Introduction: The occurrence of rotator cuff tendinopathy, which is invariably symptomatic, increases as populations age, being largely observed among patients with diabetes. The objective of the present study is to find out the occurrence of rotator cuff tendinopathy in elderly diabetic patients who were asymptomatic, composed of healthy individuals and those with diabetes mellitus. Materials and methods: The participants in this study included 87 elderly diabetic patients and 56 controls (mean age: 69.3±4.9 and 71.8±3.6, respectively), who were asymptomatic from shoulder. All patients, including, underwent shoulder MRI examination using 1.5 tesla MRI. Results: We recorded greater tendons thickness in the diabetic patients as compared with the controls (supraspinatus tendon: 6.6±0.7mm vs 5.3±0.8mm, p<0.001; biceps tendon: 3.9±0.7mm vs 3.1±0.8mm, p<0.002). Moreover, higher incidence of supraspinatus tendon tear was noted in diabetics as compared to biceps tendon (major tears: 32 (36.7%) vs 6 (10.7%), p=0.052; minor tears: 51 (58.6%) vs 11 (19.6%), p=0.032). Conclusions: The present study suggests that age-related rotator cuff tendinopathy is more prevalent among patients with diabetes. Therefore, MRI is an investigation of choice for early detection i.e., at pre-symptomatic stages of rotator cuff tendinopathy, as the patients may develop symptoms later. Keywords: asymptomatic

Purpose: Large language models (LLMs) like ChatGPT (OpenAI) are increasingly used in healthcare, raising questions about their accuracy and reliability for medical information. This study compared 2 versions of ChatGPT in answering post-discharge follow-up questions in the area of pediatric emergency medicine (PEM). Methods: Twenty-three common post-discharge questions were posed to ChatGPT-4 and -3.5, with responses generated before and after a simplification request. Two blinded PEM physicians evaluated appropriateness and accuracy as the primary endpoint. Secondary endpoints included word count and readability. Six established reading scales were averaged, including the Automated Readability Index, Gunning Fog Index, Flesch-Kincaid Grade Level, Coleman-Liau Index, Simple Measure of Gobbledygook Grade Level, and Flesch Reading Ease. T-tests and Cohen’s kappa were used to determine differences and inter-rater agreement, respectively. Results: The physician evaluations showed high appropriateness for both defaults (ChatGPT-4, 91.3%-100% vs. ChatGPT-3.5, 91.3%) and simplified responses (both 87.0%-91.3%). The accuracy was also high for default (87.0%-95.7% vs. 87.0%-91.3%) and simplified responses (both 82.6%-91.3%). The inter-rater agreement was fair overall (κ = 0.37; P < 0.001). For default responses, ChatGPT-4 produced longer outputs than ChatGPT-3.5 (233.0 ± 97.1 vs. 199.6 ± 94.7 words; P = 0.043), with a similar readability (13.3 ± 1.9 vs. 13.5 ± 1.8; P = 0.404). After simplification, both LLMs improved word count and readability (P < 0.001), with ChatGPT-4 achieving a readability suitable for the eighth grade students in the United States (7.7 ± 1.3 vs. 8.2 ± 1.5; P = 0.027). Conclusion The responses of ChatGPT-4 and -3.5 to post-discharge questions were deemed appropriate and accurate by the PEM physicians. While ChatGPT-4 showed an edge in simplifying language, neither LLM consistently met the recommended reading level of sixth grade students. These findings suggest a potential for LLMs to communicate with guardians.

Objective: Colony-stimulating factor 1 receptor-related leukoencephalopathy (CSF1R-L) is a rare adult-onset leukoencephalopathy. Reports of CSF1R-L patients from the Indian subcontinent remain limited. We aimed to report four patients with genetically confirmed CSF1R-L from four Asian Indian families and described their clinical, molecular, and radiological features. Methods: All patients underwent clinical examination, brain magnetic resonance imaging, and whole-exome sequencing to identify causative variants in the CSF1R gene. We also reviewed published reports of Indian patients with CSF1R-L. Results: The age at enrollment ranged from 34 to 40 years. The duration of symptoms ranged from 11 months to 2 years. The chief clinical phenotype in three patients was a rapidly evolving cognitive-behavioral syndrome combined with atypical parkinsonism, and asymmetrical spastic tetraparesis was observed in one patient. We identified four different variants (three missense variants and one in-frame deletion). Radiological findings revealed white matter involvement and diffusion restriction involving the subcortical white matter and pyramidal tracts. Conclusion We expand the literature on CSF1R-L patients from India by reporting four new cases.

During routine dissection, we observed a unique case of unilateral polydactyly in the left foot of a 61-year-old male cadaver. We observed the medial head of the quadratus plantae (QP) muscle, which gave off an additional tendinous slip before joining the lateral head of QP. The 4th tendon of the flexor digitorum longus (FDL) was bifurcated into two tendinous parts after receiving a thin fibrous slip from the tendinous slip of the medial head of QP. The medial division of the 4th tendon of FDL passed forward and attached to the base of the distal phalanx of the 5th toe. The extra tendinous slip from the medial head of QP was attached distally to the lateral division of the 4th tendon of FDL and formed a common anomalous tendon to the 6th toe. The knowledge of this variation would be helpful in reconstructive foot surgeries and correction of congenital deformities.

During routine dissection, we observed a unique case of unilateral polydactyly in the left foot of a 61-year-old male cadaver. We observed the medial head of the quadratus plantae (QP) muscle, which gave off an additional tendinous slip before joining the lateral head of QP. The 4th tendon of the flexor digitorum longus (FDL) was bifurcated into two tendinous parts after receiving a thin fibrous slip from the tendinous slip of the medial head of QP. The medial division of the 4th tendon of FDL passed forward and attached to the base of the distal phalanx of the 5th toe. The extra tendinous slip from the medial head of QP was attached distally to the lateral division of the 4th tendon of FDL and formed a common anomalous tendon to the 6th toe. The knowledge of this variation would be helpful in reconstructive foot surgeries and correction of congenital deformities.