Background: Vitamins are nutrients essential for human health. They act as coenzymes that help trigger important chemical reactions necessary for energy production. Reference values for vitamins help physicians evaluate the health status of patients and make clinical decisions. The aim of this study was to determine the mean values and reference intervals for some water-soluble vitamins of Mongolian adults. Materials and Methods: Three hundred and forty healthy adults (170 males and 170 females) of 17 to 69 years of age were selected for the study based on CLSI C28-P3 criteria Defining, establishing & Verifying reference interval in the clinical laboratory; Proposed Guidelines. The study was approved by the Resolution No.76 of 2018 of the Medical Ethics Review Committee of the Ministry of Health. Informed consents were taken from the selected individuals. Morning blood samples of the participants were collected under aseptic conditions. Levels of vitamins B₆, B₉, B₁₂ and vitamin C were measured using a high performance liquid chromatography method. The lower- and upper reference limits were defined as the 2.5th and 97.5th percentiles, respectively. The data were analyzed using SPSS and Excel programs. Results: The mean blood level of vitamin C was 11.88 mg/L (95% CI 10.47-13.29) for men and 9.62 mg/L (95% CI 8.11-11.13) for women. The calculated reference interval for males was 1.40-19.40 mg/L and 1.17-18.04 mg/L for females. The mean concentration of vitamin B₁₂ in the blood of males was 938.45 ng/L (95% CI 747.22-1129.68) and that of females was 864.03 ng/L (95% CI 603.81-1124.25). The reference interval for vitamin B₁₂ was 233.03-1597.00 ng/L in men and 132.45-1623.86 ng/L in women. The mean level of vitamin B₉ was 8.47 ng/mL (95% CI 5.64-11.30) for men and 6.91 ng/mL (95% CI 4.89-8.93) for women. The calculated reference interval for this vitamin in males was 1.04-24.74 ng/mL and that in females was 1.04-21.46 ng/mL. As for vitamin B₆, the mean concentration for men was 44.42 ng/mL (95% CI 37.01-51.83) and for women was 34.67 ng/mL (95% CI 29.97-39.39) with the reference intervals of 5.90-79.02 ng/mL for men and 5.27-61.72 ng/mL for women. Conclusion The reference values for vitamins B₆, B₉, B₁₂ and vitamin C of Mongolian adults do not differ significantly from those observed in other populations. The calculated reference intervals can be used in the practice of health laboratories.

Purpose: The etiology of Legg-Calve-Perthes disease (LCPD) remains unknown until today. A few studies have suggested passive smoke inhalation may be a risk factor, although the association is not confirmed and a causal relationship has not been established. Most mothers who smoke during pregnancy may continue smoking after giving a birth, it would be difficult to determine to what extent passive smoke inhalation adds to the risk of LCPD in these children. The causes of Legg-Calve-Perthes disease are largely unknown, but this pediatric disease seems to result from interruption of the blood supply to the proximal femur and is considered a vascular disease. Because maternal smoking during pregnancy influences fetal development and is associated with cardiovascular diseases in offspring, we hypothesized that this exposure and passive Tabaco smoke exposure are risk factors for Legg-Calve-Perthes disease and also investigated other markers of impaired fetal development and early-life exposures. Methods: We prospectively recruited total 96 patients, among those 32 patients with LCPD as a case group and 64 patients attending the hospital for other orthopedic complaints as control group. Conditional logistic regression was used to assess the association between the exposures and risk of LCPD. Results: The main risk factors for LCPD were family background, indoor use of a wood stove, having a family member who smoked indoors (passive smoke) and smoke during pregnancy. Children from the middle socioeconomic group appeared to be at a greater risk of developing LCPD. Conclusions This study provides further evidence that environmental tobacco smoke is associated with an increased risk of LCPD. Family background and exposure to wood smoke also appears to be risk factors. Maternal smoking during pregnancy and other factors indicated by impaired fetal development may be associated with an increased risk of Legg-Calvé-Perthes disease. However, it remains unclear why there are profound differences in the incidence of the disease between regions when the prevalence of smoking is comparable and why bilateral involvement is infrequent, and it needs further study.

