RBD-specific antibody response after two doses of different SARS-CoV-2 vaccines during the mass vaccination campaign in Mongolia.

The SARS-CoV-2 vaccination campaign began in February 2021 and achieved a high rate of 62.7% of the total population fully vaccinated by August 16, 2021, in Mongolia. We aimed to assess the initial protective antibody production after two doses of a variety of types of SARS-CoV-2 vaccines in the Mongolian pre-vaccine antibody-naïve adult population. This prospective study was conducted from March-April to July-August of 2021. All participants received one of the four government-proposed COVID-19 vaccines including Pfizer/BioNTech (BNT162b2), AstraZeneca (ChAdOx1-S), Sinopharm (BBIBP-CorV), and Sputnik V (Gam-COVID-Vac). Before receiving the first shot, anti-SARS-CoV-2 S-RBD human IgG titers were measured in all participants (n = 1833), and titers were measured 21-28 days after the second shot in a subset of participants (n = 831). We found an overall average protective antibody response of 84.8% (705 of 831 vaccinated) in 21-28 days after two doses of the four types of COVID-19 vaccines. Seropositivity and titer of protective antibodies produced after two shots of vaccine were associated with the vaccine types, age, and residence of vaccinees. Seropositivity rate varied significantly between vaccine types, 80.0% (28 of 35) for AstraZeneca ChAdOx1-S; 97.0% (193 of 199) for Pfizer BNT162b2; 80.7% (474 of 587) for Sinopharm BBIBP-CorV, and 100.0% (10 of 10) for Sputnik V Gam-COVID-Vac, respectively. Immunocompromised vaccinees with increased risk for developing severe COVID-19 disease had received the Pfizer vaccine and demonstrated a high rate of seropositivity. A high geometric mean titer (GMT) was found in vaccinees who received BNT162b2, while vaccinees who received ChAdOx1-S, Sputnik V, and BBIBP-CorV showed a lower GMT. In summary, we observed first stages of the immunization campaign against COVID-19 in Mongolia have been completed successfully, with a high immunogenicity level achieved among the population with an increased risk for developing severe illness.

The Prevalence and Risk Factors of Chronic Heart Failure in the Mongolian Population.

BACKGROUND: The prevalence of heart failure in the Mongolian population is unknown. Thus, in this study, we aimed to define the prevalence of heart failure in the Mongolian population and to identify significant risk factors for heart failure among Mongolian adults. METHODS: This population-based study included individuals 20 years and older from seven provinces as well as six districts of the capital city of Mongolia. The prevalence of heart failure was based on the European Society of Cardiology diagnostic criteria. RESULTS: In total, 3480 participants were enrolled, of which 1345 (38.6%) participants were males, and the median age was 41.0 years (IQR 30-54 years). The overall prevalence of heart failure was 4.94%. Patients with heart failure had significantly higher body mass index, heart rate, oxygen saturation, respiratory rate, and systolic/diastolic blood pressure than patients without heart failure. In the logistic regression analysis, hypertension (OR 4.855, 95% CI 3.127-7.538), previous myocardial infarction (OR 5.117, 95% CI 3.040-9.350), and valvular heart disease (OR 3.872, 95% CI 2.112-7.099) were significantly correlated with heart failure. CONCLUSIONS: This is the first report on the prevalence of heart failure in the Mongolian population. Among the cardiovascular diseases, hypertension, old myocardial infarction, and valvular heart disease were identified as the three foremost risk factors in the development of heart failure.

Assessment of global longitudinal strain and plasma natriuretic peptide in patients with asymptomatic left ventricular dysfunction.

Objective    The purpose of this study was to investigate the association between global longitudinal strain (GLS) and plasma NT-proBNP for predicting left ventricular (LV) performance in asymptomatic patients after acute myocardial infarction (AMI).Material and methods    We prospectively included patients with diagnosis of AMI without clinical signs and symptoms of heart failure (HF) and followed these patients for 6 mos. Baseline echocardiography was performed at admission, and follow-up echocardiography was performed after 6 mos. A normal GLS was defined as having an absolute value of ≥16 %. According to the baseline GLS, participants were divided into two groups and compared. In all participants, blood samples of plasma NT-proBNP were obtained at admission, before discharge, and 6 mo after discharge.Results    The study population was consisted of 98 participants, of which 80 (81.6 %) were males, and the mean age was 56.0±9.3 years. Baseline echocardiography showed that most of the participants (60, 61.2 %) had abnormal GLS<16 %, whereas 38 (38.8 %) participants had normal or borderline GLS ≥16 %. Compared with the normal GLS group, participants with abnormal GLS had higher GRACE score, higher troponin I concentration, lower systolic blood pressure, lower mean LV ejection fraction, and decreased LV diastolic function. At 6­mo follow-up, only LV systolic function remained significantly different between the two groups. Compared to baseline, there was a significant improvement of GLS in the abnormal GLS group at 6­mo follow-up (p=0.04). Prevalence of complications after AMI was significantly higher in this group. There were significant differences between baseline and discharge NT-proBNP concentrations between the two groups (p<0.05). In the abnormal GLS group, there were significant correlations between baseline and discharge NT-proBNP concentrations with baseline LV systolic function. Discharge NT-proBNP concentration also correlated significantly with 6­mo follow-up GLS. For determining the effect of baseline GLS abnormality, the areas under the ROC curve for baseline and discharge NT-proBNP concentrations were 0.73 (95 % CI 0.60-0.85, p=0.001) and 0.77 (95 % CI 0.66-0.87, p<0.001), respectively. Regarding early prediction of follow-up GLS abnormality, the area under the ROC curve for discharge NT-proBNP concentration was significantly higher 0.70 (95 % CI 0.55-0.84, p=0.016). The optimum cut-off value of discharge NT-pro-BNP was 688.5 pg / ml, with 72.4 % sensitivity and 65.4 % specificity to predict 6­mon GLS abnormality following acute myocardial infarction.Conclusion    The main finding of this study is that impaired LV GLS is associated with elevated plasma concentrations of NT-proBNP in post-AMI patients. Pre-discharge NT-proBNP concentration combined with impaired initial GLS could predict worsening LV systolic function over time in asymptomatic post-AMI patients.

