[Is treatment of diabetes too complicated for general practitioners?]

The prevalence of type 2 diabetes is increasing rapidly. In order to reduce the morbidity and mortality of type 2 diabetes, it is important to treat both hyperglycaemia and risk factors for cardiovascular disease. This means that diabetes care is becoming increasingly comprehensive and complicated. Studies in Norway show that diabetes care in general practice could be improved. The primary care system needs more resources and better organisation to be able to meet the demands for improved quality and more comprehensive care. We suggest more active use of nurses and other health care professionals, as well as changes in the remuneration system for general practitioners. Remuneration for an annual review of patients with diabetes will stimulate quality improvement work. The division of work between primary health care and hospital clinics should be clarified.

[Guidelines for diagnosis and treatment of sore throat]

BACKGROUND

Available guidelines for the diagnosis and treatment of sore throat give conflicting recommendations. Our aim was to develop evidence-based guidelines.

MATERIAL AND METHODS

We searched The Cochrane Library, Medline and other sources for systematic reviews and other evidence that met explicit inclusion criteria for all of the relevant options and outcomes we identified. The validity of included studies was assessed. Draft recommendations based on assessment of this evidence were widely circulated and discussed in focus groups with patients and physician assistants.

RESULTS

Throat infections are self-limiting and complications rare. Penicillin shortens the duration of symptoms in tonsillitis caused by beta-haemolytic streptococci and reduces the risk of complications. Penicillin has adverse effects and increases the risk of reinfections. Patients with sore throat should usually be treated without antibiotics. Visiting a physician is normally unnecessary. Antibiotics should be considered in serious cases or if the patient prefers this, but should only be prescribed for throat infections caused by beta-haemolytic streptococci. The diagnosis should be based on clinical criteria and a rapid antigen test in cases of doubt.

INTERPRETATION

Benefits of antibiotics must be weighed against harms. Patients should be given good information and involved in decision-making if they want antibiotics.

[Guidelines for diagnosis and treatment of acute urinary tract problems in women]

BACKGROUND

Available guidelines for the management of symptoms of lower urinary tract infections (UTI) in women give conflicting recommendations.

MATERIAL AND METHODS

We searched The Cochrane Library, Medline and other sources for evidence that met explicit inclusion criteria for the relevant options and outcomes identified. The validity of included studies was assessed. Draft recommendations were widely circulated and discussed in focus groups with patients and physician assistants.

RESULTS

The probability that a woman with dysuria or frequency has bacteriuria, is 80%. The probability of UTI given a negative result of a dipstick test is 50%. Evidence suggests that antibiotics will rapidly relieve symptoms, but there are limited data from placebo-controlled randomised trials. Population based studies show that many women do not visit physicians for symptoms of UTI. Women with symptoms of UTI can be treated with antibiotics without examination of the urine. Women with earlier episodes of UTI can be offered treatment by telephone. Antibiotics for three days is sufficient based on eradication of bacteriuria. Women should be seen by a physician if the symptoms are atypical.

INTERPRETATION

Implementing these guidelines could result in better service to women with UTIs. More evidence about the effects of antibiotics and other treatments is needed.

[Hemolytic-uremic syndrome caused by verotoxin-producing Escherichia coli intestinal infection]

Enteric infections with verotoxin-producing Escherichia coli can progress to the haemolytic-uraemic syndrome. Several reports suggest that the incidence of verotoxin-producing E coli infections is increasing in the USA and Europe. Small epidemics of haemolytic-uraemic syndrome are usually traced to the ingestion of beef or dairy products. Epidemics of diarrhoea-associated haemolytic-uraemic syndrome have not yet been reported in Norway. We describe, for the first time in Norway, a sporadic case of haemolytic-uraemic syndrome that was associated with a verotoxin infection. Despite several life-threatening relapses the patient eventually made a good recovery after treatment with supportive therapy, plasma exchange, plasma infusions, corticosteroids, vincristine and ciprofloxacin. The authors stress the importance of continuing with intensive supportive therapy even when the prognosis seems hopeless.

Comparative anatomy of the vomeronasal organ complex in bats

The morphology of the vomeronasal organ complex was histologically described in eight out of fourteen chiropteran species investigated. Of the six families examined, all except the family Pteropodidae (suborder Megachiroptera) were found to have at least one member possessing the organ. The organ is best developed in phyllostomatids. It is absent in vespertilionids (including a Myotis embryo) except in Miniopterus. An accessory olfactory bulb is reported for the first time in the latter. The organ is described for the first time in Rhinopoma, Megaderma, and Hipposideros. The organ in Rhinolophus is also described. Homologous anterior nasal cartilages and patent nasopalatine ducts are present in all species. The organ occupies the anterior ventral nasal septum region. In Megaderma and Hipposideros it is level with the nasal cavity floor. Areas of epithelium similar to olfactory epithelium have been observed in some organs. Epithelia, vascular sinuses, vomeronasal nerves, paravomeronasal ganglia, accessory olfactory bulbs, and vomeronasal glands have been investigated. In bats with regressed or rudimentary organs (Megaderma, Rhinopoma, Rhinolophus, Hipposideros) accessory olfactory bulbs could not be identified. Thus, presence of the organ does not necessarily indicate presence of the accessory olfactory bulb. Septal pockets located superior to the organ complex and lined with pseudostratified columnar epithelium are described in Hipposideros and may play a part in nasophonation. A unique role is proposed for the organ in the feeding behaviour of Desmodus. The desirability of extending the useful terms 'diosmatic' and 'monosmatic' to all vertebrates in reference to their respective possession or lack of the vomeronasal organ is suggested.