Clinics In Russia Research Articles

Replacement of extended ureteral strictures in children: a multicenter experience with appendicoplasty

Introduction. The first description of ureteral appendicoplasty was provided by the Italian surgeon Giannettasio in 1901, followed by two German surgeons, Franke and Rydygier. Their work was later included in a review by Melnikoff in 1912. However, it is Melnikoff who is often erroneously credited with performing the first appendicoplasty in the literature. The first ureteral appendicoplasty operation on a 1.5-year-old child in Russia was performed by Soloviev in 1976.Objective. To report the results of performing operations on replacement of ureteral defects by ureteral appendicoplasty in children.Materials & Methods. Between 2009 and 2023, a total of 11 surgeries were conducted to replace extended ureteral defects using the appendix technique in four clinics in Russia and the Republic of Belarus. The follow-up included six boys and five girls with an average age of 79 months (ranging from 18 months to 16 years). Six operations were performed by laparoscopic access (mean operative time 356 minutes). Five operations were performed by open access (mean operative time 257 minutes).Results. Long-term results were assessed between 18 and 192 months in all patients. Urinary tract patency was evaluated based on the results of micturition cystography (in one case, vesicoureteral reflux was recorded) and intravenous urography (one case of stenosis of the distal anastomosis, which was corrected by endoscopic dissection of the stricture site using a fiberoureteroscope). In patients who underwent renoscintigraphy, no progression of renal function decline was observed. In all patients, long-term follow-up showed satisfactory urine passage.Conclusion. The results of the surgical interventions performed by us are assessed as good. In all 11 cases, the replacement of the extended ureteral stricture using an appendix allowed for the restoration of urinary flow. Furthermore, any complications that arose did not necessitate repeated reconstruction of the urinary tract. Nevertheless, it is important to note that, in our opinion, this technique cannot be considered the method of choice. Rather, it represents a last resort for patients who have undergone multiple previous operations due to severe trauma or oncological diseases. In cases involving ureteral strictures, priority should always be given to an operation involving anastomosis with sufficient ureteral length and minimal tissue tension. We firmly believe that this approach offers the best chance for a successful outcome.

The founder of the Kazan neurological school, Professor L.O. Darkshevich and his influence on the development of neurology and neuromorphology in Yekaterinburg

The article is dedicated to a world-famous scientist, a major clinician, teacher and public figure, one of the founders of the Kazan neurological school, Professor Liverii Osipovich Darkshevich, who occupies a prominent place in the history of Russian medicine. July 17, 2023 marked the 165th anniversary of his birth. Liverii Osipovich was the chairman of the Kazan Society of Doctors and, together with Professor V.M. Bekhterev in 1893 participated in the creation of the society of neuropathologists and psychiatrists in Kazan. On his initiative, in 1901, the “Diary of the Society of Kazan Doctors” was reorganized into the monthly “Kazan Medical Journal”, and Liverii Osipovich became its first editor-in-chief. In Kazan, he organized the first clinic in Russia for people who abuse alcohol, where he often gave popular lectures. The article highlights the main stages of the life and work of Professor L.O. Darkshevich, his significant contribution to the development of neurology and neuromorphology, reflects his professional and personal qualities. The influence of this outstanding doctor and scientist on the development of neurology and neuromorphology in Yekaterinburg has been studied and shown.

Теоретические аспекты юридических клиник в России: история, теория, практика

в статье рассматривается современное развитие юридических клиник в Российской Федерации с точки зрения исторического аспекта. В ходе работы удалось проследить важность практического применения юридической клиники в стране, выявить преимущество реализации в ВУЗе, а также предложить дальнейшее совершенствование юридической клиники в рамках современности. Теоретический анализ исследуемой темы предоставил возможность систематизировать этапы развития юридической клиники, начиная с XIX века по сегодняшний день, указать на формирование первой юридической клиники в России, что повлияло на формирование последующих учреждений в стране. Недостатков в активной деятельности юридической клиники на территории России не было обнаружено. Цель настоящей работы – проанализировать теоретические аспекты юридических клиник в России: история, теория, практика. Методы исследования: анализ, синтез, обобщение полученных данных. the article determines the modern development of legal clinics in the Russian Federation from the point of view of the historical aspect. In the course of the work it was possible to trace the importance of the legal clinic`s practical application in the country, identify the advantage of implementation in a university, and also propose further improvement of the legal clinic within the framework of modern times. The theoretical analysis of the topic under study provided an opportunity to systematize the stages of the legal clinic`s development, from the 19th century to the present day, to point out the formation of the first legal clinic in Russia which influenced the formation of subsequent institutions in the country. No shortcomings were found in the active work of the legal clinic in Russia. The purpose of this work is to analyze the theoretical aspects of legal clinics in Russia: history, theory, practice. Research methods: analysis, synthesis, generalization of the data obtained.

