Alastair Miller | University of Liverpool (original) (raw)

Papers by Alastair Miller

Elsevier eBooks, 2017

most frequently Salmonella and Staphylococcus aureus; however, even cholera has been transmitted ... more most frequently Salmonella and Staphylococcus aureus; however, even cholera has been transmitted in this way. 3 Respiratory infection, including influenza A, H1N1, severe acute respiratory syndrome (SARS) and multidrug-resistant pulmonary tuberculosis, have also been transmitted during aircraft flights. 4,5 An estimated 13 million passengers around the globe travel on cruise ships each year. Cruise ships can be responsible for respiratory and gastrointestinal infections, involving complex patterns of transmission in a closed community. 6 Modes of transmission include person-to-person spread, water-borne, food-borne, airborne, vectorborne and even shore excursions. Historically, a number of bacterial infections including cholera and typhoid have been associated with ship-borne spread. The pathogens most commonly implicated nowadays are norovirus, 7,8 Legionella, Salmonella, Escherichia coli, Vibrio and influenza A and B. 6 There is a well-recognized association between outbreaks of Legionella infection and airconditioning systems in holiday hotels. 9 Western travelers increasingly seek more exotic destinations where, as a result of poverty and poor infrastructure, they may be at risk of infection with common pathogens (particularly of the gastrointestinal and respiratory tracts). They may also be at risk of tropical infections that do not exist in their own country (e.g. malaria). These risks are discussed in detail in Section 6. Zoonoses Zoonoses are infections of animals which can be transmitted to humans. Many leisure activities increase the opportunity for contact between humans and animals, with consequent increased risk of infection. Keeping pet animals is a common recreational pastime and increases risks of zoonotic infection. The UK recently had an outbreak of Hantavirus amongst owners of pet rats. 10 Hiking, camping and caving increase the risk of zoonoses. People may hike in a temperate climate or, increasingly, may choose to trek in a tropical or developing country. These activities increase the potential

Progress in Neurology and Psychiatry, Sep 1, 2014

Progress in Neurology and Psychiatry's dedicated website www.progressnp.com has been redesigned a... more Progress in Neurology and Psychiatry's dedicated website www.progressnp.com has been redesigned and now features news, events diary, links to continuing professional development resources and journal supplements as well as archived issues of Progress. More new features will be appearing over the coming months.

Journal of Neurology, Neurosurgery & Psychiatry

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a disabling long-term condition of... more Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a disabling long-term condition of unknown cause. The National Institute for Health and Care Excellence (NICE) published a guideline in 2021 that highlighted the seriousness of the condition, but also recommended that graded exercise therapy (GET) should not be used and cognitive–behavioural therapy should only be used to manage symptoms and reduce distress, not to aid recovery. This U-turn in recommendations from the previous 2007 guideline is controversial.We suggest that the controversy stems from anomalies in both processing and interpretation of the evidence by the NICE committee. The committee: (1) created a new definition of CFS/ME, which ‘downgraded’ the certainty of trial evidence; (2) omitted data from standard trial end points used to assess efficacy; (3) discounted trial data when assessing treatment harm in favour of lower quality surveys and qualitative studies; (4) minimised the importance of fatigue as an...

CRC Press eBooks, Oct 29, 2010

International Journal of Std & Aids, Aug 13, 2014

Chylothorax is a rare complication of visceral Kaposi&amp;amp;amp;amp;amp;amp;amp;#39;s s... more Chylothorax is a rare complication of visceral Kaposi&amp;amp;amp;amp;amp;amp;amp;#39;s sarcoma. We report a case with bilateral chylothoraces secondary to relapsed visceral Kaposi&amp;amp;amp;amp;amp;amp;amp;#39;s sarcoma who was successfully treated with paclitaxel chemotherapy.

British Journal of General Practice, Jun 1, 2013

Journal of Antimicrobial Chemotherapy, 1985

Annals of Internal Medicine, Sep 1, 1982

Excerpt To the editor: Chronic active hepatitis is a recognized complication of treatment with ni... more Excerpt To the editor: Chronic active hepatitis is a recognized complication of treatment with nitrofurantoin. All the cases previously described have occurred in women. We would like to describe t...

