Russian Family Doctor

Diabetes mellitus (DM) and oral inflammatory diseases are common and exhibit a bidirectional pathogenetic relationship, which is clinically important for primary care physicians. Hyperglycemia initiates a cascade of pathological processes, including endothelial dysfunction, accumulation of advanced glycation end products, oxidative stress, dysbiosis, and a hyperinflammatory immune response. These factors contribute to the higher rates of periodontitis (43.7% vs. 25%), candidiasis, and xerostomia in patients with DM. HbA1c is a modifiable risk factor: levels >8% are associated with increased risk of severe periodontitis and qualitative changes in the oral microbiota, whereas levels < 7% reduce dental complication rates to a level comparable to that patients without confirmed DM. Treatment of periodontitis contributes to improved glycemic control (HbA1c reduction by 0.48%–0.53%), corroborating the concept of a bidirectional relationship. Nevertheless, dental screening by primary care physicians is infrequent: only 5.7% routinely take a dental history, and 12.1% refer patients to a dentist.

This review synthesizes data on the pathogenetic mechanisms underlying the relationship between DM and oral inflammatory diseases, examines the role of HbA1c as a predictor of dental complications, and offers practical outpatient screening and referral recommendations. Regular flossing reduces the risk of periodontitis by 39% and lowers HbA1c by 0.30%, thereby confirming the potential for preventing dental complications in patients with DM. Promising directions include the development of standardized interdisciplinary protocols and training programs on oral examination for general practitioners, and integration of screening tools into primary care and dental practice. A comprehensive approach would shift care from isolated parameter monitoring to effective interdisciplinary DM management.

Allergic bronchial asthma is one of the most significant healthcare challenges, with high comorbidity with other atopic conditions, as reflected in the “unified airway” concept.

This review focuses on the analysis of current evidence regarding the role of the gut–lung axis—a bidirectional communication system that integrates immunological, metabolic, and microbial interactions between the gastrointestinal microbiota and the respiratory system. The article thoroughly examines the influence of perinatal factors on early microbiome development, a critical period for immune maturation. Meta-analyses confirm that cesarean delivery, lack of breastfeeding, and early antibiotic use significantly increase asthma and atopic march risk.

Particular attention is paid to the mechanisms by which gut dysbiosis contributes to Th2-mediated inflammation, including impaired short-chain fatty acids production, lymphocyte migration, and systemic circulation of proinflammatory cytokines.

The article systematizes the evidence supporting the efficacy of microbiome-oriented prevention and therapy strategies. It has been established that specific probiotic strains, such as Lactobacillus rhamnosus HN001 and Bifidobacterium lactis Probio-M8, as well as bacterial lysates (OM-85), improve disease control and reduce the frequency of exacerbations. For primary care physicians, we define patient selection criteria for adjuvant therapy, including those with resistant asthma, gastrointestinal comorbidity, and recurrent respiratory infections. Dietary interventions, namely the Mediterranean diet and fiber intake (25–35 g/day), also show protective effects via immune modulation.

Despite the absence of clear algorithms in current Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines, these data substantiate the need to integrate microbiome assessment and corresponding nutritional and metabolic corrections into routine clinical practice to improve allergic bronchial asthma management. The authors conclude that modification of early risk factors and personalized correction of microbiota composition open new prospects for primary prevention and personalized treatment of respiratory allergies.

BACKGROUND: Sepsis is a generalized inflammatory response to infection of various origins, accompanied by multiple organ dysfunction, hemodynamic disturbances, and hemostatic disorders. Because of the high rate of severe complications, both early etiotropic and pathogenetic therapy and timely diagnosis are crucial.

AIM: To analyze the current clinical and epidemiological characteristics of sepsis using data from a multidisciplinary medical facility.

METHODS: A cohort study of epidemiological and clinical data on sepsis cases recorded at the S.P. Botkin Clinical Infectious Diseases Hospital from 2019 to 2024 was conducted. Medical records of patients hospitalized with sepsis from January to June 2025 were also reviewed.