Family, partnership, life satisfaction and well-being, emotional burnout and depression of employees of anesthesiology and intensive care departments: a multicenter anonymous observational trial

INTRODUCTION: Currently, emotional burnout and its predictors are insufficiently studied among the staff of the departments of anesthesiology and intensive care. At the same time, burnout is associated with a decrease in the quality of medical care, patient safety, as well as the quality of life of the doctors themselves. An anonymous study was conducted in hospitals and clinics in Russia. OBJECTIVE: To assess the level of life satisfaction, well-being, emotional burnout and depression of the staff of the departments of anesthesiology — intensive care. MATERIALS AND METHODS: Maslach Burnout Inventory, Projective psychological technique “unfinished sentences” (based on Sacks sentence completion test) — tested by G.G. Rumyantsev, Beck Hopelessness Inventory, Beck Depression Inventory, Satisfaction with Life Scale (E. Diener, R.A. Emmons, R.J. Larsen, S. Griffin). Brief Inventory of Thriving (BIT) (R. Su, L. Tay, E. Diener). RESULTS: The average level of life satisfaction of anesthesiologists was 14.7 points, which corresponds to the level of dissatisfaction, resuscitators and nurses had 19 points and 17.7 points, respectively — below the average level. Average and high levels of burnout in all three subscales had: 32.77 % of anesthesiologists, 52.26 % of resuscitators, 33.7 % of nurses. Depression symptoms varying degrees was detected in 83.62 % of anesthesiologists, 80 % of resuscitators and 51.7 % of nurses. CONCLUSIONS: It is necessary today not only to identify the first symptoms of burnout, but also to assess the level of satisfaction with the life and work of doctors, because they can directly affect the quality of medical care provided. It is probably that the even greater interest in the problem of doctor’s burnout and greater number of publications about this problem will become the element that encourages medical workers to seek psychological help.

About the choice of the path of development of domestic clinical medicine at the turn of the XIX–XX centuries and once again about the founders of scientific therapy in Russia. A.A. Ostroumov and V.P. Obraztsov

Based on the analysis of literary and archival sources, the authors revise the generally accepted position about three founders of the scientific therapeutic clinic in Russia and propose to consider it to be founded by four outstanding clinicians of the second half of the 19th – early 20th centuries – S.P. Botkin (Petersburg), G.A. Zakharyin and A.A. Ostroumov (Moscow) and V.P. Obraztsov (Kyiv).

Improving the work of the dental clinic by introducing an emergency dental care room

The organization and provision of dental medical care is one of the most important tasks in the field of occupational safety and human health today. Dental diseases occupy the first place in the frequency of occurrence in medical practice, both in our country and in other countries. The issue of access to acute dental care is an urgent task in our time. The structure of the organization of the work of dental clinics in Russia does not satisfy the need of patients to receive high-quality emergency dental care.
 Objective: To improve the work of the surgical department in the structure of the dental clinic.
 Materials and methods: The work of two shifts of the dental polyclinic of Moscow was considered. An additional office for emergency dental care was introduced in one of the shifts. The efficiency of a shift with an emergency dental care office and a shift without an emergency dental care office was considered.
 Results: The introduction of the office for emergency dental care into the structure of the dental clinic allowed to distribute the workload of dental surgeons and therapists.
 Conclusion: The effectiveness of medical work has increased in the shift with the office of emergency dental care, which is proved by the provision of more treatment assistance, as well as tooth extraction. During the shift, the number of completed complex treatment of patients increased during the six months of the duty office [15; 16].

