
Scientific and practical peer-reviewed journal
Рецензируемый научно-практический журнал «Название журнала на русском» «Nazvanie zhurnala na russkom» зарегистрирован Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций 05 августа 2014 года (Свидетельство о регистрации ПИ № ФС 77-58913 — печатное издание и свидетельство, Эл № ФС 77-58914 — сетевое издание).
Тираж 1000 экземпляров, периодичность 4 выпуска в год.
Распространение – Российская Федерация, зарубежные страны.
Электронная версия журнала с мультимедийными приложениями доступна по адресу rpmj.ru.
Выходит при поддержке Министерства здравоохранения России и Федерального государственного бюджетного учреждения «Федеральный медицинский исследовательский центр имени П.А.Герцена» Министерства здравоохранения Российской Федерации.
Журнал «Исследования и практика в медицине» - профессиональное медицинское издание, в котором отражаются результаты новейших исследований в области медицинских наук, организации здравоохранения, фундаментальных и прикладных исследований.
В издании представлен уникальный клинический опыт как практических врачей, так и специалистов разных научных и клинических школ. Публикуются новости медицинского и фармацевтического сообществ, научно-практические статьи для целевой аудитории - врачей различных специальностей.
Журнал, в первую очередь, имеет практическую направленность и публикует статьи ведущих специалистов, освещающих актуальные проблемы клиники, диагностики и лечения широкого круга заболеваний, алгоритмы диагностики и терапии различных нозологий. В нем публикуются передовые и оригинальные статьи, краткие сообщения, заметки из практики, лекции и обзоры. Мы стремимся развивать принцип междисциплинарного подхода, делаем все возможное, чтобы наши читатели были в курсе современных достижений медицинской науки и практики, помогаем врачам в освоении современных принципов распознавания и лечения широкого спектра заболеваний.
Current issue
DEVELOPMENT OF DIAGNOSTIC AND TREATMENT METHODS
Aim. To assess comorbidities in patients with varying coronary calcification who visited a general practitioner.
Material and methods. The study included patients without a confirmed diagnosis of coronary artery disease (CAD) but with its risk factors. All patients underwent a pre-test assessment of CAD probability. The study included a total of 100 patients, in which an Agatston score was assessed using multislice computed tomography (MSCT) and the SmartScore software application. Patients without coronary artery calcification and with an Agatston index <11 were excluded. Of the 59 participants, three following groups were formed: group 1 — coronary calcium score 11- 100 (n=19), group 2 — 101-400 (n=20), group 3 — ≥401 U (n=20).
Results. In the formed groups n=19/20/20, the following were established: mean age (M±m, years): 60,7±1,4; 63,3±1,3; 67,2±1,03, coronary calcification score (M±m, U): 44,8±4,8; 294,4±18,1; 715,8±25,9 and pre-test CAD probability (M±m, %): 16,3±1,3; 17,3±1,2; 21,2±1,8, respectively. There was following distribution of comorbidities in the groups (n/%): chronic obstructive pulmonary disease (COPD): 4/21,1; 3/15,0; 9/45,0; type 2 diabetes (T2D): 7/36,8; 4/20,0; 5/25,0; asthma: 3/15,8; 7/35,0; 3/15,0; no COPD/asthma/T2D: 5/26,3%; 6/30,0%; 3/15,0%, respectively.
Conclusion. When conducting screening measures and assessing the pre-test CAD probability, COPD and asthma should be carefully identified, and, if present, CCS should be studied.
