Mulholland/Haglund's deformity is a symptomatic posterosuperior deformity of the heel. It affects middle-aged adults in general. It is more common in females than in males. It is mainly bilateral. The etiology is still poorly understood. The potential triggers may be a tight Achilles tendon, a high arch foot, and an inherited one. After the failure of conservative means, we record a case of bilateral Mulholland deformity showing dramatic improvement in pain following surgery.Hemifacial spasm is a rare but debilitating disorder of vascular compression of the facial nerve at the root exit zone causing repetitive, uncontrolled spasm of one half of the face. Usually, compression is caused by a pulsatile artery and less often by venous. Rarely, however, is hemifacial spasm caused by simultaneous compression by two formally named blood vessels. Here, we report a case of hemifacial spasm caused by simultaneous compression of the facial nerve root exit zone by the anterior inferior cerebellar artery and the superior petrosal vein. We describe the operative technique utilized to decompress the facial nerve and discuss the consequences of venous sacrifice in this scenario.We present two cases of posterior cruciate ligament (PCL) repair with suture augmentation (SA) in the setting of multiligamentous knee injury (MLKI). Excellent clinical outcomes were obtained at two-year follow-up with both patients returning to sport following injury. Both patients demonstrated improvements in Knee Injury and Osteoarthritis Outcome Score (KOOS) that exceeded the minimal clinically important difference (MCID) as reported in the literature for ligamentous knee injuries. One patient developed arthrofibrosis, which was successfully treated with manipulation under anesthesia and arthroscopic lysis of adhesions two months postoperatively. Both patients had full knee range of motion (ROM) by a one-year follow-up. One patient returned to full preinjury level of sport at six months postoperatively while the other patient returned to 50% of preinjury intensity at two-year follow-up. This series of two cases of PCL repair with SA in MLKIs demonstrates that PCL repair with SA is a viable procedure that can result in excellent short-term outcomes and restore knee stability.A 94-year-old woman was found unresponsive in her room at an independent living facility. Upon paramedic arrival, the patient had a Glasgow Coma Scale of 3, and she was transported to the emergency department (ED). In the ED, she was unresponsive but spontaneously breathing, bradycardia, and hypothermia. Serum concentrations of both secobarbital (3.3µg/mL; therapeutic 1.0-2.0µg/mL) and pentobarbital (9.5µg/mL; therapeutic less then 5.0µg/mL) were detected and elevated. This type of poisoning is quite rare and should be considered in patients presenting with hypothermia and coma, even in patients showing brain death signs. The use of hemodialysis for refractory pentobarbital poisoning may be helpful.Introduction Correlation between decreased levels of vitamin D in the blood of elderly patients and incidence of falls and fractures has been assessed in various studies; however, there is still ambiguity in data. In this study, we aim to establish the role of vitamin D supplements in minimizing the burden of falls and non-vertebral fractures in the elderly population in a local setting. Methods This single-blind, placebo-controlled randomized interventional study was conducted in the Internal Medicine Department of a tertiary care hospital in Pakistan from March 2018 to July 2020. Patients between the ages of 50 to 75 years were enrolled in the study and were randomly assigned to receive either placebo or 100,000 IU vitamin D oral tablets and were followed over 24 months, with regular follow-ups every three months. Results There was no significant difference in the probability of one or more falls for those assigned to the vitamin D group compared to those who received placebo (24.70% vs. 24.85%; hazard ratio [HR] 0.99; 95% CI 0.68-1.43). Similarly, the probability of non-vertebral fracture was also non-significant between both groups (4.7% vs. 5.7%; HR 0.81; 95% CI 0.32-2.01). Conclusion As per the results of this study, vitamin D supplementation had no beneficial effect on the reduction of falls and non-vertebral fractures in elderly patients. Further multi-center studies of longer duration are required to prove the favorable effects of vitamin D supplements.Introduction The protrusion of pelvic organs and their associated vaginal segments into or through the vagina is called pelvic organ prolapse (POP). One of the worrisome complications of POP is decubitus ulcer.It is a feature of old, long-standing prolapse. The standardized pelvic organ prolapse quantification (POP-Q) system of classification was proposed by the International Incontinence Society (ICS) for staging pelvic organ prolapse in 1996. This system is a clear and reproducible quantification method and has more inter-observer and intra-observer reliability. This study was designed to determine the relationship of the POP-Q stage with the presence and size of decubitus ulcer. Methods A total of 92 cases with pelvic organ prolapse were included in the study. We examined our patients by the POP-Q method and measured the dimension of the decubitus ulcer if present. Results Out of the 92 patients included in the study, 32 cases had a decubitus ulcer. As the POP-Q stage increased, the number of patients with a decubitus ulcer also increased. We also observed that larger dimension (>6 cm2) decubitus ulcers are present in stage 3 and stage 4 POP. A statistically significant correlation was observed between the POP-Q stage and the size of the decubitus ulcer, rs=0.607, p less then 0.001. Conclusion A decubitus ulcer becomes more common as the POP-Q stage increases. The size of the ulcer also increases with the advancing stage of POP-Q.Introduction The objective of the pilot study was to determine the association between learning preferences and improvement in the American Academy of Neurology Residency In-Service Training Examination (RITE) scores from postgraduate year 2 (PGY-2) to postgraduate year 3 (PGY-3) in neurology residents. Methods Neurology residents at the University of Florida were approached to participate, and their consent was obtained. VARK inventory, representing four modalities (visual, aural, read/write, kinesthetic) of learning preferences, was completed by participants. Participants could pick more than one modality. The number of responses in each sensory domain was recorded, with higher numbers indicating stronger preference. Residents' performance on the RITE was recorded for PGY-2 and PGY-3. https://www.selleckchem.com/products/cb-839.html Results Seventeen residents completed the VARK inventory and 16 had data for RITE. Residents demonstrated overall positive change in RITE from PGY-2 to PGY-3 (mean change = 6%; 95%CI 4%, 9%). The median number of responses was highest for the kinesthetic domain (median = 7, range = 1-12), followed by visual (median = 6, range = 2-12), aural (median = 4, range = 1-10), and read/write (median = 4, range = 1-10).