Innovative Journal of Medical and Health Sciences

Background: Endotracheal extubation  is almost always associated with haemodynamic changes. This increase in sympathoadrenal activity may result in hypertension, tachycardia and arrhythmias and is more hazardous to the patients with hypertension, myocardial insufficiency or cerebrovascular disease. The aim of this randomized double blind study was to compare the effect of diltiazem and esmolol in attenuating  thecardiovascular responses to tracheal extubation.Methods: Changes in heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP) and mean arteial blood pressure(MAP) were measured during extubation and emergence from anaesthesia in 150 ASA physical status I patients to assess the effect of esmolol and diltiazem.The patients were randomly assigned to one of three groups (n=50 for each group): saline 10ml(as control), 0.1mg/kg diltazem and 1mg/kg esmolol.The medications were given  3 minutes after reversal and 2 min before tracheal extubation.Results:Bothesmolol and diltiazem had greater attenuating effects on changes of  HR, SBP and DBP than control group.The inhibitory effects on changes of heart rate was greater with esmolol than diltiazem, but the attenuating effect on changes of SBP and DBP was greater with diltiazem than esmolol. Conclusion:We concluded that  a bolus dose of  intravenous diltiazem 0.1mg/kg or esmolol 1mg/kg given at 2 min before extubation was of value in attenuating the cardiovascular changes occuring in association with tracheal extubation.Esmolol is more effective than diltiazem in attenuating the heart rate changes.Diltiazem is more effective than esmolol in attenuating the systolic blood pressure changes.

Lithium is the mainstay of treatment in bipolar disorder and is associated with a variety of cutaneous side effects including psoriasis, acne form eruptions and folliculitis. Lithium can induce denovo psoriasis or exacerbate pre-existing psoriasis, the later one being most common. We report a case of lithium induced denovo scalp psoriasis and psoriatic arthritis in a patient who was on lithium since 17yr for bipolar affective disorder. Though scalp psoriasis is one of the commonly induced type, psoriatic arthritis due to lithium is very rare and only one case report was published so far.Also, as lithium is one of the commonly prescribed drug in psychiatry, the cutaneous side effects are to be known for psychiatrists and dermatologists.

Dimples are visiable identations of the skin and a dominant trait. Anatomically, dimples may be caused by variations in the structure of the some body tissue for example muscles, connective tissues, skin and subcutaneous tissue. Dimples types of the human body: Fovea buccalis (dimple of cheek), fovea mentalis (dimple of chin), zygomatic dimples, fossa supraspinosus (bi-acromial dimple=dimple of shoulder),  elbow dimples, fossa lumbales laterales (dimple of back), gluteal dimples and sacral-coocygeal  dimples (pilonidal dimple). Sometimes, dimples are permanently present, but sometimes not permanent. They vanish away when the excessive fat goes away. Dimples are not indicators good health.