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Background: Circumcision is the most common elective surgical procedure amongst Muslims. The Plastibell method is gaining popularity as it is being considered safer with a lower complication rate. Objective: To compare the open and plastibell methods of circumcision in terms of procedural time, outcomes, and parental satisfaction in our cohort of boys up to 5 years of age. Methods: This quasi-experimental study of boys aged ≤5 years was conducted from July 2018 to October 2020 at THQ Ferozewala, Punjab. Boys meeting the inclusion criteria were circumcised, based on parental preference, by the Open method or the Plastibell technique after administering age-appropriate local or general anesthesia. Follow-up was conducted on the 5th, 10th, and 30th postprocedural days. Basic demographic data, procedural duration, and outcomes were documented. Results: Of 646 boys brought for circumcision, 608 met the inclusion criteria with equal participants in both groups. The median age in the open and plastibell groups was 3.0 (IQR=1.0-12.2) and 5.0 (IQR=2.0-9.0) months respectively. The Plastibell group had a significantly shorter median operating time compared to the Open method (4.2 min vs. 13 min; p=0.008). Complications were recorded in 15% of children (n=91) and were more frequent but comparatively trivial in nature in the Plastibell group. Comparison of complications between the two methods revealed that the association of over-removal of skin was statistically significant (p=0.007) with the Open method while under-removal of skin (p=0.002) and post-operative phimosis (p=0.037) were significantly associated with the Plastibell technique; the latter two complications being significantly associated with age of the boys in the ≥2 months to 1-year group. No serious adverse outcomes were reported for both groups. The open method was preferred by parents for cosmesis and Plastibell for ease of care. Follow-up contact was established with all families. Conclusion: Plastibell, compared to the open method, is a quicker and safer method of circumcision for boys up to 5 years of age, under appropriate anesthesia. Follow-up ensures patient safety. Clinical Trial Number: ClinicalTrials.gov-NCT06120634

Background: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) worsens the respiratory symptoms that are usually triggered by infection with bacteria or viruses or by environmental pollutants. Therefore, the aim of this study was to determine the bacterial etiology from sputum culture in patients suffering from acute exacerbation of COPD, admitted in hospital. Methods: The study was cross sectional observational, where sputum bacterial cultures were analyzed from the patients with Acute exacerbation COPD treated in the ICU of a tertiary care hospital for pulmonary disease from January 2019 to December 2019. Two sputum samples were collected from each patient for bacterial examination. The results of sputum bacterial culture findings were expressed as frequency and percentage by using SPSS. Results: In the present study, there were 1296 patients, both males 749 (57.8%) and females 547 (42.2%). The mean age of patients was 57.39±19.74years. 470 (36.3%) showed negative culture reports. 440 (34.0%) patients had Moraxella infection, which was most common organism in all patients, and 149 (11.5%) patients had Pseudomonas infection, 157(12.1%) patients had Yeast Albicans and in only 1 (0.1%) patient Enterobacter infection were found. Other pathogens in low frequency identified were Haemophilus parainfluenzae, Streptococcus pneumoniae, Escherichia coli and Haemophilus influenzae. It was observed that the frequency of infections was linked with increasing age. Conclusion: With increasing age, people are prone to acquire pulmonary infections specifically COPD. It is therefore very important to perform sputum culture to identify the causative agents and treat the patients with appropriate antibiotic to reduce the episodes of AECOPD. Keywords: Bacteria; Sputum Culture; COPD; Antibiotic; Cough.

Background: Diagnosis of acute pancreatitis is based on raised serum lipase and serum amylase in the blood. However, the levels of urinary amylase can be sought for being less invasive. The study aimed to find out the diagnostic accuracy of urinary amylase compared to serum amylase and serum lipase and their association with the degree of severity of acute pancreatitis. Methods: A randomized clinical control study was conducted on n=180 acute pancreatitis patients (18-50 year) in the Ziauddin and PNS Shifa Hospital, Karachi from September 2019- August 2020. Serum amylase, serum lipase and urinary amylase levels were checked at the time of admission followed by 24 hours and at discharge. ANOVA with post-hoc Tuckey’s test was used to determine the association of amylases with the severity of acute pancreatitis and p˂0.05 was considered as statistically significant. Results: The patients with acute pancreatitis had a mean age of 51.76 ±10.8. Urinary amylase had a strong significant association (p˂0.05) with acute pancreatitis compared to serum amylase and lipase (p=0.024). There was an insignificant association of urinary amylase with acute pancreatitis after 24 hours. Similarly, urinary amylase reported good diagnostic discrimination of acute pancreatitis as the accuracy index, the area under the ROC curve was one, showing higher sensitivity and specificity by covering the maximum population under the ROC curve. Conclusion: The significance of Urinary amylase (p˂0.05) was higher than serum amylase, serum lipase because of sensitivity and specificity for diagnosing acute pancreatitis representing a positive association with the degree of severity of the disease. Keywords: Acute Pancreatitis; Amylase; Lipase; Amylase.