Background: The study of the anatomical structure of the ankle joint ligaments is essential for understanding the stability, axis, and movement of the joint, as well as their interrelationship with the function. It also provides fundamental quantitative data for the training and research of physiotherapists, as well as the practice of injury and trauma medicine. Proper diagnosis and treatment of ankle joint injuries, as well as understanding the mechanism of injury, are based on this knowledge. Ankle joint injuries are common, with ligament and tendon injuries accounting for 85% of ankle injuries. In Mongolia, 81.1% of ankle injuries are new, 9.4% are similar to the initial injury, 8.1% are recurrent injuries, and 0.7% have unknown causes. Depending on the mechanism of injury, certain ligaments and connective tissues can be damaged. Ankle ligament injuries are the most common cause of acute ankle pain, and chronic ankle pain is often due to structural changes in the ankle ligaments. Aim: To summarize the research on the normal anatomy of the ankle and subtalar joint, as well as the studies on joint injuries, using the dissection method. Materials and Methods: Literature search was conducted in Thomson Reuters, Pubmed central database, Google Scholar, and Web of Science databases, as well as the statistical data from the Health Development Center and the National Center for Trauma and Orthopedics. Keywords used include: ankle joint, subtalar joint, ankle joint and subtalar joint injuries. A total of 330 publications were identified, and 34 key articles on the normal anatomy of the ankle and subtalar joint, as well as joint injuries, were included in the review. Results: The ankle joint is formed between the distal end of the tibia and the superior articular surface of the talus. It allows plantar flexion and dorsiflexion movements, with a normal range of 30 degrees for plantar flexion and 50 degrees for dorsiflexion. The subtalar joint is formed between the posterior articular surfaces of the talus and calcaneus. It allows inversion and eversion movements, with a normal range of 35 degrees for inversion and 20 degrees for eversion. The ankle ligaments are divided into three groups: lateral, medial, and inferior tibiofibular (syndesmotic) ligaments. The most common cause of ankle joint injuries is excessive inversion of the subtalar joint, leading to injuries to the joint capsule, lateral and medial collateral ligaments, and the syndesmotic ligaments. Excessive plantar flexion and dorsiflexion of the ankle joint can also cause injuries to the posterior talofibular ligament, the osteochondral region of the talar neck, and the anterior-inferior margin of the tibia. Conclusion Comprehensive study of the ankle joint structure provides the basis for explaining the mechanism of injury. Further research in Mongolia is needed, combining dissection and imaging techniques, to develop standardized evaluation protocols that correlate with clinical outcomes.

Background: Class III malocclusion is considered to be one of the most difficult and complex orthodontic problems to treat. For patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers solution, surgery to realign the jaws or reposition dentoalveolar segments is the only possible treatment option left. Aim: The treatment objectives were to: (1) level and align the dental arches; (2) obtain an ideal overbite and overjet, to establish correct anterior guidance; and (3) improve the facial profile. Case: Patient is present with skeletal Class III malocclusion, concave facial profile, facial proportion 0.96:1:1.04, loss of occlusion due to early molar teeth loss, molar and canine relationship were Class III, overbite 0 mm, overjet -1 mm, midline shifted into the 6 mm left side. Results: Excellent facial and occlusal results were achieved with this surgical-orthodontic management, post-treatment results showed a Class I relationship and ideal overjet and overbite. The facial profile became straight type. Conclusion This case report describes the treatment of a female with dental and skeletal class III relationships. Surgical- orthodontic treatment was the best option for achieving an acceptable occlusion and a good esthetic result in this case. An experienced multidisciplinary team approach ensures a satisfactory outcome.