Background: Treatment of adult tibiofibular fractures, especially severely comminuted fractures, is technically challenging due to the lack of reduction markers and difficulty in restoring the alignment. Fixation of the fibula can facilitate reduction of the tibia fracture and restoration of the lower extremity alignment. Methods: Between 2018-2019 we have operated on 50 patients who have lie on the same plane of tibiafibular fractures. Measures of angulation were obtained from radiographs taken immediately after the surgery, a second time 3 months later, and at 3-month follow-up. The analysis was performed with STATA. Results: Fixating fractures of tibia and fibula at same level were not shown to have complications on the development of nonunion including fibular shortening, hindfoot alignment, slow process of nonunion and unstableness. Conclusions We recommend fibular fixation in all 50 distal fractures when both fractures lie on the same plane and the tibial fracture is relatively stabilized.

Background: Minerals are important for the proper body functioning. They also play a role in preventing and fighting diseases. Reference values for minerals help physicians evaluate the mineral status of patients and make clinical decisions. The aim of this study was to determine the mean values and reference intervals for some minerals to be used for evaluation of the nutrition status of Mongolians. Materials and Methods: Two hundred and forty healthy adults (120 males and 120 females) of 17 to 70 years of age were selected for the study based on CLSI C28-P3 criteria Defining, establishing & Verifying reference interval in the clinical laboratory; Proposed Guidelines. The study was approved by the ethical committee of the Ministry of Health of Mongolia. Informed consents were taken from the selected individuals. Morning blood samples of the participants were collected under aseptic conditions. Levels of iron (Fe), zinc (Zn) and copper (Cu) were measured by graphite furnace atomic absorption spectrometry. The lower and upper reference limits were defined as the 2.5th and 97.5th percentiles, respectively. The data were analyzed using SPSS and Excel programs. Results: The mean level of blood iron was 30.50 µmol/L (95% CI 29.71-31.29) for men and 30.91 µmol/L (95% CI 30.03-31.79) for women. The calculated reference interval for males was 21.39-37.72 µmol/L and 19.87-39.67 µmol/L for females. The mean concentration of zinc in the blood of males was 11.00 µmol/L (95% CI 10.69-11.31) and that of females was 11.79 µmol/L (95% CI 11.39-12.19). The reference interval for blood zinc was 8.20-14.92 µmol/L in men and 8.52-16.67 µmol/L in women. The mean level of blood copper was 15.28 µmol/L (95% CI 14.64-15.89) for men and 18.08 µmol/L (95% CI 17.30-18.86) for women. The calculated reference interval for copper in males was 9.72-22.34 µmol/L and that in females was 11.18-27.27 µmol/L. Conclusion The reference values for zinc, copper and iron of Mongolian adults do not differ significantly from those observed in other countries. The calculated reference intervals can be used for evaluation of the nutrition status and making clinical decisions.

Background: Reference values are very important for the clinical decisions in laboratory diagnosis and clinical management of patients. Method: A total of 340 adults (apparently healthy individuals) between 18 to 70 years resident in the Ulaanbaatar city were randomly selected and enrolled in this survey. 340 adults made up of 170 males, 170 females were assessed by a clinician to be healthy. About 5 ml of blood was collected with EDTA test tube and analyzed using automated analyser to enumerate the hematological parameters (red blood cell, white blood cell, hemoglobin and haematocrit). Reference values were determined at 2.5^th and 97.5^th percentiles. Results: Reference values estabilished include: red blood cell 4.69-6.04×1012/L, white blood cell 3.98-9.11×109/L, haemoglobin 145-176 g/L, haematocrit 42.6-52.9% for males and red blood cell 4.10-5.20×1012/L, white blood cell 3.50-9.08×109/L, haemoglobin 121.8-148.2 g/L, haematocrit 36-44.7% for females. Conclusion We were determined mean and reference range of haematological parameters (red blood cell, white blood cell, haemoglobin, haemotocrit) which are important for assessing the nutritional status of adults according to the international standard methodology. The international reference range shows that white blood cells counts do not indicate gender and our data (р=0.0964 are statistically insignificant) also offers no significant difference was found between samples for male and female subjects.

