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+    "id": "multiclinsum_gs_en_289.txt",
+    "fulltext": "4-year-old male patient with a history of nasal impetigo two weeks before admission (treated with topical mupirocin and oral cefadroxil; dose, duration and adherence to treatment unknown), with no other morbid history, who presented macroscopic glomerular haematuria associated with oedema of the lower extremities of 5 days' evolution, with the last 12 hours prior to the consultation adding headaches, nausea and vomiting. He went to the emergency department (ED) in convulsive status, after 20 minutes of generalised tonic-clonic convulsions.\n\nOn admission to the ED, the patient was afebrile, with non-evaluable blood pressure, with quantitative consciousness impairment associated with generalized hypertonia and bilateral and pretibial oedema. Endotracheal intubation was decided and phenobarbital (10 mg/kg) was administered to manage the convulsive status.\n\nOn physical examination in the intensive care unit (ICU), blood pressure was 134/94 mmHg (BP 110 mmHg) (p95 for patient 108/66 mmHg, p95+12 120/78 mmHg).\n\nInitial laboratory parameters included: complete urine with haematuria (> 100 erythrocytes per field), proteinuria 3+ and leucocyturia 10-25 per field, creatinemia 0.3 mg/dL, anaemia with haematocrit (HTO) 21%, haemoglobin (Hb) 7 g/dL, with normal mean corpuscular volume (VCM) and mean corpuscular haemoglobin concentration (CHCM), leukocytosis of 23,900 cells/mm3, thrombocytosis of 756,000/mm3, without elevation of acute phase reactants, hypocomplementemia with complement C3 level at 25 mg/dL (normal value, VN: 80-150 mg/dL) and normal C4. The rapid antigen test for Streptococcus beta-haemolytic group A (Streptococcus pyogenes) in pharynx was positive and the Anti-streptolysin O (ASO) was (+). The non-contrast brain computed tomography showed no acute changes. The renal ultrasound concluded bilateral nephromegaly with increased cortical echogenicity and decreased corticomedullar differentiation.\n\nThe patient was diagnosed with nephritic syndrome due to complicated GNAPE with hypertensive emergency - convulsive status.\n\nWithin the first 24 hours of his ICU stay, the patient required mechanical ventilation (MV) and anticonvulsant therapy with phenobarbital. He progressed without seizures, with a normal electroencephalogram (EEG) (on the day following admission) and a normal cerebrospinal fluid study. Antibiotic therapy was initiated for eradication of Streptococcus pyogenes with cefotaxime and diuretic therapy with furosemide.\n\nThe next day, he developed renal impairment with creatinine elevation to 0.99 mg/dL, hypertension and 24 hour proteinuria of 36.6 mg/m2/h, without oliguria. He initiated antihypertensive therapy with amlodipine and intravenous labetalol, with good initial control.\n\nWith favorable evolution, extubation was performed at 48 hours, which was well tolerated from the ventilatory point of view. However, after 24 hours of extubation, the patient's consciousness deteriorated, with both ocular opening and withdrawal of limb only in response to painful stimulus and poor verbal response (Glasgow Coma Scale 8), and developed blood pressure figures > p95+12 despite receiving therapy with labetalol in continuous infusion (up to 3 mg/kg/h), amlodipine (10 mg/day) and furosemide, which required the reintroduction of mechanical ventilation and infusion of sodium nitroprusside (up to 3 mcg/kg/min), with the aim of achieving gradual reduction of blood pressure figures (25% daily) to prevent secondary neurological damage. Given the presence of acute neurological symptomatology associated with HTA in a patient with glomerulonephritis, the diagnosis of PRES was suspected, which was confirmed by magnetic resonance imaging (MRI) of the brain (day 5), which showed an increase in the subcortical signal in bilateral and symmetric occipital region, without restriction in diffusion, which was compatible with vasogenic edema (PRES). Ophthalmological evaluation was normal and a new EEG evidenced occasional episodes of generalized voltage depression.\n\nAdding enalapril to the treatment. Finally, after 10 days with a slow pharmacological weaning, normalization of blood pressure was achieved. The control MRI (day 12) revealed regression of the previously described findings. Successful extubation was achieved after 5 days.\n\nDuring his stay in the ICU, the hemoglobin level dropped to 5 g/dL, with normal mean corpuscular volume and mean corpuscular hemoglobin concentration, without plateletopenia, so hemolytic anemia was suspected given a positive direct Coombs test and hemoglobinuria. He required red blood cell transfusions twice. Steroid therapy with methylprednisolone (1 mg/kg/d) was initiated for 72 hours. The coproculture was negative, as was the urinary antigen for Streptococcus pneumoniae. Epstein-Barr virus and Parvovirus B19 serology, extractable nuclear antigen (ENA) profile, anti-neutrophil cytoplasmic antibodies (ANCA), anti-DNA antibodies, anti-B2 glycoprotein 1 antibodies, anti-cardiolipin antibodies and lupus anticoagulant were all negative. All cultures were negative (blood cultures, urine cultures, cultures of endotracheal aspirate and pharyngeal cultures). ANA (antinuclear antibodies) was positive 1/160.\n\nThe patient improved with blood pressure normalization, increased complement levels, and a urine test without proteinuria or hematuria. The direct Coombs test remained positive on the 9th day of hospitalization.\n\nOn day 31, the patient was discharged normotensive, without anaemia, with preserved renal function, without proteinuria or haematuria, with normalisation of C3 levels and asymptomatic from the neurological point of view. He was discharged with pharmacological therapy with prednisone, amlodipine, enalapril and folic acid. The patient did not present recurrence and remained asymptomatic 6 months after discharge.\n",
+    "summary": "4-year-old male patient with a history of 5 days of haematuria and oedema, with additional headaches, nausea and vomiting, who entered a convulsive state and hypertensive crisis. Laboratory tests showed hypocomplementemia C3 and elevated Anti-Streptolysin O titers, which was interpreted as GNAPE. He developed encephalopathy, which led to suspicion of secondary PRES due to hypertensive emergency, which was finally confirmed by magnetic resonance of the brain. He also developed autoimmune haemolytic anaemia with haemoglobin up to 5 g/dL. His treatment was based on antihypertensive therapy, neuroprotection measures and steroid treatment. He was discharged after 31 days of hospitalisation, asymptomatic 6 months after discharge.\n",
+    "translated_fulltext": null,
+    "translated_summary": "চার বছর বয়সী একজন পুরুষ রোগী, যার পাঁচ দিন ধরে প্রস্রাবে রক্ত এবং শরীরে ফোলা ছিল, সেই সাথে অতিরিক্ত মাথাব্যথা, বমি বমি ভাব এবং বমি হচ্ছিল। এরপর তিনি খিঁচুনি এবং উচ্চ রক্তচাপের সংকটে পড়েন। ল্যাবরেটরি পরীক্ষায় দেখা যায় তার সি৩-এর মাত্রা কম এবং অ্যান্টি-স্ট্রেপ্টোলাইসিন ও-এর মাত্রা বেশি, যা জিএনএপিই (GNAPE) হিসেবে গণ্য করা হয়। তার এনসেফালোপ্যাথি (encephalopathy) দেখা দেয়, যা উচ্চ রক্তচাপের কারণে সেকেন্ডারি পিআরইএস (PRES)-এর সন্দেহ তৈরি করে। মস্তিষ্কের ম্যাগনেটিক রেজোন্যান্সের মাধ্যমে এটি নিশ্চিত করা হয়। এছাড়াও তার অটোইমিউন হেমোলাইটিক অ্যানিমিয়া (autoimmune haemolytic anaemia) হয়, যেখানে হিমোগ্লোবিনের মাত্রা ৫ গ্রাম/ডেসিলিটারে নেমে আসে। তার চিকিৎসায় উচ্চ রক্তচাপ কমানোর ওষুধ, স্নায়ু সুরক্ষার ব্যবস্থা এবং স্টেরয়েড ব্যবহার করা হয়। ৩১ দিন হাসপাতালে থাকার পর তাকে ছুটি দেওয়া হয় এবং ছয় মাস পর তিনি সম্পূর্ণ সুস্থ হয়ে ওঠেন।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "চার বছর বয়সী একজন পুরুষ রোগী, যার পাঁচ দিন ধরে প্রস্রাবে রক্ত এবং শরীরে ফোলা ছিল, সেই সাথে অতিরিক্ত মাথাব্যথা, বমি বমি ভাব এবং বমি হচ্ছিল। এরপর তিনি খিঁচুনি এবং উচ্চ রক্তচাপের সংকটে পড়েন। ল্যাবরেটরি পরীক্ষায় দেখা যায় তার সি৩-এর মাত্রা কম এবং অ্যান্টি-স্ট্রেপ্টোলাইসিন ও-এর মাত্রা বেশি, যা জিএনএপিই (GNAPE) হিসেবে গণ্য করা হয়। তার এনসেফালোপ্যাথি (encephalopathy) দেখা দেয়, যা উচ্চ রক্তচাপের কারণে সেকেন্ডারি পিআরইএস (PRES)-এর সন্দেহ তৈরি করে। মস্তিষ্কের ম্যাগনেটিক রেজোন্যান্সের মাধ্যমে এটি নিশ্চিত করা হয়। এছাড়াও তার অটোইমিউন হেমোলাইটিক অ্যানিমিয়া (autoimmune haemolytic anaemia) হয়, যেখানে হিমোগ্লোবিনের মাত্রা ৫ গ্রাম/ডেসিলিটারে নেমে আসে। তার চিকিৎসায় উচ্চ রক্তচাপ কমানোর ওষুধ, স্নায়ু সুরক্ষার ব্যবস্থা এবং স্টেরয়েড ব্যবহার করা হয়। ৩১ দিন হাসপাতালে থাকার পর তাকে ছুটি দেওয়া হয় এবং ছয় মাস পর তিনি সম্পূর্ণ সুস্থ হয়ে ওঠেন।"
+  },
+  {
+    "id": "multiclinsum_gs_en_564.txt",
+    "fulltext": "A 69-year-old male with prior history of CABG presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration was admitted in our center. The electrocardiogram showed ST depression in leads II, III, aVF, and V4-6, and blood examination revealed elevation of plasma N-terminal pro-B-type natriuretic peptide levels (2640 pg/mL). Echocardiogram showed left ventricular systolic dysfunction and low left ventricular ejection fraction (30%). The patient had inferior ST-segment-elevation myocardial infarction in 2009, when he was 59 years old, with angiographic evidence of severe 3 vessels disease (coronary angiography showed CTO in proximal left anterior descending artery (LAD), 90% stenosis in mid and distal left circumflex artery, and 95% stenosis in mid RCA. The patient underwent CABG with left internal mammary artery (LIMA) to LAD, and sequential SVG to 1st obtuse marginal branch (OM1), 2nd obtuse marginal branch (OM2), and posterolateral branch (PL) in 2009.\n\nCoronary angiography was performed via 6 French (Fr) left radial artery access and demonstrated patency of LIMA to LAD and SVG to OM1, OM2 conduits, but a complete occlusion of sequential SVG to PL conduit. Native left main coronary artery was occluded in ostium and native RCA was occluded in the mid portion with bridging collaterals. We decided to treat the native RCA CTO. Dual arterial access was achieved with another 6 Fr sheath in right femoral artery. The left and right coronary arteries were intubated with 6 Fr AL 0.75 (Launcher; Medtronic; USA) and 6 Fr EBU 3.5 (Launcher; Medtronic; USA) guide catheters, respectively. An antegrade approach via left radial artery was attempted; however, neither Fielder XTR wire (Asahi Intec, Japan) nor Gaia 3 wire (Asahi Intec, Japan) with Finecross microcatheter (Terumo, Japan) reached the true lumen in distal RCA. Then, parallel wire technique with Crusade microcatheter (Kaneka, Japan) and two Gaia 3 wires (Asahi Intec, Japan) were attempted, but also failed. We therefore switched to the retrograde approach using septal channel from LAD through occluded left coronary artery. Gaia 3 wire (Asahi Intec, Japan) crossed occluded left main (LM) and LAD, and finally reached true lumen in distal LAD. Sion wire was exchanged by Finecross microcatheter (Terumo, Japan) into dital LAD, and dilation of LM and proximal LAD with a 2.0 × 15 mm balloon was performed. Then, septal surfing technique (SST) was used for septal crossing. We tried different septal channels originating from proximal to distal LAD, and delivered Sion wire (Asahi Intec, Japan) retrogradely through distal septal branch into distal RCA supported by a 150-cm Finecross microcatheter (Terumo, Japan). Gaia 3 wire (Asahi Intec, Japan) crossed CTO lesion retrogradely into the true lumen in proximal RCA, and was advanced into Guidezilla guide extension catheter (Boston Scientific, USA) positioned in the antegrade guiding catheter. The Finecross microcatheter (Terumo, Japan) was delivered to the antegrade catheter and a RG3 wire (Asahi Intec, Japan) was externalized. The CTO was then predilated by a 2.0 × 15 mm balloon and stented with 2 overlapping drug-eluting stents (2.5 × 38 mm and 3.0 × 38 mm) with excellent angiographic result and TIMI3 flow in all distal branches.\n\nDyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea.",
+    "summary": "Patient concerns:\nThis is a 69-year-old male with prior history of coronary artery bypass grafting presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration.\n\nDiagnosis:\nThe patient was diagnosed as heart failure caused by ischemia after SVG failure (SVG to right coronary artery) according to electrocardiogram, plasma N-terminal pro-B-type natriuretic peptide levels, and coronary angiogram.\n\nInterventions:\nWe recanalized native right coronary artery CTO by retrograde approach using septal collaterals by surfing technique after recanalization of totally occluded left coronary artery.\n\nOutcomes:\nDyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea.",
+    "translated_fulltext": null,
+    "translated_summary": "রোগীর সমস্যা:\nএই রোগী ৬৯ বছর বয়সী একজন পুরুষ, পূর্বে তার করোনারি আর্টারি বাইপাস গ্রাফটিং করা হয়েছিল। বর্তমানে তিনি সামান্য শারীরিক কার্যকলাপের (এনওয়াইএইচএ III) সময় তীব্র শ্বাসকষ্ট অনুভব করছেন, যা প্রায় ২ মাস ধরে চলছে।\n\nরোগ নির্ণয়:\nইলেক্ট্রোকার্ডিওগ্রাম, প্লাজমা এন-টার্মিনাল প্রো-বি-টাইপ ন্যাট্রিয়ুরেটিক পেপটাইড মাত্রা এবং করোনারি অ্যাঞ্জিওগ্রামের মাধ্যমে দেখা যায়, রোগীর হৃদরোগ ইস্কেমিয়ার কারণে হয়েছে, যা এসভিজি (এসভিজি থেকে ডান করোনারি ধমনীতে) ব্যর্থতার পরে ঘটেছে।\n\nচিকিৎসা:\nআমরা প্রথমে সম্পূর্ণরূপে বন্ধ হয়ে যাওয়া বাম করোনারি ধমনীকে পুনরায় খুলে দেই এবং তারপর সেপটাল কোলাটেরাল ব্যবহার করে রেট্রোগ্রেড পদ্ধতির মাধ্যমে ডান করোনারি ধমনীর CTO (ক্রনিক টোটাল অক্লুশন) পুনরায় চালু করি।\n\nফলাফল:\nরোগী হাসপাতাল থেকে ছাড়ার সময় শ্বাসকষ্ট থেকে মুক্তি পান। ছয় মাস পর ফলো-আপে দেখা যায়, রোগীর শ্বাসকষ্টের পুনরাবৃত্তি হয়নি।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "রোগীর সমস্যা:\nএই রোগী ৬৯ বছর বয়সী একজন পুরুষ, পূর্বে তার করোনারি আর্টারি বাইপাস গ্রাফটিং করা হয়েছিল। বর্তমানে তিনি সামান্য শারীরিক কার্যকলাপের (এনওয়াইএইচএ III) সময় তীব্র শ্বাসকষ্ট অনুভব করছেন, যা প্রায় ২ মাস ধরে চলছে।\n\nরোগ নির্ণয়:\nইলেক্ট্রোকার্ডিওগ্রাম, প্লাজমা এন-টার্মিনাল প্রো-বি-টাইপ ন্যাট্রিয়ুরেটিক পেপটাইড মাত্রা এবং করোনারি অ্যাঞ্জিওগ্রামের মাধ্যমে দেখা যায়, রোগীর হৃদরোগ ইস্কেমিয়ার কারণে হয়েছে, যা এসভিজি (এসভিজি থেকে ডান করোনারি ধমনীতে) ব্যর্থতার পরে ঘটেছে।\n\nচিকিৎসা:\nআমরা প্রথমে সম্পূর্ণরূপে বন্ধ হয়ে যাওয়া বাম করোনারি ধমনীকে পুনরায় খুলে দেই এবং তারপর সেপটাল কোলাটেরাল ব্যবহার করে রেট্রোগ্রেড পদ্ধতির মাধ্যমে ডান করোনারি ধমনীর CTO (ক্রনিক টোটাল অক্লুশন) পুনরায় চালু করি।\n\nফলাফল:\nরোগী হাসপাতাল থেকে ছাড়ার সময় শ্বাসকষ্ট থেকে মুক্তি পান। ছয় মাস পর ফলো-আপে দেখা যায়, রোগীর শ্বাসকষ্টের পুনরাবৃত্তি হয়নি।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0010_0011.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0010_0011.json
new file mode 100644
index 0000000000000000000000000000000000000000..e090f7d3957db6327ac84d0bf2d10eaf51ff5eba
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0010_0011.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_399.txt",
+    "fulltext": "A 51-year-old male patient presented to us with acute painful visual loss of his left eye (LE) from 3 days ago. The best-corrected distance visual acuity (BCDVA) was 20/20, and hand motion (HM) detection for the right eye (RE) and LE, respectively. The ocular movement was normal in both eyes. Anterior segment examination was unremarkable for both eyes. The LE fundus examination showed ONH swelling, choroidal bulging, multiple patches of subretinal fluid accumulation, and retinal pigment epithelial (RPE) corrugations. Fundus examination of the RE was unremarkable.\n\nWe used multimodal imaging including Optical coherence tomography (OCT) (OptoVue, Inc., Fremont, CA, USA, software version: 2018,0,0,18), fundus blue-autofluorescence (BAF), fluorescein angiography (FA) (Heidelberg Eye Explorer version 1.9.13.0, Spectralis Viewing Module 6.5.2.0; Heidelberg Engineering), Indocyanin green angiography (ICGA), and B-scan ultrasonography for further evaluation. Besides, orbital and brain MRIs with gadolinium enhancement were ordered. The OCT image revealed a mild RPE and choroidal bulging, RPE hyper-reflectivity with back shadowing, subretinal and intraretinal fluid accumulation, and mild retinal thickening. A geographic area of macular hypocyanescence was apparent in the ICGA image of the left eye. BAF showed a geographic area with a speckled autofluorescence pattern at the macula. Optic nerve enlargement was found in the B-scan ultrasonography. In FA images, vascular leakage was apparent at the ONH (hot disc). Besides, a geographic patchy hypofluorescent area with speckled hyperfluorescent margins with a size of three disc diameters (DD) was detected. Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement at the junction of the optic nerve and sclera. An oncology consultation was done with no remarkable finding.\n\nConsidering the suspicion of malignancy and the presence of an enhancing nodular mass in the orbit, the patient underwent transconjunctival lateral orbitotomy one week after the presentation. A pink localized scleral nodule with edematous tenon was found. Sub-tenon triamcinolone acetonide was injected with the clinical diagnosis of nodular posterior scleritis. The patient refused admission and intravenous corticosteroid injection as the treatment order. Oral prednisolone 50 mg/Kg was started. Rheumatology consultation and screening lab results, including PPD test (tuberculosis), chest X-ray, serum ACE level (sarcoidosis), and C-ANCA level (Wegner granulomatosis), were unremarkable. At the last follow-up examination (one week after the surgery), the patient’s BCDVA was 20/20, and counting fingers at 2 meters for the RE and LE, respectively. Furthermore, SRF was absorbed, and the macula became atrophic. Oral prednisolone was tapered off slowly for three months.",
+    "summary": "A 51-year-old male patient presented to us with acute painful visual loss of his left eye (LE) from 3 days ago. The best-corrected distance visual acuity (BCDVA) was 20/20 and hand motion (HM) for the right eye (RE) and LE, respectively. Fundus examination of the LE showed ONH swelling, choroidal bulging, multiple patches of subretinal fluid accumulation, and retinal pigment epithelial (RPE) corrugations. Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement at the optic nerve and sclera junction. Oncology and rheumatology work-ups were unremarkable. With the clinical diagnosis of nodular posterior scleritis oral prednisolone 50 mg/Kg was started.",
+    "translated_fulltext": "একজন ৫১ বছর বয়সী পুরুষ রোগী ৩ দিন আগে তার বাম চোখের (LE) তীব্র ব্যথা এবং দৃষ্টিশক্তি হ্রাস নিয়ে আমাদের কাছে আসেন। তার সেরা সংশোধন করা দূরবর্তী দৃষ্টিশক্তি (BCDVA) ছিল ২০/২০, এবং ডান চোখ (RE) এবং বাম চোখের জন্য হাতের নড়াচড়া (HM) শনাক্ত করা যাচ্ছিল। উভয় চোখের স্বাভাবিক মুভমেন্ট ছিল। উভয় চোখের সম্মুখ অংশের পরীক্ষায় উল্লেখযোগ্য কিছু পাওয়া যায়নি। বাম চোখের ফান্ডাস পরীক্ষায় অপটিক নার্ভ হেড (ONH) ফুলে যাওয়া, কোরিওডের ফোলাভাব, রেটিনার নিচে একাধিক স্থানে তরল জমা এবং রেটিনাল পিগমেন্ট এপিথেলিয়াল (RPE) এর ঢেউ দেখা যায়। ডান চোখের ফান্ডাস পরীক্ষায় উল্লেখযোগ্য কিছু পাওয়া যায়নি।\n\nআরও মূল্যায়নের জন্য আমরা মাল্টিমোডাল ইমেজিং ব্যবহার করি, যার মধ্যে রয়েছে অপটিক্যাল কোহেরেন্স টমোগ্রাফি (OCT) (অপটোভিউ, ইনক., ফ্রেমন্ট, সিএ, মার্কিন যুক্তরাষ্ট্র, সফটওয়্যার সংস্করণ: 2018,0,0,18), ফান্ডাস ব্লু-অটোফ্লুরোসেন্স (BAF), ফ্লুরোসিন অ্যাঞ্জিওগ্রাফি (FA) (হেইডেলবার্গ আই এক্সপ্লোরার সংস্করণ 1.9.13.0, স্পেকট্রালিস ভিউইং মডিউল 6.5.2.0; হেইডেলবার্গ ইঞ্জিনিয়ারিং), ইন্ডোসায়ানিন গ্রিন অ্যাঞ্জিওগ্রাফি (ICGA), এবং বি-স্ক্যান আলট্রাসাউন্ড। এছাড়াও, গ্যাডোলিনিয়াম এনহ্যান্সমেন্ট সহ অরবিটাল এবং মস্তিষ্কের এমআরআই করা হয়। OCT ছবিতে হালকা RPE এবং কোরিওডের ফোলাভাব, ব্যাক শ্যাডোয়িং সহ RPE-এর অতিরিক্ত প্রতিফলন, রেটিনার নিচে এবং রেটিনার ভেতরের তরল জমা এবং হালকা রেটিনাল পুরুত্ব দেখা যায়। ICGA ছবিতে বাম চোখের ম্যাকুলার হাইপোসাইয়ানেসেন্সের একটি ভৌগোলিক এলাকা দেখা যায়। BAF-এ ম্যাকুলায় একটি ছোপ ছোপ অটোফ্লুরোসেন্স প্যাটার্নসহ একটি ভৌগোলিক এলাকা দেখা যায়। বি-স্ক্যান আলট্রাসাউন্ডে অপটিক নার্ভের বৃদ্ধি দেখা যায়। FA ছবিতে ONH-এ ভাস্কুলার লিকেজ দেখা যায় (হট ডিস্ক)। এছাড়াও, তিনটি ডিস্ক ব্যাসের (DD) আকারের একটি ভৌগোলিক ছোপ ছোপ হাইপোফ্লুরোসেন্ট এলাকা, যার প্রান্তে ছোপ ছোপ হাইপারফ্লুরোসেন্ট মার্জিন ছিল, তা শনাক্ত করা হয়। অরবিটাল এবং মস্তিষ্কের এমআরআই-তে অপটিক নার্ভ এবং স্ক্লেরার সংযোগস্থলে গ্যাডোলিনিয়াম এনহ্যান্সমেন্টসহ একটি রেট্রোবুলবার নোডুলার ভর দেখা যায়। একটি অনকোলজি পরামর্শ করা হয়, যেখানে উল্লেখযোগ্য কিছু পাওয়া যায়নি।\n\nম্যালিগন্যান্সির সন্দেহ এবং অরবিটে একটি বর্ধিত নোডুলার ভরের উপস্থিতি বিবেচনা করে, রোগী উপস্থাপনের এক সপ্তাহ পরে ট্রান্সকনজাংটিভাল ল্যাটারাল অরবিটোটমি করা হয়। একটি গোলাপী রঙের স্থানীয় স্ক্লেরাল নোডুল পাওয়া যায়, যার সাথে ইডিমাটাস টেনন ছিল। ক্লিনিক্যাল ডায়াগনোসিস হিসেবে নোডুলার পোস্টেরিয়র স্ক্লেরাইটিস ধরে নিয়ে সাব-টেনন ট্রায়ামসিনোলোন অ্যাসিটোনাইড ইনজেকশন দেওয়া হয়। রোগী হাসপাতালে ভর্তি এবং ইন্ট্রাভেনাস কর্টিকোস্টেরয়েড ইনজেকশন নিতে অস্বীকার করেন। তাই, মুখে খাওয়ার জন্য প্রেডনিসোলোন ৫০ মিগ্রা/কেজি শুরু করা হয়। রিউমাটোলজি পরামর্শ এবং স্ক্রিনিং ল্যাব পরীক্ষার ফলাফল, যার মধ্যে পিপিডি পরীক্ষা (যক্ষ্মা), বুকের এক্স-রে, সিরাম এসিই স্তর (সারকোইডোসিস) এবং সি-এএনসিএ স্তর (ওয়েগনার গ্রানুলোমাটোসিস) স্বাভাবিক ছিল। শেষ ফলো-আপ পরীক্ষায় (অপারেশনের এক সপ্তাহ পর), রোগীর BCDVA ছিল ২০/২০, এবং RE এবং LE-এর জন্য ২ মিটারে আঙুল গণনা করা যাচ্ছিল। এছাড়াও, SRF শোষিত হয়েছিল এবং ম্যাকুলা অ্যাট্রোফিক হয়ে যায়। মুখে খাওয়ার জন্য প্রেডনিসোলোন ধীরে ধীরে তিন মাসে কমিয়ে দেওয়া হয়।",
+    "translated_summary": "৫১ বছর বয়সী একজন পুরুষ রোগী ৩ দিন আগে থেকে তার বাম চোখে (LE) তীব্র ব্যথা এবং দৃষ্টিশক্তি হ্রাস নিয়ে আমাদের কাছে আসেন। সবচেয়ে ভালো চশমা ব্যবহার করার পরেও তার দূরের দৃষ্টিশক্তি (BCDVA) ছিল ২০/২০ এবং ডান চোখ (RE) ও বাম চোখের (LE) জন্য হাতের ইশারা (HM) দেখা যাচ্ছিল। বাম চোখের (LE) ফান্ডাস পরীক্ষায় অপটিক নার্ভ হেড (ONH) ফুলে যাওয়া, কোরিওডের ফোলাভাব, রেটিনার নিচে তরল জমা হয়ে ছোট ছোট দাগ এবং রেটিনাল পিগমেন্ট এপিথেলিয়াল (RPE) কোষের ভাঁজ দেখা যায়। অরবিটাল এবং মস্তিষ্কের এমআরআই-তে অপটিক নার্ভ এবং স্ক্লেরার সংযোগস্থলে গ্যাডোলিনিয়াম দ্বারা চিহ্নিত একটি টিউমার দেখা যায়। ক্যান্সার এবং রিউমাটোলজি সংক্রান্ত পরীক্ষাগুলোতে উল্লেখযোগ্য কিছু পাওয়া যায়নি। ক্লিনিক্যালভাবে টিউমারযুক্ত পোস্টেরিয়র স্ক্লেরাইটিস নির্ণয় করে মুখে খাওয়ার জন্য প্রেডনিসোলোন ৫০ মিগ্রা/কেজি দেওয়া শুরু করা হয়।",
+    "corrected_translated_fulltext": "একজন ৫১ বছর বয়সী পুরুষ রোগী ৩ দিন আগে তার বাম চোখের (LE) তীব্র ব্যথা এবং দৃষ্টিশক্তি হ্রাস নিয়ে আমাদের কাছে আসেন। তার সেরা সংশোধন করা দূরবর্তী দৃষ্টিশক্তি (BCDVA) ছিল ২০/২০, এবং ডান চোখ (RE) এবং বাম চোখের জন্য হাতের নড়াচড়া (HM) শনাক্ত করা যাচ্ছিল। উভয় চোখের স্বাভাবিক মুভমেন্ট ছিল। উভয় চোখের সম্মুখ অংশের পরীক্ষায় উল্লেখযোগ্য কিছু পাওয়া যায়নি। বাম চোখের ফান্ডাস পরীক্ষায় অপটিক নার্ভ হেড (ONH) ফুলে যাওয়া, কোরিওডের ফোলাভাব, রেটিনার নিচে একাধিক স্থানে তরল জমা এবং রেটিনাল পিগমেন্ট এপিথেলিয়াল (RPE) এর ঢেউ দেখা যায়। ডান চোখের ফান্ডাস পরীক্ষায় উল্লেখযোগ্য কিছু পাওয়া যায়নি।\n\nআরও মূল্যায়নের জন্য আমরা মাল্টিমোডাল ইমেজিং ব্যবহার করি, যার মধ্যে রয়েছে অপটিক্যাল কোহেরেন্স টমোগ্রাফি (OCT) (অপটোভিউ, ইনক., ফ্রেমন্ট, সিএ, মার্কিন যুক্তরাষ্ট্র, সফটওয়্যার সংস্করণ: 2018,0,0,18), ফান্ডাস ব্লু-অটোফ্লুরোসেন্স (BAF), ফ্লুরোসিন অ্যাঞ্জিওগ্রাফি (FA) (হেইডেলবার্গ আই এক্সপ্লোরার সংস্করণ 1.9.13.0, স্পেকট্রালিস ভিউইং মডিউল 6.5.2.0; হেইডেলবার্গ ইঞ্জিনিয়ারিং), ইন্ডোসায়ানিন গ্রিন অ্যাঞ্জিওগ্রাফি (ICGA), এবং বি-স্ক্যান আলট্রাসাউন্ড। এছাড়াও, গ্যাডোলিনিয়াম এনহ্যান্সমেন্ট সহ অরবিটাল এবং মস্তিষ্কের এমআরআই করা হয়। OCT ছবিতে হালকা RPE এবং কোরিওডের ফোলাভাব, ব্যাক শ্যাডোয়িং সহ RPE-এর অতিরিক্ত প্রতিফলন, রেটিনার নিচে এবং রেটিনার ভেতরের তরল জমা এবং হালকা রেটিনাল পুরুত্ব দেখা যায়। ICGA ছবিতে বাম চোখের ম্যাকুলার হাইপোসাইয়ানেসেন্সের একটি ভৌগোলিক এলাকা দেখা যায়। BAF-এ ম্যাকুলায় একটি ছোপ ছোপ অটোফ্লুরোসেন্স প্যাটার্নসহ একটি ভৌগোলিক এলাকা দেখা যায়। বি-স্ক্যান আলট্রাসাউন্ডে অপটিক নার্ভের বৃদ্ধি দেখা যায়। FA ছবিতে ONH-এ ভাস্কুলার লিকেজ দেখা যায় (হট ডিস্ক)। এছাড়াও, তিনটি ডিস্ক ব্যাসের (DD) আকারের একটি ভৌগোলিক ছোপ ছোপ হাইপোফ্লুরোসেন্ট এলাকা, যার প্রান্তে ছোপ ছোপ হাইপারফ্লুরোসেন্ট মার্জিন ছিল, তা শনাক্ত করা হয়। অরবিটাল এবং মস্তিষ্কের এমআরআই-তে অপটিক নার্ভ এবং স্ক্লেরার সংযোগস্থলে গ্যাডোলিনিয়াম এনহ্যান্সমেন্টসহ একটি রেট্রোবুলবার নোডুলার ভর দেখা যায়। একটি অনকোলজি পরামর্শ করা হয়, যেখানে উল্লেখযোগ্য কিছু পাওয়া যায়নি।\n\nম্যালিগন্যান্সির সন্দেহ এবং অরবিটে একটি বর্ধিত নোডুলার ভরের উপস্থিতি বিবেচনা করে, রোগী উপস্থাপনের এক সপ্তাহ পরে ট্রান্সকনজাংটিভাল ল্যাটারাল অরবিটোটমি করা হয়। একটি গোলাপী রঙের স্থানীয় স্ক্লেরাল নোডুল পাওয়া যায়, যার সাথে ইডিমাটাস টেনন ছিল। ক্লিনিক্যাল ডায়াগনোসিস হিসেবে নোডুলার পোস্টেরিয়র স্ক্লেরাইটিস ধরে নিয়ে সাব-টেনন ট্রায়ামসিনোলোন অ্যাসিটোনাইড ইনজেকশন দেওয়া হয়। রোগী হাসপাতালে ভর্তি এবং ইন্ট্রাভেনাস কর্টিকোস্টেরয়েড ইনজেকশন নিতে অস্বীকার করেন। তাই, মুখে খাওয়ার জন্য প্রেডনিসোলোন ৫০ মিগ্রা/কেজি শুরু করা হয়। রিউমাটোলজি পরামর্শ এবং স্ক্রিনিং ল্যাব পরীক্ষার ফলাফল, যার মধ্যে পিপিডি পরীক্ষা (যক্ষ্মা), বুকের এক্স-রে, সিরাম এসিই স্তর (সারকোইডোসিস) এবং সি-এএনসিএ স্তর (ওয়েগনার গ্রানুলোমাটোসিস) স্বাভাবিক ছিল। শেষ ফলো-আপ পরীক্ষায় (অপারেশনের এক সপ্তাহ পর), রোগীর BCDVA ছিল ২০/২০, এবং RE এবং LE-এর জন্য ২ মিটারে আঙুল গণনা করা যাচ্ছিল। এছাড়াও, SRF শোষিত হয়েছিল এবং ম্যাকুলা অ্যাট্রোফিক হয়ে যায়। মুখে খাওয়ার জন্য প্রেডনিসোলোন ধীরে ধীরে তিন মাসে কমিয়ে দেওয়া হয়।",
+    "corrected_translated_summary": "৫১ বছর বয়সী একজন পুরুষ রোগী ৩ দিন আগে থেকে তার বাম চোখে (LE) তীব্র ব্যথা এবং দৃষ্টিশক্তি হ্রাস নিয়ে আমাদের কাছে আসেন। সবচেয়ে ভালো চশমা ব্যবহার করার পরেও তার দূরের দৃষ্টিশক্তি (BCDVA) ছিল ২০/২০ এবং ডান চোখ (RE) ও বাম চোখের (LE) জন্য হাতের ইশারা (HM) দেখা যাচ্ছিল। বাম চোখের (LE) ফান্ডাস পরীক্ষায় অপটিক নার্ভ হেড (ONH) ফুলে যাওয়া, কোরিওডের ফোলাভাব, রেটিনার নিচে তরল জমা হয়ে ছোট ছোট দাগ এবং রেটিনাল পিগমেন্ট এপিথেলিয়াল (RPE) কোষের ভাঁজ দেখা যায়। অরবিটাল এবং মস্তিষ্কের এমআরআই-তে অপটিক নার্ভ এবং স্ক্লেরার সংযোগস্থলে গ্যাডোলিনিয়াম দ্বারা চিহ্নিত একটি টিউমার দেখা যায়। ক্যান্সার এবং রিউমাটোলজি সংক্রান্ত পরীক্ষাগুলোতে উল্লেখযোগ্য কিছু পাওয়া যায়নি। ক্লিনিক্যালভাবে টিউমারযুক্ত পোস্টেরিয়র স্ক্লেরাইটিস নির্ণয় করে মুখে খাওয়ার জন্য প্রেডনিসোলোন ৫০ মিগ্রা/কেজি দেওয়া শুরু করা হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_55.txt",
+    "fulltext": "An elderly 78-year-old patient from the Amhara region of Ethiopia, who has had a permanent cardiac pacemaker for 7 years, was scheduled for retropubic prostatectomy due to benign prostatic hyperplasia (BPH). This condition developed following a previous transurethral resection of the prostate 3 months earlier. The patient in the preoperative anesthesia evaluation was fully evaluated, and all the routine investigations required for the proposed surgery, which were within normal limits, were investigated. The patient presented with a history of frequency, urgency, nocturia, and dribbling for the past 2 months. Additionally, the patient had been known to have hypertension for the past 16 years and was taking amlodipine 5 mg orally daily, enalapril 10 mg orally twice daily (BID), and atorvastatin 10 mg orally daily. He had also been known to have type II diabetes mellitus for the past 25 years and was on metformin 500 mg orally BID and neutral protamine Hagedorn (NPH) 20 IU and 10 IU. He was admitted to a hospital for further evaluation, and complete bundle branch block (BBB) was detected via electrocardiogram (ECG). In an electrophysiology study, the patient was diagnosed with left ventricular hypertrophy secondary to hypertensive heart disease, mild diastolic dysfunction, and an ejection fraction of 62%. Abdominal ultrasound revealed an enlarged prostate size of 82 ml; anterior–posterior (AP) chest X-ray revealed a normal chest region with a left-side pacemaker in situ, and all the other blood parameters, including electrolytes and serum troponin levels, were within normal limits.\n\nA cardiologist was involved preoperatively as a multidisciplinary approach and risk determination tool for cardiac risk assessment. The patient had a frailty score of 5.5 with a poor functional cardiopulmonary reserve of metabolic equivalent (MET) = 3.4 and Revised Cardiac Risk Index (RCRI) class III, which accounts for 10.1% of major cardiac adverse events (myocardial infarction [MI], cardiac arrest, or death) within 30 days of the postoperative period, and intermediate risk on the basis of surgery type and patient risk factors. After preoperative evaluation and risk disclosure regarding the un-reprogrammed pacemaker and the associated complications during anesthesia and surgery, the patient was unable to afford the necessary health coverage for pacemaker reprogramming. This is because the cardiac surgery was performed in Addis Ababa, Ethiopia, which has a long waiting list with few cardiac surgeons for millions of people and is a considerable distance from the patient’s home institution, and there is a period of monitoring after pacemaker reprogramming for considerable post-reprogramming complication. As a result, the patient chose to proceed with the surgery, accepting the potential risks and harm associated with the situation. Continuous cardiac monitoring during the intraoperative period is highly advocated. Despite these factors, the patient did not experience cardiorespiratory failure, and he was stable. The patient continued on medication until the day of surgery, which included amlodipine, enalapril, atorvastatin, and a morning lower dose of two-thirds of the NPH. He also took 5 mg of diazepam orally for anxiolytics at midnight before the day of surgery.\n\nOn the day of surgery, the patient’s random blood sugar (RBS) was measured, and sliding scale glycemic control was implemented. Communication among the anesthetist, surgeon, and nurses was emphasized, ensuring that the cautery pad was placed away from the pacemaker, and that emergency drugs and a defibrillator were ready. The patient was premedicated with dexamethasone for nausea prophylaxis and paracetamol for pain relief as preemptive analgesia. American Society of Anesthesiology (ASA) standard monitoring was applied, and baseline parameters were recorded. Combined epidural–spinal anesthesia was administered via 0.5% isobaric bupivacaine (12.5 mg) and 50 µg fentanyl at the L3–L4 interspace. The block achieved anesthesia up to the umbilicus, and the sensory block was performed at T7. The surgery involved a midline incision below the umbilicus, with monopolar cautery used at low voltage (20 mA). Hemostasis was achieved through bipolar low-voltage cautery. Throughout the procedure, the patient’s vital signs remained stable. The patient’s vital signs did not change by more than 10% from the baseline vital signs. The intravenous fluid was resuscitated intraoperatively. During the postoperative period, the patient was transferred to the postanesthesia care unit (PACU) with vigilant monitoring, and 10 ml of 0.125% epidural top-up analgesia was given. Postop investigations were within normal limits. The patient was observed in the PACU for 12 hours and later transferred to the ward in stable condition with regular follow-up with the cardiology team. After 88th day of postsurgery the patient was discharged and advised to have regular checkups for pacemaker’s in situ status.",
+    "summary": "A 78-year-old male from the Amhara region, Ethiopia, with a permanent pacemaker for complete heart block was scheduled for retropubic prostatectomy. Preoperative assessments by the anesthetist and cardiologist recommended reprogramming the pacemaker to asynchronous mode to reduce risks related to its dual-chamber, rate-modulated mode setting. However, the patient could not afford reprogramming and opted to proceed with the existing perioperative plan. Informed consent was obtained, and case report publication permission was obtained after operation. The patient received combined epidural-spinal anesthesia with 2.50 ml of 0.5% isobaric bupivacaine and 50 µg fentanyl at the L3-L4 interspace. Standard American Society of Anesthesiology monitoring was applied, with a focus on cardiac stability. The patient remained stable with minimal vital sign fluctuations and maintained adequate blood pressure using isotonic saline. Postoperatively, the patient was transferred to the postanesthesia care unit, receiving analgesia after 4 hours and an epidural top-up. After 6 hours, he was transferred to the ward in stable condition. Epidural analgesia was continued for 72 hours, and the patient was discharged on the 88th postoperative hour in stable condition.",
+    "translated_fulltext": "ইথিওপিয়ার আমহারা অঞ্চলের একজন বয়স্ক ৭৮ বছর বয়সী রোগী, যার ৭ বছর ধরে একটি স্থায়ী কার্ডিয়াক পেসমেকার রয়েছে, তার প্রোস্টেটের আকার বৃদ্ধি (বেনাইন প্রোস্ট্যাটিক হাইপারপ্লাসিয়া বা বিপিএইচ) হওয়ার কারণে রেট্রোপিউবিক প্রোস্টেটেকটমির জন্য নির্ধারণ করা হয়েছিল। এর আগে ৩ মাস আগে তার ট্রান্সইউরেথ্রাল রিসেকশন করা হয়েছিল। অস্ত্রোপচারের আগে অ্যানেস্থেসিয়া মূল্যায়নের সময় রোগীর সম্পূর্ণ পরীক্ষা করা হয় এবং প্রস্তাবিত অস্ত্রোপচারের জন্য প্রয়োজনীয় সমস্ত রুটিন পরীক্ষা করা হয়, যেগুলি স্বাভাবিক সীমার মধ্যে ছিল। গত ২ মাসে রোগীর ঘন ঘন প্রস্রাবের বেগ, রাতে প্রস্রাব করা এবং প্রস্রাব ধরে রাখতে না পারার মতো সমস্যা দেখা যাচ্ছিল। এছাড়াও, রোগীর ১৬ বছর ধরে উচ্চ রক্তচাপ ছিল এবং তিনি প্রতিদিন মুখে করে অ্যামলোডিপিন ৫ মিলিগ্রাম, এনালাপ্রিল ১০ মিলিগ্রাম দিনে দুবার এবং অ্যাটোরভাস্ট্যাটিন ১০ মিলিগ্রাম গ্রহণ করতেন। গত ২৫ বছর ধরে তার টাইপ ২ ডায়াবেটিস ছিল এবং তিনি মেটফর্মিন ৫০০ মিলিগ্রাম দিনে দুবার এবং নিউট্রাল প্রোটেমিন হাগেডর্ন (এনপিএইচ) ২০ আইইউ এবং ১০ আইইউ গ্রহণ করতেন। আরও মূল্যায়নের জন্য রোগীকে হাসপাতালে ভর্তি করা হয় এবং ইলেক্ট্রোকার্ডিওগ্রামের (ইসিজি) মাধ্যমে সম্পূর্ণ বান্ডেল ব্রাঞ্চ ব্লক (বিবিবি) ধরা পড়ে। একটি ইলেক্ট্রোফিজিওলজি স্টাডিতে, রোগীর উচ্চ রক্তচাপের কারণে বাম নিলয়ের আকার বৃদ্ধি, মৃদু ডায়াস্টোলিক ডিসফাংশন এবং ৬২% ইজেকশন ফ্র্যাকশন নির্ণয় করা হয়। পেটের আল্ট্রাসাউন্ডে প্রোস্টেটের আকার ৮২ মিলি দেখা যায়; বুকের সামনের এবং পিছনের (এপি) এক্স-রেতে বুকের স্বাভাবিক অবস্থা দেখা যায় এবং বাম দিকে পেসমেকার স্থাপন করা ছিল। অন্যান্য রক্ত পরীক্ষার ফলাফল, যেমন ইলেক্ট্রোলাইট এবং সিরাম ট্রোপোনিনের মাত্রা স্বাভাবিক ছিল।\n\nহৃদরোগের ঝুঁকি মূল্যায়ন এবং মাল্টিডিসিপ্লিনারি পদ্ধতির অংশ হিসেবে অস্ত্রোপচারের আগে একজন হৃদরোগ বিশেষজ্ঞকে অন্তর্ভুক্ত করা হয়েছিল। রোগীর দুর্বলতা স্কোর ছিল ৫.৫, যেখানে বিপাকীয় সমতুল্যের (এমইটি) মান ৩.৪ এবং রিভাইজড কার্ডিয়াক রিস্ক ইনডেক্স (আরসিআরআই) ক্লাস III ছিল। এর ফলে অস্ত্রোপচারের পরবর্তী ৩০ দিনের মধ্যে গুরুতর হৃদরোগের ঘটনা (মায়োকার্ডিয়াল ইনফার্কশন, কার্ডিয়াক অ্যারেস্ট বা মৃত্যু) ঘটার সম্ভাবনা ১০.১% ছিল এবং অস্ত্রোপচারের ধরন ও রোগীর ঝুঁকির কারণের ওপর ভিত্তি করে ঝুঁকির মাত্রা মাঝারি ছিল। অস্ত্রোপচারের আগে পেসমেকার পুনরায় প্রোগ্রামিং না করার কারণে এবং অ্যানেস্থেসিয়া ও অস্ত্রোপচারের সময় সম্ভাব্য জটিলতা সম্পর্কে জানানো হলে, রোগী পেসমেকার পুনরায় প্রোগ্রামিংয়ের জন্য প্রয়োজনীয় স্বাস্থ্যসেবা খরচ বহন করতে অক্ষম ছিলেন। এর কারণ হলো, এই হৃদরোগের অস্ত্রোপচারটি আদ্দিস আবাবাতে করা হয়েছিল, যেখানে কয়েকজন হৃদরোগ বিশেষজ্ঞ রয়েছেন এবং কয়েক মিলিয়ন মানুষের জন্য দীর্ঘ অপেক্ষার তালিকা রয়েছে। এছাড়াও, রোগীর বাড়ি থেকে এটি বেশ দূরে অবস্থিত এবং পেসমেকার পুনরায় প্রোগ্রামিংয়ের পরে জটিলতা দেখা দিলে তা পর্যবেক্ষণ করার জন্য একটি নির্দিষ্ট সময় প্রয়োজন। ফলস্বরূপ, রোগী অস্ত্রোপচারের জন্য রাজি হন এবং এর সাথে জড়িত সম্ভাব্য ঝুঁকি ও ক্ষতির বিষয়টি মেনে নেন। অস্ত্রোপচারের সময় ক্রমাগত হৃদরোগের নিরীক্ষণ করা অত্যন্ত গুরুত্বপূর্ণ। এই বিষয়গুলো সত্ত্বেও, রোগীর কার্ডিওরেসপিরেটরি ব্যর্থতা হয়নি এবং তিনি স্থিতিশীল ছিলেন। অস্ত্রোপচারের দিন পর্যন্ত রোগী ওষুধ গ্রহণ করতে থাকেন, যার মধ্যে অ্যামলোডিপিন, এনালাপ্রিল, অ্যাটোরভাস্ট্যাটিন এবং সকালে এনপিএইচ-এর দুই-তৃতীয়াংশ ডোজ ছিল। অস্ত্রোপচারের আগের রাতে উদ্বেগের জন্য তিনি ৫ মিলিগ্রাম ডায়াজেপাম গ্রহণ করেন।\n\nঅস্ত্রোপচারের দিন, রোগীর রক্তের গ্লুকোজের মাত্রা (আরবিএস) পরিমাপ করা হয় এবং গ্লাইসেমিক নিয়ন্ত্রণ করা হয়। অ্যানেস্থেটিস্ট, সার্জন এবং নার্সদের মধ্যে যোগাযোগ বাড়ানো হয়, যাতে নিশ্চিত করা যায় যে কটারি প্যাড পেসমেকার থেকে দূরে রাখা হয়েছে এবং জরুরি ওষুধ ও একটি ডিফিব্রিলেটর প্রস্তুত রাখা হয়েছে। বমি বমি ভাব প্রতিরোধের জন্য ডেক্সামেথাসোন এবং ব্যথানাশক হিসেবে প্যারাসিটামল দিয়ে রোগীকে আগে থেকে ওষুধ দেওয়া হয়। আমেরিকান সোসাইটি অফ অ্যানেস্থেসিয়োলজি (এএসএ) স্ট্যান্ডার্ড মনিটরিং ব্যবহার করা হয় এবং প্রাথমিক মানগুলি রেকর্ড করা হয়। ০.৫% আইসোবারিক বুপিভাকেন (১২.৫ মিলি) এবং ৫০ মাইক্রোগ্রাম ফেন্টানিল এল৩-এল৪ ইন্টারস্পেসের মাধ্যমে সম্মিলিত এপিডিউরাল-স্পাইনাল অ্যানেস্থেসিয়া দেওয়া হয়। এই পদ্ধতিতে নাভির কাছাকাছি পর্যন্ত অ্যানেস্থেসিয়া হয় এবং টি৭-এ",
+    "translated_summary": "ইথিওপিয়ার আমহারা অঞ্চলের একজন ৭৮ বছর বয়সী পুরুষ, যার হৃদপিণ্ডের সম্পূর্ণ ব্লকের কারণে একটি স্থায়ী পেসমেকার বসানো হয়েছিল, তার রেট্রোপিউবিক প্রোস্টেটেকটমির জন্য সময়সূচী করা হয়েছিল। অ্যানেস্থেটিসিস্ট এবং কার্ডিওলজিস্টের অস্ত্রপূর্ব মূল্যায়নে পেসমেকারটিকে অ্যাসিঙ্ক্রোনাস মোডে পুনরায় প্রোগ্রাম করার সুপারিশ করা হয়েছিল, যাতে এর ডুয়াল-চেম্বার, রেট-মডুলেটেড মোড সেটিংসের কারণে সৃষ্ট ঝুঁকি কমানো যায়। তবে, রোগী পেসমেকার পুনরায় প্রোগ্রাম করার সামর্থ্য রাখেননি এবং বিদ্যমান অস্ত্রোপূর্ব পরিকল্পনা অনুযায়ী এগিয়ে যেতে চেয়েছিলেন। রোগীর কাছ থেকে সম্মতি নেওয়া হয়েছিল এবং অস্ত্রোপচারের পরে কেস রিপোর্ট প্রকাশের অনুমতি নেওয়া হয়েছিল। রোগীকে ২.৫০ মিলি ০.৫% আইসোবারিক বুপিভাকেন এবং ৫০ মাইক্রোগ্রাম ফেন্টানিল এল৩-এল৪ ইন্টারস্পেসে দিয়ে সম্মিলিত এপিডিউরাল-স্পাইনাল অ্যানেস্থেসিয়া দেওয়া হয়েছিল। স্ট্যান্ডার্ড আমেরিকান সোসাইটি অফ অ্যানেস্থেসিওলজির নিয়ম অনুযায়ী পর্যবেক্ষণ করা হয়েছিল, যেখানে কার্ডিয়াক স্থিতিশীলতার উপর বেশি মনোযোগ দেওয়া হয়েছিল। রোগীর গুরুত্বপূর্ণ লক্ষণগুলোতে সামান্য পরিবর্তন দেখা যায়, তবে তিনি স্থিতিশীল ছিলেন এবং আইসোটোনিক স্যালাইন ব্যবহার করে পর্যাপ্ত রক্তচাপ বজায় রাখা হয়েছিল। অস্ত্রোপচারের পরে রোগীকে পোস্টঅ্যানেস্থেসিয়া কেয়ার ইউনিটে স্থানান্তর করা হয়, যেখানে ৪ ঘণ্টা পর ব্যথানাশক ওষুধ এবং এপিডিউরাল টপ-আপ দেওয়া হয়। ৬ ঘণ্টা পর, তাকে স্থিতিশীল অবস্থায় ওয়ার্ডে স্থানান্তর করা হয়। এপিডিউরাল ব্যথানাশক ৭২ ঘণ্টা ধরে দেওয়া হয় এবং ৮৮তম পোস্টঅপারেটিভ ঘণ্টায় রোগীকে স্থিতিশীল অবস্থায় ছুটি দেওয়া হয়।",
+    "corrected_translated_fulltext": "ইথিওপিয়ার আমহারা অঞ্চলের একজন বয়স্ক ৭৮ বছর বয়সী রোগী, যার ৭ বছর ধরে একটি স্থায়ী কার্ডিয়াক পেসমেকার রয়েছে, তার প্রোস্টেটের আকার বৃদ্ধি (বেনাইন প্রোস্ট্যাটিক হাইপারপ্লাসিয়া বা বিপিএইচ) হওয়ার কারণে রেট্রোপিউবিক প্রোস্টেটেকটমির জন্য নির্ধারণ করা হয়েছিল। এর আগে ৩ মাস আগে তার ট্রান্সইউরেথ্রাল রিসেকশন করা হয়েছিল। অস্ত্রোপচারের আগে অ্যানেস্থেসিয়া মূল্যায়নের সময় রোগীর সম্পূর্ণ পরীক্ষা করা হয় এবং প্রস্তাবিত অস্ত্রোপচারের জন্য প্রয়োজনীয় সমস্ত রুটিন পরীক্ষা করা হয়, যেগুলি স্বাভাবিক সীমার মধ্যে ছিল। গত ২ মাসে রোগীর ঘন ঘন প্রস্রাবের বেগ, রাতে প্রস্রাব করা এবং প্রস্রাব ধরে রাখতে না পারার মতো समस्या দেখা যাচ্ছিল। এছাড়াও, রোগীর ১৬ বছর ধরে উচ্চ রক্তচাপ ছিল এবং তিনি প্রতিদিন মুখে করে অ্যামলোডিপিন ৫ মিলিগ্রাম, এনালাপ্রিল ১০ মিলিগ্রাম দিনে দুবার এবং অ্যাটোরভাস্ট্যাটিন ১০ মিলিগ্রাম গ্রহণ করতেন। গত ২৫ বছর ধরে তার টাইপ ২ ডায়াবেটিস ছিল এবং তিনি মেটফর্মিন ৫০০ মিলিগ্রাম দিনে দুবার এবং নিউট্রাল প্রোটেমিন হাগেডর্ন (এনপিএইচ) ২০ আইইউ এবং ১০ আইইউ গ্রহণ করতেন। আরও মূল্যায়নের জন্য রোগীকে হাসপাতালে ভর্তি করা হয় এবং ইলেক্ট্রোকার্ডিওগ্রামের (ইসিজি) মাধ্যমে সম্পূর্ণ বান্ডেল ব্রাঞ্চ ব্লক (বিবিবি) ধরা পড়ে। একটি ইলেক্ট্রোফিজিওলজি স্টাডিতে, রোগীর উচ্চ রক্তচাপের কারণে বাম নিলয়ের আকার বৃদ্ধি, মৃদু ডায়াস্টোলিক ডিসফাংশন এবং ৬২% ইজেকশন ফ্র্যাকশন নির্ণয় করা হয়। পেটের আল্ট্রাসাউন্ডে প্রোস্টেটের আকার ৮২ মিলি দেখা যায়; বুকের সামনের এবং পিছনের (এপি) এক্স-রেতে বুকের স্বাভাবিক অবস্থা দেখা যায় এবং বাম দিকে পেসমেকার স্থাপন করা ছিল। অন্যান্য রক্ত পরীক্ষার ফলাফল, যেমন ইলেক্ট্রোলাইট এবং সিরাম ট্রোপোনিনের মাত্রা স্বাভাবিক ছিল।\n\nহৃদরোগের ঝুঁকি মূল্যায়ন এবং মাল্টিডিসিপ্লিনারি পদ্ধতির অংশ হিসেবে অস্ত্রোপচারের আগে একজন হৃদরোগ বিশেষজ্ঞকে অন্তর্ভুক্ত করা হয়েছিল। রোগীর দুর্বলতা স্কোর ছিল ৫.৫, যেখানে বিপাকীয় সমতুল্যের (এমইটি) মান ৩.৪ এবং রিভাইজড কার্ডিয়াক রিস্ক ইনডেক্স (আরসিআরআই) ক্লাস III ছিল। এর ফলে অস্ত্রোপচারের পরবর্তী ৩০ দিনের মধ্যে গুরুতর হৃদরোগের ঘটনা (মায়োকার্ডিয়াল ইনফার্কশন, কার্ডিয়াক অ্যারেস্ট বা মৃত্যু) ঘটার সম্ভাবনা ১০.১% ছিল এবং অস্ত্রোপচারের ধরন ও রোগীর ঝুঁকির কারণের ওপর ভিত্তি করে ঝুঁকির মাত্রা মাঝারি ছিল। অস্ত্রোপচারের আগে পেসমেকার পুনরায় প্রোগ্রামিং না করার কারণে এবং অ্যানেস্থেসিয়া ও অস্ত্রোপচারের সময় সম্ভাব্য জটিলতা সম্পর্কে জানানো হলে, রোগী পেসমেকার পুনরায় প্রোগ্রামিংয়ের জন্য প্রয়োজনীয় স্বাস্থ্যসেবা খরচ বহন করতে অক্ষম ছিলেন। এর কারণ হলো, এই হৃদরোগের অস্ত্রোপচারটি আদ্দিস আবাবাতে করা হয়েছিল, যেখানে কয়েকজন হৃদরোগ বিশেষজ্ঞ রয়েছেন এবং কয়েক মিলিয়ন মানুষের জন্য দীর্ঘ অপেক্ষার তালিকা রয়েছে। এছাড়াও, রোগীর বাড়ি থেকে এটি বেশ দূরে অবস্থিত এবং পেসমেকার পুনরায় প্রোগ্রামিংয়ের পরে জটিলতা দেখা দিলে তা পর্যবেক্ষণ করার জন্য একটি নির্দিষ্ট সময় প্রয়োজন। ফলস্বরূপ, রোগী অস্ত্রোপচারের জন্য রাজি হন এবং এর সাথে জড়িত সম্ভাব্য ঝুঁকি ও ক্ষতির বিষয়টি মেনে নেন। অস্ত্রোপচারের সময় ক্রমাগত হৃদরোগের নিরীক্ষণ করা অত্যন্ত গুরুত্বপূর্ণ। এই বিষয়গুলো সত্ত্বেও, রোগীর কার্ডিওরেসপিরেটরি ব্যর্থতা হয়নি এবং তিনি স্থিতিশীল ছিলেন। অস্ত্রোপচারের দিন পর্যন্ত রোগী ওষুধ গ্রহণ করতে থাকেন, যার মধ্যে অ্যামলোডিপিন, এনালাপ্রিল, অ্যাটোরভাস্ট্যাটিন এবং সকালে এনপিএইচ-এর দুই-তৃতীয়াংশ ডোজ ছিল। অস্ত্রোপচারের আগের রাতে উদ্বেগের জন্য তিনি ৫ মিলিগ্রাম ডায়াজেপাম গ্রহণ করেন।\n\nঅস্ত্রোপচারের দিন, রোগীর রক্তের গ্লুকোজের মাত্রা (আরবিএস) পরিমাপ করা হয় এবং গ্লাইসেমিক নিয়ন্ত্রণ করা হয়। অ্যানেস্থেটিস্ট, সার্জন এবং নার্সদের মধ্যে যোগাযোগ বাড়ানো হয়, যাতে নিশ্চিত করা যায় যে কটারি প্যাড পেসমেকার থেকে দূরে রাখা হয়েছে এবং জরুরি ওষুধ ও একটি ডিফিব্রিলেটর প্রস্তুত রাখা হয়েছে। বমি বমি ভাব প্রতিরোধের জন্য ডেক্সামেথাসোন এবং ব্যথানাশক হিসেবে প্যারাসিটামল দিয়ে রোগীকে আগে থেকে ওষুধ দেওয়া হয়। আমেরিকান সোসাইটি অফ অ্যানেস্থেসিয়োলজি (এএসএ) স্ট্যান্ডার্ড মনিটরিং ব্যবহার করা হয় এবং প্রাথমিক মানগুলি রেকর্ড করা হয়। ০.৫% আইসোবারিক বুপিভাকেন (১২.৫ মিলি) এবং ৫০ মাইক্রোগ্রাম ফেন্টানিল এল৩-এল৪ ইন্টারস্পেসের মাধ্যমে সম্মিলিত এপিডিউরাল-স্পাইনাল অ্যানেস্থেসিয়া দেওয়া হয়। এই পদ্ধতিতে নাভির কাছাকাছি পর্যন্ত অ্যানেস্থেসিয়া হয় এবং টি৭-এ\n\n---",
+    "corrected_translated_summary": "ইথিওপিয়ার আমহারা অঞ্চলের একজন ৭৮ বছর বয়সী পুরুষ, যার হৃদপিণ্ডের সম্পূর্ণ ব্লকের কারণে একটি স্থায়ী পেসমেকার বসানো হয়েছিল, তার রেট্রোপিউবিক প্রোস্টেটেকটমির জন্য সময়সূচী করা হয়েছিল। অ্যানেস্থেটিসিস্ট এবং কার্ডিওলজিস্টের অস্ত্রপূর্ব মূল্যায়নে পেসমেকারটিকে অ্যাসিঙ্ক্রোনাস মোডে পুনরায় প্রোগ্রাম করার সুপারিশ করা হয়েছিল, যাতে এর ডুয়াল-চেম্বার, রেট-মডুলেটেড মোড সেটিংসের কারণে সৃষ্ট ঝুঁকি কমানো যায়। তবে, রোগী পেসমেকার পুনরায় প্রোগ্রাম করার সামর্থ্য রাখেননি এবং বিদ্যমান অস্ত্রোপূর্ব পরিকল্পনা অনুযায়ী এগিয়ে যেতে চেয়েছিলেন। রোগীর কাছ থেকে সম্মতি নেওয়া হয়েছিল এবং অস্ত্রোপচারের পরে কেস রিপোর্ট প্রকাশের অনুমতি নেওয়া হয়েছিল। রোগীকে ২.৫০ মিলি ০.৫% আইসোবারিক বুপিভাকেন এবং ৫০ মাইক্রোগ্রাম ফেন্টানিল এল৩-এল৪ ইন্টারস্পেসে দিয়ে সম্মিলিত এপিডিউরাল-স্পাইনাল অ্যানেস্থেসিয়া দেওয়া হয়েছিল। স্ট্যান্ডার্ড আমেরিকান সোসাইটি অফ অ্যানেস্থেসিওলজির নিয়ম অনুযায়ী পর্যবেক্ষণ করা হয়েছিল, যেখানে কার্ডিয়াক স্থিতিশীলতার উপর বেশি মনোযোগ দেওয়া হয়েছিল। রোগীর গুরুত্বপূর্ণ লক্ষণগুলোতে সামান্য পরিবর্তন দেখা যায়, তবে তিনি স্থিতিশীল ছিলেন এবং আইসোটোনিক স্যালাইন ব্যবহার করে পর্যাপ্ত রক্তচাপ বজায় রাখা হয়েছিল। অস্ত্রোপচারের পরে রোগীকে পোস্টঅ্যানেস্থেসিয়া কেয়ার ইউনিটে স্থানান্তর করা হয়, যেখানে ৪ ঘণ্টা পর ব্যথানাশক ওষুধ এবং এপিডিউরাল টপ-আপ দেওয়া হয়। ৬ ঘণ্টা পর, তাকে স্থিতিশীল অবস্থায় ওয়ার্ডে স্থানান্তর করা হয়। এপিডিউরাল ব্যথানাশক ৭২ ঘণ্টা ধরে দেওয়া হয় এবং ৮৮তম পোস্টঅপারেটিভ ঘণ্টায় রোগীকে স্থিতিশীল অবস্থায় ছুটি দেওয়া হয়।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0016_0017.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0016_0017.json
new file mode 100644
index 0000000000000000000000000000000000000000..dc16607748a9caa6f83da1594bdbe473b252ecf7
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0016_0017.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_30.txt",
+    "fulltext": "The patient was a 59-year-old Japanese man with a 28-year history of type 1 diabetes. He visited our hospital monthly for management of diabetes with intensive therapy employing multiple-dose insulin injections. His height and body weight were 168 cm and 52 kg (body mass index: 18.4 kg/m2), respectively. He showed depleted insulin secretion (serum C-peptide level was below the limit of detection), such that his blood glucose levels fluctuated severely, and his hemoglobin A1c (HbA1c) level was around 9.0% despite intensive insulin therapy. He had been diagnosed with asymptomatic chronic severe (grade III) aortic regurgitation (AR) 16 years before the current presentation but had declined follow-up for the AR. He had never undergone surgery nor the implantation of any prosthetic devices.\n\nEight days after his regular hospital visit, he visited an emergency clinic complaining of breathing difficulty and had a fever above 38℃. Until that day, he had not noticed any fever, chills, weakness, or any other symptoms. His blood pressure and pulse rate were 192/82 mmHg and 118/min, respectively. He showed orthopnea, and his oxygen saturation (SpO2) was 80%. He was transported to the emergency department of our hospital. A physical examination revealed a Levine 3/6 systolic murmur, although his cardiac murmur had not been checked at regular hospital visits. No physical findings suggesting IE, such as Osler nodes, Janeway lesions, or conjunctival petechiae, were recognized. His white blood cell (WBC) count was markedly increased to 20,800 /μL, and his C-reactive protein (CRP) was elevated to 6.06 mg/dL. Serum creatine phosphokinase MB was within the normal range, at 6.0 IU/L, and troponin T was negative. Chest X-ray showed pulmonary congestion with cardiac enlargement (cardiothoracic ratio: 55%). Electrocardiography revealed ST elevation on V1-V4, but emergency echocardiography showed no dysfunction of cardiac contractility. He was diagnosed with acute heart failure due to valvular disease, and treatment with non-invasive positive pressure ventilation and nitrates was initiated.\n\nAfter hospital admission, a detailed examination by transthoracic echocardiography showed severe aortic regurgitation, severe mitral regurgitation, and a mobile vegetation on the mitral valve. Transesophageal echocardiography revealed a 16.5×6-mm mobile vegetation on the anterior leaflet of the mitral valve and an 11.2×5-mm nonmobile vegetation on the noncoronary cusp of the aortic valve. These findings raised strong suspicion of NVE. In this case, head computed tomography (CT) and magnetic resonance imaging revealed no cerebral infarction or hemorrhaging, although a mobile vegetation was detected.\n\nOn reviewing the clinical course until hospitalization, we noted that at the visit four months before admission, his WBC count had been slightly elevated. The following month, his albumin (Alb) level decreased to 3.0 g/dL, and his hemoglobin (Hb) level had shown a gradual decline over the 2 months prior to admission. During this period, he had experienced a 4-kg weight loss. Esophagogastroduodenoscopy and whole-body CT were performed, but no abnormalities were detected. One month later, he had regained some weight, and the laboratory findings had nearly normalized, except for a slightly elevated CRP level (0.54 mg/dL). At the last visit (8 days before admission), his WBC count had again risen to 9,300 /μL, while his Hb and Alb levels had again decreased to 13.1 g/dL and 3.0 g/dL, respectively. Furthermore, his CRP level had increased to 4.18 mg/dL. At that time, his diastolic blood pressure has shown an obvious decrease. Thus far, he had not experienced a fever or any symptoms other than weight loss. We suspected diseases of infectious and/or malignant origin and initiated comprehensive examinations to identify the source of his clinical findings.\n\nAfter heart failure treatment had been started, his clinical symptoms showed rapid improvement, and his hemodynamic stability was maintained during the first six hours. He initially received empirical intravenous antibiotic therapy consisting of 12 g/day of ampicillin sulbactam (ABPC/S) and 120 mg/day of gentamycin (GM). Three blood culture sets were obtained on the admission, and all were positive for S. warneri [minimum inhibitory concentration (MIC) to ABPC/S ≤8 μg/mL; MIC to GM ≤1 μg/mL; MIC to cefazolin (CEZ) ≤2 μg/mL]. Thus, IE caused by this organism was diagnosed.\n\nAccording to the clinical guideline established by the Japanese Circulation Society, emergency surgery is generally recommended for heart failure of NYHA III to IV or urgent surgery for NVE mobile vegetation exceeding 10 mm and severe valve dysfunction. In this case, however, his heart failure was successfully improved. Based on the guideline, the risk of embolism was considered to have been reduced by the administration of appropriate antibiotic therapy. In addition, the patient had type 1 diabetes, and his glycemic control was so poor that we were concerned that double-valve surgery would be a high-risk procedure. Therefore, we planned elective surgery after sufficient control of both infection and diabetes.\n\nBased on the blood culture results, the antibiotic regimen was switched to 6 g/day of CEZ. A detailed dental examination revealed no abnormalities, such as periodontitis. After four weeks of antibiotic therapy, he underwent surgical therapy. His aortic valve was found to be bicuspid, and the aortic and mitral annuli were intact without abscess formation. Large vegetations were exenterated, and the mitral and aortic valves were both replaced with mechanical valves. He experienced no postoperative complications and was discharged on the 22nd day after the operation without apparent embolism. He has not had any recurrence in over two years since the operation.",
+    "summary": "A 59-year-old man with type 1 diabetes presented with heart failure. Echocardiography showed large vegetations on the mitral and aortic valves. Blood bacterial culture was positive for Staphylococcus warneri, a coagulase-negative staphylococcus (CoNS) family member. He was diagnosed with native valve endocarditis (NVE) induced by the resident bacteria and ultimately underwent double valve replacement. Retrospectively, slight laboratory data abnormalities and weight loss beginning four months before may have been signs of NVE. He had no history of immunosuppressive therapies or medical device implantation. ",
+    "translated_fulltext": null,
+    "translated_summary": "৫৯ বছর বয়সী একজন ব্যক্তি, যিনি টাইপ ১ ডায়াবেটিসে আক্রান্ত, হৃদরোগের কারণে হাসপাতালে ভর্তি হন। ইকোকার্ডিওগ্রাফিতে দেখা যায় তার মিট্রাল এবং অ্যাওর্টিক ভালভে বড় আকারের সংক্রমণ হয়েছে। রক্ত পরীক্ষায় স্ট্যাফাইলোকক্কাস ওয়ারনারি নামক ব্যাকটেরিয়ার উপস্থিতি ধরা পড়ে, যা কোয়াগুলেজ-নেগেটিভ স্ট্যাফাইলোকক্কাস (CoNS) পরিবারের সদস্য। তাকে স্থানীয় ভালভের এন্ডোকার্ডাইটিস (NVE) নির্ণয় করা হয়, যা সেখানকার ব্যাকটেরিয়া দ্বারা সৃষ্ট। অবশেষে, তার দুটি ভালভ প্রতিস্থাপন করা হয়। পরবর্তীতে দেখা যায়, ভর্তি হওয়ার চার মাস আগে থেকে তার সামান্য কিছু ল্যাবরেটরি ডেটার অস্বাভাবিকতা এবং ওজন হ্রাস NVE-এর লক্ষণ ছিল। তার আগে কখনো ইমিউনোসাপ্রেসিভ থেরাপি বা কোনো মেডিকেল ডিভাইস বসানোর ইতিহাস ছিল না।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "৫৯ বছর বয়সী একজন ব্যক্তি, যিনি টাইপ ১ ডায়াবেটিসে আক্রান্ত, হৃদরোগের কারণে হাসপাতালে ভর্তি হন। ইকোকার্ডিওগ্রাফিতে দেখা যায় তার মিট্রাল এবং অ্যাওর্টিক ভালভে বড় আকারের সংক্রমণ হয়েছে। রক্ত পরীক্ষায় স্ট্যাফাইলোকক্কাস ওয়ারনারি নামক ব্যাকটেরিয়ার উপস্থিতি ধরা পড়ে, যা কোয়াগুলেজ-নেগেটিভ স্ট্যাফাইলোকক্কাস (CoNS) পরিবারের সদস্য। তাকে স্থানীয় ভালভের এন্ডোকার্ডাইটিস (NVE) নির্ণয় করা হয়, যা সেখানকার ব্যাকটেরিয়া দ্বারা সৃষ্ট। অবশেষে, তার দুটি ভালভ প্রতিস্থাপন করা হয়। পরবর্তীতে দেখা যায়, ভর্তি হওয়ার চার মাস আগে থেকে তার সামান্য কিছু ল্যাবরেটরি ডেটার অস্বাভাবিকতা এবং ওজন হ্রাস NVE-এর লক্ষণ ছিল। তার আগে কখনো ইমিউনোসাপ্রেসিভ থেরাপি বা কোনো মেডিকেল ডিভাইস বসানোর ইতিহাস ছিল না।"
+  },
+  {
+    "id": "multiclinsum_gs_en_383.txt",
+    "fulltext": "A 27-year-old woman with multiple colorectal cancers on a background of FAP was presented to our department. Notably, a large lesion was detected in the ascending, transverse, and sigmoid colon and the upper rectum, and pathological examination confirmed some of them as adenocarcinoma. Preoperative computed tomography revealed multiple lymph node swellings along the inferior mesenteric artery (IMA) and middle colic artery, without any evidence of distant metastases. After a comprehensive evaluation by a multidisciplinary cancer board, we decided to perform TPC with lymph node dissection of the entire colorectal region, using the Hugo RAS system as a surgical device.\n\nRobot-assisted TPC using the Hugo RAS system was approved by the Evaluating Committee for Highly Difficult New Medical Technologies (approval number H-0051) and the Institutional Review Board at Kyoto University.\n\nUnder general anesthesia, the patient was placed in a lithotomy position with the arms tucked. After a 5-cm vertical skin incision was made at the umbilicus, a wound-protecting device was applied. After pneumoperitoneum, 4 robotic trocars and 2 assistant trocars were placed. The instruments used in robot-assisted TPC with Hugo were a camera, monopolar curved shears for the right hand, bipolar fenestrated forceps for the left hand, and Cadiere/double fenestrated forceps for the reserve arm. Robot-assisted TPC with Hugo consists of 3 distinct steps, followed by transanal specimen extraction, ileal pouch construction through a small laparotomy, and ileal pouch-anus anastomosis (IPAA). Two table positions, Trendelenburg and flat, were required, each with specific docking tilts but the same angles of the arm carts throughout the robotic procedure. The detailed operative procedure is presented in Supplementary Videos.\n\nStep 1: Ascending colon complete mesocolic excision (CME)\n\nThe ascending colon CME from the caudal approach proceeded until the completion of the hepatic flexure mobilization (Supplementary Video S1).\n\nStep 2: Central vessel ligation (CVL) of the IMA, descending colon CME, and total mesorectal excision (TME)\n\nAfter CVL of the IMA, descending colon CME proceeded until the completion of splenic flexure mobilization, followed by TME until the intersphincteric space was fully exposed (Supplementary Video S2).\n\nStep 3: CVL along the superior mesenteric artery (SMA)\n\nAfter undocking all the robotic arms, the patient was placed in a flat position. Then, CVL along the SMA was performed to ligate the ileocolic, right colic, and middle colic vessels (Supplementary Video S3). The final step of this procedure was the ligation of the inferior mesenteric vein (IMV) at its root, which was exposed in Step 2.\n\nTransanal and small laparotomy procedures\nAfter transection of the terminal ileum, we extracted the specimen transanally by excising the rectal mucosa entirely from just below the dentate line because of multiple adenomas in the anal canal. After constructing the ileal pouch through the small umbilical incision and confirming that the ileal pouch could reach the bottom of the anal canal for anastomosis, transanal hand-sewn IPAA was performed. A diverting ileostomy was not performed.\n\nAll 3 steps were completed without conversion to open surgery. After undocking Hugo when we finished Step 3, we performed a laparoscopy to confirm hemostasis, specimen extraction, and appropriate anastomosis. The operative time was 632 min (36 min for Step 1, 160 min for Step 2, 188 min for Step 3, and 248 min for other procedures such as positioning, docking, specimen extraction, and anastomosis), with a minimal intraoperative estimated blood loss of 20 mL. The patient exhibited an uneventful postoperative recovery, with gas passage and initiation of liquid nutrition on postoperative day 1 (POD 1) and a solid diet on POD 3 with a functional ileal pouch and satisfactory anal function. Pathological examination revealed 2 sigmoid colon cancers (S1, Type 0-Ip, 55 × 50 mm, tub1, T1b, ly0, v0; S2, Type 0-Isp, 55 × 50 mm, tub1, Tis, ly0, v0) and 1 rectal cancer (R1, Type 0-Ip, 40 × 35 mm, tub1, Tis, ly0, v0). It also revealed 18 out of 89 positive lymph nodes, all of which belonged to the sigmoid colon and rectosigmoid lesions (stations #241, 242, and 251), resulting in UICC pT1bN2b stage.",
+    "summary": "A 27-year-old woman with multiple colorectal cancers with a background of familial adenomatous polyposis underwent robot-assisted TPC, including lymph node dissection of the entire colorectal region using the Hugo RAS system. The robotic procedure was divided into 3 steps: 1) Trendelenburg position to perform ascending colon complete mesocolic excision (CME) to the hepatic flexure, 2) descending colon CME and total mesorectal excision with D3 lymph node dissection, and 3) flat position to perform central vessel ligation along the superior mesenteric artery. After undocking, the specimen was extracted transanally, and an ileal pouch was constructed from a small laparotomy at the umbilical incision, followed by ileal pouch-anal anastomosis. The operative time was 632 min, and the estimated blood loss was minimal. The postoperative period was uneventful.",
+    "translated_fulltext": null,
+    "translated_summary": "২৭ বছর বয়সী একজন মহিলার একাধিক কোলরেকটাল ক্যান্সার ছিল এবং তার পরিবারে অ্যাডেনোমেটাস পলিপোসিসের ইতিহাস ছিল। তার ওপর রোবোটিক সহায়তায় টিপিসি (টিোটাল প্রোলাপ্স কারেকশন) করা হয়, যেখানে হুগো আরএএস সিস্টেম ব্যবহার করে পুরো কোলরেকটাল অঞ্চলের লিম্ফ নোড ডিসেকশন করা হয়। রোবোটিক পদ্ধতিটি তিনটি ধাপে বিভক্ত ছিল: ১) ঊর্ধ্বমুখী কোলনের সম্পূর্ণ মেসোকোলিক এক্সcision (সিএমই) করার জন্য ট্রেন্ডেলেনবার্গ অবস্থানে রাখা, যা হেপাটিক ফ্লেক্সার পর্যন্ত করা হয়, ২) নিম্নমুখী কোলনের সিএমই এবং ডি৩ লিম্ফ নোড ডিসেকশনসহ সম্পূর্ণ মেসোরেক্টাল এক্সcision, এবং ৩) কেন্দ্রীয় রক্তনালী বন্ধ করার জন্য একটি সমতল অবস্থানে রেখে সুপিরিয়র মেসেনটেরিক ধমনীর বরাবর কাজটি করা হয়। রোবোটিক প্রক্রিয়া শেষ হওয়ার পর, নমুনাটি ট্রান্সঅ্যানালি অপসারণ করা হয় এবং নাভির ছিদ্রের কাছে একটি ছোট ল্যাপারোটমি করে একটি ইলিয়াল পাউচ তৈরি করা হয়, এরপর ইলিয়াল পাউচ-অ্যানাল অ্যানাস্টোমোসিস করা হয়। পুরো প্রক্রিয়াটি ৬৩২ মিনিটে সম্পন্ন হয় এবং আনুমানিক রক্তক্ষরণ ছিল খুবই কম। অস্ত্রোপচারের পরবর্তী সময়কালে কোনো জটিলতা দেখা যায়নি।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "২৭ বছর বয়সী একজন মহিলার একাধিক কোলরেকটাল ক্যান্সার ছিল এবং তার পরিবারে অ্যাডেনোমেটাস পলিপোসিসের ইতিহাস ছিল। তার ওপর রোবোটিক সহায়তায় টিপিসি (টিোটাল প্রোলাপ্স কারেকশন) করা হয়, যেখানে হুগো আরএএস সিস্টেম ব্যবহার করে পুরো কোলরেকটাল অঞ্চলের লিম্ফ নোড ডিসেকশন করা হয়। রোবোটিক পদ্ধতিটি তিনটি ধাপে বিভক্ত ছিল: ১) ঊর্ধ্বমুখী কোলনের সম্পূর্ণ মেসোকোলিক এক্সcision (সিএমই) করার জন্য ট্রেন্ডেলেনবার্গ অবস্থানে রাখা, যা হেপাটিক ফ্লেক্সার পর্যন্ত করা হয়, ২) নিম্নমুখী কোলনের সিএমই এবং ডি৩ লিম্ফ নোড ডিসেকশনসহ সম্পূর্ণ মেসোরেক্টাল এক্সcision, এবং ৩) কেন্দ্রীয় রক্তনালী বন্ধ করার জন্য একটি সমতল অবস্থানে রেখে সুপিরিয়র মেসেনটেরিক ধমনীর বরাবর কাজটি করা হয়। রোবোটিক প্রক্রিয়া শেষ হওয়ার পর, নমুনাটি ট্রান্সঅ্যানালি অপসারণ করা হয় এবং নাভির ছিদ্রের কাছে একটি ছোট ল্যাপারোটমি করে একটি ইলিয়াল পাউচ তৈরি করা হয়, এরপর ইলিয়াল পাউচ-অ্যানাল অ্যানাস্টোমোসিস করা হয়। পুরো প্রক্রিয়াটি ৬৩২ মিনিটে সম্পন্ন হয় এবং আনুমানিক রক্তক্ষরণ ছিল খুবই কম। অস্ত্রোপচারের পরবর্তী সময়কালে কোনো জটিলতা দেখা যায়নি।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0032_0033.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0032_0033.json
new file mode 100644
index 0000000000000000000000000000000000000000..f7ac0e1d512c9aeeb379362bfc92971d55266b26
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0032_0033.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_346.txt",
+    "fulltext": "A 19-month-old boy was admitted to the Emergency Department because he fell from his baby feeding highchair. This fall occurred in apparent well-being, without the presence of anticipatory signs or symptoms. First, he fell on his gluteus and then he banged his head (occiput) on the ground. He presented with vomiting (three episodes) and he was very irritable. His respiratory rate and heart rate were >60 breaths and >150 beats per minute, while oxygen saturation was <80%. Upon physical examination, the child was hydrated and conscious, but irritable. More importantly, we noted subcostal retractions, and, at the auscultation, decreased breath sounds in the left basal part of chest. The patient was ventilated with an AMBU balloon connected to an oxygen source and monitored with a pulse oximeter. Despite our intervention, oxygen saturation fell below 70% and the more we ventilated, the more the saturation dropped down. The lung ultrasound showed the absence of the typical A lines and the consolidation of the lung, which was directly visualized as a solid parenchyma. On the basis of the poor clinical condition, the patient underwent orotracheal intubation with a cuffed endotracheal tube. After the baby was stabilized, he underwent a chest computed tomography (CT) showing complete atelectasis of the left lung with an interruption of the main left bronchus at 12 cm from bronchial bifurcation. An FBA was suspected as the mother also stated that the baby in the previous days had an intensive cough attack and disappeared within 24 h without any treatment. Therefore, a rigid bronchoscopy was performed and an almond of 2 cm in diameter in the main left bronchus was found and promptly removed.\n\nThe patient had never consumed almonds or other nuts before and in this circumstance ingested the almond by chance.\n\nThe baby had a progressive clinical improvement, and after 24 h, he was extubated and discharged from intensive care to be admitted to the general pediatrics ward for a few days with gradual and a total respiratory function recovery.",
+    "summary": "We describe the case of a 19-month-old boy who accessed the emergency room initially for a head trauma. The clinical evaluation, however, revealed an unexplained serious respiratory distress needing tracheal intubation. After our evaluation, we hypothesized that the severe respiratory distress determined an altered state of consciousness with following head trauma. The radiological findings raised the suspicion of foreign body aspiration for the presence of an atelectasis of the entire left lung. The computed tomography showed an abrupt interruption of the main bronchus at 12 mm from the hull. The following bronchoscopy identified an almond of 2 cm.",
+    "translated_fulltext": "১৯ মাস বয়সী একটি শিশুকে জরুরি বিভাগে ভর্তি করা হয়েছিল, কারণ সে তার খাবার চেয়ার থেকে পড়ে গিয়েছিল। আপাতদৃষ্টিতে সুস্থ অবস্থায় এই ঘটনা ঘটে, এবং এর আগে কোনো সতর্কতামূলক লক্ষণ বা উপসর্গ দেখা যায়নি। প্রথমে সে নিতম্বে পড়ে এবং তারপর তার মাথা (পশ্চাৎ করোটি) মাটিতে লাগে। এরপর সে তিনবার বমি করে এবং খুব অস্থির হয়ে পড়ে। তার শ্বাস-প্রশ্বাস এবং হৃদস্পন্দন প্রতি মিনিটে ৬০ বারের বেশি এবং হৃদস্পন্দন প্রতি মিনিটে ১৫০ বারের বেশি ছিল, যেখানে অক্সিজেনের মাত্রা ছিল ৮০% এর কম। শারীরিক পরীক্ষায় দেখা যায় শিশুটি যথেষ্ট পরিমাণে তরল গ্রহণ করেছে এবং সচেতন, কিন্তু অস্থির। সবচেয়ে গুরুত্বপূর্ণ বিষয় হলো, আমরা তার পাঁজর খাঁচার নিচে দেবে যাওয়া দেখতে পাই এবং স্টেথোস্কোপ দিয়ে শোনার সময় বুকের বাম দিকের নিচের অংশে শ্বাস-প্রশ্বাসের শব্দ কমে যাওয়া লক্ষ্য করি। রোগীকে একটি অ্যামবু বেলুনের মাধ্যমে অক্সিজেন সরবরাহ করা হয় এবং পালস অক্সিমিটার দিয়ে তার অবস্থা পর্যবেক্ষণ করা হয়। আমাদের চেষ্টা সত্ত্বেও, অক্সিজেনের মাত্রা ৭০% এর নিচে নেমে যায় এবং যত বেশি আমরা অক্সিজেন সরবরাহ করি, অক্সিজেনের মাত্রা ততই কমতে থাকে। ফুসফুসের আলট্রাসাউন্ডে দেখা যায় যে, ফুসফুসের স্বাভাবিক ‘এ’ লাইন অনুপস্থিত এবং ফুসফুস সংকুচিত হয়ে গেছে, যা সরাসরি একটি কঠিন প্যারেনকাইমা হিসেবে দেখা যায়। রোগীর শারীরিক অবস্থার অবনতি দেখে, তাকে একটি কাফযুক্ত এন্ডোট্রাকিয়াল টিউবের মাধ্যমে ওরোট্রাকিয়াল ইন্টিউবেশন করা হয়। শিশুটির অবস্থা স্থিতিশীল হওয়ার পরে, বুকের একটি সিটি স্ক্যান করা হয়, যেখানে দেখা যায় বাম ফুসফুস সম্পূর্ণরূপে সংকুচিত হয়ে গেছে এবং ব্রঙ্কিয়াল বাইফারকেশন থেকে ১২ সেন্টিমিটার দূরে প্রধান বাম ব্রঙ্কাসে বাধা সৃষ্টি হয়েছে। যেহেতু শিশুটির মা জানান যে, আগের কয়েক দিনে শিশুটির তীব্র কাশি হয়েছিল এবং কোনো চিকিৎসা ছাড়াই ২৪ ঘণ্টার মধ্যে তা সেরে যায়, তাই একটি বিদেশি বস্তু (FBA) গ্রহণের সন্দেহ করা হয়। এরপর একটি রিজিড ব্রঙ্কোস্কোপি করা হয় এবং প্রধান বাম ব্রঙ্কাসে ২ সেন্টিমিটার ব্যাসের একটি কাঠবাদাম পাওয়া যায়, যা দ্রুত অপসারণ করা হয়।\n\nশিশুটির আগে কখনো কাঠবাদাম বা অন্য কোনো বাদাম খাওয়ার অভ্যাস ছিল না এবং এই পরিস্থিতিতে সে ভুল করে কাঠবাদামটি খেয়ে ফেলেছিল।\n\nশিশুটির শারীরিক অবস্থার ধীরে ধীরে উন্নতি হয় এবং ২৪ ঘণ্টা পর, তাকে ইন্টেনসিভ কেয়ার থেকে সরিয়ে সাধারণ পেডিয়াট্রিক ওয়ার্ডে কয়েক দিনের জন্য ভর্তি করা হয়, যেখানে তার শ্বাস-প্রশ্বাস ধীরে ধীরে স্বাভাবিক অবস্থায় ফিরে আসে।",
+    "translated_summary": "আমরা একটি ১৯ মাস বয়সী ছেলের ঘটনা বর্ণনা করছি, যে প্রথমে মাথায় আঘাত লাগার কারণে জরুরি বিভাগে আসে। তবে, ক্লিনিক্যাল মূল্যায়নে দেখা যায় যে তার শ্বাসকষ্টের একটি গুরুতর কারণ রয়েছে, যার জন্য শ্বাসনালীতে টিউব প্রবেশ করানো প্রয়োজন। আমাদের মূল্যায়নের পর, আমরা অনুমান করি যে গুরুতর শ্বাসকষ্টের কারণে তার চেতনা পরিবর্তিত হয়েছে এবং এর পরেই মাথায় আঘাতটি লাগে। রেডিওলজিক্যাল পরীক্ষায় দেখা যায় যে বাম ফুসফুসের সম্পূর্ণ অংশ সংকুচিত হয়ে গেছে, যা কোনো বহিরাগত বস্তু শ্বাসনালীতে আটকে থাকার কারণে হয়েছে বলে সন্দেহ করা হয়। কম্পিউটেড টমোগ্রাফিতে দেখা যায় যে প্রধান শ্বাসনালীটি ১২ মিমি দূরত্বে হঠাৎ করে বন্ধ হয়ে গেছে। এরপর ব্রঙ্কোস্কোপি করে দেখা যায় যে সেখানে ২ সেন্টিমিটার আকারের একটি বাদামের টুকরা আটকে আছে।",
+    "corrected_translated_fulltext": "১৯ মাস বয়সী একটি শিশুকে জরুরি বিভাগে ভর্তি করা হয়েছিল, কারণ সে তার খাবার চেয়ার থেকে পড়ে গিয়েছিল। আপাতদৃষ্টিতে সুস্থ অবস্থায় এই ঘটনা ঘটে, এবং এর আগে কোনো সতর্কতামূলক লক্ষণ বা উপসর্গ দেখা যায়নি। প্রথমে সে নিতম্বে পড়ে এবং তারপর তার মাথা (পশ্চাৎ করোটি) মাটিতে লাগে। এরপর সে তিনবার বমি করে এবং খুব অস্থির হয়ে পড়ে। তার শ্বাস-প্রশ্বাস এবং হৃদস্পন্দন প্রতি মিনিটে ৬০ বারের বেশি এবং হৃদস্পন্দন প্রতি মিনিটে ১৫০ বারের বেশি ছিল, যেখানে অক্সিজেনের মাত্রা ছিল ৮০% এর কম। শারীরিক পরীক্ষায় দেখা যায় শিশুটি যথেষ্ট পরিমাণে তরল গ্রহণ করেছে এবং সচেতন, কিন্তু অস্থির। সবচেয়ে গুরুত্বপূর্ণ বিষয় হলো, আমরা তার পাঁজর খাঁচার নিচে দেবে যাওয়া দেখতে পাই এবং স্টেথোস্কোপ দিয়ে শোনার সময় বুকের বাম দিকের নিচের অংশে শ্বাস-প্রশ্বাসের শব্দ কমে যাওয়া লক্ষ্য করি। রোগীকে একটি অ্যামবু বেলুনের মাধ্যমে অক্সিজেন সরবরাহ করা হয় এবং পালস অক্সিমিটার দিয়ে তার অবস্থা পর্যবেক্ষণ করা হয়। আমাদের চেষ্টা সত্ত্বেও, অক্সিজেনের মাত্রা ৭০% এর নিচে নেমে যায় এবং যত বেশি আমরা অক্সিজেন সরবরাহ করি, অক্সিজেনের মাত্রা ততই কমতে থাকে। ফুসফুসের আলট্রাসাউন্ডে দেখা যায় যে, ফুসফুসের স্বাভাবিক ‘এ’ লাইন অনুপস্থিত এবং ফুসফুস সংকুচিত হয়ে গেছে, যা সরাসরি একটি কঠিন প্যারেনকাইমা হিসেবে দেখা যায়। রোগীর শারীরিক অবস্থার অবনতি দেখে, তাকে একটি কাফযুক্ত এন্ডোট্রাকিয়াল টিউবের মাধ্যমে ওরোট্রাকিয়াল ইন্টিউবেশন করা হয়। শিশুটির অবস্থা স্থিতিশীল হওয়ার পরে, বুকের একটি সিটি স্ক্যান করা হয়, যেখানে দেখা যায় বাম ফুসফুস সম্পূর্ণরূপে সংকুচিত হয়ে গেছে এবং ব্রঙ্কিয়াল বাইফারকেশন থেকে ১২ সেন্টিমিটার দূরে প্রধান বাম ব্রঙ্কাসে বাধা সৃষ্টি হয়েছে। যেহেতু শিশুটির মা জানান যে, আগের কয়েক দিনে শিশুটির তীব্র কাশি হয়েছিল এবং কোনো চিকিৎসা ছাড়াই ২৪ ঘণ্টার মধ্যে তা সেরে যায়, তাই একটি বিদেশি বস্তু (FBA) গ্রহণের সন্দেহ করা হয়। এরপর একটি রিজিড ব্রঙ্কোস্কোপি করা হয় এবং প্রধান বাম ব্রঙ্কাসে ২ সেন্টিমিটার ব্যাসের একটি কাঠবাদাম পাওয়া যায়, যা দ্রুত অপসারণ করা হয়।\n\nশিশুটির আগে কখনো কাঠবাদাম বা অন্য কোনো বাদাম খাওয়ার অভ্যাস ছিল না এবং এই পরিস্থিতিতে সে ভুল করে কাঠবাদামটি খেয়ে ফেলেছিল।\n\nশিশুটির শারীরিক অবস্থার ধীরে ধীরে উন্নতি হয় এবং ২৪ ঘণ্টা পর, তাকে ইন্টেনসিভ কেয়ার থেকে সরিয়ে সাধারণ পেডিয়াট্রিক ওয়ার্ডে কয়েক দিনের জন্য ভর্তি করা হয়, যেখানে তার শ্বাস-প্রশ্বাস ধীরে ধীরে স্বাভাবিক অবস্থায় ফিরে আসে।",
+    "corrected_translated_summary": "আমরা একটি ১৯ মাস বয়সী ছেলের ঘটনা বর্ণনা করছি, যে প্রথমে মাথায় আঘাত লাগার কারণে জরুরি বিভাগে আসে। তবে, ক্লিনিক্যাল মূল্যায়নে দেখা যায় যে তার শ্বাসকষ্টের একটি গুরুতর কারণ রয়েছে, যার জন্য শ্বাসনালীতে টিউব প্রবেশ করানো প্রয়োজন। আমাদের মূল্যায়নের পর, আমরা অনুমান করি যে গুরুতর শ্বাসকষ্টের কারণে তার চেতনা পরিবর্তিত হয়েছে এবং এর পরেই মাথায় আঘাতটি লাগে। রেডিওলজিক্যাল পরীক্ষায় দেখা যায় যে বাম ফুসফুসের সম্পূর্ণ অংশ সংকুচিত হয়ে গেছে, যা কোনো বহিরাগত বস্তু শ্বাসনালীতে আটকে থাকার কারণে হয়েছে বলে সন্দেহ করা হয়। কম্পিউটেড টমোগ্রাফিতে দেখা যায় যে প্রধান শ্বাসনালীটি ১২ মিমি দূরত্বে হঠাৎ করে বন্ধ হয়ে গেছে। এরপর ব্রঙ্কোস্কোপি করে দেখা যায় যে সেখানে ২ সেন্টিমিটার আকারের একটি বাদামের টুকরা আটকে আছে।"
+  },
+  {
+    "id": "multiclinsum_gs_en_24.txt",
+    "fulltext": "Patient and observation\nPatient information (presentation of the patient): he is a 28-year-old single man without children, an active military. He has been present for 5 weeks with progressive abdominal pain, more marked in the epigastrium and the right hypochondrium, followed shortly after by a non-quantified fever, chills, profuse sweats in a context of anorexia and weight loss of 6 kg. Note that the patient is not a drinker or smoker, vaccinated with BCG and has no other contributing personal or family history.\n\nClinical findings: On admission, the physical examination found the patient in a general altered state, asthenic with a weight loss of 6 kg in one month. A clinical systemic inflammatory response syndrome was present with the following elements: a fever of 39.1 °C, tachycardia (124 beats/min), polypnea (22 cycles/min). The pulmonary examination and exploration of the superficial lymph node areas were without particularity. In the abdominal area, moderate sensitivity in the right hypochondrium with hepatomegaly was found.\n\nChronology: dates back to February 2022 with the onset of diffuse abdominal pain with diarrhea-constipation transit disorder, all in a context of preservation of general condition with low-grade fever predominantly at night. A syntagmatic treatment was unsuccessfully initiated. The evolution is marked by the persistence of low-grade fever associated with anorexia and progressive weight loss of 12 kg over three months. In the face of this transit disorder with unexplained fever and the deterioration of the general condition, the patient will be admitted to the emergency department for further investigation.\n\nDiagnostic approach: upon admission, a biological infectious syndrome was reported with a neutrophilic predominant hyperleucocytosis (17800 cells/mm3) and a high C-reactive protein of 323 mg/L.\n\nIn the face of his abdominal pain, the lipase and troponin tests were normal at 38 IU/L (VN: <3 78 IU/L) and 4 ng/L (VN: 2 to 16 ng/L) respectively. The liver function was stable with ALT (alanine amino transferase) at 22 IU/L (VN: < 40UI/L), AST (aspartate amino transferase) at 17 IU/L (VN: < 35UI/L), GGT (gamma glutamyl transferase) at 42 IU/L (VN: < 50UI/L), PAL (alkaline phosphatase) at 115 IU/L (VN: 40- 150 IU/L) and normal bilirubinemia. The liver function was normal with a prothrombin rate of 78% and an albuminemia of 39 g/L. The blood ionogram and renal function were normal. The chest radiograph and abdominal ultrasound were without particularity.\n\nWith a procalcitonin positive at 4.1 ng/L, an infectious disease assessment to search for the infectious focus was initiated, including a cytobacteriological examination of urine and blood cultures during the febrile peaks at 39°C, which were both negative. The hepatitis viral B, C and HIV serologies, as well as the syphilis serology performed in hospital were all negative. The lactate dehydrogenase (LDH) and beta-2 microglobulin were normal at 231 IU/L and 2.28 mg/L respectively. The GeneXpert to search for the Mycobacterium on these bioptic pieces was negative. The quantiferon was negative. The search for the Mycobacterium on the morning expectorations of 3 consecutive days was negative.\n\nOn the morphological level, a thoraco-abdomino-pelvic scan showed an enlarged liver (hepatic arrow at 17 cm), the site of multiple, well-defined, rounded hypodensities, which were not enhanced after injection of the contrast agent. The largest lesions were in segment I (21 x 16 mm) and segment V (36 x 27 mm). No suspicious lesions were detected in the thoracic and pelvic levels. The first liver biopsies obtained by echo-guided puncture revealed subacute, fibro-inflammatory liver lesions, with no histological evidence of specificity or malignancy.\n\nA liver MRI following the scan objectified a dysmorphic liver, the site of lesions in heterogeneous signal T2 surrounded by a wall in hyper signal T2, enhanced in the periphery after injection of the contrast agent, the largest of which is located in segment I (20 x 22 mm) and in segment V (33 x 31 mm). No deep lymphadenopathy had been objectified, either in the scan or in the MRI. A diagnostic laparoscopy performed on the hepatic nodules, the histological examination found epithelioid and gigantocellular granulomas of varying size with caseous necrosis in favour of a hepatic tuberculosis.\n\nTherapeutic intervention: the patient was put on anti-tuberculosis treatment according to the standard protocol for months: Phase 1: quadritherapy (Isoniazide + Rifampicine + Pyrazinamide + Ethambutol) in a single oral intake each morning on an empty stomach for 2 months. Phase 2: bithrapia (Isoniazide + Rifampicine) in a single oral intake each morning on an empty stomach for 4 months\n\nFollow-up and results of therapeutic interventions: from the first days of treatment, a good response was obtained with disappearance of the inflammatory syndrome with systemic response both clinically and biologically. After three months of treatment, a control scan of the liver showed a decrease in the number and volume of liver lesions.\n",
+    "summary": "This clinical case was reported in a young Moroccan, presenting a picture of hepatic colic that had been developing for a month, associated with subtle signs of tuberculous infection. Non-specific hepatic nodular lesions were revealed on the scanner and on the hepatic magnetic resonance imaging (MRI). The diagnosis of focal hepatic tuberculosis was confirmed after pathological analysis of hepatic nodule biopsies obtained after a laparoscopy. After the start of well-conducted anti-bacillary treatment, a good clinical-biological improvement was obtained.\n",
+    "translated_fulltext": null,
+    "translated_summary": "এই ক্লিনিক্যাল ঘটনাটি একজন অল্পবয়সী মরোক্কান ব্যক্তির ক্ষেত্রে দেখা গিয়েছিল, যেখানে এক মাসের ধরে লিভারের ব্যথার লক্ষণ দেখা যাচ্ছিল এবং এর সাথে যক্ষ্মা সংক্রমণের কিছু মৃদু উপসর্গ ছিল। স্ক্যানারে এবং লিভারের ম্যাগনেটিক রেজোন্যান্স ইমেজিংয়ে (এমআরআই) লিভারের কিছু নির্দিষ্ট নয় এমন টিউমার-সদৃশ ক্ষত দেখা যায়। ল্যাপারোস্কোপির মাধ্যমে লিভারের টিউমার থেকে নেওয়া বায়োপসির প্যাথলজিক্যাল বিশ্লেষণের পর ফোকাল হেপাটিক যক্ষ্মার রোগ নির্ণয় নিশ্চিত করা হয়। ভালোভাবে পরিচালিত অ্যান্টি-ব্যাকটেরিয়াল চিকিৎসা শুরু করার পর রোগীর শারীরিক অবস্থার উল্লেখযোগ্য উন্নতি দেখা যায়।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "এই ক্লিনিক্যাল ঘটনাটি একজন অল্পবয়সী মরোক্কান ব্যক্তির ক্ষেত্রে দেখা গিয়েছিল, যেখানে এক মাসের ধরে লিভারের ব্যথার লক্ষণ দেখা যাচ্ছিল এবং এর সাথে যক্ষ্মা সংক্রমণের কিছু মৃদু উপসর্গ ছিল। স্ক্যানারে এবং লিভারের ম্যাগনেটিক রেজোন্যান্স ইমেজিংয়ে (এমআরআই) লিভারের কিছু নির্দিষ্ট নয় এমন টিউমার-সদৃশ ক্ষত দেখা যায়। ল্যাপারোস্কোপির মাধ্যমে লিভারের টিউমার থেকে নেওয়া বায়োপসির প্যাথলজিক্যাল বিশ্লেষণের পর ফোকাল হেপাটিক যক্ষ্মার রোগ নির্ণয় নিশ্চিত করা হয়। ভালোভাবে পরিচালিত অ্যান্টি-ব্যাকটেরিয়াল চিকিৎসা শুরু করার পর রোগীর শারীরিক অবস্থার উল্লেখযোগ্য উন্নতি দেখা যায়।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0038_0039.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0038_0039.json
new file mode 100644
index 0000000000000000000000000000000000000000..c43949192156847bd800a8f0906d968e31bfe640
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0038_0039.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_164.txt",
+    "fulltext": "A 56-year-old female patient presented with complaints of dyspnea that required oxygen supplementation. Her medical history dates back to July 2013 when she was hospitalized in the chest ward for dyspnea and cough with yellow sputum. She was subsequently diagnosed with Sjogren’s syndrome complicated with interstitial lung disease (ILD) and PAH (Table I). Her chest X-ray at that time showed vascular markings with interstitial thickening, costophrenic (CP) angle blunting and cardiomegaly. An echocardiogram revealed a pulmonary arterial (PA) systolic pressure of 99 mmHg, enlargement of the right atrium and ventricle, D-shaped left ventricle (LV), and severe tricuspid regurgitation. Chest CNYCT showed no filling defects, excluding pulmonary embolism; it also displayed an enlarged pulmonary trunk, right atrium (RA), and right ventricle (RV), further evidencing pulmonary hypertension. Symptoms of dry mouth, dry eyes, and cracked tongue mucosa, with a Schirmer’s test showing <5 cm, oculus uterque (OU). A positive minor salivary gland biopsy, nuclear medicine scan showing impaired salivary gland function, and a positive anti-Ro test, confirmed Sjogren’s syndrome. She started on Revatio (Sildenafil) 20 mg three times a day (TID) for pulmonary hypertension control, adding Tracleer (Bosentan) in 2016 due to disease progression. A right heart catheterization (RHC) revealed a mean pulmonary arterial pressure (PAP) of 39 mmHg, pulmonary vascular resistance (PVR) nearly 15 Woods, and a wedge pressure of 4, indicating pre-capillary type, group I, CTD-related PAH in 2017. The right heart catheterization (RHC) report allowed for insurance coverage of Opsumit (Macitentan) 10 mg once a day (QD), replacing Tracleer (Bosentan) in 2017. From 2017 to 2020, she was hospitalized multiple times for steroid treatments to manage her underlying Sjogren’s syndrome.\n\nPulmonary hypertension treatment is risk-based, and until 2017, the patient was considered low to intermediate risk, controlled with two medications (Sildenafil + Macitentan). Her condition remained stable until October 2020, when she experienced worsened dyspnea accompanied by cough and expectoration of white sputum, suggestive of infection. On November 10, 2020, the patient experienced severe dyspnea, cold sweats, and cyanosis, with SpO2 dropping to 70%, necessitating 100% O2 via face tent. Blood gas and lab tests revealed a lactate level of 5.2 mmol/l and brain natriuretic peptide (BNP) over 10,000 pg/ml, strongly suggesting cardiogenic shock. She was prepped for intensive care unit (ICU) admission, intubated, and initiated on four pulmonary hypertension medications. Her condition stabilized and showed improvement, preventing further deterioration. On November 12, 2020, evaluation for heart-lung transplantation began. Her condition continued to improve with off vasopressors on November 13, 2020, and extubating on November 14, 2020, and transferred to a general ward on November 21, 2020, with O2 tapered to nasal cannula 2l/min. A follow-up RHC continued to show elevated pulmonary artery pressure, likely attributed to chronic hypertension leading to right heart strain and eventual failure. After intensive care unit (ICU) treatment, she was referred to National Taiwan University Hospital for evaluation for heart-lung transplant.\n\nReviewing the records since the onset of her illness, it was evident that pulmonary artery pressure had steadily increased, and the distance covered in the 6-minute walk test was progressively shortened. Currently, the patient is classified as high risk. She continues regular hospitalizations for control. Despite the relatively stable condition, her chief complaint during the admission is still dyspnea. The physical examination revealed mild rhonchi ILD and a pansystolic murmur indicative of severe valvular heart disease, with no other significant findings. Ventavis (Iloprost) 10 mcg/ml 2 ml was added in 2020. Molecular hydrogen therapy (1 capsule/day) was initiated in May 2023. Hydrogen capsules (PURE HYDROGEN) were purchased from HoHo Biotech Co., Ltd. (Taipei, Taiwan, ROC). Each capsule contained 170 mg of hydrogen-rich coral calcium containing 1.7×1,021 molecules of hydrogen, which is equivalent to 24 cups of water with 1,200 ppb of hydrogen or 0.6 mM of hydrogen per 200 ml of water. Adjuvant therapy with hydrogen capsules resulted in increased CD127 + Treg, decreased anti-Ro antibody, decreased B cell subsets, and stabilization of clinical symptoms and signs was observed following the addition of hydrogen therapy in this patient. No adverse reactions or events were observed following the administration of hydrogen capsules. Flow cytometry and serological examination were employed for whole-blood analysis to assess changes in immune cells and autoantibody before and after hydrogen therapy. For subsequent whole-blood analysis via flow cytometry, blood samples were prepared using standard fluorescent dye preparation methods and fluorescent antibody reagent kits with dried reagents (Beckman Coulter, Brea, CA, USA). The methods, steps, immunophenotypic analysis, and cell gating were conducted following previously described procedures. Our analysis of immunophenotypic markers before and after hydrogen therapy revealed increased CD127 + Treg and decreased B cell subsets after treatment. Moreover, this study adheres to the CARE reporting guidelines (2013 CARE Checklist).",
+    "summary": "We present the case of a 56-year-old female with CTD-PAH, diagnosed in 2013 with Sjogren’s syndrome complicated by interstitial lung disease (ILD) and PAH. Despite treatment with sildenafil, bosentan, macitentan, iloprost, and corticosteroids, her condition deteriorated, resulting in severe dyspnea and cardiogenic shock in 2020. In May 2023, molecular hydrogen therapy was initiated as an adjuvant treatment. The patient received daily hydrogen capsules, which led to increased CD127+ Treg cells, reduced anti-Ro antibodies, and decreased B cell subsets. Her clinical symptoms stabilized without adverse effects.",
+    "translated_fulltext": null,
+    "translated_summary": "আমরা একজন ৫৬ বছর বয়সী মহিলার ঘটনা তুলে ধরছি, যিনি সিটিডি-পিএএইচ-এ আক্রান্ত ছিলেন। ২০১৩ সালে তার শরীরে sjögren’s syndrome ধরা পড়ে, যা ইন্টারস্টিশিয়াল লাং ডিজিজ (আইএলডি) এবং পিএএইচ-এর কারণে জটিল আকার ধারণ করে। সিলডেনাফিল, বোসেনটান, ম্যাসিতেনটান, ইলোপ্রোস্ট এবং কর্টিকোস্টেরয়েড দিয়ে চিকিৎসার পরেও তার অবস্থার অবনতি হয়, যার ফলে ২০২০ সালে গুরুতর শ্বাসকষ্ট এবং কার্ডিওজেনিক শক দেখা দেয়। ২০২৩ সালের মে মাসে, সহায়ক চিকিৎসা হিসেবে মলিকিউলার হাইড্রোজেন থেরাপি শুরু করা হয়। রোগীকে প্রতিদিন হাইড্রোজেন ক্যাপসুল দেওয়া হতো, যার ফলে সিডি১২৭+ টিরেগ কোষের সংখ্যা বৃদ্ধি পায়, অ্যান্টি-রো অ্যান্টিবডির পরিমাণ হ্রাস পায় এবং বি কোষের উপশ্রেণী কমে যায়। কোনো বিরূপ প্রভাব ছাড়াই তার ক্লিনিক্যাল লক্ষণগুলো স্থিতিশীল হয়।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা একজন ৫৬ বছর বয়সী মহিলার ঘটনা তুলে ধরছি, যিনি সিটিডি-পিএএইচ-এ আক্রান্ত ছিলেন। ২০১৩ সালে তার শরীরে Sjogren’s syndrome ধরা পড়ে, যা ইন্টারস্টিশিয়াল লাং ডিজিজ (আইএলডি) এবং পিএএইচ-এর কারণে জটিল আকার ধারণ করে। সিলডেনাফিল, বোসেনটান, ম্যাসিতেনটান, ইলোপ্রোস্ট এবং কর্টিকোস্টেরয়েড দিয়ে চিকিৎসার পরেও তার অবস্থার অবনতি হয়, যার ফলে ২০২০ সালে গুরুতর শ্বাসকষ্ট এবং কার্ডিওজেনিক শক দেখা দেয়। ২০২৩ সালের মে মাসে, সহায়ক চিকিৎসা হিসেবে মলিকিউলার হাইড্রোজেন থেরাপি শুরু করা হয়। রোগীকে প্রতিদিন হাইড্রোজেন ক্যাপসুল দেওয়া হতো, যার ফলে সিডি১২৭+ টিরেগ কোষের সংখ্যা বৃদ্ধি পায়, অ্যান্টি-রো অ্যান্টিবডির পরিমাণ হ্রাস পায় এবং বি কোষের উপশ্রেণী কমে যায়। কোনো বিরূপ প্রভাব ছাড়াই তার ক্লিনিক্যাল লক্ষণগুলো স্থিতিশীল হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_354.txt",
+    "fulltext": "The patient was a 45-year-old male born in Pakistan who had resided in Portugal for 7 years. He had a history of grade 3 obesity, with no other known personal history or usual pharmacological therapy.\n\nThe patient sought emergency care for fever, dry cough, dyspnea, chest pain, dysgeusia, headache and myalgia with 4 days of evolution. In the summary neurological examination at admission, there were no reported changes. In the evaluation of the respiratory system, tachypnea and pulmonary auscultation with bilateral rough vesicular murmur, without other adventitious sounds, were noted. The remainder of the objective examination showed no changes.\n\nOf the complementary diagnostic tests performed at admission, there was a slight increase in inflammatory parameters and in arterial blood gases under an inspired oxygen fraction (FiO2) of 21%, with type 1 respiratory failure and extensive predominant bilateral, peripheral and basal opacities on chest teleradiography. After a positive reverse-transcription real-time polymerase chain reaction (RT-PCR) test for SARS-CoV-2 (nasal and oropharyngeal exudate) and negative tests for influenza A and B, Streptococcus pneumoniae and Legionella pneumophila, a diagnosis of pneumonia by SARS-CoV-2 infection was established.\n\nOver the first 48 hours, progressive worsening of fatigue, dyspnea and type 1 respiratory failure, requiring an increase in supplemental oxygen therapy, were observed. Due to the lack of improvement, noninvasive mechanical ventilation was initiated; however, due to poor adherence, high-flow oxygen therapy was initiated through a nasal cannula, without a response to therapy.\n\nIn this context, the patient was admitted to the intensive care unit (ICU), level III, where he underwent sedoanalgesia and orotracheal intubation with connection to invasive mechanical ventilation.\n\nOn the eleventh day of hospitalization, treatment with remdesivir, dexamethasone, enoxaparin and empirical antibiotic therapy with amoxicillin/clavulanic acid and azithromycin, administered on suspicion of bacterial overinfection, was continued. During this period, sustained fever was observed, with a weak response to antipyretic therapy, with improvements in inflammatory parameters after the third day of hospitalization in the ICU.\n\nTo exclude any concomitant infectious etiology, intravenous devices were replaced, and blood cultures, cultures of the tip of the central catheter and bronchial secretions, urinalysis, urine culture and transthoracic echocardiography were performed. Among the cultures, the blood culture yielded the only positive result, i.e., Klebsiella pneumoniae, which is sensitive to amoxicillin/clavulanic acid, which the patient was already receiving. The summary echocardiogram did not reveal valve changes suggestive of endocarditis, but the patient presented hypokinesia of the lateral wall and left ventricular apex, as well as poor biventricular function. A slight increase in troponins (1.8ng/mL) and ST-segment depression in leads I and aVL were confirmed, suggesting the existence of acute coronary syndrome or septic cardiomyopathy.\n\nOther noninfectious causes of febrile symptoms in the critically ill patient were excluded, including treatment with neuroleptics or altered thyroid function.\n\nNotably, there was a need for inotropic support with dobutamine in the ventilatory weaning phase as well as noninvasive ventilatory support after orotracheal extubation, which occurred on the fifteenth day of hospitalization.\n\nOn the sixteenth day of hospitalization (nineteenth day of confirmed disease), there was an episode of altered state of consciousness, conjugated deviation of gaze to the right and myoclonus of the face and thoracic region to the left followed by a generalized tonic-clonic seizure crisis, which ceased after midazolam therapy. The hypothesis that the seizure occurred in the context of a hypoxic-ischemic event was excluded because the patient remained normotensive, there was never a peri-event or hypoxemia, serum lactate level was normal, and diuresis remained preserved. Any ionic or glycemic disorders that could explain the inaugural seizure episode were excluded.\n\nIn the post-critical period, there was an absence of eye opening, no verbal response, failure to localize to pain (coma scale of Glasgow 7), and persistent left hemiparesis grade 3 out of 5. Due to the need for airway protection, the patient was sedated, subjected to orotracheal intubation and started on anticonvulsant therapy.\n\nIn the process of diagnosis of the convulsive episode, after cranial computed tomography confirmed no changes, the patient was subjected to lumbar puncture, with turbid CSF output and mild proteinorrachia but without pleocytosis and with normal opening pressure. In the CSF, neurotropic virus and venereal disease research laboratory (VDRL), acid-alcohol resistant bacteria tests and an RT-PCR test for SARS-CoV-2 were requested, and samples were collected for culture. Electroencephalography was performed 1 hour after propofol suspension and under fentanyl, with a single record and total duration of 13 minutes; the findings indicated no changes.\n\nAfter confirmation of a positive RT-PCR test for SARS-CoV-2 RNA in the CSF, without CSF pleiocytosis, the hypothesis of bacterial but nonviral meningitis was excluded, considering the hypothesis of encephalitis. Magnetic resonance imaging (MRI) performed on the seventeenth day of hospitalization showed multiple image artifacts associated with patient movement during the procedure, suggesting the need to repeat the examination.\n\nAfter discontinuation of sedoanalgesia, a change in consciousness was observed, with a Glasgow coma scale score of 14, persistent left hemiparesis with muscle strength grade 4 in 5 and an absence of involuntary movements, allowing safe orotracheal extubation in 24 hours. Given the favorable clinical outcome, brain biopsy was excluded. On the twenty-first day of hospitalization, the patient was transferred to the ward.\n\nThe patient maintained apyrexia without altered state of consciousness. No new episodes of involuntary movements were observed, and on the twenty-sixth day of hospitalization, he underwent a reassessment MRI, which revealed no pathological changes. As he maintained a favorable clinical evolution, the patient was discharged on the thirty-first day of hospitalization without antiepileptic drugs and with an appointment for follow-up with the internal medicine department.\n",
+    "summary": "The authors present the clinical case of a 45-year-old man admitted for pneumonia with a positive result for SARS-CoV-2, with no neurological history, who, on the 16th day of admission, presented a sudden change in consciousness accompanied by a conjugate deviation of the gaze to the right and myoclonia of the face and thoracic region to the left, followed by a generalized tonic-clonic convulsive seizure, associated with persistent left hemiparesis. From the study carried out, the existence of RT-PCR for SARS-CoV-2 in the cerebrospinal fluid is highlighted. The patient presented a clinical evolution with gradual improvement, and the outcome was favourable.\n",
+    "translated_fulltext": null,
+    "translated_summary": "লেখকরা ৪৫ বছর বয়সী একজন পুরুষের ক্লিনিক্যাল ঘটনা উপস্থাপন করেছেন, যিনি নিউমোনিয়ার জন্য হাসপাতালে ভর্তি হয়েছিলেন এবং তাঁর SARS-CoV-2 পরীক্ষা পজিটিভ ছিল। তাঁর পূর্বে কোনো স্নায়বিক সমস্যা ছিল না। হাসপাতালে ভর্তির ১৬তম দিনে, তিনি হঠাৎ করে চেতনা হারাতে শুরু করেন, একই সাথে তাঁর দৃষ্টি ডান দিকে সরে যায় এবং মুখের ও বুকের বাম অংশে মায়োক্লোনিয়া দেখা যায়। এর পরে তাঁর全身ব্যাপী টনিক-ক্লোনিক খিঁচুনি হয় এবং বাম দিকের শরীরের দুর্বলতা দেখা যায়। এই গবেষণা থেকে জানা যায় যে, মেরুদণ্ডীয় তরলে SARS-CoV-2-এর আরটি-পিসিআর উপস্থিতি ছিল। রোগীর ধীরে ধীরে উন্নতি হয় এবং তাঁর শারীরিক অবস্থা অনুকূলে ছিল।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "লেখকরা ৪৫ বছর বয়সী একজন পুরুষের ক্লিনিক্যাল ঘটনা উপস্থাপন করেছেন, যিনি নিউমোনিয়ার জন্য হাসপাতালে ভর্তি হয়েছিলেন এবং তাঁর SARS-CoV-2 পরীক্ষা পজিটিভ ছিল। তাঁর পূর্বে কোনো স্নায়বিক সমস্যা ছিল না। হাসপাতালে ভর্তির ১৬তম দিনে, তিনি হঠাৎ করে চেতনা হারাতে শুরু করেন, একই সাথে তাঁর দৃষ্টি ডান দিকে সরে যায় এবং মুখের ও বুকের বাম অংশে মায়োক্লোনিয়া দেখা যায়। এর পরে তাঁর সারা শরীরব্যাপী টনিক-ক্লোনিক খিঁচুনি হয় এবং বাম দিকের শরীরের দুর্বলতা দেখা যায়। এই গবেষণা থেকে জানা যায় যে, মেরুদণ্ডীয় তরলে SARS-CoV-2-এর আরটি-পিসিআর উপস্থিতি ছিল। রোগীর ধীরে ধীরে উন্নতি হয় এবং তাঁর শারীরিক অবস্থা অনুকূলে ছিল।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0042_0043.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0042_0043.json
new file mode 100644
index 0000000000000000000000000000000000000000..d955dc4ba106f3ccb43baf5e8c7830eb26e3c687
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0042_0043.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_491.txt",
+    "fulltext": "This is a 32-year-old patient, a baker, from Bamako, who was admitted to the Infectious and Tropical Diseases department of the CHU du Point G (Bamako, Mali) on 27 April 2023 for chronic productive cough, otalgia and a chronic right-sided purulent otorrhea.\n\nThe symptomatology would be of progressive installation in 1 month, initially treated in a medical center with artésunate, paracetamol and unspecified antibiotics for confirmed malaria and acute otitis media, without success. He is immunosuppressed by a HIV1 infection, diagnosed and put on a tritherapy antiretroviral (TARV) Tenofovir/Lamivudine/Dolutégravir 7 months ago, not observed due to denial of his illness.\n\nThe general physical examination found a fever (38.2 °C), altered general condition, otalgia, purulent right foul-smelling otorrhea, a right basal pulmonary condensation syndrome, a normal neurological examination, without the involvement of the cranial nerves, mainly the facial nerve VII and the VIII cochleovestibular nerve.\n\nIn the ENT examination, the otoscopy of the right ear showed an inflammatory external auditory canal with purulent secretions and the presence of a single tympanic perforation in the anterior-inferior quadrant. The left ear is normal. The Rinne and Weber test is in favor of a right conductive hearing loss.\n\nImmuno-virological evaluation shows a CD4 count of 118 cells/pl and a viral load of 12,370 copies/ml at the time of diagnosis of HIV infection, compared to a viral load of 9,460 copies/ml and a CD4 lymphocyte count of 193 cells/pl at the 6th month of antiretroviral treatment. At the time of diagnosis of tuberculosis at the 7th month, the immuno-virological evaluation shows a CD4 count of 89 cells/pl and a viral load of 10,230 copies/ml.\n\nThe Ziehl Neelsen bacilloscopy was positive with a cross in the gastric washings on admission and 19 days later in the right ear swab because of the persistent otorrhea. The Xpert-MTB/GeneXpert test did not detect rifampicin-resistant Mycobacterium tuberculosis.\n\nThe frontal chest radiograph shows a more accentuated bronchovascular network at the base of the right lung.\n\nThe diagnosis of tuberculosis of the middle ear concomitant to a pulmonary localization in the field of immunosuppression by HIV1 is therefore retained.\n\nThe patient is put on oral first-line anti-tuberculosis for 6 months, a fixed dose of a quadra-therapy in the intensive phase of isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months (2RHZE), followed by a bi-therapy in the maintenance phase of isoniazid and rifampicin for 4 months (4RH) at a dose of 3 tablets/day in the morning on an empty stomach, associated with vitamin B6 (1 tablet/day). He benefits from two sessions of therapeutic reinforcement with anti-retroviral drugs. The ART is restarted on 4 May 2023 with his consent, given the good tolerance of the anti-tuberculosis drugs, with the combination of tenofovir/lamivudine/dolutegravir at a dose of 1 tablet/day associated with dolutegravir 50 mg as a supplement (1 tablet/day) according to the protocol for the management of HIV/AIDS. A chemoprophylaxis with cotrimoxazole 960 mg (1 tablet/day) is undertaken as well as a cleaning of the external auditory canal by aspiration and the instillation of ciprofloxacin ear drops (2 drops 3 times a day) for 14 days.\n\nThe evolution is favorable after 14 days of treatment, marked by a pyrexia, a good general state, the amendment of the cough and otorrhea with the negativation of the bacilloscopy in the gastric tube liquid and the swab of the pus of the right ear. At the end of the maintenance anti-tuberculosis treatment, the clinical healing is complete with a normal ENT and neurological examination. The bacilloscopy associated with the Xpert-MTB/GeneXpert test at the end of the 2nd month of the intensive phase, during the 5th month and at the end of the 6th month of the maintenance phase were negative. The HIV viral load performed after 3 months of ART is 329 copies/ml.\n",
+    "summary": "The patient presented with a chronic productive cough, otalgia and a chronic right-sided purulent otorrhea. The search for acid-fast bacilli was positive by direct examination in the gastric tube liquid and the swab of the auricular pus.\n\nAn anti-tuberculosis treatment of 6 months, associated with adjuvants, led to the patient's complete recovery.\n",
+    "translated_fulltext": null,
+    "translated_summary": "রোগী দীর্ঘস্থায়ী কাশি, কানে ব্যথা এবং দীর্ঘস্থায়ী ডান পাশের পুঁজযুক্ত কান থেকে স্রাব নিয়ে এসেছিলেন। গ্যাস্ট্রিক টিউবের তরল এবং কানের পুঁজ থেকে সরাসরি পরীক্ষায় অ্যাসিড-ফাস্ট ব্যাসিলি পাওয়া যায়।\n\nছয় মাসের অ্যান্টি-টিউবারকুলোসিস চিকিৎসা, যা অন্যান্য সহায়ক ওষুধের সাথে দেওয়া হয়েছিল, রোগীর সম্পূর্ণ সুস্থতা এনে দেয়।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "রোগী দীর্ঘস্থায়ী কাশি, কানে ব্যথা এবং দীর্ঘস্থায়ী ডান পাশের পুঁজযুক্ত কান থেকে স্রাব নিয়ে এসেছিলেন। গ্যাস্ট্রিক টিউবের তরল এবং কানের পুঁজ থেকে সরাসরি পরীক্ষায় অ্যাসিড-ফাস্ট ব্যাসিলি পাওয়া যায়।\n\nছয় মাসের অ্যান্টি-টিউবারকুলোসিস চিকিৎসা, যা অন্যান্য সহায়ক ওষুধের সাথে দেওয়া হয়েছিল, রোগীর সম্পূর্ণ সুস্থতা এনে দেয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_90.txt",
+    "fulltext": "52-year-old male patient with no medical history, transferred from a lower-level hospital to our institution due to a tonic-clonic seizure secondary to alcohol withdrawal and non-reduced right LFGHP. He was evaluated by a traumatologist 24 hours after admission, and was found to be conscious, with bilateral ecchymosis of the shoulders and severe limitation of passive external rotation on both sides. In addition, the patient was restrained physically at this point, with both feet and his left hand held down by intermittent psychomotor agitation.\n\nThe initial evaluation included a thorough review of the patient's admission radiographs, which showed a right LFGHP and a left simple posterior dislocation. This second injury (simple posterior dislocation of the left shoulder) was not diagnosed at the referring facility, and took approximately 48 hours to be diagnosed at our facility.\n\nComputed tomography (CT) of both shoulders was requested to better characterize the injuries. These images showed a marked worsening of the left shoulder injury since the time of the first radiographic study, possibly secondary to the physical restraint of the patient. This evidence of progression from a simple left posterior glenohumeral dislocation on admission radiographs to a LFGHP on the CT taken 48 hours later.\n\n\nPlanning\n\nThe preoperative study of the right shoulder showed bone indemnity of the glenoid and 40% involvement of the articular surface of the humerus, but with a large fragment with the possibility of osteosynthesis in continuity with the lesser tuberosity, so it was planned to fix this fragment by spongeous screw 4.0 mm partial thread and high strength sutures. In the left shoulder, no significant bone defect was evidenced in the glenoid and the defect of the articular surface of the humerus was 20%, so it was planned to fill the defect with the fragment of the lesser tuberosity at the time of osteosynthesis (imitating the surgery of McLaughlin).\n\n\nSurgical technique\n\nOpen reduction and internal fixation with bilateral locked-plate is decided. The patient is placed in a beach chair position and the surgical fields are prepared in the usual way for the right shoulder. The fracture focus is accessed by a classic deltopectoral approach. A digital maneuver is performed to reduce the posterior fragment of the humeral head with a posterior mini-open incision of the size of a standard diagnostic arthroscopy portal. A provisional reduction of the fracture is achieved using high-strength sutures and needles. A partial 4.0 mm spongy screw and high-strength sutures are used to fix both fragments of the humeral head. Definitive fixation of the fracture with a Philos (Depuy Synthes®) plate achieves adequate reduction and stability of fragments. Fixation is increased with high-strength sutures to the tendons of the rotator cuff that are tied to the plate. Closure by planes of the right shoulder, healing and immobilization of the extremity with a universal shoulder immobilizer.\nThe surgical field of the left shoulder is immediately prepared. Classic deltopectoral approach is performed again to reach the fracture focus using an accessory posterior portal for digital manipulation and reduction of the humeral head. Fixation and osteosynthesis are performed in the same way as described for the right shoulder with the exception of the spongiosa screw, as the anterior fragment could be adequately fixed only with the use of high strength sutures.\nPostoperative management consisted of the use of bilateral shoulder immobilizer for four weeks. A pendular exercise of flexion-extension of the elbow and exercises of the fist were given to be performed from the second postoperative week to tolerance (according to the level of pain). In the radiographic control of the first month, loss of reduction of the greater left tuberosity was observed. It was decided to perform revision surgery achieving adequate fixation of the fragment with high-strength sutures.\nThe patient is left with a shoulder immobilizer for an additional four weeks on the left shoulder. The self-administered exercise regimen is restarted as described previously from the second postoperative week on a bilateral basis. At the sixth week after the revision surgery, face-to-face kinesiological therapy is initiated twice a week. After 30 sessions of kinesiological rehabilitation, the patient is able to return to work five months after the initial injury.\nFollow-up one year after the initial surgery shows that the patient has recovered strength and mobility in the right shoulder. The left shoulder still has severe limitations in the range of motion, especially in external rotation. At this point, it is decided to perform arthroscopic joint release surgery and remove the osteosynthesis in the left shoulder.\nIn his last check-up two years after the trauma, the patient showed a favorable evolution, consistent with the functional scales evaluated.\n",
+    "summary": "52-year-old male patient, transferred to a high-complexity center for a tonic-clonic convulsion and a right LFGHP. In the initial study with radiographs, a right shoulder injury was confirmed and a simple posterior glenohumeral dislocation of the left shoulder was diagnosed, which had not been previously detected. The study was complemented with a computed tomography (CT) of both shoulders, showing a bilateral LFGHP, which demonstrated intrahospital aggravation of the injury of the left shoulder. An open reduction and osteosynthesis with a bilateral blocked plate was performed in one time. The left shoulder required two reinterventions, one for osteosynthesis failure and another for joint release. Two years after the procedure, the patient was satisfactorily progressing with a 5% on the Quick DASH scale and a score of 72 and 76 on the Constant scale in the left and right shoulder, respectively.\n",
+    "translated_fulltext": null,
+    "translated_summary": "৫২ বছর বয়সী একজন পুরুষ রোগী, যিনি টনিক-ক্লোনিক খিঁচুনি এবং ডান দিকের এলএফজিএইচপি-এর কারণে একটি উচ্চ-জটিলতা সম্পন্ন কেন্দ্রে স্থানান্তরিত হয়েছিলেন। প্রাথমিক এক্স-রে পরীক্ষায়, ডান কাঁধে আঘাতের বিষয়টি নিশ্চিত করা হয় এবং বাম কাঁধের একটি সাধারণ পশ্চাৎবর্তী গ্লেনোহিউমেরাল স্থানচ্যুতি নির্ণয় করা হয়, যা আগে শনাক্ত করা যায়নি। এরপর উভয় কাঁধের সিটি স্ক্যান করা হয়, যেখানে উভয় দিকেই এলএফজিএইচপি দেখা যায়, যা বাম কাঁধের আঘাতের তীব্রতা বৃদ্ধি নির্দেশ করে। একটিমাত্র ধাপে উভয় কাঁধে ওপেন রিডাকশন এবং বাইলেটারাল ব্লকেড প্লেট দিয়ে অস্টিওসিন্থেসিস করা হয়। বাম কাঁধের জন্য দুটি অতিরিক্ত চিকিৎসার প্রয়োজন হয়েছিল, একটি অস্টিওসিন্থেসিসের ব্যর্থতার কারণে এবং অন্যটি জয়েন্ট রিলিজের জন্য। পদ্ধতির দুই বছর পর, রোগী কুইক ড্যাশ স্কেলে ৫% স্কোর এবং বাম ও ডান কাঁধে যথাক্রমে ৭২ এবং ৭৬ স্কোর নিয়ে সন্তোষজনকভাবে উন্নতি লাভ করেন।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "৫২ বছর বয়সী একজন পুরুষ রোগী, যিনি টনিক-ক্লোনিক খিঁচুনি এবং ডান দিকের এলএফজিএইচপি-এর কারণে একটি উচ্চ-জটিলতা সম্পন্ন কেন্দ্রে স্থানান্তরিত হয়েছিলেন। প্রাথমিক এক্স-রে পরীক্ষায়, ডান কাঁধে আঘাতের বিষয়টি নিশ্চিত করা হয় এবং বাম কাঁধের একটি সাধারণ পশ্চাৎবর্তী গ্লেনোহিউমেরাল স্থানচ্যুতি নির্ণয় করা হয়, যা আগে শনাক্ত করা যায়নি। এরপর উভয় কাঁধের সিটি স্ক্যান করা হয়, যেখানে উভয় দিকেই এলএফজিএইচপি দেখা যায়, যা বাম কাঁধের আঘাতের তীব্রতা বৃদ্ধি নির্দেশ করে। একটিমাত্র ধাপে উভয় কাঁধে ওপেন রিডাকশন এবং বাইলেটারাল ব্লকেড প্লেট দিয়ে অস্টিওসিন্থেসিস করা হয়। বাম কাঁধের জন্য দুটি অতিরিক্ত চিকিৎসার প্রয়োজন হয়েছিল, একটি অস্টিওসিন্থেসিসের ব্যর্থতার কারণে এবং অন্যটি জয়েন্ট রিলিজের জন্য। পদ্ধতির দুই বছর পর, রোগী কুইক ড্যাশ স্কেলে ৫% স্কোর এবং বাম ও ডান কাঁধে যথাক্রমে ৭২ এবং ৭৬ স্কোর নিয়ে সন্তোষজনকভাবে উন্নতি লাভ করেন।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0052_0053.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0052_0053.json
new file mode 100644
index 0000000000000000000000000000000000000000..ef9f13737fe3992ce8b27d5752777174be4018df
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0052_0053.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_590.txt",
+    "fulltext": "A 57-year-old woman with a 14-year history of asthma and allergic rhinitis, on salmeterol/fluticasone, was hospitalized for recurrent abdominal pain that began two months earlier. The pain was intermittent and dull, accompanied by nausea, anorexia, malaise, and a weight loss of 5 kg. There was no fever, blood / mucus in the stool, or respiratory symptoms (rhinorrhea, wheezing, coughing). She had no history of alcohol/tobacco use or traditional herbal medicines. Six weeks before admission, she was diagnosed with an intestinal infection in a local clinic after a complete blood count (CBC) revealed leukocytosis and significant eosinophilia (25.61 G/L, 77.8% eosinophils). She received antibiotics and mebendazole without relief of symptoms. At presentation, the patient was alerted and oriented with stable vitals (BP 110/70 mmHg, T 37°C, HR 88 bpm, RR 18 bpm). She had a BMI of 16.6 kg/m² and sarcopenia, but no skin rash, lymphadenopathy, or edema. The abdominal exam showed tenderness in the epigastric and umbilical regions without guarding. CBC revealed leukocytosis and significant eosinophilia (20.8 G/L, with a total white blood cell count of 26.8 G/L, comprising 77.8% eosinophils). Peripheral blood film examination showed normal eosinophils. Bone marrow aspiration reveals 48% eosinophils without blasts, atypical cells. Fluorescence in situ hybridization (FISH) for CHIC2 deletion as a surrogate marker for FIP1L1-PDGFRA showed no rearrangements of the PDGFRA gene. Autoimmune and vasculitis screenings (ANA, anti-dsDNA, p-ANCA, c-ANCA) were negative. Elevated serum IgG (2760 mg/dL; normal range, 700–1600 mg/dL) and IgG4 (1260 mg/dL; normal range, 3.9–86.4 mg/dL), slightly elevated IgE (137.5 IU/mL; normal range, <100 IU/mL) and high RF (144.4 IU/mL; normal range, <20 IU/mL) were observed. Other parameters were normal, including aminotransferase, blood urea nitrogen, serum creatinine, complement C3, complement C4, vitamin B12, serum cortisol, and NT-proBNP. ECG and echocardiogram were normal. Chest CT scans showed mild fibrosis and bronchiectasis. Sputum AFB smears and bronchoscopy were negative. The cytology of the bronchoalveolar lavage fluid showed 35% neutrophils, no eosinophils. Spirometry indicated severe obstruction with bronchodilator response. The fractional exhaled nitric oxide (FeNO) level was 15 ppb. Stool samples were tested positive for leukocytes, with no signs of ova or parasites. Serology tests were positive for toxocariasis (positive IgG of Toxocara canis at 54.2 NovaTec-Units) but negative for Strongyloides stercoralis, Fasciola sp., Toxoplasma gondii, Trichinella spiralis, Ancylostoma sp., Angiostrongylus cantonensis, Ascaris lumbricoides, Clonorchis sinensis, Paragonimus sp., Gnathostoma sp., Entamoeba histolytica, cysticercosis, filariasis, and HIV. An abdominal contrast-enhanced computed tomography scan revealed gallbladder stones without acute cholecystitis and showed no gastrointestinal tract abnormalities. The upper gastrointestinal endoscopy showed unremarkable results with a normal appearance. Colonoscopy showed mucosal inflammation in the sigmoid, left, transverse, and right colon with systemic biopsy. A five-day course of albendazole (400 mg twice daily) for suspected toxocariasis was ineffective. Colonic biopsies revealed significant eosinophilic infiltration (>85 eosinophils/High-power field (HPF) in the left colon, >100 eosinophils/HPF in the transverse and right colon). Given the patient’s nonresponse to toxocariasis treatment and the significant eosinophilic infiltration observed in the colon mucosa biopsy, a diagnosis of eosinophilic colitis was confirmed. The patient was treated with oral methylprednisolone (16 mg) and montelukast (5 mg). Symptoms resolved in two weeks and eosinophil counts normalized (0.3 G/L). The corticosteroid was reduced and discontinued, and the patient was maintained on montelukast for three months without symptom recurrence.",
+    "summary": "We present a unique case of a 57-year-old patient with a medical history of asthma and allergic rhinitis who presented recurrent abdominal pain, significant blood eosinophilia, and elevated levels of Immunoglobulin G4. After ruling out hematological and secondary causes of eosinophilia, a biopsy of the colon mucosa revealed an excess of tissue eosinophils, confirming the diagnosis of EoC. The patient responded well to corticosteroids and was subsequently maintained on montelukast, with no recurrence of symptoms over 3 months.",
+    "translated_fulltext": null,
+    "translated_summary": "আমরা একজন ৫৭ বছর বয়সী রোগীর একটি ব্যতিক্রমী ঘটনা উপস্থাপন করছি, যার পূর্বে হাঁপানি এবং অ্যালার্জিক রাইনাইটিসের চিকিৎসা ইতিহাস ছিল। তিনি বার বার পেটে ব্যথা, উল্লেখযোগ্য পরিমাণে রক্তে ইওসিনোফিলিয়ার উপস্থিতি এবং ইমিউনোগ্লোবুলিন জি৪-এর উচ্চ মাত্রা নিয়ে এসেছিলেন। রক্তরোগ এবং ইওসিনোফিলিয়ার অন্যান্য কারণগুলো বাতিল করার পরে, কোলন মিউকোসার বায়োপসি করে দেখা যায় টিস্যুতে অতিরিক্ত ইওসিনোফিল রয়েছে, যা ইওসিওফিলিক কোলাইটিসের রোগ নির্ণয় নিশ্চিত করে। রোগী কর্টিকোস্টেরয়েডের চিকিৎসায় ভালো সাড়া দেন এবং পরবর্তীতে মন্টেলুকাস্টের মাধ্যমে তার চিকিৎসা করানো হয়, এবং ৩ মাসের মধ্যে তার উপসর্গগুলো আর ফিরে আসেনি।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা একজন ৫৭ বছর বয়সী রোগীর একটি ব্যতিক্রমী ঘটনা উপস্থাপন করছি, যার পূর্বে হাঁপানি এবং অ্যালার্জিক রাইনাইটিসের চিকিৎসা ইতিহাস ছিল। তিনি বার বার পেটে ব্যথা, উল্লেখযোগ্য পরিমাণে রক্তে ইওসিনোফিলিয়ার উপস্থিতি এবং ইমিউনোগ্লোবুলিন জি৪-এর উচ্চ মাত্রা নিয়ে এসেছিলেন। রক্তরোগ এবং ইওসিনোফিলিয়ার অন্যান্য কারণগুলো বাতিল করার পরে, কোলন মিউকোসার বায়োপসি করে দেখা যায় টিস্যুতে অতিরিক্ত ইওসিনোফিল রয়েছে, যা ইওসিওফিলিক কোলাইটিসের রোগ নির্ণয় নিশ্চিত করে। রোগী কর্টিকোস্টেরয়েডের চিকিৎসায় ভালো সাড়া দেন এবং পরবর্তীতে মন্টেলুকাস্টের মাধ্যমে তার চিকিৎসা করানো হয়, এবং ৩ মাসের মধ্যে তার উপসর্গগুলো আর ফিরে আসেনি।"
+  },
+  {
+    "id": "multiclinsum_gs_en_324.txt",
+    "fulltext": "2 years 6 months old female pre-schooler with a previous diagnosis of NF1. She consulted due to a 4 week diarrhea with blood streaks (5 to 10 episodes a day). A week after the onset of the diarrhea she consulted the emergency department, where rotavirus (+) was detected, with low inflammatory parameters, negative coproculture and normal abdominal ultrasound. She was hospitalized for 3 days to manage dehydration and was discharged without bleeding, with persistence of semi-liquid stools. 10 days after discharge she presented diarrhea with blood streaks, associated with low intake and weight loss of 1 kg reported by parents. They consulted a pediatric gastroenterologist who requested a polymerase chain reaction (PCR) panel of gastrointestinal pathogens and PCR of Clostridium difficile (which were negative) and indicated hospitalization for study.\n\nOn direct questioning, the parents reported no fever, abdominal pain, vomiting, respiratory or urinary symptoms, arthralgia, or new skin lesions. They did not own pets, and there was no history of travel or recent dietary changes.\n\nThe patient was diagnosed with confirmed NF1 at 8 months of age by genetic testing with the heterozygous pathogenic variant c.5606_5627del (p.Gly1869Valfs*28). She has skin involvement (café con leche spots) and bone involvement. At 18 months she required ankle arthrodesis for tibial curvature. She has no family history of NF1 or inflammatory bowel disease.\n\nOn physical examination, the abdomen was soft and indistinct, with increased air-bubble murmurs, without masses or visceral enlargement. The perianal examination was normal. There were multiple brown-coffee stains on the lower extremities and back. General examinations were performed, including a blood count with moderate microcytic-hypochromic anaemia (Hb 9.6 g/dL), leukocytosis with left shift (leukocytes 13,900), and discretely elevated inflammatory parameters (CRP 1.37 mg/dL, normal value up to 0.5 mg/dL).\n\nA colonoscopy was performed, the rectum, sigmoid and various segments of the colon were examined up to the cecum, visualizing the ileocecal valve and the appendicular orifice. The last few centimeters of the distal ileum were also inspected. The mucosa from the anal margin to the cecum was observed to be erythematous, with loss of vascular transparency, unlike the cecal mucosa, which appeared normal. No lesions were identified in the anal canal or cecum.\n\nBiopsies of the small intestine (ileon) and large intestine were taken. Microscopic examination showed mucosa of ileal type with preserved villous architecture and adequate epithelial differentiation, with a non-inflamed lamina propria. The mucosa of the large intestine had a mild distortion of architecture and adequate epithelial differentiation, a swollen lamina propria with a mild mixed inflammatory infiltrate and hyperplasia of lymphoid follicles. Isolated foci of microabscesses were recognized. The biopsy was consistent with mild colitis, with signs suggesting chronicity.\n\nIn addition, a PCR study for cytomegalovirus (CMV) was requested in a colon biopsy, which was positive.\n\nGiven a positive PCR for CMV, CMV IgG and IgM and CMV viral load in blood were requested, resulting in a positive IgG, negative IgM, and CMV viral load of 79.7 IU/ml. Further laboratory studies included PCR for gastrointestinal pathogens and PCR for Clostridium difficile in stool, both of which were negative. In the colon biopsy, Gram stain microbiological studies were requested, which showed +++ leukocytes without bacteria; biopsy culture showed S. gallolyticus/equinus complex in very low amount (interpreted as bacterial flora); acridine orange, Ziehl-Neelsen, Koch culture, and ADV PCR were negative.\n\nEndoscopy and histology suggestive of UC was reported in the context of a patient with moderate symptoms (PUCAI 50) who was started on Mesalazine (70 mg/kg/day three times daily) and a request for a faecal calprotectin was made which was greater than 600 ug/g.\n\nThe immunology team evaluated the patient for suspected immunodeficiency. The parents did not report a history of infections, they reported that they were vaccinated, that they had good weight gain, no family history of immunodeficiencies, auto-immunity or early deaths. A study with lymphocyte subpopulations (normal), immunoglobulins (normal), HIV (negative), memory T lymphocytes (with alterations expected in the context of CMV viremia) and lymphoproliferation test (normal) was requested. In addition, a genetic panel of primary immunodeficiencies (Invitae) was performed, which contains 429 genes, of which 68 make up the panel of monogenic inflammatory intestinal disease. 7 variants of uncertain significance were obtained, none included in the panel of monogenic IBD.\n\nGanciclovir was initiated intravenous for CMV infection and continued for 15 days. The last PCR CMV control prior to discharge reported undetectable load.\n\nThe patient improved during the hospital stay with decreased frequency of stools and increased consistency, no rectal bleeding, no nocturnal stools and no abdominal pain, with PUCAI 0 at discharge.\n\nTwo months later, he presented with a reactivation of IBD with bloody diarrhea (PUCAI 35). A blood count was performed (normal), a panel of gastrointestinal pathogens was performed (–), PCR for Clostridium difficile was performed (+), and CMV load was undetectable. He was treated with oral metronidazole. However, he persisted with diarrhea with blood streaks, so he was hospitalized again.\n\nA colonoscopy was performed, where erythematous mucous was observed in a diffuse form from the rectum to the cecum, with nodularity and loss of vascular transparency in the submucosa, greater in the left and transverse colon segments. No focal lesions were observed. The mucosa of the ileum and anal canal were observed without lesions.\n\nBiopsy of the terminal ileum, right colon and left colon was performed. Microscopic examination of the ileal-type mucosa showed preserved villous architecture and adequate epithelial differentiation. The lamina propria showed no signs of inflammation. There were no aphthous erosions or granulomas. The mucosa of the large intestine showed mild distortion of architecture and epithelial dedifferentiation. The lamina propria was expanded by mixed inflammatory infiltrate, transmucosal distribution. Foci of cryptitis and cryptitic microabscesses and hyperplasia of reactive lymphoid follicles were recognized. No granulomas, viral or parasitic cytopathic changes were observed. All fragments of the left colon sample presented a similar histopathological picture.\n\nShe was given oral treatment with Vancomycin and Prednisone (1 mg/kg/day) with a good response and a favorable evolution. She was discharged with a decrease in the frequency of bowel movements. She persists with mild symptoms (PUCAI 5) in outpatient control, so the dose of corticosteroids is progressively decreased and she remains on treatment with Mesalazina.\n",
+    "summary": "2.5-year-old pre-schooler with a history of NF1 presenting with bloody diarrhea. On endoscopic examination, the mucosa from the anal margin to the cecum was erythematous with loss of vascular transparency. Colon mucosal biopsies showed signs of chronic inflammation consistent with a diagnosis of ulcerative colitis and CMV infection was diagnosed by PCR.\n",
+    "translated_fulltext": null,
+    "translated_summary": "২.৫ বছর বয়সী একটি প্রিস্কুলার শিশু, যার আগে থেকে নিউরোফাইব্রোমাটোসিস টাইপ ১ (NF1)-এর ইতিহাস রয়েছে, সে রক্তমিশ্রিত ডায়রিয়া নিয়ে এসেছে। এন্ডোস্কোপিক পরীক্ষায় দেখা যায়, পায়ুপথ থেকে শুরু করে সিকাম পর্যন্ত মিউকোসা লালচে হয়ে গেছে এবং এর রক্তনালীগুলো আর স্পষ্টভাবে দেখা যাচ্ছে না। কোলন মিউকোসাল বায়োপসিতে দীর্ঘস্থায়ী প্রদাহের লক্ষণ দেখা যায়, যা আলসারেটিভ কোলাইটিসের সাথে সঙ্গতিপূর্ণ। পিসিআর (PCR) পরীক্ষার মাধ্যমে সাইটোমেগালোভাইরাস (CMV) সংক্রমণেরও নির্ণয় করা হয়েছে।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "২.৫ বছর বয়সী একটি প্রিস্কুলার শিশু, যার আগে থেকে নিউরোফাইব্রোমাটোসিস টাইপ ১ (NF1)-এর ইতিহাস রয়েছে, সে রক্তমিশ্রিত ডায়রিয়া নিয়ে এসেছে। এন্ডোস্কোপিক পরীক্ষায় দেখা যায়, পায়ুপথ থেকে শুরু করে সিকাম পর্যন্ত মিউকোসা লালচে হয়ে গেছে এবং এর রক্তনালীগুলো আর স্পষ্টভাবে দেখা যাচ্ছে না। কোলন মিউকোসাল বায়োপসিতে দীর্ঘস্থায়ী প্রদাহের লক্ষণ দেখা যায়, যা আলসারেটিভ কোলাইটিসের সাথে সঙ্গতিপূর্ণ। পিসিআর (PCR) পরীক্ষার মাধ্যমে সাইটোমেগালোভাইরাস (CMV) সংক্রমণেরও নির্ণয় করা হয়েছে।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0058_0059.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0058_0059.json
new file mode 100644
index 0000000000000000000000000000000000000000..fa8ba2c03614ca30f44f1cda9d12b718acac3bd3
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0058_0059.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_443.txt",
+    "fulltext": "65-year-old woman with no relevant personal or family history. In August 2022, a posterior mediastinal tumour was found in the preoperative assessment for a knee surgery, which was why she was referred for evaluation and treatment. On admission, the physical examination was not relevant and the laboratory studies were within normal parameters. A chest CT scan was performed that showed a tumour located in the posterior right mediastinum measuring 6.5 × 4.2 cm, with well-defined borders, with a fat and solid density, with no evidence of bone erosion or infiltration of surrounding tissue. A biopsy of the lesion was performed using a 18G × 250 mm semiautomatic cutting needle, with image guidance, through a posterior approach. In the histopathological study, a benign neoplasm consisting of mature adipose tissue with areas of haemorrhage alternating with haematopoietic elements, predominantly precursors of the red series, was observed, as well as elements of the myeloid series in different stages of maturation and megakaryocytes, which established the diagnosis of MPM.  Finally, with the diagnosis established and the characteristics of the lesion, conservative management was decided. The patient evolved satisfactorily and was discharged without complications.\n",
+    "summary": "We present the case of a 65-year-old woman with a primary mediastinal myelolipoma. Computed tomography of the chest showed an ovoid, well-defined bordered tumor of 6.5 × 4.2 cm, located in the posterior mediastinum. A trans-thoracic biopsy of the lesion was performed and microscopic examination revealed haemopoietic elements and mature adipose tissue.\n",
+    "translated_fulltext": "৬৫ বছর বয়সী একজন মহিলার, যার ব্যক্তিগত বা পারিবারিক কোনো উল্লেখযোগ্য স্বাস্থ্য ইতিহাস নেই। ২০২২ সালের আগস্ট মাসে, হাঁটুতে অস্ত্রোপচারের আগে স্বাস্থ্য পরীক্ষা করার সময়, তার পেছনেরMediastinum-এ একটি টিউমার পাওয়া যায়। এই কারণে তাকে আরও পরীক্ষা এবং চিকিৎসার জন্য পাঠানো হয়। হাসপাতালে ভর্তির সময় শারীরিক পরীক্ষায় তেমন কিছু ধরা পড়েনি এবং ল্যাবরেটরির ফলাফল স্বাভাবিক ছিল। একটি বুকের সিটি স্ক্যান করা হয়, যেখানে দেখা যায় পেছনের ডানদিকে Mediastinum-এ ৬.৫ × ৪.২ সেমি আকারের একটি টিউমার রয়েছে। টিউমারটির কিনারাগুলো স্পষ্ট, এবং এতে চর্বি ও কঠিন উপাদান রয়েছে। হাড়ের ক্ষয় বা আশেপাশের টিস্যুতে কোনো সংক্রমণ দেখা যায়নি। একটি ১৮G × ২৫০ মিমি সেমি-অটোমেটিক কাটিং নিডেল ব্যবহার করে, পেছনের দিক থেকে ছবি দেখে টিউমার থেকে একটি বায়োপসি নেওয়া হয়। হিস্টোপ্যাথলজিক্যাল পরীক্ষায় দেখা যায়, টিউমারটি মূলত পরিণত অ্যাডিপোজ টিস্যু দিয়ে গঠিত, যেখানে রক্তক্ষরণের কিছু অংশ রয়েছে এবং অস্থি মজ্জার উপাদানগুলো পর্যায়ক্রমে বিদ্যমান। এর মধ্যে লোহিত রক্তকণিকা তৈরির কোষ এবং বিভিন্ন পর্যায়ে অস্থি মজ্জার কোষ এবং মেগাক্যারিওসাইট দেখা যায়। এই পরীক্ষার মাধ্যমে মাল্টিপল মায়েলোমা (MPM) রোগ নির্ণয় করা হয়। অবশেষে, রোগ নির্ণয় এবং টিউমারের বৈশিষ্ট্য অনুযায়ী, রক্ষণশীল চিকিৎসার সিদ্ধান্ত নেওয়া হয়। রোগীর শারীরিক অবস্থার উন্নতি হয় এবং কোনো জটিলতা ছাড়াই তাকে হাসপাতাল থেকে ছেড়ে দেওয়া হয়।",
+    "translated_summary": "আমরা একজন ৬৫ বছর বয়সী মহিলার ঘটনা উপস্থাপন করছি, যার মধ্যে একটি প্রাথমিক মধ্যবর্তী স্থানে মায়েলোলিপোমা দেখা গেছে। বুকের সিটি স্ক্যানে ৬.৫ × ৪.২ সেন্টিমিটার আকারের ডিম্বাকৃতির, স্পষ্টভাবে সীমাবদ্ধ একটি টিউমার দেখা যায়, যা পশ্চাৎবর্তী মধ্যবর্তী স্থানে অবস্থিত। টিউমারটির একটি ট্রান্স-থোরাসিক বায়োপসি করা হয় এবং অণুবীক্ষণ যন্ত্রের মাধ্যমে পরীক্ষায় দেখা যায় যে এতে রক্ত উৎপাদনকারী উপাদান এবং পরিপক্ক চর্বিযুক্ত টিস্যু রয়েছে।",
+    "corrected_translated_fulltext": "৬৫ বছর বয়সী একজন মহিলার, যার ব্যক্তিগত বা পারিবারিক কোনো উল্লেখযোগ্য স্বাস্থ্য ইতিহাস নেই। ২০২২ সালের আগস্ট মাসে, হাঁটুতে অস্ত্রোপচারের আগে স্বাস্থ্য পরীক্ষা করার সময়, তার পেছনেরMediastinum-এ একটি টিউমার পাওয়া যায়। এই কারণে তাকে আরও পরীক্ষা এবং চিকিৎসার জন্য পাঠানো হয়। হাসপাতালে ভর্তির সময় শারীরিক পরীক্ষায় তেমন কিছু ধরা পড়েনি এবং ল্যাবরেটরির ফলাফল স্বাভাবিক ছিল। একটি বুকের সিটি স্ক্যান করা হয়, যেখানে দেখা যায় পেছনের ডানদিকে Mediastinum-এ ৬.৫ × ৪.২ সেমি আকারের একটি টিউমার রয়েছে। টিউমারটির কিনারাগুলো স্পষ্ট, এবং এতে চর্বি ও কঠিন উপাদান রয়েছে। হাড়ের ক্ষয় বা আশেপাশের টিস্যুতে কোনো সংক্রমণ দেখা যায়নি। একটি ১৮G × ২৫০ মিমি সেমি-অটোমেটিক কাটিং নিডেল ব্যবহার করে, পেছনের দিক থেকে ছবি দেখে টিউমার থেকে একটি বায়োপসি নেওয়া হয়। হিস্টোপ্যাথলজিক্যাল পরীক্ষায় দেখা যায়, টিউমারটি মূলত পরিণত অ্যাডিপোজ টিস্যু দিয়ে গঠিত, যেখানে রক্তক্ষরণের কিছু অংশ রয়েছে এবং অস্থি মজ্জার উপাদানগুলো পর্যায়ক্রমে বিদ্যমান। এর মধ্যে লোহিত রক্তকণিকা তৈরির কোষ এবং বিভিন্ন পর্যায়ে অস্থি মজ্জার কোষ এবং মেগাক্যারিওসাইট দেখা যায়। এই পরীক্ষার মাধ্যমে মাল্টিপল মায়েলোমা (MPM) রোগ নির্ণয় করা হয়। অবশেষে, রোগ নির্ণয় এবং টিউমারের বৈশিষ্ট্য অনুযায়ী, রক্ষণশীল চিকিৎসার সিদ্ধান্ত নেওয়া হয়। রোগীর শারীরিক অবস্থার উন্নতি হয় এবং কোনো জটিলতা ছাড়াই তাকে হাসপাতাল থেকে ছেড়ে দেওয়া হয়।",
+    "corrected_translated_summary": "আমরা একজন ৬৫ বছর বয়সী মহিলার ঘটনা উপস্থাপন করছি, যার মধ্যে একটি প্রাথমিক মধ্যবর্তী স্থানে মায়েলোলিপোমা দেখা গেছে। বুকের সিটি স্ক্যানে ৬.৫ × ৪.২ সেন্টিমিটার আকারের ডিম্বাকৃতির, স্পষ্টভাবে সীমাবদ্ধ একটি টিউমার দেখা যায়, যা পশ্চাৎবর্তী মধ্যবর্তী স্থানে অবস্থিত। টিউমারটির একটি ট্রান্স-থোরাসিক বায়োপসি করা হয় এবং অণুবীক্ষণ যন্ত্রের মাধ্যমে পরীক্ষায় দেখা যায় যে এতে রক্ত উৎপাদনকারী উপাদান এবং পরিপক্ক চর্বিযুক্ত টিস্যু রয়েছে।"
+  },
+  {
+    "id": "multiclinsum_gs_en_180.txt",
+    "fulltext": "The 52-year-old man tested positive for SARS-CoV-2 using a self-test kit after having a cold. He returned to work without fever after resting for two days, but lost consciousness while working outdoors in an ambient temperature of 35°C for five hours. Upon admission to the local hospital’s emergency department, his core temperature (Tc) was recorded as 40°C. The patient presented with persistent coma, dyspnea and gastrointestinal hemorrhage. No underlying diseases and relative family history was noted. Based on the characteristic presentation of hyperpyrexia, coma and multiple organ damage, a diagnosis of HS was established. He was admitted to emergency intensive care unit (ICU) of the local hospital and then received mechanical ventilation. The test results indicated the presence of pulmonary infection, hepatic and renal dysfunction, myocardial ischemia and coagulation disorders. The patient received initial management including rehydration (intravenously infused Lactated Ringer’s solution and normal saline at a rate of 2.5mL/kg∙h), intravenous administration of Piperacillin Sodium and Tazobactam Sodium, vasoactive medications for blood pressure support, continuous mechanical ventilation, and continuous renal replacement therapy (CRRT) to manage subsequent anuria. The patient received plasma transfusion and was administered Tranexamic acid on day 5. The worsening of his condition led to his admission to the medical ICU of our hospital 7 days after HS.\n\nFollowing admission, Reverse-transcription polymerase chain reaction (RT-PCR) testing of a nasopharyngeal swab yielded positive results for SARS-CoV-2. The patient was diagnosed with HS and severe COVID-19 based on China’s COVID-19 Diagnosis and Treatment Program (trial version 10): 1. real-time fluorescent RT-PCR detection of SARS-CoV-2 nucleic acid is positive; 2. respiratory failure and requires mechanical ventilation; 3. shock; 4. combined with multiple organ failure requiring intensive care. The patient had no contact with COVID-19 diagnosed patients or healthcare workers in the hospital, indicating community-acquired infection. The physical examination showed a Glasgow Coma Scale (GCS) score of 3/15, with scores of 1 for eye-opening, verbal response, and motor response. Additionally, the pupils were symmetrical and non-reactive. The heart rate was recorded at 106 bpm and blood pressure was maintained at 126/77 mmHg by continuously infusing norepinephrine at a rate of 0.4 ug/kg·min. The laboratory test results indicated a severe infection, along with anemia, thrombocytopenia, disseminated intravascular coagulation (DIC), as well as acute liver and kidney injury. The white blood cell count (WBC) decreased from 3.55×109/L to 3.13×109/L, lymphocytes significantly decreased from 0.25×109/L to 0.1×109/L, and neutrophil percentage (N%) increased to 85.3%. The Procalcitonin level measured 2.81 ng/mL and C-reactive protein (CRP) level was 32.6 mg/L. Sputum culture testing yielded Stenotrophomonas Maltophilia and Candida lipolytica. The central venous catheter culture test detected Staphylococcus epidermidis, but the continuous blood culture test yielded no positive results. The Computed Tomography (CT) scan revealed bilateral frontal subdural effusion, consolidation and atelectasis in the lower lungs, inflammation in the right upper lobe, bilateral pleural effusion, and a small amount of abdominal fluid.\n\nThe patient received synchronized intermittent mandatory ventilation with a positive end expiratory pressure of 5 mmH2O and an oxygen concentration of 80% and continuous administration of norepinephrine and pituitrin to sustain normal blood pressure. Polyene phosphatidylcholine, adenosylmethionine budisulfonate, ulinastatin, and hemofiltration have been employed for the management of hepatic and renal dysfunction. The antibiotic was substituted with Meropenem and Thymalfasin was administered for 20 days to augment immune function. Mannitol was used to alleviate intracranial pressure for 3 days. To improve coagulation dysfunction, the patient received plasma and cryoprecipitate transfusions, continuous intravenous infusion of heparin sodium at 6000u/day and CRRT with sodium citrate for anticoagulant (8g/day) on day 7. Platelet transfusion was administered after 9 days of HS. His Tc fluctuated between 36 °C and 38.5 °C. CRRT was administered without anticoagulant on day 8. The patient had gastrointestinal hemorrhage and fever after 9 days of HS, but electronic gastroenteroscopy showed no signs of active bleeding. He underwent red blood cell suspension transfusion, hemostasis treatment and gastric acid suppression. Teicoplanin was added due to the presence of Methicillin-resistant Staphylococcus aureus isolated from sputum culture. The patient regained consciousness on day 13 with a GCS score of 14/15 and presented with a moderate fever. Gastrointestinal hemorrhage was not observed. Mechanical ventilation was discontinued and the tracheal tube was removed. But the creatinine levels increased following the suspension of CRRT on day 12.\n\nOn day 17, he developed sudden dyspnea with desaturation (oxygen saturation <85%) followed by a high fever (Tc: 39.3°C), necessitating reintubation and mechanical ventilation. Bronchoscopy revealed less sputum in both lungs and subbranches. He experienced a recurrence of coma, with a GCS score of 3/15. WBC increased to 14.94×109/L and NEU increased to 13.77×109/L. The levels of serum total bilirubin rose to 235.2 µmol/L, while creatinine increased to 441µmol/L. The brain CT scan revealed an ischemic stroke in the right frontal lobe and a hemorrhagic infarction in the right occipital lobe. The patient underwent cooling therapy using CRRT with ice-cold replacement fluid, along with persistent administration of Meropenem and Teicoplanin for anti-infection treatment. Carpofungin was added on day 18 due to the observed elevation in serum levels of Aspergillus galactomannan, Aspergillus IgG antibody, and Candida mannan. The RT-PCR testing for SARS-CoV-2 returned negative results.\n\nThe patient’s fever and infection improved on day 20, but he subsequently developed cerebral hemorrhage and hernia with bilateral dilated pupils. The dehydration therapy was used to reduce intracranial pressure, as surgery was refused by his family. On day 22, indicators of infection, levels of aspartate aminotransferase and creatinine increased again. Carbapenem-resistant Acinetobacter baumannii and A. fumigatus were cultured in the bronchoalveolar lavage fluid. The combination of Meropenem, Teicoplanin, and Carpofungine was administered for anti-infective therapy. The patient’s condition progressively worsened over the next 7 days, ultimately resulting in his demise on day 29. The patients’ inflammatory indicators, cytokines, and coagulation indicators are presented in Table 1.",
+    "summary": "We report the first case of heatstroke comorbid with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in a 52-year-old male. After receiving intravenous antibiotics, organ protection measures, and treatment for coagulation disorders, his fever and coma resolved. However, he developed dyspnea and cerebral hemorrhage after several days. This patient experienced a multi-pathogen pulmonary infection and an intractable coagulopathy that ultimately resulted in MODS and death.",
+    "translated_fulltext": null,
+    "translated_summary": "আমরা ৫২ বছর বয়সী একজন পুরুষের মধ্যে মারাত্মক তীব্র শ্বাসযন্ত্রের সিনড্রোম করোনাভাইরাস ২ (SARS-CoV-2) সংক্রমণের সাথে হিটস্ট্রোকের প্রথম ঘটনাটি তুলে ধরছি। শিরায় অ্যান্টিবায়োটিক, অঙ্গ-সুরক্ষার ব্যবস্থা এবং রক্ত জমাট বাঁধার সমস্যাগুলোর চিকিৎসার পর তার জ্বর এবং কোমা সেরে যায়। তবে, কয়েক দিন পর তার শ্বাসকষ্ট এবং মস্তিষ্কে রক্তক্ষরণ হয়। এই রোগী একাধিক প্যাথোজেন দ্বারা সৃষ্ট ফুসফুসের সংক্রমণ এবং জটিল রক্ত জমাট বাঁধার সমস্যায় ভুগছিলেন, যার ফলস্বরূপ মাল্টি-অর্গান ডিসফাংশন সিনড্রোম (MODS) এবং অবশেষে তার মৃত্যু হয়।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা ৫২ বছর বয়সী একজন পুরুষের মধ্যে মারাত্মক তীব্র শ্বাসযন্ত্রের সিনড্রোম করোনাভাইরাস ২ (SARS-CoV-2) সংক্রমণের সাথে হিটস্ট্রোকের প্রথম ঘটনাটি তুলে ধরছি। শিরায় অ্যান্টিবায়োটিক, অঙ্গ-সুরক্ষার ব্যবস্থা এবং রক্ত জমাট বাঁধার সমস্যাগুলোর চিকিৎসার পর তার জ্বর এবং কোমা সেরে যায়। তবে, কয়েক দিন পর তার শ্বাসকষ্ট এবং মস্তিষ্কে রক্তক্ষরণ হয়। এই রোগী একাধিক প্যাথোজেন দ্বারা সৃষ্ট ফুসফুসের সংক্রমণ এবং জটিল রক্ত জমাট বাঁধার সমস্যায় ভুগছিলেন, যার ফলস্বরূপ মাল্টি-অর্গান ডিসফাংশন সিনড্রোম (MODS) এবং অবশেষে তার মৃত্যু হয়।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0060_0061.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0060_0061.json
new file mode 100644
index 0000000000000000000000000000000000000000..eebd2429bf19f3c6d655d3ff63bb9fe3d400dda8
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0060_0061.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_515.txt",
+    "fulltext": "February 2020, a 36-year-old with no significant past medical history presented with 5 years history of left sided penoscrotal mass. He has no lower urinary tract symptoms. No History of trauma or infections and he denied any history of weight loss, anorexia or fever. On examination, there is a smooth surface, tender cystic lesion around 20 mm ∗ 20 mm attached to the left side of the bulbar urethra at the penoscrotal junction, it was deep without any skin tethering and not related to the left spermatic cord and it was partially mobile.\n\nDoppler ultrasonography showed a well-defined hypoechoic mass measuring 2.7 ∗ 3.1 ∗ 2.0 cm with significantly increased vascularity at the left of penoscrotal junction. Pelvis Magnetic resonance imaging revealed a mass in the left inferolateral side of the base of the penis with a clear fat plane, which is isointense to the testes in the T2 weighted imaging, T1 weighted imaging and Diffusion-weighted imaging and it was connected to the vas deferens, no lymphadenopathy was noted. Alpha fetoprotein and beta-human chronic gonadotrophin levels were all in the normal range. Given the results of workup and the pain experienced by the patient, a decision was made to proceed with surgical removal of the mass for both diagnostic and therapeutic purposes. During surgery, a mass was seen in the left posterolateral of the scrotum and it was resected completely and sent for histopathology.\n\nHistopathology of the mass showed cellular spindle cell tumour arranged into interlacing fascicle, the cells have spindle to oval vesicular nuclei with evenly dispersed chromatin and inconspicuous nucleoli. The tumour showed high mitotic activity reaching up to 3/High-power field. Immunohistochemistry analysis was consistent with synovial sarcoma, revealing a positive TLE-1, CD99, B-cell lymphoma 2 (BLC2), Focal cytokeratin and focal epithelial membrane antigen (EMA). The material was sent for Fluorescence in situ hybridization (FISH) and reported a rearrangement of the SS18 gene at 18q11.2 which has been observed in synovial sarcomas. The mass margins were difficult to be assessed by histopathology as the sample had fragmented margins.\n\nThe patient presented to the clinic after 2 weeks and given the histopathology report, a re-resection with wider margin was discussed with the patient and he agreed. Positron emission tomography – Computed tomography (PET/CT) was done for Head and Neck, Chest, Abdomen, Pelvis and musculoskeletal structures. Only a 29 ∗ 27 mm thyroid nodule in the lower pole of the left thyroid lobe with moderate hypermetabolism at standardized uptake values (SUVs) of 4.9. Thyroid US showed a solid isoechoic well-defined nodule in the lower pole of the left thyroid lobe with no echogenic foci, Thyroid Imaging Reporting and Data System (TIRADS) was TR3.\n\nA second resection was made 3 weeks from the first one. The whole specimen was resected from both cords bilaterally which was deepened until reaching the corpus spongiosum which was shaved superiorly up to the urethra. The specimen was sent for histopathology. The resected mass was 6.0 ∗ 6.0 ∗ 3.0 cm in size, and it was negative for any pathology. The patient then went into active surveillance and after 16 months of active surveillance he was found to have metastatic lesions in the sixth liver segment and L1 vertebral body. Oncology team started chemotherapy regimen of Ifosfamide and Doxorubicin for 6 cycles with no improvement in the liver lesion. Surgical resection was made for the Fifth and Sixth liver sections with cholecystectomy. Patient then developed a new lung lesion and was started on Pazopanib and Stereotactic Body Radiation Therapy SBRT. The patient then underwent surveillance for 6 months then developed new liver and lung lesions then chemotherapy regimen of Gemcitabine and Docetaxel combination for 3 cycles and progressed then he was started 2 cycles of Dacarbazine and progressed then 2 cycles of Pembrolizumab and progressed. The patient then was shifted to palliative care, and he stopped following up.",
+    "summary": "A 36-year-old man presented with a tender penoscrotal mass for 5 years. The patient underwent surgical resection of the mass. Histopathology revealed cellular spindle cell tumour arranged into interlacing fascicle, Immunohistochemistry analysis revealed a positive TLE-1, CD99, B-cell lymphoma 2 (BLC2), Focal cytokeratin and focal epithelial membrane antigen (EMA). In our case, the patient was aggressively treated with two surgical resections and still progressed and metastasized and continued progressing even after different chemotherapy regimens.",
+    "translated_fulltext": "ফেব্রুয়ারি ২০২০-তে, ৩৬ বছর বয়সী একজন ব্যক্তি, যার পূর্বে তেমন কোনো উল্লেখযোগ্য স্বাস্থ্যগত সমস্যা ছিল না, তিনি বাম দিকের পেনোস্ক্রোটাল অঞ্চলে ৫ বছর ধরে একটি পিণ্ডের কথা জানান। তার নিম্ন মূত্রনালীর কোনো উপসর্গ ছিল না। পূর্বে কোনো আঘাত বা সংক্রমণের ইতিহাস ছিল না এবং তিনি ওজন হ্রাস, ক্ষুধামান্দ্য বা জ্বরের কোনো ইতিহাস অস্বীকার করেন। পরীক্ষায় দেখা যায়, বাম দিকের পেনোস্ক্রোটাল সংযোগস্থলে প্রায় ২০ মিমি ∗ ২০ মিমি আকারের একটি মসৃণ, স্পর্শকাতর সিস্টিক পিণ্ড রয়েছে, যা ত্বকের সাথে সংযুক্ত নয় এবং বাম স্পার্মাটিক কর্ডের সাথে সম্পর্কিত নয়, এটি আংশিকভাবে নড়াচড়া করতে পারে।\n\nডপলার আল্ট্রাসাউন্ডে বাম দিকের পেনোস্ক্রোটাল সংযোগস্থলের কাছে ২.৭ ∗ ৩.১ ∗ ২.০ সেমি আকারের একটি সুস্পষ্ট হাইপোইকয়িক পিণ্ড দেখা যায়, যেখানে রক্তনালী উল্লেখযোগ্যভাবে বৃদ্ধি পেয়েছে। পেলভিক ম্যাগনেটিক রেজোন্যান্স ইমেজিং-এ দেখা যায়, পেনিসের বাম দিকের নিচের অংশে একটি পিণ্ড রয়েছে, যার চারপাশে স্পষ্ট ফ্যাট প্লেন দেখা যায়। টি২-ওয়েটেড ইমেজিং, টি১-ওয়েটেড ইমেজিং এবং ডিফিউশন-ওয়েটেড ইমেজিং-এ এটি টেস্টিসের মতো একই রকম দেখায় এবং এটি ভাস ডিফারেন্সের সাথে সংযুক্ত। কোনো লিম্ফ্যাডেনোপ্যাথি দেখা যায়নি। আলফা ফেটোপ্রোটিন এবং বিটা-হিউম্যান ক্রনিক গোন্যাডোট্রপিন-এর মাত্রা স্বাভাবিক ছিল। পরীক্ষার ফলাফল এবং রোগীর ব্যথার তীব্রতা বিবেচনা করে, রোগ নির্ণয় এবং চিকিৎসার জন্য পিণ্ডটি অস্ত্রোপচারের মাধ্যমে অপসারণ করার সিদ্ধান্ত নেওয়া হয়। অস্ত্রোপচারের সময়, বাম দিকের পোস্টেরোলেটারাল স্ক্রোটামে একটি পিণ্ড দেখা যায়, যা সম্পূর্ণরূপে অপসারণ করা হয় এবং হিস্টোপ্যাথলজির জন্য পাঠানো হয়।\n\nপিণ্ডের হিস্টোপ্যাথলজি পরীক্ষায় দেখা যায়, কোষগুলো স্পিন্ডল আকৃতির এবং একটি জটিল বিন্যাসে সাজানো। কোষগুলোর নিউক্লিয়াস স্পিন্ডল থেকে ডিম্বাকৃতির এবং ক্রোম্যাটিন সমানভাবে ছড়িয়ে ছিটিয়ে রয়েছে, নিউক্লিওলিগুলো তেমন স্পষ্ট নয়। টিউমারে উচ্চ মাত্রার মাইটোটিক কার্যকলাপ দেখা যায়, যা প্রতি উচ্চ-ক্ষমতার ক্ষেত্রে ৩টি পর্যন্ত পৌঁছায়। ইমিউনোহিস্টোকেমিস্ট্রি বিশ্লেষণে সিনোভিয়াল সারকোমার বিষয়টি নিশ্চিত করা হয়, যেখানে টিএলই-১, সিডি৯৯, বি-সেল লিম্ফোমা ২ (বিএলসি২), ফোকাল সাইটোকেরাটিন এবং ফোকাল এপিথেলিয়াল মেমব্রেন অ্যান্টিজেন (ইএমএ) পজিটিভ দেখা যায়। এরপর ফ্লুরোসেন্স ইন সিটু হাইব্রিডাইজেশন (এফআইএসএইচ) পরীক্ষার জন্য নমুনা পাঠানো হয় এবং ১৮কিউ১১.২ অবস্থানে এসএস১৮ জিনের একটি পরিবর্তন দেখা যায়, যা সিনোভিয়াল সারকোমাতে দেখা যায়। হিস্টোপ্যাথলজি দ্বারা পিণ্ডের প্রান্তগুলো মূল্যায়ন করা কঠিন ছিল, কারণ নমুনাটিতে প্রান্তগুলো খণ্ড খণ্ড ছিল।\n\nরোগী ২ সপ্তাহ পর ক্লিনিকে আসেন এবং হিস্টোপ্যাথলজি রিপোর্টের ভিত্তিতে, আরও বেশি প্রান্তসহ পুনরায় পিণ্ডটি অপসারণ করার বিষয়ে তার সাথে আলোচনা করা হয় এবং তিনি রাজি হন। এরপর মাথা ও ঘাড়, বুক, পেট, পেলভিস এবং কঙ্কাল-পেশী কাঠামোর জন্য পজিট্রন এমিশন টমোগ্রাফি - কম্পিউটেড টমোগ্রাফি (পিইটি/সিটি) করা হয়। এতে বাম থাইরয়েড লোবের নিচের অংশে ২৯ ∗ ২৭ মিমি আকারের একটি থাইরয়েড নডিউল দেখা যায়, যেখানে স্ট্যান্ডার্ডাইজড আপটেক ভ্যালু (এসইউভি) ৪.৯-এ মাঝারি হাইপারমেটাবলিজম রয়েছে। থাইরয়েড আল্ট্রাসাউন্ডে বাম থাইরয়েড লোবের নিচের অংশে একটি কঠিন, আইসোইকয়িক, সুস্পষ্ট নডিউল দেখা যায়, যেখানে কোনো ইকোজেনিক ফোকি নেই। থাইরয়েড ইমেজিং রিপোর্টিং অ্যান্ড ডেটা সিস্টেম (টিআইআরএডিএস) অনুসারে এটি টিআর৩।\n\nপ্রথম অস্ত্রোপচারের ৩ সপ্তাহ পর দ্বিতীয়বার পিণ্ডটি অপসারণ করা হয়। উভয় কর্ড থেকে সম্পূর্ণ পিণ্ডটি অপসারণ করা হয়, যা কর্পাস স্পঞ্জিওসাম পর্যন্ত বিস্তৃত ছিল এবং উপরে ইউরেথ্রা পর্যন্ত ছেঁটে ফেলা হয়। এরপর নমুনাটি হিস্টোপ্যাথলজির জন্য পাঠানো হয়। অপসারণ করা পিণ্ডটির আকার ছিল ৬.০ ∗ ৬.০ ∗ ৩.০ সেমি এবং এতে কোনো রোগ ছিল না। এরপর রোগীকে সক্রিয় পর্যবেক্ষণে রাখা হয় এবং ১৬ মাস পর সক্রিয় পর্যবেক্ষণে দেখা যায়, তার লিভারের ষষ্ঠ অংশে এবং এল১ ভার্টিব্রাল বডিতে মেটাস্ট্যাটিক ক্ষত রয়েছে। অনক",
+    "translated_summary": "৩৬ বছর বয়সী একজন ব্যক্তি ৫ বছর ধরে পুরুষাঙ্গ এবং অণ্ডকোষের মধ্যে একটি ফোলা অনুভব করছিলেন। এরপর তার সেই ফোলা অংশটি অস্ত্রোপচারের মাধ্যমে অপসারণ করা হয়। হিস্টোপ্যাথলজি পরীক্ষায় দেখা যায় যে, কোষগুলো স্পিন্ডল আকৃতির এবং একটি জটিল বিন্যাসে সজ্জিত। ইমিউনোহিস্টোকেমিস্ট্রি বিশ্লেষণে টিএলই-১, সিডি৯৯, বি-সেল লিম্ফোমা ২ (বিএলসি২), ফোকাল সাইটকেরাটিন এবং ফোকাল এপিথেলিয়াল মেমব্রেন অ্যান্টিজেন (ইএমএ)-এর উপস্থিতি ধরা পড়ে। এই ক্ষেত্রে, রোগীকে দুটি অস্ত্রোপচারের মাধ্যমে এবং পরবর্তীতে বিভিন্ন কেমোথেরাপি পদ্ধতির মাধ্যমে চিকিৎসা করা হলেও, রোগের বিস্তার অব্যাহত ছিল এবং এটি শরীরের অন্যান্য অংশে ছড়িয়ে পড়েছিল।",
+    "corrected_translated_fulltext": "ফেব্রুয়ারি ২০২০-তে, ৩৬ বছর বয়সী একজন ব্যক্তি, যার পূর্বে তেমন কোনো উল্লেখযোগ্য স্বাস্থ্যগত সমস্যা ছিল না, তিনি বাম দিকের পেনোস্ক্রোটাল অঞ্চলে ৫ বছর ধরে একটি পিণ্ডের কথা জানান। তার নিম্ন মূত্রনালীর কোনো উপসর্গ ছিল না। পূর্বে কোনো আঘাত বা সংক্রমণের ইতিহাস ছিল না এবং তিনি ওজন হ্রাস, ক্ষুধামান্দ্য বা জ্বরের কোনো ইতিহাস অস্বীকার করেন। পরীক্ষায় দেখা যায়, বাম দিকের পেনোস্ক্রোটাল সংযোগস্থলে প্রায় ২০ মিমি ∗ ২০ মিমি আকারের একটি মসৃণ, স্পর্শকাতর সিস্টিক পিণ্ড রয়েছে, যা ত্বকের সাথে সংযুক্ত নয় এবং বাম স্পার্মাটিক কর্ডের সাথে সম্পর্কিত নয়, এটি আংশিকভাবে নড়াচড়া করতে পারে।\n\nডপলার আল্ট্রাসাউন্ডে বাম দিকের পেনোস্ক্রোটাল সংযোগস্থলের কাছে ২.৭ ∗ ৩.১ ∗ ২.০ সেমি আকারের একটি সুস্পষ্ট হাইপোইকয়িক পিণ্ড দেখা যায়, যেখানে রক্তনালী উল্লেখযোগ্যভাবে বৃদ্ধি পেয়েছে। পেলভিক ম্যাগনেটিক রেজোন্যান্স ইমেজিং-এ দেখা যায়, পেনিসের বাম দিকের নিচের অংশে একটি পিণ্ড রয়েছে, যার চারপাশে স্পষ্ট ফ্যাট প্লেন দেখা যায়। টি২-ওয়েটেড ইমেজিং, টি১-ওয়েটেড ইমেজিং এবং ডিফিউশন-ওয়েটেড ইমেজিং-এ এটি টেস্টিসের মতো একই রকম দেখায় এবং এটি ভাস ডিফারেন্সের সাথে সংযুক্ত। কোনো লিম্ফ্যাডেনোপ্যাথি দেখা যায়নি। আলফা ফেটোপ্রোটিন এবং বিটা-হিউম্যান ক্রনিক গোন্যাডোট্রপিন-এর মাত্রা স্বাভাবিক ছিল। পরীক্ষার ফলাফল এবং রোগীর ব্যথার তীব্রতা বিবেচনা করে, রোগ নির্ণয় এবং চিকিৎসার জন্য পিণ্ডটি অস্ত্রোপচারের মাধ্যমে অপসারণ করার সিদ্ধান্ত নেওয়া হয়। অস্ত্রোপচারের সময়, বাম দিকের পোস্টেরোলেটারাল স্ক্রোটামে একটি পিণ্ড দেখা যায়, যা সম্পূর্ণরূপে অপসারণ করা হয় এবং হিস্টোপ্যাথলজির জন্য পাঠানো হয়।\n\nপিণ্ডের হিস্টোপ্যাথলজি পরীক্ষায় দেখা যায়, কোষগুলো স্পিন্ডল আকৃতির এবং একটি জটিল বিন্যাসে সাজানো। কোষগুলোর নিউক্লিয়াস স্পিন্ডল থেকে ডিম্বাকৃতির এবং ক্রোম্যাটিন সমানভাবে ছড়িয়ে ছিটিয়ে রয়েছে, নিউক্লিওলিগুলো তেমন স্পষ্ট নয়। টিউমারে উচ্চ মাত্রার মাইটোটিক কার্যকলাপ দেখা যায়, যা প্রতি উচ্চ-ক্ষমতার ক্ষেত্রে ৩টি পর্যন্ত পৌঁছায়। ইমিউনোহিস্টোকেমিস্ট্রি বিশ্লেষণে সিনোভিয়াল সারকোমার বিষয়টি নিশ্চিত করা হয়, যেখানে টিএলই-১, সিডি৯৯, বি-সেল লিম্ফোমা ২ (বিএলসি২), ফোকাল সাইটোকেরাটিন এবং ফোকাল এপিথেলিয়াল মেমব্রেন অ্যান্টিজেন (ইএমএ) পজিটিভ দেখা যায়। এরপর ফ্লুরোসেন্স ইন সিটু হাইব্রিডাইজেশন (এফআইএসএইচ) পরীক্ষার জন্য নমুনা পাঠানো হয় এবং ১৮কিউ১১.২ অবস্থানে এসএস১৮ জিনের একটি পরিবর্তন দেখা যায়, যা সিনোভিয়াল সারকোমাতে দেখা যায়। হিস্টোপ্যাথলজি দ্বারা পিণ্ডের প্রান্তগুলো মূল্যায়ন করা কঠিন ছিল, কারণ নমুনাটিতে প্রান্তগুলো খণ্ড খণ্ড ছিল।\n\nরোগী ২ সপ্তাহ পর ক্লিনিকে আসেন এবং হিস্টোপ্যাথলজি রিপোর্টের ভিত্তিতে, আরও বেশি প্রান্তসহ পুনরায় পিণ্ডটি অপসারণ করার বিষয়ে তার সাথে আলোচনা করা হয় এবং তিনি রাজি হন। এরপর মাথা ও ঘাড়, বুক, পেট, পেলভিস এবং কঙ্কাল-পেশী কাঠামোর জন্য পজিট্রন এমিশন টমোগ্রাফি - কম্পিউটেড টমোগ্রাফি (পিইটি/সিটি) করা হয়। এতে বাম থাইরয়েড লোবের নিচের অংশে ২৯ ∗ ২৭ মিমি আকারের একটি থাইরয়েড নডিউল দেখা যায়, যেখানে স্ট্যান্ডার্ডাইজড আপটেক ভ্যালু (এসইউভি) ৪.৯-এ মাঝারি হাইপারমেটাবলিজম রয়েছে। থাইরয়েড আল্ট্রাসাউন্ডে বাম থাইরয়েড লোবের নিচের অংশে একটি কঠিন, আইসোইকয়িক, সুস্পষ্ট নডিউল দেখা যায়, যেখানে কোনো ইকোজেনিক ফোকি নেই। থাইরয়েড ইমেজিং রিপোর্টিং অ্যান্ড ডেটা সিস্টেম (টিআইআরএডিএস) অনুসারে এটি টিআর৩।\n\nপ্রথম অস্ত্রোপচারের ৩ সপ্তাহ পর দ্বিতীয়বার পিণ্ডটি অপসারণ করা হয়। উভয় কর্ড থেকে সম্পূর্ণ পিণ্ডটি অপসারণ করা হয়, যা কর্পাস স্পঞ্জিওসাম পর্যন্ত বিস্তৃত ছিল এবং উপরে ইউরেথ্রা পর্যন্ত ছেঁটে ফেলা হয়। এরপর নমুনাটি হিস্টোপ্যাথলজির জন্য পাঠানো হয়। অপসারণ করা পিণ্ডটির আকার ছিল ৬.০ ∗ ৬.০ ∗ ৩.০ সেমি এবং এতে কোনো রোগ ছিল না। এরপর রোগীকে সক্রিয় পর্যবেক্ষণে রাখা হয় এবং ১৬ মাস পর সক্রিয় পর্যবেক্ষণে দেখা যায়, তার লিভারের ষষ্ঠ অংশে এবং এল১ ভার্টিব্রাল বডিতে মেটাস্ট্যাটিক ক্ষত রয়েছে। অনক",
+    "corrected_translated_summary": "৩৬ বছর বয়সী একজন ব্যক্তি ৫ বছর ধরে পুরুষাঙ্গ এবং অণ্ডকোষের মধ্যে একটি ফোলা অনুভব করছিলেন।\nএরপর তার সেই ফোলা অংশটি অস্ত্রোপচারের মাধ্যমে অপসারণ করা হয়।\nহিস্টোপ্যাথলজি পরীক্ষায় দেখা যায় যে, কোষগুলো স্পিন্ডল আকৃতির এবং একটি জটিল বিন্যাসে সজ্জিত। ইমিউনোহিস্টোকেমিস্ট্রি বিশ্লেষণে টিএলই-১, সিডি৯৯, বি-সেল লিম্ফোমা ২ (বিএলসি২), ফোকাল সাইটকেরাটিন এবং ফোকাল এপিথেলিয়াল মেমব্রেন অ্যান্টিজেন (ইএমএ)-এর উপস্থিতি ধরা পড়ে।\nএই ক্ষেত্রে, রোগীকে দুটি অস্ত্রোপচারের মাধ্যমে এবং পরবর্তীতে বিভিন্ন কেমোথেরাপি পদ্ধতির মাধ্যমে চিকিৎসা করা হলেও, রোগের বিস্তার অব্যাহত ছিল এবং এটি শরীরের অন্যান্য অংশে ছড়িয়ে পড়েছিল।"
+  },
+  {
+    "id": "multiclinsum_gs_en_205.txt",
+    "fulltext": "A 5-year-old presented to the paediatric emergency department (ED) having ingested chlorpyriphos 13 hours prior to presentation, followed by abnormal jerks, fast breathing and difficulty with breathing. The history was also comprised of excessive sweating and urination, mouth secretions and involuntary movement of the limbs. Vomiting followed the ingestion of crushed charcoal and palm oil. The patient had lapsed into coma prior to presentation. The temperature at presentation was 38.3°C, Glasgow coma score was 3, pupils were pinpoint pupils and there was hypotonia in all limbs. In addition, the patient was severely dyspneic, tachypneic (respiratory rate of 48/minute with intermittent sighing breaths), a saturation of 88% and widespread crackles. The pulse rate was 180/minute, blood pressure 120/80 mmHg, and random blood glucose 14 mg/dl. Serum lactate and cholinesterase tests were not done due to lack of facilities.\n\nThe patient was diagnosed with severe organophosphate poisoning (OPP) and aspiration pneumonitis. As ICU care was beyond the affordability of the parents, non-invasive ventilation (NIV) was administered using bubble continuous positive airway pressure (b-CPAP) causing his saturation to increase to 99%–100%. Hypoglycemia was corrected with a bolus of dextrose solution and tachycardia was treated with 20 ml/kg of normal saline. Intravenous Dexamethasone, Mannitol and IV Atropine at 0.02 mg/kg/dose were also administered. Empirical intravenous antibiotics were administered for aspiration pneumonitis. Pralidoxime was not given due to unavailability. Within 3 hours of presentation, the patient had fresh-whole-blood exchange-blood-transfusion (FWB-EBT) with 500mls of blood.\n\nThe patient’s GCS appreciated to 9/15 but IV Atropine was discontinued after the first dose due to a rapid increase in the heart rate. The blood glucose fluctuated between 41 to 259 mg/dl in the first 15 hours of admission and subsequently normalized with treatment. By the second day on admission, the patient developed thready pulses and hypotension for which another bolus of normal saline was administered. Dopamine infusion was commenced at 5mcg/kg/min using a peripheral vein and IV Mannitol discontinued. A second aliquot of FWB-EBT was administered with 500mls of blood.\n\nOver the first 30 hours of admission, the consciousness level improved and respiratory distress slowly declined. However, the patient developed rhonchi which was treated with nebulized Salbutamol and Budesonide and was subsequently transited to Oxygen therapy with nasal prongs with clinical improvement. The saturation remained stable at 97%. On Day 2 of admission, a chest radiograph was done which showed bilateral infiltrates in keeping with pneumonia.\n\nThe patient regained full consciousness by the 39th hour of admission. Intravenous Vitamin C and B, as well as oral Vitamin E and Zinc were commenced for their antioxidant effects, and regular diet was recommenced in a graded manner over the subsequent 48 hours. The patient’s clinical condition progressively improved and was discharged home after 10 days but was subsequently lost to follow-up.",
+    "summary": "We present the case of a 5-year-old with severe organophosphate poisoning from ingestion of chlorpyrifos, further worsened by aspiration of a charcoal-palm oil mixture. The clinical illness was marked by respiratory failure, shock, coma and type I paralysis. The patient was treated in the emergency department with noninvasive ventilation, multiple episodes of exchange transfusion, intravenous atropine, inotrope infusion, antibiotics and steroids. The patient responded rapidly to treatment, did not develop intermediate syndrome and was discharged after 10 days of admission.",
+    "translated_fulltext": "পাঁচ বছর বয়সী একটি শিশু ক্লোরপাইরিফস নামক কীটনাশক গ্রহণের ১৩ ঘণ্টা পর পেডিয়াট্রিক জরুরি বিভাগে (ইডি) আসে। এরপর তার অস্বাভাবিক খিঁচুনি, দ্রুত শ্বাস-প্রশ্বাস এবং শ্বাস নিতে অসুবিধা দেখা দেয়। রোগীর অতিরিক্ত ঘাম এবং প্রস্রাব, মুখ থেকে লালা ঝরা এবং অঙ্গপ্রত্যঙ্গগুলোর অনিয়ন্ত্রিত নড়াচড়ার ইতিহাসও পাওয়া যায়। ভাঙা কাঠকয়লা এবং পাম তেল খাওয়ার পর বমি হয়। হাসপাতালে আসার আগে রোগী কোমায় চলে গিয়েছিল। হাসপাতালে আসার সময় তার শরীরের তাপমাত্রা ছিল ৩৮.৩ ডিগ্রি সেলসিয়াস, গ্লাসগো কোমা স্কোর ছিল ৩, চোখের মণি ছোট হয়ে গিয়েছিল এবং সমস্ত অঙ্গপ্রত্যঙ্গে পেশী দুর্বলতা দেখা যায়। এছাড়াও, রোগীর শ্বাসকষ্ট ছিল, প্রতি মিনিটে ৪৮ বার শ্বাস নিত এবং মাঝে মাঝে দীর্ঘশ্বাস ফেলত, শরীরে অক্সিজেনের মাত্রা ছিল ৮৮% এবং ফুসফুসে শব্দ শোনা যাচ্ছিল। তার হৃদস্পন্দন ছিল প্রতি মিনিটে ১৮০, রক্তচাপ ছিল ১২০/৮০ মিমি Hg এবং রক্তের গ্লুকোজের মাত্রা ছিল ১৪ মিলিগ্রাম/ডিসিএল। প্রয়োজনীয় সরঞ্জাম না থাকায় সিরাম ল্যাকটেট এবং কোলিনস্টেরেজ পরীক্ষা করা হয়নি।\n\nরোগীকে গুরুতর অর্গানোফসফেট বিষক্রিয়া (ওপিপি) এবং অ্যাসপিরেশন নিউমোনাইটিস ধরা পড়ে। যেহেতু আইসিইউতে চিকিৎসা করানো অভিভাবকদের সামর্থ্যের বাইরে ছিল, তাই বাবল কন্টিনিউয়াস পজিটিভ এয়ারওয়ে প্রেসার (বি-সিপিএপি) ব্যবহার করে নন-ইনভেসিভ ভেন্টিলেশন (এনআইভি) দেওয়া হয়, যার ফলে তার শরীরে অক্সিজেনের মাত্রা ৯৯%-১০০%-এ উন্নীত হয়। ডেক্সট্রোজ দ্রবণ দিয়ে দ্রুত রক্তের গ্লুকোজের মাত্রা স্বাভাবিক করা হয় এবং স্বাভাবিক স্যালাইন দিয়ে ট্যাকিকার্ডিয়ার চিকিৎসা করা হয়। এছাড়াও, ইন্ট্রাভেনাস ডেক্সামেথাসোন, ম্যানিটল এবং ০.০২ মিলিগ্রাম/কেজি/ডোজ হারে আইভি অ্যাট্রোপিন দেওয়া হয়। অ্যাসপিরেশন নিউমোনাইটিসের জন্য অভিজ্ঞতামূলক ইন্ট্রাভেনাস অ্যান্টিবায়োটিক দেওয়া হয়। প্র্যালিডক্সিম পাওয়া না যাওয়ায় দেওয়া হয়নি। হাসপাতালে আসার ৩ ঘণ্টার মধ্যে, রোগীকে ৫০০ মিলি রক্ত দিয়ে ফ্রেশ-হোল-ব্লাড এক্সচেঞ্জ-ব্লাড-ট্রান্সফিউশন (এফডব্লিউবি-ইবিটি) করা হয়।\n\nরোগীর গ্লাসগো কোমা স্কোর ৯/১৫-এ উন্নীত হয়, তবে প্রথম ডোজের পরে হৃদস্পন্দনের দ্রুত বৃদ্ধি পাওয়ায় আইভি অ্যাট্রোপিন বন্ধ করে দেওয়া হয়। হাসপাতালে ভর্তির প্রথম ১৫ ঘণ্টায় রক্তের গ্লুকোজের মাত্রা ৪১ থেকে ২৫৯ মিলিগ্রাম/ডিসিএল-এর মধ্যে ওঠানামা করে, পরে চিকিৎসার মাধ্যমে তা স্বাভাবিক হয়ে আসে। ভর্তির দ্বিতীয় দিনে, রোগীর দুর্বল নাড়ি এবং নিম্ন রক্তচাপ দেখা দেয়, যার জন্য আবার স্বাভাবিক স্যালাইন দেওয়া হয়। একটি পেরিফেরাল শিরায় ৫ মাইক্রোগ্রাম/কেজি/মিনিট হারে ডোপামিন ইনফিউশন শুরু করা হয় এবং আইভি ম্যানিটল বন্ধ করে দেওয়া হয়। ৫০০ মিলি রক্ত দিয়ে দ্বিতীয়বার এফডব্লিউবি-ইবিটি দেওয়া হয়।\n\nভর্তির প্রথম ৩০ ঘণ্টার মধ্যে, রোগীর চেতনা ধীরে ধীরে উন্নত হয় এবং শ্বাসকষ্ট কমতে শুরু করে। তবে, রোগীর শরীরে রনকি দেখা দেয়, যার জন্য নেবুলাইজড সালবিউটামল এবং বুডেসোনাইড দিয়ে চিকিৎসা করা হয় এবং পরবর্তীতে নাকের মাধ্যমে অক্সিজেন থেরাপি দেওয়া হয়, যার ফলে রোগীর অবস্থার উন্নতি হয়। শরীরে অক্সিজেনের মাত্রা ৯৭%-এ স্থিতিশীল থাকে। ভর্তির দ্বিতীয় দিনে, বুকের একটি এক্স-রে করা হয়, যেখানে নিউমোনিয়ার সঙ্গে সঙ্গতি রেখে উভয় ফুসফুসে সংক্রমণ দেখা যায়।\n\nভর্তির ৩৯তম ঘণ্টার মধ্যে রোগী সম্পূর্ণরূপে চেতনা ফিরে পায়। অ্যান্টিঅক্সিডেন্ট প্রভাবের জন্য ইন্ট্রাভেনাস ভিটামিন সি এবং বি, সেইসাথে মুখে খাওয়ার জন্য ভিটামিন ই এবং জিঙ্ক দেওয়া শুরু হয় এবং পরবর্তী ৪৮ ঘণ্টায় ধীরে ধীরে স্বাভাবিক খাবার দেওয়া শুরু হয়। রোগীর শারীরিক অবস্থার ধীরে ধীরে উন্নতি হয় এবং ১০ দিন পর তাকে বাড়ি ছেড়ে দেওয়া হয়, তবে পরবর্তীতে ফলো-আপের জন্য তাকে আর পাওয়া যায়নি।",
+    "translated_summary": "আমরা এখানে পাঁচ বছর বয়সী একটি শিশুর ঘটনা তুলে ধরছি, যে ক্লোরোপাইরিফস নামক কীটনাশক গ্রহণের ফলে গুরুতর অর্গানোফসফেট বিষক্রিয়ায় আক্রান্ত হয়েছিল। এরপর কাঠকয়লার গুঁড়ো ও পাম তেল মেশানো মিশ্রণ শ্বাসনালীতে প্রবেশ করায় পরিস্থিতি আরও খারাপ হয়। এই শিশুর শ্বাসকষ্ট, শক, কোমা এবং প্রথম ধরনের প্যারালাইসিস দেখা যায়। জরুরি বিভাগে তাকে নন-ইনভেসিভ ভেন্টিলেশন, একাধিকবার রক্ত ​​পরিবর্তন, শিরায় অ্যাট্রোপিন, ইনোট্রপিক ইনফিউশন, অ্যান্টিবায়োটিক এবং স্টেরয়েড দিয়ে চিকিৎসা করা হয়। শিশুটি দ্রুত চিকিৎসার প্রতি সাড়া দেয়, কোনো মধ্যবর্তী সিনড্রোম তৈরি হয়নি এবং হাসপাতালে দশ দিন থাকার পর তাকে ছুটি দেওয়া হয়।",
+    "corrected_translated_fulltext": "পাঁচ বছর বয়সী একটি শিশু ক্লোরপাইরিফস নামক কীটনাশক গ্রহণের ১৩ ঘণ্টা পর পেডিয়াট্রিক জরুরি বিভাগে (ইডি) আসে। এরপর তার অস্বাভাবিক খিঁচুনি, দ্রুত শ্বাস-প্রশ্বাস এবং শ্বাস নিতে অসুবিধা দেখা দেয়। রোগীর অতিরিক্ত ঘাম এবং প্রস্রাব, মুখ থেকে লালা ঝরা এবং অঙ্গপ্রত্যঙ্গগুলোর অনিয়ন্ত্রিত নড়াচড়ার ইতিহাসও পাওয়া যায়। ভাঙা কাঠকয়লা এবং পাম তেল খাওয়ার পর বমি হয়। হাসপাতালে আসার আগে রোগী কোমায় চলে গিয়েছিল। হাসপাতালে আসার সময় তার শরীরের তাপমাত্রা ছিল ৩৮.৩ ডিগ্রি সেলসিয়াস, গ্লাসগো কোমা স্কোর ছিল ৩, চোখের মণি ছোট হয়ে গিয়েছিল এবং সমস্ত অঙ্গপ্রত্যঙ্গে পেশী দুর্বলতা দেখা যায়। এছাড়াও, রোগীর শ্বাসকষ্ট ছিল, প্রতি মিনিটে ৪৮ বার শ্বাস নিত এবং মাঝে মাঝে দীর্ঘশ্বাস ফেলত, শরীরে অক্সিজেনের মাত্রা ছিল ৮৮% এবং ফুসফুসে শব্দ শোনা যাচ্ছিল। তার হৃদস্পন্দন ছিল প্রতি মিনিটে ১৮০, রক্তচাপ ছিল ১২০/৮০ মিমি Hg এবং রক্তের গ্লুকোজের মাত্রা ছিল ১৪ মিলিগ্রাম/ডিসিএল। প্রয়োজনীয় সরঞ্জাম না থাকায় সিরাম ল্যাকটেট এবং কোলিনস্টেরেজ পরীক্ষা করা হয়নি।\n\nরোগীকে গুরুতর অর্গানোফসফেট বিষক্রিয়া (ওপিপি) এবং অ্যাসপিরেশন নিউমোনাইটিস ধরা পড়ে। যেহেতু আইসিইউতে চিকিৎসা করানো অভিভাবকদের সামর্থ্যের বাইরে ছিল, তাই বাবল কন্টিনিউয়াস পজিটিভ এয়ারওয়ে প্রেসার (বি-সিপিএপি) ব্যবহার করে নন-ইনভেসিভ ভেন্টিলেশন (এনআইভি) দেওয়া হয়, যার ফলে তার শরীরে অক্সিজেনের মাত্রা ৯৯%-১০০%-এ উন্নীত হয়। ডেক্সট্রোজ দ্রবণ দিয়ে দ্রুত রক্তের গ্লুকোজের মাত্রা স্বাভাবিক করা হয় এবং স্বাভাবিক স্যালাইন দিয়ে ট্যাকিকার্ডিয়ার চিকিৎসা করা হয়। এছাড়াও, ইন্ট্রাভেনাস ডেক্সামেথাসোন, ম্যানিটল এবং ০.০২ মিলিগ্রাম/কেজি/ডোজ হারে আইভি অ্যাট্রোপিন দেওয়া হয়। অ্যাসপিরেশন নিউমোনাইটিসের জন্য অভিজ্ঞতামূলক ইন্ট্রাভেনাস অ্যান্টিবায়োটিক দেওয়া হয়। প্র্যালিডক্সিম পাওয়া না যাওয়ায় দেওয়া হয়নি। হাসপাতালে আসার ৩ ঘণ্টার মধ্যে, রোগীকে ৫০০ মিলি রক্ত দিয়ে ফ্রেশ-হোল-ব্লাড এক্সচেঞ্জ-ব্লাড-ট্রান্সফিউশন (এফডব্লিউবি-ইবিটি) করা হয়।\n\nরোগীর গ্লাসগো কোমা স্কোর ৯/১৫-এ উন্নীত হয়, তবে প্রথম ডোজের পরে হৃদস্পন্দনের দ্রুত বৃদ্ধি পাওয়ায় আইভি অ্যাট্রোপিন বন্ধ করে দেওয়া হয়। হাসপাতালে ভর্তির প্রথম ১৫ ঘণ্টায় রক্তের গ্লুকোজের মাত্রা ৪১ থেকে ২৫৯ মিলিগ্রাম/ডিসিএল-এর মধ্যে ওঠানামা করে, পরে চিকিৎসার মাধ্যমে তা স্বাভাবিক হয়ে আসে। ভর্তির দ্বিতীয় দিনে, রোগীর দুর্বল নাড়ি এবং নিম্ন রক্তচাপ দেখা দেয়, যার জন্য আবার স্বাভাবিক স্যালাইন দেওয়া হয়। একটি পেরিফেরাল শিরায় ৫ মাইক্রোগ্রাম/কেজি/মিনিট হারে ডোপামিন ইনফিউশন শুরু করা হয় এবং আইভি ম্যানিটল বন্ধ করে দেওয়া হয়। ৫০০ মিলি রক্ত দিয়ে দ্বিতীয়বার এফডব্লিউবি-ইবিটি দেওয়া হয়।\n\nভর্তির প্রথম ৩০ ঘণ্টার মধ্যে, রোগীর চেতনা ধীরে ধীরে উন্নত হয় এবং শ্বাসকষ্ট কমতে শুরু করে। তবে, রোগীর শরীরে রনকি দেখা দেয়, যার জন্য নেবুলাইজড সালবিউটামল এবং বুডেসোনাইড দিয়ে চিকিৎসা করা হয় এবং পরবর্তীতে নাকের মাধ্যমে অক্সিজেন থেরাপি দেওয়া হয়, যার ফলে রোগীর অবস্থার উন্নতি হয়। শরীরে অক্সিজেনের মাত্রা ৯৭%-এ স্থিতিশীল থাকে। ভর্তির দ্বিতীয় দিনে, বুকের একটি এক্স-রে করা হয়, যেখানে নিউমোনিয়ার সঙ্গে সঙ্গতি রেখে উভয় ফুসফুসে সংক্রমণ দেখা যায়।\n\nভর্তির ৩৯তম ঘণ্টার মধ্যে রোগী সম্পূর্ণরূপে চেতনা ফিরে পায়। অ্যান্টিঅক্সিডেন্ট প্রভাবের জন্য ইন্ট্রাভেনাস ভিটামিন সি এবং বি, সেইসাথে মুখে খাওয়ার জন্য ভিটামিন ই এবং জিঙ্ক দেওয়া শুরু হয় এবং পরবর্তী ৪৮ ঘণ্টায় ধীরে ধীরে স্বাভাবিক খাবার দেওয়া শুরু হয়। রোগীর শারীরিক অবস্থার ধীরে ধীরে উন্নতি হয় এবং ১০ দিন পর তাকে বাড়ি ছেড়ে দেওয়া হয়, তবে পরবর্তীতে ফলো-আপের জন্য তাকে আর পাওয়া যায়নি।",
+    "corrected_translated_summary": "আমরা এখানে পাঁচ বছর বয়সী একটি শিশুর ঘটনা তুলে ধরছি, যে ক্লোরোপাইরিফস নামক কীটনাশক গ্রহণের ফলে গুরুতর অর্গানোফসফেট বিষক্রিয়ায় আক্রান্ত হয়েছিল। এরপর কাঠকয়লার গুঁড়ো ও পাম তেল মেশানো মিশ্রণ শ্বাসনালীতে প্রবেশ করায় পরিস্থিতি আরও খারাপ হয়। এই শিশুর শ্বাসকষ্ট, শক, কোমা এবং প্রথম ধরনের প্যারালাইসিস দেখা যায়। জরুরি বিভাগে তাকে নন-ইনভেসিভ ভেন্টিলেশন, একাধিকবার রক্ত ​​পরিবর্তন, শিরায় অ্যাট্রোপিন, ইনোট্রপিক ইনফিউশন, অ্যান্টিবায়োটিক এবং স্টেরয়েড দিয়ে চিকিৎসা করা হয়। শিশুটি দ্রুত চিকিৎসার প্রতি সাড়া দেয়, কোনো মধ্যবর্তী সিনড্রোম তৈরি হয়নি এবং হাসপাতালে দশ দিন থাকার পর তাকে ছুটি দেওয়া হয়।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0062_0063.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0062_0063.json
new file mode 100644
index 0000000000000000000000000000000000000000..27a7b11792379157838bc8c791f4d3527ece685e
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0062_0063.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_583.txt",
+    "fulltext": "A 19-year-old female presented to our hospital’s emergency room with a chief complaint of a two-day history of headache, accompanied by recurrent nausea, vomiting, and a one-day fever. On admission, her physical examination revealed a high fever of 39.1°C, elevated blood pressure at 189/120 mmHg, and a pulse rate of 148 beats per minute. Laboratory results indicated an elevated white blood cell count of 14.77×10^9/L and a neutrophil count of 13.55×10^9/L, suggesting a possible infection or inflammatory response. Initial empirical treatment with antibiotics was administered due to suspected infection, but her symptoms persisted. Given her abnormal vital signs, elevated inflammatory markers, and lack of symptom improvement, the patient was admitted for further diagnostic evaluation and transferred to the intensive care unit for close monitoring. A year prior, the patient had presented with similar symptoms and was diagnosed with myocarditis at a local hospital based on clinical findings at that time. During that hospitalization, she was also diagnosed with hypertension and prescribed antihypertensive medications. However, after discharge, the patient did not adhere to the prescribed antihypertensive therapy and did not regularly monitor her blood pressure. Additionally, it is notable that her father had a history of sudden, unexplained death.\n\nTo investigate the underlying etiology of the patient’s symptoms, a chest computed tomography (CT) scan was performed. Incidentally, this scan revealed a left adrenal mass with soft tissue density, measuring 43 mm × 36 mm. No pathological findings were observed in the head and chest CT scans. The electrocardiogram demonstrated sinus tachycardia with a shortened PR interval and tall, peaked P-waves in leads II, III, and aVF. Transthoracic echocardiography did not reveal any significant abnormalities.\n\nOn the second day of admission, the patient exhibited rising levels of brain natriuretic peptide (BNP) and Troponin I (TnI). The cardiologist provisionally diagnosed the patient with myocarditis of uncertain etiology, based on clinical presentation, elevated cardiac biomarkers (BNP and TnI), and supportive electrocardiogram findings. Treatment was initiated with methylprednisolone (0.25 g daily) to address potential myocardial inflammation due to suspected myocarditis. Furosemide (20 mg every 12 hours) and spironolactone (20 mg every 12 hours) were administered as diuretics to manage fluid retention and reduce cardiac workload. Perindopril amlodipine (10 mg: 5 mg daily) was prescribed as an angiotensin-converting enzyme inhibitor and calcium channel blocker combination to control blood pressure and reduce afterload. Metoprolol tartrate (25 mg every 12 hours) was used to manage heart rate and decrease myocardial oxygen demand, while esmolol (0.2 g/hour intravenous infusion), a short-acting beta-blocker, was administered for additional acute heart rate control due to sinus tachycardia. Due to concerns about a potential infection, moxifloxacin was added as empiric antibiotic therapy.\n\nGiven the patient’s presentation with an adrenal mass and hypertension, the endocrinologist recommended an evaluation of the aldosterone-to-renin ratio, plasma cortisol, plasma catecholamines, and 24-hour urinary catecholamines along with their metabolites. In the recumbent position, plasma and urinary catecholamine levels were markedly elevated (Table 1), including plasma dopamine at 524.5 pmol/L, norepinephrine at 83975 pmol/L, and epinephrine at 10579.3 pmol/L. Additionally, the 24-hour urinary levels showed free adrenaline at 4368.89 nmol/24 hours, free norepinephrine exceeding 12697.60 nmol/24 hours, normetanephrine at 8312 nmol/24 hours, metanephrines at 4078 nmol/24 hours, and vanillylmandelic acid at 58.1 mg/24 hours. These findings supported a clinical diagnosis of pheochromocytoma. On the fifth day post-admission, glucocorticoid therapy was discontinued, and perindopril amlodipine was substituted with terazosin for more targeted blood pressure management.\n\nAn enhanced abdominal CT scan further confirmed a left adrenal mass, highly suggestive of pheochromocytoma. Additionally, after obtaining informed consent, whole-exome sequencing was performed, revealing a heterozygous missense mutation, c.1900T > C: p. Cys634Arg, in the RET gene, leading to a substitution of cysteine with arginine at codon 634. This mutation raised suspicion for multiple endocrine neoplasia syndrome, prompting further evaluation of the thyroid and parathyroid glands. Thyroid color Doppler ultrasound identified a hypoechoic mass measuring 6 mm × 4 mm in the left thyroid lobe, and a mild elevation in calcitonin levels was noted. No additional significant abnormalities were detected.\n\nAs the patient’s condition gradually improved, plasma cortisol and ACTH levels returned to normal. The patient was subsequently discharged with a prescription for metoprolol tartrate (100 mg every 12 hours) and ivabradine hydrochloride (5 mg every 12 hours) for home management. Three months later, after achieving stable clinical status, the patient underwent resection of the left adrenal tumor, which measured 50 mm × 40 mm × 30 mm. Immunohistochemical analysis confirmed positive staining for Vim, CD56, Syn, CgA, and NSE, with S-100 positive in Sertoli cells, while CKpan, CD10, MART-1/Melan-A, and Melan-A were negative. The Ki67 index was 1%, leading to a definitive diagnosis of adrenal pheochromocytoma. The patient was discharged without further medications and has since been regularly followed up postoperatively without recurrence of symptoms. Over a 15-month postoperative follow-up, the patient exhibited persistently mild hypercalcitoninemia with stable thyroid nodule size, while PTH and serum calcium levels showed a progressive increase (Table 2). Further parathyroid scintigraphy using 99mTc-MIBI was performed, and the conclusion was a negative result for parathyroid adenoma.",
+    "summary": "We report the case of a 19-year-old female who presented with pheochromocytoma without experiencing a crisis, despite having a significant adrenal mass and undergoing high-dose glucocorticoid treatment. Genetic testing revealed a heterozygous missense mutation in the RET gene (c.1900T > C: p. Cys634Arg), associated with MEN2A. Further endocrine evaluation identified a thyroid nodule with mildly elevated calcitonin levels, but normal electrolyte and parathyroid hormone levels. Over a 15-month postoperative follow-up, the patient exhibited persistently mild hypercalcitoninemia with stable thyroid nodule size, while PTH and serum calcium levels showed a progressive increase. Further parathyroid scintigraphy using 99mTc-MIBI was performed, yielding a negative result for parathyroid adenoma.",
+    "translated_fulltext": null,
+    "translated_summary": "আমরা একজন ১৯ বছর বয়সী মহিলার ঘটনা বর্ণনা করছি, যিনি উল্লেখযোগ্য পরিমাণে অ্যাড্রিনাল গ্রন্থির বৃদ্ধি এবং উচ্চ মাত্রার গ্লুকোকর্টিকয়েড চিকিৎসা গ্রহণ করার পরেও কোনো সংকট অনুভব না করে ফিওক্রোমোসাইটোমার লক্ষণ নিয়ে এসেছিলেন। জেনেটিক পরীক্ষায় দেখা যায় যে, তার RET জিনে একটি হেটেরোজাইগাস মিসসেন্স মিউটেশন রয়েছে (c.1900T > C: p. Cys634Arg), যা MEN2A-এর সঙ্গে সম্পর্কিত। আরও এন্ডোক্রাইন মূল্যায়নে সামান্য পরিমাণে ক্যালসিটোনিনের মাত্রা বৃদ্ধি পাওয়া একটি থাইরয়েড নডিউল শনাক্ত করা হয়, তবে ইলেক্ট্রোলাইট এবং প্যারাথাইরয়েড হরমোনের মাত্রা স্বাভাবিক ছিল। ১৫ মাস ধরে অস্ত্রোপচারের পরবর্তী ফলো-আপে, রোগীর ক্যালসিটোনিনের মাত্রা সামান্য বেশি ছিল এবং থাইরয়েড নডিউলের আকার স্থিতিশীল ছিল, তবে পিটিএইচ এবং সিরাম ক্যালসিয়ামের মাত্রা ধীরে ধীরে বাড়তে থাকে। এরপর 99mTc-MIBI ব্যবহার করে আরও প্যারাথাইরয়েড সিন্টিগ্রাফি করা হয়, যেখানে প্যারাথাইরয়েড অ্যাডেনোমার কোনো লক্ষণ পাওয়া যায়নি।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা একজন ১৯ বছর বয়সী মহিলার ঘটনা বর্ণনা করছি, যিনি উল্লেখযোগ্য পরিমাণে অ্যাড্রিনাল গ্রন্থির বৃদ্ধি এবং উচ্চ মাত্রার গ্লুকোকর্টিকয়েড চিকিৎসা গ্রহণ করার পরেও কোনো সংকট অনুভব না করে ফিওক্রোমোসাইটোমার লক্ষণ নিয়ে এসেছিলেন। জেনেটিক পরীক্ষায় দেখা যায় যে, তার RET জিনে একটি হেটেরোজাইগাস মিসসেন্স মিউটেশন রয়েছে (c.1900T > C: p. Cys634Arg), যা MEN2A-এর সঙ্গে সম্পর্কিত। আরও এন্ডোক্রাইন মূল্যায়নে সামান্য পরিমাণে ক্যালসিটোনিনের মাত্রা বৃদ্ধি পাওয়া একটি থাইরয়েড নডিউল শনাক্ত করা হয়, তবে ইলেক্ট্রোলাইট এবং প্যারাথাইরয়েড হরমোনের মাত্রা স্বাভাবিক ছিল। ১৫ মাস ধরে অস্ত্রোপচারের পরবর্তী ফলো-আপে, রোগীর ক্যালসিটোনিনের মাত্রা সামান্য বেশি ছিল এবং থাইরয়েড নডিউলের আকার স্থিতিশীল ছিল, তবে পিটিএইচ এবং সিরাম ক্যালসিয়ামের মাত্রা ধীরে ধীরে বাড়তে থাকে। এরপর 99mTc-MIBI ব্যবহার করে আরও প্যারাথাইরয়েড সিন্টিগ্রাফি করা হয়, যেখানে প্যারাথাইরয়েড অ্যাডেনোমার কোনো লক্ষণ পাওয়া যায়নি।"
+  },
+  {
+    "id": "multiclinsum_gs_en_91.txt",
+    "fulltext": "A 13-year-old adolescent male, with no significant previous medical history, presented to the emergency department with a 3-day history of acute bilateral pleuritic chest pain associated with mild non-productive cough and no dyspnea. Associated with this, he had mild rhinorrhea and a single febrile episode that day (temperature of 38ºC). Chest pain was localized to the costal margin region and worsened with cough, without diurnal variation. The patient-reported relief with paracetamol. There were no complaints of joint pain, weight loss, anorexia, fatigue, episodes of syncope or exercise restriction. In fact, he practiced sports regularly—canoeing 2 times a week. No evidence of an infectious exposure or contact with household or environmental fumes, dust, or mineral oils was described. There was no known family history of cardiopulmonary conditions. He had a chest radiograph taken 4 years earlier during an acute illness, which showed a marked interstitial infiltrate that was presumptively treated with azithromycin with no further clinical symptoms and no further follow-up.\n\nOn admission, the patient’s temperature was 37.8°C with normal peripheral oxygen saturation (99%) in room air. His heart (93 beats per minute) and respiratory rate (15 breaths per minute) were normal and blood pressure was on the 85th percentile (115/66 mmHg). Physical examination revealed diminished breath sounds in the lower two thirds of the chest with no adventitious sounds. No respiratory distress, finger clubbing, cyanosis, abnormal heart sounds, or other findings were present. Chest radiograph revealed a marked interstitial infiltrate, comparable with his previous examination. A thoracic computed tomography (CT) revealed multiple bilateral areas of ground-glass opacities involving > 65% of lung parenchyma, suggestive of PAP. Respiratory viral testing was negative, and he remained stable throughout his monitoring in the emergency department. He was discharged with empiric antibiotics (amoxicillin-clavulanic acid and azithromycin) to cover a potential respiratory infection, with clinical resolution of symptoms and was sent for follow-up at the pediatric respiratory clinic.\n\nUpon further investigation in the outpatient setting, positive antinuclear antibodies (ANAs) at a titer of 1/89 with a fine speckled pattern were detected, while other autoantibodies tested negative and immunoglobulin levels remained within normal limits. Bronchoalveolar lavage revealed fluid with a milky appearance and positive periodic acid-Schiff staining; microbiological examination, including for mycobacteria, returned negative results. Spirometry indicated a mild restrictive pattern with reduced forced vital capacity (FVC) at 2.92 L (77%) and forced expiratory volume in 1 second (FEV1) at 3.21 L (69.9%), alongside a normal FEV1/FVC ratio (109%). In addition, the DLCO single breath (SB) showed a moderate decrease at 13.8 ml/min/mmHg (48.6%). Suspecting PAP, a genetic panel was conducted, which showed no mutations associated with surfactant dysfunction. Subsequently, GM-CSF antibody testing was performed with a positive result, raising suspicion for AI-PAP. At 20 months of follow-up, the patient remains asymptomatic and continues to exercise regularly. He repeated spirometry testing with normal FVC at 4.03 L (81.3%); FEV1 at 3.71 L (87.5%); FEV1/FVC ratio at 91.96% and DLCO SB at 25.54 ml/min/mmHg (83.7%). As the patient remains stable with no respiratory symptoms, we decided to defer treatment and continue monitoring with regular clinic visits.",
+    "summary": "We describe the case of a 13-year-old adolescent male who presented to the emergency department with acute pleuritic chest pain not associated with systemic complaints. On examination, he had diminished breath sounds in the lower two thirds of the chest with no other abnormal findings; SpO2 (oxygen saturation) was 98% on room air. Chest radiograph revealed a marked interstitial infiltrate, comparable with the one taken 4 years earlier during an acute illness that was presumptively treated with azithromycin. A computed tomography (CT) scan revealed multiple bilateral areas of ground-glass opacities with areas of crazy paving, involving > 65% of lung parenchyma, suggestive of pulmonary alveolar proteinosis (PAP). Respiratory viral testing, including for coronavirus (SARS-CoV2), was negative. Bronchoalveolar lavage performed in the outpatient setting revealed a milky fluid and positive periodic acid-Schiff staining. Spirometry indicated a mild restrictive pattern (forced vital capacity [FVC] = 77%) and diffusing capacity of the lungs for carbon monoxide (DLCO) showed a moderate decrease at 48.6%. No mutations associated with surfactant dysfunction were found on the genetic panel. Anti-granulocyte macrophage colony-stimulating factor (GM-CSF) antibody testing was strongly positive, raising suspicion for autoimmune PAP. At 20 months of follow-up, the patient remains asymptomatic with a normal spirometry.",
+    "translated_fulltext": null,
+    "translated_summary": "আমরা ১৩ বছর বয়সী একজন কিশোরের ঘটনা বর্ণনা করছি, যে বুকে তীব্র ব্যথা নিয়ে জরুরি বিভাগে এসেছিল, তবে সেই ব্যথার সাথে অন্য কোনো শারীরিক উপসর্গ ছিল না। পরীক্ষায় দেখা যায়, তার বুকের নিচের দুই-তৃতীয়াংশে শ্বাস-প্রশ্বাসের শব্দ দুর্বল ছিল এবং অন্য কোনো অস্বাভাবিকতা ছিল না; স্বাভাবিক বাতাসে তার SpO2 (অক্সিজেন স্যাচুরেশন) ছিল ৯৮%। বুকের এক্স-রেতে দেখা যায়, ফুসফুসে উল্লেখযোগ্য পরিমাণে ইন্টারস্টিশিয়াল ইনফিল্ট্রেট রয়েছে, যা ৪ বছর আগে একটি তীব্র অসুস্থতার সময় তোলা এক্স-রের সাথে তুলনীয়, তখন অ্যাজিথ্রোমাইসিন দিয়ে চিকিৎসা করা হয়েছিল। কম্পিউটেড টমোগ্রাফি (সিটি) স্ক্যানে ফুসফুসের প্রায় ৬৫% অংশে গ্রাউন্ড-গ্লাস অপাসিটির একাধিক ক্ষেত্র এবং ক্রেজি পেভিংয়ের লক্ষণ দেখা যায়, যা পালমোনারি অ্যালভিওলার প্রোটিনোসিসের (পিএপি) ইঙ্গিত দেয়। শ্বাসযন্ত্রের ভাইরাস পরীক্ষা, যার মধ্যে করোনাভাইরাস (SARS-CoV2)-এর পরীক্ষাও অন্তর্ভুক্ত ছিল, তা নেতিবাচক ছিল। বহির্বিভাগে ব্রঙ্কোঅ্যালভিওলার ল্যাভেজ করার পর দেখা যায়, সেখানে দুধের মতো তরল এবং পিরিয়ডিক অ্যাসিড-শিফ স্টেইনিং পজিটিভ ছিল। স্পাইরোমেট্রি পরীক্ষায় হালকাRestrictive প্যাটার্ন দেখা যায় (ফোর্সড ভাইটাল ক্যাপাসিটি [এফভিসি] = ৭৭%) এবং কার্বন মনোক্সাইডের জন্য ফুসফুসের ডিফিউজিং ক্ষমতা (ডিএলসিও) মাঝারিভাবে হ্রাস পেয়ে ৪8.6%-এ নেমে আসে। জেনেটিক প্যানেলে সার্ফ্যাক্ট্যান্ট ডিসফাংশনের সাথে সম্পর্কিত কোনো মিউটেশন পাওয়া যায়নি। অ্যান্টি-গ্রানুলোসাইট ম্যাক্রোফেজ কলোনি-স্টিমুলেটিং ফ্যাক্টর (জিএম-সিএসএফ) অ্যান্টিবডি পরীক্ষা করে দেখা যায়, এটি প্রবলভাবে পজিটিভ, যা অটোইমিউন পিএপি-এর সন্দেহ তৈরি করে। ২০ মাস ফলো-আপের পর, রোগীর মধ্যে আর কোনো উপসর্গ দেখা যায়নি এবং স্পাইরোমেট্রি স্বাভাবিক ছিল।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা ১৩ বছর বয়সী একজন কিশোরের ঘটনা বর্ণনা করছি, যে বুকে তীব্র ব্যথা নিয়ে জরুরি বিভাগে এসেছিল, তবে সেই ব্যথার সাথে অন্য কোনো শারীরিক উপসর্গ ছিল না। পরীক্ষায় দেখা যায়, তার বুকের নিচের দুই-তৃতীয়াংশে শ্বাস-প্রশ্বাসের শব্দ দুর্বল ছিল এবং অন্য কোনো অস্বাভাবিকতা ছিল না; স্বাভাবিক বাতাসে তার SpO2 (অক্সিজেন স্যাচুরেশন) ছিল ৯৮%। বুকের এক্স-রেতে দেখা যায়, ফুসফুসে উল্লেখযোগ্য পরিমাণে ইন্টারস্টিশিয়াল ইনফিল্ট্রেট রয়েছে, যা ৪ বছর আগে একটি তীব্র অসুস্থতার সময় তোলা এক্স-রের সাথে তুলনীয়, তখন অ্যাজিথ্রোমাইসিন দিয়ে চিকিৎসা করা হয়েছিল। কম্পিউটেড টমোগ্রাফি (সিটি) স্ক্যানে ফুসফুসের প্রায় ৬৫% অংশে গ্রাউন্ড-গ্লাস অপাসিটির একাধিক ক্ষেত্র এবং ক্রেজি পেভিংয়ের লক্ষণ দেখা যায়, যা পালমোনারি অ্যালভিওলার প্রোটিনোসিসের (পিএপি) ইঙ্গিত দেয়। শ্বাসযন্ত্রের ভাইরাস পরীক্ষা, যার মধ্যে করোনাভাইরাস (SARS-CoV2)-এর পরীক্ষাও অন্তর্ভুক্ত ছিল, তা নেতিবাচক ছিল। বহির্বিভাগে ব্রঙ্কোঅ্যালভিওলার ল্যাভেজ করার পর দেখা যায়, সেখানে দুধের মতো তরল এবং পিরিয়ডিক অ্যাসিড-শিফ স্টেইনিং পজিটিভ ছিল। স্পাইরোমেট্রি পরীক্ষায় হালকাRestrictive প্যাটার্ন দেখা যায় (ফোর্সড ভাইটাল ক্যাপাসিটি [এফভিসি] = ৭৭%) এবং কার্বন মনোক্সাইডের জন্য ফুসফুসের ডিফিউজিং ক্ষমতা (ডিএলসিও) মাঝারিভাবে হ্রাস পেয়ে ৪8.6%-এ নেমে আসে। জেনেটিক প্যানেলে সার্ফ্যাক্ট্যান্ট ডিসফাংশনের সাথে সম্পর্কিত কোনো মিউটেশন পাওয়া যায়নি। অ্যান্টি-গ্রানুলোসাইট ম্যাক্রোফেজ কলোনি-স্টিমুলেটিং ফ্যাক্টর (জিএম-সিএসএফ) অ্যান্টিবডি পরীক্ষা করে দেখা যায়, এটি প্রবলভাবে পজিটিভ, যা অটোইমিউন পিএপি-এর সন্দেহ তৈরি করে। ২০ মাস ফলো-আপের পর, রোগীর মধ্যে আর কোনো উপসর্গ দেখা যায়নি এবং স্পাইরোমেট্রি স্বাভাবিক ছিল।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0066_0067.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0066_0067.json
new file mode 100644
index 0000000000000000000000000000000000000000..8cc7ce972f5efd1c93c9d3d6e5fc072b571bfd91
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2bn_gemma(0_200)_0066_0067.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_72.txt",
+    "fulltext": "A 17-year-old male with no significant past medical or family history was referred to our clinic from the dental department following an incidental finding of a NFB during preoperative orthodontic planning, including dental x-rays and cone beam computed tomography (CBCT) without contrast. The patient was entirely asymptomatic and denied any history of nasal obstruction, rhinorrhea, epistaxis, foul odor, hyposmia, halitosis, facial pain, discomfort, or sleep disturbances. The patient's parents recalled an event when their son was seven, where he inserted an object into his nose. They sought medical advice, where no imaging was performed and an anterior rhinoscopy was utilized for diagnoses but due to the child's non-cooperation during the examination, the physician recommended the removal of the foreign body under sedation. However, the family did not follow up, and since the child remained asymptomatic, they assumed the foreign body had fallen out on its own. On endoscopic examination of the right nasal cavity, a deviated nasal septum with inferior turbinate hypertrophy was noted. The mucosa appeared erythematous and slightly edematous. A foreign body was visualized, lodged, and adhered to the floor of the nasal cavity beneath the inferior turbinate. The object was partially covered with mucus and possibly some crusted material and had a shiny appearance, indicating a metallic nature. Radiographic evaluation, including lateral and frontal X-rays, revealed a circular radiopaque object consistent with a metallic snap button located along the floor of the nasal cavity. The surrounding bony structures appeared normal. A CBCT confirmed the presence of the foreign body with associated mild inflammation, but no significant bony damage or sinus involvement was observed. With informed consent from the patient's parent, the foreign body was removed under local anesthesia in a semi-sitting position to reduce the risk of dislodgment to the airway. After decongesting the nasal cavity with Xylometazoline 0.1 % and administering Lidocaine spray (10 mg/spray) in the right nostril, a hook was utilized to disengage the foreign body, which was then retrieved using bayonet forceps. The procedure was uncomplicated, with minimal bleeding, easily controlled with saline irrigation. Post-removal examination showed no significant tissue damage. The retrieved object, a metallic snap button measuring 1 cm in diameter, exhibited signs of long-term exposure, including substantial corrosion and biological deposits. The patient was discharged in stable condition and prescribed nasal rinses with a sodium chloride irrigation solution (0.9 %). The patient was doing well at his two-week follow-up with an unremarkable examination.",
+    "summary": "We present the case of a 17-year-old male with an asymptomatic NFB discovered incidentally during routine dental radiography. The patient denied any history of nasal obstruction, epistaxis, or discomfort. Imaging revealed a radiopaque object in the right nasal cavity, later identified as a metallic snap button embedded in the floor of the nasal cavity. The foreign body had likely been retained for over a decade.",
+    "translated_fulltext": "সতেরো বছর বয়সী একজন যুবক, যার পূর্বে তেমন কোনো উল্লেখযোগ্য স্বাস্থ্যগত সমস্যা বা পারিবারিক ইতিহাস নেই, তাকে আমাদের ক্লিনিকে ডেন্টাল বিভাগ থেকে রেফার করা হয়েছিল। এর কারণ হলো, প্রাক-সার্জিক্যাল অর্থোডন্টিক পরিকল্পনার সময়, যার মধ্যে ডেন্টাল এক্স-রে এবং কোণ বিম কম্পিউটেড টমোগ্রাফি (সিবিসিটি) অন্তর্ভুক্ত ছিল (যেখানে কোনো কন্ট্রাস্ট ব্যবহার করা হয়নি), একটি অপ্রত্যাশিতভাবে নাকের মধ্যে একটি বস্তু (এনএফবি) পাওয়া যায়। রোগী কোনো উপসর্গ অনুভব করেননি এবং নাকের পথে বাধা, নাক দিয়ে পানি পড়া, নাক থেকে রক্ত পড়া, দুর্গন্ধ, ঘ্রাণশক্তি কমে যাওয়া, মুখের দুর্গন্ধ, মুখের ব্যথা, অস্বস্তি বা ঘুমের সমস্যা—এগুলোর মধ্যে কোনোটির ইতিহাসও দেননি। রোগীর বাবা-মা মনে করতে পারছিলেন, যখন তাদের ছেলে সাত বছর বয়সী ছিল, তখন সে নাকের মধ্যে একটি বস্তু ঢুকিয়েছিল। তারা ডাক্তারের পরামর্শ নিয়েছিলেন, যেখানে কোনো ইমেজিং করা হয়নি এবং রোগ নির্ণয়ের জন্য একটি অ্যানটেরিয়র রাইনোস্কোপি ব্যবহার করা হয়েছিল। কিন্তু পরীক্ষার সময় শিশুটির অসহযোগিতার কারণে, চিকিৎসক ঘুম পাড়িয়ে দিয়ে সেই বস্তুটি সরিয়ে ফেলার পরামর্শ দেন। তবে, পরিবারটি সেই পরামর্শ অনুসরণ করেনি এবং যেহেতু শিশুটির কোনো উপসর্গ ছিল না, তাই তারা ধরে নিয়েছিল যে বস্তুটা আপনাআপনি নাক থেকে পড়ে গেছে। ডান নাকের গহ্বরের এন্ডোস্কোপিক পরীক্ষায়, একটি বাঁকা নাসারন্ধ্র এবং নিচের টার্বিনেটের অতিরিক্ত বৃদ্ধি দেখা যায়। শ্লেষ্মা ঝিল্লি লালচে এবং সামান্য ফোলা দেখাচ্ছিল। একটি বিদেশি বস্তু দেখা যায়, যা নাকের গহ্বরের নিচের টার্বিনেটের নিচে লেগে ছিল। বস্তুটির কিছু অংশ শ্লেষ্মা এবং সম্ভবত কিছু শুকনো পদার্থ দিয়ে ঢাকা ছিল এবং এটি চকচকে দেখাচ্ছিল, যা নির্দেশ করে যে এটি ধাতব। ল্যাটারাল এবং ফ্রন্টাল এক্স-রেসহ রেডিওগ্রাফিক মূল্যায়নে একটি বৃত্তাকার রেডিওopaque বস্তু দেখা যায়, যা নাকের গহ্বরের নিচের দিকে অবস্থিত একটি ধাতব স্ন্যাপ বাটনের সাথে সামঞ্জস্যপূর্ণ। আশেপাশের হাড়ের গঠন স্বাভাবিক দেখাচ্ছিল। একটি সিবিসিটি পরীক্ষায় হালকা প্রদাহের সাথে বিদেশি বস্তুর উপস্থিতি নিশ্চিত করা হয়, তবে উল্লেখযোগ্য হাড়ের ক্ষতি বা সাইনাসের কোনো সমস্যা দেখা যায়নি। রোগীর বাবা-মায়ের কাছ থেকে সম্মতি নিয়ে, স্থানীয় অ্যানেস্থেসিয়ার মাধ্যমে একটি আধা-বসা অবস্থানে বিদেশি বস্তুটিকে সরানো হয়, যাতে শ্বাসনালীতে এটি সরে যাওয়ার ঝুঁকি কমানো যায়। জাইলোমেটাজোলিন ০.১% দিয়ে নাকের গহ্বর পরিষ্কার করার পরে এবং ডান নাকের ছিদ্রে লিডোকেন স্প্রে (১০ মিগ্রা/স্প্রে) দেওয়ার পরে, একটি হুক ব্যবহার করে বিদেশি বস্তুটি আলগা করা হয় এবং পরে বানেট ফোরসেপস দিয়ে সেটি বের করা হয়। পদ্ধতিটি জটিল ছিল না এবং সামান্য রক্তপাত হয়েছিল, যা স্যালাইন দিয়ে ধুয়ে সহজেই নিয়ন্ত্রণ করা যায়। অপসারণের পরে পরীক্ষায় উল্লেখযোগ্য কোনো টিস্যুর ক্ষতি দেখা যায়নি। যে বস্তুটিকে সরানো হয়েছিল, সেটি ছিল ১ সেন্টিমিটার ব্যাসের একটি ধাতব স্ন্যাপ বাটন, যার মধ্যে দীর্ঘমেয়াদী ব্যবহারের চিহ্ন, যেমন—উল্লেখযোগ্য ক্ষয় এবং জৈবিক অবক্ষেপ দেখা যায়। রোগীকে স্থিতিশীল অবস্থায় ছেড়ে দেওয়া হয় এবং ০.৯% সোডিয়াম ক্লোরাইড দ্রবণ দিয়ে নাকের গহ্বর পরিষ্কার করার পরামর্শ দেওয়া হয়। দুই সপ্তাহ পর ফলো-আপে দেখা যায়, রোগীর অবস্থা ভালো আছে এবং পরীক্ষায় তেমন কোনো অস্বাভাবিকতা ধরা পড়েনি।",
+    "translated_summary": "আমরা একজন ১৭ বছর বয়সী পুরুষের ঘটনা উপস্থাপন করছি, যার কোনো উপসর্গ ছিল না, কিন্তু রুটিন ডেন্টাল রেডিওগ্রাফির সময় একটি এনএফবি (NFB) পাওয়া যায়। রোগী নাক বন্ধ, নাক থেকে রক্তপাত বা অস্বস্তির কোনো পূর্ব ইতিহাস অস্বীকার করেছেন। ইমেজিং-এ নাকের ডান দিকে একটি রেডিওopaque বস্তু দেখা যায়, যা পরে একটি ধাতব স্ন্যাপ বোতাম হিসেবে শনাক্ত করা হয় এবং এটি নাকের গহ্বরের তলায় আটকে ছিল। সম্ভবত, এই বিদেশি বস্তুটি এক দশকের বেশি সময় ধরে সেখানে ছিল।",
+    "corrected_translated_fulltext": "সতেরো বছর বয়সী একজন যুবক, যার পূর্বে তেমন কোনো উল্লেখযোগ্য স্বাস্থ্যগত সমস্যা বা পারিবারিক ইতিহাস নেই, তাকে আমাদের ক্লিনিকে ডেন্টাল বিভাগ থেকে রেফার করা হয়েছিল। এর কারণ হলো, প্রাক-সার্জিক্যাল অর্থোডন্টিক পরিকল্পনার সময়, যার মধ্যে ডেন্টাল এক্স-রে এবং কোণ বিম কম্পিউটেড টমোগ্রাফি (সিবিসিটি) অন্তর্ভুক্ত ছিল (যেখানে কোনো কন্ট্রাস্ট ব্যবহার করা হয়নি), একটি অপ্রত্যাশিতভাবে নাকের মধ্যে একটি বস্তু (এনএফবি) পাওয়া যায়। রোগী কোনো উপসর্গ অনুভব করেননি এবং নাকের পথে বাধা, নাক দিয়ে পানি পড়া, নাক থেকে রক্ত পড়া, দুর্গন্ধ, ঘ্রাণশক্তি কমে যাওয়া, মুখের দুর্গন্ধ, মুখের ব্যথা, অস্বস্তি বা ঘুমের সমস্যা—এগুলোর মধ্যে কোনোটির ইতিহাসও দেননি। রোগীর বাবা-মা মনে করতে পারছিলেন, যখন তাদের ছেলে সাত বছর বয়সী ছিল, তখন সে নাকের মধ্যে একটি বস্তু ঢুকিয়েছিল। তারা ডাক্তারের পরামর্শ নিয়েছিলেন, যেখানে কোনো ইমেজিং করা হয়নি এবং রোগ নির্ণয়ের জন্য একটি অ্যানটেরিয়র রাইনোস্কোপি ব্যবহার করা হয়েছিল। কিন্তু পরীক্ষার সময় শিশুটির অসহযোগিতার কারণে, চিকিৎসক ঘুম পাড়িয়ে দিয়ে সেই বস্তুটি সরিয়ে ফেলার পরামর্শ দেন। তবে, পরিবারটি সেই পরামর্শ অনুসরণ করেনি এবং যেহেতু শিশুটির কোনো উপসর্গ ছিল না, তাই তারা ধরে নিয়েছিল যে বস্তুটা আপনাআপনি নাক থেকে পড়ে গেছে। ডান নাকের গহ্বরের এন্ডোস্কোপিক পরীক্ষায়, একটি বাঁকা নাসারন্ধ্র এবং নিচের টার্বিনেটের অতিরিক্ত বৃদ্ধি দেখা যায়। শ্লেষ্মা ঝিল্লি লালচে এবং সামান্য ফোলা দেখাচ্ছিল। একটি বিদেশি বস্তু দেখা যায়, যা নাকের গহ্বরের নিচের টার্বিনেটের নিচে লেগে ছিল। বস্তুটির কিছু অংশ শ্লেষ্মা এবং সম্ভবত কিছু শুকনো পদার্থ দিয়ে ঢাকা ছিল এবং এটি চকচকে দেখাচ্ছিল, যা নির্দেশ করে যে এটি ধাতব। ল্যাটারাল এবং ফ্রন্টাল এক্স-রেসহ রেডিওগ্রাফিক মূল্যায়নে একটি বৃত্তাকার radiopaque বস্তু দেখা যায়, যা নাকের গহ্বরের নিচের দিকে অবস্থিত একটি ধাতব স্ন্যাপ বাটনের সাথে সামঞ্জস্যপূর্ণ। আশেপাশের হাড়ের গঠন স্বাভাবিক দেখাচ্ছিল। একটি সিবিসিটি পরীক্ষায় হালকা প্রদাহের সাথে বিদেশি বস্তুর উপস্থিতি নিশ্চিত করা হয়, তবে উল্লেখযোগ্য হাড়ের ক্ষতি বা সাইনাসের কোনো সমস্যা দেখা যায়নি। রোগীর বাবা-মায়ের কাছ থেকে সম্মতি নিয়ে, স্থানীয় অ্যানেস্থেসিয়ার মাধ্যমে একটি আধা-বসা অবস্থানে বিদেশি বস্তুটিকে সরানো হয়, যাতে শ্বাসনালীতে এটি সরে যাওয়ার ঝুঁকি কমানো যায়। জাইলোমেটাজোলিন ০.১% দিয়ে নাকের গহ্বর পরিষ্কার করার পরে এবং ডান নাকের ছিদ্রে লিডোকেন স্প্রে (১০ মিগ্রা/স্প্রে) দেওয়ার পরে, একটি হুক ব্যবহার করে বিদেশি বস্তুটি আলগা করা হয় এবং পরে বানেট ফোরসেপস দিয়ে সেটি বের করা হয়। পদ্ধতিটি জটিল ছিল না এবং সামান্য রক্তপাত হয়েছিল, যা স্যালাইন দিয়ে ধুয়ে সহজেই নিয়ন্ত্রণ করা যায়। অপসারণের পরে পরীক্ষায় উল্লেখযোগ্য কোনো টিস্যুর ক্ষতি দেখা যায়নি। যে বস্তুটিকে সরানো হয়েছিল, সেটি ছিল ১ সেন্টিমিটার ব্যাসের একটি ধাতব স্ন্যাপ বাটন, যার মধ্যে দীর্ঘমেয়াদী ব্যবহারের চিহ্ন, যেমন—উল্লেখযোগ্য ক্ষয় এবং জৈবিক অবক্ষেপ দেখা যায়। রোগীকে স্থিতিশীল অবস্থায় ছেড়ে দেওয়া হয় এবং ০.৯% সোডিয়াম ক্লোরাইড দ্রবণ দিয়ে নাকের গহ্বর পরিষ্কার করার পরামর্শ দেওয়া হয়। দুই সপ্তাহ পর ফলো-আপে দেখা যায়, রোগীর অবস্থা ভালো আছে এবং পরীক্ষায় তেমন কোনো অস্বাভাবিকতা ধরা পড়েনি।",
+    "corrected_translated_summary": "আমরা একজন ১৭ বছর বয়সী পুরুষের ঘটনা উপস্থাপন করছি, যার কোনো উপসর্গ ছিল না, কিন্তু রুটিন ডেন্টাল রেডিওগ্রাফির সময় একটি এনএফবি (NFB) পাওয়া যায়। রোগী নাক বন্ধ, নাক থেকে রক্তপাত বা অস্বস্তির কোনো পূর্ব ইতিহাস অস্বীকার করেছেন। ইমেজিং-এ নাকের ডান দিকে একটি radiopaque বস্তু দেখা যায়, যা পরে একটি ধাতব স্ন্যাপ বোতাম হিসেবে শনাক্ত করা হয় এবং এটি নাকের গহ্বরের তলায় আটকে ছিল। সম্ভবত, এই বিদেশি বস্তুটি এক দশকের বেশি সময় ধরে সেখানে ছিল।"
+  },
+  {
+    "id": "multiclinsum_gs_en_293.txt",
+    "fulltext": "An 18-year-old hispanic male patient with no significant medical history presents to the emergency department (ED) complaining of substernal, non-radiated chest pain, orthopnoea, dry and non-productive cough, and subjective fevers at home, for the last 3–4 days. Family history remarkable for paternal grandfather diagnosed with non-ischaemic cardiomyopathy and a pacemaker at age 86 years old. Patient lives with both parents and denies any smoking, ethanol consumption, recreational drug use, abuse or neglect at home. He worked at auto-part shop and planned to start college soon.\n\n\nInvestigations\n\n\nIn the ED, serum troponin I levels were found to be elevated and ECG showed diffuse ST-segment elevation. He was admitted to the local hospital and initial workup was remarkable for an enlarged cardiac silhouette and mild pulmonary oedema observed on chest X-ray, a transthoracic echocardiogram (TTE) demonstrating left ventricular ejection fraction (LVEF) of 40%, with severe left ventricular (LV) concentric hypertrophy and mild posterior pericardial effusion. Additionally, the patient was found to have elevated titres for Coxsackie virus A and B. His symptoms initially improved with the initiation of ibuprofen and colchicine. Cardiac catheterisation was performed, which revealed no evidence of coronary artery disease. Repeat TTE showed an LVEF of 40%–45%, hypokinesis of anteroapical and inferolateral wall, with an elevated LV end-diastolic pressure, consistent with diastolic dysfunction. Chest CT angiogram showed evidence of pneumonitis and a pericardial effusion. And at this point, the constellation of symptoms was thought to be secondary to Coxsackie myopericarditis, for which he continued to receive medical treatment as previously mentioned.\n\nOn the fourth day of admission, the patient became diaphoretic, tachycardic and hypotensive with an undetectable blood pressure. Emergent TTE showed large pericardial effusion with impending cardiac tamponade features, and pericardiocentesis was performed. During the procedure, the patient developed pulseless electrical activity (PEA) cardiac arrest and received advanced cardiovascular support for 30 min. Ultimately patient was intubated, placed on venous-arterial extracorporeal membrane oxygenation (VA ECMO) and started on vasopressor support (norepinephrine 5 mcg/min and vasopressin 0.05 units/min), with numerous transfusions (9 packed red bloodcells, 10 units of platelets, 10 units of cryoprecipitate and 4 units of fresh frozen plasma) due to significant oozing of blood from the ECMO cannula. He was transferred to our hospital where endomyocardial biopsy (EMB) was then obtained due to concern of fulminant myocarditis and to test for other infiltrative cardiomyopathies. Pathology reports showed no signs suggestive of inflammatory or infiltrative process in the endomyocardium. Coxsackie Abs were repeated and were positive for Cox A type 9, Coxsackie B2 and Coxsackie B6, and an elevated Epstein-Barr virus (EBV) DNA quantitative PCR at 133 000 IU/mL. At this point, another TTE was done, which showed a severely decreased ejection fraction (EF) of 10%–15% with previously noted severe LV concentric hypertrophy (1.9 cm septum and 2.2 cm in the inferolateral wall).\n\nThe patient was started on intravenous immunoglobulin (IVIG) for treatment of Coxsackie myocarditis, and broad-spectrum antibiotics due to worsening leucocytosis, but with no identified infectious focus. Colchicine was discontinued due to concern for rhabdomyolysis, with elevation of serum creatine kinase level to 2874 unit/L. Vasopressors were then discontinued and the patient was extubated. He also developed episode of flushing, fever, dyspnoea and decreasing oxygen saturation, with chest X-ray showing congested lung parenchyma with concerns for ARDS, therefore, IVIG was stopped.\n\nGiven improvement of cardiac function in another TTE with LVEF of 25%–30%, it was decided to attempt to remove the ECMO, which was unsuccessful. The patient remained on ECMO support and emergent discussion with heart failure team took place to determine best approach. The patient was evaluated for possible left ventricle assist device, however, deemed not a candidate due to significant global concentric LV hypertrophy, and the multidisciplinary team agreed to facilitate emergency listing for heart transplantation, with consideration to transition to another cardiovascular support such as intra-aortic balloon pump, with potential inotrope support.\n\nDuring further evaluation for possible heart transplant, an incisional biopsy of a 1×1 inch palpable, painless, rubbery, mobile mass in the right arm was done and sent for pathology. The patient mentioned he first noticed this lesion approximately 2–3 months before presenting to the ED. Pathology report of the right upper extremity mass showed aggressive EBV (+) NK/T-cell lymphoma with a cytotoxic immunophenotype (positive for CD 2, CD3, CD56, BCL2, granzyme B, TIA1, MUM1 and diffuse coexpression of Epstein-Barr virus-encoded small RNAs by in situ hybridisation), and a modified SMILE (Steroids, Methotrexate with leucovorin, Ifosfamide with mesna, L-asparaginase and Etoposide) chemotherapy regimen was started. In situ hybridisation of the EMB previously obtained were negative for EBV-RNA.\n\nCardiac MRI was obtained, which revealed hypokinesis of the inferolateral and anterolateral wall, as previously described by TTE, delayed enhancement in the subendocardial and transmural distribution in these regions, with relative sparing of the septum. Additionally, avid enhancement and thickening of the pericardium, without a mass identified, and a pocket of pericardial fluid with septations, concerning for loculations, were also noted.\n\n\nDifferential diagnosis\n\nThe constellation of symptoms (shortness of breath, orthopnoea, hypotension and subjective fevers), with findings such as diffuse ST-segment elevation on ECG, leakages of cardiac markers (troponin), elevated Coxsackie virus titres (both of serotype A and B), as well as echocardiographic findings of pericardial effusion; all seemed to correlate with a classic presentation of viral pericarditis clinical due to Coxackie virus. However, despite medical treatment with colchicine, the patient continued to decompensate and eventually required pericardiocentesis due to cardiac tamponade, then developed cardiac arrest and ultimately requires ECMO support, for what seems acute onset heart failure. In this setting, fulminant myocarditis secondary to Coxsackie virus was considered. Cardiotropic RNA virus, such as Coxackie viruses, induce receptor-mediated endocytosis, with viral replication contributing to cellular dysfunction and ultimately apoptosis of the cell.1 When susceptible individuals are infected with highly virulent viral strains, maladaptive immunologic activity can occur, leading to persistent activation of T cells and continued antibody-mediated myocyte destruction, which can ultimately lead to fulminant myocarditis. EBV myocarditis could also explain the rapid deterioration in the setting of a positive EBV PCR, which is a more sensitivity test than traditional serologies for detection of acute infection.2 However, in situ hybridisation was negative for EBV-RNA.\n\nNevertheless, the significant concentric hypertrophy observed on the initial TTEs and the atypical delayed enhancement observed on the cardiac MRI are not explained by this diagnosis. Additionally, the EMB did not show an inflammatory process.\n\nFortuitous finding of EBV (+) NK/T-cell lymphoma by incisional biopsy of the right upper extremity allowed for a more fitting diagnosis for this case. The pericardial effusion, unresponsive to initial medical treatment and new acute heart failure with concentric hypertrophic cardiomyopathy, in the setting of newly diagnosed NK/T-cell lymphoma, raises the possibility of NK/T-cell lymphoma with involvement of the myocardium and pericardium as the most adequate diagnosis in this scenario, which englobes all the features previously mentioned in this case.\n\nOther differentials taken into consideration include infiltrative cardiomyopathy such as amyloidosis. However, Congo red staining of the EMB samples failed to demonstrate deposition of amyloid.\n\n\nTreatment\n\nGiven the diagnosis of extranodal NK/T-cell lymphoma (ENKTCL) with suspected pericardial involvement and no bone marrow involvement, modified SMILE regimen was desired as the first-line chemotherapy regimen. This regimen includes dexamethasone, ifosfamide, mesna and etoposide, and excluded methotrexate, due to evidence of third-spacing and effusions, which could lead to delayed excretion and increased risk of toxicity.\n\nHowever, due to his compromised cardiac function, it was believed that the patient would not tolerate cytotoxic chemotherapy which requires aggressive intravenous, and alternatively, emergent chemotherapy regimen was instituted: carboplatin (day 1–day 3), etoposide (day 1–day 5) and dexamethasone. Peg-asparaginase was later introduced in the regimen (day 7–day 21). This regimen proved effective, as evidenced by rapid recovery of the LV function and overall haemodynamic stability, and decision was made to incorporate a modified SMILE chemotherapy regimen, of which he received two cycles. Then chemotherapy regimen was changed to dexamethasone, gemcitabine, carboplatin and peg-asparaginase (DDGP). The patient received two cycles of DDGP. A full body positron emission tomography (PET) scan was negative for lymphoma. The plan is to continue two more cycles of chemotherapy (to complete six total cycles of chemotherapy). Currently, the patient is considering radiation therapy and possible stem cell transplant, after completion of the chemotherapy regimen. Additionally, the patient is currently on guideline-directed medical therapy for heart failure and has completed cardiac rehabilitation.\n\n\nOutcome and follow-up\n\nThe patient has completed five out of six chemotherapy sessions with the previously mentioned regimens. After initiation of chemotherapy and optimal medical treatment for heart failure, the patient has recovered much of his cardiac function, as evidenced by an LVEF of 55%, no wall motion abnormalities and normal myocardial wall thickness on his most recent TTE. He continues to be followed by heart failure/cardiology team and oncology team in clinic.",
+    "summary": "An 18-year-old male patient presented to the emergency department complaining of new onset chest pain, fever and orthopnoea. Initial workup was remarkable for elevated troponin, diffuse ST-segment elevation on ECG and chest X-ray with enlarged cardiac silhouette. Transthoracic echocardiogram (TTE) demonstrates severe biventricular concentric hypertrophy and pericardial effusion. Also, Coxsackie virus A and B titres were positive, concerning for a classic viral pericarditis. However, despite medical management, the patient became dyspnoeic and hypotensive. Impending cardiac tamponade was observed on repeat TTE, and pericardiocentesis was performed, complicated by pulseless electrical activity cardiac arrest, and ultimately patient requiring venoarterial extracorporeal membrane oxygenation support. Emergent endomyocardial biopsy showed no inflammatory process, and a skin biopsy of a small lesion in the right arm showed unexpected diagnosis of Epstein-Barr virus (+) natural killer/T-cell lymphoma. On initiation of chemotherapy, clinical improvement was observed as evidenced by improving ejection fraction, resolution of pericardial effusion and gradual decrease in myocardial hypertrophy.",
+    "translated_fulltext": null,
+    "translated_summary": "একজন ১৮ বছর বয়সী পুরুষ রোগী জরুরি বিভাগে এসে নতুন করে বুকে ব্যথা, জ্বর এবং শ্বাসকষ্টের কথা জানান। প্রাথমিক পরীক্ষায় দেখা যায় তার ট্রোপোনিনের মাত্রা বেশি, ইসিজিতে এসটি সেগমেন্টের ব্যাপক পরিবর্তন এবং বুকের এক্স-রেতে হৃদপিণ্ডের আকার বড় দেখা যায়। ট্রান্সথোরাসিক ইকোকার্ডিওগ্রাম (টিটিই)-এ গুরুতর বাইভেন্ট্রিকুলার কনসেন্ট্রিক হাইপারট্রফি এবং পেরিকার্ডিয়াল ইফিউশন দেখা যায়। এছাড়াও, কক্সস্যাকি ভাইরাস এ এবং বি-এর অ্যান্টিবডি পজিটিভ পাওয়া যায়, যা একটি ক্লাসিক ভাইরাল পেরিকার্ডাইটিসের ইঙ্গিত দেয়। তবে, চিকিৎসার পরেও রোগীর শ্বাসকষ্ট এবং রক্তচাপ কমে যায়। পুনরায় টিটিই করার সময় দেখা যায় যে কার্ডিয়াক ট্যাম্পোনেড হওয়ার সম্ভাবনা রয়েছে, তাই পেরিকার্ডিওসেন্টেসিস করা হয়। এর ফলে পালসলেস ইলেকট্রিক্যাল অ্যাক্টিভিটি কার্ডিয়াক অ্যারেস্ট হয় এবং শেষ পর্যন্ত রোগীকে ভেনোআর্টেরিয়াল এক্সট্রাকর্পোরিয়াল মেমব্রেন অক্সিজেনেশন সাপোর্টের প্রয়োজন হয়। জরুরি ভিত্তিতে এন্ডোমায়োকার্ডিয়াল বায়োপসি করে দেখা যায় যে সেখানে কোনো প্রদাহ নেই। রোগীর ডান হাতের ছোট একটি ক্ষত থেকে নেওয়া ত্বকের বায়োপসিতে অপ্রত্যাশিতভাবে এপস্টাইন-বার ভাইরাস (+) ন্যাচারাল কিলার/টি-সেল লিম্ফোমার উপস্থিতি ধরা পড়ে। কেমোথেরাপি শুরু করার পর রোগীর অবস্থার উন্নতি দেখা যায়, যেমন—ইজেকশন ফ্র্যাকশনের উন্নতি, পেরিকার্ডিয়াল ইফিউশন হ্রাস এবং মায়োকার্ডিয়াল হাইপারট্রফির ধীরে ধীরে হ্রাস।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "একজন ১৮ বছর বয়সী পুরুষ রোগী জরুরি বিভাগে এসে নতুন করে বুকে ব্যথা, জ्वर এবং শ্বাসকষ্টের কথা জানান। প্রাথমিক পরীক্ষায় দেখা যায় তার ট্রোপোনিনের মাত্রা বেশি, ইসিজিতে এসটি সেগমেন্টের ব্যাপক পরিবর্তন এবং বুকের এক্স-রেতে হৃদপিণ্ডের আকার বড় দেখা যায়। ট্রান্সথোরাসিক ইকোকার্ডিওগ্রাম (টিটিই)-এ গুরুতর বাইভেন্ট্রিকুলার কনসেন্ট্রিক হাইপারট্রফি এবং পেরিকার্ডিয়াল ইফিউশন দেখা যায়। এছাড়াও, কক্সস্যাকি ভাইরাস এ এবং বি-এর অ্যান্টিবডি পজিটিভ পাওয়া যায়, যা একটি ক্লাসিক ভাইরাল পেরিকার্ডাইটিসের ইঙ্গিত দেয়। তবে, চিকিৎসার পরেও রোগীর শ্বাসকষ্ট এবং রক্তচাপ কমে যায়। পুনরায় টিটিই করার সময় দেখা যায় যে কার্ডিয়াক ট্যাম্পোনেড হওয়ার সম্ভাবনা রয়েছে, তাই পেরিকার্ডিওসেন্টেসিস করা হয়। এর ফলে পালসলেস ইলেকট্রিক্যাল অ্যাক্টিভিটি কার্ডিয়াক অ্যারেস্ট হয় এবং শেষ পর্যন্ত রোগীকে ভেনোআর্টেরিয়াল এক্সট্রাকর্পোরিয়াল মেমব্রেন অক্সিজেনেশন সাপোর্টের প্রয়োজন হয়। জরুরি ভিত্তিতে এন্ডোমায়োকার্ডিয়াল বায়োপসি করে দেখা যায় যে সেখানে কোনো প্রদাহ নেই। রোগীর ডান হাতের ছোট একটি ক্ষত থেকে নেওয়া ত্বকের বায়োপসিতে অপ্রত্যাশিতভাবে এপস্টাইন-বার ভাইরাস (+) ন্যাচারাল কিলার/টি-সেল লিম্ফোমার উপস্থিতি ধরা পড়ে। কেমোথেরাপি শুরু করার পর রোগীর অবস্থার উন্নতি দেখা যায়, যেমন—ইজেকশন ফ্র্যাকশনের উন্নতি, পেরিকার্ডিয়াল ইফিউশন হ্রাস এবং মায়োকার্ডিয়াল হাইপারট্রফির ধীরে ধীরে হ্রাস।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0002_0003.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0002_0003.json
new file mode 100644
index 0000000000000000000000000000000000000000..4bd3365a8592ae392b7534a97cb6c80dbed2aefc
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0002_0003.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_27.txt",
+    "fulltext": "A 20-year-old woman was followed up since the age of eight for idiopathic NS inaugurated by cerebral venous thrombosis extended to the right jugular vein with a massive pulmonary embolism. The patient did not have any sequelae. She had no other medical or surgical history. A family history of thrombosis has not been reported. The patient was not biopsied because she had no kidney failure nor gross hematuria, or hypertension at first presentation; added to that, she had no extra renal signs suggestive of a secondary nephrotic syndrome. She was accordingly put on anticoagulant therapy (Oral vitamin K antagonist) and oral corticosteroid therapy with good evolution. Thereafter, the patient received several cures of high-dose corticosteroids for steroid-dependent relapses of NS. She was, hence, put on mycophenolate mofetil (MMF) as a background therapy to avoid corticosteroids and ensure normal growth. An exhaustive assessment of thrombophilia was performed and did not show any abnormality. Homocysteine rate, blood fibrinogen rate, Protein C, protein S, antithrombin III, factor V Leiden mutation, JAK-2 mutation, cryoglobulins, anticardiolipin antibodies, lupus anticoagulant and beta-1-glycoprotein antibodies were normal. The anticoagulant treatment was stopped after nine years. The evolution was enameled by the occurrence of several relapses of her disease controlled by oral corticosteroid therapy. Remission of NS has been noted since 2017, so MMF was gradually stopped in 2019 and the patient remained asymptomatic and without any relapse.\n\nOne year later, the patient came up to our emergency department for acute intense diffuse abdominal pain without any particular irradiation associated with postprandial vomiting and bilateral lower limb edema for the last six hours. The physical examination revealed an intense epigastric tenderness with normal vital signs (arterial pressure of 120/70 mm Hg, heart rate of 83 bpm, and oxygen saturation at 100% on room air). The patient was afebrile with normal consciousness. The rest of the physical examination was unremarkable. The urinalysis with labstix revealed proteinuria. The hemogasanalysis results showed metabolic acidosis with respiratory compensation. Further laboratory tests revealed hypoalbuminemia, hypercholesterolemia, a prothrombin time at 90%, high levels of D-dimer, lactate dehydrogenase, and creatine phosphokinase as well as a biological inflammatory syndrome with a CRP of 37 mg/L, and leucocytosis at 26.4 x 103/µL. Renal and liver functions were normal.\n\nThe patient was hospitalized in an intensive care unit with close monitoring of vital signs and initiation of resuscitation measures. An abdominal ultrasound was performed urgently showing an intra-abdominal effusion of low to moderate abundance. An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery with acute mesenteric ischemia. The patient was immediately routed to the operating room. Intraoperative exploration confirmed mesenteric ischemia with extensive necrosis of almost entirely of the small bowel making their resections incompatible with life shown in Figure 3. The patient died after 48 hours.",
+    "summary": "We present the case of a 20-year-old woman with a 12-year history of idiopathic NS revealed by extensive cerebral venous thrombosis with pulmonary embolism treated with anticoagulation therapy and oral corticosteroid therapy followed by mycophenolate mofetil (MMF). The thrombophilia assessment did not show any abnormalities. The evolution was marked by the occurrence of several NS relapses controlled by oral corticosteroid therapy until 2017. Subsequently, the patient had not presented a relapse of her disease. The anticoagulant treatment and the MMF were therefore stopped. One year later, the patient presented with severe diffuse acute abdominal pain associated with postprandial vomiting and bilateral lower limb edema. Laboratory results confirmed a NS relapse. An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery with acute mesenteric ischemia. Intraoperative exploration showed mesenteric ischemia with extensive necrosis of the small intestine making their resections incompatible with life. The patient died after 48 hours.",
+    "translated_fulltext": null,
+    "translated_summary": "हम एक 20 वर्षीय महिला के मामले को प्रस्तुत करते हैं, जिसे 12 वर्षों से अज्ञात कारणों से होने वाला नेफ्रोटिक सिंड्रोम (एनएस) है। इस दौरान, उसके मस्तिष्क की नसों में व्यापक थ्रोम्बोसिस और फुफ्फुसीय एम्बोलिज्म पाया गया, जिसका उपचार एंटीकोआग्यूलेशन थेरेपी और मौखिक कॉर्टिकोस्टेरॉइड थेरेपी से किया गया, जिसके बाद माइकोफेनोलेट मोफेटिल (एमएमएफ) दिया गया। थ्रोम्बोफिलिया मूल्यांकन में कोई असामान्यता नहीं पाई गई। 2017 तक, मौखिक कॉर्टिकोस्टेरॉइड थेरेपी से नियंत्रित कई एनएस रिलेप्स हुए। इसके बाद, रोगी में बीमारी का कोई रिलेप्स नहीं हुआ। इसलिए, एंटीकोआग्यूलेंट उपचार और एमएमएफ बंद कर दिए गए। एक वर्ष बाद, रोगी को गंभीर, व्यापक, तीव्र पेट दर्द हुआ, जिसके साथ भोजन के बाद उल्टी और दोनों निचले अंगों में सूजन भी थी। प्रयोगशाला परिणामों से एनएस रिलेप्स की पुष्टि हुई। पेट के सीटी स्कैन से पता चला कि सुपीरियर मेसेंटेरिक धमनी में तीव्र थ्रोम्बोसिस और तीव्र मेसेंटेरिक इस्किमिया है। इंट्राऑपरेटिव जांच में मेसेंटेरिक इस्किमिया और छोटी आंत के व्यापक नेक्रोसिस का पता चला, जिससे उनका पुन: सर्जिकल निष्कासन जीवन के अनुकूल नहीं था। 48 घंटे बाद रोगी की मृत्यु हो गई।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা ২০ বছর বয়সী এক মহিলার একটি কেস উপস্থাপন করছি, যিনি ১২ বছর ধরে অজ্ঞাত কারণজনিত নেফ্রোটিক সিন্ড্রোম (NS)-এ ভুগছেন। এই সময়ে, তার মস্তিষ্কের শিরায় ব্যাপক থ্রম্বোসিস এবং pulmonary embolism ধরা পড়ে, যার চিকিৎসা anticoagulation therapy এবং oral corticosteroid therapy দিয়ে করা হয়, এরপর mycophenolate mofetil (MMF) দেওয়া হয়। Thrombophilia মূল্যায়নে কোনো অস্বাভাবিকতা পাওয়া যায়নি। ২০১৭ পর্যন্ত, oral corticosteroid therapy দিয়ে নিয়ন্ত্রিত একাধিক NS relapse হয়েছে। এরপর, রোগীর রোগের কোনো relapse হয়নি। সুতরাং, anticoagulant চিকিৎসা এবং MMF বন্ধ করা হয়। এক বছর পরে, রোগীর গুরুতর, বিস্তৃত, আকস্মিক পেটব্যথা হয়, যার সাথে খাবারের পর বমি এবং উভয় নিম্ন অঙ্গে ফোলা ছিল। ল্যাবরেটরি ফলাফলে NS relapse নিশ্চিত হয়। অ্যাবডোমিনাল CT স্ক্যানে superior mesenteric artery-তে acute thrombosis এবং acute mesenteric ischemia ধরা পড়ে। ইন্ট্রাঅপারেটিভ অনুসন্ধানে mesenteric ischemia এবং ক্ষুদ্র অন্ত্রের ব্যাপক necrosis দেখা যায়, যার রিসেকশন জীবনের সাথে সামঞ্জস্যপূর্ণ ছিল না। ৪৮ ঘণ্টা পরে রোগীর মৃত্যু হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_587.txt",
