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influence of successful chronic hepatitis c virus treatment with ledipasvir sofosbuvir on warfarin dosing requirements in four veterans . to describe international normalized ratio inr trends and warfarin dosage adjustments required for four veterans who were receiving warfarin therapy and started treatment for hepatitis c virus hcv with ledipasvir sofosbuvir with or without ribavirin . abstracttext to describe international normalized ratio inr trends and warfarin dosage adjustments required for four veterans who were receiving warfarin therapy and started treatment for hepatitis c virus hcv with ledipasvir sofosbuvir with or without ribavirin . case series . abstracttext case series . pharmacist led anticoagulation clinic in a veterans affairs health care system . abstracttext pharmacist led anticoagulation clinic in a veterans affairs health care system . four patients aged 59 66 years who were receiving warfarin and had stable therapeutic inrs and started ledipasvir sofosbuvir therapy with or without ribavirin for hcv infection . abstracttext four patients aged 59 66 years who were receiving warfarin and had stable therapeutic inrs and started ledipasvir sofosbuvir therapy with or without ribavirin for hcv infection . all four patients developed subtherapeutic inrs after the addition of ledipasvir sofosbuvir with or without ribavirin . an increase in weekly warfarin dose ranging from 14 67 was required with changes in warfarin doses starting 2 3 weeks after ledipasvir sofosbuvir initiation . two patients required dose reductions after hcv treatment completion whereas the other two did not . use of the drug interaction probability scale indicated that the interaction between warfarin and ledipasvir sofosbuvir was doubtful score of 1 two patients or possible score of 4 two patients . the mechanism of this interaction is unknown but may be related to improvements in hepatic function during hcv treatment . abstracttext all four patients developed subtherapeutic inrs after the addition of ledipasvir sofosbuvir with or without ribavirin . an increase in weekly warfarin dose ranging from 14 67 was required with changes in warfarin doses starting 2 3 weeks after ledipasvir sofosbuvir initiation . two patients required dose reductions after hcv treatment completion whereas the other two did not . use of the drug interaction probability scale indicated that the interaction between warfarin and ledipasvir sofosbuvir was doubtful score of 1 two patients or possible score of 4 two patients . the mechanism of this interaction is unknown but may be related to improvements in hepatic function during hcv treatment . to our knowledge this is the first case series describing a possible drug interaction between warfarin and ledipasvir sofosbuvir with or without ribavirin . close monitoring is warranted when ledipasvir sofosbuvir is initiated in patients receiving anticoagulation therapy with warfarin especially those with evidence of cirrhosis prior to treatment . this is particularly important in the first month after starting treatment and the first month after completion . failure to monitor and achieve therapeutic inr after hcv therapy completion may have the potential to result in adverse outcomes . abstracttext to our knowledge this is the first case series describing a possible drug interaction between warfarin and ledipasvir sofosbuvir with or without ribavirin . close monitoring is warranted when ledipasvir sofosbuvir is initiated in patients receiving anticoagulation therapy with warfarin especially those with evidence of cirrhosis prior to treatment . this is particularly important in the first month after starting treatment and the first month after completion . failure to monitor and achieve therapeutic inr after hcv therapy completion may have the potential to result in adverse outcomes .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: influence of successful chronic hepatitis c virus treatment with ledipasvir sofosbuvir on warfarin dosing requirements in four veterans . to describe international normalized ratio inr trends and warfarin dosage adjustments required for four veterans who were receiving warfarin therapy and started treatment for hepatitis c virus hcv with ledipasvir sofosbuvir with or without ribavirin . abstracttext to describe international normalized ratio inr trends and warfarin dosage adjustments required for four veterans who were receiving warfarin therapy and started treatment for hepatitis c virus hcv with ledipasvir sofosbuvir with or without ribavirin . case series . abstracttext case series . pharmacist led anticoagulation clinic in a veterans affairs health care system . abstracttext pharmacist led anticoagulation clinic in a veterans affairs health care system . four patients aged 59 66 years who were receiving warfarin and had stable therapeutic inrs and started ledipasvir sofosbuvir therapy with or without ribavirin for hcv infection . abstracttext four patients aged 59 66 years who were receiving warfarin and had stable therapeutic inrs and started ledipasvir sofosbuvir therapy with or without ribavirin for hcv infection . all four patients developed subtherapeutic inrs after the addition of ledipasvir sofosbuvir with or without ribavirin . an increase in weekly warfarin dose ranging from 14 67 was required with changes in warfarin doses starting 2 3 weeks after ledipasvir sofosbuvir initiation . two patients required dose reductions after hcv treatment completion whereas the other two did not . use of the drug interaction probability scale indicated that the interaction between warfarin and ledipasvir sofosbuvir was doubtful score of 1 two patients or possible score of 4 two patients . the mechanism of this interaction is unknown but may be related to improvements in hepatic function during hcv treatment . abstracttext all four patients developed subtherapeutic inrs after the addition of ledipasvir sofosbuvir with or without ribavirin . an increase in weekly warfarin dose ranging from 14 67 was required with changes in warfarin doses starting 2 3 weeks after ledipasvir sofosbuvir initiation . two patients required dose reductions after hcv treatment completion whereas the other two did not . use of the drug interaction probability scale indicated that the interaction between warfarin and ledipasvir sofosbuvir was doubtful score of 1 two patients or possible score of 4 two patients . the mechanism of this interaction is unknown but may be related to improvements in hepatic function during hcv treatment . to our knowledge this is the first case series describing a possible drug interaction between warfarin and ledipasvir sofosbuvir with or without ribavirin . close monitoring is warranted when ledipasvir sofosbuvir is initiated in patients receiving anticoagulation therapy with warfarin especially those with evidence of cirrhosis prior to treatment . this is particularly important in the first month after starting treatment and the first month after completion . failure to monitor and achieve therapeutic inr after hcv therapy completion may have the potential to result in adverse outcomes . abstracttext to our knowledge this is the first case series describing a possible drug interaction between warfarin and ledipasvir sofosbuvir with or without ribavirin . close monitoring is warranted when ledipasvir sofosbuvir is initiated in patients receiving anticoagulation therapy with warfarin especially those with evidence of cirrhosis prior to treatment . this is particularly important in the first month after starting treatment and the first month after completion . failure to monitor and achieve therapeutic inr after hcv therapy completion may have the potential to result in adverse outcomes . 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>

unexpected lumbar abscess due to scarification wet cupping a case report . objective this case presents a rare cause of lumbar abscess . methods a 51 year old male patient was admitted to the emergency department with a complaint of lumbar pain . spinal magnetic resonance imaging revealed a lumbar abscess . results the abscess was treated with drainage of the abscess and antibiotic . conclusion scarification wet cupping therapy should be taken into consideration as a rare cause of lumbar abscesses in patients who present with skin findings indicative of scarification . scarification wet cupping therapy practitioners must pay attention to hygienic measures .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: unexpected lumbar abscess due to scarification wet cupping a case report . objective this case presents a rare cause of lumbar abscess . methods a 51 year old male patient was admitted to the emergency department with a complaint of lumbar pain . spinal magnetic resonance imaging revealed a lumbar abscess . results the abscess was treated with drainage of the abscess and antibiotic . conclusion scarification wet cupping therapy should be taken into consideration as a rare cause of lumbar abscesses in patients who present with skin findings indicative of scarification . scarification wet cupping therapy practitioners must pay attention to hygienic measures . 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>

outbreak of hepatitis a in an extended family after importation by non immune travellers . the incidence of hepatitis a in england has declined in recent years but travel related cases and imported infections remain a challenge . we report an outbreak of hepatitis a in an extended family where two primary cases were infected while in pakistan and two secondary cases were infected in england . all four were infected by the same genotype iiia virus . testing of the children in the extended family by dried blood spots dbs determined that three had evidence of recent past infections anti hav igm positive one had a current asymptomatic infection anti hav igm and hav rna positive and one was incubating the virus anti hav igm negative hav rna positive . hav rna from the dbs was identical to the adult cases . this outbreak demonstrates secondary spread of hepatitis a by asymptomatic children after importation from abroad and highlights the importance of preventing travel associated hepatitis a infection .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: outbreak of hepatitis a in an extended family after importation by non immune travellers . the incidence of hepatitis a in england has declined in recent years but travel related cases and imported infections remain a challenge . we report an outbreak of hepatitis a in an extended family where two primary cases were infected while in pakistan and two secondary cases were infected in england . all four were infected by the same genotype iiia virus . testing of the children in the extended family by dried blood spots dbs determined that three had evidence of recent past infections anti hav igm positive one had a current asymptomatic infection anti hav igm and hav rna positive and one was incubating the virus anti hav igm negative hav rna positive . hav rna from the dbs was identical to the adult cases . this outbreak demonstrates secondary spread of hepatitis a by asymptomatic children after importation from abroad and highlights the importance of preventing travel associated hepatitis a 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>

fetal autopsy findings of cardiofaciocutaneous syndrome with a unique braf mutation . cardiofaciocutaneous cfc syndrome is a rasopathy phenotypically characterized by facial cardiac and ectodermal abnormalities . the extent to which this phenotype is expressed in the affected fetus is unclear and a better understanding of the fetal autopsy findings in cfc syndrome could facilitate diagnosis and understanding of the developmental effects of dysregulated braf activity . here we describe the fetal autopsy findings in a case of cfc syndrome in a 17 week fetus with a novel braf mutation that demonstrates potential similarities and differences with the postnatal presentation of cfc syndrome .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: fetal autopsy findings of cardiofaciocutaneous syndrome with a unique braf mutation . cardiofaciocutaneous cfc syndrome is a rasopathy phenotypically characterized by facial cardiac and ectodermal abnormalities . the extent to which this phenotype is expressed in the affected fetus is unclear and a better understanding of the fetal autopsy findings in cfc syndrome could facilitate diagnosis and understanding of the developmental effects of dysregulated braf activity . here we describe the fetal autopsy findings in a case of cfc syndrome in a 17 week fetus with a novel braf mutation that demonstrates potential similarities and differences with the postnatal presentation of cfc syndrome . 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>

native aortic valve endocarditis complicated by pseudoaneurysm of mitral aortic intervalvular fibrosa . pseudoaneurysm of mitral aortic intervalvular fibrosa pa maivf is a rare complication of native aortic valve endocarditis . this region is a relatively avascular area and prone to infection during endocarditis and subsequent aneurysm formation . the rupture into the pericardial cavity and left atrium or aorta systemic embolism myocardial infarction secondary to left coronary compression and sudden death are the reported complications . herein we present a 9 year old boy who was diagnosed with bicuspid aortic valve endocarditis complicated by pa maivf cerebral embolism and hemorrhage . pa maivf was visualized by both two and three dimensional transthoracic echocardiography and ruptured into pericardial space causing a fatal outcome .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: native aortic valve endocarditis complicated by pseudoaneurysm of mitral aortic intervalvular fibrosa . pseudoaneurysm of mitral aortic intervalvular fibrosa pa maivf is a rare complication of native aortic valve endocarditis . this region is a relatively avascular area and prone to infection during endocarditis and subsequent aneurysm formation . the rupture into the pericardial cavity and left atrium or aorta systemic embolism myocardial infarction secondary to left coronary compression and sudden death are the reported complications . herein we present a 9 year old boy who was diagnosed with bicuspid aortic valve endocarditis complicated by pa maivf cerebral embolism and hemorrhage . pa maivf was visualized by both two and three dimensional transthoracic echocardiography and ruptured into pericardial space causing a fatal outcome . 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>

septic arthritis of hip due to salmonella typhi in a patient with multiple sclerosis . the most common microorganisms isolated from septic arthritis are staphylococcus aureus and streptoccocci . septic arthritis due to salmonella spp . are rare and the most commonly isolated species are
choleraesuis and
typhimurium . however the number of septic arthritis cases due to
typhi is low in literature . in this report septic arthritis of hip due to
typhi in a multiple sclerosis patient who was under steroid therapy was presented . a 25 year old female patient was admitted to our clinic with the complaints of fever left hip pain standing and walking disability for 10 days . her anamnesis revealed that she had had a multiple sclerosis attack and underwent triple pulse steroid therapy . laboratory findings were as follows wbc count _decnum_ mm3 70 polymorphonuclear leukocyte hemoglobin _decnum_ g dl erythrocyte sedimentation rate _lgnum_ mm hour crp _decnum_ g l ast 86 u l and alt 77 u
in lumbosacral magnetic resonance imaging trochanteric bursitis and generalized myositis were detected in left hip joint compatible with septic arthritis .
typhi was isolated from patient blood and operational tissue samples . serum salmonella to and th titers were found as 1 _lgnum_ and 1 _lgnum_ respectively . antibiotic susceptibility test was performed by disk diffusion method and the isolate was found susceptible to ampicillin chloramphenicol ceftriaxone ciprofloxacin and trimethoprim sulphametoxazole . the patient was treated by surgery and also by two weeks parenteral 2 x _lgnum_ mg and 6 weeks oral 2 x _lgnum_ mg ciprofloxacin treatment . six months follow up of the patient revealed that clinical radiological and laboratory findings were normal . as far as the national literature was considered this was the first
typhi septic arthritis case involving the hip joint and demonstrating bacterial growth both in blood and operational tissue . the presentation of the infection as arthritis plus diffuse myositis and bursitis is also noteworthy .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: septic arthritis of hip due to salmonella typhi in a patient with multiple sclerosis . the most common microorganisms isolated from septic arthritis are staphylococcus aureus and streptoccocci . septic arthritis due to salmonella spp . are rare and the most commonly isolated species are
choleraesuis and
typhimurium . however the number of septic arthritis cases due to
typhi is low in literature . in this report septic arthritis of hip due to
typhi in a multiple sclerosis patient who was under steroid therapy was presented . a 25 year old female patient was admitted to our clinic with the complaints of fever left hip pain standing and walking disability for 10 days . her anamnesis revealed that she had had a multiple sclerosis attack and underwent triple pulse steroid therapy . laboratory findings were as follows wbc count _decnum_ mm3 70 polymorphonuclear leukocyte hemoglobin _decnum_ g dl erythrocyte sedimentation rate _lgnum_ mm hour crp _decnum_ g l ast 86 u l and alt 77 u
in lumbosacral magnetic resonance imaging trochanteric bursitis and generalized myositis were detected in left hip joint compatible with septic arthritis .
typhi was isolated from patient blood and operational tissue samples . serum salmonella to and th titers were found as 1 _lgnum_ and 1 _lgnum_ respectively . antibiotic susceptibility test was performed by disk diffusion method and the isolate was found susceptible to ampicillin chloramphenicol ceftriaxone ciprofloxacin and trimethoprim sulphametoxazole . the patient was treated by surgery and also by two weeks parenteral 2 x _lgnum_ mg and 6 weeks oral 2 x _lgnum_ mg ciprofloxacin treatment . six months follow up of the patient revealed that clinical radiological and laboratory findings were normal . as far as the national literature was considered this was the first
typhi septic arthritis case involving the hip joint and demonstrating bacterial growth both in blood and operational tissue . the presentation of the infection as arthritis plus diffuse myositis and bursitis is also noteworthy . 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>

acute cytomegalovirus pneumonia and hepatitis presenting during acute hiv retroviral syndrome . cytomegalovirus cmv disease is a frequent opportunistic infection that usually occurs in the late stages of hiv infection as a result of reactivation of a latent infection . we report a case of a 23 year old man with acute retroviral syndrome complicated by coexisting cmv pneumonia and cmv hepatitis which were documented by histopathological examination . his cmv pneumonia and hepatitis were assumed to be primary cmv diseases owing to the absence of cmv igg antibody . to the best of our knowledge this is the first case of simultaneous cmv pneumonia and hepatitis occurring as primary cmv diseases during primary hiv infection . this case indicates that invasive cmv diseases such as pneumonia and hepatitis should be considered even in patients with primary hiv infection .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: acute cytomegalovirus pneumonia and hepatitis presenting during acute hiv retroviral syndrome . cytomegalovirus cmv disease is a frequent opportunistic infection that usually occurs in the late stages of hiv infection as a result of reactivation of a latent infection . we report a case of a 23 year old man with acute retroviral syndrome complicated by coexisting cmv pneumonia and cmv hepatitis which were documented by histopathological examination . his cmv pneumonia and hepatitis were assumed to be primary cmv diseases owing to the absence of cmv igg antibody . to the best of our knowledge this is the first case of simultaneous cmv pneumonia and hepatitis occurring as primary cmv diseases during primary hiv infection . this case indicates that invasive cmv diseases such as pneumonia and hepatitis should be considered even in patients with primary hiv 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>

co existence of hepatocellular carcinoma and hepatic tuberculosis . background many case reports describe tuberculosis tb co existent with a malignant neoplasm . however the neoplasm in most of these reports is lung or breast cancer with only two cases of liver cancer concomitant with tb reported in the literature . although both tb and cancer are very common diseases little attention has been given to the pathophysiologic and practical implications of their co existence . methods case report and literature review . case report a 73 year old female patient with a history of hypertension and hepatitis c presented with abdominal pain of 2 mos duration . laboratory findings showed an elevated serum concentration of fetoprotein . a computed tomography scan demonstrated a solitary hypodense tumor in the right lobe of the liver segment viii . a pre operative chest radiograph was within normal limits . the patient underwent an uneventful tumor resection . histologic examination of a surgical specimen of the tumor demonstrated a moderately differentiated hepatocellular carcinoma co existent with caseating granulomas . conclusion through this case report the authors discuss the pathogenesis of the rare association of tb and malignant neoplasm of the liver and present a review of the current literature on the association of tb and cancer . further research is required to determine whether a tb infection resembles other chronic infections and inflammatory conditions in having a potential to facilitate oncogenesis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: co existence of hepatocellular carcinoma and hepatic tuberculosis . background many case reports describe tuberculosis tb co existent with a malignant neoplasm . however the neoplasm in most of these reports is lung or breast cancer with only two cases of liver cancer concomitant with tb reported in the literature . although both tb and cancer are very common diseases little attention has been given to the pathophysiologic and practical implications of their co existence . methods case report and literature review . case report a 73 year old female patient with a history of hypertension and hepatitis c presented with abdominal pain of 2 mos duration . laboratory findings showed an elevated serum concentration of fetoprotein . a computed tomography scan demonstrated a solitary hypodense tumor in the right lobe of the liver segment viii . a pre operative chest radiograph was within normal limits . the patient underwent an uneventful tumor resection . histologic examination of a surgical specimen of the tumor demonstrated a moderately differentiated hepatocellular carcinoma co existent with caseating granulomas . conclusion through this case report the authors discuss the pathogenesis of the rare association of tb and malignant neoplasm of the liver and present a review of the current literature on the association of tb and cancer . further research is required to determine whether a tb infection resembles other chronic infections and inflammatory conditions in having a potential to facilitate oncogenesis . 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>

negative wound therapy to manage large for size liver graft mismatch . liver volume matching in liver transplantation lt is of paramount importance . there is no agreement for its definition ranging from a graft to recipient weight ratio greater than 4 in paediatric to less than _decnum_ in adult lt . advances have been obtained to avoid small for size grafts but management of large grafts remains a major challenge in this setting . consequences include difficult anastomosis poor vascular alignment difficult wound closure graft compression and necrosis . we report on two patients who underwent lt with large grafts and develop major liver graft injury . technical solutions used in these two cases are presented and discussed . negative wound therapy allowed a rapid closure of abdominal wall and salvage of the graft .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: negative wound therapy to manage large for size liver graft mismatch . liver volume matching in liver transplantation lt is of paramount importance . there is no agreement for its definition ranging from a graft to recipient weight ratio greater than 4 in paediatric to less than _decnum_ in adult lt . advances have been obtained to avoid small for size grafts but management of large grafts remains a major challenge in this setting . consequences include difficult anastomosis poor vascular alignment difficult wound closure graft compression and necrosis . we report on two patients who underwent lt with large grafts and develop major liver graft injury . technical solutions used in these two cases are presented and discussed . negative wound therapy allowed a rapid closure of abdominal wall and salvage of the graft . 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>

vaginal epithelioid angiosarcoma a potential pitfall in gynecologic pathology . objective epithelioid angiosarcoma of the vagina is a rare variant that can easily be misdiagnosed considering the much higher frequency of epithelial neoplasms at that particular site . material and methods we report the case of a 41 year old gravida 2 para 1 aborta 1 with no prior history of irradiation who consulted after the discovery of 3 lesions at the lower right portion of the vagina . result the lesion consisted of epithelioid cells with high grade nuclei and prominent nucleoli . these cells expressed cd31 cd34 factor viii fli 1 vimentin smooth muscle actin and wt 1 . keratin 8 18 was focally positive . they were immunonegative for keratin ae1 ae3 keratin 3
12 keratin 7 keratin 20 s100 hmb 45 myogenin desmin and human herpesvirus type 8 . polymerase chain reaction based hpv viral search was also negative . conclusions a broad immunohistochemical panel including antibodies against vascular differentiation markers as well as various cytokeratins allows proper diagnosis of this unusual and aggressive entity .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: vaginal epithelioid angiosarcoma a potential pitfall in gynecologic pathology . objective epithelioid angiosarcoma of the vagina is a rare variant that can easily be misdiagnosed considering the much higher frequency of epithelial neoplasms at that particular site . material and methods we report the case of a 41 year old gravida 2 para 1 aborta 1 with no prior history of irradiation who consulted after the discovery of 3 lesions at the lower right portion of the vagina . result the lesion consisted of epithelioid cells with high grade nuclei and prominent nucleoli . these cells expressed cd31 cd34 factor viii fli 1 vimentin smooth muscle actin and wt 1 . keratin 8 18 was focally positive . they were immunonegative for keratin ae1 ae3 keratin 3
12 keratin 7 keratin 20 s100 hmb 45 myogenin desmin and human herpesvirus type 8 . polymerase chain reaction based hpv viral search was also negative . conclusions a broad immunohistochemical panel including antibodies against vascular differentiation markers as well as various cytokeratins allows proper diagnosis of this unusual and aggressive entity . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

systemic sclerosis polymyositis overlap syndrome associated with autoimmune hepatitis and cerebral vasculitis . autoimmune hepatitis aih is a chronic disorder characterized by persistent hepatocellular inflammation and necrosis . aih overlap syndromes with other autoimmune diseases have been reported including connective tissue diseases ctd . reports of aih in systemic sclerosis ssc however are scarce and have been particularly described in the limited ssc subtype . we report a case of systemic sclerosis polymyositis overlap syndrome that developed aih and subsequently cerebral vasculitis . to our knowledge this is the first report of such a complex mosaic of autoimmunity . we also review the literature regarding scleroderma related aih .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: systemic sclerosis polymyositis overlap syndrome associated with autoimmune hepatitis and cerebral vasculitis . autoimmune hepatitis aih is a chronic disorder characterized by persistent hepatocellular inflammation and necrosis . aih overlap syndromes with other autoimmune diseases have been reported including connective tissue diseases ctd . reports of aih in systemic sclerosis ssc however are scarce and have been particularly described in the limited ssc subtype . we report a case of systemic sclerosis polymyositis overlap syndrome that developed aih and subsequently cerebral vasculitis . to our knowledge this is the first report of such a complex mosaic of autoimmunity . we also review the literature regarding scleroderma related aih . 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>

