Chief Physician Research Articles

Gender- and personality-specific differences in academic qualifications, research motivation, and attractiveness of leadership positions: a survey among radiologists from Germany.

This study investigated gender- and personality-specific differences in academic qualifications, research motivation, and options to increase the attractiveness of leadership positions in radiology.A validated questionnaire with 66 questions was distributed via the German Roentgen Society and individually sent to 4,500 radiologists in Germany. Participants were asked about their gender. Personality dimensions were assessed using the OCEAN (Big Five) model. Multivariable regression analyses were employed.Of 510 included participants (women 237 (46.5%)), men were four times more likely to have acquired an associated professorship (AP, Habilitation Privatdozent) ((odds ratio (OR) 4.39 (2.22-8.67)). Also, they planned to achieve an AP more frequently (OR 2.87 (1.47-5.61)). The only gender-specific motivator for an AP was the option to become eligible for the position of chief physician (men OR 2.56 (1.07-6.15)). Mentors increased the probability of acquiring an AP (OR 2.07 (1.13-3.80)) or striving for an AP (4.82 (2.39-9.73)). Female mentees were likelier to have female mentors (OR 4.62 (1.68-12.73)). To increase the attractiveness of leadership positions, female radiologists perceived gender balance at the management level (OR 3.32 (2.28-4.82)), top sharing (OR 2.22 (1.48-3.32)), and better work-life balance (OR 2.02 (1.19-3.43)) as more relevant than male radiologists. More pronounced openness (OR 1.62 (1.10-2.38)) and extroversion (OR 1.45 (1.07-1.97)) were positively associated with planning an AP. More pronounced agreeableness (OR 0.67 (0.50-0.91)) was negatively associated.Research motivation is mainly independent of gender. Academic qualification varies with gender and personality dimensions. Mentoring, female role models, top sharing, and better work-family compatibility could motivate women to pursue academic leadership. · Male radiologists are more frequently motivated to pursue an associated professorship by the option of becoming a chief physician.. · Openness and extroversion make pursuing an associated professorship more likely.. · Role models at the management level, top sharing, and flexible work time are more important for female radiologists.. · Molwitz I, Kemper C, Stahlmann K et al. Gender- and personality-specific differences in academic qualifications, research motivation, and attractiveness of leadership positions: a survey among radiologists from Germany. Fortschr Röntgenstr 2024; DOI 10.1055/a-2415-7337.

Evaluation of AI-enhanced non-mydriatic fundus photography for diabetic retinopathy screening

ObjectiveTo assess the feasibility of using non-mydriatic fundus photography in conjunction with an artificial intelligence (AI) reading platform for large-scale screening of diabetic retinopathy (DR). MethodsIn this study, we selected 120 patients with diabetes hospitalized in our institution from December 2019 to April 2021. Retinal imaging of 240 eyes was obtained using non-mydriatic fundus photography. The fundus images of these patients were divided into two groups based on different interpretation methods. In Experiment Group 1, the images were analyzed and graded for DR diagnosis using an AI reading platform. In Experiment Group 2, the images were analyzed and graded for DR diagnosis by an associate chief physician in ophthalmology, specializing in fundus diseases. Concurrently, all patients underwent the gold standard for DR diagnosis and grading—fundus fluorescein angiography (FFA)—with the outcomes serving as the Control Group. The diagnostic value of the two methods was assessed by comparing the results of Experiment Groups 1 and 2 with those of the Control Group. ResultsKeeping the control group (FFA results) as the gold standard, no significant differences were observed between the two experimental groups regarding diagnostic sensitivity, specificity, false positive rate, false negative rate, positive predictive value, negative predictive value, Youden's index, Kappa value, and diagnostic accuracy (X2 = 0.371, P > 0.05). ConclusionCompared with the manual reading group, the AI reading group revealed no significant differences across all diagnostic indicators, exhibiting high sensitivity and specificity, as well as a relatively high positive predictive value. Additionally, it demonstrated a high level of diagnostic consistency with the gold standard. This technology holds potential for suitability in large-scale screening of DR.

ASSESSMENT OF QUALITY-OF-LIFE INDICATORS IN OPERATED AND NON-OPERATED PATIENTS WITH PRIMARY HYPERPARATHYROIDISM IN A COMPARATIVE ASPECT AT DIFFERENT TIMES

