in fact, the poles started this next uprising, one of the arguments that was, it is unsettled in russia now, well, this is natural, great reforms have begun there, they cannot contribute to stability, we must take advantage of this, therefore, in general , this struggle of such, a counter political game, the poles hoped that the great reforms would help them...

very many countries there, spain, sweden, italy, the netherlands, portugal, even turkey, so they avoided participating, in fact, in this onslaught, only belgium and switzerland, referring to their neutrality, and it seemed that, in general, another armada could come to the territory of russia most of the concessions that european countries offered to make to the poles, formally did not at all contradict the plans.

all this is very serious it is necessary to stop feeding this movement, first of all by the french and the english. this is a historical podcast russia-west on the swings of history, we continue the conversation about the brilliant diplomat alexander gorchakov. i am not even saying that all the arguments that the russian foreign ministry used during this period.

gorchakov continued to try to balance these imbalances of power in europe, in 1872-73 , on his initiative, well, including on his initiative, an alliance of three emperors was concluded, between the german emperor, the austrian and russian emperors, and there these emperors of austria and prussia visited st. petersburg, then returned visits were made, but this alliance turned out to be short-lived, the thing is... that in 1875 otto

von bismarck decided that it was time to finish off france, there had already been a successful war, france was humiliated, france was almost knocked out completely from the concert of the great powers, after. a shameful defeat, the capture of the emperor, the emperor accordingly died, in france there was a revolution, the paris commune, bismack decided that france was now weak, alone, no one would stand up for it, it was possible to finish it off in order to achieve hegemony in fact in central, in western europe, germany, a united germany, austria at that time was already actually such a tail of the german empire, which followed the course that set the german empire, their forces were incommensurate after the defeat. and austria from prussia during the wars for the unification of the german state. and here is gorchakov. gorchakov, in fact, uh, he did not issue ultimatums, but he made it very clear, to bismarck, made it clear to germany that russia was ready to stand up for france, despite the negative policy of

france towards russia at different stages of their coexistence in the 19th century. and bismarck retreated. and he did not forgive gorchakov and russia for this. he did not forgive, no. of course. it is enough to read his memoirs. bismarck's most interesting memoirs, brilliantly written, but he there in places, just when he writes about gorchakov and russia, he simply contradicts himself, of course, he had the opportunity to take revenge. the fact is that gorchakov objected to the russo-turkish war of 7-78. he believed that russia did not have enough strength, that russia, in this sense, violated the established parity in europe, that the strengthening of russia by seizing turkish possessions would not be allowed by the great powers. and accordingly, it is not worth getting involved in this war, in russia at that time there was a very strong patriotic upsurge, a wide variety of people, just the slavophiles are set, what did you talk about, yes, you talked about the need to support the slavic brothers, the bulgarian brothers there and so on and so forth, in the end, not immediately, alexander ii

hesitated for a long time, but in the end he decided, and despite the skepticism of even the minister of war dmitry milyutin, russia entered this war, the war was expensive, 250,000 russian soldiers, of which... only 50,000 died from bullets, bayonets, saber strikes, and 2,000 died from difficult conditions, from illness, from the cold, the famous shipka seat and so on. after that, russia concludes the san stefano treaty. according to the san stefano treaty, serbia-black is independent, bulgaria is effectively independent, well, has a very broad autonomy, pays a symbolic tribute to turkey. in fact , things were also moving towards the independence of romania. turkey was losing territory in... in europe was almost losing territory in europe, in general, russian troops did not enter constantinople, as it was then called in russia, or istanbul, only because england and france, first of all england, spoke out sharply against it, brought in their fleet accordingly, actually brought to the place of military operations, and in order not to

quarrel with these powers, russia, accordingly constantinople, istanbul did not capture, although the opportunities for this were already there, not just opportunities, with difficulty it was not captured, they grabbed at every bush, so that ... yes, the turks fled so much that after the san stefano peace russia was forced again by a concert of great powers, again as then in crimea, again because of turkey, and gorchakov warned, united against russia and the conditions of the san stefano peace were considered preliminary and gathered berlin congress. as a result, the territory of bulgaria was cut in half, and divided into three parts: one autonomy, broad autonomy. from turkey, the other part of eastern rumelia - a principality under the protection of turkey and the third part of macedonia remains with turkey, they cut the territories so that the bulgarian territories became part of romania a little, part of serbia, which then laid the foundations of the balkan wars, turkey

