Background: In traditional medicine, the Shimshin-6 formulation, which consists of Rheum undulatum L., Hippophae rhamnoides L., Zingiber officinalie Roscoe, Saussurea Lappa C.B.Clark, Sal ammoniacum, Tronae veneni, is recommended for women experiencing menstrual retention disorders. In recent years, Shimshin-6 has been widely used to promote postpartum uterine involution for women and our study aimed to evaluate and determine the acute and chronic toxicity effects of Shimshin-6. Aim: To evaluate and substantiate the acute and chronic toxicity effects of Shimshin-6. Materials and Methods: The acute toxicity of Shimshin-6 was evaluated using the rapid method described by V.B. Prozorovsky (1978) by administering intraperitoneal injections of the medicinal extract in white mice to determine the lethal dose. The active dose was determined following the methodology of I.P. Zapadnyuk (1983). Chronic toxicity was evaluated in Wistar rats according to the OECD 407 (2008) guidelines. The test animals were administered Shimshin-6 in tablet form (90 mg/kg and 180 mg/kg) and decoction form (tang) (162 mg/kg) daily for 60 days. At the end of the experiment, biochemical and complete blood analyses were conducted, along with histopathological examination of major organs. The study was conducted with ethical approval granted by the Ethics Committee of the Mongolian National University of Medical Sciences (MNUMS) on October 25, 2024. Results: The LD50 for Shimshin-6 tablets was 4.47 (3.39–5.1) g/kg, indicating low acute toxicity based on the K.K. Sidorov classification. The LD50 for the decoction form was 8.1 (7.1–9.4) g/kg, suggesting it is non-toxic. Regarding chronic toxicity, platelet count was significantly reduced compared to the healthy control group: Shimshin-6 tablet group: 46% reduction at 90 mg/kg and 29.7% reduction at 180 mg/kg. Shimshin-6 decoction group: 60.5% reduction at 162 mg/ kg. Additionally, hemoglobin levels in the decoction group (162 mg/kg) decreased by 15.7% (p<0.05). Biochemical analysis showed a 36.3% reduction in total cholesterol (LDL-C) levels in the tablet group (180 mg/kg) and decoction group (162 mg/kg) compared to the control (p<0.05). Conclusion Shimshin-6 tablets showed low acute toxicity in experimental mice. However, long-term administration may lead to a reduction in platelet count.

Background: Hepatocellular carcinoma (HCC) is a primary liver cancer originating from liver cells, classified as a chronic liver disease. This cancer ranks third in the world in terms of mortality rate. The MELD (Model for End-Stage Liver Disease) and Child-Pugh scoring systems are utilized to assess the prognosis of chronic liver diseases. Based on studies suggesting that certain blood test indicators, particularly red cell distribution width (RDW), could be used to predict the prognosis of liver cancer and other cancers, as well as serve as diagnostic markers, this topic was chosen to evaluate the clinical significance of RDW in hepatocellular carcinoma. Aim: The aim is to study some blood test indicators and compare them with the MELD score and Child-Pugh score systems in order to determine the prognosis of chronic liver diseases. Materials and Methods: A retrospective, single-center, cross-sectional study was conducted at Mongolia-Japan Hospital. Among 322 patients diagnosed with HCC, 24 patients were selected for the case group, and 37 patients with liver cirrhosis were included in the control group. Results: According to the research criteria, 61 patients were selected and divided into 3 groups, and statistical analysis was performed. In the detailed blood test, platelet count and WBC count showed statistically significant differences among the 3 groups (p< 0.024). In the biochemical tests, C-reactive protein (CRP) was p< 0.018, total bilirubin p< 0.001, and the mean albumin level p< 0.015, all showing statistically significant differences among the 3 groups. A statistically significant inverse correlation was observed between RDW-CV and the clinical MELD score (r=-0.356). Conclusion Platelet count, RDW, CRP, total bilirubin, and average albumin levels are significantly different across the studied groups. RDW-CV shows a moderate inverse correlation with MELD scores, suggesting its potential as a prognostic marker in chronic liver diseases. Further research with larger sample sizes is recommended to confirm these findings.

