Background. Psoriasis is a chronic autoimmune inflammatory disease characterized by T-cell activation and keratinocyte involvement in disease pathogenesis. This disease is genetically determined (penetrance exceeds 60%).
Objective. To perform the typing of HLA-C*06 and HLA-B*27 allelic variants in moderate-to-severe psoriasis patients residing in St. Petersburg.
Methods. A prospective allele-specific genotyping of the HLA-C*06 and HLA-B*27 loci associated with psoriasis was performed in 165 moderate-to-severe psoriasis patients residing in St. Petersburg using a polymerase chain reaction. The authors assessed psoriasis severity and analyzed concomitant and comorbid conditions in patients with psoriasis, as well as performed allele-specific genotyping (identification of the HLA-C*06 and HLA-B*27 alleles) using a real-time polymerase chain reaction, followed by an analysis of amplification products. In order to assess the impact of genetic polymorphisms on clinical outcomes in psoriasis, the odds ratio (95%) and relative risk (95%) were determined using database data (http:// www.allelefrequencies.net/) and original research for comparison.
Results. The study shows the significance of HLA-C*06 detection in psoriasis patients at the stage of initial diagnosis. This genetic marker can be used to predict the risk of disease progression with aggravation of skin symptoms and to choose the appropriate treatment strategy. The obtained data also confirm the significance of genotyping psoriasis patients for the HLA-B*27 allele, since the presence of this variant is associated with an increased risk of developing psoriatic arthritis (arthropathic psoriasis). Psoriasis patients are advised to undergo genotyping for the HLA-B*27 and HLA-C*06 alleles in the early stages of treatment to identify individuals at high risk of hypertension (high blood pressure).
Conclusion. The genetic predisposition of psoriasis patients largely determines disease development and comorbidity risks. Early genotyping for informative alleles can optimize the selection of a patient management strategy. The genotyping of psoriasis patients for HLA-C*06 and HLA-B*27 alleles can help predict the severity of the disease, as well as anticipate multimorbidity and refer patients to specialists for further consultation.

Background. Cervical insufficiency, often associated with genital infections, remains one of the leading causes of extremely preterm and early preterm births. Since cervicovaginal infections change the antimicrobial properties of cervical mucus, studies of local immunity can offer new insights into the pathogenesis of this pregnancy complication and help predict preterm birth.
Objective. To examine a local immune response in the cervical mucus of pregnant women with cervical insufficiency that leads to preterm birth.
Methods. A retrospective cohort study of 106 pregnant women with cervical insufficiency was conducted. These women were diagnosed with cervical insufficiency according to the clinical guidelines (Cervical Insufficiency, 2021). A microscopic and biomolecular analysis of vaginal and cervical material was performed for all patients. Additionally, the following parameters were estimated in the cervical mucus of 58 randomly selected women: total white blood cell count and functional activity and viability of neutrophils, as well as the levels of macrophage inflammatory protein 1β, high-mobility group protein B1, and matrix metalloproteinase-8. A statistical analysis of the results was performed retrospectively, depending on obstetric outcomes: premature and term births. The obtained data were statistically processed using the SPSS software (version 25.0, IBM, USA). Differences in parameter values between the groups were considered statistically significant at p < 0.05.
Results. Cervicovaginal infections in women with cervical insufficiency were detected in 84.9% of cases in the preterm birth group and in 57.5% of cases in the term birth group (p = 0.002). In both groups, cervicitis was found to be prevalent. In the immunological study of cervical mucus, the group with cervical insufficiency leading to preterm birth differed most significantly in the number of neutrophil extracellular traps, as well as in the levels of macrophage inflammatory protein 1β and high-mobility group protein B1.
Conclusion. Cervicovaginal infections constitute a risk factor for preterm birth. In patients with cervical insufficiency, changes in the local immunity markers of cervical mucus can serve as predictors of preterm birth.