+    "fulltext": "A 22-year-old woman came to the Department of Oral Medicine with complaints of mouth ulcers causing pain and eating and drinking difficulty persisting for a duration of one month. This condition begins with a fever and appears like pimples on the lips. Based on the anamnesis, it was discovered that she had been using pod-type vapes for about a year but had never experienced complaints like when she came for treatment. She had never smoked traditional cigarettes before starting to vape. She said the reason for trying vaping was out of curiosity, and she quite often tried different types of e-liquid with different flavors. Before her complaint, she had simply changed the type of e-liquid to a different flavor without mentioning the brand. She vapes almost every day, but not all day, only in her free time or with friends. She was a healthy individual, and before this condition appeared, she had no history of taking medications, including antibiotics, analgesics, anticonvulsants, non-steroidal anti-inflammatory drugs, and antifungals. She also had no history of drug or food allergies, but the patient has unhealthy eating habits (eating irregularly and not consuming vegetables and fruit). Extraoral examination showed no lesions on other parts of the body, while the lips of the patient had serosanguineous crusts and an erosive area at the corner of the mouth, and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges, irregular, varying sizes, and pain on the labial, buccal, lateral, and ventral mucosa of the tongue and floor of the mouth.\n\nBased on the medical history of the patient and physical examination, which revealed oral mucosal involvement but no symptoms elsewhere in the body, as well as the non-reactive anti-HSV1 IgG results, the diagnosis of vaping-related oral erythema multiforme was established. The medical condition has been classified as minor erythema multiforme. The oral conditions were treated with 0.9% NaCl, which was moistened in gauze and placed on the lips three times a day. The patient was instructed to gargle 1 mg of dexamethasone in 10 mL of hyaluronic acid three times a day and avoid eating or drinking for at least 30 minutes after gargling. She was also given 2% miconazole cream applied to the wound in the right corner of the mouth twice a day, as well as vaseline album cream for dry lips. To maintain good oral hygiene, she was advised to brush her teeth and tongue twice a day, after breakfast and before bed. She was also instructed to stop vaping and avoid foods containing monosodium glutamate (MSG). The control was carried out after a week following therapy and showed that oral condition had improved. Written informed consent for the publication of details was obtained from the patient. This case report conformed with the Helsinki Declaration. The publication of this case report has also been approved by the institution.",
+    "summary": "A 22-year-old woman came to the Oral Medicine Department with complaints of stomatitis causing pain, eating, and drinking difficulty, which started with fever and pimple-like on the lips. She was an active vape user for one year. Extraoral examination revealed no lesions on other body parts. The serosanguinolent crusts on the lips, an erosive area on the labial commissures and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges and irregular, varying sizes in several parts of the oral mucosa. The anti-HSV-1 IgG laboratory results showed non-reactive, leading to a diagnosis of oral erythema multiforme. Management of oral conditions using 0.9% NaCl compress, dexamethasone mouthwash, and hyaluronic acid, applying 2% miconazole cream on labial commissures and vaseline album cream on the dry lips, and stopping vaping. Oral condition improved in a week of therapy.",
+    "translated_fulltext": "22 वर्षीय एक महिला मुंह में छाले होने, दर्द होने और खाने-पीने में कठिनाई होने की शिकायत लेकर मौखिक चिकित्सा विभाग में आई। यह समस्या एक महीने से चल रही थी। यह स्थिति बुखार से शुरू होती है और होठों पर मुंहासों की तरह दिखाई देती है। उसके लक्षणों के आधार पर, पता चला कि वह लगभग एक साल से पॉड-प्रकार के वेप का उपयोग कर रही थी, लेकिन पहले कभी उसे ऐसी कोई समस्या नहीं हुई थी। वेप करना शुरू करने से पहले उसने कभी पारंपरिक सिगरेट नहीं पी थी। उसने बताया कि वेप करने की वजह जिज्ञासा थी, और वह अक्सर अलग-अलग स्वादों वाले अलग-अलग प्रकार के ई-लिक्विड का इस्तेमाल करती थी। अपनी शिकायत से पहले, उसने केवल ई-लिक्विड का प्रकार बदलकर एक अलग स्वाद वाला इस्तेमाल किया था, लेकिन उसने ब्रांड के बारे में कुछ नहीं बताया। वह लगभग हर दिन वेप करती है, लेकिन पूरे दिन नहीं, केवल अपने खाली समय में या दोस्तों के साथ। वह स्वस्थ थी, और इस समस्या के शुरू होने से पहले, उसने कोई भी दवा, जैसे कि एंटीबायोटिक्स, एनाल्जेसिक, एंटीकॉन्वल्सेंट, गैर-स्टेरायडल एंटी-इंफ्लेमेटरी दवाएं और एंटीफंगल दवाएं नहीं ली थीं। उसे दवा या भोजन से एलर्जी भी नहीं थी, लेकिन उसकी खाने की आदतें स्वस्थ नहीं थीं (वह अनियमित रूप से खाती थी और सब्जियां और फल नहीं खाती थी)। बाहरी जांच में शरीर के अन्य हिस्सों में कोई घाव नहीं पाया गया, जबकि मरीज के होठों पर सीरोसैंगुइनस क्रस्ट और मुंह के कोने में एक कटाव वाला क्षेत्र था, और वहां से खून निकलता था। मुंह के अंदर की जांच में पीले किनारों वाले सफेद छाले, अनियमित आकार और अलग-अलग आकार, और जीभ और मुंह के तल की लैबियल, बकल, पार्श्व और वेंट्रल श्लेष्म झिल्ली पर दर्द पाया गया।\n\nमरीज के चिकित्सा इतिहास और शारीरिक जांच के आधार पर, जिसमें मौखिक श्लेष्म झिल्ली में समस्या पाई गई, लेकिन शरीर के अन्य हिस्सों में कोई लक्षण नहीं थे, और एंटी-एचएसवी1 आईजीजी के गैर-प्रतिक्रियाशील परिणाम मिले, यह निदान किया गया कि यह वेप करने से संबंधित मौखिक एरिथेमा मल्टीफॉर्म है। इस चिकित्सा स्थिति को मामूली एरिथेमा मल्टीफॉर्म के रूप में वर्गीकृत किया गया है। मौखिक समस्याओं का इलाज 0.9% सोडियम क्लोराइड से किया गया, जिसे पट्टी में भिगोकर दिन में तीन बार होठों पर लगाया गया। मरीज को 10 मिलीलीटर हाइलूरोनिक एसिड में 1 मिलीग्राम डेक्सामेथासोन से गरारे करने और गरारे करने के बाद कम से कम 30 मिनट तक कुछ भी खाने या पीने से बचने के लिए कहा गया। उसे 2% माइकोनाज़ोल क्रीम भी दी गई, जिसे दिन में दो बार मुंह के दाहिने कोने में घाव पर लगाया जाना था, साथ ही सूखे होठों के लिए वैसलीन एल्बम क्रीम भी दी गई। अच्छी मौखिक स्वच्छता बनाए रखने के लिए, उसे सुबह नाश्ते के बाद और रात को सोने से पहले दिन में दो बार अपने दांतों और जीभ को ब्रश करने के लिए कहा गया। उसे वेप करना बंद करने और मोनोसोडियम ग्लूटामेट (एमएसजी) युक्त खाद्य पदार्थों से बचने के लिए भी कहा गया। एक सप्ताह बाद थेरेपी के बाद जांच की गई, जिससे पता चला कि मौखिक स्थिति में सुधार हुआ है। मरीज से विवरण प्रकाशित करने के लिए लिखित सहमति प्राप्त की गई। यह केस रिपोर्ट हेलसिंकी घोषणा के अनुरूप है। इस केस रिपोर्ट को प्रकाशित करने की अनुमति संस्थान द्वारा भी दी गई है।",
+    "translated_summary": "22 वर्षीय एक महिला मुंह के रोगों के विभाग में इस शिकायत के साथ आई कि उसे मुखशोथ के कारण दर्द, खाने और पीने में कठिनाई हो रही है, जो बुखार और होंठों पर फुंसियों के रूप में शुरू हुआ। वह एक साल से नियमित रूप से वेप का उपयोग कर रही थी। शरीर के अन्य हिस्सों की जांच में कोई घाव नहीं पाया गया। होंठों पर सीरसैंगुइनोलेंट परतें थीं, होंठों के किनारों पर एक क्षरण क्षेत्र था और वहां से खून भी निकल रहा था। मुंह के अंदर की जांच में पीले किनारों और अनियमित, अलग-अलग आकार वाले सफेद घाव पाए गए, जो मुंह की श्लेष्म झिल्ली के कई हिस्सों में थे। एंटी-एचएसवी-1 आईजीजी प्रयोगशाला परिणामों से पता चला कि यह गैर-प्रतिक्रियाशील है, जिससे मौखिक एरिथेमा मल्टीफॉर्मे का निदान किया गया। 0.9% सोडियम क्लोराइड (NaCl) से सिकाई, डेक्सामेथासोन माउथवॉश और हाइलूरोनिक एसिड का उपयोग करके मौखिक स्थितियों का प्रबंधन किया गया, साथ ही होंठों के किनारों पर 2% माइकोनाज़ोल क्रीम और सूखे होंठों पर वैसलीन एल्बम क्रीम लगाई गई, और वेपिंग बंद कर दिया गया। एक सप्ताह के उपचार के बाद मौखिक स्थिति में सुधार हुआ।",
+    "corrected_translated_fulltext": "২২ বছর বয়সী এক নারী মুখে ঘা, ব্যথা এবং খাওয়া-পানিতে অসুবিধার অভিযোগ নিয়ে মৌখিক চিকিৎসা বিভাগে আসেন। এই সমস্যা এক মাস ধরে চলছিল। এই অবস্থা জ্বর দিয়ে শুরু হয় এবং ঠোঁটে ব্রণের মতো দেখা দেয়। তার লক্ষণগুলোর ভিত্তিতে জানা গেল যে তিনি প্রায় এক বছর ধরে pod-type vapes ব্যবহার করছিলেন, তবে আগে কখনও এ রকম কোনো সমস্যা হয়নি। ভেপ করা শুরু করার আগে তিনি কখনও ঐতিহ্যগত সিগারেট ধূমপান করেননি। তিনি জানান যে ভেপ করার কারণ ছিল কৌতূহল, এবং তিনি প্রায়ই ভিন্ন ভিন্ন ফ্লেভারের বিভিন্ন ধরনের e-liquid ব্যবহার করতেন। তার অভিযোগের আগে, তিনি শুধু e-liquid-এর ধরন বদলে ভিন্ন স্বাদেরটি ব্যবহার করেছিলেন, তবে ব্র্যান্ড সম্পর্কে কিছু বলেননি। তিনি প্রায় প্রতিদিন ভেপ করেন, তবে সারাদিন নয়, শুধু অবসর সময়ে বা বন্ধুদের সাথে। তিনি সুস্থ ছিলেন, এবং এই সমস্যা শুরু হওয়ার আগে তিনি কোনো ওষুধ, যেমন antibiotics, analgesics, anticonvulsants, non-steroidal anti-inflammatory drugs, এবং antifungals সেবন করেননি। তার ওষুধ বা খাদ্যে অ্যালার্জিও ছিল না, তবে তার খাদ্যাভ্যাস স্বাস্থ্যসম্মত ছিল না (তিনি অনিয়মিতভাবে খেতেন এবং শাকসবজি ও ফল খেতেন না)। বাহ্যিক পরীক্ষায় শরীরের অন্যান্য অংশে কোনো ক্ষত পাওয়া যায়নি, তবে রোগীর ঠোঁটে serosanguineous crusts এবং মুখের কোণে একটি ক্ষয়যুক্ত এলাকা ছিল, এবং সেখান থেকে রক্ত বের হতো। ইন্ট্রাঅরাল পরীক্ষায় হলদেটে কিনারাযুক্ত সাদা আলসার, অনিয়মিত, বিভিন্ন আকারের, এবং জিহ্বা ও মুখের তলার labial, buccal, lateral এবং ventral mucosa-তে ব্যথা পাওয়া যায়।\n\nরোগীর চিকিৎসা ইতিহাস ও শারীরিক পরীক্ষার ভিত্তিতে, যেখানে মৌখিক শ্লেষ্মা ঝিল্লির সম্পৃক্ততা পাওয়া গিয়েছিল কিন্তু শরীরের অন্য কোথাও কোনো উপসর্গ ছিল না, এবং anti-HSV1 IgG অ-প্রতিক্রিয়াশীল ফলাফল পাওয়া যায়, ভেপিং-সম্পর্কিত oral erythema multiforme হিসেবে নির্ণয় করা হয়। এই চিকিৎসাগত অবস্থাকে minor erythema multiforme হিসেবে শ্রেণিবদ্ধ করা হয়েছে। মৌখিক অবস্থার চিকিৎসা 0.9% NaCl দিয়ে করা হয়, যা গজে ভিজিয়ে দিনে তিনবার ঠোঁটে রাখা হয়। রোগীকে 10 mL hyaluronic acid-এ 1 mg dexamethasone দিয়ে গার্গল করতে এবং গার্গল করার পর অন্তত ৩০ মিনিট কিছু খাওয়া বা পান করা থেকে বিরত থাকতে বলা হয়েছিল। তাঁকে 2% miconazole cream-ও দেওয়া হয়েছিল, যা দিনে দুবার মুখের ডান কোণের ক্ষতে লাগাতে বলা হয়, সঙ্গে শুকনা ঠোঁটের জন্য vaseline album cream দেওয়া হয়। ভাল মৌখিক স্বাস্থ্যবিধি বজায় রাখতে, তাঁকে সকালে নাশতার পরে এবং রাতে শোয়ার আগে দিনে দুবার দাঁত ও জিহ্বা ব্রাশ করতে বলা হয়। তাঁকে ভেপ করা বন্ধ করতে এবং monosodium glutamate (MSG) সমৃদ্ধ খাবার এড়িয়ে চলতেও বলা হয়। থেরাপির এক সপ্তাহ পরে ফলো-আপ করা হয়, যাতে দেখা যায় যে মৌখিক অবস্থার উন্নতি হয়েছে। বিবরণ প্রকাশের জন্য রোগীর কাছ থেকে লিখিত সম্মতি নেওয়া হয়েছে। এই কেস রিপোর্ট হেলসিঙ্কি ঘোষণা অনুযায়ী। এই কেস রিপোর্ট প্রকাশের অনুমতি প্রতিষ্ঠান থেকেও দেওয়া হয়েছে।",
+    "corrected_translated_summary": "২২ বছর বয়সী এক নারী Oral Medicine Department-এ এ ধরনের অভিযোগ নিয়ে আসেন যে stomatitis-এর কারণে ব্যথা, খাওয়া ও পান করতে অসুবিধা হচ্ছে, যা জ্বর এবং ঠোঁটে ফুসকুড়ি-সদৃশ দিয়ে শুরু হয়েছিল। তিনি এক বছর ধরে সক্রিয় vape ব্যবহারকারী ছিলেন। Extraoral পরীক্ষা-নিরীক্ষায় শরীরের অন্য অংশে কোনো lesion পাওয়া যায়নি। ঠোঁটে serosanguinolent crusts ছিল, labial commissures-এ একটি erosive এলাকা ছিল এবং রক্তপাতের প্রবণতা ছিল। Intraoral পরীক্ষা-নিরীক্ষায় মুখগহ্বরের মিউকোসার বিভিন্ন স্থানে হলদেটে প্রান্তসহ অনিয়মিত, ভিন্ন ভিন্ন আকারের সাদা ulcer দেখা যায়। anti-HSV-1 IgG ল্যাবরেটরি ফলাফল non-reactive দেখায়, যার ভিত্তিতে oral erythema multiforme নির্ণয় করা হয়। ব্যবস্থাপনা হিসেবে 0.9% NaCl compress, dexamethasone mouthwash এবং hyaluronic acid ব্যবহার করা হয়, labial commissures-এ 2% miconazole cream এবং শুকনো ঠোঁটে vaseline album cream প্রয়োগ করা হয়, এবং vaping বন্ধ করা হয়। এক সপ্তাহের থেরাপির মধ্যে মৌখিক অবস্থার উন্নতি হয়।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0006_0007.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0006_0007.json
new file mode 100644
index 0000000000000000000000000000000000000000..f0af3cd48b09e5927664de0d876e2cc7fc151355
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0006_0007.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_412.txt",
+    "fulltext": "A 54-year-old male who had a medical history of membranous nephropathy II with nephrotic syndrome was administered with long-term oral glucocorticoids and immunosuppressants. The patient had a 20 pack-year history of smoking, and denied a family history of hereditary diseases. Chest x-ray demonstrated normal findings at one month before admission. On August 8, 2016, the patient was hospitalized for fever accompanied by progressive dyspnea, cough, and expectoration for 5 days. On admission, the BMI of the patient was 24.5 kg/m2, and his body temperature was 39.0°C. Furthermore, the patient had symptoms of tachypnea (35 bpm) and severe hypoxemia (SaO2 86%). On auscultation, the patient had good air entrance bilaterally with scattered diffuse crackles and rhonchi. Furthermore, the chest CT scan revealed multiple ground-glass opacities, and laboratory tests revealed normal white blood cell (WBC) count, but with elevated neutrophil count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and (1→3)-β-D-glucan. The patient was diagnosed as RSV infection on the fourth day of hospitalization when positive RSV-Ab was detected.\n\nOn admission, the patient was immediately given respiratory monitoring and supplemental oxygen to improve the low oxygen saturation, as well as antibiotics (moxifloxacin for 4 days, followed by cefminoxine for 8 days), and antifungal therapy (voriconazole for 10 days). The dose of the glucocorticoids and immunosuppressants remained largely unchanged. After 10 days of treatment, the patient's condition became worse. Chest CT revealed the progression of the disease, and oxygen partial pressure was further decreased. The patient was transferred to the Emergency Intensive Care Unit, where the patient was intensively treated, including noninvasive mechanical ventilation, broad-spectrum antibiotics (i.v. meropenem, oral moxifloxacin, and cotrimoxazole), antifungal therapy (micafungin), corticosteroids (methylprednisolone 40 mg bid iv) to relieve the inflammation, and other supportive treatment. Ganciclovir was also prescribed due to a possibility of viral infection, such as cytomegalovirus. Five days later, the patient's condition was further aggravated based on the chest x-ray evaluation. Despite receiving another round of treatments, including invasive ventilator-assisted ventilation therapy, methylprednisolone (80 mg bid), antibacterial agents (cefoperazone sulbactam, tigecycline, and cotrimoxazole) and antifungal (micafungin) therapy, the patient eventually died after 2 days.",
+    "summary": "Patient concerns:\nA 54-year-old male patient with chronic nephropathy, who received long-term immunosuppressants, was admitted to the Department of Respiratory Medicine due to the symptoms of fever, cough, expectoration, and dyspnea.\n\nDiagnoses:\nPulmonary radiology revealed multiple bilateral ground-glass opacity. Laboratory tests revealed elevated inflammation indicators, implying infection with bacteria, viruses, and/or fungi. Furthermore, the patient was positive for RSV antibodies, without positive results for other pathogens. Moreover, the patient was immunocompromised due to the long-term use of corticosteroids and immunosuppressants, as evidenced by decreased total IgG levels and reduced CD4 and CD8 T-lymphocyte counts.\n\nInterventions and outcome:\nDespite the intensive anti-infection treatment and respiratory support, the patient developed rapid progression, and subsequently died of respiratory failure.",
+    "translated_fulltext": null,
+    "translated_summary": "मरीज की शिकायतें:\n54 वर्षीय पुरुष मरीज, जिन्हें पुरानी नेफ्रोपैथी थी और जिन्हें लंबे समय तक इम्युनोसप्रेसेंट दवाएं दी गई थीं, उन्हें बुखार, खांसी, बलगम और सांस लेने में तकलीफ के लक्षणों के कारण रेस्पिरेटरी मेडिसिन विभाग में भर्ती कराया गया।\n\nनिदान:\nफुफ्फुसीय रेडियोलॉजी में द्विपक्षीय ग्राउंड-ग्लास अपारदर्शिता के कई मामले पाए गए। प्रयोगशाला परीक्षणों में सूजन के उच्च स्तर पाए गए, जिससे बैक्टीरिया, वायरस और/या कवक से संक्रमण का संकेत मिला। इसके अतिरिक्त, मरीज में आर.एस.वी. एंटीबॉडी मौजूद थे, लेकिन अन्य रोगजनकों के लिए कोई सकारात्मक परिणाम नहीं मिला। इसके अलावा, मरीज लंबे समय तक कॉर्टिकोस्टेरॉइड्स और इम्युनोसप्रेसेंट दवाओं के उपयोग के कारण प्रतिरक्षा-दबावग्रस्त थे, जैसा कि कुल आईजीजी स्तर में कमी और सीडी4 और सीडी8 टी-लिम्फोसाइट की संख्या में कमी से पता चलता है।\n\nउपचार और परिणाम:\nगहन एंटी-इंफेक्शन उपचार और श्वसन समर्थन के बावजूद, मरीज की स्थिति तेजी से बिगड़ी और बाद में श्वसन विफलता के कारण उनकी मृत्यु हो गई।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "রোগীর অভিযোগ:\n৫৪ বছর বয়সী পুরুষ রোগী, যার ক্রনিক নেফ্রোপ্যাথি ছিল এবং যিনি দীর্ঘমেয়াদে ইমিউনোসপ্রেস্যান্টস পেয়েছিলেন, তাকে জ্বর, কাশি, কফ নির্গমন এবং শ্বাসকষ্টের উপসর্গের কারণে রেসপিরেটরি মেডিসিন বিভাগে ভর্তি করা হয়।\n\nরোগনির্ণয়:\nপালমোনারি রেডিওলজিতে একাধিক দ্বিপার্শ্বিক গ্রাউন্ড-গ্লাস অপাসিটি দেখা যায়। ল্যাবরেটরি পরীক্ষায় প্রদাহসূচকের মাত্রা বৃদ্ধি পাওয়া যায়, যা ব্যাকটেরিয়া, ভাইরাস এবং/অথবা ছত্রাক সংক্রমণের ইঙ্গিত দেয়। অতিরিক্তভাবে, রোগীর RSV অ্যান্টিবডি পজিটিভ ছিল, তবে অন্যান্য প্যাথোজেনের জন্য কোনো পজিটিভ ফল পাওয়া যায়নি। তদুপরি, রোগী দীর্ঘমেয়াদে corticosteroids এবং immunosuppressants ব্যবহারের কারণে ইমিউনোকমপ্রোমাইজড ছিলেন, যা মোট IgG মাত্রা হ্রাস এবং CD4 ও CD8 T-lymphocyte গণনা কমে যাওয়া দ্বারা প্রমাণিত।\n\nহস্তক্ষেপ ও ফলাফল:\nতীব্র anti-infection চিকিৎসা এবং শ্বাস-সমর্থন সত্ত্বেও, রোগীর অবস্থা দ্রুত অবনতি ঘটে এবং পরবর্তীতে শ্বাসযন্ত্রের ব্যর্থতায় তাঁর মৃত্যু হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_301.txt",
+    "fulltext": "A 34-year-old patient with a disease duration of four weeks. Two months earlier, she had a cesarean section in the 37th week of pregnancy and had persistent bleeding from the surgical wound. She denied a history of bleeding in childhood or adolescence. Three years earlier, she had given birth to her first child (also by cesarean section), who died due to a chromosome disorder (referred to by the patient). She also stated that she was allergic to tramadol.\n\nThe clinical picture began with lower back pain due to bilateral renal lithiasis. Subsequently, he managed to expel a stone and after that he presented haematuria for three days, for which he received tranexamic acid c/12 h. Three weeks later, he presented pain in the lower region of the left thigh that increased in intensity, with hardening of the area. Due to persistence of the symptoms, he was given diclofenac intramuscularly, which caused ecchymosis and bleeding in the gluteal area and persists despite the compression with gauze.\n\nThe patient underwent a particular Doppler ultrasound that revealed deep venous thrombosis of the left lower limb, and went to the hospital in her locality with these results. She was given anticoagulation with enoxaparin 30 mg/24 h subcutaneously, in addition to morphine for pain management and was hospitalized. The next day, she presented epigastralgia, blurred vision, heart rate of 117 beats/min, blood pressure of 113/85 mmHg and saturation of 93%. It was decided to discontinue enoxaparin. The blood count revealed a hemoglobin of 6.4 g/dl, which represented a difference of 4 g/dl from the result one day before admission, which was 10.4 g/dl. Because of the above, two blood transfusions were given. Due to the suspicion of vasculitis, methylprednisolone was indicated and she was referred to our hospital for further study.\n\nOn admission, the physical examination revealed severe pallor, extensive ecchymosis on the left thigh and lateral knee, and a haematoma on the right thigh. The haemogram showed moderate anaemia (Hb = 9.8 g/dl), normocytic and normochromic. The biochemical examination showed glucose values of 160 mg/dl. The liver enzymes AST and ALT were at 52 U/L and 86 U/L, respectively. The coagulation profile showed a prolonged activated partial thromboplastin time (APTT) of 91.2 s. The rest of the haemogram, biochemical, electrolyte, liver profile and coagulation profile were normal. The ultrasound of soft parts of the right gluteal region revealed a collection at the level of the subcutaneous cellular tissue (TCSC) and oedema up to the upper third of the thigh. The Doppler ultrasound in the left lower limb showed adequate flowometry without signs of thrombosis in the common femoral vein, superficial and deep.\n\nSymptomatic treatment was initiated and blood and urine cultures were requested and were negative. Antinuclear antibody (ANA) values, complement C3 and C4 and ferritin were within the reference range.\n\nIn the face of suspected acquired haemophilia, studies were requested for confirmation, where a partial correction of aPTT was found in the mixing test. Factor VIII was measured and its activity was found to be decreased (<1.0 U/dl) and the presence of a factor VIII inhibitor was demonstrated: 8.64 Bethesda units/ml. The above allowed the diagnosis of acquired haemophilia to be confirmed, which was related to the postpartum period due to the onset of symptoms.\n\nPrednisone 50 mg orally at breakfast and 10 mg orally at lunch, cyclophosphamide 50 mg 2 tablets orally every 24 hours and anti-inhibitor coagulant complex for haemophilia (FEIBA) were initiated. Five days later, the latter was discontinued due to chest tightness, dyspnoea and nausea (possible adverse drug reaction) and replaced with activated recombinant factor VII (NovoSeven).\n\nThe patient's clinical evolution was favorable, with a decrease in ecchymosis and no other symptoms, so she was discharged from the hospital.\n",
+    "summary": "A 34-year-old female patient presented with lower back pain, haematuria and a haematoma in the right gluteal region, with no previous history of bleeding. Due to the extent of the haemorrhagic manifestations, she was transferred to the emergency department. The coagulation profile, mixing test and measurement of the factor VIII inhibitor titres confirmed the diagnosis.\n",
+    "translated_fulltext": null,
+    "translated_summary": "34 वर्षीय एक महिला रोगी पीठ के निचले हिस्से में दर्द, मूत्र में रक्त और दाहिनी ग्लूटियल क्षेत्र में रक्त जमा होने की शिकायत के साथ आई, और पहले कभी रक्तस्राव का कोई इतिहास नहीं था। रक्तस्राव की गंभीरता को देखते हुए, उसे आपातकालीन विभाग में स्थानांतरित कर दिया गया। जमावट प्रोफाइल, मिश्रण परीक्षण और फैक्टर VIII अवरोधक के स्तर के माप से निदान की पुष्टि हुई।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "34 বছর বয়সী এক নারী রোগী কোমরের নিচের অংশে ব্যথা, haematuria এবং ডানপাশের gluteal region-এ একটি haematoma নিয়ে উপস্থিত হন, এবং পূর্বে রক্তক্ষরণের কোনো ইতিহাস ছিল না। রক্তক্ষরণজনিত প্রকাশের ব্যাপকতার কারণে, তাকে জরুরি বিভাগে স্থানান্তর করা হয়। Coagulation profile, mixing test এবং factor VIII inhibitor titres-এর পরিমাপ দ্বারা রোগনির্ণয় নিশ্চিত হয়।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0008_0009.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0008_0009.json
new file mode 100644
index 0000000000000000000000000000000000000000..9b145f32346db92878e49b5e3e968d8eeee2153c
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0008_0009.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_289.txt",
+    "fulltext": "4-year-old male patient with a history of nasal impetigo two weeks before admission (treated with topical mupirocin and oral cefadroxil; dose, duration and adherence to treatment unknown), with no other morbid history, who presented macroscopic glomerular haematuria associated with oedema of the lower extremities of 5 days' evolution, with the last 12 hours prior to the consultation adding headaches, nausea and vomiting. He went to the emergency department (ED) in convulsive status, after 20 minutes of generalised tonic-clonic convulsions.\n\nOn admission to the ED, the patient was afebrile, with non-evaluable blood pressure, with quantitative consciousness impairment associated with generalized hypertonia and bilateral and pretibial oedema. Endotracheal intubation was decided and phenobarbital (10 mg/kg) was administered to manage the convulsive status.\n\nOn physical examination in the intensive care unit (ICU), blood pressure was 134/94 mmHg (BP 110 mmHg) (p95 for patient 108/66 mmHg, p95+12 120/78 mmHg).\n\nInitial laboratory parameters included: complete urine with haematuria (> 100 erythrocytes per field), proteinuria 3+ and leucocyturia 10-25 per field, creatinemia 0.3 mg/dL, anaemia with haematocrit (HTO) 21%, haemoglobin (Hb) 7 g/dL, with normal mean corpuscular volume (VCM) and mean corpuscular haemoglobin concentration (CHCM), leukocytosis of 23,900 cells/mm3, thrombocytosis of 756,000/mm3, without elevation of acute phase reactants, hypocomplementemia with complement C3 level at 25 mg/dL (normal value, VN: 80-150 mg/dL) and normal C4. The rapid antigen test for Streptococcus beta-haemolytic group A (Streptococcus pyogenes) in pharynx was positive and the Anti-streptolysin O (ASO) was (+). The non-contrast brain computed tomography showed no acute changes. The renal ultrasound concluded bilateral nephromegaly with increased cortical echogenicity and decreased corticomedullar differentiation.\n\nThe patient was diagnosed with nephritic syndrome due to complicated GNAPE with hypertensive emergency - convulsive status.\n\nWithin the first 24 hours of his ICU stay, the patient required mechanical ventilation (MV) and anticonvulsant therapy with phenobarbital. He progressed without seizures, with a normal electroencephalogram (EEG) (on the day following admission) and a normal cerebrospinal fluid study. Antibiotic therapy was initiated for eradication of Streptococcus pyogenes with cefotaxime and diuretic therapy with furosemide.\n\nThe next day, he developed renal impairment with creatinine elevation to 0.99 mg/dL, hypertension and 24 hour proteinuria of 36.6 mg/m2/h, without oliguria. He initiated antihypertensive therapy with amlodipine and intravenous labetalol, with good initial control.\n\nWith favorable evolution, extubation was performed at 48 hours, which was well tolerated from the ventilatory point of view. However, after 24 hours of extubation, the patient's consciousness deteriorated, with both ocular opening and withdrawal of limb only in response to painful stimulus and poor verbal response (Glasgow Coma Scale 8), and developed blood pressure figures > p95+12 despite receiving therapy with labetalol in continuous infusion (up to 3 mg/kg/h), amlodipine (10 mg/day) and furosemide, which required the reintroduction of mechanical ventilation and infusion of sodium nitroprusside (up to 3 mcg/kg/min), with the aim of achieving gradual reduction of blood pressure figures (25% daily) to prevent secondary neurological damage. Given the presence of acute neurological symptomatology associated with HTA in a patient with glomerulonephritis, the diagnosis of PRES was suspected, which was confirmed by magnetic resonance imaging (MRI) of the brain (day 5), which showed an increase in the subcortical signal in bilateral and symmetric occipital region, without restriction in diffusion, which was compatible with vasogenic edema (PRES). Ophthalmological evaluation was normal and a new EEG evidenced occasional episodes of generalized voltage depression.\n\nAdding enalapril to the treatment. Finally, after 10 days with a slow pharmacological weaning, normalization of blood pressure was achieved. The control MRI (day 12) revealed regression of the previously described findings. Successful extubation was achieved after 5 days.\n\nDuring his stay in the ICU, the hemoglobin level dropped to 5 g/dL, with normal mean corpuscular volume and mean corpuscular hemoglobin concentration, without plateletopenia, so hemolytic anemia was suspected given a positive direct Coombs test and hemoglobinuria. He required red blood cell transfusions twice. Steroid therapy with methylprednisolone (1 mg/kg/d) was initiated for 72 hours. The coproculture was negative, as was the urinary antigen for Streptococcus pneumoniae. Epstein-Barr virus and Parvovirus B19 serology, extractable nuclear antigen (ENA) profile, anti-neutrophil cytoplasmic antibodies (ANCA), anti-DNA antibodies, anti-B2 glycoprotein 1 antibodies, anti-cardiolipin antibodies and lupus anticoagulant were all negative. All cultures were negative (blood cultures, urine cultures, cultures of endotracheal aspirate and pharyngeal cultures). ANA (antinuclear antibodies) was positive 1/160.\n\nThe patient improved with blood pressure normalization, increased complement levels, and a urine test without proteinuria or hematuria. The direct Coombs test remained positive on the 9th day of hospitalization.\n\nOn day 31, the patient was discharged normotensive, without anaemia, with preserved renal function, without proteinuria or haematuria, with normalisation of C3 levels and asymptomatic from the neurological point of view. He was discharged with pharmacological therapy with prednisone, amlodipine, enalapril and folic acid. The patient did not present recurrence and remained asymptomatic 6 months after discharge.\n",
+    "summary": "4-year-old male patient with a history of 5 days of haematuria and oedema, with additional headaches, nausea and vomiting, who entered a convulsive state and hypertensive crisis. Laboratory tests showed hypocomplementemia C3 and elevated Anti-Streptolysin O titers, which was interpreted as GNAPE. He developed encephalopathy, which led to suspicion of secondary PRES due to hypertensive emergency, which was finally confirmed by magnetic resonance of the brain. He also developed autoimmune haemolytic anaemia with haemoglobin up to 5 g/dL. His treatment was based on antihypertensive therapy, neuroprotection measures and steroid treatment. He was discharged after 31 days of hospitalisation, asymptomatic 6 months after discharge.\n",
+    "translated_fulltext": null,
+    "translated_summary": "चार वर्षीय पुरुष रोगी, जिसे पिछले पाँच दिनों से रक्तमेह और शोफ की शिकायत थी, साथ ही सिरदर्द, मतली और उल्टी भी हो रही थी। वह दौरे की स्थिति और उच्च रक्तचाप के संकट में चला गया। प्रयोगशाला परीक्षणों में हाइपोकॉम्प्लिमेंटेमिया सी3 और एंटी-स्ट्रेप्टोलिसिन ओ के उच्च स्तर पाए गए, जिसे जीएनएपीई के रूप में व्याख्यायित किया गया। उसे एन्सेफैलोपैथी विकसित हो गई, जिससे उच्च रक्तचाप के कारण द्वितीयक पीआरईएस होने का संदेह हुआ, जिसकी पुष्टि अंततः मस्तिष्क के चुंबकीय अनुनाद से की गई। उसे ऑटोइम्यून हेमोलिटिक एनीमिया भी हुआ, जिसमें हीमोग्लोबिन का स्तर 5 ग्राम/डीएल तक गिर गया। उसका उपचार एंटीहाइपरटेंसिव थेरेपी, न्यूरोप्रोटेक्शन उपायों और स्टेरॉयड उपचार पर आधारित था। 31 दिनों के अस्पताल में रहने के बाद उसे छुट्टी दे दी गई, और छुट्टी के 6 महीने बाद वह बिना किसी लक्षण के स्वस्थ था।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "৪-বছর-বয়সী পুরুষ রোগী, যার গত ৫ দিন ধরে haematuria এবং oedema ছিল, সঙ্গে মাথাব্যথা, বমিভাব ও বমিও ছিল। সে খিঁচুনির অবস্থায় এবং hypertensive crisis-এ চলে যায়। ল্যাবরেটরি পরীক্ষায় hypocomplementemia C3 এবং উচ্চ Anti-Streptolysin O titers পাওয়া যায়, যা GNAPE হিসেবে ব্যাখ্যা করা হয়। তার encephalopathy হয়, যার ফলে hypertensive emergency-এর কারণে secondary PRES সন্দেহ করা হয়, যা শেষে মস্তিষ্কের magnetic resonance দ্বারা নিশ্চিত হয়। তার autoimmune haemolytic anaemiaও হয়, যেখানে haemoglobin ৫ g/dL পর্যন্ত নেমে যায়। তার চিকিৎসা antihypertensive therapy, neuroprotection measures এবং steroid treatment-এর উপর ভিত্তি করে ছিল। ৩১ দিনের hospitalisation-এর পর তাকে ছাড়পত্র দেওয়া হয়, এবং ছাড়পত্রের ৬ মাস পরে সে উপসর্গমুক্ত ছিল।"
+  },
+  {
+    "id": "multiclinsum_gs_en_564.txt",
+    "fulltext": "A 69-year-old male with prior history of CABG presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration was admitted in our center. The electrocardiogram showed ST depression in leads II, III, aVF, and V4-6, and blood examination revealed elevation of plasma N-terminal pro-B-type natriuretic peptide levels (2640 pg/mL). Echocardiogram showed left ventricular systolic dysfunction and low left ventricular ejection fraction (30%). The patient had inferior ST-segment-elevation myocardial infarction in 2009, when he was 59 years old, with angiographic evidence of severe 3 vessels disease (coronary angiography showed CTO in proximal left anterior descending artery (LAD), 90% stenosis in mid and distal left circumflex artery, and 95% stenosis in mid RCA. The patient underwent CABG with left internal mammary artery (LIMA) to LAD, and sequential SVG to 1st obtuse marginal branch (OM1), 2nd obtuse marginal branch (OM2), and posterolateral branch (PL) in 2009.\n\nCoronary angiography was performed via 6 French (Fr) left radial artery access and demonstrated patency of LIMA to LAD and SVG to OM1, OM2 conduits, but a complete occlusion of sequential SVG to PL conduit. Native left main coronary artery was occluded in ostium and native RCA was occluded in the mid portion with bridging collaterals. We decided to treat the native RCA CTO. Dual arterial access was achieved with another 6 Fr sheath in right femoral artery. The left and right coronary arteries were intubated with 6 Fr AL 0.75 (Launcher; Medtronic; USA) and 6 Fr EBU 3.5 (Launcher; Medtronic; USA) guide catheters, respectively. An antegrade approach via left radial artery was attempted; however, neither Fielder XTR wire (Asahi Intec, Japan) nor Gaia 3 wire (Asahi Intec, Japan) with Finecross microcatheter (Terumo, Japan) reached the true lumen in distal RCA. Then, parallel wire technique with Crusade microcatheter (Kaneka, Japan) and two Gaia 3 wires (Asahi Intec, Japan) were attempted, but also failed. We therefore switched to the retrograde approach using septal channel from LAD through occluded left coronary artery. Gaia 3 wire (Asahi Intec, Japan) crossed occluded left main (LM) and LAD, and finally reached true lumen in distal LAD. Sion wire was exchanged by Finecross microcatheter (Terumo, Japan) into dital LAD, and dilation of LM and proximal LAD with a 2.0 × 15 mm balloon was performed. Then, septal surfing technique (SST) was used for septal crossing. We tried different septal channels originating from proximal to distal LAD, and delivered Sion wire (Asahi Intec, Japan) retrogradely through distal septal branch into distal RCA supported by a 150-cm Finecross microcatheter (Terumo, Japan). Gaia 3 wire (Asahi Intec, Japan) crossed CTO lesion retrogradely into the true lumen in proximal RCA, and was advanced into Guidezilla guide extension catheter (Boston Scientific, USA) positioned in the antegrade guiding catheter. The Finecross microcatheter (Terumo, Japan) was delivered to the antegrade catheter and a RG3 wire (Asahi Intec, Japan) was externalized. The CTO was then predilated by a 2.0 × 15 mm balloon and stented with 2 overlapping drug-eluting stents (2.5 × 38 mm and 3.0 × 38 mm) with excellent angiographic result and TIMI3 flow in all distal branches.\n\nDyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea.",
+    "summary": "Patient concerns:\nThis is a 69-year-old male with prior history of coronary artery bypass grafting presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration.\n\nDiagnosis:\nThe patient was diagnosed as heart failure caused by ischemia after SVG failure (SVG to right coronary artery) according to electrocardiogram, plasma N-terminal pro-B-type natriuretic peptide levels, and coronary angiogram.\n\nInterventions:\nWe recanalized native right coronary artery CTO by retrograde approach using septal collaterals by surfing technique after recanalization of totally occluded left coronary artery.\n\nOutcomes:\nDyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea.",
+    "translated_fulltext": null,
+    "translated_summary": "मरीज की शिकायतें:\nयह 69 वर्षीय पुरुष है, जिसका पहले कोरोनरी धमनी बाईपास ग्राफ्टिंग का इतिहास रहा है। वह दो महीने से गंभीर सांस लेने में तकलीफ (एनवाईएचए III) की शिकायत लेकर आया, जो हल्की शारीरिक गतिविधि के दौरान बढ़ जाती है।\n\nनिदान:\nइलेक्ट्रोकार्डियोग्राम, प्लाज्मा एन-टर्मिनल प्रो-बी-टाइप नेट्रियुरेटिक पेप्टाइड स्तर और कोरोनरी एंजियोग्राम के अनुसार, मरीज को इस्किमिया के कारण होने वाली हृदय विफलता का निदान किया गया, जिसके बाद एसवीजी (दाएं कोरोनरी धमनी में) विफल हो गया।\n\nउपचार:\nहमने पूरी तरह से बंद बाईं कोरोनरी धमनी को फिर से खोलकर, सेप्टल कोलेटरल्स का उपयोग करके, रेट्रोग्रेड दृष्टिकोण से मूल दाएं कोरोनरी धमनी के सीटीओ (क्रोनिक टोटल ऑक्लूजन) को फिर से खोला।\n\nपरिणाम:\nडिस्चार्ज के समय सांस लेने में तकलीफ कम हो गई। छह महीने के फॉलो-अप में, मरीज को सांस लेने में तकलीफ की पुनरावृत्ति नहीं हुई।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "রোগীর অভিযোগ:\nতিনি ৬৯ বছর বয়সী একজন পুরুষ, যার পূর্বে coronary artery bypass grafting-এর ইতিহাস রয়েছে। তিনি গত ২ মাস ধরে হালকা পরিশ্রমে তীব্র শ্বাসকষ্ট (NYHA III) নিয়ে উপস্থিত হয়েছেন।\n\nনির্ণয়:\nElectrocardiogram, plasma N-terminal pro-B-type natriuretic peptide levels, এবং coronary angiogram অনুযায়ী, SVG failure (right coronary artery-তে SVG) এর পরবর্তী ischemia-জনিত heart failure হিসেবে রোগীকে নির্ণয় করা হয়েছিল।\n\nহস্তক্ষেপ:\nআমরা সম্পূর্ণভাবে অবরুদ্ধ বাম coronary artery পুনরায় খোলার পর, septal collaterals ব্যবহার করে retrograde approach-এ native ডান coronary artery-এর CTO (chronic total occlusion) রেক্যানালাইজ করেছি।\n\nফলাফল:\nডিসচার্জের সময় শ্বাসকষ্ট লাঘব হয়েছিল। ৬ মাসের ফলো-আপে রোগীর শ্বাসকষ্টের পুনরাবৃত্তি হয়নি।\n\n---"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0010_0011.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0010_0011.json
new file mode 100644
index 0000000000000000000000000000000000000000..cd38ef05d0893acf615549ab39ef93ee62fd6d39
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0010_0011.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_399.txt",
+    "fulltext": "A 51-year-old male patient presented to us with acute painful visual loss of his left eye (LE) from 3 days ago. The best-corrected distance visual acuity (BCDVA) was 20/20, and hand motion (HM) detection for the right eye (RE) and LE, respectively. The ocular movement was normal in both eyes. Anterior segment examination was unremarkable for both eyes. The LE fundus examination showed ONH swelling, choroidal bulging, multiple patches of subretinal fluid accumulation, and retinal pigment epithelial (RPE) corrugations. Fundus examination of the RE was unremarkable.\n\nWe used multimodal imaging including Optical coherence tomography (OCT) (OptoVue, Inc., Fremont, CA, USA, software version: 2018,0,0,18), fundus blue-autofluorescence (BAF), fluorescein angiography (FA) (Heidelberg Eye Explorer version 1.9.13.0, Spectralis Viewing Module 6.5.2.0; Heidelberg Engineering), Indocyanin green angiography (ICGA), and B-scan ultrasonography for further evaluation. Besides, orbital and brain MRIs with gadolinium enhancement were ordered. The OCT image revealed a mild RPE and choroidal bulging, RPE hyper-reflectivity with back shadowing, subretinal and intraretinal fluid accumulation, and mild retinal thickening. A geographic area of macular hypocyanescence was apparent in the ICGA image of the left eye. BAF showed a geographic area with a speckled autofluorescence pattern at the macula. Optic nerve enlargement was found in the B-scan ultrasonography. In FA images, vascular leakage was apparent at the ONH (hot disc). Besides, a geographic patchy hypofluorescent area with speckled hyperfluorescent margins with a size of three disc diameters (DD) was detected. Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement at the junction of the optic nerve and sclera. An oncology consultation was done with no remarkable finding.\n\nConsidering the suspicion of malignancy and the presence of an enhancing nodular mass in the orbit, the patient underwent transconjunctival lateral orbitotomy one week after the presentation. A pink localized scleral nodule with edematous tenon was found. Sub-tenon triamcinolone acetonide was injected with the clinical diagnosis of nodular posterior scleritis. The patient refused admission and intravenous corticosteroid injection as the treatment order. Oral prednisolone 50 mg/Kg was started. Rheumatology consultation and screening lab results, including PPD test (tuberculosis), chest X-ray, serum ACE level (sarcoidosis), and C-ANCA level (Wegner granulomatosis), were unremarkable. At the last follow-up examination (one week after the surgery), the patient’s BCDVA was 20/20, and counting fingers at 2 meters for the RE and LE, respectively. Furthermore, SRF was absorbed, and the macula became atrophic. Oral prednisolone was tapered off slowly for three months.",
+    "summary": "A 51-year-old male patient presented to us with acute painful visual loss of his left eye (LE) from 3 days ago. The best-corrected distance visual acuity (BCDVA) was 20/20 and hand motion (HM) for the right eye (RE) and LE, respectively. Fundus examination of the LE showed ONH swelling, choroidal bulging, multiple patches of subretinal fluid accumulation, and retinal pigment epithelial (RPE) corrugations. Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement at the optic nerve and sclera junction. Oncology and rheumatology work-ups were unremarkable. With the clinical diagnosis of nodular posterior scleritis oral prednisolone 50 mg/Kg was started.",
+    "translated_fulltext": "एक 51 वर्षीय पुरुष रोगी तीन दिन पहले अपनी बाईं आंख (एलई) में तीव्र दर्द के साथ दृष्टि हानि की शिकायत लेकर हमारे पास आया। सबसे अच्छी तरह से सुधारी गई दूर दृष्टि तीक्ष्णता (बीसीडीवीए) 20/20 थी, और दाहिनी आंख (आरई) और एलई के लिए क्रमशः हाथ की गति (एचएम) का पता लगाया गया। दोनों आंखों में नेत्र गति सामान्य थी। दोनों आंखों की पूर्वकाल खंड की जांच में कोई विशेष बात नहीं पाई गई। एलई के फंडस की जांच में ओएनएच में सूजन, कोरॉइडल उभार, सबरेटिनल तरल पदार्थ के कई पैच और रेटिनल पिगमेंट एपिथेलियल (आरपीई) में झुर्रियाँ दिखाई दीं। आरई के फंडस की जांच में कोई विशेष बात नहीं पाई गई।\n\nहमने आगे के मूल्यांकन के लिए मल्टीमॉडल इमेजिंग का उपयोग किया, जिसमें ऑप्टिकल कोहेरेंस टोमोग्राफी (ओसीटी) (ऑप्टोव्यू, इंक., फ्रेमॉन्ट, सीए, यूएसए, सॉफ्टवेयर संस्करण: 2018,0,0,18), फंडस ब्लू-ऑटोफ्लोरेसेंस (बीएएफ), फ्लोरेसेंस एंजियोग्राफी (एफए) (हाइidelberg आई एक्सप्लोरर संस्करण 1.9.13.0, स्पेक्ट्रलिस व्यूइंग मॉड्यूल 6.5.2.0; हाइidelberg इंजीनियरिंग), इंडोसायनिन ग्रीन एंजियोग्राफी (आईसीजीए), और बी-स्कैन अल्ट्रासोनोग्राफी शामिल थे। इसके अलावा, गैडोलिनियम वृद्धि के साथ कक्षीय और मस्तिष्क एमआरआई का आदेश दिया गया। ओसीटी छवि में हल्की आरपीई और कोरॉइडल उभार, बैक शैडोइंग के साथ आरपीई हाइपर-रिफ्लेक्टीविटी, सबरेटिनल और इंट्रारेटिनल तरल पदार्थ का संचय और हल्की रेटिनल मोटाई दिखाई दी। बाईं आंख की आईसीजीए छवि में मैक्युला के एक भौगोलिक क्षेत्र में हाइपोसायनेंस दिखाई दिया। बीएएफ में मैक्युला पर एक भौगोलिक क्षेत्र में धब्बेदार ऑटोफ्लोरेसेंस पैटर्न दिखाई दिया। बी-स्कैन अल्ट्रासोनोग्राफी में ऑप्टिक तंत्रिका का विस्तार पाया गया। एफए छवियों में, ओएनएच (हॉट डिस्क) पर संवहनी रिसाव स्पष्ट था। इसके अलावा, तीन डिस्क व्यास (डीडी) के आकार के साथ एक भौगोलिक धब्बेदार हाइपोफ्लोरोसेंट क्षेत्र में धब्बेदार हाइपरफ्लोरोसेंट मार्जिन का पता चला। कक्षीय और मस्तिष्क एमआरआई में ऑप्टिक तंत्रिका और स्क्लेरा के जंक्शन पर गैडोलिनियम वृद्धि के साथ एक रेट्रोबुलर नोड्यूलर द्रव्यमान दिखाई दिया। एक ऑन्कोलॉजी परामर्श किया गया, जिसमें कोई विशेष निष्कर्ष नहीं मिला।\n\nघातकता की आशंका और कक्षा में एक बढ़ती नोड्यूलर द्रव्यमान की उपस्थिति को देखते हुए, रोगी ने प्रस्तुति के एक सप्ताह बाद ट्रांसकंजंक्टिवल पार्श्व ऑर्बिटोटोमी करवाई। एक गुलाबी, स्थानीय स्क्लेरल नोड्यूल, जिसमें एडमैटस टेनन था, पाया गया। नोड्यूलर पश्च स्क्लेराइटिस के नैदानिक निदान के साथ सब-टेनन ट्रायमिसिनोलोन एसीटोनाइड का इंजेक्शन लगाया गया। रोगी ने अस्पताल में भर्ती होने और अंतःशिरा कॉर्टिकोस्टेरॉइड इंजेक्शन से इनकार कर दिया, क्योंकि यह उपचार योजना थी। मौखिक प्रेडनिसोलोन 50 मिलीग्राम/किलोग्राम शुरू किया गया। रुमेटोलॉजी परामर्श और स्क्रीनिंग प्रयोगशाला परिणाम, जिसमें पीपीडी परीक्षण (तपेदिक), छाती का एक्स-रे, सीरम एसीई स्तर (सारकोइडोसिस) और सी-एएनसीए स्तर (वेग्नर ग्रैनुलोमैटोसिस) शामिल थे, सामान्य थे। अंतिम अनुवर्ती परीक्षा (सर्जरी के एक सप्ताह बाद), रोगी की बीसीडीवीए 20/20 थी, और आरई और एलई के लिए क्रमशः 2 मीटर पर उंगलियां गिनना। इसके अलावा, एसआरएफ अवशोषित हो गया, और मैक्युला एट्रोफिक हो गया। मौखिक प्रेडनिसोलोन को तीन महीनों में धीरे-धीरे कम किया गया।",
+    "translated_summary": "एक 51 वर्षीय पुरुष रोगी तीन दिन पहले अपनी बाईं आंख (एलई) में अचानक तेज दर्द और दृष्टि हानि की शिकायत लेकर हमारे पास आया। सबसे अच्छी तरह से सुधारी गई दूर दृष्टि (बीसीडीवीए) दाहिनी आंख (आरई) और एलई दोनों के लिए क्रमशः 20/20 और हाथ की गति (एचएम) थी। एलई की फंडस जांच में ओएनएच में सूजन, कोरॉइडल उभार, सबरेटिनल तरल पदार्थ के कई धब्बे और रेटिनल पिगमेंट एपिथेलियल (आरपीई) में झुर्रियाँ दिखाई दीं। ऑर्बिटल और मस्तिष्क एमआरआई में ऑप्टिक तंत्रिका और स्क्लेरा जंक्शन पर गैडोलिनियम वृद्धि के साथ एक रेट्रोबल्बार नोड्यूलर द्रव्यमान पाया गया। ऑन्कोलॉजी और रुमेटोलॉजी जांच में कोई विशेष बात नहीं पाई गई। नैदानिक ​​निदान के आधार पर, नोड्यूलर पोस्टीरियर स्क्लेराइटिस के लिए मौखिक प्रेडनिसोलोन 50 मिलीग्राम/किलोग्राम की खुराक शुरू की गई।",
+    "corrected_translated_fulltext": "একজন ৫১ বছর বয়সী পুরুষ রোগী তিন দিন আগে থেকে বাম চোখে (LE) তীব্র ব্যথাসহ আকস্মিক দৃষ্টিহানি নিয়ে আমাদের কাছে আসেন। সর্বোত্তম-সংশোধিত দূরদৃষ্টি তীক্ষ্ণতা (BCDVA) ছিল 20/20, এবং ডান চোখ (RE) ও LE-এর জন্য যথাক্রমে hand motion (HM) শনাক্ত করা গেছে। উভয় চোখে চক্ষুগতি স্বাভাবিক ছিল। উভয় চোখের anterior segment পরীক্ষা উল্লেখযোগ্য কিছু প্রকাশ করেনি। LE-এর fundus পরীক্ষায় ONH ফোলা, choroidal bulging, subretinal তরলের একাধিক প্যাচ সঞ্চয় এবং retinal pigment epithelial (RPE) corrugations দেখা গেল। RE-এর fundus পরীক্ষা উল্লেখযোগ্য কিছু প্রকাশ করেনি।\n\nআমরা আরও মূল্যায়নের জন্য multimodal imaging ব্যবহার করি, যার মধ্যে ছিল Optical coherence tomography (OCT) (OptoVue, Inc., Fremont, CA, USA, software version: 2018,0,0,18), fundus blue-autofluorescence (BAF), fluorescein angiography (FA) (Heidelberg Eye Explorer version 1.9.13.0, Spectralis Viewing Module 6.5.2.0; Heidelberg Engineering), Indocyanin green angiography (ICGA), এবং B-scan ultrasonography। তদুপরি, gadolinium enhancement সহ orbital ও brain MRI নির্দেশ করা হয়েছিল। OCT চিত্রে মৃদু RPE ও choroidal bulging, back shadowing-সহ RPE hyper-reflectivity, subretinal ও intraretinal তরল সঞ্চয়, এবং মৃদু retinal thickening দেখা গেছে। বাম চোখের ICGA চিত্রে macula-র একটি geographic অঞ্চলে hypocyanescence স্পষ্ট ছিল। BAF-এ macula-তে speckled autofluorescence pattern-সহ একটি geographic এলাকা দেখা গেছে। B-scan ultrasonography-তে optic nerve enlargement পাওয়া গেছে। FA চিত্রে ONH-এ (hot disc) vascular leakage স্পষ্ট ছিল। তদুপরি, তিন disc diameter (DD) আকারের speckled hyperfluorescent margins-সহ একটি geographic patchy hypofluorescent এলাকা সনাক্ত করা হয়। orbital ও brain MRI-তে optic nerve ও sclera-র সংযোগস্থলে gadolinium enhancement-সহ একটি retrobulbar nodular mass দেখা যায়। oncology consultation করা হয়েছিল, কোনো উল্লেখযোগ্য ফল পাওয়া যায়নি।\n\nmalignancy-র সন্দেহ এবং orbit-এ enhancing nodular mass-এর উপস্থিতি বিবেচনায়, রোগীর presentation-এর এক সপ্তাহ পর transconjunctival lateral orbitotomy করা হয়। edematous Tenon-সহ একটি গোলাপি, স্থানীয় scleral nodule পাওয়া যায়। nodular posterior scleritis-এর ক্লিনিক্যাল ডায়াগনোসিস অনুযায়ী sub-Tenon triamcinolone acetonide ইনজেক্ট করা হয়। রোগী ভর্তি হওয়া এবং চিকিৎসা পরিকল্পনায় নির্ধারিত intravenous corticosteroid ইনজেকশন নিতে অস্বীকার করেন। oral prednisolone 50 mg/kg শুরু করা হয়। rheumatology consultation এবং screening lab ফলাফল, যার মধ্যে PPD test (tuberculosis), chest X-ray, serum ACE level (sarcoidosis), এবং C-ANCA level (Wegner granulomatosis) অন্তর্ভুক্ত ছিল, উল্লেখযোগ্য কিছু ছিল না। শেষ ফলো-আপ পরীক্ষায় (সার্জারির এক সপ্তাহ পরে) রোগীর BCDVA ছিল 20/20, এবং RE ও LE-এর জন্য যথাক্রমে ২ মিটারে counting fingers। অতিরিক্তভাবে, SRF শোষিত হয়েছে, এবং macula atrophic হয়ে গেছে। oral prednisolone তিন মাস ধরে ধীরে ধীরে কমানো হয়েছে।",
+    "corrected_translated_summary": "এক ৫১ বছর বয়সী পুরুষ রোগী তিন দিন আগে বাম চোখে (LE) আকস্মিক বেদনাযুক্ত দৃষ্টিহানি নিয়ে আমাদের কাছে এসেছিলেন। Best-corrected distance visual acuity (BCDVA) ডান চোখ (RE) এবং LE-এর জন্য যথাক্রমে 20/20 এবং hand motion (HM) ছিল। LE-এর fundus পরীক্ষায় ONH swelling, choroidal bulging, subretinal fluid accumulation-এর একাধিক প্যাচ, এবং retinal pigment epithelial (RPE) corrugations দেখা যায়। Orbital এবং brain MRI-তে optic nerve ও sclera-র junction-এ gadolinium enhancement-সহ একটি retrobulbar nodular mass দেখা গেছে। Oncology এবং rheumatology work-ups-এ কোনো উল্লেখযোগ্য অস্বাভাবিকতা পাওয়া যায়নি। Clinical diagnosis অনুযায়ী nodular posterior scleritis-এর জন্য oral prednisolone 50 mg/kg শুরু করা হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_194.txt",
+    "fulltext": "A 36-year-old female patient complained of dysphagia with longstanding cervical and upper thoracic pain. She also had a multinodular goiter with no other significant history. Esophagogastroduodenal transit was performed. It showed a posterior and lateral right impression of the proximal esophagus after ingestion of baryte, extending 3.5 cm cephalocaudal. A maximum esophageal stenosis of 60% was estimated. A cervical and thoracic CT scan revealed a congenital anomaly of the aortic arch: a mirror image of the right aortic arch. The aortic arch originates from the root of the aorta and runs above the right stem bronchus, giving rise to the three supra-aortic trunks as follows: the first is the left brachiocephalic artery (which gives rise to the left common carotid artery and the left subclavian artery); the second is the right common carotid artery; and the third is the right subclavian artery. The aortic arch then enters posteriorly to the esophagus and gives rise to a small anterior saccule of 1.3 cm, known as the Kommerell diverticulum. This configuration forms a ring around the tracheo-esophageal pair, whose edges are formed posterior-lateral to the right by the aortic arch, posterior-lateral to the left by the Kommerell diverticulum, lateral to the left by the arteriosum ligamentum (or arterial ligament), and anteriorly by the left brachiocephalic artery. A gastroscopy confirmed the endoluminal impact of extrinsic compression. In view of minimal clinical repercussions and the absence of nutritional disorders, no surgical cure was ultimately performed. The evolution was favorable with, according to the patient, a spontaneous amelioration of symptoms.\n",
+    "summary": "We report the case of a 36-year-old female patient whose dysphagia presented a congenital anomaly of the thoracic aorta: the right aortic arch with mirror image. This is a rare anomaly of embryonic development where the aorta winds around the right stem bronchus and the supra-aortic trunks emerge from the crown in the reverse and opposite order to normal. The vast majority of patients are asymptomatic unless there is a compression of the mediastinal structures. Major compression of the esophagus or trachea, aneurysmal disease, thoracic aortic dissection or the presence of a Kommerell diverticulum of more than 2 cm may warrant surgical intervention. There is no standard treatment and it must be adapted to the clinical presentation and anatomical configuration of the patient. Our patient did not receive any treatment for her condition.\n",
+    "translated_fulltext": "36 वर्षीय एक महिला रोगी ने लंबे समय से गर्दन और ऊपरी वक्ष में दर्द के साथ निगलने में कठिनाई की शिकायत की। उसे एक बहु-नोड्यूल गण्डमाला (मल्टीनोड्यूलर गोइटर) भी था और उसका कोई अन्य महत्वपूर्ण चिकित्सा इतिहास नहीं था। उस पर एसोफैगोगैस्ट्रोडुओडेनल ट्रांजिट परीक्षण किया गया। परीक्षण में बैराइट के सेवन के बाद, ऊपरी अन्नप्रणाली के पीछे और दाहिनी ओर एक उभार दिखाई दिया, जो 3.5 सेंटीमीटर तक फैला हुआ था। अन्नप्रणाली में 60% तक संकुचन का अनुमान लगाया गया। गर्दन और वक्ष का सीटी स्कैन करने पर महाधमनी चाप (एओर्टिक आर्च) में एक जन्मजात विसंगति का पता चला: यह दाहिनी महाधमनी चाप की दर्पण छवि थी। महाधमनी चाप महाधमनी की जड़ से शुरू होता है और दाहिनी स्टेम ब्रांकाई के ऊपर से गुजरता है, जिससे तीन सुप्रा-एओर्टिक ट्रंक बनते हैं: पहला, बायां ब्राकियोसेफेलिक धमनी (जो बाएं सामान्य कैरोटिड धमनी और बाएं सबक्लेवियन धमनी को जन्म देती है); दूसरा, दाहिनी सामान्य कैरोटिड धमनी; और तीसरा, दाहिनी सबक्लेवियन धमनी। इसके बाद, महाधमनी चाप अन्नप्रणाली के पीछे से गुजरता है और 1.3 सेंटीमीटर का एक छोटा सा पूर्ववर्ती थैला बनाता है, जिसे कोम्मरेल डायवर्टिकुलम कहा जाता है। यह संरचना श्वासनली-अन्नप्रणाली जोड़ी के चारों ओर एक वलय बनाती है, जिसके किनारे इस प्रकार बनते हैं: दाहिनी ओर महाधमनी चाप द्वारा पीछे-बाहरी, बाईं ओर कोम्मरेल डायवर्टिकुलम द्वारा पीछे-बाहरी, बाईं ओर आर्टेरियोसम लिगामेंटम (या धमनी लिगामेंट) द्वारा बाहरी, और आगे की ओर बाएं ब्राकियोसेफेलिक धमनी द्वारा। गैस्ट्रोस्कोपी से बाहरी संपीड़न के कारण अन्नप्रणाली के अंदर होने वाले प्रभाव की पुष्टि हुई। न्यूनतम नैदानिक ​​परिणामों और पोषण संबंधी विकारों की अनुपस्थिति को देखते हुए, अंततः कोई शल्य चिकित्सा उपचार नहीं किया गया। रोगी के अनुसार, लक्षणों में सहज सुधार के साथ, स्थिति में अनुकूल बदलाव आया।",
+    "translated_summary": "हम 36 वर्षीय महिला रोगी के एक मामले की रिपोर्ट कर रहे हैं, जिसमें निगलने में कठिनाई (डिस्फेगिया) के साथ वक्षीय महाधमनी में एक जन्मजात असामान्यता पाई गई: दाहिनी महाधमनी चाप, जो दर्पण छवि की तरह दिखती है। यह भ्रूणीय विकास की एक दुर्लभ असामान्यता है, जिसमें महाधमनी दाहिनी श्वसनी के चारों ओर घूमती है और महाधमनी के ऊपर से निकलने वाली धमनियां सामान्य क्रम के विपरीत क्रम में निकलती हैं। अधिकांश रोगियों में कोई लक्षण नहीं होते हैं, जब तक कि मध्यस्थानिका संरचनाओं पर दबाव न हो। अन्नप्रणाली या श्वासनली पर गंभीर दबाव, धमनीविस्फार रोग, वक्षीय महाधमनी का विच्छेदन या 2 सेमी से अधिक के कोम्मरेल डाइवर्टिकुलम की उपस्थिति के कारण शल्य चिकित्सा की आवश्यकता हो सकती है। इसका कोई मानक उपचार नहीं है और इसे रोगी की नैदानिक प्रस्तुति और शारीरिक संरचना के अनुसार अनुकूलित किया जाना चाहिए। हमारे रोगी को उसकी स्थिति के लिए कोई उपचार नहीं दिया गया।",
+    "corrected_translated_fulltext": "৩৬ বছর বয়সী এক নারী রোগী দীর্ঘদিনের সার্ভিকাল ও উপরের থোরাসিক ব্যথার সাথে গিলতে অসুবিধার অভিযোগ করেন। তার একটি multinodular goiter-ও ছিল এবং অন্য কোনো গুরুত্বপূর্ণ ইতিহাস ছিল না। Esophagogastroduodenal transit পরীক্ষা করা হয়েছিল। এতে barium গ্রহণের পর proximal esophagus-এর ডান দিকের posterior ও lateral ইমপ্রেশন দেখা যায়, যা cephalocaudalভাবে 3.5 সেমি পর্যন্ত বিস্তৃত। esophageal stenosis-এর সর্বোচ্চ মাত্রা 60% হিসেবে অনুমান করা হয়েছিল। cervical ও thoracic CT স্ক্যানে aortic arch-এর একটি জন্মগত অস্বাভাবিকতা ধরা পড়ে: right aortic arch-এর একটি mirror image। aortic arch aorta-এর root থেকে উৎপত্তি হয়ে right stem bronchus-এর উপর দিয়ে যায় এবং নিম্নরূপ তিনটি supra-aortic trunk দেয়: প্রথমটি left brachiocephalic artery (যা থেকে left common carotid artery এবং left subclavian artery উৎপন্ন হয়); দ্বিতীয়টি right common carotid artery; এবং তৃতীয়টি right subclavian artery। এরপর aortic arch esophagus-এর পশ্চাতে প্রবেশ করে এবং 1.3 সেমি আকারের একটি ছোট anterior saccule সৃষ্টি করে, যাকে Kommerell diverticulum বলা হয়। এই বিন্যাসটি tracheo-esophageal জুটির চারদিকে একটি রিং সৃষ্টি করে, যার প্রান্তগুলি গঠিত হয় ডানদিকে posterior-lateral অংশে aortic arch দ্বারা, বামদিকে posterior-lateral অংশে Kommerell diverticulum দ্বারা, বামদিকে lateral অংশে arteriosum ligamentum (বা arterial ligament) দ্বারা, এবং সামনের দিকে left brachiocephalic artery দ্বারা। গ্যাস্ট্রোস্কোপি দ্বারা extrinsic compression-এর endoluminal প্রভাব নিশ্চিত করা হয়। ন্যূনতম ক্লিনিকাল প্রতিক্রিয়া এবং পুষ্টিগত ব্যাধির অনুপস্থিতি বিবেচনায়, শেষ পর্যন্ত কোনো শল্য চিকিৎসা করা হয়নি। রোগীর মতে, উপসর্গের স্বতঃস্ফূর্ত উন্নতির সাথে রোগের অগ্রগতি অনুকূল ছিল।",
+    "corrected_translated_summary": "আমরা ৩৬ বছর বয়সী এক নারী রোগীর একটি কেস রিপোর্ট করছি, যার গিলতে অসুবিধা (dysphagia) থেকে বক্ষীয় মহাধমনীর একটি জন্মগত অস্বাভাবিকতা ধরা পড়ে: right aortic arch with mirror image। এটি ভ্রূণীয় বিকাশের একটি বিরল অস্বাভাবিকতা, যেখানে মহাধমনী ডান প্রধান ব্রঙ্কাসকে ঘিরে আবর্তিত হয় এবং supra-aortic trunks ক্রাউন থেকে স্বাভাবিকের উল্টো ও বিপরীত ক্রমে উদ্ভূত হয়। বেশিরভাগ রোগী উপসর্গহীন থাকে, যদি না mediastinal structures-এর ওপর চাপ থাকে। অন্ননালী বা শ্বাসনালীর ওপর গুরুতর চাপ, aneurysmal disease, thoracic aortic dissection, অথবা ২ সেমি-র বেশি আকারের Kommerell diverticulum-এর উপস্থিতি অস্ত্রোপচারের প্রয়োজনীয়তা সৃষ্টি করতে পারে। এর কোনো মানক চিকিৎসা নেই এবং এটি রোগীর ক্লিনিক্যাল উপস্থাপনা ও অ্যানাটোমিক বিন্যাস অনুযায়ী মানিয়ে নিতে হয়। আমাদের রোগী তার অবস্থার জন্য কোনো চিকিৎসা পাননি।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0012_0013.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0012_0013.json
new file mode 100644
index 0000000000000000000000000000000000000000..855543429759b4a828f1d8b5621074f0b49f1122
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0012_0013.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_55.txt",
+    "fulltext": "An elderly 78-year-old patient from the Amhara region of Ethiopia, who has had a permanent cardiac pacemaker for 7 years, was scheduled for retropubic prostatectomy due to benign prostatic hyperplasia (BPH). This condition developed following a previous transurethral resection of the prostate 3 months earlier. The patient in the preoperative anesthesia evaluation was fully evaluated, and all the routine investigations required for the proposed surgery, which were within normal limits, were investigated. The patient presented with a history of frequency, urgency, nocturia, and dribbling for the past 2 months. Additionally, the patient had been known to have hypertension for the past 16 years and was taking amlodipine 5 mg orally daily, enalapril 10 mg orally twice daily (BID), and atorvastatin 10 mg orally daily. He had also been known to have type II diabetes mellitus for the past 25 years and was on metformin 500 mg orally BID and neutral protamine Hagedorn (NPH) 20 IU and 10 IU. He was admitted to a hospital for further evaluation, and complete bundle branch block (BBB) was detected via electrocardiogram (ECG). In an electrophysiology study, the patient was diagnosed with left ventricular hypertrophy secondary to hypertensive heart disease, mild diastolic dysfunction, and an ejection fraction of 62%. Abdominal ultrasound revealed an enlarged prostate size of 82 ml; anterior–posterior (AP) chest X-ray revealed a normal chest region with a left-side pacemaker in situ, and all the other blood parameters, including electrolytes and serum troponin levels, were within normal limits.\n\nA cardiologist was involved preoperatively as a multidisciplinary approach and risk determination tool for cardiac risk assessment. The patient had a frailty score of 5.5 with a poor functional cardiopulmonary reserve of metabolic equivalent (MET) = 3.4 and Revised Cardiac Risk Index (RCRI) class III, which accounts for 10.1% of major cardiac adverse events (myocardial infarction [MI], cardiac arrest, or death) within 30 days of the postoperative period, and intermediate risk on the basis of surgery type and patient risk factors. After preoperative evaluation and risk disclosure regarding the un-reprogrammed pacemaker and the associated complications during anesthesia and surgery, the patient was unable to afford the necessary health coverage for pacemaker reprogramming. This is because the cardiac surgery was performed in Addis Ababa, Ethiopia, which has a long waiting list with few cardiac surgeons for millions of people and is a considerable distance from the patient’s home institution, and there is a period of monitoring after pacemaker reprogramming for considerable post-reprogramming complication. As a result, the patient chose to proceed with the surgery, accepting the potential risks and harm associated with the situation. Continuous cardiac monitoring during the intraoperative period is highly advocated. Despite these factors, the patient did not experience cardiorespiratory failure, and he was stable. The patient continued on medication until the day of surgery, which included amlodipine, enalapril, atorvastatin, and a morning lower dose of two-thirds of the NPH. He also took 5 mg of diazepam orally for anxiolytics at midnight before the day of surgery.\n\nOn the day of surgery, the patient’s random blood sugar (RBS) was measured, and sliding scale glycemic control was implemented. Communication among the anesthetist, surgeon, and nurses was emphasized, ensuring that the cautery pad was placed away from the pacemaker, and that emergency drugs and a defibrillator were ready. The patient was premedicated with dexamethasone for nausea prophylaxis and paracetamol for pain relief as preemptive analgesia. American Society of Anesthesiology (ASA) standard monitoring was applied, and baseline parameters were recorded. Combined epidural–spinal anesthesia was administered via 0.5% isobaric bupivacaine (12.5 mg) and 50 µg fentanyl at the L3–L4 interspace. The block achieved anesthesia up to the umbilicus, and the sensory block was performed at T7. The surgery involved a midline incision below the umbilicus, with monopolar cautery used at low voltage (20 mA). Hemostasis was achieved through bipolar low-voltage cautery. Throughout the procedure, the patient’s vital signs remained stable. The patient’s vital signs did not change by more than 10% from the baseline vital signs. The intravenous fluid was resuscitated intraoperatively. During the postoperative period, the patient was transferred to the postanesthesia care unit (PACU) with vigilant monitoring, and 10 ml of 0.125% epidural top-up analgesia was given. Postop investigations were within normal limits. The patient was observed in the PACU for 12 hours and later transferred to the ward in stable condition with regular follow-up with the cardiology team. After 88th day of postsurgery the patient was discharged and advised to have regular checkups for pacemaker’s in situ status.",
+    "summary": "A 78-year-old male from the Amhara region, Ethiopia, with a permanent pacemaker for complete heart block was scheduled for retropubic prostatectomy. Preoperative assessments by the anesthetist and cardiologist recommended reprogramming the pacemaker to asynchronous mode to reduce risks related to its dual-chamber, rate-modulated mode setting. However, the patient could not afford reprogramming and opted to proceed with the existing perioperative plan. Informed consent was obtained, and case report publication permission was obtained after operation. The patient received combined epidural-spinal anesthesia with 2.50 ml of 0.5% isobaric bupivacaine and 50 µg fentanyl at the L3-L4 interspace. Standard American Society of Anesthesiology monitoring was applied, with a focus on cardiac stability. The patient remained stable with minimal vital sign fluctuations and maintained adequate blood pressure using isotonic saline. Postoperatively, the patient was transferred to the postanesthesia care unit, receiving analgesia after 4 hours and an epidural top-up. After 6 hours, he was transferred to the ward in stable condition. Epidural analgesia was continued for 72 hours, and the patient was discharged on the 88th postoperative hour in stable condition.",
+    "translated_fulltext": null,
+    "translated_summary": "इथियोपिया के अम्हारा क्षेत्र के 78 वर्षीय एक पुरुष, जिन्हें पूर्ण हृदय अवरोध के लिए स्थायी पेसमेकर लगाया गया था, उनकी रेट्रोप्यूबिक प्रोस्टेटेक्टॉमी की योजना बनाई गई थी। एनेस्थेटिस्ट और हृदय रोग विशेषज्ञ द्वारा सर्जरी से पहले किए गए मूल्यांकन में पेसमेकर को असिंक्रोनस मोड में पुन: प्रोग्राम करने की सिफारिश की गई, ताकि इसके दो-कक्षीय, दर-नियंत्रित मोड सेटिंग से जुड़े जोखिमों को कम किया जा सके। हालांकि, रोगी पुन: प्रोग्रामिंग कराने में असमर्थ था और मौजूदा पेरिऑपरेटिव योजना के साथ आगे बढ़ने का फैसला किया। सूचित सहमति प्राप्त की गई, और ऑपरेशन के बाद केस रिपोर्ट प्रकाशित करने की अनुमति प्राप्त की गई। रोगी को 2.50 मिलीलीटर 0.5% आइसोबैरिक ब्यूपिवैकेन और 50 µg फेंटानिल के साथ संयुक्त एपिड्यूरल-स्पाइनल एनेस्थीसिया दिया गया, जो L3-L4 इंटरस्पेस पर दिया गया। मानक अमेरिकन सोसाइटी ऑफ एनेस्थेसियोलॉजी निगरानी लागू की गई, जिसमें हृदय की स्थिरता पर ध्यान केंद्रित किया गया। रोगी की महत्वपूर्ण संकेतों में न्यूनतम उतार-चढ़ाव के साथ स्थिति स्थिर रही और आइसोटोनिक सलाइन का उपयोग करके पर्याप्त रक्तचाप बनाए रखा गया। सर्जरी के बाद, रोगी को पोस्टएनेस्थीसिया देखभाल इकाई में स्थानांतरित कर दिया गया, जहां 4 घंटे बाद एनाल्जेसिया और एपिड्यूरल टॉप-अप दिया गया। 6 घंटे बाद, उसे स्थिर स्थिति में वार्ड में स्थानांतरित कर दिया गया। एपिड्यूरल एनाल्जेसिया 72 घंटों तक जारी रखा गया, और रोगी को 88वें पोस्टऑपरेटिव घंटे में स्थिर स्थिति में छुट्टी दे दी गई।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "ইথিওপিয়ার আমহারা অঞ্চলের ৭৮ বছর বয়সী এক পুরুষ, complete heart block-এর জন্য যাঁর permanent pacemaker বসানো ছিল, তাঁর retropubic prostatectomy নির্ধারিত ছিল। অ্যানেস্থেটিস্ট ও কার্ডিয়োলজিস্টের প্রি-অপারেটিভ মূল্যায়নে pacemaker-টিকে asynchronous mode-এ reprogramming করার সুপারিশ করা হয়েছিল, যাতে এর dual-chamber, rate-modulated mode setting-সংশ্লিষ্ট ঝুঁকি কমানো যায়। তবে রোগী reprogramming-এর খরচ বহন করতে পারেননি এবং বিদ্যমান perioperative পরিকল্পনাতেই এগিয়ে যাওয়ার সিদ্ধান্ত নেন। Informed consent নেওয়া হয়েছিল, এবং অপারেশনের পর case report প্রকাশের অনুমতি নেওয়া হয়েছিল। রোগীকে L3-L4 interspace-এ 0.5% isobaric bupivacaine 2.50 ml এবং fentanyl 50 µg দিয়ে combined epidural-spinal anesthesia দেওয়া হয়েছিল। Standard American Society of Anesthesiology monitoring প্রয়োগ করা হয়েছিল, যেখানে cardiac stability-তে বিশেষ গুরুত্ব দেওয়া হয়েছিল। রোগী সামান্য vital sign ওঠানামার মধ্যেও স্থিতিশীল ছিলেন এবং isotonic saline ব্যবহার করে পর্যাপ্ত blood pressure বজায় রাখা হয়েছিল। অস্ত্রোপচারের পর রোগীকে postanesthesia care unit-এ স্থানান্তর করা হয়, যেখানে ৪ ঘণ্টা পর analgesia এবং একটি epidural top-up দেওয়া হয়। ৬ ঘণ্টা পরে, তাঁকে স্থিতিশীল অবস্থায় ওয়ার্ডে স্থানান্তর করা হয়। Epidural analgesia 72 ঘণ্টা পর্যন্ত চালু রাখা হয়, এবং 88তম postoperative ঘণ্টায় রোগীকে স্থিতিশীল অবস্থায় ছাড়পত্র দেওয়া হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_317.txt",
+    "fulltext": "A 52-year-old woman referred to the urology clinic with urinary complaints. Her symptoms began three years ago with frequency, dysuria and dribbling. She also mentioned the frequent passage of red and black thread-like substances in her urine. Moreover, during these discharges, she had headache, fever and chills. Intermittent periurethral and genital itching was another complaint of hers. She had been treated by several specialists with the diagnosis of recurrent urinary tract infections, with no clinical improvement. The patient denied recent travel, camping, hiking, farming, swimming and insect bites. She had positive history of pilonidal sinus surgery and hysterectomy, 8 and 7 years earlier, respectively. Two years prior to the current visit, she had been hospitalized for assessment. On physical examination, she was well-appearing with normal vital signs. All her laboratory tests, including cell blood count, urine analysis and biochemistries were in normal ranges. Abdominopelvic computed tomography (CT) scan revealed no abnormalities. Hence, she underwent cystoscopy, which demonstrated erythema and hyperemia of the bladder mucosa, suspended debris, and dilation of the left ureteral orifice. During consultation with an infectious diseases’ specialist, schistosomiasis was suspected, Therefore, she was treated with Praziquantel with the appropriate dose and duration and was discharged from the hospital.\n\nHowever, her symptoms did not subside. She was revisited by another infectious disease specialist, who prescribed her ivermectin due to suspicion to urinary myiasis. Nevertheless, no improvement was observed. She was readmitted to undergo bladder irrigation with polyethylene glycol, but the bladder washfluid did not contain any visible larvae. This procedure was followed by a two-day hematuria with spontaneous cessation. She was discharged home and advised to repeat the urine analysis one months later. Her random urine analysis was normal, so she collected her 24-h urine and sent it to the laboratory for analysis, in which a live larva was demonstrated under light microscope by the pathologist. The larva was isolated and sent to an entomologist to be identified morphologically. Finally, it was determined that the larva belonged to the species Sarcophaga. The patient was advised to take personal hygiene and consume at least 3 L of water daily.",
+    "summary": "We report a 52-year-old woman with persistent dysuria, frequency despite multiple treatments for suspected infections. Cystoscopy revealed erythema and debris, but imaging and laboratory tests were unremarkable. A live larva was identified in urine analysis, confirming the diagnosis. Treatment involved improved hygiene and hydration.",
+    "translated_fulltext": "एक 52 वर्षीय महिला मूत्र संबंधी शिकायतों के साथ यूरोलॉजी क्लिनिक में आई। उसके लक्षण तीन साल पहले बार-बार पेशाब आना, पेशाब करने में कठिनाई और बूंद-बूंद करके पेशाब आना के रूप में शुरू हुए। उसने यह भी बताया कि उसके मूत्र में बार-बार लाल और काले धागे जैसे पदार्थ निकलते हैं। इसके अलावा, इन लक्षणों के दौरान, उसे सिरदर्द, बुखार और ठंड लगती थी। मूत्रमार्ग और जननांग क्षेत्र में रुक-रुक कर खुजली भी उसकी एक और शिकायत थी। उसका कई विशेषज्ञों द्वारा बार-बार होने वाले मूत्र पथ के संक्रमण के निदान के साथ इलाज किया गया, लेकिन उसमें कोई चिकित्सकीय सुधार नहीं हुआ। मरीज ने हाल ही में यात्रा, कैंपिंग, लंबी पैदल यात्रा, खेती, तैराकी और कीड़ों के काटने से इनकार किया। उसके पिलोनिडल साइनस सर्जरी और गर्भाशय निकालने की सर्जरी (हिस्टेरेक्टॉमी) क्रमशः 8 और 7 साल पहले हुई थी। वर्तमान दौरे से दो साल पहले, उसे मूल्यांकन के लिए अस्पताल में भर्ती कराया गया था। शारीरिक परीक्षण में, वह सामान्य दिख रही थी और उसके महत्वपूर्ण संकेत सामान्य थे। उसके सभी प्रयोगशाला परीक्षण, जिनमें रक्त कोशिका गणना, मूत्र विश्लेषण और जैव रसायन शामिल थे, सामान्य सीमा में थे। पेट और श्रोणि का कंप्यूटेड टोमोग्राफी (सीटी) स्कैन में कोई असामान्यता नहीं पाई गई। इसलिए, उसने सिस्टोस्कोपी करवाई, जिसमें मूत्राशय की श्लेष्मा झिल्ली में लालिमा और हाइपरमिया, निलंबित मलबा और बाएं मूत्रवाहिनी छिद्र का फैलाव देखा गया। संक्रामक रोगों के विशेषज्ञ से परामर्श के दौरान, शिस्टोसोमियासिस का संदेह हुआ। इसलिए, उसे उपयुक्त खुराक और अवधि के साथ प्राज़िक्वेंटेल से इलाज किया गया और अस्पताल से छुट्टी दे दी गई।\n\nहालांकि, उसके लक्षण कम नहीं हुए। उसे एक अन्य संक्रामक रोग विशेषज्ञ से फिर से दिखाया गया, जिन्होंने मूत्र संबंधी मायियासिस के संदेह के कारण उसे आइवरमेक्टिन निर्धारित किया। फिर भी, कोई सुधार नहीं देखा गया। उसे मूत्राशय को पॉलीइथिलीन ग्लाइकॉल से धोने के लिए फिर से भर्ती कराया गया, लेकिन मूत्राशय के धोने वाले तरल पदार्थ में कोई दृश्यमान लार्वा नहीं था। इस प्रक्रिया के बाद दो दिनों तक रक्तमेह (मूत्र में रक्त) हुआ, जो अपने आप बंद हो गया। उसे घर भेज दिया गया और एक महीने बाद मूत्र विश्लेषण दोहराने की सलाह दी गई। उसका यादृच्छिक मूत्र विश्लेषण सामान्य था, इसलिए उसने 24 घंटे का मूत्र एकत्र किया और विश्लेषण के लिए प्रयोगशाला में भेजा, जिसमें रोगविज्ञानी द्वारा प्रकाश सूक्ष्मदर्शी के तहत एक जीवित लार्वा देखा गया। लार्वा को अलग किया गया और आकारिकी के आधार पर उसकी पहचान करने के लिए एक कीटविज्ञानी को भेजा गया। अंततः, यह निर्धारित किया गया कि लार्वा सारकोफागा प्रजाति का है। मरीज को व्यक्तिगत स्वच्छता बनाए रखने और प्रतिदिन कम से कम 3 लीटर पानी पीने की सलाह दी गई।",
+    "translated_summary": "हम एक 52 वर्षीय महिला के बारे में बता रहे हैं, जिसे लगातार पेशाब करने में कठिनाई और बार-बार पेशाब आने की समस्या थी, भले ही संक्रमण के संदेह के कारण कई उपचार किए गए थे। सिस्टोस्कोपी में लालिमा और मलबा पाया गया, लेकिन इमेजिंग और प्रयोगशाला परीक्षणों में कोई विशेष बात नहीं दिखी। मूत्र विश्लेषण में एक जीवित लार्वा की पहचान की गई, जिससे निदान की पुष्टि हुई। उपचार में बेहतर स्वच्छता और पर्याप्त मात्रा में तरल पदार्थ का सेवन शामिल था।",
+    "corrected_translated_fulltext": "৫২ বছর বয়সী এক নারী মূত্রজনিত অভিযোগ নিয়ে ইউরোলজি ক্লিনিকে এসেছিলেন। তার উপসর্গগুলো তিন বছর আগে ঘন ঘন প্রস্রাব হওয়া, প্রস্রাবের সময় জ্বালা ও ব্যথা এবং টপটপ করে প্রস্রাব ঝরা দিয়ে শুরু হয়েছিল। তিনি আরও জানান, তার প্রস্রাবে প্রায়ই লাল ও কালো সুতা-সদৃশ পদার্থ বের হয়। এছাড়াও, এসব নিঃসরণের সময় তার মাথাব্যথা, জ্বর ও শীতকাঁপুনি হতো। মাঝে মাঝে periurethral এবং genital চুলকানি ছিল তার আরেকটি অভিযোগ। তাকে recurrent urinary tract infections হিসেবে নির্ণয় করে বেশ কয়েকজন বিশেষজ্ঞ চিকিৎসা দিয়েছিলেন, তবে কোনো ক্লিনিকাল উন্নতি হয়নি। রোগিণী সাম্প্রতিক ভ্রমণ, ক্যাম্পিং, হাইকিং, কৃষিকাজ, সাঁতার এবং পোকামাকড়ের কামড় অস্বীকার করেছেন। তার pilonidal sinus surgery এবং hysterectomy-এর পূর্ব ইতিহাস ছিল, যথাক্রমে ৮ এবং ৭ বছর আগে। বর্তমান ভিজিটের দুই বছর আগে, তাকে মূল্যায়নের জন্য হাসপাতালে ভর্তি করা হয়েছিল। শারীরিক পরীক্ষা-নিরীক্ষায়, তিনি সুস্থদর্শন ছিলেন এবং vital signs স্বাভাবিক ছিল। cell blood count, urine analysis এবং biochemistriesসহ তার সকল ল্যাবরেটরি পরীক্ষা স্বাভাবিক সীমার মধ্যে ছিল। abdominopelvic computed tomography (CT) স্ক্যানে কোনো অস্বাভাবিকতা ধরা পড়েনি। ফলে, তার cystoscopy করা হয়, যাতে bladder mucosa-র erythema ও hyperemia, suspended debris এবং বাম ureteral orifice-এর dilation দেখা যায়। একজন infectious diseases specialist-এর পরামর্শের সময় schistosomiasis সন্দেহ করা হয়। তাই, তাকে যথাযথ ডোজ ও সময়কালসহ Praziquantel দিয়ে চিকিৎসা করা হয় এবং হাসপাতাল থেকে ছাড়া হয়।\n\nতবে, তার উপসর্গগুলো কমেনি। তিনি আরেকজন infectious disease specialist-এর কাছে পুনরায় দেখান, যিনি urinary myiasis-এর সন্দেহে তাকে ivermectin প্রেসক্রাইব করেন। তবুও, কোনো উন্নতি দেখা যায়নি। polyethylene glycol দিয়ে bladder irrigation করার জন্য তাকে পুনরায় ভর্তি করা হয়, কিন্তু bladder wash fluid-এ কোনো দৃশ্যমান লার্ভা ছিল না। এই প্রক্রিয়ার পরে দুই দিনের hematuria হয়, যা স্বতঃস্ফূর্তভাবে বন্ধ হয়ে যায়। তাকে বাড়ি ছেড়ে দেওয়া হয় এবং এক মাস পর urine analysis পুনরাবৃত্তি করতে পরামর্শ দেওয়া হয়। তার random urine analysis স্বাভাবিক ছিল, তাই তিনি ২৪-ঘণ্টার urine সংগ্রহ করে বিশ্লেষণের জন্য ল্যাবরেটরিতে পাঠান, যেখানে একজন pathologist light microscope-এর নিচে একটি জীবিত লার্ভা দেখতে পান। লার্ভাটি আলাদা করা হয় এবং আকৃতিগতভাবে শনাক্তকরণের জন্য একজন entomologist-এর কাছে পাঠানো হয়। পরিশেষে, নির্ধারিত হয় যে লার্ভাটি Sarcophaga প্রজাতির। রোগিণীকে ব্যক্তিগত স্বাস্থ্যবিধি মেনে চলতে এবং প্রতিদিন অন্তত ৩ লিটার পানি পান করতে পরামর্শ দেওয়া হয়।",
+    "corrected_translated_summary": "আমরা ৫২ বছর বয়সী এক মহিলার কথা জানাচ্ছি, যাঁর স্থায়ী dysuria এবং urinary frequency ছিল, সংক্রমণের সন্দেহে একাধিক চিকিৎসা সত্ত্বেও। Cystoscopy-তে erythema এবং debris দেখা যায়, কিন্তু imaging এবং laboratory tests-এ বিশেষ কিছু ধরা পড়েনি। মূত্র বিশ্লেষণে একটি জীবিত লার্ভা শনাক্ত হয়, যা diagnosis নিশ্চিত করে। চিকিৎসায় উন্নত পরিচ্ছন্নতা ও পর্যাপ্ত hydration অন্তর্ভুক্ত ছিল।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0018_0019.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0018_0019.json
new file mode 100644
index 0000000000000000000000000000000000000000..db4e68e5a14c934cf24d9b5f5f7f2a1fd0446b48
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0018_0019.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_462.txt",
+    "fulltext": "A 65-year-old male presented with swelling and boutonniere deformity on the right middle finger for six months after a motorcycle accident on January 1st, 2023. Initially, he managed the injury with painkillers and did not seek medical attention. After six months of persistent symptoms, including an inability to fully extend the finger and noticeable edema, he sought treatment.\n\nClinical findings\nThe inspection of the right hand showed the presence of deformity with edema. The active range of motion (ROM) was impaired in PIP joint in digiti III of the right hand. The active ROM of PIP joint digiti III of the right hand 45–110 degrees. The passive ROM of PIP joint digiti III of the right hand within normal.\n\nDiagnostic assessment\nWe performed X-ray of the right hand AP/Lateral which showed there are no abnormality in the bone and we diagnosed the deformity from soft tissue which is central slip injury.\n\nSurgical technique\nA central slip defect reconstruction utilizing partial ulnar side of flexor digitorum superficial tendon was performed. Under anesthesia, the patient was positioned supine with a tourniquet applied to the upper arm. A midlateral incision was made on the ulnar aspect of the right middle phalanx, centered at the PIP joint. The incision extended dorsally in an oblique manner. A transverse incision was made over the MCP joint flexion crease, just proximal to the A1 pulley. The procedure involves identifying and protecting the ulnar digital neurovascular bundle, exposing the central slip and extensor tendon to the PIPJ, full-thickness dorsal flaps are elevated. Scar tissue and pseudotendinous tissue is identified and excised. The central slip cannot be repaired primarily, so the ulnar slip of the FDS tendon is used for reconstruction. The ulnar neurovascular bundle is mobilized to visualize the periosteal insertion of the A3 pulley.\n\nThe extensor tendon is mobilized and tenolyzed, followed by incision of the dorsal capsule of the PIP joint and removal of interposed tissue. The A3 pulley's periosteal insertion is incised longitudinally, and the PIP joint's volar capsule is incised longitudinally. The ulnar slip of the FDS tendon is identified and a 2–0 non-absorbable, monofilament suture is placed around it. A transverse incision is made at the MCP joint flexion crease, proximal to the A1 pulley revealing the flexor tendon sheath. The tendon sheath and A1 pulley are incised longitudinally. The FDS tendon is identified. The ulnar slip of the FDS tendon is isolated and transected to release the ulnar slip, avoiding entrapment or catching of the radial slip. The 2–0 suture that was placed around the ulnar slip at the level of the PIP joint is used to release distally based FDS tendon slip and deliver the ulnar slip of the FDS tendon distally.\n\nA 2.8-mm drill is used to create a vertically oriented bone tunnel dorsal to volar. An elevator is placed between the flexor digitorum profundus tendon, volar plate, and volar aspect of the base of the middle phalanx protecting the volar anatomic structures. The FDS tendon slip passes through the tunnel while maintaining the PIP joint in extension and reduced position. The FDS tendon slip passed through the intact proximal section of the central slip and extensor tendon. A tendon weaver completes a Pulvertaft weave, confirming the appropriate tension with the PIPJ in the reduced, full extension position. A 3–0 non-absorbable suture secures the pulvertaft weave. The margins of the capsule and central slip reconstruction are approximated across the PIP joint, and adhesions are released and the lateral bands mobilized.\n\nThe overall posture, stability, and motion with tenodesis assessed. All the incisions are copiously irrigated. The tourniquet is deflated and hemostasis is obtained. Capillary refill of all fingers is assessed. The skin is closed using horizontal mattress stiches. A sterile dressing is applied with an appropriately padded PIP joint extension splint to allow for early DIP joint and MCP joint motion.\n\nFollow-up and outcomes\nFirst follow-up was done 4 days after for wound treatment. The patient was given oral meloxicam 7,5 mg twice a day and doxycycline 100 mg twice a day for 3 days. The second follow-up was done 3 days after for wound treatment. After 2 weeks, we remove the back slab, remove the external suture and begin the active and passive ROM exercise. After 3 weeks, the wound was healed, and we found the ROM of PIP joint 0 to 90 degrees. And after a month, the patient came with improved ROM of PIP joint 0 to 100 degrees, and improved functional outcome. After 7 weeks of physical rehabilitation, patients already back to work with improve ROM of PIP joint 0 to 110 degrees. The function of the patient's right hand is evaluated with DASH score, which improves significantly from 50 to 4.2.",
+    "summary": "A 65-year-old male patient presented with swelling and boutonniere deformity on the digiti III of the right hand. The patient had previously fallen from a motorcycle, and the patient's right middle finger got was by a motorcycle six months ago. After the incident, the patient's right middle finger cannot be fully extended. The patient's right hand showed edema with flexion of the interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint. The Range of Motion (ROM) of the PIP joint right middle finger was 45-110 degrees. The X-ray of the right hand AP/oblique showed no bone involvement in the deformity. The patient underwent central slip defect reconstruction utilizing the partial ulnar side of the flexor digitorum superficial tendon. A PIP joint extension splint was applied for 2 weeks. Active and passive exercise of the ROM of the PIP joint began after 2 weeks of PIP extension joint splinting. The patient's ROM of the PIP joint (0-90 degrees) significantly improved 1 month after surgery. The patient's ROM of the PIP joint returned to normal after 2 months after surgery. The function of the patient's right hand is evaluated with the DASH score, which improves significantly from 50 to 4.2.",
+    "translated_fulltext": null,
+    "translated_summary": "एक 65 वर्षीय पुरुष रोगी दाहिने हाथ की तीसरी उंगली में सूजन और बटनियर विरूपता के साथ उपस्थित हुआ। रोगी पहले मोटरसाइकिल से गिर गया था, और छह महीने पहले उसकी दाहिनी मध्यमा उंगली मोटरसाइकिल से टकरा गई थी। घटना के बाद, रोगी की दाहिनी मध्यमा उंगली पूरी तरह से नहीं फैल पाती है। रोगी के दाहिने हाथ में इंटरफैलेंजियल (पीआईपी) जोड़ के फ्लेक्सन और डिस्टल इंटरफैलेंजियल (डीआईपी) जोड़ के हाइपरएक्सटेंशन के साथ शोफ दिखाई दिया। पीआईपी जोड़ की दाहिनी मध्यमा उंगली की गति की सीमा (आरओएम) 45-110 डिग्री थी। दाहिने हाथ के एपी/तिरछे एक्स-रे में विरूपता में कोई हड्डी की भागीदारी नहीं दिखाई दी। रोगी ने फ्लेक्सर डिजिटोरम सुपरफिशियेल टेंडन के आंशिक उल्ना पक्ष का उपयोग करके केंद्रीय स्लिप दोष पुनर्निर्माण कराया। 2 सप्ताह के लिए पीआईपी जोड़ एक्सटेंशन स्प्लिंट लगाया गया। 2 सप्ताह के पीआईपी एक्सटेंशन जोड़ स्प्लिंटिंग के बाद पीआईपी जोड़ की आरओएम का सक्रिय और निष्क्रिय व्यायाम शुरू किया गया। सर्जरी के 1 महीने बाद रोगी के पीआईपी जोड़ की आरओएम (0-90 डिग्री) में महत्वपूर्ण सुधार हुआ। सर्जरी के 2 महीने बाद रोगी के पीआईपी जोड़ की आरओएम सामान्य हो गई। रोगी के दाहिने हाथ के कार्य का मूल्यांकन डैश स्कोर के साथ किया गया, जिसमें 50 से 4.2 तक महत्वपूर्ण सुधार हुआ।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "একজন 65 বছর বয়সী পুরুষ রোগী ডান হাতের তৃতীয় আঙুলে ফোলা এবং boutonniere deformity নিয়ে উপস্থিত হন। রোগী পূর্বে মোটরসাইকেল থেকে পড়েছিলেন, এবং 6 মাস আগে রোগীর ডান মধ্যমা আঙুল মোটরসাইকেলে আঘাতপ্রাপ্ত হয়েছিল। ঘটনার পরে, রোগীর ডান মধ্যমা আঙুল সম্পূর্ণভাবে প্রসারিত হয় না। রোগীর ডান হাতে interphalangeal (PIP) joint-এর flexion এবং distal interphalangeal (DIP) joint-এর hyperextension সহ edema দেখা গিয়েছিল। ডান মধ্যমা আঙুলের PIP joint-এর Range of Motion (ROM) ছিল 45-110 ডিগ্রি। ডান হাতের AP/oblique X-ray-এ deformity-তে কোনো হাড়ের সম্পৃক্ততা দেখা যায়নি। রোগীর flexor digitorum superficial tendon-এর আংশিক ulnar side ব্যবহার করে central slip defect reconstruction করা হয়েছিল। 2 সপ্তাহের জন্য PIP joint extension splint প্রয়োগ করা হয়েছিল। PIP extension joint splinting-এর 2 সপ্তাহ পর PIP joint-এর ROM-এর active এবং passive exercise শুরু করা হয়। সার্জারির 1 মাস পর রোগীর PIP joint-এর ROM (0-90 ডিগ্রি) উল্লেখযোগ্যভাবে উন্নত হয়। সার্জারির 2 মাস পর রোগীর PIP joint-এর ROM স্বাভাবিক হয়ে যায়। রোগীর ডান হাতের কার্যকারিতা DASH score দিয়ে মূল্যায়ন করা হয়, যা 50 থেকে 4.2 পর্যন্ত উল্লেখযোগ্যভাবে উন্নত হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_382.txt",
+    "fulltext": "A 23-year-old male patient presented to the emergency department with a sudden onset of severe frontal headache lasting for 2 h. He experienced associated symptoms of nausea, vomiting, and chest heaviness. He has a unremarkable medical record and denies the use of illicit drugs. However, he is a smoker with a history of 23 pack-years but does not consume alcohol.\n\nOn physical examination, the young male appeared distressed but was fully conscious and oriented to time, place, and person. Chest auscultation revealed normal vesicular breathing sounds, while cardiovascular and abdominal examinations were inconclusive. Neurological examinations demonstrated neck stiffness, dilated pupils reactive to light, normal plantar reflexes, and no focal neurological deficits.\n\nHis vital signs were as follows: blood pressure 178/103 mmHg, respiratory rate 26 breaths/min, temperature 38.9°C, heart rate 87 beats/min, and oxygen saturation of 94%.\n\nEmergency tests were initiated. An ECG revealed ST segment elevation >2 mm in leads V2-V5, consistent with STEMI as the top of our differential diagnosis, requiring confirmation by cardiac markers. With prompt referral to a tertiary cardiac centre implemented, the patient received a 300 mg aspirin load while being transferred to the catheter lab. Troponin levels were significantly elevated at 1.48 mg/dl (normal <0.16 mg/dl).\n\nPercutaneous coronary intervention was performed via the femoral artery, and the result showed normal coronary arteries with thrombolysis in myocardial infarction (TIMI) flow grade of 3.\n\nHis ECG after coronary angiography revealed normal sinus rhythm with left ventricular hypertrophy LVH. An echocardiogram was performed, revealing normal ventricular function with no regional wall motion abnormalities (RWMA).\n\nFollowing coronary intervention, he was admitted to the medical ward for further assessment and investigation. Blood samples were drawn for a complete blood count, random blood sugar, renal function tests, and CRP. The results revealed lymphocytosis and mildly elevated CRP.\n\nWe proceeded further with CT brain to exclude serious cause of headache. His brain CT showed cisternal subarachnoid haemorrhage SAH with extension anterior to the right temporal lobe. Abdominal ultrasound screening was performed to rule out polycystic kidney disease which was negative and cerebral CT angiography was scheduled to exclude cerebral aneurysm Nimodipine 60 mg every 4 h was initiated, with a target blood pressure of 160/100 mmHg.\n\nOn the second day, his condition suddenly deteriorated, culminating with cardiac arrest. Therefore, cardiopulmonary resuscitation (CPR), resulting in a Glasgow Coma Scale score (GCS) of 6. The patient was subsequently, intubated and placed on mechanical ventilation in the Intensive Care Unit (ICU). Due to his unstable condition in the ICU, we could not perform a repeated CT brain scan or the planned cerebral CT angiography.\n\nOver the next 7 days, we diligently monitored him with a strict multidisciplinary team. A nasogastric tube was inserted for feeding and fluid replacement. His medications included intravenous fluids, antibiotics, proton pump inhibitors, and nimodipine.\n\nOn the 8th day, he suddenly developed ventricular fibrillation, and despite CPR with more than five defibrillations, we were unable to revive him and death was the final outcome.39734686",
+    "summary": "We present a case detailing the diagnostic challenges of a 23-year-old male presenting with a sudden severe headache, nausea, vomiting, and chest heaviness. Initial evaluation showed elevated blood pressure and respiratory rate. An emergency electrocardiogram (ECG) indicated ST-segment elevation myocardial infarction (STEMI), leading to immediate referral for percutaneous coronary intervention, which revealed normal coronary arteries. Further investigations identified a cisternal subarachnoid haemorrhage (SAH) on CT brain imaging. Despite multidisciplinary management, the patient's condition rapidly deteriorated, resulting in cardiac arrest and mortality.",
+    "translated_fulltext": null,
+    "translated_summary": "हम एक ऐसे मामले का विवरण प्रस्तुत करते हैं जिसमें 23 वर्षीय पुरुष अचानक गंभीर सिरदर्द, मतली, उल्टी और सीने में भारीपन की शिकायत लेकर आया। प्रारंभिक मूल्यांकन में उच्च रक्तचाप और श्वसन दर में वृद्धि देखी गई। आपातकालीन इलेक्ट्रोकार्डियोग्राम (ईसीजी) में एसटी-सेगमेंट एलिवेशन मायोकार्डियल इन्फार्क्शन (एसटीईएमआई) का संकेत मिला, जिसके परिणामस्वरूप तत्काल परक्यूटेनियस कोरोनरी इंटरवेंशन के लिए भेजा गया, जिसमें कोरोनरी धमनियां सामान्य पाई गईं। आगे की जांच में सीटी ब्रेन इमेजिंग में सिस्टर्नल सबअराक्नोइड रक्तस्राव (एसएएच) का पता चला। बहु-विषयक प्रबंधन के बावजूद, रोगी की स्थिति तेजी से बिगड़ती गई, जिसके परिणामस्वरूप हृदय गति रुक गई और मृत्यु हो गई।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা এমন একটি কেসের বিবরণ উপস্থাপন করছি যেখানে ২৩ বছর বয়সী এক পুরুষ হঠাৎ তীব্র মাথাব্যথা, বমিবমি ভাব, বমি এবং বুকে ভারীভাব নিয়ে উপস্থিত হন। প্রাথমিক মূল্যায়নে উচ্চ রক্তচাপ এবং শ্বাস-প্রশ্বাসের হারের বৃদ্ধি দেখা যায়। জরুরি electrocardiogram (ECG)-এ ST-segment elevation myocardial infarction (STEMI)-এর ইঙ্গিত মেলে, যার ফলস্বরূপ তাৎক্ষণিকভাবে percutaneous coronary intervention-এর জন্য প্রেরণ করা হয়, যেখানে coronary arteries স্বাভাবিক পাওয়া যায়। পরবর্তী তদন্তে CT brain imaging-এ cisternal subarachnoid haemorrhage (SAH) শনাক্ত হয়। বহুবিষয়ক ব্যবস্থাপনা সত্ত্বেও, রোগীর অবস্থা দ্রুত অবনতি ঘটে, ফলস্বরূপ cardiac arrest হয়ে মৃত্যু হয়।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0034_0035.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0034_0035.json
new file mode 100644
index 0000000000000000000000000000000000000000..fc5f05f97b14b94b7cdaca831557a2aab7ef5806
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0034_0035.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_362.txt",
+    "fulltext": "A 77-year-old male patient presented with a history of moderate cognitive impairment. The patient was admitted to the emergency department for a tonic-clonic seizure at home. The patient presented hemodynamically unstable in the context of a postcritical state and suspected intrapelvic bleeding. The code for a polytraumatized patient was activated, not because of the mechanism of injury, but because of the patient's hemodynamic status.  He was stabilized and optimized in the emergency department with intravenous fluid and transfusion of packed red blood cells. A pelvic girdle was placed. Once hemodynamic stability was achieved, a physical examination was performed. Clinically, the patient presented a shortening of the lower limb compared to the contralateral limb, external rotation and joint blockage when performing the log roll test in both limbs. He presented functional impotence in both hips. Given the patient's condition when he arrived at the emergency department, it was not possible to assess the neurological status. He had no signs of external injuries or bruises. Distal pulses were present at the foot level. He could move his upper limbs. A chest and anteroposterior pelvic radiograph was performed as part of the code for a polytraumatized patient, pending completion of an abdominal-pelvic computed tomography (CT) study. A bilateral femoral dislocation was diagnosed in the pelvic radiograph. The patient underwent a procedure to correct the dislocation.\n\n\n\nComputed tomography angiography to rule out vascular lesions given the instability in hemodynamic that presented itself on admission. Vascular lesions were ruled out after the angiography. In the 3D-CT reconstruction of the pelvis, a bilateral transverse acetabular fracture was found, according to the classification of Letournel and a bilateral longitudinal fracture of the iliac wing was found, along with intrapelvic protrusion of both femoral heads. After initial evaluation, supracondylar traction was placed on the femoral head in both extremities and the pelvic traction was removed. The patient was admitted to the recovery unit until surgery, where he remained with the traction supracondylar femoral head in both extremities and the pelvic traction was removed. The patient was operated on the eighth day of admission. In our service, the acetabular fractures were ruled out after seven days waiting for the formation of a fibrosis in the focus of fracture and the decrease of intraoperative bleeding during surgical procedures. It was decided to perform the surgery in two stages due to the long duration of each intervention. Both surgeries were performed with general anaesthesia, tranexamic acid was administered to prevent intraoperative bleeding and decrease blood transfusions in relation to the surgeries; and antibiotic (cefazolin 2 g preoperatively and 1 g of cefazolin every 8 hours postoperatively for 24 hours) as an intrahospital protocol. During the postoperative period, enoxaparin 40 mg was administered subcutaneously every 24 hours for seven weeks. Initially, the surgery of the left hemipelvis was performed since, at the radiographic level, it presented greater pelvic protrusion and it was not desirable that a hematoma in the soft tissue phase could generate complications at the time of extraction of the femoral head (vascular injuries, intraoperative bleeding). The supracondylar traction was removed. The patient was placed in lateral decubitus, and a posterior lateral approach was performed with a Moore's autograft in the acetabular background (fracture focus). Subsequently, the anti-protrusion ring was implanted (Burch SchneiderTM Reinforcement Cage, Zimmer Biomet) anchored to the ischium and ilium. Prior to the implantation of the ring, it was necessary to perform dissection of the gluteal musculature (gluteus minimus and medius) to correctly place the femoral head. The medial ischial fracture of the ring was also anchored with screws. The check was performed under the control of a scope to verify the correct implantation. Subsequently, a double mobility cementaed acetabular ring was implanted and then the non-cemented femoral stem was implanted. After finishing the placement of the components, the capsule and pelvic musculature were closed by means of transosseous trochanteric points. The surgery of the right hemipelvis was performed seven days later. The patient was placed in lateral decubitus. To address the longitudinal fracture of the iliac wing, the first window of the ilio-inguinal approach was performed. It was synthesised with a six-hole anatomical plate. Subsequently, the same procedure as the previous surgery was performed, using an anti-protrusion ring with a double mobility cemented femoral stem and non-cemented femoral stem. This type of anti-protrusion rings are used when there are acetabular fractures that could be equivalent to a pelvic disjunction (type IV classification of acetabular defects of the AAOS) and an anchorage in the ischium and ilium of the ring is needed to support the ring. They are not indicated for isolated fractures of the anterior or posterior wall of the acetabulum where there is no involvement of the acetabular background. During admission, the patient remained in bed and was mobilised to avoid decubitus ulcers. Once the second intervention was performed and when the patient tolerated it clinically, he began to transfer with the use of a wheelchair. In bed he was allowed to have a full range of motion without restriction. The patient was discharged four weeks later and did not begin to load or walk until six weeks. He began to load with the use of a walking stick. We decided to delay loading because, despite the use of arthroplasty as a treatment, it was decided to wait until there was an initial consolidation of the graft in the acetabular background that provided better support for the ring. It was also added that the patient presented bilateral involvement and it would be difficult to start partial loading, given that he did not have a healthy hip to support. During the follow-up of the patient, at 12 months of the intervention he was already doing full load with the use of a walking stick, with a Harris hip score of 79 in the left hip and 77 in the right hip; and a score of 12 on the WOMAC scale. He has not presented any postoperative complications to date. The patient is satisfied clinically, he reports occasional discomfort and a slight limp of the right side. He has a full range of motion in the examination and does not report having had any episode of instability since the surgery.\n",
+    "summary": "77-year-old patient with a history of moderate cognitive impairment who suffered bilateral central dislocation of the hip in the context of a generalized convulsive seizure. Clinically, upon arrival in the emergency department, the patient presented a shortening of the lower right limb compared to the contralateral limb, external rotation and joint blockage when performing the log roll test in both limbs. Imaging and clinical optimization study was performed prior to surgery. It was performed in two stages: first the left hip on the eighth day of admission and the right hip on the fifteenth. In both surgeries the same procedure was performed by implanting an anti-protrusive ring and prosthesis with double mobility acetabulum with non-cemented femoral stem. In the immediate postoperative period, the patient did not present any complications associated with the surgery. In the 12-month follow-up, the patient performed a full load with a Harris hip score (HHS) of 77 in the right hip and 79 in the left; 12 points in the WOMAC scale. He has not presented any postoperative complications to date.\n",
+    "translated_fulltext": null,
+    "translated_summary": "77 वर्षीय रोगी, जिसमें मध्यम संज्ञानात्मक दुर्बलता का इतिहास रहा है, उसे सामान्यीकृत आक्षेप के दौरान दोनों कूल्हों में केंद्रीय विस्थापन हुआ। आपातकालीन विभाग में आने पर, रोगी के निचले दाहिने अंग की लंबाई, विपरीत अंग की तुलना में कम पाई गई, साथ ही दोनों अंगों में लॉग रोल परीक्षण करते समय बाहरी घुमाव और जोड़ में रुकावट देखी गई। सर्जरी से पहले इमेजिंग और नैदानिक अनुकूलन अध्ययन किया गया। यह दो चरणों में किया गया: पहले अस्पताल में भर्ती होने के आठवें दिन बाएं कूल्हे की सर्जरी और फिर पंद्रहवें दिन दाहिने कूल्हे की। दोनों सर्जरी में एक ही प्रक्रिया का पालन किया गया, जिसमें एक एंटी-प्रोट्रूसिव रिंग और डबल मोबिलिटी एसिटाबुलम के साथ गैर-सीमेंटेड फेमोरल स्टेम प्रत्यारोपित किया गया। सर्जरी के तुरंत बाद, रोगी में सर्जरी से संबंधित कोई जटिलता नहीं देखी गई। 12 महीने के अनुवर्ती अध्ययन में, रोगी ने दाहिने कूल्हे में 77 और बाएं कूल्हे में 79 के हैरिस हिप स्कोर (एचएचएस) के साथ पूर्ण भार वहन किया; साथ ही, WOMAC पैमाने पर 12 अंक प्राप्त किए। अब तक, रोगी में कोई भी पोस्टऑपरेटिव जटिलता नहीं देखी गई।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "৭৭ বছর বয়সী রোগী, যার মাঝারি মাত্রার জ্ঞানীয় দুর্বলতার ইতিহাস রয়েছে, generalized convulsive seizure-এর প্রেক্ষিতে উভয় হিপে কেন্দ্রীয় ডিসলোকেশন হয়েছে। ক্লিনিক্যালি, জরুরি বিভাগে আগমনের সময়, রোগীর ডান নিম্ন অঙ্গ বিপরীত পার্শ্বের অঙ্গের তুলনায় সংক্ষিপ্ত ছিল, এবং উভয় অঙ্গে log roll test করার সময় বাহ্যিক রোটেশন ও জয়েন্ট ব্লকেজ দেখা গেছে। সার্জারির আগে ইমেজিং এবং ক্লিনিক্যাল অপ্টিমাইজেশন স্টাডি করা হয়েছিল। এটি দুই ধাপে করা হয়েছিল: ভর্তি হওয়ার অষ্টম দিনে বাম হিপ এবং পঞ্চদশ দিনে ডান হিপ। উভয় সার্জারিতে একই পদ্ধতি অনুসরণ করা হয়েছিল, যেখানে anti-protrusive ring এবং double mobility acetabulum-সহ prosthesis, সঙ্গে non-cemented femoral stem ইমপ্লান্ট করা হয়েছিল। অস্ত্রোপচারের পরপরই, রোগীর মধ্যে সার্জারি-সম্পর্কিত কোনো জটিলতা দেখা যায়নি। ১২ মাসের ফলো-আপে, রোগী পূর্ণ ভারবহন করেছেন, ডান হিপে Harris hip score (HHS) ৭৭ এবং বাম হিপে ৭৯; WOMAC scale-এ ১২ পয়েন্ট। এ পর্যন্ত রোগীর কোনো postoperative জটিলতা দেখা যায়নি।"
+  },
+  {
+    "id": "multiclinsum_gs_en_151.txt",
+    "fulltext": "The patient was a 4-month-old male from central Mexico with two healthy male siblings. His mother was hypothyroid during the first trimester of pregnancy and took drugs. The infant was born with normal weight and size, was breast-fed, and received the BCG vaccine with no scarring. The mother of the patient was a prisoner in a jail cell with the infant in a crowded cell with two others.At 4 months, the patient was medically evaluated for a painful tumor in the left axilla. A chest X-ray showed suggestive images of rib fractures; the mother was suspected of child abuse, and the infant was admitted to a pediatric hospital. The infant was weighed (4,190 g) and measured (58 cm) below the third percentile, oxygen saturation of 70%, fever, cough, increased volume in the left axilla, and pain, redness, and warmth. The blood count showed: hemoglobin of 8.8 g/dL (11.0-12.6), 29.3 × 109 leukocytes/L (6.0-17.5), 18.4 × 109 neutrophils/L (1.0-8.5), 7.0 × 109 lymphocytes/L (4.0-13.5), 3.5 × 109 monocytes/L, 459 × 109 platelets/L (150-350), and C-reactive protein of 16 mg/L (< 3.0). The first thoracoabdominal tomography showed an abscess in the left axilla, lytic lesions in ribs 3-6, left apical pneumonia, pulmonary nodules in both lungs, and enlarged cervical and mediastinal lymph nodes. The biopsy of the left axilla abscess reported myositis and suppurative panniculitis. Only the culture for bacteria from the bronchoalveolar liquid was negative, and the PCR for the Mycobacterium tuberculosis complex was negative. After 41 days of hospitalization and receiving two antimicrobial regimens of ceftriaxone-clindamycin and cefepime-vancomycin, the patient was discharged.\n\nTwo months later, at eight months of age, he was readmitted to hospital with a fever, irritability and a suppurating abscess in the left scapula. The blood count showed haemoglobin of 10.8 g/dl (10.5-12), 21.2 × 109 leukocytes/L (6-17), 12.2 × 109 neutrophils/L (1.5-8.5), 7.5 × 109 lymphocytes/L (4-10.5), 1.2 × 109 monocytes/L (600), and 583 × 109 platelets/L (150-350); the serum test for HIV was negative. A left apical consolidation, bronchiectasis, lytic lesions in ribs 2-7 and dorsal vertebrae 2-7, and a multilocular fluid collection were observed on a chest scan; ultrasound showed a fistula associated with the scapular abscess. The patient received piperacillin-tazobactam, which was later replaced with voriconazole after Aspergillus fumigatus was detected in the secretion sample culture. Given the recurrence and severity of the infection, an innate immunity defect was suspected. The dihydrorhodamine test showed no production of reactive oxygen species and the gp91phox expression in neutrophils was absent, establishing a diagnosis of X-linked chronic granulomatous disease. The pathogenic variant detected by next-generation sequencing was c.80_83del/Y (p.Val27Glyfs*33) in CYBB. The mother was a carrier of the variant (c.80_83del/WT). The two older male siblings, who were apparently healthy, could not be genetically tested. The patient was discharged after 65 days of hospitalisation and 28 days of voriconazole treatment. Daily antibiotic prophylaxis with trimethoprim-sulfamethoxazole and antifungal prophylaxis with fluconazole twice a week were initiated. Two months later, at one year of age, the infant was readmitted due to multifocal pneumonia, for which mechanical respiratory assistance was required. The galactomannan antigen was detected in the serum and A. fumigatus was detected in the culture of the lavage fluid, so treatment with voriconazole was initiated again. The patient suffered a multiple organ failure and died one month after admission.\n",
+    "summary": "A case of infant with chronic granulomatous disease and invasive aspergillosis is reported. The infant was a 4-month-old male infant living with his mother in a prison cell. The infant had tumors in the left axillary region and a chest X-ray suggested rib fractures; he was hospitalized on suspicion of child abuse. A chest X-ray showed an axillary abscess, osteolysis of ribs, pneumonia and pulmonary nodules; the patient received broad spectrum antibiotics and was discharged. At 8 months, he was readmitted with fever and extension of the purulent abscess to the left shoulder region; a chest X-ray showed worsening of the condition. Aspergillus fumigatus was isolated from the secretion of the abscess and invasive aspergillosis was diagnosed; voriconazole was initiated for 28 days. A dihydro rhodamine test was performed and a diagnosis of chronic granulomatous disease caused by the pathogenic variant c.80_83del/Y of the CYBB gene, carried by the mother (c.80_83del/WT), was made. At 12 months, the patient was readmitted with invasive aspergillosis, resistant to treatment, with fatal outcome.\n",
+    "translated_fulltext": null,
+    "translated_summary": "यहाँ एक ऐसे शिशु का मामला प्रस्तुत किया गया है जिसे क्रोनिक ग्रैनुलोमैटस रोग और इनवेसिव एस्परगिलोसिस है। यह शिशु चार महीने का लड़का था जो अपनी माँ के साथ एक जेल की कोठरी में रहता था। शिशु के बाएं बगल क्षेत्र में ट्यूमर थे और छाती के एक्स-रे से पता चला कि उसकी पसली में फ्रैक्चर है; बच्चे के साथ दुर्व्यवहार का संदेह होने पर उसे अस्पताल में भर्ती कराया गया। छाती के एक्स-रे में बगल में फोड़ा, पसली का ऑस्टियोलिसिस, निमोनिया और फेफड़ों में गांठें दिखाई दीं; रोगी को व्यापक स्पेक्ट्रम एंटीबायोटिक्स दिए गए और उसे छुट्टी दे दी गई। आठ महीने की उम्र में, उसे बुखार और बाएं कंधे के क्षेत्र में मवाद से भरे फोड़े के बढ़ने के साथ फिर से अस्पताल में भर्ती कराया गया; छाती के एक्स-रे से पता चला कि स्थिति और खराब हो गई है। फोड़े के स्राव से एस्परगिलस फ्यूमिगेटस को अलग किया गया और इनवेसिव एस्परगिलोसिस का निदान किया गया; 28 दिनों के लिए वोरिकोनाज़ोल दवा दी गई। एक डाइहाइड्रो रोडमाइन परीक्षण किया गया और यह निदान किया गया कि CYBB जीन के रोगजनक संस्करण c.80_83del/Y के कारण क्रोनिक ग्रैनुलोमैटस रोग हुआ है, जो माँ (c.80_83del/WT) में मौजूद था। बारह महीने की उम्र में, रोगी को इनवेसिव एस्परगिलोसिस के साथ फिर से अस्पताल में भर्ती कराया गया, जो उपचार के प्रति प्रतिरोधी था, जिसके परिणामस्वरूप उसकी मृत्यु हो गई।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "এখানে এমন এক শিশুর একটি কেস উপস্থাপন করা হয়েছে যার chronic granulomatous disease এবং invasive aspergillosis রয়েছে। শিশুটি চার মাস বয়সী একটি ছেলে ছিল, যে তার মায়ের সঙ্গে একটি কারাগারের সেলে বাস করত। শিশুটির বাম বগল অঞ্চলে টিউমার ছিল এবং চেস্ট এক্স-রে থেকে দেখা গেল তার পাঁজরে ফ্র্যাকচার আছে; শিশুর প্রতি নির্যাতনের সন্দেহে তাকে হাসপাতালে ভর্তি করা হয়। চেস্ট এক্স-রেতে বগলে অ্যাবসেস, পাঁজরের osteolysis, নিউমোনিয়া এবং ফুসফুসে নডিউল দেখা যায়; রোগীকে broad-spectrum antibiotics দেওয়া হয় এবং তাকে ছুটি দেওয়া হয়। আট মাস বয়সে, জ্বর এবং বাম কাঁধের অঞ্চলে পুঁজপূর্ণ অ্যাবসেসের বিস্তারসহ তাকে আবার হাসপাতালে ভর্তি করা হয়; চেস্ট এক্স-রে থেকে বোঝা গেল যে অবস্থা আরও খারাপ হয়েছে। অ্যাবসেসের স্রাব থেকে Aspergillus fumigatus পৃথক করা হয় এবং invasive aspergillosis নির্ণয় করা হয়; 28 দিনের জন্য voriconazole শুরু করা হয়। একটি dihydrorhodamine পরীক্ষা করা হয় এবং এটি নির্ণয় করা হয় যে CYBB জিনের রোগজনক ভ্যারিয়েন্ট c.80_83del/Y, যা মা বহন করতেন (c.80_83del/WT), এর কারণে chronic granulomatous disease হয়েছে। বারো মাস বয়সে, রোগীকে invasive aspergillosis নিয়ে আবার হাসপাতালে ভর্তি করা হয়, যা চিকিৎসার প্রতি প্রতিরোধী ছিল, ফলাফলস্বরূপ তার মৃত্যু ঘটে।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0036_0037.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0036_0037.json
new file mode 100644
index 0000000000000000000000000000000000000000..3690c00d35d4d7733e682886ccc2ed487ed76364
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0036_0037.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_133.txt",
+    "fulltext": "Male patient, 25 years old, Sundanese, presented at the Dental Hospital of the Faculty of Dentistry Universitas Padjadjaran with the chief complaint of mouth sores, which are painful on the upper and lower lips and exacerbated when eating and talking. Initially, four days ago, canker sores started in the oral cavity, then appeared on the lips two days later. The patient tried to self-medicate by applying petroleum jelly which he used to relieve his symptoms, but it did not improve. The patient replaced the drug with triamcinolone acetonide 0.1% in orabase ointment purchased at the pharmacy and applied it once a day. Canker sores were getting better but did not cure.\n\nThe patient had history a of fever for about a week before the canker sores appeared and there were no lesions on other parts of the body. He stated that the workload was quite heavy and he had not consumed a balanced nutritional diet for about one and a half months. He had no medical history, history of food allergies, or history of taking medication. He had no history of alcohol consumption or smoking, but he had a frequent habit of licking his lips. He also had a history of chickenpox when he was a child.\n\nThe patient had no fever with all vital signs within normal limits on general examination. Extra-oral examination showed no abnormalities in the lymph nodes. There were serosanguineous crusts that felt painful and bleed easily on the lips. Intra-oral examination revealed erythematous lesions, irregular in shape, and had diffuse borders, accompanied by pain in the upper and lower labial mucosa. Hyperkeratotic white plaque that could not be scraped off, irregular in shape, has diffuse borders, without pain in the region of tooth 38 left buccal mucosa. Yellowish-white plaques were seen on 1/3 of the posterior surface of the dorsal tongue, which could be scraped off without leaving an erythematous area, and there were indentations in the form of dental impressions without pain on the lateral right and left sides of the tongue. A painless hard nodule about 2×1 x 0.5 cm in size was seen in the midline of the hard palate. Several teeth were found in caries, radix, and edentulous conditions in all regions. The oral hygiene was poor.\n\nExamination of psychological conditions was evaluated using the DASS-21 questionnaire and showed normal depression level (score 0), normal anxiety level (score 6), and normal stress level (score 6). Based on history and clinical examination, the working diagnosis was suspected HAEM, accompanied by the coated tongue, frictional keratosis, crenated tongue, torus palatinus, reversible pulpitis of tooth 18, irreversible pulpitis of tooth 47, chronic apical periodontitis et causa radix of tooth 15, and edentulous teeth 28, 37, 36, and 46. The differential diagnosis of suspected HAEM lesions on the lips was exfoliative cheilitis. However, exfoliative cheilitis did not have herpes virus involvement. The patient was indicated for serological testing (IgG anti-HSV-1) to confirm the diagnosis. Oral health-related quality of life was measured, and the results of the OHIP-14 examination at the first visit were 35 (moderate OHRQol).\n\nThe non-pharmacological therapy included instruction to maintain oral hygiene by brushing the teeth and tongue using a soft-bristled toothbrush two times a day and using non-detergent toothpaste. Education was given such as increasing the intake of water by at least two liters per day, consuming a balanced nutritional diet, avoiding acidic, spicy, hard, and monosodium glutamate-containing foods, and stopping the bad habit of licking and peeling the skin of the lips. The pharmacological therapy included topical and systemic medications. The topical medications included instructions to compress the lips with gauze moistened with 0.9% NaCl solution at least three times a day and to apply a thin layer of triamcinolone acetonide 0.1% in orabase to the lips three times a day. The systemic medications included instruction to take a multivitamin once a day.\n\nThe progress of improvement was visible in the first follow-up, two days after the initial visit. The pain in the lips was reduced, but the canker sores have not healed. Extra-oral examination revealed serosanguinous crusts on the lips which were still painful and bled easily. The serological test result (IgG anti-HSV-1) was positive with a ratio of: 6.32 (positive: ratio > 1.1). The definitive diagnosis was established based on the history, clinical examination, and serological tests as HAEM. The non-pharmacological and pharmacological therapy was continued, and systemic medication was added in the form of instructions to consume acyclovir 200 mg tablets five times a day for one week.\n\nSignificant improvement was visible in the second follow-up, five days after the previous visit, showing excellent healing in all of the patient’s oral lesions. The OHIP-14 result at the last visit was 4 (good OHRQoL). The patient’s physical, psychological, and social conditions showed improvement and returned to normal after 7 days of treatment. Patient was referred to continue dental and oral care in the periodontics, dental conservation, oral surgery, and prosthodontics departments. The patient has approved and written informed consent for the case details to be published included publication of the images, and the institution has also approved for publication. This case had complied with the Declaration of Helsinki.",
+    "summary": "A 25-year-old male patient came to the Department of Oral Medicine with the chief complaint of painful canker sores on the lips. Extra-oral examination revealed serosanguineous crusts on the lips that were painful and easily bleed. Intra-oral examination showed diffused and painful irregular erythematous lesions on the upper and lower labial mucosa. The anti-HSV1 IgG test was positive. The patient was diagnosed with HAEM.\n\nCase management: Pharmacological therapy included triamcinolone acetonide 0.1% in orabase, acyclovir tablets, multivitamins, and 0.9% NaCl. Non-pharmacological therapy included advice on maintaining good oral hygiene, avoiding spicy and sour foods, and breaking the bad habit of licking the lips.",
+    "translated_fulltext": null,
+    "translated_summary": "25 वर्षीय एक पुरुष रोगी, होंठों पर दर्दनाक छाले की शिकायत के साथ दंत चिकित्सा विभाग में आया। बाहरी जांच में, होंठों पर दर्दनाक और आसानी से खून बहने वाले सेरोसैंगुइनस क्रस्ट पाए गए। मुंह के अंदर की जांच में, ऊपरी और निचले होंठों की श्लेष्म झिल्ली पर फैले हुए और दर्दनाक अनियमित एरिथेमेटस घाव पाए गए। एंटी-एचएसवी1 आईजीजी परीक्षण सकारात्मक रहा। रोगी को एचएईएम का निदान किया गया।\n\nमामले का प्रबंधन: औषधीय उपचार में ओरबेस में 0.1% ट्राइएम्सिनोलोन एसीटोनइड, एसिक्लोविर टैबलेट, मल्टीविटामिन और 0.9% सोडियम क्लोराइड शामिल थे। गैर-औषधीय उपचार में अच्छी मौखिक स्वच्छता बनाए रखने, मसालेदार और खट्टे खाद्य पदार्थों से बचने और होंठों को चाटने की बुरी आदत को छोड़ने की सलाह दी गई।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "25 বছর বয়সী এক পুরুষ রোগী, ঠোঁটে বেদনাদায়ক ক্যানকার সোরের অভিযোগ নিয়ে দন্ত চিকিৎসা বিভাগে আসেন। বাহ্যিক পরীক্ষায়, ঠোঁটে বেদনাদায়ক এবং সহজেই রক্তপাতকারী serosanguineous crusts পাওয়া গেছে। মুখের ভিতরের পরীক্ষায়, উপরের ও নীচের labial mucosa-তে বিস্তৃত এবং বেদনাদায়ক অনিয়মিত erythematous lesions পাওয়া গেছে। anti-HSV1 IgG পরীক্ষা পজিটিভ ছিল। রোগীর HAEM নির্ণয় করা হয়েছে।\n\nকেস ম্যানেজমেন্ট: ফার্মাকোলজিকাল থেরাপিতে orabase-এ 0.1% triamcinolone acetonide, acyclovir ট্যাবলেট, multivitamins, এবং 0.9% NaCl অন্তর্ভুক্ত ছিল। নন-ফার্মাকোলজিকাল থেরাপিতে ভালো oral hygiene বজায় রাখা, ঝাল ও টক খাবার এড়িয়ে চলা এবং ঠোঁট চাটার খারাপ অভ্যাস ত্যাগ করার পরামর্শ দেওয়া হয়েছিল।"
+  },
+  {
+    "id": "multiclinsum_gs_en_83.txt",
+    "fulltext": "A 29-year-old woman, Para 1, with abnormal vaginal bleeding of one-month duration presented to the gynecology outpatient department of a level 2 hospital. She was HIV positive, commenced on antiretroviral treatment following diagnosis, but had defaulted the antiretroviral treatment for one month when she became ill with vaginal bleeding, resulting in virological and immunological failures (viral load 37400 copies/mL and CD4 count 26 cells/μL). Of note, it was unclear when the patient first started showing HIV symptoms. However, she was diagnosed with HIV about a year prior to presentation. Physical examination revealed a large mass on the cervix measuring 8 × 8 cm extending to the parametrium and to the pelvic side walls bilaterally. There was bleeding on contact and foul-smelling vaginal discharge. Ultrasonography detected a bulky cervix and bilateral hydronephrosis. The patient was clinically diagnosed with cervical malignancy stage 3B. She was recommenced on antiretroviral therapy with a treatment change from TLD (Tenofovir-Lamivudine-Dolutegravir combination) to a preferable renal friendly regimen (Lamivudine-Abacavir-Dolutegravir combination). A punch biopsy of the cervix was performed, and the histopathological report revealed the diagnosis of an extra-nodal BL. The immunohistochemical and in situ hybridization confirmed the diagnosis, with CD20, CD75a, CD10, PAX5 and Bcl-6 positive. In addition, the CD44 and c-Myc were positive, with the EBER-ISH demonstrating focal positivity. The Ki67 demonstrated a proliferation index of almost 100% and PAX5 moderately positive BCL6. She had white cell count of 2.67 x109/L, haemoglobin of 5.7g/dl and platelet count of 71 × 109/L. Results of other investigations were serum creatinine 187 mmol/L, urea 11.1 mmol/l, albumin 21 g/l, aspartate transaminase 41 U/l and alkaline phosphatase 100 U/l.\n\nFollowing histological confirmation of the diagnosis and review at an oncology multidisciplinary meeting, she spent 43 days waiting to start treatment at oncology unit. The delay was due to long waiting list. This delay exceeded the 48 hours waiting period during which oncological treatment for BL should commence following diagnosis. The treatment plan was chemo-radiation therapy, and the patient gave written informed consent for the case to be published. However, she demised in the gynaecological ward on the 43rd day while waiting to start the treatment. During the 43 days, further imaging could not be performed due to poor functionality of the available CT and MRI machines. In addition to antiretroviral therapy, the patient received other supportive care such as blood transfusion and analgesia. Again, the number of days between the diagnosis of the BL and her death was 43 days. Histopathological postmortem was not performed as the diagnoses (BL and retroviral disease) were known. We reckon that the main primary cause of death is challenging to assign because of the multiple principal diagnoses. Because BL has rapid progression and high mortality rate in persons living with HIV particularly with high viral load, the attending physician certifying the death assigned BL as the most likely cause of death. However, the secondary cause of death was multiple organ failure (renal and haematological inclusive).",
+    "summary": "The patient was a 29-year-old woman, Para 1, with abnormal vaginal bleeding for a month and living with HIV and had a CD4 of 26 cells/μL. The histological examination of the cervical biopsy confirmed an extra-nodal BL. She had International Federation of Gynecology and Obstetrics (FIGO) stage 3B cervical cancer based on presence of hydronephrosis and pelvic wall involvement. The patient was reviewed at the oncology multidisciplinary meeting and required chemoradiation. There was delay in her management due to a long waiting list for chemoradiation at oncology unit in the referral center and the patient demised 43 days after diagnosis and did not receive the treatment.",
+    "translated_fulltext": null,
+    "translated_summary": "मरीज़ 29 वर्षीय महिला थी, जिसका यह पहला गर्भधारण था, और उसे एक महीने से असामान्य योनि से रक्तस्राव हो रहा था। वह एचआईवी से संक्रमित थी और उसके सीडी4 काउंट 26 कोशिकाएँ/µL थे। गर्भाशय ग्रीवा की बायोप्सी की हिस्टोलॉजिकल जांच में गर्भाशय ग्रीवा के बाहर एक लिम्फोमा (BL) की पुष्टि हुई। हाइड्रोनफ्रोसिस और श्रोणि की दीवार में शामिल होने के आधार पर, अंतर्राष्ट्रीय स्त्री रोग और प्रसूति संघ (FIGO) के अनुसार, उसे स्टेज 3B गर्भाशय ग्रीवा का कैंसर था। ऑन्कोलॉजी में एक बहु-विषयक बैठक में मरीज की समीक्षा की गई और उसे कीमोरेडिएशन की आवश्यकता थी। रेफरल सेंटर में कीमोरेडिएशन के लिए लंबी प्रतीक्षा सूची के कारण उसके उपचार में देरी हुई, और निदान के 43 दिन बाद मरीज की मृत्यु हो गई और उसे उपचार नहीं मिल पाया।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "রোগী ২৯ বছর বয়সী মহিলা ছিলেন, যার এটি প্রথম গর্ভধারণ ছিল, এবং তার এক মাস ধরে অস্বাভাবিক যোনি থেকে রক্তক্ষরণ হচ্ছিল। তিনি HIV-এ আক্রান্ত ছিলেন এবং তার CD4 কাউন্ট ছিল 26 cells/µL। গর্ভাশয়ের গ্রীবার বায়োপসির হিস্টোলজিক্যাল পরীক্ষায় গর্ভাশয়ের গ্রীবার বাইরে একটি লিম্ফোমা (BL) নিশ্চিত হয়েছিল। Hydronephrosis এবং শ্রোণি প্রাচীরের সম্পৃক্ততার উপস্থিতির ভিত্তিতে, International Federation of Gynecology and Obstetrics (FIGO) অনুযায়ী, তার stage 3B গর্ভাশয়ের গ্রীবার ক্যান্সার ছিল। অঙ্কোলজিতে একটি বহু-বিষয়ক বৈঠকে রোগীর পর্যালোচনা করা হয়েছিল এবং তার chemoradiation প্রয়োজন ছিল। রেফারাল সেন্টারে chemoradiation-এর জন্য দীর্ঘ অপেক্ষার তালিকার কারণে তার চিকিৎসায় বিলম্ব হয়েছিল, এবং নির্ণয়ের 43 দিন পর রোগীর মৃত্যু হয় এবং তিনি চিকিৎসা পাননি।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0042_0043.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0042_0043.json
new file mode 100644
index 0000000000000000000000000000000000000000..22fec899f62568f1194442ac3a85414717e76d70
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0042_0043.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_222.txt",
+    "fulltext": "Female patient, 16 years old, presenting a depressed gray plaque of 10.5 × 8.0 cm interspersed with hypochromic areas in the lower lateral part of the left thigh. Telangiectatic vessels overlap the lesion peripherally, with visible veins close to it. The plaque was present from birth, but was initially violaceous. It evolved with the passing of the years, with lightening and depression. There is no discrepancy in the length of the lower limbs.\n\nAngioresonance showed vascular malformations in the skin and subcutaneous tissue supplied by intermuscular branches of the popliteal artery. Early venous filling was found in both the region and the malformations, suggesting early venous shunting. Dilated draining veins were not documented, except for a superficial draining vein running along the subcutaneous cellular tissue of the anterior thigh. In addition, thinning of the subcutaneous tissue was noted in the topography of the vascular alteration, but without intramuscular or bone extension.\n",
+    "summary": "16-year-old girl with a depressed gray plaque on the left thigh, with a vascular malformation affecting the skin and subcutaneous tissue evident by angioresonance.\n",
+    "translated_fulltext": "एक महिला रोगी, जिसकी उम्र 16 वर्ष है, उसके बाएं जांघ के निचले बाहरी हिस्से में 10.5 × 8.0 सेमी का एक धँसा हुआ, भूरे रंग का चपटा घाव है, जिसमें हल्के रंग के क्षेत्र बिखरे हुए हैं। टेलेंजिएक्टैटिक रक्त वाहिकाएँ घाव के चारों ओर फैली हुई हैं, और इसके पास दिखाई देने वाली नसें हैं। यह घाव जन्म से ही मौजूद था, लेकिन शुरू में इसका रंग बैंगनी था। समय के साथ, इसका रंग हल्का होता गया और यह धँसा हुआ होता गया। निचले अंगों की लंबाई में कोई अंतर नहीं है।\n\nएंजियोरेज़ोनेंस से पता चला कि त्वचा और उपचर्म ऊतक में संवहनी विकृतियाँ हैं, जिन्हें पॉपलाइटियल धमनी की अंतःपेशीय शाखाओं द्वारा रक्त की आपूर्ति की जाती है। दोनों क्षेत्रों और विकृतियों में प्रारंभिक शिरापरक भरण पाया गया, जो प्रारंभिक शिरापरक शंटिंग का संकेत देता है। फैले हुए निकास वाली नसों का कोई दस्तावेजी प्रमाण नहीं मिला, सिवाय एक सतही निकास वाली नस के जो जांघ के सामने की उपचर्म कोशिका ऊतक के साथ चलती है। इसके अतिरिक्त, संवहनी परिवर्तन के क्षेत्र में उपचर्म ऊतक का पतला होना देखा गया, लेकिन इसमें अंतःपेशीय या हड्डी तक कोई विस्तार नहीं था।",
+    "translated_summary": "16 साल की एक लड़की, जिसके बाएं जांघ पर एक धूसर रंग का, उभरा हुआ निशान है, और एंजियोरेज़ोनेंस से पता चलता है कि त्वचा और उपत्वचीय ऊतक में रक्त वाहिकाओं की असामान्यता है।",
+    "corrected_translated_fulltext": "১৬ বছর বয়সী এক মহিলা রোগী, বাম উরুর নিম্ন পার্শ্বীয় অংশে ১০.৫ × ৮.০ সেমি আকারের ধ্বসানো ধূসর প্লাক রয়েছে, যার মাঝে হাইপোক্রোমিক এলাকা ছড়িয়ে আছে। Telangiectatic রক্তনালিগুলি ক্ষতের পরিধিতে ওভারল্যাপ করছে, এবং এর নিকটে দৃশ্যমান শিরাগুলি রয়েছে। প্লাকটি জন্ম থেকেই উপস্থিত ছিল, তবে শুরুতে এটি বেগুনি আভাযুক্ত ছিল। বছরের পর বছর ধরে এটি রঙে হালকা হয়েছে এবং আরও ধ্বসানো হয়েছে। নিম্ন অঙ্গদ্বয়ের দৈর্ঘ্যে কোনো অমিল নেই।\n\nAngioresonance-এ দেখা গেছে যে ত্বক ও উপচর্ম টিস্যুতে ভাসকুলার ম্যালফরমেশন রয়েছে, যা পপ্লিটিয়াল আর্টারির আন্তঃপেশীয় শাখা দ্বারা সরবরাহিত। অঞ্চল এবং ম্যালফরমেশন উভয়েতেই প্রারম্ভিক ভেনাস ফিলিং পাওয়া গেছে, যা প্রারম্ভিক ভেনাস শান্টিং নির্দেশ করে। প্রসারিত ড্রেনিং শিরার কোনো নথিভুক্ত প্রমাণ পাওয়া যায়নি, কেবল একটি সুপারফিশিয়াল ড্রেনিং শিরা ব্যতীত যা উরুর সম্মুখ ভাগের সাবকিউটেনিয়াস সেলুলার টিস্যুর বরাবর চলেছে। অতিরিক্তভাবে, ভাসকুলার পরিবর্তনের টপোগ্রাফিতে উপচর্ম টিস্যুর পাতলা হওয়া লক্ষ্য করা হয়েছে, তবে কোনো অন্তঃপেশীয় বা অস্থিতে বিস্তার নেই।",
+    "corrected_translated_summary": "১৬ বছর বয়সী একটি মেয়ে, যার বাম উরুতে একটি অবনমিত ধূসর প্লাক রয়েছে, এবং angioresonance দ্বারা ত্বক ও উপচর্মীয় টিস্যুকে প্রভাবিত করা একটি vascular malformation প্রতীয়মান হয়েছে।"
+  },
+  {
+    "id": "multiclinsum_gs_en_491.txt",
+    "fulltext": "This is a 32-year-old patient, a baker, from Bamako, who was admitted to the Infectious and Tropical Diseases department of the CHU du Point G (Bamako, Mali) on 27 April 2023 for chronic productive cough, otalgia and a chronic right-sided purulent otorrhea.\n\nThe symptomatology would be of progressive installation in 1 month, initially treated in a medical center with artésunate, paracetamol and unspecified antibiotics for confirmed malaria and acute otitis media, without success. He is immunosuppressed by a HIV1 infection, diagnosed and put on a tritherapy antiretroviral (TARV) Tenofovir/Lamivudine/Dolutégravir 7 months ago, not observed due to denial of his illness.\n\nThe general physical examination found a fever (38.2 °C), altered general condition, otalgia, purulent right foul-smelling otorrhea, a right basal pulmonary condensation syndrome, a normal neurological examination, without the involvement of the cranial nerves, mainly the facial nerve VII and the VIII cochleovestibular nerve.\n\nIn the ENT examination, the otoscopy of the right ear showed an inflammatory external auditory canal with purulent secretions and the presence of a single tympanic perforation in the anterior-inferior quadrant. The left ear is normal. The Rinne and Weber test is in favor of a right conductive hearing loss.\n\nImmuno-virological evaluation shows a CD4 count of 118 cells/pl and a viral load of 12,370 copies/ml at the time of diagnosis of HIV infection, compared to a viral load of 9,460 copies/ml and a CD4 lymphocyte count of 193 cells/pl at the 6th month of antiretroviral treatment. At the time of diagnosis of tuberculosis at the 7th month, the immuno-virological evaluation shows a CD4 count of 89 cells/pl and a viral load of 10,230 copies/ml.\n\nThe Ziehl Neelsen bacilloscopy was positive with a cross in the gastric washings on admission and 19 days later in the right ear swab because of the persistent otorrhea. The Xpert-MTB/GeneXpert test did not detect rifampicin-resistant Mycobacterium tuberculosis.\n\nThe frontal chest radiograph shows a more accentuated bronchovascular network at the base of the right lung.\n\nThe diagnosis of tuberculosis of the middle ear concomitant to a pulmonary localization in the field of immunosuppression by HIV1 is therefore retained.\n\nThe patient is put on oral first-line anti-tuberculosis for 6 months, a fixed dose of a quadra-therapy in the intensive phase of isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months (2RHZE), followed by a bi-therapy in the maintenance phase of isoniazid and rifampicin for 4 months (4RH) at a dose of 3 tablets/day in the morning on an empty stomach, associated with vitamin B6 (1 tablet/day). He benefits from two sessions of therapeutic reinforcement with anti-retroviral drugs. The ART is restarted on 4 May 2023 with his consent, given the good tolerance of the anti-tuberculosis drugs, with the combination of tenofovir/lamivudine/dolutegravir at a dose of 1 tablet/day associated with dolutegravir 50 mg as a supplement (1 tablet/day) according to the protocol for the management of HIV/AIDS. A chemoprophylaxis with cotrimoxazole 960 mg (1 tablet/day) is undertaken as well as a cleaning of the external auditory canal by aspiration and the instillation of ciprofloxacin ear drops (2 drops 3 times a day) for 14 days.\n\nThe evolution is favorable after 14 days of treatment, marked by a pyrexia, a good general state, the amendment of the cough and otorrhea with the negativation of the bacilloscopy in the gastric tube liquid and the swab of the pus of the right ear. At the end of the maintenance anti-tuberculosis treatment, the clinical healing is complete with a normal ENT and neurological examination. The bacilloscopy associated with the Xpert-MTB/GeneXpert test at the end of the 2nd month of the intensive phase, during the 5th month and at the end of the 6th month of the maintenance phase were negative. The HIV viral load performed after 3 months of ART is 329 copies/ml.\n",
+    "summary": "The patient presented with a chronic productive cough, otalgia and a chronic right-sided purulent otorrhea. The search for acid-fast bacilli was positive by direct examination in the gastric tube liquid and the swab of the auricular pus.\n\nAn anti-tuberculosis treatment of 6 months, associated with adjuvants, led to the patient's complete recovery.\n",
+    "translated_fulltext": null,
+    "translated_summary": "मरीज को पुरानी खांसी, कान में दर्द और दाहिनी ओर से निकलने वाला मवादयुक्त स्राव की शिकायत थी। गैस्ट्रिक ट्यूब में मौजूद तरल पदार्थ और कान के मवाद के नमूने की सीधी जांच में एसिड-फास्ट बैसिली की उपस्थिति पाई गई।\n\nसहायक दवाओं के साथ 6 महीने तक एंटी-ट्यूबरकुलोसिस उपचार देने पर मरीज पूरी तरह से ठीक हो गया।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "রোগীর দীর্ঘস্থায়ী কফসহ কাশি, কানব্যথা এবং ডানদিকে দীর্ঘস্থায়ী পুঁজযুক্ত ওটোরিয়া ছিল। গ্যাস্ট্রিক টিউবের তরল ও কর্ণপুঁজের সোয়াবের সরাসরি পরীক্ষায় acid-fast bacilli পজিটিভ পাওয়া যায়।\n\nঅ্যাডজুভ্যান্টের সঙ্গে ৬ মাসের anti-tuberculosis চিকিৎসায় রোগী সম্পূর্ণ সুস্থ হয়ে ওঠেন।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0044_0045.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0044_0045.json
new file mode 100644
index 0000000000000000000000000000000000000000..244d57a213769ed1a7880faa915a8a227ce01d67
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0044_0045.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_90.txt",
+    "fulltext": "52-year-old male patient with no medical history, transferred from a lower-level hospital to our institution due to a tonic-clonic seizure secondary to alcohol withdrawal and non-reduced right LFGHP. He was evaluated by a traumatologist 24 hours after admission, and was found to be conscious, with bilateral ecchymosis of the shoulders and severe limitation of passive external rotation on both sides. In addition, the patient was restrained physically at this point, with both feet and his left hand held down by intermittent psychomotor agitation.\n\nThe initial evaluation included a thorough review of the patient's admission radiographs, which showed a right LFGHP and a left simple posterior dislocation. This second injury (simple posterior dislocation of the left shoulder) was not diagnosed at the referring facility, and took approximately 48 hours to be diagnosed at our facility.\n\nComputed tomography (CT) of both shoulders was requested to better characterize the injuries. These images showed a marked worsening of the left shoulder injury since the time of the first radiographic study, possibly secondary to the physical restraint of the patient. This evidence of progression from a simple left posterior glenohumeral dislocation on admission radiographs to a LFGHP on the CT taken 48 hours later.\n\n\nPlanning\n\nThe preoperative study of the right shoulder showed bone indemnity of the glenoid and 40% involvement of the articular surface of the humerus, but with a large fragment with the possibility of osteosynthesis in continuity with the lesser tuberosity, so it was planned to fix this fragment by spongeous screw 4.0 mm partial thread and high strength sutures. In the left shoulder, no significant bone defect was evidenced in the glenoid and the defect of the articular surface of the humerus was 20%, so it was planned to fill the defect with the fragment of the lesser tuberosity at the time of osteosynthesis (imitating the surgery of McLaughlin).\n\n\nSurgical technique\n\nOpen reduction and internal fixation with bilateral locked-plate is decided. The patient is placed in a beach chair position and the surgical fields are prepared in the usual way for the right shoulder. The fracture focus is accessed by a classic deltopectoral approach. A digital maneuver is performed to reduce the posterior fragment of the humeral head with a posterior mini-open incision of the size of a standard diagnostic arthroscopy portal. A provisional reduction of the fracture is achieved using high-strength sutures and needles. A partial 4.0 mm spongy screw and high-strength sutures are used to fix both fragments of the humeral head. Definitive fixation of the fracture with a Philos (Depuy Synthes®) plate achieves adequate reduction and stability of fragments. Fixation is increased with high-strength sutures to the tendons of the rotator cuff that are tied to the plate. Closure by planes of the right shoulder, healing and immobilization of the extremity with a universal shoulder immobilizer.\nThe surgical field of the left shoulder is immediately prepared. Classic deltopectoral approach is performed again to reach the fracture focus using an accessory posterior portal for digital manipulation and reduction of the humeral head. Fixation and osteosynthesis are performed in the same way as described for the right shoulder with the exception of the spongiosa screw, as the anterior fragment could be adequately fixed only with the use of high strength sutures.\nPostoperative management consisted of the use of bilateral shoulder immobilizer for four weeks. A pendular exercise of flexion-extension of the elbow and exercises of the fist were given to be performed from the second postoperative week to tolerance (according to the level of pain). In the radiographic control of the first month, loss of reduction of the greater left tuberosity was observed. It was decided to perform revision surgery achieving adequate fixation of the fragment with high-strength sutures.\nThe patient is left with a shoulder immobilizer for an additional four weeks on the left shoulder. The self-administered exercise regimen is restarted as described previously from the second postoperative week on a bilateral basis. At the sixth week after the revision surgery, face-to-face kinesiological therapy is initiated twice a week. After 30 sessions of kinesiological rehabilitation, the patient is able to return to work five months after the initial injury.\nFollow-up one year after the initial surgery shows that the patient has recovered strength and mobility in the right shoulder. The left shoulder still has severe limitations in the range of motion, especially in external rotation. At this point, it is decided to perform arthroscopic joint release surgery and remove the osteosynthesis in the left shoulder.\nIn his last check-up two years after the trauma, the patient showed a favorable evolution, consistent with the functional scales evaluated.\n",
+    "summary": "52-year-old male patient, transferred to a high-complexity center for a tonic-clonic convulsion and a right LFGHP. In the initial study with radiographs, a right shoulder injury was confirmed and a simple posterior glenohumeral dislocation of the left shoulder was diagnosed, which had not been previously detected. The study was complemented with a computed tomography (CT) of both shoulders, showing a bilateral LFGHP, which demonstrated intrahospital aggravation of the injury of the left shoulder. An open reduction and osteosynthesis with a bilateral blocked plate was performed in one time. The left shoulder required two reinterventions, one for osteosynthesis failure and another for joint release. Two years after the procedure, the patient was satisfactorily progressing with a 5% on the Quick DASH scale and a score of 72 and 76 on the Constant scale in the left and right shoulder, respectively.\n",
+    "translated_fulltext": null,
+    "translated_summary": "52 वर्षीय पुरुष रोगी, जिसे टॉनिक-क्लोनिक दौरे और दाहिनी तरफ़ की एलएफजीएचपी (LFGHP) के कारण एक उच्च-स्तरीय केंद्र में स्थानांतरित किया गया। प्रारंभिक एक्स-रे जांच में, दाहिने कंधे में चोट की पुष्टि हुई और बाएं कंधे में एक साधारण पश्चवर्ती ग्लेनोह्यूमरल अव्यवस्था का पता चला, जिसे पहले नहीं देखा गया था। जांच को दोनों कंधों की कंप्यूटेड टोमोग्राफी (सीटी) स्कैन से पूरा किया गया, जिसमें द्विपक्षीय एलएफजीएचपी दिखाई दी, जिससे पता चला कि अस्पताल में भर्ती होने के दौरान बाएं कंधे की चोट और बढ़ गई। एक ही प्रक्रिया में, द्विपक्षीय ब्लॉक्ड प्लेट के साथ ओपन रिडक्शन और ऑस्टियोसिंथेसिस किया गया। बाएं कंधे में दो बार पुन: हस्तक्षेप की आवश्यकता हुई, एक ऑस्टियोसिंथेसिस की विफलता के लिए और दूसरा जोड़ को मुक्त करने के लिए। प्रक्रिया के दो साल बाद, रोगी की स्थिति में संतोषजनक सुधार हुआ, क्विक डैश स्केल पर 5% स्कोर और बाएं और दाएं कंधे में क्रमशः कांस्टेंट स्केल पर 72 और 76 का स्कोर प्राप्त हुआ।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "52 বছর বয়সী পুরুষ রোগী, টনিক-ক্লোনিক খিঁচুনি এবং ডানদিকে LFGHP-এর জন্য একটি উচ্চ-জটিলতা কেন্দ্রে স্থানান্তরিত হন। প্রাথমিক রেডিওগ্রাফি অধ্যয়নে ডান কাঁধের আঘাত নিশ্চিত হয় এবং বাম কাঁধে একটি সরল পশ্চাৎ glenohumeral dislocation নির্ণয় করা হয়, যা আগে সনাক্ত করা হয়নি। অধ্যয়নটি উভয় কাঁধের computed tomography (CT) দিয়ে সম্পূরক করা হয়, যেখানে দ্বিপাক্ষিক LFGHP দেখা যায়, যা বাম কাঁধের আঘাতের হাসপাতালে থাকাকালীন অবনতি নির্দেশ করে। এক ধাপে bilateral blocked plate সহ open reduction এবং osteosynthesis করা হয়। বাম কাঁধে দুইবার পুনঃহস্তক্ষেপের প্রয়োজন হয়, একটি osteosynthesis failure-এর জন্য এবং আরেকটি joint release-এর জন্য। প্রক্রিয়ার দুই বছর পর, রোগীর অগ্রগতি সন্তোষজনক ছিল; Quick DASH স্কেলে 5% এবং Constant স্কেলে বাম ও ডান কাঁধে যথাক্রমে 72 ও 76 স্কোর।"
+  },
+  {
+    "id": "multiclinsum_gs_en_439.txt",
+    "fulltext": "A 70-year-old white man was treated for severe symptomatic aortic regurgitation due to healed endocarditis using TAVI from the apical approach. TAVI was performed at that time because he was considered a high-risk surgical patient due to secondary pulmonary hypertension, severely impaired left ventricular function with a left ventricular ejection fraction (LVEF) of 20%, chronic renal failure, and a logistic EuroSCORE I of 24.36%. At the time he was treated by diuretics (torasemide 20 mg once a day), an angiotensin-converting enzyme (ACE) inhibitor (ramipril 5 mg once a day), a ß-blocker (bisoprolol 2.5 mg twice a day), and an aldosterone antagonist (12.5 mg once a day). On admission he had cardiac decompensation and resulting dyspnea (temperature 36.7 °C, pulse 99/minute, blood pressure 109/48 mmHg) but his emotional status and neurological constitution were good. The laboratory results were unremarkable except for: a mild increase in liver enzymes, aspartate aminotransferase (AST) 59 U/l and alanine aminotransferase (ALT) 67 U/l; a known chronic renal insufficiency (creatinine 2.1 mg/dl); and a mild decrease in hemoglobin (Hb) 10.7 g/dl. No urine analysis was done. Due to normal C-reactive protein and normal count of leukocytes no microbiological examination was performed. After interdisciplinary discussion of the case (including a normal coronary angiography that was performed a few days before) and cardiac recompensation, he was initially treated with an implantation of a JenaValve 27 mm self-expandable valve. Despite a good result after implantation with the JenaValve and minimal transvalvular central insufficiency, he presented recurrent cardiac decompensation due to his severely impaired LVEF. His case was discussed again at an interdisciplinary meeting: 4 weeks after TAVI he underwent the implantation of a LVAD system (Thoratec® HeartMate II). His postoperative course was uneventful. He remained asymptomatic for 1 year until the LVAD system showed recurrent significant high flow alarms. Echocardiography examinations during this year showed a continuous increase in transvalvular central insufficiency to the level of a severe regurgitation without any sign for structural alteration of the leaflets of the JenaValve prosthesis. Treatment options were discussed and a new TAVI as valve-in-valve was decided.\n\nThe procedure was performed under general anesthesia using a CoreValve Evolut R 29 mm prosthesis. The prosthesis was implanted without prior valvuloplasty. The flow rate of LVAD was reduced to minimum and pacing with a frequency of 140 beats/minute was applied during placement of the valve prosthesis. Positioning was done with great care using fluoroscopic and transesophageal echocardiography (TEE) guidance with the aim of having the ventricular strut end of the CoreValve Evolut R prosthesis between the ventricular end and the “cusp feelers” of the JenaValve prosthesis. This position was obtained because of JenaValve structure and individual computed tomography analysis of our patient which had shown the ventricular edge of the JenaValve well positioned in left ventricular outflow tract (LVOT). The first positioning was successful with no need for repositioning. After the last fluoroscopic control the CoreValve Evolut R was released successfully in the planned position. Slow rapid pacing was stopped and the LVAD flow was increased and required good hemodynamic under normal LVAD flow. His postoperative course was uneventful and he has shown a very good recovery. A second TEE did not show any change regarding the performance of the valve-in-valve and only marginal residual insufficiency. At 12-month follow-up our patient had no complaints and had a satisfactory capacity in daily life. Echocardiography showed no relevant aortic regurgitation and an increase of LVEF to 33%. At that time the 6-minute walk test was significantly increased to 381 m (compared to 148 m on admission).",
+    "summary": "We report the case of a 70-year-old white man who was treated for severe symptomatic aortic regurgitation using transcatheter aortic valve implantation from the apical approach. Because of recurrent cardiac decompensation 4 weeks after implantation he underwent the implantation of a left ventricular assist device system. A year later echocardiography showed a severe transvalvular central insufficiency. Our heart team decided to choose a valve-in-valve approach while reducing the flow rate of left ventricular assist device to minimum and pacing with a frequency of 140 beats/minute. There was an excellent result and our patient is doing well with no relevant insufficiency of the aortic valve at 12-month follow-up.",
+    "translated_fulltext": null,
+    "translated_summary": "हम एक 70 वर्षीय श्वेत पुरुष के मामले की रिपोर्ट कर रहे हैं, जिसका गंभीर लक्षणयुक्त महाधमनी प्रतिगमन के लिए एपिकल दृष्टिकोण से ट्रांसकैथेटर महाधमनी वाल्व प्रत्यारोपण द्वारा इलाज किया गया था। प्रत्यारोपण के 4 सप्ताह बाद बार-बार होने वाले हृदय विफलता के कारण, उस पर एक बाएँ वेंट्रिकुलर असिस्ट डिवाइस प्रणाली का प्रत्यारोपण किया गया। एक वर्ष बाद इकोकार्डियोग्राफी में गंभीर ट्रांसवाल्वुलर केंद्रीय अपर्याप्तता दिखाई दी। हमारी हृदय टीम ने वाल्व-इन-वाल्व दृष्टिकोण का चयन करने का निर्णय लिया, साथ ही बाएँ वेंट्रिकुलर असिस्ट डिवाइस की प्रवाह दर को न्यूनतम तक कम किया और 140 बीट प्रति मिनट की आवृत्ति के साथ पेसिंग की। परिणाम उत्कृष्ट रहा और हमारे रोगी की स्थिति में सुधार हुआ, और 12 महीने के अनुवर्ती परीक्षण में महाधमनी वाल्व में कोई महत्वपूर्ण अपर्याप्तता नहीं पाई गई।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা 70 বছর বয়সী শ্বেতাঙ্গ এক পুরুষের মামলার রিপোর্ট করছি, যার গুরুতর লক্ষণযুক্ত aortic regurgitation-এর জন্য apical approach থেকে transcatheter aortic valve implantation দ্বারা চিকিৎসা করা হয়েছিল। ইমপ্লান্টেশনের 4 সপ্তাহ পর বারবার হওয়া হৃদ্‌যন্ত্রের ব্যর্থতার কারণে, তার ওপর একটি left ventricular assist device সিস্টেমের ইমপ্লান্টেশন করা হয়। এক বছর পরে echocardiography-তে গুরুতর transvalvular central insufficiency দেখা গেল। আমাদের হার্ট টিম valve-in-valve approach বেছে নেওয়ার সিদ্ধান্ত নিল, একই সাথে left ventricular assist device-এর flow rate ন্যূনতমে নামিয়ে এবং 140 beats/minute ফ্রিকোয়েন্সিতে পেসিং করা হলো। ফলাফল উৎকৃষ্ট ছিল এবং আমাদের রোগীর অবস্থার উন্নতি হয়েছে, এবং 12-মাসের ফলো-আপে aortic valve-এ কোনো উল্লেখযোগ্য insufficiency পাওয়া যায়নি।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0050_0051.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0050_0051.json
new file mode 100644
index 0000000000000000000000000000000000000000..dba1150bc7124a2dee9ea42954359821a7319b1e
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0050_0051.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_459.txt",
+    "fulltext": "40-year-old HIV-positive man with regular adherence to treatment (viral load 4500/mm3 and CD4 70/mm3 from the previous year), consulted for intermittent fever of two years' evolution that did not respect the standard time and gave way to transient antinflammatory non-steroidal drugs. He added in the last two months diffuse abdominal pain with predominance in the upper right lobe where he acquired a configuration of a tree in bud and bilateral pleural effusion, and at the abdominal level, marked increase of hepato-splenomegaly associated with ascites. After 48 hours of his suspension, he presented fulminant hepatic failure and was transferred to the intensive care unit. Tracheal aspirate was performed and after transfusion support a liver biopsy was obtained by puncture.  The patient died a few hours later. The postmortem culture of the tracheal aspirate was positive for Mycobacterium tuberculosis and the liver biopsy was performed with non-necrotizing granulomas and the rest of the parenchyma preserved. This work was carried out in accordance with the principles laid out in the ethical code of the WHO (Helsinki Declaration).\n",
+    "summary": "We present the case of a 40-year-old HIV-positive man with regular adherence to treatment, who consulted for intermittent febrile episodes of two years' evolution, adding in the last two months progressive diffuse abdominal pain and generalized adenomegaly. In the laboratory, he presented pancytopenia, coagulopathy, hypoalbuminemia and increased acute phase reactants. The computed tomography (CT) of the thorax, abdomen and pelvis only showed hepato-splenomegaly and generalized adenomegaly. Multiple microbiological examinations were performed, including cultures for Mycobacterium sp. of different samples, all with negative results, with the exception of RT-PCR for HHV-8. A left iliac ganglion biopsy was performed with findings consistent with Castleman's disease. Despite restarting antiretroviral therapy, the symptomatology progressed, initiating treatment with corticosteroids and ganciclovir. After a week, he developed multiple organ failure and anasarca, which contraindicated the drugs initiated. A new chest CT was performed that showed infiltrates with a tree-like pattern in the upper right lobe associated with bilateral pleural effusion, and at the abdominal level, progression of hepato-splenomegaly and ascites. He passed to the intensive care unit 48 hours later due to fulminant hepatic failure. The patient died within a few hours. A postmortem culture of the tracheal aspirate was received positive for Mycobacterium tuberculosis and a liver biopsy with non-necrotizing granulomas.\n",
+    "translated_fulltext": "40 वर्षीय एचआईवी-पॉजिटिव व्यक्ति, जो नियमित रूप से उपचार लेता था (पिछले वर्ष में वायरल लोड 4500/मिमी3 और सीडी4 70/मिमी3), दो वर्षों से चल रहे रुक-रुक कर आने वाले बुखार की शिकायत लेकर आया, जो किसी निश्चित समय पर नहीं होता था और जिसके कारण अस्थायी एंटी-इंफ्लेमेटरी गैर-स्टेरायडल दवाओं का उपयोग करना पड़ा। पिछले दो महीनों में, उसे पेट में व्यापक दर्द होने लगा, जो मुख्य रूप से ऊपरी दाहिने हिस्से में था, जहाँ एक कलीदार पेड़ जैसा आकार बन गया और द्विपक्षीय प्लूरल इफ्यूजन भी हुआ। पेट के स्तर पर, हेपेटो-स्प्लेनोमेगाली में उल्लेखनीय वृद्धि हुई, जिसके साथ एसाइट्स भी था। 48 घंटे के बाद, जब उसका उपचार बंद कर दिया गया, तो उसे तीव्र हेपेटिक विफलता हुई और उसे गहन चिकित्सा इकाई में स्थानांतरित कर दिया गया। ट्रेकियल एस्पिरेट किया गया और रक्त आधान के बाद, पंचर द्वारा यकृत बायोप्सी प्राप्त की गई। कुछ घंटों बाद मरीज की मृत्यु हो गई। ट्रेकियल एस्पिरेट की पोस्टमॉर्टम कल्चर में माइकोबैक्टीरियम ट्यूबरकुलोसिस पाया गया और यकृत बायोप्सी में गैर-नेक्रोटाइजिंग ग्रैनुलोमा और शेष पैरेन्काइमा संरक्षित पाया गया। यह कार्य डब्ल्यूएचओ के नैतिक संहिता (हेलसिंकी घोषणा) में निर्धारित सिद्धांतों के अनुसार किया गया।",
+    "translated_summary": "हम एक 40 वर्षीय एचआईवी-पॉजिटिव व्यक्ति के मामले को प्रस्तुत करते हैं, जो नियमित रूप से उपचार का पालन करता था। वह दो वर्षों से रुक-रुक कर बुखार की शिकायत लेकर आया, जिसके साथ पिछले दो महीनों में पेट में लगातार दर्द और पूरे शरीर में लिम्फ नोड्स में सूजन भी थी। प्रयोगशाला जांच में, उसमें पैंसीटोपेनिया, जमावट संबंधी विकार, हाइपोएल्ब्यूमिनेमिया और तीव्र चरण प्रतिक्रियाओं में वृद्धि देखी गई। छाती, पेट और श्रोणि का कंप्यूटेड टोमोग्राफी (सीटी) स्कैन करने पर केवल हेपेटो-स्प्लेनोमेगाली और पूरे शरीर में लिम्फ नोड्स में सूजन दिखाई दी। कई सूक्ष्मजैविक परीक्षण किए गए, जिनमें विभिन्न नमूनों के लिए माइकोबैक्टीरियम एसपी. की जांच भी शामिल थी, और सभी परीक्षणों के परिणाम नकारात्मक आए, सिवाय एचएचवी-8 के लिए आरटी-पीसीआर के। बाएं इलियाक गैंग्लियन की बायोप्सी की गई, जिसके परिणाम कैसलमैन रोग के अनुरूप थे। एंटीरेट्रोवाइरल थेरेपी फिर से शुरू करने के बावजूद, लक्षणों में वृद्धि हुई, जिसके बाद कॉर्टिकोस्टेरॉइड्स और गैन्सीक्लोविर से उपचार शुरू किया गया। एक सप्ताह के बाद, उसमें कई अंगों की विफलता और एनासारका विकसित हो गया, जिसके कारण शुरू की गई दवाएं अब उपयुक्त नहीं रहीं। एक नया छाती सीटी स्कैन किया गया, जिसमें ऊपरी दाएं लोब में पेड़ जैसी संरचना वाले घुसपैठ और दोनों तरफ फुफ्फुस बहाव दिखाई दिया, और पेट के स्तर पर, हेपेटो-स्प्लेनोमेगाली और जलोदर में वृद्धि देखी गई। तीव्र हेपेटिक विफलता के कारण 48 घंटे बाद उसे गहन चिकित्सा इकाई में स्थानांतरित कर दिया गया। रोगी की कुछ घंटों के भीतर मृत्यु हो गई। शव परीक्षण के बाद, श्वासनली से लिए गए नमूने की संस्कृति में माइकोबैक्टीरियम ट्यूबरकुलोसिस पाया गया और यकृत की बायोप्सी में गैर-नेक्रोटाइजिंग ग्रैनुलोमा पाए गए।",
+    "corrected_translated_fulltext": "40-বছর-বয়সী HIV-পজিটিভ ব্যক্তি, যিনি নিয়মিতভাবে চিকিৎসা মেনে চলছিলেন (গত বছরের viral load 4500/mm3 এবং CD4 70/mm3), দুই বছর ধরে চলা অনিয়মিত জ্বরের জন্য পরামর্শ নেন, যা মানক সময়চক্র মানত না এবং non-steroidal anti-inflammatory drugs (NSAIDs)-এ সাময়িকভাবে সাড়া দিত। গত দুই মাসে, তার বিস্তৃত পেটব্যথা শুরু হয়, যা প্রধানত উপরের ডান দিকে প্রাধান্য পায়, যেখানে tree-in-bud কনফিগারেশন দেখা যায় এবং bilateral pleural effusion হয়। পেটের স্তরে, hepato-splenomegaly উল্লেখযোগ্যভাবে বৃদ্ধি পায় এবং ascites যুক্ত ছিল। তার চিকিৎসা স্থগিতের 48 ঘণ্টা পর, তিনি fulminant hepatic failure নিয়ে উপস্থিত হন এবং তাকে intensive care unit-এ স্থানান্তর করা হয়। Tracheal aspirate করা হয় এবং transfusion support-এর পরে puncture দ্বারা liver biopsy নেওয়া হয়। কয়েক ঘণ্টা পরে রোগীর মৃত্যু হয়। Tracheal aspirate-এর postmortem culture Mycobacterium tuberculosis-এর জন্য পজিটিভ ছিল এবং liver biopsy-তে non-necrotizing granulomas পাওয়া যায়, বাকি parenchyma সংরক্ষিত ছিল। এই কাজটি WHO-এর নৈতিক বিধিমালা (Helsinki Declaration)-এ বর্ণিত নীতিমালার সাথে সামঞ্জস্য রেখে সম্পন্ন করা হয়েছে।",
+    "corrected_translated_summary": "আমরা ৪০ বছর বয়সী এক HIV-পজিটিভ পুরুষের একটি কেস উপস্থাপন করছি, যিনি নিয়মিতভাবে চিকিৎসা মেনে চলতেন। তিনি দুই বছর ধরে অনিয়মিত জ্বরের অভিযোগ নিয়ে আসেন, যার সঙ্গে গত দুই মাসে ক্রমাগত বিস্তৃত পেটের ব্যথা এবং সর্বাঙ্গে লিম্ফ নোডের স্ফীতি যুক্ত হয়েছিল। ল্যাবরেটরি পরীক্ষায় তাঁর pancytopenia, coagulopathy, hypoalbuminemia এবং acute phase reactants বৃদ্ধি পাওয়া যায়। বক্ষ, উদর ও পেলভিসের computed tomography (CT) তে কেবল hepatosplenomegaly এবং generalized adenomegaly দেখা যায়। একাধিক মাইক্রোবায়োলজিক পরীক্ষা করা হয়, যার মধ্যে বিভিন্ন নমুনায় Mycobacterium sp. এর জন্য কালচারও অন্তর্ভুক্ত ছিল, এবং সবগুলির ফল নেগেটিভ আসে, HHV-8 এর জন্য RT-PCR ব্যতীত। বাম iliac গ্যাংলিয়নের বায়োপসি করা হয়, যার ফলাফল Castleman’s disease এর সঙ্গে সঙ্গতিপূর্ণ ছিল। antiretroviral therapy পুনরায় শুরু করা সত্ত্বেও, উপসর্গ বৃদ্ধি পায়, পরবর্তীতে corticosteroids এবং ganciclovir দিয়ে চিকিৎসা শুরু করা হয়। এক সপ্তাহ পরে, তাঁর multiple organ failure এবং anasarca হয়, যার ফলে শুরু করা ওষুধগুলি contraindicated হয়ে যায়। একটি নতুন বক্ষ CT করা হয়, যেখানে ডান উপরের লোবে tree-in-bud প্যাটার্নসহ ইনফিলট্রেট এবং দ্বিপার্শ্বীয় pleural effusion দেখা যায়, এবং উদরীয় স্তরে hepatosplenomegaly ও ascites এর অগ্রগতি দেখা যায়। fulminant hepatic failure এর কারণে ৪৮ ঘণ্টা পরে তাঁকে intensive care unit এ স্থানান্তর করা হয়। রোগীর কয়েক ঘণ্টার মধ্যেই মৃত্যু হয়। মৃত্যুর পরবর্তী ট্র্যাকিয়াল অ্যাসপিরেটের কালচারে Mycobacterium tuberculosis পজিটিভ আসে এবং লিভার বায়োপসিতে non-necrotizing granulomas পাওয়া যায়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_59.txt",
+    "fulltext": "A 2-year-old female presented with a 1-year history of painless left progressive proptosis with no reported systemic diseases or family history. Ophthalmologic examination revealed light sensation as the only vision in the left eye, along with proptosis, inward and upward eyeball displacement, and restricted extraocular muscle movements in downward and outward directions. An irregularly shaped, well-defined soft mass was palpable in the inferior aspect of the left orbit, accompanied by left lower eyelid ectropion. The pupil was enlarged (4 mm in diameter), and pupillary reaction was absent. The remaining anterior segment examination showed no apparent abnormalities. Fundus examination was challenging due to the child’s size. Hertel exophthalmometry readings measured 10.5 mm in the right eye and 18 mm in the left. Magnetic resonance imaging (MRI) revealed a well-circumscribed mass, displaying hypointense signals on T1-weighted images and hyperintense signals on T2-weighted images. Contrast-enhanced imaging demonstrated no significant improvement. A transconjunctival approach via the inferior fornix with canthotomy and cantholysis was performed, revealing a grayish-white cystic mass with a distinct boundary from surrounding tissues. During posterior separation to the eyeballs’ posterior part, tight adhesion to the optic nerve was observed. Due to the mass’s substantial size and the restricted surgical field, volume reduction was necessary. Approximately 12.5 mL of the fluid was aspirated, and the mass was completely excised. Histopathological examination disclosed a fibrous capsule wall covered with squamous and glandular epithelium, along with visible brain tissue and a cartilage-like matrix consistent with orbital teratoma. One month postsurgery, the patient exhibited enophthalmos, conjunctival hyperemia, and keratitis on ocular examination. This was attributed to the mass’s prior enlargement of the orbital cavity, resulting in postoperative enophthalmos. The cornea could not adhere to the eyelids, creating a space and causing corneal inflammation. After obtaining the consent of the patient’s guardian, a second operation involved the implantation of an allogeneic sclera into the orbit to increase the orbital volume, alleviate fossa pitting and restore keratitis to normal. No recurrence of the teratomas was noted during the 1-year follow-up. The patient still had minor enophthalmos and outer canthus abnormality. The visual acuity remained consistent with pre-operation levels. Hertel exophthalmometry readings measured 10.5 mm in the right eye and 8 mm in the left. The remaining anterior segment examination showed no apparent abnormalities.",
+    "summary": "Patient concerns: A 2-year-old female child was presented exhibiting proptosis and inward and upward eyeball displacement. Enhanced magnetic resonance imaging revealed a well-circumscribed mass, persisting with hypointense signals on T1-weighted images (T1WI) and hyperintense signals on T2-weighted images (T2WI).\n\nDiagnoses: The diagnosis of teratoma was confirmed finally through histological and immunohistochemical exams.\n\nInterventions: A transconjunctival approach via the inferior fornix, coupled with canthotomy and cantholysis, was performed. However, a month postsurgery, the patient developed enophthalmos, conjunctival hyperemia, and keratitis upon ocular examination. A second operation involved the implantation of allogeneic sclera into the orbit to increase orbital volume, improve the pitting of the fossa, and restore keratitis to normal.\n\nOutcomes: No recurrence and other complications were noted during the 1-year follow-up.",
+    "translated_fulltext": "दो साल की एक बच्ची में एक साल से लगातार बाईं आंख में दर्द रहित, धीरे-धीरे बढ़ने वाली प्रोप्टोसिस (आंख का आगे की ओर निकलना) की शिकायत थी, और उसके कोई ज्ञात प्रणालीगत रोग या पारिवारिक इतिहास नहीं था। नेत्र संबंधी जांच में, बाईं आंख में केवल प्रकाश की अनुभूति पाई गई, साथ ही प्रोप्टोसिस, आंख का अंदर और ऊपर की ओर खिसकना, और नीचे और बाहर की दिशा में अतिरिक्त नेत्र मांसपेशियों की गति में कमी देखी गई। बाईं आंख के निचले हिस्से में एक अनियमित आकार का, स्पष्ट रूप से परिभाषित, नरम द्रव्यमान महसूस किया गया, जिसके साथ बाईं निचली पलक का एक्ट्रोपियन (पलक का बाहर की ओर मुड़ना) भी था। पुतली का आकार बढ़ा हुआ था (4 मिमी व्यास), और पुतली की प्रतिक्रिया अनुपस्थित थी। शेष पूर्वकाल खंड की जांच में कोई स्पष्ट असामान्यता नहीं पाई गई। बच्चे के छोटे आकार के कारण फंडस की जांच करना मुश्किल था। हर्टेल एक्सोफ्थल्मोमेट्री रीडिंग में दाहिनी आंख में 10.5 मिमी और बाईं आंख में 18 मिमी मापा गया। चुंबकीय अनुनाद इमेजिंग (एमआरआई) में एक अच्छी तरह से परिभाषित द्रव्यमान दिखाई दिया, जिसमें टी1-भारित छवियों पर हाइपोइंटेंस संकेत और टी2-भारित छवियों पर हाइपरइंटेंस संकेत थे। कंट्रास्ट-वर्धित इमेजिंग में कोई महत्वपूर्ण सुधार नहीं देखा गया। एक ट्रांसकंजंक्टिवल दृष्टिकोण का उपयोग करके, निचले फोर्निक्स के माध्यम से कैंथोटोमी और कैंथोलिसिस किया गया, जिससे एक धूसर-सफेद सिस्टिक द्रव्यमान का पता चला, जिसकी सीमा आसपास के ऊतकों से स्पष्ट थी। आंखों के पिछले हिस्से से पीछे की ओर अलग करते समय, ऑप्टिक तंत्रिका से कसकर जुड़ाव देखा गया। द्रव्यमान के महत्वपूर्ण आकार और सीमित शल्य क्षेत्र के कारण, आयतन में कमी करना आवश्यक था। लगभग 12.5 मिलीलीटर तरल पदार्थ निकाला गया, और द्रव्यमान को पूरी तरह से हटा दिया गया। हिस्टोपैथोलॉजिकल जांच में स्क्वैमस और ग्रंथि संबंधी उपकला से ढका एक रेशेदार कैप्सूल की दीवार, साथ ही दृश्यमान मस्तिष्क ऊतक और एक उपास्थि जैसी मैट्रिक्स पाई गई, जो कक्षीय टेराटोमा के अनुरूप थी। एक महीने बाद, रोगी में एनोफ्थल्मोस (आंख का अंदर की ओर धंसना), कंजंक्टिवल हाइपरमिया (आंख की सफेद परत का लाल होना), और नेत्रश्लेष्मलाशोथ (कॉर्निया की सूजन) पाया गया। इसे कक्षीय गुहा के पूर्व में बढ़े हुए आकार के कारण माना गया, जिसके परिणामस्वरूप शल्य चिकित्सा के बाद एनोफ्थल्मोस हुआ। कॉर्निया पलकों से चिपक नहीं पाया, जिससे एक जगह बन गई और कॉर्निया में सूजन हो गई। रोगी के अभिभावक की सहमति प्राप्त करने के बाद, कक्षीय आयतन को बढ़ाने, फोसा पिटिंग को कम करने और नेत्रश्लेष्मलाशोथ को सामान्य करने के लिए एक दूसरी सर्जरी में एक एलोजेनिक स्क्लेरा को कक्ष में प्रत्यारोपित किया गया। एक साल के अनुवर्ती अवधि के दौरान टेराटोमा का कोई पुनरावर्तन नहीं देखा गया। रोगी में अभी भी मामूली एनोफ्थल्मोस और बाहरी कैंथस असामान्यता थी। दृश्य तीक्ष्णता पूर्व-शल्य चिकित्सा स्तर के अनुरूप बनी रही। हर्टेल एक्सोफ्थल्मोमेट्री रीडिंग में दाहिनी आंख में 10.5 मिमी और बाईं आंख में 8 मिमी मापा गया। शेष पूर्वकाल खंड की जांच में कोई स्पष्ट असामान्यता नहीं पाई गई।",
+    "translated_summary": "मरीज़ की शिकायतें: दो साल की एक बच्ची को प्रोप्टोसिस और अंदर की ओर और ऊपर की ओर आँख की पुतली के खिसकने के साथ लाया गया। बेहतर मैग्नेटिक रेजोनेंस इमेजिंग में एक स्पष्ट रूप से परिभाषित द्रव्यमान पाया गया, जो टी1-भारित छवियों (टी1डब्ल्यूआई) पर हाइपोइंटेंस संकेतों और टी2-भारित छवियों (टी2डब्ल्यूआई) पर हाइपरइंटेंस संकेतों के साथ बना रहा।\n\nनिदान: टेराटोमा का निदान अंततः हिस्टोलॉजिकल और इम्यूनोहिस्टोकेमिकल परीक्षणों के माध्यम से पुष्टि की गई।\n\nउपचार: अवर निम्न नेत्रकोटर के माध्यम से ट्रांसकंजंक्टिवल दृष्टिकोण, कैंथोटोमी और कैंथोलिसिस के साथ किया गया। हालाँकि, सर्जरी के एक महीने बाद, नेत्र परीक्षण पर मरीज़ में एनोफ्थैल्मोस, कंजंक्टिवल हाइपरमिया और केराटाइटिस विकसित हो गया। दूसरी सर्जरी में कक्षीय मात्रा बढ़ाने, गड्ढे की स्थिति को बेहतर बनाने और केराटाइटिस को सामान्य करने के लिए कक्ष में एलोजेनिक स्क्लेरा का प्रत्यारोपण किया गया।\n\nपरिणाम: एक साल के अनुवर्ती अवधि के दौरान कोई पुनरावृत्ति या अन्य जटिलताएं नहीं देखी गईं।",
+    "corrected_translated_fulltext": "২ বছর বয়সী একটি কন্যাশিশুর এক বছর ধরে বাম চোখে ব্যথাহীন, ধীরে ধীরে বৃদ্ধি পাওয়া proptosis (চোখের সামনের দিকে বেরিয়ে আসা) ছিল, এবং কোনো পরিচিত systemic রোগ বা পারিবারিক ইতিহাস ছিল না। চক্ষু পরীক্ষায় বাম চোখে শুধুমাত্র আলো অনুভূতি পাওয়া গেল, সাথে proptosis, চোখের ভেতরের ও উপরের দিকে সরে যাওয়া, এবং নিচের ও বাইরের দিকে extraocular muscle-গুলোর নড়াচড়ায় সীমাবদ্ধতা দেখা গেল। বাম কক্ষপথের নিম্ন অংশে একটি অনিয়মিত আকৃতির, সুস্পষ্টভাবে নির্ধারিত, নরম mass স্পর্শে অনুভূত হলো, সাথে বাম নিম্ন চোখের পাতার ectropion (পালকের বাইরে দিকে মোড় নেওয়া) ছিল। পিউপিল বড় ছিল (ব্যাস 4 mm), এবং pupillary reaction অনুপস্থিত ছিল। বাকি anterior segment পরীক্ষায় কোনো সুস্পষ্ট অস্বাভাবিকতা দেখা যায়নি। শিশুটির ছোট আকারের কারণে fundus পরীক্ষা করা কঠিন ছিল। Hertel exophthalmometry readings-এ ডান চোখে 10.5 mm এবং বাম চোখে 18 mm মাপা হয়েছে। Magnetic resonance imaging (MRI)-এ একটি সুস্পষ্টভাবে সীমানাযুক্ত mass দেখা গেল, যা T1-weighted ইমেজে hypointense সিগন্যাল এবং T2-weighted ইমেজে hyperintense সিগন্যাল প্রদর্শন করছিল। Contrast-enhanced imaging-এ কোনো উল্লেখযোগ্য enhancement দেখা যায়নি। একটি transconjunctival approach ব্যবহার করে inferior fornix-এর মাধ্যমে canthotomy এবং cantholysis করা হয়, যাতে একটি ধূসর-সাদা cystic mass দেখা যায়, যার সীমানা পার্শ্ববর্তী টিস্যু থেকে স্পষ্ট ছিল। পশ্চাদ্ভাগে eyeball-এর posterior অংশের দিকে পৃথকীকরণের সময় optic nerve-এর সঙ্গে টাইট adhesion লক্ষ্য করা হয়। mass-এর উল্লেখযোগ্য আকার এবং সীমিত surgical field-এর কারণে, volume reduction প্রয়োজনীয় ছিল। প্রায় 12.5 mL তরল aspirate করা হয়, এবং mass সম্পূর্ণরূপে excised করা হয়। Histopathological পরীক্ষায় squamous এবং glandular epithelium-দ্বারা আবৃত একটি fibrous capsule wall, সাথে দৃশ্যমান brain tissue এবং cartilage-like matrix ধরা পড়ে, যা orbital teratoma-এর সাথে সামঞ্জস্যপূর্ণ। অস্ত্রোপচারের এক মাস পর, রোগীর ocular পরীক্ষায় enophthalmos (চোখ ভেতরের দিকে দেবে যাওয়া), conjunctival hyperemia (চোখের সাদার লাল হওয়া), এবং keratitis (কর্নিয়ার প্রদাহ) দেখা যায়। এটি orbital cavity-র পূর্ববর্তী বৃদ্ধি পাওয়া আকারের জন্য দায়ী বলে ধরা হয়, যার ফলস্বরূপ অপারেশন-পরবর্তী enophthalmos হয়েছে। কর্নিয়া পালকের সঙ্গে লেগে থাকতে পারেনি, ফলে একটি ফাঁক সৃষ্টি হয়ে কর্নিয়ায় প্রদাহ হয়েছে। রোগীর অভিভাবকের সম্মতি নেওয়ার পর, orbital volume বৃদ্ধি, fossa pitting হ্রাস এবং keratitis স্বাভাবিক করার উদ্দেশ্যে দ্বিতীয় অস্ত্রোপচারে orbit-এ একটি allogeneic sclera প্রতিস্থাপন করা হয়। এক বছরের ফলো-আপ চলাকালীন teratoma-র কোনো পুনরাবৃত্তি দেখা যায়নি। রোগীর এখনও সামান্য enophthalmos এবং outer canthus-এ অস্বাভাবিকতা ছিল। visual acuity প্রি-অপারেশন স্তরের সঙ্গে সামঞ্জস্যপূর্ণ ছিল। Hertel exophthalmometry readings-এ ডান চোখে 10.5 mm এবং বাম চোখে 8 mm মাপা হয়েছে। বাকি anterior segment পরীক্ষায় কোনো সুস্পষ্ট অস্বাভাবিকতা দেখা যায়নি।",
+    "corrected_translated_summary": "রোগীর অভিযোগ: ২ বছরের এক কন্যাশিশুকে proptosis এবং চোখের বলের ভেতরের দিকে ও ওপরের দিকে স্থানচ্যুতি নিয়ে আনা হয়েছিল। Enhanced magnetic resonance imaging-এ একটি সুস্পষ্টভাবে সীমাবদ্ধ mass দেখা যায়, যা T1-weighted images (T1WI)-এ hypointense সিগন্যাল এবং T2-weighted images (T2WI)-এ hyperintense সিগন্যাল হিসেবে স্থায়ী ছিল।\n\nনির্ণয়: টেরাটোমার নির্ণয় শেষ পর্যন্ত histological এবং immunohistochemical পরীক্ষার মাধ্যমে নিশ্চিত করা হয়েছে।\n\nহস্তক্ষেপ: inferior fornix-এর মাধ্যমে transconjunctival approach, সঙ্গে canthotomy এবং cantholysis করা হয়েছিল। তবে সার্জারির এক মাস পরে, চক্ষু পরীক্ষায় রোগীর enophthalmos, conjunctival hyperemia এবং keratitis বিকশিত হয়। দ্বিতীয় অপারেশনে orbital volume বৃদ্ধি, ফোসার পিটিং উন্নত করা এবং keratitis স্বাভাবিক অবস্থায় ফিরিয়ে আনতে orbit-এ allogeneic sclera ইমপ্লান্টেশন করা হয়েছিল।\n\nফলাফল: ১ বছরের ফলো-আপে কোনো পুনরাবৃত্তি বা অন্যান্য জটিলতা দেখা যায়নি।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0052_0053.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0052_0053.json
new file mode 100644
index 0000000000000000000000000000000000000000..edec5997c288e80cc023537c09a8f0dff4404980
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0052_0053.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_590.txt",
+    "fulltext": "A 57-year-old woman with a 14-year history of asthma and allergic rhinitis, on salmeterol/fluticasone, was hospitalized for recurrent abdominal pain that began two months earlier. The pain was intermittent and dull, accompanied by nausea, anorexia, malaise, and a weight loss of 5 kg. There was no fever, blood / mucus in the stool, or respiratory symptoms (rhinorrhea, wheezing, coughing). She had no history of alcohol/tobacco use or traditional herbal medicines. Six weeks before admission, she was diagnosed with an intestinal infection in a local clinic after a complete blood count (CBC) revealed leukocytosis and significant eosinophilia (25.61 G/L, 77.8% eosinophils). She received antibiotics and mebendazole without relief of symptoms. At presentation, the patient was alerted and oriented with stable vitals (BP 110/70 mmHg, T 37°C, HR 88 bpm, RR 18 bpm). She had a BMI of 16.6 kg/m² and sarcopenia, but no skin rash, lymphadenopathy, or edema. The abdominal exam showed tenderness in the epigastric and umbilical regions without guarding. CBC revealed leukocytosis and significant eosinophilia (20.8 G/L, with a total white blood cell count of 26.8 G/L, comprising 77.8% eosinophils). Peripheral blood film examination showed normal eosinophils. Bone marrow aspiration reveals 48% eosinophils without blasts, atypical cells. Fluorescence in situ hybridization (FISH) for CHIC2 deletion as a surrogate marker for FIP1L1-PDGFRA showed no rearrangements of the PDGFRA gene. Autoimmune and vasculitis screenings (ANA, anti-dsDNA, p-ANCA, c-ANCA) were negative. Elevated serum IgG (2760 mg/dL; normal range, 700–1600 mg/dL) and IgG4 (1260 mg/dL; normal range, 3.9–86.4 mg/dL), slightly elevated IgE (137.5 IU/mL; normal range, <100 IU/mL) and high RF (144.4 IU/mL; normal range, <20 IU/mL) were observed. Other parameters were normal, including aminotransferase, blood urea nitrogen, serum creatinine, complement C3, complement C4, vitamin B12, serum cortisol, and NT-proBNP. ECG and echocardiogram were normal. Chest CT scans showed mild fibrosis and bronchiectasis. Sputum AFB smears and bronchoscopy were negative. The cytology of the bronchoalveolar lavage fluid showed 35% neutrophils, no eosinophils. Spirometry indicated severe obstruction with bronchodilator response. The fractional exhaled nitric oxide (FeNO) level was 15 ppb. Stool samples were tested positive for leukocytes, with no signs of ova or parasites. Serology tests were positive for toxocariasis (positive IgG of Toxocara canis at 54.2 NovaTec-Units) but negative for Strongyloides stercoralis, Fasciola sp., Toxoplasma gondii, Trichinella spiralis, Ancylostoma sp., Angiostrongylus cantonensis, Ascaris lumbricoides, Clonorchis sinensis, Paragonimus sp., Gnathostoma sp., Entamoeba histolytica, cysticercosis, filariasis, and HIV. An abdominal contrast-enhanced computed tomography scan revealed gallbladder stones without acute cholecystitis and showed no gastrointestinal tract abnormalities. The upper gastrointestinal endoscopy showed unremarkable results with a normal appearance. Colonoscopy showed mucosal inflammation in the sigmoid, left, transverse, and right colon with systemic biopsy. A five-day course of albendazole (400 mg twice daily) for suspected toxocariasis was ineffective. Colonic biopsies revealed significant eosinophilic infiltration (>85 eosinophils/High-power field (HPF) in the left colon, >100 eosinophils/HPF in the transverse and right colon). Given the patient’s nonresponse to toxocariasis treatment and the significant eosinophilic infiltration observed in the colon mucosa biopsy, a diagnosis of eosinophilic colitis was confirmed. The patient was treated with oral methylprednisolone (16 mg) and montelukast (5 mg). Symptoms resolved in two weeks and eosinophil counts normalized (0.3 G/L). The corticosteroid was reduced and discontinued, and the patient was maintained on montelukast for three months without symptom recurrence.",
+    "summary": "We present a unique case of a 57-year-old patient with a medical history of asthma and allergic rhinitis who presented recurrent abdominal pain, significant blood eosinophilia, and elevated levels of Immunoglobulin G4. After ruling out hematological and secondary causes of eosinophilia, a biopsy of the colon mucosa revealed an excess of tissue eosinophils, confirming the diagnosis of EoC. The patient responded well to corticosteroids and was subsequently maintained on montelukast, with no recurrence of symptoms over 3 months.",
+    "translated_fulltext": null,
+    "translated_summary": "हम एक अनूठे मामले को प्रस्तुत करते हैं, जिसमें 57 वर्षीय रोगी को दमा और एलर्जी संबंधी राइनाइटिस का इतिहास रहा है, और वह बार-बार पेट दर्द, महत्वपूर्ण रक्त इओसिनोफिलिया और इम्यूनोग्लोबुलिन जी4 के उच्च स्तर के साथ उपस्थित हुआ। रक्त संबंधी और अन्य कारणों से होने वाले इओसिनोफिलिया को खारिज करने के बाद, कोलन म्यूकोसा की बायोप्सी में ऊतक इओसिनोफिल की अधिकता पाई गई, जिससे EoC के निदान की पुष्टि हुई। रोगी ने कॉर्टिकोस्टेरॉइड्स के प्रति अच्छी प्रतिक्रिया दी और बाद में उसे मोंटेलुकास्ट पर रखा गया, और 3 महीने की अवधि में लक्षणों की पुनरावृत्ति नहीं हुई।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা ৫৭ বছর বয়সী এক রোগীর একটি অনন্য কেস উপস্থাপন করছি, যার asthma এবং allergic rhinitis-এর ইতিহাস রয়েছে, এবং যিনি পুনরাবৃত্ত পেটব্যথা, উল্লেখযোগ্য রক্ত eosinophilia, এবং Immunoglobulin G4-এর উচ্চ মাত্রা নিয়ে উপস্থিত হয়েছিলেন। eosinophilia-এর hematological ও secondary কারণগুলো বাদ দেওয়ার পর, colon mucosa-র বায়োপসিতে tissue eosinophils-এর অতিরিক্ততা ধরা পড়ে, যা EoC-এর নির্ণয় নিশ্চিত করে। রোগী corticosteroids-এ ভালো সাড়া দেন এবং পরবর্তীতে montelukast-এ রাখা হয়; ৩ মাস ধরে উপসর্গের পুনরাবৃত্তি হয়নি।"
+  },
+  {
+    "id": "multiclinsum_gs_en_569.txt",
+    "fulltext": "A 38-year-old male presented to the hospital with chest tightness and shortness of breath. Three years prior, he had experienced similar symptoms post-activity and received treatment at our hospital. Outpatient echocardiography indicated a left heart echomass suggestive of a myxoma, which led to his admission for further evaluation. Physical examination revealed pigmentation of the patient’s ears characterized by multiple small brown and black spots. Abdominal computed tomography (CT) showed multiple livers and small cysts in the left kidney. Genetic testing identified mutations in the TTN and PRKAR1A genes. The diagnosis of CNC was confirmed through clinical examination, imaging, and genetic testing. Following symptomatic treatment, the patient’s condition improved; however, he refused surgical intervention. On September 20, 2023, the patient presented to our hospital with exacerbated chest tightness and dyspnea. He reported difficulty lying supine and needing to sit upright to breathe. Physical examination revealed jugular vein distension, leftward and downward displacement of the heart boundary, irregular heart rhythm on auscultation, and a mitral valve murmur of intensity 2/6–3/6 in the fourth intercostal space along the left sternal margin. Wet rales were audible in both middle and lower lung fields. Palpation revealed a firm liver extending three fingers below the xiphoid process and two fingers below the rib cage, along with mild pitting edema in both lower limbs. Echocardiographic images indicated global heart enlargement, dilation of the aortic sinus and pulmonary artery, small-to-moderate mitral valve regurgitation, and an irregular echoic mass measuring 54 mm ×43 mm in the left chamber attached to the atrial septum. The left ventricular (LV) ejection fraction (EF) was 23.1%, with fractional shortening (FS) of 10.9%. Electrocardiography demonstrated atrial fibrillation (average ventricular rate, 150 beats/min) and abnormal Q waves in leads V1-V3. Based on the patient’s history, the diagnosis included DCM and CNC with cardiac myxoma. Given the presence of end-stage heart failure and concurrent cardiac myxoma, the patient was hospitalized, and heart transplantation was considered a viable therapeutic option to address both conditions simultaneously. A suitable donor heart became available for immediate transplantation on October 1, 2024.\n\n\nSurgical procedure\n\nThe skin and subcutaneous tissues were carefully incised layer-by-layer through a median sternotomy. The sternum was sawed longitudinally open, and bleeding was controlled using electrocoagulation and bone wax. Extracardiac exploration uncovered global heart enlargement, most prominent in the LV. The heart showed diminished contractile strength. The aorta and the main pulmonary artery (PA) were dissected from the supravalvular region. Some tissues were preserved for posterior suturing, whereas most diseased right atrium, left atrium(LA), right ventricle, and LV were excised. Resection revealed a greyish-white mucoid mass. The donor and residual recipient LA tissues were sutured using double continuous 3/0 Prolene threads. The anastomosis was meticulously inspected multiple times, and no significant bleeding was observed. Similarly, end-to-end anastomosis of the donor ascending aorta and recipient PA was performed using continuous 5/0 Prolene sutures, and careful inspection revealed no bleeding.\n\nFurthermore, the donor’s LA and recipient’s PA were securely closed using double continuous 5/0 Prolene sutures. The inferior vena cava tissues of both the donor and recipient were similarly sutured with 5/0 Prolene sutures, and several inspections were performed to confirm no significant bleeding was present. The left side of the heart was then deflated, and as rewarming commenced, oxygenation was restored, the ascending aorta was unclamped, and the heart spontaneously returned to sinus rhythm. Continuous suturing with 5/0 Prolene was applied to both the donor and recipient’s superior vena cava and diligently inspected to ensure the absence of significant bleeding. After the successful discontinuation of assisted circulation, the venous cavity was decannulated. Tissue samples from the patient’s left heart and gray matter were collected for histopathological examination, and the diagnosis of DCM and cardiac myxoma were confirmed.\n\n\nPostoperative management\n\nOn the first day after heart transplantation, the patient produced 1200 ml of urine. Laboratory tests revealed a hypersensitive troponin T level of 796.70ng/L and an NT-proBNP level of 10798pg/ml. The complete blood count showed white blood cells at 17.15 × 109/L, with no significant abnormalities in other test results. The echocardiograph displayed an LVEF of 65%, FS of 35%, normal ventricular wall thickness and echogenicity, and no discernible abnormalities in valve morphology and structure. After heart transplantation, Methylprednisolone Sodium Succinate (0.25 g)intravenous hormone therapy was administered to enhance immunity, and Cefoperazone and Sulbactam Sodium (2 g) intravenous anti-infection treatment was provided. The patient was given a nutrient solution and liver and tiopronin on the first day post-surgery. On postoperative day three, Methylprednisolone Sodium Succinate was replaced with oral Prednisone Acetate (25 mg). Mycophenolate Mofetil capsules (0.5 g) were administered orally to minimize heart rejection, and (50 mg) of Carpofungin Acetate was administered intravenously to prevent fungal infections. The patient’s urine output was 2000 ml, with hypersensitive troponin T levels of 390ng/L, NT-proBNP levels of 7877pg/ml, and a leukocyte count of 12.15 × 109/L. On the 7th day post-surgery, tacrolimus capsules were introduced at an oral dose of (1 mg) to minimize the patient’s rejection of the donor heart, with careful monitoring of blood concentrations. Subsequently, the oral dosage of Prednisone Acetate was gradually decreased to (10 mg) while adjusting the tacrolimus blood concentration to 10.90ng/ml. The patient’s recovery improved. On October 20, 2023, follow-up echocardiography (Fig. 6) indicated no abnormalities, with troponin levels of 85 ng/L, NT-proBNP of 210pg/ml, and all other test results within normal ranges. The patient exhibited excellent postoperative recovery and was discharged. Regular follow-up visits to our department after discharge showed that the patient remains in good condition.",
+    "summary": "Herein, we report a case of heart failure due to Carney syndrome that resulted in cardiac myxoma combined with dilated cardiomyopathy. A 35-year-old male was admitted to the hospital three years ago because of sudden chest tightness and shortness of breath. Echocardiography indicated myxoma, and a combination of genetic screening and physical examination confirmed Carney syndrome with cardiac myxoma. Following symptomatic management, he was discharged. Surgical interventions were not considered at the time. However, the patient’s chest tightness and shortness of breath symptoms worsened, and he returned to the hospital. A New York Heart Association grade IV heart function was confirmed, and echocardiography indicated the presence of dilated cardiomyopathy accompanied by cardiac myxoma. Ultimately, the patient’s heart failure was successfully treated with heart transplantation.",
+    "translated_fulltext": null,
+    "translated_summary": "यहाँ, हम कार्नी सिंड्रोम के कारण हृदय विफलता के एक मामले की रिपोर्ट कर रहे हैं, जिसके परिणामस्वरूप हृदय में मायक्सोमा और साथ ही फैलाव वाले कार्डियोमायोपैथी का संयोजन हुआ। 35 वर्षीय एक पुरुष को तीन साल पहले अचानक सीने में जकड़न और सांस लेने में तकलीफ के कारण अस्पताल में भर्ती कराया गया था। इकोकार्डियोग्राफी में मायक्सोमा का पता चला, और आनुवंशिक जांच और शारीरिक परीक्षण के संयोजन से हृदय में मायक्सोमा के साथ कार्नी सिंड्रोम की पुष्टि हुई। लक्षणों के आधार पर उपचार के बाद, उसे छुट्टी दे दी गई। उस समय, शल्य चिकित्सा हस्तक्षेप पर विचार नहीं किया गया। हालांकि, रोगी की सीने में जकड़न और सांस लेने में तकलीफ के लक्षण बढ़ गए, और वह अस्पताल वापस आया। न्यूयॉर्क हार्ट एसोसिएशन ग्रेड IV के हृदय कार्य की पुष्टि की गई, और इकोकार्डियोग्राफी में फैलाव वाले कार्डियोमायोपैथी के साथ हृदय में मायक्सोमा की उपस्थिति का पता चला। अंततः, रोगी की हृदय विफलता का सफलतापूर्वक हृदय प्रत्यारोपण के माध्यम से इलाज किया गया।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "এখানে, আমরা Carney syndrome-এর কারণে heart failure-এর একটি কেস রিপোর্ট করছি, যার ফলস্বরূপ cardiac myxoma এবং সঙ্গে dilated cardiomyopathy-এর সমন্বয় হয়েছে। ৩৫ বছর বয়সী এক পুরুষকে তিন বছর আগে হঠাৎ বুকে চাপ এবং শ্বাসকষ্টের কারণে হাসপাতালে ভর্তি করা হয়েছিল। Echocardiography-তে myxoma ধরা পড়ে, এবং genetic screening ও physical examination-এর সমন্বয়ে cardiac myxoma-সহ Carney syndrome নিশ্চিত হয়। লক্ষণভিত্তিক চিকিৎসার পর, তাকে ছুটি দেওয়া হয়। সেই সময়, শল্যচিকিৎসা হস্তক্ষেপ বিবেচনা করা হয়নি। তবে, রোগীর বুকে চাপ এবং শ্বাসকষ্টের উপসর্গ বেড়ে যায়, এবং তিনি হাসপাতালে ফিরে আসেন। New York Heart Association grade IV heart function নিশ্চিত হয়, এবং echocardiography-তে dilated cardiomyopathy-এর সঙ্গে cardiac myxoma-এর উপস্থিতি ধরা পড়ে। অবশেষে, রোগীর heart failure সফলভাবে heart transplantation-এর মাধ্যমে চিকিৎসা করা হয়।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0058_0059.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0058_0059.json
new file mode 100644
index 0000000000000000000000000000000000000000..13577edb0375faf096e6ad4e68d6054447259109
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0058_0059.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_443.txt",
+    "fulltext": "65-year-old woman with no relevant personal or family history. In August 2022, a posterior mediastinal tumour was found in the preoperative assessment for a knee surgery, which was why she was referred for evaluation and treatment. On admission, the physical examination was not relevant and the laboratory studies were within normal parameters. A chest CT scan was performed that showed a tumour located in the posterior right mediastinum measuring 6.5 × 4.2 cm, with well-defined borders, with a fat and solid density, with no evidence of bone erosion or infiltration of surrounding tissue. A biopsy of the lesion was performed using a 18G × 250 mm semiautomatic cutting needle, with image guidance, through a posterior approach. In the histopathological study, a benign neoplasm consisting of mature adipose tissue with areas of haemorrhage alternating with haematopoietic elements, predominantly precursors of the red series, was observed, as well as elements of the myeloid series in different stages of maturation and megakaryocytes, which established the diagnosis of MPM.  Finally, with the diagnosis established and the characteristics of the lesion, conservative management was decided. The patient evolved satisfactorily and was discharged without complications.\n",
+    "summary": "We present the case of a 65-year-old woman with a primary mediastinal myelolipoma. Computed tomography of the chest showed an ovoid, well-defined bordered tumor of 6.5 × 4.2 cm, located in the posterior mediastinum. A trans-thoracic biopsy of the lesion was performed and microscopic examination revealed haemopoietic elements and mature adipose tissue.\n",
+    "translated_fulltext": "65 वर्षीय महिला, जिसका कोई प्रासंगिक व्यक्तिगत या पारिवारिक इतिहास नहीं है। अगस्त 2022 में, घुटने की सर्जरी से पहले की जांच में, उसके पोस्टीरियर मेडियास्टिनल क्षेत्र में एक ट्यूमर पाया गया, जिसके कारण उसे मूल्यांकन और उपचार के लिए भेजा गया। अस्पताल में भर्ती होने पर, शारीरिक जांच में कोई विशेष बात नहीं मिली और प्रयोगशाला परीक्षण सामान्य सीमा के भीतर थे। एक छाती का सीटी स्कैन किया गया, जिसमें 6.5 × 4.2 सेमी आकार का एक ट्यूमर, जो पोस्टीरियर राइट मेडियास्टिनम में स्थित था, स्पष्ट सीमाओं के साथ, वसा और ठोस घनत्व के साथ पाया गया, और हड्डी के क्षरण या आसपास के ऊतकों में घुसपैठ का कोई प्रमाण नहीं मिला। 18G × 250 मिमी की सेमी-ऑटोमैटिक कटिंग सुई का उपयोग करके, इमेज मार्गदर्शन के साथ, पोस्टीरियर दृष्टिकोण से घाव का बायोप्सी किया गया। हिस्टोपैथोलॉजिकल अध्ययन में, परिपक्व वसा ऊतक से बना एक सौम्य नियोप्लाज्म देखा गया, जिसमें रक्तस्राव के क्षेत्र थे जो हेमेटोपोइएटिक तत्वों के साथ बारी-बारी से थे, जिनमें मुख्य रूप से लाल रक्त कोशिकाओं के पूर्ववर्ती शामिल थे, साथ ही विभिन्न चरणों में परिपक्वता में मायलॉइड श्रृंखला के तत्व और मेगाकार्योसाइट्स भी थे, जिससे एमपीएम का निदान स्थापित हुआ। अंत में, निदान और घाव की विशेषताओं के आधार पर, रूढ़िवादी उपचार का निर्णय लिया गया। मरीज की स्थिति में संतोषजनक सुधार हुआ और उसे बिना किसी जटिलता के छुट्टी दे दी गई।",
+    "translated_summary": "हम एक 65 वर्षीय महिला के मामले को प्रस्तुत करते हैं, जिसमें प्राथमिक मध्यस्थिका माइलोलिपोमा था। छाती की कंप्यूटेड टोमोग्राफी में 6.5 × 4.2 सेमी का एक अंडाकार, स्पष्ट रूप से सीमांकित ट्यूमर दिखाई दिया, जो पश्च मध्यस्थिका में स्थित था। घाव की ट्रांस-थोरासिक बायोप्सी की गई और सूक्ष्मदर्शी से जांच करने पर हेमोपोइएटिक तत्व और परिपक्व वसायुक्त ऊतक पाए गए।",
+    "corrected_translated_fulltext": "৬৫ বছর বয়সী নারী, যার কোনো প্রাসঙ্গিক ব্যক্তিগত বা পারিবারিক ইতিহাস নেই। আগস্ট ২০২২-এ, হাঁটুর সার্জারির প্রাক-অপারেটিভ মূল্যায়নে তার পোস্টেরিয়র মিডিয়াস্টাইনাল অঞ্চলে একটি টিউমার পাওয়া যায়, যার কারণে তাকে মূল্যায়ন ও চিকিৎসার জন্য রেফার করা হয়। ভর্তির সময় শারীরিক পরীক্ষায় কোনো বিশেষ কিছু পাওয়া যায়নি এবং ল্যাবরেটরি পরীক্ষাগুলি স্বাভাবিক সীমার মধ্যে ছিল। একটি বক্ষ CT স্ক্যান করা হয়, যাতে ৬.৫ × ৪.২ সেমি আকারের একটি টিউমার, যা পোস্টেরিয়র ডান মিডিয়াস্টিনামে অবস্থিত, সুস্পষ্ট সীমানাসহ, চর্বি ও সলিড ডেনসিটি নিয়ে দেখা যায়, এবং অস্থি ক্ষয় বা পারিপার্শ্বিক টিস্যুতে অনুপ্রবেশের কোনো প্রমাণ পাওয়া যায়নি। ইমেজ গাইডেন্স সহ ১৮G × ২৫০ mm সেমি-অটোম্যাটিক কাটিং নিডল ব্যবহার করে, পোস্টেরিয়র অ্যাপ্রোচ দিয়ে ক্ষতের বায়োপসি করা হয়। হিস্টোপ্যাথোলজিক্যাল স্টাডিতে পরিপক্ব এডিপোজ টিস্যু দিয়ে গঠিত একটি বিনাইন নিওপ্লাজম দেখা যায়, যেখানে রক্তক্ষরণের এলাকা হেমাটোপোয়েটিক উপাদানের সাথে পর্যায়ক্রমে ছিল, প্রধানত রেড সিরিজের প্রিকার্সরসমূহ, পাশাপাশি বিভিন্ন পর্যায়ের ম্যাচুরেশনে মায়েলয়েড সিরিজের উপাদান এবং মেগাকারিওসাইটসও ছিল, যা MPM-এর নির্ণয় প্রতিষ্ঠা করে। অবশেষে, নির্ণয় ও ক্ষতের বৈশিষ্ট্যের ভিত্তিতে কনজারভেটিভ ম্যানেজমেন্টের সিদ্ধান্ত নেওয়া হয়। রোগীর অবস্থা সন্তোষজনকভাবে উন্নত হয় এবং তাকে কোনো জটিলতা ছাড়াই ছাড়পত্র দেওয়া হয়।",
+    "corrected_translated_summary": "আমরা ৬৫ বছর বয়সী এক মহিলার একটি primary mediastinal myelolipoma-এর কেস উপস্থাপন করছি। বক্ষের computed tomography-তে ৬.৫ × ৪.২ সেমি আকারের একটি ডিম্বাকৃতি, সুস্পষ্ট সীমানাযুক্ত টিউমার দেখা যায়, যা posterior mediastinum-এ অবস্থিত ছিল। ক্ষতের একটি trans-thoracic biopsy করা হয়েছিল এবং microscopic পরীক্ষায় haemopoietic উপাদান ও mature adipose tissue পাওয়া যায়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_180.txt",
+    "fulltext": "The 52-year-old man tested positive for SARS-CoV-2 using a self-test kit after having a cold. He returned to work without fever after resting for two days, but lost consciousness while working outdoors in an ambient temperature of 35°C for five hours. Upon admission to the local hospital’s emergency department, his core temperature (Tc) was recorded as 40°C. The patient presented with persistent coma, dyspnea and gastrointestinal hemorrhage. No underlying diseases and relative family history was noted. Based on the characteristic presentation of hyperpyrexia, coma and multiple organ damage, a diagnosis of HS was established. He was admitted to emergency intensive care unit (ICU) of the local hospital and then received mechanical ventilation. The test results indicated the presence of pulmonary infection, hepatic and renal dysfunction, myocardial ischemia and coagulation disorders. The patient received initial management including rehydration (intravenously infused Lactated Ringer’s solution and normal saline at a rate of 2.5mL/kg∙h), intravenous administration of Piperacillin Sodium and Tazobactam Sodium, vasoactive medications for blood pressure support, continuous mechanical ventilation, and continuous renal replacement therapy (CRRT) to manage subsequent anuria. The patient received plasma transfusion and was administered Tranexamic acid on day 5. The worsening of his condition led to his admission to the medical ICU of our hospital 7 days after HS.\n\nFollowing admission, Reverse-transcription polymerase chain reaction (RT-PCR) testing of a nasopharyngeal swab yielded positive results for SARS-CoV-2. The patient was diagnosed with HS and severe COVID-19 based on China’s COVID-19 Diagnosis and Treatment Program (trial version 10): 1. real-time fluorescent RT-PCR detection of SARS-CoV-2 nucleic acid is positive; 2. respiratory failure and requires mechanical ventilation; 3. shock; 4. combined with multiple organ failure requiring intensive care. The patient had no contact with COVID-19 diagnosed patients or healthcare workers in the hospital, indicating community-acquired infection. The physical examination showed a Glasgow Coma Scale (GCS) score of 3/15, with scores of 1 for eye-opening, verbal response, and motor response. Additionally, the pupils were symmetrical and non-reactive. The heart rate was recorded at 106 bpm and blood pressure was maintained at 126/77 mmHg by continuously infusing norepinephrine at a rate of 0.4 ug/kg·min. The laboratory test results indicated a severe infection, along with anemia, thrombocytopenia, disseminated intravascular coagulation (DIC), as well as acute liver and kidney injury. The white blood cell count (WBC) decreased from 3.55×109/L to 3.13×109/L, lymphocytes significantly decreased from 0.25×109/L to 0.1×109/L, and neutrophil percentage (N%) increased to 85.3%. The Procalcitonin level measured 2.81 ng/mL and C-reactive protein (CRP) level was 32.6 mg/L. Sputum culture testing yielded Stenotrophomonas Maltophilia and Candida lipolytica. The central venous catheter culture test detected Staphylococcus epidermidis, but the continuous blood culture test yielded no positive results. The Computed Tomography (CT) scan revealed bilateral frontal subdural effusion, consolidation and atelectasis in the lower lungs, inflammation in the right upper lobe, bilateral pleural effusion, and a small amount of abdominal fluid.\n\nThe patient received synchronized intermittent mandatory ventilation with a positive end expiratory pressure of 5 mmH2O and an oxygen concentration of 80% and continuous administration of norepinephrine and pituitrin to sustain normal blood pressure. Polyene phosphatidylcholine, adenosylmethionine budisulfonate, ulinastatin, and hemofiltration have been employed for the management of hepatic and renal dysfunction. The antibiotic was substituted with Meropenem and Thymalfasin was administered for 20 days to augment immune function. Mannitol was used to alleviate intracranial pressure for 3 days. To improve coagulation dysfunction, the patient received plasma and cryoprecipitate transfusions, continuous intravenous infusion of heparin sodium at 6000u/day and CRRT with sodium citrate for anticoagulant (8g/day) on day 7. Platelet transfusion was administered after 9 days of HS. His Tc fluctuated between 36 °C and 38.5 °C. CRRT was administered without anticoagulant on day 8. The patient had gastrointestinal hemorrhage and fever after 9 days of HS, but electronic gastroenteroscopy showed no signs of active bleeding. He underwent red blood cell suspension transfusion, hemostasis treatment and gastric acid suppression. Teicoplanin was added due to the presence of Methicillin-resistant Staphylococcus aureus isolated from sputum culture. The patient regained consciousness on day 13 with a GCS score of 14/15 and presented with a moderate fever. Gastrointestinal hemorrhage was not observed. Mechanical ventilation was discontinued and the tracheal tube was removed. But the creatinine levels increased following the suspension of CRRT on day 12.\n\nOn day 17, he developed sudden dyspnea with desaturation (oxygen saturation <85%) followed by a high fever (Tc: 39.3°C), necessitating reintubation and mechanical ventilation. Bronchoscopy revealed less sputum in both lungs and subbranches. He experienced a recurrence of coma, with a GCS score of 3/15. WBC increased to 14.94×109/L and NEU increased to 13.77×109/L. The levels of serum total bilirubin rose to 235.2 µmol/L, while creatinine increased to 441µmol/L. The brain CT scan revealed an ischemic stroke in the right frontal lobe and a hemorrhagic infarction in the right occipital lobe. The patient underwent cooling therapy using CRRT with ice-cold replacement fluid, along with persistent administration of Meropenem and Teicoplanin for anti-infection treatment. Carpofungin was added on day 18 due to the observed elevation in serum levels of Aspergillus galactomannan, Aspergillus IgG antibody, and Candida mannan. The RT-PCR testing for SARS-CoV-2 returned negative results.\n\nThe patient’s fever and infection improved on day 20, but he subsequently developed cerebral hemorrhage and hernia with bilateral dilated pupils. The dehydration therapy was used to reduce intracranial pressure, as surgery was refused by his family. On day 22, indicators of infection, levels of aspartate aminotransferase and creatinine increased again. Carbapenem-resistant Acinetobacter baumannii and A. fumigatus were cultured in the bronchoalveolar lavage fluid. The combination of Meropenem, Teicoplanin, and Carpofungine was administered for anti-infective therapy. The patient’s condition progressively worsened over the next 7 days, ultimately resulting in his demise on day 29. The patients’ inflammatory indicators, cytokines, and coagulation indicators are presented in Table 1.",
+    "summary": "We report the first case of heatstroke comorbid with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in a 52-year-old male. After receiving intravenous antibiotics, organ protection measures, and treatment for coagulation disorders, his fever and coma resolved. However, he developed dyspnea and cerebral hemorrhage after several days. This patient experienced a multi-pathogen pulmonary infection and an intractable coagulopathy that ultimately resulted in MODS and death.",
+    "translated_fulltext": null,
+    "translated_summary": "हम 52 वर्षीय पुरुष में गंभीर तीव्र श्वसन सिंड्रोम कोरोनावायरस 2 (SARS-CoV-2) संक्रमण के साथ हीटस्ट्रोक के पहले मामले की रिपोर्ट करते हैं। इंट्रावेनस एंटीबायोटिक्स, अंग सुरक्षा उपाय और जमावट संबंधी विकारों के उपचार के बाद, उसका बुखार और बेहोशी ठीक हो गई। हालाँकि, कुछ दिनों बाद उसे सांस लेने में तकलीफ और मस्तिष्क में रक्तस्राव हुआ। इस मरीज को कई प्रकार के रोगजनकों से फेफड़ों का संक्रमण और एक जटिल जमावट संबंधी विकार हुआ, जिसके परिणामस्वरूप अंततः मल्टीपल ऑर्गन डिस्फंक्शन सिंड्रोम (MODS) और मृत्यु हो गई।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা ৫২ বছর বয়সী এক পুরুষের মধ্যে Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) সংক্রমণের সাথে সহ-বিদ্যমান heatstroke-এর প্রথম ঘটনার রিপোর্ট করছি। ইন্ট্রাভেনাস অ্যান্টিবায়োটিক, অঙ্গ-সুরক্ষা ব্যবস্থা এবং coagulation disorders-এর চিকিৎসার পর, তার জ্বর ও কোমা সেরে যায়। তবে, কয়েক দিন পর তার শ্বাসকষ্ট এবং মস্তিষ্কে রক্তক্ষরণ হয়। এই রোগীর বহু-রোগজীবাণুজনিত ফুসফুসীয় সংক্রমণ এবং একটি অপ্রতিকার্য coagulopathy হয়, যার ফলে শেষ পর্যন্ত Multiple Organ Dysfunction Syndrome (MODS) এবং মৃত্যু ঘটে।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0060_0061.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0060_0061.json
new file mode 100644
index 0000000000000000000000000000000000000000..b4ce51d54d3ec6397523a6cb8899f47841b09041
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0060_0061.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_212.txt",
+    "fulltext": "27-year-old woman with a history of uncontrolled asthma, mild SARS-CoV-2 infection. In March 2021, she consulted a doctor for pain in the left hemicara and trismus. She reported having completed 48 hours before the antibiotic treatment with phenoxymethyl penicillin 1,000,000 IU daily orally for five days for a peritonsillar abscess. She was hemodynamically stable at the physical examination, without the need for supplemental oxygen, and without relevant findings in respiratory symptoms. The head and neck examination showed a soft, painful, cervical adenopathy, palpable and painful, predominantly homolateral and trismus. Complementary studies were performed. The admission laboratory reported leukocytosis, platelopenia, increased acute phase reactants and the rest of the parameters within normal values. An angiotomy of the craniofacial mass was performed, where a large thrombus was found in the internal and external carotid arteries. Studies were completed with a chest tomography and arterial Doppler ultrasound of neck vessels with no relevant findings. Early intravenous antibiotic treatment was initiated with ceftriaxone 1 g every 12 hours, clindamycin 300 mg every 6 hours and anticoagulation with enoxaparin adjusted to body weight and renal function, 60 mg subcutaneously every 12 hours. The patient evolved 72 hours after initiating the directed treatment with a fever of 38.5 °C and increased leukocytosis, so new complementary studies were performed, including a Doppler ultrasound of the heart without finding cardiac vegetations and a chest tomography where bilateral pulmonary septic emboli were found. With the admission hemocultures negative, a new admission of 3 units, culture of pharyngeal exudate and rotation of ceftriaxone to piperacillin tazobactam 4.5 g every 6 hours intravenous was decided. The patient evolved favorably, without rescue of germs in cultures. After 14 days of initiating the new therapeutic scheme, and with a control chest tomography without pulmonary lesions, it was decided to continue antibiotic treatment with oral clindamycin 300 mg every 6 hours, anticoagulation with acenocumarol adjusted to body weight and hospital discharge.\n",
+    "summary": "A 27-year-old woman presented with facial oedema and trismus 48 hours after completing treatment with phenoxymethylpenicillin for an odontogenic infection. A head and neck CT scan showed a large thrombus in the internal jugular vein and a chest CT scan showed pulmonary septic embolism. Treatment consisted of early intravenous broad spectrum antibiotics and anticoagulation.\n",
+    "translated_fulltext": "27 वर्षीय महिला, जिसका पहले से अनियंत्रित अस्थमा का इतिहास रहा है, और उसे हल्का SARS-CoV-2 संक्रमण हुआ था। मार्च 2021 में, उसने बाएं हेमीकारा में दर्द और ट्रिस्मस की शिकायत के साथ एक डॉक्टर से परामर्श किया। उसने बताया कि उसने पेरिटॉन्सिलर फोड़े के लिए फेनोक्सीमिथाइल पेनिसिलिन 1,000,000 आईयू की दैनिक खुराक, पांच दिनों तक मौखिक रूप से लेने के बाद, एंटीबायोटिक उपचार पूरा कर लिया था। शारीरिक परीक्षण में, वह हेमोडायनामिक रूप से स्थिर थी, उसे अतिरिक्त ऑक्सीजन की आवश्यकता नहीं थी, और श्वसन संबंधी लक्षणों में कोई महत्वपूर्ण निष्कर्ष नहीं मिला। सिर और गर्दन की जांच में एक नरम, दर्दनाक, सर्वाइकल एडेनोपैथी दिखाई दी, जो स्पर्श करने पर दर्दनाक थी, मुख्य रूप से होमोलैटरल और ट्रिस्मस थी। पूरक अध्ययन किए गए। अस्पताल में किए गए प्रयोगशाला परीक्षणों में ल्यूकोसाइटोसिस, प्लेटलोपेनिया, तीव्र चरण प्रतिक्रियाओं में वृद्धि और अन्य पैरामीटर सामान्य सीमा के भीतर पाए गए। क्रैनियोफेशियल द्रव्यमान का एंजियोटॉमी किया गया, जिसमें आंतरिक और बाहरी कैरोटिड धमनियों में एक बड़ा थ्रोम्बस पाया गया। छाती का टोमोग्राफी और गर्दन की रक्त वाहिकाओं का धमनी डॉपलर अल्ट्रासाउंड किया गया, जिसमें कोई महत्वपूर्ण निष्कर्ष नहीं मिला। प्रारंभिक अंतःशिरा एंटीबायोटिक उपचार सेफ्ट्रियाक्सोन 1 ग्राम हर 12 घंटे, क्लिनडमाइसिन 300 मिलीग्राम हर 6 घंटे और एनोक्सापेरिन के साथ एंटीकोगुलन, जिसे शरीर के वजन और गुर्दे के कार्य के अनुसार समायोजित किया गया था, 60 मिलीग्राम हर 12 घंटे चमड़े के नीचे दिया गया। रोगी में निर्देशित उपचार शुरू करने के 72 घंटे बाद 38.5 डिग्री सेल्सियस का बुखार और ल्यूकोसाइटोसिस में वृद्धि देखी गई, इसलिए नए पूरक अध्ययन किए गए, जिसमें हृदय का डॉपलर अल्ट्रासाउंड शामिल था, जिसमें हृदय संबंधी वनस्पतियों का पता नहीं चला, और छाती का टोमोग्राफी किया गया, जिसमें द्विपक्षीय फुफ्फुसीय सेप्टिक एम्बोली पाए गए। अस्पताल में किए गए रक्त कल्चर में कोई जीवाणु नहीं पाया गया, इसलिए 3 यूनिट का नया कल्चर, ग्रसनी के स्राव का कल्चर और सेफ्ट्रियाक्सोन को पाइपेरासिलिन टाज़ोबैक्टम 4.5 ग्राम हर 6 घंटे अंतःशिरा में बदलने का निर्णय लिया गया। रोगी की स्थिति में सुधार हुआ, और कल्चर में कोई जीवाणु नहीं पाया गया। नए चिकित्सीय कार्यक्रम शुरू करने के 14 दिनों के बाद, और नियंत्रण छाती टोमोग्राफी में फुफ्फुसीय घाव नहीं पाए जाने पर, मौखिक क्लिनडमाइसिन 300 मिलीग्राम हर 6 घंटे, शरीर के वजन के अनुसार समायोजित एसीनोकुमारोल के साथ एंटीकोगुलन और अस्पताल से छुट्टी देने का निर्णय लिया गया।",
+    "translated_summary": "27 वर्षीय एक महिला चेहरे पर सूजन और जबड़े की मांसपेशियों में अकड़न की शिकायत के साथ उपस्थित हुई, यह लक्षण उसे दाँतों से संबंधित संक्रमण के लिए फेनोक्सीमिथाइलपेनिसिलिन से उपचार पूरा करने के 48 घंटे बाद महसूस हुए। सिर और गर्दन की सीटी स्कैन में आंतरिक जुगुलर नस में एक बड़ा थक्का पाया गया, और छाती की सीटी स्कैन में फुफ्फुसीय सेप्टिक एम्बोलिज्म पाया गया। उपचार में शुरुआती दौर में व्यापक स्पेक्ट्रम एंटीबायोटिक्स और एंटीकोगुलेंट दवाएं शामिल थीं।",
+    "corrected_translated_fulltext": "২৭ বছর বয়সী মহিলা, যার আগে থেকে অনিয়ন্ত্রিত অ্যাজমার ইতিহাস আছে, এবং তার হালকা SARS-CoV-2 সংক্রমণ হয়েছিল। মার্চ ২০২১-এ, তিনি বাম হেমিকারায় ব্যথা এবং ট্রিজমাসের অভিযোগ নিয়ে একজন চিকিৎসকের সাথে পরামর্শ করেন। তিনি জানান যে তিনি peritonsillar abscess-এর জন্য phenoxymethyl penicillin 1,000,000 IU দৈনিক মাত্রায়, পাঁচ দিন ধরে মৌখিকভাবে গ্রহণ করে, অ্যান্টিবায়োটিক চিকিৎসা সম্পন্ন করেছেন। শারীরিক পরীক্ষায়, তিনি হেমোডাইনামিকভাবে স্থিতিশীল ছিলেন, অতিরিক্ত অক্সিজেনের প্রয়োজন ছিল না, এবং শ্বাসপ্রশ্বাস সম্পর্কিত উপসর্গে কোনো উল্লেখযোগ্য ফল পাওয়া যায়নি। মাথা ও ঘাড়ের পরীক্ষায় একটি নরম, বেদনাদায়ক, সার্ভাইক্যাল অ্যাডেনোপ্যাথি দেখা যায়, যা স্পর্শে বেদনাদায়ক, প্রধানত হোমোল্যাটেরাল, এবং ট্রিজমাস ছিল। পরিপূরক পরীক্ষা-নিরীক্ষা করা হয়। ভর্তির সময় করা ল্যাবরেটরি পরীক্ষায় লিউকোসাইটোসিস, প্লেটেলোপেনিয়া, একিউট ফেজ রিঅ্যাক্ট্যান্টস বৃদ্ধি এবং বাকি প্যারামিটারগুলো স্বাভাবিক সীমার মধ্যে পাওয়া যায়। ক্র্যানিওফেসিয়াল ভরের অ্যাঞ্জিওটমি করা হয়, যেখানে internal এবং external carotid arteries-এ একটি বড় thrombus পাওয়া যায়। বুকের টোমোগ্রাফি এবং ঘাড়ের রক্তনালির arterial Doppler ultrasound করা হয়, যেখানে কোনো উল্লেখযোগ্য ফল পাওয়া যায়নি। প্রাথমিক অন্তঃশিরা অ্যান্টিবায়োটিক চিকিৎসা শুরু করা হয় ceftriaxone 1 g প্রতি 12 ঘণ্টা, clindamycin 300 mg প্রতি 6 ঘণ্টা এবং enoxaparin দিয়ে anticoagulation, যা শরীরের ওজন ও বৃক্কীয় কার্যকারিতার অনুযায়ী সামঞ্জস্য করা হয়েছিল, 60 mg প্রতি 12 ঘণ্টা ত্বকের নিচে দেওয়া হয়। নির্দেশিত চিকিৎসা শুরু করার 72 ঘণ্টা পর রোগীর 38.5 °C জ্বর এবং লিউকোসাইটোসিস বৃদ্ধি দেখা যায়, তাই নতুন পরিপূরক পরীক্ষা-নিরীক্ষা করা হয়, যার মধ্যে হৃদয়ের Doppler ultrasound অন্তর্ভুক্ত ছিল যেখানে cardiac vegetations পাওয়া যায়নি, এবং বুকের টোমোগ্রাফিতে bilateral pulmonary septic emboli পাওয়া যায়। ভর্তির সময়ের হিমোকালচার নেগেটিভ থাকায়, 3 ইউনিটের নতুন কালচার, ফ্যারিঞ্জিয়াল এক্সুডেটের কালচার এবং ceftriaxone-কে piperacillin tazobactam 4.5 g প্রতি 6 ঘণ্টা অন্তঃশিরায়ে বদলানোর সিদ্ধান্ত নেওয়া হয়। রোগীর অবস্থা অনুকূলে উন্নত হয়, এবং কালচারে কোনো জীবাণু উদ্ধার হয়নি। নতুন চিকিৎসা পরিকল্পনা শুরু করার 14 দিন পরে, এবং নিয়ন্ত্রণ বুকের টোমোগ্রাফিতে ফুসফুসীয় ক্ষত না পাওয়ায়, মৌখিক clindamycin 300 mg প্রতি 6 ঘণ্টা, শরীরের ওজন অনুযায়ী সামঞ্জস্য করা acenocoumarol দিয়ে anticoagulation অব্যাহত রাখা এবং হাসপাতাল থেকে ছাড় দেওয়ার সিদ্ধান্ত নেওয়া হয়।",
+    "corrected_translated_summary": "একজন ২৭ বছর বয়সী মহিলা দাঁত-উৎপত্তিজনিত সংক্রমণের জন্য phenoxymethylpenicillin দিয়ে চিকিৎসা সম্পন্ন করার ৪৮ ঘণ্টা পরে মুখমণ্ডলের ফোলা এবং trismus নিয়ে উপস্থিত হন। মাথা ও ঘাড়ের CT স্ক্যানে internal jugular vein-এ একটি বড় thrombus দেখা যায় এবং বক্ষের CT স্ক্যানে pulmonary septic embolism দেখা যায়। চিকিৎসায় শুরুতেই intravenous broad-spectrum antibiotics এবং anticoagulation অন্তর্ভুক্ত ছিল।"
+  },
+  {
+    "id": "multiclinsum_gs_en_205.txt",
+    "fulltext": "A 5-year-old presented to the paediatric emergency department (ED) having ingested chlorpyriphos 13 hours prior to presentation, followed by abnormal jerks, fast breathing and difficulty with breathing. The history was also comprised of excessive sweating and urination, mouth secretions and involuntary movement of the limbs. Vomiting followed the ingestion of crushed charcoal and palm oil. The patient had lapsed into coma prior to presentation. The temperature at presentation was 38.3°C, Glasgow coma score was 3, pupils were pinpoint pupils and there was hypotonia in all limbs. In addition, the patient was severely dyspneic, tachypneic (respiratory rate of 48/minute with intermittent sighing breaths), a saturation of 88% and widespread crackles. The pulse rate was 180/minute, blood pressure 120/80 mmHg, and random blood glucose 14 mg/dl. Serum lactate and cholinesterase tests were not done due to lack of facilities.\n\nThe patient was diagnosed with severe organophosphate poisoning (OPP) and aspiration pneumonitis. As ICU care was beyond the affordability of the parents, non-invasive ventilation (NIV) was administered using bubble continuous positive airway pressure (b-CPAP) causing his saturation to increase to 99%–100%. Hypoglycemia was corrected with a bolus of dextrose solution and tachycardia was treated with 20 ml/kg of normal saline. Intravenous Dexamethasone, Mannitol and IV Atropine at 0.02 mg/kg/dose were also administered. Empirical intravenous antibiotics were administered for aspiration pneumonitis. Pralidoxime was not given due to unavailability. Within 3 hours of presentation, the patient had fresh-whole-blood exchange-blood-transfusion (FWB-EBT) with 500mls of blood.\n\nThe patient’s GCS appreciated to 9/15 but IV Atropine was discontinued after the first dose due to a rapid increase in the heart rate. The blood glucose fluctuated between 41 to 259 mg/dl in the first 15 hours of admission and subsequently normalized with treatment. By the second day on admission, the patient developed thready pulses and hypotension for which another bolus of normal saline was administered. Dopamine infusion was commenced at 5mcg/kg/min using a peripheral vein and IV Mannitol discontinued. A second aliquot of FWB-EBT was administered with 500mls of blood.\n\nOver the first 30 hours of admission, the consciousness level improved and respiratory distress slowly declined. However, the patient developed rhonchi which was treated with nebulized Salbutamol and Budesonide and was subsequently transited to Oxygen therapy with nasal prongs with clinical improvement. The saturation remained stable at 97%. On Day 2 of admission, a chest radiograph was done which showed bilateral infiltrates in keeping with pneumonia.\n\nThe patient regained full consciousness by the 39th hour of admission. Intravenous Vitamin C and B, as well as oral Vitamin E and Zinc were commenced for their antioxidant effects, and regular diet was recommenced in a graded manner over the subsequent 48 hours. The patient’s clinical condition progressively improved and was discharged home after 10 days but was subsequently lost to follow-up.",
+    "summary": "We present the case of a 5-year-old with severe organophosphate poisoning from ingestion of chlorpyrifos, further worsened by aspiration of a charcoal-palm oil mixture. The clinical illness was marked by respiratory failure, shock, coma and type I paralysis. The patient was treated in the emergency department with noninvasive ventilation, multiple episodes of exchange transfusion, intravenous atropine, inotrope infusion, antibiotics and steroids. The patient responded rapidly to treatment, did not develop intermediate syndrome and was discharged after 10 days of admission.",
+    "translated_fulltext": "एक 5 वर्षीय बच्चा बाल चिकित्सा आपातकालीन विभाग (ईडी) में लाया गया, जिसने प्रस्तुति से 13 घंटे पहले क्लोरपाइरीफॉस का सेवन किया था, जिसके बाद असामान्य झटके, तेज़ साँस और साँस लेने में कठिनाई हुई। इतिहास में अत्यधिक पसीना और पेशाब आना, मुंह से स्राव और अंगों की अनैच्छिक गति भी शामिल थी। कुचले हुए चारकोल और पाम ऑयल के सेवन के बाद उल्टी हुई। प्रस्तुति से पहले रोगी बेहोश हो गया था। प्रस्तुति के समय तापमान 38.3°C था, ग्लासगो कोमा स्कोर 3 था, पुतलियाँ बहुत छोटी थीं और सभी अंगों में हाइपोटोनिया था। इसके अतिरिक्त, रोगी में गंभीर रूप से सांस लेने में तकलीफ, टैचीपनिया (प्रति मिनट 48 की श्वसन दर, बीच-बीच में लंबी सांसें), 88% की ऑक्सीजन संतृप्ति और व्यापक कर्कशता थी। नाड़ी की दर 180/मिनट, रक्तचाप 120/80 mmHg और यादृच्छिक रक्त शर्करा 14 mg/dl थी। सुविधाओं की कमी के कारण सीरम लैक्टेट और कोलिनेस्टरेज़ परीक्षण नहीं किए गए।\n\nरोगी को गंभीर ऑर्गेनोफॉस्फेट विषाक्तता (ओपीपी) और एस्पिरेशन निमोनिया का निदान किया गया। चूंकि आईसीयू देखभाल माता-पिता की सामर्थ्य से परे थी, इसलिए गैर-आक्रामक वेंटिलेशन (एनआईवी) का उपयोग बबल निरंतर सकारात्मक वायुमार्ग दबाव (बी-सीपीएपी) का उपयोग करके किया गया, जिससे उसकी ऑक्सीजन संतृप्ति 99%–100% तक बढ़ गई। हाइपोग्लाइसीमिया को डेक्सट्रोज घोल की एक खुराक के साथ ठीक किया गया और टैचीकार्डिया का इलाज 20 मिली/किलोग्राम सामान्य खारा घोल से किया गया। अंतःशिरा डेक्सामेथासोन, मैनिटोल और 0.02 मिलीग्राम/किलोग्राम/खुराक पर अंतःशिरा एट्रोपिन भी दिया गया। एस्पिरेशन निमोनिया के लिए अनुभवजन्य अंतःशिरा एंटीबायोटिक्स दिए गए। प्रालिडोक्सिम अनुपलब्ध होने के कारण नहीं दिया गया। प्रस्तुति के 3 घंटे के भीतर, रोगी को 500 मिलीलीटर रक्त के साथ ताजा-संपूर्ण-रक्त विनिमय-रक्त आधान (एफडब्ल्यूबी-ईबीटी) दिया गया।\n\nरोगी के जीसीएस में सुधार होकर 9/15 हो गया, लेकिन पहले खुराक के बाद हृदय गति में तेजी से वृद्धि के कारण अंतःशिरा एट्रोपिन बंद कर दिया गया। भर्ती के पहले 15 घंटों में रक्त शर्करा 41 से 259 मिलीग्राम/डीएल के बीच उतार-चढ़ाव करता रहा और बाद में उपचार के साथ सामान्य हो गया। भर्ती के दूसरे दिन तक, रोगी में कमजोर नाड़ी और निम्न रक्तचाप विकसित हो गया, जिसके लिए सामान्य खारा घोल की एक और खुराक दी गई। डोपामाइन का अंतःशिरा जलसेक 5 एमसीजी/किलोग्राम/मिनट की दर से एक परिधीय नस का उपयोग करके शुरू किया गया और अंतःशिरा मैनिटोल बंद कर दिया गया। एफडब्ल्यूबी-ईबीटी की एक और खुराक 500 मिलीलीटर रक्त के साथ दी गई।\n\nभर्ती के पहले 30 घंटों में, चेतना का स्तर सुधरा और श्वसन संकट धीरे-धीरे कम हो गया। हालांकि, रोगी में रोंची विकसित हो गई, जिसका इलाज नेबुलाइज्ड साल्बुटामोल और बुडेसोनाइड से किया गया और बाद में नैदानिक सुधार के साथ नाक के कैथेटर के माध्यम से ऑक्सीजन थेरेपी में बदल दिया गया। ऑक्सीजन संतृप्ति 97% पर स्थिर रही। भर्ती के दूसरे दिन, एक छाती का एक्स-रे किया गया, जिसमें निमोनिया के अनुरूप द्विपक्षीय घुसपैठ दिखाई दी।\n\nरोगी भर्ती के 39वें घंटे तक पूरी चेतना में आ गया। एंटीऑक्सिडेंट प्रभावों के लिए अंतःशिरा विटामिन सी और बी, साथ ही मौखिक विटामिन ई और जिंक शुरू किया गया, और अगले 48 घंटों में धीरे-धीरे सामान्य आहार फिर से शुरू किया गया। रोगी की नैदानिक स्थिति में धीरे-धीरे सुधार हुआ और 10 दिनों के बाद उसे घर भेज दिया गया, लेकिन बाद में अनुवर्ती कार्रवाई में संपर्क टूट गया।",
+    "translated_summary": "हम एक ऐसे 5 वर्षीय बच्चे का मामला प्रस्तुत करते हैं, जिसे क्लोरपाइरीफॉस के सेवन से गंभीर ऑर्गनोफॉस्फेट विषाक्तता हुई, और चारकोल-पाम ऑयल के मिश्रण के साँस में जाने से स्थिति और भी खराब हो गई। नैदानिक लक्षणों में श्वसन विफलता, सदमा, कोमा और टाइप I पक्षाघात शामिल थे। रोगी का आपातकालीन विभाग में गैर-आक्रामक वेंटिलेशन, कई बार रक्त आधान, अंतःशिरा एट्रोपिन, इनोट्रोप इन्फ्यूजन, एंटीबायोटिक्स और स्टेरॉयड के साथ इलाज किया गया। रोगी ने उपचार पर तेजी से प्रतिक्रिया दी, उसमें मध्यवर्ती सिंड्रोम विकसित नहीं हुआ और 10 दिनों के अस्पताल में रहने के बाद उसे छुट्टी दे दी गई।",
+    "corrected_translated_fulltext": "৫ বছর বয়সী এক শিশু পেডিয়াট্রিক ইমারজেন্সি ডিপার্টমেন্টে (ED) আনা হয়; উপস্থাপনের ১৩ ঘণ্টা আগে chlorpyriphos সেবন করেছিল, যার পর অস্বাভাবিক ঝাঁকুনি, দ্রুত শ্বাস ও শ্বাস নিতে অসুবিধা দেখা দেয়। ইতিহাসে অতিরিক্ত ঘাম ও প্রস্রাব, মুখগহ্বরে সিক্রেশন এবং অঙ্গপ্রত্যঙ্গের অনৈচ্ছিক নড়াচড়া ছিল। চূর্ণিত চারকোল ও পাম অয়েল সেবনের পর বমি হয়েছিল। উপস্থাপনের পূর্বেই রোগী কোমায় চলে গিয়েছিল। উপস্থাপনের সময় তাপমাত্রা ছিল 38.3°C, Glasgow coma score ছিল 3, পিউপিলস pinpoint ছিল এবং সব অঙ্গে hypotonia ছিল। অতিরিক্তভাবে, রোগীর তীব্র শ্বাসকষ্ট, tachypnea (শ্বাসের হার ৪৮/মিনিট, মাঝেমধ্যে sighing breaths), স্যাচুরেশন 88% এবং বিস্তৃত crackles ছিল। পালস রেট 180/মিনিট, রক্তচাপ 120/80 mmHg, এবং র‌্যান্ডম রক্ত গ্লুকোজ 14 mg/dl ছিল। সুবিধার অভাবে serum lactate ও cholinesterase পরীক্ষা করা হয়নি।\n\nরোগীর severe organophosphate poisoning (OPP) এবং aspiration pneumonitis নির্ণয় করা হয়। অভিভাবকদের আর্থিক সামর্থ্যের বাইরে ICU যত্ন হওয়ায়, bubble continuous positive airway pressure (b-CPAP) ব্যবহার করে non-invasive ventilation (NIV) দেওয়া হয়, ফলে তার স্যাচুরেশন 99%–100% এ উন্নীত হয়। Hypoglycemia ডেক্সট্রোজ সলিউশনের একটি bolus দিয়ে সংশোধন করা হয় এবং tachycardia 20 ml/kg normal saline দিয়ে চিকিৎসা করা হয়। Intravenous Dexamethasone, Mannitol এবং 0.02 mg/kg/dose মাত্রায় IV Atropine-ও দেওয়া হয়। Aspiration pneumonitis-এর জন্য empirical intravenous antibiotics দেওয়া হয়। উপলব্ধ না থাকায় Pralidoxime দেওয়া হয়নি। উপস্থাপনের ৩ ঘণ্টার মধ্যে রোগীকে 500 ml রক্ত দিয়ে fresh-whole-blood exchange-blood-transfusion (FWB-EBT) করা হয়।\n\nরোগীর GCS 9/15 এ উন্নীত হয়, তবে প্রথম ডোজের পর হৃদস্পন্দন দ্রুত বেড়ে যাওয়ায় IV Atropine বন্ধ করা হয়। ভর্তির প্রথম ১৫ ঘণ্টায় রক্ত গ্লুকোজ 41 থেকে 259 mg/dl-এর মধ্যে ওঠানামা করে এবং পরবর্তীতে চিকিৎসায় স্বাভাবিক হয়। ভর্তির দ্বিতীয় দিনে রোগীর thready pulses এবং hypotension দেখা দেয়, যার জন্য normal saline-এর আরেকটি bolus দেওয়া হয়। একটি পারিফেরাল শিরা ব্যবহার করে 5 mcg/kg/min হারে Dopamine infusion শুরু করা হয় এবং IV Mannitol বন্ধ করা হয়। 500 ml রক্ত দিয়ে FWB-EBT-এর দ্বিতীয় aliquot দেওয়া হয়।\n\nভর্তির প্রথম ৩০ ঘণ্টায় চেতনার স্তর উন্নত হয় এবং শ্বাসকষ্ট ধীরে ধীরে কমে। তবে রোগীর rhonchi দেখা দেয়, যা nebulized Salbutamol এবং Budesonide দিয়ে চিকিৎসা করা হয় এবং পরে ক্লিনিক্যাল উন্নতির সাথে nasal prongs দিয়ে Oxygen therapy-তে স্থানান্তর করা হয়। স্যাচুরেশন 97% এ স্থিতিশীল ছিল। ভর্তির দ্বিতীয় দিনে একটি চেস্ট রেডিওগ্রাফ করা হয়, যাতে pneumonia-র সাথে সামঞ্জস্যপূর্ণ দ্বিপার্শ্বীয় infiltrates দেখা যায়।\n\nভর্তির ৩৯তম ঘণ্টায় রোগী পূর্ণ চেতনা ফিরে পায়। অ্যান্টিঅক্সিডেন্ট প্রভাবের জন্য Intravenous Vitamin C ও B, পাশাপাশি oral Vitamin E এবং Zinc শুরু করা হয়, এবং পরবর্তী ৪৮ ঘণ্টায় ধাপে ধাপে নিয়মিত খাদ্য পুনরায় শুরু করা হয়। রোগীর ক্লিনিক্যাল অবস্থা ক্রমাগত উন্নত হয় এবং ১০ দিন পর তাকে বাসায় ছাড়পত্র দেওয়া হয়, তবে পরবর্তীতে ফলো-আপে হারিয়ে যায়।",
