Datasets:

hippocrates

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Multicare_common_train

like 0

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 40-year-old male patient presented with back pain and focal sensory and motor deficits. Magnetic resonance imaging (MRI) spine revealed a well-circumscribed intramedullary space-occupying lesion in C6-D2 region with contrast enhancement [Figure 1a]. Complete excision of the tumor was done. Intraoperative squash cytology was performed. The smears were cellular and composed of cohesive clusters of round to oval cells with bland nuclei and salt and pepper type of chromatin. No necrosis or mitosis was detected. Atypia was absent. In some places, thick bottle brush appearance was noted [Figure 1b-d]. The histopathological sections showed well-formed papillae and finger-like projections lined by single or multiple layers of tumor cells. Several perivascular pseudorosettes and ependymal canals were noted. The tumor cells were monopolar and cuboidal or columnar in shape with a moderate amount of cytoplasm and bland nuclei having speckled chromatin. A smooth surface was formed by the apical surfaces of the tumor cells. The tumor lacked nuclear hobnailing. There was no evidence of necrosis, microvascular proliferation, endothelial proliferation, or mitosis. The tumor stained strongly for glial fibrillary acidic protein (GFAP) which was highlighted in the processes of perivascular pseudorosettes [Figure 2a-c]. It also showed positive staining for S100 and vimentin. Epithelial membrane antigen (EMA) showed apical membrane positivity [Figure 2d]. The tumor was negative for CK and synaptophysin. Ki-67 labeling index was 5%.\nOUTPUT:" }, { "from": "agent", "value": "Papillary Ependymoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 59-year-old woman presenting with facial erythema and polyarthralgia was diagnosed with rheumatoid arthritis and treated by methotrexate (Figure 1). She rapidly developed hepatic cytolysis that persisted after a switch to hydroxychloroquine. Three months later, she developed vesicles and pustules on the shoulders, which firstly responded to a local corticosteroid treatment. The appearance of large cutaneous erosions on the back, chest, arms and the legs and necrotic skin lesions over the elbows and the ankles one month later led to suspect a Lyell syndrome, justifying her admission in the hospital. Cutaneous lesions of this patient have previously been described in a short letter. Her past medical history included a splenectomy for idiopathic thrombocytopenic purpura at the age of 37 years, an allergic asthma and a nasal polyposis. At the time of diagnosis, the patient showed anemia and moderate hepatic cytolysis (Table 1). Presence of antinuclear antibodies (ANA) was revealed by indirect immunofluorescence (IIF) on Hep-2 cells (Euroimmun , Germany) with the association of a homogenous staining, multiple nuclear dots pattern, anti-Golgi apparatus pattern, and rare isolated cytoplasmic islets positivity (Figure 2). Antigenic specificity was studied by immunodots (Euroimmun , Autoimmune Inflammatory Myopathies and Autoimmune Hepatopathies, Germany) using the systems EUROBlotMaster and EUROLineScan (Euroimmun , Germany), and revealed high levels of anti-MDA5 (with an intensity of the antigen band superior to 10-fold the positive threshold), anti-SSA 52 (Trim 21) and anti-Sp-100 autoantibodies. During the time of her hospitalization, the cutaneous erosions spread rapidly and reached 40% of the body surface. Because of a concomitant respiratory distress, a systemic immunosuppressive treatment with 500 mg/day of methylprednisolone for 3 days was initiated, followed by 1.5 mg/kg of prednisone per day and one pulse of 0.6 g/m2 of cyclophosphamide. Despite this treatment, a diffuse interstitial pneumonitis rapidly developed, followed by a mesenteric thrombosis with multiple organ failure and a septic shock. The patient ultimately died from a systemic infection, 3 weeks only after diagnosis.\nOUTPUT:" }, { "from": "agent", "value": "Interstitial Lung Disease, Anti-MDA5 Antibody in Clinically Amyopathic Dermatomyositis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 59-year-old male, Kurdish in origin, came to our hospital with history of recurrent chronic diarrhoea for last eighteen years. Each episode of diarrhoea was lasting for more than a month and used to get relieved with antibiotics. The patient had also history of pulmonary tuberculosis and recurrent sinopulmonary infections. We evaluated him thoroughly for his chronic diarrhoea. His stool examination showed cyst of Giardia lamblia. His routine blood examination reports were normal. His chest X-ray showed hyperinflated lungs; there was pleural thickening with inhomogeneous opacities suggestive of fibrosis in right upper zone. Ultrasonography of whole abdomen was normal. His contrast-enhanced computerized tomography of chest and abdomen revealed right apical pleural thickening and fibrosis in upper lobe and bronchial wall thickening, paraseptal emphysema, and subcentimetric mediastinal lymphadenopathy (Figure 1). Transbronchial nodal aspiration done was inconclusive. His total colonoscopy and capsule endoscopy for small bowel were normal. His 24-hour urinary protein was within normal limits. Immunological work-up was done. His human immunodeficiency viral serology was nonreactive. CD3, CD4, and CD8 counts were 1208/microlitre, 475/microlitre, and 707/microlitre, respectively. Immunoglobulin levels were IgG < 200 mg/dL (791-1643), IgA < 6 mg/dL (60-436), and IgM < 25 mg/dL (43-279). There was selective deficiency of B-cell (humoral) immunity.\nOUTPUT:" }, { "from": "agent", "value": "Inflammatory Duodenal Polyposis, Primary Immunodeficiency Disease" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 64-year-old white male with no prior medical history presented to his primary care physician for routine follow-up. There was no history of hypertension. During work-up for elevated liver transaminases, he was found to have hepatitis C. Before initiation of Harvoni, he underwent CT imaging of the abdomen with contrast which found a 5 x 6.7 x 7 cm right adrenal mass (Figure 1). On physical examination, he was afebrile with a pulse of 47 and normotensive at 118/68. His abdominal exam was nontender, nondistended, without masses, or hernias. Review of systems was negative for abdominal pain, hypertension, weakness, palpitations, headache, diaphoresis, or weight gain. He was a current smoker with a 33 pack-year history. He had no history of endocrine disease. His family history was significant only for a father with pancreatic cancer. His remaining laboratory values were within normal values including a normal potassium value. The patient was seen by the endocrine service for evaluation, and biochemical work-up revealed that the ACTH level was 9.1 pg/ml (nl 7.2-63.3); AM cortisol was normal at 10.01 mcg/dl, and 24-hour urine metanephrines was less than 50 mcg (nl). On CT imaging, the right adrenal mass contained scattered calcifications with small regions of fat. It enhanced in a peripheral globular fashion with central progression. The absolute contrast washout of 22.9% was indeterminate for adrenal adenoma (Figure 1). The mass was noted to abut but did not appear to invade the adjacent liver, right kidney, and inferior vena cava. There was no adenopathy or free fluid. There was no evidence of metastatic disease. Due to the size and atypical features of the mass, right adrenalectomy was performed. An open thoracoabdominal approach was chosen due to the patient's low lying costal margin, the size of the mass, and retrocaval extension of the mass medially towards the vertebral body. The patient recovered well postoperatively and was discharged four days after surgery. The resected specimen weighed 126 grams and measured 7.5 x 6.5 x 4.7 cm on gross pathology (Figure 2). The patient has had no evidence of recurrence for nearly 18 months.\nOUTPUT:" }, { "from": "agent", "value": "Cavernous Hemangioma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: In the early 2000s, a 55-year-old man developed bilateral eyelid and thorax xanthelasmas (Figure 1A). The eyelid lesions relapsed rapidly after two surgical excisions. In 2011, blood tests revealed monocytosis, and in the following years, splenomegaly was detected. No further diagnostic or therapeutic approaches were applied due to the lack of systemic and specific organ symptoms, as well as blood test alterations. In 2017, the patient underwent left pleurodesis due to left pleuritis after a series of ineffective conservative treatments. Bioptic and cytologic materials revealed non-specific inflammation. The patient remained asymptomatic until October 2019, when he developed fatigue and breathlessness. An electrocardiogram demonstrated sinus tachycardia. Right pleural effusion was detected on chest X-ray. Blood tests confirmed monocytosis with dysmorphic, broken, and vacuolated monocytes on a blood smear. In addition, anemia and elevated C-reactive protein were observed. Notably, despite the history of xanthelasmas, cholesterol levels were low without lipid-lowering therapy. A chest CT scan detected nodular pleuro-pericardial lesions. Furthermore, cardiac MR revealed right atrial posterior wall and pericardial thickening. It also confirmed nodular pericardial and pleural lesions showing hyperemia and edema in T2-weighted sequences (Figure 1B). Specifically, the presence of xanthelasma, pleuro-pericardial involvement, and right atrial posterior wall thickening raised the suspicion of ECD.\nOUTPUT:" }, { "from": "agent", "value": "Erdheim-Chester disease, Constrictive pericarditis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 96-year-old woman fractured her thigh and was admitted to our hospital. Two weeks after open surgery, she noticed right hemiparesis. 1). A physical examination revealed that her body temperature was 36.9C, her blood pressure was 135/77 mmHg, and her pulse rate was 84 beats per minute. Auscultation revealed normal respiratory sounds. A Levine 2/6 diastolic murmur and Levine 2/6 systolic murmur were detected at the second right sternal border. A blood analysis revealed mild anemia (hemoglobin, 10.3 g/dL), hypercoagulability (D-dimer, 4.1 mug/mL), dyslipidemia (low density lipoprotein (LDL)-cholesterol level of 161.0 mg/dL), and a high plasma b-type natriuretic peptide level of 162.7 pg/mL. A 12-lead electrocardiogram (ECG) showed left axis deviation of the QRS wave, a high R wave in lead V5, and mild ST segment elevation in leads V1 to V3 (Fig. 2, left panel). Chest radiography revealed cardiomegaly with a cardiothoracic ratio of 63% (Fig. 2, right panel). A Holter electrocardiogram showed frequent premature atrial contraction, but no atrial fibrillation. A transthoracic echocardiogram showed a normal left ventricular (LV) wall thickness (the interventricular septum and LV were both 11 mm in thickness) and wall motion (LV end-diastolic dimension, 32 mm; LV end-systolic dimension, 18 mm; LV ejection fraction, 76%). There was a mobile structure originating from the ventricular side of the proximal part of the anterior mitral leaflet that was also attached to the interventricular septum as a chordae tendineae-like structure, which matched the diagnostic criteria for an AMV (Fig. 3). Color Doppler ECG showed mild aortic regurgitation. Surgical treatment was not considered because the AMV did not cause left ventricular outflow obstruction. The patient was treated with warfarin and was discharged after rehabilitation.\nOUTPUT:" }, { "from": "agent", "value": "Acute Multiple Cerebral Infarction, Accessory Mitral Valve" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 28-year-old female patient reported to the Oral and Maxillofacial Pathology Department of Guru Nanak Institute of Dental Sciences and Research, Kolkata, with a chief complaint of a swelling involving left half of her face for the past 7 months. Extra orally, there was presence of a diffuse swelling involving left maxillary middle third region, extending from the left half of upper lip to lower border of left eye with obliteration of nasolabial fold, causing obvious facial asymmetry. On palpation, swelling was bony hard, nontender and associated with the marked expansion of the mid-facial region. Overlying skin was free from underlying structure. There were neither neurological abnormalities nor any regional lymphadenopathy. There was no sign of epistaxis and nasal obstruction. Intraoral examination revealed a large, diffuse, erythematous, exophytic, multilobular swelling involving left maxillary region extending from 21 to 27 region with obliteration of left mucobuccal fold. Prominent vascular markings were also noted on the surface of the lesion. On palpation, the lesion was bony hard, nontender along with expansion of left buccal cortical plate. The regional teeth were mobile, and 23 was displaced [Figure 1]. Upper occlusal X-ray revealed the presence of a diffuse mixed radiographic lesion involving 21-26 region with characteristic sunray appearance. Computed tomographic view (CT scan) showed the presence of a large (3.5 cm x 4.5 cm x 4.8 cm) intraosseous lesion with \"sun burst\" appearance, involving left maxillary region along with intrusion of the lesion within left maxillary antrum [Figure 2]. Routine blood investigations were within normal limits except serum alkaline phosphatase level which was increased to 195.7 U/L. Based on the above clinical and radiological findings, a provisional diagnosis of osteosarcoma was made, and an incisional biopsy was performed under local anesthesia from the representative site. The light microscopic features revealed the presence of basophilic chondroid like material along with sheets of numerous small round cells on the superficial zone of the lesion. Cells of chondroid differentiation exhibited both nuclear and cellular pleomorphism along with nuclear hyperchromatism. Areas of partial calcifications and numerous slit-like vascular spaces were also observed [Figures 3 and 4]. The patient was advised for surgical treatment.\nOUTPUT:" }, { "from": "agent", "value": "Mesenchymal chondrosarcoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 75-year-old female with a history of epiretinal membrane (ERM) removal approximately 1 year prior to presentation to the office noted progressive vision loss 5 months following uncomplicated cataract surgery in the right eye. BCVA measured 20/40-2 and IOP was 7 mmHg. FA studies showed CME with disc leakage (Figure 2A) and OCT studies revealed cystic edema with a CMT of 461 microm (Figure 2A). She was started on bromfenac 0.07% once daily (QD) for 9 months prior to her presenting visit given her history of ERM. Given the increased edema on bromfenac alone, we switched her to difluprednate, nepafenac, and brinzolamide TID in the right eye. After 14 days, BCVA measured 20/25 with a CMT of 294 microm, a 167 microm improvement (Figure 2B), and her IOP was controlled at 13 mmHg. The difluprednate was tapered weekly and stopped after 4 weeks, and the nepafenac and brinzolamide were continued BID. At week 6, however, her vision decreased to 20/30 and the CME had recurred. She was once again started on a tapering course of difluprednate and asked to continue nepafenac and brinzolamide TID. After 3 additional months of continued treatment, her BCVA improved to 20/25 with CMT of 282 microm and reduction in CME (Figure 2C). She continues to be maintained on nepafenac and dorzolamide-timolol 2%/0.5% BID given her history of ERM removal. The highest measured IOP was 18 mmHg and no additional glaucoma medications were added.\nOUTPUT:" }, { "from": "agent", "value": "Cystoid macular edema" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 53-year old man came to an introductory meeting at a center for psychotherapy for low income persons (PAAT: Psicoterapia al Alcance de Todos) in Cuernavaca, Mexico. He described feelings of distress that had been present for about two years with an increasing tendency in the last year. The main complaint was a depressive mood, accompanied by extensive sleep disorders, problems with concentration and thinking, as well as increased anxiety. Besides reducing his feelings of well-being, the symptoms had led to an overall decrease in the level of social functioning, resulting in a sharp decrease of productivity at work. The key event leading to his decision to seek help was a panic attack with intense anxiety, tachycardia and chest pain, leading to a one-night hospitalization. Due to the extent of symptoms, the patient was prescribed an antidepressant (sertraline 100 mg/d) in combination with weekly psychotherapy sessions. It was not until the third session that the man found enough confidence in the therapeutic relationship to be able to disclose his sexual preferences. Already at an early age of ten years he had found pleasure in having objects inserted in his anus. His first such experience resulted in a playful interaction with a sexually aroused dog, which had mounted him while he was kneeling. The pleasure from the sexual act of the dog resulted in the man seeking similar actions also with other dogs. As the dogs were not always sexually aroused, he started inserting other objects, such as bottles, into his anus. It was not until the age of 19, after hearing of public restrooms where men sought sex with other men, that he first had sexual contacts with other men. Our subject was always the partner receiving anal intercourse from other men. These visits continued irregularly over the years, mainly due to fears of having these tendencies become known to his social surroundings. On the other hand, he regularly sought pleasure using dildos or other objects.\nOUTPUT:" }, { "from": "agent", "value": "Paraphilia, Depression" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 7-month-old female infant from a Sudanese western tribe was referred as a case of malnutrition. At presentation, the patient had confluent eyebrows that appeared arched and well-defined, long curly eyelashes, low front and back hairlines, turned-up nose, down-turned angles of the mouth and thin lips, long philtrum, small lower jaw and protruding upper jaw, microcephaly, excessive body hair, short neck, and small broad hands with simian crease and proximal insertion of the thumb, and clinodactyly of the fifth finger. X-ray showed delayed bone development. She had low-pitched cry, short neck with limited movement, stiff muscle tone (unable to sit, she was still fisting), fixed flexion of both elbows, and she did not show any sign of speaking or babble (Fig. 1 and 2). Moreover she had tied tongue and thin skin. Her brain stem evoked potential test showed conductive hearing loss. She was about 27 inches in length, her weight was 3 kilograms and there were no records about her birth weight. Her skull circumference was 35 cm. Finally, she showed a number of features not typical of BDLS, including crowded ribs by chest by X-ray (distance between each rib is short). Hepatomegally was shown by ultrasonography. Peripheral blood from the patient was subjected to short-term culture in RPMI 1640 medium for 72 hours. After metaphase arrest through exposure to Colcemide, cells were harvested, treated with hypotonic solution, and then fixed with methanol and acetic acid according to standard procedures. The harvested cells were dropped on clean slides and stained with Wright's stain, for chromosome banding. The clonality criteria and the karyotypic descriptions were according to the ISCN recommendations. Analysis of 11 metaphase cells showed 46, XX in all cells.\nOUTPUT:" }, { "from": "agent", "value": "Cornelia de Lange syndrome" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Sibling 1 (Person F on pedigree diagram in Figure 1) was a 63-year-old Caucasian male who presented to his family physician with symptoms of dizziness, headache, and unstable gait. Along with these symptoms, the patient complained of immediate memory loss, impairment of immediate recall, as well as slurred speech for several days. He denied any symptoms of nausea, vomiting, or visual loss. The patient had only a medical history that included gastroesophageal reflux disease, diabetes mellitus, inflammatory bowel syndrome, and arthritis. Other than a slight slurring of his speech, his physical exam was without overt abnormalities. He subsequently received a magnetic resonance imaging (MRI) evaluation, which revealed a mass in the left temporal lobe approximately measuring 4.6 x 3.6 x 4.5 cm. Another lesion was discovered in the left occipital lobe measuring 1.7 x 1.5 x 1.7 cm [Figure 2a and 2b]. Histological examination of fresh tissue revealed a malignant hypercellular astrocytoma with microvascularization, necrosis, abnormal mitoses, and bizarre nuclei [Figure 2c and 2d]. Consequently, neurosurgery was consulted and two days after having presented initially with his symptoms, the patient underwent a left awake pterional craniotomy with left anterior temporal lobectomy and resection of the left mesotemporal lobe with stealth navigation as well as placement of eight gliadel wafers. He was discharged two days later with no focal deficits. A month later, the patient returned to his physician complaining of headaches, speech alteration, and right sided weakness. The night before the onset of these new symptoms, the patient again had episodes of severe headaches. MRI was performed and showed increase in size of the two previously noted lesions. The patient underwent a repeat pterional craniotomy with resection of the tumor. The patient was discharged a week later with a walker. The patient died four months later.\nOUTPUT:" }, { "from": "agent", "value": "Familial glioblastoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 12-year-old male patient was adopted at three months old, his adoptive mother referred that he was born at term without complications and that his family history was unremarkable. Anatomo-pathological evaluation of the amputated arm showed a large and homogeneous tumor lesion (lesion length, width, and height: 14, 7.5, and 7 centimeters, respectively) originating from the shaft of the humerus, extending to the metaphysis, and expansively penetrating the surrounding soft tissue without compromising vascular structures. Histological examination also showed a malignant mesenchymal neoplastic lesion made up of epithelioid cells with increased nucleus-cytoplasm ratio, anisocytosis, anisokaryosis, and evident nucleoli. These cells were positive for vimentin and CD99 markers.