Background: The most common clinical manifestation of HCV infection, which includes both hepatic and extrahepatic manifestations, is mixed cryoglobulinemia, which is characterized by the precipitation of certain proteins in the blood at temperatures below 37°C (in vitro), aggregation, and deposition in the walls of small and medium-sized vessels, causing vasculitis, which is clinically manifested by a triad of joint pain, fatigue, and rash on the soles of the feet. Cryoglobulinemia is commonly diagnosed in people with HCV infection, with a prevalence ranging from 10% to 70%. Vasculitis that occurs when cryoglobulinemia is detected mainly affects the small vessels of the skin, kidneys, and peripheral nerves, causing complications in other organ systems. Aim : To determine the prevalence of cryoglobulinemia in people with HCV infection, study it in relation to the stage of liver fibrosis, and determine its clinical relevance. Materials and Methods : 200 chronic HCV infected individuals were included in the study according to the inclusion and exclusion criteria. After obtaining informed consent from each participant, a questionnaire was used to collect information, perform physical measurements, and collect peripheral blood samples. Complete blood count and biochemical tests (liver and kidney function) were performed. The degree of liver fibrosis was assessed non-invasively (APRI, FIB4). The glomerular filtration rate was calculated electronically using the MDRD GFR Equation. Skin examination was performed to assess the presence of rash, ulcers, and scarring on the shins and ankles of cryoglobulinemia. To determine cryoglobulinemia, 8 ml of blood was collected in a tube without anticoagulant, and the sample was kept motionless for 1 hour at room temperature until clotting was complete. After centrifugation, the samples were separated and stored in a refrigerator at +4°C for 7 days, and then at room temperature for 30 minutes, the precipitate was detected. Results : A total of 200 people participated in the study, of which 71 were men (35.5%), the average age was 53.39±13.0. Cryoglobulinemia protein precipitates were determined in a total of 148 people, of which 50 were men (33.8%), the average age was 52.95±13.0. Cryoglobulinemia protein precipitates were detected in 89 people, or 60.1% of the study participants. Of the total study participants, 176 (88.0%) had chronic hepatitis C (CHC). Of these, 57 people had CHC with cryoglobulinemia. Comparing laboratory parameters, the mean GGT level in the cryoglobulinemia group was statistically significantly higher than in the non-cryoglobulinemia group (p=0.039). However, when laboratory parameters were grouped by increasing or decreasing, AST and ALT levels were significantly higher in the cryoglobulinemia group, indicating more hepatocellular damage (p<0.000). Increased creatinine levels may be associated with the risk of renal dysfunction. The FIB-4 index and APRI index showed a more severe degree of fibrosis in the cryoglobulinemia group (p<0.005; p<0.000). Univariate logistic regression analysis showed that age was associated with the occurrence of cryoglobulinemia (OR=2.48; 95% CI:1.31–4.70; p=0.005). Platelet count had a statistically significant positive effect in multivariate analysis (OR=14.38; 95% CI:1.26–163.89; p=0.032). Conclusion The prevalence of cryoglobulinemia among HCV-infected patients was 60.1%, and older age and decreased platelet count among infected individuals were associated with the occurrence of cryoglobulinemia.

Background: In 2022, the World Health Organization (WHO) reported that globally, 2.5 billion (43%) of adults aged 18 and older were overweight, with 890 million (16%) of these individuals classified as living with obesity. Some genes such as the FTO gene are strongly associated with obesity and overweigh. The FTO protein is crucial in regulating food consumption, appetite, energy equilibrium, and expenditure. Aim: The identify single nucleotide polymorphisms rs9939609 and rs17817449 of the FTO gene, which are associated with obesity, and to study their correlation with antropometric measurements and some laboratory test parameters. Materials and Methods: According to the inclusion and exclusion criteria, 50 obese (BMI >30 kg/m²) were included in the case group, and 50 relatively healthy and normal weight (BMI 18.5-24.9 kg/m²) were enrolled in the control group, for a total of 100 people matched for age and gender (1:1). We took physical measurements and collected peripheral blood samples after obtaining informed consent from each participant. Laboratory analyses assessed some parameters of lipid and glucose metabolism. We used the PCR-RFLP technique on two genotype SNPs. A p-value below 0.05 was considered a statistically significant result. Results: In this study, including 100 people aged 23 to 75, the mean age was 46.81±11.54 years, with 60% being female. In terms of antropometric measurements, body mass index, waist circumference, and arterial pressure were markedly elevated in the case group compared to the control group (p<0.001). In laboratory measures, fasting blood glucose, cholesterol, and mean LDL mean levels were statistically significantly higher in the case group compared to the control group. On the other hand, HDL cholesterol levels were lower in the case group compared to the control group. The FTO gene rs9939609 single nucleotide polymorphism was identified in 62% of the total study individuals as TT, 35% as AT, and 3% as AA genotypes. Also, FTO gene rs17817449 single nucleotide polymorphism was identified in 62% of the total study individuals as TT, 33% as AT, and 5% as AA genotypes. Conclusion The rs9939609 AT/AA genotype of the FTO gene elevates the risk of obesity and is associated with increased body weight, waist circumference, and BMI.

