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Editor – The Royal College of Physicians’ teach-in ‘Resetting of services post COVID-19’ on 29 June 2020 had some helpful advice and observations.1 Concerning was the recommendation by one of the speakers that physicians should consider arranging diagnostic tests prior to seeing patients as a way of mitigating the impact of social distancing and return to work. As a neurophysiologist running a diagnostic service, I would like to outline the adverse consequences of pursuing this route.

We write to report a rare case of unilateral cancer-associated retinopathy previously undocumented in the literature. Cancer-associated retinopathy is an uncommon paraneoplastic syndrome. It is characterised by retinal antigen autoantibodies causing rod and cone dysfunction and abnormal electroretinography findings with consequent progressive visual loss. Our patient, known to have a primary cervical intraepithelial neoplasia, presented with unilateral blurred vision as well as a disturbance in colour and night vision. Electroretinography findings of reduced a and b waves in the right eye, together with a fundoscopic appearance of a mottled retinal pigment epithelium, attenuated blood vessels and optic disc pallor were consistent with unilateral cancer-associated retinopathy. Posterior subtenon injections of triamcinolone were administered to control active disease. With periocular steroid injections, at 4 years, our patient’s visual acuity remained relatively stable and her condition persisted strictly unilaterally. Cancer-associated retinopathy may be the first presenting sign of an underlying malignancy or may indicate its recurrence. Moreover, in patients with a diagnosed gynaecological malignancy, visual symptoms could reflect cancer-associated retinopathy. In our patient visual symptoms came secondary to the diagnosis of cancer.

Echium plantagineum seed contains a highly polyunsaturated oil (approximately 14% linoleic acid, 10% γ-linolenic acid, 33% α-linolenic acid and 14% stearidonic acid); almost half of the fatty acids are omega-3 fatty acids, so there is an interest in the possible health benefits of this oil, which, once extracted, is prone to oxidation. For the first time in reported literature, oil bodies (OBs), the organelles that store the oil in mature seed, were recovered from E. plantagineum seeds. The oxidative stability of these organelles ex vivo, dispersed in an aqueous continuous phase, was tested against processed E. plantagineum oil emulsions stabilised with either SDS or Tween 20. For both primary and secondary oxidation products the OBs were the most stable form of dispersed oil, and the dispersed systems were all more stable than bulk E. plantagineum oil after incubating at 40°C for 7 days. The possible reasons for the enhanced chemical stability of E. plantagineum OBs are explored in this paper. Practical applications: OBs, the natural store of oil in oilseeds, can be recovered from seeds intact and are relatively stable to oxidation ex vivo. Echium seed OBs, enriched in physiologically active omega-3 fatty acids, therefore offer an attractive alternative to traditional oil extraction methods and overcome the need to encapsulate the omega-3 rich oil.

Introduction We report a cluster of five cases of atypical Guillain-Barre syndrome (GBS) from South East Wales admitted between October and December 2015. Methods Each patient was examined, case notes were scrutinised and nerve conduction studies were performed. Each had a cerebrospinal fluid examination. Extended testing for infective and environmental exposures was facilitated by Public Health Wales. Results All cases are male, aged 25–75. All except one had a preceding prodromal viral illness. Three cases had prominent and early facial biplegia, which presented asymmetrically resulting in ITU support and nasogastric feeding. One of these had minimal motor involvement in his distal upper-limbs, one developed a more typical GBS picture and the third developed a complete ophthalmoplegia without ataxia. A fourth case had asymmetric lower limb weakness and a fifth had distal upper-limb dominant weakness. Nerve conduction studies were in keeping with AMAN in two. Conclusions These cases are remarkable as they are from a distinct temporal and geographic area. None of these patients were positive for Campylobacter; only one has a positive anti GQ1b titre. None met the Brighton criteria for classic GBS or Miller Fisher syndrome. This cluster is currently the focus of an investigation by Public Health Wales.