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: The selection of vascular access is an important determinant of procedural success, safety, vascular complications, patient satisfaction, and hospital length of stay during percutaneous coronary intervention (PCI). Although current international guidelines recommend transradial access (TRA) as the preferred approach, comparative data between transradial and transfemoral access (TFA) in the Mongolian population remain limited. Therefore, this study aimed to compare the clinical and patient reported outcomes of the two vascular access strategies in Mongolia. Aim: To compare the clinical outcomes of transradial and transfemoral access in patients undergoing coronary angiography and percutaneous coronary intervention. Materials and Methods: A hospital-based cohort study was conducted including 200 consecutive patients undergoing coronary angiography or PCI. Participants were equally allocated into the transradial access group (TRA, n=100) and the transfemoral access group (TFA, n=100). Demographic characteristics, post procedural pain assessed using the Visual Analogue Scale (VAS), length of hospital stay, access site complications, early mobility, and patient reported satisfaction were evaluated. Patient satisfaction was assessed using a five point Likert scale based on internationally recognized patient reported outcome domains. Statistical analyses were performed using SPSS version 25.0. Continuous variables were compared using the independent samples t-test or Mann-Whitney U test, whereas categorical variables were analyzed using the Chi-square test or Fisher’s exact test. A p-value <0.05 was considered statistically significant. Result: The mean age of the participants was 60.8±11.56 years, and 75.5% were male. Patients treated via transradial access experienced significantly lower post procedural pain than those treated through transfemoral access (VAS: 2.5±0.29 vs. 3.4±0.21; p=0.031). Early mobility within 24 hours after the procedure was significantly better in the TRA group (p=0.009). Minor vascular complications and hematoma (<10 cm) occurred only in the transfemoral group (1.0% each), while no major vascular complications were observed in either group. Patient-reported assessment of treatment outcomes and symptom improvement (p=0.048) and overall patient satisfaction (p=0.041) were significantly higher in the transradial group. No significant differences were observed between the groups regarding perceived healthcare service quality, accessibility, or physician–patient communication (p>0.05). Conclusion Compared with transfemoral access, transradial access was associated with lower post-procedural pain, better early recovery, fewer access-site complications, and higher patient-reported treatment outcomes and overall satisfaction, supporting its use as the preferred vascular access strategy for coronary angiography and PCI.

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.

Background: Type 2 diabetes has increased risk of heart failure 2-4 times more than those in non-diabetic subjects. The early detection of asymptomatic ventricular dysfunction by using NT-pro BNP test in diabetic patients is the best strategy for decreasing morbidity and mortality of heart failure. Aim: The aims of this study were to detect asymptomatic cardiac ventricular dysfunction by using NT-pro BNP test in subjects with type 2 diabetes and to define the factors associated with elevated NT-proBNP. Materials and Methods: This cross-sectional study was included diabetic and non diabetic subjects aged from 35- to 64 years, who had no clinical symptoms of heart failure. Cardiovascular risk factors were detected by clinical examinations. NT-pro BNP determination was performed on an immunoassay analyzer (FIA1100, Getein Bio Medical Inc, China), which uses reagent strip to obtain quantitative NT-pro BNP results in plasma. The cut-off point for NT-pro BNP was 300 pg/ml. Results: A total of 536 subjects without clinical symptoms of heart failure were included in the study of which, 150 were diabetic and 386 were non diabetic. The mean age was 52.8 ± 7.8 years and 281 (52.4%) were females. Cardiac ventricular dysfunction was detected in 7.3% of diabetic and 5.2% of non diabetic subjects. Cardiac ventricular dysfunction in diabetic subjects was increased with age and non-significantly higher in females than in males (8.3% vs 6.4%, p>0.05). In the logistic regression analysis, uncontrolled hypertension (OR 3.80, 95% CI 1.07–13.44), long duration of disease (OR 5.30, 95% CI 1.36-20.66), and ageing (OR 5.40, 95% CI 1.29–22.88) were significantly correlated cardiac ventricular dysfunction in subjects with type 2 diabetes. Conclusion Cardiac ventricular dysfunction in subjects with type 2 diabetes was detected 1.4 times more than those in non diabetic subjects. The likelihood of positive NT-pro BNP test in subjects with type 2 diabetes was independently (p<0.05) associated with advanced age, uncontrolled hypertension and long duration of diabetes.

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.

Background: Last years increased the human and animal cases of anthrax. During 2000-2009 infected 197 livestock of them 73 cattles, 7 horses, 13 goats and 104 sheep and 10 human cases of anthrax at Khentii province. Goal: We are aimed to evaluate human and animal cases of anthrax which registered at Khentii province last 10 years.Materials and methods: Used for registration of veterinary report of 2000-2009, last 10 years report of human cases of CIDNF Khentii province. Analyzed the data, compared and evaluated the result of human and animal anthrax cases. Results: The Khentii province included at zone of middle risk, active foci by classification of anthrax risk foci (Tserendorj and et all, 2006). Totally 1148 livestock infected by anthrax during 2000-2009 in national level and of them 17.1% registered at Khentii province. Infected 10 patient during 2000-2009 occurred 12.7 % than national level. Most of patients 95.2% (16) infected by used the skin, meat with died from anthrax. The 4.8% (1) of all patients infected from soil which work at soil. All patients infected by bubonic form. Last 2007, 2008,2009 disinfected at soil and decreased the detection of cultures or positive results from soil.Conclusion: The high risk of human anthrax depends on most likely from animals and soils. Herders take more risks due to their job specialization. Male workers of working age groups are generally infected by anthrax in particular. Especially assistant workers in agriculture and mining sectors are extra vulnerable in anthrax. The new areas have been infected by the virus of human and animal anthraxes because of increases of animal movement from place to place. The reasons of animal movement are number of people working in commercial and hand operated gold mining, herders movement to another area for looking pasture (otor) and growing number of celebration activities (Batshireet, Norovlin soum in 2007).