Age-related Physiological Changes Research Articles

Evaluating pain management in older people after orthopaedic surgery - a study in Jordan.

Pain management in older people presents unique challenges due to age-related physiological changes, altered responses to medicines, comorbidities and polypharmacy. These challenges, which are exacerbated in those aged ≥75 years, can compromise the efficacy and safety of pharmacological treatment, including after discharge following orthopaedic surgery. To evaluate pain management and follow-up care provided in primary care settings in Jordan to older people who had undergone orthopaedic surgery. For this descriptive study, data were collected from the discharge summaries and electronic health records of older people who were receiving support from community nurses in rural primary care units in the Aqaba Governorate in Jordan after undergoing orthopaedic procedures in hospital. Of the 100 participants, 63 lived in a nursing home and 30 had been diagnosed with dementia. Hip fractures, diagnosed in 56 participants, were the most common reason for surgery. Thirty-two participants had a documented post-discharge follow-up plan regarding pain management in primary care. Of the 90 participants who were still being followed up 12 weeks after discharge, 51 (57%) were still being prescribed opioids for regular use or as required. Nurses have a crucial role in ensuring effective and safe pain management in older people, particularly when using opioids, due to the heightened risk of adverse effects and medicine interactions. Tailored pain management involves careful initiation of medicines; regular monitoring and assessment of pain levels, adherence to medicines and monitoring of potential side effects; and individualised follow-up plans.

New Training Frontiers in Golf Considerations from a neurosurgical perspective

Background: Golf, a sport gaining popularity globally, poses unique risks to musculoskeletal health, particularly among older players. The repetitive nature of the golf swing and inadequate athletic preparation often lead to injuries, especially in the spine, shoulders, and elbows. This study explores the biomechanics of golf and evaluates innovative training methodologies to mitigate injury risks and enhance performance. Materials and Methodology: The study integrates insights from sports science, neurosurgical assessments, and physical therapy to analyze common injury mechanisms in golf. Data from a comprehensive literature review, including clinical case studies and injury prevalence surveys, were combined with biomechanical evaluations. Modern training approaches such as the Gyrotonic Expansion System, MFT Proprioceptive Tables, and elastic resistance training were examined for their efficacy in improving flexibility, strength, and injury prevention. Results: Findings highlight that injury risk peaks during the downswing and impact phases of the golf swing due to high muscular loads and sudden force application. Older golfers exhibit higher injury rates, attributed to age-related physiological changes such as reduced spinal flexibility and muscle strength. Implementing structured training programs significantly reduced injury incidences and enhanced golfers' biomechanical efficiency. Techniques like Gyrotonic and Body Blade improved spinal mobility and neuromuscular control, while MFT tables optimized balance and coordination. Conclusion: Proper athletic preparation tailored to golfers' needs, incorporating multidisciplinary evaluations and advanced training systems, can mitigate injury risks and prolong active participation in the sport. Integrating these strategies, particularly for older players, enhances both safety and performance, underscoring the need for wider adoption in golf training protocols.

Assessment of Inflammatory Scores in Severity Prediction for Elderly Patients with Odontogenic Infections.

Background and Objectives: Odontogenic infections (OIs) can lead to severe complications, especially in elderly patients due to age-related physiological changes and comorbidities. This study aims to evaluate the predictive accuracy of inflammatory scores-APACHE II, CURB-65, SOFA, and NEWS2-in determining the severity of odontogenic infections among elderly patients (>70 years) compared to younger patients (<70 years). Materials and Methods: A retrospective cohort study was conducted on patients diagnosed with an OI at the Maxillofacial Surgery Department between January 2018 and January 2024. Patients were divided into two groups: elderly patients (>70 years, n = 49) and younger patients (<70 years, n = 64). The Symptom Severity score (SS) of odontogenic infections was calculated for all patients. Inflammatory scores-APACHE II, CURB-65, SOFA, and NEWS2-were assessed at admission and correlated with infection severity. Additional subgroup analyses were performed based on comorbidities and infection sites. Results: Elderly patients exhibited significantly higher SS scores (mean 12.47 ± 2.93) compared to younger patients (mean 7.82 ± 2.17, p < 0.001). APACHE II, CURB-65, SOFA and NEWS2 scores were significantly elevated in the elderly group (all p < 0.001). The SOFA score demonstrated the highest predictive accuracy for severe OIs in elderly patients, with an area under the curve (AUC) of 0.89 (95% CI: 0.82-0.95). Subgroup analyses revealed that comorbidities such as diabetes mellitus and cardiovascular disease significantly influenced infection severity (p < 0.05). Conclusions: Inflammatory scores, particularly SOFA, are effective in predicting the severity of odontogenic infections in elderly patients. The integration of these scores into clinical practice may enhance early identification of high-risk patients and improve management strategies.

