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extraskeletal ewing sarcoma presenting as a posterior mediastinal mass . the ewing sarcoma family of tumors is an uncommon group of malignant neoplasms that may be located in both skeletal and extraskeletal regions . extraskeletal ewing sarcoma ees is quite rare and predominantly involves the soft tissues of the trunk or the extremities . herein we report the case of a 19 year old female patient who complained of left arm pain . simple chest radiography revealed an opacity occupying almost the entire left hemithorax . diagnostic imaging techniques demonstrated a solid contrast enhanced mass in the posterior mediastinum . there was an evident mediastinal shift and the left lung was collapsed . even though lymphoma was considered as an initial diagnosis a biopsy was taken and its histopathological analysis revealed ees . in the literature there have been only a few case reports of ess located in the mediastinum . we conclude that although this is an unusual location ees should be contemplated in the differential diagnosis of mediastinal masses .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: extraskeletal ewing sarcoma presenting as a posterior mediastinal mass . the ewing sarcoma family of tumors is an uncommon group of malignant neoplasms that may be located in both skeletal and extraskeletal regions . extraskeletal ewing sarcoma ees is quite rare and predominantly involves the soft tissues of the trunk or the extremities . herein we report the case of a 19 year old female patient who complained of left arm pain . simple chest radiography revealed an opacity occupying almost the entire left hemithorax . diagnostic imaging techniques demonstrated a solid contrast enhanced mass in the posterior mediastinum . there was an evident mediastinal shift and the left lung was collapsed . even though lymphoma was considered as an initial diagnosis a biopsy was taken and its histopathological analysis revealed ees . in the literature there have been only a few case reports of ess located in the mediastinum . we conclude that although this is an unusual location ees should be contemplated in the differential diagnosis of mediastinal masses . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

primary osteomyelitis of the sternum in the pediatric age group report of a new case and comprehensive analysis of seventy four cases . pediatric primary osteomyelitis of the sternum may have a non specific onset and be diagnosed late . we analyzed all accessible published cases n 73 and 1 new case in order to describe presenting signs and symptoms laboratory findings diagnostic imaging features causative pathogens treatments complications and outcomes . this analysis represents the first comprehensive description of the natural history of this rare infection .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: primary osteomyelitis of the sternum in the pediatric age group report of a new case and comprehensive analysis of seventy four cases . pediatric primary osteomyelitis of the sternum may have a non specific onset and be diagnosed late . we analyzed all accessible published cases n 73 and 1 new case in order to describe presenting signs and symptoms laboratory findings diagnostic imaging features causative pathogens treatments complications and outcomes . this analysis represents the first comprehensive description of the natural history of this rare infection . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

mother to child transmission of hepatitis b virus a cause for concern . mother to child transmission of hepatitis b virus hbv is an important public health issue . india introduced hbv vaccine in 10 states as part of its universal immunization program uip . here we show evidence of mother to child transmission of hbv in three families from jharkhand and bihar states where hbv vaccination is not yet included in the uip . this report illustrates the need for active screening of hbv in pregnant women and implementation of hbv vaccine across all states in india to reduce the burden of disease .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: mother to child transmission of hepatitis b virus a cause for concern . mother to child transmission of hepatitis b virus hbv is an important public health issue . india introduced hbv vaccine in 10 states as part of its universal immunization program uip . here we show evidence of mother to child transmission of hbv in three families from jharkhand and bihar states where hbv vaccination is not yet included in the uip . this report illustrates the need for active screening of hbv in pregnant women and implementation of hbv vaccine across all states in india to reduce the burden of disease . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

severe alcoholic hepatitis effectively treated with vitamin e as an add on to corticosteroids . a 49 year old woman with a history of heavy alcohol drinking was admitted to our hospital due to jaundice and abdominal distention . a blood test showed leukophilia mild hypoalbuminemia hyperbilirubinemia hepatobiliary injury and coagulopathy . image studies showed an extremely enlarged fatty liver and splenomegaly . the japan alcoholic hepatitis score and maddrey discriminant function were 10 and 54 points respectively . we diagnosed her with severe alcoholic hepatitis and treated her with corticosteroids but her liver function did not improve . we therefore administered the vitamin e product tochopheryl acetate _lgnum_ mg day as an add on therapy after which her leukophilia liver enzymes and coagulopathy improved immediately .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: severe alcoholic hepatitis effectively treated with vitamin e as an add on to corticosteroids . a 49 year old woman with a history of heavy alcohol drinking was admitted to our hospital due to jaundice and abdominal distention . a blood test showed leukophilia mild hypoalbuminemia hyperbilirubinemia hepatobiliary injury and coagulopathy . image studies showed an extremely enlarged fatty liver and splenomegaly . the japan alcoholic hepatitis score and maddrey discriminant function were 10 and 54 points respectively . we diagnosed her with severe alcoholic hepatitis and treated her with corticosteroids but her liver function did not improve . we therefore administered the vitamin e product tochopheryl acetate _lgnum_ mg day as an add on therapy after which her leukophilia liver enzymes and coagulopathy improved immediately . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

fetus compressus and fetus papyraceous . clinical differences report of three cases . the items papyraceus fetus and fetus compressus are used like synonymous . the low incidence and the lack of reporting of these cases leads to confusion . clinical evidence shows significant differences between them and sustain a proper diagnosis . we report 3 cases of patients with multiple pregnancy 2 twins and 1 triplets observed in the death of one of the products of each patient obtaining 2 fetus compressus and 1 fetus papyraceous respectively .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: fetus compressus and fetus papyraceous . clinical differences report of three cases . the items papyraceus fetus and fetus compressus are used like synonymous . the low incidence and the lack of reporting of these cases leads to confusion . clinical evidence shows significant differences between them and sustain a proper diagnosis . we report 3 cases of patients with multiple pregnancy 2 twins and 1 triplets observed in the death of one of the products of each patient obtaining 2 fetus compressus and 1 fetus papyraceous respectively . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

de mello single incision for combined liver kidney transplantation keeping the kidney retroperitoneal a case report . the combined liver kidney transplantation clkt is the procedure of choice for patients with end stage liver and kidney disease . in clkt we can usually accommodate the grafts in two different ways varying the kidney placement . the retroperitoneal kidney implant has some advantages such as the easy access or avoiding vascular complications . we propose a new single incision not yet reported maintaining an extraperitoneal kidney with excellent surgical field for clkt and possible reduction of the impact of wound complications .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: de mello single incision for combined liver kidney transplantation keeping the kidney retroperitoneal a case report . the combined liver kidney transplantation clkt is the procedure of choice for patients with end stage liver and kidney disease . in clkt we can usually accommodate the grafts in two different ways varying the kidney placement . the retroperitoneal kidney implant has some advantages such as the easy access or avoiding vascular complications . we propose a new single incision not yet reported maintaining an extraperitoneal kidney with excellent surgical field for clkt and possible reduction of the impact of wound complications . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

acute hepatitis c virus infection related to capillary blood glucose meter . hepatitis c virus hcv infects an estimated _lgnum_ _lgnum_ million people worldwide becoming the major cause of chronic liver disease cirrhosis hepatocellular carcinoma and liver transplantation . there are various preventable modes of transmission of hcv infection including needlestick and sharps injuries . however hcv infection secondary to needlestick injury by a capillary blood glucose meter cbgm lancet has not been previously well reported . we describe an unusual case of a 25 year old male medical student acquiring acute hcv infection with a lancing device of cbgm . the source patient was a 54 year old diabetic male with positive anti hcv test results . in our patient after 3 months of initial exposure a standard set of investigations confirmed the diagnosis of acute hcv infection with the same genotype
 as the source . the cbgm as in our case may have a role in the transmission of hcv infection warranting radical advancements in diabetes screening and monitoring technology .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: acute hepatitis c virus infection related to capillary blood glucose meter . hepatitis c virus hcv infects an estimated _lgnum_ _lgnum_ million people worldwide becoming the major cause of chronic liver disease cirrhosis hepatocellular carcinoma and liver transplantation . there are various preventable modes of transmission of hcv infection including needlestick and sharps injuries . however hcv infection secondary to needlestick injury by a capillary blood glucose meter cbgm lancet has not been previously well reported . we describe an unusual case of a 25 year old male medical student acquiring acute hcv infection with a lancing device of cbgm . the source patient was a 54 year old diabetic male with positive anti hcv test results . in our patient after 3 months of initial exposure a standard set of investigations confirmed the diagnosis of acute hcv infection with the same genotype
 as the source . the cbgm as in our case may have a role in the transmission of hcv infection warranting radical advancements in diabetes screening and monitoring technology . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

safety and efficacy of anti pd 1 therapy for metastatic melanoma and non small cell lung cancer in patients with viral hepatitis a case series . anti pd 1 monoclonal antibodies have shown durable long term survival benefit in patients with metastatic melanoma . limited evidence exists on the safety and efficacy of pd 1 inhibitors in patients with hepatitis b virus hbv and hepatitis c virus hcv infections as these patients have traditionally been excluded from clinical trials because of a theoretical risk of immune reconstitution inflammatory syndrome . we aim to determine the safety and efficacy of treatment with pd 1 inhibitors in seven patients with hbv hcv infection and concurrent metastatic melanoma or non small cell lung cancer nsclc . we describe seven patients treated with pd 1 inhibitors nivolumab and pembrolizumab for either metastatic melanoma or metastatic nsclc in the setting of chronic or past hbv hcv infection . the safety and efficacy of treatment were analysed retrospectively by examining response to treatment alanine transaminase alt trends and viral load trends . one patient showed an increase in alt of common terminology criteria for adverse events ctcae grade 2 severity that returned to the normal range following treatment of his hcv infection with ledipasvir 90 mg sofosbuvir _lgnum_ mg . an additional four patients showed an increase in alt of ctcae grade 1 severity . the remaining two patients experienced no hepatic toxicity with stable disease continuing after more than 24 cycles of nivolumab . efficacy was similar to the data of published trials . our results indicate that patients with metastatic melanoma and nsclc can be treated safely with pd 1 inhibitors in the context of hbv hcv infection . however we recommend that those with active viral hepatitis be monitored closely in consultation with a hepatologist and treated with antiviral therapy if indicated .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: safety and efficacy of anti pd 1 therapy for metastatic melanoma and non small cell lung cancer in patients with viral hepatitis a case series . anti pd 1 monoclonal antibodies have shown durable long term survival benefit in patients with metastatic melanoma . limited evidence exists on the safety and efficacy of pd 1 inhibitors in patients with hepatitis b virus hbv and hepatitis c virus hcv infections as these patients have traditionally been excluded from clinical trials because of a theoretical risk of immune reconstitution inflammatory syndrome . we aim to determine the safety and efficacy of treatment with pd 1 inhibitors in seven patients with hbv hcv infection and concurrent metastatic melanoma or non small cell lung cancer nsclc . we describe seven patients treated with pd 1 inhibitors nivolumab and pembrolizumab for either metastatic melanoma or metastatic nsclc in the setting of chronic or past hbv hcv infection . the safety and efficacy of treatment were analysed retrospectively by examining response to treatment alanine transaminase alt trends and viral load trends . one patient showed an increase in alt of common terminology criteria for adverse events ctcae grade 2 severity that returned to the normal range following treatment of his hcv infection with ledipasvir 90 mg sofosbuvir _lgnum_ mg . an additional four patients showed an increase in alt of ctcae grade 1 severity . the remaining two patients experienced no hepatic toxicity with stable disease continuing after more than 24 cycles of nivolumab . efficacy was similar to the data of published trials . our results indicate that patients with metastatic melanoma and nsclc can be treated safely with pd 1 inhibitors in the context of hbv hcv infection . however we recommend that those with active viral hepatitis be monitored closely in consultation with a hepatologist and treated with antiviral therapy if indicated . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

isolated astasia manifested by acute infarct of the anterior corpus callosum and cingulate gyrus . astasia the inability to stand and walk in the absence of weakness or ataxia is uncommon and unique . this syndrome is easy to misdiagnose as vestibulocerebellar disease . we report a patient with anterior callosal and cingulate infarction presenting as isolated astasia . a 65 year old hypertensive man was admitted to our hospital with marked truncal instability . on neurological examination he was unable to stand and walk independently . when asked to stand up from a sitting position he had to grasp something nearby to propel himself upwards and could not use his axial muscles . he collapsed when support was withdrawn . the patient showed no signs of amnesia aphasia apraxia or hemiasomatognosia . diffusion weighted imaging at
ays after onset demonstrated an acute infarct in the anterior part of the right sided corpus callosum and cingulate gyrus . magnetic resonance angiography revealed an occlusion of the right anterior cerebral artery . we discuss the possible mechanisms of astasia due to anterior callosal and cingulate infarction .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: isolated astasia manifested by acute infarct of the anterior corpus callosum and cingulate gyrus . astasia the inability to stand and walk in the absence of weakness or ataxia is uncommon and unique . this syndrome is easy to misdiagnose as vestibulocerebellar disease . we report a patient with anterior callosal and cingulate infarction presenting as isolated astasia . a 65 year old hypertensive man was admitted to our hospital with marked truncal instability . on neurological examination he was unable to stand and walk independently . when asked to stand up from a sitting position he had to grasp something nearby to propel himself upwards and could not use his axial muscles . he collapsed when support was withdrawn . the patient showed no signs of amnesia aphasia apraxia or hemiasomatognosia . diffusion weighted imaging at
ays after onset demonstrated an acute infarct in the anterior part of the right sided corpus callosum and cingulate gyrus . magnetic resonance angiography revealed an occlusion of the right anterior cerebral artery . we discuss the possible mechanisms of astasia due to anterior callosal and cingulate infarction . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

a case of palpable purpura and nephropathy occam razor or hickam dictum . vasculitis causing palpable purpura nephropathy and hematologic abnormalities is a well known entity . however sometimes vasculitis may not be the primary cause but is part of a systemic disease . literature suggests that infections like hiv can induce nephropathy and antineutrophilic cytoplasmic antibody positive vasculitis which is different from the well known entity of quot antineutrophilic cytoplasmic antibody associated vasculitis . quot we present a 46 year old female patient with a history of intravenous drug abuse who reported with a rash swelling and palpable purpura of the lower extremities . peripheral smear showed no evidence of disseminated intravascular coagulation or thrombotic thrombocytopenic purpura metabolic profile showed acute kidney injury . she was found to be hiv and hepatitis c positive . immunologic workup was positive for both mpo and pr3 antineutrophilic cytoplasmic antibodies and negative for cryoglobulins complement levels were low . skin biopsy showed leukocytoclastic vasculitis but kidney biopsy was negative for any immunologic involvement it showed only glomerulosclerosis . thus it was thought that nephropathy and vasculitis in this case are two distinct pathologic processes both induced by infection hiv and or hepatitis c . the patient responded to low dose steroid therapy . she was later started on the definitive therapy the highly active antiretroviral therapy regimen . this case illustrates the fact that low dose steroids can still be a good alternative in acute situations in patients at risk from immunosuppression .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: a case of palpable purpura and nephropathy occam razor or hickam dictum . vasculitis causing palpable purpura nephropathy and hematologic abnormalities is a well known entity . however sometimes vasculitis may not be the primary cause but is part of a systemic disease . literature suggests that infections like hiv can induce nephropathy and antineutrophilic cytoplasmic antibody positive vasculitis which is different from the well known entity of quot antineutrophilic cytoplasmic antibody associated vasculitis . quot we present a 46 year old female patient with a history of intravenous drug abuse who reported with a rash swelling and palpable purpura of the lower extremities . peripheral smear showed no evidence of disseminated intravascular coagulation or thrombotic thrombocytopenic purpura metabolic profile showed acute kidney injury . she was found to be hiv and hepatitis c positive . immunologic workup was positive for both mpo and pr3 antineutrophilic cytoplasmic antibodies and negative for cryoglobulins complement levels were low . skin biopsy showed leukocytoclastic vasculitis but kidney biopsy was negative for any immunologic involvement it showed only glomerulosclerosis . thus it was thought that nephropathy and vasculitis in this case are two distinct pathologic processes both induced by infection hiv and or hepatitis c . the patient responded to low dose steroid therapy . she was later started on the definitive therapy the highly active antiretroviral therapy regimen . this case illustrates the fact that low dose steroids can still be a good alternative in acute situations in patients at risk from immunosuppression . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

two cases of interferon alpha induced sarcoidosis koebnerized along venous drainage lines new pathogenic insights and review of the literature of interferon induced sarcoidosis . sarcoidosis is a systemic granulomatous disorder of unknown origin commonly affecting the lung the lymphoid system and the skin . we report here two cases of cutaneous sarcoidosis in two former intravenous drug users following interferon ifn and ribavirin therapy for chronic hepatitis
both patients developed skin sarcoidosis along venous drainage lines of both forearms coinciding with the areas of prior drug injections . the unique distribution of the skin lesions suggests that tissue damage induced by repeated percutaneous drug injections represents a trigger for the local skin manifestation of sarcoidosis . interestingly skin damage was recently found to induce the local expression ifn a well known trigger of sarcoidosis in predisposed individuals . here we review the literature on sarcoidosis elicited in the context of ifn therapy and propose a new link between the endogenous expression of ifn and the induction of disease manifestations in injured skin .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: two cases of interferon alpha induced sarcoidosis koebnerized along venous drainage lines new pathogenic insights and review of the literature of interferon induced sarcoidosis . sarcoidosis is a systemic granulomatous disorder of unknown origin commonly affecting the lung the lymphoid system and the skin . we report here two cases of cutaneous sarcoidosis in two former intravenous drug users following interferon ifn and ribavirin therapy for chronic hepatitis
both patients developed skin sarcoidosis along venous drainage lines of both forearms coinciding with the areas of prior drug injections . the unique distribution of the skin lesions suggests that tissue damage induced by repeated percutaneous drug injections represents a trigger for the local skin manifestation of sarcoidosis . interestingly skin damage was recently found to induce the local expression ifn a well known trigger of sarcoidosis in predisposed individuals . here we review the literature on sarcoidosis elicited in the context of ifn therapy and propose a new link between the endogenous expression of ifn and the induction of disease manifestations in injured skin . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

growth hormone producing pituitary adenoma regrowing as pituitary adenoma with neuronal choristoma 14 years after tumor removal . background we report a case of an uncommon association of pituitary adenoma with neuronal choristoma that usually is diagnosed at initial surgery . case description a 50 year old woman with acromegaly and bitemporal hemianopsia underwent removal of a pituitary adenoma via the transsphenoidal approach . histologic examination of the first surgical specimen demonstrated only adenoma which was eosinophilic and expressed growth hormone . fourteen years later bitemporal hemianopsia recurred and magnetic resonance imaging revealed regrowth of the residual tumor . discussion the patient underwent removal of the regrown tumor via the transsphenoidal approach . histologic examination of the second surgical specimen revealed gangliocytoma and a small component of pituitary adenoma . conclusions the present case report supports the theory that pituitary adenoma with neuronal choristoma might represent the result of neuronal differentiation from pituitary adenoma .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: growth hormone producing pituitary adenoma regrowing as pituitary adenoma with neuronal choristoma 14 years after tumor removal . background we report a case of an uncommon association of pituitary adenoma with neuronal choristoma that usually is diagnosed at initial surgery . case description a 50 year old woman with acromegaly and bitemporal hemianopsia underwent removal of a pituitary adenoma via the transsphenoidal approach . histologic examination of the first surgical specimen demonstrated only adenoma which was eosinophilic and expressed growth hormone . fourteen years later bitemporal hemianopsia recurred and magnetic resonance imaging revealed regrowth of the residual tumor . discussion the patient underwent removal of the regrown tumor via the transsphenoidal approach . histologic examination of the second surgical specimen revealed gangliocytoma and a small component of pituitary adenoma . conclusions the present case report supports the theory that pituitary adenoma with neuronal choristoma might represent the result of neuronal differentiation from pituitary adenoma . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

atrial fibrillation deteriorates tricuspid regurgitation following implantable cardioverter defibrillator lead placement in patient with hypertrophic obstructive cardiomyopathy . although atrial fibrillation af often exists in patients with hypertrophic obstructive cardiomyopathy hocm combination of tricuspid regurgitation tr and af after implantation of pacemaker implantable cardioverter defibrillator icd lead and its optimal management have not been well discussed in this population . herein we present a patient with hocm who subsequently died due to severe heart failure and deterioration of tr following icd lead placement with af . autopsy findings demonstrated that icd leads were entrapped by anomaly structure in the right atrium and ventricle which might affect deterioration of tr .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: atrial fibrillation deteriorates tricuspid regurgitation following implantable cardioverter defibrillator lead placement in patient with hypertrophic obstructive cardiomyopathy . although atrial fibrillation af often exists in patients with hypertrophic obstructive cardiomyopathy hocm combination of tricuspid regurgitation tr and af after implantation of pacemaker implantable cardioverter defibrillator icd lead and its optimal management have not been well discussed in this population . herein we present a patient with hocm who subsequently died due to severe heart failure and deterioration of tr following icd lead placement with af . autopsy findings demonstrated that icd leads were entrapped by anomaly structure in the right atrium and ventricle which might affect deterioration of tr . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

