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Rajkumar C, Wilks M, Islam J, Ali K, Raftery J, Davies K, Timeyin J, Cheek E, Cohen J, Wright J, Natarajan U, Nicholl C, Dewhurst G, Fonseka M, Slovick D, Maskell P, Mukherjee S, Ali K, Nari R, Qureshi A, Gertner D, Khan Z, Shinh N, Bodmer C, Martin-Marero C, Poullis A, Pollok R, Ala A, Chauhan A, Patel M, Roberts H, Conroy S, McGowan D, Pathansali R, Yau C, Vasileiadis E, Guleri A, Orr D, Aldulami D. Do probiotics prevent antibiotic-associated diarrhoea? Results of a multicentre randomized placebo-controlled trial. J Hosp Infect 2020; 105:280-288. [DOI: 10.1016/j.jhin.2020.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 01/27/2020] [Indexed: 02/07/2023]
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Hewett R, Alexakis C, Farmer AD, Ainley J, Chhaya V, Hayat JO, Poullis A, Kang JY. Effects of eosinophilic oesophagitis on quality of life in an adult UK population: a case control study. Dis Esophagus 2017; 30:1-7. [PMID: 27868307 DOI: 10.1111/dote.12524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Eosinophilic oesophagitis (EoE) is a chronic immune-mediated esophageal disease, characterized by symptoms related to esophageal dysfunction and histologically by eosinophil predominant inflammation. Current evidence for an adverse impact on quality of life (QoL) is conflicting and there are no data from a UK population regarding QoL. We conducted a prospective cross-sectional observational study using the Short Form-36 Health Survey, Hospital Dysphagia/Odynophagia Questionnaire, and the EoE Adult Quality of Life Questionnaire to assess QoL and severity of dysphagia in EoE patients, compared to age and gender matched healthy control subjects. Data were also collected on comorbidity and medication use. Eighty-eight subjects were recruited (44 patients). Patients had higher rates of antihistamine and topical (swallowed) corticosteroid use. Physical QoL did not differ between patients and controls, although patients did report a statistically significant lower mental QoL, with small absolute magnitude of difference. Patients reported higher dysphagia scores and these were negatively correlated with both physical and mental QoL. Higher rates of dysphagia and medication use in patients may among other things account for lower mental QoL. However, a higher rate of dysphagia in patients is not associated with a reduced physical QoL. Our findings are of clinical value, particularly when a new diagnosis of EoE is made, as clinicians can reassure patients that their general physical health should not be greatly affected by the diagnosis. Moreover, it may also be useful for patients to be aware that EoE may have an impact on their mental health, but this effect is likely to be small. We therefore advocate education and reassurance in this respect for all patients at diagnosis.
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Affiliation(s)
- R Hewett
- Department of Gastroenterology, St George's Hospital NHS Trust, Tooting, London, UK
| | - C Alexakis
- Department of Gastroenterology, St George's Hospital NHS Trust, Tooting, London, UK
| | - A D Farmer
- Centre for Digestive Diseases, Blizard Institute of Cell & Molecular Science, Queen Mary University of London, London, UK.,Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK.,Department of Gastroenterology, University Hospitals of North Midlands, Stoke on Trent, Staffordshire, UK
| | - J Ainley
- Gastroenterology, Emerson's Green NHS Treatment Centre, Bristol, UK
| | - V Chhaya
- Department of Gastroenterology, St George's Hospital NHS Trust, Tooting, London, UK
| | - J O Hayat
- Department of Gastroenterology, St George's Hospital NHS Trust, Tooting, London, UK
| | - A Poullis
- Department of Gastroenterology, St George's Hospital NHS Trust, Tooting, London, UK
| | - J-Y Kang
- Department of Gastroenterology, St George's Hospital NHS Trust, Tooting, London, UK
