ABSTRACT
The in-hospital mortality in patients with COVID-19 could be correlated with severe acute respiratory syndrome coronavirus-2 induced hyper-inflammation, which is attributed to an unconstrained inflammatory cytokine storm. The pro-inflammatory cytokine, specifically, interleukin-6 plays a prominent role in the cytokine storm and may result in alveolar-capillary blood-gas exchange dysfunction. Therefore, the method to block the signal transduction pathway of interleukin-6 could be a potential treatment for severe COVID-19 patients. In this case series of three patients with severe COVID-19, we focus on the rationale for utilization of tocilizumab, an anti-interleukin-6 receptor antibody, which could block the signal transduction pathway of interleukin-6. The observations from this study allowed us to hypothesize that the infusions of tocilizumab may not reduce the elevated level of interleukin-6, and hence may not be a significant therapeutic for reducing in-hospital mortality associated with COVID-19. Additionally, it could also be speculated that interleukin-6 may not be a potentially actionable target cytokine to treat COVID-19-associated cytokine storms. Keywords: COVID-19; cytokines; interleukin-6.
Subject(s)
COVID-19 , Humans , Cytokine Release Syndrome/drug therapy , Cytokine Release Syndrome/etiology , COVID-19 Drug Treatment , Cytokines/metabolism , Cytokines/therapeutic use , Interleukin-6/therapeutic useABSTRACT
Osteoid osteoma is the most common benign bone forming tumor characterized by a nidus surrounded by reactive sclerotic bone typically associated with nocturnal pain and most common in males less than 30 years. Diagnosis may be difficult in cases of atypical presentation, intraarticular localizations or very small size. Computed tomography guided radiofrequency ablation is one of the promising treatment methods being used with an advantage of minimal invasion, faster recovery and shorter hospitalization. We present a case of an 8-year-old boy with osteoid osteoma of neck of femur managed successfully with radiofrequency ablation. To our knowledge, this is the first case reported on radiofrequency ablation in Nepal.