Background. Modern dental restoration relies on achieving reliable adhesion between dental fillings and hard tissues, which is largely determined by the quality of tooth preparation.
Objective. To analyze the effect that the condition of working parts in Diatech and MANI diamond burs, as well as chemically different conditioners, can have on the quality of tooth surface preparation.
Methods. A nonrandomized experimental controlled study was conducted using 64 intact molars that had been previously extracted for medical reasons; artificial Class I cavities of the same size were drilled in these teeth (as per G.V. Black’s classification). An air-turbine handpiece, Diatech diamond burs (with a grit size of 64–126 µ), and MANI burs (with a grit size of 106–126 µ) were used to prepare the teeth. These teeth were divided into four groups of 16 teeth each depending on the use of new or previously used diamond burs, as well as eight subgroups of eight teeth each; in half of them, the prepared surfaces were conditioned with Travex37 (Omega Dent, Russia) containing 37% orthophosphoric acid; the other half, with Multi Etchant gel containing an adhesive phosphate monomer (M-TEG-P) (Yamakin, Japan). The enamel and dentin were conditioned for 30 and 15 seconds, respectively, followed by rinsing with a jet of water and air for 60 seconds. The used burs and conditioned tooth surfaces were examined using a scanning electron microscope. The quality of conditioned tooth surfaces was comparatively analyzed through the study of electron diffraction patterns of five dentin areas obtained for each tooth; each examined surface was rated on a scale from 0 to 3. The obtained data were statistically processed using Statistica 12.0 (StatSoft, USA) and Microsoft Office Excel 2017 (Microsoft Corporation, USA). Differences were considered statistically significant at p < 0.05.
Results. A comparative analysis of the electron diffraction patterns of tooth surfaces from four experimental groups revealed a relationship between the quality of a diamond bur (the presence of visually and microscopically detectable areas on the bur surface that lack the diamond abrasive layer) and the structural characteristics of a tooth surface after preparation and conditioning. The use of both new (in 62.5% of cases) and previously used (in 100% of cases) MANI burs to prepare the surfaces led to the detection of cracks in the dental hard tissues. According to the analysis of electron diffraction patterns with the use of to the developed scale, Multi Etchant gel was found to ensure better preparation of tooth surfaces for the next stage than 37.0% orthophosphoric acid as it provides a cleaner surface even in the case lower-quality diamond burs. For example, areas of dentin surface prepared with the Mani burs and conditioned with Multi Etchant scored 1 point in 72.5% of cases, while those conditioned with Travex were given a score of 1 in only 37.5% of cases.
Conclusion. A microscopic examination of the previously used Diatech burs (ten cycles of use), revealed insignificant wear of the diamond coating, which manifested itself in a partial loss of the abrasive layer on the working surface. Therefore, the effect of bur wear on the quality of tooth surface preparation is insignificant, which contributes to the formation of a smooth surface during tooth preparation and a reduced frequency of crack formation.

Background. Lean principles are currently driving the development of primary healthcare, allowing organizations to reduce waste and address operational issues, as well as decrease the risk of burnout in healthcare workers. Professional burnout is a widely recognized workplace problem in both rich and poor countries, posing a serious threat not only to the social and professional lives of physicians but also to the health of their patients. Lean principles aim to improve the operational efficiency of healthcare organizations. Workforce optimization allows healthcare workers to better perform their duties, preventing (or mitigating) factors that contribute to professional burnout, and helps ensure the required accessibility and quality of healthcare.
Objective. To analyze the relationship between the experience of healthcare workers in lean principles and the level of professional burnout among employees of healthcare organizations under modern conditions.
Methods. A single-center prospective survey study was conducted based on a questionnaire survey completed by 201 healthcare workers from organizations providing primary care. In the study, the authors used an original questionnaire entitled “Lean Competencies of Healthcare Professionals,” as well as the burnout assessment tool developed by Christina Maslach and Susan Jackson and adapted for physicians by Natalia Vodopyanova (Attitude to Work and Professional Burnout). The survey was carried out using Online Test Pad, a multifunctional online service for conducting tests and training. The main focus of the study was to assess statistically significant correlations between the level of professional burnout in healthcare workers and their experience in lean principles. In order to assess the level of burnout among healthcare workers, the authors used a validated procedure developed by Natalia Vodopyanova, which is based on Maslach and Jackson’s three-dimensional model of burnout, comparing the results with those of a survey aimed at evaluating the experience in lean principles. The study results were statistically analyzed using IMB SPSS Statistics software (version 23; StatSoft, USA). The results were considered statistically significant at p < 0.05.
Results. The study revealed that as healthcare workers gain experience in lean projects, they experience lower levels of professional burnout. Participation in project teams working to improve healthcare organizations was inversely correlated with emotional exhaustion, work-related stress, lack of on-the-job development, and low overall self-esteem: healthcare workers with a greater commitment to lean principles suffered less from reduced personal accomplishment, which is part of professional burnout.
Conclusion. Further research into the relationship between the application of lean principles in medicine and the level of professional burnout among healthcare workers could improve the quality of healthcare and workforce productivity in this industry.

Background. Achalasia is a rare disorder characterized by the loss of esophageal peristalsis and the failure of the lower esophageal sphincter to relax during swallowing.
Сase description. A 28-year-old female patient was urgently admitted to the Regional Clinical Hospital No. 2 (Ministry of Health of Krasnodar Krai) on February 29, 2024 at 28 weeks of pregnancy. Admitted in a serious condition, the patient presented with the following complaints: severe nausea, vomiting up to 10–15 times a day (which includes after eating liquid food), weakness, and dizziness for three weeks. Her medical history revealed recurring complaints since the age of 17; she had not been seen by a gastroenterologist. The patient attributed the latest symptoms to pregnancy. Based on her complaints, medical history, clinical picture, and examination data, the patient was preliminarily diagnosed with aspiration pneumonia and Type III esophageal achalasia. The patient was admitted to the intensive care unit. The opinion of the medical team, consisting of an obstetrician, a surgeon, a gastroenterologist, an intensivist, and a neonatologist is as follows: “aspiration pneumonia; Type III achalasia; 28 weeks pregnant; dysmetabolic Wernicke’s encephalopathy with a mild vestibular ataxia and oculomotor disorders; starvation ketosis in gestational diabetes mellitus in the context of a diet therapy; Grade 2 anemia; weight deficit (body mass index of 17.3 kg/cm2 ).” A blood transfusion was performed on March 2, 2024. Due to the severity of the patient’s condition, the presence of complications of the underlying disease, and the need to restore enteral nutrition, the medical team decided to surgically treat esophageal achalasia using peroral endoscopic myotomy. After the procedure, the patient received follow-up monitoring for three months at a maternity care center. During this period, the patient gained 5.5 kg. The baby was born full-term via natural birth, with an Apgar score of 8–9.
Conclusion. The use of peroral endoscopic myotomy in a pregnant patient is a rare case in global practice. The procedure was successful and had no effect on the further development of the fetus, enabling the patient to resume normal eating habits and ensuring the healthy development of the fetus.