rosette forming glioneuronal tumor with dissemination throughout the ventricular system a case report . a 33 year old female was found to have a rosette forming glioneuronal tumor rgnt occurring within the fourth ventricle with multifocal extension to the third and lateral ventricles . she presented with headaches blurred vision nausea and intermittent dizziness . a brain magnetic resonance imaging mri scan showed hydrocephalus and multifocal nodules throughout the ventricular system with the largest mass occupying the fourth ventricle . an endoscopic third ventriculostomy and biopsy were performed . histological examination demonstrated a glioneuronal neoplasm with the characteristic features of rgnt . while the histopathological features of our case are well in accord with those reported in the literature the multifocal intraventricular growth pattern has only been described twice before . moreover rgnt of the fourth ventricle with dissemination throughout the supratentorial ventricles has only been described once before . long term studies are required to assess the best treatment modalities and clinical behavior of this extremely rare disseminated rgnt entity .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: rosette forming glioneuronal tumor with dissemination throughout the ventricular system a case report . a 33 year old female was found to have a rosette forming glioneuronal tumor rgnt occurring within the fourth ventricle with multifocal extension to the third and lateral ventricles . she presented with headaches blurred vision nausea and intermittent dizziness . a brain magnetic resonance imaging mri scan showed hydrocephalus and multifocal nodules throughout the ventricular system with the largest mass occupying the fourth ventricle . an endoscopic third ventriculostomy and biopsy were performed . histological examination demonstrated a glioneuronal neoplasm with the characteristic features of rgnt . while the histopathological features of our case are well in accord with those reported in the literature the multifocal intraventricular growth pattern has only been described twice before . moreover rgnt of the fourth ventricle with dissemination throughout the supratentorial ventricles has only been described once before . long term studies are required to assess the best treatment modalities and clinical behavior of this extremely rare disseminated rgnt entity . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

healing of a cyst like lesion involving an implant with nonsurgical management . numerous reports primarily in the implant literature outline the loss of an implant claimed to be as a consequence of endodontic pathosis from an adjacent tooth . this case report outlines the resolution of a large cyst like periapical lesion that resolved with nonsurgical management when the canal was dressed with calcium hydroxide on 4 occasions because of persistent intracanal exudate . a favorable healing outcome was achieved for the affected tooth and the implant . this report adds to a growing body of evidence to suggest that implant retained crowns are not vulnerable when an endodontic infection occurs in an adjacent tooth .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: healing of a cyst like lesion involving an implant with nonsurgical management . numerous reports primarily in the implant literature outline the loss of an implant claimed to be as a consequence of endodontic pathosis from an adjacent tooth . this case report outlines the resolution of a large cyst like periapical lesion that resolved with nonsurgical management when the canal was dressed with calcium hydroxide on 4 occasions because of persistent intracanal exudate . a favorable healing outcome was achieved for the affected tooth and the implant . this report adds to a growing body of evidence to suggest that implant retained crowns are not vulnerable when an endodontic infection occurs in an adjacent tooth . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

spontaneous clearance of hepatitis c virus after liver transplantation report of two cases . the spontaneous clearance of hepatitis c virus infection is rare especially after liver transplantation condition in which recurrence is almost universal . we report two cases in which clearance of the virus was achieved after liver transplantation . we reviewed the literature and described possible mechanisms explaining this phenomenon with emphasis on therapeutic implications .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: spontaneous clearance of hepatitis c virus after liver transplantation report of two cases . the spontaneous clearance of hepatitis c virus infection is rare especially after liver transplantation condition in which recurrence is almost universal . we report two cases in which clearance of the virus was achieved after liver transplantation . we reviewed the literature and described possible mechanisms explaining this phenomenon with emphasis on therapeutic implications . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

hypophosphatemic osteomalacia due to drug induced fanconi syndrome associated with adefovir dipivoxil treatment for hepatitis
we herein present the case of a 58 year old japanese man with fanconi syndrome with a 13 month history of bone pain in his ribs hips knees and ankles . he had been receiving low dose adefovir dipivoxil adv for the treatment of lamivudine resistant chronic hepatitis b virus infection for eight years and subsequently developed severe hypophosphatemia and proximal renal tubule dysfunction . magnetic resonance imaging showed multiple insufficiency fractures in the ribs ileum tibia and calcaneus . whole body bone scintigraphy demonstrated increased uptake in those areas . following dose reduction of adv and the administration of treatment with calcitriol and phosphates the patient serum phosphate level increased and his clinical symptoms improved . physicians prescribing adv should carefully monitor the renal function and serum phosphate level .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: hypophosphatemic osteomalacia due to drug induced fanconi syndrome associated with adefovir dipivoxil treatment for hepatitis
we herein present the case of a 58 year old japanese man with fanconi syndrome with a 13 month history of bone pain in his ribs hips knees and ankles . he had been receiving low dose adefovir dipivoxil adv for the treatment of lamivudine resistant chronic hepatitis b virus infection for eight years and subsequently developed severe hypophosphatemia and proximal renal tubule dysfunction . magnetic resonance imaging showed multiple insufficiency fractures in the ribs ileum tibia and calcaneus . whole body bone scintigraphy demonstrated increased uptake in those areas . following dose reduction of adv and the administration of treatment with calcitriol and phosphates the patient serum phosphate level increased and his clinical symptoms improved . physicians prescribing adv should carefully monitor the renal function and serum phosphate level . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

cerebellitis and acute obstructive hydrocephalus associated with mycoplasma pneumoniae infection . mycoplasma pneumoniae is associated with a variety of extrapulmonary manifestations including central nervous system inflammation . a 9 year old boy presented with acute cerebellitis and
pneumoniae infection resulting in obstructive hydrocephalus requiring neurosurgical intervention . this case along with 4 similar ones reported in the literature suggests a distinct clinicopathologic sequence caused by mycoplasma infection .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: cerebellitis and acute obstructive hydrocephalus associated with mycoplasma pneumoniae infection . mycoplasma pneumoniae is associated with a variety of extrapulmonary manifestations including central nervous system inflammation . a 9 year old boy presented with acute cerebellitis and
pneumoniae infection resulting in obstructive hydrocephalus requiring neurosurgical intervention . this case along with 4 similar ones reported in the literature suggests a distinct clinicopathologic sequence caused by mycoplasma infection . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

progressive multifocal leukoencephalopathy a rare cause of cerebellar edema and atypical mass effect . a case report . progressive multifocal leukoencephalopathy pml is an opportunistic demyelinating disease of the cns caused by the jc papovavirus jcv . demyelination due to oligodendrocyte death leads to multifocal asymmetric lesions . mri is a valuable tool for detecting and differentiating pml from other neuropathies . radiographically pml classically presents as bilateral subcortical white matter lesions with a lack of brain atrophy . as the disease progresses lesions become larger and coalesce to become confluent . minor edema and mass effect are infrequently described and the presence of significant mass effect suggests an alternative diagnosis . in our case a patient demonstrated atypical marked infratentorial mass effect . bilaterally cerebellar lesions with associated mass effect were observed as well as effacement of cerebellar folia and partial effacement of the fourth ventricle . the diagnosis of pml was confirmed with a biopsy of the right cerebellar lesion showing classic pml histology with jcv dna detection by polymerase chain reaction in the biopsy material .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: progressive multifocal leukoencephalopathy a rare cause of cerebellar edema and atypical mass effect . a case report . progressive multifocal leukoencephalopathy pml is an opportunistic demyelinating disease of the cns caused by the jc papovavirus jcv . demyelination due to oligodendrocyte death leads to multifocal asymmetric lesions . mri is a valuable tool for detecting and differentiating pml from other neuropathies . radiographically pml classically presents as bilateral subcortical white matter lesions with a lack of brain atrophy . as the disease progresses lesions become larger and coalesce to become confluent . minor edema and mass effect are infrequently described and the presence of significant mass effect suggests an alternative diagnosis . in our case a patient demonstrated atypical marked infratentorial mass effect . bilaterally cerebellar lesions with associated mass effect were observed as well as effacement of cerebellar folia and partial effacement of the fourth ventricle . the diagnosis of pml was confirmed with a biopsy of the right cerebellar lesion showing classic pml histology with jcv dna detection by polymerase chain reaction in the biopsy material . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

the significance of adrenal hemorrhage undiagnosed waterhouse friderichsen syndrome a case series . a retrospective series of five cases of nontraumatic gross adrenal hemorrhage were identified in _lgnum_ consecutive forensic autopsies . all patients were males of different ethnicities and with ages ranging from 2 to 48 years . all patients had a clinical history and autopsy findings suggestive of sepsis . pre or postmortem microbiological cultures were variably positive for pseudomonas aeruginosa streptococcus pneumoniae staphylococcus aureus and methicillin resistant staphylococcus aureus . the fifth case was positive for yeast and a coagulase negative staphylococcus contamination of this culture medium cannot be excluded . no cases had a culture positive for neisseria meningitidis . we find that the reviewed patients with grossly or microscopically identifiable adrenal hemorrhage were otherwise healthy individuals who died suddenly as a consequence of bacterial infection . in each case signs and symptoms compatible with premortem adrenal insufficiency were reported in no instance was the adrenal hemorrhage clinically identified .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: the significance of adrenal hemorrhage undiagnosed waterhouse friderichsen syndrome a case series . a retrospective series of five cases of nontraumatic gross adrenal hemorrhage were identified in _lgnum_ consecutive forensic autopsies . all patients were males of different ethnicities and with ages ranging from 2 to 48 years . all patients had a clinical history and autopsy findings suggestive of sepsis . pre or postmortem microbiological cultures were variably positive for pseudomonas aeruginosa streptococcus pneumoniae staphylococcus aureus and methicillin resistant staphylococcus aureus . the fifth case was positive for yeast and a coagulase negative staphylococcus contamination of this culture medium cannot be excluded . no cases had a culture positive for neisseria meningitidis . we find that the reviewed patients with grossly or microscopically identifiable adrenal hemorrhage were otherwise healthy individuals who died suddenly as a consequence of bacterial infection . in each case signs and symptoms compatible with premortem adrenal insufficiency were reported in no instance was the adrenal hemorrhage clinically identified . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

seizures in patients with chronic hepatitis c treated with ns3
 protease inhibitors does pharmacological interaction play a role the addition of ns3
 protease inhibitors boceprevir and telaprevir to pegylated interferon peg ifn and ribavirin for the treatment of hepatitis c virus hcv genotype 1 infected patients has led to higher rates of virological response and adverse events . among the several side effects of interferon neuropsychiatric symptoms have been described particularly depression and anxiety occurring in about 25 of patients . although seizures have been reported in interferon treated patients with multiple sclerosis and in a variety of malignancies the epileptogenic potential of interferon in the treatment of hcv infection is considered minimal . in this report we present a new onset of seizures occurring in 2 patients during anti hcv therapy in association with peg ifn ribavirin and hcv protease inhibitors .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: seizures in patients with chronic hepatitis c treated with ns3
 protease inhibitors does pharmacological interaction play a role the addition of ns3
 protease inhibitors boceprevir and telaprevir to pegylated interferon peg ifn and ribavirin for the treatment of hepatitis c virus hcv genotype 1 infected patients has led to higher rates of virological response and adverse events . among the several side effects of interferon neuropsychiatric symptoms have been described particularly depression and anxiety occurring in about 25 of patients . although seizures have been reported in interferon treated patients with multiple sclerosis and in a variety of malignancies the epileptogenic potential of interferon in the treatment of hcv infection is considered minimal . in this report we present a new onset of seizures occurring in 2 patients during anti hcv therapy in association with peg ifn ribavirin and hcv protease inhibitors . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

hbsag seroconversion after entecavir therapy for 7 years following a poor response to interferon
 monotherapy in a hbeag negative patient with chronic hepatitis b . we report a rare case of hbsag seroconversion after 7 years of entecavir therapy in a 48 year old hbeag negative chb male patient with chronic hepatitis b chb . after a poor response to a 48 week interferon
 therapy the patient received long term entecavir therapy . serum alt levels became normal and hbv dna viral load was undetectable at the 1
h week after commencement of entecavir treatment and seroconversion of hbsag was detected after 7 years of entecavir therapy .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: hbsag seroconversion after entecavir therapy for 7 years following a poor response to interferon
 monotherapy in a hbeag negative patient with chronic hepatitis b . we report a rare case of hbsag seroconversion after 7 years of entecavir therapy in a 48 year old hbeag negative chb male patient with chronic hepatitis b chb . after a poor response to a 48 week interferon
 therapy the patient received long term entecavir therapy . serum alt levels became normal and hbv dna viral load was undetectable at the 1
h week after commencement of entecavir treatment and seroconversion of hbsag was detected after 7 years of entecavir therapy . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

ectopic parathyroid adenoma . ectopic parathyroid adenoma is a rare cause of primary hyperparathyroidism and can become a diagnostic challenge . we present a case report of an ectopic mediastinal parathyroid adenoma leading to primary hyperparathyroidism and responsible for a persistent asymptomatic hypercalcemia . the preoperative location of the tumor assessed by imaging studies contribute to the choice of the surgical cervical approach . tumor resection was successful and the calcemia levels promptly returned to normal levels .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: ectopic parathyroid adenoma . ectopic parathyroid adenoma is a rare cause of primary hyperparathyroidism and can become a diagnostic challenge . we present a case report of an ectopic mediastinal parathyroid adenoma leading to primary hyperparathyroidism and responsible for a persistent asymptomatic hypercalcemia . the preoperative location of the tumor assessed by imaging studies contribute to the choice of the surgical cervical approach . tumor resection was successful and the calcemia levels promptly returned to normal levels . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

candida bezoars with urinary tract obstruction in two women without immunocompromising conditions . more than half of the cases of fungal infections of the urinary tract are caused by candida sp . but occurrence of obstructive uropathy caused by mycetomas or fungus balls urobezoars is extremely rare . the latter are conglomerates of fungal hyphae . diabetes mellitus immunosuppression chronic disease and malignancies are known predisposing factors . preoperative imaging is not pathognomonic blood clots radiolucent urinary calculi air bubbles and inflammatory debris can mimic urobezoars . we report on two otherwise healthy women presenting with urinary tract obstruction caused by candidal mycetomas of the renal pelvis that mimicked matrix lithiasis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: candida bezoars with urinary tract obstruction in two women without immunocompromising conditions . more than half of the cases of fungal infections of the urinary tract are caused by candida sp . but occurrence of obstructive uropathy caused by mycetomas or fungus balls urobezoars is extremely rare . the latter are conglomerates of fungal hyphae . diabetes mellitus immunosuppression chronic disease and malignancies are known predisposing factors . preoperative imaging is not pathognomonic blood clots radiolucent urinary calculi air bubbles and inflammatory debris can mimic urobezoars . we report on two otherwise healthy women presenting with urinary tract obstruction caused by candidal mycetomas of the renal pelvis that mimicked matrix lithiasis . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

tetany a diagnostic dilemma . tetany is a disorder of increased neuronal excitability usually associated with hypocalcemia . we report a patient with typical tetanic cramps and carpopedal spasm in the postoperative period despite normal serum concentrations of calcium which responded to intravenous infusion of calcium .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: tetany a diagnostic dilemma . tetany is a disorder of increased neuronal excitability usually associated with hypocalcemia . we report a patient with typical tetanic cramps and carpopedal spasm in the postoperative period despite normal serum concentrations of calcium which responded to intravenous infusion of calcium . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

custom rotating hinge total knee replacement in patients with spina bifida and severe neuromuscular dysfunction . spina bifida sb is a congenital disorder which may result in a number of musculoskeletal problems . total knee replacement tkr in this patient group is technically demanding due to bone deformity soft tissue contracture muscle tone abnormality and ligament insufficiency . this is a retrospective review of three patients with sb and disabling knee arthritis who were managed with a custom rotating hinge rhk total knee system . all patients reported an improvement in knee pain and stability at mean follow up 47 months 43 53 . mean oxford knee score improved from 21 preoperatively to 32 at final follow up . one patient required revision of tibial and patella components at 37 months for lateral patella instability and excessive wear . custom rhk for patients with sb severe neuromuscular dysfunction and bone deformity relieves pain restores stability and improves early knee function however there is a significant risk of extensor mechanism complications and functional outcome is worse than primary tkr in the general population .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: custom rotating hinge total knee replacement in patients with spina bifida and severe neuromuscular dysfunction . spina bifida sb is a congenital disorder which may result in a number of musculoskeletal problems . total knee replacement tkr in this patient group is technically demanding due to bone deformity soft tissue contracture muscle tone abnormality and ligament insufficiency . this is a retrospective review of three patients with sb and disabling knee arthritis who were managed with a custom rotating hinge rhk total knee system . all patients reported an improvement in knee pain and stability at mean follow up 47 months 43 53 . mean oxford knee score improved from 21 preoperatively to 32 at final follow up . one patient required revision of tibial and patella components at 37 months for lateral patella instability and excessive wear . custom rhk for patients with sb severe neuromuscular dysfunction and bone deformity relieves pain restores stability and improves early knee function however there is a significant risk of extensor mechanism complications and functional outcome is worse than primary tkr in the general population . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

surgical treatment for metastasis from lymphoepithelioma like cholangiocarcinoma in the liver a case report . rationale lymphoepithelioma like cholangiocarcinoma lel cc is a rare variant of intrahepatic cholangiocarcinoma icc which is characterized by the better outcome than normal icc . there is no report about the treatment for the metastasis of the lel cc . here we describe a rare case of lel cc of the liver and report the treatment for metastasis of it . patient concerns a 38 year old woman with a chronic hepatitis b infection was referred to the department of liver surgery in our hospital with a mass in the liver . diagnoses a past ultrasound examination had revealed a 28 mm 16 mm nodular lesion in the right posterior lobe of the liver in may _lgnum_ . she had undergone partial resection of the thyroid gland for papillary carcinoma 1 year earlier . intervention suspicious of the metastasis from thyroid cancer she underwent surgery with liver segmentectomy . the pathologic diagnosis of the lesion was lel cc . after surgery she regularly got checked in our hospital and in the 6 months after surgery there was enlargement of lymph node before the inferior vena cava in ct . the doctor did not detect the enlargement of the lymph node until june _lgnum_ . the pet ct was done in june of _lgnum_ which showed the lymph node was hypermetabolic . outcomes the patient got her second surgery for lymph node three years after the first surgery which was proved that the lymph node was metastasis from lel cc . the patient was free from recurrence 9 months after surgery . lessons we report the first case of surgery for metastasis from lel cc in the liver that was diagnosed 3 years after hepatectomy . our findings suggest that surgery could be an effective way of treating lymph node metastasis of lel cc and early pet ct can help to identify metastasis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: surgical treatment for metastasis from lymphoepithelioma like cholangiocarcinoma in the liver a case report . rationale lymphoepithelioma like cholangiocarcinoma lel cc is a rare variant of intrahepatic cholangiocarcinoma icc which is characterized by the better outcome than normal icc . there is no report about the treatment for the metastasis of the lel cc . here we describe a rare case of lel cc of the liver and report the treatment for metastasis of it . patient concerns a 38 year old woman with a chronic hepatitis b infection was referred to the department of liver surgery in our hospital with a mass in the liver . diagnoses a past ultrasound examination had revealed a 28 mm 16 mm nodular lesion in the right posterior lobe of the liver in may _lgnum_ . she had undergone partial resection of the thyroid gland for papillary carcinoma 1 year earlier . intervention suspicious of the metastasis from thyroid cancer she underwent surgery with liver segmentectomy . the pathologic diagnosis of the lesion was lel cc . after surgery she regularly got checked in our hospital and in the 6 months after surgery there was enlargement of lymph node before the inferior vena cava in ct . the doctor did not detect the enlargement of the lymph node until june _lgnum_ . the pet ct was done in june of _lgnum_ which showed the lymph node was hypermetabolic . outcomes the patient got her second surgery for lymph node three years after the first surgery which was proved that the lymph node was metastasis from lel cc . the patient was free from recurrence 9 months after surgery . lessons we report the first case of surgery for metastasis from lel cc in the liver that was diagnosed 3 years after hepatectomy . our findings suggest that surgery could be an effective way of treating lymph node metastasis of lel cc and early pet ct can help to identify metastasis . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

new aspects of immunotherapy in multiple sclerosis . the spectrum of therapeutic options for immunotherapy of multiple sclerosis is continuously broadening . after the approval of cladribine and ocrelizumab in europe two new drugs are now available with ocrelizumab being the first approved option for treatment of primary progressive multiple sclerosis however the increased use of highly effective therapies is accompanied by a rise in severe side effects . during recent months special attention was paid to the new progressive multifocal leukoencephalopathy pml risk assessment in natalizumab treated patients cardiac side effects of fingolimod cases of idiopathic thrombocytopenic purpura and listeria meningitis associated with alemtuzumab and cases of daclizumab treated patients with liver failure or encephalitis . these case reports highlight the importance of careful monitoring of all patients treated with immunomodulatory therapies .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: new aspects of immunotherapy in multiple sclerosis . the spectrum of therapeutic options for immunotherapy of multiple sclerosis is continuously broadening . after the approval of cladribine and ocrelizumab in europe two new drugs are now available with ocrelizumab being the first approved option for treatment of primary progressive multiple sclerosis however the increased use of highly effective therapies is accompanied by a rise in severe side effects . during recent months special attention was paid to the new progressive multifocal leukoencephalopathy pml risk assessment in natalizumab treated patients cardiac side effects of fingolimod cases of idiopathic thrombocytopenic purpura and listeria meningitis associated with alemtuzumab and cases of daclizumab treated patients with liver failure or encephalitis . these case reports highlight the importance of careful monitoring of all patients treated with immunomodulatory therapies . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

a bleeding duodenal gist masquerading as refractory peptic ulcer disease . gastrointestinal stromal tumors gist are the most common mesenchymal tumors of the gastrointestinal tract however the occurrence of a gist in the duodenum is rare . our case demonstrates the importance of considering gist in the evaluation of refractory duodenal ulcers as well as the utilization of endoscopic ultrasound in the evaluation of these lesions .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: a bleeding duodenal gist masquerading as refractory peptic ulcer disease . gastrointestinal stromal tumors gist are the most common mesenchymal tumors of the gastrointestinal tract however the occurrence of a gist in the duodenum is rare . our case demonstrates the importance of considering gist in the evaluation of refractory duodenal ulcers as well as the utilization of endoscopic ultrasound in the evaluation of these lesions . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

