Background: Helicobacter pylori (H. pylori) is a gram-negative, microaerophilic bacterium that colonizes the human gastric mucosa, with an estimated global prevalence exceeding 50%. The increasing resistance of H. pylori to clarithromycin, a key antibiotic in eradication regimens, has led to a decline in the efficacy of standard treatment to below 80%. Consequently, international guidelines advocate for susceptibility-guided therapy to optimize treatment outcomes. Detection of clarithromycin resistance-associated mutations, including A2143G, A2142G, A2142C, and A2144G, is essential for improving therapeutic efficacy and mitigating the propagation of antimicrobial resistance. Aim: To evaluate the efficacy of tailored H. pylori eradication therapy based on clarithromycin resistance profiling. Materials and Methods: A total of 125 treatment-naïve patients diagnosed with H. pylori infection were enrolled in this study. The infection was confirmed through upper gastrointestinal endoscopy with histopathological analysis, the urea breath test, and stool antigen detection. Clarithromycin resistance-associated mutations were identified using polymerase chain reaction (PCR) analysis on gastric biopsy and stool samples. Based on the presence or absence of resistance mutations, patients were stratified into two treatment cohorts and received targeted eradication therapy. Treatment success was assessed 28 days post-therapy using a stool antigen test to confirm H. pylori eradication. Results: Among the 120 patients who met the inclusion criteria and completed treatment, 41.6% (n=50) were male, and 58.4% (n=70) were female, with a mean age of 39±9.1 years. Clarithromycin resistance-associated mutations were detected in 36 patients (30%), with A2143G identified in 35 cases (97.2%) and A2142G in 1 case (2.7%). In the clarithromycin-sensitive cohort, 84 patients underwent eradication therapy, and among the 60 who completed post-treatment assessment, the eradication rate was 91.6%. In the clarithromycin-resistant cohort, 36 patients received treatment, and among the 20 who completed post-treatment assessment, the eradication rate was 80% (p=0.038). Conclusion A substantial prevalence of clarithromycin resistance-associated mutations was observed among the study population. Susceptibility-guided eradication therapy demonstrated superior efficacy, with eradication rates exceeding 90%. These findings underscore the necessity of implementing resistance-based treatment strategies to optimize clinical outcomes and limit the further dissemination of antimicrobial resistance. Future investigations should focus on refining therapeutic approaches for H. pylori strains exhibiting clarithromycin resistance.

Background: Patients with rheumatoid arthritis are at increased risk of developing cardiovascular disease. In Mongolia, the registration of inflammatory diseases is increasing every year, and cardiovascular diseases are the leading cause of death. Aim: We aimed to determine the degree of cardiovascular risk and its correlation in people with rheumatoid arthritis. Materials and Methods: The study was conducted in a cross-sectional study design with 64 patients with rheumatoid arthritis between May and November 2024. Cardiovascular risk was assessed using mSCORE and the World Health Organization (WHO) cardiovascular Risk Table. We received ethical approval to begin the research at the MNUMS meeting on May 17, 2024 (No. 2024/3-05). Results: The average age of the participants was 55.2±9.7 years, and the average duration since being diagnosed with RA was 9.8±8.0 years. Among the participants, 82.8% (n=53) were female, and 17.2% (n=11) were male. The mean WHO risk index was 10.25±11, while the mean mSCORE risk index was 2.9±4 (p=0.001). There was a significant difference in mSCORE scores between the 40-55 and 56-65 age groups (p<0.001). In contrast, the mSCORE risk assessment showed that 15.6% (n=10) had high risk, and 6.3% (n=4) had very high risk. Among the parameters of inflammatory biomarkers, CRP (OR=0.05, r=0.35, 95% CI 0.9-3.2, p=0.004) has a statistically significant difference and positive correlation, and HDL-C (OR=2.3, r=-0.25, 95% CI 2.9- 10.0, p<0.0001) was significantly different and negatively correlated. Conclusion A total of 64 participants participated in our study, and according to the WHO assessment, 17.2% were at high or very high risk of developing cardiovascular disease in the next 10 years, and according to the mSCORE, 21.9% were at high or very high risk of developing cardiovascular disease. Although the degree of disease activity was not significantly associated with cardiovascular risk, the inflammatory biomarker C-reactive protein was statistically significantly different or positively associated with cardiovascular risk assessment.