ВЕСТНИК СОВРЕМЕННОЙ КЛИНИЧЕСКОЙ МЕДИЦИНЫ 2024 Том 17, вып. 4 127ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ © K.К. Nasirova, N.T. Rikhsieva, Y.M. Urmanova, G.D. Narimova, O.К. Saitmuratova, R.T. Кhаydarova, 2024 УДК:7696.332-796.422.12/16:796.92-519.63 DOI: 10.20969/VSKM.2024.17(4).127-134 ASSESSMENT OF QUALITY-OF-LIFE INDICATORS IN OPERATED AND NON-OPERATED PATIENTS WITH PRIMARY HYPERPARATHYROIDISM IN A COMPARATIVE ASPECT AT DIFFERENT TIMES NASIROVA KHURSHIDAХON К., ORCID ID: 0000-0002-8104-5037, Dr. sc. med., Head of the Department of Endocrinology, Pediatric Endocrinology, Tashkent Pediatric Medical Institute, 223 Bogishamol str., 100140 Tashkent, Uzbekistan. E-mail: hursh77@mail.ru RIKHSIEVA NAZIRA T., ORCID ID: 0000-0001-9790-1208, Cand. sc. med., Associate Professor at the Department of Endocrinology, Pediatric Endocrinology, Tashkent Pediatric Medical Institute, 223 Bogishamol str., 100140 Tashkent, Uzbekistan. E-mail: nazirarikhsieva1507@gmail.com URMANOVA YULDUZ M., ORCID ID: 0000-0001-9776-053X, Dr. sc. med., Professor at the Department of Endocrinology, Pediatric Endocrinology, Tashkent Pediatric Medical Institute, 223 Bogishamol str., 100140 Tashkent, Uzbekistan. E-mail: yulduz.urmanova@mail.ru NARIMOVA GULCHEHRA D., ORCID ID: 0000-0002-1831-3633, Dr. sc. med., Head of the Department of Integrative and Preventive Endocrinology, Deputy Chief Physician, Republican Specialized Scientific and Practical Medical Center of Endocrinology named after Acad. Yo. Kh. Turakulov, 103 Mirzo Ulugbek str., Mirzo Ulugbek District, 100047 Tashkent, Uzbekistan. E-mail: mail@tashpmi.uz SAITMURATOVA OGULDZHAN Kh., ORCID ID: 0000-0002-7807-9463, Dr. sc. med., Professor at the Department of Histology and Pathological Physiology, Tashkent Pediatric Medical Institute, 223 Bogishamol str., 100140 Tashkent, Uzbekistan. E-mail: oguljon@inbox.ru KHAIDAROVA RAVSHANOY T., ORCID ID: 0009-0000-0173-5162, Cand. sc. med., Associate Professor at the Department of Endocrinology, Center for Developing Medical Professionals’ Vocational Qualifications at the Health Ministry of the Republic of Uzbekistan, 51 Parkent str., 100007 Tashkent, Uzbekistan. E-mail: mail@tashpmi.uz Abstract. Introduction. The clinical picture of primary hyperparathyroidism has changed over the past decades, mainly due to the early detection of hypercalcemia, and often occurs as an asymptomatic or oligosymptomatic disease. Aim. This study aims to evaluate the quality-of-life indicators in operated and non-operated patients with primary hyperparathyroidism in a comparative aspect at various times. Materials and Methods. The present study deals with the results of treatment of children who applied to the clinic of the specialized scientific and practical medical center of endocrinology in 2012-2022, 103 children with suspected primary hyperparathyroidism were examined according to anamnesis, outpatient cards, and detailed procedure reports. From among them, 90 children and adolescents with primary hyperparathyroidism were selected, where 50 patients are in the 1st group (after surgery) and 40 children and adolescences with primary hyperparathyroidism are in the 2nd group (no surgery). Numerical values obtained as a result of scientific research were statistically processed using MS Excel, arithmetic mean (M), mean standard error (m), standard deviation (Ϭ), relative values (% agreement), and Student’s t-test (t). Results and Discussion. It was found that the quality-of-life indicators in patients with primary hyperparathyroidism were significantly lower than in the control group, to a greater extent due to pain, general health, social functioning, and vitality (p<0.05). Thus, in patients with primary hyperparathyroidism before surgery, a significant violation of both: the physical and mental components of the quality-of-life was established. Further, in the 1st group of patients with surgical treatment, in dynamics after 3 and 6 months, all quality-of-life indicators according to SF-36 were significantly closer to the control group in all domains. In the 2nd group of patients with conservative treatment in dynamics after 3, 6, 12 months and 10 years, all quality- of-life indicators according to SF-36 remained significantly lower than in the control group in all domains and did not change significantly. Conclusions. The results obtained demonstrate the positive effect of surgical treatment from the patient’s point of view and confirm the feasibility of assessing the quality of life both at the decision-making stage when choosing a surgical approach, and as part of a comprehensive assessment of the therapy effectiveness in determining the recovery degree of various functioning aspects in patients after surgery.

