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Mongolian Medical Sciences.2019;187(1):65-70.

Amniotic fluid (AF) holds many important roles in the development of the fetus such as supporting fetal growth as well as protecting it from distress or infection. The fluid can also function as a vital source of fetal cells to be used in prenatal assessment of the fetus. Should it not be used or requested to be used by the patient, it will be discarded. There are numerous reports in the literature on the various cells present in amniotic fluid; as the population of cells is heterogeneous with a diverse range of cells, to include differentiated and undifferentiated cells.
Although AF cells were reported to have limited proliferative capacity and are terminally differentiated cells, telomerase activity was detected in both cultured and uncultured human AF cells from 14 weeks’ gestation, suggesting that cells with high proliferative capacity exist in AF. Populations of stem cells in AF are based on their potency, either multipotent or pluripotent. There are 2 types of multipotent AF cells discovered; the amniotic fluid c-Kit+, Lin- (AFKL) cells and amniotic fluid mesenchymal stem cells (AF-MSCs). AFKL are multipotent AF cells having multilineage hematopoetic potential in vitro and express CD4. Furthermore, expression of Oct4 (critical marker for pluripotency) was also discovered, indicating the presence of a pluripotent subpopulation of cells in AF-stem cells. Most importantly, the discovery of stem cells in AF, specifically Amniotic Fluid Stem Cells (AFSC), has elevated the potential of AF as AFSC signify a novel class of pluripotent stem cells with intermediate characteristics of ES cells and adult stem cells.
AFSC are easy to maintain in the laboratory, the proliferation and differentiation of AFSC is both safer and more ethical to use in clinical applications as they are non-tumorigenic and relatively accessible, being acquired using a minimally invasive procedure. Furthermore, AFSC would be an ideal candidate for autologous transplantation as they lack the MHC Class II antigen and are therefore non-immunogenic. These advantages present an interesting application for AFSC in future in vitro and in vivo studies.
In this review, we have summarized some of the important aspects of AF and AFSC and provided an update on those cells present in AF, together with its future potential for prenatal assessment. Consequently, amniotic fluid represents a very valuable tool that has the potential to save lives and reduce human suffering, particularly through regenerative medicine.

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Health impact of air pollutants and nutritional solutions to reducenegative consequences

Erkhembayar Sh ; Munkhtsetseg J

Mongolian Medical Sciences.2019;187(1):71-79.

Air pollution, including particulate matter and gases has been associated with cardiovascular and respiratory diseases, particularly in urban areas. More than 80% of world population lives in environment those exceed the air quality guideline established by World Health Organization. Air pollution is a very complex mixture and its potential to cause harm can depend on multiple factors including physical and chemical characteristic of pollutants. It has been hypothesized that the intake of anti-oxidant and anti-inflammatory nutrients may improve various respiratory and cardiovascular effects of air pollution through reductions in oxidative stress and inflammation. Several studies have suggested that essential micronutrients including B vitamins and Vitamin C, E and long-chain polyunsaturated fatty acids has potentials to modify oxidative and inflammatory stress. Here, we review literature related to air pollution and its health impact and how essential micronutrients can worsen its negative effect.

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The effect of nutrition risk factors for esophageal and gastric cancer

Enkhmyagmar D ; Tulgaa L ; Nasanjargal T ; Batbold B ; Ganchimeg D ; Tegshjargal B ; Bolor-Erdene T ; Bayar D ; Erkhembayar E ; Chinzorig M ; Dashmaa A ; Tsegmed S

Mongolian Medical Sciences.2019;187(1):80-86.

Gastric and esophageal cancer is a significant global health issue. The epidemiology of these tumors has significantly increased over the past several years especially in developing and developed countries. Many dietary exposures have been proposed to protect against or increase risk for esophageal and gastrointestinal (GI) cancers, including poor diets, foods, individual nutrients, methods of food preparation, and habits of consumption. Overweight/obese status is associated with an increased risk for many cancer types such as esophageal, gallbladder, kidney, pancreatic and gastric cancer. The association between obesity and cancer is strong. Nowadays there is a recognized decrease in incidence and mortality of distal gastric cancer and an increase in incidence and mortality of proximal esophageal cancer. In Mongolia, gastric cancer is the second most common cancer in males and the third most common in females. It is very important to understand how diet and nutrition affect to gastric and esophageal cancers. In this review we will discuss the effect of diet in locally advanced gastro-esophageal cancer. Although we tried to conclude all published articles about gastric and esophageal cancers in Mongolia.
In this survey, is considered dietary risks into 5 groups as following;
• Insufficient nutrition education(don’t know food and nutrients significance and food hygiene, don’t know right consumption of food)
• Bad habits (hot tea and meals, salty tea and food, low consumption of fruits and vegetables, sometimes eating breakfast, most of daily energy of food in the night, high amount of sugar, a drink of caffeine, overweight and etc.)
• Food processing technology (such as overcooking, pickling, preserving, frying, excessive salt in tea fried and etc).
• Chemical contaminants in food products (various inorganic fertilizers, heavy metals and etc.)
• Household economic capacity is influencing
Diet can be used as a tool to evoke the positive/desirable biological responses of an organism aiming to maximize health and protection against diseases (chronic/non-communicable diseasesparticularly cancer) by mostly means of prevention.