Background: Helicobacter pylori (H.pylori) infection is highly prevalent worldwide, with an overall infection rate of 50% of the total population. Effective and accurate eradication treatment for H.pylori is considered one of the most important preventative measures against gastric cancer. However, the increasing prevalence of clarithromycin-resistant H. pylori strains has significantly compromised the success rates of standard eradication regimens. In recent years, many countries have adopted molecular diagnostic methods to detect H.pylori infection and assess clarithromycin resistance. These approaches, which are often non-invasive, enhance both diagnostic accuracy and the ability to tailor treatment strategies. Although numerous studies have investigated methods for detecting H. pylori and clarithromycin resistance using gastric tissue specimens, relatively few have focused on the clinical application of stool-based diagnostics, despite their potential advantages in non-invasive testing. Aim: To detect H.pylori infection and clarithromycin resistance using molecular biological methods from both gastric tissue and stool samples, and to comparatively evaluate the diagnostic outcomes. Materials and Methods: The hospital-based cross-sectional study was conducted at the Gastroenterology department of the Mongolia-Japan Hospital. A total of 125 dyspeptic patients aged 18-80 years were enrolled. Eligibility criteria required the H.pylori infection to be confirmed by at least two diagnostic methods. Each participant underwent both invasive (histological examination, gastric biopsy-based real-time PCR) and non-invasive (urea breath test, stool antigen test, stool-based real-time PCR) methods. Gastric biopsies and stool samples were analyzed by real-time PCR to detect H.pylori and identify clarithromycin resistance-associated 23S rRNA point mutations (A2143G, A2142G, A2142C) Results: Among the study participants, 60.0% (n=75) were female and 40.0% (n=50) were male, with a mean age of 39±1 years. Comparative evaluation of the diagnostic methods for H.pylori infection demonstrated that the stool antigen test, performed in 104 individuals, yielded positive results in 91 cases (87.5%), whereas the urea breath test, performed in 51 individuals, was positive in 45 cases (88.2%). Using real-time polymerase chain reaction (PCR), H.pylori was detected in 76 of 101 stool samples (75.2%) collected in ENAT transport medium, and in 43 of 87 raw stool samples (49.4%). The estimated diagnostic sensitivities were 94% for the urea breath test, 91% for the stool antigen test, 78% for real-time PCR using ENAT-preserved stool, and 49% for real-time PCR using raw stool specimens. Clarithromycin resistance was found in 36 participants (28.8%), while 89 participants (71.2%) carried H.pylori strains susceptible to clarithromycin. Clarithromycin resistance was detected in 27.6% of stool samples and 30.5% of gastric biopsy specimens. Among the clarithromycin-resistant isolates identified from gastric tissue, 35 cases (97.2%) carried the A2143G point mutation, while the A2142G mutation was detected in only 1 case (2.8%). All resistant cases detected from stool samples carried the A2143G mutation, whereas the A2142G mutation was not observed. Conclusion Real-time PCR demonstrated high efficacy for the detection of H.pylori infection and clarithromycin resistance in gastric biopsy specimens. While the sensitivity of stool-based real-time PCR was comparatively lower, detection rates improved with the use of ENAT transport medium. These findings highlight the potential of stool-based real-time PCR as a non-invasive diagnostic tool; however, further investigations are warranted to optimize assay performance through rigorous standardization and refinement of sample processing protocols for the accurate detection of clarithromycin-resistant H.pylori.

