Rare bleeding disorders: spectrum of disease and clinical manifestations in the Pakistani population

Background@#Rare inherited coagulation factor deficiencies constitute an important group of bleeding disorders. A higher frequency of these disorders is seen in areas of high consanguinity.Our aim was to study the prevalence and spectrum of rare inherited bleeding disorders, characterize the severity of the deficiencies, identify different clinical manifestations, and evaluate different treatments provided. @*Methods@#This cross-sectional study was conducted in the Department of Haematology, Armed Forces Institute of Pathology Rawalpindi, between January 2014 and December 2018.A detailed history was taken, and an examination was performed. The signs and symptoms were noted, and the patients were diagnosed on the basis of a coagulation profile. The disease severity was assessed using factor assays. @*Results@#Among 2,516 patients with suspected coagulation disorders, 774 (30.8%) had an inherited bleeding disorder. Of the 774 patients, 165 (21.3%) had a rare bleeding disorder;91 (55.2%) of them were males, and 74 (44.9%) were females, with a male-to-female ratio of 1.2:1. The median patient age was 9 years 3 months. The most common disorder was factor VII deficiency (46 patients, 27.9%). The most common clinical presentation was bruising in 102 (61.8%) and gum bleeding in 91 (55.2%) patients. @*Conclusion@#The most common rare bleeding disorder in our population is factor VII deficiency. The prevalence of these bleeding disorders is high in our population due to a high number of consanguineous marriages.

Clinicohematological parameters and outcomes in a cohort of chronic lymphocytic leukemia patients with Deletion 17p from Pakistan

BACKGROUND: Chronic lymphocytic leukemia (CLL) exhibits profound heterogeneity in its clinical course. Its clinicohematological and cytogenetic features play a significant role in determining the clinical course and in predicting the treatment response and prognosis. In this context, 17p deletion is known to predict a poor prognosis, as these cases are refractory to conventional therapy. This study aimed to evaluate the clinicohematological characteristics, outcomes, and prognostic factors among CLL patients with and without del 17p in Pakistan. METHODS: This prospective observational study was conducted at the Department of Haematology, Armed Forces Institute of Pathology (Rawalpindi, Pakistan) between January 2013 and December 2017. Patients were diagnosed based on the International Workshop on Chronic Lymphocytic Leukaemia IWCLL criteria, their clinicohematological parameters were recorded, and cytogenetic analyses were performed. The time from diagnosis to treatment and the 2-year overall survival rate were also evaluated. RESULTS: We evaluated 130 CLL cases, including 24 patients (18.5%) with del 17p, who included 18 men (75%) and 6 women (25%). The median age was 68 years. Binet stage C was detected at the presentation in 16 patients (67%). Treatment was administered to 14 patients (70%) at a median interval of 11 months (range, 0–28 mo) after diagnosis. The overall response rate was 64.3%, the median event-free survival was 9 months (range, 1–23 mo), and the 2-year overall survival rate was 65%. CONCLUSION: Del 17p is relatively common in Pakistan, and patients harboring this deletion had poor treatment response and survival outcomes.

Preoperative blood transfusion, is it essential to arrange blood for patients undergoing caesarean section?

Objective: To assess the need of blood for the patients undergoing caesarean section

Place and Duration of Study: This retrospective study was conducted in Combined Military Hospital [CMH]Jhelum from December 2011 to November 2012

Material and Methods: A total of 224 Caesarean sections done at CMH Jhelum from Dec 2011 to Nov 2012 having American Society of Anaesthesiology [ASA] I and ASA II were included in the study. Patients, who met the preset inclusion criteria i.e. age 20 to 40 years, ASA I / ASA II, primigraveda, previous one, two or three C- sections emergency/ electives were included in the study. Patients with deranged coagulation profile, bleeding disorders, active bleeding [placenta praevia, abruptio placentae] and patients on anticoagulants were excluded from the study. One unit of blood was arranged for patient having hemoglobin [Hb] > 10gm/dl and two units for patient having Hb less than 10gm/dl. Blood was transfused when loss was above 20%, and intravenous fluids given when loss was less than 20%

Results: Out of 224, 181 patients underwent elective C-section and 43 emergency C sections. Emergency surgery was carried out in case of failed induction, cord prolapse, previous C-section in labour and fetal distress. Total 21 patients were considered to receive blood transfusion of which 5 had Hb > 10gm/dl, 5 had Hb between 8-10 gm/dl and 11 patients had HB < 8 gm/dl. Two patients among 11who had Hb less than 8 gm/dl were not given transfusion due to non- availability of blood rest nine received blood. So in fact 19 patients were given blood transfusion

