Background: Class III malocclusion is considered to be one of the most difficult and complex orthodontic problems to treat. For patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers solution, surgery to realign the jaws or reposition dentoalveolar segments is the only possible treatment option left. Aim: The treatment objectives were to: (1) level and align the dental arches; (2) obtain an ideal overbite and overjet, to establish correct anterior guidance; and (3) improve the facial profile. Case: Patient is present with skeletal Class III malocclusion, concave facial profile, facial proportion 0.96:1:1.04, loss of occlusion due to early molar teeth loss, molar and canine relationship were Class III, overbite 0 mm, overjet -1 mm, midline shifted into the 6 mm left side. Results: Excellent facial and occlusal results were achieved with this surgical-orthodontic management, post-treatment results showed a Class I relationship and ideal overjet and overbite. The facial profile became straight type. Conclusion This case report describes the treatment of a female with dental and skeletal class III relationships. Surgical- orthodontic treatment was the best option for achieving an acceptable occlusion and a good esthetic result in this case. An experienced multidisciplinary team approach ensures a satisfactory outcome.

Background: Breastfeeding is the ideal food source for all newborns globally. Proper feeding of infants and young children promotes optimal growth and development, especially in the critical window from birth to 2 years of age. Exclusive breastfeeding for 6 months and continued breastfeeding for the first 2 years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. Objective: To assess the indicators of infant feeding practices among 0- 23 months old children. Materials and Methods: The NNS V was implemented in 21 aimags (provinces) in 4 economic regions (Central, Eastern, Khangai, Western) and the capital city of Ulaanbaatar. Given the regional differences in lifestyle and nutrition status, target populations were stratified into 5 strata based on economic region and Ulaanbaatar with equal samples drawn from each stratum using a cluster-randomized sampling design [1]. The infant and young child feeding indicators assessed in the NNS V were based on the mother’s or caretaker’s report of breastfeeding and consumption of foods and fluids by the child during the day or night prior to being interviewed. Results: 83.7% of children under 2 years started breastfeeding within 1 hour of birth and though almost all children were ever breastfed (97.9%), a slightly higher percentage of girls were ever breastfed overall and within 1 hour of birth. Children 0-5 months were categorized according to whether they were exclusively breastfed or predominantly breastfed, with the former only allowing vitamins, mineral supplements, and medicine and the latter also including plain water and non-milk liquids. Among children 0-5 months of age, 58.3% were exclusively breastfed and 65.3% were predominantly breastfed, having received other liquids or foods in addition to breast milk. The prevalence of exclusive breastfeeding was lowest in the 4th wealth index quintile (46.5%) and wealthiest quintile (54.0%) households. Conclusions Exclusive breastfeeding and early initiation of breastfeeding practices are unacceptably low in Mongolia; 20% of newborns are not breastfed within 1 hour of birth and more than 40% of infants under 6 months of age are not exclusively breastfed and therefore, not receiving optimum nutritional and immunity benefits from breast milk. Strengthening IYCF counselling in all regions and wealth quintiles to support women to practice optimal breastfeeding, along with counselling and awareness of timely and adequate complementary feeding for children under 2 years of age, should be a top priority for public health and as it is a key strategy to reduce malnutrition in children.