Introduction: While 10 percent of global total population was above the age of 65 in 2022, it tends to rise to 16 percent in 2050. In the case of our country, as of 2021, individuals aged 60 and above comprised 7.7% of the total population, with tendency of an increase to 11.9% by 2030 and 21.1% by 2050. In 2018, a study conducted in Brazil, involving 573 elderly participants, found that 10.3% regularly taking five or more medications. This highlights the necessity of studying polypharmacy among the elderly. Goal: To identify inappropriate medication use among the elderly Materials and Methods: The study was conducted by analytic cross sectional design. Furthermore, the study was conducted during July 1, 2024, to October 1, 2024, in Ulaanbaatar, covering 6 districts. A total of 12 Family Health Centers (FHCs) were selected, including one from an apartment district and one from a ger district in each area. A random sampling method was used to select 238 elderly individuals aged 55 and above for females and 60 and above for males. From each district, 20 participants were selected, maintaining a gender ratio of 1:1. Statistical analysis was performed using Pearson’s Chisquare test and multiple logistic regression analysis. The study was conducted after obtaining approval from the research ethics committee of “Ach” Medical University. Results: Among the 238 participants in the study, the gender distribution was equal, with 119 females (50%) and 119 males (50%). When analyzing the primary conditions requiring for regular medication by organ system, cardiovascular diseases were the most common, accounting for 89.9% (214) of total cases.
Among the elderly patients included in the study, 68% were found to have inappropriate medication use. Elderly females, aged 85 years and older (n=6, 100%) demonstrated a statistically significant higher prevalence of inappropriate medication use compared to other age groups (p =.023). Among those with inappropriate medication use, 54.9% were females and 45.1% were males, a difference that was also statistically significant (p = .026). Inappropriate medication use was significantly associated with the type of medication used for the primary disease (p = .001), dosage (p = .000), duration of use (p = .000), frequency of daily intake (p =.003), use of medications due to comorbidities (p =.000), and whether the medication was prescribed by a physician (p = .001).According to multivariate logistic regression analysis, age (OR 2.31, 95% CI 1.25–4.29, p = .008), gender (OR 0.574, 95% CI 0.356–0.924, p = .022), education level (OR 2.03, 95% CI 1.21–3.58, p = .008), and pension status (OR 1.03, 95% CI 0.586–1.83, p = .904) were found to be influencing factors for inappropriate medication use. Conclutions 1. Inappropriate medication use among the elderly accounts for 68%.

Introduction: Hepatitis C virus (HCV) infection has both hepatic and extrahepatic manifestations, and it is one of the leading cause of liver transplantation. There’s limited research on extrahepatic symptoms of chronic HCV in Mongolia, thus we aimed to investigate the relationship between cryoglobulinemia and it’s related factors. Methods: The study included 200 participants with active HCV, collecting blood samples for various tests (biochemical analysis, kidney function, and cryoglobulinemia detection). The degree of liver fibrosis was assessed using APRI and FIB4 scores, and the study evaluated other health conditions through a questionnaire. Statistical analysis was performed using SPSS-26. Results: Out of 200 participants, 148 checked for cryoglobulin precipitation and 89 (60.1%) were positive. There was a statistically significant age difference between those with and without cryoglobulinemia (54.62 vs. 50.44 years). A higher percentage of participants with cryoglobulinemia had significant liver fibrosis (10.8% vs. 4.7% without). Liver fibrosis scores tended to increase with age, especially in men. Conclusion Liver fibrosis scores above 3.25 are associated with older age, lower platelet counts, elevated AST and ALT levels, and the presence of cryoglobulinemia. FIB4 scores were higher in men with active HCV and cryoglobulinemia.