+    "corrected_translated_summary": "আমরা ৫ বছর বয়সী এক শিশুর একটি কেস উপস্থাপন করছি, যে chlorpyrifos গ্রহণের ফলে গুরুতর organophosphate poisoning-এ আক্রান্ত হয়েছিল, এবং charcoal-palm oil মিশ্রণের aspiration-এর কারণে অবস্থা আরও খারাপ হয়েছিল। ক্লিনিকাল অসুস্থতা respiratory failure, shock, coma এবং type I paralysis দ্বারা চিহ্নিত ছিল। রোগীকে emergency department-এ noninvasive ventilation, exchange transfusion-এর একাধিক পর্ব, intravenous atropine, inotrope infusion, antibiotics এবং steroids দিয়ে চিকিৎসা করা হয়। রোগী চিকিৎসায় দ্রুত সাড়া দেয়, তার intermediate syndrome হয়নি এবং ভর্তি হওয়ার 10 দিন পর তাকে ছুটি দেওয়া হয়।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0062_0063.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0062_0063.json
new file mode 100644
index 0000000000000000000000000000000000000000..977fc9fccabb9ef8a409942e2868bbafb39c4137
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0062_0063.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_72.txt",
+    "fulltext": "A 17-year-old male with no significant past medical or family history was referred to our clinic from the dental department following an incidental finding of a NFB during preoperative orthodontic planning, including dental x-rays and cone beam computed tomography (CBCT) without contrast. The patient was entirely asymptomatic and denied any history of nasal obstruction, rhinorrhea, epistaxis, foul odor, hyposmia, halitosis, facial pain, discomfort, or sleep disturbances. The patient's parents recalled an event when their son was seven, where he inserted an object into his nose. They sought medical advice, where no imaging was performed and an anterior rhinoscopy was utilized for diagnoses but due to the child's non-cooperation during the examination, the physician recommended the removal of the foreign body under sedation. However, the family did not follow up, and since the child remained asymptomatic, they assumed the foreign body had fallen out on its own. On endoscopic examination of the right nasal cavity, a deviated nasal septum with inferior turbinate hypertrophy was noted. The mucosa appeared erythematous and slightly edematous. A foreign body was visualized, lodged, and adhered to the floor of the nasal cavity beneath the inferior turbinate. The object was partially covered with mucus and possibly some crusted material and had a shiny appearance, indicating a metallic nature. Radiographic evaluation, including lateral and frontal X-rays, revealed a circular radiopaque object consistent with a metallic snap button located along the floor of the nasal cavity. The surrounding bony structures appeared normal. A CBCT confirmed the presence of the foreign body with associated mild inflammation, but no significant bony damage or sinus involvement was observed. With informed consent from the patient's parent, the foreign body was removed under local anesthesia in a semi-sitting position to reduce the risk of dislodgment to the airway. After decongesting the nasal cavity with Xylometazoline 0.1 % and administering Lidocaine spray (10 mg/spray) in the right nostril, a hook was utilized to disengage the foreign body, which was then retrieved using bayonet forceps. The procedure was uncomplicated, with minimal bleeding, easily controlled with saline irrigation. Post-removal examination showed no significant tissue damage. The retrieved object, a metallic snap button measuring 1 cm in diameter, exhibited signs of long-term exposure, including substantial corrosion and biological deposits. The patient was discharged in stable condition and prescribed nasal rinses with a sodium chloride irrigation solution (0.9 %). The patient was doing well at his two-week follow-up with an unremarkable examination.",
+    "summary": "We present the case of a 17-year-old male with an asymptomatic NFB discovered incidentally during routine dental radiography. The patient denied any history of nasal obstruction, epistaxis, or discomfort. Imaging revealed a radiopaque object in the right nasal cavity, later identified as a metallic snap button embedded in the floor of the nasal cavity. The foreign body had likely been retained for over a decade.",
+    "translated_fulltext": "एक 17 वर्षीय पुरुष, जिसका कोई महत्वपूर्ण पूर्व चिकित्सा या पारिवारिक इतिहास नहीं था, उसे हमारे क्लिनिक में दंत विभाग से रेफर किया गया था। ऐसा इसलिए किया गया क्योंकि प्रीऑपरेटिव ऑर्थोडोंटिक योजना के दौरान, जिसमें दंत एक्स-रे और कोन बीम कंप्यूटेड टोमोग्राफी (सीबीसीटी) शामिल थे, बिना कंट्रास्ट के, एक विदेशी वस्तु (एनएफबी) का पता चला था। रोगी पूरी तरह से स्वस्थ था और उसने नाक में रुकावट, नाक बहना, नाक से खून आना, दुर्गंध, घ्राण शक्ति में कमी, मुंह की दुर्गंध, चेहरे में दर्द, बेचैनी या नींद में गड़बड़ी के किसी भी इतिहास से इनकार किया। रोगी के माता-पिता को याद है कि जब उनका बेटा सात साल का था, तो उसने एक वस्तु को अपनी नाक में डाल दिया था। उन्होंने चिकित्सा सलाह ली, लेकिन कोई इमेजिंग नहीं की गई और निदान के लिए एक एंटीरियर राइनोस्कोपी का उपयोग किया गया। हालांकि, बच्चे के परीक्षा के दौरान सहयोग न करने के कारण, चिकित्सक ने बेहोशी की स्थिति में विदेशी वस्तु को निकालने की सिफारिश की। हालांकि, परिवार ने इसका पालन नहीं किया, और चूंकि बच्चा स्वस्थ रहा, इसलिए उन्होंने मान लिया कि विदेशी वस्तु अपने आप गिर गई होगी। दाएं नाक के गुहा की एंडोस्कोपिक जांच में, एक विचलित नाक सेप्टम और अवर टर्बिनेट हाइपरट्रॉफी देखी गई। म्यूकोसा लाल और थोड़ा सूजन वाला दिखाई दे रहा था। एक विदेशी वस्तु देखी गई, जो अवर टर्बिनेट के नीचे नाक के गुहा के तल में फंसी और चिपकी हुई थी। वस्तु आंशिक रूप से बलगम और संभवतः कुछ क्रस्टेड सामग्री से ढकी हुई थी और इसमें एक चमकदार उपस्थिति थी, जो धातुई प्रकृति का संकेत देती है। रेडियोलॉजिकल मूल्यांकन, जिसमें पार्श्व और फ्रंटल एक्स-रे शामिल थे, से एक गोलाकार रेडियोओपेक वस्तु का पता चला, जो नाक के गुहा के तल के साथ स्थित एक धातुई स्नैप बटन के अनुरूप थी। आसपास की हड्डी की संरचनाएं सामान्य दिखाई दे रही थीं। सीबीसीटी ने संबंधित हल्की सूजन के साथ विदेशी वस्तु की उपस्थिति की पुष्टि की, लेकिन कोई महत्वपूर्ण हड्डी क्षति या साइनस की भागीदारी नहीं देखी गई। रोगी के माता-पिता की सूचित सहमति के साथ, विदेशी वस्तु को स्थानीय एनेस्थीसिया के तहत अर्ध-बैठे हुए स्थिति में निकाला गया, ताकि वायुमार्ग में इसके खिसकने के जोखिम को कम किया जा सके। ज़ाइलोमेटाज़ोलिन 0.1% के साथ नाक के गुहा को डीकॉन्गेस्ट करने और दाएं नथुने में लिडोकेन स्प्रे (10 मिलीग्राम/स्प्रे) देने के बाद, एक हुक का उपयोग विदेशी वस्तु को अलग करने के लिए किया गया, जिसे बाद में बेयोनेट फोर्सेप्स का उपयोग करके निकाला गया। प्रक्रिया सरल थी, जिसमें न्यूनतम रक्तस्राव हुआ, जिसे खारे पानी से आसानी से नियंत्रित किया गया। हटाने के बाद की जांच में कोई महत्वपूर्ण ऊतक क्षति नहीं पाई गई। निकाली गई वस्तु, एक धातुई स्नैप बटन जिसका व्यास 1 सेमी था, में दीर्घकालिक जोखिम के संकेत थे, जिसमें पर्याप्त जंग और जैविक जमाव शामिल थे। रोगी को स्थिर स्थिति में छुट्टी दे दी गई और सोडियम क्लोराइड सिंचाई घोल (0.9%) के साथ नाक धोने का निर्देश दिया गया। दो सप्ताह के फॉलो-अप में रोगी की स्थिति अच्छी थी और जांच में कोई विशेष बात नहीं पाई गई।",
+    "translated_summary": "हम एक 17 वर्षीय पुरुष के मामले को प्रस्तुत करते हैं, जिसमें बिना किसी लक्षण के एक एनएफबी (नेज़ल फ़ॉरेन बॉडी) पाया गया, जो नियमित दंत एक्स-रे के दौरान संयोगवश पता चला। रोगी ने नाक में रुकावट, नाक से खून आना या किसी भी तरह की असुविधा के बारे में कोई जानकारी नहीं दी। इमेजिंग से पता चला कि दाहिनी नाक की गुहा में एक रेडियोओपेक वस्तु है, जिसकी बाद में पहचान एक धातु की स्नैप बटन के रूप में की गई, जो नाक की गुहा के तल में धँसी हुई थी। संभावना है कि यह विदेशी वस्तु एक दशक से अधिक समय से वहीं मौजूद थी।",
+    "corrected_translated_fulltext": "১৭ বছর বয়সী এক পুরুষ, যার উল্লেখযোগ্য পূর্বের চিকিৎসা বা পারিবারিক ইতিহাস ছিল না, তাকে প্রি-অপারেটিভ অর্থোডন্টিক পরিকল্পনার সময়, যেখানে দন্ত X-rays এবং কন বীম কম্পিউটেড টোমোগ্রাফি (CBCT) কনট্রাস্ট ছাড়া অন্তর্ভুক্ত ছিল, একটি NFB আকস্মিকভাবে ধরা পড়ার পর দন্ত বিভাগ থেকে আমাদের ক্লিনিকে রেফার করা হয়। রোগী সম্পূর্ণরূপে উপসর্গহীন ছিল এবং নাসাল অবস্ট্রাকশন, রাইনোরিয়া, এপিস্ট্যাক্সিস, দুর্গন্ধ, হাইপোসমিয়া, হ্যালিটোসিস, মুখমণ্ডলের ব্যথা, অস্বস্তি বা ঘুমের ব্যাঘাতের কোনো ইতিহাস অস্বীকার করেন। রোগীর বাবা-মা স্মরণ করেন যে যখন তাদের ছেলে সাত বছর বয়সী ছিল, তখন সে নিজের নাকে একটি বস্তু ঢুকিয়ে দেয়। তারা চিকিৎসা পরামর্শ নেন, যেখানে কোনো ইমেজিং করা হয়নি এবং ডায়াগনসিসের জন্য একটি অ্যান্টেরিয়র রাইনোস্কপি ব্যবহার করা হয়েছিল, কিন্তু পরীক্ষার সময় শিশুটি সহযোগিতা না করায় চিকিৎসক সেডেশনের অধীনে বিদেশি বস্তু অপসারণের সুপারিশ করেন। তবে পরিবারটি ফলো-আপ করেনি, এবং যেহেতু শিশু উপসর্গহীনই ছিল, তারা ধরে নেন যে বিদেশি বস্তুটি নিজে থেকেই বেরিয়ে গেছে। ডান নাসাল গহ্বরের এন্ডোস্কোপিক পরীক্ষায়, একটি ডেভিয়েটেড ন্যাজাল সেপটাম এবং ইনফেরিয়র টার্বিনেট হাইপারট্রফি লক্ষ্য করা হয়। মিউকোসা ইরিথিমেটাস এবং সামান্য এডিমাটাস দেখা যাচ্ছিল। একটি বিদেশি বস্তু দৃশ্যমান ছিল, যা ইনফেরিয়র টার্বিনেটের নিচে নাসাল গহ্বরের তলে আটকে এবং লেগে ছিল। বস্তুটি আংশিকভাবে মিউকাস এবং সম্ভবত কিছু ক্রাস্টেড পদার্থে ঢাকা ছিল এবং চকচকে চেহারা ছিল, যা ধাতব প্রকৃতির ইঙ্গিত দেয়। রেডিওগ্রাফিক মূল্যায়নে, যার মধ্যে ল্যাটেরাল এবং ফ্রন্টাল X-rays অন্তর্ভুক্ত ছিল, একটি বৃত্তাকার radiopaque বস্তু ধরা পড়ে, যা নাসাল গহ্বরের তলের বরাবর অবস্থিত ধাতব snap button এর সঙ্গে সামঞ্জস্যপূর্ণ। পার্শ্ববর্তী অস্থি কাঠামো স্বাভাবিক দেখা যাচ্ছিল। একটি CBCT সংশ্লিষ্ট হালকা প্রদাহসহ বিদেশি বস্তুর উপস্থিতি নিশ্চিত করেছে, তবে উল্লেখযোগ্য অস্থিগত ক্ষতি বা সাইনাসের সম্পৃক্ততা দেখা যায়নি। রোগীর অভিভাবকের ইনফর্মড কনসেন্ট নিয়ে, এয়ারওয়েতে সরে যাওয়ার ঝুঁকি কমাতে সেমি-সিটিং অবস্থায় লোকাল অ্যানেস্থেসিয়ার অধীনে বিদেশি বস্তুটি অপসারণ করা হয়। Xylometazoline 0.1 % দিয়ে নাসাল গহ্বর ডিকনজেস্ট করার পর এবং ডান নাসারন্ধ্রে Lidocaine spray (10 mg/spray) প্রয়োগ করে, একটি হুক ব্যবহার করে বিদেশি বস্তুটি আলগা করা হয়, যা পরে bayonet forceps দিয়ে বের করা হয়। প্রক্রিয়াটি জটিলতাহীন ছিল, সামান্য রক্তপাত হয়েছিল, যা স্যালাইন ইরিগেশনে সহজেই নিয়ন্ত্রিত হয়। অপসারণ-পরবর্তী পরীক্ষায় কোনো উল্লেখযোগ্য টিস্যু ক্ষতি দেখা যায়নি। উদ্ধারকৃত বস্তুটি, 1 সেমি ব্যাসের একটি ধাতব snap button, দীর্ঘমেয়াদি এক্সপোজারের লক্ষণ দেখায়, যার মধ্যে উল্লেখযোগ্য ক্ষয় এবং জৈবিক জমা অন্তর্ভুক্ত ছিল। রোগীকে স্থিতিশীল অবস্থায় ছুটি দেওয়া হয় এবং sodium chloride irrigation solution (0.9 %) দিয়ে নাসাল রিন্স করার পরামর্শ দেওয়া হয়। দুই সপ্তাহের ফলো-আপে রোগী সুস্থ ছিলেন এবং পরীক্ষায় কোনো বিশেষ অস্বাভাবিকতা পাওয়া যায়নি।",
+    "corrected_translated_summary": "আমরা ১৭ বছর বয়সী এক পুরুষের একটি কেস উপস্থাপন করছি, যেখানে উপসর্গহীন একটি NFB (nasal foreign body) নিয়মিত ডেন্টাল এক্স-রে করার সময় আকস্মিকভাবে শনাক্ত হয়েছিল। রোগী নাসাবন্ধ, এপিস্টাক্সিস, বা কোনো ধরনের অস্বস্তির ইতিহাস অস্বীকার করেছেন। ইমেজিংয়ে ডান নাসার গহ্বরে একটি রেডিওঅপেক বস্তু দেখা যায়, যা পরে নাসার গহ্বরের তলে সন্নিবিষ্ট একটি ধাতব snap button হিসেবে সনাক্ত হয়। সম্ভাবনা রয়েছে যে ওই বিদেশি বস্তুটি এক দশকেরও বেশি সময় ধরে সেখানে অবস্থান করছিল।"
+  },
+  {
+    "id": "multiclinsum_gs_en_583.txt",
+    "fulltext": "A 19-year-old female presented to our hospital’s emergency room with a chief complaint of a two-day history of headache, accompanied by recurrent nausea, vomiting, and a one-day fever. On admission, her physical examination revealed a high fever of 39.1°C, elevated blood pressure at 189/120 mmHg, and a pulse rate of 148 beats per minute. Laboratory results indicated an elevated white blood cell count of 14.77×10^9/L and a neutrophil count of 13.55×10^9/L, suggesting a possible infection or inflammatory response. Initial empirical treatment with antibiotics was administered due to suspected infection, but her symptoms persisted. Given her abnormal vital signs, elevated inflammatory markers, and lack of symptom improvement, the patient was admitted for further diagnostic evaluation and transferred to the intensive care unit for close monitoring. A year prior, the patient had presented with similar symptoms and was diagnosed with myocarditis at a local hospital based on clinical findings at that time. During that hospitalization, she was also diagnosed with hypertension and prescribed antihypertensive medications. However, after discharge, the patient did not adhere to the prescribed antihypertensive therapy and did not regularly monitor her blood pressure. Additionally, it is notable that her father had a history of sudden, unexplained death.\n\nTo investigate the underlying etiology of the patient’s symptoms, a chest computed tomography (CT) scan was performed. Incidentally, this scan revealed a left adrenal mass with soft tissue density, measuring 43 mm × 36 mm. No pathological findings were observed in the head and chest CT scans. The electrocardiogram demonstrated sinus tachycardia with a shortened PR interval and tall, peaked P-waves in leads II, III, and aVF. Transthoracic echocardiography did not reveal any significant abnormalities.\n\nOn the second day of admission, the patient exhibited rising levels of brain natriuretic peptide (BNP) and Troponin I (TnI). The cardiologist provisionally diagnosed the patient with myocarditis of uncertain etiology, based on clinical presentation, elevated cardiac biomarkers (BNP and TnI), and supportive electrocardiogram findings. Treatment was initiated with methylprednisolone (0.25 g daily) to address potential myocardial inflammation due to suspected myocarditis. Furosemide (20 mg every 12 hours) and spironolactone (20 mg every 12 hours) were administered as diuretics to manage fluid retention and reduce cardiac workload. Perindopril amlodipine (10 mg: 5 mg daily) was prescribed as an angiotensin-converting enzyme inhibitor and calcium channel blocker combination to control blood pressure and reduce afterload. Metoprolol tartrate (25 mg every 12 hours) was used to manage heart rate and decrease myocardial oxygen demand, while esmolol (0.2 g/hour intravenous infusion), a short-acting beta-blocker, was administered for additional acute heart rate control due to sinus tachycardia. Due to concerns about a potential infection, moxifloxacin was added as empiric antibiotic therapy.\n\nGiven the patient’s presentation with an adrenal mass and hypertension, the endocrinologist recommended an evaluation of the aldosterone-to-renin ratio, plasma cortisol, plasma catecholamines, and 24-hour urinary catecholamines along with their metabolites. In the recumbent position, plasma and urinary catecholamine levels were markedly elevated (Table 1), including plasma dopamine at 524.5 pmol/L, norepinephrine at 83975 pmol/L, and epinephrine at 10579.3 pmol/L. Additionally, the 24-hour urinary levels showed free adrenaline at 4368.89 nmol/24 hours, free norepinephrine exceeding 12697.60 nmol/24 hours, normetanephrine at 8312 nmol/24 hours, metanephrines at 4078 nmol/24 hours, and vanillylmandelic acid at 58.1 mg/24 hours. These findings supported a clinical diagnosis of pheochromocytoma. On the fifth day post-admission, glucocorticoid therapy was discontinued, and perindopril amlodipine was substituted with terazosin for more targeted blood pressure management.\n\nAn enhanced abdominal CT scan further confirmed a left adrenal mass, highly suggestive of pheochromocytoma. Additionally, after obtaining informed consent, whole-exome sequencing was performed, revealing a heterozygous missense mutation, c.1900T > C: p. Cys634Arg, in the RET gene, leading to a substitution of cysteine with arginine at codon 634. This mutation raised suspicion for multiple endocrine neoplasia syndrome, prompting further evaluation of the thyroid and parathyroid glands. Thyroid color Doppler ultrasound identified a hypoechoic mass measuring 6 mm × 4 mm in the left thyroid lobe, and a mild elevation in calcitonin levels was noted. No additional significant abnormalities were detected.\n\nAs the patient’s condition gradually improved, plasma cortisol and ACTH levels returned to normal. The patient was subsequently discharged with a prescription for metoprolol tartrate (100 mg every 12 hours) and ivabradine hydrochloride (5 mg every 12 hours) for home management. Three months later, after achieving stable clinical status, the patient underwent resection of the left adrenal tumor, which measured 50 mm × 40 mm × 30 mm. Immunohistochemical analysis confirmed positive staining for Vim, CD56, Syn, CgA, and NSE, with S-100 positive in Sertoli cells, while CKpan, CD10, MART-1/Melan-A, and Melan-A were negative. The Ki67 index was 1%, leading to a definitive diagnosis of adrenal pheochromocytoma. The patient was discharged without further medications and has since been regularly followed up postoperatively without recurrence of symptoms. Over a 15-month postoperative follow-up, the patient exhibited persistently mild hypercalcitoninemia with stable thyroid nodule size, while PTH and serum calcium levels showed a progressive increase (Table 2). Further parathyroid scintigraphy using 99mTc-MIBI was performed, and the conclusion was a negative result for parathyroid adenoma.",
+    "summary": "We report the case of a 19-year-old female who presented with pheochromocytoma without experiencing a crisis, despite having a significant adrenal mass and undergoing high-dose glucocorticoid treatment. Genetic testing revealed a heterozygous missense mutation in the RET gene (c.1900T > C: p. Cys634Arg), associated with MEN2A. Further endocrine evaluation identified a thyroid nodule with mildly elevated calcitonin levels, but normal electrolyte and parathyroid hormone levels. Over a 15-month postoperative follow-up, the patient exhibited persistently mild hypercalcitoninemia with stable thyroid nodule size, while PTH and serum calcium levels showed a progressive increase. Further parathyroid scintigraphy using 99mTc-MIBI was performed, yielding a negative result for parathyroid adenoma.",
+    "translated_fulltext": null,
+    "translated_summary": "हम 19 वर्षीय एक महिला के मामले की रिपोर्ट कर रहे हैं, जिसमें फ़ियोक्रोमोसाइटोमा था, लेकिन महत्वपूर्ण अधिवृक्क द्रव्यमान होने और उच्च खुराक वाली ग्लूकोकॉर्टिकॉइड दवा लेने के बावजूद, उसे कोई गंभीर संकट नहीं हुआ। आनुवंशिक परीक्षण में RET जीन (c.1900T > C: p. Cys634Arg) में एक विषम मिससेंस उत्परिवर्तन पाया गया, जो MEN2A से जुड़ा था। आगे की अंतःस्रावी मूल्यांकन में, थायरॉयड ग्रंथि में एक नोड्यूल पाया गया, जिसमें कैल्सीटोनिन का स्तर थोड़ा बढ़ा हुआ था, लेकिन इलेक्ट्रोलाइट और पैराथायरॉइड हार्मोन का स्तर सामान्य था। 15 महीने की पोस्टऑपरेटिव अनुवर्ती अवधि में, रोगी में लगातार हल्का हाइपरकैल्सीटोनिनमिया और स्थिर थायरॉयड नोड्यूल का आकार देखा गया, जबकि पीटीएच और सीरम कैल्शियम के स्तर में धीरे-धीरे वृद्धि हुई। आगे, 99mTc-MIBI का उपयोग करके पैराथायरॉइड सिंटिग्राफी की गई, जिसके परिणामस्वरूप पैराथायरॉइड एडेनोमा के लिए नकारात्मक परिणाम प्राप्त हुआ।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা ১৯ বছর বয়সী এক নারী রোগীর একটি কেস রিপোর্ট করছি, যিনি উল্লেখযোগ্য অ্যাড্রেনাল ম্যাস থাকা এবং উচ্চ-ডোজ glucocorticoid চিকিৎসা নেওয়া সত্ত্বেও কোনো crisis ছাড়াই pheochromocytoma নিয়ে উপস্থিত হয়েছিলেন। জেনেটিক টেস্টিংয়ে RET gene-এ (c.1900T > C: p. Cys634Arg) একটি heterozygous missense mutation ধরা পড়ে, যা MEN2A-এর সাথে সংশ্লিষ্ট। পরবর্তী endocrine মূল্যায়নে সামান্য বর্ধিত calcitonin স্তরসহ একটি thyroid nodule সনাক্ত হয়, তবে electrolyte এবং parathyroid hormone মাত্রা স্বাভাবিক ছিল। ১৫ মাসের postoperative ফলো-আপ জুড়ে রোগীর স্থিতিশীল thyroid nodule আকারের সাথে ধারাবাহিকভাবে মৃদু hypercalcitoninemia ছিল, অন্যদিকে PTH এবং serum calcium মাত্রা ক্রমবর্ধমান বৃদ্ধি প্রদর্শন করেছে। পরবর্তীতে 99mTc-MIBI ব্যবহার করে parathyroid scintigraphy করা হয়, যা parathyroid adenoma-এর জন্য negative ফল দেয়।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0068_0069.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0068_0069.json
new file mode 100644
index 0000000000000000000000000000000000000000..185314cb69835a2c45c8b416f53773fac716f003
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0068_0069.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_405.txt",
+    "fulltext": "We report a rare case of euthyroid unilateral GO with early massive mono-muscular fibrosis in a 50-year-old male patient. The patient had a family history of cardiovascular disease, type 2 diabetes mellitus, and myasthenia gravis but no family or personal history of thyroid autoimmune disease. The patient was a smoker of 20 cigarettes a day from the age of 30 and presented dyslipidemia for several years. Since June 2020, he experienced rapid and progressive swelling of the soft tissues in the right orbit, moderate pain during ocular globe movements, redness of eyelids and diplopia. Visual acuity was normal in both eyes. In October 2020, the patient was evaluated in our outpatient clinic. Moderate right orbit active inflammation was confirmed by Clinical Activity Score 3/7 (CAS),3 and eyelid edema was moderate. The eyelid aperture was 14 mm in the right orbit and 10 mm in the left orbit, and the Hertel measurements were 24 mm and 18 mm in the right and left orbits, respectively. In addition, the patient presented a severe reduction in elevation, persistent depression in the primary position of the right ocular globe and constant diplopia, as scored according to the Gorman score.4 The quality of life evaluated by Graves’ Ophthalmopathy quality of life questionnaire (GO-QOL)5 was reduced in both appearance and functional subscales. However, the functional subscale was reduced with respect to the appearance subscale, as the values were 12.5 and 50, respectively (considering 0 = worse condition and 100 = the best health state). Visual acuity was normal, and color vision by Ishihara tables was 16/17 and 17/17 in the right and left eyes, respectively. Evaluation of extraocular muscles by computer tomography (CT) scan (contiguous 1.25 mm thick slices, 200 mA, 120 kV, pitch 0.5) showed severe enlargement of the lower rectal body to the edge of the insertion tendon in the right orbit. Remarkably, the morphology of the other extraocular muscles in both orbits was normal. The muscle orbit area ratio measured in the right eyes was 0.25 Autocad units (in-house method; vn ≤ 0.20±0.03).6 Thyroid function was normal with a slight increase in TSH-R-Ab: 1.75 mU/l (n.v. < 1.5 mU/l). The amplitude of the p100 wave was slightly reduced by electrophysiology evaluation in the right eye. A thyroid ultrasound scan of the thyroid gland showed a thyroiditis pattern. Biochemical and clinical evaluations were negative for hematological or other systemic diseases. Routine clinical tests were normal, but the total cholesterol levels that were 220 mg/dl, triglyceride levels were 297 mg/dl, and high-density lipoprotein cholesterol (HDL) levels were 38 mg/dl.\n\nThe patient was treated by intravenous corticosteroid pulse therapy (Solumedrol; Pfizer, Karlsruhe, Germany) with a cumulative dose of 4500 mg over 12 weeks, leading to the resolution of inflammatory signs and symptoms. However, GO-QOL, Hertel measurements and diplopia remained unchanged; in contrast, electrophysiology evaluation and visual acuity worsened. Two-wall orbital surgical decompression plus parenteral glucocorticoids was chosen as the second-line treatment for GO. In that context, a biopsy of the right inferior rectus muscle revealed massive fibrosis with adipose tissue infiltration of this extraocular muscle.",
+    "summary": "Here, we present a rare case of euthyroid single muscular GO in a 50-year-old patient who was a smoker and had dyslipidemia for several years. The patient experienced a very rapid and severe depression of ocular motility of the right eye that caused uncorrectable and constant diplopia, severely affecting his quality of life. He was euthyroid, and TSH-R-Ab plasmatic levels were only slightly elevated. Intravenous corticosteroid pulse therapy was partially effective, and two rounds of wall orbital surgical decompression were necessary. Massive mono-muscular fibrosis was evidenced by biopsy of the right inferior rectus muscle.",
+    "translated_fulltext": null,
+    "translated_summary": "यहाँ, हम एक दुर्लभ मामले को प्रस्तुत करते हैं, जिसमें 50 वर्षीय एक ऐसे रोगी में यूथायरायड एकल मांसपेशियों की नेत्र गतिशीलता संबंधी विकार (गो) पाया गया, जो धूम्रपान करते थे और कई वर्षों से डिसलिपिडेमिया से पीड़ित थे। रोगी को दाहिनी आँख की नेत्र गतिशीलता में बहुत तेजी से और गंभीर कमी का अनुभव हुआ, जिसके कारण अपरिवर्तनीय और लगातार दोहरा दृष्टि (डिप्लोपिया) की समस्या हुई, जिससे उनके जीवन की गुणवत्ता पर गंभीर प्रभाव पड़ा। वे यूथायरायड थे, और टीएसएच-आर-एबी प्लाज्मा स्तर में थोड़ी वृद्धि देखी गई। अंतःशिरा कॉर्टिकोस्टेरॉइड पल्स थेरेपी आंशिक रूप से प्रभावी रही, और दो बार दीवार कक्षीय शल्य चिकित्सा द्वारा डीकंप्रेशन की आवश्यकता पड़ी। दाहिनी अवर रेक्टस मांसपेशी के बायोप्सी से बड़े पैमाने पर मोनो-मांसपेशीय फाइब्रोसिस का पता चला।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "এখানে, আমরা ৫০ বছর বয়সী এক রোগীর ক্ষেত্রে একটি বিরল euthyroid single muscular GO উপস্থাপন করছি; তিনি ধূমপায়ী ছিলেন এবং বহু বছর ধরে dyslipidemia-তে ভুগছিলেন। রোগীর ডান চোখের ocular motility খুব দ্রুত ও তীব্রভাবে হ্রাস পেয়েছিল, যা অশোধনযোগ্য ও স্থায়ী diplopia সৃষ্টি করে তার জীবনমানকে গুরুতরভাবে প্রভাবিত করেছিল। তিনি euthyroid ছিলেন, এবং TSH-R-Ab প্লাজমার মাত্রা সামান্যই বৃদ্ধি পেয়েছিল। Intravenous corticosteroid pulse therapy আংশিকভাবে কার্যকর ছিল, এবং wall orbital surgical decompression দুই দফা প্রয়োজন হয়েছিল। ডান inferior rectus muscle-এর biopsy-তে ব্যাপক mono-muscular fibrosis প্রমাণিত হয়েছিল।"
+  },
+  {
+    "id": "multiclinsum_gs_en_345.txt",
+    "fulltext": "We present the clinical case of a 15-year-old male with no medical history or previous interventions, who presented to the paediatric emergency department with a history of vomiting and epigastric abdominal pain of four days' duration, remaining afebrile during the course of the illness.\n\nInitially treated as gastroenteritis, but with no improvement, and with persistence of epigastric abdominal pain and biliary vomiting, he was admitted to the emergency department for further evaluation.\n\nOn physical examination, the patient was in acceptable general condition, afebrile, with mild signs of dehydration. The abdomen was distended, without signs of peritonism and with decreased hydroaerolic sounds. The laboratory tests did not present significant findings, and an abdominal radiograph was performed with findings suggestive of intestinal obstruction.\n\nGiven the evolution, an urgent computed tomography was performed, which showed the presence of ascites and significant dilation of small intestine loops, suggesting the interposition of a small intestine loop at the beginning of the transcavity of the epiplons, with a change in caliber at the level of the hiatus of Winslow.\n\nUrgent surgical intervention was performed, initially by exploratory laparoscopy. Dilated loops of small intestine and terminal ileum, cecum and ascending colon of normal calibre but located in the right hypochondrium, with the cecum very mobile and without presenting adhesions to the right parietocolic space, were observed. Following the terminal ileum proximally, loops of small intestine of different calibre were observed from the depth of the theoretical location of the hiatus of Winslow. It was possible to pull the cecum and terminal ileum until they were displaced to the right iliac fossa, but without correctly identifying the point of change of calibre, since the interposition of the lower edge of the liver and the distension of loops of small intestine hampered the technique. An attempt was made to improve visualization by percutaneous puncture of a dilated loop to empty the gas, without improvement. To ensure the resolution of the obstructive picture, a supraumbilical mid-laparotomy was decided. When accessing the cavity, the change of calibre in the ileum was evident, about 40 centimetres from the ileocecal valve, with signs compatible with hernia of a section of about five centimetres of the ileum through the hiatus of Winslow. In both ends of the herniated loop, we observed the congestive imprint of the hiatus on the loop (Fig. 3). The normal calibre of the hiatus of Winslow was identified, so no preventive technique was performed to reduce the risk of recurrence.\n\nDuring the first days of the postoperative period, the patient presented a paralytic ileus, and the nasogastric tube could be removed five days after surgery and oral tolerance was initiated with a good response. Simultaneously, he developed a pelvic collection that was managed conservatively with antibiotics, with a good evolution. Finally, the patient was discharged ten days after the intervention, with preserved transit, remaining afebrile and with a good general state.\n\nThe patient is currently being followed up in the outpatient department of paediatric surgery.\n",
+    "summary": "We present the clinical case of a 15-year-old adolescent male with no previous surgical history, who presented with abdominal pain and vomiting, and whose computed tomography suggested a picture of intestinal obstruction due to internal hernia at the level of the Winslow hiatus. He required surgical intervention by exploratory laparoscopy, converted to a supraumbilical midline laparotomy due to poor visualization, for reduction of the herniated ileal loop. This presented a good appearance and intestinal resection was not necessary. No preventive technique was performed to reduce the risk of recurrence. Postoperatively, the patient presented a pelvic collection managed conservatively with antibiotics. He is currently being monitored in outpatient paediatric surgery.\n",
+    "translated_fulltext": "हम एक 15 वर्षीय पुरुष के नैदानिक मामले को प्रस्तुत करते हैं, जिसका कोई पूर्व चिकित्सा इतिहास या पिछली कोई चिकित्सीय प्रक्रिया नहीं थी। वह चार दिनों से उल्टी और ऊपरी पेट में दर्द की शिकायत के साथ बाल चिकित्सा आपातकालीन विभाग में आया, और बीमारी के दौरान उसे बुखार नहीं था।\n\nशुरुआत में इसे गैस्ट्रोएंटेराइटिस माना गया, लेकिन कोई सुधार नहीं हुआ, और ऊपरी पेट में दर्द और पित्त युक्त उल्टी जारी रहने पर, आगे की जांच के लिए उसे आपातकालीन विभाग में भर्ती कराया गया।\n\nशारीरिक परीक्षण में, रोगी की सामान्य स्थिति स्वीकार्य थी, उसे बुखार नहीं था, और उसमें हल्के निर्जलीकरण के लक्षण थे। पेट फूला हुआ था, पेरिटोनिटिस के कोई लक्षण नहीं थे, और हाइड्रोएरोलिक ध्वनियाँ कम थीं। प्रयोगशाला परीक्षणों में कोई महत्वपूर्ण निष्कर्ष नहीं मिला, और एक पेट का एक्स-रे किया गया, जिसमें आंतों में रुकावट के संकेत मिले।\n\nस्थिति को देखते हुए, तत्काल कंप्यूटेड टोमोग्राफी की गई, जिसमें जलोदर और छोटी आंत के लूप का महत्वपूर्ण फैलाव पाया गया, जिससे पता चलता है कि छोटी आंत का एक लूप एपिप्लोन की ट्रांसकैविटी की शुरुआत में स्थित है, और विंसलो के छिद्र के स्तर पर व्यास में परिवर्तन हुआ है।\n\nतत्काल शल्य चिकित्सा की गई, शुरुआत में एक्सप्लोरेटरी लैप्रोस्कोपी द्वारा। छोटी आंत और टर्मिनल इलियम के फैले हुए लूप, सामान्य व्यास की सीकम और आरोही कोलन, लेकिन दाहिनी हाइपोकॉन्ड्रियम में स्थित थे, सीकम बहुत गतिशील था और दाहिनी पैरीटोकोलिक जगह से कोई आसंजन नहीं था। टर्मिनल इलियम के समीपवर्ती भाग का अनुसरण करते हुए, विभिन्न व्यास की छोटी आंत के लूप विंसलो के छिद्र के सैद्धांतिक स्थान की गहराई से देखे गए। सीकम और टर्मिनल इलियम को खींचकर उन्हें दाहिने इलियाक फोसा में स्थानांतरित किया जा सका, लेकिन व्यास में परिवर्तन के बिंदु की सही पहचान नहीं की जा सकी, क्योंकि यकृत के निचले किनारे का इंटरपोजिशन और छोटी आंत के लूप का फैलाव तकनीक में बाधा डाल रहा था। गैस को निकालने के लिए एक फैले हुए लूप का परक्यूटेनियस पंचर करके दृश्यता में सुधार करने का प्रयास किया गया, लेकिन कोई सुधार नहीं हुआ। अवरोधक स्थिति को दूर करने के लिए, एक सुप्राउम्बिलिकल मिड-लैपरोटॉमी करने का निर्णय लिया गया। गुहा में प्रवेश करते समय, इलियम में व्यास में परिवर्तन स्पष्ट था, जो इलियोसेकल वाल्व से लगभग 40 सेंटीमीटर दूर था, और इसके लक्षण विंसलो के छिद्र के माध्यम से इलियम के लगभग पांच सेंटीमीटर के खंड के हर्निया के अनुरूप थे। हर्नियेटेड लूप के दोनों सिरों पर, हमने लूप पर छिद्र के कंजस्टिव इम्प्रिंट को देखा (चित्र 3)। विंसलो के छिद्र का सामान्य व्यास पहचाना गया, इसलिए पुनरावृत्ति के जोखिम को कम करने के लिए कोई निवारक तकनीक नहीं की गई।\n\nसर्जरी के बाद पहले कुछ दिनों में, रोगी को पैरालिटिक इलियस हुआ, और नासोगैस्ट्रिक ट्यूब को सर्जरी के पांच दिन बाद हटाया जा सका और मौखिक सहनशीलता शुरू की गई, जिसके अच्छे परिणाम मिले। साथ ही, उसमें एक श्रोणि संग्रह विकसित हुआ, जिसका एंटीबायोटिक दवाओं से रूढ़िवादी तरीके से प्रबंधन किया गया, और इसमें अच्छा सुधार हुआ। अंत में, रोगी को हस्तक्षेप के दस दिन बाद छुट्टी दे दी गई, जिसमें सामान्य पारगमन बना रहा, उसे बुखार नहीं था और उसकी सामान्य स्थिति अच्छी थी।\n\nरोगी का वर्तमान में बाल चिकित्सा सर्जरी के आउट पेशेंट विभाग में अनुवर्ती उपचार किया जा रहा है।",
+    "translated_summary": "हम एक 15 वर्षीय किशोर लड़के का नैदानिक मामला प्रस्तुत करते हैं, जिसका पहले कोई सर्जिकल इतिहास नहीं था, और जो पेट दर्द और उल्टी के साथ आया था। उसकी कंप्यूटेड टोमोग्राफी में विन्सलो हाइटस के स्तर पर आंतरिक हर्निया के कारण आंत में रुकावट का संकेत मिला। खराब दृश्यता के कारण, हर्नियेटेड इलियल लूप को कम करने के लिए एक्सप्लोरेटरी लैप्रोस्कोपी द्वारा सर्जिकल हस्तक्षेप की आवश्यकता थी, जिसे बाद में सुप्राउम्बिलिकल मिडलाइन लैपरोटॉमी में बदल दिया गया। इससे अच्छी स्थिति बनी और आंत को काटने की आवश्यकता नहीं पड़ी। पुनरावृत्ति के जोखिम को कम करने के लिए कोई निवारक तकनीक का उपयोग नहीं किया गया। सर्जरी के बाद, रोगी में श्रोणि में तरल पदार्थ जमा हो गया, जिसका एंटीबायोटिक दवाओं से रूढ़िवादी तरीके से इलाज किया गया। वर्तमान में, रोगी की निगरानी आउट पेशेंट बाल चिकित्सा सर्जरी में की जा रही है।",
+    "corrected_translated_fulltext": "আমরা ১৫ বছর বয়সী এক পুরুষের একটি ক্লিনিক্যাল কেস উপস্থাপন করছি, যার কোনো পূর্ববর্তী চিকিৎসা ইতিহাস বা আগের কোনো চিকিৎসাগত হস্তক্ষেপ ছিল না। তিনি চার দিন ধরে বমি এবং এপিগ্যাস্ট্রিক পেটব্যথার ইতিহাস নিয়ে শিশু জরুরি বিভাগে উপস্থিত হয়েছিলেন, এবং অসুস্থতার পুরো সময়ে তিনি জ্বরহীন ছিলেন।\n\nপ্রাথমিকভাবে এটিকে gastroenteritis হিসেবে ধরা হয়েছিল, কিন্তু কোনো উন্নতি হয়নি, এবং এপিগ্যাস্ট্রিক পেটব্যথা ও পিত্তযুক্ত বমি অব্যাহত থাকায়, আরও মূল্যায়নের জন্য তাকে জরুরি বিভাগে ভর্তি করা হয়।\n\nশারীরিক পরীক্ষায় রোগীর সার্বিক অবস্থা গ্রহণযোগ্য ছিল, তিনি জ্বরহীন ছিলেন, এবং হালকা ডিহাইড্রেশনের লক্ষণ ছিল। পেট ফোলা ছিল, পেরিটোনিজমের কোনো লক্ষণ ছিল না, এবং হাইড্রো-এয়ারোলিক সাউন্ড কম ছিল। ল্যাবরেটরি পরীক্ষায় উল্লেখযোগ্য কোনো ফল পাওয়া যায়নি, এবং একটি অ্যাবডোমিনাল এক্স-রে করা হয়, যাতে intestinal obstruction-এর ইঙ্গিত মেলে।\n\nপরিস্থিতি বিবেচনায় জরুরি computed tomography করা হয়, যাতে ascites এবং small intestine-এর লুপগুলোর উল্লেখযোগ্য ডাইলেশন দেখা যায়, যা নির্দেশ করে যে small intestine-এর একটি লুপ epiplons-এর transcavity-এর শুরুতে ইন্টারপোজড হয়েছে, এবং Winslow-এর hiatus-এর স্তরে ক্যালিবারে পরিবর্তন রয়েছে।\n\nজরুরি সার্জিকাল হস্তক্ষেপ করা হয়, প্রাথমিকভাবে exploratory laparoscopy দ্বারা। ছোট অন্ত্র এবং টার্মিনাল ileum-এর ডাইলেটেড লুপ দেখা যায়, cecum ও ascending colon স্বাভাবিক ক্যালিবারের হলেও ডান hypochondrium-এ অবস্থান করছিল; cecum অত্যন্ত মোবাইল ছিল এবং ডান parietocolic space-এর সাথে কোনো adhesion ছিল না। টার্মিনাল ileum-কে প্রোক্সিমালি অনুসরণ করে, বিভিন্ন ক্যালিবারের small intestine-এর লুপগুলো Winslow-এর hiatus-এর তাত্ত্বিক অবস্থানের গভীরতা থেকে পর্যবেক্ষিত হয়। cecum ও টার্মিনাল ileum-কে টেনে ডান iliac fossa-তে স্থানান্তর করা সম্ভব হয়েছিল, কিন্তু ক্যালিবার পরিবর্তনের বিন্দুটি সঠিকভাবে চিহ্নিত করা যায়নি, কারণ যকৃতের নিম্ন প্রান্তের interposition এবং small intestine-এর লুপগুলোর ডিস্টেনশন টেকনিককে ব্যাহত করছিল। গ্যাস বের করার উদ্দেশ্যে একটি ডাইলেটেড লুপে percutaneous puncture করে ভিজ্যুয়ালাইজেশন উন্নত করার চেষ্টা করা হয়, কিন্তু কোনো উন্নতি হয়নি। অবস্ট্রাকটিভ অবস্থা নিরসনের জন্য একটি supraumbilical mid-laparotomy করার সিদ্ধান্ত নেওয়া হয়। ক্যাভিটিতে প্রবেশের সময়, ileum-এ ক্যালিবার পরিবর্তন স্পষ্ট ছিল, যা ileocecal valve থেকে প্রায় ৪০ সেন্টিমিটার দূরে, এবং এর লক্ষণগুলো Winslow-এর hiatus দিয়ে প্রায় পাঁচ সেন্টিমিটার দৈর্ঘ্যের ileum-খণ্ডের হেরনিয়ার সঙ্গে সামঞ্জস্যপূর্ণ ছিল। হেরনিয়েটেড লুপের উভয় প্রান্তে, আমরা লুপের ওপর hiatus-এর congestive imprint লক্ষ্য করেছি (Fig. 3)। Winslow-এর hiatus-এর স্বাভাবিক ক্যালিবার নিশ্চিত করা হয়েছিল, তাই পুনরাবৃত্তির ঝুঁকি কমাতে কোনো প্রতিরোধমূলক কৌশল করা হয়নি।\n\nঅপারেশনের পর প্রথম কয়েক দিনে রোগীর paralytic ileus হয়, এবং নাসোগ্যাস্ট্রিক টিউব অপারেশনের পাঁচ দিন পর অপসারণ করা যায় ও মৌখিক খাদ্য গ্রহণ শুরু করা হয়, যার ভালো সাড়া মেলে। একই সময়ে, তার একটি pelvic collection তৈরি হয়, যা অ্যান্টিবায়োটিক দিয়ে কনজারভেটিভভাবে ম্যানেজ করা হয়, এবং তাতে ভালো উন্নতি হয়। অবশেষে, হস্তক্ষেপের দশ দিন পর রোগীকে ছাড়পত্র দেওয়া হয়, অন্ত্রের ট্রানজিট বজায় ছিল, তিনি জ্বরহীন ছিলেন এবং সার্বিক অবস্থা ভালো ছিল।\n\nবর্তমানে রোগীর ফলো-আপ শিশু সার্জারির আউটপেশেন্ট বিভাগে চলছে।",
+    "corrected_translated_summary": "আমরা ১৫ বছর বয়সী এক কিশোর বালকের একটি ক্লিনিকাল কেস উপস্থাপন করছি, যার আগে কোনো সার্জিকাল ইতিহাস ছিল না, এবং যে পেটের ব্যথা ও বমি নিয়ে উপস্থিত হয়েছিল। তার computed tomography-তে Winslow hiatus-এর স্তরে internal hernia-জনিত অন্ত্রের অবরোধের ইঙ্গিত পাওয়া যায়। দৃষ্টির দুর্বলতার কারণে, herniated ileal loop কমানোর জন্য exploratory laparoscopy দ্বারা সার্জিকাল হস্তক্ষেপের প্রয়োজন হয়, যা পরে supraumbilical midline laparotomy-তে রূপান্তর করা হয়। এটির অবস্থা ভালো ছিল এবং অন্ত্রের resection-এর প্রয়োজন হয়নি। পুনরাবৃত্তির ঝুঁকি কমাতে কোনো preventive technique প্রয়োগ করা হয়নি। অস্ত্রোপচারের পরে, রোগীর pelvic collection হয়, যা অ্যান্টিবায়োটিক দিয়ে রক্ষণশীলভাবে চিকিৎসা করা হয়। বর্তমানে, রোগীর পর্যবেক্ষণ outpatient paediatric surgery-এ করা হচ্ছে।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0072_0073.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0072_0073.json
new file mode 100644
index 0000000000000000000000000000000000000000..1d8bedd61b759a4ebf0e804a227694336b9dff66
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0072_0073.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_406.txt",
+    "fulltext": "A 39-year-old woman with a diagnosis of peripartum cardiomyopathy who received a heart transplant in October 2014. She received induction with Basiliximab and methylprednisolone. She also received maintenance treatment with tacrolimus XL prolonged release 7 mg daily, everolimus 1 mg twice daily, and prednisolone 5 mg/day. She had two episodes of acute rejection during the first year post-transplant, and was controlled with methylprednisolone pulse therapy with good results. There was no history of renal disease and her renal function was stable with creatinine of 0.88 mg/dL and a glomerular filtration rate (GFR) of 102 mL/min/1.73m2 during the first year post-transplant. Follow-up was done exclusively by the heart transplant group and routine polyomavirus viral load BK or urinary cytology was not performed. In 2016, she presented a creatinine serum elevation of up to 1.9 mg/dL, with a GFR of 32.6 mL/min/1.73m2. At that time, the minimum tacrolimus level was 7.2 ng/mL and everolimus, 5.2 ng/mL. Anticalcineurin toxicity was suspected; therefore, tacrolimus was reduced to 4 mg daily and creatinine returned to near baseline (creatinine 1.25 mg/dL, GFR 54.1 mL/min/1.73m2); no renal biopsy was performed. In March 2017, creatinine increased to 2.69 mg/dL, with a GFR of 21.4 mL/min/1.73m2, for which she was hospitalized. The patient stated that she did not have any symptoms. During physical examination, she was in good general condition, heart rate of 80 beats per minute, blood pressure of 130/90 mmHg, respiratory rate of 15 per minute, afebrile. Further studies were performed: renal tract ultrasound showed normal renal size but increased echogenicity; urinalysis and urine cultures were negative, without haematuria, pyuria or casts; echocardiogram with adequate cardiac function; HIV, syphilis, hepatitis B and C serologic tests were negative; minimum tacrolimus level of 5.2 ng/mL, and everolimus of 5.98 ng/mL. Control was initiated with intravenous hydration, and tacrolimus XL dose was reduced to 2 mg daily, but there was no improvement in renal function; a renal biopsy was planned.\n\nRenal biopsy revealed active chronic interstitial nephritis associated with advanced poliomyelitis virus nephritis. BK virus PCR was performed and was positive at 33,800 copies/mL in blood (log 4.5). Tacrolimus was discontinued; creatinine levels stabilized between 2.2 and 2.4 mg/dL, with no further elevation in post-discharge controls. Her viral load began to decline to undetectable levels. The patient did not have episodes of cardiac rejection in 3 years of follow-up; the last creatinine measurement was 2.5 mg/dL, corresponding to a GFR of 23.4 mL/min/1.73m2.\n",
+    "summary": "We report a case of BK virus nephropathy in a patient who underwent heart transplantation due to peripartum cardiomyopathy. The renal biopsy reported active chronic tubulointerstitial nephritis associated with late-stage BK virus nephritis and the blood viral load for BK virus was positive (log 4.5). The immunosuppressive treatment was reduced, and after two years of follow-up, the patient had stable renal function with serum creatinine of 2.5 mg/dL (GFR of 23.4 mL/min/1.73m2).\n",
+    "translated_fulltext": null,
+    "translated_summary": "हम एक ऐसे रोगी में बीके वायरस नेफ्रोपैथी के एक मामले की रिपोर्ट करते हैं, जिसकी प्रसवोत्तर कार्डियोमायोपैथी के कारण हृदय प्रत्यारोपण किया गया था। गुर्दे की बायोप्सी में सक्रिय पुरानी ट्यूबुलर इंटरस्टिशियल नेफ्राइटिस पाया गया, जो बीके वायरस नेफ्राइटिस के अंतिम चरण से जुड़ा था, और बीके वायरस के लिए रक्त में वायरल लोड सकारात्मक था (लॉग 4.5)। इम्युनोसप्रेसिव उपचार को कम किया गया, और दो साल के अनुवर्ती अध्ययन के बाद, रोगी में स्थिर गुर्दे का कार्य देखा गया, जिसमें सीरम क्रिएटिनिन का स्तर 2.5 मिलीग्राम/डीएल (जीएफआर 23.4 मिलीलीटर/मिनट/1.73 मीटर²) था।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা peripartum cardiomyopathy-এর কারণে heart transplantation করা এক রোগীতে BK virus nephropathy-এর একটি কেস রিপোর্ট করছি। রেনাল বায়োপসি-তে late-stage BK virus nephritis-এর সঙ্গে সম্পর্কিত active chronic tubulointerstitial nephritis রিপোর্ট করা হয়েছিল এবং BK virus-এর জন্য রক্তের viral load পজিটিভ ছিল (log 4.5)। immunosuppressive চিকিৎসা কমানো হয়েছিল, এবং দুই বছরের follow-up-এর পর রোগীর renal function স্থিতিশীল ছিল, serum creatinine 2.5 mg/dL (GFR 23.4 mL/min/1.73m2) সহ।"
+  },
+  {
+    "id": "multiclinsum_gs_en_504.txt",
+    "fulltext": "14-year-old previously healthy adolescent who presented to the Primary Emergency Care Service (PEC) of Osorno with a 11-day history of a predominantly nocturnal irritative cough. Symptomatic treatment was indicated, evolving with dyspnoea and orthopnoea. He presented to the Emergency Department of the Osorno Base Hospital (OBH), with severe respiratory distress, intolerance to supine position, and abdominal pain. He was admitted to the Paediatric Intensive Care Unit (PICU), tachycardic, hypertensive, polypneic, oxygen saturation 96% with FiO2 35%, rosy, hydrated and well perfused, with flat jugular veins, small bilateral supraclavicular lymphadenopathies. The thorax was without retraction of soft tissue, maintained in a genupectoral position, with decreased pulmonary murmurs in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The soft abdomen was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and\n\nA nephrological evaluation was performed, which confirmed renal failure secondary to tumor lysis syndrome, without dialysis urgency and tendency to hypertension, with creatinine 1.54 mg/dL, phosphemia 11 mg/dL, without hypernatremia. It continued with hyperhydration, diuretic (furosemide) and antihypertensive (amlodipine). From the respiratory point of view, it presented oxygen requirement, with FIO2 35% by mask of Venturi, suspending this supply on the third day of admission. It evolved with episodes of psychomotor agitation, associated to the diagnosis in process, which was treated according to the institutional protocol of psychomotor agitation, with psychological and psychiatric support, with satisfactory evolution. On the third day of admission and treatment a CT scan of the thorax, abdomen and pelvis was performed with contrast, observing an increase in the size of the thymus, of homogeneous aspect, probably in the context of a lymphoproliferative process and findings suggestive of pulmonary thromboembolism. The angioCT of the thorax showed thrombosis of the jugular vein, extensive bilateral pleural effusion associated to atelectatic phenomena in both bases, with signs of medical bilateral nephrosis. Anticoagulation with enoxaparin (1 mg/kg dose, every 12 hours) was indicated for twenty days. Then the angioCT of control showed resolution of the thrombosis.On the fourth day of admission and treatment, a diagnostic and extension study was performed, which included, among others, a complete biochemical profile including lipid profile, granulopoietic hyperplasia of the bone marrow (myelogram), flow cytometry (bone marrow) in which no cells with a predominant clonal or neoplastic immunophenotype of haemological lineage were observed, flow cytometry in peripheral blood negative for neoplastic cells, cytological of pleural fluid negative for neoplastic cells, flow cytometry of pleural fluid without evidence of haemological neoplasia. It was presented to the paediatric oncological committee, highlighting that it was not possible to take a biopsy of the tumour given that the mediastinal mass disappeared with the cytoreductive treatment, assuming the diagnosis of lymphoblastic lymphoma by the clinical picture and the response to treatment, according to the PINDA 0516 protocol. This protocol contemplates in Induction IA eight doses of Lasp E. coli of 10,000 IU/m2. Having received seven doses of L-asp and with a cumulative dose of ninety thousand international units plus glucocorticoid (prednisone), presented a picture of decline, vomiting, abdominal pain and mild dehydration. There was suspicion of pancreatitis, which was ruled out by normal amylase/lipase values and normal hepatic tests. At that time it had plasma electrolyte profile with hyponatraemia of 126 mOsm/kg and urinary osmolality of 510 mOsm/kg, both normal values. With hyponatraemia and hypertriglyceridaemia, there was suspicion of RAM of pseudohyponatraemia secondary to hypertriglyceridaemia associated to L-asp. It was evaluated by Gastroenterology and Endocrinology, indicating a diet low in refined sugars and rich in fiber, fibrates (ciprofibrato 100 mg oral daily) and omega 3 (4 g oral daily), until triglyceride values of 300 mg/dL were achieved. Two weeks later the triglycerides had a value of 79 mg/dL. Ciprofibrato and omega3 were suspended, indicating prophylactic use associated to corticoid and L-asp treatment. A total of twelve doses of L-asp were completed with a cumulative dose of one hundred and eighty four thousand international units corresponding to the induction protocol. The suspicion of RAM was subjected to causality evaluation, with the modified Karch and Lasagna algorithm by WHO5, which resulted in “Definitive” RAM for the association of L-asp and Prednisone\n",
+    "summary": "A teenager who developed pseudohyponatraemia and hypertriglyceridaemia during treatment for non-Hodgkin lymphoma (NHL) was suspected to have a drug reaction (ADR). This suspicion of ADR was evaluated according to the modified causality algorithm (Karch and Lasagna), resulting in a \"definitive\" ADR for the association of L-asp and corticosteroids. He received treatment with a low-fat diet and lipid-modifying medicines. L-asp and prednisone were not discontinued due to the end of the indication, according to the protocol. The hypertriglyceridaemia recovered without complications after 14 days of treatment.\n",
+    "translated_fulltext": null,
+    "translated_summary": "एक किशोर, जिसे नॉन-हॉजकिन लिंफोमा (NHL) के इलाज के दौरान छद्म हाइपोनेट्रेमिया और हाइपरट्राइग्लिसराइडमिया विकसित हुआ, उस पर दवा के प्रतिकूल प्रभाव (ADR) होने का संदेह था। इस ADR के संदेह का मूल्यांकन संशोधित कारण-प्रभाव एल्गोरिदम (कार्च और लासाग्ना) के अनुसार किया गया, जिसके परिणामस्वरूप एल-एस्प और कॉर्टिकोस्टेरॉइड्स के संयोजन के लिए एक \"निश्चित\" ADR पाया गया। उसे कम वसा वाले आहार और लिपिड-संशोधित करने वाली दवाओं से इलाज किया गया। प्रोटोकॉल के अनुसार, संकेत के अंत के कारण एल-एस्प और प्रेडनिसोलोन को बंद नहीं किया गया। 14 दिनों के उपचार के बाद बिना किसी जटिलता के हाइपरट्राइग्लिसराइडमिया में सुधार हुआ।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "একজন কিশোর, যিনি non-Hodgkin lymphoma (NHL)-এর চিকিৎসার সময় pseudohyponatraemia এবং hypertriglyceridaemia বিকাশ করেছিলেন, তার ক্ষেত্রে drug reaction (ADR) হওয়ার সন্দেহ করা হয়েছিল। এই ADR-এর সন্দেহটি modified causality algorithm (Karch and Lasagna) অনুযায়ী মূল্যায়ন করা হয়, যার ফলে L-asp এবং corticosteroids-এর association-এর জন্য একটি \"definitive\" ADR নির্ধারিত হয়। তাকে low-fat diet এবং lipid-modifying medicines দিয়ে চিকিৎসা দেওয়া হয়েছিল। প্রোটোকল অনুযায়ী, indication-এর সমাপ্তির কারণে L-asp এবং prednisone বন্ধ করা হয়নি। চিকিৎসার 14 দিন পর জটিলতা ছাড়াই hypertriglyceridaemia সেরে যায়।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0074_0075.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0074_0075.json
new file mode 100644
index 0000000000000000000000000000000000000000..944d2492d56ed6f8b52fbd2c4518f79de0750aec
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2hi_gemma(0_200)_0074_0075.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_54.txt",
+    "fulltext": "A 56-year-old Italian female patient with β-thalassemia major presented to the radiology department to undergo MRI to quantify myocardial, hepatic, and pancreatic iron deposition. The clinical history of the patient included a transfusion-dependent β-thalassemia condition (genotype HBB:c.118C > T/ HBB:c.93-21G > A), diagnosed at the age of 7 years, despite the fact that the first transfusion was carried out at 2 years. As a consequence of β-thalassemia, the patient underwent splenectomy and cholecystectomy.\n\nAt the moment of MRI, she had a negative HCV-RNA (Hepatitis C virus-Ribonucleic acid) test, no osteoporosis or other endocrine, cardiac, or hepatic complications, and good iron levels. The patient’s therapy included iron chelation with deferasirox, vitamin D, and luspatercept, an erythropoiesis modulator started 2 years before the MRI examination (good response, with an increase of about 35% of transfusion interval duration). Transfusion therapy included two units of concentrated and filtered red blood cells every 25 days with pre-transfusion hemoglobin values of 10–10.5 g/dl.\n\nOn MRI, a solid mass with lobulated and regular contours was incidentally identified within the prevascular compartment of the mediastinum.\n\nThe lesion was mildly hyperintense on T2-weighted images (T2-wi) and isointense on T1-wi. The mediastinal mass in question was discernible in a prior MRI examination conducted for the same purpose in 2020 before starting luspatercept therapy, albeit with a marginal enlargement.\n\nThere were no other apparent abnormalities observed in the remaining mediastinal compartments. No pleural or pericardial effusions were present.\n\nThe neurological examination was unremarkable, and in the preceding months, the patient exhibited no symptoms of mediastinal syndrome associated with compression of the adjacent neurovascular structures. Moreover, she did not exhibit any fever or experience any weight loss.\n\nFor further evaluation, the patient underwent 18F-deoxyglucose (18FDG) positron emission tomography (PET)-computed tomography (CT) and chest CT with contrast media. On PET-CT, the mediastinal mass showed only mild FDG uptake (SUVmax = 4.3); no other sites of abnormal radiotracer uptake were reported in the neck, chest, abdomen, and skeleton. On CT images, the lesion presented regular margins, solid density, and mild contrast enhancement. The adjacent structures did not exhibit any signs of invasion, and lymphadenopathies or extra-thoracic disease were not present. Such radiological features, the indolent behaviour over time, the absence of systemic symptoms, and the lack of avid FDG uptake on PET-CT scan made the diagnosis of thymoma probable.\n\nHowever, on lung window visualization, multiple rounded areas of parenchymal lucency, consistent with thin-walled cysts distributed symmetrically throughout both lungs, with normal intervening parenchyma, were evident.\n\nNo nodules or other interstitial abnormalities were associated with the cysts. No pneumothorax was detected. Coherently with thalassemic bone disease, the ribs appeared widened, and the spine displayed mild platyspondyly. The remaining portion of the chest and visible upper abdomen were unremarkable. The radiological findings were consistent with cystic lung disease, most likely LAM.\n\nThe patient was then referred to the pulmonary clinic for further evaluation. She was a never-smoker and did not report any respiratory symptoms. In particular, she denied a history of chronic cough, recurrent respiratory infections, or pneumothorax. No cutaneous lesions, notably facial fibrofolliculomas, were evident. On chest examination, the lung fields were clear. Peripheral capillary oxygen saturation was normal (98%), with a heart rate of 75 beats per minute. Pulmonary function tests revealed a substantial reduction in diffusing capacity of the lungs for carbon monoxide (DLCO; 42% of the predicted value), partly imputable to the condition of anemia, with a carbon monoxide transfer coefficient (KCO) of 73% of the predicted value. After discussion in a multidisciplinary tumor board setting, including a pulmonologist, the patient underwent left thoracoscopic thymectomy and concomitant lingual segment wedge resection. The histopathological report revealed a morphological finding and immunohistochemical pattern referable to type B2 thymoma with focal infiltration of the capsule. Extracapsular extension was not evident. However, the lesion was present at the resection margin (stage IIa according to Masaoka–Koga; stage 1a according to the tumor, node, metastasis [TNM] classification).\n\nRegarding the lung parenchyma, histopathologic analysis described lung parenchyma with cysts of variable size lined by spindle cells in myoid habit with immunohistochemical reactivity for actin, estrogen, progesterone receptors, and HMB45 (focal positivity). Modest chronic interstitial inflammation, vascular congestion, and recent blood extravasation were evident. These morphological findings were compatible with pulmonary LAM.\n\nA final histological diagnosis of thymoma and pulmonary LAM was made. For the neoplastic condition, the patient was a candidate for adjuvant radiation therapy due to the microscopically incomplete resection (R1). For LAM with concomitant β-thalassemia, treatment with sirolimus was recommended.",
+    "summary": "A 56-year-old Italian female patient with β-thalassemia major underwent magnetic resonance imaging to quantify myocardial, hepatic, and pancreatic iron deposition. Her medical history included transfusion-dependent β-thalassemia, splenectomy, and cholecystectomy. At the time of magnetic resonance imaging, she had no significant endocrine, cardiac, or hepatic complications and was on deferasirox, vitamin D, and luspatercept. Magnetic resonance imaging revealed a lobulated mass in the prevascular mediastinum, which showed mild radiotracer uptake on positron emission tomography. Chest computed tomography revealed multiple thin-walled cysts in the lungs, indicating lymphangioleiomyomatosis. Following multidisciplinary evaluation, the patient underwent thoracoscopic thymectomy and lung wedge resection. Histopathology confirmed type B2 thymoma and pulmonary lymphangioleiomyomatosis. Post-surgery, the patient was recommended for adjuvant radiation therapy and sirolimus treatment.",
+    "translated_fulltext": null,
+    "translated_summary": "56 वर्षीय एक इतालवी महिला रोगी, जिसे बीटा-थैलेसीमिया मेजर था, ने हृदय, यकृत और अग्न्याशय में लौह जमाव की मात्रा निर्धारित करने के लिए मैग्नेटिक रेजोनेंस इमेजिंग (एमआरआई) करवाई। उसके चिकित्सा इतिहास में ट्रांसफ्यूजन-निर्भर बीटा-थैलेसीमिया, स्प्लेनेक्टॉमी और कोलेसिस्टेक्टॉमी शामिल थे। एमआरआई के समय, उसे कोई महत्वपूर्ण अंतःस्रावी, हृदय या यकृत संबंधी जटिलताएं नहीं थीं और वह डेफेरासिराक्स, विटामिन डी और लसपाटेरसेप्ट ले रही थी। एमआरआई में प्रीवैस्कुलर मेडियास्टिनम में एक लोब्यूलेटेड द्रव्यमान पाया गया, जिसने पॉज़िट्रॉन उत्सर्जन टोमोग्राफी पर हल्की रेडियोट्रेसर अवशोषण दिखाया। छाती की कंप्यूटेड टोमोग्राफी में फेफड़ों में कई पतली दीवार वाले सिस्ट पाए गए, जो लिम्फैंजियोलेयोमायोसिस का संकेत देते हैं। बहु-विषयक मूल्यांकन के बाद, रोगी ने थोरैकोस्कोपिक थाइमेक्टॉमी और फेफड़े के वेज रिसेक्शन करवाया। हिस्टोपैथोलॉजी ने टाइप बी2 थाइमोमा और फुफ्फुसीय लिम्फैंजियोलेयोमायोसिस की पुष्टि की। सर्जरी के बाद, रोगी को सहायक विकिरण चिकित्सा और सिरोलिमस उपचार की सिफारिश की गई।",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "56 বছর বয়সী এক ইতালীয় নারী রোগী, যার β-thalassemia major ছিল, মায়োকার্ডিয়াল, হেপাটিক এবং প্যানক্রিয়াটিক iron deposition পরিমাপের উদ্দেশ্যে magnetic resonance imaging (MRI) করান। তার চিকিৎসা ইতিহাসে transfusion-dependent β-thalassemia, splenectomy এবং cholecystectomy ছিল। MRI-র সময়, তার উল্লেখযোগ্য endocrine, cardiac, বা hepatic জটিলতা ছিল না এবং তিনি deferasirox, vitamin D, এবং luspatercept নিচ্ছিলেন। MRI-তে prevascular mediastinum-এ একটি lobulated mass ধরা পড়ে, যা positron emission tomography-তে মৃদু radiotracer uptake দেখিয়েছে। Chest computed tomography-তে ফুসফুসে multiple thin-walled cysts দেখা যায়, যা lymphangioleiomyomatosis নির্দেশ করে। Multidisciplinary মূল্যায়নের পর, রোগীর thoracoscopic thymectomy এবং lung wedge resection করা হয়। Histopathology তে type B2 thymoma এবং pulmonary lymphangioleiomyomatosis নিশ্চিত হয়। সার্জারির পর, রোগীকে adjuvant radiation therapy এবং sirolimus treatment-এর পরামর্শ দেওয়া হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_235.txt",
+    "fulltext": "We present a case of a 49-year-old woman with renal and heart failure following a long-term (lasting from 13 years of age) SLE prepared for kidney transplantation. Due to LN (class III, then IV), starting at childhood, she was treated with steroids, together with cyclophosphamide, replaced later by methotrexate and then azathioprine. Hence, the partial remission of nephrotic syndrome was achieved and from 2002 the patient did not receive any immunosuppressive therapy. She was also HBV and HCV positive. SLE involvement of circulatory system presented with early coronary atherosclerosis, ischemic heart disease, and myocardial infarction at the age of 20. In 2007, because of deterioration of kidney function with a serum creatinine concentration of 2.2 mg/dL and proteinuria of 2 g/day, the kidney biopsy was performed. The biopsy showed active and sclerotic focal proliferative lupus nephritis nevertheless immunosuppressive therapy was not introduced for the reason of active replication of HCV. The kidney function was gradually deteriorating over time. Despite cardiac intervention (PCI RCA), the patient developed severe post-infarction and dilated cardiomyopathy and required ICD implantation in primary prevention in 2009. Later, on lupus and secondary cardiomyopathic background, the patient developed severe MV and TV regurgitation. For this reason, the patient underwent mitral and tricuspid valve repair and left ventricle volume reduction surgery complicated by low cardiac output syndrome with a need for intra-aortic balloon pump use (2014). In the postoperative period, the kidney function deteriorated, requiring the initiation of renal replacement therapy. The patient has been on dialysis for 4 years. While being on active waiting list for kidney transplantation presented remission of laboratory indices of lupus (complement splits within normal limits: C3–0,93 g/l, C4–0,4 g/l, ANA negative) and persisting circulatory insufficiency with markedly reduced stair-climbing capacity (to one flight of stairs) with elevated BNP 619 pg/ml (n. 0–100). In transthoracic echocardiography, performed before renal transplantation, the left ventricle and the left atrium were significantly enlarged and the left ventricular systolic function was significantly reduced with LVEF 26% and GLS -3. Due to the implantation of the mitral ring, it was not possible to assess the left ventricular diastolic function. The high tricuspid regurgitant flow gradient with widened and poorly respiratory mobile inferior vena cava indicated a high probability of pulmonary hypertension. Furthermore, while preparing the patient for the surgical procedure, it was decided to include cardioprotective therapy with Levosimendan. Due to the time frame associated with the transplantation procedure, the drug infusion was started as soon as possible after cross-match results were known, immediately after the dialysis session. The infusion at a dose of 0.1 μg/kg/min was continued after surgery for a total of 24 h. The patient’s anesthesia for kidney transplantation and perioperative care included the aspect of optimizing transplanted kidney perfusion, avoiding the use of renal toxic drugs and those excreted by properly functioning kidneys, as well as the use of nephroprotective agents. Because of the patient’s cardiological burden, including recurrent episodes of extrasystole proceeding with decompensation of the circulatory system, together with the need of ICD turning off for the transplantation period, the Swan-Ganz catheter for hemodynamic assessment was not used. Anesthesia monitoring was limited the to ECG, central catheter with CVP assessment, direct blood pressure measurement from the cannula inserted into the radial artery, and cardiac ultrasound. In the perioperative period the CVP parameter was used to assess the volatility, and in the postoperative period, a cardiac ultrasound was used along with the assessment of VCI respiratory fill and motility. The therapy was aimed at the standard of fluid therapy called Goal Directed Therapy (GDT). During general anesthesia, fentanyl, triacrium, propofol, desflurane, antibiotic therapy, and standard immunosuppressive treatment were used as well as 25 g of mannitol infusion was administered as a nephroprotective treatment and 0.9% NaCl as a fluid therapy. In the course of postoperative immunosuppression, she received steroids, tacrolimus with mycophenolate mofetil which was stopped due to persistent leukopenia and cytomegalovirus infection. Furthermore delayed graft function was observed with a need for hemodialysis for almost 6 weeks (mostly due to fluid retention). BNP levels raised to 2996 pg/ml and then slowly decreased. The kidney biopsy performed 2 weeks after transplantation revealed acute rejection (AR II B Banff 2015) with ATN. Finally, the patient was discharged from the hospital on the 67th POD with the serum creatinine concentration of 1.4 mg/dL and BNP level of 1794 pg/ml. One month after kidney transplantation, there was a reduction in left ventricular dimensions, improved systolic function in the EF (increase to 30%) and GLS (decrease to − 6) assessment. In addition, there was a decrease in the tricuspid regurgitant flow gradient with normal width and respiratory motility of the IVC, which indicates a low probability of pulmonary hypertension. The improvement of echocardiographic parameters also reflected the simultaneous improvement of exercise capacity in the recipient from NYHA III/IV to NYHA II. In the 5-month observation, further improvement of heart function with a drop of BNP to 1066 pg/ml and normal kidney function were noted.",
+    "summary": "We present a case of a 49-year-old woman with renal and heart failure following a long-term SLE prepared for kidney transplantation. During the SLE course, the function of the heart and kidneys gradually deteriorated. The patient required the initiation of renal replacement therapy and was dialyzed until a kidney transplantation for 4 years. In the preparation of the patient for the surgical procedure, due to the extremely low ejection fraction, it was decided to include cardioprotective treatment with Levosimendan. The postoperative period was not straightforward but successful. In the monthly and five-month follow-up, a continuous improvement of heart function with normal renal function was noted.",
+    "translated_fulltext": null,
+    "translated_summary": null,
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": null
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0000_0001.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0000_0001.json
new file mode 100644
index 0000000000000000000000000000000000000000..4edae4187c4f8e0981dcb4899d7921e2c0f28e12
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0000_0001.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_523.txt",
+    "fulltext": "We present the case of a 34-year-old woman, eight weeks pregnant with no other personal history of interest, who presents to the emergency department with generalized convulsions with dysarthria in the postcritical period, which resolve progressively in less than two hours. On physical examination, she is conscious, oriented, with no language or motor or sensory deficits. Only signs of a right lateral tongue bite are observed.\n\nThe complementary tests, such as blood tests or the electrocardiogram, are normal. Given that the episode corresponds with a first epileptic seizure and the patient is pregnant, an urgent magnetic resonance of the skull is requested.\n\nThe usual protocol was performed and 3D T1 sequences without and with intravenous contrast were obtained in axial, coronal and sagital planes, axial FLAIR, axial T2, VEN BOLD and magnetic susceptibility sequences, as well as axial diffusion and apparent diffusion coefficient map. The MRI identified multiple venous cortico-medullary vascular structures converging centripetally to a large central venous structure draining through the inferior anastomotic vein into the left transverse sinus, forming the classic ‘Medusa head’ sign. In the T1 sequences, the drainage vein was seen to be increased in signal with central hyphocaptation after contrast administration, suggesting partial thrombosis versus slow flow. In addition, in T2 and FLAIR sequences, the brain tissue surrounding the drainage vein was seen to be hyperintense, without diffusion restriction and compatible with edema.\n\nThese findings are suggestive of a venous anomaly of development with signs of partial peripheral thrombosis and slow flow more proximal, which cause edema of the surrounding tissue. She is started on clexane 60 mg/12 hours and levetiracetam 500 mg/12 hours and the patient shows improvement and symptomatic stability after one week.\n",
+    "summary": "A 34-year-old pregnant woman presents with seizures and dysarthria and is urgently referred for a cranial MRI. The classic ‘Medusa head’ sign is seen and the diagnosis is made as a venous anomaly of development with peripheral partial thrombosis and proximal slow flow.\n",
+    "translated_fulltext": "Chúng tôi xin trình bày trường hợp của một phụ nữ 34 tuổi, đang mang thai 8 tuần và không có tiền sử bệnh lý đáng chú ý, đến phòng cấp cứu với các cơn co giật toàn thân kèm theo khó phát âm trong giai đoạn sau cơn, và các cơn co giật này giảm dần trong vòng chưa đầy hai giờ. Khi khám lâm sàng, bệnh nhân tỉnh táo, định hướng tốt, không có dấu hiệu rối loạn ngôn ngữ, vận động hoặc cảm giác. Chỉ thấy dấu hiệu cắn phải bên phải của lưỡi.\n\nCác xét nghiệm bổ sung, chẳng hạn như xét nghiệm máu hoặc điện tâm đồ, đều cho kết quả bình thường. Vì đây là cơn động kinh đầu tiên và bệnh nhân đang mang thai, nên được chỉ định chụp cộng hưởng từ (MRI) sọ não khẩn cấp.\n\nThực hiện quy trình chụp MRI thông thường và thu được các chuỗi hình ảnh 3D T1 có và không có thuốc cản quang tiêm tĩnh mạch ở các mặt phẳng trục, vành và dọc, các chuỗi hình ảnh FLAIR trục, T2 trục, VEN BOLD và các chuỗi hình ảnh về độ nhạy từ, cũng như các chuỗi hình ảnh khuếch tán và bản đồ hệ số khuếch tán biểu kiến. MRI cho thấy nhiều cấu trúc mạch máu tĩnh mạch vỏ não-tủy hội tụ theo hướng tâm vào một cấu trúc tĩnh mạch trung tâm lớn, dẫn lưu qua tĩnh mạch nối dưới vào xoang ngang bên trái, tạo thành dấu hiệu \"đầu Medusa\" điển hình. Trong các chuỗi hình ảnh T1, tĩnh mạch dẫn lưu cho thấy tín hiệu tăng lên với sự tăng cường tín hiệu trung tâm sau khi tiêm thuốc cản quang, gợi ý tắc nghẽn một phần hoặc lưu lượng chậm. Ngoài ra, trong các chuỗi hình ảnh T2 và FLAIR, mô não xung quanh tĩnh mạch dẫn lưu cho thấy tín hiệu tăng lên, không có hạn chế khuếch tán và phù hợp với tình trạng phù.\n\nNhững phát hiện này gợi ý một dị tật tĩnh mạch phát triển với các dấu hiệu của tắc nghẽn ngoại vi một phần và lưu lượng chậm ở vị trí gần hơn, gây ra tình trạng phù ở mô xung quanh. Bệnh nhân được bắt đầu điều trị bằng clexane 60mg/12 giờ và levetiracetam 500mg/12 giờ, và bệnh nhân có dấu hiệu cải thiện và ổn định về mặt triệu chứng sau một tuần.",
+    "translated_summary": "Một phụ nữ 34 tuổi đang mang thai đến khám với các triệu chứng co giật và khó phát âm, và được chuyển khẩn cấp để chụp cộng hưởng từ (MRI) sọ não. Hình ảnh “đầu Medusa” đặc trưng được phát hiện, và chẩn đoán được đưa ra là dị tật tĩnh mạch bẩm sinh với tình trạng tắc nghẽn cục bộ ở vùng ngoại vi và lưu lượng máu chậm ở vùng gần.",
+    "corrected_translated_fulltext": "আমরা ৩৪ বছর বয়সী এক নারীর একটি কেস উপস্থাপন করছি; তিনি ৮ সপ্তাহের গর্ভবতী এবং উল্লেখযোগ্য ব্যক্তিগত রোগ-ইতিহাস নেই; তিনি জেনারালাইজড খিঁচুনি নিয়ে জরুরি বিভাগে আসেন, পোস্টক্রিটিক্যাল পর্যায়ে dysarthria থাকে, যা দুই ঘন্টারও কম সময়ে ধীরে ধীরে সেরে যায়। শারীরিক পরীক্ষায় তিনি সচেতন, ওরিয়েন্টেড, এবং ভাষা, মোটর বা সেনসরি ঘাটতি নেই। কেবল ডান ল্যাটারাল জিহ্বা কামড়ানোর চিহ্ন দেখা যায়। রক্তপরীক্ষা বা electrocardiogram সহ সম্পূরক পরীক্ষাগুলি স্বাভাবিক। এটি প্রথমবারের epileptic seizure এবং রোগী গর্ভবতী হওয়ায়, জরুরিভাবে খুলির magnetic resonance (MRI) চাওয়া হয়। স্বাভাবিক প্রোটোকল অনুসরণ করে axial, coronal এবং sagittal প্লেনে intravenous contrast ছাড়া ও সহ 3D T1 সিকোয়েন্স, axial FLAIR, axial T2, VEN BOLD এবং magnetic susceptibility সিকোয়েন্স, পাশাপাশি axial diffusion এবং apparent diffusion coefficient map সংগ্রহ করা হয়। MRI-তে একাধিক venous cortico-medullary ভাসকুলার স্ট্রাকচার দেখা যায়, যা কেন্দ্রাভিমুখে একটি বৃহৎ কেন্দ্রীয় ভেনাস স্ট্রাকচারের দিকে মিলিত হয়ে inferior anastomotic vein হয়ে বাম transverse sinus-এ ড্রেন করে, ফলে ক্লাসিক 'Medusa head' sign তৈরি হয়। T1 সিকোয়েন্সে কনট্রাস্ট দেওয়ার পর drainage vein-এ সিগন্যাল বৃদ্ধি সহ কেন্দ্রীয় hyphocaptation দেখা যায়, যা partial thrombosis বনাম slow flow নির্দেশ করে। অতিরিক্তভাবে, T2 ও FLAIR সিকোয়েন্সে drainage vein-কে ঘিরে থাকা মস্তিষ্কের টিস্যু hyperintense দেখা যায়, diffusion restriction নেই এবং যা edema-র সঙ্গে সামঞ্জস্যপূর্ণ। এই ফাইন্ডিংসমূহ partial peripheral thrombosis-এর লক্ষণ এবং আরও প্রোক্সিমালে slow flow-সহ একটি venous anomaly of development নির্দেশ করে, যা পার্শ্ববর্তী টিস্যুর edema সৃষ্টি করছে। তাকে clexane 60 mg/12 ঘণ্টা এবং levetiracetam 500 mg/12 ঘণ্টা শুরু করা হয় এবং এক সপ্তাহ পর রোগীর উপসর্গের উন্নতি ও স্থিতিশীলতা দেখা যায়.",
+    "corrected_translated_summary": "৩৪ বছর বয়সী এক গর্ভবতী নারী খিঁচুনি ও dysarthria নিয়ে হাজির হন এবং জরুরিভাবে cranial MRI-এর জন্য রেফার করা হয়। ক্লাসিক 'Medusa head' sign দেখা যায় এবং নির্ণয় করা হয় developmental venous anomaly with peripheral partial thrombosis and proximal slow flow।"
+  },
+  {
+    "id": "multiclinsum_gs_en_587.txt",
+    "fulltext": "A 22-year-old woman came to the Department of Oral Medicine with complaints of mouth ulcers causing pain and eating and drinking difficulty persisting for a duration of one month. This condition begins with a fever and appears like pimples on the lips. Based on the anamnesis, it was discovered that she had been using pod-type vapes for about a year but had never experienced complaints like when she came for treatment. She had never smoked traditional cigarettes before starting to vape. She said the reason for trying vaping was out of curiosity, and she quite often tried different types of e-liquid with different flavors. Before her complaint, she had simply changed the type of e-liquid to a different flavor without mentioning the brand. She vapes almost every day, but not all day, only in her free time or with friends. She was a healthy individual, and before this condition appeared, she had no history of taking medications, including antibiotics, analgesics, anticonvulsants, non-steroidal anti-inflammatory drugs, and antifungals. She also had no history of drug or food allergies, but the patient has unhealthy eating habits (eating irregularly and not consuming vegetables and fruit). Extraoral examination showed no lesions on other parts of the body, while the lips of the patient had serosanguineous crusts and an erosive area at the corner of the mouth, and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges, irregular, varying sizes, and pain on the labial, buccal, lateral, and ventral mucosa of the tongue and floor of the mouth.\n\nBased on the medical history of the patient and physical examination, which revealed oral mucosal involvement but no symptoms elsewhere in the body, as well as the non-reactive anti-HSV1 IgG results, the diagnosis of vaping-related oral erythema multiforme was established. The medical condition has been classified as minor erythema multiforme. The oral conditions were treated with 0.9% NaCl, which was moistened in gauze and placed on the lips three times a day. The patient was instructed to gargle 1 mg of dexamethasone in 10 mL of hyaluronic acid three times a day and avoid eating or drinking for at least 30 minutes after gargling. She was also given 2% miconazole cream applied to the wound in the right corner of the mouth twice a day, as well as vaseline album cream for dry lips. To maintain good oral hygiene, she was advised to brush her teeth and tongue twice a day, after breakfast and before bed. She was also instructed to stop vaping and avoid foods containing monosodium glutamate (MSG). The control was carried out after a week following therapy and showed that oral condition had improved. Written informed consent for the publication of details was obtained from the patient. This case report conformed with the Helsinki Declaration. The publication of this case report has also been approved by the institution.",
+    "summary": "A 22-year-old woman came to the Oral Medicine Department with complaints of stomatitis causing pain, eating, and drinking difficulty, which started with fever and pimple-like on the lips. She was an active vape user for one year. Extraoral examination revealed no lesions on other body parts. The serosanguinolent crusts on the lips, an erosive area on the labial commissures and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges and irregular, varying sizes in several parts of the oral mucosa. The anti-HSV-1 IgG laboratory results showed non-reactive, leading to a diagnosis of oral erythema multiforme. Management of oral conditions using 0.9% NaCl compress, dexamethasone mouthwash, and hyaluronic acid, applying 2% miconazole cream on labial commissures and vaseline album cream on the dry lips, and stopping vaping. Oral condition improved in a week of therapy.",
+    "translated_fulltext": "Một phụ nữ 22 tuổi đến Khoa Y học Răng miệng với các triệu chứng loét miệng gây đau, khó khăn trong việc ăn uống, kéo dài trong một tháng. Tình trạng này bắt đầu bằng sốt và xuất hiện như những nốt mụn trên môi. Dựa trên thông tin bệnh sử, được biết cô ấy đã sử dụng thuốc lá điện tử loại pod trong khoảng một năm, nhưng trước đây chưa từng gặp phải các triệu chứng như khi đến khám. Cô ấy chưa từng hút thuốc lá truyền thống trước khi bắt đầu sử dụng thuốc lá điện tử. Cô ấy cho biết lý do thử sử dụng thuốc lá điện tử là vì tò mò, và cô ấy thường xuyên thử các loại tinh dầu khác nhau với nhiều hương vị khác nhau. Trước khi có các triệu chứng, cô ấy chỉ đơn giản là thay đổi loại tinh dầu sang một hương vị khác mà không đề cập đến nhãn hiệu. Cô ấy sử dụng thuốc lá điện tử gần như mỗi ngày, nhưng không phải cả ngày, chỉ khi có thời gian rảnh hoặc khi ở cùng bạn bè. Cô ấy là một người khỏe mạnh, và trước khi tình trạng này xuất hiện, cô ấy không có tiền sử dùng thuốc, bao gồm cả thuốc kháng sinh, thuốc giảm đau, thuốc chống co giật, thuốc chống viêm không steroid và thuốc chống nấm. Cô ấy cũng không có tiền sử dị ứng với thuốc hoặc thực phẩm, nhưng bệnh nhân có thói quen ăn uống không lành mạnh (ăn uống không đều và không ăn rau củ quả). Khám bên ngoài miệng cho thấy không có tổn thương ở các bộ phận khác của cơ thể, trong khi môi của bệnh nhân có vảy màu vàng và một vùng bị xói mòn ở góc miệng, và có xu hướng chảy máu. Khám bên trong miệng cho thấy các vết loét màu trắng với viền màu vàng, hình dạng không đều, kích thước khác nhau và gây đau ở niêm mạc môi, má, bên và mặt dưới của lưỡi và sàn miệng.\n\nDựa trên bệnh sử và khám lâm sàng của bệnh nhân, cho thấy có tổn thương niêm mạc miệng nhưng không có triệu chứng nào khác ở các bộ phận khác của cơ thể, cũng như kết quả xét nghiệm kháng thể anti-HSV1 IgG âm tính, chẩn đoán bệnh viêm đa dạng niêm mạc miệng liên quan đến việc sử dụng thuốc lá điện tử đã được xác định. Tình trạng bệnh được phân loại là viêm đa dạng niêm mạc miệng nhẹ. Các tổn thương ở miệng được điều trị bằng dung dịch NaCl 0,9%, được thấm vào gạc và đặt lên môi ba lần một ngày. Bệnh nhân được hướng dẫn súc miệng bằng dung dịch dexamethasone 1 mg trong 10 mL dung dịch hyaluronic acid ba lần một ngày và tránh ăn hoặc uống trong ít nhất 30 phút sau khi súc miệng. Cô ấy cũng được kê đơn kem miconazole 2% bôi lên vết thương ở góc phải của miệng hai lần một ngày, cũng như kem vaseline album để làm dịu môi khô. Để duy trì vệ sinh răng miệng tốt, cô ấy được khuyên nên chải răng và lưỡi hai lần một ngày, sau khi ăn sáng và trước khi đi ngủ. Cô ấy cũng được hướng dẫn ngừng sử dụng thuốc lá điện tử và tránh các loại thực phẩm chứa glutamate mononatri (MSG). Sau một tuần điều trị, tình trạng bệnh đã được kiểm tra và cho thấy tình trạng ở miệng đã cải thiện. Sự đồng ý bằng văn bản để công bố thông tin chi tiết đã được lấy từ bệnh nhân. Báo cáo ca bệnh này tuân thủ Tuyên bố Helsinki. Việc công bố báo cáo ca bệnh này cũng đã được chấp thuận bởi cơ sở y tế.",
+    "translated_summary": "Một phụ nữ 22 tuổi đến khoa Y học Răng miệng với các triệu chứng viêm miệng gây đau, khó khăn khi ăn uống, bắt đầu bằng sốt và các nốt sần trên môi. Cô ấy đã sử dụng thuốc lá điện tử trong một năm. Khám bên ngoài không phát hiện tổn thương ở các bộ phận khác của cơ thể. Các vết loét trên môi có màu vàng nhạt, khu vực bị xói mòn ở góc miệng và dễ chảy máu. Khám bên trong miệng cho thấy các vết loét màu trắng với viền màu vàng và kích thước không đều, khác nhau ở nhiều vị trí trên niêm mạc miệng. Kết quả xét nghiệm máu để kiểm tra kháng thể IgG chống lại virus Herpes simplex loại 1 (HSV-1) cho thấy không có phản ứng, dẫn đến chẩn đoán bệnh viêm đa dạng niêm mạc miệng. Điều trị các bệnh về miệng bằng cách chườm dung dịch NaCl 0,9%, súc miệng bằng dexamethasone và hyaluronic acid, bôi kem miconazole 2% lên góc miệng và kem vaseline album lên môi khô, đồng thời ngừng sử dụng thuốc lá điện tử. Tình trạng bệnh ở miệng cải thiện sau một tuần điều trị.",
+    "corrected_translated_fulltext": "২২ বছর বয়সী এক মহিলা মুখের আলসারজনিত ব্যথা এবং খাওয়া-দাওয়ায় অসুবিধার অভিযোগ নিয়ে, যা এক মাস ধরে চলছিল, Oral Medicine বিভাগে আসেন। এই অবস্থা জ্বর দিয়ে শুরু হয় এবং ঠোঁটে ব্রণের মতো দানা হিসেবে দেখা দেয়। anamnesis-এর ভিত্তিতে জানা যায় যে তিনি প্রায় এক বছর ধরে pod-type vape ব্যবহার করছিলেন, কিন্তু চিকিৎসার জন্য আসার সময়ের মতো অভিযোগ আগে কখনও হয়নি। vape শুরু করার আগে তিনি কখনও প্রচলিত সিগারেট ধূমপান করেননি। তিনি জানান, vaping চেষ্টা করার কারণ ছিল কৌতূহল, এবং তিনি প্রায়ই বিভিন্ন স্বাদের বিভিন্ন ধরনের e-liquid চেষ্টা করতেন। অভিযোগ শুরুর আগে, তিনি কেবলমাত্র e-liquid-এর ধরনটি অন্য স্বাদে পরিবর্তন করেছিলেন, তবে ব্র্যান্ড উল্লেখ করেননি। তিনি প্রায় প্রতিদিন vape করেন, তবে সারা দিন নয়, কেবল ফাঁকা সময়ে বা বন্ধুদের সঙ্গে। তিনি একজন সুস্থ ব্যক্তি ছিলেন, এবং এই অবস্থা দেখা দেওয়ার আগে তার অ্যান্টিবায়োটিক, analgesics, anticonvulsants, non-steroidal anti-inflammatory drugs, এবং antifungals সহ কোনো ওষুধ সেবনের ইতিহাস ছিল না। তার ওষুধ বা খাদ্যজনিত অ্যালার্জিরও কোনো ইতিহাস ছিল না, তবে রোগীর খাওয়াদাওয়ার অভ্যাস অস্বাস্থ্যকর (অনিয়মিতভাবে খাওয়া এবং শাকসবজি ও ফল না খাওয়া)। Extraoral পরীক্ষা-নিরীক্ষায় শরীরের অন্যান্য অংশে কোনো ক্ষত দেখা যায়নি, তবে রোগীর ঠোঁটে serosanguineous crusts এবং মুখের কোণে একটি ক্ষয়যুক্ত এলাকা ছিল, এবং রক্তক্ষরণের প্রবণতা ছিল। Intraoral পরীক্ষায় labial, buccal, lateral এবং জিহ্বার ventral মিউকোসা ও মুখের তলায় হলদেটে প্রান্তসহ সাদা আলসার, অনিয়মিত, বিভিন্ন মাপের, এবং ব্যথাযুক্ত ক্ষত দেখা যায়।\n\nরোগীর চিকিৎসা-ইতিহাস ও শারীরিক পরীক্ষার ভিত্তিতে, যা ওরাল মিউকোসাল ইনভলভমেন্ট দেখিয়েছে কিন্তু দেহের অন্য কোথাও কোনো উপসর্গ নেই, এবং non-reactive anti-HSV1 IgG ফলাফলের সঙ্গে মিলিয়ে, vaping-সম্পর্কিত oral erythema multiforme নির্ণয় করা হয়। এ অবস্থাকে minor erythema multiforme হিসেবে শ্রেণিবদ্ধ করা হয়েছে। মৌখিক অবস্থার চিকিৎসায় 0.9% NaCl গজে ভিজিয়ে দিনে তিনবার ঠোঁটে রাখা হয়। রোগীকে দিনে তিনবার 10 mL hyaluronic acid-এ 1 mg dexamethasone মিশিয়ে গার্গল করতে এবং গার্গলের পর অন্তত ৩০ মিনিট খাওয়া-দাওয়া না করতে নির্দেশ দেওয়া হয়। তাঁকে দিনে দুবার মুখের ডান কোণের ক্ষতে 2% miconazole ক্রিম প্রয়োগ করতে এবং শুকনো ঠোঁটের জন্য vaseline album ক্রিম দিতে বলা হয়। ভালো মৌখিক স্বাস্থ্যবিধি বজায় রাখতে, তাঁকে নাশতার পর এবং শোবার আগে দিনে দুইবার দাঁত ও জিহ্বা ব্রাশ করার পরামর্শ দেওয়া হয়। তাঁকে vaping বন্ধ করতে এবং monosodium glutamate (MSG) সম্বলিত খাবার এড়াতে নির্দেশ দেওয়া হয়। থেরাপির পর এক সপ্তাহে ফলো-আপ করা হয় এবং দেখা যায় মৌখিক অবস্থা উন্নত হয়েছে। বিস্তারিত তথ্য প্রকাশের জন্য রোগীর কাছ থেকে লিখিত সম্মতিপত্র নেওয়া হয়েছে। এই কেস রিপোর্ট হেলসিঙ্কি ঘোষণার সঙ্গে সঙ্গতিপূর্ণ। এই কেস রিপোর্টের প্রকাশনাও প্রতিষ্ঠানের অনুমোদনপ্রাপ্ত।",
+    "corrected_translated_summary": "২২ বছর বয়সী এক নারী Oral Medicine বিভাগে আসেন, মুখের stomatitis থেকে হওয়া ব্যথা ও খাওয়া‑পানিতে অসুবিধার অভিযোগ নিয়ে, যা জ্বর ও ঠোঁটে পিম্পল‑সদৃশ ক্ষত দিয়ে শুরু হয়েছিল। তিনি এক বছর ধরে সক্রিয় vape ব্যবহারকারী ছিলেন। বাহ্যিক পরীক্ষায় শরীরের অন্য কোথাও কোনো লেশন পাওয়া যায়নি। ঠোঁটে serosanguinolent crusts ছিল, labial commissures‑এ একটি erosive এলাকা ছিল এবং সহজে রক্তপাতের প্রবণতা ছিল। ইনট্রাওরাল পরীক্ষায় মৌখিক মিউকোসার বিভিন্ন স্থানে হলদেটে প্রান্তযুক্ত সাদা আলসার দেখা যায়, যেগুলোর আকার অনিয়মিত ও ভিন্ন ভিন্ন ছিল। ল্যাবরেটরি‑তে anti‑HSV‑1 IgG non‑reactive পাওয়া যায়, ফলে oral erythema multiforme হিসেবে নির্ণয় করা হয়। 0.9% NaCl কমপ্রেস, dexamethasone mouthwash ও hyaluronic acid ব্যবহার করে মৌখিক অবস্থা ম্যানেজ করা হয়; labial commissures‑এ 2% miconazole ক্রিম এবং শুষ্ক ঠোঁটে vaseline album ক্রিম প্রয়োগ করা হয়, এবং vaping বন্ধ করতে বলা হয়। এক সপ্তাহের থেরাপির পর মৌখিক অবস্থার উন্নতি হয়।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0012_0013.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0012_0013.json
new file mode 100644
index 0000000000000000000000000000000000000000..de26d72b5885fe69096bc4fe5e6f24ad94043997
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0012_0013.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_317.txt",
+    "fulltext": "A 52-year-old woman referred to the urology clinic with urinary complaints. Her symptoms began three years ago with frequency, dysuria and dribbling. She also mentioned the frequent passage of red and black thread-like substances in her urine. Moreover, during these discharges, she had headache, fever and chills. Intermittent periurethral and genital itching was another complaint of hers. She had been treated by several specialists with the diagnosis of recurrent urinary tract infections, with no clinical improvement. The patient denied recent travel, camping, hiking, farming, swimming and insect bites. She had positive history of pilonidal sinus surgery and hysterectomy, 8 and 7 years earlier, respectively. Two years prior to the current visit, she had been hospitalized for assessment. On physical examination, she was well-appearing with normal vital signs. All her laboratory tests, including cell blood count, urine analysis and biochemistries were in normal ranges. Abdominopelvic computed tomography (CT) scan revealed no abnormalities. Hence, she underwent cystoscopy, which demonstrated erythema and hyperemia of the bladder mucosa, suspended debris, and dilation of the left ureteral orifice. During consultation with an infectious diseases’ specialist, schistosomiasis was suspected, Therefore, she was treated with Praziquantel with the appropriate dose and duration and was discharged from the hospital.\n\nHowever, her symptoms did not subside. She was revisited by another infectious disease specialist, who prescribed her ivermectin due to suspicion to urinary myiasis. Nevertheless, no improvement was observed. She was readmitted to undergo bladder irrigation with polyethylene glycol, but the bladder washfluid did not contain any visible larvae. This procedure was followed by a two-day hematuria with spontaneous cessation. She was discharged home and advised to repeat the urine analysis one months later. Her random urine analysis was normal, so she collected her 24-h urine and sent it to the laboratory for analysis, in which a live larva was demonstrated under light microscope by the pathologist. The larva was isolated and sent to an entomologist to be identified morphologically. Finally, it was determined that the larva belonged to the species Sarcophaga. The patient was advised to take personal hygiene and consume at least 3 L of water daily.",
+    "summary": "We report a 52-year-old woman with persistent dysuria, frequency despite multiple treatments for suspected infections. Cystoscopy revealed erythema and debris, but imaging and laboratory tests were unremarkable. A live larva was identified in urine analysis, confirming the diagnosis. Treatment involved improved hygiene and hydration.",
+    "translated_fulltext": "Một phụ nữ 52 tuổi đến khám tại phòng khám tiết niệu vì các vấn đề về đường tiết niệu. Các triệu chứng của bà bắt đầu cách đây ba năm với các biểu hiện như tiểu nhiều lần, tiểu khó và tiểu són. Bà cũng đề cập đến việc thường xuyên thấy các chất giống như sợi chỉ màu đỏ và đen trong nước tiểu. Hơn nữa, trong thời gian có các triệu chứng này, bà bị đau đầu, sốt và ớn lạnh. Ngứa ngáy không liên tục ở vùng niệu đạo và bộ phận sinh dục là một triệu chứng khác của bà. Bà đã được nhiều bác sĩ chuyên khoa điều trị với chẩn đoán nhiễm trùng đường tiết niệu tái phát, nhưng tình trạng không cải thiện. Bệnh nhân phủ nhận việc đi du lịch, cắm trại, đi bộ đường dài, làm nông, bơi lội hoặc bị côn trùng cắn gần đây. Bà có tiền sử phẫu thuật nang lông cùng cụt và cắt tử cung, lần lượt là 8 và 7 năm trước. Hai năm trước khi đến khám lần này, bà đã nhập viện để được đánh giá. Trong quá trình khám lâm sàng, bà có vẻ khỏe mạnh với các dấu hiệu sinh tồn bình thường. Tất cả các xét nghiệm trong phòng thí nghiệm của bà, bao gồm công thức máu, phân tích nước tiểu và các xét nghiệm sinh hóa đều nằm trong phạm vi bình thường. Chụp cắt lớp vi tính (CT) vùng bụng và khung chậu không phát hiện bất thường. Do đó, bà được thực hiện nội soi bàng quang, kết quả cho thấy niêm mạc bàng quang bị viêm và sung huyết, có các mảnh vụn lơ lửng và lỗ niệu quản bên trái bị giãn. Trong quá trình tư vấn với bác sĩ chuyên khoa về bệnh truyền nhiễm, bác sĩ nghi ngờ bệnh giun sán. Do đó, bà được điều trị bằng Praziquantel với liều lượng và thời gian thích hợp, sau đó được xuất viện.\n\nTuy nhiên, các triệu chứng của bà không thuyên giảm. Bà được một bác sĩ chuyên khoa về bệnh truyền nhiễm khác khám lại và được kê đơn ivermectin vì nghi ngờ bệnh ấu trùng ruồi trong đường tiết niệu. Tuy nhiên, không có sự cải thiện nào được ghi nhận. Bà được nhập viện lại để thực hiện rửa bàng quang bằng polyethylene glycol, nhưng chất lỏng rửa bàng quang không chứa ấu trùng nào. Thủ thuật này được theo sau bởi tình trạng tiểu ra máu kéo dài hai ngày, sau đó tự khỏi. Bà được xuất viện và được khuyên nên làm lại xét nghiệm nước tiểu sau một tháng. Kết quả xét nghiệm nước tiểu ngẫu nhiên của bà bình thường, vì vậy bà đã thu thập nước tiểu trong 24 giờ và gửi đến phòng thí nghiệm để phân tích, và kết quả cho thấy có một ấu trùng sống được phát hiện dưới kính hiển vi bởi bác sĩ giải phẫu bệnh. ấu trùng được phân lập và gửi đến nhà côn trùng học để xác định hình thái. Cuối cùng, kết quả xác định ấu trùng thuộc loài Sarcophaga. Bệnh nhân được khuyên nên chú trọng vệ sinh cá nhân và uống ít nhất 3 lít nước mỗi ngày.",
+    "translated_summary": "Chúng tôi báo cáo về một trường hợp bệnh nhân nữ 52 tuổi bị tiểu khó kéo dài và đi tiểu thường xuyên, mặc dù đã được điều trị nhiều lần vì nghi ngờ nhiễm trùng. Nội soi bàng quang cho thấy niêm mạc bị viêm và có mảnh vụn, nhưng các xét nghiệm hình ảnh và xét nghiệm trong phòng thí nghiệm không cho thấy bất thường. Phân tích nước tiểu xác định được một ấu trùng sống, từ đó xác nhận chẩn đoán. Điều trị bao gồm cải thiện vệ sinh cá nhân và tăng cường hydrat hóa.",
+    "corrected_translated_fulltext": "৫২ বছর বয়সী এক নারী মূত্রসংক্রান্ত সমস্যার কারণে ইউরোলজি ক্লিনিকে আসেন। তার উপসর্গ তিন বছর আগে শুরু হয়, ঘন ঘন মূত্রত্যাগ, dysuria এবং dribbling দিয়ে। তিনি আরও উল্লেখ করেন যে তার মূত্রে বারবার লাল ও কালো সুতোসদৃশ পদার্থ দেখা যায়। তদুপরি, এসব নির্গমনের সময় তার মাথাব্যথা, জ্বর এবং কাঁপুনি হতো। অন্তরায়িত periurethral এবং genital itching ছিল তার আরেকটি অভিযোগ। তাকে একাধিক বিশেষজ্ঞ recurrent urinary tract infections হিসেবে চিকিৎসা করেছিলেন, কিন্তু কোনো ক্লিনিক্যাল উন্নতি হয়নি। রোগী সাম্প্রতিক ভ্রমণ, ক্যাম্পিং, হাইকিং, চাষাবাদ, সাঁতার বা পোকামাকড়ের কামড় অস্বীকার করেন। তার pilonidal sinus surgery এবং hysterectomy-এর ইতিবাচক ইতিহাস আছে, যথাক্রমে ৮ এবং ৭ বছর আগে। বর্তমান ভিজিটের দুই বছর আগে তিনি মূল্যায়নের জন্য হাসপাতালে ভর্তি হয়েছিলেন। শারীরিক পরীক্ষায় তিনি সুস্থ-দর্শন ছিলেন এবং vital signs স্বাভাবিক ছিল। তার সমস্ত ল্যাবরেটরি পরীক্ষা, যেমন cell blood count, urine analysis এবং biochemistries স্বাভাবিক সীমার মধ্যে ছিল। Abdominopelvic computed tomography (CT) স্ক্যানে কোনো অস্বাভাবিকতা ধরা পড়েনি। অতএব, তাকে cystoscopy করা হয়, যেখানে ব্লাডার মিউকোসার erythema এবং hyperemia, suspended debris, এবং বাম ureteral orifice-এর dilation দেখা যায়। Infectious diseases’ specialist-এর সাথে পরামর্শকালে schistosomiasis সন্দেহ করা হয়। অতএব, তাকে উপযুক্ত dose এবং duration-এ Praziquantel দেওয়া হয় এবং তাকে হাসপাতাল থেকে ছাড়পত্র দেওয়া হয়। তবে তার উপসর্গ উপশম হয়নি। তাকে আরেকজন infectious disease specialist পুনরায় দেখেন এবং urinary myiasis সন্দেহে ivermectin প্রেসক্রাইব করেন। তবুও কোনো উন্নতি দেখা যায়নি। তাকে পুনরায় ভর্তি করে polyethylene glycol দিয়ে bladder irrigation করা হয়, কিন্তু bladder washfluid-এ কোনো দৃশ্যমান লার্ভা ছিল না। এই প্রক্রিয়ার পর টানা দুই দিন hematuria হয়েছিল, যা স্বতঃস্ফূর্তভাবে বন্ধ হয়। তাকে বাড়ি পাঠানো হয় এবং এক মাস পর পুনরায় urine analysis করার পরামর্শ দেওয়া হয়। তার random urine analysis স্বাভাবিক ছিল, তাই তিনি 24-h urine সংগ্রহ করে বিশ্লেষণের জন্য ল্যাবরেটরিতে পাঠান, যাতে pathologist light microscope-এ একটি জীবিত larva সনাক্ত করেন। লার্ভাটি পৃথক করে morphology নির্ণয়ের জন্য একজন entomologist-এর কাছে পাঠানো হয়। শেষ পর্যন্ত নির্ধারিত হয় যে লার্ভাটি Sarcophaga প্রজাতির। রোগীকে ব্যক্তিগত স্বাস্থ্যবিধি মেনে চলতে এবং দৈনিক কমপক্ষে ৩ L পানি পান করতে পরামর্শ দেওয়া হয়.",
+    "corrected_translated_summary": "আমরা ৫২ বছর বয়সী এক নারীর একটি কেস প্রতিবেদন করছি, যিনি সন্দেহজনক সংক্রমণের জন্য একাধিকবার চিকিৎসা নেওয়া সত্ত্বেও স্থায়ী dysuria এবং বারবার মূত্রত্যাগে ভুগছিলেন। Cystoscopy-তে erythema এবং debris দেখা গেছে, তবে ইমেজিং ও ল্যাবরেটরি পরীক্ষায় উল্লেখযোগ্য কোনো অস্বাভাবিকতা পাওয়া যায়নি। Urine analysis-এ একটি জীবিত larva শনাক্ত হয়, যা নির্ণয় নিশ্চিত করে। চিকিৎসায় উন্নত hygiene এবং পর্যাপ্ত hydration অন্তর্ভুক্ত ছিল।"
+  },
+  {
+    "id": "multiclinsum_gs_en_79.txt",
+    "fulltext": "A 36-year-old female patient with a history of ulcerative colitis and good disease control on sulfasalazine, ferrous fumarate and intermittent prednisone for flare-ups is presented.\n\nHe was admitted to the emergency unit with a 1 week history of progressive oppressive precordial pain associated with dyspnea and neurovegetative symptoms. On admission, an electrocardiogram was performed in sinus rhythm, with finding of supradesnivel of the ST segment in the lower wall.\n\nThe patient reported a 6-month history of general disorders, fatigue and night sweats. She had previously presented episodes of precordial pain in relation to effort that progressed to rest. The physical examination was without murmurs or alterations of the peripheral pulses.\n\nAn emergency coronary angiography was performed, which revealed severe 2-vessel disease: severe ostial lesion 90% in the left coronary trunk and severe subocclusive lesion 99-100% at the ostial level in the right coronary artery (culprit vessel). Primary angioplasty of the right coronary artery was performed with successful installation of a medicated stent. The hemodynamicist was impressed by a possible aortitis due to involvement of the arch and friability of the vessels when the balloon was advanced, so he suggested an etiological study oriented to inflammatory disease, prior to surgical resolution of the lesion of the left coronary trunk.\n\nLaboratory tests showed mild anaemia (haemoglobin: 11.6 g/dL), mild leukocytosis (13,800/mm3), elevated erythrocyte sedimentation rate (ESR): 42 mm/h and C-reactive protein (CRP): 4.9 mg/L (normal value <1) and elevated ultrasensitive troponin. From the autoimmunity study, normal levels of complement C3 and C4, negative anti-nuclear antibodies (ANA), anti-DNA, negative extracellular nuclear antigen (ENA) profile and non-reactive VDRL were rescued.\n\nCardiac magnetic resonance (MRI) with contrast was completed with findings of acute infarction of the left ventricular inferior wall non-transmural myocardium and subendocardial ischemia in the anteroseptoapical resting of the left ventricle. Mild aortic and mitral insufficiency. Preserved biventricular systolic function.\n\nComputed tomography angiography (CTA) of the chest, abdomen and pelvis showed periaortic fibrotic wall thickening involving the root, aortic arch and abdominal aorta with severe left coronary trunk stenosis and mild left subclavian, left vertebral artery stenosis and severe lower mesenteric artery stenosis. Immune globulin G (IgG) 4 deposition disease or Takayasu's arteritis was suggested.\n\nWithin the differential diagnosis study, IgG levels were performed at 1,600 mg/dl (reference values: 700-1,600), and its subclasses: IgG1: 1024 mg/dl (elevated), and the rest in normal range (IgG2: 456 mg/dl; IgG3: 98.8 mg/dl and IgG4: 13.6 mg/dl).\n\nTakayasu arteritis was diagnosed clinically and by imaging and treatment was initiated with prednisone 60 mg daily, methotrexate 20 mg weekly by injection and folic acid 1 mg daily. After 3 weeks of treatment she underwent myocardial revascularisation surgery with use of the left internal mammary artery (LIMA) as a graft to the descending anterior artery (DA) and aortocoronary bypass to circumflex artery. It was noted intraoperatively that the root of the aorta and the ascending aorta presented a healthy appearance. The patient is currently at home in good general condition and under ambulatory follow-up.\n",
+    "summary": "A 36-year-old woman with ulcerative colitis presented with progressive precordial pain and neurovegetative symptoms. The electrocardiogram showed a ST segment elevation in the inferior wall. The patient had a history of fatigue and night sweats. She underwent a coronary angiography that revealed severe disease in two coronary arteries, with successful primary angioplasty of the culprit artery. Aortitis was suspected, which led to additional studies, including a mild elevation of inflammatory activity indices and a computed tomographic angiography with periaortic fibrotic thickening and significant stenosis in multiple arteries, suggesting Takayasu arteritis. She was treated with prednisone, methotrexate, and underwent delayed myocardial revascularization surgery with good results.\n",
+    "translated_fulltext": null,
+    "translated_summary": "Một phụ nữ 36 tuổi bị viêm loét đại tràng đến khám với các triệu chứng đau vùng trước tim ngày càng tăng và các triệu chứng thần kinh thực vật. Điện tâm đồ cho thấy đoạn ST nâng lên ở thành dưới tim. Bệnh nhân có tiền sử mệt mỏi và đổ mồ hôi đêm. Cô được chụp mạch vành, kết quả cho thấy bệnh nặng ở hai động mạch vành, và đã được thực hiện thủ thuật nong mạch vành ban đầu thành công trên động mạch bị tắc. Nghi ngờ bệnh viêm động mạch chủ, dẫn đến các xét nghiệm bổ sung, bao gồm chỉ số hoạt động viêm tăng nhẹ và chụp cắt lớp mạch máu với tình trạng xơ hóa quanh động mạch chủ và hẹp đáng kể ở nhiều động mạch, gợi ý bệnh viêm động mạch Takayasu. Cô được điều trị bằng prednisone, methotrexate và phẫu thuật tái tạo mạch máu cơ tim muộn, kết quả tốt.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "৩৬ বছর বয়সী এক নারী, যার আলসারেটিভ কোলাইটিস ছিল, ক্রমবর্ধমান প্রিকরডিয়াল ব্যথা এবং নিউরোভেজেটেটিভ উপসর্গ নিয়ে উপস্থিত হয়েছিলেন. ইলেক্ট্রোকার্ডিওগ্রামে ইনফেরিয়র ওয়ালে ST সেগমেন্ট elevation দেখা যায়. রোগীর ক্লান্তি এবং রাতের ঘামার পূর্ব ইতিহাস ছিল. তাকে করোনারি অ্যানজিওগ্রাফি করা হয়, যাতে দুইটি করোনারি ধমনীতে গুরুতর রোগ ধরা পড়ে, এবং culprit artery-তে সফল primary angioplasty করা হয়. Aortitis সন্দেহ করা হয়, যা অতিরিক্ত পরীক্ষা-নিরীক্ষার দিকে নিয়ে যায়, যার মধ্যে inflammatory activity indices-এর মৃদু বৃদ্ধি এবং computed tomographic angiography-তে periaortic fibrotic thickening ও একাধিক ধমনীতে significant stenosis দেখা যায়, যা Takayasu arteritis নির্দেশ করে. তাকে prednisone, methotrexate দিয়ে চিকিৎসা করা হয় এবং বিলম্বিত myocardial revascularization surgery করা হয়, ফল ভালো ছিল."
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0016_0017.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0016_0017.json
new file mode 100644
index 0000000000000000000000000000000000000000..8bf020ced31dc56df83ed596e3431291ad0452e2
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0016_0017.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_30.txt",
+    "fulltext": "The patient was a 59-year-old Japanese man with a 28-year history of type 1 diabetes. He visited our hospital monthly for management of diabetes with intensive therapy employing multiple-dose insulin injections. His height and body weight were 168 cm and 52 kg (body mass index: 18.4 kg/m2), respectively. He showed depleted insulin secretion (serum C-peptide level was below the limit of detection), such that his blood glucose levels fluctuated severely, and his hemoglobin A1c (HbA1c) level was around 9.0% despite intensive insulin therapy. He had been diagnosed with asymptomatic chronic severe (grade III) aortic regurgitation (AR) 16 years before the current presentation but had declined follow-up for the AR. He had never undergone surgery nor the implantation of any prosthetic devices.\n\nEight days after his regular hospital visit, he visited an emergency clinic complaining of breathing difficulty and had a fever above 38℃. Until that day, he had not noticed any fever, chills, weakness, or any other symptoms. His blood pressure and pulse rate were 192/82 mmHg and 118/min, respectively. He showed orthopnea, and his oxygen saturation (SpO2) was 80%. He was transported to the emergency department of our hospital. A physical examination revealed a Levine 3/6 systolic murmur, although his cardiac murmur had not been checked at regular hospital visits. No physical findings suggesting IE, such as Osler nodes, Janeway lesions, or conjunctival petechiae, were recognized. His white blood cell (WBC) count was markedly increased to 20,800 /μL, and his C-reactive protein (CRP) was elevated to 6.06 mg/dL. Serum creatine phosphokinase MB was within the normal range, at 6.0 IU/L, and troponin T was negative. Chest X-ray showed pulmonary congestion with cardiac enlargement (cardiothoracic ratio: 55%). Electrocardiography revealed ST elevation on V1-V4, but emergency echocardiography showed no dysfunction of cardiac contractility. He was diagnosed with acute heart failure due to valvular disease, and treatment with non-invasive positive pressure ventilation and nitrates was initiated.\n\nAfter hospital admission, a detailed examination by transthoracic echocardiography showed severe aortic regurgitation, severe mitral regurgitation, and a mobile vegetation on the mitral valve. Transesophageal echocardiography revealed a 16.5×6-mm mobile vegetation on the anterior leaflet of the mitral valve and an 11.2×5-mm nonmobile vegetation on the noncoronary cusp of the aortic valve. These findings raised strong suspicion of NVE. In this case, head computed tomography (CT) and magnetic resonance imaging revealed no cerebral infarction or hemorrhaging, although a mobile vegetation was detected.\n\nOn reviewing the clinical course until hospitalization, we noted that at the visit four months before admission, his WBC count had been slightly elevated. The following month, his albumin (Alb) level decreased to 3.0 g/dL, and his hemoglobin (Hb) level had shown a gradual decline over the 2 months prior to admission. During this period, he had experienced a 4-kg weight loss. Esophagogastroduodenoscopy and whole-body CT were performed, but no abnormalities were detected. One month later, he had regained some weight, and the laboratory findings had nearly normalized, except for a slightly elevated CRP level (0.54 mg/dL). At the last visit (8 days before admission), his WBC count had again risen to 9,300 /μL, while his Hb and Alb levels had again decreased to 13.1 g/dL and 3.0 g/dL, respectively. Furthermore, his CRP level had increased to 4.18 mg/dL. At that time, his diastolic blood pressure has shown an obvious decrease. Thus far, he had not experienced a fever or any symptoms other than weight loss. We suspected diseases of infectious and/or malignant origin and initiated comprehensive examinations to identify the source of his clinical findings.\n\nAfter heart failure treatment had been started, his clinical symptoms showed rapid improvement, and his hemodynamic stability was maintained during the first six hours. He initially received empirical intravenous antibiotic therapy consisting of 12 g/day of ampicillin sulbactam (ABPC/S) and 120 mg/day of gentamycin (GM). Three blood culture sets were obtained on the admission, and all were positive for S. warneri [minimum inhibitory concentration (MIC) to ABPC/S ≤8 μg/mL; MIC to GM ≤1 μg/mL; MIC to cefazolin (CEZ) ≤2 μg/mL]. Thus, IE caused by this organism was diagnosed.\n\nAccording to the clinical guideline established by the Japanese Circulation Society, emergency surgery is generally recommended for heart failure of NYHA III to IV or urgent surgery for NVE mobile vegetation exceeding 10 mm and severe valve dysfunction. In this case, however, his heart failure was successfully improved. Based on the guideline, the risk of embolism was considered to have been reduced by the administration of appropriate antibiotic therapy. In addition, the patient had type 1 diabetes, and his glycemic control was so poor that we were concerned that double-valve surgery would be a high-risk procedure. Therefore, we planned elective surgery after sufficient control of both infection and diabetes.\n\nBased on the blood culture results, the antibiotic regimen was switched to 6 g/day of CEZ. A detailed dental examination revealed no abnormalities, such as periodontitis. After four weeks of antibiotic therapy, he underwent surgical therapy. His aortic valve was found to be bicuspid, and the aortic and mitral annuli were intact without abscess formation. Large vegetations were exenterated, and the mitral and aortic valves were both replaced with mechanical valves. He experienced no postoperative complications and was discharged on the 22nd day after the operation without apparent embolism. He has not had any recurrence in over two years since the operation.",
+    "summary": "A 59-year-old man with type 1 diabetes presented with heart failure. Echocardiography showed large vegetations on the mitral and aortic valves. Blood bacterial culture was positive for Staphylococcus warneri, a coagulase-negative staphylococcus (CoNS) family member. He was diagnosed with native valve endocarditis (NVE) induced by the resident bacteria and ultimately underwent double valve replacement. Retrospectively, slight laboratory data abnormalities and weight loss beginning four months before may have been signs of NVE. He had no history of immunosuppressive therapies or medical device implantation. ",
+    "translated_fulltext": null,
+    "translated_summary": "Một người đàn ông 59 tuổi mắc bệnh tiểu đường loại 1 nhập viện vì suy tim. Siêu âm tim cho thấy có nhiều khối sần lớn trên van hai lá và van động mạch chủ. Kết quả cấy máu cho thấy có vi khuẩn Staphylococcus warneri, một loại vi khuẩn thuộc họ Staphylococcus không sản xuất coagulase (CoNS). Ông được chẩn đoán mắc bệnh viêm nội tâm mạc van tim tự nhiên (NVE) do vi khuẩn cư trú gây ra và cuối cùng đã trải qua phẫu thuật thay cả hai van tim. Nhìn lại, những bất thường nhẹ trong các chỉ số xét nghiệm và tình trạng sụt cân bắt đầu bốn tháng trước có thể là dấu hiệu của NVE. Ông không có tiền sử điều trị bằng thuốc ức chế miễn dịch hoặc cấy ghép thiết bị y tế.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "টাইপ ১ ডায়াবেটিসযুক্ত ৫৯ বছর বয়সী এক পুরুষ হৃদ্‌যন্ত্রের ব্যর্থতা নিয়ে उपस्थित হন। ইকোকার্ডিওগ্রাফিতে মাইট্রাল ও অ্যাওর্টিক ভালভে বৃহৎ ভেজিটেশন দেখা যায়। রক্তের ব্যাকটেরিয়াল কালচারে Staphylococcus warneri শনাক্ত হয়, যা coagulase-negative staphylococcus (CoNS) পরিবারের সদস্য। তাঁর resident bacteria দ্বারা সৃষ্ট native valve endocarditis (NVE) নির্ণয় হয় এবং শেষ পর্যন্ত double valve replacement করা হয়। পশ্চাদ্দৃষ্টিতে, পরীক্ষাগারের সামান্য অস্বাভাবিকতা এবং চার মাস আগে শুরু হওয়া ওজন কমা NVE-র লক্ষণ হতে পারে। তাঁর ইমিউনোসাপ্রেসিভ থেরাপি বা medical device implantation-এর কোনো ইতিহাস ছিল না।"
+  },
+  {
+    "id": "multiclinsum_gs_en_383.txt",
+    "fulltext": "A 27-year-old woman with multiple colorectal cancers on a background of FAP was presented to our department. Notably, a large lesion was detected in the ascending, transverse, and sigmoid colon and the upper rectum, and pathological examination confirmed some of them as adenocarcinoma. Preoperative computed tomography revealed multiple lymph node swellings along the inferior mesenteric artery (IMA) and middle colic artery, without any evidence of distant metastases. After a comprehensive evaluation by a multidisciplinary cancer board, we decided to perform TPC with lymph node dissection of the entire colorectal region, using the Hugo RAS system as a surgical device.\n\nRobot-assisted TPC using the Hugo RAS system was approved by the Evaluating Committee for Highly Difficult New Medical Technologies (approval number H-0051) and the Institutional Review Board at Kyoto University.\n\nUnder general anesthesia, the patient was placed in a lithotomy position with the arms tucked. After a 5-cm vertical skin incision was made at the umbilicus, a wound-protecting device was applied. After pneumoperitoneum, 4 robotic trocars and 2 assistant trocars were placed. The instruments used in robot-assisted TPC with Hugo were a camera, monopolar curved shears for the right hand, bipolar fenestrated forceps for the left hand, and Cadiere/double fenestrated forceps for the reserve arm. Robot-assisted TPC with Hugo consists of 3 distinct steps, followed by transanal specimen extraction, ileal pouch construction through a small laparotomy, and ileal pouch-anus anastomosis (IPAA). Two table positions, Trendelenburg and flat, were required, each with specific docking tilts but the same angles of the arm carts throughout the robotic procedure. The detailed operative procedure is presented in Supplementary Videos.\n\nStep 1: Ascending colon complete mesocolic excision (CME)\n\nThe ascending colon CME from the caudal approach proceeded until the completion of the hepatic flexure mobilization (Supplementary Video S1).\n\nStep 2: Central vessel ligation (CVL) of the IMA, descending colon CME, and total mesorectal excision (TME)\n\nAfter CVL of the IMA, descending colon CME proceeded until the completion of splenic flexure mobilization, followed by TME until the intersphincteric space was fully exposed (Supplementary Video S2).\n\nStep 3: CVL along the superior mesenteric artery (SMA)\n\nAfter undocking all the robotic arms, the patient was placed in a flat position. Then, CVL along the SMA was performed to ligate the ileocolic, right colic, and middle colic vessels (Supplementary Video S3). The final step of this procedure was the ligation of the inferior mesenteric vein (IMV) at its root, which was exposed in Step 2.\n\nTransanal and small laparotomy procedures\nAfter transection of the terminal ileum, we extracted the specimen transanally by excising the rectal mucosa entirely from just below the dentate line because of multiple adenomas in the anal canal. After constructing the ileal pouch through the small umbilical incision and confirming that the ileal pouch could reach the bottom of the anal canal for anastomosis, transanal hand-sewn IPAA was performed. A diverting ileostomy was not performed.\n\nAll 3 steps were completed without conversion to open surgery. After undocking Hugo when we finished Step 3, we performed a laparoscopy to confirm hemostasis, specimen extraction, and appropriate anastomosis. The operative time was 632 min (36 min for Step 1, 160 min for Step 2, 188 min for Step 3, and 248 min for other procedures such as positioning, docking, specimen extraction, and anastomosis), with a minimal intraoperative estimated blood loss of 20 mL. The patient exhibited an uneventful postoperative recovery, with gas passage and initiation of liquid nutrition on postoperative day 1 (POD 1) and a solid diet on POD 3 with a functional ileal pouch and satisfactory anal function. Pathological examination revealed 2 sigmoid colon cancers (S1, Type 0-Ip, 55 × 50 mm, tub1, T1b, ly0, v0; S2, Type 0-Isp, 55 × 50 mm, tub1, Tis, ly0, v0) and 1 rectal cancer (R1, Type 0-Ip, 40 × 35 mm, tub1, Tis, ly0, v0). It also revealed 18 out of 89 positive lymph nodes, all of which belonged to the sigmoid colon and rectosigmoid lesions (stations #241, 242, and 251), resulting in UICC pT1bN2b stage.",
+    "summary": "A 27-year-old woman with multiple colorectal cancers with a background of familial adenomatous polyposis underwent robot-assisted TPC, including lymph node dissection of the entire colorectal region using the Hugo RAS system. The robotic procedure was divided into 3 steps: 1) Trendelenburg position to perform ascending colon complete mesocolic excision (CME) to the hepatic flexure, 2) descending colon CME and total mesorectal excision with D3 lymph node dissection, and 3) flat position to perform central vessel ligation along the superior mesenteric artery. After undocking, the specimen was extracted transanally, and an ileal pouch was constructed from a small laparotomy at the umbilical incision, followed by ileal pouch-anal anastomosis. The operative time was 632 min, and the estimated blood loss was minimal. The postoperative period was uneventful.",
+    "translated_fulltext": null,
+    "translated_summary": "Một phụ nữ 27 tuổi, mắc nhiều khối u ung thư đại trực tràng và có tiền sử đa polyp tuyến gia đình, đã được phẫu thuật cắt bỏ khối u bằng phương pháp hỗ trợ robot (TPC), bao gồm việc cắt bỏ hạch bạch huyết của toàn bộ vùng đại trực tràng bằng hệ thống robot Hugo RAS. Quá trình phẫu thuật bằng robot được chia thành 3 bước: 1) Tư thế Trendelenburg để thực hiện cắt bỏ hoàn toàn mạc treo đại tràng lên đến chỗ uốn gan, 2) cắt bỏ mạc treo đại tràng xuống và cắt bỏ hoàn toàn mạc trực tràng cùng với việc cắt bỏ hạch bạch huyết D3, và 3) tư thế nằm để thực hiện thắt mạch máu trung tâm dọc theo động mạch mạc treo tràng trên. Sau khi kết thúc phẫu thuật robot, mẫu vật được lấy ra qua đường hậu môn, và một túi hồi tràng được tạo ra từ một vết rạch nhỏ ở vị trí rốn, sau đó thực hiện nối túi hồi tràng với hậu môn. Thời gian phẫu thuật là 632 phút và lượng máu mất ước tính là rất ít. Giai đoạn hậu phẫu diễn ra bình thường.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "একজন ২৭ বছর বয়সী নারী, যার familial adenomatous polyposis পটভূমিতে একাধিক colorectal cancers ছিল, তাঁর Hugo RAS system ব্যবহার করে সমগ্র colorectal অঞ্চলের lymph node dissection-সহ robot-assisted TPC করা হয়েছিল. রোবোটিক পদ্ধতিটি ৩টি ধাপে বিভক্ত ছিল: 1) Trendelenburg position-এ ascending colon-এর hepatic flexure পর্যন্ত complete mesocolic excision (CME), 2) descending colon CME এবং D3 lymph node dissection-সহ total mesorectal excision, এবং 3) superior mesenteric artery বরাবর central vessel ligation করার জন্য flat position. Undocking-এর পর specimen transanally বের করা হয়, এবং umbilical incision-এ একটি ছোট laparotomy থেকে একটি ileal pouch নির্মাণ করা হয়, পরবর্তীতে ileal pouch-anal anastomosis করা হয়. অপারেশনের সময় ছিল ৬৩২ মিনিট, এবং আনুমানিক রক্তক্ষয় ছিল ন্যূনতম. পোস্টঅপারেটিভ সময়কাল জটিলতামুক্ত ছিল."
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0018_0019.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0018_0019.json
new file mode 100644
index 0000000000000000000000000000000000000000..b7bdc150f978df3077df10f35435549e1c10f75f
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0018_0019.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_462.txt",
+    "fulltext": "A 65-year-old male presented with swelling and boutonniere deformity on the right middle finger for six months after a motorcycle accident on January 1st, 2023. Initially, he managed the injury with painkillers and did not seek medical attention. After six months of persistent symptoms, including an inability to fully extend the finger and noticeable edema, he sought treatment.\n\nClinical findings\nThe inspection of the right hand showed the presence of deformity with edema. The active range of motion (ROM) was impaired in PIP joint in digiti III of the right hand. The active ROM of PIP joint digiti III of the right hand 45–110 degrees. The passive ROM of PIP joint digiti III of the right hand within normal.\n\nDiagnostic assessment\nWe performed X-ray of the right hand AP/Lateral which showed there are no abnormality in the bone and we diagnosed the deformity from soft tissue which is central slip injury.\n\nSurgical technique\nA central slip defect reconstruction utilizing partial ulnar side of flexor digitorum superficial tendon was performed. Under anesthesia, the patient was positioned supine with a tourniquet applied to the upper arm. A midlateral incision was made on the ulnar aspect of the right middle phalanx, centered at the PIP joint. The incision extended dorsally in an oblique manner. A transverse incision was made over the MCP joint flexion crease, just proximal to the A1 pulley. The procedure involves identifying and protecting the ulnar digital neurovascular bundle, exposing the central slip and extensor tendon to the PIPJ, full-thickness dorsal flaps are elevated. Scar tissue and pseudotendinous tissue is identified and excised. The central slip cannot be repaired primarily, so the ulnar slip of the FDS tendon is used for reconstruction. The ulnar neurovascular bundle is mobilized to visualize the periosteal insertion of the A3 pulley.\n\nThe extensor tendon is mobilized and tenolyzed, followed by incision of the dorsal capsule of the PIP joint and removal of interposed tissue. The A3 pulley's periosteal insertion is incised longitudinally, and the PIP joint's volar capsule is incised longitudinally. The ulnar slip of the FDS tendon is identified and a 2–0 non-absorbable, monofilament suture is placed around it. A transverse incision is made at the MCP joint flexion crease, proximal to the A1 pulley revealing the flexor tendon sheath. The tendon sheath and A1 pulley are incised longitudinally. The FDS tendon is identified. The ulnar slip of the FDS tendon is isolated and transected to release the ulnar slip, avoiding entrapment or catching of the radial slip. The 2–0 suture that was placed around the ulnar slip at the level of the PIP joint is used to release distally based FDS tendon slip and deliver the ulnar slip of the FDS tendon distally.\n\nA 2.8-mm drill is used to create a vertically oriented bone tunnel dorsal to volar. An elevator is placed between the flexor digitorum profundus tendon, volar plate, and volar aspect of the base of the middle phalanx protecting the volar anatomic structures. The FDS tendon slip passes through the tunnel while maintaining the PIP joint in extension and reduced position. The FDS tendon slip passed through the intact proximal section of the central slip and extensor tendon. A tendon weaver completes a Pulvertaft weave, confirming the appropriate tension with the PIPJ in the reduced, full extension position. A 3–0 non-absorbable suture secures the pulvertaft weave. The margins of the capsule and central slip reconstruction are approximated across the PIP joint, and adhesions are released and the lateral bands mobilized.\n\nThe overall posture, stability, and motion with tenodesis assessed. All the incisions are copiously irrigated. The tourniquet is deflated and hemostasis is obtained. Capillary refill of all fingers is assessed. The skin is closed using horizontal mattress stiches. A sterile dressing is applied with an appropriately padded PIP joint extension splint to allow for early DIP joint and MCP joint motion.\n\nFollow-up and outcomes\nFirst follow-up was done 4 days after for wound treatment. The patient was given oral meloxicam 7,5 mg twice a day and doxycycline 100 mg twice a day for 3 days. The second follow-up was done 3 days after for wound treatment. After 2 weeks, we remove the back slab, remove the external suture and begin the active and passive ROM exercise. After 3 weeks, the wound was healed, and we found the ROM of PIP joint 0 to 90 degrees. And after a month, the patient came with improved ROM of PIP joint 0 to 100 degrees, and improved functional outcome. After 7 weeks of physical rehabilitation, patients already back to work with improve ROM of PIP joint 0 to 110 degrees. The function of the patient's right hand is evaluated with DASH score, which improves significantly from 50 to 4.2.",
+    "summary": "A 65-year-old male patient presented with swelling and boutonniere deformity on the digiti III of the right hand. The patient had previously fallen from a motorcycle, and the patient's right middle finger got was by a motorcycle six months ago. After the incident, the patient's right middle finger cannot be fully extended. The patient's right hand showed edema with flexion of the interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint. The Range of Motion (ROM) of the PIP joint right middle finger was 45-110 degrees. The X-ray of the right hand AP/oblique showed no bone involvement in the deformity. The patient underwent central slip defect reconstruction utilizing the partial ulnar side of the flexor digitorum superficial tendon. A PIP joint extension splint was applied for 2 weeks. Active and passive exercise of the ROM of the PIP joint began after 2 weeks of PIP extension joint splinting. The patient's ROM of the PIP joint (0-90 degrees) significantly improved 1 month after surgery. The patient's ROM of the PIP joint returned to normal after 2 months after surgery. The function of the patient's right hand is evaluated with the DASH score, which improves significantly from 50 to 4.2.",
+    "translated_fulltext": null,
+    "translated_summary": "Một bệnh nhân nam 65 tuổi đến khám với triệu chứng sưng và biến dạng kiểu \"nút thắt\" ở ngón III của bàn tay phải. Bệnh nhân từng bị ngã từ xe máy và ngón giữa bàn tay phải bị xe máy cán cách đây sáu tháng. Sau sự cố, bệnh nhân không thể duỗi hoàn toàn ngón giữa bàn tay phải. Bàn tay phải của bệnh nhân có dấu hiệu phù nề, khớp liên đốt giữa (PIP) bị gấp và khớp liên đốt cuối (DIP) bị duỗi quá mức. Phạm vi cử động (ROM) của khớp PIP ở ngón giữa bàn tay phải là 45-110 độ. Chụp X-quang bàn tay phải theo tư thế AP/chéo cho thấy không có tổn thương xương ở vùng biến dạng. Bệnh nhân được phẫu thuật tái tạo phần trung tâm của gân uốn ngón tay nông, sử dụng một phần của gân uốn ngón tay nông ở phía trụ. Một nẹp hỗ trợ duỗi khớp PIP được đặt trong 2 tuần. Các bài tập vận động chủ động và thụ động để cải thiện ROM của khớp PIP bắt đầu sau 2 tuần sử dụng nẹp. ROM của khớp PIP của bệnh nhân (0-90 độ) cải thiện đáng kể sau 1 tháng phẫu thuật. ROM của khớp PIP của bệnh nhân trở lại bình thường sau 2 tháng phẫu thuật. Chức năng của bàn tay phải của bệnh nhân được đánh giá bằng thang điểm DASH, và điểm số cải thiện đáng kể từ 50 xuống 4,2.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "65 বছর বয়সী এক পুরুষ রোগী ডান হাতে digiti III-তে ফোলা এবং boutonniere deformity নিয়ে উপস্থিত হন. রোগী পূর্বে মোটরসাইকেল থেকে পড়েছিলেন, এবং 6 মাস আগে রোগীর ডান হাতের মধ্যমা আঙুল মোটরসাইকেলের দ্বারা আঘাতপ্রাপ্ত হয়েছিল. ঘটনার পর, রোগী ডান হাতের মধ্যমা আঙুল সম্পূর্ণরূপে প্রসারিত করতে পারেননি. রোগীর ডান হাতে edema ছিল, proximal interphalangeal (PIP) joint flexion এবং distal interphalangeal (DIP) joint hyperextension ছিল. ডান হাতের মধ্যমা আঙুলের PIP joint-এর Range of Motion (ROM) ছিল 45-110 ডিগ্রি. ডান হাতের X-ray AP/oblique ভিউতে deformity-তে কোনো bone involvement দেখা যায়নি. রোগীর central slip defect reconstruction করা হয়, যেখানে flexor digitorum superficialis tendon-এর ulnar পাশের আংশিক অংশ ব্যবহার করা হয়. PIP joint extension splint 2 সপ্তাহের জন্য প্রয়োগ করা হয়েছিল. PIP joint extension splinting-এর 2 সপ্তাহ পর PIP joint-এর ROM-এর active এবং passive exercise শুরু করা হয়. সার্জারির 1 মাস পর রোগীর PIP joint-এর ROM (0-90 ডিগ্রি) উল্লেখযোগ্যভাবে উন্নত হয়. সার্জারির 2 মাস পর রোগীর PIP joint-এর ROM স্বাভাবিক অবস্থায় ফিরে আসে. রোগীর ডান হাতের ফাংশন DASH score দিয়ে মূল্যায়ন করা হয়, যা 50 থেকে 4.2-এ উল্লেখযোগ্যভাবে উন্নত হয়."
+  },
+  {
+    "id": "multiclinsum_gs_en_382.txt",
+    "fulltext": "A 23-year-old male patient presented to the emergency department with a sudden onset of severe frontal headache lasting for 2 h. He experienced associated symptoms of nausea, vomiting, and chest heaviness. He has a unremarkable medical record and denies the use of illicit drugs. However, he is a smoker with a history of 23 pack-years but does not consume alcohol.\n\nOn physical examination, the young male appeared distressed but was fully conscious and oriented to time, place, and person. Chest auscultation revealed normal vesicular breathing sounds, while cardiovascular and abdominal examinations were inconclusive. Neurological examinations demonstrated neck stiffness, dilated pupils reactive to light, normal plantar reflexes, and no focal neurological deficits.\n\nHis vital signs were as follows: blood pressure 178/103 mmHg, respiratory rate 26 breaths/min, temperature 38.9°C, heart rate 87 beats/min, and oxygen saturation of 94%.\n\nEmergency tests were initiated. An ECG revealed ST segment elevation >2 mm in leads V2-V5, consistent with STEMI as the top of our differential diagnosis, requiring confirmation by cardiac markers. With prompt referral to a tertiary cardiac centre implemented, the patient received a 300 mg aspirin load while being transferred to the catheter lab. Troponin levels were significantly elevated at 1.48 mg/dl (normal <0.16 mg/dl).\n\nPercutaneous coronary intervention was performed via the femoral artery, and the result showed normal coronary arteries with thrombolysis in myocardial infarction (TIMI) flow grade of 3.\n\nHis ECG after coronary angiography revealed normal sinus rhythm with left ventricular hypertrophy LVH. An echocardiogram was performed, revealing normal ventricular function with no regional wall motion abnormalities (RWMA).\n\nFollowing coronary intervention, he was admitted to the medical ward for further assessment and investigation. Blood samples were drawn for a complete blood count, random blood sugar, renal function tests, and CRP. The results revealed lymphocytosis and mildly elevated CRP.\n\nWe proceeded further with CT brain to exclude serious cause of headache. His brain CT showed cisternal subarachnoid haemorrhage SAH with extension anterior to the right temporal lobe. Abdominal ultrasound screening was performed to rule out polycystic kidney disease which was negative and cerebral CT angiography was scheduled to exclude cerebral aneurysm Nimodipine 60 mg every 4 h was initiated, with a target blood pressure of 160/100 mmHg.\n\nOn the second day, his condition suddenly deteriorated, culminating with cardiac arrest. Therefore, cardiopulmonary resuscitation (CPR), resulting in a Glasgow Coma Scale score (GCS) of 6. The patient was subsequently, intubated and placed on mechanical ventilation in the Intensive Care Unit (ICU). Due to his unstable condition in the ICU, we could not perform a repeated CT brain scan or the planned cerebral CT angiography.\n\nOver the next 7 days, we diligently monitored him with a strict multidisciplinary team. A nasogastric tube was inserted for feeding and fluid replacement. His medications included intravenous fluids, antibiotics, proton pump inhibitors, and nimodipine.\n\nOn the 8th day, he suddenly developed ventricular fibrillation, and despite CPR with more than five defibrillations, we were unable to revive him and death was the final outcome.39734686",
+    "summary": "We present a case detailing the diagnostic challenges of a 23-year-old male presenting with a sudden severe headache, nausea, vomiting, and chest heaviness. Initial evaluation showed elevated blood pressure and respiratory rate. An emergency electrocardiogram (ECG) indicated ST-segment elevation myocardial infarction (STEMI), leading to immediate referral for percutaneous coronary intervention, which revealed normal coronary arteries. Further investigations identified a cisternal subarachnoid haemorrhage (SAH) on CT brain imaging. Despite multidisciplinary management, the patient's condition rapidly deteriorated, resulting in cardiac arrest and mortality.",
+    "translated_fulltext": null,
+    "translated_summary": "Chúng tôi trình bày một trường hợp điển hình, nêu bật những thách thức trong chẩn đoán của một bệnh nhân nam 23 tuổi, với các triệu chứng bao gồm đau đầu dữ dội đột ngột, buồn nôn, nôn mửa và cảm giác nặng ngực. Đánh giá ban đầu cho thấy huyết áp và nhịp thở tăng cao. Điện tâm đồ cấp cứu (ECG) cho thấy nhồi máu cơ tim cấp tính có đoạn ST chênh lên (STEMI), dẫn đến việc chuyển bệnh nhân ngay lập tức để can thiệp mạch vành qua da, và kết quả cho thấy các động mạch vành bình thường. Các xét nghiệm tiếp theo xác định tình trạng xuất huyết dưới nhện trong bể não (SAH) trên hình ảnh chụp cắt lớp não. Mặc dù đã được điều trị đa chuyên khoa, tình trạng của bệnh nhân nhanh chóng trở nên tồi tệ hơn, dẫn đến ngừng tim và tử vong.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা ২৩ বছর বয়সী এক পুরুষ রোগীর একটি কেস উপস্থাপন করছি, যা নির্ণয়ের চ্যালেঞ্জগুলোকে তুলে ধরে, এবং যার লক্ষণগুলোর মধ্যে ছিল হঠাৎ তীব্র মাথাব্যথা, বমিবমি ভাব, বমি ও বুকে ভারভাব। প্রাথমিক মূল্যায়নে রক্তচাপ ও শ্বাস-প্রশ্বাসের হার বৃদ্ধি পাওয়া যায়। জরুরি electrocardiogram (ECG) এ ST-segment elevation myocardial infarction (STEMI) ধরা পড়ে, যার ফলে percutaneous coronary intervention-এর জন্য রোগীকে অবিলম্বে রেফার করা হয়; সেখানে coronary arteries স্বাভাবিক পাওয়া যায়। পরবর্তী পরীক্ষা-নিরীক্ষায় CT brain imaging-এ cisternal subarachnoid haemorrhage (SAH) শনাক্ত হয়। বহুবিভাগীয় ব্যবস্থাপনা সত্ত্বেও রোগীর অবস্থা দ্রুত অবনতি ঘটে, ফলে cardiac arrest এবং মৃত্যু ঘটে."
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0020_0021.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0020_0021.json
new file mode 100644
index 0000000000000000000000000000000000000000..ecbde774bbde36a4d29faf3ddb62ef359e297e9d
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0020_0021.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_58.txt",
+    "fulltext": "Patient A.P., female, born in 1979, has been diagnosed with dilatation cardiomyopathy in 1996. Anamnestically, disease started with tonsillitis, possible myocarditis (which was never proven), with pronounced symptoms of heart failure and general symptoms. She was hospitalized and after one month, the left ventricular ejection fraction was 10% with the aforementioned signs of congestive heart failure. She was hospitalized for 10 months and 9 days, with standard therapy for vitally endangered patient, oxygen support, numerous adjuvant therapy, and intensive monitoring. Therapy was administered (ACE inhibitor - ramipril, cardiotonic - digoxin, beta-blockers - metoprolol and combination of diuretics - furosemide and spironolactone), with the indication of heart transplantation. Clinical improvement occured with an ejection fraction that was gradually increasing and at the age of 21 she entered in remission or stabilization phase, with the ejection fraction value of 48-57% (regular echocardiography was performed every three months). For the following four years therapy remained the same, but in Jun 2004 (after an episode of low immunity), ejection fraction fell to 25%, with a clinical deterioration of the disease. The patient was hospitalized for a period of two months, and the condition stabilized, and she was discharged with therapy that was the same but without cardiotonic. Ejection fraction was stabilized, and in year 2006 it was 50%. At the age of 27, the patient decided on the first pregnancy that was successful with beta blocker (metoprolol) in therapy. After the first pregnancy, the ejection fraction was 40% and she was treated with the same therapy with eplerenone (25 mg) instead of spironolactone. The ejection fraction was controlled and did not fall below 45%. At the end of 2015 the patient became pregnant for the second time, and the pregnancy went neatly until eighth month (35 weeks), when she was urgently admitted to hospital, due to sense of suffocation and inability to walk. Ejection fraction decreased to 18% (brain natriuretic peptide (BNP) was 2600 pg/ mL (reference values are 100-400 pg/ mL)). During pregnancy she received only metoprolol in therapy. Physicians decide to continue with her pregnancy, in the 39th week they performed c-section, and the condition stabilized again after twenty days. In October 2016 new mode of therapy was administered, ramipril (2.5 mg, in the morning), metoprolol (47.5 mg, in the morning), spironolactone (50 mg, once a day) and ivabradine (5 mg, twice a day) with torasemide (5 mg, once a day). LifeVest Defibrillator was carried from 06 December 2016 until 27 February 2017 when it was removed. When removed and after examination (ejection fraction was 44%) she continued with ramipril therapy (1.25 mg) metoprolol (23.75 mg), torasemide (5 mg), spironolactone (25 mg) and ivabradine (7.5 mg, twice a day) with potassium supplements, and compliance with non-pharmacological measures (fluid intake restricted to 1.5 L/ day). The echocardiographic finding in March 2017 showed left ventricular dilatation with moderately reduced left ventricular function and left ventricular wall hypokinesia with ejection fraction of 44% (insignificant pericardial effusion was present, inferior vena cava with physiological flow, preserved valves function - Dopler sonography showed slight insufficiency of mitral valve with dilatation of anulus). Evaluation of a patient with ejection fraction 44% showed no indication for an implantable cardioverter defibrillator (ICD), and conservative procedure and medication therapy were recommended. Regular check-ups and body mass reduction, regular control of renal function parameters and electrolytes were recommended. She is led under the diagnosis of dilated cardiomyopathy and heart failure NYHA stage II without any indication for the ICD prophylactic implantation.",
+    "summary": "Patient A.P., female, 38 years old, had symptoms of dilated cardiomyopathy (with possible infectious myocarditis in the background) at age 17. After hospitalization for ten months and ten days, while waiting for heart transplantation (with threatening death outcome), without a clearly pronounced threatening arrhythmia, but with a low ejection fraction and a poor general condition, remission occurred. The therapy focused primarily on the treatment of heart failure, prevention of arrhythmia and thromboembolism. Normalization of the disease by improving the function of the left ventricle (expected in 16% of patients) occurred and lasted for 4 years, followed by an exacerbation of the disease that lasted for two years. In the next few years the patient was stable, had a first child with normal pregnancy. During the second trimester of the second pregnancy, there was an exacerbation (postpartum dilatation cardiomyopathy) lasting for couple of months. At the time of case report (May 2017), the patient is stable on therapy (ACE inhibitor, beta blocker, diuretics, If channel blocker), without limitation of physical capacity, mother of two children, unemployed.",
+    "translated_fulltext": null,
+    "translated_summary": null,
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": null
+  },
+  {
+    "id": "multiclinsum_gs_en_81.txt",
+    "fulltext": "27-year-old male patient with a history of fibrous dysplasia in the right proximal femur, which was managed prophylactically to reduce the risk of fracture 20 years ago by curettage (intralesional resection), application of bone graft and fixation with osteosynthesis material, which was removed one year after the fixation. Two weeks before admission to hospital, the patient experienced pain after a fall with low energy mechanism characterised by axial load and rotational component of the right hip, which resulted in pain intensity 8/10 on the visual analogue scale (VAS) at the level of the inguinal fold and right thigh, which incapacitated him for walking. Radiological control was performed at four weeks, observing all prosthetic components adequately. The patient was discharged clinically and haemodynamically stable, without the need for transfusion of blood products. During his follow-up in the postoperative period (612 weeks), the patient continued with partial support until day 20, in which he began with full support even accompanied by a walker. Radiological control was performed at four weeks, observing all prosthetic components adequately. The patient is currently carrying out daily activities with slight limitation due to claudicatio intermittens caused by the incision in the middle gluteus. However, he was able to participate in low-impact sports activities, such as walking and expressed great satisfaction with the functional outcome of the procedure.\n",
+    "summary": "We present the case of a 27-year-old male patient who presented to the emergency department with a fracture of the right femur at the base of the neck in pathological ground Garden II Pauwells III AO 31B2.3r, after a low energy mechanism of injury characterized by axial load with rotational component of the right hip. The patient had a history of intralesional resection, application of bone graft and prophylactic fixation with unspecified osteosynthesis material in the pertrochanteric region 20 years ago; the biopsy later showed DF; one year later, the osteosynthesis material was removed. Due to the characteristics of the fracture and as a definitive and curative therapeutic method, it was decided to carry out a wide resection of the proximal femur and total arthroplasty of the hip with a modular prosthesis with placement of cerclage, as well as a excisional biopsy that later corroborated that it was the same DF treated in childhood.\n",
+    "translated_fulltext": "Bệnh nhân nam, 27 tuổi, có tiền sử loạn sản xơ ở phần trên của xương đùi phải. Cách đây 20 năm, bệnh nhân đã được điều trị dự phòng bằng phương pháp nạo vét (cắt bỏ khối u), ghép xương và cố định bằng vật liệu tổng hợp xương để giảm nguy cơ gãy xương, sau đó vật liệu này đã được loại bỏ một năm sau khi cố định. Hai tuần trước khi nhập viện, bệnh nhân bị đau sau khi bị ngã với lực tác động nhẹ, đặc trưng bởi tải trọng dọc trục và thành phần xoay của khớp háng phải, dẫn đến mức độ đau 8/10 trên thang đo tương tự trực quan (VAS) ở vùng bẹn và đùi phải, khiến bệnh nhân không thể đi lại. Kiểm tra bằng phương pháp chẩn đoán hình ảnh được thực hiện sau bốn tuần, cho thấy tất cả các bộ phận của bộ phận giả đều hoạt động tốt. Bệnh nhân được xuất viện trong tình trạng ổn định về lâm sàng và huyết động, không cần truyền máu. Trong quá trình theo dõi sau phẫu thuật (612 tuần), bệnh nhân tiếp tục được hỗ trợ một phần cho đến ngày thứ 20, sau đó bắt đầu đi lại bình thường và sử dụng thêm một chiếc gậy. Kiểm tra bằng phương pháp chẩn đoán hình ảnh được thực hiện sau bốn tuần, cho thấy tất cả các bộ phận của bộ phận giả đều hoạt động tốt. Hiện tại, bệnh nhân có thể thực hiện các hoạt động hàng ngày với một số hạn chế do chứng khập khiễng gián đoạn do vết mổ ở cơ mông giữa. Tuy nhiên, bệnh nhân có thể tham gia các hoạt động thể thao cường độ thấp, chẳng hạn như đi bộ, và bày tỏ sự hài lòng lớn với kết quả chức năng của thủ thuật.",
+    "translated_summary": null,
+    "corrected_translated_fulltext": "২৭ বছর বয়সী পুরুষ রোগীর ডান দিকের ফিমারের প্রোক্সিমাল অংশে fibrous dysplasia-এর ইতিহাস রয়েছে। ২০ বছর আগে, fracture-এর ঝুঁকি কমাতে রোগীকে prophylacticভাবে curettage (intralesional resection), bone graft প্রয়োগ এবং osteosynthesis material দিয়ে ফিক্সেশন করা হয়েছিল; ফিক্সেশনের এক বছর পর ওই উপকরণটি অপসারণ করা হয়। হাসপাতালে ভর্তি হওয়ার দুই সপ্তাহ আগে, নিম্ন-শক্তির মেকানিজমসহ একটি পড়ে যাওয়ার পর রোগীর ব্যথা হয়, যা ডান হিপের axial load এবং rotational component দ্বারা চিহ্নিত; এতে কুঁচকির ভাঁজ ও ডান উরুর স্তরে visual analogue scale (VAS)-এ ব্যথার মাত্রা ৮/১০ হয় এবং তিনি হাঁটতে অক্ষম হয়ে পড়েন। চার সপ্তাহে radiological control করা হয়, যেখানে সব prosthetic components যথাযথ বলে পর্যবেক্ষিত হয়। রোগীকে ক্লিনিক্যালি ও হেমোডাইনামিকালি স্থিতিশীল অবস্থায় রক্তপণ্য transfusion-এর প্রয়োজন ছাড়াই ছুটি দেওয়া হয়। অপারেশন-পরবর্তী ফলো-আপ (612 সপ্তাহ) চলাকালীন, রোগী ২০তম দিন পর্যন্ত আংশিক সমর্থন বজায় রাখেন, এরপর তিনি পূর্ণ সমর্থন শুরু করেন এবং সাথে একটি লাঠি ব্যবহার করেন। চার সপ্তাহে radiological control করা হয়, যেখানে সব prosthetic components যথাযথ বলে পর্যবেক্ষিত হয়। বর্তমানে, gluteus medius-এ incision-এর কারণে claudicatio intermittens থাকায় সামান্য সীমাবদ্ধতা সহ তিনি দৈনন্দিন কার্যক্রম পরিচালনা করছেন। তবে, তিনি হাঁটার মতো নিম্ন-প্রভাবের ক্রীড়া কার্যক্রমে অংশ নিতে সক্ষম এবং প্রক্রিয়ার কার্যকর ফলাফলে অত্যন্ত সন্তুষ্টি প্রকাশ করেছেন।",
+    "corrected_translated_summary": null
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0022_0023.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0022_0023.json
new file mode 100644
index 0000000000000000000000000000000000000000..259a8d23668d895bf35d99a5ef68494efcb1d0a3
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0022_0023.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_280.txt",
+    "fulltext": "A 4-year-old boy with stage IV neuroblastoma received four cycles of chemotherapy, including high-dose chemotherapy including busulfan and melphalan, followed by autologous peripheral blood stem cell transplantation with autologous bone marrow supplementation. After eight additional cycles of chemotherapy consisting of temozolomide and irinotecan, which led to stable disease, the patient underwent preparative conditioning with fludarabine (150 mg/m2), melphalan (140 mg/m2), and 12 Gy of TBI for subsequent allogeneic CBT. The patient received tacrolimus and a short-term course of methotrexate for GVHD prophylaxis. The patient underwent engraftment on day 17. He then developed grade 3 GVHD, which was managed by increasing the prednisolone dose and was later discharged on day 85. The patient also received proton beam therapy (39.6 Gy) from days 121 to 150 post-transplantation for a right supra-mediastinum tumor with residual I123-MIBG accumulation in the right adrenal gland.\n\nThe patient remained healthy with no evidence of GVHD until presentation at our hospital with a productive cough on day 159. As his older brother displayed similar cold symptoms, a rapid antigen test for RSV was performed, which revealed a positive result. His respiratory symptoms gradually worsened, and he revisited our hospital on day 194 with dyspnea and intercostal retractions. Upon admission, he was given 0.7-1.0 mg/kg of prednisolone, which failed to improve his respiratory condition. Chest computed tomography on day 231 revealed infiltration, ground-glass opacity, and septal thickening in the bilateral lung fields along with right pleural effusion. Echocardiography showed an elevated tricuspid regurgitation peak velocity of 4.1 m/s and an interventricular septum close to the isobaric, indicating the presence of PH. In addition, pericardial effusion was detected. On day 231, the patient was transferred to the pediatric intensive care unit, where mechanical ventilation and inhaled nitric oxide (NO) were initiated. Thoracoscopic lung biopsy on day 244 revealed diffuse intra-alveolar hemorrhage and edema on hematoxylin-eosin (HE)-stained samples. Elastica van Gieson staining revealed diffuse obstructive lesions due to fibrocellular components with plump endothelial cells in the pre-septal pulmonary veins and venules. While pulmonary muscular arteries and arterioles showed mild medial hypertrophy and focal intimal thickening (Heath-Edwards Grade 2), severe stenosis with concentric intimal fibrosis or plexiform lesions was present. Based on these results, the patient was diagnosed with PVOD with mild pulmonary arterial/arteriolar lesions. Of note, HE staining also revealed enlarged type II pneumocytes with multinucleated and giant cell-like features, indicating the presence of prior lung injury that was likely attributable to his preceding viral infection.",
+    "summary": "A 4-year-old boy was diagnosed with metastatic neuroblastoma and underwent intensive chemotherapy, autologous HSCT, and allogeneic cord blood transplantation (CBT). He experienced PVOD on day 194 following CBT after displaying upper respiratory symptoms and positive RSV antigen test results approximately one month prior. Pathological examination of a lung biopsy specimen revealed lung injury suspected to be associated with viral infection in addition to PVOD-related findings, suggesting that RSV infection might have contributed to the onset of PVOD.",
+    "translated_fulltext": null,
+    "translated_summary": "Một bé trai 4 tuổi được chẩn đoán mắc bệnh u thần kinh bào di căn và đã trải qua quá trình hóa trị tích cực, ghép tế bào gốc tự thân và ghép tế bào gốc dây rốn đồng loại. Bé bị bệnh mạch máu phổi tắc nghẽn (PVOD) vào ngày thứ 194 sau khi ghép tế bào gốc dây rốn, sau khi trước đó khoảng một tháng bé có các triệu chứng nhiễm trùng đường hô hấp trên và kết quả xét nghiệm kháng nguyên RSV dương tính. Kết quả kiểm tra mô học mẫu sinh thiết phổi cho thấy tổn thương phổi, nghi ngờ liên quan đến nhiễm virus, cùng với các dấu hiệu liên quan đến PVOD, cho thấy nhiễm RSV có thể đã góp phần vào sự khởi phát của PVOD.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "৪ বছর বয়সী এক ছেলের metastatic neuroblastoma নির্ণয় হয়েছিল এবং সে intensive chemotherapy, autologous HSCT, এবং allogeneic cord blood transplantation (CBT) সম্পন্ন করেছিল. CBT-র পর ১৯৪তম দিনে তার PVOD হয়েছিল, এর প্রায় এক মাস আগে তার upper respiratory symptoms দেখা দিয়েছিল এবং RSV antigen test-এর ফলাফল positive ছিল. ফুসফুসের biopsy নমুনার pathological examination-এ PVOD-সম্পর্কিত findings-এর পাশাপাশি viral infection-সংশ্লিষ্ট বলে সন্দেহজনক ফুসফুসের আঘাত ধরা পড়ে, যা ইঙ্গিত করে যে RSV infection PVOD-এর সূচনায় অবদান রাখতে পারে."
+  },
+  {
+    "id": "multiclinsum_gs_en_160.txt",
+    "fulltext": "65-year-old male with no personal or family history of pathology of relevance. His condition began in 2020 with productive cough that intensified and was accompanied by shortness of breath with small to medium effort; as well as loss of 10 kg of weight in a period of 4 months. He went to a doctor who requested a chest X-ray that showed massive, multilocular right pleural effusion with right bronchial obstruction and mediastinal lymphadenopathy. A thoracocentesis was performed with a biopsy of the right lung and parietal pleura. The histopathological study reported an adeno-squamous carcinoma. His evolution was bad, which is why he was referred to our institution. On admission, a physical examination found him cachectic, with right pulmonary hypoventilation, 92% oxygen saturation and pneumokoccal dysfunction, with no evidence of systemic or haemodynamic compromise. A chest X-ray was performed that showed complete opacity of the right hemithorax, and a pleural catheter was placed with a serohematic flow. In the histopathological study of the revision material, the lung parenchyma was replaced by a poorly differentiated neoplasm with a solid mantle and syncytia, surrounded by abundant lymphocytes and plasma cells. The neoplastic cells had large, ovoid nuclei, fine chromatin, prominent nucleolus and wide, poorly defined cytoplasm. An immunohistochemical study was performed that was positive for CKAE1/AE3, CK 5/6, p63, EBER ISH, and negative for Napsina A, TTF-1 and CK 7, which ruled out the reference diagnosis of adeno-squamous carcinoma and established the diagnosis of CTLP. Molecular study in the paraffin block was positive for PD-L1 (SP263) +++ in approximately 100% of the neoplastic cells, and negative for EGFR, K-RAS, ALK, ROS1. In order to confirm the pulmonary origin of the neoplasm, a nasopharyngeal examination was performed that was negative. In April 2021, a PET-CT was performed that reported a heterogeneous parahilary pulmonary lesion that compromised the main bronchus and caused atelectasis; as well as multiple cervical, mediastinal and peri-gastric lymphadenopathies. The catheter was removed due to partial resolution of the effusion and chemotherapy treatment with gemcitabine/cisplatin was initiated. He received 6 cycles, however, the patient reported hearing loss and AKIN I acute renal failure was documented, so cisplatin was changed to carboplatin, and maintenance durvalumab was continued. In December 2021, disease progression was documented and he died in January 2022 due to respiratory failure.\n",
+    "summary": "We report the case of a 65-year-old man with a pulmonary lymphoepithelioma-like carcinoma, who presented with cough, dyspnea, and weight loss. A chest CT scan showed a poorly defined nodule located in the right lung. A trans-thoracic biopsy of the lesion was performed, and microscopic examination revealed large polygonal cells arranged in sheets, infiltrated by abundant lymphocytes and plasma cells, around the interstitium. The neoplastic cells were positive for cytokeratin 5/6 and p63, and negative for Napsina A and thyroid transcription factor 1 (TTF-1). PD-L1 expression was positive (approximately 100%) by immunohistochemistry; as was the nucleus of the neoplastic cells by in situ hybridization for Epstein-Barr virus-encoded RNA (EBER-ISH). The patient received six cycles of a combination chemotherapy regimen based on platinum (gemcitabine/cisplatin) plus durvalumab. He progressed and ultimately died 9 months after diagnosis.\n",
+    "translated_fulltext": null,
+    "translated_summary": "Chúng tôi báo cáo về trường hợp của một người đàn ông 65 tuổi bị ung thư biểu mô hạch phổi, với các triệu chứng ho, khó thở và sụt cân. Chụp CT ngực cho thấy một khối u không rõ hình dạng ở phổi phải. Một mẫu sinh thiết xuyên lồng ngực đã được thực hiện, và kết quả kiểm tra dưới kính hiển vi cho thấy các tế bào đa giác lớn được sắp xếp thành các đám, với nhiều tế bào lympho và tế bào plasma xâm nhập xung quanh mô kẽ. Các tế bào ung thư dương tính với cytokeratin 5/6 và p63, và âm tính với Napsina A và yếu tố phiên mã tuyến giáp 1 (TTF-1). Biểu hiện PD-L1 dương tính (khoảng 100%) thông qua phương pháp hóa mô miễn dịch; tương tự, nhân của các tế bào ung thư cũng dương tính thông qua phương pháp lai tại chỗ để phát hiện RNA được mã hóa bởi virus Epstein-Barr (EBER-ISH). Bệnh nhân đã được điều trị bằng sáu đợt hóa trị kết hợp dựa trên bạch kim (gemcitabine/cisplatin) kết hợp với durvalumab. Tình trạng bệnh tiến triển và bệnh nhân cuối cùng đã tử vong sau 9 tháng kể từ khi được chẩn đoán.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা ৬৫ বছর বয়সী এক পুরুষের ফুসফুসীয় lymphoepithelioma-like carcinoma-এর একটি কেস রিপোর্ট করছি, যিনি কাশি, শ্বাসকষ্ট এবং ওজন হ্রাস নিয়ে উপস্থিত হয়েছিলেন। একটি চেস্ট CT স্ক্যানে ডান ফুসফুসে একটি অস্পষ্টভাবে সংজ্ঞায়িত নডিউল দেখা যায়। ক্ষতটির একটি ট্রান্স-থোরাসিক বায়োপসি করা হয়, এবং মাইক্রোস্কোপিক পরীক্ষায় দেখা যায় যে ইন্টারস্টিটিয়ামের চারপাশে প্রচুর lymphocytes এবং plasma cells দ্বারা অনুপ্রবিষ্ট, শিট আকারে সজ্জিত বড় বহুভুজাকৃতি কোষ রয়েছে। নিওপ্লাস্টিক কোষগুলো cytokeratin 5/6 এবং p63-এ পজিটিভ ছিল, এবং Napsina A ও thyroid transcription factor 1 (TTF-1)-এ নেগেটিভ ছিল। ইমিউনোহিস্টোকেমিস্ট্রিতে PD-L1 এক্সপ্রেশন পজিটিভ ছিল (প্রায় ১০০%); তেমনই, Epstein–Barr virus-encoded RNA (EBER-ISH) এর জন্য in situ hybridization-এ নিওপ্লাস্টিক কোষগুলোর নিউক্লিয়াসও পজিটিভ ছিল। রোগী প্লাটিনাম-ভিত্তিক (gemcitabine/cisplatin) প্লাস durvalumab সমন্বয়ে কম্বিনেশন কেমোথেরাপির ছয়টি সাইকেল পেয়েছিলেন। তার রোগ অগ্রসর হয় এবং শেষ পর্যন্ত নির্ণয়ের ৯ মাস পর তিনি মৃত্যুবরণ করেন।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0028_0029.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0028_0029.json
new file mode 100644
index 0000000000000000000000000000000000000000..b5839b0150e7a29d45d8ec1f8fae2ba63078b5cc
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0028_0029.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_268.txt",
+    "fulltext": "Technique\nInformation about the procedure of TFD.\nThe patient receives intravenous photosensitizer (Photogen®, King of Prussia, PA, USA - 1.5 mg/kg) 24 h before the procedure. Its peak light absorption is at the wavelength of 630 nm. The procedure begins with standard duodenoscopy (Olympus TJF-180) under general anesthesia. After the identification of the greater duodenal papilla and the retrograde cannulation, the digital cholangioscope (SpyGlassTM DS, Boston Scientific, Natick, MA) is introduced into the common bile duct. Then the cholangioscopic examination helps to identify the neoplastic stenosis. Under direct visualization, the illumination catheter (Medlight S.A., RD10-323, Switzerland) is advanced through the cholangioscope. This consists of a typical three-way cannula. The first port has a 1 cm long cylindrical light diffuser at the end. Two black radiopaque marks demarcate the limits of the diffuser. The second port accommodates a 0.025 inch guidewire and the third is a portal for injection. After positioning under cholangioscopic guidance, illumination is initiated. The dose is 90 J/cm², with a power of 70 mW/cm². Repositioning is recommended every centimeter to cover the entire stenosed area. At the end of the procedure, new cholangioscopy evaluates the bile duct for immediate outcome and adverse events.\n\nPost-procedure care\nThe patient is fasted for the next 24 h. If no adverse event is detected, oral diet is initiated. Discharge from hospital is done under strict guidance on photoprotection (prevention of exposure to light and use of sunglasses), especially during the first week after the session of TFD.\n\nRESULTS\nThis procedure was performed in an 82-year-old man who presented to our tertiary center with obstructive jaundice and weight loss over the previous two months. Endoscopic ultrasound (EUS) revealed severe dilation of the common bile duct associated with choledocholithiasis. ERCP confirmed these findings but was unable to remove the stones due to the disproportionate dilation of the common bile duct. Therefore, a plastic biliary stent was chosen. The patient showed improvement in his clinical condition, but the cholestasis returned 45 days after the first procedure. Two other ERCPs failed to remove the stones. During the third procedure, a long irregular stenosis of the common hepatic duct was apparent and he was referred for another echoendoscopic evaluation.\n\nIn addition to the choledocholithiasis, the new EUS revealed a dilated common hepatic duct with a well-circumscribed hypoechoic solid mass measuring 1.8x2 cm, which was compressing the common hepatic duct. The mass appeared to also involve the common hepatic artery. An ultrasound-guided needle biopsy confirmed the diagnosis of moderately differentiated cholangiocarcinoma (Bismuth I).\n\nAfter staging, the mass was considered inoperable and the patient was referred for palliative treatment. After a multidisciplinary meeting with the oncology team, adjunctive PDT was proposed to treat the recurrent biliary obstruction. The procedure went without complications and lasted 150 minutes. At the end, a biliary drainage was performed with a 10 Fr plastic stent, since a self-expanding metal stent was not available at that time.\n\nThe patient showed no signs or symptoms of photosensitivity in the following week. There was, however, early recurrence of cholestasis complicated with cholangitis. ERCP revealed obstruction of the stent with debris and biliary sludge secondary to tumor necrosis. A biliary scan followed by new drainage resolved the patient's acute condition. Subsequently, he remained asymptomatic for three months, the longest period since the onset of the disease. At his next recurrence, he was drained with a self-expanding metal stent. He continued with systemic treatment and eventually required a duodenal stent for palliation of dysphagia. He died due to complications of pulmonary metastases two years after the onset of symptoms and 15 months after the session of TFD.\n",
+    "summary": "Patient receives intravenous photosensitizer 24 h before the procedure which begins with regular duodenoscopy. After identification of the main papilla and retrograde cannulation, the digital cholangioscope is introduced into the common bile duct. Then the cholangioscopic examination helps to identify neoplastic stenosis. Under direct visualization, the illumination catheter is advanced through the cholangioscope. Repositioning is done every centimeter. At the end of cholangioscopy, the bile duct is evaluated for immediate outcome and adverse events.\n\nResult: This procedure was performed in an 82-year-old man with obstructive jaundice for the past two months. EUS and ERCP revealed severe dilation of the common bile duct associated with choledocholithiasis. In addition, there was dilation of the hepatic duct to a well-circumscribed hypoechoic solid mass measuring 1.8x2 cm, compressing the common hepatic duct. It was considered inoperable and the patient was referred for palliative treatment with PDT, which remained asymptomatic for three months. He died of complications 15 months after the PDT session.\n",
+    "translated_fulltext": null,
+    "translated_summary": "Bệnh nhân được truyền chất nhạy cảm với ánh sáng qua đường tĩnh mạch 24 giờ trước khi thực hiện thủ thuật, bắt đầu bằng nội soi tá tràng thông thường. Sau khi xác định được nhú Vater chính và thực hiện kỹ thuật can thiệp ngược dòng, ống nội soi đường mật kỹ thuật số được đưa vào ống mật chủ. Sau đó, việc kiểm tra bằng nội soi đường mật giúp xác định các chỗ hẹp do khối u. Trong quá trình quan sát trực tiếp, ống dẫn ánh sáng được đưa qua ống nội soi đường mật. Việc điều chỉnh vị trí được thực hiện sau mỗi centimet. Vào cuối quá trình nội soi đường mật, ống mật được đánh giá để xem kết quả ngay lập tức và các biến chứng có thể xảy ra.\n\nKết quả: Thủ thuật này được thực hiện trên một bệnh nhân nam 82 tuổi bị vàng da tắc nghẽn trong hai tháng qua. Siêu âm nội soi và nội soi ngược dòng đường mật cho thấy ống mật chủ giãn rộng nghiêm trọng, kèm theo sỏi đường mật. Ngoài ra, còn có sự giãn nở của ống gan thành một khối rắn giảm âm, có đường viền rõ ràng, kích thước 1,8x2 cm, gây chèn ép ống gan chung. Khối u được xác định là không thể phẫu thuật và bệnh nhân được chuyển đến để điều trị giảm nhẹ bằng liệu pháp quang động (PDT), và bệnh nhân không có triệu chứng trong ba tháng. Bệnh nhân qua đời do các biến chứng 15 tháng sau khi thực hiện liệu pháp PDT.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "রোগীকে প্রক্রিয়া শুরুর ২৪ ঘণ্টা আগে শিরায় photosensitizer দেওয়া হয়, এবং প্রক্রিয়াটি নিয়মিত duodenoscopy দিয়ে শুরু হয়। মূল papilla শনাক্তকরণ ও retrograde cannulation-এর পর, digital cholangioscope common bile duct-এ প্রবেশ করানো হয়। এরপর cholangioscopic পরীক্ষা neoplastic stenosis শনাক্ত করতে সহায়তা করে। সরাসরি visualization-এর অধীনে, illumination catheter cholangioscope-এর মধ্য দিয়ে অগ্রসর করা হয়। প্রতি সেন্টিমিটার অন্তর repositioning করা হয়। cholangioscopy শেষে, bile duct-এর তাৎক্ষণিক ফলাফল ও adverse events মূল্যায়ন করা হয়।\n\nফলাফল: গত দুই মাস ধরে obstructive jaundice-এ ভুগছেন এমন ৮২ বছর বয়সী এক পুরুষ রোগীর উপর এই প্রক্রিয়াটি সম্পন্ন করা হয়। EUS এবং ERCP-এ choledocholithiasis-সহ common bile duct-এর তীব্র প্রসারণ ধরা পড়ে। এছাড়াও, hepatic duct-এর প্রসারণ ছিল এবং ১.৮x২ সেমি মাপের সুস্পষ্ট সীমানাযুক্ত hypoechoic solid mass ছিল, যা common hepatic duct-কে চাপ দিচ্ছিল। এটি inoperable বলে বিবেচিত হয় এবং রোগীকে PDT দ্বারা palliative চিকিৎসার জন্য রেফার করা হয়, যার পর তিনি তিন মাস উপসর্গবিহীন থাকেন। PDT সেশনের ১৫ মাস পর তিনি জটিলতার কারণে মারা যান।"
+  },
+  {
+    "id": "multiclinsum_gs_en_201.txt",
+    "fulltext": "A 77-year-old woman with haematemesis presented to the emergency room. Her medical history included only hypertension and dyslipidaemia. When she presented to the emergency room, her vital signs indicated shock (heart rate: 100 beats/min, blood pressure: 79/56 mmHg), and blood tests revealed anaemia (haemoglobin: 9.6 g/dL), which suggested upper gastrointestinal bleeding.\n\nNon-contrast-enhanced CT was performed immediately because of renal dysfunction. CT revealed that the third part of the duodenum flexed steeply on the right side of the aorta and ran caudally, without crossing anterior to the aorta. The jejunum was located on the patient’s right side. The second part of the duodenum and the stomach were dilated, and there were high-density gastric contents that were considered to indicate a haematoma.\n\nUpper gastrointestinal endoscopy was performed following the CT examination, which revealed a mucosal laceration at the gastric cardia. Bleeding from lacerations of the cardia of the stomach as a result of forceful vomiting was first reported by Mallory and Weiss in 1929.1 In our case, the third part of the duodenum flexed steeply, and the lumen was narrowed, which caused an obstruction. As a result, repeat vomiting was considered to have caused Mallory–Weiss syndrome.\n\nOn the basis of the CT findings showing that the duodenal-jejunal junction was located in the right hemi-abdomen, intestinal malrotation was suspected.2 However, 7 days later, when CT was repeated, spontaneous resolution of the malpositioned jejunum was seen. The patient was then discharged from the hospital. However, months later, she was rushed to the emergency room for repeat haematemesis. Dynamic CT was performed before upper gastrointestinal endoscopy, on admission, and revealed contrast extravasation in the dilated stomach. Additionally, the third part of the duodenum was flexed on the right side of the aorta, and the duodenal-jejunal junction and jejunum were again located in the right hemi-abdomen. Upper gastrointestinal endoscopy revealed a laceration at the gastric cardia, as in the previous endoscopy, which was considered Mallory–Weiss syndrome.\n\nTwo months after the second episode of haematemesis, the patient presented to the emergency room with nausea. Non-contrast-enhanced CT revealed no abnormalities in the duodenal positioning, but there was oedematous wall thickening in the second part of the duodenum. If we had not had previous CT images, we would have suspected duodenitis, but on the basis of all of the CT findings, we suspected the possibility of an underlying condition after the right-sided deviation of the small intestine had resolved spontaneously.\n\nIn summary, CT was performed 4 times over 5 months. The third and fourth parts of the duodenum and the jejunum deviated repeatedly, but this resolved spontaneously, which is not indicative of intestinal malrotation. Therefore, we diagnosed dysplasia of the ligament of Treitz.\n\nClinical outcomes\nThe patient underwent laparotomy, which revealed no abnormalities in the relative position of the duodenum to the jejunum. Additionally, the jejunum was located on the patient’s left side, and there was no intestinal malrotation. The ligament of Treitz was formed; however, its fixation in the upper jejunum was incomplete as it was attached only to the duodenum. The duodenal-jejunal junction was not fixed to the retroperitoneum, and the jejunum folded easily with the ligament of Treitz as a fulcrum. Surgically, the upper jejunum was fixed with 4 sutures to the retroperitoneum on the patient’s left side. The postoperative course was good, and the patient has remained symptom-free.",
+    "summary": "A 77-year-old woman underwent CT to evaluate haematemesis. The images showed that the third part of the duodenum flexed steeply on the right side of the aorta and ran caudally, without crossing anterior to the aorta. The duodenal-jejunal junction and jejunum were located on the patient's right side. Upper gastrointestinal endoscopy revealed a laceration at the gastric cardia, and a diagnosis of Mallory-Weiss syndrome was made. Repeat CT 7 days later revealed that the abnormal positioning of the intestinal tract had resolved spontaneously. Two months later, the patient experienced another episode of haematemesis, and CT revealed repeat deviation of the duodenal-jejunal junction and jejunum to her right side. Upper gastrointestinal endoscopy revealed another laceration at the gastric cardia, as in the previous study. On the basis of the initial CT findings showing the duodenal-jejunal junction in the right hemi-abdomen, intestinal malrotation was suspected. However, because the jejunum deviated repeatedly to the right side but resolved spontaneously, we diagnosed dysplasia of the ligament of Treitz. Laparotomy revealed a formed ligament of Treitz; however, fixation in the upper jejunum was incomplete. Additionally, CT revealed that the anterior pararenal space was loosely fixed and mobile. These factors may have caused the right-sided deviation of the small intestine.",
+    "translated_fulltext": null,
+    "translated_summary": "Một phụ nữ 77 tuổi được chụp CT để đánh giá tình trạng nôn ra máu. Hình ảnh cho thấy đoạn thứ ba của tá tràng bị uốn cong mạnh về phía bên phải của động mạch chủ và kéo dài xuống phía dưới, không cắt ngang phía trước động mạch chủ. Vị trí nối giữa tá tràng và hồi tràng, cũng như hồi tràng, đều nằm ở phía bên phải của bệnh nhân. Nội soi đường tiêu hóa trên cho thấy có một vết rách ở tâm vị, và chẩn đoán hội chứng Mallory-Weiss được đưa ra. Chụp CT lại sau 7 ngày cho thấy vị trí bất thường của ống tiêu hóa đã tự khỏi. Hai tháng sau, bệnh nhân lại bị nôn ra máu, và chụp CT cho thấy vị trí nối giữa tá tràng và hồi tràng, cũng như hồi tràng, lại bị lệch về phía bên phải. Nội soi đường tiêu hóa trên cho thấy một vết rách khác ở tâm vị, tương tự như lần trước. Dựa trên kết quả chụp CT ban đầu cho thấy vị trí nối giữa tá tràng và hồi tràng nằm ở nửa bụng phải, nghi ngờ có tình trạng xoắn ruột. Tuy nhiên, vì hồi tràng liên tục bị lệch về phía bên phải nhưng sau đó tự khỏi, chúng tôi chẩn đoán là có sự phát triển bất thường của dây chằng Treitz. Phẫu thuật mở bụng cho thấy dây chằng Treitz đã hình thành; tuy nhiên, sự cố định ở phần trên của hồi tràng là không hoàn toàn. Ngoài ra, chụp CT cho thấy khoang trước thận phía trước bị cố định lỏng lẻo và có thể di chuyển. Các yếu tố này có thể đã gây ra sự lệch về phía bên phải của ruột non.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "৭৭ বছর বয়সী এক নারী haematemesis মূল্যায়নের জন্য CT করান। চিত্রগুলোতে দেখা যায় যে duodenum-এর তৃতীয় অংশটি aorta-এর ডান পাশে তীব্রভাবে বেঁকে caudally চলেছে এবং aorta-এর anterior দিকে অতিক্রম করেনি। duodenal-jejunal junction এবং jejunum রোগীর ডান পাশে অবস্থিত ছিল। Upper gastrointestinal endoscopy-তে gastric cardia-তে একটি laceration দেখা যায়, এবং Mallory-Weiss syndrome নির্ণয় করা হয়। ৭ দিন পর repeat CT-তে দেখা যায় যে intestinal tract-এর অস্বাভাবিক অবস্থান স্বতঃস্ফূর্তভাবে সেরে গেছে। দুই মাস পর রোগীর আরেকটি haematemesis-এর পর্ব হয়, এবং CT-তে duodenal-jejunal junction ও jejunum তার ডান দিকে পুনরায় সরে যাওয়া দেখা যায়। পূর্ববর্তী পরীক্ষার মতো Upper gastrointestinal endoscopy-তে gastric cardia-তে আরেকটি laceration দেখা যায়। প্রাথমিক CT-তে duodenal-jejunal junction ডান hemi-abdomen-এ দেখা যাওয়ার ভিত্তিতে intestinal malrotation সন্দেহ করা হয়েছিল। তবে, jejunum বারবার ডান দিকে সরে গেলেও স্বতঃস্ফূর্তভাবে স্বাভাবিক হয়ে যাওয়ায়, আমরা ligament of Treitz-এর dysplasia নির্ণয় করি। Laparotomy-তে একটি গঠিত ligament of Treitz পাওয়া যায়; তবে upper jejunum-এ fixation অসম্পূর্ণ ছিল। অতিরিক্তভাবে, CT-তে দেখা যায় যে anterior pararenal space ঢিলেঢালাভাবে fixed এবং mobile ছিল। এই কারণগুলো ছোট অন্ত্রের ডানদিকে deviation ঘটিয়ে থাকতে পারে।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0030_0031.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0030_0031.json
new file mode 100644
index 0000000000000000000000000000000000000000..34785c43df28316bf5bb7858dfa57c9920ddaf42
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0030_0031.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_24.txt",
+    "fulltext": "Patient and observation\nPatient information (presentation of the patient): he is a 28-year-old single man without children, an active military. He has been present for 5 weeks with progressive abdominal pain, more marked in the epigastrium and the right hypochondrium, followed shortly after by a non-quantified fever, chills, profuse sweats in a context of anorexia and weight loss of 6 kg. Note that the patient is not a drinker or smoker, vaccinated with BCG and has no other contributing personal or family history.\n\nClinical findings: On admission, the physical examination found the patient in a general altered state, asthenic with a weight loss of 6 kg in one month. A clinical systemic inflammatory response syndrome was present with the following elements: a fever of 39.1 °C, tachycardia (124 beats/min), polypnea (22 cycles/min). The pulmonary examination and exploration of the superficial lymph node areas were without particularity. In the abdominal area, moderate sensitivity in the right hypochondrium with hepatomegaly was found.\n\nChronology: dates back to February 2022 with the onset of diffuse abdominal pain with diarrhea-constipation transit disorder, all in a context of preservation of general condition with low-grade fever predominantly at night. A syntagmatic treatment was unsuccessfully initiated. The evolution is marked by the persistence of low-grade fever associated with anorexia and progressive weight loss of 12 kg over three months. In the face of this transit disorder with unexplained fever and the deterioration of the general condition, the patient will be admitted to the emergency department for further investigation.\n\nDiagnostic approach: upon admission, a biological infectious syndrome was reported with a neutrophilic predominant hyperleucocytosis (17800 cells/mm3) and a high C-reactive protein of 323 mg/L.\n\nIn the face of his abdominal pain, the lipase and troponin tests were normal at 38 IU/L (VN: <3 78 IU/L) and 4 ng/L (VN: 2 to 16 ng/L) respectively. The liver function was stable with ALT (alanine amino transferase) at 22 IU/L (VN: < 40UI/L), AST (aspartate amino transferase) at 17 IU/L (VN: < 35UI/L), GGT (gamma glutamyl transferase) at 42 IU/L (VN: < 50UI/L), PAL (alkaline phosphatase) at 115 IU/L (VN: 40- 150 IU/L) and normal bilirubinemia. The liver function was normal with a prothrombin rate of 78% and an albuminemia of 39 g/L. The blood ionogram and renal function were normal. The chest radiograph and abdominal ultrasound were without particularity.\n\nWith a procalcitonin positive at 4.1 ng/L, an infectious disease assessment to search for the infectious focus was initiated, including a cytobacteriological examination of urine and blood cultures during the febrile peaks at 39°C, which were both negative. The hepatitis viral B, C and HIV serologies, as well as the syphilis serology performed in hospital were all negative. The lactate dehydrogenase (LDH) and beta-2 microglobulin were normal at 231 IU/L and 2.28 mg/L respectively. The GeneXpert to search for the Mycobacterium on these bioptic pieces was negative. The quantiferon was negative. The search for the Mycobacterium on the morning expectorations of 3 consecutive days was negative.\n\nOn the morphological level, a thoraco-abdomino-pelvic scan showed an enlarged liver (hepatic arrow at 17 cm), the site of multiple, well-defined, rounded hypodensities, which were not enhanced after injection of the contrast agent. The largest lesions were in segment I (21 x 16 mm) and segment V (36 x 27 mm). No suspicious lesions were detected in the thoracic and pelvic levels. The first liver biopsies obtained by echo-guided puncture revealed subacute, fibro-inflammatory liver lesions, with no histological evidence of specificity or malignancy.\n\nA liver MRI following the scan objectified a dysmorphic liver, the site of lesions in heterogeneous signal T2 surrounded by a wall in hyper signal T2, enhanced in the periphery after injection of the contrast agent, the largest of which is located in segment I (20 x 22 mm) and in segment V (33 x 31 mm). No deep lymphadenopathy had been objectified, either in the scan or in the MRI. A diagnostic laparoscopy performed on the hepatic nodules, the histological examination found epithelioid and gigantocellular granulomas of varying size with caseous necrosis in favour of a hepatic tuberculosis.\n\nTherapeutic intervention: the patient was put on anti-tuberculosis treatment according to the standard protocol for months: Phase 1: quadritherapy (Isoniazide + Rifampicine + Pyrazinamide + Ethambutol) in a single oral intake each morning on an empty stomach for 2 months. Phase 2: bithrapia (Isoniazide + Rifampicine) in a single oral intake each morning on an empty stomach for 4 months\n\nFollow-up and results of therapeutic interventions: from the first days of treatment, a good response was obtained with disappearance of the inflammatory syndrome with systemic response both clinically and biologically. After three months of treatment, a control scan of the liver showed a decrease in the number and volume of liver lesions.\n",
+    "summary": "This clinical case was reported in a young Moroccan, presenting a picture of hepatic colic that had been developing for a month, associated with subtle signs of tuberculous infection. Non-specific hepatic nodular lesions were revealed on the scanner and on the hepatic magnetic resonance imaging (MRI). The diagnosis of focal hepatic tuberculosis was confirmed after pathological analysis of hepatic nodule biopsies obtained after a laparoscopy. After the start of well-conducted anti-bacillary treatment, a good clinical-biological improvement was obtained.\n",
+    "translated_fulltext": null,
+    "translated_summary": "Trường hợp lâm sàng này được báo cáo ở một người trẻ tuổi gốc Maroc, với các triệu chứng đau quặn gan kéo dài trong một tháng, kèm theo các dấu hiệu nhẹ của nhiễm trùng lao. Các tổn thương dạng nốt không đặc hiệu ở gan được phát hiện qua hình ảnh quét và hình ảnh cộng hưởng từ (MRI) của gan. Chẩn đoán lao gan khu trú được xác nhận sau khi phân tích bệnh lý các mẫu sinh thiết nốt gan thu được sau phẫu thuật nội soi ổ bụng. Sau khi bắt đầu điều trị kháng vi khuẩn toàn diện, bệnh nhân có dấu hiệu cải thiện đáng kể về mặt lâm sàng và sinh học.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "এই ক্লিনিক্যাল কেসটি একজন তরুণ মরোক্কান রোগীর ক্ষেত্রে রিপোর্ট করা হয়েছিল, যিনি এক মাস ধরে বিকশিত hepatic colic-এর চিত্র নিয়ে উপস্থিত হয়েছিলেন, যা tuberculous infection-এর সূক্ষ্ম লক্ষণের সাথে যুক্ত ছিল. স্ক্যানার এবং hepatic magnetic resonance imaging (MRI)-এ non-specific hepatic nodular lesions প্রকাশ পায়. laparoscopy-র পর প্রাপ্ত hepatic nodule biopsies-এর pathological analysis-এর পর focal hepatic tuberculosis-এর নির্ণয় নিশ্চিত করা হয়েছিল. সুষ্ঠুভাবে পরিচালিত anti-bacillary treatment শুরু করার পর, ভালো clinical-biological উন্নতি পাওয়া যায়."
+  },
+  {
+    "id": "multiclinsum_gs_en_40.txt",
+    "fulltext": "A 12-year-old boy with Down Syndrome and motoric disorders was referred from the Pediatric Department to the Oral Medicine Department of RS Hasan Sadikin Bandung. The patient was diagnosed with Down Syndrome and myeloradiculopathy. The patient’s mother said that the patient was admitted to the hospital because of weakness in both patient’s hands and feet. The patient had a history of falling down about one year ago. The patient’s mother also had a difficulty in cleaning the patient’s oral cavity regularly.\n\nIn the extraoral examination, the patient had a dysmorphic face. The patient also had a cracking and desquamative condition of the vermillion border of the lips. Lymph node examination could not be assessed because the patient wore a cervical collar. The intraoral examination showed an irregular ulcer with 1×0.7 cm in diameter, indurated margin, and white-yellowish base at the right lateral border of the tongue. There was dentinal caries on 63 tooth and also the tooth remnants on 55, 62, 74, and 85 teeth. The upper and lower tooth remnants were suggested to be extracted by pediatric dentist. The space of the extracted teeth will be maintained using a space maintainer. The 55 tooth was sharp and caused an occlusion trauma to the right lateral border of the tongue.\n\nLaboratory examination showed a decrease in sodium value (130 mEq/L) and an increase in lymphocyte value (46%). The MRI examination was performed in the Radiology Department to determine the presence of abnormalities in the cervical spine. The results of the MRI examination showed a dislocation of the patient’s cervical spine. The patient’s mother provided informed consent to publish the patient’s case details and any accompanying images.\n\nBased on the history review, the clinical examination, and appropriate investigation, the patient was diagnosed with a chronic traumatic ulcer mimicking OSCC, exfoliative cheilitis, reversible pulpitis of 63 teeth, and radix gangrene on 55, 62, 74, and 85 teeth. The diagnosis of the chronic ulcer was based on clinical examination. There was an indurated margin in the traumatic lesion, which mimicked Oral Squamous Cell Carcinoma clinically. The patient has been hospitalized for 4 days and was given paracetamol 120 mg/5 mL oral suspension and amoxicillin 125 mg/5 mL oral suspension from the Pediatric Department. The patient also was given sodium chloride 0.9% solution, povidone-iodine mouthwash 1%, and petroleum jelly from the Oral Medicine Department. The patient’s mother was instructed to clean the patient’s oral cavity using gauze soaked in sodium chloride 0.9% solution, compress the ulcer using povidone-iodine mouthwashes 1% three times a day as an antiseptic and anti-inflammatory agent to the oral ulcer, and apply petroleum jelly to moisturize the patient’s lips. The patient was also suggested to extract the 55, 62, 74, and 85 teeth.\n\nIn the second visit (3 days follow-up), oral lesions already showed improvement. In the third visit (1-week follow-up), the size of the oral ulcer at the lateral border of the tongue was getting smaller and the lesion of the lips had some improvement.\n\nIn the fourth visit (10 days follow-up), the size of the oral ulcer at the lateral border of the tongue already had significant improvement. Two days after the fourth visit, the patient underwent neurosurgery. The patient was observed in the Pediatric Intensive Care Unit postoperatively. After two weeks of observation in the Pediatric Intensive Care Unit, the experienced respiratory failure and was declared dead.",
+    "summary": "A 12-year-old boy with Down Syndrome and motoric disorders was referred to Oral Medicine Department. In the extraoral examination, the patient had a dysmorphic face and dry lips. Lymph node examination could not be assessed because the patient wore a cervical collar. The intraoral examination showed an irregular ulcer with 1×0.7 cm in diameter, indurated margin, and white-yellowish base at the right lateral border of the tongue. The 55 teeth were sharp and caused an occlusion trauma to the right lateral border of the tongue. The patient was diagnosed with a chronic traumatic ulcer mimicking OSCC based on clinical examination. The medication given to the patient were sodium chloride 0.9%, povidone-iodine mouthwash 1%, and petroleum jelly.",
+    "translated_fulltext": null,
+    "translated_summary": "Một bé trai 12 tuổi mắc hội chứng Down và các rối loạn vận động đã được chuyển đến Khoa Y học Răng miệng. Trong quá trình khám ngoài miệng, bệnh nhân có khuôn mặt biến dạng và môi khô. Việc kiểm tra các hạch bạch huyết không thể thực hiện được vì bệnh nhân đang đeo vòng cổ. Trong quá trình khám trong miệng, phát hiện một vết loét không đều, có đường kính 1 × 0,7 cm, bờ sần sùi và nền màu trắng vàng ở bờ bên phải của lưỡi. Răng số 55 sắc nhọn và gây chấn thương cho bờ bên phải của lưỡi. Dựa trên kết quả khám lâm sàng, bệnh nhân được chẩn đoán mắc chứng loét do chấn thương mãn tính, có biểu hiện tương tự như ung thư biểu mô tế bào vảy miệng (OSCC). Các loại thuốc được kê đơn cho bệnh nhân bao gồm dung dịch natri clorua 0,9%, nước súc miệng povidone-iodine 1% và vaseline.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "Down Syndrome এবং মোটরিক ডিসঅর্ডারসহ ১২ বছর বয়সী এক ছেলে ওরাল মেডিসিন বিভাগে রেফার করা হয়েছিল. এক্সট্রাঅরাল পরীক্ষায় রোগীর ডিসমর্ফিক মুখাকৃতি এবং শুকনো ঠোঁট ছিল. রোগী একটি cervical collar পরেছিলেন বলে lymph node পরীক্ষা মূল্যায়ন করা যায়নি. ইনট্রাঅরাল পরীক্ষায় জিহ্বার ডান পার্শ্বীয় প্রান্তে ১×০.৭ সেমি ব্যাসের, indurated margin-যুক্ত এবং সাদা-হলদেটে বেসসহ একটি অনিয়মিত আলসার দেখা যায়. ৫৫ নম্বর দাঁতগুলো ধারালো ছিল এবং জিহ্বার ডান পার্শ্বীয় প্রান্তে occlusion trauma সৃষ্টি করেছিল. ক্লিনিক্যাল পরীক্ষার ভিত্তিতে রোগীর OSCC-কে অনুকরণকারী chronic traumatic ulcer নির্ণয় করা হয়েছিল. ওষুধ হিসেবে রোগীকে sodium chloride 0.9%, povidone-iodine mouthwash 1%, এবং petroleum jelly দেওয়া হয়েছিল."
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0036_0037.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0036_0037.json
new file mode 100644
index 0000000000000000000000000000000000000000..e7b5548fca93c4f0c8a51b70ca5f8440b67b2cc4
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0036_0037.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_133.txt",
+    "fulltext": "Male patient, 25 years old, Sundanese, presented at the Dental Hospital of the Faculty of Dentistry Universitas Padjadjaran with the chief complaint of mouth sores, which are painful on the upper and lower lips and exacerbated when eating and talking. Initially, four days ago, canker sores started in the oral cavity, then appeared on the lips two days later. The patient tried to self-medicate by applying petroleum jelly which he used to relieve his symptoms, but it did not improve. The patient replaced the drug with triamcinolone acetonide 0.1% in orabase ointment purchased at the pharmacy and applied it once a day. Canker sores were getting better but did not cure.\n\nThe patient had history a of fever for about a week before the canker sores appeared and there were no lesions on other parts of the body. He stated that the workload was quite heavy and he had not consumed a balanced nutritional diet for about one and a half months. He had no medical history, history of food allergies, or history of taking medication. He had no history of alcohol consumption or smoking, but he had a frequent habit of licking his lips. He also had a history of chickenpox when he was a child.\n\nThe patient had no fever with all vital signs within normal limits on general examination. Extra-oral examination showed no abnormalities in the lymph nodes. There were serosanguineous crusts that felt painful and bleed easily on the lips. Intra-oral examination revealed erythematous lesions, irregular in shape, and had diffuse borders, accompanied by pain in the upper and lower labial mucosa. Hyperkeratotic white plaque that could not be scraped off, irregular in shape, has diffuse borders, without pain in the region of tooth 38 left buccal mucosa. Yellowish-white plaques were seen on 1/3 of the posterior surface of the dorsal tongue, which could be scraped off without leaving an erythematous area, and there were indentations in the form of dental impressions without pain on the lateral right and left sides of the tongue. A painless hard nodule about 2×1 x 0.5 cm in size was seen in the midline of the hard palate. Several teeth were found in caries, radix, and edentulous conditions in all regions. The oral hygiene was poor.\n\nExamination of psychological conditions was evaluated using the DASS-21 questionnaire and showed normal depression level (score 0), normal anxiety level (score 6), and normal stress level (score 6). Based on history and clinical examination, the working diagnosis was suspected HAEM, accompanied by the coated tongue, frictional keratosis, crenated tongue, torus palatinus, reversible pulpitis of tooth 18, irreversible pulpitis of tooth 47, chronic apical periodontitis et causa radix of tooth 15, and edentulous teeth 28, 37, 36, and 46. The differential diagnosis of suspected HAEM lesions on the lips was exfoliative cheilitis. However, exfoliative cheilitis did not have herpes virus involvement. The patient was indicated for serological testing (IgG anti-HSV-1) to confirm the diagnosis. Oral health-related quality of life was measured, and the results of the OHIP-14 examination at the first visit were 35 (moderate OHRQol).\n\nThe non-pharmacological therapy included instruction to maintain oral hygiene by brushing the teeth and tongue using a soft-bristled toothbrush two times a day and using non-detergent toothpaste. Education was given such as increasing the intake of water by at least two liters per day, consuming a balanced nutritional diet, avoiding acidic, spicy, hard, and monosodium glutamate-containing foods, and stopping the bad habit of licking and peeling the skin of the lips. The pharmacological therapy included topical and systemic medications. The topical medications included instructions to compress the lips with gauze moistened with 0.9% NaCl solution at least three times a day and to apply a thin layer of triamcinolone acetonide 0.1% in orabase to the lips three times a day. The systemic medications included instruction to take a multivitamin once a day.\n\nThe progress of improvement was visible in the first follow-up, two days after the initial visit. The pain in the lips was reduced, but the canker sores have not healed. Extra-oral examination revealed serosanguinous crusts on the lips which were still painful and bled easily. The serological test result (IgG anti-HSV-1) was positive with a ratio of: 6.32 (positive: ratio > 1.1). The definitive diagnosis was established based on the history, clinical examination, and serological tests as HAEM. The non-pharmacological and pharmacological therapy was continued, and systemic medication was added in the form of instructions to consume acyclovir 200 mg tablets five times a day for one week.\n\nSignificant improvement was visible in the second follow-up, five days after the previous visit, showing excellent healing in all of the patient’s oral lesions. The OHIP-14 result at the last visit was 4 (good OHRQoL). The patient’s physical, psychological, and social conditions showed improvement and returned to normal after 7 days of treatment. Patient was referred to continue dental and oral care in the periodontics, dental conservation, oral surgery, and prosthodontics departments. The patient has approved and written informed consent for the case details to be published included publication of the images, and the institution has also approved for publication. This case had complied with the Declaration of Helsinki.",
+    "summary": "A 25-year-old male patient came to the Department of Oral Medicine with the chief complaint of painful canker sores on the lips. Extra-oral examination revealed serosanguineous crusts on the lips that were painful and easily bleed. Intra-oral examination showed diffused and painful irregular erythematous lesions on the upper and lower labial mucosa. The anti-HSV1 IgG test was positive. The patient was diagnosed with HAEM.\n\nCase management: Pharmacological therapy included triamcinolone acetonide 0.1% in orabase, acyclovir tablets, multivitamins, and 0.9% NaCl. Non-pharmacological therapy included advice on maintaining good oral hygiene, avoiding spicy and sour foods, and breaking the bad habit of licking the lips.",
+    "translated_fulltext": null,
+    "translated_summary": "Một bệnh nhân nam 25 tuổi đến khoa Răng miệng với triệu chứng chính là bị loét miệng đau ở môi. Khám bên ngoài cho thấy có các mảng đóng vảy chứa dịch và máu trên môi, gây đau và dễ chảy máu. Khám bên trong miệng cho thấy các tổn thương đỏ, không đều, lan rộng và gây đau ở niêm mạc môi trên và môi dưới. Xét nghiệm kháng thể IgG chống lại virus Herpes simplex loại 1 (HSV1) cho kết quả dương tính. Bệnh nhân được chẩn đoán mắc bệnh viêm loét miệng do virus Herpes.\n\nPhương pháp điều trị: Điều trị bằng thuốc bao gồm bôi kem triamcinolone acetonide 0,1% trong orabase, uống thuốc acyclovir, bổ sung vitamin và súc miệng bằng dung dịch NaCl 0,9%. Các biện pháp không dùng thuốc bao gồm tư vấn về việc duy trì vệ sinh răng miệng tốt, tránh các loại thực phẩm cay và chua, và từ bỏ thói quen xấu là liếm môi.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "২৫ বছর বয়সী এক পুরুষ রোগী ঠোঁটে ব্যথাযুক্ত canker sores-এর প্রধান অভিযোগ নিয়ে Department of Oral Medicine-এ আসেন. Extra-oral examination-এ ঠোঁটে ব্যথাযুক্ত এবং সহজে রক্তপাত হয় এমন serosanguineous crusts দেখা যায়. Intra-oral examination-এ ওপরের ও নিচের labial mucosa-তে বিস্তৃত, ব্যথাযুক্ত, অনিয়মিত erythematous lesions দেখা যায়. anti-HSV1 IgG পরীক্ষা পজিটিভ ছিল. রোগীকে HAEM হিসেবে নির্ণয় করা হয়.\n\nCase management: Pharmacological therapy-তে triamcinolone acetonide 0.1% in orabase, acyclovir tablets, multivitamins, এবং 0.9% NaCl অন্তর্ভুক্ত ছিল. Non-pharmacological therapy-তে ভালো মৌখিক স্বাস্থ্যবিধি বজায় রাখা, ঝাল ও টক খাবার এড়ানো, এবং ঠোঁট চাটার খারাপ অভ্যাস ত্যাগ করার পরামর্শ অন্তর্ভুক্ত ছিল."
+  },
+  {
+    "id": "multiclinsum_gs_en_83.txt",
+    "fulltext": "A 29-year-old woman, Para 1, with abnormal vaginal bleeding of one-month duration presented to the gynecology outpatient department of a level 2 hospital. She was HIV positive, commenced on antiretroviral treatment following diagnosis, but had defaulted the antiretroviral treatment for one month when she became ill with vaginal bleeding, resulting in virological and immunological failures (viral load 37400 copies/mL and CD4 count 26 cells/μL). Of note, it was unclear when the patient first started showing HIV symptoms. However, she was diagnosed with HIV about a year prior to presentation. Physical examination revealed a large mass on the cervix measuring 8 × 8 cm extending to the parametrium and to the pelvic side walls bilaterally. There was bleeding on contact and foul-smelling vaginal discharge. Ultrasonography detected a bulky cervix and bilateral hydronephrosis. The patient was clinically diagnosed with cervical malignancy stage 3B. She was recommenced on antiretroviral therapy with a treatment change from TLD (Tenofovir-Lamivudine-Dolutegravir combination) to a preferable renal friendly regimen (Lamivudine-Abacavir-Dolutegravir combination). A punch biopsy of the cervix was performed, and the histopathological report revealed the diagnosis of an extra-nodal BL. The immunohistochemical and in situ hybridization confirmed the diagnosis, with CD20, CD75a, CD10, PAX5 and Bcl-6 positive. In addition, the CD44 and c-Myc were positive, with the EBER-ISH demonstrating focal positivity. The Ki67 demonstrated a proliferation index of almost 100% and PAX5 moderately positive BCL6. She had white cell count of 2.67 x109/L, haemoglobin of 5.7g/dl and platelet count of 71 × 109/L. Results of other investigations were serum creatinine 187 mmol/L, urea 11.1 mmol/l, albumin 21 g/l, aspartate transaminase 41 U/l and alkaline phosphatase 100 U/l.\n\nFollowing histological confirmation of the diagnosis and review at an oncology multidisciplinary meeting, she spent 43 days waiting to start treatment at oncology unit. The delay was due to long waiting list. This delay exceeded the 48 hours waiting period during which oncological treatment for BL should commence following diagnosis. The treatment plan was chemo-radiation therapy, and the patient gave written informed consent for the case to be published. However, she demised in the gynaecological ward on the 43rd day while waiting to start the treatment. During the 43 days, further imaging could not be performed due to poor functionality of the available CT and MRI machines. In addition to antiretroviral therapy, the patient received other supportive care such as blood transfusion and analgesia. Again, the number of days between the diagnosis of the BL and her death was 43 days. Histopathological postmortem was not performed as the diagnoses (BL and retroviral disease) were known. We reckon that the main primary cause of death is challenging to assign because of the multiple principal diagnoses. Because BL has rapid progression and high mortality rate in persons living with HIV particularly with high viral load, the attending physician certifying the death assigned BL as the most likely cause of death. However, the secondary cause of death was multiple organ failure (renal and haematological inclusive).",
+    "summary": "The patient was a 29-year-old woman, Para 1, with abnormal vaginal bleeding for a month and living with HIV and had a CD4 of 26 cells/μL. The histological examination of the cervical biopsy confirmed an extra-nodal BL. She had International Federation of Gynecology and Obstetrics (FIGO) stage 3B cervical cancer based on presence of hydronephrosis and pelvic wall involvement. The patient was reviewed at the oncology multidisciplinary meeting and required chemoradiation. There was delay in her management due to a long waiting list for chemoradiation at oncology unit in the referral center and the patient demised 43 days after diagnosis and did not receive the treatment.",
+    "translated_fulltext": null,
+    "translated_summary": "Bệnh nhân là một phụ nữ 29 tuổi, đã từng mang thai một lần, bị chảy máu âm đạo bất thường trong một tháng, nhiễm HIV và có số lượng tế bào CD4 là 26 tế bào/μL. Kết quả xét nghiệm mô học của mẫu sinh thiết cổ tử cung xác nhận có khối u lympho ngoài hạch. Dựa trên sự hiện diện của thủy niệu quản và sự xâm lấn thành chậu, bệnh nhân được chẩn đoán mắc bệnh ung thư cổ tử cung giai đoạn 3B theo phân loại của Liên đoàn Phụ khoa và Sản khoa Quốc tế (FIGO). Bệnh nhân đã được thảo luận trong cuộc họp đa ngành về ung thư và cần được điều trị bằng hóa trị kết hợp xạ trị. Việc điều trị của bệnh nhân bị trì hoãn do thời gian chờ đợi kéo dài để được hóa trị kết hợp xạ trị tại khoa ung thư của trung tâm điều trị. Bệnh nhân đã qua đời sau 43 ngày kể từ khi được chẩn đoán và không được điều trị.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "রোগীটি ২৯ বছর বয়সী এক নারী, Para 1, যার এক মাস ধরে অস্বাভাবিক যোনি রক্তক্ষরণ ছিল, তিনি HIV নিয়ে বসবাস করছিলেন এবং তার CD4 ছিল ২৬ cells/μL. সার্ভিক্যাল বায়োপসির হিস্টোলজিক্যাল পরীক্ষায় একটি extra-nodal BL নিশ্চিত হয়েছিল. hydronephrosis এবং pelvic wall involvement থাকার ভিত্তিতে তার International Federation of Gynecology and Obstetrics (FIGO) stage 3B cervical cancer ছিল. রোগীটিকে oncology multidisciplinary meeting-এ মূল্যায়ন করা হয়েছিল এবং তার chemoradiation প্রয়োজন ছিল. রেফারাল সেন্টারের oncology unit-এ chemoradiation-এর দীর্ঘ waiting list থাকায় তার চিকিৎসা ব্যবস্থাপনায় বিলম্ব হয়েছিল এবং রোগীটি নির্ণয়ের ৪৩ দিন পর মৃত্যুবরণ করেন এবং চিকিৎসা পাননি."
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0042_0043.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0042_0043.json
new file mode 100644
index 0000000000000000000000000000000000000000..2f3cbf2b7065cf44a0a46d678bc551c31f47bcae
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0042_0043.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_90.txt",
+    "fulltext": "52-year-old male patient with no medical history, transferred from a lower-level hospital to our institution due to a tonic-clonic seizure secondary to alcohol withdrawal and non-reduced right LFGHP. He was evaluated by a traumatologist 24 hours after admission, and was found to be conscious, with bilateral ecchymosis of the shoulders and severe limitation of passive external rotation on both sides. In addition, the patient was restrained physically at this point, with both feet and his left hand held down by intermittent psychomotor agitation.\n\nThe initial evaluation included a thorough review of the patient's admission radiographs, which showed a right LFGHP and a left simple posterior dislocation. This second injury (simple posterior dislocation of the left shoulder) was not diagnosed at the referring facility, and took approximately 48 hours to be diagnosed at our facility.\n\nComputed tomography (CT) of both shoulders was requested to better characterize the injuries. These images showed a marked worsening of the left shoulder injury since the time of the first radiographic study, possibly secondary to the physical restraint of the patient. This evidence of progression from a simple left posterior glenohumeral dislocation on admission radiographs to a LFGHP on the CT taken 48 hours later.\n\n\nPlanning\n\nThe preoperative study of the right shoulder showed bone indemnity of the glenoid and 40% involvement of the articular surface of the humerus, but with a large fragment with the possibility of osteosynthesis in continuity with the lesser tuberosity, so it was planned to fix this fragment by spongeous screw 4.0 mm partial thread and high strength sutures. In the left shoulder, no significant bone defect was evidenced in the glenoid and the defect of the articular surface of the humerus was 20%, so it was planned to fill the defect with the fragment of the lesser tuberosity at the time of osteosynthesis (imitating the surgery of McLaughlin).\n\n\nSurgical technique\n\nOpen reduction and internal fixation with bilateral locked-plate is decided. The patient is placed in a beach chair position and the surgical fields are prepared in the usual way for the right shoulder. The fracture focus is accessed by a classic deltopectoral approach. A digital maneuver is performed to reduce the posterior fragment of the humeral head with a posterior mini-open incision of the size of a standard diagnostic arthroscopy portal. A provisional reduction of the fracture is achieved using high-strength sutures and needles. A partial 4.0 mm spongy screw and high-strength sutures are used to fix both fragments of the humeral head. Definitive fixation of the fracture with a Philos (Depuy Synthes®) plate achieves adequate reduction and stability of fragments. Fixation is increased with high-strength sutures to the tendons of the rotator cuff that are tied to the plate. Closure by planes of the right shoulder, healing and immobilization of the extremity with a universal shoulder immobilizer.\nThe surgical field of the left shoulder is immediately prepared. Classic deltopectoral approach is performed again to reach the fracture focus using an accessory posterior portal for digital manipulation and reduction of the humeral head. Fixation and osteosynthesis are performed in the same way as described for the right shoulder with the exception of the spongiosa screw, as the anterior fragment could be adequately fixed only with the use of high strength sutures.\nPostoperative management consisted of the use of bilateral shoulder immobilizer for four weeks. A pendular exercise of flexion-extension of the elbow and exercises of the fist were given to be performed from the second postoperative week to tolerance (according to the level of pain). In the radiographic control of the first month, loss of reduction of the greater left tuberosity was observed. It was decided to perform revision surgery achieving adequate fixation of the fragment with high-strength sutures.\nThe patient is left with a shoulder immobilizer for an additional four weeks on the left shoulder. The self-administered exercise regimen is restarted as described previously from the second postoperative week on a bilateral basis. At the sixth week after the revision surgery, face-to-face kinesiological therapy is initiated twice a week. After 30 sessions of kinesiological rehabilitation, the patient is able to return to work five months after the initial injury.\nFollow-up one year after the initial surgery shows that the patient has recovered strength and mobility in the right shoulder. The left shoulder still has severe limitations in the range of motion, especially in external rotation. At this point, it is decided to perform arthroscopic joint release surgery and remove the osteosynthesis in the left shoulder.\nIn his last check-up two years after the trauma, the patient showed a favorable evolution, consistent with the functional scales evaluated.\n",
+    "summary": "52-year-old male patient, transferred to a high-complexity center for a tonic-clonic convulsion and a right LFGHP. In the initial study with radiographs, a right shoulder injury was confirmed and a simple posterior glenohumeral dislocation of the left shoulder was diagnosed, which had not been previously detected. The study was complemented with a computed tomography (CT) of both shoulders, showing a bilateral LFGHP, which demonstrated intrahospital aggravation of the injury of the left shoulder. An open reduction and osteosynthesis with a bilateral blocked plate was performed in one time. The left shoulder required two reinterventions, one for osteosynthesis failure and another for joint release. Two years after the procedure, the patient was satisfactorily progressing with a 5% on the Quick DASH scale and a score of 72 and 76 on the Constant scale in the left and right shoulder, respectively.\n",
+    "translated_fulltext": null,
+    "translated_summary": "Bệnh nhân nam, 52 tuổi, được chuyển đến một trung tâm chuyên khoa để điều trị tình trạng co giật toàn thân và tổn thương khớp vai phải. Trong quá trình thăm khám ban đầu bằng chụp X-quang, xác nhận có tổn thương vai phải và chẩn đoán trật khớp vai sau đơn giản ở vai trái, tình trạng này trước đó chưa được phát hiện. Quá trình thăm khám được bổ sung bằng chụp cắt lớp vi tính (CT) cả hai vai, cho thấy tổn thương khớp vai phải ở cả hai bên, đồng thời cho thấy tình trạng tổn thương vai trái trở nên nghiêm trọng hơn trong quá trình nằm viện. Bệnh nhân được phẫu thuật mở để cố định và tái tạo xương bằng cách sử dụng tấm cố định hai bên trong một lần phẫu thuật. Vai trái cần phải can thiệp lại hai lần, một lần do cố định xương không thành công và một lần để giải phóng khớp. Hai năm sau phẫu thuật, bệnh nhân có tiến triển tốt, đạt 5% trên thang điểm Quick DASH và điểm số 72 và 76 trên thang điểm Constant ở vai trái và vai phải, tương ứng.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "৫২ বছর বয়সী পুরুষ রোগীকে সার্বিক খিঁচুনি এবং ডান কাঁধের আঘাতের জন্য একটি বিশেষায়িত কেন্দ্রে স্থানান্তর করা হয়। প্রাথমিক এক্স-রে পরীক্ষায় ডান কাঁধের আঘাত নিশ্চিত হয় এবং বাম কাঁধে সরল পশ্চাৎমুখী ডিসলোকেশন নির্ণয় করা হয়, যা পূর্বে সনাক্ত হয়নি। মূল্যায়নটি উভয় কাঁধের computed tomography (CT) দ্বারা সম্পূরক করা হয়, যা উভয় পাশে ডান কাঁধের সন্ধির আঘাত দেখায় এবং একই সঙ্গে হাসপাতালে থাকার সময়ে বাম কাঁধের আঘাতের অবনতি প্রদর্শন করে। রোগীর খোলা অস্ত্রোপচারে হাড় স্থিতিকরণ ও পুনর্গঠন করা হয়, যেখানে একবারের অস্ত্রোপচারে দ্বিপার্শ্বিক প্লেট ব্যবহার করা হয়। বাম কাঁধে দুইবার পুনরায় হস্তক্ষেপ প্রয়োজন হয়, একবার হাড়ের স্থিতিকরণ ব্যর্থ হওয়ার কারণে এবং আরেকবার সন্ধি মুক্ত করার জন্য। অস্ত্রোপচারের দুই বছর পর রোগীর অগ্রগতি ভালো ছিল, Quick DASH স্কেলে ৫% এবং Constant স্কেলে বাম ও ডান কাঁধে যথাক্রমে ৭২ ও ৭৬ স্কোর অর্জিত হয়."
+  },
+  {
+    "id": "multiclinsum_gs_en_439.txt",
+    "fulltext": "A 70-year-old white man was treated for severe symptomatic aortic regurgitation due to healed endocarditis using TAVI from the apical approach. TAVI was performed at that time because he was considered a high-risk surgical patient due to secondary pulmonary hypertension, severely impaired left ventricular function with a left ventricular ejection fraction (LVEF) of 20%, chronic renal failure, and a logistic EuroSCORE I of 24.36%. At the time he was treated by diuretics (torasemide 20 mg once a day), an angiotensin-converting enzyme (ACE) inhibitor (ramipril 5 mg once a day), a ß-blocker (bisoprolol 2.5 mg twice a day), and an aldosterone antagonist (12.5 mg once a day). On admission he had cardiac decompensation and resulting dyspnea (temperature 36.7 °C, pulse 99/minute, blood pressure 109/48 mmHg) but his emotional status and neurological constitution were good. The laboratory results were unremarkable except for: a mild increase in liver enzymes, aspartate aminotransferase (AST) 59 U/l and alanine aminotransferase (ALT) 67 U/l; a known chronic renal insufficiency (creatinine 2.1 mg/dl); and a mild decrease in hemoglobin (Hb) 10.7 g/dl. No urine analysis was done. Due to normal C-reactive protein and normal count of leukocytes no microbiological examination was performed. After interdisciplinary discussion of the case (including a normal coronary angiography that was performed a few days before) and cardiac recompensation, he was initially treated with an implantation of a JenaValve 27 mm self-expandable valve. Despite a good result after implantation with the JenaValve and minimal transvalvular central insufficiency, he presented recurrent cardiac decompensation due to his severely impaired LVEF. His case was discussed again at an interdisciplinary meeting: 4 weeks after TAVI he underwent the implantation of a LVAD system (Thoratec® HeartMate II). His postoperative course was uneventful. He remained asymptomatic for 1 year until the LVAD system showed recurrent significant high flow alarms. Echocardiography examinations during this year showed a continuous increase in transvalvular central insufficiency to the level of a severe regurgitation without any sign for structural alteration of the leaflets of the JenaValve prosthesis. Treatment options were discussed and a new TAVI as valve-in-valve was decided.\n\nThe procedure was performed under general anesthesia using a CoreValve Evolut R 29 mm prosthesis. The prosthesis was implanted without prior valvuloplasty. The flow rate of LVAD was reduced to minimum and pacing with a frequency of 140 beats/minute was applied during placement of the valve prosthesis. Positioning was done with great care using fluoroscopic and transesophageal echocardiography (TEE) guidance with the aim of having the ventricular strut end of the CoreValve Evolut R prosthesis between the ventricular end and the “cusp feelers” of the JenaValve prosthesis. This position was obtained because of JenaValve structure and individual computed tomography analysis of our patient which had shown the ventricular edge of the JenaValve well positioned in left ventricular outflow tract (LVOT). The first positioning was successful with no need for repositioning. After the last fluoroscopic control the CoreValve Evolut R was released successfully in the planned position. Slow rapid pacing was stopped and the LVAD flow was increased and required good hemodynamic under normal LVAD flow. His postoperative course was uneventful and he has shown a very good recovery. A second TEE did not show any change regarding the performance of the valve-in-valve and only marginal residual insufficiency. At 12-month follow-up our patient had no complaints and had a satisfactory capacity in daily life. Echocardiography showed no relevant aortic regurgitation and an increase of LVEF to 33%. At that time the 6-minute walk test was significantly increased to 381 m (compared to 148 m on admission).",
+    "summary": "We report the case of a 70-year-old white man who was treated for severe symptomatic aortic regurgitation using transcatheter aortic valve implantation from the apical approach. Because of recurrent cardiac decompensation 4 weeks after implantation he underwent the implantation of a left ventricular assist device system. A year later echocardiography showed a severe transvalvular central insufficiency. Our heart team decided to choose a valve-in-valve approach while reducing the flow rate of left ventricular assist device to minimum and pacing with a frequency of 140 beats/minute. There was an excellent result and our patient is doing well with no relevant insufficiency of the aortic valve at 12-month follow-up.",
+    "translated_fulltext": null,
+    "translated_summary": "Chúng tôi báo cáo về trường hợp của một bệnh nhân nam da trắng, 70 tuổi, được điều trị suy van động mạch chủ nghiêm trọng có triệu chứng bằng phương pháp cấy ghép van động mạch chủ qua đường ống thông từ đường tiếp cận đỉnh tim. Do tình trạng suy tim tái phát 4 tuần sau khi cấy ghép, bệnh nhân đã được cấy ghép hệ thống hỗ trợ thất trái. Một năm sau, siêu âm tim cho thấy tình trạng hở van động mạch chủ trung tâm nghiêm trọng. Nhóm bác sĩ tim mạch của chúng tôi quyết định chọn phương pháp cấy van trong van, đồng thời giảm lưu lượng của hệ thống hỗ trợ thất trái xuống mức tối thiểu và điều chỉnh nhịp tim ở mức 140 nhịp/phút. Kết quả đạt được rất tốt và bệnh nhân hiện đang hồi phục tốt, không có dấu hiệu hở van động mạch chủ đáng kể trong quá trình theo dõi sau 12 tháng.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা 70 বছর বয়সী এক শ্বেতাঙ্গ পুরুষের একটি কেস রিপোর্ট করছি, যিনি এপিকাল অ্যাপ্রোচের মাধ্যমে transcatheter aortic valve implantation ব্যবহার করে গুরুতর উপসর্গযুক্ত aortic regurgitation-এর চিকিৎসা পেয়েছিলেন. ইমপ্লান্টেশনের 4 সপ্তাহ পর পুনরাবৃত্ত cardiac decompensation-এর কারণে তাঁর একটি left ventricular assist device system ইমপ্লান্ট করা হয়েছিল. এক বছর পরে ইকোকার্ডিওগ্রাফিতে গুরুতর transvalvular central insufficiency দেখা যায়. আমাদের হার্ট টিম একটি valve-in-valve অ্যাপ্রোচ বেছে নেয়, একই সঙ্গে left ventricular assist device-এর ফ্লো রেট ন্যূনতমে নামিয়ে এবং 140 beats/minute ফ্রিকোয়েন্সিতে পেসিং করে. ফলাফল অত্যন্ত ভালো ছিল এবং 12-মাসের ফলো-আপে aortic valve-এর কোনো উল্লেখযোগ্য insufficiency ছাড়াই আমাদের রোগী ভালো আছেন."