Background : Overweight and obesity are conditions of over nutrition resulting from consumption of more calories than the body requires leading to excess body fat accumulation. The prevalence of both overweight and obesity is increasing globally in all age groups in high, middle, and low-income countries and is largely attributed to the “nutrition transition” with a shift from traditional diets to readily available and inexpensive, low-nutrient unhealthy foods high in energy [1].
The move away from traditional to “junk” foods often occurs at the same time as the move of populations away from daily physical activity and increase in sedentary activities such as time spent in front of a phone, computer, or television, furthering increasing the risk of becoming overweight. People who are overweight or obese are at higher risk for serious health problems including hypertension, heart disease, stroke, diabetes, some cancers, and osteoarthritis. The increase in overweight and obesity is accompanied by a dramatic increase in prevalence of above mentioned chronic conditions in the worldwide. While the long-term repercussions of overweight and obesity are severe, they are largely preventable and treatable through healthy diets and healthy lifestyle behaviors [2]. Materials and Methods: The fifth National nutrition survey (NNSV) was implemented in 21 provinces (aimags) in 4 socio-economic regions (Central, Eastern, Khangai, and Western) and the capital city of Ulaanbaatar. Given the regional differences in dietary patterns and nutrition status, target populations were stratified into 5 strata based on 4 regions and Ulaanbaatar with equal samples drawn from each stratum using a cluster-randomized sampling design. In total, 1750 school children data on demographic and dietary information collected by interview methods and anthropometric measurement results were used in this study. Ethical considerations: The survey protocol was discussed at the Scientific Committee of the Public Health Institute (recently named by National Center for Public Health) and granted by order of director of Scientific committee of PHI on 28th June, 2016. Ethical approval for conducting the NNS V was obtained from the Medical Ethics Committee under the Ministry of Health of Mongolia on July 7, 2016. Participation in the survey was voluntary, oral and written informed consent were obtained from adult caregivers of each children. Results: Consumption of unhealthy or junk (high-calorie, low-nutrient) foods in the past week was nearly universal (99.0%) among school children 6-11 years of age. Over half of children (51.4%) consumed junk foods at least once per week and 45.7% consumed junk foods a few times a week. Consumption of sugar-sweetened beverages was high with 80.9% of children consuming these at least once in the past week. Overall consumption of fried foods was lower than consumption of junk foods or sugar-sweetened beverages with 22.7% of children not consuming any fried foods in the past week and only 8.5% of children consuming fried foods a few times per week. Consumption of sweet foods was high with nearly all children having consumed sweet foods in the past week, 45.9% of children 6-11 years having consumed sweet foods a few times per week.
The prevalence of overweight (BMI > +1 SD) was 22.2% and prevalence of obesity (BMI > +2 SD) was 6.4%. Overweight prevalence was higher in boys (26.6%) compared to girls (17.8%) and in urban (23.9%) compared to rural (17.6%) areas with the highest prevalence in Ulaanbaatar (25.6%) compared to other regions. Children 6 years old (26.1%) and 7 years old (25.6%) had a higher prevalence of overweight than older children. Conclusion
1. Consumption of unhealthy foods and drinks is common to 6-11 year olds group, with almost all children (99.2%) consuming any type of unhealthy foods and drinks at least once per week, in particular, 8 out of 10 children were found consuming sugary drinks and/or deep fried food.
2. The consumption of unhealthy foods was not differing by child’s sex, there were revealed significant differences between living area and regions. Proportion of the school children 6-11 years of age was relatively higher in Ulaanbaatar city and urban settings.
3. The prevalence of overweight and obesity in school children aged 6-11years sharply increased from 2010 NNS IV level and reached 22.2% and 6.4%, respectively. Among children with obesity consumption of any unhealthy foods and sugary drinks were 1.4–1.9 times higher than nonobese children, respectively.

Background: Weight at birth is a good indicator of the mother’s health and nutrition status during gestation and a child’s chances for survival, growth, long-term health, and psychosocial development. Low birth weight (defined as less than 2500 grams) poses a range of serious health risks for children. Objective: To assess the prevalence of low birth weights (LBW). Materials and Methods: The NNS V was implemented in 21 provinces (aimags) in 4 economic regions (Central, Eastern, Khangai, Western) and the capital city of Ulaanbaatar. A total of 2250 children aged 0-59 months. Given the regional differences in lifestyle and nutrition status, target populations were stratified into 5 strata based on economic region and Ulaanbaatar with equal samples drawn from each stratum using a cluster-randomized sampling design. For the selection of households in urban areas, the process involved first selecting 30 khoroos (clusters), then khesegs, and then households with a child 0-59 months of age. Ethical considerations : The survey methodology was discussed at the Scientific Committee of the Public Health Institute (recently named by National Center for Public Health) and granted the PHI Directors Order on 28th June, 2016. Ethics approval for conducting the NNS V, was obtained from the Medical Ethics Committee under the Mongolian Ministry of Health. Results: Almost all (99.5%) children in the sample were weighed at birth with 5.0% weighing less than 2500 grams at birth and 12.6% weighing over 4000 grams at birth. The prevalence of low birth weight was slightly higher among girls than boys, however high birth weight was much more common in boys (15.9%) compared to girls (9.5%). Prevalence of low birth weight was highest in Western region (9.6%) and the poorest households (7.8%) while the prevalence of high birth weight was highest in Ulaanbaatar (13.8%) and wealthiest households1 (16.4%). High birth weight was more than double among children of overweight (17.5%) and obese (17.3%) mothers compared to children of normal weight (8.4%) or underweight (7.0%) mothers. Among singleton births, women <29 years of age had higher LBW rates than did those 30-39 years of age in both years, irrespective of birth order. LBW rate was more than double among mothers in kazak ethnic groups (13.8%). Conclusions The younger age of the mother was more likely to develop low birth weight, and it was twice as high among mothers in Kazak ethnic groups. Therefore, adolescents and women of reproductive age needed to improve the health education and to identify the causes and risk factors of low birth weight among mothers in Kazak ethnic groups.

