| { | |
| "username": "mm", | |
| "current_index": 3, | |
| "queue": [ | |
| { | |
| "index": 18, | |
| "label": "low_health_literacy", | |
| "original_text": "A 65-year-old man had a swollen right middle finger after a motorcycle crash 6 months earlier. The middle joint stayed bent, and the fingertip bent backward. He could not fully straighten the finger. An X-ray showed no broken bones. The problem was in the soft tissues and tendon on top of the finger. Before surgery, the middle joint could bend from 45 to 110 degrees but could not straighten. The doctors repaired the top tendon using a small strip from another tendon in the same finger. They put the middle joint in a straight splint for 2 weeks. After 2 weeks, he started gentle bending and straightening exercises for that joint. One month after surgery, the middle joint moved from 0 to 90 degrees. Two months after surgery, movement went back to normal. His hand function score (DASH) improved from 50 to 4.2.", | |
| "selected_wiki_anchor": "Treatment is generally with a splint that holds the fingertip straight continuously for 8 weeks. The middle joint is allowed to move. This should be begun within a week of the injury. If the finger is bent during these weeks, healing may take longer. If a large piece of bone has been torn off surgery may be recommended. Without proper treatment a permanent deformity of the finger may occur.", | |
| "wiki_fkgl": 6.680507246376813, | |
| "doc_fkgl": 5.560996503496504 | |
| }, | |
| { | |
| "index": 5, | |
| "label": "intermediate_health_literacy", | |
| "original_text": "A 54-year-old man with chronic kidney disease on long-term corticosteroids and immunosuppressants was admitted to respiratory medicine with fever, cough with sputum, and shortness of breath. Chest CT showed multiple bilateral ground-glass opacities. Laboratory studies showed elevated inflammatory markers, indicating possible bacterial, viral, or fungal infection. RSV antibodies were positive, while tests for other pathogens were negative. He was immunocompromised from prolonged corticosteroid and immunosuppressant use, with low total IgG and reduced CD4 and CD8 T-lymphocyte counts. Despite intensive anti-infective therapy and escalating respiratory support, his condition deteriorated rapidly, and he died from respiratory failure.", | |
| "selected_wiki_anchor": "Coccidioidomycosis is amazingly diverse in terms of its scope of clinical presentation, as well as clinical severity. About 60% of Coccidioides infections as determined by serologic conversion are asymptomatic. The most common clinical syndrome in the other 40% of infected patients is an acute respiratory illness characterized by fever, cough, and pleuritic pain. Skin manifestations, such as erythema nodosum, are also common with Coccidioides infection. Coccidioides infection can cause a severe and difficult-to-treat meningitis in AIDS and other immunocompromised patients, and occasionally in immunocompetent hosts. Infection can sometimes cause acute respiratory distress syndrome and fatal multilobar pneumonia. The risk of symptomatic infection increases with age.", | |
| "wiki_fkgl": 14.871428571428577, | |
| "doc_fkgl": 16.420789473684213 | |
| }, | |
| { | |
| "index": 0, | |
| "label": "intermediate_health_literacy", | |
| "original_text": "A 20\u2011year\u2011old woman had a 12\u2011year history of idiopathic nephrotic syndrome that initially presented with extensive cerebral venous thrombosis and pulmonary embolism. She was treated with anticoagulation and oral corticosteroids, then mycophenolate mofetil as a steroid\u2011sparing agent. A comprehensive thrombophilia work\u2011up was negative. She experienced multiple relapses controlled with steroids until 2017, then remained in remission; anticoagulation and MMF were discontinued. One year later, she developed sudden diffuse abdominal pain with postprandial vomiting and bilateral leg edema. Laboratory tests confirmed a relapse of nephrotic syndrome. Abdominal CT showed acute superior mesenteric artery thrombosis causing acute mesenteric ischemia. At surgery, there was extensive small\u2011bowel necrosis not compatible with survival. She died 48 hours later.", | |
| "selected_wiki_anchor": "Signs and symptoms\nMost people will present as nephrotic syndrome, with the triad of albuminuria, edema and low serum albumin (with or without kidney failure). High blood pressure and high cholesterol are often also present. Others may not have symptoms and may be picked up on screening, with urinalysis finding high amounts of protein loss in the urine. A definitive diagnosis of membranous nephropathy requires a kidney biopsy, though given the very high specificity of anti-PLA2R antibody positivity this can sometimes be avoided in patients with nephrotic syndrome and preserved kidney function", | |
| "wiki_fkgl": 14.414782608695656, | |
| "doc_fkgl": 15.20401179941003 | |
| }, | |
| { | |
| "index": 10, | |
| "label": "proficient_health_literacy", | |
| "original_text": "A 51-year-old male presented with acute, painful visual loss of the left eye (LE) for 3 days. Best-corrected distance visual acuity (BCDVA) was 20/20 OD and hand motion (HM) OS. Ocular motility and anterior segment were unremarkable OU. Fundus OS showed optic nerve head (ONH) swelling, choroidal bulging, multiple patches of subretinal fluid (SRF), and retinal pigment epithelial (RPE) corrugations; OD fundus was unremarkable.\n\nMultimodal imaging was obtained: OCT (OptoVue, Inc., Fremont, CA, USA; software version 2018.0.0.18) demonstrated mild RPE and choroidal bulging, RPE hyper-reflectivity with back shadowing, subretinal and intraretinal fluid, and mild retinal thickening. Indocyanine green angiography (ICGA) showed a geographic macular hypocyanescent area OS. Blue-autofluorescence (BAF) revealed a geographic macular area with speckled autofluorescence. B-scan ultrasonography showed optic nerve enlargement. Fluorescein angiography (FA) demonstrated vascular leakage at the ONH (hot disc) and a geographic patchy hypofluorescent area with speckled hyperfluorescent margins measuring approximately three disc diameters. Orbital and brain MRI with gadolinium revealed a retrobulbar nodular enhancing mass at the optic nerve\u2013sclera junction. Oncology consultation was unremarkable.\n\nGiven concern for malignancy and the enhancing orbital nodule, the patient underwent transconjunctival lateral orbitotomy one week after presentation. Intraoperatively, a pink localized scleral nodule with edematous Tenon was identified. With a clinical diagnosis of nodular posterior scleritis, sub-Tenon triamcinolone acetonide was administered. The patient declined admission and intravenous corticosteroids; oral prednisolone 50 mg/Kg was initiated. Rheumatologic and infectious work-up, including PPD (tuberculosis), chest X-ray, serum ACE (sarcoidosis), and C-ANCA (Wegener granulomatosis), was unremarkable.\n\nAt the one-week postoperative follow-up, BCDVA was 20/20 OD and counting fingers at 2 meters OS. SRF had resolved, and the macula was atrophic. Oral prednisolone was tapered over three months.", | |