role of penile doppler as a diagnostic tool in penile fracture . penile fracture is defined as a traumatic rupture of either corpus cavernosum or the tunica albuginea sometimes it can be both . it may be caused by exotic masturbation acts sexual intercourse or other trauma to this area . this can be accompanied by injury to the urethra which is the cause of hematuria as a symptom for some patients . typically diagnosis of penile rupture or fracture depends on clinical examination and history told by the patients . we are stating the importance of medical imaging in the diagnosis of patients with penile fracture by presenting a case of patient suffered from penile fracture after a fall on his penis where it affected the erection of two third of his penis . in which the proper diagnosis by imaging studies and taking actions accordingly can save the patients from unnecessary surgeries that indeed increase the bill of the medical care directly and indirectly . therefore most patients can be diagnosed cost effectively and treated surgically without a need to delay surgery which is often the case if one was to resort to other investigations . investigations such as retrograde urethrography for suspected urethral injury should only be used when the diagnosis of penile fracture is in doubt .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: role of penile doppler as a diagnostic tool in penile fracture . penile fracture is defined as a traumatic rupture of either corpus cavernosum or the tunica albuginea sometimes it can be both . it may be caused by exotic masturbation acts sexual intercourse or other trauma to this area . this can be accompanied by injury to the urethra which is the cause of hematuria as a symptom for some patients . typically diagnosis of penile rupture or fracture depends on clinical examination and history told by the patients . we are stating the importance of medical imaging in the diagnosis of patients with penile fracture by presenting a case of patient suffered from penile fracture after a fall on his penis where it affected the erection of two third of his penis . in which the proper diagnosis by imaging studies and taking actions accordingly can save the patients from unnecessary surgeries that indeed increase the bill of the medical care directly and indirectly . therefore most patients can be diagnosed cost effectively and treated surgically without a need to delay surgery which is often the case if one was to resort to other investigations . investigations such as retrograde urethrography for suspected urethral injury should only be used when the diagnosis of penile fracture is in doubt . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

recurrent bleeding of parastomal varices case report . bleeding of parastomal varices is an unusual complication of portal hypertension . we report a case with recurrent parastomal variceal bleeding who had chronic liver disease secondary to autoimmune hepatitis and who had undergone abdominoperineal resection for rectal cancer . she presented four episodes of parastomal variceal bleeding in one month and was successfully treated with combined polidocanol and cyanoacrylate glue .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: recurrent bleeding of parastomal varices case report . bleeding of parastomal varices is an unusual complication of portal hypertension . we report a case with recurrent parastomal variceal bleeding who had chronic liver disease secondary to autoimmune hepatitis and who had undergone abdominoperineal resection for rectal cancer . she presented four episodes of parastomal variceal bleeding in one month and was successfully treated with combined polidocanol and cyanoacrylate glue . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

blood mrna measurement netest for neuroendocrine tumor diagnosis of image negative liver metastatic disease . early cancer detection is critical to optimize treatment . this is particularly problematic in neuroendocrine tumors nets which exhibit an 5 year diagnostic delay due to covert symptoms limitations in imaging and circulating biomarkers . despite development of continuous monitoring strategies utilizing advanced modalities ct mri or 6
allium positron emission tomography pet ct or a repertoire of monoanalyte biomarkers

chromogranin a cga pancreastatin serotonin detection of minimal residual disease or microrecurrence remains elusive . emerging molecular liquid biopsies

netest provide a substantially improved threshold for disease detection . abstracttext early cancer detection is critical to optimize treatment . this is particularly problematic in neuroendocrine tumors nets which exhibit an 5 year diagnostic delay due to covert symptoms limitations in imaging and circulating biomarkers . despite development of continuous monitoring strategies utilizing advanced modalities ct mri or 6
allium positron emission tomography pet ct or a repertoire of monoanalyte biomarkers

chromogranin a cga pancreastatin serotonin detection of minimal residual disease or microrecurrence remains elusive . emerging molecular liquid biopsies

netest provide a substantially improved threshold for disease detection . we describe the utility of a blood based multigene pcr neuroendocrine measurement netest which is representative of core molecular drivers of neuroendocrine tumorigenesis to detect hepatic micrometastases in a patient with negative blood biomarkers and negative anatomical functional imaging . the 52 year old woman who had undergone margin negative resection for a net of the ileocecal valve developed persistently elevated netest levels 8 months later . ct mri 6
allium pet and biomarkers remained negative . blood multigene analysis identified disease and peptide receptor radionuclide therapy prrt was undertaken . over 9 months netest levels increased conventional biomarkers imaging remained normal . liver biopsy was undertaken and foci of a 3 mm net in segment vi were histologically documented . at _decnum_ years after prrt the disease remained as a microscopic burden and stable biomarker 6
allium pet mri occult despite elevated blood levels of net genes . abstracttext we describe the utility of a blood based multigene pcr neuroendocrine measurement netest which is representative of core molecular drivers of neuroendocrine tumorigenesis to detect hepatic micrometastases in a patient with negative blood biomarkers and negative anatomical functional imaging . the 52 year old woman who had undergone margin negative resection for a net of the ileocecal valve developed persistently elevated netest levels 8 months later . ct mri 6
allium pet and biomarkers remained negative . blood multigene analysis identified disease and peptide receptor radionuclide therapy prrt was undertaken . over 9 months netest levels increased conventional biomarkers imaging remained normal . liver biopsy was undertaken and foci of a 3 mm net in segment vi were histologically documented . at _decnum_ years after prrt the disease remained as a microscopic burden and stable biomarker 6
allium pet mri occult despite elevated blood levels of net genes . blood measurement of net transcripts can identify image and cga negative disease . a net liquid biopsy strategy has clinical utility in the early identification of residual or metastatic disease and optimizes consideration of adjuvant therapeutic intervention . abstracttext blood measurement of net transcripts can identify image and cga negative disease . a net liquid biopsy strategy has clinical utility in the early identification of residual or metastatic disease and optimizes consideration of adjuvant therapeutic intervention .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: blood mrna measurement netest for neuroendocrine tumor diagnosis of image negative liver metastatic disease . early cancer detection is critical to optimize treatment . this is particularly problematic in neuroendocrine tumors nets which exhibit an 5 year diagnostic delay due to covert symptoms limitations in imaging and circulating biomarkers . despite development of continuous monitoring strategies utilizing advanced modalities ct mri or 6
allium positron emission tomography pet ct or a repertoire of monoanalyte biomarkers

chromogranin a cga pancreastatin serotonin detection of minimal residual disease or microrecurrence remains elusive . emerging molecular liquid biopsies

netest provide a substantially improved threshold for disease detection . abstracttext early cancer detection is critical to optimize treatment . this is particularly problematic in neuroendocrine tumors nets which exhibit an 5 year diagnostic delay due to covert symptoms limitations in imaging and circulating biomarkers . despite development of continuous monitoring strategies utilizing advanced modalities ct mri or 6
allium positron emission tomography pet ct or a repertoire of monoanalyte biomarkers

chromogranin a cga pancreastatin serotonin detection of minimal residual disease or microrecurrence remains elusive . emerging molecular liquid biopsies

netest provide a substantially improved threshold for disease detection . we describe the utility of a blood based multigene pcr neuroendocrine measurement netest which is representative of core molecular drivers of neuroendocrine tumorigenesis to detect hepatic micrometastases in a patient with negative blood biomarkers and negative anatomical functional imaging . the 52 year old woman who had undergone margin negative resection for a net of the ileocecal valve developed persistently elevated netest levels 8 months later . ct mri 6
allium pet and biomarkers remained negative . blood multigene analysis identified disease and peptide receptor radionuclide therapy prrt was undertaken . over 9 months netest levels increased conventional biomarkers imaging remained normal . liver biopsy was undertaken and foci of a 3 mm net in segment vi were histologically documented . at _decnum_ years after prrt the disease remained as a microscopic burden and stable biomarker 6
allium pet mri occult despite elevated blood levels of net genes . abstracttext we describe the utility of a blood based multigene pcr neuroendocrine measurement netest which is representative of core molecular drivers of neuroendocrine tumorigenesis to detect hepatic micrometastases in a patient with negative blood biomarkers and negative anatomical functional imaging . the 52 year old woman who had undergone margin negative resection for a net of the ileocecal valve developed persistently elevated netest levels 8 months later . ct mri 6
allium pet and biomarkers remained negative . blood multigene analysis identified disease and peptide receptor radionuclide therapy prrt was undertaken . over 9 months netest levels increased conventional biomarkers imaging remained normal . liver biopsy was undertaken and foci of a 3 mm net in segment vi were histologically documented . at _decnum_ years after prrt the disease remained as a microscopic burden and stable biomarker 6
allium pet mri occult despite elevated blood levels of net genes . blood measurement of net transcripts can identify image and cga negative disease . a net liquid biopsy strategy has clinical utility in the early identification of residual or metastatic disease and optimizes consideration of adjuvant therapeutic intervention . abstracttext blood measurement of net transcripts can identify image and cga negative disease . a net liquid biopsy strategy has clinical utility in the early identification of residual or metastatic disease and optimizes consideration of adjuvant therapeutic intervention . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

hepatic hydrothorax the shower within . hepatic hydrothorax hh is an infrequent but a well known complication of portal hypertension . transdiaphragmatic passage of ascitic fluid from peritoneal to the pleural cavity through numerous diaphragmatic defects has been shown to be the predominant mechanism in the formation of hh . medical management of this condition often fails and there are no large randomized controlled trials establishing the best treatment strategies . hh thus represents a formidable entity in the management of end stage liver disease and the only definitive treatment is liver transplantation . however in selected group of patients medical thoracoscopy not only helps in establishing the diagnosis but can also be used as an effective management strategy especially in patients awaiting liver transplantation .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: hepatic hydrothorax the shower within . hepatic hydrothorax hh is an infrequent but a well known complication of portal hypertension . transdiaphragmatic passage of ascitic fluid from peritoneal to the pleural cavity through numerous diaphragmatic defects has been shown to be the predominant mechanism in the formation of hh . medical management of this condition often fails and there are no large randomized controlled trials establishing the best treatment strategies . hh thus represents a formidable entity in the management of end stage liver disease and the only definitive treatment is liver transplantation . however in selected group of patients medical thoracoscopy not only helps in establishing the diagnosis but can also be used as an effective management strategy especially in patients awaiting liver transplantation . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

an unusual cause of febrile hepatitis . we describe the case of a 51 year old man with recently diagnosed ulcerative colitis who developed fever and elevated liver enzymes as well as cholestasis a few weeks after starting treatment with mesalazine . as no obvious cause was found and fever persisted liver biopsy was performed and revealed granulomatous hepatitis . the patient recovered completely after cessation of mesalazine so that a drug induced granulomatous hepatitis after exclusion of other differential diagnoses in an extensive work up was assumed . the present case demonstrates that even though drug induced liver injury due to mesalazine is rare it should be considered in unclear cases and lead to prompt discontinuation of mesalazine .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: an unusual cause of febrile hepatitis . we describe the case of a 51 year old man with recently diagnosed ulcerative colitis who developed fever and elevated liver enzymes as well as cholestasis a few weeks after starting treatment with mesalazine . as no obvious cause was found and fever persisted liver biopsy was performed and revealed granulomatous hepatitis . the patient recovered completely after cessation of mesalazine so that a drug induced granulomatous hepatitis after exclusion of other differential diagnoses in an extensive work up was assumed . the present case demonstrates that even though drug induced liver injury due to mesalazine is rare it should be considered in unclear cases and lead to prompt discontinuation of mesalazine . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

hemostasis with emergently modified application of intra aortic balloon occlusion in a patient with impending cardiac arrest following blunt proximal thigh amputation . a 30 year old woman had her left thigh run over by a train . we tried to compress the left femoral area to control the arterial bleeding but bleeding continued from the stump and injured soft tissue . the application of a tourniquet bandage also failed because of the limited remaining thigh . she developed impending cardiac arrest . as the left femoral arterial pulsation was still palpable we inserted an intra aortic balloon occlusion catheter percutaneously . the hemorrhage from the stump region decreased rapidly . she was transferred to an operating room to carry out surgical hemostasis and it was confirmed with deflation of the balloon in the common iliac artery . abstracttext a 30 year old woman had her left thigh run over by a train . we tried to compress the left femoral area to control the arterial bleeding but bleeding continued from the stump and injured soft tissue . the application of a tourniquet bandage also failed because of the limited remaining thigh . she developed impending cardiac arrest . as the left femoral arterial pulsation was still palpable we inserted an intra aortic balloon occlusion catheter percutaneously . the hemorrhage from the stump region decreased rapidly . she was transferred to an operating room to carry out surgical hemostasis and it was confirmed with deflation of the balloon in the common iliac artery . there was no complication of the skin or soft tissue at the surgical site caused by impaired circulation and her consciousness fully recovered . abstracttext there was no complication of the skin or soft tissue at the surgical site caused by impaired circulation and her consciousness fully recovered . we report the successful control of bleeding by the emergently modified application of intra aortic balloon occlusion in the left common iliac artery . abstracttext we report the successful control of bleeding by the emergently modified application of intra aortic balloon occlusion in the left common iliac artery .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: hemostasis with emergently modified application of intra aortic balloon occlusion in a patient with impending cardiac arrest following blunt proximal thigh amputation . a 30 year old woman had her left thigh run over by a train . we tried to compress the left femoral area to control the arterial bleeding but bleeding continued from the stump and injured soft tissue . the application of a tourniquet bandage also failed because of the limited remaining thigh . she developed impending cardiac arrest . as the left femoral arterial pulsation was still palpable we inserted an intra aortic balloon occlusion catheter percutaneously . the hemorrhage from the stump region decreased rapidly . she was transferred to an operating room to carry out surgical hemostasis and it was confirmed with deflation of the balloon in the common iliac artery . abstracttext a 30 year old woman had her left thigh run over by a train . we tried to compress the left femoral area to control the arterial bleeding but bleeding continued from the stump and injured soft tissue . the application of a tourniquet bandage also failed because of the limited remaining thigh . she developed impending cardiac arrest . as the left femoral arterial pulsation was still palpable we inserted an intra aortic balloon occlusion catheter percutaneously . the hemorrhage from the stump region decreased rapidly . she was transferred to an operating room to carry out surgical hemostasis and it was confirmed with deflation of the balloon in the common iliac artery . there was no complication of the skin or soft tissue at the surgical site caused by impaired circulation and her consciousness fully recovered . abstracttext there was no complication of the skin or soft tissue at the surgical site caused by impaired circulation and her consciousness fully recovered . we report the successful control of bleeding by the emergently modified application of intra aortic balloon occlusion in the left common iliac artery . abstracttext we report the successful control of bleeding by the emergently modified application of intra aortic balloon occlusion in the left common iliac artery . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

cirrhosis due to chronic hepatitis e infection in a child post bone marrow transplant . chronic hepatitis e virus hev infection occurs in immunosuppressed adults . we detected hev ribonucleic acid in serum of an adolescent patient who had undergone bone marrow transplantation and subsequently presented with persistently increased aminotransferases and histologic chronic hepatitis and eventually developed cirrhosis . phylogenetic analysis revealed these hev strains were similar to swine genotype
 suggesting a possible zoonosis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: cirrhosis due to chronic hepatitis e infection in a child post bone marrow transplant . chronic hepatitis e virus hev infection occurs in immunosuppressed adults . we detected hev ribonucleic acid in serum of an adolescent patient who had undergone bone marrow transplantation and subsequently presented with persistently increased aminotransferases and histologic chronic hepatitis and eventually developed cirrhosis . phylogenetic analysis revealed these hev strains were similar to swine genotype
 suggesting a possible zoonosis . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

toxoplasma gondii meningoencephalitis without cerebral mri findings in a patient with ulcerative colitis under immunosuppressive treatment . toxoplasmosis is the most common opportunistic infection of the central nervous system in immunosupressed patients . it is usually presented as a space occupying lesion detected by cerebral computerized tomography or magnetic resonance imaging . the diffuse form of the disease diffuse toxoplasmic meningoencephalitis lacks the characteristic cerebral radiologic findings rendering pre mortem diagnosis much more difficult . herein we describe a case of toxoplasmic menincoencephalitis without evidence of cerebral space occupying lesions in a patient with ulcerative colitis under combined therapy with systemic glucocorticoids and azathioprine . diagnosis was based on microscopic examination of cerebrospinal fluid csf for the parasite whereas rt pcr for toxoplasma gondii was negative . taking into consideration the limitations of molecular methods investigation of the etiology of meningeal involvement in patients under immunosuppressive therapy presenting positive serology of previous
gondii infection should include microscopic examination of csf for parasite presence .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: toxoplasma gondii meningoencephalitis without cerebral mri findings in a patient with ulcerative colitis under immunosuppressive treatment . toxoplasmosis is the most common opportunistic infection of the central nervous system in immunosupressed patients . it is usually presented as a space occupying lesion detected by cerebral computerized tomography or magnetic resonance imaging . the diffuse form of the disease diffuse toxoplasmic meningoencephalitis lacks the characteristic cerebral radiologic findings rendering pre mortem diagnosis much more difficult . herein we describe a case of toxoplasmic menincoencephalitis without evidence of cerebral space occupying lesions in a patient with ulcerative colitis under combined therapy with systemic glucocorticoids and azathioprine . diagnosis was based on microscopic examination of cerebrospinal fluid csf for the parasite whereas rt pcr for toxoplasma gondii was negative . taking into consideration the limitations of molecular methods investigation of the etiology of meningeal involvement in patients under immunosuppressive therapy presenting positive serology of previous
gondii infection should include microscopic examination of csf for parasite presence . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

na female nude mice j nu foxn
u age 6 wk were injected with 1 million mcf7 human breast cancer cells in the fourth mammary fat pads and received a 21 d sustained release estrogen pellet _decnum_ mg subcutaneously in the dorsum of the neck . all mice were maintained in sterile housing and provided sterile water and irradiated rodent chow . approximately 6 wk after implantation 4 of the 30 mice showed clinical signs of depression and dehydration . the 2 animals most severely affected were euthanized and presented for necropsy . the urinary bladders of these animals were distended with variable sized white opaque uroliths . urinalysis revealed coccal bacteria erythrocytes neutrophils and struvite crystals . urine cultures from both necropsied animals grew heavy pure growths of staphylococcus xylosus . the organism was sensitive to all antibiotics tested except erythromycin intermediate . analysis of the uroliths revealed _lgnum_ struvite composition . remaining mice in the study were evaluated clinically for hydration status the ability to urinate and the presence of palpable stones in the urinary bladder one additional mouse had a firm nonpainful bladder urolithiasis suspected . given the sensitivity of the organisms cultured from urine samples the remaining mice were placed on enrofloxacin in the drinking water _decnum_ mg ml . all remaining mice completed the study without further morbidity or mortality . previous studies have reported the association of estrogen supplementation with urinary bladder pathology including infection and urolithiasis . here we present a case of urolithiasis and cystitis in nude mice receiving estrogen supplementation that was associated with staphylococcus xylosus which previously was unreported in this context . when assessing these nude mice for urolithiasis we found that visualizing the stones through the body wall bladder palpation and bladder expression were helpful in identifying affected mice .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: na female nude mice j nu foxn
u age 6 wk were injected with 1 million mcf7 human breast cancer cells in the fourth mammary fat pads and received a 21 d sustained release estrogen pellet _decnum_ mg subcutaneously in the dorsum of the neck . all mice were maintained in sterile housing and provided sterile water and irradiated rodent chow . approximately 6 wk after implantation 4 of the 30 mice showed clinical signs of depression and dehydration . the 2 animals most severely affected were euthanized and presented for necropsy . the urinary bladders of these animals were distended with variable sized white opaque uroliths . urinalysis revealed coccal bacteria erythrocytes neutrophils and struvite crystals . urine cultures from both necropsied animals grew heavy pure growths of staphylococcus xylosus . the organism was sensitive to all antibiotics tested except erythromycin intermediate . analysis of the uroliths revealed _lgnum_ struvite composition . remaining mice in the study were evaluated clinically for hydration status the ability to urinate and the presence of palpable stones in the urinary bladder one additional mouse had a firm nonpainful bladder urolithiasis suspected . given the sensitivity of the organisms cultured from urine samples the remaining mice were placed on enrofloxacin in the drinking water _decnum_ mg ml . all remaining mice completed the study without further morbidity or mortality . previous studies have reported the association of estrogen supplementation with urinary bladder pathology including infection and urolithiasis . here we present a case of urolithiasis and cystitis in nude mice receiving estrogen supplementation that was associated with staphylococcus xylosus which previously was unreported in this context . when assessing these nude mice for urolithiasis we found that visualizing the stones through the body wall bladder palpation and bladder expression were helpful in identifying affected mice . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

hepatotoxicity from ingestion of wild mushrooms of the genus amanita section phalloideae collected in mexico city two case reports . we present two cases of acute liver injury resulting from consumption of wild mushrooms . the first case was a male who developed acute hepatitis after ingestion of diverse mushrooms including amanita species . his clinical course was favorable with complete recovery of liver function . the second case was a male who developed acute liver failure alf after ingestion of amanita bisporigera . he required mars therapy as a bridge to liver transplantation but transplantation was not performed because he succumbed to multiorgan failure . there are few trials demonstrating the efficacy of the different treatments for mushroom poisoning . these cases demonstrate that the consumption of wild mushrooms without proper knowledge of toxic species represents a serious and under recognized health problem .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: hepatotoxicity from ingestion of wild mushrooms of the genus amanita section phalloideae collected in mexico city two case reports . we present two cases of acute liver injury resulting from consumption of wild mushrooms . the first case was a male who developed acute hepatitis after ingestion of diverse mushrooms including amanita species . his clinical course was favorable with complete recovery of liver function . the second case was a male who developed acute liver failure alf after ingestion of amanita bisporigera . he required mars therapy as a bridge to liver transplantation but transplantation was not performed because he succumbed to multiorgan failure . there are few trials demonstrating the efficacy of the different treatments for mushroom poisoning . these cases demonstrate that the consumption of wild mushrooms without proper knowledge of toxic species represents a serious and under recognized health problem . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