Introduction: According to statistics from the World Health Organization, more than 19.2 million population were diagnosed with cancer in 2020, and 9.9 million population died from cancer. Furthermore, Mongolia leads the world in terms of cancer mortality. In Mongolia, 5981 new cancer incidences were registered in 2021, including cervical cancer, which accounts for 5.2 percent. The average incidence rate of cervical cancer is 19.1 cases per 100,000 females, and the mortality rate is 9.6 cases per 100,000 females, which is high in the region. As of 2021, 68,163 females have undergone early screening of cervical cancer. This represents 28.6 percent of eligible women. It can be seen that the rate of early screening of cervical cancer is low. Thus, it is essential to increase the percentage of early screening by providing knowledge regarding cervical cancer in women. Purpose: The study is aimed to screen the women for cervical cancer and make a conclusion among women, living in the 4th khoroo of Bayangol district. Material and method: The study was conducted using an analytical cross sectional design. A total of 100 women aged between 30 and 60 years of the 4th khoroo of Bayangol District were randomly chosen, cervical Pap tests were performed, and STATA13 software was used for statistical analysis. Result:
- Out of a total of 100 females participating in the study, 79% were married, 24.9% had an abortion, 82% do not use contraception, and 17% were post menopausal.
- 80% of the women who participated in the study had a healthy cervical cytology or no tumor cells, while 62% had vaginitis (coccobacillus 71%). Conclusion Cervical pap smear results that are healthy or not precancerous indicate good coverage.

Introduction: The endometrium is to receive the embryo and endometrial receptivity predicts successful implantation during window of implantation (WOI). During implantation and pregnancy ER,PR,Ki67 significant controllers of endometrial decidualization. The PRP is promoting cell proliferation neoangiogenesis and anti-inflammatory effects, facilitating successful implantation indicating the safe as well as a potential therapeutic response to its application in patients with RIF with thin endometrium. Goal: Our aim was to further elucidate the role of WOI as a diagnostic and prognostic tool to RIF with thin endometrium in the fertility field. Also the importance of PRP treatment. Materials and Methods: A prospective study was done of 72 infertile thin endometrium women with history of recurrent implantation failure (RIF). All women underwent hysteroscopy followed by endometrial sampling for histological examination. WOI was studied using the immu-nohistochemicall method of determining Ki67, ER, PR, 6 tissue preparations were excluded due to an unsatisfactory amount of tissue. Therefore, data about tissue specimens from 66 patients were included in statistical analysis. Differences in implantation rate between 2 groups were evaluated using the chi square test. Endometrial thickness was calculated by a repeated measures ANOVA test with greenhouse method. This study received approval from the Ethics Committee under the reference number 2021/3-202109 and conducted at the CL fertility clinic. Results: In this study, out of 72 cases, 6 were removed, 42 were synechiae, 24 were polyp. Ki67, ER, PR immunohistochemistry expression was found in 66 and endometrial delay was diagnosed 73,6% (Figure 1). Endometrial thickness was significantly increased with the PRP group. After adjusting the WOI, significant increase in implantation 58% and clinic pregnancy 38% (Figure 2). Conclusion Adjusting WOI, receiving PRP treatment in infertile women with thin endometrium significantly associated with implantation rate and pregnancy rate prognostic indicators including Ki67 proliferation index, ER,PR.