Reliability And Validity Study For Quick Assessment Scale Of Lymphoedem Management Information

Objective: A scale to evaluate knowledge about lymphedema has not been found in the Turkish literature before. With this study, it was aimed to develop a scale that enables the evaluation of the level of knowledge of healthcare personnel on lymphedema management. Materials and Methods: The permission for this methodological study was obtained from the Ethics Committee of University Faculty of Medicine with protocol 31 number 1453. Application permission was obtained from University Rectorate Practice and Research Hospital Chief Physician. With literature review, the item pool of the Lymphedema Management Knowledge Scale, consisting of 35 45 items including the headings of ”etiology, diagnosis, treatment, and lifestyle”, was organized. For 36 the evaluation of the scale, opinions of 16 faculty members who are experts in the field of Physical Therapy and Rehabilitation were consulted. Results:In our study, lymphedema management was gathered under four main headings and a conceptual framework was created, and it was seen that it was appropriate to evaluate all the questions in one dimension after the construct and reliability validity analyses. The scale is suitable for real life and easy to apply in terms of the questions it contains. Conclusion: With this Lymphedema Management Information Rapid Assessment Scale, which was developed by reviewing the literature and taking expert opinions, the quality of counselling services provided to lymphedema patients will be raised, and the rise in protective measures will increase the quality of life of the patients

"It's a fight - the whole personality of the patient to win." The development of concepts of psychosis in the Jewish Hospital in Warsaw, 1898-1943.

This study investigates the development of concepts of psychosis in the Jewish Hospital in Warsaw, within the context of social and historical processes to which the hospital was the subject and a broader scope of European concepts of psychosis. In the years 1898-1909, the first chief physician of the psychiatric ward, Adam Wizel, focused mainly on hysteria. The interest in psychoses was initiated by Maurycy Bornsztajn, who started to promote psychoanalytic ideas. The second decade of the functioning of the Jewish Hospital's psychiatric ward was marked by issues concerning the classification of psychoses. In the third decade, after Poland regained independence, psychosis became the main focus of the hospital's staff. Newly appointed psychiatrists, Gustaw Bychowski and Władysław Matecki, contributed substantially to the psychoanalytic understanding of psychosis. Bornsztajn continued to develop his psychoanalytically based concept of psychosis. Wizel changed his attitude toward psychoanalysis and acknowledged the importance of Freud's discoveries. Władysław Sterling contributed to the biological understanding of schizophrenia. In the last period, 1931-1943, the Jewish Hospital in Warsaw struggled with the consequences of the economic crisis in Poland, Wizel's death, and Bychowski's departure, which resulted in the reduced number of publications in the field of psychosis. Nevertheless, Bornsztajn managed to further develop his concept of somatopsychic schizophrenia and Matecki introduced the category of pseudo-neurotic schizophrenia. The psychoanalytic approach developed by Wizel, Bornsztajn, Bychowski, and Matecki was supplemented with other influences, especially phenomenology. Wizel, Bychowski, and Matecki were advocates of the psychoanalytic psychotherapy of psychotic patients.

Biography of Pandit Divi Gopalacharlu: A revolutionary reformer of Ayurveda in preindependent India

Abstract Pandit Divi Gopalacharlu was a legendary Ayurvedic physician who provided valuable service to Ayurveda and made a remarkable contribution to the upliftment of Ayurveda. His primary education and Sanskrit studies were held in Machalipatnam, and he completed his studies at Mahant school in Tirupati and was conferred with the title “Acharya.” He completed his Ayurveda education at Maharajah’s Ayurveda Oriental School in Mysore. The British Government recruited him as a special plague officer in 1895. He succeeded in curing and controlling the disease. His services were applauded across India for his exceptional contribution and successful management of an emergency epidemiological condition through Ayurveda. Later, he worked as Chief Physician at a free dispensary hospital of Kanyaka Parameswari Devasthanam and Charities. He established the Ashramam of Ayurveda. He started teaching Ayurveda in Telugu and tried to create awareness among people about Ayurveda. He started Ayurvedashrama Granthamala and published nearly 20 Ayurvedic texts. He wrote translations and commentaries in Telugu for the classical Ayurvedic texts. He also started a journal, Dhanvantari, to publish various research outcomes of Ayurveda. He deciphered many inscriptions that had medical importance. He was honored with many awards and worked as the president of many committees. Through Kanyaka Parameswari Devasthanam and Charities, he started a free hospital and Ayurveda college. He established Madras Ayurveda Laboratory and started manufacturing and supplying Ayurvedic medicines all over India. He prepared hundreds of medicines and set standards for the preparations. This article covers his contributions and scholarliness in detail.

Stavropol Regional Psychiatric Hospital: memory of the past — a ladder to the future

In 2023, 80 years have passed since the liberation of Stavropol from the Nazi invaders. The staff and patients of the psychiatric hospital were subjected to the horrors of the fascist regime. 660 patients and 30 employees of the Stavropol Psychiatric Hospital died in the gas chambers. The hospital honors the memory and does its best to preserve the story of people selflessly fulfilling their duty in difficult times for her and the whole country.The purpose of the study. In honor of the anniversary memorable date, the authors of the article want to tell about the history of the Stavropol Regional Psychiatric Hospital in chronological order from the day of its foundation to the present day.Materials and methods: a systematic analysis of scientific literature, archival data of the hospital was carried out, the A.J. Dorsht foundation, stored in the Museum of History of Stavropol State Medical University, was used.Results and discussion. The authors tell about the life of the hospital in different historical periods of our country. Special attention is paid to the period of the Great Patriotic War. It tells about the horrors that the hospital experienced during the German occupation, about the victims among patients and employees whose lives were claimed by the Great Patriotic War. The period of leadership of the outstanding chief physician, man and teacher, Adolf Yakovlevich Dorsht, is described with great respect and recognition.The article summarizes the history of the development of modern psychiatric services in the Stavropol Territory, the prevention of suicidal behavior among adolescents, the provision of psychiatric care to the population during a pandemic and a special military operation.Conclusion. Having survived many trials in its lifetime, at present the Stavropol Regional Psychiatric Hospital has been awarded numerous awards for asceticism in the field of mental health and is the largest in the North Caucasus.

