Background: Progressive supranuclear palsy (PSP), a rare neurodegenerative disorder, is mainly characterised by supranuclear palsy, trunk imbalance, and cognitive impairment. Its prevalence is believed to be high, although it remains underdiagnosed. Various clinical presentations have been linked to this entity, often making its diagnosis difficult and leading to delays of three to four years before it is established. PSP diagnosis mainly relies on clinical data and can only be confirmed with the neuropathological findings at autopsy. However, recent research indicates that neuroimaging, namely, brain MRI, can aid in earlier diagnosis. Case presentation: We report the case of a 60-something-year-old male with a history of recurrent and unexplained falls over the last few years that had been wrongly attributed to Parkinson’s disease. He initially presented complaining of ataxia and a tendency to recurring falls that got progressively worse, and eventually, he was not able to walk on his own. Concomitantly, there was also a cognitive dysfunction with frontal predominance. An exhaustive physical examination and clinical history revealed indicators consistent with PSP. Conclusion PSP diagnosis demands a high clinical suspicion, and hence, clinicians should have a good understanding of this disease for its early recognition. Although it is a devastating disorder and no medications that can reverse the disease course are currently available, early diagnosis of PSP may contribute to improving the quality of life of the patients and their families and prevent complications. This report highlights the importance of clinical examinations, particularly eye examinations and radiological imaging, in patients with PSP.

Probiotics are considered safe for all ages and anyone with a healthy functioning immune system. During antibiotic treatment, the normal intestinal microflora is destroyed and the normal balance is lost. This article reviews clinical trials of the probiotic Saccharomyces boulardii. The yeast Saccharomyces boulardii CNCM I-745 is a unique, non-bacterial microorganism classified as a probiotic agent. The mechanism of action of probiotics is to attach to intestinal pathogens and their toxins and destroy them; It also destroys the toxic extracellular degradation products of pathogens and regenerates the intestinal mucosa by having an anti-inflammatory effect.

BACKGROUND. Acute primary angle-closure glaucoma (PACG) is a severe disease requiring intensive and emergency treatment. Surgical peripheral iridectomy and laser peripheral iridectomy procedures are performed to decrease papillary block and create an opening for the aqueous humor to pass through the eye. However, the intraocular pressure (IOP) cannot be consistently controlled by peripheral iridectomy. Phacoemulsification can widen the anterior chamber angle, position the ciliary processes in eyes with PAC posteriorly and inhibit the acute angle closure. This procedure can control the intraocular pressure sustainably for a long period. The higher incidence of the acute angle closure glaucoma in Mongolia compared to other countries was the rationale of this study. MATERIAL AND METHODS. Medical records of 9 patients (9 eyes) with acute PACG, who had received phacoemulsification with intraocular lens implantation as initial management for medically uncontrolled high IOP, were analyzed in a retrospective chart review. IOP, visual acuity, anterior chamber depth (ACD) and the number of anti-glaucoma medications used were evaluated. RESULTS. The postoperative IOP was reduced in 9 eyes (100%). The mean preoperative IOP was 37.9 ± 13.0 mmHg, which decreased postoperatively to 11.0 ± 1.9 mmHg at day 1, 11.1 ± 2.1 mmHg at week 1, 11.1±2.0 mmHg at 2 weeks, 11.8 ± 1.9 mmHg at month 1, and 11.3 ± 1.4 mmHg at 3 months, which showed statistically significance (p < 0.001). The mean visual acuity improved from preoperative average of 0.04±0.03 to postoperative average of 0.17±0.24 at day 1, 0.45±0.26 at week 1, 0.54±0.31 at week 2, 0.56±0.34 at 1 month, and 0.57±0.33 (p = 0.001) at 3-months. There was functional success at month 3. СONCLUSION. Our outcome indicates that primary phacoemulsification with intraocular lens implantation lowered IOP and improved visual acuity significantly in patients with acute PACG. This is a safe and effective method of IOP control and can be considered a first line treatment option in managing patients with acute PACG and coexisting cataract.