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First Successful Endovascular Repair of Descending Thoracic Aortic Aneurysm In Mongolia

Lkhagvasuren Z ; Marcus HOWEL ; Tsegeenjav D ; Baasanjav N ; Burmaajav B

Mongolian Medical Sciences.2010;151(1):4-7.

Endovascular repair of descending thoracic aortic aneurysm is an attractive approach. Candidates for endovascular repair should have an inner aortic diameter of 23-37 mm adjacent to the aneurysm without signifi cant thrombus or calcifi cation in these so called landing zones. They should have at least 2 cm of normal aorta both proximal and distal to the aneurysm to ensure adequate fi xationof the divece. Endografting of the descending thoracic aorta requires preoperative measurements of the diameter of the proximal and distal necks of the aneurysm, tratment length, and proximal and distal angulation. This information can be obtained from CT-ic angiography using three dimensional reconstruction.

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The Hygienic Assessment of Secondary School of Organization of Teaching and Educational Activity, Chemical and Bacterial Contamination On Teaching Environment

Amardulam N ; Burmaajav B ; Kupul J ; Amgalan G ; Baigali O ; Oyunchimeg M

Mongolian Medical Sciences.2010;151(1):8-11.

NEED FOR STUDY AND GOAL: There is no data available on pupil’s health with relation to the school environmental condition and organization of educational activities in Mongolia. Therefore, the goal of the study was to assess organization of the educational activities and conduct hygienic assessment of chemical and bacteriological contamination in the school environment.MATERIALS AND METHODS: A total of 1440 children were surveyed in this cross sectional study from the 6 secondary schools of UB city, Uvurhangai and Dornod aimags.Hygiene conditions of school was assessed and organization of educational activities evaluated by class timetable and pupil’s notes of daily regime.RESULT: Timetable of lessons: It was observed that in some cases teachers’ taught to primary pupils Mathematics and Mongolian language for 2 sequential hours, depending on some indexes such as lesson content, capacity and student’s activity. According to timetable of lessons of the secondary schools, pupils have lessons for 32-34 hours in a week. It was revealed that most schools have 2-3 hours more than standard timetable and heavy lessons were taught for 2-3 sequential hours. For the secondary classes, average length of classes was 32-34 hours in a week which indicates 2-3 hours longer timetable. There was no special place for physical training and movement games etc where pupil can do physical exercise, relax and enjoy school life. DAILY REGIME: pupils have been spending most of their time watching TV and listening music and spending few hours to help housework, to read a book and to prepare meal. Urban pupils spent total of 0.5-1 hour for coming to school and going to home but rural pupils spent 20-30 minutes approximately. RESULT OF THE LABORATORY ANALYSIS: The bacteriological analysis of 36 classes in schools showed that before lesson, 94.4% of classes were clean while 5.6% was contaminated in first season of school year. After the lesson, percentage of classes without contamination had been dropped to 88.8% and classes with contamination had been increased to 11.2%. In the 4th season of school year, before lesson 61.6% of classes was clean and 16.6% was contaminated and 22.3% was highly contaminated. Moreover, after the lesson, classes without contamination had been dropped to 27.7% while 72.3% was at high level contamination.CONCLUSION: 1. Time table of lessons and break time management is inadequate in the schools and 32-39.1% of pupils do not follow the daily regime. 2. In the end of day, chemical and bacteriological contamination increased in the classes.

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Results of Study of Mongolian Pupil’s Learning Abilities

Amgalan G ; Burmaajav B ; Kupul J ; Amardulam N ; Baigali O ; Oyunchimeg M

Mongolian Medical Sciences.2010;151(1):12-16.