retained a number of possessions, including albania, in general, such a caressing story was made, which then made, yes to russia sharply reduced the contribution, and russia was forced to give up a number of territories in transcaucasia, gorchakov was then at the berlin congress, but he was 82 years old, bismarck was younger, bismarck pretended that he was an honest broker, an honest intermediary, in fact, he played, of course, on the side of england and france, in order to take revenge on russia for the seventy-fifth year and in order to prevent russia from becoming significantly stronger, therefore this mine, accordingly, under the future european peace was set, because it is from the balkan question that follows in to a large extent the first world war. chakov outlived all his fellow students at the lyceum, we started with the lyceum, we can finish with the lyceum, here pushkin, one can say, it turned out that he wrote lines that just

concern gorchakov directly, he was the last of the graduates of the tsarskoye selo lyceum, here pushkin wrote: who of us in old age will have to celebrate the day of the lyceum alone, an unfortunate friend, among new generations, a tiresome guest and superfluous. and a stranger, he will remember us and the days of unions, closing his eyes with a precious hand, but absolutely directly, no one knew that gorchakov would be the last, but he turned out to be the last, i think that, closing his eyes with a trembling hand, old man gorchakov, already retired, recalling past affairs, i think that he... honestly admitted to himself those mistakes that also happened, but at the same time, i think, he could console himself, also quite

rightly, by the fact that he made foreign policy more russian and more patriotic, in fact, this is how he will remain in our history, i agree, and here , finishing, one can quote the very gorchakov, he recalled, i was the first in my dispatches to use the expression sovereign and russia, before me... on the swings of history you can watch on the website of the first channel.

hello, this is the baden baden podcast and i am its host konstantin severinov. today we will talk about antibiotics and we will talk with sergei vasilyevich tsarenko, the chief resuscitator. these are prokaryotes, bacteria, antibiotics are against them, although in general there are antibiotics and antitumor agents, but mainly against

bacteria, who produces them, these are chemists made, where do these substances come from, well, to begin with, actually, they were found in nature, this is a way for bacteria to coexist with each other, some bacteria produce antibiotics to drive other bacteria out of their habitats, a fight for food, for a place to live, and so on, and what do medicines have to do with it, we also have microbes on us, inside us, and we also have antibiotics inside us, well , our bacteria also produce them, but actually, the most powerful antibiotics, of course, our bacteria do not produce, which live in us, basically they are antibiotics produced by bacteria living in the soil, accordingly they are found there, after that there are two options for them... and these are some kind of factories

, microbiological industry or chemical factory, which makes a substance, this is some kind of molecule, but this is a molecule, yes, you are a resuscitator, you encounter antibiotics in your medical work, this is generally one of the main points of attention, as a resuscitator. mine, because without antibiotics modern resuscitation will die, we use antibiotics in several situations: the first is a prophylactic prescription of an antibiotic, for example, a patient goes for a planned surgical operation, this is accompanied by a skin incision before the surgical intervention, therefore, preoperative prophylaxis with antibiotics exists as a reasonable measure to reduce potential, but this is in hospitals, that is, this. as i understand it, they are not taken prophylactically at home, no, this concerns a specific surgical intervention,

and this antibiotic is administered there half an hour before the operation with the expectation that it will only work for the duration of the surgical intervention, this is a single administration, this is a single or, in extreme cases, a double administration during the operation, it is repeated again if the operation is long, and if the antibiotic does not work, then what, and if one antibiotic does not work, then some inflammatory... we can select for a long time, because we live in the era of multiresistant bacteria, this means that bacteria have multiple resistance to different groups of antibacterial drugs, therefore here is such a selection, as i said, it is of course not so blind, they simply prescribed one, threw out another, it is selected based on the results of certain bacteriological studies, but nevertheless

the number of antibiotics that we can use in our clinical practice is now very limited, and for some reason... as i understand it, well, there are a lot of microbes around us, give, and you said that they communicate with each other with the help of antibiotics, it's just that microbes in general have come up with few antibiotics, four or five pieces, microbes have come up with many antibiotics, the topic of creating an antibiotic turned out to be very economically inexpedient, unfortunately, this topic was already heard before the pandemic, the idea of ​​​​what kind of pharmaceutical company that develops antibiotics...