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0046_0047.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0046_0047.json
new file mode 100644
index 0000000000000000000000000000000000000000..d73317a3e0856c416043c9d6944e3c5f63143b19
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0046_0047.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_539.txt",
+    "fulltext": "46-year-old Haitian male, residing in Chile for one year. In Haiti he was a livestock farmer. He presented a one-and-a-half-year history of a lesion that began as a papule on the anterior aspect of the right leg, which increased in size progressively. Initially asymptomatic, three months prior to the consultation he developed pruritus, pain, superficial ulceration and yellowish discharge. On physical examination, the patient was found to be of phototype V, with 1 x 1 cm, 2 x 2 cm and 3 x 2 cm warty plaques on the anterior aspect of the right leg. A dermatoscopy revealed a hyperkeratotic mass with ulcerated center, with reddish-black dots and congested hemorrhagic vessels. The general laboratory was normal; VDRL, HIV and PPD were non-reactive. Tissue samples were taken by a punch biopsy, including epidermis, dermis and subcutaneous tissue, and stained with Gram, routine bacteriological culture and anaerobic culture, which were negative. Bacilloscopy and Koch culture of the same tissue were also negative. The histopathological study was performed with hematoxylin and eosin stain, and showed a pseudoepitheliomatous epidermis with irregular hyperplasia, a dermis with abundant mixed inflammatory infiltrate with suppurative foci and giant cells of the foreign body type, some of which contained round cells with a thick brown wall, compatible with muriform cells; these cells were more evident when evaluated with PAS stain. Fungal culture was performed on Sabouraud dextrose agar at 25°C, which showed, after 15 days of incubation, the growth of black or dematiaceous, elevated, well-defined, velvety colonies. Direct microscopic examination with 20% KOH showed long, branched, sometimes tortuous, hyphae, and short chains of acropetal conidia, suggestive of Fonsecaea spp. Itraconazole was administered at 100 mg every 12 h for six months, in association with physical measures, which consisted of cryotherapy (liquid nitrogen) application to hypertrophic areas every six to eight weeks. Due to local complications, such as erosion or ulceration of the lesions, frequent healing was performed with application of mupirocin ointment topically for signs of bacterial superinfection.\n\nThe patient had a favorable evolution, with regression of the lesions and no evidence of relapses to date, remaining with a mild local hypopigmentation, expected in areas of treatment with cryotherapy.\n",
+    "summary": "A 46-year-old Haitian man, residing in Chile, presented with warty plaques in the anterior tibial region that had been present for one year. The diagnosis of chromoblastomycosis was confirmed by the presence of muriform cells in the histopathology and dematiaceous colonies in the mycological culture. In addition, conidia compatible with Fonsecaea spp. were observed in direct microscopy. After six months of treatment with systemic antimycotics and cryotherapy, complete remission of the lesions was achieved.\n",
+    "translated_fulltext": null,
+    "translated_summary": "Một người đàn ông Haiti 46 tuổi, hiện đang sinh sống ở Chile, đến khám với các mảng da sần sùi ở vùng cẳng chân trước, tình trạng này đã kéo dài một năm. Chẩn đoán bệnh nấm sắc tố da (chromoblastomycosis) được xác nhận thông qua việc phát hiện các tế bào hình thành vách ngăn trong kết quả phân tích mô bệnh học và các khuẩn lạc màu đen trong kết quả nuôi cấy nấm. Ngoài ra, các bào tử nấm có đặc điểm tương đồng với loài Fonsecaea spp. cũng được quan sát trong quá trình soi tươi. Sau sáu tháng điều trị bằng thuốc kháng nấm toàn thân và liệu pháp lạnh, các tổn thương đã hoàn toàn thuyên giảm.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "চিলিতে বসবাসকারী 46 বছর বয়সী একজন হাইতিয়ান পুরুষ এক বছর ধরে থাকা অ্যান্টেরিয়র টিবিয়াল অঞ্চলের ওয়ার্টি প্লাক নিয়ে উপস্থিত হন। হিস্টোপ্যাথোলজিতে muriform cells এবং মাইকোলজিক্যাল কালচারে dematiaceous colonies-এর উপস্থিতির মাধ্যমে chromoblastomycosis-এর রোগনির্ণয় নিশ্চিত করা হয়। এছাড়াও, ডাইরেক্ট মাইক্রোস্কোপিতে Fonsecaea spp.-এর সঙ্গে সামঞ্জস্যপূর্ণ conidia পর্যবেক্ষণ করা হয়। সিস্টেমিক অ্যান্টিমাইকোটিকস এবং ক্রাইথেরাপি দিয়ে ছয় মাস চিকিৎসার পর ক্ষতগুলির সম্পূর্ণ রিমিশন অর্জিত হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_285.txt",
+    "fulltext": "Patient information: A 19-year-old male with no significant medical history was admitted to our department with a painful left scrotal mass that had been present for 8 months and had not improved with antibiotics for pyogenic organisms. The patient reported intermittent low grade fever, night sweats, anorexia and unexplained weight loss since the onset of symptoms. He did not have a cough, sputum or haemoptysis. There was no history of tuberculosis in his personal or family medical history. He was vaccinated against tuberculosis at birth.\n\nClinical findings: Physical examination revealed a large, painful, slightly hot left bursa and two elongated, poorly defined, firm, painful subcutaneous formations in the anterior thoracic wall, 3 to 4 cm long. There were no rales on auscultation. The remainder of the examination was normal. Laboratory studies revealed a high c-reactive protein of 90 mg/dl. The blood count, creatinine, blood glucose and liver function tests were within normal limits. The standard chest X-ray showed reticulonodular infiltrates in both lung fields.\n\nDiagnostic approach: In the presence of an ultrasound finding in favour of an epididymal tumour, the patient underwent a left orchidectomy. However, the pathological examination of the surgical specimen showed a granulomatous epitheloid necrosis of the epididymis, suggestive of active epididymal tuberculosis involving the body and tail of the epididymis and sparing the head and testicle. The intradermal tuberculin reaction was positive. The search for acid-fast bacilli (AFB) in sputum and urine for 3 consecutive days was negative on direct examination and culture. The serologies for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and Wright's stain were also negative. In search of other tuberculous sites, a thoraco-abdomino-pelvic tomodensitometry was performed, which showed a miliary tuberculosis, coelo-mesenteric necrotic adenopathies, two thoracic parietal collections (at the expense of the external oblique muscles measuring 33 × 10 mm on the right and 45 × 10 mm on the left) and a focal osteolysis of D11 and L5, suggestive of a spondylodiscitis in the early stages. The magnetic resonance imaging (MRI) of the spinal cord confirmed the existence of a spondylodiscitis at the level of D7, D11, L4 and L5. The diagnosis of disseminated tuberculosis with epididymal, pulmonary, parietal, ganglionary and osteo-articular sites was retained.\n\nTherapeutic intervention: a poly-chemotherapy for tuberculosis with isoniazid, rifampicin, ethambutol and pyrazinamide for 2 months, followed by the association of isoniazid and rifampicin, was initiated.\n\nFollow-up and results: however, at the 4th month of treatment, the patient had presented generalised tonic-clonic convulsive seizures. A brain MRI was performed, showing multiple nodular lesions above and below the tentorial membrane corresponding to tuberculomas. The patient was put on anticonvulsive treatment and anti-tuberculosis treatment was continued. The evolution was favourable with recovery of the general condition and weight gain from the first months of treatment as well as a disappearance of thoracic parietal formations, adenopathies and tuberculous milia on the tomodensitometry with absence of recurrence of convulsive seizures. However, the slow decrease of the size of the tuberculomas obliged us to continue the anti-tuberculosis treatment for a long period. Finally, the patient was declared cured, without sequelae, at the end of the 234th month of treatment with a 2-year follow-up.\n",
+    "summary": "A 19-year-old man with no significant history was admitted to hospital with a painful left scrotal mass that had been present for 8 months. He had undergone an orchidectomy and the pathological examination was in favour of epididymal tuberculosis. A radiological examination had shown other sites of infection: lymph nodes, lungs, parietal and osteoarticular. An anti-tuberculosis treatment was initiated. However, in the 4th month of treatment, the patient had convulsive seizures. A brain MRI was performed and concluded that there were brain tuberculomas. The anti-tuberculosis treatment was continued in association with an anticonvulsant with good clinical and radiological evolution.\n",
+    "translated_fulltext": null,
+    "translated_summary": "Một người đàn ông 19 tuổi, không có tiền sử bệnh lý đáng kể, đã nhập viện vì một khối u đau ở tinh hoàn trái, kéo dài trong 8 tháng. Anh ta đã trải qua phẫu thuật cắt bỏ tinh hoàn và kết quả kiểm tra bệnh lý cho thấy có dấu hiệu của bệnh lao mào tinh hoàn. Chụp chiếu cho thấy các vị trí nhiễm trùng khác: hạch bạch huyết, phổi, màng xương và khớp. Việc điều trị bằng thuốc chống lao đã được bắt đầu. Tuy nhiên, trong tháng thứ 4 của quá trình điều trị, bệnh nhân bị co giật. Chụp cộng hưởng từ (MRI) não được thực hiện và kết quả cho thấy có các khối u lao ở não. Việc điều trị bằng thuốc chống lao được tiếp tục kết hợp với thuốc chống co giật, và tình trạng bệnh nhân có tiến triển tốt về mặt lâm sàng và trên phim chụp.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "১৯ বছর বয়সী এক পুরুষ, যার উল্লেখযোগ্য পূর্ব ইতিহাস ছিল না, বাম স্ক্রোটামে ৮ মাস ধরে থাকা বেদনাদায়ক একটি পিণ্ড নিয়ে হাসপাতালে ভর্তি হয়েছিলেন। তিনি অর্কিডেকটমি করিয়েছিলেন এবং প্যাথোলজিক্যাল পরীক্ষায় এপিডিডাইমাল টিউবারকিউলোসিসের পক্ষে ফলাফল পাওয়া যায়। রেডিওলজিকাল পরীক্ষায় অন্যান্য সংক্রমণস্থল দেখা যায়: লিম্ফ নোড, ফুসফুস, পারিয়েটাল এবং অস্টিওআর্টিকুলার। অ্যান্টি-টিউবারকিউলোসিস চিকিৎসা শুরু করা হয়েছিল। তবে চিকিৎসার চতুর্থ মাসে রোগীর খিঁচুনি হয়েছিল। ব্রেন MRI করা হয় এবং উপসংহার ছিল যে মস্তিষ্কে টিউবারকিউলোমা রয়েছে। অ্যান্টি-টিউবারকিউলোসিস চিকিৎসা একটি anticonvulsant এর সাথে চালিয়ে যাওয়া হয় এবং ক্লিনিক্যাল ও রেডিওলজিকালভাবে ভালো উন্নতি দেখা যায়।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0052_0053.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0052_0053.json
new file mode 100644
index 0000000000000000000000000000000000000000..eca9b9b0f04aa00f6f82eb0c5eafc8ff388f2e2a
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0052_0053.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_324.txt",
+    "fulltext": "2 years 6 months old female pre-schooler with a previous diagnosis of NF1. She consulted due to a 4 week diarrhea with blood streaks (5 to 10 episodes a day). A week after the onset of the diarrhea she consulted the emergency department, where rotavirus (+) was detected, with low inflammatory parameters, negative coproculture and normal abdominal ultrasound. She was hospitalized for 3 days to manage dehydration and was discharged without bleeding, with persistence of semi-liquid stools. 10 days after discharge she presented diarrhea with blood streaks, associated with low intake and weight loss of 1 kg reported by parents. They consulted a pediatric gastroenterologist who requested a polymerase chain reaction (PCR) panel of gastrointestinal pathogens and PCR of Clostridium difficile (which were negative) and indicated hospitalization for study.\n\nOn direct questioning, the parents reported no fever, abdominal pain, vomiting, respiratory or urinary symptoms, arthralgia, or new skin lesions. They did not own pets, and there was no history of travel or recent dietary changes.\n\nThe patient was diagnosed with confirmed NF1 at 8 months of age by genetic testing with the heterozygous pathogenic variant c.5606_5627del (p.Gly1869Valfs*28). She has skin involvement (café con leche spots) and bone involvement. At 18 months she required ankle arthrodesis for tibial curvature. She has no family history of NF1 or inflammatory bowel disease.\n\nOn physical examination, the abdomen was soft and indistinct, with increased air-bubble murmurs, without masses or visceral enlargement. The perianal examination was normal. There were multiple brown-coffee stains on the lower extremities and back. General examinations were performed, including a blood count with moderate microcytic-hypochromic anaemia (Hb 9.6 g/dL), leukocytosis with left shift (leukocytes 13,900), and discretely elevated inflammatory parameters (CRP 1.37 mg/dL, normal value up to 0.5 mg/dL).\n\nA colonoscopy was performed, the rectum, sigmoid and various segments of the colon were examined up to the cecum, visualizing the ileocecal valve and the appendicular orifice. The last few centimeters of the distal ileum were also inspected. The mucosa from the anal margin to the cecum was observed to be erythematous, with loss of vascular transparency, unlike the cecal mucosa, which appeared normal. No lesions were identified in the anal canal or cecum.\n\nBiopsies of the small intestine (ileon) and large intestine were taken. Microscopic examination showed mucosa of ileal type with preserved villous architecture and adequate epithelial differentiation, with a non-inflamed lamina propria. The mucosa of the large intestine had a mild distortion of architecture and adequate epithelial differentiation, a swollen lamina propria with a mild mixed inflammatory infiltrate and hyperplasia of lymphoid follicles. Isolated foci of microabscesses were recognized. The biopsy was consistent with mild colitis, with signs suggesting chronicity.\n\nIn addition, a PCR study for cytomegalovirus (CMV) was requested in a colon biopsy, which was positive.\n\nGiven a positive PCR for CMV, CMV IgG and IgM and CMV viral load in blood were requested, resulting in a positive IgG, negative IgM, and CMV viral load of 79.7 IU/ml. Further laboratory studies included PCR for gastrointestinal pathogens and PCR for Clostridium difficile in stool, both of which were negative. In the colon biopsy, Gram stain microbiological studies were requested, which showed +++ leukocytes without bacteria; biopsy culture showed S. gallolyticus/equinus complex in very low amount (interpreted as bacterial flora); acridine orange, Ziehl-Neelsen, Koch culture, and ADV PCR were negative.\n\nEndoscopy and histology suggestive of UC was reported in the context of a patient with moderate symptoms (PUCAI 50) who was started on Mesalazine (70 mg/kg/day three times daily) and a request for a faecal calprotectin was made which was greater than 600 ug/g.\n\nThe immunology team evaluated the patient for suspected immunodeficiency. The parents did not report a history of infections, they reported that they were vaccinated, that they had good weight gain, no family history of immunodeficiencies, auto-immunity or early deaths. A study with lymphocyte subpopulations (normal), immunoglobulins (normal), HIV (negative), memory T lymphocytes (with alterations expected in the context of CMV viremia) and lymphoproliferation test (normal) was requested. In addition, a genetic panel of primary immunodeficiencies (Invitae) was performed, which contains 429 genes, of which 68 make up the panel of monogenic inflammatory intestinal disease. 7 variants of uncertain significance were obtained, none included in the panel of monogenic IBD.\n\nGanciclovir was initiated intravenous for CMV infection and continued for 15 days. The last PCR CMV control prior to discharge reported undetectable load.\n\nThe patient improved during the hospital stay with decreased frequency of stools and increased consistency, no rectal bleeding, no nocturnal stools and no abdominal pain, with PUCAI 0 at discharge.\n\nTwo months later, he presented with a reactivation of IBD with bloody diarrhea (PUCAI 35). A blood count was performed (normal), a panel of gastrointestinal pathogens was performed (–), PCR for Clostridium difficile was performed (+), and CMV load was undetectable. He was treated with oral metronidazole. However, he persisted with diarrhea with blood streaks, so he was hospitalized again.\n\nA colonoscopy was performed, where erythematous mucous was observed in a diffuse form from the rectum to the cecum, with nodularity and loss of vascular transparency in the submucosa, greater in the left and transverse colon segments. No focal lesions were observed. The mucosa of the ileum and anal canal were observed without lesions.\n\nBiopsy of the terminal ileum, right colon and left colon was performed. Microscopic examination of the ileal-type mucosa showed preserved villous architecture and adequate epithelial differentiation. The lamina propria showed no signs of inflammation. There were no aphthous erosions or granulomas. The mucosa of the large intestine showed mild distortion of architecture and epithelial dedifferentiation. The lamina propria was expanded by mixed inflammatory infiltrate, transmucosal distribution. Foci of cryptitis and cryptitic microabscesses and hyperplasia of reactive lymphoid follicles were recognized. No granulomas, viral or parasitic cytopathic changes were observed. All fragments of the left colon sample presented a similar histopathological picture.\n\nShe was given oral treatment with Vancomycin and Prednisone (1 mg/kg/day) with a good response and a favorable evolution. She was discharged with a decrease in the frequency of bowel movements. She persists with mild symptoms (PUCAI 5) in outpatient control, so the dose of corticosteroids is progressively decreased and she remains on treatment with Mesalazina.\n",
+    "summary": "2.5-year-old pre-schooler with a history of NF1 presenting with bloody diarrhea. On endoscopic examination, the mucosa from the anal margin to the cecum was erythematous with loss of vascular transparency. Colon mucosal biopsies showed signs of chronic inflammation consistent with a diagnosis of ulcerative colitis and CMV infection was diagnosed by PCR.\n",
+    "translated_fulltext": null,
+    "translated_summary": "Một trẻ nhỏ 2,5 tuổi, tiền sử mắc hội chứng NF1, nhập viện vì tiêu chảy ra máu. Trong quá trình nội soi, niêm mạc từ rìa hậu môn đến manh tràng có màu đỏ và mất độ trong của mạch máu. Kết quả sinh thiết niêm mạc đại tràng cho thấy dấu hiệu viêm mãn tính, phù hợp với chẩn đoán viêm loét đại tràng, và nhiễm CMV được chẩn đoán bằng phương pháp PCR.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "NF1-এর ইতিহাসসহ ২.৫ বছর বয়সী একজন প্রি-স্কুলার রক্তমিশ্রিত ডায়রিয়া নিয়ে উপস্থিত হয়েছে। এন্ডোস্কোপিক পরীক্ষায়, anal margin থেকে cecum পর্যন্ত mucosa erythematous ছিল এবং vascular transparency হারিয়ে গিয়েছিল। Colon mucosal biopsies-এ chronic inflammation-এর লক্ষণ দেখা গেছে, যা ulcerative colitis-এর নির্ণয়ের সাথে সঙ্গতিপূর্ণ, এবং CMV infection PCR দ্বারা নির্ণয় করা হয়েছে।"
+  },
+  {
+    "id": "multiclinsum_gs_en_459.txt",
+    "fulltext": "40-year-old HIV-positive man with regular adherence to treatment (viral load 4500/mm3 and CD4 70/mm3 from the previous year), consulted for intermittent fever of two years' evolution that did not respect the standard time and gave way to transient antinflammatory non-steroidal drugs. He added in the last two months diffuse abdominal pain with predominance in the upper right lobe where he acquired a configuration of a tree in bud and bilateral pleural effusion, and at the abdominal level, marked increase of hepato-splenomegaly associated with ascites. After 48 hours of his suspension, he presented fulminant hepatic failure and was transferred to the intensive care unit. Tracheal aspirate was performed and after transfusion support a liver biopsy was obtained by puncture.  The patient died a few hours later. The postmortem culture of the tracheal aspirate was positive for Mycobacterium tuberculosis and the liver biopsy was performed with non-necrotizing granulomas and the rest of the parenchyma preserved. This work was carried out in accordance with the principles laid out in the ethical code of the WHO (Helsinki Declaration).\n",
+    "summary": "We present the case of a 40-year-old HIV-positive man with regular adherence to treatment, who consulted for intermittent febrile episodes of two years' evolution, adding in the last two months progressive diffuse abdominal pain and generalized adenomegaly. In the laboratory, he presented pancytopenia, coagulopathy, hypoalbuminemia and increased acute phase reactants. The computed tomography (CT) of the thorax, abdomen and pelvis only showed hepato-splenomegaly and generalized adenomegaly. Multiple microbiological examinations were performed, including cultures for Mycobacterium sp. of different samples, all with negative results, with the exception of RT-PCR for HHV-8. A left iliac ganglion biopsy was performed with findings consistent with Castleman's disease. Despite restarting antiretroviral therapy, the symptomatology progressed, initiating treatment with corticosteroids and ganciclovir. After a week, he developed multiple organ failure and anasarca, which contraindicated the drugs initiated. A new chest CT was performed that showed infiltrates with a tree-like pattern in the upper right lobe associated with bilateral pleural effusion, and at the abdominal level, progression of hepato-splenomegaly and ascites. He passed to the intensive care unit 48 hours later due to fulminant hepatic failure. The patient died within a few hours. A postmortem culture of the tracheal aspirate was received positive for Mycobacterium tuberculosis and a liver biopsy with non-necrotizing granulomas.\n",
+    "translated_fulltext": "Một người đàn ông 40 tuổi, dương tính với HIV, tuân thủ điều trị đều đặn (tải lượng virus 4500/mm3 và CD4 70/mm3 từ năm trước), đến khám vì sốt không liên tục kéo dài hai năm, không theo một quy luật thời gian nhất định và chỉ thuyên giảm khi dùng thuốc kháng viêm không steroid. Trong hai tháng gần đây, ông còn bị đau bụng lan tỏa, đặc biệt ở vùng bụng trên bên phải, nơi xuất hiện các nốt sần giống như hình cây non và tràn dịch màng phổi hai bên. Ngoài ra, còn có sự gia tăng đáng kể của gan lách to kèm theo cổ trướng. Sau 48 giờ ngừng điều trị, ông bị suy gan cấp và được chuyển đến khoa hồi sức tích cực. Bác sĩ đã hút dịch khí quản và sau khi truyền máu hỗ trợ, tiến hành sinh thiết gan bằng phương pháp chọc hút. Bệnh nhân đã qua đời vài giờ sau đó. Kết quả nuôi cấy dịch khí quản sau khi chết cho thấy có vi khuẩn Mycobacterium tuberculosis. Kết quả sinh thiết gan cho thấy có các hạt u không gây hoại tử và phần mô gan còn lại được bảo tồn. Nghiên cứu này được thực hiện theo các nguyên tắc được quy định trong quy tắc đạo đức của WHO (Tuyên bố Helsinki).",
+    "translated_summary": "Chúng tôi xin trình bày trường hợp của một người đàn ông 40 tuổi, dương tính với HIV, tuân thủ điều trị đều đặn, đến khám vì các đợt sốt ngắt quãng kéo dài hai năm, kèm theo đau bụng lan tỏa ngày càng tăng và tình trạng hạch to toàn thân trong hai tháng gần đây. Các xét nghiệm trong phòng thí nghiệm cho thấy bệnh nhân bị giảm toàn bộ tế bào máu, rối loạn đông máu, giảm albumin máu và tăng các chất phản ứng cấp tính. Chụp cắt lớp vi tính (CT) ngực, bụng và vùng chậu chỉ cho thấy gan lách to và hạch to toàn thân. Nhiều xét nghiệm vi sinh đã được thực hiện, bao gồm nuôi cấy các mẫu khác nhau để tìm Mycobacterium sp., tất cả đều cho kết quả âm tính, ngoại trừ xét nghiệm RT-PCR cho HHV-8. Một mẫu sinh thiết hạch vùng háng trái được thực hiện và kết quả phù hợp với bệnh Castleman. Mặc dù đã bắt đầu lại liệu pháp điều trị bằng thuốc kháng virus, các triệu chứng vẫn tiến triển, và bệnh nhân được điều trị bằng corticosteroid và ganciclovir. Sau một tuần, bệnh nhân bị suy đa tạng và phù toàn thân, khiến việc tiếp tục sử dụng các loại thuốc đã bắt đầu trở nên chống chỉ định. Một lần nữa, chụp CT ngực được thực hiện và cho thấy các đám thâm nhiễm có hình dạng giống như cây ở thùy phải trên, kèm theo tràn dịch màng phổi hai bên, và ở vùng bụng, tình trạng gan lách to và cổ trướng tiến triển. Bệnh nhân được chuyển đến khoa hồi sức tích cực sau 48 giờ vì suy gan cấp tính. Bệnh nhân đã qua đời trong vòng vài giờ. Mẫu nuôi cấy dịch hút khí quản sau khi chết cho kết quả dương tính với Mycobacterium tuberculosis và mẫu sinh thiết gan cho thấy các khối u hạt không gây hoại tử.",
+    "corrected_translated_fulltext": "৪০ বছর বয়সী HIV-ধনাত্মক এক পুরুষ, নিয়মিতভাবে চিকিৎসা মেনে চলছিলেন (গত বছরের viral load 4500/mm3 এবং CD4 70/mm3), তিনি গত দুই বছর ধরে অনিয়মিত জ্বরের জন্য পরামর্শ নিতে আসেন, যা নির্দিষ্ট সময়সূচি মানত না এবং non-steroidal anti-inflammatory drugs দিলে সাময়িকভাবে উপশম হতো। সাম্প্রতিক দুই মাসে, তার বিস্তৃত পেটব্যথা ছিল, বিশেষত ডান উপরের পেটের অংশে, যেখানে tree-in-bud কনফিগারেশন দেখা যায় এবং দুই পাশেই pleural effusion ছিল। এছাড়াও, ascites-সহ hepatosplenomegaly উল্লেখযোগ্যভাবে বৃদ্ধি পেয়েছিল। চিকিৎসা বন্ধের ৪৮ ঘণ্টা পর, তার fulminant hepatic failure হয় এবং তাকে intensive care unit-এ স্থানান্তর করা হয়। ট্র্যাকিয়াল aspirate করা হয় এবং ট্রান্সফিউশন সাপোর্টের পরে পাংচার করে লিভার বায়োপসি নেওয়া হয়। রোগী কয়েক ঘণ্টা পর মারা যান। মৃত্যুর পর ট্র্যাকিয়াল aspirate-এর কালচারে Mycobacterium tuberculosis পজিটিভ পাওয়া যায়। লিভার বায়োপসিতে non-necrotizing granulomas পাওয়া যায় এবং বাকি parenchyma সংরক্ষিত ছিল। এই কাজটি WHO-এর নৈতিক বিধির (Helsinki Declaration) নীতিমালা অনুযায়ী সম্পাদিত হয়েছে।",
+    "corrected_translated_summary": "আমরা ৪০ বছর বয়সী এক HIV-পজিটিভ পুরুষের একটি কেস উপস্থাপন করছি, যিনি নিয়মিত চিকিৎসা মেনে চলছিলেন, যিনি গত দুই বছর ধরে বিরতিযুক্ত জ্বরের পর্বের জন্য পরামর্শ নিতে আসেন; গত দুই মাসে এর সাথে প্রগতিশীল বিস্তৃত পেটের ব্যথা এবং generalized adenomegaly যোগ হয়েছিল। ল্যাবরেটরিতে, তাঁর pancytopenia, coagulopathy, hypoalbuminemia এবং acute phase reactants বৃদ্ধি পাওয়া লক্ষ্য করা হয়। বক্ষ, উদর ও পেলভিসের computed tomography (CT) কেবল hepato-splenomegaly এবং generalized adenomegaly প্রদর্শন করে। বহু মাইক্রোবায়োলজিক্যাল পরীক্ষা করা হয়, যার মধ্যে বিভিন্ন নমুনায় Mycobacterium sp. এর জন্য culture অন্তর্ভুক্ত ছিল, সবগুলোর ফলাফল নেগেটিভ ছিল, কেবল HHV-8-এর RT-PCR ব্যতীত। বাম iliac ganglion বায়োপসি করা হয় এবং ফলাফল Castleman's disease-এর সঙ্গে সামঞ্জস্যপূর্ণ ছিল। antiretroviral therapy পুনরায় শুরু সত্ত্বেও, লক্ষণসমষ্টি অগ্রসর হয়, এবং corticosteroids ও ganciclovir দিয়ে চিকিৎসা শুরু করা হয়। এক সপ্তাহ পর, তাঁর multiple organ failure এবং anasarca হয়, যা শুরু করা ওষুধগুলিকে contraindicated করে তোলে। নতুন করে একটি chest CT করা হয়, যা ডান উপরের লোবে গাছের মতো প্যাটার্নসহ infiltrates দেখায়, যা bilateral pleural effusion-এর সাথে সম্পর্কিত ছিল, এবং উদরের স্তরে hepato-splenomegaly ও ascites-এর অগ্রগতি দেখা যায়। ৪৮ ঘণ্টা পরে fulminant hepatic failure-এর কারণে তাঁকে intensive care unit-এ স্থানান্তর করা হয়। রোগী কয়েক ঘণ্টার মধ্যেই মৃত্যুবরণ করেন। মৃত্যুর পর tracheal aspirate-এর culture Mycobacterium tuberculosis-এর জন্য পজিটিভ আসে এবং liver biopsy-তে non-necrotizing granulomas পাওয়া যায়।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0054_0055.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0054_0055.json
new file mode 100644
index 0000000000000000000000000000000000000000..025b91cb7005445542d74f21686042ba0753cfbf
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0054_0055.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_41.txt",
+    "fulltext": "4-month-old indigenous lactating mother from the rural area of the interior of Panama, from the town of Urracá, 3 hours by canoe from the nearest health center. Her background included being the fourth daughter, born by vaginal delivery at home by a relative, without prenatal controls, her weight, height and Apgar score at birth are unknown. She did not breastfeed and was fed with powdered milk formula with iron for children under 6 months, receiving 3 ounces every 4 hours.\n\nThe nuclear family was composed of 6 people (parents and 4 children) who lived in a house with walls and floor of boards and palm roof, 2 rooms, without electricity, they were illuminated with kerosene lamps, water from a well, excreta in a river and they burned the garbage, their economic income came from subsistence agriculture.\n\nHe had no health care in his first 4 months of life and did not receive the vaccinations included in the national expanded programme of immunizations. According to his parents, his neurodevelopment was normal until his hospitalization.\n\nThe minor consulted in a health center with a history of 4 days of diarrhoea, without mucus or blood associated with vomiting of food content (the mother gave her tea because she could not tolerate milk), afebrile and without respiratory symptoms. Oral fluids and 4 doses of Enterogermina® (B. clausii: two billion spores/5 mL) were administered. Due to the lack of supplies (they did not have catheters, or intraosseous for the administration of intravenous fluids) she was transferred to a second-level hospital in the provincial capital and then to our institution in Panama City with a diagnosis of acute gastroenteritis and severe dehydration.\n\nHe presented to the emergency department with a consciousness compromise, dehydration characterised by a tearless cry, dry oral mucosa. He had oedema of +++ hands, feet, abdomen and face. He was afebrile and had signs of shock, capillary refill time > 2 seconds, cold extremities, filiform pulse and marble skin, heart rate 170 bpm, respiratory rate 55 bpm, blood pressure 91/37 mmHg, oxygen saturation 99%. He weighed 4.7 kg and was 56 cm tall at admission, Z-score height/age -2.52, weight/height and weight/age Z-scores were not quantifiable due to severe dehydration. On segmental examination, there were fine crepitus in both lung bases and erythematous-squamous lesions with desquamation of skin and others with hypopigmentation of trunk and upper limbs (interpreted as pellagroid dermatosis).\n\nLactate Ringer bolus was given at 10 ml/kg in the emergency department, followed by 5% Dextrose in 0.33% Saline 500 ml at an infusion rate of 29 ml/h over 6 hours without KCL until diuresis was obtained. She was started on Ceftriaxone 50 mg/kg/day for suspected sepsis, stabilised and sent to the ward where she continued to receive 500 ml of 5% Dextrose in 0.9% Saline at 20 ml/hr.\n\nAmong the examinations, a blood count revealed leukocytosis at 39.0 x 103/uL, severe anaemia 5.6 g/dL, thrombocytosis 502 x 103/uL, the rest of the results are detailed in. He was transfused with 50 ml of filtered and leuko-reduced red blood cells and 40 cc of fresh frozen plasma due to altered coagulation times. Enteral feeding was initiated by nasogastric tube and infusion was decreased to 15 ml/h of 5% Dextrose in 0.9% Saline 500 cc, and continued with negative water balance.\n\nOn day 2, initial peripheral blood culture was reported as Gram positive cocci in clusters, Oxacillin was added at 200 mg/kg/day, Ceftriaxone was increased to 75-100 mg/kg/day, total fluids to 120 ml/kg/day and calcium was corrected (value received 6.38 mg/dL).\n\nOn her 3rd day she lost venous access, so a central venous catheter (CVC) was placed. She was hypovolemic with subhydrated oral mucosa, increased respiratory work, cold extremities and capillary refill time of 3-4 seconds. Ringer's lactate was given at a load of 20 ml/kg in one hour. Arterial blood gas revealed uncompensated metabolic acidosis with pH 7.26, HCO3 13 mmol/L, PCO2 28.4 mmHg, PO2 39.2 mmHg, lactate 2.8 mmol/L. She was intubated and transferred to the paediatric intensive care unit (PICU) where she was placed on mechanical ventilation.\n\nTotal fluids of 100 cc/kg, infused epinephrine, low-salt albumin, and 10% calcium gluconate were administered, and fentanyl was changed to remifentanil due to elevated liver enzymes.\n\nThe blood culture of admission reported growth of methicillin-resistant Staphylococcus aureus (MRSA), Oxacillin was omitted and Clindamycin was added at 40 mg/kg/day; the blood culture of admission on the second day of admission to the ICU with Gram-negative bacillus smear was positive, and Ceftriaxone was changed to Ceftazidime at 150 mg/kg/day.\n\nOn his first day in the ICU, a substantial increase in serum biomarkers of cardiac damage was documented, the echocardiogram showed mild mitral and tricuspid regurgitation, left ventricular dilatation, left ventricular ejection fraction (LVEF) 58%, no evidence of thrombi, vegetations or pericardial effusion, and he was diagnosed with acute myocarditis. Milrinone was started at 0.4 mcg/kg/min, furosemide and IV immunoglobulin 1 g/kg single dose.\n\nThe second day blood culture the germ was identified as Bacillus clausii, identified by the system (VYTEK 2TM), the susceptibility profile was not performed because the team did not have cut points for this germ, for this reason the antibiotic coverage was adjusted, considering it was not a contaminant, Ceftazidime was changed to Ciprofloxacin at 30 mg/kg/day and Ceftaroline was added at 8 mg/kg every 8 hours along with Clindamycin for MRSA. The 3 subsequent blood cultures with intervals of 48 hours between each were positive in both peripheral blood and CVC for isolation of B. clausii.\n\nOn his 6th day in hospital, the gastrointestinal panel (Maripoc gastro test methodology) performed on the second day detected Clostridiodes difficile toxin A/B, the tests for Campylobacteryeyuni, Norovirus GI, Norovirus GII.4, Adenovirus and Rotavirus were negative. Following these findings, therapy was escalated to IV Vancomycin at a dose of 60 mg/kg/day and metronidazole was added orally. Ceftaroline, clindamycin and ciprofloxacin were omitted, covering both B. clausii and C. difficile and MRSA .\n\nHIV testing, serology for Chagas and SARS-CoV-2 antigen by immunofluorescence (FIA) were negative, immunoglobulins were within normal limits.\n\nOn the seventh day, arterial hypertension was reported and spirinolactone was added to the management.\n\nOn the 8th day, the laboratory tests showed altered coagulation times and increased azotaemia associated with anuria that had lasted for 12 hours. However, due to the patient's condition, a peritoneal catheter was not placed, the vancomycin dose was adjusted and vitamin K was administered. The patient continued to have anuria and anasarca, and she developed sustained hypotension. Noradrenaline was added, but her condition deteriorated with multisystem organ failure and she died twelve days after admission. No autopsy was performed because the mother refused permission for cultural reasons.\n",
+    "summary": "4-month-old lactating infant, indigenous ethnicity, from the rural interior of Panama, 3 hours by canoe from the nearest health subcenter, with protein-caloric malnutrition, who presented with acute diarrhea and moderate-severe dehydration, receiving Enterogermina as part of the initial treatment. She was transferred to a third-level hospital, where she arrived with respiratory distress and signs of shock. The initial blood culture reported growth of methicillin-resistant Staphylococcus aureus (MRSA), the gastrointestinal panel was positive for Clostridiodes difficile, and later growth was confirmed in serial blood cultures of peripheral blood and central venous catheter, of Bacillus clausii. With a torpid evolution and resistance to multiple antibiotic regimens, she died of multisystem organ failure twelve days after admission.\n",
+    "translated_fulltext": null,
+    "translated_summary": null,
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": null
+  },
+  {
+    "id": "multiclinsum_gs_en_59.txt",
+    "fulltext": "A 2-year-old female presented with a 1-year history of painless left progressive proptosis with no reported systemic diseases or family history. Ophthalmologic examination revealed light sensation as the only vision in the left eye, along with proptosis, inward and upward eyeball displacement, and restricted extraocular muscle movements in downward and outward directions. An irregularly shaped, well-defined soft mass was palpable in the inferior aspect of the left orbit, accompanied by left lower eyelid ectropion. The pupil was enlarged (4 mm in diameter), and pupillary reaction was absent. The remaining anterior segment examination showed no apparent abnormalities. Fundus examination was challenging due to the child’s size. Hertel exophthalmometry readings measured 10.5 mm in the right eye and 18 mm in the left. Magnetic resonance imaging (MRI) revealed a well-circumscribed mass, displaying hypointense signals on T1-weighted images and hyperintense signals on T2-weighted images. Contrast-enhanced imaging demonstrated no significant improvement. A transconjunctival approach via the inferior fornix with canthotomy and cantholysis was performed, revealing a grayish-white cystic mass with a distinct boundary from surrounding tissues. During posterior separation to the eyeballs’ posterior part, tight adhesion to the optic nerve was observed. Due to the mass’s substantial size and the restricted surgical field, volume reduction was necessary. Approximately 12.5 mL of the fluid was aspirated, and the mass was completely excised. Histopathological examination disclosed a fibrous capsule wall covered with squamous and glandular epithelium, along with visible brain tissue and a cartilage-like matrix consistent with orbital teratoma. One month postsurgery, the patient exhibited enophthalmos, conjunctival hyperemia, and keratitis on ocular examination. This was attributed to the mass’s prior enlargement of the orbital cavity, resulting in postoperative enophthalmos. The cornea could not adhere to the eyelids, creating a space and causing corneal inflammation. After obtaining the consent of the patient’s guardian, a second operation involved the implantation of an allogeneic sclera into the orbit to increase the orbital volume, alleviate fossa pitting and restore keratitis to normal. No recurrence of the teratomas was noted during the 1-year follow-up. The patient still had minor enophthalmos and outer canthus abnormality. The visual acuity remained consistent with pre-operation levels. Hertel exophthalmometry readings measured 10.5 mm in the right eye and 8 mm in the left. The remaining anterior segment examination showed no apparent abnormalities.",
+    "summary": "Patient concerns: A 2-year-old female child was presented exhibiting proptosis and inward and upward eyeball displacement. Enhanced magnetic resonance imaging revealed a well-circumscribed mass, persisting with hypointense signals on T1-weighted images (T1WI) and hyperintense signals on T2-weighted images (T2WI).\n\nDiagnoses: The diagnosis of teratoma was confirmed finally through histological and immunohistochemical exams.\n\nInterventions: A transconjunctival approach via the inferior fornix, coupled with canthotomy and cantholysis, was performed. However, a month postsurgery, the patient developed enophthalmos, conjunctival hyperemia, and keratitis upon ocular examination. A second operation involved the implantation of allogeneic sclera into the orbit to increase orbital volume, improve the pitting of the fossa, and restore keratitis to normal.\n\nOutcomes: No recurrence and other complications were noted during the 1-year follow-up.",
+    "translated_fulltext": "Một bệnh nhân nữ 2 tuổi được đưa đến khám với tiền sử 1 năm bị lồi mắt trái không đau, tiến triển dần, không có bệnh lý toàn thân hoặc tiền sử gia đình nào được ghi nhận. Khám mắt cho thấy chỉ có cảm giác ánh sáng ở mắt trái, kèm theo lồi mắt, di lệch nhãn cầu vào trong và lên trên, và hạn chế vận động các cơ vận nhãn theo hướng xuống và ra ngoài. Một khối mềm, hình dạng không đều, có đường viền rõ ràng có thể sờ thấy ở phần dưới của hốc mắt trái, kèm theo tình trạng mí mắt dưới trái bị lộn ra ngoài. Đồng tử giãn (đường kính 4 mm), và phản xạ đồng tử không có. Khám phần trước của mắt còn lại không cho thấy bất thường rõ ràng. Việc khám đáy mắt gặp khó khăn do kích thước của trẻ. Kết quả đo độ lồi mắt bằng máy Hertel cho thấy 10,5 mm ở mắt phải và 18 mm ở mắt trái. Chụp cộng hưởng từ (MRI) cho thấy một khối có đường viền rõ ràng, có tín hiệu giảm trên ảnh T1 và tín hiệu tăng trên ảnh T2. Chụp ảnh có sử dụng chất cản quang không cho thấy sự cải thiện đáng kể. Một phương pháp tiếp cận qua kết mạc thông qua hố dưới, kết hợp với rạch và tách góc mắt, đã được thực hiện, cho thấy một khối nang màu xám trắng với đường viền rõ ràng so với các mô xung quanh. Trong quá trình tách khối ra khỏi phần sau của nhãn cầu, người ta nhận thấy khối này dính chặt vào dây thần kinh thị giác. Do kích thước lớn của khối và không gian phẫu thuật hạn chế, việc giảm thể tích là cần thiết. Khoảng 12,5 ml chất lỏng đã được hút ra, và khối u đã được cắt bỏ hoàn toàn. Kết quả kiểm tra mô bệnh học cho thấy một lớp vỏ xơ bao phủ bởi biểu mô vảy và biểu mô tuyến, cùng với mô não và một chất nền giống sụn, phù hợp với u quái ở hốc mắt. Một tháng sau phẫu thuật, bệnh nhân có biểu hiện lồi mắt ngược, sung huyết kết mạc và viêm giác mạc khi khám mắt. Điều này được cho là do khối u trước đó đã làm tăng kích thước hốc mắt, dẫn đến tình trạng lồi mắt ngược sau phẫu thuật. Giác mạc không thể dính vào mí mắt, tạo ra một khoảng trống và gây viêm giác mạc. Sau khi có sự đồng ý của người giám hộ của bệnh nhân, một cuộc phẫu thuật thứ hai đã được thực hiện, bao gồm việc cấy ghép một mảnh củng mạc đồng loại vào hốc mắt để tăng thể tích hốc mắt, giảm tình trạng lõm và phục hồi giác mạc về trạng thái bình thường. Trong quá trình theo dõi 1 năm, không ghi nhận sự tái phát của u quái. Bệnh nhân vẫn còn tình trạng lồi mắt ngược nhẹ và bất thường ở góc ngoài mắt. Thị lực vẫn ổn định so với mức trước phẫu thuật. Kết quả đo độ lồi mắt bằng máy Hertel cho thấy 10,5 mm ở mắt phải và 8 mm ở mắt trái. Khám phần trước của mắt còn lại không cho thấy bất thường rõ ràng.",
+    "translated_summary": "Các vấn đề của bệnh nhân: Một bé gái 2 tuổi được đưa đến khám với các triệu chứng lồi mắt, đồng tử lệch vào trong và lên trên. Chụp cộng hưởng từ (MRI) cho thấy một khối u có ranh giới rõ ràng, vẫn còn tín hiệu giảm trên ảnh T1 và tín hiệu tăng trên ảnh T2.\n\nChẩn đoán: Chẩn đoán cuối cùng là u quái (teratoma) dựa trên kết quả xét nghiệm mô học và hóa mô miễn dịch.\n\nCan thiệp: Phương pháp tiếp cận qua kết mạc, qua hố mắt dưới, kết hợp với rạch và giải phóng góc mắt, đã được thực hiện. Tuy nhiên, một tháng sau phẫu thuật, bệnh nhân xuất hiện các triệu chứng lõm mắt, xung huyết kết mạc và viêm giác mạc khi khám mắt. Một cuộc phẫu thuật thứ hai bao gồm việc cấy ghép mảnh củng mạc đồng loại vào hốc mắt để tăng thể tích hốc mắt, cải thiện hình dạng hốc mắt và phục hồi giác mạc về trạng thái bình thường.\n\nKết quả: Không có dấu hiệu tái phát hoặc các biến chứng khác trong quá trình theo dõi 1 năm.",
+    "corrected_translated_fulltext": "২ বছর বয়সী এক কন্যা শিশুকে বাম চোখে ১ বছরের ব্যথাহীন, ধীরে ধীরে বৃদ্ধি পাওয়া proptosis নিয়ে আনা হয়; কোনো systemic রোগ বা পারিবারিক ইতিহাসের উল্লেখ ছিল না. চক্ষু পরীক্ষা‑নিরীক্ষায় দেখা যায় বাম চোখে দৃষ্টিশক্তি কেবল light sensation; সাথে proptosis, চোখের বলের ভেতরের দিকে ও উপরের দিকে স্থানচ্যুতি, এবং নিচের ও বাইরের দিকে extraocular muscle গতিতে সীমাবদ্ধতা. বাম অর্বিটের নিম্ন অংশে অনিয়মিত আকারের, সুস্পষ্ট সীমানাযুক্ত নরম একটি mass স্পর্শে অনুভূত হয়, এর সাথে বাম নিম্ন চোখের পাতার ectropion ছিল. পিউপিল বড় ছিল (ব্যাস 4 mm), এবং pupillary reaction অনুপস্থিত ছিল. অবশিষ্ট anterior segment পরীক্ষা‑নিরীক্ষায় কোনো সুস্পষ্ট অস্বাভাবিকতা পাওয়া যায়নি. শিশুর আকারের কারণে fundus পরীক্ষা করা কঠিন ছিল. Hertel exophthalmometry‑তে ডান চোখে 10.5 mm এবং বাম চোখে 18 mm পরিমাপ হয়েছিল. Magnetic resonance imaging (MRI)‑তে একটি well‑circumscribed mass দেখা যায়, যা T1‑weighted ছবিতে hypointense এবং T2‑weighted ছবিতে hyperintense সিগন্যাল প্রদর্শন করছিল. Contrast‑enhanced imaging‑এ কোনো উল্লেখযোগ্য উন্নতি দেখা যায়নি. Inferior fornix দিয়ে transconjunctival approach সহ canthotomy এবং cantholysis করা হয়, যাতে আশপাশের টিস্যু থেকে সুস্পষ্ট সীমানাযুক্ত ধূসরাভ‑সাদা cystic mass প্রকাশ পায়. চোখের বলের পশ্চাদ্ভাগের দিকে posterior separation চলাকালে, optic nerve‑এর সাথে দৃঢ় adhesion লক্ষ্য করা হয়েছিল. মাসটির বড় আকার এবং সীমিত সার্জিকাল ফিল্ডের কারণে volume reduction প্রয়োজনীয় ছিল. প্রায় 12.5 mL তরল aspirate করা হয়, এবং mass সম্পূর্ণভাবে অপসারণ করা হয়. Histopathological পরীক্ষা‑নিরীক্ষায় squamous ও glandular epithelium দ্বারা আবৃত fibrous capsule wall, সাথে দৃশ্যমান brain tissue এবং cartilage‑like matrix পাওয়া যায়, যা orbital teratoma‑র সাথে সঙ্গতিপূর্ণ. সার্জারির এক মাস পর চক্ষু পরীক্ষায় রোগীর enophthalmos, conjunctival hyperemia, এবং keratitis দেখা যায়. এটি mass‑এর কারণে পূর্বে orbital cavity বড় হয়ে যাওয়ার ফল হিসেবে বিবেচিত হয়, যা postoperative enophthalmos সৃষ্টি করেছে. Cornea চোখের পাতার সাথে সংযুক্ত থাকতে পারেনি, ফলে একটি ফাঁকা স্থান সৃষ্টি হয়ে corneal inflammation হয়েছে. রোগীর অভিভাবকের সম্মতি নিয়ে দ্বিতীয় অপারেশনে orbital volume বাড়াতে এবং fossa pitting কমাতে ও keratitis স্বাভাবিক অবস্থায় ফিরিয়ে আনতে, orbit‑এ একটি allogeneic sclera ইমপ্লান্ট করা হয়েছিল. ১ বছরের ফলো‑আপে teratoma‑র কোনো পুনরাবৃত্তি লক্ষ্য করা যায়নি. রোগীর এখনও সামান্য enophthalmos এবং outer canthus‑এর অস্বাভাবিকতা ছিল. দৃষ্টিক্ষমতা pre‑operation স্তরের সাথে সামঞ্জস্যপূর্ণ ছিল. Hertel exophthalmometry‑তে ডান চোখে 10.5 mm এবং বাম চোখে 8 mm পরিমাপ হয়েছিল. অবশিষ্ট anterior segment পরীক্ষা‑নিরীক্ষায় কোনো সুস্পষ্ট অস্বাভাবিকতা দেখা যায়নি.",
+    "corrected_translated_summary": "রোগীর উদ্বেগ: একজন ২ বছর বয়সী কন্যাশিশু proptosis এবং চক্ষুগোলকের ভিতরের দিকে ও ওপরের দিকে স্থানচ্যুতি নিয়ে উপস্থিত হয়। Enhanced magnetic resonance imaging (MRI)-এ সুনির্দিষ্ট সীমানাযুক্ত একটি mass দেখা যায়, যা T1-weighted images (T1WI)-এ hypointense এবং T2-weighted images (T2WI)-এ hyperintense সিগন্যাল প্রদর্শন করে.\n\nনির্ণয়: Histological এবং immunohistochemical পরীক্ষার মাধ্যমে teratoma-এর নির্ণয় চূড়ান্তভাবে নিশ্চিত করা হয়।\n\nহস্তক্ষেপ: Inferior fornix মাধ্যমে transconjunctival approach, সঙ্গে canthotomy এবং cantholysis, করা হয়। তবে অস্ত্রোপচারের এক মাস পর চক্ষু পরীক্ষায় রোগীর enophthalmos, conjunctival hyperemia, এবং keratitis দেখা যায়। দ্বিতীয় অপারেশনে orbital volume বৃদ্ধি, fossa-এর pitting উন্নত করা, এবং keratitis স্বাভাবিক অবস্থায় ফেরাতে orbit-এ allogeneic sclera ইমপ্লান্ট করা হয়।\n\nফলাফল: ১ বছরের ফলো-আপে কোনো পুনরাবৃত্তি বা অন্যান্য জটিলতা লক্ষ্য করা যায়নি।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0056_0057.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0056_0057.json
new file mode 100644
index 0000000000000000000000000000000000000000..532a85dcd0748383f956da5c2703ea0a66a51993
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0056_0057.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_490.txt",
+    "fulltext": "A 78-year-old woman, who came to collect her blister pack with her medication reconstituted in a personalised dosage system (PDS) from the community pharmacy, informed us that for some months she had been suffering from tiredness, weakness, dizziness and confusion. These symptoms were preventing her from leaving her home to walk as often as she normally did. In view of this situation, she was invited to the personalised care area to review the degree of knowledge that the patient had of her medication and the use she made of it, to analyse whether any of her medication could be related to the health problem described.\n\nPharmacological treatment of the patient\n\nMedication  Dose  Dosage  Health issue  Start date\nDoxazosin  2 mg/24 h  0-0-1  Hypertension  2014\nLosartan  100 mg/24 h  1-0-0  Hypertension  2014\nManidipine  20 mg/24 h  0-1-0  Hypertension  2014\nSimvastatin  40 mg/24 h  0-0-1  Hypercholesterolemia  2014\nAcetylsalicylic acid  100 mg/24 h  1-0-0  Secondary prophylaxis  2014\nOmeprazole  20 mg/24 h  1-0-0  Prevention of peptic ulcer  2014\nPregabalin  100 mg/12 h  1-0-1  Neuralgia  2019\nTorasemide  10 mg/24 h  1-0-0  Edema  2023\nDulaglutide  1.5 mg/week  1 time/week  Diabetes  2014\nInsulin glargine  74 IU/24 h  1-0-0  Diabetes  2014\nInsulin lispro  20 IU/24 h  0-1-0  Diabetes  2014\nBrimonidine  1 drop/12 h  1-0-1  Ocular hypertension  2018\n\nStudy and evaluation\nThe interview revealed that there was no new medication and that it did not appear in the SPD service register. Given the suspicion of a possible hypotension, her blood pressure was measured with an Omron Complete device, with the following values: Systolic Blood Pressure (SBP) 96 mmHg, Diastolic Blood Pressure (DBP) 52 mmHg and Heart Rate (HR) 69 beats per minute. Given these values, it was suggested that her blood pressure be monitored and the influence of her medication on these values and the symptoms described by the patient be analysed.\n\nThe patient's medication doses, starting with antihypertensive medications, are reviewed to adjust to the patient's estimated glomerular filtration rate (eGFR) and to see if hypotension is related to the dosage of these medications. The patient's eGFR value, calculated using the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) formula, is 30 ml/min/1.73 m2.\n\nThe guidelines for the revision of the dose according to the value of the eGFR are the product information for the medicinal products and the consensus guidelines for the use of medicinal products in renal impairment of the teaching and research group in the field of practical pharmacy of the Faculty of Pharmacy of the University of Barcelona, which is available on the Internet. This guide has been prepared from the analysis of the most dispensed medicinal products in community pharmacies. They have been organised by therapeutic groups according to the ATC (Anatomical-Therapeutic-Chemical) classification, information on the symptoms of overdose has been included and it has been agreed to categorise the risk to the patient of taking these medicinal products according to their eGFR as low, moderate or high.\n\nAfter the medication review was performed according to the eGFR value of 30 ml/min/1.73 m2, the results were obtained.\n\nFollowing the study of the medication, our intervention focuses on the dosage of the following medicines: losartan, manidipine, torasemide and pregabalin. The antihypertensive medicines, losartan and manidipine, and pregabalin require a dose adjustment depending on the patient's eGFR value, while the diuretic torasemide can influence blood pressure values.\n\nInitially, it was decided to intervene in the dosage of losartan and manidipine. There is the possibility of reducing the dose of pregabalin, but the pharmaceutical team agreed with the patient to assess the influence of this medication after the possible adjustment of the dose of antihypertensive during the evolution and follow-up of the patient.\n\nIntervention\nThe information is used to prepare a report for the doctor (see annex), recommending a reduction in the dose of losartan and manidipine, as the available information recommends a reduction in the dose to 50-75% of losartan for eGFR of 30-59 ml/min/1.73 m2 and adjusting the dose of manidipine for eGFR of 15-30 ml/min/1.73 m2.\n\nThe proposed intervention was explained to the patient and the report was given to the primary care doctor, explaining the possibility of adjusting the dose of losartan and manidipine to improve the patient's condition (table 4). When this information reached the doctor, he opted to reduce the dose of losartan to 50 mg/24 hours and manidipine to 10 mg/24 hours. Pregabalin 100 mg/12 hours was also replaced with gabapentin 300 mg/12 hours.\n\nFollow-up\nFollowing this change in the patient's treatment and after a follow-up of two months, the patient showed an improvement in blood pressure values (table 5) and a remission of the symptoms described. It was reviewed whether the gabapentin dose of 300 mg/12 hours was adequate for the eGFR value of 30 ml/min/1.73 m2, and it was correct (eGFR between 30 and 60, recommended total daily dose 300-900 mg).\n\n",
+    "summary": "78-year-old patient, taking many medicines and included in the Personalised Medication Dosage System (SPD). When she came to collect her medication, she informed us that for some months she had been suffering from tiredness, weakness, dizziness and confusion. A review of the medication was carried out, focusing on the dosage of the medicines metabolised or eliminated by the kidneys, depending on the patient's estimated glomerular filtration rate (EGFR). A referral was made to the Primary Care Physician (PCP) by means of a report, in which the reduction of the dose of losartan and manidipine was recommended, depending on the patient's estimated glomerular filtration rate (EGFR). The PCP reduced the dose of the antihypertensive medicines. The case was monitored, which allowed us to observe that the patient no longer presented the symptoms described initially.\n",
+    "translated_fulltext": null,
+    "translated_summary": "Bệnh nhân 78 tuổi, đang dùng nhiều loại thuốc và được theo dõi trong Hệ thống Điều chỉnh Liều lượng Thuốc Cá nhân hóa (SPD). Khi đến nhận thuốc, bà thông báo rằng trong vài tháng gần đây, bà cảm thấy mệt mỏi, yếu ớt, chóng mặt và lẫn lộn. Các bác sĩ đã xem xét lại các loại thuốc bà đang dùng, tập trung vào liều lượng của các loại thuốc được chuyển hóa hoặc đào thải qua thận, dựa trên ước tính tốc độ lọc cầu thận (EGFR) của bệnh nhân. Một báo cáo đã được gửi đến bác sĩ điều trị ban đầu (PCP), trong đó đề xuất giảm liều losartan và manidipine, tùy thuộc vào ước tính tốc độ lọc cầu thận (EGFR) của bệnh nhân. Bác sĩ điều trị ban đầu đã giảm liều các loại thuốc hạ huyết áp. Tình trạng của bệnh nhân được theo dõi và kết quả cho thấy bà không còn các triệu chứng như đã mô tả ban đầu.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "৭৮ বছর বয়সী রোগী, বহু ওষুধ গ্রহণ করছেন এবং Personalised Medication Dosage System (SPD)-এ অন্তর্ভুক্ত। ওষুধ নিতে এলে তিনি জানালেন যে গত কয়েক মাস ধরে তিনি ক্লান্তি, দুর্বলতা, মাথা ঘোরা এবং বিভ্রান্তিতে ভুগছেন। রোগীর আনুমানিক glomerular filtration rate (EGFR)-এর ভিত্তিতে কিডনির মাধ্যমে বিপাকিত বা নির্গত হয় এমন ওষুধগুলির ডোজের উপর কেন্দ্রীভূত হয়ে একটি ওষুধ পুনর্মূল্যায়ন করা হয়। একটি প্রতিবেদন মারফত Primary Care Physician (PCP)-কে রেফার করা হয়, যেখানে রোগীর আনুমানিক glomerular filtration rate (EGFR)-এর উপর ভিত্তি করে losartan এবং manidipine-এর ডোজ কমানোর সুপারিশ করা হয়। PCP অ্যান্টিহাইপারটেনসিভ ওষুধগুলির ডোজ কমিয়ে দেন। কেসটি পর্যবেক্ষণ করা হয়, যার ফলে আমরা লক্ষ্য করি যে রোগীর আর প্রাথমিকভাবে বর্ণিত উপসর্গগুলি নেই।"
+  },
+  {
+    "id": "multiclinsum_gs_en_483.txt",
+    "fulltext": "It is a case study, approved by the Research Ethics Committee (CEP) under number 1.012.635. The prior authorization of the relatives and the participant was requested from the signature of the Free and Informed Consent (TCLE) and the Free and Informed Consent (TALE).\n\nThe participant in this study is a female student in the 3rd year of elementary school. In the first evaluation, in 2018, the child was 8 years and 2 months old, while in the second evaluation, in 2019, she was 9 years and 6 months old. The interval between the evaluations occurred due to the fact that it is a public service. Thus, the laboratory was absent from activities during the holidays. In addition, it is important to consider that the appointments were only made once a week and, during that period, the participant was absent, which also prolonged the process. As for her history, she was born at term and presented adequate neuropsychomotor and linguistic development. The child was born and lived in a French-speaking country until the age of 2 years, but had exposure to another language at home, since her parents are Brazilian Portuguese speakers. However, her first words were in French. When she returned to Brazil, she went through two private schools. In the first school, she was unable to communicate, as she only expressed herself in French. After that experience, at the age of 3, she began studying in a French school, still in Brazil. Over the years, she presented difficulty in acquiring reading and writing; for that reason, she repeated the 1st year of elementary school, at the request of her mother. At the age of 6, she began studying in a bilingual Portuguese-English school. At the age of 8 years old, she underwent evaluation by an interdisciplinary team in the areas of speech therapy and neuropsychology, finding the diagnosis of developmental dyslexia (DD) and high abilities/giftedness (AH/S). Soon after, she was referred to the evaluation of reading and writing in the Laboratory of Written Language, Interdisciplinarity and Learning - LEIA/UFRN.\n\nPhases of the study: four assessment sessions for each moment - pre and post intervention (T1 and T2, respectively) - and 20 sessions of phonological remediation, once a week for 60 minutes. The intervention took place in the second semester of 2018, where parents were not very engaged due to work demands.\n\nAssessments were conducted individually over a one-hour period. They included tasks to assess performance in phonological processing - phonological working memory, phonological awareness and mental lexical access - reading and writing.\n\nThe following protocols were used to evaluate the child:\n\nPhonological awareness: to evaluate this ability, the Consciência Fonológica Instrumento de Avaliação Sequencial - CONFIAS (11) was used. This protocol proposes tasks of synthesis, segmentation, rhyme, alliteration, initial and final syllable identification, exclusion and transposition. First, syllabic awareness, formed by nine items, is analyzed, followed by phonemic awareness, formed by seven items. Each hit is equivalent to one point, with 40 for syllabic awareness and 30 for phonemic awareness, totaling 70 points. Its results should be compared with the expected writing hypotheses based on Ferreiro and Teberosky (12). In this way, the following normal values were used: for the syllabic-alphabetic writing hypothesis, 27, 12 and 39 for the syllabic, phonemic and total score, respectively; for the alphabetic writing hypothesis, 31, 15 and 46.\n\nPhonological working memory: The Phonological Working Memory Test was used (13). In the application of this protocol, the assessor should begin with the non-word test, which consists of 40 invented words. The assessor should then say each word in the list, asking the child to repeat it immediately. The child has two attempts to repeat the words correctly. In the first attempt, each correct answer is worth two points, in the second attempt, the child is awarded one point, and in the third attempt, the child is awarded zero points. After this, the assessor should move on to the test of digits in direct and reverse order, which is scored in the same way as the pseudo-words. Depending on the age of the participant at the time of the assessments, the normal values of 69, 13 and 6 were used for pseudo-words, direct and reverse digits, respectively.\n\nAccess to the mental lexicon: the Rapid Automatic Naming Test (RAN)(14) was used in the evaluation and the Automatic Naming Test (TENA)(15) in the re-evaluation. Both tests aim to estimate the individual's ability to name a sequence of stimuli, that is, to measure the speed at which the child can verbalize a visual stimulus quickly. Two protocols were used, since the TENA had not yet been published at the time of the first evaluation. In addition, the TENA is a current and more complete protocol for the verification of normality, as it allows analysis according to age and months. The two tests used have similar application and are divided into four boards, where the child must name colors, objects, letters and digits. The naming must be done with the same movement that is used for reading - from left to right and from top to bottom. For T1, which used the RAN, the normality values correspond to children aged between 8 years and 8 years and 11 months, due to the age of the participant in that period, thus, it should have a score of 28, 29, 52 and 46 seconds for the subtests of digits, letters, objects and colors, respectively. For T2, the normality values of the age of 9 years and 6 months of the protocol (TENA) were used, with an expected score of 35, 32, 50, 53 seconds for the subtests of digits, letters, objects and colors, respectively.\n\nReading: First, the Protocol for the Assessment of Reading of Words/Pseudowords Isolated – LPI(16) was used, in which the child is asked to read aloud words and pseudowords, which are scored. 19 regular words, 20 irregular words and 20 pseudowords are arranged in black Arial font, size 24 and white background. The child may obtain a total of 59 points, since each correct reading is worth one point. After this, the Protocol for the Assessment of Reading of Expository Texts was used(17). This instrument aims to assess reading comprehension through directed questions about texts compatible with the subject's school year. It assesses and times patterns of silent and oral reading. This allows the reading level to be verified and compared. In addition, the number of words read per minute is averaged, allowing the reading speed to be verified and compared.\n\nWriting: To evaluate the writing, the child was asked to produce a text on a topic of their interest. After finishing the story, the professional asked the child to read out loud what was written. Furthermore, the child was asked to write the target words of the LPI(16) on a separate sheet, in order to carry out a dictation of words and pseudo-words. With this, a qualitative investigation of the writing was carried out, based on the orthographic analysis of Zorzi and Ciasca(18).\n\nThe remediation was based on a program used for children with dyslexia(19) and included activities that aimed to improve phonological abilities, such as: identification of graphemes and phonemes, phoneme pairs, syllable pairs, word pairs, addition and subtraction of phonemes, syllabic and phonemic manipulation, rhymes, alliteration, access to mental lexicon, visual working memory, auditory working memory and reading training. In all sessions, these activities were explored in a playful way, mainly directed to the metalinguistic aspects of phonological awareness. In reading training, the child was exposed to children's books from the Mico Maneco collection. This collection has various stories that increase the level of complexity of words, so it is possible to follow the child's progress. The activities performed and the child's evolution were described in his/her medical record at the end of each session.\n\nAnalysing the results found, with regard to performance in phonological awareness, in both assessments the child presented performance consistent with the hypotheses of writing presented in each period. In the first assessment, he received the syllabic-alphabetic writing hypothesis and in the second, the alphabetic one, demonstrating progress. The performance score progressed in both categories of the skill, syllabic (T1 = 35; T2 = 37) and phonemic (T1 = 14; T2 = 20) (Table 1). The progress of 4 successes in the phonemic level is highlighted, which can be explained due to the phonological remediation having been performed with focus on the phonemic level.\n\nThe results of phonological working memory at the time prior to phonological remediation expressed below-expected performance for the pseudo-word category, with 66 points in T1, with expected performance for T1 (ET1) of 69, and for the reverse-order digits category (T1 = 04; ET1 = 06) (Table 1). Despite this, it presented results within the expected range for the reverse-order digits category (T1 = 20; ET1 = 13). In the post-intervention evaluation (T2), the results are adequate for the age. It is also possible to notice advances in this skill in all categories, pseudo-word (T1 = 66; T2 = 69), reverse-order digits (T1 = 04; T2 = 12) (Table 1), which requires aspects of executive functions that assist in the rapid storage of the response, a differential aspect in high abilities.\n\nAs for the automatic rapid naming, it is noted that in T1, the performance is inadequate for the standards of normality in all subtests. It is also possible to say that, in T2, the performance was below the expected for the categories of digits (T2 = 41; ET2 = 35), objects (T2 = 59; ET2 = 50) and colors (T2 = 56; ET2 = 53). Only the category of letters presented results within the expected (T2 = 29; ET2 = 32). On the other hand, the advance in the speed of naming is visible for the subtests of letters (T1 = 37; T2 = 29), objects (T1 = 62; T2 = 59) and colors (T1 = 60; T2 = 56), with the exception of digits (T1 = 37; T2 = 41) (Table 1). With the decrease of the time of naming of the stimuli, it is possible to say that the child becomes more effective to access the mental lexicon at the level of the phonological and visual representation, which is also not usual in isolated dyslexia.\n\nAs for reading, in T1 she presented an alphabetic level and in T2 an orthographic level. In the first test, it was noted that there was difficulty mainly with visually similar letters and phonologically close. In addition, the student used sub-vocal support to decode and had an average reading of 20 words per minute, which demonstrates extremely slow decoding and is far below what is expected for her schooling. In the reassessment, she had an average of 94.4 words per minute in oral reading, which is considered adequate for her schooling. She demonstrated presence of prosody, rhythm, global reading, interest and adequate understanding. Qualitatively, it is observed that the child, even with adequate performance, read with a low intensity of speech, still demonstrating insecurity in carrying out the task.\n\nIn writing, it can be observed that in T1 the child had inadequate pencil grip, imprecise writing, with letter changes, omissions, hyper and hyposegments, repetition of words and low use of cohesive elements. In this period, it was shown with writing in the transition from the syllabic-alphabetic phase to the alphabetic phase. In T2 no significant change was observed, since his writing continued to be imprecise, with little intelligibility of the content, visual similarities between letters (such as “d” and “b”) and lack of punctuation. According to the sample collected, it was shown in the alphabetic phase of writing, although difficulties not expected for his age persisted. Despite this, it is noted that he used a greater repertoire in the use of vocabulary for the lexicon of visual input.\n\nAfter the analysis of the results in their entirety, it can be observed that the written language skills advanced during the interval between the evaluations, despite the persistence of consonant characteristics with dyslexia, as it still presents performance below the expected in the access to the mental lexicon and in writing - with the presence of exchanges between phonemes that are audibly and visually similar in a persistent way, omission of letters and hypersegmentation.\n",
+    "summary": "This study is a case report of the evaluation and intervention process of a 9-year-old child with the paradoxical combination of high abilities associated with dyslexia. The objective was to compare the performance in the tasks of phonological processing, reading and writing before and after phonological remediation. In the first evaluation, the child presented an alphabetic level in reading, a transition phase between the syllabic-alphabetic and alphabetic levels in writing and a performance below the expected level in phonological processing abilities. After the intervention, there was an improvement in phonological processing abilities, consolidation of alphabetic writing and of the orthographic level of reading.\n",
+    "translated_fulltext": null,
+    "translated_summary": "Nghiên cứu này là một báo cáo điển hình về quá trình đánh giá và can thiệp đối với một trẻ 9 tuổi có sự kết hợp nghịch lý giữa khả năng vượt trội và chứng khó đọc. Mục tiêu là so sánh kết quả thực hiện các bài tập về xử lý âm vị, đọc và viết trước và sau khi can thiệp bằng phương pháp phục hồi âm vị. Trong lần đánh giá đầu tiên, trẻ thể hiện trình độ đọc ở mức bảng chữ cái, giai đoạn chuyển tiếp giữa mức âm tiết-bảng chữ cái và mức bảng chữ cái trong kỹ năng viết, và kết quả dưới mức kỳ vọng trong các kỹ năng xử lý âm vị. Sau khi can thiệp, trẻ có sự cải thiện về kỹ năng xử lý âm vị, củng cố kỹ năng viết bảng chữ cái và nâng cao trình độ đọc.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "এই গবেষণাটি ডিসলেক্সিয়ার সঙ্গে সংশ্লিষ্ট উচ্চ ক্ষমতার পরস্পরবিরোধী সমন্বয়যুক্ত ৯-বছর-বয়সী এক শিশুর মূল্যায়ন ও হস্তক্ষেপ প্রক্রিয়ার একটি কেস রিপোর্ট। উদ্দেশ্য ছিল phonological remediation-এর আগে ও পরে ध্বনিতাত্ত্বিক প্রক্রিয়াকরণ, পড়া এবং লেখা সংক্রান্ত কাজগুলিতে কার্যসম্পাদনের তুলনা করা। প্রথম মূল্যায়নে, শিশুটি পড়ায় alphabetic স্তর প্রদর্শন করে, লেখায় syllabic-alphabetic ও alphabetic স্তরের মধ্যবর্তী একটি রূপান্তর পর্যায়ে ছিল, এবং ধ্বনিতাত্ত্বিক প্রক্রিয়াকরণ দক্ষতায় প্রত্যাশিত স্তরের নিচে কার্যসম্পাদন করে। হস্তক্ষেপের পরে, ধ্বনিতাত্ত্বিক প্রক্রিয়াকরণ দক্ষতায় উন্নতি, alphabetic লেখার সংহতি এবং পড়ায় orthographic স্তরের সংহতি পরিলক্ষিত হয়।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0074_0075.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0074_0075.json
new file mode 100644
index 0000000000000000000000000000000000000000..29d13e17c902f7588a88bd05591d7f2ea331617d
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0074_0075.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_54.txt",
+    "fulltext": "A 56-year-old Italian female patient with β-thalassemia major presented to the radiology department to undergo MRI to quantify myocardial, hepatic, and pancreatic iron deposition. The clinical history of the patient included a transfusion-dependent β-thalassemia condition (genotype HBB:c.118C > T/ HBB:c.93-21G > A), diagnosed at the age of 7 years, despite the fact that the first transfusion was carried out at 2 years. As a consequence of β-thalassemia, the patient underwent splenectomy and cholecystectomy.\n\nAt the moment of MRI, she had a negative HCV-RNA (Hepatitis C virus-Ribonucleic acid) test, no osteoporosis or other endocrine, cardiac, or hepatic complications, and good iron levels. The patient’s therapy included iron chelation with deferasirox, vitamin D, and luspatercept, an erythropoiesis modulator started 2 years before the MRI examination (good response, with an increase of about 35% of transfusion interval duration). Transfusion therapy included two units of concentrated and filtered red blood cells every 25 days with pre-transfusion hemoglobin values of 10–10.5 g/dl.\n\nOn MRI, a solid mass with lobulated and regular contours was incidentally identified within the prevascular compartment of the mediastinum.\n\nThe lesion was mildly hyperintense on T2-weighted images (T2-wi) and isointense on T1-wi. The mediastinal mass in question was discernible in a prior MRI examination conducted for the same purpose in 2020 before starting luspatercept therapy, albeit with a marginal enlargement.\n\nThere were no other apparent abnormalities observed in the remaining mediastinal compartments. No pleural or pericardial effusions were present.\n\nThe neurological examination was unremarkable, and in the preceding months, the patient exhibited no symptoms of mediastinal syndrome associated with compression of the adjacent neurovascular structures. Moreover, she did not exhibit any fever or experience any weight loss.\n\nFor further evaluation, the patient underwent 18F-deoxyglucose (18FDG) positron emission tomography (PET)-computed tomography (CT) and chest CT with contrast media. On PET-CT, the mediastinal mass showed only mild FDG uptake (SUVmax = 4.3); no other sites of abnormal radiotracer uptake were reported in the neck, chest, abdomen, and skeleton. On CT images, the lesion presented regular margins, solid density, and mild contrast enhancement. The adjacent structures did not exhibit any signs of invasion, and lymphadenopathies or extra-thoracic disease were not present. Such radiological features, the indolent behaviour over time, the absence of systemic symptoms, and the lack of avid FDG uptake on PET-CT scan made the diagnosis of thymoma probable.\n\nHowever, on lung window visualization, multiple rounded areas of parenchymal lucency, consistent with thin-walled cysts distributed symmetrically throughout both lungs, with normal intervening parenchyma, were evident.\n\nNo nodules or other interstitial abnormalities were associated with the cysts. No pneumothorax was detected. Coherently with thalassemic bone disease, the ribs appeared widened, and the spine displayed mild platyspondyly. The remaining portion of the chest and visible upper abdomen were unremarkable. The radiological findings were consistent with cystic lung disease, most likely LAM.\n\nThe patient was then referred to the pulmonary clinic for further evaluation. She was a never-smoker and did not report any respiratory symptoms. In particular, she denied a history of chronic cough, recurrent respiratory infections, or pneumothorax. No cutaneous lesions, notably facial fibrofolliculomas, were evident. On chest examination, the lung fields were clear. Peripheral capillary oxygen saturation was normal (98%), with a heart rate of 75 beats per minute. Pulmonary function tests revealed a substantial reduction in diffusing capacity of the lungs for carbon monoxide (DLCO; 42% of the predicted value), partly imputable to the condition of anemia, with a carbon monoxide transfer coefficient (KCO) of 73% of the predicted value. After discussion in a multidisciplinary tumor board setting, including a pulmonologist, the patient underwent left thoracoscopic thymectomy and concomitant lingual segment wedge resection. The histopathological report revealed a morphological finding and immunohistochemical pattern referable to type B2 thymoma with focal infiltration of the capsule. Extracapsular extension was not evident. However, the lesion was present at the resection margin (stage IIa according to Masaoka–Koga; stage 1a according to the tumor, node, metastasis [TNM] classification).\n\nRegarding the lung parenchyma, histopathologic analysis described lung parenchyma with cysts of variable size lined by spindle cells in myoid habit with immunohistochemical reactivity for actin, estrogen, progesterone receptors, and HMB45 (focal positivity). Modest chronic interstitial inflammation, vascular congestion, and recent blood extravasation were evident. These morphological findings were compatible with pulmonary LAM.\n\nA final histological diagnosis of thymoma and pulmonary LAM was made. For the neoplastic condition, the patient was a candidate for adjuvant radiation therapy due to the microscopically incomplete resection (R1). For LAM with concomitant β-thalassemia, treatment with sirolimus was recommended.",
+    "summary": "A 56-year-old Italian female patient with β-thalassemia major underwent magnetic resonance imaging to quantify myocardial, hepatic, and pancreatic iron deposition. Her medical history included transfusion-dependent β-thalassemia, splenectomy, and cholecystectomy. At the time of magnetic resonance imaging, she had no significant endocrine, cardiac, or hepatic complications and was on deferasirox, vitamin D, and luspatercept. Magnetic resonance imaging revealed a lobulated mass in the prevascular mediastinum, which showed mild radiotracer uptake on positron emission tomography. Chest computed tomography revealed multiple thin-walled cysts in the lungs, indicating lymphangioleiomyomatosis. Following multidisciplinary evaluation, the patient underwent thoracoscopic thymectomy and lung wedge resection. Histopathology confirmed type B2 thymoma and pulmonary lymphangioleiomyomatosis. Post-surgery, the patient was recommended for adjuvant radiation therapy and sirolimus treatment.",
+    "translated_fulltext": null,
+    "translated_summary": null,
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": null
+  },
+  {
+    "id": "multiclinsum_gs_en_235.txt",
+    "fulltext": "We present a case of a 49-year-old woman with renal and heart failure following a long-term (lasting from 13 years of age) SLE prepared for kidney transplantation. Due to LN (class III, then IV), starting at childhood, she was treated with steroids, together with cyclophosphamide, replaced later by methotrexate and then azathioprine. Hence, the partial remission of nephrotic syndrome was achieved and from 2002 the patient did not receive any immunosuppressive therapy. She was also HBV and HCV positive. SLE involvement of circulatory system presented with early coronary atherosclerosis, ischemic heart disease, and myocardial infarction at the age of 20. In 2007, because of deterioration of kidney function with a serum creatinine concentration of 2.2 mg/dL and proteinuria of 2 g/day, the kidney biopsy was performed. The biopsy showed active and sclerotic focal proliferative lupus nephritis nevertheless immunosuppressive therapy was not introduced for the reason of active replication of HCV. The kidney function was gradually deteriorating over time. Despite cardiac intervention (PCI RCA), the patient developed severe post-infarction and dilated cardiomyopathy and required ICD implantation in primary prevention in 2009. Later, on lupus and secondary cardiomyopathic background, the patient developed severe MV and TV regurgitation. For this reason, the patient underwent mitral and tricuspid valve repair and left ventricle volume reduction surgery complicated by low cardiac output syndrome with a need for intra-aortic balloon pump use (2014). In the postoperative period, the kidney function deteriorated, requiring the initiation of renal replacement therapy. The patient has been on dialysis for 4 years. While being on active waiting list for kidney transplantation presented remission of laboratory indices of lupus (complement splits within normal limits: C3–0,93 g/l, C4–0,4 g/l, ANA negative) and persisting circulatory insufficiency with markedly reduced stair-climbing capacity (to one flight of stairs) with elevated BNP 619 pg/ml (n. 0–100). In transthoracic echocardiography, performed before renal transplantation, the left ventricle and the left atrium were significantly enlarged and the left ventricular systolic function was significantly reduced with LVEF 26% and GLS -3. Due to the implantation of the mitral ring, it was not possible to assess the left ventricular diastolic function. The high tricuspid regurgitant flow gradient with widened and poorly respiratory mobile inferior vena cava indicated a high probability of pulmonary hypertension. Furthermore, while preparing the patient for the surgical procedure, it was decided to include cardioprotective therapy with Levosimendan. Due to the time frame associated with the transplantation procedure, the drug infusion was started as soon as possible after cross-match results were known, immediately after the dialysis session. The infusion at a dose of 0.1 μg/kg/min was continued after surgery for a total of 24 h. The patient’s anesthesia for kidney transplantation and perioperative care included the aspect of optimizing transplanted kidney perfusion, avoiding the use of renal toxic drugs and those excreted by properly functioning kidneys, as well as the use of nephroprotective agents. Because of the patient’s cardiological burden, including recurrent episodes of extrasystole proceeding with decompensation of the circulatory system, together with the need of ICD turning off for the transplantation period, the Swan-Ganz catheter for hemodynamic assessment was not used. Anesthesia monitoring was limited the to ECG, central catheter with CVP assessment, direct blood pressure measurement from the cannula inserted into the radial artery, and cardiac ultrasound. In the perioperative period the CVP parameter was used to assess the volatility, and in the postoperative period, a cardiac ultrasound was used along with the assessment of VCI respiratory fill and motility. The therapy was aimed at the standard of fluid therapy called Goal Directed Therapy (GDT). During general anesthesia, fentanyl, triacrium, propofol, desflurane, antibiotic therapy, and standard immunosuppressive treatment were used as well as 25 g of mannitol infusion was administered as a nephroprotective treatment and 0.9% NaCl as a fluid therapy. In the course of postoperative immunosuppression, she received steroids, tacrolimus with mycophenolate mofetil which was stopped due to persistent leukopenia and cytomegalovirus infection. Furthermore delayed graft function was observed with a need for hemodialysis for almost 6 weeks (mostly due to fluid retention). BNP levels raised to 2996 pg/ml and then slowly decreased. The kidney biopsy performed 2 weeks after transplantation revealed acute rejection (AR II B Banff 2015) with ATN. Finally, the patient was discharged from the hospital on the 67th POD with the serum creatinine concentration of 1.4 mg/dL and BNP level of 1794 pg/ml. One month after kidney transplantation, there was a reduction in left ventricular dimensions, improved systolic function in the EF (increase to 30%) and GLS (decrease to − 6) assessment. In addition, there was a decrease in the tricuspid regurgitant flow gradient with normal width and respiratory motility of the IVC, which indicates a low probability of pulmonary hypertension. The improvement of echocardiographic parameters also reflected the simultaneous improvement of exercise capacity in the recipient from NYHA III/IV to NYHA II. In the 5-month observation, further improvement of heart function with a drop of BNP to 1066 pg/ml and normal kidney function were noted.",
+    "summary": "We present a case of a 49-year-old woman with renal and heart failure following a long-term SLE prepared for kidney transplantation. During the SLE course, the function of the heart and kidneys gradually deteriorated. The patient required the initiation of renal replacement therapy and was dialyzed until a kidney transplantation for 4 years. In the preparation of the patient for the surgical procedure, due to the extremely low ejection fraction, it was decided to include cardioprotective treatment with Levosimendan. The postoperative period was not straightforward but successful. In the monthly and five-month follow-up, a continuous improvement of heart function with normal renal function was noted.",
+    "translated_fulltext": null,
+    "translated_summary": "Chúng tôi xin trình bày một trường hợp bệnh nhân nữ 49 tuổi bị suy thận và suy tim do bệnh lupus ban đỏ hệ thống (SLE) kéo dài, và bệnh nhân này đã được chuẩn bị cho việc ghép thận. Trong quá trình diễn biến của bệnh SLE, chức năng tim và thận của bệnh nhân dần suy giảm. Bệnh nhân cần được bắt đầu điều trị thay thế chức năng thận và được lọc máu trong 4 năm cho đến khi được ghép thận. Trong quá trình chuẩn bị cho phẫu thuật, do chỉ số thể tích tống máu cực kỳ thấp, quyết định được đưa ra là sử dụng liệu pháp bảo vệ tim bằng Levosimendan. Giai đoạn hậu phẫu không diễn ra suôn sẻ nhưng cuối cùng đã thành công. Trong quá trình theo dõi hàng tháng và sau 5 tháng, chức năng tim của bệnh nhân đã cải thiện liên tục và chức năng thận trở lại bình thường.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা দীর্ঘমেয়াদি SLE-র পরিণতিতে কিডনি ও হৃদ্‌যন্ত্রের ব্যর্থতায় ভোগা ৪৯-বছর-বয়সী এক নারীর একটি কেস উপস্থাপন করছি, যিনি কিডনি প্রতিস্থাপনের জন্য প্রস্তুত করা হয়েছিল। SLE-এর গতিপ্রক্রিয়ার সময় ধীরে ধীরে হৃদ্‌যন্ত্র ও কিডনির কার্যকারিতা অবনতিশীল হয়েছিল। রোগীর renal replacement therapy শুরু করা প্রয়োজন হয় এবং তিনি কিডনি প্রতিস্থাপন হওয়া পর্যন্ত ৪ বছর ডায়ালাইসিসে ছিলেন। সার্জিকাল প্রক্রিয়ার প্রস্তুতিকালে, অত্যন্ত নিম্ন ejection fraction থাকার কারণে, Levosimendan দিয়ে cardioprotective চিকিৎসা অন্তর্ভুক্ত করার সিদ্ধান্ত নেওয়া হয়। অস্ত্রোপচারের পরবর্তী সময়কালটি সরল ছিল না, তবে সফল ছিল। মাসিক এবং পাঁচ-মাসের ফলো-আপে, হৃদ্‌যন্ত্রের কার্যকারিতায় ধারাবাহিক উন্নতি এবং কিডনির স্বাভাবিক কার্যকারিতা লক্ষ্য করা হয়।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0078_0079.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2vi_gemma(0_200)_0078_0079.json
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index 0000000000000000000000000000000000000000..e6bb419eee3abf2e3519c68b019f2b0ee7c6e504
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@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_313.txt",
+    "fulltext": "A male was born via an emergency cesarean section due to fetal distress at 40 weeks of gestational age. The mother's age was 33 years, with gravida 1 and para 1 parity. Both the parents and brother had no family history of congenital anomalies, aortic-related diseases, or sudden death. Based on the results of the prenatal ultrasonography at the end of the second trimester, the femur length of the fetus was found to be 1 to 3 weeks longer than the supposed length of the actual gestational age. Fetal echocardiography showed cardiomegaly with a fetal cardiothoracic circumference ratio of 0.5 or higher based on the baby's term. Moreover, the size of the foramen ovale was larger than normal, and left aortic constriction was seen next to the subclavian artery basin. Furthermore, no other abnormalities were found on prenatal ultrasound.\n\nAt birth, the weight was 3560 g (75 percentile), the length was 56.5 cm (over 90 percentile), and the head circumference was 36 cm (over 90 percentile). Apgar scores at 1 and 5 minutes were 4 and 6 points, respectively. In the delivery room, the patient had no spontaneous breathing and had bradycardia and cyanosis. After being admitted to the neonatal intensive care unit, various musculoskeletal malformations were confirmed via physical examination. Severe arachnodactyly and camptodactyly were observed in both hands and feet, and the soles of the feet were flat. The elbow and knee joints were not fully extended. The face had malar hypoplasia with senile facial appearance. The eye was deeply settled with a down-slanting palpebral fissure, and the ear with hypoplastic cartilage was poorly settled and crumpled. The patient presented with a sagging mouth, prominent coronal suture, and brachycephaly. A grade V/VI systolic murmur was heard at both the upper sternal border and left lower sternal border with grade III parasternal heave. Echocardiography showed poor cardiac contractility, severe pulmonary hypertension, dilated aortic sinus (20.2 mm) (Z-score; 8.08 by Boston, 6.37 by Detroit, or 5.97 by Halifax), and multiple intracardiac valvular dysfunction with valve prolapses (moderate aortic regurgitation, severe mitral regurgitation, moderate tricuspid regurgitation, and moderate pulmonary valve regurgitation). And the ophthalmologic examination results showed ectopia lentis in both eyes as well as lens subluxation. Liver herniation was confirmed using abdominal X-ray and ultrasound. The systemic score of the musculoskeletal manifestation was 11 points, according to the Ghent criteria (international diagnostic criteria for MFS).\n\nFor genetic diagnosis, Sanger sequencing and polymerase chain reaction were performed on the nucleotide sequence as reference for the FBN1 gene. As a result, a mutation in which G, the first base of the 32nd intron in the form of a heterogeneous mutation, was substituted with T (c.3964 + 1G > T). This was confirmed as the likely pathogen variant based on the 2015 ACMG/AMP guideline. The location of the mutation was included in the site previously known as the neonatal region of MFS (exons 24–32). The patient could be diagnosed with neonatal MFS with a novel FBN1 gene mutation within 2 weeks of life.\n\nOn the first day of life, differential cyanosis was found to show refractory hypoxemia despite more than 60% oxygen supply and signs of low cardiac output. The patient was managed medically for improving the low cardiac output according to severe mitral regurgitation and aortic regurgitation. Afterload reduction including milrinone continuous infusion, full sedation using fentanyl continuous infusion, and use of diuretic were attempt to improve the oliguria and heart failure. Despite the medical management, the patient presented with respiratory failure, heart failure, and severe pulmonary hypertension requiring continuous invasive mechanical ventilation. Aortic regurgitation, mitral regurgitation, pulmonary hypertension, and cardiac contractility got worse. After several consultations with the patient's family and medical staff about the treatment plan, palliative care was continued instead of surgical treatment. As a result, hepatic and pulmonary congestion accompanied by pulmonary hemorrhage had progressed as well. Eventually, it had progressed to multiple organ dysfunction syndrome, and the patient died 32 days after the birth.",
+    "summary": "Patient concerns:\nA newborn with neonatal MFS and severe cardiac involvement. He presented various severe clinical features such as arachnodactyly, camptodactyly, elbow and knee joint contracture, senile facial appearance, and deep settling with down-slanting palpebral fissure, hypoplastic ear cartilage, sagging mouth, brachycephaly, and ectopia lentis.\n\nDiagnosis:\nGenetic analysis revealed a novel mutation at nucleotide 3964 (c.3964 + 1 G > T) in intron 32 of the fibrillin-1 gene. This mutation is identified to be in the so-called neonatal region of fibrillin-1 exon 24 to 32, as reported previously.\n\nInterventions:\nThe patient was managed medically for improving the low cardiac output according to severe mitral regurgitation and aortic regurgitation. Afterload reduction, full sedation, and use of diuretic were attempted to improve the oliguria and heart failure.\n\nOutcomes:\nDespite the medical management, aortic regurgitation, mitral regurgitation, pulmonary hypertension, and cardiac contractility got worse. Surgical treatment is essential to prolong the patient's life, however, considerations for the grave progression of the disease make families decide to continue palliative care instead of surgical treatment. A few months after birth, he presented with rapidly progressive aortic regurgitation, mitral regurgitation, and congestive heart failure leading to death.",
+    "translated_fulltext": null,
+    "translated_summary": "Các vấn đề của bệnh nhân:\nMột trẻ sơ sinh mắc hội chứng Marfan ở trẻ sơ sinh và có các vấn đề nghiêm trọng về tim mạch. Bệnh nhi có nhiều triệu chứng lâm sàng nghiêm trọng như ngón tay và ngón chân dài, co rút các ngón, co rút khớp khuỷu và khớp gối, khuôn mặt già nua, hốc mắt sâu và mí mắt xếch xuống, sụn vành tai kém phát triển, miệng trễ, đầu ngắn và thủy tinh thể lệch.\n\nChẩn đoán:\nPhân tích di truyền cho thấy một đột biến mới ở nucleotide 3964 (c.3964 + 1 G > T) trong intron 32 của gen fibrillin-1. Đột biến này được xác định là nằm trong vùng được gọi là vùng sơ sinh của exon 24 đến 32 của fibrillin-1, như đã được báo cáo trước đó.\n\nĐiều trị:\nBệnh nhi được điều trị bằng thuốc để cải thiện lượng máu bơm ra từ tim do suy van hai lá và suy van động mạch chủ nghiêm trọng. Các biện pháp giảm hậu gánh, gây mê toàn thân và sử dụng thuốc lợi tiểu đã được thực hiện để cải thiện tình trạng thiểu niệu và suy tim.\n\nKết quả:\nMặc dù đã được điều trị bằng thuốc, nhưng tình trạng suy van động mạch chủ, suy van hai lá, tăng huyết áp phổi và khả năng co bóp của tim vẫn trở nên tồi tệ hơn. Phẫu thuật là cần thiết để kéo dài tuổi thọ của bệnh nhân, tuy nhiên, do tình trạng bệnh tiến triển nghiêm trọng, các gia đình quyết định tiếp tục điều trị giảm nhẹ thay vì phẫu thuật. Vài tháng sau khi sinh, bệnh nhi có tình trạng suy van động mạch chủ, suy van hai lá tiến triển nhanh chóng và suy tim sung huyết dẫn đến tử vong.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "রোগীর উদ্বেগ:\nneonatal MFS এবং গুরুতর কার্ডিয়াক সম্পৃক্ততা সহ এক নবজাতক। তার বিভিন্ন গুরুতর ক্লিনিক্যাল বৈশিষ্ট্য ছিল, যেমন arachnodactyly, camptodactyly, কনুই ও হাঁটু জয়েন্টের contracture, বয়স্কসুলভ মুখাবয়ব, গভীর বসে থাকা ও নিচের দিকে ঢালু palpebral fissure, hypoplastic ear cartilage, ঝুলন্ত মুখ, brachycephaly, এবং ectopia lentis.\n\nরোগনির্ণয়:\nজিনগত বিশ্লেষণে fibrillin-1 জিনের intron 32-এ nucleotide 3964 (c.3964 + 1 G > T)-এ একটি নতুন মিউটেশন ধরা পড়ে। এই মিউটেশনটি পূর্বে রিপোর্ট অনুযায়ী fibrillin-1-এর তথাকথিত neonatal region (exon 24 থেকে 32)-এর মধ্যে অবস্থিত হিসেবে শনাক্ত হয়েছে।\n\nহস্তক্ষেপ:\nগুরুতর mitral regurgitation এবং aortic regurgitation-জনিত নিম্ন cardiac output উন্নত করতে রোগীকে চিকিৎসাগতভাবে ম্যানেজ করা হয়। oliguria ও heart failure উন্নত করার লক্ষ্যে afterload reduction, পূর্ণ sedation, এবং diuretic ব্যবহারের চেষ্টা করা হয়।\n\nফলাফল:\nচিকিৎসাগত ব্যবস্থাপনার পরও aortic regurgitation, mitral regurgitation, pulmonary hypertension এবং cardiac contractility আরও খারাপ হয়। রোগীর জীবন দীর্ঘায়িত করতে সার্জিকাল চিকিৎসা অপরিহার্য; তবে রোগের গুরুতর অগ্রগতির বিবেচনায় পরিবার সার্জিকাল চিকিৎসার পরিবর্তে palliative care চালিয়ে যাওয়ার সিদ্ধান্ত নেয়। জন্মের কয়েক মাস পর, দ্রুত অগ্রগামী aortic regurgitation, mitral regurgitation এবং congestive heart failure নিয়ে তিনি উপস্থাপিত হন, যা পরিণতিতে মৃত্যুর কারণ হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_86.txt",
+    "fulltext": "A 27-year-old woman with beta-thalassemia major since 24 years and 16 weeks of pregnancy was referred from the Internal Medicine Department to the Oral Medicine Department with complaints of swelling, bleeding gums since early pregnancy, and bad breath. The patient was hospitalized with complaints of pain in her knee so he could not move. She was admitted to hospital with complaints of pain in her knees so she could not move and was diagnosed with Arthritis ar Genue Sinistra related to Thalassemia by an internal medicine specialist, sub division of rheumatology. General condition patient was weak, sick, and difficult to move during the approximately two weeks, when she was hospitalized. Patient has never visited a dentist, either before or now, with complaints about her oral cavity. The patient had a splenectomy in 2009. Her beta-thalassemia major was treated with routine blood transfusions once a month and iron anti- chelation drugs (deferoxamine); however, it was stopped due to pregnancy. There was no history of other systemic disease in this patient. A family history of the same disease was ruled out. History of recurrent stomatitis and drug or food allergies was ruled out.\n\nThe patient’s general condition weak, with normal vital signs; however, the patient had fever. Intraoral examination revealed gingival hyperplasia; erythema; soft consistency; a dark red, rounded gingival margin; tendencies to bleed on the labial, buccal, palatal, and lingual areas; and pain. Oral hygiene index-simplified (OHIS) score was poor (5.7) and there were true pockets in all regions. Peripheral blood morphology result: (1) erythrocytes: polychromacy in anisochrome populations (hypochrome, normochrome), anisopoikilocytosis (ovalocytes, target); (2) leukocytes: sufficient quantity, hypersegmentation (+); (3) platelet count: numbers increase, spread out; Interpretation: moderate anemia et causa thalassemia major accompanied by signs of increased erythropoiesis activity with suspected infection. The diagnosis was made based on the history, clinical features, and examination, as well as additional examinations, namely gingival enlargement accompanied by chronic periodontitis associated to pregnancy with β-thalassemia major and exfoliative cheilitis of the lips. The classification of periodontal disease in this patient is chronic periodontitis with gingival enlargement associated with pregnancy and beta-thalassemia major. The prognosis in this case was good because the patient was cooperative and followed the directions of the Oral Medicine Department. In this case, multidisciplinary therapy was a collaboration between an oral medicine specialist, a periodontist, and an internist. Dental therapy consisted of spooling with 3% hydrogen peroxide (H2O2) solution, chlorine dioxide spray mouthwash (Oxyfresh®, USA), antibiotics (amoxicillin 500 mg tablet, and metronidazole 300 mg tablet), and scaling/root planning. Spooling of H2O2 3% solution was performed at every visit; chlorine dioxide spray mouthwash was used three times a day after meals, and antibiotics were administered for seven days at third visit. Scaling and root planning were performed by the periodontist after the general condition was controlled and after the gingival hyperplasia and spontaneous bleeding improved. Blood transfusions to remove packed red cell buffy coat (PRC BCR) are also carried out routinely once a month. Non-pharmacological therapy, including oral hygiene instructions, was still given to patients. Oral complaints in this case occurred due to the poor oral hygiene, β-thalassemia major, and pregnancy, were also informed to the patient as education.\n\nThis patient had eight follow-up visits, consisting of two inpatient and six outpatient visits, with the following details:\n\nFirst Visit\nThe first visit was carried out one day after the initial inpatient visit (day +1). Intraoral bleeding still exists in the lingual-anterior part of the mandible, but bleeding in the anterior part of the maxilla has stopped. The patient still had a fever. Medications previously provided were used accordingly. Pharmacological were continued, including spooling 3% H2O2 on all parts of the gingiva, using chlorine dioxide as a mouthwash, and applying a thin layer of petroleum jelly to the lips. A blood transfusion was carried out last night. Oral hygiene instructions are still given to patients.\n\nSecond Visit\nThe second visit was performed two days after the initial visit (day +2). Intraoral bleeding Follow-up visits should be conducted in outpatient settings. Pharmacological therapy including spooling 3% H2O2 on all parts of the gingiva, using chlorine dioxide as a mouthwash, and applying a thin layer of petroleum jelly to the lips. A blood transfusion was carried out last night. Oral hygiene instructions are still given to patients.\n\nThird Visit\nNine days after the initial visit (Day+9). First outpatient treatment. Oral symptoms appeared to improve; bad breath was greatly reduced, but the gums were still swollen. The chlorine dioxide spray mouthwash was still being used and had run out. The patient could brush her teeth with a soft toothbrush but still experienced bleeding. Spooling was performed with 3% H2O2. The previous therapy was continued, antibiotics were prescribed 3x/day for seven days, and a blood transfusion was planned as a preparation for scaling the dental calculus. Oral hygiene instructions are still given to patients.\n\nFourth Visit\nOne month after the first visit (Day+30). Oral complaints improved significantly, bad breath was absent, gingiva enlargement decreased, and spontaneous bleeding ceased. The patient did not experience bleeding when brushing her teeth. Transfusions were performed between visits H+9 and H+30. During this visit, laboratory hematology tests and subsequent blood transfusions were performed. Antibiotics were no longer administered, 3% H2O2, chlorine dioxide, petroleum jelly and oral hygiene instructions were continued.\n\nFifth Visit\nOne week after the 4th visit (day +37), the oral complaints improved, but pharmacological and non-pharmacological therapy continued, including spooling 3% H2O2 on all parts of the gingiva, chlorine dioxide as a mouthwash, and applying a thin layer of petroleum jelly to the lips. Oral hygiene instructions are still given to patients. Supragingival scaling was planned two weeks later or after routine transfusions were administered.\n\nSixth Visit\nTwo months after the initial visit (day +60), the oral complaints improved. The gingival hyperplasia in some areas was no longer present, although in other areas still present, but they have undergone improvement. The transfusion had already been performed one week previously. Pharmacological therapy was continued, including 3% H2O2 spooling, chlorine dioxide spray mouthwash, and petroleum jelly. Non-pharmacological therapy namely oral hygiene instructions and an interdental toothbrush was suggested. Supra- and subgival scaling were performed.\n\nSeventh Visit\nTwo weeks after the 6th visit (Day+74), all the complaints improved. Gingival hyperplasia mostly resolved after scaling. Pharmacological includes 3% H2O2 spooling, chlorine dioxide spray mouthwash, and petroleum jelly as well as non-pharmacological therapy, consisting of oral hygiene instructions and the use of an interdental toothbrush.\n\nEighth Visit\nThree months after the initial visit (day +90), routine blood transfusions were performed one week before the visit. The patient is no longer presented with any oral complaints. All patients with gingival hyperplasia recovered optimally. The spooling process was stopped with 3% H2O2. Supra- and subgival scaling were performed again in all maxillary and mandibular regions. Instructions for the use of an interdental toothbrush, chlorine dioxide spray mouthwash, and petroleum jelly are still provided.",
+    "summary": "A 27-year-old woman, suffering from beta thalassemia major who is undergoing therapy in the form of routine blood transfusions every month and taking anti-chelation drugs but is currently stopping this because she is pregnant, currently 16 weeks pregnant, complains complained of swollen gums, bleeding, and bad breath. Extraoral examination revealed dry, exfoliative lips. Intraoral examination revealed gingival hyperplasia with erythema, soft consistency, dark red rounded gingival margins, bleeding, true pockets and pain throughout the labial, buccal, palatal, and lingual. There was no history of systemic disease in this patient. Patient has never visited a dentist, either before or now, with complaints about her oral cavity. Hematological parameters showed abnormalities, and peripheral blood examination revealed an infection. The oral diagnoses included gingival enlargement and chronic periodontitis associated with pregnancy and β- thalassemia major.\n\nCase Management\nDental management consisted of spooling with 3% hydrogen peroxide (H2O2) spooling, chlorine dioxide spray mouthwash, antibiotics, calculus removal, and oral hygiene instructions. Blood transfusions were administered once a month, and anti-chelation therapy was stopped during pregnancy. After three months of multidisciplinary management, the results were satisfactory.",
+    "translated_fulltext": null,
+    "translated_summary": "Một phụ nữ 27 tuổi, mắc bệnh thalassemia beta nặng, đang được điều trị bằng cách truyền máu định kỳ hàng tháng và dùng thuốc chống quá tải sắt, nhưng hiện tại đã ngừng điều trị vì đang mang thai, hiện đã được 16 tuần, phàn nàn về tình trạng nướu sưng, chảy máu và hôi miệng. Khám bên ngoài cho thấy môi khô và bong tróc. Khám bên trong miệng cho thấy tình trạng phì đại nướu với các dấu hiệu viêm, kết cấu mềm, viền nướu màu đỏ sẫm, tròn, chảy máu, có các túi sâu và đau ở vùng môi, má, vòm miệng và lưỡi. Bệnh nhân không có tiền sử mắc các bệnh toàn thân. Bệnh nhân chưa từng đi khám nha khoa, cả trước đây lẫn hiện tại, và không có phàn nàn nào về tình trạng răng miệng. Các chỉ số huyết học cho thấy có bất thường, và xét nghiệm máu ngoại vi cho thấy có nhiễm trùng. Các chẩn đoán về răng miệng bao gồm tình trạng phì đại nướu và viêm nha chu mãn tính liên quan đến thai kỳ và bệnh thalassemia beta nặng.\n\nQuản lý điều trị\nĐiều trị nha khoa bao gồm súc miệng bằng dung dịch 3% hydrogen peroxide (H2O2), sử dụng nước súc miệng chứa chlorine dioxide, dùng thuốc kháng sinh, làm sạch vôi răng và hướng dẫn vệ sinh răng miệng. Truyền máu được thực hiện một lần mỗi tháng và liệu pháp chống quá tải sắt được ngừng trong thời kỳ mang thai. Sau ba tháng điều trị đa chuyên khoa, kết quả đạt được là tốt.",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "একজন ২৭ বছর বয়সী নারী, beta thalassemia major-এ আক্রান্ত, যিনি প্রতি মাসে নিয়মিত রক্ত সঞ্চালন এবং anti-chelation ওষুধ গ্রহণ করে চিকিৎসাধীন ছিলেন, কিন্তু বর্তমানে গর্ভবতী হওয়ার কারণে এটি বন্ধ রেখেছেন, বর্তমানে গর্ভকাল ১৬ সপ্তাহ, তিনি ফোলা মাড়ি, রক্তপাত এবং মুখের দুর্গন্ধের অভিযোগ করেছেন। এক্সট্রাওরাল পরীক্ষায় ঠোঁট শুষ্ক ও এক্সফোলিয়েটিভ ছিল। ইনট্রাওরাল পরীক্ষায় ইরিথেমাসহ gingival hyperplasia, নরম কনসিস্টেন্সি, গাঢ় লাল বৃত্তাকার gingival margins, রক্তপাত, true pockets এবং ব্যথা labial, buccal, palatal, এবং lingual জুড়ে পাওয়া যায়। এই রোগীর কোনো সিস্টেমিক রোগের ইতিহাস ছিল না। রোগী কখনোই দন্তচিকিৎসকের কাছে যাননি, পূর্বে বা বর্তমানে, এবং তার মুখগহ্বর সম্পর্কে কোনো অভিযোগ নেই। হেমাটোলজিক্যাল প্যারামিটারগুলো অস্বাভাবিকতা দেখিয়েছে, এবং পারিফেরাল ব্লাড পরীক্ষায় সংক্রমণ ধরা পড়েছে। ওরাল ডায়াগনোসিসে গর্ভাবস্থা এবং β-thalassemia major-সংশ্লিষ্ট gingival enlargement এবং chronic periodontitis অন্তর্ভুক্ত ছিল।\n\nকেস ম্যানেজমেন্ট\nডেন্টাল ম্যানেজমেন্টে ৩% hydrogen peroxide (H2O2) দিয়ে স্পুলিং, chlorine dioxide স্প্রে মাউথওয়াশ, অ্যান্টিবায়োটিক, ক্যালকুলাস রিমুভাল, এবং oral hygiene নির্দেশনা অন্তর্ভুক্ত ছিল। রক্ত সঞ্চালন মাসে একবার করা হতো, এবং গর্ভাবস্থায় anti-chelation থেরাপি বন্ধ রাখা হয়েছিল। তিন মাসের মাল্টিডিসিপ্লিনারি ম্যানেজমেন্টের পর ফলাফল সন্তোষজনক ছিল।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0000_0001.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0000_0001.json
new file mode 100644
index 0000000000000000000000000000000000000000..ff87b4fdc700b16a72c3b5454575bff65fd97890
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0000_0001.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_27.txt",
+    "fulltext": "A 20-year-old woman was followed up since the age of eight for idiopathic NS inaugurated by cerebral venous thrombosis extended to the right jugular vein with a massive pulmonary embolism. The patient did not have any sequelae. She had no other medical or surgical history. A family history of thrombosis has not been reported. The patient was not biopsied because she had no kidney failure nor gross hematuria, or hypertension at first presentation; added to that, she had no extra renal signs suggestive of a secondary nephrotic syndrome. She was accordingly put on anticoagulant therapy (Oral vitamin K antagonist) and oral corticosteroid therapy with good evolution. Thereafter, the patient received several cures of high-dose corticosteroids for steroid-dependent relapses of NS. She was, hence, put on mycophenolate mofetil (MMF) as a background therapy to avoid corticosteroids and ensure normal growth. An exhaustive assessment of thrombophilia was performed and did not show any abnormality. Homocysteine rate, blood fibrinogen rate, Protein C, protein S, antithrombin III, factor V Leiden mutation, JAK-2 mutation, cryoglobulins, anticardiolipin antibodies, lupus anticoagulant and beta-1-glycoprotein antibodies were normal. The anticoagulant treatment was stopped after nine years. The evolution was enameled by the occurrence of several relapses of her disease controlled by oral corticosteroid therapy. Remission of NS has been noted since 2017, so MMF was gradually stopped in 2019 and the patient remained asymptomatic and without any relapse.\n\nOne year later, the patient came up to our emergency department for acute intense diffuse abdominal pain without any particular irradiation associated with postprandial vomiting and bilateral lower limb edema for the last six hours. The physical examination revealed an intense epigastric tenderness with normal vital signs (arterial pressure of 120/70 mm Hg, heart rate of 83 bpm, and oxygen saturation at 100% on room air). The patient was afebrile with normal consciousness. The rest of the physical examination was unremarkable. The urinalysis with labstix revealed proteinuria. The hemogasanalysis results showed metabolic acidosis with respiratory compensation. Further laboratory tests revealed hypoalbuminemia, hypercholesterolemia, a prothrombin time at 90%, high levels of D-dimer, lactate dehydrogenase, and creatine phosphokinase as well as a biological inflammatory syndrome with a CRP of 37 mg/L, and leucocytosis at 26.4 x 103/µL. Renal and liver functions were normal.\n\nThe patient was hospitalized in an intensive care unit with close monitoring of vital signs and initiation of resuscitation measures. An abdominal ultrasound was performed urgently showing an intra-abdominal effusion of low to moderate abundance. An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery with acute mesenteric ischemia. The patient was immediately routed to the operating room. Intraoperative exploration confirmed mesenteric ischemia with extensive necrosis of almost entirely of the small bowel making their resections incompatible with life shown in Figure 3. The patient died after 48 hours.",
+    "summary": "We present the case of a 20-year-old woman with a 12-year history of idiopathic NS revealed by extensive cerebral venous thrombosis with pulmonary embolism treated with anticoagulation therapy and oral corticosteroid therapy followed by mycophenolate mofetil (MMF). The thrombophilia assessment did not show any abnormalities. The evolution was marked by the occurrence of several NS relapses controlled by oral corticosteroid therapy until 2017. Subsequently, the patient had not presented a relapse of her disease. The anticoagulant treatment and the MMF were therefore stopped. One year later, the patient presented with severe diffuse acute abdominal pain associated with postprandial vomiting and bilateral lower limb edema. Laboratory results confirmed a NS relapse. An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery with acute mesenteric ischemia. Intraoperative exploration showed mesenteric ischemia with extensive necrosis of the small intestine making their resections incompatible with life. The patient died after 48 hours.",
+    "translated_fulltext": "一位20岁的女性，自8岁起开始接受随访，患有特发性肾病综合征，其病因是脑静脉血栓，血栓延伸至右颈静脉，并伴有大面积肺栓塞。患者没有出现任何后遗症，也没有其他既往病史或手术史。家族中没有血栓形成的病史。由于患者最初就诊时没有肾功能衰竭、肉眼可见血尿或高血压，因此没有进行活检。此外，她也没有其他肾外表现，这些表现可能提示继发性肾病综合征。因此，她接受了抗凝治疗（口服维生素K拮抗剂）和口服皮质类固醇治疗，并取得了良好的疗效。此后，患者接受了几次高剂量皮质类固醇治疗，以控制对皮质类固醇依赖的肾病综合征复发。因此，她开始接受霉酚酸酯（MMF）作为基础治疗，以避免使用皮质类固醇，并确保正常生长。对患者进行了全面的血栓倾向评估，结果未发现任何异常。同型半胱氨酸水平、血浆纤维蛋白原水平、蛋白C、蛋白S、抗凝血酶III、V因子Leiden突变、JAK-2突变、冷凝集蛋白、抗心磷脂抗体、狼疮抗凝剂和β-1糖蛋白抗体均正常。抗凝治疗在九年后停止。此后，患者的病情经历了多次复发，但通过口服皮质类固醇治疗得到了控制。自2017年起，肾病综合征的症状得到缓解，因此，2019年逐渐停止使用MMF，患者保持无症状，且未出现任何复发。\n\n一年后，患者因突发剧烈弥漫性腹痛，伴有餐后呕吐和双下肢水肿，症状持续了六小时，来到我院急诊科。体格检查显示，上腹部有剧烈压痛，生命体征正常（动脉血压120/70 mmHg，心率83 bpm，在室内空气中氧饱和度为100%）。患者没有发烧，意识正常。其余体格检查结果无异常。尿液分析显示蛋白尿。血气分析结果显示代谢性酸中毒，并伴有呼吸代偿。进一步的实验室检查显示低白蛋白血症、高胆固醇血症、凝血酶原时间为90%，D-二聚体、乳酸脱氢酶和肌酸激酶水平升高，以及生物炎症综合征，C反应蛋白为37 mg/L，白细胞计数为26.4 x 103/µL。肾功能和肝功能正常。\n\n患者被收治入院，进入重症监护室，密切监测生命体征，并开始进行复苏措施。紧急进行腹部超声检查，显示腹腔内有少量至中等量的积液。腹部CT扫描显示上肠系膜动脉急性血栓形成，伴有急性肠系膜缺血。患者立即被送往手术室。术中探查证实肠系膜缺血，几乎整个小肠出现广泛坏死，这使得切除手术与生命不相容，如图3所示。患者在术后48小时死亡。",
+    "translated_summary": "我们报告了一例20岁女性的病例，该患者患有特发性肾病综合征，病史长达12年。该患者曾出现广泛的脑静脉血栓形成，并伴有肺栓塞，接受了抗凝治疗和口服皮质类固醇治疗，随后又接受了霉酚酸酯（MMF）治疗。血栓形成倾向评估未发现任何异常。此后，该患者病情反复，多次出现肾病综合征复发，通过口服皮质类固醇治疗得以控制，直至2017年。此后，该患者未再出现疾病复发。因此，停止了抗凝治疗和MMF治疗。一年后，该患者出现严重的弥漫性急性腹痛，伴有餐后呕吐和双侧下肢水肿。实验室检查结果证实肾病综合征复发。腹部CT扫描显示上肠系膜动脉出现急性血栓形成，并伴有急性肠系膜缺血。术中探查显示肠系膜缺血，小肠出现广泛坏死，导致切除手术与生命不相容。患者在术后48小时内死亡。",
+    "corrected_translated_fulltext": "একজন ২০ বছর বয়সী নারী ৮ বছর বয়স থেকে idiopathic NS‑এর জন্য ফলো‑আপে ছিলেন, যা cerebral venous thrombosis দ্বারা শুরু হয়েছিল এবং ডান jugular vein পর্যন্ত বিস্তৃত হয়ে massive pulmonary embolism সহ ছিল। রোগীর কোনো সিকুয়েলা ছিল না, এবং অন্য কোনো চিকিৎসাগত বা অস্ত্রোপচারের ইতিহাসও ছিল না। থ্রম্বোসিসের পারিবারিক ইতিহাস রিপোর্ট করা হয়নি। প্রথম উপস্থাপনার সময় kidney failure, gross hematuria বা hypertension না থাকায় রোগীর biopsy করা হয়নি। তদুপরি, secondary nephrotic syndrome‑এর পক্ষে নির্দেশক কোনো extra‑renal লক্ষণও ছিল না। সেই অনুযায়ী তাকে anticoagulant therapy (oral vitamin K antagonist) এবং oral corticosteroid therapy দেওয়া হয়, যার ফল ভালো ছিল। পরবর্তীতে NS‑এর steroid‑dependent relapse‑গুলির জন্য রোগী একাধিকবার high‑dose corticosteroid পেয়েছিলেন। ফলে corticosteroid এড়াতে এবং স্বাভাবিক বৃদ্ধি নিশ্চিত করতে তাকে background therapy হিসেবে mycophenolate mofetil (MMF) শুরু করা হয়। thrombophilia‑র একটি বিস্তৃত মূল্যায়ন করা হয়েছিল এবং কোনো অস্বাভাবিকতা পাওয়া যায়নি। Homocysteine rate, blood fibrinogen rate, Protein C, Protein S, antithrombin III, factor V Leiden mutation, JAK‑2 mutation, cryoglobulins, anticardiolipin antibodies, lupus anticoagulant এবং beta‑1‑glycoprotein antibodies স্বাভাবিক ছিল। নয় বছর পর anticoagulant চিকিৎসা বন্ধ করা হয়। পরবর্তীতে রোগের একাধিক relapse ঘটে, যা oral corticosteroid therapy দ্বারা নিয়ন্ত্রিত হয়। ২০১৭ সাল থেকে NS‑এর remission লক্ষ্য করা যায়, তাই ২০১৯ সালে ধীরে ধীরে MMF বন্ধ করা হয় এবং রোগী উপসর্গহীন থাকেন ও কোনো relapse হয়নি।\n\nএক বছর পরে, রোগী গত ছয় ঘণ্টা ধরে কোনো নির্দিষ্ট রেডিয়েশন ছাড়া তীব্র বিস্তৃত পেটব্যথা, postprandial vomiting এবং উভয় নিম্ন অঙ্গের edema নিয়ে আমাদের জরুরি বিভাগে আসেন। শারীরিক পরীক্ষায় তীব্র epigastric tenderness পাওয়া যায় এবং vital signs স্বাভাবিক ছিল (arterial pressure 120/70 mm Hg, heart rate 83 bpm, এবং room air‑এ oxygen saturation 100%)। রোগীর জ্বর ছিল না এবং চেতনাস্থা স্বাভাবিক ছিল। বাকি শারীরিক পরীক্ষায় কোনো বিশেষত্ব ছিল না। labstix সহ urinalysis‑এ proteinuria ধরা পড়ে। hemogasanalysis‑এ respiratory compensation সহ metabolic acidosis দেখা যায়। পরবর্তী ল্যাব পরীক্ষায় hypoalbuminemia, hypercholesterolemia, prothrombin time 90%, D‑dimer, lactate dehydrogenase এবং creatine phosphokinase উচ্চ মাত্রা, সাথে biological inflammatory syndrome (CRP 37 mg/L) এবং leucocytosis 26.4 x 103/µL পাওয়া যায়। কিডনি ও লিভার ফাংশন স্বাভাবিক ছিল।\n\nরোগীকে intensive care unit‑এ ভর্তি করা হয়, যেখানে vital signs ঘনিষ্ঠভাবে পর্যবেক্ষণ করা হয় এবং resuscitation ব্যবস্থা শুরু করা হয়। জরুরি ভিত্তিতে abdominal ultrasound করা হয়, যাতে নিম্ন থেকে মধ্যম মাত্রার intra‑abdominal effusion দেখা যায়। abdominal CT scan‑এ superior mesenteric artery‑র acute thrombosis সহ acute mesenteric ischemia ধরা পড়ে। রোগীকে অবিলম্বে operating room‑এ নেওয়া হয়। অস্ত্রোপচারকালীন অনুসন্ধানে mesenteric ischemia নিশ্চিত হয় এবং প্রায় সম্পূর্ণ ছোট অন্ত্রে ব্যাপক নেক্রোসিস পাওয়া যায়, যা তাদের রিসেকশনকে জীবনের সাথে অসংগত করে তোলে, Figure 3‑এ দেখানো হয়েছে। রোগী ৪৮ ঘণ্টা পরে মারা যান।",
+    "corrected_translated_summary": "আমরা 20 বছর বয়সী এক নারীর একটি কেস উপস্থাপন করছি, যার idiopathic NS-এর 12 বছরের ইতিহাস রয়েছে। ওই রোগীর ব্যাপক cerebral venous thrombosis সহ pulmonary embolism হয়েছিল, এবং তিনি anticoagulation therapy ও oral corticosteroid therapy পেয়েছিলেন, পরবর্তীতে mycophenolate mofetil (MMF) দেওয়া হয়। thrombophilia assessment-এ কোনো অস্বাভাবিকতা পাওয়া যায়নি। পরবর্তী সময়ে রোগীর একাধিক NS relapses হয়েছিল, যা 2017 সাল পর্যন্ত oral corticosteroid therapy দিয়ে নিয়ন্ত্রণে ছিল। এরপর রোগীর আর রোগের relapse হয়নি। সুতরাং anticoagulant treatment এবং MMF বন্ধ করা হয়। এক বছর পর রোগীর তীব্র বিস্তৃত আকস্মিক পেটব্যথা হয়, postprandial vomiting এবং bilateral lower limb edema-সহ। Laboratory ফলাফলে NS relapse নিশ্চিত হয়। abdominal CT scan-এ superior mesenteric artery-তে acute thrombosis এবং acute mesenteric ischemia ধরা পড়ে। Intraoperative exploration-এ mesenteric ischemia এবং small intestine-এর extensive necrosis দেখা যায়, যা তাদের resection-কে জীবনের সঙ্গে অসামঞ্জস্যপূর্ণ করে তোলে। রোগী 48 ঘণ্টা পর মারা যান।"
+  },
+  {
+    "id": "multiclinsum_gs_en_523.txt",
+    "fulltext": "We present the case of a 34-year-old woman, eight weeks pregnant with no other personal history of interest, who presents to the emergency department with generalized convulsions with dysarthria in the postcritical period, which resolve progressively in less than two hours. On physical examination, she is conscious, oriented, with no language or motor or sensory deficits. Only signs of a right lateral tongue bite are observed.\n\nThe complementary tests, such as blood tests or the electrocardiogram, are normal. Given that the episode corresponds with a first epileptic seizure and the patient is pregnant, an urgent magnetic resonance of the skull is requested.\n\nThe usual protocol was performed and 3D T1 sequences without and with intravenous contrast were obtained in axial, coronal and sagital planes, axial FLAIR, axial T2, VEN BOLD and magnetic susceptibility sequences, as well as axial diffusion and apparent diffusion coefficient map. The MRI identified multiple venous cortico-medullary vascular structures converging centripetally to a large central venous structure draining through the inferior anastomotic vein into the left transverse sinus, forming the classic ‘Medusa head’ sign. In the T1 sequences, the drainage vein was seen to be increased in signal with central hyphocaptation after contrast administration, suggesting partial thrombosis versus slow flow. In addition, in T2 and FLAIR sequences, the brain tissue surrounding the drainage vein was seen to be hyperintense, without diffusion restriction and compatible with edema.\n\nThese findings are suggestive of a venous anomaly of development with signs of partial peripheral thrombosis and slow flow more proximal, which cause edema of the surrounding tissue. She is started on clexane 60 mg/12 hours and levetiracetam 500 mg/12 hours and the patient shows improvement and symptomatic stability after one week.\n",
+    "summary": "A 34-year-old pregnant woman presents with seizures and dysarthria and is urgently referred for a cranial MRI. The classic ‘Medusa head’ sign is seen and the diagnosis is made as a venous anomaly of development with peripheral partial thrombosis and proximal slow flow.\n",
+    "translated_fulltext": "我们报告了一例34岁女性的病例。该患者怀孕八周，既往病史无特殊，因出现全身性抽搐，伴有构音障碍，于危重期后到急诊科就诊，症状在不到两小时内逐渐缓解。体格检查显示，患者意识清醒，定向力正常，语言、运动和感觉功能均无异常。仅观察到右侧舌头有咬伤迹象。\n\n辅助检查，如血液检查和心电图，结果均正常。考虑到该患者的症状与首次癫痫发作相符，且患者正处于怀孕状态，因此要求进行紧急颅部磁共振检查。\n\n按照常规流程进行检查，并获取了轴位、冠状位和矢状位的3D T1序列（有和无静脉注射对比剂）、轴位FLAIR序列、轴位T2序列、VEN BOLD序列和磁敏感性序列，以及轴位弥散序列和表观弥散系数图。MRI显示，多条静脉皮质-髓质血管结构汇聚，呈向心性，最终汇入一个大的中央静脉结构，并通过下部吻合静脉流入左侧横窦，形成典型的“美杜莎头”征象。在T1序列中，可以看到引流静脉在注射对比剂后，信号增强，中心区域出现强化，提示可能存在部分血栓形成或血流缓慢。此外，在T2和FLAIR序列中，可以看到引流静脉周围的脑组织信号增强，但没有弥散受限，与水肿相符。\n\n这些发现提示存在一种发育性静脉异常，伴有部分周围血栓形成和更近端的血流缓慢，导致周围组织水肿。患者开始接受克лекса宁60毫克，每12小时一次，以及左乙拉西坦500毫克，每12小时一次，治疗一周后，患者的症状得到改善，病情稳定。",
+    "translated_summary": "一位34岁的孕妇出现癫痫和构音障碍，情况紧急，被立即转诊进行颅部MRI检查。检查结果显示出经典的“美杜莎头”征象，诊断为一种发育性静脉异常，伴有周围部分血栓形成和近端血流缓慢。",
+    "corrected_translated_fulltext": "আমরা ৩৪ বছর বয়সী এক মহিলার একটি কেস উপস্থাপন করছি। তিনি আট সপ্তাহের গর্ভবতী, অন্য কোনো উল্লেখযোগ্য ব্যক্তিগত রোগ-ইতিহাস নেই, এবং সাধারণীকৃত convulsions সহ postcritical পর্যায়ে dysarthria নিয়ে জরুরি বিভাগে আসেন, যা দুই ঘণ্টারও কম সময়ে ধীরে ধীরে সেরে যায়। শারীরিক পরীক্ষায় তিনি সচেতন, অভিমুখ ঠিক আছে, ভাষা, মোটর বা সংবেদন ঘাটতি নেই। কেবলমাত্র ডান পার্শ্বীয় জিহ্বা কামড়ানোর চিহ্ন লক্ষ্য করা যায়। সহায়ক পরীক্ষা, যেমন রক্ত পরীক্ষা ও electrocardiogram, স্বাভাবিক ছিল। এপিসোডটি প্রথম epileptic seizure-এর সঙ্গে সঙ্গতিপূর্ণ এবং রোগী গর্ভবতী হওয়ায়, জরুরি skull-এর magnetic resonance অনুরোধ করা হয়। প্রচলিত প্রোটোকল অনুসরণ করা হয় এবং axial, coronal এবং sagital plane-এ intravenous contrast ছাড়া ও সহ 3D T1 sequence, axial FLAIR, axial T2, VEN BOLD এবং magnetic susceptibility sequence, তদুপরি axial diffusion ও apparent diffusion coefficient map সংগৃহীত হয়। MRI-তে একাধিক venous cortico-medullary ভাসকুলার স্ট্রাকচারকে কেন্দ্রমুখীভাবে একটি বৃহৎ কেন্দ্রীয় venous স্ট্রাকচারের দিকে অভিসারিত হতে দেখা যায়, যা inferior anastomotic vein হয়ে left transverse sinus-এ নিষ্কাশিত হয়, এবং ক্লাসিক ‘Medusa head’ sign গঠন করে। T1 sequences-এ, ড্রেনেজ ভেইনে contrast প্রদানের পর সিগনাল বৃদ্ধি এবং কেন্দ্রীয় hyphocaptation দেখা যায়, যা partial thrombosis বনাম slow flow নির্দেশ করে। অতিরিক্তভাবে, T2 এবং FLAIR sequence-এ ড্রেনেজ ভেইনের চারপাশের brain tissue-কে hyperintense হিসেবে দেখা যায়, diffusion restriction ছাড়াই এবং edema-র সঙ্গে সামঞ্জস্যপূর্ণ। এসব ফাইন্ডিংস একটি venous anomaly of development নির্দেশ করে, যেখানে আংশিক peripheral thrombosis-এর চিহ্ন এবং আরো proximal স্থানে slow flow রয়েছে, যা পারিপার্শ্বিক টিস্যুর edema সৃষ্টি করছে। তাকে Clexane 60 mg/12 hours এবং levetiracetam 500 mg/12 hours শুরু করা হয় এবং এক সপ্তাহ পর রোগীর উপসর্গের উন্নতি ও উপসর্গগত স্থিতিশীলতা দেখা যায়।",
+    "corrected_translated_summary": "৩৪ বছর বয়সী এক গর্ভবতী নারী খিঁচুনি এবং dysarthria নিয়ে উপস্থিত হন এবং জরুরিভাবে cranial MRI-এর জন্য রেফার করা হয়। ক্লাসিক ‘Medusa head’ সাইন দেখা যায় এবং peripheral partial thrombosis ও proximal slow flow সহ একটি developmental venous anomaly হিসেবে রোগনির্ণয় করা হয়।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0006_0007.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0006_0007.json
new file mode 100644
index 0000000000000000000000000000000000000000..1f8ae987232c0e36ca4ca9a29de9de1bc01a873b
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0006_0007.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_47.txt",
+    "fulltext": "We present here the case of a two-day old neonate with in-born right scrotal swelling admitted at Children’s hospital. The patient was born at term via cesarean section at a private hospital. He was kept in the nursery for one day. The examining doctor referred them for urgent surgical care, but it took them one day to arrive at our hospital. Upon arrival in the emergency department, he was well hydrated, pink at room temperature with good perfusion. Upon examination, the right testis was found to be enlarged, tense, non-tender visibly reddish with overlying skin excoriation. Trans-illumination was negative in the right but positive in the contralateral testis. Both hernial orifices were normal. All the laboratory investigations were performed with an urgent Doppler ultrasound of the inguinoscrotal area. The ultrasound examination found the right testis to be enlarged (15.6*9.4 mm) and showed heterogeneous hypoechoic texture with prominent rete testis and no flow on color Doppler analysis. Left testis appeared normal in size, shape and echotexture with minimal hydrocele. An urgent scrotal exploration was undertaken. Intra-operatively, there was frank necrotic right testis with intravaginal torsion of the testis with minimal hydrocele. A right orchidectomy and contralateral orchidopexy was then performed.",
+    "summary": "We present here the case of a two-day old neonate with in-born right scrotal swelling admitted at Children’s hospital. The patient was born at term via cesarean section at a private hospital. Upon arrival in the emergency department, he was well hydrated, pink at room temperature with good perfusion. Upon examination, the right testis was found to be enlarged, tense, non-tender visibly reddish with overlying skin excoriation. Trans-illumination was negative in right but positive in the contralateral testis. Both hernial orifices were normal. Doppler ultrasound of the inguinoscrotal area found the right testis to be enlarged (15.6*9.4 mm) and showed heterogeneous hypoechoic texture with prominent rete testis and no flow on color doppler analysis. An urgent scrotal exploration was undertaken. Intra-operatively there was frank necrotic right testis with intravaginal torsion of the testis and minimal hydrocele. A right orchidectomy and contralateral orchidopexy were performed.",
+    "translated_fulltext": "我们在此介绍一例两日大的新生儿，因先天性右侧阴囊肿胀而入院，该患儿在儿童医院接受治疗。患儿在一家私立医院通过剖腹产足月出生。他曾在新生儿病房待了一天。检查医生建议立即进行手术治疗，但他们花费了一天时间才到达我院。抵达急诊科时，患儿水合状态良好，在室温下皮肤呈粉红色，循环良好。检查发现，右侧睾丸肿大、紧张，可见呈红色的表面，且有皮肤破损。右侧睾丸透光试验为阴性，而对侧睾丸为阳性。两个腹股沟孔均正常。所有实验室检查均已完成，并紧急进行了腹股沟-阴囊区域的多普勒超声检查。超声检查显示，右侧睾丸肿大（15.6*9.4毫米），呈现出不均匀的低回声组织，睾丸网状结构明显，彩色多普勒分析显示无血流。左侧睾丸大小、形状和回声结构均正常，并伴有轻微的阴囊积液。随后进行了紧急的阴囊探查。术中发现，右侧睾丸出现明显的坏死，并伴有阴囊内睾丸扭转，且阴囊积液较少。随后进行了右侧睾丸切除术和对侧睾丸固定术。",
+    "translated_summary": "本文介绍了一例在儿童医院就诊的、出生仅两天的新生儿，其右侧阴囊出现先天性肿胀。该患儿在一家私立医院通过剖腹产分娩，足月出生。抵达急诊科时，患儿水合状态良好，体温正常，皮肤颜色正常，循环良好。检查发现，右侧睾丸肿大、紧张，可见表面的皮肤有红斑和擦伤，触诊无明显疼痛。透光试验显示，右侧睾丸透光性为阴性，而对侧睾丸透光性为阳性。两个腹股沟孔均正常。对腹股沟阴囊区域进行多普勒超声检查，结果显示右侧睾丸肿大（15.6*9.4毫米），呈现出不均匀的低回声结构，睾网结构明显，彩色多普勒分析显示无血流。随后立即进行了紧急阴囊探查。术中发现，右侧睾丸出现明显坏死，并伴有睾丸鞘内扭转，以及少量阴囊积液。遂行右侧睾丸切除术和对侧睾丸固定术。",
+    "corrected_translated_fulltext": "আমরা এখানে দুই দিন বয়সী এক নবজাতকের একটি কেস উপস্থাপন করছি, যার জন্মগত ডান দিকের স্ক্রোটাল স্ফীতি ছিল এবং যে একটি শিশু হাসপাতালে ভর্তি হয়েছিল। রোগী একটি বেসরকারি হাসপাতালে সিজারিয়ান সেকশনের মাধ্যমে পূর্ণসময়ে জন্মগ্রহণ করেন। তাকে এক দিন নার্সারিতে রাখা হয়েছিল। পরীক্ষাকারী চিকিৎসক জরুরি সার্জিকাল কেয়ারের জন্য রেফার করেছিলেন, কিন্তু আমাদের হাসপাতালে পৌঁছাতে তাদের এক দিন লেগে যায়। ইমার্জেন্সি বিভাগে পৌঁছানোর সময় তিনি ভালোভাবে হাইড্রেটেড ছিলেন, কক্ষ তাপমাত্রায় গোলাপি বর্ণের এবং পারফিউশন ভালো ছিল। পরীক্ষায় ডান অণ্ডকোষ বড়, টেন্স, non-tender, দৃশ্যত লালচে ছিল এবং ওপরের ত্বকে excoriation ছিল। ডান দিকে trans-illumination নেগেটিভ ছিল, কিন্তু বিপরীতপক্ষের অণ্ডকোষে পজিটিভ ছিল। উভয় hernial orifice স্বাভাবিক ছিল। সব ল্যাবরেটরি ইনভেস্টিগেশন সম্পন্ন করা হয়, সাথে inguinoscrotal এলাকার জরুরি Doppler ultrasound করা হয়। আল্ট্রাসাউন্ড পরীক্ষায় ডান অণ্ডকোষ বড় (15.6*9.4 mm) পাওয়া যায় এবং heterogeneous hypoechoic texture সহ prominent rete testis দেখা যায়, color Doppler analysis-এ কোনো flow ছিল না। বাম অণ্ডকোষের আকার, আকৃতি এবং echotexture স্বাভাবিক ছিল, সাথে minimal hydrocele ছিল। জরুরি scrotal exploration করা হয়। ইনট্রা-অপারেটিভলি, ডান অণ্ডকোষ frank necrotic ছিল, testis-এর intravaginal torsion ছিল এবং minimal hydrocele ছিল। এরপর ডান পাশের orchidectomy এবং বিপরীতপক্ষের orchidopexy করা হয়।",
+    "corrected_translated_summary": "আমরা এখানে দুই দিনের এক নবজাতকের একটি কেস উপস্থাপন করছি, যার ডান অণ্ডথলিতে জন্মগত স্ফীতি ছিল এবং যাকে Children’s Hospital-এ ভর্তি করা হয়েছিল. রোগী একটি বেসরকারি হাসপাতালে cesarean section-এর মাধ্যমে পূর্ণমেয়াদে জন্মগ্রহণ করেন. জরুরি বিভাগে পৌঁছানোর সময় তিনি সুপর্যাপ্ত হাইড্রেটেড ছিলেন, কক্ষ তাপমাত্রায় গোলাপি রঙের ছিলেন এবং পারফিউশন ভাল ছিল. পরীক্ষায় দেখা যায়, ডান টেস্টিস স্ফীত, টানটান, স্পর্শে ব্যথাহীন, দৃশ্যত লালচে এবং উপরিস্থ ত্বকে excoriation ছিল. ট্রান্স-ইলুমিনেশন ডান পাশে নেগেটিভ ছিল, কিন্তু বিপরীত পার্শ্বের টেস্টিসে পজিটিভ ছিল. উভয় হার্নিয়াল ওরিফিস স্বাভাবিক ছিল. ইনগুইনোস্ক্রোটাল অঞ্চলের Doppler ultrasound-এ ডান টেস্টিস স্ফীত (15.6*9.4 mm) বলে পাওয়া যায় এবং heterogeneous hypoechoic texture সহ prominent rete testis দেখা যায়, এবং color Doppler বিশ্লেষণে কোনো flow দেখা যায়নি. জরুরি ভিত্তিতে স্ক্রোটাল এক্সপ্লোরেশন করা হয়েছিল. অপারেশনের সময় ডান টেস্টিসে স্পষ্ট নেক্রোসিসসহ intravaginal torsion ছিল এবং সামান্য hydrocele ছিল. ডানদিকে orchidectomy এবং বিপরীত পার্শ্বে orchidopexy করা হয়েছিল."
+  },
+  {
+    "id": "multiclinsum_gs_en_301.txt",
+    "fulltext": "A 34-year-old patient with a disease duration of four weeks. Two months earlier, she had a cesarean section in the 37th week of pregnancy and had persistent bleeding from the surgical wound. She denied a history of bleeding in childhood or adolescence. Three years earlier, she had given birth to her first child (also by cesarean section), who died due to a chromosome disorder (referred to by the patient). She also stated that she was allergic to tramadol.\n\nThe clinical picture began with lower back pain due to bilateral renal lithiasis. Subsequently, he managed to expel a stone and after that he presented haematuria for three days, for which he received tranexamic acid c/12 h. Three weeks later, he presented pain in the lower region of the left thigh that increased in intensity, with hardening of the area. Due to persistence of the symptoms, he was given diclofenac intramuscularly, which caused ecchymosis and bleeding in the gluteal area and persists despite the compression with gauze.\n\nThe patient underwent a particular Doppler ultrasound that revealed deep venous thrombosis of the left lower limb, and went to the hospital in her locality with these results. She was given anticoagulation with enoxaparin 30 mg/24 h subcutaneously, in addition to morphine for pain management and was hospitalized. The next day, she presented epigastralgia, blurred vision, heart rate of 117 beats/min, blood pressure of 113/85 mmHg and saturation of 93%. It was decided to discontinue enoxaparin. The blood count revealed a hemoglobin of 6.4 g/dl, which represented a difference of 4 g/dl from the result one day before admission, which was 10.4 g/dl. Because of the above, two blood transfusions were given. Due to the suspicion of vasculitis, methylprednisolone was indicated and she was referred to our hospital for further study.\n\nOn admission, the physical examination revealed severe pallor, extensive ecchymosis on the left thigh and lateral knee, and a haematoma on the right thigh. The haemogram showed moderate anaemia (Hb = 9.8 g/dl), normocytic and normochromic. The biochemical examination showed glucose values of 160 mg/dl. The liver enzymes AST and ALT were at 52 U/L and 86 U/L, respectively. The coagulation profile showed a prolonged activated partial thromboplastin time (APTT) of 91.2 s. The rest of the haemogram, biochemical, electrolyte, liver profile and coagulation profile were normal. The ultrasound of soft parts of the right gluteal region revealed a collection at the level of the subcutaneous cellular tissue (TCSC) and oedema up to the upper third of the thigh. The Doppler ultrasound in the left lower limb showed adequate flowometry without signs of thrombosis in the common femoral vein, superficial and deep.\n\nSymptomatic treatment was initiated and blood and urine cultures were requested and were negative. Antinuclear antibody (ANA) values, complement C3 and C4 and ferritin were within the reference range.\n\nIn the face of suspected acquired haemophilia, studies were requested for confirmation, where a partial correction of aPTT was found in the mixing test. Factor VIII was measured and its activity was found to be decreased (<1.0 U/dl) and the presence of a factor VIII inhibitor was demonstrated: 8.64 Bethesda units/ml. The above allowed the diagnosis of acquired haemophilia to be confirmed, which was related to the postpartum period due to the onset of symptoms.\n\nPrednisone 50 mg orally at breakfast and 10 mg orally at lunch, cyclophosphamide 50 mg 2 tablets orally every 24 hours and anti-inhibitor coagulant complex for haemophilia (FEIBA) were initiated. Five days later, the latter was discontinued due to chest tightness, dyspnoea and nausea (possible adverse drug reaction) and replaced with activated recombinant factor VII (NovoSeven).\n\nThe patient's clinical evolution was favorable, with a decrease in ecchymosis and no other symptoms, so she was discharged from the hospital.\n",
+    "summary": "A 34-year-old female patient presented with lower back pain, haematuria and a haematoma in the right gluteal region, with no previous history of bleeding. Due to the extent of the haemorrhagic manifestations, she was transferred to the emergency department. The coagulation profile, mixing test and measurement of the factor VIII inhibitor titres confirmed the diagnosis.\n",
+    "translated_fulltext": "一位34岁的女性患者，患病已四周。两个月前，她在妊娠37周时进行了剖腹产，术后伤口持续出血。她否认有儿童期或青春期出血史。三年前，她生下了她的第一个孩子（也是通过剖腹产），但孩子因染色体异常而去世（患者自述）。她还表示自己对曲马多过敏。\n\n该患者的临床症状始于双侧肾结石引起的腰痛。随后，她成功排出了结石，之后出现了持续三天的血尿，并接受了每12小时一次的氨甲环酸治疗。三周后，她左大腿下部出现疼痛，疼痛程度加剧，该区域出现硬化。由于症状持续，她接受了肌肉注射双氯芬酸，导致臀部出现瘀伤和出血，即使用纱布加压也无法缓解。\n\n该患者接受了特殊的超声多普勒检查，结果显示左下肢深静脉血栓形成，并带着这些结果前往当地医院。她接受了依诺肝素皮下注射，剂量为30毫克/24小时，同时还接受了吗啡止痛，并住院治疗。第二天，她出现了上腹部疼痛、视力模糊、心率117次/分钟、血压113/85毫米汞柱，血氧饱和度为93%。医生决定停止使用依诺肝素。血液检查显示血红蛋白为6.4克/分升，与入院前一天的结果（10.4克/分升）相比，下降了4克/分升。因此，进行了两次输血。由于怀疑血管炎，医生建议使用甲基强的松龙，并将她转到我院进行进一步检查。\n\n入院时，体格检查显示患者面色苍白，左大腿和膝关节外侧有广泛的瘀伤，右大腿有血肿。血常规显示中度贫血（血红蛋白=9.8克/分升），红细胞大小和颜色正常。生化检查显示血糖值为160毫克/分升。肝酶AST和ALT分别为52 U/L和86 U/L。凝血功能检查显示激活部分凝血活酶时间（APTT）延长至91.2秒。其余的血常规、生化、电解质、肝功能和凝血功能均正常。右臀部软组织超声显示皮下结缔组织（TCSC）处有积液，并向上延伸至大腿上三分之一处。左下肢超声多普勒显示血流良好，股静脉、浅静脉和深静脉均无血栓形成迹象。\n\n开始进行对症治疗，并进行了血液和尿液培养，结果均为阴性。抗核抗体（ANA）值、补体C3和C4以及铁蛋白均在参考范围内。\n\n考虑到患者可能患有获得性血友病，进行了相关检查以进行确认，结果显示混合试验中APTT部分恢复正常。测量了第八因子，发现其活性降低（<1.0 U/dl），并证实存在第八因子抑制剂：8.64贝塞斯达单位/毫升。以上结果证实了获得性血友病的诊断，该病与产后有关，因为症状是在产后出现的。\n\n开始口服泼尼松50毫克，早餐时服用，午餐时服用10毫克；口服环磷酰胺50毫克，每天2次，每次2片；并使用抗抑制剂凝血复合物（FEIBA）治疗血友病。五天后，由于出现胸闷、呼吸困难和恶心（可能是药物不良反应），停止使用后者，并更换为重组活性因子VII（诺和七）。\n\n患者的临床状况有所好转，瘀伤减轻，没有其他症状，因此出院。",
+    "translated_summary": "一位34岁的女性患者因腰痛、血尿以及右侧臀部区域的血肿就诊，既往无出血病史。由于出血症状严重，她被转至急诊科。凝血功能检查、混合试验以及VIII因子抑制物滴度测定结果证实了诊断。",
+    "corrected_translated_fulltext": "৩৪ বছর বয়সী একজন রোগী, রোগের স্থায়িত্ব চার সপ্তাহ। দুই মাস আগে, গর্ভাবস্থার ৩৭তম সপ্তাহে তার সিজারিয়ান সেকশন হয়েছিল এবং অস্ত্রোপচারের ক্ষত থেকে স্থায়ী রক্তক্ষরণ ছিল। তিনি শৈশব বা কৈশোরে রক্তক্ষরণের কোনো ইতিহাস অস্বীকার করেছেন। তিন বছর আগে, তিনি তার প্রথম সন্তানের জন্ম দিয়েছিলেন (এটিও সিজারিয়ান সেকশনের মাধ্যমে), যিনি ক্রোমোজোমজনিত একটি বিকারের কারণে মারা যান (রোগীর বর্ণনা অনুযায়ী)। তিনি আরও জানান যে তিনি tramadol-এ অ্যালার্জিক। ক্লিনিক্যাল চিত্রের সূচনা হয় দ্বিপাক্ষিক renal lithiasis-এর কারণে কোমরের নিচের ব্যথা দিয়ে। পরে তিনি একটি পাথর বের করতে সক্ষম হন এবং তার পর তিন দিন haematuria হয়, যার জন্য তিনি tranexamic acid c/12 h পান। তিন সপ্তাহ পরে, বাম উরুর নিচের অংশে ব্যথা হয় যা তীব্রতায় বৃদ্ধি পায়, এবং ঐ স্থানে শক্তভাব দেখা দেয়। লক্ষণগুলি স্থায়ী থাকায়, তাকে intramuscularly diclofenac দেওয়া হয়, যা gluteal অঞ্চলে ecchymosis ও রক্তক্ষরণ ঘটায় এবং গজ দিয়ে চাপ প্রয়োগ সত্ত্বেও তা স্থায়ী থাকে। রোগীর একটি বিশেষ Doppler ultrasound করা হয় যা বাম নিম্ন অঙ্গে deep venous thrombosis প্রকাশ করে, এবং এই ফলাফল নিয়ে তিনি তার এলাকার হাসপাতালে যান। তাকে enoxaparin 30 mg/24 h subcutaneously দিয়ে anticoagulation এবং ব্যথা নিয়ন্ত্রণের জন্য morphine দেওয়া হয়, এবং তাকে ভর্তি করা হয়। পরদিন, তার epigastralgia, ঝাপসা দৃষ্টি, হৃদস্পন্দন 117 beats/min, রক্তচাপ 113/85 mmHg এবং স্যাচুরেশন 93% ছিল। enoxaparin বন্ধ করার সিদ্ধান্ত নেওয়া হয়। রক্ত গণনায় hemoglobin 6.4 g/dl পাওয়া যায়, যা ভর্তি হওয়ার এক দিন আগে ফলাফল 10.4 g/dl-এর তুলনায় 4 g/dl পার্থক্য নির্দেশ করে। উপরোক্ত কারণে, দুটি রক্ত সঞ্চার দেওয়া হয়। vasculitis-এর সন্দেহে methylprednisolone নির্দেশ করা হয় এবং পরবর্তী মূল্যায়নের জন্য তাকে আমাদের হাসপাতালে রেফার করা হয়। ভর্তি সময় শারীরিক পরীক্ষায় তীব্র ফ্যাকাশে ভাব, বাম উরু ও হাঁটুর পার্শ্বীয় অংশে বিস্তৃত ecchymosis এবং ডান উরুতে একটি haematoma দেখা যায়। haemogram-এ মাঝারি anaemia (Hb = 9.8 g/dl), normocytic এবং normochromic লক্ষ্য করা যায়। বায়োকেমিক্যাল পরীক্ষায় গ্লুকোজ 160 mg/dl ছিল। লিভার এনজাইম AST এবং ALT যথাক্রমে 52 U/L এবং 86 U/L ছিল। coagulation profile-এ activated partial thromboplastin time (APTT) 91.2 সেকেন্ডে দীর্ঘায়িত ছিল। haemogram, biochemical, electrolyte, liver profile এবং coagulation profile-এর বাকি অংশ স্বাভাবিক ছিল। ডান gluteal অঞ্চলের soft parts-এর আল্ট্রাসাউন্ডে subcutaneous cellular tissue (TCSC) স্তরে একটি collection এবং উরুর উপরের এক-তৃতীয়াংশ পর্যন্ত oedema দেখা যায়। বাম নিম্ন অঙ্গের Doppler ultrasound-এ flowometry যথাযথ ছিল এবং common femoral vein-এ, superficial ও deep-এ thrombosis-এর কোনো লক্ষণ ছিল না। লক্ষণভিত্তিক চিকিৎসা শুরু করা হয় এবং রক্ত ও মূত্রের কালচার চাওয়া হয়, যা নেতিবাচক আসে। Antinuclear antibody (ANA), complement C3 এবং C4 এবং ferritin মান রেফারেন্স রেঞ্জের মধ্যে ছিল। acquired haemophilia সন্দেহে নিশ্চিতকরণের জন্য পরীক্ষা চাওয়া হয়, যেখানে mixing test-এ aPTT-এর আংশিক সংশোধন পাওয়া যায়। Factor VIII মাপা হয় এবং তার activity হ্রাসপ্রাপ্ত পাওয়া যায় (<1.0 U/dl) এবং একটি factor VIII inhibitor-এর উপস্থিতি প্রমাণিত হয়: 8.64 Bethesda units/ml। উপরোক্ত ফলাফলগুলো acquired haemophilia নির্ণয় নিশ্চিত করতে সহায়তা করে, যা postpartum সময়ের সাথে সম্পর্কিত ছিল কারণ উপসর্গের সূচনা সে সময়ই হয়। Prednisone 50 mg সকালে নাশতার সময় মুখে, এবং 10 mg দুপুরের খাবারে মুখে; cyclophosphamide 50 mg-এর 2টি ট্যাবলেট প্রতি 24 ঘণ্টায় মুখে; এবং haemophilia-র জন্য anti-inhibitor coagulant complex (FEIBA) শুরু করা হয়। পাঁচ দিন পর, বুকে চাপ, dyspnoea এবং বমিবমি ভাবের কারণে (সম্ভাব্য ওষুধজনিত প্রতিকূল প্রতিক্রিয়া) পরবর্তীটি বন্ধ করা হয় এবং activated recombinant factor VII (NovoSeven) দিয়ে প্রতিস্থাপিত হয়। রোগীর ক্লিনিক্যাল অবস্থা অনুকূল ছিল, ecchymosis কমে যায় এবং অন্য কোনো উপসর্গ থাকে না, তাই তাকে হাসপাতাল থেকে ছাড়পত্র দেওয়া হয়।",
+    "corrected_translated_summary": "একজন ৩৪ বছর বয়সী নারী রোগী নিচের পিঠের ব্যথা, haematuria এবং ডান gluteal অঞ্চলে haematoma নিয়ে উপস্থিত হন; পূর্বে রক্তক্ষরণের কোনো ইতিহাস ছিল না। haemorrhagic manifestations-এর ব্যাপ্তির কারণে তাকে জরুরি বিভাগে স্থানান্তর করা হয়। coagulation profile, mixing test এবং factor VIII inhibitor titres-এর পরিমাপ নির্ণয় নিশ্চিত করেছে।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0018_0019.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0018_0019.json
new file mode 100644
index 0000000000000000000000000000000000000000..16a8f24b43c4634b9bdb9d86242ed7dd2f4ceeca
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0018_0019.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_462.txt",
+    "fulltext": "A 65-year-old male presented with swelling and boutonniere deformity on the right middle finger for six months after a motorcycle accident on January 1st, 2023. Initially, he managed the injury with painkillers and did not seek medical attention. After six months of persistent symptoms, including an inability to fully extend the finger and noticeable edema, he sought treatment.\n\nClinical findings\nThe inspection of the right hand showed the presence of deformity with edema. The active range of motion (ROM) was impaired in PIP joint in digiti III of the right hand. The active ROM of PIP joint digiti III of the right hand 45–110 degrees. The passive ROM of PIP joint digiti III of the right hand within normal.\n\nDiagnostic assessment\nWe performed X-ray of the right hand AP/Lateral which showed there are no abnormality in the bone and we diagnosed the deformity from soft tissue which is central slip injury.\n\nSurgical technique\nA central slip defect reconstruction utilizing partial ulnar side of flexor digitorum superficial tendon was performed. Under anesthesia, the patient was positioned supine with a tourniquet applied to the upper arm. A midlateral incision was made on the ulnar aspect of the right middle phalanx, centered at the PIP joint. The incision extended dorsally in an oblique manner. A transverse incision was made over the MCP joint flexion crease, just proximal to the A1 pulley. The procedure involves identifying and protecting the ulnar digital neurovascular bundle, exposing the central slip and extensor tendon to the PIPJ, full-thickness dorsal flaps are elevated. Scar tissue and pseudotendinous tissue is identified and excised. The central slip cannot be repaired primarily, so the ulnar slip of the FDS tendon is used for reconstruction. The ulnar neurovascular bundle is mobilized to visualize the periosteal insertion of the A3 pulley.\n\nThe extensor tendon is mobilized and tenolyzed, followed by incision of the dorsal capsule of the PIP joint and removal of interposed tissue. The A3 pulley's periosteal insertion is incised longitudinally, and the PIP joint's volar capsule is incised longitudinally. The ulnar slip of the FDS tendon is identified and a 2–0 non-absorbable, monofilament suture is placed around it. A transverse incision is made at the MCP joint flexion crease, proximal to the A1 pulley revealing the flexor tendon sheath. The tendon sheath and A1 pulley are incised longitudinally. The FDS tendon is identified. The ulnar slip of the FDS tendon is isolated and transected to release the ulnar slip, avoiding entrapment or catching of the radial slip. The 2–0 suture that was placed around the ulnar slip at the level of the PIP joint is used to release distally based FDS tendon slip and deliver the ulnar slip of the FDS tendon distally.\n\nA 2.8-mm drill is used to create a vertically oriented bone tunnel dorsal to volar. An elevator is placed between the flexor digitorum profundus tendon, volar plate, and volar aspect of the base of the middle phalanx protecting the volar anatomic structures. The FDS tendon slip passes through the tunnel while maintaining the PIP joint in extension and reduced position. The FDS tendon slip passed through the intact proximal section of the central slip and extensor tendon. A tendon weaver completes a Pulvertaft weave, confirming the appropriate tension with the PIPJ in the reduced, full extension position. A 3–0 non-absorbable suture secures the pulvertaft weave. The margins of the capsule and central slip reconstruction are approximated across the PIP joint, and adhesions are released and the lateral bands mobilized.\n\nThe overall posture, stability, and motion with tenodesis assessed. All the incisions are copiously irrigated. The tourniquet is deflated and hemostasis is obtained. Capillary refill of all fingers is assessed. The skin is closed using horizontal mattress stiches. A sterile dressing is applied with an appropriately padded PIP joint extension splint to allow for early DIP joint and MCP joint motion.\n\nFollow-up and outcomes\nFirst follow-up was done 4 days after for wound treatment. The patient was given oral meloxicam 7,5 mg twice a day and doxycycline 100 mg twice a day for 3 days. The second follow-up was done 3 days after for wound treatment. After 2 weeks, we remove the back slab, remove the external suture and begin the active and passive ROM exercise. After 3 weeks, the wound was healed, and we found the ROM of PIP joint 0 to 90 degrees. And after a month, the patient came with improved ROM of PIP joint 0 to 100 degrees, and improved functional outcome. After 7 weeks of physical rehabilitation, patients already back to work with improve ROM of PIP joint 0 to 110 degrees. The function of the patient's right hand is evaluated with DASH score, which improves significantly from 50 to 4.2.",
+    "summary": "A 65-year-old male patient presented with swelling and boutonniere deformity on the digiti III of the right hand. The patient had previously fallen from a motorcycle, and the patient's right middle finger got was by a motorcycle six months ago. After the incident, the patient's right middle finger cannot be fully extended. The patient's right hand showed edema with flexion of the interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint. The Range of Motion (ROM) of the PIP joint right middle finger was 45-110 degrees. The X-ray of the right hand AP/oblique showed no bone involvement in the deformity. The patient underwent central slip defect reconstruction utilizing the partial ulnar side of the flexor digitorum superficial tendon. A PIP joint extension splint was applied for 2 weeks. Active and passive exercise of the ROM of the PIP joint began after 2 weeks of PIP extension joint splinting. The patient's ROM of the PIP joint (0-90 degrees) significantly improved 1 month after surgery. The patient's ROM of the PIP joint returned to normal after 2 months after surgery. The function of the patient's right hand is evaluated with the DASH score, which improves significantly from 50 to 4.2.",
+    "translated_fulltext": null,
+    "translated_summary": "一位65岁的男性患者，右手的第三指出现肿胀和屈指关节挛缩畸形。患者既往曾发生摩托车事故，六个月前，患者的右手中指被摩托车碾压。事故发生后，患者的右手中指无法完全伸直。检查发现，患者的右手出现水肿，指间关节（PIP）屈曲，远指间关节（DIP）过度伸展。右手中指PIP关节的活动范围为45-110度。右手的正位/斜位X光片显示，畸形处没有骨骼受累。患者接受了中央滑车缺损修复术，使用了屈指肌浅肌腱的桡侧部分。术后为患者使用了PIP关节伸展夹板，持续2周。2周后，开始进行PIP关节的主动和被动活动训练。术后1个月，患者的PIP关节活动范围（0-90度）明显改善。术后2个月，患者的PIP关节活动范围恢复正常。通过DASH评分评估患者的右手功能，评分从50显著改善至4.2。",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "৬৫ বছর বয়সী এক পুরুষ রোগীর ডান হাতের তৃতীয় (digit III) আঙুলে ফোলা এবং boutonniere deformity ছিল। রোগী পূর্বে মোটরসাইকেল থেকে পড়ে গিয়েছিলেন, এবং ছয় মাস আগে রোগীর ডান হাতের মধ্যমা একটি মোটরসাইকেল দ্বারা আঘাতপ্রাপ্ত হয়েছিল। ঘটনার পর, রোগীর ডান হাতের মধ্যমা সম্পূর্ণভাবে সোজা করা যায়নি। রোগীর ডান হাতে edema ছিল, যেখানে interphalangeal (PIP) joint-এ flexion এবং distal interphalangeal (DIP) joint-এ hyperextension দেখা যায়। ডান হাতের মধ্যমার PIP joint-এর Range of Motion (ROM) ছিল 45-110 ডিগ্রি। ডান হাতের AP/oblique X-ray-এ দেখা গেছে যে বিকৃতিটিতে কোনো অস্থি জড়িত নয়। রোগীর central slip defect reconstruction করা হয়, যেখানে flexor digitorum superficial tendon-এর ulnar পাশের আংশিক অংশ ব্যবহার করা হয়। একটি PIP joint extension splint 2 সপ্তাহের জন্য প্রয়োগ করা হয়েছিল। PIP extension joint splinting-এর 2 সপ্তাহ পর PIP joint-এর ROM-এর active এবং passive exercise শুরু করা হয়। অস্ত্রোপচারের 1 মাস পর রোগীর PIP joint-এর ROM (0-90 ডিগ্রি) উল্লেখযোগ্যভাবে উন্নত হয়। অস্ত্রোপচারের 2 মাস পর রোগীর PIP joint-এর ROM স্বাভাবিক অবস্থায় ফিরে আসে। রোগীর ডান হাতের কার্যকারিতা DASH score দিয়ে মূল্যায়ন করা হয়, যা 50 থেকে 4.2-এ উল্লেখযোগ্যভাবে উন্নত হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_382.txt",
+    "fulltext": "A 23-year-old male patient presented to the emergency department with a sudden onset of severe frontal headache lasting for 2 h. He experienced associated symptoms of nausea, vomiting, and chest heaviness. He has a unremarkable medical record and denies the use of illicit drugs. However, he is a smoker with a history of 23 pack-years but does not consume alcohol.\n\nOn physical examination, the young male appeared distressed but was fully conscious and oriented to time, place, and person. Chest auscultation revealed normal vesicular breathing sounds, while cardiovascular and abdominal examinations were inconclusive. Neurological examinations demonstrated neck stiffness, dilated pupils reactive to light, normal plantar reflexes, and no focal neurological deficits.\n\nHis vital signs were as follows: blood pressure 178/103 mmHg, respiratory rate 26 breaths/min, temperature 38.9°C, heart rate 87 beats/min, and oxygen saturation of 94%.\n\nEmergency tests were initiated. An ECG revealed ST segment elevation >2 mm in leads V2-V5, consistent with STEMI as the top of our differential diagnosis, requiring confirmation by cardiac markers. With prompt referral to a tertiary cardiac centre implemented, the patient received a 300 mg aspirin load while being transferred to the catheter lab. Troponin levels were significantly elevated at 1.48 mg/dl (normal <0.16 mg/dl).\n\nPercutaneous coronary intervention was performed via the femoral artery, and the result showed normal coronary arteries with thrombolysis in myocardial infarction (TIMI) flow grade of 3.\n\nHis ECG after coronary angiography revealed normal sinus rhythm with left ventricular hypertrophy LVH. An echocardiogram was performed, revealing normal ventricular function with no regional wall motion abnormalities (RWMA).\n\nFollowing coronary intervention, he was admitted to the medical ward for further assessment and investigation. Blood samples were drawn for a complete blood count, random blood sugar, renal function tests, and CRP. The results revealed lymphocytosis and mildly elevated CRP.\n\nWe proceeded further with CT brain to exclude serious cause of headache. His brain CT showed cisternal subarachnoid haemorrhage SAH with extension anterior to the right temporal lobe. Abdominal ultrasound screening was performed to rule out polycystic kidney disease which was negative and cerebral CT angiography was scheduled to exclude cerebral aneurysm Nimodipine 60 mg every 4 h was initiated, with a target blood pressure of 160/100 mmHg.\n\nOn the second day, his condition suddenly deteriorated, culminating with cardiac arrest. Therefore, cardiopulmonary resuscitation (CPR), resulting in a Glasgow Coma Scale score (GCS) of 6. The patient was subsequently, intubated and placed on mechanical ventilation in the Intensive Care Unit (ICU). Due to his unstable condition in the ICU, we could not perform a repeated CT brain scan or the planned cerebral CT angiography.\n\nOver the next 7 days, we diligently monitored him with a strict multidisciplinary team. A nasogastric tube was inserted for feeding and fluid replacement. His medications included intravenous fluids, antibiotics, proton pump inhibitors, and nimodipine.\n\nOn the 8th day, he suddenly developed ventricular fibrillation, and despite CPR with more than five defibrillations, we were unable to revive him and death was the final outcome.39734686",
+    "summary": "We present a case detailing the diagnostic challenges of a 23-year-old male presenting with a sudden severe headache, nausea, vomiting, and chest heaviness. Initial evaluation showed elevated blood pressure and respiratory rate. An emergency electrocardiogram (ECG) indicated ST-segment elevation myocardial infarction (STEMI), leading to immediate referral for percutaneous coronary intervention, which revealed normal coronary arteries. Further investigations identified a cisternal subarachnoid haemorrhage (SAH) on CT brain imaging. Despite multidisciplinary management, the patient's condition rapidly deteriorated, resulting in cardiac arrest and mortality.",
+    "translated_fulltext": "一名23岁的男性患者因突发严重前额头痛，持续2小时，来到急诊科。他同时伴有恶心、呕吐和胸闷等症状。他的病史无特殊之处，否认有使用非法药物。但他有吸烟史，吸烟量为23包/年，但不饮酒。\n\n体格检查显示，该年轻男性看起来很痛苦，但意识清醒，能辨认时间、地点和人物。听诊显示，胸部呼吸音正常，心血管和腹部检查结果不明确。神经系统检查显示颈部僵硬、瞳孔对光反应迟钝、足底反射正常，没有局灶性神经功能障碍。\n\n他的生命体征如下：血压178/103 mmHg，呼吸频率26次/分钟，体温38.9°C，心率87次/分钟，血氧饱和度94%。\n\n立即进行急诊检查。心电图显示V2-V5导联的ST段抬高>2 mm，与急性ST段抬高型心肌梗死（STEMI）相符，这是我们的首要诊断，需要通过心肌标志物进行确认。立即转诊至三级心脏中心，患者在转运至导管室时接受了300毫克阿司匹林负荷剂量。肌钙蛋白水平显著升高，达到1.48 mg/dl（正常值<0.16 mg/dl）。\n\n通过股动脉进行经皮冠状动脉介入治疗，结果显示冠状动脉正常，心肌梗死时冠状动脉血流分级（TIMI）为3级。\n\n冠状动脉造影后的心电图显示，窦性心律正常，左心室肥大（LVH）。进行超声心动图检查，显示心室功能正常，没有区域性室壁运动异常（RWMA）。\n\n冠状动脉介入治疗后，他被转入内科病房，进行进一步的评估和检查。抽取血液样本进行全血细胞计数、随机血糖、肾功能检查和C反应蛋白（CRP）检测。结果显示淋巴细胞增多，CRP轻度升高。\n\n为了排除头痛的严重原因，我们进一步进行了脑部CT扫描。他的脑部CT显示，脑池内蛛网膜下腔出血（SAH），并延伸至右颞叶前方。进行了腹部超声检查，以排除多囊肾病，结果为阴性，并计划进行脑部CT血管造影，以排除脑动脉瘤。开始使用尼莫地平，剂量为每4小时60毫克，目标血压为160/100 mmHg。\n\n第二天，他的病情突然恶化，最终导致心脏骤停。因此，进行了心肺复苏（CPR），格拉斯哥昏迷量表（GCS）评分达到6分。随后，患者被气管插管，并置于重症监护室（ICU）进行机械通气。由于他在ICU中的病情不稳定，我们无法进行重复的脑部CT扫描或计划的脑部CT血管造影。\n\n在接下来的7天里，我们由一个严格的多学科团队密切监测他的情况。插入鼻胃管进行喂养和补充液体。他的药物包括静脉输液、抗生素、质子泵抑制剂和尼莫地平。\n\n第八天，他突然出现心室颤动，尽管进行了超过五次除颤的心肺复苏，但我们未能使他苏醒，最终死亡。",
+    "translated_summary": "本文介绍了一例病例，详细描述了一位23岁男性患者，他突然出现剧烈头痛、恶心、呕吐和胸闷等症状，这给诊断带来了挑战。初步检查显示，患者血压和呼吸频率均升高。紧急心电图（ECG）显示ST段抬高型心肌梗死（STEMI），因此立即转诊进行经皮冠状动脉介入治疗，结果显示冠状动脉正常。进一步检查发现，CT脑部影像显示患者患有脑池蛛网膜下腔出血（SAH）。尽管进行了多学科综合治疗，患者的病情迅速恶化，最终导致心脏骤停并死亡。",
+    "corrected_translated_fulltext": "২৩ বছর বয়সী একজন পুরুষ রোগী হঠাৎ শুরু হওয়া তীব্র ফ্রন্টাল মাথাব্যথা, যা ২ ঘণ্টা ধরে স্থায়ী ছিল, নিয়ে জরুরি বিভাগে আসেন। তাঁর সাথে বমিভাব, বমি এবং বুকে ভারীভাবের মতো উপসর্গ ছিল। তাঁর চিকিৎসা-ইতিহাস উল্লেখযোগ্য নয়, এবং তিনি অবৈধ মাদক ব্যবহারের কথা অস্বীকার করেন। তবে তিনি ধূমপায়ী, ধূমপানের পরিমাণ ২৩ pack-years, কিন্তু অ্যালকোহল সেবন করেন না。\n\nশারীরিক পরীক্ষায় দেখা গেল, ওই যুবকটি কষ্টগ্রস্ত দেখাচ্ছিল, তবে তিনি সম্পূর্ণ সজাগ এবং সময়, স্থান ও ব্যক্তি সম্পর্কে অভিমুখিত ছিলেন। শ্রবণে বুকে স্বাভাবিক ভেসিকুলার শ্বাস-শব্দ শোনা যায়, আর হৃদ্‌রোগ ও পেটের পরীক্ষাগুলো অনির্ণায়ক ছিল। স্নায়ুবৈকল্য পরীক্ষায় ঘাড়ে শক্তভাব, প্রসারিত পুতলি আলোতে প্রতিক্রিয়াশীল, স্বাভাবিক প্লান্টার রিফ্লেক্স, এবং কোনো ফোকাল স্নায়বিক ঘাটতি ছিল না。\n\nতাঁর প্রাণচিহ্ন ছিল নিম্নরূপ: রক্তচাপ 178/103 mmHg, শ্বাস-হার 26 বার/মিনিট, তাপমাত্রা 38.9°C, হৃদ্‌গতি 87 বিট/মিনিট, এবং অক্সিজেন স্যাচুরেশন 94%。\n\nজরুরি পরীক্ষা শুরু করা হয়। ECG-তে V2–V5 লিডে ST segment elevation >2 mm দেখা যায়, যা আমাদের differential diagnosis-এর শীর্ষে থাকা STEMI-এর সঙ্গে সামঞ্জস্যপূর্ণ, এবং cardiac markers দ্বারা নিশ্চিতকরণ প্রয়োজন। দ্রুত tertiary cardiac centre-এ রেফারাল করা হয়, এবং রোগীকে catheter lab-এ নিয়ে যাওয়ার সময় 300 mg aspirin লোডিং ডোজ দেওয়া হয়। Troponin মাত্রা উল্লেখযোগ্যভাবে বেড়েছিল 1.48 mg/dl (স্বাভাবিক <0.16 mg/dl)।\n\nFemoral artery মাধ্যমে percutaneous coronary intervention করা হয়, এবং ফলাফলে coronary ধমনিগুলো স্বাভাবিক ছিল ও thrombolysis in myocardial infarction (TIMI) flow grade 3 পাওয়া যায়。\n\nCoronary angiography-র পর ECG-তে normal sinus rhythm সহ left ventricular hypertrophy (LVH) দেখা যায়। Echocardiogram করা হয়, যা স্বাভাবিক ventricular function দেখায় এবং কোনো regional wall motion abnormalities (RWMA) ছিল না。\n\nCoronary intervention-এর পর তাঁকে আরও মূল্যায়ন ও অনুসন্ধানের জন্য মেডিকেল ওয়ার্ডে ভর্তি করা হয়। সম্পূর্ণ রক্তকণিকা গণনা, random blood sugar, renal function tests এবং CRP-এর জন্য রক্তের নমুনা নেওয়া হয়। ফলাফলে lymphocytosis এবং সামান্য উঁচু CRP পাওয়া যায়。\n\nমাথাব্যথার গুরুতর কারণ বাদ দিতে আমরা আরও CT brain করলাম। তাঁর brain CT-তে cisternal subarachnoid haemorrhage (SAH) দেখা যায়, যা ডান temporal lobe-এর সামনের দিকে প্রসারিত। Polycystic kidney disease বাদ দিতে abdominal ultrasound করা হয়, যা নেগেটিভ ছিল, এবং cerebral aneurysm বাদ দিতে cerebral CT angiography নির্ধারিত হয়। Nimodipine 60 mg প্রতি 4 ঘন্টা শুরু করা হয়, লক্ষ্য রক্তচাপ 160/100 mmHg。\n\nদ্বিতীয় দিনে তাঁর অবস্থা হঠাৎ অবনতি ঘটে, এবং শেষ পর্যন্ত cardiac arrest হয়। অতএব cardiopulmonary resuscitation (CPR) করা হয়, যার ফলে Glasgow Coma Scale (GCS) স্কোর ছিল 6। পরবর্তীতে রোগীকে intubate করে Intensive Care Unit (ICU)-এ mechanical ventilation-এ রাখা হয়। ICU-তে তাঁর অস্থিতিশীল অবস্থার কারণে আমরা পুনরায় CT brain বা পরিকল্পিত cerebral CT angiography করতে পারিনি。\n\nপরবর্তী 7 দিনে, আমরা একটি কঠোর multidisciplinary team দ্বারা তাঁকে নিবিড়ভাবে পর্যবেক্ষণ করেছি। খাওয়ানো ও তরল প্রতিস্থাপনের জন্য nasogastric tube প্রবেশ করানো হয়। তাঁর ওষুধের মধ্যে ছিল intravenous fluids, antibiotics, proton pump inhibitors, এবং Nimodipine。\n\nঅষ্টম দিনে তিনি হঠাৎ ventricular fibrillation-এ আক্রান্ত হন, এবং পাঁচটিরও বেশি defibrillation-সহ CPR সত্ত্বেও আমরা তাঁকে ফিরিয়ে আনতে ব্যর্থ হই এবং পরিণতি ছিল মৃত্যু।",
+    "corrected_translated_summary": "আমরা একটি কেস উপস্থাপন করছি, যেখানে ২৩ বছর বয়সী এক পুরুষ রোগীর হঠাৎ তীব্র মাথাব্যথা, বমিবমি ভাব, বমি এবং বুকে ভারভাব নিয়ে উপস্থিতি থেকে উদ্ভূত নির্ণয়ের চ্যালেঞ্জগুলো বিস্তারিতভাবে বর্ণনা করা হয়েছে। প্রাথমিক মূল্যায়নে রোগীর রক্তচাপ ও শ্বাসের হার বৃদ্ধি পাওয়া যায়। জরুরি ইলেকট্রোকার্ডিওগ্রাম (ECG) এ ST-segment elevation myocardial infarction (STEMI) এর ইঙ্গিত মেলে, ফলে percutaneous coronary intervention-এর জন্য তাৎক্ষণিক রেফার করা হয়, যা করোনারি ধমনিগুলো স্বাভাবিক দেখায়। পরবর্তী তদন্তে CT ব্রেন ইমেজিংয়ে cisternal subarachnoid haemorrhage (SAH) সনাক্ত হয়। মাল্টিডিসিপ্লিনারি ব্যবস্থাপনা সত্ত্বেও রোগীর অবস্থা দ্রুত অবনতি ঘটে, যার ফলস্বরূপ cardiac arrest হয় এবং মৃত্যু ঘটে।"
+  }
+]
\ No newline at end of file
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+[
+  {
+    "id": "multiclinsum_gs_en_116.txt",
+    "fulltext": "The medical records of patients with a diagnosis of congenital myotonia studied and followed in the pediatric neurology consultation in a third-level hospital between 2015 and 2020 were reviewed. The inclusion criteria were to present a clinical diagnosis – myotonia, warm-up phenomenon, characteristic electromyographic pattern and/or family history – and/or a molecular diagnosis (mutation in the CLCN1 gene). The clinical signs and symptoms, as well as the results of the complementary explorations and the genetic mutation found, were collected by reviewing the medical record. Demographic variables (age and sex), course of the disease (age of onset, symptoms and signs, time elapsed until diagnosis and clinical evolution), family history and evaluation of the response to treatment were collected.\n\nFive cases with clinical diagnosis of congenital myotonia were identified (three with Becker's disease and two with Thomsen's disease). The incidence in relation to the number of births was estimated at 1:15,000 newborns for cases with Becker's phenotype and 1:21,000 newborns for Thomsen's phenotypes.\n\nMost of our patients were female, and the male was the only one who started before the age of six. The initial clinical presentation included myotonia in the lower limbs in four of the five patients and in the upper limbs in all but one. The age at onset ranged from 22 months to 12 years, with a median of 6 years. Genetic diagnosis was performed in all cases approximately two years after onset, and the family of one patient refused to have it performed. All had a worsening with cold, but the warming phenomenon was only in those with the Becker phenotype.\n\nPatients with recessive congenital myotonia showed some progression. As a family history, it is worth noting that patients 2 and 3 were sisters, without the parents showing any clinical signs, and that the mother of patient 1 showed mild clinical signs that were doubtful with the cold. The patient who refused the study had a history of myotonia in the maternal branch.\n\nBlood tests did not show elevated creatine kinase in any of the patients. The electromyogram was abnormal in all patients except the first one at 2.8/12 years of age. The test was not repeated later because it was not considered necessary.\n\nThe most used treatment initially was oxcarbazepine (in patients with recessive form), with a good response in general. In case 2 it lost efficacy with time and mexiletine was initiated. Patient 4 initiated several drugs without success due to loss of efficacy or side effects. Patient 5 rejected treatment due to mild clinical presentation.\n\nPatient 1 had a previously undescribed, likely pathogenic mutation (CLCN1: c.824T>C) inherited from his mother. Cases 1 to 3 had the Becker phenotype with composite heterozygosity mutations, and cases 4 and 5 had the Thomsen phenotype. Case 5 declined genetic testing.\n",
+    "summary": "The medical records of patients with a diagnosis of congenital myotonia studied and followed in the pediatric neurology consultation in a third-level hospital between 2015 and 2020 were reviewed. Demographic variables (age and sex), course of the disease (age of onset, symptoms and signs, time elapsed until diagnosis and clinical evolution), family history and evaluation of the response to treatment were collected. Five cases with a clinical diagnosis of congenital myotonia were identified (three with Becker disease and two with Thomsen disease). The incidence in relation to the number of births was estimated at 1:15,000 newborns for cases with a Becker phenotype and 1:21,000 newborns for Thomsen phenotypes. We found a probably pathogenic mutation not previously described (CLCN1: c.824T>C).\n",
+    "translated_fulltext": "回顾性分析了2015年至2020年期间，某三级医院儿科神经科门诊中，经诊断为先天性肌强直症的患者的病历资料。纳入标准为：临床诊断（肌强直症、热身现象、特征性肌电图表现和/或家族史）和/或分子诊断（CLCN1基因突变）。通过查阅病历，收集了患者的临床体征和症状，以及辅助检查结果和发现的基因突变。收集了人口学变量（年龄和性别）、疾病病程（发病年龄、症状和体征、确诊时间以及临床进展）、家族史以及对治疗的反应评估。\n\n共识别出5例临床诊断为先天性肌强直症的病例（3例为贝克氏病，2例为汤姆森氏病）。根据出生人数估算，贝克氏表型病例的发生率为1/15,000，汤姆森氏表型病例的发生率为1/21,000。\n\n大多数患者为女性，唯一的男性患者在6岁之前发病。最初的临床表现包括：5例患者中有4例出现下肢肌强直，其余患者均出现上肢肌强直。发病年龄在22个月至12岁之间，中位数为6岁。所有病例均在发病后约两年进行了基因诊断，但有一位患者的家属拒绝进行基因诊断。所有患者在寒冷环境下病情加重，但热身现象仅出现在贝克氏表型患者中。\n\n患有隐性先天性肌强直症的患者病情有所进展。值得注意的是，患者2和患者3是姐妹，父母均未出现任何临床症状；患者1的母亲出现轻微的临床症状，但在寒冷环境下症状不明显。拒绝进行检查的患者，其母系家族中存在肌强直症病史。\n\n所有患者的血液检查均未显示肌酸激酶升高。除第一例患者（2.8岁/12岁时）外，所有患者的肌电图均显示异常。由于认为没有必要，因此没有重复进行该检查。\n\n最初最常用的治疗方法是奥卡巴嗪（用于隐性型患者），总体效果良好。在第二例患者中，随着时间的推移，奥卡巴嗪的疗效降低，因此开始使用美西拉嗪。第四例患者尝试了多种药物，但均未成功，原因是疗效降低或出现副作用。第五例患者由于临床症状轻微，拒绝接受治疗。\n\n第一例患者携带了一种先前未描述的、可能具有致病性的突变（CLCN1: c.824T>C），该突变是从其母亲那里遗传的。1至3例患者为贝克氏表型，具有复合杂合子突变；4和5例患者为汤姆森氏表型。第五例患者拒绝进行基因检测。",
+    "translated_summary": "回顾性分析了2015年至2020年期间，某三级医院儿科神经科门诊中，经诊断为先天性肌强直症的患者的病历资料。收集了患者的人口学变量（年龄和性别）、疾病病程（发病年龄、症状和体征、确诊时间以及临床进展）、家族史以及对治疗的反应评估。共识别出5例临床诊断为先天性肌强直症的病例（其中3例为贝克氏病，2例为汤姆森氏病）。根据出生人数估算，贝克氏表型病例的发生率为1/15,000，汤姆森氏表型病例的发生率为1/21,000。我们发现了一种可能具有致病性的、此前未被描述过的突变（CLCN1: c.824T>C）。",
+    "corrected_translated_fulltext": "2015 থেকে 2020 সালের মধ্যে একটি তৃতীয় স্তরের হাসপাতালের শিশু স্নায়ুরোগ পরামর্শ ক্লিনিকে অধ্যয়ন ও ফলো-আপ করা congenital myotonia নির্ণয়যুক্ত রোগীদের চিকিৎসা নথি পর্যালোচনা করা হয়। অন্তর্ভুক্তি মানদণ্ড ছিল ক্লিনিক্যাল নির্ণয়—myotonia, warm-up phenomenon, বৈশিষ্ট্যপূর্ণ electromyographic pattern এবং/অথবা পারিবারিক ইতিহাস—এবং/অথবা একটি molecular diagnosis (CLCN1 gene-এ mutation)। চিকিৎসা নথি পর্যালোচনা করে ক্লিনিক্যাল লক্ষণ ও উপসর্গ, পাশাপাশি পরিপূরক পরীক্ষার ফলাফল এবং সনাক্ত জিন মিউটেশন সংগ্রহ করা হয়। জনতাত্ত্বিক ভেরিয়েবল (বয়স ও লিঙ্গ), রোগের গতিপথ (আরম্ভের বয়স, উপসর্গ ও লক্ষণ, নির্ণয় পর্যন্ত অতিবাহিত সময় এবং ক্লিনিক্যাল বিবর্তন), পারিবারিক ইতিহাস এবং চিকিৎসার প্রতিক্রিয়ার মূল্যায়ন সংগ্রহ করা হয়।\n\ncongenital myotonia-এর ক্লিনিক্যাল নির্ণয়যুক্ত পাঁচটি কেস সনাক্ত করা হয়েছিল (তিনটি Becker's disease এবং দুটি Thomsen's disease)। জন্মসংখ্যার সাথে সম্পর্কিত ঘটনার হার অনুমান করা হয়েছিল Becker phenotype-সহ কেসগুলির জন্য 1:15,000 নবজাতক এবং Thomsen phenotypes-এর জন্য 1:21,000 নবজাতক।\n\nআমাদের অধিকাংশ রোগী নারী ছিলেন, এবং একমাত্র পুরুষটি ছয় বছরের আগে আরম্ভ করেছিলেন। প্রাথমিক ক্লিনিক্যাল উপস্থাপনা হিসেবে পাঁচজনের মধ্যে চারজনের নিম্ন অঙ্গে myotonia ছিল এবং সকলের (একজন ব্যতীত) ঊর্ধ্ব অঙ্গেও ছিল। আরম্ভের বয়স ২২ মাস থেকে ১২ বছরের মধ্যে ছিল, মধ্যমা ৬ বছর। আরম্ভের প্রায় দুই বছর পর সকল কেসে genetic diagnosis করা হয়েছিল, এবং একজন রোগীর পরিবারের সদস্যরা এটি করাতে অস্বীকার করেছিলেন। সবাই ঠান্ডায় অবনতি প্রদর্শন করেছিল, তবে warming phenomenon কেবল Becker phenotype-এ থাকা রোগীদের মধ্যেই ছিল।\n\nrecessive congenital myotonia-যুক্ত রোগীদের কিছু প্রগ্রেশন দেখা গেছে। পারিবারিক ইতিহাস হিসেবে উল্লেখযোগ্য যে রোগী ২ ও ৩ সহোদরা বোন ছিলেন, পিতামাতার কারও ক্লিনিক্যাল লক্ষণ ছিল না, এবং রোগী ১-এর মায়ের হালকা ক্লিনিক্যাল লক্ষণ ছিল যা ঠান্ডায় সন্দেহজনক ছিল। যিনি অধ্যয়নটি প্রত্যাখ্যান করেছিলেন তার মাতৃকুলে myotonia-এর ইতিহাস ছিল।\n\nরক্ত পরীক্ষায় কোনো রোগীরই creatine kinase বৃদ্ধি পাওয়া দেখা যায়নি। electromyogram সকল রোগীতে অস্বাভাবিক ছিল, প্রথম রোগী ছাড়া, যখন তার বয়স ছিল ২ বছর ৮ মাস। এটি প্রয়োজনীয় বিবেচিত না হওয়ায় পরে পরীক্ষা পুনরাবৃত্তি করা হয়নি।\n\nপ্রাথমিকভাবে সর্বাধিক ব্যবহৃত চিকিৎসা ছিল oxcarbazepine (recessive form-এ থাকা রোগীদের ক্ষেত্রে), সামগ্রিকভাবে ভালো প্রতিক্রিয়া সহ। কেস ২-এ সময়ের সাথে সাথে এর কার্যকারিতা কমে যায় এবং mexiletine শুরু করা হয়। রোগী ৪ কার্যকারিতা হ্রাস বা পার্শ্বপ্রতিক্রিয়ার কারণে সাফল্য ছাড়াই বেশ কয়েকটি ওষুধ শুরু করেছিলেন। রোগী ৫ মৃদু ক্লিনিক্যাল উপস্থাপনার কারণে চিকিৎসা প্রত্যাখ্যান করেছিলেন।\n\nরোগী ১-এর আগে বর্ণিত নয় এমন, সম্ভাব্য রোগসৃষ্টিকারী একটি mutation (CLCN1: c.824T>C) ছিল, যা তিনি তার মায়ের থেকে উত্তরাধিকারসূত্রে পেয়েছিলেন। কেস ১ থেকে ৩-এর Becker phenotype ছিল composite heterozygosity mutations-সহ, এবং কেস ৪ ও ৫-এর Thomsen phenotype ছিল। কেস ৫ genetic testing প্রত্যাখ্যান করেছিলেন।",
+    "corrected_translated_summary": "২০১৫ থেকে ২০২০ সালের মধ্যে একটি তৃতীয় স্তরের হাসপাতালের শিশু স্নায়ুবিদ্যা পরামর্শ বিভাগে অধ্যয়ন ও ফলো-আপ করা, congenital myotonia-তে নির্ণয়প্রাপ্ত রোগীদের চিকিৎসা নথি পর্যালোচনা করা হয়েছিল। জনতাত্ত্বিক চলকসমূহ (বয়স ও লিঙ্গ), রোগের গতিপ্রকৃতি (উদ্ভবের বয়স, উপসর্গ ও লক্ষণ, নির্ণয় পর্যন্ত অতিবাহিত সময় ও ক্লিনিকাল বিবর্তন), পারিবারিক ইতিহাস এবং চিকিৎসার প্রতি প্রতিক্রিয়ার মূল্যায়ন সংগ্রহ করা হয়েছিল। congenital myotonia-র ক্লিনিকাল নির্ণয়সহ মোট 5টি কেস শনাক্ত করা হয়েছিল (এর মধ্যে 3টি Becker disease এবং 2টি Thomsen disease)। জন্মসংখ্যার অনুপাতে আনুমানিক ইনসিডেন্স ছিল Becker phenotype-এর ক্ষেত্রে প্রতি 15,000 নবজাতকে 1টি এবং Thomsen phenotype-এর ক্ষেত্রে প্রতি 21,000 নবজাতকে 1টি। আমরা পূর্বে বর্ণিত নয় এমন একটি সম্ভবত প্যাথোজেনিক মিউটেশন শনাক্ত করেছি (CLCN1: c.824T>C)।"
+  },
+  {
+    "id": "multiclinsum_gs_en_322.txt",
+    "fulltext": "A 67-year-old female patient presented with a six-year history of recurrent swelling in the left lower limb. One year prior, she was diagnosed with an AVM in the lower limb at another hospital. Two months before hospitalization, the patient underwent embolization treatment, which included the placement of two coils (20 mm x 40 cm, BSX, USA). Despite this intervention, the patient’s left lower limb swelling did not show any improvement. The patient has been experiencing fatigue and difficulty of breathing for a month. As these symptoms of heart failure progressed and worsened, the patient was transferred to Chengdu University of Traditional Chinese Medicine Hospital for further evaluation and treatment. The patient had no prior history of cardiovascular diseases, injuries, or surgeries. However, she reported a history of oral estrogen use for menopausal syndrome seven years ago.\n\nShe exhibited significant edema and skin sclerosis in the left lower limb. Additionally, absent pulses were observed in the popliteal artery and distal regions. A noticeable tremor was also present in the left thigh. The patient was seated during the examination. Echocardiography revealed cardiac enlargement, along with moderate mitral regurgitation and severe tricuspid regurgitation. The left ventricular ejection fraction (EF) was measured at 60%, and there was an elevation in b-type natriuretic peptide (BNP) levels to 2853 ng/L. The electrocardiogram showed a sinus rhythm with a heart rate of 105 beats per minute and evidence of left atrial enlargement. Chest CT scans confirmed cardiac enlargement, while no respiratory system abnormalities were detected. Preoperative computed tomography angiography (CTA) provided further insights, revealing a left iliac artery aneurysm, a significantly enlarged femoral artery, and complex AVMs in the superficial femoral artery. Additionally, the femoral and superficial veins appeared significantly enlarged on arterial phase imaging. Notably, the left lower limb popliteal artery and anterior tibial artery were not visualized. Based on these findings, the patient was diagnosed with complex congenital lower limb AVMs, acute exacerbation of chronic heart failure, and classified as NYHA Class IV.\n\nThe patient exhibits distinct symptoms of acute heart failure, and preoperative ultrasound assessment has revealed a volume flow of 3400 ml/min in the CFA. Given that embolization using coils may not effectively reduce the flow rate of the AVMs, the utilization of covered stents is a viable option. These stents effectively decrease the flow of lower limb AVMs, thereby improving the patient’s heart failure condition. Additionally, staged embolization treatment can further enhance the treatment outcome by improving the nidus of the lower limb AVMs.\n\nCTA of the patient revealed significant dilatation of blood vessels, with a maximum diameter of 32 mm for the iliac artery, 27 mm for the common femoral artery (CFA), and 22 mm for the superficial femoral artery (SFA). To minimize access site complications, antegrade access was achieved through a surgical approach of the CFA. Under general anesthesia, intravascular covered stents were inserted through an open femoral artery approach, utilizing 14 F (Cook Medical, USA) catheter sheaths intraoperatively. complex AVMs were visualized in the superficial femoral artery and profunda femoris artery, accompanied by early visualization of an enlarged femoral vein.\n\nPreoperative CTA measurements indicated a diameter of 19 mm for the middle segment of the SFA, leading to the selection of a 20 mm–12 mm/120 mm aorto-uni-iliac covered stent (MicroPort, China). A 0.035 guidewire, in conjunction with a single-curve catheter, was used to access the popliteal artery. Subsequently, it was replaced with a 0.035 super-hard guidewire to provide support during the implantation of the stent graft. The stent was deployed precisely at the distal end of the superficial femoral artery, the location with the highest concentration of AVMs. Completion angiography revealed a significant reduction in venous opacification around the stent and clear visualization of the popliteal artery. Postoperatively, the left femoral artery was sutured using a 6 − 0 vascular risk suture, resulting in a significant improvement in the patient’s heart failure symptoms. The patient has heart failure, so the surgery duration should not be excessive. It is planned to perform embolization treatment in the second phase.\n\nOne week post-treatment, ultrasound examination revealed a reduction in volume flow to 1600 ml/min in the CFA, with a BNP level of 1198ug/l. Targeting the nidus with embolization therapy is expected to further decrease the flow velocity of arteriovenous malformations. The right CFA was punctured, allowing the insertion of a 5 F arterial sheath and a 5 F catheter for angiographic examination. Guided by ultrasound, the drainage vein of the AVM was punctured, and a 5 F vascular sheath was introduced. The contrast agent confirmed the presence of a nidus and its draining veins. The embolization procedure of the draining veins involved the use of a coil (18–20 mm x 40 cm, BSX, USA), two microcoils (4 mm x 42 mm, 5 mm x 10 mm, USA), 3% polidocanol (6 mL Kruelle, Germany), and 99% anhydrous ethanol (10 mL).\n\nCompletion angiography showed a significant reduction in the visualization of AVMs and draining veins, indicating their disappearance. During the one-year follow-up, the patient exhibited notable improvement in lower limb swelling and cardiac function. The volume flow in the CFA decreased to 780 ml/min. Echocardiography revealed minor enlargement of the left and right atria, slight mitral and tricuspid regurgitation, and a left ventricular ejection fraction (EF) of 71%. Notably, BNP levels decreased significantly.",
+    "summary": "We present a case involving a patient with congenital AVMs in the lower limb, who had suffered from prolonged swelling in the left lower limb and recently developed symptoms of heart failure. At the age of 67, the patient was definitively diagnosed with a complex congenital AVMs in the lower limb. This article delves into the practical experiences and limitations encountered in employing an abdominal aortic stent graft, coupled with embolization, to address acute heart failure caused by complex congenital AVMs in the lower limb.",
+    "translated_fulltext": null,
+    "translated_summary": "本文介绍了一例患者，该患者患有先天性下肢动静脉畸形，长期出现左下肢肿胀，并最近出现了心力衰竭的症状。该患者现年 67 岁，最终被确诊为患有复杂的先天性下肢动静脉畸形。本文深入探讨了在治疗由复杂先天性下肢动静脉畸形引起的心力衰竭时，采用腹主动脉支架植入术并结合栓塞术所遇到的实际经验和局限性。",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা নিম্ন অঙ্গে congenital AVMs থাকা এক রোগীর একটি কেস উপস্থাপন করছি, যিনি দীর্ঘদিন ধরে বাম নিম্ন অঙ্গে স্ফীতিতে ভুগছিলেন এবং সম্প্রতি heart failure-এর উপসর্গ দেখা দিয়েছে। রোগীর বয়স ৬৭ বছর হলে, তাকে নিম্ন অঙ্গে জটিল congenital AVMs হিসেবে চূড়ান্তভাবে নির্ণয় করা হয়। এই নিবন্ধে নিম্ন অঙ্গে জটিল congenital AVMs দ্বারা সৃষ্ট acute heart failure মোকাবিলায় embolization-এর সাথে abdominal aortic stent graft প্রয়োগের ক্ষেত্রে অর্জিত বাস্তব অভিজ্ঞতা ও সীমাবদ্ধতা নিয়ে আলোচনা করা হয়েছে।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0028_0029.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0028_0029.json
new file mode 100644
index 0000000000000000000000000000000000000000..a3cce30fdd39ff177b1c4d6c9347392995dd7fce
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0028_0029.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_268.txt",
+    "fulltext": "Technique\nInformation about the procedure of TFD.\nThe patient receives intravenous photosensitizer (Photogen®, King of Prussia, PA, USA - 1.5 mg/kg) 24 h before the procedure. Its peak light absorption is at the wavelength of 630 nm. The procedure begins with standard duodenoscopy (Olympus TJF-180) under general anesthesia. After the identification of the greater duodenal papilla and the retrograde cannulation, the digital cholangioscope (SpyGlassTM DS, Boston Scientific, Natick, MA) is introduced into the common bile duct. Then the cholangioscopic examination helps to identify the neoplastic stenosis. Under direct visualization, the illumination catheter (Medlight S.A., RD10-323, Switzerland) is advanced through the cholangioscope. This consists of a typical three-way cannula. The first port has a 1 cm long cylindrical light diffuser at the end. Two black radiopaque marks demarcate the limits of the diffuser. The second port accommodates a 0.025 inch guidewire and the third is a portal for injection. After positioning under cholangioscopic guidance, illumination is initiated. The dose is 90 J/cm², with a power of 70 mW/cm². Repositioning is recommended every centimeter to cover the entire stenosed area. At the end of the procedure, new cholangioscopy evaluates the bile duct for immediate outcome and adverse events.\n\nPost-procedure care\nThe patient is fasted for the next 24 h. If no adverse event is detected, oral diet is initiated. Discharge from hospital is done under strict guidance on photoprotection (prevention of exposure to light and use of sunglasses), especially during the first week after the session of TFD.\n\nRESULTS\nThis procedure was performed in an 82-year-old man who presented to our tertiary center with obstructive jaundice and weight loss over the previous two months. Endoscopic ultrasound (EUS) revealed severe dilation of the common bile duct associated with choledocholithiasis. ERCP confirmed these findings but was unable to remove the stones due to the disproportionate dilation of the common bile duct. Therefore, a plastic biliary stent was chosen. The patient showed improvement in his clinical condition, but the cholestasis returned 45 days after the first procedure. Two other ERCPs failed to remove the stones. During the third procedure, a long irregular stenosis of the common hepatic duct was apparent and he was referred for another echoendoscopic evaluation.\n\nIn addition to the choledocholithiasis, the new EUS revealed a dilated common hepatic duct with a well-circumscribed hypoechoic solid mass measuring 1.8x2 cm, which was compressing the common hepatic duct. The mass appeared to also involve the common hepatic artery. An ultrasound-guided needle biopsy confirmed the diagnosis of moderately differentiated cholangiocarcinoma (Bismuth I).\n\nAfter staging, the mass was considered inoperable and the patient was referred for palliative treatment. After a multidisciplinary meeting with the oncology team, adjunctive PDT was proposed to treat the recurrent biliary obstruction. The procedure went without complications and lasted 150 minutes. At the end, a biliary drainage was performed with a 10 Fr plastic stent, since a self-expanding metal stent was not available at that time.\n\nThe patient showed no signs or symptoms of photosensitivity in the following week. There was, however, early recurrence of cholestasis complicated with cholangitis. ERCP revealed obstruction of the stent with debris and biliary sludge secondary to tumor necrosis. A biliary scan followed by new drainage resolved the patient's acute condition. Subsequently, he remained asymptomatic for three months, the longest period since the onset of the disease. At his next recurrence, he was drained with a self-expanding metal stent. He continued with systemic treatment and eventually required a duodenal stent for palliation of dysphagia. He died due to complications of pulmonary metastases two years after the onset of symptoms and 15 months after the session of TFD.\n",
+    "summary": "Patient receives intravenous photosensitizer 24 h before the procedure which begins with regular duodenoscopy. After identification of the main papilla and retrograde cannulation, the digital cholangioscope is introduced into the common bile duct. Then the cholangioscopic examination helps to identify neoplastic stenosis. Under direct visualization, the illumination catheter is advanced through the cholangioscope. Repositioning is done every centimeter. At the end of cholangioscopy, the bile duct is evaluated for immediate outcome and adverse events.\n\nResult: This procedure was performed in an 82-year-old man with obstructive jaundice for the past two months. EUS and ERCP revealed severe dilation of the common bile duct associated with choledocholithiasis. In addition, there was dilation of the hepatic duct to a well-circumscribed hypoechoic solid mass measuring 1.8x2 cm, compressing the common hepatic duct. It was considered inoperable and the patient was referred for palliative treatment with PDT, which remained asymptomatic for three months. He died of complications 15 months after the PDT session.\n",
+    "translated_fulltext": null,
+    "translated_summary": "患者在手术前24小时接受静脉注射光敏剂，手术以常规十二指肠镜检查开始。在确定主乳头并进行逆行插管后，将数字胆管镜插入到总胆管中。然后，通过胆管镜检查来帮助识别肿瘤性狭窄。在直接观察下，将光照导管通过胆管镜推进。每隔一厘米进行一次调整。在胆管镜检查结束时，评估胆管以了解即时效果和不良事件。\n\n结果：该手术在一名82岁男性患者身上进行，该患者在过去两个月里患有梗阻性黄疸。内镜超声和内镜逆行胰胆管造影术显示，总胆管严重扩张，并伴有胆总管结石。此外，肝管也扩张，形成一个边界清晰、低回声的实性肿块，大小为1.8×2厘米，压迫了总肝管。经评估后，认为该患者不适合手术，因此转诊至进行姑息性光动力疗法，患者在治疗后三个月内没有出现任何症状。在光动力疗法后15个月，患者因并发症去世。",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "রোগীকে প্রক্রিয়ার 24 ঘন্টা আগে শিরায় photosensitizer দেওয়া হয়, এবং প্রক্রিয়াটি নিয়মিত duodenoscopy দিয়ে শুরু হয়। প্রধান papilla শনাক্তকরণ ও retrograde cannulation সম্পন্ন করার পর, digital cholangioscope সাধারণ পিত্তনালিতে প্রবেশ করানো হয়। এরপর cholangioscopic পরীক্ষা neoplastic stenosis শনাক্ত করতে সহায়তা করে। সরাসরি দৃষ্টিপথে, cholangioscope-এর মাধ্যমে illumination catheter অগ্রসর করা হয়। প্রতি সেন্টিমিটার অন্তর পুনরায় অবস্থান ঠিক করা হয়। cholangioscopy শেষে, তৎক্ষণাৎ ফলাফল ও adverse events মূল্যায়নের জন্য পিত্তনালি মূল্যায়ন করা হয়。\n\nফলাফল: গত দুই মাস ধরে obstructive jaundice-এ ভোগা 82-বছর-বয়সী এক পুরুষ রোগীর উপর এই প্রক্রিয়া সম্পাদিত হয়। EUS এবং ERCP-তে common bile duct-এর তীব্র প্রসারণ দেখা যায়, যা choledocholithiasis-এর সাথে সম্পর্কিত। অতিরিক্তভাবে, hepatic duct-ও প্রসারিত ছিল, একটি সুস্পষ্ট সীমানাযুক্ত hypoechoic কঠিন mass (আকার 1.8×2 সেমি) তৈরি হয়ে common hepatic duct-কে চেপে ধরছিল। মূল্যায়নের পর রোগীকে অপারেশনের উপযুক্ত নয় বলে মনে করা হয়, তাই প্যালিয়েটিভ PDT-এর জন্য রেফার করা হয়, এবং চিকিৎসার পর তিন মাস রোগী উপসর্গবিহীন ছিলেন। PDT-এর 15 মাস পরে রোগী জটিলতার কারণে মৃত্যুবরণ করেন।"
+  },
+  {
+    "id": "multiclinsum_gs_en_201.txt",
+    "fulltext": "A 77-year-old woman with haematemesis presented to the emergency room. Her medical history included only hypertension and dyslipidaemia. When she presented to the emergency room, her vital signs indicated shock (heart rate: 100 beats/min, blood pressure: 79/56 mmHg), and blood tests revealed anaemia (haemoglobin: 9.6 g/dL), which suggested upper gastrointestinal bleeding.\n\nNon-contrast-enhanced CT was performed immediately because of renal dysfunction. CT revealed that the third part of the duodenum flexed steeply on the right side of the aorta and ran caudally, without crossing anterior to the aorta. The jejunum was located on the patient’s right side. The second part of the duodenum and the stomach were dilated, and there were high-density gastric contents that were considered to indicate a haematoma.\n\nUpper gastrointestinal endoscopy was performed following the CT examination, which revealed a mucosal laceration at the gastric cardia. Bleeding from lacerations of the cardia of the stomach as a result of forceful vomiting was first reported by Mallory and Weiss in 1929.1 In our case, the third part of the duodenum flexed steeply, and the lumen was narrowed, which caused an obstruction. As a result, repeat vomiting was considered to have caused Mallory–Weiss syndrome.\n\nOn the basis of the CT findings showing that the duodenal-jejunal junction was located in the right hemi-abdomen, intestinal malrotation was suspected.2 However, 7 days later, when CT was repeated, spontaneous resolution of the malpositioned jejunum was seen. The patient was then discharged from the hospital. However, months later, she was rushed to the emergency room for repeat haematemesis. Dynamic CT was performed before upper gastrointestinal endoscopy, on admission, and revealed contrast extravasation in the dilated stomach. Additionally, the third part of the duodenum was flexed on the right side of the aorta, and the duodenal-jejunal junction and jejunum were again located in the right hemi-abdomen. Upper gastrointestinal endoscopy revealed a laceration at the gastric cardia, as in the previous endoscopy, which was considered Mallory–Weiss syndrome.\n\nTwo months after the second episode of haematemesis, the patient presented to the emergency room with nausea. Non-contrast-enhanced CT revealed no abnormalities in the duodenal positioning, but there was oedematous wall thickening in the second part of the duodenum. If we had not had previous CT images, we would have suspected duodenitis, but on the basis of all of the CT findings, we suspected the possibility of an underlying condition after the right-sided deviation of the small intestine had resolved spontaneously.\n\nIn summary, CT was performed 4 times over 5 months. The third and fourth parts of the duodenum and the jejunum deviated repeatedly, but this resolved spontaneously, which is not indicative of intestinal malrotation. Therefore, we diagnosed dysplasia of the ligament of Treitz.\n\nClinical outcomes\nThe patient underwent laparotomy, which revealed no abnormalities in the relative position of the duodenum to the jejunum. Additionally, the jejunum was located on the patient’s left side, and there was no intestinal malrotation. The ligament of Treitz was formed; however, its fixation in the upper jejunum was incomplete as it was attached only to the duodenum. The duodenal-jejunal junction was not fixed to the retroperitoneum, and the jejunum folded easily with the ligament of Treitz as a fulcrum. Surgically, the upper jejunum was fixed with 4 sutures to the retroperitoneum on the patient’s left side. The postoperative course was good, and the patient has remained symptom-free.",
+    "summary": "A 77-year-old woman underwent CT to evaluate haematemesis. The images showed that the third part of the duodenum flexed steeply on the right side of the aorta and ran caudally, without crossing anterior to the aorta. The duodenal-jejunal junction and jejunum were located on the patient's right side. Upper gastrointestinal endoscopy revealed a laceration at the gastric cardia, and a diagnosis of Mallory-Weiss syndrome was made. Repeat CT 7 days later revealed that the abnormal positioning of the intestinal tract had resolved spontaneously. Two months later, the patient experienced another episode of haematemesis, and CT revealed repeat deviation of the duodenal-jejunal junction and jejunum to her right side. Upper gastrointestinal endoscopy revealed another laceration at the gastric cardia, as in the previous study. On the basis of the initial CT findings showing the duodenal-jejunal junction in the right hemi-abdomen, intestinal malrotation was suspected. However, because the jejunum deviated repeatedly to the right side but resolved spontaneously, we diagnosed dysplasia of the ligament of Treitz. Laparotomy revealed a formed ligament of Treitz; however, fixation in the upper jejunum was incomplete. Additionally, CT revealed that the anterior pararenal space was loosely fixed and mobile. These factors may have caused the right-sided deviation of the small intestine.",
+    "translated_fulltext": null,
+    "translated_summary": "一位77岁女性因呕血接受了CT检查。影像显示，十二指肠的第三部分在主动脉的右侧呈陡峭弯曲，并向尾侧延伸，未穿过主动脉前方。十二指肠空肠连接处和空肠位于患者的右侧。上消化道内镜检查显示，胃心部有一处撕裂伤，诊断为马洛里-魏斯综合征。7天后复查CT，结果显示肠道异常位置已自行恢复。两个月后，患者再次出现呕血，CT检查显示十二指肠空肠连接处和空肠再次向右侧偏移。上消化道内镜检查再次显示胃心部有一处撕裂伤，与之前的检查结果一致。根据最初的CT结果，显示十二指肠空肠连接处位于右侧腹腔，怀疑存在肠道旋转异常。然而，由于空肠反复向右侧偏移但又自行恢复，因此诊断为特雷茨韧带发育不良。剖腹探查显示，特雷茨韧带已形成，但其在上空肠的固定不完全。此外，CT显示，前肾周间隙固定不牢，活动性较大。这些因素可能导致小肠向右侧偏移。",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "একজন ৭৭ বছর বয়সী নারী রক্তবমি মূল্যায়নের জন্য CT করিয়েছিলেন। ইমেজগুলো দেখায় যে ডুওডেনামের তৃতীয় অংশ অ্যাওর্টার ডান পাশে তীব্রভাবে বেঁকে নিম্নদিকে চলেছে, এবং অ্যাওর্টার সামনের দিক দিয়ে অতিক্রম করেনি। ডুওডেনো-জেজুনাল সংযোগস্থল এবং জেজুনাম রোগীর ডান পাশে অবস্থান করছিল। Upper gastrointestinal endoscopy-তে গ্যাস্ট্রিক কার্ডিয়ায় একটি laceration দেখা যায়, এবং Mallory-Weiss syndrome নির্ণয় করা হয়েছিল। ৭ দিন পর পুনরায় CT করলে দেখা যায় যে অন্ত্রনালীর অস্বাভাবিক অবস্থান স্বতঃস্ফূর্তভাবে সেরে গেছে। দুই মাস পরে রোগীর আবার রক্তবমি হয়, এবং CT-তে ডুওডেনো-জেজুনাল সংযোগস্থল ও জেজুনামের পুনরায় ডানদিকে বিচ্যুতি দেখা যায়। Upper gastrointestinal endoscopy-তে আগের পরীক্ষার মতোই গ্যাস্ট্রিক কার্ডিয়ায় আরেকটি laceration দেখা যায়। প্রাথমিক CT-তে ডুওডেনো-জেজুনাল সংযোগস্থলকে ডান হেমি-অ্যাবডোমেনে দেখা যাওয়ার ভিত্তিতে, intestinal malrotation সন্দেহ করা হয়েছিল। তবে জেজুনাম বারবার ডান দিকে সরে গেলেও স্বতঃস্ফূর্তভাবে স্বাভাবিক অবস্থায় ফিরে আসায়, আমরা Treitz ligament-এর dysplasia নির্ণয় করেছি। Laparotomy-তে দেখা যায় Treitz ligament গঠিত আছে; তবে উপরের জেজুনামে এর ফিক্সেশন অসম্পূর্ণ ছিল। অতিরিক্তভাবে, CT-তে দেখা যায় যে অ্যান্টেরিয়র প্যারারেনাল স্পেস শিথিলভাবে ফিক্সড এবং মোবাইল ছিল। এই সব কারণ ছোট অন্ত্রের ডানদিকে বিচ্যুতি ঘটাতে পারে।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0034_0035.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0034_0035.json
new file mode 100644
index 0000000000000000000000000000000000000000..d24ddd9d9db82802628431ecb15adcc80ff37051
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0034_0035.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_3.txt",
+    "fulltext": "We present a case of a 59-year-old lady with a twelve-year history of secondary progressive multiple sclerosis who was referred to ophthalmology with a few weeks’ history of bilateral blurring of vision.\n\nThe patient had no past ophthalmic history and no drug history other than the anti-epileptic medications related to her multiple sclerosis. Previously documented ophthalmic examinations did not reveal any signs of Fuchs' endothelial corneal dystrophy, and the patient has no family history of corneal pathology.\n\nThe patient had been on amantadine therapy at a dose of 100mg twice daily for the past 7 years and was started on levetiracetam 250mg twice daily as an add-on agent. Visual deterioration was experienced shortly after commencement of levetiracetam therapy for a breakthrough seizure.\n\nOn examination, the patient’s best corrected visual acuity was 0.5 logMAR right eye and 0.5 logMAR left eye. Slit-lamp examination revealed corneal edema involving both eyes and absence of uveitis. Corrected intraocular pressures were 16mmHg right eye and 18mmHg left eye. Corneal topography was performed which confirmed bilateral significant corneal thickening with a right central corneal thickness of 936μm and left central corneal thickness of 1134μm. The rest of the eye examination was normal.\n\nSince amantadine is a known cause of corneal edema, it was agreed with the patient and her caring neurologist to switch from amantadine to lamotrigine. Levetiracetam therapy was continued at this stage. No improvement in vision was noted two months after this change in treatment. The patient expressed the wish to temporarily stop levetiracetam on a trial basis in view of the direct temporal association between the onset of symptoms and the commencement of the medication.\n\nAmantadine was re-introduced, while levetiracetam dose was tapered. Improvement in vision was noted a few days after levetiracetam dose reduction. Levetiracetam was stopped altogether, and the patient remained on amantadine and lamotrigine. A provisional diagnosis of levetiracetam-induced corneal edema was made at this stage. Her vision normalized and repeat corneal topography six months after stopping the levetiracetam showed a right central corneal thickness of 567μm and a left central corneal thickness of 573μm, and a visual acuity of 0.2 logMAR both eyes. Slit-lamp examination confirmed clear cornea and the absence of corneal guttata in either eye.\n\nThe patient was examined again thirteen months after the first presentation. No further changes in her medications were made, and her vision had remained stable at 0.2 logMAR in both eyes. Repeat corneal topography showed no further changes.",
+    "summary": "A 59-year-old woman was referred to the ophthalmology department with a few weeks’ history of bilateral blurring of vision. She is a known case of secondary progressive multiple sclerosis, and she was started on levetiracetam by her neurologist a few weeks prior to referral in view of new seizure activity. Examination revealed bilateral clinically evident corneal edema, which was documented on corneal topography.\n\nResults\nUpon levetiracetam dose reduction, symptoms started to improve and eventually the medication was stopped altogether. The patient’s vision and corneal edema normalized on follow-up.",
+    "translated_fulltext": "我们报告了一例59岁女性患者，她患有继发性进展型多发性硬化症，病史长达十二年，因双眼视力模糊，持续数周，被转诊至眼科。\n\n该患者既往无眼科病史，除了与她的多发性硬化症相关的抗癫痫药物外，没有其他用药史。既往的眼科检查未发现福氏内皮角膜营养不良的任何迹象，患者也没有角膜病史的家族史。\n\n过去7年来，患者一直服用阿曼他定，剂量为每天两次，每次100毫克，并开始额外服用左乙拉西坦，剂量为每天两次，每次250毫克。在开始服用左乙拉西坦治疗突破性癫痫发作后不久，患者的视力开始下降。\n\n检查结果显示，患者的最佳矫正视力为右眼0.5 logMAR，左眼0.5 logMAR。裂隙灯检查显示双眼均存在角膜水肿，且无葡萄膜炎。矫正后的眼内压为右眼16mmHg，左眼18mmHg。进行了角膜地形图检查，证实双眼角膜明显增厚，右眼中央角膜厚度为936μm，左眼中央角膜厚度为1134μm。其余眼部检查结果正常。\n\n由于阿曼他定已知会导致角膜水肿，因此与患者及其主治神经科医生商议，决定将阿曼他定更换为拉莫三嗪。此时，继续使用左乙拉西坦治疗。在改变治疗方案后两个月，未观察到视力改善。考虑到症状出现与药物开始使用之间存在直接的时间关联，患者表示希望暂时停止使用左乙拉西坦，进行试验性治疗。\n\n重新开始使用阿曼他定，同时逐渐减少左乙拉西坦的剂量。在减少左乙拉西坦剂量后几天，患者的视力有所改善。完全停止使用左乙拉西坦，患者继续服用阿曼他定和拉莫三嗪。此时，初步诊断为左乙拉西坦引起的角膜水肿。她的视力恢复正常，并在停止使用左乙拉西坦后六个月再次进行角膜地形图检查，结果显示右眼中央角膜厚度为567μm，左眼中央角膜厚度为573μm，双眼视力均为0.2 logMAR。裂隙灯检查证实角膜清晰，且双眼均未发现角膜小点。\n\n在首次就诊后的十三个月，再次对患者进行了检查。未对她的药物进行进一步调整，双眼视力保持稳定，均为0.2 logMAR。重复进行的角膜地形图检查未显示进一步变化。",
+    "translated_summary": "一位 59 岁的女性因双眼视力模糊，症状持续数周，被转诊至眼科。她患有继发性进展型多发性硬化症，在转诊前几周，她的神经科医生开始给她服用左乙拉西坦，以控制新出现的癫痫发作。检查显示，双眼均有临床上明显的角膜水肿，并在角膜地形图检查中得到证实。\n\n结果\n在减少左乙拉西坦的剂量后，症状开始好转，最终完全停止了该药物的服用。随访期间，患者的视力和角膜水肿均恢复正常。",
+    "corrected_translated_fulltext": "আমরা ৫৯ বছর বয়সী এক নারী রোগীর একটি কেস উপস্থাপন করছি, যার secondary progressive multiple sclerosis-এর বারো বছরের ইতিহাস আছে এবং যিনি দুই চোখে কয়েক সপ্তাহ ধরে দৃষ্টি ঝাপসা হওয়ার ইতিহাস নিয়ে ophthalmology বিভাগে রেফার্ড হয়েছিলেন।\n\nরোগীর পূর্বে কোনো ophthalmic ইতিহাস ছিল না এবং multiple sclerosis-সংশ্লিষ্ট anti-epileptic ওষুধ ছাড়া অন্য কোনো ওষুধ ব্যবহারের ইতিহাস ছিল না। পূর্বে নথিবদ্ধ ophthalmic পরীক্ষা-নিরীক্ষায় Fuchs' endothelial corneal dystrophy-এর কোনো লক্ষণ পাওয়া যায়নি, এবং রোগীর corneal pathology-এর কোনো পারিবারিক ইতিহাস নেই।\n\nগত ৭ বছর ধরে রোগী amantadine 100mg দিনে দুবার সেবন করছিলেন এবং add-on এজেন্ট হিসেবে levetiracetam 250mg দিনে দুবার শুরু করা হয়েছিল। breakthrough seizure-এর জন্য levetiracetam থেরাপি শুরু করার অল্পকাল পরই দৃষ্টি অবনতি লক্ষ্য করা হয়।\n\nপরীক্ষায়, রোগীর best corrected visual acuity ছিল ডান চোখে 0.5 logMAR এবং বাঁ চোখে 0.5 logMAR। Slit-lamp পরীক্ষায় উভয় চোখে corneal edema এবং uveitis-এর অনুপস্থিতি দেখা যায়। Corrected intraocular pressure ছিল ডান চোখে 16mmHg এবং বাঁ চোখে 18mmHg। Corneal topography করা হয়, যা bilateral উল্লেখযোগ্য corneal thickening নিশ্চিত করে; ডান চোখের central corneal thickness 936μm এবং বাঁ চোখের central corneal thickness 1134μm ছিল। চোখের বাকি পরীক্ষাগুলো স্বাভাবিক ছিল।\n\namantadine corneal edema-র একটি পরিচিত কারণ হওয়ায়, রোগী এবং তার দেখভালের দায়িত্বে থাকা neurologist-এর সঙ্গে আলোচনা করে amantadine থেকে lamotrigine-এ পরিবর্তনের সিদ্ধান্ত নেওয়া হয়। এই সময়ে levetiracetam থেরাপি চালু রাখা হয়। চিকিৎসা পরিবর্তনের দুই মাস পরেও দৃষ্টিতে কোনো উন্নতি লক্ষ্য করা যায়নি। উপসর্গের সূচনা এবং ওষুধ শুরু করার মধ্যে সরাসরি সময়গত সম্পর্ক বিবেচনায়, রোগী ট্রায়াল হিসেবে সাময়িকভাবে levetiracetam বন্ধ করার ইচ্ছা প্রকাশ করেন।\n\namantadine পুনরায় শুরু করা হয়, আর levetiracetam-এর ডোজ ধীরে ধীরে কমানো হয়। levetiracetam-এর ডোজ কমানোর কয়েক দিনের মধ্যেই দৃষ্টির উন্নতি দেখা যায়। পরবর্তীতে levetiracetam সম্পূর্ণভাবে বন্ধ করা হয়, এবং রোগী amantadine ও lamotrigine-এ থাকেন। এই পর্যায়ে levetiracetam-induced corneal edema-এর একটি provisional diagnosis করা হয়। তার দৃষ্টি স্বাভাবিক হয়ে যায় এবং levetiracetam বন্ধ করার ছয় মাস পর পুনরায় করা corneal topography-তে ডান চোখের central corneal thickness 567μm এবং বাঁ চোখের central corneal thickness 573μm পাওয়া যায়, এবং উভয় চোখে visual acuity 0.2 logMAR ছিল। Slit-lamp পরীক্ষায় cornea পরিষ্কার পাওয়া যায় এবং কোনো চোখেই corneal guttata পাওয়া যায়নি।\n\nপ্রথম উপস্থাপনার তেরো মাস পর রোগীকে আবার পরীক্ষা করা হয়। তার ওষুধে আর কোনো পরিবর্তন আনা হয়নি, এবং উভয় চোখে তার দৃষ্টি 0.2 logMAR-এ স্থিতিশীল ছিল। পুনরায় করা corneal topography-তে আর কোনো পরিবর্তন ধরা পড়েনি।",
+    "corrected_translated_summary": "৫৯ বছর বয়সী এক নারীকে উভয় চোখে কয়েক সপ্তাহের দৃষ্টি ঝাপসা থাকার ইতিহাস নিয়ে চক্ষু বিভাগে রেফার করা হয়েছিল। তিনি secondary progressive multiple sclerosis-এর পরিচিত রোগী, এবং নতুন খিঁচুনির কারণে রেফার করার কয়েক সপ্তাহ আগে তার নিউরোলজিস্ট levetiracetam শুরু করেছিলেন। পরীক্ষায় উভয় চোখে ক্লিনিক্যালি সুস্পষ্ট corneal edema পাওয়া যায়, যা corneal topography-তে নথিভুক্ত করা হয়েছিল।\n\nফলাফল\nlevetiracetam-এর ডোজ কমানোর পর লক্ষণগুলোর উন্নতি শুরু হয় এবং শেষ পর্যন্ত ওষুধটি সম্পূর্ণভাবে বন্ধ করা হয়। ফলো-আপে রোগীর দৃষ্টি এবং corneal edema স্বাভাবিক হয়ে যায়."
