Ischemic heart disease (IHD) remains a leading cause of morbidity and mortality worldwide. Metabolic syndrome (MetS), a cluster of interrelated metabolic abnormalities including central obesity, insulin resistance, hypertension, dyslipidemia, and impaired glucose metabolism, has emerged as a major contributor to the development and progression of IHD. The presence of MetS significantly increases cardiovascular risk and worsens clinical outcomes in patients with established coronary artery disease.
We summarize current evidence on the role of metabolic syndrome in ischemic heart disease, with a focus on underlying pathophysiological mechanisms and clinical implications. Key mechanisms linking MetS to IHD include insulin resistance, endothelial dysfunction, chronic low-grade inflammation, oxidative stress, atherogenic dyslipidemia, and pro-thrombotic states, all of which promote atherosclerosis and plaque instability. In addition, emerging biomarkers such as high-sensitivity C-reactive protein (hs-CRP), lipoprotein-associated phospholipase A₂ (Lp-PLA₂), adipokines, and inflammatory cytokines provide further insight into the complex interaction between metabolic disturbances and ischemic heart disease.
Understanding the role of metabolic syndrome in IHD is essential for early risk stratification and targeted prevention strategies. Comprehensive management of metabolic syndrome components may reduce the incidence, severity, and recurrence of ischemic heart disease. This review highlights the importance of an integrated metabolic and cardiovascular approach in the prevention and management of IHD.

Background: Physical inactivity is a leading risk factor for noncommunicable diseases and has become a major public health concern worldwide. More than one-third of the global population fails to meet the World Health Organization’s recommendations for physical activity. In response to this challenge, there is a growing need to introduce innovative, evidence-based approaches to promote physical activity within public health services, one of which is the physical activity prescription. Aim: This review aims to summarize international experiences and evidence-based studies on school-based physical activity prescription led by public health nurses and to assess the feasibility of implementing this approach within school health services in Mongolia. Materials and Methods: A content analysis was conducted using primary and secondary sources related to physical activity prescription, the role of public health nurses, and school health services. Relevant international and national literature was reviewed and thematically synthesized for this study. Result: Evidence indicates that public health nurses play a crucial role in reducing physical inactivity and limiting the spread of noncommunicable diseases among adolescents. In Mongolia, public health nurses eligible to work in school settings have begun training through a tiered bachelor’s degree program. Promoting health through physical activity prescription for students is a key responsibility of public health nurses. Furthermore, there is a strong opportunity to expand school-based physical activity prescriptions in Mongolia by integrating them with the Olympic Values Education Programme, which is currently being implemented nationwide. Conclusion Expanding school-based physical activity prescription within the scope of public health nursing, in alignment with the formal education system and the Olympic Values Education Programme, provides an important opportunity to integrate and align health promotion objectives across the health, education, and sports sectors.

Background: Respiratory and gastrointestinal infectious diseases are the leading causes of morbidity in children. Numerous international studies have demonstrated that handwashing with soap is one of the most effective and cost-efficient methods for preventing these diseases in children. A previous study conducted in Ulaanbaatar found that only 50.1% of general education school students practiced proper handwashing, which is considered insufficient even in areas with relatively adequate facilities. In Mongolia, 56.1% of the 865 schools lack handwashing facilities and soap, and 25% do not meet the WASH standards. Although knowledge about handwashing increased during the COVID-19 pandemic, sustained behavioral change remained limited, highlighting a gap between knowledge and practice and indicating the need for targeted educational interventions. Furthermore, there is limited research comparing the effectiveness of such interventions across different school environments and urban–rural settings, which provides the rationale for this study. Aim: To evaluate the effectiveness of a handwashing educational intervention among primary school students and determine differences in knowledge change across four schools in urban and rural areas. Materials and Methods: A quasi-experimental study design was used from December 2024 to June 2025. A total of 1,353 students from grades 3–5 in four general education schools (two in Ulaanbaatar and two in rural areas) were included in the study. Preand post-intervention handwashing knowledge scores were analyzed using paired t-tests and one-way ANOVA (α=0.05) with STATA 14.0. Ethical approval was obtained from the Ethics Committee of the Mongolian National University of Medical Sciences. Result: The mean handwashing knowledge score increased significantly from 9.68 (±2.64) before the intervention to 10.30 (±2.74) after the intervention, with a mean difference of +0.63 (p<0.001). The differences in improvement between schools were also statistically significant (ANOVA: F(3,1335)=5.90, p=0.0005). The highest improvement was observed in urban School A (+1.49), while the lowest was observed in School B (+0.16). Rural schools C and D showed moderate and relatively consistent improvements (+0.51 and +0.70, respectively). Conclusion School-based handwashing educational interventions effectively improve knowledge among primary school students. However, environmental factors, such as infrastructure and geographic location, significantly influence the effectiveness of the intervention. Therefore, educational interventions should be implemented alongside infrastructure improvements.

