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: An 80 year-old Hispanic female with history of hypertension, presented to our institution with one month of fatigue, weight loss, and two weeks of hemoptysis with blood streaks and clots, patient denied pain, fever or chills, she denied recent travels, chronic cough, night sweats, sick contacts. Her Social history was remarkable for 30 pack year of smoking. Upon presentation to emergency department, her vital signs were: Heart rate of 96, Blood pressure of 175/77, respiratory rate of 22, and Oxygen saturation of 88% on room air, improved to 96% on non rebreather mask. Her initial exam was remarkable for Cachexia, multiple ecchymoses over upper and lower extremities. Heart exam revealed for 2/6 systolic murmur best heard over the apex, she had bibasilar crackles on lung examination, her abdominal exam was unremarkable, she did not have any lower extremities edema, no palpable lymph nodes, and her neurologic exam revealed asterixis. Initial blood work is shown in Tables 1-3, initial urinalysis results are shown in Table 4. Her initial chest x radiograph is showed moderate cardiomegally and bilateral pulmonary edema (Figure 1). Overnight, patient was admitted to the intensive care unit, started on hemodialysis using a femoral Quinton catheter, she was also started on antibiotics for possible urinary tract infection. The following morning, patient continued to have hemoptysis, continued to require non rebreather mask, serologic markers for autoimmune diseases were sent. On the third day of hospitalization, patient had bilateral kidney ultrasound, showed normal sized kidneys with increased echogenicity suggestive of chronic renal insufficiency. On day four, preliminary autoimmune panel results came back, with positive ANCA antibodies, so patient was started on Intra venous Methylprednisolone 500 mg/day along with plasmapheresis. Autoimmune panel results shown in Table 5. The same evening, due to respiratory distress, patient was intubated and mechanical ventilation was started, over the following few days, her clinical course deteriorated, she expired one week after. Anti-glomerular basement membrane came back positive with titer above 100 (normal 0-3). Patient's family agreed with autopsy, which showed diffuse alveolar hemorrhages, severe glomerulosclerosis associated with acute glomerulonephritis (Figures 2-4).\nOUTPUT:" }, { "from": "agent", "value": "Double positive 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: She was hypertensive with morbid obesity (BMI-40.9). Patient was advised surgery, but the patient neglected it. Patient was bed ridden when she presented to us. 3). As the patient had extension lag, we decided to reconstruct the extensor mechanism during TKA surgery. Standard midline incision and medial parapatellar arthrotomy was performed. All the femoral and tibial cuts were performed as routine and trial implants were placed. Two parallel drill holes were made superoinferiorly through patella to pass No.2 fiber tape in figure of eight fashion. Semitendinosus was identified near insertion and released proximally using open ended tendon stripper (Fig. 4). Semitendinosus tendon was passed around patella in a cerclage manner. This was reinforced with No.2 fiber wire. The lax extensor retinaculum was double breasted with No.2 fiber wire (Fig. 5). Patellar tracking was evaluated and found satisfactory. Final components were implanted. Post-operative X-rays were satisfactory (Fig. 3). Three days after left TKA, the patient underwent right TKA uneventfully.\nOUTPUT:" }, { "from": "agent", "value": "Knee Osteoarthritis, Old Untreated Patella Fracture" } ]

[ { "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: D.S. is a 42-year-old woman without a profession and who lives with her husband. She has had approximately 20 hospitalizations; the last one being approximately two years before the rehabilitation program. During acute phases of the disease, D.S. presented delusions, visual and auditory hallucinations, stereotypies, and obsessions. D.S. was clinically stable for at least six months before the rehabilitation apart from occasionally experiencing auditory hallucinations. At the time of the study, her treatment consisted of two atypical antipsychotics (olanzapine: 2 x 10 mg; quetiapine: 1 x 200 mg) and one benzodiazepine (lorazepam: 1 x 2.5 mg), and she was seen by her psychiatrist about twice a month. D.S. expressed a desire to be more autonomous and to not have to rely on her husband all the time. She described a number of difficulties in everyday activities: following and retaining television or radio programs, following and retaining conversations, reading and maintaining text information (e.g., from a book or newspaper), remembering appointments, dates, activities (forcing her to write everything down on sheets of paper in order not to forget). These difficulties had a deleterious impact on her everyday functioning, such as social withdrawal. For instance, D.S. did not dare communicate with others as she feared that she would not be able to follow and understand the discussions. Also, if she constantly asked people to repeat what was said, she feared this will get on peoples' nerves or lead them to suspect that she is insane. An extensive cognitive battery was administered to D.S., which covered various aspects of cognitive functioning (see Table 1). A score indicating a deficit was set at <-1.65 for the z-score and at <10 for the percentile score (in order to be less strict in comparison to a threshold <1.96 and <5; some scores were presented as z-scores and others as percentiles, depending on the given norms for each test). Performance was impaired on working memory tests assessing processing load and updating, while storage was preserved. Analysis of executive functioning revealed deficits related to flexibility and planning, but not inhibition. Performance was impaired on the verbal episodic memory tests, but not on the visual episodic memory test. Performances in divided and sustained attentional functions were all impaired. Processing speed was slow, but not impaired.\nOUTPUT:" }, { "from": "agent", "value": "Paranoid schizophrenia" } ]

[ { "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 first case was a 47-year-old female hepatitis B virus carrier with normal liver functions, who denied having a previous history of other systemic diseases. She received a facial calcium hydroxylapatite injection in the glabellar area for augmentation rhinoplasty. She complained of a headache immediately while the injection was being given. Severe headache and left ocular pain occurred 1 hour later, and she was sent to our hospital. A neurological examination revealed mild right central facial palsy and right limb weakness. Brain magnetic resonance imaging showed multiple small infarctions with intracranial hemorrhages in the left cerebral hemisphere (Fig. 1A). Carotid duplex showed an adequate flow amount without obstruction or atherosclerosis. During admission, she received hydration under the impression of multiple artery embolizations; meanwhile, oral antiplatelet agents were also given. Systemic work-ups for diabetes, rheumatologic disorders, and hypercoagulation status were done, but all findings were negative. 1B). The cornea became edematous, and a mild anterior chamber reaction was noted. The fundus was blurred due to an edematous cornea; however, the retina was generally pale. We then added topical betamethasone. Multiple reticulated, erythematous-to-violaceous ulcerative skin lesions were noted over the glabella, perinasal, and periorbital areas. The ocular pain and ophthalmoplegia gradually improved (Fig. 1C), but the retina eventually became totally detached (Fig. 1D).\nOUTPUT:" }, { "from": "agent", "value": "Central retinal artery occlusion, Ophthalmoplegia of the left eye, Orbital infarction 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 55-year-old female patient with a history of poorly controlled TD2M and SAH under treatment; began suffering from productive cough, asthenia, and adynamia as initial symptoms. Eight days later, she presented to the ER with a fever of 39 C and SpO2 of 69% in room air, blood pressure of 136/83 mmHg, tachycardia (135 bpm), and tachypnea (25 rr). She was given anticoagulants, anti-inflammatory steroids, insulin, and antihypertensive and ascorbic acid treatment. A torpid evolution occurred in the form of an increase in respiratory effort and desaturation, for which non-invasive ventilation (NIV) was given with partial improvement. Notwithstanding positive airway pressure support, advanced management of the airway was decided. Neurology management was requested due to polyneuropathy in the critical state and physical rehabilitation was initiated. General NCV were performed including PNs, finding mixed polyneuropathy that symmetrically affected the four extremities, predominantly the lower ones, and there was an absence of response from both PNs (absence of bilateral compound muscle action potential). Invasive ventilation (IV) had poor pulmonary response, low compliance, and difficulty reaching oxygenation targets, even in pronation. She developed septic shock due to bacterial pneumonia secondary to health care, deterioration to multiple organ failure, high vasopressor requirements, repeated events of bronchospasm with severe hemodynamic repercussions, bradycardia, and loss of sphincters control; she passed away on day 49 of hospital stay. Case 3\nOUTPUT:" }, { "from": "agent", "value": "Acute Phrenic Neuropathy and Diaphragmatic Dysfunction, SARS-CoV-2 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: On examination, the patient was in a stuporous condition with a Glasgow coma scale of 8/15 (eye-opening 2, verbal response 2, motor response 4). He had right-side weakness and mixed aphasia (global aphasia with preserved repetition), muscle strength was 0/5 in the right. Pupils were symmetrically equal to normal size and reactive to light. He had no other significant past medical or surgical history. The patient had no history of drug abuse, anticoagulation or trauma. Hematoma measured 5x3cm in the left basal ganglia and 3x1cm in the right basal ganglia (see Figures 1 and 2). MR angiography (MRA) was negative for aneurysmal rupture. On admission, blood pressure was 220/120. Other vital signs were normal. The patient's complete blood count, comprehensive biochemistry profile, and coagulation markers were all within normal limits. An ECG showed a normal sinus rhythm. A chest x-ray and CT scan did not reveal any acute cardiopulmonary disease. The patient was admitted to the ICU and conservatively managed with blood pressure-lowering drugs, mannitol (5 days) and other supportive medications. After 2 days, Glasgow coma scale of the patient improved from 8 to 11 (eye-opening 4, verbal response 3, motor response 4), blood pressure was controlled with multiple antihypertensive medications; and he was transferred to the neurology ward on the fifth day. After another 5 days of neurology inpatient unit, the patient clinically improved (GCS 14/15) and was referred to the rehabilitation department.\nOUTPUT:" }, { "from": "agent", "value": "Spontaneous Bilateral Basal Ganglia Hemorrhage, Severe Hypertension" } ]

[ { "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 10-year-old boy was presented to the emergency department with an acute headache and disturbed consciousness. ICH was confirmed on head CT. DSA showed a right basal ganglia AVM, Spetzler-Martin grade III. Nidus size was 2.56 cm and venous drainage was deep (Figure 2A). Feeding arteries included branches arising from the posterior communicating artery (PCA) and the lenticulostriate arteries (LSAs) originating from the MCA. As in case 1, a two-stage procedure was planned. During the first stage procedure, superselective arteriography demonstrates the AVM angioarchitecture (Figure 2B). Glubran was injected via the PCA, and DSA after the first stage shows the partially embolized AVM (Figure 2C). In the second stage, the PCT was used again. Two microcatheters were positioned at the origin of the venous collector, microangiography was then performed to better visualize the angioarchitecture of draining veins and adjust the position of the microcatheter tip (Figure 2D). After the balloon was inflated to provisionally occlude the internal carotid artery, Onyx was injected transvenously into the AVM nidus through the microcatheter, and ~2 cm of embolysate reflux (black arrow) was encountered prior to achieving sufficient retrograde nidal penetration (Figure 2E). The final DSA showed complete obliteration of the AVM (Figure 2F). Unfortunately, the child awoke with difficulty from anesthesia, Dyna CT showed AVM hemorrhage (Figure 2G). The patient then underwent craniotomy for evacuation of intracranial hematoma and nidus resection. After surgery, the patient was awake and conscious with stable vital signs (mRS score, 3). One year later, DSA confirmed complete AVM obliteration and mRS score was 2 (Figure 2H). Gratifyingly, the patient is currently being educated in the regular class with a big group of normal peers.\nOUTPUT:" }, { "from": "agent", "value": "Hemorrhagic brain arteriovenous malformations" } ]

[ { "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 35-year-old man presented with a one-month history of fatigue and gingival bleeding. Physical examination of the patient revealed hepatomegaly. Complete blood count (CBC) showed low counts with peripheral blasts. Fifteen days later, the patient was admitted to hospital with deterioration of his overall condition. He received induction chemotherapy with All Trans Retinoic Acid (ATRA), cytarabine and idarubicin. On the thirtieth day of chemotherapy, chest pain, dyspnea and hemoptysis occurred. Results of laboratory examination were as follows: Hemoglobin: 8.5 g/dL, WBC: 1.4 x 109/L, Platelets: 60 x 109/L, PT 16 s, APTT: 26 s, INR of 1.3. On chest X-rays, ground glass opasities were seen in both lungs. In the parenchymal window on the thorax CT, diffuse bilateral pulmonary alveolar hemorrhaging combined with patchy opacities were observed (Fig. 1). About 15 days after initiation of steroid treatment, coughing and release of sputum started. On chest CT scans, in the parenchymal window, a thick-walled peripheral ground-glass cavitary lesion approximately 27 x 18 mm in size was observed in the left upper lobe. In the left lower lobe mediobazal segment, an atelactasis 7.5 x 4.5 cm in size was found, and in the right lower lobe irregular nodules from 10 mm to 16 mm in size of the area were observed (Fig. 2). Bronchoscopy was performed and bronchial lavage taken. Tuberculosis culture and galactomannan were negative. Serial galactomannan antigen tests on the patient's blood were performed. After 20 days galactomannan was positive and treatment with voriconazole was started (Table 1). One mounth later under voriconazole treatment, the left upper lobe cavitary lesion and lower lobe atelectasis were found to have significantly decreased (Fig. 3). The patient is still being monitored in our clinic.\nOUTPUT:" }, { "from": "agent", "value": "Acute Myeloid Leukemia (AML-M3), ATRA-dependent alveolar hemorrhage, Aspergillosis" } ]

[ { "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: Before development of the strategy, Jordan NTP assessed their TB care and control program to determine if they could adequately provide TB care and control for the Syrian refugees. They examined their i) lead agency and coordination; ii) policies, including the provision of directly observed therapy short-course (DOTS); iii) availability of human resources for the additional patient influx from Syria; iv) access to the Syrian refugees; v) type (microscopic, culture and drug-susceptibility testing capacity), location and quality assurance of diagnostic laboratory facilities; vi) treatment regimens; vii) drug procurement and storage; and viii) follow-up procedures. All of these were found to be adequate except for the iv) access to the new influx of Syrian refugees. Therefore, Jordan NTP wanted a public health strategy developed to include Syrian refugees. Increase TB screening among Syrian refugees initially processed in UNHCR camps, or among those already residing in camp or non-camp settings, by camp- or facility-based health assessments, respectively\nIncrease TB diagnosis among Syrian refugees who were patients with suspected TB. In addition, identified refugees already with TB diagnosis with or without receiving anti-TB treatment before arrival in Jordan. IOM and/or NTP assessed these individuals for the length of time without treatment, provided additional testing, if needed, and then restarted on treatment, if indicated. IOM with other health partners conducted symptomatic TB screening of Syrian refugees following the NTP diagnostic procedure and all suspected cases received chest radiographs. If radiographs were abnormal, three acid-fast bacilli (AFB) smears and culture were performed to confirm diagnosis. If the AFB results were negative and there was no improvement after receiving non-TB antibiotics, the diagnosis was based on radiograph finding and medical officer's judgment.\nOUTPUT:" }, { "from": "agent", "value": "Tuberculosis" } ]

[ { "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 received a kidney transplant from his mother at the age of 8 years. He was referred to our hospital to start regular hemodialysis at the age of 23 years. He is now 25 years old and is receiving regular hemodialysis therapy at our hospital. We initially considered that case 1 was a sporadic case of idiopathic FSGS. After obtaining informed consent, we collected DNA from cases 1-3 plus the wife of case 1. Genomic DNA was extracted from whole blood and screened for mutations in PAX2. A heterozygous PAX2 mutation (exon 2; NM_003987.3:c.76dupG, p.Val26Glyfs*28) was identified in all three cases, but not in the wife of case 1 (fig. 2). 3). Taking PAX2 mutation into account, we performed electron microscopic examination of the first biopsy from case 1. No electron-dense deposits were observed. Foot processes were generally well preserved, but segmental loss of podocytes was observed (fig. 4a). Many podocytes had several vacuoles and some also had large phagosomes (fig. 4b). Several swollen endothelial cells containing vacuoles were also observed (fig. 4c). About half of the mesangial cells had many vacuoles; in some of these vacuoles, degenerating mitochondria and the debris of membranous structures were apparent (fig. 4d). Phagosomes were also occasionally observed in the mesangial cells (fig. 4c, d).\nOUTPUT:" }, { "from": "agent", "value": "Genetic Mutation in Paired Box Protein 2, Proteinuria, Renal Dysfunction, Bilateral Hypoplastic Kidneys, Chronic Rejection, Bilateral Optic Nerve Atrophy, Bilateral Glaucomatous Cupping" } ]

[ { "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 no other symptoms. She also had a history of chronic constipation as a normal bowel habit (bowel motion every three days). On examination, she was conscious, oriented, vitally stable, and afebrile. Heart rate was 98 beats pr minute, blood pressure was 123/74, and temperature was 36.6 oC. The abdomen was soft, lax, mildly tender on the left side, and hyper-resonant on percussion. Labs were within normal limits. CT with IV and rectal contrast (Figure 3) showed dilated transverse colon with pneumoperitoneum. There was no evidence of leakage or collection. The patient underwent exploratory laparotomy with the following intraoperative findings: (i) dilated and non-healthy large bowel, (ii) leak from the anastomotic site, and (iii) pelvic localized collection. A total colectomy with end ileostomy was performed. The patient recovered well and was discharged on the ninth postoperative day.\nOUTPUT:" }, { "from": "agent", "value": "Sigmoid Volvulus, Acquired Colonic Hypoganglionosis" } ]

[ { "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 was no fistulization. Ultrasonography examination revealed a hypoechoic mass with significant ductal dilatation without collection and lymphadenopathy, which suggested mastitis. Tuberculin skin test results (Mantoux) were 16, 13 and 14 mm for cases 1, 2 and 3, respectively. Their routine hematologic and biochemical parameters were in the normal range, including negative testing for HIV. Their erythrocyte sedimentation rates were also normal. All of their chest X-rays were normal. Cures were obtained for all patients at the end of the sixth month period.\nOUTPUT:" }, { "from": "agent", "value": "Breast tuberculosis" } ]

[ { "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 1, a 76-year-old female with decompensated chronic heart failure (CHF), was admitted to our hospital in October 2011. Her CHF did not respond to medical therapy and her general condition continued to deteriorate. An electrocardiogram showed low voltage in the limb leads and low R-wave progression, compatible with pseudoinfarct pattern, in the chest leads V1-V3 (Figure 1). Echocardiography showed increased left ventricular wall thickness (Figure 2) with granular sparkling appearance (Figure 2A and B). Blood chemistry examination revealed M proteins derived from immunoglobulin (Ig) G lambda light chain, but no abnormalities in IgG levels (Table 1). The percentage of plasma cells in the bone marrow (14.8% of all nucleated cells) was slightly increased but did not fulfill the criteria for symptomatic multiple myeloma. The patient was treated with oral melphalan and dexamethasone to ameliorate M proteinemia without apparent effects, and she died of CHF 2 months after the diagnosis.\nOUTPUT:" }, { "from": "agent", "value": "Systemic amyloidosis, Amyloid cardiomyopathy" } ]