+  },
+  {
+    "id": "multiclinsum_gs_en_362.txt",
+    "fulltext": "A 77-year-old male patient presented with a history of moderate cognitive impairment. The patient was admitted to the emergency department for a tonic-clonic seizure at home. The patient presented hemodynamically unstable in the context of a postcritical state and suspected intrapelvic bleeding. The code for a polytraumatized patient was activated, not because of the mechanism of injury, but because of the patient's hemodynamic status.  He was stabilized and optimized in the emergency department with intravenous fluid and transfusion of packed red blood cells. A pelvic girdle was placed. Once hemodynamic stability was achieved, a physical examination was performed. Clinically, the patient presented a shortening of the lower limb compared to the contralateral limb, external rotation and joint blockage when performing the log roll test in both limbs. He presented functional impotence in both hips. Given the patient's condition when he arrived at the emergency department, it was not possible to assess the neurological status. He had no signs of external injuries or bruises. Distal pulses were present at the foot level. He could move his upper limbs. A chest and anteroposterior pelvic radiograph was performed as part of the code for a polytraumatized patient, pending completion of an abdominal-pelvic computed tomography (CT) study. A bilateral femoral dislocation was diagnosed in the pelvic radiograph. The patient underwent a procedure to correct the dislocation.\n\n\n\nComputed tomography angiography to rule out vascular lesions given the instability in hemodynamic that presented itself on admission. Vascular lesions were ruled out after the angiography. In the 3D-CT reconstruction of the pelvis, a bilateral transverse acetabular fracture was found, according to the classification of Letournel and a bilateral longitudinal fracture of the iliac wing was found, along with intrapelvic protrusion of both femoral heads. After initial evaluation, supracondylar traction was placed on the femoral head in both extremities and the pelvic traction was removed. The patient was admitted to the recovery unit until surgery, where he remained with the traction supracondylar femoral head in both extremities and the pelvic traction was removed. The patient was operated on the eighth day of admission. In our service, the acetabular fractures were ruled out after seven days waiting for the formation of a fibrosis in the focus of fracture and the decrease of intraoperative bleeding during surgical procedures. It was decided to perform the surgery in two stages due to the long duration of each intervention. Both surgeries were performed with general anaesthesia, tranexamic acid was administered to prevent intraoperative bleeding and decrease blood transfusions in relation to the surgeries; and antibiotic (cefazolin 2 g preoperatively and 1 g of cefazolin every 8 hours postoperatively for 24 hours) as an intrahospital protocol. During the postoperative period, enoxaparin 40 mg was administered subcutaneously every 24 hours for seven weeks. Initially, the surgery of the left hemipelvis was performed since, at the radiographic level, it presented greater pelvic protrusion and it was not desirable that a hematoma in the soft tissue phase could generate complications at the time of extraction of the femoral head (vascular injuries, intraoperative bleeding). The supracondylar traction was removed. The patient was placed in lateral decubitus, and a posterior lateral approach was performed with a Moore's autograft in the acetabular background (fracture focus). Subsequently, the anti-protrusion ring was implanted (Burch SchneiderTM Reinforcement Cage, Zimmer Biomet) anchored to the ischium and ilium. Prior to the implantation of the ring, it was necessary to perform dissection of the gluteal musculature (gluteus minimus and medius) to correctly place the femoral head. The medial ischial fracture of the ring was also anchored with screws. The check was performed under the control of a scope to verify the correct implantation. Subsequently, a double mobility cementaed acetabular ring was implanted and then the non-cemented femoral stem was implanted. After finishing the placement of the components, the capsule and pelvic musculature were closed by means of transosseous trochanteric points. The surgery of the right hemipelvis was performed seven days later. The patient was placed in lateral decubitus. To address the longitudinal fracture of the iliac wing, the first window of the ilio-inguinal approach was performed. It was synthesised with a six-hole anatomical plate. Subsequently, the same procedure as the previous surgery was performed, using an anti-protrusion ring with a double mobility cemented femoral stem and non-cemented femoral stem. This type of anti-protrusion rings are used when there are acetabular fractures that could be equivalent to a pelvic disjunction (type IV classification of acetabular defects of the AAOS) and an anchorage in the ischium and ilium of the ring is needed to support the ring. They are not indicated for isolated fractures of the anterior or posterior wall of the acetabulum where there is no involvement of the acetabular background. During admission, the patient remained in bed and was mobilised to avoid decubitus ulcers. Once the second intervention was performed and when the patient tolerated it clinically, he began to transfer with the use of a wheelchair. In bed he was allowed to have a full range of motion without restriction. The patient was discharged four weeks later and did not begin to load or walk until six weeks. He began to load with the use of a walking stick. We decided to delay loading because, despite the use of arthroplasty as a treatment, it was decided to wait until there was an initial consolidation of the graft in the acetabular background that provided better support for the ring. It was also added that the patient presented bilateral involvement and it would be difficult to start partial loading, given that he did not have a healthy hip to support. During the follow-up of the patient, at 12 months of the intervention he was already doing full load with the use of a walking stick, with a Harris hip score of 79 in the left hip and 77 in the right hip; and a score of 12 on the WOMAC scale. He has not presented any postoperative complications to date. The patient is satisfied clinically, he reports occasional discomfort and a slight limp of the right side. He has a full range of motion in the examination and does not report having had any episode of instability since the surgery.\n",
+    "summary": "77-year-old patient with a history of moderate cognitive impairment who suffered bilateral central dislocation of the hip in the context of a generalized convulsive seizure. Clinically, upon arrival in the emergency department, the patient presented a shortening of the lower right limb compared to the contralateral limb, external rotation and joint blockage when performing the log roll test in both limbs. Imaging and clinical optimization study was performed prior to surgery. It was performed in two stages: first the left hip on the eighth day of admission and the right hip on the fifteenth. In both surgeries the same procedure was performed by implanting an anti-protrusive ring and prosthesis with double mobility acetabulum with non-cemented femoral stem. In the immediate postoperative period, the patient did not present any complications associated with the surgery. In the 12-month follow-up, the patient performed a full load with a Harris hip score (HHS) of 77 in the right hip and 79 in the left; 12 points in the WOMAC scale. He has not presented any postoperative complications to date.\n",
+    "translated_fulltext": null,
+    "translated_summary": "患者为 77 岁，既往有轻度认知障碍病史，因全身性强直性发作导致双侧髋关节中央脱位。患者就诊时，与对侧肢体相比，右下肢缩短，双侧肢体在进行翻身试验时出现外旋和关节活动受限。术前进行了影像学检查和临床优化研究。手术分两个阶段进行：首先在入院后的第八天对左侧髋关节进行手术，然后在第十五天对右侧髋关节进行手术。两次手术均采用相同的手术方法，即植入抗突出环和具有双重活动度的髋臼假体，并使用非骨水泥固定股骨柄。术后早期，患者未出现与手术相关的任何并发症。12 个月随访期间，患者右侧髋关节的 Harris 髋关节评分 (HHS) 为 77 分，左侧髋关节为 79 分，WOMAC 评分 12 分，可以承受完全负重。截至目前，患者未出现任何术后并发症。",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "রোগীর বয়স ৭৭ বছর, পূর্বে হালকা জ্ঞানীয় প্রতিবন্ধকতার ইতিহাস রয়েছে, সাধারণকৃত টনিক খিঁচুনির ফলে দ্বিপার্শ্বিক হিপ জয়েন্টের সেন্ট্রাল ডিসলোকেশন হয়েছে। রোগী আগমনের সময়, বিপরীত পার্শ্বের অঙ্গের তুলনায় ডান নিম্ন অঙ্গ সংক্ষিপ্ত ছিল, এবং উভয় অঙ্গে log roll test সম্পাদনের সময় বাহ্যিক রোটেশন ও জয়েন্টের কার্যগত সীমাবদ্ধতা দেখা যায়। অস্ত্রোপচারের আগে ইমেজিং পরীক্ষা এবং ক্লিনিক্যাল অপ্টিমাইজেশন স্টাডি করা হয়েছিল। অস্ত্রোপচার দুই ধাপে করা হয়েছিল: প্রথমে ভর্তি হওয়ার অষ্টম দিনে বাম হিপে অস্ত্রোপচার করা হয়, এরপর পনেরোতম দিনে ডান হিপে করা হয়। উভয় অস্ত্রোপচারে একই পদ্ধতি ব্যবহৃত হয়েছিল, অর্থাৎ anti-protrusive ring এবং double mobility acetabulum প্রস্থেসিস প্রতিস্থাপন করা হয়, এবং non-cemented femoral stem ব্যবহৃত হয়েছিল। অস্ত্রোপচারের পরবর্তী প্রারম্ভিক সময়ে, রোগীর অস্ত্রোপচার-সম্পর্কিত কোনো জটিলতা দেখা যায়নি। ১২ মাসের ফলো-আপে, রোগীর ডান হিপের Harris hip score (HHS) ছিল ৭৭ এবং বাম হিপে ৭৯; WOMAC স্কোর ১২, এবং তিনি সম্পূর্ণ ওজন বহন করতে সক্ষম ছিলেন। এ পর্যন্ত, রোগীর কোনো পোস্টঅপারেটিভ জটিলতা দেখা যায়নি।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0036_0037.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0036_0037.json
new file mode 100644
index 0000000000000000000000000000000000000000..8be6ce2e2a360334b2baff46a21c9523af83d1e4
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0036_0037.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_151.txt",
+    "fulltext": "The patient was a 4-month-old male from central Mexico with two healthy male siblings. His mother was hypothyroid during the first trimester of pregnancy and took drugs. The infant was born with normal weight and size, was breast-fed, and received the BCG vaccine with no scarring. The mother of the patient was a prisoner in a jail cell with the infant in a crowded cell with two others.At 4 months, the patient was medically evaluated for a painful tumor in the left axilla. A chest X-ray showed suggestive images of rib fractures; the mother was suspected of child abuse, and the infant was admitted to a pediatric hospital. The infant was weighed (4,190 g) and measured (58 cm) below the third percentile, oxygen saturation of 70%, fever, cough, increased volume in the left axilla, and pain, redness, and warmth. The blood count showed: hemoglobin of 8.8 g/dL (11.0-12.6), 29.3 × 109 leukocytes/L (6.0-17.5), 18.4 × 109 neutrophils/L (1.0-8.5), 7.0 × 109 lymphocytes/L (4.0-13.5), 3.5 × 109 monocytes/L, 459 × 109 platelets/L (150-350), and C-reactive protein of 16 mg/L (< 3.0). The first thoracoabdominal tomography showed an abscess in the left axilla, lytic lesions in ribs 3-6, left apical pneumonia, pulmonary nodules in both lungs, and enlarged cervical and mediastinal lymph nodes. The biopsy of the left axilla abscess reported myositis and suppurative panniculitis. Only the culture for bacteria from the bronchoalveolar liquid was negative, and the PCR for the Mycobacterium tuberculosis complex was negative. After 41 days of hospitalization and receiving two antimicrobial regimens of ceftriaxone-clindamycin and cefepime-vancomycin, the patient was discharged.\n\nTwo months later, at eight months of age, he was readmitted to hospital with a fever, irritability and a suppurating abscess in the left scapula. The blood count showed haemoglobin of 10.8 g/dl (10.5-12), 21.2 × 109 leukocytes/L (6-17), 12.2 × 109 neutrophils/L (1.5-8.5), 7.5 × 109 lymphocytes/L (4-10.5), 1.2 × 109 monocytes/L (600), and 583 × 109 platelets/L (150-350); the serum test for HIV was negative. A left apical consolidation, bronchiectasis, lytic lesions in ribs 2-7 and dorsal vertebrae 2-7, and a multilocular fluid collection were observed on a chest scan; ultrasound showed a fistula associated with the scapular abscess. The patient received piperacillin-tazobactam, which was later replaced with voriconazole after Aspergillus fumigatus was detected in the secretion sample culture. Given the recurrence and severity of the infection, an innate immunity defect was suspected. The dihydrorhodamine test showed no production of reactive oxygen species and the gp91phox expression in neutrophils was absent, establishing a diagnosis of X-linked chronic granulomatous disease. The pathogenic variant detected by next-generation sequencing was c.80_83del/Y (p.Val27Glyfs*33) in CYBB. The mother was a carrier of the variant (c.80_83del/WT). The two older male siblings, who were apparently healthy, could not be genetically tested. The patient was discharged after 65 days of hospitalisation and 28 days of voriconazole treatment. Daily antibiotic prophylaxis with trimethoprim-sulfamethoxazole and antifungal prophylaxis with fluconazole twice a week were initiated. Two months later, at one year of age, the infant was readmitted due to multifocal pneumonia, for which mechanical respiratory assistance was required. The galactomannan antigen was detected in the serum and A. fumigatus was detected in the culture of the lavage fluid, so treatment with voriconazole was initiated again. The patient suffered a multiple organ failure and died one month after admission.\n",
+    "summary": "A case of infant with chronic granulomatous disease and invasive aspergillosis is reported. The infant was a 4-month-old male infant living with his mother in a prison cell. The infant had tumors in the left axillary region and a chest X-ray suggested rib fractures; he was hospitalized on suspicion of child abuse. A chest X-ray showed an axillary abscess, osteolysis of ribs, pneumonia and pulmonary nodules; the patient received broad spectrum antibiotics and was discharged. At 8 months, he was readmitted with fever and extension of the purulent abscess to the left shoulder region; a chest X-ray showed worsening of the condition. Aspergillus fumigatus was isolated from the secretion of the abscess and invasive aspergillosis was diagnosed; voriconazole was initiated for 28 days. A dihydro rhodamine test was performed and a diagnosis of chronic granulomatous disease caused by the pathogenic variant c.80_83del/Y of the CYBB gene, carried by the mother (c.80_83del/WT), was made. At 12 months, the patient was readmitted with invasive aspergillosis, resistant to treatment, with fatal outcome.\n",
+    "translated_fulltext": null,
+    "translated_summary": "本文报告了一例患有慢性肉芽肿病并伴有侵袭性曲霉菌病的婴儿病例。该婴儿为一名4个月大的男孩，与母亲一同居住在监狱的牢房里。该婴儿左腋窝区域有肿瘤，胸部X光片显示肋骨骨折，因此被送往医院，怀疑是虐待儿童。胸部X光片显示腋窝脓肿、肋骨骨质溶解、肺炎和肺部结节；该患者接受了广谱抗生素治疗后出院。8个月时，该婴儿因发烧和脓性脓肿扩散至左肩区域而再次入院；胸部X光片显示病情恶化。从脓肿分泌物中分离出烟曲霉菌，确诊为侵袭性曲霉菌病，并开始使用伏立康唑治疗28天。进行了二氢罗丹明测试，诊断为慢性肉芽肿病，该疾病是由CYBB基因上的致病变异c.80_83del/Y引起的，该变异由母亲携带（c.80_83del/WT）。12个月时，该患者因对治疗产生耐药性的侵袭性曲霉菌病再次入院，最终导致死亡。",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "chronic granulomatous disease এবং invasive aspergillosis সহ এক শিশু রোগীর একটি কেস রিপোর্ট করা হয়েছে। শিশুটি ৪ মাস বয়সী পুরুষ শিশু ছিল এবং মায়ের সাথে কারাগারের একটি সেলে বসবাস করছিল। শিশুটির বাম কাঁখ অঞ্চলে টিউমার ছিল এবং একটি chest X-ray পাঁজরের ভাঙার ইঙ্গিত দেয়; শিশু নির্যাতনের সন্দেহে তাকে হাসপাতালে ভর্তি করা হয়। একটি chest X-ray-এ axillary abscess, পাঁজরের osteolysis, pneumonia এবং pulmonary nodules দেখা যায়; রোগী broad spectrum antibiotics পেয়ে ডিসচার্জ করা হয়। ৮ মাসে, তিনি জ্বরসহ এবং purulent abscess বাম কাঁধ অঞ্চলে প্রসারিত হওয়ায় পুনরায় ভর্তি হন; একটি chest X-ray অবস্থার অবনতি দেখায়। abscess-এর স্রাব থেকে Aspergillus fumigatus পৃথক করা হয় এবং invasive aspergillosis নির্ণয় করা হয়; voriconazole 28 দিনের জন্য শুরু করা হয়। dihydro rhodamine test করা হয় এবং CYBB gene-এর রোগজনক ভ্যারিয়ান্ট c.80_83del/Y দ্বারা সৃষ্ট chronic granulomatous disease-এর নির্ণয় স্থাপন করা হয়, যা মা বহন করছিলেন (c.80_83del/WT)। ১২ মাসে রোগী treatment-resistant invasive aspergillosis নিয়ে পুনরায় ভর্তি হন, এবং পরিণতি ছিল প্রাণঘাতী।"
+  },
+  {
+    "id": "multiclinsum_gs_en_133.txt",
+    "fulltext": "Male patient, 25 years old, Sundanese, presented at the Dental Hospital of the Faculty of Dentistry Universitas Padjadjaran with the chief complaint of mouth sores, which are painful on the upper and lower lips and exacerbated when eating and talking. Initially, four days ago, canker sores started in the oral cavity, then appeared on the lips two days later. The patient tried to self-medicate by applying petroleum jelly which he used to relieve his symptoms, but it did not improve. The patient replaced the drug with triamcinolone acetonide 0.1% in orabase ointment purchased at the pharmacy and applied it once a day. Canker sores were getting better but did not cure.\n\nThe patient had history a of fever for about a week before the canker sores appeared and there were no lesions on other parts of the body. He stated that the workload was quite heavy and he had not consumed a balanced nutritional diet for about one and a half months. He had no medical history, history of food allergies, or history of taking medication. He had no history of alcohol consumption or smoking, but he had a frequent habit of licking his lips. He also had a history of chickenpox when he was a child.\n\nThe patient had no fever with all vital signs within normal limits on general examination. Extra-oral examination showed no abnormalities in the lymph nodes. There were serosanguineous crusts that felt painful and bleed easily on the lips. Intra-oral examination revealed erythematous lesions, irregular in shape, and had diffuse borders, accompanied by pain in the upper and lower labial mucosa. Hyperkeratotic white plaque that could not be scraped off, irregular in shape, has diffuse borders, without pain in the region of tooth 38 left buccal mucosa. Yellowish-white plaques were seen on 1/3 of the posterior surface of the dorsal tongue, which could be scraped off without leaving an erythematous area, and there were indentations in the form of dental impressions without pain on the lateral right and left sides of the tongue. A painless hard nodule about 2×1 x 0.5 cm in size was seen in the midline of the hard palate. Several teeth were found in caries, radix, and edentulous conditions in all regions. The oral hygiene was poor.\n\nExamination of psychological conditions was evaluated using the DASS-21 questionnaire and showed normal depression level (score 0), normal anxiety level (score 6), and normal stress level (score 6). Based on history and clinical examination, the working diagnosis was suspected HAEM, accompanied by the coated tongue, frictional keratosis, crenated tongue, torus palatinus, reversible pulpitis of tooth 18, irreversible pulpitis of tooth 47, chronic apical periodontitis et causa radix of tooth 15, and edentulous teeth 28, 37, 36, and 46. The differential diagnosis of suspected HAEM lesions on the lips was exfoliative cheilitis. However, exfoliative cheilitis did not have herpes virus involvement. The patient was indicated for serological testing (IgG anti-HSV-1) to confirm the diagnosis. Oral health-related quality of life was measured, and the results of the OHIP-14 examination at the first visit were 35 (moderate OHRQol).\n\nThe non-pharmacological therapy included instruction to maintain oral hygiene by brushing the teeth and tongue using a soft-bristled toothbrush two times a day and using non-detergent toothpaste. Education was given such as increasing the intake of water by at least two liters per day, consuming a balanced nutritional diet, avoiding acidic, spicy, hard, and monosodium glutamate-containing foods, and stopping the bad habit of licking and peeling the skin of the lips. The pharmacological therapy included topical and systemic medications. The topical medications included instructions to compress the lips with gauze moistened with 0.9% NaCl solution at least three times a day and to apply a thin layer of triamcinolone acetonide 0.1% in orabase to the lips three times a day. The systemic medications included instruction to take a multivitamin once a day.\n\nThe progress of improvement was visible in the first follow-up, two days after the initial visit. The pain in the lips was reduced, but the canker sores have not healed. Extra-oral examination revealed serosanguinous crusts on the lips which were still painful and bled easily. The serological test result (IgG anti-HSV-1) was positive with a ratio of: 6.32 (positive: ratio > 1.1). The definitive diagnosis was established based on the history, clinical examination, and serological tests as HAEM. The non-pharmacological and pharmacological therapy was continued, and systemic medication was added in the form of instructions to consume acyclovir 200 mg tablets five times a day for one week.\n\nSignificant improvement was visible in the second follow-up, five days after the previous visit, showing excellent healing in all of the patient’s oral lesions. The OHIP-14 result at the last visit was 4 (good OHRQoL). The patient’s physical, psychological, and social conditions showed improvement and returned to normal after 7 days of treatment. Patient was referred to continue dental and oral care in the periodontics, dental conservation, oral surgery, and prosthodontics departments. The patient has approved and written informed consent for the case details to be published included publication of the images, and the institution has also approved for publication. This case had complied with the Declaration of Helsinki.",
+    "summary": "A 25-year-old male patient came to the Department of Oral Medicine with the chief complaint of painful canker sores on the lips. Extra-oral examination revealed serosanguineous crusts on the lips that were painful and easily bleed. Intra-oral examination showed diffused and painful irregular erythematous lesions on the upper and lower labial mucosa. The anti-HSV1 IgG test was positive. The patient was diagnosed with HAEM.\n\nCase management: Pharmacological therapy included triamcinolone acetonide 0.1% in orabase, acyclovir tablets, multivitamins, and 0.9% NaCl. Non-pharmacological therapy included advice on maintaining good oral hygiene, avoiding spicy and sour foods, and breaking the bad habit of licking the lips.",
+    "translated_fulltext": null,
+    "translated_summary": "一位25岁的男性患者因主诉嘴唇上有疼痛的口腔溃疡而来到口腔科就诊。体外检查显示，嘴唇上有血清性渗出性结痂，触痛明显，且容易出血。口内检查显示，上唇和下唇黏膜上有弥漫性、不规则的、红斑样、疼痛的病灶。抗HSV1 IgG检测结果为阳性。该患者被诊断为复发性阿弗他性口炎（HAEM）。\n\n病例管理：药物治疗包括0.1%三乙酰妥尼酮口腔软膏、阿昔洛韦片、多种维生素和0.9%生理盐水。非药物治疗包括建议患者保持良好的口腔卫生，避免食用辛辣和酸性食物，并纠正舔嘴唇的坏习惯。",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "২৫ বছর বয়সী এক পুরুষ রোগী ঠোঁটে ব্যথাযুক্ত canker sores-এর প্রধান অভিযোগ নিয়ে Oral Medicine বিভাগে আসেন। Extra-oral পরীক্ষায় ঠোঁটে serosanguineous crusts দেখা যায়, যা বেদনাদায়ক এবং সহজে রক্তপাত হয়। Intra-oral পরীক্ষায় উপরের ও নিচের labial mucosa-তে বিস্তৃত ও বেদনাদায়ক অনিয়মিত erythematous lesions দেখা যায়। anti-HSV1 IgG পরীক্ষা পজিটিভ ছিল। রোগীকে HAEM হিসেবে নির্ণয় করা হয়।\n\nকেস ম্যানেজমেন্ট: ফার্মাকোলজিক্যাল থেরাপিতে triamcinolone acetonide 0.1% in orabase, acyclovir ট্যাবলেট, multivitamins এবং 0.9% NaCl অন্তর্ভুক্ত ছিল। নন-ফার্মাকোলজিক্যাল থেরাপিতে ভাল oral hygiene বজায় রাখা, ঝাল ও টক খাবার এড়ানো, এবং ঠোঁট চাটার খারাপ অভ্যাস ত্যাগ করার পরামর্শ অন্তর্ভুক্ত ছিল।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0038_0039.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0038_0039.json
new file mode 100644
index 0000000000000000000000000000000000000000..18e60633d99532f81c3047cc5ce54f45b5f86b83
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0038_0039.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_164.txt",
+    "fulltext": "A 56-year-old female patient presented with complaints of dyspnea that required oxygen supplementation. Her medical history dates back to July 2013 when she was hospitalized in the chest ward for dyspnea and cough with yellow sputum. She was subsequently diagnosed with Sjogren’s syndrome complicated with interstitial lung disease (ILD) and PAH (Table I). Her chest X-ray at that time showed vascular markings with interstitial thickening, costophrenic (CP) angle blunting and cardiomegaly. An echocardiogram revealed a pulmonary arterial (PA) systolic pressure of 99 mmHg, enlargement of the right atrium and ventricle, D-shaped left ventricle (LV), and severe tricuspid regurgitation. Chest CNYCT showed no filling defects, excluding pulmonary embolism; it also displayed an enlarged pulmonary trunk, right atrium (RA), and right ventricle (RV), further evidencing pulmonary hypertension. Symptoms of dry mouth, dry eyes, and cracked tongue mucosa, with a Schirmer’s test showing <5 cm, oculus uterque (OU). A positive minor salivary gland biopsy, nuclear medicine scan showing impaired salivary gland function, and a positive anti-Ro test, confirmed Sjogren’s syndrome. She started on Revatio (Sildenafil) 20 mg three times a day (TID) for pulmonary hypertension control, adding Tracleer (Bosentan) in 2016 due to disease progression. A right heart catheterization (RHC) revealed a mean pulmonary arterial pressure (PAP) of 39 mmHg, pulmonary vascular resistance (PVR) nearly 15 Woods, and a wedge pressure of 4, indicating pre-capillary type, group I, CTD-related PAH in 2017. The right heart catheterization (RHC) report allowed for insurance coverage of Opsumit (Macitentan) 10 mg once a day (QD), replacing Tracleer (Bosentan) in 2017. From 2017 to 2020, she was hospitalized multiple times for steroid treatments to manage her underlying Sjogren’s syndrome.\n\nPulmonary hypertension treatment is risk-based, and until 2017, the patient was considered low to intermediate risk, controlled with two medications (Sildenafil + Macitentan). Her condition remained stable until October 2020, when she experienced worsened dyspnea accompanied by cough and expectoration of white sputum, suggestive of infection. On November 10, 2020, the patient experienced severe dyspnea, cold sweats, and cyanosis, with SpO2 dropping to 70%, necessitating 100% O2 via face tent. Blood gas and lab tests revealed a lactate level of 5.2 mmol/l and brain natriuretic peptide (BNP) over 10,000 pg/ml, strongly suggesting cardiogenic shock. She was prepped for intensive care unit (ICU) admission, intubated, and initiated on four pulmonary hypertension medications. Her condition stabilized and showed improvement, preventing further deterioration. On November 12, 2020, evaluation for heart-lung transplantation began. Her condition continued to improve with off vasopressors on November 13, 2020, and extubating on November 14, 2020, and transferred to a general ward on November 21, 2020, with O2 tapered to nasal cannula 2l/min. A follow-up RHC continued to show elevated pulmonary artery pressure, likely attributed to chronic hypertension leading to right heart strain and eventual failure. After intensive care unit (ICU) treatment, she was referred to National Taiwan University Hospital for evaluation for heart-lung transplant.\n\nReviewing the records since the onset of her illness, it was evident that pulmonary artery pressure had steadily increased, and the distance covered in the 6-minute walk test was progressively shortened. Currently, the patient is classified as high risk. She continues regular hospitalizations for control. Despite the relatively stable condition, her chief complaint during the admission is still dyspnea. The physical examination revealed mild rhonchi ILD and a pansystolic murmur indicative of severe valvular heart disease, with no other significant findings. Ventavis (Iloprost) 10 mcg/ml 2 ml was added in 2020. Molecular hydrogen therapy (1 capsule/day) was initiated in May 2023. Hydrogen capsules (PURE HYDROGEN) were purchased from HoHo Biotech Co., Ltd. (Taipei, Taiwan, ROC). Each capsule contained 170 mg of hydrogen-rich coral calcium containing 1.7×1,021 molecules of hydrogen, which is equivalent to 24 cups of water with 1,200 ppb of hydrogen or 0.6 mM of hydrogen per 200 ml of water. Adjuvant therapy with hydrogen capsules resulted in increased CD127 + Treg, decreased anti-Ro antibody, decreased B cell subsets, and stabilization of clinical symptoms and signs was observed following the addition of hydrogen therapy in this patient. No adverse reactions or events were observed following the administration of hydrogen capsules. Flow cytometry and serological examination were employed for whole-blood analysis to assess changes in immune cells and autoantibody before and after hydrogen therapy. For subsequent whole-blood analysis via flow cytometry, blood samples were prepared using standard fluorescent dye preparation methods and fluorescent antibody reagent kits with dried reagents (Beckman Coulter, Brea, CA, USA). The methods, steps, immunophenotypic analysis, and cell gating were conducted following previously described procedures. Our analysis of immunophenotypic markers before and after hydrogen therapy revealed increased CD127 + Treg and decreased B cell subsets after treatment. Moreover, this study adheres to the CARE reporting guidelines (2013 CARE Checklist).",
+    "summary": "We present the case of a 56-year-old female with CTD-PAH, diagnosed in 2013 with Sjogren’s syndrome complicated by interstitial lung disease (ILD) and PAH. Despite treatment with sildenafil, bosentan, macitentan, iloprost, and corticosteroids, her condition deteriorated, resulting in severe dyspnea and cardiogenic shock in 2020. In May 2023, molecular hydrogen therapy was initiated as an adjuvant treatment. The patient received daily hydrogen capsules, which led to increased CD127+ Treg cells, reduced anti-Ro antibodies, and decreased B cell subsets. Her clinical symptoms stabilized without adverse effects.",
+    "translated_fulltext": null,
+    "translated_summary": "我们介绍了一位56岁女性患者的病例，该患者患有结缔组织病相关的肺动脉高压（CTD-PAH），于2013年被诊断出患有干燥综合征，并伴有间质性肺病（ILD）和肺动脉高压。尽管接受了西地那非、博森坦、马西替坦、伊洛前列素和皮质类固醇等药物治疗，但她的病情仍在恶化，导致2020年出现严重的呼吸困难和心源性休克。2023年5月，开始采用分子氢疗法作为辅助治疗。患者每日服用氢气胶囊，结果显示CD127+调节性T细胞数量增加，抗Ro抗体减少，B细胞亚群数量下降。她的临床症状得到稳定，且未出现不良反应。",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা 56 বছর বয়সী এক নারী রোগীর একটি কেস উপস্থাপন করছি, যিনি CTD-PAH-এ ভুগছেন; 2013 সালে তার Sjogren’s syndrome নির্ণয় হয়, যা interstitial lung disease (ILD) এবং PAH দ্বারা জটিল ছিল। sildenafil, bosentan, macitentan, iloprost এবং corticosteroids দ্বারা চিকিৎসা সত্ত্বেও, তার অবস্থা অবনতি ঘটে, যার ফলে 2020 সালে তীব্র শ্বাসকষ্ট এবং cardiogenic shock দেখা দেয়। 2023 সালের মে মাসে, adjuvant চিকিৎসা হিসেবে molecular hydrogen therapy শুরু করা হয়। রোগী প্রতিদিন hydrogen ক্যাপসুল গ্রহণ করেছিলেন, যার ফলে CD127+ Treg কোষ বৃদ্ধি পায়, anti-Ro antibodies কমে, এবং B cell subsets হ্রাস পায়। তার ক্লিনিক্যাল উপসর্গ স্থিতিশীল ছিল, এবং কোনো adverse effects দেখা যায়নি।"
+  },
+  {
+    "id": "multiclinsum_gs_en_354.txt",
+    "fulltext": "The patient was a 45-year-old male born in Pakistan who had resided in Portugal for 7 years. He had a history of grade 3 obesity, with no other known personal history or usual pharmacological therapy.\n\nThe patient sought emergency care for fever, dry cough, dyspnea, chest pain, dysgeusia, headache and myalgia with 4 days of evolution. In the summary neurological examination at admission, there were no reported changes. In the evaluation of the respiratory system, tachypnea and pulmonary auscultation with bilateral rough vesicular murmur, without other adventitious sounds, were noted. The remainder of the objective examination showed no changes.\n\nOf the complementary diagnostic tests performed at admission, there was a slight increase in inflammatory parameters and in arterial blood gases under an inspired oxygen fraction (FiO2) of 21%, with type 1 respiratory failure and extensive predominant bilateral, peripheral and basal opacities on chest teleradiography. After a positive reverse-transcription real-time polymerase chain reaction (RT-PCR) test for SARS-CoV-2 (nasal and oropharyngeal exudate) and negative tests for influenza A and B, Streptococcus pneumoniae and Legionella pneumophila, a diagnosis of pneumonia by SARS-CoV-2 infection was established.\n\nOver the first 48 hours, progressive worsening of fatigue, dyspnea and type 1 respiratory failure, requiring an increase in supplemental oxygen therapy, were observed. Due to the lack of improvement, noninvasive mechanical ventilation was initiated; however, due to poor adherence, high-flow oxygen therapy was initiated through a nasal cannula, without a response to therapy.\n\nIn this context, the patient was admitted to the intensive care unit (ICU), level III, where he underwent sedoanalgesia and orotracheal intubation with connection to invasive mechanical ventilation.\n\nOn the eleventh day of hospitalization, treatment with remdesivir, dexamethasone, enoxaparin and empirical antibiotic therapy with amoxicillin/clavulanic acid and azithromycin, administered on suspicion of bacterial overinfection, was continued. During this period, sustained fever was observed, with a weak response to antipyretic therapy, with improvements in inflammatory parameters after the third day of hospitalization in the ICU.\n\nTo exclude any concomitant infectious etiology, intravenous devices were replaced, and blood cultures, cultures of the tip of the central catheter and bronchial secretions, urinalysis, urine culture and transthoracic echocardiography were performed. Among the cultures, the blood culture yielded the only positive result, i.e., Klebsiella pneumoniae, which is sensitive to amoxicillin/clavulanic acid, which the patient was already receiving. The summary echocardiogram did not reveal valve changes suggestive of endocarditis, but the patient presented hypokinesia of the lateral wall and left ventricular apex, as well as poor biventricular function. A slight increase in troponins (1.8ng/mL) and ST-segment depression in leads I and aVL were confirmed, suggesting the existence of acute coronary syndrome or septic cardiomyopathy.\n\nOther noninfectious causes of febrile symptoms in the critically ill patient were excluded, including treatment with neuroleptics or altered thyroid function.\n\nNotably, there was a need for inotropic support with dobutamine in the ventilatory weaning phase as well as noninvasive ventilatory support after orotracheal extubation, which occurred on the fifteenth day of hospitalization.\n\nOn the sixteenth day of hospitalization (nineteenth day of confirmed disease), there was an episode of altered state of consciousness, conjugated deviation of gaze to the right and myoclonus of the face and thoracic region to the left followed by a generalized tonic-clonic seizure crisis, which ceased after midazolam therapy. The hypothesis that the seizure occurred in the context of a hypoxic-ischemic event was excluded because the patient remained normotensive, there was never a peri-event or hypoxemia, serum lactate level was normal, and diuresis remained preserved. Any ionic or glycemic disorders that could explain the inaugural seizure episode were excluded.\n\nIn the post-critical period, there was an absence of eye opening, no verbal response, failure to localize to pain (coma scale of Glasgow 7), and persistent left hemiparesis grade 3 out of 5. Due to the need for airway protection, the patient was sedated, subjected to orotracheal intubation and started on anticonvulsant therapy.\n\nIn the process of diagnosis of the convulsive episode, after cranial computed tomography confirmed no changes, the patient was subjected to lumbar puncture, with turbid CSF output and mild proteinorrachia but without pleocytosis and with normal opening pressure. In the CSF, neurotropic virus and venereal disease research laboratory (VDRL), acid-alcohol resistant bacteria tests and an RT-PCR test for SARS-CoV-2 were requested, and samples were collected for culture. Electroencephalography was performed 1 hour after propofol suspension and under fentanyl, with a single record and total duration of 13 minutes; the findings indicated no changes.\n\nAfter confirmation of a positive RT-PCR test for SARS-CoV-2 RNA in the CSF, without CSF pleiocytosis, the hypothesis of bacterial but nonviral meningitis was excluded, considering the hypothesis of encephalitis. Magnetic resonance imaging (MRI) performed on the seventeenth day of hospitalization showed multiple image artifacts associated with patient movement during the procedure, suggesting the need to repeat the examination.\n\nAfter discontinuation of sedoanalgesia, a change in consciousness was observed, with a Glasgow coma scale score of 14, persistent left hemiparesis with muscle strength grade 4 in 5 and an absence of involuntary movements, allowing safe orotracheal extubation in 24 hours. Given the favorable clinical outcome, brain biopsy was excluded. On the twenty-first day of hospitalization, the patient was transferred to the ward.\n\nThe patient maintained apyrexia without altered state of consciousness. No new episodes of involuntary movements were observed, and on the twenty-sixth day of hospitalization, he underwent a reassessment MRI, which revealed no pathological changes. As he maintained a favorable clinical evolution, the patient was discharged on the thirty-first day of hospitalization without antiepileptic drugs and with an appointment for follow-up with the internal medicine department.\n",
+    "summary": "The authors present the clinical case of a 45-year-old man admitted for pneumonia with a positive result for SARS-CoV-2, with no neurological history, who, on the 16th day of admission, presented a sudden change in consciousness accompanied by a conjugate deviation of the gaze to the right and myoclonia of the face and thoracic region to the left, followed by a generalized tonic-clonic convulsive seizure, associated with persistent left hemiparesis. From the study carried out, the existence of RT-PCR for SARS-CoV-2 in the cerebrospinal fluid is highlighted. The patient presented a clinical evolution with gradual improvement, and the outcome was favourable.\n",
+    "translated_fulltext": null,
+    "translated_summary": "本文介绍了一位45岁男性患者的临床病例。该患者因肺炎入院，SARS-CoV-2检测结果呈阳性，既往无神经系统疾病史。入院第16天，患者突然出现意识改变，伴有双眼向右偏斜，以及面部和胸部区域的左侧肌阵挛，随后出现全身性强直-阵挛性癫痫发作，并伴有持续性左侧肢体无力。研究结果显示，脑脊液中存在SARS-CoV-2的RT-PCR阳性结果。患者的病情逐渐好转，预后良好。",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "এই প্রবন্ধে ৪৫ বছর বয়সী এক পুরুষ রোগীর একটি ক্লিনিক্যাল কেস উপস্থাপন করা হয়েছে। রোগী নিউমোনিয়ার কারণে ভর্তি হন, SARS-CoV-2 পরীক্ষার ফলাফল পজিটিভ ছিল, এবং পূর্বে কোনো স্নায়ুতন্ত্রের রোগের ইতিহাস ছিল না। ভর্তির ১৬তম দিনে, রোগীর হঠাৎ চেতনার পরিবর্তন হয়, সাথে দৃষ্টির ডানদিকে conjugate deviation এবং মুখমণ্ডল ও বক্ষ অঞ্চলের বামদিকে myoclonia; পরবর্তীতে generalized tonic-clonic খিঁচুনি হয়, যা স্থায়ী বামপাশীয় hemiparesis-এর সাথে সংশ্লিষ্ট ছিল। গবেষণার ফলাফলে দেখা যায়, cerebrospinal fluid-এ SARS-CoV-2-এর RT-PCR পজিটিভ ছিল। রোগীর অবস্থা ধীরে ধীরে উন্নতি করে, এবং প্রগনোসিস অনুকূল ছিল।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0042_0043.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0042_0043.json
new file mode 100644
index 0000000000000000000000000000000000000000..e144cf1a09eee4e4feab424f2eb35842a66d6048
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0042_0043.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_285.txt",
+    "fulltext": "Patient information: A 19-year-old male with no significant medical history was admitted to our department with a painful left scrotal mass that had been present for 8 months and had not improved with antibiotics for pyogenic organisms. The patient reported intermittent low grade fever, night sweats, anorexia and unexplained weight loss since the onset of symptoms. He did not have a cough, sputum or haemoptysis. There was no history of tuberculosis in his personal or family medical history. He was vaccinated against tuberculosis at birth.\n\nClinical findings: Physical examination revealed a large, painful, slightly hot left bursa and two elongated, poorly defined, firm, painful subcutaneous formations in the anterior thoracic wall, 3 to 4 cm long. There were no rales on auscultation. The remainder of the examination was normal. Laboratory studies revealed a high c-reactive protein of 90 mg/dl. The blood count, creatinine, blood glucose and liver function tests were within normal limits. The standard chest X-ray showed reticulonodular infiltrates in both lung fields.\n\nDiagnostic approach: In the presence of an ultrasound finding in favour of an epididymal tumour, the patient underwent a left orchidectomy. However, the pathological examination of the surgical specimen showed a granulomatous epitheloid necrosis of the epididymis, suggestive of active epididymal tuberculosis involving the body and tail of the epididymis and sparing the head and testicle. The intradermal tuberculin reaction was positive. The search for acid-fast bacilli (AFB) in sputum and urine for 3 consecutive days was negative on direct examination and culture. The serologies for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and Wright's stain were also negative. In search of other tuberculous sites, a thoraco-abdomino-pelvic tomodensitometry was performed, which showed a miliary tuberculosis, coelo-mesenteric necrotic adenopathies, two thoracic parietal collections (at the expense of the external oblique muscles measuring 33 × 10 mm on the right and 45 × 10 mm on the left) and a focal osteolysis of D11 and L5, suggestive of a spondylodiscitis in the early stages. The magnetic resonance imaging (MRI) of the spinal cord confirmed the existence of a spondylodiscitis at the level of D7, D11, L4 and L5. The diagnosis of disseminated tuberculosis with epididymal, pulmonary, parietal, ganglionary and osteo-articular sites was retained.\n\nTherapeutic intervention: a poly-chemotherapy for tuberculosis with isoniazid, rifampicin, ethambutol and pyrazinamide for 2 months, followed by the association of isoniazid and rifampicin, was initiated.\n\nFollow-up and results: however, at the 4th month of treatment, the patient had presented generalised tonic-clonic convulsive seizures. A brain MRI was performed, showing multiple nodular lesions above and below the tentorial membrane corresponding to tuberculomas. The patient was put on anticonvulsive treatment and anti-tuberculosis treatment was continued. The evolution was favourable with recovery of the general condition and weight gain from the first months of treatment as well as a disappearance of thoracic parietal formations, adenopathies and tuberculous milia on the tomodensitometry with absence of recurrence of convulsive seizures. However, the slow decrease of the size of the tuberculomas obliged us to continue the anti-tuberculosis treatment for a long period. Finally, the patient was declared cured, without sequelae, at the end of the 234th month of treatment with a 2-year follow-up.\n",
+    "summary": "A 19-year-old man with no significant history was admitted to hospital with a painful left scrotal mass that had been present for 8 months. He had undergone an orchidectomy and the pathological examination was in favour of epididymal tuberculosis. A radiological examination had shown other sites of infection: lymph nodes, lungs, parietal and osteoarticular. An anti-tuberculosis treatment was initiated. However, in the 4th month of treatment, the patient had convulsive seizures. A brain MRI was performed and concluded that there were brain tuberculomas. The anti-tuberculosis treatment was continued in association with an anticonvulsant with good clinical and radiological evolution.\n",
+    "translated_fulltext": "患者信息：一位19岁的男性，既往无重大病史，因左侧阴囊肿块疼痛，持续8个月，且抗生素治疗无效而入院。患者自述自症状出现以来，间歇性出现低烧、夜间盗汗、食欲不振和原因不明的体重减轻。他没有咳嗽、咳痰或咯血。个人及家族病史中均无结核病史。出生时已接种结核疫苗。\n\n临床表现：体格检查显示，左侧阴囊肿大、疼痛、轻微发热，且在左侧前胸壁有两处细长、界限不清、坚硬、疼痛的皮下肿块，长3至4厘米。听诊时未闻及啰音。其余检查结果正常。实验室检查显示，C反应蛋白升高，为90毫克/分升。血常规、肌酐、血糖和肝功能检查结果均在正常范围内。标准胸部X光片显示双肺野有网状结节状浸润。\n\n诊断方法：鉴于超声检查结果提示为附睾肿瘤，患者接受了左侧睾丸切除术。然而，手术标本的病理检查显示附睾出现肉芽肿性坏死，提示为活动性附睾结核，累及附睾体部和尾部，但不累及头部和睾丸。皮内结核菌素试验结果为阳性。连续3天对痰液和尿液进行抗酸杆菌（AFB）检查，直接涂片和培养结果均为阴性。人类免疫缺陷病毒（HIV）、乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）的血清学检查以及Wright染色结果也均为阴性。为了寻找其他结核病病灶，进行了胸腹盆部计算机断层扫描，结果显示弥漫性结核、腹膜-肠系膜坏死性淋巴结肿大、两个胸壁集合（右侧33×10毫米，左侧45×10毫米，以腹外斜肌为基础）以及D11和L5的局灶性骨质溶解，提示早期脊髓结核。脊髓磁共振成像（MRI）证实D7、D11、L4和L5水平存在脊髓结核。最终诊断为播散性结核，累及附睾、肺、胸壁、淋巴结和骨关节。\n\n治疗干预：开始进行为期2个月的结核病多药联合化疗，包括异烟肼、利福平、乙胺丁醇和吡嗪酰胺，之后继续使用异烟肼和利福平联合治疗。\n\n随访及结果：然而，在治疗的第4个月，患者出现了全身性强直-阵挛性癫痫发作。进行了脑部MRI检查，显示脑幕上方和下方有多处结节状病灶，对应于结核瘤。患者开始接受抗惊厥治疗，并继续进行抗结核治疗。治疗效果良好，患者的整体状况得到改善，体重增加，并且在计算机断层扫描中，胸壁集合、淋巴结肿大和结核性粟粒消失，且未出现癫痫复发。然而，结核瘤体积缓慢缩小，因此我们决定继续进行长期抗结核治疗。最终，在治疗的第234个月结束时，患者被宣布治愈，且无后遗症，并进行了为期2年的随访。",
+    "translated_summary": "一位19岁的男性，既往病史不明显，因左侧阴囊出现持续8个月的疼痛性肿块而入院。他曾接受过睾丸切除术，病理检查结果显示为附睾结核。放射学检查显示，感染部位还包括淋巴结、肺部、壁层胸膜和骨关节。开始进行抗结核治疗。然而，在治疗的第四个月，患者出现了抽搐。进行了脑部MRI检查，结果显示存在脑结核瘤。继续进行抗结核治疗，并联合使用抗惊厥药物，患者的临床和放射学表现均有改善。",
+    "corrected_translated_fulltext": "রোগীর তথ্য: ১৯ বছর বয়সী এক পুরুষ, উল্লেখযোগ্য পূর্ববর্তী রোগের ইতিহাস নেই, বাম স্ক্রোটামে বেদনাদায়ক গিঁট ৮ মাস ধরে ছিল এবং অ্যান্টিবায়োটিক চিকিৎসায় ফল না পাওয়ায় ভর্তি হয়েছেন। রোগীর বর্ণনামতে, উপসর্গের শুরু থেকে তিনি অনিয়মিতভাবে নিম্নমাত্রার জ্বর, রাতের ঘাম, অরুচি এবং অজানা কারণজনিত ওজন হ্রাস অনুভব করছিলেন। তাঁর কাশি, কফ উৎপাদন বা হেমোপ্টিসিস ছিল না। ব্যক্তিগত ও পারিবারিক রোগ-ইতিহাসে টিউবারকুলোসিসের কোনো ইতিহাস ছিল না। জন্মের সময় তিনি টিউবারকুলোসিসের বিরুদ্ধে টিকা পেয়েছিলেন。\n\nক্লিনিকাল ফাইন্ডিংস: শারীরিক পরীক্ষায় দেখা যায়, বাম স্ক্রোটাম বড়, বেদনাদায়ক, সামান্য উষ্ণ; এবং বাম সামনের বক্ষ প্রাচীরে ৩ থেকে ৪ সেমি দৈর্ঘ্যের দুইটি দীর্ঘাকার, অস্পষ্ট সীমানাযুক্ত, দৃঢ়, বেদনাদায়ক চর্ম-নীচস্থ গঠন রয়েছে। অসকাল্টেশনে কোনো রেল শোনা যায়নি। বাকী পরীক্ষা-নিরীক্ষা স্বাভাবিক ছিল। ল্যাবরেটরি পরীক্ষায় C-reactive protein বেড়ে 90 mg/dl ছিল। Complete blood count, ক্রিয়াটিনিন, রক্তে গ্লুকোজ এবং লিভার ফাংশন টেস্ট স্বাভাবিক সীমার মধ্যে ছিল। স্ট্যান্ডার্ড চেস্ট X-ray এ উভয় ফুসফুসক্ষেত্রে রেটিকুলো-নোডুলার ইনফিলট্রেটস দেখা যায়。\n\nডায়াগনস্টিক অ্যাপ্রোচ: আল্ট্রাসাউন্ডে epididymal tumor এর পক্ষে ফল পাওয়ায় রোগীর বামদিকে orchidectomy করা হয়। তবে, শল্যনমুনার প্যাথলজিক পরীক্ষায় epididymis-এ granulomatous necrosis দেখা যায়, যা সক্রিয় epididymal tuberculosis নির্দেশ করে; এতে epididymis-এর body এবং tail জড়িত ছিল, head এবং testis অক্ষত ছিল। ইন্ট্রাডার্মাল tuberculin টেস্ট পজিটিভ ছিল। টানা ৩ দিন কফ ও মূত্রে acid-fast bacilli (AFB) অনুসন্ধান করা হয়; ডাইরেক্ট স্মিয়ার ও কালচারে সবই নেগেটিভ ছিল। মানব ইমিউনোডেফিসিয়েন্সি ভাইরাস (HIV), হেপাটাইটিস বি ভাইরাস (HBV), হেপাটাইটিস সি ভাইরাস (HCV) এর সেরোলজি এবং Wright's stain—উভয়ের ফলাফলও নেগেটিভ ছিল। অন্যান্য টিউবারকুলোসিস ফোকাসের সন্ধানে thoraco-abdomino-pelvic CT করা হয়, যাতে miliary tuberculosis, coelo-mesenteric necrotic adenopathy, দুটি thoracic parietal collection (বাহ্যিক oblique muscle-এর ব্যয়ে; ডানে 33 × 10 mm এবং বামে 45 × 10 mm) এবং D11 ও L5-এ ফোকাল osteolysis দেখা যায়, যা প্রাথমিক spinal tuberculosis নির্দেশ করে। Spinal cord MRI D7, D11, L4 এবং L5 স্তরে spinal tuberculosis এর উপস্থিতি নিশ্চিত করে। চূড়ান্তভাবে disseminated tuberculosis ধরা পড়ে, যা epididymis, ফুসফুস, বক্ষ প্রাচীর, লিম্ফ নোড এবং অস্থি-সন্ধি জড়িত করে。\n\nথেরাপিউটিক ইন্টারভেনশন: isoniazid, rifampicin, ethambutol এবং pyrazinamide সমন্বয়ে ২ মাসের anti-tuberculosis poly-chemotherapy শুরু করা হয়, এরপর isoniazid ও rifampicin এর সংমিশ্রণ চালানো হয়。\n\nফলো-আপ ও ফলাফল: তবে চিকিৎসার ৪র্থ মাসে রোগীর generalized tonic-clonic খিঁচুনি হয়। Brain MRI করা হয়, যাতে tentorium-এর উপর ও নিচে একাধিক nodular lesion দেখা যায়, যা tuberculoma এর সাথে সঙ্গতিপূর্ণ। রোগীকে anticonvulsant চিকিৎসা দেওয়া হয় এবং anti-tuberculosis চিকিৎসা অব্যাহত রাখা হয়। ইভোলিউশন অনুকূল ছিল; রোগীর সার্বিক অবস্থা উন্নত হয় ও ওজন বৃদ্ধি পায় এবং CT-তে বক্ষ প্রাচীরের collection, লিম্ফ্যাডেনোপ্যাথি ও টিউবারকুলাস মিলিয়া অদৃশ্য হয়ে যায়; খিঁচুনির পুনরাবৃত্তিও হয়নি। তবে tuberculoma-এর আকার ধীরে ধীরে কমছিল, তাই দীর্ঘমেয়াদি anti-tuberculosis চিকিৎসা চালিয়ে যেতে বাধ্য হই। অবশেষে, চিকিৎসার ২৩৪তম মাসের শেষে রোগীকে সম্পূর্ণ আরোগ্য হিসেবে ঘোষণা করা হয়, কোনো পরবর্তী জটিলতা ছাড়াই, এবং ২ বছরের ফলো-আপ করা হয়।",
+    "corrected_translated_summary": "১৯ বছর বয়সী একজন পুরুষ, উল্লেখযোগ্য পূর্ব ইতিহাস নেই, বাম অণ্ডথলিতে ৮ মাস ধরে থাকা ব্যথাযুক্ত গাঁটের কারণে হাসপাতালে ভর্তি হন। তার অর্কিডেকটমি করা হয়েছিল এবং প্যাথোলজিক পরীক্ষা এপিডিডাইমাল টিউবারকুলোসিসের পক্ষে ছিল। রেডিওলজিক্যাল পরীক্ষায় সংক্রমণের অন্যান্য স্থানগুলি দেখা গেছে: lymph nodes, lungs, parietal এবং osteoarticular। অ্যান্টি-টিউবারকুলোসিস চিকিৎসা শুরু করা হয়। তবে চিকিৎসার চতুর্থ মাসে রোগীর খিঁচুনি হয়। একটি brain MRI করা হয় এবং এতে brain tuberculomas থাকার উপসংহার পাওয়া যায়। অ্যান্টি-টিউবারকুলোসিস চিকিৎসা anticonvulsant-এর সাথে অব্যাহত রাখা হয়, এবং ক্লিনিক্যাল ও রেডিওলজিক্যালভাবে ভালো উন্নতি হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_222.txt",
+    "fulltext": "Female patient, 16 years old, presenting a depressed gray plaque of 10.5 × 8.0 cm interspersed with hypochromic areas in the lower lateral part of the left thigh. Telangiectatic vessels overlap the lesion peripherally, with visible veins close to it. The plaque was present from birth, but was initially violaceous. It evolved with the passing of the years, with lightening and depression. There is no discrepancy in the length of the lower limbs.\n\nAngioresonance showed vascular malformations in the skin and subcutaneous tissue supplied by intermuscular branches of the popliteal artery. Early venous filling was found in both the region and the malformations, suggesting early venous shunting. Dilated draining veins were not documented, except for a superficial draining vein running along the subcutaneous cellular tissue of the anterior thigh. In addition, thinning of the subcutaneous tissue was noted in the topography of the vascular alteration, but without intramuscular or bone extension.\n",
+    "summary": "16-year-old girl with a depressed gray plaque on the left thigh, with a vascular malformation affecting the skin and subcutaneous tissue evident by angioresonance.\n",
+    "translated_fulltext": "患者为女性，16岁，左大腿外侧下部有一块10.5×8.0厘米的灰白色斑块，其中夹杂着色素减退的区域。斑块周围有扩张的毛细血管，且可见靠近斑块的静脉。该斑块自出生时就存在，最初呈紫红色，随着时间的推移，颜色逐渐变浅，并出现凹陷。双侧下肢长度无明显差异。\n\n血管共振成像显示，皮肤和皮下组织存在血管畸形，这些畸形由腘动脉的肌间分支供血。在病灶区域和畸形组织中均观察到早期静脉充盈，提示存在早期静脉分流。除一条沿大腿前侧皮下组织走行的浅表引流静脉外，未见扩张的引流静脉。此外，在血管改变的部位，皮下组织变薄，但未见侵犯肌肉或骨骼。",
+    "translated_summary": "一位16岁的女孩，左大腿上有一块呈灰色的、凹陷的斑块，血管畸形影响了皮肤和皮下组织，血管造影显示这一点。",
+    "corrected_translated_fulltext": "১৬ বছর বয়সী নারী রোগী, বাম উরুর নিম্ন পার্শ্বীয় অংশে ১০.৫ × ৮.০ সেমি আকারের ধূসর বর্ণের অবতল plaque, যার মধ্যে hypochromic এলাকা ছড়িয়ে রয়েছে। Lesion-এর পার্শ্বীয় প্রান্তে telangiectatic vessels overlap করছে, এবং এর নিকটে দৃশ্যমান veins আছে। Plaqueটি জন্ম থেকেই উপস্থিত ছিল, তবে প্রাথমিকভাবে এটি violaceous ছিল। বছরের সাথে সাথে এটি lightening এবং depression-এর দিকে অগ্রসর হয়েছে। নিম্ন অঙ্গের দৈর্ঘ্যে কোনো পার্থক্য নেই। Angioresonance-এ দেখা গেছে ত্বক ও subcutaneous tissue-তে vascular malformations, যা popliteal artery-এর intermuscular branches দ্বারা সরবরাহিত। উক্ত অঞ্চল এবং malformations উভয়েই early venous filling পাওয়া গেছে, যা early venous shunting-এর ইঙ্গিত দেয়। Anterior thigh-এর subcutaneous cellular tissue বরাবর চলমান একটি superficial draining vein ব্যতীত dilated draining veins নথিভুক্ত হয়নি। অতিরিক্তভাবে, vascular alteration-এর টপোগ্রাফিতে subcutaneous tissue-এর thinning লক্ষ্য করা হয়েছে, তবে intramuscular বা bone extension ছিল না।",
+    "corrected_translated_summary": "১৬ বছর বয়সী এক মেয়ে, বাম উরুতে ধূসর রঙের অবতল প্ল্যাক, ত্বক ও সাবকিউটেনিয়াস টিস্যুকে প্রভাবিতকারী একটি vascular malformation, যা angioresonance-এ স্পষ্ট।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0044_0045.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0044_0045.json
new file mode 100644
index 0000000000000000000000000000000000000000..ad45f36241ddce18536265640910eb9deed3d32e
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0044_0045.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_491.txt",
+    "fulltext": "This is a 32-year-old patient, a baker, from Bamako, who was admitted to the Infectious and Tropical Diseases department of the CHU du Point G (Bamako, Mali) on 27 April 2023 for chronic productive cough, otalgia and a chronic right-sided purulent otorrhea.\n\nThe symptomatology would be of progressive installation in 1 month, initially treated in a medical center with artésunate, paracetamol and unspecified antibiotics for confirmed malaria and acute otitis media, without success. He is immunosuppressed by a HIV1 infection, diagnosed and put on a tritherapy antiretroviral (TARV) Tenofovir/Lamivudine/Dolutégravir 7 months ago, not observed due to denial of his illness.\n\nThe general physical examination found a fever (38.2 °C), altered general condition, otalgia, purulent right foul-smelling otorrhea, a right basal pulmonary condensation syndrome, a normal neurological examination, without the involvement of the cranial nerves, mainly the facial nerve VII and the VIII cochleovestibular nerve.\n\nIn the ENT examination, the otoscopy of the right ear showed an inflammatory external auditory canal with purulent secretions and the presence of a single tympanic perforation in the anterior-inferior quadrant. The left ear is normal. The Rinne and Weber test is in favor of a right conductive hearing loss.\n\nImmuno-virological evaluation shows a CD4 count of 118 cells/pl and a viral load of 12,370 copies/ml at the time of diagnosis of HIV infection, compared to a viral load of 9,460 copies/ml and a CD4 lymphocyte count of 193 cells/pl at the 6th month of antiretroviral treatment. At the time of diagnosis of tuberculosis at the 7th month, the immuno-virological evaluation shows a CD4 count of 89 cells/pl and a viral load of 10,230 copies/ml.\n\nThe Ziehl Neelsen bacilloscopy was positive with a cross in the gastric washings on admission and 19 days later in the right ear swab because of the persistent otorrhea. The Xpert-MTB/GeneXpert test did not detect rifampicin-resistant Mycobacterium tuberculosis.\n\nThe frontal chest radiograph shows a more accentuated bronchovascular network at the base of the right lung.\n\nThe diagnosis of tuberculosis of the middle ear concomitant to a pulmonary localization in the field of immunosuppression by HIV1 is therefore retained.\n\nThe patient is put on oral first-line anti-tuberculosis for 6 months, a fixed dose of a quadra-therapy in the intensive phase of isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months (2RHZE), followed by a bi-therapy in the maintenance phase of isoniazid and rifampicin for 4 months (4RH) at a dose of 3 tablets/day in the morning on an empty stomach, associated with vitamin B6 (1 tablet/day). He benefits from two sessions of therapeutic reinforcement with anti-retroviral drugs. The ART is restarted on 4 May 2023 with his consent, given the good tolerance of the anti-tuberculosis drugs, with the combination of tenofovir/lamivudine/dolutegravir at a dose of 1 tablet/day associated with dolutegravir 50 mg as a supplement (1 tablet/day) according to the protocol for the management of HIV/AIDS. A chemoprophylaxis with cotrimoxazole 960 mg (1 tablet/day) is undertaken as well as a cleaning of the external auditory canal by aspiration and the instillation of ciprofloxacin ear drops (2 drops 3 times a day) for 14 days.\n\nThe evolution is favorable after 14 days of treatment, marked by a pyrexia, a good general state, the amendment of the cough and otorrhea with the negativation of the bacilloscopy in the gastric tube liquid and the swab of the pus of the right ear. At the end of the maintenance anti-tuberculosis treatment, the clinical healing is complete with a normal ENT and neurological examination. The bacilloscopy associated with the Xpert-MTB/GeneXpert test at the end of the 2nd month of the intensive phase, during the 5th month and at the end of the 6th month of the maintenance phase were negative. The HIV viral load performed after 3 months of ART is 329 copies/ml.\n",
+    "summary": "The patient presented with a chronic productive cough, otalgia and a chronic right-sided purulent otorrhea. The search for acid-fast bacilli was positive by direct examination in the gastric tube liquid and the swab of the auricular pus.\n\nAn anti-tuberculosis treatment of 6 months, associated with adjuvants, led to the patient's complete recovery.\n",
+    "translated_fulltext": null,
+    "translated_summary": "患者出现慢性咳嗽，伴有咳痰，并伴有耳痛和慢性右侧化脓性耳漏。通过对胃管液和耳道脓液进行直接检查，发现抗酸杆菌呈阳性。\n\n经过六个月的抗结核治疗，并配合使用辅助药物，患者完全康复。",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "রোগীর দীর্ঘস্থায়ী কফসহ কাশি, কানব্যথা এবং ডান পাশে দীর্ঘস্থায়ী পুঁজযুক্ত কানের স্রাব ছিল। গ্যাস্ট্রিক টিউবের তরল এবং কানের পুঁজের সোয়াবের সরাসরি পরীক্ষায় acid-fast bacilli পজিটিভ পাওয়া যায়। অ্যাডজুভ্যান্টসহ ৬ মাসের anti-tuberculosis চিকিৎসায় রোগী সম্পূর্ণ সুস্থ হন।"
+  },
+  {
+    "id": "multiclinsum_gs_en_90.txt",
+    "fulltext": "52-year-old male patient with no medical history, transferred from a lower-level hospital to our institution due to a tonic-clonic seizure secondary to alcohol withdrawal and non-reduced right LFGHP. He was evaluated by a traumatologist 24 hours after admission, and was found to be conscious, with bilateral ecchymosis of the shoulders and severe limitation of passive external rotation on both sides. In addition, the patient was restrained physically at this point, with both feet and his left hand held down by intermittent psychomotor agitation.\n\nThe initial evaluation included a thorough review of the patient's admission radiographs, which showed a right LFGHP and a left simple posterior dislocation. This second injury (simple posterior dislocation of the left shoulder) was not diagnosed at the referring facility, and took approximately 48 hours to be diagnosed at our facility.\n\nComputed tomography (CT) of both shoulders was requested to better characterize the injuries. These images showed a marked worsening of the left shoulder injury since the time of the first radiographic study, possibly secondary to the physical restraint of the patient. This evidence of progression from a simple left posterior glenohumeral dislocation on admission radiographs to a LFGHP on the CT taken 48 hours later.\n\n\nPlanning\n\nThe preoperative study of the right shoulder showed bone indemnity of the glenoid and 40% involvement of the articular surface of the humerus, but with a large fragment with the possibility of osteosynthesis in continuity with the lesser tuberosity, so it was planned to fix this fragment by spongeous screw 4.0 mm partial thread and high strength sutures. In the left shoulder, no significant bone defect was evidenced in the glenoid and the defect of the articular surface of the humerus was 20%, so it was planned to fill the defect with the fragment of the lesser tuberosity at the time of osteosynthesis (imitating the surgery of McLaughlin).\n\n\nSurgical technique\n\nOpen reduction and internal fixation with bilateral locked-plate is decided. The patient is placed in a beach chair position and the surgical fields are prepared in the usual way for the right shoulder. The fracture focus is accessed by a classic deltopectoral approach. A digital maneuver is performed to reduce the posterior fragment of the humeral head with a posterior mini-open incision of the size of a standard diagnostic arthroscopy portal. A provisional reduction of the fracture is achieved using high-strength sutures and needles. A partial 4.0 mm spongy screw and high-strength sutures are used to fix both fragments of the humeral head. Definitive fixation of the fracture with a Philos (Depuy Synthes®) plate achieves adequate reduction and stability of fragments. Fixation is increased with high-strength sutures to the tendons of the rotator cuff that are tied to the plate. Closure by planes of the right shoulder, healing and immobilization of the extremity with a universal shoulder immobilizer.\nThe surgical field of the left shoulder is immediately prepared. Classic deltopectoral approach is performed again to reach the fracture focus using an accessory posterior portal for digital manipulation and reduction of the humeral head. Fixation and osteosynthesis are performed in the same way as described for the right shoulder with the exception of the spongiosa screw, as the anterior fragment could be adequately fixed only with the use of high strength sutures.\nPostoperative management consisted of the use of bilateral shoulder immobilizer for four weeks. A pendular exercise of flexion-extension of the elbow and exercises of the fist were given to be performed from the second postoperative week to tolerance (according to the level of pain). In the radiographic control of the first month, loss of reduction of the greater left tuberosity was observed. It was decided to perform revision surgery achieving adequate fixation of the fragment with high-strength sutures.\nThe patient is left with a shoulder immobilizer for an additional four weeks on the left shoulder. The self-administered exercise regimen is restarted as described previously from the second postoperative week on a bilateral basis. At the sixth week after the revision surgery, face-to-face kinesiological therapy is initiated twice a week. After 30 sessions of kinesiological rehabilitation, the patient is able to return to work five months after the initial injury.\nFollow-up one year after the initial surgery shows that the patient has recovered strength and mobility in the right shoulder. The left shoulder still has severe limitations in the range of motion, especially in external rotation. At this point, it is decided to perform arthroscopic joint release surgery and remove the osteosynthesis in the left shoulder.\nIn his last check-up two years after the trauma, the patient showed a favorable evolution, consistent with the functional scales evaluated.\n",
+    "summary": "52-year-old male patient, transferred to a high-complexity center for a tonic-clonic convulsion and a right LFGHP. In the initial study with radiographs, a right shoulder injury was confirmed and a simple posterior glenohumeral dislocation of the left shoulder was diagnosed, which had not been previously detected. The study was complemented with a computed tomography (CT) of both shoulders, showing a bilateral LFGHP, which demonstrated intrahospital aggravation of the injury of the left shoulder. An open reduction and osteosynthesis with a bilateral blocked plate was performed in one time. The left shoulder required two reinterventions, one for osteosynthesis failure and another for joint release. Two years after the procedure, the patient was satisfactorily progressing with a 5% on the Quick DASH scale and a score of 72 and 76 on the Constant scale in the left and right shoulder, respectively.\n",
+    "translated_fulltext": null,
+    "translated_summary": "患者为52岁男性，因强直-阵挛性抽搐和右侧肩袖撕裂被转至一家高水平的医疗中心。初步X光检查显示，患者右肩受伤，左肩为单纯的后方肩关节脱位，但之前未被发现。进一步进行了双侧肩部的计算机断层扫描（CT），结果显示双侧均存在肩袖撕裂，且左肩的损伤在住院期间加重。随后，患者接受了单次手术，进行了开放复位和双侧锁板内固定。左肩需要进行两次复查手术，一次是由于骨固定失败，另一次是为了松解关节。手术两年后，患者恢复良好，Quick DASH评分仅为5%，左肩和右肩的Constant评分分别为72和76。",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "রোগী 52 বছর বয়সী পুরুষ, টনিক-ক্লোনিক খিঁচুনি এবং ডান কাঁধের রোটেটর কাফ ছিঁড়ে যাওয়ার কারণে তাকে একটি উচ্চস্তরের চিকিৎসা কেন্দ্রে স্থানান্তর করা হয়। প্রাথমিক এক্স-রে পরীক্ষায় দেখা যায়, রোগীর ডান কাঁধে আঘাত রয়েছে এবং বাম কাঁধে সরল পশ্চাৎমুখী কাঁধ-সংযোগস্থলের ডিসলোকেশন ছিল, যা পূর্বে সনাক্ত করা যায়নি। পরবর্তীতে উভয় কাঁধের কম্পিউটেড টোমোগ্রাফি (CT) করা হয়, যাতে উভয় পাশে রোটেটর কাফ ছিঁড়ে যাওয়া দেখা যায় এবং বাম কাঁধের ক্ষতি হাসপাতালে থাকার সময় আরও বেড়ে যায়। পরবর্তীতে, রোগীর একবারের অস্ত্রোপচারে ওপেন রিডাকশন এবং দ্বিপাক্ষিক লকড প্লেট দ্বারা অভ্যন্তরীণ ফিক্সেশন করা হয়। বাম কাঁধে দুইবার পুনঃঅস্ত্রোপচার প্রয়োজন হয়, একবার হাড়ের ফিক্সেশন ব্যর্থতার কারণে এবং আরেকবার জয়েন্ট রিলিজের জন্য। অস্ত্রোপচারের দুই বছর পর, রোগী ভালোভাবে সেরে উঠছেন, Quick DASH স্কোর মাত্র 5%, এবং বাম ও ডান কাঁধের Constant স্কোর যথাক্রমে 72 ও 76।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0050_0051.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0050_0051.json
new file mode 100644
index 0000000000000000000000000000000000000000..389c8333c1b7d17990f934d4f78c27a2c3896bdd
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0050_0051.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_59.txt",
+    "fulltext": "A 2-year-old female presented with a 1-year history of painless left progressive proptosis with no reported systemic diseases or family history. Ophthalmologic examination revealed light sensation as the only vision in the left eye, along with proptosis, inward and upward eyeball displacement, and restricted extraocular muscle movements in downward and outward directions. An irregularly shaped, well-defined soft mass was palpable in the inferior aspect of the left orbit, accompanied by left lower eyelid ectropion. The pupil was enlarged (4 mm in diameter), and pupillary reaction was absent. The remaining anterior segment examination showed no apparent abnormalities. Fundus examination was challenging due to the child’s size. Hertel exophthalmometry readings measured 10.5 mm in the right eye and 18 mm in the left. Magnetic resonance imaging (MRI) revealed a well-circumscribed mass, displaying hypointense signals on T1-weighted images and hyperintense signals on T2-weighted images. Contrast-enhanced imaging demonstrated no significant improvement. A transconjunctival approach via the inferior fornix with canthotomy and cantholysis was performed, revealing a grayish-white cystic mass with a distinct boundary from surrounding tissues. During posterior separation to the eyeballs’ posterior part, tight adhesion to the optic nerve was observed. Due to the mass’s substantial size and the restricted surgical field, volume reduction was necessary. Approximately 12.5 mL of the fluid was aspirated, and the mass was completely excised. Histopathological examination disclosed a fibrous capsule wall covered with squamous and glandular epithelium, along with visible brain tissue and a cartilage-like matrix consistent with orbital teratoma. One month postsurgery, the patient exhibited enophthalmos, conjunctival hyperemia, and keratitis on ocular examination. This was attributed to the mass’s prior enlargement of the orbital cavity, resulting in postoperative enophthalmos. The cornea could not adhere to the eyelids, creating a space and causing corneal inflammation. After obtaining the consent of the patient’s guardian, a second operation involved the implantation of an allogeneic sclera into the orbit to increase the orbital volume, alleviate fossa pitting and restore keratitis to normal. No recurrence of the teratomas was noted during the 1-year follow-up. The patient still had minor enophthalmos and outer canthus abnormality. The visual acuity remained consistent with pre-operation levels. Hertel exophthalmometry readings measured 10.5 mm in the right eye and 8 mm in the left. The remaining anterior segment examination showed no apparent abnormalities.",
+    "summary": "Patient concerns: A 2-year-old female child was presented exhibiting proptosis and inward and upward eyeball displacement. Enhanced magnetic resonance imaging revealed a well-circumscribed mass, persisting with hypointense signals on T1-weighted images (T1WI) and hyperintense signals on T2-weighted images (T2WI).\n\nDiagnoses: The diagnosis of teratoma was confirmed finally through histological and immunohistochemical exams.\n\nInterventions: A transconjunctival approach via the inferior fornix, coupled with canthotomy and cantholysis, was performed. However, a month postsurgery, the patient developed enophthalmos, conjunctival hyperemia, and keratitis upon ocular examination. A second operation involved the implantation of allogeneic sclera into the orbit to increase orbital volume, improve the pitting of the fossa, and restore keratitis to normal.\n\nOutcomes: No recurrence and other complications were noted during the 1-year follow-up.",
+    "translated_fulltext": "一名2岁的女童，主诉左眼无痛性进行性眼球突出，病史已有一年，未见全身性疾病或家族病史。眼科检查显示，左眼仅有光感，伴有眼球突出、眼球向内上方移位，以及向下和向外方向的眼外肌活动受限。触诊左眼眶下部可触及一形状不规则、边界清晰的柔软肿块，伴有左下眼睑外翻。瞳孔扩大（直径4毫米），瞳孔对光反射消失。其余前节检查未见明显异常。由于患儿年龄较小，眼底检查较为困难。Hertel眼球突出度测量显示，右眼为10.5毫米，左眼为18毫米。磁共振成像（MRI）显示，肿块边界清晰，在T1加权图像上呈低信号，在T2加权图像上呈高信号。增强成像未见明显改善。采用经结膜下途径，经下穹窿进行手术，并进行外眼角切开和外眼角松解，发现一灰白色囊性肿块，与周围组织边界分明。在向后分离至眼球后部时，观察到肿块与视神经紧密粘连。由于肿块体积较大，手术视野受限，因此需要进行体积减小。抽取了约12.5毫升液体，并完全切除肿块。组织病理学检查显示，肿块具有由鳞状和腺体上皮覆盖的纤维性囊壁，并可见脑组织和类似软骨的基质，与眼眶畸胎瘤相符。术后一个月，患者眼科检查显示，出现眼球内陷、结膜充血和角膜炎。这被认为是由于肿块先前扩大了眼眶，导致术后出现眼球内陷。角膜无法与眼睑贴合，形成间隙，从而引起角膜炎症。在获得患者监护人的同意后，进行了第二次手术，将异体巩膜植入眼眶，以增加眼眶容积，减轻眼眶凹陷，并使角膜炎恢复正常。术后1年随访期间，未见畸胎瘤复发。患者仍有轻度眼球内陷和外眼角异常。视力与术前水平保持一致。Hertel眼球突出度测量显示，右眼为10.5毫米，左眼为8毫米。其余前节检查未见明显异常。",
+    "translated_summary": "患者主诉：一名2岁的女婴出现眼球突出、眼球内移和向上移位。增强磁共振成像显示，病灶边界清晰，在T1加权图像（T1WI）上呈现低信号，在T2加权图像（T2WI）上呈现高信号。\n\n诊断：最终通过组织病理学和免疫组织化学检查确诊为畸胎瘤。\n\n治疗：采用经结膜下途径，经下穹窿入路，并结合外眼角切开术和外眼角松解术进行手术。然而，术后一个月，患者在眼部检查中出现眼球内陷、结膜充血和角膜炎。第二次手术包括将异体巩膜植入眼眶，以增加眼眶容积，改善眼眶凹陷，并使角膜炎恢复正常。\n\n结果：在为期一年的随访期间，未观察到复发或其他并发症。",
+    "corrected_translated_fulltext": "২ বছর বয়সী এক কন্যাশিশু বাম চোখে ব্যথাহীন, ক্রমাগত বাড়তে থাকা proptosis-এর ১ বছরের ইতিহাসসহ উপস্থিত হয়; কোনো systemic রোগ বা পারিবারিক ইতিহাস ছিল না। চক্ষু পরীক্ষা-নিরীক্ষায় বাম চোখে কেবলমাত্র আলো অনুভূতি পাওয়া যায়; সাথে proptosis, চোখের বলের ভিতরের ও ঊর্ধ্বমুখী সরণ, এবং নিচের ও বাইরের দিকে extraocular muscle আন্দোলন সীমিত ছিল। বাম কক্ষপথের নিম্নাংশে অনিয়মিত আকারের, সুস্পষ্ট সীমাবদ্ধতাসহ নরম একটি mass স্পর্শে অনুভূত হয়, সাথে বাম নিম্ন চোখের পাতার ectropion উপস্থিত ছিল। পিউপিল বৃহদাকৃতির ছিল (ব্যাস ৪ mm), এবং pupillary reaction অনুপস্থিত ছিল। অবশিষ্ট anterior segment পরীক্ষা-নিরীক্ষায় কোনো স্পষ্ট অস্বাভাবিকতা পাওয়া যায়নি। শিশুটির ক্ষুদ্র দেহাকৃতির কারণে fundus পরীক্ষা কঠিন ছিল। Hertel exophthalmometry-তে ডান চোখে ১০.৫ mm এবং বাম চোখে ১৮ mm পরিমাপ পাওয়া যায়। MRI-তে সুস্পষ্টভাবে circumscribed একটি mass দেখা যায়, যা T1-weighted ইমেজে hypointense এবং T2-weighted ইমেজে hyperintense সিগন্যাল প্রদর্শন করছিল। কনট্রাস্ট-এনহ্যান্সড ইমেজিং-এ উল্লেখযোগ্য উন্নতি দেখা যায়নি। inferior fornix হয়ে transconjunctival approach সহ canthotomy এবং cantholysis করা হয়, যাতে ধূসর-সাদাটে cystic একটি mass দেখা যায় যার চারপাশের টিস্যু থেকে সুস্পষ্ট সীমা ছিল। চোখের বলের পশ্চাদ্ভাগে posterior separation চলাকালে mass-এর optic nerve-এর সঙ্গে দৃঢ় adhesion লক্ষ্য করা হয়। mass-এর বৃহৎ আকার এবং সীমিত সার্জিক্যাল ক্ষেত্রের কারণে volume reduction প্রয়োজন ছিল। প্রায় ১২.৫ mL তরল aspirate করা হয়, এবং mass সম্পূর্ণভাবে অপসারণ করা হয়। Histopathological পরীক্ষায় squamous ও glandular epithelium দ্বারা আবৃত fibrous capsule wall পাওয়া যায়, সাথে দৃশ্যমান brain tissue এবং cartilage‑like matrix যা orbital teratoma-এর সঙ্গে সঙ্গতিপূর্ণ। অস্ত্রোপচারের এক মাস পর চক্ষু পরীক্ষায় রোগীর enophthalmos, conjunctival hyperemia এবং keratitis দেখা যায়। এটিকে mass-এর পূর্ববর্তীভাবে orbital cavity সম্প্রসারণের ফল হিসেবে বিবেচনা করা হয়, যা postoperative enophthalmos সৃষ্টি করেছিল। কর্নিয়া চোখের পাপড়ির সঙ্গে সংলগ্ন হতে পারেনি, ফলে একটি ফাঁক তৈরি হয়ে corneal inflammation হয়েছে। রোগীর অভিভাবকের সম্মতি নিয়ে দ্বিতীয় অপারেশনে orbit-এ allogeneic sclera ইমপ্লান্ট করা হয়, যাতে orbital volume বৃদ্ধি করা, fossa pitting হ্রাস করা এবং keratitis স্বাভাবিক অবস্থায় ফিরিয়ে আনা যায়। ১ বছরের ফলো‑আপে teratoma-এর কোনো পুনরাবৃত্তি লক্ষ্য করা হয়নি। রোগীর সামান্য enophthalmos এবং outer canthus-এর অস্বাভাবিকতা রয়ে গেছে। দৃষ্টিক্ষমতা pre‑operation স্তরের সঙ্গে অপরিবর্তিত ছিল। Hertel exophthalmometry-তে ডান চোখে ১০.৫ mm এবং বাম চোখে ৮ mm পরিমাপ পাওয়া যায়। অবশিষ্ট anterior segment পরীক্ষা-নিরীক্ষায় কোনো স্পষ্ট অস্বাভাবিকতা পাওয়া যায়নি।",
+    "corrected_translated_summary": "রোগীর অভিযোগ: ২ বছর বয়সী এক কন্যাশিশুতে প্রপটোসিস এবং চোখের বলের ভেতরের দিকে ও ঊর্ধ্বমুখী স্থানচ্যুতি দেখা যায়।\nএনহ্যান্সড ম্যাগনেটিক রেজোন্যান্স ইমেজিংয়ে সুষ্পষ্ট সীমানাযুক্ত একটি mass দেখা যায়, T1-weighted images (T1WI)-এ hypointense এবং T2-weighted images (T2WI)-এ hyperintense সিগন্যালসহ।\n\nনির্ণয়: histological ও immunohistochemical পরীক্ষা দ্বারা শেষ পর্যন্ত teratoma নিশ্চিত করা হয়।\n\nহস্তক্ষেপ: inferior fornix দিয়ে transconjunctival approach নেওয়া হয়, সাথে canthotomy এবং cantholysis করা হয়।\nতবে অস্ত্রোপচারের এক মাস পর চোখের পরীক্ষায় রোগীর enophthalmos, conjunctival hyperemia এবং keratitis ধরা পড়ে।\nদ্বিতীয় অস্ত্রোপচারে চোখের কোটরে allogeneic sclera প্রতিস্থাপন করা হয়, যাতে orbital volume বৃদ্ধি পায়, কোটরের অবনতিভাবের উন্নতি হয় এবং keratitis স্বাভাবিক অবস্থায় ফিরে আসে।\n\nফলাফল: ১ বছরের ফলো-আপে কোনো পুনরাবৃত্তি বা অন্যান্য জটিলতা দেখা যায়নি।"
+  },
+  {
+    "id": "multiclinsum_gs_en_590.txt",
+    "fulltext": "A 57-year-old woman with a 14-year history of asthma and allergic rhinitis, on salmeterol/fluticasone, was hospitalized for recurrent abdominal pain that began two months earlier. The pain was intermittent and dull, accompanied by nausea, anorexia, malaise, and a weight loss of 5 kg. There was no fever, blood / mucus in the stool, or respiratory symptoms (rhinorrhea, wheezing, coughing). She had no history of alcohol/tobacco use or traditional herbal medicines. Six weeks before admission, she was diagnosed with an intestinal infection in a local clinic after a complete blood count (CBC) revealed leukocytosis and significant eosinophilia (25.61 G/L, 77.8% eosinophils). She received antibiotics and mebendazole without relief of symptoms. At presentation, the patient was alerted and oriented with stable vitals (BP 110/70 mmHg, T 37°C, HR 88 bpm, RR 18 bpm). She had a BMI of 16.6 kg/m² and sarcopenia, but no skin rash, lymphadenopathy, or edema. The abdominal exam showed tenderness in the epigastric and umbilical regions without guarding. CBC revealed leukocytosis and significant eosinophilia (20.8 G/L, with a total white blood cell count of 26.8 G/L, comprising 77.8% eosinophils). Peripheral blood film examination showed normal eosinophils. Bone marrow aspiration reveals 48% eosinophils without blasts, atypical cells. Fluorescence in situ hybridization (FISH) for CHIC2 deletion as a surrogate marker for FIP1L1-PDGFRA showed no rearrangements of the PDGFRA gene. Autoimmune and vasculitis screenings (ANA, anti-dsDNA, p-ANCA, c-ANCA) were negative. Elevated serum IgG (2760 mg/dL; normal range, 700–1600 mg/dL) and IgG4 (1260 mg/dL; normal range, 3.9–86.4 mg/dL), slightly elevated IgE (137.5 IU/mL; normal range, <100 IU/mL) and high RF (144.4 IU/mL; normal range, <20 IU/mL) were observed. Other parameters were normal, including aminotransferase, blood urea nitrogen, serum creatinine, complement C3, complement C4, vitamin B12, serum cortisol, and NT-proBNP. ECG and echocardiogram were normal. Chest CT scans showed mild fibrosis and bronchiectasis. Sputum AFB smears and bronchoscopy were negative. The cytology of the bronchoalveolar lavage fluid showed 35% neutrophils, no eosinophils. Spirometry indicated severe obstruction with bronchodilator response. The fractional exhaled nitric oxide (FeNO) level was 15 ppb. Stool samples were tested positive for leukocytes, with no signs of ova or parasites. Serology tests were positive for toxocariasis (positive IgG of Toxocara canis at 54.2 NovaTec-Units) but negative for Strongyloides stercoralis, Fasciola sp., Toxoplasma gondii, Trichinella spiralis, Ancylostoma sp., Angiostrongylus cantonensis, Ascaris lumbricoides, Clonorchis sinensis, Paragonimus sp., Gnathostoma sp., Entamoeba histolytica, cysticercosis, filariasis, and HIV. An abdominal contrast-enhanced computed tomography scan revealed gallbladder stones without acute cholecystitis and showed no gastrointestinal tract abnormalities. The upper gastrointestinal endoscopy showed unremarkable results with a normal appearance. Colonoscopy showed mucosal inflammation in the sigmoid, left, transverse, and right colon with systemic biopsy. A five-day course of albendazole (400 mg twice daily) for suspected toxocariasis was ineffective. Colonic biopsies revealed significant eosinophilic infiltration (>85 eosinophils/High-power field (HPF) in the left colon, >100 eosinophils/HPF in the transverse and right colon). Given the patient’s nonresponse to toxocariasis treatment and the significant eosinophilic infiltration observed in the colon mucosa biopsy, a diagnosis of eosinophilic colitis was confirmed. The patient was treated with oral methylprednisolone (16 mg) and montelukast (5 mg). Symptoms resolved in two weeks and eosinophil counts normalized (0.3 G/L). The corticosteroid was reduced and discontinued, and the patient was maintained on montelukast for three months without symptom recurrence.",
+    "summary": "We present a unique case of a 57-year-old patient with a medical history of asthma and allergic rhinitis who presented recurrent abdominal pain, significant blood eosinophilia, and elevated levels of Immunoglobulin G4. After ruling out hematological and secondary causes of eosinophilia, a biopsy of the colon mucosa revealed an excess of tissue eosinophils, confirming the diagnosis of EoC. The patient responded well to corticosteroids and was subsequently maintained on montelukast, with no recurrence of symptoms over 3 months.",
+    "translated_fulltext": null,
+    "translated_summary": "我们报告了一例独特的病例，患者为 57 岁，既往有哮喘和过敏性鼻炎病史，表现为复发性腹痛、显著的血液嗜酸性粒细胞增多以及免疫球蛋白 G4 水平升高。在排除血液系统疾病和其他导致嗜酸性粒细胞增多的继发性原因后，对患者的结肠黏膜进行活检，结果显示组织中的嗜酸性粒细胞数量过多，从而确诊为嗜酸性粒细胞性结肠炎 (EoC)。患者对皮质类固醇反应良好，之后继续服用孟鲁司特，并在随后的 3 个月内未出现症状复发。",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা ৫৭ বছর বয়সী এক রোগীর একটি অনন্য কেস উপস্থাপন করছি, যার পূর্ব রোগ ইতিহাসে asthma এবং allergic rhinitis ছিল এবং তিনি পুনরাবৃত্ত পেটব্যথা, উল্লেখযোগ্য রক্তে eosinophilia, এবং Immunoglobulin G4-এর মাত্রা বৃদ্ধি নিয়ে উপস্থিত হয়েছিলেন। eosinophilia-এর hematological ও secondary কারণগুলো বাদ দেওয়ার পর, colon mucosa-এর biopsy-তে tissue eosinophils-এর অতিরিক্ততা ধরা পড়ে, যা EoC নির্ণয় নিশ্চিত করে। রোগী corticosteroids-এ ভালো সাড়া দেন এবং পরবর্তীতে montelukast-এ মেইনটেন্যান্সে রাখা হয়; পরবর্তী ৩ মাসে উপসর্গের পুনরাবৃত্তি হয়নি।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0052_0053.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0052_0053.json
new file mode 100644
index 0000000000000000000000000000000000000000..26bc7252ee4bcb4041b5f9dcee249aea19181ebb
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0052_0053.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_569.txt",
+    "fulltext": "A 38-year-old male presented to the hospital with chest tightness and shortness of breath. Three years prior, he had experienced similar symptoms post-activity and received treatment at our hospital. Outpatient echocardiography indicated a left heart echomass suggestive of a myxoma, which led to his admission for further evaluation. Physical examination revealed pigmentation of the patient’s ears characterized by multiple small brown and black spots. Abdominal computed tomography (CT) showed multiple livers and small cysts in the left kidney. Genetic testing identified mutations in the TTN and PRKAR1A genes. The diagnosis of CNC was confirmed through clinical examination, imaging, and genetic testing. Following symptomatic treatment, the patient’s condition improved; however, he refused surgical intervention. On September 20, 2023, the patient presented to our hospital with exacerbated chest tightness and dyspnea. He reported difficulty lying supine and needing to sit upright to breathe. Physical examination revealed jugular vein distension, leftward and downward displacement of the heart boundary, irregular heart rhythm on auscultation, and a mitral valve murmur of intensity 2/6–3/6 in the fourth intercostal space along the left sternal margin. Wet rales were audible in both middle and lower lung fields. Palpation revealed a firm liver extending three fingers below the xiphoid process and two fingers below the rib cage, along with mild pitting edema in both lower limbs. Echocardiographic images indicated global heart enlargement, dilation of the aortic sinus and pulmonary artery, small-to-moderate mitral valve regurgitation, and an irregular echoic mass measuring 54 mm ×43 mm in the left chamber attached to the atrial septum. The left ventricular (LV) ejection fraction (EF) was 23.1%, with fractional shortening (FS) of 10.9%. Electrocardiography demonstrated atrial fibrillation (average ventricular rate, 150 beats/min) and abnormal Q waves in leads V1-V3. Based on the patient’s history, the diagnosis included DCM and CNC with cardiac myxoma. Given the presence of end-stage heart failure and concurrent cardiac myxoma, the patient was hospitalized, and heart transplantation was considered a viable therapeutic option to address both conditions simultaneously. A suitable donor heart became available for immediate transplantation on October 1, 2024.\n\n\nSurgical procedure\n\nThe skin and subcutaneous tissues were carefully incised layer-by-layer through a median sternotomy. The sternum was sawed longitudinally open, and bleeding was controlled using electrocoagulation and bone wax. Extracardiac exploration uncovered global heart enlargement, most prominent in the LV. The heart showed diminished contractile strength. The aorta and the main pulmonary artery (PA) were dissected from the supravalvular region. Some tissues were preserved for posterior suturing, whereas most diseased right atrium, left atrium(LA), right ventricle, and LV were excised. Resection revealed a greyish-white mucoid mass. The donor and residual recipient LA tissues were sutured using double continuous 3/0 Prolene threads. The anastomosis was meticulously inspected multiple times, and no significant bleeding was observed. Similarly, end-to-end anastomosis of the donor ascending aorta and recipient PA was performed using continuous 5/0 Prolene sutures, and careful inspection revealed no bleeding.\n\nFurthermore, the donor’s LA and recipient’s PA were securely closed using double continuous 5/0 Prolene sutures. The inferior vena cava tissues of both the donor and recipient were similarly sutured with 5/0 Prolene sutures, and several inspections were performed to confirm no significant bleeding was present. The left side of the heart was then deflated, and as rewarming commenced, oxygenation was restored, the ascending aorta was unclamped, and the heart spontaneously returned to sinus rhythm. Continuous suturing with 5/0 Prolene was applied to both the donor and recipient’s superior vena cava and diligently inspected to ensure the absence of significant bleeding. After the successful discontinuation of assisted circulation, the venous cavity was decannulated. Tissue samples from the patient’s left heart and gray matter were collected for histopathological examination, and the diagnosis of DCM and cardiac myxoma were confirmed.\n\n\nPostoperative management\n\nOn the first day after heart transplantation, the patient produced 1200 ml of urine. Laboratory tests revealed a hypersensitive troponin T level of 796.70ng/L and an NT-proBNP level of 10798pg/ml. The complete blood count showed white blood cells at 17.15 × 109/L, with no significant abnormalities in other test results. The echocardiograph displayed an LVEF of 65%, FS of 35%, normal ventricular wall thickness and echogenicity, and no discernible abnormalities in valve morphology and structure. After heart transplantation, Methylprednisolone Sodium Succinate (0.25 g)intravenous hormone therapy was administered to enhance immunity, and Cefoperazone and Sulbactam Sodium (2 g) intravenous anti-infection treatment was provided. The patient was given a nutrient solution and liver and tiopronin on the first day post-surgery. On postoperative day three, Methylprednisolone Sodium Succinate was replaced with oral Prednisone Acetate (25 mg). Mycophenolate Mofetil capsules (0.5 g) were administered orally to minimize heart rejection, and (50 mg) of Carpofungin Acetate was administered intravenously to prevent fungal infections. The patient’s urine output was 2000 ml, with hypersensitive troponin T levels of 390ng/L, NT-proBNP levels of 7877pg/ml, and a leukocyte count of 12.15 × 109/L. On the 7th day post-surgery, tacrolimus capsules were introduced at an oral dose of (1 mg) to minimize the patient’s rejection of the donor heart, with careful monitoring of blood concentrations. Subsequently, the oral dosage of Prednisone Acetate was gradually decreased to (10 mg) while adjusting the tacrolimus blood concentration to 10.90ng/ml. The patient’s recovery improved. On October 20, 2023, follow-up echocardiography (Fig. 6) indicated no abnormalities, with troponin levels of 85 ng/L, NT-proBNP of 210pg/ml, and all other test results within normal ranges. The patient exhibited excellent postoperative recovery and was discharged. Regular follow-up visits to our department after discharge showed that the patient remains in good condition.",
+    "summary": "Herein, we report a case of heart failure due to Carney syndrome that resulted in cardiac myxoma combined with dilated cardiomyopathy. A 35-year-old male was admitted to the hospital three years ago because of sudden chest tightness and shortness of breath. Echocardiography indicated myxoma, and a combination of genetic screening and physical examination confirmed Carney syndrome with cardiac myxoma. Following symptomatic management, he was discharged. Surgical interventions were not considered at the time. However, the patient’s chest tightness and shortness of breath symptoms worsened, and he returned to the hospital. A New York Heart Association grade IV heart function was confirmed, and echocardiography indicated the presence of dilated cardiomyopathy accompanied by cardiac myxoma. Ultimately, the patient’s heart failure was successfully treated with heart transplantation.",
+    "translated_fulltext": null,
+    "translated_summary": "在此，我们报告一例由卡尼综合征引起的充血性心力衰竭病例，该病例伴有心肌粘液瘤和扩张型心肌病。一位35岁的男性患者三年前因突发胸闷和呼吸困难入院。超声心动图显示存在心肌粘液瘤，结合基因筛查和体格检查，确诊为卡尼综合征，并伴有心肌粘液瘤。经过对症治疗后，患者出院。当时未考虑进行手术干预。然而，患者的胸闷和呼吸困难症状加重，再次入院。经检查，患者的心功能为纽约心脏协会IV级，超声心动图显示存在扩张型心肌病，并伴有心肌粘液瘤。最终，患者通过心脏移植成功治疗了心力衰竭。",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "এখানে আমরা Carney syndrome-এর কারণে সৃষ্ট heart failure-এর একটি কেস রিপোর্ট করছি, যা cardiac myxoma ও dilated cardiomyopathy-এর সাথে যুক্ত ছিল। ৩৫ বছর বয়সী একজন পুরুষ তিন বছর আগে হঠাৎ বুকে চাপভাব ও শ্বাসকষ্টের জন্য হাসপাতালে ভর্তি হয়েছিলেন। Echocardiography-তে myxoma নির্দেশিত হয়, এবং genetic screening ও physical examination-এর সমন্বয়ে cardiac myxoma-সহ Carney syndrome নিশ্চিত করা হয়। Symptomatic management-এর পর তাকে ছাড়পত্র দেওয়া হয়। সেই সময়ে surgical interventions বিবেচনা করা হয়নি। তবে রোগীর বুকে চাপভাব ও শ্বাসকষ্টের উপসর্গ বেড়ে যায়, এবং তিনি পুনরায় হাসপাতালে আসেন। New York Heart Association grade IV heart function নিশ্চিত হয়, এবং echocardiography-তে cardiac myxoma-সহ dilated cardiomyopathy উপস্থিতি নির্দেশিত হয়। পরিশেষে, রোগীর heart failure heart transplantation-এর মাধ্যমে সফলভাবে চিকিৎসা করা হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_324.txt",
+    "fulltext": "2 years 6 months old female pre-schooler with a previous diagnosis of NF1. She consulted due to a 4 week diarrhea with blood streaks (5 to 10 episodes a day). A week after the onset of the diarrhea she consulted the emergency department, where rotavirus (+) was detected, with low inflammatory parameters, negative coproculture and normal abdominal ultrasound. She was hospitalized for 3 days to manage dehydration and was discharged without bleeding, with persistence of semi-liquid stools. 10 days after discharge she presented diarrhea with blood streaks, associated with low intake and weight loss of 1 kg reported by parents. They consulted a pediatric gastroenterologist who requested a polymerase chain reaction (PCR) panel of gastrointestinal pathogens and PCR of Clostridium difficile (which were negative) and indicated hospitalization for study.\n\nOn direct questioning, the parents reported no fever, abdominal pain, vomiting, respiratory or urinary symptoms, arthralgia, or new skin lesions. They did not own pets, and there was no history of travel or recent dietary changes.\n\nThe patient was diagnosed with confirmed NF1 at 8 months of age by genetic testing with the heterozygous pathogenic variant c.5606_5627del (p.Gly1869Valfs*28). She has skin involvement (café con leche spots) and bone involvement. At 18 months she required ankle arthrodesis for tibial curvature. She has no family history of NF1 or inflammatory bowel disease.\n\nOn physical examination, the abdomen was soft and indistinct, with increased air-bubble murmurs, without masses or visceral enlargement. The perianal examination was normal. There were multiple brown-coffee stains on the lower extremities and back. General examinations were performed, including a blood count with moderate microcytic-hypochromic anaemia (Hb 9.6 g/dL), leukocytosis with left shift (leukocytes 13,900), and discretely elevated inflammatory parameters (CRP 1.37 mg/dL, normal value up to 0.5 mg/dL).\n\nA colonoscopy was performed, the rectum, sigmoid and various segments of the colon were examined up to the cecum, visualizing the ileocecal valve and the appendicular orifice. The last few centimeters of the distal ileum were also inspected. The mucosa from the anal margin to the cecum was observed to be erythematous, with loss of vascular transparency, unlike the cecal mucosa, which appeared normal. No lesions were identified in the anal canal or cecum.\n\nBiopsies of the small intestine (ileon) and large intestine were taken. Microscopic examination showed mucosa of ileal type with preserved villous architecture and adequate epithelial differentiation, with a non-inflamed lamina propria. The mucosa of the large intestine had a mild distortion of architecture and adequate epithelial differentiation, a swollen lamina propria with a mild mixed inflammatory infiltrate and hyperplasia of lymphoid follicles. Isolated foci of microabscesses were recognized. The biopsy was consistent with mild colitis, with signs suggesting chronicity.\n\nIn addition, a PCR study for cytomegalovirus (CMV) was requested in a colon biopsy, which was positive.\n\nGiven a positive PCR for CMV, CMV IgG and IgM and CMV viral load in blood were requested, resulting in a positive IgG, negative IgM, and CMV viral load of 79.7 IU/ml. Further laboratory studies included PCR for gastrointestinal pathogens and PCR for Clostridium difficile in stool, both of which were negative. In the colon biopsy, Gram stain microbiological studies were requested, which showed +++ leukocytes without bacteria; biopsy culture showed S. gallolyticus/equinus complex in very low amount (interpreted as bacterial flora); acridine orange, Ziehl-Neelsen, Koch culture, and ADV PCR were negative.\n\nEndoscopy and histology suggestive of UC was reported in the context of a patient with moderate symptoms (PUCAI 50) who was started on Mesalazine (70 mg/kg/day three times daily) and a request for a faecal calprotectin was made which was greater than 600 ug/g.\n\nThe immunology team evaluated the patient for suspected immunodeficiency. The parents did not report a history of infections, they reported that they were vaccinated, that they had good weight gain, no family history of immunodeficiencies, auto-immunity or early deaths. A study with lymphocyte subpopulations (normal), immunoglobulins (normal), HIV (negative), memory T lymphocytes (with alterations expected in the context of CMV viremia) and lymphoproliferation test (normal) was requested. In addition, a genetic panel of primary immunodeficiencies (Invitae) was performed, which contains 429 genes, of which 68 make up the panel of monogenic inflammatory intestinal disease. 7 variants of uncertain significance were obtained, none included in the panel of monogenic IBD.\n\nGanciclovir was initiated intravenous for CMV infection and continued for 15 days. The last PCR CMV control prior to discharge reported undetectable load.\n\nThe patient improved during the hospital stay with decreased frequency of stools and increased consistency, no rectal bleeding, no nocturnal stools and no abdominal pain, with PUCAI 0 at discharge.\n\nTwo months later, he presented with a reactivation of IBD with bloody diarrhea (PUCAI 35). A blood count was performed (normal), a panel of gastrointestinal pathogens was performed (–), PCR for Clostridium difficile was performed (+), and CMV load was undetectable. He was treated with oral metronidazole. However, he persisted with diarrhea with blood streaks, so he was hospitalized again.\n\nA colonoscopy was performed, where erythematous mucous was observed in a diffuse form from the rectum to the cecum, with nodularity and loss of vascular transparency in the submucosa, greater in the left and transverse colon segments. No focal lesions were observed. The mucosa of the ileum and anal canal were observed without lesions.\n\nBiopsy of the terminal ileum, right colon and left colon was performed. Microscopic examination of the ileal-type mucosa showed preserved villous architecture and adequate epithelial differentiation. The lamina propria showed no signs of inflammation. There were no aphthous erosions or granulomas. The mucosa of the large intestine showed mild distortion of architecture and epithelial dedifferentiation. The lamina propria was expanded by mixed inflammatory infiltrate, transmucosal distribution. Foci of cryptitis and cryptitic microabscesses and hyperplasia of reactive lymphoid follicles were recognized. No granulomas, viral or parasitic cytopathic changes were observed. All fragments of the left colon sample presented a similar histopathological picture.\n\nShe was given oral treatment with Vancomycin and Prednisone (1 mg/kg/day) with a good response and a favorable evolution. She was discharged with a decrease in the frequency of bowel movements. She persists with mild symptoms (PUCAI 5) in outpatient control, so the dose of corticosteroids is progressively decreased and she remains on treatment with Mesalazina.\n",
+    "summary": "2.5-year-old pre-schooler with a history of NF1 presenting with bloody diarrhea. On endoscopic examination, the mucosa from the anal margin to the cecum was erythematous with loss of vascular transparency. Colon mucosal biopsies showed signs of chronic inflammation consistent with a diagnosis of ulcerative colitis and CMV infection was diagnosed by PCR.\n",
+    "translated_fulltext": null,
+    "translated_summary": "一名2岁半的学龄前儿童，既往有神经纤维瘤病1型（NF1）病史，现出现血性腹泻。内镜检查显示，从肛门缘到盲肠的黏膜呈红斑，血管透明度降低。结肠黏膜活检显示慢性炎症迹象，与溃疡性结肠炎的诊断相符，并通过PCR检测确诊为巨细胞病毒（CMV）感染。",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "২.৫ বছর বয়সী এক প্রিস্কুলার, যার NF1-এর ইতিহাস আছে, রক্তমিশ্রিত ডায়রিয়া নিয়ে উপস্থিত হয়েছে। এন্ডোস্কোপিক পরীক্ষায় অ্যানাল মার্জিন থেকে সিকাম পর্যন্ত মিউকোসা ইরাইথেমাটাস ছিল এবং ভাসকুলার ট্রান্সপারেন্সি হ্রাস পেয়েছিল। কোলন মিউকোসাল বায়োপসিতে ক্রনিক ইনফ্ল্যামেশনের লক্ষণ দেখা গেছে, যা আলসারেটিভ কোলাইটিসের ডায়াগনোসিসের সঙ্গে সামঞ্জস্যপূর্ণ, এবং PCR দ্বারা CMV সংক্রমণ নির্ণীত হয়েছে।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0062_0063.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0062_0063.json
new file mode 100644
index 0000000000000000000000000000000000000000..490684f63bf919e208b1a97e71626cf053f16e09
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0062_0063.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_76.txt",
+    "fulltext": "A 19-year-old woman presented to the emergency department of our institution for acute onset of palpitations. An electrocardiogram (ECG) showed ventricular tachycardia, with right branch bundle block associated to left posterior hemiblock, and T waves inversion in the inferior and precordial leads. Blood test showed elevated troponin (27 ng/L, normal values <14 ng/L) and NT-pro BNP (aminoterminal pro B-Type Natriuretic Peptide) levels (2225 pg/mL, normal values <130 pg/mL). Hence, she was admitted to the coronary care unit.\n\nAbout 5 years before, she had already presented to the emergency department with cardiogenic shock due to fascicular ventricular tachycardia; she was subsequently hospitalized and underwent cardiac magnetic resonance (CMR) and a transoesophageal electrophysiological study, both with inconclusive results. She was discharged with a diagnosis of tachycardiomiopathy, with the prescription of a standard medical therapy (angiotensin-converting enzyme inhibitors, mineralocorticoid receptor antagonist, and beta blockers), and a follow-up was planned. Her subsequent clinical history was uneventful.\n\nDuring the present hospitalization, no further episodes of hyperkinetic arrhythmias were detected. Basal 12-lead ECG. Echocardiography showed diffuse hypokinesia of both the left and the right ventricles, and CMR was once again inconclusive. Then, the patient was advised to undergo cardiac computed tomography angiography (CCTA) to evaluate the anatomy of the coronary tree, under the suspicion of an undiagnosed congenital cardiac anomaly. CCTA was performed with a GE Lightspeed unit (GE HealthCare, Chicago, United States), with retrospective gating, at 100 kVp and 696 mAs, with a gantry rotation time of 0.35 s, and 0.625 mm slice thickness, with intravenous injection of 70 mL of Iomeron 400 mgI/mL (Bracco Imaging, Milan, Italy).\n\nDifferential diagnosis\nCardiogenic shock, namely a shock caused by inadequate blood flow, may be caused by different pathologies such as myocardial infarction, arrhythmias, or other cardiomyopathies. Undiagnosed congenital heart disease is a non-negligible cause of cardiogenic shock in otherwise healthy adult patients. Once myocardial infarction is ruled out by a 12-lead ECG, and an underlying cardiomyopathy has been excluded by an inconclusive CMR examination, CCTA is the technique of choice for the differential diagnosis among diverse causes of cardiogenic shock.\n\nInvestigations/imaging findings\nThe CCTA examination showed regular origin of the left main coronary artery, the left anterior descending artery, which presented a wide ramus intermedium, 2 diagonal branches, and the left circumflex artery, which appeared thin and non-dominant. Among all these vessels, there was no evidence of obstructive coronary artery disease. However, the ostium and the proximal portion of the right coronary artery (RCA) were absent, whereas its mid and distal portions were supplied by a wide collateral branch originating from the distal left anterior descending artery, which then surrounded the lateral wall of the right ventricle, ran through the distal part of the atrioventricular groove, finally giving rise to thin posterior interventricular and posterolateral arteries. Furthermore, a thin branch going from the mid left anterior descending artery to the sinoatrial node was observed.\n\nTreatment, outcome, and follow-up\nIn view of the CCTA findings, the patient underwent an echo-stress test, which confirmed the presence of inducible myocardial ischaemia in the inferior wall, in line with the positioning of the arrhythmic focus. After being transferred to a specialized centre for the diagnosis and treatment of congenital heart disease, the patient underwent transcatheter radiofrequency ablation of sustained ventricular tachycardia originating by the posteromedial papillary muscle. Then, she was discharged with medical therapy (Acetylsalicylic acid and Verapamil). At her 6-month follow-up, she has always been asymptomatic, with no further signs of arrhythmias.",
+    "summary": "A 19-year-old woman presented to the emergency department with arrhythmia and signs of cardiogenic shock. After a 12-lead electrocardiogram ruled out acute myocardial infarction, and cardiac magnetic resonance showed no sign of cardiomyopathy, cardiac computed tomography angiography (CCTA) was performed, displaying ostial atresia of the right coronary artery. She was thus referred to a specialist centre for congenital cardiovascular disease, where an electrophysiological study observed an arrhythmogenic focus on the posteromedial papillary muscle, which was ablated, and she has been asymptomatic since.",
+    "translated_fulltext": "一位19岁的女性因突发心悸来到我院急诊科。心电图（ECG）显示为室性心动过速，伴有右束支传导阻滞和左后半束支阻滞，以及下壁和胸前导联的T波倒置。血液检查显示肌钙蛋白升高（27 ng/L，正常值<14 ng/L）和NT-pro BNP（氨基末端前脑钠肽）水平升高（2225 pg/mL，正常值<130 pg/mL）。因此，她被收入重症监护室。\n\n大约5年前，她曾因束状性室性心动过速导致心源性休克来到急诊科；之后她住院，并进行了心脏磁共振成像（CMR）和经食管电生理研究，但结果均无明确结论。她被诊断为心动过速性心肌病，并处方了标准药物治疗（血管紧张素转化酶抑制剂、盐皮质激素受体拮抗剂和β受体阻滞剂），并计划进行随访。此后，她的临床病史没有出现其他问题。\n\n在本次住院期间，未检测到进一步的快速性心律失常发作。基础12导联心电图。超声心动图显示左心室和右心室均存在弥漫性运动功能减退，而CMR再次未能得出明确结论。随后，医生建议患者进行心脏计算机断层扫描血管造影（CCTA），以评估冠状动脉的解剖结构，并怀疑存在未确诊的先天性心脏异常。CCTA使用GE Lightspeed设备（GE HealthCare，芝加哥，美国）进行，采用回顾性门控，电压为100 kVp，电流为696 mAs，旋转时间为0.35 s，切片厚度为0.625 mm，静脉注射70 mL的Iomeron 400 mgI/mL（Bracco Imaging，米兰，意大利）。\n\n鉴别诊断\n心源性休克，即由血液循环不足引起的休克，可能由多种病理原因引起，如心肌梗死、心律失常或其他心肌病。在其他方面健康的成年患者中，未确诊的先天性心脏病是导致心源性休克的一个不可忽视的原因。一旦通过12导联心电图排除心肌梗死，并通过无明确结论的CMR检查排除潜在的心肌病，CCTA将成为鉴别心源性休克各种原因的首选技术。\n\n检查/影像学结果\nCCTA检查显示，左主冠状动脉、左前降支（其具有宽大的中间支、2条对角支）以及左回旋支（其显得细小且不占优势）的起源均正常。在所有这些血管中，没有发现阻塞性冠状动脉疾病的证据。然而，右冠状动脉（RCA）的开口和近段缺失，而其中段和远段则由一条宽大的侧支血管供血，该侧支血管起源于左前降支的远端，然后围绕右心室的侧壁，穿过心房室沟的远端，最终形成细小的后间隔支和后外侧支。此外，还观察到一条从左前降支中段延伸至窦房结的细小分支。\n\n治疗、结果和随访\n鉴于CCTA结果，患者接受了超声心动应激试验，证实存在可诱发的下壁心肌缺血，与心律失常病灶的位置相符。在转至专门的先天性心脏病诊断和治疗中心后，患者接受了经导管射频消融术，消除了起源于后内侧乳头肌的持续性室性心动过速。之后，她出院，并继续接受药物治疗（阿司匹林和维拉帕米）。在6个月的随访中，她一直没有症状，也没有出现进一步的心律失常迹象。",
+    "translated_summary": "一位19岁的女性患者因心律失常和心源性休克的症状来到急诊科。经过12导联心电图检查，排除急性心肌梗死，心脏磁共振成像显示未见心肌病迹象，随后进行了心脏计算机断层血管造影（CCTA），结果显示右冠状动脉开口处存在闭塞。因此，她被转诊至一家专门治疗先天性心血管疾病的中心，在该中心进行电生理研究，发现后内侧乳头肌存在致心律失常的病灶，并进行了消融术。此后，她一直没有出现任何症状。",
+    "corrected_translated_fulltext": "১৯ বছর বয়সী এক নারী হঠাৎ হৃদকম্পনের কারণে আমাদের প্রতিষ্ঠানের জরুরি বিভাগে উপস্থিত হন। ইলেকট্রোকার্ডিওগ্রাম (ECG) এ ventricular tachycardia দেখা যায়, ডান bundle branch block ও বাম posterior hemiblock সহ, এবং inferior ও precordial লিডে T wave inversion। রক্ত পরীক্ষায় troponin বৃদ্ধি (27 ng/L, স্বাভাবিক মান <14 ng/L) এবং NT-pro BNP (aminoterminal pro B-Type Natriuretic Peptide) মাত্রা বৃদ্ধি (2225 pg/mL, স্বাভাবিক মান <130 pg/mL) পাওয়া যায়। তাই তাকে ইনটেনসিভ কেয়ার ইউনিটে ভর্তি করা হয়।\n\nপ্রায় ৫ বছর আগে, তিনি fascicular ventricular tachycardia-জনিত cardiogenic shock নিয়ে জরুরি বিভাগে এসেছিলেন; পরবর্তীতে তিনি ভর্তি হন এবং cardiac magnetic resonance (CMR) ও transoesophageal electrophysiological study করানো হয়, তবে উভয়েরই ফল অস্পষ্ট ছিল। তাকে tachycardiomyopathy হিসেবে নির্ণয় করা হয় এবং standard medical therapy (angiotensin-converting enzyme inhibitors, mineralocorticoid receptor antagonist, এবং beta blockers) দেওয়া হয়, এবং ফলো-আপ পরিকল্পনা করা হয়। এরপর তার ক্লিনিক্যাল ইতিহাসে আর কোনো সমস্যা দেখা যায়নি।\n\nবর্তমান ভর্তি অবস্থায়, hyperkinetic arrhythmias-এর আর কোনো পর্ব শনাক্ত করা হয়নি। বেসলাইন ১২-লিড ECG। Echocardiography-তে বাম ও ডান উভয় ভেন্ট্রিকলে diffuse hypokinesia দেখা গেছে, আর CMR আবারও অস্পষ্ট ছিল। এরপর, অনির্ণীত জন্মগত কার্ডিয়াক অ্যানোমালির সন্দেহে করোনারি ট্রির অ্যানাটমি মূল্যায়নের উদ্দেশ্যে রোগীকে cardiac computed tomography angiography (CCTA) করতে পরামর্শ দেওয়া হয়। CCTA GE Lightspeed ইউনিট (GE HealthCare, Chicago, United States) দিয়ে করা হয়, retrospective gating সহ, 100 kVp এবং 696 mAs-এ, gantry rotation time 0.35 s, slice thickness 0.625 mm, এবং শিরায় 70 mL Iomeron 400 mgI/mL (Bracco Imaging, Milan, Italy) ইনজেকশন দিয়ে।\n\nডিফারেনশিয়াল ডায়াগনোসিস\nকার্ডিওজেনিক শক, অর্থাৎ অপর্যাপ্ত রক্তপ্রবাহজনিত শক, বিভিন্ন প্যাথোলজির কারণে হতে পারে, যেমন myocardial infarction, arrhythmias বা অন্যান্য cardiomyopathies। অন্যান্যভাবে সুস্থ প্রাপ্তবয়স্ক রোগীদের মধ্যে, অনির্ণীত জন্মগত হৃদরোগ কার্ডিওজেনিক শকের একটি অবহেলা করা যায় না এমন কারণ। একবার ১২-লিড ECG দ্বারা myocardial infarction বাদ দেওয়া হলে এবং অস্পষ্ট CMR পরীক্ষার মাধ্যমে অন্তর্নিহিত cardiomyopathy বাদ দেওয়া হলে, কার্ডিওজেনিক শকের নানাবিধ কারণের ডিফারেনশিয়াল ডায়াগনোসিসে CCTA হবে পছন্দের প্রযুক্তি।\n\nইনভেস্টিগেশন/ইমেজিং ফাইন্ডিংস\nCCTA তে দেখা যায়, left main coronary artery, left anterior descending artery (যার একটি প্রশস্ত ramus intermedium এবং 2টি diagonal branch রয়েছে), এবং left circumflex artery (যা পাতলা ও non-dominant বলে প্রতীয়মান)–এর উত্স স্বাভাবিক। এসব রক্তনালির কোনোতেও obstructive coronary artery disease-এর প্রমাণ পাওয়া যায়নি। তবে right coronary artery (RCA)-এর ostium এবং প্রোক্সিমাল অংশ অনুপস্থিত ছিল, আর এর mid ও distal অংশগুলো রক্তসরবরাহ পেত একটি প্রশস্ত collateral branch থেকে, যা উৎসারিত হয়েছিল distal left anterior descending artery থেকে; এটি এরপর ডান ভেন্ট্রিকলের ল্যাটেরাল ওয়াল ঘিরে, atrioventricular groove-এর distal অংশ দিয়ে অগ্রসর হয়ে, শেষ পর্যন্ত পাতলা posterior interventricular এবং posterolateral arteries সৃষ্টি করেছিল। অতিরিক্তভাবে, left anterior descending artery-এর mid অংশ থেকে sinoatrial node-এ গমনকারী একটি পাতলা শাখাও পর্যবেক্ষিত হয়।\n\nচিকিৎসা, ফলাফল এবং ফলো-আপ\nCCTA ফলাফলের প্রেক্ষিতে, রোগী একটি echo-stress test করেন, যা inferior wall-এ inducible myocardial ischaemia নিশ্চিত করে, যা arrhythmic focus-এর অবস্থানের সাথে সামঞ্জস্যপূর্ণ। জন্মগত হৃদরোগের নির্ণয় ও চিকিৎসার জন্য বিশেষায়িত কেন্দ্রে স্থানান্তরের পর, রোগী transcatheter radiofrequency ablation গ্রহণ করেন, যার মাধ্যমে posteromedial papillary muscle থেকে উৎপত্তি হওয়া sustained ventricular tachycardia অবলুপ্ত করা হয়। এরপর তিনি ছাড়া পান এবং ঔষধি চিকিৎসা (Acetylsalicylic acid এবং Verapamil) চালিয়ে যান। ৬ মাসের ফলো-আপে তিনি সর্বদা উপসর্গমুক্ত ছিলেন, এবং আর কোনো arrhythmias-এর চিহ্ন দেখা যায়নি।",
+    "corrected_translated_summary": "একজন ১৯ বছর বয়সী নারী রোগী আরিথমিয়া এবং কার্ডিওজেনিক শকের লক্ষণ নিয়ে জরুরি বিভাগে আসেন। ১২-লিড ইলেক্ট্রোকার্ডিওগ্রাম করে আকিউট মায়োকার্ডিয়াল ইনফার্কশন বাদ দেওয়া হয়, কার্ডিয়াক ম্যাগনেটিক রেজোন্যান্সে কার্ডিওমায়োপ্যাথির কোনো লক্ষণ দেখা যায়নি, এরপর cardiac computed tomography angiography (CCTA) করা হয়, যাতে right coronary artery-এর ostial atresia দেখা যায়। সুতরাং, তাঁকে জন্মগত কার্ডিওভাসকুলার রোগের জন্য একটি বিশেষায়িত কেন্দ্রে রেফার করা হয়, যেখানে electrophysiological study করে posteromedial papillary muscle-এ একটি arrhythmogenic focus ধরা পড়ে এবং ablation করা হয়। এরপর থেকে তিনি উপসর্গহীন।"
+  },
+  {
+    "id": "multiclinsum_gs_en_583.txt",
+    "fulltext": "A 19-year-old female presented to our hospital’s emergency room with a chief complaint of a two-day history of headache, accompanied by recurrent nausea, vomiting, and a one-day fever. On admission, her physical examination revealed a high fever of 39.1°C, elevated blood pressure at 189/120 mmHg, and a pulse rate of 148 beats per minute. Laboratory results indicated an elevated white blood cell count of 14.77×10^9/L and a neutrophil count of 13.55×10^9/L, suggesting a possible infection or inflammatory response. Initial empirical treatment with antibiotics was administered due to suspected infection, but her symptoms persisted. Given her abnormal vital signs, elevated inflammatory markers, and lack of symptom improvement, the patient was admitted for further diagnostic evaluation and transferred to the intensive care unit for close monitoring. A year prior, the patient had presented with similar symptoms and was diagnosed with myocarditis at a local hospital based on clinical findings at that time. During that hospitalization, she was also diagnosed with hypertension and prescribed antihypertensive medications. However, after discharge, the patient did not adhere to the prescribed antihypertensive therapy and did not regularly monitor her blood pressure. Additionally, it is notable that her father had a history of sudden, unexplained death.\n\nTo investigate the underlying etiology of the patient’s symptoms, a chest computed tomography (CT) scan was performed. Incidentally, this scan revealed a left adrenal mass with soft tissue density, measuring 43 mm × 36 mm. No pathological findings were observed in the head and chest CT scans. The electrocardiogram demonstrated sinus tachycardia with a shortened PR interval and tall, peaked P-waves in leads II, III, and aVF. Transthoracic echocardiography did not reveal any significant abnormalities.\n\nOn the second day of admission, the patient exhibited rising levels of brain natriuretic peptide (BNP) and Troponin I (TnI). The cardiologist provisionally diagnosed the patient with myocarditis of uncertain etiology, based on clinical presentation, elevated cardiac biomarkers (BNP and TnI), and supportive electrocardiogram findings. Treatment was initiated with methylprednisolone (0.25 g daily) to address potential myocardial inflammation due to suspected myocarditis. Furosemide (20 mg every 12 hours) and spironolactone (20 mg every 12 hours) were administered as diuretics to manage fluid retention and reduce cardiac workload. Perindopril amlodipine (10 mg: 5 mg daily) was prescribed as an angiotensin-converting enzyme inhibitor and calcium channel blocker combination to control blood pressure and reduce afterload. Metoprolol tartrate (25 mg every 12 hours) was used to manage heart rate and decrease myocardial oxygen demand, while esmolol (0.2 g/hour intravenous infusion), a short-acting beta-blocker, was administered for additional acute heart rate control due to sinus tachycardia. Due to concerns about a potential infection, moxifloxacin was added as empiric antibiotic therapy.\n\nGiven the patient’s presentation with an adrenal mass and hypertension, the endocrinologist recommended an evaluation of the aldosterone-to-renin ratio, plasma cortisol, plasma catecholamines, and 24-hour urinary catecholamines along with their metabolites. In the recumbent position, plasma and urinary catecholamine levels were markedly elevated (Table 1), including plasma dopamine at 524.5 pmol/L, norepinephrine at 83975 pmol/L, and epinephrine at 10579.3 pmol/L. Additionally, the 24-hour urinary levels showed free adrenaline at 4368.89 nmol/24 hours, free norepinephrine exceeding 12697.60 nmol/24 hours, normetanephrine at 8312 nmol/24 hours, metanephrines at 4078 nmol/24 hours, and vanillylmandelic acid at 58.1 mg/24 hours. These findings supported a clinical diagnosis of pheochromocytoma. On the fifth day post-admission, glucocorticoid therapy was discontinued, and perindopril amlodipine was substituted with terazosin for more targeted blood pressure management.\n\nAn enhanced abdominal CT scan further confirmed a left adrenal mass, highly suggestive of pheochromocytoma. Additionally, after obtaining informed consent, whole-exome sequencing was performed, revealing a heterozygous missense mutation, c.1900T > C: p. Cys634Arg, in the RET gene, leading to a substitution of cysteine with arginine at codon 634. This mutation raised suspicion for multiple endocrine neoplasia syndrome, prompting further evaluation of the thyroid and parathyroid glands. Thyroid color Doppler ultrasound identified a hypoechoic mass measuring 6 mm × 4 mm in the left thyroid lobe, and a mild elevation in calcitonin levels was noted. No additional significant abnormalities were detected.\n\nAs the patient’s condition gradually improved, plasma cortisol and ACTH levels returned to normal. The patient was subsequently discharged with a prescription for metoprolol tartrate (100 mg every 12 hours) and ivabradine hydrochloride (5 mg every 12 hours) for home management. Three months later, after achieving stable clinical status, the patient underwent resection of the left adrenal tumor, which measured 50 mm × 40 mm × 30 mm. Immunohistochemical analysis confirmed positive staining for Vim, CD56, Syn, CgA, and NSE, with S-100 positive in Sertoli cells, while CKpan, CD10, MART-1/Melan-A, and Melan-A were negative. The Ki67 index was 1%, leading to a definitive diagnosis of adrenal pheochromocytoma. The patient was discharged without further medications and has since been regularly followed up postoperatively without recurrence of symptoms. Over a 15-month postoperative follow-up, the patient exhibited persistently mild hypercalcitoninemia with stable thyroid nodule size, while PTH and serum calcium levels showed a progressive increase (Table 2). Further parathyroid scintigraphy using 99mTc-MIBI was performed, and the conclusion was a negative result for parathyroid adenoma.",
+    "summary": "We report the case of a 19-year-old female who presented with pheochromocytoma without experiencing a crisis, despite having a significant adrenal mass and undergoing high-dose glucocorticoid treatment. Genetic testing revealed a heterozygous missense mutation in the RET gene (c.1900T > C: p. Cys634Arg), associated with MEN2A. Further endocrine evaluation identified a thyroid nodule with mildly elevated calcitonin levels, but normal electrolyte and parathyroid hormone levels. Over a 15-month postoperative follow-up, the patient exhibited persistently mild hypercalcitoninemia with stable thyroid nodule size, while PTH and serum calcium levels showed a progressive increase. Further parathyroid scintigraphy using 99mTc-MIBI was performed, yielding a negative result for parathyroid adenoma.",
+    "translated_fulltext": null,
+    "translated_summary": "我们报告了一例19岁女性患者的病例，该患者患有嗜铬细胞瘤，但并未出现危象。尽管她有明显的肾上腺肿块，并且接受了高剂量糖皮质激素治疗。基因检测显示，她的RET基因存在杂合性错义突变（c.1900T>C：p.Cys634Arg），该突变与MEN2A相关。进一步的内分泌评估发现，患者的甲状腺有一个结节，降钙素水平略有升高，但电解质和甲状旁腺激素水平正常。在术后15个月的随访中，患者持续出现轻度高降钙素血症，甲状腺结节大小稳定，而甲状旁腺激素和血清钙水平则呈逐渐升高趋势。随后，进行了使用99mTc-MIBI的甲状旁腺闪烁扫描，结果显示甲状旁腺腺瘤为阴性。",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "আমরা ১৯ বছর বয়সী এক নারী রোগীর একটি কেস রিপোর্ট করছি, যিনি pheochromocytoma নিয়ে উপস্থিত হয়েছিলেন, কিন্তু কোনো crisis অভিজ্ঞতা করেননি। যদিও তার একটি উল্লেখযোগ্য adrenal mass ছিল এবং তিনি উচ্চ-ডোজ glucocorticoid চিকিৎসা নিয়েছিলেন। জেনেটিক টেস্টিংয়ে দেখা যায়, তার RET gene-এ একটি heterozygous missense mutation (c.1900T>C: p.Cys634Arg) রয়েছে, যা MEN2A-এর সঙ্গে সম্পর্কিত। পরবর্তী এন্ডোক্রাইন মূল্যায়নে দেখা যায়, রোগীর thyroid-এ একটি nodule রয়েছে এবং calcitonin মাত্রা সামান্য বৃদ্ধি পেয়েছে, তবে electrolytes এবং parathyroid hormone মাত্রা স্বাভাবিক। অস্ত্রোপচারের পর ১৫ মাসের ফলো‑আপে, রোগীর হালকা মাত্রার স্থায়ী hypercalcitoninemia ছিল এবং thyroid nodule-এর আকার স্থিতিশীল ছিল, যখন parathyroid hormone এবং serum calcium মাত্রা ধীরে ধীরে বৃদ্ধি পেয়েছে। এরপর 99mTc-MIBI ব্যবহার করে parathyroid scintigraphy করা হয়, যার ফলাফলে parathyroid adenoma নেগেটিভ পাওয়া যায়।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0064_0065.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0064_0065.json
new file mode 100644
index 0000000000000000000000000000000000000000..b6d1996dc6a964b6cee1521b41a852d3315477f1
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0064_0065.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_515.txt",
+    "fulltext": "February 2020, a 36-year-old with no significant past medical history presented with 5 years history of left sided penoscrotal mass. He has no lower urinary tract symptoms. No History of trauma or infections and he denied any history of weight loss, anorexia or fever. On examination, there is a smooth surface, tender cystic lesion around 20 mm ∗ 20 mm attached to the left side of the bulbar urethra at the penoscrotal junction, it was deep without any skin tethering and not related to the left spermatic cord and it was partially mobile.\n\nDoppler ultrasonography showed a well-defined hypoechoic mass measuring 2.7 ∗ 3.1 ∗ 2.0 cm with significantly increased vascularity at the left of penoscrotal junction. Pelvis Magnetic resonance imaging revealed a mass in the left inferolateral side of the base of the penis with a clear fat plane, which is isointense to the testes in the T2 weighted imaging, T1 weighted imaging and Diffusion-weighted imaging and it was connected to the vas deferens, no lymphadenopathy was noted. Alpha fetoprotein and beta-human chronic gonadotrophin levels were all in the normal range. Given the results of workup and the pain experienced by the patient, a decision was made to proceed with surgical removal of the mass for both diagnostic and therapeutic purposes. During surgery, a mass was seen in the left posterolateral of the scrotum and it was resected completely and sent for histopathology.\n\nHistopathology of the mass showed cellular spindle cell tumour arranged into interlacing fascicle, the cells have spindle to oval vesicular nuclei with evenly dispersed chromatin and inconspicuous nucleoli. The tumour showed high mitotic activity reaching up to 3/High-power field. Immunohistochemistry analysis was consistent with synovial sarcoma, revealing a positive TLE-1, CD99, B-cell lymphoma 2 (BLC2), Focal cytokeratin and focal epithelial membrane antigen (EMA). The material was sent for Fluorescence in situ hybridization (FISH) and reported a rearrangement of the SS18 gene at 18q11.2 which has been observed in synovial sarcomas. The mass margins were difficult to be assessed by histopathology as the sample had fragmented margins.\n\nThe patient presented to the clinic after 2 weeks and given the histopathology report, a re-resection with wider margin was discussed with the patient and he agreed. Positron emission tomography – Computed tomography (PET/CT) was done for Head and Neck, Chest, Abdomen, Pelvis and musculoskeletal structures. Only a 29 ∗ 27 mm thyroid nodule in the lower pole of the left thyroid lobe with moderate hypermetabolism at standardized uptake values (SUVs) of 4.9. Thyroid US showed a solid isoechoic well-defined nodule in the lower pole of the left thyroid lobe with no echogenic foci, Thyroid Imaging Reporting and Data System (TIRADS) was TR3.\n\nA second resection was made 3 weeks from the first one. The whole specimen was resected from both cords bilaterally which was deepened until reaching the corpus spongiosum which was shaved superiorly up to the urethra. The specimen was sent for histopathology. The resected mass was 6.0 ∗ 6.0 ∗ 3.0 cm in size, and it was negative for any pathology. The patient then went into active surveillance and after 16 months of active surveillance he was found to have metastatic lesions in the sixth liver segment and L1 vertebral body. Oncology team started chemotherapy regimen of Ifosfamide and Doxorubicin for 6 cycles with no improvement in the liver lesion. Surgical resection was made for the Fifth and Sixth liver sections with cholecystectomy. Patient then developed a new lung lesion and was started on Pazopanib and Stereotactic Body Radiation Therapy SBRT. The patient then underwent surveillance for 6 months then developed new liver and lung lesions then chemotherapy regimen of Gemcitabine and Docetaxel combination for 3 cycles and progressed then he was started 2 cycles of Dacarbazine and progressed then 2 cycles of Pembrolizumab and progressed. The patient then was shifted to palliative care, and he stopped following up.",
+    "summary": "A 36-year-old man presented with a tender penoscrotal mass for 5 years. The patient underwent surgical resection of the mass. Histopathology revealed cellular spindle cell tumour arranged into interlacing fascicle, Immunohistochemistry analysis revealed a positive TLE-1, CD99, B-cell lymphoma 2 (BLC2), Focal cytokeratin and focal epithelial membrane antigen (EMA). In our case, the patient was aggressively treated with two surgical resections and still progressed and metastasized and continued progressing even after different chemotherapy regimens.",
+    "translated_fulltext": null,
+    "translated_summary": "一位36岁的男性患者，阴茎阴囊部出现一个触痛性肿块，病史长达5年。患者接受了手术切除肿块。组织病理学检查显示，肿块由细胞性梭形细胞肿瘤构成，细胞呈交错排列。免疫组织化学分析显示，肿瘤细胞呈TLE-1、CD99、B细胞淋巴瘤2（BLC2）、局灶性细胞角蛋白和局灶性上皮膜抗原（EMA）阳性。在本例中，患者接受了两次手术切除，但肿瘤仍持续进展并发生转移，即使在接受了不同的化疗方案后，肿瘤也继续进展。",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "৩৬ বছর বয়সী এক পুরুষ রোগীর লিঙ্গ-অণ্ডথলি অঞ্চলে স্পর্শে বেদনাদায়ক একটি গাঁঠ ৫ বছর ধরে ছিল। রোগীর গাঁঠটি শল্যচিকিৎসার মাধ্যমে অপসারণ করা হয়। হিস্টোপ্যাথোলজি দেখায়, গাঁঠটি কোষ-সমৃদ্ধ spindle cell tumour দ্বারা গঠিত, যা interlacing fascicles-এ বিন্যস্ত। ইমিউনোহিস্টোকেমিস্ট্রি বিশ্লেষণে TLE-1, CD99, B-cell lymphoma 2 (BLC2), focal cytokeratin এবং focal epithelial membrane antigen (EMA) পজিটিভ পাওয়া যায়। এই ক্ষেত্রে, রোগী দুইবার শল্যচিকিৎসা দ্বারা অপসারণ গ্রহণ করেন, তবুও টিউমারটি অগ্রসর হয় ও মেটাস্টেসিস ঘটে, এবং বিভিন্ন কেমোথেরাপি রেজিমেন নেওয়ার পরেও অগ্রগতি অব্যাহত থাকে।"
+  },
+  {
+    "id": "multiclinsum_gs_en_91.txt",
+    "fulltext": "A 13-year-old adolescent male, with no significant previous medical history, presented to the emergency department with a 3-day history of acute bilateral pleuritic chest pain associated with mild non-productive cough and no dyspnea. Associated with this, he had mild rhinorrhea and a single febrile episode that day (temperature of 38ºC). Chest pain was localized to the costal margin region and worsened with cough, without diurnal variation. The patient-reported relief with paracetamol. There were no complaints of joint pain, weight loss, anorexia, fatigue, episodes of syncope or exercise restriction. In fact, he practiced sports regularly—canoeing 2 times a week. No evidence of an infectious exposure or contact with household or environmental fumes, dust, or mineral oils was described. There was no known family history of cardiopulmonary conditions. He had a chest radiograph taken 4 years earlier during an acute illness, which showed a marked interstitial infiltrate that was presumptively treated with azithromycin with no further clinical symptoms and no further follow-up.\n\nOn admission, the patient’s temperature was 37.8°C with normal peripheral oxygen saturation (99%) in room air. His heart (93 beats per minute) and respiratory rate (15 breaths per minute) were normal and blood pressure was on the 85th percentile (115/66 mmHg). Physical examination revealed diminished breath sounds in the lower two thirds of the chest with no adventitious sounds. No respiratory distress, finger clubbing, cyanosis, abnormal heart sounds, or other findings were present. Chest radiograph revealed a marked interstitial infiltrate, comparable with his previous examination. A thoracic computed tomography (CT) revealed multiple bilateral areas of ground-glass opacities involving > 65% of lung parenchyma, suggestive of PAP. Respiratory viral testing was negative, and he remained stable throughout his monitoring in the emergency department. He was discharged with empiric antibiotics (amoxicillin-clavulanic acid and azithromycin) to cover a potential respiratory infection, with clinical resolution of symptoms and was sent for follow-up at the pediatric respiratory clinic.\n\nUpon further investigation in the outpatient setting, positive antinuclear antibodies (ANAs) at a titer of 1/89 with a fine speckled pattern were detected, while other autoantibodies tested negative and immunoglobulin levels remained within normal limits. Bronchoalveolar lavage revealed fluid with a milky appearance and positive periodic acid-Schiff staining; microbiological examination, including for mycobacteria, returned negative results. Spirometry indicated a mild restrictive pattern with reduced forced vital capacity (FVC) at 2.92 L (77%) and forced expiratory volume in 1 second (FEV1) at 3.21 L (69.9%), alongside a normal FEV1/FVC ratio (109%). In addition, the DLCO single breath (SB) showed a moderate decrease at 13.8 ml/min/mmHg (48.6%). Suspecting PAP, a genetic panel was conducted, which showed no mutations associated with surfactant dysfunction. Subsequently, GM-CSF antibody testing was performed with a positive result, raising suspicion for AI-PAP. At 20 months of follow-up, the patient remains asymptomatic and continues to exercise regularly. He repeated spirometry testing with normal FVC at 4.03 L (81.3%); FEV1 at 3.71 L (87.5%); FEV1/FVC ratio at 91.96% and DLCO SB at 25.54 ml/min/mmHg (83.7%). As the patient remains stable with no respiratory symptoms, we decided to defer treatment and continue monitoring with regular clinic visits.",
+    "summary": "We describe the case of a 13-year-old adolescent male who presented to the emergency department with acute pleuritic chest pain not associated with systemic complaints. On examination, he had diminished breath sounds in the lower two thirds of the chest with no other abnormal findings; SpO2 (oxygen saturation) was 98% on room air. Chest radiograph revealed a marked interstitial infiltrate, comparable with the one taken 4 years earlier during an acute illness that was presumptively treated with azithromycin. A computed tomography (CT) scan revealed multiple bilateral areas of ground-glass opacities with areas of crazy paving, involving > 65% of lung parenchyma, suggestive of pulmonary alveolar proteinosis (PAP). Respiratory viral testing, including for coronavirus (SARS-CoV2), was negative. Bronchoalveolar lavage performed in the outpatient setting revealed a milky fluid and positive periodic acid-Schiff staining. Spirometry indicated a mild restrictive pattern (forced vital capacity [FVC] = 77%) and diffusing capacity of the lungs for carbon monoxide (DLCO) showed a moderate decrease at 48.6%. No mutations associated with surfactant dysfunction were found on the genetic panel. Anti-granulocyte macrophage colony-stimulating factor (GM-CSF) antibody testing was strongly positive, raising suspicion for autoimmune PAP. At 20 months of follow-up, the patient remains asymptomatic with a normal spirometry.",
+    "translated_fulltext": "一位13岁的男性青少年，既往无明显病史，因出现持续3天的急性双侧胸膜性胸痛就诊于急诊科，伴有轻微的非 productive 性咳嗽，无呼吸困难。同时，他还出现轻微的鼻炎和当天一次发热（体温38℃）。胸痛局限于肋骨边缘区域，咳嗽时加重，但没有昼夜变化。患者表示服用对乙酰氨基酚后症状有所缓解。他没有关节疼痛、体重减轻、食欲不振、疲劳、晕厥或活动受限等症状。事实上，他经常进行体育锻炼，每周划船两次。没有发现任何感染暴露或接触家庭或环境中的烟雾、灰尘或矿物油。已知家族史中没有心肺疾病。四年前，他在一次急性疾病期间进行了胸部X光检查，结果显示有明显的间质浸润，当时他接受了阿奇霉素治疗，之后没有出现其他临床症状，也没有进行进一步的随访。\n\n入院时，患者体温为37.8℃，在室内空气中，外周血氧饱和度正常（99%）。他的心率（93次/分钟）和呼吸频率（15次/分钟）正常，血压在第85百分位数（115/66 mmHg）。体格检查显示，胸部下三分之二的呼吸音减弱，没有其他异常呼吸音。没有呼吸窘迫、杵状指、紫绀、异常心脏杂音或其他发现。胸部X光片显示有明显的间质浸润，与他之前的检查结果相似。胸部计算机断层扫描（CT）显示，双侧肺部有多处磨玻璃样阴影，占肺实质的65%以上，提示可能为肺泡蛋白沉积症（PAP）。呼吸道病毒检测结果为阴性，他在急诊科的观察期间病情保持稳定。他出院时开了经验性抗生素（阿莫西林-克拉维酸和阿奇霉素），以治疗潜在的呼吸道感染，症状得到临床缓解，并被转诊至儿科呼吸科进行随访。\n\n在门诊进一步检查中，检测到阳性的抗核抗体（ANA），滴度为1/89，呈细点状。其他自身抗体检测结果为阴性，免疫球蛋白水平仍在正常范围内。支气管肺泡灌洗液显示液体呈乳白色，并呈阳性的过碘酸-希夫染色；包括结核分枝杆菌在内的微生物学检查结果均为阴性。肺功能检查显示，轻度限制性模式，用力肺活量（FVC）降低至2.92 L（77%），一秒用力呼气容积（FEV1）降低至3.21 L（69.9%），同时FEV1/FVC比值正常（109%）。此外，单次呼吸（SB）的弥散功能（DLCO）也显示出中度降低，为13.8 ml/min/mmHg（48.6%）。考虑到可能为肺泡蛋白沉积症（PAP），进行了基因检测，结果显示没有与表面活性物质功能障碍相关的突变。随后，进行了GM-CSF抗体检测，结果为阳性，这增加了对自身免疫性肺泡蛋白沉积症（AI-PAP）的怀疑。在随访20个月后，患者仍无症状，并继续进行规律的锻炼。他重复进行了肺功能检查，结果显示FVC正常，为4.03 L（81.3%）；FEV1为3.71 L（87.5%）；FEV1/FVC比值为91.96%，DLCO SB为25.54 ml/min/mmHg（83.7%）。由于患者病情稳定，没有呼吸道症状，我们决定推迟治疗，并继续通过定期门诊随访进行监测。",
+    "translated_summary": "我们描述了一位13岁男性青少年的病例，他因急性胸膜性胸痛来到急诊科，但没有伴有全身症状。检查发现，他的胸部下部三分之二的呼吸音减弱，没有其他异常发现；在常温下，血氧饱和度（SpO2）为98%。胸部X光片显示，肺间质有明显的浸润，与4年前因急性疾病进行阿奇霉素治疗时拍摄的X光片相似。计算机断层扫描（CT）显示，双侧肺部有多处磨玻璃样阴影，并伴有“鹅卵石样”改变，累及超过65%的肺实质，提示可能为肺泡蛋白沉积症（PAP）。呼吸道病毒检测，包括新冠病毒（SARS-CoV2）检测，结果均为阴性。在门诊进行的支气管肺泡灌洗术显示，液体呈乳白色，且过碘酸-席夫染色呈阳性。肺功能检查显示，存在轻度限制性模式（用力肺活量[FVC]=77%），肺对一氧化碳的弥散能力（DLCO）中度下降，为48.6%。基因检测未发现与表面活性物质功能障碍相关的突变。抗粒细胞-巨噬细胞集落刺激因子（GM-CSF）抗体检测结果强烈阳性，提示可能为自身免疫性PAP。在随访20个月后，患者仍无症状，肺功能检查结果正常。",
+    "corrected_translated_fulltext": "১৩ বছরের এক পুরুষ কিশোর, পূর্ববর্তী উল্লেখযোগ্য রোগ-ইতিহাস নেই, ৩ দিন ধরে তীব্র দ্বিপার্শ্বীয় pleuritic বুকে ব্যথা নিয়ে জরুরি বিভাগে আসেন, যার সঙ্গে ছিল হালকা non-productive কাশি এবং শ্বাসকষ্ট ছিল না। একই সঙ্গে, তার হালকা rhinitis ছিল এবং সেদিন একবার জ্বর হয়েছিল (তাপমাত্রা 38°C)। বুকে ব্যথা costal margin অঞ্চলে সীমাবদ্ধ ছিল এবং কাশিতে বেড়ে যেত, তবে দিন-রাতভেদে কোনো পরিবর্তন ছিল না। রোগী জানান paracetamol সেবনে উপসর্গ উপশম হয়েছিল। তার joint pain, weight loss, anorexia, fatigue, syncope বা exercise restriction ছিল না। প্রকৃতপক্ষে, তিনি নিয়মিত ক্রীড়া অনুশীলন করতেন—সপ্তাহে ২ বার canoeing করতেন। সংক্রমণের কোনো exposure বা গৃহস্থালি/পরিবেশগত ধোঁয়া, ধুলা বা mineral oils-এর সংস্পর্শের প্রমাণ পাওয়া যায়নি। পরিচিত family history-তে কোনো cardiopulmonary রোগ ছিল না। চার বছর আগে, এক তীব্র অসুস্থতার সময়ে তার একটি chest radiograph করা হয়েছিল, যাতে উল্লেখযোগ্য interstitial infiltrate দেখা গিয়েছিল; তখন presumptively azithromycin দেওয়া হয়, এরপর আর কোনো ক্লিনিক্যাল উপসর্গ দেখা যায়নি এবং আর কোনো follow-up করা হয়নি。\n\nভর্তি হওয়ার সময় রোগীর তাপমাত্রা ছিল 37.8°C এবং room air-এ peripheral oxygen saturation স্বাভাবিক ছিল (99%)। তার heart rate (93 beats per minute) ও respiratory rate (15 breaths per minute) স্বাভাবিক ছিল এবং blood pressure 85তম পারসেন্টাইলে ছিল (115/66 mmHg)। শারীরিক পরীক্ষায় বক্ষের নীচের দুই-তৃতীয়াংশে breath sounds কম ছিল, কোনো adventitious sound শোনা যায়নি। respiratory distress, finger clubbing, cyanosis, অস্বাভাবিক heart sounds বা অন্য কোনো সন্ধান ছিল না। chest radiograph-এ উল্লেখযোগ্য interstitial infiltrate দেখা গেছে, যা তার পূর্ববর্তী পরীক্ষার সঙ্গে তুলনীয়। thoracic CT-তে উভয় ফুসফুসে বহুস্থানে ground-glass opacities দেখা গেছে, যা ফুসফুসের parenchyma-এর >65% জুড়ে রয়েছে, PAP-এর সন্দেহ জাগায়। respiratory viral testing নেগেটিভ ছিল এবং জরুরি বিভাগে পর্যবেক্ষণের পুরো সময় তিনি স্থিতিশীল ছিলেন। তাকে সম্ভাব্য শ্বাসতন্ত্রের সংক্রমণ কভার করার জন্য empiric antibiotics—amoxicillin‑clavulanic acid এবং azithromycin—সহ ছাড়পত্র দেওয়া হয়; উপসর্গের ক্লিনিক্যাল রেজোলিউশন হয় এবং তাকে শিশু শ্বাসতন্ত্র ক্লিনিকে ফলো‑আপের জন্য পাঠানো হয়。\n\nআউটপেশেন্টে আরও তদন্তে positive antinuclear antibodies (ANA) ধরা পড়ে, টাইটার 1/89, fine speckled pattern। অন্যান্য autoantibodies নেগেটিভ ছিল, এবং immunoglobulin মাত্রা স্বাভাবিক সীমার মধ্যে ছিল। bronchoalveolar lavage তরল দুধের মতো দেখায় এবং periodic acid–Schiff staining পজিটিভ ছিল; mycobacteria-সহ মাইক্রোবায়োলজিক পরীক্ষাগুলো নেগেটিভ আসে। spirometry-তে হালকা restrictive pattern দেখা যায়, FVC কমে 2.92 L (77%) এবং FEV1 কমে 3.21 L (69.9%) হয়, পাশাপাশি FEV1/FVC অনুপাত স্বাভাবিক (109%)। এছাড়া DLCO single breath (SB) মাঝারি মাত্রায় কমে ছিল, 13.8 ml/min/mmHg (48.6%)। PAP সন্দেহে একটি জেনেটিক প্যানেল করা হয়, যা surfactant dysfunction‑সংশ্লিষ্ট কোনো মিউটেশন দেখায়নি। পরবর্তীতে GM‑CSF antibody পরীক্ষা করা হয় এবং তা পজিটিভ আসে, যা AI‑PAP‑এর সন্দেহ বাড়ায়। ২০ মাসের ফলো‑আপে রোগী উপসর্গবিহীন রয়েছেন এবং নিয়মিত ব্যায়াম চালিয়ে যাচ্ছেন। তিনি পুনরায় spirometry করান; ফলাফলে FVC স্বাভাবিক, 4.03 L (81.3%); FEV1 3.71 L (87.5%); FEV1/FVC অনুপাত 91.96%; DLCO SB 25.54 ml/min/mmHg (83.7%)। রোগী স্থিতিশীল এবং কোনো শ্বাসতন্ত্রীয় উপসর্গ না থাকায়, আমরা চিকিৎসা স্থগিত রাখার সিদ্ধান্ত নিয়েছি এবং নিয়মিত ক্লিনিক ভিজিটের মাধ্যমে পর্যবেক্ষণ চালিয়ে যাচ্ছি।",
+    "corrected_translated_summary": "আমরা ১৩-বছর-বয়সী এক কিশোর পুরুষের একটি কেস বর্ণনা করছি, যিনি তীব্র প্লুরিটিক বুকের ব্যথা নিয়ে, কিন্তু কোনো সিস্টেমিক উপসর্গ ছাড়াই, জরুরি বিভাগে উপস্থিত হয়েছিলেন। পরীক্ষায় বক্ষের নীচের দুই-তৃতীয়াংশে শ্বাস-শব্দ কম ছিল, অন্য কোনো অস্বাভাবিকতা পাওয়া যায়নি; রুম এয়ারে SpO2 (oxygen saturation) ছিল ৯৮%। চেস্ট রেডিওগ্রাফে উল্লেখযোগ্য ইন্টারস্টিশিয়াল ইনফিলট্রেট দেখা যায়, যা ৪ বছর আগে একটি তীব্র অসুস্থতার সময় তোলা রেডিওগ্রাফের সঙ্গে তুলনীয়, যখন presumptively azithromycin দিয়ে চিকিৎসা করা হয়েছিল। কম্পিউটেড টোমোগ্রাফি (CT) স্ক্যানে উভয় ফুসফুসে একাধিক ground-glass opacities এবং crazy paving-এর এলাকা দেখা যায়, যা ফুসফুসের প্যারেনকাইমার > ৬৫% জুড়ে বিস্তৃত, এবং pulmonary alveolar proteinosis (PAP)-এর ইঙ্গিত করে। শ্বাসযন্ত্রের ভাইরাল টেস্টিং, coronavirus (SARS-CoV2) সহ, নেগেটিভ ছিল। আউটপেশেন্ট সেটিংয়ে করা bronchoalveolar lavage-এ দুধের মতো তরল এবং periodic acid–Schiff স্টেইনিং পজিটিভ পাওয়া যায়। স্পাইরোমেট্রিতে মৃদু restrictive প্যাটার্ন (forced vital capacity [FVC] = ৭৭%) দেখা যায় এবং diffusing capacity of the lungs for carbon monoxide (DLCO) ৪৮.৬%-এ মাঝারি মাত্রায় হ্রাসপ্রাপ্ত ছিল। জেনেটিক প্যানেলে surfactant dysfunction-সম্পর্কিত কোনো মিউটেশন পাওয়া যায়নি। anti–granulocyte macrophage colony-stimulating factor (GM-CSF) অ্যান্টিবডি টেস্টিং দৃঢ়ভাবে পজিটিভ ছিল, যা autoimmune PAP-এর সন্দেহ উত্থাপন করে। ২০ মাসের ফলো-আপে রোগী উপসর্গহীন রয়েছেন এবং স্পাইরোমেট্রি স্বাভাবিক।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0074_0075.json b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0074_0075.json
new file mode 100644
index 0000000000000000000000000000000000000000..d394704bcbc5e98ade97e99f6aaa6baa60f67d61
--- /dev/null
+++ b/data/translated_data/dataset_correction_gpt5/multiclinsum_gs_train_en2zh_gemma(0_200)_0074_0075.json
@@ -0,0 +1,20 @@
+[
+  {
+    "id": "multiclinsum_gs_en_504.txt",
+    "fulltext": "14-year-old previously healthy adolescent who presented to the Primary Emergency Care Service (PEC) of Osorno with a 11-day history of a predominantly nocturnal irritative cough. Symptomatic treatment was indicated, evolving with dyspnoea and orthopnoea. He presented to the Emergency Department of the Osorno Base Hospital (OBH), with severe respiratory distress, intolerance to supine position, and abdominal pain. He was admitted to the Paediatric Intensive Care Unit (PICU), tachycardic, hypertensive, polypneic, oxygen saturation 96% with FiO2 35%, rosy, hydrated and well perfused, with flat jugular veins, small bilateral supraclavicular lymphadenopathies. The thorax was without retraction of soft tissue, maintained in a genupectoral position, with decreased pulmonary murmurs in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The soft abdomen was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and\n\nA nephrological evaluation was performed, which confirmed renal failure secondary to tumor lysis syndrome, without dialysis urgency and tendency to hypertension, with creatinine 1.54 mg/dL, phosphemia 11 mg/dL, without hypernatremia. It continued with hyperhydration, diuretic (furosemide) and antihypertensive (amlodipine). From the respiratory point of view, it presented oxygen requirement, with FIO2 35% by mask of Venturi, suspending this supply on the third day of admission. It evolved with episodes of psychomotor agitation, associated to the diagnosis in process, which was treated according to the institutional protocol of psychomotor agitation, with psychological and psychiatric support, with satisfactory evolution. On the third day of admission and treatment a CT scan of the thorax, abdomen and pelvis was performed with contrast, observing an increase in the size of the thymus, of homogeneous aspect, probably in the context of a lymphoproliferative process and findings suggestive of pulmonary thromboembolism. The angioCT of the thorax showed thrombosis of the jugular vein, extensive bilateral pleural effusion associated to atelectatic phenomena in both bases, with signs of medical bilateral nephrosis. Anticoagulation with enoxaparin (1 mg/kg dose, every 12 hours) was indicated for twenty days. Then the angioCT of control showed resolution of the thrombosis.On the fourth day of admission and treatment, a diagnostic and extension study was performed, which included, among others, a complete biochemical profile including lipid profile, granulopoietic hyperplasia of the bone marrow (myelogram), flow cytometry (bone marrow) in which no cells with a predominant clonal or neoplastic immunophenotype of haemological lineage were observed, flow cytometry in peripheral blood negative for neoplastic cells, cytological of pleural fluid negative for neoplastic cells, flow cytometry of pleural fluid without evidence of haemological neoplasia. It was presented to the paediatric oncological committee, highlighting that it was not possible to take a biopsy of the tumour given that the mediastinal mass disappeared with the cytoreductive treatment, assuming the diagnosis of lymphoblastic lymphoma by the clinical picture and the response to treatment, according to the PINDA 0516 protocol. This protocol contemplates in Induction IA eight doses of Lasp E. coli of 10,000 IU/m2. Having received seven doses of L-asp and with a cumulative dose of ninety thousand international units plus glucocorticoid (prednisone), presented a picture of decline, vomiting, abdominal pain and mild dehydration. There was suspicion of pancreatitis, which was ruled out by normal amylase/lipase values and normal hepatic tests. At that time it had plasma electrolyte profile with hyponatraemia of 126 mOsm/kg and urinary osmolality of 510 mOsm/kg, both normal values. With hyponatraemia and hypertriglyceridaemia, there was suspicion of RAM of pseudohyponatraemia secondary to hypertriglyceridaemia associated to L-asp. It was evaluated by Gastroenterology and Endocrinology, indicating a diet low in refined sugars and rich in fiber, fibrates (ciprofibrato 100 mg oral daily) and omega 3 (4 g oral daily), until triglyceride values of 300 mg/dL were achieved. Two weeks later the triglycerides had a value of 79 mg/dL. Ciprofibrato and omega3 were suspended, indicating prophylactic use associated to corticoid and L-asp treatment. A total of twelve doses of L-asp were completed with a cumulative dose of one hundred and eighty four thousand international units corresponding to the induction protocol. The suspicion of RAM was subjected to causality evaluation, with the modified Karch and Lasagna algorithm by WHO5, which resulted in “Definitive” RAM for the association of L-asp and Prednisone\n",
+    "summary": "A teenager who developed pseudohyponatraemia and hypertriglyceridaemia during treatment for non-Hodgkin lymphoma (NHL) was suspected to have a drug reaction (ADR). This suspicion of ADR was evaluated according to the modified causality algorithm (Karch and Lasagna), resulting in a \"definitive\" ADR for the association of L-asp and corticosteroids. He received treatment with a low-fat diet and lipid-modifying medicines. L-asp and prednisone were not discontinued due to the end of the indication, according to the protocol. The hypertriglyceridaemia recovered without complications after 14 days of treatment.\n",
+    "translated_fulltext": null,
+    "translated_summary": "一位青少年在接受非霍奇金淋巴瘤（NHL）治疗期间，出现了假性低钠血症和高甘油三酯血症，怀疑是药物不良反应（ADR）。根据改良的因果关系评估算法（Karch和Lasagna），对这种ADR的怀疑进行了评估，结果显示，L-天冬氨酸和皮质类固醇之间的关联被确认为“明确的”ADR。该患者接受了低脂饮食和调节血脂的药物治疗。根据治疗方案，由于治疗指征已结束，L-天冬氨酸和强的松未停止使用。经过14天的治疗后，高甘油三酯血症在没有并发症的情况下恢复正常。",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "একজন কিশোর non-Hodgkin lymphoma (NHL)-এর চিকিৎসাকালীন pseudohyponatraemia এবং hypertriglyceridaemia বিকাশ করেন, যা drug reaction (ADR) হিসেবে সন্দেহ করা হয়। এই ADR-এর সন্দেহটি modified causality algorithm (Karch and Lasagna) অনুযায়ী মূল্যায়িত হয়, যার ফলে L-asp এবং corticosteroids-এর সংযোগকে \"definitive\" ADR হিসেবে চিহ্নিত করা হয়। তিনি low-fat diet এবং lipid-modifying ওষুধে চিকিৎসা পান। প্রোটোকল অনুযায়ী, indication শেষ হয়ে যাওয়ার কারণে L-asp এবং prednisone বন্ধ করা হয়নি। ১৪ দিনের চিকিৎসার পর hypertriglyceridaemia কোনো জটিলতা ছাড়াই সেরে ওঠে।"
+  },
+  {
+    "id": "multiclinsum_gs_en_54.txt",
+    "fulltext": "A 56-year-old Italian female patient with β-thalassemia major presented to the radiology department to undergo MRI to quantify myocardial, hepatic, and pancreatic iron deposition. The clinical history of the patient included a transfusion-dependent β-thalassemia condition (genotype HBB:c.118C > T/ HBB:c.93-21G > A), diagnosed at the age of 7 years, despite the fact that the first transfusion was carried out at 2 years. As a consequence of β-thalassemia, the patient underwent splenectomy and cholecystectomy.\n\nAt the moment of MRI, she had a negative HCV-RNA (Hepatitis C virus-Ribonucleic acid) test, no osteoporosis or other endocrine, cardiac, or hepatic complications, and good iron levels. The patient’s therapy included iron chelation with deferasirox, vitamin D, and luspatercept, an erythropoiesis modulator started 2 years before the MRI examination (good response, with an increase of about 35% of transfusion interval duration). Transfusion therapy included two units of concentrated and filtered red blood cells every 25 days with pre-transfusion hemoglobin values of 10–10.5 g/dl.\n\nOn MRI, a solid mass with lobulated and regular contours was incidentally identified within the prevascular compartment of the mediastinum.\n\nThe lesion was mildly hyperintense on T2-weighted images (T2-wi) and isointense on T1-wi. The mediastinal mass in question was discernible in a prior MRI examination conducted for the same purpose in 2020 before starting luspatercept therapy, albeit with a marginal enlargement.\n\nThere were no other apparent abnormalities observed in the remaining mediastinal compartments. No pleural or pericardial effusions were present.\n\nThe neurological examination was unremarkable, and in the preceding months, the patient exhibited no symptoms of mediastinal syndrome associated with compression of the adjacent neurovascular structures. Moreover, she did not exhibit any fever or experience any weight loss.\n\nFor further evaluation, the patient underwent 18F-deoxyglucose (18FDG) positron emission tomography (PET)-computed tomography (CT) and chest CT with contrast media. On PET-CT, the mediastinal mass showed only mild FDG uptake (SUVmax = 4.3); no other sites of abnormal radiotracer uptake were reported in the neck, chest, abdomen, and skeleton. On CT images, the lesion presented regular margins, solid density, and mild contrast enhancement. The adjacent structures did not exhibit any signs of invasion, and lymphadenopathies or extra-thoracic disease were not present. Such radiological features, the indolent behaviour over time, the absence of systemic symptoms, and the lack of avid FDG uptake on PET-CT scan made the diagnosis of thymoma probable.\n\nHowever, on lung window visualization, multiple rounded areas of parenchymal lucency, consistent with thin-walled cysts distributed symmetrically throughout both lungs, with normal intervening parenchyma, were evident.\n\nNo nodules or other interstitial abnormalities were associated with the cysts. No pneumothorax was detected. Coherently with thalassemic bone disease, the ribs appeared widened, and the spine displayed mild platyspondyly. The remaining portion of the chest and visible upper abdomen were unremarkable. The radiological findings were consistent with cystic lung disease, most likely LAM.\n\nThe patient was then referred to the pulmonary clinic for further evaluation. She was a never-smoker and did not report any respiratory symptoms. In particular, she denied a history of chronic cough, recurrent respiratory infections, or pneumothorax. No cutaneous lesions, notably facial fibrofolliculomas, were evident. On chest examination, the lung fields were clear. Peripheral capillary oxygen saturation was normal (98%), with a heart rate of 75 beats per minute. Pulmonary function tests revealed a substantial reduction in diffusing capacity of the lungs for carbon monoxide (DLCO; 42% of the predicted value), partly imputable to the condition of anemia, with a carbon monoxide transfer coefficient (KCO) of 73% of the predicted value. After discussion in a multidisciplinary tumor board setting, including a pulmonologist, the patient underwent left thoracoscopic thymectomy and concomitant lingual segment wedge resection. The histopathological report revealed a morphological finding and immunohistochemical pattern referable to type B2 thymoma with focal infiltration of the capsule. Extracapsular extension was not evident. However, the lesion was present at the resection margin (stage IIa according to Masaoka–Koga; stage 1a according to the tumor, node, metastasis [TNM] classification).\n\nRegarding the lung parenchyma, histopathologic analysis described lung parenchyma with cysts of variable size lined by spindle cells in myoid habit with immunohistochemical reactivity for actin, estrogen, progesterone receptors, and HMB45 (focal positivity). Modest chronic interstitial inflammation, vascular congestion, and recent blood extravasation were evident. These morphological findings were compatible with pulmonary LAM.\n\nA final histological diagnosis of thymoma and pulmonary LAM was made. For the neoplastic condition, the patient was a candidate for adjuvant radiation therapy due to the microscopically incomplete resection (R1). For LAM with concomitant β-thalassemia, treatment with sirolimus was recommended.",
+    "summary": "A 56-year-old Italian female patient with β-thalassemia major underwent magnetic resonance imaging to quantify myocardial, hepatic, and pancreatic iron deposition. Her medical history included transfusion-dependent β-thalassemia, splenectomy, and cholecystectomy. At the time of magnetic resonance imaging, she had no significant endocrine, cardiac, or hepatic complications and was on deferasirox, vitamin D, and luspatercept. Magnetic resonance imaging revealed a lobulated mass in the prevascular mediastinum, which showed mild radiotracer uptake on positron emission tomography. Chest computed tomography revealed multiple thin-walled cysts in the lungs, indicating lymphangioleiomyomatosis. Following multidisciplinary evaluation, the patient underwent thoracoscopic thymectomy and lung wedge resection. Histopathology confirmed type B2 thymoma and pulmonary lymphangioleiomyomatosis. Post-surgery, the patient was recommended for adjuvant radiation therapy and sirolimus treatment.",
+    "translated_fulltext": null,
+    "translated_summary": "一位56岁的意大利女性患者，患有重型β-地中海贫血，接受了磁共振成像检查，以评估心肌、肝脏和胰腺中的铁沉积量。她的病史包括需要输血的β-地中海贫血、脾切除术和胆囊切除术。在进行磁共振成像时，她没有明显的内分泌、心脏或肝脏并发症，并且正在服用 deferasirox、维生素 D 和 luspatercept。磁共振成像显示，在血管前的纵隔内有一个分叶状肿块，在正电子发射断层扫描中显示出轻微的放射性示踪剂吸收。胸部计算机断层扫描显示肺部有多个薄壁囊肿，提示淋巴血管平滑肌瘤病。经过多学科评估后，该患者接受了胸腔镜胸腺切除术和肺部楔形切除术。组织病理学检查证实为B2型胸腺瘤和肺淋巴血管平滑肌瘤病。术后，建议该患者接受辅助放疗和西罗莫司治疗。",
+    "corrected_translated_fulltext": null,
+    "corrected_translated_summary": "৫৬ বছর বয়সী একজন ইতালীয় মহিলা রোগী, β-thalassemia major-এ আক্রান্ত, myocardial, hepatic এবং pancreatic iron deposition পরিমাপের জন্য magnetic resonance imaging করানো হয়েছিল। তার চিকিৎসা-ইতিহাসে transfusion-dependent β-thalassemia, splenectomy এবং cholecystectomy অন্তর্ভুক্ত ছিল। magnetic resonance imaging করার সময় তার উল্লেখযোগ্য endocrine, cardiac বা hepatic জটিলতা ছিল না এবং তিনি deferasirox, vitamin D এবং luspatercept গ্রহণ করছিলেন। magnetic resonance imaging-এ prevascular mediastinum-এ একটি lobulated mass ধরা পড়ে, যা positron emission tomography-তে মৃদু radiotracer uptake দেখায়। chest computed tomography-তে ফুসফুসে একাধিক thin-walled cysts দেখা যায়, যা lymphangioleiomyomatosis নির্দেশ করে। multidisciplinary মূল্যায়নের পর রোগীর thoracoscopic thymectomy এবং lung wedge resection করা হয়। histopathology-তে type B2 thymoma এবং pulmonary lymphangioleiomyomatosis নিশ্চিত হয়। অস্ত্রোপচারের পর রোগীকে adjuvant radiation therapy এবং sirolimus চিকিৎসার পরামর্শ দেওয়া হয়।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/old2/translation_en2be_v1.json b/data/translated_data/old2/translation_en2be_v1.json
new file mode 100644
index 0000000000000000000000000000000000000000..e7705ba422244104a9b54f05f66b1a41e73a2844
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@@ -0,0 +1,62 @@
+[
+  {
+    "english_text": "A 20-year-old woman was followed up since the age of eight for idiopathic NS inaugurated by cerebral venous thrombosis extended to the right jugular vein with a massive pulmonary embolism. The patient did not have any sequelae. She had no other medical or surgical history. A family history of thrombosis has not been reported. The patient was not biopsied because she had no kidney failure nor gross hematuria, or hypertension at first presentation; added to that, she had no extra renal signs suggestive of a secondary nephrotic syndrome. She was accordingly put on anticoagulant therapy (Oral vitamin K antagonist) and oral corticosteroid therapy with good evolution. Thereafter, the patient received several cures of high-dose corticosteroids for steroid-dependent relapses of NS. She was, hence, put on mycophenolate mofetil (MMF) as a background therapy to avoid corticosteroids and ensure normal growth. An exhaustive assessment of thrombophilia was performed and did not show any abnormality. Homocysteine rate, blood fibrinogen rate, Protein C, protein S, antithrombin III, factor V Leiden mutation, JAK-2 mutation, cryoglobulins, anticardiolipin antibodies, lupus anticoagulant and beta-1-glycoprotein antibodies were normal. The anticoagulant treatment was stopped after nine years. The evolution was enameled by the occurrence of several relapses of her disease controlled by oral corticosteroid therapy. Remission of NS has been noted since 2017, so MMF was gradually stopped in 2019 and the patient remained asymptomatic and without any relapse.\n\nOne year later, the patient came up to our emergency department for acute intense diffuse abdominal pain without any particular irradiation associated with postprandial vomiting and bilateral lower limb edema for the last six hours. The physical examination revealed an intense epigastric tenderness with normal vital signs (arterial pressure of 120/70 mm Hg, heart rate of 83 bpm, and oxygen saturation at 100% on room air). The patient was afebrile with normal consciousness. The rest of the physical examination was unremarkable. The urinalysis with labstix revealed proteinuria. The hemogasanalysis results showed metabolic acidosis with respiratory compensation. Further laboratory tests revealed hypoalbuminemia, hypercholesterolemia, a prothrombin time at 90%, high levels of D-dimer, lactate dehydrogenase, and creatine phosphokinase as well as a biological inflammatory syndrome with a CRP of 37 mg/L, and leucocytosis at 26.4 x 103/µL. Renal and liver functions were normal.\n\nThe patient was hospitalized in an intensive care unit with close monitoring of vital signs and initiation of resuscitation measures. An abdominal ultrasound was performed urgently showing an intra-abdominal effusion of low to moderate abundance. An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery with acute mesenteric ischemia. The patient was immediately routed to the operating room. Intraoperative exploration confirmed mesenteric ischemia with extensive necrosis of almost entirely of the small bowel making their resections incompatible with life shown in Figure 3. The patient died after 48 hours.",
+    "translated_text": "২০ বছর বয়সী এক নারীকে ৮ বছর বয়স থেকে অনুসরণ করা হচ্ছিল ইডিওপ্যাথিক NS-এর জন্য, যা সেরিব্রাল ভেনাস থ্রোম্বোসিস দ্বারা সূচিত হয়েছিল; এটি ডান জুগুলার শিরা পর্যন্ত প্রসারিত হয়েছিল এবং এর সাথে ছিল একটি ব্যাপক পালমোনারি এম্বোলিজম। রোগীর কোনো সিকুয়েলা ছিল না। তার অন্য কোনো চিকিৎসাগত বা শল্য চিকিৎসার ইতিহাস ছিল না। থ্রম্বোসিসের পারিবারিক ইতিহাস রিপোর্ট করা হয়নি। প্রথম উপস্থাপনার সময় কিডনি ব্যর্থতা, গ্রস হিম্যাচুরিয়া বা হাইপারটেনশন না থাকায় রোগীর বায়োপসি করা হয়নি; তদুপরি, সেকেন্ডারি নেফ্রোটিক সিন্ড্রোমের প্রতি ইঙ্গিতকারী কোনো এক্সট্রারেনাল লক্ষণও ছিল না। অতএব তাকে অ্যান্টিকোয়াগুল্যান্ট থেরাপি (ওরাল ভিটামিন K অ্যান্টাগনিস্ট) এবং ওরাল কর্টিকোস্টেরয়েড থেরাপি দেওয়া হয়, যার অগ্রগতি ভালো ছিল। পরবর্তীতে, NS-এর স্টেরয়েড-নির্ভর রিল্যাপসের জন্য রোগী একাধিক উচ্চ-ডোজ কর্টিকোস্টেরয়েডের কোর্স পেয়েছিলেন। সুতরাং কর্টিকোস্টেরয়েড এড়াতে এবং স্বাভাবিক বৃদ্ধি নিশ্চিত করতে ব্যাকগ্রাউন্ড থেরাপি হিসেবে মাইকোফেনোলেট মোফেটিল (MMF) দেওয়া হয়। থ্রম্বোফিলিয়ার একটি বিস্তৃত মূল্যায়ন করা হয় এবং কোনো অস্বাভাবিকতা পাওয়া যায়নি। হোমোসিস্টেইন মাত্রা, রক্তের ফাইব্রিনোজেন মাত্রা, প্রোটিন C, প্রোটিন S, অ্যান্টিথ্রোমবিন III, ফ্যাক্টর V লেইডেন মিউটেশন, JAK-2 মিউটেশন, ক্রাইওগ্লোবুলিন, অ্যান্টিকার্ডিওলিপিন অ্যান্টিবডি, লুপাস অ্যান্টিকোয়াগুল্যান্ট এবং বিটা-১-গ্লাইকোপ্রোটিন অ্যান্টিবডি স্বাভাবিক ছিল। নয় বছর পরে অ্যান্টিকোয়াগুল্যান্ট চিকিৎসা বন্ধ করা হয়। পরবর্তী অগ্রগতি তার রোগের একাধিক রিল্যাপসের দ্বারা চিহ্নিত ছিল, যা ওরাল কর্টিকোস্টেরয়েড থেরাপি দ্বারা নিয়ন্ত্রিত হয়েছিল। ২০১৭ সাল থেকে NS-এর রেমিশন নথিভুক্ত হয়েছে, তাই ২০১৯ সালে ধীরে ধীরে MMF বন্ধ করা হয় এবং রোগী উপসর্গবিহীন ছিলেন এবং কোনো রিল্যাপস হয়নি।\n\nএক বছর পরে, গত ছয় ঘণ্টা ধরে থাকা কোনো নির্দিষ্ট দিকে প্রসারণবিহীন অ্যাকিউট তীব্র বিস্তৃত পেটব্যথা, পোস্টপ্র্যান্ডিয়াল বমি এবং দ্বিপাক্ষিক নিম্ন অঙ্গের ইডিমার জন্য রোগী আমাদের জরুরি বিভাগে আসেন। শারীরিক পরীক্ষায় তীব্র এপিগ্যাস্ট্রিক টেন্ডারনেস পাওয়া যায় এবং ভাইটাল সাইন ছিল স্বাভাবিক (রক্তচাপ 120/70 mm Hg, হৃদস্পন্দন 83 bpm, এবং রুম এয়ারে অক্সিজেন স্যাচুরেশন 100%)। রোগী জ্বরহীন ছিলেন এবং চেতনা স্বাভাবিক ছিল। বাকি শারীরিক পরীক্ষায় উল্লেখযোগ্য কিছু পাওয়া যায়নি। ল্যাবস্টিক্সসহ ইউরিনালাইসিসে প্রোটিনিউরিয়া ধরা পড়ে। হেমোগ্যাসঅ্যানালাইসিসের ফলাফল রেসপিরেটরি কম্পেনসেশনসহ মেটাবলিক অ্যাসিডোসিস দেখায়। পরবর্তী ল্যাবরেটরি পরীক্ষায় হাইপোঅ্যালবুমিনেমিয়া, হাইপারকোলেস্টেরোলেমিয়া, প্রোথ্রম্বিন টাইম 90%, D-dimer, ল্যাকটেট ডিহাইড্রোজেনেজ এবং ক্রিয়াটিন ফসফোকাইনেজের উচ্চ মাত্রা, পাশাপাশি CRP 37 mg/L-সহ জৈবিক প্রদাহজনিত সিন্ড্রোম এবং 26.4 x 103/µL লিউকোসাইটোসিস পাওয়া যায়। কিডনি ও যকৃতের কার্যাবলি স্বাভাবিক ছিল।\n\nরোগীকে আইসিইউতে ভর্তি করা হয় ঘনিষ্ঠ ভাইটাল মনিটরিং এবং রিসাসিটেশন ব্যবস্থার সূচনাসহ। জরুরিভাবে অ্যাবডোমিনাল আল্ট্রাসাউন্ড করা হয় যা স্বল্প থেকে মধ্যম পরিমাণের ইনট্রা-অ্যাবডোমিনাল ইফিউশন দেখায়। অ্যাবডোমিনাল সিটি স্ক্যানে সুপিরিয়র মেসেন্টেরিক আর্টারির অ্যাকিউট থ্রোম্বোসিসসহ অ্যাকিউট মেসেন্টেরিক ইস্কিমিয়া ধরা পড়ে। রোগীকে অবিলম্বে অপারেশন থিয়েটারে নেওয়া হয়। ইন্ট্রঅপারেটিভ অনুসন্ধানে মেসেন্টেরিক ইস্কিমিয়া নিশ্চিত হয় এবং ক্ষুদ্রান্ত্রের প্রায় সম্পূর্ণ অংশে বিস্তৃত নেক্রোসিস দেখা যায়, যার রিসেকশন জীবন-অসঙ্গত ছিল, যা Figure 3-এ দেখানো হয়েছে। রোগী ৪৮ ঘণ্টা পরে মারা যান।"
+  },
+  {
+    "english_text": "We present the case of a 34-year-old woman, eight weeks pregnant with no other personal history of interest, who presents to the emergency department with generalized convulsions with dysarthria in the postcritical period, which resolve progressively in less than two hours. On physical examination, she is conscious, oriented, with no language or motor or sensory deficits. Only signs of a right lateral tongue bite are observed.\n\nThe complementary tests, such as blood tests or the electrocardiogram, are normal. Given that the episode corresponds with a first epileptic seizure and the patient is pregnant, an urgent magnetic resonance of the skull is requested.\n\nThe usual protocol was performed and 3D T1 sequences without and with intravenous contrast were obtained in axial, coronal and sagital planes, axial FLAIR, axial T2, VEN BOLD and magnetic susceptibility sequences, as well as axial diffusion and apparent diffusion coefficient map. The MRI identified multiple venous cortico-medullary vascular structures converging centripetally to a large central venous structure draining through the inferior anastomotic vein into the left transverse sinus, forming the classic ‘Medusa head’ sign. In the T1 sequences, the drainage vein was seen to be increased in signal with central hyphocaptation after contrast administration, suggesting partial thrombosis versus slow flow. In addition, in T2 and FLAIR sequences, the brain tissue surrounding the drainage vein was seen to be hyperintense, without diffusion restriction and compatible with edema.\n\nThese findings are suggestive of a venous anomaly of development with signs of partial peripheral thrombosis and slow flow more proximal, which cause edema of the surrounding tissue. She is started on clexane 60 mg/12 hours and levetiracetam 500 mg/12 hours and the patient shows improvement and symptomatic stability after one week.\n",
+    "translated_text": "আমরা ৩৪ বছর বয়সী এক মহিলার একটি কেস উপস্থাপন করছি, যিনি আট সপ্তাহের গর্ভবতী এবং অন্য কোনো প্রাসঙ্গিক ব্যক্তিগত ইতিহাস নেই; তিনি জরুরি বিভাগে উপস্থিত হন সার্বিক খিঁচুনি নিয়ে, পোস্টইক্টাল পর্যায়ে ডিসআর্থ্রিয়াসহ, যা দুই ঘণ্টার কম সময়ে ক্রমান্বয়ে সেরে যায়। শারীরিক পরীক্ষায় তিনি সচেতন, ওরিয়েন্টেড, ভাষাগত বা মোটর বা সেন্সরি কোনো ঘাটতি নেই। কেবল ডান পার্শ্বীয় জিহ্বা কামড়ানোর লক্ষণ দেখা যায়।\n\nঅতিরিক্ত পরীক্ষা, যেমন রক্ত পরীক্ষা বা ইলেক্ট্রোকার্ডিওগ্রাম, স্বাভাবিক। ঘটনাটি প্রথম এপিলেপটিক সিজারের সাথে সামঞ্জস্যপূর্ণ এবং রোগী গর্ভবতী হওয়ায়, জরুরি করোটির ম্যাগনেটিক রেজোন্যান্স ইমেজিং (MRI) অনুরোধ করা হয়।\n\nস্বাভাবিক প্রোটোকল অনুসারে পরীক্ষা করা হয় এবং 3D T1 সিকোয়েন্স ইন্ট্রাভেনাস কনট্রাস্ট ছাড়া এবং সহ অ্যাক্সিয়াল, কোরোনাল ও স্যাজিটাল প্লেনে গ্রহণ করা হয়, অ্যাক্সিয়াল FLAIR, অ্যাক্সিয়াল T2, VEN BOLD এবং ম্যাগনেটিক সাসসেপটিবিলিটি সিকোয়েন্স, এছাড়া অ্যাক্সিয়াল ডিফিউশন ও অ্যাপ্যারেন্ট ডিফিউশন কো-ইফিসিয়েন্ট ম্যাপ। MRI-তে বহু ভেনাস কর্টিকো-মেডুলারি ভাসকুলার স্ট্রাকচার কেন্দ্রাভিমুখভাবে একটি বৃহৎ কেন্দ্রীয় ভেনাস স্ট্রাকচারের দিকে অভিসারিত হয়ে দেখা যায়, যা ইনফেরিয়র অ্যানাস্টোমোটিক ভেইনের মাধ্যমে বাম ট্রান্সভার্স সাইনাসে ড্রেইন করে, ক্লাসিক ‘Medusa head’ সাইন গঠন করে। T1 সিকোয়েন্সে ড্রেনেজ ভেইনে সিগন্যাল বৃদ্ধি দেখা যায় এবং কনট্রাস্ট প্রয়োগের পর কেন্দ্রীয় হাইফোক্যাপটেশন লক্ষ্য করা যায়, যা আংশিক থ্রম্বোসিস বনাম স্লো ফ্লো-এর ইঙ্গিত দেয়। অতিরিক্তভাবে, T2 ও FLAIR সিকোয়েন্সে ড্রেনেজ ভেইন-সংলগ্ন মস্তিষ্কের টিস্যু হাইপারইনটেন্স, ডিফিউশন রেস্ট্রিকশন নেই এবং ইডিমার সাথে সামঞ্জস্যপূর্ণ।\n\nএই ফলাফলগুলি বিকাশজনিত ভেনাস অ্যানোমালির প্রতি ইঙ্গিতবাহী, যেখানে আংশিক পেরিফেরাল থ্রম্বোসিসের লক্ষণ এবং আরো প্রোক্সিমাল স্লো ফ্লো রয়েছে, যা পারিপার্শ্বিক টিস্যুতে ইডিমা সৃষ্টি করে। তাকে Clexane 60 mg/12 hours এবং levetiracetam 500 mg/12 hours শুরু করা হয় এবং এক সপ্তাহ পর রোগীর উপসর্গের উন্নতি ও স্থিতিশীলতা দেখা যায়।"
+  },
+  {
+    "english_text": "A 22-year-old woman came to the Department of Oral Medicine with complaints of mouth ulcers causing pain and eating and drinking difficulty persisting for a duration of one month. This condition begins with a fever and appears like pimples on the lips. Based on the anamnesis, it was discovered that she had been using pod-type vapes for about a year but had never experienced complaints like when she came for treatment. She had never smoked traditional cigarettes before starting to vape. She said the reason for trying vaping was out of curiosity, and she quite often tried different types of e-liquid with different flavors. Before her complaint, she had simply changed the type of e-liquid to a different flavor without mentioning the brand. She vapes almost every day, but not all day, only in her free time or with friends. She was a healthy individual, and before this condition appeared, she had no history of taking medications, including antibiotics, analgesics, anticonvulsants, non-steroidal anti-inflammatory drugs, and antifungals. She also had no history of drug or food allergies, but the patient has unhealthy eating habits (eating irregularly and not consuming vegetables and fruit). Extraoral examination showed no lesions on other parts of the body, while the lips of the patient had serosanguineous crusts and an erosive area at the corner of the mouth, and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges, irregular, varying sizes, and pain on the labial, buccal, lateral, and ventral mucosa of the tongue and floor of the mouth.\n\nBased on the medical history of the patient and physical examination, which revealed oral mucosal involvement but no symptoms elsewhere in the body, as well as the non-reactive anti-HSV1 IgG results, the diagnosis of vaping-related oral erythema multiforme was established. The medical condition has been classified as minor erythema multiforme. The oral conditions were treated with 0.9% NaCl, which was moistened in gauze and placed on the lips three times a day. The patient was instructed to gargle 1 mg of dexamethasone in 10 mL of hyaluronic acid three times a day and avoid eating or drinking for at least 30 minutes after gargling. She was also given 2% miconazole cream applied to the wound in the right corner of the mouth twice a day, as well as vaseline album cream for dry lips. To maintain good oral hygiene, she was advised to brush her teeth and tongue twice a day, after breakfast and before bed. She was also instructed to stop vaping and avoid foods containing monosodium glutamate (MSG). The control was carried out after a week following therapy and showed that oral condition had improved. Written informed consent for the publication of details was obtained from the patient. This case report conformed with the Helsinki Declaration. The publication of this case report has also been approved by the institution.",
+    "translated_text": "একজন 22 বছর বয়সী নারী মুখগহ্বর চিকিৎসাবিদ্যা বিভাগে এক মাস ধরে স্থায়ী মুখের আলসারের কারণে ব্যথা এবং খাওয়া-দাওয়ার অসুবিধার অভিযোগ নিয়ে আসেন। এই অবস্থা জ্বর দিয়ে শুরু হয় এবং ঠোঁটে ফুসকুড়ির (পিম্পলের) মতো দেখা দেয়। অ্যানামনেসিসের ভিত্তিতে জানা যায় যে তিনি প্রায় এক বছর ধরে পড-টাইপ ভেপ ব্যবহার করছেন, তবে চিকিৎসার জন্য আসার সময়ের মতো অভিযোগ আগে কখনও হয়নি। ভেপিং শুরু করার আগে তিনি কখনও প্রচলিত সিগারেট ধূমপান করেননি। তিনি জানান যে কৌতূহলবশত ভেপিং চেষ্টা করেছিলেন এবং বেশ প্রায়ই বিভিন্ন স্বাদের বিভিন্ন ধরনের ই-লিকুইড চেষ্টা করেছেন। নিজের অভিযোগের আগে তিনি ব্র্যান্ড উল্লেখ না করে কেবল ভিন্ন স্বাদের অন্য ধরনের ই-লিকুইডে পরিবর্তন করেছিলেন। তিনি প্রায় প্রতিদিন ভেপ করেন, তবে সারাদিন নয়, শুধু অবসর সময়ে বা বন্ধুদের সাথে। তিনি একজন সুস্থ ব্যক্তি ছিলেন, এবং এই অবস্থা দেখা দেওয়ার আগে তার ওষুধ সেবনের কোনো ইতিহাস ছিল না, যার মধ্যে অ্যান্টিবায়োটিক, ব্যথানাশক, অ্যান্টিকনভালসান্ট, নন-স্টেরয়ডাল অ্যান্টি-ইনফ্ল্যামেটরি ড্রাগস এবং অ্যান্টিফাঙ্গাল অন্তর্ভুক্ত। তার কোনো ওষুধ বা খাদ্য অ্যালার্জির ইতিহাসও ছিল না, তবে রোগীর খাদ্যাভ্যাস অস্বাস্থ্যকর (অনিয়মিতভাবে খাওয়া এবং শাকসবজি ও ফল না খাওয়া)। এক্সট্রাওরাল পরীক্ষায় শরীরের অন্যান্য অংশে কোনো ক্ষত দেখা যায়নি, আর রোগীর ঠোঁটে সিরোস্যাংগুইনাস ক্রাস্ট এবং মুখের কোণে একটি ক্ষয়জনিত এলাকা ছিল, যা রক্তক্ষরণের প্রবণতা প্রদর্শন করছিল। ইনট্রাওরাল পরীক্ষায় ল্যাবিয়াল, বুকাল, জিহ্বার পার্শ্বীয় ও ভেন্ট্রাল মিউকোসা এবং মুখের তলার মিউকোসায় হলদেটে প্রান্তবিশিষ্ট সাদা আলসার দেখা যায়, যা অনিয়মিত, বিভিন্ন আকারের এবং বেদনাদায়ক।\n\nরোগীর মেডিক্যাল ইতিহাস ও শারীরিক পরীক্ষার ভিত্তিতে, যেখানে মুখগহ্বরের মিউকোসা জড়িত ছিল কিন্তু শরীরের অন্য কোথাও কোনো লক্ষণ ছিল না, এবং নন-রিঅ্যাকটিভ anti-HSV1 IgG ফলাফলের সাথে মিলিয়ে, ভেপিং-সম্পর্কিত ওরাল ইরাইথেমা মাল্টিফর্মে নির্ণয় প্রতিষ্ঠা করা হয়। এই চিকিৎসাবস্থাকে মাইনর ইরাইথেমা মাল্টিফর্মে হিসেবে শ্রেণিবদ্ধ করা হয়েছে। মুখগহ্বরের অবস্থা 0.9% NaCl দিয়ে চিকিৎসা করা হয়, যা গজে ভিজিয়ে দিনে তিনবার ঠোঁটে স্থাপন করা হয়। রোগীকে দিনে তিনবার 10 mL হায়ালুরোনিক অ্যাসিডে 1 mg ডেক্সামেথাসন মিশিয়ে গার্গল করতে এবং গার্গল করার পর অন্তত 30 মিনিট পর্যন্ত কোনো খাবার বা পানীয় গ্রহণ না করতে নির্দেশ দেওয়া হয়। তাকে মুখের ডান কোণের ক্ষতস্থানে দিনে দুইবার 2% মাইকোনাজল ক্রিম এবং শুকনো ঠোঁটের জন্য ভ্যাসেলিন অ্যালবাম ক্রিম দেওয়া হয়। ভালো ওরাল হাইজিন বজায় রাখতে, তাকে দিনে দুইবার, নাশতার পর এবং শোবার আগে, দাঁত ও জিহ্বা ব্রাশ করতে পরামর্শ দেওয়া হয়। তাকে ভেপিং বন্ধ করতে এবং মনোসোডিয়াম গ্লুটামেট (এমএসজি) সম্বলিত খাবার এড়াতে নির্দেশ দেওয়া হয়। থেরাপি অনুসরণের এক সপ্তাহ পর ফলো-আপ করা হয় এবং দেখা যায় যে মুখগহ্বরের অবস্থা উন্নত হয়েছে। বিস্তারিত প্রকাশের জন্য রোগীর কাছ থেকে লিখিত অবগত সম্মতি নেওয়া হয়েছিল। এই কেস রিপোর্ট হেলসিঙ্কি ঘোষণাপত্রের সঙ্গে সামঞ্জস্যপূর্ণ। এই কেস রিপোর্টের প্রকাশনাও প্রতিষ্ঠানের অনুমোদন পেয়েছে।"
+  },
+  {
+    "english_text": "A 29-year-old gravida V par IV (all alive, 3 spontaneous vaginal deliveries, and the last child was delivered by cesarean section for the indication of a failed induction 4 years prior to the current pregnancy) came for ANC follow-up at a gestational age of 32 weeks from her LNMP.\n\nAfter taking a medical history, it was discovered that all four of her children are healthy, doing well in school, and have no known history of genetic or seizure disorders. She was investigated with the Venereal Disease Research Laboratory (VDRL), Hepatitis B surface antigen (HBSag), and urine analysis, all of which were negative. All cell lines in the CBC were normal, her blood group is A, and Rh is positive, according to the Complete Blood Count (CBC), blood group, and RH. Obstetric ultrasound was also performed showing normal anatomical scan of the all body parts of the fetus except the heart. Detailed fetal echocardiography evaluation was done with findings of: both atria have comparable size and normal situs. Both atrioventricular and semilunar valves are normally positioned with normal opening and closure. Both ventricles are comparable in size and contractility; in both 2D and color flow, the left ventricle forms the apex of the heart without any ventricular septal defect. But on the papillary muscles of the left ventricle there were two circumscribed, round, echogenic mass measuring 18.2 mm by 8.3mm and 13.5mm by 8.3 mm. Upon evaluation of the outflow tract, both the LVOT (left ventricular outflow tract) and RVOT (right ventricular outflow tract) have normal anatomy and function using 2D and CF ultrasound evaluation. According to the fetal echo finding, a diagnosis of cardiac rhabdomyoma was made. Since there is a high chance of tuberous sclerosis in cardiac rhabdomyoma, detailed neurosonography and other system exams were done to look for other signs of tuberous sclerosis. Despite searching for the other features of tuberous sclerosis, no other sign of it was found other than the tumor. She had regular ANC follow-up from 32 weeks of gestation up to 39 weeks without any complications.\n\nAt gestational age of 39 weeks plus 1 day, she underwent a cesarean section for the indication of full-term pregnancy plus a request for a repeat cesarean section, with the outcome of a 3200-gram female with an APGAR score of 10 and 10 at the 1st and 5th minutes. Both the mother and the neonate had a smooth post-operative period and were discharged on the third day.\n\nAfter delivery, the neonate was evaluated on the 1st, 7th, and 30th days for any regression or increment of the mass, emergence of skin lesions, or seizure. All physical examination results were normal, and the mass size was similar to the antepartal evaluation.\n\nAt her 7th month, the child was evaluated again, and upon history inquiries, the infant was doing great developmentally for her age group. The infant was examined for neurodevelopmental delay, and the child was growing appropriately for her age. An echocardiography study by a pediatric cardiologist revealed well-circumscribed hyperechoic masses on both left ventricular papillary muscles, each measuring 21.8 mm by 9.2 mm and 14.7 mm by 8.5 mm and creating no left ventricular inflow obstruction.\n\nA history from the family was obtained, and a physical examination with anthropometric measurements was performed to assess her developmental condition during her first-year evaluation. The child was developing normally, as other children her age were. Except for the heart, all of the systems examined were unremarkable. An echocardiography study has revealed well-circumscribed hyperechoic masses on both left ventricular papillary muscles with no size increment and creating no left ventricular inflow obstruction.",
+    "translated_text": "২৯ বছর বয়সী গ্রাভিডা V পার IV (সকল জীবিত, ৩টি স্বতঃস্ফূর্ত যোনিপথে প্রসব, এবং শেষ সন্তান বর্তমান গর্ভাবস্থার ৪ বছর আগে ইনডাকশন ব্যর্থতার ইঙ্গিতে সিজারিয়ান সেকশনের মাধ্যমে প্রসব) তার LNMP থেকে গণনা করে গর্ভকাল ৩২ সপ্তাহে ANC ফলো-আপের জন্য আসেন।\n\nচিকিৎসাবিষয়ক ইতিহাস নেওয়ার পর জানা যায় যে তার চারটি সন্তানই সুস্থ, স্কুলে ভালো করছে এবং জেনেটিক বা খিঁচুনি-সম্পর্কিত রোগের কোনো পরিচিত ইতিহাস নেই। তার VDRL, হেপাটাইটিস বি সারফেস অ্যান্টিজেন (HBSag), এবং ইউরিন অ্যানালাইসিস করা হয়, যেগুলো সবই নেগেটিভ ছিল। Complete Blood Count (CBC), ব্লাড গ্রুপ এবং Rh অনুযায়ী CBC-র সব সেল লাইন স্বাভাবিক ছিল, তার রক্তের গ্রুপ A, এবং Rh পজিটিভ। অবস্টেট্রিক আল্ট্রাসাউন্ডও করা হয়, যাতে হৃদয় ব্যতীত ভ্রূণের সকল অঙ্গের অ্যানাটমিক্যাল স্ক্যান স্বাভাবিক দেখা যায়। বিস্তারিত ফিটাল ইকোকার্ডিওগ্রাফি মূল্যায়নে পাওয়া যায়: উভয় এট্রিয়ার আকার তুলনীয় এবং সিটাস স্বাভাবিক। উভয় অ্যাট্রিওভেন্ট্রিকুলার এবং সেমিলুনার ভাল্‌ভ স্বাভাবিক অবস্থানে রয়েছে এবং খোলা-বন্ধ স্বাভাবিক। উভয় ভেন্ট্রিকলের আকার ও সংকোচনক্ষমতা তুলনীয়; 2D এবং কালার ফ্লো উভয়েই বাম ভেন্ট্রিকল হৃদয়ের এপেক্স গঠন করছে এবং কোনো ভেন্ট্রিকুলার সেপটাল ডিফেক্ট নেই। কিন্তু বাম ভেন্ট্রিকলের প্যাপিলারি মাংসপেশির উপর সুস্পষ্ট সীমানাযুক্ত, গোলাকার, ইকোজেনিক দুটি ম্যাস ছিল, যেগুলোর মাপ 18.2 mm by 8.3 mm এবং 13.5 mm by 8.3 mm। আউটফ্লো ট্র্যাক্ট মূল্যায়নে 2D এবং CF আল্ট্রাসাউন্ড ব্যবহার করে LVOT (left ventricular outflow tract) এবং RVOT (right ventricular outflow tract) উভয়েরই অ্যানাটমি ও ফাংশন স্বাভাবিক পাওয়া যায়। ফিটাল ইকোর ফলাফলের ভিত্তিতে কার্ডিয়াক র‌্যাবডোমায়োমা নির্ণয় করা হয়। কার্ডিয়াক র‌্যাবডোমায়োমায় টিউবারাস স্ক্লেরোসিসের সম্ভাবনা বেশি থাকায় টিউবারাস স্ক্লেরোসিসের অন্যান্য লক্ষণ খুঁজতে ডিটেইলড নিউরোসোনোগ্রাফি এবং অন্যান্য সিস্টেম পরীক্ষা করা হয়। টিউবারাস স্ক্লেরোসিসের অন্যান্য বৈশিষ্ট্য খুঁজেও টিউমার ছাড়া অন্য কোনো লক্ষণ পাওয়া যায়নি। তিনি গর্ভকাল ৩২ সপ্তাহ থেকে ৩৯ সপ্তাহ পর্যন্ত নিয়মিত ANC ফলো-আপ করেছেন, কোনো জটিলতা ছাড়াই।\n\nগর্ভকাল ৩৯ সপ্তাহ ১ দিনে, পূর্ণ-মেয়াদী গর্ভাবস্থা এবং রিপিট সিজারিয়ান সেকশনের অনুরোধের ইঙ্গিতে তার সিজারিয়ান সেকশন করা হয়, যার ফলাফলে 3200-gram ওজনের কন্যাশিশু জন্মগ্রহণ করে এবং ১ম ও ৫ম মিনিটে APGAR স্কোর যথাক্রমে 10 এবং 10 ছিল। মা ও নবজাতক উভয়েরই পোস্ট-অপারেটিভ সময়কাল নির্বিঘ্ন কেটেছে এবং তৃতীয় দিনে ছাড়পত্র দেওয়া হয়।\n\nপ্রসবের পর, নবজাতককে ১ম, ৭ম ও ৩০তম দিনে ম্যাসের রিগ্রেশন বা বৃদ্ধি, ত্বকের লেশনের উদ্ভব, বা খিঁচুনি আছে কিনা তা মূল্যায়ন করা হয়। সকল শারীরিক পরীক্ষা স্বাভাবিক ছিল, এবং ম্যাসের আকার অ্যান্টেপার্টাল মূল্যায়নের অনুরূপ ছিল।\n\nতার ৭ম মাসে শিশুটির পুনরায় মূল্যায়ন করা হয়, এবং ইতিহাস নেওয়ার পর জানা যায় যে শিশুটি তার বয়সগোষ্ঠীর জন্য বিকাশগতভাবে খুব ভালো করছে। শিশুটিকে নিউরোডেভেলপমেন্টাল বিলম্বের জন্য পরীক্ষা করা হয়, এবং সে তার বয়স অনুপাতে যথাযথভাবে বেড়ে উঠছে। একজন শিশু কার্ডিওলজিস্ট কর্তৃক ইকোকার্ডিওগ্রাফি স্টাডিতে বাম ভেন্ট্রিকলের উভয় প্যাপিলারি মাংসপেশিতে সুস্পষ্ট সীমানাযুক্ত হাইপারইকোইক ম্যাস দেখা যায়, যেগুলোর মাপ যথাক্রমে 21.8 mm by 9.2 mm এবং 14.7 mm by 8.5 mm এবং যা বাম ভেন্ট্রিকুলার ইনফ্লোতে কোনো অবস্ট্রাকশন সৃষ্টি করছে না।\n\nপরিবারের কাছ থেকে ইতিহাস নেওয়া হয়, এবং প্রথম বছরের মূল্যায়নের সময় তার বিকাশগত অবস্থা মূল্যায়নের জন্য অ্যানথ্রোপোমেট্রিক পরিমাপসহ শারীরিক পরীক্ষা করা হয়। শিশুটি তার সমবয়সী অন্যান্য শিশুদের মতো স্বাভাবিকভাবে বিকশিত হচ্ছিল। হৃদযন্ত্র ব্যতীত পরীক্ষাকৃত অন্যান্য সকল সিস্টেমে কোনো উল্লেখযোগ্য অস্বাভাবিকতা ছিল না। ইকোকার্ডিওগ্রাফি স্টাডিতে বাম ভেন্ট্রিকলের উভয় প্যাপিলারি মাংসপেশিতে সুস্পষ্ট সীমানাযুক্ত হাইপারইকোইক ম্যাস দেখা গেছে, যার আকার বৃদ্ধি পায়নি এবং যা বাম ভেন্ট্রিকুলার ইনফ্লোতে কোনো অবস্ট্রাকশন সৃষ্টি করছে না।"
+  },
+  {
+    "english_text": "13-year-old boy from Cusco with a history of laryngeal papillomatosis since the age of two (at the age of three he required a tracheostomy) and a mother with a history of genital papilloma. The patient was admitted to the San Borja National Institute of Child Health in Lima, after a 16-day illness characterised by respiratory difficulties predominantly at night, inspiratory laryngeal stridor and moderate dysphonia; he previously received azithromycin and oxygen support, without improvement.\n\nThe physical examination revealed mild subcostal retraction, decreased vesicular murmurs in the left hemithorax and scanty wheezy breath sounds with predominance in the right hemithorax, which required oxygen support with a binasal cannula at 4 liters. The rest of the evaluation had no relevant findings. At the laboratory level, leukocytes were found at 8.03 × 103/u, platelets 209 × 103/u, hemoglobin 13.2 g/dL, C-reactive protein at 36.6 mg/L. As part of the imaging studies, a chest radiograph and a head and neck tomography were performed.\n\n48 hours after admission, she presented with increased stridor and respiratory difficulty, so admission to the emergency operating room for tracheostomy, microsurgery and excision of papillomatosis lesions was decided. An appendicular tumour of papillomatose appearance with ventricular bands in the epiglottis, glottic face, vocal cords, subglottis and trachea up to ring 5 was evident. The anatomopathological report reported coilocitic atypia due to HPV and mild focal dysplasia.\n\nIn the immediate postoperative period, he was transferred to the paediatric intensive care unit for respiratory monitoring, with weaning from oxygen at 48 hours. He received a single dose of bevacizumab 400 mg intravenous and subsequently improved clinically. The patient remained hospitalised for seven days, achieving clinical stability through normalisation of oxygen saturation levels and progressive weaning from oxygen, and was subsequently referred to the hospital in Breña to continue his management. Telemonitoring was carried out after eight months and the family indicated that there was no evidence of relapse or other intercurrences.\n",
+    "translated_text": "কুসকোর ১৩ বছর বয়সী ছেলে, যার দুই বছর বয়স থেকে ল্যারিঞ্জিয়াল প্যাপিলোমাটোসিসের ইতিহাস রয়েছে (তিন বছর বয়সে ট্র্যাকিওস্টোমি প্রয়োজন হয়েছিল) এবং যার মায়ের জেনিটাল প্যাপিলোমার ইতিহাস আছে। রোগীকে লিমার San Borja National Institute of Child Health-এ ভর্তি করা হয়, ১৬ দিনের অসুস্থতার পর, যা প্রধানত রাতে শ্বাসকষ্ট, ইনস্পিরেটরি ল্যারিঞ্জিয়াল স্ট্রাইডর এবং মাঝারি ডাইসফোনিয়া দ্বারা চিহ্নিত; পূর্বে আজিথ্রোমাইসিন এবং অক্সিজেন সাপোর্ট পেয়েছিল, উন্নতি হয়নি।\n\nশারীরিক পরীক্ষায় হালকা সাবকোস্টাল রিট্র্যাকশন, বাম হেমিথোরাক্সে ভেসিকুলার শ্বাসধ্বনি হ্রাস এবং স্বল্পমাত্রার হুইজি শ্বাসধ্বনি (ডান হেমিথোরাক্সে প্রাধান্যসহ) দেখা যায়, যার জন্য দ্বিনাসাল ক্যানুলায় ৪ লিটার প্রবাহে অক্সিজেন সাপোর্ট প্রয়োজন হয়। বাকি মূল্যায়নে উল্লেখযোগ্য কোনো ফল পাওয়া যায়নি। পরীক্ষাগার পর্যায়ে, লিউকোসাইট 8.03 × 103/u, প্লেটলেট 209 × 103/u, হিমোগ্লোবিন 13.2 g/dL, সি-রিঅ্যাকটিভ প্রোটিন 36.6 mg/L পাওয়া যায়। ইমেজিং স্টাডির অংশ হিসেবে বুকের রেডিওগ্রাফি এবং মাথা ও ঘাড়ের টোমোগ্রাফি করা হয়।\n\nভর্তির ৪৮ ঘন্টা পরে, তিনি স্ট্রাইডর এবং শ্বাসকষ্ট বৃদ্ধিসহ উপস্থিত হন, তাই ট্র্যাকিওস্টোমি, মাইক্রোসার্জারি এবং প্যাপিলোমাটোসিস ক্ষতসমূহের এক্সিশনের জন্য জরুরি অপারেশন থিয়েটারে ভর্তি করার সিদ্ধান্ত নেওয়া হয়। এপিগ্লটিস, গ্লোটিক ফেস, ভোকাল কর্ড, সাবগ্লোটিস এবং ট্র্যাকিয়া (রিং ৫ পর্যন্ত) এ ভেন্ট্রিকুলার ব্যান্ডসহ প্যাপিলোমাটোসিস সদৃশ অ্যাপেন্ডিকুলার টিউমার দৃশ্যমান ছিল। অ্যানাটোমোপ্যাথোলজিক প্রতিবেদন HPV-জনিত কোয়িলোসাইটিক এটিপিয়া এবং মৃদু ফোকাল ডিসপ্লাসিয়া রিপোর্ট করে।\n\nতাৎক্ষণিক পোস্টঅপারেটিভ সময়ে তাকে শ্বাসপ্রশ্বাস পর্যবেক্ষণের জন্য শিশু নিবিড় পরিচর্যা ইউনিটে স্থানান্তর করা হয়; ৪৮ ঘন্টায় অক্সিজেন থেকে উইনিং করা হয়। তিনি বেভাসিজুমাব ৪০০ মিগ্রা ইনট্রাভেনাস একক ডোজ পেয়েছেন এবং পরবর্তীতে ক্লিনিক্যালি উন্নতি হয়েছে। রোগী সাত দিন হাসপাতালে ভর্তি ছিলেন, অক্সিজেন স্যাচুরেশন মাত্রার স্বাভাবিকীকরণ এবং প্রগতিশীল অক্সিজেন উইনিংয়ের মাধ্যমে ক্লিনিক্যাল স্থিতিশীলতা অর্জন করেন, এবং পরবর্তীতে ব্যবস্থাপনা চালিয়ে যেতে Breña হাসপাতালে রেফার করা হয়। আট মাস পর টেলিমনিটরিং করা হয় এবং পরিবার জানায় যে রিল্যাপস বা অন্যান্য ইন্টারকারেন্সের কোনো প্রমাণ নেই।"
+  },
+  {
+    "english_text": "A 54-year-old male who had a medical history of membranous nephropathy II with nephrotic syndrome was administered with long-term oral glucocorticoids and immunosuppressants. The patient had a 20 pack-year history of smoking, and denied a family history of hereditary diseases. Chest x-ray demonstrated normal findings at one month before admission. On August 8, 2016, the patient was hospitalized for fever accompanied by progressive dyspnea, cough, and expectoration for 5 days. On admission, the BMI of the patient was 24.5 kg/m2, and his body temperature was 39.0°C. Furthermore, the patient had symptoms of tachypnea (35 bpm) and severe hypoxemia (SaO2 86%). On auscultation, the patient had good air entrance bilaterally with scattered diffuse crackles and rhonchi. Furthermore, the chest CT scan revealed multiple ground-glass opacities, and laboratory tests revealed normal white blood cell (WBC) count, but with elevated neutrophil count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and (1→3)-β-D-glucan. The patient was diagnosed as RSV infection on the fourth day of hospitalization when positive RSV-Ab was detected.\n\nOn admission, the patient was immediately given respiratory monitoring and supplemental oxygen to improve the low oxygen saturation, as well as antibiotics (moxifloxacin for 4 days, followed by cefminoxine for 8 days), and antifungal therapy (voriconazole for 10 days). The dose of the glucocorticoids and immunosuppressants remained largely unchanged. After 10 days of treatment, the patient's condition became worse. Chest CT revealed the progression of the disease, and oxygen partial pressure was further decreased. The patient was transferred to the Emergency Intensive Care Unit, where the patient was intensively treated, including noninvasive mechanical ventilation, broad-spectrum antibiotics (i.v. meropenem, oral moxifloxacin, and cotrimoxazole), antifungal therapy (micafungin), corticosteroids (methylprednisolone 40 mg bid iv) to relieve the inflammation, and other supportive treatment. Ganciclovir was also prescribed due to a possibility of viral infection, such as cytomegalovirus. Five days later, the patient's condition was further aggravated based on the chest x-ray evaluation. Despite receiving another round of treatments, including invasive ventilator-assisted ventilation therapy, methylprednisolone (80 mg bid), antibacterial agents (cefoperazone sulbactam, tigecycline, and cotrimoxazole) and antifungal (micafungin) therapy, the patient eventually died after 2 days.",
+    "translated_text": "৫৪ বছর বয়সী একজন পুরুষের মেমব্রেনাস নেফ্রোপ্যাথি II সহ নেফ্রোটিক সিন্ড্রোমের চিকিৎসা ইতিহাস ছিল এবং তাকে দীর্ঘমেয়াদি মৌখিক গ্লুকোকর্টিকয়েড ও ইমিউনোসাপ্রেস্যান্ট দেওয়া হয়েছিল। রোগীর ২০ প্যাক-ইয়ার ধূমপানের ইতিহাস ছিল, এবং তিনি বংশগত রোগের পারিবারিক ইতিহাস অস্বীকার করেন। ভর্তির এক মাস আগে বুকের এক্স-রে স্বাভাবিক ফলাফল দেখায়। ২০১৬ সালের ৮ আগস্ট, রোগী ৫ দিন ধরে জ্বরের সাথে প্রগতিশীল শ্বাসকষ্ট, কাশি ও কফ ত্যাগ থাকার কারণে হাসপাতালে ভর্তি হন। ভর্তির সময়, রোগীর BMI ছিল 24.5 kg/m2, এবং তার শরীরের তাপমাত্রা ছিল 39.0°C। অতিরিক্তভাবে, রোগীর ট্যাকিপ্নিয়া (35 bpm) এবং তীব্র হাইপোক্সেমিয়া (SaO2 86%) ছিল। শ্রবণে, রোগীর উভয় ফুসফুসে ভালো এয়ার এন্ট্রি ছিল, সাথে ছড়ানো বিস্তৃত ক্র্যাকলস ও রংকাই শোনা যায়। অতিরিক্তভাবে, বক্ষ সিটি স্ক্যানে বহু গ্রাউন্ড-গ্লাস অপাসিটি দেখা যায়, এবং ল্যাবরেটরি পরীক্ষায় শ্বেত রক্তকণিকা (WBC) গণনা স্বাভাবিক ছিল, তবে নিউট্রোফিল গণনা, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), এবং (1→3)-β-D-glucan বৃদ্ধি পাওয়া যায়। ভর্তির চতুর্থ দিনে RSV-Ab পজিটিভ সনাক্ত হওয়ায় রোগীকে RSV সংক্রমণ হিসেবে নির্ণয় করা হয়।\n\nভর্তির সময়, রোগীকে সঙ্গে সঙ্গে শ্বাসতন্ত্রের মনিটরিং এবং কম অক্সিজেন স্যাচুরেশন উন্নত করতে সম্পূরক অক্সিজেন দেওয়া হয়, পাশাপাশি অ্যান্টিবায়োটিক (moxifloxacin 4 দিন, এরপর cefminoxine 8 দিন) এবং অ্যান্টিফাঙ্গাল থেরাপি (voriconazole 10 দিন) দেওয়া হয়। গ্লুকোকর্টিকয়েড ও ইমিউনোসাপ্রেস্যান্টের ডোজ মোটামুটি অপরিবর্তিত ছিল। ১০ দিন চিকিৎসার পর, রোগীর অবস্থা খারাপ হয়ে যায়। বুকের সিটি রোগের অগ্রগতি দেখায়, এবং অক্সিজেনের আংশিক চাপ আরও হ্রাস পায়। রোগীকে ইমার্জেন্সি ইনটেনসিভ কেয়ার ইউনিটে স্থানান্তর করা হয়, যেখানে রোগীকে নিবিড়ভাবে চিকিৎসা দেওয়া হয়, যার মধ্যে ছিল ননইনভেসিভ মেকানিক্যাল ভেন্টিলেশন, ব্রড-স্পেকট্রাম অ্যান্টিবায়োটিক (i.v. meropenem, oral moxifloxacin, এবং cotrimoxazole), অ্যান্টিফাঙ্গাল থেরাপি (micafungin), প্রদাহ প্রশমনের জন্য কর্টিকোস্টেরয়েড (methylprednisolone 40 mg bid iv), এবং অন্যান্য সহায়ক চিকিৎসা। সাইটোমেগালোভাইরাসসহ ভাইরাল সংক্রমণের সম্ভাবনা থাকায় Ganciclovir-ও দেওয়া হয়। পাঁচ দিন পর, বুকের এক্স-রে মূল্যায়নের ভিত্তিতে রোগীর অবস্থা আরও অবনতি ঘটে। ইনভেসিভ ভেন্টিলেটর-সহায়িত ভেন্টিলেশন থেরাপি, methylprednisolone (80 mg bid), অ্যান্টিব্যাকটেরিয়াল এজেন্ট (cefoperazone sulbactam, tigecycline, এবং cotrimoxazole) ও অ্যান্টিফাঙ্গাল (micafungin) থেরাপি সহ আরেক দফা চিকিৎসা সত্ত্বেও, রোগী শেষ পর্যন্ত ২ দিন পর মৃত্যুবরণ করেন।"
+  },
+  {
+    "english_text": "A 34-year-old patient with a disease duration of four weeks. Two months earlier, she had a cesarean section in the 37th week of pregnancy and had persistent bleeding from the surgical wound. She denied a history of bleeding in childhood or adolescence. Three years earlier, she had given birth to her first child (also by cesarean section), who died due to a chromosome disorder (referred to by the patient). She also stated that she was allergic to tramadol.\n\nThe clinical picture began with lower back pain due to bilateral renal lithiasis. Subsequently, he managed to expel a stone and after that he presented haematuria for three days, for which he received tranexamic acid c/12 h. Three weeks later, he presented pain in the lower region of the left thigh that increased in intensity, with hardening of the area. Due to persistence of the symptoms, he was given diclofenac intramuscularly, which caused ecchymosis and bleeding in the gluteal area and persists despite the compression with gauze.\n\nThe patient underwent a particular Doppler ultrasound that revealed deep venous thrombosis of the left lower limb, and went to the hospital in her locality with these results. She was given anticoagulation with enoxaparin 30 mg/24 h subcutaneously, in addition to morphine for pain management and was hospitalized. The next day, she presented epigastralgia, blurred vision, heart rate of 117 beats/min, blood pressure of 113/85 mmHg and saturation of 93%. It was decided to discontinue enoxaparin. The blood count revealed a hemoglobin of 6.4 g/dl, which represented a difference of 4 g/dl from the result one day before admission, which was 10.4 g/dl. Because of the above, two blood transfusions were given. Due to the suspicion of vasculitis, methylprednisolone was indicated and she was referred to our hospital for further study.\n\nOn admission, the physical examination revealed severe pallor, extensive ecchymosis on the left thigh and lateral knee, and a haematoma on the right thigh. The haemogram showed moderate anaemia (Hb = 9.8 g/dl), normocytic and normochromic. The biochemical examination showed glucose values of 160 mg/dl. The liver enzymes AST and ALT were at 52 U/L and 86 U/L, respectively. The coagulation profile showed a prolonged activated partial thromboplastin time (APTT) of 91.2 s. The rest of the haemogram, biochemical, electrolyte, liver profile and coagulation profile were normal. The ultrasound of soft parts of the right gluteal region revealed a collection at the level of the subcutaneous cellular tissue (TCSC) and oedema up to the upper third of the thigh. The Doppler ultrasound in the left lower limb showed adequate flowometry without signs of thrombosis in the common femoral vein, superficial and deep.\n\nSymptomatic treatment was initiated and blood and urine cultures were requested and were negative. Antinuclear antibody (ANA) values, complement C3 and C4 and ferritin were within the reference range.\n\nIn the face of suspected acquired haemophilia, studies were requested for confirmation, where a partial correction of aPTT was found in the mixing test. Factor VIII was measured and its activity was found to be decreased (<1.0 U/dl) and the presence of a factor VIII inhibitor was demonstrated: 8.64 Bethesda units/ml. The above allowed the diagnosis of acquired haemophilia to be confirmed, which was related to the postpartum period due to the onset of symptoms.\n\nPrednisone 50 mg orally at breakfast and 10 mg orally at lunch, cyclophosphamide 50 mg 2 tablets orally every 24 hours and anti-inhibitor coagulant complex for haemophilia (FEIBA) were initiated. Five days later, the latter was discontinued due to chest tightness, dyspnoea and nausea (possible adverse drug reaction) and replaced with activated recombinant factor VII (NovoSeven).\n\nThe patient's clinical evolution was favorable, with a decrease in ecchymosis and no other symptoms, so she was discharged from the hospital.\n",
+    "translated_text": "চার সপ্তাহের রোগ-স্থায়িত্বসহ ৩৪-বছর-বয়সী রোগী। দুই মাস আগে, গর্ভাবস্থার ৩৭তম সপ্তাহে তাঁর সিজারিয়ান সেকশন হয়েছিল এবং অস্ত্রোপচারের ক্ষত থেকে স্থায়ী রক্তপাত ছিল। তিনি শৈশব বা কৈশোরে রক্তক্ষরণের ইতিহাস অস্বীকার করেছিলেন। তিন বছর আগে, তিনি তাঁর প্রথম সন্তান জন্ম দিয়েছিলেন (এটিও সিজারিয়ান সেকশনের মাধ্যমে), যে একটি ক্রোমোজোমজনিত ব্যাধির কারণে মারা যায় (রোগীর বর্ণনা অনুসারে)। তিনি আরও জানিয়েছিলেন যে ট্রামাডলের প্রতি অ্যালার্জি আছে।\n\nক্লিনিকাল উপস্থাপনা দ্বিপার্শ্বিক রেনাল লিথিয়াসিসের কারণে নিচের পিঠে ব্যথা দিয়ে শুরু হয়। পরবর্তীতে, তিনি একটি পাথর নির্গত করতে সক্ষম হন এবং এর পর তিন দিন হেমাটুরিয়া হয়, যার জন্য তিনি ট্রানেক্সামিক অ্যাসিড c/12 h পেয়েছিলেন। তিন সপ্তাহ পরে, বাম উরুর নিম্ন অংশে ব্যথা হয় যা তীব্রতায় বৃদ্ধি পায়, এলাকার ইনডুরেশনের সাথে। লক্ষণ স্থায়ী থাকায়, ইন্ট্রামাসকুলার ডাইক্লোফেনাক দেওয়া হয়, যা গ্লুটিয়াল অঞ্চলে ইকিমোসিস ও রক্তপাত সৃষ্টি করে এবং গজ দিয়ে কমপ্রেশন সত্ত্বেও স্থায়ী থাকে।\n\nরোগীর একটি বিশেষ ডপলার আল্ট্রাসাউন্ড করা হয়, যাতে বাম নিম্ন অঙ্গে গভীর শিরাস্থ থ্রম্বোসিস ধরা পড়ে, এবং তিনি এই ফলাফল নিয়ে তাঁর এলাকার হাসপাতালে যান। তাঁকে এনক্সাপারিন 30 mg/24 h সাবকুটেনিয়াসলি দিয়ে অ্যান্টিকোঅ্যাগুলেশন, ব্যথা নিয়ন্ত্রণের জন্য মর্ফিনসহ, শুরু করা হয় এবং ভর্তি করা হয়। পরদিন, এপিগ্যাস্ট্রালজিয়া, দৃষ্টিধূসরতা, হার্ট রেট 117 বিট/মিনিট, রক্তচাপ 113/85 mmHg এবং স্যাচুরেশন 93% দেখা যায়। এনক্সাপারিন বন্ধ করার সিদ্ধান্ত নেওয়া হয়। ব্লাড কাউন্টে হিমোগ্লোবিন 6.4 g/dl পাওয়া যায়, যা ভর্তি হওয়ার এক দিন আগে ফলাফলের তুলনায় 4 g/dl কম, তখন ছিল 10.4 g/dl। উপরোক্ত কারণে দুটি রক্ত সঞ্চালন দেওয়া হয়। ভাসকুলাইটিসের সন্দেহে মিথাইলপ্রেডনিসোলোন নির্দেশ করা হয় এবং পরবর্তী মূল্যায়নের জন্য আমাদের হাসপাতালে রেফার করা হয়।\n\nভর্তির সময় শারীরিক পরীক্ষায় তীব্র প্যালর, বাম উরু ও হাঁটুর পার্শ্বীয় অংশে বিস্তৃত ইকিমোসিস, এবং ডান উরুতে একটি হেমাটোমা ধরা পড়ে। হেমোগ্রাম-এ মাঝারি অ্যানিমিয়া (Hb = 9.8 g/dl), নরমোসাইটিক ও নরমোক্রোমিক ছিল। বায়োকেমিক্যাল পরীক্ষায় গ্লুকোজ 160 mg/dl পাওয়া যায়। লিভার এনজাইম AST এবং ALT যথাক্রমে 52 U/L এবং 86 U/L ছিল। কোয়াগুলেশন প্রোফাইলে অ্যাক্টিভেটেড পারশিয়াল থ্রোম্বোপ্লাস্টিন টাইম (APTT) 91.2 s-এ দীর্ঘায়িত ছিল। হেমোগ্রাম, বায়োকেমিক্যাল, ইলেকট্রোলাইট, লিভার প্রোফাইল ও কোয়াগুলেশন প্রোফাইলের বাকি অংশ স্বাভাবিক ছিল। ডান গ্লুটিয়াল অঞ্চলের নরম টিস্যুর আল্ট্রাসাউন্ডে সাবকুটেনিয়াস সেলুলার টিস্যু (TCSC) স্তরে একটি কালেকশন এবং উরুর ঊর্ধ্ব তৃতীয়াংশ পর্যন্ত ইডিমা দেখা যায়। বাম নিম্ন অঙ্গে ডপলার আল্ট্রাসাউন্ডে যথাযথ ফ্লোওমেট্রি দেখা যায় এবং কমন ফেমোরাল ভেন, পৃষ্ঠীয় ও গভীর—কোনো থ্রোম্বোসিসের চিহ্ন নেই।\n\nসিম্পটোমেটিক চিকিৎসা শুরু করা হয় এবং রক্ত ও মূত্র কালচার চাওয়া হয়, যা নেগেটিভ আসে। অ্যান্টিনিউক্লিয়ার অ্যান্টিবডি (ANA), কমপ্লিমেন্ট C3 ও C4 এবং ফেরিটিন রেফারেন্স রেঞ্জের মধ্যে ছিল।\n\nঅ্যাকোয়ার্ড হিমোফিলিয়ার সন্দেহে নিশ্চিতকরণের জন্য পরীক্ষা চাওয়া হয়, যেখানে মিক্সিং টেস্টে aPTT-এর আংশিক সংশোধন পাওয়া যায়। ফ্যাক্টর VIII পরিমাপ করা হয় এবং এর ক্রিয়াশীলতা হ্রাসপ্রাপ্ত (<1.0 U/dl) পাওয়া যায় এবং ফ্যাক্টর VIII ইনহিবিটর-এর উপস্থিতি প্রমাণিত হয়: 8.64 বেথেসডা ইউনিট/ml। উপরোক্ত ফলাফল অ্যাকোয়ার্ড হিমোফিলিয়ার নির্ণয় নিশ্চিত করতে সক্ষম করে, যা উপসর্গের শুরু হওয়ার সময় বিবেচনায় প্রসবোত্তর কালের সাথে সম্পর্কিত ছিল।\n\nপ্রেডনিসোন 50 mg সকালে নাশতার সময় মুখে এবং দুপুরে 10 mg মুখে, সাইক্লোফসফামাইড 50 mg-এর 2টি ট্যাবলেট মুখে প্রতি 24 ঘণ্টায় এবং হিমোফিলিয়ার জন্য অ্যান্টি-ইনহিবিটার কোয়াগুল্যান্ট কমপ্লেক্স (FEIBA) শুরু করা হয়। পাঁচ দিন পরে, বক্ষ-জড়তা, ডিসপনিয়া ও বমি বমি ভাবের কারণে (সম্ভাব্য ওষুধ-জনিত প্রতিকূল প্রতিক্রিয়া) শেষোক্তটি বন্ধ করা হয় এবং অ্যাক্টিভেটেড রিকম্বিন্যান্ট ফ্যাক্টর VII (NovoSeven) দিয়ে প্রতিস্থাপিত করা হয়।\n\nরোগীর ক্লিনিক্যাল অগ্রগতি অনুকূল ছিল; ইকিমোসিস কমে আসে এবং অন্য কোনো উপসর্গ থাকে না, ফলে তাকে হাসপাতাল থেকে ছাড়পত্র দেওয়া হয়।"
+  },
+  {
+    "english_text": "We present here the case of a two-day old neonate with in-born right scrotal swelling admitted at Children’s hospital. The patient was born at term via cesarean section at a private hospital. He was kept in the nursery for one day. The examining doctor referred them for urgent surgical care, but it took them one day to arrive at our hospital. Upon arrival in the emergency department, he was well hydrated, pink at room temperature with good perfusion. Upon examination, the right testis was found to be enlarged, tense, non-tender visibly reddish with overlying skin excoriation. Trans-illumination was negative in the right but positive in the contralateral testis. Both hernial orifices were normal. All the laboratory investigations were performed with an urgent Doppler ultrasound of the inguinoscrotal area. The ultrasound examination found the right testis to be enlarged (15.6*9.4 mm) and showed heterogeneous hypoechoic texture with prominent rete testis and no flow on color Doppler analysis. Left testis appeared normal in size, shape and echotexture with minimal hydrocele. An urgent scrotal exploration was undertaken. Intra-operatively, there was frank necrotic right testis with intravaginal torsion of the testis with minimal hydrocele. A right orchidectomy and contralateral orchidopexy was then performed.",
+    "translated_text": "আমরা এখানে শিশু হাসপাতালে ভর্তি হওয়া ডান স্ক্রোটামের জন্মগত স্ফীতিযুক্ত দুই দিনের নবজাতকের একটি কেস উপস্থাপন করছি।\nরোগী পূর্ণ গর্ভকাল শেষে একটি বেসরকারি হাসপাতালে সিজারিয়ান সেকশনের মাধ্যমে জন্মগ্রহণ করে।\nতাকে এক দিন নার্সারিতে রাখা হয়।\nপরীক্ষাকারী চিকিৎসক জরুরি সার্জিকাল চিকিৎসার জন্য তাদের রেফার করেন, তবে আমাদের হাসপাতালে পৌঁছাতে তাদের এক দিন লেগে যায়।\nজরুরি বিভাগে আগমনের পর, সে ভালোভাবে হাইড্রেটেড ছিল, কক্ষ তাপমাত্রায় গোলাপি বর্ণ এবং ভালো পারফিউশন ছিল।\nপরীক্ষায় দেখা যায়, ডান অণ্ডকোষটি বড়, টানটান, স্পর্শে কোমলতা নেই, দৃশ্যমানভাবে লালচে এবং উপরিস্থ ত্বকে এক্সকরিয়েশন রয়েছে।\nট্রান্স-ইলুমিনেশন ডানে নেগেটিভ ছিল, তবে বিপরীত পাশের অণ্ডকোষে পজিটিভ ছিল।\nউভয় হার্নিয়াল অরিফিস স্বাভাবিক ছিল।\nসমস্ত ল্যাবরেটরি তদন্ত সম্পন্ন করা হয় এবং ইঙ্গুইনোস্ক্রোটাল এলাকার জরুরি ডপলার আল্ট্রাসাউন্ড করা হয়।\nআল্ট্রাসাউন্ড পরীক্ষায় ডান অণ্ডকোষ বড় (15.6*9.4 মিমি) পাওয়া যায় এবং হেটেরোজেনিয়াস হাইপোইকোইক ইকোটেক্সচার সহ প্রমিনেন্ট রেটে টেস্টিস ও কালার ডপলার বিশ্লেষণে কোনো ফ্লো দেখা যায়নি।\nবাম অণ্ডকোষের আকার, আকৃতি ও ইকোটেক্সচার স্বাভাবিক ছিল, সাথে ন্যূনতম হাইড্রোসিল ছিল।\nজরুরিভাবে স্ক্রোটাল এক্সপ্লোরেশন করা হয়।\nইন্ট্রা-অপারেটিভভাবে, ডান অণ্ডকোষে ইন্ট্রাভ্যাজাইনাল টরশনসহ স্পষ্ট নেক্রোসিস ছিল এবং ন্যূনতম হাইড্রোসিল ছিল।\nএরপর ডান অর্কিডেক্টোমি এবং বিপরীত পাশে অর্কিডোপেক্সি করা হয়।"
+  },
+  {
+    "english_text": "4-year-old male patient with a history of nasal impetigo two weeks before admission (treated with topical mupirocin and oral cefadroxil; dose, duration and adherence to treatment unknown), with no other morbid history, who presented macroscopic glomerular haematuria associated with oedema of the lower extremities of 5 days' evolution, with the last 12 hours prior to the consultation adding headaches, nausea and vomiting. He went to the emergency department (ED) in convulsive status, after 20 minutes of generalised tonic-clonic convulsions.\n\nOn admission to the ED, the patient was afebrile, with non-evaluable blood pressure, with quantitative consciousness impairment associated with generalized hypertonia and bilateral and pretibial oedema. Endotracheal intubation was decided and phenobarbital (10 mg/kg) was administered to manage the convulsive status.\n\nOn physical examination in the intensive care unit (ICU), blood pressure was 134/94 mmHg (BP 110 mmHg) (p95 for patient 108/66 mmHg, p95+12 120/78 mmHg).\n\nInitial laboratory parameters included: complete urine with haematuria (> 100 erythrocytes per field), proteinuria 3+ and leucocyturia 10-25 per field, creatinemia 0.3 mg/dL, anaemia with haematocrit (HTO) 21%, haemoglobin (Hb) 7 g/dL, with normal mean corpuscular volume (VCM) and mean corpuscular haemoglobin concentration (CHCM), leukocytosis of 23,900 cells/mm3, thrombocytosis of 756,000/mm3, without elevation of acute phase reactants, hypocomplementemia with complement C3 level at 25 mg/dL (normal value, VN: 80-150 mg/dL) and normal C4. The rapid antigen test for Streptococcus beta-haemolytic group A (Streptococcus pyogenes) in pharynx was positive and the Anti-streptolysin O (ASO) was (+). The non-contrast brain computed tomography showed no acute changes. The renal ultrasound concluded bilateral nephromegaly with increased cortical echogenicity and decreased corticomedullar differentiation.\n\nThe patient was diagnosed with nephritic syndrome due to complicated GNAPE with hypertensive emergency - convulsive status.\n\nWithin the first 24 hours of his ICU stay, the patient required mechanical ventilation (MV) and anticonvulsant therapy with phenobarbital. He progressed without seizures, with a normal electroencephalogram (EEG) (on the day following admission) and a normal cerebrospinal fluid study. Antibiotic therapy was initiated for eradication of Streptococcus pyogenes with cefotaxime and diuretic therapy with furosemide.\n\nThe next day, he developed renal impairment with creatinine elevation to 0.99 mg/dL, hypertension and 24 hour proteinuria of 36.6 mg/m2/h, without oliguria. He initiated antihypertensive therapy with amlodipine and intravenous labetalol, with good initial control.\n\nWith favorable evolution, extubation was performed at 48 hours, which was well tolerated from the ventilatory point of view. However, after 24 hours of extubation, the patient's consciousness deteriorated, with both ocular opening and withdrawal of limb only in response to painful stimulus and poor verbal response (Glasgow Coma Scale 8), and developed blood pressure figures > p95+12 despite receiving therapy with labetalol in continuous infusion (up to 3 mg/kg/h), amlodipine (10 mg/day) and furosemide, which required the reintroduction of mechanical ventilation and infusion of sodium nitroprusside (up to 3 mcg/kg/min), with the aim of achieving gradual reduction of blood pressure figures (25% daily) to prevent secondary neurological damage. Given the presence of acute neurological symptomatology associated with HTA in a patient with glomerulonephritis, the diagnosis of PRES was suspected, which was confirmed by magnetic resonance imaging (MRI) of the brain (day 5), which showed an increase in the subcortical signal in bilateral and symmetric occipital region, without restriction in diffusion, which was compatible with vasogenic edema (PRES). Ophthalmological evaluation was normal and a new EEG evidenced occasional episodes of generalized voltage depression.\n\nAdding enalapril to the treatment. Finally, after 10 days with a slow pharmacological weaning, normalization of blood pressure was achieved. The control MRI (day 12) revealed regression of the previously described findings. Successful extubation was achieved after 5 days.\n\nDuring his stay in the ICU, the hemoglobin level dropped to 5 g/dL, with normal mean corpuscular volume and mean corpuscular hemoglobin concentration, without plateletopenia, so hemolytic anemia was suspected given a positive direct Coombs test and hemoglobinuria. He required red blood cell transfusions twice. Steroid therapy with methylprednisolone (1 mg/kg/d) was initiated for 72 hours. The coproculture was negative, as was the urinary antigen for Streptococcus pneumoniae. Epstein-Barr virus and Parvovirus B19 serology, extractable nuclear antigen (ENA) profile, anti-neutrophil cytoplasmic antibodies (ANCA), anti-DNA antibodies, anti-B2 glycoprotein 1 antibodies, anti-cardiolipin antibodies and lupus anticoagulant were all negative. All cultures were negative (blood cultures, urine cultures, cultures of endotracheal aspirate and pharyngeal cultures). ANA (antinuclear antibodies) was positive 1/160.\n\nThe patient improved with blood pressure normalization, increased complement levels, and a urine test without proteinuria or hematuria. The direct Coombs test remained positive on the 9th day of hospitalization.\n\nOn day 31, the patient was discharged normotensive, without anaemia, with preserved renal function, without proteinuria or haematuria, with normalisation of C3 levels and asymptomatic from the neurological point of view. He was discharged with pharmacological therapy with prednisone, amlodipine, enalapril and folic acid. The patient did not present recurrence and remained asymptomatic 6 months after discharge.\n",
+    "translated_text": "ভর্তি হওয়ার দুই সপ্তাহ আগে নাসাল ইম্পেটাইগোর ইতিহাসসহ ৪-বছর বয়সী পুরুষ রোগী (টপিক্যাল মিউপিরোসিন ও ওরাল সেফাড্রক্সিল দিয়ে চিকিৎসা; ডোজ, সময়কাল ও চিকিৎসা-অনুসরণ অজানা), অন্য কোনো রোগাবলির ইতিহাস ছাড়াই, যিনি স্থূল গ্লোমেরুলার হেমাচুরিয়া ও ৫ দিন ধরে নিম্ন অঙ্গগুলোর এডিমা নিয়ে উপস্থিত হন, এবং পরামর্শের ১২ ঘণ্টা পূর্বে মাথাব্যথা, বমিবমি ভাব ও বমি যোগ হয়। সাধারণীকৃত টনিক-ক্লোনিক খিঁচুনি ২০ মিনিট স্থায়ী হওয়ার পর তিনি স্ট্যাটাস কনভালসিভাস অবস্থায় জরুরি বিভাগে (ED) উপস্থিত হন।\n\nED-তে ভর্তির সময় রোগী জ্বরবিহীন ছিলেন, রক্তচাপ মূল্যায়ন করা যাচ্ছিল না, সাধারণায়িত হাইপারটোনিয়া ও দ্বিপার্শ্বিক এবং প্রিটিবিয়াল এডিমাসহ চেতনা-স্তরের পরিমাণগত অবনতি ছিল। এন্ডোট্র্যাকিয়াল ইন্টুবেশন করার সিদ্ধান্ত নেওয়া হয় এবং খিঁচুনি নিয়ন্ত্রণে ফেনোবারবিটাল (10 mg/kg) দেওয়া হয়।\n\nআইসিইউতে শারীরিক পরীক্ষায় রক্তচাপ ছিল 134/94 mmHg (BP 110 mmHg) (রোগীর জন্য p95 108/66 mmHg, p95+12 120/78 mmHg)।\n\nপ্রাথমিক ল্যাবরেটরি প্যারামিটারগুলির মধ্যে ছিল: সম্পূর্ণ ইউরিনে হেমাচুরিয়া (> 100 ইরিথ্রোসাইট প্রতি ফিল্ড), প্রোটিনিউরিয়া 3+ এবং লিউকোসাইটিউরিয়া 10-25 প্রতি ফিল্ড, ক্রিয়াটিনেমিয়া 0.3 mg/dL, হেমাটোক্রিট (HTO) 21% সহ অ্যানিমিয়া, হিমোগ্লোবিন (Hb) 7 g/dL, স্বাভাবিক গড় কর্পাসকুলার ভলিউম (MCV) ও গড় কর্পাসকুলার হিমোগ্লোবিন কনসেন্ট্রেশন (MCHC), লিউকোসাইটোসিস 23,900 কোষ/mm3, থ্রম্বোসাইটোসিস 756,000/mm3, অ্যাকিউট ফেজ রিঅ্যাকট্যান্ট বৃদ্ধি ছাড়া, কমপ্লিমেন্ট C3 মাত্রা 25 mg/dL (স্বাভাবিক মান, VN: 80-150 mg/dL) সহ হাইপোকমপ্লিমেন্টেমিয়া এবং C4 স্বাভাবিক। ফ্যারিংক্সে গ্রুপ A বিটা-হিমোলাইটিক স্ট্রেপ্টোকক্কাস (Streptococcus pyogenes)-এর র‍্যাপিড অ্যান্টিজেন টেস্ট পজিটিভ এবং অ্যান্টি-স্ট্রেপ্টোলাইসিন O (ASO) (+)। কনট্রাস্টবিহীন মস্তিষ্কের কম্পিউটেড টোমোগ্রাফিতে কোনো তাত্ক্ষণিক পরিবর্তন দেখা যায়নি। রেনাল আল্ট্রাসাউন্ডে কর্টিকাল ইকোজেনিসিটি বৃদ্ধি ও কর্টিকোমেডুলারি ডিফারেনশিয়েশন হ্রাসসহ দ্বিপার্শ্বিক নেফ্রোমেগালি দেখা যায়।\n\nরোগীকে জটিল GNAPE-জনিত নেফ্রিটিক সিন্ড্রোম, হাইপারটেনসিভ ইমার্জেন্সি - স্ট্যাটাস কনভালসিভাস হিসেবে নির্ণয় করা হয়।\n\nআইসিইউতে প্রথম ২৪ ঘণ্টার মধ্যে রোগীর মেকানিক্যাল ভেন্টিলেশন (MV) ও ফেনোবারবিটাল দিয়ে অ্যান্টিকনভালসান্ট থেরাপি প্রয়োজন হয়। তিনি খিঁচুনিবিহীনভাবে অগ্রসর হন, স্বাভাবিক ইইজি (ভর্তি-পরবর্তী পরের দিনে) এবং স্বাভাবিক সেরিব্রোস্পাইনাল ফ্লুইডের পরীক্ষা সহ। Streptococcus pyogenes নির্মূলের জন্য সেফোট্যাক্সাইম দিয়ে অ্যান্টিবায়োটিক থেরাপি এবং ফুরোসেমাইড দিয়ে ডাইইউরেটিক থেরাপি শুরু করা হয়।\n\nপরদিন, ক্রিয়াটিনিন 0.99 mg/dL এ বৃদ্ধি, উচ্চ রক্তচাপ এবং ২৪-ঘণ্টার প্রোটিনিউরিয়া 36.6 mg/m2/h সহ কিডনি অকার্যকারিতা বিকশিত হয়, অলিগুরিয়া ছাড়া। অ্যামলোডিপিন ও শিরায় ল্যাবেটালল দিয়ে অ্যান্টিহাইপারটেনসিভ থেরাপি শুরু করা হয়, প্রাথমিক নিয়ন্ত্রণ ভালো ছিল।\n\nঅনুকূল অগ্রগতিতে ৪৮ ঘণ্টায় এক্সটিউবেশন করা হয়, ভেন্টিলেটরি দৃষ্টিকোণ থেকে ভালোভাবে সহ্য করেন। তবে, এক্সটিউবেশনের ২৪ ঘণ্টা পর রোগীর চেতনা অবনতি ঘটে; বেদনাজনিত উদ্দীপনায় তবেই চোখ খোলা ও অঙ্গ প্রত্যাহার প্রতিক্রিয়া ছিল এবং মৌখিক প্রতিক্রিয়া দুর্বল (গ্লাসগো কোমা স্কেল 8); এবং ল্যাবেটালল ধারাবাহিক ইনফিউশন (সর্বোচ্চ 3 mg/kg/h), অ্যামলোডিপিন (10 mg/day) ও ফুরোসেমাইড সত্ত্বেও রক্তচাপের মান > p95+12 হয়ে যায়; ফলে মেকানিক্যাল ভেন্টিলেশন পুনঃপ্রবর্তন এবং সোডিয়াম নাইট্রোপ্রুসাইড ইনফিউশন (সর্বোচ্চ 3 mcg/kg/min) প্রয়োজন হয়, রক্তচাপের মান ধীরে ধীরে (প্রতিদিন 25%) কমিয়ে দ্বিতীয়িক নিউরোলজিক ক্ষতি প্রতিরোধের লক্ষ্যে। গ্লোমেরুলোনেফ্রাইটিসযুক্ত রোগীর মধ্যে HTA-সংশ্লিষ্ট তীব্র স্নায়ুবৈকল্য লক্ষণের উপস্থিতিতে PRES-এর সন্দেহ হয়, যা মস্তিষ্কের MRI (দিন 5) দ্বারা নিশ্চিত হয়; তাতে দ্বিপার্শ্বিক ও সমমিত অক্সিপিটাল অঞ্চলে সাবকর্টিকাল সিগন্যাল বৃদ্ধি, ডিফিউশনে কোনো রেস্ট্রিকশন ছাড়াই, যা ভ্যাসোজেনিক এডিমার (PRES) সাথে সামঞ্জস্যপূর্ণ, দেখা যায়। অফথালমোলজিক মূল্যায়ন স্বাভাবিক ছিল এবং নতুন ইইজি-তে মাঝে মাঝে জেনারালাইজড ভোল্টেজ ডিপ্রেশনের এপিসোড প্রমাণিত হয়।\n\nচিকিৎসায় এনালাপ্রিল যোগ করা হয়। শেষ পর্যন্ত, ১০ দিন ধরে ধীর গতির ফার্মাকোলজিক উইনিংয়ের পর রক্তচাপ স্বাভাবিক করা হয়। কন্ট্রোল MRI (দিন 12) পূর্বে বর্ণিত পরিবর্তনের রিগ্রেশন দেখায়। ৫ দিন পর সফল এক্সটিউবেশন করা হয়।\n\nআইসিইউতে অবস্থানকালে, হিমোগ্লোবিন 5 g/dL-এ নেমে যায়, MCV ও MCHC স্বাভাবিক ছিল এবং থ্রম্বোসাইটোপেনিয়া ছিল না; ফলে ডাইরেক্ট কুম্বস টেস্ট পজিটিভ ও হিমোগ্লোবিনিউরিয়া থাকায় হেমোলাইটিক অ্যানিমিয়া সন্দেহ করা হয়। তাকে দুইবার রেড ব্লাড সেল ট্রান্সফিউশন প্রয়োজন হয়। মিথাইলপ্রেডনিসোলোন (1 mg/kg/d) দিয়ে 72 ঘণ্টার জন্য স্টেরয়েড থেরাপি শুরু করা হয়। কোপ্রোকালচার নেগেটিভ ছিল, যেমন Streptococcus pneumoniae-এর ইউরিনারি অ্যান্টিজেনও নেগেটিভ ছিল। এপস্টাইন-বার ভাইরাস ও পার্ভোভাইরাস B19 সিরোলজি, এক্সট্র্যাক্টেবল নিউক্লিয়ার অ্যান্টিজেন (ENA) প্রোফাইল, ANCA, অ্যান্টি-DNA অ্যান্টিবডি, অ্যান্টি-বিটা-২ গ্লাইকোপ্রোটিন ১ অ্যান্টিবডি, অ্যান্টি-কার্ডিওলিপিন অ্যান্টিবডি এবং লুপাস অ্যান্টিকোয়াগুল্যান্ট — সবই নেগেটিভ ছিল। সব কালচার নেগেটিভ ছিল (রক্তকালচার, ইউরিন কালচার, এন্ডোট্র্যাকিয়াল অ্যাসপিরেটের কালচার এবং ফ্যারিঞ্জিয়াল কালচার)। ANA (অ্যান্টিনিউক্লিয়ার অ্যান্টিবডি) 1/160 পজিটিভ ছিল।\n\nরক্তচাপ স্বাভাবিক হওয়া, কমপ্লিমেন্টের মাত্রা বৃদ্ধি এবং প্রোটিনিউরিয়া বা হেমাচুরিয়া ছাড়া ইউরিন পরীক্ষার সাথে রোগীর উন্নতি হয়। ভর্তির ৯ম দিনে ডাইরেক্ট কুম্বস টেস্ট পজিটিভই ছিল।\n\nদিন 31-এ, রোগী নরমোটেনসিভ অবস্থায়, অ্যানিমিয়া ছাড়া, কিডনি কার্যকারিতা সংরক্ষিত অবস্থায়, প্রোটিনিউরিয়া বা হেমাচুরিয়া ছাড়া, C3 মাত্রা স্বাভাবিক হয়ে এবং নিউরোলজিক দৃষ্টিকোণ থেকে উপসর্গবিহীন অবস্থায় ছাড়া পান। তাকে প্রেডনিসোন, অ্যামলোডিপিন, এনালাপ্রিল ও ফলিক অ্যাসিডসহ ফার্মাকোলজিক থেরাপি দিয়ে ছাড়া হয়। রোগীর পুনরাবির্ভাব হয়নি এবং ছাড়ার ৬ মাস পরও তিনি উপসর্গবিহীন ছিলেন।"
+  },
+  {
+    "english_text": "A 69-year-old male with prior history of CABG presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration was admitted in our center. The electrocardiogram showed ST depression in leads II, III, aVF, and V4-6, and blood examination revealed elevation of plasma N-terminal pro-B-type natriuretic peptide levels (2640 pg/mL). Echocardiogram showed left ventricular systolic dysfunction and low left ventricular ejection fraction (30%). The patient had inferior ST-segment-elevation myocardial infarction in 2009, when he was 59 years old, with angiographic evidence of severe 3 vessels disease (coronary angiography showed CTO in proximal left anterior descending artery (LAD), 90% stenosis in mid and distal left circumflex artery, and 95% stenosis in mid RCA. The patient underwent CABG with left internal mammary artery (LIMA) to LAD, and sequential SVG to 1st obtuse marginal branch (OM1), 2nd obtuse marginal branch (OM2), and posterolateral branch (PL) in 2009.\n\nCoronary angiography was performed via 6 French (Fr) left radial artery access and demonstrated patency of LIMA to LAD and SVG to OM1, OM2 conduits, but a complete occlusion of sequential SVG to PL conduit. Native left main coronary artery was occluded in ostium and native RCA was occluded in the mid portion with bridging collaterals. We decided to treat the native RCA CTO. Dual arterial access was achieved with another 6 Fr sheath in right femoral artery. The left and right coronary arteries were intubated with 6 Fr AL 0.75 (Launcher; Medtronic; USA) and 6 Fr EBU 3.5 (Launcher; Medtronic; USA) guide catheters, respectively. An antegrade approach via left radial artery was attempted; however, neither Fielder XTR wire (Asahi Intec, Japan) nor Gaia 3 wire (Asahi Intec, Japan) with Finecross microcatheter (Terumo, Japan) reached the true lumen in distal RCA. Then, parallel wire technique with Crusade microcatheter (Kaneka, Japan) and two Gaia 3 wires (Asahi Intec, Japan) were attempted, but also failed. We therefore switched to the retrograde approach using septal channel from LAD through occluded left coronary artery. Gaia 3 wire (Asahi Intec, Japan) crossed occluded left main (LM) and LAD, and finally reached true lumen in distal LAD. Sion wire was exchanged by Finecross microcatheter (Terumo, Japan) into dital LAD, and dilation of LM and proximal LAD with a 2.0 × 15 mm balloon was performed. Then, septal surfing technique (SST) was used for septal crossing. We tried different septal channels originating from proximal to distal LAD, and delivered Sion wire (Asahi Intec, Japan) retrogradely through distal septal branch into distal RCA supported by a 150-cm Finecross microcatheter (Terumo, Japan). Gaia 3 wire (Asahi Intec, Japan) crossed CTO lesion retrogradely into the true lumen in proximal RCA, and was advanced into Guidezilla guide extension catheter (Boston Scientific, USA) positioned in the antegrade guiding catheter. The Finecross microcatheter (Terumo, Japan) was delivered to the antegrade catheter and a RG3 wire (Asahi Intec, Japan) was externalized. The CTO was then predilated by a 2.0 × 15 mm balloon and stented with 2 overlapping drug-eluting stents (2.5 × 38 mm and 3.0 × 38 mm) with excellent angiographic result and TIMI3 flow in all distal branches.\n\nDyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea.",
+    "translated_text": "৬৯ বছর বয়সী এক পুরুষ, যার CABG-এর পূর্ব ইতিহাস রয়েছে, ২ মাসের স্থায়িত্বের সামান্য পরিশ্রমে (NYHA III) তীব্র শ্বাসকষ্ট নিয়ে আমাদের কেন্দ্রে ভর্তি হন। ইলেক্ট্রোকার্ডিওগ্রামে লিড II, III, aVF, এবং V4-6-এ ST ডিপ্রেশন দেখা যায়, এবং রক্ত পরীক্ষায় প্লাজমা N-terminal pro-B-type natriuretic peptide মাত্রা বৃদ্ধি (2640 pg/mL) লক্ষ্য করা হয়। ইকোকার্ডিওগ্রামে বাম নিলয়ের সিস্টোলিক ডিসফাংশন এবং বাম নিলয়ের ইজেকশন ফ্র্যাকশন কম (30%) দেখা যায়। রোগীর ২০০৯ সালে, যখন তাঁর বয়স ছিল ৫৯ বছর, ইনফেরিয়র ST-segment-elevation মায়োকার্ডিয়াল ইনফার্কশন হয়, অ্যাঞ্জিওগ্রাফিতে তীব্র ৩-ধমনী রোগের প্রমাণসহ (করোনারি অ্যাঞ্জিওগ্রাফিতে প্রোক্সিমাল left anterior descending artery (LAD)-এ CTO, মিড ও ডিস্টাল left circumflex artery-এ ৯০% স্টেনোসিস, এবং মিড RCA-তে ৯৫% স্টেনোসিস দেখা যায়)। রোগী ২০০৯ সালে CABG করান—left internal mammary artery (LIMA) থেকে LAD-এ, এবং sequential SVG থেকে 1st obtuse marginal branch (OM1), 2nd obtuse marginal branch (OM2), ও posterolateral branch (PL)-এ।\n\n৬ ফ্রেঞ্চ (Fr) বাম রেডিয়াল আর্টারি অ্যাক্সেস দিয়ে করোনারি অ্যাঞ্জিওগ্রাফি করা হয় এবং LIMA to LAD ও SVG to OM1, OM2 কন্ডুইটগুলো প্যাটেন্ট ছিল, কিন্তু sequential SVG to PL কন্ডুইটটি সম্পূর্ণ অবরুদ্ধ ছিল। নেটিভ লেফট মেইন করোনারি আর্টারি অস্টিয়ামে অবরুদ্ধ ছিল এবং নেটিভ RCA মিড অংশে ব্রিজিং কোল্যাটেরালসসহ অবরুদ্ধ ছিল। আমরা নেটিভ RCA CTO চিকিৎসা করার সিদ্ধান্ত নেই। ডান ফেমোরাল আর্টারিতে আরেকটি ৬ Fr শীথ দিয়ে ডুয়াল আর্টেরিয়াল অ্যাক্সেস অর্জন করা হয়। বাম ও ডান করোনারি আর্টারিগুলো যথাক্রমে ৬ Fr AL 0.75 (Launcher; Medtronic; USA) এবং ৬ Fr EBU 3.5 (Launcher; Medtronic; USA) গাইড ক্যাথেটার দিয়ে ক্যানুলেট করা হয়। বাম রেডিয়াল আর্টারি দিয়ে অ্যান্টিগ্রেড অ্যাপ্রোচ চেষ্টা করা হয়; তবে, Finecross মাইক্রোক্যাথেটার (Terumo, Japan) সহ Fielder XTR ওয়্যার (Asahi Intec, Japan) বা Gaia 3 ওয়্যার (Asahi Intec, Japan) কোনোটিই ডিস্টাল RCA-র ট্রু লুমেনে পৌঁছাতে পারেনি। এরপর Crusade মাইক্রোক্যাথেটার (Kaneka, Japan) এবং দুইটি Gaia 3 ওয়্যার (Asahi Intec, Japan) দিয়ে প্যারালেল ওয়্যার টেকনিক চেষ্টা করা হলেও ব্যর্থ হয়। তাই আমরা অবরুদ্ধ বাম করোনারি আর্টারির মাধ্যমে LAD থেকে সেপটাল চ্যানেল ব্যবহার করে রেট্রোগ্রেড অ্যাপ্রোচে পরিবর্তন করি। Gaia 3 ওয়্যার (Asahi Intec, Japan) অবরুদ্ধ লেফট মেইন (LM) ও LAD অতিক্রম করে অবশেষে ডিস্টাল LAD-র ট্রু লুমেনে পৌঁছে। Finecross মাইক্রোক্যাথেটার (Terumo, Japan) দিয়ে Sion ওয়্যারটি ডিস্টাল LAD-এ এক্সচেঞ্জ করা হয়, এবং ২.০ × ১৫ মিমি বেলুন দিয়ে LM ও প্রোক্সিমাল LAD ডাইলেশন করা হয়। এরপর সেপটাল ক্রসিংয়ের জন্য সেপটাল সার্ফিং টেকনিক (SST) ব্যবহার করা হয়। আমরা প্রোক্সিমাল থেকে ডিস্টাল LAD-উৎপন্ন বিভিন্ন সেপটাল চ্যানেল চেষ্টা করি, এবং ১৫০-সেমি Finecross মাইক্রোক্যাথেটার (Terumo, Japan)-এর সহায়তায় ডিস্টাল সেপটাল ব্রাঞ্চ দিয়ে রেট্রোগ্রেড পদ্ধতিতে Sion ওয়্যার (Asahi Intec, Japan) ডিস্টাল RCA-তে পৌঁছে দেওয়া হয়। Gaia 3 ওয়্যার (Asahi Intec, Japan) রেট্রোগ্রেড পথে CTO লেশন অতিক্রম করে প্রোক্সিমাল RCA-র ট্রু লুমেনে প্রবেশ করে, এবং অ্যান্টিগ্রেড গাইডিং ক্যাথেটারে অবস্থানরত Guidezilla গাইড এক্সটেনশন ক্যাথেটার (Boston Scientific, USA)-এর মধ্যে অগ্রসর করা হয়। Finecross মাইক্রোক্যাথেটার (Terumo, Japan) অ্যান্টিগ্রেড ক্যাথেটারে পৌঁছে দেওয়া হয় এবং একটি RG3 ওয়্যার (Asahi Intec, Japan) এক্সটারনালাইজ করা হয়। এরপর CTO-কে ২.০ × ১৫ মিমি বেলুন দিয়ে প্রিডাইলেট করা হয় এবং ২টি ওভারল্যাপিং ড্রাগ-ইলিউটিং স্টেন্ট (২.৫ × ৩৮ মিমি এবং ৩.০ × ৩৮ মিমি) প্রতিস্থাপন করা হয়, চমৎকার এনজিওগ্রাফিক ফলাফল এবং সব ডিস্টাল শাখায় TIMI3 ফ্লো সহ।\n\nডিসচার্জের সময় শ্বাসকষ্ট উপশম হয়েছিল। ৬-মাস ফলো-আপে রোগীর শ্বাসকষ্টের পুনরাবৃত্তি হয়নি।"
+  },
+  {
+    "english_text": "A 51-year-old male patient presented to us with acute painful visual loss of his left eye (LE) from 3 days ago. The best-corrected distance visual acuity (BCDVA) was 20/20, and hand motion (HM) detection for the right eye (RE) and LE, respectively. The ocular movement was normal in both eyes. Anterior segment examination was unremarkable for both eyes. The LE fundus examination showed ONH swelling, choroidal bulging, multiple patches of subretinal fluid accumulation, and retinal pigment epithelial (RPE) corrugations. Fundus examination of the RE was unremarkable.\n\nWe used multimodal imaging including Optical coherence tomography (OCT) (OptoVue, Inc., Fremont, CA, USA, software version: 2018,0,0,18), fundus blue-autofluorescence (BAF), fluorescein angiography (FA) (Heidelberg Eye Explorer version 1.9.13.0, Spectralis Viewing Module 6.5.2.0; Heidelberg Engineering), Indocyanin green angiography (ICGA), and B-scan ultrasonography for further evaluation. Besides, orbital and brain MRIs with gadolinium enhancement were ordered. The OCT image revealed a mild RPE and choroidal bulging, RPE hyper-reflectivity with back shadowing, subretinal and intraretinal fluid accumulation, and mild retinal thickening. A geographic area of macular hypocyanescence was apparent in the ICGA image of the left eye. BAF showed a geographic area with a speckled autofluorescence pattern at the macula. Optic nerve enlargement was found in the B-scan ultrasonography. In FA images, vascular leakage was apparent at the ONH (hot disc). Besides, a geographic patchy hypofluorescent area with speckled hyperfluorescent margins with a size of three disc diameters (DD) was detected. Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement at the junction of the optic nerve and sclera. An oncology consultation was done with no remarkable finding.\n\nConsidering the suspicion of malignancy and the presence of an enhancing nodular mass in the orbit, the patient underwent transconjunctival lateral orbitotomy one week after the presentation. A pink localized scleral nodule with edematous tenon was found. Sub-tenon triamcinolone acetonide was injected with the clinical diagnosis of nodular posterior scleritis. The patient refused admission and intravenous corticosteroid injection as the treatment order. Oral prednisolone 50 mg/Kg was started. Rheumatology consultation and screening lab results, including PPD test (tuberculosis), chest X-ray, serum ACE level (sarcoidosis), and C-ANCA level (Wegner granulomatosis), were unremarkable. At the last follow-up examination (one week after the surgery), the patient’s BCDVA was 20/20, and counting fingers at 2 meters for the RE and LE, respectively. Furthermore, SRF was absorbed, and the macula became atrophic. Oral prednisolone was tapered off slowly for three months.",
+    "translated_text": "51 বছর বয়সী এক পুরুষ রোগী 3 দিন আগে থেকে বাম চোখে (LE) তীব্র বেদনাযুক্ত দৃষ্টিহানি নিয়ে আমাদের কাছে উপস্থিত হন. সর্বোত্তম সংশোধিত দূরদৃষ্টি তীক্ষ্ণতা (BCDVA) যথাক্রমে ডান চোখে (RE) 20/20 এবং বাম চোখে হাতের নড়াচড়া (HM) সনাক্তমাত্র ছিল. উভয় চোখে চোখের নড়াচড়া স্বাভাবিক ছিল. উভয় চোখের অ্যান্টেরিয়র সেগমেন্ট পরীক্ষা উল্লেখযোগ্য কিছু ছিল না. বাম চোখের ফান্ডাস পরীক্ষায় ONH স্ফীতি, কোরয়েডাল বাল্জিং, সাবরেটিনাল তরল সঞ্চয়ের একাধিক প্যাচ, এবং রেটিনাল পিগমেন্ট ইপিথেলিয়াম (RPE)-এ করুগেশন দেখা যায়. ডান চোখের ফান্ডাস পরীক্ষা উল্লেখযোগ্য কিছু দেখায়নি.\n\nঅধিকতর মূল্যায়নের জন্য আমরা মাল্টিমোডাল ইমেজিং ব্যবহার করেছি, যার মধ্যে ছিল Optical coherence tomography (OCT) (OptoVue, Inc., Fremont, CA, USA, software version: 2018,0,0,18), fundus blue-autofluorescence (BAF), fluorescein angiography (FA) (Heidelberg Eye Explorer version 1.9.13.0, Spectralis Viewing Module 6.5.2.0; Heidelberg Engineering), Indocyanin green angiography (ICGA), এবং B-scan ultrasonography. এছাড়া গাডোলিনিয়াম এনহ্যান্সমেন্টসহ অরবিটাল ও ব্রেইন MRI চাওয়া হয়েছিল. OCT চিত্রে মৃদু RPE এবং কোরয়েডাল বাল্জিং, ব্যাক শ্যাডোয়িংসহ RPE হাইপার-রিফ্লেক্টিভিটি, সাবরেটিনাল ও ইন্ট্রারেটিনাল তরল সঞ্চয়, এবং মৃদু রেটিনাল পুরু হওয়া লক্ষ্য করা যায়. বাম চোখের ICGA চিত্রে ম্যাকুলায় জিওগ্রাফিক হাইপোসায়ানেসেন্সের একটি এলাকা স্পষ্ট ছিল. BAF-এ ম্যাকুলায় স্পেকলড অটোফ্লুরোসেন্স প্যাটার্নসহ একটি জিওগ্রাফিক এলাকা দেখা গেছে. B-স্ক্যান আল্ট্রাসোনোগ্রাফিতে অপটিক নার্ভের বর্ধন পাওয়া গেছে. FA চিত্রে ONH-এ ভাসকুলার লিকেজ (হট ডিস্ক) স্পষ্ট ছিল. এছাড়া, 3 ডিস্ক ডায়ামিটার (DD) আকারের স্পেকলড হাইপারফ্লুরোসেন্ট মার্জিনযুক্ত জিওগ্রাফিক প্যাচি হাইপোফ্লুরোসেন্ট এলাকা সনাক্ত হয়েছিল. অরবিটাল ও ব্রেইন MRI-তে অপটিক নার্ভ ও স্ক্লেরার সংযোগস্থলে গাডোলিনিয়াম এনহ্যান্সমেন্টসহ রেট্রোবালবার নডিউলার ম্যাস দেখা গেছে. অনকোলজি কনসালটেশন করা হয়েছিল; উল্লেখযোগ্য কিছু পাওয়া যায়নি.\n\nম্যালিগন্যান্সির সন্দেহ এবং অরবিটে এনহ্যান্সিং নডিউলার ম্যাসের উপস্থিতি বিবেচনায়, প্রেজেন্টেশনের এক সপ্তাহ পর রোগীর ট্রান্সকনজাঙ্কটিভাল ল্যাটেরাল অরবিটোটমি করা হয়. এডেমাটাস টেননসহ গোলাপি রঙের লোকালাইজড স্ক্লেরাল নডিউল পাওয়া যায়. নডিউলার পোস্টেরিয়র স্ক্লেরাইটিসের ক্লিনিক্যাল নির্ণয়ের ভিত্তিতে সাব-টেনন ট্রায়ামসিনোলোন অ্যাসিটোনাইড ইনজেক্ট করা হয়. রোগী ভর্তির নির্দেশ এবং চিকিৎসা হিসেবে শিরায় কর্টিকোস্টেরয়েড ইনজেকশন গ্রহণে অস্বীকৃতি জানান. ওরাল প্রেডনিসোলোন 50 mg/Kg শুরু করা হয়. রিউমাটোলজি কনসালটেশন এবং স্ক্রিনিং ল্যাব ফলাফল, যেমন PPD টেস্ট (টিউবারকিউলোসিস), চেস্ট এক্স-রে, সিরাম ACE লেভেল (সারকয়ডোসিস), এবং C-ANCA লেভেল (ভেগেনার গ্রানুলোমাটোসিস), উল্লেখযোগ্য ছিল না. শেষ ফলো-আপ পরীক্ষায় (অস্ত্রোপচারের এক সপ্তাহ পরে) রোগীর BCDVA যথাক্রমে RE-তে 20/20 এবং LE-তে 2 মিটারে আঙুল গণনা ছিল. এছাড়া, SRF শোষিত হয়েছিল এবং ম্যাকুলা অ্যাট্রফিক হয়ে গেছে. ওরাল প্রেডনিসোলোন ধীরে ধীরে 3 মাস ধরে টেপার অফ করা হয়."
