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partial homonymous hemianopia of traumatic origin after riding a high speed amusement ride . amusement park injuries have become more common in recent years . especially neurological symptoms dominate clinical findings . in this article the case of a 15 year old child with homonymous hemianopia due to an atypical intracranial bleeding with subdural hematoma after a giant swing ride is described for the first time .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: partial homonymous hemianopia of traumatic origin after riding a high speed amusement ride . amusement park injuries have become more common in recent years . especially neurological symptoms dominate clinical findings . in this article the case of a 15 year old child with homonymous hemianopia due to an atypical intracranial bleeding with subdural hematoma after a giant swing ride is described for the first time . 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>

malignant peripheral nerve sheath tumor arising in a traumatic neuroma a case report . a 67 year old woman with a history of breast cancer presented with a soft tissue mass at the site of a remote non neoplastic lumbar surgery . excisional biopsy revealed a traumatic neuroma . five years later she re presented with a rapidly growing tender nodule at the same site . an excisional biopsy was again performed and revealed a tumor composed of malignant epithelioid and spindle cells merging imperceptibly with residual traumatic neuroma . the malignant cells were positive for vimentin s _lgnum_ and micropthalmia transcription factor . they were negative for cytokeratins muscle markers melan a hmb45 glial fibrillary acidic protein and myelin basic protein . electron microscopy showed no melanosomes . the diagnosis of malignant peripheral nerve sheath tumor arising within a long standing traumatic neuroma was rendered and represents a hitherto unreported origin of this rare aggressive soft tissue sarcoma .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: malignant peripheral nerve sheath tumor arising in a traumatic neuroma a case report . a 67 year old woman with a history of breast cancer presented with a soft tissue mass at the site of a remote non neoplastic lumbar surgery . excisional biopsy revealed a traumatic neuroma . five years later she re presented with a rapidly growing tender nodule at the same site . an excisional biopsy was again performed and revealed a tumor composed of malignant epithelioid and spindle cells merging imperceptibly with residual traumatic neuroma . the malignant cells were positive for vimentin s _lgnum_ and micropthalmia transcription factor . they were negative for cytokeratins muscle markers melan a hmb45 glial fibrillary acidic protein and myelin basic protein . electron microscopy showed no melanosomes . the diagnosis of malignant peripheral nerve sheath tumor arising within a long standing traumatic neuroma was rendered and represents a hitherto unreported origin of this rare aggressive soft tissue sarcoma . 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 technique to fixate dislocated lenticules in complicated descemet stripping automated endothelial keratoplasty . purpose to describe a technique to fixate a dislocated donor lenticule following complicated descemet stripping automated endothelial keratoplasty dsaek when lenticule attachment has not been successful following previous attempts employing air tamponade due to iris defects and posterior capsule ruptures . methods in this technique we fixate the dsaek lenticule at 2 points using partial thickness sutures buried in the recipient corneal stroma . results three complicated dsaek cases were operated by this technique . the lenticules were totally attached and the corneas remained clear up to the last visit 6 months after the last procedure . conclusions our technique is easy to perform and efficient for fixation of detached lenticules and may also be performed primarily to prevent lenticule detachment in complicated dsaek eyes .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: a technique to fixate dislocated lenticules in complicated descemet stripping automated endothelial keratoplasty . purpose to describe a technique to fixate a dislocated donor lenticule following complicated descemet stripping automated endothelial keratoplasty dsaek when lenticule attachment has not been successful following previous attempts employing air tamponade due to iris defects and posterior capsule ruptures . methods in this technique we fixate the dsaek lenticule at 2 points using partial thickness sutures buried in the recipient corneal stroma . results three complicated dsaek cases were operated by this technique . the lenticules were totally attached and the corneas remained clear up to the last visit 6 months after the last procedure . conclusions our technique is easy to perform and efficient for fixation of detached lenticules and may also be performed primarily to prevent lenticule detachment in complicated dsaek eyes . 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>

reactivation of hepatitis b virus without core antibody . we present the case of a male patient not vaccinated against hepatitis b virus hbv and with reactivity to a surface antibody who after immunosuppression for a multiple myeloma had hbv reactivation . pharmacological hbv suppression was tried but viremia could not be suppressed . production detection core mutations or immunity issues can explain this clinical phenomenon .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: reactivation of hepatitis b virus without core antibody . we present the case of a male patient not vaccinated against hepatitis b virus hbv and with reactivity to a surface antibody who after immunosuppression for a multiple myeloma had hbv reactivation . pharmacological hbv suppression was tried but viremia could not be suppressed . production detection core mutations or immunity issues can explain this clinical phenomenon . 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>

generalized posttransplant kaposi sarcoma without mucocutaneous manifestations in the first liver transplantation in an hiv positive patient in poland a case report and review of literature . background kaposi sarcoma ks is the most frequent skin cancer in solid organ recipients and also a typical malignancy in hiv infected persons . case report we describe here a rare case of primary nodal ks without mucocutaneous manifestations diagnosed in a 20 year old hiv hbv co infected patient 12 months after liver transplantation lt the first one performed in a hiv positive patient in poland . the course of the disease was very aggressive the patient died four weeks after general lymphadenopathy appearance . in the autopsy ks infiltration was found in numerous lymph nodes and in the lung apexes without skin or other organs involvement . conclusions in conclusion posttransplant ks may present as general lymphadenopathy without mucocutaneous manifestations thus mimicking posttransplant lymphoproliferative disorder which is often the first clinical suspicion . lymph node histopathological examination is necessary to make the right diagnosis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: generalized posttransplant kaposi sarcoma without mucocutaneous manifestations in the first liver transplantation in an hiv positive patient in poland a case report and review of literature . background kaposi sarcoma ks is the most frequent skin cancer in solid organ recipients and also a typical malignancy in hiv infected persons . case report we describe here a rare case of primary nodal ks without mucocutaneous manifestations diagnosed in a 20 year old hiv hbv co infected patient 12 months after liver transplantation lt the first one performed in a hiv positive patient in poland . the course of the disease was very aggressive the patient died four weeks after general lymphadenopathy appearance . in the autopsy ks infiltration was found in numerous lymph nodes and in the lung apexes without skin or other organs involvement . conclusions in conclusion posttransplant ks may present as general lymphadenopathy without mucocutaneous manifestations thus mimicking posttransplant lymphoproliferative disorder which is often the first clinical suspicion . lymph node histopathological examination is necessary to make the right 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>

gastric cancer after cadaveric liver transplantation in a patient with autoimmune hepatitis a case report and review of the literature . the risk of malignancy in transplant patients is higher than in the general population . the risk is increased mostly due to immune alteration and viral infections . while the most common cancers following liver transplantation include skin cancers lymphoma and kaposi sarcoma gastric cancer is uncommon . herein we report a case of gastric adenocarcinoma developing three years after cadaveric liver transplantation in a patient with autoimmune hepatitis . the patient was successfully operated . the patient did not receive any adjuvant therapy and is free of disease at 9 months follow up .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: gastric cancer after cadaveric liver transplantation in a patient with autoimmune hepatitis a case report and review of the literature . the risk of malignancy in transplant patients is higher than in the general population . the risk is increased mostly due to immune alteration and viral infections . while the most common cancers following liver transplantation include skin cancers lymphoma and kaposi sarcoma gastric cancer is uncommon . herein we report a case of gastric adenocarcinoma developing three years after cadaveric liver transplantation in a patient with autoimmune hepatitis . the patient was successfully operated . the patient did not receive any adjuvant therapy and is free of disease at 9 months follow up . 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>

aortoarteritis in hbv associated liver cirrhosis diagnostics therapeutic strategy and prognosis . a case of decompensated liver cirrhosis in a women with a long silent period of hbv infection is presented . the first manifestation was generalized vasculitis involving small and medium size vessels and elastic type arteries with the development of aortoarteritis . proper interpretation of manifestations of viral liver cirrhosis allowed for immunosuppressive treatment in combination with effective antiviral drugs . as a result aviremia regression of vasculitis and portal hypertension along with considerable improvement of the prognosis were achieved .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: aortoarteritis in hbv associated liver cirrhosis diagnostics therapeutic strategy and prognosis . a case of decompensated liver cirrhosis in a women with a long silent period of hbv infection is presented . the first manifestation was generalized vasculitis involving small and medium size vessels and elastic type arteries with the development of aortoarteritis . proper interpretation of manifestations of viral liver cirrhosis allowed for immunosuppressive treatment in combination with effective antiviral drugs . as a result aviremia regression of vasculitis and portal hypertension along with considerable improvement of the prognosis were achieved . 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>

budd chiari syndrome diagnosed in a patient listed for liver transplant and considered to be contraindicated for the operation . we report the clinical case of 23 year old patient with liver cirrhosis of unknown genesis significant resistant ascites and 2 episodes of bleeding from esophageal varices . evaluation did not find any cause of liver disease and the patient was placed on the transplant wait list due to subcompensated liver function model for end stage liver disease score of 16 child pugh class b and poorly controlled severe portal hypertension . after treatment with diuretics largevolume paracentesis antibiotics and vasoconstrictors hepatorenal syndrome and spontaneous bacterial peritonitis resolved and liver function improved significantly . because the patient showed consistently good liver function and resistant portal hypertension liver transplant was delayed with decision to perform transjugular intrahepatic portosystemic shunting instead . during the attempt of shunting occlusive thrombosis of the iliac veins inferior vena cavae and hepatic veins were diagnosed and the procedure was stopped . therefore considering preserved liver function and severe portal hypertension diagnosis of budd chiari syndrome with subsequent development of liver cirrhosis was made . the patient was recommended to undergo evaluation to exclude thrombophilia as a cause of thrombosis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: budd chiari syndrome diagnosed in a patient listed for liver transplant and considered to be contraindicated for the operation . we report the clinical case of 23 year old patient with liver cirrhosis of unknown genesis significant resistant ascites and 2 episodes of bleeding from esophageal varices . evaluation did not find any cause of liver disease and the patient was placed on the transplant wait list due to subcompensated liver function model for end stage liver disease score of 16 child pugh class b and poorly controlled severe portal hypertension . after treatment with diuretics largevolume paracentesis antibiotics and vasoconstrictors hepatorenal syndrome and spontaneous bacterial peritonitis resolved and liver function improved significantly . because the patient showed consistently good liver function and resistant portal hypertension liver transplant was delayed with decision to perform transjugular intrahepatic portosystemic shunting instead . during the attempt of shunting occlusive thrombosis of the iliac veins inferior vena cavae and hepatic veins were diagnosed and the procedure was stopped . therefore considering preserved liver function and severe portal hypertension diagnosis of budd chiari syndrome with subsequent development of liver cirrhosis was made . the patient was recommended to undergo evaluation to exclude thrombophilia as a cause of thrombosis . 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 e virus infection in a patient with suspected drug induced liver injury . a 58 years old woman known case of multiple sclerosis was referred to the acute medical assessment unit for worsening liver function . she was recently started on a new drug fingolimod for multiple sclerosis . after excluding common causes of acute hepatitis in the community a working diagnosis of drug induced liver injury was made . when liver enzymes kept rising further investigations were carried out which revealed acute hepatitis e virus hev infection . this finding was unexpected as this patient had no risk factor to acquire hev infection and there was not a single case of hev diagnosed in our hospital since long time . this case report highlights certain issues like considering rarest possible diagnosis when meeting such clinical case concern over the infections which were once thought confined to the developing countries and inclusion of hev workup in the cases of acute hepatitis when baseline workup is inconclusive .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: hepatitis e virus infection in a patient with suspected drug induced liver injury . a 58 years old woman known case of multiple sclerosis was referred to the acute medical assessment unit for worsening liver function . she was recently started on a new drug fingolimod for multiple sclerosis . after excluding common causes of acute hepatitis in the community a working diagnosis of drug induced liver injury was made . when liver enzymes kept rising further investigations were carried out which revealed acute hepatitis e virus hev infection . this finding was unexpected as this patient had no risk factor to acquire hev infection and there was not a single case of hev diagnosed in our hospital since long time . this case report highlights certain issues like considering rarest possible diagnosis when meeting such clinical case concern over the infections which were once thought confined to the developing countries and inclusion of hev workup in the cases of acute hepatitis when baseline workup is inconclusive . 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>

persisting hepatitis e virus infection leading to liver cirrhosis despite recovery of the immune system in an hiv infected patient . chronic hepatitis e has been described several times in strongly immunosuppressed hiv patients . we describe the persistence of hev infection in an hiv patient despite a restored immune response . this case demonstrates that hev infection can persist in formerly immunosuppressed individuals irrespective of the current immune status . persisting hev infection can lead to chronic inflammation and liver cirrhosis . physicians should be aware of the possibility of chronic hepatitis e even in patients that are not any longer immunocompromised . however ribavirin is an efficient treatment option .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: persisting hepatitis e virus infection leading to liver cirrhosis despite recovery of the immune system in an hiv infected patient . chronic hepatitis e has been described several times in strongly immunosuppressed hiv patients . we describe the persistence of hev infection in an hiv patient despite a restored immune response . this case demonstrates that hev infection can persist in formerly immunosuppressed individuals irrespective of the current immune status . persisting hev infection can lead to chronic inflammation and liver cirrhosis . physicians should be aware of the possibility of chronic hepatitis e even in patients that are not any longer immunocompromised . however ribavirin is an efficient treatment option . 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>

glecaprevir pibrentasvir induced cholestatic jaundice in a hcv patient with renal failure . a case presentation . background direct acting antivirals daa are currently used in the treatment of chronic hcv infection . in patients with renal failure glecaprevir pibrentasvir genotype 1 6 is recommended for its safety and efficacy . case presentation although these pharmacological characteristics an adverse drug reaction adr has been reported during glecaprevir pibrentasvir treatment such as the development of cholestatic jaundice in an elderly patient with chronic hcv genotype 2 infection . at examination patient was jaundiced associated with intense pruritus . results ultrasound and laboratory biochemical tests excluded a liver failure

liver cancer and liver lithiasis or pancreatic cancer while naranjo probability scale score 6 suggested an association between cholestatic jaundice and glecaprevir pibrentasvir administration . about 1 month after drug discontinuation an improvement has been documented in both jaundice and pruritus with a normalization in bilirubin levels total bilirubin _decnum_ mg dl hcv rna was undetected also . it is worth mentioning that although we reported the development of cholestatic jaundice upon treatment with glecaprevir pibrentasvir we recorded a clinical efficacy hcv rna lt 15 iu l after 4 weeks from the beginning of the treatment with a complete remission of clinical symptoms until 7 months after drug discontinuation . conclusion these data support the clinical efficacy of glecaprevir pibrentasvir association in elderly patients despite the sub optimal period of treatment .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: glecaprevir pibrentasvir induced cholestatic jaundice in a hcv patient with renal failure . a case presentation . background direct acting antivirals daa are currently used in the treatment of chronic hcv infection . in patients with renal failure glecaprevir pibrentasvir genotype 1 6 is recommended for its safety and efficacy . case presentation although these pharmacological characteristics an adverse drug reaction adr has been reported during glecaprevir pibrentasvir treatment such as the development of cholestatic jaundice in an elderly patient with chronic hcv genotype 2 infection . at examination patient was jaundiced associated with intense pruritus . results ultrasound and laboratory biochemical tests excluded a liver failure

liver cancer and liver lithiasis or pancreatic cancer while naranjo probability scale score 6 suggested an association between cholestatic jaundice and glecaprevir pibrentasvir administration . about 1 month after drug discontinuation an improvement has been documented in both jaundice and pruritus with a normalization in bilirubin levels total bilirubin _decnum_ mg dl hcv rna was undetected also . it is worth mentioning that although we reported the development of cholestatic jaundice upon treatment with glecaprevir pibrentasvir we recorded a clinical efficacy hcv rna lt 15 iu l after 4 weeks from the beginning of the treatment with a complete remission of clinical symptoms until 7 months after drug discontinuation . conclusion these data support the clinical efficacy of glecaprevir pibrentasvir association in elderly patients despite the sub optimal period of treatment . 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>

parotid metastasis of an amelanotic melanoma of the scalp the great masquerader . background cutaneous melanoma is often characterized by its pigmented appearance however up to _decnum_ of such lesions contain little or no pigmentation . amelanotic melanomas lesions devoid of visible pigment present a diagnostic quandary because they can masquerade as many other skin pathologies . recognizing amelanotic melanoma is even more clinically challenging when it is first detected as a metastasis to the secondary tissue . methods we report a rare case of metastasis of an amelanotic melanoma to the parotid gland . results a 75 year old man presented with an 8 month history of a painless mobile hardened mass in the right parotid region . histopathological analysis of a fine needle aspiration biopsy of the parotid mass indicated that the mass was melanoma . careful clinical and radiological examination revealed an 8 mm erythematous papule in the right temporal scalp initially diagnosed by visual examination as basal cell carcinoma . after right superficial parotidectomy neck dissection and excision of the temporal scalp lesion histological examination revealed the scalp lesion to be amelanotic melanoma . conclusion although metastatic amelanotic melanoma to the parotid gland is a rare diagnosis the clinician should be familiar with this presentation to increase the likelihood of making the correct diagnosis and delivering prompt treatment .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: parotid metastasis of an amelanotic melanoma of the scalp the great masquerader . background cutaneous melanoma is often characterized by its pigmented appearance however up to _decnum_ of such lesions contain little or no pigmentation . amelanotic melanomas lesions devoid of visible pigment present a diagnostic quandary because they can masquerade as many other skin pathologies . recognizing amelanotic melanoma is even more clinically challenging when it is first detected as a metastasis to the secondary tissue . methods we report a rare case of metastasis of an amelanotic melanoma to the parotid gland . results a 75 year old man presented with an 8 month history of a painless mobile hardened mass in the right parotid region . histopathological analysis of a fine needle aspiration biopsy of the parotid mass indicated that the mass was melanoma . careful clinical and radiological examination revealed an 8 mm erythematous papule in the right temporal scalp initially diagnosed by visual examination as basal cell carcinoma . after right superficial parotidectomy neck dissection and excision of the temporal scalp lesion histological examination revealed the scalp lesion to be amelanotic melanoma . conclusion although metastatic amelanotic melanoma to the parotid gland is a rare diagnosis the clinician should be familiar with this presentation to increase the likelihood of making the correct diagnosis and delivering prompt treatment . 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>

proliferative glomerulonephritis with monoclonal igg1 deposits in a hepatitis c virus positive patient . hepatitis c virus infection is associated with several glomerular diseases most commonly cryoglobulinemic glomerulonephritis which is typically secondary to type ii mixed cryoglobulinemia . we present a patient with hepatitis c virus infection and cryoglobulinemic glomerulonephritis secondary to type i monoclonal cryoglobulinemia that is likely related to a concurrent hepatitis c virus infection associated lymphoproliferative disorder . we list the differential diagnosis of cryoglobulinemic glomerulonephritis . additionally the case draws attention to the possibility that rarely even clinically undetectable quot occult quot b cell lymphoproliferative disorders may result in significant kidney disease .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: proliferative glomerulonephritis with monoclonal igg1 deposits in a hepatitis c virus positive patient . hepatitis c virus infection is associated with several glomerular diseases most commonly cryoglobulinemic glomerulonephritis which is typically secondary to type ii mixed cryoglobulinemia . we present a patient with hepatitis c virus infection and cryoglobulinemic glomerulonephritis secondary to type i monoclonal cryoglobulinemia that is likely related to a concurrent hepatitis c virus infection associated lymphoproliferative disorder . we list the differential diagnosis of cryoglobulinemic glomerulonephritis . additionally the case draws attention to the possibility that rarely even clinically undetectable quot occult quot b cell lymphoproliferative disorders may result in significant kidney 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>

first isolation of enteroaggregative escherichia coli o104 h4 from a diarrhea case in argentina . we describe the first isolation of an enteroaggregative escherichia coli eaec o104 h4 strain associated with an acute diarrhea case in argentina . two multiplex pcrs mpcr were performed as screening of genes mpcr1 eae lt and st and mpcr2 ipah aggr stx1 and stx2 . a mpcr to detect the rfbo104 flich4 and terd genes and pcr assays for the detection of pcvd432 plasmid aaic and lpfo113 genes were included . biochemical and antimicrobial susceptibility assays as well as serotyping were performed . the identified
coli strain was susceptible to all antimicrobials tested and harbored the aggr aaic pcvd432 plasmid lpfo113 rfbo104 flich4 and terd genes . although serotype eaec o104 h4 rarely spreads and sporadic cases have been reported global concern increased after the large scale outbreak in europe in _lgnum_ . the finding of eaec o104 h4 reinforces the need for improved methodologies for the detection of all
coli pathotypes .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: first isolation of enteroaggregative escherichia coli o104 h4 from a diarrhea case in argentina . we describe the first isolation of an enteroaggregative escherichia coli eaec o104 h4 strain associated with an acute diarrhea case in argentina . two multiplex pcrs mpcr were performed as screening of genes mpcr1 eae lt and st and mpcr2 ipah aggr stx1 and stx2 . a mpcr to detect the rfbo104 flich4 and terd genes and pcr assays for the detection of pcvd432 plasmid aaic and lpfo113 genes were included . biochemical and antimicrobial susceptibility assays as well as serotyping were performed . the identified
coli strain was susceptible to all antimicrobials tested and harbored the aggr aaic pcvd432 plasmid lpfo113 rfbo104 flich4 and terd genes . although serotype eaec o104 h4 rarely spreads and sporadic cases have been reported global concern increased after the large scale outbreak in europe in _lgnum_ . the finding of eaec o104 h4 reinforces the need for improved methodologies for the detection of all
coli pathotypes . 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 accelerated catheter directed thrombolysis for inferior vena cava thrombosis after an orthotopic liver transplant . inferior vena cava thrombosis is a rare occurrence after an orthotopic liver transplant that is associated with a high rate of retransplant and mortality . there is no consensus regarding the optimal therapeutic strategy . surgical management including thrombectomy with revision of the cavocaval anastomosis has been described . with the use of endovascular therapies several minimally invasive approaches are available that are effective and avoid the high morbidity associated with reoperative surgery . we describe our successful experience using an approach after a liver transplant in which the inferior vena cava thrombosis in a patient presenting with acute renal failure anorexia weight loss and fatigue using an ultrasound accelerated catheter directed thrombolysis platform in conjunction with systemic anticoagulation .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: ultrasound accelerated catheter directed thrombolysis for inferior vena cava thrombosis after an orthotopic liver transplant . inferior vena cava thrombosis is a rare occurrence after an orthotopic liver transplant that is associated with a high rate of retransplant and mortality . there is no consensus regarding the optimal therapeutic strategy . surgical management including thrombectomy with revision of the cavocaval anastomosis has been described . with the use of endovascular therapies several minimally invasive approaches are available that are effective and avoid the high morbidity associated with reoperative surgery . we describe our successful experience using an approach after a liver transplant in which the inferior vena cava thrombosis in a patient presenting with acute renal failure anorexia weight loss and fatigue using an ultrasound accelerated catheter directed thrombolysis platform in conjunction with systemic anticoagulation . 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>