\nOUTPUT:" }, { "from": "agent", "value": "Bone Fragility, Multiple Fractures, Osteosarcoma, Osteogenesis Imperfecta" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: He was initiated with a Lumis 150 ventilator (Resmed, San Diego, CA, USA) in pressure-support ventilation, ST mode. His settings were, IPAP of 22 cm H2O and EPAP 8 cm H2O, inspiration trigger medium, cycling trigger medium and Timin 0.8 s and Timax 1.5 s. An ABG was performed after the initiation of NIV showing a PaCO2 of 81 mmHg. When the ventilator traces were downloaded and reviewed using the Rescan (Resmed, San Diego, CA, USA), an intracycle asynchrony was noted (Figure 3A), This made us want to establish its nature. We hypostasized that it could either be a late cycling, an intracycle effort made by the patient or as a result of a non-compliant lung. The following morning we downloaded the ventilator traces with the additional monitoring. We clearly identified a late cycling of the device because, the thoracoabdominal movements change to expiration before the ventilator finishes delivering the breath in (Figure 3B). The settings were changed on the patient's own Lumis 150 ventilator by, decreasing the Ti minimum. The following morning we downloaded the ventilator traces, we found the late cycling had been resolved (Figure 3C). However, we noted, different PVAs (Figure 4A) that we could interpret as either late cyclings or intracycle efforts. We wanted to be sure if these could be signs of underassitance, as we could also see an ineffective effort. Once again, we used the Vivo 45 with the additional monitoring and identified some intracycle efforts, shown by an inspiration movement starting in the middle of a cycle and, as a new finding, there also appeared double triggering, which is shown as two cycles in the pressure and flow traces triggered by only one respiratory effort. All these PVA suggest \"air hunger\" (Figure 4B). Thus, we increased his IPAP by 2 cmH2O which led to the asynchronism to disappear (Figure 4C). The patient had been acclimatized to the Lumis 150 device and did not want to change device preferring to keep the Lumis 150.\nOUTPUT:" }, { "from": "agent", "value": "Bronchiectasis, Thoracic distention, Chronic hypercapnic respiratory failure" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: We then sought to conduct the age at diagnosis and survival time analyses in order to define the prognosis factor of two UM subtypes. The results are shown in Table 2 . It is worth mentioning that 60-year-old or older patients were highly risky to have UM. In addition, there was a distinct difference in the average survival day between IntSub1 and IntSub2 patients: 885.2667 and 617.0000 days, respectively. This indicated that the OS of UM patients could be foreknown dependent partly on which subgroup a patient is assigned to, to some extent. Besides, the patients in the IntSub1 were characterized by the average age of 60.3333 as well as the average OS of 885.2667 days, whereas those numbers in the IntSub2 were 65.6000 years old and 617.0000 days. Obviously, although the average age of the patients in the IntSub1 was only 5 years younger than that of their counterparts in IntSub2, they could live about 9 months longer than the patients in IntSub2. These results should be understood that age-related risks and survival rates might be separate in these integrative subgroups. For a better understanding, we took into account the risk of the two age groups in each subgroup comprising the mid-adults (21-65 years) and the older adults (>65 years) from the 80 UM patients (22-86 years old) in the clinical data. The reason we chose the threshold of 65 years old was because Figure 4A illustrates a bimodal age distribution, implying that we had two groups naturally. The two age groups, the non-old group and the old group, in each subgroup were interrogated by the survival analyses. Observing the results reported in Figure 4B , we revealed a significant survival difference between the two age groups in the IntSub2, whereas no statistical significance in patient outcome between the two age groups was seen in the IntSub1, indicating that age factor could be a risk factor to predict the survival time.\nOUTPUT:" }, { "from": "agent", "value": "Uveal Melanoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 51-year-old male with a medical history of hypertension (HTN), hyperlipidemia, cerebrovascular accident (CVA) with residual right-sided weakness, depression, and smoking was brought to the emergency department (ED) by Emergency Medical Services (EMS) after he was found unresponsive for more than 24 hours. At the time of the presentation, the patient could not remember the event and had slurred speech. He also complained of pain in the left shoulder and left knee. He did not complain of any nausea, vomiting, photophobia, any new weakness, nuchal rigidity, fever, or chills. He denied taking any drugs. On general examination, the patient was well-built and nourished but increasingly somnolent. His vitals at the time of presentation showed a blood pressure of 150/105 mmHg, heart rate of 97 beats per minute, and oxygen saturation of 98% at room air. His labs were significant for elevated white blood cells at 18,000/mm3, elevated creatinine at 1.7 mg/dL, and elevated high-sensitivity troponin level at 629 pg/mL (normal = 24-30 pg/mL). His electrocardiography (EKG) and chest X-ray were negative for any acute changes. His blood level of ethyl alcohol was less than 10. Although the patient denied drug usage since December 2021, his urine drug screen (UDS) was positive for opioids, cocaine, and cannabinoids. CT scan of the head was ordered which showed fairly symmetric parenchymal hypoattenuation involving cortical and subcortical white matter in the bilateral parietal and occipital lobes as well as the bilateral cerebellar hemispheres (Figure 1). A follow-up MRI of the brain showed fairly symmetric T2/fluid-attenuated inversion recovery (FLAIR) prolongation involving the cortex and subcortical white seen in the bilateral parietal and occipital lobes and the cerebellar hemispheres (Figure 2). There was no definite restricted diffusion. These findings were consistent with PRES. Computed tomography angiography (CTA) of the head and neck showed no large-vessel occlusion, aneurysm, or vascular malformation (Figures 3, 4). Based on his clinical and radiological findings, he was diagnosed with PRES. He was treated with lisinopril 40 mg and amlodipine 10 mg to reduce his blood pressure level by 20% during the initial 8-12 hours. With an improvement in blood pressure to the normal range, his clinical and neurological status gradually recovered to baseline.\nOUTPUT:" }, { "from": "agent", "value": "Posterior Reversible Encephalopathy Syndrome" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The indication for cardiac resynchronization therapy (CRT) was made. A 9 French (CPS Direct PL 115, St. Jude) CS sheath was inserted in the enlarged right atrium using left axillary venous access. However, right atrial enlargement makes it difficult for conventional electrophysiological catheters to enter the CS; even if the electrophysiological catheter can enter the CS, it is difficult to provide sufficient support to introduce the CS sheath into the CS. Using Lee's venogram balloon catheter, these difficulties can be easily overcome with the support of a Radifocus guidewire (Terumo Co., Japan) (Figure 4A and Video 3). The venogram showed a very angulated anterolateral side branch (Figure 4B and Video 3). The Radifocus guidewire was advanced in this side branch into the anterolateral branch. Lee's venogram balloon catheter subselectively entered the anterolateral side branch along the Radifocus guidewire (Figure 4C and Video 3). Then, the Radifocus guidewire was pulled out, and a runthrough-NS floppy guidewire (Terumo) was sent into the anterolateral side branch from the lumen of Lee's venogram balloon catheter. Negotiating the acute angle with the LV lead consistently pushed the CS guiding sheath back into the right atrium. Another runthrough-NS floppy guidewire was inserted into the anterolateral branch as a second wire to attempt to straighten the angle of the vessel (Figure 4D and Video 3). The positioning of this second guidewire against the vein's wall effectively reduced the acuteness of the angle of the side branch and provided enough support, which permitted the over the wire LV lead (Quartet 1458Q, St Jude Medical) to be further advanced over the runthrough-NS floppy guidewire to reach a stable pacing position (Figures 4E,F). Both wires were then retracted, leaving the LV lead in position. Pacing threshold was 1.2 V at a pulse width of 0.5 ms.\nOUTPUT:" }, { "from": "agent", "value": "Ischemic cardiomyopathy, Persistent atrial fibrillation, Drug refractory heart failure, Severe left ventricular dysfunction, Moderate mitral valve regurgitation, Left ventricular apical aneurysm" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: She had a medical history of rheumatic heart disease, with a previous mitral valve replacement with a tissue valve, atrial fibrillation with chronic anticoagulation and pacemaker placement, and coronary artery disease. She denied any cardiac symptoms except for mild shortness of breath on exertion. The patient was taking metoprolol, valsartan, aspirin, simvastatin, and warfarin. Her blood pressure was 150/81 mmHg, heart rate was 78 beats/min, and oxygen saturation was 98% on room air. Her heart beat was irregularly irregular without murmurs. Her lung sounds were clear. There was no pitting edema. Per the Revised Cardiac Risk Index (RCRI) for preoperative risk, the patient had one risk factor (coronary artery disease) with an expected risk of having a major postsurgical adverse cardiac event of 0.9%-1.1%. Per the American College of Cardiology/American Heart Association (ACC/AHA) guidelines on perioperative cardiac evaluation, she underwent robotic total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection, with continuation of metoprolol for heart rate control. Perioperatively, she was also bridged with low molecular weight heparin and unfractionated heparin. Her postoperative course was uneventful, and she was discharged on postoperative day (POD) 1 to home with home health services. She returned to the gynecology clinic 1 month later for surgical follow-up and was found to be doing well without any overt complications.\nOUTPUT:" }, { "from": "agent", "value": "Adenocarcinoma of the endometrium, FIGO grade 2" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: OLP, a 56-year-old male fashion designer, had a very unhappy childhood, with few friends and many arguments at home. At university, he underwent a substantial change, becoming extroverted, making a lot of friends, and travelling extensively. As a professional, he was very creative, had many friends, and enjoyed going out. His father, an alcoholic who was extremely verbally abusive, committed suicide at 60 years of age. About 13 years ago, OLP began to isolate himself from his friends and to become very nervous whenever he was with a lot of people. He had difficulty concentrating, lost his enthusiasm for work and his creativity, and seemed to have lost his love for life. During that same period, he felt irritated and was bothered by noise, often getting into arguments with his neighbors for that reason. At work, he would also argue with colleagues, becoming angry easily and later regretting his outbursts. Since that time he has been undergoing psychotherapy and for the past eight years has undergone psychiatric treatment. He has used venlafaxine, mirtazapine, these two drugs together, and bupropion; however, there has been no remission of the depressive symptoms. After two months on bupropion (300 mg/day) and lamotrigine (100 mg/day) without any satisfactory improvement, aripiprazole (10 mg/day) was added. After five days of this combination, he developed major psychomotor agitation, accompanied by increased anxiety and restlessness, and akathisia that did not allow him to sit still for even three minutes at a time. He was sleepless at night even when taking 120 mg of flurazepam and complained of marked tiredness and muscle pain. In addition, his suicidal thoughts intensified and he experienced extreme anguish. He was given 50 mg of clozapine and all the other drugs were discontinued. After 10 days there was a significant improvement in his sleeping, allowing him to return to work. In addition, his psychomotor agitation decreased and there was a partial improvement in his feelings of anguish. Nevertheless, depressive symptoms remained: negative thoughts, extreme apathy, indisposition, and poor concentration. He was prescribed imipramine 150 mg and lithium 450 mg. He remained stable, with mild depressive symptoms after nine months. In the case of this patient, there is no clear evidence of hypomanic episodes; however, there is a report of unusual moods during his time at university.\nOUTPUT:" }, { "from": "agent", "value": "Dysthymia, Double Depression, Type II Bipolar Disorder" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The proposita is the second of three siblings (Figure 1; individual 2 : 4), conceived when the mother was 21 years of age. Individual 2 : 4 was first consulted at 33 years of age upon referral for suspected infertility. Following a short course of ovulatory induction, this patient experienced an early pregnancy at age 36; however, that pregnancy resulted in spontaneous abortion at 36-week gestation (individual 3 : 3). Sporadic chromosomal abnormalities as well as both maternal and paternal meiotic errors may contribute to unsuccessful pregnancies of this type. Recently, individual 2 : 4 successfully conceived a male child (Individual 3 : 4) following assisted fertility therapy using donor ovum (from Individual 2 : 5) and partner sperm (from individual 2 : 3). That pregnancy lasted 37 weeks, and the progeny (individual 3 : 4) was born without complication. The patient had been previously investigated for suitability to in vitro fertilization, which had on that occasion confirmed ovarian resistance. Both the proband and her partner underwent chromosome analysis. Individual 2 : 3 was determined karyotypically normal (46XY). The couple was informed of potentially viable pregnancy outcomes, and it was explained that the translocation was the most likely cause of the apparent ovarian failure, owing to a relative X-monosomy with partial inactivation of the second X-chromosome. The likelihood of the production of a chromosome 18 trisomy, leading to Edwards syndrome was discussed. Consultation regarding assisted reproductive technologies and preimplantation genetic diagnosis were undertaken. Analysis of chromosomal segregation patterns showed that of the 16 possible segregations (meiotic), only 2 could yield normal or balanced gametes. The risk of producing potential carrier siblings was discussed (Table 1).\nOUTPUT:" }, { "from": "agent", "value": "Hypergonadotropic hypogonadism, Premature menopause, Balanced translocation of the long arms of an X-chromosome and the distal region of chromosome 18" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Among the seven patients, 5 completed the scheduled six rTMS sessions over three days. These 5 patients showed no adverse events during hospitalization. The other two studied patients (Patients 6 and 7) showed certain pathological reactions that could be considered adverse events of rTMS application. One patient experienced nausea, vomiting and headache after two sessions of rTMS. The other patient developed acute hypotension due to vasovagal reflex during the first session of rTMS. However, the symptoms were transient in both patients and disappeared within several hours without any medical intervention. Therefore, after more than 24 hours, one 25-minute session of 10-Hz high frequency rTMS with a stimulation intensity of 80% was administered to both patients. After the session with less intensity, none of the two patients showed any adverse symptoms. None of the seven patients experienced any pathological symptoms during the two-week period after discharge. Fig. 1a shows the effect of rTMS on the VAS rate. One hour after the first rTMS session, two patients showed a more than 30% decrease in the VAS rate. At discharge, five patients showed a more than 30% decrease in the rate. Of these, three patients exhibited a more than 50% decrease in the VAS rate. Furthermore, four patients showed a more than 30% decrease in one week and in three patients two weeks after discharge. The mean VAS rate decreased by 17% at one hour after the first rTMS session (p=0.59, Fig. 1b). The decrease in the rate from the baseline value before the first rTMS was significant not only at discharge, but also at one week after discharge (all ps <0.05). However, the decrease in the VAS rate relative to the baseline at two weeks after discharge was not significant (p=0.21).\nOUTPUT:" }, { "from": "agent", "value": "Chronic Fatigue Syndrome" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 34-year-old woman with long-standing insulin-dependent diabetes mellitus (IDDM), presented with florid diabetic retinopathy after a miscarriage during the 20th week of pregnancy. Her blood pressure was always within normal limits, and there was no history of pre-eclampsia, eclampsia or any other vascular diseases as noted with her biological and clinical exam. According to her obstetrician, the miscarriage was due to poor control of her diabetes. On presentation, Best Corrected Visual Acuity (BCVA) was 20/40 right eye (OD) and 20/30 left eye (OS). Slit lamp examination was normal in both eyes (OU). Fundus abnormalities included multiple microaneurysms in the posterior pole, large blot hemorrhages and venous dilation OU. Fundus fluorescein angiogram (FFA) showed large areas of capillary nonperfusion and dye leakage from preretinal neovascularisation in all quadrants OU. There was no angiographic evidence of macular ischemia or leakage. Macular spectral-domain optical coherence tomography scan (SD-OCT) showed one small intraretinal microcyst without significant macular thickening or foveal involvement OU (Figure 1 (Fig. 1)). PRP with PASCAL photocoagulator was immediately started and completed OU the same day, using classic parameters as previously described. 2000 laser spots of 200 microns and moderate intensity producing retinal blanching, using the Mainster PRP 165 laser lens were applied. Two days later, our patient presented with a rapid decrease in her vision. Her BCVA was 20/80 OU. 2)). FFA revealed a marked reversal of microvascular lesions and leakage. 2 sub-conjunctival injections of 0.1 ml Betamethasone were done 24 hours apart on each eye. One month later, her BCVA improved to 20/30.\nOUTPUT:" }, { "from": "agent", "value": "Serous retinal detachment" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 77-year old man was evaluated in our hospital because of severe respiratory distress and cough. He was an active smoker (about 1 pack year). There was a slight fine crackle on auscultation on the right lower lobe. Nasopharyngeal swab was done for him and it was positive for COVID-19 with cycle threshold (Ct) number 18. He was treated by assisted oxygenation, hydroxychloroquine and antibiotics. His symptoms mildly decreased and recovered from the acute illness .Patient was not dependent on nasal oxygen and due to the time of peak of the SARS-CoV-2 infection and large number of critically ill patients in need of hospitalization; we decided to discharge our patient by symptomatic and conservative outpatient therapy at home, including famotidine, aspirin, atorvastatin. but he was admitted to the hospital again because of progressive orthopnea and desaturate on exercise. On clinical examination, he was suffering and dyspneic. His laboratory findings were: White blood cells (( WBC:7900/mm3) ;Hb:14/5 g/dl;platelets:165000/mm3; Lactic acid dehydrogenase ((LDH:754 unit/liter). CT scan was done and revealed bilateral and diffuse patchy ground glass opacity and lower lung bronchiectasis (Fig. 1). Because of lack of recovery from disease, progressive orthopnea and desaturate on exercise, The clinician with the patient's consent, decided to perform lung biopsy to clarify if any other added histopathology. Patient underwent throracotomy and wedge biopsy for about 3 months from the onset of first symptoms. Tissue specimen was fixed in 10% formalin for 48 h and then hematoxylin and eosin stain was performed. Sections were analyzed and revealed dilated lung alveolae lined by hyperplastic type II pneumocytes with enlarged and mild atypical nuclei and granular and clear cytoplasm. Intraalveolar hemorrahge, foamy macrophages, cellular or proteinaceous exudate. Desquamation of epithelial cells, hyaline membrane formation and intra alveolar thickening were also seen. Interstitial fibroblastic proliferation and fibrin deposition were evident (fig.2). Patient outcome: his symptoms moderately improved but not completely, and he is still suffering from exercise dyspnea.\nOUTPUT:" }, { "from": "agent", "value": "2019 novel Coronavirus (COVID-19) pneumonia" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 64 year-old-man was referred to the hospital because of dry cough since 2 weeks. The patient was an ex-smoker, smoking 2 packs per day for 40 years. His medical history revealed hypertension treated with anti-hypertensive agents. The patient was conscious and alert, with body temperature 36.5 C, heart rate 122 bpm, and blood pressure 147/88 mmHg. Oxygen saturation was 93% in room air. Coarse crackles were detected bilaterally on chest auscultation. He had felt multiple arthralgias on the limbs symmetrically without swelling or deformation. Chest X-ray showed infiltration of the both lung fields (Fig. 1a). Chest computed tomography revealed the non-segmental patchy shadow and consolidation on both sides (Fig. 1b). The white blood cell count was 17,500 cells/muL and C-reactive protein level was 26.5 mg/dL. Blood and sputum cultures were negative, whereas anti-cyclic citrullinated peptide antibody (anti-CCP Ab) was elevated significantly. Antibiotic treatment was ineffective. Bronchoscopy, performed for more thorough examination, revealed white and soft tissues scattered in the trachea that could not be removed by suction or forceps (Fig. 2a). Purulent sputum was absent. Pathological and bacteriological evaluation of the tracheal lesions and lung was performed. Specimens of tracheal mucosa revealed findings consistent with NTB indicated by necrotic tissue with squamous metaplasia and inflammatory cells of tracheal tissue (Fig. 2b). However, the findings did not confirm chondritis. No specific pathogen was identified with PAS or Grocott and Ziehl-Neelsen staining. The patient was diagnosed with NTB and OP. After the bronchoscopy, an acute exacerbation of the respiratory condition developed. Immediately, steroid pulse therapy and oxygen therapy were started. Then the both clinical condition were gotten stability. Repeat bronchoscopy to observe the tracheal lesion indicated resolution of scattered lesions without scarring; while, re-biopsy samples of trachea showed persistent necrosis. Subsequent, chest radiography indicated improvement (Fig. 3a and b).