Patient: Female, 68Final Diagnosis: Adrenal hemorrhageSymptoms: Abdominal and/or epigastric painMedication: RivaroxavanClinical Procedure: —Specialty: General and Internal MedicineObjective:Rare diseaseBackground:Adrenal hemorrhage is an uncommon and under-recognized disorder with a wide array of etiologies ranging from pregnancy to septic shock. It is one of the complications of anticoagulation therapy, including direct anticoagulant medications.Case Report:Here, we present a case of a 68-year-old female with recent right knee arthroplasty who was on rivaroxaban for deep vein thrombosis (DVT) prophylaxis presented to the emergency department (ED) for severe acute onset abdominal pain, computed tomography (CT) of abdomen and pelvis revealed possible left adrenal hemorrhage that was confirmed with magnetic resonance imaging (MRI). On repeat CT, her unilateral adrenal hemorrhage converted to a bilateral adrenal hemorrhage (BAH) and, as a result, the patient developed adrenal insufficiency.Conclusions:An undiagnosed and untreated adrenal hemorrhage can have catastrophic consequences, leading to adrenal insufficiency with potential shock and death. Therefore, it is important for clinicians to have an increased awareness and knowledge about adrenal hemorrhage.

Objectives: Although there have been associations between diabetes and mortality in COVID-19 patients, it is unclear whether this is driven by the disease itself or whether it can be attributed to an inability to exhibit effective glucose control. Methods: We conducted a retrospective cohort study of 292 patients admitted to a tertiary referral center to assess the association of mortality and glycemic control among COVID-19-positive patients. We used a logistic regression model to determine whether average fasting glycemic levels were associated with in-hospital mortality. Results: Among the diabetic and non-diabetic patients, there were no differences between mortality or length of stay. Mean glucose levels in the first 10 days of admission were higher on average among those who died (150–185 mg/dL) compared with those who survived (125–165 mg/dL). When controlling for multiple variables, there was a significant association between mean fasting glucose and mortality (odds ratio = 1.014, p < 0.001). The associations between glucose and mortality remained when controlled for comorbidities and glucocorticoid use. Conclusion: The results of this retrospective study show an association between mortality and inpatient glucose levels, suggesting that there may be some benefit to tighter glucose control in patients diagnosed with COVID-19.

Objectives: To determine the effect of a C1-C2 sustained natural apophyseal glide (SNAG) as compare to posterior anterior (PA) vertebral mobilization on cervicogenic headache.Study Design: Randomized Control Trial.Method: The study was conducted on 60 patients with CGH. In this study, patients were divided into two groups, group A and group B equally. Group A of 30 patients received SNAG and at the same time Group B of 30 patients were treated with PAVMs. A pre tested and structured questionnaire was used to collect data. Data was entered and analyzed by using SPSS 19.Outcome Measures: Pain and disability was measured on Visual Analog Scale (VAS) (0-10) and Neck Disability Index (NDI) before and after the treatment.Results: The study showed significant results for both the interventions in the treatment of CGH but SNAG mobilization has been more effective in reducing pain in CGH patients.Conclusions: On the basis of this study, it is proved that cervical SNAGS is more effective for the treatment of cervicegenic headaches as compared to PAVMs.