options for bringing the drug to the market, they carry a lot of restrictions, this is very reasonable, since this is a way to protect the patient from some unwanted side effects, everything must be studied in sufficient detail, the moment when the company finally went through this thorny path, a lot of money was spent, antibiotics are released into wide clinical practice, unfortunately, bacteria that live much longer than you and me... longer, yes, in terms of time, i mean in the evolutionary sense, they appeared much earlier, in fact, they are the main inhabitants of our extra-planet, and not you and me, as we think, although we call ourselves kings there, in general, kings are bacteria, in fact, they have many mechanisms to interfere, and what does this mean, you

say that development is underway, scientists the company made an antibiotic,

but we are forced to take into account the fact that these antibiotics must appear on the market, so the company that brings it to the market must spend this money, and accordingly, when the antibiotic stops functioning after 2-3 years, it turns out that the money is thrown away, well, not to the wind, but in any case it is not very profitable compared to the fact that, for example, a company took

and released a drug that lowers blood pressure, what you are saying sounds terrible, not all antibiotics stop.

a giant dose of antibiotic, it will be simply toxic, so i work with those doses that are non-toxic for it. in these conditions there is always a possibility, unfortunately, this is a biological law, that some bacterial cell will show resistance, wants to live and will give offspring that will be resistant to this antibiotic. another question is that if the patient is not very seriously ill, then he begins to recover, he has enough strength to cope with the infection. well, relatively speaking, on his own, and the need for a change there is no antibiotic, but in cases of severe patients, complex ones, well, the same covid patients, and they were on artificial

ventilation of the lungs due to severe viral damage to the lungs, they had an intubation tube through which bacteria entered from the external environment, and we could not wean them off artificial ventilation of the lungs, because they did not have enough of their own reserves, so during the treatment he recovered, but with... and the lung damage was high enough that i could wean him off artificial ventilation of the lungs, accordingly, he developed a new wave of bacterial infection, these waves, they eventually overwhelmed him and the person died. we watch the baden badon podcast, i am its host, konstantin severinov, we talk about antibiotics resistant to antibiotics, bacteria with sergei vasilyevich tsarenko. chief resuscitator of the ministry of health of the russian federation, this is what you are describing, it feels like the game over is coming soon, the game will end, yes, if there are no new ones, that is, little by little all the bacteria in the

scenario that you are describing should become resistant, insofar as we use antibiotics, you use antibiotics, doctors, yes, and, insofar as antibiotic-resistant microbes arise, that's right, and then it should end soon, yes, and that's very sad.

from the market from this, but it means that they have these antibiotics, they just it means that they find it economically inappropriate to develop them, to develop - it means to look for new ones, to look for new ones, yes, for which there is no resistance, for which there is no resistance yet, but this is such a bad infinity, but you will find what you described, this means that you will find a new one, but in 2-3 years you will have to introduce a new one again, yes, that's absolutely right, in this bad infinity you just need to live for some time, because you need to be sick with something...

the planet is inhabited by settlers, and the longer they live there, the harder it is for them to live, because they are defending themselves from the planet, and the more actively they defend themselves from it, the more means it invents... which you mentioned, is not at all interested in going to the morgue together with patient, she would also live and live, you understand, therefore, from the fact that she took and killed the patient and she was buried in the grip. earth, this

