Vitamin B12 deficiency presenting as neck pain and cervical radiculopathy.

Vitamin B12 is required for the formation of haematopoietic cells and the synthesis of myelin. Deficiency typically presents with fatigue and megaloblastic anaemia. Prolonged deficiency can cause neurological symptoms such as paresthesia, which can progress to subacute combined degeneration of the spinal cord. We describe an unusual presentation of B12 deficiency in a young man who was initially diagnosed and treated for cervical radiculopathy. This case highlights the challenges of diagnosing B12 deficiency in patients with neurologic but without haematologic, abnormalities. While the current incidence of B12 deficiency in developed countries is low, cases are likely to rise with the increased adoption of veganism. Clinicians should be aware of the variable presentations of B12 deficiency because delayed diagnosis and treatment increases morbidity and can cause irreversible neurological deficits.

Billing Bonanza: Improving Resident Knowledge of the 2021 Revised American Medical Association Outpatient Billing Guidelines Through Gamification.

Introduction: Residents often feel unprepared for independent practice, citing an unfamiliarity with billing as a common cause. Gamification has been well studied as a means to engage learners but not as a way to improve resident knowledge of outpatient billing guidelines. Methods: We delivered a session to incoming PGY 1 residents with a goal of improving billing proficiency. The session included a pretest and posttest questionnaire, a prerecorded PowerPoint lecture, and Billing Bonanza, a game with instructions and rules that used gamification to reinforce billing concepts. Results: Residents demonstrated improvement in percentage of correctly answered questions from 42% on the pretest to 67% on the posttest, which resulted in a statistically significant increase of 0.24 questions correct. Discussion: This session led to improvement in baseline billing knowledge.

Brachial plexus injury and facial breakdown as a consequence of proning during COVID-19 treatment.

ABSTRACT: By early 2020, the novel SARS-CoV-2 virus (COVID-19) was spreading rapidly worldwide, and its effects proved devastating. In many critically ill patients afflicted with COVID-19, treatment often involves prolonged periods of proning that, along with other interventions, can lead to improved oxygenation. However, sustaining this position predisposed patients to increased complications. We present a case of an older patient with respiratory failure secondary to COVID-19 who developed rapidly forming facial and knee wounds and a brachial plexus injury from proning. The pressure injuries were unresponsive to standard wound care treatments and resulted in full-thickness wounds. During outpatient posthospital follow-up, a facial eschar was debrided, and weakness of the left shoulder and arm secondary to a brachial plexus injury was identified. This case highlights various complications associated with prolonged proning and the importance of close attention to follow-up by both inpatient and outpatient providers.

Prodromal posterior cortical atrophy: clinical, neuropsychological, and radiological correlation.

We present longitudinal clinical, cognitive, and neuroimaging data from a 63-year-old woman who enrolled in research as a normal control and evolved posterior cortical atrophy (PCA) over 5 year follow-up. At baseline she reported only subtle difficulty driving and performed normally on cognitive tests, but already demonstrated atrophy in left visual association cortex. With follow-up she developed insidiously progressive visuospatial and visuoperceptual deficits, correlating with progressive atrophy in bilateral visual areas. Amyloid PET was positive. This case tracks the evolution of PCA from the prodromal stage, and illustrates challenges to early diagnosis as well as the utility of imaging biomarkers.