Background: We set the average value and reference range of blood plasma proteins (total protein, albumin, transferrin, retinol binding protein, prealbumin) to be used to assess the nutritional status of Mongolian adult. According to step by step research methodology, 170 women, 170 men and a total of 340 people were surveyed using a combination of questionnaires and analytic methods. Methods: The total protein and albumin content of the collected samples was analyzed by colorimetric method using “Humalyzer 2000” semi automatic analyzer and prealbumin, transferring and retinol binding protein was analyzed by ELISA method of “ELX 880”. The lower limit of the reference value of the identified parameters was calculated to be 2.5 per centil and the upper limit was 97.5 per centil. Results: Determining average and reference range of proteins in the plasma of a total 340 participants, the average of total protein was 74.54(CI 95%; 72.67-76.38) g/l for men, and 73.59(CI 95%; 72.39-74.79) g/l for women, while the reference range was 55.26-95.79 g/l for men and 58.38-84.72 g/l for women. According to determined above, there is no statistically significant difference in gender (p>0.40). The average albumin level is 48.20(CI 95%; 47.04-49.36) g/l for men and 46.28(CI 95%; 45.32-47.24) g/l for women, while reference range is 37.14-60.01 g/l for men and 34.97-57.60 g/l for women. It means there is a statistically significant difference for the gender (p=0.012). The average prealbum level is 332.43(CI 95%; 311.28-353.58) mg/l for men, 381.67(CI 95%; 360.98-402.36) mg/l for women, while reference range is 171.3-485.0 mg/l for men and 215.5-535.0 mg/l for women. It means there is a statistically significant difference for the gender (p=0.0012). The average range of transferrin 4.01(CI 95%; 3.76-4.26) g/l for men and 4.43(CI 95%; 4.20-4.66) g/l for women while reference range is 2.20-6.92 g/l for men and 2.58-7.05 g/l for women, is a statistically significant difference for the gender (p=0.017). The average level of retinol binding protein is 1.73(CI 95%; 1.61-1.85) μmol/l for men and 2.01(CI 95%; 1.89-2.13) μmol/l for women, while reference range is 0.73-3.08 μmol/l for men and 0.73-3.08 μmol/l for women, is a statistically significant difference for the gender (p=0.0017). Conclusions For the first time we conducted a study to determine the average amount and reference range of proteins needed to assess the nutritional status of adults (total protein, albumin, prealbumin, transferring, retinol binding protein) according to international standard methods, which is relatively high compared to other researchers. According to the result of the study, it is not possible to directly follow the result of researchers from other countries and the reference range of blood proteins directly to Mongolians. The result of this study has become an important innovation in practice and treatment, as medical professionals have been able to use it in their diagnosis and treatment.

Background: According to the First National Tuberculosis (TB) Prevalence Survey in Mongolia the prevalence of bacteriologically-confirmed pulmonary TB among adults was 559.6 (95% CI: 454.5–664.7) per 100000 population in 2014–2015. This was three times as high as previously estimated. Nationwide anti-tuberculosis (TB) drug resistance survey was conducted in 1999 and 2007 in Mongolia. Share of multidrug resistant TB (MDR-TB) cases among newly notified TB cases increased from 1.0% in 1999 to 1.4% in 2007. Accordingly, we aimed to perform drug susceptibility test on strains isolated from TB Prevalence Survey and to determine the prevalence of drug resistant TB. Material and Methods: All 242 MTB strains isolated from the survey TB cases were tested GenoTypeMTBDRplus test and conventional 1st line DST on solid medium. Result: Conventional DST and GenoTypeMTBDRplus tests done for 93.8% (227/242) of them and 6.2% (15/242) were tested by GenoTypeMTBDRplus only. A 61.6% (95%CI 55.3-67.4) of all cases were susceptible to first line anti-TB drugs, any drug resistance and MDR-TBdetected as 38.4% (95% CI 32.5-44.7)and 9.5% (95% CI 6.4-13.9), respectively. Prevalence of MDR-TB was7.8% (95% CI 4.9-12.4) among new and 17.9% (95% CI 9.0-32.7) among previously treated cases. The 64 strains were identified as a resistant to isoniazid, 32.8% (42/64) and 65.6% (21/64) were katG, and inhAmutation, respectively. One isolate (1.6%) was mutations in both the inhAand katGgenes.The predominant mutations detected in therpoB were S531L (91.3%) among rifampicin resistant isolates and the mutation in inhAwas C–15T (100%) and katG mutation was S315T1 (100%) among isoniazid-resistant isolates. Conclusion Prevalence of cases with DR-TB is high among prevalent TB cases, especially prevalence of MDR-TB among new cases. In comparison to previous studies, DR-TB cases seem to be increased. Rifampicin resistant strains have a mutation of the rpoBand resistance to isoniazid is predominantly associated with the inhA mutation.

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.

