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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Preparation and characterization of clay based ceramic porous membranes and their use for the removal of lead ions from synthetic wastewater with an insight into the removal mechanism

The present study explores the use of local clay from the United Arab Emirates (UAE) to prepare porous ceramic membranes (flat disk shape) for the purpose of removing toxic heavy metals from contaminated water. Four distinct ceramic membranes, crafted from locally sourced clay and incorporated with activated carbon and graphite, underwent careful and thorough preparation. The initial set of membranes was subjected to open-air sintering, resulting in the creation of mACA and mGrA membranes. Concurrently, a second set of meticulously prepared membranes underwent sintering under inert nitrogen conditions, yielding the formation of mACI and mGrI membranes, respectively. Prior to making the membranes, the clay material was characterized by thermogravimetric analysis (TGA), X-ray fluorescence (XRF), Fourier-transform infrared spectroscopy (FTIR), and X-ray diffraction analysis (XRD). The clay presented the lowest weight loss compared to AC and Gr, implying that these two materials could be used as porogen agents. The X-ray fluorescence results indicated that the natural clay contained 65.5 wt% of silicon dioxide (SiO2), aluminium oxide (Al2O3), and iron (III) oxide (Fe2O3) falling within the class C category of clays according to ASTM. The FTIR analysis showed different clay regions allocated to various stretching and deformation vibrations of hydroxide, organic fraction, and (Si, Al, Fe)–O groups. The XRD analysis revealed the presence of kaolinite, illite, smectite and calcite phyllite phases in the clay mineral. The membranes were characterized using FESEM, with those containing AC (used as porogen) exhibiting large pores clearly visible on the surface, and were tested for the removal of lead (Pb2+) ions from synthetic wastewater. The removal efficiencies of the membranes were 33 %, 75.2 %, 100 % and 100 % for mACA, mACI, mGrA and mGrI respectively after 100 min operation. The wettability of the membranes was found to follow the order mACI < mACA < mGrI < mGrA, which corroborated well with water fluxes of 7, 8, 112 and 214 L h−1 m−2 recorded after 60 min duration and 1.0 bar applied pressure. The mechanisms of filtration of Pb2+ ions were adsorption for the AC-based membranes (mACA, mACI) and a combination of adsorption and size exclusion for the Gr-based membranes (mGrA, mGrI)