Journal «MEDICINA» 4/2025

The state of the filtration bleb is a significant prognostic factor for the outcome of glaucoma surgery; however, existing methods for its assessment are subjective. The aim of this study was to develop an automated method for the objective analysis of filtering bleb images. A dataset of 100 patients with primary open-angle glaucoma who underwent trabeculectomy was used. This dataset included biomicroscopic photographs and OCT-angiographic tomograms performed preoperatively and at 1, 2, and 6 weeks postoperatively. Vascular density and tortuosity (from tomographic images), as well as hyperemia (from color photographs), were calculated programmatically using the corresponding formulas. A convolutional neural network with the U-Net architecture was trained using the calculated parameters in the resulting «OCT-A image – FP photo» pairs to automate the subsequent hyperemia calculation based on the tomographic image using an artificial intelligence tool. This resulted in the creation of specialized software that enables the quantitative assessment of key parameters of the filtration bleb state. The developed method showed high accuracy of the U-Net model during training (88.24%) and subsequent retraining (85.31%). Thus, the proposed solution provides a tool for objective monitoring of the postoperative period, which can contribute to the optimization of patient management strategies and improved prognosis for glaucoma surgery.

Key words: filtering bleb, glaucoma, computer vision, imaging segmentation, OCT-angiography, convolutional neural network, trabeculectomy

The aim of this study was to evaluate the clinical and economic rationale for the integration of camrelizumab as a first-line treatment for non-small cell lung cancer (NSCLC) in adult patients without EGFR/ALK/ROS1 mutations and with any level of PD-L1 expression in the Russian healthcare system. Methods. Data were obtained from the randomized CameL and CameL-sq clinical trials, as well as other international RCTs evaluating PD-1/PD-L1 inhibitors, domestic epidemiological studies and real-world clinical practice. Given the comparable overall survival, progression-free survival, and objective response rates across studies, a cost-minimisation analysis was performed. A budget impact analysis was conducted over a 24-month time horizon, taking into account patient flow patterns, treatment costs, registered prices of vital and essential medicines, and various camrelizumab uptake scenarios. Results. The total cost of a full course of camrelizumab therapy was 33–200% lower than the cost of regimens utilizing other PD-1/PD-L1 inhibitors. In the budget impact analysis, the introduction of camrelizumab led to a reduction in total two-year healthcare expenditures by 7.36–7.59 billion rubles (savings of 17.8–18.0%). A one-way deterministic sensitivity analysis confirmed the robustness of the model as ±10% variations in key parameters did not alter the conclusion that camrelizumab was economically preferable. Conclusion. The use of camrelizumab as first-line treatment for NSCLC provides comparable clinical efficacy and substantial cost savings compared to alternative PD-1/PD-L1 inhibitors. These results confirm the economic rationale for camrelizumab use and highlight its potential to expand patient access to immunotherapy within the Russian Federation.

Key words: non-small cell lung cancer, NSCLC, camrelizumab, PD-1/PD-L1 inhibitors, immunotherapy, cost minimization analysis, pharmacoeconomics, budget impact analysis, budgetary impact, clinical comparability, VED, first line therapy, real clinical practice, oncology, economic efficiency

The objective of the present study is to conduct a comprehensive analysis of the impact of social isolation and loneliness on the physical and mental health, cognitive functions and quality of life of older people. The analysis was based on a comprehensive selection of contemporary scientific publications, encompassing peer-reviewed articles, meta-analyses, systematic reviews, statistical reports from international organizations, and data from longitudinal studies conducted within the last five years. The research methods employed included systematic and comparative literature analysis, content analysis on key aspects (physical, mental and cognitive health) and a critical review with an evaluation of the reliability of the sources. The results of the analysis demonstrated that social isolation is predominantly associated with an objective deterioration in physical health, as indicated by reduced walking speed, cardiovascular disease and mortality. Conversely, loneliness exhibited a more pronounced impact on mental health, manifesting in depression, as well as on cognitive function and subjective perception of quality of life. The findings of the study indicated that factors such as social and economic status, age, and gender function as moderators, thereby amplifying or mitigating the consequences of these effects. The physiological mechanisms of influence were identified as follows: activation of the body's stress systems, chronic inflammation and endothelial dysfunction. The conclusion drawn from this research was that social isolation and loneliness are independent risk factors for health deterioration and reduced quality of life in older people. The experience of the pandemic demonstrated that even short-term enforced isolation can have a substantial impact on well-being. The interventions developed (individual support, group activities, educational programs and digital technologies) demonstrate inconsistent effectiveness and require further improvement. The resolution of this issue necessitates the implementation of comprehensive measures within the domains of healthcare, social policy and individual support.