\nOUTPUT:" }, { "from": "agent", "value": "Necrotizing tracheobronchitis, Organizing pneumonia, Rheumatoid arthritis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 61 year-old man with a history of follicular lymphoma complicated by myelodysplastic syndrome (MDS) presented to oncology clinic with subjective fever, malaise, and fatigue. He was receiving maintenance rituximab for MDS. Lung examination was clear but chest X-ray demonstrated new right middle lobe opacity and right pleural effusion. He was prescribed moxifloxacin for community acquired pneumonia and advised to follow up with pulmonology if symptoms persisted. One week later he presented to the ED for worsening dyspnea and malaise, now with fever, tachycardia, and hypoxia with a PaO2 of 46 mmHg. Chest X-ray again revealed a right-sided consolidation, and he was admitted and started on broad spectrum antibacterials \"because of immunocompromised state.\" The ID consultant recommended a chest CT and blood cultures. However, despite still requiring supplemental oxygen the patient reported improvement in symptoms and requested discharge prior to upcoming weekend. He was discharged on day 4 with oral azithromycin, cefpodoxime, and with a planned outpatient chest CT.\nTwo days later he was readmitted after blood cultures grew yeast. He had a further increased oxygen requirement and bilateral blurred vision. He was started on micafungin for fungemia, ophthalmologic exam and echocardiogram were requested, and ID consultants recommended an LP to evaluate for CM. He then had a minor fall with head impact, and soon thereafter had a seizure prompting transfer to the ICU, endotracheal intubation, and delay of the planned LP. The primary team started fluconazole for possible CM in addition to broad-spectrum antibacterials and acyclovir. LP opening pressure was 65 cm H2O, with budding yeast on the CSF Gram stain. ID consultants were notified and antifungals were appropriately changed to liposomal amphotericin B and flucytosine. A subsequent family meeting resulted in a de-escalation of care and he died 20 days after initial presentation to the oncology clinic.\nOUTPUT:" }, { "from": "agent", "value": "Cryptococcal meningitis, Disseminated cryptococcosis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 53-year-old man with no previous cancer history or radiation therapy presented to our emergency department with a 3-month history of headaches, vomiting, and multiple focal seizures. Physical examination revealed Glasgow Coma Scale 12, a Frisen Scale Grade II papilledema bilaterally and right hemiplegia. Brain MRI demonstrated a heterogeneous mass within the left frontal lobe, irregular rim of peripheral marginal enhancement, and central necrotic area with marked vasogenic edema causing a small uncal herniation [Figure 1]. Gross total resection of a firm pseudoencapsulated cerebral lesion was performed and the patient had recovered well from surgery. Three weeks following surgery, radiotherapy was given in 30 fractions 5 times a week, to a total dose of 60 Gy and concomitant chemotherapy consisting of temozolomide (75 mg/m2/body surface/d) was initiated. Two months later, clinical examination displayed five subcutaneous mass, firm, and unmovable at the left temple and frontoparietal scalp [Figure 2]. Therefore, an additional contrast-enhanced 18F-FDG PET/CT for oncological staging was carried out, with no evidence of extracranial lesions. The patient underwent surgery to resect the tumor and metastasis of the scalp. Final histopathological diagnosis was GS with positivity for both glial fibrillary acidic protein and nestin. Two months following surgery, he presented with general clinical deterioration and died a few weeks later, 7 months after initial diagnosis. The incidence of metastatic GSs can reach 11% with a greater propensity for hematogenous dissemination. Regarding the therapeutic approach to GS, the ideal treatment remains unknown and further studies will be needed to establish well-defined specific protocols. The authors certify that they have obtained all appropriate patient consent.\nOUTPUT:" }, { "from": "agent", "value": "Gliosarcoma, Frontotemporal and parietal GS metastasis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 66-year-old woman was referred to our hospital complaining of floaters in both eyes in February 2010. At the initial examination, her best-corrected visual acuity (BCVA) was 20/25 in both eyes, and diffuse vitreous opacifications with aggregation of large cells were present in both eyes (Figure 1A and B). Fluorescein angiography showed no abnormalities. The results of the laboratory examinations were within normal limits. Cerebral magnetic resonance imaging (MRI) detected no abnormalities. Although she was treated with corticosteroid therapy for 3 months, her VA had decreased to 20/50 in both eyes with increased vitreous opacification. She then underwent PPV by the standard three-port approach (20-gauge). The core vitreous was cut with a vitreous cutter, and about 1 mL of undiluted vitreous was collected by simultaneous manual aspiration. After the infusion line was opened, a full PPV was done, and the cortical vitreous was removed as much as possible. The undiluted vitreous was immediately frozen at -20 C, and submitted for cytokine analysis. Infusion fluid (BSS PLUS ; Alcon Japan Ltd., Tokyo, Japan) used during full PPV was obtained from the machine cassette (Fortas CV-30000; Nidek Co, LTD, Aichi, Japan) after the surgery (about 300 mL), and immediately submitted for cytological analysis with use of cytospin. Atypical lymphocytes with anisonucleosis, aberrant chromatin, and dyskaryosis were detected by cytological analysis (Figure 1C). The lymphoma cells were positive for leukocyte common antigen (LCA: Figure 1D). The ratio of interleukin (IL)-10 to IL-6 (IL-10/IL-6 ratio) of the undiluted vitreous was greater than 1.0 (IL-10 = 7650 pg/mL: IL-6 = 139 pg/mL). At 3 years after the surgery, the vitreous opacification had disappeared and her corrected VA had improved to 20/20.\nOUTPUT:" }, { "from": "agent", "value": "Primary intraocular lymphoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: An 80-year-old non-smoker female patient, presented to the ER department complaining of hemoptysis of 24 hours of onset (expectorated blood volume approximately 60ml). The patient reported a medical history of arterial hypertension, gastrointestinal bleeding (30 years ago), tetraplegia due to myelitis (onset on the age of 40), moderate to severe aortic stenosis and transient ischemic attack 4 months ago for which she was receiving antiplatelet therapy with clopidogrel. The patient presented severe dyspnoea in a background of hypoxemic respiratory failure (pO2 = 45 mmHg, pCO2 = 45 mmHg, pH = 7.44, SpO2 = 87.5%, on room air). She was hemodynamically stable (blood pressure: 155/93 mmHg), while auscultation revealed bilateral crackles. D-Dimers were within normal values as well as the rest of the laboratory tests. Chest X-ray showed bilateral alveolar infiltrates. Chest CT angiography was performed revealing bronchiectasis in the middle lobe, the lingula and the left lower lobe (Fig. 2). ENT examination was normal. Intravenous tranexamic acid, cough depressant drugs and iv piperacillin-tazobactam were initiated. As the episode of hemoptysis was clinically severe and due to the fact that bronchiectasis were detected, the patient was also investigated for autoimmune serology including antinuclear antibody (ANA), cyclic citrullinated peptide antibodies (anti-CCP) and anti-neutrophil cytoplasm antibodies (ANCA), which were all negative. Clopidogrel was discontinued. Hemoptysis had fully ceased. The patient was discharged two weeks later after significant clinical and radiologic improvement and complete remission of hemoptysis and respiratory failure.\nOUTPUT:" }, { "from": "agent", "value": "Pulmonary hemorrhage" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Among these five possible explanations, the authors assume that the last version is likely closest to the truth, even though this conclusion remains largely speculative and open to discussions. In this context, the authors would be interested to learn whether any of the distinguished readers of this case report may have made a similar observation and kindly ask him/her to share this information with us in order to better understand this interesting pathophysiological phenomenon.\nOUTPUT:" }, { "from": "agent", "value": "Inflammatory myofibroblastic tumor of the trachea, granulomatous lymph node lesions" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A male patient aged 74 years at the start of the trial, with a past medical history of chronic tobacco use and chronic obstructive pulmonary disease (COPD), presented with right flank pain and multifocal osseous metastasis in his ribs, spine, pelvic bones, right scapula, and right proximal femur in August 2007 at diagnosis. Prostate biopsies revealed a Gleason 8 (4 + 4) prostate adenocarcinoma with stage T2 disease and PSA level of 969 ng/mL. Complete androgen blockade of bicalutamide and a luteinizing hormone-releasing hormone analogue were initiated in September 2007, with PSA levels decreasing to a nadir of 1.5 ng/mL. In August 2008, the patient presented with a rising PSA. Bicalutamide was withdrawn and his PSA continued to rise in September 2008 and, though the patient was asymptomatic, progression of disease was revealed on bone scan (Figure 2A). Approximately 14 months after diagnosis, in October 2008, the patient was enrolled in the previously described open-label, phase I-II study and received 100 mg daily of dasatinib for 336 days and 75 mg/m2 of docetaxel, for a total of 16 cycles. Docetaxel was delayed 3 times during the course of treatment; in cycles 3, 5, and 7. The first delay was due to a COPD exacerbation in combination with a suspected upper respiratory infection (URI), delaying cycle 3 of treatment. A viral URI delayed cycle 5, and COPD exacerbation delayed cycle 7 of treatment. Each resulted in 1-week delays of docetaxel infusion. Of note, the patient was a long-time smoker (>120 pack-year history) and continued to smoke throughout the study. After 16 cycles, docetaxel was discontinued. Baseline study assessments prior to initiating dasatinib and docetaxel treatment (day 0), at docetaxel discontinuation (day 341), and at the last assessment on single-agent dasatinib therapy (day 1319) are summarized in Table 1.\nOUTPUT:" }, { "from": "agent", "value": "Metastatic castration-resistant prostate cancer" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Subsequently he continued to develop more papules and plaques on the feet and over the following 7 years underwent excision of around 20 skin lesions under local anaesthesia. More recently he developed, simultaneously, a crop of 5 nodules and a large plaque of KS 5.5 cm in diameter on the dorsum of the right foot with extension to the interdigital spaces and toes (fig. 1a, fig. 2a). He declined radiotherapy due to his difficulty in attending the radiotherapy centre. Chemotherapy with intravenous liposome-encapsulated doxorubicin was not considered because of the significant comorbidities including mild to moderate heart failure. Therefore, in the following order, we tried two courses of photodynamic therapy, imiquimod 5% cream applied once daily for 8 weeks and a cycle of anti-herpes therapy based on valganciclovir. No response was documented. As a result it was decided to administer intralesional vinblastine 1 mg/ml diluted 1:5 with saline solution. However, the patient developed side effects such as general malaise, swelling and erythema of the perioral and periocular areas and tingly tongue after the first injection, in keeping with a possible allergic reaction. At that point, at a bit of a loss for options, we switched to doxorubicin. Following a serial dilution test from 1:20 to undiluted, this medication was used intradermally at the dose of 2 mg/ml diluted 1:1 with saline solution. The large KS plaque on the dorsum of the right foot was treated by spacing the intradermal injections every 5 mm, using a similar technique to that used in the treatment of axillary hyperhidrosis with botulinum A toxin. About 0.2 ml was used for each site. The treatment led to complete resolution of the KS lesions after 4 treatments spaced 6 weeks apart. We observed skin necrosis in some well-delimited areas following each injection (fig. 1b), associated with mild to moderate pain which was well controlled with paracetamol 1,000 mg twice daily. The treatment caused no systemic side effects. The patient has not developed any new lesions for almost 18 months and continues to remain clear (fig. 1c, fig. 2b).\nOUTPUT:" }, { "from": "agent", "value": "Classic Kaposi's Sarcoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: He had a past medical history of chronic lower leg ulceration, due to chronic venous hypertension and recurrent deep vein thromboses, for which he took rivaroxaban. He also suffered from a depressive illness and excessive alcohol intake. The patient attended the emergency department approximately 12 hours post-injury. The last dose of rivaroxaban had been taken 32 hours prior to treatment and it was felt safe to proceed with enzymatic debridement. Blood clotting times on admission were normal. The blood pressure (measured non-invasively) fell to 50/40 mmHg and the heart rate was 110 beats per minute (BPM). Cardiovascular stabilisation was achieved quickly, with administration of intravenous fluids, 2 units of packed red cells and TXA (1 gram). The Nexobrid was completely removed, the limb was elevated and calcium alginate and a compressive crepe dressing were applied. Estimated blood loss was up to two litres. No bleeding point could be determined at the time of emergency management. Once stabilised and when it was clear that no further bleeding was taking place, a careful visual wound inspection was carried out. A single discrete breach of a venous varicosity within the Nexobrid -treated area was observed. The remaining vein tissue appeared normal. It was noted during his admission to intensive care that the patient had developed a new left-sided hemiparesis.\nOUTPUT:" }, { "from": "agent", "value": "Burn injuries, Haemorrhage, Cardiac arrest, Posterior cerebral artery infarct" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 58-year-old gentleman with a history of hepatitis C was detected to have an asymptomatic arterial enhancing right liver lobe mass on CT imaging, measuring approximately 6 x 8 cm in the longest cross-sectional diameter in liver segments 7/8, with evidence of branch portal vein thrombosis. His alpha fetoprotein levels were elevated as well. He was subsequently referred for consideration of Y-90 SIRT using SIR-Spheres . Biochemical evidence of underlying liver dysfunction was noted [albumin: 29 G/L, bilirubin: 26 umol/L, aspartate aminotransferase (AST): 164 U/L, alanine transaminase (ALT): 57 U/L, and prothrombin time (PT): 12.1 seconds], but values were still within acceptable limits for Y-90 SIRT. A hepatic angiogram was performed. A 5F Cobra catheter was advanced into the hepatic artery proper, and selective angiogram followed by an intra-arterial catheter CT angiogram was performed. The CT angiogram demonstrated good vascular blush in liver segments 7/8, corresponding to the tumor seen on prior CT imaging. However, subsequent portal venous enhancement was noted, indicating hepatic arterial-portal venous shunting [Figure 1]. Five millicuries of Tc-99m-MAA was subsequently administered slowly under manual hand control, and the patient underwent SPECT/CT imaging of the liver within one hour of administration of MAA. SPECT/CT imaging revealed minimal accumulation of MAA in the tumor in liver segment 7/8, with conversely more intense tracer localization in the surrounding liver parenchyma, resulting in an 'inverse'-type localization of microspheres within the liver [Figure 2]. Based on the findings of the Tc99m-MAA SPECT/CT, the calculated TNR by partition dosimetry model was 0.18 with a liver lung shunting value of 19%. With a calculated dose limit to the normal liver parenchyma of 70 Gy, the radiation dose to the tumor was 36 Gy and to the lung was 15Gy. Based on assessment by partition modeling, the patient was deemed not a suitable candidate for Y-90 SIRT.\nOUTPUT:" }, { "from": "agent", "value": "Hepatocellular Carcinoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 9-year-old African American male presented with four days of right sided abdominal pain, constipation, and non-bilious non-bloody emesis. He had a negative COVID test and unremarkable ultrasound of the appendix days prior. Vitals were normal. He was coagulopathic with elevated inflammatory markers. Evaluation for infectious etiologies was negative (Table 1). The history of fevers >3 days, acute gastrointestinal illness, coagulopathy, mucocutaneous physical exam findings, elevated inflammatory markers, and a positive COVID-19 antibody test were indicative of MIS-C. IVIG 2 g/kg, prednisolone 1 mg/kg q 6 hrs, enoxaparin, aspirin, and ceftriaxone were started. Initial ECG showed sinus rhythm with normal intervals and BNP was minimal. Echocardiogram showed normal biventricular systolic function. On day three, repeat showed EF of 50%. The following day, ECG revealed a right bundle branch block. Anakinra was started despite an otherwise stable clinical status. Steroids were increased to 2 mg/kg. On day five, he had asymptomatic bradycardia in the 50s shortly after methylprednisolone was decreased to 1 mg/kg. ECG progressed to a junctional rhythm, but he remained asymptomatic. Cardiac function normalized by day seven, and anakinra was stopped due to the improvements. Thereafter, HRs ranged from 38-48 bpm requiring transfer to the Pediatric Cardiac Intensive Care Unit for better monitoring and potential isoproterenol infusion. Despite the bradycardia, the patient was awake and well perfused. Heart rates improved over the next 48 hours without further intervention. Prior to discharge, ECG demonstrated sinus bradycardia with normal intervals. Echocardiogram remained normal throughout the hospital course. He was discharged home with instructions to continue aspirin and complete the prednisolone wean.\nOUTPUT:" }, { "from": "agent", "value": "Multisystem Inflammatory Syndrome in Children, Atrioventricular Conduction Abnormalities" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Of note, the patient is germline BRCA2 mutation carrier. At that time, she was treated with a cisplatin-based chemotherapy regimen, lung irradiation, and partial prophylactic radiation to the brain at another hospital. In subsequent follow-up, a rise in her CA-125 was noted, however, imaging studies have failed to demonstrate a definitive ovarian cancer recurrence. Imaging revealed an abnormality in the tail of the pancreas, and a positron emission tomography (PET) scan demonstrated uptake in this area. A distal pancreatectomy, splenectomy, and paraortic lymphadenectomy were performed. Spleen and all margins were negative for tumor. A panel of immunostains was performed, and the neoplasm in the pancreas was strongly positive for cytokeratin AE1/AE3, synaptophysin and chromogranin. While it was also positive labeling for somatostatin, this stain is known to have a very high background and it is challenging to identify how much of this labeling is specific. The neoplasm also weakly immunolabelled for TTF-1 and demonstrated a sustentacular pattern of labeling for S-100 protein. Stains for Ki-67 labeled approximately 5% of the neoplastic cells. Stains for insulin and glucagon were negative.\nOUTPUT:" }, { "from": "agent", "value": "Small cell lung cancer, Stage IIIC serous adenocarcinoma of the ovary, Metastatic atypical neuroendocrine neoplasm" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 24-year-old male patient presented to dermatology department with a history of rapidly growing skin lesion over the scalp. The lesion started around 3 months back and rapidly increased to the present size of 5-cm diameter. Lesion was asymptomatic and was associated with loss of hair over the lesion. Punch biopsy of the lesion showed features suggestive of Kaposi's sarcoma with advice for excision biopsy. After ruling out retropositive status and relevant investigations, case was posted for excision. Scalp being the vascular structure, surgery was planned under tumescent anesthesia. Lesion was excised with inclusion of 1-cm margin of clinically normal tissue [Figure 1]. After excision, a circular defect of around 7-cm diameter was formed. Around the primary defect, three flaps were raised by marking an arc around the defect, length of the arc being 1.5 times the diameter of the defect and the angle of the arc was 30 -50 [Figure 2]. With good undermining, the three arcs were rotated into the defect and sutured at the center subdermally with Vicryl 3-0 (Ethicon, Somerville, New Jersey) [Figure 3]. The three secondary defects were closed using Prolene 3-0 (Ethicon, Somerville, New Jersey) so that the suture line resembled a fan-shaped pattern [Figure 4]. Dog ear formed at the edges was corrected using two-flap technique. A pressure dressing was put. Postoperative period was uneventful. The margin of the specimen was free of tumor cells. However, in view of high recurrence and mortality associated with the condition, patient was further subjected to radiotherapy. Patient is under follow-up for 6 months without any recurrence.\nOUTPUT:" }, { "from": "agent", "value": "Epithelioid angiosarcoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A female patient aged 8 years 6 months old, attended the Universidade Norte do Parana to perform the early treatment of AOB. Parents reported that the child had the non-nutritive habit of digital sucking. The patient presents facial symmetry, non-passive lip seal, and swallowing lingual interposition. The initial AOB was -4.7 mm (Fig. 1). The patient had a mixed denture phase, with a complete eruption of the central incisors and first permanent molars, Angle Class I relationship, and absence of posterior crossbite (Fig. 1). Based on the initial panoramic radiograph, the patient did not present with agenesis or supernumerary teeth. Cephalometric analysis showed adequate relation between apical bases (ANB = 10.6 ) and vertical growth pattern (SN.GoGn = 35.6 ), presented excessive inclination for vestibular of upper incisors (U1.NA = 32.7 ) and lower (L1.NB = 37.9 ) (Table 1). The main cause of this malocclusion is attributed to the non-nutritive habit of digital suction together with the lingual interposition. He began to exhibit the digital sucking habit around the age of 5. The mother reported that it was high intensity, approximately 18 hours daily. The proposed treatment was the use of fixed palatal grids with cemented bands with glass ionomer (Multi-Curere , Unitek/3M, Monrovia, CA, USA) in the first permanent maxillary molars, made with 0.9 mm. The extension of the grid covered the entire AOB, preventing the interposition of the tongue, without interfering with the soft tissues and mandibular movements (Fig. 2). At the end of treatment, after 12 months, the positive vertical overjet reached was 1.1 mm. It can be noticed in the clinical and cephalometric aspects present in Figure 3 and in Table 1. After this period, the palatal grid was removed and maintained without the use of any containment device. The control after 2 years detected 1.7 mm of vertical trespass, showing skeletal cephalometric measures normal, with stability and improvement in the vertical positioning of the incisors, but recurrence in the inclination of the incisors, especially in the lower segment (Fig. 4). The control after 5 years detected a negative vertical overlap of 3.6 mm, showing a recurrence of the AOB can be noticed by the clinical characteristics (Fig. 5) and also by the cephalometric measurements (Table 1) due to the return of the digital suction habit.