A 34-year-old woman presented to the medical admissions unit with progressive ascending weakness of her limbs and areflexia. Diagnosis of Guillain-Barré syndrome was suspected and she was started on intravenous immunoglobulins. Owing to a poor initial response, further exploratory history revealed travel to the New Forest and a possible tick bite; subsequent investigations confirmed positive serology for antibodies againstBorrelia.The patient's weakness improved with intravenous ceftriaxone for neuroborreliosis, a manifestation of Lyme disease. With inpatient neurorehabilitation, she made good recovery and was able to mobilise with a stick from being completely bed bound 6 weeks after completion of her antibiotics.

SUMMARYA 21-year-old woman, with a background of asthma, presented to medical admissions ward, with diarrhoea and vomiting; the clinical picture during her admission evolved to include acute shortness of breath, seizures, unsteadiness, low mood and apathy. Investigations revealed pericardial, pleural effusions, myocardial infiltration and vasculitic lesions in the brain. Although serological tests for autoantibodies were negative, an eventual diagnosis of eosinophilic granulomatosis with polyangiitis, formerly known as Churg-Strauss syndrome, was performed based on the clinical picture. The multiorgan involvement meant that the initial diagnosis and effective management required multidisciplinary input from cardiology, neurology, rheumatology, psychiatry, immunology and occupational and physiotherapy. BACKGROUND

Introduction and objectivesPulmonary rehabilitation (PR) is recommended by the British Thoracic Society for patients that suffer from COPD; it is typically delivered in supervised sessions. Daily physical activity (PA) is often recorded as an outcome following PR, with variable results. National guidelines recommend that older adults should accumulate 150 min of moderate intensity activity in bouts of 10 min or more. We wanted to objectively measure the amount and intensity of PA, which patients actually accumulate during 1 PR session. This is the first study to profile PA during a PR exercise class in this way and could be useful for home training and general PA advice.MethodsWe conducted a prospective study on patients diagnosed with COPD that were enrolled for PR at Glenfield Hospital, Leicester. 12 PR sessions include walking [85% speed derived from the incremental shuttle walk test (ISWT)], leg/arm bike, and resistance training. We placed Sense-Wear™ monitors (SWM) on the patients’ arm during session 2 only. Analysis took place on Innerview™ computer software.ResultsThe patient cohort consisted of 20 patients: 60% female, mean age of 70.1 years (SD – 8.3 years), BMI 28.6 (SD 7.9), FEV1/FVC ratio 60.8 (SD 17.3). 90% of the patients were either smokers or ex-smokers. The baseline ISWT of the group was 199.5 (SD 145.0) metres.Table 1 shows that in our cohort, patients were exercising in the 0–1.5 METs range for 52% of the time (sedentary activity), 1.5–3 METs – 31% of the time (light activity) and for 17% of the time, they were exercising above 3 METs (moderate activity).Abstract P135 Table 1 MeanStd. DeviationOn Body Time (mins)42.37.4Total Energy Expenditure (cals)96.030.1Steps653.8539.1Average METS1.90.4–1.5 MET time (mins)22.39.01.5–3 MET time (mins)12.96.6 >3 MET time (mins)7.15.9ConclusionThe results highlight that, early in the PR programme COPD patients were not achieving 10 min of moderate intensity activity during 1 PR session, as recommended in national guidance. However, documented inaccuracies of the SWM, for instance at slow speeds of walking and when the arm is fixed may account for these results. Future work should aim to discover if the time spent above 3 METS increases later in the programme. In addition, we could use the PA profile of each patient to tailor home and class training progression.

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