Background: Esophageal cancer ranks as the fourth most prevalent malignancy in Mongolia. Among esophageal disorders, gastroesophageal reflux disease (GERD) accounts for 55% of cases, while esophageal motility disorders constitute 40%. Enhancing the diagnosis and management of esophageal disorders, alongside preventative strategies for esophageal cancer, necessitates a comprehensive understanding and widespread clinical application of esophageal functional assessment. However, epidemiological data and classification of esophageal motility disorders remain scarce in Mongolia, highlighting the necessity of this investigation. Aim: to identify specific risk factors associated with ineffective esophageal motility (IEM) Materials and Methods: This study was performed an analytical case-control design and was conducted at Intermed Hospital. A total of 702 HRM test results from patients attending the Gastroenterology and Endoscopy Center’s outpatient department, Intermed hospital Participants diagnosed with IEM based on HRM findings were assigned to the case group, while individuals with esophageal normal motility disorders were designated as the control group at a 1:2 ratio. Results: A total of 612 participants aged 21–80 years were included in this study of whom 57.8% (n=354) were female and 42.2% (n=258) were male, with a mean age of 51.1±12.7 years. The prevalence of IEM demonstrated a statistically significant increase in the 60–69 and ≥70 age groups compared to the control group (p<0.000). Participants diagnosed with IEM exhibited a mean lower esophageal sphincter (LES) pressure of 329.61±246 mmHg and a mean complete liquid bolus transit rate of 46.88±22.7%, both of which were significantly lower than those observed in the control group (p=0.000). Furthermore, the incidence of IEM was found to increase in correlation with the severity of hiatal hernia, as classified by both endoscopic and manometric criteria, demonstrating statistical significance (p=0.000). Conclusion IEM is more prevalent among elderly individuals and increases in incidence with the progression of hiatal hernia size. In cases of IEM, esophageal bolus transit is significantly delayed, and lower esophageal sphincter pressure is diminished. Further studies are warranted to elucidate additional risk factors contributing to ineffective esophageal motility.

Background: Accreditation of healthcare institutions serves as a fundamental mechanism for ensuring patient safety and validating the quality of medical services provided to the population. At Intermed Hospital, a quality measurement system for healthcare services has been established since 2015, encompassing 126 quality indicators at both institutional and departmental levels. This system facilitates continuous quality improvement efforts. In this context, quality indicators specific to the endoscopy department play a pivotal role in objectively assessing the quality of endoscopic services. Aim: To assess the quality indicators in gastrointestinal endoscopy unit. Materials and Methods: A retrospective single-center study was conducted by collecting data from the Intermed hospital’s electronic information systems which included HIS and PACS and Quality and Safety Department’s Database and the results were processed using the SPSS software. Ethical approval was granted by the Intermed hospital’s Scientific research committee. The quality of endoscopic services in the Intermed hospital was assessed based on: a) the average values of four quality indicators measured monthly; b) sample survey data from five categories of quality indicators. Results : Between 2016 and 2024, the quality indicators of the endoscopy unit measured as the level of early warning score evaluations for patients was 95.97%±3.33, the level of cases where peripheral blood oxygen saturation decreased during sedation was 1.54%±3.78, the level of cases where patients experienced paradoxiical response during sedation was 5.82%±1.75, surveillance culturing level for validation of endoscopy reprocessing was 11.6%. The endoscopic documentation quality by peer review showed 95.7-100%, the colonoscopy quality indicators were followings as adenoma detection rate: 24.5% Cecal intubation rate: 99.1%, 95.2%, Colonoscope withdrawal average time: 13.28±10.62 minutes, Bowel preparation quality (Boston Scale): 89.3% 95.7%), patient discharge from the recovery room, Average discharge time post-procedure: With propofol alone: 30.92 minutes; With propofol and fentanyl combined: 31.52 minutes, The intermediate risk was 0.28% by the TROOPS evaluation during procedural sedation. Conclusion The quality benchmark levels for these endoscopic units, as determined by a single-center study, can be effectively implemented by benchmark endoscopy centers to enhance their quality and safety operations.

