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You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient: 65-year-old male with Type 2 diabetes mellitus and peripheral neuropathy
Hospital Course:
The patient presented with a painless ulcer on the third toe. Radiographs indicated an unhealed fracture of the head of the proximal phalanx of the fourth toe. The patient had previously experienced trauma resulting in an insensate foot. Chronic microtrauma likely resulting from the altered biomechanics secondary to previous amputation and profound sensory neuropathy had caused bone remodeling in the neck of the proximal phalanx. A comparison radiograph showed that this was not present five years prior.
Diagnosis:
Chronic bone remodeling in the neck of the proximal phalanx of the fourth toe secondary to profound sensory neuropathy and altered biomechanics.
Outcome:
Patient discharged in stable condition.
Follow-up:
Recommend continued monitoring for future changes to bone structure and ongoing management of peripheral neuropathy and diabetes.
| proximal phalanx of the proximal phalan | {"diabetes": "YES"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Hospital Course:
The 75-year-old male patient was admitted with elevated serum hepatobiliary enzymes and a history of hypertension, type 2 diabetes mellitus, malignant otitis externa, and an operative history of emergent coronary artery bypass grafting. The results of preoperative laboratory testing showed elevated serum hepatobiliary enzymes, including alkaline phosphatase and gamma glutamic transpeptidase. Imaging tests indicated the presence of a Bismuth type 4, T2N0M0 Stage II hilar cholangiocarcinoma with abrupt narrowing of the common hepatic duct and involvement of the right anterior and posterior bile duct bifurcations. Further investigation confirmed the diagnosis of adenocarcinoma.
Treatment:
The patient underwent left trisectionectomy, extrahepatic bile duct resection, and Roux-en-Y choledochojejunostomy 51 days after undergoing percutaneous balloon arterioplasty followed by bare-metal stent placement to prevent postoperative biliary complications due to the suspected benign stricture caused by atherosclerosis in the right posterior hepatic artery (RPHA).
Clinical Course:
The patient had bile leakage postoperatively, which was successfully controlled through percutaneous drainage. However, he was re-hospitalized with multiple pyogenic liver abscesses 4 months after hepatectomy that eventually led to liver failure. Despite intensive multimodal treatment for the pyogenic liver abscesses, the patient could not be saved.
Disposition:
The patient was discharged from the hospital 3 months after surgery but was re-hospitalized due to complications related to liver abscesses. Unfortunately, he passed away due to liver failure 14 months after surgery.
| enocarcinoma with high serum hepatitis.
| {"diabetes": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
This is a discharge summary for a 53-year-old female who presented with diplopia, nausea, and bony tenderness. Physical exam revealed a right cranial nerve VI palsy and her workup revealed multiple myeloma.
Medical History and Hospital Course:
The patient had a history of type 2 diabetes mellitus, hypertension, and hypothyroidism. She presented with increasing diplopia and nausea for six days. The patient also experienced an unintentional weight loss of 10 pounds in the preceding two weeks. Physical exam revealed bony tenderness localized to the ribs as well as a right cranial nerve VI palsy manifesting as impaired right eye abduction. Remainder of the exam was unremarkable. Computed tomography (CT) of the chest/abdomen revealed multiple osteolytic lesions in the axillary skeleton throughout the thoracolumbar vertebral bodies, and pelvic bones; a healing non-displaced fifth anterior lateral rib fracture was present on the right. CT and magnetic resonance imaging (MRI) of the head showed multiple bone lesions, with a well-defined lesion measuring 12 × 15 mm within the right side of the clivus adjacent to Dorello’s canal.
Hemogram with differential was remarkable for white count of 10,700 k/µL (3.7–10.3 k/µL), with absolute neutrophil count of 7.5 k/µL (1.6–6.1 k/µL). Absolute lymphocyte count was within normal limits (2.42 k/µL (1.6–6.1 k/µL)). Blood chemistry was remarkable for: serum calcium of 15.8 mg/dL (8.9–10.2 mg/dL), ionized calcium of 7.7 mg/dL (4.6–5.1 mg/dL), and glucose of 254 mg/dL (90–120 mg/dL). Parathyroid hormone was <10 pg/mL (12–72 pg/mL) and parathyroid hormone related peptide was 1.3 (normal). Urine analysis and urine protein electrophoresis was unremarkable without evidence of Bence-Jones protein. The calculated protein gap between total protein (6.8 g/dL) and serum globulin (2.8 g/dL) was 4.0 g/dL and the albumin/gamma globulin ratio was elevated at 2.4 (0.8–2.0).
Serum protein electrophoresis revealed faint monoclonal immunoglobulin. Serum immune-quantification showed IgG 1150 mg/dL (720–1598 mg/dL), IgA 200 mg/dL (75–400 mg/dL), and IgM 41 (35–225 mg/dL). Kappa light chain was 108.18 mg/L (3.30–19.4 mg/L), lambda light chain 445.32 mg/L (5.71–26.30 mg/L), with a kappa/lambda free light chain ratio of 0.24 (0.26–1.65). Bone marrow biopsy results demonstrated hypercellular bone marrow involved by plasma cell neoplasm (50–60% aberrant lambda restricted plasma cells). Fluorescence in situ hybridization studies found evidence of CCND1/IGH gene fusion and gain of chromosome 1q. Flow cytometry of bone marrow aspirate demonstrated a small population of aberrant lambda restricted plasma cells positive for CD38, CD56, moderate CD45 and Lambda, and negative for CD19.
Treatment:
The patient's hypercalcemia was treated with IV normal saline, calcitonin, and pamidronate. Pain was controlled with acetaminophen and tramadol with oxycodone for breakthrough pain. The patient was evaluated by the hematology-oncology service and received external beam radiation therapy to the clivus, alleviating her cranial nerve VI palsy. Her disease was then managed with cyclophosphamide, bortezomib, and dexamethasone (CyBorD) chemotherapy. With treatment her symptoms resolved.
Follow-up:
Three months into therapy, her repeat laboratory testing demonstrated good response to treatment. The lambda light chain had decreased to 13.1 mg/L (5.71–26.30 mg/L), with a normal kappa/lambda free light chain ratio of 1.0 (0.26–1.65). Furthermore, a repeat bone marrow biopsy was obtained, which showed no morphologic evidence of multiple myeloma.
| ography revealed multiple myeloma and right ophthalmic | {"cancer": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Hospital Course:
The patient, a 42-year-old male, was admitted to the respiratory service for management of chronic upper airway papillomatosis. The disease extended to involve his upper trachea, resulting in marked symptoms such as constant shortness of breath, cough, wheeze, hoarse voice, and reduced exercise tolerance. The patient had a current 22 pack-year smoking history, with no other comorbid medical conditions. The patient had a history of 166 exacerbations requiring intervention for regrowth of polyps and had previously been treated with numerous multiple laser ablation procedures via micro laryngoscopy and flexible bronchoscopy. Fibre-optic bronchoscopy was performed to remove the papillomas via pulsed argon plasma coagulation (APC), followed by an injection of intralesional cidofovir via a Wary Transbronchial histology needle. The patient has had this regimen done twice before, and on follow-up procedure at 18 months, only 20% of his trachea was affected. At the next follow-up period, a 1.9 mm cryoprobe of effect 2 was used to remove the papillomas, followed by an intralesional cidofovir injection. At this follow up, <20% of his trachea was found affected. Previous exacerbations were occurring with a frequency of 4×/12 months (2013), 7×/12 months (2014) and 5×/12 months (2015).
Summary:
The patient had chronic upper airway papillomatosis which extended to involve his upper trachea, resulting in marked symptoms. The patient was successfully managed with fibre-optic bronchoscopy, followed by an injection of intralesional cidofovir via a Wary Transbronchial histology needle. On follow-up, the procedure was repeated, and the patient's symptoms improved significantly. Previous exacerbations were occurring frequently, but this regimen resulted in a decrease in the frequency and severity of exacerbations.
| tomography. The patient had a history of multiple lung | {"cancer": "NO"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [REDACTED]
Medical Record Number: [REDACTED]
Admission Date: August 2016
Discharge Date: December 2016
Admitted with:
Asymptomatic gross hematuria, renal hypofunction, CKD, AFL requiring warfarinization, and type 2 diabetes.
Hospital Course:
The patient underwent a RoboSurgeon gasless single-port retroperitoneoscopic right RNU with isthmusectomy and was diagnosed with high-grade (grade 3) invasive UC with parapelvic fat microinvasion (pT3). The patient did not undergo any adjuvant therapies following surgery.
Discharge Diagnosis:
High-grade (grade 3) invasive UC with parapelvic fat microinvasion (pT3).
Treatment:
The patient underwent RoboSurgeon gasless single-port retroperitoneoscopic right RNU with isthmusectomy.
Follow-up:
The patient is free of the disease 19 months after RNU and his serum creatinine level is 1.92 mg/dL with eGFR of 27.0 mL/min/1.73m2.
Summary:
The patient was admitted to the hospital in August 2016 with asymptomatic gross hematuria, renal hypofunction, CKD, AFL requiring warfarinization, and type 2 diabetes. After thorough evaluation, the patient underwent a RoboSurgeon gasless single-port retroperitoneoscopic right RNU with isthmusectomy in December 2016. The patient was diagnosed with high-grade (grade 3) invasive UC with parapelvic fat microinvasion (pT3) following surgery. The patient did not select any adjuvant therapies following surgery. The patient is free of the disease 19 months after RNU and his serum creatinine level is 1.92 mg/dL with eGFR of 27.0 mL/min/1.73m2.
| As a result of this complication, the patient was left | {"diabetes": "YES"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [redacted]
Record Number: [redacted]
DOB: [redacted]
Date of Discharge: [redacted]
Significant Findings/History of Present Illness:
The patient is a 32-year-old male who presented to the emergency department with the complaint of retrosternal chest pain radiating to the left shoulder, shortness of breath, and sweating. He had no history of any cardiovascular risk factors such as diabetes or hypertension. On physical examination, the patient was noted to have cystic acne. Further investigations revealed that the patient had a self-reported diagnosis of hypothyroidism for which he was administering Armour Thyroid.
Hospital Course:
An electrocardiogram revealed ST-segment elevations in leads aVL, I, and v1-v6 and ST segment depressions in leads II, III, and aVF, suggestive of an acute ST elevation myocardial infarction (STEMI). Initial lab work reported high levels of cardiac troponin. Transthoracic echocardiography (TTE) displayed increase in left ventricular (LV) wall thickness, reduced ejection fraction (EF) of 40%, grade 1 diastolic dysfunction, and hypokinetic anterior and anteroseptal walls in the distribution of the left anterior descending (LAD) coronary artery. Emergent left heart catheterization was performed, and a coronary angiogram revealed a complete occlusion of the LAD at the ostium. Manual thrombectomy of the LAD was performed, and a drug-eluting stent was positioned, leading to the return of TIMI-III flow. The patient was started on dual antiplatelet therapy with aspirin and clopidogrel, in addition to heparin and eptifibatide infusions.
Medical Management:
Following the patient's admission, a focused investigation revealed that the patient participated in recreational bodybuilding and self-administered exogenous testosterone therapy and used Armour Thyroid as a weight loss supplement. The patient's testosterone levels were elevated, and free triiodothyronine was high with a suppressed total thyroxine, confirming Armour Thyroid administration.
Discharge Medications:
The patient was discharged on dual antiplatelet therapy with aspirin and clopidogrel.
Follow-up:
The patient was instructed to follow up with his primary care physician and/or endocrinologist for further evaluation and management of his hypothyroidism.
Instructions:
The patient was advised to follow a heart-healthy diet, maintain a healthy lifestyle, and attend follow-up appointments with his healthcare provider.
Signed,
[redacted]
MD
|
Early diagnosis of hypothyroidism was by | {"diabetes": "NO"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Information:
Name: [Redacted], Age: 5, Sex: Male, Admission Date: [Redacted], Discharge Date: [Redacted]
Chief Complaint and Hospital Course:
The patient was admitted to the hospital with language articulation disorders, uncoordinated movements, and repeated episodes of seizures that occurred frequently. The patient's stutter had no obvious causes and had existed for one and a half years. The patient had gradually developed unclear enunciation, clumsy speech, and slow responses over time. Within six months prior to admission, he began to have uncoordinated movements, such as ataxia and instable gait. Three episodes of generalized tonic-clonic seizures had occurred in the week just preceding the clinic visit, every episode lasting for about one minute and occurring about once every two days. The patient underwent various tests, including blood tests to check for lactic acid, homocysteine, ammonia, ceruloplasmin, and liver and kidney function, and cerebrospinal fluid and blood tests to analyze autoimmune encephalitis antibodies and genetic metabolic diseases. The tests did not reveal any significant abnormalities, and the EEG showed multiple spikes and slow-wave discharges bilaterally. Brain MRI scans showed high hyperintensities adjacent to the bilateral posterior horns of the lateral ventricles on T2-weighted images and broadened cerebellar fissures. The patient was diagnosed with epilepsy and treated with oral sodium valproate (VPA) at 15 mg/kg per day, which was subsequently increased to approximately 25 mg/kg per day in two weeks. VPA administration was maintained at a varied blood concentration range of 56–78 μg/mL over a period of six months. At the 6-month follow-up, the episodes had decreased from once every two days to about once a month, articulation disorders and uncoordinated movements persisted, and a visual test was performed, which showed no obvious abnormalities.
Medical History and Physical Examination:
The patient was a 5-year-old Chinese male who achieved appropriate developmental milestones before the age of 3.5 years and was born at full-term by vaginal delivery, without any complications. His parents had no known consanguinity, and both they and an older sister were healthy. On physical examination, the length, weight, and head circumference were normal for age, and the patient was conscious and showed normal muscle strength and muscle tone. Patellar reflex and Achilles tendon reflex were normal, and Babinski signs were negative. He was inarticulate and responded to questions slowly. He could not complete the hand-alternating movement test, heel–knee–tibia test, or finger-nose test due to poor cooperation with the instructions. The intelligence quotient value, measured by combined Raven's test, was at a medium level.
Diagnosis:
The patient was diagnosed with epilepsy due to the history of seizures and EEG results, as well as LINCL due to the genetic analysis showing a homozygous missense point mutation c.892G > A(p.Glu298Lys) in exon 7 in CLN6. The mutation was not detected in 259 control subjects. PolyPhen-2, SIFT, and MutationTaster analysis suggested that the mutation would negatively affect protein function.
Plan and Recommendations:
The patient was treated with oral sodium valproate (VPA) at a median level to reduce the frequency of seizures, which was considered successful over the course of six months. Articulation disorders and uncoordinated movements persisted, and no significant changes were observed in visual tests. The patient was discharged and recommended to maintain follow-up visits with a neurologist and geneticist to further monitor progression of LINCL.
| before the patient was admitted. The patients were referred to | {"cancer": "NO"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [REDACTED]
Age: 68 years
Gender: male
Date of Admission: [REDACTED]
Date of Discharge: [REDACTED]
Admission Diagnosis:
Stage IV squamous NSCLC
Hospital Course:
The patient was admitted with a diagnosis of stage IV squamous NSCLC. He underwent definitive radiation therapy to the right upper lung lobe with chemotherapy consisting of carboplatin and paclitaxel combination for 6 weeks, with a positive response to therapy. However, after 9 months, his lung nodules were noted to be progressively enlarging, and two additional nodules were identified, concerning for new metastases. He was started on nivolumab, a PD-1 inhibitor, at a dose of 3 mg/kg infused every 2 weeks.
During the course of treatment with nivolumab, after six cycles, he developed a widespread pruritic eruption involving the chest, back, extremities, and penis. Upon examination, he was found to have numerous pink to pink-brown thin papules and plaques on the chest, abdomen, back, arms, legs, and penile shaft, some of which had an erythematous base. He also developed a shallow ulceration of the left lateral tongue. A biopsy of a characteristic lesion on the left upper arm was performed, which showed a lichenoid mucocutaneous eruption due to nivolumab.
Treatment was initiated with triamcinolone 0.1% ointment to the body, clobetasol 0.05% ointment to the penis, and clobetasol 0.05% gel to the tongue twice daily. Oral prednisone taper starting at 80 mg daily for 5 weeks was also started and nivolumab treatment was held for 1 week. After the completion of the oral steroid taper, his rash had significantly improved, and the penile erosions and oral ulceration had completely resolved despite resuming nivolumab therapy. However, 6 days after discontinuing prednisone, the rash recurred on the chest and back, requiring a second prednisone taper.
The patient received narrowband UVB phototherapy three times per week as an adjunct therapy. A maintenance dose of 5 mg daily prednisone was used for control of rash and pruritus. After ~70 NBUVB treatments, a slow prednisone taper with oral hydroxyzine was initiated. The patient elected to stop NBUVB treatments and has remained on 4 mg daily prednisone to date.
Discharge Diagnosis:
Lichenoid mucocutaneous eruption due to nivolumab
Discharge Plan:
The patient was discharged with a recommendation to continue the use of oral prednisone at 4 mg daily and cessation of narrowband UVB phototherapy. The patient was advised to follow up with his oncologist for further management of stage IV squamous NSCLC.
| PCR, a tricyclic combination with a | {"cancer": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
DISCHARGE SUMMARY
Patient Name: [Redacted]
Date of Admission: [Redacted]
Date of Discharge: [Redacted]
Hospital Course:
The patient was admitted to our hospital for jaundice and pruritus. Laboratory tests showed elevated blood markers, with a level of γ-glutamyl transpeptidase (γ-GTP) and total bilirubin. Additionally, the patient's serum carcinoembryonic antigen level was elevated. Computed tomography (CT) showed wall thickening in the second portion of the duodenum, dilation of the common bile duct, and swelling of the para-aortic lymph node. Upper endoscopy suggested a duodenal tumor. For obstructive jaundice, an endoscopic retrograde bile drainage tube was placed at the common bile duct. Further imaging with 18-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT demonstrated abnormal uptake in the tumor in the duodenum.
The patient underwent chemotherapy with XELOX for six cycles to address the effectiveness of the treatment, which was followed by follow-up imaging with FDG-PET/CT or CT every 2 months. The imaging confirmed the disappearance of the metastatic liver tumor and nodal metastasis. The patient underwent pancreaticoduodenectomy with lymph node dissection and partial resection of the liver for curative intent, which showed that the lesions in the duodenum, liver, and 43 lymph nodes were not visible in the surgical specimen. Postoperatively, the histological effect was determined to be grade 3, and the patient was diagnosed as having achieved pathological complete response (pCR).