Background: Chronic infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) is a major cause of liver cirrhosis and hepatocellular carcinoma worldwide, and is also associated with a wide range of extrahepatic manifestations affecting multiple organ systems. However, comparative studies on the prevalence, risk factors, and clinical associations of these extrahepatic manifestations in Mongolia remain limited. Aim: To comparatively evaluate the risk factors and clinical associations of selected extrahepatic manifestations in patients with chronic HBV and HCV infections. Materials and Methods: This retrospective cohort study included a total of 1.040 participants matched by age and sex. Extrahepatic manifestations were assessed, including hypertension, hyperglycemia, dyslipidemia, and impaired renal function. Results: Extrahepatic manifestations such as hypertension, hyperglycemia, dyslipidemia, and renal dysfunction were significantly more prevalent in the chronic HCV group (p<0.05). In contrast, obesity was more common in the chronic HBV group, particularly among males aged 50-59 years. Increasing age (OR=1.04, 95% CI: 1.02-1.06) and chronic HCV infection (OR=1.65, 95% CI: 1.20-2.26) were associated with a higher risk of extrahepatic manifestations. Liver fibrosis showed similarly high prevalence in both groups (71-72%), with the highest occurrence in the 50-59 age group. A moderate positive correlation was observed between fibrosis stage and renal function impairment (r=0.45). Conclusion Chronic HCV infection is more strongly associated with the presence and risk of extrahepatic manifestations compared to HBV. Age, sex, and metabolic abnormalities are important contributing risk factors. Therefore, regular monitoring of metabolic and renal function, in addition to liver disease, is essential in patients with chronic viral hepatitis to prevent complications.

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.

Introduction: Cardiovascular disease-related mortality accounts for 34% globally, 23% in the United States, and 22% in Europe, with Asia representing 35% of total deaths as of 2019. In Asia, ischemic heart disease and stroke are the most common causes of cardiovascular diseases (CVD), and the prevalence of these two types of CVD varies significantly across different regions and countries in Asia. Over the last 10 years, the average number of deaths due to cardiovascular diseases has been 5.7 thousand annually, representing 33.7% of total mortality. Cardiovascular diseases account for 11.1% of all illnesses, and as of 2021, the rate has increased by 128 compared to the average of the past 10 years, reaching 936 per 10.000 population. As cardiovascular disease-related mortality is the leading cause of death worldwide, every country has criteria for calculating the 10-year risk of CVD to reduce cardiovascular morbidity and mortality. These criteria are crucial for predicting the risk of stroke and cardiovascular diseases in individuals with or without diabetes. Purpose: To assess the risk of heart disease in people aged 40-74 years without cardiovascular disease. Material and Methods: A total of 394 individuals aged 40-74 were included in the study. Blood samples were taken to determine lipid profiles and fasting glucose levels. Using the World Health Organization's (2019) revised cardiovascular disease risk assessment model (which considers age, systolic blood pressure, smoking, total cholesterol, LDL and BMI), the 10-year risk of developing cardiovascular disease was calculated using both laboratory-based and non-laboratory based risk assessment criteria. Statistical analysis of the study was performed using SPSS 26 software, with a p-value of less than 0.05 considered statistically significant. Ethics: The methodology was approved by the Medical Ethics Sub-Committee of the Ach medical university on the 30th of June, 2023 (Decision #23/02/03) Result: The average age of the adults included in the study was 49.3±14.7 years. Among those aged 40-74 who participated in the CVD risk assessment criteria, the average age was 53.7±9 years, with men having an average age of 54.6±9.3 (117 participants) and women having an average age of 53±8.7 (223 participants). The total cardiovascular risk of the study participants was 54.8% very low, 15.7% low, 13.2% moderate, 8.1% high, and 8.1% very high according to laboratory-based assessment, while the non-laboratory based assessment showed 49% very low, 20.7% low, 16.8% moderate, 7.7% high and 5.9% very high risk).
Among all participants, the prevalence of cardiovascular risk factors was assessed as follows: 26.9% (95% CI: 22.6–31.6%) were smokers, 60.5% (95% CI: 55.4–65.3%) consumed alcohol, 46.4% (95% CI: 42.4–50.2%) had arterial hypertension, 10.4% (95% CI: 0.76–13.9%) had diabetes mellitus, 75% were obese, 78.4% (95% CI: 74.2–81.6%) had central obesity, 24.4% (95% CI: 18.5–31%) had hyperglycemia, 42.6% (95% CI: 35.6–49.9%) had hypercholesterolemia, 19.3% (95% CI: 14–25.5%) had hypertriglyceridemia, and 11.3% (95% CI: 0.71–16.7%) had elevated low-density lipoprotein levels.
The total cardiovascular risk of the study participants was 54.8% very low, 15.7% low, 13.2% moderate, 8.1% high, and 8.1% very high according to laboratory-based assessment, while the non-laboratory based assessment showed 49% very low, 20.7% low, 16.8% moderate, 7.7% high and 5.9% very high risk.
These distributions showed a statistically significant difference compared to the group without arterial hypertension (p<0.0001). Additionally, comparison of risk between individuals with and without diabetes mellitus using laboratory-based assessment also revealed a statistically significant difference (p<0.0001). The concordance between the two models was 88.8% (95% CI: 83.6–92.9) with a Cohen’s kappa coefficient of κ=0.6, indicating moderate agreement with statistically significant difference (p<0.001). Conclusion 75% of the people surveyed were obese and 78.4% had central obesity, with men at greater risk than women. The cardiovascular risk of having arterial hypertension and diabetes is further increased. The correlation coefficient of the risk estimates showed a strong correlation across gender and age groups. The agreement between the risk estimate models was 88.8%, or a moderate agreement with Cohen's coefficient (k=0.6).