necrolytic acral erythema a rare skin disease associated with hepatitis c virus infection . necrolytic acral erythema is a rare skin disease associated with hepatitis c virus infection . we report a case of a 31 year old woman with hepatitis c virus infection and decreased zinc serum level . physical examination revealed scaly lichenified plaques well demarcated with an erythematous peripheral rim located on the lower limbs . after blood transfusion and oral zinc supplementation the patient presented an improvement of lesions .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: necrolytic acral erythema a rare skin disease associated with hepatitis c virus infection . necrolytic acral erythema is a rare skin disease associated with hepatitis c virus infection . we report a case of a 31 year old woman with hepatitis c virus infection and decreased zinc serum level . physical examination revealed scaly lichenified plaques well demarcated with an erythematous peripheral rim located on the lower limbs . after blood transfusion and oral zinc supplementation the patient presented an improvement of lesions . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

transforaminal endoscopic decompression of a postoperative dislocated bone fragment after a 2 level lumbar total disc replacement case report . the proposed advantages of total disc replacement tdr over fusion in the lumbar spine are the preservation of motion and the avoidance of adjacent level disease . one of the complications inherent in tdr is the possibility of vertebral body fracture due to trauma or a malpositioned implant . the resulting dilemma is that posterior decompression of the displaced bone fragment could then have a destabilizing effect and possibly require fusion thus obviating the benefit of an arthroplasty procedure . in this study the authors describe the technical considerations and feasibility of the treatment of a postoperative l 5 paresis that resulted from a dislocated bone fragment at l4 5 during a 2 level lumbar tdr .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: transforaminal endoscopic decompression of a postoperative dislocated bone fragment after a 2 level lumbar total disc replacement case report . the proposed advantages of total disc replacement tdr over fusion in the lumbar spine are the preservation of motion and the avoidance of adjacent level disease . one of the complications inherent in tdr is the possibility of vertebral body fracture due to trauma or a malpositioned implant . the resulting dilemma is that posterior decompression of the displaced bone fragment could then have a destabilizing effect and possibly require fusion thus obviating the benefit of an arthroplasty procedure . in this study the authors describe the technical considerations and feasibility of the treatment of a postoperative l 5 paresis that resulted from a dislocated bone fragment at l4 5 during a 2 level lumbar tdr . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

central nervous system vasculitis and polyneuropathy as first manifestations of hepatitis
sensory or motor peripheral neuropathy may be observed in a significant proportion of hepatitis c virus hcv infected patients . however central nervous system cns involvement is uncommon especially in cryoglobulin negative subjects . we describe a case of peripheral neuropathy combined with an ischemic cns event as primary manifestations of chronic hcv infection without cryoglobulinemia . significant improvement was observed after antiviral therapy . we discuss the spectrum of neurological manifestations of hcv infection and review the literature .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: central nervous system vasculitis and polyneuropathy as first manifestations of hepatitis
sensory or motor peripheral neuropathy may be observed in a significant proportion of hepatitis c virus hcv infected patients . however central nervous system cns involvement is uncommon especially in cryoglobulin negative subjects . we describe a case of peripheral neuropathy combined with an ischemic cns event as primary manifestations of chronic hcv infection without cryoglobulinemia . significant improvement was observed after antiviral therapy . we discuss the spectrum of neurological manifestations of hcv infection and review the literature . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

johanson blizzard syndrome hepatic and hematological features with novel genotype . johanson blizzard syndrome jbs omim _lgnum_ presents with features of malabsorption and dysmorphic features with onset of symptoms in infantile age group . the disorder was first described in the year _lgnum_ with report of the first indian case in _lgnum_ . we discuss two rare phenotypes hepatitis and anemia in a molecularly confirmed case of jbs .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: johanson blizzard syndrome hepatic and hematological features with novel genotype . johanson blizzard syndrome jbs omim _lgnum_ presents with features of malabsorption and dysmorphic features with onset of symptoms in infantile age group . the disorder was first described in the year _lgnum_ with report of the first indian case in _lgnum_ . we discuss two rare phenotypes hepatitis and anemia in a molecularly confirmed case of jbs . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

lumbar fractures involving five vertebrae a case report . we report a 20 year old man who sustained lumbar fractures involving 5 vertebrae following a road traffic accident . he was initially treated non operatively to allow multiple pedicles to heal . he developed post traumatic kyphosis for which corrective osteotomy and posterior spinal instrumented fusion was performed . he achieved a good functional outcome . we emphasise the need for careful radiological evaluation in patients with high energy trauma and the option of treating such complex injuries by non operative means . if post traumatic kyphosis develops it can be dealt with later and the most mobile segments of the lumbar spine can be preserved .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: lumbar fractures involving five vertebrae a case report . we report a 20 year old man who sustained lumbar fractures involving 5 vertebrae following a road traffic accident . he was initially treated non operatively to allow multiple pedicles to heal . he developed post traumatic kyphosis for which corrective osteotomy and posterior spinal instrumented fusion was performed . he achieved a good functional outcome . we emphasise the need for careful radiological evaluation in patients with high energy trauma and the option of treating such complex injuries by non operative means . if post traumatic kyphosis develops it can be dealt with later and the most mobile segments of the lumbar spine can be preserved . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

a radiation induced meningioma quot cures quot a complex dural arteriovenous fistula . objective we report a case of spontaneous thrombosis of an extremely complex dural arteriovenous fistula davf believed to be previously incurable after the development of a radiation induced meningioma resulting from prior attempts to treat the fistula with radiosurgery . methods a very large davf was treated over the course of 3 decades with a combination of partial embolization and stereotactic radiosurgery with no angiographic or clinical treatment response at long term follow up . however with the development of new neurologic symptoms 13 years after radiosurgery a meningioma was found to have arisen in the previously irradiated field and surprisingly the fistula had spontaneously thrombosed . the meningioma was successfully removed . results we discuss the unique pathophysiology of the radiation induced meningioma causing this previously incurable davf progressing to obliteration . we also review the natural history of davfs including reported rates of spontaneous occlusion as well as the success of radiosurgery in their treatment . finally the incidence of radiosurgery induced tumors particularly meningiomas is reviewed . conclusion the relationship between the spontaneous thrombosis of a davf and the radiation induced meningioma is unique and has not previously been reported .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: a radiation induced meningioma quot cures quot a complex dural arteriovenous fistula . objective we report a case of spontaneous thrombosis of an extremely complex dural arteriovenous fistula davf believed to be previously incurable after the development of a radiation induced meningioma resulting from prior attempts to treat the fistula with radiosurgery . methods a very large davf was treated over the course of 3 decades with a combination of partial embolization and stereotactic radiosurgery with no angiographic or clinical treatment response at long term follow up . however with the development of new neurologic symptoms 13 years after radiosurgery a meningioma was found to have arisen in the previously irradiated field and surprisingly the fistula had spontaneously thrombosed . the meningioma was successfully removed . results we discuss the unique pathophysiology of the radiation induced meningioma causing this previously incurable davf progressing to obliteration . we also review the natural history of davfs including reported rates of spontaneous occlusion as well as the success of radiosurgery in their treatment . finally the incidence of radiosurgery induced tumors particularly meningiomas is reviewed . conclusion the relationship between the spontaneous thrombosis of a davf and the radiation induced meningioma is unique and has not previously been reported . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

hepatocellular carcinoma with bile duct thrombosis a case report . hepatocellular carcinoma hcc is not commonly observed with bile duct thrombosis . here we report a case of hcc with bile thrombi that extended to the liver hilum . the patient was a 61 year old man who visited us due to untreated type b hepatitis . he underwent screening with a ct scan that revealed lda on the right posterior lobe of his liver with infiltration of the bile duct . generally bile resection and reconstruction should be considered for curative resection for bile thrombi however we attempted to conserve the common bile duct to preserve the options of percutaneous therapy in case of tumor recurrence . we performed right lobectomy of the liver . the bile duct thrombus was extracted without bile duct resection or reconstruction . the patient is alive 6 months after the surgery without any development .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: hepatocellular carcinoma with bile duct thrombosis a case report . hepatocellular carcinoma hcc is not commonly observed with bile duct thrombosis . here we report a case of hcc with bile thrombi that extended to the liver hilum . the patient was a 61 year old man who visited us due to untreated type b hepatitis . he underwent screening with a ct scan that revealed lda on the right posterior lobe of his liver with infiltration of the bile duct . generally bile resection and reconstruction should be considered for curative resection for bile thrombi however we attempted to conserve the common bile duct to preserve the options of percutaneous therapy in case of tumor recurrence . we performed right lobectomy of the liver . the bile duct thrombus was extracted without bile duct resection or reconstruction . the patient is alive 6 months after the surgery without any development . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

right accessory hepatic artery arising from celiac trunk case report of a variation that must be looked for during multiorgan procurement . knowledge of the anatomy of the hepatic artery and its variations is important to hepatobiliary and liver transplant surgeons and interventional radiologists . we report a rare anatomic variation of liver hepatic arterial supply a right accessory hepatic artery arising directly from the celiac trunk and observed at the time of multiorgan procurement . the anatomic variation described in this case occurs in up to 2 of cases and their knowledge is essential to avoid injuries during multiorgan procurement that could require multiple anastomoses or lead to inadvertent vessel injury . this variation is very rarely reported in the medical literature . we document successful deceased donor liver transplantation with a graft that had an accessory right accessory hepatic artery from the celiac trunk .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: right accessory hepatic artery arising from celiac trunk case report of a variation that must be looked for during multiorgan procurement . knowledge of the anatomy of the hepatic artery and its variations is important to hepatobiliary and liver transplant surgeons and interventional radiologists . we report a rare anatomic variation of liver hepatic arterial supply a right accessory hepatic artery arising directly from the celiac trunk and observed at the time of multiorgan procurement . the anatomic variation described in this case occurs in up to 2 of cases and their knowledge is essential to avoid injuries during multiorgan procurement that could require multiple anastomoses or lead to inadvertent vessel injury . this variation is very rarely reported in the medical literature . we document successful deceased donor liver transplantation with a graft that had an accessory right accessory hepatic artery from the celiac trunk . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

autochthonous sporadic acute hepatitis e caused by two distinct subgenotype
 hepatitis e virus strains with only 90 nucleotide identity . hepatitis e which is caused by hepatitis e virus hev is a public health concern in japan where the zoonotic food borne transmission of hev from domestic pigs and wild boars plays an important role . a 44 year old japanese man with autochthonous sporadic acute hepatitis e was admitted with general fatigue and moderate liver dysfunction . in the present study two distinct hev strains were recovered from the patient who had consumed the raw or undercooked pig liver and intestine two or three times per week for 3 months before the disease onset . the recovered hev strains were segregated into two clusters within subgenotype
 the open reading frame orf 1 and orf2 sequences of which each showed
0 difference indicating hev mixed infection . because most notified patients with clinical hev infection in japan are diagnosed based on the detection of iga class hev antibodies and because serum samples from only a limited number of hev infected patients are subjected to hev rna detection and nucleotide sequencing it is very likely that patients with hev mixed infection remain largely overlooked . the identification of sources of autochthonous hev infection remains an important goal . continued efforts to trace the sources of acute or chronic autochthonous hev infection are warranted .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: autochthonous sporadic acute hepatitis e caused by two distinct subgenotype
 hepatitis e virus strains with only 90 nucleotide identity . hepatitis e which is caused by hepatitis e virus hev is a public health concern in japan where the zoonotic food borne transmission of hev from domestic pigs and wild boars plays an important role . a 44 year old japanese man with autochthonous sporadic acute hepatitis e was admitted with general fatigue and moderate liver dysfunction . in the present study two distinct hev strains were recovered from the patient who had consumed the raw or undercooked pig liver and intestine two or three times per week for 3 months before the disease onset . the recovered hev strains were segregated into two clusters within subgenotype
 the open reading frame orf 1 and orf2 sequences of which each showed
0 difference indicating hev mixed infection . because most notified patients with clinical hev infection in japan are diagnosed based on the detection of iga class hev antibodies and because serum samples from only a limited number of hev infected patients are subjected to hev rna detection and nucleotide sequencing it is very likely that patients with hev mixed infection remain largely overlooked . the identification of sources of autochthonous hev infection remains an important goal . continued efforts to trace the sources of acute or chronic autochthonous hev infection are warranted . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

a case of chronic inflammatory demyelinating polyradiculoneuropathy after treatment with pegylated interferon
 in a patient with chronic hepatitis b virus infection . we report the case of a 42 year old man with chronic hepatitis b virus infection who developed weakness and paresthesia in the extremities 2 months after administration of pegylated interferon peg ifn
 . nerve conduction studies conducted 6 months after onset showed abnormal temporal dispersions in both tibial nerves . we diagnosed chronic inflammatory demyelinating polyradiculoneuropathy cidp resulting from treatment with peg ifn
 . neurological symptoms were prolonged despite suspension of the treatment . subsequent treatment with intravenous immunoglobulin improved both clinical symptoms and temporal dispersion . ifn induced cidp is rare but can reportedly progress even after interruption of ifn without immunotherapy . patients presenting with polyneuropathy after initiation of ifn thus require close attention .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: a case of chronic inflammatory demyelinating polyradiculoneuropathy after treatment with pegylated interferon
 in a patient with chronic hepatitis b virus infection . we report the case of a 42 year old man with chronic hepatitis b virus infection who developed weakness and paresthesia in the extremities 2 months after administration of pegylated interferon peg ifn
 . nerve conduction studies conducted 6 months after onset showed abnormal temporal dispersions in both tibial nerves . we diagnosed chronic inflammatory demyelinating polyradiculoneuropathy cidp resulting from treatment with peg ifn
 . neurological symptoms were prolonged despite suspension of the treatment . subsequent treatment with intravenous immunoglobulin improved both clinical symptoms and temporal dispersion . ifn induced cidp is rare but can reportedly progress even after interruption of ifn without immunotherapy . patients presenting with polyneuropathy after initiation of ifn thus require close attention . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

systemic adamantiades behcet disease adverse effects of an otherwise successful therapy with interferon
 . background adamantiades behcet disease is an immune mediated vasculitis with relapsing course . it is characterised by the classic clinical trias of oral aphthous ulcers genital ulcers and uveitis . history and findings a 37 year old woman suffered from systemic adamantiades behcet disease with recurrent uveitis oral ulcers genital ulcers arthralgia erythema nodosum and folliculitis . course and treatment longterm interferon
 ifn
 led to reduction of the clinical manifestations except for occasional occurrence of oral ulcers . one year after initiation of treatment however the patient developed symptomatic hyperprolactinemia of unknown etiology . conclusion even in otherwise successful treatment with ifn
 possible side effects and complications of treatment can affect the course . mastodynia and hyperprolactinemia have not yet been described as potential side effects of ifn
 .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: systemic adamantiades behcet disease adverse effects of an otherwise successful therapy with interferon
 . background adamantiades behcet disease is an immune mediated vasculitis with relapsing course . it is characterised by the classic clinical trias of oral aphthous ulcers genital ulcers and uveitis . history and findings a 37 year old woman suffered from systemic adamantiades behcet disease with recurrent uveitis oral ulcers genital ulcers arthralgia erythema nodosum and folliculitis . course and treatment longterm interferon
 ifn
 led to reduction of the clinical manifestations except for occasional occurrence of oral ulcers . one year after initiation of treatment however the patient developed symptomatic hyperprolactinemia of unknown etiology . conclusion even in otherwise successful treatment with ifn
 possible side effects and complications of treatment can affect the course . mastodynia and hyperprolactinemia have not yet been described as potential side effects of ifn
 . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

patient with neonatal onset chronic hepatitis presenting with mevalonate kinase deficiency with a novel mvk gene mutation . a japanese girl with neonatal onset chronic hepatitis and systemic inflammation was diagnosed with hyper immunoglobulinemia d and periodic fever syndrome hids . however she lacked the typical hids features until the age of 32 months . she had compound heterozygous mvk mutations h38
 and a26
 the latter of which was novel . these findings suggest that hids patients could lack typical episodes of recurrent fever at the onset and that hids should be considered as a possible cause of neonatal onset chronic hepatitis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: patient with neonatal onset chronic hepatitis presenting with mevalonate kinase deficiency with a novel mvk gene mutation . a japanese girl with neonatal onset chronic hepatitis and systemic inflammation was diagnosed with hyper immunoglobulinemia d and periodic fever syndrome hids . however she lacked the typical hids features until the age of 32 months . she had compound heterozygous mvk mutations h38
 and a26
 the latter of which was novel . these findings suggest that hids patients could lack typical episodes of recurrent fever at the onset and that hids should be considered as a possible cause of neonatal onset chronic hepatitis . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

clearance of hepatitis c virus prior to lung transplantation a case report . hepatitis c virus hcv continues to be considered a relative contraindication to lung transplantation due to concerns of progression of liver disease with the introduction of immunosuppression . since the recent introduction of effective antiviral therapy for hcv new approaches in the management of the hcv positive recipient are being utilized in liver transplantation to clear hcv pre and post transplant . herein we report use of ledipasvir sofosbuvir for hcv clearance prior to lung transplantation in a patient with usual interstitial pneumonia . listing for transplant was delayed until completion of hcv treatment and he subsequently required extracorporeal membrane oxygenation as a bridge to transplantation due to progressive hypoxia . with antiviral cure rates exceeding 90 hcv should no longer be considered a relative contraindication to lung transplant and timing of antiviral treatment should consider the progressive nature of the recipient lung disease .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: clearance of hepatitis c virus prior to lung transplantation a case report . hepatitis c virus hcv continues to be considered a relative contraindication to lung transplantation due to concerns of progression of liver disease with the introduction of immunosuppression . since the recent introduction of effective antiviral therapy for hcv new approaches in the management of the hcv positive recipient are being utilized in liver transplantation to clear hcv pre and post transplant . herein we report use of ledipasvir sofosbuvir for hcv clearance prior to lung transplantation in a patient with usual interstitial pneumonia . listing for transplant was delayed until completion of hcv treatment and he subsequently required extracorporeal membrane oxygenation as a bridge to transplantation due to progressive hypoxia . with antiviral cure rates exceeding 90 hcv should no longer be considered a relative contraindication to lung transplant and timing of antiviral treatment should consider the progressive nature of the recipient lung disease . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

chronic active epstein barr virus infection mimicking autoimmune hepatitis exacerbation in a patient with systemic lupus erythematosus . chronic active epstein barr virus infection caebv is characterized by chronic infectious mononucleosis like symptoms . we report a very rare case with autoimmune hepatitis aih complicated by caebv . a 50 year old woman with systemic lupus erythematosus sle complicated by aih began to suffer from acute respiratory failure and her clinical symptoms improved rapidly in response to steroid treatment . however during the gradual tapering of the steroid dose a steady increase of the serum hepatobiliary enzyme levels subsequently was observed and the patient began to have continuous fever . moreover upper gastrointestinal endoscopy revealed multiple intractable gastric ulcers . when eber ish was performed on liver biopsy and gastric mucosal biopsy specimens eber positive lymphocytes were observed . when peripheral blood was examined _decnum_ 10 6 copies g of ebv dna were observed in the cd4 positive t cells confirming the diagnosis of caebv . a cooling therapy was started by steroid and cyclosporine . thereafter despite the start of chop therapy she developed a malignant lymphoma ptcl nos and died of hepatic failure . when treatment resistant aih patients are encountered not only aih exacerbation but also caebv should be considered in the differential diagnosis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: chronic active epstein barr virus infection mimicking autoimmune hepatitis exacerbation in a patient with systemic lupus erythematosus . chronic active epstein barr virus infection caebv is characterized by chronic infectious mononucleosis like symptoms . we report a very rare case with autoimmune hepatitis aih complicated by caebv . a 50 year old woman with systemic lupus erythematosus sle complicated by aih began to suffer from acute respiratory failure and her clinical symptoms improved rapidly in response to steroid treatment . however during the gradual tapering of the steroid dose a steady increase of the serum hepatobiliary enzyme levels subsequently was observed and the patient began to have continuous fever . moreover upper gastrointestinal endoscopy revealed multiple intractable gastric ulcers . when eber ish was performed on liver biopsy and gastric mucosal biopsy specimens eber positive lymphocytes were observed . when peripheral blood was examined _decnum_ 10 6 copies g of ebv dna were observed in the cd4 positive t cells confirming the diagnosis of caebv . a cooling therapy was started by steroid and cyclosporine . thereafter despite the start of chop therapy she developed a malignant lymphoma ptcl nos and died of hepatic failure . when treatment resistant aih patients are encountered not only aih exacerbation but also caebv should be considered in the differential diagnosis . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

application of genetic testing to define the surgical approach in a sporadic case of multiple endocrine neoplasia type 1 . we report the use of a genetic test for therapeutic decision making in a case of primary hyperparathyroidism associated with cushing disease cd . a 20 year old woman was evaluated for gradual weight gain asthenia muscle pain and hypertension . biochemical and radiologic tests confirmed cd and she underwent transsphenoidal surgery . immunohistochemistry of the microadenoma was positive for adrenocorticotropic hormone acth . on follow up hypercalcemia with high parathyroid hormone pth levels was detected associated with nephrolithiasis and low bone mineral density in the spine and hip . parathyroid scintigraphy showed tracer uptake in the inferior region of the left thyroid lobe and cervical ultrasound showed a heterogeneous nodule in the same area suggestive of a parathyroid adenoma pa . genetic testing detected mutation in the men 1 gene and total parathyroidectomy with the implantation of a fragment of one gland in the forearm was performed . pathology showed a pa and 3 normal parathyroid glands without hyperplasia despite the diagnosis of men 1 . this case illustrates the role of genetic testing in defining the therapeutic approach for sporadic men 1 .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: application of genetic testing to define the surgical approach in a sporadic case of multiple endocrine neoplasia type 1 . we report the use of a genetic test for therapeutic decision making in a case of primary hyperparathyroidism associated with cushing disease cd . a 20 year old woman was evaluated for gradual weight gain asthenia muscle pain and hypertension . biochemical and radiologic tests confirmed cd and she underwent transsphenoidal surgery . immunohistochemistry of the microadenoma was positive for adrenocorticotropic hormone acth . on follow up hypercalcemia with high parathyroid hormone pth levels was detected associated with nephrolithiasis and low bone mineral density in the spine and hip . parathyroid scintigraphy showed tracer uptake in the inferior region of the left thyroid lobe and cervical ultrasound showed a heterogeneous nodule in the same area suggestive of a parathyroid adenoma pa . genetic testing detected mutation in the men 1 gene and total parathyroidectomy with the implantation of a fragment of one gland in the forearm was performed . pathology showed a pa and 3 normal parathyroid glands without hyperplasia despite the diagnosis of men 1 . this case illustrates the role of genetic testing in defining the therapeutic approach for sporadic men 1 . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

hcv intergenotype

 recombinant detected in a daa treated patient in italy . direct acting antiviral daa combinations are potent and effective drugs currently recommended for treatment of chronic hcv infection . difficult to treat genotypes are the most important predictors of treatment failure . we report a case of daa treatment failure in an hcv infected patient carrying a recombinant genotype