Hashimoto's thyroiditis: not uncommon in simple benign goiter. A review of 1102 thyroidectomies for simple benign goiter

Objective: To see the frequency of Hashimotos Thyroiditis [HT] in patients operated with the diagnosis of simple goiter

Study Design: A retrospective multicenter study

Place and duration: From 1[st] January 1999 to 31[st] March 2011 at three tertiary care hospitals

Methodology: All patients with simple benign goiter irrespective of age and sex are included in the study. Patients already diagnosed for hashimotos thyroiditis, recurrent goiter, abnormal thyroid hormone profile, diagnosed congenital thyroid pathology or non availability of postoperative histopathology were excluded from the study. Histopathology of all patients reviewed to see the frequency of hashimotos thyroiditis in patients operated for benign simple goiter

Results: Among a total of 1102 patients, 91.28% [n=1006] were female and the majority were in 5[th] decade [35.48%, n=391] of life. Histopathology review of all patients operated for benign simple goiter showed that 2.81% [n=31] were having Hashimoto's thyroiditis and majority [87.09%, n=27] were female. Hashimoto's thyroiditis were common in patients who was in the 3[rd] decade of life followed by 4[th] decade, i.e. 35.48% [n=11] and 32.26% [n=10] respectively

Conclusion: Hashimotos thyroiditis is not uncommon and due to its varied clinical presentation it should be ruled out in simple benign goiter before surgery

Early diagnosis of dengue virus infection in clinically suspected cases

Objective: Comparison of real time reverse transcriptase polymerase chain reaction [RTPCR] and immunoglobulin M [IgM] capture enzyme linked immunosorbent assay [ELISA] for diagnosis of dengue virus infection in first week of illness in clinically suspected patients of dengue fever

Study Design: Cross sectional study

Place and Duration of Study: Department of haematology, Armed Forces Institute of Pathology [AFIP] Rawalpindi from Jan 2013 to Nov 2013

Material and Methods: A cross sectional study including 68 clinically suspected patients of dengue fever according to the World Health Organization [WHO] criteria. IgM capture ELISA and RT PCR for dengue virus ribonucleic acid [RNA] was performed on samples collected from patients having fever for 1 to 7 days. These were divided into two groups. Patients in group 1 presented with fever of 4 days or less, patients in group 2 had fever of 5 to 7 days duration

Results: In group 1, 72% of the patients were positive by RT PCR while 31% were positive by IgM capture ELISA. In group 2, 43% of the patients were positive by RT PCR while 97% were positive by ELISA

Conclusion: RT PCR can be used for early detection of dengue virus infection in the first few days of fever while IgM ELISA is diagnostic afterwards

Assessment of patients wearing auto polymerized acrylic resin fixed partial dentures

This descriptive study was carried out at dental out-patient department of Liaquat medical University Hospital Hyderabad from January 2013 to December 2013. Thirty-five patients wearing auto polymerized [self-cured] fixed partial dentures provided by unqualified and qualified dental practitioners were assessed. Condition of oral health was evaluated on the basis of proper history and clinical examination. Prosthesis condition was also assessed. Oral health of underlying soft and hard tissues was carefully evaluated after removing the prosthesis with the help of slow speed hand piece without jeopardizing oral tissues. It was evident in this study that fixed partial dentures made from auto polymerized [self cure] acrylic resins had adversely affected the oral tissues compelling the patients to visit the qualified dentist for proper treatment of their problems

High prevalence of protein C, protein S, antithrombin deficiency, and factor V Leiden mutation as a cause of hereditary thrombophilia in patients of venous thromboembolism and cerebrovascular accident