BACKGROUND: There are two general types of age-related macular degeneration: dry and wet. During wet or neovascular age-related macular degeneration new abnormal vessels grow and leak in the macula. As anti-vascular endothelial growth factor (anti-VEGF) was invented, it revolutionized the treatment of nAMD by inhibiting the progress of this disease. The incidence of AMD increases as life expectancy grows and there is a growing need to study this disease. We aimed to evaluate the outcome of anti-VEGF therapy for the treatment of nAMD and the incidence of ocular serious adverse events (SAE) after injections.. METHODS: In our retrospective, single-center study, medical records of patients receiving a single dose of anti-VEGF treatment (Bevacizumab) for nAMD between 17th of April, 2016 and October, 2017 were evaluated. Outcome measures were the change in the baseline visual acuity (VA) score at post-injective month one, incidence of ocular SAE and patients’ baseline characteristics affecting VA. Patients, whose treatment were started before April 2016 and had anti-VEGF treatment for the diseases other than nAMD, were excluded.. RESULTS: 15 eyes in 15 patients between 52 and 85 years of age received single dose of anti-VEGF (Bevacizumab/Avastin) injection. The mean baseline VA improved from pre-injective average of 0.21 to post-injective 1-month average of 0.37 by Snellen. Furthermore, there was no vision loss or other severe adverse effects, such as endophthalmitis, vitreous hemorrhage, retinal detachment, traumatic cataract after 4 weeks. CONCLUSION: Anti-vascular endothelial growth factor therapy has promising short-term outcomes on treating neovascular age-related macular degeneration.

BACKGROUND: Pterygium is a fibrovascular wing shaped encroachment of conjunctiva onto the cornea. Although the pathogenesis remains obscure, the ultraviolet radiations (UVR), especially UVR-A and UVR-B (290-400 nm), are considered the most dangerous in developing pterygium among other environmental factors (hot, dry, windy, dusty and smoky environments and hereditary factors. The main histopathological change in primary pterygium is elastotic degeneration of conjunctival collagen. Patient complaints include foreign body feeling and visual loss due to corneal astigmatism or growth over the pupil and cosmetic problems. Anti-inflammatory drugs and lubricants have an important role minimizing the patient’s discomfort, but they do not cure the disease. After surgical removal there are still many recurrences regardless of the method used. Autologous conjunctival grafting seems to be the best method, given both the low recurrence rate and high safety. As described first by Kenyon et al. in 1985, a conjunctival autograft reported a recurrence rate of 5.3% with infrequent and relatively minor complications. The primary disadvantage of this technique is the prolonged operative time required when compared to the bare sclera technique. These disadvantages are outweighed by the lack of sight-threatening complications and the relatively low recurrence rate, which made this procedure gain popularity in many centers. The application of intraoperative 0.02% mitomycin C for the 5 minutes is efficient in reducing the recurrence rate to a minimum. METHODS: This retrospective case series, single center study was conducted on 239 patients, who underwent pterygium excision from Jan 2017 to Dec 2017 at the Department of Ophthalmology of the First Central Hospital. All patients had a detailed ophthalmic examination before the surgical intervention. Data were collected through a prepared questionnaire. Postoperative follow-up examination sheets were evaluated. Data for recurrence rate of pterygium excision were collected and analyzed by using SPSS version 17.. RESULTS: Among the 239 patients, who underwent an operation, 37.2% (n=89) were male and 62.8% (n=150) were female. Participants’ age ranged from 29 -70 years with mean age of 49.5 years old. There is no statistical significance between the stages of the disease and its post-operative outcome in the patients, who underwent pterygium excision surgery in 2017. Postoperative pterygium recurrence was in 9 patients (3.8%); 5 (55.5%) out of all 9 patients with recurred pterygium had underwent pterygium excision without conjunctival autograft. MMC was not used intraoperatively for all 9 (3.8%) patients with recurrence post pterygium excision. CONCLUSION: The relationship between pterygium stage and its post-operative recurrence was not statistically significant (P=0.683). The recurrence rate after pterygium excision with conjunctival autograft was low (P≤0.001) which showed significant statistically. There was no recurrence after pterygium excision with MMC (P≤0.001). The results of studies from Canada, Hong-Kong, India, Philippines and Iran were similar to our outcome.