+  },
+  {
+    "english_text": "An elderly 78-year-old patient from the Amhara region of Ethiopia, who has had a permanent cardiac pacemaker for 7 years, was scheduled for retropubic prostatectomy due to benign prostatic hyperplasia (BPH). This condition developed following a previous transurethral resection of the prostate 3 months earlier. The patient in the preoperative anesthesia evaluation was fully evaluated, and all the routine investigations required for the proposed surgery, which were within normal limits, were investigated. The patient presented with a history of frequency, urgency, nocturia, and dribbling for the past 2 months. Additionally, the patient had been known to have hypertension for the past 16 years and was taking amlodipine 5 mg orally daily, enalapril 10 mg orally twice daily (BID), and atorvastatin 10 mg orally daily. He had also been known to have type II diabetes mellitus for the past 25 years and was on metformin 500 mg orally BID and neutral protamine Hagedorn (NPH) 20 IU and 10 IU. He was admitted to a hospital for further evaluation, and complete bundle branch block (BBB) was detected via electrocardiogram (ECG). In an electrophysiology study, the patient was diagnosed with left ventricular hypertrophy secondary to hypertensive heart disease, mild diastolic dysfunction, and an ejection fraction of 62%. Abdominal ultrasound revealed an enlarged prostate size of 82 ml; anterior–posterior (AP) chest X-ray revealed a normal chest region with a left-side pacemaker in situ, and all the other blood parameters, including electrolytes and serum troponin levels, were within normal limits.\n\nA cardiologist was involved preoperatively as a multidisciplinary approach and risk determination tool for cardiac risk assessment. The patient had a frailty score of 5.5 with a poor functional cardiopulmonary reserve of metabolic equivalent (MET) = 3.4 and Revised Cardiac Risk Index (RCRI) class III, which accounts for 10.1% of major cardiac adverse events (myocardial infarction [MI], cardiac arrest, or death) within 30 days of the postoperative period, and intermediate risk on the basis of surgery type and patient risk factors. After preoperative evaluation and risk disclosure regarding the un-reprogrammed pacemaker and the associated complications during anesthesia and surgery, the patient was unable to afford the necessary health coverage for pacemaker reprogramming. This is because the cardiac surgery was performed in Addis Ababa, Ethiopia, which has a long waiting list with few cardiac surgeons for millions of people and is a considerable distance from the patient’s home institution, and there is a period of monitoring after pacemaker reprogramming for considerable post-reprogramming complication. As a result, the patient chose to proceed with the surgery, accepting the potential risks and harm associated with the situation. Continuous cardiac monitoring during the intraoperative period is highly advocated. Despite these factors, the patient did not experience cardiorespiratory failure, and he was stable. The patient continued on medication until the day of surgery, which included amlodipine, enalapril, atorvastatin, and a morning lower dose of two-thirds of the NPH. He also took 5 mg of diazepam orally for anxiolytics at midnight before the day of surgery.\n\nOn the day of surgery, the patient’s random blood sugar (RBS) was measured, and sliding scale glycemic control was implemented. Communication among the anesthetist, surgeon, and nurses was emphasized, ensuring that the cautery pad was placed away from the pacemaker, and that emergency drugs and a defibrillator were ready. The patient was premedicated with dexamethasone for nausea prophylaxis and paracetamol for pain relief as preemptive analgesia. American Society of Anesthesiology (ASA) standard monitoring was applied, and baseline parameters were recorded. Combined epidural–spinal anesthesia was administered via 0.5% isobaric bupivacaine (12.5 mg) and 50 µg fentanyl at the L3–L4 interspace. The block achieved anesthesia up to the umbilicus, and the sensory block was performed at T7. The surgery involved a midline incision below the umbilicus, with monopolar cautery used at low voltage (20 mA). Hemostasis was achieved through bipolar low-voltage cautery. Throughout the procedure, the patient’s vital signs remained stable. The patient’s vital signs did not change by more than 10% from the baseline vital signs. The intravenous fluid was resuscitated intraoperatively. During the postoperative period, the patient was transferred to the postanesthesia care unit (PACU) with vigilant monitoring, and 10 ml of 0.125% epidural top-up analgesia was given. Postop investigations were within normal limits. The patient was observed in the PACU for 12 hours and later transferred to the ward in stable condition with regular follow-up with the cardiology team. After 88th day of postsurgery the patient was discharged and advised to have regular checkups for pacemaker’s in situ status.",
+    "translated_text": "ইথিওপিয়ার আমহারা অঞ্চলের ৭৮ বছর বয়সী এক প্রবীণ রোগী, যাঁর ৭ বছর ধরে স্থায়ী কার্ডিয়াক পেসমেকার রয়েছে, বিনাইন প্রোস্টেটিক হাইপারপ্লাসিয়া (BPH) জনিত কারণে রেট্রোপিউবিক প্রোস্টেটেক্টমির জন্য শিডিউল করা হয়েছিল। এই অবস্থা ৩ মাস আগে প্রোস্টেটের ট্রান্সইউরেথ্রাল রিসেকশনের পর বিকাশ লাভ করে। প্রি-অপারেটিভ অ্যানেস্থেসিয়া মূল্যায়নে রোগীকে সম্পূর্ণভাবে মূল্যায়ন করা হয়েছিল, এবং প্রস্তাবিত সার্জারির জন্য প্রয়োজনীয় সব রুটিন পরীক্ষা-নিরীক্ষা, যা স্বাভাবিক সীমার মধ্যে ছিল, সম্পন্ন করা হয়েছিল। গত ২ মাস ধরে রোগীর ফ্রিকোয়েন্সি, অর্জেন্সি, নক্টুরিয়া এবং ড্রিবলিংয়ের ইতিহাস ছিল। অতিরিক্তভাবে, রোগীর গত ১৬ বছর ধরে হাইপারটেনশন রয়েছে বলে জানা ছিল এবং তিনি অ্যামলোডিপিন 5 mg মুখে দৈনিক, এনালাপ্রিল 10 mg মুখে দিনে দুইবার (BID), এবং অ্যাটোরভাস্টাটিন 10 mg মুখে দৈনিক গ্রহণ করছিলেন। আরও জানা ছিল যে গত ২৫ বছর ধরে তাঁর টাইপ II ডায়াবেটিস মেলিটাস রয়েছে এবং তিনি মেটফরমিন 500 mg মুখে BID এবং নিউট্রাল প্রোটামিন হেজডর্ন (NPH) 20 IU এবং 10 IU-তে ছিলেন। তিনি আরও মূল্যায়নের জন্য একটি হাসপাতালে ভর্তি হন, এবং ইলেক্ট্রোকার্ডিওগ্রাম (ECG)-এ কমপ্লিট বান্ডল ব্রাঞ্চ ব্লক (BBB) সনাক্ত হয়। একটি ইলেক্ট্রোফিজিওলজি স্টাডিতে রোগীর হাইপারটেনসিভ হার্ট ডিজিজজনিত সেকেন্ডারি লেফট ভেন্ট্রিকুলার হাইপারট্রফি, মৃদু ডায়াস্টলিক ডিসফাংশন, এবং 62% ইজেকশন ফ্র্যাকশন নির্ণীত হয়। অ্যাবডোমিনাল আল্ট্রাসাউন্ডে 82 ml আকারের বর্ধিত প্রোস্টেট ধরা পড়ে; অ্যান্টেরিয়র–পোস্টেরিয়র (AP) চেস্ট এক্স-রেতে বাম পাশে ইন সিটু পেসমেকারসহ স্বাভাবিক চেস্ট রিজিয়ন দেখা যায়, এবং ইলেক্ট্রোলাইটস ও সিরাম ট্রোপোনিন মাত্রাসহ অন্যান্য সব রক্ত-পরামিতিও স্বাভাবিক সীমার মধ্যে ছিল।\n\nকার্ডিয়াক রিস্ক অ্যাসেসমেন্টের জন্য বহুবিষয়ক পদ্ধতির অংশ হিসেবে এবং ঝুঁকি নির্ধারণের একটি টুল হিসেবে প্রি-অপারেটিভ পর্যায়ে একজন কার্ডিয়োলজিস্টকে অন্তর্ভুক্ত করা হয়েছিল। রোগীর ফ্রেইলটি স্কোর ছিল 5.5, মেটাবলিক ইকুইভ্যালেন্ট (MET) = 3.4 সহ দুর্বল কার্যকরী কার্ডিওপালমোনারি রিজার্ভ, এবং রিভাইসড কার্ডিয়াক রিস্ক ইনডেক্স (RCRI) ক্লাস III, যা অপারেশন-পরবর্তী ৩০ দিনের মধ্যে প্রধান কার্ডিয়াক প্রতিকূল ঘটনার (মায়োকার্ডিয়াল ইনফার্কশন [MI], কার্ডিয়াক অ্যারেস্ট, বা মৃত্যু) 10.1% হিস্যারূপে গণ্য হয়, এবং সার্জারির ধরন ও রোগীর ঝুঁকি উপাদানের ভিত্তিতে ইন্টারমিডিয়েট রিস্কে পড়ে। প্রি-অপারেটিভ মূল্যায়ন ও অ্যানেস্থেসিয়া ও সার্জারির সময় রিপ্রোগ্রাম না করা পেসমেকারের ঝুঁকি ও সংশ্লিষ্ট জটিলতা সম্পর্কে অবহিতকরণের পর, পেসমেকার রিপ্রোগ্রামিংয়ের জন্য প্রয়োজনীয় স্বাস্থ্য কভারেজ বহন করার সামর্থ্য রোগীর ছিল না। কারণ কার্ডিয়াক সার্জারি অ্যাডিস আবাবা, ইথিওপিয়ায় করা হয়, যেখানে লক্ষ লক্ষ মানুষের জন্য অল্প সংখ্যক কার্ডিয়াক সার্জন সহ দীর্ঘ ওয়েটিং লিস্ট রয়েছে এবং যা রোগীর নিজস্ব প্রতিষ্ঠানের থেকে যথেষ্ট দূরত্বে, এবং পেসমেকার রিপ্রোগ্রামিংয়ের পরে সম্ভাব্য পোস্ট-রিপ্রোগ্রামিং জটিলতার জন্য একটি পর্যবেক্ষণকাল থাকে। ফলস্বরূপ, রোগী সম্ভাব্য ঝুঁকি ও ক্ষতি মেনে নিয়ে সার্জারি করার সিদ্ধান্ত নেন। ইন্ট্রাঅপারেটিভ সময়কাল জুড়ে ধারাবাহিক কার্ডিয়াক মনিটরিং জোরালোভাবে সুপারিশ করা হয়েছিল। এই সব সত্ত্বেও, রোগীর কার্ডিওরেসপিরেটরি ফেলিয়ার হয়নি, এবং তিনি স্থিতিশীল ছিলেন। রোগী সার্জারির দিন পর্যন্ত যে ওষুধগুলো নিয়েছিলেন, সেগুলোর মধ্যে ছিল অ্যামলোডিপিন, এনালাপ্রিল, অ্যাটোরভাস্টাটিন, এবং সকালে NPH-এর দুই-তৃতীয়াংশের নিম্ন ডোজ। তিনি সার্জারির আগের রাত ১২টায় উদ্বেগনাশক হিসেবে ডায়াজেপাম 5 mg মুখে গ্রহণ করেন।\n\nসার্জারির দিনে রোগীর র‌্যান্ডম ব্লাড সুগার (RBS) মাপা হয় এবং স্লাইডিং স্কেল গ্লাইসেমিক কন্ট্রোল প্রয়োগ করা হয়। অ্যানেস্থেটিস্ট, সার্জন ও নার্সদের মধ্যে যোগাযোগে গুরুত্ব আরোপ করা হয়, নিশ্চিত করা হয় যে কটারি প্যাডটি পেসমেকার থেকে দূরে স্থাপন করা হয়েছে, এবং জরুরি ওষুধ ও একটি ডিফিব্রিলেটর প্রস্তুত রয়েছে। রোগীকে বমি বমি ভাব প্রতিরোধের জন্য ডেক্সামেথাসোন এবং ব্যথা উপশমের জন্য প্রিএম্পটিভ অ্যানালজেসিয়া হিসেবে প্যারাসিটামল দিয়ে প্রিমেডিকেট করা হয়। আমেরিকান সোসাইটি অফ অ্যানেস্থেসিওলজি (ASA) স্ট্যান্ডার্ড মনিটরিং প্রয়োগ করা হয় এবং বেসলাইন প্যারামিটার রেকর্ড করা হয়। L3–L4 ইন্টারস্পেসে 0.5% আইসোবারিক বুপিভাকেইন (12.5 mg) এবং ফেন্টানিল 50 µg দিয়ে কম্বাইন্ড এপিডিউরাল–স্পাইনাল অ্যানেস্থেসিয়া দেওয়া হয়। ব্লকের অ্যানেস্থেসিয়া নাভি পর্যন্ত অর্জিত হয়, এবং সেন্সরি ব্লক T7-এ ছিল। সার্জারিতে নাভির নিচে মিডলাইন ইনসিশন করা হয়, এবং মনোপোলার কটারি নিম্ন ভোল্টেজে (20 mA) ব্যবহার করা হয়। বায়পোলার নিম্ন-ভোল্টেজ কটারির মাধ্যমে হিমোস্টেসিস অর্জিত হয়। প্রক্রিয়া জুড়ে রোগীর ভাইটাল সাইন স্থিতিশীল ছিল। রোগীর ভাইটাল সাইন বেসলাইনের তুলনায় 10% এর বেশি পরিবর্তিত হয়নি। ইন্ট্রাঅপারেটিভ সময়ে ইন্ট্রাভেনাস ফ্লুইড রিসাসিটেশন করা হয়েছিল। পোস্টঅপারেটিভ সময়ে, রোগীকে সজাগ মনিটরিংসহ পোস্টঅ্যানেস্থেসিয়া কেয়ার ইউনিট (PACU)-এ স্থানান্তর করা হয়, এবং 0.125% এপিডিউরাল 10 ml টপ-আপ অ্যানালজেসিয়া দেওয়া হয়। পোস্টঅপ ইনভেস্টিগেশন স্বাভাবিক সীমার মধ্যে ছিল। রোগীকে PACU-তে 12 ঘণ্টা পর্যবেক্ষণে রাখা হয় এবং পরে কার্ডিয়োলজি টিমের নিয়মিত ফলো-আপসহ স্থিতিশীল অবস্থায় ওয়ার্ডে স্থানান্তর করা হয়। অপারেশন-পরবর্তী ৮৮তম দিনে রোগীকে ছাড়পত্র দেওয়া হয় এবং পেসমেকারের ইন সিটু স্ট্যাটাসের নিয়মিত চেকআপ করতে পরামর্শ দেওয়া হয়।"
+  },
+  {
+    "english_text": "A 52-year-old woman referred to the urology clinic with urinary complaints. Her symptoms began three years ago with frequency, dysuria and dribbling. She also mentioned the frequent passage of red and black thread-like substances in her urine. Moreover, during these discharges, she had headache, fever and chills. Intermittent periurethral and genital itching was another complaint of hers. She had been treated by several specialists with the diagnosis of recurrent urinary tract infections, with no clinical improvement. The patient denied recent travel, camping, hiking, farming, swimming and insect bites. She had positive history of pilonidal sinus surgery and hysterectomy, 8 and 7 years earlier, respectively. Two years prior to the current visit, she had been hospitalized for assessment. On physical examination, she was well-appearing with normal vital signs. All her laboratory tests, including cell blood count, urine analysis and biochemistries were in normal ranges. Abdominopelvic computed tomography (CT) scan revealed no abnormalities. Hence, she underwent cystoscopy, which demonstrated erythema and hyperemia of the bladder mucosa, suspended debris, and dilation of the left ureteral orifice. During consultation with an infectious diseases’ specialist, schistosomiasis was suspected, Therefore, she was treated with Praziquantel with the appropriate dose and duration and was discharged from the hospital.\n\nHowever, her symptoms did not subside. She was revisited by another infectious disease specialist, who prescribed her ivermectin due to suspicion to urinary myiasis. Nevertheless, no improvement was observed. She was readmitted to undergo bladder irrigation with polyethylene glycol, but the bladder washfluid did not contain any visible larvae. This procedure was followed by a two-day hematuria with spontaneous cessation. She was discharged home and advised to repeat the urine analysis one months later. Her random urine analysis was normal, so she collected her 24-h urine and sent it to the laboratory for analysis, in which a live larva was demonstrated under light microscope by the pathologist. The larva was isolated and sent to an entomologist to be identified morphologically. Finally, it was determined that the larva belonged to the species Sarcophaga. The patient was advised to take personal hygiene and consume at least 3 L of water daily.",
+    "translated_text": "৫২ বছর বয়সী এক নারীকে মূত্রবিজ্ঞান ক্লিনিকে মূত্রজনিত অভিযোগ নিয়ে রেফার করা হয়েছিল। তাঁর উপসর্গগুলো তিন বছর আগে ফ্রিকোয়েন্সি, ডাইসুরিয়া এবং ড্রিবলিং দিয়ে শুরু হয়েছিল। তিনি প্রস্রাবে লাল ও কালো সুতোর মতো পদার্থ ঘনঘন নির্গমনের কথাও উল্লেখ করেন। তদুপরি, এসব নির্গমনের সময় তাঁর মাথাব্যথা, জ্বর ও কাঁপুনি হতো। অনিয়মিত পেরিউরেথ্রাল ও জেনিটাল চুলকানি তাঁর আরেকটি অভিযোগ ছিল। পুনরাবৃত্ত মূত্রনালীর সংক্রমণ নির্ণয়ে একাধিক বিশেষজ্ঞের মাধ্যমে চিকিৎসা দেওয়া হলেও কোনো ক্লিনিক্যাল উন্নতি হয়নি। রোগিনী সাম্প্রতিক ভ্রমণ, ক্যাম্পিং, হাইকিং, কৃষিকাজ, সাঁতার এবং পোকামাকড়ের কামড় অস্বীকার করেছেন। তাঁর পাইলোনাইডাল সাইনাস অস্ত্রোপচার এবং হিস্টেরেকটমির ইতিবাচক অতীত ইতিহাস ছিল, যথাক্রমে ৮ ও ৭ বছর আগে। বর্তমান ভিজিটের দুই বছর আগে মূল্যায়নের জন্য তাঁকে হাসপাতালে ভর্তি করা হয়েছিল। শারীরিক পরীক্ষায় তিনি সুস্বাস্থ্যের দেখাচ্ছিলেন এবং ভাইটাল সাইনস স্বাভাবিক ছিল। সেল ব্লাড কাউন্ট, ইউরিন অ্যানালাইসিস ও বায়োকেমিস্ট্রি সহ সকল ল্যাবরেটরি পরীক্ষার ফল স্বাভাবিক সীমার মধ্যে ছিল। অ্যাবডোমিনোপেলভিক কম্পিউটেড টমোগ্রাফি (CT) স্ক্যানে কোনো অস্বাভাবিকতা পাওয়া যায়নি। ফলে সিস্টোস্কোপি করা হয়, যাতে ব্লাডার মিউকোসার ইরাইথিমা ও হাইপারেমিয়া, সাসপেন্ডেড ডেব্রিস, এবং বাম ইউরেটেরাল অরিফাইসের প্রসারণ দেখা যায়। সংক্রামক রোগ বিশেষজ্ঞের সাথে পরামর্শকালে শিস্টোসোমিয়াসিস সন্দেহ করা হয়েছিল, অতএব, উপযুক্ত ডোজ ও সময়কাল অনুযায়ী প্রাজিকুয়ান্টেল দিয়ে চিকিৎসা করা হয় এবং তাঁকে হাসপাতাল থেকে ছেড়ে দেওয়া হয়।\n\nতবে তাঁর উপসর্গগুলোর উপশম হয়নি। তাঁকে আরেকজন সংক্রামক রোগ বিশেষজ্ঞ পুনরায় দেখেন, যিনি ইউরিনারি মিয়াসিসের সন্দেহে আইভারমেকটিন প্রেসক্রাইব করেন। তবুও কোনো উন্নতি দেখা যায়নি। পলিইথিলিন গ্লাইকল দিয়ে ব্লাডার ইরিগেশন করার জন্য তাঁকে পুনরায় ভর্তি করা হয়, কিন্তু ব্লাডার ওয়াশফ্লুইডে কোনো দৃশ্যমান লার্ভা পাওয়া যায়নি। এই প্রক্রিয়ার পর পরবর্তী দুই দিন হেমাটুরিয়া হয়েছিল যা স্বতঃস্ফূর্তভাবে বন্ধ হয়ে যায়। তাঁকে বাড়ি পাঠানো হয় এবং এক মাস পর ইউরিন অ্যানালাইসিস পুনরায় করতে পরামর্শ দেওয়া হয়। তাঁর র‍্যান্ডম ইউরিন অ্যানালাইসিস স্বাভাবিক ছিল, তাই তিনি ২৪-ঘণ্টার মূত্র সংগ্রহ করে বিশ্লেষণের জন্য ল্যাবরেটরিতে পাঠান, যেখানে প্যাথোলজিস্ট লাইট মাইক্রোস্কোপে একটি জীবিত লার্ভা প্রদর্শন করেন। লার্ভাটি পৃথক করে মর্ফোলজিকাল শনাক্তকরণের জন্য একজন এন্টোমোলজিস্টের নিকট পাঠানো হয়। শেষ পর্যন্ত নির্ধারিত হয় যে লার্ভাটি Sarcophaga প্রজাতির। রোগিনীকে ব্যক্তিগত স্বাস্থ্যবিধি মেনে চলা এবং দৈনিক অন্তত ৩ লিটার পানি পান করার পরামর্শ দেওয়া হয়।"
+  },
+  {
+    "english_text": "A 36-year-old female patient with a history of ulcerative colitis and good disease control on sulfasalazine, ferrous fumarate and intermittent prednisone for flare-ups is presented.\n\nHe was admitted to the emergency unit with a 1 week history of progressive oppressive precordial pain associated with dyspnea and neurovegetative symptoms. On admission, an electrocardiogram was performed in sinus rhythm, with finding of supradesnivel of the ST segment in the lower wall.\n\nThe patient reported a 6-month history of general disorders, fatigue and night sweats. She had previously presented episodes of precordial pain in relation to effort that progressed to rest. The physical examination was without murmurs or alterations of the peripheral pulses.\n\nAn emergency coronary angiography was performed, which revealed severe 2-vessel disease: severe ostial lesion 90% in the left coronary trunk and severe subocclusive lesion 99-100% at the ostial level in the right coronary artery (culprit vessel). Primary angioplasty of the right coronary artery was performed with successful installation of a medicated stent. The hemodynamicist was impressed by a possible aortitis due to involvement of the arch and friability of the vessels when the balloon was advanced, so he suggested an etiological study oriented to inflammatory disease, prior to surgical resolution of the lesion of the left coronary trunk.\n\nLaboratory tests showed mild anaemia (haemoglobin: 11.6 g/dL), mild leukocytosis (13,800/mm3), elevated erythrocyte sedimentation rate (ESR): 42 mm/h and C-reactive protein (CRP): 4.9 mg/L (normal value <1) and elevated ultrasensitive troponin. From the autoimmunity study, normal levels of complement C3 and C4, negative anti-nuclear antibodies (ANA), anti-DNA, negative extracellular nuclear antigen (ENA) profile and non-reactive VDRL were rescued.\n\nCardiac magnetic resonance (MRI) with contrast was completed with findings of acute infarction of the left ventricular inferior wall non-transmural myocardium and subendocardial ischemia in the anteroseptoapical resting of the left ventricle. Mild aortic and mitral insufficiency. Preserved biventricular systolic function.\n\nComputed tomography angiography (CTA) of the chest, abdomen and pelvis showed periaortic fibrotic wall thickening involving the root, aortic arch and abdominal aorta with severe left coronary trunk stenosis and mild left subclavian, left vertebral artery stenosis and severe lower mesenteric artery stenosis. Immune globulin G (IgG) 4 deposition disease or Takayasu's arteritis was suggested.\n\nWithin the differential diagnosis study, IgG levels were performed at 1,600 mg/dl (reference values: 700-1,600), and its subclasses: IgG1: 1024 mg/dl (elevated), and the rest in normal range (IgG2: 456 mg/dl; IgG3: 98.8 mg/dl and IgG4: 13.6 mg/dl).\n\nTakayasu arteritis was diagnosed clinically and by imaging and treatment was initiated with prednisone 60 mg daily, methotrexate 20 mg weekly by injection and folic acid 1 mg daily. After 3 weeks of treatment she underwent myocardial revascularisation surgery with use of the left internal mammary artery (LIMA) as a graft to the descending anterior artery (DA) and aortocoronary bypass to circumflex artery. It was noted intraoperatively that the root of the aorta and the ascending aorta presented a healthy appearance. The patient is currently at home in good general condition and under ambulatory follow-up.\n",
+    "translated_text": "৩৬ বছর বয়সী মহিলা রোগী, যার আলসারেটিভ কোলাইটিসের ইতিহাস রয়েছে এবং সুলফাসালাজিন, ফেরাস ফিউমারেট এবং ফ্লেয়ার-আপের ক্ষেত্রে অন্তর্বর্তী প্রেডনিসোনে রোগ নিয়ন্ত্রণ ভালো রয়েছে, উপস্থাপিত হলেন।\n\nতাকে জরুরি বিভাগে ভর্তি করা হয়েছিল 1 সপ্তাহের ক্রমবর্ধমান চাপধরনের প্রিকর্ডিয়াল ব্যথার ইতিহাসসহ, যা শ্বাসকষ্ট ও নিউরোভেজেটেটিভ উপসর্গের সাথে সম্পর্কিত ছিল। ভর্তি সময় সাইনাস রিদমে একটি ইলেক্ট্রোকার্ডিওগ্রাম করা হয়, যেখানে নিম্ন প্রাচীরে ST সেগমেন্টের উত্থান পাওয়া যায়।\n\nরোগী 6 মাসের সাধারণ অসুস্থতা, ক্লান্তি এবং রাতের ঘামের ইতিহাস জানান। পূর্বে পরিশ্রম-সম্পর্কিত প্রিকর্ডিয়াল ব্যথার এপিসোড ছিল যা বিশ্রামকালেও অগ্রসর হয়েছিল। শারীরিক পরীক্ষায় কোনো মর্মর শোনা যায়নি বা পেরিফেরাল পালসে কোনো পরিবর্তন ছিল না।\n\nজরুরি কোরোনারি এনজিওগ্রাফি করা হয়, যাতে গুরুতর 2-নালী রোগ ধরা পড়ে: বাম কোরোনারি ট্রাঙ্কে 90% গুরুতর অস্টিয়াল ক্ষত এবং ডান কোরোনারি ধমনীর অস্টিয়াল স্তরে 99–100% গুরুতর সাবঅক্লুসিভ ক্ষত (culprit vessel)। ডান কোরোনারি ধমনীর প্রাইমারি এনজিওপ্লাস্টি করা হয় এবং সফলভাবে একটি মেডিকেটেড স্টেন্ট স্থাপন করা হয়। বেলুন অগ্রসর করার সময় আর্চের সম্পৃক্ততা ও ধমনীগুলোর ভঙ্গুরতার কারণে সম্ভাব্য অর্টাইটিস সম্পর্কে হেমোডাইনামিক বিশেষজ্ঞের ধারণা হয়, তাই বাম কোরোনারি ট্রাঙ্কের ক্ষতের শল্য সমাধানের পূর্বে প্রদাহজনিত রোগের দিকে নির্দেশিত একটি ইতিয়োলজিক স্টাডি প্রস্তাব করেন।\n\nল্যাবরেটরি পরীক্ষায় হালকা অ্যানিমিয়া (হিমোগ্লোবিন: 11.6 g/dL), হালকা লিউকোসাইটোসিস (13,800/mm3), বর্ধিত ইরিথ্রোসাইট সেডিমেন্টেশন রেট (ESR): 42 mm/h এবং সি-রিঅ্যাকটিভ প্রোটিন (CRP): 4.9 mg/L (স্বাভাবিক মান <1) এবং আল্ট্রাসেনসিটিভ ট্রোপোনিন বৃদ্ধি পাওয়া যায়। অটোইমিউনিটি স্টাডিতে কমপ্লিমেন্ট C3 ও C4 স্বাভাবিক, অ্যান্টি-নিউক্লিয়ার অ্যান্টিবডি (ANA), অ্যান্টি-DNA নেগেটিভ, এক্সট্রাসেলুলার নিউক্লিয়ার অ্যান্টিজেন (ENA) প্রোফাইল নেগেটিভ এবং VDRL নন-রিঅ্যাকটিভ পাওয়া যায়।\n\nকনট্রাস্টসহ কার্ডিয়াক ম্যাগনেটিক রেজোন্যান্স (MRI) করা হয়, যাতে বাম ভেন্ট্রিকলের নিম্ন প্রাচীরের নন-ট্রান্সমিউরাল মায়োকার্ডিয়ামের তীব্র ইনফার্কশন এবং বাম ভেন্ট্রিকলের অ্যান্টেরোসেপ্টোঅ্যাপিক্যাল অঞ্চলে বিশ্রাম অবস্থায় সাবএন্ডোকার্ডিয়াল ইস্কেমিয়া পাওয়া যায়। মৃদু অর্টিক ও মাইট্রাল অপর্যাপ্ততা। বাইভেন্ট্রিকুলার সিস্টোলিক ফাংশন সংরক্ষিত।\n\nবক্ষ, উদর ও পেলভিসের কম্পিউটেড টোমোগ্রাফি এনজিওগ্রাফি (CTA) তে রুট, অর্টিক আর্চ ও অ্যাবডোমিনাল অর্টা জড়িত করে পেরি-অর্টিক ফাইব্রোটিক প্রাচীর পুরু হওয়া দেখা যায়, সঙ্গে বাম কোরোনারি ট্রাঙ্কের গুরুতর স্টেনোসিস এবং বাম সাবক্লেভিয়ান, বাম ভার্টিব্রাল ধমনীর হালকা স্টেনোসিস ও নিম্ন মেসেনটেরিক ধমনীর গুরুতর স্টেনোসিস। ইমিউন গ্লোবিউলিন G (IgG)4 ডিপোজিশন ডিজিজ অথবা তাকায়াসু আর্টেরাইটিস প্রস্তাব করা হয়।\n\nডিফারেনশিয়াল ডায়াগনোসিসের অংশ হিসেবে IgG মাত্রা 1,600 mg/dl (রেফারেন্স মান: 700–1,600) এবং এর সাবক্লাসসমূহ: IgG1: 1024 mg/dl (উচ্চ), এবং বাকিগুলি স্বাভাবিক সীমায় (IgG2: 456 mg/dl; IgG3: 98.8 mg/dl এবং IgG4: 13.6 mg/dl) পরিমাপ করা হয়।\n\nতাকায়াসু আর্টেরাইটিস ক্লিনিক্যালি ও ইমেজিং দ্বারা নির্ণয় করা হয় এবং চিকিৎসা শুরু করা হয় প্রেডনিসোন 60 mg দৈনিক, মেথোট্রেক্সেট 20 mg সাপ্তাহিক ইনজেকশন দ্বারা এবং ফোলিক অ্যাসিড 1 mg দৈনিক। চিকিৎসার 3 সপ্তাহ পর তিনি মায়োকার্ডিয়াল রিভাসকুলারাইজেশন সার্জারি করান, যেখানে বাম ইন্টারনাল ম্যামারি আর্টারি (LIMA) ডিসেন্ডিং অ্যান্টেরিয়র আর্টারি (DA)-তে গ্রাফট হিসেবে ব্যবহার করা হয় এবং সার্কামফ্লেক্স ধমনীতে অর্টোকরোনারি বাইপাস করা হয়। ইন্ট্রাঅপারেটিভভাবে লক্ষ্য করা হয় যে অর্টার রুট এবং এসেন্ডিং অর্টা সুস্থ চেহারা প্রদর্শন করেছে। রোগী বর্তমানে বাড়িতে ভালো সামগ্রিক অবস্থায় আছেন এবং অ্যাম্বুলেটরি ফলো-আপে আছেন।"
+  },
+  {
+    "english_text": "A 36-year-old female patient complained of dysphagia with longstanding cervical and upper thoracic pain. She also had a multinodular goiter with no other significant history. Esophagogastroduodenal transit was performed. It showed a posterior and lateral right impression of the proximal esophagus after ingestion of baryte, extending 3.5 cm cephalocaudal. A maximum esophageal stenosis of 60% was estimated. A cervical and thoracic CT scan revealed a congenital anomaly of the aortic arch: a mirror image of the right aortic arch. The aortic arch originates from the root of the aorta and runs above the right stem bronchus, giving rise to the three supra-aortic trunks as follows: the first is the left brachiocephalic artery (which gives rise to the left common carotid artery and the left subclavian artery); the second is the right common carotid artery; and the third is the right subclavian artery. The aortic arch then enters posteriorly to the esophagus and gives rise to a small anterior saccule of 1.3 cm, known as the Kommerell diverticulum. This configuration forms a ring around the tracheo-esophageal pair, whose edges are formed posterior-lateral to the right by the aortic arch, posterior-lateral to the left by the Kommerell diverticulum, lateral to the left by the arteriosum ligamentum (or arterial ligament), and anteriorly by the left brachiocephalic artery. A gastroscopy confirmed the endoluminal impact of extrinsic compression. In view of minimal clinical repercussions and the absence of nutritional disorders, no surgical cure was ultimately performed. The evolution was favorable with, according to the patient, a spontaneous amelioration of symptoms.\n",
+    "translated_text": "৩৬ বছর বয়সী এক মহিলা রোগী দীর্ঘস্থায়ী সার্ভাইক্যাল ও উপরের থোরাসিক ব্যথাসহ ডিসফেজিয়ার অভিযোগ করেছিলেন। তার মাল্টিনোডুলার গয়টারও ছিল এবং অন্য কোনো তাৎপর্যপূর্ণ পূর্ব ইতিহাস ছিল না। ইসোফ্যাগোগ্যাস্ট্রোডুডেনাল ট্রানজিট করা হয়েছিল। এটি বারাইট গ্রহণের পর প্রোক্সিমাল ইসোফ্যাগাসে ডানদিকে পশ্চাৎ ও ল্যাটেরাল ইমপ্রেশন দেখায়, যা সেফালো-কডালভাবে ৩.৫ সেমি পর্যন্ত বিস্তৃত। ইসোফ্যাজিয়াল স্টেনোসিসের সর্বাধিক মাত্রা আনুমানিক ৬০% হিসেবে নির্ধারিত হয়েছিল। সার্ভাইক্যাল ও থোরাসিক সিটি স্ক্যানে এওর্টিক আর্চের একটি জন্মগত অস্বাভাবিকতা প্রকাশ পায়: ডান এওর্টিক আর্চের একটি মিরর-ইমেজ। এওর্টিক আর্চ এওর্টার রুট থেকে উৎপত্তি নিয়ে ডান প্রধান ব্রঙ্কাসের উপরে দিয়ে অগ্রসর হয় এবং নিম্নরূপ তিনটি সুপ্রা-এওর্টিক ট্রাঙ্ক উৎপন্ন করে: প্রথমটি হলো বাম ব্র্যাকিওসেফালিক ধমনি (যা থেকে বাম কমন ক্যারোটিড ধমনি এবং বাম সাবক্লেভিয়ান ধমনি উৎপন্ন হয়); দ্বিতীয়টি হলো ডান কমন ক্যারোটিড ধমনি; এবং তৃতীয়টি হলো ডান সাবক্লেভিয়ান ধমনি। এরপর এওর্টিক আর্চ ইসোফ্যাগাসের পশ্চাতে প্রবেশ করে এবং ১.৩ সেমি আকারের একটি ছোট অ্যান্টেরিয়র স্যাকিউল সৃষ্টি করে, যা কোমেরেল ডাইভার্টিকুলাম নামে পরিচিত। এই বিন্যাসটি ট্রাকিও-ইসোফ্যাজিয়াল যুগলের চারদিকে একটি রিং সৃষ্টি করে, যার প্রান্তসমূহ গঠিত হয়েছে ডানদিকে পোস্টেরিয়র-ল্যাটেরালভাবে এওর্টিক আর্চ দ্বারা, বামদিকে পোস্টেরিয়র-ল্যাটেরালভাবে কোমেরেল ডাইভার্টিকুলাম দ্বারা, বামদিকে ল্যাটেরালভাবে লিগামেন্টাম আর্টেরিওসাম (বা আর্টেরিয়াল লিগামেন্ট) দ্বারা, এবং অ্যান্টেরিয়রভাবে বাম ব্র্যাকিওসেফালিক ধমনি দ্বারা। একটি গ্যাস্ট্রোস্কপি এক্সট্রিনসিক কমপ্রেশনের এন্ডোলুমিনাল প্রভাব নিশ্চিত করেছে। ন্যূনতম ক্লিনিক্যাল প্রতিক্রিয়া এবং পুষ্টিজনিত ব্যাধির অনুপস্থিতি বিবেচনায়, শেষ পর্যন্ত কোনো সার্জিক্যাল চিকিৎসা করা হয়নি। রোগের গতিপ্রকৃতি অনুকূল ছিল এবং রোগীর মতে উপসর্গগুলির স্বতঃস্ফূর্ত উন্নতি হয়েছে।"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/old2/translation_en2ch_v1.json b/data/translated_data/old2/translation_en2ch_v1.json
new file mode 100644
index 0000000000000000000000000000000000000000..98dd879afb8802f814f198b8c439bb9ec971974a
--- /dev/null
+++ b/data/translated_data/old2/translation_en2ch_v1.json
@@ -0,0 +1,62 @@
+[
+  {
+    "english_text": "A 20-year-old woman was followed up since the age of eight for idiopathic NS inaugurated by cerebral venous thrombosis extended to the right jugular vein with a massive pulmonary embolism. The patient did not have any sequelae. She had no other medical or surgical history. A family history of thrombosis has not been reported. The patient was not biopsied because she had no kidney failure nor gross hematuria, or hypertension at first presentation; added to that, she had no extra renal signs suggestive of a secondary nephrotic syndrome. She was accordingly put on anticoagulant therapy (Oral vitamin K antagonist) and oral corticosteroid therapy with good evolution. Thereafter, the patient received several cures of high-dose corticosteroids for steroid-dependent relapses of NS. She was, hence, put on mycophenolate mofetil (MMF) as a background therapy to avoid corticosteroids and ensure normal growth. An exhaustive assessment of thrombophilia was performed and did not show any abnormality. Homocysteine rate, blood fibrinogen rate, Protein C, protein S, antithrombin III, factor V Leiden mutation, JAK-2 mutation, cryoglobulins, anticardiolipin antibodies, lupus anticoagulant and beta-1-glycoprotein antibodies were normal. The anticoagulant treatment was stopped after nine years. The evolution was enameled by the occurrence of several relapses of her disease controlled by oral corticosteroid therapy. Remission of NS has been noted since 2017, so MMF was gradually stopped in 2019 and the patient remained asymptomatic and without any relapse.\n\nOne year later, the patient came up to our emergency department for acute intense diffuse abdominal pain without any particular irradiation associated with postprandial vomiting and bilateral lower limb edema for the last six hours. The physical examination revealed an intense epigastric tenderness with normal vital signs (arterial pressure of 120/70 mm Hg, heart rate of 83 bpm, and oxygen saturation at 100% on room air). The patient was afebrile with normal consciousness. The rest of the physical examination was unremarkable. The urinalysis with labstix revealed proteinuria. The hemogasanalysis results showed metabolic acidosis with respiratory compensation. Further laboratory tests revealed hypoalbuminemia, hypercholesterolemia, a prothrombin time at 90%, high levels of D-dimer, lactate dehydrogenase, and creatine phosphokinase as well as a biological inflammatory syndrome with a CRP of 37 mg/L, and leucocytosis at 26.4 x 103/µL. Renal and liver functions were normal.\n\nThe patient was hospitalized in an intensive care unit with close monitoring of vital signs and initiation of resuscitation measures. An abdominal ultrasound was performed urgently showing an intra-abdominal effusion of low to moderate abundance. An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery with acute mesenteric ischemia. The patient was immediately routed to the operating room. Intraoperative exploration confirmed mesenteric ischemia with extensive necrosis of almost entirely of the small bowel making their resections incompatible with life shown in Figure 3. The patient died after 48 hours.",
+    "translated_text": "一名20岁女性自8岁起因特发性肾病综合征（NS）随访，起病为脑静脉血栓形成并延伸至右颈静脉，合并大面积肺栓塞。患者未遗留任何后遗症。无其他内科或外科既往史。无血栓家族史。初诊时患者无肾功能衰竭、无肉眼血尿或高血压；此外，无提示继发性肾病综合征的肾外表现，故未行肾活检。据此给予抗凝治疗（口服维生素K拮抗剂）及口服糖皮质激素治疗，病情进展良好。随后因NS激素依赖性复发多次接受大剂量糖皮质激素治疗。此后予以吗替麦考酚酯（MMF）作为基础治疗，以避免糖皮质激素并确保正常生长。行全面的血栓前状态评估未见异常。同型半胱氨酸、血纤维蛋白原、蛋白C、蛋白S、抗凝血酶III、凝血因子V Leiden突变、JAK-2突变、冷球蛋白、抗心磷脂抗体、狼疮抗凝物以及β1-糖蛋白抗体均正常。抗凝治疗于9年后停止。此后病程中发生多次复发，均经口服糖皮质激素控制。自2017年起NS进入缓解，2019年逐渐停用MMF，患者保持无症状且未再复发。\n\n一年后，患者因急性剧烈弥漫性腹痛（无明显放射）伴餐后呕吐及双下肢水肿6小时来我院急诊就诊。体格检查示上腹部明显压痛，生命体征正常（血压120/70 mmHg，心率83次/分，室内空气血氧饱和度100%）。无发热，意识清楚。其余体格检查无特殊。尿试纸检查提示蛋白尿。血气分析示代谢性酸中毒伴呼吸性代偿。进一步实验室检查示低白蛋白血症、高胆固醇血症、凝血酶原时间为90%、D-二聚体、乳酸脱氢酶及肌酸磷酸激酶升高，并有炎症反应：CRP 37 mg/L，白细胞增多为26.4 x 10^3/µL。肝肾功能正常。\n\n患者收入重症监护病房，严密监测生命体征并启动复苏措施。紧急腹部超声提示腹腔内少至中等量积液。腹部CT显示上肠系膜动脉急性血栓形成并急性肠系膜缺血。患者即刻转入手术室。术中探查证实肠系膜缺血，几乎全小肠广泛坏死，其切除与生命不相容，见图3。患者于48小时后死亡。"
+  },
+  {
+    "english_text": "We present the case of a 34-year-old woman, eight weeks pregnant with no other personal history of interest, who presents to the emergency department with generalized convulsions with dysarthria in the postcritical period, which resolve progressively in less than two hours. On physical examination, she is conscious, oriented, with no language or motor or sensory deficits. Only signs of a right lateral tongue bite are observed.\n\nThe complementary tests, such as blood tests or the electrocardiogram, are normal. Given that the episode corresponds with a first epileptic seizure and the patient is pregnant, an urgent magnetic resonance of the skull is requested.\n\nThe usual protocol was performed and 3D T1 sequences without and with intravenous contrast were obtained in axial, coronal and sagital planes, axial FLAIR, axial T2, VEN BOLD and magnetic susceptibility sequences, as well as axial diffusion and apparent diffusion coefficient map. The MRI identified multiple venous cortico-medullary vascular structures converging centripetally to a large central venous structure draining through the inferior anastomotic vein into the left transverse sinus, forming the classic ‘Medusa head’ sign. In the T1 sequences, the drainage vein was seen to be increased in signal with central hyphocaptation after contrast administration, suggesting partial thrombosis versus slow flow. In addition, in T2 and FLAIR sequences, the brain tissue surrounding the drainage vein was seen to be hyperintense, without diffusion restriction and compatible with edema.\n\nThese findings are suggestive of a venous anomaly of development with signs of partial peripheral thrombosis and slow flow more proximal, which cause edema of the surrounding tissue. She is started on clexane 60 mg/12 hours and levetiracetam 500 mg/12 hours and the patient shows improvement and symptomatic stability after one week.\n",
+    "translated_text": "我们报告一例34岁女性，孕8周，既往无其他值得关注的个人病史，因全身性惊厥，发作后期伴构音障碍就诊急诊，症状在不足两小时内逐渐缓解。查体：神志清楚，定向力正常，无语言、运动或感觉障碍。仅见右侧舌侧缘咬伤体征。\n\n血液检查、心电图等辅助检查均正常。鉴于此次发作为首发癫痫发作且患者处于妊娠期，申请紧急颅脑磁共振检查。\n\n按常规流程完成检查，获得轴位、冠状位及矢状位的三维T1序列（静脉注射对比剂前后）、轴位FLAIR、轴位T2、VEN BOLD及磁敏感序列，以及轴位弥散加权成像和表观弥散系数图。MRI显示多条皮质—髓质静脉血管结构向心性汇聚至一条较大的中央静脉结构，经下交通静脉引流入左侧横窦，形成典型的“美杜莎头”征。在T1序列上，可见引流静脉信号增高，增强后中央低强化，提示部分血栓形成或血流缓慢。此外，在T2及FLAIR序列上，引流静脉周围脑实质呈高信号，未见弥散受限，符合水肿。\n\n上述发现提示发育性静脉异常，伴周围部分性血栓形成及近端更为缓慢的血流征象，导致周围组织水肿。予以克赛 60 mg/12小时及左乙拉西坦 500 mg/12小时治疗，一周后患者改善并症状稳定。"
+  },
+  {
+    "english_text": "A 22-year-old woman came to the Department of Oral Medicine with complaints of mouth ulcers causing pain and eating and drinking difficulty persisting for a duration of one month. This condition begins with a fever and appears like pimples on the lips. Based on the anamnesis, it was discovered that she had been using pod-type vapes for about a year but had never experienced complaints like when she came for treatment. She had never smoked traditional cigarettes before starting to vape. She said the reason for trying vaping was out of curiosity, and she quite often tried different types of e-liquid with different flavors. Before her complaint, she had simply changed the type of e-liquid to a different flavor without mentioning the brand. She vapes almost every day, but not all day, only in her free time or with friends. She was a healthy individual, and before this condition appeared, she had no history of taking medications, including antibiotics, analgesics, anticonvulsants, non-steroidal anti-inflammatory drugs, and antifungals. She also had no history of drug or food allergies, but the patient has unhealthy eating habits (eating irregularly and not consuming vegetables and fruit). Extraoral examination showed no lesions on other parts of the body, while the lips of the patient had serosanguineous crusts and an erosive area at the corner of the mouth, and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges, irregular, varying sizes, and pain on the labial, buccal, lateral, and ventral mucosa of the tongue and floor of the mouth.\n\nBased on the medical history of the patient and physical examination, which revealed oral mucosal involvement but no symptoms elsewhere in the body, as well as the non-reactive anti-HSV1 IgG results, the diagnosis of vaping-related oral erythema multiforme was established. The medical condition has been classified as minor erythema multiforme. The oral conditions were treated with 0.9% NaCl, which was moistened in gauze and placed on the lips three times a day. The patient was instructed to gargle 1 mg of dexamethasone in 10 mL of hyaluronic acid three times a day and avoid eating or drinking for at least 30 minutes after gargling. She was also given 2% miconazole cream applied to the wound in the right corner of the mouth twice a day, as well as vaseline album cream for dry lips. To maintain good oral hygiene, she was advised to brush her teeth and tongue twice a day, after breakfast and before bed. She was also instructed to stop vaping and avoid foods containing monosodium glutamate (MSG). The control was carried out after a week following therapy and showed that oral condition had improved. Written informed consent for the publication of details was obtained from the patient. This case report conformed with the Helsinki Declaration. The publication of this case report has also been approved by the institution.",
+    "translated_text": "一名22岁女性就诊于口腔内科，主诉口腔溃疡致疼痛及进食饮水困难，已持续1个月。该情况起病以发热为先，唇部出现类似粉刺样丘疹。根据病史采集，发现其使用烟弹式电子烟约1年，但此前从未出现此次就诊时的类似不适。在开始使用电子烟之前，她从未吸过传统香烟。其表示尝试电子烟的原因出于好奇，并且相当频繁地尝试不同类型、不同口味的烟油。在出现本次不适之前，她只是将烟油更换为另一种口味，未提及品牌。她几乎每天都抽电子烟，但并非整天，仅在空闲时或与朋友在一起时使用。她为健康个体，在本次情况出现前无用药史，包括抗生素、镇痛药、抗癫痫药、非甾体抗炎药及抗真菌药。亦无药物或食物过敏史，但患者饮食习惯不健康（进食不规律，且不食用蔬菜和水果）。口外检查显示身体其他部位无病变；患者唇部可见浆液血性痂皮及口角处糜烂区，且有出血倾向。口内检查见白色溃疡，边缘呈淡黄色，不规则、大小不一，伴有疼痛，位于唇黏膜、颊黏膜、舌侧缘及腹面黏膜和口底。\n\n根据患者病史和体格检查（显示累及口腔黏膜而全身其他部位无症状），结合抗HSV-1 IgG为非反应性，确立诊断为与电子烟相关的口腔多形红斑。该病情被归类为轻型多形红斑。口腔病变采用0.9%氯化钠溶液治疗，用纱布浸湿后置于唇部，每日3次。嘱患者以1 mg地塞米松加入10 mL透明质酸后含漱，每日3次，含漱后至少30分钟内避免进食或饮水。另给予右侧口角创面外用2%咪康唑乳膏，每日2次，并给予白凡士林软膏用于干燥的唇部。为维持良好的口腔卫生，建议其于早餐后及睡前每天两次刷牙并清洁舌头。并嘱其停止使用电子烟，避免摄入含谷氨酸钠（味精）的食物。治疗后一周进行复诊，显示口腔情况已有改善。已获得患者关于细节发表的书面知情同意。本病例报告符合《赫尔辛基宣言》。本病例报告的发表亦已获得所在机构批准。"
+  },
+  {
+    "english_text": "A 29-year-old gravida V par IV (all alive, 3 spontaneous vaginal deliveries, and the last child was delivered by cesarean section for the indication of a failed induction 4 years prior to the current pregnancy) came for ANC follow-up at a gestational age of 32 weeks from her LNMP.\n\nAfter taking a medical history, it was discovered that all four of her children are healthy, doing well in school, and have no known history of genetic or seizure disorders. She was investigated with the Venereal Disease Research Laboratory (VDRL), Hepatitis B surface antigen (HBSag), and urine analysis, all of which were negative. All cell lines in the CBC were normal, her blood group is A, and Rh is positive, according to the Complete Blood Count (CBC), blood group, and RH. Obstetric ultrasound was also performed showing normal anatomical scan of the all body parts of the fetus except the heart. Detailed fetal echocardiography evaluation was done with findings of: both atria have comparable size and normal situs. Both atrioventricular and semilunar valves are normally positioned with normal opening and closure. Both ventricles are comparable in size and contractility; in both 2D and color flow, the left ventricle forms the apex of the heart without any ventricular septal defect. But on the papillary muscles of the left ventricle there were two circumscribed, round, echogenic mass measuring 18.2 mm by 8.3mm and 13.5mm by 8.3 mm. Upon evaluation of the outflow tract, both the LVOT (left ventricular outflow tract) and RVOT (right ventricular outflow tract) have normal anatomy and function using 2D and CF ultrasound evaluation. According to the fetal echo finding, a diagnosis of cardiac rhabdomyoma was made. Since there is a high chance of tuberous sclerosis in cardiac rhabdomyoma, detailed neurosonography and other system exams were done to look for other signs of tuberous sclerosis. Despite searching for the other features of tuberous sclerosis, no other sign of it was found other than the tumor. She had regular ANC follow-up from 32 weeks of gestation up to 39 weeks without any complications.\n\nAt gestational age of 39 weeks plus 1 day, she underwent a cesarean section for the indication of full-term pregnancy plus a request for a repeat cesarean section, with the outcome of a 3200-gram female with an APGAR score of 10 and 10 at the 1st and 5th minutes. Both the mother and the neonate had a smooth post-operative period and were discharged on the third day.\n\nAfter delivery, the neonate was evaluated on the 1st, 7th, and 30th days for any regression or increment of the mass, emergence of skin lesions, or seizure. All physical examination results were normal, and the mass size was similar to the antepartal evaluation.\n\nAt her 7th month, the child was evaluated again, and upon history inquiries, the infant was doing great developmentally for her age group. The infant was examined for neurodevelopmental delay, and the child was growing appropriately for her age. An echocardiography study by a pediatric cardiologist revealed well-circumscribed hyperechoic masses on both left ventricular papillary muscles, each measuring 21.8 mm by 9.2 mm and 14.7 mm by 8.5 mm and creating no left ventricular inflow obstruction.\n\nA history from the family was obtained, and a physical examination with anthropometric measurements was performed to assess her developmental condition during her first-year evaluation. The child was developing normally, as other children her age were. Except for the heart, all of the systems examined were unremarkable. An echocardiography study has revealed well-circumscribed hyperechoic masses on both left ventricular papillary muscles with no size increment and creating no left ventricular inflow obstruction.",
+    "translated_text": "一名29岁，孕5产4（均存活，3次为自然阴道分娩，最近一次因引产失败于现孕前4年行剖宫产）的孕妇，按末次正常月经推算孕周32周来进行产前检查随访。\n\n经病史采集得知，其四个孩子均健康、在校表现良好，无已知遗传或癫痫性疾病史。行梅毒血清学试验（VDRL）、乙肝表面抗原（HBsAg）及尿常规检查，结果均为阴性。全血细胞计数（CBC）各细胞系正常；血型为A型，Rh阳性。行产科超声检查，提示除心脏外，胎儿全身各部位解剖扫查均正常。进一步行胎儿超声心动图评估，结果如下：双心房大小相当，位置关系正常（situs正常）。房室瓣及半月瓣位置正常，启闭良好。双心室大小与收缩性相当；二维和彩色血流显示左心室构成心尖，未见室间隔缺损。但在左心室乳头肌可见两个边界清楚、圆形、高回声肿块，大小分别为18.2 mm×8.3 mm和13.5 mm×8.3 mm。评估流出道时，二维及彩色血流（CF）超声显示左室流出道（LVOT）及右室流出道（RVOT）解剖与功能均正常。根据胎儿超声心动图所见，诊断为心脏横纹肌瘤。鉴于心脏横纹肌瘤提示合并结节性硬化症的概率较高，遂行详细神经超声及其他系统检查以查找结节性硬化症的其他体征。尽管进行了针对结节性硬化症其他特征的检查，除该肿瘤外未发现其他体征。自孕32周至39周期间规律产前随访，未见并发症。\n\n孕39周+1天，因足月妊娠并要求再次剖宫产而行剖宫产术，娩出女婴一名，体重3200 g，出生后第1分钟与第5分钟阿普加评分均为10分。母婴术后经过顺利，于术后第3天出院。\n\n分娩后分别于生后第1、7、30天评估肿块有无缩小或增大、是否出现皮肤损害或癫痫发作。体格检查均正常，肿块大小与产前评估相似。\n\n在其7个月时再次评估，病史询问显示该婴儿发育情况良好，符合其年龄组。对其神经发育迟缓进行了检查，儿童生长发育与年龄相称。由小儿心脏科医师行超声心动图检查，示左心室双侧乳头肌各有边界清楚的高回声肿块，大小分别为21.8 mm×9.2 mm和14.7 mm×8.5 mm，未造成左室流入道梗阻。\n\n在其第一年评估期间，获取了家族病史，并进行体格检查及人体测量，以评估其发育状况。该儿童发育正常，与同龄儿童一致。除心脏外，所查各系统未见异常。超声心动图显示左心室双侧乳头肌上均有边界清楚的高回声肿块，较前未见增大，且未造成左室流入道梗阻。"
+  },
+  {
+    "english_text": "13-year-old boy from Cusco with a history of laryngeal papillomatosis since the age of two (at the age of three he required a tracheostomy) and a mother with a history of genital papilloma. The patient was admitted to the San Borja National Institute of Child Health in Lima, after a 16-day illness characterised by respiratory difficulties predominantly at night, inspiratory laryngeal stridor and moderate dysphonia; he previously received azithromycin and oxygen support, without improvement.\n\nThe physical examination revealed mild subcostal retraction, decreased vesicular murmurs in the left hemithorax and scanty wheezy breath sounds with predominance in the right hemithorax, which required oxygen support with a binasal cannula at 4 liters. The rest of the evaluation had no relevant findings. At the laboratory level, leukocytes were found at 8.03 × 103/u, platelets 209 × 103/u, hemoglobin 13.2 g/dL, C-reactive protein at 36.6 mg/L. As part of the imaging studies, a chest radiograph and a head and neck tomography were performed.\n\n48 hours after admission, she presented with increased stridor and respiratory difficulty, so admission to the emergency operating room for tracheostomy, microsurgery and excision of papillomatosis lesions was decided. An appendicular tumour of papillomatose appearance with ventricular bands in the epiglottis, glottic face, vocal cords, subglottis and trachea up to ring 5 was evident. The anatomopathological report reported coilocitic atypia due to HPV and mild focal dysplasia.\n\nIn the immediate postoperative period, he was transferred to the paediatric intensive care unit for respiratory monitoring, with weaning from oxygen at 48 hours. He received a single dose of bevacizumab 400 mg intravenous and subsequently improved clinically. The patient remained hospitalised for seven days, achieving clinical stability through normalisation of oxygen saturation levels and progressive weaning from oxygen, and was subsequently referred to the hospital in Breña to continue his management. Telemonitoring was carried out after eight months and the family indicated that there was no evidence of relapse or other intercurrences.\n",
+    "translated_text": "来自库斯科的13岁男孩，自2岁起患喉乳头状瘤病（3岁时需行气管造口术），其母有生殖器乳头状瘤病史。患者在为期16天的病程后入院至利马的圣博尔哈国家儿童健康研究所，病程以夜间为主的呼吸困难、吸气性喉鸣及中度发声障碍为特征；此前给予阿奇霉素和氧疗支持，未见好转。\n\n体格检查示轻度肋下回缩，左侧半胸肺泡呼吸音减弱，右侧半胸以少量哮鸣音为主，需以双鼻导管给予4升氧气支持。其余评估无相关发现。实验室方面，白细胞8.03 × 103/u，血小板209 × 103/u，血红蛋白13.2 g/dL，C-反应蛋白36.6 mg/L。影像学检查包括胸部X线片及头颈部断层扫描。\n\n入院48小时后，她出现喉鸣加重和呼吸困难，遂决定收入急诊手术室行气管造口术、显微手术及乳头状瘤病病灶切除术。可见呈乳头状外观的带蒂肿瘤，累及会厌、声门面、室带、声带、声门下及气管至第5环。病理报告提示由于HPV导致的空泡细胞样异型性及轻度局灶性不典型增生。\n\n术后即刻转入小儿重症监护病房行呼吸监测，并于48小时撤离氧疗。予贝伐珠单抗400 mg静脉单次给药，随后临床好转。患者住院7天，通过血氧饱和度水平的正常化及逐步撤离氧疗达到临床稳定，随后转至布雷尼亚的医院继续管理。8个月后进行远程监测，家属表示无复发或其他并发情况的证据。"
+  },
+  {
+    "english_text": "A 54-year-old male who had a medical history of membranous nephropathy II with nephrotic syndrome was administered with long-term oral glucocorticoids and immunosuppressants. The patient had a 20 pack-year history of smoking, and denied a family history of hereditary diseases. Chest x-ray demonstrated normal findings at one month before admission. On August 8, 2016, the patient was hospitalized for fever accompanied by progressive dyspnea, cough, and expectoration for 5 days. On admission, the BMI of the patient was 24.5 kg/m2, and his body temperature was 39.0°C. Furthermore, the patient had symptoms of tachypnea (35 bpm) and severe hypoxemia (SaO2 86%). On auscultation, the patient had good air entrance bilaterally with scattered diffuse crackles and rhonchi. Furthermore, the chest CT scan revealed multiple ground-glass opacities, and laboratory tests revealed normal white blood cell (WBC) count, but with elevated neutrophil count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and (1→3)-β-D-glucan. The patient was diagnosed as RSV infection on the fourth day of hospitalization when positive RSV-Ab was detected.\n\nOn admission, the patient was immediately given respiratory monitoring and supplemental oxygen to improve the low oxygen saturation, as well as antibiotics (moxifloxacin for 4 days, followed by cefminoxine for 8 days), and antifungal therapy (voriconazole for 10 days). The dose of the glucocorticoids and immunosuppressants remained largely unchanged. After 10 days of treatment, the patient's condition became worse. Chest CT revealed the progression of the disease, and oxygen partial pressure was further decreased. The patient was transferred to the Emergency Intensive Care Unit, where the patient was intensively treated, including noninvasive mechanical ventilation, broad-spectrum antibiotics (i.v. meropenem, oral moxifloxacin, and cotrimoxazole), antifungal therapy (micafungin), corticosteroids (methylprednisolone 40 mg bid iv) to relieve the inflammation, and other supportive treatment. Ganciclovir was also prescribed due to a possibility of viral infection, such as cytomegalovirus. Five days later, the patient's condition was further aggravated based on the chest x-ray evaluation. Despite receiving another round of treatments, including invasive ventilator-assisted ventilation therapy, methylprednisolone (80 mg bid), antibacterial agents (cefoperazone sulbactam, tigecycline, and cotrimoxazole) and antifungal (micafungin) therapy, the patient eventually died after 2 days.",
+    "translated_text": "一名54岁男性，既往有膜性肾病II期合并肾病综合征病史，长期口服糖皮质激素及免疫抑制剂治疗。患者有20包年吸烟史，否认遗传性疾病家族史。入院前1个月胸部X线片示正常。2016年8月8日，因发热伴进行性呼吸困难、咳嗽、咳痰5天入院。入院时，患者BMI为24.5 kg/m2，体温39.0°C。此外，患者存在呼吸急促（35次/分）和严重低氧血症（SaO2 86%）。听诊示双侧气体进入良好，可闻及散在弥漫性湿啰音及干啰音。此外，胸部CT显示多发磨玻璃样影，实验室检查白细胞（WBC）计数正常，但中性粒细胞计数、C反应蛋白（CRP）、红细胞沉降率（ESR）及（1→3）-β-D-葡聚糖升高。住院第4天检测到RSV-Ab阳性时，诊断为RSV感染。\n\n入院后立即给予呼吸监测及吸氧以改善低氧饱和度，并予抗生素（莫西沙星4天，随后头孢米诺8天）及抗真菌治疗（伏立康唑10天）。糖皮质激素及免疫抑制剂剂量基本不变。治疗10天后，患者病情加重。胸部CT提示病情进展，氧分压进一步下降。患者转入急诊重症监护病房，予强化治疗，包括无创机械通气，广谱抗生素（静脉美罗培南、口服莫西沙星及复方磺胺甲噁唑）、抗真菌治疗（米卡芬净）、糖皮质激素（甲泼尼龙40 mg bid静脉注射）以缓解炎症，以及其他支持治疗。由于可能存在病毒感染（如巨细胞病毒），同时给予更昔洛韦。5天后，根据胸部X线片评估，患者病情进一步加重。尽管再次给予治疗，包括有创呼吸机辅助通气治疗、甲泼尼龙（80 mg bid）、抗菌药物（头孢哌酮/舒巴坦、替加环素及复方磺胺甲噁唑）及抗真菌（米卡芬净）治疗，患者最终于2天后死亡。"
+  },
+  {
+    "english_text": "A 34-year-old patient with a disease duration of four weeks. Two months earlier, she had a cesarean section in the 37th week of pregnancy and had persistent bleeding from the surgical wound. She denied a history of bleeding in childhood or adolescence. Three years earlier, she had given birth to her first child (also by cesarean section), who died due to a chromosome disorder (referred to by the patient). She also stated that she was allergic to tramadol.\n\nThe clinical picture began with lower back pain due to bilateral renal lithiasis. Subsequently, he managed to expel a stone and after that he presented haematuria for three days, for which he received tranexamic acid c/12 h. Three weeks later, he presented pain in the lower region of the left thigh that increased in intensity, with hardening of the area. Due to persistence of the symptoms, he was given diclofenac intramuscularly, which caused ecchymosis and bleeding in the gluteal area and persists despite the compression with gauze.\n\nThe patient underwent a particular Doppler ultrasound that revealed deep venous thrombosis of the left lower limb, and went to the hospital in her locality with these results. She was given anticoagulation with enoxaparin 30 mg/24 h subcutaneously, in addition to morphine for pain management and was hospitalized. The next day, she presented epigastralgia, blurred vision, heart rate of 117 beats/min, blood pressure of 113/85 mmHg and saturation of 93%. It was decided to discontinue enoxaparin. The blood count revealed a hemoglobin of 6.4 g/dl, which represented a difference of 4 g/dl from the result one day before admission, which was 10.4 g/dl. Because of the above, two blood transfusions were given. Due to the suspicion of vasculitis, methylprednisolone was indicated and she was referred to our hospital for further study.\n\nOn admission, the physical examination revealed severe pallor, extensive ecchymosis on the left thigh and lateral knee, and a haematoma on the right thigh. The haemogram showed moderate anaemia (Hb = 9.8 g/dl), normocytic and normochromic. The biochemical examination showed glucose values of 160 mg/dl. The liver enzymes AST and ALT were at 52 U/L and 86 U/L, respectively. The coagulation profile showed a prolonged activated partial thromboplastin time (APTT) of 91.2 s. The rest of the haemogram, biochemical, electrolyte, liver profile and coagulation profile were normal. The ultrasound of soft parts of the right gluteal region revealed a collection at the level of the subcutaneous cellular tissue (TCSC) and oedema up to the upper third of the thigh. The Doppler ultrasound in the left lower limb showed adequate flowometry without signs of thrombosis in the common femoral vein, superficial and deep.\n\nSymptomatic treatment was initiated and blood and urine cultures were requested and were negative. Antinuclear antibody (ANA) values, complement C3 and C4 and ferritin were within the reference range.\n\nIn the face of suspected acquired haemophilia, studies were requested for confirmation, where a partial correction of aPTT was found in the mixing test. Factor VIII was measured and its activity was found to be decreased (<1.0 U/dl) and the presence of a factor VIII inhibitor was demonstrated: 8.64 Bethesda units/ml. The above allowed the diagnosis of acquired haemophilia to be confirmed, which was related to the postpartum period due to the onset of symptoms.\n\nPrednisone 50 mg orally at breakfast and 10 mg orally at lunch, cyclophosphamide 50 mg 2 tablets orally every 24 hours and anti-inhibitor coagulant complex for haemophilia (FEIBA) were initiated. Five days later, the latter was discontinued due to chest tightness, dyspnoea and nausea (possible adverse drug reaction) and replaced with activated recombinant factor VII (NovoSeven).\n\nThe patient's clinical evolution was favorable, with a decrease in ecchymosis and no other symptoms, so she was discharged from the hospital.\n",
+    "translated_text": "34岁患者，病程4周。两个月前，于妊娠第37周行剖宫产术，术后切口持续出血。否认儿童期或青春期出血史。三年前，她分娩第一胎（亦为剖宫产），因染色体异常而死亡（据患者自述）。另述对曲马多过敏。\n\n临床表现起始为因双侧肾结石导致的腰痛。随后患者排出一枚结石，此后出现血尿3天，予氨甲环酸每12小时一次。三周后，出现左大腿下部疼痛，逐渐加重，局部变硬。因症状持续，予肌内注射双氯芬酸，导致臀部出现瘀斑及出血，即便纱布加压仍持续。\n\n患者在私人机构行多普勒超声提示左下肢深静脉血栓形成，遂携带结果至当地医院就诊。予依诺肝素30 mg/24 h皮下注射抗凝，并给予吗啡镇痛后住院。次日出现上腹痛、视物模糊，心率117次/分，血压113/85 mmHg，血氧饱和度93%。遂决定停用依诺肝素。血常规示血红蛋白6.4 g/dl，较入院前一日的10.4 g/dl下降4 g/dl。为此给予输血2次。因怀疑血管炎，予甲泼尼龙，并转至我院进一步检查。\n\n入院查体见重度苍白，左大腿及膝外侧大片瘀斑，右大腿可见血肿。血常规提示中度贫血（Hb = 9.8 g/dl），正细胞、正色素。生化检查示葡萄糖160 mg/dl。肝酶AST、ALT分别为52 U/L和86 U/L。凝血功能显示活化部分凝血活酶时间（APTT）延长至91.2 s。其余血常规、生化、电解质、肝功能及凝血指标正常。右侧臀部软组织超声示皮下蜂窝组织（TCSC）层液性集合，并可见水肿延至大腿上1/3。左下肢多普勒超声示血流量评估良好，股总静脉及浅、深静脉未见血栓征象。\n\n予对症治疗，并送血、尿培养，结果均为阴性。抗核抗体（ANA）、补体C3、C4及铁蛋白均在参考范围内。\n\n鉴于疑诊获得性血友病，申请相关检查以确认，其中混合试验显示aPTT部分矫正。测定第VIII因子，活性降低（<1.0 U/dl），并证实存在第VIII因子抑制物：8.64 Bethesda单位/ml。以上结果证实获得性血友病的诊断，结合症状起始时间，考虑与产后期相关。\n\n开始予泼尼松50 mg早餐时口服、10 mg午餐时口服，环磷酰胺50 mg片2片每24小时口服一次，以及用于血友病的第VIII因子抑制物旁路活性复合物（FEIBA）。5天后因胸闷、呼吸困难和恶心（可能为药物不良反应）停用FEIBA，改用重组活化第VII因子（NovoSeven）。\n\n患者临床转归良好，瘀斑减轻，无其他症状，遂出院。"
+  },
+  {
+    "english_text": "We present here the case of a two-day old neonate with in-born right scrotal swelling admitted at Children’s hospital. The patient was born at term via cesarean section at a private hospital. He was kept in the nursery for one day. The examining doctor referred them for urgent surgical care, but it took them one day to arrive at our hospital. Upon arrival in the emergency department, he was well hydrated, pink at room temperature with good perfusion. Upon examination, the right testis was found to be enlarged, tense, non-tender visibly reddish with overlying skin excoriation. Trans-illumination was negative in the right but positive in the contralateral testis. Both hernial orifices were normal. All the laboratory investigations were performed with an urgent Doppler ultrasound of the inguinoscrotal area. The ultrasound examination found the right testis to be enlarged (15.6*9.4 mm) and showed heterogeneous hypoechoic texture with prominent rete testis and no flow on color Doppler analysis. Left testis appeared normal in size, shape and echotexture with minimal hydrocele. An urgent scrotal exploration was undertaken. Intra-operatively, there was frank necrotic right testis with intravaginal torsion of the testis with minimal hydrocele. A right orchidectomy and contralateral orchidopexy was then performed.",
+    "translated_text": "我们在此报告一例出生两天、出生即有右侧阴囊肿胀而入院于儿童医院的新生儿病例。患儿在私立医院足月经剖宫产出生。在新生儿室留观1天。检查的医生将其转诊以行紧急外科处理，但他们花了一天才到达我院。入急诊时，患儿水合良好，在室温下皮肤呈粉红色，灌注良好。查体示右侧睾丸肿大、紧张、无压痛，肉眼可见发红，表面皮肤擦脱。透光试验右侧阴性，对侧睾丸阳性。双侧疝环正常。已完成所有实验室检查，并紧急行腹股沟阴囊区多普勒超声检查。超声发现右侧睾丸增大（15.6*9.4 mm），呈异质性低回声，睾丸网显著，彩色多普勒分析未见血流信号。左侧睾丸大小、形态及回声结构正常，伴少量鞘膜积液。紧急行阴囊探查术。术中见右侧睾丸明显坏死，存在鞘膜内睾丸扭转，伴少量鞘膜积液。随后行右侧睾丸切除术及对侧睾丸固定术。"
+  },
+  {
+    "english_text": "4-year-old male patient with a history of nasal impetigo two weeks before admission (treated with topical mupirocin and oral cefadroxil; dose, duration and adherence to treatment unknown), with no other morbid history, who presented macroscopic glomerular haematuria associated with oedema of the lower extremities of 5 days' evolution, with the last 12 hours prior to the consultation adding headaches, nausea and vomiting. He went to the emergency department (ED) in convulsive status, after 20 minutes of generalised tonic-clonic convulsions.\n\nOn admission to the ED, the patient was afebrile, with non-evaluable blood pressure, with quantitative consciousness impairment associated with generalized hypertonia and bilateral and pretibial oedema. Endotracheal intubation was decided and phenobarbital (10 mg/kg) was administered to manage the convulsive status.\n\nOn physical examination in the intensive care unit (ICU), blood pressure was 134/94 mmHg (BP 110 mmHg) (p95 for patient 108/66 mmHg, p95+12 120/78 mmHg).\n\nInitial laboratory parameters included: complete urine with haematuria (> 100 erythrocytes per field), proteinuria 3+ and leucocyturia 10-25 per field, creatinemia 0.3 mg/dL, anaemia with haematocrit (HTO) 21%, haemoglobin (Hb) 7 g/dL, with normal mean corpuscular volume (VCM) and mean corpuscular haemoglobin concentration (CHCM), leukocytosis of 23,900 cells/mm3, thrombocytosis of 756,000/mm3, without elevation of acute phase reactants, hypocomplementemia with complement C3 level at 25 mg/dL (normal value, VN: 80-150 mg/dL) and normal C4. The rapid antigen test for Streptococcus beta-haemolytic group A (Streptococcus pyogenes) in pharynx was positive and the Anti-streptolysin O (ASO) was (+). The non-contrast brain computed tomography showed no acute changes. The renal ultrasound concluded bilateral nephromegaly with increased cortical echogenicity and decreased corticomedullar differentiation.\n\nThe patient was diagnosed with nephritic syndrome due to complicated GNAPE with hypertensive emergency - convulsive status.\n\nWithin the first 24 hours of his ICU stay, the patient required mechanical ventilation (MV) and anticonvulsant therapy with phenobarbital. He progressed without seizures, with a normal electroencephalogram (EEG) (on the day following admission) and a normal cerebrospinal fluid study. Antibiotic therapy was initiated for eradication of Streptococcus pyogenes with cefotaxime and diuretic therapy with furosemide.\n\nThe next day, he developed renal impairment with creatinine elevation to 0.99 mg/dL, hypertension and 24 hour proteinuria of 36.6 mg/m2/h, without oliguria. He initiated antihypertensive therapy with amlodipine and intravenous labetalol, with good initial control.\n\nWith favorable evolution, extubation was performed at 48 hours, which was well tolerated from the ventilatory point of view. However, after 24 hours of extubation, the patient's consciousness deteriorated, with both ocular opening and withdrawal of limb only in response to painful stimulus and poor verbal response (Glasgow Coma Scale 8), and developed blood pressure figures > p95+12 despite receiving therapy with labetalol in continuous infusion (up to 3 mg/kg/h), amlodipine (10 mg/day) and furosemide, which required the reintroduction of mechanical ventilation and infusion of sodium nitroprusside (up to 3 mcg/kg/min), with the aim of achieving gradual reduction of blood pressure figures (25% daily) to prevent secondary neurological damage. Given the presence of acute neurological symptomatology associated with HTA in a patient with glomerulonephritis, the diagnosis of PRES was suspected, which was confirmed by magnetic resonance imaging (MRI) of the brain (day 5), which showed an increase in the subcortical signal in bilateral and symmetric occipital region, without restriction in diffusion, which was compatible with vasogenic edema (PRES). Ophthalmological evaluation was normal and a new EEG evidenced occasional episodes of generalized voltage depression.\n\nAdding enalapril to the treatment. Finally, after 10 days with a slow pharmacological weaning, normalization of blood pressure was achieved. The control MRI (day 12) revealed regression of the previously described findings. Successful extubation was achieved after 5 days.\n\nDuring his stay in the ICU, the hemoglobin level dropped to 5 g/dL, with normal mean corpuscular volume and mean corpuscular hemoglobin concentration, without plateletopenia, so hemolytic anemia was suspected given a positive direct Coombs test and hemoglobinuria. He required red blood cell transfusions twice. Steroid therapy with methylprednisolone (1 mg/kg/d) was initiated for 72 hours. The coproculture was negative, as was the urinary antigen for Streptococcus pneumoniae. Epstein-Barr virus and Parvovirus B19 serology, extractable nuclear antigen (ENA) profile, anti-neutrophil cytoplasmic antibodies (ANCA), anti-DNA antibodies, anti-B2 glycoprotein 1 antibodies, anti-cardiolipin antibodies and lupus anticoagulant were all negative. All cultures were negative (blood cultures, urine cultures, cultures of endotracheal aspirate and pharyngeal cultures). ANA (antinuclear antibodies) was positive 1/160.\n\nThe patient improved with blood pressure normalization, increased complement levels, and a urine test without proteinuria or hematuria. The direct Coombs test remained positive on the 9th day of hospitalization.\n\nOn day 31, the patient was discharged normotensive, without anaemia, with preserved renal function, without proteinuria or haematuria, with normalisation of C3 levels and asymptomatic from the neurological point of view. He was discharged with pharmacological therapy with prednisone, amlodipine, enalapril and folic acid. The patient did not present recurrence and remained asymptomatic 6 months after discharge.\n",
+    "translated_text": "4岁男性患儿，入院前两周有鼻部脓疱病史（外用莫匹罗星及口服头孢羟氨苄治疗；剂量、疗程及依从性不详），无其他病史，出现肉眼性肾小球性血尿，伴下肢水肿，病程5天，就诊前12小时出现头痛、恶心和呕吐。经历20分钟全身强直-阵挛性发作后，以癫痫持续状态至急诊科（ED）就诊。\n\n入ED时无发热，血压无法评估，意识水平受损，伴全身肌张力增高及双下肢和胫前水肿。决定行气管插管，并给予苯巴比妥（10 mg/kg）控制癫痫持续状态。\n\n入重症监护病房（ICU）体检：血压134/94 mmHg（BP 110 mmHg）（该患儿p95为108/66 mmHg，p95+12为120/78 mmHg）。\n\n初始实验室检查：尿常规示血尿（每视野>100个红细胞）、蛋白尿3+、白细胞尿10–25/视野，血肌酐0.3 mg/dL；贫血，红细胞比容（HTO）21%，血红蛋白（Hb）7 g/dL；平均红细胞体积（VCM）及平均红细胞血红蛋白浓度（CHCM）正常；白细胞增多23,900 个/mm3，血小板增多756,000/mm3；急性期反应物未升高；低补体血症，补体C3为25 mg/dL（正常值，VN：80–150 mg/dL），C4正常。咽部A组β溶血性链球菌（化脓性链球菌）快速抗原检测阳性，抗链球菌溶血素O（ASO）阳性。头颅CT平扫未见急性改变。肾脏超声提示双肾增大，皮质回声增强，皮髓质分界减弱。\n\n诊断为由于复杂性GNAPE所致的肾炎综合征，伴高血压急症 - 癫痫持续状态。\n\nICU入住前24小时内，患儿需机械通气（MV）及苯巴比妥抗惊厥治疗。此后无再发作，脑电图（EEG）（入院次日）正常，脑脊液检查正常。为根除化脓性链球菌予以头孢噻肟抗生素治疗，并给予呋塞米利尿治疗。\n\n次日出现肾功能损害，血肌酐升至0.99 mg/dL，高血压及24小时蛋白尿36.6 mg/m2/h，无少尿。开始氨氯地平及静脉拉贝洛尔降压治疗，初步控制良好。\n\n病情好转后于48小时拔管，通气耐受良好。然而，拔管后24小时患儿意识恶化，仅对疼痛刺激有睁眼及肢体回撤，言语反应差（格拉斯哥昏迷评分8分），并出现血压数值> p95+12，尽管接受持续输注拉贝洛尔（最高至3 mg/kg/h）、氨氯地平（10 mg/d）及呋塞米治疗，仍需重新行机械通气，并静脉泵注硝普钠（最高至3 μg/kg/min），旨在逐步降低血压（每日25%），以预防继发性神经系统损害。鉴于肾小球肾炎患儿出现与高血压（HTA）相关的急性神经系统症状，考虑PRES诊断，并于第5天行头颅磁共振成像（MRI）证实：枕叶双侧对称皮质下信号增高，弥散未受限，与血管源性水肿相符（PRES）。眼科评估正常，复查脑电图提示偶发全导联电压降低发作。\n\n治疗中加用依那普利。最终，经过10天缓慢药物减撤，血压正常化。复查MRI（第12天）显示前述改变消退。5天后成功拔管。\n\nICU期间，血红蛋白降至5 g/dL，平均红细胞体积和平均红细胞血红蛋白浓度正常，无血小板减少，因直接抗人球蛋白试验阳性及血红蛋白尿，考虑溶血性贫血。需要红细胞输注2次。给予甲泼尼龙（1 mg/kg/d）激素治疗，共72小时。粪培养阴性，肺炎链球菌尿抗原亦阴性。爱泼斯坦-巴尔病毒和B19微小病毒血清学、可提取核抗原（ENA）谱、抗中性粒细胞胞浆抗体（ANCA）、抗DNA抗体、抗β2糖蛋白1抗体、抗心磷脂抗体及狼疮抗凝物均为阴性。所有培养均为阴性（血培养、尿培养、气管插管抽吸物培养及咽部培养）。抗核抗体（ANA）1/160阳性。\n\n随着血压正常化、补体水平升高及尿检无蛋白尿或血尿，患者病情改善。住院第9天直接抗人球蛋白试验仍阳性。\n\n第31天出院时，血压正常、无贫血、肾功能保存、无蛋白尿或血尿，C3水平恢复正常，神经系统无症状。出院带药为泼尼松、氨氯地平、依那普利和叶酸。出院后6个月未复发，仍无症状。"
+  },
+  {
+    "english_text": "A 69-year-old male with prior history of CABG presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration was admitted in our center. The electrocardiogram showed ST depression in leads II, III, aVF, and V4-6, and blood examination revealed elevation of plasma N-terminal pro-B-type natriuretic peptide levels (2640 pg/mL). Echocardiogram showed left ventricular systolic dysfunction and low left ventricular ejection fraction (30%). The patient had inferior ST-segment-elevation myocardial infarction in 2009, when he was 59 years old, with angiographic evidence of severe 3 vessels disease (coronary angiography showed CTO in proximal left anterior descending artery (LAD), 90% stenosis in mid and distal left circumflex artery, and 95% stenosis in mid RCA. The patient underwent CABG with left internal mammary artery (LIMA) to LAD, and sequential SVG to 1st obtuse marginal branch (OM1), 2nd obtuse marginal branch (OM2), and posterolateral branch (PL) in 2009.\n\nCoronary angiography was performed via 6 French (Fr) left radial artery access and demonstrated patency of LIMA to LAD and SVG to OM1, OM2 conduits, but a complete occlusion of sequential SVG to PL conduit. Native left main coronary artery was occluded in ostium and native RCA was occluded in the mid portion with bridging collaterals. We decided to treat the native RCA CTO. Dual arterial access was achieved with another 6 Fr sheath in right femoral artery. The left and right coronary arteries were intubated with 6 Fr AL 0.75 (Launcher; Medtronic; USA) and 6 Fr EBU 3.5 (Launcher; Medtronic; USA) guide catheters, respectively. An antegrade approach via left radial artery was attempted; however, neither Fielder XTR wire (Asahi Intec, Japan) nor Gaia 3 wire (Asahi Intec, Japan) with Finecross microcatheter (Terumo, Japan) reached the true lumen in distal RCA. Then, parallel wire technique with Crusade microcatheter (Kaneka, Japan) and two Gaia 3 wires (Asahi Intec, Japan) were attempted, but also failed. We therefore switched to the retrograde approach using septal channel from LAD through occluded left coronary artery. Gaia 3 wire (Asahi Intec, Japan) crossed occluded left main (LM) and LAD, and finally reached true lumen in distal LAD. Sion wire was exchanged by Finecross microcatheter (Terumo, Japan) into dital LAD, and dilation of LM and proximal LAD with a 2.0 × 15 mm balloon was performed. Then, septal surfing technique (SST) was used for septal crossing. We tried different septal channels originating from proximal to distal LAD, and delivered Sion wire (Asahi Intec, Japan) retrogradely through distal septal branch into distal RCA supported by a 150-cm Finecross microcatheter (Terumo, Japan). Gaia 3 wire (Asahi Intec, Japan) crossed CTO lesion retrogradely into the true lumen in proximal RCA, and was advanced into Guidezilla guide extension catheter (Boston Scientific, USA) positioned in the antegrade guiding catheter. The Finecross microcatheter (Terumo, Japan) was delivered to the antegrade catheter and a RG3 wire (Asahi Intec, Japan) was externalized. The CTO was then predilated by a 2.0 × 15 mm balloon and stented with 2 overlapping drug-eluting stents (2.5 × 38 mm and 3.0 × 38 mm) with excellent angiographic result and TIMI3 flow in all distal branches.\n\nDyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea.",
+    "translated_text": "一名69岁男性，既往行冠状动脉旁路移植术（CABG），因轻度活动即出现重度呼吸困难（NYHA III）已持续2个月，于本中心入院。心电图示II、III、aVF及V4-6导联ST段压低，血液检查显示血浆N末端B型利钠肽前体水平升高（2640 pg/mL）。超声心动图示左心室收缩功能不全，左心室射血分数降低（30%）。患者于2009年（59岁时）发生下壁ST段抬高型心肌梗死，冠脉造影证实重度三支病变（冠脉造影示左前降支（LAD）近段CTO，左回旋支中、远段90%狭窄，右冠状动脉中段95%狭窄）。患者于2009年行CABG：左乳内动脉（LIMA）-LAD，串联大隐静脉移植（SVG）至第一钝缘支（OM1）、第二钝缘支（OM2）及后外侧支（PL）。\n\n经左桡动脉6 French（Fr）通路行冠脉造影，显示LIMA-LAD及SVG-OM1、OM2移植物通畅，但串联至PL的SVG移植物完全闭塞。本位左主干开口部闭塞，右冠本血管中段闭塞，可见桥接侧支。我们决定治疗右冠本血管CTO。于右股动脉置入另一6 Fr鞘建立双动脉通路。左、右冠分别以6 Fr AL 0.75（Launcher; Medtronic; USA）和6 Fr EBU 3.5（Launcher; Medtronic; USA）导引导管插管。尝试经左桡动脉顺行途径；然而，无论是Fielder XTR导丝（Asahi Intec, Japan）还是配合Finecross微导管（Terumo, Japan）的Gaia 3导丝（Asahi Intec, Japan）均未能进入右冠远段真腔。随后在Crusade微导管（Kaneka, Japan）辅助下采用平行导丝技术，使用两根Gaia 3导丝（Asahi Intec, Japan），亦未成功。因而改用经室间隔通道的逆行途径，自LAD经闭塞的左冠状动脉系统进入。Gaia 3导丝（Asahi Intec, Japan）跨越闭塞的左主干（LM）及LAD，最终进入LAD远段真腔。通过Finecross微导管（Terumo, Japan）在LAD远段置换为Sion导丝，并用2.0 × 15 mm球囊扩张LM及LAD近段。随后采用室间隔“冲浪”技术（SST）通过室间隔通道。我们尝试自LAD近段至远段起源的不同室间隔通道，在150 cm Finecross微导管（Terumo, Japan）支持下，将Sion导丝（Asahi Intec, Japan）经远端室间隔支逆行送入右冠远段。Gaia 3导丝（Asahi Intec, Japan）逆行跨越CTO病变进入右冠近段真腔，并进入置于顺行导引导管内的Guidezilla导引延长导管（Boston Scientific, USA）。将Finecross微导管（Terumo, Japan）送至顺行导管，随后外置RG3导丝（Asahi Intec, Japan）。随后用2.0 × 15 mm球囊预扩张CTO病变，并植入2枚重叠的药物洗脱支架（2.5 × 38 mm和3.0 × 38 mm），造影结果极佳，所有远端分支TIMI 3级血流。\n\n出院时呼吸困难缓解。6个月随访，患者无呼吸困难复发。"
+  },
+  {
+    "english_text": "A 51-year-old male patient presented to us with acute painful visual loss of his left eye (LE) from 3 days ago. The best-corrected distance visual acuity (BCDVA) was 20/20, and hand motion (HM) detection for the right eye (RE) and LE, respectively. The ocular movement was normal in both eyes. Anterior segment examination was unremarkable for both eyes. The LE fundus examination showed ONH swelling, choroidal bulging, multiple patches of subretinal fluid accumulation, and retinal pigment epithelial (RPE) corrugations. Fundus examination of the RE was unremarkable.\n\nWe used multimodal imaging including Optical coherence tomography (OCT) (OptoVue, Inc., Fremont, CA, USA, software version: 2018,0,0,18), fundus blue-autofluorescence (BAF), fluorescein angiography (FA) (Heidelberg Eye Explorer version 1.9.13.0, Spectralis Viewing Module 6.5.2.0; Heidelberg Engineering), Indocyanin green angiography (ICGA), and B-scan ultrasonography for further evaluation. Besides, orbital and brain MRIs with gadolinium enhancement were ordered. The OCT image revealed a mild RPE and choroidal bulging, RPE hyper-reflectivity with back shadowing, subretinal and intraretinal fluid accumulation, and mild retinal thickening. A geographic area of macular hypocyanescence was apparent in the ICGA image of the left eye. BAF showed a geographic area with a speckled autofluorescence pattern at the macula. Optic nerve enlargement was found in the B-scan ultrasonography. In FA images, vascular leakage was apparent at the ONH (hot disc). Besides, a geographic patchy hypofluorescent area with speckled hyperfluorescent margins with a size of three disc diameters (DD) was detected. Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement at the junction of the optic nerve and sclera. An oncology consultation was done with no remarkable finding.\n\nConsidering the suspicion of malignancy and the presence of an enhancing nodular mass in the orbit, the patient underwent transconjunctival lateral orbitotomy one week after the presentation. A pink localized scleral nodule with edematous tenon was found. Sub-tenon triamcinolone acetonide was injected with the clinical diagnosis of nodular posterior scleritis. The patient refused admission and intravenous corticosteroid injection as the treatment order. Oral prednisolone 50 mg/Kg was started. Rheumatology consultation and screening lab results, including PPD test (tuberculosis), chest X-ray, serum ACE level (sarcoidosis), and C-ANCA level (Wegner granulomatosis), were unremarkable. At the last follow-up examination (one week after the surgery), the patient’s BCDVA was 20/20, and counting fingers at 2 meters for the RE and LE, respectively. Furthermore, SRF was absorbed, and the macula became atrophic. Oral prednisolone was tapered off slowly for three months.",
+    "translated_text": "一名51岁男性患者因左眼（LE）急性疼痛性视力下降3天来就诊。最佳矫正远视力（BCDVA）分别为右眼（RE）20/20、左眼手动（HM）。双眼眼球运动正常。双眼前节检查未见异常。左眼眼底检查示ONH肿胀、脉络膜隆起、多发视网膜下液体积聚斑片及视网膜色素上皮（RPE）皱褶。右眼眼底检查未见异常。\n\n我们采用多模态成像，包括光学相干断层扫描（OCT）（OptoVue, Inc., Fremont, CA, USA, software version: 2018,0,0,18）、眼底蓝光自发荧光（BAF）、荧光素血管造影（FA）（Heidelberg Eye Explorer version 1.9.13.0, Spectralis Viewing Module 6.5.2.0；Heidelberg Engineering）、吲哚菁绿血管造影（ICGA）和B型超声检查进行进一步评估。此外，还开具了眶部和脑部MRI并行钆增强检查。OCT图像显示RPE及脉络膜轻度隆起，RPE高反射并伴后方阴影，视网膜下及视网膜内液体积聚，以及轻度视网膜增厚。左眼ICGA图像可见黄斑部地理样低荧区。BAF显示黄斑部存在一处地理样斑驳自发荧光模式的区域。B型超声发现视神经增大。FA图像中，可见ONH处血管渗漏明显（热视盘）。此外，发现一处大小为三个视盘直径（DD）的地理样斑片状低荧区，边缘呈斑点状高荧光。眶部及脑部MRI显示在视神经与巩膜交界处可见后球部结节样肿块，钆增强。肿瘤科会诊未见明显异常。\n\n鉴于存在恶性肿瘤的可疑以及眶内强化结节样肿块，患者于就诊后一周接受经结膜外侧眶切开术。术中发现局灶性粉红色巩膜结节，并见Tenon囊水肿。以结节性后巩膜炎为临床诊断行Tenon囊下注射醋酸曲安奈德。患者拒绝住院及静脉注射糖皮质激素治疗。开始口服泼尼松龙 50 mg/Kg。风湿免疫科会诊及筛查实验室结果，包括PPD试验（结核）、胸部X线片、血清ACE水平（结节病）和C-ANCA水平（韦格纳肉芽肿），均未见异常。最后一次随访检查（术后1周）时，患者的BCDVA分别为RE 20/20、LE 2米数指。此外，SRF被吸收，黄斑出现萎缩。口服泼尼松龙缓慢减量，持续三个月。"
+  },
+  {
+    "english_text": "An elderly 78-year-old patient from the Amhara region of Ethiopia, who has had a permanent cardiac pacemaker for 7 years, was scheduled for retropubic prostatectomy due to benign prostatic hyperplasia (BPH). This condition developed following a previous transurethral resection of the prostate 3 months earlier. The patient in the preoperative anesthesia evaluation was fully evaluated, and all the routine investigations required for the proposed surgery, which were within normal limits, were investigated. The patient presented with a history of frequency, urgency, nocturia, and dribbling for the past 2 months. Additionally, the patient had been known to have hypertension for the past 16 years and was taking amlodipine 5 mg orally daily, enalapril 10 mg orally twice daily (BID), and atorvastatin 10 mg orally daily. He had also been known to have type II diabetes mellitus for the past 25 years and was on metformin 500 mg orally BID and neutral protamine Hagedorn (NPH) 20 IU and 10 IU. He was admitted to a hospital for further evaluation, and complete bundle branch block (BBB) was detected via electrocardiogram (ECG). In an electrophysiology study, the patient was diagnosed with left ventricular hypertrophy secondary to hypertensive heart disease, mild diastolic dysfunction, and an ejection fraction of 62%. Abdominal ultrasound revealed an enlarged prostate size of 82 ml; anterior–posterior (AP) chest X-ray revealed a normal chest region with a left-side pacemaker in situ, and all the other blood parameters, including electrolytes and serum troponin levels, were within normal limits.\n\nA cardiologist was involved preoperatively as a multidisciplinary approach and risk determination tool for cardiac risk assessment. The patient had a frailty score of 5.5 with a poor functional cardiopulmonary reserve of metabolic equivalent (MET) = 3.4 and Revised Cardiac Risk Index (RCRI) class III, which accounts for 10.1% of major cardiac adverse events (myocardial infarction [MI], cardiac arrest, or death) within 30 days of the postoperative period, and intermediate risk on the basis of surgery type and patient risk factors. After preoperative evaluation and risk disclosure regarding the un-reprogrammed pacemaker and the associated complications during anesthesia and surgery, the patient was unable to afford the necessary health coverage for pacemaker reprogramming. This is because the cardiac surgery was performed in Addis Ababa, Ethiopia, which has a long waiting list with few cardiac surgeons for millions of people and is a considerable distance from the patient’s home institution, and there is a period of monitoring after pacemaker reprogramming for considerable post-reprogramming complication. As a result, the patient chose to proceed with the surgery, accepting the potential risks and harm associated with the situation. Continuous cardiac monitoring during the intraoperative period is highly advocated. Despite these factors, the patient did not experience cardiorespiratory failure, and he was stable. The patient continued on medication until the day of surgery, which included amlodipine, enalapril, atorvastatin, and a morning lower dose of two-thirds of the NPH. He also took 5 mg of diazepam orally for anxiolytics at midnight before the day of surgery.\n\nOn the day of surgery, the patient’s random blood sugar (RBS) was measured, and sliding scale glycemic control was implemented. Communication among the anesthetist, surgeon, and nurses was emphasized, ensuring that the cautery pad was placed away from the pacemaker, and that emergency drugs and a defibrillator were ready. The patient was premedicated with dexamethasone for nausea prophylaxis and paracetamol for pain relief as preemptive analgesia. American Society of Anesthesiology (ASA) standard monitoring was applied, and baseline parameters were recorded. Combined epidural–spinal anesthesia was administered via 0.5% isobaric bupivacaine (12.5 mg) and 50 µg fentanyl at the L3–L4 interspace. The block achieved anesthesia up to the umbilicus, and the sensory block was performed at T7. The surgery involved a midline incision below the umbilicus, with monopolar cautery used at low voltage (20 mA). Hemostasis was achieved through bipolar low-voltage cautery. Throughout the procedure, the patient’s vital signs remained stable. The patient’s vital signs did not change by more than 10% from the baseline vital signs. The intravenous fluid was resuscitated intraoperatively. During the postoperative period, the patient was transferred to the postanesthesia care unit (PACU) with vigilant monitoring, and 10 ml of 0.125% epidural top-up analgesia was given. Postop investigations were within normal limits. The patient was observed in the PACU for 12 hours and later transferred to the ward in stable condition with regular follow-up with the cardiology team. After 88th day of postsurgery the patient was discharged and advised to have regular checkups for pacemaker’s in situ status.",
+    "translated_text": "一名来自埃塞俄比亚阿姆哈拉地区的78岁老年患者，既往植入永久性心脏起搏器7年，因良性前列腺增生（BPH）拟行耻骨后前列腺切除术。该情况在3个月前既往行经尿道前列腺切除术之后出现。在术前麻醉评估中对患者进行了全面评估，并完成了拟行手术所需的所有常规检查，结果均在正常范围。患者近2个月来表现为尿频、尿急、夜尿及尿滴沥病史。此外，患者已知有16年高血压病史，口服氨氯地平5 mg每日一次，依那普利10 mg每日两次（BID），及阿托伐他汀10 mg每日一次。另有25年2型糖尿病病史，服用二甲双胍500 mg每日两次（BID）及中性鱼精蛋白胰岛素（NPH）20 IU和10 IU。患者入院进一步评估，心电图（ECG）提示完全性束支传导阻滞（BBB）。心脏电生理检查诊断为继发于高血压性心脏病的左心室肥厚、轻度舒张功能不全，射血分数62%。腹部超声提示前列腺增大，体积82 ml；前后位（AP）胸片示胸部正常，左侧起搏器在位，其余血液指标，包括电解质和血清肌钙蛋白水平均在正常范围。\n\n术前作为多学科处理及心脏风险评估的风险判定工具，心脏科医师参与评估。患者虚弱评分为5.5，功能性心肺储备差，代谢当量（MET）=3.4，修订心脏风险指数（RCRI）III级，提示术后30天内主要心脏不良事件（心肌梗死[MI]、心脏骤停或死亡）风险为10.1%，且基于手术类型和患者危险因素评估为中等风险。就未重新程控起搏器及麻醉和手术期间相关并发症进行了术前评估与风险告知后，患者因无法负担起搏器重新程控所需的医疗保障费用而未进行程控调整。其原因包括心脏外科手术需在埃塞俄比亚亚的斯亚贝巴进行，心外科医师寥寥无几而候诊名单漫长，且距离患者所在机构较远，并且起搏器重新程控后需有一段时间监测以应对程控后并发症。最终，患者选择继续手术，并接受相关潜在风险与伤害。强烈倡导术中持续心脏监测。尽管存在上述因素，患者未出现心肺衰竭，且一直平稳。患者直至手术当日仍继续服用氨氯地平、依那普利和阿托伐他汀，晨给予NPH较低剂量为原剂量的2/3。手术前一日午夜口服地西泮5 mg以抗焦虑。\n\n手术当日测随机血糖（RBS），并实施滑动尺度血糖控制。强调麻醉医师、外科医师及护士之间的沟通，确保电刀负极板置于远离起搏器的位置，并备妥急救药物及除颤器。术前给予地塞米松以预防恶心，并以对乙酰氨基酚进行预防性镇痛以缓解疼痛。应用美国麻醉医师学会（ASA）标准监测，并记录基线参数。于L3–L4间隙行腰硬联合麻醉，给予0.5%等比重布比卡因（12.5 mg）及芬太尼50 µg。阻滞平面达到脐部，感觉阻滞为T7。手术经脐下正中切口进行，采用低电压（20 mA）的单极电凝；止血通过低电压双极电凝完成。整个手术过程中患者生命体征保持稳定，其生命体征较基线值波动不超过10%。术中予以静脉补液复苏。术后将患者转入麻醉后恢复室（PACU）严密监测，并给予0.125%硬膜外追加镇痛10 ml。术后相关检查均在正常范围。患者在PACU观察12小时后病情平稳转回病房，并由心内科团队定期随访。术后第88天患者出院，并建议定期复查起搏器在位状态。"
+  },
+  {
+    "english_text": "A 52-year-old woman referred to the urology clinic with urinary complaints. Her symptoms began three years ago with frequency, dysuria and dribbling. She also mentioned the frequent passage of red and black thread-like substances in her urine. Moreover, during these discharges, she had headache, fever and chills. Intermittent periurethral and genital itching was another complaint of hers. She had been treated by several specialists with the diagnosis of recurrent urinary tract infections, with no clinical improvement. The patient denied recent travel, camping, hiking, farming, swimming and insect bites. She had positive history of pilonidal sinus surgery and hysterectomy, 8 and 7 years earlier, respectively. Two years prior to the current visit, she had been hospitalized for assessment. On physical examination, she was well-appearing with normal vital signs. All her laboratory tests, including cell blood count, urine analysis and biochemistries were in normal ranges. Abdominopelvic computed tomography (CT) scan revealed no abnormalities. Hence, she underwent cystoscopy, which demonstrated erythema and hyperemia of the bladder mucosa, suspended debris, and dilation of the left ureteral orifice. During consultation with an infectious diseases’ specialist, schistosomiasis was suspected, Therefore, she was treated with Praziquantel with the appropriate dose and duration and was discharged from the hospital.\n\nHowever, her symptoms did not subside. She was revisited by another infectious disease specialist, who prescribed her ivermectin due to suspicion to urinary myiasis. Nevertheless, no improvement was observed. She was readmitted to undergo bladder irrigation with polyethylene glycol, but the bladder washfluid did not contain any visible larvae. This procedure was followed by a two-day hematuria with spontaneous cessation. She was discharged home and advised to repeat the urine analysis one months later. Her random urine analysis was normal, so she collected her 24-h urine and sent it to the laboratory for analysis, in which a live larva was demonstrated under light microscope by the pathologist. The larva was isolated and sent to an entomologist to be identified morphologically. Finally, it was determined that the larva belonged to the species Sarcophaga. The patient was advised to take personal hygiene and consume at least 3 L of water daily.",
+    "translated_text": "一名52岁女性因泌尿系统主诉转诊至泌尿外科门诊。其症状始于三年前，表现为尿频、尿痛及尿滴沥。她还提到尿中经常排出红色和黑色丝状物。此外，在这些排出物出现时，她伴有头痛、发热及寒战。间歇性尿道周围及生殖器瘙痒亦为其一项主诉。此前曾以反复泌尿道感染诊断由多位专科医生治疗，但无临床改善。患者否认近期旅行、露营、徒步、务农、游泳及昆虫叮咬。既往有骶尾部毛窦手术及子宫切除术史，分别于8年前和7年前行。本次就诊前两年，她因评估而住院。体格检查示外观良好，生命体征正常。包括全血细胞计数、尿液分析及生化检查在内的所有实验室检查均在正常范围。腹盆腔CT扫描未见异常。因此行膀胱镜检查，示膀胱黏膜红斑和充血，有悬浮碎屑，左侧输尿管开口扩张。与感染性疾病专科医师会诊时，怀疑血吸虫病，因此按适当剂量和疗程给予吡喹酮治疗，随后出院。\n\n然而，其症状未缓解。随后再次就诊于另一位感染性疾病专科医师，因怀疑泌尿道蝇蛆病而给予伊维菌素治疗；但仍未见好转。再次入院以聚乙二醇行膀胱灌洗，但膀胱冲洗液未见可见幼虫。该操作后出现持续两天的血尿，后自行停止。出院，并建议一个月后复查尿液分析。其随机尿液分析结果正常，遂收集24小时尿并送实验室分析，病理学家在光学显微镜下证实其中有活幼虫。将该幼虫分离并送交昆虫学家进行形态学鉴定。最终确定该幼虫属于Sarcophaga物种。建议患者注意个人卫生，并每日摄入至少3 L水。"
+  },
+  {
+    "english_text": "A 36-year-old female patient with a history of ulcerative colitis and good disease control on sulfasalazine, ferrous fumarate and intermittent prednisone for flare-ups is presented.\n\nHe was admitted to the emergency unit with a 1 week history of progressive oppressive precordial pain associated with dyspnea and neurovegetative symptoms. On admission, an electrocardiogram was performed in sinus rhythm, with finding of supradesnivel of the ST segment in the lower wall.\n\nThe patient reported a 6-month history of general disorders, fatigue and night sweats. She had previously presented episodes of precordial pain in relation to effort that progressed to rest. The physical examination was without murmurs or alterations of the peripheral pulses.\n\nAn emergency coronary angiography was performed, which revealed severe 2-vessel disease: severe ostial lesion 90% in the left coronary trunk and severe subocclusive lesion 99-100% at the ostial level in the right coronary artery (culprit vessel). Primary angioplasty of the right coronary artery was performed with successful installation of a medicated stent. The hemodynamicist was impressed by a possible aortitis due to involvement of the arch and friability of the vessels when the balloon was advanced, so he suggested an etiological study oriented to inflammatory disease, prior to surgical resolution of the lesion of the left coronary trunk.\n\nLaboratory tests showed mild anaemia (haemoglobin: 11.6 g/dL), mild leukocytosis (13,800/mm3), elevated erythrocyte sedimentation rate (ESR): 42 mm/h and C-reactive protein (CRP): 4.9 mg/L (normal value <1) and elevated ultrasensitive troponin. From the autoimmunity study, normal levels of complement C3 and C4, negative anti-nuclear antibodies (ANA), anti-DNA, negative extracellular nuclear antigen (ENA) profile and non-reactive VDRL were rescued.\n\nCardiac magnetic resonance (MRI) with contrast was completed with findings of acute infarction of the left ventricular inferior wall non-transmural myocardium and subendocardial ischemia in the anteroseptoapical resting of the left ventricle. Mild aortic and mitral insufficiency. Preserved biventricular systolic function.\n\nComputed tomography angiography (CTA) of the chest, abdomen and pelvis showed periaortic fibrotic wall thickening involving the root, aortic arch and abdominal aorta with severe left coronary trunk stenosis and mild left subclavian, left vertebral artery stenosis and severe lower mesenteric artery stenosis. Immune globulin G (IgG) 4 deposition disease or Takayasu's arteritis was suggested.\n\nWithin the differential diagnosis study, IgG levels were performed at 1,600 mg/dl (reference values: 700-1,600), and its subclasses: IgG1: 1024 mg/dl (elevated), and the rest in normal range (IgG2: 456 mg/dl; IgG3: 98.8 mg/dl and IgG4: 13.6 mg/dl).\n\nTakayasu arteritis was diagnosed clinically and by imaging and treatment was initiated with prednisone 60 mg daily, methotrexate 20 mg weekly by injection and folic acid 1 mg daily. After 3 weeks of treatment she underwent myocardial revascularisation surgery with use of the left internal mammary artery (LIMA) as a graft to the descending anterior artery (DA) and aortocoronary bypass to circumflex artery. It was noted intraoperatively that the root of the aorta and the ascending aorta presented a healthy appearance. The patient is currently at home in good general condition and under ambulatory follow-up.\n",
+    "translated_text": "现呈现一例36岁女性患者，既往有溃疡性结肠炎病史，应用柳氮磺吡啶、富马酸亚铁及间歇性泼尼松控制病情良好，遇急性加重时使用。\n\n他因进行性压迫性心前区痛1周入急诊，伴呼吸困难及植物神经症状。入院时行心电图检查示窦性心律，发现下壁ST段抬高。\n\n患者报告有6个月全身不适、乏力和夜间盗汗病史。既往出现与劳力相关的心前区疼痛，后进展至静息时发生。体格检查未闻及杂音，外周脉搏无异常。\n\n行急诊冠状动脉造影提示重度双支病变：左冠状动脉主干开口处重度病变90%，右冠状动脉开口处重度亚闭塞性病变99–100%（罪犯血管）。对右冠状动脉行初次经皮血管成形术并成功置入药物洗脱支架。介入/血流动力学医师因主动脉弓受累及球囊推进时血管脆性增高而考虑可能为主动脉炎，遂建议在对左冠状动脉主干病变行外科处理前，先进行指向炎性疾病的病因学评估。\n\n实验室检查示轻度贫血（血红蛋白：11.6 g/dL）、轻度白细胞增多（13,800/mm3）、红细胞沉降率（ESR）升高：42 mm/h，C反应蛋白（CRP）：4.9 mg/L（正常值<1），高敏肌钙蛋白升高。自身免疫相关检查显示补体C3、C4正常；抗核抗体（ANA）阴性；抗DNA阴性；可提取核抗原（ENA）谱阴性；VDRL非反应性。\n\n增强心脏磁共振（MRI）提示左心室下壁非透壁性急性心肌梗死，以及左心室前间隔-心尖部静息期心内膜下缺血。轻度主动脉及二尖瓣关闭不全。双心室收缩功能保留。\n\n胸、腹、盆腔CT血管成像（CTA）示主动脉周围纤维性壁增厚，累及主动脉根部、主动脉弓及腹主动脉，并见左冠状动脉主干重度狭窄、左锁骨下动脉及左椎动脉轻度狭窄、下肠系膜动脉重度狭窄。提示IgG4相关疾病或高安动脉炎的可能。\n\n在鉴别诊断评估中，IgG为1,600 mg/dL（参考值：700–1,600），其亚类：IgG1：1024 mg/dL（升高），其余在正常范围（IgG2：456 mg/dL；IgG3：98.8 mg/dL；IgG4：13.6 mg/dL）。\n\n结合临床与影像学诊断为高安动脉炎，开始治疗：泼尼松60 mg每日，甲氨蝶呤20 mg每周注射，叶酸1 mg每日。治疗3周后行外科心肌血运重建手术，采用左乳内动脉（LIMA）移植至前降支（DA），并行主动脉-冠状动脉旁路至回旋支。术中注意到主动脉根部及升主动脉外观良好。患者目前在家，整体状况良好，门诊随访中。"
+  },
+  {
+    "english_text": "A 36-year-old female patient complained of dysphagia with longstanding cervical and upper thoracic pain. She also had a multinodular goiter with no other significant history. Esophagogastroduodenal transit was performed. It showed a posterior and lateral right impression of the proximal esophagus after ingestion of baryte, extending 3.5 cm cephalocaudal. A maximum esophageal stenosis of 60% was estimated. A cervical and thoracic CT scan revealed a congenital anomaly of the aortic arch: a mirror image of the right aortic arch. The aortic arch originates from the root of the aorta and runs above the right stem bronchus, giving rise to the three supra-aortic trunks as follows: the first is the left brachiocephalic artery (which gives rise to the left common carotid artery and the left subclavian artery); the second is the right common carotid artery; and the third is the right subclavian artery. The aortic arch then enters posteriorly to the esophagus and gives rise to a small anterior saccule of 1.3 cm, known as the Kommerell diverticulum. This configuration forms a ring around the tracheo-esophageal pair, whose edges are formed posterior-lateral to the right by the aortic arch, posterior-lateral to the left by the Kommerell diverticulum, lateral to the left by the arteriosum ligamentum (or arterial ligament), and anteriorly by the left brachiocephalic artery. A gastroscopy confirmed the endoluminal impact of extrinsic compression. In view of minimal clinical repercussions and the absence of nutritional disorders, no surgical cure was ultimately performed. The evolution was favorable with, according to the patient, a spontaneous amelioration of symptoms.\n",
+    "translated_text": "一名36岁女性患者主诉吞咽困难，伴长期颈部及上胸部疼痛。另有多结节性甲状腺肿，无其他重要病史。行食管胃十二指肠造影检查。吞服钡剂后可见食管近端右后外侧压迹，沿颅尾方向延伸3.5 cm。估计食管最大狭窄程度为60%。颈胸部CT扫描显示主动脉弓先天性畸形：右位主动脉弓的镜像型。主动脉弓起源于主动脉根部，经右主支气管上方走行，发出三条弓上血管如下：第一为左头臂动脉（其分出左颈总动脉和左锁骨下动脉）；第二为右颈总动脉；第三为右锁骨下动脉。随后主动脉弓自食管后方经过，并形成一个1.3 cm的小型前向囊袋，称为Kommerell憩室。该构型围绕气管-食管复合体形成一个环，其边界组成如下：右后外侧为主动脉弓，左后外侧为Kommerell憩室，左外侧为动脉韧带（或动脉索），前方为左头臂动脉。胃镜检查证实外源性压迫所致的腔内压迹。鉴于临床影响轻微且无营养障碍，最终未行手术治疗。转归良好，患者自述症状自行改善。"
+  }
+]
\ No newline at end of file
diff --git a/data/translated_data/translation_version_v2/multiclinsum_gs_train_en2bn_gemma(0_200).json b/data/translated_data/translation_version_v2/multiclinsum_gs_train_en2bn_gemma(0_200).json
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@@ -0,0 +1,146 @@
+[
+    {
+        "id": "multiclinsum_gs_en_587.txt",
+        "fulltext": "A 22-year-old woman came to the Department of Oral Medicine with complaints of mouth ulcers causing pain and eating and drinking difficulty persisting for a duration of one month. This condition begins with a fever and appears like pimples on the lips. Based on the anamnesis, it was discovered that she had been using pod-type vapes for about a year but had never experienced complaints like when she came for treatment. She had never smoked traditional cigarettes before starting to vape. She said the reason for trying vaping was out of curiosity, and she quite often tried different types of e-liquid with different flavors. Before her complaint, she had simply changed the type of e-liquid to a different flavor without mentioning the brand. She vapes almost every day, but not all day, only in her free time or with friends. She was a healthy individual, and before this condition appeared, she had no history of taking medications, including antibiotics, analgesics, anticonvulsants, non-steroidal anti-inflammatory drugs, and antifungals. She also had no history of drug or food allergies, but the patient has unhealthy eating habits (eating irregularly and not consuming vegetables and fruit). Extraoral examination showed no lesions on other parts of the body, while the lips of the patient had serosanguineous crusts and an erosive area at the corner of the mouth, and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges, irregular, varying sizes, and pain on the labial, buccal, lateral, and ventral mucosa of the tongue and floor of the mouth.\n\nBased on the medical history of the patient and physical examination, which revealed oral mucosal involvement but no symptoms elsewhere in the body, as well as the non-reactive anti-HSV1 IgG results, the diagnosis of vaping-related oral erythema multiforme was established. The medical condition has been classified as minor erythema multiforme. The oral conditions were treated with 0.9% NaCl, which was moistened in gauze and placed on the lips three times a day. The patient was instructed to gargle 1 mg of dexamethasone in 10 mL of hyaluronic acid three times a day and avoid eating or drinking for at least 30 minutes after gargling. She was also given 2% miconazole cream applied to the wound in the right corner of the mouth twice a day, as well as vaseline album cream for dry lips. To maintain good oral hygiene, she was advised to brush her teeth and tongue twice a day, after breakfast and before bed. She was also instructed to stop vaping and avoid foods containing monosodium glutamate (MSG). The control was carried out after a week following therapy and showed that oral condition had improved. Written informed consent for the publication of details was obtained from the patient. This case report conformed with the Helsinki Declaration. The publication of this case report has also been approved by the institution.",
+        "summary": "A 22-year-old woman came to the Oral Medicine Department with complaints of stomatitis causing pain, eating, and drinking difficulty, which started with fever and pimple-like on the lips. She was an active vape user for one year. Extraoral examination revealed no lesions on other body parts. The serosanguinolent crusts on the lips, an erosive area on the labial commissures and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges and irregular, varying sizes in several parts of the oral mucosa. The anti-HSV-1 IgG laboratory results showed non-reactive, leading to a diagnosis of oral erythema multiforme. Management of oral conditions using 0.9% NaCl compress, dexamethasone mouthwash, and hyaluronic acid, applying 2% miconazole cream on labial commissures and vaseline album cream on the dry lips, and stopping vaping. Oral condition improved in a week of therapy.",
+        "translated_fulltext": "২২ বছর বয়সী একজন নারী মুখ ও দাঁতের বিভাগে এসে অভিযোগ করেন যে, তার মুখে ঘা হয়েছে, যার কারণে ব্যথা হচ্ছে এবং গত এক মাস ধরে খাবার ও পানীয় গ্রহণে অসুবিধা হচ্ছে। এই সমস্যা প্রথমে জ্বর দিয়ে শুরু হয় এবং ঠোঁটে ছোট ছোট ফুসকুড়ি দেখা যায়। তার কাছ থেকে পাওয়া তথ্যের ভিত্তিতে জানা যায় যে, তিনি প্রায় এক বছর ধরে পড-টাইপ ভ্যাপ ব্যবহার করছেন, কিন্তু এর আগে কখনো এমন সমস্যা অনুভব করেননি। ভ্যাপ ব্যবহার শুরু করার আগে তিনি কখনো সাধারণ সিগারেট খাননি। তিনি বলেন, কৌতূহলবশত তিনি ভ্যাপ ব্যবহার শুরু করেন এবং প্রায়ই বিভিন্ন স্বাদের ই-লিকুইড ব্যবহার করে দেখতে থাকেন। সমস্যা শুরু হওয়ার আগে, তিনি কোনো ব্র্যান্ড উল্লেখ না করে কেবল ই-লিকুইডের স্বাদ পরিবর্তন করেছিলেন। তিনি প্রায় প্রতিদিন ভ্যাপ ব্যবহার করেন, তবে সারাদিন নয়, শুধুমাত্র অবসর সময়ে বা বন্ধুদের সাথে। তিনি শারীরিকভাবে সুস্থ ছিলেন এবং এই সমস্যা দেখা দেওয়ার আগে, তিনি কোনো ওষুধ, যেমন - অ্যান্টিবায়োটিক, ব্যথানাশক, অ্যান্টিকনভালসেন্ট, নন-স্টেরয়েডাল অ্যান্টি-ইনফ্ল্যামেটরি ওষুধ বা অ্যান্টিফাঙ্গাল ওষুধ সেবন করেননি। তার ওষুধ বা খাবারের প্রতি অ্যালার্জিরও কোনো ইতিহাস নেই, তবে তার খাদ্যাভ্যাস স্বাস্থ্যকর নয় (অনিয়মিতভাবে খাবার গ্রহণ এবং ফল ও সবজি কম খাওয়া)। শরীরের অন্যান্য অংশে কোনো ক্ষত দেখা যায়নি, তবে তার ঠোঁটে সেরোস্যাঙ্গুইনাস ক্রাস্ট এবং মুখের কোণে ক্ষয়প্রাপ্ত স্থান ছিল, যেখান থেকে রক্তপাত হতো। মুখের ভেতরের পরীক্ষায় দেখা যায়, সাদা রঙের ঘা, যার কিনারা হলুদ, বিভিন্ন আকারের এবং অনিয়মিত, এবং ঠোঁট, গালের ভেতরের অংশ, জিহ্বার পাশের অংশ এবং মুখের নিচের অংশে ব্যথা রয়েছে।\n\nরোগীর চিকিৎসা ইতিহাস এবং শারীরিক পরীক্ষার ফলাফলের ভিত্তিতে, যেখানে মুখের শ্লেষ্মা ঝিল্লিতে সমস্যা দেখা গেছে কিন্তু শরীরের অন্য কোনো অংশে কোনো উপসর্গ নেই, এবং অ্যান্টি-এইচএসভি১ আইজিজি পরীক্ষার ফলাফল নেগেটিভ এসেছে, তাই ভ্যাপ ব্যবহারের কারণে সৃষ্ট মুখের এরিথেমা মাল্টিফর্মের রোগ নির্ণয় করা হয়। এই স্বাস্থ্য সমস্যাটিকে মাইনর এরিথেমা মাল্টিফর্ম হিসাবে শ্রেণীবদ্ধ করা হয়েছে। মুখের সমস্যার জন্য ০.৯% স্যালাইন ব্যবহার করা হয়, যা গজ কাপড়ে ভিজিয়ে দিনে তিনবার ঠোঁটে লাগানো হয়। রোগীকে দিনে তিনবার ১০ মিলি হায়ালুরোনিক অ্যাসিড দ্রবণে ১ মিলি ডেক্সামেথাসোন মিশিয়ে গার্গল করতে এবং গার্গলের অন্তত ৩০ মিনিট পর খাবার বা পানীয় গ্রহণ করা থেকে বিরত থাকতে বলা হয়। এছাড়াও, মুখের ডান কোণে লাগানোর জন্য ২% মাইকোনাজল ক্রিম দিনে দুবার এবং শুষ্ক ঠোঁটের জন্য ভ্যাসলিন অ্যালবুম ক্রিম দেওয়া হয়। ভালো মৌখিক স্বাস্থ্যবিধি বজায় রাখার জন্য, তাকে সকালে নাস্তার পর এবং রাতে ঘুমানোর আগে দিনে দুবার দাঁত ও জিভ ব্রাশ করতে বলা হয়। তাকে ভ্যাপ ব্যবহার বন্ধ করতে এবং মনোসোডিয়াম গ্লুটামেট (এমএসজি) যুক্ত খাবার পরিহার করতে বলা হয়। থেরাপির এক সপ্তাহ পর পুনরায় পরীক্ষা করা হয় এবং দেখা যায় যে মুখের অবস্থার উন্নতি হয়েছে। বিস্তারিত তথ্য প্রকাশের জন্য রোগীর কাছ থেকে লিখিত সম্মতি নেওয়া হয়েছে। এই কেস রিপোর্ট হেলসিঙ্কি ঘোষণার সাথে সঙ্গতিপূর্ণ। এই কেস রিপোর্টটি প্রকাশের জন্য প্রতিষ্ঠানের অনুমোদনও নেওয়া হয়েছে।",
+        "translated_summary": "২২ বছর বয়সী একজন মহিলা মুখ ও দাঁতের রোগ বিভাগে এসে অভিযোগ করেন যে তার মুখে প্রদাহের কারণে ব্যথা হচ্ছে, খেতে ও পান করতে অসুবিধা হচ্ছে, যা জ্বর এবং ঠোঁটে ছোট ছোট ফুসকুড়ি দিয়ে শুরু হয়েছিল। তিনি এক বছর ধরে নিয়মিত ভ্যাপ ব্যবহার করতেন। শরীরের অন্যান্য অংশে কোনো ক্ষত দেখা যায়নি। ঠোঁটে সেরোস্যাঙ্গুইনোলেন্ট ক্রাস্ট, ঠোঁটের কোণে ক্ষয়যুক্ত স্থান এবং সামান্য রক্তপাতের প্রবণতা দেখা যায়। মুখের ভেতরের পরীক্ষায় দেখা যায়, মুখের শ্লেষ্মা ঝিল্লির বিভিন্ন অংশে সাদা রঙের আলসার রয়েছে, যেগুলোর প্রান্ত হলুদ এবং আকারগুলো অনিয়মিত ও ভিন্ন। অ্যান্টি-এইচএসভি-১ আইজিজি ল্যাবরেটরি পরীক্ষায় কোনো প্রতিক্রিয়া দেখা যায়নি, যার ফলে মুখের এরিথেমা মাল্টিফর্মের রোগ নির্ণয় করা হয়। এক্ষেত্রে ০.৯% সোডিয়াম ক্লোরাইড কম্প্রেস, ডেক্সামেথাসোন মাউথওয়াশ এবং হায়ালুরোনিক অ্যাসিড ব্যবহার করে মুখের অবস্থার উন্নতি ঘটানো হয়। এছাড়াও, ঠোঁটের কোণে ২% মাইকোনাজল ক্রিম এবং শুষ্ক ঠোঁটে ভ্যাসেলিন অ্যালবুম ক্রিম লাগানো হয় এবং ভ্যাপ ব্যবহার বন্ধ করতে বলা হয়। এক সপ্তাহের চিকিৎসার পর মুখের অবস্থার উন্নতি দেখা যায়।",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_194.txt",
+        "fulltext": "A 36-year-old female patient complained of dysphagia with longstanding cervical and upper thoracic pain. She also had a multinodular goiter with no other significant history. Esophagogastroduodenal transit was performed. It showed a posterior and lateral right impression of the proximal esophagus after ingestion of baryte, extending 3.5 cm cephalocaudal. A maximum esophageal stenosis of 60% was estimated. A cervical and thoracic CT scan revealed a congenital anomaly of the aortic arch: a mirror image of the right aortic arch. The aortic arch originates from the root of the aorta and runs above the right stem bronchus, giving rise to the three supra-aortic trunks as follows: the first is the left brachiocephalic artery (which gives rise to the left common carotid artery and the left subclavian artery); the second is the right common carotid artery; and the third is the right subclavian artery. The aortic arch then enters posteriorly to the esophagus and gives rise to a small anterior saccule of 1.3 cm, known as the Kommerell diverticulum. This configuration forms a ring around the tracheo-esophageal pair, whose edges are formed posterior-lateral to the right by the aortic arch, posterior-lateral to the left by the Kommerell diverticulum, lateral to the left by the arteriosum ligamentum (or arterial ligament), and anteriorly by the left brachiocephalic artery. A gastroscopy confirmed the endoluminal impact of extrinsic compression. In view of minimal clinical repercussions and the absence of nutritional disorders, no surgical cure was ultimately performed. The evolution was favorable with, according to the patient, a spontaneous amelioration of symptoms.\n",
+        "summary": "We report the case of a 36-year-old female patient whose dysphagia presented a congenital anomaly of the thoracic aorta: the right aortic arch with mirror image. This is a rare anomaly of embryonic development where the aorta winds around the right stem bronchus and the supra-aortic trunks emerge from the crown in the reverse and opposite order to normal. The vast majority of patients are asymptomatic unless there is a compression of the mediastinal structures. Major compression of the esophagus or trachea, aneurysmal disease, thoracic aortic dissection or the presence of a Kommerell diverticulum of more than 2 cm may warrant surgical intervention. There is no standard treatment and it must be adapted to the clinical presentation and anatomical configuration of the patient. Our patient did not receive any treatment for her condition.\n",
+        "translated_fulltext": "৩৬ বছর বয়সী একজন মহিলা রোগী দীর্ঘস্থায়ী ঘাড় এবং বুকের উপরের অংশে ব্যথার সাথে গিলতে অসুবিধা নিয়ে অভিযোগ করেন। তার মাল্টিনোডুলার গলগণ্ড ছিল এবং অন্য কোনো উল্লেখযোগ্য স্বাস্থ্যগত ইতিহাস ছিল না। তার খাদ্যনালী এবং পাকস্থলীর মধ্যে খাদ্য পরিবহনের পরীক্ষা করা হয়। পরীক্ষায় দেখা যায়, বেরিয়াম মিশ্রণ গ্রহণের পর খাদ্যনালীর উপরের অংশে পেছনের দিকে এবং ডান দিকে একটি চাপ সৃষ্টি হয়েছে, যা ৩.৫ সেন্টিমিটার পর্যন্ত বিস্তৃত। খাদ্যনালীর ৬০% পর্যন্ত সংকীর্ণতা দেখা যায়। ঘাড় এবং বুকের সিটি স্ক্যানে দেখা যায়, মহাধমনীর খিলান জন্মগতভাবে ত্রুটিপূর্ণ: এটি ডান দিকের মহাধমনীর খিলানের একটি প্রতিচ্ছবি। মহাধমনীর খিলান মহাধমনীর মূল থেকে উৎপন্ন হয় এবং ডান দিকের শ্বাসনালীর উপরে দিয়ে যায়, যা তিনটি মহাধমনী-উপরে অবস্থিত ধমনী তৈরি করে: প্রথমটি হলো বাম ব্রাকিওসেফালিক ধমনী (যা বাম সাধারণ ক্যারোটিড ধমনী এবং বাম সাবক্লাভিয়ান ধমনী তৈরি করে); দ্বিতীয়টি হলো ডান সাধারণ ক্যারোটিড ধমনী; এবং তৃতীয়টি হলো ডান সাবক্লাভিয়ান ধমনী। এরপর মহাধমনীর খিলান খাদ্যনালীর পেছনের দিকে প্রবেশ করে এবং ১.৩ সেন্টিমিটারের একটি ছোট সম্মুখ স্যাক তৈরি করে, যা কোমেরেল ডাইভার্টিকুলাম নামে পরিচিত। এই গঠন শ্বাসনালী এবং খাদ্যনালীর চারপাশে একটি বলয় তৈরি করে, যার প্রান্তগুলি ডান দিকে মহাধমনীর খিলান, বাম দিকে কোমেরেল ডাইভার্টিকুলাম, বাম দিকে আর্টেরিওসাম লিগামেন্ট (বা ধমনী লিগামেন্ট) এবং সামনের দিকে বাম ব্রাকিওসেফালিক ধমনী দ্বারা গঠিত। গ্যাস্ট্রোস্কোপি পরীক্ষায় বাহ্যিক চাপের কারণে খাদ্যনালীর ভেতরের অংশে প্রভাবের বিষয়টি নিশ্চিত করা হয়। যেহেতু তেমন কোনো ক্লিনিক্যাল জটিলতা ছিল না এবং পুষ্টির অভাবজনিত কোনো সমস্যাও ছিল না, তাই শেষ পর্যন্ত কোনো অস্ত্রোপচার করা হয়নি। রোগীর মতে, অবস্থার উন্নতি হওয়ায় এবং উপসর্গগুলো স্বতঃস্ফূর্তভাবে হ্রাস পাওয়ায় পরিস্থিতি অনুকূলে ছিল।",
+        "translated_summary": "আমরা একজন ৩৬ বছর বয়সী মহিলা রোগীর ঘটনা বর্ণনা করছি, যার খাদ্যনালীতে সমস্যা দেখা দেয় এবং পরীক্ষায় ধরা পড়ে যে তার থোরাসিক অ্যাওর্টাতে জন্মগত ত্রুটি রয়েছে: ডান দিকের অ্যাওর্টিক আর্চ, যা আয়নার প্রতিবিম্বের মতো। এটি ভ্রূণের বিকাশের একটি বিরল ত্রুটি, যেখানে অ্যাওর্টা ডান দিকের শ্বাসনালীর চারপাশে ঘুরে যায় এবং সুপ্রা-অ্যাওর্টিক ধমনীগুলো স্বাভাবিকের বিপরীত ক্রমে এবং উল্টো দিক থেকে উৎপন্ন হয়। বেশিরভাগ রোগীরই কোনো উপসর্গ থাকে না, যতক্ষণ না মধ্যচ্ছদীয় কাঠামোর ওপর চাপ পড়ে। খাদ্যনালী বা শ্বাসনালীর ওপর গুরুতর চাপ, অ্যানিউরিসমাল রোগ, থোরাসিক অ্যাওর্টিক ডিসেকশন অথবা ২ সেন্টিমিটারের বেশি আকারের কোমেরেলে ডাইভার্টিকুলামের উপস্থিতি দেখা গেলে অস্ত্রোপচারের প্রয়োজন হতে পারে। এর জন্য কোনো নির্দিষ্ট চিকিৎসা নেই এবং রোগীর ক্লিনিক্যাল অবস্থা ও শারীরবৃত্তীয় গঠনের ওপর ভিত্তি করে চিকিৎসা পদ্ধতি নির্ধারণ করতে হয়। আমাদের রোগী তার এই সমস্যার জন্য কোনো চিকিৎসা নেননি।",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_3.txt",
+        "fulltext": "We present a case of a 59-year-old lady with a twelve-year history of secondary progressive multiple sclerosis who was referred to ophthalmology with a few weeks’ history of bilateral blurring of vision.\n\nThe patient had no past ophthalmic history and no drug history other than the anti-epileptic medications related to her multiple sclerosis. Previously documented ophthalmic examinations did not reveal any signs of Fuchs' endothelial corneal dystrophy, and the patient has no family history of corneal pathology.\n\nThe patient had been on amantadine therapy at a dose of 100mg twice daily for the past 7 years and was started on levetiracetam 250mg twice daily as an add-on agent. Visual deterioration was experienced shortly after commencement of levetiracetam therapy for a breakthrough seizure.\n\nOn examination, the patient’s best corrected visual acuity was 0.5 logMAR right eye and 0.5 logMAR left eye. Slit-lamp examination revealed corneal edema involving both eyes and absence of uveitis. Corrected intraocular pressures were 16mmHg right eye and 18mmHg left eye. Corneal topography was performed which confirmed bilateral significant corneal thickening with a right central corneal thickness of 936μm and left central corneal thickness of 1134μm. The rest of the eye examination was normal.\n\nSince amantadine is a known cause of corneal edema, it was agreed with the patient and her caring neurologist to switch from amantadine to lamotrigine. Levetiracetam therapy was continued at this stage. No improvement in vision was noted two months after this change in treatment. The patient expressed the wish to temporarily stop levetiracetam on a trial basis in view of the direct temporal association between the onset of symptoms and the commencement of the medication.\n\nAmantadine was re-introduced, while levetiracetam dose was tapered. Improvement in vision was noted a few days after levetiracetam dose reduction. Levetiracetam was stopped altogether, and the patient remained on amantadine and lamotrigine. A provisional diagnosis of levetiracetam-induced corneal edema was made at this stage. Her vision normalized and repeat corneal topography six months after stopping the levetiracetam showed a right central corneal thickness of 567μm and a left central corneal thickness of 573μm, and a visual acuity of 0.2 logMAR both eyes. Slit-lamp examination confirmed clear cornea and the absence of corneal guttata in either eye.\n\nThe patient was examined again thirteen months after the first presentation. No further changes in her medications were made, and her vision had remained stable at 0.2 logMAR in both eyes. Repeat corneal topography showed no further changes.",
+        "summary": "A 59-year-old woman was referred to the ophthalmology department with a few weeks’ history of bilateral blurring of vision. She is a known case of secondary progressive multiple sclerosis, and she was started on levetiracetam by her neurologist a few weeks prior to referral in view of new seizure activity. Examination revealed bilateral clinically evident corneal edema, which was documented on corneal topography.\n\nResults\nUpon levetiracetam dose reduction, symptoms started to improve and eventually the medication was stopped altogether. The patient’s vision and corneal edema normalized on follow-up.",
+        "translated_fulltext": "আমরা এখানে ৫৯ বছর বয়সী একজন মহিলার ঘটনা তুলে ধরছি, যিনি ১২ বছর ধরে সেকেন্ডারি প্রগ্রেসিভ মাল্টিপল স্ক্লেরোসিসে ভুগছেন এবং কয়েক সপ্তাহ ধরে উভয় চোখের দৃষ্টি ঝাপসা হওয়ার কারণে চক্ষু বিভাগে রেফার করা হয়েছিলেন।\n\nরোগীর পূর্বে কোনো চক্ষু সংক্রান্ত সমস্যা ছিল না এবং মাল্টিপল স্ক্লেরোসের কারণে ব্যবহৃত অ্যান্টি-এপিলেপটিক ওষুধ ছাড়া অন্য কোনো ওষুধের ইতিহাসও ছিল না। পূর্বে করা চক্ষু পরীক্ষার নথিতে ফুচসের এন্ডোথেলিয়াল কর্নিয়াল ডিস্ট্রফির কোনো লক্ষণ পাওয়া যায়নি এবং রোগীর পরিবারে কর্নিয়ার কোনো রোগ ছিল না।\n\nগত ৭ বছর ধরে রোগী প্রতিদিন দুবার ১০০ মিলিগ্রাম করে অ্যামান্টাডিন গ্রহণ করছিলেন এবং একটি অতিরিক্ত ওষুধ হিসেবে প্রতিদিন দুবার ২৫০ মিলিগ্রাম লেভেтираসেটাম দেওয়া শুরু করা হয়। লেভেтираসেটাম থেরাপি শুরু করার অল্প সময়ের মধ্যেই, একটি আকস্মিক খিঁচুনির পরে দৃষ্টিশক্তি হ্রাস পায়।\n\nপরীক্ষায় দেখা যায়, রোগীর সবচেয়ে ভালো দৃষ্টিশক্তি ছিল ডান চোখে ০.৫ লগমার এবং বাম চোখে ০.৫ লগমার। স্লিট-ল্যাম্প পরীক্ষায় উভয় চোখের কর্নিয়াল ইডিমা এবং ইউভাইটিসের অনুপস্থিতি দেখা যায়। সঠিক ইন্ট্রাওকুলার চাপ ছিল ডান চোখে ১৬ মিমি Hg এবং বাম চোখে ১৮ মিমি Hg। কর্নিয়াল টপোগ্রাফি করা হয়, যেখানে উভয় চোখের কর্নিয়ার উল্লেখযোগ্য পুরুত্ব দেখা যায়; ডান চোখের কেন্দ্রীয় কর্নিয়ার পুরুত্ব ছিল ৯৩৬ মাইক্রোমিটার এবং বাম চোখের কেন্দ্রীয় কর্নিয়ার পুরুত্ব ছিল ১১৩৪ মাইক্রোমিটার। চোখের বাকি পরীক্ষা স্বাভাবিক ছিল।\n\nযেহেতু অ্যামান্টাডিন কর্নিয়াল ইডিমার একটি পরিচিত কারণ, তাই রোগীর সাথে এবং তার তত্ত্বাবধায়ক নিউরোলজিস্টের সাথে আলোচনা করে অ্যামান্টাডিন থেকে ল্যামোট্রিজিনে পরিবর্তন করার সিদ্ধান্ত নেওয়া হয়। এই পর্যায়ে লেভেтираসেটাম থেরাপি চালিয়ে যাওয়া হয়। এই পরিবর্তনের পর দুই মাস পর্যন্ত দৃষ্টিশক্তিতে কোনো উন্নতি দেখা যায়নি। রোগী সাময়িকভাবে লেভেтираসেটাম বন্ধ করার ইচ্ছা প্রকাশ করেন, কারণ লক্ষণ শুরু হওয়ার সাথে ওষুধের ব্যবহার শুরু করার একটি সরাসরি সম্পর্ক ছিল।\n\nঅ্যামান্টাডিন পুনরায় শুরু করা হয়, এবং লেভেтираসেটামের ডোজ কমানো হয়। লেভেтираসেটামের ডোজ কমানোর কয়েক দিন পর দৃষ্টিশক্তিতে উন্নতি দেখা যায়। লেভেтираসেটাম সম্পূর্ণরূপে বন্ধ করে দেওয়া হয়, এবং রোগী অ্যামান্টাডিন ও ল্যামোট্রিজিন গ্রহণ করতে থাকেন। এই পর্যায়ে লেভেтираসেটাম-এর কারণে কর্নিয়াল ইডিমা হয়েছে বলে প্রাথমিকভাবে ধারণা করা হয়। এরপর, লেভেтираসেটাম বন্ধ করার ছয় মাস পর পুনরায় কর্নিয়াল টপোগ্রাফি করা হলে দেখা যায়, ডান চোখের কেন্দ্রীয় কর্নিয়ার পুরুত্ব ৫৬৭ মাইক্রোমিটার এবং বাম চোখের কেন্দ্রীয় কর্নিয়ার পুরুত্ব ৫৭৩ মাইক্রোমিটার, এবং উভয় চোখের দৃষ্টিশক্তি ০.২ লগমার। স্লিট-ল্যাম্প পরীক্ষায় কর্নিয়া পরিষ্কার এবং উভয় চোখেই কর্নিয়াল গুটাটার অনুপস্থিতি দেখা যায়।\n\nপ্রথমবার দেখার পর তেরো মাস পর রোগীকে আবার পরীক্ষা করা হয়। তার ওষুধে আর কোনো পরিবর্তন করা হয়নি এবং উভয় চোখের দৃষ্টিশক্তি ০.২ লগমার-এ স্থিতিশীল ছিল। পুনরায় কর্নিয়াল টপোগ্রাফি করা হলে আর কোনো পরিবর্তন দেখা যায়নি।",
+        "translated_summary": "৫৯ বছর বয়সী এক মহিলাকে চোখের সমস্যা নিয়ে চক্ষু বিভাগে পাঠানো হয়। কয়েক সপ্তাহ ধরে তার উভয় চোখের দৃষ্টি ঝাপসা হয়ে যাচ্ছিল। তিনি সেকেন্ডারি প্রগ্রেসিভ মাল্টিপল স্ক্লেরোসিসে আক্রান্ত, এবং কয়েক সপ্তাহ আগে তার স্নায়ুরোগ বিশেষজ্ঞ নতুন খিঁচুনি দেখা দেওয়ার কারণে তাকে লেভেтираসেটাম ওষুধ দেওয়া শুরু করেন। পরীক্ষায় দেখা যায়, তার উভয় চোখের কর্নিয়ায় দৃশ্যমান ফোলাভাব রয়েছে, যা কর্নিয়াল টপোগ্রাফিতে নথিভুক্ত করা হয়েছে।\n\nফলাফল\nলেভেтираসেটামের ডোজ কমানোর পর, তার উপসর্গগুলো ধীরে ধীরে উন্নতি হতে শুরু করে এবং অবশেষে ওষুধটি সম্পূর্ণরূপে বন্ধ করে দেওয়া হয়। ফলো-আপে দেখা যায়, রোগীর দৃষ্টি এবং কর্নিয়ার ফোলাভাব স্বাভাবিক হয়ে গেছে।",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_474.txt",
+        "fulltext": "Patient and observation\nPatient information: This was a 67-year-old patient with no medical history who presented with dysphagia, dysphonia and altered general condition.\n\nClinical findings: initial clinical examination found a conscious patient with a Glasgow score of 15/15, apyrexia, blood pressure of 12/07 cmHg, oxygen saturation of 100%, heart rate of 80/min, conjunctivae of normal colour with a large mass in the cavum. There was no hepatomegaly or splenomegaly, the lymph node areas were free, the rest of the physical examination was normal.\n\nChronology: the patient had been experiencing difficulty swallowing with dysphonia for 6 months, the clinical picture worsened with the development of dysphagia for solids with a deterioration in general condition (weight loss of 15kg/6 months).\n\nDiagnostic approach: cervico-thoraco-abdomino-pelvic CT scan showed a 70 mm x 40 mm nasopharyngeal mass extending to 60 mm. The patient's blood work was normal (white blood cell count, renal and hepatic function, lactate dehydrogenase and HIV, HCV and HBV serologies). The histological and immunohistochemical study of the nasopharyngeal biopsy was in favour of a grade 1,2 CD20+; CD19+; CD79a+; CD10+ follicular B-cell NHL in 2 readings in 2 different laboratories. The bone marrow biopsy was normal as was the pre-therapeutic work-up.\n\nTherapeutic intervention: the patient received 4 RCHOP 21 cures (rituximab 375mg/m2 intravenous (iv), cyclophosphamide 750 mg/m2 iv, oncovin 2 mg iv, prednisolone 100 mg orally, and doxorubicin 50 mg/m2 (iv) with no response and then 3 RDHAOX cures (rituximab 375 mg/m2 intravenous (iv) on day 1, high dose aracytine 2 g/m2 x 2 iv on day 2, dexamethasone 40 mg from day 1 to day 4, and oxalipatine 100 mg/m2 on day 1) with no clinical response.\n\nFollow-up and results of therapeutic interventions: the persistence and increase of the nasopharyngeal mass led to the realization of the tracheotomy, the biopsy of the nasopharyngeal mass objectified the disappearance of the lymphoid B infiltration with presence of the amyloid deposits AL type kappa.\n\nImmune electrophoresis of plasma proteins showed the presence of immunoglobulin M kappa, the dosage of light chains was not performed due to lack of resources, the myelogram and a second bone marrow biopsy were normal, the TEP scan objectified a hypermetabolic nasopharyngeal process without other anomalies, the cardiac evaluation (ECG, natriuretic peptides, troponin, echocore) and renal were without particularities, the patient is currently under protocol bortezomib, prednisone and bendamustine with good clinical evolution after the first treatment.\n",
+        "summary": "We report the case of a 67-year-old patient without pathological CDDs who presented with a deterioration of general condition with progressive dysphonia and dysphagia with a large mass in the neck that was biopsy-proven to be a grade 1 and 2 follicular non-Hodgkin lymphoma. A cervico-thoraco-abdomino-pelvic CT scan showed a 70 mm x 40 mm nasopharyngeal mass extending to 60 mm. Bone marrow biopsy was normal and the pre-therapeutic evaluation was normal. The patient received 4 courses of rituximab plus CHOP (cyclophosphamide, adriamycin, prednisone and oncovin) without response and then 3 courses of rituximab plus DHAOX (dexamethasone, high dose ara-cytin and oxalipatin) with persistence of the mass. The biopsy of the latter showed the disappearance of the B lymphocyte infiltration with presence of the AL amyloid deposits. The immunoelectrophoresis of plasma proteins showed the presence of immunoglobulin M. A positron emission tomography (PET) scan showed a hypermetabolic nasopharyngeal process. The patient is currently receiving a protocol of bortezomib, prednisone and bendamustine.\n",
+        "translated_fulltext": "রোগী এবং পর্যবেক্ষণ\n\nরোগীর তথ্য: এই রোগী ৬৭ বছর বয়সী, পূর্বে কোনো স্বাস্থ্যগত সমস্যা ছিল না। তিনি গিলতে অসুবিধা, কণ্ঠস্বর পরিবর্তন এবং শারীরিক অবস্থার অবনতি নিয়ে এসেছিলেন।\n\nক্লিনিক্যাল ফলাফল: প্রাথমিক পরীক্ষায় দেখা যায় রোগী সচেতন, গ্লাসগো স্কোর ১৫/১৫, জ্বর নেই, রক্তচাপ ১২/০৭ সেমিএইচজি, অক্সিজেনের মাত্রা ১০০%, হৃদস্পন্দন ৮০/মিনিট, চোখের সাদা অংশ স্বাভাবিক, এবং গলায় একটি বড় পিণ্ড রয়েছে। যকৃত বা প্লীহায় কোনো অস্বাভাবিকতা ছিল না, লিম্ফ নোডগুলো স্বাভাবিক ছিল, এবং অন্যান্য শারীরিক পরীক্ষা স্বাভাবিক ছিল।\n\nসময়কাল: রোগীর ছয় মাস ধরে গিলতে অসুবিধা এবং কণ্ঠস্বর পরিবর্তনের সমস্যা ছিল। এরপর কঠিন খাবার গিলতে সমস্যা শুরু হয় এবং শারীরিক অবস্থার আরও অবনতি ঘটে (ছয় মাসে ১৫ কেজি ওজন হ্রাস)।\n\nরোগ নির্ণয়ের পদ্ধতি: সারভাইকো-থোরাকো-অ্যাবডোমিনো-পেলভিক সিটি স্ক্যানে দেখা যায়, নাকের পিছনের অংশে ৭০ মিমি x ৪০ মিমি আকারের একটি পিণ্ড রয়েছে, যা ৬০ মিমি পর্যন্ত বিস্তৃত। রোগীর রক্ত পরীক্ষা স্বাভাবিক ছিল (শ্বেত রক্তকণিকার সংখ্যা, কিডনি এবং যকৃতের কার্যকারিতা, ল্যাকটেট ডিহাইড্রোজেনেস, এইচআইভি, এইচসিভি এবং এইচবিভি)। নাকের পিছনের অংশের বায়োপসির হিস্টোলজিক্যাল এবং ইমিউনোহিস্টোকেমিক্যাল পরীক্ষায় দেখা যায়, এটি গ্রেড ১, ২ সিডি২০+; সিডি১৯+; সিডি৭৯এ+; সিডি১০+ ফলিকুলার বি-সেল এনএইচএল, যা দুটি ভিন্ন ল্যাবরেটরিতে দুটিবার পরীক্ষা করে নিশ্চিত করা হয়েছে। অস্থি মজ্জার বায়োপসি স্বাভাবিক ছিল এবং চিকিৎসার আগে করা পরীক্ষাগুলোতেও কোনো সমস্যা দেখা যায়নি।\n\nচিকিৎসা পদ্ধতি: রোগীকে ৪টি আরসিএইচওপি ২১ (রিটুক্সিম্যাব ৩৭৫ মিগ্রা/মি২ ইন্ট্রাভেনাস, সাইক্লোফসফামাইড ৭৫০ মিগ্রা/মি২ ইন্ট্রাভেনাস, অনকোভিন ২ মিগ্রা ইন্ট্রাভেনাস, প্রেডনিসোলোন ১০০ মিগ্রা মুখে এবং ডক্সোরুবিসিন ৫০ মিগ্রা/মি২ ইন্ট্রাভেনাস) দেওয়া হয়েছিল, কিন্তু কোনো উন্নতি হয়নি। এরপর ৩টি আরডিএইচএওএক্স (রিটুক্সিম্যাব ৩৭৫ মিগ্রা/মি২ ইন্ট্রাভেনাস, উচ্চ মাত্রার অ্যারাসাইটিন ২ গ্রাম/মি২ x ২ ইন্ট্রাভেনাস, ডেক্সামেথাসোন ৪০ মিগ্রা প্রথম দিন থেকে চতুর্থ দিন পর্যন্ত, এবং অক্সালিপাটিন ১০০ মিগ্রা/মি২ প্রথম দিন) দেওয়া হয়েছিল, কিন্তু তাতেও কোনো ক্লিনিক্যাল উন্নতি হয়নি।\n\nফলো-আপ এবং চিকিৎসার ফলাফল: নাকের পিছনের পিণ্ডটি বাড়তে থাকায় ট্র্যাকিওটমি করা হয়। বায়োপসিতে দেখা যায়, লিম্ফয়েড বি-কোষের অনুপ্রবেশ হ্রাস পেয়েছে এবং অ্যামাইলয়েড ডিপোজিট এএল টাইপ ক্যাপা উপস্থিত রয়েছে।\n\nপ্লাজমা প্রোটিনের ইমিউন ইলেকট্রোফোরেসিসে ইমিউনোগ্লোবুলিন এম ক্যাপা পাওয়া যায়। লাইট চেইনের মাত্রা নির্ধারণ করা হয়নি, কারণ পর্যাপ্ত সরঞ্জাম ছিল না। মায়েলোগ্রাম এবং দ্বিতীয় অস্থি মজ্জার বায়োপসি স্বাভাবিক ছিল। টিইপি স্ক্যানে দেখা যায়, নাকের পিছনের অংশে একটি হাইপারমেটাবলিক প্রক্রিয়া চলছে, তবে অন্য কোনো অস্বাভাবিকতা নেই। হৃদরোগের মূল্যায়ন (ইসিজি, ন্যাট্রিয়ুরেটিক পেপটাইড, ট্রোপোনিন, ইকোকার্ডিওগ্রাম) এবং কিডনির পরীক্ষাতেও কোনো বিশেষ সমস্যা দেখা যায়নি। বর্তমানে রোগীকে বর্টেজোমিব, প্রেডনিসোন এবং বেন্ডামুস্টিন প্রোটোকল অনুযায়ী চিকিৎসা দেওয়া হচ্ছে এবং প্রথম চিকিৎসার পর তার শারীরিক অবস্থার উন্নতি দেখা যাচ্ছে।",
+        "translated_summary": "আমরা একজন ৬৭ বছর বয়সী রোগীর ঘটনা বর্ণনা করছি, যার প্যাথলজিক্যাল সিডিডি (CDDs) ছিল না। তিনি ধীরে ধীরে কণ্ঠস্বর পরিবর্তন এবং গিলতে অসুবিধা নিয়ে এসেছিলেন, এবং তার ঘাড়ে একটি বড় পিণ্ড ছিল, যা বায়োপসির মাধ্যমে প্রথম এবং দ্বিতীয় গ্রেডের ফলিকুলার নন-হজকিন লিম্ফোমা হিসেবে শনাক্ত করা হয়েছে। একটি সারভিকো-থোরাকো-অ্যাবডোমিনো-পেলভিক সিটি স্ক্যানে দেখা যায়, নাসোফ্যারিঞ্জিয়াল পিণ্ডটি ৭০ মিমি x ৪০ মিমি আকারের এবং এটি ৬০ মিমি পর্যন্ত বিস্তৃত। অস্থি মজ্জার বায়োপসি স্বাভাবিক ছিল এবং চিকিৎসার আগের মূল্যায়নও স্বাভাবিক ছিল। রোগীকে চারটি কোর্স রিটুক্সিম্যাব (rituximab) এবং সিএইচওপি (CHOP) (সাইক্লোফসফামাইড, অ্যাড্রিয়ামাইসিন, প্রেডনিসোন এবং অনকোভিন) দেওয়া হয়েছিল, কিন্তু কোনো উন্নতি হয়নি। এরপর তাকে তিনটি কোর্স রিটুক্সিম্যাব (rituximab) এবং ডিএইচএওএক্স (DHAOX) (ডেক্সামেথাসোন, উচ্চ মাত্রার আরা-সাইটিন এবং অক্সালিপাটিন) দেওয়া হয়েছিল, কিন্তু পিণ্ডটি রয়ে গেছে। পরবর্তী বায়োপসিতে দেখা যায়, বি লিম্ফোসাইটের অনুপ্রবেশ হ্রাস পেয়েছে এবং এএল অ্যামাইলয়েড জমাটবদ্ধ হয়েছে। প্লাজমা প্রোটিনের ইমিউনোইলেক্ট্রোফোরেসিসে ইমিউনোগ্লোবুলিন এম-এর উপস্থিতি দেখা যায়। একটি পজিট্রন এমিশন টমোগ্রাফি (পিইটি) স্ক্যানে দেখা যায়, নাসোফ্যারিঞ্জিয়াল অংশে অতিরিক্ত বিপাকীয় কার্যকলাপ রয়েছে। বর্তমানে রোগীকে বর্টেজোমিব, প্রেডনিসোন এবং বেন্ডামুস্টিনের একটি প্রোটোকল অনুযায়ী চিকিৎসা দেওয়া হচ্ছে।",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_222.txt",
+        "fulltext": "Female patient, 16 years old, presenting a depressed gray plaque of 10.5 × 8.0 cm interspersed with hypochromic areas in the lower lateral part of the left thigh. Telangiectatic vessels overlap the lesion peripherally, with visible veins close to it. The plaque was present from birth, but was initially violaceous. It evolved with the passing of the years, with lightening and depression. There is no discrepancy in the length of the lower limbs.\n\nAngioresonance showed vascular malformations in the skin and subcutaneous tissue supplied by intermuscular branches of the popliteal artery. Early venous filling was found in both the region and the malformations, suggesting early venous shunting. Dilated draining veins were not documented, except for a superficial draining vein running along the subcutaneous cellular tissue of the anterior thigh. In addition, thinning of the subcutaneous tissue was noted in the topography of the vascular alteration, but without intramuscular or bone extension.\n",
+        "summary": "16-year-old girl with a depressed gray plaque on the left thigh, with a vascular malformation affecting the skin and subcutaneous tissue evident by angioresonance.\n",
+        "translated_fulltext": "একজন নারী রোগী, বয়স ১৬ বছর, বাম ঊরুর নিচের বাইরের অংশে ১০.৫ × ৮.০ সেমি আকারের একটি চাপা, ধূসর রঙের প্ল্যাক দেখা যাচ্ছে, যার মধ্যে কিছু অংশে বিবর্ণতা রয়েছে। প্ল্যাকটির চারপাশে ছোট ছোট রক্তনালী দেখা যায় এবং এর কাছাকাছি দৃশ্যমান শিরা রয়েছে। এই প্ল্যাকটি জন্ম থেকেই ছিল, তবে প্রথমে এটি বেগুনি রঙের ছিল। সময়ের সাথে সাথে এর রঙ হালকা হয়েছে এবং এটি আরও চাপা হয়ে গেছে। রোগীর দুই পায়ের দৈর্ঘ্যে কোনো পার্থক্য নেই।\n\nঅ্যাঙ্গিওরেসোনেন্স পরীক্ষায় দেখা যায়, ত্বকে এবং পপলাইটাল ধমনীর আন্তঃপেশী শাখা দ্বারা সরবরাহকৃত চর্বিযুক্ত টিস্যুতে রক্তনালীর ত্রুটি রয়েছে। উভয় স্থানে এবং ত্রুটিপূর্ণ অংশে দ্রুত শিরায় রক্ত ​​প্রবাহিত হতে দেখা যায়, যা প্রাথমিক পর্যায়ে শিরায় রক্ত ​​পরিবাহনের ইঙ্গিত দেয়। প্রসারিত নিষ্কাশনকারী শিরাগুলো তেমনভাবে দেখা যায়নি, তবে সামনের ঊরুর চর্বিযুক্ত টিস্যুর উপর দিয়ে যাওয়া একটি অগভীর নিষ্কাশনকারী শিরা দেখা গেছে। এছাড়াও, রক্তনালীর পরিবর্তনের স্থানে চর্বিযুক্ত টিস্যু পাতলা হয়ে গেছে, তবে পেশী বা হাড়ে এর বিস্তার দেখা যায়নি।",
+        "translated_summary": "বাম ঊরুতে একটি বিবর্ণ ধূসর রঙের দাগযুক্ত ১৬ বছর বয়সী একটি মেয়ে, যার ত্বকে এবং চর্মের নিচের টিস্যুতে রক্তনালীর ত্রুটি দেখা গেছে, যা অ্যাঞ্জিওরেসোনেন্সের মাধ্যমে শনাক্ত করা হয়েছে।",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_59.txt",
+        "fulltext": "A 2-year-old female presented with a 1-year history of painless left progressive proptosis with no reported systemic diseases or family history. Ophthalmologic examination revealed light sensation as the only vision in the left eye, along with proptosis, inward and upward eyeball displacement, and restricted extraocular muscle movements in downward and outward directions. An irregularly shaped, well-defined soft mass was palpable in the inferior aspect of the left orbit, accompanied by left lower eyelid ectropion. The pupil was enlarged (4 mm in diameter), and pupillary reaction was absent. The remaining anterior segment examination showed no apparent abnormalities. Fundus examination was challenging due to the child’s size. Hertel exophthalmometry readings measured 10.5 mm in the right eye and 18 mm in the left. Magnetic resonance imaging (MRI) revealed a well-circumscribed mass, displaying hypointense signals on T1-weighted images and hyperintense signals on T2-weighted images. Contrast-enhanced imaging demonstrated no significant improvement. A transconjunctival approach via the inferior fornix with canthotomy and cantholysis was performed, revealing a grayish-white cystic mass with a distinct boundary from surrounding tissues. During posterior separation to the eyeballs’ posterior part, tight adhesion to the optic nerve was observed. Due to the mass’s substantial size and the restricted surgical field, volume reduction was necessary. Approximately 12.5 mL of the fluid was aspirated, and the mass was completely excised. Histopathological examination disclosed a fibrous capsule wall covered with squamous and glandular epithelium, along with visible brain tissue and a cartilage-like matrix consistent with orbital teratoma. One month postsurgery, the patient exhibited enophthalmos, conjunctival hyperemia, and keratitis on ocular examination. This was attributed to the mass’s prior enlargement of the orbital cavity, resulting in postoperative enophthalmos. The cornea could not adhere to the eyelids, creating a space and causing corneal inflammation. After obtaining the consent of the patient’s guardian, a second operation involved the implantation of an allogeneic sclera into the orbit to increase the orbital volume, alleviate fossa pitting and restore keratitis to normal. No recurrence of the teratomas was noted during the 1-year follow-up. The patient still had minor enophthalmos and outer canthus abnormality. The visual acuity remained consistent with pre-operation levels. Hertel exophthalmometry readings measured 10.5 mm in the right eye and 8 mm in the left. The remaining anterior segment examination showed no apparent abnormalities.",
+        "summary": "Patient concerns: A 2-year-old female child was presented exhibiting proptosis and inward and upward eyeball displacement. Enhanced magnetic resonance imaging revealed a well-circumscribed mass, persisting with hypointense signals on T1-weighted images (T1WI) and hyperintense signals on T2-weighted images (T2WI).\n\nDiagnoses: The diagnosis of teratoma was confirmed finally through histological and immunohistochemical exams.\n\nInterventions: A transconjunctival approach via the inferior fornix, coupled with canthotomy and cantholysis, was performed. However, a month postsurgery, the patient developed enophthalmos, conjunctival hyperemia, and keratitis upon ocular examination. A second operation involved the implantation of allogeneic sclera into the orbit to increase orbital volume, improve the pitting of the fossa, and restore keratitis to normal.\n\nOutcomes: No recurrence and other complications were noted during the 1-year follow-up.",
+        "translated_fulltext": "দুই বছর বয়সী একটি মেয়ে, যার বাম চোখে এক বছর ধরে ব্যথাহীনভাবে ধীরে ধীরে প্রোপটোসিস (চোখের গ্লোব সামনের দিকে প্রসারিত হওয়া) দেখা যাচ্ছিল, এবং যার কোনো সিস্টেমিক রোগ বা পারিবারিক ইতিহাস নেই, তাকে পরীক্ষা করা হয়েছিল। চক্ষু পরীক্ষা করে দেখা যায়, বাম চোখে আলো অনুভব করা যায়, সেই সাথে প্রোপটোসিস, চোখের গ্লোবের ভেতরের দিকে এবং উপরের দিকে সরে যাওয়া, এবং নিচের দিকে ও বাইরের দিকে অতিরিক্ত চোখের পেশীর নড়াচড়া সীমিত ছিল। বাম চোখের নিচের অংশে একটি অনিয়মিত আকারের, স্পষ্ট সীমানাযুক্ত নরম পিণ্ড অনুভব করা যাচ্ছিল, এবং এর সাথে বাম চোখের নিচের পাতাটি বাইরের দিকে বেঁকে গিয়েছিল (একট্রোপিয়ন)। চোখের মণি বড় ছিল (প্রায় ৪ মিমি ব্যাস), এবং মণির আলো সংবেদী ক্ষমতা ছিল না। চোখের বাকি অংশের পরীক্ষায় কোনো দৃশ্যমান অস্বাভাবিকতা দেখা যায়নি। শিশুটির আকারের কারণে ফান্ডাস পরীক্ষা করা কঠিন ছিল। হার্টেল এক্সোফথালমোমেট্রি পরীক্ষায় ডান চোখে ১০.৫ মিমি এবং বাম চোখে ১৮ মিমি পরিমাপ করা হয়। ম্যাগনেটিক রেজোন্যান্স ইমেজিং (এমআরআই) পরীক্ষায় একটি সুস্পষ্ট পিণ্ড দেখা যায়, যা টি১-ওয়েটেড ছবিতে হাইপোইনটেন্স সংকেত এবং টি২-ওয়েটেড ছবিতে হাইপারইনটেন্স সংকেত প্রদর্শন করে। কন্ট্রাস্ট-এনহ্যান্সড ইমেজিংয়ে উল্লেখযোগ্য কোনো উন্নতি দেখা যায়নি। একটি ট্রান্সকনজাংটিভাল পদ্ধতির মাধ্যমে নিচের ফোরামিক্স, কান্থোটমি এবং কান্থোলাইসিস করে পিণ্ডটি অপসারণ করা হয়। এতে দেখা যায়, একটি ধূসর-সাদা সিস্টিক পিণ্ড, যার চারপাশের টিস্যু থেকে একটি স্পষ্ট সীমানা রয়েছে। চোখের গ্লোবের পেছনের অংশে পিণ্ডটি সরানোর সময়, অপটিক নার্ভের সাথে দৃঢ়ভাবে লেগে থাকার বিষয়টি লক্ষ্য করা যায়। পিণ্ডটির আকারের কারণে এবং অস্ত্রোপচারের স্থান সীমিত থাকায়, এর আকার কমানো প্রয়োজন ছিল। প্রায় ১২.৫ মিলি তরল অপসারণ করা হয় এবং পিণ্ডটি সম্পূর্ণরূপে কেটে ফেলা হয়। হিস্টোপ্যাথলজিক্যাল পরীক্ষায় দেখা যায়, পিণ্ডটির বাইরের স্তরটি ফাইব্রাস ক্যাপসুল দিয়ে গঠিত, যা স্কোয়ামাস এবং গ্রন্থিময় এপিথেলিয়াম দ্বারা আবৃত, এবং এর মধ্যে দৃশ্যমান মস্তিষ্কের টিস্যু এবং কার্টিলেজ-সদৃশ ম্যাট্রিক্স রয়েছে, যা অরবিটাল টেরাটোমার সাথে সামঞ্জস্যপূর্ণ। অস্ত্রোপচারের এক মাস পর, রোগীর চোখে এনওফথালমোস (চোখের গ্লোব ভেতরের দিকে দেবে যাওয়া), কনজাংটিভাল হাইপারেমিয়া (চোখের সাদা অংশ লাল হয়ে যাওয়া) এবং কেরাটাইটিস (কর্নিয়ার প্রদাহ) দেখা যায়। এটি পিণ্ডের কারণে অরবিটাল গহ্বরের পূর্বের প্রসারণের ফলস্বরূপ ঘটে, যা অস্ত্রোপচারের পরে এনওফথালমোসের কারণ হয়। কর্নিয়া চোখের পাতায় লেগে থাকতে না পারায় একটি ফাঁকা স্থান তৈরি হয় এবং এর ফলে কর্নিয়ার প্রদাহ হয়। রোগীর অভিভাবকের সম্মতি পাওয়ার পর, দ্বিতীয় অস্ত্রোপচারে অরবিটাল ভলিউম বাড়ানোর জন্য একটি অ্যালোজেনিক স্ক্লেরা (অন্যের শরীর থেকে নেওয়া) অরবিটে স্থাপন করা হয়, ফোসা পিটিং উপশম করা হয় এবং কেরাটাইটিস স্বাভাবিক অবস্থায় ফিরিয়ে আনা হয়। এক বছরের ফলো-আপের সময় টেরাটোমার পুনরাবৃত্তি হয়নি। রোগীর সামান্য এনওফথালমোস এবং বাইরের ক্যান্থাসের অস্বাভাবিকতা ছিল। অস্ত্রোপচারের আগের মতো দৃষ্টিশক্তি একই ছিল। হার্টেল এক্সোফথালমোমেট্রি পরীক্ষায় ডান চোখে ১০.৫ মিমি এবং বাম চোখে ৮ মিমি পরিমাপ করা হয়। চোখের বাকি অংশের পরীক্ষায় কোনো দৃশ্যমান অস্বাভাবিকতা দেখা যায়নি।",
+        "translated_summary": "রোগীর সমস্যা: দুই বছর বয়সী একটি মেয়ে শিশুকে পরীক্ষা করে দেখা যায় তার চোখের মণি বাইরের দিকে প্রসারিত এবং ভেতরের দিকে ও উপরের দিকে সরে গেছে। উন্নত ম্যাগনেটিক রেজোন্যান্স ইমেজিং-এ একটি সুস্পষ্ট পিণ্ড দেখা যায়, যা টি১-ওয়েটেড ইমেজে (টি১ডব্লিউআই) দুর্বল সংকেত এবং টি২-ওয়েটেড ইমেজে (টি২ডব্লিউআই) তীব্র সংকেত দেখাচ্ছে।\n\nরোগ নির্ণয়: হিস্টোলজিক্যাল এবং ইমিউনোহিস্টোকেমিক্যাল পরীক্ষার মাধ্যমে অবশেষে টেরাটোমার রোগ নির্ণয় নিশ্চিত করা হয়।\n\nচিকিৎসা: নিচের কনজাংটিভার মাধ্যমে একটি ট্রান্সকনজাংটিভাল পদ্ধতি অবলম্বন করা হয়, যার সাথে ক্যান্থোটমি এবং ক্যান্থোলাইসিস করা হয়। তবে, অস্ত্রোপচারের এক মাস পর, চোখের পরীক্ষায় দেখা যায় রোগীর এনওফথালমোস, কনজাংটিভাল হাইপারেমিয়া এবং কেরাটাইটিস হয়েছে। দ্বিতীয় অস্ত্রোপচারে অ্যালোজেনিক স্ক্লেরা প্রতিস্থাপন করে চোখের গহ্বরের আয়তন বাড়ানো হয়, ফোসার গঠন উন্নত করা হয় এবং কেরাটাইটিস স্বাভাবিক অবস্থায় ফিরিয়ে আনা হয়।\n\nফলাফল: এক বছরের ফলো-আপে কোনো পুনরাবৃত্তি বা অন্য কোনো জটিলতা দেখা যায়নি।",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_325.txt",
+        "fulltext": "This is a 75-year-old para 6 patient from Western Ethiopia who saw her last menses 25 years back. Her age at giving birth to her 1st child and menopause were 18 and 50 years, respectively. She had occasional pelvic pain for the last 3 years for which she was visiting different health facilities. Currently, she presented to Nekemte Specialized Hospital with exacerbation of lower abdominal pain for 3 weeks. She feels discomfort in her vagina but no protrusion of mass through her vagina. She has no history of fever, abdominal swelling, vaginal discharge, or bleeding. All her previous deliveries were normal vaginal deliveries. Upon enquiring about the history of family planning utilization, she reported that the intrauterine device was inserted 40 years back at a public hospital. Since then, she had no history of gynecologic evaluation for a checkup. She had no history of gynecologic procedures, pelvic or abdominal surgery. The patient has no history of medical problems like diabetes mellitus, hypertension, cardiac or renal problems.\n\nOn examination, she was acutely sick-looking. Her vital signs were blood pressure (BP) = 120/80mmHg, pulse rate (PR) = 82 beats per minute, respiratory rate (RR) = 18 breaths per minute, and temperature of 37.1°C. She had pink conjunctivae. Lymph glandular system, chest, and cardiovascular system were normal. On abdominal examination, there was no mass, organomegaly, area of tenderness, or signs of fluid collection. Inspection of external genitalia showed no vulvar mass or lesion. On speculum examination, there is a foreign body at the external cervical os. However, there is no other cervical mass or lesion. On bimanual examination, the uterus was not enlarged and there was no adnexal mass or tenderness. On the integumentary system, she had no palmar pallor. On neurologic examination, she was oriented to time, person, and place. She had normal reflexes and no neurologic deficits.\n\nOn laboratory investigation, an ultrasound examination was done by a radiologist and showed unremarkable pelvic findings. Urinalysis, complete blood count, and serum blood glucose level were normal. With the final diagnosis of postmenopausal pelvic pain secondary to the retained intrauterine device, the patient was prepared and taken to the gynecology procedure room. In the lithotomy position, the speculum was inserted and the intrauterine device was easily removed with spongy forceps. The mother was observed for 4 hours and discharged with analgesia and doxycycline 100 mg PO twice a day for three days. Upon follow-up, the pelvic pain was resolved.",
+        "summary": "We present the case of retained Lippes loop IUD for 40 years in a 75-year-old postmenopausal patient from Western Ethiopia. The patient presented to the hospital with postmenopausal pelvic pain. Speculum exam showed part of loop at external cervical os. The loop was easily removed with spongy forceps. The patient was discharged with analgesia and doxycycline twice a day for 3 days.",
+        "translated_fulltext": "এই রোগী পশ্চিম ইথিওপিয়ার একজন ৭৫ বছর বয়সী, যিনি ২৫ বছর আগে শেষবার মাসিক হয়েছিলেন। তার প্রথম সন্তান জন্মদানের সময় বয়স ছিল ১৮ বছর এবং মেনোপজ হয়েছিল ৫০ বছর বয়সে। গত ৩ বছর ধরে তিনি মাঝে মাঝে পেটের নিচের দিকে ব্যথা অনুভব করতেন, যার কারণে তিনি বিভিন্ন স্বাস্থ্যকেন্দ্রে গিয়েছেন। বর্তমানে, তিনি নেকেমটে স্পেশালাইজড হাসপাতালে পেটের নিচের দিকে তীব্র ব্যথা নিয়ে এসেছেন, যা ৩ সপ্তাহ ধরে চলছে। তিনি যোনিপথে অস্বস্তি অনুভব করেন, তবে যোনিপথের মাধ্যমে কোনো ফোলা বা পিণ্ড দেখা যায় না। তার জ্বর, পেটে ফোলা, যোনি থেকে স্রাব বা রক্তপাতের কোনো ইতিহাস নেই। তার আগের সব সন্তান প্রসব স্বাভাবিকভাবে হয়েছিল। পরিবার পরিকল্পনা ব্যবহারের বিষয়ে জিজ্ঞাসা করলে, তিনি জানান যে ৪০ বছর আগে একটি সরকারি হাসপাতালে তার জরায়ুতে একটি ইন্ট্রাইউটেরাইন ডিভাইস (আইইউডি) স্থাপন করা হয়েছিল। এরপর থেকে, তিনি কোনো স্ত্রীরোগ সংক্রান্ত পরীক্ষার জন্য যাননি। তার স্ত্রীরোগ সংক্রান্ত কোনো অস্ত্রোপচার বা পেটের কোনো অস্ত্রোপচারের ইতিহাস নেই। রোগীর ডায়াবেটিস, উচ্চ রক্তচাপ, হৃদরোগ বা কিডনির সমস্যার কোনো ইতিহাস নেই।\n\nশারীরিক পরীক্ষায় দেখা যায়, তিনি অসুস্থ দেখাচ্ছেন। তার ভাইটাল সাইনগুলো হলো: রক্তচাপ (বিপি) = ১২০/৮০ মিমি Hg, পালস রেট (পিআর) = প্রতি মিনিটে ৮২ বিট, শ্বাস-প্রশ্বাস হার (আরআর) = প্রতি মিনিটে ১৮ বার এবং তাপমাত্রা ৩৭.১ ডিগ্রি সেলসিয়াস। তার চোখের কনজাংটিভা গোলাপি। লিম্ফ গ্রন্থি, বুক এবং কার্ডিওভাসকুলার সিস্টেম স্বাভাবিক ছিল। পেটের পরীক্ষায় কোনো ফোলা, অঙ্গের বৃদ্ধি, স্পর্শকাতর স্থান বা তরল জমা হওয়ার লক্ষণ দেখা যায়নি। বাহ্যিক যৌনাঙ্গের পরীক্ষায় কোনো ভলভার পিণ্ড বা ক্ষত দেখা যায়নি। স্পেকুলাম পরীক্ষায়, বাহ্যিক জরায়ুমুখে একটি বিদেশি বস্তু দেখা যায়। তবে, অন্য কোনো জরায়ুর পিণ্ড বা ক্ষত নেই। বাইম্যানুয়াল পরীক্ষায়, জরায়ু স্বাভাবিক আকারের ছিল এবং কোনো অ্যাডনেক্সাল পিণ্ড বা স্পর্শকাতরতা ছিল না। তার ত্বকে কোনো ফ্যাকাসে ভাব ছিল না। স্নায়বিক পরীক্ষায়, তিনি সময়, স্থান এবং ব্যক্তি সম্পর্কে সচেতন ছিলেন। তার স্বাভাবিক রিফ্লেক্স ছিল এবং কোনো স্নায়বিক দুর্বলতা ছিল না।\n\nল্যাবরেটরি পরীক্ষায়, একজন রেডিওলজিস্ট আলট্রাসাউন্ড করে দেখেন এবং তাতে পেটের তেমন কোনো অস্বাভাবিকতা দেখা যায়নি। প্রস্রাব পরীক্ষা, সম্পূর্ণ রক্ত গণনা এবং সিরাম গ্লুকোজের মাত্রা স্বাভাবিক ছিল। অবশেষে, জরায়ুতে স্থাপিত আইইউডি-এর কারণে মেনোপজের পরের পেটের ব্যথা হয়েছে বলে রোগ নির্ণয় করা হয়। এরপর রোগীকে অস্ত্রোপচারের জন্য প্রস্তুত করা হয় এবং স্ত্রীরোগ বিভাগে নিয়ে যাওয়া হয়। লিথোটমি অবস্থানে, স্পেকুলাম প্রবেশ করানো হয় এবং স্পঞ্জি ফোরসেপসের সাহায্যে আইইউডিটি সহজে অপসারণ করা হয়। এরপর রোগীকে ৪ ঘণ্টা পর্যবেক্ষণ করা হয় এবং ব্যথানাশক ওষুধ ও ডক্সিসাইক্লিন ১০০ মিগ্রা, দিনে দুবার, তিন দিনের জন্য দেওয়া হয়। ফলোআপে দেখা যায়, পেটের ব্যথা সেরে গেছে।",
+        "translated_summary": "পশ্চিম ইথিওপিয়ার ৭৫ বছর বয়সী একজন মেনোপজ-পরবর্তী রোগীর ক্ষেত্রে ৪০ বছর ধরে লিপ্পেস লুপযুক্ত আইইউডি ( intrauterine device) থাকার ঘটনাটি আমরা তুলে ধরছি। রোগী হাসপাতালে এসে মেনোপজ-পরবর্তী পেলভিক ব্যথার কথা জানান। স্পেকুলাম পরীক্ষার মাধ্যমে দেখা যায় লুপের একটি অংশ বাহ্যিক জরায়ুমুখে রয়েছে। স্পঞ্জি ফোরসেপসের সাহায্যে লুপটি সহজেই অপসারণ করা হয়। রোগীকে ব্যথানাশক ওষুধ এবং দিনে দুবার ডক্সিসাইক্লিন সেবনের পরামর্শ দিয়ে ৩ দিনের জন্য ছুটি দেওয়া হয়।",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_88.txt",
+        "fulltext": "The patient was a 42-year-old woman with a history of menstrual migraine, Hashimoto Thyroiditis, Familial Mediterian Fever (FMF), and dyspepsia. She was taking 75 mg of levothyroxine, 30 mg of lansoprazole, and 1.5 mg of colchicine daily. In February of 2023, she was diagnosed with acute bronchitis, which was treated with antibiotics and bronchodilators. She developed a daily headache after two weeks, manifesting as more than ten short-lasting attacks per day provoked by coughing, straining, and lifting. The duration of each attack was 30 minutes, and the pain was bilaterally distributed from the neck to the top of the head. The headache was sharp and severe. She described the attack as a sensation of storm-like fluid movement in the head. She did not suffer any of the symptoms associated with previous migraine attacks, such as phonophobia, photophobia, vomiting, or throbbing. The severity of the attack was determined using a numeric rating scale (NRS) with a score of 9 out of 10. These attacks typically necessitated a visit to the emergency room. The results of her physical and neurological exams were unremarkable. The laboratory tests, including those for thyroid hormones, electrolytes, liver and kidney function, and serology, were negative. Brain and cervical spinal magnetic resonance imaging (MRI) with and without contrast, magnetic resonance venography (MRV), and angiography (MRA) were all normal. She did not give consent for a lumbar puncture. When we first encountered her in the clinic, she was taking 25 mg of indomethacin per day. Her attacks stopped after putting her on 60 mg of lansoprazole and increasing her daily dose of indomethacin to 150 mg. However, she encountered gastrointestinal side effects, so the indomethacin was discontinued on day three. Due to the adverse effects, she was unable to take topiramate and propranolol.\n\nShe came to the clinic 15 days after her initial visit with an NRS score of 9/10. She was taken to the local operating room. We used a GE Healthcare, Voluson™ E6, ultrasonography system with a linear 13–5 MHz probe for unilateral PGONB. The patient’s neck was prone to flexion. The linear probe was initially transversely positioned on the occipital protuberance and then advanced caudally, demonstrating that the C2 spinous process resembled the two horns. Through lateral probe movement, the inferior muscles of the obliquus capitis and semispinalis capitis were located. Here, the superior to the inferior oblique capitis muscle and beneath the semispinalis capitis muscle were identified to be the greater occipital neuron (GON). From this location, a 22-gauge spinal needle and 3 ccs of bupivacaine at a concentration of 0.5% were used to perform GON blocking. The intensity of her attack decreased from 9/10 to 2/10 after the first 20 minutes of the block. Throughout a month, the blocks were repeated once a week. In the second month, the frequency of her attacks decreased to two per month, with an intensity of 4/10. She did not encounter any attacks in the sixth month.\n\n",
+        "summary": "Herein, we report that a 42-year-old female patient with PCH who could not use the oral medication because of side effects. When she came to the pain clinic with an attack with intensity of 9/10 , we took her to the local operating room. The ultrasound (US) guided proximal greater occipital nerve block with bupivacaine was performed and the intensity of the attack was reduced to 2/10. The blockage was repeated once a week for a month. After two months, both the intensity of headache and number of attacks decreased and no adverse effect was observed.",
+        "translated_fulltext": "রোগী ছিলেন ৪২ বছর বয়সী একজন মহিলা, যিনি মাসিককালীন মাইগ্রেন, হাশিমোটো থাইরয়েডাইটিস, ফ্যামিলিয়াল মেডিটেরানিয়ান ফিভার (এফএমএফ) এবং ডিসপেপসিয়ায় ভুগছিলেন। তিনি প্রতিদিন ৭৫ মিলিগ্রাম লেভোথাইরক্সিন, ৩০ মিলিগ্রাম ল্যানসোপ্রাজল এবং ১.৫ মিলিগ্রাম কোলচিসিন গ্রহণ করতেন। ২০২৩ সালের ফেব্রুয়ারিতে, তাকে তীব্র ব্রঙ্কাইটিসে আক্রান্ত হিসেবে নির্ণয় করা হয়, যার চিকিৎসায় অ্যান্টিবায়োটিক এবং ব্রঙ্কোডাইলেটর ব্যবহার করা হয়। দুই সপ্তাহ পর তার প্রতিদিন মাথাব্যথা শুরু হয়, যা কাশি, চাপ এবং কোনো কিছু তোলার কারণে দিনে দশটির বেশি স্বল্পমেয়াদী আক্রমণে প্রকাশ পায়। প্রতিটি আক্রমণের সময়কাল ছিল ৩০ মিনিট এবং ব্যথা ঘাড় থেকে মাথার উপরের অংশে উভয় দিকে ছড়িয়ে যেত। মাথাব্যথা ছিল তীব্র এবং অসহ্য। তিনি এটিকে মাথার মধ্যে ঝড়ের মতো তরল পদার্থের প্রবাহের মতো অনুভব করতেন। আগের মাইগ্রেনের আক্রমণের সময় যে লক্ষণগুলো দেখা যেত, যেমন - ফোনোফোবিয়া, ফটোফোবিয়া, বমি বা ধড়ফড় করা, তার মধ্যে কোনোটিই তার ক্ষেত্রে দেখা যায়নি। আক্রমণের তীব্রতা একটি সংখ্যাসূচক রেটিং স্কেল (এনআরএস) ব্যবহার করে পরিমাপ করা হয়, যেখানে ১০-এর মধ্যে ৯ স্কোর পাওয়া যায়। এই আক্রমণের কারণে সাধারণত জরুরি বিভাগে যেতে হতো। তার শারীরিক এবং স্নায়বিক পরীক্ষার ফলাফল স্বাভাবিক ছিল। থাইরয়েড হরমোন, ইলেক্ট্রোলাইট, লিভার এবং কিডনির কার্যকারিতা এবং সেরোলজি সহ ল্যাবরেটরি পরীক্ষাগুলোর ফলাফল নেতিবাচক ছিল। মস্তিষ্কের এবং ঘাড়ের মেরুদণ্ডের ম্যাগনেটিক রেজোন্যান্স ইমেজিং (এমআরআই), কন্ট্রাস্টসহ এবং কন্ট্রাস্ট ছাড়া, ম্যাগনেটিক রেজোন্যান্স ভেনোগ্রাফি (এমআরভি) এবং অ্যাঞ্জিওগ্রাফি (এমআরএ) - সবকিছুই স্বাভাবিক ছিল। তিনি লাম্বার পাংচারের জন্য সম্মতি দেননি। যখন আমরা প্রথম তাকে ক্লিনিকে দেখি, তখন তিনি প্রতিদিন ২৫ মিলিগ্রাম ইন্ডোমেথাসিন গ্রহণ করছিলেন। ৬০ মিলিগ্রাম ল্যানসোপ্রাজল এবং দৈনিক ১৫০ মিলিগ্রাম ইন্ডোমেথাসিন দেওয়ার পর তার আক্রমণ বন্ধ হয়ে যায়। তবে, তিনি গ্যাস্ট্রোইনটেস্টাইনাল পার্শ্বপ্রতিক্রিয়া অনুভব করেন, তাই তৃতীয় দিনে ইন্ডোমেথাসিন বন্ধ করে দেওয়া হয়। প্রতিকূল প্রভাবের কারণে, তিনি টপিরামেট এবং প্রোপ্রানোলল গ্রহণ করতে পারেননি।\n\nতিনি প্রাথমিক ভিজিটের ১৫ দিন পর ৯/১০ এনআরএস স্কোর নিয়ে ক্লিনিকে আসেন। তাকে স্থানীয় অপারেশন থিয়েটারে নিয়ে যাওয়া হয়। আমরা জিই হেলথকেয়ার, ভলিউসন™ ই৬ আল্ট্রাসাউন্ড সিস্টেম এবং একটি লিনিয়ার ১৩-৫ মেগাহার্টজ প্রোব ব্যবহার করে একতরফা পিজিওএনবি করি। রোগীর ঘাড় সামান্য বাঁকানো ছিল। লিনিয়ার প্রোবটি প্রথমে অনুভূমিকভাবে অক্সিপিটাল প্রোটুবারেন্সের উপর স্থাপন করা হয় এবং তারপর কডালি দিকে সরানো হয়, যেখানে দেখা যায় যে সি২ স্পাইনাস প্রক্রিয়াটি দুটি শিংয়ের মতো। প্রোবের পার্শ্বীয় আন্দোলনের মাধ্যমে, অব্লিকিউস ক্যাপিটিসের নিচের পেশী এবং সেমিস্পিনালিস ক্যাপিটিসের পেশী সনাক্ত করা হয়। এখানে, সেমিস্পিনালিস ক্যাপিটিসের পেশীর উপরে এবং নিচের অব্লিক ক্যাপিটিস পেশীর মধ্যে বৃহত্তর অক্সিপিটাল নিউরন (জিওএন) চিহ্নিত করা হয়। এই স্থান থেকে, একটি ২২-গেজ স্পাইনাল নিডেল এবং ০.৫% ঘনত্বে ৩ সিসি বুপিভাকেন ব্যবহার করে জিওএন ব্লকিং করা হয়। ব্লকিংয়ের প্রথম ২০ মিনিটের মধ্যে তার আক্রমণের তীব্রতা ৯/১০ থেকে ২/১০-এ নেমে আসে। এক মাস ধরে, সপ্তাহে একবার ব্লকিং করা হয়। দ্বিতীয় মাসে, তার আক্রমণের ফ্রিকোয়েন্সি মাসে দুটিতে নেমে আসে, যেখানে তীব্রতা ছিল ৪/১০। ষষ্ঠ মাসে তার কোনো আক্রমণ হয়নি।",
+        "translated_summary": "এখানে, আমরা জানাচ্ছি যে, একজন ৪২ বছর বয়সী নারী রোগী, যিনি পিসিএইচ-এ আক্রান্ত, তিনি পার্শ্বপ্রতিক্রিয়ার কারণে মুখে খাওয়ার ওষুধ ব্যবহার করতে পারছিলেন না। যখন তিনি তীব্র মাথাব্যথা নিয়ে (মাত্রা ৯/১০) আমাদের ব্যথানাশক ক্লিনিকে আসেন, তখন আমরা তাকে স্থানীয় অপারেশন থিয়েটারে নিয়ে যাই। বুপিভাকেন ব্যবহার করে আলট্রাসাউন্ডের (ইউএস) মাধ্যমে গ্রেটার অক্সিপিটাল নার্ভ ব্লকের একটি পদ্ধতি করা হয়, যার ফলে মাথাব্যথার তীব্রতা কমে ২/১০-এ নেমে আসে। এই প্রক্রিয়াটি এক মাস ধরে সপ্তাহে একবার পুনরাবৃত্তি করা হয়। দুই মাস পর, মাথাব্যথার তীব্রতা এবং ব্যথার পুনরাবৃত্তি উল্লেখযোগ্যভাবে কমে যায় এবং কোনো বিরূপ প্রভাব দেখা যায়নি।",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_505.txt",
+        "fulltext": "Patient information\nA 24-year-old man residing in Yopougon, a popular commune in the city of Abidjan, single, having stopped his studies in the final year, unemployed, suffering from undocumented psychiatric disorders was accompanied by his parents to the emergency department of our hospital for epigastric pain and swelling that had been developing for 15 days following the voluntary ingestion of a knife. No other signs (dysphagia, vomiting, intestinal disorders, cough, gastrointestinal haemorrhage) were found during the examination. The parents informed us of the presence of a mental disorder in the patient that had been diagnosed and was not being treated by psychiatrists or traditional therapists.\n\nClinical results\nThe physical examination revealed an ulcerated inflammatory mass measuring 3 x 4 cm, with the emergent tip of a blade in its center. The rest of the abdomen was soft and undistended, with no umbilical cry, and the rectal examination was normal. The patient had a body temperature of 37.5 °C.\n\nDiagnostic evaluation\nAn unprepared abdominal X-ray shows a linear, sharp-edged, knife-blade-shaped, radiopaque image.\n\nLaboratory tests revealed a haemoglobin level of 10 g/dl, a hyperleucocytosis of 16 600/mm3.\n\nTreatment and follow-up\nSurgical intervention under general anaesthesia was performed.\n\nThe intraoperative findings showed a healthy abdominal cavity, an adhesion of the anterior face of the gastric body with the abdominal wall, the release of which showed a gastric perforation, with a blade inside it, the tip of which passed through the entire anterior abdominal wall, the handle remaining in the gastric lumen.\n\nIntragastric foreign body extraction was performed: it was a whole knife of local craftsmanship with a sharp blade at one end, 6 cm long, 1.5 cm wide at its base, and a round carved wooden handle 2 cm in diameter and 7 cm long. The knife measured 13 cm. For gastric perforation, a superior wedge resection was performed. This sample did not show any histological abnormality. A gastric suture was then performed. The hospital stay lasted eight days, the consequences were simple. The one-year follow-up is excellent, the patient has a psychiatric follow-up.\n",
+        "summary": "We report the successful management of the consequences of the voluntary ingestion of a knife in a 24-year-old man with undocumented psychiatric disorders. The patient was admitted to the emergency department for a fistulized epigastric cutaneous abscess with the tip of a knife emerging. This was the extraordinary migration of an ingested dagger that perforated the stomach and externalized itself as an epigastric abscess. Surgical extraction of the foreign body was performed.\n",
+        "translated_fulltext": "রোগীর তথ্য\nইয়োপোগনে বসবাসকারী ২৪ বছর বয়সী একজন পুরুষ, যিনি আবিদজানের একটি জনপ্রিয় কমিউনে থাকেন, অবিবাহিত, পড়াশোনা শেষ করার আগের বছরে ছেড়ে দিয়েছেন, বেকার, এবং পূর্বে নির্ণয় করা হয়নি এমন মানসিক সমস্যায় ভুগছেন। পেটের উপরের অংশে ব্যথা এবং ফোলা নিয়ে তাকে তার বাবা-মা আমাদের হাসপাতালের জরুরি বিভাগে নিয়ে আসেন, যা ১৫ দিন ধরে ধীরে ধীরে বাড়ছিল এবং এর কারণ ছিল স্বেচ্ছায় একটি ছুরি গিলে ফেলা। পরীক্ষায় অন্য কোনো উপসর্গ (যেমন গিলতে অসুবিধা, বমি, পেটের সমস্যা, কাশি, গ্যাস্ট্রোইনটেস্টাইনাল রক্তপাত) পাওয়া যায়নি। বাবা-মা আমাদের জানান যে রোগীর মানসিক সমস্যা রয়েছে, যা আগে নির্ণয় করা হয়েছিল কিন্তু মনোরোগ বিশেষজ্ঞ বা ঐতিহ্যবাহী থেরাপিস্টের মাধ্যমে এর চিকিৎসা করা হয়নি।\n\nক্লিনিক্যাল ফলাফল\nশারীরিক পরীক্ষায় ৩ x ৪ সেমি আকারের একটি আলসারযুক্ত প্রদাহপূর্ণ পিণ্ড দেখা যায়, যার কেন্দ্রে একটি ছুরির ফলা দেখা যাচ্ছিল। পেটের বাকি অংশ নরম ছিল এবং স্বাভাবিক আকারে ছিল, নাভির কাছে কোনো ফোলা ছিল না এবং মলদ্বারের পরীক্ষা স্বাভাবিক ছিল। রোগীর শরীরের তাপমাত্রা ছিল ৩৭.৫ ডিগ্রি সেলসিয়াস।\n\nরোগ নির্ণয়\nপেটের এক্স-রেতে একটি সরল, ধারালো ছুরির মতো আকারের, রেডিওopaque চিত্র দেখা যায়।\n\nল্যাবরেটরি পরীক্ষায় দেখা যায়, হিমোগ্লোবিনের মাত্রা ১০ গ্রাম/ডিসিএল এবং শ্বেত রক্তকণিকার সংখ্যা ১৬,৬০০/মিমি³।\n\nচিকিৎসা এবং ফলো-আপ\nসাধারণ অ্যানেস্থেশিয়ার অধীনে অস্ত্রোপচার করা হয়।\n\nঅস্ত্রোপচারের সময় দেখা যায়, পেটের ভেতরের অংশ সুস্থ ছিল, পেটের প্রাচীরের সাথে গ্যাস্ট্রিক বডির সামনের অংশ লেগে ছিল। সেটি আলাদা করার পর দেখা যায়, গ্যাস্ট্রিকের মধ্যে একটি ছিদ্র হয়েছে এবং ছুরির ফলা পেটের সামনের দেয়াল ভেদ করে বেরিয়ে এসেছে, ছুরির হাতলটি গ্যাস্ট্রিকের ভেতরে রয়ে গেছে।\n\nগ্যাস্ট্রিকের ভেতর থেকে ছুরিটি বের করা হয়। এটি স্থানীয়ভাবে তৈরি একটি ছুরি ছিল, যার এক প্রান্তে ধারালো ফলা, দৈর্ঘ্য ৬ সেমি, ভিত্তির প্রস্থ ১.৫ সেমি এবং একটি গোলাকার খোদাই করা কাঠের হাতল, যার ব্যাস ২ সেমি এবং দৈর্ঘ্য ৭ সেমি। ছুরিটির মোট দৈর্ঘ্য ছিল ১৩ সেমি। গ্যাস্ট্রিকের ছিদ্রের জন্য, একটি ওয়েজ রিসেকশন করা হয়। এই নমুনায় কোনো হিস্টোলজিক্যাল অস্বাভাবিকতা দেখা যায়নি। এরপর গ্যাস্ট্রিকের সেলাই করা হয়। হাসপাতালে আট দিন থাকতে হয় এবং এর পরে রোগীর তেমন কোনো জটিলতা দেখা যায়নি। এক বছর পর ফলো-আপে দেখা যায়, রোগীর অবস্থা ভালো আছে এবং তিনি মনোরোগ বিশেষজ্ঞের তত্ত্বাবধানে আছেন।",
+        "translated_summary": "আমরা একজন ২৪ বছর বয়সী পুরুষের ক্ষেত্রে স্বেচ্ছায় ছুরি গিলে ফেলার ফলে সৃষ্ট জটিলতাগুলোর সফল ব্যবস্থাপনার বিবরণ দিচ্ছি, যার পূর্বে মানসিক স্বাস্থ্য সংক্রান্ত কোনো রোগ নির্ণয় করা হয়নি। রোগীটিকে জরুরি বিভাগে ভর্তি করা হয়েছিল, যেখানে তার পেটের উপরের অংশে একটি ফোলাভাব দেখা যায় এবং ছুরির ফলাটি সেখান থেকে বেরিয়ে আসছিল। এটি ছিল একটি অসাধারণ ঘটনা, যেখানে গিলে ফেলা ছুরিটি পেটের মধ্যে ঢুকে সেটিকে ছিদ্র করে পেটের উপরের অংশে ফোলা হিসেবে প্রকাশ পায়। এরপর অস্ত্রোপচারের মাধ্যমে সেই ছুরিটি অপসারণ করা হয়।",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_425.txt",
+        "fulltext": "An 82-year-old woman presented to the emergency department with abdominal pain, diarrhea, confusion, and a deteriorating general condition of several days' duration. Her medical history included hypertension under treatment and hypothyroidism under replacement therapy. No surgical history or toxic habits of interest were noted. On physical examination, the heart rate was 84 bpm, blood pressure 105/82 mmHg, temperature 38°C, and oxygen saturation 95% in room air. The mucous membranes were dry, and the abdomen was diffusely painful on palpation with no palpable masses or peritoneal reaction. The laboratory findings showed a hemoglobin of 13.1 g/dL, C-reactive protein of 122.9 mg/L without leukocytosis (8.9 × 10^9/L), hyponatraemia (130 mmol/L), hypokalemia (2.9 mmol/L), normal renal, hepatic, lipase, and cardiac enzyme tests. The swab for SARSCoV-2 was negative. The urine was foul-smelling with positive nitrites, red blood cells (+++) and leukocytes (+) so the sample was sent for microbiological culture. In view of these findings, probabilistic antibiotic therapy was initiated with ceftriaxone on suspicion of a possible urinary infection and a thoraco-abdomino-pelvic tomography was performed to rule out the presence of a deep infectious focus. This examination revealed signs of chronic bronchopathy and a parietal vesical pneumatosis at abdominal level compatible with an emphysematous cystitis. The urine culture revealed the presence of Escherichia coli (> 100 000 CFU/m) sensitive to the empirically prescribed antibiotic therapy and the blood cultures were positive to the same germ. The patient was admitted to the internal medicine department and the antibiotic therapy was continued for 7 days with a favorable clinical and analytical evolution, allowing the hospital discharge.\n",
+        "summary": "An 82-year-old woman with a history of hypertension and hypothyroidism presented to the emergency department with abdominal pain, diarrhea, confusion, and a multi-day history of deterioration in her general condition. On admission, the patient was febrile and the blood work showed a C-reactive protein elevation without leukocytosis (8.9 × 10^9/L). In this context, a nasopharyngeal swab for SARS-CoV-2 was performed and was negative. With these results, the initial suspicion was of a digestive-origin infectious disease. The urine sample was foul-smelling with the presence of leukocytes and nitrites and was sent for microbiological culture. Empirical antibiotic treatment was initiated with a third-generation cephalosporin due to the suspicion of a possible urinary infection. It was decided to perform a thoraco-abdomino-pelvic tomography with the objective of evaluating the presence of other infectious foci in an elderly patient. This study showed an emphysematous cystitis, a rare disease in a patient without any of the classic risk factors for this entity. The urine and blood cultures were positive for Escherichia coli sensitive to the empirical antibiotic, so treatment was continued for a total of 7 days. The clinical evolution was favorable.\n",
+        "translated_fulltext": "একজন ৮২ বছর বয়সী মহিলা পেটে ব্যথা, ডায়রিয়া, বিভ্রান্তি এবং কয়েক দিনের ধরে চলা দুর্বল শারীরিক অবস্থার কারণে জরুরি বিভাগে আসেন। তার পূর্বের স্বাস্থ্য সংক্রান্ত তথ্যে উচ্চ রক্তচাপের চিকিৎসার ইতিহাস এবং থাইরয়েড হরমোনের অভাবের কারণে রিপ্লেসমেন্ট থেরাপির ইতিহাস ছিল। তার কোনো অস্ত্রোপচারের ইতিহাস বা ক্ষতিকর কোনো অভ্যাস ছিল না। শারীরিক পরীক্ষায় দেখা যায়, তার হৃদস্পন্দন ছিল ৮৪ বিপিএম, রক্তচাপ ছিল ১০৫/৮২ মিমি Hg, তাপমাত্রা ছিল ৩৮ ডিগ্রি সেলসিয়াস এবং সাধারণ বাতাসে অক্সিজেনের মাত্রা ছিল ৯৫%। তার শ্লেষ্মা ঝিল্লি শুষ্ক ছিল এবং পেটে চাপ দিলে ব্যথা অনুভব হয়, তবে কোনো ফোলা বা পেটের ভেতরের প্রদাহের লক্ষণ দেখা যায়নি। ল্যাবরেটরি পরীক্ষায় দেখা যায়, তার হিমোগ্লোবিনের মাত্রা ছিল ১৩.১ গ্রাম/ডিএল, সি-রিঅ্যাক্টিভ প্রোটিনের মাত্রা ছিল ১২২.৯ মিলিগ্রাম/লিটার (লিউকোসাইটোসিস ছাড়াই), সোডিয়ামের মাত্রা কম (১৩০ মিলি মোল/লিটার), পটাশিয়ামের মাত্রা কম (২.৯ মিলি মোল/লিটার), এবং কিডনি, লিভার, লাইপেজ এবং কার্ডিয়াক এনজাইমের পরীক্ষা স্বাভাবিক ছিল। SARSCoV-2-এর জন্য নেওয়া নমুনায় ভাইরাস পাওয়া যায়নি। প্রস্রাবে দুর্গন্ধ ছিল এবং নাইট্রাইট, লোহিত রক্তকণিকা (+++) এবং শ্বেত রক্তকণিকা (+) পাওয়া যায়, তাই নমুনাটি মাইক্রোবায়োলজিক্যাল কালচারের জন্য পাঠানো হয়। এই ফলাফলগুলোর ওপর ভিত্তি করে, সম্ভাব্য মূত্রনালীর সংক্রমণ সন্দেহ করে সেফট্রিয়াক্সোন দিয়ে অ্যান্টিবায়োটিক থেরাপি শুরু করা হয় এবং গভীর সংক্রমণ আছে কিনা, তা জানার জন্য থোরাকো-অ্যাবডোমিনো-পেলভিক টমোগ্রাফি করা হয়। এই পরীক্ষায় দীর্ঘস্থায়ী ব্রঙ্কোপ্যাথির লক্ষণ এবং পেটের স্তরে প্যারাইটাল ভেসিক্যাল নিউমোতোসিস দেখা যায়, যা এমফাইসেমাটাস সিস্টাইটিসের সঙ্গে সামঞ্জস্যপূর্ণ। প্রস্রাবের কালচারে ইশ্চেরিকিয়া কোলাই (>১০০,০০০ সিএফইউ/মি) পাওয়া যায়, যা পূর্বে নির্ধারিত অ্যান্টিবায়োটিক থেরাপির প্রতি সংবেদনশীল ছিল এবং রক্ত কালচারেও একই জীবাণু পাওয়া যায়। রোগীকে অভ্যন্তরীণ মেডিসিন বিভাগে ভর্তি করা হয় এবং অ্যান্টিবায়োটিক থেরাপি ৭ দিন ধরে চালানো হয়। এর ফলে রোগীর শারীরিক ও পরীক্ষাগারের ফলাফল ইতিবাচক থাকে এবং তাকে হাসপাতাল থেকে ছুটি দেওয়া হয়।",
+        "translated_summary": "৮২ বছর বয়সী একজন মহিলা, যিনি উচ্চ রক্তচাপ এবং থাইরয়েড হরমোনের স্বল্পতার সমস্যায় ভুগছিলেন, পেটে ব্যথা, ডায়রিয়া, বিভ্রান্তি এবং কয়েক দিনের ধরে শারীরিক অবস্থার অবনতির কারণে জরুরি বিভাগে আসেন। হাসপাতালে ভর্তির সময়, তার জ্বর ছিল এবং রক্ত পরীক্ষার ফলাফলে দেখা যায় সি-রিঅ্যাক্টিভ প্রোটিনের মাত্রা বৃদ্ধি পেয়েছে, কিন্তু শ্বেত রক্তকণিকার সংখ্যা স্বাভাবিক ছিল (৮.৯ × ১০^৯/লিটার)। এই পরিস্থিতিতে, তার নাকের ভেতরের অংশ থেকে SARS-CoV-2 ভাইরাসের উপস্থিতি পরীক্ষা করার জন্য নমুনা নেওয়া হয়, কিন্তু ফলাফল নেগেটিভ আসে। এই ফলাফলের ভিত্তিতে, প্রাথমিকভাবে ধারণা করা হয় যে এটি হজমতন্ত্রের সংক্রমণজনিত রোগ। প্রস্রাবের নমুনায় দুর্গন্ধ ছিল এবং শ্বেত রক্তকণিকা ও নাইট্রেট পাওয়া যায়, তাই এটি জীবাণু পরীক্ষা করার জন্য পাঠানো হয়। সম্ভাব্য মূত্রনালীর সংক্রমণের সন্দেহে, তৃতীয় প্রজন্মের সেফালোস্পোরিন নামক অ্যান্টিবায়োটিক দিয়ে পরীক্ষামূলক চিকিৎসা শুরু করা হয়। একজন বয়স্ক রোগীর মধ্যে অন্যান্য সংক্রমণজনিত স্থান আছে কিনা, তা জানার জন্য থোরাকো-অ্যাবডোমিনো-পেলভিক টমোগ্রাফি করার সিদ্ধান্ত নেওয়া হয়। এই পরীক্ষায় এমফাইসেমাটাস সিস্টাইটিস নামক একটি বিরল রোগ ধরা পড়ে, যা সাধারণত কোনো রোগীর মধ্যে দেখা যায় না, বিশেষ করে যাদের এই রোগের কোনো পরিচিত ঝুঁকি নেই। প্রস্রাব এবং রক্ত পরীক্ষায় ইশ্চেরিকিয়া কোলাই নামক ব্যাকটেরিয়ার উপস্থিতি ধরা পড়ে, যা পরীক্ষামূলক অ্যান্টিবায়োটিকের প্রতি সংবেদনশীল ছিল। তাই, মোট ৭ দিন ধরে চিকিৎসা চালিয়ে যাওয়া হয়। রোগীর শারীরিক অবস্থার উন্নতি হয়।",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_531.txt",
+        "fulltext": "We present the case of the management of a giant omphalocele, in a patient with prenatal diagnosis in week 14. After the initial diagnosis, chromosomal anomalies were ruled out. The service of prenatal diagnosis of the Gynecology and Obstetrics department contacted the service of Pediatric Surgery for prenatal evaluation and the infiltration of botulinum toxin was considered. In week 37, the infiltration of botulinum toxin was scheduled in the transverse plane of the abdomen (TAP) of the foetus. This process was performed by a multidisciplinary team formed by gynecologists, pediatric surgeons, neonatologists and anesthetists, with the pregnant woman under sedation. Fetal sedation was performed with an intramuscular injection of atropine, fentanyl and rocuronium. Given the position of the foetus intrauterine, only the transverse plane of the abdomen on the right side of the foetus could be infiltrated. Through a single placental infiltration, botulinum toxin was infiltrated (dose 12 IU/kg) at the subcostal level, 10th rib and right iliac fossa. During the process and in the following days, no complications were evidenced. The caesarean section was scheduled in week 39. At birth, a silo was placed with a plastic bag over the defect and once the patient was relaxed and intubated, botulinum toxin was infiltrated on the left side and the relaxation test was performed, achieving total reduction of the eviscerated content and inversion of the amnion on the first day of life. The intra-abdominal pressure (IAP) was monitored at all times by bladder catheterisation and by control of renal flow by INVOS system. A hydrocolloid dressing (Varihesive Gel ControlTM) was placed over the defect, which was changed every 48 hours. On the third day of life, trophic feeding was initiated and on the fourth day, the patient was extubated without observing incidences, and breast feeding was initiated. On the eighth day of life, the definitive wall closure was scheduled and the separation of components technique (Ramírez technique) was performed, by which the semilunar line is incised to separate the rectus muscle from the external oblique muscle. At the end of the intervention, intra-abdominal pressure was 10 and good renal flow was observed. The patient remained intubated for the first 24 hours postoperatively. Tolerance was initiated on the first postoperative day, and the evolution was favourable, with the patient being discharged home on the 14th day of life.\n",
+        "summary": "We present a case of hepatoonfalocele with prenatal diagnosis, without associated anomalies. In week 37 under maternal and fetal sedation, botulinum toxin was injected into the right hemiabdomen. After the scheduled cesarean section in week 39, injection into the left hemiabdomen was completed and a complete reduction of the hepatic content and total inversion of the amnion was achieved. Definitive repair was performed with separation of components on the eighth day of life and discharge on the fourteenth day of life.\n",
+        "translated_fulltext": "আমরা একটি বিশাল ওμφালোসেল (omphalocele)-এর চিকিৎসা পদ্ধতির বিবরণ দিচ্ছি, যেখানে গর্ভাবস্থার ১৪তম সপ্তাহে রোগ নির্ণয় করা হয়েছিল। প্রাথমিক রোগ নির্ণয়ের পর, ক্রোমোজোমাল অস্বাভাবিকতাগুলি বাতিল করা হয়। স্ত্রীরোগ এবং প্রসূতি বিভাগ থেকে গর্ভাবস্থায় রোগ নির্ণয়ের জন্য শিশু সার্জারি বিভাগের সাথে যোগাযোগ করা হয় এবং বোটুলিনাম টক্সিনের প্রয়োগের কথা বিবেচনা করা হয়। ৩৭তম সপ্তাহে, ভ্রূণের পেটের ট্রান্সভার্স প্লেনে (TAP) বোটুলিনাম টক্সিনের প্রয়োগের সময়সূচী করা হয়। এই প্রক্রিয়াটি স্ত্রীরোগ বিশেষজ্ঞ, শিশু সার্জন, নবজাতক বিশেষজ্ঞ এবং অ্যানেস্থেটিস্টদের সমন্বয়ে গঠিত একটি বহু-বিষয়ক দল দ্বারা পরিচালিত হয়, যেখানে গর্ভবতী মহিলাকে সিডেশন দেওয়া হয়। ভ্রূণের সিডেশনের জন্য অ্যাট্রোপিন, ফেন্টানিল এবং রোকিউরোনিয়ামের একটি ইন্ট্রামাসকুলার ইনজেকশন দেওয়া হয়। ভ্রূণের জরায়ু অবস্থানের কারণে, শুধুমাত্র ভ্রূণের পেটের ডান পাশের ট্রান্সভার্স প্লেনে বোটুলিনাম টক্সিন প্রয়োগ করা সম্ভব ছিল। একটিমাত্র প্ল্যাসেন্টাল প্রয়োগের মাধ্যমে, সাবকস্টাল স্তরে, দশম পাঁজর এবং ডান ইলিয়াক ফোসাতে বোটুলিনাম টক্সিন (মাত্রা ১২ IU/kg) প্রয়োগ করা হয়। প্রক্রিয়া চলাকালীন এবং পরবর্তী দিনগুলোতে, কোনও জটিলতা দেখা যায়নি। ৩৯তম সপ্তাহে সিজারিয়ান সেকশনের সময়সূচী করা হয়। জন্মের সময়, ত্রুটিপূর্ণ স্থানে একটি প্লাস্টিক ব্যাগ দিয়ে একটি সাইলো স্থাপন করা হয় এবং রোগীর শরীর শিথিল ও ইন্টিউবেটেড করার পরে, বাম পাশে বোটুলিনাম টক্সিন প্রয়োগ করা হয় এবং রিলাক্সেশন পরীক্ষা করা হয়, যার ফলে প্রথম দিনে ইভিসসেরেটেড অংশের সম্পূর্ণ হ্রাস এবং অ্যামনিয়নের বিপরীতকরণ সম্ভব হয়। মূত্রাশয়ের ক্যাথেটারাইজেশন এবং INVOS সিস্টেমের মাধ্যমে রেনাল প্রবাহ নিয়ন্ত্রণ করে ইন্ট্রা-অ্যাবডোমিনাল চাপ (IAP) সবসময় পর্যবেক্ষণ করা হয়। ত্রুটিপূর্ণ স্থানের উপরে একটি হাইড্রোকালেয়েড ড্রেসিং (ভেরিহেসিভ জেল কন্ট্রোল™) স্থাপন করা হয়, যা প্রতি ৪৮ ঘন্টা পর পর পরিবর্তন করা হয়। জীবনের তৃতীয় দিনে, ট্রফিক ফিডিং শুরু করা হয় এবং চতুর্থ দিনে, কোনও সমস্যা ছাড়াই রোগীকে ইন্টিউবেশন থেকে সরানো হয় এবং বুকের দুধ খাওয়ানো শুরু করা হয়। জীবনের অষ্টম দিনে, চূড়ান্ত প্রাচীর বন্ধ করার সময়সূচী করা হয় এবং উপাদান পৃথকীকরণ কৌশল (রামিরেজ কৌশল) প্রয়োগ করা হয়, যেখানে সেমিলুনার লাইন কেটে রেকটাস পেশীটিকে বাহ্যিক তির্যক পেশী থেকে আলাদা করা হয়। পদ্ধতির শেষে, ইন্ট্রা-অ্যাবডোমিনাল চাপ ১০ ছিল এবং ভাল রেনাল প্রবাহ দেখা যায়। পোস্টঅপারেটিভভাবে প্রথম ২৪ ঘন্টা রোগীর ইন্টিউবেশন বজায় রাখা হয়। প্রথম পোস্টঅপারেটিভ দিনেই খাবার দেওয়া শুরু করা হয় এবং রোগীর উন্নতি সন্তোষজনক ছিল, এবং জীবনের ১৪তম দিনে রোগীকে বাড়ি ছেড়ে দেওয়া হয়।",
+        "translated_summary": "আমরা ভ্রূণকালীন রোগ নির্ণয়ের মাধ্যমে হেপাটোনফালোসেল নামক একটি বিরল রোগের ঘটনা তুলে ধরছি, যেখানে অন্য কোনো জটিলতা ছিল না। গর্ভাবস্থার ৩৭তম সপ্তাহে, মা ও ভ্রূণের জন্য উপযুক্ত ওষুধ দেওয়ার পর, বোটুলিনাম টক্সিন ডান দিকের পেটের অংশে ইনজেকশন করা হয়। এরপর ৩৯তম সপ্তাহে নির্ধারিত সিজারিয়ান অপারেশনের পর, বাম দিকের পেটের অংশে ইনজেকশন দেওয়া সম্পন্ন করা হয় এবং এর ফলে লিভারের ভেতরের অঙ্গগুলির সম্পূর্ণ পুনরুদ্ধার এবং অ্যামনিওনের সম্পূর্ণ বিপরীতমুখী পরিবর্তন ঘটানো সম্ভব হয়। জন্মের অষ্টম দিনে বিভিন্ন অংশ আলাদা করে চূড়ান্তভাবে মেরামত করা হয় এবং ১৪তম দিনে রোগীকে হাসপাতাল থেকে ছাড়া দেওয়া হয়।",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_255.txt",
+        "fulltext": "Female patient, 12 years old, diagnosed with cytotoxic T lymphocyte antigen 4 (CTLA-4) deficiency. She had a history of recurrent sinusitis, otitis media and tonsillitis since the age of 3. Between the ages of 7 and 9, the patient had recurrent episodes of autoimmune haemolytic anaemia and an episode of immune thrombocytopenia. Since the diagnosis of primary immunodeficiency (PID) with hypogamaglobulinemia at the age of 9, she received IVIG infusion every 3 weeks and antimicrobial prophylaxis with sulphamethoxazole-trimethoprim.\n\nAt 10 years of age, the patient developed granulomatous-lymphocytic interstitial lung disease (GLILD), a non-infectious pulmonary complication, for which she received treatment with rituximab and mycophenolate mofetil. A few months after discontinuing immunosuppressive therapy, the patient developed fungal pneumonia.\n\nIn the sixth week of treatment with voriconazole for pulmonary infection with Aspergillus sp, the patient was hospitalized to receive a regular dose of IVIG (580 mg/kg), but the product available (3%, Sandoglobulin®, CSL Behring, lot 4302500091) was different from that used in previous infusions. Physical examination was normal, with 95% oxygen saturation (SatO2) at room temperature. Laboratory tests performed on the same day showed normal renal function. The IVIG infusion began at 1 ml/kg/hour, and the infusion rate was increased every 30 minutes, until it reached 6.7 ml/kg/h. The patient received a total of 600 ml of the immunoglobulin solution (concentration 3%), and remained without symptoms during the infusion.\n\nAbout 30 minutes after the end of the administration, the patient reported increased dyspnoea and had bilateral rales on auscultation, hypoxaemia (SatO2 of 88% to 89% at room temperature), respiratory rate of 28bpm, heart rate of 125bpm, blood pressure of 114x68mmHg, axillary temperature of 37.1°C, with no other symptoms or signs. Non-invasive oxygen support at an inspired oxygen fraction of 50% was offered, resulting in SatO2 of 99%, and the patient was transferred to the emergency unit. The chest radiograph showed signs of bilateral diffuse infiltrate, mostly at the base of the lungs, with normal cardiac silhouette.\n\nThe patient received a single dose of intravenous furosemide (0.5 mg/kg) due to the initial hypothesis of volume overload. The echocardiogram did not show signs of abnormality, with an ejection fraction of 79%. The patient did not demonstrate other signs of congestion. After 24 hours, she presented SatO2>93% in ambient air, without other complaints, and, after 36 hours of the event, remained asymptomatic and was discharged from hospital.\n\nAfter 3 weeks, the patient received IVIG infusion with the same product as used prior to the reaction without adverse effects. One year after the adverse effect was reported, the patient continues on regular IVIG replacement without further complications.\n",
+        "summary": "Case report of a patient with immunodeficiency who required regular intravenous immunoglobulin replacement. She presented an episode of acute pulmonary injury related to transfusion after use of an immunoglobulin product different from the one she received habitually. She developed respiratory changes (hypoxia, dyspnea and altered pulmonary auscultation) minutes after the end of the infusion, requiring non-invasive respiratory support. The patient was discharged from hospital after 36 hours, with a good evolution. She recovered fully from the symptoms, without further reactions to subsequent infusions of immunoglobulin (and it was decided not to prescribe the product that was used when the episode of acute pulmonary injury related to transfusion occurred).\n",
+        "translated_fulltext": "১২ বছর বয়সী একজন নারী রোগী, যার সাইটোটক্সিক টি লিম্ফোসাইট অ্যান্টিজেন ৪ (সিটিএলএ-৪) এর ঘাটতি রয়েছে। তার ৩ বছর বয়স থেকে বারবার সাইনোসাইটিস, ওটাইটিস মিডিয়া এবং টনসিলাইটিসের ইতিহাস ছিল। ৭ থেকে ৯ বছর বয়সের মধ্যে, রোগীর অটোইমিউন হেমোলাইটিক অ্যানিমিয়া এবং ইমিউন থ্রম্বোসাইটোপেনিয়ার পুনরাবৃত্তিমূলক ঘটনা দেখা যায়। ৯ বছর বয়সে প্রাইমারি ইমিউনোডেফিসিয়েন্সি (পিআইডি) এবং হাইপোগ্যামাগ্লোবুলিনেমিয়া নির্ণয় হওয়ার পর, তাকে প্রতি ৩ সপ্তাহে আইভিআইজি ইনফিউশন এবং সালফামেথোক্সাজোল-ট্রাইমেথোপ্রিমের সাথে অ্যান্টিমাইক্রোবিয়াল প্রোফাইল্যাক্সিস দেওয়া হয়েছিল।\n\n১০ বছর বয়সে, রোগীর গ্রানুলোমেটাস-লিম্ফোসাইটিক ইন্টারস্টিশিয়াল লাং ডিজিজ (জিএলআইএলডি) দেখা দেয়, যা একটি অসংক্রামক পালমোনারি জটিলতা। এর জন্য তাকে রিটুক্সিম্যাব এবং মাইকোফেনোলেট মোফেটিল দিয়ে চিকিৎসা করা হয়। ইমিউনোসাপ্রেসিভ থেরাপি বন্ধ করার কয়েক মাস পর, রোগীর ছত্রাকজনিত নিউমোনিয়া হয়।\n\nঅ্যাসপারগিলাস এসপি-এর কারণে পালমোনারি সংক্রমণের জন্য ভোরিকোনাজোলের সাথে ষষ্ঠ সপ্তাহে চিকিৎসা করার সময়, রোগীকে নিয়মিত ডোজের আইভিআইজি (৫৮০ মিলিগ্রাম/কেজি) দেওয়ার জন্য হাসপাতালে ভর্তি করা হয়, তবে যে পণ্যটি পাওয়া যায় (৩%, স্যান্ডোগ্লোবুলিন®, সিএসএল বেরিং, লট ৪৩০২৫০০0৯১), তা পূর্বের ইনফিউশনে ব্যবহৃত পণ্যের থেকে ভিন্ন ছিল। শারীরিক পরীক্ষায় সবকিছু স্বাভাবিক ছিল, ঘরের তাপমাত্রায় অক্সিজেনের স্যাচুরেশন ছিল ৯৫% (স্যাটও২)। একই দিনে করা ল্যাবরেটরি পরীক্ষায় স্বাভাবিক রেনাল ফাংশন দেখা যায়। আইভিআইজি ইনফিউশন ১ মিলি/কেজি/ঘণ্টা হারে শুরু হয় এবং প্রতি ৩০ মিনিটে ইনফিউশনের হার বাড়ানো হয়, যতক্ষণ না এটি ৬.৭ মিলি/কেজি/ঘণ্টায় পৌঁছায়। রোগীকে মোট ৬০০ মিলি ইমিউনোগ্লোবুলিন দ্রবণ (ঘনত্ব ৩%) দেওয়া হয় এবং ইনফিউশনের সময় তার মধ্যে কোনো উপসর্গ দেখা যায়নি।\n\nইনফিউশন শেষ হওয়ার প্রায় ৩০ মিনিট পর, রোগী শ্বাসকষ্ট অনুভব করেন এবং অস্কাল্টেশনে উভয় ফুসফুসে র‍্যালস শোনা যায়, হাইপোক্সেমিয়া (ঘরের তাপমাত্রায় স্যাটও২ ৮৮% থেকে ৮৯%), শ্বাস-প্রশ্বাস প্রতি মিনিটে ২৮ বার, হৃদস্পন্দন প্রতি মিনিটে ১২৫ বার, রক্তচাপ ১১৪x৬৮ মিমিএইচজি, বগলের তাপমাত্রা ৩৭.১ ডিগ্রি সেলসিয়াস, অন্য কোনো উপসর্গ বা লক্ষণ ছিল না। ৫০% অনুপ্রাণিত অক্সিজেনের ভগ্নাংশে নন-ইনভেসিভ অক্সিজেন সাপোর্ট দেওয়া হয়, যার ফলে স্যাটও২ ৯৯% হয় এবং রোগীকে জরুরি বিভাগে স্থানান্তর করা হয়। বুকের রেডিওগ্রাফে উভয় ফুসফুসে ছড়িয়ে ছিটিয়ে থাকা ইনফিল্ট্রেটের লক্ষণ দেখা যায়, বিশেষ করে ফুসফুসের নিচের দিকে, যেখানে হৃদপিণ্ডের আকৃতি স্বাভাবিক ছিল।\n\nপ্রাথমিকভাবে ভলিউম ওভারলোডের কারণে রোগীকে ইন্ট্রাভেনাস ফিউরোসেমাইড (০.৫ মিলিগ্রাম/কেজি) এর একটি ডোজ দেওয়া হয়। ইকোকার্ডিওগ্রামে কোনো অস্বাভাবিকতা দেখা যায়নি, ইজেকশন ফ্র্যাকশন ছিল ৭৯%। রোগীর অন্য কোনো কনজেশনের লক্ষণ ছিল না। ২৪ ঘণ্টা পর, সাধারণ বাতাসে স্যাটও২ >৯৩% ছিল এবং অন্য কোনো অভিযোগ ছিল না। ঘটনার ৩৬ ঘণ্টা পর, রোগী উপসর্গমুক্ত ছিলেন এবং হাসপাতাল থেকে ছুটি দেওয়া হয়।\n\n৩ সপ্তাহ পর, রোগীকে একই পণ্য দিয়ে আইভিআইজি ইনফিউশন দেওয়া হয়, যা প্রতিক্রিয়ার আগে ব্যবহার করা হয়েছিল এবং এর ফলে কোনো বিরূপ প্রভাব দেখা যায়নি। বিরূপ প্রতিক্রিয়া হওয়ার এক বছর পরেও, রোগী নিয়মিত আইভিআইজি প্রতিস্থাপন চালিয়ে যাচ্ছেন এবং এতে কোনো জটিলতা দেখা যায়নি।",
+        "translated_summary": "ইমিউনোডেফিসিয়েন্সি (রোগ প্রতিরোধ ক্ষমতা দুর্বলতা) রয়েছে এমন একজন রোগীর ঘটনা বিবরণ, যিনি নিয়মিতভাবে ইন্ট্রাভেনাস ইমিউনোগ্লোবুলিন প্রতিস্থাপন গ্রহণ করতেন। তিনি এমন একটি ঘটনার সম্মুখীন হন, যেখানে একটি ভিন্ন ইমিউনোগ্লোবুলিন পণ্য ব্যবহারের পর রক্ত পরিসঞ্চালনের কারণে তীব্র পালমোনারি ইনজুরির (ফুসফুসের আঘাত) লক্ষণ দেখা যায়, যা তিনি আগে নিয়মিত ব্যবহার করতেন না। ইনফিউশন শেষ হওয়ার কয়েক মিনিটের মধ্যেই তার শ্বাস-প্রশ্বাস সংক্রান্ত পরিবর্তন (হাইপোক্সিয়া, ডিস্পনিয়া এবং পরিবর্তিত পালমোনারি অস্কালটেশন) দেখা দেয়, যার কারণে তাকে নন-ইনভেসিভ রেসপিরেটরি সাপোর্ট দিতে হয়। ৩৬ ঘণ্টা পর রোগীকে হাসপাতাল থেকে ছুটি দেওয়া হয় এবং তার শারীরিক অবস্থার উন্নতি দেখা যায়। তিনি সম্পূর্ণরূপে উপসর্গ থেকে সেরে ওঠেন এবং পরবর্তীতে ইমিউনোগ্লোবুলিনের ইনফিউশনগুলোতে আর কোনো প্রতিক্রিয়া দেখা যায়নি (এবং যে পণ্যটি ব্যবহারের সময় তীব্র পালমোনারি ইনজুরির ঘটনা ঘটেছিল, সেটি আর ব্যবহার না করার সিদ্ধান্ত নেওয়া হয়)।",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_451.txt",
+        "fulltext": "A 13-year-old otherwise healthy male sustained an injury after falling. Upon initial assessment by emergency services personnel, the patient exhibited signs of hypoxia and shock. Consequently, he was intubated, a chest tube was placed on the left side, and he received an intravenous bolus of tranexamic acid from a helicopter emergency medical service. Radiography revealed a large bilateral pulmonary contusion and left femoral fracture. Enhanced computed tomography (CT) revealed a thoracic aortic injury with a pseudoaneurysm (SVS grade III), in addition to multiple thoracic vertebral fractures with extravasation and bilateral pulmonary contusions. The pseudoaneurysm was situated at the aortic isthmus 8 mm distal to the left subclavian artery.\n\nAfter initial fluid resuscitation and blood pressure control, his oxygenation level decreased to P/F 140 (FiO2: 0.8). As we suspected pulmonary contusion progression, venovenous extracorporeal membrane oxygenation (VV-ECMO) was considered, and ECMO catheters were inserted into the internal jugular and common femoral veins before TEVAR. The patient was 163 cm tall, weighed 48 kg, and had a body surface area of 1.5 m [2] (estimated using the Du Bois formula). The native proximal aortic diameter was 15 mm; we chose a 21-mm diameter stent graft (TAG TGM212110J; Gore, Arizona, US), as it was the smallest device available at the time. Because of the small diameter of the common femoral arteries on both sides (4 mm), we approached the left common iliac artery (8 mm) under laparotomy. In addition, the proximal landing zone of the stent graft on the thoracic pseudoaneurysm was relatively short (8 mm). To prevent endoleaks, the pseudoaneurysm was filled with a 33% mixture of n-butyl-2-cyanoacrylate (Histoacryl; B. Braun, Melsungen, Germany) and iodized oil (Lipiodol; Guerbet, Aulnay-sous-Bois, France) after stent graft deployment. The final stent graft diameter was 15 mm. The patient was postoperatively admitted to the ICU. Subsequent CT scans performed on postoperative days (POD) 3 and 25 revealed no endoleaks, resolution of the mediastinal hematoma, distal migration of the stent graft, or other postoperative complications.\n\nA heparin-coated circuit was used for VV-ECMO; anticoagulants were not used immediately after induction because of the risk of bleeding. Unfractionated heparin was initiated on POD 2, with a target activated clotting time of 140–180 s. However, heparin was discontinued owing to worsening of the left hemothorax on POD 3; subsequently, open chest hemostasis and temporary chest closure were performed. Nonetheless, on POD 5, the ECMO circuit was occluded twice, and heparin administration was resumed. A left hemothorax reoperation was performed, and the thoracotomy was closed on POD 7, after which the patient was on stable VV-ECMO with unfractionated heparin at 10,000 units/day. The patient was weaned off VV-ECMO on POD 16 and discharged on POD 110.",
+        "summary": "We report a case of TEVAR for BTAI performed under laparotomy with n-butyl-2-cyanoacrylate (NBCA) injection in an adolescent patient. The patient was a 13-year-old male who sustained injuries due to a fall and presented with severe hypoxia and shock on admission. Computed tomography (CT) showed a thoracic aortic injury with a pseudoaneurysm (SVS grade III) and bilateral pulmonary contusions. We planned to perform TEVAR after venovenous extracorporeal membrane oxygenation (ECMO); however, because of the small diameters of the bilateral common femoral arteries, we placed a stent graft through the left common iliac artery under laparotomy. In addition, the proximal landing zone of the stent graft to the thoracic pseudoaneurysm was short, and we filled the pseudoaneurysm with NBCA after deploying the stent graft to prevent endoleaks. Subsequent CTs showed no endoleaks, and the patient was discharged on day 110.",
+        "translated_fulltext": "তেরো বছর বয়সী একজন সুস্থ যুবক পড়ে গিয়ে আঘাত পান। জরুরি বিভাগের কর্মীরা প্রাথমিক মূল্যায়নে দেখেন যে রোগীর শরীরে অক্সিজেনের অভাব এবং শকের লক্ষণ দেখা যাচ্ছে। এর ফলস্বরূপ, তাকে ভেন্টিলেটরে রাখা হয়, বুকের বাম দিকে একটি টিউব স্থাপন করা হয় এবং হেলিকপ্টার থেকে আসা জরুরি চিকিৎসা দলের মাধ্যমে তাকে শিরায় ট্রানেক্সামিক অ্যাসিড দেওয়া হয়। রেডিওগ্রাফিতে দেখা যায়, তার উভয় ফুসফুসে বড় ধরনের আঘাত লেগেছে এবং বাম দিকের ফিমার হাড়ে ফ্র্যাকচার হয়েছে। আরও উন্নত সিটি স্ক্যানে দেখা যায়, থোরাসিক অ্যাওর্টিক ধমনীতে একটি সিউডোঅ্যানিউরিজম (SVS গ্রেড III) হয়েছে, সেই সাথে একাধিক থোরাসিক ভার্টিব্রাল ফ্র্যাকচার এবং উভয় ফুসফুসে রক্তক্ষরণ হয়েছে। সিউডোঅ্যানিউরিজমটি অ্যাওর্টিক ইস্তমাসের বাম সাবক্লেভিয়ান ধমনী থেকে ৮ মিমি দূরে অবস্থিত ছিল।\n\nপ্রাথমিক পর্যায়ে তরল দিয়ে পুনরায় হাইড্রেশন এবং রক্তচাপ নিয়ন্ত্রণে আনার পর, তার অক্সিজেনের মাত্রা কমে P/F 140-এ নেমে আসে (FiO2: 0.8)। যেহেতু ফুসফুসের আঘাত আরও বাড়ার সম্ভাবনা ছিল, তাই ভেনো-ভেনাস এক্সট্রাকর্পোরিয়াল মেমব্রেন অক্সিজেনেশন (VV-ECMO) করার সিদ্ধান্ত নেওয়া হয় এবং টিইভিএআর করার আগে অভ্যন্তরীণ জুগুলার এবং সাধারণ ফিমোরাল শিরায় ইসিএমও ক্যাথেটার স্থাপন করা হয়। রোগীর উচ্চতা ছিল ১৬৩ সেমি, ওজন ৪৮ কেজি এবং শরীরের ক্ষেত্রফল ছিল ১.৫ বর্গমিটার [২] (ডু বোইস ফর্মুলা ব্যবহার করে হিসাব করা হয়েছে)। স্বাভাবিক অবস্থায় অ্যাওর্টিক ধমনীর ব্যাস ছিল ১৫ মিমি; আমরা ২১ মিমি ব্যাসের একটি স্টেন্ট গ্রাফট (TAG TGM212110J; গোর, অ্যারিজোনা, মার্কিন যুক্তরাষ্ট্র) বেছে নিয়েছিলাম, কারণ সেই সময়ে এটিই সবচেয়ে ছোট আকারের ডিভাইস ছিল। উভয় দিকের সাধারণ ফিমোরাল ধমনীর ব্যাস কম (৪ মিমি) হওয়ায়, আমরা ল্যাপারোটমির মাধ্যমে বাম সাধারণ ইলিয়াক ধমনীতে (৮ মিমি) প্রবেশ করি। এছাড়াও, থোরাসিক সিউডোঅ্যানিউরিজমের উপর স্টেন্ট গ্রাফটের প্রক্সিমাল ল্যান্ডিং জোন তুলনামূলকভাবে ছোট ছিল (৮ মিমি)। এন্ডোলিক প্রতিরোধ করার জন্য, স্টেন্ট গ্রাফট স্থাপনের পরে সিউডোঅ্যানিউরিজমে ৩৩% এন-বিউটাইল-২-সায়ানোঅ্যাক্রিলেট (হিস্টোঅ্যাক্রিল; বি. ব্রাউন, মেলসুঙ্গেন, জার্মানি) এবং আয়োডিনযুক্ত তেল (লিপিওডল; গুয়েরবেট, অউলনে-সু-বোয়া, ফ্রান্স) মিশ্রণ দিয়ে ভরা হয়। চূড়ান্ত স্টেন্ট গ্রাফটের ব্যাস ছিল ১৫ মিমি। অস্ত্রোপচারের পর রোগীকে আইসিইউতে ভর্তি করা হয়। অস্ত্রোপচারের পরবর্তী ৩ এবং ২৫ দিনে করা সিটি স্ক্যানে কোনো এন্ডোলিক, মধ্যচ্ছদার হেমাটোমার উন্নতি, স্টেন্ট গ্রাফটের স্থানচ্যুতি বা অন্য কোনো জটিলতা দেখা যায়নি।\n\nভিভি-ইসিএমও-এর জন্য হেপারিন-কোটেড সার্কিট ব্যবহার করা হয়েছিল; রক্তপাতের ঝুঁকির কারণে ইন্ডাকশনের পরপরই অ্যান্টিকোয়াগুলেন্ট ব্যবহার করা হয়নি। অস্ত্রোপচারের পরবর্তী ২য় দিনে আনফ্র্যাকশনেটেড হেপারিন শুরু করা হয়, যার লক্ষ্য ছিল ১৪০-১৮০ সেকেন্ডের অ্যাক্টিভেটেড ক্লটিং টাইম বজায় রাখা। তবে, অস্ত্রোপচারের পরবর্তী ৩য় দিনে বাম হেমোথোরাক্সের অবনতি হওয়ায় হেপারিন বন্ধ করে দেওয়া হয়; পরবর্তীতে, ওপেন চেস্ট হেমোস্ট্যাসিস এবং অস্থায়ীভাবে বুক বন্ধ করা হয়। তা সত্ত্বেও, অস্ত্রোপচারের পরবর্তী ৫ম দিনে, ইসিএমও সার্কিট দুবার বন্ধ হয়ে যায় এবং হেপারিন দেওয়া পুনরায় শুরু করা হয়। বাম হেমোথোরাক্সের জন্য পুনরায় অস্ত্রোপচার করা হয় এবং অস্ত্রোপচারের পরবর্তী ৭ম দিনে থোরাকটমি বন্ধ করা হয়, এরপর রোগীকে ১০,০০০ ইউনিট/দিনে আনফ্র্যাকশনেটেড হেপারিন দিয়ে স্থিতিশীল ভিভি-ইসিএমও-তে রাখা হয়। রোগীকে অস্ত্রোপচারের পরবর্তী ১৬তম দিনে ভিভি-ইসিএমও থেকে সরিয়ে নেওয়া হয় এবং ১১০তম দিনে হাসপাতাল থেকে ছুটি দেওয়া হয়।",
+        "translated_summary": "আমরা একজন কিশোর রোগীর ক্ষেত্রে ল্যাপারোটমির মাধ্যমে এন-বিউটাইল-২-সায়ানোঅ্যাক্রিলেট (এনবিসিএ) ইনজেকশন ব্যবহার করে বিটিএআই-এর জন্য টিইভিএআর করার একটি ঘটনা তুলে ধরছি। রোগীটি ১৩ বছর বয়সী একজন পুরুষ, যে পড়ে গিয়ে আঘাত পেয়েছিল এবং হাসপাতালে ভর্তির সময় গুরুতর হাইপোক্সিয়া ও শকে ভুগছিল। কম্পিউটেড টমোগ্রাফি (সিটি) স্ক্যানে দেখা যায় তার থোরাসিক অ্যাওর্টিক ধমনীতে আঘাত লেগেছে এবং একটি সিউডোঅ্যানিউরিজম (এসভিএস গ্রেড III) হয়েছে, সেইসাথে উভয় ফুসফুসে কনট্যুশন হয়েছে। আমরা ভেনোভেনাস এক্সট্রাকর্পোরিয়াল মেমব্রেন অক্সিজেনেশন (ইসিএমও)-এর পরে টিইভিএআর করার পরিকল্পনা করেছিলাম; তবে, উভয় সাধারণ ফিমোরাল ধমনীর ব্যাস ছোট হওয়ায়, আমরা ল্যাপারোটমির মাধ্যমে বাম সাধারণ ইলিয়াক ধমনীর মাধ্যমে একটি স্টেন্ট গ্রাফট স্থাপন করি। এছাড়াও, স্টেন্ট গ্রাফটের প্রক্সিমাল ল্যান্ডিং জোনটি থোরাসিক সিউডোঅ্যানিউরিজমের কাছাকাছি ছিল এবং এন্ডোলিক প্রতিরোধ করার জন্য স্টেন্ট গ্রাফট স্থাপনের পরে আমরা সিউডোঅ্যানিউরিজমে এনবিসিএ দিয়ে ভরাট করি। পরবর্তী সিটি স্ক্যানগুলোতে কোনো এন্ডোলিক দেখা যায়নি এবং রোগীকে ১১০তম দিনে হাসপাতাল থেকে ছেড়ে দেওয়া হয়।",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_100.txt",
+        "fulltext": "A six-month-old male infant was observed in the emergency department for fever (maximum temperature 40ºC every 6 hours), rhinorrhea, cough and refusal of food with three days of evolution. The pregnancy was full term, monitored and without complications. In the neonatal period he was admitted for congenital pneumonia complicated with pneumothorax and recovered with drainage, antibiotic therapy and invasive mechanical ventilation. He had vaccinations up to date according to the National Vaccination Calendar and including three doses of the Hib vaccine, two doses of the MenB vaccine, two doses of the MenACWY vaccine and two doses of the rotavirus vaccine. He attended a day care center and his family history was not relevant.\n",
+        "summary": "A six-month old infant presented to the emergency department with a fever, cough and runny nose. He was alert and hemodynamically stable at admission, but became progressively lethargic and had a bulging fontanelle. Blood tests showed a normal white blood cell count and elevated C-reactive protein. A cerebrospinal fluid cytology and biochemistry were consistent with bacterial meningitis, and ceftriaxone was initiated. A blood culture and a cerebrospinal fluid culture were positive for Haemophilus influenzae. Serotyping of the strain identified a Haemophilus influenzae serotype A. Viral testing of the cerebrospinal fluid and nasopharyngeal aspirate was positive for adenovirus. He was discharged after 10 days of antibiotics and full clinical recovery.\n",
+        "translated_fulltext": "ছয় মাস বয়সী একটি ছেলে শিশুকে জরুরি বিভাগে জ্বর (সর্বোচ্চ তাপমাত্রা প্রতি ৬ ঘণ্টায় ৪০ ডিগ্রি সেলসিয়াস), নাক দিয়ে পানি পড়া, কাশি এবং তিন দিন ধরে খাবার গ্রহণে অনীহা নিয়ে পর্যবেক্ষণ করা হয়েছিল। গর্ভাবস্থা স্বাভাবিক ছিল, নিয়মিত পর্যবেক্ষণ করা হয়েছিল এবং কোনো জটিলতা ছিল না। জন্মের পর নবজাতককালে তাকে জন্মগত নিউমোনিয়ার জন্য হাসপাতালে ভর্তি করা হয়েছিল, যা নিউমোথোরাক্সের কারণে জটিল আকার ধারণ করে। এরপর ড্রেনেজ, অ্যান্টিবায়োটিক থেরাপি এবং ইনভেসিভ মেকানিক্যাল ভেন্টিলেশনের মাধ্যমে তার চিকিৎসা করা হয় এবং সে সুস্থ হয়ে ওঠে। জাতীয় টিকাদান ক্যালেন্ডার অনুযায়ী তার বয়স অনুযায়ী প্রয়োজনীয় সব টিকা দেওয়া হয়েছিল, যার মধ্যে তিনটি ডোজের হিবি (Hib) টিকা, দুটি ডোজের মেনবি (MenB) টিকা, দুটি ডোজের মেনএসিডব্লিউওয়াই (MenACWY) টিকা এবং দুটি ডোজের রোটাভাইরাস টিকা অন্তর্ভুক্ত ছিল। সে একটি ডে-কেয়ার সেন্টারে যেত এবং তার পারিবারিক ইতিহাস তেমন গুরুত্বপূর্ণ ছিল না।",
+        "translated_summary": "ছয় মাস বয়সী একটি শিশু জ্বর, কাশি এবং নাক দিয়ে পানি পড়া নিয়ে জরুরি বিভাগে আসে। হাসপাতালে ভর্তির সময় সে সজাগ ছিল এবং তার রক্তচাপ স্বাভাবিক ছিল, কিন্তু ধীরে ধীরে সে দুর্বল হয়ে পড়ে এবং তার মাথার খুলির নরম অংশটি ফুলে যায়। রক্ত পরীক্ষায় দেখা যায়, তার শ্বেত রক্তকণিকার সংখ্যা স্বাভাবিক এবং সি-রিঅ্যাক্টিভ প্রোটিনের মাত্রা বেশি। মেরুদণ্ডের তরলের সাইটোলজি এবং বায়োকেমিস্ট্রি পরীক্ষা করে দেখা যায়, এটি ব্যাকটেরিয়াল মেনিনজাইটিসের সঙ্গে সঙ্গতিপূর্ণ, এবং তাকে সেফট্রিয়াক্সোন দেওয়া শুরু করা হয়। রক্ত এবং মেরুদণ্ডের তরলের কালচারে হেমোফিলাস ইনফ্লুয়েঞ্জা নামক ব্যাকটেরিয়ার উপস্থিতি পাওয়া যায়। ব্যাকটেরিয়ার সেরোটাইপিং করে দেখা যায়, এটি হেমোফিলাস ইনফ্লুয়েঞ্জা সেরোটাইপ এ। মেরুদণ্ডের তরল এবং নাকের ভেতরের তরলের ভাইরাল পরীক্ষায় অ্যাডেনোভাইরাসের উপস্থিতি ধরা পড়ে। অ্যান্টিবায়োটিক দেওয়ার পর ১০ দিন এবং সম্পূর্ণ সুস্থ হওয়ার পর তাকে হাসপাতাল থেকে ছেড়ে দেওয়া হয়।",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_359.txt",
+        "fulltext": "Neonate born at 920 grams in the 29th week of pregnancy by emergency cesarean due to risk of loss of fetal well-being and suspicion of maternal chorioamnionitis. She is the first daughter of non-consanguineous parents, without known diseases to date, or history of previous abortions. However, the mother's infertility stands out, requiring up to 4 cycles of in vitro fertilization to achieve pregnancy. The pregnancy was monitored and moderate polyhydramnios was observed. After premature rupture of membranes and initiation of uterine dynamics, two doses of prenatal corticotherapy were administered for pulmonary maturation and neuroprotection with magnesium sulphate prior to delivery. The patient presented hyaline membrane disease, which was managed with administration of surfactant and invasive mechanical ventilation until 7 days of life. Subsequently, she was kept on non-invasive mechanical ventilation until 85 days of life, after 41 weeks of postmenstrual age, presenting a striking difficulty in withdrawing respiratory assistance. In addition, she presented frequent and severe mixed-character apneas (obstructive and central), some of which required resuscitation with self-inflating bag and cardiac massage.\n\nThe physical examination revealed severe hypotonia and muscular weakness, with lower limbs in a frog position, hyporreflexia and bilateral Achilles tendon retraction, as well as facial diplegia with an inverted “V” shape of the upper lip, characteristics that initially could go unnoticed due to the gestational age and the difficulty of exploration due to the clinical instability of the patient, but that nevertheless later became evident in the various physical examinations. In addition, at 35 weeks of corrected gestational age, difficulty in oral feeding was observed, not attributable to prematurity, with difficulty in removing the nasogastric tube.\n\nGiven the maternal history of infertility, the history of polyhydramnios during pregnancy, and the physical examination findings of hypotonia, facial diplegia, and arthrogryposis, the possibility of neuromuscular disease was considered.\n\nA full neurological examination was then performed on the parents, and the mother was found to have clinical signs of myotonia (showing slow relaxation of fingers and hand after normal muscle contraction), which she did not perceive as symptomatic, as it allowed her to lead a normal life.\n\nFollowing this finding, the mother underwent an electromyogram, which showed a pattern of myotonic discharges that, in the clinical context of the patient, suggested DM1. In view of these results, a directed genetic study was requested, which found 2,000 CTG copies in the newborn, and 833 copies in her mother, confirming the definitive diagnosis of DM1 in both, as well as explaining the different clinical expressivity according to the genetic anticipation phenomenon.\n",
+        "summary": "A 29-week pre-term newborn required non-invasive mechanical ventilation until the 41st week of postmenstrual age, presenting apneas that were managed with manual ventilation with self-inflating bag and cardiac massage. Initially, they were attributed to prematurity. However, the patient presented hypotonia, hyporeflexia, bilateral Achilles' retraction, facial diplegia and weak suction, characteristics that, together with respiratory compromise, indicated a neuromuscular disease. As a background, the mother's infertility and polyhydramnios during pregnancy were highlighted. In the exploration directed to the mother, clinical myotonia was presented, confirmed later in the electromyogram, which indicated a congenital myotonic dystrophy. It was confirmed genetically, with 2000 CTG copies in the newborn and 833 in her mother.\n",
+        "translated_fulltext": "নবজাতকটি গর্ভাবস্থার ২৯তম সপ্তাহে ৯২০ গ্রাম ওজনে জরুরি সিজারিয়ানের মাধ্যমে জন্ম নেয়, কারণ ভ্রূণের স্বাস্থ্যহানি এবং মায়ের কোরিওঅ্যামনিওনাইটিসের ঝুঁকি ছিল। সে তার বাবা-মায়ের প্রথম কন্যা, যাদের মধ্যে কোনো রক্তের সম্পর্ক নেই এবং জন্মের আগে পর্যন্ত তার কোনো রোগ বা গর্ভপাতের ইতিহাস ছিল না। তবে, মায়ের বন্ধ্যাত্ব বিশেষভাবে লক্ষণীয়, যার কারণে গর্ভধারণের জন্য ইন ভিট্রো ফার্টিলাইজেশনের চারটি চক্রের প্রয়োজন হয়েছিল। গর্ভাবস্থা চলাকালীন নিয়মিত পর্যবেক্ষণ করা হয় এবং মাঝারি পরিমাণে পলিহাইড্রামনিওস দেখা যায়। সময়ের আগে জরায়ুর ঝিল্লি ফেটে যাওয়া এবং জরায়ুর সংকোচন শুরু হওয়ার পরে, ফুসফুসের পরিপক্কতা এবং নিউরোপrotection-এর জন্য দুটি ডোজ প্রসবপূর্ব কর্টিকোথেরাপি দেওয়া হয় এবং ম্যাগনেসিয়াম সালফেট ব্যবহার করা হয়। নবজাতকের হাইলাইন মেমব্রেন রোগ দেখা যায়, যার জন্য সারফ্যাক্টেন্ট এবং আক্রমণাত্মক যান্ত্রিক বায়ুচলাচল (ইনভেসিভ মেকানিক্যাল ভেন্টিলেশন) সাত দিন পর্যন্ত চালানো হয়। এরপর, ৪১ সপ্তাহ পোস্টমেনস্ট্রুয়াল বয়স পর্যন্ত, তাকে ৮৫ দিন পর্যন্ত নন-ইনভেসিভ মেকানিক্যাল ভেন্টিলেশনে রাখা হয়, যেখানে শ্বাস-প্রশ্বাস সহায়ক ব্যবস্থা সরিয়ে নেওয়ার ক্ষেত্রে উল্লেখযোগ্য অসুবিধা দেখা যায়। এছাড়াও, তার মধ্যে প্রায়শই তীব্র মিশ্র-ধরনের অ্যাপনিয়া (অবস্ট্রাকটিভ এবং সেন্ট্রাল) দেখা যায়, যার জন্য কিছু ক্ষেত্রে সেল্ফ-ইনফ্লেটিং ব্যাগ এবং কার্ডিয়াক ম্যাসাজের মাধ্যমে পুনরায় শ্বাস-প্রশ্বাস চালু করতে হয়েছিল।\n\nশারীরিক পরীক্ষায় দেখা যায়, তার শরীরে গুরুতর হাইপোটোনিয়া এবং পেশীর দুর্বলতা রয়েছে, যেখানে পায়ের পাতা ব্যাঙের মতো অবস্থানে থাকে, রিফ্লেক্স দুর্বল হয়ে যায় এবং উভয় অ্যাচিলেস টেন্ডন সংকুচিত হয়ে যায়। এছাড়াও, তার মুখের পেশী দুর্বল হয়ে যায় এবং উপরের ঠোঁটের আকৃতি উল্টো \"ভি\" আকারের হয়। গর্ভাবস্থার বয়স এবং রোগীর শারীরিক অবস্থার কারণে প্রথমে এই লক্ষণগুলো সহজে চোখে নাও পড়তে পারে, তবে পরবর্তীকালে বিভিন্ন শারীরিক পরীক্ষায় তা স্পষ্ট হয়ে ওঠে। এছাড়া, সংশোধিত গর্ভাবস্থার ৩৫ সপ্তাহে দেখা যায়, তার মুখে খাবার দিতে অসুবিধা হচ্ছে, যা সময়ের আগে জন্ম দেওয়ার কারণে নয়, বরং নাকের মাধ্যমে খাদ্যনালীতে টিউব প্রবেশ করাতে সমস্যা হচ্ছে।\n\nমায়ের বন্ধ্যাত্বের ইতিহাস, গর্ভাবস্থায় পলিহাইড্রামনিওসের ইতিহাস এবং শারীরিক পরীক্ষায় হাইপোটোনিয়া, মুখের পেশীর দুর্বলতা এবং আর্থ্রোগ্রিপোসিসের লক্ষণ দেখে, নিউরোমাসকুলার রোগের সম্ভাবনা বিবেচনা করা হয়।\n\nএরপর বাবা-মায়ের একটি সম্পূর্ণ নিউরোলজিক্যাল পরীক্ষা করা হয়, যেখানে মায়ের মায়োটোনিয়ার (স্বাভাবিক পেশী সংকোচনের পরে আঙুল এবং হাতের ধীর শিথিলতা) ক্লিনিক্যাল লক্ষণ দেখা যায়, যদিও তিনি এটিকে তেমন গুরুতর মনে করেননি, কারণ এর কারণে তার স্বাভাবিক জীবনযাত্রায় কোনো বাধা আসেনি।\n\nএই অনুসন্ধানের পর, মায়ের একটি ইলেক্ট্রোমায়োগ্রাম করা হয়, যেখানে মায়োটোনিক ডিসচার্জের একটি প্যাটার্ন দেখা যায়, যা রোগীর ক্লিনিক্যাল অবস্থার প্রেক্ষিতে ডিএম১ (ডিস্ট্রফি মায়োটোনিকা ১) রোগের ইঙ্গিত দেয়। এই ফলাফলের ভিত্তিতে, একটি বিশেষ জেনেটিক পরীক্ষা করা হয়, যেখানে নবজাতকের শরীরে ২,০০০টি সিটিজি কপি এবং মায়ের শরীরে ৮৩৩টি সিটিজি কপি পাওয়া যায়, যা উভয় ক্ষেত্রেই ডিএম১ রোগ নিশ্চিত করে এবং জেনেটিক অ্যান্টিসিপেশন ফেনোমেননের কারণে বিভিন্ন ক্লিনিক্যাল লক্ষণ প্রকাশের কারণ ব্যাখ্যা করে।",
+        "translated_summary": "২৯ সপ্তাহে জন্ম নেওয়া একটি অপরিণত শিশু, মাসিক চক্রের ৪১তম সপ্তাহ পর্যন্ত নন-ইনভেসিভ মেকানিক্যাল ভেন্টিলেশনের প্রয়োজন ছিল। শিশুটি শ্বাসকষ্টের সমস্যা দেখাচ্ছিল, যার কারণে ম্যানুয়াল ভেন্টিলেশন এবং কার্ডিয়াক ম্যাসাজের মাধ্যমে চিকিৎসা করা হয়েছিল। প্রথমে, এটিকে অপরিণততার কারণে বলে মনে করা হয়েছিল। তবে, শিশুটির মধ্যে হাইপোটোনিয়া, হাইপোরিফ্লেক্সিয়া, উভয় অ্যাচিলেস টেন্ডনের সংকোচন, মুখের প্যারালাইসিস এবং দুর্বল চোষণের ক্ষমতা দেখা যায়। এই লক্ষণগুলো একত্রে শ্বাসযন্ত্রের দুর্বলতার সাথে মিলিত হয়ে একটি নিউরোমাসকুলার রোগের ইঙ্গিত দেয়। এক্ষেত্রে, মায়ের বন্ধ্যাত্ব এবং গর্ভাবস্থায় অতিরিক্ত অ্যামনিওটিক ফ্লুইড থাকার বিষয়টি বিশেষভাবে উল্লেখ করা হয়। মায়ের স্বাস্থ্য পরীক্ষা করার সময় ক্লিনিক্যাল মায়োটোনিয়া ধরা পড়ে, যা পরবর্তীতে ইলেক্ট্রোমায়োগ্রামের মাধ্যমে নিশ্চিত করা হয়। এটি জন্মগত মায়োটোনিক ডিস্ট্রফির ইঙ্গিত দেয়। জেনেটিক পরীক্ষার মাধ্যমেও এটি নিশ্চিত করা হয়, যেখানে দেখা যায় শিশুর শরীরে ২০০০টি সিটিজি কপি এবং মায়ের শরীরে ৮৩৩টি সিটিজি কপি রয়েছে।",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_178.txt",
+        "fulltext": "A 56-year-old male presented to the emergency department of our hospital due to sudden onset shortness of breath and an episode of syncope while walking around inside his house. He underwent robotic assisted laparoscopic prostatectomy for prostate carcinoma, 5 days prior to his presentation to the Emergency Department. His post-operative course in the hospital was uneventful. In the emergency department, his blood pressure was 94/54 mmHg, heart rate 121 beats per minute, respiratory rate 20 breathes per minute, he was afebrile, and his oxygen saturation was 92% on 6 L per minute of oxygen via nasal cannula. Cardiac examination revealed S1S2, regular, tachycardic, no murmur/gallops/rubs. Respiratory examination revealed normal vesicular breath sounds bilaterally. He was noted to have asymmetrical left lower extremity edema. Electrocardiogram (ECG) revealed sinus tachycardia, no ST-T wave changes. Troponin was mildly elevated at 0.120 ng/mL (reference range: 0 to 0.020). Computed tomography angiography (CTA) of chest showed extensive bilateral pulmonary emboli, with a large clot burden in both main pulmonary arteries, evidence of acute right ventricular failure. Duplex venous scan showed acute left infra-popliteal deep vein thrombosis. Echocardiogram showed normal left ventricular ejection fraction of 60% to 65%, abnormal septal motion and flattening of interventricular septum, right ventricular systolic pressure of 49.7 mmHg, moderately dilated right ventricle, decreased right ventricle function, Tricuspid annular plane systolic excursion of 12.1 mm (normal 15 to 20 mm). As the majority of the clot burden was distal, it was not deemed amenable to surgical extraction as recent surgery was a major contraindication for thrombolysis. The patient was started on a heparin drip and inhaled nitric oxide at 20 ppm along with oral sildenafil 40 mg every 8 hours. The next day, the patient was stable hemodynamically and his inhaled nitric oxide was tapered off. Repeat echocardiogram 48 hours from initial presentation showed improved right ventricle size and function. His right ventricular systolic pressure decreased to 22.4 mmHg and his tricuspid annular plane systolic excursion improved to 17.8 mm. We recommended that he continue sildenafil for the next month after discharge along with oral anticoagulation with a plan to follow-up as an outpatient. The patient gave written consent to treatment during his hospitalization. The patient and his family members were well-informed regarding the entire plan of care, and they were in agreement with the care plan.",
+        "summary": "Patient: Male, 56\n\nFinal Diagnosis: Right heart failure due to pulmonary embolism\n\nSymptoms: Syncope\n\nMedication: —\n\nClinical Procedure: —\n\nSpecialty: Cardiology\n\nThis is a case report where sildenafil was used as a rescue agent to achieve improvement in the right ventricle size and function in a case of acute onset massive pulmonary embolism with acute right ventricle failure in the scenario where systemic thrombolytic therapy was contraindicated.",
+        "translated_fulltext": "একজন ৫৬ বছর বয়সী পুরুষ শ্বাসকষ্ট এবং হাঁটার সময় অজ্ঞান হয়ে যাওয়ার ঘটনার কারণে আমাদের হাসপাতালের জরুরি বিভাগে আসেন। প্রোস্টেট কার্সিনোমার জন্য তার রোবোটিক সহায়তায় ল্যাপারোস্কোপিক প্রোস্টেটেকটমি করা হয়েছিল, যা জরুরি বিভাগে আসার ৫ দিন আগে করা হয়েছিল। হাসপাতালে তার অস্ত্রোপচার-পরবর্তী অবস্থা স্বাভাবিক ছিল। জরুরি বিভাগে তার রক্তচাপ ছিল ৯৪/৫৪ মিমি Hg, হৃদস্পন্দন ছিল প্রতি মিনিটে ১২১, শ্বাস-প্রশ্বাস ছিল প্রতি মিনিটে ২০, জ্বর ছিল না এবং নাকের ক্যানুলা দিয়ে প্রতি মিনিটে ৬ লিটার অক্সিজেন দেওয়ার সময় তার অক্সিজেনের মাত্রা ছিল ৯২%। হৃদরোগ পরীক্ষায় S1S2, নিয়মিত, ট্যাকিকার্ডিক, কোনো শব্দ/অস্বাভাবিক হৃদস্পন্দন/ঘর্ষণ শোনা যায়নি। শ্বাসযন্ত্রের পরীক্ষায় উভয় দিকে স্বাভাবিক ভেসিকুলার শ্বাস-প্রশ্বাস শোনা যায়। তার বাম পায়ের নিচের অংশে অপ্রতিসম ফোলা দেখা যায়। ইলেক্ট্রোকার্ডিওগ্রাম (ইসিজি) থেকে সাইনাস ট্যাকিকার্ডিয়া এবং এসটি-টি তরঙ্গের কোনো পরিবর্তন দেখা যায়নি। ট্রোপোনিনের মাত্রা সামান্য বেড়ে ০.১২০ এনজি/এমএল (রেফারেন্স রেঞ্জ: ০ থেকে ০.০২০) ছিল। বুকের সিটি অ্যাঞ্জিওগ্রাফিতে উভয় ফুসফুসে বিস্তৃত পালমোনারি এমবোলিজম দেখা যায়, যেখানে উভয় প্রধান পালমোনারি ধমনীতে বড় আকারের রক্ত জমাট ছিল এবং তীব্র ডান নিলয়ের দুর্বলতার লক্ষণ ছিল। ডুপ্লেক্স ভেনাস স্ক্যানে দেখা যায় বাম ইনফ্রাপোপলিটাল গভীর শিরায় তীব্র রক্ত জমাট হয়েছে। ইকোকার্ডিওগ্রামে দেখা যায় বাম নিলয়ের স্বাভাবিক ইজেকশন ফ্র্যাকশন ৬০% থেকে ৬৫%, অস্বাভাবিক সেপটাল মুভমেন্ট এবং ইন্টারভেন্ট্রিকুলার সেপটামের সমতলতা, ডান নিলয়ের সিস্টোলিক চাপ ৪৯.৭ মিমি Hg, মাঝারিভাবে প্রসারিত ডান নিলয়, ডান নিলয়ের কার্যকারিতা হ্রাস, ট্রিকাস্পিড অ্যানুলার প্লেনের সিস্টোলিক এক্সকারসন ১২.১ মিমি (স্বাভাবিক ১৫ থেকে ২০ মিমি)। যেহেতু জমাট বাঁধা রক্তের বেশিরভাগ অংশ প্রান্তীয় দিকে ছিল, তাই সাম্প্রতিক অস্ত্রোপচারের কারণে থ্রম্বোলাইসিসের জন্য অস্ত্রোপচার করে রক্ত বের করা উপযুক্ত ছিল না। রোগীকে হেপারিন ড্রিপ এবং ২০ পিপিএম-এ ইনহেলড নাইট্রিক অক্সাইড দেওয়া শুরু করা হয়, সেই সাথে প্রতি ৮ ঘণ্টা পর মুখে খাওয়ার জন্য সিলডেনাফিল ৪০ মিগ্রা দেওয়া হয়। পরের দিন, রোগীর রক্তচাপ স্থিতিশীল ছিল এবং ইনহেলড নাইট্রিক অক্সাইডের পরিমাণ ধীরে ধীরে কমানো হয়। প্রাথমিক অবস্থার ৪৮ ঘণ্টা পর পুনরায় ইকোকার্ডিওগ্রাম করা হলে দেখা যায় ডান নিলয়ের আকার এবং কার্যকারিতা উন্নত হয়েছে। তার ডান নিলয়ের সিস্টোলিক চাপ কমে ২২.৪ মিমি Hg-এ নেমে আসে এবং ট্রিকাস্পিড অ্যানুলার প্লেনের সিস্টোলিক এক্সকারসন বেড়ে ১৭.৮ মিমি হয়। আমরা সুপারিশ করি যে তিনি হাসপাতাল থেকে discharge হওয়ার পরে আরও এক মাস সিলডেনাফিল গ্রহণ করা চালিয়ে যান এবং মুখে খাওয়ার জন্য অ্যান্টি-কোয়াগুলেন্ট ওষুধ সেবন করেন, এবং বহির্বিভাগে নিয়মিত ফলো-আপে থাকেন। হাসপাতালে থাকাকালীন রোগী চিকিৎসার জন্য লিখিত সম্মতি দিয়েছিলেন। রোগীকে এবং তার পরিবারের সদস্যদের সম্পূর্ণ চিকিৎসা পরিকল্পনা সম্পর্কে বিস্তারিত জানানো হয়েছিল এবং তারা চিকিৎসা পরিকল্পনার সাথে একমত ছিলেন।",
+        "translated_summary": "রোগী: পুরুষ, ৫৬ বছর\n\nচূড়ান্ত রোগ নির্ণয়: পালমোনারি এমবোলিজমের কারণে ডান হৃদপিণ্ডের কার্যকারিতা হ্রাস\n\nলক্ষণ: সিনকোপ\n\nওষুধ: —\n\nক্লিনিক্যাল পদ্ধতি: —\n\nবিশেষজ্ঞতা: কার্ডিওলজি\n\nএটি একটি কেস রিপোর্ট, যেখানে সিলডেনাফিলকে একটি সহায়ক ওষুধ হিসেবে ব্যবহার করা হয়েছিল। এর মাধ্যমে তীব্র পালমোনারি এমবোলিজমের ক্ষেত্রে ডান নিলয়ের আকার এবং কার্যকারিতা উন্নত করা সম্ভব হয়েছিল। এক্ষেত্রে সিস্টেমিক থ্রম্বোলাইটিক থেরাপি ব্যবহারের ক্ষেত্রে বাধা ছিল।",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_360.txt",
+        "fulltext": "A 60-year-old female, with rural origins, patient presented with acute right iliac pain that had onset since 4 days. The pain was dull, intermittent, and became increasingly severe. The patient did mention episodes of paroxysmal abdominal pain months earlier which were disregarded. She reported also fever, nausea, and vomiting. She didn't had diarrhea or blood in her stool. Furthermore, there was no history of recent travel to tropical countries.\nThe physical examination showed a high temperature at 38.9 °C and tenderness in the right hemiabdomen. No palpable abdominal mass was detected. Laboratory findings found Hemoglobin level at 12 g/dL, leukocytosis (14,650/mm3) and an elevated C-reactive protein (CRP) level of 176 mg/L. The abdominal CT scan revealed irregular, non-stenosing caecal thickening measuring 7 cm, with surrounding fat stranding and hypodense components suggestive of a perilesional abscess. An infected caecal tumor was suspected.\n\nAn exploratory laparotomy was performed. Intraoperatively, a 7 cm caecal mass with adjacent necrotic tissue infiltrating the retroperitoneal region was identified. A right hemicolectomy was performed, followed by a terminalized mechanical side-to-side ileocolic anastomosis. The patient was maintened on antibiotics with association of C3G and metronidazole for 07 days totally. The postoperative course was uneventful and the patient was discharged on the 5th postoperative day.\nHistopathological examination of the specimen showed multiple colonic ulcerations with perforation of the serosal layers. There were abundant acute and chronic inflammatory cells and areas of necrosis. Amoebic trophozoites were readily identified within the necrotic areas in the colonic wall. The resection margins of the ileum were clear. A colonoscopy was scheduled two months after the surgery; however, she did not attend.",
+        "summary": "We report a case of a 60-year-old female presenting with acute right iliac pain, fever, and nausea, but no diarrhea or recent travel history. Imaging revealed irregular cecal thickening with features suggestive of a perilesional abscess. Exploratory laparotomy identified a 7 cm cecal mass with necrotic tissue, leading to a right hemicolectomy. Histopathology confirmed amoebic colitis with trophozoites in necrotic areas. Postoperative recovery was uneventful with antibiotic therapy.",
+        "translated_fulltext": "একজন ৬০ বছর বয়সী মহিলা, যিনি গ্রামীণ পরিবেশে বেড়ে উঠেছেন, তিনি তীব্র ডান দিকের পেটের ব্যথার কথা জানান, যা ৪ দিন আগে শুরু হয়েছিল। ব্যথাটি ছিল মৃদু, মাঝে মাঝে হতো এবং ক্রমশ বাড়তে থাকে। রোগী পূর্বে কয়েক মাস আগে পেটে তীব্র ব্যথার কথা উল্লেখ করেছিলেন, কিন্তু সেটিকে গুরুত্ব দেওয়া হয়নি। তিনি জ্বর, বমি বমি ভাব এবং বমির কথাও জানান। তার ডায়রিয়া বা মলের সাথে রক্ত যাওয়ার কোনো ঘটনা ছিল না। এছাড়াও, সম্প্রতি গ্রীষ্মমণ্ডলীয় কোনো দেশে ভ্রমণের কোনো ইতিহাস ছিল না।\n\nশারীরিক পরীক্ষায় দেখা যায় তার শরীরের তাপমাত্রা ৩৮.৯ ডিগ্রি সেলসিয়াস এবং ডান দিকের পেটে স্পর্শ করলে ব্যথা লাগে। পেটে কোনো ফোলা বা পিণ্ড অনুভব করা যায়নি। ল্যাবরেটরি পরীক্ষায় হিমোগ্লোবিনের মাত্রা ১২ গ্রাম/ডিসিএল, লিউকোসাইটোসিস (১৪,৬৫০/মিমি³) এবং সি-রিঅ্যাক্টিভ প্রোটিনের (সিআরপি) মাত্রা ১৭৬ মিলিগ্রাম/লিটার পাওয়া যায়। পেটের সিটি স্ক্যানে দেখা যায়, ৭ সেন্টিমিটার আকারের একটি অনিয়মিত, অ-সংকুচিত সিকাল থিকেনিং রয়েছে, যার চারপাশে ফ্যাট স্ট্র্যান্ডিং এবং হাইপোডেনস উপাদান দেখা যায়, যা একটি পেরিলেশনাল অ্যাবসেসের ইঙ্গিত দেয়। একটি সংক্রমিত সিকাল টিউমারের সন্দেহ করা হয়।\n\nএকটি অনুসন্ধানী ল্যাপারোটমি করা হয়। অস্ত্রোপচারের সময়, ৭ সেন্টিমিটার আকারের একটি সিকাল পিণ্ড পাওয়া যায়, যার সংলগ্ন নেক্রোটিক টিস্যু রেট্রোপেরিটোনিয়াল অঞ্চলে ছড়িয়ে পড়েছিল। এরপর রোগীর ডান দিকের হেমিকোলেক্টমি করা হয় এবং একটি টার্মিনাল মেকানিক্যাল সাইড-টু-সাইড আইলিওকোলিক অ্যানাস্টোমোসিস করা হয়। রোগীকে সি৩জি এবং মেট্রোনিডাজোলের সমন্বয়ে ৭ দিনের জন্য অ্যান্টিবায়োটিক দেওয়া হয়। অস্ত্রোপচারের পরবর্তী সময়কালে কোনো জটিলতা দেখা যায়নি এবং ৫ দিন পর রোগীকে হাসপাতাল থেকে ছেড়ে দেওয়া হয়।\n\nনমুনাটির হিস্টোপ্যাথলজিক্যাল পরীক্ষায় দেখা যায়, সেরোসাল স্তরের ছিদ্রসহ একাধিক কোলনিক আলসার রয়েছে। সেখানে প্রচুর পরিমাণে তীব্র এবং দীর্ঘস্থায়ী প্রদাহজনক কোষ এবং নেক্রোসিসের ক্ষেত্র দেখা যায়। কোলনিক প্রাচীরের নেক্রোটিক অংশে সহজেই অ্যামিবিক ট্রফোজোয়াইট সনাক্ত করা যায়। আইলিয়ামের রিসেকশন মার্জিনগুলো পরিষ্কার ছিল। অস্ত্রোপচারের দুই মাস পর একটি কোলনোস্কোপির সময়সূচী করা হয়েছিল; তবে, তিনি উপস্থিত হননি।",
+        "translated_summary": "আমরা একজন ৬০ বছর বয়সী মহিলার একটি ঘটনা বর্ণনা করছি, যিনি তীব্র ডান দিকের পেটে ব্যথা, জ্বর এবং বমি বমি ভাব নিয়ে এসেছিলেন, তবে তার ডায়রিয়া বা সম্প্রতি ভ্রমণের কোনো ইতিহাস ছিল না। ইমেজিং-এ দেখা যায়, সেকাল অঞ্চলে অনিয়মিতভাবে ফোলাভাব রয়েছে এবং এর বৈশিষ্ট্যগুলো একটি পেরিলেশনাল অ্যাবসেসের ইঙ্গিত দেয়। অনুসন্ধানী ল্যাপারোটমির মাধ্যমে ৭ সেন্টিমিটারের একটি সেকাল টিউমার শনাক্ত করা হয়, যেখানে নেক্রোটিক টিস্যু ছিল। এর ফলে ডান দিকের হেমিকোলেক্টমি করা হয়। হিস্টোপ্যাথলজি পরীক্ষায় নেক্রোটিক অংশে ট্রফোজোয়েটসহ অ্যামিবিক কোলাইটিস নিশ্চিত করা হয়। অস্ত্রোপচারের পরে অ্যান্টিবায়োটিক থেরাপির মাধ্যমে তিনি দ্রুত সুস্থ হয়ে ওঠেন।",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_501.txt",
+        "fulltext": "He is a 16-year-old boy who in the months prior to consultation suffers occasional sleep paralysis, after a few minutes of the postprandial nap, which causes him a lot of anxiety, the main reason why he comes to the consultation. Occasionally, these sleep paralyses were accompanied by hypnopompic hallucinations (which he associated with dreams or not being fully awake). He has a nightly sleep schedule of about seven hours plus two hours of nap that are very refreshing. He has good academic performance. When we asked him a directed history, he said that after months of suffering these sleep paralyses, episodes of shaking of arms and legs appeared, especially when he laughed, which almost made him fall (he thought it happened to everyone). Afterwards, these symptoms were added to three short nightly awakenings, with immediate subsequent reconciliation and occasional attacks of sleep in the morning, which he associated with mathematics classes (the teacher is very boring). After clinical suspicion, we requested a multiple sleep latency test and a nightly polysomnographic study, which are conclusive with the diagnosis of narcolepsy (very short sleep latency, REM sleep latency, somewhat fragmented sleep, average in the multiple sleep latency test of 2.1 minutes and the presence of four sleep onset REM). Since the episodes of drowsiness occur every day at the same time, we prescribed a short morning nap that refreshed him a lot and he reported being able to continue with his school activities. Afterwards, we had to add modafinil at the same time (200 mg). We recommended venlafaxine for cataplexy or even initiate treatment with sodium oxybate (the latter he does not want to take because of the discomfort of the second dose, and he also rejects venlafaxine because of fear of the side effects). We agreed that he would comply with good sleep hygiene, take modafinil and continue with the scheduled naps (the afternoon one he already took and the morning one) and, if it got worse, we would add other treatments. He is doing well with this schedule, he does not perceive much fragmentation of nightly sleep (one or two very brief awakenings after which he falls asleep again without problems); in fact, he wakes up rested, the cataplexy is occasional and does not interfere with his daily life, and the sleep attacks are very controlled. He reports feeling better and without major limitations in his daily life (good academic performance, he does not drink alcohol, but he does not care because he has never drunk, he keeps regular sleep hours and he exercises regularly).\n",
+        "summary": "16-year-old male presenting after seeing several specialists with sleep paralysis during naps, which causes fear and occasional dropping of objects from hands (diagnosed as possible myoclonus). In the history, we were surprised by the presence of sleep paralysis immediately after the onset of naps and, in the directed history, these sudden movements caused by emotions were consistent with cataplexy, so we performed a nocturnal polysomnographic study and a multiple sleep latency test. With the evolution, hypnopompic hallucinations and fragmented night sleep appeared, as well as occasional daytime somnolence (the typical symptomatological tetrad of narcolepsy with cataplexy of type 1 was completed).\n",
+        "translated_fulltext": "সে একজন ১৬ বছর বয়সী ছেলে, যে পরামর্শের আগে কয়েক মাস ধরে মাঝে মাঝে ঘুমের মধ্যে অসাড় হয়ে যাওয়ার (স্লিপ প্যারালাইসিস) সমস্যায় ভুগছিল। খাবারের পরে অল্প সময়ের জন্য ঘুমিয়ে যাওয়ার পর এই সমস্যা দেখা দিত, যা তাকে অনেক উদ্বেগের কারণ হত এবং এই কারণেই সে পরামর্শের জন্য আসে। মাঝে মাঝে, এই ঘুমের মধ্যে অসাড় হয়ে যাওয়ার ঘটনার সাথে সম্মোহন-পরবর্তী বিভ্রম (হিপনোপম্পিক হ্যালুসিনেশন) দেখা দিত, যা সে স্বপ্ন অথবা সম্পূর্ণরূপে জেগে না থাকার সাথে যুক্ত করত। তার প্রতিদিন প্রায় সাত ঘণ্টা ঘুমের প্রয়োজন হয়, এছাড়াও সে দুই ঘণ্টা করে দিনের বেলা ঘুমায়, যা তাকে সতেজ করে তোলে। তার পড়াশোনায় ভালো ফল করে। যখন আমরা তার বিস্তারিত ইতিহাস জানতে চাই, তখন সে জানায় যে কয়েক মাস ধরে ঘুমের মধ্যে অসাড় হয়ে যাওয়ার সমস্যা হওয়ার পর, তার হাত ও পায়ে কাঁপুনি শুরু হয়, বিশেষ করে যখন সে হাসে, তখন প্রায় পড়ে যাচ্ছিল (সে মনে করত, এটা সবার সাথেই হয়)। এরপর, এই উপসর্গের সাথে রাতে অল্প সময়ের জন্য কয়েকবার ঘুম ভেঙে যাওয়া, এবং সকালে ঘুমের মধ্যে হঠাৎ করে তন্দ্রাচ্ছন্ন হয়ে যাওয়ার মতো ঘটনা যুক্ত হয়, যা সে গণিতের ক্লাসের সাথে যুক্ত করত (শিক্ষক খুব একঘেয়েভাবে পড়ান)। ক্লিনিক্যাল সন্দেহের পরে, আমরা একটি মাল্টিপল স্লিপ ল্যাটেন্সি পরীক্ষা এবং একটি রাতের পলিসমনোগ্রাফিক স্টাডি করার জন্য বলি, যা নারকোলেপসির রোগ নির্ণয় নিশ্চিত করে (খুব কম সময়ের মধ্যে ঘুম আসা, দ্রুত আরইএম (REM) ঘুমের আগমন, কিছুটা বিক্ষিপ্ত ঘুম, মাল্টিপল স্লিপ ল্যাটেন্সি পরীক্ষায় গড়ে ২.১ মিনিট এবং চারটি ঘুমের শুরুতে আরইএম পর্যায়)। যেহেতু তন্দ্রাচ্ছন্ন হওয়ার ঘটনা প্রতিদিন একই সময়ে ঘটে, তাই আমরা তাকে সকালে অল্প সময়ের জন্য ঘুমিয়ে থাকার পরামর্শ দিই, যা তাকে অনেক সতেজ করে তোলে এবং সে জানায় যে এর ফলে সে তার স্কুলের কাজকর্ম চালিয়ে যেতে পারছে। এরপর, আমরা একই সময়ে মোডাফিনিল (২০০ মিগ্রা) যুক্ত করি। আমরা ভেনলাফ্যাক্সিনের মাধ্যমে ক্যাটাপ্লেক্সির (cataplexy) চিকিৎসা করার অথবা সোডিয়াম অক্সিবেট (sodium oxybate) দিয়ে চিকিৎসা শুরু করার পরামর্শ দিই (তবে সে দ্বিতীয় ডোজের কারণে অস্বস্তি বোধ করার জন্য এবং পার্শ্বপ্রতিক্রিয়া হওয়ার ভয়ে ভেনলাফ্যাক্সিন নিতে রাজি হয় না)। আমরা একমত হই যে সে ভালো ঘুমের অভ্যাস বজায় রাখবে, মোডাফিনিল গ্রহণ করবে এবং দিনের বেলা ঘুমের সময়সূচী মেনে চলবে (বিকেলে সে ইতিমধ্যেই ঘুমিয়ে নেয় এবং সকালে ঘুমাবে)। যদি অবস্থার অবনতি হয়, তবে আমরা অন্যান্য চিকিৎসার ব্যবস্থা করব। এই সময়সূচী অনুযায়ী সে ভালো আছে, রাতে তার ঘুমের ব্যাঘাত খুব কম হয় (এক বা দুটি খুব অল্প সময়ের জন্য ঘুম ভেঙে যায়, যার পরে সে আবার কোনো সমস্যা ছাড়াই ঘুমিয়ে পড়ে)। আসলে, সে সতেজ হয়ে ঘুম থেকে ওঠে, ক্যাটাপ্লেক্সির সমস্যা মাঝে মাঝে দেখা যায় এবং এটি তার দৈনন্দিন জীবনে তেমন প্রভাব ফেলে না, এবং ঘুমের আক্রমণগুলোও ভালোভাবে নিয়ন্ত্রণে থাকে। সে জানায় যে সে এখন ভালো বোধ করছে এবং তার দৈনন্দিন জীবনে কোনো বড় সীমাবদ্ধতা নেই (পড়াশোনায় ভালো ফল করছে, সে অ্যালকোহল পান করে না, তবে সে এ বিষয়ে উদাসীন, কারণ সে আগে কখনো পান করেনি, সে নিয়মিত ঘুমের সময়সূচী মেনে চলে এবং নিয়মিত ব্যায়াম করে)।",
+        "translated_summary": "১৬ বছর বয়সী একজন পুরুষ, দিনের বেলায় অল্প সময়ের জন্য ঘুমিয়ে থাকার সময় ঘুমের প্যারালাইসিস অনুভব করার পরে একাধিক বিশেষজ্ঞের কাছে যাওয়ার পর এসেছেন। এর ফলে তিনি ভয় পান এবং মাঝে মাঝে হাত থেকে জিনিসপত্র পড়ে যায় (সম্ভাব্য মায়োক্লোনাস হিসেবে নির্ণয় করা হয়েছে)। অনুসন্ধানে দেখা যায়, দিনের বেলায় অল্প সময়ের জন্য ঘুমিয়ে পড়ার পরপরই ঘুমের প্যারালাইসিস শুরু হয় এবং বিস্তারিত অনুসন্ধানে জানা যায়, আবেগপ্রবণতার কারণে হঠাৎ করে যে নড়াচড়াগুলো হয়, তা ক্যাটাপ্লেক্সির সঙ্গে সঙ্গতিপূর্ণ। তাই, আমরা রাতের বেলা পলিসমনোগ্রাফিক পরীক্ষা এবং একাধিক ঘুম-বিলম্ব পরীক্ষা করি। সময়ের সাথে সাথে, হাইপনোপম্পিক হ্যালুসিনেশন এবং রাতের ঘুমের ব্যাঘাত দেখা যায়, সেইসাথে দিনের বেলায় মাঝে মাঝে তন্দ্রাচ্ছন্ন ভাব (ক্যাটাপ্লেক্সিসহ নারকোলেপসির প্রথম ধরনের সাধারণ লক্ষণগুলো সম্পূর্ণভাবে দেখা যায়)।",
+        "judge_pass": true
+    }
+]
\ No newline at end of file
diff --git a/data/translated_data/translation_version_v2/multiclinsum_gs_train_en2hi_gemma(0_200).json b/data/translated_data/translation_version_v2/multiclinsum_gs_train_en2hi_gemma(0_200).json
new file mode 100644
index 0000000000000000000000000000000000000000..82de07a76e8cf29505cc986ad90f2686eb978aa2
--- /dev/null
+++ b/data/translated_data/translation_version_v2/multiclinsum_gs_train_en2hi_gemma(0_200).json
@@ -0,0 +1,10 @@
+[
+    {
+        "id": "multiclinsum_gs_en_100.txt",
+        "fulltext": "A six-month-old male infant was observed in the emergency department for fever (maximum temperature 40ºC every 6 hours), rhinorrhea, cough and refusal of food with three days of evolution. The pregnancy was full term, monitored and without complications. In the neonatal period he was admitted for congenital pneumonia complicated with pneumothorax and recovered with drainage, antibiotic therapy and invasive mechanical ventilation. He had vaccinations up to date according to the National Vaccination Calendar and including three doses of the Hib vaccine, two doses of the MenB vaccine, two doses of the MenACWY vaccine and two doses of the rotavirus vaccine. He attended a day care center and his family history was not relevant.\n",
+        "summary": "A six-month old infant presented to the emergency department with a fever, cough and runny nose. He was alert and hemodynamically stable at admission, but became progressively lethargic and had a bulging fontanelle. Blood tests showed a normal white blood cell count and elevated C-reactive protein. A cerebrospinal fluid cytology and biochemistry were consistent with bacterial meningitis, and ceftriaxone was initiated. A blood culture and a cerebrospinal fluid culture were positive for Haemophilus influenzae. Serotyping of the strain identified a Haemophilus influenzae serotype A. Viral testing of the cerebrospinal fluid and nasopharyngeal aspirate was positive for adenovirus. He was discharged after 10 days of antibiotics and full clinical recovery.\n",
+        "translated_fulltext": "एक छह महीने के शिशु को आपातकालीन विभाग में बुखार (हर 6 घंटे में अधिकतम तापमान 40ºC), नाक बहना, खांसी और तीन दिनों से भोजन करने से इनकार करने के लक्षणों के साथ लाया गया। गर्भावस्था पूर्ण अवधि की थी, जिसकी निगरानी की गई और इसमें कोई जटिलता नहीं थी। नवजात अवस्था में, उसे जन्मजात निमोनिया के कारण अस्पताल में भर्ती कराया गया था, जिसमें न्यूमोथोरैक्स भी था, और उसे ड्रेनेज, एंटीबायोटिक थेरेपी और इनवेसिव मैकेनिकल वेंटिलेशन के माध्यम से ठीक किया गया। उसे राष्ट्रीय टीकाकरण कैलेंडर के अनुसार सभी आवश्यक टीके लगाए गए थे, जिसमें तीन खुराक हिब वैक्सीन, दो खुराक मेनबी वैक्सीन, दो खुराक मेनएसीडब्ल्यूवाई वैक्सीन और दो खुराक रोटावायरस वैक्सीन शामिल थीं। वह एक डे केयर सेंटर में जाता था और उसके परिवार का कोई प्रासंगिक चिकित्सा इतिहास नहीं था।",
+        "translated_summary": "छह महीने का एक शिशु बुखार, खांसी और नाक बहने की शिकायत के साथ आपातकालीन विभाग में लाया गया। भर्ती के समय वह सचेत था और उसका रक्तचाप सामान्य था, लेकिन धीरे-धीरे वह सुस्त होने लगा और उसके सिर पर मौजूद नरम भाग (फॉन्टनेल) फूल गया। रक्त परीक्षण में श्वेत रक्त कोशिकाओं की सामान्य संख्या और सी-रिएक्टिव प्रोटीन का स्तर बढ़ा हुआ पाया गया। रीढ़ की हड्डी के तरल पदार्थ (सेरेब्रोस्पाइनल फ्लूइड) की साइटोलॉजी और जैव रसायन परीक्षण में जीवाणु मेनिनजाइटिस के लक्षण पाए गए, और सेफ्ट्रियाक्सोन दवा शुरू की गई। रक्त कल्चर और रीढ़ की हड्डी के तरल पदार्थ के कल्चर में हीमोफिलस इन्फ्लुएंजा की उपस्थिति पाई गई। इस स्ट्रेन का सेरोटाइपिंग करने पर हीमोफिलस इन्फ्लुएंजा सेरोटाइप ए की पहचान हुई। रीढ़ की हड्डी के तरल पदार्थ और नाक-ग्रसनी के नमूने में किए गए वायरल परीक्षण में एडेनोवायरस की उपस्थिति पाई गई। दस दिनों तक एंटीबायोटिक दवा देने और पूरी तरह से ठीक होने के बाद उसे छुट्टी दे दी गई।",
+        "judge_pass": true
+    }
+]
\ No newline at end of file
diff --git a/data/translated_data/translation_version_v2/multiclinsum_gs_train_en2vi_gemma(0_200).json b/data/translated_data/translation_version_v2/multiclinsum_gs_train_en2vi_gemma(0_200).json
new file mode 100644
index 0000000000000000000000000000000000000000..f9da505871f04a13d767ca935e876a2e45d9e00b
--- /dev/null
+++ b/data/translated_data/translation_version_v2/multiclinsum_gs_train_en2vi_gemma(0_200).json
@@ -0,0 +1,130 @@
+[
+    {
+        "id": "multiclinsum_gs_en_222.txt",
+        "fulltext": "Female patient, 16 years old, presenting a depressed gray plaque of 10.5 × 8.0 cm interspersed with hypochromic areas in the lower lateral part of the left thigh. Telangiectatic vessels overlap the lesion peripherally, with visible veins close to it. The plaque was present from birth, but was initially violaceous. It evolved with the passing of the years, with lightening and depression. There is no discrepancy in the length of the lower limbs.\n\nAngioresonance showed vascular malformations in the skin and subcutaneous tissue supplied by intermuscular branches of the popliteal artery. Early venous filling was found in both the region and the malformations, suggesting early venous shunting. Dilated draining veins were not documented, except for a superficial draining vein running along the subcutaneous cellular tissue of the anterior thigh. In addition, thinning of the subcutaneous tissue was noted in the topography of the vascular alteration, but without intramuscular or bone extension.\n",
+        "summary": "16-year-old girl with a depressed gray plaque on the left thigh, with a vascular malformation affecting the skin and subcutaneous tissue evident by angioresonance.\n",
+        "translated_fulltext": null,
+        "translated_summary": "Một cô gái 16 tuổi có một vùng da màu xám, bị lõm ở đùi trái, kèm theo dấu hiệu của một dị dạng mạch máu ảnh hưởng đến da và mô dưới da, được phát hiện qua phương pháp chụp cộng hưởng mạch máu.",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_373.txt",
+        "fulltext": "A 91-year-old man presented to the emergency department with a high fever (maximum body temperature 39.0 °C).\n\nHe was elderly and in need of nursing care, almost bedridden.\n\nOver the last few years, he had long-term BIC due to urinary retention caused by BPH, which changed regularly at a community clinic every four weeks. The next exchange was scheduled for three days later. The patient had no relevant medical history.\n\nLaboratory findings showed renal dysfunction (serum creatinine was 1.18 mg/dL, and eGFR was 44.4 mL/min/1.73 m2) and inflammation (white blood cell count was 15120/μL). Blood culture yielded negative results. However, the urine culture indicated infections with Klebsiella oxytoca. The physical examination findings were unremarkable. Ultrasonography revealed a left-sided hydronephrosis. Computed tomography (CT) revealed extensive prostatic hypertrophy and urine retention in the bladder. The tip of the catheter was located in the left ureter. The bladder cuff was swollen in front of the ureteral orifice, causing obstruction and hydroureteronephrosis. CT showed no other cause of fever, and we diagnosed acute obstructive pyelonephritis; he was hospitalized. With little traction on the catheter, the pyuria drained.\n\nA new catheter was replaced, and CT showed improvement in the hydronephrosis on day 3. He was treated with antibiotic therapy with sulbactam/ampicillin. Consequently, his condition gradually improved, and he was discharged on day 10.\n\nSince discharged from the hospital, the BIC was changed regularly at the clinic, and there was no recurrence.",
+        "summary": "A 91-year-old man with a long-term bladder indwelling catheter (BIC) for benign prostatic hyperplasia (BPH) presented to our emergency department with fever. Computed tomography (CT) showed the tip of the BIC was located within the left ureterovesical junction, which caused left hydronephrosis and a hydroureter. The catheter was replaced, and the hydronephrosis improved quickly. The patient was treated with antibiotic therapy and discharged on day 10.",
+        "translated_fulltext": "Một người đàn ông 91 tuổi đến phòng cấp cứu với tình trạng sốt cao (nhiệt độ cơ thể cao nhất là 39,0°C).\n\nÔng là người lớn tuổi, cần được chăm sóc y tế và gần như phải nằm liệt giường.\n\nTrong vài năm qua, ông bị bí tiểu do phì đại tuyến tiền liệt (BPH), dẫn đến tình trạng bí tiểu kéo dài. Ông được thay ống thông tiểu định kỳ mỗi bốn tuần tại một phòng khám cộng đồng. Lần thay ống thông tiếp theo được lên lịch sau ba ngày. Bệnh nhân không có tiền sử bệnh lý đáng chú ý.\n\nKết quả xét nghiệm cho thấy chức năng thận suy giảm (creatinine huyết thanh là 1,18 mg/dL và eGFR là 44,4 mL/phút/1,73 m2) và có tình trạng viêm (số lượng bạch cầu là 15120/μL). Kết quả cấy máu cho thấy không có vi khuẩn. Tuy nhiên, kết quả cấy nước tiểu cho thấy có nhiễm trùng do vi khuẩn Klebsiella oxytoca. Kết quả khám lâm sàng không có gì đặc biệt. Siêu âm cho thấy có tình trạng giãn đường tiết niệu bên trái. Chụp cắt lớp vi tính (CT) cho thấy tuyến tiền liệt phì đại đáng kể và có tình trạng bí tiểu trong bàng quang. Đầu ống thông tiểu nằm trong niệu quản bên trái. Vùng bàng quang xung quanh lỗ niệu quản bị sưng lên, gây tắc nghẽn và giãn đường tiết niệu. Chụp CT không cho thấy nguyên nhân nào khác gây sốt, và chúng tôi chẩn đoán bệnh viêm bể thận cấp tính do tắc nghẽn; ông được nhập viện. Khi kéo nhẹ ống thông tiểu, nước tiểu có mủ được dẫn lưu.\n\nMột ống thông tiểu mới được đặt, và chụp CT cho thấy tình trạng giãn đường tiết niệu đã cải thiện vào ngày thứ 3. Ông được điều trị bằng liệu pháp kháng sinh sulbactam/ampicillin. Do đó, tình trạng của ông dần cải thiện và ông được xuất viện vào ngày thứ 10.\n\nKể từ khi xuất viện, ống thông tiểu được thay định kỳ tại phòng khám và không có dấu hiệu tái phát.",
