Conception via in vitro fertilization and delivery by Caesarean section are associated with paediatric asthma incidence.

BACKGROUND: The association between perinatal factors and asthma inception is under rigorous investigation. Nevertheless, evidence of a correlation between asthma, conception via in vitro fertilization (IVF) and delivery through Caesarean section (C-section) is inconclusive. OBJECTIVE: We aimed to assess the relation of asthma incidence with IVF and C-section, after controlling for several potential confounding factors. METHODS: Parent-reported wheeze in the last 12 months (current), wheeze ever, physician-diagnosed asthma, method of conception, and type of delivery were recorded from questionnaires filled in by the parents of 2016 Greek children aged 9-13, (the Healthy Growth Study population). Some perinatal data were recorded from children's medical records and others were reported by parents; anthropometric measurements were also conducted in children. RESULTS: IVF was correlated with physician-diagnosed asthma (OR = 2.25; 95% CI = 1.11-4.56), but not with current/ever wheeze after adjustment for potential confounding factors. After adjustment, C-section was also associated with asthma (OR = 1.39; 95% CI = 1.04-1.87), but not with current/ever wheeze. When the association of both IVF and C-section with asthma was examined in the same multivariate logistic regression model, it was weakened to borderline significance (OR = 2.04; 95% CI = 1-4.15 and OR = 1.34; 95% CI = 1-1.81 respectively). CONCLUSIONS AND CLINICAL RELEVANCE: Conception via IVF and delivery by C-section may predispose children to future asthma development. Either variable could also exert a confounding effect on the link of the other to asthma; this may partially be accountable for inconsistencies in the findings of pertinent studies.

Viruses and bacteria in acute asthma exacerbations--a GA² LEN-DARE systematic review.

A major part of the burden of asthma is caused by acute exacerbations. Exacerbations have been strongly and consistently associated with respiratory infections. Respiratory viruses and bacteria are therefore possible treatment targets. To have a reasonable estimate of the burden of disease induced by such infectious agents on asthmatic patients, it is necessary to understand their nature and be able to identify them in clinical samples by employing accurate and sensitive methodologies. This systematic review summarizes current knowledge and developments in infection epidemiology of acute asthma in children and adults, describing the known impact for each individual agent and highlighting knowledge gaps. Among infectious agents, human rhinoviruses are the most prevalent in regard to asthma exacerbations. The newly identified type-C rhinoviruses may prove to be particularly relevant. Respiratory syncytial virus and metapneumovirus are important in infants, while influenza viruses seem to induce severe exacerbations mostly in adults. Other agents are relatively less or not clearly associated. Mycoplasma and Chlamydophila pneumoniae seem to be involved more with asthma persistence rather than with disease exacerbations. Recent data suggest that common bacteria may also be involved, but this should be confirmed. Although current information is considerable, improvements in detection methodologies, as well as the wide variation in respect to location, time and populations, underline the need for additional studies that should also take into account interacting factors.

Digital ischemic necrosis in a patient with systemic sclerosis: the role of laser Doppler perfusion imaging.

The impairment of microcirculation is a cardinal feature of systemic sclerosis (SSc). Raynaud's phenomenon and SSc can cause painful digital ulcers on the fingers or toes, with resulting complications such as serious infections, gangrene or possible amputation. This case report shows the possible role laser Doppler perfusion imaging (LDPI) could play in diagnosis and follow-up of digital arterial obstructions in SSc patients. LDPI is a non-invasive microvascular imaging technique able to provide maps of the cutaneous blood flow (CBF). We describe here the case of a woman affected by SSc who suddenly presented with pallor and pain; afterwards an area of necrosis became clearly visible at the distal phalanx of the third right finger. The LDPI of the dorsal surface of that finger showed a reduction of CBF. Selective arteriography was performed in order to assess the degree and location of the obstruction before proceeding with adventitiectomy. Following this procedure LDPI showed a normal CBF in the distal phalanx and complete healing of the necrotic area. Consequently, we can state that LDPI alone provides an indirect functional estimation of possible digital artery obstruction. Further, we can assert that the overall effect of the adventitiectomy resulted in an increase of the CBF.

Dilated cardiomyopathy due to thrombotic microangiopathy as the only manifestation of antiphospholipid syndrome: a case report.

Dilated cardiomyopathy due to thrombotic microangiopathy has been rarely reported as a clinical manifestation of antiphospholipid syndrome (APS). We describe the case of a 39-year-old woman affected by systemic lupus erythematosus (SLE) and positive antiphospholipid antibodies (aPL) who presented with orthopnea and peripheral oedema. Diagnosis of dilated cardiomyopathy due to myocardial thrombotic microangiopathy was made and treatment with anticoagulants prevented the worsening of the clinical condition. Interestingly, at variance with other cases, our patient showed no extracardiac signs of APS. The review of the current literature has confirmed that dilated cardiomyopathy due to thrombotic microangiopathy is a rare manifestation of APS.