Background: According to the International Labor Organization (ILO), 2.78 million workers are injured and killed each year as a result of occupational diseases, while 374 million are injured. Furthermore, work-related injuries cost the global economy 4% of its GDP. Construction workers are more likely than other workers to die and twice as likely to be injured. Construction accidents are frequently caused by a lack of knowledge and training, negligence, and inadequate safety equipment. Workers account for 70% of the factors influencing accidents, 49% of workplace problems, 56% of equipment shortages, 27% of material conditions, and 84% of risk management. Between 2009 and 2017, 3321 industrial accidents and acute poisoning cases were reported in Mongolia. 509 people died as a result of industrial accidents, 761 people became disabled as a result of injuries, and 2051 people temporarily lost their ability to work. As a result, determining the distribution, causes, and factors of accidents is reasonable. Purpose: To detect the prevalence and influencing factors of accidents in the construction industry in the last 5 years. Material and Method: Secondary data was collected using a quantitative research method based on a single-moment model of observational research from the "General Directorate of Professional Supervision" quantitative data on industrial accidents and acute poisoning by sampling 10 groups and 59 indicators of accident cases in the construction industry. Result: The prevalence of accidents in the construction industry was calculated for 1000 workers in Ulaanbaatar's 21 provinces and 9 districts using the ARC GS program. For the calculation of influencing factors and injury causes at www.graphpad.com, P values less than 0.05 was considered significant.
Between 2017 and 2021, 134 accidents and injuries were reported in Mongolia's construction industry. All accidents were male in 123 cases (92%), and female in 11 cases (8%).
Accidents and injuries in the construction industry are distributed. In Mongolia, Ulaanbaatar had 66 cases, Umnugovi had 10, Orkhon had 10, and Khovd province had 12, all of which had more accidents than other provinces. Calculating the distribution per 1000 workers, Sukhbaatar has 20, Dornogovi has 15, Umnugovi has 12, and Khovd has 10.9.
The most important factors influencing construction accidents are the workplace environment and human factors. In terms of accident causes, falling, tripping, or slipping caused 55 or 41% of all accidents, falling objects caused 24 or 18%, being trapped by objects caused 19 or 14%, and 20 or 15% were remaining causes of injuries. In the last 5 years, 47 or 35.07% of all accidents were caused by workplace environment, 45 or 33.5% by human factors, 23 or 17.1% by management system, and 19 or 14.1% by technical and technological factors. Conclusions
1. In the last five years, the prevalence of accidents among construction workers is 16.3 per 1000. The prevalence is 42.9% (66) highest in Ulaanbaatar City, 20.1% (27) in Khan-Uul district, and 8.9% (12) in Khovd province. The prevalence per 1000 workers is 20 in Sukhbaatar, 15.7 in Dornogovi, 12 in Umnugovi, and 10.9 in Khovd, with a high prevalence of 1.07 in Ulaanbaatar.
2. Human factors, such as falling from a height due to noncompliance with safety rules, limited space in the workplace and environment, and falling into pits, wells, ditches, and excavated pits, are the leading causes of injuries and accidents. Closed fractures and head injuries are the most common.

