Anabolic steroid misuse

There is a service called "Ripped" for anabolic steroid users at the Health Shop. The medical adviser is Dr Ken Brown (GP).

The Health Shop
12 Broad Street
Hockley
Nottingham  NG1 3AL

Tel. 0115 947 5414
Fax. 0115 859 9297

Ken advised me that several months' treatment with tamoxifen can help to settle gynaecomastia caused by previous anabolic steroid misuse, although this is an unlicensed indication.

Measles outbreak

The Health Protection Unit have advised that there have been an increased number of cases of measles in Nottinghamshire recently especially in the Mansfield and Ashfield areas, but there has been a confirmed case in the Greater Nottingham conurbation in the south of the county. They ask us to make early notification of suspected cases.

Management of a patient with suspected measles

Please contact the East Midlands North Health Protection Unit (HPU) on 01623 819000 between 0900 - 1700hrs as soon as you suspect or become aware of a possible case of measles.

We would like to confirm all cases as soon as possible. The following laboratory tests may be done to confirm measles:

1. Saliva/oral fluid sample: can be tested for IgM and for PCR if indicated. The HPU stocks oral fluid testing kits and can arrange for kits to be sent to the patient's home or to the surgery as soon as you ring them on 01623 819000. Saliva samples are usually positive for measles specific IgM on the day the rash appears. This is the preferred method for confirmation.
   
2. Serum sample: can be tested for IgM. Less useful for PCR.
   
3. Throat swab: in viral transport media this can be tested for measles PCR and for viral culture.
   
4. Urine: can be tested for measles by PCR.
   

Please try to avoid sending children to the hospital unless they are very unwell, to reduce the risk of transmission to vulnerable patients.

Management of those in contact with a patient with suspected measles

Susceptible contacts should be offered MMR vaccine or Human Normal Immunoglobulin (HNIG) if appropriate. The HPU will assist in identifying close and at risk contacts and will provide advice on immunisation of contacts. Please contact them on 01623 819000 to discuss this. They would also like to know if you have seen any other patients in the last 4 weeks who may have been ill with measles.

Further advice may be obtained from www.immunisation.nhs.uk or from

• Caroline Jordan: 0115 8839441 or 07817 108026
  
• Jackie Thom: 07811 465 376
  

The following advice is offered to parents.

What are the symptoms of measles?

The symptoms of measles can start from between nine and twelve days after your child has been infected, through contact with someone who has the disease. It begins like a normal cold - hoarse cough, runny nose and fever. The temperature will fluctuate between 37.5oC and 40oC. The child will develop a rash that will start on the throat and behind the ears. It then spreads to the face and the rest of the body. The rash will initially appear as small, scarlet, slightly raised spots. It then gradually changes into irregular areas of reddish brown. The child’s eyes may become red and sore.

The Green Book

Immunisation against infectious disease - "the Green Book"

Chapters from the Green Book are available on this page.

Click on the link for the chapter you want to read. If you get a dialog box with options "Open" "Save" and "Cancel" then click on "Open".

• "Download update" links are to pages that contain updates, which you can print out and paste over the relevant page in your hard copy of the book.
• "Download Chapter" links are to the entire chapter (updated as appropriate) for you to read on screen.