Reassessment of practice of Chinese surgeons since introduction of the watch and wait strategy after neoadjuvant therapy for rectal cancer

Objective: To investigate perspectives and changes in treatment selection by Chinese surgeons since introduction of the watch-and-wait approach after neoadjuvant therapy for rectal cancer. Methods: A cross-sectional survey was conducted using a questionnaire distributed through the "Wenjuanxing" online survey platform. The survey focused on the recognition and practices of Chinese surgeons regarding the strategy of watch-and-wait after neoadjuvant therapy for rectal cancer and was disseminated within the China Watch-and-Wait Database (CWWD) WeChat group. This group targets surgeons of deputy chief physician level and above in surgical, radiotherapy, or internal medicine departments of nationally accredited tumor-specialist or comprehensive hospitals (at provincial or municipal levels) who are involved in colorectal cancer diagnosis and treatment. From 13 to 16 December 2023, 321 questionnaires were sent with questionnaire links in the CWWD WeChat group. The questionnaires comprised 32 questions encompassing: (1) basic physician characteristics (including surgical volume); (2) assessment methods and criteria for clinical complete response (cCR); (3) patients eligible for watch-and-wait; (4) neoadjuvant therapies and other measures for achieving cCR; (5) willingness to implement watch-and-wait and factors influencing that willingness; (6) risks and monitoring of watch-and-wait; (7) subsequent treatment and follow-up post watch-and-wait; (8) suggestions for development of the CWWD. Descriptive statistics were employed for data analysis, with intergroup comparisons conducted using the χ2 or Fisher's exact probability tests. Results: The response rate was 31.5%, comprising 101 responses from the 321 individuals in the WeChat group. Respondents comprised 101 physicians from 70 centers across 23 provinces, municipalities, and autonomous regions nationwide, 85.1% (86/101) of whom represented provincial tertiary hospitals. Among the respondents, 87.1% (88/101) had implemented the watch-and-wait strategy. The approval rate (65.6%, 21/32) and proportion of patients often informed (68.8%, 22/32) were both significantly higher for doctors in oncology hospitals than for those in general hospitals (27.7%, 18/65; 32.4%, 22/68) (χ2=12.83, P<0.001; χ2=11.70, P=0.001, respectively). The most used methods for diagnosing cCR were digital rectal examination (90.1%, 91/101), colonoscopy (91.1%, 92/101), and rectal T2-weighted magnetic resonance imaging (86.1%, 87/101). Criteria used to identify cCR comprised absence of a palpable mass on digital rectal examination (87.1%, 88/101), flat white scars or new capillaries on colonoscopy (77.2%, 78/101), absence of evident tumor signals on rectal T2-weighted sequences or T2WI low signals or signals equivalent to the intestinal wall (83.2%, 84/101), and absence of tumor hyperintensity on diffusion-weighted imaging with no corresponding hypointensity on apparent diffusion coefficient maps (66.3%, 67/101). As for selection of neoadjuvant regimen and assessment of cCR, 57.4% (58/101) of physicians preferred a long course of radiotherapy with or without induction and/or consolidation capecitabine + oxaliplatin, whereas 25.7% (26/101) preferred immunotherapy in combination with chemotherapy and concurrent radiotherapy. Most (96.0%, 97/101) physicians believed that the primary lesion should be assessed ≤12 weeks after completion of radiotherapy. Patients were frequently informed about the possibility of achieving cCR after neoadjuvant therapy and the strategy of watch-and-wait by 43.6% (44/101) of the responding physicians and 38.6% (39/101) preferred watch-and-wait for patients who achieved cCR or near cCR after neoadjuvant therapy for rectal cancer. Capability for multiple follow-up evaluations (70.3%, 71/101) was a crucial factor influencing physicians' choice of watch-and-wait after cCR. The proportion who patients who did not achieve cCR and underwent surgical treatment was lower in provincial tertiary hospitals (74.2%, 23/31) than in provincial general hospitals (94.5%, 52/55) and municipal hospitals (12/15); these differences are statistically significant (χ2=7.43, P=0.020). The difference between local recurrence and local regrowth was understood by 88.1% (89/101) of respondents and 87.2% (88/101) agreed with monitoring every 3 months for 5 years. An increase in local excision or puncture rates to reduce organ resections in patients with pCR was proposed by 64.4% (65/101) of respondents. Conclusion: Compared with the results of a previous survey, Chinese surgeons' awareness of the watch-and-wait concept has improved significantly. Oncologists in oncology hospitals are more aware of the concept of watch-and-wait.