Background: Hepatocellular carcinoma (HCC) is a primary liver cancer originating from liver cells, classified as a chronic liver disease. This cancer ranks third in the world in terms of mortality rate. The MELD (Model for End-Stage Liver Disease) and Child-Pugh scoring systems are utilized to assess the prognosis of chronic liver diseases. Based on studies suggesting that certain blood test indicators, particularly red cell distribution width (RDW), could be used to predict the prognosis of liver cancer and other cancers, as well as serve as diagnostic markers, this topic was chosen to evaluate the clinical significance of RDW in hepatocellular carcinoma. Aim: The aim is to study some blood test indicators and compare them with the MELD score and Child-Pugh score systems in order to determine the prognosis of chronic liver diseases. Materials and Methods: A retrospective, single-center, cross-sectional study was conducted at Mongolia-Japan Hospital. Among 322 patients diagnosed with HCC, 24 patients were selected for the case group, and 37 patients with liver cirrhosis were included in the control group. Results: According to the research criteria, 61 patients were selected and divided into 3 groups, and statistical analysis was performed. In the detailed blood test, platelet count and WBC count showed statistically significant differences among the 3 groups (p< 0.024). In the biochemical tests, C-reactive protein (CRP) was p< 0.018, total bilirubin p< 0.001, and the mean albumin level p< 0.015, all showing statistically significant differences among the 3 groups. A statistically significant inverse correlation was observed between RDW-CV and the clinical MELD score (r=-0.356). Conclusion Platelet count, RDW, CRP, total bilirubin, and average albumin levels are significantly different across the studied groups. RDW-CV shows a moderate inverse correlation with MELD scores, suggesting its potential as a prognostic marker in chronic liver diseases. Further research with larger sample sizes is recommended to confirm these findings.

Background: Vulnerable populations at risk of micronutrient deficiencies include children and women, especially pregnant women, lactating mothers, infants and young children. According to WHO guidelines, a population with a micronutrient (vitamin and mineral) deficiency of more than 20% is considered a public health problem.
Although Mongolia has made significant progress in improving the nutritional status of the population, especially children and women, the 2024 VI survey found that micronutrient deficiencies are high among pregnant women.
The MMS (Multi-ingredient Micronutrient Supplement) distributed to pregnant women by soum and household health centers contains all the essential vitamins and minerals for pregnant women, but coverage has remained inadequate for more than 10 years. Goal: To establish the prevalence of micronutrients deficiency in pregnant women Materials and Methods: Totally 2796 pregnant women included in cross-sectional study from urban and rural area. Survey procedures consisted of interview, anthropometric measurements, clinical examinations, and the collection of biological (blood and urine) samples for pregnant women. Micronutrient deficiencies were assessed by tests for hemoglobin, serum, ferritin, soluble transferrin receptor (sTfR), 25-hydroxyvitamin D {25(ОН)D}, spot urine samples for determination of urinary iodine concentration. Statistical processing : The data from the survey questionnaires were entered into a database created in the “EpiData 3.1” software environment. The data created and verified in the EpiData software environment were converted to the “SPSS–25” program, and statistical analysis was also performed using the SPSS-25 program. The results table was prepared using Microsoft Word 2021 and Microsoft Excel 2021 programs. Research ethics: The research methodology was discussed at the meeting of the Medical Ethics Review Committee under the Ministry of Health on 2023.03.27 (23/017), and permission to conduct the study was obtained Result : The prevalence of anemia, as measured by hemoglobin, was 22.3% and the iron deficiency anemia (IDA), as measured by adjusted serum ferritin or soluble transferrin receptor (sTfR) was (39.8%/9.0%). Prevalence of iron deficiency as measured by serum ferritin was also highest in Western 41.9% and lowest in Khangai region 40.2% (P<0.01). The prevalence of vitamin D deficiency among pregnant women was high at 92.5%, and 7.5% of all pregnant women had adequate vitamin D status. The median concentration of 76.4µg/l indicates inadequate iodine status in pregnant women, as the desired range for adequate iodine nutrition in pregnancy 150-249 µg/l. Conclusions 1. 22.3 percent of pregnant women are anemic, and the prevalence of anemia has not decreased from 2017 levels and remains common.
2. The prevalence of iron deficiency (as measured by ferritin levels) was 39.8 μg/L and the soluble transferrin receptor level was 9.0 μg/L, which is higher than previous studies.
3. The prevalence of vitamin D deficiency among pregnant women remains common, with 76.6% having severe or moderate deficiency, and 15.9% having mild deficiency.