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Poullis A, Moodie SJ, Ang L, Finlayson CJ, Levin GE, Maxwell JD. Routine transferrin saturation measurement in liver clinic patients increases detection of hereditary haemochromatosis. Ann Clin Biochem 2016; 40:521-7. [PMID: 14503989 DOI: 10.1258/000456303322326434] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Hereditary haemochromatosis (HH) is one of the commonest genetic disorders in European populations. Transferrin saturation (TFS) measurement has been advocated as a phenotypic screening test to improve detection. We undertook a prospective study to examine the value of routine TFS measurement in detecting new cases of HH in unselected liver clinic attenders. Methods: Non-fasting TFS was measured in new patients. HH mutations were determined in those with elevated TFS (>45%) and all who underwent liver biopsy. Liver biopsy was performed in 349 patients, including all found to be C282Y homozygotes or compound heterozygotes. Results: Of 667 new patients attending over 5 years, 156 had TFS >45% and 18 had significant mutations (12 C282Y homozygotes and six compound heterozygotes). Eleven of the 12 C282Y homozygotes identified had an elevated TFS and 10 had significant hepatic siderosis. Only two of the six compound heterozygotes had an elevated TFS and hepatic siderosis. Conclusions: The prevalence of new HH cases in patients of European origin attending a liver clinic, detected by phenotypic screening over a 5-year period, was 2.8%. All were identified by a TFS cut off >45%, but TFS >60% provided the best combination of sensitivity and specificity for detecting C282Y homozygosity.
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Affiliation(s)
- A Poullis
- Department of Gastroenterology, St George's Hospital and Medical School, London SW17 0RE, UK.
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Tai CK, Leung P, Poullis A, Curry G. Comment on 'Reasons for non-uptake and subsequent participation in the NHS bowel cancer screening programme: a qualitative study'. Br J Cancer 2015; 112:1834. [PMID: 25356805 PMCID: PMC4647244 DOI: 10.1038/bjc.2014.559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- C K Tai
- Department of Gastroenterology, St George's Hospital, Blackshaw Road, London SW170QT, UK
| | - P Leung
- Department of General Surgery, St George's Hospital, Blackshaw Road, London SW170QT, UK
| | - A Poullis
- Department of Gastroenterology, St George's Hospital, Blackshaw Road, London SW170QT, UK
| | - G Curry
- Bowel Cancer UK, Willcox House, 140-148 Borough High Street, London SE1 1LB, UK
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Soubieres A, Wilson P, Poullis A, Wilkins J, Rance M. The Cost Of Irritable Bowel Syndrome (Ibs) In England. Value Health 2014; 17:A365. [PMID: 27200760 DOI: 10.1016/j.jval.2014.08.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- A Soubieres
- St George's Healthcare NHS Trust, London, UK
| | - Pdp Wilson
- St George's Healthcare NHS Trust, London, UK
| | - A Poullis
- St George's Healthcare NHS Trust, London, UK
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Alexakis C, Davies G, Stephens J, Clark S, Rogers S, Poullis A. Perspectives and attitudes of young patients with inflammatory bowel disease: symptoms, burden of disease and communication with their healthcare professionals. Frontline Gastroenterol 2014; 5:197-202. [PMID: 28839770 PMCID: PMC5369726 DOI: 10.1136/flgastro-2013-100400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 11/19/2013] [Accepted: 11/20/2013] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Inflammatory bowel disease (IBD) affects a significant proportion of young patients in the UK. The role of the healthcare professional, and their relationship with the young patient is particularly important at this difficult stage of their life, when education, social integration and career planning, can be dramatically affected by this consuming condition. OBJECTIVES To address the attitudes, experiences and erspectives of young patients suffering from IBD, focusing particularly on the relationship between sufferer and healthcare provider. METHODS Crohn's and Colitis UK invited its young members to respond to a detailed internet based questionnaire addressing various aspects of patients' disease and their relationship with respective healthcare workers. RESULTS 1081 patients aged 29 years or less responded. Self reported burden of illness was high with only 12% respondents free from a disease flare in the previous 12 months with almost half being hospitalised in the same period. Quality of ommunication with healthcare providers was generally high, with three-quarters of patients feeling appropriately empowered in their healthcare decisions. The IBD nurse specialist was highlighted as a particularly valuable member of the team, scoring the highest of the professional groups in communication comfort scores, as well as being nominated by the patients as the preferred professional group to discuss their disease with. CONCLUSIONS The results emphasize the considerable impact of the disease that this group is encumbered with, and identifies areas in the patient-professional relationship that can be augmented to improve the overall healthcare of this complex and fragile subgroup of patients.
