A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Radiology Johannesburg, 2011 / Management guidelines for urinary tract infections (UTI) invariably include renal ultrasound (RUS). Adequacy of RUS requests and reports is important for clinical practice. Aim To assess the adequacy of paediatric RUS requests and reports, the effects of the former on the latter, the effect of reporter`s rank, determine the yield and correlate adequacy with regard to the frequency of pathology. Materials and Methods Retrospective review of RUS reports of children was performed. A “Request Adequacy Score” (total 3) and a “Report Adequacy Score” (total 21) based on the RSNA reporting template was developed. A UTI subgroup was created. Results Mean “Report Adequacy Score” was 6.67. Residents performed better than consultants. There was no significant factor correlating with report adequacy. Hydronephrosis was the commonest pathology. Conclusion RUS requests and reports are inadequate. To improve reporting a renal ultrasound reporting template was developed.

Research report submitted in partial fulfilment of the requirements for the degree of Master of Medicine in Paediatrics. Johannesburg, 2015. / Urinary tract infections (UTIs) are an important cause of morbidity in children in developing countries and increasing antimicrobial resistance is reported in many countries. This retrospective study describes the performance of urine dipsticks, the aetiology and the antimicrobial susceptibility of paediatric UTIs at Rahima Moosa Mother and Child Hospital, Johannesburg. METHODS: We conducted a retrospective study of results from patients investigated for UTI over a four year period between January 2009 and December 2012 in the Department of Paediatrics & Child Health at Rahima Moosa Mother and Child Hospital. RESULTS: Escherichia coli was the commonest isolated uropathogen. Dipsticks sensitivity to identify UTI was 40% for leucocyte esterase and 34% for nitrites. The specificity was 94.6% for leucocyte esterase and 96% for nitrites. Malnutrition was associated with greater risk of having a UTI, with odds ratio of 2.06 (95% Confidence interval 1.4-2.9). In addition malnourished children tended to present with more resistant uropathogens. Resistance to sulphamethoxasole/trimethoprim and cephalexin has been progressively increasing between 2009 and 2012. From 64% to 79% for sulphamethoxasole/trimethoprim and from 24% to 63% for cephalexin. CONCLUSION: Positive urine dipsticks results allow immediate patient treatment but negative results need to be interpreted within the clinical context due to a high rate of false negatives. Malnourished children are significantly predisposed to urinary tract infections and tend to have more resistant uropathogens. Resistance to cephalexin is rising and studies to assess patient outcomes are needed to determine whether cephalexin still has a role in the treatment of paediatric UTI.

Thesis (M. Nurs.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 61-65).

Inauguraldissertation zur Erlangung der Würde einer Doktorin der Philosophie, vorgelegt der Philosophie-Naturwissenschaftlichen Fakultät der Universität Basel. / Literaturverz.

Thesis (M. Med. Sc.)--University of Hong Kong, 2007.

published_or_final_version / Nursing Studies / Master / Master of Nursing

Thesis (M.S.)--Virginia Polytechnic Institute and State University, 1991. / Vita. Abstract. Includes bibliographical references (leaves 44-51). Also available via the Internet.

Thesis (doctoral)--Freie Universität Berlin, 1979.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Masters of Science in Medicine in Emergency Medicine. Johannesburg, 2013 / To determine the types of uropathogens encountered in patients presenting to a busy private emergency department in Johannesburg and compare sensitivity patterns of the bacteria identified with current antimicrobial prescribing patterns.

Background A pandemic clone, Escherichia coli sequence type 131 (ST131), has been disseminated worldwide and represents an important cause of antimicrobial resistant infections. The spread of this resistant clone has become a great public health concern. Objectives The aims of this study were to investigate the prevalence of ST131 in Escherichia coli isolates from human urinary cultures in Hong Kong and study the antimicrobial phenotypes of ST131. Methodology This study included 340 E. coli clinical urinary isolates obtained from patients in four district hospitals between May 2013 and July 2013 in Hong Kong. Antimicrobial susceptibilities were assessed by disk diffusion method with reference to CLSI. The isolates were investigated by phylogroup-specific and ST131-specific PCR assays. ST131 strains were further assessed for subclone distribution, antimicrobial resistance and extended-spectrum β-lactamase (ESBL) type. Results A total of 18.5% (63/340) of the E. coli population was identified as ST131. ST131 isolates were significantly more likely than non-ST131 isolates to be ciprofloxacin resistant (69.8%, 44/63 versus 31.0%, 86/277; P <0.001), gentamicin resistant (38.1%, 24/63 versus 24.9%, 69/277; P=0.03) and ESBL producers (41.3%, 26/63 versus 18.8%, 52/277; P <0.001). Among the ST131 E. coli isolates, 68.3% (43/63) belonged to the H30 subclone. Most H30 isolates were ST131-O25b (97.7%, 42/43). Also, the ST131-H30 E. coli subclone was statistically associated with ciprofloxacin resistance compared with the non-H30 ST131 isolates (P <0.001). Additionally, strains which were co-resistant to ciprofloxacin, co-trimoxazole and gentamicin were overwhelmingly associated with the H30 subclone than non-H30 (23.3%, 10/43 versus 0%, 0/20; P=0.02). Conclusion This study showed that ST131 isolates were widespread among human E. coli urinary isolates in Hong Kong. The increase in antimicrobial resistance phenotypes are highlighted with ST131, especially the H30 subclone isolates. The dissemination of the ST131 resistant clonal group has aroused clinical attention and limited the choice of empirical treatment. / published_or_final_version / Medical Sciences / Master / Master of Medical Sciences