Annals of the Russian academy of medical sciences

Postpartum purulent-inflammatory diseases remain one of the leading causes of maternal mortality, second only to extragenital pathologies and amniotic fluid embolism in frequency. According to several authors, the incidence of postpartum inflammatory diseases (PID) ranges from 2.0 to 54.3%, while in high-risk women, the frequency of such complications reaches 80.4%. Objective — to conduct a systematic review and meta-analysis of current data on the effectiveness of organ-preserving surgical methods for treating obstetric peritonitis after cesarean section, with an evaluation of favorable outcomes regarding uterine preservation and postoperative complications (adverse events). This study presents a systematic review and meta-analysis of the effectiveness of organ-preserving metroplasty for obstetric peritonitis, conducted in accordance with the PRISMA 2020 international standards and GRADE criteria. The analysis included 12 studies (n = 1,386 patients) published since 2010, ensuring data completeness, reliability, and relevance. The results showed that the average clinical success rate of metroplasty was 79.96% (95% CI: 20.7–100.0%), with significant variability depending on the surgical technique. Classical methods demonstrated an efficacy of 85–100%, while innovative approaches (ultrasonic cavitation, local antibiotic therapy) showed only 33–70%. The hysterectomy rate as an adverse outcome was 20.04%, reaching 66.7% in some studies. The complication profile included: generalized peritonitis (33.64%), surgical site infection (14.04%), sepsis (6.13%), uterine suture dehiscence (11.38%). High heterogeneity (I²=97.41%) and signs of publication bias indicate the need for cautious data interpretation. The meta-analysis highlights the importance of strict patient selection for organ-preserving techniques and standardization of surgical protocols. The uniqueness of this review lies in its comprehensive analysis of complications and comparison of different metroplasty techniques, which is absent in similar studies. The findings may be used to develop clinical guidelines for reducing risks in organ-preserving surgeries during the puerperium.

Sarcopenia is defined as a decrease in muscle mass, strength, and function. The primary population affected by sarcopenia consists of elderly and old-aged individuals, which is caused by an imbalance between anabolic and catabolic processes in the muscles, leading to a reduction in their volume and function. Loss of muscle mass during aging due to chronic diseases has serious negative effects: development of weakness, inability to perform self-care, worsening of existing somatic pathology, and an increased risk of mortality. As the global elderly population continues to grow, a sharp increase in sarcopenia cases is expected. Currently, the prevalence of sarcopenia worldwide ranges from 10 to 27% among people aged 60 and older. Sarcopenia is classified into primary sarcopenia, which is considered an independent disease, and secondary sarcopenia, which occurs against the background of existing chronic illnesses. The diagnosis of sarcopenia is confirmed based on measurements of muscle mass, strength, and physical performance. Assessment of muscle mass is performed using dual-energy X-ray absorptiometry (DXA) and bioimpedance analysis (BIA) — these are the most common methods. Muscle strength is evaluated with handgrip dynamometry, while physical performance (daily activity) is assessed using specific tests: the Short Physical Performance Battery (SPPB) and the “Get Up and Go” test (Timed Up and Go, TUG).Special questionnaires also play a significant role in confirming sarcopenia: the SARC-F questionnaire for rapid screening of sarcopenia (SARC-F-Sarcopenia Fast), the “Sarcopenia and Quality of Life” (SarQol) questionnaire, and the short form of the International Physical Activity Questionnaire (IPAQ-SF).The aim of this work was to analyze the prevalence and role of non-instrumental methods in diagnosing sarcopenia based on data from literary sources in foreign and domestic bibliographic and abstract databases (PubMed, Science Direct, Google Scholar, Elibrary) from 2014 to 2024.