Multisystem nature is characteristic for inflammatory bowel diseases (IBD), which is considered a predictor of unfavorable course. According to the European Crohn’s and Colitis Organisation (ECCO) extraintestinal manifestations (EIMs) are defined as "an inflammatory pathology in a patient with IBD that is located outside the gut whose pathogenesis is either dependent on extension/translocation of immune responses from the intestine, or is an independent inflammatory event perpetuated by IBD or that shares a common environmental or genetic predisposition with IBD". Data from several studies indicate that EIMs may affect 50-60% of patients. This report describes a case of HLA-B27-positive ankylosing spondylitis (AS) diagnosed prior to the confirmation of ulcerative colitis (UC) with subsequent development of idiopathic chronic pancreatitis. At onset, elevated acutephase reactants were revealed. MRI demonstrated active bilateral stage III sacroiliitis and active spondylitis of all lumbar vertebrae. Sulfasalazine was initiated. Subsequently given the absence of peripheral manifestations of AS, a decision to initiate therapy with upadacitinib 15 mg daily was made. Several years later a diagnosis of UC was established. Consequently, the upadacitinib dose was increased to 30 mg daily, achieving control of AS and clinical and endoscopic remission of UC. Later, contrast-enhanced abdominal computed tomography (CT) was performed due to abdominal pain. Chronic calcific pancreatitis was revealed. The patient's history of alcohol and smoking was negative. Laboratory investigations ruled out hypertriglyceridemia, elevated IgG levels, antinuclear antibodies. There were no autoimmune pancreatitis-specific CT features and histopathological findings. While the autoimmune pancreatitis is considered unlikely, it cannot be definitively ruled out due to the absence of all diagnostic criteria, including IgG4 subclass evaluation. Therefore, maintaining a high level of suspicion for immune-mediated pathology increases the chances of an accurate diagnosis for both IBD and EIMs. This facilitates the selection of effective targeted therapy.
EXPERT COUNCIL
At the Expert Council meeting, key issues related to the prevention of latent iron deficiency (LID) and iron deficiency anemia (IDA) in at-risk populations were discussed, including women of reproductive age, pregnant women, blood donors, and patients with chronic diseases. Participants reviewed international and national guidelines, acceptable levels of iron intake, as well as barriers limiting the implementation of standard preventive approaches in clinical practice. Particular attention was given to chelated forms of iron, especially iron bisglycinate, noted for its high bioavailability and favorable tolerability profile. The experts emphasized the importance of using formulations containing components that enhance iron absorption and metabolism. Following the discussion, a resolution was adopted reflecting the consolidated interdisciplinary position of specialists on the prevention of LID and IDA, including patient management algorithms, care pathways, risk group identification, and recommendations for improving the regulatory framework.
DIGITAL TECHNOLOGIES FOR PRIMARY HEALTH CARE
In the 21st century, artificial intelligence (AI) has become one of the key drivers of the digital transformation of healthcare. Its implementation spans virtually all levels, from primary care to high-tech clinics, enabling the automation of routine processes, increased diagnostic accuracy, and personalized treatment. Global challenges, such as population aging, the increasing prevalence and severity of chronic diseases, a shortage of healthcare professionals, and the need to ensure equal access to healthcare requires large-scale digital solutions. AI is viewed not only as a tool for optimizing clinical and administrative processes but also as the technological foundation for a new healthcare paradigm, shifting the emphasis from treatment to prevention and early detection.
The choice of 1960-2025 time period for this study is due to the historical significance of these six decades in the development of AI in medicine. It was in the 1960s that the first health information systems appeared, marking the beginning of automated medical data processing. In subsequent decades, the development of expert systems, machine learning, deep learning, and generative models led to the formation of a multi-layered AI infrastructure in healthcare, and by 2025, these technologies had reached a high degree of integration into clinical practice.