The Barriers to the CLE Practice in Russia, in Comparison Light with the European Union and the United Kingdom

Clinical legal education (CLE) is commonly used to refer to a law teaching method that incorporates experiential learning aimed at development of students’ legal knowledge and skills. At the same time, CLE also has social justice mission as it serves the needs of vulnerable members of society. Like any other teaching methods, CLE requires a specific environment and factors to be in place to embrace its mission at maximum level and to allow its learners to reach pre-defined learning outcomes. While researching in three Western European university legal clinics, and then studying the legal clinics in Russia, I have reached the conclusion that CLE in Russia cannot fully exploit its mission and reach its objectives. While some barriers that prevent Russian universities to effectively run CLE are obvious, there are also the ones which will be new to a reader. Below I discuss the factors that could be considered as barriers preventing CLE practice in Russia to be effective in driving for its mission and goals, both from educational and social justice perspectives.

Enhanced recovery after spine surgery: state of the art in the Russian Federation

Objective. To analyze the attitude of neurosurgeons to the technology of enhanced recovery after spine and spinal cord surgery in the Russian Federation.Material and Methods. In March 2022, a continuous cohort comparative sociological study was conducted among 83 neurosurgeons of the Russian Federation, during which they were asked to fill out a specially designed online questionnaire consisting of 22 questions on the Google Forms platform.Results. The vast majority of respondents (95.2 %) noted the lack of information in the Russian literature on the technology of enhanced recovery after surgery (ERAS). Nevertheless, most neurosurgeons, regardless of specialization, are familiar with the terms “fast track” (79.5 %) and “ERAS” (60.2 %). Only 44.6 % of specialists declared the implementation of ERAS recommendations into their daily clinical practice, while 78.3 % of neurosurgeons draw attention to the existence of problems that hamper adoption of enhanced recovery protocols (ERP) in Russia. The interviewed respondents are confident that it is possible to introduce ERP into spinal neurosurgery in adults (91.6 %) and children (85.5 %) in Russia. Every second respondent (50.6 %) considers it possible to directly extrapolate foreign ERP into clinical practice in Russian healthcare. Spinal neurosurgeons are more aware of ERAS than cerebral neurosurgeons (p = 0.017), and they also more often use elements of ERAS in their clinical practice (p = 0.002). In other parameters, the respondents did not differ significantly depending on their specialization. Only 7.2 % of interviewed neurosurgeons work in private clinics. All of them are engaged in spinal surgery and introduce the ERAS technology into their clinical practice. Less than half (40.0 %) of neurosurgeons in public clinics implement elements of the ERAS (p = 0.007). More than half (69.7 %) of specialists and every second manager consider the introduction of ERAS in a neurosurgical clinic to be progressive, and only a few of them (3.6 %), on the contrary, believe that the quality of medical care may decrease with the introduction of ERAS. Neurosurgeons (n = 13) identified 7 clinics of the Russian Federation, where the enhanced recovery protocol after spine surgery is implemented. In total, according to the results of the study, 23 elements of the ERAS protocol are implemented in the practice of respondents (n = 20) in the conditions of Russian healthcare.Conclusions. Despite the lack of publications in the Russian literature and the existing organizational problems in the context of domestic healthcare, neurosurgeons have a positive attitude towards the introduction of ERAS protocol into clinical practice. This protocol or its individual elements are already successfully implemented in a group of clinics in Russia.

The concept of lean manufacturing in the management of a medical clinic. How to beat the competition through lean manufacturing

The introduction of the concept of lean manufacturing in a medical clinic allows you to quickly achieve a strong competitive advantage by increasing the efficiency of resource management, including reducing labor costs, the efficiency of space and capacity, downtime to normalized KPIs, increase overall customer satisfaction and loyalty (NPS). The introduction of the lean manufacturing concept at the first stage does not require significant organizational efforts or investments. But it allows you to achieve results due to industry novelty: so far, SMEs and large clinics in Russia are not seriously engaged in studying and debugging life cycles, limiting themselves to individual sections, for example, promotion.

