text_id
stringclasses 37
values | sentence_id
int64 1
43
| text
stringlengths 20
513
| relations
listlengths 0
13
|
|---|---|---|---|
100606
| 15
|
The rest of the systemic examination was within normal limits.
|
[
[
"normal limits",
"examination"
]
] |
100606
| 16
|
Considering this as a probable case of TB with COVID-19 he was advised a chest radiograph with sputum microscopy (Ziehl Neelsen (ZN) staining for acid-fast bacilli), Cartridge-based nucleic acid amplification test (CBNAAT) of the sputum and other routine investigations.
|
[] |
100606
| 17
|
To check for the COVID-19 he was advised qualitative polymerase chain reaction (PCR) test from the oropharyngeal swab.
|
[] |
100606
| 18
|
The results were surprising with Mycobacterium tuberculosis detected on sputum fluorescent microscopy and were also confirmed by the CBNAAT.
|
[] |
100606
| 19
|
However, there was no resistance to Rifampicin.
|
[] |
100606
| 20
|
The results of the PCR were positive for RNA specific to SARS-CoV-2.
|
[
[
"positive",
"SARS-CoV-2"
]
] |
100606
| 21
|
Besides, the chest radiograph PA-view was suggestive of bilateral consolidations on the middle lobes of lungs with ill-defined borders.
|
[] |
100606
| 22
|
The other investigations revealed a low lymphocyte count (1x 10 9 /L) and increased levels of C-reactive protein (CRP) (57 mg/L), lactate dehydrogenase (LDH) (580 U/L), and erythrocyte sedimentation rate (ESR) (70 mm in the 1 st hour).
|
[
[
"1x 10 9 /L",
"count"
],
[
"57 mg/L",
"CRP"
],
[
"57 mg/L",
"protein"
],
[
"580 U/L",
"dehydrogenase"
],
[
"580 U/L",
"LDH"
],
[
"70 mm",
"ESR"
],
[
"70 mm",
"rate"
]
] |
100606
| 23
|
Also, a sample for liquid culture (MGIT BACTEC) was sent to the Intermediate Reference Laboratory (IRL) which revealed the growth of Mycobacterium tuberculosis.
|
[] |
100606
| 24
|
Computed tomography was not performed as the diagnosis was established by other cheaper and faster methods and also the patient was unwilling for the same.
|
[] |
100606
| 25
|
All the other routine investigations were within normal limits.
|
[
[
"normal limits",
"investigations"
]
] |
100606
| 26
|
He was referred to the nearest designated COVID-19 management center, where he was managed as per national guidelines.
|
[] |
100606
| 27
|
Besides, he was also started on an antitubercular treatment of four drugs as per the National Tuberculosis Elimination Program (NTEP) guidelines.
|
[] |
100606
| 28
|
He was advised follow-up post completion of his stay at the designated COVID-19 center, but he has not yet reported back for follow-up.
|
[] |
100606
| 29
|
Written informed consent was obtained from the patient for using clinical data and images for publication in this study.
|
[] |
100653
| 1
|
A 31-year-old woman with no pathological history was admitted to our hospital for chest pain, bone and joint pain, hair loss and asthenia for the last 3 months.
|
[] |
100653
| 2
|
On physical examination, we found fever at 38°C, polypnea at 32 cycles/min, arterial hypertension at 160/90 mmHg, malar rash, synovitis of wrists, elbows and ankles, and edema on both legs.
|
[
[
"38°C",
"fever"
],
[
"32 cycles/min",
"polypnea"
],
[
"160/90 mmHg",
"hypertension"
]
] |
100653
| 3
|
Diagnostic assessment: laboratory tests disclosed the following values: Increase level of erythrocyte sedimentation rate 120 mm/1 st hour, C reactive protein was 20 mg/l.
|
[
[
"120 mm/1 st hour",
"rate"
],
[
"20 mg/l",
"protein"
]
] |
100653
| 4
|
The blood count showed hemoglobin at 9g/dl, MCV at 85 µ 3, lymphopenia at 400/mm 3, while platelets were normal 450 000/mm 3.
|
[
[
"9g/dl",
"hemoglobin"
],
[
"85 µ 3",
"MCV"
],
[
"400/mm 3",
"lymphopenia"
],
[
"450 000/mm 3",
"platelets"
]
] |
100653
| 5
|
Direct coombs test was negative.