[ { "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 man, treated for arterial hypertension, was diagnosed with stage I colon cancer. He was submitted to colon resection and one week later developed an infectious peritonitis, that was controlled with systemic broad spectrum antibiotics. One month after surgery, he presents to his general practitioner (GP) with daily fever (>38 C), weight loss, and progressive asthenia. Physical examination was not remarkable. The GP suspected infection and prescribed oral antibiotics. Blood tests showed pancytopenia (Table 2) with negative serology for HIV, B and C hepatitis, EBV, CMV, Rickettsia conorii, Leptospira, Borrelia burgdorferi, and Salmonella typhi. Active tuberculosis infection was also excluded. The condition extended for 3 months, with no response to treatment and clinical deterioration with unremitting fever. The patient was admitted to hospital where he began broad spectrum antibiotics (piperacillin-tazobactam 4,5 g, t.i.d.) and prednisolone 40 mg/m2. Repeated serologies and bacteriologic cultures were inconclusive. A thoracoabdominal CT scan showed a soft spleen enlargement (14,5 cm x 6 cm). The main clinical suspicion was an occult infection. Blood tests showed persistent and worsening pancytopenia, with hepatic cytolysis and cholestasis, elevated ferritin, and triglycerides (Table 2). A bone marrow biopsy was performed presenting signs of phagocytosis of blood elements. The diagnosis of HPS was then made (Figure 1). Despite the diagnosis, his clinical status worsened and rapidly evolved to multiorgan failure (MOF) with hepatic, respiratory, and cardiac dysfunction. He died 10 days after admission.\nOUTPUT:" }, { "from": "agent", "value": "Secondary hemophagocytic 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: When asked, she reported both absences and myoclonic jerks for some time, misinterpreted by her parents as inattention and clumsiness. EEG showed generalized epileptogenic activity, and she was diagnosed with JME. To treat her condition, valproate has been used in various doses from the time of diagnosis, while lamotrigine was started five years later. Levetiracetam and perampanel were briefly tried but discontinued due to seizure worsening and side effects, respectively. Recently, topiramate was added, leading to one year of seizure freedom from GTC seizures, but seizures have now returned. Both the GTCSs and the myoclonic jerks predominantly occurs in the morning, exacerbated by stress and sleep deprivation. Due to this strict circadian seizure pattern, she regained her driver's license. Comment: This pattern is characteristic of JME. Pedersen and Petersen reported that 53.7% of patients had GCTSs primarily on awakening, and 62.8% had most myoclonic seizures on awakening. Moreover, sleep deprivation is a typical risk factor. Seizures related to awakening are also characteristic of West syndrome. Overall, mornings and evenings are reported to be the periods of highest seizure frequency in patients with circadian rhythms. The different drugs may be affected differently by circadian rhythms, accounting for why particular syndromes show highest seizure frequencies at different times. Evidence suggests that administering drugs to maintain elevated plasma concentrations during periods of heightened seizure risk could be advantageous for treating patients with well-defined circadian rhythms. Therefore, it would be reasonable to anticipate positive outcomes from administering the medication in the evening for this patient.\nOUTPUT:" }, { "from": "agent", "value": "Epilepsy, JME (Juvenile Myoclonic Epilepsy)" } ]

[ { "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 July 2004, Mr. L, a 29-year-old male, suffered from a left thigh injury playing football and presented the next day to the emergency department. It was noted that he had increased swelling and paraesthesia and was unable to weight-bear. On further questioning, this gentleman had a history of recurrent haematomas presenting in 1994 and again in 1998. No surgical intervention was required on these occasions. He was previously surgically challenged undergoing a tonsillectomy as a child with no haemorrhagic complications. Mr. L remembers suffering multiple epistaxis as a teenager but never required hospital admissions. He gave no family history of any bleeding disorders on direct questioning. On this occasion, Mr. L was treated conservatively with bed rest, analgesia, neurovascular observations, and serial ultrasounds of the haematoma. Mr. L received prophylactic enoxaparin during admission for his VTE risk. The haematoma was slow to resolve resulting in a prolonged hospital admission. Coagulation screen persistently revealed elevated APTT for 44 seconds (normal range 21-32 seconds) and therefore haematology was contacted. After the 50 : 50 plasma mix showed correction of the APTT, intrinsic factors were quantified. Factor VIII was low at 24% and VW antigen and activity were appropriate for his blood group. The patient returned to sport after 1 month of outpatient physiotherapy and is now treated with on-demand factor replacement.\nOUTPUT:" }, { "from": "agent", "value": "Mild Haemophilia A, Compartment 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 health economic analysis showed that, from a societal perspective, where indirect costs were included in the analysis, the vaccine would be directly cost saving. From a health sector perspective, however, vaccines would be cost-effective but not directly cost saving (Table 2). In addition, the risk-benefit ratio was deemed favorable as the risk of intussusception is estimated to be low in Sweden and the condition is treatable in hospitals. The Public Health Agency also emphasized the findings from the health economic evaluation, the generally high acceptance of the existing NIP which has a coverage of 97-98% among 2-year olds. In Norway, the decision to introduce a new vaccine into the NIP is taken by the Ministry of Health and Care Services, based on advice from the NIPH (National Institute of Public Health). Evaluation of the vaccine was done by a working group chaired by the NIPH and including representatives from the NIPH as well as from the scientific community and health professionals (doctors and nurses). Among the evidence considered by the group were studies on disease burden.\nOUTPUT:" }, { "from": "agent", "value": "Rotavirus 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: An eighty-year-old man was admitted to hospital under hepatology for investigation of abnormal LFTs (ALP 2500 IU/L) associated with a raised C-reactive protein (CRP) (259 mg/L). He had a background of hypertension, hypercholesterolaemia, and gastro-oesophageal reflux. His regular medications were rabeprazole 20 mg/day, telmisartan 80 mg/day, amlodipine 10 mg/day, ezetimibe 10 mg/day, and aspirin 100 mg/day. Six months prior, he had visited his primary physician with sinus pain. Blood tests taken at that time demonstrated an ALP of 215 IU/L (normal range 20-140 IU/L). He underwent removal of a left maxillary molar as a possible cause of his pain. However, he continued to experience sinus pain which was associated with head and neck pain, night sweats, and a dry cough. Blood tests then revealed an ALP of 2500 IU/L with a CRP of 259 mg/L and he was referred to hospital. Examination on admission revealed mild nontender hepatomegaly with pitting oedema to his midshin. There were no cardiac murmurs. There was no tenderness over the maxillary sinuses and the dental socket was nontender. A transthoracic echo was unremarkable. A computer tomography coronary angiogram (CTCA) scan revealed borderline cardiac enlargement and a small pericardial effusion. A CT chest/abdomen/pelvis also demonstrated mild cardiac enlargement but had no other significant findings. An MRI cholangio-pancreatogram did not detect any biliary dilation or obstruction. The patient's LFTs continued to deteriorate: ALP 3091 IU/L, GGT 753 IU/L, AST 147 IU/L, ALT 130 IU/L, and total bilirubin 16 mumol/L. His ESR was also elevated (77 mm/hour) and his CRP remained elevated (250 mg/L). ANCA, ANA, anti-smooth muscle antibodies, liver/kidney antibodies, and viral serology were all negative. In the context of raised inflammatory markers and atypical head and sinus pain, bilateral temporal artery biopsies were performed. The patient was treated with oral corticosteroids and responded well to treatment. His LFTs normalised, his sinus pain abated, and his cough and oedema resolved.\nOUTPUT:" }, { "from": "agent", "value": "Giant Cell Arteritis, Cholestatic Hepatitis" } ]

[ { "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 United Kingdom (UK) the prevalence amongst women aged 60-79 years old is 22.45%. A recent systematic review concluded that DED has a substantial economic burden, with indirect costs making up the largest proportion of overall costs from loss of work productivity. Current treatments for DED have been comprehensively reviewed in the management and therapy report by the Tear Film & Ocular Surface Society. Haemoderivative treatments have trophic effects on epithelial cells and this makes them beneficial for managing ocular surface diseases. This has been recognised since the 1940s when their use was described for managing ocular blast injuries and persistent epithelial defects. Today autologous serum (AS) is the most widely utilised and studied haemoderivative eye drop for DED. However, various other haemoderivative therapies have demonstrated beneficial effects including allogeneic serum, umbilical serum, platelet rich plasma (PRP), plasma rich in growth factors (PRGF) and autologous platelet lysate. Restrictions in haemoderivative licencing, cost and availability can mean such treatments are reserved for severe and recalcitrant disease. In the UK, obtaining such treatment requires named patient application and can involve prolonged delays depending on service workload. The estimated UK cost of producing AS drops is ~$300 per month. In 2017 our group described a technique utilising finger-prick autologous blood (FAB) eye drops as an ocular surface therapy. FAB was found to be safe, effective and well tolerated in single armed pilot studies for both DED and persistent epithelial defects (PED). More recently, a group in Cambridge (UK) have successfully used maternal allogeneic fingerprick blood to treat a young only eye patient's PED. FAB benefits from being cheaper and instantaneously available compared to other haemoderivative treatments for the ocular surface. The present study is the first investigator-masked randomised controlled trial (RCT) to investigate FAB as an add-on therapy for severe DED comparing it against conventional medical treatment alone.\nOUTPUT:" }, { "from": "agent", "value": "Dry Eye 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 66-year-old patient with an erythematous lesion on the frontal part of the face was referred from the Department of Dermatology of the Bernhoven Hospital, Oss, The Netherlands. At this hospital, the lesion was treated with cryotherapy followed by Efudix. Unfortunately, both treatments were ineffective. However, the lesion persisted and increased in size. The biopsies obtained after photodynamic therapy showed chronic inflammation and no residual tumor tissue. For further management, the patient was referred to the outpatient clinic of the Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. A clinical diagnosis of the erythematous lesion with a size of 2.3 x 2.1 cm was difficult due to the previously performed biopsies and treatments (fig. 1). This made it challenging to determine the most suspect area for a biopsy. Treatment by surgical excision without prior establishment of the diagnosis was unfavorable due to the size and the location of the lesion. Therefore, we used RCM for a noninvasive evaluation of the complete lesion to select the most suspect area for a biopsy. More importantly, one small part showed prominent aberrant features: a disrupted stratum corneum, keratinocyte atypia, spongiosis, increased capillary blood flow, flattening of the dermal epidermal junction, solar elastosis and a nest of atypical cells (fig. 2). A 3-mm punch biopsy was taken from this part of the lesion.\nOUTPUT:" }, { "from": "agent", "value": "Superficial BCC, SCC, Actinic keratosis" } ]

[ { "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 37-year-old healthy male presented to a private hospital with right iliac fossa pain and was diagnosed to have acute appendicitis. He underwent a laparoscopic appendectomy uneventfully and the histopathological examination of the appendix was reported as a neuroendocrine tumour of the appendix with lymphovascular infiltration. The patient denied symptoms suggesting of a carcinoid tumour, such as diarrhoea, flushing or wheezing. He denies any constitutional symptoms and there was no family history of malignancy. Clinical examination was uneventful. He was subsequently referred to our centre for further evaluation. The conventional group, composing of nests and cords of tumour cells, exhibited round uniform nuclei with salt and pepper chromatin and scanty eosinophilic cytoplasm (NET appearance). The second group of cells displayed irregular infiltrating nests of goblet cells with abundant univacuolated cytoplasm and peripheral compressed nuclei. Both tumour groups (Figures 1 and 2) encompass >30% of tumour volume each. Mitotic figures were not seen. Immunohistochemical studies showed both tumour groups being positive to synaptophysin and chromogranin. Only the goblet group shows positivity to CK20. The Ki-67 proliferation index is <2% (Figure 3). Based on the HPE results, he was classified as Tang's classification group A (classic GCC and underwent right hemicolectomy. The histopathological examination of the colon and its surrounding lympho-vascular are showed no local invasion. His whole body 18F-fluorodeoxyglucose (FDG) PET/ CT and a 68-Gallium DOTATATE PET/CT scan showed no FDG or DOTATATE avid lesions. His post-operative CEA was elevated despite his being asymptomatic. At the moment the patient is still under close surveillance with routine CEA measurement and FDG PET/CT Scan.\nOUTPUT:" }, { "from": "agent", "value": "Appendiceal Goblet Cell Carcinoid 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: A 29-year-old man was attended in a hospital after suffering a car accident. He was examined by the surgical and the oral and maxillofacial traumatology team, and during this examination, increased volume in the right mandibular region and the middle third of the left side of the face was observed, in association with a blepharohematoma. A computed tomography scan of this patient's face was requested. This showed fracturing of the left-side zygomatic complex, without displacement, and it was decided to implement conservative treatment. In the mandible, a hyperdense image with well-defined edges, separated from the adjacent bone by a thin hypodense line, was noted. Inside the lesion, an image of mixed density was observed (Fig. 1A-D). After release from the emergency service, the patient was taken to the hospital, for follow-up on the fracturing in the zygomatic complex and for a better diagnosis of the mandibular lesion to be made. A posteroanterior panoramic radiograph of the patient's face and teleradiography were requested in order to better document the case (Fig. 2, Fig. 3, Fig. 4). An incisional biopsy was performed, and the material was taken for analysis in the histopathological anatomy laboratory of a university. Based on these results, it was decided to undertake a surgical procedure. The patient underwent an elective surgical procedure under general anesthesia and nasotracheal intubation. Before opening the surgical access, dental osteosynthesis was performed using an Erich bar, along with maxillary-mandibular blockade using steel wires, for reference to and maintenance of the patient's occlusion. The surgical access chosen was the Risdon access (submandibular). The lesion was removed completely, with rigid internal fixation using a titanium system 2.7 reconstruction plate (Fig. 5). Radiographs were produced for postoperative follow-ups. A new anatomopathological examination confirmed the diagnosis. The patient underwent postoperative follow-up for 1 year, without any signs of recurrence (Fig. 6).\nOUTPUT:" }, { "from": "agent", "value": "Ossifying fibroma" } ]

[ { "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 man underwent ureteroscopy treatment for his right vesicoureteral junction stone. His preoperative urine analysis showed negative for leukocyte and nitrite. Intraoperatively, the procedure was completed in 1 h without any complication. Ureteral stent was inserted. Two days postoperatively, he complained of frequency, dysuria, suprapubic pain, and fever. Despite initial treatment with antibiotics, the symptoms did not diminish. He started to notice a rapid deterioration in the vision of his right eye in the following 2 days. The affected eye was also painful, red, and swollen. He is a known case of diabetes mellitus and hypertension. On examination, his best-corrected visual acuity was 6/60 for the right eye and 6/6 for the left eye. There was associated lid swelling and conjunctival injection, with reduced red reflex. Fundus examination of the right eye showed vitreous haze secondary to vitritis, deep yellow subretinal lesion with fluffy edges, \"string of pearls\" abscess, and swollen optic discs. There was no retinitis or vasculitis noted [Figure 1]. The left eye examination was unremarkable. His urine and ureteric stent culture grew Candida albicans, which was sensitive to amphotericin B, voriconazole, fluconazole, and caspofungin. Blood sample and vitreous tapping were negative. He was also given intravitreal amphotericin B 5 mcg in 0.1 ml and intravitreal voriconazole 100 mcg in 0.1 ml. He was initially treated with intravenous (IV) amphotericin B and IV fluconazole. IV amphotericin B was changed to intravitreal injection due to nephrotoxicity. IV fluconazole was substituted with tablet voriconazole. Repeat urine samples were clear after 1 week. Due to nonclearing vitritis, he underwent transscleral pars plana vitrectomy (TPPV) after 1 month, with intravitreal injections of amphotericin B, vancomycin, and ceftriaxone. Second TPPV and phacoemulsification, with intraocular lens implant, were performed after 3 weeks. He was followed up in the eye clinic. One month after the second operation, the best-corrected visual acuity of his right eye was 6/60.\nOUTPUT:" }, { "from": "agent", "value": "Endogenous endophthalmitis, Candiduria" } ]

[ { "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: Example of a one-day menu designed for a 3 years old boy, weighing 14 kg. (1150 kcal/day and 20 g protein) is shown in Table 2. A non-fasting initiation protocol was used for all children without hospital admission. Patients remained on diet for a median of 4 weeks (range, 2-24). Ten patients (40%) discontinued the diet after 2 weeks. At one month from diet initiation, 16 patients (57%) were on diet. At three months, 26 patients were still adherent to their dietary plan (21.4%). Six months after initiating the diet, only 3 of the initial 28 (11%) remained on the diet. Ten patients (35.7%) discontinued the dietary intervention because they found it too restrictive and/or intolerable. Six patients (21.4%) discontinued the diet because of dietary ineffectiveness. Other causes behind diet discontinuation and the timing of discontinuation are illustrated in Table 3. One or more minor adverse events were reported in 15 (54%) patients. Those included constipation in 5 patients (17.8%), fatigue in 2 patients (7.1%), hypoglycemia in 2 patients (7.1) and vomiting in 3 patients (10.7%). Eight patients (28.5%) suffered from 2 or more of the previously mentioned side effects. None of the noted adverse events was significant enough to require dietary modification. At 1 month from diet initiation, 16 patients (57%) remained on the diet. One of them (6.3%) had more than a 90% reduction in seizure frequency; an additional 6 patients (37.5%) had a 50-90% decrease in seizure frequency. In total, 7 out of the 16 patients continuing the diet for 1 month (43.8%) had a >= 50% improvement in seizure control from the baseline. Despite having 50-90% seizure control, three children discontinued the diet after one month. Three months after diet initiation, 6 patients (22%) remained on diet, 4 of them (66.7%) had a >= 50% reduction in seizure frequency. At 6 months, only 3 patients were still on diet, 2 of them (66.6%) achieved 50-90% seizure reduction, while one patient (33.3%) achieved > 90% reduction in seizure frequency. Table 4 shows the outcomes of the ketogenic diet at different time points.\nOUTPUT:" }, { "from": "agent", "value": "Drug-resistant epilepsy" } ]

[ { "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 15-year-old female teenager presented to the emergency department with fever, cough and shortness of breath. Her family history revealed that both parents were positive for SARS-CoV-2 infection. The personal history underlined no important pathologies up to this age, and the vaccines were administered according to her age and the national recommendations. The clinical exam at the time of admission showed influenced general status, fever (39 Celsius), dry cough, and an O2 saturation of 84%. The patient weighed 46 kg. The laboratory tests pointed out lymphopenia (940/muL), thrombocytopenia (136,000/muL), a neutrophile count within the normal ranges (3,010/muL), a normal leukocyte count (7,910/muL), elevated lactate dehydrogenase (776 U/L), and a CRP of 4.1 mg/L. The tests for other viral infections (Influenza A and B) were negative. The thoracic radiography showed multiple asymmetric patchy infiltrates within both lungs, certain consolidations presenting a surrounding halo (Figure 1), with a similar aspect on the chest CT. The patient presented no signs of PIMS-TS and no signs of organ failure were identified during her clinical course (Table 1). She was admitted to the intensive care unit for 3 days requiring intubation during the first 24 h with favorable evolution after the initiation of antiviral therapy (lopinavir/ritonavir in a dose of 200/50 mg twice a day) associated with mask O2 supplementation, antibiotics (ceftriaxone in a dose of 1.5 g twice a day), antipyretics (paracetamol) and analgesics (ibuprofen 200 mg three times a day). After 3 days of hospitalization in the intensive care unit, the patient was further referred to the infectious diseases clinic for another 5 days where the antiviral and antibiotic therapy was continued, presenting favorable evolution and no sequelae were further described. Fortunately, no side-effects were noticed as a result of antiviral therapy and the patient presented a good tolerability.\nOUTPUT:" }, { "from": "agent", "value": "COVID-19" } ]