To determine the frequency of Protein C, Protein S [PC and PS], antithrombin deficiency [AT III] and Factor V Leiden mutation [FVL] as a cause of thrombophilia in the patients with venous thromboembolism [VTE] and cerebrovascular accident [CVA]. It was an observational study conducted at Department of Haematology, Armed Forces Institute of Pathology [AFIP], Rawalpindi, Pakistan. All patients referred for thrombophilia screening from July 2009 to June 2012 were screened. Patients with evidence of VTE or CVA were screened for PC and PS, AT III deficiency, and FVL. Total 404 patients of age between 1-71 years mean 33 +/- 14 with male to female ratio of 2.4:1 had evidence of thrombophilia. Two hundred eighteen [54%] patients presented with CVA, 116 [29%] with deep vein thrombosis [DVT], 42 [10.5%] with pulmonary embolism [PE], and 28 [7.5%] with portal or mesenteric vein thrombosis [PV]. Protein C and S deficiency was detected in 35/404 [8.7%], AT III in 9/404 [2%], and FVL in 25/173 patients [14.5%]. The findings were suggestive of a significant association of FVL mutation for developing DVT [OR=11.0, 95% C I 4.6-26.3], CVA [OR=5.7, 95% C I 2.1-15.1], and PV [OR=5.4, 95% C I 1.3-21.9]. PC and PS deficiency was a significant risk factor for developing PE [OR=3, 95% C I 0.8-11.4]. FVL mutation and Protein C and S are the leading causes of thrombophilia with strong association of Factor V Leiden mutation as risk for developing DVT

Relationship of anemia during pregnancy with education and trimester of pregnancy

To find out relationship of anemia during pregnancy with education and trimester of pregnancy. Community based cross-sectional descriptive study. This study was conducted in urban slum areas of Taluka Qasimabad, District Hyderabad during six months of studying period from 1[st] March 2011 to 31[st] August 2011. The total population residing in the study areas was twelve thousand two hundred and seven [12207]. During the study period of six months, two hundred and fifty [250] pregnant women were enrolled for the study. Pregnant women during 2[nd] and 3[rd] trimester of pregnancy were included in the study. The data was collected by conducting interviews, filling of the pre-tested, structured questionnaire and by assessing anemia by determining the hemoglobin level in the enrolled pregnant women. The questionnaire was a close-ended one, filled by the principle researcher herself. It comprised of demographic information about woman, her family, trimester of pregnancy about her education. Every woman's hemoglobin was determined by using Sahli's Hemoglobinometer. Anemia in pregnancy according to WHO classified into mild anemia hemoglobin level in the range of 10.0-10.9 g/dl, moderate anemia hemoglobin level in the range of 7-9.9 g/dl and severe anemia hemoglobin level is <7 g/dl The association of various factors [determinants] with anemia was analyzed by applying chi-squared test; the p-value of <0.05 was taken as the level of significance. Two hundred and thirty three pregnant women were anemic while only seventeen women [6.8%] were found non-anemic. Majority of the women i.e. 70% presented with moderate anemia [hemoglobin level 7.0-9.9Gm /dl] while severe anemia [hemoglobin level <7 Gm/dl] was recorded in 5.2% pregnant women. Among total studied women, one hundred and forty seven were illiterate and were having different levels of severity of anemia; moderate anemia was recorded in majority of them ie in 127 pregnant women. The educational level had strong association with occurrence of anemia as well as on its severity [p=0.00].Regarding trimester of pregnancy and the occurrence of anemia, out of 158 pregnant women presenting in their third trimester of pregnancies, 143 were moderately to severely anemic. Trimester of pregnancy and occurrence of anemia were found statistically significant. It was also associated with severity of anemia [p=0.00]. Relationship of anemia during pregnancy with low level of education and trimester of pregnancy is very high residing in urban slum areas of Taluka Qasimabad, District Hyderabad is high. Current findings highlight the anemia in pregnancy, education and early booking during pregnancy as a priority area of concern

Giant goiter: not uncommon in endemic areas of Pakistan. a 10 years experience

Objectives: To determine the prevalence of giant goiter and morbidity after surgery and to compare the data with the national and international literature

Study Design: A prospective, observational study

Place And Duration: Department of Surgery, Fauji Foundation Hospital, Rawalpindi from May 1999 to April 2008

Methodology: All patients with giant multinodular goiter [Grade IV] were operated and prevalence of compilations was recorded meticulously, and data compared with national and international literature

Results: A total of 744 patients operated and majority were female 94.89% [n=706] from 5[th] decade of life i.e. 35.75% [n=266]. Giant multinodular goiter [Grade IV] found in 26.08% [n=194]. Among them, 96.90% [n=188] were euthyroid. Near total thyroidectomy was done in 59.79% [n=116] patients, total thyroidectomy in 28.86% [n=56] and subtotal thyroidectomy in 11.35% [n=22] patients. Transient hypocalcaemia was the commonest complication observed, in 8.24% [n=16] patients followed by seroma formation- 7.21%, [n=14]. Permanent hopoparathyroidism-2.66%, [n=4], Permanent recurrent laryngeal nerve injury-1.03%, [n=2], transient recurrent laryngeal nerve palsy-4.63%, [n=9], postoperative bleeding-1.03%, [n=2] and wound infection noticed in 2.57% [n=5] patients

