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Guillain–Barré Syndrome (GBS) is an acute polyneuropathy commonly preceded by infection, with growing recognition of the human immunodeficiency virus (HIV) as a trigger. We present a case of a 44‐year‐old male with HIV‐associated GBS refractory to intravenous immunoglobulin (IVIG) therapy, who achieved remission upon starting highly active antireroviral therapy (HAART). There remains a lack of consensus on the management of this condition across the spectrum of disease, and the interplay between the therapeutic options is poorly understood. This report aims to add to the current body of knowledge on this rare condition and highlight the need for retrospective analysis of the currently available literature.

IntroductionThe Emergency Department (ED) opt-out BBV testing programme was initiated in April 2022. People who test positive for HIV are managed by local Sexual Health Services (SHS) for follow-up and partner notification (PN).We reviewed PN outcomes for people diagnosed during the first six months of the London ED programme to assess effectiveness and to measure performance against national PN standards.MethodsSHS representing nine EDs across six NHS Trusts provided PN data for people diagnosed through the ED from 1st April to 30th September 2022. For each index case clinics were asked to provide: data on partners, testing outcomes for contactable partners and timeframes.Primary outcomes were calculated using the BASHH/BHIVA/NAT standards.ResultsA total of 77 index cases were reported for the first 6 months of the programme. A breakdown of partner reporting and follow-up is summarised in Figure 1.Abstrct P042 Figure 1Summary of index patients and PN outcomes[Figure omitted. See PDF]Outcome 1 - Number of contacts tested per total number of index cases= 0.38 (standard 0.6 HCP verified (HCPv); 0.8 HCPv and Index patient reported (IPR))Outcome 2 - Proportion of contactable partners tested= 67.4% (standard 65% HCPv; 85% HCPv and IPR)DiscussionED HIV testing provides an opportunity to diagnose people who are unaware of their status. Partner notification amplifies this reach, allowing healthcare professionals to engage a population who may not be aware they are at risk of HIV, and is extremely effective with high test positivity. Current reported performance of PN is below national standards; however this is likely to improve over time with further follow up. Further examination is being undertaken to determine HCPv outcomes.ReferenceBritish Association for Sexual Health and HIV: HIV partner notification for adults: definitions, outcomes and standards. 2015. https://www.bashhguidelines.org/media/1070/hiv_partner_notification_standards_2015.pdf (accessed 23rd March 2023).

BackgroundOn World AIDS Day 2021, the UK Government committed £20 million to expand opt-out HIV testing in EDs in extremely high HIV prevalence (>5/1000) areas as part of their commitment to achieve zero new HIV infections, AIDS and HIV-related deaths by 2030. 34 EDs in London, Brighton, Greater Manchester and Blackpool were included. The initiative started in April 2022 and expanded to include hepatitis C (HCV) and hepatitis B (HBV) testing in collaboration with the HCV Elimination programme.MethodsAll adults undergoing blood tests in EDs had BBV testing (4th generation HIV test, HBV surface antigen and HCV antibody with reflex RNA if HCV antibody positive) unless they opted out. An opt-out approach was taken, based on successful pilots, to maximise uptake and minimise impact on ED workload. Testing information was displayed using accessible and translated posters in EDs. HIV/Sexual Health and Hepatology managed all reactive/positive results.ResultsBy March 2023, 33 EDs had implemented HIV testing, 25 HCV and 19 HBV. From April 2022 through March 2023 there were 1,384,378 adult ED attendances with blood tests and 853,015 HIV, 346,041 HBV and 452,284 HCV tests were performed. Median test uptake increased from 51.1% (HIV), 16.3% (HBV), 23.7% (HCV) in April 2022 to 62% (HIV), 57% (HBV) and 62% (HCV) in March 2023.ED opt-out BBV testing identified 2002 people who were newly diagnosed (343 HIV, 1190 HBV, 484 HCV) and 473 who were previously diagnosed but not in care (HIV 209, HBV 156, HCV 108). Initial linkage to care was 339/552 (61%) for HIV (268/343 (78%) for new HIV diagnoses), 329/1346 (24%) for HBV and 292/592 (49%) for HCV.ConclusionsOpt-out BBV testing in EDs has proven extremely effective for making new BBV diagnoses and re-engaging those previously diagnosed but not in care. We found very high rates of HBV. Initial linkage to care is encouraging and is expected to increase over time.

