Cardiac manifestations of MIS-C: cardiac magnetic resonance and speckle-tracking data

BackgroundCardiac involvement is central in MIS-C and represents the main cause of morbidity. In this study, we aimed to assess myocardial damage in patients with MIS-C using cardiac magnetic resonance (CMR) during the acute phase, as well as left ventricular and atrial longitudinal strain on admission, at discharge, and after 3 months.MethodsWe performed a single-center prospective cohort study and case–control study. Between September 2020 and February 2022, we enrolled 39 patients hospitalized for MIS-C at our center. We performed left ventricular and atrial longitudinal 2D strain analysis on admission and during follow-up; echocardiographic data were compared to a matched control population. Patients above 4 years old with increased troponin underwent CMR.ResultsOf 24 patients (mean age: 8.2 ± 4.9 years) who underwent CMR, 14 (58%) presented myocardial edema and 6 (25%) late gadolinium enhancement (LGE). LGE was associated with older age (p < 0.01), increased BMI (p = 0.03), increased ferritin levels (p < 0.001), lower left ventricular (LV) ejection fraction (p < 0.001), LV longitudinal strain (p = 0.004), left atrial (LA) strain (p = 0.05), and prolonged hospital stay (p = 0.02). On admission, LV ejection fraction, LV longitudinal strain, and LA strain were impaired, but each improved gradually over time; LVEF was the fastest to recover, while global LV longitudinal strain was still impaired as compared to controls after 3 months (p = 0.01).ConclusionOur study demonstrates that myocardial injury is present in a quarter of MIS-C patients, and impaired LA and LV myocardial deformation persist for at least several weeks after the acute phase. CMR and LV/LA strain could help us to individualize follow-up of MIS-C patients

La filiacion y la fecundacion "in vitro"

Las tecnicas de reproduccion asistida no solo representan una solucion para ayudar a superar problemas de esterilidad, sino que su practica conlleva problemas eticos y juridicos. Esta Tesis analiza los problemas que plantea la fecundacion "in vitro", desde el punto de vista de la filiacion, para determinar la paternidad y maternidad cuando se utilizan los gametos de la pareja o de un tercero. Desde este punto de vista, se estudian la situacion juridica del tercero -llamado donante- y de las madres subrogadas, asi como las acciones de filiacion Tambien se examina la problematica que plantea la congelacion de semen y embriones, al poder un hombre engendrar un hijo despues de muerto. Entre las fuentes que se analizan estan los principales informes extranjeros que han estudiado la problematica de estas tecnicas, asi como el Informe especial de..