Association of serum ferritin with COVID-19 in a cross-sectional study of 200 intensive care unit patients in a rural hospital: Is ferritin the forgotten biomarker of mortality in severe COVID-19?

Background: The COVID-19 disease caused by the SARS-CoV-2 virus, has toppled the world since first case noted in 2019, and the cases have been increasing there after. This grave effect is caused by the cytokine storm induced inflammation produced by the noxious virus. As it is an inflammatory state, various acute phase reactants are expected to raise; thus serum ferritin is contemplated to increase. Here we aim to anchor serum ferritin as a way marker for diagnosis and management of COVID-19 patients and study its role as a prognostic marker. Another aspect is the association of COVID-19 with the N: L ratio; observation has stated that higher N: L ratio results in more severe outcome. The study aimed to establish a correlation of COVID-19 severity with serum ferritin in the form of HRCT Score, N: L Ratio and Clinical Outcome in the patients admitted in Intensive Care Unit. Result: Out of 200 patients who were admitted in the intensive care unit with COVID-19, the association of serum ferritin with N: L Ratio and HRCT Score was significant, and the association of serum ferritin with clinical outcome in terms of discharged and expired was found to be statistically significant. Conclusion: Serum ferritin was found to be a potent marker for clinical outcome in intensive care unit patients in terms of death versus treated. HRCT Score and N:L ratio were found to be correlated with serum ferritin. Therefore, we conclude that serum ferritin may determine the severity of COVID-19 infection and it can be used as a marker for Clinical Outcome thereby making it an often neglected biomarker for predicting prognosis in COVID-19 with most of the physicians focusing mostly on interleukin 6, C Reactive protein and d dimer as a marker of severe COVID infection.

Intraoperative gamma probe directed rib resection.

Radioguided surgery has slowly gained acceptance since the first gamma probe directed sentinel node lymph node biopsy in a patient with melanoma in 1993. We describe how the intraoperative gamma probe is used to localize a rib with abnormal uptake on the bone scan in a patient with rib pain.

False-positive Meckel's scan in a case of infected ovarian cyst.

Abdominal scanning using sodium pertechnetate Tc 99m is useful in demonstrating Meckel's diverticula containing ectopic gastric mucosa. However, other structures like the uterus may also concentrate 99mTc. We present a case which showed a focal area of increased uptake in the pelvis due to an infected ovarian cyst.

Gallium-67 citrate imaging in subcutaneous abscess.

The value of Ga-67 images in identifying unsuspected locations of subcutaneous Staphylococcus aureus abscess is presented. Many of the lesions detected on the Ga-67 study were not clinically evident. In addition, follow-up studies show resolution of the changes after antibiotic therapy.

The effect of cimetidine on blood clearance, gastric uptake, and secretion of 99mTc-pertechnetate in dogs.

The effect of cimetidine, an H2-receptor blocking agent, on the secretion of 99mTc-pertechnetate was studied in 11 dogs. In cimetidine-treated animals, there was increased retention of 99mTc-pertechnetate by the gastric wall as compared with the untreated animals. The results indicate the potential use of cimetidine for enhanced visualization of Meckel's diverticulum, Barrett's esophagus, and the stomach, with 99mTc-pertechnetate.

Studies of skeletal tracer kinetics. III. Tc-99m(Sn)methylenediphosphonate uptake in the canine tibia as a function of blood flow.

Experiments were performed in 14 dogs to study the effect of changes in bone blood flow on the tibial uptake of the skeletal tracer Tc-99m(Sn)methylenediphosphonate (Tc-99m MDP). Aortic blood was diverted through a pulsatile-flow pump in order to monitor and control femoral arterial blood flow. Tibial nutrient perfusion, as measured with labeled microspheres, paralleled the changes in arterial flow. We found that increments in bone blood flow up to four times normal produced only minimal augmentation of Tc-99m MDP uptake (mean = 33%), a markedly nonproportional relationship. The data points clustered about a predicted curve produced by perturbing the rate constants of a seven-compartment model obtained in normal dogs. These findings indicate that bone uptake of Tc-99m MDP is diffusion-limited, and they therefore cast doubt upon the validity of a method used for many years for estimating bone blood flow, the so-called skeletal tracer clearance technique. Nerve section, performed in 14 other dogs, augmented Tc-99m MDP uptake by about 50% at supranormal flows, suggesting a parallel-flow model of the microcirculation in bone, under sympathetic control. Such a model satisfactorily explains many scintigraphic findings in disease states.

Spleen scan in histiocytic lymphoma: response to therapy.

Spleen scan demonstration of space-occupying lesions in patients with histiocytic lymphoma is a sensitive but not a specific finding. However, response to therapy could be evaluated if pretreatment scans show well-defined space-occupying lesions and posttreatment scans showed resolution of those changes.