Background: The annual incidence of stroke in different regions of the world ranges from 100 to 336 per 100,000 pop ulation, and mortality ranges from 36 to 136, and in Mongolia there are 220 new cases of stroke per 100,000 people and 113 deaths annually, making it one of the countries with the high stroke incidence rate. Aim: To conduct a systematic review of published sources on the epidemiology, causes, and risk factors of ischemic stroke in young people. Materials and Methods: The research sources were searched using keywords such as “Stroke”, “Definition”, “Epidemi ology”, “Etiology”, “Risk factors”, “Young Adult”, “Ischemia”, “Hemorrhage”, “Silent stroke” from the works published in international platforms such as Cochrane Library, Datebase, Medline, PubMed, Google Scholar, and Web of Science, and relevant information and data were selected from the collected sources and a review article was developed. Results: According to the WHO MONICA project report, stroke incidence was reported in 16 countries, with 101–285 men and 47–198 women per 100,000 people aged 35–64 years, while in the United States it was 113.8 per 100,000 people under 55 years, of which 73.1 were cerebral infarctions per 100,000 people, and more than 10 percent were under 55 years. A recent study in Mongolia found that 21–26% of stroke patients were young people (20-50 year old), compared with 10–13% in Western countries. Among the traditional causes and risk factors for stroke in young people, arterial hypertension accounts for 45-60%, smoking 40-60%, alcoholism 40-50%, heart disease 18-30%, dyslipidemia 30%, diabetes 13%, obesity 7-36%; among the specific risk factors, migraine accounts for 10-35%, taking hormonal contraceptives 10-22%, vasculitis 6-10%, blood clotting disorders 2-10%, vascular dissection 6-40%. According to the TOAST classification, large vessel disease accounts for 16-17%, small vessel occlusion 14-15%, cardiac embolism 19-20%, other determined etiologies 22-23% and undetermined 26-27%. Conclusion Epidemiological indicators of stroke vary significantly depending on the level of development of the country, geographical characteristics of the region, lifestyle, age, and gender (stroke incidence rate range: 100–336 per 100,000 population; mortality: 36–136 per 100,000 population). Mongolia is among the countries with high rates of stroke incidence and mortality (incidence rate 220 per 100 000, mortality 113 per 100 000 population). While stroke among young people accounts for 10–13% of all cases in Western countries, this figure reaches 21–26% in Mongolia, which is explained by a combination of traditional and specific risk factors. As stroke is becoming more common among younger populations, it is essential to study its causes and risk factors in detail and to intensify efforts in diagnosis, treatment, and prevention.

Background: Hypokalemia is considered when the serum potassium level is less than 3.5 mmol/L. Clinical research indicates that hypokalemia affects 20% of hospitalized patients, and in 24% of these cases, inadequate interventions result in life-threatening complications. At present, there is no research available on the prevalence, management, and outcomes of hypokalemia in hospitalized patients, which justifies the need for this study. Aim: The study aimed to examine the prevalence of hypokalemia and the effectiveness of its management in hospitalized patients within the internal medicine department, in relation to the knowledge of doctors and resident physicians. Materials and Methods: This hospital-based retrospective study included a total of 553 cases of patients hospitalized in the Internal Medicine Department of the Mongolia Japan Hospital between January 2024 and August 2024. Patients with a potassium level of <3.5 mmol/L were diagnosed with hypokalemia, and the effectiveness of potassium replacement therapy was evaluated according to the method of supplementation employed. Results: The prevalence of hypokalemia among hospitalized patients in the Internal Medicine Department was 9.8% (54 cases). Based on the study criteria, 42 cases of hypokalemia were selected for further analysis, and a total of 118 potassium replacements were performed through oral, intravenous, and mixed methods. Following potassium replacement therapy, 37.3% (44) of patients achieved normalized potassium levels, while 62.7% (74) still had persistent hypokalemia. Conclusion According to the study results, the prevalence of hypokalemia among hospitalized patients in the Internal Medicine Department is 9.8%. The method of potassium replacement and the severity of hypokalemia do not impact the normalization of potassium levels, with the critical factor being the proper dosage of supplementation. The knowledge of doctors and resident physicians regarding hypokalemia is insufficient, and there is a need to implement guidelines and protocols for potassium replacement therapy in daily clinical practice.

