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

Eventual role of myocardial muscular «bridges» in the pathogenesis of acute coronary syndrome

Aim of the study was to investigate the role of myocardial muscular «bridges» (MMB) in the pathogenesis of acute coronary syndrome (ACS). Material and methods. The study comprised of 27 patents with ACS: 21 (77,8 %) with diagnosed unstable angina pectoris (UA) and 6 (22,2 %) with acute anterior myocardial infarction with ST elevation (STEMI). Results. All patients with STEMI had positive qualitative troponin test. The serum level of creatine phosphokinase (CPK) was 857.7 ± 495.5 U/l, the CPK MB level was 46.5 ± 42.4 U/l. The patients’ age varied from 32 to 68 years (on average, 52.4 ± 4.6 years). Selective coronary angiography (CAG) revealed systolic functional obstruction of the LAD with vessel’s lumen recovery to the norm during diastole in all 27 patients, which is typical for MMB. In all cases with UA, the clinical aggravation was associated with ECG signs of transitory or permanent myocardial hypoxia in the territory supplied by the LAD, while the patients with STEMI had ECG, biochemical and EchoCG signs of myocardial damage and kinetics disturbances in the left ventricular areas supplied by the LAD. All patients underwent intravascular instrumental investigation. During in-hospital stage all patients received conservative therapy including β-adrenergic receptors or CA-channels blockers; ACE inhibitors; disaggregants. Upon 12 months all patients underwent repeated outpatient examination. In all cases, the conducted therapy resulted in the improvement of the patients’ condition. Conclusion. This study allows concluding that MMB play an essential role in the pathogenesis of ACS, including STEMI