serotonin syndrome after the use of tramadol and ziprasidone in a patient with a deep brain stimulator for parkinson disease . serotonin syndrome ss is a life threatening adverse reaction that can result from the therapeutic use of serotonergic drugs or accidental drug interactions . tramadol is a drug that is widely prescribed because of its low abuse potential but physicians need to be aware of its significant potential to cause ss because it inhibits serotonin reuptake . ziprasidone is an atypical antipsychotic that can also cause dangerous interactions to cause ss because it is not only a potent 5 ht
 agonist but also has been reported to inhibit serotonin reuptake with an affinity similar to tricyclic antidepressants in addition to inhibiting reuptake of norepinephrine . we are describing the clinical characteristics of a gentleman with bipolar disorder and parkinson disease who presented with ss despite having a deep brain stimulator in the subthalamic nucleus which decreases central serotonin levels and a discussion of the factors that contributed to his presentation .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: serotonin syndrome after the use of tramadol and ziprasidone in a patient with a deep brain stimulator for parkinson disease . serotonin syndrome ss is a life threatening adverse reaction that can result from the therapeutic use of serotonergic drugs or accidental drug interactions . tramadol is a drug that is widely prescribed because of its low abuse potential but physicians need to be aware of its significant potential to cause ss because it inhibits serotonin reuptake . ziprasidone is an atypical antipsychotic that can also cause dangerous interactions to cause ss because it is not only a potent 5 ht
 agonist but also has been reported to inhibit serotonin reuptake with an affinity similar to tricyclic antidepressants in addition to inhibiting reuptake of norepinephrine . we are describing the clinical characteristics of a gentleman with bipolar disorder and parkinson disease who presented with ss despite having a deep brain stimulator in the subthalamic nucleus which decreases central serotonin levels and a discussion of the factors that contributed to his presentation . 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 overlap syndrome involving systemic lupus erythematosus and autoimmune hepatitis in an adolescent girl . overlap of systemic lupus erythematosus and autoimmune hepatitis is a rare condition occasionally described . both autoimmune diseases can share common autoimmune features such as polyartralgia hypergammaglobulinemia and positive antinuclear antibody but they have been considered as two different entities . we report a 14 year old female patient with systemic lupus erythematosus who developed autoimmune hepatitis two years later . she had jaundice with no history of viral infections drug intake alcohol abuses or exposition to blood products . she was positive for antinuclear antibody double stranded dna antibody and lkm 1 antibody . histological examination of the liver showed interface hepatitis with lymphoplasmacytic cell infiltration . the patient satisfied the international criteria for both systemic lupus erythematosus and type 2 autoimmune hepatitis . clinical symptoms and laboratory findings improved under treatment with steroids and mycophenolate mofetil . abstracttext overlap of systemic lupus erythematosus and autoimmune hepatitis is a rare condition occasionally described . both autoimmune diseases can share common autoimmune features such as polyartralgia hypergammaglobulinemia and positive antinuclear antibody but they have been considered as two different entities . we report a 14 year old female patient with systemic lupus erythematosus who developed autoimmune hepatitis two years later . she had jaundice with no history of viral infections drug intake alcohol abuses or exposition to blood products . she was positive for antinuclear antibody double stranded dna antibody and lkm 1 antibody . histological examination of the liver showed interface hepatitis with lymphoplasmacytic cell infiltration . the patient satisfied the international criteria for both systemic lupus erythematosus and type 2 autoimmune hepatitis . clinical symptoms and laboratory findings improved under treatment with steroids and mycophenolate mofetil . autoimmune hepatitis may occur during the course of systemic lupus erythematosus and an early diagnosis is important for preventing advanced liver disease . definitive diagnosis of autoimmune hepatitis requires confirmation by means of a liver biopsy . abstracttext autoimmune hepatitis may occur during the course of systemic lupus erythematosus and an early diagnosis is important for preventing advanced liver disease . definitive diagnosis of autoimmune hepatitis requires confirmation by means of a liver biopsy . la superposicion del lupus eritematoso sistemico y la hepatitis autoinmune se describe ocasionalmente . aunque ambas enfermedades pueden compartir ciertos hallazgos como poliartralgias hipergammaglobulinemia y anticuerpo antinucleo positivo son consideradas dos diferentes . se presenta a una paciente de 14 anos con lupus eritematoso sistemico que luego de dos anos consulto por ictericia . sin antecedentes de ingesta de drogas alcohol o exposicion a virus hepatotropos . tenia un aumento de las enzimas hepaticas con anticuerpos antinucleo anti adn de doble cadena y lkm 1 positivos . la biopsia hepatica mostro una hepatitis de interfase con infiltrado linfoplasmocitario . de esta manera cumplia con los criterios diagnosticos tanto para lupus eritematoso sistemico como para hepatitis autoinmune . tratada con corticoides y micofenolato mofetil mejoro su clinica y laboratorio . conclusion . la hepatitis autoinmune puede ocurrir en el curso del lupus eritematoso sistemico . un diagnostico temprano es importante para prevenir el avance de la enfermedad es obligatoria la realizacion de la biopsia hepatica .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: an overlap syndrome involving systemic lupus erythematosus and autoimmune hepatitis in an adolescent girl . overlap of systemic lupus erythematosus and autoimmune hepatitis is a rare condition occasionally described . both autoimmune diseases can share common autoimmune features such as polyartralgia hypergammaglobulinemia and positive antinuclear antibody but they have been considered as two different entities . we report a 14 year old female patient with systemic lupus erythematosus who developed autoimmune hepatitis two years later . she had jaundice with no history of viral infections drug intake alcohol abuses or exposition to blood products . she was positive for antinuclear antibody double stranded dna antibody and lkm 1 antibody . histological examination of the liver showed interface hepatitis with lymphoplasmacytic cell infiltration . the patient satisfied the international criteria for both systemic lupus erythematosus and type 2 autoimmune hepatitis . clinical symptoms and laboratory findings improved under treatment with steroids and mycophenolate mofetil . abstracttext overlap of systemic lupus erythematosus and autoimmune hepatitis is a rare condition occasionally described . both autoimmune diseases can share common autoimmune features such as polyartralgia hypergammaglobulinemia and positive antinuclear antibody but they have been considered as two different entities . we report a 14 year old female patient with systemic lupus erythematosus who developed autoimmune hepatitis two years later . she had jaundice with no history of viral infections drug intake alcohol abuses or exposition to blood products . she was positive for antinuclear antibody double stranded dna antibody and lkm 1 antibody . histological examination of the liver showed interface hepatitis with lymphoplasmacytic cell infiltration . the patient satisfied the international criteria for both systemic lupus erythematosus and type 2 autoimmune hepatitis . clinical symptoms and laboratory findings improved under treatment with steroids and mycophenolate mofetil . autoimmune hepatitis may occur during the course of systemic lupus erythematosus and an early diagnosis is important for preventing advanced liver disease . definitive diagnosis of autoimmune hepatitis requires confirmation by means of a liver biopsy . abstracttext autoimmune hepatitis may occur during the course of systemic lupus erythematosus and an early diagnosis is important for preventing advanced liver disease . definitive diagnosis of autoimmune hepatitis requires confirmation by means of a liver biopsy . la superposicion del lupus eritematoso sistemico y la hepatitis autoinmune se describe ocasionalmente . aunque ambas enfermedades pueden compartir ciertos hallazgos como poliartralgias hipergammaglobulinemia y anticuerpo antinucleo positivo son consideradas dos diferentes . se presenta a una paciente de 14 anos con lupus eritematoso sistemico que luego de dos anos consulto por ictericia . sin antecedentes de ingesta de drogas alcohol o exposicion a virus hepatotropos . tenia un aumento de las enzimas hepaticas con anticuerpos antinucleo anti adn de doble cadena y lkm 1 positivos . la biopsia hepatica mostro una hepatitis de interfase con infiltrado linfoplasmocitario . de esta manera cumplia con los criterios diagnosticos tanto para lupus eritematoso sistemico como para hepatitis autoinmune . tratada con corticoides y micofenolato mofetil mejoro su clinica y laboratorio . conclusion . la hepatitis autoinmune puede ocurrir en el curso del lupus eritematoso sistemico . un diagnostico temprano es importante para prevenir el avance de la enfermedad es obligatoria la realizacion de la biopsia hepatica . 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>

mesenchymal epithelial transition in culture of stromal progenitor cells isolated from the liver of a patient with alcoholic cirrhosis . the cells isolated from biopsy specimen of a patient with alcoholic liver cirrhosis and cultured under standard conditions for obtaining stromal cell culture clearly diverged during early passages into two morphologically and phenotypically different subtypes epithelial and mesenchymal . mesenchymal cells expressed cd90 and cd44 and epithelial cells expressed cd166 cd227 and hepatocyte growth factor receptor met . starting from passage 6 the culture underwent spontaneous morphological changes and by passages 8 10 contained only epithelium like cells . cd90 and cd44 expression disappeared cd166 and cd227 expression remained unchanged and met expression increased . a small fraction of cells expressed gata 4 hnf3 hnf1 and hnf4 . after addition of inducers of hepatogeneic differentiation the cells started producing albumin .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: mesenchymal epithelial transition in culture of stromal progenitor cells isolated from the liver of a patient with alcoholic cirrhosis . the cells isolated from biopsy specimen of a patient with alcoholic liver cirrhosis and cultured under standard conditions for obtaining stromal cell culture clearly diverged during early passages into two morphologically and phenotypically different subtypes epithelial and mesenchymal . mesenchymal cells expressed cd90 and cd44 and epithelial cells expressed cd166 cd227 and hepatocyte growth factor receptor met . starting from passage 6 the culture underwent spontaneous morphological changes and by passages 8 10 contained only epithelium like cells . cd90 and cd44 expression disappeared cd166 and cd227 expression remained unchanged and met expression increased . a small fraction of cells expressed gata 4 hnf3 hnf1 and hnf4 . after addition of inducers of hepatogeneic differentiation the cells started producing albumin . 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>

intravascular leiomyomatosis with intracardiac extension . intravenous leiomyomatosis ivl is a rare nonmalignant tumor defined as a benign smooth muscle cell neoplasia in the veins . patients with ivl may present with symptoms of a uterine leiomyoma such as pelvic pain and vaginal bleeding or cardiorespiratory symptoms including dyspnea and leg swelling . we report the case of a 65 year old otherwise healthy caucasian woman . past medical history consisted of hysterectomy and left salpingo oophorectomy 15 years before for multiple uterine fibromyomas associated with leiomyoma of vascular origin . a thoracoabdominal computed tomography ct scan confirmed the presence of a mass measuring 76 37 44 mm arising from the inferior vena cava ivc at the level of the left renal vein extending all the way into the right atrium and right ventricle . at laparotomy a tumoral mass was excised from the left broad ligament up to the left renal vein and from the ivc up to its retrohepatic tract . sternotomy was performed and cardiopulmonary bypass cpb was established among ascending aorta upper vena cava and right common femoral vein . after atriotomy a voluminous and firm mass was excised from the right atrium down to the level of the ivc . cpb was maintained for 80 min . perioperative transfusion included two plasma and two red blood cells units . no adjuvant treatment was administered . follow up with annual ct scans was performed . patient had no signs of recurrence after 3 years .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: intravascular leiomyomatosis with intracardiac extension . intravenous leiomyomatosis ivl is a rare nonmalignant tumor defined as a benign smooth muscle cell neoplasia in the veins . patients with ivl may present with symptoms of a uterine leiomyoma such as pelvic pain and vaginal bleeding or cardiorespiratory symptoms including dyspnea and leg swelling . we report the case of a 65 year old otherwise healthy caucasian woman . past medical history consisted of hysterectomy and left salpingo oophorectomy 15 years before for multiple uterine fibromyomas associated with leiomyoma of vascular origin . a thoracoabdominal computed tomography ct scan confirmed the presence of a mass measuring 76 37 44 mm arising from the inferior vena cava ivc at the level of the left renal vein extending all the way into the right atrium and right ventricle . at laparotomy a tumoral mass was excised from the left broad ligament up to the left renal vein and from the ivc up to its retrohepatic tract . sternotomy was performed and cardiopulmonary bypass cpb was established among ascending aorta upper vena cava and right common femoral vein . after atriotomy a voluminous and firm mass was excised from the right atrium down to the level of the ivc . cpb was maintained for 80 min . perioperative transfusion included two plasma and two red blood cells units . no adjuvant treatment was administered . follow up with annual ct scans was performed . patient had no signs of recurrence after 3 years . 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>

sudden death due to polyarteritis nodosa . classical polyarteritis nodosa cpan refers to a rare potentially fatal systemic transmural necrotizing vasculitis that usually affects medium sized and occasionally small muscular arteries primarily involves the kidneys gastrointestinal tract skin nervous system joints and muscles and is rarely if ever expressed in the lungs . the incidence of mortality has significantly decreased with recently developed treatment modalities in particular antiviral medications . sudden death due to previously undiagnosed cpan is rarely encountered . we report a case of a young man who had been evaluated on three occasions by medical personnel in the 3 weeks prior to his death . he had complained of nonspecific symptoms of abdominal and perineal suprapubic pain nausea vomiting sensation of chilling and constipation . the spectrum of diagnoses included quot gastroenteritis quot enteric infection and prostatitis . found agonal at home and dying despite immediate cardiopulmonary resuscitation cpr he underwent a medicolegal autopsy which revealed vasculitis of various organs including heart myocardium and epicardium and extramural coronary arteries liver spleen kidneys adrenal glands stomach and bowel omentum gallbladder and pancreas . his sudden death was cardiac in nature due to pan associated clinically with hepatitis b surface antigen positivity hepatitis b virus associated pan hbv pan . a complete autopsy with thorough histopathological examination is necessary to diagnose this uncommon yet potentially fatal vasculitis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: sudden death due to polyarteritis nodosa . classical polyarteritis nodosa cpan refers to a rare potentially fatal systemic transmural necrotizing vasculitis that usually affects medium sized and occasionally small muscular arteries primarily involves the kidneys gastrointestinal tract skin nervous system joints and muscles and is rarely if ever expressed in the lungs . the incidence of mortality has significantly decreased with recently developed treatment modalities in particular antiviral medications . sudden death due to previously undiagnosed cpan is rarely encountered . we report a case of a young man who had been evaluated on three occasions by medical personnel in the 3 weeks prior to his death . he had complained of nonspecific symptoms of abdominal and perineal suprapubic pain nausea vomiting sensation of chilling and constipation . the spectrum of diagnoses included quot gastroenteritis quot enteric infection and prostatitis . found agonal at home and dying despite immediate cardiopulmonary resuscitation cpr he underwent a medicolegal autopsy which revealed vasculitis of various organs including heart myocardium and epicardium and extramural coronary arteries liver spleen kidneys adrenal glands stomach and bowel omentum gallbladder and pancreas . his sudden death was cardiac in nature due to pan associated clinically with hepatitis b surface antigen positivity hepatitis b virus associated pan hbv pan . a complete autopsy with thorough histopathological examination is necessary to diagnose this uncommon yet potentially fatal vasculitis . 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>

pyosalpinx causing acute appendicitis in a 32 year old cameroonian female a case report . background pyosalpinx as a cause of acute appendicitis is very rare . we report the first case of a right pyosalpinx causing an extrinsic compression of the appendiceal lumen and consequently an acute appendicitis following an obstruction . case presentation a 32 year old female from the north west region of cameroon presented with an acute exacerbation of a mild chronic right iliac fossa pain over a 2 day duration . she underwent exploratory laparotomy and intraoperative findings were a bilateral pyosalpinx with the right fallopian tube adhering to the caecum and the terminal ileum and obstructing the lumen of an inflammed appendix . a classical appendectomy and a right salpingectomy were done . the post operative period was uneventful and she returned after 2 weeks for a follow up visit with no further complaints . conclusion we describe to the best of our knowledge the first case of an acute appendicitis caused by an extrinsic obstruction of the appendiceal lumen by a pyosalpinx . the close proximity of the caecum to the right fallopian tube most likely accounted for this occurrence . although a rare entity physicians should always keep in mind very rare causes of an acute appendicitis to guide management . this case highlights the shortcomings of pelvic ultrasonography in the diagnosis this condition . a pelvic computed tomography scanning should therefore be sought in case of a doubtful pelvic ultrasonography result . finally there is an urgent need to improve the awareness on sexually transmitted infections in our setting .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: pyosalpinx causing acute appendicitis in a 32 year old cameroonian female a case report . background pyosalpinx as a cause of acute appendicitis is very rare . we report the first case of a right pyosalpinx causing an extrinsic compression of the appendiceal lumen and consequently an acute appendicitis following an obstruction . case presentation a 32 year old female from the north west region of cameroon presented with an acute exacerbation of a mild chronic right iliac fossa pain over a 2 day duration . she underwent exploratory laparotomy and intraoperative findings were a bilateral pyosalpinx with the right fallopian tube adhering to the caecum and the terminal ileum and obstructing the lumen of an inflammed appendix . a classical appendectomy and a right salpingectomy were done . the post operative period was uneventful and she returned after 2 weeks for a follow up visit with no further complaints . conclusion we describe to the best of our knowledge the first case of an acute appendicitis caused by an extrinsic obstruction of the appendiceal lumen by a pyosalpinx . the close proximity of the caecum to the right fallopian tube most likely accounted for this occurrence . although a rare entity physicians should always keep in mind very rare causes of an acute appendicitis to guide management . this case highlights the shortcomings of pelvic ultrasonography in the diagnosis this condition . a pelvic computed tomography scanning should therefore be sought in case of a doubtful pelvic ultrasonography result . finally there is an urgent need to improve the awareness on sexually transmitted infections in our setting . 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>

case of tibola debonel tick borne lymphadenopathy dermacentor spp . borne necrosis erythema lymphadenopathy in poland . rickettsia slovaca was recognized as the causative agent of the disease named tick borne lymphadenopathy tibola or dermacentor spp . borne necrosis erythema lymphadenopathy debonel . generally this ricketsiosis is considered a mild disease but the disease is considered a mild rickettsiosis but severe symptoms can appeare especially in untreated patients . described infection is the first case of tibola debonel found in poland . the patient had typical symptoms such as enlarged painful cervical lymph nodes and maculo papular rash . milium on the scalp behind the ear concha was a probably scar formation associated with typical eschar . the diagnosis was confirmed by detection of _lgnum_ titer in mif tests with
rickettsii and
slovaca antigens and four fold decrease after treatment .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: case of tibola debonel tick borne lymphadenopathy dermacentor spp . borne necrosis erythema lymphadenopathy in poland . rickettsia slovaca was recognized as the causative agent of the disease named tick borne lymphadenopathy tibola or dermacentor spp . borne necrosis erythema lymphadenopathy debonel . generally this ricketsiosis is considered a mild disease but the disease is considered a mild rickettsiosis but severe symptoms can appeare especially in untreated patients . described infection is the first case of tibola debonel found in poland . the patient had typical symptoms such as enlarged painful cervical lymph nodes and maculo papular rash . milium on the scalp behind the ear concha was a probably scar formation associated with typical eschar . the diagnosis was confirmed by detection of _lgnum_ titer in mif tests with
rickettsii and
slovaca antigens and four fold decrease after treatment . 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>

bitter correlationship between autoimmune hepatitis and smoking . cigarette smoke contains numerous toxic carcinogenic and mutagenic chemicals stable and unstable free radicals and reactive oxygen species ros which cause biological oxidative damage . continuous exposure to those chemicals leads to immense amount of damage to the human health either directly or indirectly . a hypothesis is advanced here that a possible explanation for developing autoimmune hepatitis aih is due to regular smoking for long years of time . to examine this hypothesis i relied on an experience of a case of a patient as well as critical reading of the literature on smoking and different autoimmune disorders . among the autoimmune diseases rheumatoid arthritis ra multiple sclerosis ms thyroid disease primary biliary cirrhosis pbc are reported mostly among tobacco exposed animals . the observational and theoretical knowledge strengthen the hypothesis that smoking can be one of the causes of generating autoimmune hepatitis . this hypothesis could lead to a new diagnostic category as well as therapeutic approaches for changing the regular smoking behavior .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: bitter correlationship between autoimmune hepatitis and smoking . cigarette smoke contains numerous toxic carcinogenic and mutagenic chemicals stable and unstable free radicals and reactive oxygen species ros which cause biological oxidative damage . continuous exposure to those chemicals leads to immense amount of damage to the human health either directly or indirectly . a hypothesis is advanced here that a possible explanation for developing autoimmune hepatitis aih is due to regular smoking for long years of time . to examine this hypothesis i relied on an experience of a case of a patient as well as critical reading of the literature on smoking and different autoimmune disorders . among the autoimmune diseases rheumatoid arthritis ra multiple sclerosis ms thyroid disease primary biliary cirrhosis pbc are reported mostly among tobacco exposed animals . the observational and theoretical knowledge strengthen the hypothesis that smoking can be one of the causes of generating autoimmune hepatitis . this hypothesis could lead to a new diagnostic category as well as therapeutic approaches for changing the regular smoking behavior . 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>

three different histological subtypes of epstein barr virus negative post transplant lymphoproliferative disorder in a patient with hepatitis c infection . we report a rare case in which epstein barr virus ebv negative polymorphic b cell post transplant lymphoproliferative disorder ptld and ebv negative monomorphic t cell ptld anaplastic lymphoma kinase alk positive anaplastic large cell lymphoma alcl were observed simultaneously in the same cervical lymph node 34 months after liver transplantation for hepatitis c liver cirrhosis . although hepatitis c recurred after 2 months he had no other complications until ptld occurred 34 months post transplantation . the patient underwent reduction of the immunosuppressive drug and rituximab plus cyclophosphamide doxorubicin vincristine and prednisone therapy and he was considered to have achieved complete remission . however ptld recurred and he died 6 months after the initial diagnosis . autopsy revealed only ebv negative monomorphic t cell ptld alk negative alcl that involved the liver spleen bilateral kidneys stomach bladder heart bone marrow right ureter and pons . thus recurrent ptld may show a different histological type from the primary disorder as ptld has a multiclonal potentiality that causes various types of lymphomas . therefore it may be difficult to predict ptld related prognosis from the initial ptld histological identification .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: three different histological subtypes of epstein barr virus negative post transplant lymphoproliferative disorder in a patient with hepatitis c infection . we report a rare case in which epstein barr virus ebv negative polymorphic b cell post transplant lymphoproliferative disorder ptld and ebv negative monomorphic t cell ptld anaplastic lymphoma kinase alk positive anaplastic large cell lymphoma alcl were observed simultaneously in the same cervical lymph node 34 months after liver transplantation for hepatitis c liver cirrhosis . although hepatitis c recurred after 2 months he had no other complications until ptld occurred 34 months post transplantation . the patient underwent reduction of the immunosuppressive drug and rituximab plus cyclophosphamide doxorubicin vincristine and prednisone therapy and he was considered to have achieved complete remission . however ptld recurred and he died 6 months after the initial diagnosis . autopsy revealed only ebv negative monomorphic t cell ptld alk negative alcl that involved the liver spleen bilateral kidneys stomach bladder heart bone marrow right ureter and pons . thus recurrent ptld may show a different histological type from the primary disorder as ptld has a multiclonal potentiality that causes various types of lymphomas . therefore it may be difficult to predict ptld related prognosis from the initial ptld histological identification . 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>

liver transplantation using graft from a donor with aplastic anemia . liver transplantation lt is a life saving procedure in patients with end stage liver disease . the number of patients in the waiting list for lt has steadily increased over time so removing liver from deceased donors with unusual disorders could possibly be used for transplantation . we describe a case of lt from a donor with quot aplastic anemia quot to a patient with liver failure due to hepatitis
aplastic anemia is a syndrome of bone marrow failure . aplastic anemia is one of the most common conditions linked to transfusion dependence and long term repeated transfusion inevitably results in iron overload . also iron is a cofactor that influences the severity and progression of nonhemochromatic liver diseases especially steatohepatitis and viral hepatitis . the aim of this report is to highlight the posttransplant findings of the recipient with specific emphasis on the graft function . our findings provide insights into the clinical implications of lt using graft with this rare disorder .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: liver transplantation using graft from a donor with aplastic anemia . liver transplantation lt is a life saving procedure in patients with end stage liver disease . the number of patients in the waiting list for lt has steadily increased over time so removing liver from deceased donors with unusual disorders could possibly be used for transplantation . we describe a case of lt from a donor with quot aplastic anemia quot to a patient with liver failure due to hepatitis
aplastic anemia is a syndrome of bone marrow failure . aplastic anemia is one of the most common conditions linked to transfusion dependence and long term repeated transfusion inevitably results in iron overload . also iron is a cofactor that influences the severity and progression of nonhemochromatic liver diseases especially steatohepatitis and viral hepatitis . the aim of this report is to highlight the posttransplant findings of the recipient with specific emphasis on the graft function . our findings provide insights into the clinical implications of lt using graft with this rare 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: 1 </s>