is not good for her, this is also evolutionarily wrong for her, that's why, since a microorganism can be alive, but at the same time not emit pathogenicity factors that kill the macroorganism, that is, a person, then a theoretically achievable story, it is generally not fantasy, when a conditional pseudomonas aeruginosa gets along with a patient, they exist perfectly, he lives with her, walks safely. she with him, well, we have on the surface it is a skin bacterium, yes, in the lungs, as far as i understand, it is usually there, that is, in principle, we always have it, yes, in this sense we already coexist with it, which means that somehow we need to understand why at one moment it gets out of control and we begin to strangle it with antibiotics, at that moment it is some kind of indomitable planet that produces an even more powerful means of attack, as a result, everyone dies together and she is the patient, well, that is, this is my personal relationship with

my personal microbes, when i am treated... they become resistant, or i also pass them on to everyone else, and you also pass them on to everyone else, because firstly, well, i don’t know, you cough, grab something with your hands, then this one can take, that is , antibiotic resistance is contagious, yes , bacteria have actually learned to interact with each other in such a way that in some cases they simply in their ability to be resistant to antibiotics, simply pass them on to each other, there is such a structure.

nevertheless, we exchanged a trailer, everything at home , we have this pseudomonas aeruginosa resistant to antibiotic, and you have clepsyella, no question, but how do you, you said that when a serious patient comes to you, you, well, i don’t want to say, i hope that it’s not at random, but you take the first antibiotics, try them, then how do you know what to take from the four antibiotics that you have in your arsenal? there are several points here, the first point, of course, is ideal, i must get that... bacterium, which, in fact, causes uh from a specific patient, so i get the bacterium, i in a certain way i research in the bacteriological laboratory and test for sensitivity to antibiotics, so i tested it and realized that at this time he is lying in your intensive care unit, he should lie down for some time, but you understand from the essence of the explanation that he may not be there for some time, he is severe, he

is getting worse, and there is such a rule, the later you prescribe effective antibiotics, the worse the results, well, it is also obvious that the bacteria did not get in the first time, only on the fourth time, yes, the chances are much worse, therefore, to unfortunately, we have to work in this zone of uncertainty, and well, and then it turns on, well, i would say, excuse me, common sense, common sense says that a patient admitted, for example, from home with bacterial pneumonia, that most likely there is pneumococcus. some specific because i don’t have time to wait, it’s not for nothing that he is on antibiotics, and i prescribe these antibiotics, he came to me in intensive care, he is already so bad that he already needs to be treated in the intensive care unit, i expect that according to the results of my colleagues who are researching these topics, i don’t know, in the population, these are microbiologists, this is some kind of microbiological service that looks at

who has what. yes, who, what of us, and in specific regions there is a different picture, sensitivity to antibiotics, accordingly, these are people who come directly, no one has ever approached me with an offer to donate microbes, or it’s just when we take some tests, of course, tests are taken, well, this one, again, this patient was admitted, yes, i got from him, before prescribing antibiotics, i got from him some biological environment, or he spat phlegm into a petri dish.

and this was an idea, it actually, at first seemed to them to be common sense, common sense suggested that - a viral infection cannot but weaken the human body, if it weakens the human body, then the bacteria living in us or present in the environment will attack these affected lungs in this context, there will be a terrible bacterial pneumonia, from which the patient will die, therefore, in order to... in order to prevent this from happening, you need to give him an antibiotic, well for example, the widespread use of azitermetsin during the pandemic led to the fact that at one time it was not even enough in pharmacies , it was necessary to find aptekh, well, fortunately, in our

country it was more lacking than, for example, in some china, this is good, this turned out to be good, thank god, because now this mycoplasma pneumonia, which, for example, now they write a lot about chinese, it is also a bacterium, only it is so peculiar, it is mycoplasma, in china will it... drive you in this way? no, well, it will not drive you to the grave, well, if something else happens later, i'll end up in intensive care, strategically it's not the right decision, tactically it won't kill you, it won't drive you into a coffin, but strategically it's wrong, strategically it's wrong to drink antibiotics, to drink