| "selected_wiki_anchor": "First stage: This is the initial phase of the condition, and it takes place from birth to the age of 14 years old; it is characterized by the appearance of a large, perforated chorioretinal atrophic lesion at the central part of the macula which contains the vascular arch, alongside extra-macular white deposits and localized areas of hyperpigmentation in the retinal pigment epithelium. The heads of the optic nerve start taking a vertical ovaloid shape during this stage.\nSecond stage: This stage of the condition takes place from the age of 15 to 45 years old. In this phase of the condition, the previously mentioned macular perforation starts growing outside its original starting point, beyond the vascular arch, with relatively new spots of atrophy in the nasal retina starting to join into one, making one white, chorioretinal atrophic lesion as a result. Patients also start reporting visual hallucinations of flashing lights (photopsias) during this stage. Myopia, which is previously absent in affected patients, starts becoming apparent during one's 20th years of life.\nThird stage: This is the final stage, and it takes place at the age of 46 years old and later. In this stage, the previously mentioned atrophic lesions of the macula and the nasal retina expand and grow towards the optic disc, which consequently results in a narrow bridge of intact retina that passes through the optic disc in a vertical manner. During this stage, patients are more likely to report having difficulties seeing in low-light conditions.", | |
| "wiki_fkgl": 14.712311827956992, | |
| "doc_fkgl": 14.661870129870131 | |
| }, | |
| { | |
| "index": 14, | |
| "label": "intermediate_health_literacy", | |
| "original_text": "A 36-year-old woman had dysphagia due to a congenital right aortic arch with mirror-image branching.\nIn this rare pattern, the aorta runs to the right, wraps around the right main bronchus, and the head-and-arm arteries branch in the reverse order of normal.\nMost people have no symptoms unless the aorta or an associated bulge compresses the esophagus or trachea.\nSurgery is considered for major airway or esophageal compression, aneurysmal disease, thoracic aortic dissection, or a Kommerell diverticulum larger than 2 cm.\nThere is no standard operation; treatment is tailored to the person\u2019s anatomy and symptoms.\nIn this case, imaging showed external compression of the upper esophagus with a small Kommerell diverticulum (about 1.3 cm), so no intervention was performed and her symptoms improved.", | |
| "selected_wiki_anchor": "Diagnosis\nIn patients who have dysphagia, testing may first be done to exclude an anatomical cause of dysphagia, such as distortion of the anatomy of the esophagus. This usually includes visualization of the esophagus with an endoscope, and can also include barium swallow X-rays of the esophagus. Endoscopy is typically normal in patients with nutcracker esophagus; however, abnormalities associated with gastroesophageal reflux disease, or GERD, which associates with nutcracker esophagus, may be seen. Barium swallow in nutcracker esophagus is also typically normal, but may provide a definitive diagnosis if contrast is given in tablet or granule form. Studies on endoscopic ultrasound show slight trends toward thickening of the muscularis propria of the esophagus in nutcracker esophagus, but this is not useful in making the diagnosis.", | |
| "wiki_fkgl": 17.5712, | |
| "doc_fkgl": 11.984808362369339 | |
| }, | |
| { | |
| "index": 4, | |
| "label": "low_health_literacy", | |
| "original_text": "This is about a 13-year-old boy. He has had small growths in his throat since he was two years old. The growths were in his voice box and windpipe. They narrowed his breathing tube, so he had trouble breathing. It was like trying to breathe through a pinched straw. A chest scan showed several small cysts in his lungs. Doctors removed the throat growths. They also placed a breathing tube through a small hole in his neck to help him breathe. He got one dose of a medicine called bevacizumab (400 mg) through a vein. He also had breathing therapy. He got better. The problem has not come back during follow-up.", | |
| "selected_wiki_anchor": "Signs and symptoms \nA common symptom of laryngeal papillomatosis is a change in voice quality. More specifically, hoarseness is observed. As a consequence of the narrowing of the laryngeal or tracheal parts of the airway, shortness of breath, chronic cough and stridor (i.e. noisy breathing which can sound like a whistle or a snore), can be present. As the disease progresses, occurrence of secondary symptoms such as dysphagia, pneumonia, acute respiratory distress syndrome, failure to thrive, and recurrent upper respiratory infections can be diagnosed. The risk of laryngeal papillomatosis spreading to the lungs is higher in the juvenile-onset than the adult-onset. In children, symptoms are usually more severe and often mistaken for manifestations of other diseases such as asthma, croup or bronchitis. Therefore, diagnosis is usually delayed.", | |
| "wiki_fkgl": 12.342982283464568, | |
| "doc_fkgl": 2.581463963963966 | |
| }, | |
| { | |
| "index": 3, | |
| "label": "intermediate_health_literacy", | |
| "original_text": "This case describes an isolated, asymptomatic fetal cardiac rhabdomyoma first detected at 32 weeks\u2019 gestation. The pregnancy was monitored as an outpatient until 39 weeks plus one day, when delivery occurred by cesarean section. Postnatal follow-up at day 1, day 7, day 30, 7 months, and 12 months showed normal growth and neurodevelopment. The intracardiac mass remained stable in size across all visits. Up to one year of age, the child did not meet any clinical diagnostic criteria for tuberous sclerosis complex (TSC).", | |
| "selected_wiki_anchor": "It is much more common to find metastasis from an alternate site than a primary heart tumor. However, primary cardiac tumors do occur. One of these is the cardiac rhabdomyoma. Approximately 80-90% of these tumors are found in patients with tuberous sclerosis, a genetic condition causing multiple tumors, with most found prior to the age of one. Although these tumors are most commonly treated with resection, symptomatic tumors in fetuses have been shown to decrease in size after maternal sicrolimus administration. If clinically silent, they can be watched with routine imaging as the tumor will likely spontaneously regress.", | |
| "wiki_fkgl": 11.490204081632655, | |
| "doc_fkgl": 11.214120481927715 | |
| }, | |
| { | |
| "index": 7, | |
| "label": "intermediate_health_literacy", | |
| "original_text": "A full\u2011term male newborn, 2 days old and delivered by cesarean section, presented with a congenital right scrotal swelling. On arrival he appeared well perfused and stable. Examination showed the right testis was enlarged, tense, non\u2011tender, and visibly reddish with excoriated overlying skin. Transillumination was negative on the right and positive on the left; both hernia openings were normal. Doppler ultrasound showed the right testis was enlarged with a heterogeneous, darker appearance and no detectable blood flow; the left testis looked normal, with only a small amount of fluid. He was taken urgently to surgery. Intra\u2011operatively, the right testis was frankly nonviable due to intravaginal torsion, with minimal hydrocele. Surgeons removed the right testis (orchidectomy) and fixed the left testis in place (contralateral orchidopexy) to reduce the risk of future twisting.", | |