intense 1
 fdg uptake in chronic subcutaneous opioid injection sites . subcutaneous f fdg uptake is a common finding on pet scans with causes including both benign and malignant conditions . often the pattern of uptake or the clinical indication for the pet scan will suggest the etiology . however unusual or unexpected patterns may require careful clinical history . we report the case of a 45 year old woman who underwent a pet ct study for paraneoplastic syndrome evaluation and was found to have intense extensive bilaterally symmetric nodular subcutaneous fdg uptake in the lower back and buttocks that was related to long term repeated subcutaneous opioid injections .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: intense 1
 fdg uptake in chronic subcutaneous opioid injection sites . subcutaneous f fdg uptake is a common finding on pet scans with causes including both benign and malignant conditions . often the pattern of uptake or the clinical indication for the pet scan will suggest the etiology . however unusual or unexpected patterns may require careful clinical history . we report the case of a 45 year old woman who underwent a pet ct study for paraneoplastic syndrome evaluation and was found to have intense extensive bilaterally symmetric nodular subcutaneous fdg uptake in the lower back and buttocks that was related to long term repeated subcutaneous opioid injections . 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>

lymphangioleiomyomatosis multifocal micronodular pneumocyte hyperplasia and sarcoidosis more pathological findings in the same chest ct or a single pathological pathway background autoimmune hepatitis primary biliary cirrhosis overlap syndrome lymphangioleiomyomatosis tuberous sclerosis complex lam tsc and sarcoidosis are three rare diseases . here we present to the best of our knowledge the first description of a patient with the coexistence of these three diseases . case presentation a 47 year old woman affected by lam tsc and primary biliary cirrosis autoimmune hepatitis overlap syndrome . during her follow up a high resolution chest ct scan hrtc confirmed the presence of both multiple cysts and micronodular opacities consistent with multifocal micronodular pneumocytes hyperlasia mmph and revealed multiple hilar mediastinal symmetrical lymphadenopathies suggestive of sarcoidosis . simultaneously subcutaneous nodules appeared on her forearm bilaterally . cutaneous biopsy showed granulomatous dermatitis with sarcoid like granulomas . a diagnosis of stage i pulmonary sarcoidosis was made . no treatment for sarcoidosis was initiated since the patient had neither systemic involvement nor respiratory impairment . conclusions the presence of more than one rare disease should challenge the concept of a potential common underlying mechanism since the a priori probability of the concomitant presence of different conditions with different pathogenic mechanisms especially if rare diseases is low . we speculate that the dysregulation of the pathway involving mtor and mapk and their interaction might play a role in the pathogenesis of other diseases including sarcoidosis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: lymphangioleiomyomatosis multifocal micronodular pneumocyte hyperplasia and sarcoidosis more pathological findings in the same chest ct or a single pathological pathway background autoimmune hepatitis primary biliary cirrhosis overlap syndrome lymphangioleiomyomatosis tuberous sclerosis complex lam tsc and sarcoidosis are three rare diseases . here we present to the best of our knowledge the first description of a patient with the coexistence of these three diseases . case presentation a 47 year old woman affected by lam tsc and primary biliary cirrosis autoimmune hepatitis overlap syndrome . during her follow up a high resolution chest ct scan hrtc confirmed the presence of both multiple cysts and micronodular opacities consistent with multifocal micronodular pneumocytes hyperlasia mmph and revealed multiple hilar mediastinal symmetrical lymphadenopathies suggestive of sarcoidosis . simultaneously subcutaneous nodules appeared on her forearm bilaterally . cutaneous biopsy showed granulomatous dermatitis with sarcoid like granulomas . a diagnosis of stage i pulmonary sarcoidosis was made . no treatment for sarcoidosis was initiated since the patient had neither systemic involvement nor respiratory impairment . conclusions the presence of more than one rare disease should challenge the concept of a potential common underlying mechanism since the a priori probability of the concomitant presence of different conditions with different pathogenic mechanisms especially if rare diseases is low . we speculate that the dysregulation of the pathway involving mtor and mapk and their interaction might play a role in the pathogenesis of other diseases including sarcoidosis . 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>

molecular analysis of the interspousal transmission of hepatitis b virus in two japanese patients who acquired fulminant hepatitis b after 50 and 49 years of marriage . a 71 year old c
 and 69 year old c
 japanese female contracted fulminant hepatitis b after 50 and 49 years of marriage respectively . both index cases exhibited high levels of anti hbc igm antibodies _decnum_ and _decnum_ s co respectively suggestive of acute hepatitis b virus hbv infection although they had no discernible risk factors for hbv infection except for chronically hbv infected spouses with detectable hbv dna _decnum_ log copies ml c
 72 year old and _decnum_ log copies ml c
 71 year old . the hbv genotype subgenotype was identical in each couple b b1 or c c2 . the hbv isolates from the index cases and spouses shared a nucleotide sequence identity of _decnum_ and _decnum_ respectively over the entire genome and these four isolates had the highest nucleotide sequence identity of only 97 to hbv isolates deposited in dna databases . phylogenetic trees confirmed a close relationship of the hbv isolates between c
 and c
 and between c
 and c
 supported by a high bootstrap value of _lgnum_ within each couple indicating the transfer of hbv infection between spouses . these four isolates shared a precore mutation of g189
 known to be associated with fulminant hepatitis
although the history of sexual contact within a reasonable incubation period was obscure for one stable monogamous couple c
 and c
 the other couple had a monogamous sexual relationship within six months prior to disease onset . this study indicates that two elderly japanese patients with fulminant hepatitis b acquired hbv infection via interspousal most likely sexual transmission during long lasting marriages .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: molecular analysis of the interspousal transmission of hepatitis b virus in two japanese patients who acquired fulminant hepatitis b after 50 and 49 years of marriage . a 71 year old c
 and 69 year old c
 japanese female contracted fulminant hepatitis b after 50 and 49 years of marriage respectively . both index cases exhibited high levels of anti hbc igm antibodies _decnum_ and _decnum_ s co respectively suggestive of acute hepatitis b virus hbv infection although they had no discernible risk factors for hbv infection except for chronically hbv infected spouses with detectable hbv dna _decnum_ log copies ml c
 72 year old and _decnum_ log copies ml c
 71 year old . the hbv genotype subgenotype was identical in each couple b b1 or c c2 . the hbv isolates from the index cases and spouses shared a nucleotide sequence identity of _decnum_ and _decnum_ respectively over the entire genome and these four isolates had the highest nucleotide sequence identity of only 97 to hbv isolates deposited in dna databases . phylogenetic trees confirmed a close relationship of the hbv isolates between c
 and c
 and between c
 and c
 supported by a high bootstrap value of _lgnum_ within each couple indicating the transfer of hbv infection between spouses . these four isolates shared a precore mutation of g189
 known to be associated with fulminant hepatitis
although the history of sexual contact within a reasonable incubation period was obscure for one stable monogamous couple c
 and c
 the other couple had a monogamous sexual relationship within six months prior to disease onset . this study indicates that two elderly japanese patients with fulminant hepatitis b acquired hbv infection via interspousal most likely sexual transmission during long lasting marriages . 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>

phenotypic assay of a hepatitis b virus strain carrying an rts24
 variant using a new strategy . phenotypic assays of hepatitis b virus hbv play an important role in research related to the problem of drug resistance that emerges during long term nucleot s ide therapy in patients with chronic hepatitis
most of the phenotypic assay systems that are available currently rely on the transfection of recombinant replication competent hbv dna into hepatoma cell lines . cloning clinical hbv isolates using conventional digestion and ligation techniques to generate replication competent recombinants can be very difficult because of the sequence heterogeneity and unique structure of the hbv genome . in this study a new strategy for constructing an hbv _decnum_ recombinant was developed . the core of this strategy is the quot fragment substitution reaction quot fsr . fsr allows pcr fragments to be cloned without digestion or ligation providing a new tool for cloning fragments or genomes amplified from serum hbv dna and therefore making the assay of hbv phenotypes more convenient . using this strategy a phenotypic assay was performed on an hbv strain carrying an rts24
 variant isolated from a patient with chronic hepatitis b that was only responsive partially to entecavir therapy . the results indicated that this strain is sensitive to entecavir in vitro .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: phenotypic assay of a hepatitis b virus strain carrying an rts24
 variant using a new strategy . phenotypic assays of hepatitis b virus hbv play an important role in research related to the problem of drug resistance that emerges during long term nucleot s ide therapy in patients with chronic hepatitis
most of the phenotypic assay systems that are available currently rely on the transfection of recombinant replication competent hbv dna into hepatoma cell lines . cloning clinical hbv isolates using conventional digestion and ligation techniques to generate replication competent recombinants can be very difficult because of the sequence heterogeneity and unique structure of the hbv genome . in this study a new strategy for constructing an hbv _decnum_ recombinant was developed . the core of this strategy is the quot fragment substitution reaction quot fsr . fsr allows pcr fragments to be cloned without digestion or ligation providing a new tool for cloning fragments or genomes amplified from serum hbv dna and therefore making the assay of hbv phenotypes more convenient . using this strategy a phenotypic assay was performed on an hbv strain carrying an rts24
 variant isolated from a patient with chronic hepatitis b that was only responsive partially to entecavir therapy . the results indicated that this strain is sensitive to entecavir in vitro . 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>

the first childhood case with coexisting hashimoto thyroiditis vitiligo and autoimmune hepatitis . hashimoto thyroiditis ht is the most common pediatric autoimmune endocrine disorder . it results in autoimmune mediated thyroid gland destruction and is an organ specific typical autoimmune disease . the presence of antithyroid antibodies and the typical pattern on ultrasonography indicate the diagnosis . it is also frequently seen together with other autoimmune disorders including type 1 insulin dependent diabetes celiac disease alopecia and vitiligo . autoimmune hepatitis aih is a chronic type of liver injury with an immune etiology that can frequently cause end stage liver disease if left untreated . autoimmune hepatitis patients may present with hepatitis and the laboratory tests in the absence of other etiology usually reveal a positive immune serology together with elevated immunoglobulins and abnormal liver histology . it is interesting that ht and aih are rarely seen together although both have an autoimmune etiology . 14 year old male who was being followed up for vitiligo presented with symptoms of a swelling at the neck and fatigue . he was diagnosed with ht after the tests and the liver enzymes were found to be high . the patient was also diagnosed with aih after tests revealed that the liver enzyme elevation had continued for longer than six months . the thyroid functions and liver enzymes returned to normal and the symptoms decreased after sodium l thyroxine replacement together with steroid and azathioprine treatment . we present this case as we believe it is the first pediatric patient diagnosed with ht aih and vitiligo .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: the first childhood case with coexisting hashimoto thyroiditis vitiligo and autoimmune hepatitis . hashimoto thyroiditis ht is the most common pediatric autoimmune endocrine disorder . it results in autoimmune mediated thyroid gland destruction and is an organ specific typical autoimmune disease . the presence of antithyroid antibodies and the typical pattern on ultrasonography indicate the diagnosis . it is also frequently seen together with other autoimmune disorders including type 1 insulin dependent diabetes celiac disease alopecia and vitiligo . autoimmune hepatitis aih is a chronic type of liver injury with an immune etiology that can frequently cause end stage liver disease if left untreated . autoimmune hepatitis patients may present with hepatitis and the laboratory tests in the absence of other etiology usually reveal a positive immune serology together with elevated immunoglobulins and abnormal liver histology . it is interesting that ht and aih are rarely seen together although both have an autoimmune etiology . 14 year old male who was being followed up for vitiligo presented with symptoms of a swelling at the neck and fatigue . he was diagnosed with ht after the tests and the liver enzymes were found to be high . the patient was also diagnosed with aih after tests revealed that the liver enzyme elevation had continued for longer than six months . the thyroid functions and liver enzymes returned to normal and the symptoms decreased after sodium l thyroxine replacement together with steroid and azathioprine treatment . we present this case as we believe it is the first pediatric patient diagnosed with ht aih and vitiligo . 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>

successful use of reduced intensity conditioning and matched unrelated hematopoietic stem cell transplant in a child with diamond blackfan anemia and cirrhosis . for patients with dba who are transfusion dependent hsct is the only cure . chronic transfusions can lead to cirrhosis secondary to iron overload making them poor candidates for myeloablative hsct . ric regimens are associated with lower morbidity and mortality compared to myeloablative regimens but use of ric in dba has been limited . here we present a 14 yr old girl with dba and multiple comorbidities including liver cirrhosis who underwent mud hsct utilizing a ric regimen that is novel to this condition . she tolerated the regimen well and at 21 months she remains transfusion independent with chimerisms at 99 .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: successful use of reduced intensity conditioning and matched unrelated hematopoietic stem cell transplant in a child with diamond blackfan anemia and cirrhosis . for patients with dba who are transfusion dependent hsct is the only cure . chronic transfusions can lead to cirrhosis secondary to iron overload making them poor candidates for myeloablative hsct . ric regimens are associated with lower morbidity and mortality compared to myeloablative regimens but use of ric in dba has been limited . here we present a 14 yr old girl with dba and multiple comorbidities including liver cirrhosis who underwent mud hsct utilizing a ric regimen that is novel to this condition . she tolerated the regimen well and at 21 months she remains transfusion independent with chimerisms at 99 . 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>

congenital coronary artery fistula in an intercoronary communication between the left main and the diagonal branch of the left anterior descending coronary artery an interesting case report . intercoronary communication is a very rare coronary artery anomaly . it is defined as an open ended circulation with bidirectional blood flow between two coronary arteries . coronary artery fistulas are abnormal communications between a coronary artery and a cardiac chamber or major vessel . a 62 year old man was admitted to our hospital with sudden development of general weakness dizziness and a sensation of compression in his chest . at presentation his blood pressure was 80 40 mmhg and heart rate was 65 beats min . the ecg revealed sinus rhythm and 1 2 mm st elevation in the anterior leads . the patient was taken to the catheterization laboratory for percutaneous coronary intervention . the left main and left circumflex coronary arteries were normal . coronary angiography showed a communication between the left main and the diagonal branch of the left anterior descending and a fistula between the intercoronary connection and the left atrium . the other coronary arteries were normal . laboratory test results including cardiac troponin i and creatine kinase mb levels were normal . the angina symptoms disappeared and the st elevation resolved within four hours . we report an interesting case of congenital coronary artery fistula in an intercoronary communication between the left main and the diagonal branch of the left anterior descending coronary artery presenting as an acute coronary syndrome . to the best of our knowledge this is the first case in the literature involving a coronary artery fistula in an intercoronary communication .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: congenital coronary artery fistula in an intercoronary communication between the left main and the diagonal branch of the left anterior descending coronary artery an interesting case report . intercoronary communication is a very rare coronary artery anomaly . it is defined as an open ended circulation with bidirectional blood flow between two coronary arteries . coronary artery fistulas are abnormal communications between a coronary artery and a cardiac chamber or major vessel . a 62 year old man was admitted to our hospital with sudden development of general weakness dizziness and a sensation of compression in his chest . at presentation his blood pressure was 80 40 mmhg and heart rate was 65 beats min . the ecg revealed sinus rhythm and 1 2 mm st elevation in the anterior leads . the patient was taken to the catheterization laboratory for percutaneous coronary intervention . the left main and left circumflex coronary arteries were normal . coronary angiography showed a communication between the left main and the diagonal branch of the left anterior descending and a fistula between the intercoronary connection and the left atrium . the other coronary arteries were normal . laboratory test results including cardiac troponin i and creatine kinase mb levels were normal . the angina symptoms disappeared and the st elevation resolved within four hours . we report an interesting case of congenital coronary artery fistula in an intercoronary communication between the left main and the diagonal branch of the left anterior descending coronary artery presenting as an acute coronary syndrome . to the best of our knowledge this is the first case in the literature involving a coronary artery fistula in an intercoronary communication . 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>

pyogenic flexor tenosynovitis in an infant . pyogenic flexor tenosynovitis is a rare though well known infectious process of the flexor tendon sheath of the hand . this condition is generally diagnosed in adults by the observance of the four kanavel signs . application of the kanavel signs to diagnosis in the pediatric population however is of unknown utility . we present the case of a 13 month old male with pyogenic flexor tenosynovitis who presented with all four of the kanavel signs .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: pyogenic flexor tenosynovitis in an infant . pyogenic flexor tenosynovitis is a rare though well known infectious process of the flexor tendon sheath of the hand . this condition is generally diagnosed in adults by the observance of the four kanavel signs . application of the kanavel signs to diagnosis in the pediatric population however is of unknown utility . we present the case of a 13 month old male with pyogenic flexor tenosynovitis who presented with all four of the kanavel signs . 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>

phosphatidylinositol
 bisphosphate 3 kinase catalytic subunit alpha pik
a related overgrowth spectrum a brief report . a patient with extensive multisystem overgrowth caused by a somatic gain of function pik
a mutation is described . this case is an example of the clinical diversity of the pik
a related overgrowth spectrum pros as the patient had overlapping features of congenital lipomatous overgrowth vascular malformations epidermal nevi and skeletal abnormalities cloves syndrome and megalencephaly capillary malformation polymicrogyria mcap syndrome and underlines the utility of this umbrella term .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: phosphatidylinositol
 bisphosphate 3 kinase catalytic subunit alpha pik
a related overgrowth spectrum a brief report . a patient with extensive multisystem overgrowth caused by a somatic gain of function pik
a mutation is described . this case is an example of the clinical diversity of the pik
a related overgrowth spectrum pros as the patient had overlapping features of congenital lipomatous overgrowth vascular malformations epidermal nevi and skeletal abnormalities cloves syndrome and megalencephaly capillary malformation polymicrogyria mcap syndrome and underlines the utility of this umbrella term . 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>

hbv associated cryoglobulinemic vasculitis remission after antiviral therapy with entecavir . aims cryoglobulinemic vasculitis remains an uncommon complication of hepatitis b virus infection . methods we report the case of a 40 years old female chinese patient with chronic hepatitis b developing cryoglobulinemic vasculitis with multiple organ involvement liver kidney and skin coupled with weakness arthralgias haemolytic anaemia and autoimmune thyroiditis . she received entecavir mono therapy at dose adjusted for estimated glomerular filtration rate . results within five months of entecavir treatment hepatitis b viraemia decreased below the limit of detection with normal serum amino transferase levels hbeag clearance occurred vasculitis regressed with disappearance of purpura and ascites in addition renal function normalized and nephritic syndrome remitted . after a five year follow up the patient is asymptomatic with intact kidney function proteinuria in the normal range and normal liver biochemistry despite the antiviral treatment was withdrawn and the patient remained hbsag positive . conclusions this is the second case of hepatitis b virus related cryoglobulinemic vasculitis successfully treated with entecavir suggesting that effective antiviral therapy may counteract both the hepatic and extra hepatic manifestations of infection by hepatitis b virus .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: hbv associated cryoglobulinemic vasculitis remission after antiviral therapy with entecavir . aims cryoglobulinemic vasculitis remains an uncommon complication of hepatitis b virus infection . methods we report the case of a 40 years old female chinese patient with chronic hepatitis b developing cryoglobulinemic vasculitis with multiple organ involvement liver kidney and skin coupled with weakness arthralgias haemolytic anaemia and autoimmune thyroiditis . she received entecavir mono therapy at dose adjusted for estimated glomerular filtration rate . results within five months of entecavir treatment hepatitis b viraemia decreased below the limit of detection with normal serum amino transferase levels hbeag clearance occurred vasculitis regressed with disappearance of purpura and ascites in addition renal function normalized and nephritic syndrome remitted . after a five year follow up the patient is asymptomatic with intact kidney function proteinuria in the normal range and normal liver biochemistry despite the antiviral treatment was withdrawn and the patient remained hbsag positive . conclusions this is the second case of hepatitis b virus related cryoglobulinemic vasculitis successfully treated with entecavir suggesting that effective antiviral therapy may counteract both the hepatic and extra hepatic manifestations of infection by hepatitis b virus . 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>

exchange autotransfusion for rapid correction of hyperkalemia during liver transplantation a case report . a 46 year old woman with alcoholic cirrhosis and hepatorenal syndrome requiring hemodialysis presented with hyperkalemia _decnum_ meq l immediately before liver transplantation . for correction of hyperkalemia an exchange transfusion began by removing her blood into an autotransfusion system to wash out noncellular components while maintaining normovolemia . additionally she received washed homologous red blood cells insulin and glucose to minimize or reduce the degree of hyperkalemia . serum potassium level decreased to _decnum_ meq l within 3 hours and was _decnum_ meq l 30 seconds after reperfusion of the grafted liver . postreperfusion syndrome was not observed . in summary exchange transfusion was used successfully for rapid correction of hyperkalemia showing the value of its application in liver transplantation .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: exchange autotransfusion for rapid correction of hyperkalemia during liver transplantation a case report . a 46 year old woman with alcoholic cirrhosis and hepatorenal syndrome requiring hemodialysis presented with hyperkalemia _decnum_ meq l immediately before liver transplantation . for correction of hyperkalemia an exchange transfusion began by removing her blood into an autotransfusion system to wash out noncellular components while maintaining normovolemia . additionally she received washed homologous red blood cells insulin and glucose to minimize or reduce the degree of hyperkalemia . serum potassium level decreased to _decnum_ meq l within 3 hours and was _decnum_ meq l 30 seconds after reperfusion of the grafted liver . postreperfusion syndrome was not observed . in summary exchange transfusion was used successfully for rapid correction of hyperkalemia showing the value of its application in 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>

reconstruction of the pediatric lateral malleolus and physis by free microvascular transfer of the proximal fibular physis . traumatic injury to the pediatric growth plate can result in growth disturbances late angular deformity and limb length inequalities . complete traumatic loss the entire growth plate complex physis epiphysis and distal metaphysis of the ankle can lead to severe joint instability and loss of function . in the growing child physeal preservation is paramount however the reconstructive options are limited . we report a case of post traumatic loss of the distal fibular physis resulting in severe ankle valgus in a pediatric patient after a gustilo grade
 open injury . ankle valgus secondary to post traumatic necrosis of the lateral ankle physeal complex was successfully managed by microvascular free transfer of the ipsilateral proximal fibula physis . the 24 month follow up examination demonstrated continued growth of the free vascularized physeal graft and a stable ankle . the donor site had healed without incident . the patient was able to return to age appropriate play sports and social integration .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: reconstruction of the pediatric lateral malleolus and physis by free microvascular transfer of the proximal fibular physis . traumatic injury to the pediatric growth plate can result in growth disturbances late angular deformity and limb length inequalities . complete traumatic loss the entire growth plate complex physis epiphysis and distal metaphysis of the ankle can lead to severe joint instability and loss of function . in the growing child physeal preservation is paramount however the reconstructive options are limited . we report a case of post traumatic loss of the distal fibular physis resulting in severe ankle valgus in a pediatric patient after a gustilo grade
 open injury . ankle valgus secondary to post traumatic necrosis of the lateral ankle physeal complex was successfully managed by microvascular free transfer of the ipsilateral proximal fibula physis . the 24 month follow up examination demonstrated continued growth of the free vascularized physeal graft and a stable ankle . the donor site had healed without incident . the patient was able to return to age appropriate play sports and social integration . 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>