The patient suffered from grade A postoperative pancreatic fistula but was discharged from our hospital on postoperative day 32 without fatal complications. The patient received capecitabine orally for 6 months and has been disease-free for 14 months after the surgery with no evidence of metastatic lesion.
Diagnosis:
- Jaundice and Pruritus
- Duodenal Tumor
- Obstructive Jaundice
Treatment:
- Six Cycles of XELOX Chemotherapy
- Pancreaticoduodenectomy with Lymph Node Dissection and Partial Resection of the Liver
Follow-Up:
- Follow-up Imaging with FDG-PET/CT or CT Every 2 Months
Summary:
The patient was admitted to our hospital for jaundice and pruritus caused by a duodenal tumor. The patient underwent chemotherapy with XELOX for six cycles, which was followed by imaging that confirmed elimination of the liver and lymph node metastases. The patient then underwent pancreaticoduodenectomy with lymph node dissection and partial resection of the liver for curative intent. The patient recovered from surgery and achieved pathological complete response. The patient received capecitabine orally for 6 months and has been disease-free for 14 months after the surgery with no evidence of metastatic lesion.
| revealed no signs of metastasis.
The clinical phase | {"cancer": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [Redacted]
Age: 5 years
Gender: Female
Admission Date: [Redacted]
Discharge Date: [Redacted]
Hospital Course:
The patient was admitted for evaluation and management of recurrent episodes of cellulitis in the left scapular region. Physical examination revealed a cellulitis area approximately 7 × 5 cm with a small opening and associated purulent drainage in the left scapular region. An ultrasound and MRI were performed to further assess the lesion, and surgical excision was recommended. The patient underwent a surgical excision under general anesthesia which was successful, and the histopathology revealed a benign cyst lined with ciliated columnar epithelium.
Discharge Diagnosis:
The discharge diagnosis was that of a benign bronchogenic cyst.
Discharge Medications:
None.
Follow-Up:
A 1-year postoperative follow-up was scheduled to monitor for recovery and the absence of any symptoms or signs of recurrence of the cyst.
| At 6 months the lesion was healed and the hist | {"cancer": "NO"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
DISCHARGE SUMMARY:
Patient Name: [Name]
Gender: Male
Date of Birth: [Date of Birth]
Date of Admission: [Date of Admission]
Date of Discharge: [Date of Discharge]
Admitting Diagnosis: Multifocal Motor Neuropathy with Conduction Blocks
Medical History: No previous long-term medical conditions (diabetes, hypertension, or cancer) or surgical procedures reported.
Hospital Course:
The patient, a 20-year-old Sri Lankan male, was admitted to our unit with a complaint of weakness in both hands for one month. He had previously been treated for dengue fever at a local hospital and had made a full recovery. However, five days after discharge, he began to experience weakness in his right hand, which subsequently progressed over time. He presented with an inability to write or button his shirt due to the weakness of his hands. The patient also reported mild weakness in both feet that did not significantly interfere with walking. He did not present with any accompanying numbness, parasthesia or pain.
On general examination, the patient had an average build with no pallor, lymphadenopathy, or signs of malnutrition. The patient showcased some small muscle wasting of bilateral hands and feet. The patient had diminished power asymmetrically graded as 3 out of 5 in the right hand and 4 out of 5 in the left hand. Additionally, all fine finger movements were affected along with some degree of weakness in wrist extension. The patient showcased diminished power grade 4 in distal lower limbs (feet). Bilateral foot dorsiflexion was weak, while ankle jerks were elicited with reinforcement. Knee jerks were elicited without reinforcement and there was no objective sensory impairment of touch, pain, temperature, vibration, and joint position sensations in both upper and lower limbs. No cerebellar signs were demonstrated and his gait showed a minimal degree of high-stepping due to weak dorsiflexion.
Blood tests revealed white blood cell count: 8.5 × 109/L, platelet count: 274 × 109/L, hemoglobin 12 g/dl with normal red cell indices. The blood picture showed normochromic normocytic cells with some reactive lymphocytes suggestive of a recent viral infection. CSF analysis did not show any increase in proteins or cells and the values were within the normal limits. Anti-GM1 IgM antibody test was not carried out due to the high cost of the test and the patient’s unstable financial background.
Based on the findings, the patient was diagnosed with multifocal motor neuropathy with conduction blocks. The patient was referred to the neurologist and started on intravenous immunoglobulin (IVIg) therapy (2 g/kg/day) which was given for 5 days. He showed improvement in his neurological weakness with the treatment and outpatient physiotherapy was arranged.
Discharge Condition:
The patient was discharged in a stable condition and was advised to follow up with his neurologist for further treatment.
Patient Education:
The patient was advised to abstain from alcohol and smoking, continue a healthy lifestyle, and comply with his treatment plan.
Follow-up:
The patient was advised to follow up with his Neurologist for the continuation of treatment.
Disposition:
The patient has been discharged in a stable condition.
| referral to hospital, and he had been sent to a | {"diabetes": "NO"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Hospital Course:
A 56-year-old Sri Lankan female with a history of diabetes presented with fever, chills, and rigors for 2 weeks. The patient was admitted for treatment and received IV ceftazidime with suspicion of melioidosis. Blood culture was positive for Burkholderia cepacia and the melioidosis antibody titer was 1:640. During her 2nd week of hospital stay, the patient developed right sacroiliitis with multiple intramuscular abscesses. The abscess was drained and cultured positive for Burkholderia pseudomallei. The patient's Melioidosis antibody titers increased to 1/10240. IV ceftazidime was replaced with IV meropenem and oral co-trimoxazole. The patient's IV therapy was extended for an additional 14 days. She developed pancytopenia, and the treatment was switched to oral doxycycline. The patient responded well to therapy and was discharged with instructions to follow up monthly for 6 months.
Hospital Diagnosis and Treatment:
The patient was diagnosed with melioidosis based on the presence of fever, multiple abscesses, and sacroiliitis. The treatment consisted of IV therapy with ceftazidime initially and then changed to meropenem and oral co-trimoxazole. The intensive phase of treatment was extended for an additional 14 days. Due to pancytopenia, the patient was switched to oral doxycycline. She responded well to therapy and was discharged on eradication phase with instructions for monthly follow-up.
Hospital Course Summary:
A 56-year-old Sri Lankan female with diabetes was admitted with fever, chills, and rigors for 2 weeks. A diagnosis of melioidosis was made based on blood culture and elevated melioidosis antibody titers. The patient developed right sacroiliitis and multiple intramuscular abscesses, which were drained and cultured positive for Burkholderia pseudomallei. The treatment consisted of IV therapy with ceftazidime initially and then changed to meropenem and oral co-trimoxazole. The intensive phase of treatment was extended for an additional 14 days due to deep abscesses. The patient was switched to oral doxycycline due to pancytopenia and responded well to treatment. She was discharged on eradication phase with instructions for monthly follow-up. MRI scan showed a marked reduction in infection, oedema, and sacroiliitis.
| . Within 2 weeks of her discharge, the patient received | {"diabetes": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Hospital Course:
The patient, a 73-year-old female, was admitted to our hospital with the complaint of coughing up blood. Her medical history included hypertension, high cholesterol, and atrioventricular block with an implanted dual chamber pacemaker. On examination in the emergency room, the patient's vital signs were stable, and laboratory test results were within normal limits. Imaging studies revealed a collapsed right lower lobe and a diaphragmatic hernia. Bronchoscopic examination demonstrated the presence of blood clots in the right inferior lobar bronchus. Two arterial embolizations were performed with the insertion of an endobronchial Watanabe spigot but failed to stop the bleeding, leading to a thoracoscopic right lower lobectomy. The surgical specimen was diagnosed with pulmonary tumorlets on a hypoplastic right lower lobe. The postoperative course was uneventful, and the patient was eventually discharged.
Discharge Summary:
The patient was admitted to our hospital with the complaint of coughing up blood. The patient's medical history included hypertension, high cholesterol, and atrioventricular block with an implanted dual chamber pacemaker. Following imaging studies, bronchoscopic examination, and subsequent arterial embolizations, a thoracoscopic right lower lobectomy was performed. The surgical specimen was diagnosed with pulmonary tumorlets on a hypoplastic right lower lobe. The postoperative course was uneventful, and the patient was eventually discharged.
| Anterior cervical vertebrae were observed, but none | {"cancer": "NO"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Admitting Diagnoses:
- Chest pain on exertion
- Stable exertional angina pectoris
Hospital Course:
A 72-year-old man with multiple coronary risk factors, including hypertension, dyslipidemia, and diabetes mellitus, was admitted to our hospital with chest pain on exertion. Transthoracic echocardiography revealed mild left ventricular hypertrophy and no segmental wall motion abnormality. Coronary computed tomography angiography revealed significant stenosis in the distal left main trunk (LMT), ostial left anterior descending artery (LAD), and ostial left circumflex artery (LCX). The patient refused a surgical approach and underwent percutaneous coronary intervention (PCI) using a simultaneous jailed balloon and jailed Corsair technique for the left main trifurcation lesion. The post-procedure course was uneventful, and the patient's angina symptoms disappeared. Follow-up coronary angiography was performed two weeks after the procedure, which revealed no signs of restenosis in both the main vessel and side branches.
Hospital Course Summary:
- Admitted with chest pain on exertion
- Transthoracic echocardiography: mild left ventricular hypertrophy and no segmental wall motion abnormality
- Coronary computed tomography angiography: significant stenosis in the distal left main trunk (LMT), ostial left anterior descending artery (LAD), and ostial left circumflex artery (LCX)
- Underwent percutaneous coronary intervention (PCI) using a simultaneous jailed balloon and jailed Corsair technique for the left main trifurcation lesion
- Follow-up coronary angiography two weeks after the procedure revealed no signs of restenosis in both the main vessel and side branches.
| cutaneous angiography.
On the night | {"diabetes": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [REDACTED]
Medical Record Number: [REDACTED]
Date of Admission: [REDACTED]
Date of Discharge: [REDACTED]
Chief Complaint:
Slurred speech, unsteadiness and fatigue.
Diagnosis:
Haemorrhagic transformation of embolic ischaemic infarcts secondary to left atrial myxoma.
Hospital Course:
The patient presented with slurred speech, unsteadiness, and fatigue. She was found to have multiple supra- and infratentorial lesions with haemosiderin staining. The initial differential diagnoses were haemorrhagic metastases (recurrent melanoma) or an atypical presentation of amyloid angiopathy. CT chest identified a mass in the left atrium, which was later confirmed to be an atrial myxoma. Histological assessment was non-contributory towards a diagnosis. The excised material consisted of haemorrhage and some distortion of the underlying vascular architecture, without evidence of vasculitis or amyloid angiopathy. The patient underwent left atrial myxoma excision and therapeutic heparin cover on a cardiopulmonary bypass machine. The patient had an uncomplicated post-operative course and a normal post-operative echocardiogram. She was discharged home with a follow-up MRI and neurosurgical review booked at 6 weeks.
Medical Management:
The patient was prescribed dexamethasone and referred to Interventional radiology for formal cerebral angiography assessment to evaluate for cerebral vasculitis.
Follow-up:
Follow-up MRI and neurosurgical review booked at 6 weeks.
Condition at Discharge:
Stable.
Discharge Medications:
None.
Instructions:
None.
Follow-up Appointments:
Follow-up MRI and neurosurgical review booked at 6 weeks.
Follow-up Investigations:
Follow-up MRI and neurosurgical review booked at 6 weeks.
Signed,
[Physician Name] MD.
| an atypical metastasis.
Patient Ad | {"cancer": "NO"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Hospital Course:
The patient, a 61-year-old female with a history of diabetes, hypertension, and dyslipidemia, was admitted to the hospital for recurrent chest pain and fatigue. She was evaluated for worsening anemia, and her electrocardiogram (ECG) showed an RSR pattern in V1 and V2 leads. A stress myocardial perfusion imaging (MPI) was negative for cardiac ischemia. A transthoracic echocardiogram revealed an atrial mass attached to the anterior wall of the left atrium, and further characterization by transesophageal echocardiogram (TEE) revealed a solid, partly mobile mass attached to the atrial septum and extending to the anterior mitral valve leaflet.
Diagnosis:
The patient underwent a minimal incision valve surgery for resection of the mass, which was presumed to be myxoma based on its location. Intraoperatively, it was noted that the mass originated from the fossa ovalis region of the interatrial septum and infiltrated the atrial wall down onto the entire anterior leaflet of the mitral valve. The mass along with a portion of the interatrial septum and the mitral valve was resected. The mitral valve was replaced using a bioprosthetic valve.
Follow-up and Concerns:
Two weeks after discharge, the patient returned to the emergency room with cough, diaphoresis, and palpitations. She was found to be in acute heart failure and was diagnosed with severe mitral regurgitation with paravalvular leak. The histopathologic examination of the atrial mass showed a high-grade sarcoma consistent with dedifferentiated liposarcoma. Blood cultures were obtained with suspicion of postsurgical infective endocarditis causing valvular dehiscence, but cultures did not grow any bacteria. Due to high suspicion of metastatic disease, MVR and cardiac transplant were not offered until further evaluation for metastasis. Unfortunately, due to rapid clinical decline with a new diagnosis of high-grade cardiac tumor with possible metastases, the patient opted for hospice care.
Summary:
The patient was admitted for chest pain and fatigue, and an atrial mass was discovered and eventually resected during valve surgery. Despite the aftermath of a successful operation, the patient returned to the hospital two weeks later with complications that led to a diagnosis of dedifferentiated liposarcoma. Due to rapid clinical decline and the possibility of metastasis, the patient opted for hospice care.
| the lateral ventricle. There was a transient and | {"diabetes": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Admission Date: [Date]
Discharge Date: [Date]
Patient: [Name], Age: 63, Gender: Female
Admission Diagnosis:
• cT3N2M0 stage IIIb rectal cancer
• Bloody stool
Hospital Course:
• The patient was started on mFOLFOX6 plus cetuximab as NAT.
• At the completion of five courses, the patient presented with complaints of no defecation for several days.
• Emergency colonoscopy revealed a stenosis in the lower rectum due to the primary tumor located 80 mm from the anal verge.
• CT showed a cPR of the tumor to the NAT.
• A SEMS (Niti-S Colonic Stent) was placed to alleviate the stenosis.
• NAT was restarted, and six courses were completed.
• The patient underwent laparoscopic low anterior resection with diverting ileostomy.
• Upon histopathological examination, the chemotherapeutic effect was grade 2.
• Adjuvant chemotherapy was started after surgery with mFOLFOX6.
• The patient had an uneventful postoperative course and was discharged 24 days after surgery.
• At the time of this writing, the patient had been alive without recurrence for 11 months.
Summary:
The patient, a 63-year-old woman, was admitted with complaints of bloody stool. Colonoscopy revealed a circumferential tumor in the lower rectum. The tumor was diagnosed as cT3N2M0 stage IIIb rectal cancer, and the patient was started on mFOLFOX6 plus cetuximab as NAT. Upon completion of five courses, the patient presented with complaints of no defecation due to stenosis caused by the tumor. The tumor exhibited a cPR to the NAT, and a SEMS was placed to alleviate the stenosis. After completing six courses of NAT, the patient underwent laparoscopic low anterior resection with diverting ileostomy. Histopathology showed a grade 2 chemotherapeutic effect. Adjuvant chemotherapy was started after surgery with mFOLFOX6. The patient was discharged 24 days after surgery and had been alive without recurrence for 11 months at the time of this writing.
| The patient underwent a biopsy in the early stages of | {"cancer": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Hospital Course:
The patient was a 68-year-old male with metastatic CRPC who presented with severe lethargy one month after treatment with abiraterone. The patient received docetaxel and prednisone initially, but the treatment was interrupted due to severe fatigue. Abiraterone and prednisone were initiated thereafter. The patient had a history of chronic heart failure, and received furosemide. Laboratory and endocrinology findings revealed decreased levels of potassium and cortisol and elevated levels of ACTH. The patient was diagnosed with hypokalemia associated with abiraterone therapy.
Hospital Course Summary:
Admission History and Physical:
The patient, a 68-year-old male with metastatic CRPC, was admitted to the hospital with a chief complaint of severe lethargy. The patient had a history of chronic heart failure and had been treated with docetaxel and prednisone followed by abiraterone and prednisone. Laboratory and endocrinology findings revealed decreased levels of potassium and cortisol and elevated levels of ACTH. The patient was diagnosed with hypokalemia associated with abiraterone therapy.
Hospital Course:
The patient was treated with potassium supplementation and an increase in prednisone. After seven days of potassium supplementation therapy, the levels of plasma ACTH and serum potassium were normalized; however, cortisol was still at reference value or lower. At 14 days, plasma cortisol was also normalized. The patient was discharged on oral prednisone, 20 mg daily.
Hospital Course Summary:
Treatment and Consultation:
The patient was treated with potassium supplementation and an increase in prednisone. The levels of plasma ACTH and serum potassium were normalized after seven days of therapy. At 14 days, plasma cortisol was also normalized. The patient was discharged on oral prednisone, 20 mg daily.
Discharge Medications:
Oral prednisone, 20 mg daily.
Follow-up:
The patient is advised to follow up with their primary care physician for ongoing management of their chronic heart failure.
| CRPC, was diagnosed with a metastatic CRPC | {"cancer": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
DISCHARGE SUMMARY
Patient Name: Unnamed Female
Age: 60 years old
Admission Date: February 2013
Discharge Date: N/A
Admitting Diagnosis: Sjogren's Syndrome
Summary of Hospital Course:
The patient was admitted to the hospital in February 2013 with complaints of weakness, weight loss, dryness of the eyes, and enlargement of lymph nodes. Her medical history was consistent with a 20-year course of Sjogren's Syndrome. Laboratory tests showed elevated levels of serum lactate dehydrogenase and reduced levels of C4 complement. The patient's diagnosis of Sjogren's Syndrome was confirmed based on the clinical, serological, and pathological features.