Hypertension prevalence and control in Ulaanbaatar, Mongolia.

This study examines the prevalence, awareness, treatment, and control of hypertension in Ulaanbaatar, Mongolia, using both the American Heart Association and conventional thresholds (130/80 and 140/90 mm Hg, respectively). In this randomized cross-sectional study, two-stage cluster sampling was used to obtain a sample of 4515 individuals aged ≥20 years. Hypertension was defined by the use of antihypertensives in the last 2 weeks or a blood pressure at or above the thresholds of 140/90 and 130/80 mm Hg. The mean age of the participants was 41.1 ± 14.0 years and 54.5% were women. Hypertension prevalence was 25.6% (using 140/90 mm Hg) and 46.5% (using 130/80 mm Hg). Prevalence increased with age and below 50 years men were consistently more likely to be hypertensive. Among hypertensive participants, the rates of awareness, treatment, and control were 69.7%, 46.8%, and 24.0% (using 140/90 mm Hg) and 49.1%, 25.8%, and 6.4% (using 130/80 mm Hg, respectively). Men had lower rates of awareness, treatment, and control compared with women, with the most pronounced differences at younger ages. This study shows that awareness, treatment, and control rates in Ulaanbaatar are better than in most low- and middle-income countries but are still suboptimal. The largest "care gap" was in young men where a regulatory requirement for annual workplace blood pressure screening has the potential to enhance care. A major hypertension control program has just been initiated in Ulaanbaatar.

Hypertension knowledge, attitudes, and practices of nurses and physicians in primary care in Ulaanbaatar Mongolia.

Increased blood pressure is a leading risk for death globally, and interventions to enhance hypertension control have become a high priority. An important aspect of clinical interventions is understanding the knowledge, attitudes, and practices (KAP) of differing primary healthcare practitioners. We examined KAP surveys from 803 primary care practitioners in Ulaanbaatar, Mongolia (response rate 80%), using a comprehensive KAP survey developed by the World Hypertension League (WHL). The WHL KAP survey uniquely includes an assessment of key World Health Organization recommended interventions to enhance hypertension control. There were few substantive differences between healthcare professional disciplines. Primary care practitioners mostly had a positive attitude toward hypertension management. However, confidence and practice in performing specific tasks to control hypertension were suboptimal. A low proportion indicated they systematically screened adults for hypertension and many were not aware of the need to or were confident in prescribing more than two antihypertensive medications. It was the practice of a high proportion of doctors to not pharmacologically treat most people with hypertension who were at high cardiovascular risk. There was a reluctance by physicians to task share hypertension diagnosis, drug prescribing and assessing cardiovascular risk to nurses. The minority of health care professions use a hypertension management algorithm, and few have patient registries with performance reporting functions. There were few substantive differences based on the age, gender, and years of clinical practice of the practitioners. The study findings support the need for standardized education and training of primary care practitioners in Ulaanbaatar to enhance hypertension control.

Hypertension, knowledge, attitudes, and practices of primary care physicians in Ulaanbaatar, Mongolia.

We examined the knowledge, attitudes, and practices of primary care doctors in Ulaanbaatar, Mongolia using a recently developed World Hypertension League survey. The survey was administered as part of a quality assurance initiative to enhance hypertension control. A total of 577 surveys were distributed and 467 were completed (81% response rate). The respondents had an average age of 35 years and 90.1% were female. Knowledge of hypertension epidemiology was low (13.5% of questions answered correctly); 31% of clinical practice questions had correct answers and confidence in performing specific tasks to improve hypertension control had 63.2% "desirable/correct" answers. Primary care doctors mostly had a positive attitude toward hypertension management (76.5% desirable/correct answers) and highly prioritized hypertension management activities (85.7% desirable/correct answers). Some important highlights included the majority (> 80%) overestimating hypertension awareness, treatment, and control rates; 78.2% used aneroid blood pressure manometers; 15% systematically screened adults for hypertension in their clinics; 21.8% reported 2 or more drugs were required to control hypertension in most people; and 16.1% reported most people could be controlled by lifestyle changes alone. 55% of respondents were not comfortable prescribing more than 1 or 2 antihypertensive drugs in a patient and the percentage of desirable/correct responses to treating various high-risk patients was low. Most (53%-74%) supported task shifting to nonphysician health care providers except for drug prescribing, which only 13.9% supported. A hypertension clinical education program is currently being designed based on the specific needs identified in the survey.

Assessing healthcare professional knowledge, attitudes, and practices on hypertension management. Announcing a new World Hypertension League resource.

To assist hypertension control programs and specifically the development of training and education programs on hypertension for healthcare professionals, the World Hypertension League has developed a resource to assess knowledge, attitudes, and practices on hypertension management. The resource assesses: (1) the importance of hypertension as a clinical and public health risk; (2) education in national or international hypertension recommendations; (3) lifestyle causes of hypertension; (4) measurement of blood pressure, screening, and diagnosis of hypertension; (5) lifestyle therapy counseling; (6) cardiovascular risk assessment; (7) antihypertensive drug therapy; and (8) adherence to therapy. In addition, the resource assesses the attitudes and practices of healthcare professionals for task sharing/shifting, use of care algorithms, and use of registries with performance reporting functions. The resource is designed to help support the Global Hearts Alliance to provide standardized and enhanced hypertension control globally.