Background: Overweight and obesity are conditions of over nutrition resulting from consumption of more calories than the body requires leading to excess body fat accumulation. The prevalence of both overweight and obesity is increasing globally in all age groups in high, middle, and low-income countries and is largely attributed to the “nutrition transition” with a shift from traditional diets to readily available and inexpensive high-energy and low-nutrient foods [1].
The move away from traditional to “Junk” foods often occurs at the same time as the move of populations away from daily physical activity and increase in sedentary activities such as time spent in front of a phone, computer, or television, furthering increasing the risk of becoming overweight. People who are overweight or obese are at higher risk for serious health problems including hypertension, heart disease, stroke, diabetes, some cancers, and osteoarthritis. The increase in overweight and obesity is accompanied by a dramatic increase in prevalence of these chronic diseases at the global level. While the long-term repercussions of overweight and obesity are severe, they are largely preventable and treatable through healthy diets and healthy lifestyle behaviors [2]. Materials and Methods: The NNS V was implemented in 21 provinces (aimags) in 4 economic regions (Central, Eastern, Khangai, and Western) and the capital city of Ulaanbaatar. Given the regional differences in lifestyle and nutrition status, target populations were stratified into 5 strata based on economic region and Ulaanbaatar with equal samples drawn from each stratum using a cluster-randomized sampling design [3]. Total participated 1944 mothers’ years of age who had a child aged 0-59 months. Ethical considerations : The survey methodology was discussed at the Scientific Committee of the Public Health Institute (recently named by National Center for Public Health) and granted the PHI Directors Order on 28th June, 2016. Ethics approval for conducting the NNS V, including obtaining biological (blood and urine) samples, was obtained from the Medical Ethics Committee under Ministry of Health, Mongolia on 7th July, 2016 with granted approval to conduct the survey and send blood serum samples to the VitMin laboratory in Germany. Participation in the survey was voluntary and oral and written informed consent was obtained from all individuals selected for the survey. Participant confidentiality was maintained during data collection, data entry, data analysis, and in the dissemination of survey findings. Results: Nearly half of mothers (46.2%) were overweight with 16.5% of mothers obese and 4.1% underweight. The prevalence of overweight in mothers was highest in rural areas (50.1%), married status (49.3%), and lowest in Ulaanbaatar (42.3%) compared to other regions (48.6% to 52.6%). The overall prevalence of anaemia among mothers was 16.2% with highest prevalence amongst Kazakh (31.9%) and other ethnic minority mothers (25.1%), mothers with secondary education (20.3%) and unemployed mothers (19.9%). Minimum dietary diversity is a proxy indicator for the nutrient content of a diet based on consumption of at least 5 of 10 food groups.¹ People who consume food items from at least 5 food groups are likely to consume at least 1 animal-source food and items from 2 or more of the fruit and vegetable food groups. In the NNS V, 70.2% of mothers met the minimum dietary diversity requirement with a higher prevalence in urban areas (74.8%) and Ulaanbaatar (77.5%). Conclusion: The prevalence of overweight and obesity in mothers of reproductive age is 46.2%, with the highest percentage of mothers with overweight and obesity being in rural areas (50.1%), which is 5.8 percentage points higher than that of urban mothers. 16.2% of mothers are anemic. Prevalence of Minimum dietary diversity among mothers is 70.2%. Food consumption is inadequate in mothers with the primary and secondary education, and in mothers in rural areas, and in poorest mothers or in mothers with the second and third wealth index. ¹FAO and FHI 360. 2016. Minimum Dietary Diversity for Women: A Guide for Measurement. Rome: FAO.