Background: The continuous annual increase in the prevalence of diabetes mellitus (DM) poses significant challenges not only within our nation but also globally in the control and management of tuberculosis. Aim: This study aimed to determine the incidence of pulmonary tuberculosis among individuals with type 2 diabetes mellitus (T2DM) residing in six central districts of Ulaanbaatar and to investigate associated factors. Materials and Methods: A cross-sectional study design was employed. Participants aged 18 years and older diagnosed with T2DM and receiving care at endocrinology clinics in six central districts of Ulaanbaatar were selected using systematic random sampling. Presumptive TB cases were identified through a structured questionnaire and chest X-ray. Sputum specimens were collected and subjected to smear microscopy and Xpert MTB/RIF assay for tuberculosis detection. Cases confirmed by laboratory diagnosis, currently undergoing tuberculosis treatment and previously treated cases as per questionnaire data were classified as tuberculosis cases, and prevalence was calculated. Results: A total of 1,644 individuals with T2DM were enrolled in the study, of whom 836 (50.9%) were female, with a mean age of 58 years (range 19–89). The overall prevalence of presumptive TB cases was 10.5% (n=172; 95% CI, 9.0–12.0). Among 112 suspected cases from whom sputum samples were obtained, 10 (8.9%; 95% CI, 4.9–15.7) were laboratory-confirmed for M.tuberculosis. Notably, 7.2% (6 cases; 95% CI, 3.4–14.9) of asymptomatic individuals with abnormal X-ray findings were diagnosed with tuberculosis. According to questionnaire responses, 9 participants (0.5%; 95% CI, 0.3–1.0) were undergoing tuberculosis treatment, and 53 (3.2%; 95% CI, 2.5–4.2) reported a previously treated TB cases. The overall prevalence of tuberculosis among individuals with diabetes was 4.4% (n=72; 95% CI, 3.5–5.5). Stratification by age and sex revealed a significantly higher prevalence among males (5.9%; n=48; 95% CI, 4.5–7.8) compared to females (2.9%; 95% CI, 1.2–4.2) (p=0.002), indicating a twofold increased risk of tuberculosis in males. Although no statistically significant differences in tuberculosis prevalence were observed across age groups (p>0.05), a declining trend in prevalence with older age was noted. Conclusion The prevalence of tuberculosis among individuals with type 2 diabetes was 4.4% (n=72; 95% CI, 3.5–5.5), with a significantly higher rate in males (p=0.002) and a decreasing trend with increasing age. Among asymptomatic individuals exhibiting radiographic abnormalities, 7.2% were confirmed to have tuberculosis via laboratory testing

BACKGROUND. Heart failure is public health burden in developed countries. There are currently 6.5 million adults in the US who heart failure and this number is expected to rise to more than 8 million people by 2030. AHA and ESC recommend natriuretic peptide biomarker-based screening and interventions aimed at modifying risk factors for patients at risk of developing heart failure as these can be useful in prevention of left ventricular dysfunction or new onset heart failure. OBJECTIVE: To investigate the level of NT-proBNP and its association with metabolic risk factors and possible early detection of chronic heart failure in general population. MATERIAL AND METHODS. In the study, 194 participants aged from 35 to 65 were enrolled. We measured metabolic risk factors and level of NT-proBNP of participants. The two group of participants who have positive and negative NT-proBNP results were compared by the metabolic risk factors. RESULTS. NT-proBNP results were positive in 16.49% (n=32) of the participants. The mean values of age, frequencies of hypertension, systolic and diastolic blood pressure significantly increased in participants with positive NT-proBNP results, while mean values of BMI, frequencies of diabetes, total cholesterol and LDL decreased in participants with negative NT-pro BNP results. CONCLUSION: NT-proBNP was positively related to age, arterial hypertension, sistolic and diastolic blood pressure and inversely related to body mass index, obesity, diabetes, cholesterol, LDL.BACKGROUND. Heart failure is public health burden in developed countries. There are currently 6.5 million adults in the US who heart failure and this number is expected to rise to more than 8 million people by 2030. AHA and ESC recommend natriuretic peptide biomarker-based screening and interventions aimed at modifying risk factors for patients at risk of developing heart failure as these can be useful in prevention of left ventricular dysfunction or new onset heart failure. OBJECTIVE: To investigate the level of NT-proBNP and its association with metabolic risk factors and possible early detection of chronic heart failure in general population. MATERIAL AND METHODS. In the study, 194 participants aged from 35 to 65 were enrolled. We measured metabolic risk factors and level of NT-proBNP of participants. The two group of participants who have positive and negative NT-proBNP results were compared by the metabolic risk factors. RESULTS. NT-proBNP results were positive in 16.49% (n=32) of the participants. The mean values of age, frequencies of hypertension, systolic and diastolic blood pressure significantly increased in participants with positive NT-proBNP results, while mean values of BMI, frequencies of diabetes, total cholesterol and LDL decreased in participants with negative NT-pro BNP results. CONCLUSION: NT-proBNP was positively related to age, arterial hypertension, sistolic and diastolic blood pressure and inversely related to body mass index, obesity, diabetes, cholesterol, LDL.

BACKGROUND. To introduce a new electronic technology which is mobile-based ophthalmoscope to the clinical practice for the patients with diabetes and hypertension. MATERIAL AND METHODS. There are 32 participants who were diagnosed with hypertension (blood pressure measured more than 140/90 mm Hg three times a month or for 2 weeks) participated in our study. We selected the patients with type II diabetes and hypertension who were referred to the RTW diabetes center. RESULTS. In the hypertensive group, based on Keith Wagener Barker (KWB) Grades, there are 1st and 2nd degree retinopathy cases are more common and it increases with the age. In the diabetic group, non-proliferative diabetic retinopathy is diagnosed among the patients aged above 60 years old and it correlates with the duration of disease.

