Background: Midwives provide essential maternal, neonatal, reproductive and sexual health care and save lives. In our country, in 2017, the job description of midwives was revised and approved by the Minister of Health in accordance with the core competencies established by the International Federation of Midwives by Order A/216. Therefore, it is necessary to study the extent to which midwives are performing the duties included in the revised job description. Aim: To assess of the professional role and performance of midwives in Mongolia five years after the updated midwifery job description was declared. Materials and Methods: There were 1119 midwives working at all levels of the facilities national wide, and 589 respondents were analyzed. Data were collected using a questionnaire, which was developed with input from an obstetrics and midwifery care advisory group, and was distributed online through Google Forms. We developed a questionnaire on the daily professional roles and performances of midwifery services and skills that were part of the job description of midwives in Mongolia. The questionnaire consisted of three parts and were scored based on a Likert scale. This study was approved by the research ethics committee of the School of Nursing (protocol №22/07-b), Mongolian National University of Medical Sciences (MNUMS), and Ministry of Health. Result: 62.3% of the participants had a bachelor’s degree, 34.3% had a professional degree, 93.5% worked as midwives at all levels of health care, 73.4% worked according to their job description, but 21.9% were unable to work according to their main duties; 56% considered that they faced some difficulties in performing their duties at work. Within the scope of maternity care services mentioned in the job description, 71.4% of them often provide monitoring and counseling to normal, low-risk pregnant women according to guidelines (mean 3.07± 0.96); childbirth and postpartum care are occasionally (mean 2.70±1.10) or not regularly provided; and the average ratings of reproductive health, family planning services, and emergency obstetric care interventions are 2.32±1.120 and 2.40±0.040, respectively. According to self-assessment of professional skills, the average score for the ability to provide care during pregnancy was 3.10±0.038, which is sufficient; the ability to provide care during childbirth and postpartum was 2.83±0.037, which is above average; and the ability to provide emergency obstetric care and reproductive health and family planning care was 2.77±0.84 and 2.57±0.890, which is moderate, respectively. Conclusion The education and professional level of midwives working at all levels of the health sector has improved. While midwives frequently provide the pregnancy care outlined in their job descriptions, they only occasionally perform duties related to childbirth, postpartum and reproductive health, family planning, and obstetric emergency care. According to their self-assessments, midwives demonstrate sufficient competence in teamwork and pregnancy care; above-average competence in childbirth and postpartum care; and moderate competence in obstetric emergency care, reproductive health, and family planning services.There is a need to improve the involvement of midwives in certain professional activities.

Background: Cardiovascular disease (CVD) remains the leading cause of death worldwide, accounting for approximately 19.8 million deaths in 2022, or 32% of all deaths. Insulin resistance is an important pathophysiological mechanism not only in the development of type 2 diabetes mellitus (T2DM) but also in the development and progression of cardiovascular disease. Evidence remains limited regarding the simultaneous assessment of associations between selected anthropometric measures and insulin resistance in patients with ischemic heart disease (IHD). Aim: To investigate the association between waist-to-height ratio (WHtR) and insulin resistance indices (TG/HDL and HOMA-IR) in patients with chronic ischemic heart disease. Materials and Methods: This hospital-based cross-sectional study included 274 patients aged 40–75 years. Written informed consent was obtained from all participants. Data were collected using a structured questionnaire, anthropometric measurements were performed, and peripheral blood samples were collected. Laboratory measurements included fasting lipid profile, fasting glucose, and fasting insulin levels. WHtR was calculated as waist circumference (cm) divided by height (cm). Insulin resistance was assessed using the TG/HDL ratio, calculated as TG (mmol/L) divided by HDL (mmol/L), and the HOMA-IR index. Metabolic syndrome was defined according to the Joint Interim Statement (JIS-2009) criteria. Results: Among the 274 participants, 209 (76.3%) were male and 65 (23.7%) were female, with a mean age of 61.1±7.9 years. WHtR was significantly and positively correlated with HOMA-IR, with a weak-to-moderate correlation (Spearman’s ρ=0.303, p<0.001). A weak but statistically significant positive correlation was also observed between WHtR and the TG/HDL ratio (ρ=0.136, p=0.039). The discriminative ability of WHtR for insulin resistance was moderate (AUC=0.645, 95% CI: 0.562–0.729; p=0.001). The optimal cutoff value determined using the Youden index was 0.60, with a sensitivity of 63.2% and specificity of 64.2%. Multivariable logistic regression analysis showed that WHtR ≥0.60 was independently associated with insulin resistance. Conclusion WHtR was significantly and positively associated with HOMA-IR and the TG/HDL ratio, and WHtR ≥0.60 was independently associated with insulin resistance.

