Background: The continuous annual increase in the prevalence of diabetes mellitus (DM) poses significant challenges not only within our nation but also globally in the control and management of tuberculosis. Aim: This study aimed to determine the incidence of pulmonary tuberculosis among individuals with type 2 diabetes mellitus (T2DM) residing in six central districts of Ulaanbaatar and to investigate associated factors. Materials and Methods: A cross-sectional study design was employed. Participants aged 18 years and older diagnosed with T2DM and receiving care at endocrinology clinics in six central districts of Ulaanbaatar were selected using systematic random sampling. Presumptive TB cases were identified through a structured questionnaire and chest X-ray. Sputum specimens were collected and subjected to smear microscopy and Xpert MTB/RIF assay for tuberculosis detection. Cases confirmed by laboratory diagnosis, currently undergoing tuberculosis treatment and previously treated cases as per questionnaire data were classified as tuberculosis cases, and prevalence was calculated. Results: A total of 1,644 individuals with T2DM were enrolled in the study, of whom 836 (50.9%) were female, with a mean age of 58 years (range 19–89). The overall prevalence of presumptive TB cases was 10.5% (n=172; 95% CI, 9.0–12.0). Among 112 suspected cases from whom sputum samples were obtained, 10 (8.9%; 95% CI, 4.9–15.7) were laboratory-confirmed for M.tuberculosis. Notably, 7.2% (6 cases; 95% CI, 3.4–14.9) of asymptomatic individuals with abnormal X-ray findings were diagnosed with tuberculosis. According to questionnaire responses, 9 participants (0.5%; 95% CI, 0.3–1.0) were undergoing tuberculosis treatment, and 53 (3.2%; 95% CI, 2.5–4.2) reported a previously treated TB cases. The overall prevalence of tuberculosis among individuals with diabetes was 4.4% (n=72; 95% CI, 3.5–5.5). Stratification by age and sex revealed a significantly higher prevalence among males (5.9%; n=48; 95% CI, 4.5–7.8) compared to females (2.9%; 95% CI, 1.2–4.2) (p=0.002), indicating a twofold increased risk of tuberculosis in males. Although no statistically significant differences in tuberculosis prevalence were observed across age groups (p>0.05), a declining trend in prevalence with older age was noted. Conclusion The prevalence of tuberculosis among individuals with type 2 diabetes was 4.4% (n=72; 95% CI, 3.5–5.5), with a significantly higher rate in males (p=0.002) and a decreasing trend with increasing age. Among asymptomatic individuals exhibiting radiographic abnormalities, 7.2% were confirmed to have tuberculosis via laboratory testing

Background: Pregnancy induces multiple physiological, metabolic, and immunological alterations that increase susceptibility to infections, often necessitating antibiotic therapy. Evaluating the rational use of antibiotics among pregnant women is crucial for optimizing antimicrobial stewardship at the hospital level, improving clinical pharmacy services, and reducing the risk of antimicrobial resistance. Aim: To assess the rational use of antibiotics, including indication, selection, dosage, and treatment duration—among hospitalized pregnant women in the Department of High-Risk Pregnancy and the Department of Preterm Birth at the National Center for Maternal and Child Health. Materials and Methods: A retrospective study was conducted using a specifically designed data collection form to assess antibiotic use among inpatients at the National Center for Maternal and Child Health. Descriptive statistical analyses were performed using SPSS version 29.0. Results: A total of 348 pregnant inpatients were included, with a mean age of 31.6 ± 6.9 years. The mean length of hospital stay was significantly longer in the Department of Preterm Birth (12.5 ± 5.0 days) compared to the Department of High-Risk Pregnancy (5.9 ± 2.0 days; p < 0.001). The indications for antibiotic use were therapeutic in 39.1%, prophylactic in 33.0%, and unspecified in 21.3% of cases. The most frequently prescribed antibiotic regimen was a combination of β-lactams and metronidazole (29%). While the dosing of cefazolin and cefotaxime was largely appropriate, notable dosing discrepancies were observed in the dosing of ampicillin and azithromycin. Based on the U.S. FDA pregnancy risk classification, among a total of 762 antibiotic prescriptions, 87.0% belonged to category B, 8.8% to category C, and 4.2% to category D, with no significant variation across trimesters (p = 0.695). Conclusion The assessment of antibiotic use among hospitalized pregnant women at the National Center for Maternal and Child Health revealed that 39.1% of the prescriptions were therapeutic, 33.0% were prophylactic, and 21.3% lacked a clear indication for use. β-lactam antibiotics were the most commonly used agents, frequently combined with metronidazole. Based on the FDA classification system, 87% of the prescribed antibiotics belonged to category B, 8.8% to category C, and 4.2% to category D. These findings indicate inappropriate antibiotic use and insufficient implementation of antimicrobial susceptibility testing. Therefore, strict adherence to antibiotic stewardship programs and strengthening of clinical pharmacy services are necessary to improve antibiotic use practices.

