Contents + EDITORIAL BOARD 4 + CONGRESS REVIEW Review of the European Conference on Rare Diseases, 10 15th – 16th May 2020 + FEATURE The COVID-19 Conundrum and Cancer – Making Perfect Sense of 19 Imperfect Data Utkarsh Acharya + SYMPOSIUM REVIEW Early Intervention with Anti-Tumour Necrosis Factor in Ulcerative 22 Colitis: The Missing Piece of The Puzzle? + POSTER REVIEWS Eicosapentaenoic Acid: Atheroprotective Properties and the Reduction 29 of Atherosclerotic Cardiovascular Disease Events Chlormethine Gel for Mycosis Fungoides T-cell Lymphoma: Recent 37 Real-World Data + INTERVIEWS Data from the AUGUSTUS Trial Adds an Important Piece to the 42 Complex Puzzle of Antithrombotic Treatment for Those with Nonvalvular Atrial Fibrillation with Acute Coronary Syndrome and/or Percutaneous Coronary Intervention Renato D. Lopes and Amit N. Vora Oral Prostacyclin Pathway Agents in Pulmonary Arterial Hypertension: 47 An Expert Clinical Consensus Vallerie McLaughlin and Sean Gaine 2 EMJ • June 2020 • Cover Image © Anna Grigorjeva / 123rf.com EMJ “It is more important than ever that information is disseminated rapidly and responsibly in the face of such global threats” Spencer Gore, CEO + ARTICLES Editor's Pick: Bone-Related Markers of Cardiovascular Disease 54 Ernesto Maddaloni et al. National Institute for Health and Care Excellence (NICE) Guidelines on 63 Cannabis-Based Medicinal Products: Clinical Practice Implications for Epilepsy Management Rhys H. Thomas and Jacob Brolly The Role of Next-Generation Sequencing and Reduced Time to 76 Diagnosis In Haematological Diseases: Status Quo and Prospective Overview of Promising Molecular Testing Approaches Christina Ranft Bernasconi et al. Sebaceous Carcinoma: A Rare Extraocular Presentation of the Cheek 85 Ritu Swali et al. Pathophysiology Underpinning Gestational Diabetes Mellitus and the 90 Role of Biomarkers for its Prediction Natassia Rodrigo & Sarah J. Glastras Case Report: Inhaled Nitroglycerine as an Alternative to Inhaled 97 Nitric Oxide in the Acute Treatment of Pulmonary Hypertension and Impending Acute Right Ventricular Failure in the Intensive Care Unit Khaled Sorour et al. A Case Report: Isolated Pontine Lesion in Hypertensive of a Pregnant 103 Patient with Idiopathic Thrombocytopeni Ilknur Yardimci et al. Mesenteric Panniculitis in a patient with Homozygous Factor V Leiden 108 gene mutation: A Case and Literature to Review. Mohammad Sohaib Asghar et al. Breast Cancer Immunotherapy: From Biology to Current Clinical 113 Applications Jorge Henrique Santos Leal and Heather McArthur Managing Pemphigoid Gestationis 125 Christine Sävervall and Simon Francis Thomsen + WHAT'S NEW 136 Creative Commons Attribution-Non Commercial 4.0 June 2020 • EMJ 3 Editorial Board Editor-in-Chief Prof Markus Peck-Radosavljevic Klinikum Klagenfurt am Wörthersee, Austria Editorial Board Dr Pierfrancesco Agostoni St. Antonius Hospital, Netherlands Dr Fernando Alfonso Hospital Universitario de La Princesa, Spain Dr Emanuele Angelucci IRCCS Ospedale Policlinico, San Martino, Italy Dr George Anifandis University of Thessaly, Greece Dr Riccardo Autorino Virginia Commonwealth University, USA Prof Ahmad Awada Jules Bordet Institute, Belgium Dr Sorin T. Barbu “Iuliu Hațieganu” University of Medicine & Pharmacy, Romania Dr Mátyás Benyó University of Debrecen, Hungary Prof Andrew Bush Imperial College London, UK Dr Abdullah Erdem Canda Yildirim Beyazit University, Turkey Dr Ian Chikanza Barts and The Royal London Hospital, UK Dr Hassan Galadari United Arab Emirates University, United Arab Emirates Prof Jörg Huber University of Brighton, UK Prof Norbert Lameire Ghent University, Belgium Dr Amir Hamzah Abdul Latiff Pantai Hospital, Malaysia Dr Lorenz Räber Bern University Hospital, Switzerland Prof Lászlo Vécsei University of Szeged, Hungary VIEW IN FULL 4 EMJ • June 2020 EMJ Aims and Scope We are always keen to hear from healthcare professionals wishing to discuss potential submissions, please email: EMJ is an online only, peer-reviewed, open access general journal, targeted towards readers in the medical sciences. [email protected] We aim to make all our articles accessible to readers from To submit a paper, use our online submission site: any medical discipline. www.editorialmanager.com/e-m-j EMJ allows healthcare professionals to stay abreast of key advances and opinions across Europe. Submission details can be found through our website: www.emjreviews.com/contributors/authors EMJ aims to support healthcare professionals in continuously developing their knowledge, effectiveness, Reprints and productivity. The editorial policy is designed to encourage discussion among this peer group. All articles included in EMJ are available as reprints (minimum order 1,000). Please contact EMJ is published