Today, there are 382 million people living with diabetes. A further 316 million with impaired glucose tolerance are at high risk from the disease – an alarming number that is set to reach 471 million by 2035. One of the most overlooked of all serious complications of diabetes is cardiovascular autonomic neuropathy (CAN) which encompasses damage to the autonomic nerve fibers that innervate the heart and blood vessels, resulting in abnormalities in heart rate control and vascular dynamics. The present report discusses the clinical manifestations (eg, resting tachycardia, orthostatic hypotension exercise intolerance, intra operative cardiovascular liability, silent myocardial infarction (MI), and increased risk of mortality) in the presence of CAN. The reported prevalence of CAN varies greatly depending on the criteria used to identify CAN and the population studied. CAN prevalence ranges from as low as 2.5% of the primary prevention cohort in the Diabetes Control and Complications Trial (DCCT) to as high as 90% of patients with long-standing type 1 diabetes who were potential candidates for a pancreas transplantation. Objective: The aim of this study was to evaluate the Cardiac Autonomic Neuropathy (CAN) among diabetic patients.This study included patients with T1 DM and 20 patients with T2 DM total (97 male, 86 female) diabetic patients. The CAN diagnosed by 6 clinical tests: Resting Heart Rate (RHR), Expiration : Inspiration (E:I) ratio, Heart rate response to standing (30:15 ratio), Orthostatic hypotension (OH) and Sustained Hand Grip (SHG) using Cardiac Autonomic Neuropathy System Analyzer CAN-504. CAN was indicated at least two of five tests are abnormal.Diabetic patients’ mean age was 48.74±12.74, diabetes duration 7.55±5.72, systolic blood pressure 136.25±22.76mm Hg, diastolic blood pressure 84.82±11.90 mmHg, cholesterol 5.04±1.04mmol/l, triglyceride 2.20±1.24mmol/l, LDL2.64±0.85mmol/l, HDL 1.12±0.41mmol/l, non-HDL 3.71±1.06, cholesterol/HDL ratio 4.70±1.29, HBA1c 10.08±2.39%. Result of RHR resting heart rate test was normal 92%, borderline 0.5% and abnormal 7.1%,Expiration:inspiration(E:I) ratio was normal 72.7%,borderline 13.7% and abnormal 14%, Heart rate response to standing (30:15ratio) was normal 47%,borderline 13.714% and abnormal 39.3%, Valsalva was normal 97.8%,borderline 2.2% and abnormal 0%, Orthostatic hypotension (OH) was normal 66%,borderline 29% abnormal 6% and Sustained hand grip(SHG) test was normal 4.9%,borderline 9%, and abnormal 87.8%.Number of abnormal cardiac autonomic neuropathy test results <2 (no cardiac autonomic neuropathy) was in 86(47%) and >2 (with cardiac autonomic neuropathy) was in 97(53%) among diabetic patients. Among diabetic patients cardiac autonomic neuropathy (CAN) was 53%.

