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Background: Tuberculosis notification rates for London have risen dramatically in recent years. Molecular typing of Mycobacterium tuberculosis has contributed to our understanding of the epidemiology of tuberculosis throughout the world. This study aimed to assess the degree of recent transmission of M tuberculosis in London and subpopulations of the community with high rates of recent transmission.Methods: M tuberculosis isolates from all persons from Greater London diagnosed with culture positive tuberculosis between 1 July 1995 and 31 December 1997 were genetically fingerprinted using IS6110 restriction fragment length polymorphism (RFLP) typing. A structured proforma was used during record review of cases of culture confirmed tuberculosis. Cluster analysis was performed and risk factors for clustering were examined in a univariate analysis followed by a logistic regression analysis with membership of a cluster as the outcome variable.Results: RFLP patterns were obtained for 2042 isolates with more than four copies of IS6110; 463 (22.7%) belonged to 169 molecular clusters, which ranged in size from two (65% of clusters) to 12 persons. The estimated rate of recent transmission was 14.4%. Young age (0-19 years) (odds ratio (OR) 2.65, 95% confidence interval (CI) 1.59 to 4.44), birth in the UK (OR 1.55, 95% CI 1.04 to 2.03), black Caribbean ethnic group (OR 2.19, 95% CI 1.15 to 4.16), alcohol dependence (OR 2.33, 95% CI 1.46 to 3.72), and streptomycin resistance (OR 1.82, 95% CI 1.15 to 2.88) were independently associated with an increased risk of clustering.Conclusions: Tuberculosis in London is largely caused by reactivation or importation of infection by recent immigrants. Newly acquired infection is also common among people with recognised risk factors. Preventative interventions and early diagnosis of immigrants from areas with a high incidence of tuberculosis, together with thorough contact tracing and monitoring of treatment outcome among all cases of tuberculosis (especially in groups at higher risk of recent infection), remains most important. [ABSTRACT FROM AUTHOR]

Gynaecomastia affects half of the male population at some stage in their life. Only a small proportion of them would require treatment for cosmetic appearance or to relieve pain and tenderness. Recently, tamoxifen has shown some promising results in the management of gynaecomastia. To assess the efficacy of tamoxifen, we carried out a retrospective study of all men treated for gynaecomastia with particular emphasis on those treated medically. Men with painful gynaecomastia were given 10 mg of tamoxifen for 3 months. Response to treatment was categorised as good, moderate and no response. Thirteen men (median age 36) were placed on tamoxifen. Ten patients responded well to tamoxifen. One patient developed calf tenderness and stopped the medication. No other adverse effects were reported. Two patients could not be followed up. Tamoxifen appears safe and effective in men with painful idiopathic or physiological gynaecomastia and should be considered as an initial option before contemplating surgery.

Background: Imported malaria continues to be a significant cause of morbidity and mortality in the United Kingdom. Low uptake and poor compliance of chemoprophylaxis are thought to be contributory factors. Little information is available on how well health care physicians comply with malaria chemoprophylaxis when they travel to malarial areas. The aim of this study was to determine the usage and compliance of malarial chemoprophylaxis by general practitioners who have traveled to South Asia., Method: A telephone survey of 172 general practitioners practicing in the West Yorkshire area of the UK who have traveled to South Asia., Results: Of the 145 (84%) responding to the survey, 50 (35%) took no chemoprophylaxis, 28 (19%) did not complete the chemoprophylaxis course, and 67 (46%) were fully compliant. The reasons for noncompliance were; the belief the area visited was free from malaria (34%), no wish to take prophylaxis (18%), previous side-effects (10%), the belief of possessing long-term immunity (10%), no time to obtain prophylaxis (4%), malaria is easier to treat than to prevent (2%), costs of purchasing prophylaxis (2%), went for a short period of time and took the risk (2%), and no specific reason (18%)., Conclusions: This study has shown that a large proportion of general practitioners questioned did not take the recommended antimalarial prophylaxis. If they themselves do not keep to the guidelines, it is of concern that they may not reinforce the taking of chemoprophylaxis by their patients. Training in travel medicine may improve chemoprophylaxis uptake by general practitioners, but until then, such physicians should not be regarded as the main provider of pretravel advice. All travelers including health care physicians should be aware, and should comply with malarial prophylaxis guidelines, with emphasis on chemoprophylaxis compliance and mosquito avoidance.

The evacuation of a 102-bed geriatrics hospital in the middle of the night and from the centre of a riot in Toxteth, Liverpool, is described, together with its effect on the patients involved. No increase in the mortality rate occurred during the six weeks following the evacuation, but a significant increase in morbidity was found. Specific recommendations are made for action to be taken should other city centre geriatrics hospitals need to be evacuated in similar circumstances.