Bruk av SCOFF for diagnostisering av spiseforstyrrelser i allmennpraksis

Den initiale presentasjonen av spiseforstyrrelser i allmennpraksis er ofte kryptisk med diffuse fysiske og psykiske symptomer og derfor vanskelig å diagnostisere. Britiske studier har vist at under halvparten av klinisk presenterte spiseforstyrrelser identifiseres. Vi har liten grunn til å tro at det er vesentlig forskjellig i Norge. Det er en alminnelig oppfatning i litteraturen og blant spesialister på området at tidlig diagnostisering har en klar positiv effekt på pasientens prognose. Målet med oppgaven har vært å finne frem til et godt dokumentert tiltak som vil kunne bedre diagnostiseringen av spiseforstyrrelser i en norsk allmennpraksis. Etter en gjennomgang av temaet ved litteratursøk i Cochrane og Pubmed, samt samtaler med norske allmennleger og speisalister på fagfeltet, kom vi frem til at SCOFF bør brukes som et screeningverktøy ved mistanke om en spiseforstyrrelse. En SCOFF-anamnese er rask og enkel å gjennomføre og har høy negativ prediktiv verdi. Positiv SCOFF-anamnese må føre til videre utredning. KONKLUSJON: Vi ser SCOFF som et enkelt, godt tilgjengelig, billig og trygt verktøy for bruk i norsk allmennpraksis. Det egner seg godt til å utelukke en mistenkt spiseforstyrrelse, og kan gi et kraftig insitament for videre utredning

Antimicrobial susceptibility testing of Bacteroides species by disk diffusion: The NordicAST Bacteroides study

Objectives - Antimicrobial susceptibility testing (AST) of anaerobic bacteria has until recently been done by MIC methods. We have carried out a multi-centre evaluation of the newly validated EUCAST disk diffusion method for AST of Bacteroides spp. Methods - A panel of 30 Bacteroides strains was assembled based on reference agar dilution MICs, resistance gene detection and quantification of cfiA carbapenemase gene expression. Nordic clinical microbiology laboratories (n = 45) performed disk diffusion on Fastidious Anaerobe Agar with 5% mechanically defibrinated horse blood (FAA-HB) for piperacillin-tazobactam, meropenem and metronidazole. Results - A total of 43/45 (95.6%) laboratories carried out disk diffusion per protocol. Intraclass correlation coefficients were 0.87 (0.80–0.93) for piperacillin-tazobactam, 0.95 (0.91–0.97) for meropenem and 0.89 (0.83–0.94) for metronidazole. For metronidazole, one media lot yielded smaller zones and higher variability than another. Piperacillin-tazobactam and meropenem zone diameters correlated negatively with cfiA expression. A meropenem zone diameter of Conclusions - Inter-laboratory agreement by disk diffusion was good or very good. The main challenges were media-related variability for metronidazole and categorical disagreement with the reference method for piperacillin-tazobactam in some cfiA-positive strains. An area of technical uncertainty specific for such strains may be warranted

DEET som malariaprofylakse : Er norske retningslinjer hensiktsmessige?

Background. Prevention of mosquito bites is an important part of a malaria prevention strategy. The insect repellent N,N-diethyl-m-toluamide (DEET) is the globally most widely used product for this purpose. DEET is considered very effective and is the gold standard for mosquito repellents. However, there are concerns related to possible toxic effects, most notably seizures or other neurologic symptoms, particularly in children. In Norway, the sale of products containing more than 20 % DEET is prohibited, whereas higher concentrations are allowed and recommended in Canada, the United Kingdom and the United States. Objective. To determine the best practice for DEET use for the purpose of malaria prevention, based on current liturature, with an emphasis on a trade-off between optimal effect and avoidance of adverse reactions. Also, specifically to determine whether the Norwegian limitation of 20 % DEET maximum is warranted. Methods. The project is based on original and review articles in medical journals, obtained through literature searches in the databases MEDLINE/PubMed and EMBASE. The search terms “DEET” and “concentration” were used, and combined with keywords such as “efficacy”, “repellency”, “effect”, “adverse effects” and “toxicity”. Results. The duration of action of DEET is directly dependent on the concentration of DEET applied to the skin. Mosquitoes of the genus Anopheles have a significantly higher tolerance to DEET than mosquitos of the genera Aedes and Culex. Based on this, and other factors such as climate that influence the duration of action of DEET in tropical areas, a concentration of 20 % may be too low to provide adequate protection against malaria vector mosquitoes. There is no evidence that higher concentrations of DEET lead to a higher risk of toxicity, although pharmacological studies suggest that concern should be used when applying DEET to children. Products that deliver DEET through a polymer or liposphere formulation may reduce the amount of DEET absorbed and thereby the risk of systemic adverse effects, although these products have not been systematically evaluated