Clinical Medicine, Sep 1, 2002

Oxford University Press eBooks, Jul 1, 2015

Introduction: infectious diseases - Viral infections - Bacterial infections - Malaria - Other pro... more Introduction: infectious diseases - Viral infections - Bacterial infections - Malaria - Other protozoal infections - Filarial worms - Worm infections - Flukes - Emerging infections - Sexually transmitted infections

Journal of Tropical Diseases & Public Health, 2013

Clinical Microbiology and Infection, Apr 1, 1999

Remoteness of colleagues (therefore, nobody to d~scuss difficult medical cases with; may be easie... more Remoteness of colleagues (therefore, nobody to d~scuss difficult medical cases with; may be easier with improving communication technology); of technical diagnostic and therapeutic equipment; of drugs and equipment (resupply may be especially difficult) Unfamiliar workplace Operating in a tent or on a small boat may be technically difficult Unfamiliar patients May be different racial backgrounds, different cultures, etc. Proximity of patients Having to live with patients in cramped circumstances may give rise to hfficulties 'Hostile environment' Hot, cold, altitude 'Tropical disease' Many expeditions involve travel in or through a developing country with poor sanitation and much infection in the local population. 'Dangerous pastimes' Many expeditions involve potentially dangerous occupations such as mountaineering, diving or canoeing and there is therefore significant risk of accidents and trauma

British journal of hospital medicine, May 2, 2018

A new 3-year curriculum for training in internal medicine was approved by the General Medical Cou... more A new 3-year curriculum for training in internal medicine was approved by the General Medical Council in December 2017. This will replace core medical training in August 2019. It mandates specific experiences and introduces a novel assessment strategy that hopefully will lessen the perceived ‘burden of assessment’ on trainees (and trainers). It is hoped that it will improve the experience of and enthusiasm for training in internal medicine.

Journal of Medical Case Reports, Dec 1, 2008

Introduction: Acute Human Immunodeficiency Virus infection is associated with a range of neurolog... more Introduction: Acute Human Immunodeficiency Virus infection is associated with a range of neurological conditions. Guillain-Barré syndrome is a rare presentation; acute inflammatory demyelinating polyneuropathy is the commonest form of Guillain-Barré syndrome. Acute inflammatory demyelinating polyneuropathy has occasionally been reported in acute Immunodeficiency Virus infection but little data exists on frequency, management and outcome. Case presentation: We describe an episode of Guillain-Barré syndrome presenting as acute inflammatory demyelinating polyneuropathy in a 30-year-old man testing positive for Immunodeficiency Virus, probably during acute seroconversion. Clinical suspicion was confirmed by cerebrospinal fluid analysis and nerve conduction studies. Rapid clinical deterioration prompted intravenous immunoglobulin therapy and early commencement of highly active anti-retroviral therapy. All symptoms resolved within nine weeks. Conclusion: Unusual neurological presentations in previously fit patients are an appropriate indication for Immunodeficiency-Virus testing. Highly active anti-retroviral therapy with adequate penetration of the central nervous system should be considered as an early intervention, alongside conventional therapies such as intravenous immunoglobulin.

Research in context Evidence before the study In recent years viral meningitis has been recognise... more Research in context Evidence before the study In recent years viral meningitis has been recognised increasingly, and can be a significant cause of morbidity. Since the widespread introduction of conjugate vaccines against Haemophilus influenzae type B in 1992, Neisseria meningitidis serogroup C in 1999 and Streptococcus pneumoniae in 2002, the incidence of community acquired bacterial meningitis has been declining. This, in combination with increased molecular testing, means viruses are growing in relative importance as a cause of meningitis. Recent studies, using historical data, have also suggested changes in the aetiology of childhood viral meningitis over several decades. Variation in the incidence and aetiology of viral meningitis is reported. Some countries have a high incidence of herpesviruses, mainly herpes simplex type 2 and varicella zoster virus, whilst others rarely see them. We searched PubMed for "viral" AND "meningitis" AND "adults" with no date or language restrictions. 307 publications were returned, 22 were cohort studies looking at the aetiology of meningitis. Several papers describe the varying aetiology of meningitis but only 1 attempted to determine the incidence-in a cohort of Israeli soldiers. There has been a recent attempt to report the national incidence of viral meningitis in the UK, but this study only included laboratory confirmed cases, and did not distinguish between meningitis and encephalitis-where the aetiologies, treatment and prognoses are vastly different. No UK study has examined the incidence and aetiology of viral meningitis in adults. The outcomes following viral meningitis are also unclear, although subtle sequelae such as neurocognitive and sleep disorders have been described. Added value of this study This study takes a unique approach that combines the benefits of a prospective clinical epidemiological study with laboratory confirmed cases to estimate the incidence, aetiology and sequelae of viral meningitis in UK adults. It is the largest clinical study of adults with viral meningitis reported to date and gives us the first accurate incidence of viral meningitis, other causes and those with no known cause. It also describes the significant longer-term impact that viral meningitis has on quality of life, especially in regard to memory and mental health. Implications of all the available evidence Our findings demonstrate that viruses are the predominant cause of adult meningitis in the UK with enteroviruses and herpesviruses responsible for the majority of cases where a cause is found. Combined with previous studies this shows that there is significant geographical variation in the aetiology of viral meningitis. We highlight the burden that viral meningitis imposes on the health system and suggest areas where improvements could be made; a reduction in the length of hospitalisation and an increase in those with an aetiological diagnosis might be achieved through more rapid diagnostics. Additionally, we add to the literature suggesting that viral meningitis has significant impact long after the patient has been discharged.