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Purpose of the Review To describe trends and clinical characteristics of HIV and cerebrovascular disease between 1990 and 2021 in LMICs and identify the gaps in our understanding. Recent Findings In the era of antiretroviral therapy (ART), people living with HIV (PLWH) live longer and risk excess cerebrovascular events due to ageing and HIV-driven factors. Despite the highest burden of HIV infection in low-to-middle income countries, there is underreporting in the literature of cerebrovascular events in this population. We systematically reviewed published literature for primary clinical studies in adult PLWH and cerebrovascular disease in LMICs. Summary The clinical phenotype of cerebrovascular disease among PLWH over the last three decades in LMICs has evolved and transitioned to an older group with overlapping cerebrovascular risk factors. There is an important need to increase research in this population and standardise reporting to facilitate understanding, guide development of appropriate interventions, and evaluate their impact.

Background Correctly eliciting and interpreting physical examination (PEx) signs contributes to successful diagnosis and is fundamental to patient care. A significant decline in the time spent acquiring these skills by medical students, and the decreased ability to elicit and recognise signs is widely acknowledged. However, organising teaching to counteract this in the busy clinical environment is challenging. We evaluated the prior exposure to clinical signs, and experience of examination teaching among a cohort of final-year medical students. Following this, we assessed the utility of a structured circuit-based approach (Signs Circuits) using hospital inpatients and junior doctors to provide high-yield PEx teaching and overcome these limitations. Materials and methods Qualitative and quantitative survey feedback, including a standardised list of 62 clinical signs, was sought from final-year medical students during their rotations at a teaching hospital in London, UK, before and after the provision of Signs Circuits. Results Prior to the course the 63 students reported limited exposure to even the most common clinical signs. For example, the murmurs of mitral and tricuspid regurgitation and the sound of lung crackles eluded 43%, 87%, and 32%, respectively. From qualitative feedback, the reasons for this included that much of their prior PEx experience had focused on the performance of appropriate examination steps and techniques in patients without pathology. During the course, students were exposed to an average of 4.4 new signs, and left with increased confidence examining and eliciting signs, and a firmer belief in their importance to diagnosis. Conclusion Medical students continue to have limited exposure to clinical signs in medical school. This signs-focused approach to PEx teaching is an effective and reproducible way to counter the deficiencies identified in signsexposure.

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Optic disc swelling is a challenging presentation with a wide differential including potentially life-threatening diagnoses alongside benign causes. In this retrospective review, we assess over 33,000 referrals to an Eye Treatment Centre between 2014 and 2018. We identify 167 referrals for ‘optic disc swelling’ or similar terms. The overall rate of referrals to the ETC remained stable throughout this period, however the rate of referrals for optic disc swelling increased almost threefold from 2016 onwards. This was primarily due to a large increase in the number of referrals from Opticians, which correlates chronologically with the case of missed papilloedema resulting in a criminal conviction of the optometrist in question, Honey Rose.77 patients were confirmed to have papilloedema, and in this group the most common final diagnosis was Idiopathic Intracranial Hypertension (IIH). 74 patients were diagnosed with pseudopapilloedema, the most common cause of which was drusen. Of note, over one-fifth were found to have normal optic discs on examination.Pathways for the workup of patients with suspected IIH were examined. A large proportion of patients experienced delays of up to 31 months awaiting essential imaging or lumbar puncture. Importantly, 37% never had venography.