The State of Hip Arthroscopy in Russia: Assessment Based on a Sociological Survey of Doctors

Background. Hip arthroscopy is a minimally invasive surgical technique most commonly performed to correct femoroacetabular impingement (FAI). Currently, it is widely used by worldwide; in addition, there are a significant number of english-language publications on this topic. The number of hip arthroscopy performed in Russia is unknown. Information about this surgical technique is also very limited in our country.
 The aim of the study was to assess the level of hip arthroscopy in Russia.
 Methods. A total sociological survey of orthopaedic surgeon with experience in performing hip arthroscopy was conducted. The questionnaire was posted on the Google Forms platform and consisted of 13 questions of closed, semi-closed and open types. The survey included 54 surgeons from Russian clinics, 45 people filled out the questionnaire.
 Results. Among the respondents, doctors with experience in performing arthroscopic operations on the knee and shoulder joints predominated (100.000.00% and 93.300.03%, respectively). The majority of specialists (73.300.06%) were trained in hip arthroscopy during the primary course in one of the clinics in Russia. More than half of the respondents (68.800.06%) are currently engaged in this surgical area, however, in 45.160.07% of them, the number of operations does not exceed 5 per year. For surgeons who have completed two or more training courses, the volume of operations performed is higher (p0.05); 51.110.07% of doctors perform arthroscopy using an alternative technique. There are 2.5 time more specialists doing just bone resection, than surgeons who apply any kind of reconstruction technique while treating FAI (p0.05). Fifteen respondents (48.390.08%) perform debridement as an attempt to delay arthroplasty. The most common difficulties faced by surgeon are problems with the diagnosis of FAI (no patients) (40.000.02%), lack of the necessary tools (40.000.02%) and sufficient time to master the technique (33.300.07%). Only three (6.600.07%) respondents believe that they manage to achieve the planned results of the operation, 93.300.03% of surgeons said that it is not always possible to achieve the desired outcomes.
 Conclusion. Hip arthroscopy in Russia is not very common, the volume of such interventions is insignificant. Doctors with minimal skills in arthroscopic hip surgery predominate. Factors that impede the development of this area in our country are related to teaching methods, problems with FAI diagnostics, the lack of necessary instruments for performing operations, and the lack of time for specialists to master surgical techniques.

Improving the organizational structure of the population prevention in the megapolis

Highlights. A comparative analysis of the morbidity rate in the population in Moscow, the Central Federal District and the Russian Federation for the period from 2012 to 2019 depending on the age groups was carried out; performance of the Center for Prevention and Health Centers in Moscow and in its administrative districts was assessed; suggestions for improving the organizational structure of the population prevention in the megapolis were made.Aim. To analyze and assess the organizational structure of population prevention in Moscow, and to suggest proposals for its improvement.Methods. The data of the Ministry of Health of Russian Federation on the morbidity rate in the (general) population in Moscow, the Central Federal District and the Russian Federation, by age groups of the population was analyzed. The analysis and assessment of the performance was done for the following entities carrying out preventive programs in Moscow: the Center for Prevention (CP), 58 departments and 224 offices for prevention, 62 Health Centers (HC) and the performance of youth-friendly clinics in the Russian Federation. We used statistical, sociological, analytical research methods for the analysis.Results. Total morbidity rate in the population of Moscow (2019) was lower than in the Central Federal District and in the Russian Federation, it amounted to 140,743.0 per 100 thousand of the population, in the Central Federal District it was 149701.0‰оо, and in the Russian Federation it was 164899.4‰оо.At the same time, total morbidity rate in children aged 14 years old in Moscow was higher than in the Russian Federation and in the Central Federal District; it amounted to 222946.1 per 100 thousand of the corresponding population, in the Russian Federation it was 219845.6‰оо, and the Central Federal District it was 211643.2‰оо. The analysis of total morbidity in children in Moscow by classes of diseases is given. The article analyzes the performance of CP and HC in Moscow and output of youth-friendly clinics in Russia. Suggestions for improving the organizational structure of the population prevention in the megapolis were made.Conclusion. Total morbidity rate in the population in Moscow is lower than in the Central Federal District and the Russian Federation, however, the rates in children are higher than in the Russian Federation for a number of diseases. The results obtained should be taken into account in the development of the population-based prevention strategies for children. Based on the results of the study, it can be concluded that the Center and departments for prevention in Moscow are subject to reorganization; additional duties and responsibilities should be introduced and existing ones should be adjusted. It is necessary to organize the continuity and coordination in care provided by the CP, HC and primary health care physicians. It is recommended to create more youth-friendly clinics in the Russian Federation, in particular, in Moscow.