Key words: demographic aging, social isolation, loneliness, elderly people, COVID-19 pandemic, interventional strategies

According to the World Health Organization, hundreds of millions of patients around the world experience medical-related infections every year. In developed countries, such infections occur in 5-15% of those hospitalized, and in countries with limited resources, the risk increases by 2-20 times.  Over the past two decades, about 30 thousand cases of ISMP have been registered in Russia annually, but experts believe the real number is much higher – up to 2-2.5 million people. The purpose of the study is to analyze the literature review on the current state of the problem of the spread of infections associated with medical care. Current literary sources of domestic and foreign authors were used as materials and methods. The literature was searched in such databases as PubMed and Elibrary. As a result of the conducted research, it was established that infectious diseases associated with the provision of medical care remain an important problem requiring comprehensive measures and interdisciplinary cooperation. The insufficient effectiveness of epidemiological surveillance leads to an underestimation of the importance of the prevention of ISMP and reduces the effectiveness of the fight against these infections. The issue of the formation of resistance of many microorganisms to antibiotics and disinfectants emphasizes the importance of inter-bacterial interactions in improving the effectiveness of therapeutic, diagnostic and preventive measures.

Key words: accounting and registration of ISMP, prevention of ISMP, antibiotic resistance, epidemiology

Relevance. To develop measures to combat the resistance of microorganisms to antibacterial drugs, it is important to investigate the factors associated with the development of antibiotic resistance. To conduct a systematic review and meta-analysis of studies on the association of individual factors associated with the provision of medical care with the development of diseases caused by penicillin-resistant (or insensitive) strains of Streptococcus pneumoniae. Methods. A literature search was conducted using the electronic databases PubMed, ScienceDirect, Google Scholar. The search depth is from January 1980 to December 2024. The studies were selected in English. The selection of articles and meta-analysis were carried out in accordance with the recommendations of the PRISMA Group and MOOSE. Conclusions. Previous administration of beta-lactam antibiotics for 1 or 3 months (OR=2.74, 95% CI 1.44-5.2, p=0.002, I2=0 and OR=2.12 (95%CI 1.62-2.78, p=0.001, I2=38%, respectively), hospitalization in the last six months (OR= 1.45, 95% CI 1.06-1.99, p=0.02, I2=19%), nosocomial infection (OR= 2.13, 95% CI 2.66-2.72, p=0.001, I2=22%), pneumonia suffered during the last year (OR= 1.85, 95% DI 1.29-2.66, p=0.001, I2=43%) were significant risk factors for the development of pneumococcal nonsusceptibility to penicillin. Significant risk factors for the development of pneumococcal resistance to penicillin are taking antibiotics in the last 3 months before the examination and hospitalization in the last six months (OR= 2.42, 95% CI 1.45-4.04, p=0.001, I2=79%).

Key words: antibiotic resistance, Streptococcus pneumoniae, pneumococcus, risk factors, penicillin resistance, penicillin susceptibility, penicillin