Knowledge, attitudes, and practice toward postoperative cognitive dysfunction among anesthesiologists in China: a cross-sectional study

BackgroundTo investigate the knowledge, attitudes, and practice (KAP) toward postoperative cognitive dysfunction (POCD) among anesthesiologists in China.MethodsThis cross-sectional study was conducted nationwide among Chinese anesthesiologists between December 2022 and January 2023. The demographic information and KAP scores of the respondents were collected using a web-based questionnaire. The mean KAP dimension scores ≥ 60% were considered good.ResultsThis study enrolled 1032 anesthesiologists (51.2% male). The mean total scores of knowledge, positive attitude, and positive practice were 9.3 ± 1.2 (max 12), 34.8 ± 3.3 (max 40), and 30.6 ± 6.7 (max 40), respectively. The knowledge items with correctness scores < 60% were “the anesthetic drugs that tend to cause POCD” (23.3%) and “Treatment of POCD” (40.3%). Multivariable analysis showed that ≥ 40 years old, master’s degree or above, intermediate professional title (i.e., attending physician), senior professional title (i.e., chief physician), and working in tertiary hospitals were independently associated with adequate knowledge. Multivariable analysis showed that the attitude scores, middle professional title, and ≥ 16 years of experience were independently associated with good practice.ConclusionsThese results suggest that Chinese anesthesiologists have good knowledge, favorable attitudes, and good practice toward POCD. Still, some points remain to be improved (e.g., the drugs causing POCD and managing POCD) and should be emphasized in training and continuing education.Trial registrationChiCTR2200066749.

Diagnostic efficacy of tract-specific diffusion tensor imaging in cervical spondylotic myelopathy with electrophysiological examination validation.

This study aimed to investigate the effectiveness of tract-specific diffusion tensor imaging (DTI) metrics in identifying the responsible segments for neurological dysfunction in cervical spondylotic myelopathy (CSM). The study encompassed nineteen participants diagnosed with CSM, including 10 males and 9 females. Additionally, a control group consisting of ten healthy caregivers (5 males and 5 females) were recruited with no symptoms and no compressions on magnetic resonance imaging (MRI). All participants underwent a comprehensive physical examination, MRI assessment, and DTI examination conducted by a senior chief physician. Several parameters were collected from the MR images, including the aspect ratio (defined as the anteroposterior diameter / the transverse diameter of the corresponding segment's spinal cord), transverse ratio (defined as the transverse diameter of the corresponding segment's spinal cord / the transverse diameter of the spinal cord at C2/3), and T2 high signal of the spinal cord. Furthermore, quantitative DTI metrics, such as axial diffusivity (AD), mean diffusivity (MD), radial diffusivity (RD), and fractional anisotropy (FA), were calculated using automatic region-of-interest (ROI) analysis for both whole spinal cord column and dorsal column. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic efficacy of the aspect ratio, transverse ratio, and DTI parameters. The area under the curve (AUC), sensitivity, and specificity were calculated. Intraoperative spinal cord electrophysiological examination was performed as the objective measure of spinal cord function during surgery. As determined by electrophysiological examination, neurological dysfunction was found in 2 patients due to C3/4 compression, in 10 patients due to C4/5 compression, in 6 patients due to C5/6 compression, and in 1 patient due to C6/7 compression. The modified Japanese Orthopedic Association scale (mJOA) was 12.71 ± 1.55 in the CSM group, with 4.87 ± 0.72 for sensory nerve function and 5.05 ± 1.35 for motor nerve function. For the control group, none of the volunteers had neurological dysfunction. T2 high signal was found at the most stenotic segment in 13 patients of the CSM group. Considering all the cervical segments, the aspect ratio (AUC = 0.823, P = 0.001, Sensitivity = 68.42%, Specificity = 82.47%) was more capable of determining the responsible segment than transverse ratio (AUC = 0.661, P = 0.027, Sensitivity = 68.42%, Specificity = 67.01%). AD, MD, and RD were significantly higher while FA was significantly lower in the responsible segment than in the irresponsible segment (P < 0.05). The AUC of DTI-Dorsal column parameters (AD, MD, RD, FA) was larger than the corresponding parameters of the DTI (Whole spinal cord). AD of DTI-Dorsal Column possessed the greatest efficacy (AUC = 0.823, sensitivity = 84.21%, specificity = 77.32%) to determine the responsible segment, larger than AD of DTI-Whole spinal cord (AUC = 0.822, P = 0.001, Sensitivity = 89.47%, Specificity = 77.32%), aspect ratio (AUC = 0.823, P = 0.001, Sensitivity = 68.42%, Specificity = 82.47%) and transverse ratio (AUC = 0.661, P = 0.027, Sensitivity = 68.42%, Specificity = 67.01%). Subgroup analysis revealed that the diagnostic efficacy of DTI and MRI parameters was influenced by cervical spine segment. When considering all cervical segments, AD from the DTI-Dorsal Column exhibited the most significant potential in identifying responsible segments. This potential was found to be superior to that of DTI-Whole spinal cord, aspect ratio, the most stenotic segment, T2 high signals, transverse ratio, motor nerve dysfunction, and sensory nerve dysfunction. The diagnostic effectiveness of both DTI and MRI parameters was notably influenced by the specific cervical spine segment.

