Pharmacovigilance (PV) is the science and activities related to the detection, assessment, understanding and prevention of adverse effects. Healthcare professionals (HCPs) have an important role in reporting Adverse Drug Reaction (ADR) cases. However under-reporting has been a major challenge in PV. Hence, we assessed the knowledge, attitude and practice (KAP) of HCPs about PV in a tertiary hospital of Kathmandu. A cross-sectional study was conducted using pretested questionnaire consisting of 21 closed ended questions (twelve on knowledge, five on attitude, four on practice and one open ended question to know the causes of under-reporting. Out of 520 HCPs, 448 (207 doctors and 241 nurses) participated in the study with the response rate of 86.2%. The mean KAP score for doctors was 10.38 ± 2.68 and 9.60 ± 2.32 for nurses. The major barriers for under-reporting were identified as the difficulty in deciding if it’s an ADR and lack of time to report ADRs. No significant correlation between knowledge and attitude of the HCPs was found (r=0, n=448, p< 0.01). However, there was a weak positive correlation between knowledge and practice (r= 0.05, n=448, p< 0.01) and also for attitude and practice (r= 0.09, n=448, p< 0.01). Hence, the HCPs had poor knowledge and practice but positive attitude towards PV. It is therefore strongly recommended to have an immediate educational intervention among the HCPs to improve the spontaneous ADR reporting.

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.

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.