 . this strain first isolated from a russian patient in _lgnum_ has now been observed for the first time in italy .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: hcv intergenotype

 recombinant detected in a daa treated patient in italy . direct acting antiviral daa combinations are potent and effective drugs currently recommended for treatment of chronic hcv infection . difficult to treat genotypes are the most important predictors of treatment failure . we report a case of daa treatment failure in an hcv infected patient carrying a recombinant genotype

 . this strain first isolated from a russian patient in _lgnum_ has now been observed for the first time in italy . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

abacavir induced fulminant hepatic failure in a hiv hcv co infected patient . abacavir hypersensitivity is a rare yet significant adverse reaction that results in a spectrum of physical and laboratory abnormalities and has been postulated to stem from a variety of aetiological factors . the major histocompatibility complex haplotype human leucocyte antigen hla b5701 is a significant risk factor in development of hypersensitivity reactions yet only 55 of hla b5701 individuals develop such reactions suggesting a multifactorial aetiology . nevertheless prospective screening and avoidance of abacavir in these patients has limited adverse events . within this spectrum of adverse events abacavir induced liver toxicity is exceedingly rare and reported events have ranged from mild elevations of aminotransferases to fulminant hepatic failure . we report the case of a 50 year old caucasian woman with a history significant for hiv hepatitis c virus and a hla b5701 status transferred to our emergency department in a hypotensive state and found to have acute liver failure acute renal failure and significant rhabdomyolysis following a change of highly active antiretroviral therapy regimen .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: abacavir induced fulminant hepatic failure in a hiv hcv co infected patient . abacavir hypersensitivity is a rare yet significant adverse reaction that results in a spectrum of physical and laboratory abnormalities and has been postulated to stem from a variety of aetiological factors . the major histocompatibility complex haplotype human leucocyte antigen hla b5701 is a significant risk factor in development of hypersensitivity reactions yet only 55 of hla b5701 individuals develop such reactions suggesting a multifactorial aetiology . nevertheless prospective screening and avoidance of abacavir in these patients has limited adverse events . within this spectrum of adverse events abacavir induced liver toxicity is exceedingly rare and reported events have ranged from mild elevations of aminotransferases to fulminant hepatic failure . we report the case of a 50 year old caucasian woman with a history significant for hiv hepatitis c virus and a hla b5701 status transferred to our emergency department in a hypotensive state and found to have acute liver failure acute renal failure and significant rhabdomyolysis following a change of highly active antiretroviral therapy regimen . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

laparoscopic distal splenoadrenal shunt for the treatment of portal hypertension in children with congenital hepatic fibrosis a case report . background the distal splenorenal shunt is an effective procedure for the treatment of portal hypertension in children . however there has been no report about laparoscopic distal splenorenal shunt in the treatment of portal hypertension in children . methods from december _lgnum_ to august _lgnum_ 4 children with upper gastrointestinal bleeding underwent laparoscopic distal splenoadrenal shunt . portal hypertension and splenomegaly were demonstrated on the preoperative computed tomography ct and sonography . the distal splenic vein was mobilized and anastomosed to the left adrenal vein laparoscopically . all patients were followed up postoperatively . results the laparoscopic distal splenoadrenal shunt was successfully performed in all patients . the liver fibrosis was diagnosed by postoperative liver pathology . the operative time ranged from _lgnum_ to _lgnum_ minutes . the blood loss was minimal . the length of hospital stay was 6 to 13 days . the duration of following up was 1 to 9 months median 3 months . the portal pressure and splenic size were decreased postoperatively . the complete blood count normalized and the biochemistry tests were within normal range after surgery . postoperative ultrasound and ct confirmed shunt patency and satisfactory flow in the splenoadrenal shunt in all patients . no patient developed recurrence of variceal bleeding . conclusions the laparoscopic splenoadrenal shunt is a feasible treatment of portal hypertension in children .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: laparoscopic distal splenoadrenal shunt for the treatment of portal hypertension in children with congenital hepatic fibrosis a case report . background the distal splenorenal shunt is an effective procedure for the treatment of portal hypertension in children . however there has been no report about laparoscopic distal splenorenal shunt in the treatment of portal hypertension in children . methods from december _lgnum_ to august _lgnum_ 4 children with upper gastrointestinal bleeding underwent laparoscopic distal splenoadrenal shunt . portal hypertension and splenomegaly were demonstrated on the preoperative computed tomography ct and sonography . the distal splenic vein was mobilized and anastomosed to the left adrenal vein laparoscopically . all patients were followed up postoperatively . results the laparoscopic distal splenoadrenal shunt was successfully performed in all patients . the liver fibrosis was diagnosed by postoperative liver pathology . the operative time ranged from _lgnum_ to _lgnum_ minutes . the blood loss was minimal . the length of hospital stay was 6 to 13 days . the duration of following up was 1 to 9 months median 3 months . the portal pressure and splenic size were decreased postoperatively . the complete blood count normalized and the biochemistry tests were within normal range after surgery . postoperative ultrasound and ct confirmed shunt patency and satisfactory flow in the splenoadrenal shunt in all patients . no patient developed recurrence of variceal bleeding . conclusions the laparoscopic splenoadrenal shunt is a feasible treatment of portal hypertension in children . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

tenofovir induced fanconi syndrome in chronic hepatitis b monoinfected patients that reverted after tenofovir withdrawal . tenofovir disoproxil fumarate tdf is a nucleotide reverse transcriptase inhibitor widely used to treat patients with human immunodeficiency virus hiv and hepatitis b virus hbv infection . despite the excellent safety records of this regimen a few cases of acute renal failure and fanconi syndrome have been reported among hiv patients exposed to tdf . in the hbv monoinfection scenario only two cases of tdf associated fanconi syndrome have been reported thus far . here we describe two additional patients with chronic hepatitis b chb who developed a tdf induced fanconi syndrome that reverted after tdf withdrawal and had viral replication fully suppressed upon switching to entecavir etv . though the overall risk of tdf associated severe renal toxicity in hbv patients appears to be negligible both glomerular and tubular function should be monitored in patients exposed to tdf especially when other renal risk factors or a history of previous exposure to adefovir dipivoxil adv are present .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: tenofovir induced fanconi syndrome in chronic hepatitis b monoinfected patients that reverted after tenofovir withdrawal . tenofovir disoproxil fumarate tdf is a nucleotide reverse transcriptase inhibitor widely used to treat patients with human immunodeficiency virus hiv and hepatitis b virus hbv infection . despite the excellent safety records of this regimen a few cases of acute renal failure and fanconi syndrome have been reported among hiv patients exposed to tdf . in the hbv monoinfection scenario only two cases of tdf associated fanconi syndrome have been reported thus far . here we describe two additional patients with chronic hepatitis b chb who developed a tdf induced fanconi syndrome that reverted after tdf withdrawal and had viral replication fully suppressed upon switching to entecavir etv . though the overall risk of tdf associated severe renal toxicity in hbv patients appears to be negligible both glomerular and tubular function should be monitored in patients exposed to tdf especially when other renal risk factors or a history of previous exposure to adefovir dipivoxil adv are present . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

shortened stapedius tendon a rare cause of conductive hearing loss . introduction anomalies of the stapedius tendon have been reported to cause conductive hearing loss in theory such anomalies limit the movement of the stapes . objectives to demonstrate a rare cause of conductive hearing loss resulting from anomaly of the stapedius tendon and to compare the clinical findings of this patient to other stapedius tendon anomalies reported in the literature . method case report of a single case of shortened stapedius tendon and a review of the english literature on stapedius tendon anomalies . results this is a case report of a 15 year old boy with shortened stapedius tendon causing unilateral hearing loss accompanied by a review of the literature . contrary to other reported cases this patient did not have an ossified tendon but rather an extremely short tendon . the boy regained normal hearing following excision of the stapedius tendon . conclusion a shortened stapedius tendon is a very rare diagnosis yet it should be considered as a possible cause of conductive hearing loss .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: shortened stapedius tendon a rare cause of conductive hearing loss . introduction anomalies of the stapedius tendon have been reported to cause conductive hearing loss in theory such anomalies limit the movement of the stapes . objectives to demonstrate a rare cause of conductive hearing loss resulting from anomaly of the stapedius tendon and to compare the clinical findings of this patient to other stapedius tendon anomalies reported in the literature . method case report of a single case of shortened stapedius tendon and a review of the english literature on stapedius tendon anomalies . results this is a case report of a 15 year old boy with shortened stapedius tendon causing unilateral hearing loss accompanied by a review of the literature . contrary to other reported cases this patient did not have an ossified tendon but rather an extremely short tendon . the boy regained normal hearing following excision of the stapedius tendon . conclusion a shortened stapedius tendon is a very rare diagnosis yet it should be considered as a possible cause of conductive hearing loss . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

augmented reality game related injury . there are an increasing number of injuries associated with ambulatory mobile phone use . pokemon go is one of the first widely used mobile phone augmented reality games and generated substantial media interest . we present a case of electrical burns in a pokemon go player and review literature on ambulatory mobile phone injuries .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: augmented reality game related injury . there are an increasing number of injuries associated with ambulatory mobile phone use . pokemon go is one of the first widely used mobile phone augmented reality games and generated substantial media interest . we present a case of electrical burns in a pokemon go player and review literature on ambulatory mobile phone injuries . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

ultrasound imaging of median nerve conduit in a patient with persistent median nerve symptoms . peripheral nerve injury can be reconstructed using composite polymer nerve autografts but the sonographic appearance of nerve wraps and conduits have not been well documented . this case report describes the sonographic findings in a 42 year old woman with bilateral carpal tunnel syndrome status post nerve repair with a conduit . the cross sectional area of the left median nerve was 24 mm at the carpal tunnel inlet and 5 mm at the forearm . the wrist to forearm ratio was _decnum_ . there was a hypoechoic space surrounding the nerve that was _decnum_ to _decnum_ mm thick and bordered by a thin hyperechoic outer rim . on review of the operative record and consultation with her surgeon dr it was determined that this represented the 2 mm nerve wrap used in the last surgery . inclusion of these structures with the median nerve measured a total area of 52 mm at its maximum . in describing this image we hope to lay the foundation for describing the sonographic appearance of peripheral nerve repair .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: ultrasound imaging of median nerve conduit in a patient with persistent median nerve symptoms . peripheral nerve injury can be reconstructed using composite polymer nerve autografts but the sonographic appearance of nerve wraps and conduits have not been well documented . this case report describes the sonographic findings in a 42 year old woman with bilateral carpal tunnel syndrome status post nerve repair with a conduit . the cross sectional area of the left median nerve was 24 mm at the carpal tunnel inlet and 5 mm at the forearm . the wrist to forearm ratio was _decnum_ . there was a hypoechoic space surrounding the nerve that was _decnum_ to _decnum_ mm thick and bordered by a thin hyperechoic outer rim . on review of the operative record and consultation with her surgeon dr it was determined that this represented the 2 mm nerve wrap used in the last surgery . inclusion of these structures with the median nerve measured a total area of 52 mm at its maximum . in describing this image we hope to lay the foundation for describing the sonographic appearance of peripheral nerve repair . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

long term response to peginterferon in hepatitis c virus associated nephrotic syndrome from focal segmental glomerulosclerosis . hepatitis c virus hcv infection is a global public health problem . chronic hcv infection is an important cause of chronic liver disease . since the first reported association between hcv and membranoproliferative glomerulonephritis mpgn in _lgnum_ hcv has been described with other types of glomerular diseases although less frequently . focal segmental glomerulosclerosis fsgs is one such glomerular disease that has been rarely reported in association with hcv . antiviral therapy with interferon and ribavirin has been shown to be beneficial in hcv associated mpgn . the optimal therapy of hcv associated fsgs is not currently known . to our knowledge long term response to pegylated interferon monotherapy in treatment of hcv associated fsgs has not been reported . we report an adult patient with hcv associated fsgs who presented with nephrotic syndrome and renal failure . treatment with pegylated interferon alfa
 monotherapy resulted in sustained virological response with a clinical remission of nephrotic syndrome and stabilization of renal function . patient continued to remain in clinical remission of nephrotic syndrome with stable renal function 5 years after treatment . we also briefly review the literature on hcv associated glomerular diseases particularly hcv associated fsgs .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: long term response to peginterferon in hepatitis c virus associated nephrotic syndrome from focal segmental glomerulosclerosis . hepatitis c virus hcv infection is a global public health problem . chronic hcv infection is an important cause of chronic liver disease . since the first reported association between hcv and membranoproliferative glomerulonephritis mpgn in _lgnum_ hcv has been described with other types of glomerular diseases although less frequently . focal segmental glomerulosclerosis fsgs is one such glomerular disease that has been rarely reported in association with hcv . antiviral therapy with interferon and ribavirin has been shown to be beneficial in hcv associated mpgn . the optimal therapy of hcv associated fsgs is not currently known . to our knowledge long term response to pegylated interferon monotherapy in treatment of hcv associated fsgs has not been reported . we report an adult patient with hcv associated fsgs who presented with nephrotic syndrome and renal failure . treatment with pegylated interferon alfa
 monotherapy resulted in sustained virological response with a clinical remission of nephrotic syndrome and stabilization of renal function . patient continued to remain in clinical remission of nephrotic syndrome with stable renal function 5 years after treatment . we also briefly review the literature on hcv associated glomerular diseases particularly hcv associated fsgs . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

pure red cell aplasia caused by pegylated interferon
 plus ribavirin in the treatment of chronic hepatitis
pure red cell aplasia prca is a rare hematological disorder which is characterized by severe anemia reticulocytopenia and almost complete absence of erythroid precursors in bone marrow . the pathophysiology of prca may be congenital or acquired . to our knowledge there is only one case report in the english literature of prca after pegylated interferon combination therapy for chronic hepatitis
we report a second case of prca after pegylated interferon combination treatment for chronic hepatitis
the diagnosis of prca was confirmed by the typical findings of bone marrow biopsy . the possible etiologies of our case are also discussed in this paper .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: pure red cell aplasia caused by pegylated interferon
 plus ribavirin in the treatment of chronic hepatitis
pure red cell aplasia prca is a rare hematological disorder which is characterized by severe anemia reticulocytopenia and almost complete absence of erythroid precursors in bone marrow . the pathophysiology of prca may be congenital or acquired . to our knowledge there is only one case report in the english literature of prca after pegylated interferon combination therapy for chronic hepatitis
we report a second case of prca after pegylated interferon combination treatment for chronic hepatitis
the diagnosis of prca was confirmed by the typical findings of bone marrow biopsy . the possible etiologies of our case are also discussed in this paper . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

development of duodenal ulcers due to the discontinuation of proton pump inhibitors after the induction of sofosbuvir plus ledipasvir therapy a report of two cases . sofosbuvir plus ledipasvir sof ldv combination therapy is a promising therapy for post transplant hepatitis c virus hcv reinfection . it is known that gastric ph elevation induces lower absorption of ledipasvir therefore the use of proton pump inhibitors ppis should be considered regarding dose reduction after sof ldv therapy induction . here we report two patients who developed duodenal ulcers due to the discontinuation of ppis after the induction of sof ldv therapy for post transplant hcv reinfection . the first patient was a 71 year old man who had undergone living donor liver transplantation due to hcv related liver cirrhosis . lansoprazole 30 mg daily was discontinued upon sof ldv therapy induction . seven days after sof ldv therapy induction gastrointestinal endoscopy revealed the presence of a duodenal ulcer . the second patient was a 54 year old man who had undergone living donor liver transplantation due to hcv related end stage liver disease . similar to the first patient rabeprazole sodium was discontinued upon the induction of sof ldv therapy . eighteen days after sof ldv therapy induction gastrointestinal endoscopy revealed the presence of a duodenal ulcer . in both cases these duodenal ulcers improved after the resumption of the administration of ppis and a sustained virologic response at 12 weeks was achieved by sof ldv therapy with ppi use . thus ppi use should be continued consistently during sof ldv therapy for post transplant hcv reinfection .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: development of duodenal ulcers due to the discontinuation of proton pump inhibitors after the induction of sofosbuvir plus ledipasvir therapy a report of two cases . sofosbuvir plus ledipasvir sof ldv combination therapy is a promising therapy for post transplant hepatitis c virus hcv reinfection . it is known that gastric ph elevation induces lower absorption of ledipasvir therefore the use of proton pump inhibitors ppis should be considered regarding dose reduction after sof ldv therapy induction . here we report two patients who developed duodenal ulcers due to the discontinuation of ppis after the induction of sof ldv therapy for post transplant hcv reinfection . the first patient was a 71 year old man who had undergone living donor liver transplantation due to hcv related liver cirrhosis . lansoprazole 30 mg daily was discontinued upon sof ldv therapy induction . seven days after sof ldv therapy induction gastrointestinal endoscopy revealed the presence of a duodenal ulcer . the second patient was a 54 year old man who had undergone living donor liver transplantation due to hcv related end stage liver disease . similar to the first patient rabeprazole sodium was discontinued upon the induction of sof ldv therapy . eighteen days after sof ldv therapy induction gastrointestinal endoscopy revealed the presence of a duodenal ulcer . in both cases these duodenal ulcers improved after the resumption of the administration of ppis and a sustained virologic response at 12 weeks was achieved by sof ldv therapy with ppi use . thus ppi use should be continued consistently during sof ldv therapy for post transplant hcv reinfection . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

unusual renal manifestation of caroli disease aa amyloidosis . congenital hepatic fibrosis is a fairly uncommon disorder and it is usually associated with other fibropolycystic disorders including renal involvement . main clinical features are hepatic fibrosis portal hypertension and renal cystic disease . there are multifocal saccular dilatations of segmental bile ducts usually with accompanying calculi formation and recurrent bacterial cholangitis . renal cystic disorders are common complications of caroli disease cd but renal amyloidosis is fairly uncommon . we present a patient who was diagnosed with cd at the age of 31 years and in whom renal aa amyloidosis developed at the age of 45 years due to recurrent bacterial cholangitis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: unusual renal manifestation of caroli disease aa amyloidosis . congenital hepatic fibrosis is a fairly uncommon disorder and it is usually associated with other fibropolycystic disorders including renal involvement . main clinical features are hepatic fibrosis portal hypertension and renal cystic disease . there are multifocal saccular dilatations of segmental bile ducts usually with accompanying calculi formation and recurrent bacterial cholangitis . renal cystic disorders are common complications of caroli disease cd but renal amyloidosis is fairly uncommon . we present a patient who was diagnosed with cd at the age of 31 years and in whom renal aa amyloidosis developed at the age of 45 years due to recurrent bacterial cholangitis . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

termination of idiopathic sustained monomorphic ventricular tachycardia by synchronized electrical cardioversion during pregnancy . the most common cardiac complications detected during pregnancy are an arrhythmia . however idiopathic continuous monomorphic ventricular tachycardia vt during pregnancy is unusual . a 31 year old pregnant woman presented at 20 weeks of gestation with progressive palpitation and episodes of agitation . an initial 12 lead electrocardiogram ecg showed normal sinus rhythm . however 30 minutes after presenting at the emergency room she complained of chest pain . a subsequent ecg showed wide complex monomorphic vt . we attempted to administer an antiarrhythmic drug but the patient refused any medication because of concerns regarding possible adverse effects on the fetus . therefore we performed synchronized electrical cardioversion eight times . after the eighth synchronized cardioversion at _lgnum_ j the ecg showed successful restoration of sinus rhythm . the condition of the fetus was monitored via ultrasonography and cardiotocography and no adverse events were observed . we present the case of a successful synchronized electrical cardioversion performed in a woman at 20 weeks of gestation because of sustained symptomatic vt .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: termination of idiopathic sustained monomorphic ventricular tachycardia by synchronized electrical cardioversion during pregnancy . the most common cardiac complications detected during pregnancy are an arrhythmia . however idiopathic continuous monomorphic ventricular tachycardia vt during pregnancy is unusual . a 31 year old pregnant woman presented at 20 weeks of gestation with progressive palpitation and episodes of agitation . an initial 12 lead electrocardiogram ecg showed normal sinus rhythm . however 30 minutes after presenting at the emergency room she complained of chest pain . a subsequent ecg showed wide complex monomorphic vt . we attempted to administer an antiarrhythmic drug but the patient refused any medication because of concerns regarding possible adverse effects on the fetus . therefore we performed synchronized electrical cardioversion eight times . after the eighth synchronized cardioversion at _lgnum_ j the ecg showed successful restoration of sinus rhythm . the condition of the fetus was monitored via ultrasonography and cardiotocography and no adverse events were observed . we present the case of a successful synchronized electrical cardioversion performed in a woman at 20 weeks of gestation because of sustained symptomatic vt . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