The patient was found to have monoclonal immunoglobulin M kappa with properties of cryoglobulin. Urine protein electrophoresis and immunofixation assays revealed the presence of monoclonal free kappa type light chains. Full staging computerized tomography (CT) scan showed multiple enlarged lymph nodes and mild splenomegaly. Histologic examination of the right axillary lymph node revealed a completely effaced architecture. The patient was diagnosed with concomitant RDD and plasmacytic marginal zone lymphoma.
After undergoing six cycles of MDB, a partial response was achieved, and a follow-up analysis performed did not detect any presence of monoclonal IgM kappa. One month after chemotherapy, a fast-growing firm mass developed in the left mandibular fossa spreading anteriorly to the parotid area. Peripheral paralysis of the facial nerve also occurred. Histological examination of this mass revealed a necrotic tissue interspersed with foci of small lymphoid cells with scarce large tumor cells. Large tumor cells were also present as perivascular and perineural clusters. The resulting condition was considered a transformation of NMZL into an EBV-positive DLBCL, NOS.
R-CHOP immunochemotherapy was prescribed to the patient, but unfortunately, a few days following the completion of the first cycle, the patient suddenly lost consciousness and died. No postmortem study was performed.
Discharge Condition: Deceased.
Discharge Medications: N/A.
Follow-Up: N/A.
|
He was treated with a variety of drugs, which | {"cancer": "YES"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary
Patient Information:
The patient is a 44-year-old Asian woman with t2d and schizophrenia who attempted suicide by ingesting multiple metformin tablets and alcohol.
Hospital Course:
The patient was transferred to the emergency department with disturbed consciousness and diagnosed with metformin-associated lactic acidosis (MALA) worsened by alcohol. She received continuous intravenous noradrenaline to treat her shock and was administered with midazolam for sedation. She underwent tracheal intubation and decontamination through gastric lavage, followed by administration of activated charcoal and magnesium citrate. To treat her metabolic acidosis and remove lactic acid and metformin, the patient underwent high flow high volume intermittent hemodiafiltration (HFHV-iHDF) for 6 hours using a polysulfone high-performance membrane (APS-15E, Asahi Kasei Medical, Tokyo, Japan) on first day of admission. Her serum metformin concentration decreased from 1138 ng/mL to 136 ng/mL after HFFV-iHDF. The patient received HFHV-iHDF again on the second day of admission to improve her consciousness. On the 10th day of her hospital stay, the patient was able to be extubated after healing from aspiration pneumonia. She was moved to the psychiatry ward on the 12th of admission and was discharged one month later.
Follow-up Care:
Upon discharge from the hospital, the patient discontinued metformin administration. It should be noted that the patient recommitted herself into the psychiatry ward two months after her discharge because of an overdose of sleeping pills. The patient remained in the hospital under careful metabolic, mental and physical health management for more than 2 months.
Discharge Medications:
The patient is not scheduled to take any medications upon discharge.
Discharge Instructions:
The patient is advised to abide by strict mental, metabolic and physical health management. She is advised to attend regular follow-up appointments to prevent future depressive episodes and suicide attempts. The patient should abstain from alcohol consumption to prevent further triggering of metabolic disarray.
Follow-up Appointment(s):
The patient is advised to schedule and attend regular follow-up appointments with the psychiatry and endocrinology departments to address her schizophrenia and t2d.
| intraperitoneal intubation, and was int | {"diabetes": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [Patient Name]
Gender: Female
Age: 54 years
Medical Record Number: [Medical Record Number]
Hospital Course:
The patient presented to her family physician with right side flank pain. Laboratory testing showed elevated liver function tests including alkaline phosphatase and aspartate aminotransferase. An abdominal ultrasound revealed a 1.5 cm hypodense lesion in the left lobe of the liver, and a CT scan showed a 1.8 × 1.4 cm mass located in the left lateral section of the liver. Magnetic resonance imaging (MRI) of the liver revealed an indeterminate lesion. No other abnormalities were detected by axial imaging. The patient underwent a CT-guided biopsy which showed nodular collections of polyclonal T and B lymphocytes and plasma cells. Based on her clinical presentation and imaging, she was seen at the hepatobiliary high-risk clinic and a laparoscopic left lateral sectionectomy of the liver was recommended. Postoperatively, the patient had an uneventful hospital stay and was discharged home on postoperative day 3.
Diagnosis:
Final pathology revealed nodular reactive lymphoid follicular hyperplasia (RLH) and evidence of primary biliary cholangitis (PBC), which was not diagnosed until final pathology was obtained.
Treatment:
The patient underwent a laparoscopic left lateral sectionectomy of the liver.
Follow-Up:
The patient will be followed up with the hepatobiliary high-risk clinic for further management of PBC.
Instructions:
The patient should follow up with the hepatobiliary high-risk clinic for further management of PBC.
| scan with a CT laser on her left side side and | {"cancer": "NO"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
[Header]
Discharge Summary
[Patient information]
Patient Name: [Patient Name]
Medical Record Number: [MRN]
Date of Admission: [Admit Date]
Date of Discharge: [Discharge Date]
Length of Stay: [LOS]
[Hospital course summary]
The patient was admitted with a diagnosis of squamous cell carcinoma of the left maxillary gingiva and underwent an operation requiring partial maxillectomy. Two years post-operation, three dental implants were placed, two in the anterior maxillary region, and one into the right side zygomatic bone. After six months, second stage surgery was performed, though one dental implant in the anterior maxillary region required removal because of failure to integrate with the bone. Afterwards, there was stability in implants and prosthesis functional loading for 1 year and 6 months.
[Condition at discharge]
At the time of discharge, the patient showed stability in dental implants, and the prosthesis was functioning well without any sign of pain or discomfort.
[Treatment and procedures]
The patient underwent partial maxillectomy and three dental implants (two in the anterior maxillary region and one in the right zygomatic bone). Second stage surgery was performed, and one dental implant in the anterior maxillary region was removed due to loss of osseointegration.
[Follow-up appointments]
Outpatient follow-up is recommended to monitor any changes to the stability of the dental implants. Regular follow-up appointments with the patient's dentist and oncologist are also recommended.
[Instructions]
The patient is to follow a recommended oral hygiene routine and continue to maintain a healthy diet.
[Discharge medications]
None specified.
[Signatures]
Attending physician: [Physician Name]
Date: [Discharge Date]
| it was a non-complicated surgery. A second | {"cancer": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Admission Date: [insert date]
Discharge Date: [insert date]
Patient Name: [insert name]
Age: 42 years
Gender: Male
Address: [insert address]
Diagnosis:
The patient was diagnosed with chronic active Epstein-Barr virus infection of T/NK-cell type, systemic form.
Hospital Course:
The patient was admitted due to a seizure and a history of wasting and worsening health condition for six months. Upon admission, he presented with recurrent fever, hepatosplenomegaly, and acute kidney failure. The patient underwent several diagnostic approaches, including CT scan, PET-CT, bone marrow biopsy, and thyroid gland biopsy. These examinations revealed atypical pulmonary infiltrates, bilateral hilar lymphadenopathy, increased LDH, mild pancytopenia, and granulomatosis with polyangiitis. Bronchial lavage was positive for Aspergillus antigen, but the patient's symptoms were not fully explained by pulmonary aspergillosis. The high positive proteinase 3 titer (1:135) indicated granulomatosis with polyangiitis, but biopsy of the kidney was not performed due to low platelet counts.
The patient was treated with high-dose steroid burst initially. However, the patient's condition worsened rapidly with further loss of weight and intermittent high fever despite antibiotic and antifungal treatments, and the assumption of granulomatosis with polyangiitis was ruled out. Infectious disease testing, including human immunodeficiency virus, Tuberculosis, Schistosomiasis, Malaria, and Leishmaniosis were negative, except for previous Hepatitis B and EBV infection. EBV DNA in the peripheral blood reached high levels. The clinical criteria for HLH were evaluated, but they were not fulfilled, and no typical findings of HLH were seen in the bone marrow biopsy.
Treatment:
Based on the data by Sawada et al., the patient was treated with methylprednisolone and cyclophosphamide as a cooling down step to reduce the high viral load. The patient developed an epileptic seizure and clinical symptoms of meningitis, and a lumbar puncture was performed. Cranial MRI showed typical radiological signs for viral meningitis. The patient was initiated chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) due to the clinical progression. Despite its limited activity for EBV-infection, treatment with foscavir was started. Upon two cycles of CHOP, the EBV load decreased remarkably from 2.8 × 106 copies/mL to < 200 copies/mL. An additional cycle of CHOP was administered and the patient remained in complete remission so far.
Outcome:
The patient was discharged in stable condition with instructions to follow up with their physician regularly. Further diagnostic imaging, laboratory work, or close clinical follow-up may be required to monitor the patient's condition.
Discharge Instructions:
1. Follow up with your physician regularly.
2. Take medications as prescribed.
3. Report any new symptoms or concerns to your physician immediately.
4. Maintain a healthy diet and exercise regularly.
5. Avoid contact with individuals who have been sick recently.
6. Rest and take things easy.
| techniques were successful and he became less responsive to treatment. | {"cancer": "NO"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [REDACTED]
Sex: Female
Age: 55 years
Date of admission: [REDACTED]
Date of discharge: [REDACTED]
Admission diagnosis:
Acute diffuse peritonitis due to small bowel perforation caused by a mussel shell.
Hospital course:
The patient was admitted to the Surgical Department of our institution with acute abdominal pain. An exploratory laparotomy was immediately performed, revealing free intestinal fluid in the abdomen and fecal peritonitis caused by a 3 cm linear tear in the ileum. The foreign body (a mussel shell) was extracted from the lumen, and the bowel breach was sutured with simple double-strand stitches. Abdominal cavity washing was carried out, and two drains were placed on suction for 24 hours. The patient was started on antibiotics and nil by mouth regimen. She was transferred to Intensive Care Unit for observation and ventilation. Her condition improved, and breathing support was successfully removed. She was discharged from the ward on the sixth postoperative day.
Diagnosis:
Small bowel perforation caused by a mussel shell.
Treatment:
Exploratory laparotomy, extraction of foreign body, suture of bowel breach, abdominal cavity washing, two drains on suction, and antibiotic therapy.
Follow-up:
The patient was discharged in good clinical condition. At the 30-day follow-up, her surgical wounds were completely healed, blood tests were normal, and bowel function was fully recovered.
Recommendations:
No further interventions are recommended. The patient should follow up regularly with her primary care provider for management of hypertension, t2d, and minor depression.
Signed,
[REDACTED]
| and an endoscope was fitted to the right side of | {"diabetes": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Patient Overview:
The patient is a 76-year-old woman who underwent subtotal maxillectomy and neck dissection of the right side due to malignant melanoma of the upper gingiva. The patient had two zygomatic implants and two dental implants inserted into the anterior region of the maxilla six months after the tumor resection.
Hospital Course:
The patient underwent second-stage surgery, but the position and depth of the dental implants were unsuitable for the final prosthesis, rendering them unable to provide support. The zygomatic implants and prosthesis in use have remained stable over the past 3 years since functional loading.
Discharge:
The patient was discharged with stable zygomatic implants and prosthesis. A follow-up appointment was scheduled with the dentist to assess potential alternative options for the support of the anterior implants. The patient will be encouraged to participate in oral hygiene activities and to monitor for any future complications. Further follow-up may be required as necessary.
Impression:
The patient continued to have stable zygomatic implants and prosthesis; however, the positioning and depth of the dental implants were unsuitable for use in the final prosthesis.
| up scan with two zygomatic implants and two dental | {"cancer": "YES"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: ABC and XYZ
DOB: N/A
Gender: Female and Male
Admission Date: N/A
Discharge Date: N/A
Brief Hospital Course:
The patients were siblings from a Pakistani consanguineous family diagnosed with insulin-dependent diabetes mellitus (IDDM) and progressive flexion contracture of small joints of hands and feet. Both siblings also had short stature and hyperpigmented skin lesion. They were evaluated for various autoimmune and rheumatological disorders, and the laboratory investigations were negative. Further, genetic tests revealed a homozygous mutation in the SCL29A3 gene, confirming the diagnosis of histiocytosis lymph adenopathy plus syndrome.
Summary of Hospitalization:
ABC and XYZ, siblings from the same Pakistani family, were admitted as inpatients for further evaluation of IDDM with progressive flexion contracture of small joints of hands and feet. Upon examination, they both had short stature and hyperpigmented skin. Lab investigations were performed to rule out rheumatological and autoimmune causes, which were negative, and a genetic study confirmed a diagnosis of histiocytosis lymph adenopathy plus syndrome (H syndrome). Due to their cultural beliefs, the patient left against medical advice before further workup and treatment.
Diagnosis:
Histiocytosis Lymph Adenopathy Plus Syndrome (H syndrome)
Treatment:
N/A
Follow-up:
Due to the patient leaving against medical advice, it is recommended they follow up with a local specialized medical facility for further evaluation and treatment.
Patient Instructions:
N/A
Responsible Parties:
N/A
Dictated By:
N/A
Prepared By:
N/A
Reviewed By:
N/A
Attending Physician:
N/A
Discharge Diagnosis:
Histiocytosis Lymph Adenopathy Plus Syndrome (H syndrome)
Disposition:
The patient left against medical advice before further workup and treatment.
| associated with the disease. The patient had not received insulin | {"diabetes": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient: [Name], 53-year-old male of Puerto-Rican origin
Diagnosis: Pheochromocytoma and paraganglioma
Hospital Course:
The patient presented with persistent hematuria, urinary frequency, weak stream, and nocturia. CT urogram indicated bilateral, irregular, heterogeneous large adrenal masses. Biochemical characterization of masses showed significantly elevated 24-hour urine normetanephrine, leading to the diagnosis of pheochromocytoma. Negative symptoms included flushing, headaches, sweating, palpitations, anxiety, blurry vision, or dizziness, and no history of adrenal tumors, hyperparathyroidism, medullary thyroid cancer, renal cancer, or pituitary tumors. Ultimately, the patient underwent an open bilateral adrenalectomy and paracaval lymph node excision.
Pathology:
Surgical pathology confirmed pheochromocytomas in the bilateral adrenal glands. The paracaval lymph node was described as paraganglioma versus metastatic pheochromocytoma.
Genetic testing:
The patient was offered genetic screening for familial paraganglioma syndromes. With the patient's informed written consent, genomic DNA was isolated from a peripheral blood sample and targeted gene sequencing was performed using PGLNext. The patient was found to have a heterozygous germline mutation, c.524A>G in the VHL gene, corresponding to the Y175C substitution in the protein. This was identified as a likely pathogenic variant and confirmed by Sanger sequencing.
Treatment:
The patient required vasopressor support and a large amount of crystalloid resuscitation to maintain hemodynamic stability. Intraoperative ultrasound was used to identify one mesenteric lymph node of mildly suspicious appearance which was resected, in addition to a large retroperitoneal paracaval lymph node. The patient was started on life-long glucocorticoid and mineralocorticoid replacement.
Outcomes:
The patient's diabetes and hypertension resolved.
Follow-up:
Due to the multifocal nature of the pheochromocytomas and the presence of first-degree relatives likely to be affected, the patient was offered further genetic testing for familial paraganglioma syndromes.
Overall, the patient's hospital course was unremarkable.
| adrenal, adrenal plexor. The patient | {"cancer": "NO"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Hospital Course:
The patient, a male infant born small for gestational age at 33 weeks, was admitted to our center due to persistent hypoglycemia on DOL 5. The infant had a low birth weight and length and was born to a 35-year-old mother with gestational diabetes and pregnancy-induced hypertension. There was no family history of hypoglycemia reported, however, the maternal grandmother had a history of type 2 diabetes. The infant received initial treatment for hypoglycemia with dextrose 10% IVF and increased oral feeds. The infant also received hydrocortisone treatment secondary to low cortisol levels. After discontinuing hydrocortisone therapy, hypoglycemia recurred, and the pediatric endocrinology team was consulted. High-dose ACTH stimulation testing was performed due to random low cortisol level and the infant responded adequately.
Diagnosis:
The infant was diagnosed with Congenital Hyperinsulinism (CHI). DNA sequencing for CHI revealed a heterozygous pathogenic missense variant in exon 7 of HNF4A, (p.Arg267Cys; c.799C > T; legacy Arg245Cys), which affected a highly conserved amino acid and has been previously detected in patients with MODY 1.
Treatment:
The infant was started on diazoxide at 15 mg/kg/day with good response. Diazoxide was gradually tapered based on point-of-care (POC) home glucose values in the range of 70-100 mg/dL and eventually discontinued at 6 months of age. The fasting challenge test was not performed before total discontinuation of diazoxide. The infant remained euglycemic at the time of his last visit at 2 years 9 months of age.
Follow-up:
The infant was discharged in a stable condition and has been followed up regularly in the outpatient clinic, with no further episodes of hypoglycemia noted. Renal ultrasound, liver function tests, and urinalysis of this patient were normal.
| at the hospital was able to diagnose diabetes.
What | {"diabetes": "NO"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Information:
Name: ____________
Age: 76 years old
Sex: Female
Medical record number: ____________
Admission Date: ____________
Discharge Date: ____________
Admitting Diagnosis: Necrotizing fasciitis with associated abscess and sepsis
Hospital Course Summary:
The patient was admitted to the emergency department with complaints of left thigh and hip pain and swelling. She had a history of chronic left leg sciatic pain and a fall two days prior to the onset of these symptoms. Her past medical history was significant for colon ca requiring a low anterior resection eight years ago. She was noted to be confused and tachycardic, but afebrile with leukocytosis of 14,000. Physical examination revealed significant crepitus to the left thigh and knee, and radiographs confirmed subcutaneous emphysema consistent with necrotizing fasciitis. She received a pelvic CT scan, which further confirmed the necrotizing fasciitis and identified a collection in the presacral space consistent with an AL.
An exploratory laparotomy with diverting colostomy was done to control the contamination of the leg. The left thigh and hip were incised revealing a significant amount of feculent and purulent drainage, and necrotic, nonviable tissue was debrided. The wound was left open and dressed. The patient remained septic postoperatively and orthopedic and trauma consultants recommended an above the knee amputation with potential hemipelvectomy. However, the patient's family ultimately decided to withdraw care, and the patient died in the hospital on the third day of admission.
Discharge Diagnosis: Necrotizing fasciitis with associated abscess and sepsis resulting in death.
Discharge Instructions:
Given the patient's unfortunate clinical course, there are no discharge instructions. Our deepest condolences go out to the patient's family during this difficult time.
