Cytomegalovirus (CMV)-associated thrombocytopenia can cause clinically important bleeding in young infants, but evidence guiding immunomodulatory treatment is limited. We evaluated the association between intravenous immunoglobulin (IVIG) exposure and recovery and explored whether virologic or hematologic markers modified this association. We retrospectively studied 87 immunocompetent children with CMV-associated thrombocytopenia admitted to a tertiary children’s hospital from July 2018 through April 2024. IVIG, ganciclovir, and glucocorticoid exposure were modeled as time-dependent covariates in multivariable Cox models. Outcomes were time to platelet recovery (≥ 100 × 10⁹/L) and, among children bleeding at Day 0, time to bleeding recovery. Sensitivity analyses used time-dependent propensity-score matching (TD-PSM) and excluded congenital CMV. 49 children received IVIG. IVIG exposure was associated with faster bleeding recovery (adjusted HR, 3.55; 95
Clinical improvement during initial macrolide-based management varies among children with macrolide-resistant Mycoplasma pneumoniae (MRMP) pneumonia. We evaluated the associations between inflammatory burden, chest radiographic phenotypes, and clinical improvement. We conducted a retrospective multicenter cohort study at nine university hospitals in South Korea from 2012 to 2024. Eligible patients had PCR-confirmed M. pneumoniae infection and sequencing-confirmed macrolide resistance. Fever-based clinical improvement was defined as defervescence within 5 days of macrolide initiation before any rescue therapy. Multivariable logistic regression analysis was used to evaluate factors independently associated with clinical improvement. Among the 169 identified MRMP pneumonia cases, 130 were included, and 47 (36.2
The Streptococcus anginosus group (SAG) is comprised of S. anginosus, constellatus, and S. intermedius which can cause invasive infection with a particular predilection for abscess formation. We aimed to describe the clinical characteristics, infectious sources, abscess formation and outcomes of SAG bacteraemia across NHS Greater Glasgow and Clyde, Scotland, UK, and compare clinical manifestations between species. We retrospectively identified all blood culture sets isolating SAG bacteria in NHS GG C from 1st January 2020 to 31st December 2024 using our electronic laboratory information management system. Electronic clinical records were reviewed. Among 200 positive blood culture sets, 180 patients with clinically significant SAG bacteraemia were identified. The overall annual incidence was 3.0 per 100,000 population-years (95
Inflammaging is a chronic, low-grade inflammatory state associated with aging and age-related diseases. This review examines the mechanisms underlying inflammaging, emphasizing the interplay between oxidative stress, mitochondrial dysfunction, DNA damage, cellular senescence, and immune dysregulation. Persistent cellular stress promotes senescence and the senescence-associated secretory phenotype (SASP), while impaired immune clearance allows senescent cells to accumulate, sustaining a self-amplifying inflammatory cycle. We further discuss the involvement of inflammaging in neurodegenerative, infectious, autoimmune, cardiometabolic, and musculoskeletal diseases. Finally, we summarize current and emerging interventions, including lifestyle modifications, pharmacological approaches, senolytics, senomorphics, and strategies targeting mitochondrial quality control and cellular metabolism. Understanding the interconnected mechanisms and tissue-specific effects of inflammaging may facilitate the development of targeted interventions to mitigate age-related diseases and promote healthy aging.
Severe generalized tetanus remains associated with substantial mortality despite being vaccine preventable. Management is complicated by limited high-quality evidence, conflicting trial results, and the need to balance effective control of spasms and autonomic dysfunction against the risks of prolonged mechanical ventilation. We describe the management of a 57-year-old man with Ablett grade III generalized tetanus and use this case as a clinical framework for an expert narrative review. The review synthesizes randomized controlled trials, systematic reviews, meta-analyses, prospective studies, and relevant observational literature addressing neuromodulatory therapy, airway management, autonomic dysfunction, intrathecal antitoxin, and supportive critical care. The patient was managed using a multimodal strategy comprising continuous midazolam infusion, magnesium sulphate, oral baclofen, dexmedetomidine, intramuscular and intrathecal human tetanus immunoglobulin, and meticulous low-stimulation supportive care. Therapy was titrated using serial bedside assessment of neuromuscular burden. He recovered without endotracheal intubation, neuromuscular blockade, or tracheostomy and was discharged on day 21. We argue that discordant findings in tetanus trials are substantially attributable to heterogeneity in disease severity, clinical practice, airway management thresholds, and resource availability, rather than to true therapeutic inconsistency. Available evidence supports a physiology-directed multimodal approach using agents with complementary mechanisms to suppress spasms and autonomic dysfunction while preserving spontaneous ventilation whenever safely feasible. Management of severe tetanus should focus on achieving physiological targets rather than escalating individual drugs. A structured, individualized, multimodal neuromodulatory strategy delivered within an experienced, low-stimulation critical care environment may allow selected patients to be managed without mechanical ventilation; safety cannot be established from a single case and requires prospective evaluation. Greater emphasis should also be placed on preventive adult immunization, as vaccination remains the intervention most likely to reduce the burden of severe tetanus.