The future of physiological research: A greater understanding of female master athletes and aging?

High caliber master athletes provide a valuable model for studying inherent physiological aging and performance capacity, without the confounding factor of physical inactivity. Despite the remarkable achievements of female master athletes, their participation rates remain significantly lower than those of their male counterparts, particularly at more advanced ages. This review examines the biological sex gap in sports participation among master athletes and the subsequent disparity in empirical research, thereafter exploring possible contributing factors. It highlights the importance of studying female master athletes to better understand the aging process and offers recommendations to address current evidence gaps. The need for more comprehensive mechanistic data on highly trained older women, novel cataloguing and analysis of real-world datasets, case studies/series, and longitudinal research are also emphasized. Although analyzing the records of female master athletes as a surrogate to determine age-related physiological and performance changes is a common approach, the process may be hindered by the considerably lower participation rates of women. Therefore, an important step toward bridging these gaps is the longitudinal, integrative study of female athletes engaged in lifelong exercise. Such analyses would improve our understanding of senescence in women and may inform interventions targeting the promotion of physical function in older adults.

Minimising Harm and Managing Pain: Deprescribing Opioids in Older Adults.

Approximately one in three older adults (aged 65 years and over) experience pain, negatively impacting their quality of life. Opioid analgesics are commonly prescribed to manage pain; however, balancing the benefits and harms of these high-risk analgesics can be challenging for both healthcare professionals and patients. This is particularly true for older adults, as factors such as polypharmacy, age-related physiological changes and cognitive decline may impact upon opioid safety and efficacy. Deprescribing is the patient-centred process of reducing or discontinuing a medication that is no longer appropriate, or where the risks of continuation are deemed to outweigh the anticipated benefits. Opioid deprescribing has been proposed as a mechanism to reduce individual and societal opioid-related harm; however, to date, research has predominantly focused on the general adult population, rather than older adults. This current opinion aims to summarise the existing opioid deprescribing literature, discussing its applicability for older adults. Drawing on a non-systematic review of the literature, it identifies unique challenges and considerations for this population, highlights international initiatives to enhance opioid deprescribing in clinical practice and proposes future directions to advance the field.

Weaning Failure in Elderly Patients: A Systematic Review and Meta-Analysis.

Background/Objectives: Weaning failure in elderly patients undergoing mechanical ventilation presents a complex clinical challenge due to age-related physiological changes and comorbidities. Understanding the dynamics of this phenomenon through systematic analysis can provide valuable insights for clinical management. This meta-analysis aims to investigate the factors contributing to weaning failure in elderly patients and to assess the efficacy of different strategies in mitigating this challenge. Design: The design of this study is a systematic review and meta-analysis. Methods: A systematic search of electronic databases was conducted to identify relevant studies focusing on weaning failure in elderly patients. Studies reporting outcomes related to mechanical ventilation weaning failure were included. Data extraction, quality assessment, and statistical analysis were performed following established guidelines. Results: A total of 15 studies met the inclusion criteria and were included in the meta-analysis. The average age of participants throughout the studies was 66.24 ± 10.21 years. This suggests that the study population largely consisted of older adults and displayed a moderate range of ages centered around the mean. The rate of weaning failure across these studies was slightly above 31.56%, indicating a significant occurrence of this complication in the patient cohorts. The analysis revealed age-related physiological changes, such as decreased respiratory muscle strength and increased chest wall stiffness, as significant contributors to weaning failure in elderly patients. Comorbidities, including chronic pulmonary diseases and cardiovascular conditions, further exacerbated the challenge. Various interventions, including tailored weaning protocols and respiratory therapies, showed promising results in improving weaning outcomes in this population. Conclusions: Weaning failure in elderly patients undergoing mechanical ventilation is influenced by a combination of age-related physiological changes and comorbidities. Tailored interventions addressing these factors are essential for optimizing weaning success rates in this vulnerable population. Further research is warranted to refine the strategies and enhance outcomes in elderly patients requiring mechanical ventilation.

CMS121, a Novel Drug Candidate for the Treatment of Alzheimer's Disease and Age-Related Dementia.