The role of the gut microbiota in the genesis of gallstone formation in childhood

Cholelithiasis has been and remains a frequent socially significant public health problem worldwide. The pathomorphosis of the disease has also undergone significant changes, which has significantly rejuvenated, occurring not only at a young age, but also in childhood. More than 175,000 cholecystectomies are performed annually for cholelithiasis. Cholelithiasis affects 10-20% of the adult population in our country. At the same time, cholecystectomy came in second place after appendectomy. There are no official statistics on the prevalence of GCD in the general population of children in Russia. In the Krasnodar Territory, the incidence of cholelithiasis in childhood, according to the data of circulation, is 1.8-3.3%. Over the past decade, a number of studies have been conducted confirming the role of the microbiota in various parts of the gastrointestinal tract as a new link in the etiopathogenesis of GI. Intestinal bacteria (Clostridium, Bifidobacterium, Peptostreptococcus, Bacteroides, Eubacterium, Escherichia coli), involved in the oxidation and epimerization of bile acids, can disrupt enterohepatic circulation and lead to the formation of gallstones. At the same time, cholecystectomy leads to further transformation of the microbiota composition in various parts of the gastrointestinal tract, increasing the risk of developing stomach cancer and colorectal cancer. Further research is needed to determine the possibility of using the assessment of the composition of the gastrointestinal microbiota as a marker for the early diagnosis of various gastroenterological diseases of cholelithiasis in particular. The purpose of the study: To determine the role of the intestinal microbiota in the development of metabolic disorders in children with cholelithiasis in order to predict the complicated course of the disease. Material and methods. The work was carried out on the basis of the children’s city polyclinic No. 122 Moscow`s Health Department (chief physician - A.I. Bragin), 194 children with housing and communal services were under supervision. The control group consisted of 78 practically healthy children of the I Health group. The study groups were comparable in gender and age. Criteria for inclusion in the study: children with an established diagnosis of cholelithiasis, asymptomatic course at the age of 3 to 15 years. Exclusion criteria from the study: refusal of the child’s legal representative from the study, the presence of diagnosed acute diseases in the child during the last month, chronic somatic diseases, taking antibiotics and probiotics in the last 6 months, catamnestic observation for less than 12 months. General clinical studies were conducted: questionnaires, health assessment, anthropometry, biochemical examination of blood serum, including lipidogram, ultrasound examination of the abdominal cavity and gallbladder. To assess the intestinal microbiome, the following methods were used: standard bacteriological analysis of feces (method of sowing feces on liquid agarized nutrient media); complex coprological examination with the determination of pancreatic elastase (ELISA method) and fecal carbohydrates (Benedict method); biochemical examination of feces with the determination of short-chain fatty acids (SCFCS) (gas-liquid chromatography method); The Shannon index was adopted as a measure of intestinal dysbiosis. Statistical analysis was performed using the software package Statistica8.0 and MS OfficeExcel 2010/ The results of the study and the conclusion. The biotransformation of the bile acid pool mediated by the gut microbiota regulates the metabolism of bile, glucose and lipids. In children with GI, the number of bacteria representing the indigenous microbiota is generally lower, the intensity of colonization of the intestinal mucosa by them is significantly less, the species diversity of opportunistic and pathogenic bacteria is significantly higher compared with those in practically healthy children. There is an unstable and poor-quality system of interrelation with the macroorganism, disparate metabolic pathways. MK is not able to qualitatively maintain homeostasis within its own consortium. All this creates conditions for disruption of bile acid metabolism and the formation of lithogenic bile. The presence of intestinal dysbiosis in children with GI can cause not only the formation of gallstones, but also negatively affect the further growth and development of children, including the formation of metabolic complications and inflammatory processes.

Professional and social role of the chief doctor of the clinic

Competition in the healthcare market leads to quality of medical services, optimization of medical service costs and retention of medical personnel. Optimizing patient service design in a clinic refers to the entire process of treatment from patient admission to discharge. Successful strategic and operational management is ensured by positioning leadership in a unified process. The chief physician must recognize that, in addition to providing personal services, his task is to continuously optimize processes in terms of medical quality, service quality, and cost effectiveness. Medical quality, service quality and economic efficiency should be coordinated and optimized.