| "selected_wiki_anchor": "Torsion\nThe appendix of testis can, occasionally, undergo torsion (i.e. become twisted), causing acute one-sided testicular pain and may require surgical excision to achieve relief. One third of patients present with a palpable \"blue dot\" discoloration on the scrotum. This is nearly diagnostic of this condition. If clinical suspicion is high for the serious differential diagnosis of testicular torsion, a surgical exploration of the scrotum is warranted. Torsion of the appendix of testis occurs at ages 0\u201315 years, with a mean at 10 years, which is similar to that of testicular torsion.", | |
| "wiki_fkgl": 11.937826086956523, | |
| "doc_fkgl": 11.784036259541985 | |
| }, | |
| { | |
| "index": 18, | |
| "label": "low_health_literacy", | |
| "original_text": "A 65-year-old man had a swollen right middle finger after a motorcycle crash 6 months earlier. The middle joint stayed bent, and the fingertip bent backward. He could not fully straighten the finger. An X-ray showed no broken bones. The problem was in the soft tissues and tendon on top of the finger. Before surgery, the middle joint could bend from 45 to 110 degrees but could not straighten. The doctors repaired the top tendon using a small strip from another tendon in the same finger. They put the middle joint in a straight splint for 2 weeks. After 2 weeks, he started gentle bending and straightening exercises for that joint. One month after surgery, the middle joint moved from 0 to 90 degrees. Two months after surgery, movement went back to normal. His hand function score (DASH) improved from 50 to 4.2.", | |
| "selected_wiki_anchor": "Treatment is generally with a splint that holds the fingertip straight continuously for 8 weeks. The middle joint is allowed to move. This should be begun within a week of the injury. If the finger is bent during these weeks, healing may take longer. If a large piece of bone has been torn off surgery may be recommended. Without proper treatment a permanent deformity of the finger may occur.", | |
| "wiki_fkgl": 6.680507246376813, | |
| "doc_fkgl": 5.560996503496504 | |
| }, | |
| { | |
| "index": 5, | |
| "label": "intermediate_health_literacy", | |
| "original_text": "A 54-year-old man with chronic kidney disease on long-term corticosteroids and immunosuppressants was admitted to respiratory medicine with fever, cough with sputum, and shortness of breath. Chest CT showed multiple bilateral ground-glass opacities. Laboratory studies showed elevated inflammatory markers, indicating possible bacterial, viral, or fungal infection. RSV antibodies were positive, while tests for other pathogens were negative. He was immunocompromised from prolonged corticosteroid and immunosuppressant use, with low total IgG and reduced CD4 and CD8 T-lymphocyte counts. Despite intensive anti-infective therapy and escalating respiratory support, his condition deteriorated rapidly, and he died from respiratory failure.", | |
| "selected_wiki_anchor": "Coccidioidomycosis is amazingly diverse in terms of its scope of clinical presentation, as well as clinical severity. About 60% of Coccidioides infections as determined by serologic conversion are asymptomatic. The most common clinical syndrome in the other 40% of infected patients is an acute respiratory illness characterized by fever, cough, and pleuritic pain. Skin manifestations, such as erythema nodosum, are also common with Coccidioides infection. Coccidioides infection can cause a severe and difficult-to-treat meningitis in AIDS and other immunocompromised patients, and occasionally in immunocompetent hosts. Infection can sometimes cause acute respiratory distress syndrome and fatal multilobar pneumonia. The risk of symptomatic infection increases with age.", | |
| "wiki_fkgl": 14.871428571428577, | |
| "doc_fkgl": 16.420789473684213 | |
| }, | |
| { | |
| "index": 0, | |
| "label": "intermediate_health_literacy", | |
| "original_text": "A 20\u2011year\u2011old woman had a 12\u2011year history of idiopathic nephrotic syndrome that initially presented with extensive cerebral venous thrombosis and pulmonary embolism. She was treated with anticoagulation and oral corticosteroids, then mycophenolate mofetil as a steroid\u2011sparing agent. A comprehensive thrombophilia work\u2011up was negative. She experienced multiple relapses controlled with steroids until 2017, then remained in remission; anticoagulation and MMF were discontinued. One year later, she developed sudden diffuse abdominal pain with postprandial vomiting and bilateral leg edema. Laboratory tests confirmed a relapse of nephrotic syndrome. Abdominal CT showed acute superior mesenteric artery thrombosis causing acute mesenteric ischemia. At surgery, there was extensive small\u2011bowel necrosis not compatible with survival. She died 48 hours later.", | |
| "selected_wiki_anchor": "Signs and symptoms\nMost people will present as nephrotic syndrome, with the triad of albuminuria, edema and low serum albumin (with or without kidney failure). High blood pressure and high cholesterol are often also present. Others may not have symptoms and may be picked up on screening, with urinalysis finding high amounts of protein loss in the urine. A definitive diagnosis of membranous nephropathy requires a kidney biopsy, though given the very high specificity of anti-PLA2R antibody positivity this can sometimes be avoided in patients with nephrotic syndrome and preserved kidney function", | |
| "wiki_fkgl": 14.414782608695656, | |
| "doc_fkgl": 15.20401179941003 | |
| }, | |
| { | |
| "index": 10, | |
| "label": "proficient_health_literacy", | |
| "original_text": "A 51-year-old male presented with acute, painful visual loss of the left eye (LE) for 3 days. Best-corrected distance visual acuity (BCDVA) was 20/20 OD and hand motion (HM) OS. Ocular motility and anterior segment were unremarkable OU. Fundus OS showed optic nerve head (ONH) swelling, choroidal bulging, multiple patches of subretinal fluid (SRF), and retinal pigment epithelial (RPE) corrugations; OD fundus was unremarkable.\n\nMultimodal imaging was obtained: OCT (OptoVue, Inc., Fremont, CA, USA; software version 2018.0.0.18) demonstrated mild RPE and choroidal bulging, RPE hyper-reflectivity with back shadowing, subretinal and intraretinal fluid, and mild retinal thickening. Indocyanine green angiography (ICGA) showed a geographic macular hypocyanescent area OS. Blue-autofluorescence (BAF) revealed a geographic macular area with speckled autofluorescence. B-scan ultrasonography showed optic nerve enlargement. Fluorescein angiography (FA) demonstrated vascular leakage at the ONH (hot disc) and a geographic patchy hypofluorescent area with speckled hyperfluorescent margins measuring approximately three disc diameters. Orbital and brain MRI with gadolinium revealed a retrobulbar nodular enhancing mass at the optic nerve\u2013sclera junction. Oncology consultation was unremarkable.\n\nGiven concern for malignancy and the enhancing orbital nodule, the patient underwent transconjunctival lateral orbitotomy one week after presentation. Intraoperatively, a pink localized scleral nodule with edematous Tenon was identified. With a clinical diagnosis of nodular posterior scleritis, sub-Tenon triamcinolone acetonide was administered. The patient declined admission and intravenous corticosteroids; oral prednisolone 50 mg/Kg was initiated. Rheumatologic and infectious work-up, including PPD (tuberculosis), chest X-ray, serum ACE (sarcoidosis), and C-ANCA (Wegener granulomatosis), was unremarkable.\n\nAt the one-week postoperative follow-up, BCDVA was 20/20 OD and counting fingers at 2 meters OS. SRF had resolved, and the macula was atrophic. Oral prednisolone was tapered over three months.", | |