Introduction. Pain syndrome (PS) in genital endometriosis (GE) and the associated psychoemotional disorders, sexual dysfunctions, and family-sexual disharmonies negatively affect women's quality of life. Psychoemotional disorders and sexual dysfunctions, in turn, are involved in the pathogenetic mechanisms of the formation and exacerbation of PS in GE. Currently, medical practice lacks an algorithm for the diagnosis and treatment-preventive measures for PS in GE that considers psychoemotional and psychosexual factors of its development. This necessitates the development of an interdisciplinary therapeutic approach for managing patients with PS in GE, in accordance with the biopsychosocial model integrating knowledge of somatic symptoms with the latest research in psychiatry and sexology. Objective: To improve the components (strategy) of a comprehensive approach to the examination, prevention, and therapy of pain syndrome in genital endometriosis, taking into account psychoemotional and psychosexual factors. Materials and research methods. Study type: retrospective descriptive analytical case-control study with selective coverage of subjects. The research was based on epidemiological, clinical-anamnestic, clinical, clinical-psychopathological, clinical-sexological, psychometric, and statistical methods. Research results and discussion. A comparative clinical assessment of the psychoemotional and personal characteristics of patients with painful and non-painful forms of GE, conducted in the study, revealed the influence on the development and chronicity of pain syndrome from impairments in psychoemotional state, anxiety-asthenic, anxiety-depressive, and anxiety-hypochondriac syndromes within neurotic, stress-related, and somatoform disorders, as well as such personal characteristics as alexithymia, a tendency towards catastrophizing, somatization, high personal and situational anxiety, a tendency to obsession-compulsion, hostility, and paranoid tendencies. Conclusion. The fully implemented treatment and rehabilitation measures demonstrated high effectiveness in reducing the severity of pain syndrome, normalizing psychoemotional state, harmonizing the sexual sphere, and improving the quality of life of women, as evidenced by the results of follow-up data.

Key words: genital endometriosis, pain syndrome, psychosexual development, sexual dysfunctions, family-sexual disharmonies, psychoemotional disorders

The activities of healthcare workers are associated with occupational risks of acquiring hemocontact infections (HIV infection, viral hepatitis B and C). In this regard, monitoring of accidental exposures to blood and body fluids (AEB) continues to be relevant in order to identify weak links in the organization of preventive measures after the occurrence of AEB and timely response to existing problems. The aim is to assess the frequency and nature of reported AEB among healthcare workers in Tatarstan Republic in 2015–2024 and the coverage of their post–exposure prophylaxis of HIV infection. Methods. A descriptive epidemiological study was conducted. The AEB statistics among healthcare workers in Tatarstan Republic for 2015–2024 are analyzed. The dynamics of the AEB frequency among healthcare workers during the study period, their structure by type of injury and job category of a healthcare worker, and coverage of antiretroviral therapy (ART) for post-exposure prophylaxis were studied. The proportions were compared using Pearson's χ2 criterion or Fisher's exact criterion. Results. In 2015–2024, 2206 cases of AEB were registered in Tatarstan Republic, of which 85.6% were among healthcare workers. There is a significant upward trend for the long–term dynamics of the AEB frequency: from 2.3‰ (95% CI 2.0–2.7‰) in 2015 to 3.9‰ (95% CI 3.5-4.3‰) in 2024. AEB occurs more often in doctors than in representatives of other professional qualification groups (according to the average rates of AS in doctors – 4.6‰, in mid-level medical personnel – 3.0‰, in orderlies – 2.6‰). In the dynamics over the period under study, a significant tendency towards an increase in the frequency of AEB in groups of mid-level and in orderlies was noted. Needle stick injuries consistently predominate in the structure of AEB (75.0%). ART was received by 87.4% (1660/1888) of medical workers injured in emergency facilities. Over the period studied, the proportion of healthcare workers who received ART as part of post-exposure HIV prevention increased significantly from 80.0% in 2015 to 98.8% in 2024 (χ2 = 58.3, p<0.001). The reasons for the lack of specific chemoprophylaxis are dominated by the refusal of a healthcare professional to take ART (52.3%, 124/228) and late initiation of ART after AEB (26.2%, 62/228). Conclusion. It is necessary to conduct regular training of healthcare personnel in order to reduce the frequency of AEB and to form an algorithm of actions in the case of accidental exposures to blood and body fluids.