Aconitum navicular (Brϋhl) Stapf, a Himalayan endemic, is an endangered medicinal herb of the alpine region. A search was made under the Latin Name Aconitum navicular (Brϋhl) Stapf. to summarize the use of phytochemical and biological information on the use of ethnomedicine available for the species. The keyword “Aconitum navicular (brϋhl) Stapf.” was collected and compiled from the rankings of PubMed, Web of Science, Google Scholar and other scientific websites. Phytochemical analysis done so far has led to the isolation of 14 alkaloids, 3 flavonoid glycosides, and 4 phenolglycosides. Most commonly, aqueous extract of this plant has been used against various kinds of fever, bitter tonic and intoxicating liquors. In addition, Aconitum species contain the most diterpenoid alkaloids, and this compound is bioactive and somewhat toxic. Many studies have shown that diterpenoid alkaloids exhibit cytotoxic, antioxidant, antimicrobial, analgesic, and anti-inflammatory biological activities. We hope this information will be useful in future research and development of this valuable medicinal plant.

Short and long term impacts of outdoor air pollution on semen quality Introduction: Ulaanbaatar is one of the most polluted capital cities1. In winter, the average daily PM2.5 level of pollution is 687 micrograms per cubic meter, which is 80 times higher than the WHO recommended safe level2. Air pollution contributes to a variety of diseases, including cardiovascular disease, chronic obstructive pulmonary disease, and neurological disorders and infertility3. According to the World Health Organization, 48 million couples and 186 million people worldwide are infertile4, 5. Factors affecting semen quality include chronic diseases, urogenital infections, environmental pollution, lifestyles, and geographical location of nations12,13 . Fine particles and toxins (PM10, SO2, NO2, PM2.5) in ambient air pollution affect the maturation of male gametes and activate DNA damage, cell apoptosis, oxidation, and inflammation14,15. According to researchers, foreign Ambient air pollution affects semen quality, but there is little evidence. Therefore, more research is needed in this regard. Materials and methods: The survey was conducted from January 1, 2020 to April 31, 2021 based on the retrospective longitudinal survey model based on the NСМCH-Infertility Reproductive Center. To measure sperm quality, the sample was diluted for 15 to 60 minutes, stored at 20 to 37 degrees Celsius, and viewed under a microscope at 200x magnification using a Makler Chamber instrument for 1 hour to determine sperm motility and concentration. Count 200 sperm in the field of view and evaluate and classify sperm motility. Measurement of air pollutants: The average daily amount of air pollutants in Ulaanbaatar is determined by the average of 6 guard stations of the Meteorological and Environmental Research Agency. The study used 24-hour measurement data of 4 air pollutants (SO2, NO2, PM2.5, PM10) at 1-hour intervals. Total measurement results from October 1, 2019 to December 31, 2020 are included. Statistical analysis of the survey was performed using STATA 16.0 software. Statistical analysis of the survey was performed using STATA 16.0 software. After clearing and sorting the survey data, if the missing value is 10 percent or less of the total data, the variable is deleted and analyzed. Results: High levels of air pollution have a negative effect on semen volume and sperm count. For example, an increase in particulate matter (PM2.5) in the ambient air by 1 μg / m3 reduces the amount of semen by 0.002 ml and the number of sperm by 17.0 thousand. However, when the amount of PM10 particles increases by 10 μg / m3, the concentration in the semen decreases by 1.14 million. Outdoor air pollution is likely to have a long-term negative impact on semen quality. For example, when the amount of PM2.5 particles in the ambient air increases by 1 μg / m3, the number of sperm in the semen decreases by 81.0 thousand after 3 months. However, if the average amount of SO2 in the ambient air increases by 1 μg / m3, the number of sperm in the semen will decrease by 1.49 million after 3 months. Conclusions: 1. The use of toxic habits in the two groups of men from Ulaanbaatar, who were treated at the andrology laboratory of the National Center for Obstetrics and Gynecology, did not differ statistically. 2. PM10 levels are 129.111.6 μg / m3 higher than the average daily levels of air pollutants in Ulaanbaatar, which indicates a level of adverse health effects. 3. Long- and short-term exposure to ambient air pollutants can adversely affect semen volume and sperm count.

