Säsongsvariation i prevalens av beta-hemolytiska streptokocker bör beaktas vid diagnostik av halsinfektioner [Seasonal variation in prevalence of beta-hemolytic streptococci should be considered when diagnosing the sore throat]

Inledning: Infektioner med beta-hemolytiska streptokocker (BHS) är vanligast förekommande under vinter och tidig vår. Enbart klinisk bedömning av halsinfektion grundad på anamnes och status är otillförlitligt och diagnostiken bör kompletteras med test som påvisar närvaron av BHS. När väl BHS påvisas vid en infektion kan patienten vara asymptomatisk bärare av BHS men ha halsont av annat skäl, vanligen ett virus. Antibiotikabehandling bör då undvikas. Syfte: Att jämföra förekomst och mängd av BHS hos friska individer och hos patienter med svalgsmärtor och relatera fyndet vid svalgodling till personernas ålder, eventuell barnomsorg och årstid vid provtagning. Material Och Metod: Svalgprov togs från 400 friska förskolebarn, 381 friska skolbarn i åldern 7-15 år och från 516 vuxna med ålder >=16 år. Dessa jämfördes med svalgprover från 86 förskolebarn, 60 skolbarn och från 289 vuxna med svalgsmärtor. Prover insamlades under jan-febr och juli-sept 1991. Barnomsorgsform efterfrågades. Växt av BHS kvantifierades som sparsam (1-10), måttlig (10-50) och riklig (>50 kolonier per platta). Resultat: Prevalensen av BHS hos friska individer var lägst före 3 års ålder (1,9-7,1%) och bland vuxna 16 år eller äldre (2,4-3,7%). Högst var den i åldersgruppen 3-15 år (5,0-21,2%). Motsvarande prevalens av BHS för patienter med svalgsmärta var hos barn <3 år (11,8-26,1%), för vuxna 16 år eller äldre (15,7-21,4%) och för skolbarnen 3-15 år med halsont (30,6-41,4%). Ingen statistiskt signifikant skillnad i prevalens kunde observeras mellan olika barnomsorgsformer. Vid fynd av BHS var det vanligare att bakterieväxten var riklig hos patienter (85%) jämfört med hos friska individer (41%). Skillnaden i prevalens av BHS mellan friska individer och patienter med ont i halsen var liten under sommaren och stor under vintern. Konklusion: Prevalensen av BHS varierar med ålder och årstid bland friska individer och patienter med svalgsmärtor. Sommartid är det mycket svårare än under vintertid att tolka svaret på en svalgodling hos patienter yngre än 16 år eftersom antalet asymptomatiska bärare är högt. [Introduction: Infections with beta-hemolytic streptococci (BHS) is most common during the winter and early spring in a temperate climate. Clinical assessment alone based on the history and physical examination of patients with a sore throat is unreliable and diagnostics should be complemented with a test detecting the presence of BHS. Once BHS is detected in a symptomatic patient, the patient may be an asymptomatic carrier of BHS having a sore throat for other reasons, usually a virus. Antibiotic treatment should be avoided in such cases. Aim: To compare the prevalence and quantity of BHS in healthy subjects and in patients with a sore throat and relate this finding to the age, child care and seasonal variation. Material and method: Throat samples were taken from 400 healthy preschool children, 381 healthy school children aged 7-15 years and from 516 adults with aged ≥16 years. These were compared with samples from the throat of 86 pre-schoolers, 60 school-children and from 289 adults with a sore throat. Samples were collected during two seasons; January-February and July-September 1991. Information about child care was asked for. Growth of BHS was quantified as sparse (1-10), moderate (10-50) or abundant (> 50 colonies per plate). Results: Prevalence of BHS in healthy individuals was low before the age of 3 (1.9 to 7.1%) and among adults 16 years or older (2.4-3.7%). It was highest in the age group 3-15 years (5.0 to 21.2%). The corresponding prevalence of BHS for patients with a sore throat was in children <3 years (11.8 to 26.1%), for adults 16 years or older (15.7 to 21.4%) and for school children 3-15 years with sore throat (30.6 to 41.4%). No statistically significant difference in prevalence was observed between different types of child care. It was more common for bacterial growth to be abundant in patients with a sore throat (85%) compared to healthy subjects (41%). The difference in the prevalence of BHS between healthy individuals and patients with a sore throat was small during the summer and high in winter. Conclusion: The prevalence of BHS varies with age and season in healthy individuals and patients with throat pain. It is more difficult to interpret the result of a throat culture during summer compared to winter season in individuals younger than 16 years because the number of asymptomatic carriers is high.