quarterly and comprises review articles, [email protected] if you would like to order reprints. case reports, practice guides, theoretical discussions, and original research. Distribution and Readership EMJ also publishes 18 therapeutic area journals, which provide concise coverage of salient developments at EMJ is distributed through controlled circulation to the leading European congresses. These are published healthcare professionals in the relevant fields annually, approximately 6 weeks after the relevant across Europe. congress. Further details can be found on our website: www.emjreviews.com Indexing and Availability Editorial Expertise EMJ is indexed on DOAJ, the Royal Society of Medicine, and Google Scholar®; selected articles are indexed in EMJ is supported by various levels of expertise: PubMed Central®. • Guidance from an Editorial Board consisting of leading EMJ is available through the websites of our leading authorities from a wide variety of disciplines. partners and collaborating societies. • Invited contributors are recognised authorities from their respective fields. EMJ journals are all available via our website: www.emjreviews.com • Peer review, which is conducted by EMJ’s Peer Review Panel as well as other experts appointed due to their knowledge of a specific topic. Open Access • An experienced team of editors and technical editors. This is an open-access journal in accordance with the Creative Commons Attribution-Non Commercial 4.0 Peer Review (CC BY-NC 4.0) license. On submission, all articles are assessed by the editorial team to determine their suitability for the journal and Congress Notice appropriateness for peer review. Staff members attend medical congresses as reporters Editorial staff, following consultation with either a when required. member of the Editorial Board or the author(s) if necessary, identify three appropriate reviewers, who are This Publication selected based on their specialist knowledge in the relevant area. European Medical Journal is published four times a year. For subscription details please visit: All peer review is double blind. www.emjreviews.com Following review, papers are either accepted without ISSN 2397-6764 modification, returned to the author(s) to incorporate required changes, or rejected. All information obtained by EMJ and each of the contributions from various sources is as current and Editorial staff have final discretion over any proposed amendments. accurate as possible. However, due to human or mechanical errors, EMJ and the contributors cannot guarantee the accuracy, adequacy, or completeness of Submissions any information, and cannot be held responsible for any We welcome contributions from professionals, errors or omissions. consultants, academics, and industry leaders on relevant and topical subjects. Front cover and contents photograph: Stockholm, Sweden. © Anna Grigorjeva / 123rf.com We seek papers with the most current, interesting, and relevant information in each therapeutic area and accept original research, review articles, case reports, and features. Creative Commons Attribution-Non Commercial 4.0 June 2020 • EMJ 5 EMJ 5.2 Chief Executive Officer Operations Assistants Spencer Gore Satkartar Chagger, Emma Knight Senior Project Director Daniel Healy Editor Evgenia Koutsouki Chief Operating Officer Dan Scott Deputy Managing Editor Sam Davis Head of Publishing Hamish Dickie Content Manager Kirstie Turner Head of Content Marketing Sen Boyaci Editorial Assistants Lenos Archer-Diaby, Michaila Byrne, Katherine Head of Commercial Colvin, Rachel Donnison, Anaya Malik, Isabel Michael McConaghy O’Brien, Layla Southcombe Performance Managers Editorial Consultant Darren Brace, Magnus Barber, Robert Hancox Katie Earl Senior Project Managers Design Manager Hayley Cooper, Nabihah Durrani, Stacey Rivers Millie McGowan, Max Roy Graphic Designers Project Managers Roy Ikoroha, Warren Uytenbogaardt Lucy Bull, Emilie De Meritens, Tilly Flack, Rhian Frost, Mary Gregory, Rebecca Harrison, Jessica Junior Designer Lowman, Lewis Mackie, Thomas Madden, Emma Rayner Billy Nicholson, Fabian Niavarany, Alexsander Director of Digital Innovation Popovic, Alexander Skedd, Caleb Wright, Fiona Salmon Mariana Napoleao Digital and Data Innovation Manager Sales Administrator Louis Jonesco Simi Ige Marketing Assistant Head of Client Services Noah Banienuba Courtney Jones Head of Finance Executive Assistant Nikki Curtis Emma Cook Head of Recruitment Head of Operations Karen Lee Keith Moule 6 EMJ • June 2020 EMJ Welcome It is my great pleasure to introduce the newest edition of our flagship journal EMJ 5.2. The pages inside contain the latest exciting developments from a wide range of therapeutic areas. As the COVID-19 pandemic continues to dominate the headlines