\nOUTPUT:" }, { "from": "agent", "value": "Anterior Open Bite" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 75-year-old African American female presented with acute nausea, diaphoresis, and weakness while climbing stairs. CXR showed diffuse interstitial changes. Vitals on presentation included HR 58 bpm, RR 22, BP 99/56mmHg, and SpO2 of 100% on room air. Physical exam was noncontributory. Repeat ECG in the ED demonstrated inferolateral ST-elevation (Figure 3(a)). Coronary angiography revealed 99% ostial stenosis of the RCA with TIMI-2 flow, mid-RCA 40% stenosis, distal RCA 60% stenosis, 40% proximal lesion in LAD, and LCX without obstruction (Figure 3(b)). DES was placed to ostial RCA with good flow (Figure 3(c)). Systemic anticoagulation was not initiated due to the patient's spontaneous conversion to normal sinus rhythm after successful PCI. These symptoms were treated with intravenous methylprednisone. The patient was discharged home after six-day hospitalization.\nOUTPUT:" }, { "from": "agent", "value": "ST-Elevation Myocardial Infarction, COVID-19, Atrial Fibrillation, Angioedema" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 54-year-old male presented with right shoulder pain and back pain for the past 9 months. He also complained of an increasing mass in his right scapula during this time. He also had dyspnea on exertion but denied any cough, orthopnea or paroxysmal nocturnal dyspnea. He denied any weight loss. He also had a 40-pack-year history of smoking. A CT of the chest showed a right upper lobe mass of approximately 6.0 x 6.0 x 3.5 cm, small bilateral pulmonary nodules and a large ST mass (7.3 x 5.5 x 6.8 cm) associated with lytic destruction of the inferior margin of the right scapula (fig. 2). Bronchoscopy and biopsy of the right upper lobe mass revealed moderately differentiated adenocarcinoma. A CT of the head showed a 3.9 x 3.0 cm right frontal lobulated mass with surrounding edema. The patient completed radiation to the brain and the base of the skull. Unfortunately, he developed worsening neurological function with inability to ambulate. Repeat MRI of the brain showed acute infarcts. He was started on erlotinib and was discharged to inpatient hospice care. He passed away 6 months after diagnosis.\nOUTPUT:" }, { "from": "agent", "value": "Lung cancer, Soft-tissue metastasis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 46-year-old woman presented to the emergency room with the right knee pain and swelling which had worsened over the past 2 weeks. The patient was unable to fully extend her knee secondary to pain and restriction from swelling. Radiographs were obtained and showed no osseous lesions or fractures. Blood work was obtained which revealed a white blood cell count of 12.7, C-reactive protein of 7.2, and erythrocyte sedimentation rate of 105. The patient was evaluated by the internal medicine service and orthopedics was consulted to rule out septic right knee. A right knee aspiration was performed which revealed a synovial white blood cell count of 6500, polymorphonuclear leukocytes of 71%, and no crystals present. The patient was admitted for further evaluation and vancomycin was prophylactically started to treat suspected infections due to her worsening symptoms. On hospital day 2, a new fluctuant area with erythema and tenderness was identified on her medial proximal tibia. Magnetic resonance imaging with and without contrast was obtained of her right lower leg (Fig. The following day, the patient developed a fever, worsening anion-gap metabolic-acidosis and became tachycardic and disoriented. An aspiration was performed of the posteromedial knee fluid collection which revealed purulent aspirate. Subsequently, as a results of the aspiration findings, an incision and debridement were performed of dressing. Two hundred milliliters of purulent fluid were evacuated and multiple cultures were sent for analysis. Vancomycin and Zoysn were discontinued and Nafcillin was commenced. Multiple subsequent irrigation and debridement procedures were performed with eventual wound closure. Drains were removed 3 days after wound closure and she was discharged with 4 weeks of intravenous Nafcillin. At time of discharge, knee pain and fevers had resolved and knee range of motion was nearly full. The patient presented to the clinic 2 weeks later. She was weight-bearing as tolerated at that time. Her incisions were healing well without any sign of infection, fluid reaccumulation, and her pain was well-controlled.\nOUTPUT:" }, { "from": "agent", "value": "Infection of Baker's Cyst, Methicillin-Sensitive Staphylococcus aureus (MSSA) infection" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: He came to our attention at the age of 62, in quite good clinical conditions, with eastern cooperative oncology group performance status (ECOG-PS) 1. The BRAF mutational analysis (V600) was negative (cobas z 480 analyzer). The high tumor burden, with LDH more than 2 ULN, and the absence of an actionable BRAF mutation led us to choose a first-line treatment with immune checkpoint inhibitors (ICIs). Before starting ipilimumab, we made a careful multidisciplinary assessment with dermatological and neurological evaluation. On dermatological evaluation, the patient presented psoriatic plaques on the trunk and extremities; a baseline EMG was performed that showed the residual functional loss, mainly to the legs (Figure 1).\nOUTPUT:" }, { "from": "agent", "value": "Metastatic Melanoma, Psoriasis, Guillain-Barré Syndrome" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 60-year-old woman was admitted to our hospital with left plantar pain. The patient found a black maculopapular rash on the left foot with pressing pain, and the pain was aggravated by walking, so she was hospitalized for further treatment. On physical examination, the visible size of the black tumor on the left plantar was approximately 2 x 1 cm, with an outward expansive growth and tough texture, which cannot be pushed and does not touch the blood vessel ( Figure 1 ). Based on the patient's medical history, she was previously healthy. Because the patient has a strong desire to undergo operation, on the second day after admission, the lesion of the left foot was removed under local anesthesia, and the removed tissue was sent for pathological examination. The pathological findings showed that there were nests of abnormal cells in the epidermis and subcutaneous tissue, accompanied by pigmentation. The results of immunohistochemistry were as follows: PCK (-), HMB45 (+), S-100 (+), P53 (+), Ki-67 (+), CyclinD1 (+), Bcl-2 (+), and P16 (+). Combined with immunohistochemistry, it was consistent with MM. During hospitalization, the patient developed abdominal pain and asked for gastroscopy. Gastroscopy revealed two 0.5 cm x 0.6 cm spots that can be seen arising from the stomach mucosa which were slightly swollen, slightly black in the center, and without erosion, and no abnormality was found in the other parts ( Figure 2 ). At the same time, a biopsy was taken under a gastroscope. Pathology suggests MM ( Figure 3 ). No obvious abnormality was found on chest CT. Due to cost, the patient refused further treatment and was discharged automatically. The patient was followed up until February 2022 and she was well until that period of time.\nOUTPUT:" }, { "from": "agent", "value": "Malignant melanoma of the lower limb, Gastric metastasis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The 25-year-old, slightly overweighted women for the first time suffered from increasing depression in summer 2008. Possible trigger factors were the work on a ward of apallic patients, a new partnership, and the move to a new apartment. In October, she consulted a psychiatrist, her psychopathology corresponding to a moderate depression (ICD 10 F32.1). Due to ineffectiveness of opipramol (maximum dose 2*50 mg) citalopram outpatient-treatment was added with increasing doses (20 to 60 mg). Although the depression symptoms improved slightly, she was admitted to the psychiatric ward due to undulating mood in November 2008. During the interview, she showed a moderate-to-severe depression with somatic syndrome without suicidal ideation. Due to disturbed sleep, zolpidem (5 mg) was administered transiently, and after a few days after admission, mirtazapine with increasing doses (15 up to 30 mg) was initiated. Moreover, the patient complained of intermittenl paraesthesias and dysaesthesias particularly in both arms and left sided headaches. An ophthalmologist was consulted the same day and diagnosed a left-sided acute optic neuritis with paracentral scotoma. We immediately started an intravenous pulse treatment with methyl-prednisolone (initially 1 g for 3 days, then oral dose reduction step by step with 10 days). Simultaneously, neurological and cardiologic was initiated to assess inflammatory or ischemic brain disorders within 5 days. Thorough electrophysiological investigations including visual evoked potentials, cMRT, clinical laboratory, and cerebral spinal fluid analysis did not indicate an inflammatory brain disorder or ischemia. Blood coagulation tests were within normal range. Neurosonography showed physiological extra- and intracranial vessels. Echocardiographic investigations (TTE and TEE) confirmed a very small PFO which had probably no clinical relevance, but low-dose Aspirin (100 mg) was recommended. Gynecological assessment revealed normal findings apart from left sided lactation; prolactin was not increased. The patient responded well to steroid pulse therapy but temporarily tended towards increased blood glucose levels and ankle edema occurred. Blood glucose normalized after cessation of steroid treatment and edema disappeared after small doses of frusemide.\nOUTPUT:" }, { "from": "agent", "value": "Marked mydriasis, neuritis nervi optici, galactorrhea" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: She underwent an 8-week home-based program delivered by her husband. The aim of the intervention was to reduce anxiety and promote sleep. The patient, aged 78 years, was born and educated in Hong Kong. After completing her university education, the mother of three became a teacher. She retired at the age of 60 years. Presently, she lives with her husband and a domestic helper. She had a stroke in 2011, resulting in left hemiparalysis. She suffers from memory loss and deteriorating verbal communication. Her functional performance improved somewhat after continuous physiotherapy but she still fully relies on her domestic helper for bathing and transferring. She also required some assistance in toileting and dressing, but was capable of feeding herself. Her Modified Barthel Index score when she joined our study was 35/100, suggesting that she was severely dependent on others for her activities of daily living. Her mini-mental state examination (MMSE) score at baseline (12 November 2014) was 19/30 (the cut-off score for someone with her educational background is 25). Her sleep quality was poor (Pittsburgh Sleep Quality Index (PSQI) = 18/25). The patient has regular appointments with a psychiatrist every 6 months for reported depression and anxiety 2 years ago. Due to her high GDS and RAID scores found during our study, she was referred to the social worker of her social center by the research team. As for her neuropsychiatric condition, she scored 8/36 in the Neuropsychiatric Inventory Questionnaire (NPI-Q), which was relatively low.\nOUTPUT:" }, { "from": "agent", "value": "Early dementia" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 63-year-old man presented a transient loss of consciousness and muscle strength with spontaneous recovery while walking in the street. The patient denied fever, cough, sputum production, dyspnea, chills, muscle pain, loss of taste/smell or any other symptoms. He also denied excessive decrease in physical activity during the last week or any other risk factor for venous thromboembolism (VTE). Vital signs at admission were: arterial blood pressure 123/93 mm Hg, temperature 35.6C, heart rate 115/minute, respiratory rate 23/minute, and oxygen saturation 94% at room air. His physical examination revealed a contusion and hematoma in right supraciliary arch, shallow breathing without respiratory distress. The rest of the physical examination was unremarkable. Electrocardiography demonstrated sinus tachycardia and complete right bundle branch block. Chest X-ray showed no relevant alterations. Complete blood count and basic metabolic panel results were within normal ranges. Arterial blood gas analysis results were as follows: pH 7.40, PaCO2 39 mmHg, PaO2 64 mmHg and HCO3- 24 mmol/L. Dimer D was raised (4850 mug/mL). A multidetector computed tomography (CT) pulmonary angiography was performed to exclude pulmonary artery embolism. It demonstrated an obstruction of the posterior-basal and anterior-basal segmental branches of the right lower lobe (RLL) (Figure 1), with no associated areas of consolidation, crazy-paving or ground-glass opacities. High-sensitivity cardiac troponin, B-type natriuretic peptide (pro-BNP) and echocardiography were normal. Anticoagulation with enoxaparin (1mg/kg/12 hours) was initiated. Taking into account the current pandemic due to COVID-19 and despite the absence of specific symptoms, we decided to perform a PCR for SARS-CoV-2. Lactic Acid Dehydrogenase (LDH) was 242 U/L, interleukin 6 (IL-6) 15 pg/mL and ferritin 106 ng/mL. Inpatient hospitalization took an adequate course with no incidents. After seven days, the patient was discharged with home isolation.\nOUTPUT:" }, { "from": "agent", "value": "Steinert Disease, COVID-19 related acute pulmonary embolism" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: An 80-year-old woman was referred to our clinic for evaluation and treatment of a pigmented oral lesion. She had a history of pigmentations diagnosed elsewhere 2 years earlier as racial pigmentation. Intraoral examination showed multiple lesions represented by macules and nodules on the hard and soft palate, superior alveolar mucosa and gingiva (fig. 1a, b). They were irregular and their color varied from dark blue to black. The size of the lesions ranged from 0.4 to 3.5 cm in dimension. One of them was an ulcerated nodule causing a little discomfort. There were no palpable lymph nodes of the head and neck regions. A biopsy, which included the free and attached gingiva and alveolar mucosa was performed and submitted to histopathological analysis. Histological examination (fig. 2a, b) showed sheets and nests of melanocytes, some with round, plasmacytoid or epithelioid morphology in the superficial corium extending to the deep tissues. Some of them presented round nuclei of various sizes, occupying nearly the entire cell cytoplasm and prominent nucleoli. A few tumor cells contained variable amounts of melanin. The overlying epithelium was atrophic and did not present melanocytes. There was no invasion of blood vessels or nerve fibers. Immunohistochemistry showed tumor cells positive for HMB-45 (fig. 3a), melan-A (fig. 3b), S-100 (fig. 3c), Ki-67 (fig. 3d) and negative for AE1/AE3 (not shown), confirming the diagnosis of melanoma. The Ki-67 labeling index was around 25%. The patient refused a complete workup examination (i.e. CT scan, MRI, etc.) as well as any type of treatment and died 11 months later.\nOUTPUT:" }, { "from": "agent", "value": "Oral Malignant Melanoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Pelvic ultrasound revealed the following: uterine size and volume, 3.75 cm x 2.4 x 1.4 cm and 6 mL, respectively; endometrium size, 5 mm; right ovarian volume, 2.8 mL; left ovarian volume, 3.3 mL; and ovarian follicles with diameter >5 mm. Bone age was 4.0 years old. Laboratory values showed a significant increase in the levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) after the GnRH stimulation test. The results are as follows: basal LH: 3.3 IU/L and 60 min LH: 72.1 IUI/L; basal FSH: 3.9 IU/L and 60 min FSH: 18.8 IU/L. Skin biopsy, from the right hemibody lesions, showed histological features of papillomatosis, acanthosis, and hyperkeratosis, which were consistent with verrucous epidermal nevus (Figure 5). Laboratory investigation demonstrated normal levels of serum calcium, phosphorus, urinary phosphate, electrolytes, parathyroid hormone (PTH), and vitamin D. Renal and adrenal ultrasound, skeletal survey, and brain MRI showed no abnormalities. Analyses of the H-RAS, K-RAS, and N-RAS genes in the blood and in the skin were performed, and in the latter, a missense mutation in exon 2 of the gene, H-RAS c37G > C (p.G13R), was detected. The DNA was extracted and purified using DNA binding columns (Qiagen). DNA integrity and quality were evaluated with spectrophotometry. The presence of mutations in the three genes was evaluated by the selective amplification of each gene using PCR. For sequencing, the ABI PRISM 377 DNA fluorescent sequencer was used. Based on these findings, a monthly treatment with long-acting GnRH analog (triptorelin) was initiated. After two months, secondary sexual characteristics reverted (Figure 2), and a decrease in the uterine and ovarian volume and suppression of the gonadotropins were observed; the bone age also stabilized.\nOUTPUT:" }, { "from": "agent", "value": "Central Precocious Puberty, Schimmelpenning-Feuerstein-Mims Syndrome" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A regular follow-up by US showed a suspect of IaEL with increase of the aortic diameter (55-61 mm). A followed CT scan revealed an IaEL with inflow close to left renal artery (Figure 4(a)), confirming the aortic diameter increase. In both cases, a graft distal migration and distal enlargment were detected. The same procedure was performed in both patients. Under local anesthesia, right surgical femoral access and percutaneous left brachial artery (LBA) were obtained. A preliminary angiogram confirmed the IaEL (Figure 2(a)). After systemic heparinization, selective catheterization of the distal renal artery was done by the brachial access, using Terumo Radifocus Guidewire Stiff. After placing an Advanta V12 covered stent (Atrium, USA) in the renal artery, with controlled hypotension, an Endurant (Medtronic, USA) cuff was deployed just below the higher renal artery, supported by an Amplatz Stiff (Boston Scientific, USA) guidewire gently curved to optimize the deployment. Afterward, the renal stent graft was delivered by overlapping few millimeters with the previous endograft. Simultaneously, ballooning of the aortic cuff was performed with compliant balloon (Reliant:Medtronic, USA). An angiogram check showed persistent endoleak, even though with flow reduction (Figure 2(b)). Therefore, implant of Heli-FX (Medtronic, USA) endoanchors was performed using multiple devices on inflow endoleak side (Figure 2(c)). The final angiogram showed the endoleak resolution (Figure 2(d)). Postoperative course was uneventful, and the patients were both discharged on postoperative day 3. Postoperative 6 months CT scan showed a complete exclusion of aneurysms and renal stent graft patency (Figures 3 and 4(b))\nOUTPUT:" }, { "from": "agent", "value": "Late type 1a endoleak, Obesity, Moderate hypertension, Diabetes mellitus, Dyslipidemia, OSAS, Moderate chronic obstructive pulmonary disease" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Anterior segment examination showed diffuse corneal edema, descemet membrane folds and an anterior chamber IOL (Figure 1A). 20 years earlier, she had a bilateral cataract extraction with an anterior chamber IOL implantation. The left eye had a corrected visual acuity of 20/200. Three months after explantation of the anterior chamber IOL and a limited anterior vitrectomy a scleral-fixated IOL was implanted. The IOL was fixated using a knotless zigzag-shaped intrascleral suture (Z-suture) . After this surgery best-corrected visual acuity (BCVA) in her left eye was 1/15 at one meter with 0 sph = -3.00 cyl 131 . Anterior segment examination showed diffuse corneal edema and a stable, well-positioned, scleral-fixated IOL (Figure 1B). A DMEK procedure was performed. The postoperative course was normal. BCVA had improved by 3 months to 20/63 without any changes in refraction. The cornea was clear with a well-centered and well-attached graft, and the scleral-fixated IOL was in place and well-centred (Figure 1C). The baseline donor endothelial cell densitiy decreased from 2700 cells per square millimeter preoperative to 1900 cells per square millimeter 3 months after surgery.\nOUTPUT:" }, { "from": "agent", "value": "Corneal decompensation with bullous keratopathy, Advanced glaucoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Therefore, osimertinib (80 mg once daily) was started. After 16 days of osimertinib treatment, she developed acute shortness of breath on exertion. 1). However, shortness of breath on exertion persisted. Although she had no chest pain, leg pain, hemodynamic instability, and abnormalities on echocardiography, PE was considered. 2A) and the vein of the lower extremities. She was immediately given apixaban, a direct inhibitor of factor Xa. After one month, dyspnea completely disappeared and the D-dimer values normalized, however, neurological deterioration occurred rapidly. We retreated her with osimertinib (80 mg daily) after receiving full informed consent for the risk of recurrent VTE, because no alternative treatment was available. One month later, a contrast CT and MRI scan showed disappearance of the thrombus (Fig. As a result, her neurological symptoms improved. Currently, she is being treated with osimertinib and apixaban for 4 months without major adverse events.