Background: Sleep quality is frequently highlighted in the literature as a key factor for overall health. Poor sleep quality significantly affects both physical and mental health, diminishing quality of life and potentially harming personal finances. While this issue is influenced by various risk factors, no well-studied research has been conducted on it in Mongolia. Aim: The aim of this study was to assess the frequency of poor sleep quality among visitors to the Sleep center in Mongolia and to identify the factors associated with poor sleep quality. Materials and Methods: This study, conducted using a cross-sectional design, included 200 participants aged 18 to 65 years who visited the Sleep Center at the General Hospital for State Special Servants between January and May 2024. Data were collected using a structured questionnaire. Sleep quality was assessed using the Mongolian version of the Pittsburgh Sleep Quality Index, with a global score above 6 indicating poor sleep. Participants were divided into two groups: “Good sleepers” (n=105) and “Poor sleepers” (n=95). Socio-demographic and clinical variables such as age, sex, levels of education were also recorded. The level of depression, anxiety, and stress was assessed using the DASS 21 (Depression Anxiety Stress Scale) criteria. Univariate analysis was performed using the t-test, Mann-Whitney U test for continuous data, the Х2 or Fishers’s exact test for categorical data, and logistic regression for multivariable analysis. A P-value of less than or equal to 0.05 was considered significant. Results: Poor sleep quality, indicated by a PSQI global score above 6, was observed in 52.5% of the total participants. Univariate analtysis’s test results showed that age, being female, having depression, anxiety, BMI ≥ 25, alcoholism, comorbidities, and using concomitant medications were significantly associated with poor sleep quality (all p<0.05). In the multivariate logistic regression analysis, 50 < age (OR 3.133, 95% CI, 1.245-7.884, p<0.05), BMI ≥ 25 (OR 2.084, 1.039-4.179, p<0.05), alcoholism (OR 3.018, 95% CI, 1.495-6.093, p<0.01) and depression (OR 15.957, 95% CI, 1.592-159.922, p<0.05) were identified as significant risk factors for poor sleep quality. Depression and alcoholism were associated with longer sleep latency and decreased daytime activity (p<0.05). Conclusions 1. In our study, more than half of the participants experienced poor sleep quality. 2. Age over fifty, depression, BMI ≥ 25, and alcoholism emerged as independent significant risk factors for sleep disturbance. Alterations in sleep latency, sleep disruption, and impaired daytime functioning may be associated with poor sleep quality.

Background: Some findings of an artifacts have revealed that nature based the raw have been used for the treatment of mankind's diseases over 60 000 years ago. WHO estimates that about 80 percentage of the world's population are consume the traditional medical care, and uses more than 21,000 plant species for therapeutic purposes. In order to help guide its member countries the World Health Organization (WHO) has developed The WHO Traditional Medicine Strategy 2014-2023. Some of the strategic actions in this document include:
• To develop and share appropriate research methodologies and criteria for evaluating the safety, efficacy, and quality of TM (Traditional Medicine) products;
• To study and explain the disease prevention, health maintenance, the diagnosis and the treatment of the TM disease according to the evidence based scientific studies. Objectives: to determine the most frequently used medicinal plants for the treatment of "Rlung" in the TM. Methods: The comparison method, the synthesis and analysis method, the induction and deduction method, the listing and sorting method, the inspecting and arrange method, and the methods of documents' drafting were used in this study. Results: It is shown that over 80 raw materials of plant, mineral and animal origins has to list within 32 drug recipes which used "Rlung" disease of TM. The first five raw materials from these 80 ingredients have been repeatedly lists zadi - 30, agar (black, white, red agar) -19, arur-19, lish -18, and nin shosh -18 times. Conclusion The most frequently used the raw materialin the treatment of "Rlung" diseases is the seeds of Myristica fragrans Houtt. which contains a lot of the saturated acids with membrane-enhancing effects and strong antioxidant substances.

BACKGROUND. Sensorineural hearing impairment (SNHI) is the most common inherited sensory defect, affecting about 3 per 1000 children. More than 50% of these patients have a genetic cause (i.e. hereditary hearing impairment; HHI). Mutations in certain genes were noted to be extraordinarily popular in the deaf patients across different populations, making molecular screening feasible for these common deafness genes. One of the most important characteristics that we have learned concerning hereditary hearing loss is that common deafness genes and their mutations are usually different according to the ethnic background. As demonstrated in our previous studies performed in Taiwanese patients, the mutation spectrums of common deafness genes, such as the GJB2 gene and the SLC26A4 gene, are different from those in the Caucasian or even other Asian populations. These findings further underscore the indispensability of the collection of local data in terms of genetic counseling. In the collaborative project, we have successfully established a cohort of >100 hearingimpaired families, and clarified the genetic epidemiology of deafness in the Mongolian population. We identified several special deafness mutations such as GJB2 c.23+1G>A, c.559_604dup, and SLC26A4 c.919-2A>G, and our results revealed that Mongolian patients demonstrate a unique genetic profile in deafness as compared to other East Asian populations (paper in preparation). Meanwhile, by organizing a seminar at National Taiwan University Hospital in March 2017, we have transferred crucial concepts and techniques regarding how to perform genetic testing for deafness to the Mongolian colleagues. In the future, we plan to strengthen the mutual collaboration by expanding the clinical cohort and upgrading the genetic examination platform using the NGS techniques.