[ { "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 Japanese girl, gravida 0 para 0, visited our gynecologic outpatient department for mild lower abdominal pain. Her history was noncontributory, and she had no remarkable family history. A pelvic examination was avoided since she was a virgin. A transabdominal ultrasound test detected a large left ovarian cyst, measuring 9.9 cm x 6.6 cm with calcification inside it, with no vascularity. Her uterus and right adnexa were normal. Magnetic resonance imaging (MRI) of the pelvis revealed a left ovarian tumor (9.2 x 7.6 x 7.5 cm in diameter) with high signal intensity that was capsulated with small amount of fluid in the Douglas pouch (Figure 1). The right ovary was normal. Laboratory examination showed that the level of cancer antigen (CA) 125 was 36.8 U/mL (normal range < 35 U/mL), and no other tumor marker levels were elevated. She underwent laparotomy later. She was also diagnosed with left ovarian tumor without rupture and torsion. A left cystectomy was performed, and no surgical complications occurred. Microscopic and histopathological examination of the cystic mass revealed that it was a benign teratoma emerging from the left ovary. After discharge, the patient was followed every third month. Fifteen months after the first surgery, a right ovarian cystic mass was detected with an elevated CA125 level (35.6 U/mL), and she presented to the emergency room because of severe lower abdominal pain with acute onset. A right ovarian cyst with torsion was suspected. She underwent laparotomy again, and right salpingooophorectomy was then performed because of twisted and black-and-blue ovarian findings. The patient recovered well after the surgery, and histological analysis of the ovarian cyst revealed that it was a benign teratoma with infarcted and necrotic tissue. We resumed regular follow-up. Twenty months after the second surgery, a left ovarian cystic tumor (4 cm in size) was detected without any symptoms. Regular pelvic examination was continued, and an enlarged ovarian cystic mass (6.6 cm in size) was diagnosed, with an elevated squamous cell carcinoma (SCC) antigen level (2.0 U/mL; the normal range is less than 1.0 U/mL) on hematological investigation. A third laparotomy was performed, and the left ovarian cystic tumor was resected. The histological diagnosis was a benign teratoma. After 13 months, the patient continued to do well and her blood SCC antigen level was normalized.\nOUTPUT:" }, { "from": "agent", "value": "Ovarian Mature and Immature Teratomas" } ]

[ { "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 infant was born to consanguineous healthy parents at 29 + 6 week of gestation. The mother has had three previous pregnancies and the first two were complicated by polyhydramnios, leading to preterm deliveries at 26 and 32 weeks, respectively. The first child died in the early neonatal period of an unexplained etiology whereas the second was diagnosed as having pseudohypoaldosteronism. The correct diagnosis of BS was subsequently made when this child developed nephrocalcinosis at the age of 4 years. Both parents are carriers of the KCNJ1 gene. Their third child is healthy and unaffected. This pregnancy was complicated by polyhydramnios and gestational diabetes. Antenatal genetic testing was offered, but was declined. Mother developed premature rupture of membrane at 26 weeks gestation and received antenatal steroids. She was delivered by emergency caesarean section because of abnormal fetal monitoring, but Apgar scores were normal. He weighed 1.33 kg (25th-50th centiles) and his head circumference was 27 cm (25th centiles). Clinical examinations showed no facial dysmorphisms. He remained clinically stable in the 1st 24 h of life receiving routine care. However, on day 2 he developed hyperkalemia, hypocalcaemia, hyponatremia, and polyuria. The maximum serum potassium level was 8.5 mmol/l (ref 3.5-4.5 mmol/l). This proved difficult to control needing bicarbonate and calcium gluconate infusions, salbutamol nebulization, and calcium resonium enema. There was no associated cardiac arrhythmia. The lowest serum sodium was 120 mmol/l on day 6, and he required sodium supplementation to a maximum requirement of 28 mmol/kg/day on day 8 of life. The polyuria led to significant weight loss and dehydration necessitating liberal fluid replacement to a maximum of 240 ml/kg/day on day 8 of his life. His maximum urine output measured 155 ml/kg/day on day 7. He also needed calcium and magnesium supplementation to maintain normal electrolyte balance. Urinary electrolyte analysis showed extensive sodium, potassium, and chloride loss and high urinary calcium/creatinine ratio. The initial hyperkalemia gave way to hypokalemia and metabolic alkalosis during the 2nd week of life. Thereafter, he required potassium replacement therapy to a maximum of 6 mmol/kg/day.\nOUTPUT:" }, { "from": "agent", "value": "Neonatal Bartter syndrome, ileal atresia, cystic fibrosis" } ]

[ { "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 13-year-old boy came to a pediatric fever clinic in our hospital with intermittent fever having lasted 1 day on February 7, 2020 (Figure 1). She developed a fever on February 1, 2020. Her CT showed a few signs of infection. She was hospitalized in Wuhan Central Hospital for 4 days, and the SARS-CoV-2 nucleic acid tests were negative twice. The boy had been in close contact with his mother. Physical examination showed: temperature 37.4 C, pulse 88 beats per minute, respiration 23 breaths per minute, SpO2 100%. No abnormal respiratory signs were found. Nasopharyngeal swab samples were collected and tested negative for SARS-CoV-2. The serum IgM antibody of Influenza A was positive. A high-resolution chest computed tomography (HRCT) scan on February 7 demonstrated little ground glass nodules seen in the upper lobe of the right lung (Figure 2). Other laboratory findings included a leukocyte count of 7.83 x 109/L, lymphocytes of 1.62 x 109/L, and C-reactive protein of < 0.1 mg/L (Table 1). Isolation treatment was recommended. Then, he started treatment with Tamiflu and lotus qingwen capsules. Five days later, his temperature was normal. Considering the boy's and his mother's medical history, serum antibody of SARS-CoV-2 and fecal nucleic acid were assessed on February 27.\nOUTPUT:" }, { "from": "agent", "value": "COVID-19, Influenza A virus 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 66-year-old male was diagnosed with PMF in December 2010 at a local hospital. Bone marrow biopsy showed megakaryocytic proliferation, grade 3 fibrosis and the JAK2V617F mutation. Because rux was not available in China at that time, he received regular interferon therapy for 7.5 years. To mitigate the progression of splenomegaly, rux (20 mg, twice daily) monotherapy started in late June 2018. The DIPSS risk group was intermediate-2. The single dose was adjusted to 25 mg in early August owing to an unsatisfactory reduction in spleen size. Unexplained fever started on 20th August and lasted until September (Tmax 39.2 C). Laboratory tests showed WBC 14.14x109/L, hemoglobin 78 g/L, platelet 198x109/L, PCT 0.65 mug/L, and ESR 60 mm/h. Blood samples were positive for T-SPOT.TB and TB antibody. His purified protein derivative (PPD) test was strongly positive. Chest CT scan presented small diffuse nodules in the bilateral lungs, pleural effusion, adhesion, and enlarged lymph nodes in the retroperitoneum. His temperature gradually stabilized when 12 months of ATT (isoniazid, levofloxacin, rifapentine and amikacin) started in October 2018. Considering the potential progression of PMF, rux (20 mg, twice daily) was retained under close monitoring of liver function. Nevertheless, accompanied by the reappearance of fever, his left hip joint began to hurt, and a neck mass was found by palpation on the same side. Imageology examinations confirmed the existence of neck and bilateral psoas abscesses and Schmorl's nodes at L4 and L5 (Figure 3). During debridement, a 3x15.6x2.8 cm focus on the left, a 3x10x2 cm focus on the right, and a 4x3 cm focus of the neck were found. All three contained yellow pus and caseous necrosis, in which the DNA and RNA of MTB were detected as positive. Amikacin was replaced by ethambutol in November.\nOUTPUT:" }, { "from": "agent", "value": "Primary Myelofibrosis, Disseminated Tuberculosis" } ]

[ { "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 brought to our hospital with severe right knee pain after falling down 15 steps at her home. She did not present loss of consciousness, central nervous system dysfunction, or paralysis. Her vital signs were normal. On examination, bruising and tenderness were present on her head, back, right hip, right knee, and left shoulder. The patient complained of severe pain in the right knee and could not move her knee. 1). The fracture was intra-articular and simple oblique through the notch (AO classification: 33-B2.1). No intracranial hemorrhage and fracture of other sites were detected. The patient was admitted to our hospital for open reduction and internal fixation to be performed the following day. Informed consent was obtained for the surgery. Two days after the injury, we performed an open reduction and internal fixation using locking compression plate for proximal tibia and lag screws. We gained access to the joint through the medial parapatellar approach, anatomical restoration of the joint surface was achieved with clamp application. Then, we placed the proximal tibia plate (Depuy Synthes: LCP proximal tibial plate 4.5) upside down (Fig. 2). The plate was fixed provisionally and lag screw fixation was done with two cannulated cancellous screws. The plate was bent to fit the bone surface and fixed with cortical and locking screws. Restoration, stability, and postoperative radiographs were acceptable (Fig. 3). The patient had an uneventful postoperative recovery. Range of motion exercises and mobilized non-weight bearing were started on day one. The weight bearing protocol was: touch gait for first 4 weeks, 1/4 partial weight bearing (PWB) for weeks 4-6, 1/2 PWB for weeks 6-8, 3/4 PWB for weeks 8-10, and full weight bearing. At the latest follow-up, the patient had a range of motion of 0 to 120 without any pain, could walk freely, and joint surface restoration was maintained radiologically.\nOUTPUT:" }, { "from": "agent", "value": "Femoral medial condyle fracture" } ]

[ { "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 26-year-old gravida 2 para 1 had labor induced by intravenous administration of oxytocin at 39 weeks' gestation. Her monochorionic-diamniotic twin pregnancy had progressed uneventfully based on weekly ultrasonic examinations. The amniotic fluid pockets and estimated fetal growth of both twins were normal at 5 days before the labor. On admission, her body temperature was 36.2 C and blood pressure was 124/78 mmHg. During the latent phase of labor, fetal heart rate tracings showed reassuring patterns in both twins. At this time, the base lines of twins A and B were 150 and 150 bpm, respectively, as shown in Figure 1. When the cervix was dilated 8 cm, the membranes of twin A were ruptured. Within 10-20 minutes, the fetal heart rate of twin A was increased to 170-180 bpm with repeated variable decelerations as shown in Figure 2. Thirty minutes later, a 3138 g male infant (twin A) with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively, was born. His hemoglobin concentration was 11.4 g/dL (normal: 13-22 g/dL) with reticulocyte counts of 2.1% (normal: <7%). Six minutes after the delivery of the first twin, a 2720 g male infant (twin B), was delivered spontaneously with Apgar scores of 9 and 9 at 1 and 5 minutes, respectively. His hemoglobin concentration was 24.0 g/dL. He required intravenous infusion of 10% glucose for correction of polycythemia. The placenta was confirmed as monochorionic with 2 large superficial arterio-arterial anastomoses and 2 deep arterio-venous anastomoses. The growth and hemoglobin differences between the twins were 13% and 12.6 g/dL, respectively.\nOUTPUT:" }, { "from": "agent", "value": "Twin-twin transfusion" } ]

[ { "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 man was referred to the emergency department for severe abdominal pain and diarrhea. He had undergone radiotherapy for squamous cell carcinoma of the external auditory canal six months before; however, he underwent additional radiotherapy again for recurrence of disease. He was otherwise healthy and with no history of abdominal diseases. He had taken oxycodone 10 mg daily for moderate to severe cancer pain in the ear. Initially, he did not complain of constipation, and his cancer pain was well controlled. However, the pain gradually increased over a period of several months, and the dose of oxycodone was increased to 80 mg. His ear pain then worsened and he suddenly became constipated. His dose of oxycodone was then increased to 100 mg, and he was given magnesium hydrochloride for the constipation. However, he self-medicated with oxycodone at dosages of up to 180 mg/day. After five days, he suddenly complained of diarrhea, hence, the laxative was stopped. Digital examination of the rectum was performed, and hard stool was detected. Abdominal radiography showed a large amount of gas in the colon, and a computed tomography scan also showed colonic gas and a large stool mass blocking the rectum (Figure 1). This patient was treated with hydration and stool extraction, and the abdominal pain gradually ceased. His pain is now well controlled by percutaneous fentanyl administration.\nOUTPUT:" }, { "from": "agent", "value": "Acute abdomen" } ]

[ { "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 female with a history of diabetes mellitus and hypertension presented to the Orthopedic Clinic at King Khalid National Guard Hospital, Jeddah, Saudi Arabia, complaining of bilateral knee pain, primarily affecting the right knee, for the past 20 years. She had only been on pain medication and there was no surgical intervention. She described the pain as constant and nonradiating that got aggravated by activities and relieved by rest. The patient had a history of knee trauma, while her systemic review was unremarkable, except for a positive first-degree family history of breast cancer. On examination, she walked without assistance and showed a full range of motion without the signs of effusion. She had previously been diagnosed with osteoarthritis, and weight-bearing X-ray showed severe bilateral osteoarthritic changes, positive bilateral findings of osteopenia, small effusion and genu varus deformity. Later, an MRI of the right knee showed high-signal intensity in the anteromedial fibers of the anterior cruciate ligaments. Moreover, the posterior horn of the medial meniscus had a complex tear and displacement consistent with a bucket handle tear. The lateral meniscus showed a mild increase in signal intensity, representing intrameniscal degeneration. The MRI also showed old injuries and trauma-related findings in collateral ligaments and medial retinaculum, respectively. Furthermore, a small Baker's cyst was noted [Figure 1]. Accordingly, the right knee arthroscopy was done, and partial synovectomy was performed. After arthroscopy, and because of advanced osteoarthritic changes, the patient underwent total knee replacement. Intraoperatively, a bright brown inflamed synovium was seen. A decision was made to obtain synovial biopsy from the right femoral notch, which confirmed the diagnosis of PVNS. Macroscopically, a single piece of irregular, gray-tan, rubbery tissue with a lobulated outer surface was observed. Microscopically, a circumscribed lesion consisting of sheets of mononuclear synoviocytes mixed with multinucleated giant cells and foamy histiocytes along with focal hemosiderin pigmentation was noted [Figure 2]. The patient tolerated the operation well, without any postoperative complications. She was discharged and seen at the clinic after 2 weeks for suture removal. At her 2-month follow-up, clinical and radiological examinations were unremarkable.\nOUTPUT:" }, { "from": "agent", "value": "Pigmented Villonodular Synovitis" } ]

[ { "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: Kidney sonography showed bilateral hydronephrosis, and the initial serum creatinine level was 3.5 mg/dL. The patient underwent suprapubic cystostomy, and after that, he had been hospitalized on numerous occasions with cystostomy-related complications. At that time, another Cimino shunt was created in his left forearm. During the evaluation of the patient's second episode, his thrombophilic predisposition was disclosed. Less than 20% of serum PS activity was determined by clotting assays, whereas other coagulation studies were normal (Table 1). He had started to receive antiplatelet agents after this episode. At that time, both upper angiographies were negative except for the presence of a thrombus at the arteriovenous shunt. Electrocardiography (ECG) showed a normal sinus rhythm. 1). Based on the transesophageal echocardiography findings and clinical presentation, the mass was concluded to be a thrombus.\nOUTPUT:" }, { "from": "agent", "value": "Inherited protein S deficiency, Recurrent vascular access thrombosis, Chronic kidney disease, Severe vesicoureteral reflux, End-stage renal disease, Right popliteal artery thrombosis, Atrial fibrillation" } ]

[ { "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 patient was referred to our ENT department with a 1-year history of left-sided otorrhea. She had no other otological symptoms (no hearing loss, otalgia, tinnitus, or vertigo). She had a medical history of LCH diagnosed at 3 years. The initial disease was multifocal with mandible, temporal bone, skin, and gastrointestinal tract involvement. We reviewed her charts and initial imaging done at that time (Figures 1 and 2). Imaging at the time of initial LCH diagnosis with a CT scan showed extensive bony erosion of the lateral skull base (Figure 1). Magnetic resonance imaging demonstrated soft tissue mass with hyperintensity in T1 with contrast images (Figure 2). Biopsies were obtained on colonoscopy and results were in keeping with LCH. She was treated with induction chemotherapy (Vinblastine) and steroids followed by Cytarabine and Cladribine. She was then considered in complete remission. The only sequelae of the disease were the absence of several teeth due to mandibular involvement. She subsequently underwent dental implant insertion for rehabilitation. On current presentation, physical examination showed a defect in the posterior ear canal wall on the left with purulent otorrhea. Tympanic membranes were normal, and she had normal hearing on both sides. High-resolution CT scan of the temporal bone was obtained (Figure 3). It showed a posterior external ear canal defect opening into the mastoid with soft tissue density in the mastoid air cells. The middle ear and ossicular chain were reported as normal. A skull base MRI was obtained (Figure 4). It showed a partial soft tissue filling of the mastoid on that side with T2 hyperintensity. Diffusion-weighted images could not be performed due to dental restoration artifacts. A biopsy was performed in the outpatient clinic and showed inflammatory tissues. The microbiology sample was non-contributive. An initial diagnosis of recurrent LCH of the temporal bone was made, and the case was discussed in a multidisciplinary meeting. Given the unusual timeframe of the recurrence of symptoms, we proceeded to a mastoid exploration with a postauricular approach. There was no evidence of LCH. Final histology showed no recurrence of LCH. Informed consent was obtained from the patient involved in this report.\nOUTPUT:" }, { "from": "agent", "value": "Cholesteatoma" } ]

[ { "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 18 year-old single white female patient, born and raised in Pelotas, southern Brazil, reported having suffered slight scratches on the back of her right hand (while cleaning the glass wall of an aquarium). The fish that lived there died a week later. After three months, she noticed the lesion was difficult to heal and, after using many medications, including antibiotics, she sought medical care from a specialist. The dermatological examination revealed two ulcerated nodular lesions with abundant exudate located on the middle finger and on the back of the right hand, with the presence of nodular type satellite on the wrist of the same hand, resembling a sporotrichoid infection (Figure 2). Physical examination found no other changes. In the laboratory investigation, material was collected for skin testing for fungus and bacteria, as well as skin fragment for a biopsy. Mycological examination was negative. The histological report was descriptive, showing granulomatous inflammatory infiltrate with giant cells, mixed inflammatory cells and the presence of necrosis, suggestive of granulomatous disease. It is known that tetracyclines are an alternative therapy for mycobacteriosis. We chose to start treatment with one drug of this class, lymecycline 150mg/orally/day, due to history of gastritis triggered by previous antibiotic treatments, since this drug is better tolerated. After 10 days of treatment, she had clear signs of lesion improvement and we chose to keep the treatment and reevaluate after 45 days (Figure 3). After this period, the patient returned to the clinic with total remission of lesions; we decided then to suspend all medication and discharged the patient, in view of the good development, thereby obtaining a clinical cure.\nOUTPUT:" }, { "from": "agent", "value": "Mycobacterium marinum" } ]

[ { "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 41-year-old female presented with extreme shortness of breath and fatigue for the past half year. The patient reports that a lump was discovered in her chest about 7 years ago, but she did not seek care at the time. Initially, it was the size of a coin but increased to the size of a grapefruit. She reports that the shortness of breath has been present for a long time, but that over the past few months, she has experienced dyspnea even on light exertion, which severely hinders her daily life. On exam, she was afebrile, normotensive with tachycardia (108 beats per minute). Her respiratory rate was 18 breaths per minute and oxygen saturation was 93%. Cardiac exam revealed tachycardia without rubs or murmurs. Lung exam revealed normal chest excursion with clear lung sounds bilaterally without rhonchi, rales or wheezes. Chest exam revealed a hard, non-mobile non-tender nodule located at the lower aspect of her right rib. Upon admission to the hospital, a contrast-enhanced computed tomography (CT) scan revealed a mass occupying the 5th rib, with destruction of the normal bone structure of the rib (Fig. 1) and visible compression on the right heart border and deviation of the mediastinal structures. The mass was non-enhancing. The tumor was removed by osteotomy of nearly the entire 5th rib, and the anterior parts of the 4th and 6th ribs. The diaphragm was also partially resected, and parts of the upper and lower lobes of the right lung were removed. The resected specimen measured 16 cm x 12 cm x 12 cm (Fig. 2). A diagnosis of GCTB was made. Chest wall reconstruction was performed, and in a follow up visit three months later, there was no evidence of recurrence. The patient's chest CT appeared normal at that time.\nOUTPUT:" }, { "from": "agent", "value": "Giant cell tumor of the bone" } ]