RESULTS: From 2019 to 2024, 356 sepsis cases were recorded. The highest mortality rates occurred in 2022 and 2023: 32.4% and 41.7%, respectively. The most common etiologies were unspecified sepsis, staphylococcal sepsis, and sepsis due to gram-negative organisms. Mortality was highest in meningococcal and streptococcal septicemia and gram-negative sepsis. At onset, flu-like symptoms and intestinal dysfunction were noted, followed by systemic inflammatory response syndrome, multiple organ failure, coagulation disturbances, and cardiovascular complications. The mean age was 50.5 ± 15.5 years. Risk factors included extensive comorbidities, trauma, surgery, drug addiction, alcoholism, and low social status.

CONCLUSION: The rising incidence of septic complications, predominance of working-age patients with increased comorbidity, flu-like symptoms, and signs of acute intestinal infection at onset should raise awareness among physicians of all specialties for the timely detection of systemic inflammation and initiation of adequate treatment.

BACKGROUND: Demographic aging in the Russian Federation shows marked regional variation. The existing geriatric care system uses the administrative age criterion, which creates a mismatch with biological aging and leads to the phenomenon of “hidden demographic burden.” A uniform approach to geriatric care planning ignores regional differences.

AIM: To provide a scientific basis for transitioning to cluster-oriented geriatric care planning by validating the concept of “hidden demographic burden.”

METHODS: The study had two stages. Stage 1 was a cohort study of demographic trends in Saint Petersburg (2019–2024) with scenario forecasting (2025–2030). Stage 2 was a multicenter cross-sectional study with cluster analysis of 12 Russian regions. We also analyzed population-based frailty screening data (n = 378,631). Bootstrap stability analysis, cross-validation, and sensitivity analysis were performed.

RESULTS: In 2024, for the first time in Saint Petersburg, the biological (60+) group exceeded the administrative group by 31.6 thousand people. Population screening showed an exponential rise in frailty prevalence with age. K-means clustering identified three regional clusters: “Depressive” (n = 8), “Urbanized” (n = 3), and “Special Conditions” (n = 1). The silhouette coefficient was 0.41, indicating a satisfactory structure. Bootstrap analysis confirmed high stability for Cluster 1 (Jaccard = 0.89) and good stability for Cluster 2 (Jaccard = 0.76).

CONCLUSION: These findings support the “hidden demographic burden” concept and justify a shift to cluster-oriented geriatric care planning. A key limitation is the small sample size for cluster analysis, which requires validation of the typology on a larger sample.

BACKGROUND: Over the past few years, many studies have confirmed the role of chronic non-communicable diseases in the risk of hand osteoarthritis development and progression. However, information on the comorbidity profile in patients with hand osteoarthritis is limited to specific diseases, and data on the impact of comorbidity on joint symptoms are lacking.

AIM: To assess comorbidity in patients with hand osteoarthritis and its association with joint symptoms.

METHODS: The study included 101 women. Hand osteoarthritis was confirmed in 70 (69.3%) women, and large-joint osteoarthritis in 31 (30.7%). Among patients with hand osteoarthritis, the most common comorbidities were arterial hypertension (71.4%), obesity (37.1%), degenerative spinal disease (37.1%), osteoporosis (34.3%), pancreatobiliary disease (31.4%), and lower-extremity varicose veins (30.0%). Women with a Charlson Comorbidity Index of 3–4 had more severe night-time hand pain (p = 0.034) and a trend toward more severe morning stiffness (p = 0.065) than those with an index of 1–2.

RESULTS: 70 (69.3%) women had hand osteoarthritis, and 31 (30.7%) women had osteoarthritis of the large joints. In the structure of concomitant diseases in patients with hand osteoarthritis, the leading positions were occupied by arterial hypertension (71.4%), obesity (37.1%), degenerative disc diseases (37.1%), osteoporosis (34.3%), pancreatobiliary system diseases (31.4%), and lower extremity varicose vein disease (30.0%). Women with a comorbidity index of 3–4 had more severe pain in the hand joints at night (p = 0.034) and a tendency of more severe morning stiffness in the hand joints (p = 0.065) than women with a comorbidity index of 1–2.

CONCLUSION: Hand osteoarthritis is associated with high comorbidity. The disease is clinically heterogeneous, since patients with a higher Charlson Comorbidity Index experience more severe hand pain.