An important problem remains drug addiction in the population of most countries, including residents of Russian regions. A significant transformation of the drug situation in the world is associated with changes in the motives for initiation and drug use, with the social portrait and lifestyle of drug and psychoactive substance users, and the composition of the substances taken. On the other hand, there is a weakening of social control institutions due to emerging trends in the “everyday” use of illegal substances. The authors noted that the trend of growth and transformation of drug addiction registered in the world community is also registered in the regions of Russia, the distinctive features of which are considered using the example of the Kabardino-Balkarian Republic. The purpose of the study was to analyze and summarize the causes of drug use in the world, country, region in order to establish emerging trends. Based on the results of the analysis of domestic and foreign sources, the researchers noted that scientists tend to divide the problems of drug addiction into “sectoral” aspects: medical, psychological, legal, pedagogical, sociological. The above determines the relevance of a systematic study of medical-social, medical-organizational and medical-legal aspects of combating illegal trafficking and non-medical use of narcotic drugs and psychotropic substances. As part of the review, the authors came to the conclusion that the multifaceted nature of the problems of drug addiction in society requires solving not individual, isolated, mainly departmental, regional, country problems, but a set of problems of drug addiction in society that have common features at all levels. Apparently, an important aspect is a comparative legal analysis of the emerging national anti-drug policy aimed at finding tools for its implementation in accordance with international principles, norms, country and regional specifics. The formation of a well-developed scientific methodology and effective measures aimed at managing the growing set of trends, potential threats and ways to eliminate the consequences of the addiction in society will allow forming the right anti-drug patterns.

Background. Oligometastatic disease (OMD) represents an intermediate state between localized and disseminated cancer, characterized by a limited number of metastases (typically 1–5). Stereotactic ablative radiotherapy (SABR) is a precise local treatment modality capable of delivering ablative doses to metastatic lesions of various sites with minimal toxicity. Despite growing clinical evidence, the impact of primary tumor type and metastatic site on survival outcomes after SABR remains insufficiently explored.

Aim — to evaluate overall survival (OS) and progression-free survival (PFS) in patients with oligometastatic disease treated with SABR, and to analyze the association of these outcomes with the localization of the primary tumor and distant metastases.

Methods. This retrospective cohort study included 68 patients with 1–5 metastatic lesions treated with SABR at the European Medical Center (Moscow) between 2015 and 2024. Total radiation doses ranged from 16 to 60 Gy in 1–7 fractions, depending on tumor histology and anatomic site. The median follow-up was 51 months (range: 11–75). Forty-nine patients (72%) received systemic therapy — chemotherapy, immunotherapy, or targeted therapy — selected individually according to treatment guidelines for each tumor type and clinical status. Treatment toxicity was evaluated according to CTCAE v4.0.

Results. The 1-, 3-, and 5-year OS rates were 97.1%, 83.6%, and 73.4%, respectively; corresponding PFS rates were 57.3%, 36.6%, and 28.0%. Patients with bone metastases demonstrated a tendency toward improved OS (p = 0.049), whereas the localization of the primary tumor had no significant impact on survival (p = 0.41). Grade ≥ 2 toxicity occurred in 5.8% of patients.

Conclusions. SABR was associated with favorable survival outcomes and acceptable tolerance in patients with oligometastatic disease. The site of metastases may represent a prognostic factor influencing long-term outcomes. Further prospective studies are warranted to validate these findings and to refine patient selection criteria for SABR as part of combined-modality treatment.

Background. Clozapine is recognized as the most effective medication for treatment-resistant schizophrenia (TRS). However, the use of clozapine in clinical practice remains limited due to challenges related to its efficacy and safety. Pharmacogenetics may help enhance both the effectiveness and safety of its use.

Aims — to analyze the role of polymorphic variants in genes associated with pharmacogenetic factors in the development of adverse reactions and the efficacy of clozapine therapy.

Methods. We conducted a prospective pharmacogenetic study of the efficacy and safety of clozapine in patients with TRS (F20 according to ICD-10). The observation period was 28 ± 3 days. The primary endpoint was the change in the severity of psychopathological symptoms, assessed using the PANSS, CGI-S, and CGI-I scales. Treatment safety was evaluated using the UKU Side Effect Rating Scale. Genotyping was performed using the real-time PCR method.

Results. The study included 61 patient receiving treatment in a psychiatric inpatient facility. According to our data, clozapine efficacy was associated with CYP2C9 rs1799853, DRD4 rs1800955, and ABCB1 rs1128503. The final clozapine dose was influenced by ABCB1 rs1045642, rs2032582, and rs1128503. Associations with safety were identified for CYP2D6 rs3892097 and rs1065852; CYP2D6 rs3892097; CYP2C19 rs4244285; CYP2C9 rs1057910; CYP3A4 rs2740574; CYP2C19 rs12248560; ABCB1 rs1045642, rs2032582, and rs1128503; HTR2A rs6313; DRD2 rs1800497 and DRD4 rs1800955.

