This overview will address the epidemiology, main risk factors and clinical course of multiple sclerosis (MS). The clinical as well as pathophysiological features of both relapsing–remitting and progressive MS will be discussed. Furthermore, an overview of diagnostic criteria will be given, supplemented by a differential diagnostic work-up for the clinician.

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that encompasses both neuroinflammatory and prominent neurodegenerative aspects. A significant proportion of MS patients will develop neurological disability over time and, until recently, licensed drugs could not satisfactorily halt this process. However, in recent years, MS treatment has entered a phase of rapid progress. Several new drugs with significantly improved efficacy have entered the therapeutic field, and several others are currently undergoing phase III clinical trials. In this review, the efficacy data and safety and tolerability issues of currently licensed drugs for relapsing–remitting MS will be summarized, including a short update on new drugs currently undergoing late-stage clinical trials.

Although a wide range of therapeutic options are available for relapsing–remitting multiple sclerosis (MS), the therapeutic landscape for progressive forms of the disease is highly unsatisfactory. Therefore, the identification of effective therapies for progressive MS (PMS) is a highly relevant challenge for the global MS medical community. To achieve this, a better understanding of the mechanisms involved in PMS is required through novel clinical trial designs, new drug repurposing strategies and new methods of collaboration in identifying effective therapies. In this review, we discuss the first compounds already available for PMS as well as other therapies currently undergoing phase II and III clinical trials.

Patients with serious and non-serious limb complaints are diverted to emergency departments (EDs) at night, when regular clinics are closed. This study was conducted to identify the impact of extending the opening hours of family medicine (FM) clinics on the detection of limb fractures in patients with limb complaints, which could be a measure of expected patient influx in EDs. A cross-sectional comparative study was conducted in a health centre in Dubai, United Arab Emirates. Patients with limb complaints were categorized by attendance during regular hours (7:30–21:30 hours) and extended hours (21:30–7:30 hours). Rates of fracture positivity, patients handled by the FM clinic and patients referred by the FM clinic to other departments were analysed. SPSS Statistics version 24 (IBM Corporation, Armonk, NY, USA) was used for analysis; chi-squared tests were used to determine association and P-values <0.05 were considered significant. A total of 736 patients with limb complaints were studied: 81.79% (602) attended the FM clinic during regular hours and 18.21% (134) attended during extended hours. The total number of fracture-positive patients was 108. Fracture positivity was more frequent during extended hours: 23 of 134 (17.16%) patients were fracture positive during extended hours and 85 of 602 (14.11%) patients were fracture positive during regular hours. Only 30 of 134 (22.38%) patients were referred to the ED or another department during extended hours, whereas 150 of 602 (24.91%) patients were referred to the ED or another department during regular hours. Referral of fracture-positive patients was not affected by time of attendance (P>;0.05). More fracture-positive patients and fewer referrals during extended hours indicates the significance of extending clinic opening hours; extending the opening hours of this clinic to 24 hours indirectly reduced ED crowding.

Superior mesenteric artery (SMA) syndrome is a rare acquired vascular compression disorder in which acute angulation of the SMA results in compression of the third part of the duodenum, leading to intestinal obstruction. This is typically caused by an angle of 6–25° between the abdominal aorta and the SMA, in comparison with the normal range of 38–56°, as a result of a lack of retroperitoneal visceral fat (mesenteric fat). In addition, the aortomesenteric distance is 2–8 mm as opposed to the typical 10–20 mm. Here we report the case of an 11-year-old girl who presented with frequent attacks of non-specific abdominal pain over a few years, who had been treated symptomatically without a clear diagnosis. However, in the last admission, she presented to our hospital with symptoms of subacute small bowel obstruction including bilious vomiting and epigastric pain that prompted extensive investigations including multislice abdominal computerized tomography with oral and intravenous contrast. This scan confirmed the diagnosis of SMA syndrome.

We present a case of mucosal leishmaniasis located in the pharynx and possibly the maxillary sinus in a healthy 51-year-old man. The only manifestations of leishmaniasis disease in the described case were dysphagia, voice changes and a longstanding painless pharyngeal mass. Thorough clinical examination and investigations were carried out and treatment was provided in the form of amphotericin B, piperacillin/tazobactam and linezolid. A review of the literature on this subject has been undertaken.

Cysts of the falciform ligament of the liver are rare. To date there have been only 12 reported cases, including the case reported here. In each case, diagnosis was made surgically after the patient complained of pain in the right upper quadrant of the abdomen or following palpation of a mass. We report the diagnosis of a falciform cyst following sonography, computerized tomography, magnetic resonance imaging and exploratory laparoscopy. The cyst was laparoscopically excised (see video clip).

Coarctation of the aorta is a narrowing of the descending aorta, resulting in left ventricular overload, arterial hypertension and cardiovascular and neurological complications. It is frequently diagnosed in infancy and childhood; first-time presentation in adults is rare. The classic symptom is arterial hypertension; most patients are asymptomatic unless hypertension is present. We report the case of a 19-year-old woman who presented with a headache, tiredness and arterial hypertension. Clinical examination revealed that blood pressure was significantly lower in the lower extremities than in the upper extremities and radiofemoral delay (delayed femoral pulses). Severe aortic coarctation was confirmed by computerized tomography aortography; echocardiography was inconclusive. The lesion was successfully treated with balloon dilatation and mesh stent placement.