Introduction: The worldwide prevalence of obesity and its metabolic complications have increased substantially in recent decades. According to the World Health Organization (WHO) indicate that in 2016, over 1.9 billion adults were overweight and, of these, over 650 million were obese. Obesity is a major risk factor for heart disease, type 2 diabetes, steatotic liver, chronic liver disease, stroke, and some cancers. The global prevalence of obesity and its associated comorbidities continue to increase on a pandemic scale. Aim: To determine metabolic changes in overweight and obese adults and their related diseases based on some parameters of anthropometric and laboratory tests. Materials and Methods: This study was conducted with a case-control design in 2023–2024. There were 150 participants in the study, 50 in the control group with normal weight, 50 in the overweight (BMI<29.9kg/m2) case group, and 50 in the obesity (BMI>30kg/m²) case group. Subjects of three groups were matched by age (±1) and sex. We estimated anthropometric parameters and biochemical laboratory analysis including glucose, lipid, ferrum, and liver parameters. CBC All statistical analysis was performed using SPSS 23 software. Categorical variables were described by numbers and percentages, and the numerical variables were characterized by the median (min and max) for the normal distribution, and mean± standard deviation for the non-normal distribution. The statistical tests utilized were the Chi-square, Fisher’s exact, student t-test, and Mann–Whitney tests. Ethical approval for the survey was obtained from the Medical Ethics Committee under the Ministry of Health Of Mongolia in January 2023. Results: The participants' average age was 46.73±11.45, with 60% being women (90) and 40% being men (60). The prevalence of central obesity and fat % were 52.3% and 37.2%, respectively. Between study groups, there were significant differences in fat% (p=0.004), central obesity (p<0.001), FBG (p=0.024), cholesterin (p=0.017), LDL (p=0.018), HDL (p=0.003), ferrum (p=0.010), АЛАТ (p=0.020), and GGT (p<0.001). Conclusion In overweight and obesity groups, the body fat, fasting blood glucose, cholesterol, LDL, and ALT levels are increased. These changes often lead to conditions like type 2 diabetes, arterial hypertension, steatotic liver disease, and liver fibrosis. Therefore, it is important to develop plans for prevention, early detection, public awareness, and intervention programs targeting obesity in the general population.

Introduction: The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) has increased significantly over the last three decades worldwide, from 17.6% in 1990 to 23.4% in 2019. The development of this disease depends on many risk factors, including genetics, lifestyle, and environment. The PNPLA3 (patatin-like phospholipase domain-containing protein 3) gene is the most relevant genetic factor influencing the risk of metabolic dysfunction-associated steatotic liver disease. The PNPLA3 rs738409 GG genotype impairs adiponutrin function, accumulating triglyceride in liver cells and forming small fat droplets within the liver. Aim: To determine rs738409 and rs2896019 single nucleotide polymorphisms of the PNPLA3 gene in metabolic dysfunction-associated steatotic liver disease and their correlation with some parameters of anthropometric and laboratory tests. Materials and Methods: This study was conducted with a case-control design in 2023–2024. There were 150 participants in the study, 50 in the control group without MASLD, and 100 in the case group with MASLD. The PNPLA3 (rs738409, rs2896019) gene’s single nucleotide polymorphism was identified by the RFLP-PCR technique. All statistical analysis was performed using SPSS 23 software. Categorical variables were described by numbers and percentages, and the numerical variables were characterized by the median (min and max) for the normal distribution, and mean± standard deviation for the non-normal distribution. The statistical tests utilized were the Chi-square test, Fisher’s exact test, student t-test, and Mann–Whitney test. Ethical approval for the survey was obtained from the Medical Ethics Committee under the Ministry of Health Of Mongolia in January 2023. Results: The participants’ average age was 46.73±11.45, with 60% being women (90) and 40% being men (60). Among all patients, the PNPLA3 gene’s single nucleotide polymorphism rs738409 revealed 44.7% (67) CC, 54.7% (82) GC, and 0.7% (1) GG (OR-CG+GG genotype- 2.9, p=0.003). In addition, as a result of determining the PNPLA3 gene rs2896019 single nucleotide polymorphism, the frequency of the TT genotype was significantly higher in the control group than in the case group (48%, 31%, p = 0.042). Conclusion The frequency of CG/GG genotypes rs738409, and rs2896019 of the PNPLA3 gene is higher in the case group, suggesting that they may be more susceptible to MASLD.

