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

Figure 17 from: Fernandez-Triana J, Buffam J, Beaudin M, Davis H, Fernandez-Galliano A, Griffin E, Lin S-Y, McAulay MK, Richter R, Rodriguez F, Várkonyi G (2017) An annotated and illustrated checklist of Microgastrinae wasps (Hymenoptera, Braconidae) from the Canadian Arctic Archipelago and Greenland. ZooKeys 691: 49-101. https://doi.org/10.3897/zookeys.691.14491

Figure 17 - Glyptapanteles sp. 4. A Habitus, lateral B Fore wing C Metasoma, dorsal D Head, frontal E Head and mesosoma, dorsal

An annotated and illustrated checklist of Microgastrinae wasps (Hymenoptera, Braconidae) from the Canadian Arctic Archipelago and Greenland

The Microgastrinae (Hymenoptera: Braconidae) from ten islands of the Canadian Arctic Archipelago (CAA) and Greenland were studied based on 2,183 specimens deposited in collections. We report a total of 33 species in six genera, more than doubling the totals previously known. Most of the species (75.7%) have a distribution restricted to the Nearctic, with nine of those (27.3%) confirmed to be High Arctic endemics and another 10 species considered very likely to be High Arctic endemics as well – accounting for all of those, more than half of all species found are endemic to the region. The most diverse genera were Cotesia (10 species), Glyptapanteles (9 species), and Microplitis (7 species), representing 78.8% of the overall species diversity in the region. The six most frequently collected species comprised 84.7% of all examined specimens. The flight period for Microgastrinae in the High Arctic encompasses only two months, with activity peaking during the first half of July, when almost 40% of all available specimens were collected, and then plummeting in the first half to the end of August. Microgastrinae wasps from the High Arctic are currently known to parasitize eight species within four families of Lepidoptera: three species of Noctuidae, two each of Lymantridae and Nymphalidae, and one species of Pterophoridae. However, that information is very preliminary, as only six of the 33 species of microgastrines currently have associated host data. An annotated checklist, including photographs for 24 of the 33 species, is provided, as well as a key to all Microgastrinae genera present in the region