Background: Studying the human embryonic and fetal organ systems development patterns and determining their quantitative indicators is of scientific and practical importance in medicine and health in every nation.
Distortions and pathologies during the development of the embryo are the causes of congenital disabilities. Among the congenital malformations, facial malformations are the 3rd place, including cleft lip and palate in 70% and Srouzon's syndrome in 30%. In addition, abnormalities due to changes in the size, shape, and position of the jaw are also mentioned in the 2021.04.21 issue of Morphology magazine in the study "Morphometric parameters of the bones of the skull and face during the development of newborns and fetuses". In our country, Ariuntuul G (2005) determined that cleft lip and cleft palate occur at 0.76/1000 or 1 in 1314 live births, while Ayanga G (2012) found that it occurs at 1 in 1072 live births or 0.93/1000. Moreover, the eye cup dimensions of Mongolian fetuses aged 16 36 weeks have a positive linear relationship with the gestational age determined using ultrasound by Nandintsetseg B (2015) et al. Compared with the other countries, the eyecup is slightly wider, and the outer edge distance is similar, whereas the inner edge distance is shorter. Purpose: To summarize research work and determine the embryonic development of bones involved in the formation of the face and facial parts, the period of bone formation, the point of ossification, and the period of formation. Methods: During fetal development, human organ systems grow and develop at different rates but in a particular relationship. This feature of growth and development is also clearly observed in the structure of the head and facial bones, and the results of researchers who have studied this aspect are selected in the articles. Results: Embryonic and fetal development of bone are clinically significant not only from the point of view of its morphogenesis but also from the point of view of congenital disabilities. Conclusion In the analysis of the sources, most of the works on the prenatal period of the development of the same body have studied the development of specific structures of the face and facial area, such as the palatine bones and nasal bones, or have generally covered the development of particular systems in the embryo and fetus, and face, there are relatively few works that show the entire dynamics of growth and development of facial bones.

Introduction: The department of Maxillofacial surgery of the National Center for Maternal and Child Health (NCMCH) has a nationwide tertiary medical service for the children who is with congenital orofacial anomalies, facial injury, nonmalignant tumors of this area, and inflammations of maxillofacial area following odontogenic infection and other reasons as well. For the last years the number of the patients who are with odontogenic inflammation on the department has been growing constantly meaning that the necessity of medical care for our countries for children is also growing. Therefore by studying and analyzing the structure of the odontogenic inflammation and to determine the most frequent odontogenic inflammation among children in our country, to prevent them, define the treatment plan. Aim: To clarify what kind of odontogenic maxillofacial inflammatory diseases mainly occurs among Mongolian children. Materials and Method: We included all patients who are with odontogenic inflammation and underwent emergency and planned surgery in the department of Maxillofacial surgery, NCMCH between 2014-2018.
We used descriptive method based on the information of inpatients history record between 2014.01.01- 2018.12.31 at the department of Maxillofacial surgery, NCMCH and using our own –designed, prescreened survey card.
Statistical data processing is done using Microsoft Office-2019, SPSS for windows and STATA programs, and the results are shown illustrated method. The survey identified the incidence and frequency of each disease classification, and analyzed the characteristics of the child’s age, sex, and residency. Result : In total 3533 children with odontogenic inflammation, whom age range is 0-18 years old, admitted at the department of Maxillofacial surgery for the surgical treatment were involved in this study.
Among which 1452(41.1%) male, 2081(58.9%) female. Considering the residency 2918(82.5%) children from Ulan-Bator and 615 (17.5%) children from countryside. The most of patients, who involved in this study were with odontogenic periostitis of maxillofacial area (67.5%), most were girls and preschool age (3-5 ages). Conclusion Based on the result of our study the most frequent inflammation was odontogenic periostitis of maxilla and mandible bone with 67.5%. The odontogenic phlegmon of orofacial area was the 2nd most frequent with 25.1%.
Inflammation of maxillofacial area was most frequent in 3-5 age group (preschool age) with 41.4%, and mostly in male. Considering the residency with 82.5% highest in Ulanbator.