| "selected_wiki_anchor": "First stage: This is the initial phase of the condition, and it takes place from birth to the age of 14 years old; it is characterized by the appearance of a large, perforated chorioretinal atrophic lesion at the central part of the macula which contains the vascular arch, alongside extra-macular white deposits and localized areas of hyperpigmentation in the retinal pigment epithelium. The heads of the optic nerve start taking a vertical ovaloid shape during this stage.\nSecond stage: This stage of the condition takes place from the age of 15 to 45 years old. In this phase of the condition, the previously mentioned macular perforation starts growing outside its original starting point, beyond the vascular arch, with relatively new spots of atrophy in the nasal retina starting to join into one, making one white, chorioretinal atrophic lesion as a result. Patients also start reporting visual hallucinations of flashing lights (photopsias) during this stage. Myopia, which is previously absent in affected patients, starts becoming apparent during one's 20th years of life.\nThird stage: This is the final stage, and it takes place at the age of 46 years old and later. In this stage, the previously mentioned atrophic lesions of the macula and the nasal retina expand and grow towards the optic disc, which consequently results in a narrow bridge of intact retina that passes through the optic disc in a vertical manner. During this stage, patients are more likely to report having difficulties seeing in low-light conditions.", | |
| "wiki_fkgl": 14.712311827956992, | |
| "doc_fkgl": 14.661870129870131 | |
| }, | |
| { | |
| "index": 4, | |
| "label": "proficient_health_literacy", | |
| "original_text": "A 13-year-old male from Cusco with recurrent respiratory papillomatosis (RRP) since age two (tracheostomy at age three) and a maternal history of genital papilloma presented after 16 days of predominantly nocturnal respiratory difficulty, inspiratory laryngeal stridor, and moderate dysphonia. He had previously received azithromycin and supplemental oxygen without improvement. On exam, there was mild subcostal retraction, decreased vesicular breath sounds over the left hemithorax, and scant wheezes predominating on the right; he required 4 L/min oxygen via binasal cannula. Laboratory studies showed WBC 8.03 \u00d7 10^3/\u03bcL, platelets 209 \u00d7 10^3/\u03bcL, hemoglobin 13.2 g/dL, and CRP 36.6 mg/L. Imaging included a chest study and head and neck tomography; chest tomography visualized several pulmonary cysts. Forty-eight hours after admission, he developed worsening stridor and respiratory distress, prompting emergent OR transfer for tracheostomy, microlaryngoscopy, and excision of papillomatous lesions. Intraoperative findings demonstrated extensive papillomatous disease with appendicular tumor-like lesions and ventricular bands involving the epiglottis, glottic surface, vocal cords, subglottis, and trachea to ring 5. Histopathology showed koilocytotic atypia consistent with HPV and mild focal dysplasia. Postoperatively, he was managed in the PICU with respiratory monitoring and was weaned off oxygen within 48 hours. He received a single intravenous dose of bevacizumab 400 mg and showed prompt clinical improvement. He completed a seven-day hospitalization with normalization of oxygen saturation and progressive oxygen weaning, then was transferred for ongoing care. He also received respiratory therapy. On telemonitoring at eight months, there was no evidence of recurrence or intercurrent events. Clinical context: RRP is typically HPV-related (often low-risk types) and can cause multifocal papillomas leading to airway stenosis; anti-VEGF therapy such as bevacizumab is used off-label to reduce angiogenesis and disease recurrence, and in this case was associated with a favorable short- to mid-term outcome.", | |
| "selected_wiki_anchor": "Signs and symptoms \nA common symptom of laryngeal papillomatosis is a change in voice quality. More specifically, hoarseness is observed. As a consequence of the narrowing of the laryngeal or tracheal parts of the airway, shortness of breath, chronic cough and stridor (i.e. noisy breathing which can sound like a whistle or a snore), can be present. As the disease progresses, occurrence of secondary symptoms such as dysphagia, pneumonia, acute respiratory distress syndrome, failure to thrive, and recurrent upper respiratory infections can be diagnosed. The risk of laryngeal papillomatosis spreading to the lungs is higher in the juvenile-onset than the adult-onset. In children, symptoms are usually more severe and often mistaken for manifestations of other diseases such as asthma, croup or bronchitis. Therefore, diagnosis is usually delayed.", | |
| "wiki_fkgl": 12.342982283464568, | |
| "doc_fkgl": 15.644583333333337 | |
| }, | |
| { | |
| "index": 13, | |
| "label": "proficient_health_literacy", | |
| "original_text": "A 36-year-old female with ulcerative colitis (well controlled on sulfasalazine, ferrous fumarate, and intermittent prednisone for flares) presented with 1 week of progressive oppressive precordial pain associated with dyspnea and neurovegetative symptoms. On admission, the ECG was in sinus rhythm with ST-segment elevation in the inferior wall. She endorsed a 6-month history of general malaise, fatigue, and night sweats, and had experienced exertional precordial pain that progressed to occur at rest. Physical examination revealed no murmurs or peripheral pulse abnormalities.\n\nEmergency coronary angiography demonstrated severe 2-vessel coronary disease: a severe 90% ostial lesion in the left coronary trunk (left main) and a severe 99\u2013100% subocclusive ostial lesion in the right coronary artery (culprit vessel). Primary angioplasty of the right coronary artery was performed with successful placement of a drug-eluting stent. The hemodynamicist noted possible aortitis given arch involvement and vessel friability during balloon advancement and recommended an inflammatory/etiologic evaluation prior to definitive management of the left main lesion.\n\nLaboratory testing showed mild anemia (hemoglobin 11.6 g/dL), mild leukocytosis (13,800/mm3), elevated ESR 42 mm/h, CRP 4.9 mg/L (normal <1), and elevated high-sensitivity troponin. Autoimmunity panel: normal complement C3/C4, negative ANA, anti-DNA, and ENA profile; non-reactive VDRL. Cardiac MRI with contrast demonstrated acute non-transmural infarction of the left ventricular inferior wall and subendocardial ischemia in the anteroseptoapical region at rest, with mild aortic and mitral insufficiency and preserved biventricular systolic function.\n\nComputed tomographic angiography of the chest/abdomen/pelvis showed periaortic fibrotic wall thickening involving the aortic root, arch, and abdominal aorta, with severe left coronary trunk stenosis, mild left subclavian and left vertebral artery stenoses, and severe inferior mesenteric artery stenosis. The differential included IgG4-related disease versus Takayasu arteritis. Total IgG was 1,600 mg/dL (ref 700\u20131,600) with IgG1 1,024 mg/dL (elevated) and normal IgG2 456 mg/dL, IgG3 98.8 mg/dL, and IgG4 13.6 mg/dL, findings not supportive of IgG4-related aortitis. Takayasu arteritis was diagnosed clinically and by imaging.