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卷 29, 编号 4 (2025)
- 年: 2025
- 文章: 7
- URL: https://journal-vniispk.ru/RFD/issue/view/26024
- DOI: https://doi.org/10.17816/RFD.20254
Review
Personalized management of chronic obstructive pulmonary disease using artificial intelligence technologies in primary care
摘要
Chronic obstructive pulmonary disease remains one of the leading causes of morbidity and mortality worldwide, exerting a substantial impact on patients’ quality of life and healthcare systems. Traditional diagnostic and therapeutic approaches, including spirometry, clinical scoring systems, and imaging techniques, have important limitations related to the requirement for active patient participation, high costs, and difficulties in ensuring long-term monitoring. In recent years, artificial intelligence technologies integrated with physiological signal analysis have opened new opportunities for personalized and management of chronic obstructive pulmonary disease, particularly in ambulatory and primary care settings. This review summarizes recent advances in the application of artificial intelligence across four key domains: diagnosis, severity classification, exacerbation prediction, and therapeutic interventions. Special emphasis is placed on multimodal analysis of physiological signals, including respiratory sounds, blood oxygen saturation, electromyographic, and cardiorespiratory parameters. Integration of these data with machine learning and deep learning algorithms has been shown to improve early diagnostic accuracy, enable preclinical prediction of exacerbations, optimize therapeutic interventions, and enhance treatment adherence. Despite these promising developments, substantial barriers to clinical implementation of artificial intelligence remain, including fragmentation and heterogeneity of medical data, limited interpretability of complex models, the need for standardized data acquisition protocols, and the requirement for large-scale multicenter clinical studies. Nevertheless, integration of intelligent systems into the workflow of primary care physicians has the potential to transform chronic obstructive pulmonary disease management by shifting from reactive treatment toward proactive and personalized monitoring, ultimately reducing exacerbation frequency and improving patient quality of life.
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Pathogenetic and diagnostic features of osteoporosis in men
摘要
Osteoporosis has traditionally been perceived by clinicians as a disease predominantly affecting women. However, contemporary epidemiological data indicate that its prevalence among men is substantially underestimated, particularly in the Russian Federation. Epidemiological studies show that approximately one in five men aged 50 years and older will sustain at least one osteoporotic fracture during their remaining lifetime. The etiology of osteoporosis in men is multifactorial, and a key role is played by genetic factors, reduced testosterone levels, and various comorbid conditions. Notably, the proportion of secondary osteoporosis attributable to underlying diseases or medication exposure ranges from 50% to 80%. Nevertheless, in the Russian population, secondary osteoporosis has been diagnosed in only 17% of men, suggesting insufficient or ineffective evaluation of male patients with osteoporosis for secondary causes. The diagnosis of osteoporosis in men, as in women, is based on bone mineral density assessment by densitometry and fracture risk estimation using the FRAX (Fracture Risk Assessment Tool) calculator, with universal application of diagnostic criteria originally developed for female populations. Despite the widespread adoption of this approach, its clinical validity in men older than 50 years has not been convincingly established.
This review substantiates the need to implement a dedicated diagnostic algorithm for men, incorporating systematic evaluation for secondary causes of osteoporosis, thereby enabling personalized and etiologically targeted therapy to improve clinical outcomes.
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Original study article
Prevalence of smoking and use of nicotine-containing products among medical students and physicians in CIS countries: a cross-sectional study
摘要
BACKGROUND: To implement effective measures to reduce smoking and the use of novel nicotine-containing products among medical students and physicians, objective national-level data on smoking behavior are required.
AIM: This work aimed to assess the prevalence of smoking and use of nicotine-containing products among medical students and primary care physicians in the CIS.
METHODS: A cross-sectional consent-based survey was conducted. An online questionnaire administered via an electronic platform was used to assess the type of products consumed, frequency and duration of use, age of initiation, attempts to quit smoking, exposure to passive smoking, awareness of nicotine-related health risks, and availability of smoking cessation programs.
RESULTS: The study included 9222 students and 1599 physicians from five countries. The prevalence of smoking among students and physicians, respectively, was: Russia 20.3% and 17.1%; Belarus 17.0% and 18.3%; Kyrgyzstan 15.4% and 6.8%; Kazakhstan 8.2% and 12.8%; Uzbekistan 3.2% and 5.9%. Smoking prevalence among women was lower than among men in all countries (p < 0.05), except among students in Belarus (p > 0.05). The prevalence of nicotine-containing product use (including combined use with conventional cigarettes) did not differ between men and women among students in most countries, except in Kyrgyzstan (p < 0.05). The primary risk factors for smoking among students, regardless of country, were smoking by friends and smoking by classmates or dormitory roommates. Among physicians, 3.7%–12.5% of men and 10%–50% of women who reported quitting tobacco continued to use electronic cigarettes. Male physicians were more frequently exposed to passive smoking at work, whereas female physicians were more frequently exposed at home. Attitudes of healthcare professionals toward tobacco products and electronic cigarettes remarkably influenced the likelihood of using specific forms of smoking.