|
[
[
"negative",
"test"
]
] |
100653
| 6
|
Serum Albumin was 25g/l; proteins level was low at 50g/l and proteinuria at 3.2g/day.
|
[
[
"25g/l",
"Albumin"
],
[
"low",
"level"
],
[
"50g/l",
"level"
],
[
"3.2g/day",
"proteinuria"
]
] |
100653
| 7
|
Creatinine was normal.
|
[
[
"normal",
"Creatinine"
]
] |
100653
| 8
|
Anti-nuclear antibody ANA were positive 1/320 with homogeneous pattern, anti-dsDNA level was 160U/ml.
|
[
[
"positive 1/320",
"antibody"
],
[
"positive 1/320",
"ANA"
],
[
"160U/ml",
"level"
]
] |
100653
| 9
|
Anti-cardiolipin IgG antibodies were positive 25UGPL.
|
[
[
"positive 25UGPL",
"antibodies"
]
] |
100653
| 10
|
Rheumatoid Factor was negative.
|
[
[
"negative",
"Factor"
]
] |
100653
| 11
|
C3 and C4 complement fractions were low (0.2 g/l and 0.05 g/l).
|
[
[
"low",
"fractions"
],
[
"0.2 g/l",
"fractions"
],
[
"0.05 g/l",
"fractions"
]
] |
100653
| 12
|
Chest x-ray, electrocardiogram and echocardiography were normal.
|
[
[
"normal",
"electrocardiogram"
],
[
"normal",
"x-ray"
],
[
"normal",
"echocardiography"
]
] |
100653
| 13
|
Chest computed tomography (CT) scan showed proximal pulmonary embolism.
|
[] |
100653
| 14
|
Renal ultrasound was normal.
|
[
[
"normal",
"ultrasound"
]
] |
100653
| 15
|
Renal biopsy reveals immunocomplex nephritis, lupus nephritis, segmental mesangial proliferation, mild activity lupus nephritis class III (A/C).
|
[] |
100653
| 16
|
Before starting corticosteroids, we analyzed electrolytes.
|
[] |
100653
| 17
|
Serum calcium was elevated 132 mg/l with hyper-calciuria 479 mg/24 h. 25 OHD was normal.
|
[
[
"elevated",
"calcium"
],
[
"132 mg/l",
"calcium"
],
[
"479 mg/24 h",
"hyper-calciuria"
],
[
"normal",
"OHD"
]
] |
100653
| 18
|
Alcaline phosphatase was 420 UI/l. the patient did not have any symptoms of hypercalcemia.
|
[
[
"420 UI/l",
"phosphatase"
]
] |
100653
| 19
|
Serum protein Electrophoresis showed polyclonal hypergammaglobulinaemia.
|
[] |
100653
| 20
|
Serum and urine immunofixation as well as Bence-Jones proteinuria were negative.
|
[
[
"negative",
"proteinuria"
],
[
"negative",
"immunofixation"
]
] |
100653
| 21
|
Intact parathyroid hormone (iPTH) was high 628 pg/ml.
|
[
[
"high",
"hormone"
],
[
"high",
"iPTH"
],
[
"628 pg/ml",
"hormone"
],
[
"628 pg/ml",
"iPTH"
]
] |
100653
| 22
|
CT scan and ultrasound of parathyroid imaging revealed a lower left parathyroid nodule measuring 2cm x 1 cm.
|
[
[
"2cm x 1 cm",
"measuring"
]
] |
100653
| 23
|
Femoral and lumbar bone mineral density (BMD) showed osteoporosis (T-score: -2.6).
|
[
[
"2.6",
"T-score"
]
] |
100653
| 24
|
In addition, we found multiple pelvic osteolytic lesions at CT scan.
|
[] |
100653
| 25
|
Other causes of hypercalcemia and bone lysis were excluded.
|
[] |
100653
| 26
|
The diagnosis in this case was SLE with lupus nephritis class III and anti-phospholipid syndrome, complicated by pulmonary embolism associated to primary hyperparathyroidism causing severe hypercalcemia, osteoporosis.
|
[] |
100653
| 27
|
Therapeutic intervention: the patient was given a pulse of methyl-prednisolone 15 mg/kg/day for 3 days followed by oral prednisone 1 mg/kg/day, associated with intravenous cyclophosphamide 750 mg/m 2 /month for 6 months.