Background: To investigate relapse rates after the successful treatment of patients with non-atypical endometrial hyperplasia (EH) either a levonorgestrel impregnated intrauterine system (LNG-IUS; MIRENA®) or two regimens of oral dydrogesterone (DGS) after primary histological response. Currently, the incidence of EH is indistinctly reported to be around 200,000 new EH cases per year in Western countries. Methods: Patients were at their choice assigned to one of the following three treatment arms: LNG-IUS; 10 mg of oral DGS administered for 10 days per cycle for 6 months; or 10 mg of oral DGS administered daily for 6 months. The women were followed for 6 months after ending therapy. [Figure2] Women aged 25-55 years with low or medium risk endometrial hyperplasia met the inclusion criteria, and 35 completed the therapy. Results: Histological relapse was observed in 55/ (41%) women who had an initial complete treatment response. The relapse rates were similar in the three therapy groups (P = 0.66). In our study involved 25-55 (mean 42.2±1.61) aged 35 women. Among them had reproductive aged 31.43% (n= 11) premenopausal women 42.86 % (n= 15) postmenopausal women 25.71% (n= 9). Their mean body mass index had 28.8±1.15 kg/m², and normal weight 34.29% (n=12), overweight 34.29% (n=12), obese 17.14% (n=6), extremely obese 14.29 % (n=5). [Figure3] Types of obesity had normal 37.14% (n=13), android 25.71% (n=9), gynecoid 37.14% (n=13). Mean parity had 1.8±0.19 to nulliparous 14.29% (n=5), primiparous 60% (n=21), multiparous 25.71% (n=9). Smoke 17.14% (n=6). Non combined disease had 65.7% (n=23), diabetes mellitus 17.14% (n=6), PCOS 14.29% (n=5), cardiovascular disease had 2.86% (n=1). [Table1] Mean endometrial thickness of TVUS had ( 16.0±0.91mm). Smoke (p=0.0391), types of obesity (p=0.0436) and myoma of the uterus (p=0.0187) seen affected the endometrial thickness. LNG-IUD group had after treatment’s menstrual period 11.11% heavy 80ml (n=1), 88.89% light 5ml (n=8). DGS (5-25 day) group had after treatment’s menstrual period 9.09% heavy =80ml (n=1), 90.91% light5ml (n=10), DGS (16-25 day) group after treatment menstrual period 40% heavy 80ml (n=6), 46.67% normal 5-80ml (n=7), 13.33% light 5ml (n=2) байв. Therefore between the three treatment groups had no differences. But treatment’s before and after result had statistics probability differences (P= 0.4064). [Figure4] Conclusions Finally, given the long natural history of menorrhagia, study outcomes need to be assessed over a period that is longer than 2 years. In conclusion, our study showed that both the LNG-IUD, oral progestin treatment reduced the adverse effect of menorrhagia on women’s lives over the course of two years. LNG-IUD was the more effective first choice, as assessed impact of bleeding on the women’s quality of life.

Introduction: Air pollution has become one of the major problems in socio-economic and health issues in Mongolia. Among the various hazards of particulate matter (PM) pollutants, microorganisms in PM2.5 and PM10 are thought to be responsible for various allergies and for the spread of respiratory diseases. Recent studies have shown that PM2.5 particles can cause chronic heart failure, heart arrhythmias, and strokes, as well as lung damage, cirrhosis, inflammation, cancer, cardiovascular disease, and metabolic disorders. Furthermore, some studies have concluded that PM2.5 particles in the environment are a risk factor for gastrointestinal, liver, colon, and lung cancer as well as it affects the growth and metastasis of various cancer cells caused by other factors. In our country, the health effects of air pollution and the relationship between the pathogenesis of cancer research are scarce. Therefore, the study of the effects of PM2.5 particles on cancer cell proliferation, migration (metastasis) can provide a significant role for cancer treatment, diagnosis, and prevention. Purpose: Determining the effects of PM2.5 particles on cancer cell proliferation, migration (metastasis) in in-vitro Material and Methods: A human liver cancer cell line (HepG2), human gastric cancer cell line (AGS) were obtained from the central scientific research laboratory in the Institute of medical sciences. HepG2, AGS cells were seeded at a concentration of 1*105 cells/mL in a culture flask and cultured in RPMI-1640 medium supplemented with 10% FBS, 1% antibiotic mix (penicillin, streptomycin) in a humidified atmosphere of 5% CO2 at 37 °C. The cytotoxic effect of PM 2.5 in AGS, HepG2 cells were evaluated by MTT, CCK8 assays. AGS, HepG2 cells were incubated in 96 well plates for 24h then treated with different concentrations (0, 5, 10, 25, 50 and 100 μg ) of Bayankhoshuu, Buhiin urguu, and Zaisan samples for 24h, respectively. Results: Concentrations of 10, 25, and 50 μg/ml of samples collected from the Bukhiin urguu and Zaisan in March increased HepG2 cell growth, while doses of 25, 50 μg/ml of samples collected from Bayankhoshuu in March and December increased HepG2 cell growth. Therefore, concentrations of 25 and 50 μg/ml of samples collected from Bayankhoshuu in March increased AGS cell growth, while concentrations of 25, 100 and μg/ml of samples collected in December increased AGS cell growth. However, no cytotoxic effect was observed in the sample collected from Zaisan in March, whereas the PM2.5 sample enhanced AGS cell growth in dose dependent manner in December.(p <0.05) Conclusion High levels of heavy metals were detected in samples collected in December from Bayankhoshuu, Bukhiin urguu and Zaisan of Ulaanbaatar. Concentration of 25 μg/ml of samples collected from the Bukhiin urguu and Zaisan in March increased HepG2 cell growth. Concentrations of 25 μg/ml of PM2.5 collected from three regions around Ulaanbaatar increased HepG2 and AGS cell migration.