huge hilar carcinoid tumor resected by transsternal pneumonectomy a case presentation . carcinoid tumors comprise an uncommon group of pulmonary neoplasms with neuroendocrine origin . in comparison with typical carcinoid tumors atypical tumors are less common and more aggressive . we present a 35 year old female with atypical carcinoid tumor . the mass was located centrally and transsternal pneumonectomy was performed to resect the tumor .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: huge hilar carcinoid tumor resected by transsternal pneumonectomy a case presentation . carcinoid tumors comprise an uncommon group of pulmonary neoplasms with neuroendocrine origin . in comparison with typical carcinoid tumors atypical tumors are less common and more aggressive . we present a 35 year old female with atypical carcinoid tumor . the mass was located centrally and transsternal pneumonectomy was performed to resect the tumor . 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 genotype 7 a new genotype originating from central africa . we report a new hepatitis c virus hcv genotype identified in patients originating from the democratic republic of congo . the prototype qc69 virus is shown to be a new lineage distinct from genotypes 1 to 6 . three additional patients were also found to be infected by a virus from this lineage confirming its circulation in humans . we propose that these viruses be classified into hcv genotype 7 .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: hepatitis c virus genotype 7 a new genotype originating from central africa . we report a new hepatitis c virus hcv genotype identified in patients originating from the democratic republic of congo . the prototype qc69 virus is shown to be a new lineage distinct from genotypes 1 to 6 . three additional patients were also found to be infected by a virus from this lineage confirming its circulation in humans . we propose that these viruses be classified into hcv genotype 7 . 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>

an harmonic smile resulted from the use of ceramic prosthesis with zirconia structure a case report . the rehabilitation of patients requiring an esthetic smile demands a multidisciplinary approach . this clinical report describes a treatment plan for recovery aesthetics smile of anterior teeth using ceramic prosthesis with zirconia structure . initially a review of aesthetic parameters diagnostic waxing mock up and provisional restorations was performed . a contextual assessment of aesthetic proportion and shape of teeth was done to recreate a natural looking for teeth in consonance with the smile line . subsequently based on these parameters fixed prostheses of the upper anterior teeth using ceramic restorations with zirconia infrastructures were performed . the use of ceramic restorations with zirconia structures associated with a careful treatment plan allows the professional to integrate esthetic and function for satisfactory clinical results . how to cite the article tavarez rr goncalves lm dias ap dias ac malheiros as silva ac bandeca mc . an harmonic smile resulted from the use of ceramic prosthesis with zirconia structure a case report . j int oral health _lgnum_ 6 3 90 2 .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: an harmonic smile resulted from the use of ceramic prosthesis with zirconia structure a case report . the rehabilitation of patients requiring an esthetic smile demands a multidisciplinary approach . this clinical report describes a treatment plan for recovery aesthetics smile of anterior teeth using ceramic prosthesis with zirconia structure . initially a review of aesthetic parameters diagnostic waxing mock up and provisional restorations was performed . a contextual assessment of aesthetic proportion and shape of teeth was done to recreate a natural looking for teeth in consonance with the smile line . subsequently based on these parameters fixed prostheses of the upper anterior teeth using ceramic restorations with zirconia infrastructures were performed . the use of ceramic restorations with zirconia structures associated with a careful treatment plan allows the professional to integrate esthetic and function for satisfactory clinical results . how to cite the article tavarez rr goncalves lm dias ap dias ac malheiros as silva ac bandeca mc . an harmonic smile resulted from the use of ceramic prosthesis with zirconia structure a case report . j int oral health _lgnum_ 6 3 90 2 . 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 choroidal neovascularization after pegylated interferon therapy . a 30 year old male presented with gradual decrease in vision in his both eyes after the use of interferon alpha for his hepatitis
ocular examination of patient included best corrected visual acuity bcva fundus photographs fundus fluorescein angiography ffa and optical coherence tomography oct . his bcva was recorded as 6 18 in the right eye and 6 12 in the left eye . the anterior segments were unremarkable with normal intraocular pressure iop in his both eyes . both fundi revealed the presence of bilateral choroidal neovascularization cnv confirmed on ffa and oct . to the best of authors knowledge simultaneous presence of cnv in both eyes is not reported in the literature .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: bilateral choroidal neovascularization after pegylated interferon therapy . a 30 year old male presented with gradual decrease in vision in his both eyes after the use of interferon alpha for his hepatitis
ocular examination of patient included best corrected visual acuity bcva fundus photographs fundus fluorescein angiography ffa and optical coherence tomography oct . his bcva was recorded as 6 18 in the right eye and 6 12 in the left eye . the anterior segments were unremarkable with normal intraocular pressure iop in his both eyes . both fundi revealed the presence of bilateral choroidal neovascularization cnv confirmed on ffa and oct . to the best of authors knowledge simultaneous presence of cnv in both eyes is not reported in 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>

heterotopic ossification of the xiphoid process after abdominal surgery for traumatic hemoperitoneum . heterotopic ossification of the xiphoid process is extremely rare with only three cases previously reported . however the surgical pathology for postoperative elongation of the xiphoid process after abdominal surgery has not yet been reported . we report a case of the postoperative elongation of the xiphoid process 8 years after abdominal surgery for traumatic hemoperitoneum in a 53 year old man . the patient underwent surgical excision of the elongated mass of the xiphoid process . histopathology revealed multiple exostoses . heterotopic ossification can occur after surgical trauma to soft or bone tissue . surgical excision with primary closure is the treatment of choice for symptomatic heterotopic ossification .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: heterotopic ossification of the xiphoid process after abdominal surgery for traumatic hemoperitoneum . heterotopic ossification of the xiphoid process is extremely rare with only three cases previously reported . however the surgical pathology for postoperative elongation of the xiphoid process after abdominal surgery has not yet been reported . we report a case of the postoperative elongation of the xiphoid process 8 years after abdominal surgery for traumatic hemoperitoneum in a 53 year old man . the patient underwent surgical excision of the elongated mass of the xiphoid process . histopathology revealed multiple exostoses . heterotopic ossification can occur after surgical trauma to soft or bone tissue . surgical excision with primary closure is the treatment of choice for symptomatic heterotopic ossification . 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>

chylous ascites after liver transplant case report and review of literature . case a 62 year old man with cirrhosis hepatitis c and hepatocellular carcinoma underwent a liver transplant . on day 11 after surgery a chylous leak from a partial wound dehiscence was noted . the leak did not respond to 2 weeks of uninterrupted fat free clear liquid diet and 12 hour total parenteral nutrition at night . the same treatment was continued for another 6 weeks with fatty meal challenge every weekend which he failed . he was then given a fat free clear liquid diet 24 hour total parenteral nutrition and octreotide _lgnum_ g subcutaneously every 8 hours for 14 days . a prompt response was noted . his recovery was excellent at the time of this writing 9 months follow up . discussion eleven major cases have been reported with 9 cases being managed conservatively . four were given a diet plus total parenteral nutrition without octreotide producing a cure in 3 to 36 days . two cases including ours were given the diet and total parenteral nutrition which failed octreotide was then added and these cases were cured in 2 to 4 weeks . therefore diet with total parenteral nutrition failed in _decnum_ of the cases 2 6 . in 3 cases octreotide was used from the outset . they were all cured in 2 weeks . one case was operated on for peritonitis chylous ascites was found and a leak was ligated . one patient with congenital lymphatic disorder underwent peritoneovenous shunting . octreotide was not used in any of the cases of chylous ascites that were treated surgically . conclusions if exploratory surgery is done for any other reason it is best to identify a chylous leak and ligate it . otherwise we recommend octreotide combined with a fat free clear liquid diet and supplementation with medium chain triglycerides and total parenteral nutrition from the outset .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: chylous ascites after liver transplant case report and review of literature . case a 62 year old man with cirrhosis hepatitis c and hepatocellular carcinoma underwent a liver transplant . on day 11 after surgery a chylous leak from a partial wound dehiscence was noted . the leak did not respond to 2 weeks of uninterrupted fat free clear liquid diet and 12 hour total parenteral nutrition at night . the same treatment was continued for another 6 weeks with fatty meal challenge every weekend which he failed . he was then given a fat free clear liquid diet 24 hour total parenteral nutrition and octreotide _lgnum_ g subcutaneously every 8 hours for 14 days . a prompt response was noted . his recovery was excellent at the time of this writing 9 months follow up . discussion eleven major cases have been reported with 9 cases being managed conservatively . four were given a diet plus total parenteral nutrition without octreotide producing a cure in 3 to 36 days . two cases including ours were given the diet and total parenteral nutrition which failed octreotide was then added and these cases were cured in 2 to 4 weeks . therefore diet with total parenteral nutrition failed in _decnum_ of the cases 2 6 . in 3 cases octreotide was used from the outset . they were all cured in 2 weeks . one case was operated on for peritonitis chylous ascites was found and a leak was ligated . one patient with congenital lymphatic disorder underwent peritoneovenous shunting . octreotide was not used in any of the cases of chylous ascites that were treated surgically . conclusions if exploratory surgery is done for any other reason it is best to identify a chylous leak and ligate it . otherwise we recommend octreotide combined with a fat free clear liquid diet and supplementation with medium chain triglycerides and total parenteral nutrition from the outset . 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>

case report 8 years after liver transplantation de novo hepatocellular carcinoma 8 months after hcv clearance through ifn free antiviral therapy . after orthotopic liver transplantation olt for hepatocellular carcinoma hcc recurrent hcc mostly develops within 2 years . all cases of de novo hcc described so far occurred later than 2 years after olt . prevention of post transplantation hcc has usually been tried to achieve by curing or controlling recurrent liver disease . this has been rationale for treatment with interferon ifn ribavirin of hcv recurrence in patients after olt transplanted for advanced hcv induced liver disease and or hcc . the availability of new and more efficient drugs has improved chances also for previously difficult to treat hcv positive patients . abstracttext after orthotopic liver transplantation olt for hepatocellular carcinoma hcc recurrent hcc mostly develops within 2 years . all cases of de novo hcc described so far occurred later than 2 years after olt . prevention of post transplantation hcc has usually been tried to achieve by curing or controlling recurrent liver disease . this has been rationale for treatment with interferon ifn ribavirin of hcv recurrence in patients after olt transplanted for advanced hcv induced liver disease and or hcc . the availability of new and more efficient drugs has improved chances also for previously difficult to treat hcv positive patients . a 75 year old male patient who had undergone olt for decompensated hcv cirrhosis in _lgnum_ and bilio digestive surgery in _lgnum_ under tracrolimus _decnum_ mg day and prednisone 5 mg day immunosuppressive therapy started to receive antiviral treatment for recurrent hcv infection of graft with _lgnum_ mg day ribavirin in combination with ledipasvir and sofosbuvir by the end of october _lgnum_ . because of multiple side effects anemia asthenia infections and reduction of kidney functions palliated by treatment with erythropoietin treatment was stopped after 16 weeks . at the third control a minimal increase in alpha fetoprotein afp serum level to 10 g l was measured 8 months after therapy whereas both liver sonography and serum transaminases were normal . the patient general condition however remained poor and a magnetic resonance imaging mri of abdomen was performed 2 months later . a nodule of 3 cm in diameter with a pseudocapsule was found centrally in the liver . the patient had to be hospitalized for recurrent infections of the lung overt ascites and peritonitis . rapid tumor growth 10 cm was detected during last stay in hospital april _lgnum_ concomitant with a rise of afp serum levels to 91 g
the family decided to take the patient home and best supportive care was provided by a general practitioner local nurses and the patient dedicated wife until his death . abstracttext a 75 year old male patient who had undergone olt for decompensated hcv cirrhosis in _lgnum_ and bilio digestive surgery in _lgnum_ under tracrolimus _decnum_ mg day and prednisone 5 mg day immunosuppressive therapy started to receive antiviral treatment for recurrent hcv infection of graft with _lgnum_ mg day ribavirin in combination with ledipasvir and sofosbuvir by the end of october _lgnum_ . because of multiple side effects anemia asthenia infections and reduction of kidney functions palliated by treatment with erythropoietin treatment was stopped after 16 weeks . at the third control a minimal increase in alpha fetoprotein afp serum level to 10 g l was measured 8 months after therapy whereas both liver sonography and serum transaminases were normal . the patient general condition however remained poor and a magnetic resonance imaging mri of abdomen was performed 2 months later . a nodule of 3 cm in diameter with a pseudocapsule was found centrally in the liver . the patient had to be hospitalized for recurrent infections of the lung overt ascites and peritonitis . rapid tumor growth 10 cm was detected during last stay in hospital april _lgnum_ concomitant with a rise of afp serum levels to 91 g
the family decided to take the patient home and best supportive care was provided by a general practitioner local nurses and the patient dedicated wife until his death . before treating olt patients with hcv graft reinfection one should not only consider possible advantages of newly effective antiviral therapies but also life expectancy and possible side effects difficult to manage at an outpatient service basis including severe disadvantages such as the development of hcc . abstracttext before treating olt patients with hcv graft reinfection one should not only consider possible advantages of newly effective antiviral therapies but also life expectancy and possible side effects difficult to manage at an outpatient service basis including severe disadvantages such as the development of hcc .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: case report 8 years after liver transplantation de novo hepatocellular carcinoma 8 months after hcv clearance through ifn free antiviral therapy . after orthotopic liver transplantation olt for hepatocellular carcinoma hcc recurrent hcc mostly develops within 2 years . all cases of de novo hcc described so far occurred later than 2 years after olt . prevention of post transplantation hcc has usually been tried to achieve by curing or controlling recurrent liver disease . this has been rationale for treatment with interferon ifn ribavirin of hcv recurrence in patients after olt transplanted for advanced hcv induced liver disease and or hcc . the availability of new and more efficient drugs has improved chances also for previously difficult to treat hcv positive patients . abstracttext after orthotopic liver transplantation olt for hepatocellular carcinoma hcc recurrent hcc mostly develops within 2 years . all cases of de novo hcc described so far occurred later than 2 years after olt . prevention of post transplantation hcc has usually been tried to achieve by curing or controlling recurrent liver disease . this has been rationale for treatment with interferon ifn ribavirin of hcv recurrence in patients after olt transplanted for advanced hcv induced liver disease and or hcc . the availability of new and more efficient drugs has improved chances also for previously difficult to treat hcv positive patients . a 75 year old male patient who had undergone olt for decompensated hcv cirrhosis in _lgnum_ and bilio digestive surgery in _lgnum_ under tracrolimus _decnum_ mg day and prednisone 5 mg day immunosuppressive therapy started to receive antiviral treatment for recurrent hcv infection of graft with _lgnum_ mg day ribavirin in combination with ledipasvir and sofosbuvir by the end of october _lgnum_ . because of multiple side effects anemia asthenia infections and reduction of kidney functions palliated by treatment with erythropoietin treatment was stopped after 16 weeks . at the third control a minimal increase in alpha fetoprotein afp serum level to 10 g l was measured 8 months after therapy whereas both liver sonography and serum transaminases were normal . the patient general condition however remained poor and a magnetic resonance imaging mri of abdomen was performed 2 months later . a nodule of 3 cm in diameter with a pseudocapsule was found centrally in the liver . the patient had to be hospitalized for recurrent infections of the lung overt ascites and peritonitis . rapid tumor growth 10 cm was detected during last stay in hospital april _lgnum_ concomitant with a rise of afp serum levels to 91 g
the family decided to take the patient home and best supportive care was provided by a general practitioner local nurses and the patient dedicated wife until his death . abstracttext a 75 year old male patient who had undergone olt for decompensated hcv cirrhosis in _lgnum_ and bilio digestive surgery in _lgnum_ under tracrolimus _decnum_ mg day and prednisone 5 mg day immunosuppressive therapy started to receive antiviral treatment for recurrent hcv infection of graft with _lgnum_ mg day ribavirin in combination with ledipasvir and sofosbuvir by the end of october _lgnum_ . because of multiple side effects anemia asthenia infections and reduction of kidney functions palliated by treatment with erythropoietin treatment was stopped after 16 weeks . at the third control a minimal increase in alpha fetoprotein afp serum level to 10 g l was measured 8 months after therapy whereas both liver sonography and serum transaminases were normal . the patient general condition however remained poor and a magnetic resonance imaging mri of abdomen was performed 2 months later . a nodule of 3 cm in diameter with a pseudocapsule was found centrally in the liver . the patient had to be hospitalized for recurrent infections of the lung overt ascites and peritonitis . rapid tumor growth 10 cm was detected during last stay in hospital april _lgnum_ concomitant with a rise of afp serum levels to 91 g
the family decided to take the patient home and best supportive care was provided by a general practitioner local nurses and the patient dedicated wife until his death . before treating olt patients with hcv graft reinfection one should not only consider possible advantages of newly effective antiviral therapies but also life expectancy and possible side effects difficult to manage at an outpatient service basis including severe disadvantages such as the development of hcc . abstracttext before treating olt patients with hcv graft reinfection one should not only consider possible advantages of newly effective antiviral therapies but also life expectancy and possible side effects difficult to manage at an outpatient service basis including severe disadvantages such as the development of hcc . 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 as a manifestation of parvovirus b19 infection . there are few reports in the literature of hepatitis as a manifestation of parvovirus b19 infection . we describe a case of parvovirus b19 associated acute hepatitis diagnosed based on a positive serologic test igm and molecular detection of parvovirus b19 dna in a liver biopsy specimen . parvovirus b19 infection should be considered in the differential diagnosis of patients presenting with acute hepatitis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: acute hepatitis as a manifestation of parvovirus b19 infection . there are few reports in the literature of hepatitis as a manifestation of parvovirus b19 infection . we describe a case of parvovirus b19 associated acute hepatitis diagnosed based on a positive serologic test igm and molecular detection of parvovirus b19 dna in a liver biopsy specimen . parvovirus b19 infection should be considered in the differential diagnosis of patients presenting with acute 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>

an abnormal alpha fetoprotein fractionation provides additional information a case of retroperitoneal germ cell tumor accompanied by liver cirrhosis type c . most of germ cell tumor is gonadal origin . however 5 of malignant germ cell tumors appear in extragonadal organs . because extragonadal germ cell tumors eggcts are found anywhere on the midline such as pineal gland mediastinum and retroperitoneum the origin of this type of tumor is controversial . eggcts are often seen between childhood and young adult an elderly patient with eggct is rarely met . here we report a case that an abnormal alpha fetoprotein afp fractionation pattern was helpful for diagnosis of retroperitoneal germ cell tumor . a presenile man with hepatic cirrhosis caused by chronic hepatitis c showed an intraperitoneal tumor like mass on computed tomography and thus hepatocellular carcinoma was suspected . a serological test re vealed elevated total afp level and afp l3 . the latter is the proportion of fucosylated afp on the lectin affinity based fractionation . noticeably the fractionation pattern of afp of this patient was abnormal sug gesting a diversity of lectin affinity of afp in germ cell tumors . this patient also showed an atypical in crease in beta human chorionic gonadotropin
cg . we suggest the measurement of
cg for early differ ential diagnosis of retroperitoneal germ cell tumor and hepatocellular carcinoma when an abnormal afp frac tionation pattern was detected in a patient with suspected hepatocellular carcinoma . short communication .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: an abnormal alpha fetoprotein fractionation provides additional information a case of retroperitoneal germ cell tumor accompanied by liver cirrhosis type c . most of germ cell tumor is gonadal origin . however 5 of malignant germ cell tumors appear in extragonadal organs . because extragonadal germ cell tumors eggcts are found anywhere on the midline such as pineal gland mediastinum and retroperitoneum the origin of this type of tumor is controversial . eggcts are often seen between childhood and young adult an elderly patient with eggct is rarely met . here we report a case that an abnormal alpha fetoprotein afp fractionation pattern was helpful for diagnosis of retroperitoneal germ cell tumor . a presenile man with hepatic cirrhosis caused by chronic hepatitis c showed an intraperitoneal tumor like mass on computed tomography and thus hepatocellular carcinoma was suspected . a serological test re vealed elevated total afp level and afp l3 . the latter is the proportion of fucosylated afp on the lectin affinity based fractionation . noticeably the fractionation pattern of afp of this patient was abnormal sug gesting a diversity of lectin affinity of afp in germ cell tumors . this patient also showed an atypical in crease in beta human chorionic gonadotropin
cg . we suggest the measurement of
cg for early differ ential diagnosis of retroperitoneal germ cell tumor and hepatocellular carcinoma when an abnormal afp frac tionation pattern was detected in a patient with suspected hepatocellular carcinoma . short communication . 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>

total lower lip reconstruction with functional gracilis free muscle flap . free flaps based on static slings principles cannot provide esthetic and functional outcomes at a desired level in total or close to total lip loss . therefore dynamic methods have become a current issue in recent years and especially the idea of functional gracilis free muscle flap has been suggested . in this study we present a case of a successful total lower lip repair with this flap . in a 78 year old female patient who was diagnosed with squamous cell carcinoma involving the entire lower lip bilateral modified radical neck dissection and full thickness total resection with 1 cm surgical margin so as to include both commissures of the tumor were performed and then a free gracilis muscle flap was transferred from the same side . after microvascular anastomoses the motor nerve of the flap was coapted to the marginal mandibular branch of the fascial nerve . the entire intra and extraoral surfaces of the flap were covered with a partial thickness skin graft which was taken from the right thigh . there was no any intra or early postoperative complication . the skin graft and flap survived without any problem . in the controls of the patient who was followed up for 8 postoperative months it was observed that the gracilis muscle flap was well adapted to its place gained a very good tonus its volume reduced over time and reached to ideal dimensions and the overlying skin graft provided a good color and texture match with the surrounding tissues . the motor activity of the muscle was monitored with the tinel test . the speech and facial expressions of the patient were very clear . despite the patient has an edentulous mandible and was not using prosthesis her feeding with fluid and solid foods was free of problems oral competence was highly sufficient and there was no any drooling . esthetic appearance was very good and intraoral vestibular depth was sufficient . the mouth opening was 3 cm . when comparing with upper orbicularis oculi muscle on the electroneuromyography enmg ordered at the
h month a similar nerve conduction time _decnum_ versus _decnum_ ms and contraction amplitude _decnum_ versus _decnum_ mv values were obtained from the gracilis muscle . follow up of the patient is still continued with no tumor recurrence observed during this period . being the real dynamic flap and its tonus of the functional gracillis free muscle flap in opposite to the static methods provides a significant superiority over the other options in terms of oral functions moreover the overlying skin graft presents a very good color and texture harmony aesthetically . this method is a candidate to be an exclusive surgical technique in the repair of total or close to total lip losses in the future .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: total lower lip reconstruction with functional gracilis free muscle flap . free flaps based on static slings principles cannot provide esthetic and functional outcomes at a desired level in total or close to total lip loss . therefore dynamic methods have become a current issue in recent years and especially the idea of functional gracilis free muscle flap has been suggested . in this study we present a case of a successful total lower lip repair with this flap . in a 78 year old female patient who was diagnosed with squamous cell carcinoma involving the entire lower lip bilateral modified radical neck dissection and full thickness total resection with 1 cm surgical margin so as to include both commissures of the tumor were performed and then a free gracilis muscle flap was transferred from the same side . after microvascular anastomoses the motor nerve of the flap was coapted to the marginal mandibular branch of the fascial nerve . the entire intra and extraoral surfaces of the flap were covered with a partial thickness skin graft which was taken from the right thigh . there was no any intra or early postoperative complication . the skin graft and flap survived without any problem . in the controls of the patient who was followed up for 8 postoperative months it was observed that the gracilis muscle flap was well adapted to its place gained a very good tonus its volume reduced over time and reached to ideal dimensions and the overlying skin graft provided a good color and texture match with the surrounding tissues . the motor activity of the muscle was monitored with the tinel test . the speech and facial expressions of the patient were very clear . despite the patient has an edentulous mandible and was not using prosthesis her feeding with fluid and solid foods was free of problems oral competence was highly sufficient and there was no any drooling . esthetic appearance was very good and intraoral vestibular depth was sufficient . the mouth opening was 3 cm . when comparing with upper orbicularis oculi muscle on the electroneuromyography enmg ordered at the
h month a similar nerve conduction time _decnum_ versus _decnum_ ms and contraction amplitude _decnum_ versus _decnum_ mv values were obtained from the gracilis muscle . follow up of the patient is still continued with no tumor recurrence observed during this period . being the real dynamic flap and its tonus of the functional gracillis free muscle flap in opposite to the static methods provides a significant superiority over the other options in terms of oral functions moreover the overlying skin graft presents a very good color and texture harmony aesthetically . this method is a candidate to be an exclusive surgical technique in the repair of total or close to total lip losses in the future . 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>

