Background: Achilles tendon rupture accounts for approximately 10.7% of all tendon injuries, and has been reported to be responsible for 47% of acute sports-related injuries. Although Achilles tendon rupture is more commonly observed in athletes, intrinsic factors such as body composition, age, and sex contribute to decreased tendon elasticity between the ages of 30–50, increasing the likelihood of injury. According to the World Health Organization, the annual incidence of Achilles tendon rupture ranges from 7 to 40 cases per 100,000 population. Aim: To investigate the relationship between ankle range of motion limitations and dynamic balance performance in patients following Achilles tendon rupture. Materials and Methods: Using a cross-sectional study design. A total of 60 patients who underwent surgical repair for Achilles tendon rupture at Songino-khairkhan District General Hospital were included. The Achilles Tendon Total Rupture Score (ATRS) questionnaire (10 items) was used to assess self-reported functional status. Ankle dorsiflexion range of motion was measured using an inclinometer, and dynamic balance was assessed using the modified Star Excursion Balance Test (mSEBT). Statistical analyses were performed using SPSS version 25.0. Results: The mean ATRS score among participants was 45.25±14.27, indicating a high level of functional limitation. The dorsiflexion range of motion of the injured limb was 11.12 ± 3.90 degrees, which was significantly reduced compared to the non-injured side (p < 0.05). A weak correlation was observed between dorsiflexion range of motion of the uninjured ankle and dynamic balance in the posterolateral and posteromedial directions (p < 0.05). Conclusion 1. The dorsiflexion range of motion in the injured ankle was three times lower than that of the uninjured side 2. The limited ankle dorsiflexion range of motion was not associated with dynamic balance performance.

Flail arm syndrome (FAS), an atypical variant of amyotrophic lateral sclerosis (ALS), is characterized by progresses slowly, predominantly proximal, weakness of upper limbs, with no involvement of the lower limb, bulbar, or respiratory muscles. In the world, 1-3 cases per 100,000 people per year are registered. Incidence is higher among whites. The peak age is 55-75 years, although it can occur at a younger age. The male gender is dominant. Signs of upper motor neuron (UMN) lesions of the cervical region in flail arm syndrome patients are rare. The lack of information regarding FAS may make differential diagnosis between flail arm syndrome, upper limb onset amyotrophic lateral sclerosis and other lower motor neuron syndromes difficult in clinical settings. The prognosis of FAS is better than that of upper limb ALS and most cases of FAS are sporadic. Therefore, a reliable differential diagnosis is essential to determine the prognosis. Compared with the other varient of ALS, clinical symptoms progress over a relatively long period of time in flail hand syndrome, with a median survival of 4 years and a 10-year survival of 17%. We report a 79 year old patient admitted to the hospital with a 1 year history of proximal weakness and 2 arm shoulder girdle muscle stiffness, wasting and 2 arm m.deltoideus fasciculations with Flail arm syndrome. It was one of the few cases of arm drooping syndrome, which begins only with weakness, stiffness, and symmetry in the proximal part of the upper limbs. Definite ALS was diagnosed based on clinical examination /neurological abnormalities/ and electromyography results.

Introduction: Worldwide, an estimated two billion people have evidence of HBV infection, and approximately 240 million have CHB. In this study, a representative group of Mongolian adults was tested for hepatitis B virus (HBV) in 2017. The prevalence estimates of HBV the general Mongolian adult population were found to be 11.1%, respectively.
In April 2017, EASL added a drug newly approved for treatment of CHB, tenofovir alafenamide (TAF) to their list of recommended first-line therapies. The requirement for long-term therapy in chronic HBV highlights the importance of these efficacy and safety trends, however their true clinical relevance is yet to be established and further studies with long-term follow up and real-world clinical data are needed. Goal: Evaluate for result of tenofovir alafenamide in the treatment of chronic hepatitis B infection. Materials and Methods: The clinical trials have evaluated TAF in HBeAg-positive and HBeAg-negative chronic HBV patients. The trials have similar designs and are randomized, double blind, non-inferiority studies. The primary efficacy endpoint was the proportion of patients with HBV DNA<29 IU/ml at week 24 and 48. Other prespecified efficacy endpoints were the proportion of patients with HBsAg seroncoversion to anti-HBs at week 24 and 48. Key secondary safety end- points at week 24 and 48 included the percentage change in T-score, and Z-score bone mineral density (BMD), percentage change in BMD and change from baseline serum creatinine. Results: The primary efficacy endpoint, an HBV DNA level <29 IU/ml at week 24, was achieved by 120 (59.1%) of 203 patients receiving TAF, which was non-inferior to the 63 (55.2%) of 114 patients receiving TDF who had an HBV DNA<29 IU/ml. After 24 weeks of treatment, patients receiving TAF had significantly smaller reductions in bone mineral density (BMD) compared with patients receiving TDF. Conclusion The development of TAF, specifically designed to deliver potent antiviral activity but with an improved safety profile compared with TDF, is therefore timely.