Old age is the major risk factor for sporadic Alzheimer's disease (AD). However, old age-related changes in brain physiology have generally not been taken into consideration in developing drug candidates for the treatment of AD. This is at least partly because the role of these age-related processes in the development and progression of AD are still not well understood. Nevertheless, we and others have described an association between the oxytosis/ferroptosis non-apoptotic regulated cell death pathway and aging. Based on this association, we incorporated protection against this pathway as part of a cell-based phenotypic screening approach to identify novel drug candidates for the treatment of AD. Using this approach, we identified the fisetin derivative CMS121 as a potent neuroprotective molecule that is able to maintain cognitive function in multiple pre-clinical models of AD. Furthermore, we identified a key target of CMS121 as fatty acid synthase, a protein which had not been previously considered in the context of AD. Herein, we provide a comprehensive description of the development of CMS121, its preclinical activities, and the results of the toxicology testing that led to its IND approval.

Oral Wound Healing in Aging Population

Background: Oral wound healing in the aging population is a multifaceted issue requiring a comprehensive approach, considering the physiological changes that come with aging and the frequent presence of comorbidities. Methods: This descriptive review summarizes the factors influencing oral wound healing in aging patients, including age-related physiological changes, hormonal modifications, multimorbidities, polypharmacy, oralome alterations, and nutritional status. Results: The aging population encounters numerous challenges in oral wound healing due to intrinsic factors, such as biological aging and hormonal changes, and extrinsic factors, such as medication use and lifestyle. Conclusion: Understanding these factors and their combined impact is essential for effective clinical management and improved outcomes in older adults.

Age estimation at death in individuals over 50 using CT images: An innovative anthropological approach

ObjectivesThe aim of the present work is to develop a novel method for predicting age in individuals over 50 years old, utilizing regression models. MethodsThe conducted study is of an analytical cross-sectional nature, involving a sample of 44 young subjects and 107 elderly subjects. The necessary data for this research were extracted from "The New Mexico Decedent Image Database." Based on the phenomenon of height shrinkage with age, we created models for young subjects and applied them to elderly subjects, allowing us to extract the variables. ResultsWe obtained highly encouraging results with an R2 of 0.73, a mean absolute error of 3.94, and stable cross-validation. We used a Student's t-test, which demonstrated no significant difference between predicted and actual values (p-value >0.05). We also conducted a learning curve analysis and examined residuals against predicted values. This suggests that the forecasts are accurate, with no significant bias in predictions. ConclusionThis work has allowed us to conclude that it is possible to reliably estimate the age of subjects over 50, taking into account age-related physiological and pathological changes.

HYPERTENSION IN THE ELDERLY: CHALLENGES IN MANAGEMENT AND TREATMENT

Hypertension is a prevalent and significant health issue among the elderly, contributing to increased risks of cardiovascular diseases, stroke, and kidney failure. Managing hypertension in older adults poses unique challenges due to age-related physiological changes, comorbidities, and polypharmacy. This review explores the complex pathophysiology of hypertension in the elderly, including age-related changes in vascular function and the impact of comorbid conditions. It examines the difficulties in diagnosing hypertension, such as variability in blood pressure readings, white coat syndrome, and masked hypertension, highlighting the need for accurate monitoring through home and ambulatory techniques. The review discusses current management strategies, emphasizing the importance of setting appropriate treatment goals, implementing lifestyle modifications, and utilizing pharmacological treatments, including new antihypertensive drugs and combination therapies. It also addresses challenges such as adverse drug reactions, medication adherence, and the management of polypharmacy. Recent advances, including innovations in drug delivery systems and digital health technologies, offer promising solutions for improving hypertension management. Future research directions include exploring precision medicine, understanding the role of the gut microbiome, and addressing health disparities. Clinicians are advised to adopt personalized treatment approaches, integrate technological tools, and address socioeconomic barriers to optimize hypertension management in the elderly. This review underscores the need for ongoing research and tailored strategies to improve outcomes and quality of life for older patients with hypertension.

