A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Public Health in the field of Hospital Management May 2013 / Laboratory tests are considered a critical clinical intervention in the diagnosis and treatment of various medical conditions. However, ordering of laboratory tests is not immune from abuse (under / over-use), which necessitates that the service be effectively managed. It has been a matter for concern that there actually are no benchmarks in existence against which district hospitals laboratory test ordering patterns can be measured. This study concerns the generation and compilation of a body of knowledge that will serve as a baseline / benchmark for comparison purposes on a month-to-month basis at Brits District Hospital, as well as for comparisons with other district hospitals, towards the development of best practices.

Antral mucosal biopsies were examined microbiologically and histologically for the presence of Campylobacter pylori in 224 patients with upper gastrointestinal symptoms. One hundred and eighty three (83%) patients were found to harbour Campylobacter pylori in their gastric mucosa. Campylobacter pylori was strongly associated with the presence of histological gastritis (93%) and was detected in only 10% of 30 patients whose gastric biopsies showed normal histology. Endoscopically diagnosed duodenal lesions were more strongly associated with the presence of Campylobacter pylori than were gastric lesions (p<0.001). A variety of laboratory methods were evaluated to determine the sensitivity and specificity to detect the presence of Campylobacter pylori. Histology was the most sensitive and specific method to detect the presence of Campylobacter pylori. Although culture was highly specific, it was less sensitive than histology in detecting Campylobacter pylori in gastric antral mucosal specimens. The "conventional" gastric urease assay, although specific, needs be performed under controlled conditions (37°C) for optimal results. The "one-minute" urease assay was more sensitive than the "conventional" gastric urease assays and was highly specific. ELISA to detect specific-IgG antibodies to Campylobacter pylori was a moderately sensitive non-invasive method to detect Campylobacter pylori infection, but was non-specific. / Thesis (M.Med.)-University of Natal, 1988.

Microbiological and molecular epidemiological studies were conducted on 36 multi-resistant Haemophilus influenzae strains, isolated from paediatric patients, over a 26 month period (April 1986 to May 1988). The majority of strains (80,5%) had been isolated from blood and cerebrospinal fluid. More than 80% of isolates tested belonged to biotype II and 90% were of serotype B. Minimal inhibitory concentrations against 6 antibiotics (ampicillin, chloramphenicol, tetracycline, rifampicin, streptomycin and cefotaxime) confirmed the presence of multi-resistant strains. Resistance to rifampicin was confirmed in 6 (16,7%) strains. All strains were susceptible to cefotaxime. Ten transconjugants analysed with respect to their plasmid content were shown to harbour an identical 41 MDa plasmid. Restriction endonuclease digests of these plasmids with Eco R1 and Sst1 revealed almost identical restriction patterns. Outer membrane protein profiles of 19 strains revealed the predominance of one particular subtype. By combining the microbiological and molecular epidemiological findings, it is concluded that one strain of H. influenzae type b is responsible for the nosocomial acquisition of infections amongst paediatric patients. The implifications of these findings are discussed. / Thesis (M.Med.)-University of Natal, Durban, 1988.

Call number: LD2668 .T4 1985 C348 / Master of Science

The susceptibility of 80 StaphyIococcus aureus isolated to oxacillin was investigated using microtitre, agar dilution and Stokes' disc diffusion methods. There was a bimodal distribution of the isolates according to the oxacillin minimum inhibitory concentration (MIC) values. For the sensitive isolates, the agar dilution method generally gave lower MIC values than the microtitre method, while for the resistant isolates the agar dilution method gave comparable to slightly lower MIC values than the microtitre method. The Stokes disc diffusion method yielding the best results when performed on Mueller-Hinton agar incubated at 30°C for 18 hours; however local strains grew poorly when incubated at 30 C for 18 hours. The next best medium which provided clear disc diffusion results plus good growth was Mueller-Hinton agar incubated at 35°C for 18 hours, on which 10 % of the sensitive isolates appeared intermediate in susceptibility, and none resistant, while all the resistant isolates (microtitre MIC >8mg/1) appeared resistant. Oxacillin resistance among strains of Staphylococcus aureus tested by Stokes' disc diffusion method correlated best with gentamicin resistance, and less often with tetracycline resistance. Therefore gentamicin- or tetracycline-resistance may indicate oxacillin resistance in Staphylococcus aureus. / Thesis (M.Med.)-University of Natal, Durban, 1988.

Thesis (M.S.P.H.)--University of Michigan, 1941.

Thesis (M.S.P.H.)--University of Michigan, 1941.

Thesis (Ph.D.) OGI School of Science & Engineering at OHSU, July 2007. / Includes bibliographical references (leaves 202-216).