BACKGROUND. Over 5% of the world’s population or 466 million people have disabling hearing loss (432 million adults and 34 million children). Profound sensorineural hearing loss and deafness can be treated successfully with a cochlear implant. A cochlear implant (CI) stimulates the auditory nerve, bypassing the defective cochlea, and provides auditory information to the developing brain, thus improving oral language. Children, who receive an early diagnosis of deafness and proper speech rehabilitation, and undergo early cochlear implantation, are able to develop auditory and linguistic skills at par with their hearing peers. METHOD. 6 deaf patients who underwent unilateral Cochlear Implantation at the NCMCH from January 2017 to June 2018 were included in the study. Participants were divided into 3 groups on the basis of age at which participants underwent implantation. RESULTS. Pre-op average MAIS was 1,6/40, Category of Auditory Performance (CAP) - 0,77 and SIR - 0,7/5 in all implanted age groups. Score increased over time to attain average score MAIS -29.6/40, CAP- 3.3/7 SIR-2.7/5 in all implanted groups at one year after implantation. CONCLUSION. There is a need for more research on patient age and gender composition, and outcomes of cochlear implantation and hearing devices in this study population. A robust set of study measures would provide statistical significance. Parent-child relationships affect hearing and speech therapy results, so there’s a need to improve parents’ knowledge regarding these therapies.

Background: The basics of the development of the Traditional Medicine (TM) in the XXI century are to study medical books created by physicians of the early period; and need to scientific - based understanding the concepts in those scripts. Goals: To investigate the physical properties and the composition of saturated and unsaturated fatty acids (FA) sesame oil which used the symptoms of the wind humor root diseases (the symbolic terminology in TM) comparing with some vegetable oils or seed oils. Materials and methods: We are used “The Instruction Tantra” of “The Quintessence Tantras”, “The Golden Decoration” (གསེར་རྒྱན།) of Darma maaramba Luvsanchoidog which is the explanation scripts of “The Instruction Tantra”. The research was conducted through the method of original manuscript analysis, the comparison method, induction and deduction method. Results: The sesame oil has the saturated FA (14.2%) and unsaturated FA (81.4%) and which approximately amount with the olive oil (13.8%; 83.5%), sunflower oil (9.7%; 87.4%), corn oil (12.9%; 82.3%), soybean oil (15.6%; 80.5%). Conclusions Sesame oil has saturated (14.2%) and unsaturated fatty acids (81.4%); and has been used for the treatment of wind humor such as light, mobile, non-oily, cool nature – external characteristics of body in Ancient Indian Ayurvedic Medicine. We can be substitute olive oil, sunflower oil, corn oil, soybean oil which have rich of the amount of unsaturated FA (especially high level of mono and poly unsaturated FA) instead of the sesame oil in the treatment.

Background: Headache disorders are most prevalent public-health problem. Worldwide, among the adults 46% suffer from primary headache, where the migraine presents 11% and tension type headache (TTH) presents 25%. Recently, one type of the primary headache, medication overuse headache tends to increase. Nowadays, there is no sufficient study about primary headache in Mongolia. So that, it is necessary to investigate prevalence, clinical type and risk factors of the primary headache. Purpose: To study prevalence and risk factors of primary headache in Mongolia. Materials and Methods: This cross-sectional study was carried out from June to November of 2017. Participants aged 18-65 years old were randomly selected from four provinces and three districts of Ulaanbaatar city. The diagnosis of headache was made using the International Classification of Headache Disorders-3 beta. Statistical analysis was performed on SPSS-23 program. Results: A total of 2043 participants (812 men and 1231 women) were reviewed. The participant’s average age was 38.6±13.4years. 1350 (66.1%) participants reported recurrent headache within the last 1 year. Of the total study population, the prevalence rate of primary headache was 1305 (63.9%). Number of people who suffered from migraine was 494 (24.2%), significantly greater in female than male participants (p=0.0001), with most frequent attacks at age 26-45 years. The risk of migraine associated with sex, education and family history (p=0.001). 592 (29.0%) of participants had TTH, mean age of them was 37.7±5.24, significant high rate in female than men, risk of TTH depends on education and job. The medication overuse headache was diagnosed at 116 (5.7%), 29.4% in men and 70.5% in women with average of 45.6±11.4 and 43±12.7 respectively. Among the participants 38.6% used medications, 28% people had one drug, 8.5% two drugs and 2% used three or more drugs. Use of non-steroid anti-inflammatory drugs (NSAID) made up major percent in headache patients. Increased frequency of medication and multidrug affected to medication overuse headache (p=0.008). Conclusion More than half of studied population had primary headache. Migraine was in 24.2%, TTH in 29.0% of people, and associated with sex, education and family history. Use of non-steroid anti-inflammatory drugs made up major percent in headache patients.