intrafamilial transmission of hepatitis c virus in patients with severe haemophilia
the history behind the production of clotting factor concentrates produced differences in the prevalence of hepatitis c virus hcv and other blood borne infections in haemophilic patients . prevalence rates of hcv infection up to _lgnum_ were reported in patients treated with concentrates before _lgnum_ . conversely nowadays viral inactivation and recombinant technologies have effectively prevented transfusion transmitted viral pathogens . recently new hcv infections in three young brothers were observed . in the absence of any other risk of transmission their hiv hcv coinfected uncle who was living in the same house was subject to study . plasma samples of the four relatives were investigated in order to test whether the infections have a common source . a phylogenetic approach using the most variable e2 viral sequences was carried out using samples from the four family members . the hcv sequences from the study resulted highly related being those obtained from the uncle the most ancestral ones . because of the chronological order in which the infections occurred and the relatedness of the sequences an infection from the uncle to his nephews is the most likely explanation . special cares must be applied in the case of household contact among members of a family with inherited bleeding disorders .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: intrafamilial transmission of hepatitis c virus in patients with severe haemophilia
the history behind the production of clotting factor concentrates produced differences in the prevalence of hepatitis c virus hcv and other blood borne infections in haemophilic patients . prevalence rates of hcv infection up to _lgnum_ were reported in patients treated with concentrates before _lgnum_ . conversely nowadays viral inactivation and recombinant technologies have effectively prevented transfusion transmitted viral pathogens . recently new hcv infections in three young brothers were observed . in the absence of any other risk of transmission their hiv hcv coinfected uncle who was living in the same house was subject to study . plasma samples of the four relatives were investigated in order to test whether the infections have a common source . a phylogenetic approach using the most variable e2 viral sequences was carried out using samples from the four family members . the hcv sequences from the study resulted highly related being those obtained from the uncle the most ancestral ones . because of the chronological order in which the infections occurred and the relatedness of the sequences an infection from the uncle to his nephews is the most likely explanation . special cares must be applied in the case of household contact among members of a family with inherited bleeding disorders . 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>

bilateral blindness in endogenous endophthalmitis with fulminant course a clinical case . we present the case of man with endogenous endophtalmitis ao with insulin dependent diabetes mellitus type 2 and viral hepatitis type
the prognosis was reserved in the context of the underlying disease with loss of his visual acuity od and evisceration os . despite the correct treatment and many clinical laboratory imaging and interclinical examinations etiologic diagnosis was established with great difficulty and very late .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: bilateral blindness in endogenous endophthalmitis with fulminant course a clinical case . we present the case of man with endogenous endophtalmitis ao with insulin dependent diabetes mellitus type 2 and viral hepatitis type
the prognosis was reserved in the context of the underlying disease with loss of his visual acuity od and evisceration os . despite the correct treatment and many clinical laboratory imaging and interclinical examinations etiologic diagnosis was established with great difficulty and very late . 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>

co existence of familial mediterranean fever and multiple sclerosis in two patients . abstract two female patients aged 23 and 25 years old diagnosed with familial mediterranean fever fmf were presented with ataxia and headache . multiple sclerosis plaques were detected in their spinal and cranial mri and diagnosis of multiple sclerosis was established . genetic analysis demonstrated m694 v mutation one homozygous and the other heterozygous in both of the patients . although it is quite rare coexistence of familial mediterranean fever and multiple sclerosis should be kept in the mind .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: co existence of familial mediterranean fever and multiple sclerosis in two patients . abstract two female patients aged 23 and 25 years old diagnosed with familial mediterranean fever fmf were presented with ataxia and headache . multiple sclerosis plaques were detected in their spinal and cranial mri and diagnosis of multiple sclerosis was established . genetic analysis demonstrated m694 v mutation one homozygous and the other heterozygous in both of the patients . although it is quite rare coexistence of familial mediterranean fever and multiple sclerosis should be kept in the mind . 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>

low grade fibromyxoid sarcoma of the extremities a clinicopathologic study of 24 cases and review of the literature . low grade fibromyxoid sarcoma lgfms and hybrid sclerosing epithelioid fibrosarcoma sef lgfms have a low potential for recurrence 10 and metastasis 5 but they are notorious for late occurring metastases . the aim of this study was to evaluate the outcome of lgfms and review similar cases reported in the literature . we retrospectively evaluated 24 lgfms operated at a single institution . all cases were histologically revised . mean age was 34 years range 8 to 74 . two cases presented areas of sef hybrid tumours . three patients presented with metastasis at diagnosis . a strong cytoplasmic staining for muc4 antibody was found in the majority of neoplastic cells . rt pcr was feasible in 6 cases and it detected the presence of fus creb
2 fusion gene chimeric transcript . mean follow up was 44 months range 6 to _lgnum_ . two patients developed lung metastasis after 9 and 26 months respectively . low grade fibromyxoid sarcoma has a various histopathologic spectrum with few cases of lgfms that share histopathologic resemblance with sef thereby reinforcing a possibility of a link within these two . it is of paramount importance an accurate and extensive sampling and examination of the whole specimen in order to identify higher risk patients .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: low grade fibromyxoid sarcoma of the extremities a clinicopathologic study of 24 cases and review of the literature . low grade fibromyxoid sarcoma lgfms and hybrid sclerosing epithelioid fibrosarcoma sef lgfms have a low potential for recurrence 10 and metastasis 5 but they are notorious for late occurring metastases . the aim of this study was to evaluate the outcome of lgfms and review similar cases reported in the literature . we retrospectively evaluated 24 lgfms operated at a single institution . all cases were histologically revised . mean age was 34 years range 8 to 74 . two cases presented areas of sef hybrid tumours . three patients presented with metastasis at diagnosis . a strong cytoplasmic staining for muc4 antibody was found in the majority of neoplastic cells . rt pcr was feasible in 6 cases and it detected the presence of fus creb
2 fusion gene chimeric transcript . mean follow up was 44 months range 6 to _lgnum_ . two patients developed lung metastasis after 9 and 26 months respectively . low grade fibromyxoid sarcoma has a various histopathologic spectrum with few cases of lgfms that share histopathologic resemblance with sef thereby reinforcing a possibility of a link within these two . it is of paramount importance an accurate and extensive sampling and examination of the whole specimen in order to identify higher risk patients . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

fatal recurrent dermatoneuro syndrome associated with systemic al amyloidosis . a male patient is presented with long lasting paraproteinemia of monoclonal igg who suffered from recurrent and until the last one mostly reversible episodes of dermatoneuro syndrome described exclusively in scleromyxedema . the skin biopsy revealed light chain amyloid deposition instead of changes typical for scleromyxedema . systemic al amyloidosis was diagnosed post mortem since the patient had no clinical signs of any other organ impairment except skin and brain . neuropathology is described and possible etiopathogenesis of brain involvement is considered .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: fatal recurrent dermatoneuro syndrome associated with systemic al amyloidosis . a male patient is presented with long lasting paraproteinemia of monoclonal igg who suffered from recurrent and until the last one mostly reversible episodes of dermatoneuro syndrome described exclusively in scleromyxedema . the skin biopsy revealed light chain amyloid deposition instead of changes typical for scleromyxedema . systemic al amyloidosis was diagnosed post mortem since the patient had no clinical signs of any other organ impairment except skin and brain . neuropathology is described and possible etiopathogenesis of brain involvement is considered . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

bisphosphonate induced hypocalcaemia report of six cases and review of the literature . intravenous bisphosphonates are widely used to treat osteoporosis and bone metastasis in cancer patients the risk of hypocalcaemia is a rare but underestimated side effect of anti resorptive treatment . clinically apparent hypocalcaemia is mostly related to high dose treatment with zoledronate and denosumab in cancer patients particular caution is mandatory in all malnourished patients and patients with renal failure who are treated for either bone metastases or osteoporosis . to avoid serious hypocalcaemia pre treatment calcium and vitamin d status should be assessed and corrected if appropriate .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: bisphosphonate induced hypocalcaemia report of six cases and review of the literature . intravenous bisphosphonates are widely used to treat osteoporosis and bone metastasis in cancer patients the risk of hypocalcaemia is a rare but underestimated side effect of anti resorptive treatment . clinically apparent hypocalcaemia is mostly related to high dose treatment with zoledronate and denosumab in cancer patients particular caution is mandatory in all malnourished patients and patients with renal failure who are treated for either bone metastases or osteoporosis . to avoid serious hypocalcaemia pre treatment calcium and vitamin d status should be assessed and corrected if appropriate . 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>

telaprevir induced renal impairment three clinical cases and a review of the literature . telaprevir tpv is one of the ns3
 serine protease inhibitors on the market for the treatment of chronic hepatitis c genotype 1 in combination with peginterferon alpha and ribavirin . well documented potential adverse reactions of tpv are hematological skin and gastro intestinal disorders . until now there were no conclusive data from clinical trials about renal adverse reactions of tpv . we report here three cases of renal impairment that occurred after a few days of tpv treatment and resolved in about 2 weeks after stopping the drug . two of the patients were hospitalized because of this serious adverse drug reaction . therefore renal impairment seems to be a new adverse drug reaction of tpv and clinicians should be aware of this potentially serious complication of chronic hepatitis c therapy .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: telaprevir induced renal impairment three clinical cases and a review of the literature . telaprevir tpv is one of the ns3
 serine protease inhibitors on the market for the treatment of chronic hepatitis c genotype 1 in combination with peginterferon alpha and ribavirin . well documented potential adverse reactions of tpv are hematological skin and gastro intestinal disorders . until now there were no conclusive data from clinical trials about renal adverse reactions of tpv . we report here three cases of renal impairment that occurred after a few days of tpv treatment and resolved in about 2 weeks after stopping the drug . two of the patients were hospitalized because of this serious adverse drug reaction . therefore renal impairment seems to be a new adverse drug reaction of tpv and clinicians should be aware of this potentially serious complication of chronic hepatitis c therapy . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

acute cholestatic hepatitis induced by epstein barr virus infection in an adult a case report . background acute cholestatic hepatitis without features of infectious mononucleosis is a rare presentation of primary epstein barr infection with only several cases previously reported in the medical literature . early investigation for epstein barr virus in febrile patients with deranged liver function tests and no demonstrable biliary obstruction on imaging can expedite both diagnosis and treatment thereby avoiding costly or invasive procedures such as liver biopsy . case presentation a 59 year old white woman of anglo saxon descent presenting with a febrile illness was noted to have a cholestatic picture of deranged liver function tests . over the following week a progressive obstructive jaundice developed with no evidence of choledocholithiasis on ultrasound or magnetic resonance cholangiopancreatography . specific immunoglobulin m antibodies against epstein barr virus were detected in her serum and the diagnosis of epstein barr hepatitis was confirmed by polymerase chain reaction testing . supportive treatment was implemented and her liver function had normalized 3 months after presentation . conclusions epstein barr virus is associated with a wide variety of clinical manifestations and can present as cholestatic hepatitis with or without features of infectious mononucleosis . while the diagnosis is often suggested by serological testing epstein barr virus polymerase chain reaction is a new non invasive laboratory study that can help identify infection in cases where the clinical presentation is atypical .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: acute cholestatic hepatitis induced by epstein barr virus infection in an adult a case report . background acute cholestatic hepatitis without features of infectious mononucleosis is a rare presentation of primary epstein barr infection with only several cases previously reported in the medical literature . early investigation for epstein barr virus in febrile patients with deranged liver function tests and no demonstrable biliary obstruction on imaging can expedite both diagnosis and treatment thereby avoiding costly or invasive procedures such as liver biopsy . case presentation a 59 year old white woman of anglo saxon descent presenting with a febrile illness was noted to have a cholestatic picture of deranged liver function tests . over the following week a progressive obstructive jaundice developed with no evidence of choledocholithiasis on ultrasound or magnetic resonance cholangiopancreatography . specific immunoglobulin m antibodies against epstein barr virus were detected in her serum and the diagnosis of epstein barr hepatitis was confirmed by polymerase chain reaction testing . supportive treatment was implemented and her liver function had normalized 3 months after presentation . conclusions epstein barr virus is associated with a wide variety of clinical manifestations and can present as cholestatic hepatitis with or without features of infectious mononucleosis . while the diagnosis is often suggested by serological testing epstein barr virus polymerase chain reaction is a new non invasive laboratory study that can help identify infection in cases where the clinical presentation is atypical . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

a solitary presentation of panniculitis in a patient with a history of breast cancer . panniculits presents as an inflammation of the subcutaneous adipose tissue of the skin . in breast panniculitis is very rare and is usually a manifestation of underlying inflammatory conditions . the typical presentation is palpable tender nodules which in cases of breast panniculitis triggers an extensive work up to exclude a malignancy . herein we present a case of septal and lobar panniculitis in a female with clinical history of invasive ductal carcinoma . abstracttext panniculits presents as an inflammation of the subcutaneous adipose tissue of the skin . in breast panniculitis is very rare and is usually a manifestation of underlying inflammatory conditions . the typical presentation is palpable tender nodules which in cases of breast panniculitis triggers an extensive work up to exclude a malignancy . herein we present a case of septal and lobar panniculitis in a female with clinical history of invasive ductal carcinoma . a 52 year old female with past medical history of invasive breast carcinoma 5 years prior to the presentation . the patient chief complaint was a 1 year history of a subcutaneous nodular lesion on her left breast . a core biopsy of the firm nodule showed marked inflammation of the breast . a second skin biopsy showed an abundant chronic inflammatory infiltrate with lymphocytic vasculitis and neuritis suggestive of an underlying autoimmune process . abstracttext a 52 year old female with past medical history of invasive breast carcinoma 5 years prior to the presentation . the patient chief complaint was a 1 year history of a subcutaneous nodular lesion on her left breast . a core biopsy of the firm nodule showed marked inflammation of the breast . a second skin biopsy showed an abundant chronic inflammatory infiltrate with lymphocytic vasculitis and neuritis suggestive of an underlying autoimmune process . subcutaneous panniculitis with or without vasculitis is a rare condition when presenting in the breast . panniculitis can mimic malignancy and thus it is important to differentially diagnose it from breast carcinoma . histologically it is classified in lobular and septal lymphocytic panniculitis depending on specific diagnostic characteristics . abstracttext subcutaneous panniculitis with or without vasculitis is a rare condition when presenting in the breast . panniculitis can mimic malignancy and thus it is important to differentially diagnose it from breast carcinoma . histologically it is classified in lobular and septal lymphocytic panniculitis depending on specific diagnostic characteristics . panniculitis of the breast is a rare condition that needs to be included in the differential diagnosis of subcutaneous breast masses . in all cases but specifically in females with history of breast cancer panniculitis still should be thought of as a possibility and imaging as well as other diagnostic techniques can aid in making the correct diagnosis . abstracttext panniculitis of the breast is a rare condition that needs to be included in the differential diagnosis of subcutaneous breast masses . in all cases but specifically in females with history of breast cancer panniculitis still should be thought of as a possibility and imaging as well as other diagnostic techniques can aid in making the correct diagnosis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: a solitary presentation of panniculitis in a patient with a history of breast cancer . panniculits presents as an inflammation of the subcutaneous adipose tissue of the skin . in breast panniculitis is very rare and is usually a manifestation of underlying inflammatory conditions . the typical presentation is palpable tender nodules which in cases of breast panniculitis triggers an extensive work up to exclude a malignancy . herein we present a case of septal and lobar panniculitis in a female with clinical history of invasive ductal carcinoma . abstracttext panniculits presents as an inflammation of the subcutaneous adipose tissue of the skin . in breast panniculitis is very rare and is usually a manifestation of underlying inflammatory conditions . the typical presentation is palpable tender nodules which in cases of breast panniculitis triggers an extensive work up to exclude a malignancy . herein we present a case of septal and lobar panniculitis in a female with clinical history of invasive ductal carcinoma . a 52 year old female with past medical history of invasive breast carcinoma 5 years prior to the presentation . the patient chief complaint was a 1 year history of a subcutaneous nodular lesion on her left breast . a core biopsy of the firm nodule showed marked inflammation of the breast . a second skin biopsy showed an abundant chronic inflammatory infiltrate with lymphocytic vasculitis and neuritis suggestive of an underlying autoimmune process . abstracttext a 52 year old female with past medical history of invasive breast carcinoma 5 years prior to the presentation . the patient chief complaint was a 1 year history of a subcutaneous nodular lesion on her left breast . a core biopsy of the firm nodule showed marked inflammation of the breast . a second skin biopsy showed an abundant chronic inflammatory infiltrate with lymphocytic vasculitis and neuritis suggestive of an underlying autoimmune process . subcutaneous panniculitis with or without vasculitis is a rare condition when presenting in the breast . panniculitis can mimic malignancy and thus it is important to differentially diagnose it from breast carcinoma . histologically it is classified in lobular and septal lymphocytic panniculitis depending on specific diagnostic characteristics . abstracttext subcutaneous panniculitis with or without vasculitis is a rare condition when presenting in the breast . panniculitis can mimic malignancy and thus it is important to differentially diagnose it from breast carcinoma . histologically it is classified in lobular and septal lymphocytic panniculitis depending on specific diagnostic characteristics . panniculitis of the breast is a rare condition that needs to be included in the differential diagnosis of subcutaneous breast masses . in all cases but specifically in females with history of breast cancer panniculitis still should be thought of as a possibility and imaging as well as other diagnostic techniques can aid in making the correct diagnosis . abstracttext panniculitis of the breast is a rare condition that needs to be included in the differential diagnosis of subcutaneous breast masses . in all cases but specifically in females with history of breast cancer panniculitis still should be thought of as a possibility and imaging as well as other diagnostic techniques can aid in making the correct 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: 0 </s>

acute liver failure associated with occupational exposure to tetrachloroethylene . tetrachloroethylene is a chlorinated solvent that is primarily used in dry cleaning and degreasing operations . although the hepatotoxicity caused by tetrachloroethylene has been well documented in literature it is rarely considered as a cause of acute liver failure . we report a case of a 39 yr old man who was admitted to our hospital for acute liver failure due to tetrachloroethylene exposure . histological examination of the liver revealed massive hepatic necrosis prominently in zone 3 of the hepatic lobules . the patient underwent supportive treatment along with 3 sessions of plasmapheresis and consequently he presented a favorable outcome . repeat liver biopsy performed 6 months after the patient discharge showed architectural distortion with postnecrotic cirrhosis . physicians should be aware of the possibility of acute liver failure induced by tetrachloroethylene . early plasmapheresis can be effective for individuals with sufficient capacity for hepatocyte regeneration .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: acute liver failure associated with occupational exposure to tetrachloroethylene . tetrachloroethylene is a chlorinated solvent that is primarily used in dry cleaning and degreasing operations . although the hepatotoxicity caused by tetrachloroethylene has been well documented in literature it is rarely considered as a cause of acute liver failure . we report a case of a 39 yr old man who was admitted to our hospital for acute liver failure due to tetrachloroethylene exposure . histological examination of the liver revealed massive hepatic necrosis prominently in zone 3 of the hepatic lobules . the patient underwent supportive treatment along with 3 sessions of plasmapheresis and consequently he presented a favorable outcome . repeat liver biopsy performed 6 months after the patient discharge showed architectural distortion with postnecrotic cirrhosis . physicians should be aware of the possibility of acute liver failure induced by tetrachloroethylene . early plasmapheresis can be effective for individuals with sufficient capacity for hepatocyte regeneration . 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>

telaprevir to boceprevir switch highlights lack of cross reactivity . hepatitis c viral protease inhibitors increase sustained virologic response rates compared to interferon and ribavirin but also add side effects . telaprevir and boceprevir are structurally similar and share cross resistant mutations . this case report highlights successful management of telaprevir skin rash and anal discomfort by switching to boceprevir .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: telaprevir to boceprevir switch highlights lack of cross reactivity . hepatitis c viral protease inhibitors increase sustained virologic response rates compared to interferon and ribavirin but also add side effects . telaprevir and boceprevir are structurally similar and share cross resistant mutations . this case report highlights successful management of telaprevir skin rash and anal discomfort by switching to boceprevir . 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 use of bone graft substitutes in large bone defects any specific needs introduction the gold standard for restoring bone defects is still considered to be autologous bone grafting . however clinical benefits are not guaranteed and donor site complications and morbidity is not infrequent . research is on going for the development of alternative bone substitutes of both biological and synthetic origin . the purpose of this study was to evaluate the type of materials used and their efficacy for the treatment of large bone defects in traumatology and orthopaedic surgery . materials and method a literature review was carried out of embase and pubmed databases . inclusion criteria were articles in english language focusing on the use of bone substitutes in trauma and orthopaedic surgery for the treatment of bone defects and included details on the structural biological or biomechanical properties of the pure product . furthermore based on two clinical challenges fracture non union and impaction grafting we elaborated on the use of polytherapy for large bone defects as guided by the diamond concept . results all the products indicated in this manuscript possess osteoconductive activities but have different resorption times and biomechanical properties . bone graft substitute materials are used for a wide range of clinical applications even when the level of clinical evidence is low . the size and location of the defect and the local biological and mechanical environment as well as the biomechanical characteristics of the material determine the type of device that can be implanted in a bone defect . conclusion proper assessment of the biological and mechanical environment and accurate patient selection are necessary to judge the extent of therapy the injury warrants . a sound understanding of various aspects of biomaterial properties and their relation and influence towards bone healing is of utmost importance . we suggest the application of polytherapy for the treatment of large bone defects and advocate the use of the diamond concept as a guideline .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: the use of bone graft substitutes in large bone defects any specific needs introduction the gold standard for restoring bone defects is still considered to be autologous bone grafting . however clinical benefits are not guaranteed and donor site complications and morbidity is not infrequent . research is on going for the development of alternative bone substitutes of both biological and synthetic origin . the purpose of this study was to evaluate the type of materials used and their efficacy for the treatment of large bone defects in traumatology and orthopaedic surgery . materials and method a literature review was carried out of embase and pubmed databases . inclusion criteria were articles in english language focusing on the use of bone substitutes in trauma and orthopaedic surgery for the treatment of bone defects and included details on the structural biological or biomechanical properties of the pure product . furthermore based on two clinical challenges fracture non union and impaction grafting we elaborated on the use of polytherapy for large bone defects as guided by the diamond concept . results all the products indicated in this manuscript possess osteoconductive activities but have different resorption times and biomechanical properties . bone graft substitute materials are used for a wide range of clinical applications even when the level of clinical evidence is low . the size and location of the defect and the local biological and mechanical environment as well as the biomechanical characteristics of the material determine the type of device that can be implanted in a bone defect . conclusion proper assessment of the biological and mechanical environment and accurate patient selection are necessary to judge the extent of therapy the injury warrants . a sound understanding of various aspects of biomaterial properties and their relation and influence towards bone healing is of utmost importance . we suggest the application of polytherapy for the treatment of large bone defects and advocate the use of the diamond concept as a guideline . 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>

buprenorphine for human immunodeficiency virus hepatitis c virus coinfected patients does it serve as a bridge to hepatitis c virus therapy objectives buprenorphine is associated with enhanced human immunodeficiency virus hiv treatment outcomes including increased antiretroviral therapy initiation rates adherence and cd4 cell counts among hiv infected opioid dependent individuals . buprenorphine facilitates hepatitis c virus hcv treatment in opioid dependent patients with hcv monoinfection . less is known about buprenorphine role in hiv hcv coinfection . methods we conducted a retrospective chart review to evaluate hcv care for hiv infected buprenorphine patients in the first 4 years of buprenorphine integration into a rhode island hiv clinic . results sixty one patients initiated buprenorphine . all had hcv antibody testing 57 93 were antibody positive . all antibody positive patients underwent hcv rna testing 48 84 were rna positive . of these 15 31 were not referred to hcv care . among chronically infected patients 3 received hcv treatment after buprenorphine all had cirrhosis and none achieved viral eradication . at buprenorphine induction most patients had inadequately controlled hiv infection with detectable hiv rna 59 or cd4 cell count less than or equal to _lgnum_ l 38 . conclusions buprenorphine has shown limited success to date as a bridge to hcv treatment within an hiv clinic . buprenorphine stabilization of opioid dependence and hiv disease may permit the use of hcv therapy over time .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: buprenorphine for human immunodeficiency virus hepatitis c virus coinfected patients does it serve as a bridge to hepatitis c virus therapy objectives buprenorphine is associated with enhanced human immunodeficiency virus hiv treatment outcomes including increased antiretroviral therapy initiation rates adherence and cd4 cell counts among hiv infected opioid dependent individuals . buprenorphine facilitates hepatitis c virus hcv treatment in opioid dependent patients with hcv monoinfection . less is known about buprenorphine role in hiv hcv coinfection . methods we conducted a retrospective chart review to evaluate hcv care for hiv infected buprenorphine patients in the first 4 years of buprenorphine integration into a rhode island hiv clinic . results sixty one patients initiated buprenorphine . all had hcv antibody testing 57 93 were antibody positive . all antibody positive patients underwent hcv rna testing 48 84 were rna positive . of these 15 31 were not referred to hcv care . among chronically infected patients 3 received hcv treatment after buprenorphine all had cirrhosis and none achieved viral eradication . at buprenorphine induction most patients had inadequately controlled hiv infection with detectable hiv rna 59 or cd4 cell count less than or equal to _lgnum_ l 38 . conclusions buprenorphine has shown limited success to date as a bridge to hcv treatment within an hiv clinic . buprenorphine stabilization of opioid dependence and hiv disease may permit the use of hcv therapy over 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: 1 </s>

