[Clinical observation of the successful outcome of balloon angioplasty of the right coronary artery of the heart fourteen years after the procedure in a patient with chronic ischemic heart disease].

The method of isolated angioplasty has long ceased to be the leading interventional method of treating ischemic heart disease. This clinical case study describes an example of a good fourteen-year result of balloon angioplasty in a patient with stable angina pectoris. A specific example demonstrates the excellent super-long-distance result of such a procedure on the right coronary artery using an additional method of intravascular vizualization - optical coherent tomography. Using the method, the state of the vascular wall in the intervention zone is described in detail, as well as reparative processes in the layers of the artery. Special attention is focused on the progression of atherosclerosis in other previously compromised coronary arteries. The pre­ sented clinical observation allows for a new look at the already historical method of minimally invasive restoration of vascular patency of the heart.

Ambulatory tuberculosis treatment in post-Semashko health care systems needs supportive financing mechanisms.

The tuberculosis (TB) control strategy in the Republic of Karakalpakstan, Uzbekistan, is being changed to decentralised out-patient care for most TB patients by the Government of Uzbekistan, in collaboration with the international medical humanitarian organisation Médecins Sans Frontières. Ambulatory treatment of both drug-susceptible and drug-resistant TB from the first day of treatment has been recommended since 2011. Out-patient treatment of TB from the beginning of treatment was previously prohibited. However, the current Uzbek health financing system, which evolved from the Soviet Semashko model, offers incentives that work against the adoption of ambulatory TB treatment. Based on the 'Comprehensive TB Care for All' programme implemented in Karakalpakstan, we describe how existing policies for the allocation of health funds complicate the scale-up of ambulatory-based management of TB.

[Efficiency of modern technology in obstetric practice].

Bleeding is one of the key components of critical states in obstetrics. The fight against obstetric hemorrhage related to the following aspects: the organization of care, qualifications of medical personnel, the availability and quality of the protocol. The introduction of modern technologies to reduce the frequency of massive postpartum hemorrhage and disability among women of reproductive age.

[The main directions of public health reforms in the Republic of Uzbekistan].

The article covers the directive documents regulating the development of public health. The main directions of reforms of public health system of the Republic of Uzbekistan are covered too. The statistical data reflecting the structural changes in public health is presented. The purpose and tasks of reformation of the key public health issues in the Republic of Uzbekistan are explained.

The quality of care in post-soviet Uzbekistan: are health reforms and international efforts succeeding?

The idea of healthcare quality improvement (QI) and disseminating evidence-based practice has been attractive for local health policy makers in Uzbekistan since the early 2000s. One aspect in need of discussion is the degree to which the country's healthcare system is open for the proposed QI activities. Funding of health care resulted in building and equipping rural primary care practices, training medical and administrative personnel for these practices, and vesting some regulatory functions at primary care level and enhancing their autonomy from the central regional hospitals. However, these inputs did not provide the sustainability of practices required to meet the needs for improvement in local quality of care. Although standards are effective tools for external and internal quality control, their development in Uzbekistan is rather sporadic and has not been regulated. An important quality of care issue is the need for evidence-based medicine fundamentals to be taught in graduate and postgraduate curricula. However, efforts to implement this through the training of medical school teachers and students have weak support from faculty heads, despite being declared to be among the institute's priorities. International policy regarding Uzbekistan currently ranges from local short-term health projects to large-scale medium-term efforts. The latter are very ambitious, but are the most resource- and time-consuming. In contrast to the view that developing world health systems are becoming more flexible to local QI projects, the post-Soviet health systems, including that in Uzbekistan, seem to resist such interventions.

[Problems of registration of morbidity and ways of its improvement].

New system of registration of primary morbidity was developed for the purpose of elimination of systemic error factors and decrease of human element input. The following principles are included: simplification of registration rules; more exact registration of acute conditions; unified rules of registration for out-patient and in-patient medical institutions; unified form of information fields in medical documentation for morbidity registration in out-patient and in-patient medical institutions; succession in basic parameters, indicators and terms of medical statistics in currently in force and modernized systems. New system includes following information fields: "stage of diagnostics", "urgency of condition"; "ICD-10 code", "diagnosis", "life identification", "calendar year identification". All fields, except field "diagnosis", are formalized and for them (except field "ICD-10 code") corresponding codings are developed. Rules for filling information fields, algorithms of validity control of primary information and receiving such indicators as first time identified morbidity", "chronic morbidity", "emergency (acute) morbidity", "chronic sickliness/morbidity identified for the first time in previous years", "chronic sickliness" are developed. This system is implemented experimentally in medical institutions of primary and secondary levels of health care system in Yakka-Saraysk district of City of Tashkent.

[Morbidity and mortality in acute viral hepatitides in a hyperendemic region. The role of viral hepatitis E]. / Zabolevaemost' i smertnost' pri ostrykh virusnykh gepatitakh v giperéndemichnom regione. Rol' virusnogo gepatita E.

Official annual statistical data on morbidity in acute viral hepatitides (AVH), including the number of lethal cases, for 1985-1995 were analyzed. Mortality rates per 100,000 of the population at the period of 11 years were calculated for different age groups, sex and the place of residence. 396 and 99 patients were examined for the presence of serological markers of hepatitides A, B and E, respectively, at the periods of epidemic rises in morbidity and satisfactory epidemic situation. In the course of 11 years AVH caused the death of 22,405 persons. In 1985-1987 the average mortality level (ML) reached 12.3-17.8 per 100,000 of the population (with morbidity being 1,200-1,400 and was essentially higher among the rural population in comparison with the urban population. During these years the highest ML, was registered among children aged 0-2 years (190-50 per 100,000) and, among adults, mainly among women aged 20-29 years (21.4-19.6 per 100,000). During the years when the epidemic of AVH was absent, ML among these groups was essentially lower: 40-20 among children aged 0-2 years and 4-5 among women aged 20-29 years. In 1987 in the Fergana Valley hepatitis E was detected in 72.2% of all examined patients, and in the southern areas of the country in 68.7%. A sharp rise on mortality among women of the productive age at the period of the epidemic rise of AVH morbidity in the endemic region indicated that this epidemic was linked with hepatitis E. High ML among young children may be indicative of a highly unfavorable course of hepatitis E in the group of infants, which had never been registered before. This newly established regularity may be used for the retrospective diagnostics of the outbreak of hepatitis E.