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: To determine the visual and anatomical outcomes after rhegmatogenous retinal detachment surgery. Methods: Case files of patients who had surgery for rhegmatogenous retinal detachment at the 3rd state central hospital May 2019 and May 2021 were reviewed. Information obtained included age, sex, presenting and post-operative visual acuity, anatomical reattachment, post- operative complications and causes of treatment failure. Results: Risk factors for retinal detachment included myopia in 8 eyes (32%), trauma in 7 eyes (28%), prior cataract surgery in 2 eyes (8%). 22 eyes (88%) presented with macula off while 3 eyes (12%) presented with macula partly or completely attached. Visual acuity at presentation was <0.01 in 15 eyes (60%). Following surgery, retina was attached in 23 eyes (92%) and remained detached 2 eyes (8%). Visual acuity after surgery was 0.1< 17 eyes, 0.4< 7 eyes. Visual acuity improved in 23 eyes (84%), remained the same in 2 eyes (8%). Conclusion Myopia and trauma are important risk factors for Rhegmatogenous Retinal Detachment. Majority of patients in this setting presented late with Rhegmatogenous Retinal Detachment and this was responsible for relatively poor visual outcomes despite good anatomical results after surgery. Proper screening of eyes at risk and education of patients is important for preventing visual loss due to retinal detachment.

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.

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).

Complete seizure control is the single most important determinant of good quality of life for patients with epilepsy and the chronic nature of the disorder requires that antiepileptic drugs (AEDs) be administered for many years, often for a lifetime. Therefore, long-term experience is of particular importance in evaluating the efficacy and safety of an AED. Valproic acid increases γ-aminobutyric acid (GABA) synthesis and release and potentiates GABAergic transmission in specific brain regions and it also has also been found to reduce the release of the excitatory amino acid β-hydroxybutyric acid and to attenuate neuronal excitation mediated by activation of N-methyl-D-aspartate (NMDA) glutamate receptors. In addition to these effects, valproic acid exerts direct actions on excitable membranes, including blockade of voltage-dependent sodium channels. Valproate is generally regarded as a first-choice agent for most forms of idiopathic and symptomatic generalised epilepsies. Many of these syndromes are associated with multiple seizure types, including tonic-clonic, myoclonic and absence seizures, and prescription of a broad-spectrum drug such as valproate has clear advantages in this situation. The elimination half-life is in the order of 9 to 18 hours, but shorter values (5 to 12 hours) are observed in patients comedicated with enzymeinducing agents such as phenytoin, carbamazepine and barbiturates. The most commonly reported adverse effects of valproate include gastrointestinal disturbances, tremor and bodyweight gain. Other notable adverse effects include encephalopathy symptoms (at times associated with hyperammonaemia), platelet disorders, pancreatitis, liver toxicity and teratogenicity. According to the some study results, endocrine manifestations of reproductive system disorders, including polycystic ovary syndrome, may be more common in women treated with valproate than in those treated with other AEDs.

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.

Aim and objective of the study. Aim of the study is to study artery disease of lower extremities by dopplerograph method. - To study dopplerograph symptom of artery disease of lower extremities. - To study dependence of age, sex and which vessel is at risk Material and Methods. We involved 61 cases which were done dopplerograph analyse because of artery disease of lower extremities at the centre of BestEMA from 2006 to January 2008 dopplerograph analyse was done by using Angiodin apparatus and by standard method divided them into 6 groups by 10 ages and studied by male and female. Results and Discussion. From 100 cases which the disease revealed in 37 artery blockade, in 27 artery stenosis in 36 hemodynamic changes revealed. In order to put differential diagnose of artery blockade and artery stenosis we defined LPI in all persons. In the period of artery blockade and artery stenosis of lower extremities form of artery stream is changed LPI is decreased below 1 depending on disease. These symptoms were common. By our study 40.9% of people with artery disease of lower extremities smoked more than 20 years and 27.3% had hyperglycemia more than 10 years. Result of our study suits to the study of A.G. Evdoximov (1999), V.G. Leluk (2003), Volmar (1996). Conclusion: 1. In 75.4% of people who were done dopplerograph analyse artery disease of lower extremities, artery blockade of lower extremities revealed in 45 stenosis in 37 and hemodynamic change in 42. 2. In the period of artery blockade and artery stenosis of lower extremities from of artery stream changes and decreases below LPI, These symptoms mostly revealed. 3. Artery blockade and artery stenosis are mostly occur in the hip and on males.

Disease of venous of the lower limb has been studied since the period of ancient Hippocrat, Glan and Avitsen and it occurred among the people not a few. Among the disease of venous of the lower limb, disease of venous dilatation occurs mostly (Savliev., B.S, 1999, Morosov, V, Savranski 2000). By recent study about 20% of population where industry developed highly, are affected by disease of venous. It occurs mostly among the people aged 25-55. In medical practice of our country since 1996, diagnosing method of dopplerography has been introduced and began to diagnose venous disease of lower limb in the recent years numbers of people involved in analyze because of acute and chronic insuffi ciency increased year by year. In up-todate phlebolog practice method of ultra sound diagnosing which is harmless to vascular and doesnt hurt is widely used and new methods have been introduced. Aim and Objectives. In order to realize aim of studying and diagnosing venous disease of the lower limb by the method of dopplerography, well solve the following objectives; -to study form and location of venous of the lower limb, to study dependence of age and sex of venous disease of the lower limb, to study symptom of dopplerography in the process of venous disease of the lower limb. Material and Methods. The study was done on the base of 120 patients material that was done dopplerography in the centre Best Ema of private structure in 2007-2008. We used dopplerographic apparatus such as: sonomed 325 and Angiodin. Conclusion 1. Venous disease of the lower limb revealed in 85% of people involved in the analyse. 2. 88.3% of people with venous disease of the lower limb were women aged 31-60. 3. In dopplerography in 37% - symptom of change of venous stream form and the breath is not coordinated, symptom of stream negative in the deep leg vascular after the test -89.4%., in superfi cial venous -10.6%.