Perm Medical Journal

The objective of this review is to systematize and summarize the available literature data on the problem of sarcopenia in patients with type 1 diabetes mellitus (DM 1). Sarcopenia is a progressive and generalized disease characterized by loss of muscle mass, strength, and decreased skeletal muscle function. More and more data reflecting the deterioration of a muscle mass condition and decreased muscle function and strength in patients with DM 1 have accumulated over the past few years. A hypothesis concerning impaired muscle condition and function in young patients with DM is put forward, thus, diabetic sarcopenia can be considered as a direct complication of DM 1.

Currently, diagnostics is based on the clinical algorithm proposed in the consensus of the European Working Group on Sarcopenia in Older People in 2019 (EWGSOP2). Despite numerous studies on sarcopenia, the issue of validated biomarkers used for early diagnosis and monitoring of sarcopenia remains unresolved.

Multiple sclerosis (MS) is a chronic dysimmune neurodegenerative disease that predominantly affects young women, has a high risk of disability and significantly impairs the quality of life. Considering the high medical and social significance of multiple sclerosis, issues related to the management of the disease at different periods of a woman's life cycle deserve special attention.

The disease is associated with hormonal levels, its impact on fertility is discussed, as well as the risk of transmitting the disease to the offspring. The authors consider the course of MS in pregnant women, as well as approaches to pregnancy planning in patients receiving disease modifying drugs (DMD) for multiple sclerosis. The data on the prognosis of the disease in the near and late postpartum period are analyzed, and the features of the course of the disease during menopause are considered.

Studying the features of the disease course in women at different ages in relation to changes in hormonal levels contributes to a more complete understanding of its pathogenesis and treatment strategy.

A  joint council of experts in the field of hepatology reviewed the results of experimental and clinical studies evaluating the efficacy of hepatotropic drugs (ademetionine, ursodeoxycholic acid, ornithine, bicyclol,  morpholinium
tiazotate, phospholipids, a fixed combination of inosine + meglumine + methionine + nicotinamide + succinic acid), glucocorticoids, extracorporeal detoxification methods in drug-induced liver injury (DILI); inclusion of these medications and treatment methods in clinical guidelines in various countries was analyzed.

Indications for the use of hepatotropic drugs were formulated depending on the pattern of DILI (hepatocellular, cholestatic, mixed), as well as in some DILI phenotypes.

Objective. To investigate the main risk factors and symptoms of hemorrhoids in maternity patients in the postpartum department of the PC of the Saratov region for the period from 2021 to 2022 by means of anonymous questionnaire.

Materials and methods. Patients were categorized into 3 groups according to receipt of progesterone therapy during the last pregnancy: In Group I, pregnant and postpartum women did not receive hormonal therapy (n=114). Group II included pregnant and postpartum women who received progesterone during their pregnancy for not more than 1 trimester (n=64). Group III consisted of pregnant and postpartum women whose pregnancy resulted from IVF. They received progesterone therapy for 2 or more trimesters (n=36).

Results. The study revealed that hemorrhoid symptoms were statistically more frequent in the women from group III, who had received progesterone hormone therapy for more than 2 trimesters. The most significant risk factors for the development of hemorrhoids in pregnant and postpartum women were: natural delivery: the number of births 3 and more; prolonged gestagens intake; tendency to constipation; positive family history of hemorrhoidal and varicose diseases.

Conclusions. Unfortunately, hemorrhoids in pregnant and postpartum women is still an urgent problem of interdisciplinary control of proctologic complaints in pregnant and postpartum women. Most physicians do not give recommendations on the present symptomatology in women.

Objective. To study the diagnostic representativeness of ScolView™ clinical photogrammetry compared to the results of computer optical topography.

Materials and methods. The study material included protocols for the functioning of computer optical topography and ScolView™ for 160 participants of both sexes with an average age of 8 ± 0.78 years.

 Results. Despite the excellent physical principles of the methods, the ScolView™ outputs have a significant number of reliable correlations that lend themselves to logical clinical interpretation. The study data determined a total of 54 reliable Spearman criteria in the range of 0,712–0,800 when comparing the output data of both methods in three planes.

Conclusions. The work carried out is pioneering and at the same time prospective – for the purpose of a deeper analysis of the output data of ScolView™ with the segregation of the participants into comparison groups depending on the severity of spinal deformity.

Objective. To assess the levels of homocysteine, thrombocytes and indicators of systemic inflammation in patients with inflammatory bowel disease, non-alcoholic fatty liver disease and their combination depending on the severity and phenotype of the disease.

Materials and methods. A total of 62 patients with non-alcoholic fatty liver disease (NAFLD), ulcerative colitis (UC), Crohn's disease (CD) at the onset and exacerbation of the disease were examined. The following hemostasis parameters were studied: vascular (homocysteine) and platelet (platelet count). The levels of CRP, fibrinogen, α-1 and α-2 globulin were assessed as markers of systemic inflammation.

Results. The CRP value in the IBD and NAFLD group was 4.4 times higher than in patients of the NAFLD group, p=0.03, and 1.8 times higher than in patients with IBD, p=0.121. No significant differences in acute phase protein levels were revealed in the IBD and NAFLD groups. No changes were observed depending on the disease phenotypes either. The proportion of individuals with hyperhomocysteinemia was 2.4 times higher in the IBD+NAFLD group than in patients with isolated NAFLD, p=0.055. A correlation between the homocysteine ​​level with the NAFLD phenotype and the homocysteine ​​level with the severity of an IBD attack was detected. In patients with IBD, the homocysteine ​​level correlated with the marker of systemic inflammation (a-1 globulin), r = 0.587, p = 0.05. Platelet values ​​were significantly higher in individuals with combined pathology of IBD and NAFLD than in patients of the group with isolated NAFLD, p = 0.000. There were no differences in platelet levels depending on the phenotypes of IBD and NAFLD.