\nOUTPUT:" }, { "from": "agent", "value": "Lung adenocarcinoma, EGFR L858R mutation, EGFR T790M mutation, Osimertinib-induced interstitial lung disease, Pulmonary embolism" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The patient was admitted 2 weeks after chemotherapy infusion with few days' history of progressive left calf pain and swelling. There was no associated trauma, joint pain, or fever. Physical exam confirmed left calf redness, hotness, tenderness, and swelling below the knee joint down to the ankle. Platelet counts 1 and 2 weeks earlier were 376 x 109/L and 286 x 109/L, respectively. On admission the platelet counts were 103 x 109/L with a normal activated partial thromboplastin time (aPTT) and international normalized ratio (INR). Patient was started on anticoagulation with unfractionated heparin (UFH). The next day, however, platelet counts were noted to be low at 33 x 109/L. Work up for disseminated intravascular coagulation (DIC) including blood film, fibrinogen, and D-dimer were all negative. Both aPTT and INR were within normal limits, too. Further evaluation failed to show any new venous thrombosis, progression of the old thrombus, or arterial ischemia. Heparin infusion was stopped and a decision was made to anticogulate with fondaparinux 7.5 mg subcutaneously once daily. Platelet counts, which were followed daily (Figure 1), started to improve 3 days later and normalized on day 6. The patient was discharged home on day 8 with normal counts.\nOUTPUT:" }, { "from": "agent", "value": "Gastroesophageal junction cancer, Left lower extremity deep vein thrombosis (DVT), Heparin-induced thrombocytopenia (HIT)" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The patient's SARS-CoV-2 Reverse Transcriptase -Polymerase Chain Reaction (RT-PCR) was sent, which was negative. However, SARS CoV-2 total antibodies report was positive [81,360 reference interval, 1000 index (S/C)] with SARS CoV-2 IgM positive. On admission patient's complete Blood count was normal. His renal function test was deranged with a creatinine of 2.5 mg/dl and urea of 74 mg/dl. The liver function tests were deranged with alanine transaminase of [944 U/L; reference interval 7 to 55 U/Lt] and aspartate transaminase of [1138 U/L; reference interval 8-48 U/Lt]. The patient's Inflammatory markers were as follows C-Reactive Protein- [16.2 mg/L reference interval low cardiovascular risk <2.0 mg/L], Ferritin- [794.12 ng/ml; male reference interval 21.81-274.66], d-dimer- 1612 ng/ml, which increased up to [>10,000 ng/ml; reference interval 0 to 500 ng/ml] on the fifth day of admission in subsequent days and serum Lactate Dehydrogenase [1674 U/L; reference interval 85 to 227 U/Lt]. The patient's Troponin I level was normal, and Creatinine Kinase MB (CKMB) was [78 IU/mL; reference interval < 24 U/Lt] interleukin-6 levels were done on day three of admission and were high at [12.94 pg/mL; reference interval < 7 pg/mL] The patient thyroid profile showed an elevated Thyroid Stimulating Hormone (TSH) of [37.25 microIU/mL; reference interval 0.35 to 4.94 microIU/mL, normal T3 and T4, but positive Anti-Thyroid Peroxidase antibodies [191.69 IU/mL; reference interval <5.61 IU/mL] (table 1). The patient's blood and urine cultures showed no growth of any micro-organisms.\nOUTPUT:" }, { "from": "agent", "value": "Post-COVID Multisystem Inflammatory Syndrome-Adult, Cardiomyopathy, Autoimmune Thyroiditis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 12-year-old male neutered domestic longhair cat was presented to the emergency service at the University of Florida for inappetence and ataxia. Aldosterone levels were elevated (2718 pmol/l; RI 194-388). Patient preparation was the same as for case 1. A three-port technique was used, as previously described. The gland was completely excised and removed using the inverted thumb of a surgical glove. Total surgical time was 54 mins. Complications were grade 1 and consisted of hypothermia and temporary hypertension. During the procedure, hemorrhage was minimal and the endoscopic cotton swab was sufficient to keep the site free of fluid. Laparoscopic suctioning devices or hemostatic clips were not necessary. No charring was noted in the surrounding tissue. Postoperative supportive care was the same as for case 1. PCV increased postoperatively (37%). ACTH stimulation revealed concerns for a hypoadrenocortical state (pre-ACTH cortisol: 0.26 microg/dl [RI 0.8-5.0]; 60 mins post-ACTH cortisol: 0.49 microg/dl [RI 3.6-10.0]) and treated with prednisolone (0.35 mg/kg PO q24h). The patient was discharged after 2 days with the same medications as case 1. Blood pressure and potassium were normal at 1 month postoperatively. ACTH stimulation revealed improved but persistent hypoadrenocorticism. Prednisolone (0.2 mg/kg every other day) was continued for 14 days. At 28 months postoperatively, the patient was doing well at home, with no clinical signs nor any medications.\nOUTPUT:" }, { "from": "agent", "value": "Adrenal adenoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: An 8-year-old female was referred to pediatric endocrinology for short stature. She was born at 38 weeks and small for gestational age (SGA) - birth weight of 4 pounds 8 oz (2.04 kg), and birth length of 16 in. (40.6 cm). Her father was from Mexico and her mother was from Puerto Rico and their heights are 5'9'' (175.3 cm) and 5'5'' (165.1 cm) respectively giving her a mid-parental height of 5'4.5'' (163.8 cm). She had normal development, without any significant medical problems. Physical examination demonstrated severe short stature (height Z-score - 3.46), midface hypoplasia, and severe brachydactyly of her hands and feet. Laboratory analysis showed mildly elevated TSH with normal free thyroxine, mildly low calcium with elevated PTH and low normal IGF-1 level (Table 1). Radiographs revealed severe brachymetatarsia, brachymetacarpia, and brachydactyly with cone-shaped epiphyses in the proximal phalanges (Fig. 1). Genetic testing revealed a mutation of the PRKAR1A gene, specifically R368X (CGA > TGA). To address her TSH and PTH resistance, she was started on levothyroxine and calcitriol. We postulated that her severe short stature was from a combination of GHRH resistance and being born SGA. GH therapy was initiated at 0.35 mg/kg/week - a mid-range dose for children with SGA. Three months later, her serum IGF-1 Z-score increased from - 1.2 to 2.1 at an effective GH dose of 0.33 mg/kg/week. After 7 months, her annualized growth velocity had increased from 3 cm/year to 11 cm/year and she had grown 6.5 cm (Fig. 2). However, she also reported right knee pain for 1 week. Radiographs (Fig. 3) revealed flattening of the right femoral head consistent with LCPD. She was made non-weight bearing and GH therapy was discontinued.\nOUTPUT:" }, { "from": "agent", "value": "Legg-Calve-Perthes disease, Acrodysostosis type 1" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Case 2: The patient was a 43-year-old non-smoking woman with a 39-month history of RA. Before tofacitinib was administered, she had been treated with MTX (4 mg/week) and BUC (100 mg/day), and the DAS28-CRP was well controlled for 29 months as follows: from 2.0 (the baseline) to 1.2 (after 29 months of treatment). However, because of the lack of a response to the treatment with MTX and BUC, the further administration of tofacitinib (10 mg/day) was started. The patient had no complications, such as diabetes mellitus, hypertension, or systemic viral infections, at baseline. The rheumatologic assessments showed a decrease in the SDAI, DAS28-CRP, tender joint count (TJC), swollen joint count (SJC), and gVAS at reassessment after starting tofacitinib therapy (Table 1). Tofacitinib therapy reduced periodontal inflammation as indicated by the mean values of the GI, PD, and CAL, as well as the percentage of sites with BOP and of those with PD and CAL of >=4 mm at reassessment, although the teeth count and supragingival bacterial plaque level as defined by the PCR were relatively unchanged after tofacitinib therapy (Table 2).\nOUTPUT:" }, { "from": "agent", "value": "Rheumatoid Arthritis, Localized Moderate Chronic Periodontitis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: History:This 30-year-old woman sustained a solitary close range GSW to the left side of the back of her head [Figure 2a and b]. She had a GCS score of 3 at the scene and her pupils were 2.5 mm and minimally reactive. She had a short downtime, was intubated by the EMT, and transported to hospital within 20 minutes. She was hemodynamically stable and was taken to the CT scanner within 15 minutes upon arrival. Management:Despite the bullet being lodged in the posterior fossa, we opted for emergent surgical intervention because we felt that several factors were in her favor: (1) the bullet had missed the brainstem; (2) there was no apparent injury to the posterior cerebral circulation; and (3) the fourth ventricle was closed and intact. An intraoperative right-sided external ventricular drain (EVD) was inserted prior to performing a bilateral suboccipital craniectomy with evacuation of the blood clot without disturbing the lodged bullet fragment [Figure 2e and f]. Clinical outcome:The patient had ICP monitoring in the ICU for 48 h. There were no spikes in her ICPs above normal and she was following commands on postoperative day 2. The EVD remained in situ for 6 days. Her postoperative exam was significant for nystagmus, double vision, and scanning speech. She was initially nonambulatory due to balance issues. She was sent to rehabilitation and at 3 years following her injury, she has made a wonderful recovery with almost no gait impairment and no permanent deficits.\nOUTPUT:" }, { "from": "agent", "value": "Traumatic subarachnoid hemorrhage, Infratentorial epidural hematoma, Intraparenchymal hematoma with pneumocephalus" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 52-year-old female who had no past medical history and no family history had systemic edema and ascites. Computed tomography (CT) and Doppler ultrasonography (DUS) revealed thrombus and obstructing the IVC and hepatic veins. Percutaneous transluminal angioplasty was performed with thrombectomy and IVC stent placement by the intervention radiology team and anticoagulants treatment for hepatic vein obstruction was performed as the initial management (Fig. 1). Despite these treatments, portal and hepatic venous flow by UDS, symptoms such as systemic edema and ascites and liver functional tests were not improved. Transjugular intrahepatic portosystemic shunt (TIPS) was considered as a second therapeutic option. However, it had failed and had increased ascites with rapid deterioration of liver functional tests such as the serum levels of bilirubin 8 from 4 mg/ml and INR 2.2 from 1.2 within one month. Liver transplantation was considered and the patient was referred to our hospital. The patient was scheduled for liver transplantation. The Child-Paugh and the MELD scores were 11, 18, respectively at the time of transplant qualification. Preoperative enhanced abdominal CT scan obtained stenosis of distal end of IVC stent, abundant ascites, a thrombus in the transverse portion of the left portal vein, and could not identify any of the hepatic veins. To determine the cause of BCS; protein C and S activities, and Gene mutations for thrombosis were assessed and did not assign specific cause.\nOUTPUT:" }, { "from": "agent", "value": "Budd-Chiari syndrome, Polycythemia vera" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 44-year-old (G0) female presented to the gynecology clinic complaining of intermittent right-sided pelvic pain that radiated to her back for one year. She was postmenopausal from age of 37. There was a past surgical history of left oophorectomy and right ovarian cystectomy for \"dermoid cyst.\" A subsequent pelvic ultrasound was performed. The right ovary measured approximately 3.6 x 3 x 3.2 cm. In the right adnexal region dense acoustical shadowing was appreciated. The left ovary was absent. No free pelvic fluid was noted. Robotic right salpingo-oophorectomy was performed and entire specimen was sent to pathology for examination. Grossly, the specimen consisted of right fallopian tube and ovary. A circumscribed tan-white solid nodule of 0.8 x 0.8 x 0.7 cm was also noted in the adjacent ovarian tissue. The fallopian tube was grossly unremarkable. Microscopically, the ovarian cyst was lined by stratified squamous epithelium associated with keratinous material, hair follicles, and sebaceous glands (Figure 1). Respiratory epithelium, cartilage, and fatty tissue were also present. No evidence of immature elements was observed. The solid nodule showed an unencapsulated but circumscribed tumor with several lymphoid aggregates noted towards the periphery of the tumor (Figure 2(a)). The tumor was composed of clefts and spaces lined by cuboidal, low columnar, and flattened epithelial-like cells, predominantly arranged in adenoid and glandular patterns. Some tumor cells exhibited marked vacuolation (Figure 2(b)). Cytologic atypia and mitoses were absent. On serial sections, this solid tumor was situated 0.2 cm from the closest teratomatous components containing hair follicles and respiratory epithelium. The circumscribed solid tumor was strongly positive for pancytokeratin (AE1/AE3), calretinin (Figure 3), and D2-40, weakly positive for WT1, and negative for CD31. A final diagnosis of AT coexisting with MCT of the ovary was rendered.\nOUTPUT:" }, { "from": "agent", "value": "Ovarian Adenomatoid Tumor, Mature Cystic Teratoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 28 years-old man presented with maxillofacial discomfort and headache for 2 weeks, and then visited a regional hospital for consultation. Neurologic and physical exams showed he was both mentally and physically healthy. No past medical history was reported. Computer tomography (CT) indicated a high-density nodule in the right frontal lobe. Magnetic resonance imaging (MRI) with contrast revealed a heterogeneously intradural lesion measuring 19 x 17 cm in the right frontotemporal lobe (Figure 1). A meningioma or an oligodendroglioma was suspected. The patient underwent the conventional right pterional craniotomy, which revealed an ill-defined mass with a soft grayish-white surface. There were many calcifications in the middle, and the surrounding tissue was slightly edematous. The tumor tissue was completely resected under the microscope. Microscopically, the lesion was composed of meningothelial and spindle cells, which formed small whorls. In the whorl center, psammoma bodies were observed. There was no evidence of necrosis or mitotic activity. The histopathological features of the lesion were consistent with those of a transitional meningioma. In the adjacent cerebral parenchyma to the lesion, significant proliferation of meningothelial cells surrounding the small blood vessels was detected (Figures 2A,B). This was the same as the characteristic morphology of MA. Immunohistochemical analysis revealed that tumor cells of the meningioma were positive for vimentin, somatostatin receptor (SSTR)-2 (Figure 2C), epithelial membrane antigen (EMA), and progesterone receptor (PR). The perivascular fibroblast-like spindle cells were positive for vimentin and SSTR2 but lacked immunoreactivity for EMA and GFAP (Figure 2D). Ki-67 (MIB-1) index was smaller than 2% in all areas. Mutational analysis of NF2 was negative. After surgery, the patient was followed up for 8 months without receiving any adjuvant radiotherapy or chemotherapy. During this period, the patient was disease-free. All English literature about MA-M published on PubMed was reviewed, and the clinical pathology information on sex, age, location of the lesion, clinical presentation, histopathological type of the meningioma, and clinical outcomes was obtained. A total of 62 cases of MA-M were included. Clinical information on these cases and the present case is detailed in Table 1.\nOUTPUT:" }, { "from": "agent", "value": "Transitional meningioma (WHO grade 1) associated with MA" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The patient is positioned in the prone position. Localization of the axillary nerve and its cutaneous branch is done prior to prepping and draping. A longitudinal line is drawn from the postero-lateral acromion to the olecranon. A second transverse line is drawn from the axillary fold to intersect the first line at 90 angle. Anatomically, the quadrilateral space should be 2 cm cranial to this point of intersection. This point is marked blue in Fig. 1a&b. Using 6-15 Mhz linear ultrasound probe (Fig. 1C) positioned at the postero-medial aspect of the upper arm in the sagittal plane, we first identify the humeral head and neck. The probe is then moved medially to view quadrilateral space and the target structures within the space (the circumflex artery and the axillary nerve which appears as hyper-echoic oval-shaped structure). The ultrasound probe is then moved to scan the cutaneous branch of the axillary nerve as it branches-off the main nerve trunk. Finally, the cutaneous branch is traced superficially till it becomes subcutaneous. In the current case, the cutaneous branch at the level of the skin is marked as a red circle in Fig. 2. The patient is now prepped and draped. A longitudinal surgical incision is made along the acromion-olecranon line passing through the previously located quadrilateral space point as well as the point of the cutaneous branch of the axillary nerve. The cutaneous branch is then identified and dissected (Fig. 3). Next, the cutaneous branch is followed retrograde to the axillary nerve in the quadrilateral space (Fig. 4). The motor part of the axillary nerve is isolated and divided as far as possible from its entry to the deltoid muscle. The radial nerve branches to the three heads of the triceps muscle are then identified. We usually use the motor branch to either the lateral or medial head of the triceps. The selected triceps motor branch is transected as distal as possible and is transposed proximally for coaptation to the divided deltoid nerve using fibrin glue (Fig. 5).\nOUTPUT:" }, { "from": "agent", "value": "No specific diagnosis provided in the case report." } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 32-year-old gravid 3, para 2 woman with a history of one prior cesarean section was referred to the Department of Obstetrics and Gynecology because of continuous vaginal bleeding from 3 weeks ago. The present gravidity was conceived spontaneously; it was detected in the 12th week of gestation. Physical examination and gynecologic examination of the vulva and vagina were normal. The cervix was long and rigid and mild vaginal bleeding was detected. Vaginal ultrasonography demonstrated a mass in the uterus and it was suspected to be gestational sac without fetal pole, with one of the differential diagnoses being molar pregnancy. Dilatation and curettage was down for patients and some tissue was extracted. In the curettage, she has severe vaginal bleeding that was immediately controlled with oxytocin and misoprostol. After 2 days, she was discharged from the hospital without any problems. After 1.5 months, she returned with continuance minimal and intermittent vaginal bleeding. In the physical examination, she was anemic but had stable hemodynamic, her uterine size about 14 weeks with soft and nontender uterus, cervix was closed and vaginal bleeding was less than menses period. Transvaginal sonography indicated that the uterine size was 101 mm* 50 mm * 72 mm, the endometrial thickness was about 6 mm and the mixed echo lucent lesion was 48 mm * 52 mm in myometrial thickness of the lower segment alike hydatiform mole [Figure 4] and serum BHCG was 55 mUI/mL. A total abdominal hysterectomy was performed [Figure 5].\nOUTPUT:" }, { "from": "agent", "value": "Placenta increta" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 56-year-old woman, with no relevant medical or family history, was referred to our movement disorders service for a two-year-history of progressive tremors in her left hand. She was not using any medications and denied using illicit agents. On examination, she demonstrated a coarse left upper limb tremor at rest, as well as with posture and action. Tone was normal but mild bradykinesia was found on the left side, with reduced arm swing while walking. Four weeks later, on a dose of 100/25 mg three times a day, she called in panic because of sudden severe hair loss on the right back of her head (see Figure 2a). Dopaminergic medication was ceased immediately. There were no signs of another underlying auto-immune disease. The patient was commenced on combination therapy topical steroids/calcineurin inhibitors/minoxidil and after three months she noticed slow regrowth of hair on the scalp. Half a year later, our patient described worsening of her tremors when holding cups. She had also experienced reduction after alcohol consumption, and we trialed her on propranolol therapy. Initially, she reported an 50% improvement of tremulous movements, however, on a dose of 40 mg per day, she developed significant patchy hair loss again (see Figure 2b), causing us to cease the beta-blocking agent. This time, regrowth occurred in a couple of weeks, and in the light of the good response on propranolol, we commenced her on a build-up scheme of primidone. Despite an excellent effect on her tremors, she had to be weaned off on a dose of 125 mg bi-daily because of cognitive dysfunction and early hallucinations. One year later, her tremors had extended to her left leg, and after a long discussion we started her on a low dose of topiramate, 50 mg daily.\nOUTPUT:" }, { "from": "agent", "value": "Early-stage Parkinson's disease, Alopecia areata" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 48-year-old female presented with recurrent episodes of carpopedal spasm, starting at the age of 22. At that time, she was found to have hypocalcemia and was managed with calcium supplements, though she was irregular with calcium intake. She complained of neck and back stiffness for the past 8 years. She had a recent fall in the bathroom and sustained an intertrochanteric fracture of the right femur. She was treated with an internal fixator and was referred to our hospital for further investigation and treatment. Physical examination of the woman revealed Chovstek's sign, with neck and back stiffness. After a workup for metabolic bone disease, biochemical serum parameters revealed low calcium (7.3mg/100ml), high phosphate (6.2mg/100ml), very low PTH (<1.0 pg/ml), and normal magnesium (1.86mg/100ml). After a skeletal survey, anteroposterior (AP) radiography of the pelvis showed ossification of iliolumbar ligaments at the lateral margin of the acetabulum and capsular calcification around the hip joints. Enthesopathic changes were seen at the muscular insertions of lesser trochanter and greater trochanter, ischial tuberosities, and iliac crests, with normal sacroiliac joints (Fig. 1). AP radiography of the thoracolumbar spine revealed extensive ossification of the interspinous and supraspinous ligaments, and a syndesmophyte formation (Fig. 2). Lateral radiography of the cervical spine showed ossification of the anterior longitudinal ligament and enthesopathic changes at the posterior elements (Fig. 3). AP radiography of the forearm bones demonstrated ossification of the interosseous membrane (Fig. 4). There was a generalized mild increase in the bone density. Computed tomography (CT) of sacroiliac joints was performed to rule out sacroilitis. It showed normal sacroiliac joints with ossification of iliolumbar ligaments, enthesopathic changes, and osteophytes at the superior and inferior margins of the sacroiliac joint (Figure 5, Figure 6). A plain CT scan of brain showed bilateral symmetric basal-ganglia calcification (Fig. 7).