\n\nImmunosuppression was initiated with prednisone 60 mg daily and methotrexate 20 mg weekly (parenteral) with folic acid 1 mg daily. After 3 weeks of therapy, she underwent myocardial revascularization surgery using the left internal mammary artery graft to the descending anterior artery (LAD) and an aortocoronary bypass to the circumflex artery. Intraoperatively, the aortic root and ascending aorta appeared healthy. She was discharged home in good general condition and remains under ambulatory follow-up.\n\nContext: Takayasu arteritis is a large-vessel granulomatous vasculitis affecting the aorta and its major branches that can produce aorto-ostial coronary lesions (as in this case, involving the left main and right coronary ostia), leading to myocardial ischemia/infarction. The mildly elevated inflammatory indices, periaortic fibrotic thickening, and multifocal arterial stenoses on CTA are characteristic, and the lack of IgG4 elevation argues against IgG4-related aortitis. The staged approach\u2014urgent culprit-vessel PCI followed by immunosuppression and delayed CABG\u2014is consistent with management principles aiming to control vascular inflammation before definitive surgical revascularization.", | |
| "selected_wiki_anchor": "There is a weak relationship between severity of angina and degree of oxygen deprivation in the heart muscle, however, the severity of angina does not always match the degree of oxygen deprivation to the heart or the risk of a myocardial infarction (heart attack). Some people may experience severe pain even though there is little risk of a heart attack. Others may have a heart attack and experience little or no pain. In some cases, angina can be quite severe. Worsening angina attacks, sudden-onset angina at rest, and angina lasting more than 15 minutes are symptoms of unstable angina (usually grouped with similar conditions as the acute coronary syndrome). As these may precede a heart attack, they require urgent medical attention and are, in general, treated similarly to myocardial infarction.", | |
| "wiki_fkgl": 14.372307692307697, | |
| "doc_fkgl": 16.972754430379748 | |
| }, | |
| { | |
| "index": 15, | |
| "label": "intermediate_health_literacy", | |
| "original_text": "A 62-year-old white North African woman with Von Hippel\u2013Lindau (VHL) disease diagnosed in 2021 developed several VHL-related tumors: a left petrous bone tumor, a left pheochromocytoma, left renal cell carcinoma, a multicystic right kidney, and pancreatic masses. She was treated with radiotherapy to the petrous bone lesion, left adrenalectomy, left nephrectomy, and cephalic duodenopancreatectomy for the pancreatic tumors. During surveillance, ultrasound and MRI showed a solid\u2013cystic mass in the left adnexal (ovary/tube) region. Laparoscopy then identified cystic tumors in the mesosalpinx on both the right and left sides. She underwent hysterectomy with removal of both adnexa. Pathology confirmed bilateral clear-cell papillary cystadenomas of the mesosalpinx and broad ligament, a pattern consistent with VHL.", | |
| "selected_wiki_anchor": "Most cysts are small and asymptomatic. Typical sizes reported are 1 to 8\u00a0cm in diameter. PTCs may be found at surgery or during an imaging examination that is performed for another reason. Larger lesions may reach 20 or more cm in diameter and become symptomatic exerting pressure and pain symptoms in the lower abdomen. Large cysts can lead to torsion of the adnexa inflicting acute pain.", | |
| "wiki_fkgl": 9.537492537313433, | |
| "doc_fkgl": 13.893053097345135 | |
| }, | |
| { | |
| "index": 9, | |
| "label": "intermediate_health_literacy", | |
| "original_text": "A 69-year-old man with prior coronary bypass surgery presented with two months of severe shortness of breath with mild activity (NYHA class III). He was diagnosed with heart failure due to ischemia after failure of a saphenous vein graft to the right coronary artery. This was supported by an abnormal ECG, elevated NT-proBNP, and a coronary angiogram; echocardiography also showed reduced pumping function. The team reopened a chronic total occlusion in the native right coronary artery using a retrograde approach through septal channels (septal surfing). To enable that route, they first re-opened the totally occluded left coronary artery. After the procedure, his dyspnea improved before discharge, and at 6 months he had no recurrence of shortness of breath.", | |
| "selected_wiki_anchor": "Recently, an operation was carried out by the SQUH medical team of surgeons headed by Dr. Hilal Al Sabti. The patient, who is a mother of three, was suffering from a rare heart condition known as automatic coronary dissection, which disease affects the coronary arteries of the heart and occurs more often in women under the age of 50 years. The woman was having elevated heart enzymes and the dissection in coronary arteries are expanding to the branch arteries. The surgical team successfully performed an operation by replacing three arteries in the heart. The procedure was accompanied by the use of a new technique that demonstrated the advanced skills of the surgical team. A medical team at Sultan Qaboos University Hospital has managed to save the patient's life. SQUH added that \u201cThe surgery will be documented and published as a scientific paper in a refereed international scientific journal, so that the benefit is widespread among specialists in cardiothoracic surgery around the world,\u201d.", | |
| "wiki_fkgl": 13.06675925925926, | |
| "doc_fkgl": 13.480000000000004 | |
| }, | |
| { | |
| "index": 6, | |
| "label": "intermediate_health_literacy", | |
| "original_text": "A 34-year-old woman with no prior bleeding history developed lower back pain, passed a kidney stone, and then had three days of haematuria. She later developed painful thigh and right gluteal bruising after an intramuscular injection. Because the bleeding was extensive, she was transferred to the emergency department. Her coagulation work-up showed a markedly prolonged aPTT. A mixing study only partially corrected the aPTT, and factor VIII activity was very low with a measurable factor VIII inhibitor (8.64 BU/mL), confirming acquired haemophilia A, likely postpartum. She was treated with prednisone and cyclophosphamide, and received bypassing therapy (initially FEIBA, then switched to recombinant factor VIIa due to side effects). Her bleeding improved and she was discharged.", | |
| "selected_wiki_anchor": "Alfredo Pavlovsky (24 November 1907 \u2013 26 April 1984) was an Argentinian physician who discovered that haemophilia has two types (A and B). Pavlovsky graduated with his medical degree in 1931, then worked as Bernardo Houssay's assistant professor in physiology. In 1947 he reported in Buenos Aires that \"occasionally (in vitro) the blood of some of the haemophilic patients with a greatly prolonged clotting time ... when added to other haemophilic blood possessed a coagulant action nearly as effective as normal blood\". This was later shown to be due to the blood of people with haemophilia B providing the clotting factor factor VIII to correct the defect in those with the more common haemophilia A.", | |
| "wiki_fkgl": 12.124884955752215, | |
| "doc_fkgl": 11.051032608695653 | |
| }, | |
| { | |
| "index": 9, | |
| "label": "proficient_health_literacy", | |
