Russian Medicine

BACKGROUND: The role of serum immunoglobulin A is often underestimated; however, its functions in systemic protection and endotoxin clearance make it an important marker of the “cost of adaptation.” Serum immunoglobulin A concentration depends on sex and age, but the influence of contrast climate and the specifics of non-contact injury during the off-season has not been thoroughly studied before.

AIM: To assess the influence of climatic factors and the specifics of non-contact injury on the variability of serum immunoglobulin A levels, taking into account age and sex, in elite athletes during the off-season.

METHODS: A retrospective analysis of data from 7549 athletes (mean age 19.98 years) was performed. Comparative pairs were formed: “Biathlon–Triathlon” (climate influence with similar energy expenditure) and “Figure Skating–Speed Skating” (influence of biomechanics and injury patterns). Serum immunoglobulin A levels were measured using immunochemiluminescence analysis (g/L). Statistical analysis included estimation of 95% confidence intervals and neural network modeling (multilayer perceptron) to assess the contribution of factors.

RESULTS: Reduced serum IgA levels were observed in athletes participating in winter and impact-loading sports. In biathletes, the level (1.67 g/L) was lower than in triathletes (1.73 g/L); the weight of the cold factor was –0.443. The minimum value was recorded in figure skating (1.40 g/L), which was significantly lower than that in speed skating (1.68 g/L). Modeling showed that impact loads (weight: –0.548) were associated with a lower level of serum immunoglobulin A. Sexual dimorphism (males > females) and positive age-related trends were confirmed.

CONCLUSION: Serum immunoglobulin A serves as a sensitive integrated marker of allostatic load. Cold stress and chronic trauma resulting from impact loads act as independent factors contributing to its reduction. The risk group includes female and young athletes specializing in complex coordination and winter sports.

BACKGROUND: Access to dental care for homeless individuals remains a substantial healthcare system challenge, driven by a combination of social, organizational, and legal barriers. Given the limited engagement of this population in planned healthcare services, the analysis of process characteristics of dental care delivery in specialized, socially oriented settings is of particular importance.

AIM: This study aimed to characterize process indicators of dental care delivery to homeless individuals in a specialized, socially oriented dental clinic.

METHODS: A retrospective observational study was conducted based on the analysis of anonymized medical records from a specialized clinic for 2022–2025. Sociodemographic characteristics of patients, healthcare utilization indicators, the volume and structure of dental interventions, repeat visits, and patient encounters across different calendar years were analyzed. The analysis was descriptive and included calculation of absolute and relative indicators, as well as medians and interquartile ranges.

RESULTS: Data from 547 patients were included. The study population was socially heterogeneous in terms of living conditions and documentation status. Changes in the number of unique patients, total visits, and dental interventions were observed across years. The structure of care included diagnostic, surgical, therapeutic, and preventive interventions, with variations in their proportions over time. Repeat visits were recorded in a subset of patients, including visits spanning two or more calendar years.

CONCLUSION: The findings characterize organizational features of dental care delivery for homeless individuals in a specialized, socially oriented clinic and may inform planning and evaluation of similar care models for socially vulnerable populations. Study limitations include the retrospective design and data from a single clinic.

This review focuses on the analysis of bacterial biofilms as one of the most significant risk factors for the development and chronicity of infectious complications in surgery. Biofilms are structured communities of microorganisms encased in a protective exopolysaccharide matrix, which exhibit high resistance to standard antibiotic therapy and host immune factors through a combination of mechanisms, including limited diffusion of antibacterial agents, the presence of metabolically inactive persister cells, and active horizontal gene transfer of resistance determinants.

This review systematizes data on the clinical significance of biofilms in implant-associated infections, chronic wounds, peritonitis, and mediastinitis. Modern diagnostic methods are examined in detail, highlighting the limitations of traditional microbiological culturing techniques and the significant potential of imaging approaches (specifically confocal microscopy), molecular genetic methods, and the value of detecting specific biofilm biomarkers.