AIMAim of this study was to evaluate Predicted 4 and 10-years risk of major CVD of DMpatients.METHODSCross-sectional study included 80 (40 male and 40 female) DM patients with meanage 66.32 ±7.94 years old. Predicted 4-year risk of major CVD was calculated by usingADVANCE Risk Engine of the George Institute for Global Health, Australia. Ten parameters(age at diagnosed diabetes, duration of diabetes, sex, atrial fibrillation, retinopathy,HbA1C, pulse pressure, treated hypertension, albuminuria and Non HDL-cholesterol)were used for risk calculation. Predicted 10-year risk of major CVD was calculated byusing WHO/ISH risk prediction chartrs Parameters (age, sex, systolic blood pressure, totalcholesterol, smoking) were used for risk calculation.RESULTSOur study relieved that average of diagnosis diabetes was 54.98±9.37 years oldand mean diabetes duration was 11.35±7.46 years. DM patient with atrial fibrillation,retinopathy and treated hypertension were 0(0%), 20(16%) and 77.5(62%). Mean HbA1C,microalbuminuria and Non HDL cholesterol were 7.74±1.5%, 49.99±94.02 mg/l and3.61±1.08 mmol/l. DM patients with <10%, 11-20% and >20% Predicted 4-year riskof major CVD were 64( 80%), 12 (15%) and 4(5.0%). Age (p<0.042), age at diagnoseddiabetes (p=0.013), duration of diabetes (p=0.045), total cholesterol (p<0.027)Microalbuminuria (p<0.001) and retinopathy (p=0.028) were risks for Predicted 4-yearrisk of major CVD.DM patients with <10%, 11-20%, 20-30%, >30% Predicted 10-year risk of major CVDwere 44 (55%), 20 (25%), 6 (7.5.0%) and 10 (12.5%). Age (p=0.008), total cholesterol(p=0.001), systolic blood pressure (p=0.001) and treated hypertension (p=0.023) wererisks for Predicted 10-year risk of major CVD.CONCLUSIONSAmong the diabetic patients 80% have a low, 15% have a moderate and 5.0%have a high Predicted 4-year risk of major CVD. Age (p<0.042), age at diagnoseddiabetes (p=0.013), , duration of diabetes (p=0.045), total cholesterol (p<0.027)Microalbuminuria (p<0.001) and retinopathy (p=0.028) were risks for Predicted 4-yearrisk of major CVD. Among the diabetic patients 55% have a low, 25% have a moderate,7.5% have a high and 12.5% have a very high Predicted 10-year risk of major CVD. Age(p=0.008), total cholesterol (p=0.00, systolic blood pressure (p=0.001) and treatedhypertension (p=0.023) were risks for Predicted 10-year risk of major CVD.

Aim of this study was to evaluate the effectiveness of weight loss intervention in overweight and obese patients with newly diagnosed type 2 diabetes mellitus (T2D).92 overweight and obese subjects (42 men and 50 women), aged 32-56 years, with recently diagnosed type 2 diabetes were enrolled to the prospective cohort study. A 6-month counselingbased intervention was conducted between December 2011 and June 2012. Participants were Mongolian and received education sessions on healthy lifestyle guidelines including nutrition and physical activity in small groups. Before and after intervention, body weight (kg), body fat (%), waist and hip circumferences (cm), blood pressure (mm Hg), fasting blood glucose (mmol/l), HbA1C (%), total cholesterol (mmol/L) and triglyceride (mmol/L) were measured.80 out of 92 (86.9%) overweight and obese patients with T2D (BMI 31.57±4.2) completed weight loss intervention. Results of this study before and after the intervention showed mean body weight 84.41±13.08 vs 80.11±12.42, p<0.0001; BMI 31.57±4.2 vs 29.87±3.72, p<0.0001; waist circumference 104.18±10.51 vs 99.78±8.52, p<0.0001); hip circumference 107.04±8.66 vs 105.38±7.79, p<0.01; WHR 0.96±0.07 vs 0.94±0.05, p<0.0005; body fat 36.19±5.64 vs 34.26±6.57, p<0.0005; systolic blood pressure 133.03±22.5 vs 127.54±17.5, p<0.01; diastolic blood pressure 81.18±13.14 vs 77.61±11.03, p<0.05; fasting blood glucose 11.57±4.06 vs 7.99±2.64, p<0.0001; HbA1C 8.45±2.70 vs 5.95±1.70, p<0.0001; and total cholesterol 3.87±1.05 vs 3.15±0.96, p<0.0001 were improved significantly, except triglyceride 2.11±0.82 vs 1.73±1.8, p=0.0519. Thus results of the study showed an average weight loss of 4.3 kg and a significant decrease in BMI, percent body fat, and waist and hip circumferences, waist to hip ratio at 6 month. Significant reduction found in levels of fasting glucose, HbA1c and total cholesterol in blood after intervention, however no significant change found in blood level of triglyceride. Systolic and diastolic blood pressures were reduced significantly.Weight reduction of 5.1% of body weight in overweight and obese subjects with type 2 diabetes by the lifestyle intervention for 6 months resulted in significant reductions in total, abdominal and trunk adiposity and reduced blood pressure and improved glycemic control and dislipidemia.