Background: The knowledge about the normal and abnormal vaginal microbiome has changed over the last years. The normal and the abnormal vaginal microbiota are complex ecosystems of more than 200 bacterial species influenced by genes, ethnic background and environmental and behavioral factors. Major changes in the vaginal physiology and microbiota over a woman’s lifetime are largely shaped by transitional periods such as puberty, menopause and pregnancy. Many studies have shown that bacterial vaginitis (BV) has an increased risk of preterm birth, miscarriage, premature rupture of membran, and postpartum uterine inflammation and sepsis. To assess different bacterial and epidemiological factors associations with increased vaginal pH in the women of reproductive age. Methods: In the 1st Health center of Bayanzurkh district hospital, 100 non-pregnant women were randomly selected between 18-45 years of age. Women were submitted to an interview, vaginal examination and vaginal specimen collection for pH measurement and microscopy. Descriptive statistics are reported for the vaginal pH according to a specially designed survey card, the survey respondents assessed the status of the mother’s health. Results: The non pregnant group studied herein were mostly young adults with ages in the age range 25-29 (32.0; 32%, mean±SD: 29.1±5.7) years. The vaginal pH mean in non-pregnant women was 4.5±0.5. Elevated vaginal pH was signicantly associated with bacterial vaginosis (p < 0.001), and bacterial vaginosis flora (p < 0.001). 162 of 200 women (81%) had an increased vaginal pH. 65,8% of participants in research were normal nugent score. Conclusion In non-pregnant women, the vaginal pH mean was 4.5 ± 0.5. Changes in vaginal pH are statistically significant with age, and clinical manifestations. /р<0.05/. The human vaginal ecosystem is a dynamic environment in which microbes can affect host physiology but also where host physiology can affect the composition and function of the vaginal microbiota.

Research of function of vitamin D on immune system has been studying since the study revealed that vitamin D receptor is expressed on the surface of the immune cells. 1,2-dihydroxyvitamin D3 [1,25(OH)2D], physiologically active form, can be generated through hydroxylation of 25-hydroxyvitamin D3 [25(OH)D], inactive form of vitamin D, in a liver, connecting with specific VDR make biological action. Vitamin D make different biological actions depends on connecting with different immunological cells. Some studies indicated that Vitamin D plays pivotal role in antibacterial innate immune responses through regulating reaction of the main cells as macrophages and dendritic cells. Moreover, calcitriol, the active form of vitamin D, is connected with VDRE, modulates the innate immune response through directly inducing expression of catelicithin and β-defensin as antimicrobial peptides, reducing secretion of IL-1b, IL-6, TNF-a, RANKL, COX-2 as proinflammatory cytokines and increasing production of IL-10, an anti-inflammatory cytokine. Vitamin D plays in proliferation and differentiation of T and B cells and regulates the activities of over 500 genes. Vitamin D differently impacts on per se stages of T cells’ proliferation. Vitamin D indirectly mitigates the differentiation from immature B cells to plasma B cells while it directly impacts on regulation of overloaded production of antibodies in plasma B cells. In conclusion, vitamin D modulates the innate- and adaptive immune response through regulation on activation of APCells, proliferation and differentiation of immune cells, secretion of some antibacterial peptides.