ORGANIZATION OF PREVENTIVE CARE TO THE POPULATION
This article summarizes Russian and international experience in improving the effectiveness of outpatient monitoring for patients with atrial fibrillation (AF). AF is one of the most common arrhythmias, diagnosed in approximately 2-3% of the adult population. AF prevalence rises with the increasing proportion of older people in the population. Without anticoagulant therapy, left atrial appendage thrombi develop in a significant proportion of patients, increasing the risk of stroke, heart failure, and death. In Russia, outpatient monitoring is regulated by standards and clinical guidelines, but only about half of patients are regularly monitored. Indicators of hospitalizations, disability, mortality, and adherence to therapy are rarely included in the reporting, making it difficult to assess outpatient monitoring effectiveness. The need for a unified methodology for outpatient management of patients with AF, including validated questionnaires, digital remote monitoring platforms, and the use of health information systems, is emphasized. The need for a multicenter Russian study aimed at developing and implementing managing and methodological approaches to improve the effectiveness of remote monitoring for patients with AF is identified.
PROVIDING MEDICAL CARE TO VARIOUS GROUPS OF THE POPULATION
Iron deficiency anemia is a multietiological disease, the development of which is associated with iron deficiency due to its impaired intake, absorption or increased losses, characterized by microcytosis and hypochromic anemia. The practical guide describes in detail the etiology, paraclinical diagnostics, management of patients in various clinical situations. Guidelines are intended for primary health care professionals, including internists, general practitioners, cardiologists, gastroenterologists and other specialists providing care to patients with iron deficiency anemia.
These guidelines outline modern approaches to the diagnosis and management of overweight and obese patients without noncommunicable diseases in health centers, including scripts for patient interviews, algorithms of individualized nutrition programs, and methods necessary for assessing patients' condition. Key attention is paid to dynamic follow-up, and the key criteria for monitoring treatment effectiveness are presented to reduce the risk of complications and improve the overall quality and life expectancy of patients. The algorithmization and structuring of modern clinical guidelines and standards in relation to dynamic follow-up make the guide relevant, practiceoriented, and useful for healthcare professionals. The inclusion of scientific data ensures the high effectiveness of the proposed approaches and their application in everyday health practice.
The guidelines can be used by health professionals, heads of primary care facilities, and their departments.
Immunoprophylaxis is one of the most effective tools for reducing morbidity and mortality from infectious diseases. In the context of global epidemiological challenges and increased population mobility, the issues of managing immunization, proper patient selection, safety and effectiveness of vaccination are of particular importance.
The document systematizes modern approaches to organizing and conducting vaccination of adults. It includes sections on planning and vaccination techniques, contraindications and "false contraindications", features of vaccination against specific infections (influenza, pneumococcal infection, hepatitis, diphtheria, tetanus, poliomyelitis, measles, rubella, etc.), as well as vaccination in pregnant women and military personnel. Particular attention is paid to the registration and treatment of post-vaccination reactions and complications, and the costeffectiveness of vaccination.
The guidelines are intended for general practitioners, infectious disease specialists, epidemiologists, pediatricians, and public health specialists.
These guidelines describe the management of follow-up monitoring of patients with gastritis and duodenitis. They include the approximate scope and frequency of paraclinical investigations, as well as information on the diagnosis, treatment, and prevention of complications.
The guidelines are intended for general practitioners, family doctors, as well as for mid-level health providers working with the above-mentioned doctors, for paramedics performing the doctor functions. These guidelines can be used by healthcare executives, heads of primary care facilities, and their departments.
Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths both globally and in Russia. Screening is a key element in the prevention and early diagnosis of CRC. This guide presents current guidelines aimed at managing effective CRC screening among the adult population as part of routine health examinations.
The primary goal of screening is to identify precancerous conditions and early stages of CRC for timely treatment and an improved prognosis. The guidelines include a list of target groups, particularly individuals aged 40 to 75 years, as well as individuals with a family history or other risk factors.
The key screening method is a immunochemical fecal occult blood test, followed by a colonoscopy in positive results. Particular attention is paid to compliance with standards for the preparation and conduct of examinations.
The guidelines outline the stages of patient care, from initial identification to specialized treatment, including regulatory frameworks and the use of information systems for monitoring and reporting outcomes.
These guidelines are rested on evidence-based medicine and are an essential tool for primary care specialists and healthcare executives.
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ISSN 3034-4565 (Online)