Background: Employee satisfaction in the healthcare sector has a direct impact not only on the quality of medical services, but also on workforce stability and overall organizational performance. High levels of job satisfaction are associated with improved work performance, whereas low satisfaction often leads to negative outcomes such as stress and burnout. Although studies on job satisfaction have been conducted in Mongolia, research specifically targeting healthcare workers—and identifying the key factors influencing their satisfaction—remains relatively limited. This gap provides the rationale for the present study Aim: The objective of this study is to examine job satisfaction among healthcare workers at primary and referral hospitals and to identify key factors influencing it. Materials and Methods: The study was conducted between 2022 and 2024 among 1,883 physicians, nurses, and other healthcare professionals aged 18–65 years from 11 provinces and Ulaanbaatar city, using a quantitative research approach with a cross-sectional design. Job satisfaction was assessed with a questionnaire comprising six subdomains (supportive leadership, opportunities for human resource development, professional ethics, organizational culture, quality of healthcare services, and workplace safety), rated on a three-point Likert scale. Data analysis was performed using IBM SPSS Statistics version 26.0. Results: The overall level of job satisfaction among participants was 77.6%. Among the subdomains, workplace safety and supportive environment scored the lowest at 71.7%, whereas the quality and safety of healthcare services scored the highest at 83.4%. The findings indicated that holding a managerial position in hospitals in Ulaanbaatar and working as a physician in primary-level hospitals were positively associated with job satisfaction (p < 0.05). Age demonstrated a statistically significant association with job satisfaction, while years of work experience showed a negative correlation, with satisfaction decreasing as tenure increased (r = −0.09, p < 0.001). The findings indicate that improving healthcare workers’ job satisfaction requires strengthening and supporting several organizational dimensions, including supportive leadership, opportunities for human resource development, organizational culture, workplace safety, and a supportive work environment Conclusion Workplace safety and support, opportunities for human resource development, and organizational culture were found to be critical determinants of employee job satisfaction. The findings suggest that job satisfaction can be enhanced by optimizing organizational support, ensuring opportunities for professional growth, and strengthening workplace safety

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%).

Chronic kidney disease (CKD) is a global health issue characterized by a gradual loss of kidney function over time. As the disease progresses, it leads to an increased risk of cardiovascular complications, which are the leading cause of morbidity and mortality in CKD patients. B-type natriuretic peptide (BNP) and its inactive fragment, N-terminal pro b-type natriuretic peptide (NT-proBNP), are biomarkers widely used in the diagnosis and management of heart failure. Their role in CKD, however, is complex due to the overlapping pathophysiological mechanisms between cardiac and renal dysfunctions. This literature review aims to explore the diagnostic and prognostic value of BNP and NT-proBNP in patients with CKD, highlighting their clinical relevance, the impact of renal function on their levels, and potential therapeutic implications. The review focuses on studies published in the last decade, examining the clinical applications, outcomes, and challenges associated with using BNP and NT-proBNP as biomarkers in CKD patients.

Background and Aims: The BALAD scores are developed to provide an objective determination of prognosis for hepatocellular carcinoma (HCC) by incorporating five serum markers, namely albumin, bilirubin, alpha-fetoprotein (AFP), agglutinin-reactive alpha fetoprotein (AFP-L3), and des-γ-carboxy prothrombin. We aim to study the applicability of BALAD score and prognostication of the three tumor markers, albumin and bilirubin. Methods: Patients who were served by clinical laboratory were prospectively enrolled. All the baseline characteristics and serum albumin and bilirubin level were documented at base line. The levels of the three tumor markers (AFP, AFP-L3, and des-γ-carboxy prothrombin) were determined in serum samples. assays of AFP, AFP-L3, and DCP were conducted in the same serum sample by using a microchip capillary electrophoresis and liquid phase binding assay on a μTAS Wako i30 analyzer (Wako Pure Chemical Industries, Ltd, Osaka, Japan). To detect albumin and bilirubin amount were using the cobas 6000 analyzer series that is a fully automated, software-controlled system for immunoassay and photometric analysis intended for qualitative and quantitative in vitro determinations. Results: A total of 103 patients who were served by clinical laboratory were recruited. AFP, albumin, bilirubin, DCP and AFP-L3 levels were independent prognostic factors. When the study participants evaluated BALAD scores, 45.63% scored 0 points, 28.16% scored 1 point, 10.68% scored 2 points, 8.74% scored 3 points, 3.88% scored 4 points, 1.94% 5 points, and 0.97% 7 points. Conclusion BALAD score is applicable in the population of hepatitis B and C virus related HCC. When AFP L3% increases by one unit, BALAD scores are 0.04 times higher (P=0.0001) that is presenting statistically significance.