Sultan Mahmud II's diseases and cause of death from the perspective of medical doctor’s and current medical literature

The illness of Sultan Mahmud II, the 30th Sultan of the Ottoman Empire and the 109th Islamic Caliph, started to be discussed after his death. In this study, the possible illnesses of Sultan Mahmud II, his illness process and death were analysed by comparing the claims and explanations made by his physicians during his illness and death. The research includes: the incomplete document of Abdülhak Molla, the chief physician of the period; the book titled Deux Annees de l’Histoire d’Orient 1839-1840 (Two Years in the East 1839-1840) written by Edmond De Cadalvene and Emile Barrault; the book titled Relation Officielle de la Maladie et de la Mort du Sultan Mahmud II (Sultan Mahmud II’s Illness and Death) by Mac Carthy and Konstantin Kara Todori. The Illness and Death of Sultan Mahmud II), published in 1841; and, three reports sent by Karl Ambros Bernard to the Austrian government on different dates based on Jakob Neuner. In the light of current medical knowledge, the above-mentioned information and documents about the sultan’s illness suggest that Sultan Mahmud II suffered from “lung cancer” and “alcohol withdrawal syndrome”. It was concluded that his death was due to sepsis developing as a result of the infection caused by the disease and the deterioration of metabolite balances in the body.

Utility of deep learning for the diagnosis of cochlear malformation on temporal bone CT.

Diagnosis of cochlear malformation on temporal bone CT images is often difficult. Our aim was to assess the utility of deep learning analysis in diagnosing cochlear malformation on temporal bone CT images. A total of 654 images from 165 temporal bone CTs were divided into the training set (n = 534) and the testing set (n = 120). A target region that includes the area of the cochlear was extracted to create a diagnostic model. 4 models were used: ResNet10, ResNet50, SE-ResNet50, and DenseNet121. The testing data set was subsequently analyzed using these models and by 4 doctors. The areas under the curve was 0.91, 0.94, 0.93, and 0.73 in ResNet10, ResNet50, SE-ResNet50, and DenseNet121. The accuracy of ResNet10, ResNet50, and SE-ResNet50 is better than chief physician. Deep learning technique implied a promising prospect for clinical application of artificial intelligence in the diagnosis of cochlear malformation based on CT images.

Quality management of medical care in temporary storage of medicines in polyclinic conditions using standard operating procedures

The article presents the experience of one of the major medical organizations of the Samara Region Togliatti City Clinical Polyclinic No. 3 in ensuring safe storage conditions for medicines. Aim. Summarizing the results and spreading the experience of the Togliatti City Clinical Polyclinic No. 3 of ensuring the storage of medicines in a polyclinic. Results. Standard operating procedures approved by the chief physician of the polyclinic, which present clear and comprehensible information for medical personnel for use in their professional activities.

Career goals of surgeons in Switzerland.

Recent studies from the United States and Germany have shown a general decline in the number of surgical residents, as trainees increasingly prioritize a positive work-life balance. The current study sought to evaluate the career goals of surgeons in Switzerland. Members of the Swiss College of Surgeons, being surgical consultant or attending regardless of specialty, were surveyed online as to their purported career goals, future employment ideals, aspired leadership positions, and managerial training. A total of 269 questionnaires were analysed. Most participants (93%) were board- certified and 30% of participants were female. With regard to desired specialty, 50% of participants intended to pursue a career in visceral surgery followed by general surgery, traumatology, hand and plastic surgery, vascular surgery and thoracic surgery. Regardless of specialty, 53% of respondents strived for the position of senior physician, while 28% indicated a desire to become chief physician. In terms of work environment, most participants preferred to seek employment at a cantonal hospital, followed by a rural hospital, a university hospital, private practice or a non-clinical setting. About half of respondents favoured the option of part time employment of 80% or less and about a quartile intended to retire before 62years of age. The current study found that surgeons in Switzerland remain highly motivated to pursue leadership positions in their respective fields. Going forward, the challenge will lie in reconciling the needs of the respective departments with the personal ambition, career opportunities, and desired work-life balance of young trainees.

Trends and Patterns of Antibiotic Prescriptions in Primary Care Institutions in Southwest China, 2017-2022.