BACKGROUND. Otitis media (OM) is any inflammation of the middle ear. It is very common in children. The purpose of Survey is to analyzing result that insertion of tympanostopmy tube treatment for children who had otitis media. METHOD. The study covers total 482 tympanostomy surgery cases conducted, between 2013-2015, at ENT Surgery Department, National Center for Child and Maternal Health. Titanium tube had been placed for the patients with either adhesive otitis media and otitis media with effusion. In order to evaluate surgery results, follow up examinations were carried out in 2 weeks, 1, 3 and 6 months using otoscopy, audiometer, ABR and ASSR test. RESULTS. Most of the children (82.4%) in whom a ventilating tube have been placed in tympanic membrane had exudative otitis and the remaining (17.6%) children had adhesive otitis. In means of age group, children with 0-2 years, 3-4 years, 5-6 years, 7 and more were, 39.9% (n=173), 42.7% (n=206), 15.6% (n=75) and 5.8% (n=28) respectively. After the tympanostomy surgery tympanic membrane color gets better, turns pearl grey, fluctuation improves, membrane cavity pressure lowers to -50daPa and hearing status ranged 20.4-5.4dB which allows the patient to continue normal speech development. CONCLUSION. Among 482 patients whom involved surgical procedure of Insertion of tympanostomy tube treatment last 3 years in Department of Pediatric Otolaryngologists in Maternal and Child Health of Mongolia and otitis media with effusion and adhesive otitis media type were occurred 30% to 40% from above cases. After tube placement tympanic membrane movement improved and color of tympanic membrane is getting pearl-grey and middle ear pressure decreasing until to 50daPa and children hearing range changed 20.4 to 5.4 db. So we could prevent these children suffer speech disorder .

BACKGROUND. Hearing loss is likely to be the most common congenital abnormality in newborns, with a reported prevalence of 1 to 2 per 1000 live births. It is vitally important to diagnose infant hearing loss or deafness at its early stages. Early detection and intervention is critical to prevent the adverse consequences of a delayed diagnosis on speech, language and cognitive development. Universal screening of hearing loss has been introduced in practice with distortion product of otoacoustic emission (DPOAE). The automated auditory brainstem response (AABR) screener is a dedicated hearing screening device which provides information not only about the outer and middle ear and cochlea but also about the auditory pathway up to the brainstem. METHODS. The study was descriptive and based on a retrospective analysis of the two year period databases (2014-2016) from the newborn hearing screening program. We have started the hearing screening from December 2012. Between 2014 to 2017 we have been screened total of 11218 newborns. We tested automated audiotory brainstem response of the newborns in their 1- 3 days of birth, using Maico MB11 Beraphone machine (German) according to the Joint Committee on Hearing Screening guidence. We assessed the test result of “pass” as “normal hearing, “refer” as to rescreen and tested again after 1 month. Infants referred again were gone to a specialist for further audio logic analysis (behavioral tests, auditory brainstem response, otoacoustic emissions and auditory steady state response). RESULTS. Our study was the first in Mongolia. Total of 10290 newborns passed bilaterally out of 11218 and 1323 referred in the first screening. For the rescreen test, 1088 out of 1134 infants resulted with “pass” and 46 infants with “refer”. For those infants, we did ABR test in their 3 and 6 months, and result of 9 children (18 ears) have bilateral profound hearing loss, 2 children (2 ears) have bilateral mixed profound hearing loss and 13 (26 ears) have bilateral profound conductive hearing loss. Coverage rate was 34,7%. First refer rate was 11,7%. Follow rate was 39,7%. We conducted the cochlear implantation surgery for 2 children out of 11. Currently, we are preparing other infants with bilateral profound hearing loss of 0-3 years old for the follow up CI surgery. CONCLUSION. In Mongolia, the data of infant hearing difficulties and prevalence of deafness is lacking. Although newborn hearing screening program has been approved in 2014 and brought opportunities to conduct universal neonatal hearing screening program. But at the moment, its only available at NCMCH which located in Ulaanbaatar city. 11 cases have a bilateral profound hearing loss out of 11218 newborns. Our study result shows similiar pattern (1.1 - 1.3 ear deafness in every 1000 birth. Lenarz et all.2008). Automated audiotory brainstem response was efficient in early identification of newborn hearing loss with high sensitivity and specification rates. Small population in the remote locations, high birth percentage, short period in the hospital after birth, lack of technology and human resources, and other factors result in higher level of referral rate newborn hearing screening and lower level of follow up and confirmation rate referals in Mongolia.