rapid deterioration of latent hbv hepatitis during cushing disease and posttraumatic stress disorder after earthquake . reactivation of the hepatitis b virus hbv is a risk in the _lgnum_ million hbv carriers worldwide . hbv reactivation may cause hepatocellular carcinoma cirrhosis and fulminant hepatitis and hbv reactivation accompanied with malignant tumor and or chemotherapy is a critical problem for patients with chronic hbv infection . multiple risk factors causing an immunosuppressive state can also induce hbv reactivation . we present a case of hbv reactivation during an immunosuppressive state caused by cushing disease and physical and psychological stress after a disaster . a 47 year old japanese woman was an inactive hbv carrier until the great east japan earthquake occurred and follow up was discontinued . one year after the earthquake she had intractable hypertension and her visual acuity gradually worsened . head magnetic resonance imaging showed a sellar tumor compressing the optic chiasm and hepatic dysfunction with hbv reactivation was identified . endocrinologic examination established the diagnosis as cushing disease . after normalization of hepatic dysfunction with antiviral therapy transsphenoidal tumor removal was performed that resulted in subtotal removal except the right cavernous portion . steroid hormone supplementation was discontinued after 3 days of administration and gamma knife therapy was performed for the residual tumor . eighteen months after the operation adrenocorticotropic hormone and cortisol values returned to normal . the patient has been free from tumor regrowth and hbv reactivation throughout the postoperative course . accomplishment of normalization with intrinsic steroid value with minimization of steroid supplementation should be established . precise operative procedures and careful treatment planning are essential to avoid hbv reactivation in patients with this threatening condition .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: rapid deterioration of latent hbv hepatitis during cushing disease and posttraumatic stress disorder after earthquake . reactivation of the hepatitis b virus hbv is a risk in the _lgnum_ million hbv carriers worldwide . hbv reactivation may cause hepatocellular carcinoma cirrhosis and fulminant hepatitis and hbv reactivation accompanied with malignant tumor and or chemotherapy is a critical problem for patients with chronic hbv infection . multiple risk factors causing an immunosuppressive state can also induce hbv reactivation . we present a case of hbv reactivation during an immunosuppressive state caused by cushing disease and physical and psychological stress after a disaster . a 47 year old japanese woman was an inactive hbv carrier until the great east japan earthquake occurred and follow up was discontinued . one year after the earthquake she had intractable hypertension and her visual acuity gradually worsened . head magnetic resonance imaging showed a sellar tumor compressing the optic chiasm and hepatic dysfunction with hbv reactivation was identified . endocrinologic examination established the diagnosis as cushing disease . after normalization of hepatic dysfunction with antiviral therapy transsphenoidal tumor removal was performed that resulted in subtotal removal except the right cavernous portion . steroid hormone supplementation was discontinued after 3 days of administration and gamma knife therapy was performed for the residual tumor . eighteen months after the operation adrenocorticotropic hormone and cortisol values returned to normal . the patient has been free from tumor regrowth and hbv reactivation throughout the postoperative course . accomplishment of normalization with intrinsic steroid value with minimization of steroid supplementation should be established . precise operative procedures and careful treatment planning are essential to avoid hbv reactivation in patients with this threatening condition . 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>

septo optic dysplasia and hemophagocytic lymphohistiocytosis in an infant . macrophage activation in hemophagocytic lymphohistiocytosis hlh leads to severe inflammation resulting in cytopenias and multi organ dysfunction . septo optic dysplasia sod is an as yet unaffiliated disorder that manifests with optic hepatic endocrine and or constitutional defects . we detail the first reported occurrence of both hlh and sod in one patient . this two month old patient presented with acute hepatitis direct hyperbilirubinemia anemia and thrombocytopenia . treatment followed standard of care practices for sod and hlh . the patient subsequently underwent an allogeneic bone marrow transplant within eight months of diagnosis and remained in full remission at day 90 . we suggest considering a diagnosis of hlh in patients with sod who present with severe liver failure refractory to standard therapy .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: septo optic dysplasia and hemophagocytic lymphohistiocytosis in an infant . macrophage activation in hemophagocytic lymphohistiocytosis hlh leads to severe inflammation resulting in cytopenias and multi organ dysfunction . septo optic dysplasia sod is an as yet unaffiliated disorder that manifests with optic hepatic endocrine and or constitutional defects . we detail the first reported occurrence of both hlh and sod in one patient . this two month old patient presented with acute hepatitis direct hyperbilirubinemia anemia and thrombocytopenia . treatment followed standard of care practices for sod and hlh . the patient subsequently underwent an allogeneic bone marrow transplant within eight months of diagnosis and remained in full remission at day 90 . we suggest considering a diagnosis of hlh in patients with sod who present with severe liver failure refractory to standard 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>

successful liver transplantation from a donor with a continuous flow left ventricular assist device for 9 months . organ donor criteria continue to be extended in an attempt to meet growing demands . patients with continuous flow left ventricular assist devices are one group of potential donors being considered . one concern with this group is the effect of continuous flow for a prolonged duration as opposed to normal pulsatile flow on end organ function . we report the
t case of a liver transplantation from a donor who had a continuous flow left ventricular assist device for 9 months . the recipient was a 69 year old woman with a history of cryptogenic cirrhosis and hepatocellular carcinoma . the transplantation was complicated by moderate acute cellular rejection as well as biliary obstruction requiring sphincterotomy and stent placement . after management of those complications the patient liver function tests returned to normal values and remained stable at her 6 month post transplantation follow up . this case shows that organ transplantation from a donor with a continuous flow left ventricular assist device for a prolonged period can be performed successfully .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: successful liver transplantation from a donor with a continuous flow left ventricular assist device for 9 months . organ donor criteria continue to be extended in an attempt to meet growing demands . patients with continuous flow left ventricular assist devices are one group of potential donors being considered . one concern with this group is the effect of continuous flow for a prolonged duration as opposed to normal pulsatile flow on end organ function . we report the
t case of a liver transplantation from a donor who had a continuous flow left ventricular assist device for 9 months . the recipient was a 69 year old woman with a history of cryptogenic cirrhosis and hepatocellular carcinoma . the transplantation was complicated by moderate acute cellular rejection as well as biliary obstruction requiring sphincterotomy and stent placement . after management of those complications the patient liver function tests returned to normal values and remained stable at her 6 month post transplantation follow up . this case shows that organ transplantation from a donor with a continuous flow left ventricular assist device for a prolonged period can be performed successfully . 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 unique reconstructive technique in a young patient after manubrial recestion in grade ii chondrosarcoma . objective approximately 30 of malignant primary bone tumors are chondrosarcomas which occur on the anterior chest wall most frequently . patients who are treated with adequate surgical intervention recover well 10 years survival rate is 97 . besides the aesthetic outcome preservation of breathing and loading are crucial . methods authors present a case of a 44 year old male patient who worked as a sport masseur operated on grade ii chondrosarcoma of the manubrium . concerning the age of the patient an immediate reconstruction was carried out . the involved part of the sternum was resected with wide margins . the reconstruction was performed with dual mesh covered by a pedicled left sided pectoral major muscle . as a unique technique authors used the tendons of the semitendinous and gracilis muscles to fix both claviculas together to give the proper stability and function for the shoulder girdle . result after an uneventful postoperative period the patient had a fast recovery . conclusion there are no data in the literature for such a method of fixation of the anterior chest wall . the method is suggested by the authors .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: a unique reconstructive technique in a young patient after manubrial recestion in grade ii chondrosarcoma . objective approximately 30 of malignant primary bone tumors are chondrosarcomas which occur on the anterior chest wall most frequently . patients who are treated with adequate surgical intervention recover well 10 years survival rate is 97 . besides the aesthetic outcome preservation of breathing and loading are crucial . methods authors present a case of a 44 year old male patient who worked as a sport masseur operated on grade ii chondrosarcoma of the manubrium . concerning the age of the patient an immediate reconstruction was carried out . the involved part of the sternum was resected with wide margins . the reconstruction was performed with dual mesh covered by a pedicled left sided pectoral major muscle . as a unique technique authors used the tendons of the semitendinous and gracilis muscles to fix both claviculas together to give the proper stability and function for the shoulder girdle . result after an uneventful postoperative period the patient had a fast recovery . conclusion there are no data in the literature for such a method of fixation of the anterior chest wall . the method is suggested by the authors . 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>

thrombotic microangiopathy associated with use of interferon beta . interferon beta is widely used for the treatment of relapsing multiple sclerosis . the drug is usually well tolerated but autoimmune adverse effects including kidney disease have been reported . only a few cases of hemolytic uremic syndrome thrombotic microangiopathy associated interferon alpha have been described so far and even fewer with beta interferon . we report a patient who developed thrombotic microangiopathy during treatment with interferon beta and improved after discontinuation and steroid therapy . complement cascade and antiphospholipid antibodies are investigated . the spectrum of renal diseases associated with interferon beta treatment is also reviewed .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: thrombotic microangiopathy associated with use of interferon beta . interferon beta is widely used for the treatment of relapsing multiple sclerosis . the drug is usually well tolerated but autoimmune adverse effects including kidney disease have been reported . only a few cases of hemolytic uremic syndrome thrombotic microangiopathy associated interferon alpha have been described so far and even fewer with beta interferon . we report a patient who developed thrombotic microangiopathy during treatment with interferon beta and improved after discontinuation and steroid therapy . complement cascade and antiphospholipid antibodies are investigated . the spectrum of renal diseases associated with interferon beta treatment is also reviewed . 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>

successful treatment with pulse cyclophosphamide of a steroid refractory hepatitic variant of liver acute graft
host disease in a child . a 13 yr old boy with recurrent acute myeloid leukemia underwent hsct using cells from an unrelated donor who matched all hla antigens except one . forty two days later the patient developed a steroid refractory hepatitic variant of liver gvhd with peak alt and
bil values of _lgnum_ mu ml and _decnum_ mg dl respectively . he was successfully treated with pulse cy _lgnum_ mg dose one day without a change in chimerism being observed or acquiring an infection . all immunosuppressant therapies could be discontinued 12 months after hsct . two yr after hsct the patient remains in cr without chronic gvhd . this single case report suggests that pulse cy may be a promising therapy for steroid refractory gvhd especially hepatitic gvhd but needs to be further tested in clinical trials .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: successful treatment with pulse cyclophosphamide of a steroid refractory hepatitic variant of liver acute graft
host disease in a child . a 13 yr old boy with recurrent acute myeloid leukemia underwent hsct using cells from an unrelated donor who matched all hla antigens except one . forty two days later the patient developed a steroid refractory hepatitic variant of liver gvhd with peak alt and
bil values of _lgnum_ mu ml and _decnum_ mg dl respectively . he was successfully treated with pulse cy _lgnum_ mg dose one day without a change in chimerism being observed or acquiring an infection . all immunosuppressant therapies could be discontinued 12 months after hsct . two yr after hsct the patient remains in cr without chronic gvhd . this single case report suggests that pulse cy may be a promising therapy for steroid refractory gvhd especially hepatitic gvhd but needs to be further tested in clinical trials . 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>

concomitant interferon alpha and chemotherapy in hepatitis c and colorectal cancer a case report . hepatitis c virus hcv infection is one of the main causes of liver disease worldwide . patients undergoing surgery are at risk of acquiring acute hcv infection and those undergoing surgical eradication of a neoplasia may be indicated for adjuvant treatment . therefore unlike chronic infection these patients may simultaneously need antiviral therapy with interferon for acute hepatitis c and cytotoxic chemotherapy . to date no data are available regarding the efficacy and tolerability of concomitant interferon treatment and antineoplastic chemotherapy in the setting of acute hepatitis c treatment . here we report the case of a 60 year old man who developed acute hepatitis c after left hemicolectomy for an adenocarcinoma . he received concomitant antiviral treatment with interferon and adjuvant chemotherapy with capecitabine and oxaliplatin . both treatments were well tolerated and the patient completed the scheduled therapies . hcv infection was eradicated and the patient is free of neoplastic disease two years and 6 months after surgery .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: concomitant interferon alpha and chemotherapy in hepatitis c and colorectal cancer a case report . hepatitis c virus hcv infection is one of the main causes of liver disease worldwide . patients undergoing surgery are at risk of acquiring acute hcv infection and those undergoing surgical eradication of a neoplasia may be indicated for adjuvant treatment . therefore unlike chronic infection these patients may simultaneously need antiviral therapy with interferon for acute hepatitis c and cytotoxic chemotherapy . to date no data are available regarding the efficacy and tolerability of concomitant interferon treatment and antineoplastic chemotherapy in the setting of acute hepatitis c treatment . here we report the case of a 60 year old man who developed acute hepatitis c after left hemicolectomy for an adenocarcinoma . he received concomitant antiviral treatment with interferon and adjuvant chemotherapy with capecitabine and oxaliplatin . both treatments were well tolerated and the patient completed the scheduled therapies . hcv infection was eradicated and the patient is free of neoplastic disease two years and 6 months after surgery . 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>

high 9
tc dpd myocardial uptake in a patient with apolipoprotein ai related amyloidotic cardiomyopathy . amyloidotic cardiomyopathy is still a widely underdiagnosed condition that usually requires endomyocardial biopsy emb for a definite diagnosis . 9
tc
 diphosphono
 propanodicarboxylic acid 9
tc dpd has proven highly sensitive for detecting amyloidotic cardiomyopathy due to transthyretin related amyloid deposition . herein we report the first description of the 9
tc dpd scintigraphy profile in a patient with suspected amyloidotic cardiomyopathy and a final emb and genetically proven diagnosis of familial apolipoprotein ai amyloidosis due to leu17
er variant .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: high 9
tc dpd myocardial uptake in a patient with apolipoprotein ai related amyloidotic cardiomyopathy . amyloidotic cardiomyopathy is still a widely underdiagnosed condition that usually requires endomyocardial biopsy emb for a definite diagnosis . 9
tc
 diphosphono
 propanodicarboxylic acid 9
tc dpd has proven highly sensitive for detecting amyloidotic cardiomyopathy due to transthyretin related amyloid deposition . herein we report the first description of the 9
tc dpd scintigraphy profile in a patient with suspected amyloidotic cardiomyopathy and a final emb and genetically proven diagnosis of familial apolipoprotein ai amyloidosis due to leu17
er variant . 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>

first report of chronic hepatitis e in renal transplant recipients in portugal . hepatitis e virus hev infection can be responsible for chronic hepatitis in immunocompromised patients and can rapidly evolve into fibrosis and or hepatic cirrhosis . we present two cases of chronic hepatitis e emphasizing the need to be aware of this entity as a growing etiology of hepatitis in transplant and immunocompromised patients .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: first report of chronic hepatitis e in renal transplant recipients in portugal . hepatitis e virus hev infection can be responsible for chronic hepatitis in immunocompromised patients and can rapidly evolve into fibrosis and or hepatic cirrhosis . we present two cases of chronic hepatitis e emphasizing the need to be aware of this entity as a growing etiology of hepatitis in transplant and immunocompromised 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: 1 </s>

bioglue associated loss of aortic valve leaflet motility sonographically masked by both newly replaced mechanical aortic and mitral valves . bioglue is a surgical adhesive widely used to help reinforce complex cardiac and vascular repairs . since its introduction several case reports have emerged revealing complications that all providers should be mindful of whenever the product is used . this report considers a unique situation where bioglue was used after double cardiac valve repair that resulted in adhesion of the new mechanical aortic valve leaflets and was difficult to visualize with transesophageal echocardiography .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: bioglue associated loss of aortic valve leaflet motility sonographically masked by both newly replaced mechanical aortic and mitral valves . bioglue is a surgical adhesive widely used to help reinforce complex cardiac and vascular repairs . since its introduction several case reports have emerged revealing complications that all providers should be mindful of whenever the product is used . this report considers a unique situation where bioglue was used after double cardiac valve repair that resulted in adhesion of the new mechanical aortic valve leaflets and was difficult to visualize with transesophageal echocardiography . 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>

use of rituximab in pemphigus patients with chronic viral hepatitis report of three cases . use of rituximab in patients with chronic viral hepatitis can worsen pre existing hepatitis or reactivate occult infection . there are no reports of use of rituximab in pemphigus patients with co existing viral hepatitis . herein we report three pemphigus patients with co existing chronic viral hepatitis hepatitis c n 2 hepatitis b n 1 who were treated successfully with rituximab under close supervision and concurrent antiviral drug administration . there was no derangement of the liver function tests or increase in viral load in any of the patients . by incorporating good collaboration with a hepatologist and close follow up such patients can be managed successfully with biologic therapies when the conventional treatment modalities have failed .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: use of rituximab in pemphigus patients with chronic viral hepatitis report of three cases . use of rituximab in patients with chronic viral hepatitis can worsen pre existing hepatitis or reactivate occult infection . there are no reports of use of rituximab in pemphigus patients with co existing viral hepatitis . herein we report three pemphigus patients with co existing chronic viral hepatitis hepatitis c n 2 hepatitis b n 1 who were treated successfully with rituximab under close supervision and concurrent antiviral drug administration . there was no derangement of the liver function tests or increase in viral load in any of the patients . by incorporating good collaboration with a hepatologist and close follow up such patients can be managed successfully with biologic therapies when the conventional treatment modalities have failed . 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>

extraventricular anaplastic ependymoma with metastasis to scalp and neck . we report a case of anaplastic ependymoma with extracranial metastases in a 22 year old female . the patient originally presented with headaches and dysarthria . neuroimaging revealed a large solid and cystic right fronto temporal lesion . it was located completely extraventricularly and a glioblastoma was suspected based on the neuroimaging findings . a gross total resection was achieved . histopathologic examination revealed an anaplastic ependymoma . the patient was treated with radiotherapy . approximately 1 year after the initial surgery the patient presented with metastatic disease to the scalp . at 2 years an intraparotid metastasis was detected . subsequent neck dissection revealed positive lymph nodes at several levels . it was followed by radiotherapy to the neck . 5 years after the initial surgery the patient has residual metastatic disease . the case is discussed and the literature on extraventricular ependymal neoplasms is reviewed .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: extraventricular anaplastic ependymoma with metastasis to scalp and neck . we report a case of anaplastic ependymoma with extracranial metastases in a 22 year old female . the patient originally presented with headaches and dysarthria . neuroimaging revealed a large solid and cystic right fronto temporal lesion . it was located completely extraventricularly and a glioblastoma was suspected based on the neuroimaging findings . a gross total resection was achieved . histopathologic examination revealed an anaplastic ependymoma . the patient was treated with radiotherapy . approximately 1 year after the initial surgery the patient presented with metastatic disease to the scalp . at 2 years an intraparotid metastasis was detected . subsequent neck dissection revealed positive lymph nodes at several levels . it was followed by radiotherapy to the neck . 5 years after the initial surgery the patient has residual metastatic disease . the case is discussed and the literature on extraventricular ependymal neoplasms is reviewed . 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>

chronic and acute hypersensitivity pneumonitis in a dairy farmer and his son . we encountered a dairy farmer and his son with farmer lung who had worked on the same farm for 25 years and 5 years respectively . the son was admitted to our hospital because of cough sputum and shortness of breath . chest computed tomography ct on admission revealed diffuse ground glass opacities in both lung fields . following admission the clinical symptoms and radiological findings improved spontaneously without specific treatment . a provocation test following return to work on the farm elicited recurrence of the symptoms and radiological findings . he was diagnosed with acute hypersensitivity pneumonitis hp based on the clinical findings . after quitting his job no reccurence was noted . the farther was admitted to our hospital complaining of repeated episodes of cough and high fever . he had been diagnosed with lung fibrosis 10 years previously . chest ct on admission revealed progression of thin walled cystic changes over ten years . following admission his symptoms improved without medication . however because he has continued working on the farm his radiological findings have gradually deteriorated . he was diagnosed with chronic hp based on his clinical features . these cases are suggestive of farmer lung with familial occurrence difference between acute hp and chronic hp and long term prognosis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: chronic and acute hypersensitivity pneumonitis in a dairy farmer and his son . we encountered a dairy farmer and his son with farmer lung who had worked on the same farm for 25 years and 5 years respectively . the son was admitted to our hospital because of cough sputum and shortness of breath . chest computed tomography ct on admission revealed diffuse ground glass opacities in both lung fields . following admission the clinical symptoms and radiological findings improved spontaneously without specific treatment . a provocation test following return to work on the farm elicited recurrence of the symptoms and radiological findings . he was diagnosed with acute hypersensitivity pneumonitis hp based on the clinical findings . after quitting his job no reccurence was noted . the farther was admitted to our hospital complaining of repeated episodes of cough and high fever . he had been diagnosed with lung fibrosis 10 years previously . chest ct on admission revealed progression of thin walled cystic changes over ten years . following admission his symptoms improved without medication . however because he has continued working on the farm his radiological findings have gradually deteriorated . he was diagnosed with chronic hp based on his clinical features . these cases are suggestive of farmer lung with familial occurrence difference between acute hp and chronic hp and long term prognosis . 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>

histopathology of igg4 related autoimmune hepatitis and igg4 related hepatopathy in igg4 related disease . immunoglobulin g4 related disease igg4 rd is a systemic disease involving many organs it includes igg4 related sclerosing cholangitis and inflammatory pseudotumor in the hepatobiliary system . two types of hepatic parenchymal involvement have been reported in igg4 rd igg4 related autoimmune hepatitis aih and igg4 hepatopathy . moreover only three cases of igg4 related aih have been reported . immunoglobulin g4 related aih is clinicopathologically similar to aih except for an elevated serum igg4 level and heavy infiltration of igg4 positive plasma cells in the liver tissue . interestingly igg4 related aih can be complicated by well known igg4 rd s . immunoglobulin g4 hepatopathy which includes various histopathological lesions encountered in the liver of patients with type i autoimmune pancreatitis is classified into five histological categories portal inflammation large bile duct damage portal sclerosis lobular hepatitis and cholestasis . immunoglobulin g4 hepatopathy is currently a collective term covering hepatic lesions primarily or secondarily related to igg4 related sclerosing cholangitis and type 1 autoimmune pancreatitis . in conclusion the liver is not immune to igg4 rd and at least two types of hepatic involvement in igg4 rd have been reported igg4 related aih and igg4 hepatopathy . additional studies are required to clarify their precise clinical significance with respect to igg4 rd and inherent liver diseases .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: histopathology of igg4 related autoimmune hepatitis and igg4 related hepatopathy in igg4 related disease . immunoglobulin g4 related disease igg4 rd is a systemic disease involving many organs it includes igg4 related sclerosing cholangitis and inflammatory pseudotumor in the hepatobiliary system . two types of hepatic parenchymal involvement have been reported in igg4 rd igg4 related autoimmune hepatitis aih and igg4 hepatopathy . moreover only three cases of igg4 related aih have been reported . immunoglobulin g4 related aih is clinicopathologically similar to aih except for an elevated serum igg4 level and heavy infiltration of igg4 positive plasma cells in the liver tissue . interestingly igg4 related aih can be complicated by well known igg4 rd s . immunoglobulin g4 hepatopathy which includes various histopathological lesions encountered in the liver of patients with type i autoimmune pancreatitis is classified into five histological categories portal inflammation large bile duct damage portal sclerosis lobular hepatitis and cholestasis . immunoglobulin g4 hepatopathy is currently a collective term covering hepatic lesions primarily or secondarily related to igg4 related sclerosing cholangitis and type 1 autoimmune pancreatitis . in conclusion the liver is not immune to igg4 rd and at least two types of hepatic involvement in igg4 rd have been reported igg4 related aih and igg4 hepatopathy . additional studies are required to clarify their precise clinical significance with respect to igg4 rd and inherent liver diseases . 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>

