Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Corrosion inhibition of N80 steel in hydrochloric acid by phenol derivatives

501-506The inhibitory action of methoxy phenol (MPH) and nonyl phenol (NPH) on corrosion of N80 steel in 15% HCl has been investigated at different period of exposure (6 to 24 h) and temperature (30 to 110°C). Nonyl phenol and methoxy phenol have shown maximum inhibition of about 83 and 78% at 75 mM inhibitor concentration in the acid respectively after 6 h exposure test at ambient temperature. The inhibition efficiencies of nonyl phenol and methoxy phenol are found to be about 79 and 30% respectively after 24 h exposure. Nonyl phenol has shown maximum inhibition of about 59 and 44% at 75 mM inhibitor concentration in the acid respectively at 90 and 110°C respectively. The inhibition afforded by methoxy phenol was found to be relatively low (about 34% at 60°C). Heat of adsorption was found to be 50 KJ/mol in case of MPH, indicating formation of a protective chemisorbed film on the metal surface, which suppresses the dissolution reaction. NPH showed heat of adsorption of about 26 KJ/mol indicating a weak chemisorption. Both these compounds inhibit corrosion by adsorption mechanism and follow Temkin isotherm. The results of polarization studies indicate that the compounds are mixed type inhibitors. The FTIR spectral analyses of the surface product suggest involvement of hydroxyl group (un protonated as well as protonated) of these inhibitor molecules in the adsorption process

Texture and Microstructural Evolution in Pearlitic Steel During Triaxial Compression

This article presents the deformation behavior of high-strength pearlitic steel deformed by triaxial compression to achieve ultra-fine ferrite grain size with fragmented cementite. The consequent evolution of microstructure and texture has been studied using scanning electron microscopy, electron back-scatter diffraction, and X-ray diffraction. The synergistic effect of diffusion and deformation leads to the uniform dissolution of cementite at higher temperature. At lower temperature, significant grain refinement of ferrite phase occurs by deformation and exhibits a characteristic deformation texture. In contrast, the high-temperature deformed sample shows a weaker texture with cube component for the ferrite phase, indicating the occurrence of recrystallization. The different mechanisms responsible for the refinement of ferrite as well as the fragmentation of cementite and their interaction with each other have been analyzed. Viscoplastic self-consistent simulation was employed to understand deformation texture in the ferrite phase during triaxial compression

Unilateral traumatic adrenal hemorrhage with shock

Trauma to the adrenal glands is very rare. The variation in clinical manifestations is marked and markers for its diagnosis being limited, makes it tough to be diagnosed. Computed tomography remains the gold standard for detecting this injury. Prompt recognition and the potential for mortality with adrenal insufficiency can provide the best guidance for the treatment and care of the severely injured. We present a case of a 33-year-old trauma patient who was not responding to the management of his shock. He was finally found to have a right adrenal haemorrhage leading to adrenal crisis. The patient was resuscitated in the Emergency Department but succumbed 10 days post admission