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: Acute myocardial infarction is leading cause of global morbidity and mortality and major health care burden in worldwide. Previous studies demonstrated that restoration of myocardial tissue perfusion after primary PCI is significant factor of improved outcome. In Mongolia, studying long term effects of primary PCI in patients with AMI and its’ association with coronary blood flow, tissue Doppler imaging, left ventricular global strain pattern in speckle-tracking echocardiography and risk factors are essential in theoretical and clinical practice. AIMS: To determine long term effects of primary PCI in patients with AMI and its’ association with left ventricular strain pattern in speckle-tracking echocardiography, risk factors and patient prognosis. METHODS: We used prospective cohort study design. We were selected 414 patients with AMI who treated by primary PCI between 2015 and 2016 at the State Third Central Hospital. Echocardiographic examination was conducted on Philips iE33 xMATRIX ultrasound machine. The PCI was performed according to the MNS:6379-2013 standard. RESULTS: Mean age was 60±13 and majority of them were male 84% (n=347). Complete coronary perfusion (TIMI-3) was achieved in patients 88% (n=367) after primary PCI. There was weak, negative correlation between coronary TIMI flow grade and left ventricular global longitudinal strain (r=-0.183, CI 95% -0.289 to-0.066, p<0.001). In patients with incomplete coronary perfusion (TIMI<3), mortality rate was significantly higher during 24 months follow-up. After primary PCI, 24 months mortality was 9.9% (n=39). Cut-off value of left ventricular global longitudinal strain which predict long term (within 24 month follow-up) mortality was -12.93% (sensitivity 74.4%, specificity 74.3%). Mortality during 24 months follow-up was significantly different between left ventricular global longitudinal strain groups (log-rank test p<0.001) and mortality was higher in left ventricular global longitudinal strain ≥ -12.93% group. CONCLUSION: Coronary no-reflow phenomenon is associated with long term mortality in patients with AMI. In patients with AMI who treated by PCI, long term mortality is predictable with left ventricular global longitudinal (≥-12.93%, p<0.001) strain.

Introduction : In the last years other country scientists told about not only determine infant weights, need to interest correlation between maternal weight, height and infant weight. In our country few research articles posted about anthropometry of obstetrics and gynecology. Our study aim is determine maternal weight, infant weight, placenta weight and assess factors affecting roles on maternal story of “Amgalan” Maternity Hospital in 2014-2015. Goal: The current study aimed at assessing maternal weight, infant weight, placenta weight and evaluating the effect of factors leading to it. Materials and Methods: The data was already collected from “Amgalan” Maternity Hospital using maternal history and record and it was collected measuring general physical characteristics such as body weight and height, infant weight, placenta weight and body circumferences. We used retrospective method and collected statistical data was analyzed using SPSS 21.0 software. Results: Of total 964 study participants aged 18-45. The average age of participants was 29.6 ± 5.8 years old and 49.7% (n=479) was working during pregnancy, 45.7% (n=441) hadn’t works, 4.6% (n=44) was student. The average weight of mothers was 75.4±11.5, weight of infants was 3439.5±456, weight of placenta was 685±129. The following factors affected maternal and infant weights: lower education, working, early and late pregnancy complication. Maternal weight had a low direct correlation with infant weight (r=0.267, p<0.01) and placenta weight (r=0.208, p<0.01). In our study maternal height had a low direct correlation with infant weight(r=0.173, p<0.01) and infant weight had a moderate direct correlation with placenta weight (r=0.376, p<0.01). Conclusions
1. The average maternal weight was 75.4±11.5, infant weight was 3539.5±456, placenta weight was 685±129.
2. The following factors affected maternal and infant weights: lower education, working status, early and late pregnancy complications.
3. Maternal weight had a little direct correlation with infant weight (r=0.267, p<0.01) and placenta weight (r=0.208, p<0.01).

Introduction Coronary TIMI flow gradewas previously demonstrated to be related to outcome after acute myocardial infarction. However, the relationship between coronary flow grade and left ventricular global longitudinal strainin patients with acute myocardial infarction (AMI) treated by primary percutaneous intervention (PCI) were unclear. Goal In this study, we aimed to reveal the relationship between coronary TIMI flow grade and LV GLS in patients with AMI. Materials and Methods We prospectively selected patients with AMI who treated by primary PCI. Based on whether TIMI 3 flow achieved at the end of the procedure patients were divided into two groups. Group I (TIMI 3 flow was achieved, n=367), Group II (TIMI 3 flow was not achieved, n=47). The LV GLS was assessed by 2dimensional speckle-tracking echocardiography (2D STE). Results A total of 413 patients (mean age 60±13, 84% male) were included and TIMI 3 flow was achieved in 367 patients (88%). LV GLS was significantly impaired in patients who had TIMI 3 flow not achieved compared with TIMI 3 flow achieved group (-13.1±4.8% vs. -15.3±3.8%, p<0.001). Multiple linear regression analysis which included age, gender, clinical, biochemical and angiographic variables showed that coronary TIMI flow grade of culprit artery was independently associated with LV GLS. There was negative correlation between coronary TIMI flow grade and LV GLS (Pearson’s r=-0.183, p<0.001). Simple linear regression analysis revealed that coronary TIMI flow grade is directly associated with LV GLS (β=-1.61, p<0.001) and which indicated that every 1 scale increase of final coronary TIMI flow grade resulted -1.61% increase of LV GLS. Conclusion Our study demonstrated the coronary TIMI flow grade of the culprit artery was independently associated with LV GLSin patients with AMI treated by primary PCI.