To explore the prescription patterns and usage trends of antibiotics within primary care institutions located in underdeveloped regions of China from 2017 to 2022. A retrospective analysis of antibiotic prescriptions was conducted from 25 primary care institutions in Guizhou Province during the period of 2017-2022. Antibiotic prescriptions were categorized into appropriate and inappropriate use. Appropriate use is further categorized into preferred medication, and antibiotics can be used or substituted. Inappropriate use is further categorized into unnecessary use, incorrect spectrum of antibiotics and combined use of antibiotics. Factors associated with inappropriate use were investigated using generalized estimation equations. Holt-Winters and SARIMA models were employed to predict the number of inappropriate antibiotic prescriptions as the alternative model. A total of 941,924 prescriptions were included, revealing a decreasing trend in both the number and inappropriate rates of antibiotic prescriptions from 2017 to 2022. Diseases of the respiratory system (70.66%) was the most frequent target of antibiotic use, with acute upper respiratory infections of multiple and unspecified sites representing 52.04% of these cases. The most commonly used antibiotics were penicillins (64.44%). Among all prescriptions, inappropriate antibiotic prescriptions reached 66.19%. Physicians aged over 35, holding the title of associate chief physician and possessing more than 11 years of experience were more likely to prescribe antibiotics inappropriately. The phenomenon of inappropriate antibiotic use was commoner among children aged five or younger. By comparing model parameters, it was determined that the SARIMA model outperforms the Holt-Winters model in predicting the number of inappropriate antibiotic prescriptions among primary care institutions. The number and inappropriate rates of antibiotic prescriptions in southwest China exhibited a downward trend from 2017 to 2022, but inappropriate prescription remains a serious problem in primary care institutions. Therefore, future efforts should focus on strengthening physician education, training, and clinical practice. Additionally, physicians' awareness of common misconceptions about inappropriate antibiotic use must be improved, and the prescribing behavior of physicians who fulfill patients' expectations by prescribing antibiotics needs to be modified.

Epidemic diseases during the World War I and Dr Server Kamil Tokgöz.

Server Kamil became one of the most prominent doctors during the period of the Ottoman Empirey. Server Kamil, who specialized in bacteriology and sanitation, made a name for himself primarily through his fight in the memories against epidemic diseases on the Caucasus front during World War I. He was sent to the Caucasus front as chief physician of Erzurum Red Crescent (Hilâl-i Ahmer) Hospital, and made great efforts to prevent the disease typhus-which was a major problem in the region-as soon as he reached the front line. He worked long and hard to develop a vaccine to prevent typhus, which affects thousands of soldiers and civilians. He also played a pioneering role in establishing important institutions such as the Sivas Smallpox Vaccine Laboratory and the Rabies Treatment Centre, which accomplished significant work and achieved great success both during the World War I and in the period that followed. This article attempts to clarify the activities of Server Kamil on Caucasus front during World War I based on the documents of the Turkish Red Crescent Archive, the reports of the Red Crescent Society.

Remembering Alexander Ivanovich Panyushkin: the first neurosurgeon at the Lenringad Road Hospital, successor of the neurosurgical school of the Military Medical Academy named after S.M. Kirov

ABSTRACT. This article focuses on the life and professional achievements of Alexander Ivanovich Panyushkin (19332022), who served as the first neurosurgeon at the Oktyabrskaya Railway Road Hospital and later became its chief physician from 1974 to 1999. Panyushkin obtained his neurosurgical specialization at the Department of Neurosurgery of the Military Medical Academy named after S.M. Kirov, studying under renowned academic neurosurgeons such as V.A. Shustin, V.A. Grebenyuk, and B.A. Samotokin. In the 1960s, Panyushkin studied under renowned academic neurosurgeons such as Associate Professor V.A. Shustin (a specialist in treating discogenic radiculitis), Professor V.A. Grebenyuk, and Professor B.A. Samotokin (head of the department) and other figures and doctors of the academy. The article highlights the establishment of the neurosurgical department of the Road Hospital, which served as the base of the Department of Neuro surgery of the Military Medical Academy named after S.M. Kirov, as well as the close relationship between the hospital and the academy for many years. It also explores Panyushkins significant contributions to the diagnosis and surgical treatment of discogenic lumbosacral radiculomyeloishemia, as reflected in his well-known monographs. The article provides insights into Panyushkins remarkable career journey from a young surgeon to the head physician of a renowned spinal neurosurgical department in Leningrad. Under Panyushkins leadership, the hospital witnessed substantial development, including the construction and equipping of new buildings between 1976 and 1985, where the main capacities of the hospital are concentrated today. The authors draw on Panyushkins memoir to shed light on the history of the Road Hospital, its doctors from different generations, and the experiences of Soviet medicine during the 1960s to 1990s. The authors of this article constantly refer to the materials of this book, which may be useful to clinicians as well as those who are interested in the history of domestic medicine.

Dmitry Egorovich Gorokhov (1863–1921): Founder of Pediatric Surgery and Promoter of Child Welfare in Moscow

The article dwells upon Dmitry Egorovich Gorokhov, prominent representative of the Moscow pediatric school. D.E. Gorokhov, as the chief physician and director of the Sofia Children’s Hospital in Moscow, is well-recognized as the author of the first Russian pediatric surgery guidelines and he is rightfully considered the founder of this discipline. Management tactics for such socially significant diseases in children as appendicitis, tuberculosis of bones and joints, tumors, and various congenital abnormalities were developed under his supervision. D.E. Gorokhov was the first who summarized the experience of using anesthesia in pediatric surgery. He became the initiator and organizer of nutrition in Moscow municipal schools. The scientific, practical, educational, and social activities of the doctor and scientist who notably contributed to the child welfare are shown.