Association between diagonal earlobe crease (DELC), also known as Frank’s sign and CAD was first found by Sanders T. Frank in 1973. Since its first description, others have shown it to be associated with the presence, as well as the extent and severity of CAD, independent of traditional CAD risk factors, such as serum lipids, diabetes mellitus, and smoking status.DELC is also associated with higher risk of major adverse cardiac events in patients with known CAD.Recent studies have suggested that DELC may also be a marker of generalized atherosclerotic disease. This study evaluates the association between the presence of diagonal earlobe creases (DELC) and coronary artery disease (CAD). Four hundred people (246 men and 154 women, aged 28 to 92 years) were examined for the presence of DELC.400 people participated. In case group 200 people(142 men and 58 women, aged 30-87) who were getting treatment at State’s central 3rd hospital participated. In control group 200 people(104 men and 96 women, aged 28-92 who were getting treatment at State’s central 3rd hospital, National Traumatology Center included.We did statistic processing with MS Excel 2013, SPSS 20.0 DELC was present in 164 patients (82%) and absent in 36 patients (18%) of 200 participants documented with CAD (presence of > or = 50% coronary diameter stenosis at angiography). DELC was present in 42 people (21%) and absent in 158 people (79%) of 200 people documented without CAD. 82% of individuals with CAD had DELC. There was significant association between diagonal earlobe crease (DELC) and coronary artery disease (CAD), (p=0.039).

BACKGROUND: Chronic viral hepatitis is the most important public health problems and main cause of liver fibrosis. Progressive hepatic fibrosis will gradually lead to liver cirrhosis, hepato-cellular carcinoma and liver failure and deaths. Study of liver fibrosis is becomes an essential issue of prevention, prognosis and radical treatment plan. The evaluation of liver fibrosis using ultrasound based-electrographic shear wave elastography (SWE) with elastography point quantification (ElastPQ) is a modern non-invasive method. This study is aimed to evaluate diagnostic value of SWE with ElastPQ feature of liver fibrosis. MATERIAL: A total of 110 patients with chronic viral (B, C and D) infection and 50 healthy controls were involved. Quantitative evaluation of LS was performed by Philips iU 22 ultrasound system with ElastPQ using convex transducer C5-1. RESULTS: In HBV patients: no fibrosis F0 score 7, mean liver stiffness was 3.1±0.28 kPa, mild liver fibrosis F1 score 26, mean LS was 4.9±0.90 kPa, F2 score 4, mean LS was 8.0±0.56 kPa, F3 score 3, mean LS was 11.0±0.83 kPa, and F4 score or liver cirrhosis 2, mean LS was 17±4.3 kPa, respectively. In patients HCV; F0 score -5, mean LS was 3.2±0,08 kPa, F1-36, mean LS was 5.0±0.94 kPa, F2 score-10, mean LS was 8.1±0.90 kPa, F3-10, mean LS was 10.9±1.03kPa, and F4 score 5, mean LS 15.9±2.8kPa, respectively. In patients with HBV, HDV; F0 score-1, liver stiffness was 3.2kPa, F1-13, mean LS was 4.9±0.72 kPa, F2 score 2, mean LS was 8.0±0.56kPa, F3 score, LS was 10.8kPa, F4 score 1, LS was 20.1kPa, respectively. CONCLUSIONS: Shear wave elastography with elastography point quantification technique is a reliable that can to detect of the earlier fibrosis stage in chronic viral hepatitis patients. ElastPQ SWE method is an optimal to monitor liver tissue stiffness in patients with chronic liver diseases.