Background: Spinal muscular atrophy (SMA) is a degenerative neuromuscular disease that causes progressive muscle weakness and atrophy due to the loss of the motor neurons. Approximately 95% of patients with SMA are homozygous for the deletion of SMN1 exon 7. With an incidence of 1/10.000 and a carrier frequency of 1/40 to 1/50, SMA is the most common genetic cause of death in infants. Purpose: To detect homozygous deletion of SMN1 exon 7 and to analyse the SMN1 copy number by molecular genetic analysis. Materials and Methods: In this study, 3 SMA patients with SMN1 gene homozygous deletion and 17 people of their relatives were included. Molecular genetic analysis was performed in the Central Scientific Research Laboratory of the Institute of Medical Sciences. DNA was extracted from peripheral blood, and its purity was assessed by spectrophotometer. Homozygous deletion of SMN1 gene was analyzed with allele-specific PCR, and the SMN1 gene copy number was evaluated by real-time PCR. Results: Among the five participants diagnosed with SMA by clinical symptom and electromyographic test, three cases were found to have homozygous deletion of exon 7 of the SMN1 gene, while two cases did not exhibit such mutation by the allele specific PCR analysis.
The mean age of study participants was 27.76±16.07 (ranging from 8 months to 52 years). Six of the 7 relatives of the first proband had 1 copy number of SMN1 (0.75±0.29) or were carriers of SMA, while one had 3 copy numbers (2.99) or no deletion of SMN1 gene. Additionally, 6 of the 7 individuals of the second proband had 1 copy number of the SMN1 gene (0.72±0.14), and 1 person had 2 copy numbers. All 3 relatives of the third proband had 1 copy number of SMN1 gene (0.96±0.37). Conclusion We consider that determination of SMN1 gene homozygous deletion and carrier testing can be performed by the PCR method locally. Further, it is necessary to implement the molecular genetic testing method into practice and to study the requirements and needs of early detection of SMA in the newborn screening program of Mongolia.

Introduction : Water is a vital resource for human existence and is essential for daily food processing, preparation, washing, hygiene, and sanitation. Furthermore, providing the population with safe drinking water is one of the pressing problems of the world and some regions.
In recent years, population density and the scale of commercial and industrial activities, as well as clean and dirty water consumption were increased in the capital city. As a result of these, ground and surface water resources are becoming scarce and polluted.
Therefore, assessment of daily drinking and residential water consumption of Ulaanbaatar should be determined to use drinking water properly in daily life and water loss. This study assessed the actual amount of households’ daily water consumption. Goal: The purpose of this study is to determine the daily consumption of drinking water for households in ger areas and apartments in Ulaanbaatar. Materials and Method: This study covers 30 households in ger areas and 15 apartment households, in Ulaanbaatar. Household members performed 6-10 types of measurements every day, within 7 days. As a result of these measurements, actual consumption of water quantity used for drinking and household purposes was calculated. Statistical analysis was done by SPSS Version 21 to calculate the true probability of difference between parameters. Result: 67.9% of the households in the ger areas were 4-5 family members. The average daily household consumption of drinking and domestic water were 68.3 ± 3.57 L (95% 61.3-75.3), the minimum consumption was 12 L, and the maximum was 227 L. Average of the household water consumption water was 97.6-108.9 liters during the weekends, and water consumption was statistically higher than weekdays (p=0.001; p=0.01).
The water consumption of residential households with 3 family members accounted for the majority (30.8%) in this study. The average daily consumption of drinking and domestic water was 297.67±19.7 liters. There was no statistically significant difference (p=0.96) in week. The average daily water consumption including drinking and residential was 270.3-335.97 L.
The total daily drinking and residential water consumption per person was 15.57 L for households in ger areas and 90 L for apartment households. Calculating the daily water consumption of households in ger areas, 60.3% of it is used for laundry, washing dishes, food preparation, washing face and hands, and clothes, 31% for drinking, and 8.7% for outdoor water use. While apartment households, approximately 94.1%, were used for household and 5.9% for drinking purposes. Research ethics approval : This study was discussed at the meeting of the Academic Council of the National Center for Public Health. In addition, this study was carried out according to the methods and methods discussed and approved at the meeting of the Medical Ethics Control Committee of the Ministry of Health (Resolution No. 08). Conclusion The total daily consumption of drinking and residential water per person were 15.57 litres for the households in the ger areas and 90 litres for the apartment households. It implies that it does not exceed the WHO recommendations