Säsongsvariation i prevalens av beta-hemolytiska streptokocker bör beaktas vid diagnostik av halsinfektioner [Seasonal variation in prevalence of beta-hemolytic streptococci should be considered when diagnosing the sore throat]

Inledning: Infektioner med beta-hemolytiska streptokocker (BHS) är vanligast förekommande under vinter och tidig vår. Enbart klinisk bedömning av halsinfektion grundad på anamnes och status är otillförlitligt och diagnostiken bör kompletteras med test som påvisar närvaron av BHS. När väl BHS påvisas vid en infektion kan patienten vara asymptomatisk bärare av BHS men ha halsont av annat skäl, vanligen ett virus. Antibiotikabehandling bör då undvikas. Syfte: Att jämföra förekomst och mängd av BHS hos friska individer och hos patienter med svalgsmärtor och relatera fyndet vid svalgodling till personernas ålder, eventuell barnomsorg och årstid vid provtagning. Material Och Metod: Svalgprov togs från 400 friska förskolebarn, 381 friska skolbarn i åldern 7-15 år och från 516 vuxna med ålder >=16 år. Dessa jämfördes med svalgprover från 86 förskolebarn, 60 skolbarn och från 289 vuxna med svalgsmärtor. Prover insamlades under jan-febr och juli-sept 1991. Barnomsorgsform efterfrågades. Växt av BHS kvantifierades som sparsam (1-10), måttlig (10-50) och riklig (>50 kolonier per platta). Resultat: Prevalensen av BHS hos friska individer var lägst före 3 års ålder (1,9-7,1%) och bland vuxna 16 år eller äldre (2,4-3,7%). Högst var den i åldersgruppen 3-15 år (5,0-21,2%). Motsvarande prevalens av BHS för patienter med svalgsmärta var hos barn <3 år (11,8-26,1%), för vuxna 16 år eller äldre (15,7-21,4%) och för skolbarnen 3-15 år med halsont (30,6-41,4%). Ingen statistiskt signifikant skillnad i prevalens kunde observeras mellan olika barnomsorgsformer. Vid fynd av BHS var det vanligare att bakterieväxten var riklig hos patienter (85%) jämfört med hos friska individer (41%). Skillnaden i prevalens av BHS mellan friska individer och patienter med ont i halsen var liten under sommaren och stor under vintern. Konklusion: Prevalensen av BHS varierar med ålder och årstid bland friska individer och patienter med svalgsmärtor. Sommartid är det mycket svårare än under vintertid att tolka svaret på en svalgodling hos patienter yngre än 16 år eftersom antalet asymptomatiska bärare är högt. [Introduction: Infections with beta-hemolytic streptococci (BHS) is most common during the winter and early spring in a temperate climate. Clinical assessment alone based on the history and physical examination of patients with a sore throat is unreliable and diagnostics should be complemented with a test detecting the presence of BHS. Once BHS is detected in a symptomatic patient, the patient may be an asymptomatic carrier of BHS having a sore throat for other reasons, usually a virus. Antibiotic treatment should be avoided in such cases. Aim: To compare the prevalence and quantity of BHS in healthy subjects and in patients with a sore throat and relate this finding to the age, child care and seasonal variation. Material and method: Throat samples were taken from 400 healthy preschool children, 381 healthy school children aged 7-15 years and from 516 adults with aged ≥16 years. These were compared with samples from the throat of 86 pre-schoolers, 60 school-children and from 289 adults with a sore throat. Samples were collected during two seasons; January-February and July-September 1991. Information about child care was asked for. Growth of BHS was quantified as sparse (1-10), moderate (10-50) or abundant (> 50 colonies per plate). Results: Prevalence of BHS in healthy individuals was low before the age of 3 (1.9 to 7.1%) and among adults 16 years or older (2.4-3.7%). It was highest in the age group 3-15 years (5.0 to 21.2%). The corresponding prevalence of BHS for patients with a sore throat was in children <3 years (11.8 to 26.1%), for adults 16 years or older (15.7 to 21.4%) and for school children 3-15 years with sore throat (30.6 to 41.4%). No statistically significant difference in prevalence was observed between different types of child care. It was more common for bacterial growth to be abundant in patients with a sore throat (85%) compared to healthy subjects (41%). The difference in the prevalence of BHS between healthy individuals and patients with a sore throat was small during the summer and high in winter. Conclusion: The prevalence of BHS varies with age and season in healthy individuals and patients with throat pain. It is more difficult to interpret the result of a throat culture during summer compared to winter season in individuals younger than 16 years because the number of asymptomatic carriers is high.

Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study

<p>Abstract</p> <p>Background</p> <p>Our aim was to compare the effects of a Paleolithic ('Old Stone Age') diet and a diabetes diet as generally recommended on risk factors for cardiovascular disease in patients with type 2 diabetes not treated with insulin.</p> <p>Methods</p> <p>In a randomized cross-over study, 13 patients with type 2 diabetes, 3 women and 10 men, were instructed to eat a Paleolithic diet based on lean meat, fish, fruits, vegetables, root vegetables, eggs and nuts; and a Diabetes diet designed in accordance with dietary guidelines during two consecutive 3-month periods. Outcome variables included changes in weight, waist circumference, serum lipids, C-reactive protein, blood pressure, glycated haemoglobin (HbA1c), and areas under the curve for plasma glucose and plasma insulin in the 75 g oral glucose tolerance test. Dietary intake was evaluated by use of 4-day weighed food records.</p> <p>Results</p> <p>Study participants had on average a diabetes duration of 9 years, a mean HbA1c of 6,6% units by Mono-S standard and were usually treated with metformin alone (3 subjects) or metformin in combination with a sulfonylurea (3 subjects) or a thiazolidinedione (3 subjects). Mean average dose of metformin was 1031 mg per day. Compared to the diabetes diet, the Paleolithic diet resulted in lower mean values of HbA1c (-0.4% units, <it>p </it>= 0.01), triacylglycerol (-0.4 mmol/L, <it>p </it>= 0.003), diastolic blood pressure (-4 mmHg, <it>p </it>= 0.03), weight (-3 kg, <it>p </it>= 0.01), BMI (-1 kg/m², <it>p </it>= 0.04) and waist circumference (-4 cm, <it>p </it>= 0.02), and higher mean values of high density lipoprotein cholesterol (+0.08 mmol/L, <it>p </it>= 0.03). The Paleolithic diet was mainly lower in cereals and dairy products, and higher in fruits, vegetables, meat and eggs, as compared with the Diabetes diet. Further, the Paleolithic diet was lower in total energy, energy density, carbohydrate, dietary glycemic load, saturated fatty acids and calcium, and higher in unsaturated fatty acids, dietary cholesterol and several vitamins. Dietary GI was slightly lower in the Paleolithic diet (GI = 50) than in the Diabetic diet (GI = 55).</p> <p>Conclusion</p> <p>Over a 3-month study period, a Paleolithic diet improved glycemic control and several cardiovascular risk factors compared to a Diabetes diet in patients with type 2 diabetes.</p> <p>Trial registration</p> <p>ClinicalTrials.gov NCT00435240.</p