[ { "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: Currently the patient presents malformations of the lower left limb (hip, knee and ankle), evident on the articular and periarticular level, where there are diffuse exostoses. This case discusses the main occupational concerns relating to the patient's workspace at a high floor level that could create critical issues in the event of an emergency exodus. Given the impossibility of placing the patient in heavy manual activities, employment is limited to office activities. Adjustments were carried out at the patient's workstation, and thus the patient has been recognized as fit to work. Increased frequency of breaks were prescribed in order to allow the physiological alternation of postures. Image Caption and Description: \nImage caption: []\nImage description: []\nCase Report: \nThe presence of an automatic fire detection and extinguishing system may constitute a risk element for our patient as it maked the floors more slippery, increasing the risk of falls. Therefore, a training plan aimed at emergency evacuation and a specific exercise was planned for the entire staff. In addition, two work colleagues were trained specifically for the assistance of the patient, and a tested evacuation and transport chair (model PRO-SKID by SPENCER) was purchased to descend the external fire escape stairs.\nOUTPUT:" }, { "from": "agent", "value": "Overgrowth 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 27-year-old nullipara presented to her local hospital at 33 weeks' gestation with decreased fetal movement, uterine contractions, and possible leakage of fluid from the vagina. Testing confirmed rupture of membranes; therefore, the patient was started on antibiotics to increase latency and was given betamethasone to hasten fetal lung maturity. The mother was transferred to Penn State Milton S Hershey Medical Center for anticipation of preterm delivery in a fetus that would require postnatal surgery. After transfer, fetal monitoring showed normal fetal heart rate variability with accelerations and occasional decelerations related to contractions. An ultrasound confirmed the double bubble sign and polyhydramnios. The patient was taken to the operating room and an emergent cesarean section was performed. The amniotic fluid was grossly bloody. A viable male infant weighing 2295 grams was delivered with Apgar scores of 7 and 8 at one and five minutes, respectively. A discrete area from which the hemorrhage emanated was not identified. The placental disk was of normal weight and appeared grossly normal. The infant had no stigmata of Down syndrome. He appeared pale at birth and an initial hematocrit was 29.4% that was treated by a blood transfusion upon admission to the neonatal intensive care unit. A nasogastric tube was placed and 37 ml of bloody secretions were suctioned. He did well postoperatively and was discharged on day 30 of life.\nOUTPUT:" }, { "from": "agent", "value": "Hemorrhage from Umbilical Cord Ulceration, Duodenal Atresia" } ]

[ { "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: Following resuscitation by paramedics, he continued to have recurrent nonsustained episodes of VF. Because of recurrent VF, an intra-aortic balloon pump was placed and salvage angioplasty was attempted. Closed-chest cardiac massage was continued en-route to the operating room for emergency salvage coronary revascularization (total closed-chest massage time was seventy minutes). After sternotomy, and while closed-chest massage was being performed, the patient was heparinized and CPB was initiated using right atrial outflow and aortic inflow cannulae. Doppler examination confirmed good diastolic flows in both grafts. As the patient could not be weaned from CPB despite escalating inotropic support, ECMO was initiated using pre-existing cannulae. The sternotomy was left open, and the patient was transported to the ICU. The sternotomy was closed two days later at the bedside. He subsequently had an automatic implantable defibrillator device placed and was discharged home in satisfactory condition.\nOUTPUT:" }, { "from": "agent", "value": "Ventricular tachycardia and fibrillatory arrest (VF), critical left anterior descending artery lesion, greater than 50% left main coronary artery stenosis, VF cardiac arrest, severe coagulopathy, local and systemic infections." } ]

[ { "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 27-year-old woman presented to a dermatology practice in Williamstown, Massachusetts with a pigmented skin lesion on her left anterior shoulder. She was originally seen four months earlier, and as the lesion was noted to be \"somewhat atypical,\" she had been given a follow-up appointment to be reviewed in six months. She made the decision to present earlier because \"the lesion had changed in color.\" On examination a 4-5 mm diameter tan papule with an irregularity of pigment was observed and the notation was made in the patient's notes that \"...clinically this does not look very worrisome but the change is concerning...\" and for that reason excision biopsy was performed. The preferred algorithmic method of the treating dermatologist (DJE) is a novel method known as 'BLINCK'. This method combines both clinical and dermatoscopic clues to guide the decision to biopsy. The fact that the lesion was \"lonely\" (the only one of its kind in that location) and that the patient was \"nervous\" gave a score of two and that score leads to excision biopsy according to 'BLINCK'. Prior to excision biopsy, dermatoscopic images were obtained in both polarizing and non-polarizing mode (Figures 1-3) with a Canfield DermScope (Canfield Scientific Inc. USA) coupled to an iPhone (Apple Inc. USA). The Breslow thickness was 1.01 mm and the mitotic rate was reported as 1 per square millimeter. The lesion was re-excised with one a centimeter peripheral clearance margin, deep to but not including muscle fascia, and a sentinel lymph node biopsy was performed, which was negative.\nOUTPUT:" }, { "from": "agent", "value": "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 37-year-old female, weight 56.5 kg and height 1.67 m, with RRMS resistant to interferon administration and a family history positive for hypothyroidism pathology received alemtuzumab in April 2016 for 6 days. In October 2017 (18 months after the second alemtuzumab administration), the patient had tachycardia, and the ultrasound scan showed a volume-increased thyroid gland and a markedly inhomogeneous parenchyma suggesting the presence of thyroiditis. The blood test revealed a suppressed thyroid-stimulating hormone (TSH; 0.0 mIU/L, normal values 0.34-4.2) and elevated FT4 (51.6 ng/dL, normal values 7.9-14.4) and FT3 (25 ng/dL, normal values 3.32-7.45) levels. She had also positive anti-thyroglobulin (TG; 196 IU/mL, normal values <4) and anti-thyroid peroxidase (TPO) antibodies (482 IU/mL, normal values <9), but negative TSH receptor antibody. The patient was prescribed propranolol (40 mg, once daily) up to the remission of symptoms. In November 2017, the patient was already asymptomatic. The blood test revealed TSH (0.02 mIU/L) and low levels of FT4 (0.67 ng/dL) and FT3 (2.32 ng/dL). TSH receptor antibody continued to be negative. The patient begins a tight control without therapeutic prescription. In December 2017, the ultrasound scan showed a thyroid parenchyma with a leopard patch appearance as a flogistic insult and vascularization of both lobes increased widely. The blood test revealed a strong spontaneous increase in TSH (43.97 mIU/L) and persisting low FT4 (4.8 ng/dL), but normal values of FT3 (4.1 ng/dL; Figure 1). As a result of persistence of hypothyroidism, the patient was given LT4 replacement therapy at the dose of 50 microg once daily. In May 2018, the patient must increase the dosage of LT4 replacement therapy at 75 microg once daily to achieve good hormonal compensation. In effect, the patient takes LT4 replacement therapy at the dose of 87.5 mug once daily.\nOUTPUT:" }, { "from": "agent", "value": "Autoimmune thyroid 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 total of 67 consecutive patients were included in the study. The average age was 60 years with the youngest patient being 34 and the oldest 78 years old. On average 2-3 lymph nodes were removed (min-max: 1-7; SD 1.4). 42 patients were classified as pT1 and a further 25 as pT2. All patients had completed the surgical treatment with resection of the tumour with at least 0.5 mm resection margin. The tumour characteristics and primary tumour site are displayed in Table 1. In our case series the SN clip volume received a mean dose of 40.7 Gy (min 28.8 Gy/max 47.6 Gy). In 42 patients (63%) the dose at the SN clips was at least 40 Gy, and 55 patients (82%) had a dose of 30 Gy or more. In eight patients the total dose of the SN was more than 50 Gy. In five of those the primary tumour was in the upper outer quadrant. A further two patients had the tumour located in the upper inner quadrant and one in the lower outer quadrant. This correlates with the distribution of the primary tumour sites. The radiotherapy data sets are illustrated in Table 2. The average follow-up time was 40 months (6-66 months). One patient died due to a nontumour related cause 40 months after diagnosis and one patient had a local and distant recurrence after 17 months. Primarily this patient (aged 79 years) had a hormone receptor positive tumour (ER12/PR8/Her2 negative) with lymphangiosis and minimum margins of 9 mm and 1 tumour-free sentinel node. The sentinel bed received 46.4 Gy. The primary treatment was incomplete as the patient declined the recommended chemotherapy.\nOUTPUT:" }, { "from": "agent", "value": "Breast 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 62 year old female was referred to the surgical team at her local district general hospital after seeing her GP complaining of a one week history of abdominal pain, and a swollen tender right groin. The patient was afebrile, normotensive but tachycardic at 104 beats per minute. She had normal haematological and biochemical parameters, but a raised acute phase protein level, with a CRP of 62 mg/L. On examination she had a painful, erythematous, irreducible swelling in her right groin consistent with a strangulated femoral hernia. No imaging was arranged as this may have delayed operative intervention. The patient was scheduled on the emergency theatre list and consented for a repair of this hernia, as well as the possibility of small bowel resection (Fig. 1). McEvedy's approach was adopted in anticipation of a strangulated section of bowel, and to allow for a possible resection. Laparoscopic approach was not considered for this emergency case. Inside the sac was a gangrenous vermiform appendix with some turbid free fluid (Fig. 2). A timely appendicectomy was performed, and the stump buried inside the caecum. The patient was discharged two days after admission with a total course of five days' antibiotics. Two months after this presentation the patient was seen in a follow-up clinic, and was well with no recurrence of the hernia or any wound infection.\nOUTPUT:" }, { "from": "agent", "value": "De Garengeot's hernia, Appendicitis" } ]

[ { "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 ingested 120 mL of chlorpyrifos in 2.5 hours. No one was home at the time. She was found by neighbors who called her estranged daughter to take her to the hospital. The patient reports that her attempt was a result of her daughter marrying a man in a lower caste system, which by Nepalese Hindu culture mandates that the patient disown her. The patient presented to the emergency department (ED) with bradycardia, miosis, lacrimation, salivation, bronchorrhea, bronchospasm, urination, emesis, and diarrhea. ED vitals were HR of 104 beats per minute (bpm), BP of 140/90 mmHg, oxygen saturation of 98%, temperature of 97 F, RR of 20 breaths per minute. She was immediately given a loading dose of 1.8 mg atropine IV and 2 g pralidoxime IV. Subsequently, charcoal packing and nasogastric lavage were performed within an hour of presentation. She required an additional 2 mg of atropine for resolution of respiratory distress. ED labs were significant for hyponatremia (131 mmol/L) and low serum cholinesterase of (895.5 mU/mL). She was then transferred to the ICU where she stayed for 14 days. She was given 1 g of pralidoxime every 8 hours for 4 days. Her atropine dose was increased 20% per day to maintain HR over 80 bpm until she reached a max dose of 10.2 mg atropine per day (three times the normal dose). The patient's signs and symptoms of cholinergic excess resolved; however, she developed atropine-induced psychosis. Per nursing reports, patient was agitated, delusional, giving inappropriate responses, and alert and oriented to self and day. She was weaned off atropine by 20% each day and by day 8 her psychosis resolved. Her ICU course was also complicated by aspiration pneumonia with fevers (Temperature max of 102.4 F) which resolved with clindamycin. Once she was stable, she was downgraded to a medicine unit where she remained for 4 days and was discharged on hospital day 19.\nOUTPUT:" }, { "from": "agent", "value": "Organophosphate Poisoning, Bipolar Disorder I, 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 27-year-old male patient had an interpersonal fight and received a blow with a blunt object on the left side of the face. Patient presented to the Department of Oral and Maxillofacial Surgery with the chief complaints of inability to chew and pain in left retromandibular region. On presentation patient was fully conscious, oriented and vitals were stable. There was no history of loss of consciousness. Also there was history of bleeding after trauma form the left ear. On local examination of the head and neck region there was diffuse swelling with retromandibular fossa and lower third of the face in the mental region on the left side. But an orthopantamogram revealed intact condylar process on either side. Inter-maxillary fixation was maintained for 2 weeks post-operatively. Post-operative period was uneventful. Patient was asymptomatic and occlusion remained intact after 11/2 year follow-up.\nOUTPUT:" }, { "from": "agent", "value": "Fracture of the styloid process, Mandible fracture" } ]

[ { "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 girl child presented with episodes of generalized tonic-clonic seizures for 6 months and headache and episodic vomiting for 2 months. Neurological examination did not reveal any significant abnormality. Bilateral papilledema was detected on fundoscopy. Routine blood and biochemical investigations were within normal limits. Brain magnetic resonance imaging (MRI) revealed a large well-defined predominantly cystic lesion without perilesional edema in right parietal region extending from cortex to periventricular region with mass effect in form of effacement of overlying cortical sulci, ipsilateral sylvian fissure, and lateral ventricle with significant midline shift towards left. The lesion was hyper intense on T2 fluid-attenuated inversion recovery (FLAIR), T2- and T1-weighted images (WI). Foci blooming on gradient recoiled echo images were noted at the periphery of lesion suggestive of calcifications. The patient was operated under general anaesthesia. A right parietal craniotomy was made and gross total excision of tumor was achieved. The tumor was largely cystic with small soft, vascular, and suckable solid component. The tumor was well-demarcated from the surrounding brain without any areas of hemorrhage or necrosis. Patient made an uneventful recovery in the postoperative period and there was no additional neurological deficit. Histopathological examination of tumor tissue revealed perivascular arrangement of cells with short stout cytoplasmic processes anchored to blood vessel walls (pseudorosettes) without any evidence of necrosis, mitosis, or vascular proliferation. Tumor cells were spindle shaped having moderately eosinophilic cytoplasm and eccentrically placed nuclei with strong immunopositivity to glial fibrillary acidic protein (GFAP), vimentin, and S-100 [Figure 2].\nOUTPUT:" }, { "from": "agent", "value": "Cerebral astroblastoma" } ]

[ { "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 29-year-old Pakistani male was referred to the Oral Surgery Department for rehabilitation of the left edentulous mandible secondary to partial mandibulectomy surgery. The patient has been diagnosed with (KCOT) in Pakistan, where he received his first surgical treatment. A second surgical partial mandibulectomy was attempted due to recurrence. He has been reviewed regularly and he requested to have a replacement of his missing teeth on the lower left side due to a difficulty in eating and the effect on his appearance (Figure 1). Clinical examination reveals an asymmetrical face with a slightly depressed left lower body of the mandible on a class I skeletal pattern (Figures 1 and 2). The patient reported an absence of paraesthesia on the left mandible. The smile line was high exposing the gingiva on the upper maxillary incisors. Intraorally, the oral hygiene was fair with the presence of mild gingivitis. The dentition on the maxillary arch was unrestored (Figure 3). The left edentulous mandible was irregular basal bone with firm mucosa covering the bone from 41 until 37. There were marked loss of bony structure horizontally and vertically. This has caused the tongue to occupy the space that used to be occupied by teeth and alveolus in the left mandibular segment (Figures 4, 5, and 6). The healing of the operation site was uneventful (Figures 6 and 7). An orthopantomogram was taken to evaluate the remaining bony structure of the mandible (Figure 8). Radiographically, the operation site (lower left posterior segment) has no abnormalities. The remaining basal bone was adequate in thickness to support the mandible with an irregular margin. There are no radiopaque abnormalities suggestive of new pathology.\nOUTPUT:" }, { "from": "agent", "value": "Keratocystic Odontogenic Tumour" } ]

[ { "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 69-year-old woman presented with a 14-month history of intermittent fornication in the distribution of the left mandibular (V3) division of the trigeminal nerve. MRI scan identified a presence of an ill-defined, diffuse lesion, involving cortex and subcortical white matter of the left occipital and parietal lobes extending into the frontal lobe, with only slight mass effect and relative preservation of underlying anatomy with no postcontrast enhancement. The MRI features were suggestive of low-grade diffuse glioma or gliomatosis cerebri. After five months time follow-up MR scan with MRS (1.5 T Siemens Avanto) using 2D CSI and single voxel (SV) technique (TE of 135 ms, TR of 1500 ms) was performed. The analysis of MRS findings was done using the standard software provided by the manufacturer. The MRI scan again confirmed the presence of extensive signal abnormality, which unchanged in size from the previous scan (Figure 1). The MRS (SV and CSI) through the abnormal areas was extensively assessed but showed no alteration in choline and N-acetyl aspartate (NAA) peaks compared to normal brain tissue and was entirely within normal limits (Figures 2 and 3). The patient presented six months later with 2 weeks history of partial seizures, involving the right upper and lower limbs. Repeat cranial MRI scan revealed significant progression of the lesion into the occipital region and an increase in the mass effect. An area of enhancement in the left parietal lobe was also present, measuring 19 x 18 mm (Figure 4). The patient subsequently went on to have a biopsy.\nOUTPUT:" }, { "from": "agent", "value": "Glioblastoma multiforme (GBM)" } ]