Follow-up:
There is no need for a follow-up after discharge as the patient has passed away.
| ated for the first 3-4 days.
An | {"cancer": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [Name]
Age: 70
Gender: Male
Admission Date: [Admission Date]
Discharge Date: [Discharge Date]
Hospital Course:
The patient was admitted to our hospital due to hepatic dysfunction that was discovered during a routine health examination. The patient underwent a battery of tests, including blood tests, abdominal ultrasonography, enhanced computed tomography, and T2-weighted magnetic resonance imaging, which revealed an 8 × 7-mm solid mass at the gallbladder fundus and several stones in the gallbladder. Based on these findings, the patient was diagnosed with an intraepithelial papillary neoplasm (ICPN) with low-grade dysplasia.
Surgery was performed, and laparoscopic cholecystectomy and liver bed resection were carried out. The resected specimen revealed a 15 × 10-mm milky yellow mass at the gallbladder fundus with papillary lesions. Histopathological analysis confirmed the presence of papillary tumors with cystic formation, mucin secretion, and low-grade dysplasia. Immunohistochemical analysis of the mucosal characteristics showed that MUC1, MUC5AC, and MUC6 were positive, whereas MUC2 was negative. The Ki67 index was a little less than 10%, indicating that the tumor was not malignant.
The patient's postoperative course was good, and the patient did not experience any complications. The patient was discharged from the hospital 9 days after the operation, and a recurrence has not been detected for 3.5 years.
Diagnosis:
Intraepithelial papillary neoplasm (ICPN) with low-grade dysplasia.
Follow-up:
The patient should be closely monitored, and any new or suspicious symptoms should be immediately reported to the healthcare provider.
Discharge Medications:
N/A
Follow-up Appointments:
The patient should make an appointment with their healthcare provider for a check-up in 6 months to ensure that the patient is not experiencing any complications or recurrences.
Physician Signature:
[Physician Name]
| plasia of the gallbladder. He was admitted | {"cancer": "MAYBE"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [Redacted]
Age: 59
Gender: Female
Hospital Course:
The patient presented with scalp alopecia and was diagnosed with female pattern alopecia with diffuse and nearly complete hair loss on the central and vertex region with retention of hair on the occipital scalp. She had also experienced hair loss on other areas such as eyebrows, axillae, pubic region, and upper lip. The biopsy from the affected areas of the scalp showed extensive miniaturization of the hair follicles and other changes consistent with alopecia areata.
After reviewing the patient’s history, clinical presentation, and pathologic findings, the diagnosis of antineoplastic (chemotherapy and hormonal) treatment-associated alopecia was established. The patient was started on minoxidil 5% foam to be topically applied to the scalp twice daily.
During the subsequent follow-up visits at four months and six months, the patient showed marked improvement with increased hair regrowth. The central and vertex area of her scalp had thickening of hair, and there was new hair growth on the parietal regions bilaterally. The patient continues to use minoxidil 5% foam once daily.
Plan:
- The patient will continue to use minoxidil 5% foam once daily.
- The patient will follow up with her oncologist as scheduled.
Summary:
The patient had antineoplastic treatment-associated alopecia, which was managed with topical minoxidil therapy. The patient showed marked improvement on follow-up visits, with increased hair regrowth. The patient continues to use minoxidil 5% foam and will follow up with her oncologist as scheduled.
| IBS) was indicated as a "diagnosis" | {"cancer": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Hospital Course Summary:
Admission date: [Date]
Discharge date: [Date]
Reason for admission:
The patient, a 78-year-old woman, was admitted to the Department of Neurology after experiencing her third episode of generalized tonic clonic seizures. The patient had previously been diagnosed with a glioma and had received a resection 5 years prior.
Medical History:
The patient had been taking warfarin for 14 years as a secondary prevention measure against embolic events resulting from paroxysmal atrial fibrillation (AF). Apart from a diagnosis of glioma and warfarin use, the patient’s medical history was unremarkable.
Hospitalization course:
Upon admission, the patient was treated for status epilepticus (SE) with intravenous diazepam to terminate a five-minute episode of GTCS, followed by a loading dose of intravenous valproate sodium (1200 mg) to relieve recurrent GTCS and frequent focal aware seizures. The patient was subsequently prescribed oral levetiracetam (LEV) of 500 mg twice daily once she regained consciousness.
On the second day of admission, routine laboratory studies were conducted, which revealed unremarkable results. The patient’s ECG showed evidence of paroxysmal AF. A carotid Doppler ultrasonography was also conducted, which showed hypoechoic plaques on the anterior wall of the bifurcation of the right common carotid artery.
After 44 hours of admission and a total dosage of approximately 2200 mg of intravenous valproate sodium, the medication was discontinued. An electroencephalogram (EEG) was also conducted, which demonstrated global interictal θ waves (4-7 Hz), but without epileptiform discharges.
On the 3rd hospital day, the patient developed renal dysfunction based on the results of the BUN and serum creatinine levels, which were attributed to insufficient fluid intake. The International Normalized Ratio (INR) was found to be elevated, leading to the cessation of oral warfarin medication. A 5mg dose of vitamin K1 was administered intravenously following consultation with a hematologist. The patient remained asymptomatic and was observed without any evidences of bleeding. The repeat brain CT scan also revealed no intracranial hemorrhage. The renal dysfunction was resolved on the 4th day.
Discharge:
The patient was discharged on [Date], with oral warfarin cautiously restarted at a dose of 1.25 mg and titrated back to 1.875 mg while monitoring the INR between 2 and 3.
Follow-up:
The Neurology department recommended a follow-up with the patient in one week to monitor the improvement of her condition. The patient was advised to keep up with the fluid intake and attend regular INR monitoring sessions to check the therapeutic window of warfarin. The patient was also advised to continue taking isosorbide mononitrate and succinate metoprolol for her cardiovascular ailments.
Discharge medications:
1. Isosorbide mononitrate sustained release tablets (40 mg oral) daily.
2. Succinate metoprolol tablets (12.5 mg oral) twice daily as needed.
3. Warfarin (1.875 mg) oral, titrated to maintain INR values between 2 and 3.
|
The patient had been diagnosed as a patient with | {"cancer": "YES"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: N/A
Medical Record Number: N/A
Date of Admission: September 2018
Date of Discharge: N/A
History of Present Illness:
The patient, a 42-year-old Chinese man, presented to the outpatient clinic complaining of right ear discharge accompanied by discomfort for 3 years. The patient had a history of seawater contact and noticed a small volume of clear drainage from both ears. As the condition progressed, the drainage from the left ear vanished and the drainage from the right ear increased and became a thick, purulent exudate containing debris. The ear canal became obstructed by the thick excretion, which caused the patient to experience mild hearing loss, coupled with intermittent tinnitus, and a sensation of ear fullness. The patient did not use any medications to relieve symptoms, but instead removed debris from the right ear using cotton swabs, which resulted in a return to normal hearing and relief of symptoms. Within a few days, new thick drainage would obstruct the ear canal causing the symptoms to reappear. The patient sought health care twice at local hospitals in Xi’an City from Shaanxi Province; however, the underlying illness remained unidentified and did not improve. The discharge from the right ear gradually reduced and turned from brown to white until March 2018, when a low-concentration hydrogen peroxide solution was used to rinse the right ear canal at a local hospital.
Past Medical History:
The patient denied any history of infectious diseases, diabetes, or any immunocompromising condition.
Physical Exam:
The patient underwent audiometric and otoscopic examinations as well as radiological examinations using computed tomography imaging to examine the temporal bone. The exudate was collected from his right ear using a sterile swab and was transferred to the clinical microbiology laboratory for examination.
Diagnostic Studies:
The exudate from the right ear was analyzed by the clinical microbiology laboratory. All specimen processing and bacteriological analysis procedures were performed with approval from the ethics committee. The patient provided written informed consent prior to participation in this project.
Assessment and Plan:
The underlying illness causing the right ear discharge and discomfort was not identified, despite seeking health care twice at local hospitals prior to presentation at our clinic. Further testing and evaluation will be needed to determine the cause of the patient's symptoms.
Summary:
The patient presents with a history of right ear discharge and discomfort for 3 years, which was not resolved after seeking health care twice at local hospitals prior to presentation at our clinic. The patient has no history of infectious diseases, diabetes, or any immunocompromising condition. The exudate from the right ear was analyzed by the clinical microbiology laboratory to determine the underlying cause of the symptoms. Further testing and evaluation will be needed to determine the underlying illness.
| itus, and required a referral to the University of Illinois | {"diabetes": "NO"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Patient Information:
Name: 3-month old Japanese boy
Gender: Male
Admission Date: [date]
Discharge Date: [date]
Chief Complaint:
Poor body weight gain, vomiting, and fever that had persisted for one week.
Hospital Course:
The patient was diagnosed with Nephrogenic Diabetes Insipidus (NDI) based on the polyuria and the high serum Antidiuretic Hormone (ADH) level. Treatment was initiated with hydrochlorothiazide. Spironolactone and potassium were added at 2 and 4 years of age, respectively. The patient was also started on indomethacin and a protein-restricted diet when he was 6 years old. Brain magnetic resonance imaging (MRI) was performed and showed normal findings. The patient has mild hydronephrosis in the right kidney.
Current Medical Condition:
At the time of discharge, the patient's height was 150 cm (-0.8 standard deviation) and his weight was 37 kg (-0.6 standard deviation). The patient's urine volume was approximately 7 L/day. The patient's mother is asymptomatic.
Follow-Up Plan:
The patient will need long-term follow-up due to his Nephrogenic Diabetes Insipidus diagnosis. Close monitoring of the patient's kidney function and urine output will be necessary to ensure that his condition remains stable.
Summary:
The 3-month-old Japanese boy was admitted due to poor body weight gain, vomiting, and fever. He was diagnosed with Nephrogenic Diabetes Insipidus based on the high serum ADH level and polyuria. The patient was started on hydrochlorothiazide, spironolactone, potassium supplementation, indomethacin, and a protein-restricted diet. Brain MRI showed normal findings, but the patient has mild hydronephrosis. At the time of discharge, the patient's height, weight, and urine output were within normal range. The patient will need long-term follow-up to monitor his Nephrogenic Diabetes Insipidus condition.
| There was no history of any other drugs that might have | {"diabetes": "MAYBE"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [Redacted]
Date of Admission: March 2011
Date of Discharge: August 2017
Admission Diagnosis: Breast cancer with osteoporosis
Hospital Course: The patient was diagnosed with breast ca in July 2010 and underwent surgery, radiotherapy, and chemotherapy. In February 2011, AI therapy with letrozole was initiated for 5 years. A DXA scan in March 2011 revealed osteoporosis, with BMD T-scores of -2.9 at the lumbar spine and -1.9 at the total hip. The patient was started on antiresorptive treatment with denosumab every 6 months and received it for 12 half-yearly injections, with the last one administered in August 2016. As the patient ended letrozole treatment in November 2016, a DXA scan was performed that showed no more osteoporosis in the lumbar spine and total hip, and she continued receiving adequate daily calcium and vitamin D supplementation.
Follow-up and Outcome: A CTX in March 2017 was normal at 33 ng/L, but it increased to 2070 ng/L in August. As a result, antiresorptive treatment was initiated with raloxifene 60 mg daily, which was being taken regularly by the patient until mid-July when she started experiencing spontaneous low back pain. An MRI of the thoracolumbar spine revealed two fractures, with medullary edema at D11 and L5. The CTX also showed extremely high levels, and an emergency injection of denosumab was administered at the time of fracture diagnosis to rapidly reduce the increased bone turnover.
Final Diagnosis: Osteoporotic fractures with high bone turnover
Discharge Plan: The patient was discharged after treatment with an injection of denosumab to help overcome the high bone turnover and reduce the risk of potential fracture. The patient was advised to increase her physical activity, maintain a healthy diet, and continue taking regular daily calcium and vitamin D supplementation. The patient was advised to follow-up and monitor her CTX levels at regular intervals for any signs of high bone turnover. She was also advised to contact her healthcare provider immediately if she experienced any new episodes of back pain.
Follow-up Plan: The patient was scheduled for follow-up appointments with the primary care provider and the endocrinologist to monitor and adjust her treatment as needed. The patient was advised to maintain a healthy lifestyle, increase her physical activity, incorporate weight-bearing exercises in her routine, and keep her body weight in a healthy range for optimal bone health. Further, the patient was advised to avoid smoking and limit alcohol consumption to maintain optimal bone health.
| one for 1 month. The patient was diagnosed with a | {"cancer": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Hospital Course:
The patient, a 56-year-old woman with a past medical history of scleroderma, chronic constipation, and hypertension, presented to the emergency room with generalized abdominal pain, vomiting, and constipation. Initial blood count and basic metabolic panel were normal but the lactic acid on presentation was raised. A computed tomography (CT) scan revealed multiple loops of large bowel positioned between the liver and the right diaphragm indicative of Chilaiditi syndrome, cecal wall thickening, multiloculated pelvic abscess with droplets of air suggestive of peritonitis, and segmental distension of several loops of distal small bowel concerning for ileus or partial obstruction. The patient underwent CT-guided drainage of the pelvic abscess and was started on intravenous antibiotics. Over the next 2 days, drain output was increased gradually, and there was a spike in white blood cell count. Repeat CT scan showed worsening of the pelvic fluid collection as well as development of new distant fluid collections in the abdomen. The patient underwent exploratory laparotomy with abdominal washout and right hemicolectomy. Operative findings included feculent peritonitis and necrotic cecum with perforations. Pathology of the specimen reported moderately differentiated adenocarcinoma with invasion into pericolonic adipose tissue. The patient was discharged with an end ileostomy on day 7 and is scheduled to follow-up with hematology oncology.
| abdominal wall and was able to move the lumen of | {"cancer": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary
Patient Name: [Redacted]
Age: 49
Sex: Male
Date of Admission: [Redacted]
Date of Discharge: [Redacted]
Admitting Diagnosis: Bruxism
Hospital Course
The patient presented with complaints of snoring, daytime fatigue, clenching and grinding of the teeth, perceived increased masseter muscle tension, dissatisfaction with his quality of sleep, and pain located bilaterally in masseter muscles and area of temporomandibular joints. Medical history was significant for hypertension, psoriasis, and Barrett’s esophagus. Dental examination confirmed malocclusion, dental crowding, excessive overbite, teeth midline deviation, and high Tooth Wear Index. The patient was diagnosed with severe sleep and awake bruxism.
Laboratory tests revealed lowered concentration of HDL cholesterol, slight hypertriglyceridemia, and slightly increased fasting glucose levels with normal levels of hormones and other metabolic parameters. V-PSG confirmed the diagnosis of severe SB and suspected OSAS was ruled out. ESS score indicated mild daytime sleepiness and the patient scored five points and confirmed increased risk of Obstructive Sleep Apnea Syndrome (OSAS) in both the STOP BANG and Berlin questionnaires. The patient had several episodes of sexual activity during most sleep stages (N1, N2 and REM) which were preceded by a bruxism episode with EEG arousal lasting for a few seconds. The patient was referred for treatment including manual therapy jaw massages and an occlusal splint for the lower teeth arch to relax the masticatory muscles and decrease the number of SB/AW episodes, but he refused.
The patient was discharged home with a recommendation to follow-up with a physician and dentist for further management and support.
Final Diagnosis
1. Severe sleep and awake bruxism
2. Mild daytime sleepiness
Condition on Discharge
Stable, with recommendations for long-term care with respect to his condition and follow-up with healthcare providers.
| patient has to be hospitalized with acute acute and subac | {"cancer": "NO"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [redacted]
Age: 52 y.o.
Sex: Male
HOSPITAL COURSE:
The patient presented with fifth toe swelling, and was found to have evidence of chronic microtrauma in the context of diabetes mellitus with remodeling of the bone and surrounding soft tissue reaction. The patient's laboratory workup revealed the presence of diabetes mellitus, which was already known to the patient, and peripheral neuropathy.
During the patient’s hospital stay, imaging studies comprising a CT scan and MRI were performed and revealed remodelling of the distal phalanx of the fifth toe, with periosteal reaction and surrounding soft tissue changes consistent with the chronic microtrauma.
Given the patient’s clinical picture and imaging results, he was referred for podiatric evaluation, and a plan for close follow-up, including symptom monitoring and foot care education, was established.
DISCHARGE DIAGNOSIS:
- Chronic microtrauma of the left fifth toe
- Diabetes mellitus
- Peripheral neuropathy
DISCHARGE INSTRUCTIONS:
- Prompt follow-up with podiatrist
- Proper footwear that accommodates swelling and neuropathy
- Maintaining optimal blood glucose control and peripheral neuropathy management
- Regular monitoring of the affected toe and adjacent areas for signs of inflammation and infection
- Active participation in preventative foot care practices and consultation with a qualified healthcare provider for foot care education and guidance.
FOLLOW-UP APPOINTMENTS:
The patient is advised to follow up regularly with the podiatrist as directed.
| . The patient's clinical features were identified.
| {"diabetes": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
DISCHARGE SUMMARY
Patient Name: [REDACTED]
Medical Record Number: [REDACTED]
Admission Date: [REDACTED]
Discharge Date: [REDACTED]
Clinical Summary:
The patient is a 44-year-old right-handed man who was admitted to our clinic for radial-side pain associated with the left wrist. He has a history of playing golf and weight training, and the wrist pain had been present for 4 months. The patient received physical therapy, nonsteroidal anti-inflammatory drugs and steroid injections twice, but the pain was only temporarily relieved. The patient had no evidence of systemic diseases or trauma history.
Diagnostic Findings:
Upon examination, the patient's wrist showed mild swelling on the radial side, severe tenderness associated with the radial styloid process and moderate tenderness on the mid-dorsal aspect of the radio-carpal joint. He yielded positive results in Finkelstein's test and displayed limited range of motion of the left wrist. The visual analog scale (VAS) score for pain was 10 at rest. The initial plain left-wrist radiograph showed no abnormalities. MRI of the left wrist suggested mild tenosynovitis at the third extensor compartment and intersection syndrome. We clinically diagnosed him with de Quervain's disease and focal synovitis of radio-carpal joint. Upon performing diagnostic wrist arthroscopy and retinacular release of the first extensor compartment for de Quervain's disease, we observed dorsal synovitis, scapho-lunate and lunato-triquetral instability.