Perception of the organization's safety culture by medical staff in Germany and Russia

Purpose of the study. To compare the perception of the safety culture of the organisation by medical staff in Germany and Russia.Materials and methods. In the study carried out in Germany (Bohmann F. O. et al.), the original Safety Attitudes Questionnaire (SAQ), was used. The Russian sample, an adapted and validated Russian-language version of the questionnaire was used (Tsaranov, K.N. et al.).Results. According to the indicator "Experience of work" among German medical workers, the results of the questionnaire showed higher results for all of the studied indicators except "Stress recognition" in the group of medics with more than 5 years of work experience. Among Russian medics higher results were observed in the group of respondents with less than 5 years of work experience except for the "Perceptions of management".For the indicator "professional position" among medics in Germany, the results of the questionnaire showed higher results for all of the studied indicators in the group of medics who occupy the professional position of "physician". In Russia nursing staff score higher on the "Working conditions" factor, while physicians score higher on "Teamwork climate", "Safety climate" and "Stress recognition", showed a coincidence of results on "Job satisfaction" and "Perceptions of management" scales.The neuroradiology department scores higher than the neurology department of German clinics on the factors "Teamwork climate", "Safety climate", "Job satisfaction" and "Working conditions". The coincidence with the results of the mean values in both groups is observed for the factor "Perceptions of management". Russia has the highest scores for most of the factors: "Safety climate", "Job satisfaction", "Perceptions of management" and "Working conditions" were shown by the staff in the reception and diagnostic department. Low scores were found for the factors "Teamwork climate" and "Safety climate" among staff in the infectious diseases department, and "Stress recognition" in the intensive care and combustiology departments.Conclusion. Significant differences were revealed according to the indices "length of professional experience", "professional position" and "department of work" among employees of medical clinics in Russia and Germany. The results enable the identification of target points for the design of a medical organisation development program aimed at increasing the level of evaluation of the safety culture of a medical organisation.

Foundation and development of the oldest orthopedic department and clinic of Russia

Issues of the foundation and development of scientific schools, medical specialties, departments, and clinics of the Military Medical Academy of S.M. Kirov, as well as their succession, remain largely debatable to this day. Moreover, their study appears to be extremely interesting when understanding the processes underlying the differentiation of the fundamental sections of medicine, formation of new areas of surgery, and their evolution to the state of independent surgical specialties. Several archival documents, reports, historical essays on the departments of desmurgy and mechanurgy, orthopedics, military field surgery, desmurgy and orthopedics, orthopedics and traumatology, and traumatology and orthopedics are analyzed. The origins of the formation and stages of transformation of the modern department of military traumatology and orthopedics are traced. Scientific orthopedics in Russia was started at the end of the 18th century in the bowels of the fundamental surgical departments of the Imperial Medical and Surgical Academy. On March 7, 1836, by the resolution of the conference of the Academy, the Department of Surgery was divided into the Department of General and Private Surgery with theoretical oculistics and the Department of Operative Surgery and Oculistics, Desmurgy and Mechanurgy, and Surgery on troupes. On February 20, 1888, an independent department of desmurgy and mechanurgy was established at the Academy. On March 24, 1900 (April 6, O.S.), based on Order No. 301 of the Minister of War of October 29, 1899, the Academy Conference decided to create the Orthopedic Clinic headed by Professor G.I. Turner, and the date mentioned went down in history as the birthday of the first orthopedic chair and clinic in Russia. From August 21, 1924, to August 8, 1931, it was renamed the Department of Military Field Surgery, Desmurgy and Orthopedics (Order no. 205 of August 9, 1924, by the Military Sanitary Department), and the reading of this subject was assigned to the senior assistant of the department E.Yu. Osten-Sacken who prepared the corresponding programs. From August 8, 1931, the department and the clinic reverted to their former name the Department and Clinic of Orthopedics, and Professor V.A. Oppel headed already an independent, established based on the Decree of the Union of Soviet Socialist Republics Revolutionary Military Council of April 2, 1931, the Department of Military Field Surgery. In 1955, the Department of Orthopedics was renamed the Department of Orthopedics and Traumatology (Directive of the Chief of Staff of the Army No. OSN 5/1367869 of November 28, 1955), and in 1960, due to the pronounced traumatological orientation in educational and clinical work, to the Department of Traumatology and Orthopedics (Directive of the Chief of the Union of Soviet Socialist Republics Defense Ministry No. ST/2/711247 of June 4, 1960). In 1974 the department was renamed Military Traumatology and Orthopedics Department (Directive No. 158/0267 of the Headquarters of the Union of Soviet Socialist Republics Armed Forces Rear No. 158/0267 of February 15, 1974). Based on the analysis, it appears reasonable to offer readers a view of the prehistory of the origin, continuity, and development of the specialty traumatology and orthopedics at the Military Medical Academy of S.M. Kirov.