Age-related disparities in older adults in trauma

As the population of older adults (≥65 years of age) continues to grow, the incidence of traumatic injuries in this demographic is also increasing nationwide. It has been well established that older adults experience worse outcomes, that is, an increased morbidity and mortality, when compared to younger adults. Moreover, survivors often experience accelerated cognitive and functional decline, loss of independence, and recurring injuries and hospitalizations. This manuscript examines the multifaceted challenges and disparities faced by older adults in trauma care. Factors such as age-related physiological changes, racial disparities, access to health care, and structural ageism that contribute to poor outcomes in geriatric patients who experience trauma. This is exacerbated by the sparsity of geriatric-specific practice management guidelines, thier poor implementation, and the critical under-representation of older adults in trauma research. However, significant efforts are being made to improve the care of older adults, including geriatric patients who experience trauma, through age-friendly systems, and initiatives aimed at promoting inclusive and effective care. These endeavors hold promise for a future where trauma care for older adults is comprehensive and equitable.

SP6.13 - Management of Older Major Trauma Patients: Impact of a dedicated guideline for facilitating older trauma care within a Pan London Trauma Network

Abstract Background and Aim Older age trauma is an increasing challenge for trauma networks with many clinical protocols needing to adapt and reflect age-related changes in physiology and management. In 2018, our older trauma guidance was introduced into our trauma system to improve early recognition of injury, admission pathways, clinical management and outcomes for those aged ≥65yrs (LMTS Older Trauma Guidance). The aim of our study was to assess the impact of the guideline on our trauma processes and patient outcomes. Methods This retrospective analysis of TARN compared process and outcome data for patients aged ≥65yrs admitted to hospitals within the North East London and Essex Trauma Network, pre (01/01/2016-31/07/2018) and post (01/08/2018-31/07/2020) guidance introduction. The primary outcome was mortality at 30 days post injury. Results and conclusions There were 4317 patients pre and 3992 patient post guidance. Time to CT reduced on average by 57 minutes, Neurotrauma transfers decreased from 2116 patients to 1519 patients and more older patients were discharged for rehabilitation. Older trauma mortality reduced across the network post guidance (13.59% vs 10.64%). The greatest mortality reductions were seen in Trauma Units, (19.20% pre vs 6.99% post) with increasing benefit seen with advancing age: reduced 75-84 years by 2.20%; 85-94 years 2.41%; 95+ years by 7.44%. This analysis suggests that dedicated guidance highlighting the special needs and risk profiles of older trauma patients significantly improves processes and outcomes. Improvements in early assessment and time to imaging appear to result in enhanced survival. Further research at a system level is required.

Mortality Risk Factors at Time on ED Admission in Elderly Patients with Infectious Diseases

Background: As elderly individuals often exhibit heightened vulnerability to infections due to factors such as compromised immune systems, chronic illnesses, and age-related physiological changes, understanding the characteristics and risk factors associated with infectious diseases in this population is crucial. The aim of the present study was to evaluate the characteristics of elderly patients with infectious disease in ED admission and to identify risk factors that influence in-hospital mortality. Material and Method: In this study, we enrolled 448 adult patients diagnosed with infectious diseases such as pneumonia, urinary tract infection, gastroenteritis, meningitis, and cellulitis. The participants were directly admitted to our Emergency Department (ED) from their homes or their relatives' residences between November 1, 2014, and May 31, 2015. We investigated patient’s vital signs, disease signs, source of infection, length of staying at hospital, length of staying at emergency service, mortality related scores, laboratory data, treatment and prognosis. Results and Conclusion: The rate of emergency care admissions with an infectious etiology was found as 17%. Average age of patients was 76±8 with 180 (40%) of them being female and 268 (60%) of them being male. Mortality rate was found as 23%. Cox regression analysis concluded that for 65 years or older patients, risk factors that effected mortality were; septic shock, cardiac disease and presence of malignancy, absence of COPD/Asthma, higher pCO2 and lower HCO3 at the time of admission to the emergency service. Calculating MEDS score and APACHE 2 score at admission to the emergency department and intensive care unit can facilitate early intervention, improving recovery prospects. Further research and clinical strategies may benefit from these identified predictors to improve the management and outcomes of elderly patients with infectious diseases in the ED.