Background: Spine disorder is the first cause of disability of workers below 45 years and economicalburden costs 20-50 billion us.dol, in European countries. Lumbar disc hernia estimates 40% of 30-50aged population in U.S and in Japan 26/10000. In last 5 years, spine surgeries increased in 4-5 timesdue intervertebral disc hernia, at Shastin State Third Central hospital of Mongolia.Goal: To populate new methods of surgical treatment for compressive lesions of spinal cord, spinalnerve root of cervix, thorax and lumbar spineMaterials and Methods: We did clinical research involving patients who had spine surgery at ourdepartment due “compressive lesion of spinal nerve root and spinal cord”. From, total 217 patients,excluded 9. Excluded cases are: declined from surgery 3, Arnold-Chiari malformation 5, and epiduralabscess 1. We collected data with permission of patient and did statistical analysis by IBM SPSS 17.Results: The surgery for intervertebral disc hernia takes 84.6% (176) of total surgery and 94.9% (167)of lumbar disease. Tumor of spinal cord estimates 9.1% (19) of total case, dominates in lumbar area(57.9%). We used posterior approach mostly, because it is frequently used in lumbar spine. The surgerycontinued 36-750 min (204.6, SD 128.5) ten patients (4.8%) had complications. In this project weused 5 surgical methods totally in solitary or combined. Spondilodesis is the most combined methodamong them. We used Oswestry disability index in Mongolia at first, to count treatment effect. Currentindex evaluated pre and post surgery period. Patient complaint and difficulty of daily life progressivelydecreased after surgery and almost disappeared at third month (p<0.00).Conclusion:1. It is possible to develop international standard surgical treatment of compressive lesions of spinalnerve root, spinal cord of cervix, thorax and lumbar spine in Mongolia.2. We used Oswestry disability index in Mongolia at first, so this questionnaire is simpler and accuratemethod for spine, spinal cord induced disability.3. Twenty seven point nine percent of patients who had surgical treatment has minimal to moderatedisability by Oswestry disability index, so it means we have to process standard of spine surgeryand increase non surgical treatment efficiency.4. Working ability recovers faster when spine surgery has been done.5. These new methods of spine surgery are cost effective than same surgery which will be doneabroad.

Background. Low back pain is a frequently encountered symptom. Although 70-80% of the entirepopulation have low back pain complaints in their lives, only 2-4% of them require surgical intervention.’Department of Neurosurgery, Shastin 3rd Central Hospital about 200 patients who undergo back surgery,while 90% of patients who have prolapsed lumbar disc surgery from 2010 to 2012. There are variousstudies indicating that exercise improves pain and disability in chronic low back pain and in those whohave had surgery. The main objectives of the postoperative rehabilitation programmes are to accelerateand maximize function recovery as much as possible, and to prevent further injury by restricting theprogression of degenerative changes. We evaluated the effectiveness of rehabilitation treatments thatare used in our department which is the first time in our country.Goal. To evaluate the effectiveness of rehabilitation after lumbar discectomy.Materials and Method. We examined 83 patients were included the Shastin central hospital, Departmentof neurosurgery and rehabilitation after lumbar discectomy at a single level and operated in the periodfrom May 15, 2013 to September 15, 2014. All patients were evaluated at the beginning and at theend of treatment by Oswestry Disability Index which is a specific functional questionnaire for back pain.Pretreatment values are one month after surgery and posttreatment values three months after surgery.All patients received the intensity specific exercise and back school education programme 3 days aweek for eight weeks.Results. All patients pain intensity are reduced after treatment evaluated by VAS (p<0.000). Functionalability had significantly increased after treatment which is evaluated by Oswestry Disability Index in allpatients (p<0.000). 46 from all patients had minimal disability before treatment and this number wasincreased in to 79 after treatment. The number of moderate and severe disabled patients ability wasincreased after treatment.Conclusion: Back school education and specific exercise programme should be one of the parts oftreatment after lumbar discectomy. After treatment was increased functional ability and early painrelief.

BackgroundDandy described first, about intervertebral disc hernia (1929). Mixter W.J and Barr J.S (1934) investigated that correlation of sciatica and lumbar disc hernia. Discectomy is most confirming surgery among all spine surgery. Asymptomatic lumbar disc hernia revealed in 70% of adult, by MRI. Spine disorder is first cause of disability of workers below 45 yrs, in European countries. International research for predisposing, risk factors of intervertebral disc hernia is widely confirmed, but diagnostic and treatment aspects are not completed.Materials and MethodsWe did computer aided search using key words “disc degeneration, risk factor, discectomy, lumbar disc hernia, spinal instrumentation” in online library: MEDLINE, E pub, PUBMED, HINARI, Mongolmed, years 1970-2011, also domestic research works from Central library of HSUM, Mongolia. We included article, case-control study, systematic review, case study.ConclusionIncidence and disability caused by lumbar disc hernia, requiring surgical treatment is common problem in world. By anatomical region, lumbar disc hernia is the highest. Research work revealed that patients who took surgical treatment different by gender (male:female=2:1), geographical region (US 160/100000, Switzerland 62/100000). At last 20 yrs, dramatically changed theory about predisposing factor of disc hernia. It is changed from mechanical load to genetic role. Disc degeneration disease is basis of disc hernia. Nucleus pulposus, annulus fibrosus losing own structure, containing moleculs, and water under degeneration. The risk factors are frequent heavy lifting, frequent twisting and bending, vibration, sedentary work, driving and overweight. The golden standard surgery of herniated disc of cervical area is anterior cervical discectomy and fusion (ACDF). Posterior screw fixation of lumbar vertebrae is most frequently confirming surgery among the world.