Operative Findings:
During the operation, we observed stenosing tenosynovitis at the second extensor compartment with partial tearing. We partially removed the hard bony protrusion. The oblique EPL tendon was found to originate from the ulnar side of the forearm to the radial styloid at the radial and proximal sites of Lister's tubercle. No EPB tendon was found.
Follow-up:
At 12 months follow-up, the patient was completely asymptomatic at the radial styloid process and able to resume full daily activities.
Impression:
Based on this patient's clinical and operative findings, we can conclude that the patient presented with de Quervain's disease and focal synovitis of radio-carpal joint. The presence of dorsal synovitis, scapho-lunate and lunato-triquetral instability was also observed during operative examination. No evidence of systemic diseases or trauma history was found. At 12 months follow-up, the patient was completely asymptomatic at the radial styloid process and able to resume full daily activities.
| right side of his body that was not present on the | {"cancer": "NO"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [REDACTED]
Medical Record Number: [REDACTED]
Admission Date: [REDACTED] Discharge Date: [REDACTED]
Hospital Course:
The patient was admitted to our hospital for surgical treatment of two hepatic tumors. During the initial examination, the patient was found to have a history of hepatitis B and C viral infections, diabetes, and diabetic renal failure. The patient had a CT scan which revealed two hepatic tumors. The patient was diagnosed with small, regular, oval-shaped cells with mild atypia that formed the luminal structure. The postoperative course was uneventful and the patient was discharged on postoperative day 13.
Past Medical History:
The patient had a history of blood transfusion at the age of 6 years during surgical treatment for a traumatic left femoral fracture. He was diagnosed with hepatitis B and C viral infections at the age of 30 years and had a history of interferon therapy. He also had a history of diabetes, and hemodialysis was introduced for diabetic renal failure at the age of 49 years. He had no familial history.
Hospital Course:
The patient had a soft and flat abdomen without ascites. Laboratory tests showed low platelet and white blood cell counts, and elevated hemoglobin, albumin, and total bilirubin levels. The patient had Child-Pugh grade A with an indocyanine green retention rate of 4.9%. Hepatitis B virus antigen and hepatitis C antibody were positive. Serum alpha-fetoprotein was elevated at 126.0 ng/mL. Pre-contrast CT scans revealed two hypoattenuating hepatic lesions, and contrast-enhanced CT scans revealed that the tumor in one of the lesions was enhanced in the arterial phase, while the other lesion was not enhanced.
Diagnostic Findings:
Magnetic resonance imaging revealed similar findings of low signal intensity on T1-weighted images and high signal intensity on T2-weighted images for both the lesions. The preoperative diagnosis was multiple HCCs. However, CT findings were not typical of HCCs. Partial resections of both lesions were performed, and the tumors were found to be well-defined lesions of 8.0 mm and 14.0 mm, respectively. Pathological examination of tissue from one tumor revealed CoCC, while the tumor from the other lesion corresponded to moderately differentiated HCC. The pathological findings of each cancer resulted in T1aN0M0 stage I according to Union for International Cancer Control the 8th edition. The pathological findings of non-cancerous tissue showed liver cirrhosis.
Follow-up:
The patient was alive without recurrence 36 months after surgery.
Summary:
A 58-year-old Japanese man with a history of hepatitis B and C viral infections, diabetes, and diabetic renal failure was admitted to our hospital for surgical treatment of two hepatic tumors. The tumors were found to be well-defined lesions of CoCC and moderately differentiated HCC. The patient underwent partial resections, and the postoperative course was uneventful. The patient was discharged on postoperative day 13 and was alive without recurrence 36 months after surgery.
| Patient Care Record Number: [REDACTED]
| {"cancer": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary
Patient Name: [Redacted]
Medical Record Number: [Redacted]
Date of Admission: [Redacted]
Date of Discharge: [Redacted]
Hospital Course:
This is a discharge summary for a 66-year-old female with infiltrating ductal cancer in the lower outer quadrant of her left breast. The patient underwent left partial mastectomy and sentinel node biopsy. The patient also had bilateral lung masses that were proven to be positron emission tomography (PET) fludeoxyglucose avid. Transthoracic core biopsy of the lung lesions revealed adenocarcinoma acinar type. The case was discussed at the multidisciplinary tumour board, and histology suggested three distinct curable primaries: T1N1 breast cancer and bilateral T1N0 lung cancers. The breast cancer was managed with partial mastectomy with sentinel node sampling, adjuvant tangential whole breast irradiation (WBI) with regional nodal irradiation (RNI), and an aromatase inhibitor (letrozole). The bilateral lung primaries were treated with stereotactic ablative radiotherapy (SABR). The left and right lung tumors were each treated with 48 Gy in 4 fractions prescribed to the isocenter of each lung lesion, using SABR with volumetric modulated arc therapy technique. The breast and regional nodes (supraclavicular and axilla levels I, II and III) were treated to 50 Gy in 25 fractions using a field-in-field technique in a four-field beam arrangement. All three sites were treated concurrently. The patient completed all her treatments without toxicity.
The patient developed dyspnoea and cough 5 weeks post lung radiotherapy and within 1 week of completing breast radiotherapy. She did not feel her symptoms warranted therapy, and given her diabetic history, steroids were withheld. Her CT scan was consistent with post-radiotherapy changes. Pulmonary function tests showed mild restrictive defect.
The patient was discharged home in a stable condition and without any complications. Follow-up appointments were scheduled as appropriate.
Diagnoses:
1. Infiltrating ductal cancer in left breast
2. Adenocarcinoma acinar type in bilateral lungs
Procedures:
1. Left partial mastectomy and sentinel node biopsy
2. Stereotactic ablative radiotherapy (SABR) of bilateral lung tumors
3. Adjuvant tangential whole breast irradiation (WBI) with regional nodal irradiation (RNI)
Current Medications:
1. Aromatase inhibitor (letrozole)
Condition Upon Discharge:
The patient was discharged home in a stable condition with follow-up appointments scheduled as appropriate.
| . All three tumors were diagnosed with a lower density metast | {"cancer": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [Redacted]
Medical Record Number: [Redacted]
Date of Admission: [Redacted]
Date of Discharge: [Redacted]
Length of Stay: [Redacted]
Reason for Admission:
The patient was admitted to the hospital for breast reconstruction due to ductal carcinoma in situ (DCIS) in the right breast.
Hospital Course:
The patient underwent nipple-sparing mastectomy (NSM), sentinel node biopsy (SNB) and breast reconstruction with a de-epithelialized DIEP flap using thoracodorsal vessels as recipient vessels. Postoperative hormone therapy was continued at a nearby medical facility. At an outpatient visit three years and eight months after surgery, a tumor measuring 5mm was detected by palpation at the lower right region of the right breast and a tumor shadow was identified on ultrasound. Further treatment was necessary due to multiple cancer recurrences in the reconstructed breast. Therefore, extensive extirpation of the nipple-areola, breast skin, and initial breast reconstruction with an anatomical tissue expander (TE) were performed at another hospital. Postoperative adjuvant therapy with tamoxifen and leuprorelin was given.
At one year and eight months after insertion of the TE, breast reconstruction with a right S-GAP flap using internal thoracic vessels as anastomotic vessels was performed. The patient did not experience recurrence at two years and five months (four years after the surgery for the recurrence) postoperatively. Areola and nipple reconstruction were performed through transplantation of a part of the contralateral nipple and use of a full-thickness skin graft from the proximal thigh.
Follow-up Care:
The patient has been monitored for four years and currently continues to be seen every three months on an outpatient basis, each time receiving adjuvant therapy with leuprorelin and anastrozole. The right reconstructed breast appears both upper pole fullness and lower pole skin shortage, but the patient does not desire further surgery.
Disposition:
The patient was discharged to home in stable condition. Follow-up care will be provided on an outpatient basis.
Discharge Diagnosis:
Breast cancer, DCIS and invasive ductal carcinoma (IDC) with ductal spread.
| , there was no treatment for the patient.
App | {"cancer": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Patient Information:
Name: [redacted]
Gender: Male
Age: 14
Admission Date: [redacted]
Discharge Date: [redacted]
Hospital Course Summary:
The patient was admitted to the hospital on [redacted] with a chief complaint of a mandibular jaw lesion found on routine orthodontic exam. Patient reported feeling some “loosening of the teeth” but denied any significant pain. The patient had normal growth and development during childhood as reported by his mother. Pubertal development was appropriate for sex and age as well.
Diagnostic Assessment:
Panoramic dental X-rays showed a large, destructive, expansile lesion with ill-defined borders. The imaging findings were consistent with an aggressive lytic lesion, leading to differential diagnoses of osteosarcoma, aneurysmal bone cyst, or a giant cell tumor. Pathology results revealed bland-appearing spindle cell proliferation with giant cells. The final diagnosis was a giant cell granuloma.
Laboratory Assessment:
Initial laboratory workup showed normal reference ranges except for NTx levels, which were 157 nM/BCE/mM creatinine, and a 25 OH D of 14.2 ng/mL.
Treatment:
The patient was started on denosumab 120 mg monthly for the treatment of the giant cell granuloma. After two doses, NTx levels decreased to 14 nM/BCE/mM creatinine. The patient received six consecutive doses of denosumab 120 mg every 4 weeks, which were then decreased to a lower dose of denosumab 60 mg every 3 months.
Outcome:
After a year of treatment with denosumab, repeat imaging showed a marked improvement in the jaw lesion, with improved bone quality.
Follow-Up:
Continued monitoring of the patient is recommended to ensure that the giant cell granuloma remains under control.
| that seemed to have been on the lower jaw (about | {"cancer": "NO"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Hospital Course:
This 26-year-old primigravida unbooked patient with a past history of left salpingo-oophorectomy for a left ovarian mucinous adenocarcinoma presented to antenatal clinic at 23 weeks of pregnancy with abdominal distension. Per abdominal examination revealed ascites and a 24 weeks size uterus. Ultrasound examination revealed an intra-uterine pregnancy of 23 weeks and a right ovarian mass with internal echoes. The patient was diagnosed with recurrent ovarian ca in pregnancy and was advised surgical management. However, the patient declined and was prescribed chemotherapy, with two courses of single dose carboplatin 450mg I.V. administered three weeks apart. The patient experienced derange liver functions tests after the second course, and the third course could not be administered. Ascites was progressive despite chemotherapy, resulting in maternal respiratory distress and fetal growth restriction with oligohydramnios.
Delivery and Procedure:
At 34 weeks of the gestation period, an elective Cesarean section with staging laparotomy was performed because of breech presentation, decreased liquor, and gross ascites after completing steroid cover. During the operation, 20 liters of hemorrhagic ascetic fluid were drained, and the omentum was agglutinated over the intestine while deposits were present over the uterus. Right ovary was replaced by a tumor that was 15x15cm with rupture and hemorrhage. Total abdominal hysterectomy with right salpingo-oopherectomy, infracolic omentectomy, and appendectomy were performed. Peritoneal washings were captured, and multiple peritoneal biopsies were taken. Palpation of pelvic and para-aortic lymph nodes was negative. The patient had an uneventful recovery.
Outcome:
This live healthy baby girl weighing 2.3kg was delivered with APGAR scores of 6/10 and 8/10 at 1 and 5 minutes, respectively. The placenta appeared normal during delivery. Histopathology revealed mucinous adenocarcinoma of ovary. She was started on chemotherapy (carboplatin and paclitaxel) six days postoperative day 14, and she received six cycles. The patient and baby were healthy at follow-up six months later.
| the patient was referred to a specialist on the other side | {"cancer": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: Unspecified
Medical Record Number: Unspecified
Date of Admission: Unspecified
Date of Discharge: Unspecified
Hospital Course:
The patient, a 68-year-old female presented to the emergency department with complaints of sudden onset of shortness of breath, chest pain, orthopnea, and paroxysmal nocturnal dyspnea. The notably past medical history includes hypertension, high cholesterol, chronic kidney disease stage 3, and hereditary hemorrhagic telangiectasia (HHT). Initial vital signs and laboratory investigations confirms acute systolic heart failure with markedly elevated BNP levels. Following prompt medical management, the patient demonstrated symptomatic improvement and was started on guideline-directed medical therapy including beta-blocker, ACE inhibitor, aldosterone antagonist and an oral diuretic. Subsequent left and right heart catheterization reveals widely patent coronary vessels, elevated pulmonary capillary wedge pressure, and elevated left ventricular end-diastolic pressure. The patient continued to attend regular bevacizumab infusions with her haematologist as this was not thought to be the cause of her cardiomyopathy at the time. Unfortunately, the patient developed recurrent episodes of flash pulmonary edema deemed to be due to medication non-compliance and subsequently experienced sudden onset of chest pain and shortness of breath at home followed by ventricular fibrillation related cardiac arrest which required prolonged resuscitation attempts leading to therapeutic hypothermia, but eventually passed away 3 days later.
Discharge Diagnosis:
1. Acute systolic heart failure
2. Hereditary hemorrhagic telangiectasia (HHT).
Discharge Instructions:
1. The patient was discharged to their family to pursue necessary funeral arrangements.
2. No outpatient follow-up is needed.
Discharge Medications:
None.
Follow-up:
The patient did not survive.
| .
Patient Name: Unknown
Date of Admission | {"cancer": "MAYBE"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [REDACTED]
Date of Admission: [REDACTED]
Date of Discharge: [REDACTED]
Primary Diagnosis: Worsening dyskinesia in Parkinson's disease
History of Presenting Illness:
Mr. [REDACTED] is a 68-year-old gentleman with a 20-year history of idiopathic Parkinson's disease who presented with worsening dyskinesia. The patient had bilateral subthalamic nucleus deep brain stimulation with left 2-, 1+ amplitude=2.0mV, pulse width=60 microseconds, frequency=130Hz, right 11-, C+ amplitude=1.0mV, pulse width=60 microseconds, and frequency=130Hz. He had been taking amantadine 100 mg three times a day and carbidopa-levodopa four to six tablets crushed and infused three times a day over four hours through a G-tube. Due to worsening dyskinesia, the patient was evaluated for Duopa.
Past Medical History:
The patient had a history of idiopathic sensorimotor axonal polyneuropathy with baseline pain in his feet 3/10 on a visual analog scale. A nerve conduction study done two years ago showed abnormal results. Neuropathic pain was managed with gabapentin.
Hospital Course:
The patient was started on Duopa at the initial visit. Within 24 hours of initiating Duopa, the patient developed severe neuropathic pain characterized by burning and stinging in his feet. The continuous rate was reduced to 2.5 cc/h, However, this did not relieve the symptoms. The gabapentin dose was increased to 600 mg two times a day, and he developed severe dizziness. Other medications such as Duloxetine, topical lidocaine cream, and hydrocodone-acetaminophen 5/325 mg failed to provide any relief. The continuous infusion rate was brought down to 1.4 cc/h, and the neuropathic pain started to improve.
Condition at Discharge:
The patient's condition at discharge had improved, and he expressed satisfactory pain control with the adjusted dose of Duopa. He was instructed to monitor his pain to maintain the optimal dose of Duopa.
Follow-Up:
The patient is to follow up with his primary care physician for further management of his Parkinson's disease and neuropathic pain.
Disposition:
The patient was discharged to his home in stable condition.
Signed,
[REDACTED]
| Hz.
Upon diagnosis he had a mild form of | {"cancer": "NO"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient: [Patient Name]
Age: 93-year-old
Gender: Female
Chief Complaint: Mental status decline
Diagnosis: Hyponatremia
Hospital Course:
The patient was admitted to the hospital due to a gradual decline in mental status over a period of one week. The patient had a past medical history of coronary artery disease, high blood pressure, diabetes, high cholesterol, and mild cognitive dysfunction. The patient had been started on escitalopram four days prior to the onset of symptoms. The patient's lab results showed a low serum sodium level and high serum osmolality. The patient also had a tonic-clonic seizure in the emergency room during the hospital stay. The patient's condition was managed by administering intravenous lorazepam.
Treatment:
The patient's hyponatremia was initially treated with intravenous saline. The patient's medications were reviewed and the decision to stop escitalopram was made. The patient was closely monitored for any signs of worsening symptoms and her fluid intake, urine output, and electrolyte levels were closely monitored throughout the hospital stay. Vitamin D supplementation was also started during the hospital stay.
Outcome:
The patient's condition gradually improved with treatment and close monitoring. The patient's hyponatremia was corrected and her mental status improved. The patient was eventually discharged to home with close follow-up by her primary care physician. The patient was advised to continue with vitamin D supplementation and to limit her fluid intake. In addition, the patient was advised to attend regular follow-up appointments with her primary care physician.
| department.
The patient did not need any medication | {"diabetes": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary
Patient Information
Patient Name: [REDACTED]
Medical Record Number: [REDACTED]
Admission Date: [REDACTED]
Discharge Date: [REDACTED]
Brief Hospital Course
The patient is a 62-year-old female with a history of lupus anticoagulant and grade II obesity. She presented with a 3-day history of bleeding per rectum and left-lower quadrant abdominal pain. Upon admission, her haemoglobin was 9.4 and INR was 2.1. The patient was evaluated and managed in the hospital for her symptoms. She was monitored closely for any signs of complications and received appropriate treatment during her stay. She was discharged in stable condition after her symptoms had significantly improved.
Hospitalization Course
Admission: [REDACTED]
During admission, the patient had stable vital signs. A physical exam was unremarkable, with the exception of left-lower quadrant abdominal pain. The patient's haemoglobin level and INR were both monitored closely throughout her stay. Appropriate interventions were taken to address the bleeding per rectum, with close monitoring of her progress. The patient was also assessed for any complications related to her lupus anticoagulant and obesity. She received treatment as needed based on her presenting symptoms. Daily progress notes were recorded in the patient chart to ensure up-to-date monitoring and tracking of her hospitalization course.
Management and Treatment
The patient was managed and treated with appropriate interventions based on her presenting symptoms. The bleeding per rectum was addressed by a multidisciplinary team and closely monitored for signs of improvement. The patient's lupus anticoagulant and obesity were also managed, with interventions implemented as needed.
Follow-up Plan
At the time of discharge, the patient was in stable condition and was educated on her follow-up plan. She was advised to follow up with her primary care physician for ongoing management of her health conditions. She was also given instructions on when to seek medical care in case of any worsening symptoms. Appropriate referrals were made to relevant specialists for ongoing management of her condition.