paradoxical embolization in tips take a closer look to the heart . no definitive indications are provided in the literature for pre tips patient workup which is often limited to prevent the incidence of refractory hepatic encephalopathy or unacceptable deterioration of liver function . concerning cardiologic workup efforts are generally limited at excluding ventricular failure or porto pulmonary hypertension . the cases presented herein focus the attention of the readers on the possible occurrence of post tips paradoxical embolization in the presence of a patent foramen ovale frequently recognized in adult population . in conclusion although this complication has been already reported in literature in the present manuscript we concentrate on possible additional risk factors which may allow to identify a subset of patients with a higher likelihood to experience paradoxical embolization following tips . another important line of information presented herein is the feasibility of percutaneous closure of a patent foramen ovale before tips deployment in the presence of portal vein thrombosis and possibly with additional risk factors .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: paradoxical embolization in tips take a closer look to the heart . no definitive indications are provided in the literature for pre tips patient workup which is often limited to prevent the incidence of refractory hepatic encephalopathy or unacceptable deterioration of liver function . concerning cardiologic workup efforts are generally limited at excluding ventricular failure or porto pulmonary hypertension . the cases presented herein focus the attention of the readers on the possible occurrence of post tips paradoxical embolization in the presence of a patent foramen ovale frequently recognized in adult population . in conclusion although this complication has been already reported in literature in the present manuscript we concentrate on possible additional risk factors which may allow to identify a subset of patients with a higher likelihood to experience paradoxical embolization following tips . another important line of information presented herein is the feasibility of percutaneous closure of a patent foramen ovale before tips deployment in the presence of portal vein thrombosis and possibly with additional risk factors . 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>

unexpected natural death secondary to intra abdominal bleeding report of one idiopathic spontaneous intraperitoneal hemorrhage case . a 39 year old woman was found dead at home . she was single foreign national chronic alcoholic and had given shelter to a compatriot for three days . this man found the deceased in her bed after a night of heavy drinking . the emergency medical team observed numerous recent blue ecchymoses of the upper limbs . because of the unclear circumstances a medicolegal autopsy was ordered by the public prosecutor . massive hemoperitoneum was diagnosed with no visible internal traumatic injury . autopsy revealed hepatic and pancreatic abnormalities secondary to chronic alcoholism which were confirmed by pathological study . the source of the hemoperitoneum was not identified despite careful visceral and vascular examination . the authors concluded that death was secondary to idiopathic spontaneous hemoperitoneum or abdominal apoplexy . the forensic literature on unexpected death due to massive nontraumatic intra abdominal hemorrhage in association with liver cirrhosis is sparse with only five cases reported including the present case .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: unexpected natural death secondary to intra abdominal bleeding report of one idiopathic spontaneous intraperitoneal hemorrhage case . a 39 year old woman was found dead at home . she was single foreign national chronic alcoholic and had given shelter to a compatriot for three days . this man found the deceased in her bed after a night of heavy drinking . the emergency medical team observed numerous recent blue ecchymoses of the upper limbs . because of the unclear circumstances a medicolegal autopsy was ordered by the public prosecutor . massive hemoperitoneum was diagnosed with no visible internal traumatic injury . autopsy revealed hepatic and pancreatic abnormalities secondary to chronic alcoholism which were confirmed by pathological study . the source of the hemoperitoneum was not identified despite careful visceral and vascular examination . the authors concluded that death was secondary to idiopathic spontaneous hemoperitoneum or abdominal apoplexy . the forensic literature on unexpected death due to massive nontraumatic intra abdominal hemorrhage in association with liver cirrhosis is sparse with only five cases reported including the present case . 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>

fitz hugh curtis syndrome lacking typical characteristics of pelvic inflammatory disease . a 23 year old japanese woman previously a commercial sex worker presented with a 2 day history of right upper quadrant ruq abdominal pain worse on deep inspiration . she had noticed increased vaginal discharge 2 months earlier and had developed dull lower abdominal pain 3 weeks prior to presentation . although pelvic examination and transvaginal ultrasonography revealed neither a tubal nor ovarian pathology abdominal ct scan with contrast demonstrated early enhancement of the hepatic capsule a finding pathognomonic for fitz hugh curtis syndrome fhcs . cervical discharge pcr assay confirmed chlamydia trachomatis infection . this case highlights that normal gynaecological evaluation may be insufficient to rule out fhcs for which physicians should have a high index of suspicion when seeing any woman of reproductive age with ruq pain .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: fitz hugh curtis syndrome lacking typical characteristics of pelvic inflammatory disease . a 23 year old japanese woman previously a commercial sex worker presented with a 2 day history of right upper quadrant ruq abdominal pain worse on deep inspiration . she had noticed increased vaginal discharge 2 months earlier and had developed dull lower abdominal pain 3 weeks prior to presentation . although pelvic examination and transvaginal ultrasonography revealed neither a tubal nor ovarian pathology abdominal ct scan with contrast demonstrated early enhancement of the hepatic capsule a finding pathognomonic for fitz hugh curtis syndrome fhcs . cervical discharge pcr assay confirmed chlamydia trachomatis infection . this case highlights that normal gynaecological evaluation may be insufficient to rule out fhcs for which physicians should have a high index of suspicion when seeing any woman of reproductive age with ruq 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: 1 </s>

antibodies to gabaa receptor 1 and 2 subunits clinical and serologic characterization . objective to search for antibodies against neuronal cell surface proteins . methods using immunoprecipitation from neuronal cultures and tandem mass spectrometry we identified antibodies against the 1 subunit of the aminobutyric acid a receptor gabaar in a patient whose immunoglobulin g igg antibodies bound to hippocampal neurons . we searched
48 sera for antibodies binding to gabaar and subunits on live hek293 cells and identified the class subclass and gabaar subunit specificities of the positive samples . results gabaar abs were identified in 40 of
46 2 referred sera previously found negative for neuronal antibodies in 5 _lgnum_ 1 previously positive for other neuronal surface antibodies but not in 92 healthy individuals . the antibodies in 40 bound to either the 1 9 45 20 or the 2 subunits 9 45 20 and were of igg1 94 or igg3 6 subclass . the remaining 60 had lower antibody titers p _decnum_ which were mainly immunoglobulin m igm p _decnum_ and showed no defined subunit specificity . incubation of primary hippocampal neurons with gabaar igg1 sera reduced surface gabaar membrane expression . the clinical features of 15 patients gabaar 1 n 6 2 n 5 undefined n 4 included seizures 47 memory impairment 47 hallucinations 33 or anxiety 20 . most patients had not been given immunotherapies but one with new onset treatment resistant catatonia made substantial improvement after plasma exchange . conclusions the gabaar 1 and 2 are new targets for antibodies in autoimmune neurologic disease . the full spectrum of clinical features treatment responses correlation with antibody specificity and in particular the role of the igm antibodies will need to be assessed in future studies .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: antibodies to gabaa receptor 1 and 2 subunits clinical and serologic characterization . objective to search for antibodies against neuronal cell surface proteins . methods using immunoprecipitation from neuronal cultures and tandem mass spectrometry we identified antibodies against the 1 subunit of the aminobutyric acid a receptor gabaar in a patient whose immunoglobulin g igg antibodies bound to hippocampal neurons . we searched
48 sera for antibodies binding to gabaar and subunits on live hek293 cells and identified the class subclass and gabaar subunit specificities of the positive samples . results gabaar abs were identified in 40 of
46 2 referred sera previously found negative for neuronal antibodies in 5 _lgnum_ 1 previously positive for other neuronal surface antibodies but not in 92 healthy individuals . the antibodies in 40 bound to either the 1 9 45 20 or the 2 subunits 9 45 20 and were of igg1 94 or igg3 6 subclass . the remaining 60 had lower antibody titers p _decnum_ which were mainly immunoglobulin m igm p _decnum_ and showed no defined subunit specificity . incubation of primary hippocampal neurons with gabaar igg1 sera reduced surface gabaar membrane expression . the clinical features of 15 patients gabaar 1 n 6 2 n 5 undefined n 4 included seizures 47 memory impairment 47 hallucinations 33 or anxiety 20 . most patients had not been given immunotherapies but one with new onset treatment resistant catatonia made substantial improvement after plasma exchange . conclusions the gabaar 1 and 2 are new targets for antibodies in autoimmune neurologic disease . the full spectrum of clinical features treatment responses correlation with antibody specificity and in particular the role of the igm antibodies will need to be assessed in future studies . 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>

immunological analysis of a patient with hepatitis b virus hbv reactivation after bone marrow transplantation . patients with resolved hepatitis b virus hbv infection undergoing chemo or immunosuppressive therapy are at potential risk for hbv reactivation . to determine whether the host immune response contributes to liver injury we performed an immunological analysis of a patient with hbv reactivation . consistent with the detection of hbv dna in the sera the number of polyclonal hbv specific cytotoxic t lymphocytes ctls gradually increased however the number of cd4 cd25 regulatory t cells treg decreased . the interaction between hbv specific ctls and cd4 cd25 treg is an important determinant of liver injury during hbv reactivation . therefore monitoring the number of these cells might be a useful modality for the diagnosis of acute hepatitis resulting from hbv reactivation .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: immunological analysis of a patient with hepatitis b virus hbv reactivation after bone marrow transplantation . patients with resolved hepatitis b virus hbv infection undergoing chemo or immunosuppressive therapy are at potential risk for hbv reactivation . to determine whether the host immune response contributes to liver injury we performed an immunological analysis of a patient with hbv reactivation . consistent with the detection of hbv dna in the sera the number of polyclonal hbv specific cytotoxic t lymphocytes ctls gradually increased however the number of cd4 cd25 regulatory t cells treg decreased . the interaction between hbv specific ctls and cd4 cd25 treg is an important determinant of liver injury during hbv reactivation . therefore monitoring the number of these cells might be a useful modality for the diagnosis of acute hepatitis resulting from hbv reactivation . 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>

misdiagnosed roberts uterus leading to surgical misadventures . background developmental anomalies of the mullerian duct system are some of the most intriguing and challenging disorders that gynecologists and surgeons encounter in their practice . case we report on a 16 year old adolescent girl with regular menstrual cycles who presented with recurrent cyclical abdominal pain for which she had undergone 2 unsuccessful surgeries . when correctly diagnosed with the rare condition of quot robert uterus quot she underwent successful metroplasty and is completely asymptomatic at 2 year follow up . summary and conclusion to avoid inappropriate management gynecologists and surgeons should be aware of this rare entity while evaluating cases of severe dysmenorrhoea in previously normal menstruating young girls .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: misdiagnosed roberts uterus leading to surgical misadventures . background developmental anomalies of the mullerian duct system are some of the most intriguing and challenging disorders that gynecologists and surgeons encounter in their practice . case we report on a 16 year old adolescent girl with regular menstrual cycles who presented with recurrent cyclical abdominal pain for which she had undergone 2 unsuccessful surgeries . when correctly diagnosed with the rare condition of quot robert uterus quot she underwent successful metroplasty and is completely asymptomatic at 2 year follow up . summary and conclusion to avoid inappropriate management gynecologists and surgeons should be aware of this rare entity while evaluating cases of severe dysmenorrhoea in previously normal menstruating young girls . 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>

acute hepatitis c in a patient receiving etanercept . according to the literature the use of tumor necrosis factor tnf inhibitors in patients with chronic hepatitis c infection is safe and effective . there have been no reports however of primary infection with the hepatitis c virus during treatment with a biologic agent . we report the case of a patient with long standing moderate to severe psoriasis who developed acute hepatitis c while being treated with etanercept . biologic therapy was continued and the infection was successfully treated with pegylated interferon which achieved a sustained virologic response . etanercept did not have a negative impact on disease outcome or on response to antiviral treatment .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: acute hepatitis c in a patient receiving etanercept . according to the literature the use of tumor necrosis factor tnf inhibitors in patients with chronic hepatitis c infection is safe and effective . there have been no reports however of primary infection with the hepatitis c virus during treatment with a biologic agent . we report the case of a patient with long standing moderate to severe psoriasis who developed acute hepatitis c while being treated with etanercept . biologic therapy was continued and the infection was successfully treated with pegylated interferon which achieved a sustained virologic response . etanercept did not have a negative impact on disease outcome or on response to antiviral 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>

synergistic anti tumor effects of zoledronic acid and radiotherapy against metastatic hepatocellular carcinoma . a 72 year old man with advanced hepatocellular carcinoma and decompensated hepatitis c virus related cirrhosis suffered from a metastatic femoral fracture . after undergoing radiotherapy he was only treated with supportive care except for the administration of zoledronic acid za . thereafter the initially elevated serum fetoprotein and des gamma carboxyprothrombin levels declined to within the normal ranges . hepatic and metastatic adrenal tumors distant from the radiation field exhibited a surprising regression . za is known to inhibit the activity of osteoclasts bone residential macrophages and has been reported to have a direct anti tumor effect . za may adjust the immunological milieu in tumor microenvironments by inhibiting the tumor associated macrophages . because radiotherapy can enhance the presentation of tumor associated antigens za and radiotherapy may exert synergistic anti tumor effects .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: synergistic anti tumor effects of zoledronic acid and radiotherapy against metastatic hepatocellular carcinoma . a 72 year old man with advanced hepatocellular carcinoma and decompensated hepatitis c virus related cirrhosis suffered from a metastatic femoral fracture . after undergoing radiotherapy he was only treated with supportive care except for the administration of zoledronic acid za . thereafter the initially elevated serum fetoprotein and des gamma carboxyprothrombin levels declined to within the normal ranges . hepatic and metastatic adrenal tumors distant from the radiation field exhibited a surprising regression . za is known to inhibit the activity of osteoclasts bone residential macrophages and has been reported to have a direct anti tumor effect . za may adjust the immunological milieu in tumor microenvironments by inhibiting the tumor associated macrophages . because radiotherapy can enhance the presentation of tumor associated antigens za and radiotherapy may exert synergistic anti tumor effects . 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>

serum amyloid a positive hepatocellular neoplasms in the resected livers from 3 patients with alcoholic cirrhosis . twelve hepatocellular nodules were characterized in the resected livers from 3 patients 2 men and a woman with alcoholic cirrhosis . imaging techniques suggested that the nodules were hypervascular and may be hepatocellular carcinoma . five nodules 4 31 mm in diameter were serum amyloid a positive hepatocellular neoplasm which shares features with inflammatory hepatocellular adenoma . the remaining 7 nodules 5 8 mm were focal nodular hyperplasia like nodules showing focal or no immunostaining for serum amyloid
the serum amyloid a positive hepatocellular neoplasms showed increased cellular density inflammatory infiltrate sinusoidal dilatation and ductular reaction to various degrees . these histologic features tended to be less extensive in focal nodular hyperplasia like nodules . three of 4 serum amyloid a positive hepatocellular neoplasms showed slight hypointensity in the hepatobiliary phase on the magnetic resonance mr imaging with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid gd eob dtpa enhancement . in contrast 3 focal nodular hyperplasia like nodules showed iso intensity in the hepatobiliary phase . this study further confirms characteristics of serum amyloid a positive hepatocellular neoplasm arising in alcoholic cirrhosis that share features with inflammatory hepatocellular adenomas . serum amyloid a positive hepatocellular neoplasms sometimes co exist with focal nodular hyperplasia like nodules and may show different findings on gd eob enhanced mr imaging .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: serum amyloid a positive hepatocellular neoplasms in the resected livers from 3 patients with alcoholic cirrhosis . twelve hepatocellular nodules were characterized in the resected livers from 3 patients 2 men and a woman with alcoholic cirrhosis . imaging techniques suggested that the nodules were hypervascular and may be hepatocellular carcinoma . five nodules 4 31 mm in diameter were serum amyloid a positive hepatocellular neoplasm which shares features with inflammatory hepatocellular adenoma . the remaining 7 nodules 5 8 mm were focal nodular hyperplasia like nodules showing focal or no immunostaining for serum amyloid
the serum amyloid a positive hepatocellular neoplasms showed increased cellular density inflammatory infiltrate sinusoidal dilatation and ductular reaction to various degrees . these histologic features tended to be less extensive in focal nodular hyperplasia like nodules . three of 4 serum amyloid a positive hepatocellular neoplasms showed slight hypointensity in the hepatobiliary phase on the magnetic resonance mr imaging with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid gd eob dtpa enhancement . in contrast 3 focal nodular hyperplasia like nodules showed iso intensity in the hepatobiliary phase . this study further confirms characteristics of serum amyloid a positive hepatocellular neoplasm arising in alcoholic cirrhosis that share features with inflammatory hepatocellular adenomas . serum amyloid a positive hepatocellular neoplasms sometimes co exist with focal nodular hyperplasia like nodules and may show different findings on gd eob enhanced mr imaging . 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>

virus associated haemophagocytic lymphohistiocytosis in a young filipino man . haemophagocytic lymphohistiocytosis hlh is a rare syndrome of pathological immune activation characterised by extreme inflammation . we present a case of a young filipino man consulting for non specific symptoms of fever body malaise and weight loss . prominent physical examination findings included gross pallor cachexia and hepatosplenomegaly . laboratory results revealed pancytopaenia while bone marrow examination revealed haemophagocytosis . further workup for hlh showed hypertriglyceridaemia hypofibrinogenaemia and hyperferritinaemia fulfilling 6 of 8 diagnostic criteria . exhaustive serological and haematological examinations showed chronic hepatitis b virus infection and past evidence of epstein barr virus infection as possible triggers . the patient was started on antiviral therapy high dose steroids and chemotherapy . he initially improved but eventually succumbed to severe fungal sepsis and pulmonary haemorrhage . an autopsy confirmed the diagnosis of hlh .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: virus associated haemophagocytic lymphohistiocytosis in a young filipino man . haemophagocytic lymphohistiocytosis hlh is a rare syndrome of pathological immune activation characterised by extreme inflammation . we present a case of a young filipino man consulting for non specific symptoms of fever body malaise and weight loss . prominent physical examination findings included gross pallor cachexia and hepatosplenomegaly . laboratory results revealed pancytopaenia while bone marrow examination revealed haemophagocytosis . further workup for hlh showed hypertriglyceridaemia hypofibrinogenaemia and hyperferritinaemia fulfilling 6 of 8 diagnostic criteria . exhaustive serological and haematological examinations showed chronic hepatitis b virus infection and past evidence of epstein barr virus infection as possible triggers . the patient was started on antiviral therapy high dose steroids and chemotherapy . he initially improved but eventually succumbed to severe fungal sepsis and pulmonary haemorrhage . an autopsy confirmed the diagnosis of hlh . 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 fulminant hepatitis e virus genotype
 infection description of the first case in europe . hepatitis e virus hev is the most important causative agent of acute hepatitis in developing countries . the disease is usually characterized by a self limiting benign course . however when particular conditions coexist pregnancy old age pre existing liver disease it may run an unfavourable course . to date 4 hev genotypes have been described . historically in the western world hev infection was considered a travel related disease however in the last 2 decades a great number of non travel related autochthonous cases have been described more often related to genotype 3 or 4 and in the context of zoonosis . we report the case of an elderly italian man with an acute fulminant hev infection genotype
 that developed in the context of pre existing liver disease this is the first case of an unfavourable outcome associated with subgenotype
 . the potential pathogenicity of this subgenotype together with the influence of host related risk factors are discussed .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: acute fulminant hepatitis e virus genotype
 infection description of the first case in europe . hepatitis e virus hev is the most important causative agent of acute hepatitis in developing countries . the disease is usually characterized by a self limiting benign course . however when particular conditions coexist pregnancy old age pre existing liver disease it may run an unfavourable course . to date 4 hev genotypes have been described . historically in the western world hev infection was considered a travel related disease however in the last 2 decades a great number of non travel related autochthonous cases have been described more often related to genotype 3 or 4 and in the context of zoonosis . we report the case of an elderly italian man with an acute fulminant hev infection genotype
 that developed in the context of pre existing liver disease this is the first case of an unfavourable outcome associated with subgenotype
 . the potential pathogenicity of this subgenotype together with the influence of host related risk factors 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: 1 </s>

an integrated approach to worker self management and health outcomes chronic conditions evidence based practice and health coaching . employee health prevention and maintenance programs are growing exponentially each year as costs continue to rise across the health care continuum . employers and payers alike continue to be challenged by chronic health risks effective prevention strategies optimal health and wellness strategies and programs that are effective for america work force . in light of these challenges new and exciting health management approaches are evolving . changes in occupational health nursing practice can ultimately affect the way occupational health nurses plan structure and conduct education sessions . new trends such as health coaching embrace the incorporation of health research through evidence based practice and standards of care to provide the science clinicians need to support interventions . through knowledge of chronic conditions evidence based practice and health coaching occupational health nurses possess the skills and strategies that form the foundation necessary to affect and safely guide employee self discovery and self management and produce optimal health outcomes .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: an integrated approach to worker self management and health outcomes chronic conditions evidence based practice and health coaching . employee health prevention and maintenance programs are growing exponentially each year as costs continue to rise across the health care continuum . employers and payers alike continue to be challenged by chronic health risks effective prevention strategies optimal health and wellness strategies and programs that are effective for america work force . in light of these challenges new and exciting health management approaches are evolving . changes in occupational health nursing practice can ultimately affect the way occupational health nurses plan structure and conduct education sessions . new trends such as health coaching embrace the incorporation of health research through evidence based practice and standards of care to provide the science clinicians need to support interventions . through knowledge of chronic conditions evidence based practice and health coaching occupational health nurses possess the skills and strategies that form the foundation necessary to affect and safely guide employee self discovery and self management and produce optimal health outcomes . 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 mixed cryoglobulinemia despite sustained virologic response to treatment a case report . cryoglobulinemia is a manifestation of hepatitis c virus hcv infection . treatment of hcv is the mainstay of therapy for mixed cryoglobulinemia syndrome and newer hcv therapies with direct acting antiviral agents have achieved great success in treating hcv infection compared with pegylated interferon alfa and ribavirin . recurrence of mixed cryoglobulinemia syndrome following successful treatment with direct acting antiviral agents is uncommon and when it occurs it is most often due to relapse of hcv viremia . we report a case of recurrent mixed cryoglobulinemia syndrome following hcv treatment with a new direct acting antiviral agent sofosbuvir and ribavirin in which hcv rna was undetectable in serum but detectable in the cryoprecipitate .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: recurrent mixed cryoglobulinemia despite sustained virologic response to treatment a case report . cryoglobulinemia is a manifestation of hepatitis c virus hcv infection . treatment of hcv is the mainstay of therapy for mixed cryoglobulinemia syndrome and newer hcv therapies with direct acting antiviral agents have achieved great success in treating hcv infection compared with pegylated interferon alfa and ribavirin . recurrence of mixed cryoglobulinemia syndrome following successful treatment with direct acting antiviral agents is uncommon and when it occurs it is most often due to relapse of hcv viremia . we report a case of recurrent mixed cryoglobulinemia syndrome following hcv treatment with a new direct acting antiviral agent sofosbuvir and ribavirin in which hcv rna was undetectable in serum but detectable in the cryoprecipitate . 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>

