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The article presents a study that discussed appraisal of the methods used in the study like aware of the details of the design of the study, different study designs involve different data collection methods, employ different analysis methods, and a precise understanding of the design. It discussed the challenges of conduct of observational research also describe common observational study designs and the use of such designs in headache research.

Early differentiation between infection and aseptic inflammation is difficult and is a challenge often faced in the rheumatology practice. Procalcitonin (PCT) is a biomarker that is preferentially induced in patients with bacterial infections, and a growing body of evidence supports its use for improving diagnosis of bacterial infections and guiding antibiotic therapy. In this article, we review the evidence for the use of PCT measurement in rheumatology practice. Several studies have examined the use of PCT to assist in the differentiation between septic and non-septic arthritis in patients with an inflamed joint and found it to be a sensitive and specific marker of infection. A number of studies in patients with diverse inflammatory rheumatic diseases have provided useful information regarding the usefulness of PCT in these patients. In summary, PCT when used in the appropriate clinical setting can be a useful adjunct to currently available laboratory infection markers, though further studies are warranted. Furthermore, PCT results should be interpreted in parallel with the clinical assessment. [ABSTRACT FROM PUBLISHER]

Objective: Recently, new predictors of vesicoureteral reflux (VUR) in children with a first febrile UTI such as Procalcitonin (PCT) were introduced as selective approaches for cystography. This study wants to show the capability of PCT in predicting presence of VUR at the first febrile UTI in children. Methods: Patients between 1 month and 15 years of age with febrile UTI were included in this prospective study. PCT values were measured through a semi-quantitative method in four grades comprising values less than 0.5, 0.5-2.0, 2.0-10.0 and above 10.0 ng/ml. The independence of PCT levels in predicting VUR were assessed after adjustment for all potential confounders using a logistic-regression model. Findings: A total of 68 patients, 54 (79.4%) girls and 14 (20.6%) boys were evaluated. PCT level demonstrated a significant difference between patients with positive VUR and those with negative VUR (P=0.012). To calculate the independent factors that may predict the presence of VUR, all included variables were adjusted for age and sex. Results of logistic regression showed that a PCT level between 2.0 and 10.0 ng/mL could independently predict presence of VUR (Odds ratio=6.11, CI 95%= 1.22-30.77, P=0.03). Conclusion: Our finding in this study showed that readily available semi-quantitative measures for PCT are feasible for detecting patients with VUR. We suggest that in semi-quantitative measurements of PCT, levels between 2.0 and 10.0 ng/ml could be an independent predictor of positive VUR. [ABSTRACT FROM AUTHOR]

Background and Objective: Most of the studies emphasize increasing PCT in septic shock. The aim of this study was to determine the level of CRP in children suffering from bacterial infection and compare it with PCT in children hospitalised in Mousavi Hospital. Materials and Methods: This study was carried out with 81 children aged 3 months to 13 years old hospitalised in pediatrics ward and the PICU of Mousavi Hospital in 2011-2012. Venous sampling was obtained for the tests and for blood cultures before starting the antibiotic treatment. In special cases, urine and CSF cultures were done. The chest radiography was carried out for children suspected of having the pneumonia and sepsis. Patients who had received parenteral antibiotics one week before their admission to the hospital, were excluded from the study. Results: The level of PCT was equal or less than 0.5 ng/ml, 0.5 to 10 ng/ml and 10 ng/ml in 41.7%, 36.9% and 20.2 % of patients, respectively. The increase in the rate of serum PCT in patients with septic shock was significantly higher than patients infected with SIRS and sepsis. CRP was found higher than 10 in 71.4% of patients. The kappa agreement rate of PCT and CRP was 0.46 and meaningful (p < 0.0001). Conclusion: Despite the high diagnostic sensitivity of PCT, measuring the CRP is also convenient and affordable in differentiating different stages of infection. [ABSTRACT FROM AUTHOR]