\nOUTPUT:" }, { "from": "agent", "value": "Spondyloarthropathy, Long-standing idiopathic hypoparathyroidism" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 47-year old female patient received ipilimumab in an adjuvant setting (10 mg/kg body weight). Two weeks after the first infusion, erythematous maculae developed in sun-exposed regions a few hours after two short outdoor stays despite extensive sun protection (sun protection factor 50+; ultraviolet (UV)-B/UV-A). The erythema disappeared during the next five days. and subsequently oral steroids) 37 weeks after treatment initiation. In addition, circumscribed depigmented, non itchy areas below both knees, a pronounced itchy rash, erythematous macules and infiltrated plaques affecting the lumbar and inguinal region, the flexural areas, scalp, both palms and the lower right leg, were reported. Laboratory blood tests showed no signs of inflammation. Histological evaluation demonstrated a spongiotic epidermis with parakeratosis and acanthosis, a discrete edema in the dermal papillae and a perivascular infiltrate of lympho-histiocytes with some eosinophils.\nOUTPUT:" }, { "from": "agent", "value": "Metastatic melanoma, Pruritic exanthema, Drug eruption, Diarrhea/colitis, Bowel perforations, Pancreatitis, Amenorrhea with hyperprolactemia" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Thereafter, he underwent combination therapy with HD (for 4 hours, once per week) and PD (1.5% Dianeal PD-2, 4 times per day, 6 days per week). Factor VIII (1000 U) was administered about three times a week (once a week after HD and irregular self-injection). When he presented at the emergency room, his blood pressure was 200/100 mmHg. His blood tests showed prolonged APTT (110 second). Emergency surgery was performed to remove the hematoma. He received a large amount of factor VIII to achieve an APTT level less than 40 seconds for one week. He regained consciousness after surgery and was managed with PD without HD to avoid cerebral edema. He received 1000 U of factor VIII before removal of the dialysis needle at the end of every HD session to maintain the APTT level between 50 sec and 60 sec. The factor VIII levels were not influenced by the hemodialysis (Figure 1), indicating that factor VIII did not pass through the dialysis filter.The APTT levels under management with HD were significantly shorter than those under combination therapy (PD and HD) (Figure 2). He could be discharged from hospital, and he underwent maintenance dialysis safely without anti-coagulant as outpatient thrice weekly.\nOUTPUT:" }, { "from": "agent", "value": "Severe hemophilia A, Chronic kidney disease, Congestive heart failure, End-stage renal disease, Intracerebral hemorrhage, Hydrocephalus" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: An otherwise healthy 41-year-old man complained of paroxysmal occipital headaches lasting over a week, with increased severity for 3 days accompanied by slight dizziness and mild nausea. These symptoms lasted 10-20 min every time and were exacerbated by postural changes. No coma, seizure, or other signs were reported. Neurological examination showed no evidence of focal deficit. Computer tomography (CT) of brain revealed a hyper-dense lesion in the prepontine cistern (Fig. 1b, c). 1d). 1e, f). The patient underwent surgery for removal of the lesion via the right-sided far-later approach. The wall of the lesion was semi-transparent, white-grayish and fragile. After aspiration of the contents, the lesion was dissected away from the surrounding neurovascular structures and removed totally. The postoperative MRI revealed that the lesion disappeared completely. Postoperatively, the patient manifested fever, headache, nausea, and positive signs of meningeal irritation. Cerebrospinal fluid (CSF) specimens were collected by lumbar punctures and laboratory results showed polymorphonuclear pleocytosis, slightly higher protein and negative culture results. Repeated lumber punctures were performed and a continuous lumbar subarachnoid drainage was retained for 3 days. The leukocyte count in the CSF decreased gradually, accompanied with a gradual normalization of body temperature. Seven days after operation, the symptoms caused by meningeal irritation were relieved, and the patient was discharged uneventfully.\nOUTPUT:" }, { "from": "agent", "value": "Enterogenous cyst, Chemical meningitis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A woman in her 80s was transferred to our hospital as an emergency due to consciousness disturbance, right conjugate deviation, and severe left hemiparesis. She had been on rehabilitation with a walking frame at another hospital after surgery for right femoral neck fracture and had untreated hypertension and hyperlipidemia with no smoking. On admission, the blood pressure was 157/97 mmHg, body temperature was 36.3 C, and heart rate was 73 beats/min, sinus rhythm on electrocardiography. Blood test showed brain natriuretic peptide of 68.2 pg/mL, D-dimer of 2.7 mug/mL, triglyceride of 231 mg/dL, total cholesterol of 244 mg/dL, and low-density lipoprotein (LDL) of 163 mg/dL. 1A-B). Intravenous tissue plasminogen activator and mechanical thrombectomy were performed 4 hours after the onset. (Fig. 1C-D). A yellowish thrombus was retrieved in a single procedure by a combined technique using an aspiration catheter and stent retriever (Fig. 1I). The MCA was completely recanalized (TICI 3), and the symptoms tended to improve immediately (Fig. 1E). However, follow-up MRI showed newly embolic infarcts in the left frontal lobe and in the bilateral cerebellar hemispheres, although no re-occlusion of the MCA was observed (Fig. 1F-H).\nOUTPUT:" }, { "from": "agent", "value": "Cerebral Embolism" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 58-year-old Caucasian female with a past medical history of Hashimoto thyroiditis had been well until 2012 when she noticed redness and thickening of the skin on the face, progressively spreading to the trunk and extremities. The rash was neither painful nor pruritic. She reported no history of cardiovascular, neurological, nor respiratory symptoms, though she reported occasional joint pains. Skin biopsy in 2012 showed an increased amount of mucin deposition, increased fibroblasts, and a perivascular infiltrate of lymphocytes, histiocytes, and plasma cells. Laboratory testing in 2012 was significant for an elevated thyroid peroxidase antibody level of 1,113 IU/mL. Other labs including CBC, CMP, TSH, ANA, rheumatoid factor, ESR, CPK, anti-Ro, and anti-La were within normal limits. Serum protein electrophoresis was within normal limits. One year after diagnosis, in 2013, she was started on intravenous immunoglobulin therapy and responded well, with clearance of her skin after two infusions. However, once her dose was reduced in 2016, her dermatologic symptoms relapsed. At current presentation in 2018, physical examination was significant for widespread indurated, waxy, erythematous, and thickened skin throughout the entire body. Erythematous, confluent papules measuring 2-4 mm were most visible on the face and chest (Fig. 1). Her back and thighs showed indurated skin folds consistent with the \"Shar Pei sign\" (Fig. 2). Bilateral forearms and legs lacked hair. Her fingers, upper extremities, and neck showed normal motility. Laboratory testing was significant for elevated IgG at 1,953 mg/dL (normal range 700-1,600 mg/dL), and serum protein electrophoresis showed elevated gamma globulin at 2.1 g/dL (normal range 0.4-1.8 g/dL), with a pattern demonstrating a single peak M-spike in the gamma region. Urinary analysis showed positive leukocyte esterase and 11-30 WBC/HPF associated with urinary tract infection, but normal immunofixation and electrophoresis.\nOUTPUT:" }, { "from": "agent", "value": "Discrete Papular Lichen Myxedematosus, Scleromyxedema, Hypothyroidism" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 70-year-old man was referred to our Breast Center from his primary care provider with the chief complaint of a left breast lump. The patient was seen eight years prior to the current presentation with a lump in his opposite breast. On current evaluation, the patient presented with the history of a left breast lump for more than one month with no associated pain or nipple discharge. He had no family history of breast cancer. On physical exam, there was a 2 cm, visible and palpable lump beneath the left areola of the left breast with no nipple retraction or discharge. Axillary lymph nodes were not palpable and exam of the right breast was unremarkable. Ultrasound of the left breast lump demonstrated a well-circumscribed, mostly cystic, complex mass with a solid nodular component along one wall, measuring 2.4 by 1.4 by 2.4 cm (Figure 3A, Figure 3B). On Doppler, blood flow was present within the nodular component (Fig. 4). Myoepithelial cell marker stains of smooth muscle myosin, p63, calponin and cytokeratin 5/6 were negative, supporting the diagnosis. The specimen was estrogen receptor positive at 100% and progesterone receptor positive at 80%. Her2/Neu FISH testing revealed no evidence of amplification of the HER2 gene. The patient underwent left simple mastectomy with left axillary sentinel lymph node biopsy. The left axillary sentinel lymph node removed was negative for metastatic disease.\nOUTPUT:" }, { "from": "agent", "value": "Intracystic Papillary Carcinoma, Gynecomastia" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 56-year-old female patient attended the Department of Orthopedics at our hospital with a history of knee and hip pain for more than five years, and of increasing intensity during the previous six months. The patient also complained of nausea, fatigue, and several episodes of vomiting during the previous week. Blood tests revealed a serum calcium level of 3.89 mmol/L and a parathyroid hormone level of 274 ng/L. The initial management plan included intensive fluid therapy with normal saline. Salmon calcitonin together with pamidronate disodium was also given to decrease serum calcium. After five days, the serum calcium was still at 2.88 mmol/L. Ultrasound and computed tomography (CT) scan of the thyroid glands both indicated a posterior right lobe cystic mass, and the 99mTc sestamibi imaging indicated a hyperfunctioning right lower parathyroid lesion. Seven days after admission and medical treatment, the serum calcium level was still raised at 3.6 mmol/L. The patient was then referred to the Department of General Surgery for emergency surgical treatment. A 1 cm x 1 cm x 1 cm friable mass on the posterior inferior aspect of the right thyroid lobe was excised during surgery. On the first postoperative day, the total serum calcium was 2.14 mmol/L and parathyroid hormone was 0.81 ng/L. Three days later, the patient complained of body numbness and mouth twitching due to postoperative reactive hypocalcemia. Consequently, calcium gluconate 10% and other calcium supplements were given to the patient, after which the serum calcium level returned back to normal. The patient's condition eventually improved and she was discharged with regular follow-up for six months.\nOUTPUT:" }, { "from": "agent", "value": "Parathyroid crisis secondary to parathyroid tumors, Osteoporosis, Nodular goiter" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 56-year-old man with no previously known comorbidities presented with a 3-week history of radicular pain along the medial aspect of the left arm and forearm, numbness along the medial aspect of the left arm and forearm, and progressive left-hand grip weakness. On examination, he had left-sided partial ptosis and miosis [Figure 1a], wasting of the left forearm muscles and small muscles of the hand [Figure 1b], weakness of the intrinsic muscles of the left hand, and decreased sensation along the medial aspect of his left arm and forearm. His reflexes were normal. Blood counts and inflammatory markers were normal. Chest X-ray and computed tomography (CT) thorax were normal. The lesion was seen compressing the left T1 nerve root. The radiological differential diagnosis of the lesion we considered was (i) inflammatory lesions such as pyogenic discitis or Pott's spine, (ii) benign lesions such as schwannoma, neurofibroma, or meningioma, (iii) malignant lesions such as metastasis, lymphoma, or Pancoast tumor, or (iv) cervicothoracic IVDP. Under general anesthesia, he underwent left T1 hemilaminectomy, upper half of left T2 hemilaminectomy, and removal of the lesion through a posterior approach in prone position with electrophysiological monitoring. Intraoperatively, the foraminal lesion was seen filling the left T1 foramen and pushing the T1 nerve root superiorly and the dural tube medially. The lesion was removed and the nerve root and dural tube were made lax. The dura and the nerve roots were not infiltrated by the lesion. There was no purulent material. Biopsy of the lesion revealed tissue consistent with disc material with no evidence of granuloma, atypical, or malignant cells. The tissue culture from the lesion was reported as sterile. Immediately after surgery, his left upper limb radicular pain improved significantly. At 3-month follow-up, there was a total improvement in his left upper limb radicular pain, numbness, and weakness.\nOUTPUT:" }, { "from": "agent", "value": "Horner's syndrome, T1-T2 intervertebral disc prolapse" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 57 year old woman presented to her ophthalmologist complaining of protrusion of her right eye in August 2005. Six months later, she developed redness, dryness, and pain in the right eye with worsening exophthalmos. She also complained of double vision and headaches. She was started on thyroid replacement for borderline hypothyroidism but had no relief in proptosis. Antibiotics were prescribed for suspected bacterial infection of the right eye without resolution of her symptoms. She was then started on prednisone 80 mg daily for possible autoimmune/inflammatory etiology and her symptoms improved significantly. At this time, her visual acuity was noted to be 20/25 in the affected eye. Fundoscopic exam was normal. Hertel exophthalmometry, ocular tension, and biomicroscopy were not documented. An MRI of brain and orbit revealed an enhancing soft tissue mass behind the right globe (Fig. 1). 2). ANA, ANCA, ACE, anti-SSA and anti-SSB antibodies were negative though the patient was found to have an equivocal MPO-ANCA of 6. A diagnosis of limited WG was made. Patient was started on oral cyclophosphamide at 2 mg/kg/day in August 2006 and prednisone was continued. A repeat MRI of the orbit in November 2006 showed decreased enhancement and infiltration of fat adjacent to right optic nerve. In April 2007, cyclophosphamide was discontinued because of leucopenia and methotrexate was started. The prednisone has been discontinued. She continues to remain stable with no worsening till to date.\nOUTPUT:" }, { "from": "agent", "value": "Limited Wegener's Granulomatosis, Graves' Disease" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 62-year-old male was referred for surgical consultation due to complaints of recurrent abdominal pain accompanied by nausea and vomiting for the past year. The patient received proton pump inhibitors (PPIs) for treatment of reflux symptoms for over 4 years. In addition the patient was obese (Body Mass Index 33.3 kg/m2) with known hyperlipidemia and fatty liver. Gastroscopy did not reveal mucosal pathology. The procedure was performed laparoscopically based on Nissen fundoplication. After preparation of the diaphragmatic crus and the distal esophagus, the hiatal defect was closed using V-Loc Wound Closure Device, nonabsorbable sutures (Covidien). A tension-free closure of the defect was performed using 10 x 15 cm ETHICON PHYSIOMESH Composite Mesh tucked anteriorly and sutured posteriorly to the diaphragm. The postoperative course was uneventful; the patient was put on liquid diet and was discharged from the department four days after surgery for ambulatory follow-up. He was prescribed with PPIs for 6 weeks and pain relievers. During 3 years' outpatient follow-up the patient is feeling well and is free of complaints.\nOUTPUT:" }, { "from": "agent", "value": "Large Paraesophageal Hernia, Migration of the Stomach into the Mediastinum, Upside-Down Stomach, Gastric Volvulus" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: In 2020, a 66-year-old woman presented with recurrent headaches, fever and generalized myalgia/arthralgia since several months. Clinical investigation was unremarkable. Familial anamnesis did not include hemato-oncological abnormalities. There was no use of medicines. Bone marrow biopsy then showed hypercellularity with a strong representation of the granulocytic lineage in intermediary and mature stages, toxic granulations, and sea-blue histiocytes. Central plasmocytosis was 10.5%. No central blast excess was observed. Cytogenetic and molecular analysis resulted normal. Given the suspicion of CNL, the patient was shortly treated with hydroxycarbamide, which was rapidly stopped due to provoked cytopenia. Relapse of breast carcinoma was excluded and PET-CT resulted normal. Treatment with bortezomib-lenalidomide and dexamethasone (VRD) was initiated and resulted in partial response (PR). The patient refused intensification with autologous HSCT. VRD was stopped after three cycles due to neurological complications. According to patient requirement, low-dose lenalidomide (5 mg) was continued in monotherapy and PR was maintained. Currently, the patient is in follow-up; leukocyte count remains normal.\nOUTPUT:" }, { "from": "agent", "value": "Chronic neutrophilic leukemia, Monoclonal gammopathies, Smoldering MM, MM (R-ISS II), Nephrotic syndrome, Glomerulonephritis with mesangial IgA deposits" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: In practice, the treatment approaches are pursued based on the patient's age, performance status, and baseline neurocognitive status. In many instances, the standard care comprises surgical resection followed by chemoradiation and adjuvant chemotherapy in cognitively competent patients younger than 70 years old. In elderly subjects however, radiotherapy and palliative care is perhaps all that is sought. Despite the best possible care today, GBM prognosis has remained poor given the aggressive nature of the tumor. Therefore it is crucial to ensure that not only an extended progression-free survival but also an acceptable quality of life is provided through treatments. In terminal cases where treatments are withheld, best supportive or palliative care has to be provided to ameliorate symptoms as much as possible. The general, neurological and cognitive examination constitute the key imperatives while evaluating a case with GBM. When baseline measures are established, an improvement in the patient's clinical status can be witnessed, in terms of intracranial hypertension, focal neurological signs or cognitive profile. The assessment needs to be dynamic based on the treatment response,. As the clinical status improves, evaluation of the patient may advance to more sophisticated tests including neuropsychological evaluations, language assessments, neurocognitive profiling, and rehabilitation or studies where the patient's cooperation is definitional, including the functional magnetic resonance imaging (fMRI) of functional near infra-red spectroscopy (fNIRS). The functional status of patients is usually reported by the Karnofsky performance status (KPS) score or Eastern Cooperative Oncology Group (ECOG) scale, where patients with KPS of 70 and above or ECOG score of 0 to 1 have maintained their autonomy and can actively engage in activities of daily living,. Other than comprehensive neurological examination, patients would need to be assessed for neurocognitive performance and their quality of life. As such pre- and post-treatment quality of life and neurocognitive manifestations would be comparatively measured as a part of clinical evaluations and follow-up,. Some validated tools which are used for neurocognitive assessment include testing batteries such as Addendrook's Neurocognitive Examination (ACE), Repetitive Battery for the Assessment of Neuropsychological Status (RBANS), the Trail Making Test and the Multilingual Aphasia Examination.\nOUTPUT:" }, { "from": "agent", "value": "High-grade glioma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 2-month-old female infant previously healthy, presented to the pediatric emergency department. The infant's mother reported weight loss, colic, crying for feeding alternating with lethargy, mild diarrhea and worsening of vomiting beginning 5 days before ( Figure 1 ). Previously, she reported nasal congestion, sporadic cough, conjunctivitis, small skin vesicles on the chest and no fever. The real time reverse transcription-polymerase chain reaction (RT-PCR) SARS-CoV-2 nasopharyngeal test result was positive ( Table 1 ). The mother had been infected with SARS-CoV-2 10 days before the child. On physical examination, the infant was markedly irritable alternating with lethargy, with painful facies suggestive of abdominal colic associated to interruption of feeding several times, moderate dehydration, and hypothermia (<36 C). Her weight was 4.8kg, she had a mottled skin, prolonged capillary refill and a decreased urine output. Pulse rate was 125 beats/minute, respiratory rate was 54 breaths/minute, and oxygen saturation by pulse oximetry of 97% in room air. She was transferred to the pediatric intensive care unit (PICU) after fluid resuscitation. The patient was born at term, had no pre-existing medical conditions or use of antibiotics, and had been breastfed and complemented with infant formula since the second week of life. Table 1 summarizes data on blood biochemistry, urine, stool analysis, coagulation tests and infection biomarker tests performed after confirming SARS-CoV-2 infection by RT-PCR upon admission, and in follow-up. Serology for SARS-CoV-2 was IgM positive (2.11AU/mL, with normal range <0.90) and IgG was negative. The SARS-CoV-2 PCR persisted positive in fecal samples for more than 27 days, although the respiratory tract test was negative. Additional viral panel testing, urine and fecal culture were negative, and only the nucleic acid amplification test (NAAT or PCR) was positive for C. difficile . The helical multislice chest computed tomography (CT) scan, Doppler echocardiography and abdominal ultrasonography were normal. During 4 days of hospitalization in the PICU, the patient persisted with abdominal colic, and required additional intravenous fluids due poor acceptance of breast milk or infant formula. The proton pump inhibitor initially prescribed was withdrawn. The patient was not prescribed antivirals, glycocorticoids or antimicrobials.