OBJECTIVES: According to the millennium development goals particularly in the fifth goal it was noted to reduce the incidence of miscarriages into 75% from 1990 till 2016. However, it’s reduced only 34% in worldwide. The incidence of maternal mortality rate have been estimated to 358000 annually, and from 1000 to 1500 maternal death occurred per day.The pregnancy rate have been registered into 40-50 million in Asia Pacific regional countries annually, and the incidence of maternal death is estimated from 30500 to 50000. Moreover, overall 300000 neonates have been died in the first day of prenatal life. There numerous number of studies and surveys in terms of the maternal care have been performed in supports of the “Strategy for women’s and child’s health”, “National program for reproduction” and other projects and national program and other related order, regulation has helped to perform the studies. We aimed to study the pregnancy control in healthy gestational period of pregnancy and to evaluate the counseling for the pregnant women who were admitted to the Family health center in Ulaanbaatar city, Mongolia METHODS: There are 135 pregnant women who are routinely monitored at the Family health centers who were selected randomly, according to the rule number 338 which stated about the pregnancy control, and used questionnaire with 55 questions. The results have been calculated by the SPSS 20 program and statistic information provided by pregnancy monitoring guides. RESULTS: Married women 72.2 % got involved on routine check on time, while only 33.3% women who weren’t married got checked on time. Marital status was also the key factor in women being involved for regular monitoring (p=0.006). Around 70.9 % involved within the 12 week of gestational period were women with higher education, and only 55% of women with secondary education got involved in first examination. Within early monitored women 66.7% of women were aged from 20 to 24, 82.6 percent of women were aged from 30 to 34, 83.3 percent of women who were aged above 35 and higher have been involved in regular checkups on time (p=0.031). Employment has been a factor in checkup attendance. 92.9 percent of women who work at state authorities, 63.6 of women who work in non-government organizations, 51.6 percent of women who are self-employed, 57.9 percent of students, 57.9 percent of unemployed women have participated in checkups on time (p=0.017). 84.9% of women with higher education have been examined on routine examination; however, only 50% of women with lower education have been examined on routine examination. The women with spouses have been examined on routine examination is estimated to 87.6%; however, 75% of women with unclear marital status have been examined on routine examination on time. In the study, 100% of women have been examined on time in the first examination. But in the second time it was estimated to 80%, in the third time it was estimated to 75%. CONCLUSION: The attendance of women in the first examination within the 12 week of gestational period has been depending on the education, age, marital status, and employment of the women. Also the women get pregnant for the first time has actively involved in the first and routine examination.

Introduction : In the last years other country scientists told about not only determine infant weights, need to interest correlation between maternal weight, height and infant weight. In our country few research articles posted about anthropometry of obstetrics and gynecology. Our study aim is determine maternal weight, infant weight, placenta weight and assess factors affecting roles on maternal story of “Amgalan” Maternity Hospital in 2014-2015. Goal: The current study aimed at assessing maternal weight, infant weight, placenta weight and evaluating the effect of factors leading to it. Materials and Methods: The data was already collected from “Amgalan” Maternity Hospital using maternal history and record and it was collected measuring general physical characteristics such as body weight and height, infant weight, placenta weight and body circumferences. We used retrospective method and collected statistical data was analyzed using SPSS 21.0 software. Results: Of total 964 study participants aged 18-45. The average age of participants was 29.6 ± 5.8 years old and 49.7% (n=479) was working during pregnancy, 45.7% (n=441) hadn’t works, 4.6% (n=44) was student. The average weight of mothers was 75.4±11.5, weight of infants was 3439.5±456, weight of placenta was 685±129. The following factors affected maternal and infant weights: lower education, working, early and late pregnancy complication. Maternal weight had a low direct correlation with infant weight (r=0.267, p<0.01) and placenta weight (r=0.208, p<0.01). In our study maternal height had a low direct correlation with infant weight(r=0.173, p<0.01) and infant weight had a moderate direct correlation with placenta weight (r=0.376, p<0.01). Conclusions
1. The average maternal weight was 75.4±11.5, infant weight was 3539.5±456, placenta weight was 685±129.
2. The following factors affected maternal and infant weights: lower education, working status, early and late pregnancy complications.
3. Maternal weight had a little direct correlation with infant weight (r=0.267, p<0.01) and placenta weight (r=0.208, p<0.01).

