocardialinfarction increased from 25.8% in 2005-2009 to 40.4% in 2010-2014. ST elevation myocardialinfarction and non ST elevation myocardial infarction were detected in 61% and 39% of patientstreated in 2010-2014. Diagnostic use of troponin was increased significantly in last 5 year (44.2% vs.88.6%, p<0.05).The study revealed only 17.2% of patients with acute myocardial infarction met the national guidelinesgoal of pre-hospital time <12 hours. Eighty four (88.3%) patients of the main group received medicaltherapy and 11(11.7%) treated with percutaneous coronary intervention. Aspirin was prescribed in80.7% of main group, heparin in 97.9%, ACE inhibitors in 47.9%, Beta blocker in 14.9% within 24hours of acute myocardial infarction.ConclusionsCompared with control group use of troponin and invasive treatment strategy has increased since2010 in the management of patients with acute myocardial infarction. Delay of pre-hospital timeremains an actual problem in the management of acute myocardial infarction.