Introduction: PCOS prevalence is 5-10 percent among reproductive age women in worldwide. It is caused by imbalance of sex hormones which ultimately leads to menstrual irregularities, infertility, anovulation and other metabolic disturbances. Most women with chronic anovulation is caused by polycystic ovary syndrome [PCOS] The Rotterdam criteria is useful diagnostic tool for PCOS. In Mongolia there is almost no study on PCOS related infertility and there are increasing trend infertility among reproductive aged women with PCOS, lead us to conduct the study. Objective: The aim of this study was to estimate incidence of PCOS and to study clinical and biochemical characteristics of PCOS among infertility women. Material and Methods: We used the cross-sectional and case control study designs. Total 1334 infertility women enrolled in this study. The study was conducted after approval from the Ethical and research review board of the hospital, and written informed consent was taken from all the women. Among 114 women with PCOS were found by Rotterdam’s criteria at the Infertility and reproductive department, National Center for Maternal and Child Health, between December, 2018 - 2019. Total of 43 females with PCOS were screened among 1334 infertile women. All parameters were assessed either with ELISA in 43 infertile PCOS women and 17 age matched apparently healthy controls diagnosed according to Rotterdam consensus. IDF diagnostic criteria for MS was used. The PCOS patients divided into following groups: (1) with MS ( n=42) and (2) without MS (n=72). Results: The main age, body mass index (BMI), and duration of infertility were 28.7±4.1 years, 27.3±5.2 kg/ m² and 4.4±3.1y, respectively. Among patients 57.9% of them have oligomenorrhea, 22.8% with amenorrhea, primary infertility 57.0% and 51.9% with hirsutism and acne 50.8%. As a result of hormone assays were LH 9.3±3.5mIU/ml, LH/FSH 1.6 ±0.83 [0.1-3.6], AMH 6.1ng/ml ±3.6 /2.9-21.0/. The prevalence of MS was 36.8%. The variables including age (30.9±4.9), body mass (75.9±11.6kg) and also some metabolic parameters which is hypertension (133.6/88.4±13.6 mm Hg), WC (94.1±8.6 cm) and high triglyceride (1.8±1.0 mmol/l) were observed in MS group compared to without MS group. Conclusion Among 1334 women with infertility, the incidence of PCOS 8.7% (116), close to the prevalence in other countries. Considering the diagnose was confirmed of three criteria by the Rotterdam criteria. We found out that the prevalence of metabolic syndrome was 35.3% among infertility women with PCOS. Age, BMI, WC, amenorrhea, acne and acanthosis nigricans, were highly related to metabolic syndrome.

Background: According to the study conducted by International Diabetes Federation, total of 127,1 million pregnant women were participated in the study and 21,7million (16,8%) of them were diagnosed as Gestational diabetes mellitus.³ Maternal physical structure, figure and correlation between maternal anthropometrics and fetal measurements influence directly to fetal status, process of labor and termination of birth. During the period between 1950-1960, it was described for the very first time that gestational diabetes mellitus can lead to infant overweight.⁴ Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels after 24 weeks thus the risk to develop Diabetes mellitus type 2 increases. The average infant at right after birth weighs approximately 3200-3500 grams but sometimes infants with more than average weight are born. If infant weighs 4000-5000 grams and more than this, it is defined as overweighed. The infant’s weight depends on several factors. However, hereditary factors and blood glucose levels are the main cause of infant’s overweight. According to study conducted by Koyanagi et al, 2003, maternal obesity, diabetes mellitus type 2, post term pregnancy, subsequent pregnancy, maternal and paternal height and weight, maternal older age and previous history of giving birth to overweight infant can lead to infant being born overweight.⁷ Methods: The study is made by using cross sectional method of analytic study and total of 200 pregnant women from Khan-Uul, Bayangol, Chingeltey and Bayanzurkh districts who were attending the first admission of pregnancy follow-ups. According to WHO recommendation, we made diagnosis based on results of glucose tolerance test (blood glucose measurement 2 hours after giving 75 grams of sugar orally). The body mass index is calculated by using body weight and height as BMI. In full term birth, infant weighs less than 3999 grams is normal and more than 4000 grams is termed as overweight infant Results: Infant weight depends on maternal age and it is statistically significant (р<0.025). Pre pregnancy weight and BMI are affecting the increasing level of blood glucose by statistically significant (р<0.005) (table 3). In addition, maternal age (0.012) and Glucose tolerance test (blood glucose level after 2 hours) (0.002) have direct correlation to infant weight and it is statistically significant respectively.
96 of total (48.0%) pregnant women gave vaginal birth, 104 (52,0 %) of them have undergone caesarean section. It seems, that as fetus weight rises, frequency of caesarean section increases (table 5). Moreover, fetal weight depends on gestational physical activities rather than frequency of pregnancy and gestational weight gain (р<0.002). Conclusion Women who gave birth to overweighed infant have higher fasting blood glucose and glucose tolerance test (glucose level after 2 hours) results and higher index than mean BMI. In other words, gestational diabetes mellitus is one of the risk factors which leads to infant’s overweight.