hepatitis c virus late relapse after sustained virologic response from interferon and ribavirin treatment as confirmed by rna sequencing . hepatitis c virus hcv viremia is unusual lt 5 after successful treatment defined as sustained virologic response svr or undetectable hcv pcr 12 to 24 weeks after therapy . we present a case of late virologic relapse de novo infection was excluded by rna sequencing after svr followed by spontaneous viral clearance .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: hepatitis c virus late relapse after sustained virologic response from interferon and ribavirin treatment as confirmed by rna sequencing . hepatitis c virus hcv viremia is unusual lt 5 after successful treatment defined as sustained virologic response svr or undetectable hcv pcr 12 to 24 weeks after therapy . we present a case of late virologic relapse de novo infection was excluded by rna sequencing after svr followed by spontaneous viral clearance . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

cisplatin induced acute myocardial infarction and dyslipidemia . myocardial infarction commonly occurs due to rupture of atherosclerotic plaque in the coronary arteries and is manifested on coronary angiography . myocardial infarction with angiographically normal coronary arteries can occur due to hypercoagulable state coronary spasm embolism arteritis congenital condition and drugs . illicit drugs such as cocaine amphetamines and marijuana are known to cause myocardial infarction . of the many medications that are associated with cardiovascular toxicity chemotherapeutic agents form a large group with both acute and delayed cardiotoxicity . we present a case of acute myocardial infarction in a patient with no organic coronary artery disease on the bleomycin etoposide and cisplatin bep regimen for treatment of testicular seminoma . patient developed symptoms of acute coronary syndrome acs after his third cycle of the regimen . this case highlights the need for prior careful cardiovascular evaluation close monitoring and use of strategies to prevent cardiovascular morbidity in patients on cisplatin therapy .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: cisplatin induced acute myocardial infarction and dyslipidemia . myocardial infarction commonly occurs due to rupture of atherosclerotic plaque in the coronary arteries and is manifested on coronary angiography . myocardial infarction with angiographically normal coronary arteries can occur due to hypercoagulable state coronary spasm embolism arteritis congenital condition and drugs . illicit drugs such as cocaine amphetamines and marijuana are known to cause myocardial infarction . of the many medications that are associated with cardiovascular toxicity chemotherapeutic agents form a large group with both acute and delayed cardiotoxicity . we present a case of acute myocardial infarction in a patient with no organic coronary artery disease on the bleomycin etoposide and cisplatin bep regimen for treatment of testicular seminoma . patient developed symptoms of acute coronary syndrome acs after his third cycle of the regimen . this case highlights the need for prior careful cardiovascular evaluation close monitoring and use of strategies to prevent cardiovascular morbidity in patients on cisplatin therapy . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

treatment of a patient with genotype 7 hepatitis c virus infection with sofosbuvir and velpatasvir . during a phase 3 study evaluating the combination of sofosbuvir velpatasvir for 12 weeks in patients with genotype 1 2 4 5 and 6 hepatitis c virus hcv infection we enrolled a patient who was subsequently found to be infected with genotype 7 hcv . this patient tolerated the study regimen well and achieved sustained virological response 12 weeks after treatment svr12 . hepatology _lgnum_ _time_ 3 _lgnum_ .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: treatment of a patient with genotype 7 hepatitis c virus infection with sofosbuvir and velpatasvir . during a phase 3 study evaluating the combination of sofosbuvir velpatasvir for 12 weeks in patients with genotype 1 2 4 5 and 6 hepatitis c virus hcv infection we enrolled a patient who was subsequently found to be infected with genotype 7 hcv . this patient tolerated the study regimen well and achieved sustained virological response 12 weeks after treatment svr12 . hepatology _lgnum_ _time_ 3 _lgnum_ . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

point of care echocardiography in an acute thoracic dissection with tamponade in a young man with chest pain tachycardia and fever . background although thoracic aortic dissections are uncommon in young patients they must be considered in the differential diagnosis in the presence of chest pain and abnormal vital signs . although computed tomography angiography is the test of choice for thoracic dissection in the emergency department point of care poc transthoracic echocardiography has a high specificity in the diagnosis of this disease . it is especially helpful in patients with proximal ascending dissections in the presence of a pericardial effusion . case report this case report illustrates a young patient presenting with chest pain persistent tachycardia and fever with a presumed upper respiratory infection who had an ascending thoracic dissection with tamponade discovered on poc echocardiography . why should an emergency physician be aware of this poc echocardiography should be an important part of the algorithm in young patients presenting with chest pain and abnormal vital signs that do not improve with supportive measures . definitive care in patients who present with a thoracic aortic dissection in the presence of cardiac tamponade diagnosed on poc echocardiography should not be delayed in order to wait for other imaging methods to be performed . poc echocardiography may expedite care and treatment in young patients presenting with this deadly disease .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: point of care echocardiography in an acute thoracic dissection with tamponade in a young man with chest pain tachycardia and fever . background although thoracic aortic dissections are uncommon in young patients they must be considered in the differential diagnosis in the presence of chest pain and abnormal vital signs . although computed tomography angiography is the test of choice for thoracic dissection in the emergency department point of care poc transthoracic echocardiography has a high specificity in the diagnosis of this disease . it is especially helpful in patients with proximal ascending dissections in the presence of a pericardial effusion . case report this case report illustrates a young patient presenting with chest pain persistent tachycardia and fever with a presumed upper respiratory infection who had an ascending thoracic dissection with tamponade discovered on poc echocardiography . why should an emergency physician be aware of this poc echocardiography should be an important part of the algorithm in young patients presenting with chest pain and abnormal vital signs that do not improve with supportive measures . definitive care in patients who present with a thoracic aortic dissection in the presence of cardiac tamponade diagnosed on poc echocardiography should not be delayed in order to wait for other imaging methods to be performed . poc echocardiography may expedite care and treatment in young patients presenting with this deadly disease . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

disclosure of diagnosis to tell or not to tell case jimmy is an 8 year old boy with hepatitis b e antigen hbeag positive hiv and hepatitis c negative who was adopted from vietnam when he was 5 years and has been followed in your primary care practice since that time . before adoption he lived in an orphanage where he was placed soon after birth . jimmy currently lives with his adoptive mother and grandparents . his adoptive father has amyotrophic lateral sclerosis and recently moved to a nursing home due to a need for more intensive care . jimmy continues to see him regularly . jimmy mother presents today upset about a recent encounter with his hepatologist . during this visit jimmy doctor was insistent that jimmy should be told about his illness immediately . he felt that jimmy quot had a right to know quot and that it was important for the protection of other children . jimmy family practices universal precautions and jimmy is compliant with these safety measures . jimmy mother has chosen not to share his diagnosis with the school and in addition has not felt the time was right to disclose the diagnosis to jimmy . he is asymptomatic takes no medications and is followed yearly by a hepatologist . his mother is concerned that jimmy would have difficulty managing this information and maintaining a quot secret . quot however she also worries that he may feel his trust has been violated if she delays telling him . jimmy is currently 8 years old in second grade and is struggling academically with math and reading . socially he is reported to have difficulty making friends and reading social cues . for example he displays inappropriate boundaries often standing too close or touching others which has resulted in children avoiding him . during your annual visit jimmy presented as a friendly and engaging boy . he maintained conversation about school and some of his interests but he was often distractible impulsive at times grabbing things and fidgety frequently standing up and then sitting back down . jimmy mother reports that this behavior is similar to what he exhibits in the classroom . he is currently receiving english as a second language services and is enrolled in a weekly quot lunch bunch . quot what advice would you give the family .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: disclosure of diagnosis to tell or not to tell case jimmy is an 8 year old boy with hepatitis b e antigen hbeag positive hiv and hepatitis c negative who was adopted from vietnam when he was 5 years and has been followed in your primary care practice since that time . before adoption he lived in an orphanage where he was placed soon after birth . jimmy currently lives with his adoptive mother and grandparents . his adoptive father has amyotrophic lateral sclerosis and recently moved to a nursing home due to a need for more intensive care . jimmy continues to see him regularly . jimmy mother presents today upset about a recent encounter with his hepatologist . during this visit jimmy doctor was insistent that jimmy should be told about his illness immediately . he felt that jimmy quot had a right to know quot and that it was important for the protection of other children . jimmy family practices universal precautions and jimmy is compliant with these safety measures . jimmy mother has chosen not to share his diagnosis with the school and in addition has not felt the time was right to disclose the diagnosis to jimmy . he is asymptomatic takes no medications and is followed yearly by a hepatologist . his mother is concerned that jimmy would have difficulty managing this information and maintaining a quot secret . quot however she also worries that he may feel his trust has been violated if she delays telling him . jimmy is currently 8 years old in second grade and is struggling academically with math and reading . socially he is reported to have difficulty making friends and reading social cues . for example he displays inappropriate boundaries often standing too close or touching others which has resulted in children avoiding him . during your annual visit jimmy presented as a friendly and engaging boy . he maintained conversation about school and some of his interests but he was often distractible impulsive at times grabbing things and fidgety frequently standing up and then sitting back down . jimmy mother reports that this behavior is similar to what he exhibits in the classroom . he is currently receiving english as a second language services and is enrolled in a weekly quot lunch bunch . quot what advice would you give the family . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

remission of hepatic hydrothorax after ok _lgnum_ pleurodesis . hepatic hydrothorax in the absence of ascites is a rare complication of liver cirrhosis . a 71 year old man with liver cirrhosis due to alcohol abuse was referred to our department because of massive pleural effusion on the right side . the properties of pleural effusion and clinical course led to a diagnosis of hepatic hydrothorax . nonsurgical ok _lgnum_ pleurodesis resulted in a marked decrease of pleural effusion . after 2 months of follow up effusion was well controlled . patients with hepatic hydrothoraces have few options . ok _lgnum_ pleurodesis is relatively safe and may provide an effective alternative to peritoneovenous shunt transjugular intrahepatic portosystemic shunt or surgical pleurodesis . it may also be a bridge toward liver transplantation in patients with few other options . herein we report a case of refractory hepatic hydrothorax successfully treated by nonsurgical ok _lgnum_ pleurodesis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: remission of hepatic hydrothorax after ok _lgnum_ pleurodesis . hepatic hydrothorax in the absence of ascites is a rare complication of liver cirrhosis . a 71 year old man with liver cirrhosis due to alcohol abuse was referred to our department because of massive pleural effusion on the right side . the properties of pleural effusion and clinical course led to a diagnosis of hepatic hydrothorax . nonsurgical ok _lgnum_ pleurodesis resulted in a marked decrease of pleural effusion . after 2 months of follow up effusion was well controlled . patients with hepatic hydrothoraces have few options . ok _lgnum_ pleurodesis is relatively safe and may provide an effective alternative to peritoneovenous shunt transjugular intrahepatic portosystemic shunt or surgical pleurodesis . it may also be a bridge toward liver transplantation in patients with few other options . herein we report a case of refractory hepatic hydrothorax successfully treated by nonsurgical ok _lgnum_ pleurodesis . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

interstitial lung disease preceding primary biliary cirrhosis in a male patient . a 47 year old male was admitted with subacute onset of dry cough and fever . chest tomography demonstrated multifocal areas of consolidation and ground glass attenuation . cytological analysis of bronchoalveolar lavage revealed lymphocytosis and eosinophilia and anatomopathological exam of transbronchial cryobiopsy showed poorly formed non caseous granulomas associated to interstitial lympho plasmocitary infiltrate . the diagnosis of idiopathic granulomatous lung disease gld was assumed and the patient started oral prednisolone presenting clinical functional and radiological improvement . two years later the patient was diagnosed with primary biliary cirrhosis pbc . at this time it was possible to associate gld with the autoimmune hepatobiliary disease . clinical epidemiological and pathological aspects of this uncommon case of interstitial lung disease as first presentation of pbc in a male patient are discussed .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: interstitial lung disease preceding primary biliary cirrhosis in a male patient . a 47 year old male was admitted with subacute onset of dry cough and fever . chest tomography demonstrated multifocal areas of consolidation and ground glass attenuation . cytological analysis of bronchoalveolar lavage revealed lymphocytosis and eosinophilia and anatomopathological exam of transbronchial cryobiopsy showed poorly formed non caseous granulomas associated to interstitial lympho plasmocitary infiltrate . the diagnosis of idiopathic granulomatous lung disease gld was assumed and the patient started oral prednisolone presenting clinical functional and radiological improvement . two years later the patient was diagnosed with primary biliary cirrhosis pbc . at this time it was possible to associate gld with the autoimmune hepatobiliary disease . clinical epidemiological and pathological aspects of this uncommon case of interstitial lung disease as first presentation of pbc in a male patient are discussed . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

coinfection of hepatitis a virus genotype ia and iiia complicated with autoimmune hemolytic anemia prolonged cholestasis and false positive immunoglobulin m anti hepatitis e virus a case report . a 37 year old male presented with fever and jaundice was diagnosed as hepatitis a complicated with progressive cholestasis and severe autoimmune hemolytic anemia . he was treated with high dose prednisolone _decnum_ mg kg and eventually recovered . his initial serum contained genotype ia hepatitis a virus hav which was subsequently replaced by genotype iiia hav . moreover at the time of development of hemolytic anemia he became positive for immunoglobulin m igm anti hepatitis e virus hev . we detected hav antigens in the liver biopsy specimen while we detected neither hev antigen in the liver nor hev rna in his serum . this is the first report of hepatitis a coinfected with two different genotypes manifesting with autoimmune hemolytic anemia prolonged cholestasis and false positive igm anti hev .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: coinfection of hepatitis a virus genotype ia and iiia complicated with autoimmune hemolytic anemia prolonged cholestasis and false positive immunoglobulin m anti hepatitis e virus a case report . a 37 year old male presented with fever and jaundice was diagnosed as hepatitis a complicated with progressive cholestasis and severe autoimmune hemolytic anemia . he was treated with high dose prednisolone _decnum_ mg kg and eventually recovered . his initial serum contained genotype ia hepatitis a virus hav which was subsequently replaced by genotype iiia hav . moreover at the time of development of hemolytic anemia he became positive for immunoglobulin m igm anti hepatitis e virus hev . we detected hav antigens in the liver biopsy specimen while we detected neither hev antigen in the liver nor hev rna in his serum . this is the first report of hepatitis a coinfected with two different genotypes manifesting with autoimmune hemolytic anemia prolonged cholestasis and false positive igm anti hev . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

do everything . a 57 year old with an incurable cancer suffered an abdominal catastrophe putting him in the icu comatose with no chance of survival . his attending oncologist had only met him once and had no knowledge of his goals of care . lacking an advance directive the staff turned to his family who said quot do everything . quot this loaded statement was thought to be a demand for futile care even though it ultimately proved a reflection of their emotional response to a terrible unanticipated event not an irrational demand for useless care . a sympathetic exploration of the patient goals and expectations with his family using buckman spikes format disclosed that their major concern was that he not die on his wife birthday . the family agreed to withdraw him from ventilator support the following day . unraveling a medical conflict requires a sensitive process of shared decision making based on a transparent process of clinical reasoning that synthesizes patient and family values with medical knowledge and ethical duties . properly done the outcome usually is a satisfactory experience for all concerned .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: do everything . a 57 year old with an incurable cancer suffered an abdominal catastrophe putting him in the icu comatose with no chance of survival . his attending oncologist had only met him once and had no knowledge of his goals of care . lacking an advance directive the staff turned to his family who said quot do everything . quot this loaded statement was thought to be a demand for futile care even though it ultimately proved a reflection of their emotional response to a terrible unanticipated event not an irrational demand for useless care . a sympathetic exploration of the patient goals and expectations with his family using buckman spikes format disclosed that their major concern was that he not die on his wife birthday . the family agreed to withdraw him from ventilator support the following day . unraveling a medical conflict requires a sensitive process of shared decision making based on a transparent process of clinical reasoning that synthesizes patient and family values with medical knowledge and ethical duties . properly done the outcome usually is a satisfactory experience for all concerned . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

pathophysiology of hnpp explored using axonal excitability . objective hereditary liability to pressure palsies hnpp is an autosomal dominant disorder of myelination resulting in susceptibility to pressure palsies from compression or stretching of peripheral nerves . patients and methods this study examined axonal excitability at two sites one distal and one proximal in five patients with biopsy and genetically proven hnpp to understand the pathophysiology of the disease . comparisons were made with age matched control subjects as well as five charcot marie tooth type
 patients to contrast the findings and explain the different phenotypes of diseases affecting the same gene . results changes in axonal excitability were found in hnpp subjects but these were not uniform along the nerve at the wrist there were prominent alterations in threshold electrotonus whereas at the elbow there were only subtle alterations in the recovery cycle and the response to strong long lasting hyperpolarisation . threshold was raised at both sites but the nerves were probably not hyperpolarised . not unexpectedly changes in cmt
 subjects were more marked than those in hnpp subjects and were uniform along the nerve . conclusions structural abnormalities at the node of ranvier are sufficient to explain the changes in axonal excitability in hnpp and these abnormalities would predispose the nerves to conduction block when subjected to pressure or stretch .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: pathophysiology of hnpp explored using axonal excitability . objective hereditary liability to pressure palsies hnpp is an autosomal dominant disorder of myelination resulting in susceptibility to pressure palsies from compression or stretching of peripheral nerves . patients and methods this study examined axonal excitability at two sites one distal and one proximal in five patients with biopsy and genetically proven hnpp to understand the pathophysiology of the disease . comparisons were made with age matched control subjects as well as five charcot marie tooth type
 patients to contrast the findings and explain the different phenotypes of diseases affecting the same gene . results changes in axonal excitability were found in hnpp subjects but these were not uniform along the nerve at the wrist there were prominent alterations in threshold electrotonus whereas at the elbow there were only subtle alterations in the recovery cycle and the response to strong long lasting hyperpolarisation . threshold was raised at both sites but the nerves were probably not hyperpolarised . not unexpectedly changes in cmt
 subjects were more marked than those in hnpp subjects and were uniform along the nerve . conclusions structural abnormalities at the node of ranvier are sufficient to explain the changes in axonal excitability in hnpp and these abnormalities would predispose the nerves to conduction block when subjected to pressure or stretch . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

atypical abdominal lacerated wound differentiation from an incised wound . in the department of forensic medicine medical university in lodz there was performed an autopsy of a man with an extensive defect of the abdominal integument and perineum . the inspection of the body at the site it was found together with the deposition of the deceased man concubine suggested the possibility of criminal degloving of the body using a sharp edged tool with superimposed injuries inflicted by a dog . autopsy findings combined with results of additional tests microscopic examination of tissue sections ethyl alcohol level determination allowed for verification of the investigation hypothesis exclusion of a criminal act and demonstrating dog inflicted injuries as the cause of death .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: atypical abdominal lacerated wound differentiation from an incised wound . in the department of forensic medicine medical university in lodz there was performed an autopsy of a man with an extensive defect of the abdominal integument and perineum . the inspection of the body at the site it was found together with the deposition of the deceased man concubine suggested the possibility of criminal degloving of the body using a sharp edged tool with superimposed injuries inflicted by a dog . autopsy findings combined with results of additional tests microscopic examination of tissue sections ethyl alcohol level determination allowed for verification of the investigation hypothesis exclusion of a criminal act and demonstrating dog inflicted injuries as the cause of death . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

pharmaceutical care for a patient with warfarin induced autoimmune hepatitis . here we reported a patient with warfarin induced autoimmune hepatitis aih and explored new concerns for the pharmaceutical care of warfarin . a 57 year old woman was admitted to hospital for repeated anorexia abdominal pain and abnormal liver function . she received prosthetic heart valve replacement because of rheumatic heart disease and had started warfarin medication since 2 years before . her liver function was elevated with highest alanine aminotransferase _lgnum_ u l aspertate aminotransferase _lgnum_ u l and total bilirubin _decnum_ mol
her anticoagulant therapy was switched to low molecular weight heparin and the liver function returned to normal . the liver function was elevated when she started to take warfarin again . the patient was then on liver protection therapy and warfarin was stopped again for the liver biopsy for diagnosis reason . through medication consultation and evaluation pharmacists were invited to work together with the physicians and helped to differentiate the reason for abnormal liver function and provided therapeutic suggestions . also the pharmacists gained experiences in the treatment of aih and discovered a new and severe adverse drug reaction for warfarin . in treating this case the pharmacists active involvement into the treatment and evaluation of the effect on the patient reflected the advantage and importance of the multidisciplinary cooperation for pharmacists and physicians when complex diseases are faced .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: pharmaceutical care for a patient with warfarin induced autoimmune hepatitis . here we reported a patient with warfarin induced autoimmune hepatitis aih and explored new concerns for the pharmaceutical care of warfarin . a 57 year old woman was admitted to hospital for repeated anorexia abdominal pain and abnormal liver function . she received prosthetic heart valve replacement because of rheumatic heart disease and had started warfarin medication since 2 years before . her liver function was elevated with highest alanine aminotransferase _lgnum_ u l aspertate aminotransferase _lgnum_ u l and total bilirubin _decnum_ mol
her anticoagulant therapy was switched to low molecular weight heparin and the liver function returned to normal . the liver function was elevated when she started to take warfarin again . the patient was then on liver protection therapy and warfarin was stopped again for the liver biopsy for diagnosis reason . through medication consultation and evaluation pharmacists were invited to work together with the physicians and helped to differentiate the reason for abnormal liver function and provided therapeutic suggestions . also the pharmacists gained experiences in the treatment of aih and discovered a new and severe adverse drug reaction for warfarin . in treating this case the pharmacists active involvement into the treatment and evaluation of the effect on the patient reflected the advantage and importance of the multidisciplinary cooperation for pharmacists and physicians when complex diseases are faced . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