Introduction: Studies demonstrated that the apolipoprotein B/apolipoprotein A-I (Apo B/apo A-I) ratio predicts cardiovascular risk better than any of the cholesterol indexes. Apo B and Apo A-1 are assumed to be superiormarkers for lipoprotein abnormalities [1,2]. The concentrations of Apo B and Apo A-1 are associated with cardiovascular disease more strongly than the corresponding lipoprotein cholesterol fractions, the discriminant value of these apoproteins in absolute terms appears to be less important than of their ratio (the Apo B/Apo A-1 ratio) [3, 5-7]. The Apo B/Apo A-1 ratio reflects the balance of atherogenic and antiatherogenic lipoproteins in plasma [4]. Multiple clinical and epidemiological studies have confirmed that the Apo B/Apo A-1 ratio is a superior marker for cardiovascular disease compared with lipids and lipoproteins or their ratios [8, 9]. Goal: We determined the variation limits of the Apo B/Apo A-1 ratio in healthy participants with normolipidemia and the relationship of this ratio with other lipid parameters. Material and Methods: A total of 146 normolipidemic healthy participants aged 25–60 years were included in the study. Anthropometric measurements (height and weight) and other personal information were obtained during the clinical examination and the interview. Participants were included in the study using the following criteria:
1. body mass index < 30 kg/m2;

2. TC < 5.2mmol/L;
3. triglycerides (TG) ≤1.7 mmol/L;
4. HDL-C ≥1.03 mmol/L ( woman), ≥ 1.29 mmol/L (male) .
The plasma levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), apo A-I, Apo B and Apo B/Apo A-1 were determined after a 12 h fasting period. The non-HDL-C was calculated as the difference between the TC and HDL-C. Most research data emphasized that the values for the Apo B/Apo A-1 ratio that define a high cardiovascular risk were proposed to be 0.9 for men and 0.8 for women. Statistical Analysis. The statistical analysis was performed using SPSS 21.0 (USA). Differences between the groups were analyzed using the Mann-Whitney test and the chi-squared test. Correlations between the indices were assessed using the Spearman’s rank correlation. A value of < 0.05 was accepted as statistically significant. Results: The relationship of ratio of apolipoprotein (Apo) B/Apo A-1 with other indicators of lipid metabolism in healthy people with normal lipidemia was analyzed. The Apo B/Apo A-1 ratio in the studied normolipidemic subjects was 0.69 ± 0.17. The percentage of subjects with the Apo B/Apo A-1 ratio exceeding 0.9 (the accepted risk value of cardiovascular disease) was 36.3 %.The subjects with Apo B/Apo A-1>0.9 were characterized by higher HDL-C levels and atherogenic Aпo B, Apo B/Apo A-1 but lower values Apo A-1. Conclusion The subjects with normolipidemia the unfavorable Apo B/Apo A-I ratio> 0.9 had more atherogenic lipid profile.

Introduction: Cardiovascular Disease (CVD) is a major cause of morbidity and a leading contributor to mortality in both developed and developing countries. With rapid socioeconomic development, CVD has reached epidemic proportions in developing countries in recent decades. Dyslipidemia, elevated level of plasma cholesterol, together with arterial hipertension, is the main modifiable risk factor atherosclerosis and cardiovascular diseases (CVD) development. Surveys to monitor and measure dyslipidemia burden in a Mongolian population has not been conducted in recent years and the available data on the prevalence, types, and associated factors of dyslipidemia in the general population is relatively insufficient and outdated. Monitoring of lipid profile at populational level is an important instrument of prevention medicine, applied for CVD populational risk assessment. Goal: Evaluate comparisons of adult blood lipid levels in age, gender and location. Material and Methods: In this study, 500 people aged 25-65 were classified into age groups (47.1% for males and 52.9% for females). Blood plasma in total cholesterol (TC), triglyceride (TG), high density (HDL-C) and low density (LDL-C) lipoprotein-cholesterol, apolipoprotein - ApoA1, Apo B and ratio of ApoB / ApoA1 were estimated. Statistical analysis was performed using SPSS 22.0 Results: Mean age of the participants was 48.8±14.2 years old. Mean values for male TC-4.85±0.92 mmol/l, TG-1.58±1.19 mmol/l, LDL-C-3.24±0.98 mmol/l, HLD-C-1.62±0.21, for women- 4.47±0.96 mmol/l, 1.22±0.47 mmol/l, 2.95±1.01 mmol/l, 1.77±0.23 mmol/l respectively. The mean blood TC,TG levels tended to increase with age group in male compared to women. The prevalence of an increased blood LDL-C levels or risks for an increased blood LDL-C was statistically significantly high in male. Conclusion The prevalence of lipid was shown as high, that demands respective prevention and management.