|
[] |
100653
| 28
|
Mycophenolate mofetil 2 g/day was prescribed as a maintenance therapy of lupus nephritis with hydroxychloroquine at a dose of 400 mg/day.
|
[] |
100653
| 29
|
Treatment of pulmonary embolism was initiated with subcutaneous low molecular weight heparin (enoxaparin 0.1 ml/10 kg/12h) followed by antivitamin K.
|
[] |
100653
| 30
|
For Hypercalcemia, patient has received intravenous fluid with furosemide.
|
[] |
100653
| 31
|
She also required Alendronate 70 mg/week with Vitamin D 400u/day for osteoporosis.
|
[] |
100653
| 32
|
The left parathyroid gland was surgically removed.
|
[] |
100653
| 33
|
Histopathological examination revealed parathyroid adenoma.
|
[] |
100653
| 34
|
Her immediate postoperative parathyroid hormone level was 64 pg/ml with a calcium level of 98 mg/l.
|
[
[
"64 pg/ml",
"level"
],
[
"98 mg/l",
"level"
]
] |
100653
| 35
|
Follow-up and outcomes: forty-eight hours after the surgery she developed oral paresthesia.
|
[
[
"72 mg/l",
"hypocalcemia"
]
] |
100653
| 36
|
She had hypocalcemia at 72 mg/l.
|
[] |
100653
| 37
|
She required oral supplementation for few months.
|
[] |
100653
| 38
|
Additional investigations for multiple endocrine neoplasia were negative.
|
[
[
"negative",
"investigations"
]
] |
100653
| 39
|
The patient remained asymptomatic.
|
[] |
100653
| 40
|
Her SLE was calm without any relapse.
|
[
[
"negative",
"Control"
]
] |
100653
| 41
|
Control of proteinuria was negative.
|
[] |
100653
| 42
|
Corticosteroids was dropped.
|
[] |
100653
| 43
|
The follow-up was 4 years.
|
[] |
100658
| 1
|
A 35-year-old mentally ill man was transferred from a local psychiatric hospital after attempted suicide by fire 3 days before admission.
|
[] |
100658
| 2
|
He acquired full-and partial-thickness injury in approximately 38% of his TBSA, including face and neck (5%), both upper extremities (8%), right thigh (4%), left thigh and leg (3%), and most of his anterior and posterior trunk (16%).
|
[] |
100658
| 3
|
The patient was hospitalized for 66 days and underwent five debridement surgeries.
|
[] |
100658
| 4
|
The psychiatric diagnosis was schizophrenia type ICD 10 F20.3, treated with Haloperidol 1.5 mg and Diazepam 5 mg daily.
|
[] |
100658
| 5
|
The patient was occasionally restrained due to rebellious and self-destruction behavior.
|
[] |
100658
| 6
|
The nutrition management of this patient was started after a week of hospitalization, which is considered late.
|
[] |
100658
| 7
|
In the initial nutrition assessment, the patient was 40 kg weight and 150 cm tall thus the body mass index (BMI) was 17,57 kg/m 2 or underweight.
|
[
[
"40 kg",
"weight"
],
[
"150 cm",
"tall"
],
[
"17,57 kg/m 2",
"index"
],
[
"17,57 kg/m 2",
"BMI"
]
] |
100658
| 8
|
Gastrointestinal symptoms and signs were not found.
|
[] |
100658
| 9
|
Information regarding the patient's dietary intake in the last two weeks and weight change within the last 6 months could not be obtained, but his mother claimed that the patient seemed to lose weight because he refused any food that had been offered to him; he only smoked and drank coffee.
|
[] |
100658
| 10
|
Albumin level was 3.6 gr/L with imbalanced electrolyte levels.
|
[
[
"3.6 gr/L",
"level"
]
] |
100658
| 11
|
Signs of fluid accumulation were not found.
|
[] |
100658
| 12
|
According to the subjective global assessment (SGA) tool, the patient belonged to group C (severely malnourished).
|
[] |
100658
| 13
|
Energy and protein were given starting from 30 kcal/kg, increasing gradually to 50 kcal/kg, and 2 gp/kg divided into oral nutrition and oral nutrition supplements (ONS) with a 50:50 ratio.
|
[] |
100658
| 14
|
The patient was also given micronutrient supplementations, specifically vitamin A 100,000 units for the first week, vitamin C 100 mg 3 times a day, and zinc 20 mg once a day.