CONCLUSION: This study expands current data on the prevalence of smoking, including passive smoking, as well as on cross-country similarities and differences in smoking behavior and smoking-related risk factors among healthcare professionals.
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Secondary prevention of congenital cytomegalovirus infection with valacyclovir: pharmacoeconomic aspects
摘要
BACKGROUND: Congenital cytomegalovirus infection is associated with an increased risk of congenital malformations and neonatal disability, resulting in reduced quality of life for both the child and the mother. Therefore, secondary prevention of congenital cytomegalovirus infection remains highly relevant.
AIM: This work aimed to evaluate the cost-effectiveness of valacyclovir therapy for primary cytomegalovirus infection in pregnant women during the first trimester for the prevention of congenital cytomegalovirus infection.
METHODS: A model-based analysis with a 5-year time horizon was conducted from a societal perspective. The effectiveness of the intervention was derived from previously published double-blind randomized controlled trial data including women with primary cytomegalovirus infection in the first trimester of pregnancy. The model accounted for the probability of disability in children with congenital cytomegalovirus infection due to severe sensorineural hearing loss and neurodegenerative disorders. The impact of congenital cytomegalovirus infection on maternal and child quality of life was consistent with previously published data. Costs and quality-adjusted life years were discounted at an annual rate of 3%.
RESULTS: Valacyclovir therapy is expected to reduce the proportion of children with disability resulting from congenital cytomegalovirus infection from 4.8% to 1.4% among all women with primary cytomegalovirus infection in the first trimester. Over a 5-year period, life expectancy increased by 0.172 quality-adjusted life years (QALY), whereas government expenditures decreased by 25.8 thousand rubles per patient with primary cytomegalovirus infection in the first trimester. Sensitivity analysis confirmed the robustness of the findings.
CONCLUSION: Under the adopted assumptions, secondary prevention of congenital cytomegalovirus infection through valacyclovir therapy in pregnant women with primary cytomegalovirus infection during the first trimester leads not only to reduced neonatal mortality and disability but also to decreased healthcare budget expenditures.
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Analysis of cases of antibiotic-associated diarrhea caused by Clostridium difficile in patients of an infectious diseases hospital
摘要
BACKGROUND: Over the past 20 years, the global incidence of infection caused by Clostridium difficile has increased almost fourfold. Widespread and uncontrolled use of antibiotics has resulted in clostridial infection becoming one of the most dangerous healthcare-associated infections, with mortality increasing at an alarming rate.
AIM: This work aimed to determine changes in the proportion of clostridial infection within the distribution of acute intestinal infections, to analyze risk factors contributing to disease development, and to assess the association between disease severity, major clinical manifestations, and outcomes in patients of an infectious diseases hospital.
METHODS: Statistical data on all cases of acute intestinal infections registered at the S.P. Botkin Clinical Infectious Diseases Hospital from 2019 to 2024 were analyzed. In addition, a retrospective review of medical records of patients hospitalized in this institution from January to April 2025 with a confirmed diagnosis of A04.7 Enterocolitis due to Clostridium difficile according to the International Classification of Diseases, Tenth Revision (ICD-10) was performed.
RESULTS: A substantial increase in the proportion of clostridial infection within the overall distribution of acute intestinal infections from 2019 to 2024 was identified in Saint Petersburg and the Leningrad Region. Clostridium difficile infection was associated with advanced age, hospital readmission within 3 months after discharge, antibiotic therapy, presence of comorbidities—primarily cardiovascular diseases—gastrointestinal disorders, type 2 diabetes mellitus, postoperative conditions, and chronic kidney and liver diseases. In addition, a direct association was established between the severity of clinical manifestations, overall disease severity, and infection-related mortality.
CONCLUSION: Given the widespread increase in cases of clostridial infection in recent years, it is necessary not only to strengthen infection control measures in hospitals and other healthcare institutions but also to implement educational programs in outpatient and primary care settings to improve medical staff awareness of Clostridium difficile infection.