Introduction: The department of Maxillofacial surgery of the National Center for Maternal and Child Health (NCMCH) has a nationwide tertiary medical service on the patients who is with congenital orofacial anomalies, facial injury, nonmalignant tumors of this area, and inflammations of maxillofacial area following dental caries and other reasons as well. For the last years nationwide the number of inpatient of the department has been growing constantly meaning that the necessity of medical care for our countries for children is also growing. Therefore by studying and analyzing the structure of the illness of the department will be able to determine the most frequent orofacial illness among children in our country, to prevent them, define the treatment plan. Aim: To clarify what disease in the Maxillofacial area mainly occurs among Mongolian children. Materials and Method: We included all patients who underwent emergency and planned surgery in the department of Max-illofacial surgery, NCMCH between 2014-2015.
We used descriptive and case-control method based on the information of inpatients history record between 2014.01.01-2015.01.01 at the department of Maxillofacial surgery, NCMCH and using our own –designed, pre-screened survey card.
Statistical data processing is done using Microsoft Office-2017 and SPSS for windows programs, and the results are shown illustrated method. The survey identified the incidence and frequency of each disease classification, and analyzed the characteristics of the child’s age, sex, and residency. Result: The most of patients, who involved in this study were with the inflammation of maxillofacial area (57%), and the congenital orofacial clefts (24.4%).
In total 3300 children from 0-18 years old admitted at the department of Maxillofacial surgery and Infants study for orofacial surgery treatment were involved in this study.
Among which were 1803(54.6%) male, 1497(45.4%) female. Considering the residency, 2525(76.5%) children from Ulaanbaatar and 775 (23.5%) children from countryside. The most of patients, who involved in this study, were with the inflammation of maxillofacial area (57%), and the congenital orofacial clefts (24.4%). Conclusion Based on the result of our study the highest incidence among the participants was inflammation of maxillofacial area with 57% in which odontogenic periostitis was the most frequent with 21.6%. Congenital orofacial clefts and disorders was the 2^nd most frequent with 24.4%. Inflammation of maxillo-facial area was most frequent in 0-2 age group with 33.7%, and mostly in male. Considering there were residency with 83.2% highest in Ulaanbaatar and mostly in Bayanzurkh district with 24.7%.

Introduction: Coronary atherosclerosis is the leading cause of morbidity and mortality in the world. Hypogonadism is not considered a traditional risk factor for coronary artery disease (CAD). Higher CVD mortality may be partially attributed to behavioral and physical characteristics of males, including increased smoking, drinking, endocrine and metabolic factor like fat distribution, and low male engagement in preventive care. In the last decades, many studies have suggested that low testosterone levels are associated with increased prevalence of risk factors for CVD, including dyslipidemia and diabetes. For the reason, this research focused on identifying any association between testosterone deficiency and risk factors of coronary heart disease. Goal: This study aimed to identify any association between testosterone deficiency and risk factors of coronary heart disease in Mongolian men. Material and methods: In this case control study, we determined plasma total testosterone, total cholesterol, triglyceride, high density lipoprotein-cholesterol, apolipoprotein – ApoA1, Apo B and glucose in 287 subjects, among them 125 patients with ACS and 162 healthy subjects. Statistical analysis was performed using SPSS 22.0 of IBM. Results: Mean age of the participants was 55.19±6.99 years old. It was found that, mean plasma TT levels in patients with ACS (4.17 ng/ml) was significantly lower than in the healthy subjects (4.70 ng/ml). There was a negative association between plasma TT level and glucose level (r=-0.185; p=0.002) and ApoB/ApoA1 (r=-0.132, p=0.026). Conclusion The results in the present study suggest that low plasma TT level may be a risk factor for CHD in men, which may relate to the influence of plasma lipoprotein and glucose metabolism by endogenous testosterone.

Background: Cardiac surgery with cardiopulmonary bypass is grown rapidly in last years. The application of cardiopulmonary bypass using a heart-lung machine to perform open heart surgery is known to be associated with numerous pathophysiologic changes including injury of cellular components as erythrocyte, platelets, coagulopathy, and fibrinolysis. Objectives: Our study objective is to study on relation of open heart surgery phases and blood coagulation parameters. Materials and Methods: Blood samples from 49 patients (28 females and 21 males, aged 18- 63 years) who underwent open heart surgery with cardiopulnonary bypass (CPB) were collected before and at several time points during, after surgery and analyzed for coagulation parameters at Shastin Third Central Hospital. Results: To compare long continued cardiopulmonary bypass (over 1 h) surgery with less 1 h groups there prothrombin time was found 18.8±5.9 sec, international normalized ratio (INR) 2.09±0.9 sec prolonged (p<0.001) in 7 days after surgery. All coagulation parameters were decreased significantly (p<0.001) in during extracorporeal circulation and after 1 h declamping than preoperative level and reached near normal value in 48 h after surgery. Our results have referred to platelet counts reduction to about 53% in during surgery, 46.8% in 48 h after surgery of the preoperative level 237.4±57.1 with final return to normal levels 228.9±78.6 within 7 days. Conclusions
1. The cardiopulmonary bypass time and patient age in relation to open heart surgery type there were significant difference (p <0.01).
2. The coagulation parameters have revealed significant changes (p <0.01) in relation cardiopulmonary bypass time.
3. All coagulation parameters were decreased significantly (p<0.001) in during extracorporeal circulation and after 1 h decamping than preoperative level and reached near normal value in 48 h after surgery.
4. There was direct and less correlation between platelet level and CPB time (r=0.37, p<0.001).

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.