Introduction: Cardiovascular diseases are one of the leading causes of mortality and morbidity in Mongolia during last 10 years. Accordingly, increasing number of the procedures cardiac open heart surgeries in Mongolia.The aim is to evaluate of the scientific literature related toestimation of expenditure for open heart surgeries.Method: The literature search strategies were developed to identify published studies. The following literature databases were searched and collected individually: MEDLINE PubMed, Google and abstract books in Mongolian libraries.Result: Analyzed the 28 published literatures which made in estimation of expenditures for open heart surgery. The most of the study were generally focused on the expenses of diagnosis and treatments of open heart surgery. Literature showed that for patients not covered by health insurance, valve replacement surgery typically costs from about $80,000 -$200,000 or more with an average, according to an American Heart Association report, of $164,238, not including the doctor fee. A surgeon fee can add $5,000 or more to the final bill. For example, Dartmouth-Hitchcock Medical Center in New Hampshire charges about $86,500, including doctor fee, after a 30% uninsured discount. St. Mary’s Hospital in Wisconsin charges an average of $107,000, but costs can reach $200,000 or more. AndBaptist Memorial Health Care charges about $75,000 -$140,000, not including doctor fee, but cost can go up to more than $200,000 with major complications. In Russia, total 700,000 people take surgery on annual average each year and on which they spend 10 902 500 000$ annually, it has been stated on Bokeriya.L found that 464 637.840 ruble annually on cardiac surgery coronary angioplasty surgery, 792 237 ruble on coronary heart disease surgery and 9 522 ruble on congenital heart defect repairment surgery. Up to per 15 years old children, 24 288 ruble spend on average. Bokeria et all reported that, expenses of medicine through ABC/VEN analysis, 47 types of medicines of A group(13.1% of total medicines) takes 79.62% of total expenses, 71 types of medicines of B group(19.8% of total medicines) takes 15.36% of total expenses, 242 types of medicines of C group(67.1% of total medicines) takes 5.02% of total expenses. Out of this report, N group’s portion of A group medicines takes 0.79% by VENanalysis. Approximate, all inclusive cost for open heart bypass surgery (CABG ) vary between USD 5500 - USD 7800, depending on the facility & city you chose to get the procedure done in India. D.Tsegeenjav and D.Bat-Undral reported the expenses on open heart surgery in Mongolia, as a result showed that health insurance spend 56 422 656 ₮ (appx 39,100,093$) for 156 numbers of procedures. But real cost expenditure was 440 300 000.00₮. It means health insurance spent 12.6% of total expenditure for procedures. Also health insurance expenditure for CABG and one valve replacement per patient were same as 643 272.00₮, but real expenditures for CABG was 2 000 000.00₮, and for one valve replacement surgery per patient was 5 000 000.00 ₮.Conclution: The scientific literatures showed that many studies related in estimation of expenditure for open heart surgery made in international countries such as Russia, USA, UK and India et all. But we didn’t found the study for estimation of expenditures for open heart surgery by using ABC/VEN analysis in Mongolia.References:1. Health indicators of Mongolia 2002-2012. Report of the state implementing agency.2. Цэгээнжав д, Бат-ундрал д. зүрхний нээлттэй мэс заслûн эмчилгээний зардлûн асуудалд, “авьяслаг шастинчууд 2013” эрдэм шинжилгээний хурлûн эмхэтгэл, х3-4Бокерия л. а.самородская и. в.ßрустовский и др., Oпыт применения авс- и ven-анализа в сердечно- сосудистой хирургии фгбу. Бюллетень нЦссх им. а.н. Бакулева рамн, 2012, ¹1, стр http://lekarius. ru/external/paper/26143. The European health report 2009: health and health system. WHO Library Cataloguing in Publication Data.4. Shear A, Scuffham P, Mollon P. The cost of coronary artery disease in the UK. Br. J. Cardiol. 2004. Vol. 11. P 218-223.5. Htt://health.costhelper.com/valve-replacement.html Heart valve replacement costKey words : Open heart surgery, expenditure