Background: Serum natriuretic peptide (NT-proBNP) is a critical biomarker for diagnosing left ventricular dysfunction. Heart failure is the leading cause of mortality in chronic kidney disease (CKD), emphasizing the need for its early detection and prognosis. Objective: This study aimed to determine the serum NT-proBNP levels in participants with CKD and establish a cut-off value for predicting heart failure. Methods: A descriptive cross-sectional study was conducted from April 1 to July 1,2024. This study received approval from the Ethics Committee of the Institute of Medical Sciences (Approval No.24/01). A total of 117 CKD patients hospitalized in the Nephrology and Endocrinology Department of the third state hospital were enrolled based on predefined inclusion and exclusion criteria. Data were collected using questionnaires, laboratory and heart ultrasound test results. Serum NT-proBNP levels were measured using a rapid immunofluorescence quantitative analyzer. Data were analyzed with SPSS 26.0. Results: The mean age of the 117 participants was 57.9 ± 14.7 years, with 51.3% being male. The mean serum NT-proBNP level was 7686 ± 12149 pg/mL. Statistically significant differences were observed in serum creatinine, sodium, calcium, CKD stage, and arterial hypertension between genders (p<0.05). NT-proBNP levels in hemodialysis patients differed significantly between heart failure and non-heart failure groups (p<0.05). Significant differences were also found in hemoglobin, serum albumin, NT-proBNP levels, and CKD stages (p<0.05). NT-proBNP correlated significantly with risk factors such as hemodialysis, diabetes, and decreased systolic blood pressure (p<0.0001). A weak inverse relationship was noted between systolic blood pressure and NT-proBNP (R² = 0.16). The NT-proBNP cut-off value for predicting heart failure was 3027 pg/mL, with an AUC of 61.7% (sensitivity: 74.5%, specificity: 55%). Conclusion Serum NT-proBNP levels are elevated in CKD patients regardless of heart failure. The established cut-off value for NT-proBNP in CKD patients to detect heart failure was 3027 pg/mL, with moderate diagnostic utility (AUC = 61.7%).

Background: Spinal Muscular Atrophy (SMA), an autosomal recessive disorder characterized by lower motor neuron loss, leads to progressive muscle weakness and atrophy. With a neonatal incidence ranging from 1:6000 to 1:11000, individuals affected by SMA face challenges in locomotor function. The advent of newborn screening tests, early diagnostic techniques, and the introduction of gene therapy have, however, shown promise in enabling the acquisition of these motor skills. Objective: This review article seeks to shed a light on current understandings of the epidemiology, clinical presentations, diagnostic methods, and treatments for spinal muscular atrophy, highlighting cutting edge approaches within the discipline. Methods: A thorough search was conducted on PubMed, Cochrane, National Institutes of Health, and Web of Science databases for recent research articles concerning SMA’s incidence, prevalence, clinical manifestations, early detection, genetic testing and contemporary gene therapy. Results: The prevalence of SMA stands at 1-2 cases per 100,000 population, with an incidence of approximately 8 cases per 100,000 live births. Pre-1995 studies exhibited varying prevalence rates due to using non molecular-biological methods, small localized populations, diagnostic errors, and regional characteristics. Diagnosis involving Multiplex ligation-dependent probe amplification (MLPA), quantitative polymerase chain reaction (qPCR), or next-generation sequencing (NGS) analysis to confirm SMN1 and SMN2 gene status aids in identifying carriers and SMA subtypes. Countries implementing newborn screening programs have demonstrated early SMA detection in asymptomatic newborns, contributing to reduced mortality and disability rates. Currently, several types of gene therapy are being used in the treatment of SMA. Conclusion The epidemiology of SMA varies between countries and regions. It is fully possible to confirm the disease, identify carriers and subtypes. The inclusion of SMA in newborn early detection programs is crucial for reducing infant mortality and disability, and several gene therapies have received approval from relevant authorities for SMA treatment. In Mongolia, it is possible to introduce tests to confirm the disease and determine carriers and subtypes.

