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Click here for the corresponding questions to this CME article. [ABSTRACT FROM AUTHOR]

Background von Willebrand disease ( VWD) is the most common congenital bleeding disorder. In women, menorrhagia is the most common bleeding symptom, and is disabling with iron deficiency anaemia, high health cost and poor quality of life. Current hormonal and non-hormonal therapies are limited by ineffectiveness and intolerance. Few data exist regarding von Willebrand factor ( VWF), typically prescribed when other treatments fail. The lack of effective therapy for menorrhagia remains the greatest unmet healthcare need in women with VWD. Better therapies are needed to treat women with menorrhagia. Methods We conducted a survey of US haemophilia treatment centres ( HTCs) and a literature review using medical subject heading (Me SH) search terms 'von Willebrand factor,' 'menorrhagia' and 'von Willebrand disease' to assess the use of VWF in menorrhagia. Analysis was by descriptive statistics. Results Of 83 surveys distributed to HTC MDs, 20 (24.1%) provided sufficient data for analysis. Of 1321 women with VWD seen during 2011-2014, 816 (61.8%) had menorrhagia, for which combined oral contraceptives, tranexamic acid and desmopressin were the most common first-line therapies for menorrhagia, whereas VWF was third-line therapy reported in 13 women (1.6%). Together with data from 88 women from six published studies, VWF safely reduced menorrhagia in 101 women at a dose of 33-100 IU kg−1 on day 1-6 of menstrual cycle. Conclusions This represents the largest VWD menorrhagia treatment experience to date. VWF safely and effectively reduces menorrhagia in women with VWD. A prospective clinical trial is planned to confirm these findings. [ABSTRACT FROM AUTHOR]

Surveillance for Middle East Respiratory Syndrome (MERS) has been undertaken in the UK since September 2012. This study describes the surveillance outcomes in England from 2012 to 2018. This was a descriptive study using surveillance data. Local health protection teams in England report possible MERS cases to the National Infection Service with clinical and laboratory data. A total of 1301 possible MERS cases were identified in the study period. Five cases were laboratory-confirmed MERS. The majority of cases had travelled to Saudi Arabia (56.7%) and United Arab Emirates (25.9%). Fifty-four percent of cases were men and 43.7% were women. The majority of cases (65.1%) were aged 45 years or older. The number of tests increased in the period after Hajj each year. Laboratory-confirmed alternative diagnoses were available for 513 (39.4%) cases; influenza was the most common virus detected (n = 255, 52.4%). Our study highlights the importance of differential diagnosis of influenza and other respiratory pathogens and early influenza antiviral treatment. • Routine surveillance for Middle East Respiratory Syndrome has been carried out. • In total, 1301 possible cases were identified including five laboratory-confirmed cases. • Influenza was the most common pathogen detected for differential diagnosis. [ABSTRACT FROM AUTHOR]

The experience of using a telemedicine feasibility study to integrate respiratory health response and environmental stimuli information is presented. The effects of ambient air quality, pollen and local environment conditions on asthmatic patients'' lung function were investigated through the use of a novel European health telematic system. The Medical Diagnosis, Communication and Analysis Throughout Europe (MEDICATE) project developed and tested the feasibility of using a telemedicine system for chronic asthmatics in London, UK, and Barcelona, Spain. The key to this was the determination of the real time health (lung function) response to the ambient environment and allergens. Air quality, pollen and environmental lifestyle information were related to respiratory measurements for recruited asthmatic patients in the study through the design of a dedicated environmental management system (EMS) database. In total, 28 patients completed the study trial, subject to ambulatory monitoring of spirometric lung function (PEF, FEV1 and FVC) up to four times a day over a 2-week period recorded during the year 2000. Alongside this, ambient air quality and pollen counts were used to represent local exposure to potential environmental stimuli. Personal questionnaire interviewing collected additional data about patient lifestyles, social-economic conditions and quality of life perceptions.The methods and indicative results of integrating environmental and health data in this respect are examined. Assessment tools such as GIS and object-orientated databases were designed to locate and compile environmental information about the patients'' locations and lifestyles in the study areas (London and Barcelona). Socioeconomic and lifestyle factors, such as exposure to smoking, pets, personal journey lengths and modes, income, household occupancy and domestic fuel use, were found to have limited detectable effects on the patients'' basic lung function levels. Patients'' gender, age and predicted PEFR were significantly associated with the 2-week mean and minimum respiratory measurements. Lung function data were compared with air quality and pollen indicators to examine relationships on a daily or lagged-day basis controlling for confounding factors. The paper discusses the new methodology and the practicalities of using the telemedical system as a tool for assessing the impacts of environmental stimuli on respiratory health. [Copyright &y& Elsevier]