successful recovery of acute renal transplant failure in recurrent hepatitis c virus associated membranoproliferative glomerulonephritis . recurrence of hepatitis c virus hcv associated membranoproliferative glomerulonephritis mpgn in the kidney transplant may lead to continuous graft deterioration and the need for further renal replacement therapy . the novel direct acting antiviral agents daas allow a highly effective and interferon free treatment option for chronic hcv infected patients . data on the therapeutic safety and efficacy in hcv infected renal transplant patients are sparse especially for patients with severe renal impairment . we report the case of a 63 year old female hcv positive renal transplant patient with biopsy proven recurrence of mpgn in the renal graft 3 years after transplant . because of rapid loss of transplant function and consecutive need for hemodialysis we initiated a combined anti hcv directed therapy regimen consisting of daclatasvir and simeprevir over 12 weeks . viral clearance of hcv was obtained as early as 2 weeks after start of treatment . no adverse therapy associated side effects were observed and immunosuppressive dosing remained unchanged . importantly graft function fully recovered and hemodialysis was stopped 2 mo after the end of daclatasvir simeprevir treatment . we report the first case of successful recovery of dialysis dependent renal transplant failure after treatment of recurrent hcv associated mpgn in a kidney transplant recipient by curing the underlying hcv infection with a combination of novel daas .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: successful recovery of acute renal transplant failure in recurrent hepatitis c virus associated membranoproliferative glomerulonephritis . recurrence of hepatitis c virus hcv associated membranoproliferative glomerulonephritis mpgn in the kidney transplant may lead to continuous graft deterioration and the need for further renal replacement therapy . the novel direct acting antiviral agents daas allow a highly effective and interferon free treatment option for chronic hcv infected patients . data on the therapeutic safety and efficacy in hcv infected renal transplant patients are sparse especially for patients with severe renal impairment . we report the case of a 63 year old female hcv positive renal transplant patient with biopsy proven recurrence of mpgn in the renal graft 3 years after transplant . because of rapid loss of transplant function and consecutive need for hemodialysis we initiated a combined anti hcv directed therapy regimen consisting of daclatasvir and simeprevir over 12 weeks . viral clearance of hcv was obtained as early as 2 weeks after start of treatment . no adverse therapy associated side effects were observed and immunosuppressive dosing remained unchanged . importantly graft function fully recovered and hemodialysis was stopped 2 mo after the end of daclatasvir simeprevir treatment . we report the first case of successful recovery of dialysis dependent renal transplant failure after treatment of recurrent hcv associated mpgn in a kidney transplant recipient by curing the underlying hcv infection with a combination of novel daas . 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 alcoholic fatty liver disease and hepatocellular carcinoma in a 7 year old obese boy coincidence or comorbidity background hepatocellular carcinoma hcc may develop from non alcoholic fatty liver disease nafld either in the presence or in the absence of established cirrhosis . non cirrhotic patients with nafld related hcc are usually adult male and obese . however this association has not been reported yet in younger age groups . objectives in the present study the clinical case of a 7 yaer old obese boy with steatosis and hcc is presented . methods a 7 year old boy with no evidence of chronic liver disease was admitted for assessment of a liver mass . preliminary assessment was suggestive of a combined and severe liver steatosis together with a malignant disease . results a biopsy confirmed the suspected diagnosis of hcc interestingly the non neoplastic liver was surrounded and characterized by the presence of steatosis and ballooning and being absent of lobular inflammation and fibrosis . chemotherapy and diet changes were conducted successfully with ultrasound characteristics suggesting improvements on both aspects conventional liver mass resection could take place . conclusions this case report suggests that hcc might develop in paediatric age patients with obesity related nafld even in the absence of fibrosis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: non alcoholic fatty liver disease and hepatocellular carcinoma in a 7 year old obese boy coincidence or comorbidity background hepatocellular carcinoma hcc may develop from non alcoholic fatty liver disease nafld either in the presence or in the absence of established cirrhosis . non cirrhotic patients with nafld related hcc are usually adult male and obese . however this association has not been reported yet in younger age groups . objectives in the present study the clinical case of a 7 yaer old obese boy with steatosis and hcc is presented . methods a 7 year old boy with no evidence of chronic liver disease was admitted for assessment of a liver mass . preliminary assessment was suggestive of a combined and severe liver steatosis together with a malignant disease . results a biopsy confirmed the suspected diagnosis of hcc interestingly the non neoplastic liver was surrounded and characterized by the presence of steatosis and ballooning and being absent of lobular inflammation and fibrosis . chemotherapy and diet changes were conducted successfully with ultrasound characteristics suggesting improvements on both aspects conventional liver mass resection could take place . conclusions this case report suggests that hcc might develop in paediatric age patients with obesity related nafld even in the absence of fibrosis . 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>

internal decompressive craniectomy with craniotomy a novel surgical therapy of giant frontal mucocele complicated by subdural empyema . introduction giant frontal mucocele gfm is an extremely rare cause of frontal lobe syndrome . subdural empyema sde is an uncommon complication of paranasal sinisutis for which craniotomy and decompressive craniotomy are the most effective surgical procedures . case report a 54 year old man was brought unconscious to the emergency room where recurrent generalized seizures occurred . heroine abuse hcv related hepatitis prolonged antibiotic therapy for treatment of purulent rhinorrhea along with recent personality changes was reported . high white blood cell count pansinusitis gfm sde and cerebritis were documented . the patient underwent bifrontal craniotomy in emergency extensive drilling of the inner aspect of the frontal bone surgical toilette of the enlarged frontal sinus and its quot cranialization quot . prevotella intermedia and fusobacterium nucleatum were isolated and antibiotic therapy was started intravenously and then continued orally for three months . two years later the patient has recovered though minor signs of frontal lobe syndrome persist . discussion to the authors knowledge this is the first case of gfm with sde reported in the literature . although decompressive craniectomy is advocated in extreme conditions as in this case quot internal decompressive craniectomy quot obtained with craniotomy and cranialization of the frontal sinuses is strongly advocated in cases of sde associated with megasinuses .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: internal decompressive craniectomy with craniotomy a novel surgical therapy of giant frontal mucocele complicated by subdural empyema . introduction giant frontal mucocele gfm is an extremely rare cause of frontal lobe syndrome . subdural empyema sde is an uncommon complication of paranasal sinisutis for which craniotomy and decompressive craniotomy are the most effective surgical procedures . case report a 54 year old man was brought unconscious to the emergency room where recurrent generalized seizures occurred . heroine abuse hcv related hepatitis prolonged antibiotic therapy for treatment of purulent rhinorrhea along with recent personality changes was reported . high white blood cell count pansinusitis gfm sde and cerebritis were documented . the patient underwent bifrontal craniotomy in emergency extensive drilling of the inner aspect of the frontal bone surgical toilette of the enlarged frontal sinus and its quot cranialization quot . prevotella intermedia and fusobacterium nucleatum were isolated and antibiotic therapy was started intravenously and then continued orally for three months . two years later the patient has recovered though minor signs of frontal lobe syndrome persist . discussion to the authors knowledge this is the first case of gfm with sde reported in the literature . although decompressive craniectomy is advocated in extreme conditions as in this case quot internal decompressive craniectomy quot obtained with craniotomy and cranialization of the frontal sinuses is strongly advocated in cases of sde associated with megasinuses . 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>

superior horn of thyroid cartilage dysplasia in 1 case . the external stimuli and other reasons may result in hyperplasia and abnormal angle of the upper corner of the thyroid cartilage . the upper corner of the thyroid cartilage has anatomical variations . to oppression stimulate carotid artery cervical sympathetic dry section and so on could causing pharyngeal foreign body sensation and sore throat . by surgical removal of the thyroid cartilage hyperplasia upper corner postoperative symptoms would be resolved .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: superior horn of thyroid cartilage dysplasia in 1 case . the external stimuli and other reasons may result in hyperplasia and abnormal angle of the upper corner of the thyroid cartilage . the upper corner of the thyroid cartilage has anatomical variations . to oppression stimulate carotid artery cervical sympathetic dry section and so on could causing pharyngeal foreign body sensation and sore throat . by surgical removal of the thyroid cartilage hyperplasia upper corner postoperative symptoms would be resolved . 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>

angiomatoid fibrous histiocytoma of the radial pulse groove . background angiomatoid fibrous histiocytoma afh is a slowly progressing rare soft tissue tumour of moderate malignant potential . it is most commonly seen in children and young adults . clinically the lesion is easily confused with a haematoma or soft tissue haemangioma and the radiological aspects are not specific . patients and methods a 16 year old male patient presented with a nodular lesion situated very close to the right radial artery vein and nerve and which had been developing for several years . surgical resection was carried out with sparing of vasculonervous and functional structures . histological examination revealed a tumour of plurinodular architecture surrounded by a fibrous pseudocapsule consisting of histiocytoid or fusiform cells in short bundles associated with a mononuclear inflammatory reaction of nodular architecture . the tumour cells expressed the following immunomarkers desmin smooth muscle actin cd99 and epithelial membrane antigen . fusion transcript ewsr1 atf1 was found . discussion in this case as occurs in the literature a diagnosis of afh was not made on clinical examination or imaging . the enlarged excision normally recommended was greatly restricted in our patient due to the complex localization of the lesion which was in contact with major anatomical structures . the diagnosis was based on histological examination of the surgical excision and identification of the fusion gene . long term follow up is required to detect local recurrence or metastasis . management is decided in multidisciplinary meetings .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: angiomatoid fibrous histiocytoma of the radial pulse groove . background angiomatoid fibrous histiocytoma afh is a slowly progressing rare soft tissue tumour of moderate malignant potential . it is most commonly seen in children and young adults . clinically the lesion is easily confused with a haematoma or soft tissue haemangioma and the radiological aspects are not specific . patients and methods a 16 year old male patient presented with a nodular lesion situated very close to the right radial artery vein and nerve and which had been developing for several years . surgical resection was carried out with sparing of vasculonervous and functional structures . histological examination revealed a tumour of plurinodular architecture surrounded by a fibrous pseudocapsule consisting of histiocytoid or fusiform cells in short bundles associated with a mononuclear inflammatory reaction of nodular architecture . the tumour cells expressed the following immunomarkers desmin smooth muscle actin cd99 and epithelial membrane antigen . fusion transcript ewsr1 atf1 was found . discussion in this case as occurs in the literature a diagnosis of afh was not made on clinical examination or imaging . the enlarged excision normally recommended was greatly restricted in our patient due to the complex localization of the lesion which was in contact with major anatomical structures . the diagnosis was based on histological examination of the surgical excision and identification of the fusion gene . long term follow up is required to detect local recurrence or metastasis . management is decided in multidisciplinary meetings . 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 genotype 4 after liver retransplantation . background hepatitis c virus hcv related cirrhosis remains the most common indication for liver transplantation worldwide . graft reinfection with hcv is nearly universal causing significant morbidity and mortality . spontaneous clearance of hcv after liver transplantation and retransplantation is extremely rare . we report a case of spontaneous clearance of hcv genotype 4 that occurred shortly after
d liver transplantation . case report a 32 year old female patient received a cadaveric liver transplant for hcv related cirrhosis in _lgnum_ . she was not treated for hcv before transplantation . the patient developed biopsy proven hcv recurrence with elevated transaminases and 6
53 iu ml hcv rna genotype 4 . she could not tolerate interferon based treatment . the patient condition progressively worsened and required a
d cadaveric liver transplantation in march _lgnum_ . immunosuppression initially included steroids and prograf which was then switched to cyclosporine after the patient developed seizure . she developed acute cellular rejection which was readily treated with immunosuppression adjustment . hcv rna became negative in april which was confirmed in may _lgnum_ . conclusions spontaneous clearance of hepatitis c rarely occurs after liver transplantation and is extremely rare after retransplantation . this finding may be explained by alterations in the host immune responses to hcv after transplantation . to our knowledge this is the first case of spontaneous clearance of hcv genotype 4 after liver retransplantation .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: spontaneous clearance of hepatitis c genotype 4 after liver retransplantation . background hepatitis c virus hcv related cirrhosis remains the most common indication for liver transplantation worldwide . graft reinfection with hcv is nearly universal causing significant morbidity and mortality . spontaneous clearance of hcv after liver transplantation and retransplantation is extremely rare . we report a case of spontaneous clearance of hcv genotype 4 that occurred shortly after
d liver transplantation . case report a 32 year old female patient received a cadaveric liver transplant for hcv related cirrhosis in _lgnum_ . she was not treated for hcv before transplantation . the patient developed biopsy proven hcv recurrence with elevated transaminases and 6
53 iu ml hcv rna genotype 4 . she could not tolerate interferon based treatment . the patient condition progressively worsened and required a
d cadaveric liver transplantation in march _lgnum_ . immunosuppression initially included steroids and prograf which was then switched to cyclosporine after the patient developed seizure . she developed acute cellular rejection which was readily treated with immunosuppression adjustment . hcv rna became negative in april which was confirmed in may _lgnum_ . conclusions spontaneous clearance of hepatitis c rarely occurs after liver transplantation and is extremely rare after retransplantation . this finding may be explained by alterations in the host immune responses to hcv after transplantation . to our knowledge this is the first case of spontaneous clearance of hcv genotype 4 after liver retransplantation . 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>

diffuse autoimmune enteropathy and colopathy in an adult patient successfully treated with adalimumab and a review of the literature . autoimmune enteropathy aie is a rare disease that causes intractable diarrhea not responsive to a gluten free diet and must be distinguished from refractory sprue . it is associated with circulating autoantibodies against goblet cells and enterocytes . aie mainly involves the small intestines with very few cases reported in adults . because of the paucity of cases the epidemiology of the disease remains unclear and treatment is based on the cases found in the literature . of the 35 adult cases reported only 4 involved the colon . because of the low number of cases there have been no clear recommendations on treatment modalities with most reports heavily emphasizing steroids as the mainstay of treatment . we present the case of adult female patient who developed postpartum aie and colopathy with profuse diarrhea successfully treated with adalimumab and a review of the literature . to the best of our knowledge this case is only the fourth case of a tumor necrosis factor alpha antagonist being used in the treatment of aie and the first case of adalimumab being used .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: diffuse autoimmune enteropathy and colopathy in an adult patient successfully treated with adalimumab and a review of the literature . autoimmune enteropathy aie is a rare disease that causes intractable diarrhea not responsive to a gluten free diet and must be distinguished from refractory sprue . it is associated with circulating autoantibodies against goblet cells and enterocytes . aie mainly involves the small intestines with very few cases reported in adults . because of the paucity of cases the epidemiology of the disease remains unclear and treatment is based on the cases found in the literature . of the 35 adult cases reported only 4 involved the colon . because of the low number of cases there have been no clear recommendations on treatment modalities with most reports heavily emphasizing steroids as the mainstay of treatment . we present the case of adult female patient who developed postpartum aie and colopathy with profuse diarrhea successfully treated with adalimumab and a review of the literature . to the best of our knowledge this case is only the fourth case of a tumor necrosis factor alpha antagonist being used in the treatment of aie and the first case of adalimumab being used . 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>

sepsis and siderosis yersinia enterocolitica and hereditary haemochromatosis . a 60 year old woman was admitted with sepsis relative bradycardia ct evidence of numerous small liver abscesses and kin bronzing consistent with hereditary haemochromatosis hh . yersinia enterocolitica o 9 infection was confirmed by serology specimens taken 10 days apart . iron overload was detected and homozygous c28
 gene mutation confirmed hh . liver biopsy revealed grade iv siderosis with micronodular cirrhosis . haemochromatosis is a common inherited disorder leading to iron overload that can produce end organ damage from excess iron deposition . haemochromatosis diagnosis allowed aggressive medical management with phlebotomy achieving normalisation of iron stores . screening for complications of cirrhosis was started that included hepatoma surveillance . iron overload states are known to increase patient susceptibility to infections caused by lower virulence bacteria lacking sophisticated iron metabolism pathways for example yersinia enterocolitica although these serious disseminated infections are rare they may serve as markers for occult iron overload and should prompt haemochromatosis screening .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: sepsis and siderosis yersinia enterocolitica and hereditary haemochromatosis . a 60 year old woman was admitted with sepsis relative bradycardia ct evidence of numerous small liver abscesses and kin bronzing consistent with hereditary haemochromatosis hh . yersinia enterocolitica o 9 infection was confirmed by serology specimens taken 10 days apart . iron overload was detected and homozygous c28
 gene mutation confirmed hh . liver biopsy revealed grade iv siderosis with micronodular cirrhosis . haemochromatosis is a common inherited disorder leading to iron overload that can produce end organ damage from excess iron deposition . haemochromatosis diagnosis allowed aggressive medical management with phlebotomy achieving normalisation of iron stores . screening for complications of cirrhosis was started that included hepatoma surveillance . iron overload states are known to increase patient susceptibility to infections caused by lower virulence bacteria lacking sophisticated iron metabolism pathways for example yersinia enterocolitica although these serious disseminated infections are rare they may serve as markers for occult iron overload and should prompt haemochromatosis screening . 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 splenic infarction in an elderly cirrhotic patient with multiple comorbidities . spontaneous splenic infarction has been seen rarely in cirrhosis and portal hypertension . the clinical presentation can mimic other causes of acute abdominal pain . the diagnosis of the condition is based on clinical findings and splenic imaging . in recent years ultrasonography and computed tomographic scan have gained in popularity for the diagnosis of splenic infarction . most reported cases are of focal infarction and treatment is mostly conservative . herein we describe a rare case of spontaneous splenic infarction in an elderly cirrhotic patient with portal hypertension who also had comorbidities . a 72 year old female previously diagnosed with cirrhosis was admitted for left upper quadrant abdominal pain for two days . her medical history included cryptogenic cirrhosis congestive heart failure chronic obstructive pulmonary disease and hypertension . physical examination on admission revealed a palpable splenomegaly . abdominal ultrasonography revealed splenomegaly and a hypoechoic area with lobulated contours measuring 62 x 35 mm extending from the subcapsular area to the hilus in the middle section of the spleen . abdominal computed tomographic showed a subcapsular hypodense lesion of the spleen measuring 64 x 58 mm . doppler ultrasound revealed a wedge shaped heterogeneous hypoechoic avascular area extending from the central zone to the lateral zone of the spleen . in our case diagnosis of splenic infarction was made by computed tomographic and doppler ultrasonography . our patient received conservative treatment for the underlying diseases . spontaneous splenic infarction must be kept in mind in cirrhotic patients with underlying comorbidities presenting with left upper quadrant pain .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: spontaneous splenic infarction in an elderly cirrhotic patient with multiple comorbidities . spontaneous splenic infarction has been seen rarely in cirrhosis and portal hypertension . the clinical presentation can mimic other causes of acute abdominal pain . the diagnosis of the condition is based on clinical findings and splenic imaging . in recent years ultrasonography and computed tomographic scan have gained in popularity for the diagnosis of splenic infarction . most reported cases are of focal infarction and treatment is mostly conservative . herein we describe a rare case of spontaneous splenic infarction in an elderly cirrhotic patient with portal hypertension who also had comorbidities . a 72 year old female previously diagnosed with cirrhosis was admitted for left upper quadrant abdominal pain for two days . her medical history included cryptogenic cirrhosis congestive heart failure chronic obstructive pulmonary disease and hypertension . physical examination on admission revealed a palpable splenomegaly . abdominal ultrasonography revealed splenomegaly and a hypoechoic area with lobulated contours measuring 62 x 35 mm extending from the subcapsular area to the hilus in the middle section of the spleen . abdominal computed tomographic showed a subcapsular hypodense lesion of the spleen measuring 64 x 58 mm . doppler ultrasound revealed a wedge shaped heterogeneous hypoechoic avascular area extending from the central zone to the lateral zone of the spleen . in our case diagnosis of splenic infarction was made by computed tomographic and doppler ultrasonography . our patient received conservative treatment for the underlying diseases . spontaneous splenic infarction must be kept in mind in cirrhotic patients with underlying comorbidities presenting with left upper quadrant pain . 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>

isolated single coronary artery with dual right coronary artery distribution . a rare anatomical variation . we present the case of a 76 year old patient in whom coronary angiography performed due to non st segment elevation myocardial infarction revealed an isolated single coronary sca artery with dual right coronary artery rca distribution . one rca arose from the mid segment of the left anterior descending lad artery and followed a prepulmonic course to the right while the other rca arose as the terminal extension of the left circumflex artery beyond the crux cordis . this is the second reported case of the combination of these two variants of sca and the first such case in which the lad derived rca originated as a single branch . furthermore this is the first report presenting a sinus node artery with origin from an ectopic lad connected rca . the clinical implications of this rare coronary artery pattern are discussed .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: isolated single coronary artery with dual right coronary artery distribution . a rare anatomical variation . we present the case of a 76 year old patient in whom coronary angiography performed due to non st segment elevation myocardial infarction revealed an isolated single coronary sca artery with dual right coronary artery rca distribution . one rca arose from the mid segment of the left anterior descending lad artery and followed a prepulmonic course to the right while the other rca arose as the terminal extension of the left circumflex artery beyond the crux cordis . this is the second reported case of the combination of these two variants of sca and the first such case in which the lad derived rca originated as a single branch . furthermore this is the first report presenting a sinus node artery with origin from an ectopic lad connected rca . the clinical implications of this rare coronary artery pattern 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>

use of intraoperative navigation for reconstruction of the c1 lateral mass after resection of aneurysmal bone cyst . background aneurysmal bone cysts abcs are rare blood filled cystic lesions that are found in the long bones and spine . here we present a case of an abc found in the lateral mass and lamina of c1 . lesions in this area provide a surgical challenge because of its difficulty to access as well as its need for reconstruction . we describe a novel use of intraoperative navigation ion to assist in the placement of a c1 lateral mass titanium cage . case description an 18 year old female patient presented with headaches and progressive neck pain . imaging revealed a large cystic lesion involving the c1 lamina and right lateral mass . the patient underwent ion assisted aggressive intralesional resection of the abc and reconstruction of the c1 lateral mass with a static titanium cage supplemented with posterior fusion from the occiput to c3 . at 2 year follow up there was no evidence of recurrence and the hardware remained intact . conclusions ion is a useful aid in assessing the extent of tumor resection and performing cage reconstruction of the c1 lateral mass .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: use of intraoperative navigation for reconstruction of the c1 lateral mass after resection of aneurysmal bone cyst . background aneurysmal bone cysts abcs are rare blood filled cystic lesions that are found in the long bones and spine . here we present a case of an abc found in the lateral mass and lamina of c1 . lesions in this area provide a surgical challenge because of its difficulty to access as well as its need for reconstruction . we describe a novel use of intraoperative navigation ion to assist in the placement of a c1 lateral mass titanium cage . case description an 18 year old female patient presented with headaches and progressive neck pain . imaging revealed a large cystic lesion involving the c1 lamina and right lateral mass . the patient underwent ion assisted aggressive intralesional resection of the abc and reconstruction of the c1 lateral mass with a static titanium cage supplemented with posterior fusion from the occiput to c3 . at 2 year follow up there was no evidence of recurrence and the hardware remained intact . conclusions ion is a useful aid in assessing the extent of tumor resection and performing cage reconstruction of the c1 lateral mass . 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 secondary spontaneous pneumothorax in silicosis a case report . silicosis is an occupational lung disease which is caused by inhalation and accumulation of crystalline silica particles in the lung . it commonly occurs in workers involved in quarrying mining sandblasting tunneling foundry work and ceramics . pneumothorax is one of the complications of silicosis with pleural involvement . the occurrence of pneumothorax in a patient with silicosis is a rare event but it may be fatal . the rate of pneumothorax recurrence in silicosis is usually low . we report a case of recurrent secondary spontaneous pneumothorax in silicosis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: recurrent secondary spontaneous pneumothorax in silicosis a case report . silicosis is an occupational lung disease which is caused by inhalation and accumulation of crystalline silica particles in the lung . it commonly occurs in workers involved in quarrying mining sandblasting tunneling foundry work and ceramics . pneumothorax is one of the complications of silicosis with pleural involvement . the occurrence of pneumothorax in a patient with silicosis is a rare event but it may be fatal . the rate of pneumothorax recurrence in silicosis is usually low . we report a case of recurrent secondary spontaneous pneumothorax in silicosis . 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>