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Affiliation(s)
- C Alexakis
- Department of Gastroenterology, St George's Hospital, London, UK
| | - G Davies
- Crohn's and Colitis UK, Hertfordshire, UK
| | - J Stephens
- Crohn's and Colitis UK, Hertfordshire, UK
| | - S Clark
- Crohn's and Colitis UK, Hertfordshire, UK
| | - S Rogers
- Crohn's and Colitis UK, Hertfordshire, UK
| | - A Poullis
- Department of Gastroenterology, St George's Hospital, London, UK
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Affiliation(s)
- C Timms
- St George's University of London, UK
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Chan D, Robbins H, Rogers S, Clark S, Poullis A. Inflammatory bowel disease and exercise: results of a Crohn's and Colitis UK survey. Frontline Gastroenterol 2014; 5:44-48. [PMID: 28839750 PMCID: PMC5369708 DOI: 10.1136/flgastro-2013-100339] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/15/2013] [Accepted: 07/17/2013] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Over 250 000 people in the UK are affected with inflammatory bowel disease (IBD) and approximately 10 000 new cases are diagnosed every year. These chronic bowel conditions have been shown to affect both work and recreational activity. In the general population, regular exercise has numerous benefits to health and well-being and there are additional benefits for those with IBD. However, people with IBD face significant challenges in trying to take regular exercise. OBJECTIVE With the renewed focus on sport brought about by the recent London Olympics, Crohn's and Colitis UK surveyed its members to explore their sport and fitness habits. METHODS 918 members participated in the survey, which is the largest survey of its kind, investigating the exercise habits of people with IBD. RESULTS The survey showed widespread uptake of exercise in those with IBD, with a large number feeling better for it. However, it also identified a considerable number of respondents who reported a significant negative impact of IBD on their ability to take up, enjoy and derive benefit from sporting activities. CONCLUSION Asking questions about sporting leisure activity in clinical consultations may identify those in need of help and support and possibly identify factors to be dealt with, in order to enable them to take part in these beneficial activities.
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Affiliation(s)
- D Chan
- Department of Gastroenterology, St George's Hospital, London, UK
| | - H Robbins
- Department of Gastroenterology, St George's Hospital, London, UK
| | - S Rogers
- Crohns and Colitis UK, Hertfordshire, UK
| | - S Clark
- Crohns and Colitis UK, Hertfordshire, UK
| | - A Poullis
- Department of Gastroenterology, St George's Hospital, London, UK
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Chatu S, Poullis A, Holmes R, Greenhalgh R, Pollok RCG. Temporal trends in imaging and associated radiation exposure in inflammatory bowel disease. Int J Clin Pract 2013; 67:1057-65. [PMID: 24073979 DOI: 10.1111/ijcp.12187] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 04/10/2013] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Increasing use of diagnostic imaging in inflammatory bowel disease (IBD) has led to concerns about the malignant potential of ionising radiation in a cohort that have an increased lifetime risk of gastrointestinal malignancy. The aim was to quantify radiation exposure in IBD patients referred from primary care, determine predictors of high exposure and evaluate temporal trends in diagnostic imaging over a 20-year period. METHODS This was a retrospective cohort study whereby IBD patients were recruited from the outpatient clinic and evaluated retrospectively. The total cumulative effective dose (CED) received from tests was calculated for each subject. Cox regression was performed to assess factors associated with potentially harmful levels of ionising radiation defined as total CED > 50 milli-sieverts (mSv; equivalent to five CT abdomen scans). RESULTS The cohort included 415 patients. Median total CED was 7.2 mSv (IQR: 3.0-22.7) in Crohn's disease and 2.8 mSv (IQR: 0.8-8.9) in ulcerative colitis patients, respectively. A total of 32 patients (8%) received a CED > 50 mSv. A history of IBD-related surgery was associated with high exposure (HR 7.7). During the study period, usage of abdominal CT increased by 310%. CONCLUSION Approximately 1 in 13 patients in the study cohort were exposed to potentially harmful levels of ionising radiation. Strategies to minimise exposure to diagnostic medical radiation in IBD patients are required.