\nOUTPUT:" }, { "from": "agent", "value": "COVID-19, Coinfection with Clostridioides (Clostridium) difficile" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 25-year-old male was brought to the emergency department after being found at the side of the road. At presentation, the patient was unconscious. His vital signs were: blood pressure of 145 mmHg systolic over 122 mmHg diastolic, heart rate of 130 beats/min, respiratory rate of 24, and peripheral oxygen saturation of 91% on room air. No exit wound was identified. The bullet was round and measured approximately 5 mm in diameter, the characteristic size and shape of a BB gun bullet. Due to extensive intracranial haemorrhage, the patient was taken to the operating room for placement of an external ventriculostomy shunt catheter. Post-operatively, contrast enhanced computed tomography angiography of the head was performed, which demonstrated occlusion of the left internal carotid artery [Figure 1b]. However, it was also noted that the previously identified bullet was no longer located in the right transverse sinus. At admission, a portable chest radiograph had been unremarkable [Figure 2a]. Approximately 2.5 h later, a repeat post-operative chest radiograph showed a new round foreign body resembling a BB that projected over the left hilum with interval development of a wedge shaped pulmonary opacity silhouetting the left hemidiaphragm [Figure 2b]. The patient was admitted to the intensive care unit and evaluated by cardiothoracic surgery. No intervention to remove the bullet was performed as the patient was critically ill from a neurological perspective.\nOUTPUT:" }, { "from": "agent", "value": "Bullet embolism to the pulmonary artery, Secondary pulmonary infarction, Gunshot wound to the left globe" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 45-year-old obese male (BMI 40.8 kg/m2) presented with acute-onset swelling and severe pain in the left sternoclavicular joint associated with fever (<=38.2 C). His past medical history was notable for controlled hypertension and hypercholesterolaemia. He did not follow any particular diet and admitted occasional alcohol use (less than once a week). Laboratory evaluation showed leucocytosis of 14 200/mul, elevated erythrocyte sedimentation rate of 70 mm/h, hypoalbuminaemia, elevated levels of alpha2- and beta-globulins and a decreased albumin-to-globulin ratio. His serum uric acid concentration was 392 mumol/l [6.6 mg/dl; normal range: 202-417 mumol/l (3.4-7.0 mg/dl)]. Computed tomography revealed destructive changes in the left sternoclavicular joint (Fig. 1). With suspicion for malignancy, the patient was referred to the oncological centre, where resection of the left sternoclavicular joint was performed. Histological analysis, including polarized light microscopy, revealed uric acid crystals in the joint and periarticular tissues consistent with gout. Nevertheless, gout should be considered in the differential diagnosis of left sternoclavicular joint swelling, especially in patients with multiple metabolic risk factors. The differential diagnosis may be challenging if serum uric acid concentrations are not elevated. Nonetheless, a normal serum uric acid concentration does not exclude a diagnosis of gout, and gouty attacks are not always related to uric acid concentrations. Funding: No specific funding was received from any funding bodies in the public, commercial or not-for-profit sectors to carry out the work described in this manuscript. Disclosure statement: the authors have declared no conflicts of interest.\nOUTPUT:" }, { "from": "agent", "value": "Acute gouty arthritis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 68-year-old female patient was admitted to our department after progressive epigastric discomfort, along with nausea, gastric reflux and episodes of vomiting for the past four months. Her medical history included diabetes mellitus and no previous abdominal surgery. Her vital signs were normal, while physical examination was insignificant, with a mild discomfort during epigastric palpation but no abdominal pain. Laboratory examinations where within normal limits, with a hematocrit of 39.7%, and a hemoglobin of 12.4 mg/dL. 1). Upon entering the abdominal cavity, a huge anterior diaphragmatic defect was identified, with part of the greater omentum, small bowel loops, and gastric portions protruding through it inside the right thoracic cavity. Excision of the sac was next performed, with a tension-free closure of the diaphragmatic defect and reinforcement of the diaphragmatic wall with the fixation of an intraperitoneal non-absorbable mesh. The esophageal hiatus along with both right and left diaphragmatic crura and esophagogastric junction were identified in their normal anatomical position, so no further anti-reflux operation (360 or partial) was performed (Fig. 2). Post-surgical period was uneventful for the patient. She resumed normal diet on the 2nd post-operative day and was discharged on the 4th. During 6-month follow up she reported no further symptoms related to gastroesophageal reflux, while a plain chest x-ray revealed no malposition of the abdominal viscera.\nOUTPUT:" }, { "from": "agent", "value": "Morgagni hernia, Upside-down stomach" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: There are various ways of producing hydrogen in the literature, such as biological processes that extract energy from biomass. The idea of electrically splitting water molecules is 260 years old, however, the principle of using electrolysis to produce green energy arose in the 1990s. This idea was adopted due to the increased concern about tackling environmental issues. This current study introduces a new idea to decarbonize one of the important sectors in society which is water and wastewater services and reduce the industrial reliance on wastewater to produce energy. This can be achieved by utilizing the treated effluent into producing green hydrogen. The salient part of this paper is hydrogen production from treated effluent and sewage sludge that were employed as reuse applications. Hydrogen is one of the eco-friendly energy sources that has rapidly gained attention in recent years because it relies on water to be produced. It can be characterized through different color spectrums depending on its source. The most sustainable hydrogen is green hydrogen which is produced from renewable energy and has no greenhouse gas emissions. In this paper, the technical and economic feasibility of green hydrogen production in Oman was carried out. An overview of wastewater treatment and green hydrogen production was discussed. The feasibility study was conducted using the Al Ansab Sewage Treatment Plant (STP) which is managed by Oman Water and Wastewater Services Company (OWWSC), located in the governate of Muscat in Wilayat (region) Bousher. The study was evaluated using sustainable alternatives to produce hydrogen from a Proton Exchange Membrane (PEM) electrolyzer system for two cases with capacities of 1,500 kg H2/day and 50,000 kg H2/day. This study could help in achieving a circular economy by considering treated effluent as a source of producing new products. Furthermore, the study could help stakeholders and policymakers in wastewater industries forge a green pathway to achieving decarbonization.\nOUTPUT:" }, { "from": "agent", "value": "This case report does not contain a medical diagnosis as it is not related to a medical case." } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 14-year-old male presented to the emergency department with a finger sized \"mood\" ring on his penis down to the penoscrotal junction. The patient attempted to remove the ring with pliers and later with an engraving tool, which resulted in minor lesions on the dorsal shaft skin. Upon arrival he was in good condition, afebrile, and denied dysuria. On exam a finger-sized metal ring was noted at the base of the patient's penis with significant distal edema (Figure 1). After an initial attempt at removal with a ring cutter was unsuccessful due to the ring's width, an orthopedic oscillating saw equipped with a diamond blade was utilized for removal. In the emergency department the patient was placed under ketamine anesthesia and monitored by the ED attending. Under anesthesia, a wooden tongue depressor was placed between the ring and the patient's penis to protect the skin (Figure 2). The diamond blade saw was then used to cut the ring after which it was possible to bend, and remove it from the penis (Figure 3). Following removal, the distal edema began to resolve immediately and no clear necrosis or iatrogenic damage to the phallus was noted. Child psychiatry was consulted, it was determined that the patient placed the ring on his penis for autoerotic purposes and was not deemed to be a threat to himself. The patient was also advised that it would be unnecessary to report this event in any future medical history taking. Due to the uniquely stressful nature of the incident, both the patient and his family were counseled prior to release to ensure the wellbeing of all parties. He was discharged the following day, after voiding with no postvoid residual.\nOUTPUT:" }, { "from": "agent", "value": "Penile constriction" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 45-year-old female patient initially developed complaint of chest pain with hemoptysis, and antitubercular treatment was started empirically. She was subjected to 18F-FDG PET/CT scan for staging of primary disease in June 2014. The scan showed FDG avid soft tissue lesion (maximum standardized uptake value [SUVmax] 9.0) in the RLL along with mediastinal, abdominal, and bilateral pelvic lymph nodal involvement. The PET stage was III E.\nShe was treated with 5 cycles of chemotherapy (rituximab and bendamustine) and an interim PET/CT scan performed in November 2014 showed metabolically active residual disease in the RLL (SUVmax 11.5) and mediastinal lymph nodes. The Deauville score was 4. Thereafter, she received 2 more cycles of chemotherapy. Subsequent PET/CT scan done in July 2015 showed minimal residual disease in RLL (SUV max 2.45) along with metabolically active mediastinal lymph nodes with relatively increased FDG activity as compared to the previous PET, thus suspicious for disease recurrence. However, biopsy from the lymph node was nonreactive. The Deauville score at this time was 2. In this well-responded disease, PET scan done in January 2016 showed resolution of FDG avidity and a significant decrease in size of the right lung lesion (SUVmax 1.45) along with significant decrease in size and FDG avidity of mediastinal lymph nodes. However, new appearance of FDG avidity in the cutaneous and subcutaneous plane of the right vulva and posteromedial aspect of the right thigh along with the right external iliac and right inguinal lymph nodes were noted as new lesions, thus Deauville score was labeled as X [Figures 1 and 2]. She received tablet valacyclovir 3 times a day, tablet pregabalin once a day orally for 10 day, and responded well. She is under regular follow-up and doing well for the last 11 months.\nOUTPUT:" }, { "from": "agent", "value": "Active Herpes Zoster Infection, Marginal Zone Non-Hodgkin Lymphoma" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: In addition, significant tortuosity was present in the head and neck vessels. In the immediate postoperative period, the patient was noted to have diminished pulses in the lower extremities. As a result, the patient was taken back to the operating room where plication of the graft was performed. Five days after discharge, the patient presented with the upper extremity weakness, ptosis, and asymmetric pupils. The risk of surgical intervention was deemed so great as to preclude attempted surgery, and she was placed on a beta-blockade infusion. The patient was placed on comfort care at the request of the family and expired. There was a large hematoma within the false lumen compressing the true lumen. In addition, a large blood clot was formed around the thoracic aorta. A perforation was detected at the right renal artery ostium, and a large amount of free blood was visualized in the abdomen.\nOUTPUT:" }, { "from": "agent", "value": "Aortic complications, Loeys-Dietz syndrome, Aortic insufficiency, Aortic stenosis, Left ventricular dilation and dysfunction, Ascending aorta aneurysm, Aortic dissection, Left-sided hemothorax" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Our patient is a 76-year-old female of Chinese descent who came in for initial consult in year 2000 at age 61 at another institution, due to symptoms of upper airway obstruction, i.e., choking, snoring and difficulty of breathing on lying supine. On examination, she was noted to have enlarged hands, feet, tongue, lip, and nose; and a prominent mandible. She is a diabetic, maintained on oral hypoglycemic medications. Workup revealed an elevated IGF-1; and confirmed with an unsuppressed growth hormone levels on oral glucose challenge (Table 1). An MRI of the sella with contrast (pituitary protocol) revealed a normal pituitary. A CT scan of the neck, chest and abdomen done were also unremarkable. After explaining treatment options and the risks associated with each intervention, our patient opted for medical management. Patient was started on octreotide [Sandostatin-LAR] 20 mg monthly for 8 months, but repeat IGF-1 level was persistently elevated. Hence, cabergoline, 0.5 mg/tab, 2 tablets twice a week was added to her Sandostatin regimen. But unfortunately, due to cost, difficulty in procuring the medication, and the bothersome nature of administration (subcutaneous), patient stopped Sandostatin-LAR and continued with cabergoline, 0.5 mg, 2 tablets twice a week. A repeat pituitary MRI 2 years later (2002) showed an \"empty sella.\" Another MRI scan of the pituitary was done in 2004, where no pituitary adenoma was again identified (Appendix A). In June 2015, patient consulted in our institution for diabetes management follow up. The attending endocrinologist still noted coarse facial features, enlarged hands and feet (Figure 1-3). She was noted to be hypertensive on blood pressure lowering medications and diabetic on oral hypoglycemic agents. Repeat IGF-1 and levels of IGF-1 through the years are shown on Table 2. A repeat MRI imaging of the sella revealed normal pituitary, with no evidence of pituitary adenoma (Figure 4-5).\nOUTPUT:" }, { "from": "agent", "value": "Acromegaly" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: We report the case of a 60-year-old woman, menopausal for 10 years, mother of two children, hypertensive on amlodipine, who consulted a gynecologist in private for postmenopausal bleeding. An endovaginal ultrasound was performed, showing an intracavitary image of 15 mm in favor of a polyp. Then, the patient had an ambulatory hysteroscopy with polyp resection and endometrial biopsy. Forty-eight hours later, the patient went to the medical-surgical emergency room for abdominal pelvic pain. The examination found a tachycardic, febrile, hypotensive patient with a saturation of 90% and diffuse abdominal sensibility. A computed tomography (CT) scan of the abdomen and pelvis was performed to eliminate any perforation or pelvis peritonitis. During the realization of the CT scan, the patient started to desaturate with a fall of pressure to 90/50 mmHg. The patient was admitted to the recovery room with conditioning and realization of biological sample (C-reactive protein 360), blood gases (lactate 4), then intubated on neurological criteria (Glasgow coma scale 12) and desaturation at 80%. The CT result was in favor of an intra-uterine collection with hydroaeric level and an increased uterus size without any sign of perforation or pelvic peritonitis [Figures 1 and 2]. A gynecological examination was requested, and we performed an aspiration of the collection made of fetid blood with the realization of bacteriological samples and blood cultures. Afterward, the patient was put under antibiotic therapy (imipinem with amikacine) and administration of the vasoactive drug (noradrenaline), but unfortunately, without any improvement, the patient died 3 h later. The results of bacteriological sampling and blood culture were concordant and showed a sensitive Escherichia coli.\nOUTPUT:" }, { "from": "agent", "value": "Septic Shock" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: The second-generation total exon sequencing technique was used to analyze the ataxia caused by single-gene mutations; additionally, the dynamic mutations and repetitions were detected by using capillary electrophoresis sequencing technology to verify and analyze the mutation sites of the patient and her family members. The results of the pre-existent (IV.1) gene tests of her and her brother showed variation in ATXN8OS. The capillary electrophoresis method suggested that the number of CTG triple nucleotide repeats in ATXN8OS coding area was abnormal, totaling >400 times (SCA8 diagnostic reference value: normal repetitions = 15-50; abnormal repetitions = 70-1300) (Koob et al.,). Owing to limitations of the genetic company's testing equipment, capillary electrophoresis did not have a cliff-like interruption, and the specific number of replicates could not be detected. The number of CTG triple nucleotide repeats in the CTG coding region of ATXN8OS was >300 times for her mother. The proband received antispasmodic rehabilitation. According to her clinical performance, the first stage of systematic physical therapy was selected. She was guided by a professional rehabilitation therapist in our department. Her program included physiotherapy training (2 times a day for 50 min), gait training (treadmill) (once a day for 30 min), and instrument training using passive traction instruments (20 min/group, 10 times/group, 6 groups/day). In the case of poor physical system rehabilitation, the second stage was supplemented with a knee and ankle-foot orthosis, oral clonazepam (0.05 mg/kg/d, bid; later adjusted to 0.1 mg/kg/d, bid), oral baclofen (0.5 mg/kg/d, tid; later adjusted to 1 mg/kg/d, tid), and botulinum toxin injection for almost 1 year to improve the lower muscle tone (400 units, the injection sites were the bilateral hamstring, flounder, and gastrocnemius muscles; after 2 months, 200 units were added, the injection sites were the bilateral iliopsoas and adductor muscles). The third phase involved the surgical implantation of a baclofen pump system (Medtronic SynchroMed II infusion system) in March 2022. It was placed between the third fourth lumbar vertebral bodies. The pump administered 140 mug of baclofen daily.\nOUTPUT:" }, { "from": "agent", "value": "Spastic paraplegia, Spinocerebellar ataxia type 8" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A previously healthy 3-month-old girl was transferred to our hospital for severe abdominal distention, post-prandial vomiting, obstipation, and anuria for the last 5 days. CT scan done prior to presentation at another hospital showed a cystic abdominal mass displacing the girl's bowels, bladder globus, and bilateral hydroureteronephrosis (not shown). Her creatinine level was elevated reaching 4.99 mg/dl upon admission. 1). To restore kidney function and prevent renal failure, a urinary foley was inserted and was successful in dropping her creatinine levels to normal reaching 0.28 mg/dl the third day. Surgical resection was performed on the fifth day with a posterior approach starting with an incision from S3 to the coccyx and a laminectomy to expose the sacral canal. The dural communication was ligated from the rest of the thecal sac followed by cyst cerebrospinal fluid drainage. The next day, post-operation echography showed residual cysts in the intra-abdominal cavity. Abdominal laparoscopy was done on the eleventh day to drain the remaining cysts which enabled urinary foley removal and patient's discharge symptoms free. A year later, the child presented back with constipation. A lumbosacral MRI showed a solid lesion of 7.5 cm of height and 6.5 cm of diameter associated with adenopathies (Fig. 2). An inguinal lymph node biopsy demonstrated the presence of a yolk sac tumor. Neoadjuvant chemotherapy was started. 3 months later the tumor was resected. 3).\nOUTPUT:" }, { "from": "agent", "value": "Currarino Syndrome, Anterior Sacral Meningocele, Malignant Mixed Germ Cell Tumor" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: More challenges are linked to the content posted, as extra attention is constantly needed to make sure not only that shared content is appropriate, but also appropriate to a specific age group ('It's acceptable for a 16 year old on our site to ask where they can get free condoms, but if an 11 year old is asking that question we are reacting in a very different way' (PTS3)). Additionally, attention is constantly needed to ensure that the digital platforms do not foster any type of dis- or mis-information ('We are very aware we're not medical professionals and their peers certainly aren't either so with those questions what we tend to do is we'll say: we're really sorry we can't publish this [...] but hey let's have a talk about it, maybe here's an NHS information page we can give you that you can read and come back if you have any questions' (PTS3)). Also, anonymity and confidentiality must be maintained throughout, so that extra effort is needed to check, for instance, that the same username is not used across social media as that could easily reveal the real identity of a user ('Something that could be useful to do with some automation if possible', PTS1). At times, the content posted could be difficult to interpret because slang (from different geographical areas) is used, or users make references to numbers (for instance, of county lines offences) and moderators could not be familiar with those (PTS2). A final set of risks refers to the need and importance to foster a climate of trust with users, and to build and maintain a relationship ('you need to build that rapport with them first, before they feel that they can open up' (PTS5)). This entails showing that staff care about users, but also that they need to be treated with respect ('You know, we sometimes get asked \"are you robots, like are you real people?