Background: A midwifery services are recognized as one of essential health care and services. The amplification of trained midwives plays very important role to improve the quality of and access to health care services as highlighted in the global Human Development Report [1]. Obstetric care is the integrated specialized interventions aimed to detect, monitor, manage delivery, treat and prevent illnesses of mothers, fetus and newborns in pregnancy, childbirth and postnatal periods. Every year, 287,000 women die from complications related to pregnancy and childbirth, and 2.9 million newborns die before they reach the age of four weeks worldwide. The majority of the preventable maternal and newborn deaths occur in low-income countries [3]. Goal: This assessment was aimed to review the current situation and legal framework of midwifery services and comprehensive competencies of midwives, and to provide baseline data for the project as well as evidence based recommendations for further improvement of midwifery services in Mongolia. Materials and Methods: In order to assess the current status of midwifery services and integrated competencies of midwives, a range of quantitative and qualitative methods were used. A cross- sectional study for assessing the quality of obstetric care and practice was conducted by using observation checklists, questionnaires and interview guides. Midwives who are providing obstetric care in Mongolia were involved in the assessment. Results: A total of 321 midwives from NCMCH, and 2 maternity hospitals of Ulaanbaatar and 21 aimags were involved in the assessment. Out of them 97.2% were female and the mean age was 37.2±10.1 [95%CI: 36.03-38.21]. The mean of working years in health sector was 14.54±10.9 years and mean of working years with the current institution was 11.7±10.1 years. Minimum work experience was few months and maximum was 38 years. A majority of the assessed midwives hold some abilities sufficiently such as keeping medical documents during pregnancy [4.23; 95%CI: 4.15-4.32], educating and giving advice to the customers about after and before the pregnancy period [4.01; 95%CI: 3.91-4.11]. A majority of the assessed midwives answered holding some abilities as important, such as basic knowledge of mother and child public health care in the fertility system [4.11; 95%CI:4.00-4.21], implementing experiences [4.07; 95%CI:3.97-4.19], and very important documents for the Obstetricians Association to know about midwives’ practical and professional activity [4.05; 95%CI:3.92-4.17]. None of the midwives took “A” or point indicates highest level. 40.5 percent of assessed midwives took “D” or “Able to make a relatively easy content; Lack of general knowledge, skills and practices”. One third of participated midwives took “F” indicating lack of knowledge, skill and practice. Moreover, one fifth of the midwives took “C” indicating average level, understood most of the content, skilled moderately, and prepared enough to practice more in this field. Even though rural midwives got average level (22.0%) score 4.1 functions more than city midwives, it didn’t have any difference in the statistic correlation. 3.3 percent of all participant 7 midwives took “B” indicating above the average level in the knowledge test. The midwives have told training for them hadn’t organized frequently which is shown in the quality assessment. Conclusions Furthermore, it is necessary to increase the skill of midwives who would perform complex care based on clinical evidence to reveal the risks faced to maternal and infant health, prevent from degradation and manage safe birth.

Tuberculosis disease is directly proportional to a country’s socio-economic situation and standard of living. Studies have shown that in Mongolia the inflation, unemployment, poverty and migration that have emerged as a consequence of the socio-economic changes in 1990s have influenced the spread of the disease.The Global Fund to Fight AIDS and Tuberculosis Project was initiated by the UN and launched in our country in 2003. In relation to an expected completion of the project in 2016, the need has been determined to include the funds required for AIDS and tuberculosis (TB) treatment into the state budget and, therefore, the necessity to conduct a detailed study of TB drug usage to validate this need has become the basis of this research.[3,5,6] Materials and methods: Patient history of 200 inpatients in (NCCD). Registration of drug expenditure of pulmonary tuberculosis and multi-drug resistant tuberculosis (MDRTb) and statistic survey data.As WHO recommended determining drug consumption by disease and mathematic statistic method. Purpose:Multi-drug resistant drugs tuberculosis used in the treatment of estimated needs, and to be determined by the main anti-tuberculosis drug spending.Results: 1. 50 patients diagnosed as MDRtb by the NCCD used 9 main types of drugs, Out of these 5 were most widely used. 2. 1,211,700,0±546,008,9million was spent on treatment of MDRtb in inpatient facilitiesКey words:Multi-drug resistant tuberculosis

INTRODUCTION: Urinary tract infections among the most common bacterial infectious diseases encountered at all ages. Escherichia coli are being the etiologic agent in 50–80%. Therefore, it is an important public health problem. E.coli causing urinary tract infections express pilli, fimbriae and others adherence virulence factors. GOAL: To detect the some adherence virulence factors of Uropathogenic Escherichia coli (UPEC) in Ulaanbaatar, Mongolia MATERIALS AND METHODS: A total of 76E.colisampleswere collected. These samples were positive bacteriological examination of urine, performed at the bacteriological laboratory of the State Central Third Hospital and State Central First Hospital, Ulaanbaatar, Mongolia. The biofilm formation was evaluated by the growth rate of E.coli on plastic surface.The detection of the virulence factors type 1 fimbriae (fimA gene) and P-fimbriae (papC) was performed by multiplex PCR using gene specific primers.Curli expression was determined by using congo red agar. RESULTS: The evaluation of bacterial biofilm formation using 96 well plates showed 40 negative (52.6%), 32 weak biofilm (42.1%) and 4 moderate biofilm (5.3%) formation for E.coli and no strong biofilm forming strain was detected. The cell surface protein (curli) was detected by Congo red agar. The result was 71% positive for studied E.coli strains. The detection result of pili genes by multiplex PCR showed that fimH gene detected for 73 (96.1%) and papC gene detected for 18 (23.7%) E.coli cultures. CONCLUSION: Almost half of surveyed Uropathogenic E.coli isolated in Ulaanbaatar, Mongolia had ability of biofilm formation and it has been determined by the bacterial surface protein (curli), which is one of bacterial adherence factors, may cause biofilm formation.