immune complex mediated autoimmunity in a patient with smith magenis syndrome del 1
11.2 . smith magenis syndrome sms is a sporadic congenital disorder involving multiple organ systems caused by chromosome 1
11.2 deletions . smith magenis syndrome features craniofacial and skeletal anomalies cognitive impairment and neurobehavioral abnormalities . in addition some sms patients may exhibit hypogammaglobulinemia . we report the first case of sms associated autoimmunity in a woman who presented with adult onset of multiple autoimmune disorders including systemic lupus erythematosus antiphospholipid antibody syndrome and autoimmune hepatitis . molecular analysis using single nucleotide polymorphism array confirmed a de novo _decnum_ mb deletion breakpoints chr17 1
6
21 2
1
75 resulting in haploinsufficiency for taci transmembrane activator and caml interactor . our data are consistent with potential loss of function for the baff b cell activating factor receptor taci as a contributing factor to human autoimmune phenomena .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: immune complex mediated autoimmunity in a patient with smith magenis syndrome del 1
11.2 . smith magenis syndrome sms is a sporadic congenital disorder involving multiple organ systems caused by chromosome 1
11.2 deletions . smith magenis syndrome features craniofacial and skeletal anomalies cognitive impairment and neurobehavioral abnormalities . in addition some sms patients may exhibit hypogammaglobulinemia . we report the first case of sms associated autoimmunity in a woman who presented with adult onset of multiple autoimmune disorders including systemic lupus erythematosus antiphospholipid antibody syndrome and autoimmune hepatitis . molecular analysis using single nucleotide polymorphism array confirmed a de novo _decnum_ mb deletion breakpoints chr17 1
6
21 2
1
75 resulting in haploinsufficiency for taci transmembrane activator and caml interactor . our data are consistent with potential loss of function for the baff b cell activating factor receptor taci as a contributing factor to human autoimmune phenomena . 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>

occult hbv reactivation induced by ibrutinib treatment a case report . ibrutinib is a small molecule that has been recently developped for the treatment of b cell malignancies . common side effects are diarrhoea nausea fatigue infections neutropenia and thrombocytopenia . here we report the first case of hepatitis b virus reactivation in a 80 years old chronic lymphocytic leukaemia patient receiving ibrutinib suggesting that such treatment must be associated with hbv screening .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: occult hbv reactivation induced by ibrutinib treatment a case report . ibrutinib is a small molecule that has been recently developped for the treatment of b cell malignancies . common side effects are diarrhoea nausea fatigue infections neutropenia and thrombocytopenia . here we report the first case of hepatitis b virus reactivation in a 80 years old chronic lymphocytic leukaemia patient receiving ibrutinib suggesting that such treatment must be associated with hbv screening . 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>

rapidly progressive glomerulonephritis a wild card manifestation of lupus nephritis . a significant proportion of individuals with systemic lupus erythematosus sle will have clinical or laboratory evidence of renal involvement at some point in the course of their disease . lupus nephritis ln is one of the more important systemic manifestations of sle and although progression to end stage renal disease esrd is not usually the norm a significant minority of patients will do so some in a rather dramatic fashion . it is in such instances that ln constitutes a true nephrologic emergency . gratifyingly it is rarely a silent emergency and heightened awareness amongst clinicians about its unpredictable course should lead to earlier recognition and intervention . for this reason a case of ln presenting with historical and histologic evidence of chronic kidney disease and superimposed acute acceleration of renal function decline leading rapidly to esrd is reported here . a brief review of the literature surrounding the pathophysiologic mechanisms clinicopathologic characteristics and current therapeutic approaches to ln is subsequently explored .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: rapidly progressive glomerulonephritis a wild card manifestation of lupus nephritis . a significant proportion of individuals with systemic lupus erythematosus sle will have clinical or laboratory evidence of renal involvement at some point in the course of their disease . lupus nephritis ln is one of the more important systemic manifestations of sle and although progression to end stage renal disease esrd is not usually the norm a significant minority of patients will do so some in a rather dramatic fashion . it is in such instances that ln constitutes a true nephrologic emergency . gratifyingly it is rarely a silent emergency and heightened awareness amongst clinicians about its unpredictable course should lead to earlier recognition and intervention . for this reason a case of ln presenting with historical and histologic evidence of chronic kidney disease and superimposed acute acceleration of renal function decline leading rapidly to esrd is reported here . a brief review of the literature surrounding the pathophysiologic mechanisms clinicopathologic characteristics and current therapeutic approaches to ln is subsequently explored . 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>

therapeutic plasmapheresis enabling radioactive iodine treatment in a patient with thyrotoxicosis . therapeutic plasma exchange tpe is one possible treatment for patients resistant to conventional antithyroid drugs or requiring urgent attention for thyrotoxicosis . we report a 35 yr old man with thyrotoxicosis ultimately attributed to graves disease in whom antithyroid drug used initially was soon discontinued due to abnormal liver function and replaced by lugol solution . three weeks later an escape phenomenon to lugol solution was apparent so we performed tpe to control the thyrotoxicosis . two courses of tpe by a centrifugal type machine resulted in diminished levels of thyroid hormone levels which then rebounded after another two courses of membrane filtration type tpe . however the patient could be treated with radioactive iodine therapy without any complications at present .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: therapeutic plasmapheresis enabling radioactive iodine treatment in a patient with thyrotoxicosis . therapeutic plasma exchange tpe is one possible treatment for patients resistant to conventional antithyroid drugs or requiring urgent attention for thyrotoxicosis . we report a 35 yr old man with thyrotoxicosis ultimately attributed to graves disease in whom antithyroid drug used initially was soon discontinued due to abnormal liver function and replaced by lugol solution . three weeks later an escape phenomenon to lugol solution was apparent so we performed tpe to control the thyrotoxicosis . two courses of tpe by a centrifugal type machine resulted in diminished levels of thyroid hormone levels which then rebounded after another two courses of membrane filtration type tpe . however the patient could be treated with radioactive iodine therapy without any complications at 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>

isolated abducens nerve palsy following neonatal hepatitis b vaccination . we report a case of sudden onset abducens nerve palsy in an otherwise healthy 8 day old boy following neonatal hepatitis b vaccination . a complete workup including magnetic resonance imaging of the brain and orbits revealed no abnormalities . the patient recovered fully with no recurrence of the abducens nerve palsy despite receiving the full course of the hepatitis b vaccine as well as other recommended immunizations through 18 months of age . we review the literature regarding vaccination induced abducens nerve palsy and discuss the possible mechanisms of injury .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: isolated abducens nerve palsy following neonatal hepatitis b vaccination . we report a case of sudden onset abducens nerve palsy in an otherwise healthy 8 day old boy following neonatal hepatitis b vaccination . a complete workup including magnetic resonance imaging of the brain and orbits revealed no abnormalities . the patient recovered fully with no recurrence of the abducens nerve palsy despite receiving the full course of the hepatitis b vaccine as well as other recommended immunizations through 18 months of age . we review the literature regarding vaccination induced abducens nerve palsy and discuss the possible mechanisms of injury . 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>

subdural hemorrhage a unique case involving secondary vitamin k deficiency bleeding due to biliary atresia . extrahepatic biliary atresia ehba is a rare disease characterized by progressive and obliterative cholangiopathy in infants and is one of the major causes of secondary vitamin k deficiency bleeding vkdb due to cholestasis induced fat malabsorption . breast feeding increases the tendency of bleeding in ehba patients because breast milk contains low amounts of vitamin
a 2 month old female infant unexpectedly died with symptoms of vomiting and jaundice prior to death . she had been born by uncomplicated vaginal delivery and exhibited normal growth and development with breastfeeding . there was no history of trauma . she received vitamin k prophylaxis orally . in an emergency hospital a ct scan showed a right intracranial hematoma and mass effect with midline shift to the left . in the postmortem examination severe atresia was observed in the whole extrahepatic bile duct . histologically cholestasis periductal fibrosis and distorted bile ductules were noted . the gallbladder was not identified . a subdural hematoma and cerebellar tonsillar herniation were found however no traumatic injury in any part of the body was observed . together these findings suggest that the subdural hemorrhage was caused by secondary vitamin k deficiency resulting from a combination of cholestasis induced fat malabsorption and breastfeeding . subdural hemorrhage by secondary vkdb sometimes occurs even when vitamin k prophylaxis is continued . this case demonstrated that intrinsic factors such as secondary vkdb

ehba neonatal hepatitis chronic diarrhea should also be considered in infant autopsy cases presenting with subdural hemorrhage .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: subdural hemorrhage a unique case involving secondary vitamin k deficiency bleeding due to biliary atresia . extrahepatic biliary atresia ehba is a rare disease characterized by progressive and obliterative cholangiopathy in infants and is one of the major causes of secondary vitamin k deficiency bleeding vkdb due to cholestasis induced fat malabsorption . breast feeding increases the tendency of bleeding in ehba patients because breast milk contains low amounts of vitamin
a 2 month old female infant unexpectedly died with symptoms of vomiting and jaundice prior to death . she had been born by uncomplicated vaginal delivery and exhibited normal growth and development with breastfeeding . there was no history of trauma . she received vitamin k prophylaxis orally . in an emergency hospital a ct scan showed a right intracranial hematoma and mass effect with midline shift to the left . in the postmortem examination severe atresia was observed in the whole extrahepatic bile duct . histologically cholestasis periductal fibrosis and distorted bile ductules were noted . the gallbladder was not identified . a subdural hematoma and cerebellar tonsillar herniation were found however no traumatic injury in any part of the body was observed . together these findings suggest that the subdural hemorrhage was caused by secondary vitamin k deficiency resulting from a combination of cholestasis induced fat malabsorption and breastfeeding . subdural hemorrhage by secondary vkdb sometimes occurs even when vitamin k prophylaxis is continued . this case demonstrated that intrinsic factors such as secondary vkdb

ehba neonatal hepatitis chronic diarrhea should also be considered in infant autopsy cases presenting with subdural hemorrhage . 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>

pulmonary nocardiosis in an adolescent patient with crohn disease treated with infliximab a serious complication of tnf alpha blockers . nocardiosis is a serious complication of tumor necrosis factor tnf alpha blockers . with the increasing use of biologics for inflammatory bowel disease it is to be anticipated that opportunistic infections such as nocardia will be more frequently encountered in children . we present the case of a 16 year old male with crohn disease who developed pulmonary nocardiosis during the course of his treatment with infliximab . this case illustrates the diagnostic and therapeutic challenges faced in patients with inflammatory bowel disease infected with opportunistic organisms . pediatric health care providers need to be aware so that early diagnosis and treatment can be provided thereby preventing disseminated disease and having favorable outcomes . although tnf blocker therapy must be discontinued in the presence of such infections biologic therapy may be reintroduced after successful treatment with trimethoprim sulfamethoxazole to control underlying symptoms of inflammatory bowel disease .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: pulmonary nocardiosis in an adolescent patient with crohn disease treated with infliximab a serious complication of tnf alpha blockers . nocardiosis is a serious complication of tumor necrosis factor tnf alpha blockers . with the increasing use of biologics for inflammatory bowel disease it is to be anticipated that opportunistic infections such as nocardia will be more frequently encountered in children . we present the case of a 16 year old male with crohn disease who developed pulmonary nocardiosis during the course of his treatment with infliximab . this case illustrates the diagnostic and therapeutic challenges faced in patients with inflammatory bowel disease infected with opportunistic organisms . pediatric health care providers need to be aware so that early diagnosis and treatment can be provided thereby preventing disseminated disease and having favorable outcomes . although tnf blocker therapy must be discontinued in the presence of such infections biologic therapy may be reintroduced after successful treatment with trimethoprim sulfamethoxazole to control underlying symptoms of inflammatory bowel 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>

a rare case of retinal artery occlusion in the context of mediterranean spotted fever . background mediterranean spotted fever is a zoonosis endemic in the mediterranean region . the microorganism rickettsia conorii is responsible for the disease due to its angiotropism for endothelial cells . it produces host cell necrosis thrombosis and organ dysfunction . ophthalmologic manifestations are rare . findings the authors describe the case of a 55 year old female with mediterranean spotted fever who developed localized retinal vasculitis with associated macular edema . treatment with intravitreal triamcinolone allowed a significant recovery of visual acuity . conclusion ophthalmological symptoms in these patients should be emphasized because there can be severe ocular complications with a potentially irreversible loss of visual acuity .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: a rare case of retinal artery occlusion in the context of mediterranean spotted fever . background mediterranean spotted fever is a zoonosis endemic in the mediterranean region . the microorganism rickettsia conorii is responsible for the disease due to its angiotropism for endothelial cells . it produces host cell necrosis thrombosis and organ dysfunction . ophthalmologic manifestations are rare . findings the authors describe the case of a 55 year old female with mediterranean spotted fever who developed localized retinal vasculitis with associated macular edema . treatment with intravitreal triamcinolone allowed a significant recovery of visual acuity . conclusion ophthalmological symptoms in these patients should be emphasized because there can be severe ocular complications with a potentially irreversible loss of visual acuity . 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>

cervical digits a report of 3 cases . the occurence of digit like structures around vertebral column is a rare and only one case in the cervical region has been reported before . here we report three more cases of cervical digits with computed tomography and magnetic resonance imaging correlations as the first cases of the literature .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: cervical digits a report of 3 cases . the occurence of digit like structures around vertebral column is a rare and only one case in the cervical region has been reported before . here we report three more cases of cervical digits with computed tomography and magnetic resonance imaging correlations as the first cases of 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: 0 </s>

surgical treatment of multiple spine metastases from gastrinoma . study design case report . clinical question to report successful surgical therapy for spinal cord compression in a patient with spinal metastases from a pancreatic gastrinoma . methods a 43 year old man presented three times within 4 years with cervical and upper thoracic spinal cord compression because of metastatic gastrinoma . he had two previous spine metastases to the lower thoracic and lumbar spine a t11 compressive lesion which required a t
1 fusion and an l4 lesion that was treated with chemotherapy and stereotactic radiation . the compression was relieved each time by surgery . results the patient underwent three surgeries in 4 years 1 debulking and removal of the rib head on the left at t3 and debulking of the tumor at t3 with hemilaminectomy and spinal cord decompression with internal fixation from t1 t5 using posterolateral instrumented fusion and allograft 2 anterior c7 corpectomy with placement of a cage from c7 t1 with both anterior and posterior fusion of c
7 and 3 t1 t3 laminectomy t1 t3 exploration of wound revision of hardware t1 t3 removal of spinal tumor and t3 bilateral transpedicular circumferential decompression . the patient is alive and regained the ability to walk 8 years after initial diagnosis despite the appearance of spinal metastases 1 year after the diagnosis of liver metastases . conclusion surgery for spinal cord compression in patients with metastatic neuroendocrine tumors can be effective in relieving radicular pain weakness and numbness and while not curative can greatly improve quality of life .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: surgical treatment of multiple spine metastases from gastrinoma . study design case report . clinical question to report successful surgical therapy for spinal cord compression in a patient with spinal metastases from a pancreatic gastrinoma . methods a 43 year old man presented three times within 4 years with cervical and upper thoracic spinal cord compression because of metastatic gastrinoma . he had two previous spine metastases to the lower thoracic and lumbar spine a t11 compressive lesion which required a t
1 fusion and an l4 lesion that was treated with chemotherapy and stereotactic radiation . the compression was relieved each time by surgery . results the patient underwent three surgeries in 4 years 1 debulking and removal of the rib head on the left at t3 and debulking of the tumor at t3 with hemilaminectomy and spinal cord decompression with internal fixation from t1 t5 using posterolateral instrumented fusion and allograft 2 anterior c7 corpectomy with placement of a cage from c7 t1 with both anterior and posterior fusion of c
7 and 3 t1 t3 laminectomy t1 t3 exploration of wound revision of hardware t1 t3 removal of spinal tumor and t3 bilateral transpedicular circumferential decompression . the patient is alive and regained the ability to walk 8 years after initial diagnosis despite the appearance of spinal metastases 1 year after the diagnosis of liver metastases . conclusion surgery for spinal cord compression in patients with metastatic neuroendocrine tumors can be effective in relieving radicular pain weakness and numbness and while not curative can greatly improve quality of life . 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>

parathryoid hormone related peptide causing hypercalcaemia in a patient with hepatocellular carcinoma . the incidence of hepatocellular carcinoma hcc is increasing . in addition its presentation without bony metastasis as a part of paraneoplastic syndrome is recognised but uncommon . this unusual presentation of hcc is highlighted in the case of a 63 years old lady who presented with lethargy and tiredness and hypercalcaemia due to secretion of parathryoid hormone related peptide pthrp . further imaging showed 11 cm hepatic mass with normal alpha fetoprotein . she underwent partial hepatectomy and is doing well since then . malignant hypercalcaemia is thought to arise from the secretion of pthrp which is synthesised by tumour cells and has a similar action to parathyroid hormone . early recognition of this uncommon condition can lead to complete cure as seen in our patient .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: parathryoid hormone related peptide causing hypercalcaemia in a patient with hepatocellular carcinoma . the incidence of hepatocellular carcinoma hcc is increasing . in addition its presentation without bony metastasis as a part of paraneoplastic syndrome is recognised but uncommon . this unusual presentation of hcc is highlighted in the case of a 63 years old lady who presented with lethargy and tiredness and hypercalcaemia due to secretion of parathryoid hormone related peptide pthrp . further imaging showed 11 cm hepatic mass with normal alpha fetoprotein . she underwent partial hepatectomy and is doing well since then . malignant hypercalcaemia is thought to arise from the secretion of pthrp which is synthesised by tumour cells and has a similar action to parathyroid hormone . early recognition of this uncommon condition can lead to complete cure as seen in our patient . 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>

live birth after intrauterine insemination with spermatozoa from an oligoasthenozoospermic patient vitrified without permeable cryoprotectants . we report the first case of a healthy baby born after intrauterine insemination with vitrified swim up spermatozoa from an oligoasthenozoospermic patient . a 39 year old patient was subjected to intrauterine insemination with spermatozoa from her 35 year old husband diagnosed with oligoasthenozoospermia . the swim up spermatozoa from 2 ejaculates were suspended in a culture medium supplemented with 1 human serum albumin and _decnum_ m sucrose . three hermetically packaged _lgnum_ l sperm portions each containing _decnum_ 10 6 spermatozoa ml were vitrified by direct plunging into liquid nitrogen . the presence of leukocytes in the ejaculates was determined by indirect immunofluorescence assay . production of reactive oxygen species was measured by chemiluminescent assay . before intrauterine insemination all portions were warmed in culture medium at 3
 and the spermatozoa were concentrated by centrifugation they were then resuspended in _lgnum_ l of culture medium and inseminated . the cell suspension used for insemination displayed 60 progressive motility . clinical pregnancy was confirmed at 7 weeks of gestation and a healthy baby was born at term . our results show that a successful intrauterine insemination can be achieved with aseptic vitrification of spermatozoa .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: live birth after intrauterine insemination with spermatozoa from an oligoasthenozoospermic patient vitrified without permeable cryoprotectants . we report the first case of a healthy baby born after intrauterine insemination with vitrified swim up spermatozoa from an oligoasthenozoospermic patient . a 39 year old patient was subjected to intrauterine insemination with spermatozoa from her 35 year old husband diagnosed with oligoasthenozoospermia . the swim up spermatozoa from 2 ejaculates were suspended in a culture medium supplemented with 1 human serum albumin and _decnum_ m sucrose . three hermetically packaged _lgnum_ l sperm portions each containing _decnum_ 10 6 spermatozoa ml were vitrified by direct plunging into liquid nitrogen . the presence of leukocytes in the ejaculates was determined by indirect immunofluorescence assay . production of reactive oxygen species was measured by chemiluminescent assay . before intrauterine insemination all portions were warmed in culture medium at 3
 and the spermatozoa were concentrated by centrifugation they were then resuspended in _lgnum_ l of culture medium and inseminated . the cell suspension used for insemination displayed 60 progressive motility . clinical pregnancy was confirmed at 7 weeks of gestation and a healthy baby was born at term . our results show that a successful intrauterine insemination can be achieved with aseptic vitrification of spermatozoa . 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>

chronic hbv with pregnancy reactivation flare causing fulminant hepatic failure . chronic hbv infection is a dynamic state of interaction between hbv hepatocytes and the immune system of the host . a series of reactivation flares and remissions may occur due to multiple causes . among them spontaneous reactivation and immunosuppressive drugs including steroids or cancer chemotherapy are well known . this is due to immune mediated destruction of hbv expressing cells following withdrawal of immunosuppressive effect . few cases have been reported in females during postpartum period . we report a case of fulminant hepatic failure during pregnancy in a previously unrecognized hepatitis b positive female requiring emergent liver transplantation .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: chronic hbv with pregnancy reactivation flare causing fulminant hepatic failure . chronic hbv infection is a dynamic state of interaction between hbv hepatocytes and the immune system of the host . a series of reactivation flares and remissions may occur due to multiple causes . among them spontaneous reactivation and immunosuppressive drugs including steroids or cancer chemotherapy are well known . this is due to immune mediated destruction of hbv expressing cells following withdrawal of immunosuppressive effect . few cases have been reported in females during postpartum period . we report a case of fulminant hepatic failure during pregnancy in a previously unrecognized hepatitis b positive female requiring emergent 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: 1 </s>

acute respiratory distress syndrome due to influenza virus a h

 in a patient with hiv hcv co infection . the clinical severity of human infection with the novel influenza virus a h

 has not been completely defined especially in hiv hepatitis c virus hcv infected patients . although most patients develop mild to moderate symptoms severe disease may occur in a limited proportion of cases . we report the case of a 44 year old man infected with hiv and hcv with a high cd4 cell count who developed acute respiratory distress syndrome associated with influenza virus a h

 infection . the patient recovered completely after oseltamivir therapy and mechanical ventilation .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: acute respiratory distress syndrome due to influenza virus a h

 in a patient with hiv hcv co infection . the clinical severity of human infection with the novel influenza virus a h

 has not been completely defined especially in hiv hepatitis c virus hcv infected patients . although most patients develop mild to moderate symptoms severe disease may occur in a limited proportion of cases . we report the case of a 44 year old man infected with hiv and hcv with a high cd4 cell count who developed acute respiratory distress syndrome associated with influenza virus a h

 infection . the patient recovered completely after oseltamivir therapy and mechanical ventilation . 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>

vibrio cholerae non o1 and non o139 bacteremia in a non traveler portuguese cirrhotic patient first case report . bacteremia due to vibrio cholerae non o1 and non o139 is a rare condition and potentially fatal . we report a case of bacteremia due to
cholerae non o1 and non o139 in a portuguese male with hepatitis c cirrhosis admitted due to acute diarrhea after consuming shrimp . he had no recent travels . to our knowledge this is the first reported case of bacteremia due to
cholerae non o1 and non o139 in portugal .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: vibrio cholerae non o1 and non o139 bacteremia in a non traveler portuguese cirrhotic patient first case report . bacteremia due to vibrio cholerae non o1 and non o139 is a rare condition and potentially fatal . we report a case of bacteremia due to
cholerae non o1 and non o139 in a portuguese male with hepatitis c cirrhosis admitted due to acute diarrhea after consuming shrimp . he had no recent travels . to our knowledge this is the first reported case of bacteremia due to
cholerae non o1 and non o139 in portugal . 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>

