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Robert Hill

Bio: Robert Hill is an academic researcher from Maidstone and Tunbridge Wells NHS Trust. The author has contributed to research in topics: Anxiety disorder & Superior mesenteric vein. The author has an hindex of 1, co-authored 2 publications receiving 5 citations.

Papers
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Journal ArticleDOI
TL;DR: A 70-year-old man with a 45-year history of meprobamate dependency and multiple failed previous withdrawal attempts who was successfully withdrawn from meProbamate using diazepam during a 2-week inpatient stay on a specialist Addictions ward is discussed.
Abstract: Meprobamate, a benzodiazepine-like drug, was commonly prescribed for anxiety in the 1960s and 1970s, but fell out of favour, at least in part, due to the risk of dependence, for which there is little published evidence to guide clinical management. We discuss a 70-year-old man with a 45-year history of meprobamate dependency and multiple failed previous withdrawal attempts who was successfully withdrawn from meprobamate using diazepam during a 2-week inpatient stay on a specialist Addictions ward. An appropriate diazepam dose was established using the Clinical Institute Withdrawal Assessment scale for benzodiazepines (CIWA-B). This dose was then slowly reduced over 12 days. Multidisciplinary input, especially psychological therapy tackling his underlying anxiety disorder during his admission, was thought to be particularly helpful.

4 citations

Journal ArticleDOI
TL;DR: In this paper, a 68-year-old man was referred to the general surgeons on account of abdominal pain of unknown cause, and CT chest abdomen and pelvis revealed an extensive thrombus extending from the portal vein to the superior mesenteric vein.
Abstract: A 68-year-old man was referred to the general surgeons on account of his abdominal pain of unknown cause. He had contracted COVID-19, 9 days prior. CT chest abdomen and pelvis revealed an extensive thrombus extending from the portal vein to the superior mesenteric vein. Further investigation ruled out haematological causes, and COVID-19 was determined to be the cause. He was treated with an extended course of therapeutic dose low molecular weight heparin under the guidance of the haematology team. He was discharged once he was clinically stable and pain-free, with a plan to be followed up by both the surgeons and haematologists. This case highlights the different ways in which COVID-19 presents, and the need for clearer guidance on the treatment and prevention of thromboembolism in COVID-19.

3 citations


Cited by
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DOI
18 Oct 2021
TL;DR: In this article, vascular inflammation and thrombosis were presented as a potential mechanism of liver injury and liver-related complications in coronavirus disease 2019 (COVID-19) symptoms caused by SARS-CoV-2.
Abstract: Liver injury, characterized predominantly by elevated aspartate aminotransferase and alanine aminotransferase, is a common feature of coronavirus disease 2019 (COVID-19) symptoms caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). Additionally, SARS-CoV-2 infection is associated with acute-on-chronic liver failure in patients with cirrhosis and has a notably elevated mortality in patients with alcohol-related liver disease compared to other etiologies. Direct viral infection of the liver with SARS-CoV-2 remains controversial, and alternative pathophysiologic explanations for its hepatic effects are an area of active investigation. In this review, we discuss the effects of SARS-CoV-2 and the inflammatory environment it creates on endothelial cells and platelets more generally and then with a hepatic focus. In doing this, we present vascular inflammation and thrombosis as a potential mechanism of liver injury and liver-related complications in COVID-19.

34 citations

Journal ArticleDOI
TL;DR: The case of a 49-year-old man who initially presented with intermittent fevers and generalized weakness of 1-month duration and was subsequently found to have COVID-19 infection, PVT, and Bacteroides fragilis bacteremia with associated pyogenic liver abscess is presented.
Abstract: The 2019 coronavirus disease (COVID-19) can present with a wide variety of clinical manifestations, including a hypercoagulable state leading to both arterial and venous thrombosis. Portal vein thrombosis (PVT) in the setting of COVID-19 has rarely been reported in the medical literature. Pylephlebitis with concomitant liver abscess is a rare complication of intra-abdominal infection. Here, we present the case of a 49-year-old man who initially presented with intermittent fevers and generalized weakness of 1-month duration and was subsequently found to have COVID-19 infection, PVT, and Bacteroides fragilis bacteremia with associated pyogenic liver abscess. The patient was treated with intravenous antibiotics and oral anticoagulation with plan to follow up outpatient with gastroenterology in 3 months to ensure resolution of PVT and liver abscess.

2 citations

Dissertation
02 Jul 2019
TL;DR: Gordon et al. as discussed by the authors developed a method to identify and define human populations contributing to environmental water contamination and additionally uses previous sampling efforts to apply this method at three scales: national, regional, and local.
Abstract: POPULATION DYNAMICS AND PHARMACEUTICAL CONTAMINATION IN STREAMS AND RIVERS ACROSS THE UNITED STATES Stephanie Gordon, M.S. George Mason University, 2019 Thesis Director: Dr. Gregory D. Foster Pharmaceutical contamination of surface waters across the United States has become an issue of increasing concern and study. These compounds can negatively impact the health of aquatic species and present an exposure risk to other species and humans who interact with contaminated water or use them as a source of drinking water. Pharmaceutical compounds and metabolites can enter streams from multiple sources including leaky sewer pipes, septic tanks, sewer overflow, and wastewater treatment plant effluent. Although human use is undoubtedly the main source of pharmaceutical loading to streams, stream contamination studies often focus on landscape point and non-point sources as it is difficult to geographically define populations affecting contamination in surface waters. This study develops a method to identify and define human populations contributing to environmental water contamination and additionally uses previous sampling efforts to apply this method at three scales: national, regional, and local. The method developed is also used to understand the relationships between population demographics and socioeconomic factors with type and concentration of pharmaceuticals at each scale using Classification and Regression Tree (CART) analysis. Results indicate that at the national scale, income is an important variable in determining presence of a variety of pharmaceutical groups while at the regional scale age and gender variables were most important. Results at the local scale were not able to be generated with the data available. The method presented and subsequent results may be useful in future study efforts to tailor sampling locations and lab efforts to pharmaceuticals of interest based on contributing populations.