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Affiliation(s)
- S Chatu
- Department of Gastroenterology, St George's Hospital NHS Trust, London, UK
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Kang JY, Firwana B, Green AE, Matthews H, Poullis A, Barnabas A, Tan LT, Lim AG. Uncomplicated diverticular disease is not a common cause of colonic symptoms. Aliment Pharmacol Ther 2011; 33:487-94. [PMID: 21158878 DOI: 10.1111/j.1365-2036.2010.04540.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Colonic diverticular disease is common among older individuals whereas colonic symptoms, such as those of irritable bowel syndrome, are frequent in the general population. AIM To determine among patients in secondary care, if uncomplicated diverticular disease is a common cause of colonic symptoms. METHODS Patients aged ≥50 years attending gastroenterology out-patient clinics or scheduled for colonoscopy or barium enema in a secondary care hospital were invited to take part. Those with structural gastrointestinal diseases were excluded. Participants completed a locally validated Rome II questionnaire on colonic symptoms. Patients with diverticular disease were compared with those without. RESULTS Seven hundred and eighty four patients with no structural pathology other than diverticular disease or benign colonic polyps completed the study. A total of 744 patients underwent colonoscopy, 40 barium enema. Of these, 281 patients had diverticular disease. Among patients with and without diverticular disease, the frequency of abdominal pain, diarrhoea, constipation and irritable bowel syndrome were 123 (44%) and 226 (46%), 44 (16%) and 80 (17%), 38 (14%) and 80 (17%) and 66 (25%) and 119 (25%), respectively (N.S.). CONCLUSION Uncomplicated colonic diverticular disease is not a common cause of colonic symptoms among patients in secondary care.
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Affiliation(s)
- J Y Kang
- Department of Gastroenterology, St George's Hospital, London, UK.
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Price LC, Poullis A, Grubnic S, Kang JY, Rayner CFJ. Mesalazine-induced bronchiectasis and eosinophilia in a patient with ulcerative colitis: a case report. J R Soc Med 2007. [PMID: 17339311 DOI: 10.1258/jrsm.100.3.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- L C Price
- Department of Respiratory Medicine, St George's Hospital, London, UK
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Price LC, Poullis A, Grubnic S, Kang JY, Rayner CFJ. Mesalazine-induced bronchiectasis and eosinophilia in a patient with ulcerative colitis: a case report. J R Soc Med 2007; 100:151-2. [PMID: 17339311 PMCID: PMC1809164 DOI: 10.1177/014107680710000314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- L C Price
- Department of Respiratory Medicine, St George's Hospital, London, UK
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Abstract
BACKGROUND Gastro-oesophageal reflux disease affects approximately 20% of western populations. Barrett's oesophagus, associated with severe gastro-oesophageal reflux disease, is premalignant and regular endoscopic surveillance is generally performed. In contrast, mild gastro-oesophageal reflux disease is thought not to progress and is not generally subjected to endoscopic follow-up. Aim To investigate whether gastro-oesophageal reflux disease progresses endoscopically. METHODS Systematic review of the literature. RESULTS Well-designed prospective studies are few, diagnostic criteria were not always standardized, management strategies varied and various sources of bias could not be excluded. Whilst most patients do not progress to more severe forms of gastro-oesophageal reflux disease, and some cases actually regress, progression is seen in a small proportion of patients. Annual progression rates for non-erosive gastro-oesophageal reflux disease developing erosive oesophagitis ranged from 0% to 30%. About 1-22% of patients with mild erosive oesophagitis developed more severe inflammation annually, while 1-13% of patients with erosive oesophagitis developed Barrett's oesophagus each year. CONCLUSION Although most patients with gastro-oesophageal reflux disease do not progress, and some actually regress, progression does occur in a minority. Better data are required to determine whether patients with mild gastro-oesophageal reflux disease would benefit from increased surveillance with the aim of detecting more advanced disease.