not all infantile respiratory distress in winter is bronchiolitis congenital lobar emphysema . the authors report the case of a 4 week old male infant presented during the winter period with respiratory distress . he had a 3 day history of cough and coryza and a 2 day history of breathlessness and reduced feeding . he had evidence of tachypnoea subcostal recession and hypoxia on examination . an initial diagnosis of bronchiolitis was made . the authors explore how the correct diagnosis of congenital lobar emphysema cle was reached highlighting key clinical signs and investigations . he had evidence of a hyperinflated right middle lobe with collapse of right upper and lower lobes and left upper lobe with associated mediastinal shift on chest x ray cxr and ct scan . he was referred to the regional paediatric cardiothoracic centre where right middle lobectomy was performed with complete resolution of his respiratory distress and re expansion of the compressed lobes on cxr . current literature concerning cle is reviewed .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: not all infantile respiratory distress in winter is bronchiolitis congenital lobar emphysema . the authors report the case of a 4 week old male infant presented during the winter period with respiratory distress . he had a 3 day history of cough and coryza and a 2 day history of breathlessness and reduced feeding . he had evidence of tachypnoea subcostal recession and hypoxia on examination . an initial diagnosis of bronchiolitis was made . the authors explore how the correct diagnosis of congenital lobar emphysema cle was reached highlighting key clinical signs and investigations . he had evidence of a hyperinflated right middle lobe with collapse of right upper and lower lobes and left upper lobe with associated mediastinal shift on chest x ray cxr and ct scan . he was referred to the regional paediatric cardiothoracic centre where right middle lobectomy was performed with complete resolution of his respiratory distress and re expansion of the compressed lobes on cxr . current literature concerning cle 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>

autoimmune hepatitis trust in transaminases . a rational and appropriate evaluation of liver biochemical tests is essential given the increased number of abnormal laboratory results in asymptomatic patients . critical judgement allows early diagnosis in the absence of typical clinical signs . autoimmune hepatitis is a rare disease with high clinical variability . we present a child investigated for unexplained increase in aminotransferases discovered accidentally 2 months earlier in a standard laboratory panel approach . she was asymptomatic and no physical signs of chronic or acute liver disease were found . laboratory investigation showed hypergammaglobulinaemia with selective elevation of igg and a positive anti liver cytosol type 1 . severe interface hepatitis was found on liver biopsy and treatment was initiated with steroids and azathioprine with good response . this case highlights the importance of trusting in any serum aminotransferase abnormality even in asymptomatic children and emphasises the value of clinical suspicion and specific immunosuppressive therapy in prognosis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: autoimmune hepatitis trust in transaminases . a rational and appropriate evaluation of liver biochemical tests is essential given the increased number of abnormal laboratory results in asymptomatic patients . critical judgement allows early diagnosis in the absence of typical clinical signs . autoimmune hepatitis is a rare disease with high clinical variability . we present a child investigated for unexplained increase in aminotransferases discovered accidentally 2 months earlier in a standard laboratory panel approach . she was asymptomatic and no physical signs of chronic or acute liver disease were found . laboratory investigation showed hypergammaglobulinaemia with selective elevation of igg and a positive anti liver cytosol type 1 . severe interface hepatitis was found on liver biopsy and treatment was initiated with steroids and azathioprine with good response . this case highlights the importance of trusting in any serum aminotransferase abnormality even in asymptomatic children and emphasises the value of clinical suspicion and specific immunosuppressive therapy in 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: 1 </s>

developed diplopia due to a pituitary macroadenoma during pregnancy . physiologic pituitary enlargement is common during normal pregnancy . however symptoms such as diplopia blurred vision and headache resulting from physiologic pituitary enlargement are very rare during pregnancy . a 43 year old woman complained of sudden headache and left eye ptosis at 3
h weeks of gestation . an magnetic resonance imaging mri demonstrated the pituitary enlargement and a macroadenoma without a compressing of the optic chiasm but with an extension to the left cavernous sinus . 48 hours after the prescription of the bromocriptine we had a spectacular evolution with disappearance of the headache and a total regression of the ptosis . we report a case of visual loss due to the physiologic pituitary enlargement or to the macroadenoma during pregnancy which regressed after the prescription of bromocroptine .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: developed diplopia due to a pituitary macroadenoma during pregnancy . physiologic pituitary enlargement is common during normal pregnancy . however symptoms such as diplopia blurred vision and headache resulting from physiologic pituitary enlargement are very rare during pregnancy . a 43 year old woman complained of sudden headache and left eye ptosis at 3
h weeks of gestation . an magnetic resonance imaging mri demonstrated the pituitary enlargement and a macroadenoma without a compressing of the optic chiasm but with an extension to the left cavernous sinus . 48 hours after the prescription of the bromocriptine we had a spectacular evolution with disappearance of the headache and a total regression of the ptosis . we report a case of visual loss due to the physiologic pituitary enlargement or to the macroadenoma during pregnancy which regressed after the prescription of bromocroptine . 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>

autoimmune hepatitis primary biliary cirrhosis concurrent with biliary stricture after liver transplantation . although the development of de novo autoimmune liver disease after liver transplantation lt has been described in both children and adults autoimmune hepatitis aih primary biliary cirrhosis pbc overlap syndrome has rarely been seen in liver transplant recipients . here we report a 50 year old man who underwent lt for decompensated liver disease secondary to alcoholic steatohepatitis . his liver function tests became markedly abnormal 8 years after lt . standard autoimmune serological tests were positive for anti nuclear and anti mitochondrial antibodies and a marked biochemical response was observed to a regimen consisting of prednisone and ursodeoxycholic acid added to maintain immunosuppressant tacrolimus . liver biopsy showed moderate bile duct lesions and periportal lymphocytes infiltrating along with light fibrosis which confirmed the diagnosis of aih pbc overlap syndrome . we believe that this may be a case of post lt de novo aih pbc overlap syndrome a novel type of autoimmune overlap syndrome .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: autoimmune hepatitis primary biliary cirrhosis concurrent with biliary stricture after liver transplantation . although the development of de novo autoimmune liver disease after liver transplantation lt has been described in both children and adults autoimmune hepatitis aih primary biliary cirrhosis pbc overlap syndrome has rarely been seen in liver transplant recipients . here we report a 50 year old man who underwent lt for decompensated liver disease secondary to alcoholic steatohepatitis . his liver function tests became markedly abnormal 8 years after lt . standard autoimmune serological tests were positive for anti nuclear and anti mitochondrial antibodies and a marked biochemical response was observed to a regimen consisting of prednisone and ursodeoxycholic acid added to maintain immunosuppressant tacrolimus . liver biopsy showed moderate bile duct lesions and periportal lymphocytes infiltrating along with light fibrosis which confirmed the diagnosis of aih pbc overlap syndrome . we believe that this may be a case of post lt de novo aih pbc overlap syndrome a novel type of autoimmune overlap syndrome . 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>

use of sofosbuvir based direct acting antiviral therapy for hepatitis c viral infection in patients with severe renal insufficiency . sofosbuvir based direct acting antiviral therapy revolutionized the treatment of hepatitis c virus hcv infection . however sofosbuvir use is not approved for patients with severe renal insufficiency estimated glomerular filtration egfr rate below 30 ml min or end stage renal disease esrd based on concerns raised during premarket animal testing over hepatobiliary and cardiovascular toxicity in this population . we report the first published data on use of sofosbuvir based regimens in patients with severe renal insufficiency and esrd focusing on clinical efficacy and safety . six patients were treated with full dose sofosbuvir three received sofosbuvir and simeprevir two received sofosbuvir and ribavirin and one received sofosbuvir ribavirin and interferon . three of the patients had cirrhosis . on treatment viral suppression was _lgnum_ and sustained virological response svr rate at 12 weeks was 67 . one patient had to discontinue antiviral therapy early due to side effects . no hepatobiliary or cardiovascular toxicity was reported .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: use of sofosbuvir based direct acting antiviral therapy for hepatitis c viral infection in patients with severe renal insufficiency . sofosbuvir based direct acting antiviral therapy revolutionized the treatment of hepatitis c virus hcv infection . however sofosbuvir use is not approved for patients with severe renal insufficiency estimated glomerular filtration egfr rate below 30 ml min or end stage renal disease esrd based on concerns raised during premarket animal testing over hepatobiliary and cardiovascular toxicity in this population . we report the first published data on use of sofosbuvir based regimens in patients with severe renal insufficiency and esrd focusing on clinical efficacy and safety . six patients were treated with full dose sofosbuvir three received sofosbuvir and simeprevir two received sofosbuvir and ribavirin and one received sofosbuvir ribavirin and interferon . three of the patients had cirrhosis . on treatment viral suppression was _lgnum_ and sustained virological response svr rate at 12 weeks was 67 . one patient had to discontinue antiviral therapy early due to side effects . no hepatobiliary or cardiovascular toxicity was reported . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

extreme hypercholesterolemia presenting with pseudohyponatremia a case report and review of the literature . pseudohyponatremia has been reported in association with severe hypertriglyceridemia and hyperparaproteinemia but its association with severe hypercholesterolemia is not well known . we report a 43 year old woman with refractory primary biliary cirrhosis who presented with asymptomatic hyponatremia _lgnum_ mmol l normal range _lgnum_ _lgnum_ mmol l . she was ultimately found to have a total serum cholesterol level of _lgnum_ mg dl normal range _lgnum_ _lgnum_ mg dl secondary to accumulation of lipoprotein x causing pseudohyponatremia . the diagnosis was confirmed by measurement of serum osmolality _lgnum_ mosm kg h
 normal range _lgnum_ _lgnum_ mosm kg h
 and serum sodium by direct potentiometry _lgnum_ mmol l . furthermore following 16 sessions of plasmapheresis over a 4 month period there was marked lowering of serum cholesterol to _lgnum_ mg dl and normalization of serum sodium _lgnum_ mmol l as measured by indirect potentiometry . this case shows that extreme hypercholesterolemia from elevation of lipoprotein x particles in cholestasis can be a rare cause of pseudohyponatremia . it highlights the need to measure serum sodium with direct potentiometry in the setting of extreme hypercholesterolemia and consider this possibility before initiating treatment of hyponatremia .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: extreme hypercholesterolemia presenting with pseudohyponatremia a case report and review of the literature . pseudohyponatremia has been reported in association with severe hypertriglyceridemia and hyperparaproteinemia but its association with severe hypercholesterolemia is not well known . we report a 43 year old woman with refractory primary biliary cirrhosis who presented with asymptomatic hyponatremia _lgnum_ mmol l normal range _lgnum_ _lgnum_ mmol l . she was ultimately found to have a total serum cholesterol level of _lgnum_ mg dl normal range _lgnum_ _lgnum_ mg dl secondary to accumulation of lipoprotein x causing pseudohyponatremia . the diagnosis was confirmed by measurement of serum osmolality _lgnum_ mosm kg h
 normal range _lgnum_ _lgnum_ mosm kg h
 and serum sodium by direct potentiometry _lgnum_ mmol l . furthermore following 16 sessions of plasmapheresis over a 4 month period there was marked lowering of serum cholesterol to _lgnum_ mg dl and normalization of serum sodium _lgnum_ mmol l as measured by indirect potentiometry . this case shows that extreme hypercholesterolemia from elevation of lipoprotein x particles in cholestasis can be a rare cause of pseudohyponatremia . it highlights the need to measure serum sodium with direct potentiometry in the setting of extreme hypercholesterolemia and consider this possibility before initiating treatment of hyponatremia . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

the role of hepatitis e virus infection in adult americans with acute liver failure . acute hepatitis e virus hev infection is a leading cause of acute liver failure alf in many developing countries yet rarely identified in western countries . given that antibody testing for hev infection is not routinely obtained we hypothesized that hev related alf might be present and unrecognized in north american alf patients . serum samples of _lgnum_ adults enrolled in the

acute liver failure study group were tested for anti hev immunoglobulin ig m and anti hev igg levels . subjects with a detectable anti hev igm also underwent testing for hev rna . mean patient age was _decnum_ years _decnum_ were male and alf etiologies included acetaminophen apap hepatotoxicity 29 indeterminate alf 23 idiosyncratic drug induced liver injury dili 22 acute hepatitis b virus infection 12 autoimmune hepatitis 12 and pregnancy related alf 2 . three men ages 36 39 and 70 demonstrated repeatedly detectable anti hev igm but all were hev rna negative and had other putative diagnoses . the latter 2 subjects died within 3 and 11 days of enrollment whereas the 36 year old underwent emergency liver transplantation on study day 2 . at admission _lgnum_ _decnum_ of the alf patients were anti hev igg positive with the seroprevalence being highest in those from the midwest 50 and lowest in those from the southeast 28 . anti hev igg subjects were significantly older less likely to have apap overdose and had a lower overall 3 week survival compared to anti hev igg subjects 63
70 p _decnum_ . acute hev infection is very rare in adult americans with alf

_decnum_ and could not be implicated in any indeterminate autoimmune or pregnancy related alf cases . past exposure to hev with detectable anti hev igg was significantly more common in the alf patients compared to the general

abstracttext acute hev infection is very rare in adult americans with alf

_decnum_ and could not be implicated in any indeterminate autoimmune or pregnancy related alf cases . past exposure to hev with detectable anti hev igg was significantly more common in the alf patients compared to the general

.

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: the role of hepatitis e virus infection in adult americans with acute liver failure . acute hepatitis e virus hev infection is a leading cause of acute liver failure alf in many developing countries yet rarely identified in western countries . given that antibody testing for hev infection is not routinely obtained we hypothesized that hev related alf might be present and unrecognized in north american alf patients . serum samples of _lgnum_ adults enrolled in the

acute liver failure study group were tested for anti hev immunoglobulin ig m and anti hev igg levels . subjects with a detectable anti hev igm also underwent testing for hev rna . mean patient age was _decnum_ years _decnum_ were male and alf etiologies included acetaminophen apap hepatotoxicity 29 indeterminate alf 23 idiosyncratic drug induced liver injury dili 22 acute hepatitis b virus infection 12 autoimmune hepatitis 12 and pregnancy related alf 2 . three men ages 36 39 and 70 demonstrated repeatedly detectable anti hev igm but all were hev rna negative and had other putative diagnoses . the latter 2 subjects died within 3 and 11 days of enrollment whereas the 36 year old underwent emergency liver transplantation on study day 2 . at admission _lgnum_ _decnum_ of the alf patients were anti hev igg positive with the seroprevalence being highest in those from the midwest 50 and lowest in those from the southeast 28 . anti hev igg subjects were significantly older less likely to have apap overdose and had a lower overall 3 week survival compared to anti hev igg subjects 63
70 p _decnum_ . acute hev infection is very rare in adult americans with alf

_decnum_ and could not be implicated in any indeterminate autoimmune or pregnancy related alf cases . past exposure to hev with detectable anti hev igg was significantly more common in the alf patients compared to the general

abstracttext acute hev infection is very rare in adult americans with alf

_decnum_ and could not be implicated in any indeterminate autoimmune or pregnancy related alf cases . past exposure to hev with detectable anti hev igg was significantly more common in the alf patients compared to the general

. Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

a domestic human case of hepatitis e in finland . we describe the first verified domestic hev case in a previously healthy 53 year old man who presented a three day history of upper stomach pain nausea fever arthralgia and fatigue . at the first phase laboratory tests revealed high levels of ast and alt and at the second phase high levels of bilirubin . serum was positive for anti hev igm and for hev rna confirming the diagnosis of acute hepatitis
the hev was genotype 3 . jaundice resolved in three months . in nonendemic areas autochthonous hepatitis e is more common than previously recognized and is possible in patients with acute hepatitis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: a domestic human case of hepatitis e in finland . we describe the first verified domestic hev case in a previously healthy 53 year old man who presented a three day history of upper stomach pain nausea fever arthralgia and fatigue . at the first phase laboratory tests revealed high levels of ast and alt and at the second phase high levels of bilirubin . serum was positive for anti hev igm and for hev rna confirming the diagnosis of acute hepatitis
the hev was genotype 3 . jaundice resolved in three months . in nonendemic areas autochthonous hepatitis e is more common than previously recognized and is possible in patients 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>

acute portal vein thrombosis precipitated by indomethacin in a hcv positive elderly patient . background an increased risk of venous thromboembolism has been reported in patients treated with non steroidal anti inflammatory drugs nsaids . we describe a case of acute portal vein thrombosis pvt in a hepatitis c virus hcv positive elderly patient following administration of indomethacin . case presentation a 79 year old hcv positive man was hospitalized for severe abdominal pain nausea and vomiting 15 days after starting indomethacin for back pain . clinical signs and imaging evaluations disclosed a picture of pvt . indomethacin was discontinued and the patient was started on fondaparinux and antithrombin . he was discharged 15 days later due to improvement of his clinical conditions . thirty days later a follow up ultrasound did not show appreciable signs of pvt . the time elapsing between the start of analgesic therapy and pvt onset suggests a role of indomethacin as the triggering agent . indomethacin could have precipitated pvt by a combination of at least two detrimental mechanisms 1 direct action on liver vascular endothelium by inhibition of prostacyclin biosynthesis 2 damage to the intestinal mucosa followed by inflammatory and pro coagulant activation of portal endothelium upon exposure to bacterial endotoxins . conclusions this case can be of interest to physicians who should exert caution when prescribing nsaids for inflammatory pain in patients with background inflammatory dysfunctions of the portal vein endothelium .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: acute portal vein thrombosis precipitated by indomethacin in a hcv positive elderly patient . background an increased risk of venous thromboembolism has been reported in patients treated with non steroidal anti inflammatory drugs nsaids . we describe a case of acute portal vein thrombosis pvt in a hepatitis c virus hcv positive elderly patient following administration of indomethacin . case presentation a 79 year old hcv positive man was hospitalized for severe abdominal pain nausea and vomiting 15 days after starting indomethacin for back pain . clinical signs and imaging evaluations disclosed a picture of pvt . indomethacin was discontinued and the patient was started on fondaparinux and antithrombin . he was discharged 15 days later due to improvement of his clinical conditions . thirty days later a follow up ultrasound did not show appreciable signs of pvt . the time elapsing between the start of analgesic therapy and pvt onset suggests a role of indomethacin as the triggering agent . indomethacin could have precipitated pvt by a combination of at least two detrimental mechanisms 1 direct action on liver vascular endothelium by inhibition of prostacyclin biosynthesis 2 damage to the intestinal mucosa followed by inflammatory and pro coagulant activation of portal endothelium upon exposure to bacterial endotoxins . conclusions this case can be of interest to physicians who should exert caution when prescribing nsaids for inflammatory pain in patients with background inflammatory dysfunctions of the portal vein endothelium . 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>

direct acting antivirals and hepatitis b virus hbv reactivation in co infected hbv hcv kidney transplant recipients . direct acting agents daas are highly efficient at treating hepatitis c virus hcv infections after kidney transplantation . although drug agencies have recently warned of the risk of hepatitis b virus hbv reactivation after patients have received daas reports have discrepant results in hbsag positive and hbsag negative patients . we report on 3 cases of hbv reactivation that were detected after achieving a daa associated sustained virological response in 3 kidney transplant recipients initially hbsag negative . in the first case retrospective virological analysis revealed that hbsags had become positive and hbv dna was detectable before initiating daa therapy . in the second and third cases hbv reactivation occurred 2 months and more than 1 year after stopping anti hcv therapy . these cases underline the discrepancies and highlight the need for comprehensive information before making definitive conclusions regarding the causal link between daas and hbv reactivation .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: direct acting antivirals and hepatitis b virus hbv reactivation in co infected hbv hcv kidney transplant recipients . direct acting agents daas are highly efficient at treating hepatitis c virus hcv infections after kidney transplantation . although drug agencies have recently warned of the risk of hepatitis b virus hbv reactivation after patients have received daas reports have discrepant results in hbsag positive and hbsag negative patients . we report on 3 cases of hbv reactivation that were detected after achieving a daa associated sustained virological response in 3 kidney transplant recipients initially hbsag negative . in the first case retrospective virological analysis revealed that hbsags had become positive and hbv dna was detectable before initiating daa therapy . in the second and third cases hbv reactivation occurred 2 months and more than 1 year after stopping anti hcv therapy . these cases underline the discrepancies and highlight the need for comprehensive information before making definitive conclusions regarding the causal link between daas and hbv reactivation . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

hepatitis e virus infection after platelet transfusion in an immunocompetent trauma patient . hepatitis e virus hev infection causes acute liver disease but severe infections are rare in immunocompetent patients . we describe a case of hev infection in a previously healthy male trauma patient in france who received massive transfusions . genotyping confirmed hev in a transfused platelet pool and the donor .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: hepatitis e virus infection after platelet transfusion in an immunocompetent trauma patient . hepatitis e virus hev infection causes acute liver disease but severe infections are rare in immunocompetent patients . we describe a case of hev infection in a previously healthy male trauma patient in france who received massive transfusions . genotyping confirmed hev in a transfused platelet pool and the donor . 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>

hbv reactivation in an occult hbv infection patient treated with prednisone for nephrotic syndrome case report and literature review . background reactivation of hepatitis b virus hbv characterized by increased levels of serum hbv dna abnormal liver function and hepatic failure is a frequent complication of immunosuppressive therapy and chemotherapy in patients with hbv infection . however reactivation of occult hbv infection with immunosuppressive therapy or chemotherapy is rare . case presentation a 77 year old man was diagnosed with nephrotic syndrome and igm nephropathy with unclear pathogenesis . liver function was normal hbv related serum markers were negative and hbv dna titer was below the upper limits of normal . two months following the start of prednisone therapy for his nephrotic syndrome laboratory tests revealed a substantial increase in serum transaminase levels alt _lgnum_ iu l ast _lgnum_ iu l and an elevation of hbv dna level _decnum_ 6 copies ml . we tested stored kidney tissue for hbsag and hbcag using immunohistochemistry and found the sample to be hbcag positive allowing us to confirm the etiology of nephropathy as an occult hbv infection . the cause of the hepatitis was thought to be hbv reactivation so we immediately administered lamivudine . one month after the initiation of daily lamivudine treatment laboratory tests revealed that serum levels of transaminases had improved alt 35 iu l ast 17 iu l . patient examination one year later showed that hbeag had decreased with a concomitant increase of hbeab the quantity of hbv dna was undetectable and liver function and renal function had stabilized . conclusion this is the first report describing hbv reactivation in an occult hbv infection patient treated with oral prednisone for nephrotic syndrome . hbv associated antigen should be regularly tested for in patients with unknown etiological glomerulonephritis in areas with high hbv viral popular and even in those with no clinical evidence for diagnosis of hbv .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: hbv reactivation in an occult hbv infection patient treated with prednisone for nephrotic syndrome case report and literature review . background reactivation of hepatitis b virus hbv characterized by increased levels of serum hbv dna abnormal liver function and hepatic failure is a frequent complication of immunosuppressive therapy and chemotherapy in patients with hbv infection . however reactivation of occult hbv infection with immunosuppressive therapy or chemotherapy is rare . case presentation a 77 year old man was diagnosed with nephrotic syndrome and igm nephropathy with unclear pathogenesis . liver function was normal hbv related serum markers were negative and hbv dna titer was below the upper limits of normal . two months following the start of prednisone therapy for his nephrotic syndrome laboratory tests revealed a substantial increase in serum transaminase levels alt _lgnum_ iu l ast _lgnum_ iu l and an elevation of hbv dna level _decnum_ 6 copies ml . we tested stored kidney tissue for hbsag and hbcag using immunohistochemistry and found the sample to be hbcag positive allowing us to confirm the etiology of nephropathy as an occult hbv infection . the cause of the hepatitis was thought to be hbv reactivation so we immediately administered lamivudine . one month after the initiation of daily lamivudine treatment laboratory tests revealed that serum levels of transaminases had improved alt 35 iu l ast 17 iu l . patient examination one year later showed that hbeag had decreased with a concomitant increase of hbeab the quantity of hbv dna was undetectable and liver function and renal function had stabilized . conclusion this is the first report describing hbv reactivation in an occult hbv infection patient treated with oral prednisone for nephrotic syndrome . hbv associated antigen should be regularly tested for in patients with unknown etiological glomerulonephritis in areas with high hbv viral popular and even in those with no clinical evidence for diagnosis of hbv . 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>