Key words: HIV Infections, Blood-Borne Pathogens, Occupational Exposure, Health Personnel, Post-Exposure Prophylaxis

Ocular blood flow is one of the factors initiating the development and maintaining the progression of glaucomatous optic neuropathy. The purpose of this study is to investigate the effect of glaucoma surgery on retinal blood flow and the optic nerve head using laser speckle flowgraphy. Blood flow changes were measured in 40 patients with developed and advanced primary open-angle glaucoma (POAG) using the LSFG-RetFlow analyzer. The quantitative integral parameter of volumetric blood flow velocity (MBR) in the studied areas was analyzed one week before and 1.5 months after trabeculectomy. Statistically significant (p≤0.05) changes in MV and MT in the optic nerve head and peripapillary retina were observed in groups 1 and 2, with similar trends: an increase in 1.5 months after surgery. A significant inverse correlation between MV and MT and IOP parameters after trabeculectomy was observed. The study results indicate an improvement in hemodynamic parameters after trabeculectomy. However, the impact of ocular microcirculation on the prognosis of glaucomatous optic neuropathy progression requires further study.

Key words: primary open-angle glaucoma, intraocular pressure, ocular hemodynamics, retinal blood flow, trabeculectomy

Williams syndrome (WS) is a rare multisystem genetic disorder caused by a deletion at locus 7q11.23. WS presents with specific somatic anomalies and a unique neurocognitive profile. Key features include intellectual disability, marked hypersociability, and a high prevalence of anxiety disorders. To illustrate the typical manifestations of Williams syndrome in adulthood and discuss the challenges of its lifelong management using the clinical case of patient B., 24 years old. A detailed case description is provided, including history, somatic, neurological, and mental status examinations, and results of a pathopsychological study. The patient exhibits a classic WS phenotype. Mild intellectual disability (IQ=56) was identified, with severe deficits in abstract-logical thinking and social intelligence, combined with preserved initiative speech. Traits of «hypersociability» are pronounced: excessive friendliness, talkativeness, lively eye contact. Somatic status includes heart defects (valvular pulmonary artery stenosis) and neurological anomalies (Arnold-Chiari malformation). Behavior is characterized by anxiety and motor restlessness. The key paradox of this case is the discrepancy between outward communicativeness and profound social naivety, creating a high risk of victimization in adulthood. This case clearly demonstrates the complexity of the neurocognitive profile in WS. Despite successful formal socialization (obtaining several professions, having hobbies), the patient remains vulnerable due to impaired social intelligence and judgment. This underscores the necessity for lifelong multidisciplinary support focused on socio-occupational adaptation and protection from social risks.

Key words: Williams syndrome, Williams-Beuren syndrome, 7q11.23 deletion, hypersociability, intellectual disability, clinical case

Introduction. As a result of the aging of the population, age-related diseases are an urgent problem of modern medicine, the early manifestations of which include insulin resistance. To diagnose insulin resistance, one of the indirect methods is the glucose tolerance test (TSH). Since the use of oral hypoglycemic agents is limited due to the manifestation of clinically significant undesirable side effects, it is relevant to search for drugs among substances of plant origin that have a high safety profile. Plants of the genus Rubus (family Rosaceae) have antidiabetic potential, in particular Rubus idaeus, which has shown clinical efficacy in the treatment of gestational diabetes. The aim of the study is to study the sugar-lowering activity of an aqueous extract of raspberry rhizomes with roots in young and old animals. Materials and methods of research. A dry extract of rhizomes with raspberry roots (ECCM) was used as the object of the study. The raw materials for obtaining the extract were raspberry rhizomes with roots harvested in autumn. The assessment of the sugar-lowering activity of the studied extract was carried out by changing the concentration of glucose in the blood of intact animals and in TSH. The comparison drug was metformin. The results of the study and their discussion. When studying the effect of ECCM on the glycemia level of intact and experimental animals of different ages, the glucose concentration of the background observation period did not significantly differ from that of control animals of the same age, which indicates the absence of ECCM effect on blood glucose concentration. TSH revealed a statistically significant increase in blood glucose concentration in old rats compared with young ones, which indicates a change in carbohydrate metabolism. The administration of ECCM to young and old animals led to a statistically significant decrease in the hyperglycemic peak after 30 minutes compared with the control groups, after 60 and 120 minutes there were no significant differences with the control groups. Conclusion. The dried extract of raspberry rhizomes with roots does not affect the concentration of glucose in the blood of intact young and old rats, and in old animals it improves the indicators of glycemia in TSH. The extract of rhizomes with raspberry roots is promising for further study as an antidiabetic agent.

Key words: insulin resistance, raspberry, rhizomes with roots, extract, glucose tolerance test