Conclusion: Giant goiter is not uncommon in our setup, with expected high postoperative complications so surgery should be done by experienced hands in the centers where all facilities are available. Public awareness should be created by health authorities and organizations regarding prevention and early treatment

Comparison of real time polymerase chain reaction with microscopy and antigen detection assay for the diagnosis of malaria

To determine the sensitivity of a real time polymerase chain reaction [PCR] for malaria diagnosis and to compare its accuracy with microscopy and an antigen based rapid diagnostic test [OptiMal]. Cross-sectional analytical study. Military Hospital, Armed Forces Institute of Transfusion and Armed Forces Institute of Pathology, Rawalpindi, from July to December 2011. Venous blood samples of 300 clinically suspected patients of malaria were tested for malaria parasite by microscopy and OptiMal; and malaria parasite index was calculated for the positive samples. Plasmodium genus specific real time PCR was performed on all specimens, targeting small subunit rRNA gene. Diagnostic accuracy of three tests was compared and cost analysis was done. Out of 300 patients, malaria parasite was detected in 110, 106 and 123 patients by microscopy, OptiMAL and PCR respectively. Real time PCR was 100% sensitive while microscopy and OptiMal had sensitivity of 89.4% and 86.2% respectively. All methods were 100% specific. The cost per test was calculated to be 0.2, 2.75 and 3.30 US$ by microscopy, OptiMal and PCR respectively, excluding the once capital cost on PCR equipment. Genus specific real time PCR for the diagnosis of malaria was successfully established as a highly sensitive and affordable technology that should be incorporated in the diagnostic algorithm in this country.

Histochemical and serological parameters of hepatic lithium toxicity ameliorated by L-arginine supplementation

The purpose of this study was to judge the ability of L-arginine to restore the carbohydrate, protein and fat metabolism particularly in the liver against lithium carbonate induced hepatotoxicity. This study is randomized, interventional, prospective, morphometric and histochemical study. This study was conducted in the department of anatomy, BMSI, JPMC, Karachi. Animals were obtained from the animal house of BMSI, JPMC, Karachi. The duration of this study comprises of two, six and twelve weeks. Sixty albino adult rats 90 - 120 days of age weighing about 200 - 300 grams were used for this study. Animals were divided into four different groups each comprising 15 rats. Each major group was subdivided into three sub-groups 1, 2 and 3 on the basis of 02 weeks, 6 weeks and 12 weeks duration of treatment respectively. 4 um thick sections of rat liver were stained with PAS haematoxylin, Gomori's calcium phosphate and oil red O. Serum analysis of ALT and ALP was done. Lithium treated group on PAS staining displayed depletion of glycogen content of hepatocytes. Gomori's calcium phosphate staining revealed diminution of the intracellular enzyme contents of hepatocytes especially alkaline phosphatase [ALP] and concomitant rise in serum hepatic enzymes like Alanine aminotransferase [ALT] and ALP. Oil red O stained sections of the liver depicted microvesicular fatty infiltration in liver cells in lithium treated group B animals. This study revealed that the toxicity of lithium is manifested histochemically by disturbances of in the glycogen, lipid and enzyme metabolism in the liver simultaneously exhibiting the restoration of the same metabolism by L-arginine as a best adjuvant in the treatment of bipolar disorder with lithium carbonate

L-arginine as a protective adjuvant in the treatment of bipolar disorders with hepatotoxic agent lithium