Background. Treatment of children with suppurative maxillofacial space infections remains an ongoing problem, which is exacerbated by the growing microbial resistance and immune response dysfunction that can prolong the recovery process.
Objective. To analyze the clinical and immunological effects of using an immunomodulator based on a synthetic hexapeptide (Imunofan) in a combination therapy of suppurative maxillofacial space infections in children.
Methods. A prospective nonrandomized comparative pilot trial was conducted. The study included 47 children aged 8–17 years with suppurative maxillofacial space infections, who were comparable in terms of the baseline data. The patients received either the standard treatment (surgical debridement + antibiotics; n = 27, Subgroup 1) or the standard treatment supplemented with Imunofan (45 µg/day intramuscularly for five days; n = 20, Subgroup 2). The comparison group comprised 13 relatively healthy children. The study assessed the subpopulations of lymphocytes (via flow cytometry), the levels of immunoglobulins, and the phagocytic activity of neutrophilic granulocytes. The obtained data were processed using Microsoft Excel 2019 (Microsoft, USA) and an online calculator (https://medstatistic.ru). In order to control the risk of Type I errors in the multiple comparisons of immunological parameters, the Holm-Bonferroni correction was used. After correction, the significance level was set at p < 0.05.
Results. Prior to treatment, the children with suppurative maxillofacial space infections were found to have combined immune disorders: decreased relative count of T lymphocytes, helper T cells (CD3+CD4+ ), and cytotoxic lymphocytes (CD3+CD8+ ), as well as incomplete phagocytosis. The standard treatment (Subgroup 1) normalized only the leukocyte level (p < 0.05 after correction), while cellular immunity and phagocytic function remained impaired. In Subgroup 2, a clear tendency was observed toward the normalization of median T-cell parameters (T lymphocytes: 76.1% in Subgroup 2 vs. 75.73% in the comparison group; helper T cells: 46.75% vs. 46.05%) and significantly improved completeness of phagocytosis; however, after correction for multiple comparisons, no statistically significant differences were found in most immunological parameters between Subgroup 2 and the comparison group. The key clinical outcome was a statistically significant reduction in the hospital length of stay in Subgroup 2 as compared to Subgroup 1 (8.70 ± 2.49 vs. 12.89 ± 1.50 days, p = 0.02).
Conclusion. The study results indicate the potential efficacy of Imunofan immunomodulator in the combination therapy of suppurative maxillofacial space infections in children, which manifests itself in the positive changes in the immunological parameters and a significant reduction in the hospital length of stay. The obtained data justify further randomized controlled effectiveness trials.

Background. The traditional division of the educational process into the mastery of fundamental concepts, acquisition of theoretical knowledge, its practical application, and development of skills significantly reduces its effectiveness, as does the teaching of fundamental disciplines to residents and postgraduate medical students as independent components within a program or through different approaches and delivery methods. This gives rise to innovative perspectives and leads to the implementation of new ideas and teaching methods, particularly those based on integration principles related to theory and practice, while raising interdisciplinary issues and problems associated with various forms of postgraduate medical education. Noteworthy is that in addition to the varying availability and feasibility of educational technologies based on these principles, certain contradictions arise when integration principles are applied, which raises the need to improve their use in the educational process.
Objective. To apply an original integrative model of an educational module together with other modules and evaluate its effectiveness in improving a postgraduate pulmonology education program.
Methods. A group of residents and postgraduate medical students were educated using traditional and original integrative models of the educational module developed through analysis of an extensive body of literature and research findings. The integrative model combined horizontal and vertical integration and was implemented before or after completing other modules. It was compared with the traditional model of the educational module primarily by evaluating answers to test questions.
Results. The obtained indicators and comparative effectiveness evaluation of the traditional and integrative models indicate a more significant trend toward correct answers when the latter model is used (p < 0.05), i.e., an increase in the number of correct answers by over 1.5 times. The effectiveness of the integrative model is higher when it is completed after other modules (by 18.2%) rather than before them. These data are consistent with the conducted student questionnaire survey.
Conclusion. The education of postgraduate medical students and residents can be significantly improved with the use of the integrative model of the educational module. This module should ideally be completed after other Pulmonology modules.