removal of tracheobronchial foreign bodies via suspension laryngoscope and hopkins telescope in infants . objectives tracheobronchial foreign body aspiration is a life threatening accident in infants and is still a formidable clinical emergency to both otorhinolaryngologists and anesthesiologists . in this study we attempted to assess the safety and ease of tracheobronchial foreign body removal in infants via suspension laryngoscopy and hopkins telescopy under general anesthesia with endotracheal intubation . methods the retrospective clinical study from _lgnum_ to _lgnum_ included 50 infants with foreign body aspiration of whom 35 underwent suspension laryngoscopy and hopkins telescopy and the other 15 underwent rigid bronchoscopy . all of the procedures were under general anesthesia with endotracheal intubation . results all of the patients underwent temporary extubation . the foreign body was successfully removed in 46 cases and was not found in the other 4 cases . the mean operation time in the rigid bronchoscopy group was _decnum_ _decnum_ minutes and that in the hopkins telescopy group was _decnum_ _decnum_ minutes . the oxygen saturation level was below 90 in 17 cases of which 7 were in the rigid bronchoscopy group and 10 were in the hopkins telescopy group . the vital signs including the partial pressure of carbon dioxide in expiratory gas and the heart rate were stable in all cases . conclusions foreign body removal in infants via suspension laryngoscopy and hopkins telescopy under general anesthesia with endotracheal intubation should be promoted since it is relatively safe and easy for both anesthesiologists and otorhinolaryngologists to perform and has a remarkable success rate .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: removal of tracheobronchial foreign bodies via suspension laryngoscope and hopkins telescope in infants . objectives tracheobronchial foreign body aspiration is a life threatening accident in infants and is still a formidable clinical emergency to both otorhinolaryngologists and anesthesiologists . in this study we attempted to assess the safety and ease of tracheobronchial foreign body removal in infants via suspension laryngoscopy and hopkins telescopy under general anesthesia with endotracheal intubation . methods the retrospective clinical study from _lgnum_ to _lgnum_ included 50 infants with foreign body aspiration of whom 35 underwent suspension laryngoscopy and hopkins telescopy and the other 15 underwent rigid bronchoscopy . all of the procedures were under general anesthesia with endotracheal intubation . results all of the patients underwent temporary extubation . the foreign body was successfully removed in 46 cases and was not found in the other 4 cases . the mean operation time in the rigid bronchoscopy group was _decnum_ _decnum_ minutes and that in the hopkins telescopy group was _decnum_ _decnum_ minutes . the oxygen saturation level was below 90 in 17 cases of which 7 were in the rigid bronchoscopy group and 10 were in the hopkins telescopy group . the vital signs including the partial pressure of carbon dioxide in expiratory gas and the heart rate were stable in all cases . conclusions foreign body removal in infants via suspension laryngoscopy and hopkins telescopy under general anesthesia with endotracheal intubation should be promoted since it is relatively safe and easy for both anesthesiologists and otorhinolaryngologists to perform and has a remarkable success rate . 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>

low dose cyclosporine a in the treatment of severe atopic dermatitis complicated by chronic hepatitis c virus infection . atopic dermatitis ad is the most frequent chronic inflammatory skin disorder in children and is usually accompanied by genetic and environmental factors . effective management and treatment of ad is challenging and often requires systemic immunosuppressive therapy when refractory to topical treatments . we report a rare association between chronic hepatitis c virus hcv and severe ad management of which required systemic cyclosporine because of its favorable effects on inflammatory and viral related clinical outcomes .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: low dose cyclosporine a in the treatment of severe atopic dermatitis complicated by chronic hepatitis c virus infection . atopic dermatitis ad is the most frequent chronic inflammatory skin disorder in children and is usually accompanied by genetic and environmental factors . effective management and treatment of ad is challenging and often requires systemic immunosuppressive therapy when refractory to topical treatments . we report a rare association between chronic hepatitis c virus hcv and severe ad management of which required systemic cyclosporine because of its favorable effects on inflammatory and viral related clinical outcomes . 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>

cholangiolocellular carcinoma in a young patient who showed sustained virological response after treatment for hepatitis c virus infection . a 35 year old male patient who showed sustained virological response svr following treatment for hepatitis c virus infection developed liver cancer . the lesion was identified by imaging studies with atypical findings suggestive of hepatocellular carcinoma . partial hepatectomy was performed and the histopathological diagnosis was cholangiolocellular carcinoma clc . only a few cases of clc have been described in young patients who achieved svr . hepatologists should recognize the potential development of clc even in young patients who achieve svr and the need for a close follow up by imaging studies . in addition true characteristics and cell origin of clc were discussed in this report .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: cholangiolocellular carcinoma in a young patient who showed sustained virological response after treatment for hepatitis c virus infection . a 35 year old male patient who showed sustained virological response svr following treatment for hepatitis c virus infection developed liver cancer . the lesion was identified by imaging studies with atypical findings suggestive of hepatocellular carcinoma . partial hepatectomy was performed and the histopathological diagnosis was cholangiolocellular carcinoma clc . only a few cases of clc have been described in young patients who achieved svr . hepatologists should recognize the potential development of clc even in young patients who achieve svr and the need for a close follow up by imaging studies . in addition true characteristics and cell origin of clc were discussed in this report . 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>

rivaroxaban postmarketing risk of liver injury . background amp aims rivaroxaban is an oral direct factor xa inhibitor that has been marketed worldwide since _lgnum_ for the primary and secondary prevention and treatment of thromboembolic disorders . although liver injury was observed in premarketing trials of rivaroxaban there are no published postmarketing cases of liver injury associated with rivaroxaban . methods report of 14 cases of liver injury associated with rivaroxaban including two with liver biopsy and search queries in three large international pharmacovigilance databases for comparable cases . results formal causality assessment classified rivaroxaban as the quot highly probable quot quot probable quot and quot possible quot cause in 4 7 and 3 patients respectively . search results from three large international pharmacovigilance databases revealed a considerable number of additional hepatic adverse events where rivaroxaban was reported as a suspected cause . conclusions we interpret the presented information as a relevant safety signal that should be followed by pharmacoepidemiological studies in order to reliably estimate absolute and relative risks of liver injury associated with rivaroxaban in support of rational risk benefit assessment . meanwhile incident symptoms and signs of liver disease in patients treated with rivaroxaban should be considered as a potential adverse drug reaction and if no other likely cause can be identified rivaroxaban should be stopped as soon as possible .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: rivaroxaban postmarketing risk of liver injury . background amp aims rivaroxaban is an oral direct factor xa inhibitor that has been marketed worldwide since _lgnum_ for the primary and secondary prevention and treatment of thromboembolic disorders . although liver injury was observed in premarketing trials of rivaroxaban there are no published postmarketing cases of liver injury associated with rivaroxaban . methods report of 14 cases of liver injury associated with rivaroxaban including two with liver biopsy and search queries in three large international pharmacovigilance databases for comparable cases . results formal causality assessment classified rivaroxaban as the quot highly probable quot quot probable quot and quot possible quot cause in 4 7 and 3 patients respectively . search results from three large international pharmacovigilance databases revealed a considerable number of additional hepatic adverse events where rivaroxaban was reported as a suspected cause . conclusions we interpret the presented information as a relevant safety signal that should be followed by pharmacoepidemiological studies in order to reliably estimate absolute and relative risks of liver injury associated with rivaroxaban in support of rational risk benefit assessment . meanwhile incident symptoms and signs of liver disease in patients treated with rivaroxaban should be considered as a potential adverse drug reaction and if no other likely cause can be identified rivaroxaban should be stopped as soon as possible . 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>

sacrum b cell non hodgkin lymphoma complicating a chronic viral hepatitis c related to a blood exposure a case report . frequency of the association between non hodgkin lymphoma nhl and the hepatitis c virus hcv infection is variable according to previous studies . besides direct and or indirect implication of the hcv infection in the development of nhl is probable but its pathophysiological mechanisms remain unclear . in this report we described the case of a 49 year old patient with a b cell nhl of the sacrum complicating a chronic hcv related to a blood exposure and we report the recent data of this association .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: sacrum b cell non hodgkin lymphoma complicating a chronic viral hepatitis c related to a blood exposure a case report . frequency of the association between non hodgkin lymphoma nhl and the hepatitis c virus hcv infection is variable according to previous studies . besides direct and or indirect implication of the hcv infection in the development of nhl is probable but its pathophysiological mechanisms remain unclear . in this report we described the case of a 49 year old patient with a b cell nhl of the sacrum complicating a chronic hcv related to a blood exposure and we report the recent data of this association . 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>

does this patient with liver disease have cirrhosis context among adult patients with liver disease the ability to identify those most likely to have cirrhosis noninvasively is challenging . objective to identify simple clinical indicators that can exclude or detect cirrhosis in adults with known or suspected liver disease . data sources we searched medline and embase _lgnum_ to december _lgnum_ and reference lists from retrieved articles previous reviews and physical examination textbooks . study selection we retained 86 studies of adequate quality that evaluated the accuracy of clinical findings for identifying histologically proven cirrhosis . data extraction two authors independently abstracted data sensitivity specificity and likelihood ratios lrs and assessed methodological quality . random effects meta analyses were used to calculate summary lrs across studies . results among the 86 studies 1
33 patients were included in this meta analysis among whom _lgnum_ had biopsy proven cirrhosis prevalence rate 24 95 ci 20 28 . many physical examination and simple laboratory tests increase the likelihood of cirrhosis though the presence of ascites lr _decnum_ 95 ci _decnum_ 12 a platelet count lt _lgnum_ x 10 3 l lr _decnum_ 95 ci _decnum_ _decnum_ spider nevi lr _decnum_ 95 ci _decnum_ _decnum_ or a combination of simple laboratory tests with the bonacini cirrhosis discriminant score gt 7 lr _decnum_ 95 ci _decnum_ 37 are the most frequently studied reliable and informative results . for lowering the likelihood of cirrhosis the most useful findings are a lok index lt _decnum_ a score created from the platelet count serum aspartate aminotransferase and alanine aminotransferase and prothrombin international normalized ratio lr _decnum_ 95 ci _decnum_ _decnum_ a platelet count _lgnum_ x 10 3 l lr _decnum_ 95 ci _decnum_ _decnum_ or the absence of hepatomegaly lr _decnum_ 95 ci _decnum_ _decnum_ . the overall impression of the clinician was not as informative as the individual findings or laboratory combinations . conclusions for identifying cirrhosis the presence of a variety of clinical findings or abnormalities in a combination of simple laboratory tests that reflect the underlying pathophysiology increase its likelihood . to exclude cirrhosis combinations of normal laboratory findings are most useful .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: does this patient with liver disease have cirrhosis context among adult patients with liver disease the ability to identify those most likely to have cirrhosis noninvasively is challenging . objective to identify simple clinical indicators that can exclude or detect cirrhosis in adults with known or suspected liver disease . data sources we searched medline and embase _lgnum_ to december _lgnum_ and reference lists from retrieved articles previous reviews and physical examination textbooks . study selection we retained 86 studies of adequate quality that evaluated the accuracy of clinical findings for identifying histologically proven cirrhosis . data extraction two authors independently abstracted data sensitivity specificity and likelihood ratios lrs and assessed methodological quality . random effects meta analyses were used to calculate summary lrs across studies . results among the 86 studies 1
33 patients were included in this meta analysis among whom _lgnum_ had biopsy proven cirrhosis prevalence rate 24 95 ci 20 28 . many physical examination and simple laboratory tests increase the likelihood of cirrhosis though the presence of ascites lr _decnum_ 95 ci _decnum_ 12 a platelet count lt _lgnum_ x 10 3 l lr _decnum_ 95 ci _decnum_ _decnum_ spider nevi lr _decnum_ 95 ci _decnum_ _decnum_ or a combination of simple laboratory tests with the bonacini cirrhosis discriminant score gt 7 lr _decnum_ 95 ci _decnum_ 37 are the most frequently studied reliable and informative results . for lowering the likelihood of cirrhosis the most useful findings are a lok index lt _decnum_ a score created from the platelet count serum aspartate aminotransferase and alanine aminotransferase and prothrombin international normalized ratio lr _decnum_ 95 ci _decnum_ _decnum_ a platelet count _lgnum_ x 10 3 l lr _decnum_ 95 ci _decnum_ _decnum_ or the absence of hepatomegaly lr _decnum_ 95 ci _decnum_ _decnum_ . the overall impression of the clinician was not as informative as the individual findings or laboratory combinations . conclusions for identifying cirrhosis the presence of a variety of clinical findings or abnormalities in a combination of simple laboratory tests that reflect the underlying pathophysiology increase its likelihood . to exclude cirrhosis combinations of normal laboratory findings are most useful . 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>

it not what it looks like atypical rash in cryoglobulinaemic vasculitis . a 48 year old man with a history of intravenous drug use and chronic untreated hepatitis c presented to the emergency room with acute bilateral lower extremity swelling erythema and maculopapular rash . serum c4 levels were low but dermatology felt the rash was due to venous stasis dermatitis . the patient was discharged with compression stockings but returned to the hospital 5 days later with no improvement in his symptoms . a more extensive laboratory workup revealed hepatitis c viral load of 4 million elevated serum cryoglobulins and skin biopsy showing leucocytoclastic vasculitis . he was treated with oral prednisone with complete resolution of his symptoms after 2 weeks . he was scheduled for follow up in gastroenterology clinic for treatment of his hepatitis c for definitive cure of his mixed cryoglobulinaemia but failed to get insurance authorisation to begin treatment with harvoni . he presented to the hospital 4 months later with diffuse alveolar haemorrhage .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: it not what it looks like atypical rash in cryoglobulinaemic vasculitis . a 48 year old man with a history of intravenous drug use and chronic untreated hepatitis c presented to the emergency room with acute bilateral lower extremity swelling erythema and maculopapular rash . serum c4 levels were low but dermatology felt the rash was due to venous stasis dermatitis . the patient was discharged with compression stockings but returned to the hospital 5 days later with no improvement in his symptoms . a more extensive laboratory workup revealed hepatitis c viral load of 4 million elevated serum cryoglobulins and skin biopsy showing leucocytoclastic vasculitis . he was treated with oral prednisone with complete resolution of his symptoms after 2 weeks . he was scheduled for follow up in gastroenterology clinic for treatment of his hepatitis c for definitive cure of his mixed cryoglobulinaemia but failed to get insurance authorisation to begin treatment with harvoni . he presented to the hospital 4 months later with diffuse alveolar haemorrhage . 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>

cirrhosis improvement to alcoholic liver fibrosis after passive abstinence . we present a rare case of long term alcoholic liver disease that progressed from alcoholic liver fibrosis to alcoholic liver cirrhosis and following passive abstinence the patient condition then improved to alcoholic liver fibrosis . a 70 year old japanese man who had consumed large amounts of alcohol since he was 20 years old received a liver biopsy for evaluation of liver dysfunction at the age of 48 in _lgnum_ . the biopsy indicated alcoholic liver fibrosis stage 2 . eight years later a second biopsy indicated alcoholic liver cirrhosis . the patient continued to drink until a cerebral haemorrhage in _lgnum_ led to left hemiparesis . thereafter he had to accept passive abstinence . he then received follow up liver biopsies in _lgnum_ and _lgnum_ both of which indicated improvement of the fibrosis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: cirrhosis improvement to alcoholic liver fibrosis after passive abstinence . we present a rare case of long term alcoholic liver disease that progressed from alcoholic liver fibrosis to alcoholic liver cirrhosis and following passive abstinence the patient condition then improved to alcoholic liver fibrosis . a 70 year old japanese man who had consumed large amounts of alcohol since he was 20 years old received a liver biopsy for evaluation of liver dysfunction at the age of 48 in _lgnum_ . the biopsy indicated alcoholic liver fibrosis stage 2 . eight years later a second biopsy indicated alcoholic liver cirrhosis . the patient continued to drink until a cerebral haemorrhage in _lgnum_ led to left hemiparesis . thereafter he had to accept passive abstinence . he then received follow up liver biopsies in _lgnum_ and _lgnum_ both of which indicated improvement of the 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>

a successful case of liver biopsy via the right femoral vein using the quick core biopsy needle . a 35 year old male with ascites and coagulopathy underwent transjugular liver biopsy tjlb for severe hepatic dysfunction . however the acute angle of the inferior vena cava and hepatic veins hvs prevented insertion of a 14 gauge inner stiffening metallic cannula into the hv . he then underwent successful liver biopsy by right femoral vein access transfemoral liver biopsy using a tjlb device without complications and was pathologically diagnosed with nonalcoholic steatohepatitis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: a successful case of liver biopsy via the right femoral vein using the quick core biopsy needle . a 35 year old male with ascites and coagulopathy underwent transjugular liver biopsy tjlb for severe hepatic dysfunction . however the acute angle of the inferior vena cava and hepatic veins hvs prevented insertion of a 14 gauge inner stiffening metallic cannula into the hv . he then underwent successful liver biopsy by right femoral vein access transfemoral liver biopsy using a tjlb device without complications and was pathologically diagnosed with nonalcoholic steatohepatitis . 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>

late effects of childhood cancer treatment severe hypertriglyceridaemia central obesity non alcoholic fatty liver disease and diabetes as complications of childhood total body irradiation . background childhood cancer survivors may develop a number of endocrine complications linked to organ failure such as hypogonadism diabetes and growth hormone deficiency . however increasing evidence now suggests that total body irradiation treatment specifically is linked with future risk of insulin resistance hepatic steatosis and dyslipidaemia possibly because total body irradiation affects adipocyte differentiation and impairs subcutaneous adipose tissue depot expansion during times of positive energy balance . case report we describe a 20 year old woman who developed pancreatitis with severe hypertriglyceridaemia serum triglycerides gt _lgnum_ mmol l that required plasmapheresis . she had received total body irradiation prior to her bone marrow transplant at age 6 years for relapsed acute lymphoblastic leukaemia . she developed ovarian failure at age 12 years . at age 15 years she was noted to have hyperglycaemia increased blood pressure hepatic steatosis and mild hypertriglyceridaemia . she presented with severe hypertriglyceridaemia and eruptive xanthoma and developed pancreatitis 12 h after admission . she was treated with plasmapheresis and intravenous insulin and made an excellent recovery . we implicate and discuss total body irradiation as the major contributing factor to her severe hypertriglyceridaemia compounded by worsening glycaemic control oestrogen deficiency and a changing adult lifestyle . conclusion children who have received total body irradiation are at risk of diabetes and an exaggerated form of the metabolic syndrome with hypertriglyceridaemia which can be life threatening . we suggest that survivors of total body irradiation treatment require careful lifelong monitoring of their metabolic status .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: late effects of childhood cancer treatment severe hypertriglyceridaemia central obesity non alcoholic fatty liver disease and diabetes as complications of childhood total body irradiation . background childhood cancer survivors may develop a number of endocrine complications linked to organ failure such as hypogonadism diabetes and growth hormone deficiency . however increasing evidence now suggests that total body irradiation treatment specifically is linked with future risk of insulin resistance hepatic steatosis and dyslipidaemia possibly because total body irradiation affects adipocyte differentiation and impairs subcutaneous adipose tissue depot expansion during times of positive energy balance . case report we describe a 20 year old woman who developed pancreatitis with severe hypertriglyceridaemia serum triglycerides gt _lgnum_ mmol l that required plasmapheresis . she had received total body irradiation prior to her bone marrow transplant at age 6 years for relapsed acute lymphoblastic leukaemia . she developed ovarian failure at age 12 years . at age 15 years she was noted to have hyperglycaemia increased blood pressure hepatic steatosis and mild hypertriglyceridaemia . she presented with severe hypertriglyceridaemia and eruptive xanthoma and developed pancreatitis 12 h after admission . she was treated with plasmapheresis and intravenous insulin and made an excellent recovery . we implicate and discuss total body irradiation as the major contributing factor to her severe hypertriglyceridaemia compounded by worsening glycaemic control oestrogen deficiency and a changing adult lifestyle . conclusion children who have received total body irradiation are at risk of diabetes and an exaggerated form of the metabolic syndrome with hypertriglyceridaemia which can be life threatening . we suggest that survivors of total body irradiation treatment require careful lifelong monitoring of their metabolic status . 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>

navigating the benefits and burdens of life saving treatment in severely decompensated cirrhosis an illustrative multisourced narrative . severely decompensated cirrhosis presents major challenges in terms of balancing the benefits and burdens of life extending treatment . using accounts and interviews with a patient her mother consultant hepatologists and a consultant intensivist this article explores the decision making around a 43 year old woman with alcoholic liver disease who died after _lgnum_ days in a hospital . particular focus is given to decisions on escalation recognition of futility distress associated with therapy and how messages given during end of life discussions are processed . without suggesting that the case is an example of ideal practice the importance of frequent multidisciplinary discussion clinical re evaluation and continuity of care is emphasised .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: navigating the benefits and burdens of life saving treatment in severely decompensated cirrhosis an illustrative multisourced narrative . severely decompensated cirrhosis presents major challenges in terms of balancing the benefits and burdens of life extending treatment . using accounts and interviews with a patient her mother consultant hepatologists and a consultant intensivist this article explores the decision making around a 43 year old woman with alcoholic liver disease who died after _lgnum_ days in a hospital . particular focus is given to decisions on escalation recognition of futility distress associated with therapy and how messages given during end of life discussions are processed . without suggesting that the case is an example of ideal practice the importance of frequent multidisciplinary discussion clinical re evaluation and continuity of care is emphasised . 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>

temporomandibular joint surgery what does it mean to the dental practitioner a poor appreciation of the role of surgery in the management of temporomandibular disorders tmd may result in some patients being denied access to appropriate care . while surgery is often considered as an option of last resort there are instances where surgery is the definitive and sometimes the only treatment option . the aim of this paper was to review the role of temporomandibular joint tmj surgery and its place in the treatment armamentarium of temporomandibular disorders . indications rationale for surgery risks
benefits are discussed and complemented with examples of clinical cases treated by the author . all dental practitioners should be aware of the benefits of tmj surgery so that patients do not suffer unnecessarily from ongoing non surgical treatments that ultimately prove to be ineffective in the management of their condition .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: temporomandibular joint surgery what does it mean to the dental practitioner a poor appreciation of the role of surgery in the management of temporomandibular disorders tmd may result in some patients being denied access to appropriate care . while surgery is often considered as an option of last resort there are instances where surgery is the definitive and sometimes the only treatment option . the aim of this paper was to review the role of temporomandibular joint tmj surgery and its place in the treatment armamentarium of temporomandibular disorders . indications rationale for surgery risks
benefits are discussed and complemented with examples of clinical cases treated by the author . all dental practitioners should be aware of the benefits of tmj surgery so that patients do not suffer unnecessarily from ongoing non surgical treatments that ultimately prove to be ineffective in the management of their 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: 0 </s>

