COVID-19 Sars Co V2 or Corona Virus disease is a highly infectious multisystem disease with severe acute lung injury leading to ARDS and respiratory failure as its main complication. Spontaneous pneumothorax is a complication which is though uncommon but could be life threatening and hence carries poor prognosis. We hereby describe a series of six cases of spontaneous pneumothorax which were seen in Bahria International Hospital COVID management unit during last 3 months of COVID-19 surge in Lahore These cases indicate that multiple factors are associated with development of spontaneous pneumothorax in COVID-19 pneumonia patients but main role is played by the increased inflammatory response and can be regarded as a potential underlying mechanism of pneumothorax in such patients, leading to acute decompensation and worsening of respiratory failure and poor outcome.

Renal failure in hospitalized patients is associated with significant morbidity, mortality, and resource utilization, with up to 18% of patients experiencing this condition. Hemodialysis is widely used as a renal replacement therapy worldwide. However, the long-term maintenance of functional upper extremity vascular access remains challenging for healthcare providers. This study assessed the performance of tunneled catheters used for dialysis access. A total of 97 eligible patients were included from Bahria Town International Hospital Lahore, and their demographic data and the duration of hemodialysis were recorded. The lead investigator inserted a tunneled catheter in each patient for dialysis purposes. After a three-month follow-up period, patients were evaluated for catheter use during their subsequent appointments. Infection was diagnosed if patients were presented with redness, discomfort, or pus. The catheter condition was assessed, noting any signs of breakage, dislodgement, exposed cuff, fractures, or obstructions. Data was collected using a standardized Performa. The study population had an average age of 47.76 ± 16.317 years, with an average duration of dialysis of 6.87 ± 2.754 months. Male patients constituted 60.824%, while female patients accounted for 39.176% of the sample. Catheter placements were performed in the internal jugular vein in 79 (81.44%) individuals, the subclavian vein in 13 (13.40%), and the femoral vein in 5 (5.154%). Infection was observed in 16.49% of patients, while 83.505% remained infection-free. Catheter failure was identified in 5.154% of patients. However, no significant correlations were found between the occurrence of catheter failure and age group, gender, body mass index (BMI), dialysis duration, or catheter site. All the pre-values for these variables were greater than 0.05. Similarly, age group, gender, BMI, dialysis duration, and catheter site did not exhibit a statistically significant association with the presence of infection. Catheter failure in patients with chronic renal disease undergoing continuous hemodialysis was observed in 5.154% of cases, while infection occurred in 16.49%. Age group, gender, BMI, dialysis duration, and catheter location were not found to be significant effect modifiers.

Brain death is the complete and irreversible cessation of all activity in the brain, including the brain stem and cortex. It's critical to declare someone brain dead to stop providing life support or donating their organs. This study was carried out to evaluate postgraduate trainee doctors’knowledge and understanding of brain death in the Lahore cityas the Punjab Human Organ Transplant Authority (PHOTA) moves towards cadaveric donor program. Utilizing the universal sample approach, a questionnaire-based survey with 150 senior trainee registrars from several postgraduate fields was conducted at four teaching hospitals in Lahore. The registrars had 45 minutes to finish a pre-validated questionnaire form that inquired about their perspectives, knowledge, and the procedure for determining brain death. Quantitative data were shown as means, whereas qualitative data was shown as frequencies. SPSS software version 21 was used for statistical analysis. The questionnaire was given to 150 postgraduate trainees in total, of which 70% were men and 30% were women. Approximately 88.90% of participants were able to define brain death as the total cessation of all brain functioning, including brainstem reflexes. 121 doctors (82%) said yes when asked if they would perform brainstem reflexes twice, six hours apart. Only 40(26.66%) doctors were able to reliably identify the absence of brain stem responses, such as the corneal and pupillary reflexes. Just 10 (6.66%) out of 150 participants were able to correctly define what a positive apnea test means, but 33.33% of respondents agreed that it is a necessary test to demonstrate the cessation of brain stem activity. 15.50% of resident doctors had knowledge that a committee of four doctors was required to declare brain deathThe gold standard test for determining brain death, according to 4.66% of responders, is cerebral angiography. 95% of respondents were ignorant of the measures being taken by the Punjab Human Organ Authority (PHOTA) concerning the dead organ harvesting program or that such a program even existed. Although everyone agreed that getting an agreement before organ harvesting was required but only five trainees understood the exactmethodologyof taking consent and how it functioned. The PGRs lacked knowledge about brain death, its detection and documentation, concerning cadaveric donor organ donation and transplantation. The results of this study showed a lot of work needed to start cadaveric organ transplant safely.