Propofol is an IV anesthetic that is often used as an adjuvant during monitored anesthesia care, the addition of ketamine to propofol may counteract the cardiorespiratory depression seen with propofol used alone. Ketofol (ketamine/propofol combination) was used for procedural sedation and analgesia. However, evaluation of the effectiveness of different concentrations of Ketofol in procedural operation regarding changes in haemodynamics, emergence phenomena, recovery time, the doses, and adverse effects was not yet studied, so this randomized, double blinded study was designed to compare the quality of analgesia and side effects of intravenous different concentrations of ketofol in hundred children of both sex undergoing procedural operation, e.g. esophagoscopy, rectoscopy, bone marrow aspiration and liver biopsy participated in this randomized, double-blinded study. Patients received an infusion of a solution containing either combination of propofol: ketamine (1:1) (Group I) or propofol: ketamine (4:1) (Group II). Subsequent infusion rates to a predetermined sedation level using Ramsay Sedation Scale. Heart rate, noninvasive arterial blood pressure (NIBP), oxygen saturation (SpO2), end tidal carbon dioxide (Etco2) and incidence of any side effects were recorded. There were no significant hemodynamic changes in both groups after induction. However, there was an increase in postoperative nausea, psychomimetic side effects, and delay in discharge times with the largest ketamine dosage (Group I). We concluded that the adjunctive use of smaller dose of ketamine in ketofol combination minimizes the psychomimetic side effects and shorten the time to discharge.

Background: In Type 2 Diabetes Mellitus (T2DM), assessing newer inflammatory markers like IL-6, CRP, and TNF-alpha can help identify and manage inflammation, which is linked to insulin resistance and cardiovascular risk. These markers, along with HbA1c and other established markers like IL-10 and IFN-γ can provide insights into the disease's progression and the effectiveness of treatments. Aims and Objectives: The aims and objectives of the study was to evaluate the levels of SII, SIRI, PLR, NLR and other inflammatory markers in T2DM patients as well as their relationship to HbA1c and blood sugar. Materials and Methods: This cross-sectional study was conducted in Department of Biochemistry in a tertiary care hospital of Central India. In this study, 100 T2DM patients and 100 non-diabetic subjects were recruited. Fasting and post-prandial blood samples were collected and used for the estimation of blood sugar, urea, creatinine and lipid profile parameters. Whole blood (EDTA) samples were used for analysis of complete blood count (CBC), HbA1c and various inflammatory markers. Demographic details were collected and correlation of inflammatory markers with T2DM were measured. Results: In this study, significant increase in blood pressure (systolic & diastolic), fasting blood sugar (FBS), post-prandial blood sugar, HbA1c, urea, creatinine, total cholesterol, triglycerides, LDLC, VLDL and neutrophil count was observed in T2DM cases (p<0.05). Inflammatory markers such as NLR, PLR, SII, SIRI, MHR, NHR and PHR were significantly increased in T2DM cases than non-diabetic subjects (p<0.05). FBS was positively correlated with SIRI (r=0.180), MHR (r=0.257), NHR (r=0.418), and PHR (r=0.212). Similarly, HbA1c positively correlated with NHR (r=0.353) and PHR (r=0.177) in T2DM subjects. In this study, HDL level and lymphocyte count was significantly decreased in T2DM cases. Conclusion: The study concludes that increased levels of various inflammatory markers observed in T2DM and their positive correlation with blood sugar and HbA1c. Analyses of various markers of inflammation are useful to assess the impact of systemic inflammatory response in T2DM patients.

Bullying in the workplace is emerging as a problem over the past decade. Despite the tendency for incidents of bullying to be underreported 2 it is widespread in all sectors of the workforce including healthcare in the United Kingdom (UK) 3. The culture of bullying in medicine contributes to this pattern of bullying behaviour that can adversely affect any aspect of working life from an employee’s health 4 to the reputation of the organization 5. Therefore, immediate changes are required to increase the recognition of this problem and take further steps to a solution.

Over the past decade, the United States has undergone a remarkable evolution in the way it delivers inpatient medical care. In the mid-1990s, much of American health care was dominated by a managed care paradigm, which gave incentives to control health care inflation3. Hospitalist model was uniquely well versed in evidence-based practice and systems improvement. Their focus on providing clinically appropriate care, improving efficiency, reduce length of inpatient stay and helping to make the hospital system work better, without compromising patient satisfaction & outcome was big boon for its growth. Hospitalist field has now become the fastest growing specialty in the history of American medicine, approximately today close to 15,000 hospitalists practice in America, and the field is likely to grow to about 30,000 making it a larger specialty than cardiology4.