Conclusions. The homocysteine ​​level and platelet count in patients with associated course of IBD + NAFLD are higher than those in the isolated groups. Moreover, the values correlate with the severity of an IBD attack and the degree of systemic inflammation and depend neither on IBD phenotype nor on NAFLD phenotype.

Objective. To develop a machine learning model for predicting the fact of recurrence in patients with thyroid cancer after surgical intervention.

Materials and Methods. According to the aim of the study, the case histories of 300 patients who had undergone surgical intervention for thyroid cancer were analyzed. The average age was 43.54 years. All patients included in the study underwent a comprehensive examination according to the clinical recommendations on the diagnosis and treatment of patients with thyroid cancer. Selection of the most appropriate model in machine learning is critical as it directly affects the accuracy and efficiency of prediction. Selection of the best model was done through comparing the performance of different algorithms on the same training sample using cross-validation. Each model was evaluated on such metrics as average accuracy and standard deviation to determine which model demonstrates the best results.  The random forest model performed best in terms of average accuracy and was used hereafter. The model was trained using a matrix of predefined features. Using param grid, we can efficiently adjust hyperparameters such as the number of trees, maximum depth and minimum number of samples for separation, which will help us to find the optimal settings for our task. RandomizedSearchCV method was used to select the hyperparameters. During the hyperparameter search process, the model was trained on training data selected as 70% of the original dataset. The search resulted in the following best hyperparameters for the random forest model for our data specifically: n_estimators = 161; min_samples_split = 5; max_leaf_nodes = 39; max_depth = 12; bootstrap = True.

 Results. A model that demonstrated high target feature accuracy was trained during the study. The proportion of patients with postoperative recurrence correctly identified by the model was 98 % of all patients with recurrence, and the proportion of patients without recurrence correctly classified by the model «as patients at no risk of recurrence» was 95 % of all patients without recurrence. This shows that the developed model effectively handles the task of classification based on medical parameters, which may be particularly important for decision making in clinical practice. The high accuracy indicates the reliability of the model and its ability to identify cases of recurrence correctly, this may contribute to the improvement of diagnostics and treatment.

Conclusions. A machine learning model to predict a high probability of thyroid cancer recurrence based on the analysis of medical parameters was developed while carrying out the study. The development process began with careful data preprocessing, which is a critical step in reliable models’ construction. During preprocessing, outliers and columns containing monotonic values were removed to improve the data quality and avoid distortions in the model training. Categorical variables were also coded to ensure that they could be used correctly in machine learning algorithms, and correlated features were excluded to minimize multicollinearity and increase the interpretability of the model.

Objective. To identify the current features of the epizootiological and epidemiological situation of Crimean hemorrhagic fever (hereinafter referred to as CHF) in the Rostov region to improve the strategy of preventive (anti-epidemic) measures.

Materials and methods. The data from the Reference Center for monitoring the causative agent of CHF of the Federal Medical Institution Stavropol Anti-Plague Institute of Rospotrebnadzor and the Office of Rospotrebnadzor in the Rostov region are used in the work. Methods of epidemiological analysis, laboratory diagnostics, statistical methods were applied.

Results. The data on the epizootic activity of natural foci of CHF in the Rostov region in recent years were obtained, the features of the natural foci formation were analyzed, the main sources and carriers of the infectious agent were determined, and the epidemiological profile of the epidemic process of CHF in the Rostov region was compiled. A conditional classification of municipal divisions of the Rostov region (cities and districts) according to the degree of epidemic activity has been developed and proposed.

Conclusions. As a result of the studies, the main current features of epizootic and epidemic processes of CHF in the Rostov region were identified, considering them an additional complex of preventive (anti-epidemic) measures aimed at preventing the population morbidity with CHF was proposed. It was determined that 40 administrative territories out of a total 55 of the region were involved in the epidemic process, the expansion of the endemic area (nozoareal) of the natural focus was proved.

A clinical case of a patient treated for a rare disease of dysgenetic polycystosis of the parotid salivary glands was analyzed.

Patient S., a 46-year-old man, was treated in the department of maxillofacial surgery from 25.11.24 to 02.12.24. Over the past 5 years, he noted a painless enlargement of the parotid salivary glands, which was confirmed by the clinical examination. The diagnosis of polycystosis of parotid salivary gland was confirmed histologically. Recommendations on the treatment strategy for patients with dysgenetic polycystic disease are proposed.

March 23, 2025 marked the 125^th anniversary of Professor A.V. Pshenichnov, the founder of the Perm microbiological school, Honored Scientist, and Laureate of the State Prize. The article provides a historical overview on the main scientific achievements of Professor A.V. Pshenichnov and his students. His most significant researches are in the field of rickettsiosis, in particular epidemic typhus and Volyn fever, as well as tick-borne encephalitis. He and his colleague B.I. Raikher were awarded the State Prize for the development of a vaccine for the prevention of epidemic typhus, which played a decisive role in the fight against this disease during the Great Patriotic War. Students and followers of Professor A.V. Pshenichnov continue the traditions established by him as a long-term head of the department. At present, the department staff, together with specialists in various fields, are conducting successful researches on current issues of medical microbiology.