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Affiliation(s)
- M Fullard
- Department of Gastroenterology, St George's Hospital, London, UK
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Affiliation(s)
- A Poullis
- St George's Hospital Medical School, London, UK
| | - J D Maxwell
- St George's Hospital Medical School, London, UK
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Abstract
The fundamental pathological process behind ulcerative colitis and Crohn's disease is intestinal inflammation. As the precise cause of this is not yet completely understood, current treatment strategies are aimed at reducing or eliminating the inflammation. Endoscopic examination and histological analysis of biopsy specimens remain the 'gold standard' methods for detecting and quantifying bowel inflammation; however, these techniques are costly, invasive, and repeated examinations are unpopular with patients. Disease activity questionnaires and laboratory 'inflammatory markers', although widely used, show an unreliable correlation with endoscopy and histology. New markers need to be developed to detect and quantify bowel inflammation. These would be of use diagnostically and also an aid to pharmacological treatment.
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Affiliation(s)
- A Poullis
- GEM Division, 2nd Floor, Jenner Wing, St George's Hospital Medical School, London, UK
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Poullis A. Ascitic fluid analysis: the role of imaging. Hosp Med 2001; 62:511. [PMID: 11530598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Poullis A, Poullis M. Helicobacter pylori and cardiac surgery. Eur J Cardiothorac Surg 2001; 20:217-8. [PMID: 11476064 DOI: 10.1016/s1010-7940(01)00749-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Poullis A, Gould SR, Lim AG. It could only happen to a doctor--Haemophilus aphrophilus septicaemia complicated by a prevertebral infection after dental work. Postgrad Med J 2001; 77:261-2. [PMID: 11264493 PMCID: PMC1741965 DOI: 10.1136/pmj.77.906.261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A 53 year old man presented with severe neck pain and a flu-like illness; he had recently returned from Sri Lanka and had had dental treatment six days before illness onset. Blood culture showed infection by Haemophilus aphrophilus. Magnetic resonance imaging was performed and exploratory surgery undertaken. The prevertebral cervical fascia was inflamed but no abscess identified. He was treated with antibiotics and made an uneventful recovery.
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Affiliation(s)
- A Poullis
- Department of Gastroenterology, Epsom General Hospital, Surrey, UK.
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Hodson AC, Poullis A. Postictal electrocardiographic changes mimicking acute myocardial infarction. Hosp Med 2001; 62:242-3. [PMID: 11338959 DOI: 10.12968/hosp.2001.62.4.1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A63-year-old male presented to the accident and emergency department having collapsed. On arrival in the department a generalized tonic—clonic fit was witnessed which lasted less than a minute and resolved spontaneously. The patient was asymptomatic following this episode.
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Affiliation(s)
- A C Hodson
- Department of General Medicine, Chelsea and Westminster Hospital, London
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Poullis A. Medical causes of GI symptoms. Hosp Med 2001; 62:113. [PMID: 11236612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Poullis A. Tuberculous peritonitis: a non-invasive test. Hosp Med 2000; 61:145. [PMID: 10748803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Affiliation(s)
- M Poullis
- Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, Hammersmith Hospital, London, United Kingdom.
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