The purpose of this randomized experimental study was to explore the beneficial effects of L-arginine on lithium carbonate induced liver toxicity. This study is randomized, interventional, prospective and experimental in nature. This study was conducted in the department of anatomy, Basic medical sciences institute, Jinnah post graduate medical centre, Karachi. Animals were obtained from the animal house of BMSI, JPMC, Karachi. The duration of this study comprises of two to twelve weeks. Sixty albino adult rats of 90 - 120 days of age weighing about 200 - 300 grams were used for this study. These were divided into four major groups A,B, C and D each comprising 15 rats. Each major group was sub-divided into three sub-groups 1, 2 and 3 on the basis of 02 weeks, 6 weeks and 12 weeks duration of treatment respectively. 4 um thick sections of rat liver were cut using rotary microtome for H and E. The statistical significance of the differences of various quantitative changes between lithium carbonate and lithium carbonate + L-arginine treated rats from the control rats were evaluated by the student T-test. Lithium treated group exhibited significant augmentation in absolute and relative liver weight. Histopathological findings of liver revealed dilatation of central and portal veins, congestion of sinusoids, increment in mononuclear cell infiltration, microvesicular fatty change, swelling and hydropic degeneration of hepatocytes leading to pyknosis of nuclei, disintegration of organelles consequently leading to cell apoptosis and necrosis. Rats fed on co-administration of lithium plus L-arginine displayed significant improvement in the altered histology of liver lobules. This study revealed that concomitant administration of L-arginine with lithium considerably reduces lithium's adverse effects

Frequency of femoral fractures; comparison in patients less than and more than 40 years of age

To compare the frequency of various types of fractures of femur in patients less than and more than 40 years of age in a tertiary care hospital. Descriptive cross-sectional study. Emergency department. Period: January 2009 to April 2011. A total of 1756 patients were divided into two groups with respect to age. Then they were further categorized according to the part of femur involved, and compared in both age groups. The study was conducted on a total number of 1756 patients over a period of 2 years from 2009 to 2011. 51.1% patients were less than 40 years of age and 48.9% patients were more than 40 years of age. In patients more than 40 years of age, pertrochanteric fracture was most common [86.40%]. In patients less than 40 years of age, mid shaft of femur was most common region involved [87.02%]. The incidence of proximal femur fractures is high in elderly patients because of several factors like osteoporosis, visual impairment and cognitive disability. Whereas incidence of fractures of mid-shaft of femur is more common in young patients

Frequency of abo and RH [D] blood groups among blood donors in Rawalpindi/Islamabad area

To determine the frequency of various ABO and Rh [D] blood groups among the blood donors in Rawalpindi/Islamabad area of Pakistan. Cross sectional descriptive study. Armed Forces Institute of Transfusion [AFIT], Rawalpindi from Sep 2010 to Jan 2011. A total of 4642 healthy adult, blood donors [volunteer and directed both] belonging to Rawalpindi/Islamabad region were included. From each donor 2 ml of EDTA blood was taken. ABO and Rh [D] blood grouping were carried out by tube method using commercially prepared antisera. The frequency of each type was calculated. Among ABO blood groups the most frequent was B with 1593 subjects [34.3%], followed by O with 1454 [31.3%], A with 1124 [24.2%], and AB with 471 [10.1%] individuals. The Rh [D] positive were 4226 subjects [91%] and Rh [D] negative were 416 [9%]. Among Rh [D] positive cases, blood group B was most frequent with 1476 [34.9%] individuals, however among Rh [D] negative individuals the most frequent blood group was O with 149 individuals [35.8%]. 'B' was most frequent among the ABO blood groups. Knowledge of prevalence of various blood groups in the area will help in managing the transfusion services

Prevalence of methicillin resistant staphylococcus epidermidis in biomaterial related infections

To determine the prevalence spectrum of methicillin resistant Staphylococcus epidermidis in biomaterial infections. Experimental and observational study. This study was conducted in the department of Microbiology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi, during the period of January 2010 to Dec. 2010. A total of 300 subjects of all ages and sex were included. Swab from cannulae tips, catheters tips, old cannulae infected wounds, injection abscess were collected from Jinnah Postgraduate Medical Centre, National Institute of Child Health and Civil Hospital, Karachi and processed according to standard laboratory methods. A total 103 methicillin resistant Staphylococcus epidermidis, causing biomaterial related infection, isolated from 300 patients were analyzed. Bacterial pathogens were commonly isolated from patients of all ages who developed biomaterial related infections. Patients suffering from infections related with biomaterial should be monitored for MRSE at regular intervals

Bacteriological spectrum of clinical specimens from cases of nosocomial infections in paediatric ICU

To assess bacteriological spectrum, of isolates from cases of nosocomial infections in pediatric ICU. subjective study that was carried out from November 2009 to September 2010, on two hundred samples which were taken from patients in pediatric ICU, tertiary care hospital who were clinically suspected of having nosocomial infection and processed for the diagnosis and isolation of the infective organisms in the Department of Microbiology, Basic Medical Sciences Institute [BMSI], Jinnah Postgraduate Medical Centre [JPMC], Total 200 samples were collected. Out of these 143 samples showed positive results. 138 were of bacterial growth while 5 samples were positive for fungus. Among these 61 were positive for septicemia, 44 positive for UTI and 17 samples were positive for respiratory tract related disease, while 21 positive for miscellaneous samples. This study presents a general overview of nosocomial pathogens in Pediatric ICUS and emphasizes the importance of timely clinical and bacteriological monitoring among children especially in patients in critically ill situation