In this published case of a male patient B., 53, has some epidemiological specifics. There is transient ischemic attack (TIA) syndrome, particularly while with clear mind there is sudden temporary paralysis of left leg and arm and loss of ability to speak. Temporary refers here to a period of 2-3 minutes after which everything gets back to normal. The incidence occurred again in two days during the medical treatment.MRA test concluded on the presence of obvious stenosis at the beginning part of both sides of a.cerebri media. The mentioned blood vessel pictures were undefined. Hence selected catheter angiography has been done with a purpose to establish the presence of a full occlusion or clogging stenosis in a.cerebri media and to clarify which specific vessels are being mobilized for the collateral supply. This test established that the a.cerebri media had full occlusion on both sides.A duplex sonography conducted in order to clarify characteristics of the clogging (blocking) process concluded the presence of gradual thickening of and blocking in intima (inner wall) of a. carotis interna. Based on these tests we considered that despite the atherosclerosis symptoms (Ischemia in ECG, 20 years of smoking,being male and aged 53, etc), this case had conditions of gradual (slow progressing) arteriopathy. Thus because of the presence in this case simultaneous arteriopathy process (gradually progressing and causing the blocking) in addition to atherosclerosis syndromes we consider it as a Moya-Moya syndrome. The disease of Moya-Moya is mostly found in children and youth and is a unique arteriopathy considered unrelated with atherosclerosis.

Aim and objective of studyTo study possibility of detecting Arteria carotis communis disease by dopplerosonography.Objectives:- To study dopplerography symptom which reveals in the period of Arteria carotis communis disease?- To study dependence of age, sex and artery pressure.Materials and Methods. Study was done on 100 patients who were analysed by dopplerosonograph at the centre of cerebrovessel diagnose BestEMA in 2006-2007. Study was done by using Angiodin ultrasonic dopplerosonograph apparatus and by standard method.Results: On 33 patients who were involved in the study functional defi ciency of Arteria carotis communis was revealed. Functional deficiency of carotis artery of one side was revealed on 12 patients, functional defi ciency of carotis artery of 2 sides on 21 patients, on 7 people had defi ciency of carotis artery hemodynamic over 30% and on 12 more than 50%. 84, 8% of people with functional defi ciency of general artery of carotis have hypertension at some extent. For age there were 19 males-32-77 aged and 14 females. There is Tendency of increasing defi ciency of Arteria carotis communis of 2 sides when the people become older. By dopplerosonograph analyse, when defi ciency of Arteria carotis communis increases speed of blood stream decreases, survey changes, becoming without window, sound /noise/ of stream changes and peripheral resistance increases. Such symptoms are mostly revealed.Conclusion:1. By dopplerosonograph analyse on 33% defi ciency because of Arteria carotis communis sclerosis was revealed.2. 90% of functional defi ciency of Arteria carotis communis occurs on people who are more than 40 years old.3. In the period of general artery scleroses of carotis speed of artery stream decreases survey and noise are changed, peripheral resistance increases. These symptoms are revealed.4. 84.8% of people, on whom carotis artery defi ciency was revealed, hypertension increases at some extent.