Ferritin and Neutrophil Lymphocyte Ratio in Assessingthe Severity of Disease in COVID 19 Positive Pregnancy

Introduction: The pandemic of coronavirus disease 2019 caused bythe SARS-CoV-2 is affecting many women during pregnancy and inthe postpartum period worldwide. A peculiar characteristic ofCOVID-19 is the release of a large amount of inflammatory cytokines. Some biomarkers have been considered as tools to monitor theevaluation of COVID-19, namely CRP, LDH, D-dimer and ferritin.Currently the neutrophil lymphocyte ratio constitutes a new stronginflammatory marker for the detection of inflammation. Neutrophillymphocyte ratio has also been used as a predictor of complication ofpregnancy, such as pre-eclampsia, gestational diabetes mellitus,hyperemesis gravidarum, premature labour and ectopic pregnancy.Aims &Objectives: To study the neutrophil lymphocyte ratio (NLR)and ferritin levels in COVID-19 positive pregnancy and correlate itwith the severity of the disease.Materials &Methods: This is an observational study conducted inthe obstetrics ward of a tertiary care center. The inclusion criteriawere all the pregnant females admitted in the obstetrics ward with adiagnosis of COVID-19 by RT PCR in the period of 3 months. Theexclusion criteria were patients with non reactive rapid test results.Clinical and demographic data were extracted from electronic medical records.Result: In our study, 32 out of 70 patients showed ferritin valuesabove 400 ng/ml. Lymphocytopenia, increased neutrophil lymphocyte ratio and increased ferritin had all been linked with diseaseseverity or mortality. Decreased lymphocyte value was associatedwith an increased likelihood of receiving oxygen supplementationduring hospitalization. These markers show abnormal values inobstetrics patients and reflects the course of the disease. It suggestedthat additional care should be reserved to patients presenting withdecreased value of these blood cells. Pregnancy is a physiologicanemic state and high levels of ferritin, especially in third trimesterare associated with negative outcomes like preterm delivery andgestational diabetes mellitus.Conclusions: Both neutrophil lymphocyte ratio and ferritin levels canact as independent markers in assessing the disease severity ofCOVID-19 in obstetrics patients.

Assessing viability of a minimally invasive autopsy technique in ascertaining the probable cause of death in patients who were SARS CoV19 positive at the time of their demise

Background: SARS CoV-19 was declared as a pandemic by the World Health Organization (WHO), raising up challenges on various levels ranging from therapeutics to diagnostics. The conventional autopsy technique may pose a health hazard to health care workers. A minimally invasive autopsy technique can diminish this hazard. Materials and methods: Between August and November 2020, 51 patients who were suffering from Covid-19 at the time of their demise were included. A novel minimally invasive ultrasound-guided technique for procuring tissue samples of major organs was employed which were thereafter subject to histopathological examination. A detailed review of the course in hospital was noted. An analysis was performed to correlate the cause of death ascertained from our minimally invasive technique with the cause of death ascertained clinically. Results: There was adequate tissue sampling in 45 cases, where the minimally invasive autopsy technique confirmed the cause of death in all 45 cases (100%) and made it more specific in 5 cases (11.11%). Conclusion: Minimally Invasive Autopsy is an easily reproducible technique which has the potential to strengthen the probable the cause of death with reasonable certainty while ensuring safety and ethics.