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: A drug related problem is defined by the Pharmaceutical Care Network Europe Association as an an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes. One critical aspect of preventing such errors is proper dose adjustment, which plays a vital role in the diagnosis and treatment of disease. For instance, adjusting the dose of warfarin based on the patient’s INR level is essential. In a 1995 study conducted in England, clinical pharmacists recommended target doses of angiotensin-converting enzyme (ACE) inhibitors for patients with chronic heart failure. As a result, patients experienced a significant reduction in pulmonary and peripheral edema, along with improved exercise test outcomes. At the Mongolian-Japanese Hospital of the Mongolian Medical University of Science and Technology, it is important to analyze dosage-related issues identified by clinical pharmacists and inform healthcare professionals about common dosage selection errors and associated risks. Aim: We analyzed issues related to medication dosage. Materials and Methods: A retrospective study was conducted to examine problem related to dosage detected through prescription monitoring at the Mongolian Japanese Hospital of the Mongolian National University of Health Sciences from 2023 to 2024. Results: Out of a total of 2340 drug-related problem identified across five inpatient wards during this period, 581 (100%) were related to dosage. Clinical pharmacists performed prescription review on approximately 67% of all inpatients, which was consistent between years. However, medication-related problems tended to decrease from 41.1% (n=1499) in 2023 to 22.3% (n=841) in 2024 (p=0.05). The majority of dose-related problems, 75.6% (n=440), were overdoses. Medication-related problems were most common in the surgical department, with 59.5% (n=346) (p=0.001). The most frequent dosage-related errors involved exceeding the daily dose of diclofenac, administering higher- than-recommended doses of ceftriaxone, failing to adjust cefotaxime for renal function, and using inappropriate doses of metronidazole in patients with impaired liver function. The leading cause of these errors was failure to adhere to guideline-recommended dosing, which accounted for 71.3% (n=415) of cases (p=0.001). When dosage-related recommendations were provided to physicians before of treatment, acceptance rates increased by 14% (p=0.001). These interventions resulted in an estimated cost saving of 1.267.219₮ and a reduction of 363 injections. Conclusion Therefore, clinical pharmacist-led prescription review can help reduce the risk of dosage errors, lower associated healthcare costs, and alleviate the burden on medical staff.

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: The frequency of cerebral infarction and stenosis of intra- and extracranial arteries may be vary with age-group and gender. Objective: This study was conducted to clarify the risk factors and characteristics of cerebral infarction and stenosis of vessels in Mongolian young adults. Methods: This was a prospective study, from October 2015 to July 2020, of 100 patients below 50 years diagnosed with acute cerebral infarction. Patient characteristics were compared according to sex (61 males and 39 females) and age group (29 patients were below 34 years and 71 patients were 35–49 years). Characteristics of acute cerebral infarction were studied by DWI-diffusion weighted MRI imaging. Stenosis of intra- and extracranial arteries was diagnosed by duplex sonography, head and cervical magnetic resonance angiography (MRA). Results: Leading causes for cerebral infarction in the young patients were hypertension (71%), smoking (57%), dyslipidemia (45%), diabetes (33%), and migraine with aura (25%). Lacunar Infarction was most common in our patients (33%). Partial anterior circulation infarction was predominant in males (45.9% vs 38.5%; P<0.05) and posterior circulation infarction in females (23.1% vs 11.5 %; P<0.05). Small artery atherosclerosis was found in 33% cases, with higher prevalence in patients of the 35–49 years age-group. Intracranial stenosis was more common than extracranial stenosis, and middle cerebral artery stenosis was most prevalent (38.9%). Stenosis in the anterior circulation was more frequent than in the posterior circulation (P<0.001). Conclusions In these young patients, hypertension, smoking, dyslipidemia, diabetes, and migraine with aura were common risk factors. Intracranial stenosis was most common, particularly in the middle cerebral artery.

Stroke is a major healthcare problem ranking as the second leading cause of death and the first cause of disability in the world. The stroke incidence in the world varied from 100 to 336 per 100.000 people per year. In different world regions the incidence of stroke ranges between 134.9 to 336.3 new cases per 100.000 inhabitants and the annual frequency of deaths within 36.7 to 136.7 per 100.000 events, while the frequency of stroke and mortality in Mongolia is within the upper limits of the above mentioned indicators. A recent report of the WHO MONICA Project documented that stroke incidence ranged between 101-285 in males and 47-198 in females per 100,000 people aged 35 to 64 years in 16 countries involved in this study. In the United States the average annual incidence rates of all strokes under the age of 55 years was 113.8 per 100,000, while that for cerebral infarction was 73.1 per 100,000. More than 10% of patients with cerebral infarction were 55 years or younger. Almost two thirds of the global burden of stroke is borne by those in developing countries. Recent study in Mongolia showed that young adults account for 21%-26% of all stroke patients as opposed to 10%-13% Western countries. In this review we sought to discuss the tissue-based definitions, epidemiological trends, risk factors, and specific causes associated with stroke in the young.