Discharge Medications
None given, patient advised to follow up with primary care physician for further management.
Discharge Diagnosis
The patient was admitted with bleeding per rectum. Further evaluation revealed no significant pathology. There was no evidence of acute or chronic medical illness that would require continued hospitalization. Hence, the patient was discharged in stable condition and advised to follow up with her primary care physician.
Discharge Condition
The patient was discharged in stable condition.
Signed by:
[REDACTED], MD
| and were discharged from the hospital with a minimum of bleeding | {"cancer": "NO"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Electronic Health Record Discharge Summary
Patient Name: [REDACTED]
Date of Birth: [REDACTED]
Admission Date: [REDACTED]
Discharge Date: [REDACTED]
Admitting Diagnosis: Giant Prolactinoma with Extrasellar Extension
Discharge Diagnosis: Insulinoma
Hospital Course:
The patient, an eight-year-old male with giant prolactinoma with extrasellar extension, presented in 2008 with progressive headache and visual disturbances. The patient was treated with high doses of cabergoline, resulting in normalization of prolactin and total tumor shrinkage. In 2013, the patient underwent transcranial excision of the tumor due to its resistance to cabergoline therapy and developed recurrent hypoglycemic episodes during the immediate postoperative period. Biochemical analysis confirmed this to be endogenous insulin dependent hypoglycemia. Imaging located a well-circumscribed lesion in the head of the pancreas, confirmed via histology as an insulinoma with benign characteristics. Six months after the pituitary surgery, the patient received three-field radiotherapy and continued on cabergoline resulting in declining prolactin levels. The patient's baseline echocardiography was normal. The patient is being evaluated for new onset primary hyperparathyroidism due to high calcium levels.
Summary:
The patient initially presented with giant prolactinoma with extrasellar extension, which was treated with high doses of cabergoline resulting in normalization of prolactin and total tumor shrinkage. Later, the patient underwent transcranial excision of the tumor due to its resistance to cabergoline therapy and developed recurrent hypoglycemic episodes postoperatively, which was confirmed biochemically as endogenous insulin dependent hypoglycemia. An imaging revealed an insulinoma in the head of the pancreas, which was enucleated and confirmed histologically as benign. The patient underwent three-field radiotherapy and continued treatment with cabergoline resulting in declining prolactin levels. The patient is being evaluated for new onset primary hyperparathyroidism due to high calcium levels.
| a new form of tumor with complete control of the primary | {"cancer": "NO"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [Redacted]
Age: 65
Sex: Male
Admission Date: [Redacted]
Discharge Date: [Redacted]
Admitting Diagnosis: Recurrent Oral Cavity Squamous Cell Carcinoma
Hospital Course:
The patient was admitted to the hospital on [Redacted] with the diagnosis of recurrent oral cavity squamous cell carcinoma. The patient underwent a composite resection of the floor of mouth, mandible and chin pad. A left fibular free flap with a skin paddle of 15 cm x 14 cm was used for reconstruction and four osteotomies were made in the fibula to reconstruct the angle-to-angle bony defect.
The anastomoses of the peroneal artery and its two venae comitantes were done to the right facial artery, right external jugular vein, and right common facial vein, respectively. The pedicle to the anterior tibial perforator was then sewn to the distal ends of the peroneal artery and of one of the venae comitantes.
Throughout the hospital course, the patient was closely monitored and treated for pain as needed. Appropriate wound care was provided to the surgical site. The patient was also provided with nutritional support and education to aid in the healing process.
The patient's post-operative course was uneventful, and the patient was discharged on [Redacted] with the appropriate post-operative care instructions. The patient was also given a follow-up appointment with their surgical team to monitor their progress and ensure a complete recovery.
Discharge Medications:
None.
Discharge Diagnoses:
Recurrent oral cavity squamous cell carcinoma.
Postsurgical fibular free flap reconstruction of the floor of mouth, mandible and chin pad.
Discharge Instructions:
The patient is advised to continue practicing good wound care and nutritional support practices as advised by their care team. The patient is also advised to attend their scheduled follow-up appointments with their surgical team. Any concerns or issues should be addressed promptly with their physician.
Provider Name: [Redacted]
Provider Signature: [Redacted]
Date/Time Signed: [Redacted]
| omosis was repaired.
The patient was returned | {"cancer": "YES"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Comprehensive Discharge Summary
Patient Name: [REDACTED]
Gender: Female
Age: 21
Admitting Date: [REDACTED]
Discharge Date: [REDACTED]
Length of Stay: [REDACTED] days
Hospital Course:
The patient presented to the dermatology clinic with severe facial acne, rated grade 4 on the Investigator Global Assessment of Acne scale. The patient had been using topical retinoids for several months with no satisfactory results. The patient was started on 20mg isotretinoin, which was maintained for 6 months. The patient presented with mild chelitis and skin dryness, and complained of mild hair fall. Liver enzymes and lipid profile were within the normal range for both the initial laboratory works and the repeated tests done after one month and four months. The patient experienced total clearance of her acne. However, treatment was interrupted because they could not visit the clinic for several weeks.
Two months after stopping the isotretinoin treatment, the patient developed depigmented lesions reminiscent of acrofacial vitiligo. The pattern of the vitiligo persisted despite topical treatment with Antifungal agents, so the patient was prescribed Tacrolimus 0.1% cream, which led to mild improvement of some of the lesions after eight weeks before recurrence. The patient, in favor of alternative medicine, opted to cease topical treatment and receive homeopathic treatment instead.
Medical History:
Patient had no history of vitiligo but did have a family history of diabetes, hypertension, and systemic lupus erythematosus. An auntie had died from renal complications of SLE.
Diagnosis:
Acne, severe facial, clearance achieved with isotretinoin
Acrofacial vitiligo with complaints of depigmented lesions
Treatment:
The patient was treated with 20 mg isotretinoin for six months, which led to complete clearance of her acne. The patient then received Antifungal and Tacrolimus 0.1% topical therapy for her vitiligo with mild improvement after eight weeks, but later stopped it in favor of homeopathic treatment.
Follow-up:
Patient was discharged in good condition. The patient was advised to follow up with the medical clinic given their positive thyroid antibodies and family history of lupus.
Discharge medications:
The patient had no discharge medications.
Discharge condition:
Discharged in stable condition.
Discharge instructions:
- Continue using good sun protection to prevent worsening of existing vitiligo and development of new spots.
- Regularly follow up with your medical clinic.
- Consult with your clinicians before considering new treatments.
| patient and the dermatologist. The dermatologist diagnosed the | {"diabetes": "NO"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Identification:
Mr. X, a 41-year-old male with no significant past medical history, presented with fever, headache, sinusitis, and exanthematous maculopapular rash over neck, thorax and upper limbs. He was admitted to the internal medicine and infectious disease ward.
Hospital Course:
Mr. X was evaluated for suspected arbovirus infection by his general practitioner due to the current outbreak of Dengue and his wife's recent diagnosis. His symptoms worsened, and he presented to the emergency department six days post the onset of symptoms. He had a high-grade fever, dehydration, erythroderma on trunk and face, and lymphadenopathy. Laboratory analysis showed lymphopenia with associated stimulated lymphocytes and hepatic cytolysis. He was treated with intravenous paracetamol and metoclopramide. A drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome was suspected due to a recent administration of ibuprofen, amoxicillin and clavulanic acid.
Hospitalization and Discharge:
Mr. X received proper medical treatment and care during his hospitalization. He was discharged in stable condition and advised to follow up with his primary care physician.
Follow-up:
Mr. X was advised to monitor his health, follow recommended preventive measures, and continue to manage his general well-being.
| that he was mildly hyperthyroid and in a poor | {"diabetes": "NO"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Hospital Course:
The patient presented with symptoms of shortness of breath, cough, weakness, lightheadedness, acrocyanosis, jaundice, and darkening of urine. Physical examination revealed mucosal pallor, acrocyanosis, and icterus of the facial skin. The chest x-ray showed an enlarged cardiac silhouette, perihilar vascular fullness, and bilateral interstitial prominence likely indicative of pulmonary vascular congestion. The cardiac echocardiogram revealed an ejection fraction of 60-65% with mild left ventricular wall thickness and grade I diastolic dysfunction. The patient was positive for SARS-CoV-2 but negative for influenza A, influenza B, and respiratory syncytial virus.
Treatment:
The patient received two units of crossmatch least incompatible warmed blood on day one and one unit of the same on day two of admission to treat the symptomatic anemia. The SARS-CoV-2 pneumonia was treated with oral remdesivir for five days and intravenous dexamethasone 6 mg for seven days. The patient was given intravenous 40 mg furosemide for pulmonary congestion, and empiric ceftriaxone and azithromycin for pneumonia for three days. Post-transfusions, the patient’s day-three hemoglobin was 10.2 g/dL which stabilized at her baseline of 7-8 g/dL by discharge.
Follow-up:
The patient required readmission to a cancer institute two days post-discharge where she was hospitalized for eight days, requiring five units of packed red blood cells and 60 mg of methylprednisolone IV daily. Her hemoglobin level improved to 9.2 g/dl and remained stable prior to discharge. On evaluation by an oncologist, weekly treatment with rituximab was recommended post-discharge for four weeks. On discharge, she was prescribed prednisone 40 mg for seven days followed by a taper to 20 mg for another seven days and a follow-up appointment with oncology. The patient is recommended to be discharged to a sub-acute rehabilitation center.
| A few weeks later, we did a complete assessment on | {"cancer": "MAYBE"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [Full name not given]
Age: 48
Gender: Male
Medical History:
- Dental amalgam fillings 15 years ago
- No significant history of medical conditions
Chief Complaint:
- Pain in the gum behind the lower second molar
Hospital Course Summary:
Upon examination, the patient was found to have a supra-erupted upper third molar that was causing abnormal contact with the lower gum, resulting in pain. Radiographic examination confirmed the clinical findings. The oral examination also revealed generalized erosion on the facial, cervical, incisal, and occlusal surfaces of the teeth. Heat and cold sensitivity tests revealed normal results. The patient's medical history did not reveal any usual suspected causes of erosion.
The patient was asked to record a diet log for 1 week until the next appointment to determine the extrinsic source of erosion. Salivary tests were also carried out, which revealed normal salivary flow with a decrease in salivary pH and buffering capacity. On examining the diet log at the next appointment, the only dietary agent that was consistently consumed by the patient that had the potential to cause such erosion was Granny Smith apples.
The patient was advised to reduce his consumption of Granny Smith apples and to implement better oral hygiene practices. The patient was discharged with instructions to return for a follow-up appointment in 3 months.
| included dental amalgam fillings (1/22) | {"diabetes": "NO"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
HOSPITAL COURSE SUMMARY:
Patient Case Report: A 70-year-old man presented with a hypervascular, 7 cm pancreatic body mass that involved the splenic vein on routine surveillance CT scan. He had a history of RCC and underwent a left nephrectomy and adrenalectomy in 2002, as well as pancreaticoduodenectomy for adenocarcinoma of the ampulla of Vater in 2003. He never received chemotherapy for either the RCC or PDA.
Hospital Course:
- Completion pancreatectomy and splenectomy were performed to resect the newly discovered pancreatic lesion.
- Due to the patient's apancreatic status, he received diabetic teaching and was started on parenteral insulin. He was referred to an endocrinologist for follow-up.
- He received appropriate vaccinations for encapsulated organisms due to his splenectomy and asplenic status.
- Repeat CT scans were scheduled at 4 months postoperatively, and every 3 months thereafter provided no active disease progression.
- The patient followed up with the medical oncologist who advised against adjuvant chemotherapy or radiation therapy, opting for imaging surveillance for now despite the one positive lymph node.
Summary:
A 70-year-old man presented with a hypervascular pancreatic body mass, which was determined to be metastatic RCC after investigations. He underwent completion pancreatectomy and splenectomy, and due to his apancreatic status, received diabetic teaching and appropriate vaccinations. He will continue imaging surveillance and follow up with his medical oncologist.
| was declared dead within 4 years of the procedure.
| {"diabetes": "YES"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: N/A
Date of Admission: N/A
Date of Discharge: N/A
History of Presenting Illness:
The patient, a 59-year-old diabetic male, presented with urinary urgency, frequency, hesitancy, intermittency, straining, and slow stream for three weeks. He also developed fever, myalgia, chill, and an episode of gross hematuria. Abdominopelvic ultrasonography showed a hypoechogenic and enlarged prostate, and computed tomography urography revealed a prostatic abscess and ureterohydronephrosis. Urethral catheterization was performed, and the patient was referred to urology.
Hospital Course:
The patient was in good general health without fever. A painful digital rectal examination revealed a firm and enlarged prostate. A transurethral resection of the prostate (TURP) was performed, and this allowed for the drainage of pus pockets under control of view. There were no postoperative complications. Histologic examination of resected tissue concluded on suppurated xanthogranulomatous prostatitis.
Diagnosis:
Suppurated xanthogranulomatous prostatitis.
Patient Status at Discharge:
The patient was discharged in stable condition with prescriptions for pain medication and antibiotics.
Follow-Up Care:
The patient was advised to schedule a follow-up appointment with his urologist.
| No other diagnosis for the patient was ever identified, with | {"diabetes": "YES"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Patient Information:
- Age: 65-year-old
- Gender: Female
- Medical history: Hypertension, Type II diabetes mellitus
Reason for Admission:
- Sudden chest pain and dyspnea
Hospital Course:
- Upon arrival, patient had high blood pressure, rapid heartbeat, and rapid breathing. She was given a diuretic to relieve the fluid in her lungs.
- An electrocardiogram was obtained, which revealed a sinus rhythm with a right bundle branch block and ST segment elevation in leads II, III, and AVF.
- Coronary angiography was performed, showing normal coronary arteries but an aberrant origin of the right coronary artery from the mid-segment of the left anterior descending artery.
- Echocardiography revealed inferior wall hypokinesis with an ejection fraction of 50%.
- Patient was stable and her pulmonary oedema resolved. A cardiac CT angiogram was performed and showed the abnormality in the right coronary artery.
- The condition is a rare variant, which has not been categorized in the classification of coronary anomalies, but it closely resembles the IB1 type of Shirani and Roberts’s classification with the only exception of the right coronary artery origin at the mid-segment of the left anterior descending artery.
Discharge Summary:
- Patient with hypertension and Type II diabetes mellitus admitted due to sudden onset of chest pain and dyspnea.
- Aberrant origin of the right coronary artery from the mid-segment of the left anterior descending artery discovered during coronary angiography.
- Patient's pulmonary oedema resolved and was discharged in a stable condition.
- CT angiogram confirmed the anomaly in the right coronary artery.
- Condition resembles the IB1 type of Shirani and Roberts’s classification.
- Further follow-up with cardiologist recommended.
| left artery (left, lower right).
- She | {"diabetes": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Admission Date: [DATE]
Discharge Date: [DATE]
Patient Name: [NAME]
Medical Record Number: [MRN]
Hospital Course:
The patient was admitted to the hospital on [DATE] with the chief complaint of an enlarging right testicular mass and aching groin pain. The patient underwent a right radical orchiectomy and port-a-cath placement for chemotherapy. Pathology of the testicle revealed 100% choriocarcinoma with markers CD30, CD117, and OCT4 negative. After diagnosis, the patient was started on bleomycin/etoposide/cisplatin (BEP) therapy and was discharged with an appointment to begin treatment as an outpatient.
Ten days later, the patient was found unconscious at home with multiple bilateral supratentorial hemorrhagic masses resulting in a midline shift. The patient was admitted to the intensive care unit for close monitoring and treated with medication. After one dose of cisplatin, the patient became increasingly altered.
An esophagogastroduodenoscopy was performed, which showed only mild gastritis and a hiatal hernia. Pathology revealed gastritis and reactive gastropathy. A colonoscopy was noted to have blood in the terminal ileum but was otherwise unremarkable. A push enteroscopy revealed a small ulcerated mass in the jejunum. Two hemoclips were placed there. The enteroscope could not be advanced any further, and it was decided that an angiogram would be performed if the hemoglobin continued to drop or his gastrointestinal bleeding persisted.
The patient also developed several clustered erythematous-violaceous firm subcutaneous nodules without ulceration or other epidermal changes on the zygoma, with a larger nodule on the anterior neck and right posterior shoulder. A punch biopsy was performed on the shoulder lesion and showed findings consistent with choriocarcinoma with small nests and cords of epithelioid cells with abundant cytoplasm and enlarged highly atypical and pleomorphic nuclei.
The patient completed cycle 1 of BEP and then elected to move to be closer to his family.
Discharge Diagnosis:
Choriocarcinoma with metastases.
Discharge Medications:
None.
Follow-up Instructions:
The patient is advised to follow-up with their oncologist for further treatment. Further follow-up instructions were provided to the patient prior to discharge.
Follow-up with recommendations:
The case report suggests that, in addition to patient follow-up with their oncologist for further treatment, consideration should also be given to the different symptoms that the patient presents.
| a single endocardectomy. The primary outcome was an | {"cancer": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Hospital Course:
The patient, a 35-year-old woman, presented with a 1-year history of a progressively growing painless mass in the left temporal area. Physical examination revealed a firm, nontender palpable mass in the left temporal area just superior to the zygomatic arch. All laboratory data were normal. Further evaluation with ultrasound revealed a hypoechoic mass located subcutaneously in the left temporal region. A subsequent MRI scan revealed a mass located in the left temporal scalp, between the temporal fascia and the temporalis muscle, with a multilobulated margin. The final diagnosis was epithelioid sarcoma based on the results of an incisional biopsy. Follow-up with 18F-fluorodeoxyglucose positron emission tomography/CT showed focally intense FDG uptake but no regional lymph node or distant metastasis.