[ { "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 history of frequent sun exposure was admitted when the patient was 20 to 40 years old, with an average of 3 to 5 hours a day, due to the patient's gardening hobby. When gardening, the patient wore light clothes without sun protection. The complaints were not accompanied by drastic weight loss, unexplained fever, shortness of breath, prolonged cough, diarrhea, or tumoral nodular lesion on the neck, armpits, and groin. The patient never had organ transplantation. A history of similar complaints in the family was denied. History of smoking and receiving radiation therapy were also denied. The patient and her family had no history of diabetes. On physical examination, vital signs and nutritional status were within normal limits. There were no abnormalities besides the tumoral nodular lesion on the right shoulder. Figure 1A. The lesion was solitary, irregular, measuring 5x2.5x0.5 cm in size, hyperpigmented, and nodular with an erythematous base. Erosions and serous crusts were also observed. Figure 1B. Dermoscopic examination showed ulceration. Figure 2 (black arrow), blue-gray ovoid nests. Figure 2 (red arrow), deeply pigmented borders. Figure 2 (yellow arrow), and arborizing vessels. Figure 2 (blue arrow) suggestive of BCC. The patient was initially treated with sunscreen SPF 45 twice a day and 10 mg oral cetirizine once a day. A 6-mm punch biopsy was performed. Post-biopsy, the patient was given systemic antibiotics and analgesics. Histopathological examination showed tumor mass composed of round and oval hyperplastic cells, compact, with some forming groups. Tumor cells formed a palisading structure with the myxoid stroma were also observed. Figure 3 (red circle). The nuclei were polymorphic, hyperchromatic, and mitotic. The surrounding fibrocollagenous connective tissue was lined with lymphocytes. These findings were suggestive of nodular BCC. The final diagnosis of nodular BCC was subsequently established. Cryotherapy was performed with a direct open spray technique and liquid nitrogen cryogen, two freeze cycles of 60 seconds with a thawing interval of 90 seconds. Two-cycle of cryotherapy was performed and yielded a satisfying result.\nOUTPUT:" }, { "from": "agent", "value": "Nodular Basal Cell 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 32-year-old female presented with symptoms of low energy level, weight gain, cold intolerance, increased bowel movements, flaking, and itchy scalp in the year 2014. On examination, she was found to have a palpable goiter. Neck ultrasound demonstrated diffusely enlarged thyroid with mild heterogeneous echotexture and left hypoechoic solid nodule measuring 0.75 cm [Figure 1]. Thyroid function test (TFT) was within the normal limits (TSH: 3.4 muIU/mL and FT4: 1.1 ng/dL; normal laboratory values of TSH 0.350-4.940 uIU/mL and FT4: 0.7-1.5 ng/dL respectively) however, antithyroid peroxidase (1446.0 IU/ml; reference range 0.0-5.6 IU/ml) and Tg antibodies (95.4 IU/ml; reference range 0.0-4.1 IU/ml) were high. In the year 2016, the patient presented with irritability and anxiety. Repeat ultrasound showed status quo. However, there was a surge in thyroid antibodies and an increase in TSH levels (7.2 muIU/mL). The clinical impression was consistent with Hashimoto's thyroiditis and the patient was started on low-dose thyroxine, which she tolerated well for 3 years. On yearly follow-up, there was a downtrend in thyroid antibodies, TSH returned to normal range, and findings on ultrasound remained stable. In October 2019, the patient presented with syncopal episode. Evaluation of TFT demonstrated low TSH of 0.003 muIU/mL and raised FT4 of 2.4 ng/dL. The patient was asked to stop thyroxine tablets and to repeat TFTs in 4 weeks. Repeat TSH was <0.002 muIU/mL and FT4 of 2.6 ng/dL. The patient was subsequently treated with 15.9 mCi of radioiodine (I-131). Follow-up in 6 weeks of radioiodine therapy, the patient was clinically stable.\nOUTPUT:" }, { "from": "agent", "value": "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 35-year-old woman with a second and intended pregnancy received partial prepregnancy care at the comprehensive health-care center without testing and follow-up by health-care personnel. She received prenatal care from the comprehensive health-care center. At 8 weeks gestation, the mother's platelet count was 129,000. The mother with gestational age of 39 weeks and 5 days with labor pain, reduced fetal movement and bloody show is admitted to maternity hospital. On arrival, the dilatation was 2-3 cm, effacement, 40%, and station-3. Fetal heart rate is monitored and reactive NST, negative CST, and biophysical score of 4/8 are reported. The mother is transferred to labor after 3 h of admission. On the same day, the female baby is born with a Thick meconium and weighing 3130 g and Apgar of 9/10. Episiotomy is repaired. Due to uncontrolled bleeding and tachycardia (pulse 157), the mother is transferred to the operation room. The mother in the operating room received 3 units of pack cell, 4 units of FFP. A cookie-type Bakri balloon is fitted to the mother, and 6 pair of forceps are applied to the cervical wall. The mother is then subjected to cardiopulmonary monitoring and after controlling for bleeding, the forceps are removed and the Bakri balloon is automatically removed and excreted. Postpartum thromboembolic protocol did not apply to the mother, despite being over 35 years old, weighing more than 80 kg and blood and product injection. The mother is then discharged early after 4 days of hospitalization with a platelet count of 66,000 without any required training.\nOUTPUT:" }, { "from": "agent", "value": "Severe maternal hemorrhage, Partial uterine atony" } ]

[ { "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 both cases, the persistence of anemia negatively affected each patient's quality of life, resulting in intense fatigue, weakness, and dizziness. The desensitization protocol began with 48 h of hospitalization to prepare for the procedure through the provision of systemic steroids, antihistamines and anti-leukotrienes (Table 2). The patients were admitted to the intensive care unit under continuous monitoring, and an hour before starting the procedure, 80 mg of methylprednisolone and 25 mg of hydroxyzine were administered intravenously. In both cases, the procedure was completed without complications. The daily supply of 200 mg was administered intravenously in the following manner: 20 mg was injected in two doses over the first 30 min while the patient was monitored for a reaction. In the absence of further reaction, the remaining 180 mg of the daily dose was administered over a period of 4 h, with time intervals between each daily dose of 24 to 26 hours. No secondary allergic reactions were noted in either case. The patients' follow-up examinations demonstrated evidence of the success of the treatment, and the patients reported the total disappearance of their symptoms (Table 4).\nOUTPUT:" }, { "from": "agent", "value": "Hypersensitivity to iron, Iron deficiency anemia" } ]

[ { "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 3 presents a contrasting scenario where survival was not achieved. The patient was a 2-month-old boy born at an early-term 37 weeks' diamniotic gestation. Prior to the incident, he was in good health at home with no significant social or family history. However, he was found apneic and unresponsive in the prone position after being fed and placed on his side for sleep. Cardiopulmonary resuscitation was administered until emergency medical services arrived. Initially asystolic, his cardiac activity was restored after receiving two doses of epinephrine within a span of 10 min. The coroner's autopsy indicated an asphyxiating sleep environment as the cause. Throughout his stay, the cvEEG showed diffuse low amplitude slowing without a seizure. On the first day, the patient's anatomical MRI was severely affected by movement artifacts, and purposeful-appearing movements were observed (Figure 5). This raised concerns regarding the possibility of a less severe injury that required further evaluation. The medical team felt that the available information at that time was insufficient. The rs-fMRI results revealed no detectable resting-state network or rs-SOZ, indicating incompatibility with the potential for CMD, volitional movement, or consciousness recovery. This pointed to an extremely poor outcome with no evidence of a treatable network disorder. The option of WLST was discussed with the family both before and after consistently unfavorable rs-fMRI findings.\nOUTPUT:" }, { "from": "agent", "value": "Brain death" } ]

[ { "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 man with a history of chronic heart failure collapsed at work, and his colleagues contacted the emergency medical service (EMS). Our hospital's RRC was requested and dispatched to the scene at the same time. Because this is an indication for prehospital ECPR, EMS requested for MOREs. The EMS immediately started resuscitation using mechanical CPR and transferred the patient from the scene. Eight minutes after the EMS started ACLS, RRC joined the EMS on the way to the hospital and confirmed that VF persisted. The RRC staff decided to carry out prehospital ECPR and transferred the patient to the MOREs docking point 16 km from the hospital (26 min by car). On patient arrival at the MOREs docking point, cannulation was carried out (56 min after the call). The ECMO cannulas were percutaneously inserted, and ECMO was initiated 10 min after the operation with a 63-min low-flow time. Return of spontaneous circulation was achieved when the patient arrived at the hospital. The pupillary light reflex was absent, but he showed miosis and spontaneous breathing. An emergency percutaneous coronary intervention was carried out, and the patient was admitted to the ICU. On day 3 of the ICU, although he was in a comatose state, he was taken off the ECMO.\nOUTPUT:" }, { "from": "agent", "value": "Cardiopulmonary arrest, Ventricular fibrillation, Cerebral hypoxia, Severe neurological impairment" } ]

[ { "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 male patient living in a rural area with low socioeconomic condition, admitted to the Hacettepe University Department of Emergency Medicine, Ankara, Turkey in July 2013, because of a suppurated, massive destructive lesion containing numerous larvae covering left half of his face. The patient had poor general condition. He had been operated four times because of his tumour before. The tumoural lesion of the patient was covered the left maxillary-orbital region and nose and there were a great number of larvae moving in his tumour lesion (Fig. 1). Approximately 200 larvae were removed from his wound by mechanical and the lesion was rinsed using hydrogen peroxide solution. Some of the larvae delivered to the parasitology laboratory. After morphological examination the larvae washed in distilled water and killed in alcohol 70 % and they were taken to the Ankara University Veterinary Faculty Department of Parasitology for identification. The morphological characters of cephalopharyngeal skeleton, anterior spiracles and slits of the posterior spiracles were examined. Measured length of 10-15 larvae were about 12 to 16 mm (Fig. 2). The anterior spiracles with 7-9 lobes, the posterior spiracles with narrow and complete peritreme, straight and parallel 3 slits and cephalopharyngeal skeleton without accessory oral sclerite were observed by microscopically (Fig. 3). We also observed inner, median, outer and anal tubercles on the posterior segment of the larvae and the distance between the tubercles on the top side of the posterior cavity was equal. The larvae were identified as 3rd instar of L. sericata. Because of all the larvae were dead we could not rear the larvae to adult stage. The patient's white blood cell count and C-reactive protein values were found high so meropeneme therapy was started. He had severe protein-energy malnutrition because of unabling to eat and a dietary supplement was intended. The patient was taken to the Department of Otorhinolaryngology for palliative operation for his tumour. Excision of mass, total left maxillectomy, total parotidectomy, partial mandibulectomy and rinectomy was performed.\nOUTPUT:" }, { "from": "agent", "value": "Extensive Wound Myiasis, Maxillary Sinus Squamous Cell 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 10-year-old female child presented with pain in the left flank of 2 months duration. 1). Serum creatinine was 0.5 mg% and hemoglobin was 10.4 g%. 2). It was decided to tackle the stones in one sitting. Under cover of injectable antibiotics and under general anesthesia, the child was placed in supine position. PCCL was performed using a 24F nephroscope and pneumatic lithotripter. PCNL was performed using an 18F amplatz and 16F pediatric nephroscope. 3). A new 4.5F DJ was inserted along with a 12F nephrostomy catheter. The total operating time was 240 minutes. and blood loss was <50 mL. After surgery, the child was placed in supine position and it was noticed that the child's abdomen was distended. Intraoperative ultrasonography revealed collection of fluid in the peritoneal cavity. A small intraperitoneal drain was introduced and connected to a collection device. Postoperatively the child had an uneventful recovery. The intraperitoneal drain was removed after 48 hours, nephrostomy after 24 hours, suprapubic cystostomy after 72 hours, and perurethral catheter after 5 days. The child did not require any blood transfusions.\nOUTPUT:" }, { "from": "agent", "value": "Retained Double J Stent, Huge Renal Calculi, Bladder Calculi" } ]

[ { "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 33-year-old male presented to the Department of Dental and Maxillofacial Surgery at our hospital with a 3-year history of painless, progressive right upper lip swelling [Figure 1]. There was no history of previous trauma, and past medical and dental history was unremarkable. Clinical examination revealed a rubbery, well-circumscribed, freely mobile and lobulated mass in the right half of the right upper lip, measuring 4 cm at its widest diameter. The overlying labial mucosal was intact and appeared pink and smooth [Figure 2]. The general condition of the patient was normal, with negative regional lymphadenopathy and no abnormalities were detected on further examination. A provisional diagnosis of lipoma was established. Surgery was performed through regional block of the right infraorbital nerve and augmented with infiltration of the surrounding area of the lesion with 2% lignocaine with 1:100,000 adrenaline hydrochloride. A horizontal labial transmucosal incision was made over the lesion with the upper lip cervically retracted. Complete excision of the lesion was achieved intraorally without compromising the surrounding tissues and overlying skin. Following hemostasis, 3.0 Vicryl sutures were used to close the labial mucosa. The excised lesion was oval, multinodular, yellowish and encapsulated, measuring 3.5 cm in diameter. Early postoperative recovery was uneventful. The patient was subsequently discharged on the same day and consecutively followed up monthly over a period of 6 months. No evidence of recurrence was recorded. Histopathologic examination of the specimen showed an encapsulated tumor composed of an island and sheets of epithelial and myoepithelial cells arranged in duct, acini, irregular tubules and strands, dispersed within a background of loose myxoid stroma exhibiting chondroid differentiation. There was no evidence of mitosis or necrosis [Figures 3 and 4]. Based on the histological findings, a diagnosis of PA was made.\nOUTPUT:" }, { "from": "agent", "value": "Pleomorphic 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 88-year-old Japanese male with a history of prostate cancer and hypertension boarded the cruise ship with his wife 16 days before the ship was quarantined. He recognized fever (day 0) and underwent RT-PCR testing on day 4, with a positive result, and was admitted on day 6. On admission, he suffered from fever and fatigue without cough or breathing difficulty. Blood results were as follows: WBC 3,100/muL, lymphocyte 704/mL, AST 39 IU/L, ALT 18 IU/L, sodium 127 mmol/L, and CRP 1.52 mg/dL. Fever and fatigue persisted, and other symptoms such as cough and diarrhea were developed on day 11. Despite our efforts to correct sodium abnormality, hyponatremia continued, ranging from 125 to 127 mmol/L, with a mild oxygen requirement (1-2 L/min). Chest X-ray revealed a new appearance of infiltrative shadow in the bilateral lung, and the CT scan image showed GGO in the outer area with or without consolidation. He had continued to take telmisartan 40 mg and trichlormethiazide 1 mg for hypertension, tamsulosin hydrochloride 0.2 mg for dysuria, and bicalutamide, an androgen receptor antagonist, 80 mg for prostate cancer. Symptoms gradually decreased in severity, with improvements in hyponatremia and lymphocytopenia. Although diarrhea and appetite loss due to LPV/r were seen, he was able to continue treatment. On day 25, he tested RT-PCR-negative for two samples and was discharged.\nOUTPUT:" }, { "from": "agent", "value": "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: The patient is a previously healthy 20-year-old male who presented to our trauma bay after sustaining multiple gunshot wounds of the left upper and lower extremities. On vascular examination, he had a diminished left radial pulse. 1, Fig. 2, Fig. 3). Imaging did not reveal any vascular injury to the lower extremity. Intraoperatively, selective angiograms better characterized the injury (Fig. 4) and the decision was made to use a covered stent. Access was obtained via the common femoral artery. One 6 mm x 5 cm stent was deployed to the distal left subclavian artery and two stents, 7 mm x 5 cm and a 7 mm x 10 cm, were deployed to the proximal subclavian and axillary arteries. He received heparin throughout the procedure. Completion angiograms were performed to rule out an endoleak, and to confirm good distal runoff to the upper extremity (Fig. 5). The patient was taken to the ICU postoperatively. He had a palpable left brachial and radial pulse. Antiplatelet therapy with aspirin 325 mg and venous thromboembolism prophylaxis with enoxaparin were initiated. He was transferred from the ICU to the surgical floor on POD#2 and was discharged to home on POD#5. On follow up the patient had a patent stent graft without endoleak.\nOUTPUT:" }, { "from": "agent", "value": "Left axillo-subclavian injury, Lung contusion, Nondisplaced humerus fracture" } ]

[ { "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: 66-years-old male patient was admitted with 3-month history of gait disturbance, urinary incontinence, and mental decline. In cranial CT and MRI scans normal pressure hydrocephalus was suspected, and diagnostic lumbar puncture was done three times every other day. Patient complained of low back pain after the third puncture. Systemic examination was unremarkable. There was no fever. Laboratory examination revealed elevated erythrocyte sedimentation rate (80 mm/h) and C-reactive protein level (3.6 mg/L) with 9.5 x 109/L white blood cells. Ceftazidime (6000 mg/day) and vancomycin (2000 mg/day) were given for 4 weeks. The blood and CSF cultures were negative. Antimicrobial therapy was replaced by teikoplanin (200 mg/day). After 8-week treatment of teikoplanin, infection markers declined to normal ranges, and the patient improved clinically.\nOUTPUT:" }, { "from": "agent", "value": "Spondylodiscitis" } ]

[ { "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: This case report was approved by the Ethics Committee of Daping Hospital [2022(03)]. A 47-year-old Chinese female patient was admitted to the hospital with paroxysmal abdominal pain in June 2020. During the DNA-NGS analysis, the patient received 1 week of chemotherapy with pemetrexed disodium (0.8 g) and nedaplatin (100 mg) and did not show any response ( Figure 1 ). The DNA sequencing identified a novel ALK fusion with a mutation frequency of 5.3% ( Figure 2A ). Integrative Genomics Viewer revealed a novel intergenic-ALK rearrangement generated by a fusion of the intergenic region between SLC8A1 and PKDCC to the intron 19 of ALK, and Sanger's sequencing result supported the accuracy of DNA-NGS detection. Furthermore, the gene fusion was confirmed by fluorescence in situ hybridization (FISH) with ALK break-apart probe (Healthcare, NMPA: 20183400004) ( Figure 2B ). A high level of ALK protein expression was further validated with immunohistochemistry (Ventana ALK (D5F3 ) XP , #3633, Cell Signaling Technology) ( Figure 2C ). The patient was referred to enroll in phase III clinical trial (NCT04632758) and was randomly administered an orally active second-generation ALK inhibitor WX-0593. An initial dose of 60 mg was administered for 1 week, followed by a maintenance dose of 180 mg. According to the Response Evaluation Criteria for Solid Tumors 1.1 guidelines, the CT scan indicated a partial response (PR) lasting longer than 22 months, with no noticeable side effects ( Figure 1 ).\nOUTPUT:" }, { "from": "agent", "value": "Lung Adenocarcinoma" } ]

[ { "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 multiple episodes of vomiting for a day and 2 days history of fever before the admission. There was no history of any laxative or diuretic use, no difficulty in opening the mouth or swallowing. He was then hydrated with ringers lactate and Oral Rehydration Solutions (ORS). Calcium and magnesium supplement was given and discharged home after 3days on admission. On examination, he was small for age, weight is 11kg (68.8% of expected). His body mass index was 12.2 kg/m2. Abdomen is flat, soft and moves with respiration. He was managed with intravenous fluids (4.3% D/S), calcium and magnesium supplement, IV diazepam and antimalarial. He has been coming to neurologic clinic for follow up.\nOUTPUT:" }, { "from": "agent", "value": "Carpopedal spasm, Hypocalcaemia, Hypomagnesaemia, Hypokalaemia, Metabolic Alkalosis, Hypochloraemia" } ]

[ { "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: USA 300 S. aureus was selected as the clonal complex with the closest phylogenetic similarity to our isolates to permit meaningful comparison with the study strains. Using MUMmer (http://www.mummer.sourceforge.net/) the reference genome sequences and SNP calling was performed. The haplotypes for each of the study samples were generated with confident homyzygous single nucleotide variant (SNV) sites for which the read fractions supporting major alleles were greater than 0.9 for every sample. These haplotypes were used as the nucleotide input for MEGA 6.06 (Molecular Evolutionary Genetics Analysis) http://www.megasoftware.net/mega.php during the phylogenetic analysis. Maximum Likelihood (ML) phylogenetic reconstruction was peformed with the Jukes-Cantor model using the ML Heuristic Method of Nearest-Neighbor-Interchange (NNI). The initial tree was assembled using maximum parsimony to estimate the evolutionary distances between sequences by computing the proportion of nucleotide differences between each pair of sequences. A review of literature identified 78 genes with virulence potential in the USA300 genome. The number of pathogenic genes in clinical isolates was compared to that of the reference strains using the Mann-Whitney U test. The test was conducted using R (http://www.r-project.org/).\nOUTPUT:" }, { "from": "agent", "value": "Methicillin Resistant Staphylococcus aureus, Acute Hematogenous Osteomyelitis" } ]