Thesis submitted in fulfillment of the requirements of the degree Master of Technology: Biomedical Technology in the Faculty of Health and Wellness Sciences at the Cape Peninsula University of Technology 2015 / Aim: The aim of the study was to compile pre-tested laboratory results stored in the laboratory database of the Namibia Institute of Pathology (NIP). The study also aimed to assess the usefulness and validity of using retrospective laboratory results of different patients in varying degrees of health and which were produced using various methods in different laboratories in Namibia. Methods: 254,271 test results (female: 134,261, male = 117,091, unknown gender= 2,919) consisting of Haemoglobin, serum Urea, serum Creatinine, plasma Glucose (fasting and random), serum Cholesterol, serum Triglycerides and serum Uric Acid was extracted from NIP Laboratory Information System over a period of four years and of the 13 different regions of Namibia were analyzed.. Each data set was sorted in ascending order and outliers were eliminated using SPSS Box plot function. Data available for analysis were Haemoglobin: 18,999 (male = 7,716, female = 11,283, serum Urea: 8,111 (male = 3,836, female=4.275), serum Creatinine: 8,794 (male=4,099, female= 4,506), plasma Glucose: 78,106 (fasting=32,591, random=45,515), serum Cholesterol: 48,354 (male=24,815, female=23,539), Serum Triglycerides: 22,138 (male=9,291, female=12,847) serum Uric Acid: 37,389 (male=18,972, female=18,427). Results of tests were also analysed according to the 13 regions in Namibia. Outliers were removed using the Box plot function of SPSS and statistics were calculated for each of the parameters. Tables and histogram as well as percentile ranges (2.5th -97.5th and 5th -95th) were determined for each parameter. Results: Non-parametric percentile ranges were as follows: Haemoglobin (2.5-97.5: M=6.64-16.9, F=7.81-15.2 and 5-95: M=7.39-16.3, F=8.48-14.7) g/L, Urea (2.5-97.5: 1.3- 9.1, 5-95:1.6-8.4) mmol/L, Creatinine (2.5-97.5: M=37-141, F=33-103 and 5-95: M=43- 133, F=39-117) μmol/L, Glucose (2.5-97.5: fasting=3.4-9.5, random=3.7-7.1 and 5-95: fasting=3.9-9.1, random 4-6.9) mmol/L, Cholesterol (2.5-97.5: M=2.6-6.9, F=2.8-7.0 and 5- 95: M=2.9-6.1, F=3.1-6.2) mmol/L, Triglyceride (2.5-97.5: 0.39-2.72 and 5-95: 0.46-2.5) mmol/L and Uric Acid (2.5-97.5: M=0.21-0.62, F=0.17-0.51 and 5-95: M=0.24-0.58, F=0.19-0.48) mmol/L. Conclusion: A statistically significant difference between the mean values of the study and the mean values of NIP reference range was detected and differences between these values and reference values in the region were observed. More work needs to be done to improve the data extraction process, data selection criteria and improvement of statistical analysis. If these can be addressed, it can be stated that using patient laboratory data values is a relatively easy and cost effective method of establishing laboratory and population specific reference values if skewness and kurtosis of the distribution are not too large.

A dissertation submitted to the Faculty of Health Sciences, University of Witwatersrand, in fulfilment of the requirements for the degree of Master of Science (Medicine) in the branch of Anatomical Pathology Johannesburg, 2012 / Objective To determine the effectiveness of the cell block technique for immunocytochemical diagnosis by comparing cytomorphologic preservation and immunocytochemistry (ICC) stains in paired cell block and conventional fine needle aspiration (FNA) samples. Study Design This was a prospective study. Material for both conventional smears and cell blocks were collected simultaneously during fine needle aspiration of 50 lesions comprising lymph node, lung and liver masses. Grading of cellularity, morphological preservation, architectural preservation, immunocytochemical staining intensity and presence of background staining were compared on paired FNA smears and cell block samples derived from the same case. Each arm of the paired analysis was performed blindly without knowledge of the grading outcome of the other. The Kappa statistic (Κ) was used to measure inter-rater agreement. Results The fifty samples evaluated included FNAs from the lung, 24/50 (48%); liver, 23/50 (46%) and lymph node, 3/50 (6%). The immunocytochemistry stains consisted of 44/50 (88%) CK7, 44/50 (88%) CK20, 18/50 (36%) TTF1, 10/50 (20%) synaptophysin, 10/50 (20%) Hepar-1 and 7/50 (14%) AE1/3. There was no overall agreement in preservation of cytomorphological detail and ICC staining between the two methods. The Papanicolaou stained conventional FNA smears fared better then cell block for the vi evaluation of nuclear and cytomorphologic characteristics; cells in the cell block were poorly preserved in many cases. The ICC stains worked better on the cell block samples due to lack of background and aberrant staining. Conclusion Conventional FNA smears and cell blocks complement each other. Our results indicate that it would be optimal to use both modalities in the diagnostic work-up of mass lesions amenable to FNA diagnosis; the former to assess morphology, and the latter for optimal immunocytochemistry results. In resource constrained settings, the cost implications of performing both conventional and blocked smears on all FNA material warrants further evaluation.