| "original_text": "A 69-year-old male with prior CABG presented with 2 months of severe dyspnea on mild exertion (NYHA III). ECG showed ST depression in II, III, aVF, and V4\u20136; NT-proBNP was 2640 pg/mL. Echocardiography demonstrated LV systolic dysfunction with LVEF 30%. His history included an inferior STEMI in 2009 with severe 3-vessel disease (proximal LAD CTO, 90% mid/distal LCx stenoses, 95% mid RCA stenosis) treated with CABG (LIMA\u2013LAD; sequential SVG to OM1, OM2, and PL). Current angiography via 6 Fr left radial access showed patent LIMA\u2013LAD and SVG\u2013OM1/OM2, but complete occlusion of the sequential SVG to PL. The native LM was occluded at the ostium and the native RCA was occluded in the mid segment with bridging collaterals. The strategy was to treat the native RCA CTO. Dual arterial access was obtained with an additional 6 Fr right femoral sheath. The right and left coronaries were engaged with 6 Fr AL 0.75 (Launcher; Medtronic) and 6 Fr EBU 3.5 (Launcher; Medtronic) guide catheters, respectively. An antegrade approach from the left radial artery failed: neither a Fielder XTR nor a Gaia 3 with a Finecross microcatheter could enter the distal true lumen. A parallel wire technique with a Crusade microcatheter and two Gaia 3 wires also failed. The team then switched to a retrograde approach via septal channels from the LAD through the occluded left coronary system. A Gaia 3 crossed the occluded LM and LAD to reach the distal LAD true lumen. A Sion wire was exchanged via a Finecross into the distal LAD, followed by dilation of the LM and proximal LAD with a 2.0 \u00d7 15 mm balloon. Septal surfing technique (SST) was then used to identify a viable septal channel. A Sion wire, supported by a 150-cm Finecross, was advanced retrogradely through a distal septal branch into the distal RCA. A Gaia 3 traversed the RCA CTO retrogradely into the proximal RCA true lumen and was advanced into a Guidezilla guide extension catheter positioned in the antegrade guide. The Finecross was delivered to the antegrade guide and an RG3 wire was externalized. The CTO segment was predilated with a 2.0 \u00d7 15 mm balloon and stented with two overlapping DES (2.5 \u00d7 38 mm and 3.0 \u00d7 38 mm), achieving an excellent angiographic result with TIMI 3 flow in all distal branches. Dyspnea was relieved at discharge, and at 6-month follow-up there was no recurrence of dyspnea.", | |
| "selected_wiki_anchor": "Background\nCoronary artery disease is a condition in which the blood vessels to the heart become clogged.\nIt often leads to heart attacks and is one of the leading causes of death in the United States. Beginning in the mid-1960s, the leading treatment consisted of invasive bypass surgery, in which a healthy blood vessel from another part of the body is grafted onto the coronary artery, forming a detour around the afflicted region. Due to the high cost and risk of this procedure, an alternative was in high demand. In 1977, Andreas Gruentzig performed the first successful percutaneous coronary angioplasty. In this procedure, a catheter attached to a small balloon is inserted into the afflicted artery. The balloon is subsequently expanded, compressing the accumulated plaque to allow increased blood flow. This was a substantial improvement over bypass surgery in terms of invasiveness, but unfortunately restenosis, a recurrence of arterial clogging, occurred in nearly 50% of patients after the balloon was removed.", | |
| "wiki_fkgl": 13.146948757763976, | |
| "doc_fkgl": 9.065632911392406 | |
| }, | |
| { | |
| "index": 16, | |
| "label": "proficient_health_literacy", | |
| "original_text": "A 59-year-old Japanese man with a 28-year history of type 1 diabetes on intensive multiple-dose insulin therapy (BMI 18.4 kg/m2, undetectable C\u2011peptide, HbA1c ~9.0%) and remote, asymptomatic chronic severe (grade III) aortic regurgitation (diagnosed 16 years earlier without subsequent follow\u2011up) presented with acute decompensated heart failure. He had never undergone surgery or prosthetic device implantation and had no history of immunosuppressive therapies.\n\nEight days after a routine visit, he developed dyspnea and fever >38\u2103. On arrival: BP 192/82 mmHg, HR 118/min, orthopnea, SpO2 80%. Exam: Levine 3/6 systolic murmur; no Osler nodes, Janeway lesions, or conjunctival petechiae. Labs: WBC 20,800/\u03bcL, CRP 6.06 mg/dL, CK\u2011MB 6.0 IU/L, troponin T negative. CXR showed pulmonary congestion with cardiomegaly (CTR 55%). ECG had ST elevation in V1\u2013V4, but emergent echocardiography showed no systolic dysfunction. He was diagnosed with acute heart failure due to valvular disease and treated with non\u2011invasive positive pressure ventilation and nitrates.\n\nTransthoracic echocardiography demonstrated severe aortic regurgitation and severe mitral regurgitation with a mobile mitral vegetation. Transesophageal echocardiography identified a 16.5\u00d76\u2011mm mobile vegetation on the anterior leaflet of the mitral valve and an 11.2\u00d75\u2011mm nonmobile vegetation on the noncoronary cusp of the aortic valve, raising strong suspicion for native valve endocarditis (NVE). Head CT and MRI showed no cerebral infarction or hemorrhage.\n\nRetrospective review revealed subtle abnormalities starting four months pre\u2011admission: mildly elevated WBC, albumin decreased to 3.0 g/dL the following month, and gradual hemoglobin decline over two months, with a 4\u2011kg weight loss. EGD and whole\u2011body CT were unrevealing. He partially regained weight and labs nearly normalized except for a CRP of 0.54 mg/dL. At the last pre\u2011admission visit (8 days prior), WBC was 9,300/\u03bcL, Hb 13.1 g/dL, Alb 3.0 g/dL, CRP 4.18 mg/dL, and diastolic BP had fallen; he remained afebrile and asymptomatic aside from weight loss.\n\nEmpiric antibiotics were initiated with ampicillin\u2013sulbactam 12 g/day plus gentamicin 120 mg/day. Three admission blood culture sets all grew Staphylococcus warneri, a coagulase\u2011negative staphylococcus (CoNS) and resident skin flora (MICs: ABPC/S \u22648 \u03bcg/mL; GM \u22641 \u03bcg/mL; CEZ \u22642 \u03bcg/mL), confirming S. warneri IE. Per Japanese Circulation Society guidance, emergency surgery is generally recommended for NYHA III\u2013IV heart failure or urgent surgery for NVE with mobile vegetation >10 mm and severe valve dysfunction. Because heart failure improved rapidly and appropriate antibiotics were started (reducing embolic risk), and given poorly controlled type 1 diabetes increasing operative risk, elective surgery was planned after stabilization of infection and glycemia. Antibiotics were narrowed to cefazolin 6 g/day; dental evaluation showed no periodontitis.\n\nAfter four weeks of antibiotics, surgery revealed a bicuspid aortic valve with intact aortic and mitral annuli and no abscess. Large vegetations were exenterated, and both valves were replaced with mechanical prostheses. The postoperative course was uneventful; he was discharged on postoperative day 22 without apparent embolism and has remained recurrence\u2011free for over two years. This case represents NVE due to the resident CoNS S. warneri in a patient without prosthetic material or immunosuppression, with prodromal laboratory abnormalities and weight loss evident up to four months before presentation.", | |