Conclusions. Our study revealed considerable interindividual variability in clozapine treatment outcomes among patients with TRS. Polymorphisms CYP2C9 and DRD4 were associated with improvements in negative symptoms, while ABCB1 variants showed the strongest impact, influencing both final clozapine dose and tolerability. Additional associations with CYP2D6, CYP2C19, CYP3A4, HTR2A, and DRD2 were observed for adverse drug reactions such as sedation, weight gain, memory impairment, and depression. These findings highlight the importance of pharmacogenetic profiling in optimizing clozapine therapy, though replication in larger and ethnically diverse cohorts remains necessary.

Background. The main characteristics of augmented reality (AR) and virtual reality (VR) technologies are immersion, presence, and interaction, which are defined by the technology used and individual perception. AR and VR automate processes and assist in areas that require repetitive tasks, particularly in medical education and training, including surgery. Recently, VR and AR have significantly entered the fields of maxillofacial surgery and dentistry, allowing doctors to create 3D models and conduct virtual surgeries, as well as train specialists on virtual models. These new methods require assessment of their usability and accuracy.

Aims — to evaluate the accuracy of our developed augmented reality system for creating surgical access in radicular cysts of the jaws.

Methods. We conducted a clinical comparative study to assess the accuracy of our developed augmented reality system using HoloLens software and Medgital Vision Editor for creating surgical access in radicular cysts of the jaws. Forty patients were selected and divided into three groups: Group 1 (n = 10) consisted of patients operated on using a surgical template; Group 2 (n = 20) consisted of patients operated on using a virtual template and augmented reality (AR); Group 3 (n = 10) consisted of patients operated on using the freehand method. In all three groups, preoperative computer modeling for surgical access, with a diameter of 5 mm, corresponding to a bone trephine, was performed based on CT scans of the jaws and intraoral scanning. Subsequently, all patients underwent surgical access to the cyst using a surgical trephine, followed by cystectomy and closure of the surgical wound. After the surgical intervention, all patients underwent a follow-up CT scan. The obtained CT data (DICOM files) were uploaded into Exoplan 3.0 software. We assessed the differences between the planned preoperative computer modeling and the actual surgical access performed. Furthermore, we analyzed the deviation angles of the formed surgical access and the depth preparation deviations. A statistical analysis of the obtained data was conducted.

Results. The analysis of the angle of deviation of the formed surgical access was 2.82, 2.25, and 9.77 in Groups I, II, and III, respectively. Significant differences were established (p < 0.001; method used — Kruskal–Wallis test). The analysis of the depth preparation deviation showed results of 0.53, 0.73, and 2.38 in Groups I, II, and III, respectively (p < 0.001; method used — Welch’s F-test). The accuracy results of our augmented reality navigation system are comparable to the accuracy achieved with surgical templates and significantly surpass the results obtained with the freehand method.

Conclusion. The accuracy of AR navigation is sufficient for clinical use, but some improvements are necessary.

Background. To improve the effectiveness of measures to strengthen public health and prolong working life, it is necessary to systematically study the lifestyle of students as the future reproductive and economic potential of the country. Studying the socio-environmental risk factors that affect the development of diseases among students is essential for developing preventive measures to maintain and improve health. The obtained data on socio-environmental risk factors for the development of chronic non-communicable diseases should be taken into account when implementing corporate medical and preventive measures and developing individual programs for promoting a healthy lifestyle.

Aims — to study the social and environmental risk factors that affect the development of diseases among students.

Methods. In the Udmurt Republic, on the basis of the Federal State Budgetary Educational Institution of Higher Education “Izhevsk State Medical Academy” of the Ministry of Health of the Russian Federation, a study was conducted on the risk factors for the development of diseases among students using a questionnaire survey. A total of 351 students from the 5th and 6th years of the medical, pediatric, and dental faculties were surveyed, with a majority of female students (76.1%, 267) and male students (23.9%, 84) aged between 21 and 30 years.

Results. Today’s youth is characterized by a high level of exposure to socio-related risk factors, which can lead to the development of chronic non-communicable diseases. Two-thirds of the respondents were satisfied with their living conditions, while less than half were satisfied with the environmental conditions. One-third of the respondents reported a lack of opportunities for physical activity and sports. Two-thirds of the respondents showed no interest in any leisure activities and did not see the need for health-promoting behaviors, despite being future healthcare professionals who play a crucial role in shaping healthy lifestyle habits among the population.

Conclusions. The study showed the need to train specialists in higher medical educational institutions, along with teaching professional skills and abilities, to teach them the values of preserving their own health. It is necessary to monitor the social and environmental risk factors among students on a regular basis and to develop measures to promote healthy behavior.