Fyodor Ivanovich INOZEMTSEV - Professor, founder of the Moscow Society of Russian Doctors. To the 220th of birthday

Fyodor Inozemtsev was born on February 24, 1802 in the family of a manor manager in the village of Belkino, Kaluga province. In 1814, after the death of his father, F.I. Inozemtsev moved to his older brother, a student of the medical faculty of Kharkiv University, Egor. At the age of 12, Fyodor studied first at a college, then at a gymnasium, and after completing preparatory courses, he entered the verbal faculty of Kharkiv University to study at the state expense, although he initially aspired to the medical faculty. Protesting against studying at the Faculty of Words, he skips classes, becomes the "first hooligan" and for re-education is sent as a history teacher to the Kursk province, where he also teaches arithmetic, geometry and German. In 1826, F.I. Inozemtsev was already studying medicine at the 2nd year of Kharkov, and after that - Dorpat University. A good knowledge of the German language in which the teaching is conducted distinguishes him from other students. The famous surgeon Nikolai Yellinsky, considering that F.I. Inozemtsev has an unconditional "operator talent" already in the 3rd year allows him to perform his first operation - amputation of the lower leg. In 1833, Fyodor Ivanovich defended his doctoral dissertation and went on an internship abroad. Since 1835, F.I. Inozemtsev has been an extraordinary, and in 1937 an ordinary professor of surgery at Moscow University. In 1839-1840 F.I. Inozemtsev studied medicine in Germany, France, Italy, after which he created his own free clinic. He was one of the reformers of the educational system (1840-1860): he prepared a new modern training program for practical surgery (1850), was one of the first in the country to lecture on topographic anatomy; developed a course of eye diseases; created the first faculty surgical clinic in Russia at Moscow University (1846). Fedor Inozemtsev was a very popular doctor, who treated over 6 thousand patients a year. F.I. Inozemtsev performed the operation under general ether anesthesia for the first time in the country; Russian Russian doctor proposed to use a setting for treatment, the recipe of which has been used for more than 100 years; was the organizer of the Congress of Russian doctors, the founder of the Society of Russian Doctors in Moscow (1861); created the Moscow Medical Newspaper (1858-1878). Fyodor Ivanovich advocated that the surgeon should be a therapist at the same time. F.I. Inozemtsev author of 3-x monographs and 33 scientific articles, the founder of the medical school, whose prominent representatives were I.M. Sechenov, S.P. Botkin, G. A. Zakharin, N.V. Sklifosovsky and others. Inozemtsev was awarded the rank of state councilor with seniority, the Orders of St. Anna of the 2nd and 3rd degrees, St. Stanislav of the 2nd degree. In 1859, F.I. Inozemtsev retired due to deteriorating health, but in 1864 he was elected an honorary member of Moscow University. F.I. Inozemtsev died on August 6, 1869 and was buried in the famous cemetery of the Donskoy Monastery. The historian Pyotr Ivanovich Bartenev wrote about Fyodor Ivanovich: "A useful professor, a skilled doctor, a well-meaning citizen, a kind man, an ever-memorable friend of mankind."

Organization of the Space of the First Maternity Clinics in Russia (XVIII – beginning of the XX centuries)

Organization of the Space of the First Maternity Clinics in Russia (XVIII – beginning of the XX centuries)

Analysis of the activities of the largest medical clinics in Russia

Analysis of the activities of the largest medical clinics in Russia

Legislative regulation of legal clinics in Russia

Legislative regulation of legal clinics in Russia

The renaissance of barrier contraception (based on the data from an international clinical trial)