+        "translated_summary": "Một bệnh nhân nam 91 tuổi, đã đặt ống thông tiểu lâu ngày để điều trị phì đại tuyến tiền liệt lành tính, nhập viện tại khoa cấp cứu của chúng tôi với triệu chứng sốt. Chụp cắt lớp vi tính (CT) cho thấy đầu ống thông tiểu nằm trong vị trí nối niệu quản trái và bàng quang, gây ra tình trạng giãn niệu quản và thận trái. Ống thông tiểu đã được thay thế, và tình trạng giãn niệu quản và thận trái cải thiện nhanh chóng. Bệnh nhân được điều trị bằng kháng sinh và xuất viện vào ngày thứ 10.",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_505.txt",
+        "fulltext": "Patient information\nA 24-year-old man residing in Yopougon, a popular commune in the city of Abidjan, single, having stopped his studies in the final year, unemployed, suffering from undocumented psychiatric disorders was accompanied by his parents to the emergency department of our hospital for epigastric pain and swelling that had been developing for 15 days following the voluntary ingestion of a knife. No other signs (dysphagia, vomiting, intestinal disorders, cough, gastrointestinal haemorrhage) were found during the examination. The parents informed us of the presence of a mental disorder in the patient that had been diagnosed and was not being treated by psychiatrists or traditional therapists.\n\nClinical results\nThe physical examination revealed an ulcerated inflammatory mass measuring 3 x 4 cm, with the emergent tip of a blade in its center. The rest of the abdomen was soft and undistended, with no umbilical cry, and the rectal examination was normal. The patient had a body temperature of 37.5 °C.\n\nDiagnostic evaluation\nAn unprepared abdominal X-ray shows a linear, sharp-edged, knife-blade-shaped, radiopaque image.\n\nLaboratory tests revealed a haemoglobin level of 10 g/dl, a hyperleucocytosis of 16 600/mm3.\n\nTreatment and follow-up\nSurgical intervention under general anaesthesia was performed.\n\nThe intraoperative findings showed a healthy abdominal cavity, an adhesion of the anterior face of the gastric body with the abdominal wall, the release of which showed a gastric perforation, with a blade inside it, the tip of which passed through the entire anterior abdominal wall, the handle remaining in the gastric lumen.\n\nIntragastric foreign body extraction was performed: it was a whole knife of local craftsmanship with a sharp blade at one end, 6 cm long, 1.5 cm wide at its base, and a round carved wooden handle 2 cm in diameter and 7 cm long. The knife measured 13 cm. For gastric perforation, a superior wedge resection was performed. This sample did not show any histological abnormality. A gastric suture was then performed. The hospital stay lasted eight days, the consequences were simple. The one-year follow-up is excellent, the patient has a psychiatric follow-up.\n",
+        "summary": "We report the successful management of the consequences of the voluntary ingestion of a knife in a 24-year-old man with undocumented psychiatric disorders. The patient was admitted to the emergency department for a fistulized epigastric cutaneous abscess with the tip of a knife emerging. This was the extraordinary migration of an ingested dagger that perforated the stomach and externalized itself as an epigastric abscess. Surgical extraction of the foreign body was performed.\n",
+        "translated_fulltext": null,
+        "translated_summary": "Chúng tôi báo cáo về việc điều trị thành công các biến chứng do một người đàn ông 24 tuổi, có tiền sử bệnh tâm thần chưa được ghi nhận, tự ý nuốt một con dao. Bệnh nhân được đưa vào khoa cấp cứu vì bị áp xe dưới da vùng thượng vị có lỗ rò, và đầu dao nhô ra ngoài. Đây là trường hợp di chuyển bất thường của con dao đã nuốt vào, xuyên thủng dạ dày và tạo thành một ổ áp xe vùng thượng vị. Phẫu thuật đã được thực hiện để lấy dị vật ra.",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_7.txt",
+        "fulltext": "27-year-old male with a history of HIV infection on antiretroviral therapy, recurrent genital herpes and late latent syphilis treated with benzatin penicillin 2.4 million weekly IM for three times 10 months ago, with good serological response during follow-up. In the last four months he started with a firm increase in volume in the right inguinal region of approximately 4 cm, sensitive to palpation, partially adhered to deep planes, associated with a herpetiform ulcerated lesion on the body of the penis of 1 cm size, on an erythematous, painful and scarcely indurated base, without superficial secretion. The patient did not refer to anorectal or systemic symptoms. The patient did not refer to other mucous involvement. He was evaluated in the emergency department, where he was prescribed acyclovir and amoxicillin for two weeks, with no clinical response. The right inguinal lesion evolved with two fistulous tracts on the skin surface, with abundant seropurulent secretion. He also received cefadroxil and amoxicillin-clavulanic acid for four weeks, with no improvement. Among the laboratory examinations, a normocytic, normochromic anaemia with a haemoglobin of 11.9 g/dl, a haematocrit of 35.1%, a leukocytes of 10810 cells/mm3 and a VHS of 83 mm/h stood out. The study of hepatitis B (HbsAg) and hepatitis C (Ac VHC) was negative. The VDRL was weakly reactive and MHA-TP reactive. The HIV viral load was undetectable, with CD4 lymphocytes of 911 cells/mm3. In the directed anamnesis he referred to three male sexual partners in the last year, of Chilean nationality, with insertive and receptive oral and anal sexual relations, with occasional use of condom. In addition, he consumed marijuana and cocaine occasionally.\n\nGiven the clinical suspicion of LGV and active genital herpes, PCR was requested for C. trachomatis (commercial kit, LightMix Kit Neisseria gonorrhoeae and Chlamydia trachomatis 3.0; TIB Molbiol, Roche) in the secretion of the inguinal fistulas in the reference center, which was positive. Treatment with doxycycline 100 mg every 12 h orally, for three weeks, and acyclovir 400 mg every 8 h orally for five days, with progressive decrease in the size of the inguinal lesions, and disappearance of both the fistulous tracts and the genital ulcerated lesion, was indicated. Treatment with doxycycline was maintained for three additional weeks given the persistence of the adenopathies, evolving without alterations or signs of local or systemic complications. The control examinations showed improvement of the anaemia, with haemoglobin of 12.3 g/dl, haematocrit 38.9%, without leukocytosis and decrease of the VHS (30 mm/h). A clinical evaluation and treatment of sexual contacts was performed, without presenting symptoms suggestive of genital or anorectal infection at the time of the evaluation.\n",
+        "summary": "We present the case of a MSM with HIV infection on antiretroviral therapy, recurrent genital herpes and treated latent syphilis, with no recent travel abroad, with fistulized inguinal adenopathies to skin, associated with a painful genital ulcer, without anorectal or systemic symptoms, refractory to multiple antibacterial and antiviral treatments. The PCR study of the secretion of the fistula was positive for C. trachomatis. He was treated with doxycycline for six weeks, with a good clinical response, without complications.\n",
+        "translated_fulltext": null,
+        "translated_summary": "Chúng tôi xin trình bày trường hợp một người đàn ông có quan hệ tình dục đồng giới (MSM) bị nhiễm HIV, đang điều trị bằng thuốc kháng virus, bị tái phát herpes sinh dục và đã được điều trị bệnh giang mai tiềm ẩn, không có tiền sử đi lại nước ngoài gần đây, có tình trạng hạch bẹn bị viêm và tạo thành lỗ rò ra da, kèm theo loét sinh dục gây đau, không có triệu chứng ở vùng hậu môn trực tràng hoặc các triệu chứng toàn thân, và không đáp ứng với nhiều đợt điều trị bằng thuốc kháng khuẩn và kháng virus. Kết quả xét nghiệm PCR mẫu dịch từ lỗ rò cho thấy dương tính với C. trachomatis. Bệnh nhân được điều trị bằng doxycycline trong sáu tuần, có đáp ứng lâm sàng tốt và không có biến chứng.",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_184.txt",
+        "fulltext": "10-year-old female patient with no family history of thyroid disease, who had a goiter diagnosed at the age of 9 years (thyroid ultrasound with compatible signs of chronic thyroiditis) and had positive antithyroid antibodies. She was not being treated at the time of admission. She presented with 5 days of foamy urine associated with abdominal pain, profuse vomiting and diarrhea. She had developed eyelid and limb edema, decreased diuresis, weakness and a fever of 38° C the day before admission. She presented with bilateral and pretibial eyelid edema, an obvious goiter (painless and without palpable nodules) and a systolic ejection murmur in the IV/VI pulmonary focus without irradiation. The rest of the examination was normal. Blood pressure 120/78 mmHg (95th percentile), temperature 38.1° C, weight: 33.9 kg, height: 131.5 cm (p7), BMI 19.8 (p83).\n\nThe admission tests included a complete urine test with proteinuria +++, no bacteria, no nitrites, 7 leukocytes/uL (VN: 0-10 leukocytes/uL), 4 leukocytes/uL (VN: 0-15 leukocytes/uL), protein/creatinine ratio (IPC) 2 mg/mg, total protein of 3.8 g/dL, hypoalbuminemia of 2.1 g/dL, hypercholesterolemia of 416 mg/dL, hypertriglyceridemia of 127 mg/dL and plasma creatinine of 0.46 mg/dL (creatinine clearance calculated by Schwartz formula: 125 ml/min/1.73 m2). Venous gases, plasma electrolytes and blood counts were within normal ranges. The immunological study included: immunoglobulin A 181 mg/dL (VN 45-236), immunoglobulin M 131 mg/dL (VN 52-242), immunoglobulin G 208 (VN 608-1572) mg/dL, C3 125 mg/dL (VN 80-150), C4 37.3 mg/dL (VN 12-36). Normal renal ultrasound. The patient was admitted with a diagnosis of SN and autoimmune thyroiditis.\n\nIn the context of NS, treatment with prednisone (60 mg/m2/day) was initiated with a good response, achieving melting of edema and a progressive decrease in proteinuria until normal ranges were reached prior to discharge (IPC of discharge: 0.09, after 6 days).\n\nFrom the thyroid function point of view, his study showed thyroid stimulating hormone (TSH) 4.4 IU/ml (VN: 0.67-4.16 IU/ml), free thyroxine (T4) 0.80 ng/dL (VN: 0.86-1.4 ng/dL), antiperoxidase antibodies (Anti Tpo) 120 U/ml (VN: 0-60 U/ml), antithyroglobulin antibodies (Anti-Tg) 82 U/ml (VN: 0-60 U/ ml), so replacement therapy with levothyroxine (25 mcg/day) was initiated. Thyroid ultrasound described normal size thyroid with mild increase of diffuse vascularisation to Doppler, without solid or cystic focal lesions, these findings suggestive of thyroiditis. Rest of the study (PCR for SARS CoV-2, anti neutrophil cytoplasmic antibodies, anti nuclear antibodies, anti DNA antibodies, anti streptolysin O antibodies, anti cardiolipin antibodies, anti myeloperoxidase antibodies and anti proteinase 3 antibodies) was negative.\n\nThe patient was in good condition 6 days after admission and was discharged with prednisone (60 mg daily) and levothyroxine (25 mcg daily). At the 12-month follow-up, the patient was asymptomatic, with her thyroid disease under control (TSH 1.11 IU/ml) with replacement treatment. She has not had a relapse of the NS (urine examination without proteinuria and creatinine 0.44 mg/dL).\n",
+        "summary": "10-year-old patient presenting with nephrotic syndrome and goiter. There was a history of autoimmune thyroiditis and untreated hypothyroidism. Corticosteroid and thyroid replacement therapy (levothyroxine) was initiated, with a good clinical and laboratory response.\n",
+        "translated_fulltext": null,
+        "translated_summary": "Bệnh nhân 10 tuổi nhập viện với các triệu chứng của hội chứng thận hư và bướu cổ. Bệnh nhân có tiền sử viêm tuyến giáp tự miễn và suy giáp không được điều trị. Bệnh nhân được bắt đầu điều trị bằng corticosteroid và liệu pháp thay thế hormone tuyến giáp (levothyroxine), và có đáp ứng tốt về mặt lâm sàng cũng như xét nghiệm.",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_170.txt",
+        "fulltext": "32-year-old female patient, farmer, admitted on 8 June 2022 for fever and altered consciousness. Her symptomatology was of progressive onset for about ten days, preceded by a permanent fever, headaches and vomiting. She appeared after a uterine revision in a Guinean health facility on 25 May 2022 for spontaneous abortion of a pregnancy of 18 weeks of amenorrhea. She was treated before admission for bacterial meningitis and suspected genital infection with ceftriaxone and metronidazole injections. She had no known medical-surgical history or notion of use of immunosuppressors. The physical examination of the patient objectified a body mass index (BMI) of 20.9 kg/m2 for a weight of 61 kg, a fever of 39.2°C, a SOFA (Sequential Organ Failure Assessment) score of 3 (1 for mean arterial pressure at 65 mmHg and 2 for the Glasgow score at 11/15), generalised tonic-clonic convulsions, meningal stiffness, right hemiplegia. There was a genital infection: purulent lochia, non-retracted pelvic uterus.\n\nA craniocerebral CT scan revealed a large range of hypodensity in the left hemisphere, enhanced by the contrast agent with a significant mass effect. The biochemical profile showed a capillary hypoglycaemia of 3.2 mmol/l, a creatinine clearance (CKDEPI formula) of 155.32 ml/min for a creatinine of 38.5 µmol/l, ALT transaminases of 58 Ul/l, and a blood group of O positive. The cerebrospinal fluid (CSF) examination showed a purulent fluid, a hyperleucocytopenia of 1,100/mm3 with a neutrophil predominance, a hypoglycorachia of 1.2 mmol/l, a hyperproteinaemia of 1.8 g/l, gram negative E. coli bacilli resistant to penicillin (amoxicillin, ampicillin, amoxicillin clavulanate), to carboxypenicillin (ticarcillin), to cephalosporins (ceftriaxone, cefixime, cephalotine, cefepime), to quinolones (ciprofloxacin, norfloxacin), to cyclic (tetracycline) and to cotrimoxazole.\n\nThe blood culture on aerobic medium and the examination of the vaginal sample isolated the same strain. The blood count showed severe anaemia (4.2 g/dl of haemoglobin), normocytic (VGM at 85.2 fl), normochromic (CCMH at 32.7 g/dl), regenerative (reticulocytes at 160 g/l), leukocytes at 8000/mm3 (neutrophils at 6200/mm3, lymphocytes at 1000/mm3) and platelets at 14000/µl. Two HIV serologies were negative, and the CD4 level was at 850 cells/mm3 of blood. The diagnosis of sepsis post abortum, complicated by meningococcal encephalitis and severe anaemia was then retained.\n\nShe was admitted on admission and was given amoxicillin-clavulanic acid 2 g every 8 hours and amikacin 1 g/day intravenous. On day 4, following the results of the antibiogram, treatment with meropenem was initiated at 2 g every 8 hours intravenous for 21 days. Severe anaemia was corrected by daily transfusion of 450 ml of isogroup-isoresus erythrocyte concentrate for 6 days. Hypoglycaemia was corrected by infusion of 500 ml of 10% glucose serum, convulsions by administration of diazepam. In addition, daily genital hygiene with chlorhexidine was performed for 5 days and physiotherapy on day 8 of meropenem treatment. The evolution was favourable, marked by apyrexia on day 4 of bi-antibiotic therapy, the amendment of convulsions, and the recovery of consciousness respectively on day 2 and 7 of meropenem treatment. The control haemoglobin returned to 11.9 g/ dl on day 7 of blood transfusion. The motor strength of the right limbs with deficits was measured at 1/5 and 3/5 respectively on day 7 and 4 of physiotherapy. Exeat was authorised on 5 July 2022, with physiotherapy in outpatient and an appointment fourteen days later. At this appointment, the evolution was globally favourable with a motor strength of the initially deficits limbs at 5/5.\n",
+        "summary": "The first, who had recently miscarried, was on ceftriaxone when she was admitted for meningitic syndrome and pyramidal syndrome related to a brain injury. Cephalorachidian fluid (CSF), blood and a swab of purulent genital secretions were isolated E. coli resistant to penicillin and cephalosporins. She recovered on treatment with meropenem for 21 days, with few sequelae.\n",
+        "translated_fulltext": null,
+        "translated_summary": "Bệnh nhân đầu tiên, người vừa sảy thai, đang được điều trị bằng ceftriaxone khi nhập viện vì hội chứng viêm màng não và hội chứng tháp liên quan đến chấn thương não. Dịch não tủy, máu và mẫu dịch tiết âm đạo có mủ được phân lập, cho thấy sự hiện diện của vi khuẩn E. coli kháng penicillin và cephalosporin. Bệnh nhân đã hồi phục sau khi điều trị bằng meropenem trong 21 ngày, với ít di chứng.",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_480.txt",
+        "fulltext": "A 36-year-old woman, gravida 2 para 1, with no significant medical history except for one prior low-transverse cesarean delivery at term for arrest of dilatation, presented at a gestational age of 24 weeks 5 days for preterm premature rupture of membranes (PPROM) and chorioamnionitis. She underwent an emergent classical cesarean delivery due to non-reassuring fetal heart tones within 1 h of admission. Placental abruption and Couvelaire uterus were diagnosed intraoperatively, with the fetus and anterior placenta delivered en caul. Pathologic examination of the placenta indicated “abnormal placental separation” and ascending infection. She completed standard antibiotic therapy with ampicillin 2 g every 6 h and gentamicin 5 mg/kg every 24 h for her intrauterine infection until she was afebrile for 24 h, and had an otherwise uncomplicated postpartum course with discharge home in good condition on postoperative day 3.\n\nShe presented again on postoperative day 16 complaining of severe lower abdominal pain and foul-smelling vaginal discharge and was evaluated by a new team of physicians. Upon presentation, her physical examination revealed a well-healed skin incision, no abdominal distention, and marked fundal tenderness. She was afebrile and normotensive and had a high-normal white blood cell count at 9.85 × 109/L (normal: 4.5–11.0 × 109). Her urinalysis and urine cultures were negative, and there was no other obvious source of abdominal pain. She was diagnosed with postpartum endometritis, admitted, and started on intravenous gentamycin and clindamycin. After 36 h of antibiotic therapy, her lower abdominal pain persisted and she continued to have abnormal dark vaginal discharge, so transvaginal and transabdominal ultrasound were performed to investigate for retained products of conception as a potential cause. The ultrasound demonstrated an ill-defined, infiltrating echogenicity extending from the anterior junctional zone into the subserosal myometrium that protruded into the endometrial canal proximally. The endometrial canal otherwise appeared unremarkable, without evidence of abnormal fluid or air. These findings were not felt to be consistent with endometrial infection, but rather with postsurgical changes. Because of the immediate clinical presentation, ultrasound findings, and the pathology report reading “abnormal placental separation”, initially there was concern for focal placenta accreta. However, the patient had not experienced significant vaginal bleeding and her placenta had delivered intact without difficulty – in fact, it had delivered en caul and the intrauterine cavity was cleared of clots and debris, and the mass seen on ultrasound was avascular, atypical for focally invasive placenta. Upon closer review of the complete pathology report, the “abnormal placental separation” appeared to describe premature placental separation rather than lack of separation, which was initially presumed. Serum quantitative beta-hCG was drawn and resulted at less than 1.5 milli-international units, below the limit of detection, and supportive of complete placental removal.\n\nBy hospital day four, pain and dark vaginal discharge persisted, despite normalization of the white blood cell count and continued absence of fever. Her prolonged clinical course with only subtle improvement with antibiotic therapy raised concern for myometrial necrosis, septic pelvic thrombophlebitis, or a non-gynecologic intraabdominal pathology such as appendicitis. Magnetic resonance imaging (MRI) with and without contrast was performed on post-operative day 20 to evaluate for these diagnoses. Therapeutic low-molecular weight heparin was initiated, and her antibiotic coverage was broadened with a plan to continue antibiotic therapy until 48 h without fever and with improvement in fundal tenderness. MRI revealed no evidence of septic pelvic thrombophlebitis but did show a large area of non-enhancement predominantly in the midline of the anterior myometrium, with a sharp posterior margin at the anterior junctional zone. This area revealed an infiltrating pattern of poorly defined T1 hyperintensity on the pre-contrast sequences that corresponded with the area of ill-defined avascular echogenicity seen on the prior ultrasound. Such an appearance is not typical for focal accreta which typically appears as an infiltrating mass-like process with areas of internal vascularity. Non-enhancing T1 hyperintensity involving the previously retroplacental myometrium indicates blood products in this clinical context, and imaging findings were hence considered consistent with a large, dissecting anterior intramural hematoma, likely related to Couvelaire uterus or postsurgical changes following classical cesarean delivery. Myometrial necrosis was considered due to the lack of enhancement in the affected anterior myometrium, which is an expected finding in a recent hematoma. There was no evidence of extra-serosal extension of the hematoma and no hemoperitoneum was identified. A contrast-enhanced computed tomography (CT) of the abdomen and pelvis was performed the same day because the MRI showed trace fluid around the cecum and appendix, which was concerning for an inflammatory process. On CT the appendix was unremarkable and these findings were ultimately thought to be consistent with a susceptibility artifact. The CT images also showed a large, relatively hypodense area in the anterior myometrium that corresponded with the same area of abnormality on ultrasound and MRI. On correlation with the intraoperative observations, the findings on multimodality imaging of a large dissecting anterior intramural hematoma were ruled most consistent with the diagnosis of Couvelaire uterus.\n\nBy hospital day six, the patient’s pain markedly improved, her vital signs and laboratory findings normalized, and she was discharged home with oral clindamycin to complete a ten-day course of antibiotics, in case of infection of the intramural hematoma. A follow-up MRI performed 2 weeks after the initial study showed interval evolution of the hematoma, without evidence of infection or abscess formation in the anterior myometrium.",
+        "summary": "In this report, we discuss the case of a multipara who presented with abdominal pain and vaginal discharge several days after a classical cesarean delivery. Her prolonged and complex clinical course led to evaluation via several radiologic modalities. At first, a focal placenta accreta or retained products of conception were suspected, however these diagnoses did not correlate with the patient’s reported intraoperative findings of a clean endometrial cavity or with histopathology that was consistent with massive abruption.",
+        "translated_fulltext": null,
+        "translated_summary": "Trong báo cáo này, chúng tôi trình bày về trường hợp một phụ nữ đã sinh nhiều lần, đến khám vì đau bụng và ra khí hư vài ngày sau khi sinh mổ theo phương pháp truyền thống. Tình trạng bệnh kéo dài và phức tạp của bệnh nhân đã dẫn đến việc đánh giá bằng nhiều phương pháp chẩn đoán hình ảnh khác nhau. Ban đầu, nghi ngờ có tình trạng rau bám bất thường hoặc sót các sản phẩm của thai kỳ, tuy nhiên, những chẩn đoán này không phù hợp với kết quả quan sát được trong quá trình phẫu thuật, cho thấy khoang tử cung sạch sẽ, cũng như không phù hợp với kết quả giải phẫu bệnh cho thấy có tình trạng bong non rau diện rộng.",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_514.txt",
+        "fulltext": "An 86-year-old male patient presented to the emergency room for a 3-week nonpainful priapism. Our patient, a former cleaner agent, is only known for a transient ischemic incident. He has no previous surgical history. Physical examination showed a semierect nontender penis with a mild lateral deviation and a smooth glans. No superficial penile lesion was observed. The patient reported that he had lost normal erections almost 20 years ago. All clinical signs were in favor of a nonischemic priapism. The patient was a former smoker and reported mild upper respiratory tract symptoms as well. Lab work-ups and urine analyses were unremarkable; hence, the decision was to pursue investigations in an ambulatory setting using a penile ultrasound and a thoracoabdominal computed tomography (CT) scan looking for a malignancy.\n\nDoppler ultrasonography (US) of the penis was performed, revealing circumscribed hypoechogenic nodules infiltrating the albuginea of the corpus cavernosum, with a base and right-side predominance. No abnormalities were detected in the corpus spongiosum. A normal resistive index with a normal penile artery velocity was measured, in favor of a nonischemic situation.\n\nThoracoabdominal CT revealed a mass at the lung's left hilum surrounding the bronchovascular structures. Several bilateral nodules and micronodules were observed. The largest ones were located at the right apex and right lung base. Mediastinal enlarged lymph nodes were also seen at the lower paratracheal station. The liver was also affected by several lesions; the largest was located at Segment 7, which measured 96 mm. The left adrenal gland and pancreatic lesions were noted. Finally, two osteolytic lesions were observed on the first left rib and on the transverse process of fifth lumbar vertebra (L5). The patient was referred to the lung cancer specialist for further investigations. A pulmonary biopsy was performed, confirming adenocarcinoma of the lung. Molecular analysis of the cells showed a pGly12Cys (G12C) variant of the KRAS gene. PDL-1 was also noted as positive.\n\nAfter a multidisciplinary discussion, the decision was for the patient to pursue four-cycle chemotherapy and immunotherapy by cisplatin, pemetrexed, and pembrolizumab. The patient poorly tolerated the first cycle of chemotherapy and developed febrile pancytopenia. The decision was to halt the chemotherapy and pursue the immunotherapy by pembrolizumab.\n\nAs for the penile lesions, since the patient did not have any pain, surveillance was adopted.",
+        "summary": "We hereby report the case of an 86-year-old male patient who presented with a 3-week-long nonpainful priapism. A penile Doppler ultrasound and a chest and abdominal CT scan were performed, showing a left hilar lung mass as well as lesions in the liver, the adrenal glands, the pancreas, bone structures, and the penis. Penile metastasis is associated with a poor prognosis because of the frequent disseminated malignant lesions in other sites.",
+        "translated_fulltext": null,
+        "translated_summary": "Chúng tôi xin báo cáo về trường hợp của một bệnh nhân nam 86 tuổi, đến khám với tình trạng cương dương kéo dài không đau trong 3 tuần. Bệnh nhân đã được thực hiện siêu âm Doppler dương vật và chụp CT ngực, bụng. Kết quả cho thấy có khối u ở vùng rốn phổi bên trái, cũng như các tổn thương ở gan, tuyến thượng thận, tuyến tụy, xương và dương vật. Di căn dương vật thường liên quan đến tiên lượng xấu do các tổn thương ác tính lan rộng ở các vị trí khác.",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_327.txt",
+        "fulltext": "A 4-month-old male infant, after an uncomplicated pregnancy and delivery, weighed 3000 g at birth; there were no complications during pregnancy and no family history. The infant had symptoms of mild respiratory distress for 2 months, without fever or cough. He was diagnosed with patent foramen ovale by echocardiography at the primary hospital and received no treatments. Later, the symptoms were aggravated, and his parents sought care, again at the primary hospital, 9 days later. Ultrasonography of the abdomen showed features suggestive of hemangioendothelioma of liver. The hospital suggested that to the infant should be transferred to our hospital for treatment.\n\nExamination revealed an irritable infant with cough, fever, breathlessness and cyanosis; the infant weighed 6.8 kg and was in respiratory distress with a relative ratio of approximately 130/min. The infant had multiple skin hemangiomas of varying sizes on the head, neck, right index finger, and right shank. His physical examination was remarkable for bilateral wheezy phlegm in both lung bases. The physical examination showed enlarged cardiac dullness, but there were no significant heart murmurs. Abdominal distention was noted. The liver was soft and located 8 cm below the costal margin at the right mid-clavicular line.\n\nEchocardiography showed right atrial and right ventricular dilatation with a thickened right ventricular anterior wall and interventricular septum. The normal structure of the cardiac chamber and continuous atrioventricular septum were observed. The infant was diagnosed as having severe pulmonary artery hypertension with mild tricuspid regurgitation and trivial mitral regurgitation. Ultrasonography of the abdomen showed densely hypodense lesions, increased volume of liver lobes, with a clear boundary and a maximum diameter of 4.1 cm. The liver lobes had a heterogeneous internal echo and enhanced peripheral echo. Visible blood vessels were observed in the hypodense lesions. There were only a few normal liver parenchymas.\n\nA computed tomography (CT) scan of the abdomen showed an enlarged, irregularly shaped liver with multiple low-density intrahepatic masses, and its CT value was approximately 43 HU. Contrast-enhanced abdomen CT showed significant enhancement in the periphery of tumor, uneven enhancement in the center part of tumor during the arterial phase, centripetal enhancement in portal vein phase and even enhancement in late phase of tumor, which was more enhanced than normal liver. The lesions were more uniformly strengthened, and their degree of strengthening was higher than that of normal liver tissue in the delayed period.\n\nThe laboratory examinations showed normal values for creatine kinase, creatine kinase-MB, alanine aminotransferase, aspartate aminotransferase, unconjugated bilirubin, serum total bilirubin, conjugated bilirubin, creatinine, serum urea, and coagulant activity. However, thyroid-stimulating hormone (TSH) was 19.5 uIU/mL (NL = 1.36–8.8 uIU/mL), free triiodothyronine (fT3) was 3.21 pmol/L (NL = 4.5–10.5 pmol/L), and free thyroxine was normal. Meanwhile, alpha-fetoprotein was 15434.76 Ug/L (NL = 0–25 Ug/L).\n\nAfter we discussed the patient's condition, the infant was diagnosed with hepatomegaly, pulmonary artery hypertension, cardiac insufficiency, pneumonia, hepatic hemangioendothelioma, hypothyroidism, and multiple hemangiomas. Then, PAH and cardiac insufficiency were managed with fluid restriction, oxygen, diuretics, and inotropic support. In addition, the pneumonia was managed with antibiotics. Because fT3 was mildly decreased, we suggested that the infant should be regularly seen for endocrinology consultation. Meanwhile, propranolol was given at a dosage of 1 mg/kg every 12 hours.\n\nEight days after admission, the patient underwent transcatheter arterial embolization under general anesthesia. Unfortunately, because the diagnosis was relatively clear and the condition of the infant was worsening, his parents agreed to allow the patient to undergo TAE and refused a digital subtraction angiography-guided percutaneous biopsy after we informed them of the clinical risk. In addition, the TAE was approved by the ethics committee of Ji’nan Children's Hospital. The perineum was disinfected and draped with the patient in the supine position. The femoral artery was punctured by the Seldinger technique, and 100 IU/kg of heparin was administered to avoid thrombosis. The celiac artery was catheterized with a 4-F PIG angiographic catheter (Cordis, MI) under X-ray guidance. We observed that the blood supply to the IHH was derived from the proper hepatic artery branches, including the left hepatic artery and right hepatic artery, by digital subtraction angiography. The celiac artery was catheterized again with a 4-F Cobra guide catheter (Terumo, Tokyo, Japan) under X-ray guidance. Then, the 2.6 F microcatheter (Asahi, Nagoya, Japan) was used for superselective catheterization of the feeding artery. During the procedure, a pingyangmycin-lipiodol emulsion was injected slowly through the catheter until the periphery of the hemangioma was completely surrounded. Gelatin sponge particle (350–560 μm) embolization of the feeding artery was performed if the blood supply artery was faster, as shown by angiography. Selective celiac arteriography was performed once again if necessary to judge the degree of embolism of the supplying arteries. The injection was stopped when a small branch of the portal vein around the tumor was developed or the total volume was administered. At the conclusion of the embolization, the microcatheter was withdrawn, and the sheath was removed. Hemostasis of the femoral artery was then achieved by manual compression for 10 to 15 minutes.\n\nPostoperatively, meticulous nursing care was given to the patient, and symptomatic relief and supportive treatment were continued. Thirty-five days after admission, the PAH decreased, the symptoms of cardiac insufficiency were alleviated, and the severe pneumonia was cured. On the third month after the TAE, the abdominal distention was alleviated. The liver was soft and located 2 cm below the costal margin at the right mid-clavicular line. A CT scan of the abdomen still showed an irregularly shaped liver with multiple significantly strengthened intrahepatic masses, and the size of the largest mass was 1.6 cm. Echocardiography showed normal pulmonary artery pressure and EF. The patient underwent a second TAE under general anesthesia. There were no serious complications after the operation. At the 1-year follow-up, the infant had steadily gained weight, the liver volume and size of the mass decreased considerably, and the hypothyroidism returned to normal.",
+        "summary": "Patient concerns:\nWe present a case with hepatomegaly, pulmonary artery hypertension, and cardiac insufficiency caused by infantile hepatic hemangioendothelioma.\n\nDiagnosis:\nInfantile hepatic hemangioendothelioma was diagnosed.\n\nInterventions:\nThe patient underwent transcatheter arterial embolization and was given propranolol.\n\nOutcomes:\nThe patient responded well to treatment with transcatheter arterial embolization and propranolol. The patient gained weight steadily, liver volume, and mass size have decreased considerably, echocardiography showed normal pulmonary artery pressure and ejection fraction, and we discovered no serious complications after 1 year of follow-up.",
+        "translated_fulltext": null,
+        "translated_summary": "Những vấn đề mà bệnh nhân gặp phải:\nChúng tôi trình bày một trường hợp bệnh nhân bị gan to, tăng huyết áp động mạch phổi và suy tim do khối u mạch máu gan lành tính ở trẻ sơ sinh.\n\nChẩn đoán:\nBệnh nhân được chẩn đoán mắc khối u mạch máu gan lành tính ở trẻ sơ sinh.\n\nĐiều trị:\nBệnh nhân được điều trị bằng phương pháp tắc mạch động mạch qua da và dùng thuốc propranolol.\n\nKết quả:\nBệnh nhân đáp ứng tốt với điều trị bằng phương pháp tắc mạch động mạch qua da và thuốc propranolol. Bệnh nhân tăng cân đều đặn, thể tích gan và kích thước khối u giảm đáng kể, siêu âm tim cho thấy áp lực động mạch phổi và phân suất tống máu trở lại bình thường, và chúng tôi không phát hiện bất kỳ biến chứng nghiêm trọng nào sau 1 năm theo dõi.",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_100.txt",
+        "fulltext": "A six-month-old male infant was observed in the emergency department for fever (maximum temperature 40ºC every 6 hours), rhinorrhea, cough and refusal of food with three days of evolution. The pregnancy was full term, monitored and without complications. In the neonatal period he was admitted for congenital pneumonia complicated with pneumothorax and recovered with drainage, antibiotic therapy and invasive mechanical ventilation. He had vaccinations up to date according to the National Vaccination Calendar and including three doses of the Hib vaccine, two doses of the MenB vaccine, two doses of the MenACWY vaccine and two doses of the rotavirus vaccine. He attended a day care center and his family history was not relevant.\n",
+        "summary": "A six-month old infant presented to the emergency department with a fever, cough and runny nose. He was alert and hemodynamically stable at admission, but became progressively lethargic and had a bulging fontanelle. Blood tests showed a normal white blood cell count and elevated C-reactive protein. A cerebrospinal fluid cytology and biochemistry were consistent with bacterial meningitis, and ceftriaxone was initiated. A blood culture and a cerebrospinal fluid culture were positive for Haemophilus influenzae. Serotyping of the strain identified a Haemophilus influenzae serotype A. Viral testing of the cerebrospinal fluid and nasopharyngeal aspirate was positive for adenovirus. He was discharged after 10 days of antibiotics and full clinical recovery.\n",
+        "translated_fulltext": "Một bé trai 6 tháng tuổi được đưa đến khoa cấp cứu vì sốt (nhiệt độ cao nhất là 40ºC, cứ 6 giờ một lần), chảy nước mũi, ho và bỏ bú trong vòng ba ngày. Thai kỳ đủ tháng, được theo dõi và không có biến chứng. Trong giai đoạn sơ sinh, bé nhập viện vì viêm phổi bẩm sinh, có biến chứng tràn khí màng phổi và đã hồi phục sau khi được dẫn lưu, điều trị bằng kháng sinh và thở máy xâm lấn. Bé đã được tiêm phòng đầy đủ theo Lịch tiêm chủng quốc gia, bao gồm ba liều vắc-xin Hib, hai liều vắc-xin MenB, hai liều vắc-xin MenACWY và hai liều vắc-xin rotavirus. Bé đi học tại một trung tâm trông trẻ và tiền sử gia đình không đáng lưu ý.",
+        "translated_summary": "Một trẻ sơ sinh 6 tháng tuổi được đưa đến khoa cấp cứu vì sốt, ho và chảy nước mũi. Khi nhập viện, trẻ tỉnh táo và tình trạng huyết động ổn định, nhưng sau đó trở nên ngày càng lờ đờ và có dấu hiệu phồng thóp. Xét nghiệm máu cho thấy số lượng bạch cầu bình thường và mức protein C phản ứng tăng cao. Kết quả phân tích tế bào và sinh hóa dịch não tủy phù hợp với viêm màng não do vi khuẩn, và trẻ được bắt đầu điều trị bằng ceftriaxone. Kết quả cấy máu và cấy dịch não tủy đều dương tính với Haemophilus influenzae. Phân loại huyết thanh của chủng vi khuẩn xác định được Haemophilus influenzae thuộc nhóm A. Xét nghiệm virus trên dịch não tủy và dịch hút từ mũi họng cho thấy dương tính với adenovirus. Sau 10 ngày điều trị bằng kháng sinh và khi tình trạng lâm sàng đã ổn định, trẻ được xuất viện.",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_178.txt",
+        "fulltext": "A 56-year-old male presented to the emergency department of our hospital due to sudden onset shortness of breath and an episode of syncope while walking around inside his house. He underwent robotic assisted laparoscopic prostatectomy for prostate carcinoma, 5 days prior to his presentation to the Emergency Department. His post-operative course in the hospital was uneventful. In the emergency department, his blood pressure was 94/54 mmHg, heart rate 121 beats per minute, respiratory rate 20 breathes per minute, he was afebrile, and his oxygen saturation was 92% on 6 L per minute of oxygen via nasal cannula. Cardiac examination revealed S1S2, regular, tachycardic, no murmur/gallops/rubs. Respiratory examination revealed normal vesicular breath sounds bilaterally. He was noted to have asymmetrical left lower extremity edema. Electrocardiogram (ECG) revealed sinus tachycardia, no ST-T wave changes. Troponin was mildly elevated at 0.120 ng/mL (reference range: 0 to 0.020). Computed tomography angiography (CTA) of chest showed extensive bilateral pulmonary emboli, with a large clot burden in both main pulmonary arteries, evidence of acute right ventricular failure. Duplex venous scan showed acute left infra-popliteal deep vein thrombosis. Echocardiogram showed normal left ventricular ejection fraction of 60% to 65%, abnormal septal motion and flattening of interventricular septum, right ventricular systolic pressure of 49.7 mmHg, moderately dilated right ventricle, decreased right ventricle function, Tricuspid annular plane systolic excursion of 12.1 mm (normal 15 to 20 mm). As the majority of the clot burden was distal, it was not deemed amenable to surgical extraction as recent surgery was a major contraindication for thrombolysis. The patient was started on a heparin drip and inhaled nitric oxide at 20 ppm along with oral sildenafil 40 mg every 8 hours. The next day, the patient was stable hemodynamically and his inhaled nitric oxide was tapered off. Repeat echocardiogram 48 hours from initial presentation showed improved right ventricle size and function. His right ventricular systolic pressure decreased to 22.4 mmHg and his tricuspid annular plane systolic excursion improved to 17.8 mm. We recommended that he continue sildenafil for the next month after discharge along with oral anticoagulation with a plan to follow-up as an outpatient. The patient gave written consent to treatment during his hospitalization. The patient and his family members were well-informed regarding the entire plan of care, and they were in agreement with the care plan.",
+        "summary": "Patient: Male, 56\n\nFinal Diagnosis: Right heart failure due to pulmonary embolism\n\nSymptoms: Syncope\n\nMedication: —\n\nClinical Procedure: —\n\nSpecialty: Cardiology\n\nThis is a case report where sildenafil was used as a rescue agent to achieve improvement in the right ventricle size and function in a case of acute onset massive pulmonary embolism with acute right ventricle failure in the scenario where systemic thrombolytic therapy was contraindicated.",
+        "translated_fulltext": null,
+        "translated_summary": "Bệnh nhân: Nam, 56 tuổi\n\nChẩn đoán cuối cùng: Suy tim phải do thuyên tắc phổi\n\nTriệu chứng: Ngất\n\nThuốc: —\n\nThủ thuật lâm sàng: —\n\nChuyên khoa: Tim mạch\n\nĐây là một báo cáo ca bệnh, trong đó sildenafil được sử dụng như một phương pháp điều trị hỗ trợ để cải thiện kích thước và chức năng của tâm thất phải trong trường hợp thuyên tắc phổi cấp tính, gây suy tim phải cấp tính, trong tình huống liệu pháp tiêu sợi huyết toàn thân bị chống chỉ định.",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_168.txt",
+        "fulltext": "A 21-year-old single female patient with a known history of hypertension and metastatic pheochromocytoma presented to our hospital. Her cancer has metastasized to the bladder, bones, and lungs. She also has a strong family history of malignancy, particularly pheochromocytoma. The patient was admitted due to uncontrolled hypertension and chronic symptoms related to her condition.\n\nOn admission (09/06/2024), the patient was normotensive (BP: 104/66 mmHg), her heart rate was approximately 90 beats per minute, afebrile at 36.9°C, and had an oxygen saturation of 99% on room air. Physical examination indicated an Eastern Cooperative Oncology Group (ECOG) performance status of 2, pallor consistent with chronic anemia, regular heart beat with no murmurs or additional sounds. The abdominal examination was unremarkable, and no edema or ecchymosis was noted in the lower limbs.\n\nThe patient has a history of hypertension and paraganglioma, her medication includes (Doxazosin 2 mg, Labetalol 100 mg, Oxybutynin 5 mg, Paraffin oil, Nifedipine 30 mg). Her surgical history includes a right adrenalectomy at age ten, and she has received various treatments, including somatostatin analogues and palliative radiotherapy. Family history reveals a familial succinate dehydrogenase subunit B mutation (SDBH mutation) with a significant history of endocrine malignancies, including pheochromocytomas in her father and sister and pancreatic cancer in her grandmother.\n\nLaboratory investigations including Complete Blood Count revealed significant anemia, with a hemoglobin level of 7.5 g/dl. There was evidence of hemolysis, as indicated by the high reticulocyte count, indirect bilirubin, and Lactate Dehydrogenase. Haptoglobin was low. Laboratory results are shown in. Coagulation profile excluded Disseminated Intravascular Coagulation (DIC), which shows (PT: 15.6, PTT: 23.3, fibrinogen: 489, D-dimer: 0.63). Direct Coombs test to exclude autoimmune hemolytic anemia was negative. Peripheral blood smears showed the presence of schistocytes, echinocytes a few teardrop cells in addition to thrombocytopenia, all pointing towards microangiopathic hemolytic anemia (MAHA). Given the context of metastatic cancer, the patient was diagnosed with paraneoplastic microangiopathic hemolytic anemia in march/2024.\n\nThe patient was scheduled for CVD protocol (cyclophosphamide, vincristine and doxorubicin), but without cyclophosphamide due to the anemia-inducing effect of alkylating agents. The patient received a total of 5 cycles. As an indicator of clinical response, the patient no longer experienced anemia or thrombocytopenia. A new peripheral blood smear revealed normal cells, which suggests a clinical response to the MAHA that coincides with the improvement of the underlying malignancy. This aligns with the definition of MAHA as a paraneoplastic syndrome.\n\nThe patient medications on discharge are dexamethasone 2 mg tablet, 4 mg peroral (PO) once daily (OD) for 3 days, ondansetron tablet 8 mg PO OD for 3 days, metoclopramide10 mg tablet PO Trible daily for 3 days, calcium 600 mg with vitamin D PO OD for 1 day, labetalol100 mg tablet PO BID for 1 day, doxazocin 2 mg tablet 4 mg PO BID for 1 day, citalopram20 mg tablet PO for 1 day, omeprazole 20 mg, 40 mg PO for 1 day, paracetamol 500 mg tablet, 1000 mg PO BID for 1 day, aprepitant 125 mg/80 mg capsules, 1 capsule PO OD for 3 days (with a prescription).\n\nThe patient had a follow up in 01/07/2024, clinically the patent looks well and active. The patient underwent laboratory investigations including Complete Blood Count (WBC 6.59 10e3/ul, RBC 4.47 × 10^6/ul, HGB 13.2 g/dl, 40.0%, MCV 89.4 fL, PLT 41.5 10e3/ul), Blood Urea Nitrogen 33.8 mg/dl, Creatine kinase-MB 36.1 u/l, Serum Creatinine 0.97 mg/dl, Chloride 101.5 mmol/l, Potassium 4.52 mmol/l, Sodium 135 mmol/l.",
+        "summary": "In this case report, we present a 21-year-old single female with a strong family history of endocrine malignancy. She was referred to our hospital for chemotherapy due to a diagnosis of malignant pheochromocytoma, which had metastasized to the urinary bladder, bone, and lung. Additionally, she developed microangiopathic hemolytic anemia as a paraneoplastic syndrome.",
+        "translated_fulltext": null,
+        "translated_summary": "Trong báo cáo ca bệnh này, chúng tôi trình bày về một bệnh nhân nữ 21 tuổi, độc thân, có tiền sử gia đình mắc các bệnh ung thư nội tiết. Cô được chuyển đến bệnh viện của chúng tôi để điều trị hóa trị do được chẩn đoán mắc bệnh u tủy thượng thận ác tính, đã di căn đến bàng quang, xương và phổi. Ngoài ra, cô còn bị thiếu máu tan máu vi mạch, một hội chứng cận ung thư.",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_208.txt",
+        "fulltext": "Clinical Data\nA 19-year-old male presented at the endocrinology department of our hospital on January 11, 2023. Two months prior, the patient developed emotional agitation without obvious inducement, accompanied by chest tightness, hand-shaking, and diarrhea. Thyroid function was examined at another hospital on November 8, 2022, and revealed the following: triiodothyronine (T3), 2.85 (normal range, 1.01–2.95) nmol/L; thyroxine (T4), 196.00 (normal range, 55.34–160.88) nmol/L; free triiodothyronine (FT3), 8.69 (normal range, 2.77–6.50) pmol/L; free thyroxine (FT4), 37.50 (normal range, 10.43–24.32) pmol/L; and TSH, 3.48 (normal range, 0.40–4.34) mIU/L. At that time, the patient was unable to receive further diagnosis and treatment for personal reasons. One week before presenting at our hospital, the patient developed palpitations, and the reported symptoms were slightly worse than before. The outpatient clinic examined his thyroid function and revealed the following: T3, 2.20 (normal range, 1.01–2.95) nmol/L; T4, 209.90 (normal range, 55.34–160.88) nmol/L; FT3, 8.63 (normal range, 2.77–6.50) pmol/L; FT4, 34.06 (normal range, 10.43–24.32) pmol/L; TSH, 4.13 (normal range, 0.40–4.34) mIU/L; thyroid peroxidase antibody (TPOAb), 43.80 (normal range, <60) U/mL; and thyroglobulin antibody (TGAb), <15 (normal range, <60) U/mL. The patient was admitted to the hospital from the outpatient clinic with suspected syndrome of inappropriate secretion of TSH (SITSH). During the course of the disease, the patient did not experience fever, chills, or sweating. The patient’s appetite was unaffected, and he did not experience weight loss, fatigue, constipation, or other discomfort. The patient was in good health and had no history of chronic disease or radiation exposure to the neck. His parents were not consanguineous, and no genetic history in the family.\n\nPhysical examination revealed the following: body temperature, 36.5°C; pulse, 97 bpm; breathing, 19 bpm; blood pressure, 120/78 mmHg; height, 172 cm; weight, 70 kg; BMI, 23.66 kg/m2; clear mind; normal development, intelligence, vision, and hearing; no exophthalmos; free eye movements; mild thyroid enlargement and softness, with no tenderness and with swallowing up and down; no vascular murmur; no positive signs in the heart, lung or abdomen; normal muscle strength and tension of the extremities; no mucinous edema of lower limbs.\n\nSupplementary Examination\nRe-examination of thyroid function on January 12, 2023, revealed the following results: T3, 1.99 (normal range, 1.01–2.95) nmol/L; T4, 184.30 (normal range, 55.34–160.88) nmol/L; FT3, 8.17 (normal range, 2.77–6.50) pmol/L; FT4, 32.74 (normal range, 10.43–24.32) pmol/L; TSH, 2.30 (normal range, 0.40–4.34) mIU/L; TPOAb, 52.00 (normal range, <60) U/mL; TGAb, <15 (normal range, <60) U/mL; thyroid stimulating receptor antibody (TRAb), <0.10 (normal range, <1.00) U/L; and reverse triiodothyronine (rT3), 66.13 (normal range, 35.00–95.00) ng/dl. There were no obvious abnormalities in the blood routine, biochemistry, cortisol rhythm, adrenocorticotropin, growth hormone, or sex hormone test results. The 2-hour thyroid iodine uptake rate was lower than the normal value, and the 6-hour thyroid iodine uptake rate was normal. Thyroid color Doppler ultrasound revealed a right thyroid follicular cyst (TI-RADS-II). Thyroid single photon emission computed tomography revealed an enlarged thyroid volume. Bone age: adult bone age. No obvious abnormalities were found on routine or enhanced magnetic resonance imaging (MRI) of the pituitary gland. The patient’s electrocardiogram results were normal.\n\nGenetic Testing\nThe patient showed elevated FT3, FT4, and T4 levels and some manifestations of thyrotoxicosis; however, his TSH and thyroid autoantibody levels were normal, and the thyroid iodine uptake rate decreased, which did not support the diagnosis of primary hyperthyroidism. The physical and other auxiliary examinations also ruled out thyroiditis, TSH secreting pituitary adenoma (TSHoma), and other central hyperthyroidism. The patient was highly suspected to have RTH. Genetic analyses were performed on the patient and his family after obtaining informed consent. The full exome of genomic DNA was captured and sequenced by KingMed Diagnostics Co., Ltd. The result revealed a heterozygous mutation in the THRB gene encoding thyroid hormone receptor β (TRβ) on chromosome 3. The 947 base G in the gene’s coding region was converted to A, and the nucleotide codon changed from CGC to CAC, converting amino acid 316 from arginine to histidine (R316H). Missense mutations can lead to RTH. The mother and the patient had a heterozygous mutation at the same site; the father had no mutation.",
+        "summary": "We report a 19-year-old male patient with elevation of thyroid hormones. Serological examination showed elevated thyroid hormone levels, and thyroid-stimulating hormone levels within the reference interval. The patient was finally diagnosed with RTH after genetic testing that identified a gene mutation inherited from his mother. Due to timely diagnosis, the patient’s condition has been well controlled, and his prognosis is good.",
+        "translated_fulltext": null,
+        "translated_summary": "Chúng tôi báo cáo về một bệnh nhân nam 19 tuổi có nồng độ hormone tuyến giáp tăng cao. Xét nghiệm huyết thanh cho thấy nồng độ hormone tuyến giáp tăng và nồng độ hormone kích thích tuyến giáp nằm trong khoảng tham chiếu bình thường. Sau khi thực hiện xét nghiệm di truyền và phát hiện một đột biến gen di truyền từ mẹ, bệnh nhân cuối cùng được chẩn đoán mắc hội chứng kháng hormone tuyến giáp (RTH). Nhờ chẩn đoán kịp thời, tình trạng của bệnh nhân đã được kiểm soát tốt và tiên lượng bệnh là tốt.",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_501.txt",
+        "fulltext": "He is a 16-year-old boy who in the months prior to consultation suffers occasional sleep paralysis, after a few minutes of the postprandial nap, which causes him a lot of anxiety, the main reason why he comes to the consultation. Occasionally, these sleep paralyses were accompanied by hypnopompic hallucinations (which he associated with dreams or not being fully awake). He has a nightly sleep schedule of about seven hours plus two hours of nap that are very refreshing. He has good academic performance. When we asked him a directed history, he said that after months of suffering these sleep paralyses, episodes of shaking of arms and legs appeared, especially when he laughed, which almost made him fall (he thought it happened to everyone). Afterwards, these symptoms were added to three short nightly awakenings, with immediate subsequent reconciliation and occasional attacks of sleep in the morning, which he associated with mathematics classes (the teacher is very boring). After clinical suspicion, we requested a multiple sleep latency test and a nightly polysomnographic study, which are conclusive with the diagnosis of narcolepsy (very short sleep latency, REM sleep latency, somewhat fragmented sleep, average in the multiple sleep latency test of 2.1 minutes and the presence of four sleep onset REM). Since the episodes of drowsiness occur every day at the same time, we prescribed a short morning nap that refreshed him a lot and he reported being able to continue with his school activities. Afterwards, we had to add modafinil at the same time (200 mg). We recommended venlafaxine for cataplexy or even initiate treatment with sodium oxybate (the latter he does not want to take because of the discomfort of the second dose, and he also rejects venlafaxine because of fear of the side effects). We agreed that he would comply with good sleep hygiene, take modafinil and continue with the scheduled naps (the afternoon one he already took and the morning one) and, if it got worse, we would add other treatments. He is doing well with this schedule, he does not perceive much fragmentation of nightly sleep (one or two very brief awakenings after which he falls asleep again without problems); in fact, he wakes up rested, the cataplexy is occasional and does not interfere with his daily life, and the sleep attacks are very controlled. He reports feeling better and without major limitations in his daily life (good academic performance, he does not drink alcohol, but he does not care because he has never drunk, he keeps regular sleep hours and he exercises regularly).\n",
+        "summary": "16-year-old male presenting after seeing several specialists with sleep paralysis during naps, which causes fear and occasional dropping of objects from hands (diagnosed as possible myoclonus). In the history, we were surprised by the presence of sleep paralysis immediately after the onset of naps and, in the directed history, these sudden movements caused by emotions were consistent with cataplexy, so we performed a nocturnal polysomnographic study and a multiple sleep latency test. With the evolution, hypnopompic hallucinations and fragmented night sleep appeared, as well as occasional daytime somnolence (the typical symptomatological tetrad of narcolepsy with cataplexy of type 1 was completed).\n",
+        "translated_fulltext": "Cậu bé 16 tuổi này, trong những tháng trước khi đến khám, thỉnh thoảng bị chứng tê liệt khi ngủ, xảy ra sau vài phút ngủ trưa sau bữa ăn, gây ra nhiều lo lắng cho cậu, đây là lý do chính khiến cậu đến khám. Đôi khi, những đợt tê liệt khi ngủ này đi kèm với ảo giác khi vừa tỉnh giấc (cậu liên tưởng đến những giấc mơ hoặc cảm giác không hoàn toàn tỉnh táo). Cậu có lịch trình ngủ khoảng bảy tiếng mỗi đêm, cộng thêm hai tiếng ngủ trưa, giúp cậu cảm thấy rất sảng khoái. Cậu học rất giỏi. Khi chúng tôi hỏi về tiền sử bệnh, cậu cho biết sau nhiều tháng bị chứng tê liệt khi ngủ, cậu bắt đầu bị run tay và chân, đặc biệt là khi cười, khiến cậu suýt ngã (cậu nghĩ rằng điều này xảy ra với tất cả mọi người). Sau đó, các triệu chứng này kèm theo ba lần thức giấc ngắn vào ban đêm, sau đó lại ngủ ngay lập tức, và thỉnh thoảng bị buồn ngủ vào buổi sáng, điều mà cậu liên tưởng đến các tiết học toán (giáo viên rất tẻ nhạt). Sau khi nghi ngờ về tình trạng bệnh, chúng tôi yêu cầu làm xét nghiệm đa giấc ngủ và nghiên cứu đa ký giấc ngủ vào ban đêm, kết quả cho thấy cậu bị chứng ngủ rũ (thời gian ngủ ngắn, thời gian vào giấc ngủ nhanh, giấc ngủ bị gián đoạn, thời gian ngủ trung bình trong xét nghiệm đa giấc ngủ là 2,1 phút và có bốn lần xuất hiện giấc ngủ REM ngay khi bắt đầu ngủ). Vì các đợt buồn ngủ xảy ra hàng ngày vào cùng một thời điểm, chúng tôi kê đơn cho cậu một giấc ngủ ngắn vào buổi sáng, giúp cậu cảm thấy sảng khoái và cậu cho biết có thể tiếp tục các hoạt động học tập. Sau đó, chúng tôi phải bổ sung thêm thuốc modafinil vào cùng thời điểm (200mg). Chúng tôi khuyên cậu nên tuân thủ các nguyên tắc về giấc ngủ tốt, dùng thuốc modafinil và tiếp tục ngủ trưa theo lịch trình (buổi chiều cậu đã ngủ trưa và buổi sáng). Nếu tình trạng bệnh trở nên tồi tệ hơn, chúng tôi sẽ bổ sung các phương pháp điều trị khác. Hiện tại, cậu đang có kết quả tốt với lịch trình này, cậu không cảm thấy giấc ngủ ban đêm bị gián đoạn nhiều (một hoặc hai lần thức giấc rất ngắn sau đó lại ngủ lại bình thường); thực tế, cậu thức dậy với cảm giác khỏe khoắn, chứng tê liệt chỉ xảy ra thỉnh thoảng và không ảnh hưởng đến cuộc sống hàng ngày của cậu, và các cơn buồn ngủ được kiểm soát tốt. Cậu cho biết cảm thấy tốt hơn và không gặp nhiều hạn chế trong cuộc sống hàng ngày (học tập tốt, không uống rượu, nhưng cậu không quan tâm vì chưa từng uống, cậu có giờ giấc ngủ đều đặn và tập thể dục thường xuyên).",
+        "translated_summary": "Một nam thanh niên 16 tuổi đến khám sau khi đã đi khám với nhiều chuyên gia về tình trạng tê liệt khi ngủ trong giấc ngủ ngắn, gây ra cảm giác sợ hãi và đôi khi làm rơi đồ vật khỏi tay (được chẩn đoán có thể là chứng giật cơ). Trong tiền sử bệnh, chúng tôi ngạc nhiên khi thấy tình trạng tê liệt khi ngủ xảy ra ngay sau khi bắt đầu giấc ngủ ngắn và, theo khai thác tiền sử chi tiết, những cử động đột ngột do cảm xúc gây ra phù hợp với triệu chứng mất trương lực cơ, vì vậy chúng tôi đã thực hiện xét nghiệm đa ký giấc ngủ ban đêm và xét nghiệm độ trễ giấc ngủ nhiều lần. Theo diễn biến bệnh, xuất hiện ảo giác khi thức giấc và giấc ngủ ban đêm bị gián đoạn, cũng như tình trạng buồn ngủ ban ngày (bộ bốn triệu chứng điển hình của chứng ngủ rũ với mất trương lực cơ loại 1 đã được xác định).",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_460.txt",
+        "fulltext": "A 53-year-old African man with a medical history of hypertension diagnosed in his mid-20s, systolic CHF and non-ischaemic cardiomyopathy presented with worsening exertional dyspnoea, lower extremity oedema, paroxysmal nocturnal dyspnoea and orthopnoea for approximately 1 week. The patient was on six hypertensive agents as an outpatient including clonidine, hydralazine, isosorbide mononitrate, valsartan and furosemide. Despite compliance with medications, he had frequent admissions for CHF exacerbations. He denied tobacco, drug or alcohol use. Although he was diagnosed with hypertension at a young age, the patient did not recall having additional testing for secondary causes of HTN at the time of diagnosis. He did recall a diagnosis of chronic hypokalaemia, which had been attributed to furosemide use, and he had been prescribed potassium supplements intermittently in the past. He denied any known family history of PA or uncontrolled HTN. Vital signs revealed a blood pressure of 163/103 mm Hg, heart rate of 74 beats per minute, respiration rate of 17 and 95% oxygen saturation on 3 L nasal cannula. Pertinent findings on physical examination included jugular venous distention, bilateral lower extremity pitting oedema, bilateral rales and a prominent S3 gallop.\n\n\nInvestigations\n\nEKG showed no acute ischaemic changes, sinus rhythm with chronic left bundle branch block. Troponins were negative on three consecutive occasions. Chest X-ray revealed bilateral pulmonary vascular congestion. Transthoracic echocardiography revealed moderate left ventricular hypertrophy and dilatation with global hypokinesis and an ejection fraction of 10%–15%. No valvular abnormalities were noted. Cardiac MRI showed areas of myocardial fibrosis likely related to hypertrophy, atypical for ischaemic disease and atypical for previous infarct or amyloidosis. Laboratory studies showed serum potassium of 2.6 mmol/L and bicarbonate of 34 mmol/L. PA was suspected, and further testing revealed an elevated plasma aldosterone level of 154 ng/dL (normal less than 39.2 ng/dL), a decreased plasma renin activity (RA) of less than 2.1 ng/mL/hour and a plasma aldosterone concentration/plasma RA (PAC/PRA) ratio of 73.3 (ng/dL)/(ng/mL/hour).\n\nResults of an overnight dexamethasone suppression test, thyroid function testing and plasma and urine metanephrines were normal. An oral salt loading suppression test was not performed for fear that it would exacerbate his pulmonary oedema and heart failure. CT of the abdomen and pelvis with contrast showed a 1.2×2.4 cm well-defined, homogeneous adenoma of the left adrenal gland. Subsequent adrenal vein sampling confirmed unilateral PA with lateralisation to the left adrenal gland (table 1.) The adrenal vein cortisol to inferior vena cava cortisol ratio for both the left and right adrenal vein was greater than 3, consistent with successful adrenal vein cannulation. The left and right adrenal vein aldosterone to adrenal vein cortisol ratio were 14.8 and 2.2, respectively. A lateralisation ratio greater than 4 is consistent with unilateral disease, whereas a lateralisation ratio less than 3 is consistent with bilateral disease. Our patient’s lateralisation ratio of left to right was 6.7, consistent with unilateral disease. The patient was started on spironolactone treatment with improvement of his blood pressure, and hypokalaemia and was referred for left adrenalectomy.",
+        "summary": "A 53-year-old African man with a 25-year history of uncontrolled hypertension and systolic heart failure presented with an acute congestive heart failure exacerbation. He was found to have severe hypokalaemia, so additional testing was performed, and primary aldosteronism was confirmed. CT scan showed a 1.2×2.4 cm well-defined, homogeneous adenoma of the left adrenal gland. Adrenal vein sampling confirmed unilateral primary aldosteronism with lateralisation to the left adrenal gland. The patient was started on spironolactone and was referred to surgery for laparoscopic left adrenalectomy.",
+        "translated_fulltext": null,
+        "translated_summary": "Một người đàn ông gốc Phi, 53 tuổi, có tiền sử tăng huyết áp không kiểm soát được trong 25 năm và suy tim tâm thu, đã nhập viện vì tình trạng suy tim cấp tính trở nên nghiêm trọng hơn. Kết quả xét nghiệm cho thấy ông bị hạ kali máu nghiêm trọng, do đó, các xét nghiệm bổ sung đã được thực hiện và chẩn đoán xác nhận là cường aldosterone nguyên phát. Chụp cắt lớp vi tính (CT) cho thấy một khối u tuyến thượng thận trái có kích thước 1,2 × 2,4 cm, hình dạng rõ ràng và đồng nhất. Lấy mẫu tĩnh mạch tuyến thượng thận xác nhận cường aldosterone nguyên phát một bên, tập trung ở tuyến thượng thận trái. Bệnh nhân được bắt đầu điều trị bằng spironolactone và được giới thiệu đến phẫu thuật để cắt bỏ tuyến thượng thận trái bằng phương pháp nội soi.",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_489.txt",
+        "fulltext": "A 58-year-old female presented to the Emergency Department with a 6-month history of worsening dyspnea. Over the preceding 10 days, her symptoms had acutely worsened, accompanied by mild chest discomfort and bilateral leg swelling. Her medical history included asthma and hypertension. On arrival, she was found to be hypoxemic with an oxygen saturation of 74%, which improved to 94% with 5 liters of supplemental oxygen. Physical examination revealed bilateral inspiratory crackles and pitting edema in the lower extremities.\n\nLaboratory investigations demonstrated an elevated NT-proBNP (Brain natriuretic peptide) level of 2110 ng/mL (range <125 ng/mL) and normal troponin levels. Computed tomography (CT) chest angiography revealed mild bilateral patchy ground-glass infiltrates, an enlarged pulmonary artery (PA) trunk, and dilatation of the right atrium (RA) and right ventricle (RV) with no evidence of pulmonary embolism. Transthoracic echocardiography (TTE) showed a left ventricular ejection fraction (LVEF) of 75% to 80%, moderate RA and RV dilatation, systolic and diastolic flattening of the interventricular septum, reduced RV systolic function, and an estimated PA systolic pressure of 55 to 60 mm Hg. No intracardiac shunt was identified on color Doppler or agitated saline contrast injection.\n\nThe patient was initiated on intravenous furosemide. Right heart catheterization (RHC) performed the following day, while the patient was receiving 3 liters of supplemental oxygen via nasal cannula. The procedure confirmed PH, with a mean pulmonary artery pressure (mPAP) of 41 mm Hg and a high cardiac output of 8.46 L/min by the Fick method. A vasoreactivity test using the standard adenosine protocol confirmed that the patient was non-vasoreactive, indicating calcium channel blocker therapy would not be beneficial. Further investigations, including complete blood count, thyroid-stimulating hormone, HIV screening, antinuclear antibody screen, rheumatoid factor, and thiamine levels, were unremarkable. Imaging studies, including CT angiography of the chest and abdomen and Doppler ultrasound of the liver, ruled out systemic shunts, pulmonary arteriovenous malformations, and splenomegaly. At the time of discharge, the patient’s hypoxemia had resolved with diuresis.\n\nOutpatient evaluation included a pulmonary function testing that showed mild obstructive ventilatory defect. The sleep study and ventilation-perfusion study were unremarkable. As RHC demonstrated a pulmonary artery occlusion pressure (wedge pressure) of 11 mm Hg (<15 mm Hg) and a high transpulmonary gradient of 26 mm Hg (>12 mm Hg), Group II PH due to left heart disease was excluded. She was prescribed a corticosteroid inhaler, and oral furosemide (20 mg daily) was continued. Pulmonary hypertension-specific therapy was not initiated, given her PH was categorized as group III, attributed to obstructive lung disease. During follow-up appointments, the patient reported an initial improvement in her perceived dyspnea, which later stabilized. She consistently remained in the intermediate-low risk category according to the 4-strata risk assessment tool for PH follow-up.\n\nTwo years later, she returned with worsening dyspnea and leg swelling after discontinuing furosemide. Repeat CT pulmonary angiography revealed findings similar to her initial imaging but additionally identified an anomalous left pulmonary vein draining into the left brachiocephalic trunk. A retrospective review of her initial CT confirmed the missed anomaly. The TTE showed LVEF of 60%, moderate RA and RV dilation, reduced RV systolic function, and an estimated pulmonary artery systolic pressure of 50 to 55 mm Hg. In contrast to previous RHC, the shunt evaluation this time demonstrated a 6% step-up in oxygen saturation between the superior vena cava (SVC) and RA, confirming a left-to-right shunt. This discrepancy was due to the SVC saturation measurement being appropriately obtained above the drainage of the left brachiocephalic trunk, now guided by the knowledge of PAPVR from the CT findings. The shunt fraction (Qp/Qs) was calculated to be 1.52. Consequently, her PH was reclassified as group I due to adult congenital heart disease.\n\nThe patient received treatment with intravenous diuretics. Due to her mild PH and intermediate-low risk classification based on the 4-strata risk assessment tool (WHO-FC III, NT-proBNP 81 pg/mL, and a 6-min walk distance of 460 m), PH-specific therapy was not advised. She declined additional evaluations, including cardiac magnetic resonance imaging (MRI) and referral to an adult congenital heart disease center, choosing instead to continue with close outpatient monitoring.",
+        "summary": "We report the case of a 58-year-old woman who initially presented with progressive dyspnea and was diagnosed with group III pulmonary hypertension attributed to obstructive lung disease. Two years later, she returned with similar symptoms after discontinuing diuretic therapy. Further evaluation uncovered a previously undetected anomalous left pulmonary vein draining into the left innominate vein.",
+        "translated_fulltext": null,
+        "translated_summary": "Chúng tôi báo cáo về trường hợp của một phụ nữ 58 tuổi, ban đầu đến khám với các triệu chứng khó thở ngày càng tăng và được chẩn đoán mắc chứng tăng huyết áp phổi nhóm III do bệnh phổi tắc nghẽn. Hai năm sau, bà tái khám với các triệu chứng tương tự sau khi ngừng điều trị bằng thuốc lợi tiểu. Các xét nghiệm tiếp theo cho thấy một tĩnh mạch phổi trái bất thường trước đây chưa được phát hiện, dẫn máu vào tĩnh mạch vô danh trái.",
+        "judge_pass": true
+    }
+]
\ No newline at end of file
diff --git a/data/translated_data/translation_version_v2/multiclinsum_gs_train_en2zh_gemma(0_200).json b/data/translated_data/translation_version_v2/multiclinsum_gs_train_en2zh_gemma(0_200).json
new file mode 100644
index 0000000000000000000000000000000000000000..d091f9ea2e0ab450a2c1c5b2c11a6b1a904a4a48
--- /dev/null
+++ b/data/translated_data/translation_version_v2/multiclinsum_gs_train_en2zh_gemma(0_200).json
@@ -0,0 +1,194 @@
+[
+    {
+        "id": "multiclinsum_gs_en_523.txt",
+        "fulltext": "We present the case of a 34-year-old woman, eight weeks pregnant with no other personal history of interest, who presents to the emergency department with generalized convulsions with dysarthria in the postcritical period, which resolve progressively in less than two hours. On physical examination, she is conscious, oriented, with no language or motor or sensory deficits. Only signs of a right lateral tongue bite are observed.\n\nThe complementary tests, such as blood tests or the electrocardiogram, are normal. Given that the episode corresponds with a first epileptic seizure and the patient is pregnant, an urgent magnetic resonance of the skull is requested.\n\nThe usual protocol was performed and 3D T1 sequences without and with intravenous contrast were obtained in axial, coronal and sagital planes, axial FLAIR, axial T2, VEN BOLD and magnetic susceptibility sequences, as well as axial diffusion and apparent diffusion coefficient map. The MRI identified multiple venous cortico-medullary vascular structures converging centripetally to a large central venous structure draining through the inferior anastomotic vein into the left transverse sinus, forming the classic ‘Medusa head’ sign. In the T1 sequences, the drainage vein was seen to be increased in signal with central hyphocaptation after contrast administration, suggesting partial thrombosis versus slow flow. In addition, in T2 and FLAIR sequences, the brain tissue surrounding the drainage vein was seen to be hyperintense, without diffusion restriction and compatible with edema.\n\nThese findings are suggestive of a venous anomaly of development with signs of partial peripheral thrombosis and slow flow more proximal, which cause edema of the surrounding tissue. She is started on clexane 60 mg/12 hours and levetiracetam 500 mg/12 hours and the patient shows improvement and symptomatic stability after one week.\n",
+        "summary": "A 34-year-old pregnant woman presents with seizures and dysarthria and is urgently referred for a cranial MRI. The classic ‘Medusa head’ sign is seen and the diagnosis is made as a venous anomaly of development with peripheral partial thrombosis and proximal slow flow.\n",
+        "translated_fulltext": null,
+        "translated_summary": "一位34岁的孕妇出现癫痫和构音障碍，情况紧急，被立即转诊进行颅部MRI检查。检查结果显示出经典的“美杜莎头”征象，诊断为一种发育性静脉异常，伴有周围部分血栓形成和近端血流缓慢。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_587.txt",
+        "fulltext": "A 22-year-old woman came to the Department of Oral Medicine with complaints of mouth ulcers causing pain and eating and drinking difficulty persisting for a duration of one month. This condition begins with a fever and appears like pimples on the lips. Based on the anamnesis, it was discovered that she had been using pod-type vapes for about a year but had never experienced complaints like when she came for treatment. She had never smoked traditional cigarettes before starting to vape. She said the reason for trying vaping was out of curiosity, and she quite often tried different types of e-liquid with different flavors. Before her complaint, she had simply changed the type of e-liquid to a different flavor without mentioning the brand. She vapes almost every day, but not all day, only in her free time or with friends. She was a healthy individual, and before this condition appeared, she had no history of taking medications, including antibiotics, analgesics, anticonvulsants, non-steroidal anti-inflammatory drugs, and antifungals. She also had no history of drug or food allergies, but the patient has unhealthy eating habits (eating irregularly and not consuming vegetables and fruit). Extraoral examination showed no lesions on other parts of the body, while the lips of the patient had serosanguineous crusts and an erosive area at the corner of the mouth, and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges, irregular, varying sizes, and pain on the labial, buccal, lateral, and ventral mucosa of the tongue and floor of the mouth.\n\nBased on the medical history of the patient and physical examination, which revealed oral mucosal involvement but no symptoms elsewhere in the body, as well as the non-reactive anti-HSV1 IgG results, the diagnosis of vaping-related oral erythema multiforme was established. The medical condition has been classified as minor erythema multiforme. The oral conditions were treated with 0.9% NaCl, which was moistened in gauze and placed on the lips three times a day. The patient was instructed to gargle 1 mg of dexamethasone in 10 mL of hyaluronic acid three times a day and avoid eating or drinking for at least 30 minutes after gargling. She was also given 2% miconazole cream applied to the wound in the right corner of the mouth twice a day, as well as vaseline album cream for dry lips. To maintain good oral hygiene, she was advised to brush her teeth and tongue twice a day, after breakfast and before bed. She was also instructed to stop vaping and avoid foods containing monosodium glutamate (MSG). The control was carried out after a week following therapy and showed that oral condition had improved. Written informed consent for the publication of details was obtained from the patient. This case report conformed with the Helsinki Declaration. The publication of this case report has also been approved by the institution.",
+        "summary": "A 22-year-old woman came to the Oral Medicine Department with complaints of stomatitis causing pain, eating, and drinking difficulty, which started with fever and pimple-like on the lips. She was an active vape user for one year. Extraoral examination revealed no lesions on other body parts. The serosanguinolent crusts on the lips, an erosive area on the labial commissures and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges and irregular, varying sizes in several parts of the oral mucosa. The anti-HSV-1 IgG laboratory results showed non-reactive, leading to a diagnosis of oral erythema multiforme. Management of oral conditions using 0.9% NaCl compress, dexamethasone mouthwash, and hyaluronic acid, applying 2% miconazole cream on labial commissures and vaseline album cream on the dry lips, and stopping vaping. Oral condition improved in a week of therapy.",
+        "translated_fulltext": null,
+        "translated_summary": "一位22岁的女性因口腔黏膜炎引起疼痛、进食和饮水困难而来到口腔医学科就诊。她的症状始于发烧，并在嘴唇上出现类似丘疹的病灶。她已经吸电子烟一年。体外检查显示，身体其他部位没有病灶。嘴唇上有血清性渗出性结痂，唇角处有糜烂区域，且容易出血。口腔内检查显示，口腔黏膜的多个部位有白色溃疡，边缘呈黄色，形状不规则，大小不一。抗HSV-1 IgG实验室结果显示为阴性，因此诊断为口腔多形红斑。治疗方案包括：使用0.9%生理盐水湿敷，漱口含地塞米松，涂抹透明质酸，在唇角处涂抹2%咪康唑霜，在干燥的嘴唇上涂抹凡士林软膏，并停止吸电子烟。经过一周的治疗，口腔状况得到改善。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_289.txt",
+        "fulltext": "4-year-old male patient with a history of nasal impetigo two weeks before admission (treated with topical mupirocin and oral cefadroxil; dose, duration and adherence to treatment unknown), with no other morbid history, who presented macroscopic glomerular haematuria associated with oedema of the lower extremities of 5 days' evolution, with the last 12 hours prior to the consultation adding headaches, nausea and vomiting. He went to the emergency department (ED) in convulsive status, after 20 minutes of generalised tonic-clonic convulsions.\n\nOn admission to the ED, the patient was afebrile, with non-evaluable blood pressure, with quantitative consciousness impairment associated with generalized hypertonia and bilateral and pretibial oedema. Endotracheal intubation was decided and phenobarbital (10 mg/kg) was administered to manage the convulsive status.\n\nOn physical examination in the intensive care unit (ICU), blood pressure was 134/94 mmHg (BP 110 mmHg) (p95 for patient 108/66 mmHg, p95+12 120/78 mmHg).\n\nInitial laboratory parameters included: complete urine with haematuria (> 100 erythrocytes per field), proteinuria 3+ and leucocyturia 10-25 per field, creatinemia 0.3 mg/dL, anaemia with haematocrit (HTO) 21%, haemoglobin (Hb) 7 g/dL, with normal mean corpuscular volume (VCM) and mean corpuscular haemoglobin concentration (CHCM), leukocytosis of 23,900 cells/mm3, thrombocytosis of 756,000/mm3, without elevation of acute phase reactants, hypocomplementemia with complement C3 level at 25 mg/dL (normal value, VN: 80-150 mg/dL) and normal C4. The rapid antigen test for Streptococcus beta-haemolytic group A (Streptococcus pyogenes) in pharynx was positive and the Anti-streptolysin O (ASO) was (+). The non-contrast brain computed tomography showed no acute changes. The renal ultrasound concluded bilateral nephromegaly with increased cortical echogenicity and decreased corticomedullar differentiation.\n\nThe patient was diagnosed with nephritic syndrome due to complicated GNAPE with hypertensive emergency - convulsive status.\n\nWithin the first 24 hours of his ICU stay, the patient required mechanical ventilation (MV) and anticonvulsant therapy with phenobarbital. He progressed without seizures, with a normal electroencephalogram (EEG) (on the day following admission) and a normal cerebrospinal fluid study. Antibiotic therapy was initiated for eradication of Streptococcus pyogenes with cefotaxime and diuretic therapy with furosemide.\n\nThe next day, he developed renal impairment with creatinine elevation to 0.99 mg/dL, hypertension and 24 hour proteinuria of 36.6 mg/m2/h, without oliguria. He initiated antihypertensive therapy with amlodipine and intravenous labetalol, with good initial control.\n\nWith favorable evolution, extubation was performed at 48 hours, which was well tolerated from the ventilatory point of view. However, after 24 hours of extubation, the patient's consciousness deteriorated, with both ocular opening and withdrawal of limb only in response to painful stimulus and poor verbal response (Glasgow Coma Scale 8), and developed blood pressure figures > p95+12 despite receiving therapy with labetalol in continuous infusion (up to 3 mg/kg/h), amlodipine (10 mg/day) and furosemide, which required the reintroduction of mechanical ventilation and infusion of sodium nitroprusside (up to 3 mcg/kg/min), with the aim of achieving gradual reduction of blood pressure figures (25% daily) to prevent secondary neurological damage. Given the presence of acute neurological symptomatology associated with HTA in a patient with glomerulonephritis, the diagnosis of PRES was suspected, which was confirmed by magnetic resonance imaging (MRI) of the brain (day 5), which showed an increase in the subcortical signal in bilateral and symmetric occipital region, without restriction in diffusion, which was compatible with vasogenic edema (PRES). Ophthalmological evaluation was normal and a new EEG evidenced occasional episodes of generalized voltage depression.\n\nAdding enalapril to the treatment. Finally, after 10 days with a slow pharmacological weaning, normalization of blood pressure was achieved. The control MRI (day 12) revealed regression of the previously described findings. Successful extubation was achieved after 5 days.\n\nDuring his stay in the ICU, the hemoglobin level dropped to 5 g/dL, with normal mean corpuscular volume and mean corpuscular hemoglobin concentration, without plateletopenia, so hemolytic anemia was suspected given a positive direct Coombs test and hemoglobinuria. He required red blood cell transfusions twice. Steroid therapy with methylprednisolone (1 mg/kg/d) was initiated for 72 hours. The coproculture was negative, as was the urinary antigen for Streptococcus pneumoniae. Epstein-Barr virus and Parvovirus B19 serology, extractable nuclear antigen (ENA) profile, anti-neutrophil cytoplasmic antibodies (ANCA), anti-DNA antibodies, anti-B2 glycoprotein 1 antibodies, anti-cardiolipin antibodies and lupus anticoagulant were all negative. All cultures were negative (blood cultures, urine cultures, cultures of endotracheal aspirate and pharyngeal cultures). ANA (antinuclear antibodies) was positive 1/160.\n\nThe patient improved with blood pressure normalization, increased complement levels, and a urine test without proteinuria or hematuria. The direct Coombs test remained positive on the 9th day of hospitalization.\n\nOn day 31, the patient was discharged normotensive, without anaemia, with preserved renal function, without proteinuria or haematuria, with normalisation of C3 levels and asymptomatic from the neurological point of view. He was discharged with pharmacological therapy with prednisone, amlodipine, enalapril and folic acid. The patient did not present recurrence and remained asymptomatic 6 months after discharge.\n",
+        "summary": "4-year-old male patient with a history of 5 days of haematuria and oedema, with additional headaches, nausea and vomiting, who entered a convulsive state and hypertensive crisis. Laboratory tests showed hypocomplementemia C3 and elevated Anti-Streptolysin O titers, which was interpreted as GNAPE. He developed encephalopathy, which led to suspicion of secondary PRES due to hypertensive emergency, which was finally confirmed by magnetic resonance of the brain. He also developed autoimmune haemolytic anaemia with haemoglobin up to 5 g/dL. His treatment was based on antihypertensive therapy, neuroprotection measures and steroid treatment. He was discharged after 31 days of hospitalisation, asymptomatic 6 months after discharge.\n",
+        "translated_fulltext": null,
+        "translated_summary": "该患者为一名4岁男性，既往有血尿和水肿5天的病史，并伴有头痛、恶心和呕吐，随后进入抽搐状态并出现高血压危象。实验室检查显示C3水平降低，抗链球菌溶血素O滴度升高，诊断为GNAPE（链球菌感染后肾小球肾炎）。患者发展为脑病，这引发了对继发性PRES（高血压脑病综合征）的怀疑，最终通过脑部磁共振成像确诊。此外，患者还发展为自身免疫性溶血性贫血，血红蛋白水平低至5克/分升。他的治疗方案包括降压治疗、神经保护措施和类固醇治疗。住院31天后出院，出院后6个月无症状。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_564.txt",
+        "fulltext": "A 69-year-old male with prior history of CABG presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration was admitted in our center. The electrocardiogram showed ST depression in leads II, III, aVF, and V4-6, and blood examination revealed elevation of plasma N-terminal pro-B-type natriuretic peptide levels (2640 pg/mL). Echocardiogram showed left ventricular systolic dysfunction and low left ventricular ejection fraction (30%). The patient had inferior ST-segment-elevation myocardial infarction in 2009, when he was 59 years old, with angiographic evidence of severe 3 vessels disease (coronary angiography showed CTO in proximal left anterior descending artery (LAD), 90% stenosis in mid and distal left circumflex artery, and 95% stenosis in mid RCA. The patient underwent CABG with left internal mammary artery (LIMA) to LAD, and sequential SVG to 1st obtuse marginal branch (OM1), 2nd obtuse marginal branch (OM2), and posterolateral branch (PL) in 2009.\n\nCoronary angiography was performed via 6 French (Fr) left radial artery access and demonstrated patency of LIMA to LAD and SVG to OM1, OM2 conduits, but a complete occlusion of sequential SVG to PL conduit. Native left main coronary artery was occluded in ostium and native RCA was occluded in the mid portion with bridging collaterals. We decided to treat the native RCA CTO. Dual arterial access was achieved with another 6 Fr sheath in right femoral artery. The left and right coronary arteries were intubated with 6 Fr AL 0.75 (Launcher; Medtronic; USA) and 6 Fr EBU 3.5 (Launcher; Medtronic; USA) guide catheters, respectively. An antegrade approach via left radial artery was attempted; however, neither Fielder XTR wire (Asahi Intec, Japan) nor Gaia 3 wire (Asahi Intec, Japan) with Finecross microcatheter (Terumo, Japan) reached the true lumen in distal RCA. Then, parallel wire technique with Crusade microcatheter (Kaneka, Japan) and two Gaia 3 wires (Asahi Intec, Japan) were attempted, but also failed. We therefore switched to the retrograde approach using septal channel from LAD through occluded left coronary artery. Gaia 3 wire (Asahi Intec, Japan) crossed occluded left main (LM) and LAD, and finally reached true lumen in distal LAD. Sion wire was exchanged by Finecross microcatheter (Terumo, Japan) into dital LAD, and dilation of LM and proximal LAD with a 2.0 × 15 mm balloon was performed. Then, septal surfing technique (SST) was used for septal crossing. We tried different septal channels originating from proximal to distal LAD, and delivered Sion wire (Asahi Intec, Japan) retrogradely through distal septal branch into distal RCA supported by a 150-cm Finecross microcatheter (Terumo, Japan). Gaia 3 wire (Asahi Intec, Japan) crossed CTO lesion retrogradely into the true lumen in proximal RCA, and was advanced into Guidezilla guide extension catheter (Boston Scientific, USA) positioned in the antegrade guiding catheter. The Finecross microcatheter (Terumo, Japan) was delivered to the antegrade catheter and a RG3 wire (Asahi Intec, Japan) was externalized. The CTO was then predilated by a 2.0 × 15 mm balloon and stented with 2 overlapping drug-eluting stents (2.5 × 38 mm and 3.0 × 38 mm) with excellent angiographic result and TIMI3 flow in all distal branches.\n\nDyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea.",
+        "summary": "Patient concerns:\nThis is a 69-year-old male with prior history of coronary artery bypass grafting presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration.\n\nDiagnosis:\nThe patient was diagnosed as heart failure caused by ischemia after SVG failure (SVG to right coronary artery) according to electrocardiogram, plasma N-terminal pro-B-type natriuretic peptide levels, and coronary angiogram.\n\nInterventions:\nWe recanalized native right coronary artery CTO by retrograde approach using septal collaterals by surfing technique after recanalization of totally occluded left coronary artery.\n\nOutcomes:\nDyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea.",
+        "translated_fulltext": null,
+        "translated_summary": "患者主诉：\n该患者为69岁男性，既往有冠状动脉搭桥手术史，现因轻微活动后出现严重呼吸困难（NYHA III级），症状持续2个月。\n\n诊断：\n根据心电图、血浆N端脑钠肽前体水平和冠状动脉造影结果，诊断为因搭桥血管（连接于右冠状动脉）功能衰竭引起的缺血性心力衰竭。\n\n干预：\n我们采用逆行入路，利用室间隔侧支血管，通过“冲浪”技术，成功开通了原位右冠状动脉的完全闭塞部位，此前已成功开通了完全闭塞的左冠状动脉。\n\n结果：\n患者出院时呼吸困难症状已缓解。6个月随访时，患者未出现呼吸困难复发。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_194.txt",
+        "fulltext": "A 36-year-old female patient complained of dysphagia with longstanding cervical and upper thoracic pain. She also had a multinodular goiter with no other significant history. Esophagogastroduodenal transit was performed. It showed a posterior and lateral right impression of the proximal esophagus after ingestion of baryte, extending 3.5 cm cephalocaudal. A maximum esophageal stenosis of 60% was estimated. A cervical and thoracic CT scan revealed a congenital anomaly of the aortic arch: a mirror image of the right aortic arch. The aortic arch originates from the root of the aorta and runs above the right stem bronchus, giving rise to the three supra-aortic trunks as follows: the first is the left brachiocephalic artery (which gives rise to the left common carotid artery and the left subclavian artery); the second is the right common carotid artery; and the third is the right subclavian artery. The aortic arch then enters posteriorly to the esophagus and gives rise to a small anterior saccule of 1.3 cm, known as the Kommerell diverticulum. This configuration forms a ring around the tracheo-esophageal pair, whose edges are formed posterior-lateral to the right by the aortic arch, posterior-lateral to the left by the Kommerell diverticulum, lateral to the left by the arteriosum ligamentum (or arterial ligament), and anteriorly by the left brachiocephalic artery. A gastroscopy confirmed the endoluminal impact of extrinsic compression. In view of minimal clinical repercussions and the absence of nutritional disorders, no surgical cure was ultimately performed. The evolution was favorable with, according to the patient, a spontaneous amelioration of symptoms.\n",
+        "summary": "We report the case of a 36-year-old female patient whose dysphagia presented a congenital anomaly of the thoracic aorta: the right aortic arch with mirror image. This is a rare anomaly of embryonic development where the aorta winds around the right stem bronchus and the supra-aortic trunks emerge from the crown in the reverse and opposite order to normal. The vast majority of patients are asymptomatic unless there is a compression of the mediastinal structures. Major compression of the esophagus or trachea, aneurysmal disease, thoracic aortic dissection or the presence of a Kommerell diverticulum of more than 2 cm may warrant surgical intervention. There is no standard treatment and it must be adapted to the clinical presentation and anatomical configuration of the patient. Our patient did not receive any treatment for her condition.\n",
+        "translated_fulltext": "一位36岁的女性患者主诉长期存在吞咽困难，并伴有颈部和上胸部疼痛。她还患有结节性甲状腺肿，但没有其他重要的病史。进行了食管-胃-十二指肠通透性检查，结果显示，钡剂摄入后，近端食管的后部和右侧出现压痕，长度为3.5厘米。估计食管最大狭窄程度为60%。颈部和胸部的CT扫描显示，患者患有先天性主动脉弓异常，表现为右侧主动脉弓的镜像。主动脉弓起源于主动脉根部，位于右侧主支气管上方，并分出三个位于主动脉上方的血管分支，具体如下：第一个是左无名动脉（分出左侧颈总动脉和左侧锁骨下动脉）；第二个是右侧颈总动脉；第三个是右侧锁骨下动脉。然后，主动脉弓从食管后方进入，形成一个1.3厘米的小前部囊状结构，称为科默雷尔憩室。这种结构围绕着气管-食管对形成一个环，其边缘由以下结构构成：右侧为主动脉弓，后外侧；左侧为科默雷尔憩室，后外侧；左侧为动脉韧带（或动脉血管韧带），外侧；前部为左无名动脉。胃镜检查证实了食管内腔受到外部压迫。考虑到临床症状轻微，且没有营养障碍，最终没有进行手术治疗。患者表示，病情逐渐好转，症状得到缓解。",
+        "translated_summary": "我们报告了一例36岁女性患者的病例，该患者出现吞咽困难，经检查发现其患有先天性胸主动脉异常：右侧主动脉弓呈镜像状。这是一种罕见的胚胎发育异常，表现为主动脉绕右侧主支气管盘绕，且超主动脉干从冠部以与正常情况相反的顺序发出。绝大多数患者没有症状，除非胸腔内结构受到压迫。如果食道或气管受到严重压迫，或出现动脉瘤性疾病、胸主动脉夹层，或存在超过2厘米的科默雷尔憩室，则可能需要进行手术干预。目前尚无标准治疗方案，必须根据患者的临床表现和解剖结构进行调整。我们的患者未接受任何针对该病情的治疗。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_382.txt",
+        "fulltext": "A 23-year-old male patient presented to the emergency department with a sudden onset of severe frontal headache lasting for 2 h. He experienced associated symptoms of nausea, vomiting, and chest heaviness. He has a unremarkable medical record and denies the use of illicit drugs. However, he is a smoker with a history of 23 pack-years but does not consume alcohol.\n\nOn physical examination, the young male appeared distressed but was fully conscious and oriented to time, place, and person. Chest auscultation revealed normal vesicular breathing sounds, while cardiovascular and abdominal examinations were inconclusive. Neurological examinations demonstrated neck stiffness, dilated pupils reactive to light, normal plantar reflexes, and no focal neurological deficits.\n\nHis vital signs were as follows: blood pressure 178/103 mmHg, respiratory rate 26 breaths/min, temperature 38.9°C, heart rate 87 beats/min, and oxygen saturation of 94%.\n\nEmergency tests were initiated. An ECG revealed ST segment elevation >2 mm in leads V2-V5, consistent with STEMI as the top of our differential diagnosis, requiring confirmation by cardiac markers. With prompt referral to a tertiary cardiac centre implemented, the patient received a 300 mg aspirin load while being transferred to the catheter lab. Troponin levels were significantly elevated at 1.48 mg/dl (normal <0.16 mg/dl).\n\nPercutaneous coronary intervention was performed via the femoral artery, and the result showed normal coronary arteries with thrombolysis in myocardial infarction (TIMI) flow grade of 3.\n\nHis ECG after coronary angiography revealed normal sinus rhythm with left ventricular hypertrophy LVH. An echocardiogram was performed, revealing normal ventricular function with no regional wall motion abnormalities (RWMA).\n\nFollowing coronary intervention, he was admitted to the medical ward for further assessment and investigation. Blood samples were drawn for a complete blood count, random blood sugar, renal function tests, and CRP. The results revealed lymphocytosis and mildly elevated CRP.\n\nWe proceeded further with CT brain to exclude serious cause of headache. His brain CT showed cisternal subarachnoid haemorrhage SAH with extension anterior to the right temporal lobe. Abdominal ultrasound screening was performed to rule out polycystic kidney disease which was negative and cerebral CT angiography was scheduled to exclude cerebral aneurysm Nimodipine 60 mg every 4 h was initiated, with a target blood pressure of 160/100 mmHg.\n\nOn the second day, his condition suddenly deteriorated, culminating with cardiac arrest. Therefore, cardiopulmonary resuscitation (CPR), resulting in a Glasgow Coma Scale score (GCS) of 6. The patient was subsequently, intubated and placed on mechanical ventilation in the Intensive Care Unit (ICU). Due to his unstable condition in the ICU, we could not perform a repeated CT brain scan or the planned cerebral CT angiography.\n\nOver the next 7 days, we diligently monitored him with a strict multidisciplinary team. A nasogastric tube was inserted for feeding and fluid replacement. His medications included intravenous fluids, antibiotics, proton pump inhibitors, and nimodipine.\n\nOn the 8th day, he suddenly developed ventricular fibrillation, and despite CPR with more than five defibrillations, we were unable to revive him and death was the final outcome.39734686",
+        "summary": "We present a case detailing the diagnostic challenges of a 23-year-old male presenting with a sudden severe headache, nausea, vomiting, and chest heaviness. Initial evaluation showed elevated blood pressure and respiratory rate. An emergency electrocardiogram (ECG) indicated ST-segment elevation myocardial infarction (STEMI), leading to immediate referral for percutaneous coronary intervention, which revealed normal coronary arteries. Further investigations identified a cisternal subarachnoid haemorrhage (SAH) on CT brain imaging. Despite multidisciplinary management, the patient's condition rapidly deteriorated, resulting in cardiac arrest and mortality.",
+        "translated_fulltext": null,
+        "translated_summary": "本文介绍了一例病例，详细描述了一位23岁男性患者，因突发剧烈头痛、恶心、呕吐和胸闷就诊时所面临的诊断挑战。初步检查显示血压和呼吸频率均升高。紧急心电图（ECG）显示ST段抬高型心肌梗死（STEMI），因此立即转诊进行经皮冠状动脉介入治疗，结果显示冠状动脉正常。进一步检查发现，CT脑部影像显示脑池内蛛网膜下腔出血（SAH）。尽管进行了多学科综合治疗，患者的病情迅速恶化，最终导致心脏骤停并死亡。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_280.txt",
+        "fulltext": "A 4-year-old boy with stage IV neuroblastoma received four cycles of chemotherapy, including high-dose chemotherapy including busulfan and melphalan, followed by autologous peripheral blood stem cell transplantation with autologous bone marrow supplementation. After eight additional cycles of chemotherapy consisting of temozolomide and irinotecan, which led to stable disease, the patient underwent preparative conditioning with fludarabine (150 mg/m2), melphalan (140 mg/m2), and 12 Gy of TBI for subsequent allogeneic CBT. The patient received tacrolimus and a short-term course of methotrexate for GVHD prophylaxis. The patient underwent engraftment on day 17. He then developed grade 3 GVHD, which was managed by increasing the prednisolone dose and was later discharged on day 85. The patient also received proton beam therapy (39.6 Gy) from days 121 to 150 post-transplantation for a right supra-mediastinum tumor with residual I123-MIBG accumulation in the right adrenal gland.\n\nThe patient remained healthy with no evidence of GVHD until presentation at our hospital with a productive cough on day 159. As his older brother displayed similar cold symptoms, a rapid antigen test for RSV was performed, which revealed a positive result. His respiratory symptoms gradually worsened, and he revisited our hospital on day 194 with dyspnea and intercostal retractions. Upon admission, he was given 0.7-1.0 mg/kg of prednisolone, which failed to improve his respiratory condition. Chest computed tomography on day 231 revealed infiltration, ground-glass opacity, and septal thickening in the bilateral lung fields along with right pleural effusion. Echocardiography showed an elevated tricuspid regurgitation peak velocity of 4.1 m/s and an interventricular septum close to the isobaric, indicating the presence of PH. In addition, pericardial effusion was detected. On day 231, the patient was transferred to the pediatric intensive care unit, where mechanical ventilation and inhaled nitric oxide (NO) were initiated. Thoracoscopic lung biopsy on day 244 revealed diffuse intra-alveolar hemorrhage and edema on hematoxylin-eosin (HE)-stained samples. Elastica van Gieson staining revealed diffuse obstructive lesions due to fibrocellular components with plump endothelial cells in the pre-septal pulmonary veins and venules. While pulmonary muscular arteries and arterioles showed mild medial hypertrophy and focal intimal thickening (Heath-Edwards Grade 2), severe stenosis with concentric intimal fibrosis or plexiform lesions was present. Based on these results, the patient was diagnosed with PVOD with mild pulmonary arterial/arteriolar lesions. Of note, HE staining also revealed enlarged type II pneumocytes with multinucleated and giant cell-like features, indicating the presence of prior lung injury that was likely attributable to his preceding viral infection.",
+        "summary": "A 4-year-old boy was diagnosed with metastatic neuroblastoma and underwent intensive chemotherapy, autologous HSCT, and allogeneic cord blood transplantation (CBT). He experienced PVOD on day 194 following CBT after displaying upper respiratory symptoms and positive RSV antigen test results approximately one month prior. Pathological examination of a lung biopsy specimen revealed lung injury suspected to be associated with viral infection in addition to PVOD-related findings, suggesting that RSV infection might have contributed to the onset of PVOD.",
+        "translated_fulltext": null,
+        "translated_summary": "一位4岁的男孩被诊断出患有转移性神经母细胞瘤，并接受了强化化疗、自体造血干细胞移植和异基因脐带血移植。在接受脐带血移植后约194天，他出现了肺血管闭塞性疾病（PVOD），此前大约一个月，他曾出现上呼吸道症状，且呼吸道合胞病毒（RSV）抗原检测结果呈阳性。对肺部活检样本进行病理检查后发现，除了与PVOD相关的病理发现外，还存在疑似与病毒感染相关的肺部损伤，这表明RSV感染可能促成了PVOD的发生。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_384.txt",
+        "fulltext": "28-year-old male patient with no significant history presented to the dermatology department with a 48-hour history of a skin condition characterized by two erythematous plaques with central vesicles and superficial ulceration located on the flexor surface of the right arm and forearm equidistant from the elbow crease, accompanied by a burning sensation and pruritus at the site of the lesions. He did not have systemic symptoms or self-medicate. As a background, he reported that he was on vacation in the coastal region of Ecuador at the time of the lesions. An incisional biopsy was performed that reported epidermis with acanthosis, parakeratosis and spongiosis, neutrophils in the stratum corneum and perivascular lymphocyte infiltration in the superficial, middle and deep dermis. Based on the clinical characteristics, the background of travel to a tropical region and the histological findings, a diagnosis of Paederus dermatitis was made. Treatment with antihistamines, topical steroids and cold compresses was indicated. After 8 days of treatment, the lesions resolved, leaving a post-inflammatory hyperpigmentation.\n",
+        "summary": "The case of a 28-year-old male patient who presented to the dermatology department with a 48-hour history of two erythematous plaques with central vesicles and superficial ulceration located on the flexor surface of the right arm and forearm, accompanied by a burning sensation and pruritus at the site of the lesions, without accompanying symptoms, is reported. As a background, he stated that he was on vacation in the coastal region of Ecuador at the time of the lesions. An incisional biopsy was performed and, due to the clinical characteristics and the background of travel to a tropical region, the diagnosis was made as dermatitis by Paederus and treatment with antihistamines, topical steroids and cold compresses was indicated. After 8 days of treatment, the lesions subsided, leaving a post-inflammatory hyperpigmentation.\n",
+        "translated_fulltext": "一位28岁的男性患者，既往病史不明显，因出现持续48小时的皮肤问题而就诊于皮肤科。该皮肤问题表现为：在右臂和前臂的屈侧表面，肘部皱褶处等距离的位置出现两块红斑样斑块，斑块中央有水疱，表面有浅表溃疡，伴有灼烧感和瘙痒。患者没有全身症状，也没有自行用药。他表示，在出现皮损时，他正在厄瓜多尔的沿海地区度假。进行了切取活检，结果显示表皮有棘状增生、角化不全和海绵状水肿，角质层中有中性粒细胞，浅层、中层和深层真皮中有血管周围淋巴细胞浸润。根据临床特征、旅行史（前往热带地区）以及组织病理学检查结果，诊断为水黾虫皮炎。建议使用抗组胺药、外用类固醇和冷敷进行治疗。治疗8天后，皮损消退，仅留下炎症后色素沉着。",
+        "translated_summary": null,
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_24.txt",
+        "fulltext": "Patient and observation\nPatient information (presentation of the patient): he is a 28-year-old single man without children, an active military. He has been present for 5 weeks with progressive abdominal pain, more marked in the epigastrium and the right hypochondrium, followed shortly after by a non-quantified fever, chills, profuse sweats in a context of anorexia and weight loss of 6 kg. Note that the patient is not a drinker or smoker, vaccinated with BCG and has no other contributing personal or family history.\n\nClinical findings: On admission, the physical examination found the patient in a general altered state, asthenic with a weight loss of 6 kg in one month. A clinical systemic inflammatory response syndrome was present with the following elements: a fever of 39.1 °C, tachycardia (124 beats/min), polypnea (22 cycles/min). The pulmonary examination and exploration of the superficial lymph node areas were without particularity. In the abdominal area, moderate sensitivity in the right hypochondrium with hepatomegaly was found.\n\nChronology: dates back to February 2022 with the onset of diffuse abdominal pain with diarrhea-constipation transit disorder, all in a context of preservation of general condition with low-grade fever predominantly at night. A syntagmatic treatment was unsuccessfully initiated. The evolution is marked by the persistence of low-grade fever associated with anorexia and progressive weight loss of 12 kg over three months. In the face of this transit disorder with unexplained fever and the deterioration of the general condition, the patient will be admitted to the emergency department for further investigation.\n\nDiagnostic approach: upon admission, a biological infectious syndrome was reported with a neutrophilic predominant hyperleucocytosis (17800 cells/mm3) and a high C-reactive protein of 323 mg/L.\n\nIn the face of his abdominal pain, the lipase and troponin tests were normal at 38 IU/L (VN: <3 78 IU/L) and 4 ng/L (VN: 2 to 16 ng/L) respectively. The liver function was stable with ALT (alanine amino transferase) at 22 IU/L (VN: < 40UI/L), AST (aspartate amino transferase) at 17 IU/L (VN: < 35UI/L), GGT (gamma glutamyl transferase) at 42 IU/L (VN: < 50UI/L), PAL (alkaline phosphatase) at 115 IU/L (VN: 40- 150 IU/L) and normal bilirubinemia. The liver function was normal with a prothrombin rate of 78% and an albuminemia of 39 g/L. The blood ionogram and renal function were normal. The chest radiograph and abdominal ultrasound were without particularity.\n\nWith a procalcitonin positive at 4.1 ng/L, an infectious disease assessment to search for the infectious focus was initiated, including a cytobacteriological examination of urine and blood cultures during the febrile peaks at 39°C, which were both negative. The hepatitis viral B, C and HIV serologies, as well as the syphilis serology performed in hospital were all negative. The lactate dehydrogenase (LDH) and beta-2 microglobulin were normal at 231 IU/L and 2.28 mg/L respectively. The GeneXpert to search for the Mycobacterium on these bioptic pieces was negative. The quantiferon was negative. The search for the Mycobacterium on the morning expectorations of 3 consecutive days was negative.\n\nOn the morphological level, a thoraco-abdomino-pelvic scan showed an enlarged liver (hepatic arrow at 17 cm), the site of multiple, well-defined, rounded hypodensities, which were not enhanced after injection of the contrast agent. The largest lesions were in segment I (21 x 16 mm) and segment V (36 x 27 mm). No suspicious lesions were detected in the thoracic and pelvic levels. The first liver biopsies obtained by echo-guided puncture revealed subacute, fibro-inflammatory liver lesions, with no histological evidence of specificity or malignancy.\n\nA liver MRI following the scan objectified a dysmorphic liver, the site of lesions in heterogeneous signal T2 surrounded by a wall in hyper signal T2, enhanced in the periphery after injection of the contrast agent, the largest of which is located in segment I (20 x 22 mm) and in segment V (33 x 31 mm). No deep lymphadenopathy had been objectified, either in the scan or in the MRI. A diagnostic laparoscopy performed on the hepatic nodules, the histological examination found epithelioid and gigantocellular granulomas of varying size with caseous necrosis in favour of a hepatic tuberculosis.\n\nTherapeutic intervention: the patient was put on anti-tuberculosis treatment according to the standard protocol for months: Phase 1: quadritherapy (Isoniazide + Rifampicine + Pyrazinamide + Ethambutol) in a single oral intake each morning on an empty stomach for 2 months. Phase 2: bithrapia (Isoniazide + Rifampicine) in a single oral intake each morning on an empty stomach for 4 months\n\nFollow-up and results of therapeutic interventions: from the first days of treatment, a good response was obtained with disappearance of the inflammatory syndrome with systemic response both clinically and biologically. After three months of treatment, a control scan of the liver showed a decrease in the number and volume of liver lesions.\n",
+        "summary": "This clinical case was reported in a young Moroccan, presenting a picture of hepatic colic that had been developing for a month, associated with subtle signs of tuberculous infection. Non-specific hepatic nodular lesions were revealed on the scanner and on the hepatic magnetic resonance imaging (MRI). The diagnosis of focal hepatic tuberculosis was confirmed after pathological analysis of hepatic nodule biopsies obtained after a laparoscopy. After the start of well-conducted anti-bacillary treatment, a good clinical-biological improvement was obtained.\n",
+        "translated_fulltext": null,
+        "translated_summary": "本病例为一名年轻的摩洛哥患者，其临床表现为持续一个月之久的肝绞痛，并伴有轻微的结核感染迹象。扫描和肝脏磁共振成像（MRI）显示，患者肝脏存在非特异性结节状病变。在腹腔镜检查后，对肝脏结节活检样本进行病理分析，最终确诊为局灶性肝结核。在开始规范的抗结核治疗后，患者的临床和生物学指标均得到明显改善。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_3.txt",
+        "fulltext": "We present a case of a 59-year-old lady with a twelve-year history of secondary progressive multiple sclerosis who was referred to ophthalmology with a few weeks’ history of bilateral blurring of vision.\n\nThe patient had no past ophthalmic history and no drug history other than the anti-epileptic medications related to her multiple sclerosis. Previously documented ophthalmic examinations did not reveal any signs of Fuchs' endothelial corneal dystrophy, and the patient has no family history of corneal pathology.\n\nThe patient had been on amantadine therapy at a dose of 100mg twice daily for the past 7 years and was started on levetiracetam 250mg twice daily as an add-on agent. Visual deterioration was experienced shortly after commencement of levetiracetam therapy for a breakthrough seizure.\n\nOn examination, the patient’s best corrected visual acuity was 0.5 logMAR right eye and 0.5 logMAR left eye. Slit-lamp examination revealed corneal edema involving both eyes and absence of uveitis. Corrected intraocular pressures were 16mmHg right eye and 18mmHg left eye. Corneal topography was performed which confirmed bilateral significant corneal thickening with a right central corneal thickness of 936μm and left central corneal thickness of 1134μm. The rest of the eye examination was normal.\n\nSince amantadine is a known cause of corneal edema, it was agreed with the patient and her caring neurologist to switch from amantadine to lamotrigine. Levetiracetam therapy was continued at this stage. No improvement in vision was noted two months after this change in treatment. The patient expressed the wish to temporarily stop levetiracetam on a trial basis in view of the direct temporal association between the onset of symptoms and the commencement of the medication.\n\nAmantadine was re-introduced, while levetiracetam dose was tapered. Improvement in vision was noted a few days after levetiracetam dose reduction. Levetiracetam was stopped altogether, and the patient remained on amantadine and lamotrigine. A provisional diagnosis of levetiracetam-induced corneal edema was made at this stage. Her vision normalized and repeat corneal topography six months after stopping the levetiracetam showed a right central corneal thickness of 567μm and a left central corneal thickness of 573μm, and a visual acuity of 0.2 logMAR both eyes. Slit-lamp examination confirmed clear cornea and the absence of corneal guttata in either eye.\n\nThe patient was examined again thirteen months after the first presentation. No further changes in her medications were made, and her vision had remained stable at 0.2 logMAR in both eyes. Repeat corneal topography showed no further changes.",
+        "summary": "A 59-year-old woman was referred to the ophthalmology department with a few weeks’ history of bilateral blurring of vision. She is a known case of secondary progressive multiple sclerosis, and she was started on levetiracetam by her neurologist a few weeks prior to referral in view of new seizure activity. Examination revealed bilateral clinically evident corneal edema, which was documented on corneal topography.\n\nResults\nUpon levetiracetam dose reduction, symptoms started to improve and eventually the medication was stopped altogether. The patient’s vision and corneal edema normalized on follow-up.",
+        "translated_fulltext": null,
+        "translated_summary": "一位 59 岁的女性因双眼视力模糊，症状持续数周，被转诊至眼科。她确诊为继发性进展型多发性硬化症，在转诊前几周，她的神经科医生开始给她服用左乙拉西坦，以控制新出现的癫痫发作。检查显示，双眼均有临床上明显的角膜水肿，并在角膜地形图检查中得到了证实。\n\n结果\n在减少左乙拉西坦的剂量后，症状开始好转，最终完全停止了该药物的服用。随访期间，患者的视力和角膜水肿均恢复正常。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_491.txt",
+        "fulltext": "This is a 32-year-old patient, a baker, from Bamako, who was admitted to the Infectious and Tropical Diseases department of the CHU du Point G (Bamako, Mali) on 27 April 2023 for chronic productive cough, otalgia and a chronic right-sided purulent otorrhea.\n\nThe symptomatology would be of progressive installation in 1 month, initially treated in a medical center with artésunate, paracetamol and unspecified antibiotics for confirmed malaria and acute otitis media, without success. He is immunosuppressed by a HIV1 infection, diagnosed and put on a tritherapy antiretroviral (TARV) Tenofovir/Lamivudine/Dolutégravir 7 months ago, not observed due to denial of his illness.\n\nThe general physical examination found a fever (38.2 °C), altered general condition, otalgia, purulent right foul-smelling otorrhea, a right basal pulmonary condensation syndrome, a normal neurological examination, without the involvement of the cranial nerves, mainly the facial nerve VII and the VIII cochleovestibular nerve.\n\nIn the ENT examination, the otoscopy of the right ear showed an inflammatory external auditory canal with purulent secretions and the presence of a single tympanic perforation in the anterior-inferior quadrant. The left ear is normal. The Rinne and Weber test is in favor of a right conductive hearing loss.\n\nImmuno-virological evaluation shows a CD4 count of 118 cells/pl and a viral load of 12,370 copies/ml at the time of diagnosis of HIV infection, compared to a viral load of 9,460 copies/ml and a CD4 lymphocyte count of 193 cells/pl at the 6th month of antiretroviral treatment. At the time of diagnosis of tuberculosis at the 7th month, the immuno-virological evaluation shows a CD4 count of 89 cells/pl and a viral load of 10,230 copies/ml.\n\nThe Ziehl Neelsen bacilloscopy was positive with a cross in the gastric washings on admission and 19 days later in the right ear swab because of the persistent otorrhea. The Xpert-MTB/GeneXpert test did not detect rifampicin-resistant Mycobacterium tuberculosis.\n\nThe frontal chest radiograph shows a more accentuated bronchovascular network at the base of the right lung.\n\nThe diagnosis of tuberculosis of the middle ear concomitant to a pulmonary localization in the field of immunosuppression by HIV1 is therefore retained.\n\nThe patient is put on oral first-line anti-tuberculosis for 6 months, a fixed dose of a quadra-therapy in the intensive phase of isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months (2RHZE), followed by a bi-therapy in the maintenance phase of isoniazid and rifampicin for 4 months (4RH) at a dose of 3 tablets/day in the morning on an empty stomach, associated with vitamin B6 (1 tablet/day). He benefits from two sessions of therapeutic reinforcement with anti-retroviral drugs. The ART is restarted on 4 May 2023 with his consent, given the good tolerance of the anti-tuberculosis drugs, with the combination of tenofovir/lamivudine/dolutegravir at a dose of 1 tablet/day associated with dolutegravir 50 mg as a supplement (1 tablet/day) according to the protocol for the management of HIV/AIDS. A chemoprophylaxis with cotrimoxazole 960 mg (1 tablet/day) is undertaken as well as a cleaning of the external auditory canal by aspiration and the instillation of ciprofloxacin ear drops (2 drops 3 times a day) for 14 days.\n\nThe evolution is favorable after 14 days of treatment, marked by a pyrexia, a good general state, the amendment of the cough and otorrhea with the negativation of the bacilloscopy in the gastric tube liquid and the swab of the pus of the right ear. At the end of the maintenance anti-tuberculosis treatment, the clinical healing is complete with a normal ENT and neurological examination. The bacilloscopy associated with the Xpert-MTB/GeneXpert test at the end of the 2nd month of the intensive phase, during the 5th month and at the end of the 6th month of the maintenance phase were negative. The HIV viral load performed after 3 months of ART is 329 copies/ml.\n",
+        "summary": "The patient presented with a chronic productive cough, otalgia and a chronic right-sided purulent otorrhea. The search for acid-fast bacilli was positive by direct examination in the gastric tube liquid and the swab of the auricular pus.\n\nAn anti-tuberculosis treatment of 6 months, associated with adjuvants, led to the patient's complete recovery.\n",
+        "translated_fulltext": null,
+        "translated_summary": "患者出现慢性咳嗽，伴有咳痰，并伴有耳痛和慢性右侧化脓性耳漏。通过胃管液和耳道分泌物直接涂片检查，发现抗酸杆菌呈阳性。\n\n经过六个月的抗结核治疗，并配合使用辅助药物，患者完全康复。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_285.txt",
+        "fulltext": "Patient information: A 19-year-old male with no significant medical history was admitted to our department with a painful left scrotal mass that had been present for 8 months and had not improved with antibiotics for pyogenic organisms. The patient reported intermittent low grade fever, night sweats, anorexia and unexplained weight loss since the onset of symptoms. He did not have a cough, sputum or haemoptysis. There was no history of tuberculosis in his personal or family medical history. He was vaccinated against tuberculosis at birth.\n\nClinical findings: Physical examination revealed a large, painful, slightly hot left bursa and two elongated, poorly defined, firm, painful subcutaneous formations in the anterior thoracic wall, 3 to 4 cm long. There were no rales on auscultation. The remainder of the examination was normal. Laboratory studies revealed a high c-reactive protein of 90 mg/dl. The blood count, creatinine, blood glucose and liver function tests were within normal limits. The standard chest X-ray showed reticulonodular infiltrates in both lung fields.\n\nDiagnostic approach: In the presence of an ultrasound finding in favour of an epididymal tumour, the patient underwent a left orchidectomy. However, the pathological examination of the surgical specimen showed a granulomatous epitheloid necrosis of the epididymis, suggestive of active epididymal tuberculosis involving the body and tail of the epididymis and sparing the head and testicle. The intradermal tuberculin reaction was positive. The search for acid-fast bacilli (AFB) in sputum and urine for 3 consecutive days was negative on direct examination and culture. The serologies for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and Wright's stain were also negative. In search of other tuberculous sites, a thoraco-abdomino-pelvic tomodensitometry was performed, which showed a miliary tuberculosis, coelo-mesenteric necrotic adenopathies, two thoracic parietal collections (at the expense of the external oblique muscles measuring 33 × 10 mm on the right and 45 × 10 mm on the left) and a focal osteolysis of D11 and L5, suggestive of a spondylodiscitis in the early stages. The magnetic resonance imaging (MRI) of the spinal cord confirmed the existence of a spondylodiscitis at the level of D7, D11, L4 and L5. The diagnosis of disseminated tuberculosis with epididymal, pulmonary, parietal, ganglionary and osteo-articular sites was retained.\n\nTherapeutic intervention: a poly-chemotherapy for tuberculosis with isoniazid, rifampicin, ethambutol and pyrazinamide for 2 months, followed by the association of isoniazid and rifampicin, was initiated.\n\nFollow-up and results: however, at the 4th month of treatment, the patient had presented generalised tonic-clonic convulsive seizures. A brain MRI was performed, showing multiple nodular lesions above and below the tentorial membrane corresponding to tuberculomas. The patient was put on anticonvulsive treatment and anti-tuberculosis treatment was continued. The evolution was favourable with recovery of the general condition and weight gain from the first months of treatment as well as a disappearance of thoracic parietal formations, adenopathies and tuberculous milia on the tomodensitometry with absence of recurrence of convulsive seizures. However, the slow decrease of the size of the tuberculomas obliged us to continue the anti-tuberculosis treatment for a long period. Finally, the patient was declared cured, without sequelae, at the end of the 234th month of treatment with a 2-year follow-up.\n",
+        "summary": "A 19-year-old man with no significant history was admitted to hospital with a painful left scrotal mass that had been present for 8 months. He had undergone an orchidectomy and the pathological examination was in favour of epididymal tuberculosis. A radiological examination had shown other sites of infection: lymph nodes, lungs, parietal and osteoarticular. An anti-tuberculosis treatment was initiated. However, in the 4th month of treatment, the patient had convulsive seizures. A brain MRI was performed and concluded that there were brain tuberculomas. The anti-tuberculosis treatment was continued in association with an anticonvulsant with good clinical and radiological evolution.\n",
+        "translated_fulltext": null,
+        "translated_summary": "一位19岁的男性，既往无特殊病史，因左侧阴囊出现持续8个月的疼痛性肿块而入院。他曾接受过睾丸切除术，病理检查结果显示为附睾结核。放射学检查显示，感染部位还包括淋巴结、肺部、壁层胸膜和骨关节。开始进行抗结核治疗。然而，在治疗的第四个月，患者出现了抽搐。进行了脑部MRI检查，结果显示存在脑结核瘤。继续进行抗结核治疗，并联合使用抗惊厥药物，患者的临床和放射学表现均有改善。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_508.txt",
+        "fulltext": "We present the case of a 10-year-old male diagnosed with high-risk early T-cell acute lymphoblastic leukaemia, who was treated according to the LAL SEHOP-PETHEMA 2013 protocol. Two years after diagnosis, he developed an early CNS relapse, so he was treated according to the InteReALL HR 2010 protocol with bortezomib. During induction, after being neutropenic for four weeks (20 neutrophils/μL), he was receiving prophylaxis with cefepime, cotrimoxazole and fluconazole. In addition, he was being treated with acyclovir for a herpes simplex virus 1 skin infection. In this context, he developed a severe headache that did not respond to usual analgesia. A cranial computed tomographic scan was performed that showed a hypodens lesion in the right temporal lobe. When the possibility of an infectious origin was considered, a lumbar puncture was performed and cefepime was replaced with meropenem and vancomycin.\n\nDespite remaining afebrile, he developed signs of septic shock on the first day after admission to the clinic and was transferred to the paediatric intensive care unit for inotropic and vasoactive support. In addition, the antimicrobial spectrum was extended with gentamicin and caspofungin.\n\nThe blood analysis showed a progressive increase in C-reactive protein and procalcitonin (up to 312 mg/L and 47.58 ng/mL, respectively, on the third day of evolution), with no other relevant biochemical alterations. The blood count showed pancytopenia due to chemotherapy. The blood cultures ruled out bacteremia and fungemia, and herpes virus serologies were negative. The urine culture and the fecal culture were also negative. The biochemical analysis of the cerebrospinal fluid was completely normal (glucose, 63 mg/dL; proteins, 16 mg/dL; leukocytes 1/µL), but the presence of B. cereus was detected in the microbiological study (sensitive to meropenem, vancomycin, linezolid and ciprofloxacin). The presence of herpes simplex 1 and 2, herpes virus 6, cytomegalovirus, varicella-zoster virus, enterovirus, parechovirus, toxoplasma, Neisseria meningitidis, Listeria monocytogenes, Streptococcus pneumoniae and Cryptococcus was ruled out in the cerebrospinal fluid.\n\nThe EEG showed diffuse slowing of brain activity with no clear epileptiform activity. On day 4, after the haemodynamic support was removed, a cranial MRI showed two hyperintense lesions in T2 and FLAIR that involved the subcortical region of the right temporal and parietal lobes. The parietal lesion had ring enhancement after administration of gadolinium and both lesions showed peripheral diffusion restriction. In addition, small haemorrhagic foci were observed scattered in the brain parenchyma. The image suggested a bacterial origin with an atypical germ, and these findings, together with those of the cerebrospinal fluid, led to the diagnosis of B. cereus abscess.\n\nAfter two weeks of treatment, the patient had a favorable outcome with resolution of the headache and no neurological findings. A follow-up MRI showed a decrease in the size of the lesions. Vancomycin and acyclovir were discontinued after three weeks and meropenem was continued for six weeks.\n",
+        "summary": "We present the case of a 10-year-old boy undergoing chemotherapy for acute lymphoblastic leukaemia. During the induction period he developed a cerebral abscess caused by B. cereus that was diagnosed by imaging tests and direct detection in the cerebrospinal fluid. His evolution was favourable with antibiotic treatment.\n",
+        "translated_fulltext": null,
+        "translated_summary": "我们介绍一例10岁男孩，他因急性淋巴细胞白血病接受化疗。在化疗初期，他出现了由蜡样芽孢杆菌引起的脑脓肿，通过影像学检查和脑脊液直接检测确诊。经过抗生素治疗，他的病情得到了良好的控制。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_129.txt",
+        "fulltext": "Patient presentation: This is a 37-year-old female patient who presented with a mixed dysphagia of gradual onset in the context of weight loss and altered general condition. The history was unremarkable. The evolution was marked by a progressive worsening of inspiratory dyspnoea. The patient presented with laryngeal dyspnoea which led to an emergency tracheotomy.\n\nClinical findings: the general clinical examination found a patient well oriented in time and space, with a stable haemodynamic state. The ENT examination revealed a right parapharyngeal mass that almost completely filled the pharyngeal lumen and obstructed the upper airway.\n\nTimeline: After the clinical examination, the patient underwent a cervical MRI and a biopsy of the parapharyngeal mass under local anaesthesia. The pathological examination of the biopsy led to the performance of a thoraco-abdomino-pelvic tomodensitometry (TDM) and bone scintigraphy.\n\nDiagnostic approach: MRI of the cervical region showed a tumour process in the right parapharyngeal space bulging into the pharynx with a T2 hyper signal with diffusion restriction and enhancement after gadolinium injection. It measures 47 x 40 x 50 mm. The tumour occupies almost the entire pharyngeal lumen and invades the upper palatal arch. The latter is swollen with areas of necrosis. A biopsy of the mass with histopathological examination showed basophilic round tumour cells. The immunohistochemical study was positive for CD99, anti-S100 antibodies and Ki67. In addition, a cytogenetic study was performed on the sample to look for a EWS/FLI1 translocation, which was positive. The final pathological result concluded that it was an extraosseous Ewing sarcoma of the parapharyngeal space. The extension assessment was negative.\n\nTherapeutic intervention: the patient was referred to oncology for first-line chemotherapy with vincristine, ifosfamide, doxorubicin and etoposide.\n\nFollow-up and results of therapeutic interventions: after 6 courses of chemotherapy, the progression of the tumour continued and the patient died due to the extension of the disease to the base of the skull.\n",
+        "summary": "We report the clinical case of a 37-year-old female patient who was admitted as an emergency for inspiratory dyspnoea in a picture of asthenia and anorexia. The cervical magnetic resonance imaging (MRI) objectified a process that was obstructing almost the entire pharyngeal lumen. The anatomopathological, immunohistochemical and cytogenetic study concluded that it was an extraskeletal Ewing sarcoma. The extension assessment was negative. The patient received chemotherapy.\n",
+        "translated_fulltext": null,
+        "translated_summary": "我们报告了一例37岁女性患者的临床病例。该患者因呼吸困难、虚弱和食欲不振等症状被紧急送往医院。颈部磁共振成像（MRI）显示，病灶几乎完全阻塞了咽腔。通过解剖病理学、免疫组织化学和细胞遗传学研究，最终确诊为骨外尤文肉瘤。评估结果显示，肿瘤未发生扩散。该患者接受了化疗。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_156.txt",
+        "fulltext": "24-year-old male patient with no relevant medical history. Pre-event systemic review was negative. He presented with a 10-day history that began with nasal congestion. On the third day, he participated in a rescue operation in a forest fire, where he did not suffer visible burns. On the fourth day, he developed general systemic involvement and night sweats, red eye with mucopurulent discharge, epiphora, erosive lesions of the upper lip and whitish plaques on the inner walls of the oral cavity, which were painful. He consulted emergency services three times, where he was treated on an outpatient basis with chlorpheniramine, paracetamol and NSAIDs. Despite this, the condition progressed with myalgia, fever of up to 39°C, greater involvement of the general system and oral mucosa that made it difficult to eat, dry cough and vomiting of food.\n\nConsultation for the fourth time, 10 days before the onset of the clinical picture, in the emergency department of our center. On admission he was described as tachycardic (115 bpm), temperature 37.8°C, respiratory rate of 20 bpm, saturating 97% with FIO2 ambient. On physical examination he had conjunctival injection with bipalpebral edema, purulent discharge and epiphora, erosive lesions sensitive with mobile whitish plaques in oral mucosa and urinary meatus. On physical examination he had conjunctival injection with bipalpebral edema, purulent discharge and epiphora, erosive lesions sensitive with mobile whitish plaques in oral mucosa and urinary meatus. Scarce skin lesions (< 5% body surface) in anterior thorax, hyperpigmented, non-pruritic, with negative Nikolsky sign. No other alterations. In his laboratory examinations he had leukocytes at 13,200, without eosinophilia and PCR at 205.4 mg/l (normal < 5). Red series, platelets, plasma electrolytes, renal and hepatic function normal. Complete urine examination and non-inflammatory sediment. He was diagnosed with \"non-oncological mucositis\", and was managed with infusions of physiological serum, ceftriaxone and hospitalization in a room with protective isolation.\n\nIn the study, a naso-fibroscopy was performed that showed congestive mucous from the nose to the hypopharynx with mucopurulent secretion, ruling out burns. The Computed Axial Tomography (TAC) of the thorax showed multiple foci of alveolar filling associated with a budding tree image, compatible with interstitial pneumonia.\n\nIn the etiological study, a respiratory filmArray™ was performed, positive for Chlamydophila pneumoniae and adenovirus. Serology was also requested for hepatitis B and C viruses, HIV, EBV, CMV, Mycoplasma pneumoniae, VDRL, PCR in oral lesions of HSV I and II, culture of current urethral secretion, for Neisseria gonorrhoeae and fungi, PCR urethral secretion, uroculture and blood cultures, all with negative results.\n\nThe patient was treated in a team with dermatology, ophthalmology, immunology and internal medicine. Support was provided with parenteral hydration and nutrition, nursing care, azithromycin associated with hydrocortisone for 5 days, antibiotic eye drops for suspected superinfection, oral rinses with miconazole 20 mg in gel format and protection of lips and urethral meatus with cream based on panthenol, bisabolol and glycerine.\n\nAfter five days of treatment, good clinical and laboratory evolution was observed, so skin biopsy was discarded and oral feeding was gradually initiated.\n\nOn day 12 of hospitalization, the patient was in good general condition, eating properly orally, with clinical resolution of pulmonary condition, healing of oral and urethral mucous lesions.\n\nSo he was discharged with a referral for immunology check-ups.\n",
+        "summary": "A 24-year-old patient with extensive mucous and respiratory involvement compatible with mucous respiratory syndrome caused by Chlamydophila pneumoniae is presented. Initially treated with NSAIDs, which makes it difficult to differentiate from other syndromes with mucous and cutaneous involvement caused by these drugs.\n",
+        "translated_fulltext": null,
+        "translated_summary": "本文介绍了一位24岁的患者，该患者出现广泛的黏膜和呼吸道受累症状，符合由肺炎衣原体引起的黏膜呼吸综合征。最初，患者接受了非甾体抗炎药（NSAIDs）的治疗，但由于这些药物也会引起黏膜和皮肤受累，因此难以将其与其他综合征区分开来。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_514.txt",
+        "fulltext": "An 86-year-old male patient presented to the emergency room for a 3-week nonpainful priapism. Our patient, a former cleaner agent, is only known for a transient ischemic incident. He has no previous surgical history. Physical examination showed a semierect nontender penis with a mild lateral deviation and a smooth glans. No superficial penile lesion was observed. The patient reported that he had lost normal erections almost 20 years ago. All clinical signs were in favor of a nonischemic priapism. The patient was a former smoker and reported mild upper respiratory tract symptoms as well. Lab work-ups and urine analyses were unremarkable; hence, the decision was to pursue investigations in an ambulatory setting using a penile ultrasound and a thoracoabdominal computed tomography (CT) scan looking for a malignancy.\n\nDoppler ultrasonography (US) of the penis was performed, revealing circumscribed hypoechogenic nodules infiltrating the albuginea of the corpus cavernosum, with a base and right-side predominance. No abnormalities were detected in the corpus spongiosum. A normal resistive index with a normal penile artery velocity was measured, in favor of a nonischemic situation.\n\nThoracoabdominal CT revealed a mass at the lung's left hilum surrounding the bronchovascular structures. Several bilateral nodules and micronodules were observed. The largest ones were located at the right apex and right lung base. Mediastinal enlarged lymph nodes were also seen at the lower paratracheal station. The liver was also affected by several lesions; the largest was located at Segment 7, which measured 96 mm. The left adrenal gland and pancreatic lesions were noted. Finally, two osteolytic lesions were observed on the first left rib and on the transverse process of fifth lumbar vertebra (L5). The patient was referred to the lung cancer specialist for further investigations. A pulmonary biopsy was performed, confirming adenocarcinoma of the lung. Molecular analysis of the cells showed a pGly12Cys (G12C) variant of the KRAS gene. PDL-1 was also noted as positive.\n\nAfter a multidisciplinary discussion, the decision was for the patient to pursue four-cycle chemotherapy and immunotherapy by cisplatin, pemetrexed, and pembrolizumab. The patient poorly tolerated the first cycle of chemotherapy and developed febrile pancytopenia. The decision was to halt the chemotherapy and pursue the immunotherapy by pembrolizumab.\n\nAs for the penile lesions, since the patient did not have any pain, surveillance was adopted.",
+        "summary": "We hereby report the case of an 86-year-old male patient who presented with a 3-week-long nonpainful priapism. A penile Doppler ultrasound and a chest and abdominal CT scan were performed, showing a left hilar lung mass as well as lesions in the liver, the adrenal glands, the pancreas, bone structures, and the penis. Penile metastasis is associated with a poor prognosis because of the frequent disseminated malignant lesions in other sites.",
+        "translated_fulltext": null,
+        "translated_summary": "现报告一例86岁男性患者，其主诉为持续3周的无痛性阴茎勃起。经阴茎多普勒超声检查以及胸部和腹部CT扫描，结果显示左侧肺门处有肿块，同时肝脏、肾上腺、胰腺、骨骼和阴茎也存在病灶。阴茎转移与不良预后相关，因为其他部位经常出现广泛的恶性病灶。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_248.txt",
+        "fulltext": "Our patient is a healthy 37-year-old Hispanic male who sustained a simultaneous rupture of his bilateral patellar tendons after jumping attempting to make a “lay-up basket” while playing basketball. Pertinent history includes anterior cruciate ligament (ACL) reconstruction of the right knee using an ipsilateral bone-patellar tendon bone (BPTB) autograft in 2002. The patient was unable to ambulate and presented to our clinic in wheelchair. The patient was unable to perform a straight leg raise and had a tender defect at the inferior pole of the patella bilaterally. Plane radiographs demonstrated bilateral patella alta and MRI studies demonstrated bilateral proximal patellar tendon ruptures. The recommendation for acute simultaneous surgical repair of both knees was given to the patient.\n\nOperative technique\nIntraoperative exam showed significant swelling of both knees, with full extension and flexion to 140 degrees bilaterally. There was palpable defect and patella alta bilaterally associated with patellar tendon rupture.\n\nThe knee was approached through the standard anterior midline approach. The extent of the tear was elucidated, involving both the medial and lateral retinaculum. A hematoma was evacuated, and the deep and subcutaneous tissues were irrigated. Traction sutures were placed in the quadricep tendon to help mobilize the patella distally. The proximal patellar tendon and the distal stump of the patellar tendon were elucidated.\n\nTwo 4.75 mm bio-composite SwiveLock suture anchors (SpeedBridge Implant System with Scorpion-Multifire Needle, Arthrex, Inc., No. AR-2600SBS-8) were placed within the inferior pole of the patella at the origin of the patellar tendon. A Krackow locking stitch was performed with each of the SwiveLock suture anchors with a pull through suture. This was brought up and down the patellar tendon in a locking stitch configuration. The knee was placed in 30 degrees of flexion, and the patellar length was made to be 4.5 cm. As the patient did not have an intact contra-lateral patellar tendon to base our patella tendon length, 4.5 cm was chosen as this has been an average male patella length recently described in the literature. Intraoperative C-arm fluoroscopy was utilized to confirm appropriate patellar height. This was double checked by attempting to obtain a Caton-Deschamps index of approximately 1:1. The knots were then tied down from the locking stitch configuration in the upper repair back onto the suture anchors in the patella.\n\nThe same anchors had #2 FiberTape sutures (Arthrex, Inc) loaded. These were crisscrossed in a suture bridge configuration and placed in separate SwiveLock anchors in the tibial tubercle with the knee at 30 degrees of flexion. The remaining paratenon and soft tissue was imbricated to help reinforce the repair. The medial and lateral retinaculum were then repaired with a running locking #2 FiberWire suture (Arthrex, Inc). After an extensive irrigation of the deep and subcutaneous tissues, a standard layered closure was then performed.\n\nThe left knee was addressed next in an identical fashion. At the end of this case, each knee was able to obtain 0 to 30 degrees of flexion without any undue tension on the repairs.\n\nPatient follow-up\nThe patient remained non-weight bearing except for transfers for 6 weeks post-operatively. Both knees were initially locked in full extension with a brace. Two days after surgery, the patient started physical therapy with Continuous Passive Motion machine, increasing ∼15° per week. After 6 weeks, the patient started full weight bearing with braces locked in extension with a walker. His ROM was approximately 0–110° on both legs, and he could perform straight leg raises without difficulty.\n\nAt 10 months he demonstrated 5/5 quadriceps strength, −10° of extension, and 140° of flexion bilaterally. Knee Documentation Committee (IKDC) score was 57 bilaterally.\n\nAt 12 months the patient had normal alignment with symmetric quadriceps strength bilaterally. His ROM remained at −10 degrees of uncorrectable passive extension and 140 degrees of flexion bilaterally. The patient's right and left knee IKDC score improved to 69 and 72, respectively. His recorded Lysholm score at 12 months for his right and left knee was 94 and 99, respectively.",
+        "summary": "We describe the case of a 37-year-old male who presented with simultaneous bilateral patellar tendon rupture without any associated risk factors. Additionally, this is the first reported use of the suture bridge technique with patellar and tibial suture anchors in repairing bilateral proximal patellar tendon rupture. At 12-month follow-up, the patient had normal alignment, no effusion, and symmetric quadriceps strength.",
+        "translated_fulltext": null,
+        "translated_summary": "我们报告了一例37岁男性患者，该患者同时发生了双侧髌腱断裂，且没有任何相关的危险因素。此外，这是首次报道使用缝合桥技术，结合髌骨和胫骨缝合锚，来修复双侧近端髌腱断裂。在12个月的随访中，患者的肢体对齐正常，没有积液，且股四头肌力量对称。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_107.txt",
+        "fulltext": "We present the case of an 82-year-old man with a diagnosis of adenocarcinoma of the ascending colon, confirmed by endoscopic biopsy. In the preoperative staging studies, there were no signs of distant disease and he had a CEA of 2.8 ng/mL. He underwent a laparoscopic right hemicolectomy and had a favorable postoperative course. The pathology report showed a moderately differentiated adenocarcinoma, stage 1, T1 N0, and did not require adjuvant treatment.\n\nIn the oncological follow-up, a nodular image in the left iliac chain measuring 22 mm in its minor axis was identified by tomography. Due to this finding, a PET-CT with 18F-FDG was performed in which a single ovoid lesion was evidenced at the retroperitoneal level, adjacent to the aortic bifurcation of approximately 34 mm in major diameter with scarce enhancement after administration of iodinated contrast.\n\nThis image proved to be hypermetabolic (SUV: 6.7). No other images linked to the pathology under study were found. Given the patient's background, a percutaneous biopsy guided by images was scheduled with local anaesthesia. The procedure was well tolerated and was not associated with complications. This study demonstrated that the finding was a schwannoma. After a year of follow-up, the size of the biopsy lesion increased (44 mm in major diameter), however, without clinical manifestations. In turn, there was no evidence of progression of oncological disease.\n",
+        "summary": "We present the case of an 82-year-old male patient with a newly diagnosed moderately differentiated colon adenocarcinoma and a hypermetabolic periaortic nodule as an incidental finding.\n\nResults: Percutaneous biopsy of the periaortic node confirmed the diagnosis of schwannoma. At one year follow-up, the schwannoma has demonstrated growth. There is no evidence of progression of his cancer disease.\n",
+        "translated_fulltext": null,
+        "translated_summary": "我们报告了一例82岁男性患者的病例，该患者新近被诊断出患有中度分化的结肠腺癌，同时在检查中偶然发现其主动脉周围区域存在一个代谢活跃的结节。\n\n结果：经皮穿刺活检证实该主动脉周围结节为神经鞘瘤。一年随访后，神经鞘瘤显示出生长迹象。目前尚无证据表明患者的癌症病情有进展。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_178.txt",
+        "fulltext": "A 56-year-old male presented to the emergency department of our hospital due to sudden onset shortness of breath and an episode of syncope while walking around inside his house. He underwent robotic assisted laparoscopic prostatectomy for prostate carcinoma, 5 days prior to his presentation to the Emergency Department. His post-operative course in the hospital was uneventful. In the emergency department, his blood pressure was 94/54 mmHg, heart rate 121 beats per minute, respiratory rate 20 breathes per minute, he was afebrile, and his oxygen saturation was 92% on 6 L per minute of oxygen via nasal cannula. Cardiac examination revealed S1S2, regular, tachycardic, no murmur/gallops/rubs. Respiratory examination revealed normal vesicular breath sounds bilaterally. He was noted to have asymmetrical left lower extremity edema. Electrocardiogram (ECG) revealed sinus tachycardia, no ST-T wave changes. Troponin was mildly elevated at 0.120 ng/mL (reference range: 0 to 0.020). Computed tomography angiography (CTA) of chest showed extensive bilateral pulmonary emboli, with a large clot burden in both main pulmonary arteries, evidence of acute right ventricular failure. Duplex venous scan showed acute left infra-popliteal deep vein thrombosis. Echocardiogram showed normal left ventricular ejection fraction of 60% to 65%, abnormal septal motion and flattening of interventricular septum, right ventricular systolic pressure of 49.7 mmHg, moderately dilated right ventricle, decreased right ventricle function, Tricuspid annular plane systolic excursion of 12.1 mm (normal 15 to 20 mm). As the majority of the clot burden was distal, it was not deemed amenable to surgical extraction as recent surgery was a major contraindication for thrombolysis. The patient was started on a heparin drip and inhaled nitric oxide at 20 ppm along with oral sildenafil 40 mg every 8 hours. The next day, the patient was stable hemodynamically and his inhaled nitric oxide was tapered off. Repeat echocardiogram 48 hours from initial presentation showed improved right ventricle size and function. His right ventricular systolic pressure decreased to 22.4 mmHg and his tricuspid annular plane systolic excursion improved to 17.8 mm. We recommended that he continue sildenafil for the next month after discharge along with oral anticoagulation with a plan to follow-up as an outpatient. The patient gave written consent to treatment during his hospitalization. The patient and his family members were well-informed regarding the entire plan of care, and they were in agreement with the care plan.",
+        "summary": "Patient: Male, 56\n\nFinal Diagnosis: Right heart failure due to pulmonary embolism\n\nSymptoms: Syncope\n\nMedication: —\n\nClinical Procedure: —\n\nSpecialty: Cardiology\n\nThis is a case report where sildenafil was used as a rescue agent to achieve improvement in the right ventricle size and function in a case of acute onset massive pulmonary embolism with acute right ventricle failure in the scenario where systemic thrombolytic therapy was contraindicated.",
+        "translated_fulltext": null,
+        "translated_summary": "患者：男性，56岁\n\n最终诊断：肺栓塞引起的右心衰竭\n\n症状：晕厥\n\n用药：无\n\n临床流程：无\n\n专科：心脏病学\n\n这是一份病例报告，其中西地那非被用作抢救药物，以改善急性发作的大量肺栓塞患者的右心室大小和功能，该患者同时患有急性右心室衰竭，且全身性溶栓治疗存在禁忌症。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_168.txt",
+        "fulltext": "A 21-year-old single female patient with a known history of hypertension and metastatic pheochromocytoma presented to our hospital. Her cancer has metastasized to the bladder, bones, and lungs. She also has a strong family history of malignancy, particularly pheochromocytoma. The patient was admitted due to uncontrolled hypertension and chronic symptoms related to her condition.\n\nOn admission (09/06/2024), the patient was normotensive (BP: 104/66 mmHg), her heart rate was approximately 90 beats per minute, afebrile at 36.9°C, and had an oxygen saturation of 99% on room air. Physical examination indicated an Eastern Cooperative Oncology Group (ECOG) performance status of 2, pallor consistent with chronic anemia, regular heart beat with no murmurs or additional sounds. The abdominal examination was unremarkable, and no edema or ecchymosis was noted in the lower limbs.\n\nThe patient has a history of hypertension and paraganglioma, her medication includes (Doxazosin 2 mg, Labetalol 100 mg, Oxybutynin 5 mg, Paraffin oil, Nifedipine 30 mg). Her surgical history includes a right adrenalectomy at age ten, and she has received various treatments, including somatostatin analogues and palliative radiotherapy. Family history reveals a familial succinate dehydrogenase subunit B mutation (SDBH mutation) with a significant history of endocrine malignancies, including pheochromocytomas in her father and sister and pancreatic cancer in her grandmother.\n\nLaboratory investigations including Complete Blood Count revealed significant anemia, with a hemoglobin level of 7.5 g/dl. There was evidence of hemolysis, as indicated by the high reticulocyte count, indirect bilirubin, and Lactate Dehydrogenase. Haptoglobin was low. Laboratory results are shown in. Coagulation profile excluded Disseminated Intravascular Coagulation (DIC), which shows (PT: 15.6, PTT: 23.3, fibrinogen: 489, D-dimer: 0.63). Direct Coombs test to exclude autoimmune hemolytic anemia was negative. Peripheral blood smears showed the presence of schistocytes, echinocytes a few teardrop cells in addition to thrombocytopenia, all pointing towards microangiopathic hemolytic anemia (MAHA). Given the context of metastatic cancer, the patient was diagnosed with paraneoplastic microangiopathic hemolytic anemia in march/2024.\n\nThe patient was scheduled for CVD protocol (cyclophosphamide, vincristine and doxorubicin), but without cyclophosphamide due to the anemia-inducing effect of alkylating agents. The patient received a total of 5 cycles. As an indicator of clinical response, the patient no longer experienced anemia or thrombocytopenia. A new peripheral blood smear revealed normal cells, which suggests a clinical response to the MAHA that coincides with the improvement of the underlying malignancy. This aligns with the definition of MAHA as a paraneoplastic syndrome.\n\nThe patient medications on discharge are dexamethasone 2 mg tablet, 4 mg peroral (PO) once daily (OD) for 3 days, ondansetron tablet 8 mg PO OD for 3 days, metoclopramide10 mg tablet PO Trible daily for 3 days, calcium 600 mg with vitamin D PO OD for 1 day, labetalol100 mg tablet PO BID for 1 day, doxazocin 2 mg tablet 4 mg PO BID for 1 day, citalopram20 mg tablet PO for 1 day, omeprazole 20 mg, 40 mg PO for 1 day, paracetamol 500 mg tablet, 1000 mg PO BID for 1 day, aprepitant 125 mg/80 mg capsules, 1 capsule PO OD for 3 days (with a prescription).\n\nThe patient had a follow up in 01/07/2024, clinically the patent looks well and active. The patient underwent laboratory investigations including Complete Blood Count (WBC 6.59 10e3/ul, RBC 4.47 × 10^6/ul, HGB 13.2 g/dl, 40.0%, MCV 89.4 fL, PLT 41.5 10e3/ul), Blood Urea Nitrogen 33.8 mg/dl, Creatine kinase-MB 36.1 u/l, Serum Creatinine 0.97 mg/dl, Chloride 101.5 mmol/l, Potassium 4.52 mmol/l, Sodium 135 mmol/l.",
+        "summary": "In this case report, we present a 21-year-old single female with a strong family history of endocrine malignancy. She was referred to our hospital for chemotherapy due to a diagnosis of malignant pheochromocytoma, which had metastasized to the urinary bladder, bone, and lung. Additionally, she developed microangiopathic hemolytic anemia as a paraneoplastic syndrome.",
+        "translated_fulltext": null,
+        "translated_summary": "在本病例报告中，我们介绍了一位21岁的未婚女性，其家族中有明显的内分泌系统恶性肿瘤病史。她因被诊断出患有恶性嗜铬细胞瘤而被转诊至我院，该肿瘤已转移至膀胱、骨骼和肺部，并接受化疗。此外，她还出现了与肿瘤相关的副肿瘤综合征，表现为微血管病性溶血性贫血。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_368.txt",
+        "fulltext": "42-year-old man with a history of major depressive disorder on treatment with venlafaxine, clonazepam and mirtazapine presents a history of worsening mood with thoughts of death, for which he consumes rodenticide 20 mg of the active Brodifacoum with an attempt at self-harm. He was hospitalized one day after the event, treated with intravenous vitamin K and transfusion of fresh frozen plasma, and was discharged 24 hours after normalization of the INR. At his home, he presented anterior epistaxis 5 days later. Emergency consultation where oxaloacetic transaminase, SGOT 63 U/L (VR 10-40 U/L); pyruvic transaminase, SGPT 93 U/L (VR 10-55 U/L); alkaline phosphatase, FA 139 (VR 45-115 U/L); prothrombin time, TP 9% (VR 70-120%); International normalized ratio, INR 7; activated partial thromboplastin time, TTPA 73.2s (VR 25-37s), concordant with coagulopathy due to Brodifacoum ingestion.\n\nDuring hospitalization, the patient presented variable INR measurements, with initial ranges between 7 and 11.6 in the first three days. During the fourth day, the INR ranged between 3.6 and 1.8. After this, the patient achieved stable therapeutic ranges with INR between 1.5 and 1.2. The total daily doses of vitamin K administered during the hospitalization period varied between 20 and 40 mg depending on the results obtained from the INR measurements. Finally, an optimal dose of supplementation for the normalization of the INR of 10 mg intravenous every 8 hours (30 mg a day) was reached. The frequency of the coagulogram controls performed and the respective doses of oral vitamin K administered, until the optimal dose of supplementation with vitamin K for normalization of the INR was reached, are described.\n\nDischarge was indicated and an optimised dose of vitamin K 10 mg orally every 8 hours was maintained, in addition to daily control of the INR with a haematologist and guidance on the importance of adhering to the medication and the need to avoid substances that may increase the risk of bleeding. In addition, a period of control in the polyclinic of anticoagulant treatment and outpatient control with haematology and psychiatry was indicated.\n\nThe patient was contacted at 4 months and indicated that he had not presented episodes of bleeding during this period. He reported that he had maintained the treatment with 10 mg of vitamin K, with which the INR level had been maintained in the therapeutic range. The patient did not report adverse effects, however, he reported difficulty in accessing the drug due to the cost of treatment and the low availability in pharmacies.\n",
+        "summary": "We present the case of a 42-year-old man who ingested a toxic dose of rodenticide in a suicide attempt, with epistaxis, INR of 11.6 and need for hospitalization. During 7 days, serial checks of coagulation tests were performed, with optimization of different doses of vitamin K supplementation.\n",
+        "translated_fulltext": null,
+        "translated_summary": "我们报告了一例42岁男性因企图自杀而误服大量毒性鼠药的病例。该患者出现鼻出血，国际标准化比值（INR）为11.6，需要住院治疗。在接下来的7天里，我们对其进行了多次凝血功能检查，并根据结果调整了维生素K的补充剂量。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_208.txt",
+        "fulltext": "Clinical Data\nA 19-year-old male presented at the endocrinology department of our hospital on January 11, 2023. Two months prior, the patient developed emotional agitation without obvious inducement, accompanied by chest tightness, hand-shaking, and diarrhea. Thyroid function was examined at another hospital on November 8, 2022, and revealed the following: triiodothyronine (T3), 2.85 (normal range, 1.01–2.95) nmol/L; thyroxine (T4), 196.00 (normal range, 55.34–160.88) nmol/L; free triiodothyronine (FT3), 8.69 (normal range, 2.77–6.50) pmol/L; free thyroxine (FT4), 37.50 (normal range, 10.43–24.32) pmol/L; and TSH, 3.48 (normal range, 0.40–4.34) mIU/L. At that time, the patient was unable to receive further diagnosis and treatment for personal reasons. One week before presenting at our hospital, the patient developed palpitations, and the reported symptoms were slightly worse than before. The outpatient clinic examined his thyroid function and revealed the following: T3, 2.20 (normal range, 1.01–2.95) nmol/L; T4, 209.90 (normal range, 55.34–160.88) nmol/L; FT3, 8.63 (normal range, 2.77–6.50) pmol/L; FT4, 34.06 (normal range, 10.43–24.32) pmol/L; TSH, 4.13 (normal range, 0.40–4.34) mIU/L; thyroid peroxidase antibody (TPOAb), 43.80 (normal range, <60) U/mL; and thyroglobulin antibody (TGAb), <15 (normal range, <60) U/mL. The patient was admitted to the hospital from the outpatient clinic with suspected syndrome of inappropriate secretion of TSH (SITSH). During the course of the disease, the patient did not experience fever, chills, or sweating. The patient’s appetite was unaffected, and he did not experience weight loss, fatigue, constipation, or other discomfort. The patient was in good health and had no history of chronic disease or radiation exposure to the neck. His parents were not consanguineous, and no genetic history in the family.\n\nPhysical examination revealed the following: body temperature, 36.5°C; pulse, 97 bpm; breathing, 19 bpm; blood pressure, 120/78 mmHg; height, 172 cm; weight, 70 kg; BMI, 23.66 kg/m2; clear mind; normal development, intelligence, vision, and hearing; no exophthalmos; free eye movements; mild thyroid enlargement and softness, with no tenderness and with swallowing up and down; no vascular murmur; no positive signs in the heart, lung or abdomen; normal muscle strength and tension of the extremities; no mucinous edema of lower limbs.\n\nSupplementary Examination\nRe-examination of thyroid function on January 12, 2023, revealed the following results: T3, 1.99 (normal range, 1.01–2.95) nmol/L; T4, 184.30 (normal range, 55.34–160.88) nmol/L; FT3, 8.17 (normal range, 2.77–6.50) pmol/L; FT4, 32.74 (normal range, 10.43–24.32) pmol/L; TSH, 2.30 (normal range, 0.40–4.34) mIU/L; TPOAb, 52.00 (normal range, <60) U/mL; TGAb, <15 (normal range, <60) U/mL; thyroid stimulating receptor antibody (TRAb), <0.10 (normal range, <1.00) U/L; and reverse triiodothyronine (rT3), 66.13 (normal range, 35.00–95.00) ng/dl. There were no obvious abnormalities in the blood routine, biochemistry, cortisol rhythm, adrenocorticotropin, growth hormone, or sex hormone test results. The 2-hour thyroid iodine uptake rate was lower than the normal value, and the 6-hour thyroid iodine uptake rate was normal. Thyroid color Doppler ultrasound revealed a right thyroid follicular cyst (TI-RADS-II). Thyroid single photon emission computed tomography revealed an enlarged thyroid volume. Bone age: adult bone age. No obvious abnormalities were found on routine or enhanced magnetic resonance imaging (MRI) of the pituitary gland. The patient’s electrocardiogram results were normal.\n\nGenetic Testing\nThe patient showed elevated FT3, FT4, and T4 levels and some manifestations of thyrotoxicosis; however, his TSH and thyroid autoantibody levels were normal, and the thyroid iodine uptake rate decreased, which did not support the diagnosis of primary hyperthyroidism. The physical and other auxiliary examinations also ruled out thyroiditis, TSH secreting pituitary adenoma (TSHoma), and other central hyperthyroidism. The patient was highly suspected to have RTH. Genetic analyses were performed on the patient and his family after obtaining informed consent. The full exome of genomic DNA was captured and sequenced by KingMed Diagnostics Co., Ltd. The result revealed a heterozygous mutation in the THRB gene encoding thyroid hormone receptor β (TRβ) on chromosome 3. The 947 base G in the gene’s coding region was converted to A, and the nucleotide codon changed from CGC to CAC, converting amino acid 316 from arginine to histidine (R316H). Missense mutations can lead to RTH. The mother and the patient had a heterozygous mutation at the same site; the father had no mutation.",
+        "summary": "We report a 19-year-old male patient with elevation of thyroid hormones. Serological examination showed elevated thyroid hormone levels, and thyroid-stimulating hormone levels within the reference interval. The patient was finally diagnosed with RTH after genetic testing that identified a gene mutation inherited from his mother. Due to timely diagnosis, the patient’s condition has been well controlled, and his prognosis is good.",
+        "translated_fulltext": null,
+        "translated_summary": "我们报告了一例19岁男性患者，其甲状腺激素水平升高。血清学检查显示甲状腺激素水平升高，促甲状腺激素水平在正常范围内。经过基因检测，发现患者存在从母亲那里遗传来的基因突变，最终确诊为甲状腺激素抵抗综合征（RTH）。由于及时诊断，患者的病情得到了有效控制，预后良好。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_23.txt",
+        "fulltext": "Nine-year-old male school patient with attempted suicide. Product of second pregnancy, unplanned, unwanted, but accepted. Preeclampsia was reported at eight months of pregnancy with unspecified pharmacological management, obtained at term via abdominal, weight of 3,500 grams.\n\nHead trauma at age 2 years from a fall from approximately 50 centimeters, without loss of alertness or medical attention. The 31-year-old father had symptoms of unspecified anxiety at age 26 without attention; the 14-year-old brother reported academic difficulties and irritability. Resto questioned and denied.\n\nThe family was disintegrated by the parents' separation when the patient was three years old, so he had been living for a year in a large family nucleus with his father, and living with his mother during school holidays. Low socioeconomic status.\n\nAbout an hour before admission to hospital, and following a disagreement with his brother, the minor impulsively locked himself in the bathroom, where he got the shower curtain around his neck. When found by a relative, without knowing how much time had passed, he was observed with a loss of alertness, and was taken to a hospital unit near his home for treatment. On admission, he was reported to have a temperature of 35ºC, blood pressure of 80/44 mmHg, heart rate of 100 beats per minute, respiratory rate of 30 breaths per minute, weak central pulse, dilated pupils, hypertonic, with generalised cyanosis, ecchymosis in the left side of the neck and pulmonary fields with respiratory roughness, so advanced airway management and aminergic support with norepinephrine at a dose of 0.2 mcg/kg/min was carried out.\n\nHe was sent to a third level unit to continue his care, where a tomography of the skull was performed, which showed data of mild edema with decreased subarachnoid space and loss of the convolutions. He was kept sedated and neuroprotective in the pediatric intensive care unit, and was extubated five days later without incident. He was started on oral medication tolerating the diet.\n\nHe was referred to the mental health service for assessment and identification of potentially related risk factors. During his stay in the hospital area, the minor was directly questioned and symptoms of insidious onset, chronic course, with a factor associated with the separation of the parents and little contact with his mother were detected. He presented a picture characterised by sadness most of the time, hyporexia, recurrent dreams where he sees himself alone, with feelings of guilt, a decrease in the ability to think and concentrate (mainly in school), thoughts of death, which generated dysfunction in the family and school areas and attempted suicide a few days earlier. Based on the above, a diagnosis of severe depressive episode was made, and pharmacological treatment with fluoxetine at 20 mg/day was initiated.\n\nThe family structure and organization was found to be lacking a shared hierarchy between both parents, with confusion in the lines of responsibility and rules of living together, without clear boundaries, along with ambivalent parenting practices ranging from authoritarian to indifferent and inadequate supervision. In terms of communication, problems were observed manifested by discomfort in expressing ideas and feelings, which consequently led to the transmission of confusing messages. The older brother had a parental role to the patient. Consequently, the family showed dysfunction and psychotherapeutic intervention was granted to both the patient and his relatives.\n\nThe patient was discharged fifteen days after admission to the hospital, as he showed improvement and stability. He continued with follow-up in the outpatient department where the presence of a persistent pattern of inattention, hyperactivity and impulsivity was detected, which, according to the mother, was noticeable from the age of two years. This could hinder his development and functioning, as in the case of the acquisition of reading, as he presented learning difficulties (he succeeded in learning up to the third grade of primary school with the help of the Regular Education Support Unit, USAER).\n\nThe results of the psychological tests (Bender test and human figure) indicated neurological immaturity, which supported the diagnosis of attention deficit disorder with hyperactivity (ADHD). Treatment with methylphenidate 20 mg/day was initiated.\n\nRegarding his evolution, an improvement in the symptomatology was observed, so after a year of follow-up he was discharged to his General Hospital of the Zone to continue surveillance. Currently, the minor has remained with remission of affective symptoms, stability in symptoms of inattention, hyperactivity and impulsivity and without presenting suicidal behaviors.\n",
+        "summary": "The nine-year-old male patient put his life at risk by attempting suicide by hanging in the bathroom. He received emergency care and was in the intensive care unit. During his hospitalization he was approached by the mental health service. Among the factors that have been previously associated with suicide attempts in school age that could be identified in the patient are: family disintegration, symptoms of severe depressive episode, difficulty in learning to read and a disorder of attention deficit with hyperactivity. The patient received treatment and follow-up, and to date has not returned to suicidal behaviour. He is currently thirteen years old.\n",
+        "translated_fulltext": null,
+        "translated_summary": "这名九岁的男性患者在浴室里试图上吊自杀，危及了自己的生命。他接受了紧急救治，并被送入重症监护室。住院期间，心理健康服务部门与他进行了沟通。在患者身上，可以识别出一些此前与学龄儿童自杀行为相关的因素，包括：家庭破裂、出现严重的抑郁症症状、阅读学习困难以及注意力缺陷多动障碍。该患者接受了治疗和随访，截至目前，他没有再次出现自杀行为。他现在十三岁。",
+        "judge_pass": true
+    },
+    {
+        "id": "multiclinsum_gs_en_574.txt",
+        "fulltext": "4-year-old patient with no family history of interest was referred to the dermatology department for congenital ichthyosiform syndrome since birth. Erythematous plaques with active desquamative border were observed on the scalp, face, trunk, elbows, knees, extremities, palms and soles. Skin biopsy revealed hyperkeratosis consistent with seborrheic eczema.\n\nLaboratory findings were normal except for aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP). Persistent hypertransaminemia was observed. The clinical morphology of the lesions suggested the clinical diagnosis of probable erythrokeratoderma variabilis given the changing and migratory character of the hyperkeratotic lesions. However, the alteration of the hepatic tests forced to evaluate other possibilities. The ichthyosiform aspect of the process associated with hepatopathy required to rule out the Chanarin Dorfman syndrome.\n\nReview of the peripheral blood smear (PBS) was requested, revealing multiple cytoplasmic vacuoles within granulocyte series cells and platelets. Thus, the picture of generalized dry ichthyosiform erythroderma and the presence of lipid vacuoles in the polymorphonuclear (PMN) cells of the PBS suggested that the most likely diagnosis was neutral lipid storage disease, also known as Chanarin-Dorfman syndrome. Examination of the PBS smear of the patient's parents did not show the presence of vacuoles in the PMNs.\n\nThe diagnosis was confirmed by Sanger sequencing of the CGI-58 gene, the causative gene of the syndrome. It was performed in the index case and parents, and a nonsense mutation in exon 6 (934G→T; R312X) inherited from the father and an insertion/deletion at position 617 in exon 4 inherited from the mother were detected. The latter caused a change in the reading frame that resulted in a premature stop codon. The patient turned out to be a carrier of both mutations in homozygosis.\n\nFollowing the diagnosis, ophthalmological examination, evaluation of muscle enzymes, otorhinolaryngological examination to rule out hearing disorders and neuropaediatric examination were recommended. In addition, periodic checks by the dermatology service were advised and contact was made with the nutrition and dietetics service to make an assessment. The ophthalmological and neuropaediatric examination was unremarkable; however, mild neurosensorial hearing loss and creatine kinase levels of 2 to 5 times the upper normal limit were observed despite no muscular pains.\n\nAs there is no specific treatment for this disease, the only effective treatment was the restriction of long chain triglycerides in the diet and supplementation with medium chain triglycerides. After six months of treatment, the patient showed clinical improvement manifesting a reduction of the scaling areas, without finding a significant variation in the levels of AST, ALT and FAL.\n",
+        "summary": "4-year-old patient with generalized erythematous-scaly ichthyosiform syndrome since the first days of birth. The laboratory report highlighted persistent hypertransaminemia. Among other complementary tests, the peripheral blood smear (SP) was performed, revealing the presence of multiple cytoplasmic vacuoles inside the polymorphonuclear leukocytes (PMN) and platelets. The ichthyosiform lesions together with the presence of lipid vacuoles in the SP PMN are signs compatible with Chanarin-Dorfman syndrome. The diagnosis was confirmed by genetic sequencing.\n",
+        "translated_fulltext": null,
+        "translated_summary": "患者为一名四岁的儿童，自出生之初就患有全身性红斑鳞屑状鱼鳞病。实验室报告显示，患者持续存在转氨酶升高。在进行的其他辅助检查中，进行了外周血涂片检查，结果显示，在多形核白细胞和血小板的细胞质内存在多个空泡。鱼鳞病样病变以及外周血涂片中多形核白细胞内存在脂质空泡，这些都是与夏纳林-多夫曼综合征相符的症状。通过基因测序确诊。",
+        "judge_pass": true
+    }
+]
\ No newline at end of file
diff --git a/data/translated_data/translation_wo_judge/multiclinsum_gs_train_en2bn_gemma(0_200).json b/data/translated_data/translation_wo_judge/multiclinsum_gs_train_en2bn_gemma(0_200).json
new file mode 100644
index 0000000000000000000000000000000000000000..757dba31aaa0e844e2c9d0b606007ea909f3d441
--- /dev/null
+++ b/data/translated_data/translation_wo_judge/multiclinsum_gs_train_en2bn_gemma(0_200).json
@@ -0,0 +1,562 @@
+[
+  {
+    "id": "multiclinsum_gs_en_27.txt",
+    "fulltext": "A 20-year-old woman was followed up since the age of eight for idiopathic NS inaugurated by cerebral venous thrombosis extended to the right jugular vein with a massive pulmonary embolism. The patient did not have any sequelae. She had no other medical or surgical history. A family history of thrombosis has not been reported. The patient was not biopsied because she had no kidney failure nor gross hematuria, or hypertension at first presentation; added to that, she had no extra renal signs suggestive of a secondary nephrotic syndrome. She was accordingly put on anticoagulant therapy (Oral vitamin K antagonist) and oral corticosteroid therapy with good evolution. Thereafter, the patient received several cures of high-dose corticosteroids for steroid-dependent relapses of NS. She was, hence, put on mycophenolate mofetil (MMF) as a background therapy to avoid corticosteroids and ensure normal growth. An exhaustive assessment of thrombophilia was performed and did not show any abnormality. Homocysteine rate, blood fibrinogen rate, Protein C, protein S, antithrombin III, factor V Leiden mutation, JAK-2 mutation, cryoglobulins, anticardiolipin antibodies, lupus anticoagulant and beta-1-glycoprotein antibodies were normal. The anticoagulant treatment was stopped after nine years. The evolution was enameled by the occurrence of several relapses of her disease controlled by oral corticosteroid therapy. Remission of NS has been noted since 2017, so MMF was gradually stopped in 2019 and the patient remained asymptomatic and without any relapse.\n\nOne year later, the patient came up to our emergency department for acute intense diffuse abdominal pain without any particular irradiation associated with postprandial vomiting and bilateral lower limb edema for the last six hours. The physical examination revealed an intense epigastric tenderness with normal vital signs (arterial pressure of 120/70 mm Hg, heart rate of 83 bpm, and oxygen saturation at 100% on room air). The patient was afebrile with normal consciousness. The rest of the physical examination was unremarkable. The urinalysis with labstix revealed proteinuria. The hemogasanalysis results showed metabolic acidosis with respiratory compensation. Further laboratory tests revealed hypoalbuminemia, hypercholesterolemia, a prothrombin time at 90%, high levels of D-dimer, lactate dehydrogenase, and creatine phosphokinase as well as a biological inflammatory syndrome with a CRP of 37 mg/L, and leucocytosis at 26.4 x 103/µL. Renal and liver functions were normal.\n\nThe patient was hospitalized in an intensive care unit with close monitoring of vital signs and initiation of resuscitation measures. An abdominal ultrasound was performed urgently showing an intra-abdominal effusion of low to moderate abundance. An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery with acute mesenteric ischemia. The patient was immediately routed to the operating room. Intraoperative exploration confirmed mesenteric ischemia with extensive necrosis of almost entirely of the small bowel making their resections incompatible with life shown in Figure 3. The patient died after 48 hours.",
+    "summary": "We present the case of a 20-year-old woman with a 12-year history of idiopathic NS revealed by extensive cerebral venous thrombosis with pulmonary embolism treated with anticoagulation therapy and oral corticosteroid therapy followed by mycophenolate mofetil (MMF). The thrombophilia assessment did not show any abnormalities. The evolution was marked by the occurrence of several NS relapses controlled by oral corticosteroid therapy until 2017. Subsequently, the patient had not presented a relapse of her disease. The anticoagulant treatment and the MMF were therefore stopped. One year later, the patient presented with severe diffuse acute abdominal pain associated with postprandial vomiting and bilateral lower limb edema. Laboratory results confirmed a NS relapse. An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery with acute mesenteric ischemia. Intraoperative exploration showed mesenteric ischemia with extensive necrosis of the small intestine making their resections incompatible with life. The patient died after 48 hours.",
+    "translated_fulltext": "একজন ২০ বছর বয়সী মহিলার আট বছর বয়স থেকে ইডিওপ্যাথিক এনএস-এর (idiopathic NS) চিকিৎসা করা হচ্ছিল, যা সেরিব্রাল ভেনাস থ্রম্বোসিসের (cerebral venous thrombosis) মাধ্যমে শুরু হয়েছিল এবং ডান দিকের জুগুলার শিরায় (jugular vein) ছড়িয়ে পড়েছিল, যার সাথে একটি বড় পালমোনারি এমবোলিজম (pulmonary embolism) ছিল। রোগীর কোনো জটিলতা দেখা যায়নি। তার অন্য কোনো চিকিৎসা বা অস্ত্রোপচারের ইতিহাস ছিল না। পরিবারে থ্রম্বোসিসের (thrombosis) কোনো ইতিহাস পাওয়া যায়নি। রোগীর কিডনি বিকল ছিল না, অথবা প্রথম দেখাতে গুরুতর হেমাটুরিয়া (hematuria) বা উচ্চ রক্তচাপ ছিল না, তাই প্রথমে বায়োপসি করা হয়নি। এছাড়াও, তার শরীরে দ্বিতীয় স্তরের নেফ্রোটিক সিনড্রোমের (nephrotic syndrome) কোনো লক্ষণ ছিল না। সেই অনুযায়ী, তাকে অ্যান্টিকোয়াগুল্যান্ট থেরাপি (ওরাল ভিটামিন কে অ্যান্টাগনিস্ট) এবং ওরাল কর্টিকোস্টেরয়েড থেরাপির (oral corticosteroid therapy) অধীনে রাখা হয়, এবং এতে ভালো ফল পাওয়া যায়। এরপর, স্টেরয়েড-নির্ভর এনএস-এর পুনরাবৃত্তির (relapses) জন্য রোগীকে উচ্চ মাত্রার কর্টিকোস্টেরয়েড দেওয়া হয়। তাই, কর্টিকোস্টেরয়েড ব্যবহার এড়াতে এবং স্বাভাবিক বৃদ্ধি নিশ্চিত করতে তাকে ব্যাকগ্রাউন্ড থেরাপি হিসেবে মাইকোফেনোলেট মোফেটিল (Mycophenolate Mofetil - MMF) দেওয়া হয়। থ্রম্বোফিলিয়ার (thrombophilia) বিস্তারিত পরীক্ষা করা হয়, কিন্তু কোনো অস্বাভাবিকতা পাওয়া যায়নি। হোমোসিস্টাইন (homocysteine) এবং রক্তে ফাইব্রিনোজেনের (fibrinogen) মাত্রা, প্রোটিন সি (Protein C), প্রোটিন এস (protein S), অ্যান্টিথ্রমবিন III (antithrombin III), ফ্যাক্টর ভি লিডেন মিউটেশন (factor V Leiden mutation), জেএকে-২ মিউটেশন (JAK-2 mutation), ক্রায়োগ্লোবুলিন (cryoglobulins), অ্যান্টিকার্ডিওলাইপিন অ্যান্টিবডি (anticardiolipin antibodies), লুপাস অ্যান্টিকোয়াগুল্যান্ট (lupus anticoagulant) এবং বিটা-১-গ্লাইকোপ্রোটিন অ্যান্টিবডি (beta-1-glycoprotein antibodies) স্বাভাবিক ছিল। নয় বছর পর অ্যান্টিকোয়াগুল্যান্ট চিকিৎসা বন্ধ করা হয়। এরপর, ওরাল কর্টিকোস্টেরয়েড থেরাপির মাধ্যমে তার রোগের পুনরাবৃত্তি নিয়ন্ত্রণ করা হয়। ২০১৭ সাল থেকে এনএস-এর উন্নতি দেখা যায়, তাই ২০১৯ সালে ধীরে ধীরে এমএমএফ (MMF) বন্ধ করে দেওয়া হয় এবং রোগী উপসর্গবিহীন অবস্থায় থাকে এবং পুনরায় কোনো সমস্যা দেখা যায় না।\n\nএক বছর পর, রোগী তীব্র পেটে ব্যথা নিয়ে আমাদের জরুরি বিভাগে আসে। ব্যথাটি পেটের সর্বত্র ছড়িয়ে পড়েছিল এবং এর সাথে খাবার খাওয়ার পরে বমি এবং গত ছয় ঘন্টায় উভয় পায়ে ফোলাভাব ছিল। শারীরিক পরীক্ষায় পেটের মাঝের অংশে তীব্র ব্যথা পাওয়া যায়, তবে অন্যান্য শারীরিক লক্ষণগুলো স্বাভাবিক ছিল (ধমনীর চাপ ১২০/৭০ মিমি এইচজি, হৃদস্পন্দন ৮৩ বিপিএম এবং স্বাভাবিক বাতাসে অক্সিজেনের মাত্রা ১০০%)। রোগীর জ্বর ছিল না এবং তার চেতনা স্বাভাবিক ছিল। অন্যান্য শারীরিক পরীক্ষায় তেমন কিছু পাওয়া যায়নি। প্রস্রাব পরীক্ষায় প্রোটিনুরিয়া (proteinuria) দেখা যায়। রক্ত পরীক্ষার ফলাফলে শ্বাস-প্রশ্বাস স্বাভাবিক রেখে বিপাকীয় অ্যাসিডোসিস (metabolic acidosis) ধরা পড়ে। আরও কিছু ল্যাবরেটরি পরীক্ষায় হাইপোঅ্যালবুমিনেমিয়া (hypoalbuminemia), হাইপারকোলেস্টেরোলেমিয়া (hypercholesterolemia), নব্বই শতাংশ প্রোথ্রোমবিন টাইম (prothrombin time), উচ্চ মাত্রার ডি-ডাইমার (D-dimer), ল্যাকটেট ডিহাইড্রোজেনেস (lactate dehydrogenase) এবং ক্রিয়েটিন ফসফোকাইনেজ (creatine phosphokinase) পাওয়া যায়, সেইসাথে সিআরপি (CRP) ৩৭ মিলিগ্রাম/লিটার এবং শ্বেত রক্তকণিকার সংখ্যা ২৬.৪ x ১০৩/µL ছিল, যা প্রদাহের লক্ষণ নির্দেশ করে। কিডনি এবং লিভারের কার্যকারিতা স্বাভাবিক ছিল।\n\nরোগীকে একটি নিবিড় পরিচর্যা কেন্দ্রে (intensive care unit) ভর্তি করা হয়, যেখানে তার শারীরিক লক্ষণগুলোর দিকে নজর রাখা হয় এবং প্রয়োজনীয় চিকিৎসা শুরু করা হয়। দ্রুত পেটের আলট্রাসাউন্ড (ultrasound) করে দেখা যায় পেটের মধ্যে অল্প থেকে মাঝারি পরিমাণে তরল জমা হয়েছে। পেটের সিটি স্ক্যান (CT scan) করে দেখা যায় supérieure mesenteric ধমনীতে (superior mesenteric artery) তীব্র থ্রম্বোসিস (thrombosis) হয়েছে, যার কারণে মেসেন্টেরিক ইস্কেমিয়া (mesenteric ischemia) হয়েছে। রোগীকে দ্রুত অপারেশন থিয়েটারে নিয়ে যাওয়া হয়। অপারেশনের সময় দেখা যায় মেসেন্টেরিক ইস্কেমিয়ার (mesenteric ischemia) কারণে ক্ষুদ্রান্ত্রের (small bowel) প্রায় পুরোটাই মারাত্মকভাবে ক্ষতিগ্রস্ত হয়েছে, যা অপসারণ করলে রোগীর জীবন বাঁচানো সম্ভব হবে না (চিত্র ৩)। অপারেশনের পর ৪৮ ঘণ্টার মধ্যে রোগীর মৃত্যু হয়।",
+    "translated_summary": "আমরা একজন ২০ বছর বয়সী মহিলার ঘটনা তুলে ধরছি, যিনি ১২ বছর ধরে ইডিওপ্যাথিক এনএস-এ ভুগছিলেন। ব্যাপক সেরিব্রাল ভেনাস থ্রম্বোসিস এবং পালমোনারি এমবোলিজমের কারণে তার রোগটি প্রকাশ পায়। তাকে অ্যান্টিকোয়াগুলেশন থেরাপি এবং মুখে খাওয়ার কর্টিকোস্টেরয়েড থেরাপি দেওয়া হয়, এরপর মাইকোফেনোলেট মোফেটিল (এমএমএফ) দেওয়া হয়। থ্রম্বোফিলিয়া মূল্যায়নে কোনো অস্বাভাবিকতা দেখা যায়নি। 2017 সাল পর্যন্ত মুখে খাওয়ার কর্টিকোস্টেরয়েড থেরাপির মাধ্যমে বেশ কয়েকবার এনএস-এর পুনরাবৃত্তি নিয়ন্ত্রণ করা হয়েছিল। এরপর, রোগীর রোগের পুনরাবৃত্তি হয়নি। তাই অ্যান্টিকোয়াগুলেশন চিকিৎসা এবং এমএমএফ বন্ধ করে দেওয়া হয়। এক বছর পর, রোগীর তীব্র এবং ব্যাপক পেটে ব্যথা হয়, যার সাথে খাবার খাওয়ার পরে বমি এবং উভয় পায়ের নিচের অংশে ফোলা দেখা যায়। ল্যাবরেটরি পরীক্ষায় এনএস-এর পুনরাবৃত্তি নিশ্চিত করা হয়। পেটের সিটি স্ক্যানে দেখা যায় যে সুপিরিয়র মেসেনটেরিক ধমনীতে তীব্র থ্রম্বোসিস হয়েছে, যার ফলে তীব্র মেসেনটেরিক ইস্কেমিয়া হয়েছে। অস্ত্রোপচারের সময় দেখা যায় যে মেসেনটেরিক ইস্কেমিয়ার কারণে ক্ষুদ্রান্ত্রের ব্যাপক নেক্রোসিস হয়েছে, যা অপসারণ করলে রোগীর জীবন বাঁচানো সম্ভব নয়। ৪৮ ঘণ্টা পর রোগীর মৃত্যু হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_523.txt",
+    "fulltext": "We present the case of a 34-year-old woman, eight weeks pregnant with no other personal history of interest, who presents to the emergency department with generalized convulsions with dysarthria in the postcritical period, which resolve progressively in less than two hours. On physical examination, she is conscious, oriented, with no language or motor or sensory deficits. Only signs of a right lateral tongue bite are observed.\n\nThe complementary tests, such as blood tests or the electrocardiogram, are normal. Given that the episode corresponds with a first epileptic seizure and the patient is pregnant, an urgent magnetic resonance of the skull is requested.\n\nThe usual protocol was performed and 3D T1 sequences without and with intravenous contrast were obtained in axial, coronal and sagital planes, axial FLAIR, axial T2, VEN BOLD and magnetic susceptibility sequences, as well as axial diffusion and apparent diffusion coefficient map. The MRI identified multiple venous cortico-medullary vascular structures converging centripetally to a large central venous structure draining through the inferior anastomotic vein into the left transverse sinus, forming the classic ‘Medusa head’ sign. In the T1 sequences, the drainage vein was seen to be increased in signal with central hyphocaptation after contrast administration, suggesting partial thrombosis versus slow flow. In addition, in T2 and FLAIR sequences, the brain tissue surrounding the drainage vein was seen to be hyperintense, without diffusion restriction and compatible with edema.\n\nThese findings are suggestive of a venous anomaly of development with signs of partial peripheral thrombosis and slow flow more proximal, which cause edema of the surrounding tissue. She is started on clexane 60 mg/12 hours and levetiracetam 500 mg/12 hours and the patient shows improvement and symptomatic stability after one week.\n",
+    "summary": "A 34-year-old pregnant woman presents with seizures and dysarthria and is urgently referred for a cranial MRI. The classic ‘Medusa head’ sign is seen and the diagnosis is made as a venous anomaly of development with peripheral partial thrombosis and proximal slow flow.\n",
+    "translated_fulltext": "আমরা ৩৪ বছর বয়সী একজন মহিলার ঘটনা উপস্থাপন করছি, যিনি আট সপ্তাহ গর্ভবতী এবং অন্য কোনো উল্লেখযোগ্য স্বাস্থ্যগত ইতিহাস নেই। তিনি জরুরি বিভাগে এসে সাধারণ খিঁচুনি এবং কথা বলতে সমস্যা নিয়ে আসেন, যা গুরুতর অবস্থার পরে ধীরে ধীরে দুই ঘণ্টার মধ্যে সেরে যায়। শারীরিক পরীক্ষায় দেখা যায়, তিনি সচেতন, স্বাভাবিক অবস্থায় আছেন এবং তার ভাষা, মোটর বা সংবেদী ক্ষমতাতে কোনো ত্রুটি নেই। শুধুমাত্র ডান পাশের জিহ্বার সামান্য কামড়ের চিহ্ন দেখা যায়।\n\nরক্ত পরীক্ষা এবং ইলেক্ট্রোকার্ডিওগ্রামের মতো অন্যান্য পরীক্ষাগুলো স্বাভাবিক ছিল। যেহেতু এটি প্রথমবার খিঁচুনি এবং রোগী গর্ভবতী, তাই মাথার একটি জরুরি ম্যাগনেটিক রেজোন্যান্স (এমআরআই) করার অনুরোধ করা হয়।\n\nসাধারণ নিয়ম অনুযায়ী পরীক্ষা করা হয় এবং অ্যাক্সিয়াল, করোনার এবং সাগিটাল প্লেনে 3D T1 সিকোয়েন্স, ইন্ট্রাভেনাস কন্ট্রাস্টসহ এবং ছাড়া, অ্যাক্সিয়াল FLAIR, অ্যাক্সিয়াল T2, VEN BOLD এবং ম্যাগনেটিক সাসসেপ্টিবিলিটি সিকোয়েন্স, সেইসাথে অ্যাক্সিয়াল ডিফিউশন এবং অ্যাপারেন্ট ডিফিউশন কোয়েফিসিয়েন্ট ম্যাপ তৈরি করা হয়। এমআরআই-তে দেখা যায়, একাধিক ভেনাস কর্টিকো-মেডুলারি ভাস্কুলার গঠন কেন্দ্রমুখীভাবে একটি বড় কেন্দ্রীয় ভেনাস কাঠামোর দিকে মিলিত হচ্ছে, যাInferior anastomotic vein-এর মাধ্যমে বাম ট্রান্সভার্স সাইনাসে নিষ্কাশিত হয় এবং ক্লাসিক ‘মেদুসা হেড’ চিহ্ন তৈরি করে। T1 সিকোয়েন্সে, কন্ট্রাস্ট দেওয়ার পরে দেখা যায় যে নিষ্কাশনকারী শিরাটির সংকেত বৃদ্ধি পেয়েছে এবং কেন্দ্রে হাইপোক্যাপটেশন হয়েছে, যা আংশিক থ্রম্বোসিস বা ধীর গতির প্রবাহের ইঙ্গিত দেয়। এছাড়াও, T2 এবং FLAIR সিকোয়েন্সে, নিষ্কাশনকারী শিরাটির চারপাশের মস্তিষ্কের টিস্যু হাইপারইনটেনস দেখা যায়, যেখানে ডিফিউশন সীমাবদ্ধতা নেই এবং এটি শোথের সাথে সামঞ্জস্যপূর্ণ।\n\nএই ফলাফলগুলো উন্নয়নমূলক ভেনাস অস্বাভাবিকতার ইঙ্গিত দেয়, যেখানে আংশিক পেরিফেরাল থ্রম্বোসিস এবং আরও কাছের অংশে ধীর গতির প্রবাহের লক্ষণ রয়েছে, যা আশেপাশের টিস্যুতে শোথ সৃষ্টি করে। তাকে ক্ল্যাক্সেন ৬০ মিগ্রা/১২ ঘণ্টা এবং লেভেটিরাসিটাম ৫০০ মিগ্রা/১২ ঘণ্টা দেওয়া হয় এবং এক সপ্তাহ পর রোগীর অবস্থার উন্নতি দেখা যায় এবং উপসর্গগুলো স্থিতিশীল হয়।",
+    "translated_summary": "৩৪ বছর বয়সী একজন গর্ভবতী মহিলা খিঁচুনি এবং কথা বলতে সমস্যা নিয়ে উপস্থিত হন এবং জরুরি ভিত্তিতে তার মস্তিষ্কের এমআরআই করার জন্য বলা হয়। পরীক্ষায় ‘মেদুসা হেড’ চিহ্নের মতো একটি বৈশিষ্ট্য দেখা যায় এবং রোগ নির্ণয় করা হয় যে এটি একটি জন্মগত শিরা সংক্রান্ত অস্বাভাবিকতা, যেখানে প্রান্তীয় অংশে আংশিক থ্রম্বোসিস এবং প্রক্সিমাল অংশে ধীর গতির রক্তপ্রবাহ রয়েছে।"
+  },
+  {
+    "id": "multiclinsum_gs_en_587.txt",
+    "fulltext": "A 22-year-old woman came to the Department of Oral Medicine with complaints of mouth ulcers causing pain and eating and drinking difficulty persisting for a duration of one month. This condition begins with a fever and appears like pimples on the lips. Based on the anamnesis, it was discovered that she had been using pod-type vapes for about a year but had never experienced complaints like when she came for treatment. She had never smoked traditional cigarettes before starting to vape. She said the reason for trying vaping was out of curiosity, and she quite often tried different types of e-liquid with different flavors. Before her complaint, she had simply changed the type of e-liquid to a different flavor without mentioning the brand. She vapes almost every day, but not all day, only in her free time or with friends. She was a healthy individual, and before this condition appeared, she had no history of taking medications, including antibiotics, analgesics, anticonvulsants, non-steroidal anti-inflammatory drugs, and antifungals. She also had no history of drug or food allergies, but the patient has unhealthy eating habits (eating irregularly and not consuming vegetables and fruit). Extraoral examination showed no lesions on other parts of the body, while the lips of the patient had serosanguineous crusts and an erosive area at the corner of the mouth, and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges, irregular, varying sizes, and pain on the labial, buccal, lateral, and ventral mucosa of the tongue and floor of the mouth.\n\nBased on the medical history of the patient and physical examination, which revealed oral mucosal involvement but no symptoms elsewhere in the body, as well as the non-reactive anti-HSV1 IgG results, the diagnosis of vaping-related oral erythema multiforme was established. The medical condition has been classified as minor erythema multiforme. The oral conditions were treated with 0.9% NaCl, which was moistened in gauze and placed on the lips three times a day. The patient was instructed to gargle 1 mg of dexamethasone in 10 mL of hyaluronic acid three times a day and avoid eating or drinking for at least 30 minutes after gargling. She was also given 2% miconazole cream applied to the wound in the right corner of the mouth twice a day, as well as vaseline album cream for dry lips. To maintain good oral hygiene, she was advised to brush her teeth and tongue twice a day, after breakfast and before bed. She was also instructed to stop vaping and avoid foods containing monosodium glutamate (MSG). The control was carried out after a week following therapy and showed that oral condition had improved. Written informed consent for the publication of details was obtained from the patient. This case report conformed with the Helsinki Declaration. The publication of this case report has also been approved by the institution.",
+    "summary": "A 22-year-old woman came to the Oral Medicine Department with complaints of stomatitis causing pain, eating, and drinking difficulty, which started with fever and pimple-like on the lips. She was an active vape user for one year. Extraoral examination revealed no lesions on other body parts. The serosanguinolent crusts on the lips, an erosive area on the labial commissures and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges and irregular, varying sizes in several parts of the oral mucosa. The anti-HSV-1 IgG laboratory results showed non-reactive, leading to a diagnosis of oral erythema multiforme. Management of oral conditions using 0.9% NaCl compress, dexamethasone mouthwash, and hyaluronic acid, applying 2% miconazole cream on labial commissures and vaseline album cream on the dry lips, and stopping vaping. Oral condition improved in a week of therapy.",
+    "translated_fulltext": "২২ বছর বয়সী একজন মহিলা মুখের ঘা-এর কারণে ব্যথা এবং খাবার ও পানীয় গ্রহণে অসুবিধা নিয়ে ডেন্টাল মেডিসিন বিভাগে আসেন, যা প্রায় এক মাস ধরে চলছে। এই সমস্যা প্রথমে জ্বর দিয়ে শুরু হয় এবং ঠোঁটে ছোট ছোট ফুসকুড়ি মতো দেখা যায়। তার কাছ থেকে পাওয়া তথ্যের ভিত্তিতে জানা যায় যে, তিনি প্রায় এক বছর ধরে পড-টাইপ ভ্যাপ ব্যবহার করছেন, কিন্তু এর আগে কখনো এমন সমস্যা অনুভব করেননি। ভ্যাপ ব্যবহার শুরু করার আগে তিনি কখনো সাধারণ সিগারেট খাননি। তিনি জানান, কৌতূহলবশত তিনি ভ্যাপ ব্যবহার শুরু করেন এবং প্রায়ই বিভিন্ন স্বাদের ই-লিকুইড ব্যবহার করে দেখতে থাকেন। সমস্যা শুরু হওয়ার আগে, তিনি কোনো ব্র্যান্ড উল্লেখ না করে কেবল ই-লিকুইডের স্বাদ পরিবর্তন করেছিলেন। তিনি প্রায় প্রতিদিন ভ্যাপ করেন, তবে সারাদিন নয়, শুধুমাত্র অবসর সময়ে বা বন্ধুদের সাথে। তিনি শারীরিকভাবে সুস্থ ছিলেন এবং এই সমস্যা দেখা দেওয়ার আগে, তিনি কোনো ওষুধ, যেমন - অ্যান্টিবায়োটিক, ব্যথানাশক, অ্যান্টিকনভালসেন্ট, নন-স্টেরয়েডাল অ্যান্টি-ইনফ্ল্যামেটরি ওষুধ বা অ্যান্টিফাঙ্গাল ওষুধ গ্রহণ করেননি। তার ওষুধ বা খাবারের প্রতি অ্যালার্জিরও কোনো ইতিহাস ছিল না, তবে তার খাদ্যাভ্যাস স্বাস্থ্যকর ছিল না (অনিয়মিত খাবার গ্রহণ এবং সবজি ও ফল কম খাওয়া)। শারীরিক পরীক্ষায় দেখা যায়, শরীরের অন্যান্য অংশে কোনো ক্ষত নেই, তবে তার ঠোঁটে সেরোস্যাঙ্গুইনাস ক্রাস্ট এবং মুখের কোণে ক্ষয়প্রাপ্ত স্থান ছিল, যেখান থেকে রক্তপাত হতে দেখা যায়। মুখের ভেতরের পরীক্ষায় দেখা যায়, সাদা রঙের ঘা, যার কিনারাগুলো হলুদ, বিভিন্ন আকারের এবং অনিয়মিত, এবং ঠোঁট, গালের ভেতরের অংশ, জিহ্বার পাশের অংশ এবং মুখের নিচের অংশে ব্যথা রয়েছে।\n\nরোগীর চিকিৎসা ইতিহাস এবং শারীরিক পরীক্ষার ফলাফলের ভিত্তিতে, যেখানে মুখের শ্লেষ্মা ঝিল্লিতে সমস্যা দেখা যায় কিন্তু শরীরের অন্য কোনো অংশে কোনো উপসর্গ নেই, এবং অ্যান্টি-এইচএসভি১ আইজিজি পরীক্ষায় কোনো প্রতিক্রিয়া পাওয়া যায়নি, তাই ভ্যাপ ব্যবহারের কারণে সৃষ্ট মুখের এরিথেমা মাল্টিফর্মের রোগ নির্ণয় করা হয়। এই রোগটিকে মাইনর এরিথেমা মাল্টিফর্ম হিসাবে শ্রেণীবদ্ধ করা হয়েছে। মুখের সমস্যার জন্য ০.৯% স্যালাইন দ্রবণ ব্যবহার করা হয়, যা একটি গজ কাপড়ে ভিজিয়ে দিনে তিনবার ঠোঁটে লাগানো হয়। রোগীকে দিনে তিনবার ১০ মিলি হায়ালুরোনিক অ্যাসিড দ্রবণে ১ মিলি ডেক্সামেথাসোন মিশিয়ে গার্গল করতে এবং গার্গলের অন্তত ৩০ মিনিট পর কিছু খাওয়া বা পান করা থেকে বিরত থাকতে বলা হয়। এছাড়াও, মুখের ডান কোণে থাকা ক্ষতের উপর দিনে দুবার ২% মাইকোনাজল ক্রিম এবং শুষ্ক ঠোঁটের জন্য ভ্যাসলিন অ্যালবুম ক্রিম ব্যবহার করতে দেওয়া হয়। ভালো মৌখিক স্বাস্থ্যবিধি বজায় রাখার জন্য, তাকে সকালে নাস্তার পর এবং রাতে ঘুমানোর আগে দিনে দুবার দাঁত ও জিভ ব্রাশ করতে বলা হয়। তাকে ভ্যাপ করা বন্ধ করতে এবং মনোসোডিয়াম গ্লুটামেট (এমএসজি) যুক্ত খাবার পরিহার করতে বলা হয়। থেরাপির এক সপ্তাহ পর পুনরায় পরীক্ষা করা হয় এবং দেখা যায় যে মুখের অবস্থার উন্নতি হয়েছে। বিস্তারিত তথ্য প্রকাশের জন্য রোগীর কাছ থেকে লিখিত সম্মতি নেওয়া হয়েছে। এই কেস রিপোর্ট হেলসিঙ্কি ঘোষণার সাথে সঙ্গতিপূর্ণ। এই কেস রিপোর্টটি প্রকাশের জন্য প্রতিষ্ঠানের অনুমোদনও নেওয়া হয়েছে।",
+    "translated_summary": "২২ বছর বয়সী একজন মহিলা মুখ ও দাঁতের রোগ বিভাগে এসে অভিযোগ করেন যে তার মুখে প্রদাহের কারণে ব্যথা হচ্ছে, খেতে ও পান করতে অসুবিধা হচ্ছে, যা জ্বর এবং ঠোঁটে ছোট ছোট ফুসকুড়ি দিয়ে শুরু হয়েছিল। তিনি এক বছর ধরে নিয়মিত ভ্যাপ ব্যবহার করতেন। শরীরের অন্যান্য অংশে কোনো ক্ষত দেখা যায়নি। ঠোঁটে সেরোস্যাঙ্গুইনোলেন্ট ক্রাস্ট, ঠোঁটের কোণে ক্ষয়যুক্ত স্থান এবং সামান্য রক্তপাতের প্রবণতা দেখা যায়। মুখের ভেতরের পরীক্ষায় দেখা যায়, মুখের শ্লেষ্মা ঝিল্লির বিভিন্ন অংশে হলুদ রঙের কিনারাযুক্ত সাদা আলসার রয়েছে, যেগুলোর আকার বিভিন্ন এবং अनियमित। অ্যান্টি-এইচএসভি-১ আইজিজি ল্যাবরেটরি পরীক্ষায় কোনো প্রতিক্রিয়া দেখা যায়নি, যার ফলে ওরাল এরিথেমা মাল্টিফর্মের রোগ নির্ণয় করা হয়। চিকিৎসার জন্য ০.৯% সোডিয়াম ক্লোরাইড কম্প্রেস, ডেক্সামেথাসোন মাউথওয়াশ এবং হায়ালুরোনিক অ্যাসিড ব্যবহার করা হয়। এছাড়াও, ঠোঁটের কোণে ২% মাইকোনাজল ক্রিম এবং শুষ্ক ঠোঁটে ভ্যাসেলিন অ্যালবুম ক্রিম লাগানো হয় এবং ভ্যাপ ব্যবহার বন্ধ করতে বলা হয়। এক সপ্তাহের মধ্যে মুখের অবস্থার উন্নতি দেখা যায়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_274.txt",
+    "fulltext": "A 29-year-old gravida V par IV (all alive, 3 spontaneous vaginal deliveries, and the last child was delivered by cesarean section for the indication of a failed induction 4 years prior to the current pregnancy) came for ANC follow-up at a gestational age of 32 weeks from her LNMP.\n\nAfter taking a medical history, it was discovered that all four of her children are healthy, doing well in school, and have no known history of genetic or seizure disorders. She was investigated with the Venereal Disease Research Laboratory (VDRL), Hepatitis B surface antigen (HBSag), and urine analysis, all of which were negative. All cell lines in the CBC were normal, her blood group is A, and Rh is positive, according to the Complete Blood Count (CBC), blood group, and RH. Obstetric ultrasound was also performed showing normal anatomical scan of the all body parts of the fetus except the heart. Detailed fetal echocardiography evaluation was done with findings of: both atria have comparable size and normal situs. Both atrioventricular and semilunar valves are normally positioned with normal opening and closure. Both ventricles are comparable in size and contractility; in both 2D and color flow, the left ventricle forms the apex of the heart without any ventricular septal defect. But on the papillary muscles of the left ventricle there were two circumscribed, round, echogenic mass measuring 18.2 mm by 8.3mm and 13.5mm by 8.3 mm. Upon evaluation of the outflow tract, both the LVOT (left ventricular outflow tract) and RVOT (right ventricular outflow tract) have normal anatomy and function using 2D and CF ultrasound evaluation. According to the fetal echo finding, a diagnosis of cardiac rhabdomyoma was made. Since there is a high chance of tuberous sclerosis in cardiac rhabdomyoma, detailed neurosonography and other system exams were done to look for other signs of tuberous sclerosis. Despite searching for the other features of tuberous sclerosis, no other sign of it was found other than the tumor. She had regular ANC follow-up from 32 weeks of gestation up to 39 weeks without any complications.\n\nAt gestational age of 39 weeks plus 1 day, she underwent a cesarean section for the indication of full-term pregnancy plus a request for a repeat cesarean section, with the outcome of a 3200-gram female with an APGAR score of 10 and 10 at the 1st and 5th minutes. Both the mother and the neonate had a smooth post-operative period and were discharged on the third day.\n\nAfter delivery, the neonate was evaluated on the 1st, 7th, and 30th days for any regression or increment of the mass, emergence of skin lesions, or seizure. All physical examination results were normal, and the mass size was similar to the antepartal evaluation.\n\nAt her 7th month, the child was evaluated again, and upon history inquiries, the infant was doing great developmentally for her age group. The infant was examined for neurodevelopmental delay, and the child was growing appropriately for her age. An echocardiography study by a pediatric cardiologist revealed well-circumscribed hyperechoic masses on both left ventricular papillary muscles, each measuring 21.8 mm by 9.2 mm and 14.7 mm by 8.5 mm and creating no left ventricular inflow obstruction.\n\nA history from the family was obtained, and a physical examination with anthropometric measurements was performed to assess her developmental condition during her first-year evaluation. The child was developing normally, as other children her age were. Except for the heart, all of the systems examined were unremarkable. An echocardiography study has revealed well-circumscribed hyperechoic masses on both left ventricular papillary muscles with no size increment and creating no left ventricular inflow obstruction.",
+    "summary": "We are reporting an isolated, asymptomatic fetal intra-cardiac mass (rhabdomyoma) that was discovered at 32 weeks of gestation and was followed as an outpatient until 39 weeks plus one day, at which point a cesarean section was performed. After delivery, the child underwent evaluations at the 1st day, 7th day, 30th day, 7th month, and 12th month of age. Following a checkup, the child's anthropometric and neurobehavioral growth were both healthy. Except for the tumor, which was neither growing nor shrinking in size, none of the clinical diagnostic criteria for tuberous sclerosis complex were met for this child up to the age of one year.",
+    "translated_fulltext": "২৯ বছর বয়সী একজন মহিলা, যিনি পূর্বে ৪ বার গর্ভধারণ করেছেন (এবং তার চারটি সন্তানই জীবিত), তার ৩৫ সপ্তাহে একটি স্বাভাবিক প্রসব এবং শেষ সন্তানটি ৪ বছর আগে সিজারিয়ান সেকশনের মাধ্যমে প্রসব করা হয়েছিল। তিনি তার শেষ মাসিক থেকে ৩২ সপ্তাহ পর প্রসবপূর্ব পরিচর্যা (এএনসি) ফলো-আপের জন্য আসেন।\n\nশারীরিক পরীক্ষা করার পর জানা যায়, তার চারটি সন্তানই সুস্থ আছে, তারা স্কুলে ভালো করছে এবং তাদের মধ্যে কোনো বংশগত বা খিঁচুনিজনিত রোগের ইতিহাস নেই। তার ভেনিরিয়াল ডিজিজ রিসার্চ ল্যাবরেটরি (ভিডিআরএল), হেপাটাইটিস বি সারফেস অ্যান্টিজেন (এইচবিএসএজি) এবং প্রস্রাব পরীক্ষা করা হয়, যেগুলোর ফলাফল নেতিবাচক আসে। সম্পূর্ণ রক্ত ​​গণনা (সিবিসি) অনুসারে, তার রক্তের প্রতিটি উপাদান স্বাভাবিক, রক্তের গ্রুপ এ এবং আরএইচ পজিটিভ। এরপর একটি আলট্রাসাউন্ড করা হয়, যেখানে দেখা যায় ভ্রূণের শরীরের অন্যান্য অঙ্গ স্বাভাবিক আছে, শুধু হৃদপিণ্ডে সামান্য সমস্যা আছে। এরপর ভ্রূণের হৃদপিণ্ডের বিস্তারিত ইকোকার্ডিওগ্রাফি করা হয়, যেখানে দেখা যায় উভয় অ্যাট্রিয়ার আকার একই রকম এবং স্বাভাবিক অবস্থানে আছে। অ্যাট্রিওভেন্ট্রিকুলার এবং সেমিলুনার ভালভগুলো স্বাভাবিকভাবে খোলা এবং বন্ধ হচ্ছে। উভয় ভেন্ট্রিকলের আকার এবং সংকোচন ক্ষমতা একই রকম; 2D এবং কালার ফ্লো ইমেজে দেখা যায়, বাম ভেন্ট্রিকল হৃদপিণ্ডের শীর্ষ তৈরি করেছে এবং ভেন্ট্রিকুলার সেপ্টাল ত্রুটি নেই। তবে বাম ভেন্ট্রিকলের প্যাপিলারি পেশীতে দুটি গোলাকার, ইকোজেনিক ভর দেখা যায়, যেগুলোর আকার ১৮.২ মিমি বাই ৮.৩ মিমি এবং ১৩.৫ মিমি বাই ৮.৩ মিমি। আউটফ্লো ট্র্যাক্ট মূল্যায়ন করে দেখা যায়, এলভিওটি (বাম ভেন্ট্রিকুলার আউটফ্লো ট্র্যাক্ট) এবং আরভিওটি (ডান ভেন্ট্রিকুলার আউটফ্লো ট্র্যাক্ট)-এর গঠন এবং কার্যকারিতা 2D এবং সিএফ আলট্রাসাউন্ডে স্বাভাবিক দেখা যায়। ভ্রূণের ইকোকার্ডিওগ্রাফি ফলাফলের ভিত্তিতে, কার্ডিয়াক র‍্যাবডোমায়োমার রোগ নির্ণয় করা হয়। যেহেতু কার্ডিয়াক র‍্যাবডোমায়োমাতে টিউবারাস স্ক্লেরোসিসের ঝুঁকি থাকে, তাই অন্যান্য লক্ষণ দেখার জন্য বিস্তারিত নিউরোসোনোগ্রাফি এবং অন্যান্য পরীক্ষা করা হয়। টিউবারাস স্ক্লেরোসিসের অন্যান্য বৈশিষ্ট্য খুঁজে বের করার চেষ্টা করা হলেও, টিউমারটি ছাড়া আর কোনো লক্ষণ পাওয়া যায়নি। তিনি গর্ভাবস্থার ৩২ সপ্তাহ থেকে ৩৯ সপ্তাহ পর্যন্ত নিয়মিত এএনসি ফলো-আপে ছিলেন এবং কোনো জটিলতা দেখা যায়নি।\n\nগর্ভাবস্থার ৩৯ সপ্তাহ ১ দিনে, তার সিজারিয়ান সেকশন করা হয়। অপারেশনের পর একটি ৩২০০ গ্রামের কন্যা সন্তানের জন্ম হয়, যার জন্মের ১ মিনিট এবং ৫ মিনিটে অ্যাপগার স্কোর ছিল ১০। মা এবং শিশু উভয়েই সুস্থ ছিল এবং তৃতীয় দিনে হাসপাতাল থেকে ছাড়া হয়।\n\nজন্মের পর, শিশুটির ১, ৭ এবং ৩০ দিনে শারীরিক পরীক্ষা করা হয়, যেখানে দেখা যায় টিউমারের আকার একই আছে, ত্বকে কোনো পরিবর্তন নেই এবং খিঁচুনিও হয়নি। সমস্ত শারীরিক পরীক্ষার ফলাফল স্বাভাবিক ছিল।\n\nশিশুটি ৭ মাস বয়সে পুনরায় পরীক্ষা করা হয় এবং জানা যায়, তার বয়স অনুযায়ী সে স্বাভাবিকভাবে বিকাশ লাভ করছে। নিউরোডেভেলপমেন্টাল বিলম্বের জন্য শিশুটির পরীক্ষা করা হয় এবং দেখা যায়, তার বয়স অনুযায়ী সে স্বাভাবিকভাবে বাড়ছে। একজন শিশু হৃদরোগ বিশেষজ্ঞের করা ইকোকার্ডিওগ্রাফি পরীক্ষায় দেখা যায়, বাম ভেন্ট্রিকলের উভয় প্যাপিলারি পেশীতে দুটি সুস্পষ্ট হাইপেরেকোয়িক ভর রয়েছে, যেগুলোর আকার ২১.৮ মিমি বাই ৯.২ মিমি এবং ১৪.৭ মিমি বাই ৮.৫ মিমি এবং এগুলো বাম ভেন্ট্রিকলের রক্ত ​​প্রবাহে কোনো বাধা সৃষ্টি করছে না।\n\nপরিবারের কাছ থেকে বিস্তারিত তথ্য নেওয়া হয় এবং অ্যানথ্রোপোমেট্রিক পরিমাপের মাধ্যমে শিশুটির প্রথম বছরের বিকাশের মূল্যায়ন করা হয়। দেখা যায়, শিশুটি স্বাভাবিকভাবে বিকাশ লাভ করছে। হৃদপিণ্ড ছাড়া, অন্যান্য অঙ্গের পরীক্ষাতেও কোনো অস্বাভাবিকতা পাওয়া যায়নি। ইকোকার্ডিওগ্রাফি পরীক্ষায় বাম ভেন্ট্রিকলের উভয় প্যাপিলারি পেশীতে দুটি সুস্পষ্ট হাইপেরেকোয়িক ভর দেখা যায়, যেগুলোর আকার একই আছে এবং এগুলো বাম ভেন্ট্রিকলের রক্ত ​​প্রবাহে কোনো বাধা সৃষ্টি করছে না।",
+    "translated_summary": "আমরা একটি বিরল, উপসর্গবিহীন ভ্রূণের অন্তঃহৃদপিণ্ডের টিউমার (র‍্যাবডোমায়োমা) সম্পর্কে জানাচ্ছি, যা গর্ভাবস্থার ৩২ সপ্তাহে শনাক্ত করা হয়েছিল এবং এরপর এটিকে বহির্বিভাগে পর্যবেক্ষণ করা হয়। গর্ভাবস্থার ৩৯ সপ্তাহ এবং একদিন পর্যন্ত এটি পর্যবেক্ষণ করা হয়, এরপর সিজারিয়ান সেকশনের মাধ্যমে বাচ্চা প্রসব করানো হয়। প্রসবের পর, বাচ্চার বয়স ১ দিন, ৭ দিন, ৩০ দিন, ৭ মাস এবং ১২ মাস—এই সময়গুলোতে বিভিন্ন পরীক্ষা করা হয়। পরীক্ষার পর দেখা যায়, বাচ্চার শারীরিক গঠন এবং স্নায়বিক বিকাশ স্বাভাবিক ছিল। টিউমারটি বাড়েওনি বা ছোটও হয়নি, এছাড়া অন্যান্য ক্লিনিক্যাল নির্ণয় পদ্ধতির মাধ্যমে টিউবারাস স্ক্লেরোসিস কমপ্লেক্সের কোনো লক্ষণ এই বাচ্চার মধ্যে এক বছর বয়স পর্যন্ত দেখা যায়নি।"
+  },
+  {
+    "id": "multiclinsum_gs_en_124.txt",
+    "fulltext": "13-year-old boy from Cusco with a history of laryngeal papillomatosis since the age of two (at the age of three he required a tracheostomy) and a mother with a history of genital papilloma. The patient was admitted to the San Borja National Institute of Child Health in Lima, after a 16-day illness characterised by respiratory difficulties predominantly at night, inspiratory laryngeal stridor and moderate dysphonia; he previously received azithromycin and oxygen support, without improvement.\n\nThe physical examination revealed mild subcostal retraction, decreased vesicular murmurs in the left hemithorax and scanty wheezy breath sounds with predominance in the right hemithorax, which required oxygen support with a binasal cannula at 4 liters. The rest of the evaluation had no relevant findings. At the laboratory level, leukocytes were found at 8.03 × 103/u, platelets 209 × 103/u, hemoglobin 13.2 g/dL, C-reactive protein at 36.6 mg/L. As part of the imaging studies, a chest radiograph and a head and neck tomography were performed.\n\n48 hours after admission, she presented with increased stridor and respiratory difficulty, so admission to the emergency operating room for tracheostomy, microsurgery and excision of papillomatosis lesions was decided. An appendicular tumour of papillomatose appearance with ventricular bands in the epiglottis, glottic face, vocal cords, subglottis and trachea up to ring 5 was evident. The anatomopathological report reported coilocitic atypia due to HPV and mild focal dysplasia.\n\nIn the immediate postoperative period, he was transferred to the paediatric intensive care unit for respiratory monitoring, with weaning from oxygen at 48 hours. He received a single dose of bevacizumab 400 mg intravenous and subsequently improved clinically. The patient remained hospitalised for seven days, achieving clinical stability through normalisation of oxygen saturation levels and progressive weaning from oxygen, and was subsequently referred to the hospital in Breña to continue his management. Telemonitoring was carried out after eight months and the family indicated that there was no evidence of relapse or other intercurrences.\n",
+    "summary": "A 13-year-old boy with a history of laryngeal papillomatosis since the age of two years was presented. The patient presented respiratory distress and multiple stenosing nodules in the larynx and trachea, and several pulmonary cysts were visualized on a chest tomography. The patient underwent exeresis of the papillomatosis lesions and tracheostomy. He received a single dose of 400 mg bevacizumab intravenous and respiratory therapy with a favorable evolution, without recurrence in the follow-up.\n",
+    "translated_fulltext": "কুস্কো থেকে আসা ১৩ বছর বয়সী একটি ছেলে, যার বয়স দুই বছর থেকে ল্যারিঞ্জিয়াল প্যাপিলোমাটোসিস ছিল (তিন বছর বয়সে তার একটি ট্র্যাকিওস্টমি করার প্রয়োজন হয়েছিল) এবং যার মায়েরও যৌনাঙ্গে প্যাপিলোমা ছিল। শ্বাসকষ্টের কারণে ছেলেটিকে ১৬ দিন ধরে অসুস্থ থাকার পর লিমার সান বোর্জা ন্যাশনাল ইনস্টিটিউট অফ চাইল্ড হেলথে ভর্তি করা হয়। শ্বাসকষ্ট মূলত রাতে বেশি হতো, শ্বাস নেওয়ার সময় ল্যারিঞ্জিয়াল স্ট্রিডর এবং মাঝারি ডিসফোনিয়া দেখা যাচ্ছিল। এর আগে তাকে অ্যাজিথ্রোমাইসিন এবং অক্সিজেন দেওয়া হয়েছিল, কিন্তু কোনো উন্নতি হয়নি।\n\nশারীরিক পরীক্ষায় দেখা যায়, হালকা সাবকস্টাল রিট্রাকশন, বাম হেমিতোরাক্সে ভেসিকুলার মারমারের পরিমাণ কমে যাওয়া এবং ডান হেমিতোরাক্সে অল্প পরিমাণে হিসহিস শব্দযুক্ত শ্বাস-প্রশ্বাস শোনা যাচ্ছিল, যার জন্য ৪ লিটার অক্সিজেন দেওয়ার জন্য একটি বাইন্যাসাল ক্যানুলা ব্যবহার করা হয়েছিল। বাকি পরীক্ষাগুলোতে উল্লেখযোগ্য কিছু পাওয়া যায়নি। ল্যাবরেটরিতে দেখা যায়, শ্বেত রক্তকণিকার সংখ্যা ৮.০৩ × ১০³/µL, প্লেটলেট ২০৯ × ১০³/µL, হিমোগ্লোবিন ১৩.২ গ্রাম/ডেসিলিটার এবং সি-রিঅ্যাক্টিভ প্রোটিন ৩৬.৬ মিলিগ্রাম/লিটার। ইমেজিং পরীক্ষার অংশ হিসেবে, বুকের একটি রেডিওগ্রাফ এবং মাথা ও ঘাড়ের টমোগ্রাফি করা হয়।\n\nভর্তির ৪৮ ঘণ্টা পর, তার স্ট্রিডর এবং শ্বাসকষ্ট বেড়ে যায়। তাই জরুরি ভিত্তিতে ট্র্যাকিওস্টমি, মাইক্রোসার্জারি এবং প্যাপিলোমাটোসিস ক্ষত অপসারণের জন্য তাকে অপারেশন থিয়েটারে নিয়ে যাওয়া হয়। দেখা যায়, এপিগ্লটিস, গ্লোটিক ফেস, ভোকাল কর্ড, সাবগ্লটিস এবং ট্র্যাকিয়া পর্যন্ত (রিং ৫ পর্যন্ত) ভেন্ট্রিকুলার ব্যান্ডসহ একটি অ্যাপেন্ডিকুলার টিউমার রয়েছে, যা প্যাপিলোমাটোসিসের মতো দেখাচ্ছে। অ্যানাটোমোপ্যাথলজিক্যাল রিপোর্টে এইচপিভি-এর কারণে কোয়লোসাইটিক অ্যাটিপিয়া এবং হালকা ফোকাল ডিসপ্লাসিয়া দেখা যায়।\n\nঅপারেশনের পরপরই, শ্বাস-প্রশ্বাস পর্যবেক্ষণের জন্য তাকে পেডিয়াট্রিক ইনটেনসিভ কেয়ার ইউনিটে স্থানান্তর করা হয় এবং ৪৮ ঘণ্টার মধ্যে অক্সিজেন সরবরাহ ধীরে ধীরে কমানো হয়। তাকে বেভাসিজুমাব ৪০০ মিলিগ্রাম ইন্ট্রাভেনাস দেওয়া হয় এবং এরপর তার শারীরিক অবস্থার উন্নতি হয়। রোগীটিকে সাত দিন হাসপাতালে রাখা হয়। অক্সিজেনের মাত্রা স্বাভাবিক করে এবং ধীরে ধীরে অক্সিজেন সরবরাহ কমিয়ে তার শারীরিক স্থিতিশীলতা আনা হয়। এরপর তাকে ব্রেণার হাসপাতালে পাঠানো হয়, যেখানে তার চিকিৎসা চলতে থাকে। আট মাস পর টেলিমনিটরিং করা হয় এবং পরিবার জানায়, কোনো পুনরাবৃত্তি বা অন্য কোনো সমস্যা দেখা যায়নি।",
+    "translated_summary": "দুই বছর বয়স থেকে ল্যারিঞ্জিয়াল প্যাপিলোমাটোসিসের ইতিহাস রয়েছে এমন ১৩ বছর বয়সী একটি ছেলেকে উপস্থাপন করা হলো। রোগীর শ্বাসকষ্ট এবং ল্যারিংস ও শ্বাসনালীতে একাধিক সংকীর্ণ টিউমার দেখা যায়, এবং বুকের টমোগ্রাফিতে বেশ কয়েকটি ফুসফুসের সিস্ট দেখা যায়। রোগীর প্যাপিলোমাটোসিস ক্ষত অপসারণ এবং ট্র্যাকিওস্টমি করা হয়। তাকে ৪০০ মিলিগ্রাম বেভাসিজুমাব ইনট্রাভেনাস এবং শ্বাস-প্রশ্বাস থেরাপি দেওয়া হয়, যার ফলে রোগীর অবস্থা ধীরে ধীরে উন্নতি লাভ করে এবং ফলো-আপে কোনো পুনরাবৃত্তি দেখা যায়নি।"
+  },
+  {
+    "id": "multiclinsum_gs_en_412.txt",
+    "fulltext": "A 54-year-old male who had a medical history of membranous nephropathy II with nephrotic syndrome was administered with long-term oral glucocorticoids and immunosuppressants. The patient had a 20 pack-year history of smoking, and denied a family history of hereditary diseases. Chest x-ray demonstrated normal findings at one month before admission. On August 8, 2016, the patient was hospitalized for fever accompanied by progressive dyspnea, cough, and expectoration for 5 days. On admission, the BMI of the patient was 24.5 kg/m2, and his body temperature was 39.0°C. Furthermore, the patient had symptoms of tachypnea (35 bpm) and severe hypoxemia (SaO2 86%). On auscultation, the patient had good air entrance bilaterally with scattered diffuse crackles and rhonchi. Furthermore, the chest CT scan revealed multiple ground-glass opacities, and laboratory tests revealed normal white blood cell (WBC) count, but with elevated neutrophil count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and (1→3)-β-D-glucan. The patient was diagnosed as RSV infection on the fourth day of hospitalization when positive RSV-Ab was detected.\n\nOn admission, the patient was immediately given respiratory monitoring and supplemental oxygen to improve the low oxygen saturation, as well as antibiotics (moxifloxacin for 4 days, followed by cefminoxine for 8 days), and antifungal therapy (voriconazole for 10 days). The dose of the glucocorticoids and immunosuppressants remained largely unchanged. After 10 days of treatment, the patient's condition became worse. Chest CT revealed the progression of the disease, and oxygen partial pressure was further decreased. The patient was transferred to the Emergency Intensive Care Unit, where the patient was intensively treated, including noninvasive mechanical ventilation, broad-spectrum antibiotics (i.v. meropenem, oral moxifloxacin, and cotrimoxazole), antifungal therapy (micafungin), corticosteroids (methylprednisolone 40 mg bid iv) to relieve the inflammation, and other supportive treatment. Ganciclovir was also prescribed due to a possibility of viral infection, such as cytomegalovirus. Five days later, the patient's condition was further aggravated based on the chest x-ray evaluation. Despite receiving another round of treatments, including invasive ventilator-assisted ventilation therapy, methylprednisolone (80 mg bid), antibacterial agents (cefoperazone sulbactam, tigecycline, and cotrimoxazole) and antifungal (micafungin) therapy, the patient eventually died after 2 days.",
+    "summary": "Patient concerns:\nA 54-year-old male patient with chronic nephropathy, who received long-term immunosuppressants, was admitted to the Department of Respiratory Medicine due to the symptoms of fever, cough, expectoration, and dyspnea.\n\nDiagnoses:\nPulmonary radiology revealed multiple bilateral ground-glass opacity. Laboratory tests revealed elevated inflammation indicators, implying infection with bacteria, viruses, and/or fungi. Furthermore, the patient was positive for RSV antibodies, without positive results for other pathogens. Moreover, the patient was immunocompromised due to the long-term use of corticosteroids and immunosuppressants, as evidenced by decreased total IgG levels and reduced CD4 and CD8 T-lymphocyte counts.\n\nInterventions and outcome:\nDespite the intensive anti-infection treatment and respiratory support, the patient developed rapid progression, and subsequently died of respiratory failure.",
