Clinical course and outcome of SARS-CoV-2 infection in multiple sclerosis patients treated with disease-modifying therapies — the Polish experience

Introduction. The aim of this study was to report the course and outcome of SARS-CoV-2 infection in multiple sclerosis (MS) patients treated with disease-modifying therapies (DMTs) in Poland. A major concern for neurologists worldwide is the course and outcome of SARS-CoV-2 infection in patients with MS treated with different DMTs. Although initial studies do not suggest an unfavourable course of infection in this group of patients, the data is limited.Materials and methods. This study included 396 MS patients treated with DMTs and confirmed SARS-CoV-2 infection from 28 Polish MS centres. Information concerning patient demographics, comorbidities, clinical course of MS, current DMT use, as well as symptoms of SARS-CoV-2 infection, need for pharmacotherapy, oxygen therapy, and/or hospitalisation, and short-term outcomes was collected up to 30 January 2021. Additional data about COVID-19 cases in the general population in Poland was obtained from official reports of the Polish Ministry of Health.Results. There were 114 males (28.8%) and 282 females (71.2%). The median age was 39 years (IQR 13). The great majority of patients with MS exhibited relapsing-remitting course (372 patients; 93.9%). The median EDSS was 2 (SD 1.38), and the mean disease duration was 8.95 (IQR 8) years. Most of the MS patients were treated with dimethyl fumarate (164; 41.41%). Other DMTs were less frequently used: interferon beta (82; 20.70%), glatiramer acetate (42; 10.60%), natalizumab (35;8.84%), teriflunomide (25; 6.31%), ocrelizumab (20; 5.05%), fingolimod (16; 4.04), cladribine (5; 1.26%), mitoxantrone (3; 0.76%), ozanimod (3; 0.76%), and alemtuzumab (1; 0.25%). The overall hospitalisation rate due to COVID-19 in the cohort was 6.81% (27 patients). Only one patient (0.3%) died due to SARS-CoV-2 infection, and three (0.76%) patients were treated with mechanical ventilation; 106 (26.8%) patients had at least one comorbid condition. There were no significant differences in the severity of SARS-CoV-2 infection regarding patient age, duration of the disease, degree of disability (EDSS), lymphocyte count, or type of DMT used.Conclusions and clinical implications. Most MS patients included in this study had a favourable course of SARS-CoV-2 infection. The hospitalisation rate and the mortality rate were not higher in the MS cohort compared to the general Polish population. Continued multicentre data collection is needed to increase the understanding of SARS-CoV-2 infection impact on the course of MS in patients treated with DMTs

Observational properties of puffy discs: radiative GRMHD spectra of mildly sub-Eddington accretion

International audienceNumerical general relativistic radiative magnetohydrodynamic simulations of accretion discs around a stellar-mass black hole with a luminosity above 0.5 of the Eddington value reveal their stratified, elevated vertical structure. We refer to these thermally stable numerical solutions as puffy discs. Above a dense and geometrically thin core of dimensionless thickness h/r ~ 0.1, crudely resembling a classic thin accretion disc, a puffed-up, geometrically thick layer of lower density is formed. This puffy layer corresponds to h/r ~ 1.0, with a very limited dependence of the dimensionless thickness on the mass accretion rate. We discuss the observational properties of puffy discs, particularly the geometrical obscuration of the inner disc by the elevated puffy region at higher observing inclinations, and collimation of the radiation along the accretion disc spin axis, which may explain the apparent super-Eddington luminosity of some X-ray objects. We also present synthetic spectra of puffy discs, and show that they are qualitatively similar to those of a Comptonized thin disc. We demonstrate that the existing XSPEC spectral fitting models provide good fits to synthetic observations of puffy discs, but cannot correctly recover the input black hole spin. The puffy region remains optically thick to scattering; in its spectral properties, the puffy disc roughly resembles that of a warm corona sandwiching the disc core. We suggest that puffy discs may correspond to X-ray binary systems of luminosities above 0.3 of the Eddington luminosity in the intermediate spectral states