ischemic colitis during interferon ribavirin therapy for chronic hepatitis c a case report . ischemic colitis is a rare complication of interferon administration . only 9 cases in 6 reports have been described to date . this report describes a case of ischemic colitis during pegylated interferon and ribavirin treatment for chronic hepatitis c and includes a review of the relevant literature . a 48 year old woman was treated with pegylated interferon
 and ribavirin for chronic hepatitis c genotype ib . after 19 wk of treatment the patient complained of severe afebrile abdominal pain with hematochezia . vital signs were stable and serum white blood cell count was within the normal range . abdominal computed tomography showed diffuse colonic wall thickening from the splenic flexure to the proximal sigmoid colon which is the most vulnerable area for the development of ischemic colitis . colonoscopy revealed an acute mucosal hyperemic change with edema and ulcerations extending from the proximal descending colon to the sigmoid colon . colonic mucosal biopsy revealed acute exudative colitis . polymerase chain reaction and culture for mycobacterium tuberculosis were negative and the cultures for cytomegalovirus salmonella and shigella species were negative . after discontinuation of interferon and ribavirin therapy abdominal pain and hematochezia subsided and following colonoscopy showed improvement of the mucosal ulcerations . ischemic colitis cases during interferon therapy in patients with chronic hepatitis c reported so far have all involved the descending colon . ischemic colitis is a rarely encountered complication of interferon administration in patients with chronic hepatitis c and should be considered when a patient complains of abdominal pain and hematochezia .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: ischemic colitis during interferon ribavirin therapy for chronic hepatitis c a case report . ischemic colitis is a rare complication of interferon administration . only 9 cases in 6 reports have been described to date . this report describes a case of ischemic colitis during pegylated interferon and ribavirin treatment for chronic hepatitis c and includes a review of the relevant literature . a 48 year old woman was treated with pegylated interferon
 and ribavirin for chronic hepatitis c genotype ib . after 19 wk of treatment the patient complained of severe afebrile abdominal pain with hematochezia . vital signs were stable and serum white blood cell count was within the normal range . abdominal computed tomography showed diffuse colonic wall thickening from the splenic flexure to the proximal sigmoid colon which is the most vulnerable area for the development of ischemic colitis . colonoscopy revealed an acute mucosal hyperemic change with edema and ulcerations extending from the proximal descending colon to the sigmoid colon . colonic mucosal biopsy revealed acute exudative colitis . polymerase chain reaction and culture for mycobacterium tuberculosis were negative and the cultures for cytomegalovirus salmonella and shigella species were negative . after discontinuation of interferon and ribavirin therapy abdominal pain and hematochezia subsided and following colonoscopy showed improvement of the mucosal ulcerations . ischemic colitis cases during interferon therapy in patients with chronic hepatitis c reported so far have all involved the descending colon . ischemic colitis is a rarely encountered complication of interferon administration in patients with chronic hepatitis c and should be considered when a patient complains of abdominal pain and hematochezia . 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>

brief report a second primary endodermal sinus tumor 9 years after initial diagnosis . background ovarian yolk sac tumors ysts are rare malignant germ cell tumors known to present unilaterally allowing for fertility sparing surgical treatment with adjuvant chemotherapy . the few published cases of bilateral ovarian involvement were at the time of original diagnosis in patients with widely metastatic disease . we present to our knowledge the first case of bilateral ovarian ysts diagnosed several years apart and discuss the implications on recurrence and tumor marker surveillance for these tumors . case this is a case of a young woman who re presented 9 years after initial treatment with a yst in the contralateral ovary . summary and conclusions ysts are well established as unilateral tumors however in rare cases such as this they might reappear years later on the contralateral ovary .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: brief report a second primary endodermal sinus tumor 9 years after initial diagnosis . background ovarian yolk sac tumors ysts are rare malignant germ cell tumors known to present unilaterally allowing for fertility sparing surgical treatment with adjuvant chemotherapy . the few published cases of bilateral ovarian involvement were at the time of original diagnosis in patients with widely metastatic disease . we present to our knowledge the first case of bilateral ovarian ysts diagnosed several years apart and discuss the implications on recurrence and tumor marker surveillance for these tumors . case this is a case of a young woman who re presented 9 years after initial treatment with a yst in the contralateral ovary . summary and conclusions ysts are well established as unilateral tumors however in rare cases such as this they might reappear years later on the contralateral ovary . 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>

acute ischaemic stroke as a manifestation of pituitary apoplexy in a young lady . pituitary apoplexy pa is defined as a clinical syndrome comprising headache visual deficits and altered sensorium which can result from haemorrhage or infarction of the pituitary gland . acute ischaemic stroke following pa is very rare . we are presenting a 35 year old young otherwise healthy lady who presented with neuro ophthalmological and vascular symptoms on a background of pa . imaging revealed a pituitary macro adenoma with parasellar extension with internal bleed . cerebral angiography revealed that the mass compressed the bilateral cavernous sinuses left more than right resulting in obliteration of the cavernous portion of the left internal carotid artery ica . she was treated with steroids and surgical debulking of the tumour through trans sphenoidal approach and postoperative imaging showed recanalization of the ica with reduction of the tumour size . the histopathological diagnosis was consistent with pituitary macro adenoma . patient improved in level of sensorium eye movement and the patient showed almost full recovery after the operation . pa resulting in ica occlusion is very rare . early intervention is required for reducing mortality and morbidity and to improve quality of life .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: acute ischaemic stroke as a manifestation of pituitary apoplexy in a young lady . pituitary apoplexy pa is defined as a clinical syndrome comprising headache visual deficits and altered sensorium which can result from haemorrhage or infarction of the pituitary gland . acute ischaemic stroke following pa is very rare . we are presenting a 35 year old young otherwise healthy lady who presented with neuro ophthalmological and vascular symptoms on a background of pa . imaging revealed a pituitary macro adenoma with parasellar extension with internal bleed . cerebral angiography revealed that the mass compressed the bilateral cavernous sinuses left more than right resulting in obliteration of the cavernous portion of the left internal carotid artery ica . she was treated with steroids and surgical debulking of the tumour through trans sphenoidal approach and postoperative imaging showed recanalization of the ica with reduction of the tumour size . the histopathological diagnosis was consistent with pituitary macro adenoma . patient improved in level of sensorium eye movement and the patient showed almost full recovery after the operation . pa resulting in ica occlusion is very rare . early intervention is required for reducing mortality and morbidity and to 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>

diagnosis of hepatitis c virus genotype

 needs ns
 sequencing . hepatitis c virus hcv is probably the most common cause of liver cirrhosis and hepatocellular carcinoma worldwide . the correct identification of hcv genotype has important clinical implications as a marker of responsiveness to antiviral therapy and serves as a guideline for the duration of treatment . the versant hcv genotype _decnum_ assay failed to detect hcv genotype

 . hcv genotype

 detection requires ns
 sequencing .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: diagnosis of hepatitis c virus genotype

 needs ns
 sequencing . hepatitis c virus hcv is probably the most common cause of liver cirrhosis and hepatocellular carcinoma worldwide . the correct identification of hcv genotype has important clinical implications as a marker of responsiveness to antiviral therapy and serves as a guideline for the duration of treatment . the versant hcv genotype _decnum_ assay failed to detect hcv genotype

 . hcv genotype

 detection requires ns
 sequencing . 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>

reversible sudden hearing loss in a chronic hepatitis c patient who achieved a sustained response to antiviral re treatment . we describe the case of a patient with chronic hepatitis c treated with standard and pegylated interferon peg ifn alpha and ribavirin . he developed a reversible hearing loss during the first course of peg ifn ribavirin but achieved sustained viral clearance and biochemical normalization after peg ifn ribavirin re treatment .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: reversible sudden hearing loss in a chronic hepatitis c patient who achieved a sustained response to antiviral re treatment . we describe the case of a patient with chronic hepatitis c treated with standard and pegylated interferon peg ifn alpha and ribavirin . he developed a reversible hearing loss during the first course of peg ifn ribavirin but achieved sustained viral clearance and biochemical normalization after peg ifn ribavirin re 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>

lessons from a 15 year old boy with advanced schistosomiasis japonica in china a case report . schistosomiasis is a chronic parasitic disease caused by flukes trematodes of the genus schistosoma which presents the most important global burden of the 17 neglected tropical diseases listed by the world health organization . china has made great achievements in schistosomiasis control and now china is planning to move forward to eliminate schistosomiasis within _lgnum_ but the fact cannot be denied that the possibility of schistosome infection is still there in some endemic due to its zoonotic nature as well as wide distribution of its intermediate hosts snails . thus how to interrupt the transmission in areas with distribution of schistosomes and intermediate snails becomes a very serious challenge that china is facing . in this paper it is reported an advanced schistosomiasis japonica case of a 15 year old boy which is extremely rare in the current schistosomiasis control in china . thus it is supposed to strengthen health education of school children and to train professional physicians of local hospitals .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: lessons from a 15 year old boy with advanced schistosomiasis japonica in china a case report . schistosomiasis is a chronic parasitic disease caused by flukes trematodes of the genus schistosoma which presents the most important global burden of the 17 neglected tropical diseases listed by the world health organization . china has made great achievements in schistosomiasis control and now china is planning to move forward to eliminate schistosomiasis within _lgnum_ but the fact cannot be denied that the possibility of schistosome infection is still there in some endemic due to its zoonotic nature as well as wide distribution of its intermediate hosts snails . thus how to interrupt the transmission in areas with distribution of schistosomes and intermediate snails becomes a very serious challenge that china is facing . in this paper it is reported an advanced schistosomiasis japonica case of a 15 year old boy which is extremely rare in the current schistosomiasis control in china . thus it is supposed to strengthen health education of school children and to train professional physicians of local hospitals . 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 engraftment and durable graft versus host disease control with haploidentical peripheral blood and a short term conditioning regimen for primary graft failure . primary graft failure occurred after cord blood transplantation for a patient with acute lymphoblastic leukemia . the second transplantation was performed using haploidentical peripheral blood . the conditioning regimen consisted of fludarabine day 1 30 mg m 2 cyclophosphamide day 1
00 mg m 2 and total body irradiation day 1 2 gy . the immunosuppressants contained tacrolimus prednisolone and rabbit anti thymocyte globulin day 3 to 2 total dose _decnum_ mg kg . the engraftment was confirmed on day 9 . both acute and chronic graft versus host disease were controllable . the present regimen appears to be suitable for immediate management fast engraftment and the durable control of complications .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: successful engraftment and durable graft versus host disease control with haploidentical peripheral blood and a short term conditioning regimen for primary graft failure . primary graft failure occurred after cord blood transplantation for a patient with acute lymphoblastic leukemia . the second transplantation was performed using haploidentical peripheral blood . the conditioning regimen consisted of fludarabine day 1 30 mg m 2 cyclophosphamide day 1
00 mg m 2 and total body irradiation day 1 2 gy . the immunosuppressants contained tacrolimus prednisolone and rabbit anti thymocyte globulin day 3 to 2 total dose _decnum_ mg kg . the engraftment was confirmed on day 9 . both acute and chronic graft versus host disease were controllable . the present regimen appears to be suitable for immediate management fast engraftment and the durable control of complications . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

a case of orbital metastasis of uterine leiomyosarcoma with intracranial extension presenting with proptosis . a 57 year old woman presented with protrusion of the os 2 months in duration and decreased vision 1 month in duration . the patient was diagnosed with uterine leiomyosarcoma approximately 3 years before presentation . lung and liver metastases were diagnosed by biopsy 1 year prior to this visit . ct revealed a solid mass with central necrosis in the left lateral orbit that resulted in orbital shifting bony destruction and intracranial extension . the diagnosis was left orbital metastatic leiomyosarcoma and the patient died 2 months after receiving the diagnosis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: a case of orbital metastasis of uterine leiomyosarcoma with intracranial extension presenting with proptosis . a 57 year old woman presented with protrusion of the os 2 months in duration and decreased vision 1 month in duration . the patient was diagnosed with uterine leiomyosarcoma approximately 3 years before presentation . lung and liver metastases were diagnosed by biopsy 1 year prior to this visit . ct revealed a solid mass with central necrosis in the left lateral orbit that resulted in orbital shifting bony destruction and intracranial extension . the diagnosis was left orbital metastatic leiomyosarcoma and the patient died 2 months after receiving the 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: 0 </s>

the failing heart a bad case of the flu . a 24 year old nepali man presented to hospital with a short history of feeling unwell with a flu like illness . he subsequently went into acute renal failure requiring several sessions of renal replacement therapy by haemofiltration . the underlying aetiology of his renal failure was unclear . his renal function recovered following haemofiltration and he was discharged home with a plan for outpatient follow up and investigations . he re presented to hospital 6 days later with severe fluid overload . echocardiogram was suggestive of impaired left ventricular systolic function subsequent cardiac mri confirmed this and was indicative of a dilated cardiomyopathy . a diagnosis of dilated cardiomyopathy with cardiorenal syndrome was made most likely secondary to viral myocarditis in view of his initial presentation . he was diuresed and treated with prognostic medications for heart failure . his symptoms resolved and on subsequent outpatient review he was feeling well .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: the failing heart a bad case of the flu . a 24 year old nepali man presented to hospital with a short history of feeling unwell with a flu like illness . he subsequently went into acute renal failure requiring several sessions of renal replacement therapy by haemofiltration . the underlying aetiology of his renal failure was unclear . his renal function recovered following haemofiltration and he was discharged home with a plan for outpatient follow up and investigations . he re presented to hospital 6 days later with severe fluid overload . echocardiogram was suggestive of impaired left ventricular systolic function subsequent cardiac mri confirmed this and was indicative of a dilated cardiomyopathy . a diagnosis of dilated cardiomyopathy with cardiorenal syndrome was made most likely secondary to viral myocarditis in view of his initial presentation . he was diuresed and treated with prognostic medications for heart failure . his symptoms resolved and on subsequent outpatient review he was feeling well . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

the diagnostic and treatment challenge of type iiib endoleaks . type iiib endoleak is a rare complication of endovascular aortic repair caused by endoprosthesis deterioration leading to aneurysm pressurization and potential rupture . because of its rarity few cases are published . we report six cases of type iiib endoleak in a 15 year period . appropriate preoperative diagnosis was achieved in five cases duplex ultrasonography computed tomography angiography and contrast enhanced ultrasonography were useful diagnostic tools in one case and angiography led to the correct diagnosis in four cases . in the remaining case only surgical exploration identified the type iiib endoleak . successful treatment was achieved by endovascular relining in five cases and by surgical conversion in one case .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: the diagnostic and treatment challenge of type iiib endoleaks . type iiib endoleak is a rare complication of endovascular aortic repair caused by endoprosthesis deterioration leading to aneurysm pressurization and potential rupture . because of its rarity few cases are published . we report six cases of type iiib endoleak in a 15 year period . appropriate preoperative diagnosis was achieved in five cases duplex ultrasonography computed tomography angiography and contrast enhanced ultrasonography were useful diagnostic tools in one case and angiography led to the correct diagnosis in four cases . in the remaining case only surgical exploration identified the type iiib endoleak . successful treatment was achieved by endovascular relining in five cases and by surgical conversion in one case . 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>

lingual cavernous hemangioma in a nepalese boy a difficult associate hemangiomas are benign tumors comprising of ectatic blood vessels . although common in the head and neck region those occurring within the oral cavity and tongue are exceedingly rare . we report a 5 year old boy with a swelling over the anterior third of tongue post failed conservative therapy eventually treated with surgical excision and confirmed histologically as a cavernous hemangioma probably first of its kind reported from nepal .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: lingual cavernous hemangioma in a nepalese boy a difficult associate hemangiomas are benign tumors comprising of ectatic blood vessels . although common in the head and neck region those occurring within the oral cavity and tongue are exceedingly rare . we report a 5 year old boy with a swelling over the anterior third of tongue post failed conservative therapy eventually treated with surgical excision and confirmed histologically as a cavernous hemangioma probably first of its kind reported from nepal . 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>

expanding phenotype of nephronophthisis related ciliopathy an elderly patient with homozygous rpgrip
 mutation . nephronophthisis related ciliopathies nphp rc are autosomal recessive disorders characterized by renal corticomedullary cysts with the extrarenal symptoms . typically patients with nphp rc reach end stage kidney disease eskd before the age of 30 years . we herein report a japanese woman with nphp rc who had unusually delayed progression to eskd after 6 decades . she exhibited liver dysfunction at the age of 23 years . she also showed mild renal dysfunction at the age of 43 years . ultrasonography revealed bilateral multiple renal cysts with loss of corticomedullary differentiation . her liver and renal functions gradually deteriorated . she was diagnosed with liver fibrosis as a result of biopsy and initiated the maintenance hemodiafiltration therapy for eskd at the age of 61 years . because of a unique combination of multiple renal cysts and liver fibrosis ciliopathy was suspected and medical exome analysis was performed . a novel homozygous missense mutation was identified in rpgrip
 c _lgnum_
 gt a
glu60
ys a causative gene for nphp rc . to the best of our knowledge this patient is the oldest one who progressed to eskd in nphp rc . our case illustrates that nphp rc should be included in the differential diagnosis of the patient with corticomedullary polycystic kidneys accompanied by the extrarenal organ involvements even if the patient is elderly .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: expanding phenotype of nephronophthisis related ciliopathy an elderly patient with homozygous rpgrip
 mutation . nephronophthisis related ciliopathies nphp rc are autosomal recessive disorders characterized by renal corticomedullary cysts with the extrarenal symptoms . typically patients with nphp rc reach end stage kidney disease eskd before the age of 30 years . we herein report a japanese woman with nphp rc who had unusually delayed progression to eskd after 6 decades . she exhibited liver dysfunction at the age of 23 years . she also showed mild renal dysfunction at the age of 43 years . ultrasonography revealed bilateral multiple renal cysts with loss of corticomedullary differentiation . her liver and renal functions gradually deteriorated . she was diagnosed with liver fibrosis as a result of biopsy and initiated the maintenance hemodiafiltration therapy for eskd at the age of 61 years . because of a unique combination of multiple renal cysts and liver fibrosis ciliopathy was suspected and medical exome analysis was performed . a novel homozygous missense mutation was identified in rpgrip
 c _lgnum_
 gt a
glu60
ys a causative gene for nphp rc . to the best of our knowledge this patient is the oldest one who progressed to eskd in nphp rc . our case illustrates that nphp rc should be included in the differential diagnosis of the patient with corticomedullary polycystic kidneys accompanied by the extrarenal organ involvements even if the patient is elderly . 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>

swallow presyncope in an athletic patient caused by third degree atrioventricular block . introduction swallow syncope is a neurally mediated syncope . multiple causes have been described in literature . a rare cause is arrhythmias . only a limited amount of cases present the association of swallow syncope and third degree av block . case presentation a 39 year old man presented with episodes of presyncope while eating . further medical history physical examination resting 12 lead ecg cyclo ergometry transthoracic echocardiography and mri of the heart were normal . 24 h holter monitoring demonstrated high grade third degree atrioventricular av block . the patient was scheduled for pacemaker implantation . discussion arrhythmia is a rare cause of swallow syncope . reported arrhythmic causes are sinus bradycardia sinoatrial block atrioventricular block and complete atrial and ventricular asystole . essential to the diagnosis is that pre syncope is preceded by swallowing and documentation of av block on 24 h holter monitoring . treatment is guided by esc guidelines which state that reflex syncope has a grade iia recommendation for pacing while current evidence suggests that asymptomatic vagally mediated av block should not be treated until symptomatic .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: swallow presyncope in an athletic patient caused by third degree atrioventricular block . introduction swallow syncope is a neurally mediated syncope . multiple causes have been described in literature . a rare cause is arrhythmias . only a limited amount of cases present the association of swallow syncope and third degree av block . case presentation a 39 year old man presented with episodes of presyncope while eating . further medical history physical examination resting 12 lead ecg cyclo ergometry transthoracic echocardiography and mri of the heart were normal . 24 h holter monitoring demonstrated high grade third degree atrioventricular av block . the patient was scheduled for pacemaker implantation . discussion arrhythmia is a rare cause of swallow syncope . reported arrhythmic causes are sinus bradycardia sinoatrial block atrioventricular block and complete atrial and ventricular asystole . essential to the diagnosis is that pre syncope is preceded by swallowing and documentation of av block on 24 h holter monitoring . treatment is guided by esc guidelines which state that reflex syncope has a grade iia recommendation for pacing while current evidence suggests that asymptomatic vagally mediated av block should not be treated until symptomatic . 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>

granulomatous hepatitis revealing a mycobacterium bovis widespread infection following intravesical bcg therapy . introduction intravesical therapy with bacillus calmette guerin bcg has proved to be effective in the treatment of superficial bladder tumors . side effects include local infections and rarely disseminated bcg infection with multiple end organ complications such as granulomatous hepatitis pneumonitis aortitis and bone marrow involvement . case report we report an 83 year old man who presented with chronic granulomatous hepatitis . this was related to intravesical bcg therapy received two years earlier for superficial bladder cancer . aortitis splenic infarction and hematopoietic involvement were also diagnosed . outcome was favorable following adapted antibiotic course . conclusion this case report highlights the possibility of widespread bcg infection following intravesical treatment and the need for vigilance in patients with a history of such a therapy even several years later .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: granulomatous hepatitis revealing a mycobacterium bovis widespread infection following intravesical bcg therapy . introduction intravesical therapy with bacillus calmette guerin bcg has proved to be effective in the treatment of superficial bladder tumors . side effects include local infections and rarely disseminated bcg infection with multiple end organ complications such as granulomatous hepatitis pneumonitis aortitis and bone marrow involvement . case report we report an 83 year old man who presented with chronic granulomatous hepatitis . this was related to intravesical bcg therapy received two years earlier for superficial bladder cancer . aortitis splenic infarction and hematopoietic involvement were also diagnosed . outcome was favorable following adapted antibiotic course . conclusion this case report highlights the possibility of widespread bcg infection following intravesical treatment and the need for vigilance in patients with a history of such a therapy even several years later . 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>

pseudotumor cerebri in acute promyelocytic leukemia patients on intergroup protocol _lgnum_ clinical description and recommendations for new diagnostic criteria . background multiple randomized trials have demonstrated a benefit for all trans retinoic acid atra in patients with acute promyelocytic leukemia apl . pseudotumor cerebri ptc is an infrequently reported adverse effect of atra . methods we examined the incidence clinical course and outcomes of patients with apl treated on intergroup protocol _lgnum_ i0129 who developed ptc . this trial evaluated the role of atra alone during induction and or as maintenance therapy . results of the patients on trial _lgnum_ received atra during induction maintenance or both 8 had a clinical suspicion for ptc . upon review of individual cases this was felt to be quot probable quot in 4 patients quot possible quot in 1 and quot unlikely quot in 3 due to lack of diagnostic criteria or presence of a more likely alternate diagnosis . conclusions quot probable quot ptc occurred in _decnum_ of patients who received atra during induction and or maintenance therapy . in agreement with previous reports the incidence of ptc in apl patients receiving atra was higher in the pediatric population . here we discuss the method for diagnosing ptc in the setting of atra therapy and management strategies .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: pseudotumor cerebri in acute promyelocytic leukemia patients on intergroup protocol _lgnum_ clinical description and recommendations for new diagnostic criteria . background multiple randomized trials have demonstrated a benefit for all trans retinoic acid atra in patients with acute promyelocytic leukemia apl . pseudotumor cerebri ptc is an infrequently reported adverse effect of atra . methods we examined the incidence clinical course and outcomes of patients with apl treated on intergroup protocol _lgnum_ i0129 who developed ptc . this trial evaluated the role of atra alone during induction and or as maintenance therapy . results of the patients on trial _lgnum_ received atra during induction maintenance or both 8 had a clinical suspicion for ptc . upon review of individual cases this was felt to be quot probable quot in 4 patients quot possible quot in 1 and quot unlikely quot in 3 due to lack of diagnostic criteria or presence of a more likely alternate diagnosis . conclusions quot probable quot ptc occurred in _decnum_ of patients who received atra during induction and or maintenance therapy . in agreement with previous reports the incidence of ptc in apl patients receiving atra was higher in the pediatric population . here we discuss the method for diagnosing ptc in the setting of atra therapy and management strategies . 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>