Bacground: DST by conventional methods takes several weeks, while early diagnosis of the disease and the rapid identification of resistant strains are essential for efficient treatment and control of the MDR strains. Rapid molecular testing of detecting MDR-TB is needed.Objective: The aim of this study was to assess performance of molecular line probe assay, Genotype16 MTBDRp/us, for rapid detection of RIF and INH resistance for M.Tuberculosis in Mongolia. The sensitivity and specificity of Genotype® MTBDRp/us to detect RIF and INH resistance-associated mutations in culture specimens and directly in smear-positive clinical specimens was examined and compared with conventional culture and drug susceptibility testing on solid medium.Material and Methods: The subjects of this study were 218 MDR-TB suspects aged 14-75 years from 8 districts in Ulaanbaatar city. The study was conducted from July 2009 to May 2010. The Genotype M. Tuberculosis drug resistance first line (MTBDR plus) assay (Hain Life-science, Nehren, Germany) was tested on directly on 41 sputum specimens and 109 clinical isolates.Results: The high correlation of the results from Genotype® MTBDRp/us and conventional drug susceptibility testing was obtained from this study. The results clearly show high performance of Genotype® MTBDRp/us with almost 100% accuracy for all the important indicators, such as sensitivity, specificity, positive and negative predictive values of detection of RIF and INH resistance. Some minor discrepancies were obtained in comparison with DNA sequencing results.Our study found that among high proportion for detection of RIF resistance, S531L mutation (MUT3 band) occurred the most commonly, with 80.0% of all RIF-resistant strains (83.6% of MDR) having the mutation. Other mutation in the 530-533 regions was common, as detected by the lack of binding to the WT8 probe in the absence of S531L mutation.In this study we observed that mutations in the promoter region of inhA gene played a major role (67.6 % (63.9% of MDR strains and 90% of INH-mono-resistant strains) had a mutation in the inhA.Conclusion: The Genotype® MTBDRp/us assay was demonstrated as a rapid, reliable and highly accurate tool for early detection of MDR-TB through examining smear positive cases enabling early start of appropriate therapeutic and public health measures to control of the spread of drug resistant M.tuberculosis in the population.

BACKGROUND:Tuberculosis is still an important infectious disease today. The resent World Health Organization TB Fact Sheet statesthat it kills approximately 2 million people each year. WHO estimated that between the years 2002 and 2020 inclusive,approximately 1000 million people will be newly infected. According to the fact sheet over the same period, more than150 million people will become infected, and 36 million will be die due to tuberculosis, if control of the diseases is furthernot strengthened.1In 2009, there were registered 4218 tuberculosis new cases in Mongolia. Among them 1809 cases were smear positivepulmonary cases. Mongolia has the 7th highest tuberculosis case rate country in the WHO.WPR.2GOAL: To review “Reporting Form” of the new registered cases of tuberculosis in Mongolia (2007-2009).OBJECTIVES:1. Evaluation how correct fills out of the “Reporting Form”–s of new registered cases tuberculosis.2. Social and professionals status of tuberculosis cases in Mongolia.MATERIALS AND METHODS:We conducted a retrospective study of 10237 Reporting Form of new case of TB. Which are cases reported from 21aimags and 9 districts of Ulaanbaatar city to the Tuberculosis Department of NCCD, between 2007 and 2009.Retrospective analysis for the “line list of tempore office leave’s” among health care works in National Center forCommunicable DiseasesRESULTS:10237 (79%) out of 12802 new TB cases were correct fill out new cases Reporting Forms in 2007-2009In 2007-2009, there were 43.3 %( 4436) unemployed people, 9.7% (994) students, 8.8 %( 901) pupils, 7.0 %( 712)pensionaries of all registered cases. A total cases 18.5 percentage was students.Also 111 health care workers were developed TB throughout country and it is 1.1% of total cases. A total cases of Healthcare workers; 30.6% (34) nurses, 28 %( 31) doctors, 15.3 %( 17) house keepers, nurses are most affected TB fromhealth care workers. Doctor’s who are working in TB and the judicial department, surgeons, dentists, center to recoverthe alcoholic, soum and family practitioners are most affected compared other doctors.CONCLUSION:1. In 2007-2009, there were 43.3% unemployed people, 9.7% students, 8.8% pupils, 7.0% pensionaries, 1.1%health care workers of all registered cases.2. Excepting students TB rate is 18.5% and this rate increasing year by year. We need to more study and analysisof students TB cases and need to planning further intervention among students3. Among health care workers who are working in tuberculosis hospital more risk of get infected tuberculosis.Urgent needs to improve the infection control intervention in the TB hospital and clinics, branch offices, whichhave high risk of infection.