Background. In recent years, interest in the use of barrier methods of contraception has increased, since many women prefer them in connection with the change in the epidemiological situation associated with COVID-19, with contraindications to other methods of contraception, as well as with irregular sex life and casual sexual intercourse. In addition, these methods of contraception are preferred for breastfeeding mothers and pre- and postmenopausal women. Studies of the efficacy of spermicidal agents in late reproductive age women have not previously been carried out, although their use in this population is of particular interest, since these agents do not have a systemic effect and, if used correctly, can prevent unwanted pregnancies. The article presents data from an international French-Russian study of the efficacy of spermicides containing benzalkonium chloride in late reproductive age women (over 40 years). The study was carried out on the basis of 7 private offices of obstetricians and gynecologists in France and 6 obstetric and gynecological clinics in Russia.
 Aim. Assessment of the contraceptive efficacy, safety and acceptability of a cream containing benzalkonium chloride in women over 40 years of age.
 Materials and methods. The study included non-pregnant women aged 40 and over who had at least 1 menstrual period in the past 3 months and who would like to use spermicides as contraception for at least 6 months. After a 6-month period of mandatory use of spermicide, patients could, if desired, continue to use it for the next 6 months. All women were given Pharmatex (1.2%), a vaginal cream containing benzalkonium chloride (1.2 g per 100 g of cream) as the active ingredient, 1 standard dose before each intercourse. The primary endpoint was the Pearl Index. The acceptability of the method after each use of the cream, the moisturizing effect, and the woman's and researcher's overall satisfaction with this method of contraception were also assessed. Safety was assessed using adverse event monitoring.
 Results. An analysis of efficacy of the study drug showed that during study, pregnancy did not occur in any of the women. Pearl Index for 12 months was 0. Over the mandatory 6-month period, the use of Pharmatex cream was assessed by patients as acceptable (to some extent acceptable, acceptable, completely acceptable) in 98% of sexual intercourse, and over the 12-month period in 98.6% of intercourse. The moisturizing effect of the cream was noted by 96.1% of women. In 6 months of the use of Pharmatex cream, overall satisfaction was rated as quite good, good, or very good by 99.3% of patients and in 12 months by 100% of patients. Adverse events were noted only in 0.5% of cases. Most of these events were assessed as unrelated to the study drug.
 Conclusion. The use of a benzalkonium chloride spermicidal cream can be considered an effective and acceptable method of contraception for women over the age of 40. It is well tolerated, has a moisturizing effect on the vaginal mucosa, and meets the needs and lifestyle of women. The contraceptive with benzalkonium chloride has a favorable safety profile: it does not adversely affect the normal flora of the vagina, can be used during breastfeeding, since it does not penetrate into the vascular bed and doesnt have systemic effects.

Director of the Faculty Therapeutic Clinic Nikolay Fedorovich Golubov: Scientific Activity, Last Years of Life and Finding of the Lost Grave (by the 165th Anniversary from Birthday)

September, 2021 marks the 175th anniversary of the opening of the Faculty Therapeutic Clinic (FTC) of the Imperial Moscow University, which is a successor of the First (1805) and Second (1820) Clinical Institutes with their therapeutic beds and chairs, and thus is the oldest therapeutic clinic in Russia. From 1930 the Clinic became part of the newly formed I.M. Sechenov First Moscow Medical Institute (now Sechenov University) and retains continuity to the present day. This publication is one of three research articles prepared by the staff of the Clinic for the anniversary and devoted to little-known pages of biography and scientific activities of the three heads of the FTC at the crucial stages of its history – A.I. Over, G.A. Zakharyin and the last prerevolutionary director – N.F. Golubov.

Diagnosis and treatment of lobar pneumonia in the pre-antibiotic era Anton Chekhov's medical report (1883)

In the late 19th century, pneumonia was one of the leading causes of death in Europe and the USA. Although at this time doctors knew about the infectious cause of pneumonia, they were not able to offer patients specific antimicrobial therapy. In the current paper, we translated into English for the first time and analyzed the almost forgotten medical report of a pneumonic patient written by the famous Russian writer and physician Anton Chekhov (1860–1904), which describes the classic stages of lobar pneumonia, now no longer observed in clinical practice due to antibacterial treatment. Despite the limited capabilities of lung disease diagnosis compared to the possibilities of modern medicine, physicians were able to diagnose lobar pneumonia using techniques of percussion and auscultation. Therapy in this case was limited to diet and symptomatic treatment and could only relieve some of the symptoms. This case history shows that in the early 1880s, in the one of the leading university clinics in Russia, despite the transition from humoral theory and ideas of natural philosophy to the concept of cellular pathology, there were still contradictory trends in the treatment of diseases.