Ventricular tachycardia ablation across age groups: Outcomes, trends and demographics. Insights from the National Inpatient Sample Database

BackgroundVentricular tachycardia ablation (VTA) is an important treatment option for ventricular tachycardia (VT), with increasing use across all age groups. However, age-related differences in outcomes remain a concern. ObjectiveThis study aims to investigate age-related trends in ventricular tachycardia ablation (VTA) procedures and their associated adverse events (AEs) across the United States from 2011 to 2021. The primary objective is to analyze VTA outcomes across different age groups. Secondary objectives include examining variation in VTA rate by sex and geographic regions. MethodsWe conducted a retrospective analysis of the National Inpatient Sample (NIS), focusing on adult patients (≥18 years) hospitalized with a primary diagnosis of VT. Patients were divided into three age groups: ≤59, 60-79, and ≥80 years. We evaluated VTA frequency, in-hospital mortality, and complications using propensity score matching to control for confounders. Secondary analyses examined sex and geographic differences. ResultsThe study included 95,913 VTA procedures. The mean age of patients undergoing VTA increased over time, with a growing proportion of procedures performed in older patients. While overall adverse events did not significantly differ across age groups, specific outcomes such as mortality and hemorrhage were significantly higher in patients aged ≥80 years. In-hospital mortality was highest in the ≥80 years group (5.1%), compared to 1.6% in the ≤59 years group and 2.7% in the 60-79 years group. Significant differences by sex and region were also observed. ConclusionsOur study demonstrates that while the overall incidence of adverse events with VTA did not significantly increase with age, specific severe outcomes, such as in-hospital mortality and hemorrhage, were more prevalent in older patients. These findings suggest that VTA can be safely performed across age groups, but careful consideration is essential for elderly patients. Future research should focus on understanding the impact of age-related physiological changes and comorbidities on VTA outcomes.

A Comprehensive Review of Advanced Biomarkers for Chronic Kidney Disease in Older Adults: Current Insights and Future Directions.

Chronic kidney disease (CKD) is a growing health concern, particularly in older adults, due to its high prevalence and association with increased morbidity and mortality. Early detection and effective management are crucial to slowing disease progression and reducing complications such as cardiovascular events and end-stage renal disease (ESRD). Traditional biomarkers, including serum creatinine and estimated glomerular filtration rate (eGFR), often have limitations in older populations, where age-related physiological changes can obscure early signs of kidney dysfunction. Advanced biomarkers offer a more precise and comprehensive understanding of kidney health, providing insights into pathological processes such as inflammation, fibrosis, oxidative stress, and tubular injury. These biomarkers have the potential to enhance early diagnosis, predict disease progression, and inform personalized treatment approaches, particularly in the elderly. This review explores the current landscape of advanced biomarkers for CKD in older adults, highlighting their clinical utility and limitations. Key biomarkers, including those related to inflammation (C-reactive protein, interleukin-6), fibrosis (transforming growth factor-beta, collagen degradation products), oxidative stress (F2-isoprostanes, malondialdehyde), and tubular injury (kidney injury molecule-1, neutrophil gelatinase-associated lipocalin), are examined in the context of CKD. Emerging technologies, such as multi-omics and machine learning, are also discussed as they offer new opportunities for biomarker discovery and integration into clinical practice. While challenges remain, including the need for longitudinal studies and better standardization, advanced biomarkers hold promise for transforming CKD management in older adults, paving the way for earlier detection, better risk stratification, and more targeted therapeutic interventions.

A Comprehensive Review of Biomarkers for Chronic Kidney Disease in Older Individuals: Current Perspectives and Future Directions.

Chronic kidney disease (CKD) is a progressive condition characterized by a gradual loss of kidney function, leading to significant health complications and an increased risk of cardiovascular events. Early detection and effective management are crucial for slowing disease progression and improving patient outcomes. Biomarkers are valuable tools in CKD diagnosis, prognosis, and treatment. Traditional biomarkers, such as serum creatinine and urine protein, are widely used, but emerging biomarkers like cystatin C, kidney injury molecule-1 (KIM-1), and neutrophil gelatinase-associated lipocalin (NGAL) offer enhanced diagnostic precision and insights into disease severity. These advanced biomarkers are particularly important in older adults, who may present with age-related physiological changes and comorbid conditions that complicate CKD management. This review explores the current state of biomarker research in CKD, focusing on their application in older populations. It highlights the role of traditional and emerging biomarkers, discusses their relevance for early detection and prognosis, and examines future directions in biomarker research, including technological innovations and personalized medicine approaches. By integrating biomarkers into clinical practice, healthcare providers can achieve more accurate diagnoses, tailor treatments to individual patient needs, and potentially improve the overall management of CKD. Continued research and development in this field are essential for addressing the complexities of CKD and advancing patient care.

Changing landscape of geriatric clinical trials: Analysis of Clinical Trials Registry of India.

