Diabetes and the Risk of Multi-System Aging Phenotypes: A Systematic Review and Meta-Analysis

[[abstract]]Background: Observational studies suggested an association between diabetes and the risk of various geriatric conditions (i.e., cognitive impairment, dementia, depression, mobility impairment, disability, falls, and urinary incontinence). However, the magnitude and impact of diabetes on older adults have not been reviewed. Methodology/Principal Findings: MEDLINE and PSYCINFO databases were searched through November 2007 for published studies, supplemented by manual searches of bibliographies of key articles. Population-based, prospective cohort studies that reported risk of geriatric outcomes in relation to diabetes status at baseline were selected. Two authors independently extracted the data, including study population and follow-up duration, ascertainment of diabetes status at baseline, outcomes of interest and their ascertainment, adjusted covariates, measures of association, and brief results. Fifteen studies examined the association of DM with cognitive dysfunction. DM was associated with a faster decline in cognitive function among older adults. The pooled adjusted risk ratio (RR) for all dementia when persons with DM were compared to those without was 1.47 (95% CI, 1.25 to 1.73). Summary RRs for Alzheimer's disease and vascular dementia comparing persons with DM to those without were 1.39 (CI, 1.16 to 1.66) and 2.38 (CI, 1.79 to 3.18), respectively. Four of 5 studies found significant association of DM with faster mobility decline and incident disability. Two studies examined the association of diabetes with falls in older women. Both found statistically significant associations. Insulin users had higher RR for recurrent falls. One study for urinary incontinence in older women found statistically significant associations. Two studies for depression did not suggest that DM was an independent predictor of incident depression. Conclusions/Significance: Current evidence supports that DM is associated with increased risk for selected geriatric conditions. Clinicians should increase their awareness and provide appropriate care. Future research is required to elucidate the underlying pathological pathway. 2009 Lu et al

Invasive aspergillosis in children and adolescents with solid tumors: clinical cases and registry analysis

We presented two cases of invasive aspergillosis (IA) in children with solid tumors, data of IA patients register, and a literature review. In the register of patients with IA (1997–2018), we found 57 patients with IA from 0 to 18 years. It was established that the number of patients with solid tumors was 15.7 %. Background diseases were: central nervous system tumors – 33.5 %, neuroblastoma – 33.5 %, osteosarcoma – 11.0 %, Wilms tumor – 11.0 %, hemangioblastoma – 11.0 %. Chemotherapy-induced neutropenia was reported in 100 % of IA cases in children and adolescents with solid tumors. The additional risk factors were treatment in intensive care unit – 22.2 %, high-dose chemotherapy with autologous hematopoietic stem cell transplantation – 22.2 %, concomitant bacterial infection – 33.0 %. Surgical intervention for the underlying disease was performed in 77.7 % of patients. The most common clinical site of IA was the lungs – 88.9 %. The predominant clinical sign was fever – 66.7 %, cough and respiratory failure were seen less frequently – 33.4 % and 33.4 %, respectively. The etiological agents of IA were Aspergillus fumigatus – 33.3 %, Aspergillus nidulans – 33.3 % and Aspergillus ustus – 33.3 %. 88.9 % of patients received antimycotic therapy, voriconazole predominantly – 66.7 %. Combination therapy was used in 33.3 % of patients. The overall 12-week survival in children and adolescents with IA in case of solid tumors was 77.8 %

Лучевая диагностика мукормикоза легких

Pulmonary mucormycosis is a rare opportunistic fungal infection, caused by Zygomycetes, order Mucorales. Poorly controlled diabetes mellitus and neutropenia are main risk factors. In recent years, the incidence of mucormycosis is increasing, due to widespread use of aggressive chemotherapy, including schemes for elder patients and increasing amount of stem cell transplantation. The disease is characterised by severe course, rapid spread and high mortality rates. Radiological diagnostics is first line methods in detecting infectious process in patients. Detecting specific features helps physician in early diagnosis and improve outcome of disease.Мукормикоз легких – редко встречающаяся оппортунистическая инфекция, вызванная грибами, которые относятся к порядку Mucorales класса Zygomycetes. Основными факторами риска развития заболеванияявляются сахарный диабет и глубокая нейтропения. В последние годы отмечается рост частоты встречаемости мукормикоза, что связывают с более широким применением агрессивных схем химиотерапии, в том числе возрастным пациентам, а также увеличением числа трансплантаций стволовых клеток крови. Заболевание характеризуется тяжелым течением с быстрой генерализацией и высокой летальностью. Применение лучевых методов диагностики – первый способ обследования пациента при подозрении на инфекционный процесс. Выявление характерных признаков мукормикоза позволяет лечащему врачу назначать дальнейшие исследования и поставить ранний диагноз, что в свою очередь значительно улучшает прогноз заболевания