A 21-year-old woman presented to our department in July with vulval candidiasis and genital warts. A routine genitourinary screen was carried out (vaginal samples for TV/BV, cervical EIA for Chlamydia trachomatis, cervical and urethral culture for gonorrhoea). Review 3 weeks later revealed no other sexually transmitted infection (cervical EIA negative). However, she was noted to be complaining of passing mucus with her stool. Proctoscopy was performed and rectal samples were taken for gonorrhoea and Chlamydia trachomatis (microtrak immunofluorescence). She defaulted arranged follow-up and was recalled by telephone and letter. She reattended the unit in October and in the mean time had been investigated for possible Crohn's disease by the gastroenterology team as her rectal symptoms had persisted for 3 months. She had recently had a sigmoidoscopy and biopsy and was awaiting the results. Her rectal microtrak immunofluorescence test was in fact positive and repeat proctoscopy confirmed the presence of proctitis with a 'cobblestone' appearance. She was given a 2-week course of erythromycin for rectal Chlamydia trachomatis infection. Her proctitis resolved and she made an unremarkable recovery. Her regular partner was screened both in July and November and was chlamydia-negative. He was treated epidemiologically. It later transpired that she had had a one-off episode of unprotected anal intercourse (with no other intercourse) outside her regular relationship 6 months previously. This case illustrates the importance of accurate sexual history taking in guiding the most relevant investigations.

A retrospective case note analysis and contact tracing of 118 women diagnosed with Chlamydia trachomatis by EIA identified 119 current male sexual partners also seen at our department. Analysis was carried out on 119 'couples'. Comparing 118 couples the male partner was older in 85 (72%) cases, younger in 16 cases (13.5%). Overall the male partner was 3.3 years older (no details in 1 case). Thirty-three of 119 (27.7%) couples attended together. In 56 of 119 (47%) cases the female partner was seen first (average time for male partner to be seen 34.3 days). When the male partner was seen first (30/119 (25%) cases) it was 27.1 days. In those not seen together (86/119 couples) 67% of partners were seen within 1 month, 86% within 2 months and 93% within 3 months. Thirteen women were re-treated because of interim sex with their partner. In 5 of these cases it was known that the male partner had not been treated yet. Seven men required treatment because of interim sex during the treatment period. Forty-five of 119 (37.8%) male sexual partners tested EIA-positive for Chlamydia trachomatis. Thirty-four of 45 (76%) had urethritis on microscopy. Twenty-five of 45 (55%) chlamydia-positive men complained of symptoms (urethral discharge, dysuria or scrotal pain). Seventy-four of 119 (62.2%) male partners tested EIA-negative. Twenty-six of 74 (35%) had urethritis and 10 of 74 (14%) were symptomatic. All male partners were treated epidemiologically for Chlamydia trachomatis. This study highlights the difficulties in treating partners concurrently and the importance of improving access to genitourinary medicine services.

Why did Sir Clive succeed in 2003? Certainly, England had many leading players. Yet, previous England teams had had outstanding players, but they never matched the [Clive Woodward] team's status going into the World Cup tournament. The difference this time was in the management process that Sir Clive employed. The starting point is a clear and compelling objective. In Sir Clive's case, it was \"win the World Cup\", despite England's history of failures. It was a transformational objective because his goal was not just an aspiration. Rather, it was the trigger for the articulation of the \"strategy\" - the steps necessary to achieve it and the tasks that would be undertaken within each of those steps. Moreover, Sir Clive analysed England's opponents and built specific capabilities to match or outmatch them. His staff built statistics that were as much leading indicators (foretelling likely performance under match conditions) as lagging indicators (match statistics per match). They worked on the beliefs within the squad, developed clear boundaries of what would not be tolerated either on or off the pitch, tracked adherence to all of the above and intervened swiftly when they did not like what they saw. They were consistently clear about what they were setting out to do.

While investors have generally understood \"best performing\" and \"best managed\" to be two sides of the same coin, the evidence of the last few years challenges such a simple connection. It is a lot subtler than that. The best managed companies deliver year-in and year-out. They do not have value-destroying scandals. They are usually sound - if not necessarily spectacular performers. Conversely, poorly managed companies, even if they appear to be the best performers, are disasters waiting to happen. This \"best managed\" approach can work on at least two levels. First, it can protect investors against individual stock disasters - such as Marconi, Enron, Parmalat or WorldCom. Second, it can distinguish between competitors in the same industry on the basis of their overall \"management\" as well as their performance. Investors would prefer Walmart over Kmart. Such companies have a stronger likelihood of delivering steady growth while being less likely to suffer from the kind of governance or executional weaknesses that have caused precipitous share price drops in many high-profile, but poorly managed, growth companies. Avoiding such losses can become the core added-value of the investment industry.