a case report of gender dysphoria with morbid jealousy in a natal female . gender dysphoria is a new entity introduced in the diagnostic and statistical manual of mental disorder v to address the distress of the previously labeled gender identity disorder patients . it is less commonly seen in natal females often starting in their childhood . adults and adolescent natal females with early onset gender dysphoria are almost always gynephilic . this case report is presented to discuss the interesting evolution of the symptoms in gender dysphoria case with difficulties in adjusting to the assigned sexual role relationship problems morbid jealousy and severe depressive features with suicidal ideations .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: a case report of gender dysphoria with morbid jealousy in a natal female . gender dysphoria is a new entity introduced in the diagnostic and statistical manual of mental disorder v to address the distress of the previously labeled gender identity disorder patients . it is less commonly seen in natal females often starting in their childhood . adults and adolescent natal females with early onset gender dysphoria are almost always gynephilic . this case report is presented to discuss the interesting evolution of the symptoms in gender dysphoria case with difficulties in adjusting to the assigned sexual role relationship problems morbid jealousy and severe depressive features with suicidal ideations . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

porphyria cutanea tarda masquerading as epidermolysis bullosa acquisita a report of two cases . porphyria cutanea tarda pct is the most common type of porphyria worldwide and is often initially diagnosed when cutaneous manifestations arise . we present two patients where misdiagnosis of pct occurred due to the condition masquerading as epidermolysis bullosa acquisita histologically . in patients with undifferentiated bullous erosive skin conditions occurring in photo distributed regions pct should be considered in the differential diagnosis irrespective of histopathological findings on biopsies and further investigated and treated appropriately .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: porphyria cutanea tarda masquerading as epidermolysis bullosa acquisita a report of two cases . porphyria cutanea tarda pct is the most common type of porphyria worldwide and is often initially diagnosed when cutaneous manifestations arise . we present two patients where misdiagnosis of pct occurred due to the condition masquerading as epidermolysis bullosa acquisita histologically . in patients with undifferentiated bullous erosive skin conditions occurring in photo distributed regions pct should be considered in the differential diagnosis irrespective of histopathological findings on biopsies and further investigated and treated appropriately . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

severe thrombocytopenia in a patient with hepatitis c treated with eltrombopag from off label drug use to on label drug use a case report . introduction off label drug use refers to drug use beyond the specifications authorized for marketing . eltrombopag is a new thrombopoietin receptor agonist which was used successfully in this critical case of thrombocytopenia associated with hepatitis c infection before it became an approved drug for such cases . case presentation a 56 year old kuwaiti woman with hepatitis c virus infection was treated with pegylated interferon
 and ribavirin laboratory test results prior to therapy were within normal values . after 4 weeks of that treatment she developed neutropenia and severe thrombocytopenia . her hepatitis c virus treatment was stopped for many years until eltrombopag was used as an off label drug with an episode of severe thrombocytopenia . her platelets count returned to normal level when triple therapy for hepatitis c virus was used successfully . conclusions an off label drug should be used only when it is the best available drug based on evidence from on going multicenter trials . it could be life saving for some patients in critical situations . however clinical use of eltrombopag later confirmed that it is a safe and effective drug for immune thrombocytopenic purpura or thrombocytopenia associated with hepatitis c virus infection .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: severe thrombocytopenia in a patient with hepatitis c treated with eltrombopag from off label drug use to on label drug use a case report . introduction off label drug use refers to drug use beyond the specifications authorized for marketing . eltrombopag is a new thrombopoietin receptor agonist which was used successfully in this critical case of thrombocytopenia associated with hepatitis c infection before it became an approved drug for such cases . case presentation a 56 year old kuwaiti woman with hepatitis c virus infection was treated with pegylated interferon
 and ribavirin laboratory test results prior to therapy were within normal values . after 4 weeks of that treatment she developed neutropenia and severe thrombocytopenia . her hepatitis c virus treatment was stopped for many years until eltrombopag was used as an off label drug with an episode of severe thrombocytopenia . her platelets count returned to normal level when triple therapy for hepatitis c virus was used successfully . conclusions an off label drug should be used only when it is the best available drug based on evidence from on going multicenter trials . it could be life saving for some patients in critical situations . however clinical use of eltrombopag later confirmed that it is a safe and effective drug for immune thrombocytopenic purpura or thrombocytopenia associated with hepatitis c virus infection . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

fibrocartilaginous mesenchymoma a unique osseous lesion case report with review of the literature . fibrocartilaginous mesenchymoma is a rare osseous tumor that primarily arises in the long bones of children and adolescents . this lesion can grow quickly and reach a considerable size despite its benign nature . it has proved challenging to diagnose and can be mistaken for a spectrum of benign and malignant bone tumors . the histological presentation of unique epiphyseal plate like cartilage with destruction of the surrounding cortical bone and exhibition of dense fibrous stroma are important indicators for the diagnosis of fibrocartilaginous mesenchymoma . an 11 year old boy presented with a left proximal humerus mass thought to be an aneurysmal bone cyst . the patient was lost to follow up and came back 3 years later with massive growth of the lesion . owing to the aggressive nature of the tumor a left forequarter amputation was performed . histological examination demonstrated numerous islands of cartilage with an exuberant spindle cell component characteristic of fcm . no distant metastases or local recurrences were identified at 2 years post amputation . because of the rapid growth of this lesion it should be considered in the differential diagnosis of bone lesions in children and young adults .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: fibrocartilaginous mesenchymoma a unique osseous lesion case report with review of the literature . fibrocartilaginous mesenchymoma is a rare osseous tumor that primarily arises in the long bones of children and adolescents . this lesion can grow quickly and reach a considerable size despite its benign nature . it has proved challenging to diagnose and can be mistaken for a spectrum of benign and malignant bone tumors . the histological presentation of unique epiphyseal plate like cartilage with destruction of the surrounding cortical bone and exhibition of dense fibrous stroma are important indicators for the diagnosis of fibrocartilaginous mesenchymoma . an 11 year old boy presented with a left proximal humerus mass thought to be an aneurysmal bone cyst . the patient was lost to follow up and came back 3 years later with massive growth of the lesion . owing to the aggressive nature of the tumor a left forequarter amputation was performed . histological examination demonstrated numerous islands of cartilage with an exuberant spindle cell component characteristic of fcm . no distant metastases or local recurrences were identified at 2 years post amputation . because of the rapid growth of this lesion it should be considered in the differential diagnosis of bone lesions in children and young adults . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

shwachman diamond syndrome with autoimmune like liver disease and enteropathy mimicking celiac disease . liver abnormalities that normalize during infancy as well an enteropathy are reported in shwachman diamond syndrome sds . the pathogenesis of both conditions is unknown . we report two sds cases with autoimmune like antismooth muscle and or antinuclear antibody positivity liver disease and antigliadin antibody positive inflammatory enteropathy . hypertransaminasemia did not resolve after immunosuppressive therapy and or a gluten free diet . these transient autoimmune phenomena and gut liver axis perturbations may have played a role in transient sds hepatopathy and enteropathy . our report may stimulate other studies to define the relationship between the sds genetic defect and intestinal permeability as the pathogenic mechanism underlying sds related liver and intestinal inflammation .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: shwachman diamond syndrome with autoimmune like liver disease and enteropathy mimicking celiac disease . liver abnormalities that normalize during infancy as well an enteropathy are reported in shwachman diamond syndrome sds . the pathogenesis of both conditions is unknown . we report two sds cases with autoimmune like antismooth muscle and or antinuclear antibody positivity liver disease and antigliadin antibody positive inflammatory enteropathy . hypertransaminasemia did not resolve after immunosuppressive therapy and or a gluten free diet . these transient autoimmune phenomena and gut liver axis perturbations may have played a role in transient sds hepatopathy and enteropathy . our report may stimulate other studies to define the relationship between the sds genetic defect and intestinal permeability as the pathogenic mechanism underlying sds related liver and intestinal inflammation . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

recurrent kaposi sarcoma associated with koebner phenomenon in two hiv seronegative patients two case reports and a review of the literature . rationale koebner phenomenon is occasionally reported in patients affected by classic kaposi sarcoma ks . patient concerns here we report 2 cases of ks associated with koebner phenomenon and the correlation of human herpesvirus 8 molecular analysis with the clinical outcome . interventions in the first case a patient with a history of sporadic cutaneous ks developed a recurrent lesion at the laryngeal tract the site of a previous nodulectomy . in our second case immunodeficiency induced by chemotherapy triggered the development of ks and koebner phenomenon was limited to the skin at the site of safenectomy . lessons our observations suggest that careful planning of surgical treatment is required in immunocompetent and immunocompromised patients with a medical history of ks . moreover mucosal sites both respiratory and in the gastrointestinal tract should be considered as potential sites for ks development .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: recurrent kaposi sarcoma associated with koebner phenomenon in two hiv seronegative patients two case reports and a review of the literature . rationale koebner phenomenon is occasionally reported in patients affected by classic kaposi sarcoma ks . patient concerns here we report 2 cases of ks associated with koebner phenomenon and the correlation of human herpesvirus 8 molecular analysis with the clinical outcome . interventions in the first case a patient with a history of sporadic cutaneous ks developed a recurrent lesion at the laryngeal tract the site of a previous nodulectomy . in our second case immunodeficiency induced by chemotherapy triggered the development of ks and koebner phenomenon was limited to the skin at the site of safenectomy . lessons our observations suggest that careful planning of surgical treatment is required in immunocompetent and immunocompromised patients with a medical history of ks . moreover mucosal sites both respiratory and in the gastrointestinal tract should be considered as potential sites for ks development . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

renal cell carcinoma presenting as mandibular metastasis . renal clear cell carcinoma rcc has different manifestations including uncommon metastasis and paraneoplastic syndromes . here we report a rare case of rcc presenting as metastasis to the mandible . a 57 year old patient with mandibular swelling was referred to the dentist . after necessary evaluations an incisional biopsy of mandible showed metastatic rcc . the patient was referred to the urologist . the patient underwent right radical nephrectomy . pathological examination showed clear renal cell carcinoma . every abnormal bone lesion in the oral cavity should be evaluated carefully and the possibility of a malignant lesion should always be considered .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: renal cell carcinoma presenting as mandibular metastasis . renal clear cell carcinoma rcc has different manifestations including uncommon metastasis and paraneoplastic syndromes . here we report a rare case of rcc presenting as metastasis to the mandible . a 57 year old patient with mandibular swelling was referred to the dentist . after necessary evaluations an incisional biopsy of mandible showed metastatic rcc . the patient was referred to the urologist . the patient underwent right radical nephrectomy . pathological examination showed clear renal cell carcinoma . every abnormal bone lesion in the oral cavity should be evaluated carefully and the possibility of a malignant lesion should always be considered . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

lichen striatus like eruption in an adult following hepatitis b vaccination a case report and review of the literature . lichen striatus is a rare inflammatory dermatosis that follows the lines of blaschko . this paper discusses an unusual presentation of lichen striatus following hepatitis b vaccination and reviews the literature of vaccine induced lichen striatus .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: lichen striatus like eruption in an adult following hepatitis b vaccination a case report and review of the literature . lichen striatus is a rare inflammatory dermatosis that follows the lines of blaschko . this paper discusses an unusual presentation of lichen striatus following hepatitis b vaccination and reviews the literature of vaccine induced lichen striatus . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

fatal rhabdomyolysis in a patient with liver cirrhosis after switching from simvastatin to fluvastatin . hmg coa reductase inhibitors statins are widely used to treat hypercholesterolemia . among the adverse effects associated with these drugs are statin associated myopathies ranging from asymptomatic elevation of serum creatine kinase to fatal rhabdomyolysis . fluvastatin induced fatal rhabdomyolysis has not been previously reported . we describe here a patient with liver cirrhosis who experienced fluvastatin induced fatal rhabdomyolysis . this patient had been treated with simvastatin 20 mg day for coronary artery disease and was switched to fluvastatin 20 mg day 10 days before admission . he was also taking aspirin betaxolol candesartan lactulose and entecavir . rhabdomyolysis was complicated and continued to progress . he was treated with massive hydration urine alkalization intravenous furosemide and continuous renal replacement therapy for acute renal failure but eventually died due to rhabdomyolysis complicated by hepatic failure . in conclusion fluvastatin should be used with caution in patients with liver cirrhosis especially with other medications metabolized with cyp
9 .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: fatal rhabdomyolysis in a patient with liver cirrhosis after switching from simvastatin to fluvastatin . hmg coa reductase inhibitors statins are widely used to treat hypercholesterolemia . among the adverse effects associated with these drugs are statin associated myopathies ranging from asymptomatic elevation of serum creatine kinase to fatal rhabdomyolysis . fluvastatin induced fatal rhabdomyolysis has not been previously reported . we describe here a patient with liver cirrhosis who experienced fluvastatin induced fatal rhabdomyolysis . this patient had been treated with simvastatin 20 mg day for coronary artery disease and was switched to fluvastatin 20 mg day 10 days before admission . he was also taking aspirin betaxolol candesartan lactulose and entecavir . rhabdomyolysis was complicated and continued to progress . he was treated with massive hydration urine alkalization intravenous furosemide and continuous renal replacement therapy for acute renal failure but eventually died due to rhabdomyolysis complicated by hepatic failure . in conclusion fluvastatin should be used with caution in patients with liver cirrhosis especially with other medications metabolized with cyp
9 . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

occasional spontaneous clearance of chronic hepatitis c virus in hiv infected individuals . the il2
 genotype has been found to have a strong influence on spontaneous clearance of acute hcv both in hcv mono and hiv the hcv co infected patients . spontaneous clearance of chronic hcv without hcv treatment is rare . here we report on three chronic hcv cases co infected with hiv with spontaneous clearance of their hcv infection all with the il2
 cc genotype . these cases were derived from a surveillance of the total hiv hcv co infected cohort in sweden n 4 66 . the estimated frequency of spontaneous clearance of chronic hcv infection in our cohort was calculated to be _decnum_ _decnum_ . our cases lend some support to the initiation of art prior to hcv treatment in hiv hcv co infected patients . furthermore hcv rna testing should be recommended immediately before initiation of hcv treatment to find the subset of hiv hcv co infected patients with il2
 cc that may have cleared their chronic infection spontaneously .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: occasional spontaneous clearance of chronic hepatitis c virus in hiv infected individuals . the il2
 genotype has been found to have a strong influence on spontaneous clearance of acute hcv both in hcv mono and hiv the hcv co infected patients . spontaneous clearance of chronic hcv without hcv treatment is rare . here we report on three chronic hcv cases co infected with hiv with spontaneous clearance of their hcv infection all with the il2
 cc genotype . these cases were derived from a surveillance of the total hiv hcv co infected cohort in sweden n 4 66 . the estimated frequency of spontaneous clearance of chronic hcv infection in our cohort was calculated to be _decnum_ _decnum_ . our cases lend some support to the initiation of art prior to hcv treatment in hiv hcv co infected patients . furthermore hcv rna testing should be recommended immediately before initiation of hcv treatment to find the subset of hiv hcv co infected patients with il2
 cc that may have cleared their chronic infection spontaneously . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

nucleotide polymorphisms in the 5 utr region of hcv can affect the ability of two widely used assays to assign an hcv genotype . determination of hepatitis c virus genotype is crucial for establishing the duration of antiviral therapy and predicts response to treatment . in this study consecutive serum samples collected from two patients with chronic hepatitis c infection were tested by two assays used widely the abbott realtime hcv genotype ii and the versant hcv genotype _decnum_ assays in order to assign a genotype to the virus . the obtained results were verified by phylogenetic analysis of the ns
 region and sequencing of the 5 utr of the viral genome . testing of the serum samples from both patients gave an indeterminate result with the abbott assay . by contrast the versant assay gave an indeterminate result for one patient and identified an hcv
 subtype in the other patient . phylogenetic analysis of the ns
 region confirmed the presence of hcv
 in this latter patient and disclosed the presence of hcv
 in the other patient . sequencing of the 5 utr revealed the presence of nucleotide changes at positions _lgnum_ and _lgnum_ of hcv
 and at positions _lgnum_ _lgnum_ and 99 of hcv
 . nucleotide mutations located in the 5 untraslated region of hepatitis c virus may impair the ability of commercial assays to assign an hcv genotype .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: nucleotide polymorphisms in the 5 utr region of hcv can affect the ability of two widely used assays to assign an hcv genotype . determination of hepatitis c virus genotype is crucial for establishing the duration of antiviral therapy and predicts response to treatment . in this study consecutive serum samples collected from two patients with chronic hepatitis c infection were tested by two assays used widely the abbott realtime hcv genotype ii and the versant hcv genotype _decnum_ assays in order to assign a genotype to the virus . the obtained results were verified by phylogenetic analysis of the ns
 region and sequencing of the 5 utr of the viral genome . testing of the serum samples from both patients gave an indeterminate result with the abbott assay . by contrast the versant assay gave an indeterminate result for one patient and identified an hcv
 subtype in the other patient . phylogenetic analysis of the ns
 region confirmed the presence of hcv
 in this latter patient and disclosed the presence of hcv
 in the other patient . sequencing of the 5 utr revealed the presence of nucleotide changes at positions _lgnum_ and _lgnum_ of hcv
 and at positions _lgnum_ _lgnum_ and 99 of hcv
 . nucleotide mutations located in the 5 untraslated region of hepatitis c virus may impair the ability of commercial assays to assign an hcv genotype . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

relationship of recovered hepatitis b infection with appearance of toxic propylthiouracil hepatitis . aim to investigate the relationship between recovered hepatitis b infection with appearance of toxic propylthiouracil ptu hepatitis and point out the growing importance of the use of drugs in the development of hepatitis . methods a case of a 45 year old female patient with suspicion of acute viral hepatitis who had polypragmasy of drugs in the last ten years due to the polymorphism of symptoms illnesses diabetes mellitus depression hypertension hypothyroidism was presented . results a female patient had hyperthyroidism after resolved viral hepatitis b with hbsag seroconversion hbsag negative antihbs positive . ptu had the greatest potential for hepatotoxicity of all administered drugs . after corticosteroid therapy there was a significant improvement in liver function tests . in the course of the disease there was no change of hepatitis markers and exacerbations of hepatitis
conclusion clinical practice should comprehensively monitor the effects of the intricate and tight connection between drugs liver and endocrine system in order to better resolve all manifestations complications and worsening of one or another organic system .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: relationship of recovered hepatitis b infection with appearance of toxic propylthiouracil hepatitis . aim to investigate the relationship between recovered hepatitis b infection with appearance of toxic propylthiouracil ptu hepatitis and point out the growing importance of the use of drugs in the development of hepatitis . methods a case of a 45 year old female patient with suspicion of acute viral hepatitis who had polypragmasy of drugs in the last ten years due to the polymorphism of symptoms illnesses diabetes mellitus depression hypertension hypothyroidism was presented . results a female patient had hyperthyroidism after resolved viral hepatitis b with hbsag seroconversion hbsag negative antihbs positive . ptu had the greatest potential for hepatotoxicity of all administered drugs . after corticosteroid therapy there was a significant improvement in liver function tests . in the course of the disease there was no change of hepatitis markers and exacerbations of hepatitis
conclusion clinical practice should comprehensively monitor the effects of the intricate and tight connection between drugs liver and endocrine system in order to better resolve all manifestations complications and worsening of one or another organic system . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

genetic characterization of a novel unique recombinant form of hiv 1 originating from subtype a1 and c in guangdong province china . the dominant human immunodeficiency virus type 1 hiv 1 subtypes are crf01_ae crf07_bc and crf08_bc in guangdong province china . in this study we report a unique recombinant form urf of hiv 1 that was identified in an hiv hepatitis b virus hbv hepatitis c virus hcv triple infected patient who was an intravenous drug user idu in heyuan city guangdong province . the near full length genome was amplified and the pcr products were sequenced by sanger method . the recombination identification program rip _decnum_ and jphmm online tools showed that four subtype c fragments were inserted into the a1 backbone genome in the gag pol vpr and nef gene regions . in the phylogenetic tree analysis the subtype a1 and c fragments clustered with hiv 1 a1 and c reference sequences respectively . no similar breakpoints between our strain and the other strains in the los alamos hiv database were observed . the results of evolutionary analysis using beast software showed that the subtype a1 fragment originated from guangzhou city china however the subtype c fragment originated from east africa . this is the first report of hiv 1 urf a
 in guangdong province china . the identification of this urf suggested that further dynamic surveillance of new recombinant forms is needed .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: genetic characterization of a novel unique recombinant form of hiv 1 originating from subtype a1 and c in guangdong province china . the dominant human immunodeficiency virus type 1 hiv 1 subtypes are crf01_ae crf07_bc and crf08_bc in guangdong province china . in this study we report a unique recombinant form urf of hiv 1 that was identified in an hiv hepatitis b virus hbv hepatitis c virus hcv triple infected patient who was an intravenous drug user idu in heyuan city guangdong province . the near full length genome was amplified and the pcr products were sequenced by sanger method . the recombination identification program rip _decnum_ and jphmm online tools showed that four subtype c fragments were inserted into the a1 backbone genome in the gag pol vpr and nef gene regions . in the phylogenetic tree analysis the subtype a1 and c fragments clustered with hiv 1 a1 and c reference sequences respectively . no similar breakpoints between our strain and the other strains in the los alamos hiv database were observed . the results of evolutionary analysis using beast software showed that the subtype a1 fragment originated from guangzhou city china however the subtype c fragment originated from east africa . this is the first report of hiv 1 urf a
 in guangdong province china . the identification of this urf suggested that further dynamic surveillance of new recombinant forms is needed . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