Background and Aim Community-acquired pneumonia ( CAP) is a leading cause of mortality, morbidity and hospital admission, which places strain on our healthcare system. Procalcitonin ( PCT) is a biomarker of bacterial infection which may help gauge the severity and prognosis of patients with CAP. In addition to clinical predictors, PCT may assist in decisions pertaining to timing of discharge from hospital and the discontinuation of antibiotics. This study aimed to determine the predictive role of PCT measurement in reducing hospital admissions, length of stay ( LOS) and antibiotic ( AB) usage in patients with CAP. Methods A prospective, single-blinded, externally controlled study of consenting adult patients admitted with CAP. PCT levels were obtained on day 1 and day 3 (when indicated). Investigator-evaluated clinical parameters, together with results of PCT levels, determined the timing of oral AB switch and discharge from hospital. This process was compared against standard practice, but was not actually implemented, for the purpose of this study. Results Sixty patients were included in the study. The mean age was 66.5 ± 21.2 years (56.3% male). The average Pneumonia Severity Index was 93 ± 39 (class IV) and the median CURB-65 was 2. The mean LOS for the standard practice cohort was 5.3 ± 4.6 days versus calculated LOS using the PCT guidance pathway of 3.7 ± 2.8 days. ( P = 0.00006). Conclusions Our study supports the hypothesis that by incorporation of PCT levels, hospital admission and LOS in patients with CAP can be reduced. A randomised prospective clinical trial is planned in an attempt to help confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Acute exacerbations of chronic obstructive pulmonary disease (AeCOPD) are important causes of morbidity and mortality. In this study, we analyzed procalcitonin (PCT) levels in AeCOPD and stable period of COPD in order to evaluate usage of PCT in the prediction of the severity of AeCOPD, and its value on the planing of noninvasive positive pressure ventilation (NPPV). Materials and Methods: In this cross sectional study (2009-2010) 118 COPD patients were enrolled, 68 of them (58%) were in acute exacerbations (case group). The others had stabile COPD and they were defined as control group. Results: In case group the mean levels of PCT (0.19 ± 0.02) C-Reactive Protein (44.7 ± 5.92), erythrocyte sedimentation rate (28.4 ± 2.65), white blood cell (9.4 ± 0.43) and %neutrophils (69.9 ± 1.22) were significantly higher than controls (P = 0.0001). There was no difference between PCT levels based on stages of COPD. There were significiant differences in mean PCT levels according to type and severity of AeCOPD. Mean PCT level in hospitalized patients receiving NPPV was 0.36 ng/ml, while it was 0.15 ng/ml for those treated without NPPV (P = 0.0001). PCT cut-off value for NPPV indication was determined to be 0.10 ng/ml. Conclusions: PCT levels were found to be higher in AeCOPD patients than in stable COPD patients, as expected. Also mean PCT levels increased especially in cases with severe AeCOPD and those receiving NPPV among them. In the present study, we determined a cut off value of PCT as 0.10 ng/ml as a predictor of necessity of NPPV in AeCOPD. [ABSTRACT FROM AUTHOR]

An introduction to the periodical is presented in which the editor discusses various topics within the issue including mutations acquired by H1N1 virus, treatment outcome of the triple-combination antiviral drugs and outcome of H1N1 influenza.

The article focuses on migraine is a plausible candidate for impacting the accident rate, as its cognitive, visual, and vestibular symptoms can all affect the ability to drive. It mentions the accident rate seems to double in migraine sufferers, but it is unclear to what extent this is due to the disease itself; and also mentions the degree of disability and stigma associated with migraine is ramped.

The Cochrane Library of systematic reviews is published quarterly. Issue 2 for 2003 of the library was published in May 2003. That issue contains 2395 reviews of which 1669 are in full text. The issue contains 79 new reviews, seven of those are directly relevant to pain management and palliative care. Annotated bibliographies for those seven reviews are provided. Issue 3 for 2003, published in July 2003, contains 3058 reviews and protocols of which 1754 are fully published reviews. Issue 3 contains 85 new reviews, five are relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews. The Cochrane trials database now stands at over 375,000 records with an additional 4100 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including acute treatment of migraine attacks, use of target calcitonin gene-related peptide (CGRP) for migraine, and clinical trials of 5HT-1F receptor agonists.

An editorial is presented which talks about the need for using simpler terms to explain lung diseases to patients. It specifically talks about finding easily understandable names for acute exacerbation of chronic obstructive pulmonary disease (AE-COPD). Comparison with terms for neurological and cardiological conditions such as stroke and myocardial infarction are noted.

An introduction is presented in which the editor discusses articles in the issue on topics including dietary interventions for migraine; research on the influence of the gut microbiome on migraine; and the challenge of treating migraine in patients with comorbid vascular disease.