Abstract Background: Approximately 13% of the world’s population is more than 65 years old, and they consume major proportion of all medicinal products. Geriatric population constitute the majority of patients for chronic conditions including cardiac disease, malignancies, metabolic disorders, neurodegenerative disorders among others. However, in clinical trials, the elderly population is not adequately represented. In clinical studies, age-related physiological changes that impact the drug’s pharmacokinetics and pharmacodynamics in the elderly are not adequately assessed. Additionally, concomitant medications and comorbid conditions make elderly individuals more vulnerable to side effects. Objective: To analyse the trends of clinical trials involving the geriatric population in India over the past 16 years registered under Clinical Trial Registry of India. Materials and Methods: All clinical trials registered under CTRI from July 2007 to December 2023 were reviewed and analyzed using the key words “geriatrics”, “elderly”, “old age” in the ‘trial search’ section. Data was extracted for the year of study, type of trial, therapeutic area and sites of study. Results: Out of a total of 63,063 studies were registered in CTRI, 254 studies (0.37%) had geriatric population in their inclusion criteria. Of these studies 157 studies (61.8%) were interventional in nature. 29.9% of the studies were related to improvement in quality of life in the elderly. Regulatory clinical trials which included geriatrics to evaluate the efficacy and safety of drugs were only 5.5%. A gradual increase in the number of trials including elderly population was noted over the last 5 years. Conclusion: There is a major dearth of clinical trials that evaluate the geriatric population. However, there is an increasing trend of inclusion of geriatric population in clinical trials over the recent years.

Characterization of cortical volume and whole-brain functional connectivity in Parkinson's disease patients: a MRI study combined with physiological aging brain changes.

This study employed multiple MRI features to comprehensively evaluate the abnormalities in morphology, and functionality associated with Parkinson's disease (PD) and distinguish them from normal physiological changes. For investigation purposes, three groups: 32 patients with PD, 42 age-matched healthy controls (HCg1), and 33 young and middle-aged controls (HCg2) were designed. The aim of the current study was to differentiate pathological cortical changes in PD from age-related physiological cortical volume changes. Integrating these findings with functional MRI changes to characterize the effects of PD on whole-brain networks. Cortical volumes in the bilateral temporal lobe, frontal lobe, and cerebellum were significantly reduced in HCg1 compared to HCg2. Although no significant differences in cortical volume were observed between PD patients and HCg1, the PD group exhibited pronounced abnormalities with significantly lower mean connectivity values compared to HCg1. Conversely, physiological functional changes in HCg1 showed markedly higher mean connectivity values than in HCg2. By integrating morphological and functional assessments, as well as network characterization of physiological aging, this study further delineates the distinct characteristics of pathological changes in PD.

Long COVID Syndrome: A Narrative Review on Burden of Age and Vaccination.

Background/Objective: The COVID-19 pandemic has led to the emergence of post-acute COVID-19 syndrome, also known as long COVID, which presents a significant challenge due to its varied symptoms and unpredictable course, particularly in older adults. Similar to COVID-19 infections, factors such as age, pre-existing health conditions, and vaccination status may influence the occurrence and severity of long COVID. The objective is to analyze the role of aging in the context of long COVID and to investigate prevalence rates and vaccination efficacy to improve prevention strategies and treatment in this age group. Methods: Four researchers independently conducted a literature search of the PubMed database to trace studies published between July 2020 and July 2024. Results: Aging influences both the likelihood of developing long COVID and the recovery process, due to age-related physiological changes, immune system alterations, and the presence of comorbidities. Vaccination plays a key role in reducing the risk of long COVID by attenuating the inflammatory responses associated with its symptoms. Conclusions: Despite the protection vaccines offer against severe infection, hospitalization, and post-infection sequelae, vaccine hesitancy remains a major obstacle, worsening the impact of long COVID. Promising treatments for this condition include antivirals although further research is needed.

Multimodality imaging of bone marrow involvement in paediatric oncology

Identifying bone marrow involvement (with or without bone destruction) in children with cancer is essential for adequate diagnosis, prognostication, therapy planning, and response assessment. Imaging plays an increasing role, with MRI including DWI and [18F]FDG-PET/CT as the most commonly used imaging techniques. Interpretation of the paediatric bone marrow on imaging might be challenging because of age-related physiological changes in the bone marrow, as well as disease and therapy related effects. In this review, we discuss how the imaging techniques available may be employed to detect bone marrow involvement (BMI) in paediatric oncology. Furthermore, insights into physiological, disease and therapy related bone marrow changes in children that might influence bone marrow imaging interpretation will be provided.