Smoking cigarettes is known to be harmful to our health whether if you are a smoker or passive smoker. Smoking causes lung cancer, cardiovascular disease, emphysema and etc. Quiting smoking is very much depend on willpower of the person to be ready to quit. Government increases the taxes for cigarettes every year and it will become more expensive to smoke cigarettes in future.

If you need help to quit smoking, you can talk to your doctor about this. There are medications can be prescribed by the doctors to help with quitting smoking.

  1. Champix- authority prescription by a doctor is required. Champix works by reducing craving for cigarettes smoking. It works well in 50-80% of  people who are on Champix. Side effects of the medication are nausea, headache, insomnia and vivid dreams. These side effects tend to wear off after few weeks of taking Champix. The whole course of Champix takes 3-6 months depending on individual circumstances and patient will need to go back to see the doctor again for continuation of prescription of Champix. Part of the criteria for this prescription, patient will need to enrol into counselling program like Quitline (Ph: 137848). Exception for patient who have severe depression, Champix may not suitable in such circumstances. 
  2. Nicotine patch- known to be available for a long time even before Champix. Nicotine patch is a replacement therapy for cigarretes smoking given cigarretes have nicotine in it which is known to cause craving. Nicotine patch is now available through doctor prescription under PBS. This means it is cheaper to buy nicotine patch with doctor prescription rather than over the counter.
  3. Zyban/Bupropion- rarely prescribed nowadays due to its more signficant side effects as there is better alternative. It is thought to help with craving and other withdrawal effects from nicotine.

 stop smoking1

The shingles vaccine, Zostavax®, has been approved by National Immunisation Program (NIP), to be provided free of charge from 1 November 2016 to people aged 70 years, subject to vaccine supply. There will also be a five year catch-up program for people aged 71 – 79 years.

  • Efficacy in this age group is 41%
  • Zostavax is contraindicated in the immunocompromised
  • A single dose of vaccine should be administered subcutaneously in the deltoid region
  • Zostavax can be co-administered with an inactivated vaccine at a separate injection site
  • It’s not necessary to check VZV serology before vaccination
  • Zoster vaccination is not recommended in people previously vaccinated with varicella vaccine
  • People who’ve had shingles can be vaccinated after a wait of at least a year

Individuals who should not receive the vaccine include the immunocompromised, pregnant women, and those who have previously had anaphylaxis to any varicella zoster virus-containing vaccine or its components.

 Immunocompromised patients are as follows:

  • Haematological or generalised malignancies (including those not on treatment): eg. lymphoma, acute or chronic leukaemia, Hodgkin's disease
  • Solid organ or bone marrow transplant recipients (with exceptions as advised by specialists)
  • HIV/AIDS (with exceptions as advised by specialists) or other congenital/acquired immunodeficiencies
  • Current or recent high dose systemic immunosuppressive therapy: eg. chemotherapy, radiation therapy, oral corticosteroids, disease modifying anti-rheumatic drugs

Psoriasis is a chronic inflammatory skin condition characterised by red and scaly plaque rash. It is thought to be immune-mediated inflammatory (autoimmune) disease. It is not contagious. Psoriasis also can affect nails and joints (causing psoriatic arthritis). Psoriasis affects 2-4% of males and females. It affects at any age from childhood to adult. It has peaks onset of 30-39 years and 50-69 years.

Risk factor for triggering or worsening psoriasis:

  • Family history especially in those with first degree relatives. Genetics suspectibility with major histocompatibility complex on chromosome 6p21, IL-12 and IL-23 genes had been implicated in psoriasis
  • Smoking
  • Obesity
  • Drugs such as Lithium, Beta- blockers, antimalarials, nonsteroidal anti-inflammatory drugs
  • Infections due to viral or bacterial infections. Poststreptococcal infection causes flare of guttate psoriasis. HIV is known to worsen the condition of psoriasis.
  • Excess alcohol consumption

Clinical features:

Psoriasis usually presents with symmetrically distributed, red, scaly plaques with well defined borders. The scale can be silvery white and may have peeling surface. Scaling and redness of skin occurs due to increased growth than normal and cells turnover in psoriasis with inflammation. In normal skin, the skin cells turnover is 27 days but in psoriasis, the skin cells turnover become shortened to 4 days. The most common sites affected are scalp, elbows and knees. In severe form of psoriasis, it can affect the whole body. Some patient can complain itchy of the skin leading to scratching and lichenification (thickened leathery skin).