description of 3 cases of skin and soft tissue infections caused by streptococcus pneumoniae . the role of streptococcus pneumoniae as a causative agent of skin and soft tissue infections ssti is unusual and its clinical interpretation is difficult . we describe here three cases of ssti due to
pneumoniae in patients admitted to the provincial pediatric hospital of misiones argentina that were detected during 10 years of invasive disease id surveillance documented in _lgnum_ _lgnum_ and _lgnum_ . these cases involved two girls aged 8 and 7 months old and a two year old male child with diagnoses of gluteal abscess preseptal cellulites and pyoderma respectively . all the patients were eutrophic and in good general condition on admission one of them was seropositive for hiv . antimicrobial susceptibility and serotypes were framed within the local epidemiology of invasive pneumococcal disease . despite its low frequency
pneumoniae as an etiological agent of ssti must be considered . our findings revalue the role of the diagnostic laboratory and contribute to document the behavior of this pathogen .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: description of 3 cases of skin and soft tissue infections caused by streptococcus pneumoniae . the role of streptococcus pneumoniae as a causative agent of skin and soft tissue infections ssti is unusual and its clinical interpretation is difficult . we describe here three cases of ssti due to
pneumoniae in patients admitted to the provincial pediatric hospital of misiones argentina that were detected during 10 years of invasive disease id surveillance documented in _lgnum_ _lgnum_ and _lgnum_ . these cases involved two girls aged 8 and 7 months old and a two year old male child with diagnoses of gluteal abscess preseptal cellulites and pyoderma respectively . all the patients were eutrophic and in good general condition on admission one of them was seropositive for hiv . antimicrobial susceptibility and serotypes were framed within the local epidemiology of invasive pneumococcal disease . despite its low frequency
pneumoniae as an etiological agent of ssti must be considered . our findings revalue the role of the diagnostic laboratory and contribute to document the behavior of this pathogen . 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 in perinatally acquired hiv and hbv coinfection a case report . this report describes a case of hepatocellular carcinoma in an adolescent with perinatally acquired hiv and hepatitis b virus coinfection arising despite more than a decade of suppressive antiretroviral therapy for both hiv and hepatitis b virus . this case raises important questions regarding optimal hepatocellular carcinoma screening in this high risk group and the oncogenic potential of even very well controlled viral infection .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: hepatocellular carcinoma in perinatally acquired hiv and hbv coinfection a case report . this report describes a case of hepatocellular carcinoma in an adolescent with perinatally acquired hiv and hepatitis b virus coinfection arising despite more than a decade of suppressive antiretroviral therapy for both hiv and hepatitis b virus . this case raises important questions regarding optimal hepatocellular carcinoma screening in this high risk group and the oncogenic potential of even very well controlled viral 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>

synchronous breast cancer and breast lymphoma two case reports and literature review . synchronous breast cancer and breast lymphoma are rare . it is of high rate of misdiagnosis in clinical practice . here we present two cases with this presentation . they are both middle aged women with stage i invasive ductal carcinoma of the breast . one patient happened to have primary breast lymphoma pbl the other was secondary breast lymphoma sbl . their pathology and immunohistochemistry ihc findings supported the diagnosis of multiple primary carcinoma . both patients had a surgery . then they both received chop regime chemotherapy and subsequent endocrine therapy .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: synchronous breast cancer and breast lymphoma two case reports and literature review . synchronous breast cancer and breast lymphoma are rare . it is of high rate of misdiagnosis in clinical practice . here we present two cases with this presentation . they are both middle aged women with stage i invasive ductal carcinoma of the breast . one patient happened to have primary breast lymphoma pbl the other was secondary breast lymphoma sbl . their pathology and immunohistochemistry ihc findings supported the diagnosis of multiple primary carcinoma . both patients had a surgery . then they both received chop regime chemotherapy and subsequent endocrine 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>

extensive mesenteric lipodystrophy of the left colon case report and brief review of the literature . mesenteric lipodystrophy is a rare inflammatory process that predominantly affects mesenteric adipose tissue of the small bowell . several mechanisms have been suggested as responsible for this entity although the precise etiolog remains unknown . the diagnosis is based on ct or mri imaging and generally confirmed by surgical biopsies . treatment is individualized and empiric and depends on disease stage and symptoms . we report a case of a 35 year old male who was admitted to our hospital with a history of abdominal pain constipation and a palpable mass in the left lower quadrant . abdominal ct scan showed diffuse thickening of the descending and rectosigmoid colon associated with increased density of the mesenteric fat . after failure ofan initial treat ment with glucocorticoids he underwent a laparoscopic sigmoidectomy . histopatholog analysis revealed extensive stea tonecrosis ofpericolonicfat and lipid ladenfoamy cells which was consistent with the diagnosis of mesenteric lipodystrophy . clinical presentation and treatment as well as a brief review of the literature are discussed .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: extensive mesenteric lipodystrophy of the left colon case report and brief review of the literature . mesenteric lipodystrophy is a rare inflammatory process that predominantly affects mesenteric adipose tissue of the small bowell . several mechanisms have been suggested as responsible for this entity although the precise etiolog remains unknown . the diagnosis is based on ct or mri imaging and generally confirmed by surgical biopsies . treatment is individualized and empiric and depends on disease stage and symptoms . we report a case of a 35 year old male who was admitted to our hospital with a history of abdominal pain constipation and a palpable mass in the left lower quadrant . abdominal ct scan showed diffuse thickening of the descending and rectosigmoid colon associated with increased density of the mesenteric fat . after failure ofan initial treat ment with glucocorticoids he underwent a laparoscopic sigmoidectomy . histopatholog analysis revealed extensive stea tonecrosis ofpericolonicfat and lipid ladenfoamy cells which was consistent with the diagnosis of mesenteric lipodystrophy . clinical presentation and treatment as well as a brief review of the literature 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>

clinical problems in medical mycology problem number 48 . we present the case of a 42 year old man hiv positive with low cd4 t cell count 31 cells l who was admitted to hospital de infecciosas

muniz in buenos aires argentina due to a severe lower back pain . he had a history of several highly active antiretroviral therapy treatments and he also had diabetes and chronic b and c viral hepatitis . a spinal cord ct scan showed two lytic bone lesions in l2 and l3 . a bone biopsy was carried out and its microbiological study allowed the isolation of a methicillin resistant staphylococcus aureus . intravenous vancomycin was prescribed together with a corset and physical rest . a few days later the patient presented with acute dermatitis with papules vesicles scales and erythema which spread over the whole lumbar region . the mycological study of the scales led to the isolation in culture of candida albicans and candida parapsilosis . with the diagnosis of decubitus candidiasis he was initially treated with a topical ointment containing 3 salicylic acid and 6 benzoic acid but only slow partial improvement was observed . the treatment was changed to oral fluconazole at a daily dose of 20
g . with the latter the patient showed a rapid complete clinical response .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: clinical problems in medical mycology problem number 48 . we present the case of a 42 year old man hiv positive with low cd4 t cell count 31 cells l who was admitted to hospital de infecciosas

muniz in buenos aires argentina due to a severe lower back pain . he had a history of several highly active antiretroviral therapy treatments and he also had diabetes and chronic b and c viral hepatitis . a spinal cord ct scan showed two lytic bone lesions in l2 and l3 . a bone biopsy was carried out and its microbiological study allowed the isolation of a methicillin resistant staphylococcus aureus . intravenous vancomycin was prescribed together with a corset and physical rest . a few days later the patient presented with acute dermatitis with papules vesicles scales and erythema which spread over the whole lumbar region . the mycological study of the scales led to the isolation in culture of candida albicans and candida parapsilosis . with the diagnosis of decubitus candidiasis he was initially treated with a topical ointment containing 3 salicylic acid and 6 benzoic acid but only slow partial improvement was observed . the treatment was changed to oral fluconazole at a daily dose of 20
g . with the latter the patient showed a rapid complete clinical response . 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>

an immunocompetent adult patient with hepatitis and guillain barre syndrome after cytomegalovirus infection . objectives it is to describe an immunocompetent adult patient with hepatitis and guillain barre syndrome gbs after cytomegalovirus cmv infection . in the initial course of the diagnosis and treatment cmv infection was ignored . case report a 19 year old chinese girl complained of fatigue with pain and numbness of the limbs with abnormal liver function . she was diagnosed as a case of gbs based on history clinical findings and auxiliary examinations . on day 13 of admission her liver function was still abnormal . so cmv was recommended to examine . cmv hepatitis was diagnosed on positive serum anti cmv igg and igm antibodies . the case was improved only with intravenous immunoglobulin therapy without the use of antiviral therapy . conclusions this case showed an immunocompetent adult patient with hepatitis and gbs induced by cmv . the physicians should take into account multi system involvement of severe cmv infection .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: an immunocompetent adult patient with hepatitis and guillain barre syndrome after cytomegalovirus infection . objectives it is to describe an immunocompetent adult patient with hepatitis and guillain barre syndrome gbs after cytomegalovirus cmv infection . in the initial course of the diagnosis and treatment cmv infection was ignored . case report a 19 year old chinese girl complained of fatigue with pain and numbness of the limbs with abnormal liver function . she was diagnosed as a case of gbs based on history clinical findings and auxiliary examinations . on day 13 of admission her liver function was still abnormal . so cmv was recommended to examine . cmv hepatitis was diagnosed on positive serum anti cmv igg and igm antibodies . the case was improved only with intravenous immunoglobulin therapy without the use of antiviral therapy . conclusions this case showed an immunocompetent adult patient with hepatitis and gbs induced by cmv . the physicians should take into account multi system involvement of severe cmv 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>

vulvovaginal pyoderma gangrenosum secondary to rituximab therapy . rituximab is being used increasingly for the treatment of b cell malignancies and nonmalignant conditions . pyoderma gangrenosum is a rare neutrophilic dermatosis which can be either idiopathic or associated with underlying systemic inflammatory conditions . we present a series of 4 patients who presented with ulcerative pyoderma gangrenosum in the vulvovaginal area after treatment with rituximab .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: vulvovaginal pyoderma gangrenosum secondary to rituximab therapy . rituximab is being used increasingly for the treatment of b cell malignancies and nonmalignant conditions . pyoderma gangrenosum is a rare neutrophilic dermatosis which can be either idiopathic or associated with underlying systemic inflammatory conditions . we present a series of 4 patients who presented with ulcerative pyoderma gangrenosum in the vulvovaginal area after treatment with rituximab . 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 79 year old woman with acute hepatitis b caused by the infection of subgenotype d1 hepatitis b virus in japan a case study . a 79 year old japanese woman was diagnosed with acute hepatitis b based on laboratory tests showing positivity for igm class antibody against hepatitis b virus hbv core and hepatitis b surface antigen hbsag as well as elevated transaminases . a phylogenetic analysis revealed that the hbv strain obtained from the patient belonged to genotype d subgenotype d1 similar to strains circulating in foreign countries but different from those in japan . the clinical course was favorable . hbsag became negative within 10 weeks after the onset . to our knowledge this is the first report of acute hepatitis b caused by subgenotype d1 hbv in japan .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: a 79 year old woman with acute hepatitis b caused by the infection of subgenotype d1 hepatitis b virus in japan a case study . a 79 year old japanese woman was diagnosed with acute hepatitis b based on laboratory tests showing positivity for igm class antibody against hepatitis b virus hbv core and hepatitis b surface antigen hbsag as well as elevated transaminases . a phylogenetic analysis revealed that the hbv strain obtained from the patient belonged to genotype d subgenotype d1 similar to strains circulating in foreign countries but different from those in japan . the clinical course was favorable . hbsag became negative within 10 weeks after the onset . to our knowledge this is the first report of acute hepatitis b caused by subgenotype d1 hbv in japan . 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>

takayasu arteritis with isolated pulmonary artery involvement in a middle aged asian woman with hepatitis b and latent tuberculosis infection . we report a rare case of takayasu arteritis with isolated pulmonary artery stenosis in the presence of active hepatitis b and latent mycobacterium tuberculosis infection in a middle aged asian woman who initially presented with severe dyspnea on exertion and recurrent syncope occasional burning chest pains and fatigue . therapy of the active hepatitis b and latent
tuberculosis infection together with a course of methotrexate led to a slight reversal of the symptoms as angioplasty with or without stenting was not an option . the constellation described here hints at the possible link between hepatitis b and
tuberculosis infection and the development of takayasu arteritis . the case also supports the little evidence available indicating that treatment of active hepatitis b infection could positively influence the course of takayasu arteritis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: takayasu arteritis with isolated pulmonary artery involvement in a middle aged asian woman with hepatitis b and latent tuberculosis infection . we report a rare case of takayasu arteritis with isolated pulmonary artery stenosis in the presence of active hepatitis b and latent mycobacterium tuberculosis infection in a middle aged asian woman who initially presented with severe dyspnea on exertion and recurrent syncope occasional burning chest pains and fatigue . therapy of the active hepatitis b and latent
tuberculosis infection together with a course of methotrexate led to a slight reversal of the symptoms as angioplasty with or without stenting was not an option . the constellation described here hints at the possible link between hepatitis b and
tuberculosis infection and the development of takayasu arteritis . the case also supports the little evidence available indicating that treatment of active hepatitis b infection could positively influence the course of takayasu arteritis . 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>

hyperhemolysis syndrome in a patient without a hemoglobinopathy unresponsive to treatment with eculizumab . background hyperhemolysis is a serious transfusion reaction most often described in patients with hemoglobinopathies . hyperhemolysis is characterized by the destruction of host red blood cells rbcs in addition to donor rbcs via an unknown mechanism . study design and methods we present the case of a 58 year old woman with treated human immunodeficiency virus and a normal hemoglobin hb electrophoresis who developed hyperhemolysis in the setting of a delayed hemolytic transfusion reaction dhtr . results the patient was abo group b and had a previously identified anti fy b alloantibody . after transfusion of fy b rbcs she developed a dhtr and was found to have anti e anti c w anti s and an additional antibody to an unrecognized high frequency rbc alloantigen . subsequent transfusion of abo compatible rbcs that were negative for fy b e c w and s antigens resulted in immediate intravascular hemolysis . in the absence of bleeding her hematocrit hct decreased to _decnum_ . an extensive serologic evaluation failed to identify the specificity of the high frequency antibody . severe hemolytic reactions also occurred despite pretransfusion conditioning with eculizumab . the hct and clinical symptoms slowly improved after the cessation of transfusions and treatment with erythropoietin and steroids . this case demonstrates several noteworthy features including hyperhemolysis in a patient without a hb disorder the development of an antibody to an unknown rbc antigen and the failure of eculizumab to prevent intravascular hemolysis after transfusion . conclusion hyperhemolysis is not restricted to patients with hemoglobinopathies . whether eculizumab offers any benefit in the hyperhemolysis syndrome or in the prevention of intravascular hemolysis due to rbc alloantibodies remains uncertain .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: hyperhemolysis syndrome in a patient without a hemoglobinopathy unresponsive to treatment with eculizumab . background hyperhemolysis is a serious transfusion reaction most often described in patients with hemoglobinopathies . hyperhemolysis is characterized by the destruction of host red blood cells rbcs in addition to donor rbcs via an unknown mechanism . study design and methods we present the case of a 58 year old woman with treated human immunodeficiency virus and a normal hemoglobin hb electrophoresis who developed hyperhemolysis in the setting of a delayed hemolytic transfusion reaction dhtr . results the patient was abo group b and had a previously identified anti fy b alloantibody . after transfusion of fy b rbcs she developed a dhtr and was found to have anti e anti c w anti s and an additional antibody to an unrecognized high frequency rbc alloantigen . subsequent transfusion of abo compatible rbcs that were negative for fy b e c w and s antigens resulted in immediate intravascular hemolysis . in the absence of bleeding her hematocrit hct decreased to _decnum_ . an extensive serologic evaluation failed to identify the specificity of the high frequency antibody . severe hemolytic reactions also occurred despite pretransfusion conditioning with eculizumab . the hct and clinical symptoms slowly improved after the cessation of transfusions and treatment with erythropoietin and steroids . this case demonstrates several noteworthy features including hyperhemolysis in a patient without a hb disorder the development of an antibody to an unknown rbc antigen and the failure of eculizumab to prevent intravascular hemolysis after transfusion . conclusion hyperhemolysis is not restricted to patients with hemoglobinopathies . whether eculizumab offers any benefit in the hyperhemolysis syndrome or in the prevention of intravascular hemolysis due to rbc alloantibodies remains uncertain . 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 spine infection by granulicatella and abiotrophia species . background the granulicatella and abiotrophia species are streptococci and natural inhabitants of the oral and urogenital flora . they are uncommonly associated with human pathology although they can cause septicemia endocarditis or bacteremia . these microorganisms are difficult to culture and identify due to particular microenvironment requirements . rarely presentation is osteomyelitis or infections of the spine . case description the case report referenced patient notes laboratory values and imaging from the electronic health record . in this 48 year old male with a history of hepatitis c and intravenous drug use back pain was a relatively common presentation of an uncommon infection . his hospital course was significant for low back pain that did not resolve with conservative measures . imaging was concerning for infection of the lumbar spine . biopsies negative early on were ultimately positive for granulicatella and abiotrophia species a rare infectious etiology . this infection uncommonly affects the lumbar spine and has not been previously documented in iv drug users . intravenous antibiotics were prescribed for 6 weeks after which the patient demonstrated significant clinical improvement . conclusion with such an uncommon pathogen there are no universal protocol changes indicated . however awareness of such unusual microbes and their potential role as the etiology of more common infections such as lumbar osteomyelitis is crucial in developing a thorough infectious workup in cases resistant to treatment targeting typical microorganisms .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: lumbar spine infection by granulicatella and abiotrophia species . background the granulicatella and abiotrophia species are streptococci and natural inhabitants of the oral and urogenital flora . they are uncommonly associated with human pathology although they can cause septicemia endocarditis or bacteremia . these microorganisms are difficult to culture and identify due to particular microenvironment requirements . rarely presentation is osteomyelitis or infections of the spine . case description the case report referenced patient notes laboratory values and imaging from the electronic health record . in this 48 year old male with a history of hepatitis c and intravenous drug use back pain was a relatively common presentation of an uncommon infection . his hospital course was significant for low back pain that did not resolve with conservative measures . imaging was concerning for infection of the lumbar spine . biopsies negative early on were ultimately positive for granulicatella and abiotrophia species a rare infectious etiology . this infection uncommonly affects the lumbar spine and has not been previously documented in iv drug users . intravenous antibiotics were prescribed for 6 weeks after which the patient demonstrated significant clinical improvement . conclusion with such an uncommon pathogen there are no universal protocol changes indicated . however awareness of such unusual microbes and their potential role as the etiology of more common infections such as lumbar osteomyelitis is crucial in developing a thorough infectious workup in cases resistant to treatment targeting typical microorganisms . 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>

retreatment with sofosbuvir velpatasvir in cirrhotic patients with genotype 4 who failed a previous interferon free regimen a case series . the novel available interferon ifn free regimens significantly improved the sustained virological response svr in patients with chronic hepatitis c chc without important side effects and with shorter duration of treatment . in a subset of patients however the treatment failure tf was due to the presence of resistance associated substitutions ras that lead to virological breakthrough bt or relapse . we analysed in this case series the role of ras on the tf in cirrhotic patients with genotype gt 4 treated with a previous ifn free regimen and retreated with the combination of sofosbuvir sof velpatasvir vel for 12 or 24 weeks without ribavirin rbv . abstracttext the novel available interferon ifn free regimens significantly improved the sustained virological response svr in patients with chronic hepatitis c chc without important side effects and with shorter duration of treatment . in a subset of patients however the treatment failure tf was due to the presence of resistance associated substitutions ras that lead to virological breakthrough bt or relapse . we analysed in this case series the role of ras on the tf in cirrhotic patients with genotype gt 4 treated with a previous ifn free regimen and retreated with the combination of sofosbuvir sof velpatasvir vel for 12 or 24 weeks without ribavirin rbv . we included in this analysis all patients with gt4 who failed a previous ifn free treatment with the presence of ras at bt or relapse . all patients were retreated with a fixed combination of sof vel for 12 24 weeks without rbv . we evaluated the svr and the meld score change after the treatment . abstracttext we included in this analysis all patients with gt4 who failed a previous ifn free treatment with the presence of ras at bt or relapse . all patients were retreated with a fixed combination of sof vel for 12 24 weeks without rbv . we evaluated the svr and the meld score change after the treatment . seven patients were described . all were cirrhotic child pugh a n 5 b n 2 baseline ras were detected in 4 7 subjects at post treatment detection ns5 ras were f2
 n 1 q3
 n 2 s3
 n 1 ns3 were s12
 n 1 s12
 n 2 d16
 n 3 . all retreated patients gained svr . meld score improved in all subjects with a median change of 3 points . no significant side effects or adverse events were reported . abstracttext seven patients were described . all were cirrhotic child pugh a n 5 b n 2 baseline ras were detected in 4 7 subjects at post treatment detection ns5 ras were f2
 n 1 q3
 n 2 s3
 n 1 ns3 were s12
 n 1 s12
 n 2 d16
 n 3 . all retreated patients gained svr . meld score improved in all subjects with a median change of 3 points . no significant side effects or adverse events were reported . the combination sof vel could be considered for the retreatment of cirrhotic gt4 patients who failed a previous ifn free treatment with the presence of ras in ns3 or ns5 regions . abstracttext the combination sof vel could be considered for the retreatment of cirrhotic gt4 patients who failed a previous ifn free treatment with the presence of ras in ns3 or ns5 regions .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: retreatment with sofosbuvir velpatasvir in cirrhotic patients with genotype 4 who failed a previous interferon free regimen a case series . the novel available interferon ifn free regimens significantly improved the sustained virological response svr in patients with chronic hepatitis c chc without important side effects and with shorter duration of treatment . in a subset of patients however the treatment failure tf was due to the presence of resistance associated substitutions ras that lead to virological breakthrough bt or relapse . we analysed in this case series the role of ras on the tf in cirrhotic patients with genotype gt 4 treated with a previous ifn free regimen and retreated with the combination of sofosbuvir sof velpatasvir vel for 12 or 24 weeks without ribavirin rbv . abstracttext the novel available interferon ifn free regimens significantly improved the sustained virological response svr in patients with chronic hepatitis c chc without important side effects and with shorter duration of treatment . in a subset of patients however the treatment failure tf was due to the presence of resistance associated substitutions ras that lead to virological breakthrough bt or relapse . we analysed in this case series the role of ras on the tf in cirrhotic patients with genotype gt 4 treated with a previous ifn free regimen and retreated with the combination of sofosbuvir sof velpatasvir vel for 12 or 24 weeks without ribavirin rbv . we included in this analysis all patients with gt4 who failed a previous ifn free treatment with the presence of ras at bt or relapse . all patients were retreated with a fixed combination of sof vel for 12 24 weeks without rbv . we evaluated the svr and the meld score change after the treatment . abstracttext we included in this analysis all patients with gt4 who failed a previous ifn free treatment with the presence of ras at bt or relapse . all patients were retreated with a fixed combination of sof vel for 12 24 weeks without rbv . we evaluated the svr and the meld score change after the treatment . seven patients were described . all were cirrhotic child pugh a n 5 b n 2 baseline ras were detected in 4 7 subjects at post treatment detection ns5 ras were f2
 n 1 q3
 n 2 s3
 n 1 ns3 were s12
 n 1 s12
 n 2 d16
 n 3 . all retreated patients gained svr . meld score improved in all subjects with a median change of 3 points . no significant side effects or adverse events were reported . abstracttext seven patients were described . all were cirrhotic child pugh a n 5 b n 2 baseline ras were detected in 4 7 subjects at post treatment detection ns5 ras were f2
 n 1 q3
 n 2 s3
 n 1 ns3 were s12
 n 1 s12
 n 2 d16
 n 3 . all retreated patients gained svr . meld score improved in all subjects with a median change of 3 points . no significant side effects or adverse events were reported . the combination sof vel could be considered for the retreatment of cirrhotic gt4 patients who failed a previous ifn free treatment with the presence of ras in ns3 or ns5 regions . abstracttext the combination sof vel could be considered for the retreatment of cirrhotic gt4 patients who failed a previous ifn free treatment with the presence of ras in ns3 or ns5 regions . 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>