[ORGANIZATION OF MEDICAL CARE FOR ELDERLY PATIENTS UNDER THE CONDITIONS OF THE COVID-19 PANDEMIC].

The first report of the new coronavirus infection (COVID-19) appeared at the end of December 2019 and in March,2020 the World Health Organization announced COVID-19 a pandemic. The steady number of newly detected cases increase predetermined the modernization of the global healthcare system, shifting the paradigm of fighting with the COVID-19 pandemic towards maximum resource conservation. The change in the medical care provision for infectious patient's approach led first to a gradual decrease, and then to a complete cessation of planned surgical treatment, outpatient examinations, as well as observation of high-risk patients, which primarily include elderly patients. As a result of this, the key objective of this systematic review was to analyze sources of existing practice of providing urological care to patients of the older age group in the context of the COVID-19 pandemic. In accordance with the search for the keywords, the study reflects world and its own experience of MSMSU Urology Department in the treatment of age-related patients in the current epidemiological situation. The analysis showed that infectious complications from the urinary system take a leading position among the common complications inherent in elderly patients with COVID-19. The development of catheter-associated infection, the occurrence of antibiotic-resistant forms of bacteria, asymptomatic bacteriuria are only a small part of the problems clinicians have to face in newly profiled departments.

[The molecular mechanisms and morphological manifestations of leiomyoma reduction induced by selective progesterone receptor modulators]. / Molekuliarnye mekhanizmy i morfologicheskie proiavleniia reduktsii leiomiomy pod vozdeistviem selektivnykh moduliatorov retseptorov progesterona.

AIM: to investigate the molecular mechanisms and morphological substrate of reduced uterine leiomyoma in patients receiving the selective progesterone receptor modulator (SPRM) ulipristal acetate for 3 months, by estimating the immunohistochemical expression of the markers steroid receptor coactivator 1 (SRC-1), nuclear receptor corepressor 1 (NCoR-1), ER, PgR, Ki-67, p16, TGF-ß, and VEGF in tumor tissue. SUBJECTS AND METHODS: The investigation enrolled 75 women with uterine leiomyoma, menorrhagias, and anemia. Group 1 included 40 patients who were treated with ulipristal for 3 months, followed by laparoscopic myomectomy. Group 2 consisted of 35 patients who underwent surgery without previous preparation. The intra- and postoperative parameters and molecular and morphological changes in the myomatous nodules were comparatively analyzed in both groups. RESULTS: After 3 months of therapy initiation, menorrhagia completely ceased, myomatous nodules decreased in size (p<0.05), hemoglobin levels were elevated (p<0.01), and total intraoperative blood loss and operative time decreased in all the patients in Group 1. The morphological substrate of partial leiomyoma reduction was leiomyocyte apoptosis and dystrophy, tumor stroma sclerosis and hyalinosis with diminished Ki-67 expression and elevated p16 in the smooth muscle cells, trophic nodular tissue disorders exhibited by vascular wall sclerosis and lower VEGF and TGF-ß expression, and leiomyocyte hormonal reception dysregulation that made itself evident through the reduced expression of SRC-1 with the unchanged expression of PR and ER and the maintained level of NCoR-1. CONCLUSION: The molecular mechanisms of tumor reduction involved the reduced Ki-67 expression and elevated p16, lower VEGF and TGF-ß, diminished SRC-1 expression with the maintained level of PR, ER, and NCoR-1. Overall, this is suggestive of enhanced apoptosis and reduced leiomyoma proliferation and angiogenesis induced by SPRM and indicative of the expediency of using ulipristal acetate as a preoperative agent for organ-sparing surgery in reproductive-aged patients with uterine myoma, menorrhagias, and anemia.