Hospital Course Summary:
This is a summary of the hospital course for a 35-year-old female patient who presented with a progressively growing painless mass in the left temporal area. A firm, nontender palpable mass with no superficial ulceration or cutaneous erosion was observed during a physical exam. Further diagnostic tests, including an ultrasound and MRI scan, revealed a multilobulated mass located subcutaneously in the left temporal region. An incisional biopsy was performed and confirmed a diagnosis of epithelioid sarcoma. Follow-up with 18F-fluorodeoxyglucose positron emission tomography/CT revealed focally intense FDG uptake but no regional lymph node or distant metastasis. The patient underwent total surgical resection of the tumor followed by postoperative irradiation. The patient did not present with any recurrent disease during the follow-up period of 18 months.
| ose was not successful. The patient's body temperature and | {"cancer": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [REDACTED]
Medical Record Number: [REDACTED]
Date of Admission: [REDACTED]
Date of Discharge: [REDACTED]
Admitting Diagnosis: Abdominal wall tumor
Principal Diagnosis: Foreign-body granuloma
Secondary Diagnosis: Elevated inflammatory markers
Hospital Course:
A 57-year-old Japanese man was admitted to the hospital with increasing right lower abdominal pain. On initial examination, an abdominal wall tumor was detected using transabdominal ultrasound. Laboratory results revealed elevated inflammatory markers. Helical computed tomography (CT) revealed a solid mass and magnetic resonance imaging showed a mass that exhibited low intensity. Positron emission tomography–CT revealed fluorodeoxyglucose accumulation.
The patient underwent exploratory laparotomy and a malignant tumor was suspected. Intraoperative findings at laparotomy revealed an elastic, hard, milky-whitish mass with a rough surface and capillary growth in the right lower quadrant. The mass was completely removed, and the surgical margin secured. Pathologic examination revealed that these masses were foreign-body granulomas consisting of string-like crystals and a foreign-body giant cell. Immunohistological staining was positive in cells surrounding phosphoglyceride crystals. The patient underwent regular follow-up abdominal ultrasound examination and CT postoperatively. As of 3 years after the procedure, no signs of recurrence have been detected.
Discussion:
PGDD is a rare disease characterized by deposition of phosphoglyceride crystals. It can sometimes form a large mass and be misdiagnosed as a malignant tumor. Little is known about its etiology and pathogenesis. This deposition disease is apparently triggered by injury and subsequent macrophage aggregation, with a histological picture of deposited crystal radiating from the cell membranes of epithelioid cells. No specific markers exist for PGDD, and differentiating this disease from malignant tumors without pathological examination is difficult.
Conclusion:
In conclusion, a foreign-body granuloma was discovered during the patient's exploratory laparotomy. The mass was completely removed, and the surgical margin secured. Regular follow-up has not revealed any findings suspicious of recurrence.
| cholic albumin. It was concluded that this tumor | {"cancer": "NO"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Information:
Patient Name: [Insert Name]
Gender: Female
Age: 46
Medical Record Number: [Insert MRN]
Reason for Admission:
The patient underwent skin-sparing mastectomy breast reconstruction surgery using a pedicled TRAM flap and modified C-H flap for nipple reconstruction.
Hospital Course:
The patient did not experience any complications during her hospital stay. She was able to tolerate oral intake, and her pain was managed effectively by the medical team. The height of the reconstructed nipple 1 year postoperatively was similar to that of the contralateral nipple.
Discharge Plan:
The patient was discharged home in stable condition with a 1-year follow-up appointment with her surgeon. Post-operative care instructions were reviewed with the patient, including wound management, and the importance of follow-up appointments was emphasized. The patient was advised to contact her provider for any increase in pain, signs of infection, or any other concerns.
Follow-Up:
The patient's 1-year follow-up appointment with her surgeon was scheduled, but no further follow-up appointments or recommendations were made at this time.
Summary:
The 46-year-old female patient underwent successful skin-sparing mastectomy breast reconstruction using a pedicled TRAM flap and modified C-H flap for nipple reconstruction. The patient tolerated the procedure well without complications during her hospital stay and was discharged home in stable condition with follow-up instructions.
| up at the hospital where her breast reconstruction surgery was performed | {"cancer": "MAYBE"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
DISCHARGE SUMMARY
Patient Name: [REDACTED]
Admission Date: [REDACTED]
Discharge Date: [REDACTED]
CLINICAL COURSE:
The patient, a 48-year-old male, was admitted to the psychiatric emergency room with dysmorphic mood. Subsequently, he was referred to medical service to manage hyponatremia. The patient had a past medical history of lumbar spondylosis managed with intermittent nonsteroidal anti-inflammatory drug use. He occasionally consumed alcohol but denied having any history of diabetes, prediabetes, obesity, binge drinking, abdominal trauma, any offending drugs, and any procedures including endoscopic retrograde cholangiopancreatography. The family history was unremarkable.
During admission, the patient experienced abdominal discomfort that worsened alongside a fever. The patient developed tachycardia and hypotension, and the physical examination was notable for mild tenderness in the epigastrium. Laboratory investigations showed increased levels of hematocrit, leukocytes with neutrophil predominance, platelets, creatinine, C-reactive protein, amylase, and lipase. An alarming laboratory finding was a severe elevation of TGs with mild AP. The diagnosis of HTG-induced AP was established.
The patient received aggressive intravenous rehydration therapy, antiemetics, opioids for pain control, and insulin to decrease TG levels. The patient's condition improved significantly, and apheresis was not performed due to the response to insulin therapy alone. The patient was discharged after his condition had improved, and he began tolerating oral feeds. Fenofibrate was initiated, and empiric antibiotic therapy was stopped due to negative blood cultures.
DISCHARGE DIAGNOSIS:
HTG-induced AP.
DISCHARGE INSTRUCTIONS:
The patient is advised to continue fenofibrate therapy indefinitely to prevent further attacks of AP. The patient is asked to follow a healthy diet and avoid alcohol intake. If the patient experiences any recurring symptoms, he should seek medical attention immediately.
FOLLOW-UP:
The patient is recommended to follow up with the primary care provider for further monitoring of the TG levels. The TG levels were recorded at 230 mg/dL after three months from the time of discharge.
| described as being of "recent onset" to the " | {"diabetes": "NO"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient: 55-year-old, right-hand-dominant male
Admission Date: [Insert date]
Discharge Date: [Insert date]
Hospital Course Summary:
The patient presented with a history of acute inflammatory demyelinating process and a 3-month history of a left volar wrist and hypothenar soft tissue mass. Initially, his sensory deficits were thought to relate to his generalized demyelinating disorder. However, on examination, the ulnar deficit was thought to be related to the mass in his hand.
Magnetic resonance angiography of the left hand showed a soft-tissue mass of unclear etiology. Operative excision was performed under general anesthesia. Grossly, the mass was tan-white, rubbery, and lobulated. Pathology confirmed the mass to be a benign myxoma. There were no postoperative complications.
At 5 weeks postoperatively, the patient reported marked improvement in his numbness and weakness. He was found to have intact sensation in the ulnar nerve distribution distal to the site of the excised mass, and improved grip strength.
Follow-up:
The patient was asked to return in several months for repeat sensorimotor assessment but was subsequently lost to follow-up.
Diagnosis:
Benign myxoma.
Summary:
The 55-year-old, right-hand-dominant male with a history of acute inflammatory demyelinating process and a 3-month history of a left volar wrist and hypothenar soft tissue mass presented for evaluation. Operative excision was performed, and the pathology confirmed the mass to be a benign myxoma. The patient reported marked improvement in his numbness and weakness at 5 weeks postoperatively.
| He did not have any swelling or the loss of muscle | {"cancer": "NO"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Hospital Course:
A 5-year-old male patient on immunosuppressive therapy after bone marrow transplantation was admitted to the hospital with persistent cough. A CT thorax scan revealed a mass in the right lower lobe with mild irregular margins, which was suspected to be a malignant mass lesion. A CT-guided biopsy was performed, and a diagnosis of cryptococcal infection was made based on the histopathological features. The patient was started on antifungal therapy but unfortunately succumbed to widespread sepsis.
Consultations:
The patient was consulted with the radiology department, who performed the CT-thorax scan and CT-guided biopsy.
Conclusions:
Based on the patient's clinical presentation and diagnostic testing, the patient’s condition was diagnosed as cryptococcal infection. Antifungal therapy was initiated, but unfortunately, the patient’s condition worsened, leading to widespread sepsis. Despite all medical interventions, the patient tragically passed away due to sepsis.
Plan:
The patient continued antifungal therapy and received supportive care measures during hospitalization. The treatment plan focused on slowing down the progression of the infection and mitigating the symptoms to provide the patient with comfort. Unfortunately, the patient passed away, and no further action was taken.
Summary:
The patient, a 5-year-old male, was diagnosed with a cryptococcal infection after presenting with a persistent cough. The infection was confirmed by histopathological examination of a biopsy sample. Treatment was initiated with antifungal therapy, but the patient eventually passed away due to widespread sepsis.
| , that he has been treated with a highly effective ant | {"cancer": "NO"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary
Patient: 61-year-old male from northern Sri Lanka with a prevertebral abscess at the cervical area.
Hospital Course:
The patient presented with high-grade fever, neck pain, odynophagia, and dysphagia for three days duration with the background of uncontrolled diabetes mellitus. Upon examination, the patient had a temperature of 102°F and few enlarged lymph nodes on the left anterior cervical chain. Complete ear, nose, throat, and dental examinations were normal. Blood cultures were sterile after incubation, and the patient had neutrophilic leukocytosis and elevated inflammatory markers, suggestive of bacterial inflammation.
Fiber optic laryngoscopic examination revealed fullness and inflamed pyriform fossa bilaterally with inflamed arytenoids and aryepiglottis. Imaging studies confirmed a prevertebral abscess at the cervical area. Intravenous broad spectrum antibiotics were administered empirically, and a few milliliters of pus were drained.
The patient's aspirated pus grew Acinetobacter baumannii, which was treated with meropenem, imipenem, and piperacillin-tazobactam, all to which the pathogen was sensitive. The patient underwent ultrasound scan-guided transcervical surgical drainage of 45 ml of pus to facilitate early recovery.
Discharge Diagnosis:
Prevertebral abscess, Acinetobacter baumannii
Discharge Condition:
The patient's condition improved significantly with treatment and is now ready for discharge.
Discharge Instructions:
The patient is advised to complete the course of antibiotics as prescribed. Routine monitoring of blood sugar levels and HbA1c is also recommended to manage diabetes mellitus. The patient should also maintain proper oral hygiene and follow-up with their primary care physician or otolaryngologist as scheduled.
Follow Up:
The patient will follow up with their primary care physician or otolaryngologist in one week.
Signed,
[Physician name]
| amed skin lesions with large blood masses. The patient had | {"diabetes": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Hospital Course:
The patient is a 64-year-old Native American man who was admitted to the hospital due to worsening lower back pain, numbness, and tingling radiating down both legs. On admission, the patient also reported gradually increasing weakness in both legs for 3 days that led to an inability to walk. The patient had a medical history significant for hepatitis C, for many years, which led to liver cirrhosis. The patient also had a history of a previously repaired umbilical hernia. The patient's family history included breast cancer (sister) and lung cancer (mother). The patient was a former heroin abuser, but never consumed alcohol. The patient worked as a manager in the laundry department in a hospital, and family members denied any exposure to asbestos. An ultrasound of the liver 1 year prior to the current presentation reported coarse echotexture suggestive of underlying cirrhosis.
Physical examination revealed marked weakness of the patient's lower extremities and swelling over the T9 area of his spine. On neurological examination, the patient was alert and awake, oriented to time, his name, and his location; and his cranial nerves were grossly intact. While no gait disturbance was observed, severe cord compression was noted due to a pathologic fracture at T11. Magnetic resonance imaging of his thoracic and lumbar spine revealed numerous metastatic lesions, and a large right liver mass and multiple lesions were also seen in MRI scans of the chest, abdomen, and pelvis.
Surgical spinal cord decompression and stabilization/fusion of his spine was performed, and pathology results of an intervertebral disc and the T9 vertebral body showed metastatic carcinoma favoring HCC. Tumor cells were positive for Hep Par-1 and glypican-3 and negative for CK7, CK20, TTF-1, inhibin, OCT3/4, PSA, PSAP, RCC, and PAX8. Subsequently, the patient was treated with radiation to the T11 spine lesion and was scheduled to begin radioembolization with yttrium-90.
Unfortunately, the patient's condition deteriorated, and he died 2 months after diagnosis. No autopsy was performed.
Discharge Diagnosis:
1. Metastatic carcinoma favoring hepatocellular carcinoma (HCC).
Discharge Condition:
Patient expired.
Discharge Instructions:
None to provide as the patient expired.
| knowledge of her, and were afraid to report her. | {"cancer": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: N/A
Date of Admission: N/A
Date of Discharge: N/A
Hospital Course:
The patient was admitted to the hospital for evaluation of abdominal pain. She had a history of breast cancer with metastasis to the lymph nodes, bone, and brain, and had undergone mastectomy, axillary dissection, and whole brain radiotherapy.
During hospitalization, a CT scan was performed which showed moderate amount of PI along the caecum, and ascending and proximal transverse colon. However, there were no signs of peritonism or sepsis on clinical examination and the patient was asymptomatic.
The surgical consultant recommended close conservative observation with supportive care alone. A follow-up CT scan showed an increase in the amount and extent of PI, but there were no other worrisome gastrointestinal findings on the CT and the patient continued to be asymptomatic.
Steroids were discontinued and a conservative approach was followed. A CT scan performed a month later documented resolution of the PI.
The patient was discharged without any complications and was instructed to follow-up with her treating physician.
Diagnosis:
N/A
Treatment:
Close conservative observation with supportive care alone.
Follow-Up:
The patient was advised to follow-up with her treating physician.
| radiotherapy for the following:
Clinical evaluation | {"cancer": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Overall summary:
The patient is a 70-year-old woman who presented with left upper jaw pain and mastication difficulties several weeks after complete dental extraction. The physical examination was unremarkable except for the oral examination showing edentulism and an area of osteonecrosis with acute inflammation in the left maxilla bone. The tissue sections revealed Actinomyces-like organisms and some vegetable fragments. The patient was diagnosed with acute osteomyelitis caused by actinomycosis and was started on a six-month regimen of oral penicillin VK and oral hygiene measures. At the end of the therapy, she had made a complete recovery.
Medical history:
The patient had multiple myeloma treated for nine years with pomalidomide and oral dexamethasone prior to presenting with left upper jaw pain. The patient also had a history of type 2 diabetes mellitus, hypertension, and chronic kidney disease stage 3.
Hospital course:
The patient presented with left upper jaw pain and mastication difficulties several weeks after complete dental extraction. Physical examination was unremarkable except for an area of osteonecrosis with acute inflammation in the left maxilla bone noted during the oral examination. The tissue sections revealed Actinomyces-like organisms and vegetable fragments, and a diagnosis of acute osteomyelitis caused by actinomycosis was made. The patient was started on a six-month regimen of oral penicillin VK and oral hygiene measures. At the end of the therapy, she had made a complete recovery.
Treatment:
The patient was started on a six-month regimen of oral penicillin VK and oral hygiene measures to treat acute osteomyelitis caused by actinomycosis.
Follow-up:
The patient had a follow-up visit one month after starting the therapy, where her symptoms had completely resolved and the oral defect was beginning to close.
Discharge condition:
The patient was discharged in good condition at the end of her therapy and had made a complete recovery from acute osteomyelitis caused by actinomycosis.
| the two treatment groups. None of the patients showed any | {"cancer": "YES"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Hospital Course:
The patient is a Hispanic male infant born at an outside medical center with uncontrolled gestational diabetes and pre-eclampsia. He was born large for gestational age (LGA) at 34 weeks with a birth weight of 4.11 kg. His Apgar scores were 2 at 1 min and 6 at 5 min. On day of life (DOL) 2, he was transferred to our hospital for respiratory distress syndrome (RDS), supraventricular tachycardia, persistent hypoglycemia, and hypoplastic aortic arch.
Diagnostic Assessment and Treatment:
During the hospital stay, the patient's glucose infusion rate (GIR) was gradually increased to 16 mg/kg/min to maintain plasma glucose close to 70 mg/dL when titrating IV dextrose. Despite consuming 26 cal/oz. of formula, he developed hypoglycemic episodes (BG below 50mg/dL) on DOL 21. A workup for Congenital Hyperinsulinism (CHI) was initiated on DOL 25. The results revealed an elevated insulin level of 16.3 mcIU/mL coincident with a plasma glucose level of 48 mg/dL and beta hydroxybutyrate level of less than 100 mcmol/L. The patient's ammonia, pyruvic acid, cortisol level, serum amino acids, acyl carnitine profile, and urine organic acids were all normal. A DNA sequencing test for CHI revealed a heterozygous maternally-inherited likely pathogenic variant in KCNJ11, c.616C > T (p.Arg206Cys). This variant is rare in population databases (ExAC and gnomAD; 3/242,646 alleles) and damaging according to in silico tools (GERP, SIFT, PolyPhen). Diazoxide was started and plasma glucose levels stabilized above 70 mg/dL at the dose of 15 mg/kg/day by DOL 30.
Hospital Discharge:
The patient was discharged home on DOL 71 with diazoxide at a dose of 10 mg/kg/day. His plasma glucose was stable on a similar dose at the time of his last visit, when he was 11 months old. The patient will need close follow-up with a pediatric endocrinologist to monitor his blood glucose levels and adjust medication dosages if necessary. No further follow-up arrangements were made as the patient was discharged in stable condition.
| glucose to 18 mg/kg/min. The g | {"diabetes": "NO"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [Name]
Medical Record Number: [Number]
Discharge Date: [Date]
Hospital Course:
The patient was a 71-year-old male with metastatic CRPC who presented to our hospital with convulsive seizures. Upon admission, his blood pressure was noted to be 90/65, and routine laboratory and endocrinology tests revealed mild liver dysfunction and decreased levels of potassium and cortisol. These results suggested that hypokalemia was associated with abiraterone therapy. The patient was given potassium supplementation and prescribed an increased dosage of prednisone following discontinuation of abiraterone. Additionally, furosemide, which had been used for a prolonged period due to protracted lower extremity edema, was also interrupted.
The patient showed marked improvement after supplementation therapy, with normalized levels of serum potassium and plasma cortisol. He was discharged two weeks after admission and continued on a regimen of oral prednisone.