[ { "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 denied allergic reactions, use of alcohol, cigarettes. His family history was not significant. The symptoms developed acutely during the day. The patient was admitted to the Sechenov University for surgical treatment. At admission, the condition was severe, and the patient's posture was visibly contorted due to pain in the lower abdomen. The lungs exhibited vesicular respiration and no wheezing. The blood pressure was 100/80 mm Hg. The pulse rate was 92 beats per minute. The abdomen was painful on the right side and positive peritoneal symptoms were exhibited. In the blood test, red blood cell count was 4.4 x 1012 cells/L, hemoglobin was 112 g/L, the leukocyte (white blood cell) count was 19 x 109/L, the erythrocyte sedimentation rate was 16 mm/h, and the C-reactive protein reading was 21.0 mg/dL. One-hundred ml of pus was obtained and sent to for microbiological investigation. The fistulogram with contrast (Omnipaque 76%) showed a cavity with uneven, indistinct contours and heterogeneous content in the right lower quadrant (volume 10 x 6 cm), and the contrast flowed into the terminal ileum (Figure 2). The outflow drain was left in place.\nOUTPUT:" }, { "from": "agent", "value": "Abdominal Abscess, Crohn's 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 74-year-old female presented with chronic diarrhea, weight loss, hematochezia, abdominal cramps, and fever. Her past medical history was significant for hypertension, metabolic syndrome, and perforated diverticulitis. Physical examination identified a nontender mass in her left submandibular area with no thyromegaly. The serological exam was remarkable for elevated chromogranin A level of 299 (normal <93). Suspicion for carcinoid tumor warranted an octreotide scan that identified increased uptake on the right side of the abdomen and left side of her neck. Laboratory tests revealed elevated calcitonin level, 11,290 pg/mL (ref. value <7.6 pg/mL) (Figure 1). Ultrasound of the neck identified a highly suspicious thyroid mass (Figure 2(a)), and a CT scan showed a heterogeneous thyroid nodule, and several enhanced lesions in the liver (Figure 2(b)). Patient had no family history of MTC or MEN syndrome. She underwent a total thyroidectomy followed by treatment with Vandetanib, which lead to resolution of diarrhea and normalization of bowel function. However, the drug was poorly tolerated, patient developed rash, fatigue, weakness, and nausea, and the dosage had to be tapered down and eventually stopped completely. Two and a half years after the initial diagnosis of MTC, the patient returned to the clinic with edema, skin acne, elevated blood pressure, hyperglycemia, hypernatremia, and hypokalemia. The Cortisol level was drastically elevated, 120.2 microg/dL (ref. range for A.M. cortisol 6.2-19.4 microg/dL). High dose dexamethasone suppression test was indicative of ectopic ACTH tumor. Brain MRI ruled out pituitary adenoma. It was concluded that liver lesions were the source of ectopic ACTH. To control hypokalemia, Aldactone was started along with a cortisol lowering ketoconazole, potassium, and calcium replacement. The patient was not a good surgical candidate, and bilateral adrenalectomy was not an option. While still in the hospital, the patient developed altered mental status and bleeding of colovaginal fistula. Her calcitonin level increased to 20,503 pg/mL (Figure 1). The patient's family decided in favor of comfort care, and less than two weeks later the patient passed away.\nOUTPUT:" }, { "from": "agent", "value": "Sporadic Medullary Thyroid Carcinoma, Paraneoplastic Cushing 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 49-year-old Hispanic male with fairly well-controlled type two diabetes mellitus presented with several days of subjective fever with difficult urination including micturition of small amounts and dribbling associated with low back pain. His exam demonstated mild tachycardia with no fever and normal blood-pressure measurements. His skin was clammy with suprapubic tenderness and bilateral mild low back pain with no vertebral tenderness. The prostate was 3+ and boggy with significant tenderness, The laboratory studies were only significant for leukocytosis of 16.2 x 109 L with a bandemia of 10%. His labs were otherwise normal except for a creatinine of 114.9 mumol/L and a glucose of 14.5 mmol/L. Testing for the human immunodeficiency virus and chlamydial/gonorrheal urinary antigens were negative. A Foley was placed, and the urinary sediment showed significant leucocytes with moderate protein and a small amount of blood. His chest X-ray was normal. The patient was started on intravenous fluids and antibiotics with glucose control via a sliding scale of regular insulin. The blood cultures and urine culture all grew Methicillin Resistant Staphylcoccus Aureus (MRSA). With intravenous Vancomycin and drainage the patient markedly improved clinically with negative cultures of the urine and blood. The Foley remained in place for two weeks and then was pulled without difficulty. He was subsequently treated with another month of oral doxycycline with clinical success. A six- week followup PSA level was 1.2 ug/L.\nOUTPUT:" }, { "from": "agent", "value": "Prostatic abscess" } ]

[ { "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 20-year-old boy presented with abdominal pain and distension in the emergency department following blunt trauma to the abdomen by a steering wheel of the tractor. The patient had generalized abdominal tenderness, abdominal rigidity, and generalized abdominal distension. The patient was conscious, oriented, and his blood pressure was 100/60 mm Hg. All the blood parameters were normal except for raised amylase (137), lipase (1769), and low hemoglobin was 8.8 g/dL. Ultrasonography of the whole abdomen with spleno-portal axis Doppler reveals complete transection of the head with loss of communication between head and body of pancreas with a hypoechoic collection in the neck region and free fluid in the abdomen. Immediate exploratory laparotomy with peritoneal lavage and bilateral drain placement was done. Magnetic resonance cholangiopancreatography (MRCP) was done after exploratory laparotomy. The patient still had pus drainage from the initial drainage site even after 3 months; he was advised for follow-up CECT. The patient had been planned for distal pancreatectomy.\nOUTPUT:" }, { "from": "agent", "value": "Disconnected Pancreatic Duct Syndrome, pancreatic ascites, walled-off necrosis" } ]

[ { "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 was extensive marrow involvement. Cytogenetic and molecular details are displayed in Table 1. The decision was made to start decitabine with venetoclax, and the patient was admitted for induction therapy. During induction, the patient received dose-reduced venetoclax 100 mg daily for 21 days due to concern for drug-drug interactions, given the concomitant use of posaconazole for fungal prophylaxis. A bone marrow biopsy following cycle 1 showed a cellular marrow with reduction of blasts from 80% down to 14%, with a normal absolute neutrophil count and stable thrombocytopenia (platelet counts stable around 20,000, compared to 25,000 on admission), and he was discharged without further complications. On follow-up, the patient was continued on decitabine and venetoclax, receiving only 14 days of dose-reduced 100 mg venetoclax for each cycle, given persistent cytopenias. His course was complicated by anemia and fatigue, and the patient received G-CSF during periods of neutropenia between cycles and transfusions as needed. For cycles 2 and 3, the patient received a shorter dose of 14 days of venetoclax due to anemia. Bone marrow biopsy after cycle 3 showed ongoing reduction in the blast count (9% blasts). Cycle 4 was with decitabine alone, and the patient developed leukocytosis and a bacteremia, so after stabilization, cycle 5 was resumed with decitabine and venetoclax once again. Following cycle 5, the patient developed GI bleeding in the setting of thrombocytopenia. The patient was managed supportively on hydroxyurea and transfusion support, ultimately transitioning to hospice care, 6 months after his original diagnosis with AML.\nOUTPUT:" }, { "from": "agent", "value": "Acute Myeloid Leukemia" } ]

[ { "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 eighteen year old African American male presented to the emergency room with a 1-week history of sore throat, muscle aches, fever, headache, and photophobia. He also complained of nausea, one episode of vomiting, and abdominal pain. He was a college student and lived in a dormitory. He denied any recent travel or contact with ill people. Past medical history was significant for sickle cell trait and Osgood Schlatter's disease. He was up to date on vaccinations. Physical examination revealed a tall, thinly built young man, in mild pain with an oral temperature of 97.5 F, blood pressure of 114/69 mmHg, heart rate of 89 beats per minute (BPM) and respirations of 18/minute. He had injected conjunctiva of the right eye, and pharyngeal and tonsillar exudates. The examination of the central nervous system revealed neck stiffness; Kernig's and Brudzinski's signs were not elicited. Cranial nerves were intact. The power and deep tendon reflexes were essentially normal. The rest of the systemic examinations were unremarkable. Hemoglobin was 17.5 g/dL, hematocrit 50.8 g/dL, and white count 20.3 x 109/L with 89% granulocytosis, and platelet count of 35 x 109/L. Basic metabolic profile was within normal limits, except for a potassium level of 3.2 meq/L, blood urea nitrogen of 44.9 mg/dL, and creatinine of 2.3 mg/dL. Chest X-ray revealed bilateral infiltrates in the middle and lower lung fields. Computed tomography (CT) of the head was unremarkable. The patient declined lumbar puncture. A few hours into the admission, he developed third and sixth nerve palsy. Multiple patchy cavitary lesions on both lungs were seen in the chest CT. There was no vegetation on transesophageal echocardiogram. The oculomotor and abducens palsies resolved after medical management for 16 days.\nOUTPUT:" }, { "from": "agent", "value": "Streptococcus group C meningitis, Cavernous sinus 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: A 52-year-old female patient had displayed numbness (paresthesia) and weakness in her limbs for 3 months. No hemodynamic or respiratory complications were observed during her initial care, and a neurological examination indicated a AIS was D (American Spinal Injury Association Impairment Scale) and no pyramidal syndrome. Cervical flexion and extension radiographs suggested atlantoaxial instability (Figure 1), and a cervical computed tomography (CT) scan demonstrated the existence of a bony continuity that had not been displaced within the odontoid process (Figure 2). Figure 4 indicates the presence of a high left carotid artery span in the patient. However, the patient's clinical progress was rapid and favorable, with the paresthesia regressing and motor recovery reaching grade 4 out of 5 by MRC (Medical Research Council) Scale for Muscle Strength. She was discharged one week after the surgery with no scarring and no longer presenting paresthesia in the right upper limb, and her ASIA was E. At 3 months, a complete neurological recovery was confirmed. Some cervical pain was reported, 2/10 on the VAS (Visual Analog Scale), without it being debilitating.\nOUTPUT:" }, { "from": "agent", "value": "Os odontoideum, Retro-odontoid cyst" } ]

[ { "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 Mallampati score could not be evaluated in the girl because she was uncooperative. Restricted mouth opening, cervical immobility, maxillary and mandibular deformities, and other hypoplasias were not observed. Preoperative imaging showed no evidence of tracheostenosis or airway abnormalities (Figure 3). Electronic laryngoscopy and lower airway examination were not performed. Upon arrival to the operating room, standard monitoring was applied, peripheral venous access was established, and SpO2 was 100% in room air. In addition to direct laryngoscopy and endotracheal tube (ETT) with an inner diameter of 3.5 mm, we also prepared materials for a difficult airway, including video laryngoscopy, laryngeal mask airway, and fiberoptic bronchoscopy, and assigned two anesthesiologists for this patient. We intravenously administered 30 mg propofol after pre-oxygenation. Once adequate mask mechanical ventilation was performed, 1 mg of cisatracurium and 20 mug of fentanyl were administered to facilitate orotracheal intubation. Dexamethasone (2 mg) was administered to prevent airway spasms, edema, and postoperative nausea and vomiting. Endotracheal intubation was performed by the attending anesthesiologist using a direct laryngoscope. Transoral placement under direct laryngoscopic visualization revealed the epiglottis and glottis; the former appeared to be redundant and curly leaf-shaped. A reinforced ETT with a sealing cuff [internal diameter (I.D. ), 3.5 mm] was chosen for intubation. However, since the forepart of the trachea passed the glottis and advanced past it, the anesthesiologist encountered some resistance and inserted the ETT by rotating it slightly. After intubation, auscultation of breath sounds was routinely performed to confirm the location of the tube, which was fixed at a depth of 13 cm from the upper incisors and connected to a mechanical ventilator. Respiratory parameters were as follows: volume control mode; tidal volume, 70 mL; respiratory rate, 20 breaths/min; fraction of inspired oxygen, 60%; and oxygen flow, 2 L/min. Anesthesia was maintained by a combination of propofol 100 mg/h and remifentanil 0.2 mug/kg min during the surgical procedure, and no volatile anesthetics were administered.\nOUTPUT:" }, { "from": "agent", "value": "Waardenburg 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 38-year-old male presented to Butare University Teaching Hospital, a tertiary hospital in the Southern Province, Rwanda. He complained of hypogastric pain, excessive flatulence and intermittent constipation over a period of 3 years. He was born and lived in Nyagatare district, Eastern Province, and attested to having swum since childhood in local rivers. He reported no diarrhoea, no fever, weight loss, anorexia or other medical history. The physical exam was normal, with no hepatosplenomegaly, ascites or visible abdominal venomegaly. Prior to presentation, basic investigations including negative multiple direct stool exams for protozoa (worms or eggs), normal liver transaminases and complete blood count. Due to vague abdominal pain, he underwent esophagogastroduodenoscopy which was normal, and the pain had not previously responded to proton pump inhibitors, mebendazole or tinidazole during the course of his symptoms. In our center he underwent abdominal CT scan which revealed multiple enlarged pericecal and mesenteric lymph nodes (Figure 1(a)). A repeat Kato-Katz test was negative for protozoa (eggs or worms). To complete the investigation of intestinal chronic schistosomiasis, abdominal ultrasound revealed periportal fibrosis (Figure 1(c)) with no features of cirrhosis or ascites, and the spleen size was normal. Echocardiography was normal with no features of pulmonary hypertension. The patient received a single dose of praziquantel 40 mg/kg orally, the standard for treating Schistosoma. One week later, the patient was called to monitor his symptom progression. He reported that he took the dose in the evening, and his symptoms were decreasing by the following morning, and within 24 h his symptoms had entirely resolved.\nOUTPUT:" }, { "from": "agent", "value": "Intestinal Schistosoma mansoni" } ]

[ { "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 42-year-old woman was admitted to our hospital with abdominal distension. However, the disease control was not good. Her condition initially improved, but she repeatedly experienced feelings of abdominal fullness. A physical examination on admission showed a distended abdomen, reduced bowel sounds, and general tenderness of the abdomen. Furrows were apparent around the mouth perpendicular to the lips, but sclerodactyly was not clear. Her height and weight were 161 cm and 49 kg, respectively. The laboratory findings were as follows: WBC count, 10,700 /muL; Hb, 13.2 g/dL; platelet count, 19.0x104/muL; total protein, 6.2 g/dL; albumin, 2.7 g/dL; AST, 37 U/L; ALT, 44 U/L; LDH, 324 U/L; CK, 437 U/L; TC, 126 mg/dL; CRP, 5.15 mg/dL; and negative results for anti-Jo-1 antibody, anti-Scl-70 antibody, and anti-centromere antibody. Abdominal X-ray showed massive gas accumulation and dilation of the intestines (Fig. 3a). CT showed massive gas accumulation in the intestines and gas in the intestinal walls (Fig. 3b). Oral ingestion was stopped, and total parenteral nutrition was initiated to allow the gastrointestinal tract to rest. High-dose oxygen was administered, along with purgative medicines. Erythromycin was also administered to promote motilin-responsive movement of the digestive tract. After starting treatment, CT showed reduced findings of gas in the abdomen, and the PCI was improved. The abdominal distension resolved, and the patient was able resume normal eating before discharge.\nOUTPUT:" }, { "from": "agent", "value": "Pneumatosis Cystoides Intestinalis, Connective Tissue Diseases, Dermatomyositis, Ileus, Scleroderma" } ]

[ { "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 41-year-old woman presented to us with complaints of poor vision and conjunctival redness. Her UCVA of the right eye was 20/200 and her SMR was -3.75 -10.50 x 088 with no visual improvement. BCVA in the left eye was 20/20 with a SMR of -0.25 -0.75 x 172. Her white-to-white and PA were 11.5 mm and 10.46 mm, respectively. Her posterior elevation was 96.5 mum. A MSCL Onefit A diagnostic lens with 14.7 mm diameter and 7.10 mm base curve was trialed based on Pentacam data. The subsequent fitting process was done similar to that of case 1, evaluating the fit after insertion and after four hours of lens settling. The apical cornea and landing zone relationships were assessed with AS-OCT, as seen in Figure 3B-D). Given the great fit and reliable over-refraction findings, a trial lens of 6.90 mm base curve, 14.7 mm diameter lens, -10.50 power was ordered. She was comfortably wearing the lenses for 12 hours per day with no signs of redness or vision complaints at the 1-week follow-up. Her final visual acuity was 20/30 with adequate central clearance, limbal clearance and edge alignment. At the 1-month, she still reported good vision and subjectively described the lenses to be comfortable Also, no contact lens related complications were observed.\nOUTPUT:" }, { "from": "agent", "value": "Corneal ulcer" } ]

[ { "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 71-year-old woman with a past history of hypertension, prior ischemic stroke with mild residual left hemiparesis 6 years prior and poorly differentiated ovarian carcinoma in remission for 18 years presented with subacute worsening left hemiparesis and headache for 3 weeks. On admission, the patient was hypertensive (159/78 mm Hg), mildly confused, and presented with left hemineglect and spastic left hemiparesis. Neuroradiological studies are displayed in figure 1. Computed tomography showed a 26-cm 3 right frontoparietal ICH with surrounding edema throughout the right hemisphere and a 1-cm midline shift. Magnetic resonance imaging (MRI) demonstrated increased fluid-attenuated inversion recovery both surrounding the hemorrhage with contrast enhancement and in the bilateral periventricular white matter hyperintensities. All of these findings, except for the hemorrhagic mass, were seen 6 years prior on an MRI scan performed for left-sided weakness. In 2006, MR spectroscopy of the right leukoencephalic region demonstrated a reduced N-acetyl aspartate/choline ratio, but no lactate peak. Cerebral angiography showed normal arterial and venous phases. The patient underwent a right hemicraniectomy and eventual resection of the hemorrhagic mass. Biopsy was notable for gliosis and thickened blood vessels, but no amyloid deposition or malignancy. A follow-up MRI demonstrated resolution of the hemorrhage and surrounding edema. Complete body positron emission tomography demonstrated no regions of hypermetabolism.\nOUTPUT:" }, { "from": "agent", "value": "Late-onset leukoencephalopathy, calcifications, and cysts" } ]

[ { "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 29-year-old male patient presented with severe persistent headache of 1-2 months duration which was acute in onset and was not relieved by any oral analgesic. There was no history of visual disturbance, diplopia, vomiting, seizures, trauma, or head injury. Patient had neither medical history of blood disorders nor was on any medications. Distant and near visual acuity of the patient was 20/20 and N6 respectively in both eyes. Anterior segment examination was within normal limits. Following are the colored and red-free fundus photographs [Figures 1 and 2]. B-scan was performed which ruled out optic nerve head drusen. A plain computed tomography (CT) scan brain was within normal limits. Magnetic resonance (MR) venography was performed with the following findings:\nPartial thrombus involving cranial part of right sigmoid sinus, transverse sinus, sinus confluence, superior sagittal sinus, and terminal part of left transverse sinus [Figure 4]. Hematological investigations revealed haemoglobin at 18.4 g/dL (13-17) and red blood cell (RBC) count at 6.04 million (4.5-5.5). Rest of histogram, prothrombin time, activated partial thromboplastin time, vitamin B12, serum total calcium, protein, thyroid stimulating hormone, VDRL, human immunodeficiency virus which were within normal limits. Hematology consultation was obtained which ruled out polycythemia as the patient had only raised RBC and hemoglobin with a normal erythrocyte sedimentation rate, platelets, and total counts without splenomegaly. Diagnosis of CVT was kept and a neurology consultation was obtained. Patient was started on treatment as per guidelines from the American Stroke Association. A trial of aspirin was given first and LMW heparin therapy was kept in plan if the symptoms did not improve. After 2 days, patient was symptomatically better with relief from headache. On subsequent follow-up visits, the visual acuity remained 20/20 with normal color vision.\nOUTPUT:" }, { "from": "agent", "value": "Cerebral venous sinus thrombosis, Bilateral papilledema" } ]

