Background: Hemodialysis patients with end-stage renal illness use a tunnelled central vein catheter for vascular access. Heparin with a preservative, in contrast, exhibits inferior antibacterial effects against biofilm and plank tonic bacteria. Aim: To evaluate the effectiveness of taurolidine citrate solution versus heparin lock solution when infused into the catheter lumens of hemodialysis patients with end-stage renal illness. Study design: Randomized clinical trial Place and duration of study: Hemodialysis Unit, King Fahad Specialist Hospital, Buraidah, Saudi Arabia from 11th December 2018 to 10th June 2019. Methodology: One hundred and fourteen patients on hemodialysis aged 40-70 years with end stage renal disease with Glomerular filtration rate (GFR) less than 15 mL/min, on maintenance hemodialysis through tunnelled dialysis catheter dependent for at least 6 months and patent catheters were selected and randomized into two equal groups by using sealed opaque envelopes bearing a tag of Heparin group and citrate-taurolidine group. Patients were excluded from the study if they had a catheter site infection or an infection unrelated to a catheter that was on antibiotic therapy or had positive blood cultures within two weeks of enrollment. Every two weeks and at the time the catheter was removed, blood cultures were routinely obtained from the catheter lumen to look for bacterial colonization. At the conclusion of six months of hemodialysis, the CRI was assessed. All instances of infections caused by catheters were documented. Results: Incidence of catheter related infection occurred in 5 (8.8%) patients who underwent Heparin group while none of the patient (0%) of taurolidine/citrate group suffered with catheter related infection. This data reveals significantly high incidence of CRI in Heparin group (p=0.029) and significantly high efficacy of taurolidine/citrate group over Heparin group. Conclusion: Efficacy of taurolidine citrate solution is superior versus heparin lock solution instilled in the catheter lumens of patients on hemodialysis. Keywords: Catheter, Infection, Renal disease, Hemodialysis

Background: A hypersensitivity condition called cytokine storm is the main cause of death in COVID-19 patients. A monoclonal antibody called tocilizumab may be able to suppress the Interleukin-6 receptors (IL-6R) and lessen the likelihood that the body would have a hypersensitive immune response. Aim: To evaluate the mortality advantages of tocilizumab in individuals with COVID-19. Study design: Retrospective study. Place and duration of study: Bahria Town International Hospital Lahore from 16th June 2020 to 17th September 2021. Methodology: Patients with 96 confirmed instances of COVID-19 were enrolled. Two groups of patients were created. A single dosage of tocilizumab was administered to 52 participants in the first group, referred to as the survivors, and 44 patients in the second group, who passed away within 14 days. From the patients' medical records, the demographic information, co-morbid conditions, and laboratory values were obtained. The hospital's institutional review board and ethics committee (IRBEC) gave its approval for this study. The permission was ignored because this was a retroactive analysis. Results: 54.24 16.58 was the average age, and 54 (56.25%) of the population were men. 52 (54.16%) patients were survivors, compared to 44(45.83%) patients in the non-survivor group. In non-survivors compared to survivors, the older age group was shown to be statistically significant (62.78±12.86 vs. 51.65±11.68, p=0.003). Additionally, non-survivors had a greater BMI (p=0.006). In our study, hypertension and diabetes were the two co-morbid conditions that were most frequently detected (35.24% and 28.94%, respectively). The mortality rates among patients with diabetes, asthma, COPD, and cancer were all considerably higher (P=0.01, 0.006, and 0.004, respectively). Cancer and type-2 diabetes patients had death rates that were considerably higher (p=0.05 and p=0.01, respectively). C-reactive protein (CRP), D. Dimer, procalcitonin (PCT), and IL-6 were discovered to be the significant predictors of mortality (p 0.0001, 0.05, 0.001, and 0.004 respectively). Conclusion: Even though tocilizumab is authorised and has been shown to have positive results, people with diabetes, COPD, and asthma are more likely to experience negative results even after getting a single dosage of the medication. Similar to CRP, D. Dimer levels are reliable indicators of death. Keywords: Tocilizumab, Motility predictors, Co-morbid conditions, COVD-19, Procalcitonin, D. Dimer