Background: Acute respiratory viral infection caused by human new coronavirus that was reported in last December of 2019, is becoming the most serious issue worldwide. During human coronavirus infection, upper and lower respiratory symptoms are common. However, other systemic symptoms, especially neurological signs were reported previously. It is further noted that sometimes the neurological manifestations can precede the typical features like fever and cough and later on typical manifestations develop in these patients. Purpose: to analyze information of neurological manifestations related to COVID-19 disease and possible way of affection of nervous system by SARS-CoV-2 virus. Material and Methods: We searched Medline, PubMed, Central and Google Scholar, Web of Science for related published articles and case reports, using keywords such as “COVID-19”, “Coronavirus”, “pandemic”, “SARS-CoV-2”, “Neurological manifestations”; “Complications”; “Clinical characteristics”. There were found and considered few articles of clinical characteristics and case series reports related to COVID-19 with neurological manifestations and complications, also articles of SARS-CoV-2 virus affection to nervous system. Results Neurological manifestations including headache, dizziness, myalgia, confusion, and hyposmia were observed during COVID-19 in 6-36.4% cases. A few cases with COVID-19 showed more severe symptoms such as stroke, polyneuropathy, encephalopathy, myelitis and acute necrotizing encephalitis. SARS-CoV-2 viral infection pathway may be two different ways, namely, a) binding ACE-2 receptor on capillary endothelium and causing inflammation where then can cross blood-brain barrier and to emerge brain tissue damage; b) entering via nasal epithelium where the bipolar cells locate, from there directs to central nervous system to cause neuronal injury through olfactory bulb.
Conclusion: neurological manifestations are relatively common in COVID-19, however, there is lack of evidence-based study. There may have two possible pathways of SARS-CoV-2 to affect nervous system, but is required necessary further elaborately study

Background: Data from yearly statistical reports on morbidity and mortality in Mongolia show that young adults account for approximately 20-26% of all stroke patients as opposed to 10-13% in Western countries. Objectives: The aim of this study was to compare characteristics of ischemic stroke between young (20-49 years) and old (50-79 years) patients undergoing investigations and treatment according to one common protocol in a tertiary hospital. Material and Methods: This hospital based prospective study included 110 young and 130 old patients with acute ischemic stroke. Data regarding the etiology of the stroke, diagnostic neuroimaging test results and degree of functional improvement of patients were examined during their observation. Results: The frequency of ischemic stroke at the age of 20-49 years grows from 9.6% to 24.2% and is predominant in the male sex (17.1%), which indicates a young stroke in mongolians is not uncommon. Young adults with ischemic stroke frequently bear both traditional and specific vascular risk factorsthan elderly people (p<0.05). The most common TOAST subtype in the young and old groups was undetermined (26.4% vs.12.3%; p=0.004), other determined cause (22.7% vs. 6.9%; p<0.001), and cardioembolism (20.0% vs. 22.3%) followed by Large-artery atherosclerosis (17.3% vs. 26.2%) and small vessel occlusion (15.6% vs. 33.8%; p<0.001). Partial anterior circulation infarcts were more common among young patients (p<0.001), than in posterior circulation infarcts. Silent brain infarcts and leukoaraiosis are not uncommon brain imaging findings (<0.05) in hypertensive and migraineur patients and should not be overlooked due to their potential prognostic relevance. Outcomes in young adults with hemispheric ischemic stroke can safely be improved with Low- molecular-weight-heparin therapy (OR 1.58; 95% CI, 0.99-2.51; p=0.001).
There were large differences between two groups concerning the 6-month outcome which showed beneficial effect for young stroke patients (mRS:89.1% vs. 66.9%, p=0.002; BI: 84.2% vs.73.1%). Conclusion There are significant differences between young and old patients with ischemic stroke regarding to risk factors, etiological subtypes and improvement of functional deficits associated with the stroke. However, severity of stroke on admittance is similar but six weeks outcome is different among young and old patients with relatively rapid improvement of functional deficit in young stroke patients than old one (mRS: 89.1% vs. 66.9%, p=0.002; BI: 84.2% vs.73.1%).

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: 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.