antibiotics for a viral infection, yes, but you can buy antibiotics in pharmacies without a prescription, yes, these are now so furtively, is he just a kind person or she is a kind person or is this a violation of the law or i just went through a lot. in fact, of course, this is not good, that is, he is bringing us all under the monastery, thereby, well, a pharmacist, who does this, yes, unfortunately, yes, it is an unpopular measure, but uh, without strict prescription control, prescription of antibiotics we will not go anywhere, look, as a doctor i will only suffer from this, because i am a resuscitation specialist, i, i do not work in a clinic, i do not have prescription forms, i know when i personally need an antibiotic, when i do not need it, but... i am glad because we still and even i could not buy it without a prescription at the pharmacy, that is, you are for greater regulation of this entire area, absolutely definitely, antibiotics absolutely definitely need regulation, strict regulation, but how about, you know,

there is labeling on food, on meat, yes, that it was grown without antibiotics, as i understand it, that many of the agricultural products that we eat are grown, i don’t know, maybe the cows get sick or something else, there are antibiotics there too. this is generally a sad story, actually, over-the-counter sale of antibiotics in pharmacies is such a small fraction that contributes to the resistance of bacteria to antibiotics, the main thing is of course agriculture, but they they get sick because they are not only sick animals chickens get sick or whoever gets sick they are not about diseases even actually antibiotics - it was our american partners who at one time found this beautiful idea, if you inject antibiotics into a cow it will gain weight faster, that is meat, again the economy, meat will be cheaper, then, probably, meat becomes cheaper, there is more of it because you inject antibiotics, and they also get prescriptions, where do they get these antibiotics from, all the sadness that is used in the agricultural industry

antibiotics that are needed in medicine, for example, there is such an antibiotic as colestin, for now it is the main reserve against the adopted pseudobacillus, clipsi, that is, when you have tried number one, number two and number three you... switch to colestin, that's right, that's how it is, chickens in china, for example, are given colistin, agriculture solves the problem of feeding the people and at the same time, giving the people resistance to colestin, therefore when the people are sick with severe bacterial infections, colestin will not help them, the more you use antibiotic, the more resistance to it, and an antibiotic is like an atomic bomb for bacteria, it kills everyone or and it is not an atomic bomb, but...

it is invented, we need to develop those strategies when we will not kill the bacteria that lives in us, that is, we will somehow learn to interact, that is, there will only be antibiotics that kill bad microbes, they do not work on good ones, there will be antibiotics that limit the pathogenicity of the bacteria, that is, its pathogenicity, that is, ideally , it should remain with us to live, not purulent stick, but just not to kill us, in general , this is not science fiction, you understand, a doctor, he is not... a scientist, a doctor, he is a consumer, i can

only say that i would need it, but how to do this, i do not know, i do not have enough biological knowledge, i do not have enough chemical knowledge, and you communicate with scientists, with russian scientists, that is, i understand that there is a demand, you really need it, and most importantly, patients need it, yes, we communicate, now there are several developments, for example, in the same gomaleya institute, if they are trying to bring to market, an antibiotic such a vtortesian, it has certain prospects, but it is also not... a magic bullet, strictly speaking, that will solve everything, that is why some spectrum is needed here anyway, the development of new antibiotics should simply be supported only by some state grants, money and what is called will. where do microbes resistant to antibiotics come from, why don't antibiotics work? we are talking about this and many other things today in the badin baden podcast. with sergei vasilyevich tsarenko,

chief resuscitator of the russian ministry of health. there is some understanding of the percentage in how many cases does an antibiotic work, what percentage of bacteria are resistant? 5% or if 90, then this is probably really a problem. clinically hopeless situations, i would say so, i would estimate them, well, in the region of 5 - 10%. these are people whom you will not be able to help, they will be as if there are no antibiotics, then, well, as the chips fall, you will survive or not . yes, that means, well, i will try to select a combination of antibiotics for this patient, based on common sense, and someone will be lucky, and someone will not. here you are now you say 5-10 years today, and 5 years ago, for example, how much in your practice, and 5 years ago, it was, well, 2-3%. well, in our pneumonia on ev, the mortality rate was 30-40% before the pandemic. the mortality was due to the fact that you could not, you could not find an antibiotic that would. one of the reasons was, one of the reasons was, well, there was also the severe