INTRODUSTION: There have been limited research studies done in Mongolia on health status of children in relation to density of children in school classrooms.GOAL: This study aims to evaluate learning ability of children in Mongolia and develop recommendations for next intervention measures.MATERIALS AN METHODS: A total of 1440 children were surveyed in a cross sectional study that included 6 classes from 6 secondary schools of UB city, Uvurhangai and Dornod aimags. The test of letter drawing created by of V.Ya.Anfi mova was used to evaluate the pupil’s learning skills. This test was performed at the fi rst and last classes in each day of which was tested at the beginning (I quarter or September) and end (IV quarter or May) of the academic year.For each tests we accounted the mean of drawing letter, mean of mistake for 500 letter and standard deviation.RESULTS: The results of pupil’s letter drawing tests were compared by quarter for fi rst and last classes in each day. Pupil’s learning ability of class 4 was enough while other classes were not enough (P index 1) on the fi rst and last tests.CONCLUSION: Pupil’s learning ability has been changed by the same way of physiological adaptation process of child.Pupil’s learning ability had been decreased in last tests of each day and on Friday which was revealed by letter drawing test.Pupil’s learning ability of classes between 4 to 9 were not enough on the fi rst term while 4th class was good enough on the forth term (P index 1).

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The Study of Respiratory System Disease Morbidity and Mortality of Ulaanbaatar City Population

Suvd B ; Enkhjargal A ; Oyunerdene O ; Narantungalag G ; Saijaa N

Mongolian Medical Sciences.2010;151(1):16-20.

This survey had conducted for determining respiratory system disease and mortality trend of Ulaanbaatar city population and for developing evidence based recommendations. In accordance with the methodology we had done meta-analysis and statistical analysis on data 2004-2008. For the data analysis we used SPSS and parametric and non-parametric tests were used for determining disease changes and differences of seasonal, age and gender. In recent 5 years, in Ulaanbaatar, respiratory system disease cases are continuously leading 5 leading causes of disease. In 2008, respiratory system disease cases were 865.0 per 10000 populations and it is compare to 2004 increased by 10-30 percent. Children and women are more tend to attend to hospitals due to diseases cases. The survey also revealed that incidence of pneumonia (116.7-145.8 per 10000 populations) was the most visited case from other ICD10 causes of diseases.The mean age of mortality of respiratory system disease was 36.6±31.8 and the oldest age was 101 and the youngest was under 1 year old during 2004-2008 in Ulaanbaatar. During spring season, acute respiratory system disease, chronic bronchitis pneumonia and others respiratory system disease cases were more admitted from the respiratory system disease. Whereas, during autumn season, emphysema, during winter season bronchitis were the leading causes of respiratory system disease admission (x2=33.779, p=0.013).CONCLUSION: The statistics, 2004-2008 in Ulaanbaatar, were showing respiratory system disease trend constantly and continuously increasing. Age, gender and seasonal characteristics were signifi cantly correlated with the respiratory system disease. During these 5 years, 932 deaths were recorded and mean age of dying was 36.6±31.8.

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Survey of Knowledge, Attitudes and Practices For Tuberculosis Among Health Care Workers In Mongolia

Erdenechimeg E ; Naranzul D ; Naransukh D ; Maygmarchuluun ; Enkhgargal G ; Tsolmon CH ; Tsevegdorj TS ; Ouyntogos L

Mongolian Medical Sciences.2010;151(1):21-25.