Abstract The aim of this study is to compare the effects of traditional and conventional treatment of chronic pyelonephritis. Total of 100 patients diagnosed with chronic pyelonephritis were enrolled in the study. Traditional medicines included following: Sugmel-10, Sarichun, Yuna-4, Sema-3, and Sojid-11. Conventional medicines included following: ciprofloxacin, cefasolin, and negram. After 10-14 days of treatment questionnaire, physical examinations, and laboratory tests were performed. In 90% of patient treated with traditional medicines, changes of smell and color of urine was disappeared. Back pain and dysuria was reduced in 89.7% and 75% of patients respectively. While in control or conventional treatment group, changes of smell and color of urine was completely disappeared and back pain and dysuria was reduced in 80% and 88% of patients respectively. Pasternatskii’s symptom and arterial hypertension was reduced in about 58% and 77% of patients respectively. Bacterial growth (Escherichia coli and Staphylococcus aureus) was ceased in 39.4% and reduced in 46.4% of patients treated with traditional medicines. It was ceased in 60% and reduced in 30% of control patients.Traditional medicines reduced signs and symptoms of chronic pyelonephritis. Bacterial growth was ceased or reduced by traditional treatment. Traditional medicines are effective as conventional medicines for treatment of chronic pyelonephritis.

Introduction: In order to Implement the Mongolian government's 2000 provisions for national health care, on May 28,2004, the Health Minister approved the "Home Care Nursing Service and Rules for Caring and Nursing" according to resolution # 136 and indicated that family clinic nurses should provide home care nursing services [6'71. Interestingly, it is noted that throughout the world, nursing home services have not been limited to family clinic nurses but are being delivered by nurses with diverse areas of specialization.Goal: Purpose of the study is to determine needs for making home nursing services to the population in some province and soum.Objectives:1. To comparatively search needs for providing home nursing services to citizens in the province and soum which were involved to the study.2. To determine nursing type which is required at home3. To develop needs of nurses who make home nursing servicesMaterials and Methods: Conducted studies among the 1109 people from the 520 families in 17 soums of five provinces such as Orkhon, Bulgan, Arkhangai, Khuvsgul and Selenge. We have chosen the clients with anamnesis who are repeatedly served and treated at the hospital for our study and had interviews with them. Questionnaire for citizens consists of 2 basic chapters including 17 questions which determine demographic information and needs of home nursing services. We asked and searched about needs of Home Care Nursing assistances under the 3 basic groups such as General nursing, Treatment nursing and Specialized nursing. After inserting study data into the SPSS-17 program, checked it by appropriate statistical methods (t, x2, fisher exact) and checked if difference between groups and relations has statistical truth.Results: 35.89 percent of clients who got involved to the study answered that they are interested in taking nursing and caring services at home. Also we consider needs for having home nursing at home according to numerical indexes in the provinces involved to the study, clients mostly want to be injected by intramuscular (25.88%), intravenous (31.02%) and IV fluid (30.57%). As we consider specialized nursing assistances at home under the types of needs, health education and assistance for people suffered with hemorrhage and injured people occupy major percent. Clients who got involved to the training, were asked question "With whom do you want to be made nursing assistance at home?" and 75.6% of them answered that they prefer nurses of family clinic.Conclusions:1. It was observed that 35.89% of clients who got involved to the survey, want to receive home nursing assistance and demands for home nursing is being increased with aging.2. Also we conclude that nursing after hemorrhage, nursing for injured patients and nursing for patients with cardiovascular disease occupies higher percent and it shows that percent of cardiovascular diseases and injuries is relatively high and clients' needs to receive nursing assistance at home are faced problems after they were discharged from hospital.3. 75.6% of people who got involved to the study are interested in taking home nursing assistance and we reached to conclusion that it is suitable to train nurses according to it.