Diagnosis:
Metastatic castration-resistant prostate cancer
Hypokalemia associated with abiraterone therapy
Condition at Discharge:
Stable with improved symptoms
Follow-up:
The patient is advised to schedule follow-up appointments with his primary care physician.
| ity pain, was administered and was taken as a supplement | {"cancer": "YES"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: Case 7
Age: 59 years
Gender: Male
Admission Date: [insert date]
Discharge Date: [insert date]
HISTORY OF PRESENT ILLNESS AND HOSPITAL COURSE:
The patient, a 59-year-old male with dm2, was admitted with a diagnosis of HCV genotype 2. Before starting treatment, his viral load was 99,400 IU/mL. The treatment strategy of SOF+RBV was given, and the patient had a rapid virologic response with undetectable viral load at week 4 that remained undetectable for the remainder of 10 weeks of SOF+RBV therapy. The treatment was stopped after 12 weeks and a sustained virologic response (SVR) was observed. The viral load remained undetectable until SVR24.
PAST MEDICAL HISTORY:
- DM2
MEDICATIONS AT DISCHARGE:
The patient was not on any medications at discharge.
FOLLOW-UP APPOINTMENTS:
The patient is scheduled for a follow-up appointment in 1 month to monitor the HCV viral load.
DISCHARGE INSTRUCTIONS:
No regular medications were prescribed at the time of discharge. The patient is advised to follow-up with the healthcare provider in 1 month to monitor the HCV viral load.
| weeks. The patient was diagnosed with a viral load that | {"diabetes": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [patient's name]
DOB: [patient's date of birth]
Gender: Female
Admission Date: [admission date]
Discharge Date: [discharge date]
Admitting Diagnosis: Perineal swelling
Hospital Course:
The patient presented with complaints of perineal swelling, which was noticed 6 months ago in the right perineal region. The MRI of the perineum was carried out, which revealed a well-encapsulated lesion measuring 36 × 26 × 24 mm, suggestive of an epidermoid cyst. Surgical excision of the swelling was performed, and subsequent histopathology confirmed it to be an epidermoid cyst without any evidence of malignancy.
Clinical Course:
The patient's perineal swelling was successfully treated with surgical excision, and there were no complications during the hospitalization. Postoperative care was satisfactory, and the patient was discharged in stable condition. The patient was advised to follow up with her primary care physician for routine care.
Medications:
None
Advised follow-up:
The patient was advised to follow up with her primary care physician for routine care.
Diagnostic Results:
MRI of the perineum revealed a well-encapsulated lesion measuring 36 × 26 × 24 mm in the soft tissues of the perineum on the right side, indicative of an epidermoid cyst without any malignancy.
Condition at Discharge:
The patient's condition at discharge was stable with complete resolution of perineal swelling.
Procedures:
Surgical excision of the perineal swelling was performed successfully.
Consultations:
None
Summary:
The patient presented with perineal swelling and was diagnosed with an epidermoid cyst through MRI and subsequent histopathology. Surgical excision was performed successfully without any complications. The patient was discharged in stable condition and advised to follow up with her primary care physician for routine care.
| . The remaining lesions were also found to be associated with | {"cancer": "NO"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Hospital Course:
The 50-year-old male presented for preoperative evaluation in August 2013 revealing an abnormality not seen on previous imaging. Additional testing confirmed adenocarcinoma, poorly differentiated with a solid and single cell pattern. The patient underwent right upper lobe lobectomy with concurrent chemo-radiotherapy consisting of cisplatin and pemetrexed. Following the second chemotherapy treatment, the patient experienced intolerable side effects leading to the decision to not continue therapy. A subsequent PET scan and CT imaging have been negative for evidence of recurrence. Postoperatively the patient experienced numerous challenges including several admissions for pneumonia, fluid overload, and bronchospasms, a pulmonary embolism, and placement of an inferior vena cava (IVC) filter. The patient has a history of tracheostomy for chronic hypercapnic respiratory failure and radical prostatectomy.
Discharge Summary:
The patient, a 50-year-old male, was discharged from care following treatment for adenocarcinoma of the right upper lobe. The patient underwent right upper lobe lobectomy with concurrent chemo-radiotherapy with cisplatin and pemetrexed. The patient experienced intolerable side effects following the second treatment session, leading to a decision to not continue with chemotherapy. While postoperatively the patient had several admissions for various complications, subsequent imaging has been negative for evidence of recurrence. The patient has a history of tracheostomy for chronic hypercapnic respiratory failure and radical prostatectomy. The patient is currently on medications including rivaroxaban, amlodipine, atorvastatin, clonidine, insulin lispro, insulin glargine, losartan, metoprolol, prednisone, montelukast, diltiazem, and low-dose naltrexone. The care team recommends continued follow-up with imaging and oncology specialists.
| in the neck that may have led to pulmonary embol | {"diabetes": "MAYBE"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient: [Name]
DOB: [Date of birth]
Sex: [Gender]
Admission date: [Admission date]
Discharge date: [Discharge date]
Clinical presentation: Worsening fatigue associated with abdominal discomfort
Hospital course:
The patient, [Name], was admitted to the hospital at 36 weeks of gestation due to worsening fatigue associated with abdominal discomfort. The patient had a history of an uncomplicated cesarean delivery of a first child six years prior and was diagnosed with chronic myeloid leukemia (CML) one year ago. Despite initial treatment with imatinib 400 mg per day during the first and second trimester and interferon-α in the later half of pregnancy, the patient was found to have a palpable spleen and leukocytosis at 245,000WBC/mm3 including 32% blast cells.
Upon bone marrow aspiration, the patient was diagnosed with CML in acute phase with a karyotype of 46,XX,t(9,22)(q34;q11.2) in 100% of the analyzed cells. Due to the significant deterioration and urgent need for chemotherapy, a cesarean delivery was planned at the end of 36 weeks, which was uneventful under general anesthesia. Postoperatively, the patient received a multimodal analgesia and thromboprophylaxis.
Following the delivery, the patient was started on treatment with imatinib, 800 mg daily, without any satisfactory response. Palliative treatment with hydroxyurea was initiated due to disease progression resulting in partial response.
Course of hospitalization:
- Admitted at 36 weeks of gestation with worsening fatigue associated with abdominal discomfort
- Diagnosed with CML in acute phase with a karyotype of 46,XX,t(9,22)(q34;q11.2) in 100% of the analyzed cells
- Cesarean delivery was planned and carried out uneventfully under general anesthesia at the end of 36 weeks
"- Ruled out gdm\n - Postoperatively", the patient received a multimodal analgesia and thromboprophylaxis
- The patient was started on treatment with imatinib, 800 mg daily, without any satisfactory response
- Palliative treatment with hydroxyurea was initiated due to disease progression with partial response
Discharge plan:
The patient's condition has been stabilized and she is being discharged with palliative treatment with hydroxyurea. The patient will be followed up by her hematologist and obstetrician. Further management will be determined accordingly.
| fourth trimester, the patient did not develop an effective | {"cancer": "YES"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary
Patient: 60-year-old overweight female
Diagnoses: Nonalcoholic steatohepatitis with fibrosis, pancreatitis with hyperdense material within the common bile duct
Hospital Course:
The patient presented to her primary care physician for a health maintenance exam and complained of hematuria and pruritus. The CT scan revealed diffuse hepatic steatosis and the follow-up MRI Liver with Gadavist revealed hepatosplenomegaly with hepatic steatosis with no evidence of liver masses. Further serologic testing for elevated alkaline phosphatase levels revealed negative results. The subsequent liver biopsy showed central zone macrovesicular steatosis and a large amount of ballooning hepatocytes with Mallory-Denk bodies, consistent with steatohepatitis with fibrosis. After biopsy, she experienced intermittent bouts of acute chest and epigastric abdominal pain with nausea and increasing stool frequency. Work-ups and imaging modalities showed no defining etiology until the contrasted CT scan finally revealed pancreatitis with hyperdense material within the common bile duct. She underwent EGD that failed to reveal any abnormalities, including any signs of bleeding, but subsequently underwent ERCP with sphincterotomy and 9-12 mm balloon sweep of small blood clot from the left intrahepatic duct. A 10 French by 7 cm stent was placed in the common bile duct and there was adequate bile flow. A follow-up ERCP was performed 8 weeks later and showed no biliary dilation or obstruction.
Course in Hospital:
The patient was referred to a tertiary center for further management. She underwent EGD and ERCP with stent placement with no evidence of further bleeding. Her alkaline phosphatase and bilirubin returned to their baseline prior to the liver biopsy. She did not have any recurrence or relapse of her symptoms. There were no further signs of bleeding and her hemoglobin returned to baseline.
Discharge Instructions:
The patient is advised to follow up with the gastroenterologist to monitor the steatohepatitis and pancreatitis, and to continue a healthy diet and lifestyle to manage her comorbidities, including type 2 diabetes, hypothyroidism, hyperlipidemia, hypertension, and internal hemorrhoids. She is also advised to avoid alcohol and tobacco products.
Follow-up:
Follow-up with the gastroenterologist for monitoring and further management of the steatohepatitis and pancreatitis.
| omas. These findings were confirmed by 3x cross- | {"diabetes": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient: 42-year-old Caucasian male
Admission Date: TBD
Discharge Date: TBD
Hospital Course:
The patient was admitted with rapidly progressive gait disturbance, lower extremity weakness, and ascending hypoesthesia. The nerve conduction studies showed a proximal demyelinating sensorimotor polyneuropathy with active denervation, prolonged motor distal latency, and a reduction in the motor conduction velocity in N. medianus and N. ulnaris. The cerebrospinal fluid (CSF) revealed albuminocytologic dissociation with an elevated protein level. The patient was diagnosed with typical CIDP (chronic inflammatory demyelinating polyneuropathy) and treated with IVIg therapy with significant improvement.
During follow-up, the patient complained of increasing physical exhaustion, reduction in walking distance, and worsening of residual dysphagia. The patient was found to have MG (Myasthenia gravis) due to the positive AChR (Acetylcholine receptor) antibodies, titin antibodies, and abnormal decrement seen on repetitive nerve stimulation. The patient received pyridostigmine and had the anterior mediastinal mass confirmed to be a thymoma.
The patient was maintained on long-term immunosuppression with azathioprine and prednisone in addition to IVIg therapy, which improved dysphagia, dysarthria, and gait unsteadiness. The patient was later diagnosed with anti-phospholipase A2 receptor antibody-positive membranous glomerulonephritis, a common cause of nephrotic syndrome, and was treated appropriately. Despite being hospitalized for a year due to critical illness complicated by sepsis, the patient ultimately recovered from myasthenic crisis and regained partial autonomy.
Diagnosis:
1. Typical CIDP (chronic inflammatory demyelinating polyneuropathy)
2. MG (Myasthenia gravis)
3. Anti-phospholipase A2 receptor antibody-positive membranous glomerulonephritis
Treatment:
1. IVIg therapy
2. Long-term immunosuppression with azathioprine and prednisone
3. Pyridostigmine therapy
4. Thymectomy
Follow-up:
The patient will continue to follow up with the healthcare team regularly for monitoring of their conditions and treatment efficacy.
| and was treated with an immunoagulation therapy. | {"cancer": "YES"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary:
Patient Name: [Patient Name]
Medical Record Number: [Medical Record Number]
Admission Date: [Admission Date]
Discharge Date: [Discharge Date]
Hospital Course:
The patient was admitted to the hospital with symptoms of dyspnea, orthopnea, and tachycardia, which were promptly treated and controlled. The patient's medical history included a diagnosis of hemophilia carrier with low FVIII level, which was redefined as mildly severe during the latest assessment. The patient had a history of menorrhagia, hematemesis, and abundant hemorrhages during childbirth and dental extractions, as well as having two sons with hemophilia A. The patient was treated with cryoprecipitate and later Factor VIII concentrates as necessary. There was no history of bleeding problems in the father. The patient had well-controlled hypertension and was not diabetic.
Diagnostic Results:
A chest X-ray confirmed heart failure, and the ECG showed atrial fibrillation with a rapid ventricular response. 3D echocardiography showed a dilated left auricular of 22 mm3 with preserved ejection fraction and no valvular disease. Her CHADS2-VASC score was 3, and the HAS-BLED score was 2.
Treatment:
The patient was treated with amiodarone and a beta-blocker, which were effective in controlling the AF rate. Aspirin 100 mg/day was started along with omeprazole 20 mg/day for the previous history of gastrointestinal bleeding. The patient declined pulmonary vein isolation due to its high cost.
Discharge Condition:
During the 11-month follow-up, the patient did not experience any bleeding or gastric symptoms. The AF rate was well controlled, and the patient was discharged in stable condition.
Discharge Medications:
None mentioned in the case report.
Discharge Instructions:
The patient was advised to continue taking aspirin and omeprazole as instructed and to follow-up with their physician as scheduled. The patient was also encouraged to adhere to a healthy lifestyle and manage their hypertension to prevent complications.
Follow-up Recommendations:
Follow-up with the physican as scheduled and adhere to a healthy lifestyle.
| diagnosis was that of a hyperalgesia, hyp | {"diabetes": "NO"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
DISCHARGE SUMMARY
Patient Name: N/A
Date of Birth: N/A
Date of Admission: N/A
Date of Discharge: N/A
Reason for Admission: N/A
HOSPITAL COURSE:
This patient is a 37-year-old woman with Autism Spectrum Disorder (ASD) who provided home care for her mother who had end-stage breast cancer. Her father was visually impaired, and the daughter was the main caregiver. The home care staff initially had difficulty contacting and communicating with her as she often focused on household tasks such as dishwashing.
After the diagnosis of ASD was disclosed, the patient received consultation and social skill training at an outpatient clinic to improve her communication, scheduling, and caregiving abilities. Inappropriate behavior decreased following explanations and making communication rules with the patient.
The patient's mother's condition worsened, and she required opioids for pain control. The patient was able to communicate with the home care staff effectively and provide appropriate care during this time. Unfortunately, the patient's mother passed away at home.
DISCHARGE CONDITION:
The patient is being discharged from care and services as her mother has passed away.
FOLLOW-UP RECOMMENDATIONS:
No further follow-up recommendations are needed at this time.
DISCHARGE INSTRUCTIONS:
We extend our sincerest condolences to the patient and her family. If the patient requires further assistance with grief counseling or support, she is encouraged to contact her primary care physician for further recommendations.
Signed:
[Name and Signature of Discharge Physician]
[Date and Time of Discharge]
| and to address her personal issues. The mother was diagnosed | {"cancer": "NO"} |
You are a medical doctor specialized in diabetes diagnosis.
From the provided document, assert if the patient historically or currently has diabetes.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"diabetes": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Discharge Summary
Patient Name: [REDACTED] MRN: [REDACTED]
Date of Admission: [REDACTED] Date of Discharge: [REDACTED]
Admitting Diagnosis: Sarcomatoid gastric carcinoma with hepatic, regional and abdominal metastases.
Hospital Course:
The patient is a 50-year-old female with a medical history significant for diabetes mellitus type 2, hypertension, and cardiomyopathy who presented with sharp abdominal pain in the right upper quadrant for 4 weeks and hematemesis with bright red blood and clots.
A computed tomography (CT) of the abdomen/pelvis with contrast showed a partially exophytic lobular mass along the superior wall of the gastric fundus measuring 4.5 × 4.3 × 2.0 cm, seven lesions within the liver with the largest measuring 2.2 × 2.0 × 2.5 cm, and a metastatic lymph node anterior to the GE junction.
EGD showed a large polypoid fundic mass. H&E staining demonstrated characteristics of gastric carcinoma with final pathological findings of a sarcomatoid carcinoma, which was positive for cytokeratin, SMA, desmin, and GATA3. The mammogram was reported as BIRADS-1, with no evidence of any urothelial mass/neoplasm on the earlier CT scans.
The patient was discharged to follow up with an oncologist. However, she presented again with nausea and vomiting, and a repeat CT of the abdomen/pelvis showed an increase in the gastric mass to 8.7 cm with ulceration and invasion of the left lobe of the liver. There was a massive increase in the regional and hepatic metastases with the largest measuring 10 cm, and there was metastasis to the right adrenal gland with associated ascites. The patient was then transferred to a tertiary care hospital but died before starting therapy.
Discharge Diagnosis: Sarcomatoid gastric carcinoma with hepatic, regional and abdominal metastases.
Discharge Instructions: This patient has expired, and there are no discharge instructions.
Follow-up Appointments: Not applicable.
Primary Care Provider: Not applicable.
Specialist(s): Oncologist.
Recommended Follow-up: The patient was recommended to have follow up with an oncologist though it was not possible due to death.
| , nocturnal pattern, and a partial exophy | {"diabetes": "YES"} |
You are a medical doctor specialized in cancer diagnosis.
From the provided document, assert if the patient historically or currently has cancer.
For each condition, only pick from "YES", "NO", or "MAYBE". And you must following format without anything further. The results have to be directly parseable with python json.loads().
Sample output: {"cancer": 'MAYBE'}.
Never output anything beyond the format.
Provided document:
Hospital Admission Summary:
This document summarizes the hospitalization of a 52-year-old female patient who was admitted due to complications related to schizoaffective disorder. The patient had a history of lithium treatment for over 18 years and had reported various comorbidities including high body mass index, hypertension, and chronic kidney disease. Diagnostic imaging revealed multiple tumors that eventually led to respiratory failure and the patient passed away.
Hospital Course:
The patient was admitted for medical evaluations in September 2015. Diagnostic imaging revealed multiple tumors located in the thyroid gland and kidneys. The patient underwent thyroidectomy and subsequent histological examinations showed the presence of two different tumors - a papillary thyroid carcinoma and an epithelial sarcoma-like tumor arising from the right lobe. A renal biopsy suggested the presence of oncocytoma. The patient's condition declined rapidly, and despite aggressive treatment, the patient eventually passed away in May 2016.
Physical Exam:
The physical examination revealed multiple nodules and tumors present in the thyroid gland and both kidneys. The patient also reported comorbidities, including hypertension, chronic kidney disease, increased body mass index, and elevated fasting plasma glucose levels.
Diagnostic Studies:
Computer tomography scans revealed pulmonary metastasis, an increased adrenal gland, and a renal mass in the left kidney. Further diagnostic examinations included thyroidectomy, histological examinations, and renal biopsy.
Summary and Discharge Instructions:
The patient's condition continued to worsen despite aggressive treatment interventions. The patient eventually passed away due to respiratory failure caused by pulmonary metastases. The hospital team would like to express condolences to the patient's family.
| anterior pituitary gland (a form of thyroid gland | {"cancer": "YES"} |