non o1 non o139 vibrio cholerae bacteremic skin and soft tissue infections . background non o1 non o139 vibrio cholerae can cause sporadic cases of gastroenteritis and extra intestinal invasive infections following exposure to contaminated seawater or freshwater or after consumption of raw seafood . bacteremic infections with skin and soft tissue manifestations are uncommon and in most cases are associated with liver cirrhosis haematologic malignancies diabetes mellitus and other immunosuppressed conditions . methods the medical literature was reviewed and we found 47 published cases of non o1 non o139 vibrio cholerae bacteremic skin and soft tissue infections . a fatal case of bacteremia with bullous cellulitis in a 43 year old patient with liver cirrhosis is described which is the first reported in greece . results from january _lgnum_ to may _lgnum_ a total of 48 patients with non o1 non o139 vibrio cholerae bacteremia with skin and soft tissue infections were reported . males predominated . liver cirrhosis chronic liver disease and alcohol abuse were common comorbidities . the soft tissue lesions most commonly described were localised cellulitis with or without bullous and haemorrhagic lesions _decnum_ while necrotising fasciitis was more rare _decnum_ . of the 48 patients with non o1 non o139
cholerae bacteremic skin and soft tissue infections 20 _decnum_ died despite treatment . conclusion although rarely encountered non o1 non o139 vibrio cholerae should be included in the differential diagnosis of bacteremic skin and soft tissue infections in patients with underlying illnesses and epidemiologic risk factors . timely and appropriate antibiotic and surgical treatments are important in the management of the infection .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: non o1 non o139 vibrio cholerae bacteremic skin and soft tissue infections . background non o1 non o139 vibrio cholerae can cause sporadic cases of gastroenteritis and extra intestinal invasive infections following exposure to contaminated seawater or freshwater or after consumption of raw seafood . bacteremic infections with skin and soft tissue manifestations are uncommon and in most cases are associated with liver cirrhosis haematologic malignancies diabetes mellitus and other immunosuppressed conditions . methods the medical literature was reviewed and we found 47 published cases of non o1 non o139 vibrio cholerae bacteremic skin and soft tissue infections . a fatal case of bacteremia with bullous cellulitis in a 43 year old patient with liver cirrhosis is described which is the first reported in greece . results from january _lgnum_ to may _lgnum_ a total of 48 patients with non o1 non o139 vibrio cholerae bacteremia with skin and soft tissue infections were reported . males predominated . liver cirrhosis chronic liver disease and alcohol abuse were common comorbidities . the soft tissue lesions most commonly described were localised cellulitis with or without bullous and haemorrhagic lesions _decnum_ while necrotising fasciitis was more rare _decnum_ . of the 48 patients with non o1 non o139
cholerae bacteremic skin and soft tissue infections 20 _decnum_ died despite treatment . conclusion although rarely encountered non o1 non o139 vibrio cholerae should be included in the differential diagnosis of bacteremic skin and soft tissue infections in patients with underlying illnesses and epidemiologic risk factors . timely and appropriate antibiotic and surgical treatments are important in the management of the infection . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

anti p200 pemphigoid remission under mycophenolate mofetil cellcept . background anti p200 pemphigoid is a recently described autoimmune subepidermal bullous dermatosis characterized by its target antigen and the associated anatomoclinical picture . the treatment is not as yet well defined . patient and methods a 73 year old man consulted for a pruritic bullous eruption with buccal involvement . direct immunofluorescence revealed linear deposits of igg and c3 at the dermal epidermal junction . elisa screening for circulating anti bp180 and anti bp230 antibodies was negative . a diagnosis of bullous pemphigoid was suspected . after an unfavourable clinical outcome under clobetasol and then prednisolone and methotrexate other immunological tests were performed . indirect immunofluorescence on nacl cleaved skin revealed a deposit of igg4 antibodies on the dermal side . immunoblotting showed antibodies directed against a _lgnum_ kda antigen on a dermal extract . a diagnosis of anti p200 pemphigoid was made . the patient was treated with dapsone combined with prednisolone . seventy two hours later treatment was stopped due to hepatic cytolysis related to immunoallergic hepatitis . treatment with mycophenolate mofetil was then initiated and resulted in complete remission which persisted at seven months . discussion the diagnosis of anti p200 pemphigoid was made on the basis of a set of clinical and immunological factors . anti p200 pemphigoid differs from standard bullous pemphigoid in terms of more frequent cephalic acral and mucous membrane involvement as well as a greater degree of miliary scarring . there was no eosinophilia . elisa screening for anti bp180 and anti bp230 antibodies was negative . immunoblotting showed antibodies directed against a 20
da protein on dermal extract . the treatment is not well defined even if dapsone appears to be the most effective therapy . to our knowledge our patient is the first to be successfully treated with mycophenolate mofetil . conclusion treatment of anti p200 pemphigoid is difficult . in our case treatment by mycophenolate mofetil was effective and could offer an alternative to dapsone .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: anti p200 pemphigoid remission under mycophenolate mofetil cellcept . background anti p200 pemphigoid is a recently described autoimmune subepidermal bullous dermatosis characterized by its target antigen and the associated anatomoclinical picture . the treatment is not as yet well defined . patient and methods a 73 year old man consulted for a pruritic bullous eruption with buccal involvement . direct immunofluorescence revealed linear deposits of igg and c3 at the dermal epidermal junction . elisa screening for circulating anti bp180 and anti bp230 antibodies was negative . a diagnosis of bullous pemphigoid was suspected . after an unfavourable clinical outcome under clobetasol and then prednisolone and methotrexate other immunological tests were performed . indirect immunofluorescence on nacl cleaved skin revealed a deposit of igg4 antibodies on the dermal side . immunoblotting showed antibodies directed against a _lgnum_ kda antigen on a dermal extract . a diagnosis of anti p200 pemphigoid was made . the patient was treated with dapsone combined with prednisolone . seventy two hours later treatment was stopped due to hepatic cytolysis related to immunoallergic hepatitis . treatment with mycophenolate mofetil was then initiated and resulted in complete remission which persisted at seven months . discussion the diagnosis of anti p200 pemphigoid was made on the basis of a set of clinical and immunological factors . anti p200 pemphigoid differs from standard bullous pemphigoid in terms of more frequent cephalic acral and mucous membrane involvement as well as a greater degree of miliary scarring . there was no eosinophilia . elisa screening for anti bp180 and anti bp230 antibodies was negative . immunoblotting showed antibodies directed against a 20
da protein on dermal extract . the treatment is not well defined even if dapsone appears to be the most effective therapy . to our knowledge our patient is the first to be successfully treated with mycophenolate mofetil . conclusion treatment of anti p200 pemphigoid is difficult . in our case treatment by mycophenolate mofetil was effective and could offer an alternative to dapsone . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

interleukin 2 receptor antagonist immunosuppression and consecutive viral management in living donor liver transplantation for human immunodeficiency virus hepatitis c co infected patients a report of 2 cases . management of immunosuppression for human immunodeficiency virus hepatitis c hiv hcv in living donor liver transplantation ldlt has not been established . we performed ldlt for two patients with hiv hcv co infected end stage liver disease . the immunosuppression protocol consisted of early calcineurin inhibitor free and interleukin 2 receptor antagonist il
a induction and methylprednisolone . maintenance low dose tacrolimus was started and anti retroviral therapy for hiv was re started 1 week after ldlt . consecutively pegylated interferon and ribavirin therapy were successfully added as pre emptive therapy for hcv . hiv rna and hcv rna were undetectable on anti retroviral therapy and hcv treatment at 17 and 8 months after ldlt respectively with normal liver function . this study is the first report of early calcineurin inhibitor free and il
a induction with methylprednisolone immunosuppression in ldlt for hiv hcv co infected patients with a favorable outcome . consecutive hiv hcv treatment was well tolerated .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: interleukin 2 receptor antagonist immunosuppression and consecutive viral management in living donor liver transplantation for human immunodeficiency virus hepatitis c co infected patients a report of 2 cases . management of immunosuppression for human immunodeficiency virus hepatitis c hiv hcv in living donor liver transplantation ldlt has not been established . we performed ldlt for two patients with hiv hcv co infected end stage liver disease . the immunosuppression protocol consisted of early calcineurin inhibitor free and interleukin 2 receptor antagonist il
a induction and methylprednisolone . maintenance low dose tacrolimus was started and anti retroviral therapy for hiv was re started 1 week after ldlt . consecutively pegylated interferon and ribavirin therapy were successfully added as pre emptive therapy for hcv . hiv rna and hcv rna were undetectable on anti retroviral therapy and hcv treatment at 17 and 8 months after ldlt respectively with normal liver function . this study is the first report of early calcineurin inhibitor free and il
a induction with methylprednisolone immunosuppression in ldlt for hiv hcv co infected patients with a favorable outcome . consecutive hiv hcv treatment was well tolerated . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

hepatitis e virus associated acute encephalitic parkinsonism . hepatitis e virus hev is a common infection worldwide and is an emerging infectious disease in the developed countries . the unique characteristics of hev is that it displays different epidemiological and clinical characteristics between developing and developed countries . neurological disorders are emerging extra hepatic manifestations of both acute and chronic hepatitis e virus infection . we report a 17 year old sportsman presenting with acute encephalitic parkinsonism concurrent with acute hepatitis . serology was positive for hepatitis e virus hev and hev rna was confirmed . patient improved completely with symptomatic treatment . we suggest offering diagnostic testing for hepatitis e virus in patients of neurological disorders with concurrent liver impairment .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: hepatitis e virus associated acute encephalitic parkinsonism . hepatitis e virus hev is a common infection worldwide and is an emerging infectious disease in the developed countries . the unique characteristics of hev is that it displays different epidemiological and clinical characteristics between developing and developed countries . neurological disorders are emerging extra hepatic manifestations of both acute and chronic hepatitis e virus infection . we report a 17 year old sportsman presenting with acute encephalitic parkinsonism concurrent with acute hepatitis . serology was positive for hepatitis e virus hev and hev rna was confirmed . patient improved completely with symptomatic treatment . we suggest offering diagnostic testing for hepatitis e virus in patients of neurological disorders with concurrent liver impairment . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

a case of wilson disease in an elderly patient initially diagnosed with nash . a 62 year old female was admitted to our hospital for examination of icterus and thrombocytopenia . she had a history of diabetes mellitus under treatment and liver cirrhosis was evident on abdominal ct . because she was clinically obese and had no past history of alcohol consumption the initial diagnosis was nash . however subsequent mri findings and normal serum transaminase levels were not consistent with this diagnosis . we then performed additional examinations including liver biopsy measurements of serum cu and ceruloplasmin concentrations and measurement of urinary cu secretion which resulted in a diagnosis of wilson disease . it is necessary to include wilson disease in the differential diagnosis of nash in cases of unidentified liver disease even among elderly patients .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: a case of wilson disease in an elderly patient initially diagnosed with nash . a 62 year old female was admitted to our hospital for examination of icterus and thrombocytopenia . she had a history of diabetes mellitus under treatment and liver cirrhosis was evident on abdominal ct . because she was clinically obese and had no past history of alcohol consumption the initial diagnosis was nash . however subsequent mri findings and normal serum transaminase levels were not consistent with this diagnosis . we then performed additional examinations including liver biopsy measurements of serum cu and ceruloplasmin concentrations and measurement of urinary cu secretion which resulted in a diagnosis of wilson disease . it is necessary to include wilson disease in the differential diagnosis of nash in cases of unidentified liver disease even among elderly patients . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

local recurrence of pheochromocytoma in multiple endocrine neoplasia type
 a diagnostic and therapeutic challenge . in a patient with multiple endocrine neoplasia type
 men
 an inverted physiological ratio between urinary normetanephrines and metanephrines is an early marker of recurrence in epinephrine secreting pheochromocytoma and 13
 mibg treatment appears to be a useful therapeutic option in order to avoid multiple invasive surgical procedures in pheochromocytomatosis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: local recurrence of pheochromocytoma in multiple endocrine neoplasia type
 a diagnostic and therapeutic challenge . in a patient with multiple endocrine neoplasia type
 men
 an inverted physiological ratio between urinary normetanephrines and metanephrines is an early marker of recurrence in epinephrine secreting pheochromocytoma and 13
 mibg treatment appears to be a useful therapeutic option in order to avoid multiple invasive surgical procedures in pheochromocytomatosis . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

bilateral symmetrical cortical osteolytic lesions in two patients with gaucher disease . gaucher disease gd is an autosomal recessive lysosomal storage disorder characterized by the reduced or absent activity of glucocerebrosidase . the disease is split into three types . type 3 or chronic neuronopathic gd manifests with heterogeneous clinical presentations . skeletal manifestations of gd can include abnormal bone remodeling resulting in the characteristic erlenmeyer flask deformities painful bone crises osteopenia and an increased frequency of fractures . osteolytic lesions can also occur but are rare and tend to be large expanding intramedullary lesions with cortical thinning . we present two adolescent patients with type 3 gd who developed bilateral symmetrical cortical osteolytic lesions . the lesions in both cases demonstrate predominant cortical scalloping with fairly indolent growth . neither patient manifests some of the more common bony manifestations of gd bone crises or osteonecrosis . these atypical and unique skeletal findings in two unrelated probands with type 3 gd further expand the extent of phenotypic variation encountered in this single gene disorder .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: bilateral symmetrical cortical osteolytic lesions in two patients with gaucher disease . gaucher disease gd is an autosomal recessive lysosomal storage disorder characterized by the reduced or absent activity of glucocerebrosidase . the disease is split into three types . type 3 or chronic neuronopathic gd manifests with heterogeneous clinical presentations . skeletal manifestations of gd can include abnormal bone remodeling resulting in the characteristic erlenmeyer flask deformities painful bone crises osteopenia and an increased frequency of fractures . osteolytic lesions can also occur but are rare and tend to be large expanding intramedullary lesions with cortical thinning . we present two adolescent patients with type 3 gd who developed bilateral symmetrical cortical osteolytic lesions . the lesions in both cases demonstrate predominant cortical scalloping with fairly indolent growth . neither patient manifests some of the more common bony manifestations of gd bone crises or osteonecrosis . these atypical and unique skeletal findings in two unrelated probands with type 3 gd further expand the extent of phenotypic variation encountered in this single gene disorder . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

from laparoscopic cholecystectomy to liver transplantation when the gallbladder becomes the pandora s box . bile duct injuries bdi tend to be more complex in laparoscopic than in open cholecystectomy procedures and frequently involve young adults with benign pathologies . the ultimate consequence may be a liver transplantation lt making this situation one of the most rare transplant indications . fatal post transplant outcome is extreme infrequently reported . aim of this study is to report on our single case experience and to review the literature concerning lethal outcome after lt for major bdi following cholecystectomy . a 36 year old obese caucasian woman underwent a laparoscopic cholecystectomy for symptomatic cholecystolithiasis at an outside institution . intraoperatively she sustained an e4 bdi in conjunction with total transection of the right hepatic artery . the surgeon converted to an open laparotomy examined the site placed two drains and immediately transferred the patient to our center for further evaluation and treatment . at relaparotomy a dearterialized right liver as well as 7 bile duct orifices was found a right hemihepatectomy and a roux en y drainage of 4 left sided bile ducts were performed . the postoperative course was complicated by bile leaks requiring re operation and relapsing episodes of cholangitis and intrahepatic bilomas requiring re submissions of the patient and conservative treatment with intravenous antibiotics and percutaneous drainage procedures respectively . she subsequently developed severe endocarditis leading to cardiac mitral and aortic valves insufficiency grade iii and ii respectively demanding mechanical replacement of them . the patient developed secondary biliary cirrhosis was listed to eurotransplant with a model for end stage liver disease score of 39 and underwent lt 19 months after the laparoscopic cholecystectomy . histology of the explanted liver showed 50 parenchymal necrosis chronic cholestasis and cirrhosis . on post transplant day 5 she developed cardiogenic shock associated with pericardial tamponade that despite adequate surgical drainage progressed to multi organ failure and death 2 days later . the two most frequent complications of hepatobiliary surgery that may ultimately require lt are 1 lesions of the bile duct leading to recurrent cholangitis chronic cholestasis and secondary biliary cirrhosis and 2 hilar vascular lesions almost always arterial associated with fulminant hepatic failure . up to date there have been very few publications about lt as a treatment option following major bdi . to the best of our knowledge 4 deaths post lt after major bdi during laparoscopic cholecystectomy are reported in the literature 1 3 table 1 . the indications for lt in these 4 cases were fulminant hepatic failure n 2 2 and secondary biliary cirrhosis n 2 1 3 and the deaths occurred 6 days 1 month 7 and 18 months post operatively respectively . five additional fatal outcomes after lt for secondary biliary cirrhosis after major bdi during open cholecystectomy were reported in the literature 3 5 . four patients died at 7 days 1 month 7 and 8 months post lt respectively 3 4 . the fifth patient died after 2 subsequent transplants for hepatic artery thrombosis unrelated to the initial injury sustained during cholecystectomy 5 . this indeed displeasing analysis of the overall 10 cases shows that despite the very few post transplant fatal outcomes reported in the literature this is a real scenario representing one of the most dreaded outcomes of a seemingly simple procedure such as cholecystectomy .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: from laparoscopic cholecystectomy to liver transplantation when the gallbladder becomes the pandora s box . bile duct injuries bdi tend to be more complex in laparoscopic than in open cholecystectomy procedures and frequently involve young adults with benign pathologies . the ultimate consequence may be a liver transplantation lt making this situation one of the most rare transplant indications . fatal post transplant outcome is extreme infrequently reported . aim of this study is to report on our single case experience and to review the literature concerning lethal outcome after lt for major bdi following cholecystectomy . a 36 year old obese caucasian woman underwent a laparoscopic cholecystectomy for symptomatic cholecystolithiasis at an outside institution . intraoperatively she sustained an e4 bdi in conjunction with total transection of the right hepatic artery . the surgeon converted to an open laparotomy examined the site placed two drains and immediately transferred the patient to our center for further evaluation and treatment . at relaparotomy a dearterialized right liver as well as 7 bile duct orifices was found a right hemihepatectomy and a roux en y drainage of 4 left sided bile ducts were performed . the postoperative course was complicated by bile leaks requiring re operation and relapsing episodes of cholangitis and intrahepatic bilomas requiring re submissions of the patient and conservative treatment with intravenous antibiotics and percutaneous drainage procedures respectively . she subsequently developed severe endocarditis leading to cardiac mitral and aortic valves insufficiency grade iii and ii respectively demanding mechanical replacement of them . the patient developed secondary biliary cirrhosis was listed to eurotransplant with a model for end stage liver disease score of 39 and underwent lt 19 months after the laparoscopic cholecystectomy . histology of the explanted liver showed 50 parenchymal necrosis chronic cholestasis and cirrhosis . on post transplant day 5 she developed cardiogenic shock associated with pericardial tamponade that despite adequate surgical drainage progressed to multi organ failure and death 2 days later . the two most frequent complications of hepatobiliary surgery that may ultimately require lt are 1 lesions of the bile duct leading to recurrent cholangitis chronic cholestasis and secondary biliary cirrhosis and 2 hilar vascular lesions almost always arterial associated with fulminant hepatic failure . up to date there have been very few publications about lt as a treatment option following major bdi . to the best of our knowledge 4 deaths post lt after major bdi during laparoscopic cholecystectomy are reported in the literature 1 3 table 1 . the indications for lt in these 4 cases were fulminant hepatic failure n 2 2 and secondary biliary cirrhosis n 2 1 3 and the deaths occurred 6 days 1 month 7 and 18 months post operatively respectively . five additional fatal outcomes after lt for secondary biliary cirrhosis after major bdi during open cholecystectomy were reported in the literature 3 5 . four patients died at 7 days 1 month 7 and 8 months post lt respectively 3 4 . the fifth patient died after 2 subsequent transplants for hepatic artery thrombosis unrelated to the initial injury sustained during cholecystectomy 5 . this indeed displeasing analysis of the overall 10 cases shows that despite the very few post transplant fatal outcomes reported in the literature this is a real scenario representing one of the most dreaded outcomes of a seemingly simple procedure such as cholecystectomy . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

two cases of transfusion transmitted hepatitis b virus hbv infection in a low endemic country before implementation of hbv nucleic acid testing . background the risk of hepatitis b virus hbv transmission by transfusion is higher than that of other blood borne viruses . in france before the introduction of hbv nucleic acid testing nat in _lgnum_ blood donations were tested for hepatitis b surface antigen hbsag and antibodies against hepatitis b core antigen and the residual risk of hbv transfusion related to preseroconversion acute phase was estimated at _decnum_ per million donations . the additional value of the implementation of a highly sensitive hbv nat to prevent such transmissions is discussed . study design and methods two lookback investigations based on hbv seroconversion of repeat donors were performed . donors and recipients were followed up in multiple samples that were tested for hbv serologic and molecular markers . results the recipients have shown posttransfusion hbsag seroconversion . the archived samples from the implicated donations were positive for hbv dna at extremely low viral load in both cases . hbv isolates from donors and recipients of each case were organized in the same cluster with _lgnum_ identities into genotypes a2 and b4 respectively . one recipient spontaneously recovered from infection while the second was successfully treated . conclusion the present cases highlight the importance of introducing highly sensitive hbv nat to prevent transmission . moreover the lookback studies based on appropriate molecular and serologic investigations of patients transfused with previous donations from newly identified hbv infected repeat donors offer the opportunity to treat a recently infected recipient .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: two cases of transfusion transmitted hepatitis b virus hbv infection in a low endemic country before implementation of hbv nucleic acid testing . background the risk of hepatitis b virus hbv transmission by transfusion is higher than that of other blood borne viruses . in france before the introduction of hbv nucleic acid testing nat in _lgnum_ blood donations were tested for hepatitis b surface antigen hbsag and antibodies against hepatitis b core antigen and the residual risk of hbv transfusion related to preseroconversion acute phase was estimated at _decnum_ per million donations . the additional value of the implementation of a highly sensitive hbv nat to prevent such transmissions is discussed . study design and methods two lookback investigations based on hbv seroconversion of repeat donors were performed . donors and recipients were followed up in multiple samples that were tested for hbv serologic and molecular markers . results the recipients have shown posttransfusion hbsag seroconversion . the archived samples from the implicated donations were positive for hbv dna at extremely low viral load in both cases . hbv isolates from donors and recipients of each case were organized in the same cluster with _lgnum_ identities into genotypes a2 and b4 respectively . one recipient spontaneously recovered from infection while the second was successfully treated . conclusion the present cases highlight the importance of introducing highly sensitive hbv nat to prevent transmission . moreover the lookback studies based on appropriate molecular and serologic investigations of patients transfused with previous donations from newly identified hbv infected repeat donors offer the opportunity to treat a recently infected recipient . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>