Introduction Chronic obstructive pulmonary disease (COPD) has a significant disease burden and is among the leading causes of hospital readmissions, adding a significant burden on healthcare resources. The association between 30-day readmission in a COPD patient undergoing bronchoscopy and a wide range of modifiable potential risk factors, after adjusting for sociodemographic and clinical factors, has been assessed, and comparison has been made with COPD patients not undergoing bronchoscopy. Methods We conducted a comprehensive analysis of the 2016 Nationwide Readmission Database (NRD) of 30-day all-cause readmission among COPD patients undergoing bronchoscopy. A Cox's proportional hazards model was used to obtain independent relative risks of readmission following bronchoscopy in COPD patients as compared to patients not undergoing bronchoscopy. Our primary outcome was the 30-day all-cause readmission rate in both groups. Other secondary outcomes of interest were the 10 most common reasons for readmission, rd patients, and the rationale should be clarified, as it affects the overall LOS and healthcare expenditure.Cardiac manifestations of coronavirus disease 19 (COVID-19), including arrhythmia, have been described in the literature. However, to our knowledge, association of COVID-19 with bradycardia has not been reported. This case study describes sinus bradycardia as a potential manifestation of COVID-19. This is a retrospective case series of four patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, admitted to St. Luke's University Health Network ICU between 24 March 2020 and 5 April 2020. Medical records of these patients were reviewed using the EPIC electronic health record system. Demographic, clinical, laboratory, and treatment data were reviewed against periods of bradycardia in each patient. The patient group comprised two males and two females. Two patients had pre-existing cardiovascular (CV) comorbidities but no history of arrythmias. Heart rates ranged between 66 and 88 beats/min on admission. The lowest rates during bradycardia were between 42 and 49 ed response to medications are possible triggers. High levels of pro-inflammatory cytokines may act directly on the sinoatrial (SA) node contributing to the development of bradycardia.  https://www.selleckchem.com/products/OSI-906.html  This may be a warning sign of the onset of a serious cytokine storm. An increased awareness of possible exaggerated bradycardia response is important to consider with the use of empiric medications which have arrhythmogenic effects.Acute adrenal hemorrhage (adrenal apoplexy) in the context of severe sepsis is potentially life-threatening. Diagnosis of this condition is difficult to achieve without a strong sense of suspicion. The concurrent use of anticoagulants increases the risk of adrenal hemorrhage in the context of sepsis. Abdominal CT imaging is helpful in detecting hemorrhage within the adrenal gland. Once the diagnosis is considered, prompt therapy with corticosteroids can improve recovery and survival. A follow-up scan to confirm the resolution of the hematoma is useful to ensure that there is no other cause of adrenal enlargement. We report a 76-year-old lady who was hospitalized because of unexplained anemia and abdominal pain and was discovered to have bilateral pneumonia and urinary tract infection with severe hypotension not responding to standard treatments. An abdominal CT scan confirmed the presence of bilateral adrenal hemorrhage. A subsequent finding of an inappropriately low serum cortisol level in the presence of physiological stress confirmed adrenal insufficiency. The patient's condition improved following corticosteroid replacement. A repeat CT scan performed 10 months following the patient's initial presentation demonstrated signs of resolution of the adrenal hematomas; however, the patient's adrenal function remained impaired.Introduction Dapagliflozin is a member of a novel class of drugs (sodium-glucose cotransporter-2 inhibitors) used to treat type 2 diabetes mellitus and licensed in Pakistan in 2017. This retrospective observational study evaluated the effects of dapagliflozin on glycated hemoglobin (HbA1c) concentrations in patients treated at endocrinology clinics in Islamabad, Pakistan. The secondary objectives included assessing the effects of dapagliflozin on weight reduction and blood pressure control and to determining its safety. Methodology Patients with type 2 diabetes who were treated with dapagliflozin were identified by screening the electronic medical records at tertiary care hospitals in Islamabad. Data were collected at the first visit and at follow-up. Categorical variables were recorded as frequencies and percentages and compared by McNemar's tests, and continuous variables were recorded as means and standard deviations and compared by paired sample t-tests. Results Mean HbA1C concentration was significantly lower at follow-up than at the first visit (7.57%±0.98% vs. 9.07%±2.07%, respectively; p less then 0.001). Bodyweight (85.09±15.92 kg vs. 87.07±16.11 kg, respectively; p less then 0.001) and diastolic blood pressure (80.34±7.12 mmHg vs. 82.34±9.61 mmHg, respectively; p less then 0.001) were also significantly lower at follow-up than at the first visit, whereas systolic pressure showed a marginally significant reduction (123.5±16.57 mmHg vs. 126.83±19.97 mmHg, p=0.048). Conclusion This first observational study of patients in Pakistan treated with dapagliflozin found that HbA1c concentration, weight, and blood pressure were reduced after initiation of dapagliflozin treatment.Introduction Coronavirus disease 2019 (COVID-19) has challenged medical educators on continuing to provide quality educational content in a virtual setting. The objective of this module was to create a gamified review of core obstetric and gynecology (OB-GYN) topics that residents would find educational and informative. Methods The game created was modeled after the TV show "So You Think You Can Dance?", with a warm-up and several rounds of rapid-fire OB-GYN questions and cases, eliminating teams to a final face-off. The residents were given a post-session survey to determine their attitudes and learning towards this virtual conference approach. Results Based on the post-session survey, the majority of the residents found this activity to be educational, entertaining, engaging, and better than the traditional lecture format. Conclusion This initial attempt at migrating gamification, a core component of our live conferences, into the new virtual arena, was well-received by learners as effective, educational, and engaging.