Prevalence of hepatitis C virus ribonucleic acid in antibody screened blood in Northern Pakistan

Blood donors are currently screened for antibodies to hepatitis C virus [HCV] by enzyme immunoassay. This pilot study aimed to estimate the prevalence of viremic and potentially infectious donors by the HCV-RNA polymerase chain reaction [PCR] in donor population of Northern Pakistan and also to examine the prospects of adding nucleic acid testing [NAT] to serological screening protocols for donated blood with the purpose of reducing the risk of transfusion-transmission of HCV infection. Descriptive cross sectional study. The study was conducted at Armed Forces Institute of Transfusion, Rawalpindi in January 2010. Fifteen hundred samples negative for anti-HCV [EIA, third generation] were screened for HCV RNA using RT-PCR method for qualitative detection of HCV RNA, with a lower limit of detection of 200 Ill/ml. The prevalence of HCV RNA positivity in HCV antibody negative infectious blood could not be estimated as all blood donations were negative for HCV RNA. The prevalence of HCV transmission in anti-HCV screened blood has not yet been documented in Pakistan. The sample size [1500] of the pilot study was not large enough to predict prevalence of HCV RNA in anti-HCV tested blood donors. The introduction of NAT to screen donated blood has shown to improve blood -safety in developed world and is likely to have greater impact in Pakistan because of high prevalence of HCV in general population

Clinicomycological study in Karachi

To find out frequency of dermatophytosis in Karachi and correlation between clinical types and strain isolated. This prospective study was conducted in the Department of Microbiology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi from September 2000 to August, 2001.Three hundreds seventy-three patients having skin, hair and nail infection [clinically suspected cases of dermatophytosis] were examined. The skin scraping, hair plucking and nail clipping were taken and subjected to direct microscopy and culture on mycobiotic agar [Difco] for isolation of dermatophytes. Various special media were used for species identification. Dermatophytosis was predominantly found among adults 246 [66.8%] population. Most common clinical pattern was of tinea corporis [26.9], followed by tinea cruris [25.8],tinea unguium [19.3], tinea capitis [17.4], tinea pedis [7.9], tinea faciei [4.6] tinea manuum [2.2] and tinea barbae [0.8] respectively. Tinea cruris was significantly found more in males 83 [36.9%] than females 12 [8.4%] [P<0.001]. Species of dermatophytes were recovered from 184 cases, out of which 95 [51.6%] strains of Trichophyton rubrum, 43 [23.4%] strains of Trichophyton violaceum, 25 [13.7%] strains of Epidermophyton floccosum,15 [8.2%] strains of Trichophyton mentagrophytes and 06 [3.2%] strains of Trichophyton tonsurans respectively. Trichophyton rubrum was found to be commonest etiological agent in different clinical types. Dermatophytosis is found to be more common in adult population. Tinea cruris being more common in miles while tinea corporis and tinea unguium relatively common in females Trichophyton rubrum was found to be commonest etiological agent in different clinical types

Evaluation of sampling sites for detection of potential pathogenic bacteris in children with upper respiratory infections [URTIs]

URTIs are common cause of morbidity in children. Two sampling techniques, oropharynx [OP] and nasopharynx [NP] for detection of upper respiratory tract [URT] pathogenic bacteria were studied. To determine which sample site, NP or Op yields the highest rate of S. pneunoinae, H. influenze, M. catarrhalis, S. aureus and S. pyogenes isolates at different age group. The aim of present study was to evaluate as to which sample site yields the highest rates of bacterial isolates in children with upper respiratory tract infection [URTIs]. The prevalence of potential pathogenic bacteria [S. pneumoinae, H. influenzae, M. catarrhalis, S. aureus and S. pyogenes] from 150 infected children of various ages, >5, 6-10 and 11-15 years were compared in NP and OP samples having URTIs. S. pneumoinae was found equally in both NP and OP sites while H. influenzae, M. catarrhalis, S. aureus were more in OP sample while S. pyogenes was isolated in OP alone