severity of the pneumonia itself and so on, but in general, uh, 30-40%. then here is mathematics, common sense does not beat, you say in patients who cannot be helped now 5 dash 10% due to antibiotic resistance, on the other hand you say that the mortality rate of pneumonia is 30-40, this is a big gap, and this mortality is due to the fact that antibiotics do not work, did i understand correctly, look, here we are talking about different nasal groups, different groups of patients, for example, patients with viral pneumonia, these were patients, extremely seriously ill, who were in bed for a long time, this is one, that simply does not have such a number of patients, now in general in the circle in the proportion of this kind of patient it has fallen, thank god, that's why i say that the approximate estimate of such a patient who won't be able to help is every tenth, but it can all come back, the bacteria can become sensitive again. or it shouldn't, they will now always be resistant and we

can't do anything about it, you know, i don't really understand how they will suddenly become sensitive again, but they used to, before there was some wonderful time, the golden age of antibiotics, when microbes were sensitive to antibiotics, i understood that they became resistant, well, and thanks in particular to your doctors, well, and to people who are engaged in agriculture and those who buy and use antibiotics without a prescription, this was our collective effort and... now we have what we have, right, after all, but initially this was not the case, so, probably, they should have been able to return, well, i see only one option, we stop using antibiotics altogether, we just make a moratorium, how long should it take for everything to return to normal, well, let's just understand, that during the moratorium patients will die, we will be satisfied with this option, well, if antibiotics do not work, they will die anyway, oh well, your relative is in my intensive care unit, i am telling you, konstantin, you know, there is a stable handicap here, in a good way, we

will find a combination as friends, maybe, or maybe we will not, yes, on the other hand, i have a sensitivity analysis of antibiotics, all the letters r, that is, resistant, from a formal point of view there is nothing to prescribe, therefore, if we theoretically would not prescribe to these patients uh, they, excuse me, would die along with their bacteria, then uh, i think it's a matter of a few years. it is said that we no longer use penicillin, so you as the director say, i, that's it, that's it, yes, we don't use it, we wait, usually it takes a process, well , around a year, i heard that in 4-5 years the frequency of resistant microbes has doubled, maybe multi-resistant,

that is, then in 5 years it will become even more, and in general, well, i'm not very fond of the state program in itself i understand what it will do. medicinal, i must clearly say this, antibiotics are prescribed just in case, this applies to colleagues of any american, chinese, russian, this is just in case, what do we need, well, in china they use colestin in agriculture, for example, and you ate chinese chicken and got your microbes in microdoses of colistin,

well and at the same time i understand that a microbe that has become resistant to colistin, even if it did not come here on chicken, since the border... there is no for microbes, yes, that's all equally spreads eventually across the entire planet, that is, what is happening in america or in chile is important for us, because these microbes will turn out to be the opposite here, absolutely right, sooner or later it will turn out, this is practically an apocalypse, it is practically and so calmly to talk about it, and i have simply gotten over this topic, i don’t know, you have become stable, well, you can’t live in a tense state all the time, we are about to die, but i feel incredibly sorry for my patients. and i understand that there is no light at the end of the tunnel yet appeared, and you can on the fingers of one hand, maybe, what needs to be done, here each specific person can do something to protect themselves or their relatives or be prepared when suddenly they meet you, god forbid, at least not using antibiotics in situations

where it is not justified from a medical point of view, but we don’t know, we are you are a doctor, absolutely right, but nevertheless still... also sold, that is, do not wash, do not eat chicken, therefore, antibacterial soap, it is for you will cleanse your entire skin of bacteria, including beneficial ones, and there are antibiotics, because there is, because there is an antiseptic, well, this is a field antibiotic, a drug that kills bacteria on the surface, washed

with an antiseptic, treated your hands, there are no bacteria, in fact, this is completely unnecessary, because when you just washed yourself with a regular wash, the number of bacteria decreased. to 30-40% of the original hundred that were on your dirty hands, this is enough to not get sick with some kind of intestinal infection, for example, if you have treated it 100%, killed it with antibacterial soap, then sooner or later pathogenic, disease-causing bacteria will settle on your skin, so you don’t need to clean too much, you need to wash your hands before eating, uh, and after being outside, but not with antibacterial soap, ask, question...