Although in the 5th goal of the millennial development goals it is stated that by within 2015 iscarriages will be reduced by 75% from the year 1990. So far it has been reduced by 34%, only third of its intended goal. Around 358.000 miscarriages happen in a year, which leads to around 1000-1500 miscarriages per day during numerous stages such as: pregnancy, labor, or after birth. Thisproblem has been gathering a lot of attention around the world that it had been added in to the goalsof the millennium development goals. Of the 130 million babies who are born in a year 7.6 millionof them are born with birth defects and 3.2 million die while they are still infants, and 3.6 millioninfants are left handicapped. Of 40-50 million pregnancies that are reported in Asia and the PacificOceania, 30500-50000 women miscarry, and 300000 infants die within the first day since birth. In the Mongolian government’s population development policy, it is stated that the government shall support population growth, to provide a safe living environment for people to live a long prosperous life, and to improve healthcare services for mothers and babies. The total population as of late 2014 is 2 million 995.9 thousand it has risen up by 65.9 thousand since the previous year a 2.2 percent increase. 48.9 percent of the population are males and 51.1 percent are females the ratio of gender is 96:100 for every 100 females there are 96 males. As for age, 28 percent of the population is under 15 years old, 68 percent of the population is between the ages 15-64, 4 percent of the population is 64 years old or older. We have selected this topic because there are no sufficient scientific researchmaterials regarding to pregnancy monitoring despite there are regular reports being made about pregnancy monitoring in accordance to Mongolia’s maternity orders. 135 pregnant women who are routinely monitored at family healthcare centers were selected randomly, the results have been calculated by the SPSS 20 program and statistic information provided by pregnancy monitoring guides, and by a 48 question survey made in accordance by the 338th rule of the pregnancy monitoring of regularly processed women.Of the total 135 pregnant women, 88 (65.2%) have been checked on time. While 47 (34.8%) haven’t been checked on time. Furthermore, of women who are married 72.2 % got checked on time while only a third of the women who weren’t married (33.3%) got checked on time. Marital status was also a key factor in women being on time for regular monitoring (p=0.006). Around 70 percent ofwomen with higher education have shown up on time for regular monitoring whereas only 55 percent of women with secondary education got monitored. Considering the age structure 66.7 percent of women aged 20-24, 82.6 percent of women aged 30-34, 83.3 percent of women aged 35 and higher have been involved in regular checks on time. (p=0.031). Employment has been a factor in checkupattendance. 92.9 percent of women who work at state authorities, 63.6 of women who work in nongovernmentorganizations, 51.6 percent of women who are self-employed, 57.9 percent of students,57.9 percent of unemployed women have participated in checkups on time.(p=0.017).From the women who were surveyed, 57 (41.3%) women who didn’t show up on time for their second examination, by the looks of the women 10(83.3%) who went in monitoring on the second three months into pregnancy were pregnant before. It is clear that the women who were pregnant before lose concern about being monitored.87 (63%) of the women took pregnancy class, of the 51 (37%) who didn’t 13 (15%) took the class because they weren’t able to claim their pregnancy benefits and 35 (68.8%) of the women who didn’t take the pregnancy class have stated that they hadn’t had the time. 16 (31.4%) have claimed that it wasn’t needed. This shows that class attendance is insufficient and people only attend to claim their pregnancy benefits. Because of the lack of special service for pregnant women at district hospitals, women are forced to get service elsewhere. It is clear that local doctors give little advice and information about birth, miscarriage and prevention of misbirth.

Learning objectives: After reading this article, readers should be able to:1. Get information about brief historical aspects of the cleft palate treatment;2. Understand techniques used to repair various types of the cleft palate;3. Understand the optimal timing of the cleft palate repair;4. Understand the results and complications following palate repair including speech, maxillary growth, and fistula formation, regarding with operative techniques and timing of palatoplasty.Summary: Cleft palate is more common congenital anomaly, but surgeons have been eluding surgical correction of the cleft palate for centuries. Many surgical techniques have been described during last two centuries, the goals of these include separating the nasal and oral cavities (avoiding fistulas), establishing normal speech, and preserving maxillofacial growth. This article reviews the brief historical aspects of the cleft palate, palatoplasty techniques, the optimal timing, and the results and complication associated with palate repair technique and timing.