Background and Aims: Hepatocellular carcinoma (HCC) is a common cause of cancer related death in Mongolia. Early diagnosis is the very important management to increase successful treatment and survival rate. Glypican-3 (GPC3) protein is highly expressed in hepatocellular carcinoma (HCC) tissue and in serum of HCC patients. Recent studies have been conducted and suggested as a diagnostic biomarker for detecting HCC in the early stage. Therefore, we investigated the diagnostic value of the serum GPC3 level and compared it to the alpha-fetoprotein (AFP) level as a diagnostic biomarker of HCC. Methods: We enrolled a total of 90 participants and divided into 3 groups with HCC (30), with liver cirrhosis (LC/30) and healthy (30) as the control group (30). GPC3 and AFP serum (sGPC-3, sAFP) levels were measured using commercially available enzyme-linked immunosorbent assay kits. The diagnostic accuracy was analyzed using the receiver operating characteristics (ROC) curve and estimated sensitivity and specificity of each biomarker. Results: sGPC3 was significantly elevated in the HCC group as compared to liver cirrhosis and healthy subjects (658±138.2 pg/ml, 378±25.5 pg/ml, 356.3±29 pg/ml) respectively. sGPC-3 sensitivity was 96.6% and specificity was 100%. The area under the ROC curve (AUC) for GPC3 was 0.999 (0.996- 1.0).
In comparison, the mean of AFP was significantly higher in HCC (16.9±11.7 ng/ml) than in LC (6.7±7.6 ng/ml) and in healthy subject (3.3±2.1 ng/ml) and AFP sensitivity was 43,3 %, specificity was 95 % with an AUC of 0.808 (0.696- 0.921).
The combination of GPC-3 with AFP achieved the highest sensitivity (97.1%) and specificity (97%). Conclusion Serum GPC3 has a higher sensitivity than AFP for the early diagnosis of HCC. Combination of two markers showed greatest diagnostic accuracy.

Background: Healthcare organizations are successfully implementing quality management system by forming legal entity, administration’s structure, arrangement and developing healthcare organization’s structure, arrangement, functional standard, clinical guideline, rule and employee’s moral principles. Implementation of accreditation system into healthcare organizations is proof of accepted standard application. However, the results of healthcare paradigm shift outcome is insufficient. Also researchers, citizens and policy makers commented that quality and access of healthcare service began to worsen compared with previous degree of development. Management capability index presents management assessment by score, assesses outcome of organizational functions and give chance to measure capability of management. Methods: This study was performed at the Amgalan Maternity Hospital, Urguu Maternity Hospital and Khuree Maternity Hospital. The study involved 480 employees of above-mentioned hospitals. The study used 9 chapter and 90 criteria that was used in over 30 Mongolian Governmental Organizations for capability assessment to determine management capability index of Maternity Hospitals, using Cross-Sectional study method. In the study, a questionnaire with 90 questions including organization management capability 9 chapters which are organizational goal and task, leadership skill in organization, worthwhile structure and arrangement, organization’s motivation and leverage, organization’s relationship and collaboration, organizational culture, resource utilization, knowledge and innovation, organizational productivity, quality and performance was used. Organizations capability index was estimated by assessment of each questions in scores 1 to 5. Results: Total 480 employees consisting of 220 employees working at Urguu Maternity Hospital, 125 employees of Khuree Maternity Hospital and 135 employees of Amgalan Maternity Hospital filled the questionnaire. 46 administration officials, 75 doctors, 208 nurses and obstetricians, 105 caregivers and service assistants and 46 economic employees involved it. Organizational management capability was 71.8, 73.6 and 93 respectively Urguu Maternity Hospital, Khuree Maternity Hospital and Amgalan Maternity Hospital. It is obvious that there has necessity to improve organizational knowledge, innovation, resource utilization, behavior, culture and activate their organization. In result of studying doctors, nurses, obstetricians and other employee’s work task management, there has relatively little difference of management capability index with 0-3.9% between Urguu Maternity Hospital and Khuree Maternity Hospital while management capability index of Amgalan Maternity Hospital had difference with 14.7-20.1%. In the work task questionnaire analysis, no difference was noted but administrative officials and service assistants gave high assessment for organizational management. Regression analysis was used to assess the relationship between management capability assessment of doctors, nurses, obstetricians and other employee of Maternity Hospitals and the result was p<0.001 and r=0.89. It represented the presence of strong association between those. Conclusions Management capabilities of Urguu and Khuree Maternity Hospitals which don’t implement the quality management system have difference from Amgalan Maternity Hospital’s management capability. All participants of Amgalan Maternity Hospital implementing quality management system gave same assessment for their organizational management capability index regarding of differences of work tasks.