| "selected_wiki_anchor": "Diabetic cardiomyopathy is a disorder of the heart muscle in people with diabetes. It can lead to inability of the heart to circulate blood through the body effectively, a state known as heart failure(HF), with accumulation of fluid in the lungs (pulmonary edema) or legs (peripheral edema). Most heart failure in people with diabetes results from coronary artery disease, and diabetic cardiomyopathy is only said to exist if there is no coronary artery disease to explain the heart muscle disorder.", | |
| "wiki_fkgl": 16.935, | |
| "doc_fkgl": 12.497337640821737 | |
| }, | |
| { | |
| "index": 18, | |
| "label": "proficient_health_literacy", | |
| "original_text": "A 65-year-old male presented with six months of swelling and boutonniere deformity of the right digit III following a motorcycle accident on January 1, 2023. He initially self-managed with analgesics and did not seek care. He reported inability to fully extend the right middle finger. Examination demonstrated edema and a boutonniere posture (PIP flexion, DIP hyperextension). Active PIP ROM was 45\u2013110 degrees, with passive PIP ROM within normal limits. Radiographs of the right hand (AP/lateral) revealed no osseous pathology, supporting a soft-tissue etiology consistent with a central slip injury. \n\nSurgical technique: Central slip defect reconstruction was performed using the partial ulnar slip of the flexor digitorum superficialis (FDS) tendon. Under anesthesia and tourniquet control in the supine position, a midlateral incision was made on the ulnar aspect of the middle phalanx centered at the PIP joint with dorsal oblique extension, and a transverse incision was made over the MCP flexion crease proximal to the A1 pulley. The ulnar digital neurovascular bundle was identified and protected. Full-thickness dorsal flaps were elevated to expose the central slip and extensor mechanism to the PIPJ. Scar and pseudotendinous tissue were excised. The central slip was not amenable to primary repair; therefore, the ulnar slip of the FDS was selected for reconstruction. The ulnar neurovascular bundle was mobilized to visualize the periosteal insertion of the A3 pulley. The extensor tendon was mobilized and tenolyzed; the dorsal PIP capsule was incised with removal of interposed tissue. The A3 pulley periosteal insertion and the volar capsule of the PIP joint were incised longitudinally. A 2\u20130 non-absorbable monofilament suture was placed around the ulnar FDS slip at the PIP level. Through the proximal incision, the flexor sheath and A1 pulley were incised longitudinally to expose the FDS; the ulnar slip was isolated and transected, preserving the radial slip. The previously placed 2\u20130 suture facilitated delivery of the distally based ulnar FDS slip distally. A 2.8\u2011mm dorsal-to-volar bone tunnel was drilled at the base of the middle phalanx; an elevator protected the FDP, volar plate, and volar structures. With the PIP reduced in full extension, the FDS slip was passed through the tunnel and routed through the intact proximal segment of the central slip/extensor tendon. A tendon weaver completed a Pulvertaft weave under appropriate tension with the PIP in full extension and reduction, secured with 3\u20130 non-absorbable suture. The capsule and central slip reconstruction margins were approximated; adhesions were released and lateral bands mobilized. Tenodesis effect, posture, stability, and motion were assessed. Wounds were irrigated, the tourniquet deflated, hemostasis obtained, and capillary refill confirmed. Skin was closed with horizontal mattress sutures. A sterile dressing and a well-padded PIP extension splint were applied to allow early DIP and MCP motion.\n\nPostoperative course: First wound check at postoperative day 4; the patient received meloxicam 7.5 mg PO BID and doxycycline 100 mg PO BID for 3 days. A second wound visit occurred 3 days later. At 2 weeks, the back slab and external sutures were removed, and active and passive PIP ROM exercises were initiated. By 3 weeks, the wound had healed and PIP ROM was 0\u201390 degrees. At 1 month, PIP ROM improved to 0\u2013100 degrees, with continued functional gains. After 7 weeks of rehabilitation, he returned to work with PIP ROM 0\u2013110 degrees. Overall function improved substantially, with the DASH score decreasing from 50 to 4.2.\n\nInterpretation: Clinical and radiographic findings were concordant with a chronic central slip injury producing boutonniere deformity (PIP flexion, DIP hyperextension due to dorsal apparatus disruption and volar migration of lateral bands). Reconstruction using an ulnar FDS slip via bone tunnel and Pulvertaft weave restored PIP extension and yielded progressive ROM gains and marked functional recovery.", | |
| "selected_wiki_anchor": "Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. The median nerve controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers, is the sensory nerve for the first three fingers, etc. Because of this major role of the median nerve, it is also called the eye of the hand. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.", | |
| "wiki_fkgl": 9.951523722627737, | |
| "doc_fkgl": 11.863529411764706 | |
| }, | |
| { | |
| "index": 18, | |
| "label": "intermediate_health_literacy", | |
| "original_text": "A 65-year-old man developed persistent swelling and a boutonniere deformity of the right middle finger after a motorcycle fall six months earlier. He could not fully extend the finger. On exam, the finger showed edema with flexion at the proximal interphalangeal (PIP) joint and hyperextension at the distal interphalangeal (DIP) joint. Active PIP range of motion (ROM) was 45\u2013110 degrees. X\u2011rays of the right hand (AP/oblique) showed no bone injury, indicating a soft-tissue problem consistent with a central slip injury. The patient underwent reconstruction of the central slip using a partial ulnar slip of the flexor digitorum superficialis (FDS) tendon. A PIP extension splint was used for 2 weeks. Active and passive PIP ROM exercises began after 2 weeks. One month after surgery, PIP ROM improved to 0\u201390 degrees, and by 2 months it returned to normal. Hand function, measured by the DASH score, improved markedly from 50 to 4.2.", | |
| "selected_wiki_anchor": "It is important to check for viability of the affected limb post trauma. Clinical parameters such as temperature of the limb extremities (warm or cold), capillary refilling time, oxygen saturation of the affected limb, presence of distal pulses (radial and ulnar pulses), assessment of peripheral nerves (radial, median, and ulnar nerves), and any wounds which would indicate open fracture. Doppler ultrasonography should be performed to ascertain blood flow of the affected limb if the distal pulses are not palpable. Anterior interosseus branch of the median nerve most often injured in postero-lateral displacement of the distal humerus as the proximal fragment is displaced antero-medially. This is evidenced by the weakness of the hand with a weak \"OK\" sign on physical examination (Unable to do an \"OK\" sign; instead a pincer grasp is performed). Radial nerve would be injured if the distal humerus is displaced postero-medially. This is because the proximal fragment will be displaced antero-laterally. Ulnar nerve is most commonly injured in the flexion type of injury because it crosses the elbow below the medial epidcondyle of the humerus.", | |
| "wiki_fkgl": 14.632443820224719, | |
| "doc_fkgl": 9.454666666666668 | |
| }, | |
| { | |
| "index": 1, | |