|
[] |
100658
| 15
|
During the early weeks of hospitalization, the patient's weight loss continued.
|
[] |
100658
| 16
|
At the end of the second week, his body weight was 36 kilograms while his serum albumin level was 2.7 gr/L.
|
[
[
"36 kilograms",
"weight"
],
[
"2.7 gr/L",
"level"
]
] |
100658
| 17
|
On the 28 th day, the patient's body weight was 33 kilograms while his serum albumin level was 2.1 gr/L.
|
[
[
"33 kilograms",
"weight"
],
[
"2.1 gr/L",
"level"
]
] |
100658
| 18
|
Energy and protein intake was maintained, but the ratio of oral intake and ONS was modified to 70:30.
|
[] |
100658
| 19
|
During the treatment, the patient's appetite was unstable.
|
[] |
100658
| 20
|
The patient was also hardly cooperative with enteral access.
|
[] |
100658
| 21
|
The patient often writhed in pain and became more aggressive.
|
[] |
100658
| 22
|
The patient did not respond well to analgesics and sedations.
|
[] |
100658
| 23
|
Partially parenteral nutrition (PN) enriched with branched-chain amino acid (BCAA) was administered to support protein needs.
|
[] |
100658
| 24
|
However, his BMI continued to decline, and on the 42 nd day, his body weight dropped to 32 kilograms with a serum albumin level of 2 gr/L.
|
[
[
"32 kilograms",
"weight"
],
[
"2 gr/L",
"level"
]
] |
100658
| 25
|
On the 66 th day, granulation tissues appeared on the wound bed.
|
[] |
100658
| 26
|
Considering the mental and nutrition status of the patient, it was decided not to continue with the skin graft surgery.
|
[] |
100658
| 27
|
The patient had lost 24% of body weight (BMI 11.96 kg/m 2) and the serum albumin level was 2.5 gr/L.
|
[
[
"11.96 kg/m 2",
"BMI"
],
[
"2.5 gr/L",
"level"
]
] |
100658
| 28
|
The patient displayed severe muscle wasting and subcutaneous fat loss.
|
[] |
100658
| 29
|
However, the general and mental condition was relatively better.
|
[] |
100658
| 30
|
The patient was discharged from the hospital.
|
[] |
100682
| 1
|
A 19-year-old healthy man was admitted to our cardiology department following a syncopal episode.
|
[] |
100682
| 2
|
His past medical history was unremarkable.
|
[] |
100682
| 3
|
He no family history of heart disease or sudden death.
|
[] |
100682
| 4
|
Two-days prior the syncope, he developed chest pain and an influenza-like illness consisting of fevers, rhinorrhea, and sore throat.
|
[] |
100682
| 5
|
At the physical exam, the patient was febrile at 39°C.
|
[
[
"39°C",
"febrile"
]
] |
100682
| 6
|
He had an inflamed throat, bradycardia at cardiac auscultation and there were no signs of heart failure.
|
[] |
100682
| 7
|
The electrocardiogram (EKG) showed grade III atrioventricular (AV) bloc with a ventricular rate of 38 beats per minute.
|
[
[
"38 beats per minute",
"rate"
]
] |
100682
| 8
|
Laboratory studies were remarkable for a HS-troponin level 181ng/L, a white blood cell count of 14270/mm³ with 48% lymphocytes, and elevated C-reactive protein at 90mg/L.
|
[
[
"181ng/L",
"level"
],
[
"14270/mm³",
"count"
],
[
"48%",
"lymphocytes"
],
[
"90mg/L",
"protein"
]
] |
100682
| 9
|
Serum electrolytes, kidney and liver functions were within normal limits.
|
[
[
"normal limits",
"functions"
]
] |
100682
| 10
|
A chest X-ray showed an appropriate cardiac size.
|
[] |
100682
| 11
|
The initial transthoracic echocardiography (TTE) showed a normal global left ventricular function (left ventricular ejection fraction (LVEF) 60%) and wall motion abnormalities (anteroseptal hypokinesia), with reduced left ventricular global longitudinal strain (LV GLS= -14.1%).
|
[
[
"60%",
"LVEF"
],
[
"60%",
"fraction"
],
[
"-14.1%",
"GLS"
],
[
"-14.1%",
"strain"
]
] |
100682
| 12
|
Cardiac magnetic resonance (CMR) showed increased signal intensity at the mid-lateral wall on T2-weighted images.
|
[] |
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