\"' (PTS3); 'You do get some users who sign up and they just send like erm, ridiculous things. And, or they think that we're like robots. [...] Yeah, or like those and rude things, or......very inappropriate things. [..] We always message them in a way that shows that we are human, [...] a lot of the time, the users who send something silly, they're just kind of testing the water' (PTS9)).\nOUTPUT:" }, { "from": "agent", "value": "The case report does not provide information about a specific diagnosis." } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 43-year-old man had a deceased-donor renal transplantation for the management of end-stage renal disease secondary to IgA nephropathy. The induction agent used at the time of transplantation was ATG 4.5 mg/kg. Afterwards, he received immunosuppressive maintenance therapy that consisted of mycophenolate mofetil (MMF) 1000 mg twice daily, tacrolimus, and prednisone 5 mg daily. The donor's and recipient's PB19 statuses were unknown. After the transplant, hemoglobin remained stable in the range of 100-120 g/L until 4-month posttransplantation when the patient started to complain of dizziness and shortness of breath on exertion. Blood work at that time showed hemoglobin level of 58 mg/L that was normocytic and normochromic with normal morphology on the blood smear. The patient's reticulocyte count was inappropriately low at 3 x 109/L (normal range 10 - 86 x 109/L). Vitamin B12 and iron indices were normal, and the hemolytic screen was negative. PCR for Cytomegalovirus (CMV), BK virus, and Epstein-Barr virus (EBV) was negative. Serology for PB19 showed a negative IgG and an indeterminate IgM antibody level. The patient was transfused 2 units of red blood cells and discharged home on erythropoietin stimulating agent. MMF dose also reduced to 500 mg twice daily upon discharge. Unfortunately, the patient was readmitted 2 weeks later with the same complaints and a hemoglobin level of 56 g/L. The reticulocyte count was persistently low at 5 x 109/L. PB19 serology was repeated and showed negative IgG and an indeterminate IgM. The patient received transfusion of 2 units of RBCs and PB19 PCR also positive this time. Patient started on IVIG (0.5 g/kg) for a total of 4 doses. MMF discontinued on this admission and patient discharge after completing IVIG course on prednisolone and tacrolimus only. On discharge, the patient's symptoms had improved, and hemoglobin was 87 g/L. Patients followed monthly in posttransplant clinic, and hemoglobin normalized after 1 month. MMF resumed at 500 mg bid after 4 months, and hemoglobin remained above 125 g/L during 3 years follow-up with no further relapse.\nOUTPUT:" }, { "from": "agent", "value": "Parvovirus B19 Infection" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 30-year-old woman was admitted to our hospital because of exertional dyspnea and chest pain. With suspicion of pulmonary thromboembolism, enoxoparin (a low molecular weight heparin; LMWH) was started. On admission, laboratory examination revealed; white blood cell count (WBC): 11000/muL, serum creatinine; 1 mg/dl and BUN of 35 mg/dl (Table 1). Left atrium also had two large mobile masses of 2.52x1.35 and 1.9x1.0 cm in diameter, attached to the mitral valve. Three days after LMWH starting, platelets count dropped to 96000/mul. At seventh day of admission, left leg became swollen and painful. Treatment was continued with hirudin and immunoglobulin (IVIG 20 g/day/ for five day). Bone marrow aspiration and biopsy disclosed a reactive bone marrow with normal cellularity. Rheumatic factor and antinuclear antibody were negative. D-dimmer; 8 mg/l (<0.3 mg/l), fibrinogen; 70 mg/dl (200-400). Antiphospholipid antibody of IgG and IgM were, 1.6 and 3.7 respectively U/ml (normal<12 U/ml). Also anticardiolipin antibody serum level of IgG and IgM were 5.2 and 9.2 U/ml (normal<12 U/ml) respectively. It revealed a tumoral involvement of right ventricle, left ventricle and inferior vena cava (IVC). Patient finally died because of right ventricular failure and shock state.\nOUTPUT:" }, { "from": "agent", "value": "Cardiac leiomyosarcoma, Thrombocytopenia, Thrombosis" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: He was born to a 28-year-old primigravida mother by caesarean section (Ind: Cephalopelvic disproportion) at 39 weeks of gestation and weighed 3460 g at birth. Antenatal ultrasound was normal. Apgar scores were 8 and 9 at 1 and 5 min of age. He was exclusively breastfed. Except for occasional vomiting he was well and weight gain was adequate. On examination, the baby had respiratory distress with respiratory rate of 72/min and subcostal retractions. On auscultation, air entry was decreased on the left side and bowel sounds were heard. He was febrile with temperature of 100.9 F, heart rate 142/min, and SpO2 89% in room air. Chest X-ray [Figure 1] showed bowel loops in left hemithorax with mediastinal shift to the right. A provisional diagnosis of CDH was made, and computed tomography (CT) scan of chest and abdomen was done. CT scan showed bowel loops and spleen in left hemithorax with mediastinal shift to the right side suggestive of CDH on the left side. Laparotomy done through left subcostal incision revealed classical posterolateral defect in the diaphragm with herniation of the small bowel, colon and spleen into left hemithorax [Figure 2]. Examination showed MD located at 38 cm from the ileocecal junction, measuring 6 cm in length and 1.5 cm in width along the antimesenteric border of the ileum. Palpation of MD did not show any nodule or mass within its lumen. The diaphragmatic defect was closed primarily after reducing the contents from left hemithorax. Ladd's procedure (excision of the Ladd bands, widening of the mesentery, appendectomy, derotation and intestinal repositioning) was done, and MD was excised. Baby was fed from the 3rd day and was discharged uneventfully on the 8th post-operative day.\nOUTPUT:" }, { "from": "agent", "value": "Congenital diaphragmatic hernia, Meckel's diverticulum, Malrotation" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Male 1 and male 2 witnessed at the court that they had survived with no vital damage on their bodies, they had seen the perpetrators and heard them talking. According to the post mortem examination results (Diyarbakir Office of the Chief Prosecutor, November 10th, 2005 and investigation number 2005/2855) are as follows; \n 1. 2. 1.\nOUTPUT:" }, { "from": "agent", "value": "Shrapnel wounds, Multi-piece fracture and deformities, The right eye emptied from bulbus oculi, Ecchymosis under head skin, Break at outher lamina, Subrocnoidal bleeding at both hemisphere, Rough edged bone defect at inner lamina, Subpleural bleeding on lung and congested cuts, Generalized subcutan bleeding on the left neck soft tissue, Free blood at hepatic lobe and full cut wound at right bottom edge liver, Cerebral and inner hemorrhage due to internal organ woundings, Fatal shrapnel wounds at head frontal hairy part and right subcostal area." } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 56-year-old lady presented with severe right anterior chest pain radiating into her arm and back, with significant arm paresthesia, following a fall on her extended arm 11 months earlier. There was no evidence on the CT chest scan of any rib fractures. She had a past medical history of discectomy on her lower spine and a right carpal tunnel decompression. Diagnosis of TOS was based on clinical history, physical examination, and imaging. MRI confirmed compression in her right subclavian artery within the interscalene triangle triangle distally (Figure 1()). There was no evidence of either cervical rib involvement of the brachial plexus. These findings supported the possibility of the arterial compression to be the origin of her symptoms and surgical option was discussed with her after failure of symptoms improvement following 6 months of intense physiotherapy. She underwent VATS first rib resection. After intubation with double lumen tube, the patient was placed in the lateral decubitus position with the arm abducted to 90 degrees. Three standard VATS ports were utilized. Two ports were placed in the anterior third and the lateral fourth intercostal spaces, while the third scope port was placed laterally in the fifth intercostal space. While being on single lung ventilation, the apex of the right lung was gently freed from all the adhesions. The first rib was identified, and both the parietal pleura and periosteum overlying it were stripped off (Figure 2()). With blunt dissection, the rib was freed from the neurovascular bundle from above. Gentle retraction of the neurovascular bundle was performed using a peanut before passing an endoscopic rib cutter (Figure 3()). The rib was cut anteriorly near the costoclavicular junction and posteriorly at the costovertebral junction. Dissection and nibbling of both stumps were then performed. All periosteal remnants were trimmed releasing the neurovascular bundle completely. The postoperative course was uncomplicated and patient was discharged within 24 hours following surgery. At the initial follow-up, the patient had marked improvement of her main symptoms.\nOUTPUT:" }, { "from": "agent", "value": "Arterial Thoracic Outlet Syndrome" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: All children were excluded from COVID-19 by nasopharyngeal PCR. Among the 101 children, 44 were males and 57 were females. The age of the children ranged from 1 to 16 years old. (2) The clinical data of children were complete. (3) Informed consent was signed for bronchoscopy and mNGS examination. Exclusion criteria were as follows: (1) Hospitalization for other reasons. (2) Basic diseases such as immune deficiency disease. General demographic data, clinical data, and imaging information were collected material. The clinical characteristics of the children are shown in Table 1. \nmNGS detection was performed by a medical laboratory. Its microbial database covers bacteria, fungi, atypical pathogens (Mycoplasma, Chlamydia, Bartonella, etc. ), viruses, and parasites. NGS technology extracts total nucleic acid from clinical samples, removes human nucleic acid through dehostization, randomly interrupts PCR-Free library construction, and performs quantitative quality inspection of Qubit library. Bioinformatics analysis identifies specific microbial species and then excludes the microbial community background that often occurs in different sampling sites and specimen types to find possible pathogenic microorganisms in the detected clinical specimens. The genome sequence was obtained from the National Center of Biotechnology Information (fp:/fip.acbi alm nhgov/genomes/). The pathogen detection index provided by mNGS technology includes the number of specific nucleic acid sequence reads identified by pathogen. The larger the number of reads, the higher the relative content of the pathogen detected. SPSS 22.0 software was used for data processing and statistical analysis. The measurement data that conformed to the normal distribution were expressed as +-s, and the t-test was used for the comparison between groups; the measurement data that was not normally distributed was expressed as M (Q1, Q3), and the comparison between groups was used Mann-Whitney rank sum test. The correlation between continuous variables was assessed using Pearson's correlation test. The enumeration data were expressed as cases (%), the detection rate of each group was compared by chi2-test, and P<0.05 was considered statistically significant.\nOUTPUT:" }, { "from": "agent", "value": "Severe Pneumonia" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: As part of the evaluation, PET/CT scan of the whole body was performed. It revealed high-grade uptake at the site of primary malignancy in the right lower lobe with a mean SUV of 7.8 (Fig. 1) and a 10 by 7 mm ipsilateral precarinal lymph node with mean SUV of 2.4 (not shown). In addition, it revealed a hyperactive metabolic nodular density with mean SUV of 2.4, localized anterior and to the left of the main pulmonary artery (Fig. 1-arrow). The CT portion of the PET/CT described it as soft tissue nodular density of about 11*7 cm in size and 40 house field units. The possibility of additional focus of metastatic lymphadenopathy was raised. The prior dedicated chest CT 2 weeks before PET/CT staging described it as soft tissue density, of unknown significance. The 3D PET, CT and PET/CT fusion imaging was not more helpful to further characterize the lesion in terms of its benign or malignant nature (Figure 2). The biopsy was performed shortly after the PET/CT scan and 3 months after the biopsy of primary lesion. The gross description of the lesion was described as yellow fatty tissue of 1.5 by 1.4 by 1.0 cm in size and final diagnosis was \"pericardial adipose tissue with no evidence of malignancy\" (Fig. 3). 4). The CD56 (Fig. 5) and synaptophysin antibody markers (Fig. Patient underwent radiation and chemotherapy treatment. Subsequent follow-up with PET/CT 6 months later (Fig. 7) showed marked improvement in the primary lesion showing photopenia with minimal rim of hypermetabolic activity and no new lesions. The contralateral pericardial soft tissue nodular density was unchanged in appearance and showed a mild decrease in SUV from 2.4 to 2.0.\nOUTPUT:" }, { "from": "agent", "value": "Lung Cancer" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 30-year-old female patient presented to another center in September 2019 with primary manifestations of upper limb muscle spasms and was diagnosed as multiple sclerosis (MS). In November 2019, she was admitted in our center with complaints of headache and lower limbs paresis. The patient's headache was positional aggravated by lying down. Opthalmoscopy examination revealed bilateral papilledema. Paresis was progressive and within 4 days, had increased from force level 5 from 5, to 1 from 5, and also she had a sensory level belowT4, which all representing acute myelitis. Brain MRI revealed periventricular lesions, periependymal enhancement and linear enhancement of corpus callosum (Figure 1- A, B, C). Cervical MRI revealed longitudinal extensive transverse myelitis (LETM) with ring enhancement (Figure 2- A, B, C). Brain MR venography (MRV) was normal. Lumbar puncture (LP) was performed for her. Opening pressure (OP) was 42 cm H2O in the first LP, so we began tablet acetazolamide 250mg twice daily and tablet lasix 20mg daily for the patient. CSF profile was white blood cell (WBC) count 99 cells (85% lymphocytes, 15% neutrophil), glucose 45, protein 55, and red blood cell (RBC) count 10. The patient's CSF samples were sent for rule out of tuberculosis, brucellosis, and Cryptococcus, which all of them were negative and also all other vascular, autoimmune diseases, and malignancies were considered and ruled out. The second patient's LP also had OP 27 cm H2O. Due to severe presentation of disease, we also began the plasmapheresis and corticosteroid simultaneously. According to the clinical evidences and imaging, the patient's positive anti- aquaporin antibody (AQP4-IGg), the diagnosis of NMOSD was established in terms of the revised 2015 criteria, and rituximab was then ordered for her. After foregoing treatments, the patient's headache gradually improved, muscle force returned to 4/5, and the patient was discharged after 23 days. No other disease was found in the studies that explained the patient's headache.\nOUTPUT:" }, { "from": "agent", "value": "Neuromyelitis Optica Spectrum Disorder" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: After informed consent was obtained, patient was prepared and draped in standard sterile fashion. After demonstration of appropriate pacing sensing function, the leads were anchored to pectoralis muscle and connected to a Guidant pulse generator (H 219). The leads along with pulse generator were placed inside the prepectoral pocket and the defibrillation threshold was assessed. There was difficulty in defibrillating at initial polarity and reversed polarity at 21 and 31 joules. A separate Superior vena cava (SVC) coil was placed at the juncture of the SVC and right atrium which did not improve the defibrillation threshold in either polarity. Subsequently the azygos vein was cannulated utilizing a Rapido IC 90, then a long sheath was placed and a Transvene lead (6937 A-Medtronic) was placed in azygos vein and the patient was successfully defibrillated at 31 joules (Figure 1A). Post operative chest x-ray confirmed the position of lead (Figure 2A)\nOUTPUT:" }, { "from": "agent", "value": "Dilated cardiomyopathy, Severe left ventricular dysfunction, Symptomatic heart failure, Intraventricular conduction delay" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Agenesis of teeth is the most common developmental dental anomaly in human beings. Several terms have been used to describe the congenital absence of teeth. Often teeth absent are the terminal teeth of a series [premolars (32-15%), maxillary lateral incisors (27%), and third molars (25%)]. Besides agenesis, other anomalies of size and shape can also be observed, such as rotation of the teeth, delayed dental development, and eruption. Furthermore, hypo-development of the jaws and alveolar bone with modification of the facial structures and functional consequences were noticed. Optimally, agenesis should be detected earlier during childhood. Multiple dental agenesis is most frequently discovered fortuitously. The diagnosis can only be confirmed by the orthopantogram (the absence of the dental follicle is a sign of agenesis).\nOUTPUT:" }, { "from": "agent", "value": "Oligodontia, Dubowitz syndrome" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: An 81-year-old woman with a previous history of hypertension and ischemic heart disease presented with fever, malaise, productive cough, and shortness of breath. She was taking clopidogrel, losartan, and propranolol. The patient's vital signs on admission were as follows: T, 37.5 C; PR, 95 bpm; RR, 22/min; and BP, 155/70 mmHg. Initially, O2Sat with pulse oximeter was 75% under ambient air. In laboratory work-up, hemoglobin was 13 gr/dL; D-dimer was 1540 ng/mL. Platelet count, PT, aPTT, and INR were in the normal range. Chest CT scan was performed, and bilateral diffuse ground glass and consolidative opacities were observed. The patient was started on antibiotics (azithromycin, vancomycin, and meropenem), interferon beta-1b, supplementary oxygen, and 5000 units of subcutaneous heparin twice daily. On day 9 after admission, the patient complained of abdominal pain, and her hemoglobin level dropped to 9.6 gr/dL. At the same time, her BP was 110/70 mmHg and her PR was 90 bpm. Abdominal examination was unremarkable. The patient was admitted to the ICU. Non-contrast CT scan of abdomen and pelvis showed a 132x112x78 mm extraperitoneal hematoma in the left lower quadrant as well as left rectus sheath hematoma (Fig. 2C). Therefore, anticoagulation was stopped immediately, and IV fluid, packed RBCs, and FFP were administered. The hemoglobin level increased to 10.5 gr/dL and her vital signs normalized. Over the course of the hospitalization, the patient's clinical status and hemoglobin remained stable. She successfully recovered, and finally she was discharged on day 27 after admission.\nOUTPUT:" }, { "from": "agent", "value": "COVID-19, Retroperitoneal Hemorrhage" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: A 48-year-old woman presented to the hematologist for evaluation of chronic refractory anemia. She complained of easy fatigability and generalized weakness for the last 4 years. She also complained of lower backache and ankle pain for the same duration. Despite being been on treatment of anemia with oral iron and vitamin B12 tablets for almost 2 years, she required a transfusion of 4 units of packed red blood cells. She had no history of blood loss, fracture, renal calculi, or recurrent abdominal pain. The reticulocyte production index was 1.75. She underwent a bone marrow biopsy, which showed bone marrow fibrosis (Fig. 1). During further evaluation, she was found to have hypercalcemia, hypophosphatemia, and elevated total alkaline phosphatase (Table 1). Hence, she was referred to the metabolic bone disease clinic. A biochemical evaluation confirmed the diagnosis of PHPT. Dual-energy X-ray absorptiometry showed low bone mass (Z-score [bone mineral density]: lumbar spine, -2.3 [0.728], total hip -2.4 [0.603], and distal one third of the radius -4.1 [0.410]). Ultrasound of the neck revealed a 4.4 x 4.5 x 1.8-cm isodense lesion with cystic spaces in the inferior part of the right lobe of the thyroid. Parathyroid scintigraphy revealed a right parathyroid adenoma (Fig. 2), which was concordant with the ultrasound findings. Her serum calcium level was optimized preoperatively by saline hydration and intravenous zoledronic acid. She was given a transfusion of 1 unit of packed red blood cells prior to surgery. She underwent focused right inferior parathyroidectomy. Her serum calcium normalized postoperatively. On further follow-up at 3 months, she was asymptomatic, her hemoglobin had improved to 10.1 g/dL, and the other blood cell lines had also normalized (Table 2).\nOUTPUT:" }, { "from": "agent", "value": "Myelofibrosis, Pancytopenia, Primary Hyperparathyroidism" } ]

[ { "from": "human", "value": "As a physician engaged in clinical diagnostic reasoning, here is a case report from Pubmed, please analyze the input and accurately identify the diagnosis presented within it.\nINPUT: Economic conditions result in a diet quality, which contributes to the health status of a population. Income conditions, social status, quality of work, education, unemployment, social exclusion, and poverty are the most representative elements of the socioeconomic determinants of health. Various international research confirms the impact of social capital on health, and a particularly strong relationship between gross national product (GNP) per capita and life expectancy. Per capita income and the structure of health expenditures financed by the government are strongly associated with better health outcomes. There is also a consistent correlation between national income inequality and population health at the country level. Change in inequality is significantly related to change in life expectancy. According to the WHO, lack of adequate access to health care is one of the health risk factors for a population. Primary care is the first level of contact with the health care system, which should be universally available. Modern and efficient primary care takes responsibility for both health promotion and public health activity. Increased accessibility to primary care physicians contributes to better health and lowers overall costs in the health care system.\nOUTPUT:" }, { "from": "agent", "value": "Obesity, physical inactivity, coronary heart disease" } ]