[ { "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: Her medical history included benign essential hypertension, schizophrenia, gastroesophageal reflux disease, and irritable bowel syndrome. She was taking hydrochlorothiazide, labetalol, olanzapine, lovastatin, trazodone, lansoprazole, amlodipine, potassium chloride, and vitamin E. She denied any cardiovascular (CV) symptoms. Her schizophrenia was well controlled on antipsychotic medications and, although she has received assistance from a social worker, she was independent on all her activities and instrumental activities of daily living (ADLs and IADLs). In the PAC, her blood pressure was 136/64 mmHg, heart rate was 74 beats/min, and oxygen saturation was 98% on room air. Her heart beat was regular without murmurs. Her lung sounds were clear. There was no pitting edema. Per the RCRI, the patient had no major CV risk factors and the expected risk of having a major adverse postoperative cardiac event was 0.4%-0.5%. Per the ACC/AHA guidelines on perioperative cardiac evaluation, it was advised that she proceed with the surgery without further work-up. She underwent a robotic total hysterectomy, bilateral salpingo-oophorectomy, ureteral stent placement, and pelvic washing. Her immediate postoperative course was uncomplicated, and she was discharged, accompanied by her son, to her home on POD 2, without home health services. She underwent a closed reduction and debridement, and was discharged to a skilled nursing facility.\nOUTPUT:" }, { "from": "agent", "value": "Complex atypical hyperplasia of the endometrium, Stage I adenocarcinoma grade 2, Open tarsometatarsal fracture dislocation of her left foot" } ]

[ { "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 16-year-old boy presented at our hospital with sudden-onset general headache and vomiting which had lasted for 2 days. His headache was aggravated in the orthostatic position and relieved in the recumbent position. Neurological examination was uninformative. The patient stated that he had had no recent head trauma. Computed tomography (CT) revealed bilateral subdural effusions and slit-like lateral ventricles with no significant changes to the AC [Figure 1a]. In addition to the CT findings, MRI showed obliteration of the prepontine cistern with flattening of the pons against the clivus and descent of the cerebellar tonsils, suggesting brain sagging. After intravenous hydration followed by 2 days bed rest, his symptoms abated. One month later, the patient again experienced recurrent headache and vomiting. This time, the headache was significantly on the right and had been gradual in onset. MRI showed the presence of the outer membrane of the AC between the AC and the SDH. The size of the AC was unchanged. His blood count and coagulation markers were normal. An urgent hematoma evacuation was performed under local anesthesia by burr-hole irrigation surgery. Postoperative CT confirmed complete evacuation of the SDH and the patient became symptom-free immediately after surgery. Postoperative follow-up CT 3 months after surgery showed no change in the volume of the AC and no recurrence of SDH. The lateral ventricles and subdural space were again normal in size [Figure 1c].\nOUTPUT:" }, { "from": "agent", "value": "Arachnoid cyst, cerebrospinal fluid hypovolemia, nontraumatic chronic subdural hematoma" } ]

[ { "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 84-year-old male smoker (60 pack-years) was first seen in our urological clinic in January 2008, when he presented with macrohematuria. The abdominal CT for staging revealed no metastasis within the abdomen. The patient underwent three instances of palliative transurethral partial resection of the bladder. Histology revealed a vesicular carcinoma pT2 NX MX G3 and a second carcinoma in situ (CIS). Based on the age of the patient, a cystectomy was not indicated, and symptomatic treatment was performed. In January 2009, he was admitted to our hospital with a history of exacerbating cough and progressive dyspnea. A chest radiograph (Fig. 1) was initially interpreted as showing signs of COPD but no further pathology, so he was treated symptomatically. During the hospital stay he complained about right shoulder pain for the prior two weeks. Clinically he had an elevation deficiency of the right arm. An X-ray of the right shoulder (Fig. 2) showed a lytic lesion within the right acromion. CT confirmed the lytic lesion within the acromion (Fig. 3) and revealed further lytic lesions in the neck and corpus of the scapula, and the third rib on the left side; it also detected several pulmonary nodules as well as two subcutaneous nodes in the upper back. In the context of malignancy, presence of distant metastases was assumed. To confirm this, CT-guided percutaneous biopsies were performed in the acromion and the subcutaneous nodes. In both regions, histology showed a poorly differentiated carcinoma. The immunohistochemical marker CK20 was expressed, while CK7 was negative. The patient underwent palliative radiation therapy.\nOUTPUT:" }, { "from": "agent", "value": "Urinary bladder carcinoma 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: DMD is associated with the DMD gene (OMIM* 300377), which consists of 79 exons and is one of the largest genes. DMD is located on chromosome Xp21.2-p21.1. About two-thirds of patients inherit DMD maternally, while the remaining cases are a result of de novo mutations in DMD. There are many DMD variants, including those with deletions (~60%) or duplication (~7%) of one or more exons, small insertions and deletions (INDELs) within an exon (~7%), single nucleotide variants (SNVs) (~20%), and rare mutations such as splice site or intronic mutations (<1%) and partial exonic deletions (~5%). In 2018, Liu et al. observed a novel mutation of c.6241_c.6290 + 1109del1159insAC using targeted next-generation sequencing (NGS). This mutation was a 1,159-bp deletion spanning the last 50 bp of exon 43 and the first 1,109 bp of intron 43, causing the partial deletion of exon 43 of DMD. In 2021, Geng et al. detected intron 44 deletion breakpoints using long-read whole-genome sequencing (LR-WGS). This study was the first to use LR-WGS to explore the possible mechanisms underlying exon deletions starting from intron 44 of DMD. Later in 2021, Chin et al. used LR-WGS to confirm that a 33-year-old G2P1 proband at 26 weeks of pregnancy with a heterozygous 426.1-kb duplication on chromosome Xp21.2 (chX:30936321-31362374, GRCh37/hg19) carried the duplication at chrX:30939526-31362638 as a direct repeat inserted downstream of DMD. In this study, we identified a de novo partial exon 51 deletion in DMD in a 10-year-old boy diagnosed with DMD by using whole exome sequencing (WES), Sanger sequencing, and LR-WGS.\nOUTPUT:" }, { "from": "agent", "value": "Duchenne muscular dystrophy" } ]

[ { "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 morbidly obese man underwent gastric bypass with stapled division of the stomach and Roux-en-Y gastrojejunostomy 21 years before he developed cancer. He experienced persistent symptoms of regurgitation, particularly after overeating. Upper endoscopy (EGD) disclosed a columnar-lined esophagus without atypia 5 years before his cancer was diagnosed. Surveillance endoscopy was performed on 2 occasions. Atypia had been noted 26 months earlier. The patient failed to have a follow-up EGD, but 3 months prior to presentation, he developed dysphagia. Computed tomography (CT) demonstrated a thickened esophagus with no tumor outside the chest, in the liver, or the abdomen, and no evidence of nodal involvement. A total esophagectomy was performed with en bloc resection of the upper stomach through a midline incision and right thoracotomy. A jejunal free-tissue transfer was used for alimentary tract reconstruction, with an anastomosis between the cervical esophagus and jejunal graft proximally and the graft and stomach remnant distally. A tube jejunostomy was placed as well. The patient recovered after a lengthy operative procedure and was able to eat solid food, but he required supplemental tube feedings to maintain adequate caloric intake. Cancer recurred at 8 months postesophagectomy, and he died 13 months after his operation.\nOUTPUT:" }, { "from": "agent", "value": "Esophageal 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: Oral prednisolone 30 mg/day was given until her symptoms improved. When her prednisolone was decreased to 10 mg on November 12, 2008, she experienced a sudden loss of vision in the right eye and presented to us. Ocular examination showed that visual acuity was hand motion in the right eye and 25/20 in the left eye. Slit-lamp examination and intraocular pressure were normal. Funduscopy revealed retinal whitening and a cherry-red spot (Figure 1A). Three days later, retinal whitening became marked and soft exudates appeared (Figure 1B), in which macula edema was confirmed by optical coherence tomography. Left funduscopy was within normal limits. Venous lamellar flow was observed at 43 seconds (Figure 2B). Finally, perfusion of the retinal arterioles was completed at 48 seconds. There was no leakage secondary to vasculitis from the posterior pole retinal vessels (both arteries and veins) or optic disc, and CRAO in the right eye was diagnosed. When she developed CRAO, laboratory data showed eosinophilia (17.6%, normal value < 4%), but other parameters, including C-reactive protein, white blood cell count, and blood coagulation, were within normal limits. Both proteinase-3-ANCA and MPO-ANCA were also negative. The likely cause of CRAO was underlying vasculitis associated with the systemic condition and secondary localized thrombosis under the hypercoagulable state. Intravenous urokinase was given within 6 hours of onset of symptoms. High-dose intravenous steroids (40 mg/day) were also started one day after onset, resulting in gradual improvement of macular edema confirmed by optical coherence tomography on December 5, 2008. Vision in the right eye recovered for a while but was poor (no better than 20/400), and central scotoma remained.\nOUTPUT:" }, { "from": "agent", "value": "Central retinal artery occlusion, ANCA-negative Churg-Strauss 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: Silver explored the adoption of standard cognitive behavioural therapy (CBT) for anxiety and depression with a 44-year-old woman with premanifest HD. The author reported a decrease from moderate to minimal difficulties on the Beck Anxiety Inventory (BAI; 60) and the Beck Depression Inventory (BDI; 61), as well as maintenance of benefits at 6-month follow-up. However, the study did not include any information on the statistical significance of such changes. Blass and colleagues reported the adoption of a combination of pharmacological therapy with a behavioural management plan based on applied behaviour analysis to target challenging behaviours in a 32-year-old man with advanced HD. The results showed a reduction of challenging and inappropriate behaviours (e.g., inappropriate touching) at post-intervention. However, the behavioural difficulties reappeared four months following discharge after the treatment, which led the participant to be readmitted, and no follow-up data were provided following the second inpatient stay. Fisher and Brown carried out a single case experimental design adopting sensory modulation with adjunct behaviour modification to treat physical and verbal aggression with a 50-year-old man with symptomatic HD. The results showed that the combined approaches appeared to work well in tandem, with sensory modulation techniques showing to be effective at de-escalating early agitation, and behaviour modification leading to a reduction of the frequency of behavioural triggers. A trend towards aggression decrease was also noticed with sensory modulation alone. Sullivan et al. carried out a case series with six people with symptomatic HD to target constructs akin to apathy, such as levels of interest, awareness, oral communication, and overall participation. The intervention consisted of 12 sessions of remotivation therapy (RmT), a single group technique focused on motivating pwHD to think about reality in relation to themselves as opposed to their disabilities. The authors reported improvements in interest, awareness, and overall participation at post-intervention, but no quantitative data were provided to evidence such benefits. Brown and Fisher investigated the effectiveness of a bespoke sensory modulation treatment to reduce behavioural difficulties in pwHD. The sample consisted of a man and a woman aged 22 and 31 who had received a diagnosis of juvenile HD prior to age 20. The authors reported reduced agitation and wandering and improved ability to engage in activities for participant one, as well as reduced aggression and vocalisation and better engagement in occupations such as reading for participant two. However, no details were provided on the specifics of the sensory modulation intervention.\nOUTPUT:" }, { "from": "agent", "value": "Huntington's 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 15-year-old boy born to healthy Japanese parents developed a fever, headache, and malaise 13 days before admission. He visited his local doctor one week prior to admission due to his persistent fever, and a blood test was performed but revealed no abnormalities. He was prescribed acetaminophen, but as the fever did not resolve, he visited our hospital three days prior to admission and was prescribed ampicillin/clavulanic acid. However, he was admitted due to his continued fever. He had never been scratched by a cat or other animals. On admission, his consciousness was clear. His temperature was 39.0 C, and he had no respiratory disturbance or tachycardia. There was a 3-cm smooth, mobile, and tender lymphadenopathy in the right axilla. There were no scratches or injuries on his right arm. Other physical examination findings were normal. Laboratory results are shown in Table 1. Contrast-enhanced computed tomography (CT) showed multiple lymphadenopathies in the right axilla but no solid tumor. Initially, we suspected pyogenic lymphadenitis and started treatment with cefepime and vancomycin. However, since the fever did not resolve and there was a discrepancy between inflammatory findings on blood tests and clinical findings, an axillary lymph node biopsy was performed on the fourth day of admission in order to differentiate malignant lymphoma. The pathology showed indistinct lymph node structure and an infiltrate of large lymphocytes and histiocytes from cortical to paracortical areas. In addition, the central part of the lymph node was necrotic, and macrophages with numerous nuclear karyorrhectic debris were observed in the necrotic tissue. The biopsied lymph node showed no neutrophilic infiltration (Figure 1(a) and 1(b)). Antimicrobial therapy was discontinued on day 9 of hospitalization. On the same day, small erythematous plaques without fusion appeared on the extremities and trunk. Olopatadine was administered because itching also appeared. On the 13th day of hospitalization, the patient's symptoms improved, and the inflammatory findings became negative, so he was discharged. Since then, the patient's symptoms have not flared up.\nOUTPUT:" }, { "from": "agent", "value": "Kikuchi's 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 Gabonese woman was hospitalized in January 2013 with a 7-day history of fever, cough, weakness, headache, vomiting, and a painful knee. She did not report coughing or shortness of breath. She had poorly controlled diabetes mellitus and was taking glibenclamide. She had no history of cardiopulmonary or renal disease, was receiving no long-term medications other than glibenclamide, and did not smoke. She was a retired school teacher but still engaged in family farming. Physical examination revealed blood pressure of 160/90 mm Hg, a pulse rate of 130 beats per minute, and a temperature of 40.5 C. She had a wound with an underlying abscess on her right leg, together with diffuse tenderness of the right knee with warmth, erythema, and limitation of active and passive ranges of motion because of pain and effusion. Neurologic, cardiovascular, and respiratory examinations revealed no abnormalities. Laboratory findings obtained at admission showed an elevated blood glucose level of 24 mmol/L but values within reference range for creatinine (0.85 mg/dL), leukocytes (9,800 x 103 mm3), and hemoglobin (9.2 g/dL). No other blood or urine test was performed, and chest radiographs were not taken. On hospitalization day 1, treatment with amoxicillin/clavulanic acid was empirically initiated for sepsis. On day 2, the abscess was incised and drained, and on day 3 antimicrobial drug therapy was switched to ceftriaxone. Cultures of blood, wound, and synovial fluid grew identical gram-negative rods, which were initially classified as Pseudomonas spp. No other pathogens were detected. The patient's clinical condition deteriorated, and she died of septic shock on day 8. A postmortem examination was not performed. After the patient's death, the Pseudomonas species was classified as B. pseudomallei (patient strain Gb100) and confirmed by MLST and whole-genome sequencing. This isolate was later determined to be susceptible to trimethoprim/sulfamethoxazole, amoxicillin/clavulanic acid, ceftazidime, and meropenem (Table 1).\nOUTPUT:" }, { "from": "agent", "value": "Melioidosis" } ]

[ { "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 present a case of a 20-year-old boy with a history of kidney transplantation for medical renal disease 6 months ago, who presented with generalized weakness, weight loss, fever, and loose motions and was referred for an 18F-FDG PET-CT scan. His K + was 2.8 mEq/l (N: 3.3-4.8), Na + was 124 mEq/l (N: 135-147), Cl-was 114 mEq/l (N: 101-111), serum creatinine: 3.4 mg% (N: 0.7-1.31), Hb: 9.8 g/dl (N: 13-18), RBC:3.16 million cells/ulit (N: 4.5-6.5), and ultrasonography revealed increased echogenicity of transplanted kidney. Because of frequent episodes of loose motions, he had developed hypokalemia for which he required potassium chloride (KCl) infusion (10 cc KCl in 0.9% NS at a rate of 100 ml/h) which was continued till the time of 18F-FDG injection. The whole-body PET-CT scan demonstrated altered physiological distribution of 18F-FDG with markedly increased uptake in almost all major muscle groups, including those of the neck, thorax, abdomen, pelvis, and the extremities [Figure 1] and reduced uptake in organs that physiologically show much better uptake for example, liver. There were no obvious morphologic changes in these muscles on CT scan. Hence, the study was not interpretable. The patient's medication at the time of 18F-FDG PET-CT scan included KCl infusion and steroids (Deflazacort). There was no history of incomplete fasting, hyperglycemia, insulin administration, or excess muscle activity before imaging. The whole-body 18F-FDG PET-CT scan was repeated after stopping KCl infusion 12 h before 18F-FDG injection.\nOUTPUT:" }, { "from": "agent", "value": "Pancreatitis" } ]

[ { "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 boy with a history of asthma since being 2 years old was admitted to hospital with history of seizure and loss of consciousness. There was a history of common cold in the patient a week before and he had experienced severe shortness of breath 4 days before admission. No significant history of trauma was recorded. His mother had a history of abortion. His mother had no certain disease during and before being pregnant with him. He had used atrovent and salbutamol sprays. No family history of similar illness was present. At the time of admission, vital signs were as follows: temperature 37.8 c, pulse 131 beats per minute, respiratory rate 26 per minute and blood pressure 90/50 mmHg. On physical examination, he was confused and there was bilateral expiratory wheezes as well as scattered rhonchi in the lower lobes. His thoracic x-ray was normal. The neurologic examination results were normal. His complete blood count was as follows: 25,600 white cells/mm3, with 81% neutrophils, 2% eosinophils, 15% lymphocytes, and 3.0% monocytes, Erythrocyte sedimentation rate (ESR) was (8, 0-10 mg/dl), C-reactive protein (CRP) was (4.1 mg/dl, 0-6 mg/dl), pH= 7.59, Po2= 96.5, HCO3= 25.9 mmol/l, and O2sat=94%. Other routine laboratory test results were normal. The antiviral antibodies in paired serum samples showed no significant changes in any of the examined viruses, including herpes 1 and 2, echovirus, enterovirus, coxsackievirus, and poliovirus types 1, 2, and 3. TORCH, anti-mycoplasma, and anti-borrelia titers were normal. Hbs Ag, Abs Ab, HCV Ab and HIV Ab were negative. The cerebrospinal fluid cultures were negative. No cardiac abnormalities were noted on clinical and ultrasound examinations. The sleeping EEG showed anomalies in the frontocentral regions with left prevalence and tendency toward contralateral diffusion. Abdominal ultrasound and computed tomography (CT) scans were normal. His brain MRI was normal. He experienced no other asthma and seizure attack. During a 5-month follow-up from the episode there were no new clinical symptoms.\nOUTPUT:" }, { "from": "agent", "value": "Hopkins 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: Case 2) A 13-month-old, neutered male Pembroke Welsh Corgi presented with severe systemic ulcerative skin lesions. The dog had shown soft feces after having a new snack 2 days ago, and the owner had also seen patchy ulcerative skin lesions around the hip. The lesions were spreading to the neck and flank. The dog showed systemic weakness and anorexia. Physical examinations showed hyperthermia (about 40 C), generalized patchy ulcerative lesions, and erythema around the skin lesions (Figures 2A,B). Complete blood cell count showed thrombocytopenia. Elevated alkaline phosphatase (ALKP) and CRP were found in serum chemistry. Prolonged aPTT and elevated D-dimer were identified in the coagulation test (Supplementary Table 1). Cytology of skin lesion impressions showed numerous sterile inflammatory cells (neutrophils and macrophages). The x-ray did not show specific findings except for mild splenomegaly. In histopathology of the dorsal skin lesions, dermis and epidermis were separated and infiltrations of inflammatory cells such as neutrophils, macrophages, and lymphocytes were found on the interface sites (Figures 4C,D). The patient received an immunosuppressive dose of prednisolone (Solondo , Yuhan, Seoul, Korea; 2 mg/kg PO bid), cyclosporine (Cipol-N , Chongkundang, Seoul, Korea; 7 mg/kg PO bid), and human intravenous immunoglobulin (hIVIG) (Liv -Gamma, SK Plasma, Seongnam, Korea; 0.5 g/kg, IV, 2 days in a row). After 10 days, the patient's appetite and vitality, and the skin lesions were significantly improved (Figures 2C,D). The laboratory findings showed that the abnormalities were markedly improved (Supplementary Table 1). The prednisolone was tapered (up to 1 mg/kg PO bid) and the patient came back to the local hospital.\nOUTPUT:" }, { "from": "agent", "value": "Immune-mediated skin 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 10-yr-old boy with underlying T1DM since the age of 4 yr and on sc multiple daily injections of insulin therapy, sc Glargine 4u ON, and sc Aspart 4u TDS (0.7 u/kg/d) was admitted in 2017 due to generalized body swelling for 4 d. There was no frothy urine, hematuria, or oliguria. The patient did not have any cardiac symptoms. He had three previous hospital admissions: hypoglycemic seizure on one occasion and DKA on two occasions. Blood sugar monitoring at home showed fluctuating blood sugar levels, ranging from low to high. His HbA1c level ranged from 10 to 13.3%. On examination, he had no jaundice and had no peripheral signs of chronic liver disease. His weight was 23 kg (less than 3rd percentile), height 128 cm (less than 3rd centile), and body mass index 14.04 kg/m2 (less than 3rd percentile). The liver was palpable 5 cm below the costal margin. He had ascites and scrotal and lower limb edema. Other findings on systemic examination were unremarkable. In the emergency department, his blood sugar level was found to be low. Investigations to rule out renal and cardiac causes of edema were normal. However, his liver enzymes were not normal, with an ALT level of 286 IU/l, AST level of 128 IU/l, and GGT level of 187 IU/l. Serum albumin was 37 g/l, and bilirubin was 6 micromol/l. Serum lactate was increased at 6.88 mmol/l. Levels of serum copper, ceruloplasmin, alpha-1 antitrypsin, and alpha-fetoprotein were normal. The infective and autoimmune screening tests showed negative results. Liver US showed hepatomegaly measuring 15.7 cm with normal liver parenchymal echogenicity. Doppler US of the lower limbs was normal. Follow-up was continued at the pediatric endocrine clinic. There were significant psychological concerns; hence, he was referred to a psychologist for counseling. He had better diabetic control with a recent HbA1c level of 9% at the age of 13 yr. His weight and height parameters also improved to the 3rd percentile. His hepatomegaly resolved, and the liver enzyme levels normalized.\nOUTPUT:" }, { "from": "agent", "value": "Glycogenic hepatopathy" } ]

