NICOTINE REPLACEMENT THERAPY

manisha143manuLeave a comment

Cigarettes contain nicotine and by smoking regularly and for long hours, your body becomes dependent on it. Giving up smoking can cause nicotine withdrawal symptoms which are :

  • Restlessness ,impatience
  • Eating more than usual
  • Anxiety / tension
  • Headaches,irritability / anger
  • Difficulty in concentration + Depression
  • Loss of energy,dizziness
  • Sweating
  • Insomnia
  • Stomach or bowel problems
  • Heart palpitations
  • Tremors
  • Craving for tobacco

Stop smoking medicines along with nicotine replacement therapy are effective aid to tobacco cessation & can help control these symptoms.

What are these?

3 types –

  • Champix tablets (varenicline)
  • Zyban tablets (bupropion)
  • Nicotine replacement therapies (gums,patches,lozenges,microtabs,sublingual tablets,insulators,cigs,nasal sprays)

How does it work?

Tobacco intakers who are motivated to quit the habit & are dependent on nicotine should be offered NRT.

  • Prescribed for 6 to 8 weeks,in blocks of up to 2 weeks,contingent on continued abstinence.
  • If one type of NRT is not working for the patient ,the health professional is advised to prescribe a suitable type informing about the dosage & maximum amount to take a day.

Is it safe?

NRT is safe because of the facts that the nicotine levels are low and it’s less addictive delivery mechanism (unlike smoking tobacco where the nicotine reaches the brain quickly) and also because most of the harmful problems are caused by the other components of tobacco smoke ,not by the nicotine.

NRT is safe for most adults and in people with stable cardiac diseases, but caution needed in unstable,acute cardiovascular disease,pregnancy,or breastfeeding or in those aged under 18 years.

Brownie points-reduces the constant urge to munch on food,thus reducing weight gain.😊

When should one stop using NRT?

Most courses of NRT recommend use for about 12 weeks.This is because it takes this much time for the brain to adjust to working without the high doses of nicotine that the cigarettes supply.However there is no hard and fast rule.After starting the therapy,most people mistake the lack of discomfort for the belief that the addiction is over,leading to stop using the product too soon. This can result only in reappearing of the symptoms.

The best method is to take the help of the health professional when you start the therapy and keep them updated about the progress.

Lastly ,we all are not the same….each tobacco smoker’s tendency & pattern to quit may vary & it depends on different factors like age,gender,environment, general physical and mental health.

Sources:S.S Hiremath textbook of preventive and community dentistry, http://www.healthunlocked.com(Quit Support)

Hunter syndrome

Dr. Kriti JainLeave a comment

Features of Mucopolysaccharidosis Syndromes– Hunter syndrome:-

  • Type- II
  • Eponym-Hunter.
  • Inheritance- X-Linked R.
  • Enzyme Defi ciency- Iduronate-2-sulfatase.Stored Substrate- HS heparan sulfate and DS DS, dermatan sulfate.
  • Clinical Features – Appears at 1 to 2 years of age; clear corneas, reduced intelligence, growth retardation, stiff joints

  • Differs from Hurler’s syndrome in –

  1. Mode of inheritance (X – linked).
  2. Absence of corneal clouding.
  3. Milder clinical course..Results from deficiency of iduronate – 2 – sulfatase (I2S).
  4. Without enough I2S, partially broken-down mucopolysaccharides accumulate in the organs and tissues of the body and become toxic.

Clinical features :-

  • Hunter syndrome is divided into two types.

I-   Type A is he severe form, which usually is diagnosed in children aged 18-36 months.

  • Considered the classic form.
  • Children with type A may survive into the second and third decades of life.

  • Symptoms in type A may include:

  1. coarse facial features and short stature.

  2. enlarged liver and spleen.

  3. progressive and profound mental retardation.

  4. ivory-colored skin lesions on the upper back and sides of the upper arms and thighs.skeletal changes, joint stiffness, short neck, broad chest, and too-large head.

  5. progressive deafness.

  6. atypical retinitis pigmentosa and visual impairment.

II.Type B Hunter syndrome is much milder than type A

  • May not be diagnosed until adulthood.
  • Individuals with type B may live into their 70s.
  • Their physical features are similar to those in type A.
  • Individuals with type B, however, usually have normal intelligence and do not have the severe skeletal problems of type A.

Diagnosis:-

  • In type A Hunter syndrome, the child’s appearance combined with other symptoms such as enlarged liver and spleen and the ivory-colored skin lesions can suggest the child has mucopolysaccharidosis.
  • Type B Hunter syndrome is much harder to identify, and might only be recognized when looking at the maternal relatives of a child with Hunter syndrome.
  • In either type, the diagnosis can be confirmed by a blood test for deficiency of I2S.

Treatment:-

  • Medical care is directed towards relieving the symptoms of Hunter syndrome.
  • Treatment with Elaprase (idursulfase) replaces I2S in the body and helps reduce symptoms and pain.

References:-

1.SHAFERS 8th edition

2.NEVILLE ‘S 3rd edition