Multiple sclerosis (MS) is the leading cause of non-traumatic neurological disability in young adults. Between 1990 and 2016, the UK prevalence increased by 28%, due to earlier diagnosis and increased survival. The female to male ratio is 2:1, and patients have a minimally reduced life expectancy. Diagnostic criteria require that clinical, radiological and laboratory signs of MS are disseminated in both time and space. Diagnosis is based on a combination of features (relapses and clinical progression), MRI findings, and CSF analysis.

Heavy menstrual bleeding has been defined as ‘excessive menstrual blood loss which interferes with a woman’s physical, social, emotional, and/or material quality of life’. Heavy menstrual bleeding affects 25% of women of reproductive age and is estimated to be the fourth most common reason for gynaecological referrals. Women should be asked about pelvic pain which might suggest endometriosis and pressure symptoms which might suggest significant fibroids. Examination is appropriate if there is intermenstrual or postcoital bleeding and, if the woman is actively bleeding, may identify the source of the bleeding.

Impetigo is a common contagious bacterial infection of the skin. The causative organisms are either Staphylococcus aureus or, less commonly, Streptococcus pyogenes. The infection can occur at any age, but it is particularly common in children, especially the pre-school and early school age years, and tends to be more frequent during the summer months. It may arise on previously normal skin or complicate a pre-existing dermatosis. The diagnosis is essentially a clinical one, but if in doubt a swab should be taken for bacteriological culture.

Anxiety disorders are common, highly treatable conditions, with a strong evidence base for cognitive behaviour therapy. In a recent population sample of the under 12s, only 65% of those who met criteria for a diagnosis of an anxiety disorder had sought professional help and only 3.4% had received an evidence-based treatment. Assessment should include an exploration of neurodevelopmental conditions, drug and alcohol misuse, and speech and language problems.

Patients with rheumatoid arthritis (RA) have an excess of stroke and heart failure which appears to accumulate in the five years before diagnosis, an English population-based study has found. The excess risk for further cardiovascular disease (CVD) events persisted after diagnosis and was not totally explained by differences in traditional CVD risk factors or RA-related risk factors at diagnosis.

Use of oral or inhaled corticosteroids appears to be an independent risk factor for osteoporosis and fragility fractures in patients with asthma, a UK population-based study has found.

I will never forget that day in George’s house. He was 52 and had developed a particularly aggressive cancer three years earlier. He had shown tremendous bravery and had withstood and appreciated everything that high-tech hospital medicine could throw at him. Now it looked like we were near the end of the road. On his last visit to the hospital he had been told that his secondaries were widespread, and that the armoury of potential treatments had been exhausted. There was nothing else that could be done from a curative point of view.