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Osteoporosis in rural women of the Ural Region: clinical and metabolic profile, comorbidity, and diagnostic opportunities at the primary health care level
摘要
BACKGROUND: Rural populations remain underrepresented in osteoporosis research in the Russian Federation.
AIM: This study aimed to describe the clinical and metabolic profile of rural women with osteoporosis, taking into account comorbidity and risk factors for chronic noncommunicable diseases, in the context of osteoporosis detection opportunities in primary health care.
METHODS: A single-center, population-based, cross-sectional study was conducted including all women aged ≥50 years residing in the settlement of Kalinovo, Sverdlovsk Region. Osteoporosis was diagnosed; anthropometric, clinical, and laboratory parameters were assessed, along with pain level, physical activity, alcohol consumption, smoking status, and questionnaire-based measures using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the “Age Is Not a Barrier” questionnaire. Comorbid conditions were recorded.
RESULTS: A total of 533 women were included. Osteoporosis was diagnosed in 113 participants (110 newly diagnosed), corresponding to 21.2% (95% confidence interval, 17.9%–24.8%); 80% of affected women had already sustained fractures and/or required immediate initiation of therapy. Women with osteoporosis were older than those without the condition (median age, 70 vs 66 years; p < 0.001) but did not differ from age-matched controls in anthropometric parameters, alcohol consumption, smoking status, physical activity, glycemia, cholesterol levels, or prevalence of comorbidities, including hypertension, type 2 diabetes mellitus, and ischemic heart disease. Median PHQ-9 scores (4 vs 3; p = 0.051) and GAD-7 scores (2 vs 1; p = 0.04), as well as the proportion of individuals with frailty syndrome (16.8% vs 10.0%; p = 0.065), were slightly higher among women with osteoporosis.
CONCLUSION: One in five rural women aged ≥50 years has osteoporosis, with prevalence increasing with age. A history of low-energy fractures or a fracture risk exceeding the therapeutic threshold according to FRAX were the only clinical and anamnestic markers that reliably distinguished women with osteoporosis from their age-matched peers during consultations in general practice. The high burden of risk factors for chronic noncommunicable diseases and comorbid conditions, primarily cardiovascular, among rural women likely shifts the rural physician’s focus from osteoporosis diagnosis toward the detection of other diseases, despite the availability of accessible osteoporosis screening tools.
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Role of P-selectin and the receptor for advanced glycation end products (RAGE) in the development of obesity-associated bronchial asthma in adults
摘要
BACKGROUND: Obesity-associated bronchial asthma is a common and difficult-to-treat phenotype of adult asthma. Currently, asthma is classified into two major endotypes: Th2 and non-Th2. The non-Th2 endotype reflects a non-allergic inflammatory mechanism but lacks clearly defined laboratory criteria, unlike the Th2 endotype. In this context, P-selectin and the receptor for advanced glycation end products (RAGE) are of particular interest as potential markers of non-allergic inflammation. However, their role remains insufficiently studied.
AIM: This study aimed to evaluate the role of P-selectin and the receptor for advanced glycation end products (RAGE) in the development of bronchial asthma in adults with obesity.
METHODS: A cross-sectional consecutive study was conducted. Clinical characteristics, spirometric parameters, and immunological markers were assessed in patients with and without obesity, depending on the presence of bronchial asthma. Immunological markers were evaluated using enzyme-linked immunosorbent assay, including P-selectin, receptor for advanced glycation end products (RAGE), interleukin-4, interleukin-8, tumor necrosis factor alpha, and interferon gamma.
RESULTS: 96 participants were divided into four groups: group I, patients with bronchial asthma without obesity (n = 29); group II, patients with bronchial asthma and obesity (n = 27); group III (control), normal-weight individuals (n = 22); group IV (control), individuals with obesity (n = 8). Comparative analysis between the two asthma groups revealed no substantial differences in the analyzed markers; however, both groups differed remarkably from the control group III. Median P-selectin levels in groups I and II were 57.49 (46.82–129.29) pg/mL and 114.4 (58.5–161.5) pg/mL, respectively, which were significantly higher than in the control group III: 44.99 (34.00–60.07) pg/mL (p < 0.05). Elevated levels of RAGE and TNF-α were also observed, indicating the presence of a systemic inflammatory response associated with obesity in patients with bronchial asthma.
CONCLUSION: The study demonstrated substantial similarity of immunological responses in bronchial asthma and obesity. In the presence of both conditions, P-selectin demonstrated the most specific response, confirming the neutrophilic nature of inflammation.
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