BACKGROUND: Tuberculosis (TB) morbidity and mortality has been one of the pressing issues in the health sector of our country. In Mongolia, 2 people out of 1000 people developed tuberculosis annually, which leads to becoming one of the 7 countries with high TB morbidity among 37 countries of the Western Pacifi c Region.OBJECTIVE: The aim of the study is to have the baseline to understand and measure knowledge, attitudes and practices regarding tuberculosis among non-tuberculosis health care workers including family group practitioners, nurses and specialized doctors at the primary, secondary and tertiary health care level of Mongolia.MATERIALS AND METHOD: Cross-sectional descriptive qualitative study. Self-admitted questionnaire were performed for 572 health care workers. Total of 4 aimags/provinces and 3 districts were randomly selected. Selenge, Darkhan-Uul, and Khentii aimags are regions with high tuberculosis burden, Dornogobi and Orkhon aimags are with low Tuberculosis incidence and prevalence in 2008.Altogether 572 doctors and health professionals from selected health facilities were involved in survey questionnaire and 39.9% (228 people) of respondents were working at the primary level, 31.3% (179 people) in secondary level, and 28.8% (165 people) in the tertiary level health facility, respectively. Altogether 23 focus group discussions were organized, involving 130 people.RESULTS: Around 98.6% of respondents answered that TB is spread when infected person coughs and sneezes. However, one of every three respondents answered TB can be transmitted when sharing cups, dishes and other cooking utensils with the infected person, one in every ten people–shaking hands with the infected person, and one in every four people–through mother to child transmission. Such misconception is common among the health professionals, especially among nurses of the secondary and tertiary level health facilities. Around 47.6% or 272 people answered correctly that TB patients have symptoms such as coughing for 2 weeks and longer, develop sputum with blood traces, fever and sweating during night sleep, and loss of weight. However, there is some misunderstanding among the doctors and nurses such as there are skin rashes. When doctors and nurses where asked which form of TB is the infectious one, 86.9% answered correctly that TB with positive smear test is infectious. On assessing the knowledge, attitude and practice on TB treatment, about 93.4% of the respondents answered that treatment shall be done by anti-TB drugs and this result is equally strong among health professionals at all service delivery levels (p=0.075). However, there are some misconceptions among the nurses that TB patients should buy anti-TB drugs from the pharmacies, try traditional medicines and follow religious rituals. This should be paid further attention and issues covering TB should be included in their curriculum. Every second person knows the treatment continuation period of drug susceptible TB patient, which is relatively low knowledge level. According to survey results, every second person knows what DOTS stand for. In other words, 55.4% of the respondents identifi ed correctly what is DOTS, and 13.8% answered that it is a combination of anti-TB drugs, 3 .3% - as TB treatment method, 5.6% - as combination of TB reduction measures, and 2.2% answered that they don’t know.CONCLUSION: Many misunderstandings were found in the fi eld of transmission, BCG vaccination, treatment and anti-TB drugs. There is a need to provide training for non-TB medical doctors and nurses.

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The Diagnosis of Rheumatic Fever and Rheumatic Heart Disease

Bolormaa T ; Zulgerel D ; Tsogt-Ochir CH

Mongolian Medical Sciences.2010;151(1):33-36.

The Jones criteria is a clinical guideline for the diagnosis of rheumatic fever(RF) and carditis. The clinical features were divided into major and minor categories. Major manifestations include carditis, joint symptoms, subcutaneous nodules, erythema marginatum and chorea. The minor manifestations comprised clinical fi ndings(fever, artralgia, cardialgia,abdominal pain, nose bleeding ) and laboratory markers(Leukocytosis, elevated erythrocyte sedimentation rate and C-reactive protein, prolonged PR on ECG). It was proposed that the presence of two major, or one major and two minor manifestations offered reasonable clinical evidence of rheumatic activity.Carditis is the single most important prognostic factor in RF; only valvulitis leads to permanent damage and its presence determines the prophylactic strategy. The clinical diagnosis of carditis in an index attack of RF is based on the presence of signifi cant murmurs (suggestive of mitral and aortic regurgitation), pericardial rub, or unexplained cardiomegaly with congestive heart failure.Myocarditis(alone) in the absence of valvulitis is unlikely to be of rheumatic origin and by itself should not be used as a basis for such a diagnosis. Two dimentional echo-Doppler and colour fl ow Doppler echocardiography are most sensitive for detecting structural abnormality, abnormal blood fl ow and valvular regurgitation. This method can detect all audible valvular regurgitations to be dThe use of 2D echo-Doppler and colour fl ow Doppler echocardiography may prevent the overdaignosis of a functional murmur as a valvular heart disease. Similarly, the overinterpretation of physiological or trivial valvular regurgitation may result in misdiagnosis of iatrogenic valvular disease. Accurate interpretation of the echocardiographic signals is therefore important.

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Adult Diffuse Pharenchymal Lung Diseases (Dplds): Diagnosis and Treatment

Ichinnorov D ; Oyunchimeg O

Mongolian Medical Sciences.2010;151(1):47-51.

The DPLDs are important, accounting for about 15% of respiratory practice. They comprise a very wide spectrum of pathologies, presentations, and outcomes. There is a serious paucity of evidence about the management of DPLDs, but the morbidity of the DPLDs themselves and the treatments available may be high, with potentially serious consequences therefore for mismanagement. There is concern that DPLDs may be poorly recognized and managed by nonspecialists. Respiratory specialists are the only group with appropriate training and skills to deal with the complexity of the diagnosis and management of these conditions. British Thoracic Society (BTS) Standards of Care Committee set up a sub-committee to formulate recommendations on DPLD management. Purpose of the recommendations: to support improved recognition, diagnosis, assessment, and treatment of patients with DPLD, to raise awareness of the importance of DPLDs, to provide an authoritative current literature review of DPLDs management, to provide practical, evidence and consensus based recommendations that will aid the development of clinical services for patients with DPLD. This article contains the summary of diagnosis and assessment of diffuse parenchymal lung disease, based on BTS recommendations on DPLD management.

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