Association between biomarkers of ovarian reserve and maternal age among infertility women Background: Ovarian reserve declines with maternal age and researchers have proposed a variety of biomarkers to determine ovarian reserve and function. Also, for couples diagnosed with infertility, the determination of ovarian reserve is an important predictor of pregnancy outcome. Therefore, researchers report that there is a need to specifically study the relationship between women's age and ovarian reserve markers in women diagnosed with infertility. Materials and methods: The study was conducted in cross-sectional design from May 2021 to April 2022 at the National Center for Maternal and Child Health based on the Infertility and Reproductive Center. Maternal diagnosed with infertility were included in the study, and laboratory markers (Follicle stimulating hormone, Luteinizing Hormone, Estradiol, Anti-muller hormone) were measured, and data were collected. Results: The study included 158 women aged 23-47 who were diagnosed with infertility, and the mean age was 33.6±5.3. The mean markers of the laboratory tests of the women included in the study were Follicle Stimulating Hormone 7.9±2.8, Luteinizing Hormone 7.9±2.84, Estradiol 43.2±6, and Anti-Mullerian Hormone 3.3±5.0. Women's age was associated with Follicle-stimulating hormone (r=-0.116, p=0.045), Luteinizing Hormone (r=-0.16, p=0.006), Estradiol (r=-0.26, p=0.008) and Anti-Mullerian hormone(r= -0.204., p=0.032) had a statistically significant negative relationship. Conclusions: Ovarian reserve declines with age in women diagnosed with infertility, and biomarkers are measured with different efficacy. Ovarian reserve was significantly lower in women aged 40 and older who participated in the study.

Introduction: Among the endocrine, nutritional, and metabolic disease and thyroid disorders occupy a significant place. According to the World Health Organization, 8-18% of the world’s population suffer from thyroid disorders. In our country, no research on the prevalence of the disorders has been conducted before, and this research methodology was discussed by the Scientific committee of the National Center for Public Health and was approved by resolution No.156 of the Ethics Committee of the Ministry of Health on 2020. Materials and Methods: In order to determine the prevalence of thyroid disease in the country, we collected the actual number of thyroid disorders registered in 9 districts of the capital city and 330 soums of 21 aimags for a total of 10 years from 2011 to 2020. The prevalence of thyroid disorders was mapped using Arc view and GIS software. Results Endocrine, nutritional and metabolic disease account for 2.3% of all outpatient cases. Endocrine, nutritional, and metabolic disease accounted for an average of 168.3 per 10000 population over the past 10 years, and thyroid disorders accounted for 45 or 26.7% of endocrine, nutritional, and metabolic diseases. Thyroid disorders are highest in people aged 40-49 years.
Thyroid toxicity is the most common type of thyroid disease in Mongolia, accounting for 56.2%, with an average of 17.2 per 10000 population in 2011-2020. However, iodine deficiency-related thyroid disease accounts for 5.5% of all thyroid disorders, with an average of 2.5 per 10000 population in 2011-2020. In 2011, it decreased by 2.2 per 10000 population, and by 2020, it decreased by 0.2 per thousand to 2.0, but in the last 5 years, it has increased by an average of 2.4 per 10,000 population, and in the last 5 years it has increased by 0.2 per thousand, or 2.6 per 10,000 population. Morbidity is high in the Khangai and Central regions.