pseudodacryocystitis paediatric case series of infected atypical ethmoid air cells masquerading as recurrent dacryocystitis . purposeto highlight the clinical and surgical considerations in treating patients with apparent recurrent acute dacryocystitis with a patent lacrimal system . methodsthree children referred to a tertiary unit as recurrent acute dacryocystitis were reviewed retrospectively . imaging and subsequent surgical intervention revealed the underlying diagnosis . resultsall three cases presented with recurrent abscesses in the region of the lacrimal sac that failed to respond to incision and drainage . the lesions were lower and more lateral to the usual location of a sac abscess and closer to the inferior orbital rim . all three cases were found to have patent lacrimal systems on syringing and all were found to have infected low lying anteriorly placed aberrant ethmoid air cells on computed tomography and magnetic resonance imaging . these were confirmed on subsequent surgical exploration . conclusionsinfected low lying ethmoid air cells can mimic dacryocystitis with recurrent abcesses . in cases where a patent nasolacrimal system is demonstrated and a more inferolateral location of the swelling than would be expected in dacryocystitis is seen imaging is warranted to ensure the appropriate intervention is undertaken . anterior ethmoidectomy as opposed to dacryocystorhinostomy is the appropriate treatment in these cases .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: pseudodacryocystitis paediatric case series of infected atypical ethmoid air cells masquerading as recurrent dacryocystitis . purposeto highlight the clinical and surgical considerations in treating patients with apparent recurrent acute dacryocystitis with a patent lacrimal system . methodsthree children referred to a tertiary unit as recurrent acute dacryocystitis were reviewed retrospectively . imaging and subsequent surgical intervention revealed the underlying diagnosis . resultsall three cases presented with recurrent abscesses in the region of the lacrimal sac that failed to respond to incision and drainage . the lesions were lower and more lateral to the usual location of a sac abscess and closer to the inferior orbital rim . all three cases were found to have patent lacrimal systems on syringing and all were found to have infected low lying anteriorly placed aberrant ethmoid air cells on computed tomography and magnetic resonance imaging . these were confirmed on subsequent surgical exploration . conclusionsinfected low lying ethmoid air cells can mimic dacryocystitis with recurrent abcesses . in cases where a patent nasolacrimal system is demonstrated and a more inferolateral location of the swelling than would be expected in dacryocystitis is seen imaging is warranted to ensure the appropriate intervention is undertaken . anterior ethmoidectomy as opposed to dacryocystorhinostomy is the appropriate treatment in these cases . 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>

entecavir as a first line treatment for hepatitis b virus reactivation following polychemotherapy for chronic lymphocytic leukemia and invasive ductal carcinoma a report of two cases and review of the literature . objective hepatitis b reactivation has been reported in chronic carriers of hepatitis b hepatitis b surface antigen hbsag or in patients with prior hepatitis b virus hbv infection who are hbsag negative and have antibodies against hepatitis b core antigen anti hbc with or without antibodies to hbsag anti hbs . lamivudine has been the first and commonly used nucleoside analog to inhibit hbv replication however prolonged therapy has been associated with an increased risk for drug resistant mutations and mortality rates . entecavir a deoxyguanosine analog offers several advantages over lamivudine for the treatment of hbv reactivation following chemotherapy while exhibiting more potent antiviral activity and a lower resistance rate . methods herein we report rapid and sustained suppression of polychemotherapy related hbv reactivation by entecavir administered as a prompt antiviral therapy in the cases of two patients with chronic lymphocytic leukemia and invasive ductal carcinoma . a review of the literature is discussed . results entecavir produced a rapid and sustained suppression of polychemotherapy related hbv reactivation as a prompt antiviral therapy in the cases of two patients with chronic lymphocytic leukemia and invasive ductal carcinoma . conclusion allowing a rapid and sustained control of hbv replication entecavir seems to be a promising drug for first line prompt treatment of hbv reactivation in patients undergoing chemotherapy for hematological as well as solid organ malignancies with safe long term use enabling maintenance of resolved hepatitis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: entecavir as a first line treatment for hepatitis b virus reactivation following polychemotherapy for chronic lymphocytic leukemia and invasive ductal carcinoma a report of two cases and review of the literature . objective hepatitis b reactivation has been reported in chronic carriers of hepatitis b hepatitis b surface antigen hbsag or in patients with prior hepatitis b virus hbv infection who are hbsag negative and have antibodies against hepatitis b core antigen anti hbc with or without antibodies to hbsag anti hbs . lamivudine has been the first and commonly used nucleoside analog to inhibit hbv replication however prolonged therapy has been associated with an increased risk for drug resistant mutations and mortality rates . entecavir a deoxyguanosine analog offers several advantages over lamivudine for the treatment of hbv reactivation following chemotherapy while exhibiting more potent antiviral activity and a lower resistance rate . methods herein we report rapid and sustained suppression of polychemotherapy related hbv reactivation by entecavir administered as a prompt antiviral therapy in the cases of two patients with chronic lymphocytic leukemia and invasive ductal carcinoma . a review of the literature is discussed . results entecavir produced a rapid and sustained suppression of polychemotherapy related hbv reactivation as a prompt antiviral therapy in the cases of two patients with chronic lymphocytic leukemia and invasive ductal carcinoma . conclusion allowing a rapid and sustained control of hbv replication entecavir seems to be a promising drug for first line prompt treatment of hbv reactivation in patients undergoing chemotherapy for hematological as well as solid organ malignancies with safe long term use enabling maintenance of resolved 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>

hyperbilirubinaemia and haemolytic anaemia in acute alcoholic hepatitis there oil in them thar veins . a caucasian woman in her late 3
 was evaluated after a period of binge drinking and found to have hyperbilirubinaemia for which she was referred for consideration of cholecystectomy . after exclusion of other possibilities zieve syndrome was diagnosed . this is a condition of hyperbilirubinaemia coombs negative haemolytic anaemia and hyperlipidaemia associated with alcoholism . abstinence from alcohol remains the only known effective treatment and appreciation of the entity can prevent unnecessary biliary procedures . the patient improved with supportive measures and was discharged in stable condition .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: hyperbilirubinaemia and haemolytic anaemia in acute alcoholic hepatitis there oil in them thar veins . a caucasian woman in her late 3
 was evaluated after a period of binge drinking and found to have hyperbilirubinaemia for which she was referred for consideration of cholecystectomy . after exclusion of other possibilities zieve syndrome was diagnosed . this is a condition of hyperbilirubinaemia coombs negative haemolytic anaemia and hyperlipidaemia associated with alcoholism . abstinence from alcohol remains the only known effective treatment and appreciation of the entity can prevent unnecessary biliary procedures . the patient improved with supportive measures and was discharged in stable 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>

interventricular dyssynchrony in a patient with a biventricular physiology and a systemic right ventricle . we describe of a unique pattern of cardiac dyssynchrony in a patient with a biventricular physiology and systemic right ventricle rv the interventricular dyssynchrony due to a contraction delay between the left ventricle and rv . in the present case the cineangiography and intracardiac electrocardiography of the rv did not reveal intraventricular dyssynchrony of the rv but revealed interventricular dyssynchrony . in addition the pressure curves of the ventricles exhibited time phase differences between the two ventricles . the cardiac resynchronization therapy determining the pacing lead positions based on the idea of interventricular dyssynchrony induced reverse cardiac remodeling in this patient with systemic rv dysfunction .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: interventricular dyssynchrony in a patient with a biventricular physiology and a systemic right ventricle . we describe of a unique pattern of cardiac dyssynchrony in a patient with a biventricular physiology and systemic right ventricle rv the interventricular dyssynchrony due to a contraction delay between the left ventricle and rv . in the present case the cineangiography and intracardiac electrocardiography of the rv did not reveal intraventricular dyssynchrony of the rv but revealed interventricular dyssynchrony . in addition the pressure curves of the ventricles exhibited time phase differences between the two ventricles . the cardiac resynchronization therapy determining the pacing lead positions based on the idea of interventricular dyssynchrony induced reverse cardiac remodeling in this patient with systemic rv dysfunction . 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>

acute hepatitis b due to immune escape mutations in a naturally immune patient . incidence of hepatitis b virus infection hbv has been greatly reduced globally after the introduction of universal vaccination programs . however another potential threat was noticed almost 2 decades ago which is the selection of antibody escape hbv strains . antibody or immune escape strains of hbv carry mutations in the s gene which encodes quot a quot determinant region located at amino acid positions _lgnum_ to _lgnum_ . certain mutations in this region which promotes antibody response might lead to an alteration in the antigenicity of hepatitis b surface antigen hbsag . anti hbs might fail to neutralize the mutant virus and transmission or reappearance of infection in previously immunized individuals can be possible . herein we report a patient with known hbv seropositivity hbsag negative anti hbs positive anti hbc igg positive for more than 10 years who developed a symptomatic acute hepatitis due to occurrence of immune escape mutants in the absence of any immunosuppression or cytotoxic chemotherapy . to the best of our knowledge this is the first reported case of acute hepatitis b due to escape mutations in a naturally immune patient .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: acute hepatitis b due to immune escape mutations in a naturally immune patient . incidence of hepatitis b virus infection hbv has been greatly reduced globally after the introduction of universal vaccination programs . however another potential threat was noticed almost 2 decades ago which is the selection of antibody escape hbv strains . antibody or immune escape strains of hbv carry mutations in the s gene which encodes quot a quot determinant region located at amino acid positions _lgnum_ to _lgnum_ . certain mutations in this region which promotes antibody response might lead to an alteration in the antigenicity of hepatitis b surface antigen hbsag . anti hbs might fail to neutralize the mutant virus and transmission or reappearance of infection in previously immunized individuals can be possible . herein we report a patient with known hbv seropositivity hbsag negative anti hbs positive anti hbc igg positive for more than 10 years who developed a symptomatic acute hepatitis due to occurrence of immune escape mutants in the absence of any immunosuppression or cytotoxic chemotherapy . to the best of our knowledge this is the first reported case of acute hepatitis b due to escape mutations in a naturally immune 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: 1 </s>

auxiliary liver transplantation for acute liver failure . background auxiliary partial orthotopic liver transplantation is a technique where part of diseased native liver is removed and replaced with healthy donor liver so that the left behind native liver could later regenerate . case characteristics 2 year 6 month old girl with acute liver failure due to hepatitis
she underwent a successful auxiliary partial orthotopic liver transplantation . outcome successful native liver regeneration and immunosuppression withdrawal after two and half years of surgery . message in selective cases of acute liver failure auxiliary partial orthotopic liver transplantation could provide a chance for native liver regeneration and immunosuppression free life .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: auxiliary liver transplantation for acute liver failure . background auxiliary partial orthotopic liver transplantation is a technique where part of diseased native liver is removed and replaced with healthy donor liver so that the left behind native liver could later regenerate . case characteristics 2 year 6 month old girl with acute liver failure due to hepatitis
she underwent a successful auxiliary partial orthotopic liver transplantation . outcome successful native liver regeneration and immunosuppression withdrawal after two and half years of surgery . message in selective cases of acute liver failure auxiliary partial orthotopic liver transplantation could provide a chance for native liver regeneration and immunosuppression free 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: 1 </s>

retreatment with peginterferon and ribavirin in chronic hepatitis
the development of boceprevir and telaprevir was a major step forward in the treatment of chronic hepatitis
in addition the treatment of these infections has been recently revolutionized by the approval of sofosbuvir and simeprevir . however there are several challenges associated with the application of novel drugs such as new and more frequent adverse events new drug interactions and excessively high treatment costs . an additional concern is viral resistance . these considerations highlight the fact that direct acting antiviral agents are not a panacea and may not be the best option for all patients who are in need of therapy . this retrospective study revealed that the sustained virologic response was not significantly reduced following peginterferon and ribavirin retreatment compared with the new therapy . we suggest that patients who experience relapse shortly after completing treatment with peginterferon and ribavirin have a reasonable chance of achieving a sustained virologic response when retreated with these drugs alone .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: retreatment with peginterferon and ribavirin in chronic hepatitis
the development of boceprevir and telaprevir was a major step forward in the treatment of chronic hepatitis
in addition the treatment of these infections has been recently revolutionized by the approval of sofosbuvir and simeprevir . however there are several challenges associated with the application of novel drugs such as new and more frequent adverse events new drug interactions and excessively high treatment costs . an additional concern is viral resistance . these considerations highlight the fact that direct acting antiviral agents are not a panacea and may not be the best option for all patients who are in need of therapy . this retrospective study revealed that the sustained virologic response was not significantly reduced following peginterferon and ribavirin retreatment compared with the new therapy . we suggest that patients who experience relapse shortly after completing treatment with peginterferon and ribavirin have a reasonable chance of achieving a sustained virologic response when retreated with these drugs alone . 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>

neonatal lupus . case report . neonatal lupus has a rare incidence distinct from systemic lupus erythematosus . this is an acquired autoimmune disease associated with maternal antibodies to proteins ro la ssa ssb transferred by the placenta it represents the prototype of passive transfer of antibodies from mother to child . the disease can affect the skin heart and rarely the hepatobiliary or hematologic systems . congenital complete heart block is the most severe form of neonatal lupus . in clinical practice it is important to distinguish in utero a complete from an incomplete atrioventricular block av in order to render prompt care . we present the case of a new born female who was diagnosed with an atrio ventricular block at 26 weeksi gestation . when the baby was delivered at 38 weeksi gestation she presented bradycardia 54 xi . on the suspicion of neonatal lupus we required antinuclear antibodies anti sm anti rnp anti ss a and anti ss b which were positive . a bicameral pacemaker was placed uneventfully .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: neonatal lupus . case report . neonatal lupus has a rare incidence distinct from systemic lupus erythematosus . this is an acquired autoimmune disease associated with maternal antibodies to proteins ro la ssa ssb transferred by the placenta it represents the prototype of passive transfer of antibodies from mother to child . the disease can affect the skin heart and rarely the hepatobiliary or hematologic systems . congenital complete heart block is the most severe form of neonatal lupus . in clinical practice it is important to distinguish in utero a complete from an incomplete atrioventricular block av in order to render prompt care . we present the case of a new born female who was diagnosed with an atrio ventricular block at 26 weeksi gestation . when the baby was delivered at 38 weeksi gestation she presented bradycardia 54 xi . on the suspicion of neonatal lupus we required antinuclear antibodies anti sm anti rnp anti ss a and anti ss b which were positive . a bicameral pacemaker was placed uneventfully . 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>

t cell immunity and hepatitis c virus reinfection after cure of chronic hepatitis c with an interferon free antiviral regimen in a chimpanzee . memory cd8 t cells generated by spontaneous resolution of hepatitis c virus hcv infection rapidly control secondary infections and reduce the risk of virus persistence . here cd8 t cell immunity and response to reinfection were assessed in a chimpanzee cured of an earlier chronic infection with an interferon ifn free antiviral regimen . cd8 t cells expanded from liver immediately before and 2 years after cure of chronic infection with two direct acting antivirals daas targeted epitopes in the e2 nonstructural ns
 and ns
 proteins . a second infection to assess cd8 t cell responsiveness resulted in rapid suppression of hcv replication by week 2 but viremia rebounded 3 weeks later and the infection persisted . the e2 ns
 and ns
 proteins remained dominant cd8 t cell targets after reinfection . resurgent hcv replication was temporally associated with mutational escape of ns
 and ns
 class i epitopes that had also mutated during the first chronic infection . two epitopes in e2 remained intact throughout both persistent infections . intrahepatic cd8 t cells targeting intact and escape prone epitopes differed in expression of phenotypic markers of functional exhaustion 2 years after successful daa therapy and in the capacity to expand in liver upon reinfection . abstracttext memory cd8 t cells generated by spontaneous resolution of hepatitis c virus hcv infection rapidly control secondary infections and reduce the risk of virus persistence . here cd8 t cell immunity and response to reinfection were assessed in a chimpanzee cured of an earlier chronic infection with an interferon ifn free antiviral regimen . cd8 t cells expanded from liver immediately before and 2 years after cure of chronic infection with two direct acting antivirals daas targeted epitopes in the e2 nonstructural ns
 and ns
 proteins . a second infection to assess cd8 t cell responsiveness resulted in rapid suppression of hcv replication by week 2 but viremia rebounded 3 weeks later and the infection persisted . the e2 ns
 and ns
 proteins remained dominant cd8 t cell targets after reinfection . resurgent hcv replication was temporally associated with mutational escape of ns
 and ns
 class i epitopes that had also mutated during the first chronic infection . two epitopes in e2 remained intact throughout both persistent infections . intrahepatic cd8 t cells targeting intact and escape prone epitopes differed in expression of phenotypic markers of functional exhaustion 2 years after successful daa therapy and in the capacity to expand in liver upon reinfection . conclusions the intrahepatic hcv specific cd8 t cell repertoire established during chronic infection was narrowly focused but very stable after cure with daa . existing intrahepatic cd8 t cells targeting dominant epitopes of the challenge virus failed to prevent persistence . vaccination after daa cure may be necessary to broaden t cell responses and reduce the risk of a second persistent infection .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: t cell immunity and hepatitis c virus reinfection after cure of chronic hepatitis c with an interferon free antiviral regimen in a chimpanzee . memory cd8 t cells generated by spontaneous resolution of hepatitis c virus hcv infection rapidly control secondary infections and reduce the risk of virus persistence . here cd8 t cell immunity and response to reinfection were assessed in a chimpanzee cured of an earlier chronic infection with an interferon ifn free antiviral regimen . cd8 t cells expanded from liver immediately before and 2 years after cure of chronic infection with two direct acting antivirals daas targeted epitopes in the e2 nonstructural ns
 and ns
 proteins . a second infection to assess cd8 t cell responsiveness resulted in rapid suppression of hcv replication by week 2 but viremia rebounded 3 weeks later and the infection persisted . the e2 ns
 and ns
 proteins remained dominant cd8 t cell targets after reinfection . resurgent hcv replication was temporally associated with mutational escape of ns
 and ns
 class i epitopes that had also mutated during the first chronic infection . two epitopes in e2 remained intact throughout both persistent infections . intrahepatic cd8 t cells targeting intact and escape prone epitopes differed in expression of phenotypic markers of functional exhaustion 2 years after successful daa therapy and in the capacity to expand in liver upon reinfection . abstracttext memory cd8 t cells generated by spontaneous resolution of hepatitis c virus hcv infection rapidly control secondary infections and reduce the risk of virus persistence . here cd8 t cell immunity and response to reinfection were assessed in a chimpanzee cured of an earlier chronic infection with an interferon ifn free antiviral regimen . cd8 t cells expanded from liver immediately before and 2 years after cure of chronic infection with two direct acting antivirals daas targeted epitopes in the e2 nonstructural ns
 and ns
 proteins . a second infection to assess cd8 t cell responsiveness resulted in rapid suppression of hcv replication by week 2 but viremia rebounded 3 weeks later and the infection persisted . the e2 ns
 and ns
 proteins remained dominant cd8 t cell targets after reinfection . resurgent hcv replication was temporally associated with mutational escape of ns
 and ns
 class i epitopes that had also mutated during the first chronic infection . two epitopes in e2 remained intact throughout both persistent infections . intrahepatic cd8 t cells targeting intact and escape prone epitopes differed in expression of phenotypic markers of functional exhaustion 2 years after successful daa therapy and in the capacity to expand in liver upon reinfection . conclusions the intrahepatic hcv specific cd8 t cell repertoire established during chronic infection was narrowly focused but very stable after cure with daa . existing intrahepatic cd8 t cells targeting dominant epitopes of the challenge virus failed to prevent persistence . vaccination after daa cure may be necessary to broaden t cell responses and reduce the risk of a second persistent 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>

successful tenofovir treatment for fulminant hepatitis b infection in an infant . fulminant hepatic failure is defined by the presence of severe impairment of liver function with or without encephalopathy in patients with no underlying chronic liver disease . we report the case of a 4 month old infant who developed fulminant hepatitis b infection and recovered concomitant with tenofovir therapy without liver transplantation .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: successful tenofovir treatment for fulminant hepatitis b infection in an infant . fulminant hepatic failure is defined by the presence of severe impairment of liver function with or without encephalopathy in patients with no underlying chronic liver disease . we report the case of a 4 month old infant who developed fulminant hepatitis b infection and recovered concomitant with tenofovir therapy without 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>

pathologic femoral neck fracture due to fanconi syndrome induced by adefovir dipivoxil therapy for hepatitis
in fanconi syndrome hypophosphatemic osteomalacia is caused by proximal renal tubule dysfunction which leads to impaired reabsorption of amino acids glucose urate and phosphate . we present a rare case of a 43 year old korean male who was found to have insufficiency stress fracture of the femoral neck secondary to osteomalacia due to fanconi syndrome . he had been receiving low dose adefovir dipivoxil adv 10 mg day for the treatment of chronic hepatitis b virus infection for 7 years and he subsequently developed severe hypophosphatemia and proximal renal tubule dysfunction . the incomplete femoral neck fracture was fixed with multiple cannulated screws to prevent further displacement of the initial fracture . after cessation of adv and correction of hypophosphatemia with oral phosphorus supplementation the patient clinical symptoms such as bone pain muscle weakness and laboratory findings improved .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: pathologic femoral neck fracture due to fanconi syndrome induced by adefovir dipivoxil therapy for hepatitis
in fanconi syndrome hypophosphatemic osteomalacia is caused by proximal renal tubule dysfunction which leads to impaired reabsorption of amino acids glucose urate and phosphate . we present a rare case of a 43 year old korean male who was found to have insufficiency stress fracture of the femoral neck secondary to osteomalacia due to fanconi syndrome . he had been receiving low dose adefovir dipivoxil adv 10 mg day for the treatment of chronic hepatitis b virus infection for 7 years and he subsequently developed severe hypophosphatemia and proximal renal tubule dysfunction . the incomplete femoral neck fracture was fixed with multiple cannulated screws to prevent further displacement of the initial fracture . after cessation of adv and correction of hypophosphatemia with oral phosphorus supplementation the patient clinical symptoms such as bone pain muscle weakness and laboratory findings improved . 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 treatment of fibrosing cholestatic hepatitis with daclatasvir and asunaprevir after liver transplantation a case report . background fibrosing cholestatic hepatitis fch is an aggressive form of hepatitis c virus hcv recurrence after liver transplantation lt . most fch cases are fatal occurring as a secondary disease following rapidly progressive liver dysfunction and graft failure . we report a case of early onset fch after lt that was successfully treated using daclatasvir and asunaprevir . case report a 59 year old woman underwent living donor lt for hcv related liver cirrhosis . however liver function was not improved after lt and gradually worsened . a liver biopsy was performed at 30 and 47 days after the living donor lt to identify the cause of the liver dysfunction . the first biopsy result showed no specific finding . however combined treatment with pegylated interferon and ribavirin was started because of a high hcv viral load gt _decnum_ log iu ml . nevertheless liver function and hcv viral load deteriorated and the second biopsy performed on postoperative day 47 revealed fch . we converted the antiviral agents into daclatasvir and asunaprevir and performed plasmapheresis twice . since then the liver dysfunction and hcv viral load gradually improved and hcv rna clearance occurred at week 11 after treatment . the patient achieved a sustained virologic response at week 24 after completion of the treatment . conclusion daclatasvir combined with asunaprevir can be a useful treatment option in potentially fatal fch after lt .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: successful treatment of fibrosing cholestatic hepatitis with daclatasvir and asunaprevir after liver transplantation a case report . background fibrosing cholestatic hepatitis fch is an aggressive form of hepatitis c virus hcv recurrence after liver transplantation lt . most fch cases are fatal occurring as a secondary disease following rapidly progressive liver dysfunction and graft failure . we report a case of early onset fch after lt that was successfully treated using daclatasvir and asunaprevir . case report a 59 year old woman underwent living donor lt for hcv related liver cirrhosis . however liver function was not improved after lt and gradually worsened . a liver biopsy was performed at 30 and 47 days after the living donor lt to identify the cause of the liver dysfunction . the first biopsy result showed no specific finding . however combined treatment with pegylated interferon and ribavirin was started because of a high hcv viral load gt _decnum_ log iu ml . nevertheless liver function and hcv viral load deteriorated and the second biopsy performed on postoperative day 47 revealed fch . we converted the antiviral agents into daclatasvir and asunaprevir and performed plasmapheresis twice . since then the liver dysfunction and hcv viral load gradually improved and hcv rna clearance occurred at week 11 after treatment . the patient achieved a sustained virologic response at week 24 after completion of the treatment . conclusion daclatasvir combined with asunaprevir can be a useful treatment option in potentially fatal fch after lt . 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>