[ { "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 39-year-old never-smoker female without prior relevant medical history was admitted to the hospital with progressive symptoms of abdominal pain, dyspnea, and bilateral leg edema. A computed tomography scan revealed pericardial effusion; bilateral pleural effusion; a 3 cm mass in the right lung; hilar, mediastinal, and retroperitoneal lymphadenopa-thies; and ascitis (Figure 1). A core biopsy of the lung mass was performed. Molecular analysis of the EGFR and the KRAS genes revealed absence of mutations. Immunostaining with IHC VENTANA clone DF53 identified overexpression of ALK, and fluorescence in situ hybridization using Vysis LSI ALK dual-color break-apart probe demonstrated an ALK rearrangement. When the sample was analyzed by nCounter, it showed a 3'/5' imbalance indicative of an ALK rearrangement, but failed to give a positive signal for the EML4-ALK v1, v2, v3, or v5; TFG-ALK_T5:A20; KIF5B-ALK_K17:A20; or KIF5BALK_K24:A20 fusions. Finally, a band with a molecular weight higher than expected (239 bp) appeared after reverse transcriptase-polymerase chain reaction analysis (RT-PCR) with primers specific for EML4-ALK v1. No additional bands were apparent. The 239 bp band was submitted to Sanger sequencing revealing an atypical EML4-ALK fusion gene with a 129 bp insertion in the canonical junction of v1. A 115 bp segment of the insertion corresponded to an intronic region of LTBP1, a gene located in the short arm of chromosome 2, between the ALK and EML4 genes. The in silico translation of this new variant, which will be referred to as v1insLTBP1, showed an in-frame insertion of 43 aminoacids (Figure 1). The patient started crizotinib with good tolerance. The computed tomography scan performed a month later showed a reduction of the primary lesion, disappearance of hilary and reroperitoneal lymphadenopathies, and a reduction of the mediastinal lymph nodes. After 14 months, the patient continues to demonstrate partial response. Written informed consent has been provided by the patient to have the case details and any accompanying images published.\nOUTPUT:" }, { "from": "agent", "value": "Lung adenocarcinoma stage IV" } ]

[ { "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: \"If an incident happens a group, a person is called for debriefing, they ask you questions and look into your eyes and then you go home. And that's the end of the story. (Participant 13: Male. 51 years old. Table 2 presents the themes and subthemes, with verbatim responses on collective interventions the participants suggested across the three sectors. From Table 2, it is clear that the three sectors share common themes on the PTMP they would prefer in their occupations. The data for the first theme centered on a preventative approach. The respondents indicated various PTMP interventions they would prefer on a recuperative level, during the acute phase of the crisis. One sector (policing) indicated that they would prefer an independent service provider. Medical support and evaluations were further mentioned as forms of preferred intervention. On a post-crisis level, the participants in the mining and policing sectors indicated that they value management support, while the participants from the EMS sector highlighted the value of peer and family support. Further suggestions were continuous development and training where employees could be empowered and informed.\nOUTPUT:" }, { "from": "agent", "value": "Psychological Trauma" } ]

[ { "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-year-old girl was diagnosed with fetal magnetic resonance imaging as a mediastinal mass lesion ( Fig. 1a ). She was delivered by cesarean section at 32 weeks' gestation with a birth weight of 1,890 g. EPS was diagnosed with postnatal computed tomography (CT). The CT at 2 years of age showed two anomalous systemic arteries originating from the left gastric artery and supplying the lung mass. All drainage veins in the mass drained to the portal vein ( Fig. 2a - d ). 1b ). She was initially treated by mosapride, which is a gastroprokinetic agent that acts as a selective 5-hydroxytryptamine receptor 4 agonist. At 2 years of age (body weight of 10.7 kg and height of 76.5 cm, both within +- 2.0 standard deviations), the patient underwent one-stage laparoscopic Nissen's fundoplication for treatment of the GER and resection of the EPS in the posterior mediastinum because she sometimes experienced nausea and we considered that the EPS might be associated with this symptom. Three port sites were used ( Fig. 3a ), and a wound edge protector was inserted at the umbilical site to allow use of the scope and grasping forceps. 3c ). We elevated the esophagus to prepare for fundoplication in the usual manner. After dissection of three aberrant vessels, the sequestrated lung was grasped via the esophageal hiatus and removed through the umbilical port site. We used size medium polymer ligating clips (Hem-o-lok; Teleflex, Wayne, Pennsylvania, United States) that were entered through the 5-mm port for aberrant vascular control to avoid burn injury from hemoclips when using energy devices intraoperatively ( Fig. 3d ). The anterior and posterior aspects of the esophageal hiatus were repaired with ETHIBOND sutures, and Nissen's fundoplication was performed in the usual manner ( Fig. 3e ). This procedure was performed with only three port sites ( Fig. 3b ). The pathological diagnosis was EPS. The patient's postoperative course was uneventful, with no recurrence of GER symptoms after 1 year of follow-up.\nOUTPUT:" }, { "from": "agent", "value": "Pulmonary Sequestration, Hiatal Hernia" } ]

[ { "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 old lateral incision with an approach including an osteotomy of the greater trochanter was used. A Zimmer Revitan stem (distal part: diameter 14 mm, length 140 mm; proximal part: length 75 mm, conical, taper 12/14; head Biolox diameter 28 mm). The osteotomy was fixed with cerclage wires intraoperatively. The definite distal part was implanted first and tested with a trail proximal part. Then, the surgeon experienced difficulties with the connection of the definite proximal part of the stem to the definite distal part. Although it fitted, the screw to fix the two parts together could not be tightened. The surgeon even contacted the company during the operation but failed to find an explanation for the problem. As the 2 parts seemed to be fixed well together, he left the situation as it was. The postoperative radiographs (Figure 1) were acceptable, and no explanation for the intraoperative problem was found. The patient did well, and there were no complications. Two and a half years postoperatively, the patient felt a sudden pain while walking. He could only limp and hardly walk. He walked on without consulting a doctor for another 2 months, where after he presented to us. A rerevision was performed using the same approach and through the nonunion of the greater trochanter. Intraoperatively, the proximal part of the stem was found broken on the medial side. The distal part was well fixed, and there seemed to be no need to change this part. Even the threaded part of the distal stem was intact. However, connection of a new proximal part to the distal part failed, as during the first revision. On further inspection, a small ring was suddenly born from the distal part. It was then discovered to be a part of the proximal trial part (Figure 3). Thereafter, connecting the two parts was easy. The nonunion of the trochanter was debrided and fixed with a hooked plate (proximal conical spout Revitan 75 mm, Biolox Delta Ceramic femoral head 28 mm medium, Trofix Trochanter Fixation plate large head 150 mm) (Figure 2). Postoperatively, the patient did well, and 5 years after the second revision, the patient is still without pain, hardly, and back to work.\nOUTPUT:" }, { "from": "agent", "value": "Fracture of a Femoral Revision Stem" } ]

[ { "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 3 is a 68-year-old man with HRF, diagnosed following admission for leg swelling. His hemoglobin was 20.3 g m/dL (hematocrit 0.66) and he admitted to shortness of breath and a cough, with an exercise tolerance of 50 meters. The polycythemia was deemed secondary to smoking (Table 1), and he admitted to lethargy and headache and had a cyanotic appearance. He was commenced on seretide (250) two puffs bid via a spacer, tiotropium 18 mug mane, and salbutamol as required. Arterial gases confirmed HRF (Table 2). Overnight oximetry showed mean SpO2 of 77% on air, but he rejected NIPPV. Once clinically improved by bronchodilators, steroids, and diuretics, his arterial gases still showed HRF with significant hypoxemia. On 1 L/min oxygen over 4 hours, his PaCO2 increased to >;8.84 kPa. His life quality had been poor, and he smoked to increase his state of alertness. He was commenced on modafinil 200 mg in the morning, and by 14 days, he felt better, more alert, and stopped smoking. Oximetry improved (Table 2) along with his arterial gases. His forced vital capacity (FVC) improved on treatment and smoking cessation to 63% predicted. He remained awake by day and slept well at night. He no longer appears cyanosed, has had no further admissions in 21 months, and went on to complete pulmonary rehabilitation. He remains active and stable on modafinil 200 mg mane, without adverse effects.\nOUTPUT:" }, { "from": "agent", "value": "Hypercapnic Respiratory Failure, Cor Pulmonale, COPD" } ]

[ { "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 underwent LT for multifocal HCC, combined with hepatitis C related cirrhosis. According to preoperative CT scan images, a massive lesion with greatest extent over 8 cm was found in the right lobe and 2-3 small lesions were found in segment 2. AFP level was elevated at 278 ng/mL. Histological examination of the explanted liver revealed disseminated HCC with numerous nodules in all segments and widespread vessel infiltration. In the posttransplant period the patient received immunosuppressive therapy with tacrolimus, prednisolone, and mycophenolate mofetil (MMF). Nine months after LT a routine CT scan revealed an extrahepatic, 2 cm lesion adjacent to segment 6 (Figure 1). Ultrasound guided biopsy verified HCC. The case was determined suitable for laparoscopic resection. Pneumoperitoneum was established through an open approach via right pararectal region, supplemented by three trocars: a 12 mm through the scar from previous incision and two 5 mm in the right flank. After complete mobilization of the right lobe, the tumor was found retroperitoneally between the right kidney and adrenal gland. Intraoperative ultrasound was carried out to determine the borders of the tumor. Despite close relation with renal capsule, no signs of infiltration to the kidney were revealed. Division of Gerota's fascia and exposing the upper part of the kidney allowed mobilization of the tumor laterally and cranially, separating it from the renal capsule. No evidence of infiltration to adjacent structures was found and the tumor was removed. No significant bleeding occurred during the surgery and the operation time was 131 min. Histological findings confirmed the presence of two (40 mm and 12 mm) extrahepatic recurrences from HCC. The postoperative course was uneventful. Surveillance for the first 8 months revealed no signs of disease recurrence, but one year after the reresection, metastases in liver, lungs, and adrenal gland were detected. Subsequent therapy with sorafenib was considered as the only possible active treatment.\nOUTPUT:" }, { "from": "agent", "value": "Recurrence from 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: Given the EBV viremia that had worsened over time and a diagnosis of EBV-positive LPD in an otherwise healthy 21-year old, an immune workup was pursued. He had no parental consanguinity. The absolute lymphocyte count was mildly low at 715 cells/uL. The absolute CD19 B-cell count was normal at 130 cells/uL as was the absolute CD16/56 NK-cell count at 227 cells/uL. T-cell subsets were not assessed clinically. He had an absolute CD4 count of 314 cells/uL and absolute CD3 count of 715 cells/uL. His immunoglobulins were low with IgM of 33 mg/dL and total IgG of 492 mg/dL. His IgA was normal at 99.3 mg/dL. IgG subclasses 1-4 were low at 266, 159, 11.8, and 1.9 mg/dL, respectively. HIV antigen and antibodies were negative. Mitogen studies showed significantly decreased proliferative responses to phytohemagglutinin (PHA) for both total CD45+ and CD3+ cells (7.3% and 14.3%, respectively, with normal ranges being >=49.9% and >=58.5%, respectively). He was also found to have two additional heterozygous VUS in the CD79B gene (c.152G > A) and ORAI1 gene (c.141_142ins37). Finally, ZAP-70 flow cytometry showed normal ZAP-70 expression in T cells and NK cells. The patient's treatment was approached similarly to a paradigm for LPDs in the post-organ-transplant setting. He received a risk-stratified approach with rituximab 375 mg/m2 weekly for four weeks followed by a PET/CT scan showing a complete response (Figure 1). He completed 4 additional doses of rituximab 375 mg/m2 consolidation every 3 weeks. In addition, he also received 4 doses of dexamethasone 40 mg daily given the presence of HLH and 4 weeks of a valganciclovir taper. His EBV viremia cleared four months after starting therapy, (Figure 2).\nOUTPUT:" }, { "from": "agent", "value": "ZAP-70-Related Immunodeficiency, Epstein-Barr Virus Lymphoproliferative Disorder, Hemophagocytic Lymphohistiocytosis" } ]

[ { "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 17-year-old man with a chief complaint of right flank pain was referred to our hospital. Abdominal computed tomography (CT) revealed focal calcification at the upper pole of the right kidney (Fig. 1-a). We suspected renal stones in a caliceal diverticulum, and planned further assessment including drip infusion pyelography (DIP). However, because the patient became asymptomatic, he made no further visits to our hospital for 5 years. At the age of 22 years, however, he presented again because of right flank pain. DIP demonstrated focal calcification at the upper pole of the right kidney, and ultrasound (US) and CT scan demonstrated a large right renal mass with calcification invading the hepatic lobe (Figs. 1-b, and 1-c). Selective renal arterial angiography demonstrated a hypovascular tumor in the same area where the mass lesion had been observed by US, DIP, and CT. The patient underwent curative right nephrectomy and partial right hepatic lobectomy under a diagnosis of malignant renal tumor. The upper pole of the extirpated kidney was occupied by the tumor, which adhered tightly to the liver. The mass was completely removed along with the hepatic lobe, without rupture. No other invasion or lymph node metastasis was found. Macroscopic examination showed an encapsulated tumor with calcification that had infiltrated hepatic lobe (Fig. 2). The specimen weighed 280.0 g. The cut surface was solid and homogeneously white-yellow. After surgery, the patient received adjuvant chemotherapy with vincristine-actinomycin D for 60 weeks. He has been well without tumor recurrence for 15 months after surgery.\nOUTPUT:" }, { "from": "agent", "value": "Adult Wilms' 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: A 66-year-old man presented at our emergency department (ED) with lower back pain for three weeks, mictalgia, pollakiuria, night sweating and anorexia. He had no recent travel history. Past medical history included hypertension, chronic obstructive pulmonary disease and rheumatoid arthritis treated by methylprednisolone. On examination, temperature was 37.3 C, blood pressure 107/85 mmHg, heart rate 90 beats per minute, oxygen saturation 96% at room air and respiratory rate 20 breaths per minute. Positive physical examination findings included lower abdominal pain without tenderness nor guarding and bilaterally painful costolumbar angles. Initial laboratory findings are shown in Table 2. Beside the systemic biological inflammatory state, an initial alteration of liver function tests and renal function were observed. Urine analysis as well as blood collection for cultures were done and the patient was empirically started on intravenous cefuroxime for a presumptive urinary tract infection. Blood and urine cultures came back positive for Salmonella species, later identified as Salmonella Enteritidis sensitive to usual antimicrobials except cefuroxime. Stool culture was not performed. Cefuroxime was shifted to ceftriaxone then to oral cotrimoxazole. However, because of persistent fever after 10 days of treatment, a computed tomography (CT) scan was performed and revealed vertebral lesions in Th12-L1, L3 and L5 suggestive of discitis with tomodensitometric stigmata of instability. This was confirmed by magnetic resonance imaging (Fig. 1, Fig. 2, A-B-C). At week 14 post-admission, after optimal infection control (Fig. 2 D-E-F), chirurgical stabilization of the spine was conducted and the patient was advised to wear a SpinoMed corset for one year. Subsequent imaging showed improvement of collections. The microbiologic examination of the paravertebral collection did not show the presence of bacteria. A dual therapy with cotrimoxazole and ciprofloxacin was administered for 15 weeks. The patient underwent five months of rehabilitation prior to discharge. He remained stable and no recurrent disease was observed up to 15 months after rehabilitation.\nOUTPUT:" }, { "from": "agent", "value": "Invasive non-typhoidal Salmonella infection, Metastatic infections" } ]

[ { "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: Review of this case and presentation in this format was in accordance with the guidelines of the Institutional Review Board of Nationwide Children's Hospital (Columbus, Ohio). A 4-year-old, 18.8 kilogram girl with a history of chronic bilateral serous otitis media with effusion presented for bilateral myringotomy with tympanostomy tube insertion. Her past medical history was significant for chronic serous otitis media and Wolff Parkinson-White syndrome. Her home medication regimen included only cetirizine, administered as needed. By parental report, the patient had fasted for more than 8 h prior to the POCUS examination and surgery. Her last per os intake was the evening before at a fast food restaurant. The patient was enrolled in the healthy, fasted, control arm of the trial. Twenty minutes prior to scanning, the patient received oral midazolam and acetaminophen (total volume of 8 mL) for premedication. Ultrasonography was performed in the preoperative care unit using a Sonosite X-Porte (Fujifilm Sonosite Inc, Bothweell, WA) with a mid-frequency (3-8 MHZ) curvilinear probe in the standard abdominal setting. During gastric POCUS, the presence of gastric contents was observed. In the right lateral decubitus position (RLD), the cross-sectional area of the gastric antrum was traced and found to measure 5.9 cm2 [Figure 1]. The pattern of the material in the gastric antrum was heterogeneous suggesting the recent intake of solid food. In the operating room, standard American Society of Anesthesiologists' monitors were placed. Following pre-oxygenation with 100% oxygen, general anesthesia was induced with sevoflurane in nitrous oxide and oxygen. The patient received intranasal fentanyl (25 mug) to provide postoperative analgesia. She tolerated the procedure well and her postoperative course was unremarkable.\nOUTPUT:" }, { "from": "agent", "value": "High risk of aspiration" } ]