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ObjectivesWe aimed to explore patient pathways using a chlamydia/gonorrhoea point-of-care (POC) nucleic acid amplification test (NAAT), and estimate and compare the costs of the proposed POC pathways with the current pathways using standard laboratory-based NAAT testing.Design/participantsWorkshops were conducted with healthcare professionals at four sexual health clinics representing diverse models of care in the UK. They mapped out current pathways that used chlamydia/gonorrhoea tests, and constructed new pathways using a POC NAAT. Healthcare professionals' time was assessed in each pathway.Outcome measureThe proposed POC pathways were then priced using a model built in Microsoft Excel, and compared to previously published costs for pathways using standard NAAT-based testing in an off-site laboratory.ResultsPathways using a POC NAAT for asymptomatic and symptomatic patients and chlamydia/gonorrhoea-only tests were shorter and less expensive than most of the current pathways. Notably, we estimate that POC testing as part of a sexual health screen for symptomatic patients, or as stand-alone chlamydia/gonorrhoea testing, could reduce costs per patient by as much as £16 or £6, respectively. In both cases, healthcare professionals' time would be reduced by approximately 10 min per patient.ConclusionsPOC testing for chlamydia/gonorrhoea in a clinical setting may reduce costs and clinician time, and may lead to more appropriate and quicker care for patients. Further study is warranted on how to best implement POC testing in clinics, and on the broader clinical and cost implications of this technology.

In a purely clinical, unbiased study, 50 patients with verrucae plana were treated with dinitrochlorobenzene for 1-24 weeks, keeping half the lesions as controls. The results were statistically insignificant when the treated patients were compared to the control group.

Cluster headache (CH) and paroxysmal hemicrania (PH) falls into group 3 of the International Headache Society (IHS) classification, the trigeminal autonomic cephalalgias (TACs) (1). The chronic forms of both diseases lack the remission and are diagnosed after 1 year without remission or if remissions have lasted < 1 month (1). The number one differential diagnosis for chronic paroxysmal hemicrania (CPH) is chronic cluster headache (CCH) (2). There is considerable overlap in diagnostic criteria of CCH and CPH in the IHS criteria, except for the response to indomethacin in case of CPH (1). Drug treatments are able to control or prevent the attacks in approximately 90% of CH. In the remaining 10%, drugs are ineffective (3). Verapamil is the drug of choice for CH (3). However, no intervention works for every patient, and some options are highly effective for a small percentage of patients. Surgery is a last resort measure in treatment-resistant patients. However, before surgical procedure is considered, it is incumbent on the clinician to exhaust all potential medical options (4). We report a case of CCH responding to high-dose indomethacin when other treatments failed and discuss the relationship of CCH to CPH.