Introduction: Studies in many countries have found that the satisfaction of medical workers is closely linked to the quality and efficiency of medical services, as well as the satisfaction of patients. Satisfied employees will bring about satisfied clients. The satisfaction of employees remains a key factor linking the internal management and external management of an organisation. The World Health Organization (WHO) Global strategy on human resources on health workforce 2030 sets out the policy agenda to ensure a workforce that is ft for purpose to attain the targets of the Sustainable Development Goals (SDGs). Motivation of health care workers can initiate them to exert and maintain an efort towards organizational goals. Motivation depends up on many factors, and job satisfaction is one of the most important factors. Healthcare is a service industry where the overall service experience is important for customer satisfaction and quality of care (even if in different extents according to the professional at stake) and that the literature has been bringing about the pertinence of such a holistic approach, this research was conducted within this perspective. Likewise, it is also known that there is close correlation between the job satisfaction of health care staff and the total quality of health services. Different groups have reported differences between the job satisfaction of doctors and that of other health providers. Various satisfaction levels of health care workers, including general practitioners, nurses and midwives, have been reported previously. Materials and Methods: This study was performed at the Amgalan Maternity Hospital, Urguu Maternity Hospital and Khuree Maternity Hospital The study involved 480 employees of above mentioned hospitals. The short form of the Minnesota Satisfaction Questionnaire, with 20 items, was used to examine satisfaction with professional life. The self-administered questionnaire was distributed to all people at their workplaces. Responses of 4 (satisfied) or 5 (very satisfied) were classified as ‘satisfied’, those of 1 (very dissatisfied) or 2 (dissatisfied) as ‘dissatisfied’. Results: The study recruited total 480 employees consisting of 220 employees working at Urguu Maternity Hospital, 125 employees of Khuree Maternity Hospital and 135 employees of Amgalan Maternity Hospital. 46 administration officials, 75 doctors, 208 nurses and obstetricians, 105 caregivers and service assistants and 46 economic employees involved it. In table, 87.1% of total employees of maternity hospitals were female and 12.9% were male. While there had significantly difference for gender, occupation type and worked year in this sector and workplace between 3 maternity hospitals (p<.001), age and education level had no significantly difference between these 3 groups. The proportion of health care staff satisfied with their work was 80.7%. The chance to tell people what to do’ and ‘Being able to do things that do not go against my conscience’, and mostly dissatisfied with ‘The working conditions’ and ‘My pay and the amount of work I do’. There was no significant difference between satisfaction scores of health care staff according to age, gender, marital status, and experience of profession. When the 20 items constituting job satisfaction were examined specifically, the satisfaction score showed a difference related to profession. The midwives’ satisfaction score was significantly lower than that of the others. In table 4, to assess employee’s satisfaction of each maternal hospital: While the minimum satisfaction was assessed by employees of Urguu maternity hospital whether salary is equal for work performance, the maximum satisfaction was assessed by employees of Amgalan maternity hospital under scope of consistent workplace at 93.9 percent. Conclusion Maternity satisfy external and internal factors of employees are influenced. Maternity is different, depending on the satisfaction of other working areas of employment.

Background: Postpartum readmission rate has been increasing after both caesarean and vaginal delivery. Postpartum diseases, in some cases with infection and anemia, result in hospital readmission. Also it raises the issue associated with maternal hospital’s healthcare quality. There has lack of study focusing on postpartum readmission. So we will study postpartum readmission rate. Material and Methods: 112 patients who readmitted in Amgalan maternity hospital in Ulaanbaatar were involved in this study. We used patient’s medical history to determine risk factors resulted in hospital readmission after caesarean and vaginal therapy. Results: The mean age of women delivered by cesarean was 30.2±7.32 and vaginal delivery’s was 28.3±7.21. 34.8 percent of women who readmitted after vaginal delivery had 1-3 readmission days and 56.5 percent was 4-6 days and 8.7 percent was 7-10 days. Readmission day for women delivered by caesarean was 1-3 days in 21.2 percent of these, 4-6 days in 56.1 percent and 7-10 days in 19.7 percent. The mean readmission day of women delivered by vaginal delivery was 4.73±1.61 (mean±SD) and the mean of women delivered by caesarean delivery was 5.54±2.34 (mean±SD). In each category, there had 24.2-28.3 percent cases with lochia. Women who had caesarian delivery were infected their scar with 24(36.3) cases. Renal urinary system infection had in 12(26.0) women delivered by vaginal delivery. Conclusion 58.9 percent of total readmissions cases were caesarean and 41.1 percent was vaginal delivery. Lochia and renal urinary infection had influence in readmission after vaginal delivery. Also both lochia and infected wound impacted on postpartum readmission after caesarian delivery.