| "label": "proficient_health_literacy", | |
| "original_text": "A 34-year-old woman, 8 weeks pregnant and without other relevant history, presented with generalized convulsions and postictal dysarthria that resolved within two hours. On examination she was alert, oriented, and without focal language, motor, or sensory deficits; a right lateral tongue bite was noted. Laboratory tests and ECG were unremarkable. Given a first epileptic seizure in pregnancy, an urgent cranial MRI was performed. The protocol included 3D T1 pre- and post-contrast (axial, coronal, sagittal), axial FLAIR, axial T2, VEN BOLD and magnetic susceptibility sequences, as well as axial diffusion and ADC mapping. MRI demonstrated multiple venous cortico-medullary vascular structures converging centripetally to a large central draining vein that emptied via the inferior anastomotic vein into the left transverse sinus, forming the classic \u201cMedusa head\u201d sign. On T1 post-contrast, the drainage vein showed increased signal with central hyphocaptation, suggesting partial thrombosis versus slow flow. On T2 and FLAIR, the parenchyma surrounding the drainage vein was hyperintense, without diffusion restriction, compatible with edema. Overall, the findings are diagnostic of a developmental venous anomaly with signs of partial peripheral thrombosis and more proximal slow flow, causing perilesional edema. Management was initiated with clexane 60 mg every 12 hours and levetiracetam 500 mg every 12 hours, with symptomatic improvement and stability after one week. Contextually, DVAs are typically benign venous variants; however, pregnancy-associated hypercoagulability may predispose to thrombosis. Partial thrombosis and impaired outflow in a DVA can lead to venous congestion and edema, manifesting clinically with seizures.", | |
| "selected_wiki_anchor": "Perinatal stroke is a disease where an infant has a stroke between the 140th day of the gestation period and the 28th postpartum day, affecting up to 1 in 2300 live births. This disease is further divided into three subgroups, namely neonatal arterial ischemic stroke, neonatal cerebral sinovenous ischemic stroke, and presumed perinatal stroke. Several risk factors contribute to perinatal stroke including birth trauma, placental abruption, infections, and the mother's health. Detection and diagnosis of perinatal stroke are often delayed due to prenatal onset or inadequacy of neonatal signs and symptoms. A child may be asymptomatic in the early stages of life and may develop common signs of perinatal stroke such as seizures, poor coordination, and speech delays as they get older. Diagnostic tests such as magnetic resonance imaging, electroencephalogram, and blood tests are conducted when doctors suspect the patients have developed signs of a perinatal stroke. The prognosis of this disease is associated with the severity and the development of the symptoms. This disease can be treated by anticoagulant and anticonvulsant drugs, surgical procedures, and therapeutic hypothermia, depending on the condition of the patient.", | |
| "wiki_fkgl": 14.923885135135137, | |
| "doc_fkgl": 16.247417695473253 | |
| }, | |
| { | |
| "index": 0, | |
| "label": "low_health_literacy", | |
| "original_text": "This is about a 20-year-old woman. She had a kidney problem since age eight that made protein leak into her urine. The problem first showed up when a big blood clot blocked veins in her brain, and a clot also went to her lungs. She took blood thinners and steroid pills. Later she took a medicine that calms the immune system to help her use fewer steroids. Tests showed no inherited blood-clotting problem. She had several flare-ups of the kidney problem. Steroid pills controlled them until 2017. After that she had no relapses. Her doctors stopped the blood thinner and the immune-calming medicine. One year later she had sudden, very bad belly pain all over. She threw up after eating. Both legs were swollen. Tests showed the kidney problem was back. A special X-ray picture (CT scan) showed a new clot in the main artery that feeds the small intestine. It was like a plug in a pipe that stops water. Blood could not reach the intestines. In surgery, most of her small intestine was dead. Taking out that much bowel would not allow life. She died 48 hours later.", | |
| "selected_wiki_anchor": "Stella fell ill one week after she gave birth to her son on Jan 2, and was admitted into hospital On Jan 24, 2010. After being directly admitted into ICU, she lost consciousness and lapsed into a coma. Tests revealed that she had hyperparathyroidism, a rare disease in which a defective parathyroid gland allows dangerously high calcium levels (hypercalcaemia). Being too weak for an operation to remove her parathyroid, she was placed on an artificial lung and heart machine. After five days and requiring dialysis several times a day, Stella showed signs of improvement. Unfortunately, complications soon developed. A restricted blood-flow to her right leg caused infection and an above-the-knee amputation was required. Soon after the removal of the leg, and with signs of infection having disappeared, Stella's parathyroid gland was then safely removed, ensuring her survival. Stella woke from the coma one month after she was admitted.", | |
| "wiki_fkgl": 10.35711711711712, | |
| "doc_fkgl": 4.138157894736846 | |
| }, | |
| { | |
| "index": 19, | |
| "label": "intermediate_health_literacy", | |
| "original_text": "A 23-year-old man came to the emergency department with a sudden severe headache, nausea, vomiting, and chest heaviness. His initial vital signs showed high blood pressure and a fast breathing rate. An emergency ECG showed a heart attack pattern (STEMI), so he was urgently sent for percutaneous coronary intervention; the angiogram revealed normal coronary arteries. Further evaluation with a brain CT identified a cisternal subarachnoid hemorrhage (bleeding around the brain). Despite coordinated care by multiple teams, his condition rapidly worsened, leading to cardiac arrest and death.", | |
| "selected_wiki_anchor": "30% of intraventricular hemorrhage (IVH) are primary, confined to the ventricular system and typically caused by intraventricular trauma, aneurysm, vascular malformations, or tumors, particularly of the choroid plexus. However 70% of IVH are secondary in nature, resulting from an expansion of an existing intraparenchymal or subarachnoid hemorrhage. Intraventricular hemorrhage has been found to occur in 35% of moderate to severe traumatic brain injuries. Thus the hemorrhage usually does not occur without extensive associated damage, and so the outcome is rarely good.", | |
| "wiki_fkgl": 16.19885802469136, | |
| "doc_fkgl": 13.757534883720933 | |
| } | |
| ], | |
| "results": [ | |
| { | |
| "queue_position": 0, | |
| "doc_id": 18, | |
| "rating": 3, | |
| "timestamp": "2026-01-14 09:14:08" | |
| }, | |
| { | |
| "queue_position": 1, | |
| "doc_id": 5, | |
| "rating": 4, | |
| "timestamp": "2026-01-14 09:20:48" | |
| }, | |
| { | |
| "queue_position": 2, | |
| "doc_id": 0, | |
| "rating": 3, | |
| "timestamp": "2026-01-14 09:20:49" | |
| }, | |
| { | |
| "queue_position": 3, | |
| "doc_id": 10, | |
| "rating": 4, | |
| "timestamp": "2026-01-14 09:14:16" | |
| }, | |
| { | |
| "queue_position": 4, | |
| "doc_id": 14, | |
| "rating": 2, | |
| "timestamp": "2026-01-14 09:14:18" | |
| } | |
| ], | |
| "completed": false | |
| } |