rehabilitation with ear prosthesis linked to osseointegrated implants . background the absence of an ear which can be the result of a congenital malformation surgical tumour resection or traumatic injury is a significant aesthetic problem . attachment of ear prostheses with adhesives can cause local irritation for the wearer and affect the colour of the prostheses . use of implants in craniofacial reconstruction can improve the retention and stability of prostheses giving to patient greater comfort and security relative to adhesive attachment . objective the aim of this report was to present a clinical case of a mutilated patient who was rehabilitated by means of installing an ear prosthesis fixed through osseointegrated implants . materials and methods the patient had two implants installed in the mastoid region that were linked by a bar and a clip type system was used . the ear prosthesis was constructed from medical use silicone pigmented to match the patient skin colour and linked to the retention system . conclusion the patient rehabilitation was satisfactory from both a functional and an aesthetic point of view making it possible for the patient to return to a normal social life and regain lost self esteem .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: rehabilitation with ear prosthesis linked to osseointegrated implants . background the absence of an ear which can be the result of a congenital malformation surgical tumour resection or traumatic injury is a significant aesthetic problem . attachment of ear prostheses with adhesives can cause local irritation for the wearer and affect the colour of the prostheses . use of implants in craniofacial reconstruction can improve the retention and stability of prostheses giving to patient greater comfort and security relative to adhesive attachment . objective the aim of this report was to present a clinical case of a mutilated patient who was rehabilitated by means of installing an ear prosthesis fixed through osseointegrated implants . materials and methods the patient had two implants installed in the mastoid region that were linked by a bar and a clip type system was used . the ear prosthesis was constructed from medical use silicone pigmented to match the patient skin colour and linked to the retention system . conclusion the patient rehabilitation was satisfactory from both a functional and an aesthetic point of view making it possible for the patient to return to a normal social life and regain lost self esteem . 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>

urticaria and periorbital edema as prodromal presenting signs of acute hepatitis b infection . a 34 year old patient presented with giant transient urticarial skin lesions and periorbital edema after a 3 month stay in dr congo . retrospective analysis of stored samples revealed that these signs were prodromal manifestations of acute hepatitis b infection . the hepatitis b infection was spontaneously cleared the skin lesion did not recur .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: urticaria and periorbital edema as prodromal presenting signs of acute hepatitis b infection . a 34 year old patient presented with giant transient urticarial skin lesions and periorbital edema after a 3 month stay in dr congo . retrospective analysis of stored samples revealed that these signs were prodromal manifestations of acute hepatitis b infection . the hepatitis b infection was spontaneously cleared the skin lesion did not recur . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

a case of synthetic oestrogen induced autoimmune hepatitis with microvesicular steatosis . what is known and objective drug induced liver injury dili is a leading cause of acute liver failure in developed countries . hepatotoxicity is a well recognized adverse effect associated with synthetic oestrogens which can cause cholestasis . the current report describes ethinyloestradiol ee2 associated highly unusual adverse effects of autoimmune hepatitis aih and microvesicular steatosis ms . dili that fulfils the criteria for aih is referred to as drug induced autoimmune hepatitis diaih . ms is a potentially severe liver lesion that results from mitochondrial dysfunction . we explore the pathophysiological mechanisms underlying diaih and
case summary a 51 year old woman presented with jaundice increased liver enzymes and igg and positive ana . she had been taking ee2 for 3 years . liver biopsy showed prominent interface hepatitis with
a drug lymphocyte stimulation test dlst using ee2 was positive . the liver biochemical parameters had normalized after the ee2 discontinuation however they exacerbated 5 months post onset . repeated liver biopsy showed interface hepatitis with no
considering ee2 induced diaih corticosteroids treatment was initiated . then all liver biochemical parameters had normalized and the corticosteroids were successfully withdrawn . the patient continued to be in complete remission over the next 3 years . what is new and conclusion five remarkable points should be emphasized i a long latency interval despite the acute presentation ii exacerbation of liver biochemical parameters even after drug cessation iii the paired liver biopsies indicating continuing inflammation and disappearance of toxic features iv a positive dlst and the absence of fibrosis consistent with diaih and not aih and v a rare histological feature of
intense immunoallergic reactions were likely triggers of ms in the current case . a possibility of diaih should be considered in cases of dili which exhibit overt jaundice autoantibodies intense histological inflammation and a long latency period .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: a case of synthetic oestrogen induced autoimmune hepatitis with microvesicular steatosis . what is known and objective drug induced liver injury dili is a leading cause of acute liver failure in developed countries . hepatotoxicity is a well recognized adverse effect associated with synthetic oestrogens which can cause cholestasis . the current report describes ethinyloestradiol ee2 associated highly unusual adverse effects of autoimmune hepatitis aih and microvesicular steatosis ms . dili that fulfils the criteria for aih is referred to as drug induced autoimmune hepatitis diaih . ms is a potentially severe liver lesion that results from mitochondrial dysfunction . we explore the pathophysiological mechanisms underlying diaih and
case summary a 51 year old woman presented with jaundice increased liver enzymes and igg and positive ana . she had been taking ee2 for 3 years . liver biopsy showed prominent interface hepatitis with
a drug lymphocyte stimulation test dlst using ee2 was positive . the liver biochemical parameters had normalized after the ee2 discontinuation however they exacerbated 5 months post onset . repeated liver biopsy showed interface hepatitis with no
considering ee2 induced diaih corticosteroids treatment was initiated . then all liver biochemical parameters had normalized and the corticosteroids were successfully withdrawn . the patient continued to be in complete remission over the next 3 years . what is new and conclusion five remarkable points should be emphasized i a long latency interval despite the acute presentation ii exacerbation of liver biochemical parameters even after drug cessation iii the paired liver biopsies indicating continuing inflammation and disappearance of toxic features iv a positive dlst and the absence of fibrosis consistent with diaih and not aih and v a rare histological feature of
intense immunoallergic reactions were likely triggers of ms in the current case . a possibility of diaih should be considered in cases of dili which exhibit overt jaundice autoantibodies intense histological inflammation and a long latency period . 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>

myasthenia crisis induced by pegylated interferon in patient with chronic hepatitis c a case report . myasthenia gravis is occasionally associated with thymoma that needs surgical resection and may progress to severe respiratory failure . we experienced a rare case of myasthenia crisis during antiviral therapy for chronic hepatitis c in whom mediastinal thymoma was discovered and successfully managed with surgical thymectomy and meticulous medical care . a 47 year old male patient complained of sudden diplopia 1 week after stopping 11 week administration of pegylated interferon and ribavirin for chronic hepatitis
ophthalmologic examinations revealed ptosis on the right eyelid and restricted right eye movement . myasthenia gravis was confirmed by positive repetitive nerve stimulation test and positive serum antiacetylcholine receptor antibody test and mediastinal thymoma was found on chest ct scan . the ocular myasthenia gravis progressed to respiratory failure even after discontinuing antiviral treatment but eventually recovered with thymectomy anticholinesterase administration steroid pulse therapy and prolonged ventilator care . we describe the clinical features of this life threatening complication of interferon treatment along with previous myasthenia crisis cases by interferon for chronic hepatitis
in patients with chronic hepatitis c who is going to receive interferon based antiviral treatment physicians need to keep in mind the potential life threatening manifestations of myasthenia gravis before and during antiviral treatment especially when patients complain of muscular weakness and easy fatigability .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: myasthenia crisis induced by pegylated interferon in patient with chronic hepatitis c a case report . myasthenia gravis is occasionally associated with thymoma that needs surgical resection and may progress to severe respiratory failure . we experienced a rare case of myasthenia crisis during antiviral therapy for chronic hepatitis c in whom mediastinal thymoma was discovered and successfully managed with surgical thymectomy and meticulous medical care . a 47 year old male patient complained of sudden diplopia 1 week after stopping 11 week administration of pegylated interferon and ribavirin for chronic hepatitis
ophthalmologic examinations revealed ptosis on the right eyelid and restricted right eye movement . myasthenia gravis was confirmed by positive repetitive nerve stimulation test and positive serum antiacetylcholine receptor antibody test and mediastinal thymoma was found on chest ct scan . the ocular myasthenia gravis progressed to respiratory failure even after discontinuing antiviral treatment but eventually recovered with thymectomy anticholinesterase administration steroid pulse therapy and prolonged ventilator care . we describe the clinical features of this life threatening complication of interferon treatment along with previous myasthenia crisis cases by interferon for chronic hepatitis
in patients with chronic hepatitis c who is going to receive interferon based antiviral treatment physicians need to keep in mind the potential life threatening manifestations of myasthenia gravis before and during antiviral treatment especially when patients complain of muscular weakness and easy fatigability . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

a rare variant of the ulnar artery with important clinical implications a case report . background variations in the major arteries of the upper limb are estimated to be present in up to one fifth of people and may have significant clinical implications . case presentation during routine cadaveric dissection of a 69 year old fresh female cadaver a superficial brachioulnar artery with an aberrant path was found bilaterally . the superficial brachioulnar artery originated at midarm level from the brachial artery pierced the brachial fascia immediately proximal to the elbow crossed superficial to the muscles that originated from the medial epicondyle and ran over the pronator teres muscle in a doubling of the antebrachial fascia . it then dipped into the forearm fascia in the gap between the flexor carpi radialis and the palmaris longus . subsequently it ran deep to the palmaris longus muscle belly and superficially to the flexor digitorum superficialis muscle reaching the gap between the latter and the flexor carpi ulnaris muscle where it assumed is usual position lateral to the ulnar nerve . conclusion as far as the authors could determine this variant of the superficial brachioulnar artery has only been described twice before in the literature . the existence of such a variant is of particular clinical significance as these arteries are more susceptible to trauma and can be easily confused with superficial veins during medical and surgical procedures potentially leading to iatrogenic distal limb ischemia .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: a rare variant of the ulnar artery with important clinical implications a case report . background variations in the major arteries of the upper limb are estimated to be present in up to one fifth of people and may have significant clinical implications . case presentation during routine cadaveric dissection of a 69 year old fresh female cadaver a superficial brachioulnar artery with an aberrant path was found bilaterally . the superficial brachioulnar artery originated at midarm level from the brachial artery pierced the brachial fascia immediately proximal to the elbow crossed superficial to the muscles that originated from the medial epicondyle and ran over the pronator teres muscle in a doubling of the antebrachial fascia . it then dipped into the forearm fascia in the gap between the flexor carpi radialis and the palmaris longus . subsequently it ran deep to the palmaris longus muscle belly and superficially to the flexor digitorum superficialis muscle reaching the gap between the latter and the flexor carpi ulnaris muscle where it assumed is usual position lateral to the ulnar nerve . conclusion as far as the authors could determine this variant of the superficial brachioulnar artery has only been described twice before in the literature . the existence of such a variant is of particular clinical significance as these arteries are more susceptible to trauma and can be easily confused with superficial veins during medical and surgical procedures potentially leading to iatrogenic distal limb ischemia . 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>

ns
 resistance leading to failure of 24 week therapy with sofosbuvir ledipasvir and ribavirin for the treatment of hepatitis c genotype
 infection in a hiv 1 co infected patient . herein we report a previously undescribed case of treatment emergent non structural protein
 ns
 resistance mutations q3
 and y9
 leading to a failure of 24 week course of sofosbuvir ledipasvir ribavirin therapy for the treatment of hepatitis c virus hcv genotype
 in interferon experienced human immunodeficiency virus type 1 hiv 1 co infected patient with cirrhosis .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: ns
 resistance leading to failure of 24 week therapy with sofosbuvir ledipasvir and ribavirin for the treatment of hepatitis c genotype
 infection in a hiv 1 co infected patient . herein we report a previously undescribed case of treatment emergent non structural protein
 ns
 resistance mutations q3
 and y9
 leading to a failure of 24 week course of sofosbuvir ledipasvir ribavirin therapy for the treatment of hepatitis c virus hcv genotype
 in interferon experienced human immunodeficiency virus type 1 hiv 1 co infected patient with cirrhosis . 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>

cytomegalovirus reactivation induced acute hepatitis and gastric erosions in a patient with rheumatoid arthritis under treatment with an anti il 6 receptor antibody tocilizumab . tocilizumab an anti human interleukin 6 receptor il
 monoclonal antibody is widely used to treat rheumatoid arthritis ra and is expected to exhibit clinical efficacy when used to treat other autoimmune diseases . however a risk of opportunistic infection is occasionally recognized . a 54 year old woman had received an oral corticosteroid and methotrexate to treat ra . despite receiving these treatments she received additional treatment with tocilizumab due to poor control of the disease activity . she presented at our hospital with a high fever and epigastralgia 19 days after receiving this treatment . a laboratory evaluation revealed liver injury and cytomegalovirus cmv viremia . abdominal ultrasonography and computed tomography ct revealed hepatosplenomegaly but no ascites . upper gastrointestinal endoscopy revealed gastric erosions induced by cmv which were confirmed immunohistochemically . hence we diagnosed the patient with cmv reactivation induced acute hepatitis and gastric erosions under tocilizumab treatment . she received an anti cytomegalovirus drug ganciclovir for 14 days due to her viremia and impaired general condition which was suggestive of a severe infection . her general condition subsequently improved the liver function test results normalized and the gastric erosions disappeared . in conclusion although tocilizumab is very useful for treating certain autoimmune and inflammatory diseases and will be prescribed more widely in the future associated cmv infections must be closely monitored as these can be lethal .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: cytomegalovirus reactivation induced acute hepatitis and gastric erosions in a patient with rheumatoid arthritis under treatment with an anti il 6 receptor antibody tocilizumab . tocilizumab an anti human interleukin 6 receptor il
 monoclonal antibody is widely used to treat rheumatoid arthritis ra and is expected to exhibit clinical efficacy when used to treat other autoimmune diseases . however a risk of opportunistic infection is occasionally recognized . a 54 year old woman had received an oral corticosteroid and methotrexate to treat ra . despite receiving these treatments she received additional treatment with tocilizumab due to poor control of the disease activity . she presented at our hospital with a high fever and epigastralgia 19 days after receiving this treatment . a laboratory evaluation revealed liver injury and cytomegalovirus cmv viremia . abdominal ultrasonography and computed tomography ct revealed hepatosplenomegaly but no ascites . upper gastrointestinal endoscopy revealed gastric erosions induced by cmv which were confirmed immunohistochemically . hence we diagnosed the patient with cmv reactivation induced acute hepatitis and gastric erosions under tocilizumab treatment . she received an anti cytomegalovirus drug ganciclovir for 14 days due to her viremia and impaired general condition which was suggestive of a severe infection . her general condition subsequently improved the liver function test results normalized and the gastric erosions disappeared . in conclusion although tocilizumab is very useful for treating certain autoimmune and inflammatory diseases and will be prescribed more widely in the future associated cmv infections must be closely monitored as these can be lethal . 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>

interferon free therapy with sofosbuvir plus ribavirin for successful treatment of genotype 2 hepatitis c virus with lichen planus a case report . hepatitis c virus hcv infection remains the main cause of liver disease and can lead to chronic hepatitis cirrhosis and hepatocellular carcinoma . hcv may also develop extrahepatic manifestations in the skin eyes joints kidneys nervous system and immune system . in fact several studies reported that up to 70 of hcv patients experienced extrahepatic manifestations . lichen planus lp which is an immune system disorder that is triggered by viral infections allergens and stress can affect the skin mouth nails and scalp . the association of lp with hcv has been reported but the effect of hcv treatment on lp remission is controversial . we encountered a 53 year old man with hcv genotype
 and lp that were successfully treated with sofosbuvir and ribavirin for 12 weeks . after treatment he achieved sustained virological response against hcv and remission of erosive lp lesions on the lip . in the era of interferon ifn based treatment for hcv exacerbation of autoimmune diseases is a common adverse event . therefore use of an ifn free regimen of direct acting antivirals for hcv might prevent the extrahepatic manifestation of an immune disorder .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: interferon free therapy with sofosbuvir plus ribavirin for successful treatment of genotype 2 hepatitis c virus with lichen planus a case report . hepatitis c virus hcv infection remains the main cause of liver disease and can lead to chronic hepatitis cirrhosis and hepatocellular carcinoma . hcv may also develop extrahepatic manifestations in the skin eyes joints kidneys nervous system and immune system . in fact several studies reported that up to 70 of hcv patients experienced extrahepatic manifestations . lichen planus lp which is an immune system disorder that is triggered by viral infections allergens and stress can affect the skin mouth nails and scalp . the association of lp with hcv has been reported but the effect of hcv treatment on lp remission is controversial . we encountered a 53 year old man with hcv genotype
 and lp that were successfully treated with sofosbuvir and ribavirin for 12 weeks . after treatment he achieved sustained virological response against hcv and remission of erosive lp lesions on the lip . in the era of interferon ifn based treatment for hcv exacerbation of autoimmune diseases is a common adverse event . therefore use of an ifn free regimen of direct acting antivirals for hcv might prevent the extrahepatic manifestation of an immune 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>

transient vitreomacular traction syndrome caused by traumatic incomplete posterior vitreous detachment . purpose to report transient vitreomacular traction vmt syndrome following acute blunt trauma associated with incomplete posterior vitreous detachment . methods the authors present the analysis of 2 eyes of consecutive patients with acute vmt following mild blunt trauma . both patients reported a sudden decrease in visual acuity and metamorphopsia . spectral domain optical coherence tomography oct images showed typical vmt syndrome . results the development of complete posterior vitreous detachment demonstrated by oct after 15 and 30 days respectively was associated with complete resolution of symptoms and complete recovery of foveal architecture . conclusions the authors report spontaneous resolution of vmt associated with blunt trauma . as spontaneous resolution may occur in some eyes with vmt following traumatic acute incomplete vitreous detachment a period of observation may be considered prior to vitrectomy . spectral domain oct is a useful tool in following the evolution of these patients .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: transient vitreomacular traction syndrome caused by traumatic incomplete posterior vitreous detachment . purpose to report transient vitreomacular traction vmt syndrome following acute blunt trauma associated with incomplete posterior vitreous detachment . methods the authors present the analysis of 2 eyes of consecutive patients with acute vmt following mild blunt trauma . both patients reported a sudden decrease in visual acuity and metamorphopsia . spectral domain optical coherence tomography oct images showed typical vmt syndrome . results the development of complete posterior vitreous detachment demonstrated by oct after 15 and 30 days respectively was associated with complete resolution of symptoms and complete recovery of foveal architecture . conclusions the authors report spontaneous resolution of vmt associated with blunt trauma . as spontaneous resolution may occur in some eyes with vmt following traumatic acute incomplete vitreous detachment a period of observation may be considered prior to vitrectomy . spectral domain oct is a useful tool in following the evolution of these patients . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 0 </s>

drug induced lung injury associated with combination therapy of daclatasvir and asunaprevir the first case report . combination therapy with direct acting antiviral agents daas without interferon ifn has emerged as a treatment for chronic hepatitis c because of its high overall sustained virologic response rates and favorable side effect profile as compared to that with interferon . we report the first case of drug induced lung injury dli associated with ifn free therapy with the daas daclatasvir ns
 inhibitor and asunaprevir ns3
 protease inhibitor . although this combination therapy of daas has been considered to have fewer side effects than ifn more attention should be paid to dli as an important side effect .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: drug induced lung injury associated with combination therapy of daclatasvir and asunaprevir the first case report . combination therapy with direct acting antiviral agents daas without interferon ifn has emerged as a treatment for chronic hepatitis c because of its high overall sustained virologic response rates and favorable side effect profile as compared to that with interferon . we report the first case of drug induced lung injury dli associated with ifn free therapy with the daas daclatasvir ns
 inhibitor and asunaprevir ns3
 protease inhibitor . although this combination therapy of daas has been considered to have fewer side effects than ifn more attention should be paid to dli as an important side effect . 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>

fitz hugh curtis syndrome abdominal pain in women of 26 years old . fitz hugh curtis syndrome is an inflammation of the liver capsule as a complication of pelvic inflammatory disease whose etiologic agent is the most common
trachomatis . the acute phase fitz hugh curtis syndrome may present with pain in upper right quadrant abdomen commonly confused with other diseases of the hepatobiliary and gastrointestinal tract . definitive diagnosis is now possible for non invasive techniques such as ultrasound computed tomography as well as techniques for the isolation of the germ responsible available in most centers .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: fitz hugh curtis syndrome abdominal pain in women of 26 years old . fitz hugh curtis syndrome is an inflammation of the liver capsule as a complication of pelvic inflammatory disease whose etiologic agent is the most common
trachomatis . the acute phase fitz hugh curtis syndrome may present with pain in upper right quadrant abdomen commonly confused with other diseases of the hepatobiliary and gastrointestinal tract . definitive diagnosis is now possible for non invasive techniques such as ultrasound computed tomography as well as techniques for the isolation of the germ responsible available in most centers . Choose a digit corresponding to the correct answer from below list: 1. This report is about Hepatitis 0. This report is not about Hepatitis [/INST] Answer: 1 </s>

a novel surgical approach to refractory hepatic hydrothorax . hepatic hydrothorax is defined as the presence of a pleural effusion in a patient with liver cirrhosis in the absence of cardiopulmonary disease and it is a devastating complication impairing quality of life in the end stage of liver disease . the management of the effusion is challenging and chest tube drainage can sometimes cause more serious complications by removing massive amounts of protein rich fluid . though the most plausible mechanism is the influx of ascites to the pleural cavity through a small diaphragmatic defect the defect often cannot be found . hepatic hydrothorax could be controlled by repairing an invisible defect of the diaphragm . with pneumoperitoneum after intraperitoneal administration of indocyanine green the defect clearly dyed green appeared on the diaphragm . this novel combination technique could be useful for ensuring the surgical repair of an invisible diaphragmatic defect .

<s>[INST] Analyze the following case report to determine if it is about Hepatitis or not: a novel surgical approach to refractory hepatic hydrothorax . hepatic hydrothorax is defined as the presence of a pleural effusion in a patient with liver cirrhosis in the absence of cardiopulmonary disease and it is a devastating complication impairing quality of life in the end stage of liver disease . the management of the effusion is challenging and chest tube drainage can sometimes cause more serious complications by removing massive amounts of protein rich fluid . though the most plausible mechanism is the influx of ascites to the pleural cavity through a small diaphragmatic defect the defect often cannot be found . hepatic hydrothorax could be controlled by repairing an invisible defect of the diaphragm . with pneumoperitoneum after intraperitoneal administration of indocyanine green the defect clearly dyed green appeared on the diaphragm . this novel combination technique could be useful for ensuring the surgical repair of an invisible diaphragmatic defect . 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>