The section on prevention emphasizes the methods for modifying implant surfaces and the application of antimicrobial coatings during surgical procedures. Eradication strategies are analyzed from the perspective of a combined approach, encompassing radical surgical debridement of the infectious focus, physical methods (negative pressure wound therapy with instillation, ultrasonic cavitation), and contemporary pharmacotherapy principles that involve local and systemic antibiotic delivery. Promising innovative directions are highlighted separately, including the use of quorum-sensing inhibitors, bacteriophages producing depolymerases, enzymatic matrix degradation, electrochemical methods, and nanotechnological systems for targeted delivery of antibacterial agents.

We emphasize the necessity of developing multimodal strategies that integrate surgical, physical, and pharmacological methods for the effective control of biofilm-associated infections, which is expected to subsequently reduce the incidence of postoperative complications.

Hypertension is a global public health problem. According to the World Health Organization (September 2025 data), at least 1.4 billion adults aged 30–79 years worldwide live with this condition. However, only 44% of patients receive treatment, and effective disease control (defined as achieving standard target blood pressure [BP] levels) is achieved in just 23% of those requiring therapy. This highlights the necessity of enhancing out-of-hospital blood pressure monitoring through the development of innovative digital remote systems.

This review aimed to identify the key characteristics of international digital systems for BP monitoring, including mobile applications, messengers, chatbots, artificial intelligence–based platforms, and smart devices. The work is based on an in-depth analysis of 38 substantial publications selected using Google ecosystem tools and relevant search queries in the PubMed database.

Digital technologies for BP monitoring are implemented using solutions that include automated BP measurement and recording systems, telemonitoring, remote patient communication tools, and computer-based medical data processing.

The implementation of these technologies considerably expands the capabilities for monitoring and follow-up of patients with hypertension, surpassing traditional methods. However, their widespread adoption requires technical device validation, standardization of application methodologies, training of personnel and patients, and additional research in real-world clinical settings.

Periodontitis remains one of the leading causes of tooth loss, with disruption of microbial balance in the oral cavity considered a key mechanism in its pathogenesis. In recent years, growing interest has focused on the oral microbiota as a therapeutic target, highlighting the relevance of analyzing current approaches aimed at restoring microbial balance and reducing inflammatory activity.

The review aimed to evaluate the effectiveness of probiotics, prebiotics, and other microbiota-modulating interventions in periodontitis. An analysis of publications from 2020 to 2025, including clinical studies and reviews, demonstrated that the use of probiotics (Lactobacillus reuteri, L. salivarius, Bifidobacterium spp.) and prebiotics (inulin) is associated with a reduction in periodontal pocket depth, decreased gingival bleeding, normalization of microbial composition, and reduced levels of proinflammatory cytokines. The most pronounced clinical effect was observed when these agents were combined with conventional mechanical debridement of root surfaces.

The available evidence indicates that modulation of the oral microbiota represents an effective and safe adjunctive approach in the treatment of periodontitis. This review systematizes current data on the use of probiotics and prebiotics in dentistry and identifies promising directions for future clinical research aimed at optimizing treatment protocols.

High-energy pelvic fractures represent a considerable challenge in modern traumatology and orthopedics, associated with a high risk of massive blood loss, thromboembolism, neurological deficits, and prolonged lоss of function. Unstable, comminuted fractures pose a particular difficulty, requiring not only early stabilization but also precise anatomical reductiоn of all elements of the pelvic ring.

Achieving proper fragment alignment, especially in cases of vertical and rotational displacement, remains a complex task. Open surgical approaches are associated with significant blood loss, risk of damage to neurovascular structures, and infectious complications, highlighting the need for the development of minimally invasive techniques.

This article describes the clinical experience of intraoperative application of a pelvic reduction frame for anatomical reduction in a comminuted pelvic fracture, as well as an assessment of rehabilitation outcomes, long-term functional results, and patient quality of life.

We present a clinical case оf a 39-year-old patient who sustained multiple pelvic fractures due to a fall from height. The article demonstrates the use оf an intraoperative pelvic reduction frame (hereinafter referred to as the “pelvic frame”) during closed reduction and osteosynthesis of the pelvic ring, which facilitated early patient verticalization and led to good functional outcomes (Majeed score 88, Oxford Hip Score 52).

This clinical case confirms the effectiveness of using a pelvic frame in the treatment of complex, vertically unstable pelvic fractures. The methоd provided accurate closed reduction and stable fixation without the need for extensive surgical approaches. This, in turn, enabled early mobilization and a favorable long-term functional result.