Worldwide, an estimated two billion people have evidence of HBV infection, and approximately 240 million have CHB. In April 2017, EASL added a drug newly approved for treatment of CHB, tenofoviralafenamide (TAF) to their list of recommended first-line therapies. Treatment with these therapies can achieve sustained suppression of HBV DNA replication, decreases in inflammation, and histological activity that decrease the risk of cirrhosis and hepatocellular carcinoma in both cirrhotic and noncirrhotic patients and, ultimately, of CHB-associated mortality [1, 2]. However, recent advances in understanding the HBV life cycle have enabled multiple, novel therapeutic targets to be identified and new therapies of direct-acting antiviral (DAAs) and host-targeting agents (HTAs) are indevelopment.
In most clinical trials, TAF was non-inferior to TDF in achieving HBV DNA levels below 29 IU/ml.No amino-acid substitutions associated with viral breakthrough were detected by deep sequencing, and no resistance to TAF.With clear evidence from major studies showing that TAF is safe, tolerable, and non-inferior to TDF, its recommendation as a first-line therapy is appropriate.
Long-term safety is an important consideration in the therapeutic management of patients with CHB because treatment is often life-long.
The efficacy of TAF in patients with resistance mutations associated with older nucleos(t)ide analogues is unclear. Although no evidence of TAF or TDF resistance was detected in the phase III studies through 96 weeks of treatment, very small numbers of patients had baseline mutations indicating resistance to lamivudine, adefovir or entecavir and efficacy data specifically for this group is not available.

BackgroundChildren’s congenital hip dislocation is ranked first, accounting for 49,4% among other skeletal anomalieswhich cause to physical disability.There is a tendency that the number of newborn with the congenitalhip dislocation is going to be increased in recent years, 5000:1 were in 1976 and 1000:1,3% in 1998.Bilateral dysplasia accounts for 50-62% of the total incidences. In unilateral cases,left hip seems to beinvolved 2 times more than the right,and the sex ratio is 2,5:1. Some cultures who swaddle their infantstightly with their legs straightened have a far greater incidence of developmental dysplasia of the hip. Aresearch indicated that discouraging this traditional swaddling method has reduced the prevalence ofdevelopmental dysplasia of the hip and congenital hip dislocationby 6 times in America. It is noted thatthis methodhas also been implemented in Japan and Turkey.Aim.This research aimed to study about the prevalence of congenital hip dislocation, developmental dysplasiaof the hip and other anomalies among the children who were underwent treatment at Pediatric Traumaand Orthopedic Department of National Trauma and OrthopedicResearch Centre of Mongolia in 2013-2015 and children served by outpatient visit in the clinics in 2011-2015.The following objectives were defined in the scope of the research. Herein:1. Evaluate and determine the percentage and prevalence of congenital hip dislocation anddevelopmental dysplasia of the hip among the children who undergo treatment in Pediatric Traumaand Orthopedic Departmentof National Trauma Orthopedic Research Center of Mongolia.2. Evaluate and determine the percentage and prevalence of congenital hip dislocation, developmentaldysplasia of the hip and other anomalies among children who are being served by outpatient visit inClinics of National Trauma and Orthopedic Research Center of Mongolia.Materialis and MethodThis research were studied the prevalence of congenital hip dislocation, developmental dysplasia of thehip and other anomalies among the children who were underwent treatment at Pediatric Trauma andOrthopedic Department of National Trauma and OrthopedicResearch Centre of Mongolia in 2013-2015and children served by outpatient visit in the clinics in 2011-2015.ResultTotal of 40559 inpatients underwent treatment in National Trauma andOrthopedic Research of Mongolia;of which 12217 were inpatient in Pediatric Trauma and Orthopedic Department, aged 0-19;of which1351 has been registered with birth defects of hip; of which 248 has been diagnosed with developmentaldysplasia hip, 869 with congenital hip dislocation. Sex ratio of cases of congenital hip dislocationinmales to female is around 1:4.Total of 633 (13,8%) examinations were performed in the clinics in 2011;704 (15,3%) in 2012;962 (20,9%)in 2013;1013 (22%) in 2014;1287 (28%) in 2015 respectively. It shows an increase in the number ofexaminations year by year.Total of 4142 (90,1%) cases were diagnosed with congenital hip dislocation and developmental dysplasiain both hips; left hip has been dislocated 2 times more than the right, 162 (3,5%) with congenitaldislocation of right hip; 292 (6.4%) with congenital dislocation of left hip.ConclusionTo conclude, the analysis above shows that the prevalence of developmental dysplasia of the hip andcongenital hip dislocation is still high in Mongolia. Therefore, number of diagnosis with congenital hipdislocation has rapidly increased in the recent 2 years.