+    "translated_fulltext": "৫৪ বছর বয়সী একজন পুরুষ, যার পূর্বে মেমব্রেনাস নেফ্রোপ্যাথি II এবং নেফ্রোটিক সিনড্রোমের ইতিহাস ছিল, তাকে দীর্ঘমেয়াদী ওরাল গ্লুকোকর্টিকয়েড এবং ইমিউনোসাপ্রেসেন্ট ওষুধ দেওয়া হয়েছিল। রোগীর ২০ বছর ধরে ধূমপানের অভ্যাস ছিল এবং পরিবারে বংশগত রোগের কোনো ইতিহাস ছিল না। হাসপাতালে ভর্তির এক মাস আগে বুকের এক্স-রে স্বাভাবিক ছিল। ২০১৬ সালের ৮ই আগস্ট, রোগীর জ্বর, শ্বাসকষ্ট, কাশি এবং ৫ দিন ধরে কফ হওয়ার কারণে হাসপাতালে ভর্তি করা হয়। ভর্তির সময় রোগীর বিএমআই ছিল ২৪.৫ কেজি/মি², এবং শরীরের তাপমাত্রা ছিল ৩৯.০° সেলসিয়াস। এছাড়াও, রোগীর শ্বাস-প্রশ্বাসের হার বেশি (৩৫ বিপিএম) এবং গুরুতর হাইপোক্সেমিয়া (SaO2 86%) ছিল। অস্কাল্টেশনে দেখা যায়, রোগীর উভয় ফুসফুসে ভালোভাবে বাতাস প্রবেশ করছে এবং বিক্ষিপ্তভাবে ক্র্যাকলস ও রনকি শোনা যাচ্ছিল। বুকের সিটি স্ক্যানে একাধিক গ্রাউন্ড-গ্লাস অপাসিটি দেখা যায় এবং ল্যাবরেটরি পরীক্ষায় স্বাভাবিক সংখ্যক শ্বেত রক্তকণিকা (ডব্লিউবিসি) পাওয়া যায়, তবে নিউট্রোফিলের সংখ্যা, সি-রিঅ্যাক্টিভ প্রোটিন (সিআরপি), এরিথ্রোসাইট সেডিমেন্টেশন রেট (ইএসআর) এবং (১→৩)-β-ডি-গ্লুকান-এর মাত্রা বেশি ছিল। হাসপাতালে ভর্তির চতুর্থ দিনে রোগীর আরএসভি সংক্রমণের বিষয়টি নিশ্চিত করা হয়, যখন পজিটিভ আরএসভি-এবি পাওয়া যায়।\n\nভর্তির সময়, রোগীর অক্সিজেনের মাত্রা কম থাকায় শ্বাস-প্রশ্বাস পর্যবেক্ষণ করা হয় এবং অক্সিজেন সরবরাহ করা হয়। এছাড়াও, অ্যান্টিবায়োটিক (৪ দিনের জন্য মক্সিফ্লক্সাসিন, এরপর ৮ দিনের জন্য সেফমিনক্সিন) এবং অ্যান্টিফাঙ্গাল থেরাপি (১০ দিনের জন্য ভরিকোনাজল) দেওয়া হয়। গ্লুকোকর্টিকয়েড এবং ইমিউনোসাপ্রেসেন্ট ওষুধের ডোজ মূলত অপরিবর্তিত রাখা হয়। ১০ দিন চিকিৎসার পর রোগীর অবস্থা আরও খারাপ হয়। বুকের সিটি স্ক্যানে রোগের বিস্তার দেখা যায় এবং অক্সিজেনের আংশিক চাপ আরও কমে যায়। রোগীকে ইমার্জেন্সি ইনটেনসিভ কেয়ার ইউনিটে স্থানান্তর করা হয়, যেখানে তাকে নিবিড় চিকিৎসা দেওয়া হয়, যার মধ্যে ছিল নন-ইনভেসিভ মেকানিক্যাল ভেন্টিলেশন, ব্রড-স্পেকট্রাম অ্যান্টিবায়োটিক (আইভি মেরোপেনেম, ওরাল মক্সিফ্লক্সাসিন এবং কোট্রিমোক্সাজল), অ্যান্টিফাঙ্গাল থেরাপি (মাইকাফাঙ্গিন), কর্টিকোস্টেরয়েড (মিথাইলপ্রেডনিসোলোন ৪০ মিলিগ্রাম দিনে দুবার আইভি) প্রদাহ কমাতে এবং অন্যান্য সহায়ক চিকিৎসা। সাইটোমেগালোভাইরাসের মতো ভাইরাল সংক্রমণের সম্ভাবনা থাকায় গ্যানসিক্লোভিরও দেওয়া হয়। পাঁচ দিন পর, বুকের এক্স-রে মূল্যায়নের ভিত্তিতে রোগীর অবস্থা আরও খারাপ হয়। আরও একটি চিকিৎসা কোর্স দেওয়া সত্ত্বেও, যার মধ্যে ছিল ইনভেসিভ ভেন্টিলেটর-সহায়ক ভেন্টিলেশন থেরাপি, মিথাইলপ্রেডনিসোলোন (৮০ মিলিগ্রাম দিনে দুবার), অ্যান্টিব্যাকটেরিয়াল এজেন্ট (সেফোপেরাজোন সালব্যাক্টাম, টিজেসাইক্লিন এবং কোট্রিমোক্সাজল) এবং অ্যান্টিফাঙ্গাল (মাইকাফাঙ্গিন) থেরাপি, অবশেষে ২ দিন পর রোগীর মৃত্যু হয়।",
+    "translated_summary": "রোগীর সমস্যা:\n৫৪ বছর বয়সী একজন পুরুষ রোগী, যিনি দীর্ঘস্থায়ী নেফ্রোপ্যাথিতে ভুগছিলেন এবং দীর্ঘমেয়াদী ইমিউনোসাপ্রেসেন্ট গ্রহণ করেছিলেন, তাকে জ্বর, কাশি, কফ এবং শ্বাসকষ্টের উপসর্গ দেখা দেওয়ায় রেসপিরেটরি মেডিসিন বিভাগে ভর্তি করা হয়েছিল।\n\nরোগ নির্ণয়:\nপালমোনারি রেডিওলজি পরীক্ষায় উভয় ফুসফুসে একাধিক গ্রাউন্ড-গ্লাস অপাসিটি দেখা যায়। ল্যাবরেটরি পরীক্ষায় প্রদাহের মাত্রা বেশি পাওয়া যায়, যা ব্যাকটেরিয়া, ভাইরাস এবং/অথবা ছত্রাক দ্বারা সংক্রমণের ইঙ্গিত দেয়। এছাড়াও, রোগীর আরএসভি অ্যান্টিবডি পজিটিভ ছিল, তবে অন্যান্য প্যাথোজেনের জন্য পরীক্ষাগুলোতে নেগেটিভ ফলাফল পাওয়া যায়। উপরন্তু, দীর্ঘমেয়াদী কর্টিকোস্টেরয়েড এবং ইমিউনোসাপ্রেসেন্ট ব্যবহারের কারণে রোগীর রোগ প্রতিরোধ ক্ষমতা দুর্বল হয়ে পড়েছিল, যা মোট আইজিজি-এর মাত্রা হ্রাস এবং সিডি৪ এবং সিডি৮ টি-লিম্ফোসাইটের সংখ্যা কমে যাওয়ার মাধ্যমে প্রমাণিত হয়।\n\nচিকিৎসা এবং ফলাফল:\nতীব্র অ্যান্টি-ইনফেকশন চিকিৎসা এবং শ্বাসযন্ত্রের সহায়তার পরেও রোগীর দ্রুত অবনতি হয় এবং পরবর্তীতে শ্বাসযন্ত্রের ব্যর্থতায় তার মৃত্যু হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_301.txt",
+    "fulltext": "A 34-year-old patient with a disease duration of four weeks. Two months earlier, she had a cesarean section in the 37th week of pregnancy and had persistent bleeding from the surgical wound. She denied a history of bleeding in childhood or adolescence. Three years earlier, she had given birth to her first child (also by cesarean section), who died due to a chromosome disorder (referred to by the patient). She also stated that she was allergic to tramadol.\n\nThe clinical picture began with lower back pain due to bilateral renal lithiasis. Subsequently, he managed to expel a stone and after that he presented haematuria for three days, for which he received tranexamic acid c/12 h. Three weeks later, he presented pain in the lower region of the left thigh that increased in intensity, with hardening of the area. Due to persistence of the symptoms, he was given diclofenac intramuscularly, which caused ecchymosis and bleeding in the gluteal area and persists despite the compression with gauze.\n\nThe patient underwent a particular Doppler ultrasound that revealed deep venous thrombosis of the left lower limb, and went to the hospital in her locality with these results. She was given anticoagulation with enoxaparin 30 mg/24 h subcutaneously, in addition to morphine for pain management and was hospitalized. The next day, she presented epigastralgia, blurred vision, heart rate of 117 beats/min, blood pressure of 113/85 mmHg and saturation of 93%. It was decided to discontinue enoxaparin. The blood count revealed a hemoglobin of 6.4 g/dl, which represented a difference of 4 g/dl from the result one day before admission, which was 10.4 g/dl. Because of the above, two blood transfusions were given. Due to the suspicion of vasculitis, methylprednisolone was indicated and she was referred to our hospital for further study.\n\nOn admission, the physical examination revealed severe pallor, extensive ecchymosis on the left thigh and lateral knee, and a haematoma on the right thigh. The haemogram showed moderate anaemia (Hb = 9.8 g/dl), normocytic and normochromic. The biochemical examination showed glucose values of 160 mg/dl. The liver enzymes AST and ALT were at 52 U/L and 86 U/L, respectively. The coagulation profile showed a prolonged activated partial thromboplastin time (APTT) of 91.2 s. The rest of the haemogram, biochemical, electrolyte, liver profile and coagulation profile were normal. The ultrasound of soft parts of the right gluteal region revealed a collection at the level of the subcutaneous cellular tissue (TCSC) and oedema up to the upper third of the thigh. The Doppler ultrasound in the left lower limb showed adequate flowometry without signs of thrombosis in the common femoral vein, superficial and deep.\n\nSymptomatic treatment was initiated and blood and urine cultures were requested and were negative. Antinuclear antibody (ANA) values, complement C3 and C4 and ferritin were within the reference range.\n\nIn the face of suspected acquired haemophilia, studies were requested for confirmation, where a partial correction of aPTT was found in the mixing test. Factor VIII was measured and its activity was found to be decreased (<1.0 U/dl) and the presence of a factor VIII inhibitor was demonstrated: 8.64 Bethesda units/ml. The above allowed the diagnosis of acquired haemophilia to be confirmed, which was related to the postpartum period due to the onset of symptoms.\n\nPrednisone 50 mg orally at breakfast and 10 mg orally at lunch, cyclophosphamide 50 mg 2 tablets orally every 24 hours and anti-inhibitor coagulant complex for haemophilia (FEIBA) were initiated. Five days later, the latter was discontinued due to chest tightness, dyspnoea and nausea (possible adverse drug reaction) and replaced with activated recombinant factor VII (NovoSeven).\n\nThe patient's clinical evolution was favorable, with a decrease in ecchymosis and no other symptoms, so she was discharged from the hospital.\n",
+    "summary": "A 34-year-old female patient presented with lower back pain, haematuria and a haematoma in the right gluteal region, with no previous history of bleeding. Due to the extent of the haemorrhagic manifestations, she was transferred to the emergency department. The coagulation profile, mixing test and measurement of the factor VIII inhibitor titres confirmed the diagnosis.\n",
+    "translated_fulltext": "একজন ৩৪ বছর বয়সী রোগী, যার রোগের সূত্রপাত চার সপ্তাহ আগে। দুই মাস আগে, গর্ভাবস্থার ৩৭তম সপ্তাহে তার সিজারিয়ান সেকশন হয়েছিল এবং অস্ত্রোপচারের স্থান থেকে ক্রমাগত রক্তপাত হচ্ছিল। তিনি শৈশব বা কৈশোরে রক্তপাতের কোনো ইতিহাস অস্বীকার করেছেন। তিন বছর আগে, তিনি তার প্রথম সন্তানের জন্ম দেন (সিজারিয়ান সেকশনের মাধ্যমে), যে একটি ক্রোমোজোমজনিত সমস্যার কারণে মারা যায় (রোগী এটি উল্লেখ করেছেন)। তিনি আরও জানান যে তিনি ট্রামাডলের প্রতি অ্যালার্জিক।\n\nরোগীর শারীরিক অবস্থার অবনতি প্রথমে দ্বিপাক্ষিক রেনাল লিথিয়াসিসের কারণে কোমর ব্যথার মাধ্যমে শুরু হয়। এরপর, তিনি একটি পাথর শরীর থেকে বের করে দেন এবং তারপর তিন দিন ধরে রক্তমিশ্রিত প্রস্রাব হতে থাকে, যার জন্য তাকে ট্রানেক্সামিক অ্যাসিড দেওয়া হয় (প্রতি ১২ ঘণ্টা পর)। তিন সপ্তাহ পর, তার বাম উরুর নিচের অংশে ব্যথা শুরু হয়, যা তীব্র হতে থাকে এবং ওই অংশে শক্ত হয়ে যায়। উপসর্গের কারণে, তাকে ইন্ট্রামাসকুলার ডাইক্লোফেনাক দেওয়া হয়, যার ফলে নিতম্বের অঞ্চলে কালশিটে এবং রক্তপাত হয় এবং তা ব্যান্ডেজ করার পরেও persist করে।\n\nরোগীর একটি বিশেষ ডপলার আল্ট্রাসাউন্ড করা হয়, যেখানে বাম পায়ের গভীর শিরায় থ্রম্বোসিস ধরা পড়ে। এরপর তিনি স্থানীয় হাসপাতালে যান এবং সেখানে এই পরীক্ষার ফলাফল দেখানো হয়। তাকে ৩০ মিলিগ্রাম/২৪ ঘণ্টা করে সাবকিউটেনিয়াসভাবে এনোক্সাপারিন দেওয়া হয়, সেই সাথে ব্যথানাশক হিসেবে মরফিন দেওয়া হয় এবং হাসপাতালে ভর্তি করা হয়। পরের দিন, তার পেটের উপরের অংশে ব্যথা, দৃষ্টি ঝাপসা হয়ে যাওয়া, হৃদস্পন্দন ১১৭ বিট/মিনিট, রক্তচাপ ১১৩/৮৫ মিমি Hg এবং অক্সিজেনের স্যাচুরেশন ৯৩% ছিল। এরপর এনোক্সাপারিন বন্ধ করার সিদ্ধান্ত নেওয়া হয়। রক্ত পরীক্ষায় দেখা যায়, তার হিমোগ্লোবিনের মাত্রা ৬.৪ গ্রাম/ডিসিএল, যা হাসপাতালে ভর্তির আগের দিনের (১০.৪ গ্রাম/ডিসিএল) থেকে ৪ গ্রাম/ডিসিএল কম। এই কারণে, তাকে দুটি রক্ত পরিসঞ্চালন করা হয়। ভাস্কুলাইটিসের সন্দেহের কারণে, মিথাইলপ্রেডনিসোলোন দেওয়া হয় এবং আরও পরীক্ষার জন্য আমাদের হাসপাতালে রেফার করা হয়।\n\nহাসপাতালে ভর্তির সময়, শারীরিক পরীক্ষায় দেখা যায় তার শরীরে তীব্র রক্তাল্পতা, বাম উরু এবং হাঁটুর পাশে ব্যাপক কালশিটে এবং ডান উরুতে একটি হেমাটোমা রয়েছে। রক্ত পরীক্ষায় মাঝারি রক্তাল্পতা (Hb = ৯.৮ গ্রাম/ডিসিএল) এবং স্বাভাবিক আকারের লোহিত রক্তকণিকা দেখা যায়। বায়োকেমিক্যাল পরীক্ষায় গ্লুকোজের মাত্রা ১৬০ মিগ্রা/ডিসিএল পাওয়া যায়। লিভারের এনজাইম এএসটি এবং এএলটি যথাক্রমে ৫২ ইউ/এল এবং ৮৬ ইউ/এল ছিল। জমাট বাঁধার প্রোফাইলে দেখা যায়, অ্যাক্টিভেটেড পার্শিয়াল থ্রম্বোপ্লাস্টিন টাইম (এপিটিটি) স্বাভাবিকের চেয়ে বেশি (৯১.২ সেকেন্ড)। অন্যান্য রক্ত পরীক্ষা, বায়োকেমিক্যাল, ইলেক্ট্রোলাইট, লিভার প্রোফাইল এবং জমাট বাঁধার প্রোফাইল স্বাভাবিক ছিল। ডান নিতম্বের নরম টিস্যুর আল্ট্রাসাউন্ডে দেখা যায়, সাবকিউটেনিয়াস সেলুলার টিস্যুতে (টিসিএসসি) তরল জমা হয়েছে এবং উরুর উপরের অংশে ফোলা রয়েছে। বাম পায়ের ডপলার আল্ট্রাসাউন্ডে দেখা যায়, সাধারণ ফেমোরাল শিরা, অগভীর এবং গভীর শিরায় রক্ত প্রবাহ স্বাভাবিক আছে এবং থ্রম্বোসিসের কোনো লক্ষণ নেই।\n\nরোগীকে উপসর্গ অনুযায়ী চিকিৎসা দেওয়া শুরু করা হয় এবং রক্ত ও প্রস্রাবের কালচার পরীক্ষা করা হয়, যেখানে কোনো সংক্রমণ পাওয়া যায়নি। অ্যান্টি-নিউক্লিয়ার অ্যান্টিবডি (এএনএ), কমপ্লিমেন্ট সি৩ এবং সি৪ এবং ফেরিটিনের মাত্রা স্বাভাবিক সীমার মধ্যে ছিল।\n\nঅ্যাকোয়ার্ড হিমোফিলিয়ার সন্দেহে, রোগ নির্ণয়ের জন্য আরও কিছু পরীক্ষা করা হয়, যেখানে মিক্সিং পরীক্ষায় এপিটিটির আংশিক উন্নতি দেখা যায়। ফ্যাক্টর VIII-এর মাত্রা পরীক্ষা করা হয় এবং দেখা যায় এর কার্যকারিতা হ্রাস পেয়েছে (<১.০ ইউ/ডিসিএল) এবং ফ্যাক্টর VIII ইনহিবিটরের উপস্থিতি প্রমাণিত হয়: ৮.৬৪ বেথেসডা ইউনিট/মিলিলিটার। এই ফলাফলের ভিত্তিতে অ্যাকোয়ার্ড হিমোফিলিয়ার রোগ নির্ণয় নিশ্চিত করা হয়, যা উপসর্গের সূত্রপাতের সাথে সম্পর্কিত এবং প্রসব-পরবর্তী সময়ের সাথে জড়িত।\n\nরোগীকে প্রেডনিসোন ৫০ মিলিগ্রাম, সকালে নাস্তার সাথে এবং ১০ মিলিগ্রাম, দুপুরে খাবারের সাথে, সাইক্লোফসফামাইড ৫০ মিলিগ্রাম, দিনে দুইবার (প্রতি ২৪ ঘণ্টা পর) এবং হিমোফিলিয়ার জন্য অ্যান্টি-ইনহিবিটর কোয়াগুল্যান্ট কমপ্লেক্স (এফইআইবিএ) দেওয়া শুরু করা হয়।",
+    "translated_summary": "৩৪ বছর বয়সী একজন নারী রোগী কোমরের নিচের অংশে ব্যথা, প্রস্রাবে রক্ত এবং ডান নিতম্বের অঞ্চলে একটি রক্তক্ষরণজনিত ফোলা নিয়ে উপস্থিত হন। পূর্বে তার রক্তপাতের কোনো ইতিহাস ছিল না। রক্তক্ষরণের ব্যাপকতার কারণে, তাকে জরুরি বিভাগে স্থানান্তর করা হয়। রক্ত জমাট বাঁধার প্রোফাইল, মিশ্রণ পরীক্ষা এবং ফ্যাক্টর VIII ইনহিবিটর টাইটারের পরিমাপের মাধ্যমে রোগ নির্ণয় নিশ্চিত করা হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_47.txt",
+    "fulltext": "We present here the case of a two-day old neonate with in-born right scrotal swelling admitted at Children’s hospital. The patient was born at term via cesarean section at a private hospital. He was kept in the nursery for one day. The examining doctor referred them for urgent surgical care, but it took them one day to arrive at our hospital. Upon arrival in the emergency department, he was well hydrated, pink at room temperature with good perfusion. Upon examination, the right testis was found to be enlarged, tense, non-tender visibly reddish with overlying skin excoriation. Trans-illumination was negative in the right but positive in the contralateral testis. Both hernial orifices were normal. All the laboratory investigations were performed with an urgent Doppler ultrasound of the inguinoscrotal area. The ultrasound examination found the right testis to be enlarged (15.6*9.4 mm) and showed heterogeneous hypoechoic texture with prominent rete testis and no flow on color Doppler analysis. Left testis appeared normal in size, shape and echotexture with minimal hydrocele. An urgent scrotal exploration was undertaken. Intra-operatively, there was frank necrotic right testis with intravaginal torsion of the testis with minimal hydrocele. A right orchidectomy and contralateral orchidopexy was then performed.",
+    "summary": "We present here the case of a two-day old neonate with in-born right scrotal swelling admitted at Children’s hospital. The patient was born at term via cesarean section at a private hospital. Upon arrival in the emergency department, he was well hydrated, pink at room temperature with good perfusion. Upon examination, the right testis was found to be enlarged, tense, non-tender visibly reddish with overlying skin excoriation. Trans-illumination was negative in right but positive in the contralateral testis. Both hernial orifices were normal. Doppler ultrasound of the inguinoscrotal area found the right testis to be enlarged (15.6*9.4 mm) and showed heterogeneous hypoechoic texture with prominent rete testis and no flow on color doppler analysis. An urgent scrotal exploration was undertaken. Intra-operatively there was frank necrotic right testis with intravaginal torsion of the testis and minimal hydrocele. A right orchidectomy and contralateral orchidopexy were performed.",
+    "translated_fulltext": "আমরা এখানে একটি দুই দিন বয়সী নবজাতকের ঘটনা তুলে ধরছি, যার জন্মগতভাবে ডান দিকের অণ্ডকোষে ফোলা ছিল এবং তাকে শিশু হাসপাতালে ভর্তি করা হয়েছে। শিশুটি একটি বেসরকারি হাসপাতালে সিজারিয়ান অপারেশনের মাধ্যমে নির্ধারিত সময়ে জন্মগ্রহণ করে। তাকে একদিনের জন্য নার্সারিতে রাখা হয়েছিল। যে ডাক্তার পরীক্ষা করেছিলেন, তিনি জরুরি ভিত্তিতে অস্ত্রোপচারের জন্য পরামর্শ দেন, কিন্তু তাদের হাসপাতালে আসতে একদিন সময় লাগে। জরুরি বিভাগে আসার পর দেখা যায়, শিশুটি ভালোভাবে হাইড্রেটেড, স্বাভাবিক তাপমাত্রায় তার ত্বক স্বাভাবিক এবং রক্ত সঞ্চালনও ঠিক আছে। পরীক্ষায় দেখা যায়, ডান দিকের অণ্ডকোষটি বড়, শক্ত, দৃশ্যত লালচে এবং এর উপরে ত্বকের সামান্য ক্ষত রয়েছে। ডান দিকের অণ্ডকোষে ট্রান্স-ইলুমিনেশন নেগেটিভ ছিল, কিন্তু অন্য অণ্ডকোষে পজিটিভ। দুটি হার্নিয়াল অরফিসই স্বাভাবিক ছিল। এরপর জরুরি ভিত্তিতে ইনগুইনোস্ক্রোটাল অঞ্চলের ডপলার আলট্রাসাউন্ড করা হয় এবং অন্যান্য পরীক্ষাও করা হয়। আলট্রাসাউন্ড পরীক্ষায় দেখা যায়, ডান দিকের অণ্ডকোষটি বড় (15.6*9.4 মিমি) এবং এর মধ্যে বিভিন্ন ধরনের হাইপোইক টেক্সচার রয়েছে, রেটে টেস্টিস স্পষ্টভাবে দেখা যাচ্ছে এবং কালার ডপলার বিশ্লেষণে কোনো রক্ত প্রবাহ নেই। বাম দিকের অণ্ডকোষের আকার, আকৃতি এবং ইকোটেক্সচার স্বাভাবিক দেখা যায়, সামান্য হাইড্রোসেলও রয়েছে। এরপর জরুরি ভিত্তিতে স্ক্রোটাল এক্সপ্লোরেশন করা হয়। অস্ত্রোপচারের সময় দেখা যায়, ডান দিকের অণ্ডকোষে স্পষ্ট নেক্রোসিস হয়েছে এবং অণ্ডকোষের মধ্যে সামান্য হাইড্রোসেলসহ ইন্ট্রাভ্যাজাইনাল টরশন রয়েছে। এরপর ডান দিকের অণ্ডকোষ অপসারণ (অর্কিডেক্টমি) এবং অন্য অণ্ডকোষের অর্কিওপেক্সি করা হয়।",
+    "translated_summary": "আমরা এখানে একটি দুই দিন বয়সী নবজাতকের ঘটনা তুলে ধরছি, যার জন্মগতভাবে ডান দিকের অণ্ডকোষে ফোলা ছিল এবং তাকে শিশু হাসপাতালে ভর্তি করা হয়েছে। শিশুটি একটি বেসরকারি হাসপাতালে সিজারিয়ান অপারেশনের মাধ্যমে নির্ধারিত সময়ে জন্মগ্রহণ করে। জরুরি বিভাগে আসার পর দেখা যায়, তার শরীর ভালোভাবে হাইড্রেটেড, স্বাভাবিক তাপমাত্রায় ত্বক স্বাভাবিক এবং রক্ত সঞ্চালনও ঠিক ছিল। পরীক্ষায় দেখা যায়, ডান দিকের অণ্ডকোষটি আকারে বড়, শক্ত, স্পর্শ করলে ব্যথা লাগে না, তবে এর বাইরের ত্বক লালচে এবং কিছুটা ক্ষতিগ্রস্ত। ডান দিকের অণ্ডকোষে আলো প্রবেশ করানো হলে তা দেখা যায়নি, কিন্তু অন্য দিকের অণ্ডকোষে আলো প্রবেশ করানো হলে তা দেখা গেছে। দুটি হার্নিয়াল ছিদ্রই স্বাভাবিক ছিল। ইনগুইনোস্ক্রোটাল অঞ্চলের ডপলার আলট্রাসাউন্ডে দেখা যায়, ডান দিকের অণ্ডকোষটি বড় (15.6*9.4 মিমি) এবং এর মধ্যে বিভিন্ন ধরনের হাইপোইক টেক্সচার রয়েছে, রেটে টেস্টিস স্পষ্টভাবে দেখা যাচ্ছে এবং কালার ডপলার বিশ্লেষণে কোনো রক্ত প্রবাহ দেখা যায়নি। দ্রুততার সাথে স্ক্রোটাল এক্সপ্লোরেশন করা হয়। অপারেশনের সময় দেখা যায়, ডান দিকের অণ্ডকোষে স্পষ্ট নেক্রোসিস হয়েছে এবং অণ্ডকোষের মধ্যে টর্শন হয়েছে, সেই সাথে সামান্য হাইড্রোসেলও রয়েছে। এরপর ডান দিকের অণ্ডকোষ অপসারণ (অর্কিডেক্টমি) এবং অন্য দিকের অণ্ডকোষকে সঠিক স্থানে স্থাপন (অর্কিডোপেক্সি) করা হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_564.txt",
+    "fulltext": "A 69-year-old male with prior history of CABG presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration was admitted in our center. The electrocardiogram showed ST depression in leads II, III, aVF, and V4-6, and blood examination revealed elevation of plasma N-terminal pro-B-type natriuretic peptide levels (2640 pg/mL). Echocardiogram showed left ventricular systolic dysfunction and low left ventricular ejection fraction (30%). The patient had inferior ST-segment-elevation myocardial infarction in 2009, when he was 59 years old, with angiographic evidence of severe 3 vessels disease (coronary angiography showed CTO in proximal left anterior descending artery (LAD), 90% stenosis in mid and distal left circumflex artery, and 95% stenosis in mid RCA. The patient underwent CABG with left internal mammary artery (LIMA) to LAD, and sequential SVG to 1st obtuse marginal branch (OM1), 2nd obtuse marginal branch (OM2), and posterolateral branch (PL) in 2009.\n\nCoronary angiography was performed via 6 French (Fr) left radial artery access and demonstrated patency of LIMA to LAD and SVG to OM1, OM2 conduits, but a complete occlusion of sequential SVG to PL conduit. Native left main coronary artery was occluded in ostium and native RCA was occluded in the mid portion with bridging collaterals. We decided to treat the native RCA CTO. Dual arterial access was achieved with another 6 Fr sheath in right femoral artery. The left and right coronary arteries were intubated with 6 Fr AL 0.75 (Launcher; Medtronic; USA) and 6 Fr EBU 3.5 (Launcher; Medtronic; USA) guide catheters, respectively. An antegrade approach via left radial artery was attempted; however, neither Fielder XTR wire (Asahi Intec, Japan) nor Gaia 3 wire (Asahi Intec, Japan) with Finecross microcatheter (Terumo, Japan) reached the true lumen in distal RCA. Then, parallel wire technique with Crusade microcatheter (Kaneka, Japan) and two Gaia 3 wires (Asahi Intec, Japan) were attempted, but also failed. We therefore switched to the retrograde approach using septal channel from LAD through occluded left coronary artery. Gaia 3 wire (Asahi Intec, Japan) crossed occluded left main (LM) and LAD, and finally reached true lumen in distal LAD. Sion wire was exchanged by Finecross microcatheter (Terumo, Japan) into dital LAD, and dilation of LM and proximal LAD with a 2.0 × 15 mm balloon was performed. Then, septal surfing technique (SST) was used for septal crossing. We tried different septal channels originating from proximal to distal LAD, and delivered Sion wire (Asahi Intec, Japan) retrogradely through distal septal branch into distal RCA supported by a 150-cm Finecross microcatheter (Terumo, Japan). Gaia 3 wire (Asahi Intec, Japan) crossed CTO lesion retrogradely into the true lumen in proximal RCA, and was advanced into Guidezilla guide extension catheter (Boston Scientific, USA) positioned in the antegrade guiding catheter. The Finecross microcatheter (Terumo, Japan) was delivered to the antegrade catheter and a RG3 wire (Asahi Intec, Japan) was externalized. The CTO was then predilated by a 2.0 × 15 mm balloon and stented with 2 overlapping drug-eluting stents (2.5 × 38 mm and 3.0 × 38 mm) with excellent angiographic result and TIMI3 flow in all distal branches.\n\nDyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea.",
+    "summary": "Patient concerns:\nThis is a 69-year-old male with prior history of coronary artery bypass grafting presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration.\n\nDiagnosis:\nThe patient was diagnosed as heart failure caused by ischemia after SVG failure (SVG to right coronary artery) according to electrocardiogram, plasma N-terminal pro-B-type natriuretic peptide levels, and coronary angiogram.\n\nInterventions:\nWe recanalized native right coronary artery CTO by retrograde approach using septal collaterals by surfing technique after recanalization of totally occluded left coronary artery.\n\nOutcomes:\nDyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea.",
+    "translated_fulltext": "একজন ৬৯ বছর বয়সী পুরুষ, যার পূর্বে CABG-এর ইতিহাস রয়েছে, তিনি হালকা শারীরিক কার্যকলাপের সময় তীব্র শ্বাসকষ্ট (NYHA III) অনুভব করছিলেন, যা প্রায় ২ মাস ধরে চলে আসছিল। তাকে আমাদের কেন্দ্রে ভর্তি করা হয়। ইলেক্ট্রোকার্ডিওগ্রামে II, III, aVF এবং V4-6 লিডে ST ডিপ্রেশন দেখা যায় এবং রক্ত পরীক্ষায় প্লাজমা N-টার্মিনাল প্রো-বি-টাইপ ন্যাট্রিয়ুরেটিক পেপটাইডের মাত্রা বৃদ্ধি পায় (2640 pg/mL)। ইকোকার্ডিওগ্রামে বাম নিলয়ের সিস্টোলিক ডিসফাংশন এবং বাম নিলয়ের ইজেকশন ফ্র্যাকশন কম (30%) দেখা যায়। রোগীর 2009 সালে নিম্নবর্তী ST-সেগমেন্ট এলিভেশন মায়োকার্ডিয়াল ইনফার্কশন হয়েছিল, তখন তার বয়স ছিল ৫৯ বছর। এনজিওগ্রাফিতে দেখা যায়, তিনটি প্রধান রক্তনালীতে গুরুতর ব্লকেজ রয়েছে (করোনারি এনজিওগ্রাফিতে দেখা যায়, প্রক্সিমাল বাম অ্যানটেরিয়র ডিসেন্ডিং ধমনীতে (LAD) সম্পূর্ণ ব্লকেজ, মধ্যবর্তী এবং দূরবর্তী বাম সার্কামফ্লেক্স ধমনীতে 90% স্টেনোসিস এবং মধ্যবর্তী RCA-তে 95% স্টেনোসিস)। 2009 সালে রোগীর CABG করা হয়েছিল, যেখানে বাম অভ্যন্তরীণ স্তনধমনী (LIMA) ব্যবহার করে LAD-এর সাথে এবং সিকোয়েন্সিয়াল SVG ব্যবহার করে প্রথম অবটিউস মার্জিনাল শাখা (OM1), দ্বিতীয় অবটিউস মার্জিনাল শাখা (OM2) এবং পোস্টেরোলেটারাল শাখা (PL)-এর সাথে সংযোগ স্থাপন করা হয়েছিল।\n\n৬ ফ্রেঞ্চ (Fr) বাম রেডিয়াল ধমনী দিয়ে করোনারি এনজিওগ্রাফি করা হয়। এতে দেখা যায়, LIMA থেকে LAD এবং SVG থেকে OM1, OM2-এর সংযোগ স্বাভাবিক আছে, কিন্তু সিকোয়েন্সিয়াল SVG থেকে PL-এর সংযোগে সম্পূর্ণ ব্লকেজ রয়েছে। স্বাভাবিক বাম প্রধান করোনারি ধমনীটি অস্টিয়ামে এবং স্বাভাবিক RCA-এর মধ্যবর্তী অংশে ব্লকেজ ছিল, যেখানে কিছু সংযোগকারী রক্তনালী ছিল। আমরা স্বাভাবিক RCA-এর CTO (ক্রনিক টোটাল অক্লুশন) চিকিৎসার সিদ্ধান্ত নেই। ডান ফিমোরাল ধমনীতে আরও একটি ৬ Fr শীথ ব্যবহার করে দ্বৈত ধমনীপথে প্রবেশ করা হয়। বাম এবং ডান করোনারি ধমনীতে ৬ Fr AL 0.75 (লঞ্চার; মেডট্রনিক; মার্কিন যুক্তরাষ্ট্র) এবং ৬ Fr EBU 3.5 (লঞ্চার; মেডট্রনিক; মার্কিন যুক্তরাষ্ট্র) গাইডের ক্যাথিটার প্রবেশ করানো হয়। বাম রেডিয়াল ধমনী দিয়ে অ্যান্টারোগ্রেড পদ্ধতিতে চেষ্টা করা হয়; তবে, ফielder XTR ওয়্যার (আসাহি ইন্টেক, জাপান) বা গাইয়া 3 ওয়্যার (আসাহি ইন্টেক, জাপান) এবং ফাইনক্রস মাইক্রোক্যাথিটার (টেরুমো, জাপান) ব্যবহার করেও দূরবর্তী RCA-এর সঠিক স্থানে পৌঁছানো যায়নি। এরপর, ক্রুসেড মাইক্রোক্যাথিটার (কানেকা, জাপান) এবং দুটি গাইয়া 3 ওয়্যার (আসাহি ইন্টেক, জাপান) ব্যবহার করে প্যারালাল ওয়্যার কৌশল প্রয়োগ করা হয়, কিন্তু তাতেও ব্যর্থ হওয়া যায়। তাই, আমরা রিট্রোগ্রেড পদ্ধতিতে স্যুইচ করি এবং LAD থেকে সেপটাল চ্যানেল ব্যবহার করে অবরুদ্ধ বাম করোনারি ধমনীর মাধ্যমে প্রবেশ করি। গাইয়া 3 ওয়্যার (আসাহি ইন্টেক, জাপান) অবরুদ্ধ বাম প্রধান (LM) এবং LAD অতিক্রম করে অবশেষে দূরবর্তী LAD-এর সঠিক স্থানে পৌঁছায়। ফাইনক্রস মাইক্রোক্যাথিটার (টেরুমো, জাপান) ব্যবহার করে সিয়ন ওয়্যারকে দূরবর্তী LAD-এ প্রতিস্থাপন করা হয় এবং LM এবং প্রক্সিমাল LAD-কে 2.0 × 15 মিমি বেলুন দিয়ে প্রসারিত করা হয়। এরপর, সেপটাল সার্ফিং কৌশল (SST) ব্যবহার করে সেপটাল অতিক্রম করা হয়। আমরা প্রক্সিমাল থেকে দূরবর্তী LAD পর্যন্ত বিভিন্ন সেপটাল চ্যানেল চেষ্টা করি এবং সিয়ন ওয়্যার (আসাহি ইন্টেক, জাপান) ব্যবহার করে দূরবর্তী সেপটাল শাখা থেকে রিট্রোগ্রেডলি RCA-তে প্রবেশ করাই এবং 150 সেমি ফাইনক্রস মাইক্রোক্যাথিটার (টেরুমো, জাপান) দিয়ে সাপোর্ট করি। গাইয়া 3 ওয়্যার (আসাহি ইন্টেক, জাপান) CTO ক্ষতটিকে রিট্রোগ্রেডলি অতিক্রম করে প্রক্সিমাল RCA-এর সঠিক স্থানে পৌঁছায় এবং গাইড্রজিলা গাইড এক্সটেনশন ক্যাথিটার (বোস্টন সায়েন্টিফিক, মার্কিন যুক্তরাষ্ট্র)-এ প্রবেশ করানো হয়, যা অ্যান্টারোগ্রেড গাইডিং ক্যাথিটারে স্থাপন করা হয়েছিল। ফাইনক্রস মাইক্রোক্যাথিটার (টেরুমো, জাপান) অ্যান্টারোগ্রেড ক্যাথিটারে প্রবেশ করানো হয় এবং RG3 ওয়্যার (আসাহি ইন্টেক, জাপান) বের করে আনা হয়। এরপর, 2.0 × 15 মিমি বেলুন দিয়ে CTO-টিকে প্রসারিত করা হয় এবং দুটি ওভারল্যাপিং ড্রাগ-এলুটিং স্টেন্ট (2.5 × 38 মিমি এবং 3.0 × 38 মিমি) স্থাপন করা হয়। এর ফলে চমৎকার এনজিওগ্রাফিক ফলাফল পাওয়া যায় এবং সমস্ত দূরবর্তী শাখায় TIMI3 ফ্লো দেখা যায়।\n\nহাসপাতাল থেকে ছাড়ার সময় শ্বাসকষ্ট কমে যায়। ৬ মাস পরে ফলো-আপে দেখা যায়, রোগীর শ্বাসকষ্টের পুনরাবৃত্তি হয়নি।",
+    "translated_summary": "রোগীর সমস্যা:\nএই রোগী ৬৯ বছর বয়সী একজন পুরুষ, যার আগে করোনারি ধমনী বাইপাস গ্রাফটিং করা হয়েছিল। তিনি হালকা শারীরিক কার্যকলাপের সময় তীব্র শ্বাসকষ্টের (এনওয়াইএইচএ III) সমস্যা নিয়ে এসেছেন, যা প্রায় ২ মাস ধরে চলছে।\n\nরোগ নির্ণয়:\nইলেক্ট্রোকার্ডিওগ্রাম, প্লাজমা এন-টার্মিনাল প্রো-বি-টাইপ ন্যাট্রিয়ুরেটিক পেপটাইড মাত্রা এবং করোনারি অ্যাঞ্জিওগ্রামের মাধ্যমে রোগীর ইস্কেমিয়ার কারণে হার্ট ফেইলিউর হয়েছে বলে নির্ণয় করা হয়, যেখানে এসভিজি (ডান করোনারি ধমনীতে) ব্যর্থ হয়েছে।\n\nচিকিৎসা:\nআমরা পশ্চাৎমুখী পদ্ধতির মাধ্যমে সেপটাল কোলাটেরাল ব্যবহার করে সার্ফিং কৌশল প্রয়োগ করে সম্পূর্ণরূপে বন্ধ হয়ে যাওয়া বাম করোনারি ধমনীকে পুনরায় খুলে দেই এবং এরপর স্থানীয় ডান করোনারি ধমনীর সিটিও (ক্রনিক টোটাল অক্লুশন) পুনরুদ্ধার করি।\n\nফলাফল:\nরোগী হাসপাতাল থেকে ছাড়ার সময় শ্বাসকষ্ট থেকে মুক্তি পান। ছয় মাস পর ফলো-আপে দেখা যায়, রোগীর শ্বাসকষ্টের সমস্যা আর ফিরে আসেনি।"
+  },
+  {
+    "id": "multiclinsum_gs_en_289.txt",
+    "fulltext": "4-year-old male patient with a history of nasal impetigo two weeks before admission (treated with topical mupirocin and oral cefadroxil; dose, duration and adherence to treatment unknown), with no other morbid history, who presented macroscopic glomerular haematuria associated with oedema of the lower extremities of 5 days' evolution, with the last 12 hours prior to the consultation adding headaches, nausea and vomiting. He went to the emergency department (ED) in convulsive status, after 20 minutes of generalised tonic-clonic convulsions.\n\nOn admission to the ED, the patient was afebrile, with non-evaluable blood pressure, with quantitative consciousness impairment associated with generalized hypertonia and bilateral and pretibial oedema. Endotracheal intubation was decided and phenobarbital (10 mg/kg) was administered to manage the convulsive status.\n\nOn physical examination in the intensive care unit (ICU), blood pressure was 134/94 mmHg (BP 110 mmHg) (p95 for patient 108/66 mmHg, p95+12 120/78 mmHg).\n\nInitial laboratory parameters included: complete urine with haematuria (> 100 erythrocytes per field), proteinuria 3+ and leucocyturia 10-25 per field, creatinemia 0.3 mg/dL, anaemia with haematocrit (HTO) 21%, haemoglobin (Hb) 7 g/dL, with normal mean corpuscular volume (VCM) and mean corpuscular haemoglobin concentration (CHCM), leukocytosis of 23,900 cells/mm3, thrombocytosis of 756,000/mm3, without elevation of acute phase reactants, hypocomplementemia with complement C3 level at 25 mg/dL (normal value, VN: 80-150 mg/dL) and normal C4. The rapid antigen test for Streptococcus beta-haemolytic group A (Streptococcus pyogenes) in pharynx was positive and the Anti-streptolysin O (ASO) was (+). The non-contrast brain computed tomography showed no acute changes. The renal ultrasound concluded bilateral nephromegaly with increased cortical echogenicity and decreased corticomedullar differentiation.\n\nThe patient was diagnosed with nephritic syndrome due to complicated GNAPE with hypertensive emergency - convulsive status.\n\nWithin the first 24 hours of his ICU stay, the patient required mechanical ventilation (MV) and anticonvulsant therapy with phenobarbital. He progressed without seizures, with a normal electroencephalogram (EEG) (on the day following admission) and a normal cerebrospinal fluid study. Antibiotic therapy was initiated for eradication of Streptococcus pyogenes with cefotaxime and diuretic therapy with furosemide.\n\nThe next day, he developed renal impairment with creatinine elevation to 0.99 mg/dL, hypertension and 24 hour proteinuria of 36.6 mg/m2/h, without oliguria. He initiated antihypertensive therapy with amlodipine and intravenous labetalol, with good initial control.\n\nWith favorable evolution, extubation was performed at 48 hours, which was well tolerated from the ventilatory point of view. However, after 24 hours of extubation, the patient's consciousness deteriorated, with both ocular opening and withdrawal of limb only in response to painful stimulus and poor verbal response (Glasgow Coma Scale 8), and developed blood pressure figures > p95+12 despite receiving therapy with labetalol in continuous infusion (up to 3 mg/kg/h), amlodipine (10 mg/day) and furosemide, which required the reintroduction of mechanical ventilation and infusion of sodium nitroprusside (up to 3 mcg/kg/min), with the aim of achieving gradual reduction of blood pressure figures (25% daily) to prevent secondary neurological damage. Given the presence of acute neurological symptomatology associated with HTA in a patient with glomerulonephritis, the diagnosis of PRES was suspected, which was confirmed by magnetic resonance imaging (MRI) of the brain (day 5), which showed an increase in the subcortical signal in bilateral and symmetric occipital region, without restriction in diffusion, which was compatible with vasogenic edema (PRES). Ophthalmological evaluation was normal and a new EEG evidenced occasional episodes of generalized voltage depression.\n\nAdding enalapril to the treatment. Finally, after 10 days with a slow pharmacological weaning, normalization of blood pressure was achieved. The control MRI (day 12) revealed regression of the previously described findings. Successful extubation was achieved after 5 days.\n\nDuring his stay in the ICU, the hemoglobin level dropped to 5 g/dL, with normal mean corpuscular volume and mean corpuscular hemoglobin concentration, without plateletopenia, so hemolytic anemia was suspected given a positive direct Coombs test and hemoglobinuria. He required red blood cell transfusions twice. Steroid therapy with methylprednisolone (1 mg/kg/d) was initiated for 72 hours. The coproculture was negative, as was the urinary antigen for Streptococcus pneumoniae. Epstein-Barr virus and Parvovirus B19 serology, extractable nuclear antigen (ENA) profile, anti-neutrophil cytoplasmic antibodies (ANCA), anti-DNA antibodies, anti-B2 glycoprotein 1 antibodies, anti-cardiolipin antibodies and lupus anticoagulant were all negative. All cultures were negative (blood cultures, urine cultures, cultures of endotracheal aspirate and pharyngeal cultures). ANA (antinuclear antibodies) was positive 1/160.\n\nThe patient improved with blood pressure normalization, increased complement levels, and a urine test without proteinuria or hematuria. The direct Coombs test remained positive on the 9th day of hospitalization.\n\nOn day 31, the patient was discharged normotensive, without anaemia, with preserved renal function, without proteinuria or haematuria, with normalisation of C3 levels and asymptomatic from the neurological point of view. He was discharged with pharmacological therapy with prednisone, amlodipine, enalapril and folic acid. The patient did not present recurrence and remained asymptomatic 6 months after discharge.\n",
+    "summary": "4-year-old male patient with a history of 5 days of haematuria and oedema, with additional headaches, nausea and vomiting, who entered a convulsive state and hypertensive crisis. Laboratory tests showed hypocomplementemia C3 and elevated Anti-Streptolysin O titers, which was interpreted as GNAPE. He developed encephalopathy, which led to suspicion of secondary PRES due to hypertensive emergency, which was finally confirmed by magnetic resonance of the brain. He also developed autoimmune haemolytic anaemia with haemoglobin up to 5 g/dL. His treatment was based on antihypertensive therapy, neuroprotection measures and steroid treatment. He was discharged after 31 days of hospitalisation, asymptomatic 6 months after discharge.\n",
+    "translated_fulltext": "ভর্তির দুই সপ্তাহ আগে থেকে নাকের ইম্পেটিগোর (impetigo) ইতিহাসসহ ৪ বছর বয়সী একজন পুরুষ রোগী, যার পূর্বে অন্য কোনো গুরুতর অসুস্থতার ইতিহাস নেই। রোগীর শরীরে ৫ দিন ধরে ধীরে ধীরে বাড়তে থাকা ম্যাক্রোস্কোপিক গ্লোমেরুলার হেমাটুরিয়া (glomerular haematuria) এবং নিম্ন extremities-এ ইডিমা (oedema) দেখা যায়। এর সাথে গত ১২ ঘন্টায় মাথাব্যথা, বমি বমি ভাব এবং বমি হওয়ার লক্ষণ যুক্ত হয়। এরপর তিনি খিঁচুনি অবস্থায় জরুরি বিভাগে (ED) যান, যেখানে ২০ মিনিট ধরে সাধারণ টনিক-ক্লোনিক খিঁচুনি (tonic-clonic convulsions) হয়।\n\nজরুরি বিভাগে ভর্তির সময়, রোগীর জ্বর ছিল না, রক্তচাপ পরিমাপ করা যায়নি, এবং সাধারণ হাইপারটোনিয়া (hypertonia) ও দ্বিপাক্ষিক এবং প্রিটিবিয়াল ইডিমা (pretibial oedema) সহ তার চেতনা দুর্বল ছিল। এরপর এন্ডোট্রাকিয়াল ইন্টুবেশন (endotracheal intubation) করার সিদ্ধান্ত নেওয়া হয় এবং খিঁচুনি নিয়ন্ত্রণের জন্য ফেনোবারবিটাল (phenobarbital) (10 mg/kg) দেওয়া হয়।\n\nইনটেনসিভ কেয়ার ইউনিটে (ICU) শারীরিক পরীক্ষার সময়, রক্তচাপ ছিল 134/94 mmHg (BP 110 mmHg) (রোগীর জন্য p95 108/66 mmHg, p95+12 120/78 mmHg)।\n\nপ্রাথমিক ল্যাবরেটরি পরীক্ষায় দেখা যায়: প্রস্রাবে হেমাটুরিয়া (> 100 এরিথ্রোসাইট প্রতি ফিল্ড), প্রোটিনুরিয়া 3+ এবং লিউকোসাইটুরিয়া 10-25 প্রতি ফিল্ড, ক্রিয়েটিনেমিয়া 0.3 mg/dL, হিমাটোক্রিট (HTO) 21% এবং হিমোগ্লোবিন (Hb) 7 g/dL সহ রক্তাল্পতা, স্বাভাবিক গড় কর্পাসকুলার ভলিউম (VCM) এবং গড় কর্পাসকুলার হিমোগ্লোবিন ঘনত্ব (CHCM), 23,900 কোষ/mm3 লিউকোসাইটোসিস, 756,000/mm3 থ্রম্বোসাইটোসিস, অ্যাকিউট ফেজ রিঅ্যাক্টেন্টগুলির (acute phase reactants) বৃদ্ধি ছাড়াই, কমপ্লিমেন্ট C3-এর মাত্রা 25 mg/dL (স্বাভাবিক মান, VN: 80-150 mg/dL) এবং স্বাভাবিক C4। মুখের মধ্যে স্ট্রেপ্টোকক্কাস বিটা-হেমোলাইটিক গ্রুপ এ (Streptococcus pyogenes)-এর দ্রুত অ্যান্টিজেন পরীক্ষা পজিটিভ ছিল এবং অ্যান্টি-স্ট্রেপ্টোলাইসিন ও (ASO) (+)। মস্তিষ্কের নন-কন্ট্রাস্ট কম্পিউটেড টমোগ্রাফিতে (non-contrast brain computed tomography) কোনো তীব্র পরিবর্তন দেখা যায়নি। রেনাল আল্ট্রাসাউন্ডে (renal ultrasound) উভয় কিডনিতে বৃদ্ধি (nephromegaly) এবং কর্টিকাল ইকোজেনিসিটির (cortical echogenicity) বৃদ্ধি এবং কর্টিকোমেডুলারি ডিফারেন্সিয়েশনের (corticomedullar differentiation) হ্রাস দেখা যায়।\n\nরোগীকে জটিল জিএনএপিই (GNAPE) এবং উচ্চ রক্তচাপের কারণে নেফ্রাইটিক সিনড্রোম (nephritic syndrome) হিসাবে নির্ণয় করা হয় - খিঁচুনি।\n\nআইসিইউতে থাকার প্রথম ২৪ ঘণ্টার মধ্যে, রোগীর যান্ত্রিক বায়ুচলাচল (MV) এবং ফেনোবারবিটাল দিয়ে অ্যান্টি-কনভালসেন্ট থেরাপির প্রয়োজন হয়। খিঁচুনি ছাড়াই, স্বাভাবিক ইলেক্ট্রোএনসেফালোগ্রাম (EEG) (ভর্তির পরের দিন) এবং স্বাভাবিক সেরিব্রোস্পাইনাল ফ্লুইড (cerebrospinal fluid) পরীক্ষার মাধ্যমে রোগীর উন্নতি হয়। স্ট্রেপ্টোকক্কাস পায়োজেনেস (Streptococcus pyogenes) নির্মূল করার জন্য সেফোট্যাক্সিম (cefotaxime) এবং ডায়ইউরেটিক থেরাপির (diuretic therapy) জন্য ফুরোসেমাইড (furosemide) দিয়ে অ্যান্টিবায়োটিক থেরাপি শুরু করা হয়।\n\nপরের দিন, ক্রিয়েটিনিনের মাত্রা বেড়ে 0.99 mg/dL, উচ্চ রক্তচাপ এবং 24 ঘন্টায় 36.6 mg/m2/h প্রোটিনুরিয়া দেখা যায়, তবে অলিগুরিয়া (oliguria) ছিল না। এরপর অ্যামলোডিপাইন (amlodipine) এবং ইন্ট্রাভেনাস ল্যাবেটালল (intravenous labetalol) দিয়ে অ্যান্টিহাইপারটেনসিভ থেরাপি শুরু করা হয়, যা প্রাথমিক পর্যায়ে ভালো কাজ করে।\n\nইতিবাচক উন্নতির সাথে, ৪৮ ঘন্টায় ইন্টুবেশন অপসারণ করা হয়, যা শ্বাস-প্রশ্বাস প্রক্রিয়ার দিক থেকে ভালোভাবে সহ্য করা হয়েছিল। তবে, ইন্টুবেশন সরানোর ২৪ ঘন্টা পর, রোগীর চেতনা দুর্বল হয়ে যায়, চোখের পাতা খোলা এবং অঙ্গপ্রত্যঙ্গ সরানোর প্রতিক্রিয়া শুধুমাত্র ব্যথাদায়ক উদ্দীপনার প্রতি দেখা যায় এবং মৌখিক প্রতিক্রিয়া দুর্বল ছিল (গ্লাসগো কোমা স্কেল 8)। ল্যাবেটালল (labetalol) একটানা দেওয়ার (3 mg/kg/h পর্যন্ত), অ্যামলোডিপাইন (10 mg/day) এবং ফুরোসেমাইড (furosemide) দেওয়ার পরেও রক্তচাপ p95+12-এর বেশি ছিল, যার কারণে যান্ত্রিক বায়ুচলাচল পুনরায় শুরু করতে হয় এবং সোডিয়াম নাইট্রোপ্রুসাইড (sodium nitroprusside) (3 mcg/kg/min পর্যন্ত) দেওয়া হয়, যার উদ্দেশ্য ছিল ধীরে ধীরে রক্তচাপ কমানো (প্রতিদিন ২৫%) যাতে দ্বিতীয় neurological ক্ষতি এড়ানো যায়। গ্লোমেরুলোনেফ্রাইটিসের (glomerulonephritis) সাথে উচ্চ রক্তচাপের কারণে তীব্র স্নায়বিক লক্ষণ দেখা যাওয়ায় পিআরইএস (PRES) হওয়ার সম্ভাবনা ছিল, যা মস্তিষ্কের ম্যাগনেটিক রেজোন্যান্স ইমেজিং (MRI) (৫ম দিন) দ্বারা নিশ্চিত করা হয়েছিল। এতে দেখা যায় উভয় দিকে এবং প্রতিসম অক্সিপিটাল অঞ্চলে সাবকর্টিক্যাল সংকেত (subcortical signal) বৃদ্ধি পেয়েছে, তবে ডিফিউশনে কোনো বাধা নেই, যা ভাসোজেনিক ইডিমা (vasogenic edema) (PRES)-এর সাথে সামঞ্জস্যপূর্ণ। চক্ষু বিশেষজ্ঞের মূল্যায়ন স্বাভাবিক ছিল এবং নতুন ইইজি (EEG)-তে মাঝে মাঝে সাধারণ ভোল্টেজ হ্রাসের ঘটনা দেখা যায়।\n\nচিকিৎসায় এনালাপ্রিল (enalapril) যোগ করা হয়। অবশেষে, ১০ দিন ধরে ধীরে ধীরে ওষুধের মাত্রা কমানোর পর, রক্তচাপ স্বাভাবিক হয়ে আসে। কন্ট্রোল এমআরআই (MRI) (১২তম দিন)-তে পূর্বে বর্ণিত লক্ষণগুলির উন্নতি দেখা যায়। ৫ দিন পর সফলভাবে ইন্টুবেশন অপসারণ করা হয়।\n\nআইসিইউতে থাকার সময়, হিমোগ্লোবিনের মাত্রা কমে 5 g/dL হয়, গড় কর্পাসকুলার ভলিউম এবং গড় কর্পাসকুলার হিমোগ্লোবিন ঘনত্ব স্বাভাবিক ছিল, তবে প্লেটলেটোপেনিয়া (plateletopenia) ছিল না, তাই পজিটিভ ডিরেক্ট কম্বস (direct Coombs) পরীক্ষা এবং হিমোগ্লোবিনুরিয়ার (hemoglobinuria) কারণে হিমোলাইটিক অ্যানিমিয়া (hemolytic anemia) সন্দেহ করা হয়েছিল। রোগীর দুবার রেড ব্লাড সেল ট্রান্সফিউশন (red blood cell transfusions) করা হয়েছিল। মিথাইলপ্রেডনিসোলোন (methylprednisolone) (1 mg/kg/d) দিয়ে 72 ঘন্টার জন্য স্টেরয়েড থেরাপি শুরু করা হয়। কোপ্রোকালচার (coproculture) নেগেটিভ ছিল, সেইসাথে স্ট্রেপ্টোকক্কাস নিউমোনিয়ার (Streptococcus pneumoniae) জন্য মূত্র অ্যান্টিজেন পরীক্ষাও নেগেটিভ ছিল। এপস্টাইন-বার ভাইরাস (Epstein-Barr virus) এবং পারভোভাইরাস বি19 (Parvovirus B19) সেরোলজি, এক্সট্র্যাক্টেবল নিউক্লিয়ার অ্যান্টিজেন (ENA) প্রোফাইল, অ্যান্টি-নিউট্রোফিল সাইটোপ্লাজমিক অ্যান্টিবডি (ANCA), অ্যান্টি-ডিএনএ অ্যান্টিবডি, অ্যান্টি-বি2 গ্লাইকোপ্রোটিন 1 অ্যান্টিবডি, অ্যান্টি-কার্ডিওলাইপিন অ্যান্টিবডি এবং লুপাস অ্যান্টিকোয়াগুল্যান্ট (lupus anticoagulant) সবই নেগেটিভ ছিল। সমস্ত কালচার (রক্ত কালচার, প্রস্রাব কালচার, এন্ডোট্রাকিয়াল অ্যাসপিরেশনের (endotracheal aspirate) কালচার এবং ফ্যারিঞ্জিয়াল কালচার) নেগেটিভ ছিল। এএনএ (antinuclear antibodies) পজিটিভ ছিল 1/160।\n\nরোগীর রক্তচাপ স্বাভাবিক হয়, কমপ্লিমেন্টের মাত্রা বাড়ে এবং প্রস্রাব পরীক্ষায় প্রোটিনুরিয়া বা হেমাটুরিয়া ছিল না, তাই রোগীর উন্নতি হয়। হাসপাতালে থাকার নবম দিনে ডিরেক্ট কম্বস (direct Coombs) পরীক্ষা পজিটিভ ছিল।\n\n৩১তম দিনে, রোগীকে স্বাভাবিক রক্তচাপ, রক্তাল্পতা ছাড়াই, স্বাভাবিক কিডনি ফাংশন, প্রোটিনুরিয়া বা হেমাটুরিয়া ছাড়াই এবং C3-এর মাত্রা স্বাভাবিক করে ছেড়ে দেওয়া হয় এবং স্নায়বিক দিক থেকে উপসর্গমুক্ত ছিল। রোগীকে প্রেডনিসোন (prednisone), অ্যামলোডিপাইন (amlodipine), এনালাপ্রিল (enalapril) এবং ফলিক অ্যাসিড (folic acid) দিয়ে ওষুধ দেওয়া হয়। রোগীকে ছাড়ার পর ৬ মাস পর্যন্ত কোনো পুনরাবৃত্তি হয়নি এবং তিনি উপসর্গমুক্ত ছিলেন।",
+    "translated_summary": "চার বছর বয়সী একজন পুরুষ রোগী, যার পাঁচ দিন ধরে প্রস্রাবে রক্ত এবং শরীরে ফোলা ছিল, সেই সাথে অতিরিক্ত মাথাব্যথা, বমি বমি ভাব এবং বমি হচ্ছিল। এরপর তিনি খিঁচুনি এবং উচ্চ রক্তচাপের সংকটে পড়েন। ল্যাবরেটরি পরীক্ষায় দেখা যায় তার সি৩-এর মাত্রা কম এবং অ্যান্টি-স্ট্রেপ্টোলাইসিন ও-এর মাত্রা বেশি, যা জিএনএপিই (GNAPE) হিসেবে গণ্য করা হয়। তার এনসেফালোপ্যাথি (encephalopathy) দেখা দেয়, যা উচ্চ রক্তচাপের কারণে সেকেন্ডারি পিআরইএস (PRES)-এর সন্দেহ তৈরি করে। মস্তিষ্কের ম্যাগনেটিক রেজোন্যান্সের মাধ্যমে এটি নিশ্চিত করা হয়। এছাড়াও তার অটোইমিউন হেমোলাইটিক অ্যানিমিয়া (autoimmune haemolytic anaemia) হয়, যেখানে হিমোগ্লোবিনের মাত্রা ৫ গ্রাম/ডেসিলিটারে নেমে আসে। তার চিকিৎসা ছিল অ্যান্টিহাইপারটেনসিভ থেরাপি, নিউরোপrotection এবং স্টেরয়েড চিকিৎসার ওপর ভিত্তি করে। ৩১ দিন হাসপাতালে থাকার পর তাকে ছুটি দেওয়া হয় এবং ছয় মাস পর তিনি উপসর্গবিহীন অবস্থায় ছিলেন।"
+  },
+  {
+    "id": "multiclinsum_gs_en_399.txt",
+    "fulltext": "A 51-year-old male patient presented to us with acute painful visual loss of his left eye (LE) from 3 days ago. The best-corrected distance visual acuity (BCDVA) was 20/20, and hand motion (HM) detection for the right eye (RE) and LE, respectively. The ocular movement was normal in both eyes. Anterior segment examination was unremarkable for both eyes. The LE fundus examination showed ONH swelling, choroidal bulging, multiple patches of subretinal fluid accumulation, and retinal pigment epithelial (RPE) corrugations. Fundus examination of the RE was unremarkable.\n\nWe used multimodal imaging including Optical coherence tomography (OCT) (OptoVue, Inc., Fremont, CA, USA, software version: 2018,0,0,18), fundus blue-autofluorescence (BAF), fluorescein angiography (FA) (Heidelberg Eye Explorer version 1.9.13.0, Spectralis Viewing Module 6.5.2.0; Heidelberg Engineering), Indocyanin green angiography (ICGA), and B-scan ultrasonography for further evaluation. Besides, orbital and brain MRIs with gadolinium enhancement were ordered. The OCT image revealed a mild RPE and choroidal bulging, RPE hyper-reflectivity with back shadowing, subretinal and intraretinal fluid accumulation, and mild retinal thickening. A geographic area of macular hypocyanescence was apparent in the ICGA image of the left eye. BAF showed a geographic area with a speckled autofluorescence pattern at the macula. Optic nerve enlargement was found in the B-scan ultrasonography. In FA images, vascular leakage was apparent at the ONH (hot disc). Besides, a geographic patchy hypofluorescent area with speckled hyperfluorescent margins with a size of three disc diameters (DD) was detected. Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement at the junction of the optic nerve and sclera. An oncology consultation was done with no remarkable finding.\n\nConsidering the suspicion of malignancy and the presence of an enhancing nodular mass in the orbit, the patient underwent transconjunctival lateral orbitotomy one week after the presentation. A pink localized scleral nodule with edematous tenon was found. Sub-tenon triamcinolone acetonide was injected with the clinical diagnosis of nodular posterior scleritis. The patient refused admission and intravenous corticosteroid injection as the treatment order. Oral prednisolone 50 mg/Kg was started. Rheumatology consultation and screening lab results, including PPD test (tuberculosis), chest X-ray, serum ACE level (sarcoidosis), and C-ANCA level (Wegner granulomatosis), were unremarkable. At the last follow-up examination (one week after the surgery), the patient’s BCDVA was 20/20, and counting fingers at 2 meters for the RE and LE, respectively. Furthermore, SRF was absorbed, and the macula became atrophic. Oral prednisolone was tapered off slowly for three months.",
+    "summary": "A 51-year-old male patient presented to us with acute painful visual loss of his left eye (LE) from 3 days ago. The best-corrected distance visual acuity (BCDVA) was 20/20 and hand motion (HM) for the right eye (RE) and LE, respectively. Fundus examination of the LE showed ONH swelling, choroidal bulging, multiple patches of subretinal fluid accumulation, and retinal pigment epithelial (RPE) corrugations. Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement at the optic nerve and sclera junction. Oncology and rheumatology work-ups were unremarkable. With the clinical diagnosis of nodular posterior scleritis oral prednisolone 50 mg/Kg was started.",
+    "translated_fulltext": "একজন ৫১ বছর বয়সী পুরুষ রোগী ৩ দিন আগে তার বাম চোখের (LE) তীব্র ব্যথা এবং দৃষ্টিশক্তি হ্রাস নিয়ে আমাদের কাছে আসেন। তার সেরা সংশোধন করা দূরবর্তী দৃষ্টিশক্তি (BCDVA) ছিল ২০/২০, এবং ডান চোখ (RE) এবং বাম চোখের জন্য হাতের নড়াচড়া (HM) শনাক্ত করা যাচ্ছিল। উভয় চোখের স্বাভাবিক মুভমেন্ট ছিল। উভয় চোখের সম্মুখ অংশের পরীক্ষায় উল্লেখযোগ্য কিছু পাওয়া যায়নি। বাম চোখের ফান্ডাস পরীক্ষায় অপটিক নার্ভ হেড (ONH) ফুলে যাওয়া, কোরিওডের ফোলাভাব, রেটিনার নিচে একাধিক স্থানে তরল জমা এবং রেটিনাল পিগমেন্ট এপিথেলিয়াল (RPE) এর ঢেউ দেখা যায়। ডান চোখের ফান্ডাস পরীক্ষায় উল্লেখযোগ্য কিছু পাওয়া যায়নি।\n\nআরও মূল্যায়নের জন্য আমরা মাল্টিমোডাল ইমেজিং ব্যবহার করি, যার মধ্যে রয়েছে অপটিক্যাল কোহেরেন্স টমোগ্রাফি (OCT) (অপটোভিউ, ইনক., ফ্রেমন্ট, সিএ, মার্কিন যুক্তরাষ্ট্র, সফটওয়্যার সংস্করণ: 2018,0,0,18), ফান্ডাস ব্লু-অটোফ্লুরোসেন্স (BAF), ফ্লুরোসিন অ্যাঞ্জিওগ্রাফি (FA) (হেইডেলবার্গ আই এক্সপ্লোরার সংস্করণ 1.9.13.0, স্পেকট্রালিস ভিউইং মডিউল 6.5.2.0; হেইডেলবার্গ ইঞ্জিনিয়ারিং), ইন্ডোসায়ানিন গ্রিন অ্যাঞ্জিওগ্রাফি (ICGA), এবং বি-স্ক্যান আলট্রাসাউন্ড। এছাড়াও, গ্যাডোলিনিয়াম এনহ্যান্সমেন্ট সহ অরবিটাল এবং মস্তিষ্কের এমআরআই করা হয়। OCT ছবিতে হালকা RPE এবং কোরিওডের ফোলাভাব, ব্যাক শ্যাডোয়িং সহ RPE-এর অতিরিক্ত প্রতিফলন, রেটিনার নিচে এবং রেটিনার ভেতরের তরল জমা এবং হালকা রেটিনাল পুরুত্ব দেখা যায়। ICGA ছবিতে বাম চোখের ম্যাকুলার হাইপোসাইয়ানেসেন্সের একটি ভৌগোলিক এলাকা দেখা যায়। BAF-এ ম্যাকুলায় একটি ছোপ ছোপ অটোফ্লুরোসেন্স প্যাটার্নসহ একটি ভৌগোলিক এলাকা দেখা যায়। বি-স্ক্যান আলট্রাসাউন্ডে অপটিক নার্ভের বৃদ্ধি দেখা যায়। FA ছবিতে ONH-এ ভাস্কুলার লিকেজ দেখা যায় (হট ডিস্ক)। এছাড়াও, তিনটি ডিস্ক ব্যাসের (DD) আকারের একটি ভৌগোলিক ছোপ ছোপ হাইপোফ্লুরোসেন্ট এলাকা, যার প্রান্তে ছোপ ছোপ হাইপারফ্লুরোসেন্ট মার্জিন ছিল, তা শনাক্ত করা হয়। অরবিটাল এবং মস্তিষ্কের এমআরআই-তে অপটিক নার্ভ এবং স্ক্লেরার সংযোগস্থলে গ্যাডোলিনিয়াম এনহ্যান্সমেন্টসহ একটি রেট্রোবুলবার নোডুলার ভর দেখা যায়। একটি অনকোলজি পরামর্শ করা হয়, যেখানে উল্লেখযোগ্য কিছু পাওয়া যায়নি।\n\nম্যালিগন্যান্সির সন্দেহ এবং অরবিটে একটি বর্ধিত নোডুলার ভরের উপস্থিতি বিবেচনা করে, রোগী উপস্থাপনের এক সপ্তাহ পরে ট্রান্সকনজাংটিভাল ল্যাটারাল অরবিটোটমি করা হয়। একটি গোলাপী রঙের স্থানীয় স্ক্লেরাল নোডুল পাওয়া যায়, যার সাথে ইডিমাটাস টেনন ছিল। ক্লিনিক্যাল ডায়াগনোসিস হিসেবে নোডুলার পোস্টেরিয়র স্ক্লেরাইটিস ধরে নিয়ে সাব-টেনন ট্রায়ামসিনোলোন অ্যাসিটোনাইড ইনজেকশন দেওয়া হয়। রোগী হাসপাতালে ভর্তি এবং ইন্ট্রাভেনাস কর্টিকোস্টেরয়েড ইনজেকশন নিতে অস্বীকার করেন। তাই, মুখে খাওয়ার জন্য প্রেডনিসোলোন ৫০ মিগ্রা/কেজি শুরু করা হয়। রিউমাটোলজি পরামর্শ এবং স্ক্রিনিং ল্যাব পরীক্ষার ফলাফল, যার মধ্যে পিপিডি পরীক্ষা (যক্ষ্মা), বুকের এক্স-রে, সিরাম এসিই স্তর (সারকোইডোসিস) এবং সি-এএনসিএ স্তর (ওয়েগনার গ্রানুলোমাটোসিস) স্বাভাবিক ছিল। শেষ ফলো-আপ পরীক্ষায় (অপারেশনের এক সপ্তাহ পর), রোগীর BCDVA ছিল ২০/২০, এবং RE এবং LE-এর জন্য ২ মিটারে আঙুল গণনা করা যাচ্ছিল। এছাড়াও, SRF শোষিত হয়েছিল এবং ম্যাকুলা অ্যাট্রোফিক হয়ে যায়। মুখে খাওয়ার জন্য প্রেডনিসোলোন ধীরে ধীরে তিন মাসে কমিয়ে দেওয়া হয়।",
+    "translated_summary": "৫১ বছর বয়সী একজন পুরুষ রোগী ৩ দিন আগে থেকে তার বাম চোখে (LE) তীব্র ব্যথা এবং দৃষ্টিশক্তি হ্রাস নিয়ে আমাদের কাছে আসেন। সবচেয়ে ভালো চশমা ব্যবহার করার পরেও তার দূরের দৃষ্টিশক্তি (BCDVA) ছিল ২০/২০ এবং ডান চোখ (RE) ও বাম চোখের (LE) জন্য হাতের ইশারা (HM) দেখা যাচ্ছিল। বাম চোখের (LE) ফান্ডাস পরীক্ষায় অপটিক নার্ভ হেড (ONH) ফুলে যাওয়া, কোরিওডের ফোলাভাব, রেটিনার নিচে তরল জমা হয়ে ছোট ছোট দাগ এবং রেটিনাল পিগমেন্ট এপিথেলিয়াল (RPE) কোষের ভাঁজ দেখা যায়। অরবিটাল এবং মস্তিষ্কের এমআরআই-তে অপটিক নার্ভ এবং স্ক্লেরার সংযোগস্থলে গ্যাডোলিনিয়াম দ্বারা চিহ্নিত একটি টিউমার দেখা যায়। ক্যান্সার এবং রিউমাটোলজি সংক্রান্ত পরীক্ষাগুলোতে উল্লেখযোগ্য কিছু পাওয়া যায়নি। ক্লিনিক্যালভাবে টিউমারযুক্ত পোস্টেরিয়র স্ক্লেরাইটিস নির্ণয় করে মুখে খাওয়ার জন্য প্রেডনিসোলোন ৫০ মিগ্রা/কেজি দেওয়া শুরু করা হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_55.txt",
+    "fulltext": "An elderly 78-year-old patient from the Amhara region of Ethiopia, who has had a permanent cardiac pacemaker for 7 years, was scheduled for retropubic prostatectomy due to benign prostatic hyperplasia (BPH). This condition developed following a previous transurethral resection of the prostate 3 months earlier. The patient in the preoperative anesthesia evaluation was fully evaluated, and all the routine investigations required for the proposed surgery, which were within normal limits, were investigated. The patient presented with a history of frequency, urgency, nocturia, and dribbling for the past 2 months. Additionally, the patient had been known to have hypertension for the past 16 years and was taking amlodipine 5 mg orally daily, enalapril 10 mg orally twice daily (BID), and atorvastatin 10 mg orally daily. He had also been known to have type II diabetes mellitus for the past 25 years and was on metformin 500 mg orally BID and neutral protamine Hagedorn (NPH) 20 IU and 10 IU. He was admitted to a hospital for further evaluation, and complete bundle branch block (BBB) was detected via electrocardiogram (ECG). In an electrophysiology study, the patient was diagnosed with left ventricular hypertrophy secondary to hypertensive heart disease, mild diastolic dysfunction, and an ejection fraction of 62%. Abdominal ultrasound revealed an enlarged prostate size of 82 ml; anterior–posterior (AP) chest X-ray revealed a normal chest region with a left-side pacemaker in situ, and all the other blood parameters, including electrolytes and serum troponin levels, were within normal limits.\n\nA cardiologist was involved preoperatively as a multidisciplinary approach and risk determination tool for cardiac risk assessment. The patient had a frailty score of 5.5 with a poor functional cardiopulmonary reserve of metabolic equivalent (MET) = 3.4 and Revised Cardiac Risk Index (RCRI) class III, which accounts for 10.1% of major cardiac adverse events (myocardial infarction [MI], cardiac arrest, or death) within 30 days of the postoperative period, and intermediate risk on the basis of surgery type and patient risk factors. After preoperative evaluation and risk disclosure regarding the un-reprogrammed pacemaker and the associated complications during anesthesia and surgery, the patient was unable to afford the necessary health coverage for pacemaker reprogramming. This is because the cardiac surgery was performed in Addis Ababa, Ethiopia, which has a long waiting list with few cardiac surgeons for millions of people and is a considerable distance from the patient’s home institution, and there is a period of monitoring after pacemaker reprogramming for considerable post-reprogramming complication. As a result, the patient chose to proceed with the surgery, accepting the potential risks and harm associated with the situation. Continuous cardiac monitoring during the intraoperative period is highly advocated. Despite these factors, the patient did not experience cardiorespiratory failure, and he was stable. The patient continued on medication until the day of surgery, which included amlodipine, enalapril, atorvastatin, and a morning lower dose of two-thirds of the NPH. He also took 5 mg of diazepam orally for anxiolytics at midnight before the day of surgery.\n\nOn the day of surgery, the patient’s random blood sugar (RBS) was measured, and sliding scale glycemic control was implemented. Communication among the anesthetist, surgeon, and nurses was emphasized, ensuring that the cautery pad was placed away from the pacemaker, and that emergency drugs and a defibrillator were ready. The patient was premedicated with dexamethasone for nausea prophylaxis and paracetamol for pain relief as preemptive analgesia. American Society of Anesthesiology (ASA) standard monitoring was applied, and baseline parameters were recorded. Combined epidural–spinal anesthesia was administered via 0.5% isobaric bupivacaine (12.5 mg) and 50 µg fentanyl at the L3–L4 interspace. The block achieved anesthesia up to the umbilicus, and the sensory block was performed at T7. The surgery involved a midline incision below the umbilicus, with monopolar cautery used at low voltage (20 mA). Hemostasis was achieved through bipolar low-voltage cautery. Throughout the procedure, the patient’s vital signs remained stable. The patient’s vital signs did not change by more than 10% from the baseline vital signs. The intravenous fluid was resuscitated intraoperatively. During the postoperative period, the patient was transferred to the postanesthesia care unit (PACU) with vigilant monitoring, and 10 ml of 0.125% epidural top-up analgesia was given. Postop investigations were within normal limits. The patient was observed in the PACU for 12 hours and later transferred to the ward in stable condition with regular follow-up with the cardiology team. After 88th day of postsurgery the patient was discharged and advised to have regular checkups for pacemaker’s in situ status.",
+    "summary": "A 78-year-old male from the Amhara region, Ethiopia, with a permanent pacemaker for complete heart block was scheduled for retropubic prostatectomy. Preoperative assessments by the anesthetist and cardiologist recommended reprogramming the pacemaker to asynchronous mode to reduce risks related to its dual-chamber, rate-modulated mode setting. However, the patient could not afford reprogramming and opted to proceed with the existing perioperative plan. Informed consent was obtained, and case report publication permission was obtained after operation. The patient received combined epidural-spinal anesthesia with 2.50 ml of 0.5% isobaric bupivacaine and 50 µg fentanyl at the L3-L4 interspace. Standard American Society of Anesthesiology monitoring was applied, with a focus on cardiac stability. The patient remained stable with minimal vital sign fluctuations and maintained adequate blood pressure using isotonic saline. Postoperatively, the patient was transferred to the postanesthesia care unit, receiving analgesia after 4 hours and an epidural top-up. After 6 hours, he was transferred to the ward in stable condition. Epidural analgesia was continued for 72 hours, and the patient was discharged on the 88th postoperative hour in stable condition.",
+    "translated_fulltext": "ইথিওপিয়ার আমহারা অঞ্চলের একজন 78 বছর বয়সী রোগী, যার 7 বছর ধরে একটি স্থায়ী কার্ডিয়াক পেসমেকার রয়েছে, তার প্রোস্টেটের আকার বৃদ্ধি (বেনাইন প্রোস্ট্যাটিক হাইপারপ্লাসিয়া বা বিপিএইচ) হওয়ার কারণে রেট্রোপিউবিক প্রোস্টেটেকটমির জন্য নির্ধারণ করা হয়েছিল। এর আগে ৩ মাস পূর্বে তার ট্রান্সইউরেথ্রাল রিসেকশন করা হয়েছিল। অস্ত্রোপচারের আগে রোগীকে ভালোভাবে মূল্যায়ন করা হয়েছিল এবং প্রস্তাবিত অস্ত্রোপচারের জন্য প্রয়োজনীয় সমস্ত রুটিন পরীক্ষা করা হয়েছিল, যেগুলোর ফলাফল স্বাভাবিক ছিল। গত 2 মাসে রোগীর ঘন ঘন প্রস্রাবের বেগ, রাতে প্রস্রাব করা এবং প্রস্রাব ধরে রাখতে না পারার মতো সমস্যা দেখা যাচ্ছিল। এছাড়াও, গত 16 বছর ধরে তার উচ্চ রক্তচাপের সমস্যা ছিল এবং তিনি প্রতিদিন মুখে করে অ্যামলোডিপিন ৫ মিগ্রা, দিনে দুবার এনালapril ১০ মিগ্রা এবং অ্যাটোরভাস্ট্যাটিন ১০ মিগ্রা গ্রহণ করতেন। এছাড়াও, গত ২৫ বছর ধরে তার টাইপ II ডায়াবেটিস ছিল এবং তিনি দিনে দুবার মুখে করে মেটফর্মিন ৫০০ মিগ্রা এবং নিউট্রাল প্রোটেমিন হাগেডর্ন (এনপিএইচ) ২০ আইইউ এবং ১০ আইইউ গ্রহণ করতেন। রোগীকে আরও মূল্যায়নের জন্য হাসপাতালে ভর্তি করা হয়েছিল এবং ইলেক্ট্রোকার্ডিওগ্রামের (ইসিজি) মাধ্যমে সম্পূর্ণ বান্ডেল ব্রাঞ্চ ব্লক (বিবিবি) সনাক্ত করা হয়েছিল। একটি ইলেক্ট্রোফিজিওলজি গবেষণায়, রোগীর উচ্চ রক্তচাপজনিত হৃদরোগের কারণে বাম নিলয়ের আকার বৃদ্ধি, মৃদু ডায়াস্টোলিক কর্মহীনতা এবং ৬২% ইজেকশন ফ্র্যাকশন নির্ণয় করা হয়েছিল। পেটের আল্ট্রাসাউন্ডে প্রোস্টেটের আকার ৮২ মিলি দেখা যায়; বুকের সামনের এবং পিছনের (এপি) এক্স-রেতে বুকের স্বাভাবিক অবস্থা এবং বাম দিকে পেসমেকার দেখা যায়, এবং অন্যান্য রক্ত ​​পরীক্ষার ফলাফল, যেমন ইলেক্ট্রোলাইট এবং সিরাম ট্রোপোনিনের মাত্রা স্বাভাবিক ছিল।\n\nহৃদরোগের ঝুঁকি মূল্যায়ন এবং চিকিৎসার জন্য অস্ত্রোপচারের আগে একজন হৃদরোগ বিশেষজ্ঞকে অন্তর্ভুক্ত করা হয়েছিল। রোগীর দুর্বলতা স্কোর ছিল ৫.৫, যেখানে বিপাকীয় সমতুল্যের (এমইটি) মান ছিল ৩.৪ এবং রিভাইজড কার্ডিয়াক রিস্ক ইনডেক্স (আরসিআরআই) ক্লাস III, যা অস্ত্রোপচারের পরবর্তী ৩০ দিনের মধ্যে গুরুতর হৃদরোগের (মায়োকার্ডিয়াল ইনফার্কশন, কার্ডিয়াক অ্যারেস্ট বা মৃত্যু) ১০.১% ঝুঁকি নির্দেশ করে এবং অস্ত্রোপচারের ধরন ও রোগীর ঝুঁকির কারণের ওপর ভিত্তি করে মাঝারি ঝুঁকিও নির্দেশ করে। অস্ত্রোপচারের আগে পেসমেকারের প্রোগ্রামিং না করার কারণে এবং অ্যানেস্থেসিয়া ও অস্ত্রোপচারের সময় সম্ভাব্য জটিলতা সম্পর্কে জানানো সত্ত্বেও, রোগী পেসমেকারের প্রোগ্রামিংয়ের জন্য প্রয়োজনীয় স্বাস্থ্যসেবা খরচ বহন করতে অক্ষম ছিলেন। এর কারণ হলো, এই হৃদরোগের অস্ত্রোপচারটি আদ্দিস আবাবাতে করা হয়েছিল, যেখানে কয়েকজন হৃদরোগ বিশেষজ্ঞ রয়েছেন এবং কয়েক মিলিয়ন মানুষের জন্য দীর্ঘ অপেক্ষার তালিকা রয়েছে। এছাড়াও, রোগীর বাড়ি থেকে হাসপাতালের দূরত্ব অনেক এবং পেসমেকারের প্রোগ্রামিংয়ের পরে জটিলতা দেখা দিলে তা পর্যবেক্ষণ করার জন্য একটি নির্দিষ্ট সময় প্রয়োজন। ফলস্বরূপ, রোগী অস্ত্রোপচার চালিয়ে যেতে রাজি হন এবং এর সাথে জড়িত সম্ভাব্য ঝুঁকি ও ক্ষতির বিষয়টি মেনে নেন। অস্ত্রোপচারের সময় অবিচ্ছিন্নভাবে হৃদরোগের ওপর নজর রাখা অত্যন্ত গুরুত্বপূর্ণ। এই বিষয়গুলো সত্ত্বেও, রোগীর কার্ডিওরেসপিরেটরি ব্যর্থতা হয়নি এবং তিনি স্থিতিশীল ছিলেন। অস্ত্রোপচারের দিন পর্যন্ত রোগী ওষুধ গ্রহণ করতে থাকেন, যার মধ্যে অ্যামলোডিপিন, এনালাপ্রিল, অ্যাটোরভাস্ট্যাটিন এবং সকালে এনপিএইচ-এর দুই-তৃতীয়াংশ ডোজ ছিল। অস্ত্রোপচারের আগের রাতে উদ্বেগের জন্য তিনি ৫ মিগ্রা ডায়াজেপাম গ্রহণ করেন।\n\nঅস্ত্রোপচারের দিন, রোগীর রক্তের গ্লুকোজের মাত্রা (আরবিএস) পরিমাপ করা হয় এবং গ্লাইসেমিক নিয়ন্ত্রণ করা হয়। অ্যানেস্থেটিসিস্ট, সার্জন এবং নার্সদের মধ্যে যোগাযোগ স্থাপন করা হয়েছিল, যাতে নিশ্চিত করা যায় যে কটারি প্যাড পেসমেকার থেকে দূরে রাখা হয়েছে এবং জরুরি ওষুধ ও একটি ডিফিব্রিলেটর প্রস্তুত রাখা হয়েছে। বমি বমি ভাব প্রতিরোধের জন্য ডেক্সামেথাসোন এবং ব্যথানাশক হিসেবে প্যারাসিটামল দেওয়া হয়। আমেরিকান সোসাইটি অফ এনেস্থেসিওলজি (এএসএ) এর স্ট্যান্ডার্ড মনিটরিং ব্যবহার করা হয় এবং প্রাথমিক মানগুলি রেকর্ড করা হয়। 0.5% আইসোবারিক বুপিভাকেন (12.5 মিগ্রা) এবং 50 µg ফেন্টানিল এল3-এল4 ইন্টারস্পেসে দিয়ে সম্মিলিত এপিডিউরাল-স্পাইনাল অ্যানেস্থেসিয়া দেওয়া হয়। এই পদ্ধতিতে নাভির কাছাকাছি পর্যন্ত অ্যানেস্থেসিয়া এবং টি7-এ সংবেদী ব্লক তৈরি করা হয়। অস্ত্রোপচারে নাভির নিচে একটি মাঝখানের ছেদ করা হয় এবং নিম্ন ভোল্টেজে (20 এমএ) মনো polar কটারি ব্যবহার করা হয়। বাইপোলার নিম্ন-ভোল্টেজ কটারির মাধ্যমে রক্তপাত বন্ধ করা হয়। পুরো প্রক্রিয়া চলাকালীন, রোগীর গুরুত্বপূর্ণ লক্ষণগুলি স্থিতিশীল ছিল। রোগীর গুরুত্বপূর্ণ লক্ষণগুলি প্রাথমিক মানের থেকে ১০% এর বেশি পরিবর্তিত হয়নি। অস্ত্রোপচারের সময় শিরায় তরল দেওয়া হয়। অস্ত্রোপচারের পরে, রোগীকে নিবিড় পরিচর্যা ইউনিটে (পিএসিইউ) স্থানান্তর করা হয় এবং 10 মিলি 0.125% এপিডিউরাল টপ-আপ অ্যানালজেসিয়া দেওয়া হয়। অস্ত্রোপচারের পরবর্তী পরীক্ষাগুলোর ফলাফল স্বাভাবিক ছিল। রোগীকে পিএসিইউতে 12 ঘণ্টা পর্যবেক্ষণ করা হয় এবং পরে স্থিতিশীল অবস্থায় নিয়মিত ফলো-আপের জন্য ওয়ার্ডে স্থানান্তর করা হয়। অস্ত্রোপচারের ৮৮তম দিনে রোগীকে হাসপাতাল থেকে ছুটি দেওয়া হয় এবং পেসমেকারের অবস্থা নিয়মিতভাবে পরীক্ষা করার পরামর্শ দেওয়া হয়।",
+    "translated_summary": "ইথিওপিয়ার আমহারা অঞ্চলের একজন ৭৮ বছর বয়সী পুরুষ, যার হৃদপিণ্ডের সম্পূর্ণ ব্লকের কারণে একটি স্থায়ী পেসমেকার বসানো হয়েছিল, তার রেট্রোপিউবিক প্রোস্টেটেকটমির জন্য সময়সূচী করা হয়েছিল। অ্যানেস্থেটিসিস্ট এবং কার্ডিওলজিস্টের অস্ত্রপূর্ব মূল্যায়নে পেসমেকারটিকে অ্যাসিঙ্ক্রোনাস মোডে পুনরায় প্রোগ্রাম করার সুপারিশ করা হয়েছিল, যাতে এর ডুয়াল-চেম্বার, রেট-মডুলেটেড মোড সেটিংসের কারণে সৃষ্ট ঝুঁকি কমানো যায়। তবে, রোগী পেসমেকার পুনরায় প্রোগ্রাম করার সামর্থ্য রাখেননি এবং বিদ্যমান অস্ত্রোপূর্ব পরিকল্পনা অনুযায়ী এগিয়ে যেতে চেয়েছিলেন। রোগীর কাছ থেকে সম্মতি নেওয়া হয়েছিল এবং অস্ত্রোপচারের পরে কেস রিপোর্ট প্রকাশের অনুমতি নেওয়া হয়েছিল। রোগীকে ২.৫০ মিলি ০.৫% আইসোবারিক বুপিভাকেন এবং ৫০ মাইক্রোগ্রাম ফেন্টানিল এল৩-এল৪ ইন্টারস্পেসে দিয়ে সম্মিলিত এপিডিউরাল-স্পাইনাল অ্যানেস্থেসিয়া দেওয়া হয়েছিল। স্ট্যান্ডার্ড আমেরিকান সোসাইটি অফ অ্যানেস্থেসিওলজির নিয়ম অনুযায়ী পর্যবেক্ষণ করা হয়েছিল, যেখানে কার্ডিয়াক স্থিতিশীলতার উপর বেশি মনোযোগ দেওয়া হয়েছিল। রোগীর গুরুত্বপূর্ণ লক্ষণগুলোতে সামান্য পরিবর্তন দেখা যায়, তবে তিনি স্থিতিশীল ছিলেন এবং আইসোটোনিক স্যালাইন ব্যবহার করে পর্যাপ্ত রক্তচাপ বজায় রাখা হয়েছিল। অস্ত্রোপচারের পরে রোগীকে পোস্টঅ্যানেস্থেসিয়া কেয়ার ইউনিটে স্থানান্তর করা হয়, যেখানে ৪ ঘণ্টা পর ব্যথানাশক ওষুধ এবং এপিডিউরাল টপ-আপ দেওয়া হয়। ৬ ঘণ্টা পর, তাকে স্থিতিশীল অবস্থায় ওয়ার্ডে স্থানান্তর করা হয়। এপিডিউরাল ব্যথানাশক ৭২ ঘণ্টা ধরে দেওয়া হয় এবং ৮৮তম পোস্টঅপারেটিভ ঘণ্টায় রোগীকে স্থিতিশীল অবস্থায় ছুটি দেওয়া হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_317.txt",
+    "fulltext": "A 52-year-old woman referred to the urology clinic with urinary complaints. Her symptoms began three years ago with frequency, dysuria and dribbling. She also mentioned the frequent passage of red and black thread-like substances in her urine. Moreover, during these discharges, she had headache, fever and chills. Intermittent periurethral and genital itching was another complaint of hers. She had been treated by several specialists with the diagnosis of recurrent urinary tract infections, with no clinical improvement. The patient denied recent travel, camping, hiking, farming, swimming and insect bites. She had positive history of pilonidal sinus surgery and hysterectomy, 8 and 7 years earlier, respectively. Two years prior to the current visit, she had been hospitalized for assessment. On physical examination, she was well-appearing with normal vital signs. All her laboratory tests, including cell blood count, urine analysis and biochemistries were in normal ranges. Abdominopelvic computed tomography (CT) scan revealed no abnormalities. Hence, she underwent cystoscopy, which demonstrated erythema and hyperemia of the bladder mucosa, suspended debris, and dilation of the left ureteral orifice. During consultation with an infectious diseases’ specialist, schistosomiasis was suspected, Therefore, she was treated with Praziquantel with the appropriate dose and duration and was discharged from the hospital.\n\nHowever, her symptoms did not subside. She was revisited by another infectious disease specialist, who prescribed her ivermectin due to suspicion to urinary myiasis. Nevertheless, no improvement was observed. She was readmitted to undergo bladder irrigation with polyethylene glycol, but the bladder washfluid did not contain any visible larvae. This procedure was followed by a two-day hematuria with spontaneous cessation. She was discharged home and advised to repeat the urine analysis one months later. Her random urine analysis was normal, so she collected her 24-h urine and sent it to the laboratory for analysis, in which a live larva was demonstrated under light microscope by the pathologist. The larva was isolated and sent to an entomologist to be identified morphologically. Finally, it was determined that the larva belonged to the species Sarcophaga. The patient was advised to take personal hygiene and consume at least 3 L of water daily.",
+    "summary": "We report a 52-year-old woman with persistent dysuria, frequency despite multiple treatments for suspected infections. Cystoscopy revealed erythema and debris, but imaging and laboratory tests were unremarkable. A live larva was identified in urine analysis, confirming the diagnosis. Treatment involved improved hygiene and hydration.",
+    "translated_fulltext": "একজন ৫২ বছর বয়সী মহিলা মূত্রনালীর সমস্যা নিয়ে ইউরোলজি ক্লিনিকে আসেন। তার উপসর্গগুলো প্রায় তিন বছর আগে শুরু হয়েছিল, যার মধ্যে ঘন ঘন প্রস্রাবের বেগ, প্রস্রাবে ব্যথা এবং ফোঁটা ফোঁটা প্রস্রাব পড়া ছিল। তিনি আরও জানান যে তার প্রস্রাবের সাথে প্রায়ই লাল এবং কালো রঙের সুতার মতো পদার্থ বের হয়। এছাড়াও, এই সময়ে তার মাথাব্যথা, জ্বর এবং শীত লাগার মতো উপসর্গ দেখা যায়। মাঝে মাঝে মূত্রনালী এবং যৌনাঙ্গে চুলকানিও হতো। তাকে বিভিন্ন বিশেষজ্ঞের দ্বারা মূত্রনালীর সংক্রমণ হয়েছে বলে সন্দেহ করে চিকিৎসা করা হয়েছিল, কিন্তু কোনো উন্নতি হয়নি। রোগী সম্প্রতি ভ্রমণ, ক্যাম্পিং, হাইকিং, কৃষিকাজ, সাঁতার বা পোকামাকড়ের কামড়ের কথা অস্বীকার করেন। তার পূর্বে পাইলোনাইডাল সাইনাস সার্জারি এবং হিস্টেরেক্টমি করা হয়েছিল, যথাক্রমে ৮ এবং ৭ বছর আগে। বর্তমান ভিজিটের দুই বছর আগে তাকে পর্যবেক্ষণের জন্য হাসপাতালে ভর্তি করা হয়েছিল। শারীরিক পরীক্ষায় দেখা যায়, তার শারীরিক অবস্থা স্থিতিশীল এবং vital signs স্বাভাবিক। তার সমস্ত ল্যাবরেটরি পরীক্ষা, যেমন - রক্তের কোষ গণনা, প্রস্রাব বিশ্লেষণ এবং বায়োকেমিস্ট্রি স্বাভাবিক সীমার মধ্যে ছিল। অ্যাবডোমিনোপেলভিক কম্পিউটেড টমোগ্রাফি (সিটি) স্ক্যানে কোনো অস্বাভাবিকতা দেখা যায়নি। তাই, তার সিস্টোস্কোপি করা হয়, যেখানে মূত্রাশয়ের শ্লেষ্মা ঝিল্লিতে লালচে ভাব এবং অতিরিক্ত রক্ত ​​​​প্রবাহ, কিছু ভাসমান কণা এবং বাম ইউরেটেরাল অরফিসের প্রসারণ দেখা যায়। একজন সংক্রামক রোগ বিশেষজ্ঞের সাথে পরামর্শ করার সময়, সিস্টোসোমিয়াসিসের সন্দেহ করা হয়। তাই, তাকে উপযুক্ত মাত্রায় এবং নির্দিষ্ট সময়কালের জন্য প্রাজিকুয়ানটেল ওষুধ দেওয়া হয় এবং হাসপাতাল থেকে ছুটি দেওয়া হয়।\n\nতবে, তার উপসর্গগুলো কমেনি। এরপর তিনি অন্য একজন সংক্রামক রোগ বিশেষজ্ঞের কাছে যান, যিনি প্রস্রাবের মাইয়াসিসের সন্দেহে তাকে আইভারমেকটিন ওষুধ দেন। কিন্তু তাতেও কোনো উন্নতি হয়নি। এরপর তাকে পলিইথিলিন গ্লাইকোল দিয়ে মূত্রাশয় ধোয়ার জন্য আবার হাসপাতালে ভর্তি করা হয়, কিন্তু মূত্রাশয়ের ধোয়া তরলে কোনো দৃশ্যমান লার্ভা পাওয়া যায়নি। এই পদ্ধতির পরে, দুই দিন ধরে তার প্রস্রাবের সাথে রক্ত ​​বের হতে থাকে, যা পরে নিজে থেকেই বন্ধ হয়ে যায়। তাকে বাড়ি থেকে ছুটি দেওয়া হয় এবং এক মাস পরে আবার প্রস্রাব পরীক্ষা করার পরামর্শ দেওয়া হয়। তার সাধারণ প্রস্রাব পরীক্ষায় সবকিছু স্বাভাবিক ছিল, তাই তিনি ২৪ ঘণ্টার প্রস্রাবের নমুনা সংগ্রহ করে ল্যাবরেটরিতে পাঠান। সেখানে একজন প্যাথলজিস্ট লাইট মাইক্রোস্কোপের নিচে একটি জীবন্ত লার্ভা দেখতে পান। লার্ভাটিকে আলাদা করে একজন কীটতত্ত্ববিদের কাছে পাঠানো হয়, যিনি এটিকে চিহ্নিত করেন। অবশেষে, জানা যায় যে লার্ভাটি সারকোফাগা প্রজাতির। রোগীকে ব্যক্তিগত স্বাস্থ্যবিধি মেনে চলতে এবং প্রতিদিন কমপক্ষে ৩ লিটার জল পান করার পরামর্শ দেওয়া হয়।",
+    "translated_summary": "আমরা ৫২ বছর বয়সী একজন মহিলার ঘটনা বর্ণনা করছি, যিনি দীর্ঘস্থায়ী প্রস্রাব করার সময় ব্যথা এবং ঘন ঘন প্রস্রাবের সমস্যায় ভুগছিলেন, যদিও সন্দেহভাজন সংক্রমণের জন্য একাধিক চিকিৎসা করা হয়েছিল। সিস্টোস্কোপিতে লালচে ভাব এবং কিছু আবর্জনা দেখা যায়, তবে ইমেজিং এবং ল্যাবরেটরি পরীক্ষায় তেমন কিছু পাওয়া যায়নি। প্রস্রাবের বিশ্লেষণে একটি জীবন্ত লার্ভা শনাক্ত করা হয়, যা রোগ নির্ণয় নিশ্চিত করে। চিকিৎসায় ব্যক্তিগত স্বাস্থ্যবিধি উন্নত করা এবং পর্যাপ্ত পরিমাণে জল পান করার পরামর্শ দেওয়া হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_79.txt",
+    "fulltext": "A 36-year-old female patient with a history of ulcerative colitis and good disease control on sulfasalazine, ferrous fumarate and intermittent prednisone for flare-ups is presented.\n\nHe was admitted to the emergency unit with a 1 week history of progressive oppressive precordial pain associated with dyspnea and neurovegetative symptoms. On admission, an electrocardiogram was performed in sinus rhythm, with finding of supradesnivel of the ST segment in the lower wall.\n\nThe patient reported a 6-month history of general disorders, fatigue and night sweats. She had previously presented episodes of precordial pain in relation to effort that progressed to rest. The physical examination was without murmurs or alterations of the peripheral pulses.\n\nAn emergency coronary angiography was performed, which revealed severe 2-vessel disease: severe ostial lesion 90% in the left coronary trunk and severe subocclusive lesion 99-100% at the ostial level in the right coronary artery (culprit vessel). Primary angioplasty of the right coronary artery was performed with successful installation of a medicated stent. The hemodynamicist was impressed by a possible aortitis due to involvement of the arch and friability of the vessels when the balloon was advanced, so he suggested an etiological study oriented to inflammatory disease, prior to surgical resolution of the lesion of the left coronary trunk.\n\nLaboratory tests showed mild anaemia (haemoglobin: 11.6 g/dL), mild leukocytosis (13,800/mm3), elevated erythrocyte sedimentation rate (ESR): 42 mm/h and C-reactive protein (CRP): 4.9 mg/L (normal value <1) and elevated ultrasensitive troponin. From the autoimmunity study, normal levels of complement C3 and C4, negative anti-nuclear antibodies (ANA), anti-DNA, negative extracellular nuclear antigen (ENA) profile and non-reactive VDRL were rescued.\n\nCardiac magnetic resonance (MRI) with contrast was completed with findings of acute infarction of the left ventricular inferior wall non-transmural myocardium and subendocardial ischemia in the anteroseptoapical resting of the left ventricle. Mild aortic and mitral insufficiency. Preserved biventricular systolic function.\n\nComputed tomography angiography (CTA) of the chest, abdomen and pelvis showed periaortic fibrotic wall thickening involving the root, aortic arch and abdominal aorta with severe left coronary trunk stenosis and mild left subclavian, left vertebral artery stenosis and severe lower mesenteric artery stenosis. Immune globulin G (IgG) 4 deposition disease or Takayasu's arteritis was suggested.\n\nWithin the differential diagnosis study, IgG levels were performed at 1,600 mg/dl (reference values: 700-1,600), and its subclasses: IgG1: 1024 mg/dl (elevated), and the rest in normal range (IgG2: 456 mg/dl; IgG3: 98.8 mg/dl and IgG4: 13.6 mg/dl).\n\nTakayasu arteritis was diagnosed clinically and by imaging and treatment was initiated with prednisone 60 mg daily, methotrexate 20 mg weekly by injection and folic acid 1 mg daily. After 3 weeks of treatment she underwent myocardial revascularisation surgery with use of the left internal mammary artery (LIMA) as a graft to the descending anterior artery (DA) and aortocoronary bypass to circumflex artery. It was noted intraoperatively that the root of the aorta and the ascending aorta presented a healthy appearance. The patient is currently at home in good general condition and under ambulatory follow-up.\n",
+    "summary": "A 36-year-old woman with ulcerative colitis presented with progressive precordial pain and neurovegetative symptoms. The electrocardiogram showed a ST segment elevation in the inferior wall. The patient had a history of fatigue and night sweats. She underwent a coronary angiography that revealed severe disease in two coronary arteries, with successful primary angioplasty of the culprit artery. Aortitis was suspected, which led to additional studies, including a mild elevation of inflammatory activity indices and a computed tomographic angiography with periaortic fibrotic thickening and significant stenosis in multiple arteries, suggesting Takayasu arteritis. She was treated with prednisone, methotrexate, and underwent delayed myocardial revascularization surgery with good results.\n",
+    "translated_fulltext": "৩৬ বছর বয়সী একজন মহিলা রোগী, যার আলসারেটিভ কোলাইটিসের ইতিহাস রয়েছে এবং সালফাসালাজিন, ফেরাস ফিউমারেট এবং মাঝে মাঝে প্রেডনিসোন ব্যবহারের মাধ্যমে রোগের লক্ষণগুলো নিয়ন্ত্রণে রাখা হয়েছে, তার ঘটনা এখানে তুলে ধরা হলো।\n\nতাকে জরুরি বিভাগে ভর্তি করা হয়, যেখানে তিনি এক সপ্তাহ ধরে ক্রমাগত বুকে ব্যথা, শ্বাসকষ্ট এবং স্নায়ু-উদ্দীপক উপসর্গের কথা জানান। হাসপাতালে ভর্তির সময়, তার ইলেক্ট্রোকার্ডিওগ্রাম করা হয়, যেখানে সাইনাস রিদমের মধ্যে এসটি সেগমেন্টের নিম্ন অংশে পরিবর্তন দেখা যায়।\n\nরোগী ছয় মাস ধরে সাধারণ দুর্বলতা, ক্লান্তি এবং রাতের বেলা ঘাম হওয়ার কথা জানান। এর আগে, তিনি শারীরিক পরিশ্রমের সময় বুকে ব্যথার কথা বলেছিলেন, যা বিশ্রাম নেওয়ার পরেও অব্যাহত ছিল। শারীরিক পরীক্ষায় হৃদস্পন্দন স্বাভাবিক ছিল এবং পেরিফেরাল পালসে কোনো অস্বাভাবিকতা দেখা যায়নি।\n\nজরুরি ভিত্তিতে করোনারি অ্যাঞ্জিওগ্রাফি করা হয়, যেখানে গুরুতর দুই-নালীর রোগ ধরা পড়ে: বাম করোনারি ধমনীর গোড়ায় ৯০% গুরুতর ক্ষত এবং ডান করোনারি ধমনীর গোড়ায় ৯৯-১০০% গুরুতর অবরুদ্ধতা (যে ধমনীটি ক্ষতিগ্রস্ত)। ডান করোনারি ধমনীতে প্রাথমিক অ্যাঞ্জিওপ্লাস্টি করা হয় এবং একটি ওষুধযুক্ত স্টেন্ট স্থাপন করা হয়। রক্তনালীর আর্চ এবং রক্তনালীর ভঙ্গুরতা দেখে, যখন বেলুন প্রবেশ করানো হয়, তখন হেModynamics বিশেষজ্ঞ সন্দেহ করেন যে এটি সম্ভবত অ্যাওর্টাইটিস হতে পারে। তাই, বাম করোনারি ধমনীর ক্ষত সার্জিক্যালি সমাধানের আগে প্রদাহজনিত রোগের কারণ অনুসন্ধানের জন্য একটি পরীক্ষা করার পরামর্শ দেওয়া হয়।\n\nল্যাবরেটরি পরীক্ষায় সামান্য রক্তাল্পতা (হিমোগ্লোবিন: ১১.৬ গ্রাম/ডিএল), সামান্য লিউকোসাইটোসিস (১৩,৮০০/মিমি³), উচ্চ এরিথ্রোসাইট সেডিমেন্টেশন রেট (ইএসআর): ৪২ মিমি/ঘণ্টা এবং সি-রিঅ্যাক্টিভ প্রোটিন (সিআরপি): ৪.৯ মিলিগ্রাম/লিটার (স্বাভাবিক মান <১) এবং উচ্চ আলট্রাসেনসিটিভ ট্রোপোনিন পাওয়া যায়। অটোইমিউনিটি পরীক্ষায়, কমপ্লিমেন্ট সি৩ এবং সি৪-এর মাত্রা স্বাভাবিক, অ্যান্টি-নিউক্লিয়ার অ্যান্টিবডি (এএনএ), অ্যান্টি-ডিএনএ, এবং এক্সট্রাসেলুলার নিউক্লিয়ার অ্যান্টিজেন (ইএনএ) প্রোফাইল নেগেটিভ এবং ভিডিআরএল (VDRL) পরীক্ষায় কোনো প্রতিক্রিয়া দেখা যায়নি।\n\nকন্ট্রাস্টের সাথে কার্ডিয়াক ম্যাগনেটিক রেজোন্যান্স (এমআরআই) করা হয়, যেখানে বাম নিলয়ের নিচের অংশে তীব্র ইনফার্কশন এবং বাম নিলয়ের অ্যান্টেরোসেপ্টোএপিক্যাল অংশে সাবএন্ডোকার্ডিয়াল ইস্কেমিয়া দেখা যায়। এছাড়া, হালকা অ্যাওর্টিক এবং মাইট্রাল ইনসাফিসিয়েন্সিও ধরা পড়ে। বাইভেন্ট্রিকুলার সিস্টোলিক ফাংশন স্বাভাবিক ছিল।\n\nবুক, পেট এবং পেলভিসের কম্পিউটেড টমোগ্রাফি অ্যাঞ্জিওগ্রাফি (সিটিএ) পরীক্ষায় দেখা যায়, অ্যাওর্টার চারপাশে ফাইব্রোটিক প্রাচীর পুরু হয়ে গেছে, যা অ্যাওর্টিক আর্চ এবং পেটের অ্যাওর্টাকে প্রভাবিত করেছে। এছাড়াও, বাম করোনারি ধমনীতে গুরুতর স্টেনোসিস, বাম সাবক্লেভিয়ান ধমনী এবং বাম ভার্টিব্রাল ধমনীতে হালকা স্টেনোসিস এবং নিচের মেসেন্টেরিক ধমনীতে গুরুতর স্টেনোসিস দেখা যায়। ইমিউন গ্লোবুলিন জি (আইজিজি) ৪ ডিপোজিশন রোগ অথবা তাকায়াসু আর্টেরাইটিস হওয়ার সম্ভাবনা রয়েছে।\n\nডিফারেনশিয়াল ডায়াগনোসিস পরীক্ষার অংশ হিসেবে, আইজিজি-এর মাত্রা ১,৬০০ মিলিগ্রাম/ডিএল (রেফারেন্স মান: ৭০০-১,৬০০) পাওয়া যায় এবং এর উপশ্রেণীগুলো হলো: আইজিজি১: ১০২৪ মিলিগ্রাম/ডিএল (উচ্চ), এবং বাকিগুলো স্বাভাবিক সীমার মধ্যে (আইজিজি২: ৪৫৬ মিলিগ্রাম/ডিএল; আইজিজি৩: ৯৮.৮ মিলিগ্রাম/ডিএল এবং আইজিজি৪: ১৩.৬ মিলিগ্রাম/ডিএল)।\n\nক্লিনিক্যালি এবং ইমেজিংয়ের মাধ্যমে তাকায়াসু আর্টেরাইটিস নির্ণয় করা হয় এবং প্রতিদিন ৬০ মিলিগ্রাম প্রেডনিসোন, সপ্তাহে ২০ মিলিগ্রাম মিথোট্রেক্সেট ইনজেকশনের মাধ্যমে এবং প্রতিদিন ১ মিলিগ্রাম ফলিক অ্যাসিড দিয়ে চিকিৎসা শুরু করা হয়। চিকিৎসার তিন সপ্তাহ পর, তার মায়োকার্ডিয়াল রিভাস্কুলারাইজেশন সার্জারি করা হয়, যেখানে বাম অভ্যন্তরীণ স্তন ধমনী (এলআইএমএ) ব্যবহার করে ডিসেন্ডিং অ্যানটেরিয়র ধমনীতে (ডিএ) গ্রাফট করা হয় এবং অ্যাওর্টো-করোনারি বাইপাস করে সার্কামফ্লেক্স ধমনীতে স্থাপন করা হয়। অস্ত্রোপচারের সময় দেখা যায়, অ্যাওর্টার মূল অংশ এবং ঊর্ধ্বমুখী অ্যাওর্টা সুস্থ দেখাচ্ছে। বর্তমানে রোগী ভালো অবস্থায় বাড়িতে আছেন এবং বহির্বিভাগে তার ফলো-আপ চলছে।",
+    "translated_summary": "৩৬ বছর বয়সী একজন মহিলা, যিনি আলসারেটিভ কোলাইটিসে ভুগছিলেন, ক্রমশ বাড়তে থাকা বুকে ব্যথা এবং নিউরোভেজিটেটিভ উপসর্গের সঙ্গে হাসপাতালে আসেন। তাঁর ইলেক্ট্রোকার্ডিওগ্রামে দেখা যায় নিচের দিকের হৃদপিণ্ডের দেয়ালে এসটি সেগমেন্টের উচ্চতা বেড়েছে। রোগীর আগে থেকে ক্লান্তি এবং রাতের বেলা ঘাম হওয়ার ইতিহাস ছিল। তাঁর করোনারি অ্যাঞ্জিওগ্রাফি করা হয়, যেখানে দুটি করোনারি ধমনীতে গুরুতর রোগ ধরা পড়ে। এরপর সফলভাবে একটি ধমনীতে প্রাথমিক অ্যাঞ্জিওপ্লাস্টি করা হয়। রোগীর অ্যাওর্টিটিস হওয়ার সম্ভাবনা ছিল, তাই আরও কিছু পরীক্ষা করা হয়। পরীক্ষায় সামান্য প্রদাহজনক কার্যকলাপের সূচক এবং কম্পিউটেড টমোগ্রাফিক অ্যাঞ্জিওগ্রাফিতে দেখা যায় অ্যাওর্টার চারপাশে ফাইব্রোটিক পুরুত্ব এবং একাধিক ধমনীতে উল্লেখযোগ্য স্টেনোসিস রয়েছে, যা তাকায়াসু আর্টেরাইটিসের ইঙ্গিত দেয়। তাঁকে প্রেডনিসোন এবং মেথোট্রেক্সেট দিয়ে চিকিৎসা করা হয় এবং পরবর্তীতে সফলভাবে মায়োকার্ডিয়াল রিভাস্কুলারাইজেশন সার্জারি করা হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_194.txt",
+    "fulltext": "A 36-year-old female patient complained of dysphagia with longstanding cervical and upper thoracic pain. She also had a multinodular goiter with no other significant history. Esophagogastroduodenal transit was performed. It showed a posterior and lateral right impression of the proximal esophagus after ingestion of baryte, extending 3.5 cm cephalocaudal. A maximum esophageal stenosis of 60% was estimated. A cervical and thoracic CT scan revealed a congenital anomaly of the aortic arch: a mirror image of the right aortic arch. The aortic arch originates from the root of the aorta and runs above the right stem bronchus, giving rise to the three supra-aortic trunks as follows: the first is the left brachiocephalic artery (which gives rise to the left common carotid artery and the left subclavian artery); the second is the right common carotid artery; and the third is the right subclavian artery. The aortic arch then enters posteriorly to the esophagus and gives rise to a small anterior saccule of 1.3 cm, known as the Kommerell diverticulum. This configuration forms a ring around the tracheo-esophageal pair, whose edges are formed posterior-lateral to the right by the aortic arch, posterior-lateral to the left by the Kommerell diverticulum, lateral to the left by the arteriosum ligamentum (or arterial ligament), and anteriorly by the left brachiocephalic artery. A gastroscopy confirmed the endoluminal impact of extrinsic compression. In view of minimal clinical repercussions and the absence of nutritional disorders, no surgical cure was ultimately performed. The evolution was favorable with, according to the patient, a spontaneous amelioration of symptoms.\n",
+    "summary": "We report the case of a 36-year-old female patient whose dysphagia presented a congenital anomaly of the thoracic aorta: the right aortic arch with mirror image. This is a rare anomaly of embryonic development where the aorta winds around the right stem bronchus and the supra-aortic trunks emerge from the crown in the reverse and opposite order to normal. The vast majority of patients are asymptomatic unless there is a compression of the mediastinal structures. Major compression of the esophagus or trachea, aneurysmal disease, thoracic aortic dissection or the presence of a Kommerell diverticulum of more than 2 cm may warrant surgical intervention. There is no standard treatment and it must be adapted to the clinical presentation and anatomical configuration of the patient. Our patient did not receive any treatment for her condition.\n",
+    "translated_fulltext": "৩৬ বছর বয়সী একজন মহিলা রোগী দীর্ঘদিনের ধরে থাকা ঘাড় এবং বুকের উপরের অংশে ব্যথা এবং গিলতে অসুবিধা নিয়ে অভিযোগ করেন। তার মাল্টিনোডুলার গলগণ্ড ছিল এবং অন্য কোনো উল্লেখযোগ্য স্বাস্থ্যগত সমস্যা ছিল না। তার খাদ্যনালী এবং পাকস্থলীর মধ্যে খাদ্য পরিবহনের পরীক্ষা করা হয়। পরীক্ষায় দেখা যায়, বেরিয়াম মিশ্রণ খাওয়ার পর খাদ্যনালীর উপরের অংশে পেছনের দিকে এবং ডান দিকে একটি চাপ সৃষ্টি হয়েছে, যা ৩.৫ সেন্টিমিটার পর্যন্ত বিস্তৃত। খাদ্যনালীর ৬০% পর্যন্ত সংকীর্ণতা দেখা যায়। ঘাড় এবং বুকের সিটি স্ক্যানে দেখা যায়, মহাধমনীর খিলান জন্মগতভাবে ত্রুটিপূর্ণ: এটি ডান দিকের মহাধমনীর খিলানের একটি প্রতিচ্ছবি। মহাধমনীর খিলান মহাধমনীর মূল থেকে উৎপন্ন হয়ে ডান দিকের শ্বাসনালীর উপরে দিয়ে যায় এবং তিনটি শাখা তৈরি করে: প্রথমটি হলো বাম ব্রাকিওসেফালিক ধমনী (যা বাম সাধারণ ক্যারোটিড ধমনী এবং বাম সাবক্লাভিয়ান ধমনীতে বিভক্ত হয়); দ্বিতীয়টি হলো ডান সাধারণ ক্যারোটিড ধমনী; এবং তৃতীয়টি হলো ডান সাবক্লাভিয়ান ধমনী। এরপর মহাধমনীর খিলান খাদ্যনালীর পেছনের দিকে প্রবেশ করে এবং ১.৩ সেন্টিমিটারের একটি ছোট সম্মুখের থলি তৈরি করে, যা কোমেরেল ডাইভার্টিকুলাম নামে পরিচিত। এই গঠন শ্বাসনালী এবং খাদ্যনালীর চারপাশে একটি বলয় তৈরি করে, যার প্রান্তগুলি ডান দিকে মহাধমনীর খিলান, বাম দিকে কোমেরেল ডাইভার্টিকুলাম, বাম দিকে আর্টেরিওসাম লিগামেন্ট (বা ধমনী লিগামেন্ট) এবং সামনের দিকে বাম ব্রাকিওসেফালিক ধমনী দ্বারা গঠিত। গ্যাস্ট্রোস্কোপি পরীক্ষায় বাহ্যিক চাপের কারণে খাদ্যনালীর ভেতরের অংশে প্রভাবের বিষয়টি নিশ্চিত করা হয়। যেহেতু তেমন কোনো ক্লিনিক্যাল সমস্যা ছিল না এবং পুষ্টির অভাবজনিত কোনো রোগ ছিল না, তাই শেষ পর্যন্ত কোনো অস্ত্রোপচার করা হয়নি। রোগীর ভাষ্য অনুযায়ী, অবস্থার উন্নতি হওয়ায় সবকিছু স্বাভাবিক হয়ে যায়।",
+    "translated_summary": "আমরা একজন ৩৬ বছর বয়সী মহিলা রোগীর ঘটনা বর্ণনা করছি, যার খাদ্যনালীতে সমস্যা দেখা দেয় এবং পরীক্ষায় ধরা পড়ে যে তার থোরাসিক অ্যাওর্টাতে জন্মগত ত্রুটি রয়েছে: ডান দিকের অ্যাওর্টিক আর্চ, যা আয়নার প্রতিবিম্বের মতো। এটি ভ্রূণের বিকাশের একটি বিরল ত্রুটি, যেখানে অ্যাওর্টা ডান দিকের শ্বাসনালীর চারপাশে ঘুরে যায় এবং সুপ্রা-অ্যাওর্টিক ধমনীগুলো স্বাভাবিকের বিপরীত ক্রমে এবং উল্টো দিক থেকে উৎপন্ন হয়। বেশিরভাগ রোগীরই কোনো উপসর্গ থাকে না, যতক্ষণ না মধ্যচ্ছদীয় কাঠামোর ওপর চাপ পড়ে। খাদ্যনালী বা শ্বাসনালীর ওপর গুরুতর চাপ, অ্যানিউরিসমাল রোগ, থোরাসিক অ্যাওর্টিক ডিসেকশন অথবা ২ সেন্টিমিটারের বেশি আকারের কোমেরেলে ডাইভার্টিকুলামের উপস্থিতি দেখা গেলে অস্ত্রোপচারের প্রয়োজন হতে পারে। এর জন্য কোনো নির্দিষ্ট চিকিৎসা নেই এবং রোগীর ক্লিনিক্যাল অবস্থা ও শারীরবৃত্তীয় গঠনের ওপর ভিত্তি করে চিকিৎসা পদ্ধতি নির্ধারণ করতে হয়। আমাদের রোগী তার এই সমস্যার জন্য কোনো চিকিৎসা নেননি।"
+  },
+  {
+    "id": "multiclinsum_gs_en_419.txt",
+    "fulltext": "A 62-year-old Tunisian Arab postmenopausal female diagnosed with Von Hippel–Lindau disease in 2021 presented with various manifestations related to the disease. She had a history of multiple surgeries, primarily for renal, adrenal, and pancreatic tumors, with incidental findings of ovarian masses.\n\nThe patient was asymptomatic from a gynecological standpoint, but primarily complained of headaches before undergoing brain surgery. She had no significant family or psychosocial history.\n\nHer surgical history included\n2021: A non-operable tumor (6 cm) of the left petrous bone endolymphatic sac, managed with radiotherapy.\n\n2021: Left adrenalectomy for a 6 cm pheochromocytoma. Pathological examination revealed pheochromocytoma.\n\n2021: Left nephrectomy for a ruptured left renal tumor. Microscopy showed multifocal clear-cell renal carcinoma of nuclear grade 2.\n\n2022: Cephalic duodenopancreatectomy for a mass in the pancreas. Histological examination confirmed three serous cystadenomas and two well-differentiated neuroendocrine tumors.\n\nIn January 2021, during postoperative surveillance with an abdominal–pelvic computed tomography (CT) scan, a 4 cm solid cystic left adnexal mass was incidentally discovered, which raised suspicion of malignancy. The mass was confirmed by transvaginal ultrasound and pelvic MRI, classified as Ovarian-Adnexal Reporting and Data System (O-RADS) 5 (high suspicion for malignancy).\n\nGynecological examination and surgical history\nPhysical examination: No abdominal–pelvic mass detected.\n\nSpeculum examination: Healthy cervix observed.\n\nSurgical scars from previous left nephrectomy and cephalic duodenopancreatectomy were noted.\n\nA multidisciplinary staff meeting concluded that surgery was necessary. A laparotomy was performed via a midline incision below the umbilicus, revealing a well-defined solid cystic mass in the left adnexa. No ascites or signs of peritoneal carcinomatosis were present, and the right adnexa appeared normal, with no macroscopic signs of malignancy observed intraoperatively, including the absence of exocystic vegetations.\n\nCytology was performed along with left adnexectomy, and the specimen was sent for frozen section examination. The results were inconclusive, raising the possibility of borderline tumors or tumors specific to Von Hippel–Lindau syndrome. Considering the patient’s postmenopausal status, a right adnexectomy and total hysterectomy were performed.\n\nHistological examination later revealed bilateral clear-cell papillary cystadenomas of the Fallopian Tubes and broad ligament, characteristic of Von Hippel–Lindau disease (0.5 cm on the right side and 4 cm on the left side).The tumors consisted of tightly packed papillae with fibrous cores, covered by monolayered epithelium.\n\nThe immediate postoperative period was uneventful, and at the 1-month follow-up, no abnormalities were detected. The patient has since been followed up with every 4 months with normal pelvic ultrasounds. During these 2 years of follow-up, no complications have arisen, but the patient was recently readmitted to the neurosurgery department for recurrence of a brain tumor.",
+    "summary": "A 62-year-old white North African woman diagnosed with Von Hippel-Lindau disease in 2021 presented with multiple manifestations, including a left petrous bone tumor, left pheochromocytoma, left renal cell carcinoma, multi-cystic right kidney, and pancreatic masses. She underwent various treatments, including radiotherapy, adrenalectomy, nephrectomy, and cephalic duodenopancreatectomy. Ultrasonographic and magnetic resonance imaging examinations revealed a solid cystic mass in the left adnexal region. Laparoscopy identified cystic tumors in the right and left mesosalpinx. Following a hysterectomy with bilateral adnexectomy, histological examination revealed bilateral clear-cell papillary cystadenomas of the mesosalpinx and broad ligament, consistent with Von Hippel-Lindau disease.",
+    "translated_fulltext": "একজন ৬২ বছর বয়সী তিউনিসীয় আরব নারী, যিনি ২০২১ সালে ভন হিপ্পেল-লিন্ডাউ রোগে আক্রান্ত হন, বিভিন্ন উপসর্গের সঙ্গে হাসপাতালে আসেন। তার আগে একাধিক অস্ত্রোপচারের ইতিহাস ছিল, মূলত কিডনি, অ্যাড্রিনাল এবং অগ্ন্যাশয়ের টিউমারের জন্য। সেই সময় ডিম্বাশয়ের কিছু টিউমারও পাওয়া যায়।\n\nরোগীর স্ত্রীরোগ সংক্রান্ত কোনো উপসর্গ ছিল না, তবে মস্তিষ্কে অস্ত্রোপচারের আগে তিনি মাথাব্যথার কথা জানান। তার উল্লেখযোগ্য কোনো পারিবারিক বা মানসিক ইতিহাস ছিল না।\n\nতার অস্ত্রোপচারের ইতিহাস:\n২০২১: বাম দিকের পেট্রাস হাড়ের এন্ডোলিম্ফ্যাটিক স্যাকের একটি ৬ সেমি আকারের টিউমার, যা রেডিয়োথেরাপির মাধ্যমে চিকিৎসা করা হয়।\n\n২০২১: ৬ সেমি আকারের ফিওক্রোমোসাইটোমার জন্য বাম অ্যাড্রেনালেক্টোমি করা হয়। প্যাথলজিক্যাল পরীক্ষায় ফিওক্রোমোসাইটোমা ধরা পড়ে।\n\n২০২১: ফেটে যাওয়া বাম কিডনির টিউমারের জন্য বাম নেফ্রেক্টমি করা হয়। মাইক্রোস্কোপিক পরীক্ষায় নিউক্লিয়ার গ্রেড ২-এর মাল্টিফোকাল ক্লিয়ার-সেল রেনাল কার্সিনোমা দেখা যায়।\n\n২০২২: অগ্ন্যাশয়ের একটি টিউমারের জন্য সেফালিক ডুওডেনোপ্যানক্রিয়েক্টমি করা হয়। হিস্টোলজিক্যাল পরীক্ষায় তিনটি সেরাস সিস্টাডেনোমা এবং দুটি ভালোভাবে গঠিত নিউরোএন্ডোক্রাইন টিউমার পাওয়া যায়।\n\nজানুয়ারি ২০২১-এ, পেটের একটি সিটি স্ক্যান করার সময় ৪ সেমি আকারের একটি কঠিন সিস্টিক বাম অ্যাডনেক্সাল টিউমার পাওয়া যায়, যা থেকে ক্যান্সারের সন্দেহ হয়। ট্রান্সভ্যাজাইনাল আল্ট্রাসাউন্ড এবং পেলভিক এমআরআই-এর মাধ্যমে টিউমারটি নিশ্চিত করা হয় এবং এটিকে ওভারিয়ান-অ্যাডনেক্সাল রিপোর্টিং অ্যান্ড ডেটা সিস্টেম (ও-RADS) ৫ হিসাবে চিহ্নিত করা হয়, যা ক্যান্সারের উচ্চ ঝুঁকির ইঙ্গিত দেয়।\n\nস্ত্রীরোগ সংক্রান্ত পরীক্ষা এবং অস্ত্রোপচারের ইতিহাস:\nশারীরিক পরীক্ষা: পেটে বা পেলভিসে কোনো টিউমার ধরা পড়েনি।\n\nস্পেকুলাম পরীক্ষা: জরায়ু স্বাভাবিক দেখা যায়।\n\nআগের বাম নেফ্রেক্টমি এবং সেফালিক ডুওডেনোপ্যানক্রিয়েক্টমির দাগ দেখা যায়।\n\nএকটি মাল্টিডিসিপ্লিনারি মিটিংয়ে সিদ্ধান্ত নেওয়া হয় যে অস্ত্রোপচার করা প্রয়োজন। নাভির নিচে একটি মাঝখানের ইনসিশনের মাধ্যমে ল্যাপারোটমি করা হয়, যেখানে বাম অ্যাডনেক্সাতে একটি সুস্পষ্ট কঠিন সিস্টিক টিউমার দেখা যায়। পেটে কোনো তরল বা পেরিটোনিয়াল কার্সিনোমাটোসিসের লক্ষণ ছিল না। ডান অ্যাডনেক্সা স্বাভাবিক দেখাচ্ছিল এবং অস্ত্রোপচারের সময় কোনো দৃশ্যমান ক্যান্সারের লক্ষণ দেখা যায়নি, যেমন এক্সোসিস্টিক ভেজিটেশন।\n\nবাম অ্যাডনেক্সেক্টোমির সঙ্গে সাইটোলজি করা হয় এবং নমুনাটি ফ্রোজেন সেকশন পরীক্ষার জন্য পাঠানো হয়। পরীক্ষার ফলাফল অস্পষ্ট ছিল, যা বর্ডারলাইন টিউমার বা ভন হিপ্পেল-লিন্ডাউ সিনড্রোমের সঙ্গে সম্পর্কিত টিউমারের সম্ভাবনা নির্দেশ করে। রোগীর মেনোপজের অবস্থা বিবেচনা করে, ডান অ্যাডনেক্সেক্টোমি এবং সম্পূর্ণ হিস্টেরেক্টমি করা হয়।\n\nপরবর্তী হিস্টোলজিক্যাল পরীক্ষায় ফ্যালোপিয়ান টিউব এবং ব্রড লিগামেন্টের উভয় দিকে ক্লিয়ার-সেল প্যাপিলারি সিস্টাডেনোমা পাওয়া যায়, যা ভন হিপ্পেল-লিন্ডাউ রোগের বৈশিষ্ট্য (ডান দিকে ০.৫ সেমি এবং বাম দিকে ৪ সেমি)। টিউমারগুলো ফাইবার সমৃদ্ধ কোর দিয়ে আবৃত এবং এক স্তর বিশিষ্ট এপিথেলিয়াম দ্বারা গঠিত।\n\nঅস্ত্রোপচারের পরবর্তী সময়কালে কোনো জটিলতা দেখা যায়নি এবং ১ মাস পর ফলো-আপে কোনো অস্বাভাবিকতা ধরা পড়েনি। এরপর থেকে প্রতি ৪ মাস অন্তর রোগীর পেলভিক আল্ট্রাসাউন্ড করা হয় এবং সবকিছু স্বাভাবিক থাকে। এই ২ বছরে কোনো জটিলতা দেখা যায়নি, তবে সম্প্রতি মস্তিষ্কের টিউমার ফিরে আসায় রোগীকে নিউরোসার্জারি বিভাগে পুনরায় ভর্তি করা হয়েছে।",
+    "translated_summary": "2021 সালে ভন হিপ্পেল-লিন্ডাউ রোগে আক্রান্ত ৬২ বছর বয়সী একজন শ্বেতাঙ্গ উত্তর আফ্রিকান নারী বিভিন্ন উপসর্গ নিয়ে উপস্থিত হন, যার মধ্যে বাম দিকের পেট্রাস হাড়ের টিউমার, বাম দিকের ফিওক্রোমোসাইটোমা, বাম দিকের রেনাল সেল কার্সিনোমা, বহু-সিস্টিক ডান কিডনি এবং অগ্ন্যাশয়ের টিউমার অন্তর্ভুক্ত ছিল। তিনি বিভিন্ন চিকিৎসা গ্রহণ করেন, যার মধ্যে রয়েছে রেডিওথেরাপি, অ্যাড্রেনালেক্টমি, নেফ্রেক্টমি এবং সেফালিক ডুওডেনোপ্যানক্রিয়েক্টমি। আলট্রাসাউন্ড এবং ম্যাগনেটিক রেজোন্যান্স ইমেজিং পরীক্ষায় বাম দিকের অ্যাডনেক্সাল অঞ্চলে একটি কঠিন সিস্টিক টিউমার দেখা যায়। ল্যাপারোস্কোপির মাধ্যমে ডান এবং বাম মেসোস্যালপিংক্সে সিস্টিক টিউমার শনাক্ত করা হয়। এরপর উভয় পাশের অ্যাডনেক্সেক্টমির সাথে হিস্টেরেক্টমি করার পর হিস্টোলজিক্যাল পরীক্ষায় মেসোস্যালপিংক্স এবং ব্রড লিগামেন্টের উভয় পাশের ক্লিয়ার-সেল প্যাপিলারি সিস্টেডেনোমা দেখা যায়, যা ভন হিপ্পেল-লিন্ডাউ রোগের সাথে সঙ্গতিপূর্ণ।"
+  },
+  {
+    "id": "multiclinsum_gs_en_30.txt",
+    "fulltext": "The patient was a 59-year-old Japanese man with a 28-year history of type 1 diabetes. He visited our hospital monthly for management of diabetes with intensive therapy employing multiple-dose insulin injections. His height and body weight were 168 cm and 52 kg (body mass index: 18.4 kg/m2), respectively. He showed depleted insulin secretion (serum C-peptide level was below the limit of detection), such that his blood glucose levels fluctuated severely, and his hemoglobin A1c (HbA1c) level was around 9.0% despite intensive insulin therapy. He had been diagnosed with asymptomatic chronic severe (grade III) aortic regurgitation (AR) 16 years before the current presentation but had declined follow-up for the AR. He had never undergone surgery nor the implantation of any prosthetic devices.\n\nEight days after his regular hospital visit, he visited an emergency clinic complaining of breathing difficulty and had a fever above 38℃. Until that day, he had not noticed any fever, chills, weakness, or any other symptoms. His blood pressure and pulse rate were 192/82 mmHg and 118/min, respectively. He showed orthopnea, and his oxygen saturation (SpO2) was 80%. He was transported to the emergency department of our hospital. A physical examination revealed a Levine 3/6 systolic murmur, although his cardiac murmur had not been checked at regular hospital visits. No physical findings suggesting IE, such as Osler nodes, Janeway lesions, or conjunctival petechiae, were recognized. His white blood cell (WBC) count was markedly increased to 20,800 /μL, and his C-reactive protein (CRP) was elevated to 6.06 mg/dL. Serum creatine phosphokinase MB was within the normal range, at 6.0 IU/L, and troponin T was negative. Chest X-ray showed pulmonary congestion with cardiac enlargement (cardiothoracic ratio: 55%). Electrocardiography revealed ST elevation on V1-V4, but emergency echocardiography showed no dysfunction of cardiac contractility. He was diagnosed with acute heart failure due to valvular disease, and treatment with non-invasive positive pressure ventilation and nitrates was initiated.\n\nAfter hospital admission, a detailed examination by transthoracic echocardiography showed severe aortic regurgitation, severe mitral regurgitation, and a mobile vegetation on the mitral valve. Transesophageal echocardiography revealed a 16.5×6-mm mobile vegetation on the anterior leaflet of the mitral valve and an 11.2×5-mm nonmobile vegetation on the noncoronary cusp of the aortic valve. These findings raised strong suspicion of NVE. In this case, head computed tomography (CT) and magnetic resonance imaging revealed no cerebral infarction or hemorrhaging, although a mobile vegetation was detected.\n\nOn reviewing the clinical course until hospitalization, we noted that at the visit four months before admission, his WBC count had been slightly elevated. The following month, his albumin (Alb) level decreased to 3.0 g/dL, and his hemoglobin (Hb) level had shown a gradual decline over the 2 months prior to admission. During this period, he had experienced a 4-kg weight loss. Esophagogastroduodenoscopy and whole-body CT were performed, but no abnormalities were detected. One month later, he had regained some weight, and the laboratory findings had nearly normalized, except for a slightly elevated CRP level (0.54 mg/dL). At the last visit (8 days before admission), his WBC count had again risen to 9,300 /μL, while his Hb and Alb levels had again decreased to 13.1 g/dL and 3.0 g/dL, respectively. Furthermore, his CRP level had increased to 4.18 mg/dL. At that time, his diastolic blood pressure has shown an obvious decrease. Thus far, he had not experienced a fever or any symptoms other than weight loss. We suspected diseases of infectious and/or malignant origin and initiated comprehensive examinations to identify the source of his clinical findings.\n\nAfter heart failure treatment had been started, his clinical symptoms showed rapid improvement, and his hemodynamic stability was maintained during the first six hours. He initially received empirical intravenous antibiotic therapy consisting of 12 g/day of ampicillin sulbactam (ABPC/S) and 120 mg/day of gentamycin (GM). Three blood culture sets were obtained on the admission, and all were positive for S. warneri [minimum inhibitory concentration (MIC) to ABPC/S ≤8 μg/mL; MIC to GM ≤1 μg/mL; MIC to cefazolin (CEZ) ≤2 μg/mL]. Thus, IE caused by this organism was diagnosed.\n\nAccording to the clinical guideline established by the Japanese Circulation Society, emergency surgery is generally recommended for heart failure of NYHA III to IV or urgent surgery for NVE mobile vegetation exceeding 10 mm and severe valve dysfunction. In this case, however, his heart failure was successfully improved. Based on the guideline, the risk of embolism was considered to have been reduced by the administration of appropriate antibiotic therapy. In addition, the patient had type 1 diabetes, and his glycemic control was so poor that we were concerned that double-valve surgery would be a high-risk procedure. Therefore, we planned elective surgery after sufficient control of both infection and diabetes.\n\nBased on the blood culture results, the antibiotic regimen was switched to 6 g/day of CEZ. A detailed dental examination revealed no abnormalities, such as periodontitis. After four weeks of antibiotic therapy, he underwent surgical therapy. His aortic valve was found to be bicuspid, and the aortic and mitral annuli were intact without abscess formation. Large vegetations were exenterated, and the mitral and aortic valves were both replaced with mechanical valves. He experienced no postoperative complications and was discharged on the 22nd day after the operation without apparent embolism. He has not had any recurrence in over two years since the operation.",
+    "summary": "A 59-year-old man with type 1 diabetes presented with heart failure. Echocardiography showed large vegetations on the mitral and aortic valves. Blood bacterial culture was positive for Staphylococcus warneri, a coagulase-negative staphylococcus (CoNS) family member. He was diagnosed with native valve endocarditis (NVE) induced by the resident bacteria and ultimately underwent double valve replacement. Retrospectively, slight laboratory data abnormalities and weight loss beginning four months before may have been signs of NVE. He had no history of immunosuppressive therapies or medical device implantation. ",
+    "translated_fulltext": "রোগী ছিলেন ৫৯ বছর বয়সী একজন জাপানি পুরুষ, যিনি ২৮ বছর ধরে টাইপ ১ ডায়াবেটিসে ভুগছিলেন। তিনি ডায়াবেটিস নিয়ন্ত্রণের জন্য আমাদের হাসপাতালে প্রতি মাসে যেতেন এবং সেখানে মাল্টিপল-ডোজ ইনসুলিন ইনজেকশনের মাধ্যমে নিবিড় চিকিৎসা গ্রহণ করতেন। তার উচ্চতা ছিল ১৬৮ সেমি এবং ওজন ৫২ কেজি (বডি মাস ইনডেক্স: ১৮.৪ কেজি/মি২)। দেখা যায় তার ইনসুলিন নিঃসরণ কমে গেছে (সিরাম সি-পেপটাইড মাত্রা সনাক্তকরণের সীমার নিচে ছিল), যার ফলে তার রক্তে গ্লুকোজের মাত্রা ব্যাপকভাবে ওঠানামা করত এবং নিবিড় ইনসুলিন থেরাপি সত্ত্বেও তার হিমোগ্লোবিন এ১সি (HbA1c) মাত্রা প্রায় ৯.০% ছিল। বর্তমান অবস্থায় আসার ১৬ বছর আগে তাকে উপসর্গবিহীন গুরুতর (গ্রেড III) অ্যাওর্টিক রিগারজিটেশন (এআর) নির্ণয় করা হয়েছিল, কিন্তু তিনি এআর-এর জন্য ফলো-আপ চিকিৎসা করানো বন্ধ করে দিয়েছিলেন। তিনি আগে কখনো কোনো সার্জারি বা কৃত্রিম অঙ্গ প্রতিস্থাপন করাননি।\n\nহাসপাতালে নিয়মিত চিকিৎসার আট দিন পর, তিনি শ্বাসকষ্ট এবং ৩৮ ডিগ্রি সেলসিয়াসের বেশি জ্বর নিয়ে জরুরি বিভাগে আসেন। এর আগে পর্যন্ত তিনি জ্বর, কাঁপুনি, দুর্বলতা বা অন্য কোনো উপসর্গ অনুভব করেননি। তার রক্তচাপ ছিল ১৯২/৮২ মিমি Hg এবং পালস রেট ছিল ১১৮/মিনিট। তিনি অর্থোপনিয়া অনুভব করছিলেন এবং তার অক্সিজেন স্যাচুরেশন (SpO2) ছিল ৮০%। তাকে আমাদের হাসপাতালের জরুরি বিভাগে নিয়ে যাওয়া হয়। শারীরিক পরীক্ষায় লেভিনের ৩/৬ সিস্টোলিক মারমার শোনা যায়, যদিও নিয়মিত হাসপাতালে আসার সময় তার হৃদরোগের মারমার পরীক্ষা করা হয়নি। ওসলার নোড, জেনওয়ে লেসন বা কনজাংটিভাল পেটেকিয়া-এর মতো আইই (সংক্রামক হৃদরোগ)-এর কোনো শারীরিক লক্ষণ দেখা যায়নি। তার শ্বেত রক্তকণিকার (ডব্লিউবিসি) সংখ্যা উল্লেখযোগ্যভাবে বেড়ে ২০,৮০০ /μL হয় এবং সি-রিঅ্যাক্টিভ প্রোটিন (সিআরপি) ৬.০৬ মিলিগ্রাম/ডিএল-এ উন্নীত হয়। সিরাম ক্রিয়েটিন ফসফোকাইনেজ এমবি স্বাভাবিক সীমার মধ্যে ছিল, ৬.০ আইইউ/এল, এবং ট্রোপোনিন টি নেগেটিভ ছিল। বুকের এক্স-রেতে দেখা যায় ফুসফুসে তরল জমেছে এবং হৃদপিণ্ড বড় হয়ে গেছে (কার্ডিওথোরাসিক অনুপাত: ৫৫%)। ইলেক্ট্রোকার্ডিওগ্রাফিতে ভি১-ভি৪-এ এসটি এলিভেশন দেখা যায়, তবে জরুরি ইকোকার্ডিওগ্রাফিতে হৃদপিণ্ডের সংকোচনকার্যের কোনো ত্রুটি ধরা পড়েনি। তাকে ভাল্ভের রোগের কারণে অ্যাকিউট হার্ট ফেইলিউর হয়েছে বলে নির্ণয় করা হয় এবং নন-ইনভেসিভ পজিটিভ প্রেসার ভেন্টিলেশন ও নাইট্রেট দিয়ে চিকিৎসা শুরু করা হয়।\n\nহাসপাতালে ভর্তির পর, ট্রান্সথোরাসিক ইকোকার্ডিওগ্রাফির মাধ্যমে বিস্তারিত পরীক্ষায় দেখা যায় গুরুতর অ্যাওর্টিক রিগারজিটেশন, গুরুতর মাইট্রাল রিগারজিটেশন এবং মাইট্রাল ভালভে একটি চলমান ভেজিটেশন রয়েছে। ট্রান্সএসোফেজিয়াল ইকোকার্ডিওগ্রাফিতে মাইট্রাল ভালভের সম্মুখ লিফলেটে ১৬.৫×৬ মিমি আকারের একটি চলমান ভেজিটেশন এবং অ্যাওর্টিক ভালভের নন-করোনারি কাস্পে ১১.২×৫ মিমি আকারের একটি স্থির ভেজিটেশন দেখা যায়। এই ফলাফলগুলো এনভিই (নন-ব্যাকটেরিয়াল এন্ডোকার্ডাইটিস)-এর তীব্র সন্দেহ তৈরি করে। এই ক্ষেত্রে, মাথার কম্পিউটেড টমোগ্রাফি (সিটি) এবং ম্যাগনেটিক রেজোন্যান্স ইমেজিং-এ কোনো সেরিব্রাল ইনফার্কশন বা রক্তক্ষরণ দেখা যায়নি, যদিও একটি চলমান ভেজিটেশন শনাক্ত করা হয়েছিল।\n\nহাসপাতালে ভর্তির আগে চার মাস আগের ভিজিটের সময় তার ডব্লিউবিসি গণনা সামান্য বেশি ছিল, তা পর্যালোচনা করে দেখা যায়। পরের মাসে, তার অ্যালবুমিনের (অ্যালব) মাত্রা কমে ৩.০ গ্রাম/ডিএল হয় এবং ভর্তির আগের দুই মাসে তার হিমোগ্লোবিনের (এইচবি) মাত্রা ধীরে ধীরে কমতে থাকে। এই সময়ে, তার ৪ কেজি ওজন কমেছিল। ইসোফাগোগ্যাস্ট্রোডুওডেনোস্কোপি এবং পুরো শরীরের সিটি স্ক্যান করা হয়েছিল, কিন্তু কোনো অস্বাভাবিকতা ধরা পড়েনি। এক মাস পর, তার ওজন কিছুটা পুনরুদ্ধার হয় এবং ল্যাবরেটরি ফলাফল প্রায় স্বাভাবিক হয়ে আসে, শুধুমাত্র সিআরপি-এর মাত্রা সামান্য বেশি ছিল (০.৫৪ মিলিগ্রাম/ডিএল)। শেষ ভিজিটে (ভর্তির ৮ দিন আগে), তার ডব্লিউবিসি গণনা আবার বেড়ে ৯,৩০০ /μL হয়, যেখানে তার এইচবি এবং অ্যালবুমিনের মাত্রা যথাক্রমে ১৩.১ গ্রাম/ডিএল এবং ৩.০ গ্রাম/ডিএল-এ নেমে আসে। উপরন্তু, তার সিআরপি-এর মাত্রা বেড়ে ৪.১৮ মিলিগ্রাম/ডিএল হয়। সেই সময়ে, তার ডায়াস্টোলিক রক্তচাপ উল্লেখযোগ্যভাবে কমে যায়। এখন পর্যন্ত, তিনি জ্বর বা ওজন কমানো ছাড়া অন্য কোনো উপসর্গ অনুভব করেননি। আমরা সংক্রামক এবং/অথবা ম্যালিগন্যান্ট রোগের সন্দেহ করি এবং তার ক্লিনিক্যাল ফলাফলের উৎস সনাক্ত করার জন্য ব্যাপক পরীক্ষা শুরু করি।\n\nহার্ট ফেইলিউরের চিকিৎসা শুরু করার পর, তার ক্লিনিক্যাল উপসর্গ দ্রুত উন্নতি লাভ করে এবং প্রথম ছয় ঘণ্টার মধ্যে তার হেমোডাইনামিক স্থিতিশীলতা বজায় থাকে। প্রাথমিকভাবে, তাকে ১২ গ্রাম/দিনের অ্যাম্পিসিলিন সালব্যাকটাম (এবিপিসি/এস) এবং ১২০ মিলিগ্রাম/দিনের জেন্টামাইসিন (জিএম) সমন্বিত একটি পরীক্ষামূলক ইন্ট্রাভেনাস অ্যান্টিবায়োটিক থেরাপি দেওয়া হয়। ভর্তির সময় তিনটি রক্তের কালচার নেওয়া হয়েছিল এবং সেগুলোতে এস. ওয়ারনারি-এর উপস্থিতি পাওয়া যায় [ন্যূনতম ইনহিবিটরি কনসেনট্রেশন (এমআইসি) এবিপি/এস-এর জন্য ≤৮ μg/mL; জিএম-এর জন্য ≤১ μg/mL; সেফাজোলিনের (সিইজেড) জন্য ≤২ μg/mL]। সুতরাং, এই জীবাণু দ্বারা সৃষ্ট আইই (সংক্রামক হৃদরোগ) নির্ণয় করা হয়।\n\nজাপানি সার্কুলেশন সোসাইটি কর্তৃক প্রতিষ্ঠিত ক্লিনিক্যাল নির্দেশিকা অনুসারে, এনওয়াইএইচএ III থেকে IV হৃদরোগের ক্ষেত্রে সাধারণত জরুরি ভিত্তিতে সার্জারির সুপারিশ করা হয় অথবা এনভিই-এর ক্ষেত্রে ১০ মিমি-এর বেশি আকারের চলমান ভেজিটেশন এবং গুরুতর ভালভের ত্রুটির জন্য জরুরি সার্জারির প্রয়োজন হয়। তবে, এই ক্ষেত্রে, তার হার্ট ফেইলিউর সফলভাবে নিয়ন্ত্রণ করা সম্ভব হয়েছিল। নির্দেশিকার ভিত্তিতে, উপযুক্ত অ্যান্টিবায়োটিক থেরাপি প্রদানের মাধ্যমে এম্বোলিজমের ঝুঁকি কমানো হয়েছে বলে মনে করা হয়। এছাড়াও, রোগীর টাইপ ১ ডায়াবেটিস ছিল এবং তার গ্লাইসেমিক নিয়ন্ত্রণ খুবই খারাপ ছিল, তাই আমরা উদ্বিগ্ন ছিলাম যে ডাবল-ভালভ সার্জারি একটি উচ্চ-ঝুঁকির পদ্ধতি হতে পারে। তাই, সংক্রমণ এবং ডায়াবেটিস উভয়ই সম্পূর্ণরূপে নিয়ন্ত্রণের পর আমরা একটি পরিকল্পিত সার্জারির পরিকল্পনা করি।\n\nরক্তের কালচারের ফলাফলের ভিত্তিতে, অ্যান্টিবায়োটিক থেরাপি পরিবর্তন করে ৬ গ্রাম/দিনের সিইজেড দেওয়া হয়। বিস্তারিত ডেন্টাল পরীক্ষায় পেরিওডন্টাইটিসের মতো কোনো অস্বাভাবিকতা পাওয়া যায়নি। চার সপ্তাহ অ্যান্টিবায়োটিক থেরাপির পর, তিনি সার্জারি করান। তার অ্যাওর্টিক ভালভ বাইকাস্পিড ছিল এবং অ্যাওর্টিক ও মাইট্রাল অ্যানুলাস অক্ষত ছিল, কোনো ফোড়া ছিল না। বড় ভেজিটেশনগুলো অপসারণ করা হয় এবং মাইট্রাল ও অ্যাওর্টিক ভালভ উভয়ই যান্ত্রিক ভালভ দিয়ে প্রতিস্থাপন করা হয়। অস্ত্রোপচারের পর তার কোনো জটিলতা হয়নি এবং কোনো দৃশ্যমান এম্বোলিজম ছাড়াই ২২তম দিনে তাকে হাসপাতাল থেকে ছেড়ে দেওয়া হয়। অস্ত্রোপচারের পর দুই বছরের বেশি সময় ধরে তার মধ্যে কোনো পুনরাবৃত্তি দেখা যায়নি।",
+    "translated_summary": "৫৯ বছর বয়সী একজন ব্যক্তি, যিনি টাইপ ১ ডায়াবেটিসে আক্রান্ত, হৃদরোগের কারণে হাসপাতালে ভর্তি হন। ইকোকার্ডিওগ্রাফিতে দেখা যায় তার মিট্রাল এবং অ্যাওর্টিক ভালভে বড় আকারের সংক্রমণ হয়েছে। রক্ত পরীক্ষায় স্ট্যাফাইলোকক্কাস ওয়ারনারি নামক ব্যাকটেরিয়ার উপস্থিতি পাওয়া যায়, যা কোয়াগুলেজ-নেগেটিভ স্ট্যাফাইলোকক্কাস (CoNS) পরিবারের সদস্য। তাকে স্থানীয় ভালভের এন্ডোকার্ডাইটিস (NVE) নির্ণয় করা হয়, যা সেখানকার ব্যাকটেরিয়া দ্বারা সৃষ্ট। অবশেষে, তার দুটি ভালভ প্রতিস্থাপন করা হয়। পরবর্তীতে দেখা যায়, ভর্তি হওয়ার চার মাস আগে থেকে তার সামান্য কিছু ল্যাবরেটরি ডেটার অস্বাভাবিকতা এবং ওজন হ্রাস NVE-এর লক্ষণ ছিল। তার আগে কখনো ইমিউনোসাপ্রেসিভ থেরাপি বা কোনো মেডিকেল ডিভাইস বসানোর ইতিহাস ছিল না।"
+  },
+  {
+    "id": "multiclinsum_gs_en_383.txt",
+    "fulltext": "A 27-year-old woman with multiple colorectal cancers on a background of FAP was presented to our department. Notably, a large lesion was detected in the ascending, transverse, and sigmoid colon and the upper rectum, and pathological examination confirmed some of them as adenocarcinoma. Preoperative computed tomography revealed multiple lymph node swellings along the inferior mesenteric artery (IMA) and middle colic artery, without any evidence of distant metastases. After a comprehensive evaluation by a multidisciplinary cancer board, we decided to perform TPC with lymph node dissection of the entire colorectal region, using the Hugo RAS system as a surgical device.\n\nRobot-assisted TPC using the Hugo RAS system was approved by the Evaluating Committee for Highly Difficult New Medical Technologies (approval number H-0051) and the Institutional Review Board at Kyoto University.\n\nUnder general anesthesia, the patient was placed in a lithotomy position with the arms tucked. After a 5-cm vertical skin incision was made at the umbilicus, a wound-protecting device was applied. After pneumoperitoneum, 4 robotic trocars and 2 assistant trocars were placed. The instruments used in robot-assisted TPC with Hugo were a camera, monopolar curved shears for the right hand, bipolar fenestrated forceps for the left hand, and Cadiere/double fenestrated forceps for the reserve arm. Robot-assisted TPC with Hugo consists of 3 distinct steps, followed by transanal specimen extraction, ileal pouch construction through a small laparotomy, and ileal pouch-anus anastomosis (IPAA). Two table positions, Trendelenburg and flat, were required, each with specific docking tilts but the same angles of the arm carts throughout the robotic procedure. The detailed operative procedure is presented in Supplementary Videos.\n\nStep 1: Ascending colon complete mesocolic excision (CME)\n\nThe ascending colon CME from the caudal approach proceeded until the completion of the hepatic flexure mobilization (Supplementary Video S1).\n\nStep 2: Central vessel ligation (CVL) of the IMA, descending colon CME, and total mesorectal excision (TME)\n\nAfter CVL of the IMA, descending colon CME proceeded until the completion of splenic flexure mobilization, followed by TME until the intersphincteric space was fully exposed (Supplementary Video S2).\n\nStep 3: CVL along the superior mesenteric artery (SMA)\n\nAfter undocking all the robotic arms, the patient was placed in a flat position. Then, CVL along the SMA was performed to ligate the ileocolic, right colic, and middle colic vessels (Supplementary Video S3). The final step of this procedure was the ligation of the inferior mesenteric vein (IMV) at its root, which was exposed in Step 2.\n\nTransanal and small laparotomy procedures\nAfter transection of the terminal ileum, we extracted the specimen transanally by excising the rectal mucosa entirely from just below the dentate line because of multiple adenomas in the anal canal. After constructing the ileal pouch through the small umbilical incision and confirming that the ileal pouch could reach the bottom of the anal canal for anastomosis, transanal hand-sewn IPAA was performed. A diverting ileostomy was not performed.\n\nAll 3 steps were completed without conversion to open surgery. After undocking Hugo when we finished Step 3, we performed a laparoscopy to confirm hemostasis, specimen extraction, and appropriate anastomosis. The operative time was 632 min (36 min for Step 1, 160 min for Step 2, 188 min for Step 3, and 248 min for other procedures such as positioning, docking, specimen extraction, and anastomosis), with a minimal intraoperative estimated blood loss of 20 mL. The patient exhibited an uneventful postoperative recovery, with gas passage and initiation of liquid nutrition on postoperative day 1 (POD 1) and a solid diet on POD 3 with a functional ileal pouch and satisfactory anal function. Pathological examination revealed 2 sigmoid colon cancers (S1, Type 0-Ip, 55 × 50 mm, tub1, T1b, ly0, v0; S2, Type 0-Isp, 55 × 50 mm, tub1, Tis, ly0, v0) and 1 rectal cancer (R1, Type 0-Ip, 40 × 35 mm, tub1, Tis, ly0, v0). It also revealed 18 out of 89 positive lymph nodes, all of which belonged to the sigmoid colon and rectosigmoid lesions (stations #241, 242, and 251), resulting in UICC pT1bN2b stage.",
+    "summary": "A 27-year-old woman with multiple colorectal cancers with a background of familial adenomatous polyposis underwent robot-assisted TPC, including lymph node dissection of the entire colorectal region using the Hugo RAS system. The robotic procedure was divided into 3 steps: 1) Trendelenburg position to perform ascending colon complete mesocolic excision (CME) to the hepatic flexure, 2) descending colon CME and total mesorectal excision with D3 lymph node dissection, and 3) flat position to perform central vessel ligation along the superior mesenteric artery. After undocking, the specimen was extracted transanally, and an ileal pouch was constructed from a small laparotomy at the umbilical incision, followed by ileal pouch-anal anastomosis. The operative time was 632 min, and the estimated blood loss was minimal. The postoperative period was uneventful.",
+    "translated_fulltext": "এফএপি-এর প্রেক্ষাপটে একাধিক কোলোরেক্টাল ক্যান্সারে আক্রান্ত ২৭ বছর বয়সী একজন মহিলাকে আমাদের বিভাগে আনা হয়েছিল। উল্লেখযোগ্যভাবে, আরোহী, অনুপ্রস্থ এবং সিগময়েড কোলন এবং উপরের মলদ্বারে একটি বড় ক্ষত সনাক্ত করা হয়েছিল এবং প্যাথলজিক্যাল পরীক্ষায় সেগুলোর মধ্যে কিছু অ্যাডেনোকার্সিনোমা হিসেবে নিশ্চিত করা হয়েছিল। অস্ত্রোপচারের আগে করা কম্পিউটেড টমোগ্রাফিতে দেখা যায় যে নিম্ন মেসেন্টারিক ধমনী (আইএমএ) এবং মধ্য কোলিক ধমনীর পাশে একাধিক লিম্ফ নোড ফুলে গেছে, তবে দূরবর্তী মেটাস্ট্যাসিসের কোনো প্রমাণ পাওয়া যায়নি। একটি মাল্টিডিসিপ্লিনারি ক্যান্সার বোর্ডের মাধ্যমে ব্যাপক মূল্যায়নের পর, আমরা পুরো কোলোরেক্টাল অঞ্চলের লিম্ফ নোড ডিসেকশনসহ টিপিসি করার সিদ্ধান্ত নেই এবং সার্জিক্যাল ডিভাইস হিসেবে হুগো আরএএস সিস্টেম ব্যবহার করি।\n\nহুগো আরএএস সিস্টেম ব্যবহার করে রোবট-সহায়ক টিপিসি-এর অনুমোদন দেওয়া হয়েছিল ইভালুয়েটিং কমিটি ফর হাইলি ডিফিকাল্ট নিউ মেডিকেল টেকনোলজিস (অনুমোদন নম্বর এইচ-0051) এবং কিয়োটো বিশ্ববিদ্যালয়ের ইনস্টিটিউশনাল রিভিউ বোর্ড কর্তৃক।\n\nসাধারণ অ্যানেস্থেসিয়ার অধীনে, রোগীকে লিথোটমি অবস্থানে রাখা হয় এবং হাতগুলো শরীরের কাছে রাখা হয়। নাভির কাছে ৫ সেমি উল্লম্ব ত্বকের একটি ছেদ করার পরে, একটি ক্ষত-সুরক্ষামূলক ডিভাইস প্রয়োগ করা হয়। নিউমোপেরিটোনিয়ামের পরে, ৪টি রোবোটিক ট্রোকার এবং ২টি সহকারী ট্রোকার স্থাপন করা হয়। হুগোর সাহায্যে রোবট-সহায়ক টিপিসি-তে ব্যবহৃত যন্ত্রগুলো হলো একটি ক্যামেরা, ডান হাতের জন্য মনো polar কার্ভড কাঁচি, বাম হাতের জন্য বাইপোলার ফেনেসট্রেটেড ফোরসেপস এবং রিজার্ভ হাতের জন্য ক্যাডিয়েরে/ডাবল ফেনেসট্রেটেড ফোরসেপস। হুগোর সাহায্যে রোবট-সহায়ক টিপিসি-তে ৩টি স্বতন্ত্র ধাপ রয়েছে, এরপর ট্রান্সঅ্যানাল স্পেসিমেন নিষ্কাশন, একটি ছোট ল্যাপারোটমির মাধ্যমে ইলিয়াল পাউচ তৈরি এবং ইলিয়াল পাউচ-অ্যানাস অ্যানাস্টোমোসিস (আইপিএএ) করা হয়। দুটি টেবিল পজিশন, ট্রেন্ডেলেনবার্গ এবং ফ্ল্যাট, প্রয়োজন ছিল, যেখানে প্রতিটি অবস্থানে নির্দিষ্ট ডকিং অ্যাঙ্গেল ছিল, তবে পুরো রোবোটিক পদ্ধতির সময় হাতের কার্টগুলোর অ্যাঙ্গেল একই ছিল। বিস্তারিত অস্ত্রোপচার পদ্ধতি সাপ্লিমেন্টারি ভিডিওতে উপস্থাপন করা হয়েছে।\n\nধাপ ১: আরোহী কোলনের সম্পূর্ণ মেসোকোলিক এক্সিশন (সিএমই)\n\nকডাল পদ্ধতির মাধ্যমে আরোহী কোলনের সিএমই শুরু হয় এবং হেপাটিক ফ্লেক্সার মোবিলিাইজেশন সম্পন্ন না হওয়া পর্যন্ত এটি চলতে থাকে (সাপ্লিমেন্টারি ভিডিও এস১)।\n\nধাপ ২: আইএমএ-এর কেন্দ্রীয় রক্তনালী লিগেশন (সিভিএল), নিম্নগামী কোলনের সিএমই এবং মোট মেসোরেক্টাল এক্সিশন (টিএমই)\n\nআইএমএ-এর সিভিএল-এর পরে, নিম্নগামী কোলনের সিএমই চলতে থাকে যতক্ষণ না স্প্লেনিক ফ্লেক্সার মোবিলিাইজেশন সম্পন্ন হয়, এরপর টিএমই করা হয় যতক্ষণ না ইন্টারস্ফিংক্টেরিক স্থান সম্পূর্ণরূপে উন্মুক্ত হয় (সাপ্লিমেন্টারি ভিডিও এস২)।\n\nধাপ ৩: সুপিরিয়র মেসেন্টারিক ধমনী (এসএমএ) বরাবর সিভিএল\n\nসমস্ত রোবোটিক হাত সরানোর পরে, রোগীকে ফ্ল্যাট অবস্থানে রাখা হয়। এরপর, এসএমএ বরাবর সিভিএল করা হয় যাতে ইলিয়োকোলিক, ডান কোলিক এবং মধ্য কোলিক রক্তনালীগুলো বাঁধা যায় (সাপ্লিমেন্টারি ভিডিও এস৩)। এই পদ্ধতির চূড়ান্ত ধাপ হলো ইনফেরিয়র মেসেন্টারিক ভেইন (আইএমভি)-কে তার মূল স্থানে বাঁধা, যা দ্বিতীয় ধাপে উন্মুক্ত করা হয়েছিল।\n\nট্রান্সঅ্যানাল এবং ছোট ল্যাপারোটমি পদ্ধতি\nটার্মিনাল ইলিয়ামের ছেদ করার পরে, আমরা অ্যানাল ক্যানালে একাধিক অ্যাডেনোমা থাকার কারণে রেকটাল মিউকোসা সম্পূর্ণরূপে অপসারণ করে ট্রান্সঅ্যানালি স্পেসিমেনটি বের করি, যা ডেন্টேட் লাইনের ঠিক নিচ থেকে শুরু হয়। ছোট নাভির ছেদ দিয়ে ইলিয়াল পাউচ তৈরি করার পরে এবং নিশ্চিত করার পরে যে ইলিয়াল পাউচটি অ্যানাস্টোমোসিসের জন্য অ্যানাল ক্যানালের নীচে পৌঁছাতে পারবে, ট্রান্সঅ্যানাল হ্যান্ড-সেউন আইপিএএ করা হয়। একটি ডাইভার্টিং ইলিয়োস্টমি করা হয়নি।\n\nসমস্ত ৩টি ধাপ খোলা অস্ত্রোপচারে পরিবর্তন না করেই সম্পন্ন করা হয়েছিল। তৃতীয় ধাপ শেষ করার পরে হুগো সরানোর পরে, আমরা হেমোস্ট্যাসিস, স্পেসিমেন নিষ্কাশন এবং যথাযথ অ্যানাস্টোমোসিস নিশ্চিত করার জন্য একটি ল্যাপারোস্কোপি করি। অস্ত্রোপচারের সময় ছিল ৬৩২ মিনিট (প্রথম ধাপের জন্য ৩৬ মিনিট, দ্বিতীয় ধাপের জন্য ১৬০ মিনিট, তৃতীয় ধাপের জন্য ১৮৮ মিনিট এবং অন্যান্য পদ্ধতির জন্য ২৪৮ মিনিট, যেমন অবস্থান, ডকিং, স্পেসিমেন নিষ্কাশন এবং অ্যানাস্টোমোসিস), এবং অস্ত্রোপচারের সময় আনুমানিক রক্তক্ষরণ ছিল মাত্র ২০ মিলি। রোগীর অস্ত্রোপচারের পরে স্বাভাবিকভাবে সেরে ওঠে, প্রথম দিনে গ্যাস নির্গত হয় এবং তরল খাবার শুরু করা হয় (পিওডি ১) এবং তৃতীয় দিনে (পিওডি ৩) কার্যকরী ইলিয়াল পাউচ এবং সন্তোষজনক অ্যানাল ফাংশনসহ কঠিন খাবার দেওয়া হয়। প্যাথলজিক্যাল পরীক্ষায় ২টি সিগময়েড কোলন ক্যান্সার (এস১, টাইপ ০-আইপি, ৫৫ × ৫০ মিমি, টিউব১, টি১বি, এলওয়াই০, ভি০; এস২, টাইপ ০-আইএসপি, ৫৫ × ৫০ মিমি, টিউব১, টিআইএস, এলওয়াই০, ভি০) এবং ১টি রেকটাল ক্যান্সার (আর১, টাইপ ০-আইপি, ৪০ × ৩৫ মিমি, টিউব১, টিআইএস, এলওয়াই০, ভি০) পাওয়া যায়। এছাড়াও, ৮৯টি লিম্ফ নোডের মধ্যে ১৮টি পজিটিভ ছিল, যা সবই সিগময়েড কোলন এবং রেকটোসিগময়েড ক্ষতগুলোর (স্টেশন #২৪১, ২৪২ এবং ২৫১) অন্তর্ভুক্ত ছিল, যার ফলে ইউআইসিসি পিটি১বিএন২বি স্টেজ নির্ণয় করা হয়।",
+    "translated_summary": "২৭ বছর বয়সী একজন মহিলার একাধিক কোলরেকটাল ক্যান্সার ছিল এবং তার পরিবারে অ্যাডেনোমেটাস পলিপোসিসের ইতিহাস ছিল। তার ওপর রোবোটিক সহায়তায় টিপিসি (টিোটাল প্রোলাপ্স কারেকশন) করা হয়, যেখানে হুগো আরএএস সিস্টেম ব্যবহার করে পুরো কোলরেকটাল অঞ্চলের লিম্ফ নোড ডিসেকশন করা হয়। রোবোটিক পদ্ধতিটি তিনটি ধাপে বিভক্ত ছিল: ১) ট্রেন্ডেলেনবার্গ অবস্থানে থেকে অ্যাসেন্ডিং কোলনের সম্পূর্ণ মেসোকলিক এক্সcision (সিএমই) করা হয়, যা হেপাটিক ফ্লেক্সার পর্যন্ত বিস্তৃত ছিল, ২) ডিসেন্ডিং কোলনের সিএমই এবং ডি৩ লিম্ফ নোড ডিসেকশনসহ সম্পূর্ণ মেসোরেক্টাল এক্সcision করা হয়, এবং ৩) অনুভূমিক অবস্থানে থেকে সুপিরিয়র মেসেনটেরিক ধমনীর সাথে কেন্দ্রীয় রক্তনালীগুলো বাঁধা হয়। রোবোটিক প্রক্রিয়া শেষে, নমুনাটি ট্রান্সঅ্যানালি অপসারণ করা হয় এবং নাভির কাছে একটি ছোট ল্যাপারোটমি করে একটি ইলিয়াল পাউচ তৈরি করা হয়, এরপর ইলিয়াল পাউচ-অ্যানাল অ্যানাস্টোমোসিস করা হয়। পুরো প্রক্রিয়াটি ৬৩২ মিনিটে সম্পন্ন হয় এবং রক্তক্ষরণ খুবই কম ছিল। অস্ত্রোপচারের পরবর্তী সময়কালে কোনো জটিলতা দেখা যায়নি।"
+  },
+  {
+    "id": "multiclinsum_gs_en_462.txt",
+    "fulltext": "A 65-year-old male presented with swelling and boutonniere deformity on the right middle finger for six months after a motorcycle accident on January 1st, 2023. Initially, he managed the injury with painkillers and did not seek medical attention. After six months of persistent symptoms, including an inability to fully extend the finger and noticeable edema, he sought treatment.\n\nClinical findings\nThe inspection of the right hand showed the presence of deformity with edema. The active range of motion (ROM) was impaired in PIP joint in digiti III of the right hand. The active ROM of PIP joint digiti III of the right hand 45–110 degrees. The passive ROM of PIP joint digiti III of the right hand within normal.\n\nDiagnostic assessment\nWe performed X-ray of the right hand AP/Lateral which showed there are no abnormality in the bone and we diagnosed the deformity from soft tissue which is central slip injury.\n\nSurgical technique\nA central slip defect reconstruction utilizing partial ulnar side of flexor digitorum superficial tendon was performed. Under anesthesia, the patient was positioned supine with a tourniquet applied to the upper arm. A midlateral incision was made on the ulnar aspect of the right middle phalanx, centered at the PIP joint. The incision extended dorsally in an oblique manner. A transverse incision was made over the MCP joint flexion crease, just proximal to the A1 pulley. The procedure involves identifying and protecting the ulnar digital neurovascular bundle, exposing the central slip and extensor tendon to the PIPJ, full-thickness dorsal flaps are elevated. Scar tissue and pseudotendinous tissue is identified and excised. The central slip cannot be repaired primarily, so the ulnar slip of the FDS tendon is used for reconstruction. The ulnar neurovascular bundle is mobilized to visualize the periosteal insertion of the A3 pulley.\n\nThe extensor tendon is mobilized and tenolyzed, followed by incision of the dorsal capsule of the PIP joint and removal of interposed tissue. The A3 pulley's periosteal insertion is incised longitudinally, and the PIP joint's volar capsule is incised longitudinally. The ulnar slip of the FDS tendon is identified and a 2–0 non-absorbable, monofilament suture is placed around it. A transverse incision is made at the MCP joint flexion crease, proximal to the A1 pulley revealing the flexor tendon sheath. The tendon sheath and A1 pulley are incised longitudinally. The FDS tendon is identified. The ulnar slip of the FDS tendon is isolated and transected to release the ulnar slip, avoiding entrapment or catching of the radial slip. The 2–0 suture that was placed around the ulnar slip at the level of the PIP joint is used to release distally based FDS tendon slip and deliver the ulnar slip of the FDS tendon distally.\n\nA 2.8-mm drill is used to create a vertically oriented bone tunnel dorsal to volar. An elevator is placed between the flexor digitorum profundus tendon, volar plate, and volar aspect of the base of the middle phalanx protecting the volar anatomic structures. The FDS tendon slip passes through the tunnel while maintaining the PIP joint in extension and reduced position. The FDS tendon slip passed through the intact proximal section of the central slip and extensor tendon. A tendon weaver completes a Pulvertaft weave, confirming the appropriate tension with the PIPJ in the reduced, full extension position. A 3–0 non-absorbable suture secures the pulvertaft weave. The margins of the capsule and central slip reconstruction are approximated across the PIP joint, and adhesions are released and the lateral bands mobilized.\n\nThe overall posture, stability, and motion with tenodesis assessed. All the incisions are copiously irrigated. The tourniquet is deflated and hemostasis is obtained. Capillary refill of all fingers is assessed. The skin is closed using horizontal mattress stiches. A sterile dressing is applied with an appropriately padded PIP joint extension splint to allow for early DIP joint and MCP joint motion.\n\nFollow-up and outcomes\nFirst follow-up was done 4 days after for wound treatment. The patient was given oral meloxicam 7,5 mg twice a day and doxycycline 100 mg twice a day for 3 days. The second follow-up was done 3 days after for wound treatment. After 2 weeks, we remove the back slab, remove the external suture and begin the active and passive ROM exercise. After 3 weeks, the wound was healed, and we found the ROM of PIP joint 0 to 90 degrees. And after a month, the patient came with improved ROM of PIP joint 0 to 100 degrees, and improved functional outcome. After 7 weeks of physical rehabilitation, patients already back to work with improve ROM of PIP joint 0 to 110 degrees. The function of the patient's right hand is evaluated with DASH score, which improves significantly from 50 to 4.2.",
+    "summary": "A 65-year-old male patient presented with swelling and boutonniere deformity on the digiti III of the right hand. The patient had previously fallen from a motorcycle, and the patient's right middle finger got was by a motorcycle six months ago. After the incident, the patient's right middle finger cannot be fully extended. The patient's right hand showed edema with flexion of the interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint. The Range of Motion (ROM) of the PIP joint right middle finger was 45-110 degrees. The X-ray of the right hand AP/oblique showed no bone involvement in the deformity. The patient underwent central slip defect reconstruction utilizing the partial ulnar side of the flexor digitorum superficial tendon. A PIP joint extension splint was applied for 2 weeks. Active and passive exercise of the ROM of the PIP joint began after 2 weeks of PIP extension joint splinting. The patient's ROM of the PIP joint (0-90 degrees) significantly improved 1 month after surgery. The patient's ROM of the PIP joint returned to normal after 2 months after surgery. The function of the patient's right hand is evaluated with the DASH score, which improves significantly from 50 to 4.2.",
+    "translated_fulltext": "একজন ৬৫ বছর বয়সী পুরুষ, যিনি ২০২৩ সালের ১ জানুয়ারি মোটরসাইকেল দুর্ঘটনার পর ছয় মাস ধরে ডান হাতের মাঝের আঙুলে ফোলা এবং বুটোনিয়ের বিকৃতি নিয়ে এসেছিলেন। প্রথমে, তিনি ব্যথানাশক ওষুধ দিয়ে আঘাতের চিকিৎসা করেন এবং কোনো ডাক্তারের কাছে যাননি। ছয় মাস ধরে উপসর্গগুলো persist করার পরে, যার মধ্যে আঙুল সম্পূর্ণরূপে সোজা করতে না পারা এবং দৃশ্যমান ফোলা অন্তর্ভুক্ত ছিল, তিনি চিকিৎসা সহায়তা চান।\n\nক্লিনিক্যাল ফলাফল\nডান হাত পরীক্ষা করে দেখা যায়, ফোলাসহ বিকৃতি রয়েছে। ডান হাতের তৃতীয় আঙুলের পিআইপি জয়েন্টে সক্রিয় গতির পরিসীমা (ROM) কমে গেছে। ডান হাতের তৃতীয় আঙুলের পিআইপি জয়েন্টের সক্রিয় ROM ৪৫-১১০ ডিগ্রি। ডান হাতের তৃতীয় আঙুলের পিআইপি জয়েন্টের প্যাসিভ ROM স্বাভাবিক সীমার মধ্যে।\n\nরোগ নির্ণয়\nআমরা ডান হাতের এপি/ল্যাটেরাল এক্স-রে করি, যেখানে হাড়ে কোনো অস্বাভাবিকতা দেখা যায়নি। আমরা নরম টিস্যুর আঘাতের কারণে বিকৃতি নির্ণয় করি, যা সেন্ট্রাল স্লিপ ইনজুরি।\n\nসার্জিক্যাল পদ্ধতি\nফ্লেক্সর ডিজিটোরম সুপারফিসিয়াল টেন্ডনের আংশিক আলনার দিক ব্যবহার করে সেন্ট্রাল স্লিপের পুনর্গঠন করা হয়। অ্যানেস্থেশিয়ার অধীনে, রোগীকে চিৎ করে শোয়ানো হয় এবং উপরের বাহুতে একটি ট্যুরনিক্যাট লাগানো হয়। ডান হাতের মাঝের ফ্যালানক্সের আলনার দিকে একটি মধ্য-পার্শ্বীয় ছেদ করা হয়, যা পিআইপি জয়েন্টের কেন্দ্রে অবস্থিত। ছেদটি তির্যকভাবে ডরসাল দিকে বিস্তৃত হয়। এমসিপি জয়েন্টের ফ্লেক্সন ক্রিজের উপরে একটি ট্রান্সভার্স ছেদ করা হয়, যা এ১ পুলির ঠিক proximal-এ অবস্থিত। এই পদ্ধতিতে আলনার ডিজিটাল নিউরোভাসকুলার বান্ডল সনাক্ত এবং রক্ষা করা, সেন্ট্রাল স্লিপ এবং পিআইপি জয়েন্টের এক্সটেনসর টেন্ডন উন্মুক্ত করা, এবং পুরো পুরুত্বের ডরসাল ফ্ল্যাপ তৈরি করা হয়। এরপর scar tissue এবং pseudotendinous tissue সনাক্ত করে অপসারণ করা হয়। সেন্ট্রাল স্লিপ সরাসরি মেরামত করা যায় না, তাই এফডিএস টেন্ডনের আলনার স্লিপ পুনর্গঠনের জন্য ব্যবহার করা হয়। আলনার নিউরোভাসকুলার বান্ডলটিকে এমনভাবে সরানো হয় যাতে এ৩ পুলির পেরিওস্টিয়াল সন্নিবেশ দেখা যায়।\n\nএক্সটেনসর টেন্ডনটিকে সরানো এবং টেনোলাইসিস করা হয়, এরপর পিআইপি জয়েন্টের ডরসাল ক্যাপসুলের ছেদ করা হয় এবং interposed tissue অপসারণ করা হয়। এ৩ পুলির পেরিওস্টিয়াল সন্নিবেশটি অনুদৈর্ঘিকভাবে ছেদ করা হয় এবং পিআইপি জয়েন্টের ভোলার ক্যাপসুলটিও অনুদৈর্ঘিকভাবে ছেদ করা হয়। এফডিএস টেন্ডনের আলনার স্লিপ সনাক্ত করা হয় এবং এর চারপাশে একটি ২-০ নন-অ্যাবসোরবেবল, মনোফিলামেন্ট সেলাই করা হয়। এমসিপি জয়েন্টের ফ্লেক্সন ক্রিজের উপরে একটি ট্রান্সভার্স ছেদ করা হয়, যা এ১ পুলির proximal-এ অবস্থিত, এবং ফ্লেক্সর টেন্ডন শীথ উন্মুক্ত করা হয়। টেন্ডন শীথ এবং এ১ পুলি অনুদৈর্ঘিকভাবে ছেদ করা হয়। এফডিএস টেন্ডন সনাক্ত করা হয়। এফডিএস টেন্ডনের আলনার স্লিপটিকে আলাদা করা হয় এবং আলনার স্লিপটিকে ছেড়ে দেওয়ার জন্য ছেদ করা হয়, যাতে রেডিয়াল স্লিপের কোনো বাধা বা আটকে যাওয়া না হয়। পিআইপি জয়েন্টের স্তরে আলনার স্লিপের চারপাশে যে ২-০ সেলাই করা হয়েছিল, সেটি ব্যবহার করে ডিস্টালি অবস্থিত এফডিএস টেন্ডন স্লিপটিকে ছেড়ে দেওয়া হয় এবং এফডিএস টেন্ডনের আলনার স্লিপটিকে ডিস্টালি নিয়ে আসা হয়।\n\nএকটি ২.৮ মিমি ড্রিল ব্যবহার করে উল্লম্বভাবে একটি হাড়ের টানেল তৈরি করা হয়, যা ভোলার থেকে ডরসাল দিকে বিস্তৃত। ফ্লেক্সর ডিজিটোরম প্রোফান্ডাস টেন্ডন, ভোলার প্লেট এবং মাঝের ফ্যালানক্সের ভিত্তির ভোলার দিকের মধ্যে একটি এলিভেটর স্থাপন করা হয়, যা ভোলার অ্যানাটমিক্যাল কাঠামোকে রক্ষা করে। এফডিএস টেন্ডন স্লিপটি টানেলের মধ্য দিয়ে যায়, যখন পিআইপি জয়েন্টটিকে এক্সটেনশন এবং রিডিউসড অবস্থানে রাখা হয়। এফডিএস টেন্ডন স্লিপটি অক্ষত প্রক্সিমাল অংশের সেন্ট্রাল স্লিপ এবং এক্সটেনসর টেন্ডনের মধ্য দিয়ে যায়। একটি টেন্ডন ওয়েভার একটি পালভারটাফট ওয়েভ তৈরি করে, এবং পিআইপি জয়েন্টকে রিডিউসড, সম্পূর্ণ এক্সটেনশন অবস্থানে রেখে উপযুক্ত টেনশন নিশ্চিত করা হয়। একটি ৩-০ নন-অ্যাবসোরবেবল সেলাই দিয়ে পালভারটাফট ওয়েভটিকে সুরক্ষিত করা হয়। ক্যাপসুলের প্রান্ত এবং সেন্ট্রাল স্লিপ পুনর্গঠনের প্রান্তগুলি পিআইপি জয়েন্টের উপরে একত্রিত করা হয়, এবং আঠালোতা দূর করা হয় এবং ল্যাটারাল ব্যান্ডগুলিকে সরানো হয়।\n\nটেনো deskis-এর মাধ্যমে সামগ্রিক ভঙ্গি, স্থিতিশীলতা এবং গতি মূল্যায়ন করা হয়। সমস্ত ছেদ প্রচুর পরিমাণে সেচ করা হয়। ট্যুরনিক্যাটটি খুলে ফেলা হয় এবং রক্তপাত বন্ধ করা হয়। সমস্ত আঙুলের কৈশিক রিফিল মূল্যায়ন করা হয়। ত্বকটি অনুভূমিক ম্যাট্রেস সেলাই দিয়ে বন্ধ করা হয়। একটি জীবাণুমুক্ত ড্রেসিং প্রয়োগ করা হয় এবং একটি উপযুক্ত প্যাডেড পিআইপি জয়েন্ট এক্সটেনশন স্প্লিন্ট ব্যবহার করা হয়, যা আর্লি ডিআইপি জয়েন্ট এবং এমসিপি জয়েন্টের গতিবিধিতে সহায়তা করে।\n\nফলো-আপ এবং ফলাফল\nপ্রথম ফলো-আপটি ক্ষত চিকিৎসার জন্য ৪ দিন পরে করা হয়েছিল। রোগীকে দিনে দুবার ৭.৫ মিগ্রা মেলোক্সিকাম এবং ৩ দিনের জন্য দিনে দুবার ১০০ মিগ্রা ডক্সিসাইক্লিন দেওয়া হয়েছিল। দ্বিতীয় ফলো-আপটি ক্ষত চিকিৎসার জন্য ৩ দিন পরে করা হয়েছিল। ২ সপ্তাহ পরে, আমরা ব্যাক স্ল্যাব সরিয়ে ফেলি, বাহ্যিক সেলাই অপসারণ করি এবং সক্রিয় এবং প্যাসিভ ROM ব্যায়াম শুরু করি। ৩ সপ্তাহ পরে, ক্ষত সেরে যায় এবং আমরা পিআইপি জয়েন্টের ROM ০ থেকে ৯০ ডিগ্রি পর্যন্ত দেখতে পাই। এবং এক মাস পরে, রোগীর পিআইপি জয়েন্টের উন্নত ROM ০ থেকে ১০০ ডিগ্রি এবং উন্নত কার্যকরী ফলাফল দেখা যায়। ৭ সপ্তাহ ধরে শারীরিক পুনর্বাসনের পর, রোগীরা তাদের কাজে ফিরে যায় এবং পিআইপি জয়েন্টের উন্নত ROM ০ থেকে ১১০ ডিগ্রি পর্যন্ত হয়। রোগীর ডান হাতের কার্যকারিতা DASH স্কোর দিয়ে মূল্যায়ন করা হয়, যা উল্লেখযোগ্যভাবে ৫০ থেকে ৪.২-এ উন্নত হয়েছে।",
+    "translated_summary": "একজন ৬৫ বছর বয়সী পুরুষ রোগী ডান হাতের তৃতীয় আঙুলে ফোলা এবং বাটনিয়ার বিকৃতি নিয়ে এসেছিলেন। এর আগে তিনি মোটরসাইকেল থেকে পড়ে গিয়েছিলেন এবং ছয় মাস আগে মোটরসাইকেলের চাকায় তার ডান হাতের মাঝের আঙুলটি সামান্য ক্ষতিগ্রস্ত হয়েছিল। ঘটনার পর থেকে, রোগী তার ডান হাতের মাঝের আঙুলটি সম্পূর্ণরূপে সোজা করতে পারছেন না। রোগীর ডান হাতে আন্তঃফ্যালাঞ্জিয়াল (পিআইপি) জয়েন্টের ফ্লেক্সনের কারণে ফোলা দেখা যায় এবং দূরবর্তী আন্তঃফ্যালাঞ্জিয়াল (ডিপ) জয়েন্টের অতিরিক্ত প্রসারণ হয়েছে। ডান হাতের মাঝের আঙুলের পিআইপি জয়েন্টের নড়াচড়ার পরিসীমা ছিল ৪৫-১১০ ডিগ্রি। ডান হাতের এপি/তির্যক এক্স-রেতে দেখা যায়, বিকৃতির কারণে হাড়ের কোনো ক্ষতি হয়নি। রোগীর ফ্লেক্সর ডিজিটোরাম সুপারফিসিয়াল টেন্ডনের আংশিক আলনার অংশের সাহায্যে কেন্দ্রীয় স্লিপ ত্রুটি পুনর্গঠন করা হয়। দুই সপ্তাহের জন্য একটি পিআইপি জয়েন্ট এক্সটেনশন স্প্লিন্ট ব্যবহার করা হয়। দুই সপ্তাহ পর পিআইপি এক্সটেনশন জয়েন্ট স্প্লিন্ট ব্যবহারের পর সক্রিয় এবং নিষ্ক্রিয়ভাবে পিআইপি জয়েন্টের নড়াচড়ার ব্যায়াম শুরু করা হয়। অস্ত্রোপচারের এক মাস পর রোগীর পিআইপি জয়েন্টের নড়াচড়ার পরিসীমা (০-৯০ ডিগ্রি) উল্লেখযোগ্যভাবে উন্নত হয়। অস্ত্রোপচারের দুই মাস পর রোগীর পিআইপি জয়েন্টের নড়াচড়ার পরিসীমা স্বাভাবিক অবস্থায় ফিরে আসে। ড্যাশ স্কোর ব্যবহার করে রোগীর ডান হাতের কার্যকারিতা মূল্যায়ন করা হয়, যেখানে ৫০ থেকে ৪.২-এ উল্লেখযোগ্য উন্নতি দেখা যায়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_382.txt",
+    "fulltext": "A 23-year-old male patient presented to the emergency department with a sudden onset of severe frontal headache lasting for 2 h. He experienced associated symptoms of nausea, vomiting, and chest heaviness. He has a unremarkable medical record and denies the use of illicit drugs. However, he is a smoker with a history of 23 pack-years but does not consume alcohol.\n\nOn physical examination, the young male appeared distressed but was fully conscious and oriented to time, place, and person. Chest auscultation revealed normal vesicular breathing sounds, while cardiovascular and abdominal examinations were inconclusive. Neurological examinations demonstrated neck stiffness, dilated pupils reactive to light, normal plantar reflexes, and no focal neurological deficits.\n\nHis vital signs were as follows: blood pressure 178/103 mmHg, respiratory rate 26 breaths/min, temperature 38.9°C, heart rate 87 beats/min, and oxygen saturation of 94%.\n\nEmergency tests were initiated. An ECG revealed ST segment elevation >2 mm in leads V2-V5, consistent with STEMI as the top of our differential diagnosis, requiring confirmation by cardiac markers. With prompt referral to a tertiary cardiac centre implemented, the patient received a 300 mg aspirin load while being transferred to the catheter lab. Troponin levels were significantly elevated at 1.48 mg/dl (normal <0.16 mg/dl).\n\nPercutaneous coronary intervention was performed via the femoral artery, and the result showed normal coronary arteries with thrombolysis in myocardial infarction (TIMI) flow grade of 3.\n\nHis ECG after coronary angiography revealed normal sinus rhythm with left ventricular hypertrophy LVH. An echocardiogram was performed, revealing normal ventricular function with no regional wall motion abnormalities (RWMA).\n\nFollowing coronary intervention, he was admitted to the medical ward for further assessment and investigation. Blood samples were drawn for a complete blood count, random blood sugar, renal function tests, and CRP. The results revealed lymphocytosis and mildly elevated CRP.\n\nWe proceeded further with CT brain to exclude serious cause of headache. His brain CT showed cisternal subarachnoid haemorrhage SAH with extension anterior to the right temporal lobe. Abdominal ultrasound screening was performed to rule out polycystic kidney disease which was negative and cerebral CT angiography was scheduled to exclude cerebral aneurysm Nimodipine 60 mg every 4 h was initiated, with a target blood pressure of 160/100 mmHg.\n\nOn the second day, his condition suddenly deteriorated, culminating with cardiac arrest. Therefore, cardiopulmonary resuscitation (CPR), resulting in a Glasgow Coma Scale score (GCS) of 6. The patient was subsequently, intubated and placed on mechanical ventilation in the Intensive Care Unit (ICU). Due to his unstable condition in the ICU, we could not perform a repeated CT brain scan or the planned cerebral CT angiography.\n\nOver the next 7 days, we diligently monitored him with a strict multidisciplinary team. A nasogastric tube was inserted for feeding and fluid replacement. His medications included intravenous fluids, antibiotics, proton pump inhibitors, and nimodipine.\n\nOn the 8th day, he suddenly developed ventricular fibrillation, and despite CPR with more than five defibrillations, we were unable to revive him and death was the final outcome.39734686",
+    "summary": "We present a case detailing the diagnostic challenges of a 23-year-old male presenting with a sudden severe headache, nausea, vomiting, and chest heaviness. Initial evaluation showed elevated blood pressure and respiratory rate. An emergency electrocardiogram (ECG) indicated ST-segment elevation myocardial infarction (STEMI), leading to immediate referral for percutaneous coronary intervention, which revealed normal coronary arteries. Further investigations identified a cisternal subarachnoid haemorrhage (SAH) on CT brain imaging. Despite multidisciplinary management, the patient's condition rapidly deteriorated, resulting in cardiac arrest and mortality.",
+    "translated_fulltext": "২৩ বছর বয়সী একজন পুরুষ রোগী জরুরি বিভাগে এসে তীব্র মাথাব্যথার কথা জানান, যা হঠাৎ করে শুরু হয়েছিল এবং প্রায় ২ ঘণ্টা ধরে ছিল। এর সাথে বমি বমি ভাব, বমি এবং বুকে ভারী লাগার মতো উপসর্গ দেখা যায়। তার তেমন কোনো উল্লেখযোগ্য স্বাস্থ্যগত ইতিহাস নেই এবং তিনি অবৈধ মাদক দ্রব্য সেবন করেন না। তবে, তিনি ধূমপান করেন এবং তার ধূমপানের ইতিহাস ২৩ বছর, কিন্তু তিনি অ্যালকোহল সেবন করেন না।\n\nশারীরিক পরীক্ষায় দেখা যায়, যুবকটি কিছুটা অস্থির, তবে সম্পূর্ণরূপে সচেতন এবং সময়, স্থান ও ব্যক্তি সম্পর্কে অবগত। ফুসফুসের শব্দ স্বাভাবিক ছিল, তবে হৃদরোগ এবং পেটের পরীক্ষায় কোনো বিশেষত্ব পাওয়া যায়নি। স্নায়বিক পরীক্ষায় দেখা যায়, তার ঘাড় শক্ত, আলোতে তার চোখের মণি প্রসারিত, স্বাভাবিক প্ল্যান্টার রিফ্লেক্স এবং কোনো নির্দিষ্ট স্নায়বিক দুর্বলতা নেই।\n\nতার গুরুত্বপূর্ণ লক্ষণগুলো হলো: রক্তচাপ ১৭৮/১০৩ মিমি Hg, শ্বাস-প্রশ্বাস প্রতি মিনিটে ২৬ বার, তাপমাত্রা ৩৮.৯ ডিগ্রি সেলসিয়াস, হৃদস্পন্দন প্রতি মিনিটে ৮৭ বার এবং অক্সিজেনের মাত্রা ৯৪%।\n\nজরুরি ভিত্তিতে কিছু পরীক্ষা শুরু করা হয়। ইসিজি-তে দেখা যায় V2-V5 লিডে ST সেগমেন্ট ২ মিমি-এর বেশি উঁচু হয়েছে, যা STEMI-এর সাথে সামঞ্জস্যপূর্ণ। এটি আমাদের প্রাথমিক রোগ নির্ণয়ের মধ্যে অন্যতম। হৃদরোগের মার্কার দিয়ে এটি নিশ্চিত করার প্রয়োজন ছিল। দ্রুত একটি বিশেষায়িত হৃদরোগ কেন্দ্রে রেফার করার ব্যবস্থা করা হয় এবং ক্যাথেটার ল্যাবে স্থানান্তরের সময় রোগীকে ৩০০ মিগ্রা অ্যাসপিরিন দেওয়া হয়। ট্রোপোনিনের মাত্রা উল্লেখযোগ্যভাবে বৃদ্ধি পেয়ে ১.৪৮ মিগ্রা/ডিসিএল (স্বাভাবিক <০.১৬ মিগ্রা/ডিসিএল) হয়।\n\nফেমোরাল ধমনীর মাধ্যমে পারকিউটেনিয়াস করোনারি ইন্টারভেনশন করা হয় এবং পরীক্ষায় দেখা যায় করোনারি ধমনী স্বাভাবিক আছে এবং মায়োকার্ডিয়াল ইনফার্কশনে থ্রম্বোলাইসিস (TIMI) ফ্লো গ্রেড ৩।\n\nকরোনারি অ্যাঞ্জিওগ্রাফির পরে তার ইসিজি-তে দেখা যায় স্বাভাবিক সাইনাস রিদম এবং বাম নিলয়ের হাইপারট্রফি (LVH)। একটি ইকোকার্ডিওগ্রাম করা হয়, যেখানে দেখা যায় নিলয়ের কার্যকারিতা স্বাভাবিক এবং কোনো আঞ্চলিক প্রাচীর গতির অস্বাভাবিকতা (RWMA) নেই।\n\nকরোনারি ইন্টারভেনশনের পরে, তাকে আরও পরীক্ষা এবং মূল্যায়নের জন্য মেডিকেল ওয়ার্ডে ভর্তি করা হয়। সম্পূর্ণ রক্ত গণনা, রক্তের গ্লুকোজ, কিডনির কার্যকারিতা পরীক্ষা এবং সিআরপি-এর জন্য রক্তের নমুনা নেওয়া হয়। ফলাফলে লিম্ফোসাইটোসিস এবং সামান্য পরিমাণে সিআরপি বৃদ্ধি পায়।\n\nমাথাব্যথার গুরুতর কারণগুলি বাদ দেওয়ার জন্য আমরা মস্তিষ্কের সিটি স্ক্যান করি। তার মস্তিষ্কের সিটি স্ক্যানে দেখা যায়, সিসটার্নাল সাবঅ্যারাকনয়েড হেমোরেজ (SAH), যা ডান টেম্পোরাল লোবের দিকে বিস্তৃত। পলিসিস্টিক কিডনি রোগ (polycystic kidney disease) বাদ দেওয়ার জন্য পেটের আল্ট্রাসাউন্ড করা হয়, কিন্তু সেটি নেগেটিভ আসে। মস্তিষ্কের অ্যানিউরিজম (cerebral aneurysm) বাদ দেওয়ার জন্য সেরিব্রাল সিটি অ্যাঞ্জিওগ্রাফি করার পরিকল্পনা করা হয়। প্রতি ৪ ঘণ্টা পর ৬০ মিগ্রা নিমোডিপিন দেওয়া শুরু করা হয়, যার লক্ষ্য রক্তচাপ ১৬০/১০০ মিমি Hg রাখা।\n\nদ্বিতীয় দিনে, তার অবস্থা হঠাৎ খারাপ হতে শুরু করে এবং শেষ পর্যন্ত হৃদরোগে আক্রান্ত হন। তাই কার্ডিওপালমোনারি রিসাসিটেশন (CPR) করা হয়, যার ফলে গ্লাসগো কোমা স্কেলে (GCS) ৬ স্কোর পাওয়া যায়। এরপর রোগীকে ভেন্টিলেটরে রাখা হয় এবং ইনটেনসিভ কেয়ার ইউনিটে (ICU) স্থানান্তর করা হয়। আইসিইউতে তার অবস্থা স্থিতিশীল না থাকায়, আমরা মস্তিষ্কের সিটি স্ক্যান বা পরিকল্পিত সেরিব্রাল সিটি অ্যাঞ্জিওগ্রাফি করতে পারিনি।\n\nপরের ৭ দিন, আমরা একটি কঠোর মাল্টিডিসিপ্লিনারি দলের মাধ্যমে তার অবস্থা পর্যবেক্ষণ করি। খাদ্য এবং তরল গ্রহণের জন্য একটি নাসোগ্যাস্ট্রিক টিউব স্থাপন করা হয়। তার ওষুধগুলির মধ্যে ছিল ইন্ট্রাভেনাস তরল, অ্যান্টিবায়োটিক, প্রোটন পাম্প ইনহিবিটর এবং নিমোডিপিন।\n\n৮তম দিনে, তিনি হঠাৎ ভেন্ট্রিকুলার ফাইব্রিলেশনে আক্রান্ত হন এবং পাঁচটিরও বেশি ডিফাইব্রিলেশন করার পরেও, আমরা তাকে বাঁচাতে ব্যর্থ হই এবং শেষ পর্যন্ত তার মৃত্যু হয়।",
+    "translated_summary": "আমরা একটি ঘটনা উপস্থাপন করছি যেখানে ২৩ বছর বয়সী একজন পুরুষ হঠাৎ করে তীব্র মাথাব্যথা, বমি বমি ভাব, বমি এবং বুকে ভারী অনুভব নিয়ে আসেন। প্রাথমিক মূল্যায়নে উচ্চ রক্তচাপ এবং শ্বাস-প্রশ্বাসের হার বেশি দেখা যায়। জরুরি ভিত্তিতে করা একটি ইলেক্ট্রোকার্ডিওগ্রাম (ইসিজি)-এ এসটি-সেগমেন্ট এলিভেশন মায়োকার্ডিয়াল ইনফার্কশন (এসটিইএমআই) দেখা যায়, যার ফলে দ্রুত পারকিউটেনিয়াস করোনারি ইন্টারভেনশনের জন্য রেফার করা হয়, যেখানে করোনারি ধমনী স্বাভাবিক ছিল। আরও অনুসন্ধানে সিটি স্ক্যানে মস্তিষ্কে সিসটার্নাল সাবঅ্যারাকনয়েড হেমোরেজ (এসএএইচ) শনাক্ত করা হয়। বহু-বিষয়ক চিকিৎসার পরেও রোগীর অবস্থা দ্রুত খারাপ হতে থাকে, যার ফলে হৃদরোগে আক্রান্ত হয়ে তিনি মারা যান।"
+  },
+  {
+    "id": "multiclinsum_gs_en_58.txt",
+    "fulltext": "Patient A.P., female, born in 1979, has been diagnosed with dilatation cardiomyopathy in 1996. Anamnestically, disease started with tonsillitis, possible myocarditis (which was never proven), with pronounced symptoms of heart failure and general symptoms. She was hospitalized and after one month, the left ventricular ejection fraction was 10% with the aforementioned signs of congestive heart failure. She was hospitalized for 10 months and 9 days, with standard therapy for vitally endangered patient, oxygen support, numerous adjuvant therapy, and intensive monitoring. Therapy was administered (ACE inhibitor - ramipril, cardiotonic - digoxin, beta-blockers - metoprolol and combination of diuretics - furosemide and spironolactone), with the indication of heart transplantation. Clinical improvement occured with an ejection fraction that was gradually increasing and at the age of 21 she entered in remission or stabilization phase, with the ejection fraction value of 48-57% (regular echocardiography was performed every three months). For the following four years therapy remained the same, but in Jun 2004 (after an episode of low immunity), ejection fraction fell to 25%, with a clinical deterioration of the disease. The patient was hospitalized for a period of two months, and the condition stabilized, and she was discharged with therapy that was the same but without cardiotonic. Ejection fraction was stabilized, and in year 2006 it was 50%. At the age of 27, the patient decided on the first pregnancy that was successful with beta blocker (metoprolol) in therapy. After the first pregnancy, the ejection fraction was 40% and she was treated with the same therapy with eplerenone (25 mg) instead of spironolactone. The ejection fraction was controlled and did not fall below 45%. At the end of 2015 the patient became pregnant for the second time, and the pregnancy went neatly until eighth month (35 weeks), when she was urgently admitted to hospital, due to sense of suffocation and inability to walk. Ejection fraction decreased to 18% (brain natriuretic peptide (BNP) was 2600 pg/ mL (reference values are 100-400 pg/ mL)). During pregnancy she received only metoprolol in therapy. Physicians decide to continue with her pregnancy, in the 39th week they performed c-section, and the condition stabilized again after twenty days. In October 2016 new mode of therapy was administered, ramipril (2.5 mg, in the morning), metoprolol (47.5 mg, in the morning), spironolactone (50 mg, once a day) and ivabradine (5 mg, twice a day) with torasemide (5 mg, once a day). LifeVest Defibrillator was carried from 06 December 2016 until 27 February 2017 when it was removed. When removed and after examination (ejection fraction was 44%) she continued with ramipril therapy (1.25 mg) metoprolol (23.75 mg), torasemide (5 mg), spironolactone (25 mg) and ivabradine (7.5 mg, twice a day) with potassium supplements, and compliance with non-pharmacological measures (fluid intake restricted to 1.5 L/ day). The echocardiographic finding in March 2017 showed left ventricular dilatation with moderately reduced left ventricular function and left ventricular wall hypokinesia with ejection fraction of 44% (insignificant pericardial effusion was present, inferior vena cava with physiological flow, preserved valves function - Dopler sonography showed slight insufficiency of mitral valve with dilatation of anulus). Evaluation of a patient with ejection fraction 44% showed no indication for an implantable cardioverter defibrillator (ICD), and conservative procedure and medication therapy were recommended. Regular check-ups and body mass reduction, regular control of renal function parameters and electrolytes were recommended. She is led under the diagnosis of dilated cardiomyopathy and heart failure NYHA stage II without any indication for the ICD prophylactic implantation.",
+    "summary": "Patient A.P., female, 38 years old, had symptoms of dilated cardiomyopathy (with possible infectious myocarditis in the background) at age 17. After hospitalization for ten months and ten days, while waiting for heart transplantation (with threatening death outcome), without a clearly pronounced threatening arrhythmia, but with a low ejection fraction and a poor general condition, remission occurred. The therapy focused primarily on the treatment of heart failure, prevention of arrhythmia and thromboembolism. Normalization of the disease by improving the function of the left ventricle (expected in 16% of patients) occurred and lasted for 4 years, followed by an exacerbation of the disease that lasted for two years. In the next few years the patient was stable, had a first child with normal pregnancy. During the second trimester of the second pregnancy, there was an exacerbation (postpartum dilatation cardiomyopathy) lasting for couple of months. At the time of case report (May 2017), the patient is stable on therapy (ACE inhibitor, beta blocker, diuretics, If channel blocker), without limitation of physical capacity, mother of two children, unemployed.",
+    "translated_fulltext": "রোগী এ.পি., একজন মহিলা, যিনি ১৯৭৯ সালে জন্মগ্রহণ করেন, ১৯৯৬ সালে তার ডাইলেটেড কার্ডিওমায়োপ্যাথি ধরা পড়ে। রোগের শুরুতে টনসিলাইটিস এবং সম্ভবত মায়োকার্ডাইটিস (যা নিশ্চিত করা যায়নি) দেখা যায়, এরপর হৃদরোগের লক্ষণ এবং সাধারণ দুর্বলতা প্রকাশ পায়। তাকে হাসপাতালে ভর্তি করা হয় এবং এক মাস পর দেখা যায়, তার বাম নিলয়ের ইজেকশন ফ্র্যাকশন ১০%-এ নেমে এসেছে, যা কনজেস্টিভ হার্ট ফেইলিউরের লক্ষণ দেখাচ্ছে। তাকে ১০ মাস ৯ দিন হাসপাতালে রাখা হয় এবং জীবন রক্ষাকারী চিকিৎসা, অক্সিজেন সহায়তা, বিভিন্ন সহায়ক চিকিৎসা এবং নিবিড় পর্যবেক্ষণে রাখা হয়। তাকে এসিই ইনহিবিটর (র‍্যামিপ্রিল), কার্ডিওটোনিক (ডিগক্সিন), বিটা-ব্লকার (মেটপ্রোলল) এবং ডায়ুরেটিক্সের (ফিউরোসেমাইড ও স্পিরোনোল্যাকটোন) সমন্বিত ওষুধ দেওয়া হয়, এবং হৃদরোগের জন্য ট্রান্সপ্লান্টেশনের পরামর্শ দেওয়া হয়। ধীরে ধীরে তার অবস্থার উন্নতি হতে থাকে এবং ইজেকশন ফ্র্যাকশন বাড়তে থাকে। ২১ বছর বয়সে তিনি স্থিতিশীল অবস্থায় পৌঁছান, তখন ইজেকশন ফ্র্যাকশনের মান ছিল ৪৮-৫৭% (প্রতি তিন মাস অন্তর নিয়মিত ইকোকার্ডিওগ্রাফি করা হতো)। পরবর্তী চার বছর একই চিকিৎসা চলতে থাকে। কিন্তু ২০০৪ সালের জুনে (রোগ প্রতিরোধ ক্ষমতা কমে যাওয়ার পর) ইজেকশন ফ্র্যাকশন ২৫%-এ নেমে আসে এবং রোগের অবনতি ঘটে। তাকে দুই মাস হাসপাতালে রাখা হয়, এরপর তার অবস্থা স্থিতিশীল হয় এবং একই ওষুধ দেওয়া হলেও কার্ডিওটোনিক ওষুধটি বাদ দেওয়া হয়। ইজেকশন ফ্র্যাকশন স্থিতিশীল থাকে এবং ২০০৬ সালে এটি ৫০%-এ পৌঁছায়। ২৭ বছর বয়সে তিনি প্রথমবার গর্ভধারণ করেন এবং বিটা-ব্লকার (মেটপ্রোলল) ব্যবহারের মাধ্যমে সেটি সফল হয়। প্রথম গর্ভধারণের পর ইজেকশন ফ্র্যাকশন ৪০%-এ নেমে আসে এবং স্পিরোনোল্যাকটোনের পরিবর্তে এপ্লেরেনোন (২৫ মিগ্রা) দিয়ে একই চিকিৎসা চলতে থাকে। ইজেকশন ফ্র্যাকশন নিয়ন্ত্রণে থাকে এবং ৪৫%-এর নিচে নামে না। ২০০৫ সালের শেষে তিনি দ্বিতীয়বার গর্ভধারণ করেন এবং গর্ভাবস্থা অষ্টম মাস (৩৫ সপ্তাহ) পর্যন্ত স্বাভাবিকভাবে চলে। এরপর শ্বাসকষ্ট ও হাঁটার অক্ষমতার কারণে তাকে জরুরি ভিত্তিতে হাসপাতালে ভর্তি করা হয়। তখন ইজেকশন ফ্র্যাকশন ১৮%-এ নেমে আসে (ব্রেইন ন্যাট্রিয়ুরেটিক পেপটাইড (বিএনপি) ছিল ২৬০০ পিজি/এমএল, যেখানে স্বাভাবিক মান ১০০-৪০০ পিজি/এমএল)। গর্ভাবস্থায় তাকে শুধুমাত্র মেটপ্রোলল দেওয়া হয়। চিকিৎসকরা তার গর্ভাবস্থা চালিয়ে যাওয়ার সিদ্ধান্ত নেন এবং ৩৯ সপ্তাহে সিজারিয়ান করা হয়। এরপর ২০ দিন পর তার অবস্থা আবার স্থিতিশীল হয়। ২০০৬ সালের অক্টোবরে নতুন চিকিৎসা শুরু হয়, যেখানে র‍্যামিপ্রিল (২.৫ মিগ্রা, সকালে), মেটপ্রোলল (৪৭.৫ মিগ্রা, সকালে), স্পিরোনোল্যাকটোন (৫০ মিগ্রা, দিনে একবার) এবং ইভা Brad্রেডিন (৫ মিগ্রা, দিনে দুবার) এবং টোরাসেমাইড (৫ মিগ্রা, দিনে একবার) দেওয়া হয়। ২০০৬ সালের ৬ ডিসেম্বর থেকে ২০১৭ সালের ২৭ ফেব্রুয়ারি পর্যন্ত লাইফভেস্ট ডিফিব্রিলেটর ব্যবহার করা হয়, এরপর সেটি সরিয়ে নেওয়া হয়। ডিফিব্রিলেটর সরানোর পর এবং পরীক্ষার মাধ্যমে (ইজেকশন ফ্র্যাকশন ৪৪%) জানা যায়, তাকে র‍্যামিপ্রিল (১.২৫ মিগ্রা), মেটপ্রোলল (২৩.৭৫ মিগ্রা), টোরাসেমাইড (৫ মিগ্রা), স্পিরোনোল্যাকটোন (২৫ মিগ্রা) এবং ইভা Brad্রেডিন (৭.৫ মিগ্রা, দিনে দুবার) এর সাথে পটাশিয়াম সাপ্লিমেন্ট দেওয়া হয় এবং অন্যান্য ওষুধ ও জীবনযাত্রার পরিবর্তন (যেমন, দৈনিক তরল গ্রহণ ১.৫ লিটারে সীমিত রাখা) মেনে চলতে বলা হয়। ২০১৭ সালের মার্চ মাসে ইকোকার্ডিওগ্রাফিতে দেখা যায়, বাম নিলয়ের আকার বৃদ্ধি পেয়েছে এবং বাম নিলয়ের কার্যকারিতা মাঝারিভাবে হ্রাস পেয়েছে, সেই সাথে বাম নিলয়ের দেওয়ালের হাইপোকাইনেসিয়া রয়েছে এবং ইজেকশন ফ্র্যাকশন ৪৪%। সামান্য পেরিকার্ডিয়াল ইফিউশন, স্বাভাবিক রক্তপ্রবাহ সহ ইনফেরিয়র ভেনা কাভা এবং ভালভের স্বাভাবিক কার্যকারিতা (ডপলার সোনোগ্রাফিতে দেখা যায়, মাইট্রাল ভালভে সামান্য দুর্বলতা রয়েছে এবং অ্যানুলাসের আকার বৃদ্ধি পেয়েছে)। ইজেকশন ফ্র্যাকশন ৪৪% হওয়ায়, রোগীর জন্য ইমপ্লান্টেবল কার্ডিওভার্টার ডিফিব্রিলেটর (আইসিডি) ব্যবহারের কোনো প্রয়োজন নেই বলে মনে করা হয় এবং রক্ষণশীল চিকিৎসা ও ওষুধ ব্যবহারের পরামর্শ দেওয়া হয়। নিয়মিত স্বাস্থ্য পরীক্ষা, ওজন কমানো, কিডনির কার্যকারিতা এবং ইলেক্ট্রোলাইটের মাত্রা নিয়মিত পর্যবেক্ষণ করার পরামর্শ দেওয়া হয়। তাকে ডাইলেটেড কার্ডিওমায়োপ্যাথি এবং হার্ট ফেইলিউর NYHA স্টেজ II রোগ হিসেবে বিবেচনা করা হয় এবং আইসিডি প্রোফাইল্যাকটিক ইমপ্লান্টেশনের কোনো প্রয়োজন নেই।",
+    "translated_summary": "রোগী এ.পি., একজন মহিলা, বয়স ৩৮ বছর, যখন তার বয়স ১৭ বছর ছিল, তখন তার ডাইলেটেড কার্ডিওমায়োপ্যাথির লক্ষণ দেখা যায় (সম্ভবত এর সাথে সংক্রমণজনিত মায়োকার্ডাইটিসও ছিল)। দশ মাস এবং দশ দিন হাসপাতালে থাকার পর, হৃদপিণ্ড প্রতিস্থাপনের জন্য অপেক্ষা করার সময় (যেখানে মৃত্যুর ঝুঁকি ছিল), কোনো স্পষ্ট এবং গুরুতর অ্যারিথমিয়া না থাকলেও, নিম্ন ইজেকশন ফ্র্যাকশন এবং দুর্বল শারীরিক অবস্থার কারণে তার অবস্থার উন্নতি হয়। চিকিৎসায় মূলত হৃদরোগের চিকিৎসা, অ্যারিথমিয়া এবং থ্রম্বোইম্বোলিজম প্রতিরোধ করার ওপর জোর দেওয়া হয়েছিল। বাম নিলয়ের কার্যকারিতা উন্নত করার মাধ্যমে রোগের স্বাভাবিকীকরণ ঘটে (যা রোগীদের ১৬% ক্ষেত্রে প্রত্যাশিত), এবং এটি ৪ বছর ধরে স্থায়ী হয়। এরপর রোগের তীব্রতা বৃদ্ধি পায় এবং এটি দুই বছর ধরে চলে। পরবর্তী কয়েক বছরে রোগীর অবস্থা স্থিতিশীল ছিল এবং তিনি স্বাভাবিক গর্ভাবস্থায় একটি সন্তানের জন্ম দেন। দ্বিতীয় গর্ভাবস্থার দ্বিতীয় ত্রৈমাসিকে, তার অবস্থার অবনতি হয় (প্রসব-পরবর্তী ডাইলেটেড কার্ডিওমায়োপ্যাথি), যা কয়েক মাস ধরে চলে। এই প্রতিবেদন লেখার সময় (মে ২০১৭), রোগী চিকিৎসায় স্থিতিশীল (এসিই ইনহিবিটর, বিটা ব্লকার, ডায়ুরেটিক্স, ইফ চ্যানেল ব্লকার গ্রহণ করছেন), তার শারীরিক ক্ষমতা সীমিত নয়, এবং তিনি দুই সন্তানের মা, বর্তমানে কর্মহীন।"
+  },
+  {
+    "id": "multiclinsum_gs_en_81.txt",
+    "fulltext": "27-year-old male patient with a history of fibrous dysplasia in the right proximal femur, which was managed prophylactically to reduce the risk of fracture 20 years ago by curettage (intralesional resection), application of bone graft and fixation with osteosynthesis material, which was removed one year after the fixation. Two weeks before admission to hospital, the patient experienced pain after a fall with low energy mechanism characterised by axial load and rotational component of the right hip, which resulted in pain intensity 8/10 on the visual analogue scale (VAS) at the level of the inguinal fold and right thigh, which incapacitated him for walking. Radiological control was performed at four weeks, observing all prosthetic components adequately. The patient was discharged clinically and haemodynamically stable, without the need for transfusion of blood products. During his follow-up in the postoperative period (612 weeks), the patient continued with partial support until day 20, in which he began with full support even accompanied by a walker. Radiological control was performed at four weeks, observing all prosthetic components adequately. The patient is currently carrying out daily activities with slight limitation due to claudicatio intermittens caused by the incision in the middle gluteus. However, he was able to participate in low-impact sports activities, such as walking and expressed great satisfaction with the functional outcome of the procedure.\n",
+    "summary": "We present the case of a 27-year-old male patient who presented to the emergency department with a fracture of the right femur at the base of the neck in pathological ground Garden II Pauwells III AO 31B2.3r, after a low energy mechanism of injury characterized by axial load with rotational component of the right hip. The patient had a history of intralesional resection, application of bone graft and prophylactic fixation with unspecified osteosynthesis material in the pertrochanteric region 20 years ago; the biopsy later showed DF; one year later, the osteosynthesis material was removed. Due to the characteristics of the fracture and as a definitive and curative therapeutic method, it was decided to carry out a wide resection of the proximal femur and total arthroplasty of the hip with a modular prosthesis with placement of cerclage, as well as a excisional biopsy that later corroborated that it was the same DF treated in childhood.\n",
+    "translated_fulltext": "২৭ বছর বয়সী একজন পুরুষ রোগী, যার পূর্বে ডান দিকের প্রক্সিমাল ফিমারে ফাইব্রাস ডিসপ্লাসিয়ার ইতিহাস ছিল। ২০ বছর আগে কিউরেটেজ (ইন্ট্রালেশনাল রিসেকশন), হাড়ের গ্রাফ্ট প্রয়োগ এবং অস্টিওসিন্থেসিস উপাদান দিয়ে ফিক্সেশন করে প্রোফাইলেক্টিকভাবে ফ্র্যাকচারের ঝুঁকি কমানো হয়েছিল, যা ফিক্সেশনের এক বছর পর অপসারণ করা হয়। হাসপাতালে ভর্তির দুই সপ্তাহ আগে, রোগী সামান্য শক্তি প্রয়োগের কারণে পড়ে গিয়েছিলেন, যার ফলে ডান নিতম্বে অ্যাক্সিয়াল লোড এবং রোটেশনাল উপাদান যুক্ত ব্যথা হয়। এর ফলে ভিজ্যুয়াল অ্যানালগ স্কেলে (ভিএএস) ব্যথার তীব্রতা ৮/১০-এ পৌঁছায়, যা কুঁচকির ভাঁজ এবং ডান উরুতে অনুভূত হয়েছিল এবং এর কারণে তিনি হাঁটতে অক্ষম হয়ে পড়েন। চার সপ্তাহ পর রেডিওলজিক্যাল পরীক্ষা করা হয়, যেখানে দেখা যায় প্রোস্থেটিক উপাদানগুলো যথাযথভাবে কাজ করছে। রোগী ক্লিনিক্যালি এবং হেমোডাইনামিকভাবে স্থিতিশীল অবস্থায় ছিলেন এবং রক্ত সঞ্চালনের প্রয়োজন হয়নি। পোস্টঅপারেটিভ সময়ে (৬১২ সপ্তাহ) ফলোআপের সময়, রোগী ২০ দিন পর্যন্ত আংশিক সহায়তার ওপর নির্ভর করেন, এরপর তিনি সম্পূর্ণভাবে হাঁটাচলা করতে শুরু করেন এবং একটি ওয়াকার ব্যবহার করেন। চার সপ্তাহ পর রেডিওলজিক্যাল পরীক্ষা করা হয়, যেখানে দেখা যায় প্রোস্থেটিক উপাদানগুলো যথাযথভাবে কাজ করছে। বর্তমানে রোগী সামান্য সীমাবদ্ধতা নিয়ে দৈনন্দিন কাজকর্ম করছেন, কারণ মিডল গ্লুটিয়াসের ইনসিশনের কারণে মাঝে মাঝে তার পায়ে ব্যথা হয়। তবে, তিনি কম প্রভাব যুক্ত খেলাধুলায় অংশ নিতে সক্ষম এবং পদ্ধতির কার্যকারিতা নিয়ে তিনি অত্যন্ত সন্তুষ্ট।",
+    "translated_summary": "আমরা একজন ২৭ বছর বয়সী পুরুষ রোগীর ঘটনা উপস্থাপন করছি, যিনি ডান দিকের ফিমারের ঘাড়ের নিচের অংশে প্যাথলজিক্যাল গ্রাউন্ড গার্ডেন II পাওয়েলস III এও 31B2.3r-এর মতো ফ্র্যাকচার নিয়ে জরুরি বিভাগে এসেছিলেন। এই ফ্র্যাকচারটি কম শক্তির কারণে হয়েছিল, যেখানে ডান নিতম্বের অক্ষীয় লোড এবং ঘূর্ণনশীল উপাদান ছিল। রোগীর পূর্বে ইন্ট্রালেশনাল রিসেকশন, হাড়ের গ্রাফ্ট স্থাপন এবং পেরিট্রোক্যান্টেরিক অঞ্চলে ২০ বছর আগে অনির্দিষ্ট অস্টিওসিন্থেসিস উপাদান দিয়ে প্রোফাইল্যাকটিক ফিক্সেশন করা হয়েছিল; পরবর্তীকালে বায়োপসিতে ডিএফ (DF) ধরা পড়ে। এক বছর পর, অস্টিওসিন্থেসিস উপাদানটি অপসারণ করা হয়। ফ্র্যাকচারের বৈশিষ্ট্য এবং একটি নিশ্চিত ও নিরাময়মূলক থেরাপিউটিক পদ্ধতি হিসেবে, প্রক্সিমাল ফিমারের একটি বিস্তৃত রিসেকশন এবং মডুলার প্রোস্থেসিসের সাথে সারক্লেজ স্থাপন করে নিতম্বের সম্পূর্ণ আর্থ্রোপ্লাস্টি করার সিদ্ধান্ত নেওয়া হয়। সেই সাথে একটি এক্সিসনাল বায়োপসি করা হয়, যা পরে নিশ্চিত করে যে এটি শৈশবে চিকিৎসা করা একই ডিএফ (DF)।"
+  },
+  {
+    "id": "multiclinsum_gs_en_280.txt",
+    "fulltext": "A 4-year-old boy with stage IV neuroblastoma received four cycles of chemotherapy, including high-dose chemotherapy including busulfan and melphalan, followed by autologous peripheral blood stem cell transplantation with autologous bone marrow supplementation. After eight additional cycles of chemotherapy consisting of temozolomide and irinotecan, which led to stable disease, the patient underwent preparative conditioning with fludarabine (150 mg/m2), melphalan (140 mg/m2), and 12 Gy of TBI for subsequent allogeneic CBT. The patient received tacrolimus and a short-term course of methotrexate for GVHD prophylaxis. The patient underwent engraftment on day 17. He then developed grade 3 GVHD, which was managed by increasing the prednisolone dose and was later discharged on day 85. The patient also received proton beam therapy (39.6 Gy) from days 121 to 150 post-transplantation for a right supra-mediastinum tumor with residual I123-MIBG accumulation in the right adrenal gland.\n\nThe patient remained healthy with no evidence of GVHD until presentation at our hospital with a productive cough on day 159. As his older brother displayed similar cold symptoms, a rapid antigen test for RSV was performed, which revealed a positive result. His respiratory symptoms gradually worsened, and he revisited our hospital on day 194 with dyspnea and intercostal retractions. Upon admission, he was given 0.7-1.0 mg/kg of prednisolone, which failed to improve his respiratory condition. Chest computed tomography on day 231 revealed infiltration, ground-glass opacity, and septal thickening in the bilateral lung fields along with right pleural effusion. Echocardiography showed an elevated tricuspid regurgitation peak velocity of 4.1 m/s and an interventricular septum close to the isobaric, indicating the presence of PH. In addition, pericardial effusion was detected. On day 231, the patient was transferred to the pediatric intensive care unit, where mechanical ventilation and inhaled nitric oxide (NO) were initiated. Thoracoscopic lung biopsy on day 244 revealed diffuse intra-alveolar hemorrhage and edema on hematoxylin-eosin (HE)-stained samples. Elastica van Gieson staining revealed diffuse obstructive lesions due to fibrocellular components with plump endothelial cells in the pre-septal pulmonary veins and venules. While pulmonary muscular arteries and arterioles showed mild medial hypertrophy and focal intimal thickening (Heath-Edwards Grade 2), severe stenosis with concentric intimal fibrosis or plexiform lesions was present. Based on these results, the patient was diagnosed with PVOD with mild pulmonary arterial/arteriolar lesions. Of note, HE staining also revealed enlarged type II pneumocytes with multinucleated and giant cell-like features, indicating the presence of prior lung injury that was likely attributable to his preceding viral infection.",
+    "summary": "A 4-year-old boy was diagnosed with metastatic neuroblastoma and underwent intensive chemotherapy, autologous HSCT, and allogeneic cord blood transplantation (CBT). He experienced PVOD on day 194 following CBT after displaying upper respiratory symptoms and positive RSV antigen test results approximately one month prior. Pathological examination of a lung biopsy specimen revealed lung injury suspected to be associated with viral infection in addition to PVOD-related findings, suggesting that RSV infection might have contributed to the onset of PVOD.",
+    "translated_fulltext": "চার বছর বয়সী একজন শিশু, যার নিউরোব্লাস্টোমার চতুর্থ পর্যায়ে ছিল, তাকে চারটি চক্রের কেমোথেরাপি দেওয়া হয়েছিল, যার মধ্যে বুসালফান এবং মেলফালানসহ উচ্চ ডোজের কেমোথেরাপি অন্তর্ভুক্ত ছিল। এরপর তাকে অটোলোগাস পেরিফেরাল ব্লাড স্টেম সেল ট্রান্সপ্লান্টেশন এবং অটোলোগাস বোন ম্যারো সাপ্লিমেন্টেশন করা হয়। এরপর টেমোজোলোমাইড এবং ইরিনোটেকান সমন্বিত আরও আটটি চক্রের কেমোথেরাপি দেওয়া হয়, যার ফলে রোগের স্থিতিশীলতা আসে। এরপর রোগীকে ফ্লুডারাবিন (১৫০ মিগ্রা/মি২), মেলফালান (১৪০ মিগ্রা/মি২) এবং ১২ গাই টিবিআই দিয়ে প্রিপারেটিভ কন্ডিশনিং করা হয়, যা পরবর্তী অ্যালোজেনিক সিবিটি-এর জন্য করা হয়েছিল। জিভিএইচডি প্রতিরোধের জন্য রোগীকে ট্যাক্রোলিমাস এবং স্বল্পমেয়াদী মেথোট্রেক্সেট দেওয়া হয়েছিল। ১৭তম দিনে রোগীর গ্রাফটিং সম্পন্ন হয়। এরপর তার গ্রেড ৩ জিভিএইচডি দেখা দেয়, যার জন্য প্রেডনিসোলোনের ডোজ বাড়ানো হয় এবং পরে ৮৫তম দিনে তাকে হাসপাতাল থেকে ছেড়ে দেওয়া হয়। রোগীকে প্রোটন বিম থেরাপি (৩৯.৬ গাই) দেওয়া হয়েছিল, যা ট্রান্সপ্লান্টেশনের ১২১ থেকে ১৫০ দিন পর দেওয়া হয়েছিল। এটি ডান দিকের সুপ্রামিডিয়াস্টিনাম টিউমারের জন্য দেওয়া হয়েছিল, যেখানে ডান অ্যাড্রিনাল গ্রন্থিতে অবশিষ্ট আই-১২৩-এমআইবিজি জমা ছিল।\n\nহাসপাতালে আসার আগে পর্যন্ত, ১৫৯তম দিন পর্যন্ত রোগীর স্বাস্থ্যের উন্নতি ছিল এবং জিভিএইচডি-এর কোনো লক্ষণ ছিল না। এরপর যখন তার কাশি দেখা দেয়, তখন তার বড় ভাইয়েরও একই ধরনের ঠান্ডা লাগার লক্ষণ দেখা যাওয়ায়, আরএসভি-এর জন্য দ্রুত অ্যান্টিজেন পরীক্ষা করা হয়, যেখানে পজিটিভ ফলাফল পাওয়া যায়। ধীরে ধীরে তার শ্বাসকষ্ট বাড়তে থাকে এবং ১৯৪তম দিনে সে আবার হাসপাতালে আসে, যেখানে তার শ্বাসকষ্ট এবং ইন্টারকস্টাল রিট্রাকশন দেখা যায়। হাসপাতালে ভর্তির পর, তাকে ০.৭-১.০ মিগ্রা/কেজি প্রেডনিসোলোন দেওয়া হয়, কিন্তু তাতে তার শ্বাসকষ্টের উন্নতি হয়নি। ২৩১তম দিনে বুকের সিটি স্ক্যানে দেখা যায় যে উভয় ফুসফুসের অঞ্চলে ইনফিলট্রেশন, গ্রাউন্ড-গ্লাস অপাসিটি এবং সেপ্টাল থিকেনিং হয়েছে, সেইসাথে ডান প্লুরাল ইফিউশনও দেখা যায়। ইকোকার্ডিওগ্রাফিতে ট্রিকাসপিড রিগারজিটেশন পিক ভেলোসিটি ৪.১ মি/সে এবং ইন্টারভেন্ট্রিকুলার সেপটাম আইসোবারিক অবস্থার কাছাকাছি দেখা যায়, যা পিএইচ-এর উপস্থিতি নির্দেশ করে। এছাড়াও, পেরিকার্ডিয়াল ইফিউশনও ধরা পড়ে। ২৩১তম দিনে রোগীকে পেডিয়াট্রিক ইনটেনসিভ কেয়ার ইউনিটে স্থানান্তর করা হয়, যেখানে যান্ত্রিক বায়ুচলাচল এবং ইনহেলড নাইট্রিক অক্সাইড (এনও) শুরু করা হয়। ২৪৪তম দিনে থোরাস্কোপিক ফুসফুসের বায়োপসিতে দেখা যায় যে হেম্যাটক্সিলিন-ইওসিন (এইচই) স্টেইন করা নমুনায় ডিফিউজ ইন্ট্রা-অ্যালভিওলার হেমোরেজ এবং ইডিমা রয়েছে। ইলাস্টিকা ভ্যান গিসন স্টেইনিং-এ দেখা যায় যে প্রি-সেপ্টাল পালমোনারি শিরা এবং ভেনুলে ফাইব্রোসেলুলার উপাদানের কারণে ডিফিউজ অবস্ট্রাকটিভ ক্ষত রয়েছে, যেখানে প্লম্প এন্ডোথেলিয়াল কোষ দেখা যায়। পালমোনারি মাস্কুলার ধমনী এবং আর্টারিওলে হালকা মিডিয়াল হাইপারট্রফি এবং ফোকাল ইন্টিমাল থিকেনিং (হিথ-এডওয়ার্ডস গ্রেড ২) দেখা গেলেও, গুরুতর স্টেনোসিস, কনসেন্ট্রিক ইন্টিমাল ফাইব্রোসিস বা প্লেক্সিফর্ম ক্ষত ছিল। এই ফলাফলের ভিত্তিতে, রোগীকে হালকা পালমোনারি আর্টেরিয়াল/আর্টারিওলার ক্ষতসহ পিভিওডি নির্ণয় করা হয়। উল্লেখযোগ্যভাবে, এইচই স্টেইনিং-এ দেখা যায় যে টাইপ II নিউমোকাইটগুলি বড় হয়েছে এবং এতে মাল্টিনুক্লিয়েটেড এবং জায়ান্ট সেল-সদৃশ বৈশিষ্ট্য রয়েছে, যা পূর্বের ফুসফুসের আঘাতের উপস্থিতি নির্দেশ করে, যা সম্ভবত তার পূর্ববর্তী ভাইরাল সংক্রমণের কারণে হয়েছিল।",
+    "translated_summary": "চার বছর বয়সী একটি ছেলের মেটাস্ট্যাটিক নিউরোব্লাস্টোমা ধরা পড়ে এবং তাকে নিবিড় কেমোথেরাপি, অটোলোগাস এইচএসসিটি এবং অ্যালোজেনিক কর্ড ব্লাড ট্রান্সপ্লান্টেশন (সিবিটি) করানো হয়। সিবিটি-র ১৯৪ দিন পর, শ্বাসযন্ত্রের উপরের অংশে কিছু উপসর্গ দেখা দেওয়ার এবং প্রায় এক মাস আগে আরএসভি অ্যান্টিজেন পরীক্ষায় পজিটিভ ফলাফল আসার পর তার মধ্যে পিভিওডি দেখা যায়। ফুসফুসের বায়োপসি পরীক্ষার ফলে ফুসফুসের ক্ষতির প্রমাণ পাওয়া যায়, যা সম্ভবত ভাইরাল সংক্রমণের কারণে হয়েছে। এর সঙ্গে পিভিওডি-সম্পর্কিত অন্যান্য বিষয়ও দেখা যায়, যা থেকে ধারণা করা হয় যে আরএসভি সংক্রমণ পিভিওডি হওয়ার ক্ষেত্রে অবদান রাখতে পারে।"
+  },
+  {
+    "id": "multiclinsum_gs_en_160.txt",
+    "fulltext": "65-year-old male with no personal or family history of pathology of relevance. His condition began in 2020 with productive cough that intensified and was accompanied by shortness of breath with small to medium effort; as well as loss of 10 kg of weight in a period of 4 months. He went to a doctor who requested a chest X-ray that showed massive, multilocular right pleural effusion with right bronchial obstruction and mediastinal lymphadenopathy. A thoracocentesis was performed with a biopsy of the right lung and parietal pleura. The histopathological study reported an adeno-squamous carcinoma. His evolution was bad, which is why he was referred to our institution. On admission, a physical examination found him cachectic, with right pulmonary hypoventilation, 92% oxygen saturation and pneumokoccal dysfunction, with no evidence of systemic or haemodynamic compromise. A chest X-ray was performed that showed complete opacity of the right hemithorax, and a pleural catheter was placed with a serohematic flow. In the histopathological study of the revision material, the lung parenchyma was replaced by a poorly differentiated neoplasm with a solid mantle and syncytia, surrounded by abundant lymphocytes and plasma cells. The neoplastic cells had large, ovoid nuclei, fine chromatin, prominent nucleolus and wide, poorly defined cytoplasm. An immunohistochemical study was performed that was positive for CKAE1/AE3, CK 5/6, p63, EBER ISH, and negative for Napsina A, TTF-1 and CK 7, which ruled out the reference diagnosis of adeno-squamous carcinoma and established the diagnosis of CTLP. Molecular study in the paraffin block was positive for PD-L1 (SP263) +++ in approximately 100% of the neoplastic cells, and negative for EGFR, K-RAS, ALK, ROS1. In order to confirm the pulmonary origin of the neoplasm, a nasopharyngeal examination was performed that was negative. In April 2021, a PET-CT was performed that reported a heterogeneous parahilary pulmonary lesion that compromised the main bronchus and caused atelectasis; as well as multiple cervical, mediastinal and peri-gastric lymphadenopathies. The catheter was removed due to partial resolution of the effusion and chemotherapy treatment with gemcitabine/cisplatin was initiated. He received 6 cycles, however, the patient reported hearing loss and AKIN I acute renal failure was documented, so cisplatin was changed to carboplatin, and maintenance durvalumab was continued. In December 2021, disease progression was documented and he died in January 2022 due to respiratory failure.\n",
+    "summary": "We report the case of a 65-year-old man with a pulmonary lymphoepithelioma-like carcinoma, who presented with cough, dyspnea, and weight loss. A chest CT scan showed a poorly defined nodule located in the right lung. A trans-thoracic biopsy of the lesion was performed, and microscopic examination revealed large polygonal cells arranged in sheets, infiltrated by abundant lymphocytes and plasma cells, around the interstitium. The neoplastic cells were positive for cytokeratin 5/6 and p63, and negative for Napsina A and thyroid transcription factor 1 (TTF-1). PD-L1 expression was positive (approximately 100%) by immunohistochemistry; as was the nucleus of the neoplastic cells by in situ hybridization for Epstein-Barr virus-encoded RNA (EBER-ISH). The patient received six cycles of a combination chemotherapy regimen based on platinum (gemcitabine/cisplatin) plus durvalumab. He progressed and ultimately died 9 months after diagnosis.\n",
+    "translated_fulltext": "৬৫ বছর বয়সী একজন পুরুষ, যার ব্যক্তিগত বা পারিবারিক ইতিহাসে তেমন কোনো রোগ নেই। ২০২০ সালে তার এই সমস্যা শুরু হয়, যেখানে প্রথমে সামান্য কাশি দেখা যায়, যা ধীরে ধীরে বাড়তে থাকে এবং সামান্য পরিশ্রমে শ্বাসকষ্ট হতে শুরু করে। এছাড়াও, চার মাসের মধ্যে তার প্রায় ১০ কেজি ওজন কমে যায়। তিনি একজন ডাক্তারের কাছে যান, যিনি তার বুকের একটি এক্স-রে করার পরামর্শ দেন। এক্স-রে-তে দেখা যায়, তার ডান ফুসফুসে প্রচুর পরিমাণে তরল জমেছে এবং ডান ব্রঙ্কিয়াল পথে বাধা সৃষ্টি হয়েছে, সেই সাথে মিডিয়াস্টিনাল লিম্ফ নোডগুলোতেও সমস্যা দেখা যায়। এরপর তার ডান ফুসফুস এবং প্যারাইটাল প্লুরা থেকে বায়োপসি নিয়ে থোরাকোসেন্টেসিস করা হয়। হিস্টোপ্যাথলজিক্যাল পরীক্ষায় অ্যাডেনো-স্কোয়ামাস কার্সিনোমা ধরা পড়ে। তার শারীরিক অবস্থা খারাপ হতে থাকে, তাই তাকে আমাদের প্রতিষ্ঠানে রেফার করা হয়। হাসপাতালে ভর্তির সময় শারীরিক পরীক্ষায় দেখা যায়, তিনি দুর্বল হয়ে গেছেন, ডান ফুসফুসের বায়ু চলাচল কমে গেছে, অক্সিজেনের মাত্রা ৯২%-এ নেমে এসেছে এবং নিউমোকক্কাল ডিসফাংশন দেখা যায়। তবে, কোনো সিস্টেমিক বা হেমোডাইনামিক জটিলতা ছিল না। বুকের এক্স-রে-তে দেখা যায়, ডান হেমিতোরাক্স সম্পূর্ণরূপে অস্বচ্ছ হয়ে গেছে এবং প্লুরায় একটি ক্যাথেটার স্থাপন করা হয়, যেখান থেকে সেরোমেটিক তরল বের হতে থাকে। পুনরায় করা হিস্টোপ্যাথলজিক্যাল পরীক্ষায় দেখা যায়, ফুসফুসের প্যারেনকাইমা একটি দুর্বলভাবে গঠিত টিউমার দ্বারা প্রতিস্থাপিত হয়েছে, যার একটি কঠিন আবরণ এবং সিনসিটিয়া রয়েছে এবং এটি প্রচুর লিম্ফোসাইট ও প্লাজমা কোষ দ্বারা বেষ্টিত। টিউমারের কোষগুলোর বড়, ডিম্বাকৃতির নিউক্লিয়াস, সূক্ষ্ম ক্রোমাটিন, সুস্পষ্ট নিউক্লিওলাস এবং প্রশস্ত, অস্পষ্ট সাইটোপ্লাজম রয়েছে। একটি ইমিউনোহিস্টোকেমিক্যাল পরীক্ষায় দেখা যায়, CKAE1/AE3, CK 5/6, p63, EBER ISH পজিটিভ, কিন্তু Napsina A, TTF-1 এবং CK 7 নেগেটিভ। এর ফলে অ্যাডেনো-স্কোয়ামাস কার্সিনোমার প্রাথমিক রোগ নির্ণয় বাতিল করা হয় এবং CTLP-এর রোগ নির্ণয় করা হয়। প্যারাফিন ব্লকে করা আণবিক পরীক্ষায় দেখা যায়, প্রায় ১০০% টিউমার কোষে PD-L1 (SP263) +++ পজিটিভ, কিন্তু EGFR, K-RAS, ALK, ROS1 নেগেটিভ। টিউমারের উৎস ফুসফুস কিনা, তা নিশ্চিত করার জন্য একটি নাসোফ্যারিঞ্জিয়াল পরীক্ষা করা হয়, যেখানে কোনো অস্বাভাবিকতা পাওয়া যায়নি। ২০২১ সালের এপ্রিলে একটি PET-CT করা হয়, যেখানে দেখা যায়, ডান ফুসফুসে একটি হেটেরোজেনাস প্যারাহিলারি ক্ষত রয়েছে, যা প্রধান ব্রঙ্কাসকে প্রভাবিত করে এবং অ্যাটেলেক্টেসিসের কারণ হয়েছে। এছাড়াও, একাধিক সার্ভিকাল, মিডিয়াস্টিনাল এবং পেরিগ্যাস্ট্রিক লিম্ফ নোডগুলোতেও সমস্যা দেখা যায়। তরলের পরিমাণ কিছুটা কম হওয়ায় ক্যাথেটারটি সরিয়ে ফেলা হয় এবং জেমসিটাবিন/সিসপ্ল্যাটিন দিয়ে কেমোথেরাপি শুরু করা হয়। তিনি ৬টি সাইকেল কেমোথেরাপি গ্রহণ করেন, তবে এরপর তার শ্রবণশক্তি কমে যায় এবং AKIN I-এর কারণে তীব্র কিডনি বিকলতা দেখা দেয়। তাই সিসপ্ল্যাটিন পরিবর্তন করে কার্বোপ্ল্যাটিন দেওয়া হয় এবং ডুরভালুমাব দিয়ে রক্ষণাবেক্ষণ চিকিৎসা চলতে থাকে। ২০২১ সালের ডিসেম্বরে রোগের progression দেখা যায় এবং শ্বাসকষ্টের কারণে ২০২২ সালের জানুয়ারিতে তিনি মারা যান।",
+    "translated_summary": "আমরা একজন ৬৫ বছর বয়সী পুরুষের ঘটনা বর্ণনা করছি, যিনি ফুসফুসের লিম্ফোএপিথেলিওমা-সদৃশ কার্সিনোমায় আক্রান্ত ছিলেন এবং কাশি, শ্বাসকষ্ট ও ওজন হ্রাস নিয়ে এসেছিলেন। বুকের সিটি স্ক্যানে ডান ফুসফুসে একটি অস্পষ্ট টিউমার দেখা যায়। টিউমারটির একটি ট্রান্স-থোরাসিক বায়োপসি করা হয় এবং মাইক্রোস্কোপিক পরীক্ষায় দেখা যায় যে, প্রচুর লিম্ফোসাইট ও প্লাজমা কোষ দ্বারা ঘেরা আন্তঃকোষীয় স্থানে বড় আকারের বহুভুজাকার কোষগুলো স্তরে স্তরে সজ্জিত রয়েছে। ক্যান্সার কোষগুলোতে সাইটোকেরাটিন ৫/৬ এবং পি৬৩ পজিটিভ ছিল, কিন্তু ন্যাপসিনা এ এবং থাইরয়েড ট্রান্সক্রিপশন ফ্যাক্টর ১ (টিটিএফ-১) নেগেটিভ ছিল। ইমিউনোহিস্টোকেমিস্ট্রি দ্বারা পিডি-এল১-এর প্রকাশ পজিটিভ ছিল (প্রায় ১০০%) এবং ইন সিটু হাইব্রিডাইজেশন দ্বারা এপস্টাইন-বার ভাইরাস-এনকোডেড আরএনএ (ইবিইআর-আইএসএইচ)-এর জন্য ক্যান্সার কোষের নিউক্লিয়াসও পজিটিভ ছিল। রোগীকে প্ল্যাটিনাম (জেমসিটাবিন/সিসপ্ল্যাটিন) এবং ডুরভালুমাবের সমন্বিত কেমোথেরাপির ছয়টি চক্র দেওয়া হয়েছিল। এরপর তার অবস্থার অবনতি হয় এবং রোগ নির্ণয়ের ৯ মাস পর তিনি মারা যান।"
+  },
+  {
+    "id": "multiclinsum_gs_en_436.txt",
+    "fulltext": "A 13-year-old male patient was admitted to the Children’s Hospital in Damascus after noticing a palpable enlarged mass in the left inguinal region. His medical history was unremarkable except for a surgical intervention on his spine 6 years ago due to an accident, which resulted in the loss of motor function and sensation in both of his lower extremities.\n\nDue to the long period he had spent in bed, the patient developed decubitus sores on his left foot. The only finding on clinical examination was a mass in the left inguinal area, which was movable on deep structures and so was the overlaying skin on it. The mass was not tender on palpation, and no signs of local inflammation were observed.\n\nLaboratory tests revealed an Elevated ESR (119 mm/h in the first hour). Other Basic Laboratory tests including (Complete Blood Count, Liver function tests, electrolytes, Urea, Creatinine and LDH) were ordered and were within normal ranges for age. Ordering these tests was essential to rule out systemic diseases. Given the absence of indicative physical findings for systemic disorders or immunodeficiencies, additional tests like those for HIV or Direct Antiglobulin were deemed unnecessary.\n\nA CT of the abdomen, chest, and pelvis showed enlarged lymph nodes inferior to the inguinal ligament, with the largest measuring approximately (3.5 × 2.4 cm). Other organs and nodes were within normal limits.\n\nAll of the above-mentioned investigations were essential to rule other high-risk diagnosis including lymphoma and leukemia. However, these were not sufficient to reach the definite diagnosis, so a decision of surgical resection of the nodes was taken.\n\nTo confirm the diagnoses and exclude other potential differentials presenting with enlarged lymph nodes, surgical removal of all of these enlarged nodes was performed under general anesthesia, and biopsies were sent for microscopic study.\n\nThe biopsy showed hyperplastic nodal architecture with proliferation of histiocytes and plasma cells with vascular proliferation, consistent with Plasma cell subtype of Castleman’s Disease.\n\nThe patient was discharged from the hospital after 14-day period after ensuring that there were no remaining enlarged lymph nodes. The only recommendation was oral prednisolone. The patient underwent follow-up using a whole-body CT scan every three months. During each hospital visit, a comprehensive clinical examination and laboratory tests (e.g. Complete Blood Test, ESR, C-reactive protein, liver function tests, renal function tests) were performed in addition to the CT scan. After a 12-month follow-up period, the patient reported no new symptoms or enlarged lymph nodes. Additionally, no abnormalities were observed during clinical examination or in laboratory tests.",
+    "summary": "We report a unique case of a 13-year-old boy who presented with a palpable enlarged mass in the left inguinal region without any constitutional symptoms. Surgical removal of this mass was essential to exclude worrying causes. Pathologic examination revealed proliferative changes consistent with Castleman's disease plasma cell type which is one of the rarest forms of the disease in children. To our knowledge, this case is the first reported case of Unicentric Castleman Disease (UCD) in the inguinal area. During a 12-month-period of follow-up, no additional lymph node enlargements or other symptoms were reported.",
+    "translated_fulltext": "তেরো বছর বয়সী একজন পুরুষ রোগীকে দামেস্কের শিশু হাসপাতালে ভর্তি করা হয়। তার বাম কুঁচকির অঞ্চলে একটি ফোলাভাব লক্ষ্য করা যায়। রোগীর পূর্বের স্বাস্থ্য বিষয়ক তথ্যে তেমন উল্লেখযোগ্য কিছু ছিল না, তবে ছয় বছর আগে একটি দুর্ঘটনার কারণে তার মেরুদণ্ডে অস্ত্রোপচার করা হয়েছিল, যার ফলে তার উভয় পায়ের মোটর ফাংশন এবং সংবেদনে সমস্যা দেখা দেয়।\n\nদীর্ঘদিন ধরে বিছানায় থাকার কারণে রোগীর বাম পায়ে ডেসিকিউবিটাস আলসার দেখা দেয়। শারীরিক পরীক্ষায় দেখা যায়, বাম কুঁচকির অঞ্চলে একটি ফোলাভাব রয়েছে, যা গভীর টিস্যুর উপর নড়াচড়া করে এবং এর উপরের ত্বকও নড়াচড়া করে। ফোলাভাবটিতে চাপ দিলে ব্যথা লাগে না এবং স্থানীয় প্রদাহের কোনো লক্ষণও দেখা যায় না।\n\nল্যাবরেটরি পরীক্ষায় দেখা যায়, তার ইএসআর (ইরিথ্রোসাইট সেডিমেন্টেশন রেট) বেশি (প্রথম ঘন্টায় ১১৯ মিমি/ঘণ্টা)। অন্যান্য সাধারণ ল্যাবরেটরি পরীক্ষা, যেমন - (কমপ্লিট ব্লাড কাউন্ট, লিভার ফাংশন পরীক্ষা, ইলেক্ট্রোলাইট, ইউরিয়া, ক্রিয়েটিনিন এবং এলডিএইচ) করা হয় এবং দেখা যায় যে তার বয়স অনুযায়ী এই মানগুলো স্বাভাবিক সীমার মধ্যে আছে। এই পরীক্ষাগুলো করানো জরুরি ছিল, যাতে অন্য কোনো শারীরিক সমস্যা আছে কিনা, তা নিশ্চিত করা যায়। যেহেতু শারীরিক পরীক্ষায় অন্য কোনো সমস্যা বা ইমিউনোডেফিসিয়েন্সির লক্ষণ দেখা যায়নি, তাই এইচআইভি বা ডিরেক্ট অ্যান্টিগ্লোবুলিনের মতো অতিরিক্ত পরীক্ষা অপ্রয়োজনীয় বলে বিবেচিত হয়।\n\nপেট, বুক এবং পেলভিসের সিটি স্ক্যান করে দেখা যায়, কুঁচকির লিগামেন্টের নিচে লিম্ফ নোডগুলো বড় হয়ে গেছে, যার মধ্যে সবচেয়ে বড়টির আকার প্রায় (৩.৫ × ২.৪ সেমি)। অন্যান্য অঙ্গ এবং নোডগুলো স্বাভাবিক সীমার মধ্যেই ছিল।\n\nলিফোমা এবং লিউকেমিয়ার মতো অন্যান্য উচ্চ-ঝুঁকির রোগ নির্ণয় করার জন্য উপরে উল্লিখিত পরীক্ষাগুলো করা জরুরি ছিল। তবে, এই পরীক্ষাগুলো চূড়ান্ত রোগ নির্ণয়ের জন্য যথেষ্ট ছিল না, তাই নোডগুলো অস্ত্রোপচারের মাধ্যমে অপসারণ করার সিদ্ধান্ত নেওয়া হয়।\n\nরোগ নির্ণয় নিশ্চিত করার জন্য এবং অন্যান্য সম্ভাব্য রোগ, যেগুলোর কারণে লিম্ফ নোড বড় হতে পারে, সেগুলোকে বাদ দেওয়ার জন্য, সাধারণ অ্যানেস্থেসিয়ার অধীনে সমস্ত বড় লিম্ফ নোড অস্ত্রোপচারের মাধ্যমে অপসারণ করা হয় এবং মাইক্রোস্কোপিক পরীক্ষার জন্য বায়োপসি পাঠানো হয়।\n\nবায়োপসিতে দেখা যায়, হিসটিওসাইট এবং প্লাজমা কোষের বিস্তার এবং ভাস্কুলার প্রসারণের সাথে হাইপারপ্লাস্টিক নোডাল আর্কিটেকচার রয়েছে, যা ক্যাসেলম্যান রোগের প্লাজমা সেল সাবটাইপের সাথে সামঞ্জস্যপূর্ণ।\n\nরোগীকে ১৪ দিন পর হাসপাতাল থেকে ছুটি দেওয়া হয়, এই নিশ্চিত করার পরে যে আর কোনো বড় লিম্ফ নোড নেই। শুধুমাত্র মুখে খাওয়ার জন্য প্রেডনিসোলোন দেওয়ার পরামর্শ দেওয়া হয়। এরপর প্রতি তিন মাস অন্তর পুরো শরীরের সিটি স্ক্যান করে রোগীর ফলো-আপ করা হয়। প্রতিটি হাসপাতালে আসার সময়, সিটি স্ক্যানের পাশাপাশি একটি বিস্তারিত শারীরিক পরীক্ষা এবং ল্যাবরেটরি পরীক্ষা (যেমন - কমপ্লিট ব্লাড টেস্ট, ইএসআর, সি-রিঅ্যাক্টিভ প্রোটিন, লিভার ফাংশন পরীক্ষা, রেনাল ফাংশন পরীক্ষা) করা হয়। ১২ মাস ফলো-আপ করার পর, রোগী নতুন কোনো উপসর্গ বা বড় লিম্ফ নোড সম্পর্কে জানাননি। এছাড়াও, শারীরিক পরীক্ষা বা ল্যাবরেটরি পরীক্ষায় কোনো অস্বাভাবিকতা দেখা যায়নি।",
+    "translated_summary": "আমরা ১৩ বছর বয়সী একটি ছেলের একটি ব্যতিক্রমী ঘটনার কথা জানাচ্ছি, যে কোনো শারীরিক উপসর্গ ছাড়াই বাম দিকের কুঁচকির অঞ্চলে একটি সুস্পষ্ট ফোলা দেখাচ্ছিল। উদ্বেগের কারণগুলো দূর করার জন্য এই ফোলাটি অস্ত্রোপচারের মাধ্যমে অপসারণ করা জরুরি ছিল। প্যাথলজিক্যাল পরীক্ষায় দেখা যায়, এতে ক্যাসেলম্যান রোগের প্লাজমা কোষের বৈশিষ্ট্য রয়েছে, যা শিশুদের মধ্যে এই রোগের সবচেয়ে বিরল রূপগুলোর মধ্যে একটি। আমাদের জানামতে, কুঁচকির অঞ্চলে ইউনিকেন্ট্রিক ক্যাসেলম্যান রোগ (ইউসিডি)-এর এটিই প্রথম নথিভুক্ত ঘটনা। ১২ মাসের ফলো-আপের সময়, অতিরিক্ত লিম্ফ নোড বৃদ্ধি বা অন্য কোনো উপসর্গ দেখা যায়নি।"
+  },
+  {
+    "id": "multiclinsum_gs_en_116.txt",
+    "fulltext": "The medical records of patients with a diagnosis of congenital myotonia studied and followed in the pediatric neurology consultation in a third-level hospital between 2015 and 2020 were reviewed. The inclusion criteria were to present a clinical diagnosis – myotonia, warm-up phenomenon, characteristic electromyographic pattern and/or family history – and/or a molecular diagnosis (mutation in the CLCN1 gene). The clinical signs and symptoms, as well as the results of the complementary explorations and the genetic mutation found, were collected by reviewing the medical record. Demographic variables (age and sex), course of the disease (age of onset, symptoms and signs, time elapsed until diagnosis and clinical evolution), family history and evaluation of the response to treatment were collected.\n\nFive cases with clinical diagnosis of congenital myotonia were identified (three with Becker's disease and two with Thomsen's disease). The incidence in relation to the number of births was estimated at 1:15,000 newborns for cases with Becker's phenotype and 1:21,000 newborns for Thomsen's phenotypes.\n\nMost of our patients were female, and the male was the only one who started before the age of six. The initial clinical presentation included myotonia in the lower limbs in four of the five patients and in the upper limbs in all but one. The age at onset ranged from 22 months to 12 years, with a median of 6 years. Genetic diagnosis was performed in all cases approximately two years after onset, and the family of one patient refused to have it performed. All had a worsening with cold, but the warming phenomenon was only in those with the Becker phenotype.\n\nPatients with recessive congenital myotonia showed some progression. As a family history, it is worth noting that patients 2 and 3 were sisters, without the parents showing any clinical signs, and that the mother of patient 1 showed mild clinical signs that were doubtful with the cold. The patient who refused the study had a history of myotonia in the maternal branch.\n\nBlood tests did not show elevated creatine kinase in any of the patients. The electromyogram was abnormal in all patients except the first one at 2.8/12 years of age. The test was not repeated later because it was not considered necessary.\n\nThe most used treatment initially was oxcarbazepine (in patients with recessive form), with a good response in general. In case 2 it lost efficacy with time and mexiletine was initiated. Patient 4 initiated several drugs without success due to loss of efficacy or side effects. Patient 5 rejected treatment due to mild clinical presentation.\n\nPatient 1 had a previously undescribed, likely pathogenic mutation (CLCN1: c.824T>C) inherited from his mother. Cases 1 to 3 had the Becker phenotype with composite heterozygosity mutations, and cases 4 and 5 had the Thomsen phenotype. Case 5 declined genetic testing.\n",
+    "summary": "The medical records of patients with a diagnosis of congenital myotonia studied and followed in the pediatric neurology consultation in a third-level hospital between 2015 and 2020 were reviewed. Demographic variables (age and sex), course of the disease (age of onset, symptoms and signs, time elapsed until diagnosis and clinical evolution), family history and evaluation of the response to treatment were collected. Five cases with a clinical diagnosis of congenital myotonia were identified (three with Becker disease and two with Thomsen disease). The incidence in relation to the number of births was estimated at 1:15,000 newborns for cases with a Becker phenotype and 1:21,000 newborns for Thomsen phenotypes. We found a probably pathogenic mutation not previously described (CLCN1: c.824T>C).\n",
+    "translated_fulltext": "২০১৫ থেকে ২০২০ সালের মধ্যে একটি তৃতীয় স্তরের হাসপাতালে পেডিয়াট্রিক নিউরোলজি পরামর্শে জন্মগত মায়োটোনিয়া রোগ নির্ণয় করা রোগীদের চিকিৎসা সংক্রান্ত নথিপত্র পর্যালোচনা করা হয়েছিল। অন্তর্ভুক্তির মানদণ্ড ছিল ক্লিনিক্যাল ডায়াগনোসিস – মায়োটোনিয়া, ওয়ার্ম-আপ ফেনোমেনন, বৈশিষ্ট্যপূর্ণ ইলেক্ট্রোমায়োগ্রাফিক প্যাটার্ন এবং/অথবা পারিবারিক ইতিহাস – এবং/অথবা আণবিক ডায়াগনোসিস (সিএলসিএন১ জিনে মিউটেশন)। ক্লিনিক্যাল লক্ষণ ও উপসর্গ, সেইসাথে অন্যান্য পরীক্ষার ফলাফল এবং জেনেটিক মিউটেশন, রোগীর চিকিৎসা সংক্রান্ত নথিপত্র পর্যালোচনা করে সংগ্রহ করা হয়েছিল। জনসংখ্যা-সংক্রান্ত তথ্য (বয়স এবং লিঙ্গ), রোগের গতিপ্রকৃতি (রোগের শুরু, লক্ষণ ও উপসর্গ, রোগ নির্ণয় পর্যন্ত সময় এবং ক্লিনিক্যাল বিবর্তন), পারিবারিক ইতিহাস এবং চিকিৎসার প্রতিক্রিয়ার মূল্যায়ন সংগ্রহ করা হয়েছিল।\n\nক্লিনিক্যাল ডায়াগনোসিস হিসেবে জন্মগত মায়োটোনিয়া রোগ নির্ণয় করা পাঁচজন রোগীর ঘটনা চিহ্নিত করা হয়েছে (তিনজনের বেকারের রোগ এবং দুজনের থমসনের রোগ)। বেকারের বৈশিষ্ট্যযুক্ত রোগীদের ক্ষেত্রে প্রতি ১৫,০০০ নবজাতকের মধ্যে ১ জন এবং থমসনের বৈশিষ্ট্যযুক্ত রোগীদের ক্ষেত্রে প্রতি ২১,০০০ নবজাতকের মধ্যে ১ জন হিসেবে এই রোগের প্রাদুর্ভাবের হার অনুমান করা হয়েছে।\n\nআমাদের বেশিরভাগ রোগীই মহিলা ছিলেন, এবং পুরুষদের মধ্যে মাত্র একজন ছয় বছর বয়সের আগে রোগটিতে আক্রান্ত হয়েছিল। প্রাথমিক ক্লিনিক্যাল উপসর্গের মধ্যে পাঁচজনের মধ্যে চারজনের ক্ষেত্রে নিচের অংশে মায়োটোনিয়া এবং বাকি একজনের ক্ষেত্রে উপরের অংশে মায়োটোনিয়া দেখা যায়। রোগের শুরু হওয়ার বয়স ২২ মাস থেকে ১২ বছর পর্যন্ত ছিল, যেখানে গড় বয়স ছিল ৬ বছর। সমস্ত ক্ষেত্রেই রোগের শুরু হওয়ার প্রায় দুই বছর পর জেনেটিক ডায়াগনোসিস করা হয়েছিল, তবে একজন রোগীর পরিবার এটি করাতে রাজি হয়নি। সবার ক্ষেত্রেই ঠান্ডায় অবস্থার অবনতি হয়েছিল, তবে শুধুমাত্র বেকারের বৈশিষ্ট্যযুক্ত রোগীদের ক্ষেত্রে ওয়ার্ম-আপ ফেনোমেনন দেখা যায়।\n\nরিসেসিভ জন্মগত মায়োটোনিয়া রোগে আক্রান্ত রোগীদের মধ্যে কিছু ক্ষেত্রে রোগের অগ্রগতি দেখা যায়। পারিবারিক ইতিহাসে দেখা যায়, রোগী ২ এবং ৩ ছিল বোন, এবং তাদের বাবা-মায়ের মধ্যে কোনো ক্লিনিক্যাল লক্ষণ দেখা যায়নি। তবে, রোগী ১-এর মায়ের মধ্যে হালকা ক্লিনিক্যাল লক্ষণ দেখা গিয়েছিল, যা ঠান্ডায় আরও স্পষ্ট হতো। যে রোগী পরীক্ষা করাতে রাজি হননি, তার মায়ের দিক থেকে মায়োটোনিয়ার ইতিহাস ছিল।\n\nরক্ত পরীক্ষায় কোনো রোগীর ক্ষেত্রেই ক্রিয়েটিন কাইনেজের মাত্রা বেশি পাওয়া যায়নি। ইলেক্ট্রোমায়োগ্রাম পরীক্ষায় প্রথম রোগীর (২.৮/১২ বছর বয়সে) বাদে বাকি রোগীদের ক্ষেত্রে অস্বাভাবিকতা দেখা যায়। যেহেতু এটি প্রয়োজনীয় বলে বিবেচিত হয়নি, তাই পরে পরীক্ষাটি আর করা হয়নি।\n\nপ্রাথমিকভাবে সবচেয়ে বেশি ব্যবহৃত চিকিৎসা ছিল অক্সকার্বাজেপিন (রিসেসিভ ফর্মের রোগীদের ক্ষেত্রে), এবং সাধারণভাবে এর ভালো প্রতিক্রিয়া দেখা যায়। রোগী ২-এর ক্ষেত্রে সময়ের সাথে সাথে এর কার্যকারিতা হ্রাস পায় এবং মেক্সিলেটাইন শুরু করা হয়। রোগী ৪ বিভিন্ন ওষুধ ব্যবহার করেও কোনো ফল পাননি, কারণ কার্যকারিতা হ্রাস পায় অথবা পার্শ্বপ্রতিক্রিয়া দেখা দেয়। রোগী ৫ হালকা ক্লিনিক্যাল উপসর্গের কারণে চিকিৎসা নিতে অস্বীকার করেন।\n\nরোগী ১-এর মধ্যে পূর্বে অন্বেষণ করা হয়নি এমন একটি সম্ভাব্য প্যাথোজেনিক মিউটেশন (সিএলসিএন১: সি.৮২৪টি>সি) দেখা যায়, যা তার মায়ের কাছ থেকে উত্তরাধিকার সূত্রে পাওয়া। রোগী ১ থেকে ৩-এর মধ্যে বেকারের বৈশিষ্ট্যযুক্ত এবং কম্পোজিট হেটেরোসাইগোসিটি মিউটেশন ছিল, এবং রোগী ৪ ও ৫-এর মধ্যে থমসনের বৈশিষ্ট্য ছিল। রোগী ৫ জেনেটিক পরীক্ষা করাতে রাজি হননি।",
+    "translated_summary": "একটি তৃতীয় স্তরের হাসপাতালে ২০১৫ থেকে ২০২০ সালের মধ্যে পেডিয়াট্রিক নিউরোলজি পরামর্শ বিভাগে জন্মগত মায়োটোনিয়া রোগ নির্ণয় করা রোগীদের চিকিৎসা সংক্রান্ত নথিগুলো পর্যালোচনা করা হয়েছিল এবং তাদের ফলোআপ করা হয়েছিল। রোগীদের বয়স ও লিঙ্গ, রোগের গতিপ্রকৃতি (রোগের শুরু, লক্ষণ ও উপসর্গ, রোগ নির্ণয় পর্যন্ত সময় এবং ক্লিনিক্যাল বিবর্তন), পারিবারিক ইতিহাস এবং চিকিৎসার প্রতিক্রিয়ার মূল্যায়ন করা হয়েছিল। পাঁচটি ক্ষেত্রে জন্মগত মায়োটোনিয়ার ক্লিনিক্যাল রোগ নির্ণয় করা হয়েছে (তিনটিতে বেকারের রোগ এবং দুটিতে থমসনের রোগ)। বেকারের বৈশিষ্ট্যযুক্ত ক্ষেত্রে প্রতি ১৫,০০০ নবজাতকের মধ্যে ১ জন এবং থমসনের বৈশিষ্ট্যযুক্ত ক্ষেত্রে প্রতি ২১,০০০ নবজাতকের মধ্যে ১ জন হিসেবে এই রোগের প্রাদুর্ভাবের হার নির্ণয় করা হয়েছে। আমরা সম্ভবত একটি রোগ সৃষ্টিকারী মিউটেশন খুঁজে পেয়েছি যা আগে কখনো বর্ণনা করা হয়নি (CLCN1: c.824T>C)।"
+  },
+  {
+    "id": "multiclinsum_gs_en_322.txt",
+    "fulltext": "A 67-year-old female patient presented with a six-year history of recurrent swelling in the left lower limb. One year prior, she was diagnosed with an AVM in the lower limb at another hospital. Two months before hospitalization, the patient underwent embolization treatment, which included the placement of two coils (20 mm x 40 cm, BSX, USA). Despite this intervention, the patient’s left lower limb swelling did not show any improvement. The patient has been experiencing fatigue and difficulty of breathing for a month. As these symptoms of heart failure progressed and worsened, the patient was transferred to Chengdu University of Traditional Chinese Medicine Hospital for further evaluation and treatment. The patient had no prior history of cardiovascular diseases, injuries, or surgeries. However, she reported a history of oral estrogen use for menopausal syndrome seven years ago.\n\nShe exhibited significant edema and skin sclerosis in the left lower limb. Additionally, absent pulses were observed in the popliteal artery and distal regions. A noticeable tremor was also present in the left thigh. The patient was seated during the examination. Echocardiography revealed cardiac enlargement, along with moderate mitral regurgitation and severe tricuspid regurgitation. The left ventricular ejection fraction (EF) was measured at 60%, and there was an elevation in b-type natriuretic peptide (BNP) levels to 2853 ng/L. The electrocardiogram showed a sinus rhythm with a heart rate of 105 beats per minute and evidence of left atrial enlargement. Chest CT scans confirmed cardiac enlargement, while no respiratory system abnormalities were detected. Preoperative computed tomography angiography (CTA) provided further insights, revealing a left iliac artery aneurysm, a significantly enlarged femoral artery, and complex AVMs in the superficial femoral artery. Additionally, the femoral and superficial veins appeared significantly enlarged on arterial phase imaging. Notably, the left lower limb popliteal artery and anterior tibial artery were not visualized. Based on these findings, the patient was diagnosed with complex congenital lower limb AVMs, acute exacerbation of chronic heart failure, and classified as NYHA Class IV.\n\nThe patient exhibits distinct symptoms of acute heart failure, and preoperative ultrasound assessment has revealed a volume flow of 3400 ml/min in the CFA. Given that embolization using coils may not effectively reduce the flow rate of the AVMs, the utilization of covered stents is a viable option. These stents effectively decrease the flow of lower limb AVMs, thereby improving the patient’s heart failure condition. Additionally, staged embolization treatment can further enhance the treatment outcome by improving the nidus of the lower limb AVMs.\n\nCTA of the patient revealed significant dilatation of blood vessels, with a maximum diameter of 32 mm for the iliac artery, 27 mm for the common femoral artery (CFA), and 22 mm for the superficial femoral artery (SFA). To minimize access site complications, antegrade access was achieved through a surgical approach of the CFA. Under general anesthesia, intravascular covered stents were inserted through an open femoral artery approach, utilizing 14 F (Cook Medical, USA) catheter sheaths intraoperatively. complex AVMs were visualized in the superficial femoral artery and profunda femoris artery, accompanied by early visualization of an enlarged femoral vein.\n\nPreoperative CTA measurements indicated a diameter of 19 mm for the middle segment of the SFA, leading to the selection of a 20 mm–12 mm/120 mm aorto-uni-iliac covered stent (MicroPort, China). A 0.035 guidewire, in conjunction with a single-curve catheter, was used to access the popliteal artery. Subsequently, it was replaced with a 0.035 super-hard guidewire to provide support during the implantation of the stent graft. The stent was deployed precisely at the distal end of the superficial femoral artery, the location with the highest concentration of AVMs. Completion angiography revealed a significant reduction in venous opacification around the stent and clear visualization of the popliteal artery. Postoperatively, the left femoral artery was sutured using a 6 − 0 vascular risk suture, resulting in a significant improvement in the patient’s heart failure symptoms. The patient has heart failure, so the surgery duration should not be excessive. It is planned to perform embolization treatment in the second phase.\n\nOne week post-treatment, ultrasound examination revealed a reduction in volume flow to 1600 ml/min in the CFA, with a BNP level of 1198ug/l. Targeting the nidus with embolization therapy is expected to further decrease the flow velocity of arteriovenous malformations. The right CFA was punctured, allowing the insertion of a 5 F arterial sheath and a 5 F catheter for angiographic examination. Guided by ultrasound, the drainage vein of the AVM was punctured, and a 5 F vascular sheath was introduced. The contrast agent confirmed the presence of a nidus and its draining veins. The embolization procedure of the draining veins involved the use of a coil (18–20 mm x 40 cm, BSX, USA), two microcoils (4 mm x 42 mm, 5 mm x 10 mm, USA), 3% polidocanol (6 mL Kruelle, Germany), and 99% anhydrous ethanol (10 mL).\n\nCompletion angiography showed a significant reduction in the visualization of AVMs and draining veins, indicating their disappearance. During the one-year follow-up, the patient exhibited notable improvement in lower limb swelling and cardiac function. The volume flow in the CFA decreased to 780 ml/min. Echocardiography revealed minor enlargement of the left and right atria, slight mitral and tricuspid regurgitation, and a left ventricular ejection fraction (EF) of 71%. Notably, BNP levels decreased significantly.",
+    "summary": "We present a case involving a patient with congenital AVMs in the lower limb, who had suffered from prolonged swelling in the left lower limb and recently developed symptoms of heart failure. At the age of 67, the patient was definitively diagnosed with a complex congenital AVMs in the lower limb. This article delves into the practical experiences and limitations encountered in employing an abdominal aortic stent graft, coupled with embolization, to address acute heart failure caused by complex congenital AVMs in the lower limb.",
+    "translated_fulltext": "একজন ৬৭ বছর বয়সী মহিলা রোগী, যার বাম পায়ের নিচের অংশে ছয় বছর ধরে মাঝে মাঝে ফোলা দেখা যাচ্ছিল, এমন উপসর্গ নিয়ে এসেছিলেন। এক বছর আগে অন্য একটি হাসপাতালে তার পায়ের নিচের অংশে একটি আর্টেরিওভেনাস মালফরমেশন (এভিএম) শনাক্ত করা হয়েছিল। হাসপাতালে ভর্তির দুই মাস আগে, রোগীর এমবোলাইজেশন চিকিৎসা করা হয়েছিল, যেখানে দুটি কয়েল (২০ মিমি x ৪০ সেমি, বিএসএক্স, মার্কিন যুক্তরাষ্ট্র) স্থাপন করা হয়েছিল। এই চিকিৎসার পরেও, রোগীর বাম পায়ের নিচের অংশের ফোলাভাবের উন্নতি হয়নি। রোগী এক মাস ধরে ক্লান্তি এবং শ্বাসকষ্ট অনুভব করছেন। হৃদরোগের উপসর্গগুলো বাড়তে থাকায়, রোগীকে আরও পরীক্ষা এবং চিকিৎসার জন্য চেংদু ইউনিভার্সিটি অফ ট্র্যাডিশনাল চাইনিজ মেডিসিন হাসপাতালে স্থানান্তর করা হয়। রোগীর আগে হৃদরোগ, আঘাত বা অস্ত্রোপচারের কোনো ইতিহাস ছিল না। তবে, তিনি জানিয়েছিলেন যে সাত বছর আগে মেনোপজের কারণে তিনি মুখে ইস্ট্রোজেন ব্যবহার করতেন।\n\nরোগীর বাম পায়ের নিচের অংশে উল্লেখযোগ্য ফোলা এবং ত্বকের শক্তভাব দেখা যায়। এছাড়াও, পপলাইটাল ধমনী এবং এর কাছাকাছি অঞ্চলে পালস পাওয়া যাচ্ছিল না। বাম উরুতে সামান্য কাঁপুনিও ছিল। পরীক্ষার সময় রোগীকে বসানো হয়েছিল। ইকোকার্ডিওগ্রাফিতে হৃদপিণ্ডের আকার বৃদ্ধি, মাঝারি মিতরাল রিগারজিটেশন এবং গুরুতর ট্রিকাসপিড রিগারজিটেশন দেখা যায়। বাম নিলয়ের ইজেকশন ফ্র্যাকশন (ইএফ) ছিল ৬০%, এবং বি-টাইপ ন্যাট্রিয়ুরেটিক পেপটাইড (বিএনপি) এর মাত্রা বেড়ে ২৮৫৩ এনজি/এল হয়েছে। ইলেক্ট্রোকার্ডিওগ্রামে সাইনাস রিদম দেখা যায়, হৃদস্পন্দন ছিল প্রতি মিনিটে ১০৫ বার এবং বাম অ্যাট্রিয়ামের আকার বৃদ্ধি পাওয়ার প্রমাণ পাওয়া যায়। বুকের সিটি স্ক্যানে হৃদপিণ্ডের আকার বৃদ্ধি নিশ্চিত করা হয়, তবে শ্বাসযন্ত্রের কোনো অস্বাভাবিকতা ধরা পড়েনি। অস্ত্রোপচারের আগে করা কম্পিউটেড টমোগ্রাফি অ্যাঞ্জিওগ্রাফি (সিটিএ)-তে বাম ইলিয়াক ধমনীতে একটি অ্যানিউরিজম, উল্লেখযোগ্যভাবে প্রসারিত ফেমোরাল ধমনী এবং অগভীর ফেমোরাল ধমনীতে জটিল এভিএম দেখা যায়। এছাড়াও, ফেমোরাল এবং অগভীর শিরাগুলো ধমনী পর্যায়ে চিত্রায়নে উল্লেখযোগ্যভাবে প্রসারিত মনে হয়েছে। লক্ষণীয়ভাবে, বাম পায়ের নিচের অংশের পপলাইটাল ধমনী এবং সম্মুখ টিবিয়াল ধমনী স্পষ্টভাবে দেখা যাচ্ছিল না। এই অনুসন্ধানের ভিত্তিতে, রোগীকে জটিল জন্মগত নিম্ন-পায়ের এভিএম, দীর্ঘস্থায়ী হৃদরোগের তীব্রতা এবং এনওয়াইএইচএ ক্লাস IV হিসাবে নির্ণয় করা হয়।\n\nরোগীর তীব্র হৃদরোগের সুস্পষ্ট লক্ষণ রয়েছে এবং অস্ত্রোপচারের আগে করা আল্ট্রাসাউন্ড পরীক্ষায় দেখা গেছে যে সিএফএ-তে রক্তের প্রবাহের পরিমাণ ৩৪০০ মিলি/মিনিট। যেহেতু কয়েল ব্যবহার করে এমবোলাইজেশন এভিএম-এর প্রবাহের হার কার্যকরভাবে কমাতে নাও পারে, তাই কভার্ড স্টেন্ট ব্যবহার করা একটি কার্যকর বিকল্প হতে পারে। এই স্টেন্টগুলো পায়ের নিচের অংশের এভিএম-এর প্রবাহকে কার্যকরভাবে কমিয়ে রোগীর হৃদরোগের অবস্থার উন্নতি ঘটাতে পারে। এছাড়াও, পর্যায়ক্রমে এমবোলাইজেশন চিকিৎসা করলে পায়ের নিচের অংশের এভিএম-এর নিডাসের উন্নতি ঘটিয়ে চিকিৎসার ফলাফল আরও বাড়ানো যেতে পারে।\n\nরোগীর সিটিএ-তে রক্তনালীর উল্লেখযোগ্য প্রসারণ দেখা যায়, যেখানে ইলিয়াক ধমনীর সর্বোচ্চ ব্যাস ছিল ৩২ মিমি, সাধারণ ফেমোরাল ধমনীর (সিএফএ) ২৭ মিমি এবং অগভীর ফেমোরাল ধমনীর (এসএফএ) ২২ মিমি। অ্যাক্সেস সাইটের জটিলতা কমাতে, সিএফএ-এর একটি অস্ত্রোপচার পদ্ধতির মাধ্যমে অগ্রবর্তী অ্যাক্সেস তৈরি করা হয়। সাধারণ অ্যানেস্থেসিয়ার অধীনে, একটি খোলা ফেমোরাল ধমনীর মাধ্যমে ইন্ট্রাভাসকুলার কভার্ড স্টেন্ট স্থাপন করা হয়, যেখানে অস্ত্রোপচারের সময় ১৪ এফ (কুক মেডিকেল, মার্কিন যুক্তরাষ্ট্র) ক্যাথেটার শীথ ব্যবহার করা হয়। অগভীর ফেমোরাল ধমনী এবং প্রোফান্ডা ফেমোরিস ধমনীতে জটিল এভিএম দেখা যায়, সেইসাথে একটি প্রসারিত ফেমোরাল শিরাও দেখা যায়।\n\nঅস্ত্রোপচারের আগে করা সিটিএ পরিমাপ থেকে এসএফএ-এর মাঝের অংশের ব্যাস ১৯ মিমি পাওয়া যায়, যার ফলে ২০ মিমি–১২ মিমি/১২০ মিমি অ্যাওর্টো-ইউনি-ইলিয়াক কভার্ড স্টেন্ট (মাইক্রোপোর্ট, চীন) নির্বাচন করা হয়। একটি ০.০৩৫ গাইডওয়্যার, একটি একক-বক্র ক্যাথেটারের সাথে ব্যবহার করে পপলাইটাল ধমনীতে প্রবেশ করা হয়। পরবর্তীতে, স্টেন্ট গ্রাফ্ট স্থাপনের সময় সহায়তার জন্য এটিকে একটি ০.০৩৫ সুপার-হার্ড গাইডওয়্যার দিয়ে প্রতিস্থাপন করা হয়। স্টেন্টটি অগভীর ফেমোরাল ধমনীর দূরবর্তী প্রান্তে স্থাপন করা হয়, যেখানে এভিএম-এর ঘনত্ব সবচেয়ে বেশি। চূড়ান্ত অ্যাঞ্জিওগ্রাফিতে স্টেন্টের চারপাশে শিরায় রক্ত ​​প্রবাহ উল্লেখযোগ্যভাবে হ্রাস পায় এবং পপলাইটাল ধমনী স্পষ্টভাবে দেখা যায়। অস্ত্রোপচারের পরে, বাম ফেমোরাল ধমনী একটি ৬-০ ভাস্কুলার রিস্ক সেলাই দিয়ে সেলাই করা হয়, যার ফলে রোগীর হৃদরোগের উপসর্গে উল্লেখযোগ্য উন্নতি হয়। রোগীর হৃদরোগ রয়েছে, তাই অস্ত্রোপচারের সময়কাল অতিরিক্ত হওয়া উচিত নয়। দ্বিতীয় পর্যায়ে এমবোলাইজেশন চিকিৎসা করার পরিকল্পনা করা হয়েছে।\n\nচিকিৎসার এক সপ্তাহ পরে, আল্ট্রাসাউন্ড পরীক্ষায় দেখা যায় যে সিএফএ-তে রক্তের প্রবাহের পরিমাণ কমে ১৬০০ মিলি/মিনিট হয়েছে, এবং বিএনপি-এর মাত্রা ১১৯৮ ইউজি/এল। এমবোলাইজেশন থেরাপির মাধ্যমে নিডাসকে লক্ষ্য করে চিকিৎসা করলে আর্টেরিওভেনাস মালফরমেশনের রক্ত ​​প্রবাহের গতি আরও কমবে বলে আশা করা যায়। ডান সিএফএ-তে একটি ৫ এফ ধমনী শীথ এবং একটি ৫ এফ ক্যাথেটার প্রবেশ করানো হয়, যা অ্যাঞ্জিওগ্রাফিক পরীক্ষার জন্য ব্যবহার করা হয়। আল্ট্রাসাউন্ডের সাহায্যে, এভিএম-এর নিষ্কাশনকারী শিরায় ছিদ্র করা হয় এবং একটি ৫ এফ ভাস্কুলার শীথ প্রবেশ করানো হয়। কনট্রাস্ট এজেন্ট ব্যবহারের মাধ্যমে নিডাস এবং এর নিষ্কাশনকারী শিরাগুলোর উপস্থিতি নিশ্চিত করা হয়। নিষ্কাশনকারী শিরাগুলোর এমবোলাইজেশন পদ্ধতিতে একটি কয়েল (১৮-২০ মিমি x ৪০ সেমি, বিএসএক্স, মার্কিন যুক্তরাষ্ট্র), দুটি মাইক্রোকয়েল (৪ মিমি x ৪২ মিমি, ৫ মিমি x ১০ মিমি, মার্কিন যুক্তরাষ্ট্র), ৩% পলিডোকানল (৬ মিলি ক্রুয়েল, জার্মানি) এবং ৯৯% অ্যানহাইড্রাস ইথানল (১০ মিলি) ব্যবহার করা হয়।\n\nচূড়ান্ত অ্যাঞ্জিওগ্রাফিতে এভিএম এবং নিষ্কাশনকারী শিরাগুলোর চিত্র উল্লেখযোগ্যভাবে হ্রাস পায়, যা তাদের অদৃশ্য হয়ে যাওয়া নির্দেশ করে। এক বছরের ফলো-আপের সময়, রোগীর পায়ের নিচের অংশের ফোলা এবং হৃদপিণ্ডের কার্যকারিতায় উল্লেখযোগ্য উন্নতি দেখা যায়। সিএফএ-তে রক্তের প্রবাহ কমে ৭৪০ মিলি/মিনিট হয়েছে। ইকোকার্ডিওগ্রাফিতে বাম এবং ডান অ্যাট্রিয়ার সামান্য বৃদ্ধি, সামান্য মিতরাল এবং ট্রিকাসপিড রিগারজিটেশন এবং বাম নিলয়ের ইজেকশন ফ্র্যাকশন (ইএফ) ৭১% দেখা যায়। লক্ষণীয়ভাবে, বিএনপি-এর মাত্রা উল্লেখযোগ্যভাবে হ্রাস পেয়েছে।",
+    "translated_summary": "আমরা এমন একজন রোগীর ঘটনা তুলে ধরছি, যার পায়ে জন্মগতভাবে এভিএম (অ্যাভিওভাসকুলার মালফরমেশন) ছিল এবং যিনি দীর্ঘ সময় ধরে বাম পায়ের ফোলাভাবের সমস্যায় ভুগছিলেন এবং সম্প্রতি হৃদরোগের লক্ষণ দেখা দিয়েছে। ৬৭ বছর বয়সে, রোগীর পায়ে জটিল জন্মগত এভিএম নির্ণয় করা হয়। এই নিবন্ধে পেটের মহাধমনীতে স্টেন্ট গ্রাফ্ট স্থাপন এবং একই সাথে এমবোলাইজেশন করার মাধ্যমে জটিল জন্মগত এভিএম-এর কারণে সৃষ্ট তীব্র হৃদরোগের চিকিৎসায় আমাদের বাস্তব অভিজ্ঞতা এবং যেসব সীমাবদ্ধতা দেখা দিয়েছে, তা নিয়ে আলোচনা করা হয়েছে।"
+  },
+  {
+    "id": "multiclinsum_gs_en_384.txt",
+    "fulltext": "28-year-old male patient with no significant history presented to the dermatology department with a 48-hour history of a skin condition characterized by two erythematous plaques with central vesicles and superficial ulceration located on the flexor surface of the right arm and forearm equidistant from the elbow crease, accompanied by a burning sensation and pruritus at the site of the lesions. He did not have systemic symptoms or self-medicate. As a background, he reported that he was on vacation in the coastal region of Ecuador at the time of the lesions. An incisional biopsy was performed that reported epidermis with acanthosis, parakeratosis and spongiosis, neutrophils in the stratum corneum and perivascular lymphocyte infiltration in the superficial, middle and deep dermis. Based on the clinical characteristics, the background of travel to a tropical region and the histological findings, a diagnosis of Paederus dermatitis was made. Treatment with antihistamines, topical steroids and cold compresses was indicated. After 8 days of treatment, the lesions resolved, leaving a post-inflammatory hyperpigmentation.\n",
+    "summary": "The case of a 28-year-old male patient who presented to the dermatology department with a 48-hour history of two erythematous plaques with central vesicles and superficial ulceration located on the flexor surface of the right arm and forearm, accompanied by a burning sensation and pruritus at the site of the lesions, without accompanying symptoms, is reported. As a background, he stated that he was on vacation in the coastal region of Ecuador at the time of the lesions. An incisional biopsy was performed and, due to the clinical characteristics and the background of travel to a tropical region, the diagnosis was made as dermatitis by Paederus and treatment with antihistamines, topical steroids and cold compresses was indicated. After 8 days of treatment, the lesions subsided, leaving a post-inflammatory hyperpigmentation.\n",
+    "translated_fulltext": "২৮ বছর বয়সী একজন পুরুষ রোগী, যার পূর্বে তেমন কোনো উল্লেখযোগ্য স্বাস্থ্য ইতিহাস নেই, তিনি ৪৮ ঘণ্টা ধরে ত্বকের সমস্যা নিয়ে চর্মরোগ বিভাগে আসেন। সমস্যাটি ছিল এমন যে, ডান হাতের কনুই থেকে সমান দূরত্বে অবস্থিত হাতের ভেতরের দিকে দুটি লালচে রঙের ফুসকুড়ি দেখা যায়, যেগুলোর কেন্দ্রে ছোট ছোট ফোস্কা এবং অগভীর ক্ষত ছিল। এর সাথে জ্বালাপোড়া এবং চুলকানিও ছিল। তিনি কোনো systemic উপসর্গ অনুভব করেননি এবং নিজে থেকে কোনো ওষুধ খাননি। তিনি জানান, ফুসকুড়ি ওঠার সময় তিনি ইকুয়েডরের উপকূলীয় অঞ্চলে ছুটিতে ছিলেন। এরপর একটি ছোট অংশের বায়োপসি করা হয়, যেখানে দেখা যায় এপিডার্মিসে অ্যাকান্থোসিস, প্যারাকেরাটোসিস এবং স্পঞ্জিওসিস, স্ট্রেটাম কর্নিয়ামে নিউট্রোফিল এবং অগভীর, মধ্যবর্তী এবং গভীর ডার্মিসে পেরভাসকুলার লিম্ফোসাইট অনুপ্রবেশ ঘটেছে। ক্লিনিক্যাল বৈশিষ্ট্য, গ্রীষ্মমণ্ডলীয় অঞ্চলে ভ্রমণের ইতিহাস এবং হিস্টোলজিক্যাল ফলাফল—এসবের ওপর ভিত্তি করে রোগীর পেডেরাস ডার্মাটাইটিস হয়েছে বলে নির্ণয় করা হয়। অ্যান্টিহিস্টামিন, টপিক্যাল স্টেরয়েড এবং ঠান্ডা সেঁকের মাধ্যমে চিকিৎসা করার পরামর্শ দেওয়া হয়। আট দিন চিকিৎসার পর ফুসকুড়ি সেরে যায় এবং প্রদাহ-পরবর্তী হাইপারপিগমেন্টেশন দেখা যায়।",
+    "translated_summary": "২৮ বছর বয়সী একজন পুরুষ রোগী, যিনি ৪৮ ঘণ্টা ধরে ডান হাতের এবং ডান বাহুর বাঁকানো অংশে দুটি লালচে ফুসকুড়ি, যার মাঝে ছোট ছোট ফোস্কা এবং অগভীর ক্ষত দেখা যাচ্ছিল, এবং যেখানে জ্বালা ও চুলকানি ছিল, কিন্তু অন্য কোনো উপসর্গ ছিল না—এই ঘটনাটি চর্মরোগ বিভাগে জানানো হয়েছিল। তিনি আরও জানান যে, ফুসকুড়ি ওঠার সময় তিনি ইকুয়েডরের উপকূলীয় অঞ্চলে ছুটিতে ছিলেন। এরপর একটি ছোট অংশের বায়োপসি করা হয় এবং ক্লিনিক্যাল বৈশিষ্ট্য ও গ্রীষ্মমণ্ডলীয় অঞ্চলে ভ্রমণের ইতিহাসের ভিত্তিতে, এটিকে পেডেরাস নামক পোকার কারণে হওয়া ডার্মাটাইটিস হিসেবে নির্ণয় করা হয় এবং অ্যান্টিহিস্টামিন, টপিক্যাল স্টেরয়েড এবং ঠান্ডা সেঁকের মাধ্যমে চিকিৎসার পরামর্শ দেওয়া হয়। আট দিন চিকিৎসার পর ফুসকুড়িগুলো সেরে যায় এবং সেখানে প্রদাহ-পরবর্তী হাইপারপিগমেন্টেশন দেখা যায়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_268.txt",
+    "fulltext": "Technique\nInformation about the procedure of TFD.\nThe patient receives intravenous photosensitizer (Photogen®, King of Prussia, PA, USA - 1.5 mg/kg) 24 h before the procedure. Its peak light absorption is at the wavelength of 630 nm. The procedure begins with standard duodenoscopy (Olympus TJF-180) under general anesthesia. After the identification of the greater duodenal papilla and the retrograde cannulation, the digital cholangioscope (SpyGlassTM DS, Boston Scientific, Natick, MA) is introduced into the common bile duct. Then the cholangioscopic examination helps to identify the neoplastic stenosis. Under direct visualization, the illumination catheter (Medlight S.A., RD10-323, Switzerland) is advanced through the cholangioscope. This consists of a typical three-way cannula. The first port has a 1 cm long cylindrical light diffuser at the end. Two black radiopaque marks demarcate the limits of the diffuser. The second port accommodates a 0.025 inch guidewire and the third is a portal for injection. After positioning under cholangioscopic guidance, illumination is initiated. The dose is 90 J/cm², with a power of 70 mW/cm². Repositioning is recommended every centimeter to cover the entire stenosed area. At the end of the procedure, new cholangioscopy evaluates the bile duct for immediate outcome and adverse events.\n\nPost-procedure care\nThe patient is fasted for the next 24 h. If no adverse event is detected, oral diet is initiated. Discharge from hospital is done under strict guidance on photoprotection (prevention of exposure to light and use of sunglasses), especially during the first week after the session of TFD.\n\nRESULTS\nThis procedure was performed in an 82-year-old man who presented to our tertiary center with obstructive jaundice and weight loss over the previous two months. Endoscopic ultrasound (EUS) revealed severe dilation of the common bile duct associated with choledocholithiasis. ERCP confirmed these findings but was unable to remove the stones due to the disproportionate dilation of the common bile duct. Therefore, a plastic biliary stent was chosen. The patient showed improvement in his clinical condition, but the cholestasis returned 45 days after the first procedure. Two other ERCPs failed to remove the stones. During the third procedure, a long irregular stenosis of the common hepatic duct was apparent and he was referred for another echoendoscopic evaluation.\n\nIn addition to the choledocholithiasis, the new EUS revealed a dilated common hepatic duct with a well-circumscribed hypoechoic solid mass measuring 1.8x2 cm, which was compressing the common hepatic duct. The mass appeared to also involve the common hepatic artery. An ultrasound-guided needle biopsy confirmed the diagnosis of moderately differentiated cholangiocarcinoma (Bismuth I).\n\nAfter staging, the mass was considered inoperable and the patient was referred for palliative treatment. After a multidisciplinary meeting with the oncology team, adjunctive PDT was proposed to treat the recurrent biliary obstruction. The procedure went without complications and lasted 150 minutes. At the end, a biliary drainage was performed with a 10 Fr plastic stent, since a self-expanding metal stent was not available at that time.\n\nThe patient showed no signs or symptoms of photosensitivity in the following week. There was, however, early recurrence of cholestasis complicated with cholangitis. ERCP revealed obstruction of the stent with debris and biliary sludge secondary to tumor necrosis. A biliary scan followed by new drainage resolved the patient's acute condition. Subsequently, he remained asymptomatic for three months, the longest period since the onset of the disease. At his next recurrence, he was drained with a self-expanding metal stent. He continued with systemic treatment and eventually required a duodenal stent for palliation of dysphagia. He died due to complications of pulmonary metastases two years after the onset of symptoms and 15 months after the session of TFD.\n",
+    "summary": "Patient receives intravenous photosensitizer 24 h before the procedure which begins with regular duodenoscopy. After identification of the main papilla and retrograde cannulation, the digital cholangioscope is introduced into the common bile duct. Then the cholangioscopic examination helps to identify neoplastic stenosis. Under direct visualization, the illumination catheter is advanced through the cholangioscope. Repositioning is done every centimeter. At the end of cholangioscopy, the bile duct is evaluated for immediate outcome and adverse events.\n\nResult: This procedure was performed in an 82-year-old man with obstructive jaundice for the past two months. EUS and ERCP revealed severe dilation of the common bile duct associated with choledocholithiasis. In addition, there was dilation of the hepatic duct to a well-circumscribed hypoechoic solid mass measuring 1.8x2 cm, compressing the common hepatic duct. It was considered inoperable and the patient was referred for palliative treatment with PDT, which remained asymptomatic for three months. He died of complications 15 months after the PDT session.\n",
+    "translated_fulltext": "পদ্ধতি\nটিএফডি পদ্ধতির বিবরণ।\n\nরোগীকে পদ্ধতির ২৪ ঘণ্টা আগে ইন্ট্রাভেনাস ফটোসেন্সিটাইজার (ফোটোজেন®, কিং অফ প্রুশিয়া, পিএ, মার্কিন যুক্তরাষ্ট্র - ১.৫ মিগ্রা/কেজি) দেওয়া হয়। এর সর্বোচ্চ আলো শোষণ ক্ষমতা ৬৩০ ন্যানোমিটার তরঙ্গদৈর্ঘ্যে থাকে। সাধারণ অ্যানেস্থেসিয়ার অধীনে স্ট্যান্ডার্ড ডুওডেনোস্কোপি (অলিম্পাস টিজেএফ-180) দিয়ে পদ্ধতি শুরু হয়। বৃহত্তর ডুওডেনাল প্যাপিলা এবং রেট্রোগ্রেড ক্যানুলেশন সনাক্ত করার পরে, ডিজিটাল কোল্যাঞ্জিওস্কোপ (স্পাইগ্লাসটিএম ডিএস, বোস্টন সায়েন্টিফিক, ন্যাটিক, এমএ) সাধারণ পিত্তনালীতে প্রবেশ করানো হয়। এরপর কোল্যাঞ্জিওস্কোপিক পরীক্ষার মাধ্যমে নিওপ্লাস্টিক স্টেনোসিস সনাক্ত করা হয়। সরাসরি পর্যবেক্ষণের মাধ্যমে, আলোকসজ্জা ক্যাথেটার (মেডলাইট এস.এ., আরডি10-323, সুইজারল্যান্ড) কোল্যাঞ্জিওস্কোপের মাধ্যমে প্রবেশ করানো হয়। এটি একটি সাধারণ তিন-মুখী ক্যানুলা নিয়ে গঠিত। প্রথম পোর্টে ১ সেমি লম্বা একটি নলাকার আলো বিচ্ছুরক রয়েছে। দুটি কালো রেডিওopaque চিহ্ন বিচ্ছুরকের সীমা চিহ্নিত করে। দ্বিতীয় পোর্টে ০.০২৫ ইঞ্চি গাইডের তার এবং তৃতীয়টি ইনজেকশনের জন্য একটি পোর্ট। কোল্যাঞ্জিওস্কোপিক গাইডের অধীনে স্থাপন করার পরে, আলোকসজ্জা শুরু করা হয়। ডোজ হল ৯০ জুল/সেমি², ক্ষমতা ৭০ মিলিওয়াট/সেমি²। পুরো স্টেনোটিক এলাকা জুড়ে দেওয়ার জন্য প্রতি সেন্টিমিটারে পুনরায় স্থাপন করার পরামর্শ দেওয়া হয়। পদ্ধতির শেষে, নতুন কোল্যাঞ্জিওস্কোপির মাধ্যমে পিত্তনালীর তাৎক্ষণিক ফলাফল এবং বিরূপ ঘটনা মূল্যায়ন করা হয়।\n\nপদ্ধতির পরবর্তী যত্ন\nরোগীকে পরবর্তী ২৪ ঘণ্টা উপোস রাখা হয়। যদি কোনো বিরূপ ঘটনা সনাক্ত না হয়, তবে মুখে খাবার দেওয়া শুরু করা হয়। হাসপাতালে থেকে যাওয়ার সময়, আলোক সুরক্ষা (আলোর সংস্পর্শে আসা থেকে বিরত থাকা এবং সানগ্লাস ব্যবহার করা) সম্পর্কে কঠোর নির্দেশনা দেওয়া হয়, বিশেষ করে টিএফডি সেশনের প্রথম সপ্তাহে।\n\nফলাফল\nএই পদ্ধতিটি ৮২ বছর বয়সী একজন পুরুষের উপর করা হয়েছিল, যিনি আমাদের তৃতীয় স্তরের কেন্দ্রে অবস্ট্রাকটিভ জন্ডিস এবং বিগত দুই মাসে ওজন হ্রাস নিয়ে এসেছিলেন। এন্ডোস্কোপিক আল্ট্রাসাউন্ড (ইইউএস) পিত্তনালীর গুরুতর প্রসারণ এবং কোলেডোকোলিথিয়াসিসের সাথে সম্পর্কিত असल्याचे প্রকাশ করে। ইআরসিপি এই ফলাফলগুলি নিশ্চিত করে, তবে পিত্তনালীর অতিরিক্ত প্রসারণের কারণে পাথর অপসারণ করতে পারেনি। তাই, একটি প্লাস্টিক বিলিয়ারি স্টেন্ট নির্বাচন করা হয়। রোগীর ক্লিনিকাল অবস্থার উন্নতি দেখা যায়, তবে প্রথম পদ্ধতির ৪৫ দিন পরে কোলেস্টেসিস ফিরে আসে। আরও দুটি ইআরসিপি পাথর অপসারণে ব্যর্থ হয়। তৃতীয় পদ্ধতির সময়, সাধারণ হেপাটিক ডাক্টে একটি দীর্ঘ, অনিয়মিত স্টেনোসিস দেখা যায় এবং তাকে আরও একটি ইকোএন্ডোস্কোপিক মূল্যায়নের জন্য পাঠানো হয়।\n\nকোলেডোকোলিথিয়াসিসের পাশাপাশি, নতুন ইইউএস-এ একটি প্রসারিত সাধারণ হেপাটিক ডাক্ট দেখা যায়, যেখানে ১.৮x২ সেমি আকারের একটি সুস্পষ্ট হাইপোইক সলিড ভর ছিল, যা সাধারণ হেপাটিক ডাক্টকে সংকুচিত করছিল। ভরটি সাধারণ হেপাটিক ধমনীকেও প্রভাবিত করছিল। আল্ট্রাসাউন্ড-নির্দেশিত নিডেল বায়োপসি মাঝারিভাবে পার্থক্যযুক্ত কোল্যাঞ্জিওকার্সিনোমার (বিসমুথ আই) রোগ নির্ণয় নিশ্চিত করে।\n\nস্টেজ করার পরে, ভরটিকে অস্ত্রোপচারযোগ্য নয় বলে বিবেচনা করা হয় এবং রোগীকে উপশমমূলক চিকিৎসার জন্য পাঠানো হয়। অনকোলজি দলের সাথে একটি বহু-বিষয়ক বৈঠকের পরে, পুনরাবৃত্ত বিলিয়ারি অবস্ট্রাকশন নিরাময়ের জন্য সহায়ক পিডিটি প্রস্তাব করা হয়। পদ্ধতিটি জটিলতা ছাড়াই সম্পন্ন হয় এবং ১৫০ মিনিট স্থায়ী হয়। শেষে, একটি ১০ ফ্র প্লাস্টিক স্টেন্ট দিয়ে বিলিয়ারি ড্রেনেজ করা হয়, কারণ সেই সময়ে একটি স্ব-প্রসারিত ধাতব স্টেন্ট পাওয়া যায়নি।\n\nরোগীর নিম্নলিখিত সপ্তাহে ফটোসেন্সিটিভিটির কোনো লক্ষণ বা উপসর্গ দেখা যায়নি। তবে, কোলেস্টেসিসের প্রাথমিক পুনরাবৃত্তি দেখা যায়, যা কোল্যাঞ্জাইটিসের সাথে জটিল ছিল। ইআরসিপি-তে টিউমার নেক্রোসিসের কারণে স্টেন্টে ধ্বংসাবশেষ এবং বিলিয়ারি শ্লেষ্মা জমে থাকার কারণে বাধা দেখা যায়। একটি বিলিয়ারি স্ক্যান এবং নতুন ড্রেনেজের মাধ্যমে রোগীর তীব্র অবস্থার উন্নতি হয়। এরপর, তিনি তিন মাস উপসর্গবিহীন ছিলেন, যা রোগের শুরু থেকে দীর্ঘতম সময়কাল ছিল। পরবর্তী পুনরাবৃত্তিতে, একটি স্ব-প্রসারিত ধাতব স্টেন্ট দিয়ে তার ড্রেনেজ করা হয়। তিনি পদ্ধতিগত চিকিৎসা চালিয়ে যান এবং শেষ পর্যন্ত ডিসফ্যাগিয়ার উপশমের জন্য একটি ডুওডেনাল স্টেন্টের প্রয়োজন হয়। উপসর্গের শুরু হওয়ার দুই বছর পর এবং টিএফডি সেশনের ১৫ মাস পরে জটিলতার কারণে তিনি মারা যান।",
+    "translated_summary": "রোগীকে পদ্ধতির ২৪ ঘণ্টা আগে শিরায় ফটোসেন্সিটাইজার দেওয়া হয়, যা সাধারণ ডিওডেনোস্কোপি দিয়ে শুরু হয়। প্রধান প্যাপিলা শনাক্তকরণ এবং রেট্রোগ্রেড ক্যানুলেশনের পরে, ডিজিটাল কোল্যাঞ্জিওস্কোপটি সাধারণ পিত্তনালীতে প্রবেশ করানো হয়। এরপর কোল্যাঞ্জিওস্কোপিক পরীক্ষা নব্যোপ্লাস্টিক স্টেনোসিস শনাক্ত করতে সাহায্য করে। সরাসরি পর্যবেক্ষণের মাধ্যমে, আলোকসজ্জা ক্যাথেটার কোল্যাঞ্জিওস্কোপের মাধ্যমে ধীরে ধীরে প্রবেশ করানো হয়। প্রতি সেন্টিমিটারে এর অবস্থান পরিবর্তন করা হয়। কোল্যাঞ্জিওস্কোপির শেষে, পিত্তনালীর তাৎক্ষণিক ফলাফল এবং বিরূপ ঘটনাগুলো মূল্যায়ন করা হয়।\n\nফলাফল: এই পদ্ধতিটি ৮২ বছর বয়সী একজন রোগীর ওপর করা হয়েছিল, যিনি গত দুই মাস ধরে অবস্ট্রাকটিভ জন্ডিসে ভুগছিলেন। ইইউএস এবং ইআরসিপি-তে দেখা যায় যে সাধারণ পিত্তনালীর মারাত্মক প্রসারণ হয়েছে এবং এর সাথে কোলেডোকোলিথিয়াসিসও রয়েছে। এছাড়াও, হেপাটিক ডাক্টের প্রসারণ দেখা যায়, যেখানে একটি সুস্পষ্ট হাইপোইকোলিক কঠিন পিণ্ড ছিল, যার আকার ১.৮x২ সেন্টিমিটার এবং এটি সাধারণ হেপাটিক ডাক্টকে সংকুচিত করছিল। এটিকে অস্ত্রোপচারযোগ্য নয় বলে বিবেচনা করা হয় এবং রোগীকে পিডিটি-এর মাধ্যমে উপশমমূলক চিকিৎসার জন্য পাঠানো হয়, যার ফলে তিনি তিন মাস কোনো উপসর্গ ছাড়াই ছিলেন। পিডিটি সেশনের ১৫ মাস পর জটিলতার কারণে তিনি মারা যান।"
+  },
+  {
+    "id": "multiclinsum_gs_en_201.txt",
+    "fulltext": "A 77-year-old woman with haematemesis presented to the emergency room. Her medical history included only hypertension and dyslipidaemia. When she presented to the emergency room, her vital signs indicated shock (heart rate: 100 beats/min, blood pressure: 79/56 mmHg), and blood tests revealed anaemia (haemoglobin: 9.6 g/dL), which suggested upper gastrointestinal bleeding.\n\nNon-contrast-enhanced CT was performed immediately because of renal dysfunction. CT revealed that the third part of the duodenum flexed steeply on the right side of the aorta and ran caudally, without crossing anterior to the aorta. The jejunum was located on the patient’s right side. The second part of the duodenum and the stomach were dilated, and there were high-density gastric contents that were considered to indicate a haematoma.\n\nUpper gastrointestinal endoscopy was performed following the CT examination, which revealed a mucosal laceration at the gastric cardia. Bleeding from lacerations of the cardia of the stomach as a result of forceful vomiting was first reported by Mallory and Weiss in 1929.1 In our case, the third part of the duodenum flexed steeply, and the lumen was narrowed, which caused an obstruction. As a result, repeat vomiting was considered to have caused Mallory–Weiss syndrome.\n\nOn the basis of the CT findings showing that the duodenal-jejunal junction was located in the right hemi-abdomen, intestinal malrotation was suspected.2 However, 7 days later, when CT was repeated, spontaneous resolution of the malpositioned jejunum was seen. The patient was then discharged from the hospital. However, months later, she was rushed to the emergency room for repeat haematemesis. Dynamic CT was performed before upper gastrointestinal endoscopy, on admission, and revealed contrast extravasation in the dilated stomach. Additionally, the third part of the duodenum was flexed on the right side of the aorta, and the duodenal-jejunal junction and jejunum were again located in the right hemi-abdomen. Upper gastrointestinal endoscopy revealed a laceration at the gastric cardia, as in the previous endoscopy, which was considered Mallory–Weiss syndrome.\n\nTwo months after the second episode of haematemesis, the patient presented to the emergency room with nausea. Non-contrast-enhanced CT revealed no abnormalities in the duodenal positioning, but there was oedematous wall thickening in the second part of the duodenum. If we had not had previous CT images, we would have suspected duodenitis, but on the basis of all of the CT findings, we suspected the possibility of an underlying condition after the right-sided deviation of the small intestine had resolved spontaneously.\n\nIn summary, CT was performed 4 times over 5 months. The third and fourth parts of the duodenum and the jejunum deviated repeatedly, but this resolved spontaneously, which is not indicative of intestinal malrotation. Therefore, we diagnosed dysplasia of the ligament of Treitz.\n\nClinical outcomes\nThe patient underwent laparotomy, which revealed no abnormalities in the relative position of the duodenum to the jejunum. Additionally, the jejunum was located on the patient’s left side, and there was no intestinal malrotation. The ligament of Treitz was formed; however, its fixation in the upper jejunum was incomplete as it was attached only to the duodenum. The duodenal-jejunal junction was not fixed to the retroperitoneum, and the jejunum folded easily with the ligament of Treitz as a fulcrum. Surgically, the upper jejunum was fixed with 4 sutures to the retroperitoneum on the patient’s left side. The postoperative course was good, and the patient has remained symptom-free.",
+    "summary": "A 77-year-old woman underwent CT to evaluate haematemesis. The images showed that the third part of the duodenum flexed steeply on the right side of the aorta and ran caudally, without crossing anterior to the aorta. The duodenal-jejunal junction and jejunum were located on the patient's right side. Upper gastrointestinal endoscopy revealed a laceration at the gastric cardia, and a diagnosis of Mallory-Weiss syndrome was made. Repeat CT 7 days later revealed that the abnormal positioning of the intestinal tract had resolved spontaneously. Two months later, the patient experienced another episode of haematemesis, and CT revealed repeat deviation of the duodenal-jejunal junction and jejunum to her right side. Upper gastrointestinal endoscopy revealed another laceration at the gastric cardia, as in the previous study. On the basis of the initial CT findings showing the duodenal-jejunal junction in the right hemi-abdomen, intestinal malrotation was suspected. However, because the jejunum deviated repeatedly to the right side but resolved spontaneously, we diagnosed dysplasia of the ligament of Treitz. Laparotomy revealed a formed ligament of Treitz; however, fixation in the upper jejunum was incomplete. Additionally, CT revealed that the anterior pararenal space was loosely fixed and mobile. These factors may have caused the right-sided deviation of the small intestine.",
+    "translated_fulltext": "একজন ৭৭ বছর বয়সী মহিলা, যিনি রক্তবমি (হেম্যাটেমেসিস) নিয়ে জরুরি বিভাগে এসেছিলেন। তার পূর্বের স্বাস্থ্য সংক্রান্ত তথ্যে উচ্চ রক্তচাপ এবং ডিসলিপিডেমিয়া ছাড়া আর কিছু ছিল না। জরুরি বিভাগে আসার সময়, তার শারীরিক অবস্থা দেখে বোঝা যাচ্ছিল যে তিনি শকে আছেন (হৃদস্পন্দন: ১০০ বিট/মিনিট, রক্তচাপ: ৭৯/৫৬ মিমি Hg), এবং রক্ত পরীক্ষার ফলাফলে রক্তাল্পতা (হিমোগ্লোবিন: ৯.৬ গ্রাম/ডিএল) দেখা যায়, যা সম্ভবত পরিপাকতন্ত্রের উপরের অংশে রক্তক্ষরণের ইঙ্গিত দেয়।\n\nকিডনির কার্যকারিতা দুর্বল থাকায় দ্রুত একটি নন-কন্ট্রাস্ট-এনহ্যান্সড সিটি স্ক্যান করা হয়। সিটি স্ক্যানে দেখা যায় যে ডিওডেনামের তৃতীয় অংশটি অ্যাওর্টার ডান দিকে তীক্ষ্ণভাবে বাঁকানো এবং কডালি দিকে বিস্তৃত, কিন্তু অ্যাওর্টার সামনের দিক দিয়ে যায়নি। জেজুনাম রোগীর ডান দিকে অবস্থিত ছিল। ডিওডেনামের দ্বিতীয় অংশ এবং পাকস্থলী প্রসারিত ছিল, এবং সেখানে উচ্চ ঘনত্বের গ্যাস্ট্রিক উপাদান ছিল, যা সম্ভবত একটি হেমাটোমার ইঙ্গিত দেয়।\n\nসিটি স্ক্যান করার পরে, পরিপাকতন্ত্রের উপরের অংশে এন্ডোস্কোপি করা হয়, যেখানে গ্যাস্ট্রিক কার্ডিয়ার অংশে একটি মিউকোসাল ল্যাক্সারেশন দেখা যায়। পাকস্থলীর কার্ডিয়ার অংশে আঘাতের কারণে রক্তক্ষরণ, যা অতিরিক্ত বমির কারণে হয়, প্রথম ১৯২৯ সালে ম্যালরি এবং ওয়েইস উল্লেখ করেছিলেন। আমাদের ক্ষেত্রে, ডিওডেনামের তৃতীয় অংশটি তীক্ষ্ণভাবে বাঁকানো ছিল এবং এর ভেতরের অংশটি সংকীর্ণ ছিল, যার ফলে একটি বাধা সৃষ্টি হয়েছিল। এর ফলে, মনে করা হয় যে বারবার বমির কারণে ম্যালরি-ওয়েইস সিনড্রোম হয়েছে।\n\nসিটি স্ক্যানের ফলাফলের ভিত্তিতে, যেখানে দেখা যায় ডিওডেনো-জেজুনাল জাংশনটি ডান হেমী-অ্যাবডোমেনে অবস্থিত, তাই অন্ত্রের স্থানচ্যুতি সন্দেহ করা হয়েছিল। তবে, ৭ দিন পরে, যখন সিটি স্ক্যানটি আবার করা হয়, তখন দেখা যায় যে স্থানচ্যুত জেজুনাম স্বাভাবিক অবস্থায় ফিরে এসেছে। এরপর রোগীকে হাসপাতাল থেকে ছুটি দেওয়া হয়। কিন্তু, কয়েক মাস পরে, তিনি আবার রক্তবমি নিয়ে জরুরি বিভাগে আসেন। পরিপাকতন্ত্রের উপরের অংশে এন্ডোস্কোপি করার আগে, হাসপাতালে ভর্তির সময় একটি ডায়নামিক সিটি স্ক্যান করা হয়, যেখানে প্রসারিত পাকস্থলীতে কন্ট্রাস্টের নিঃসরণ দেখা যায়। এছাড়াও, ডিওডেনামের তৃতীয় অংশটি অ্যাওর্টার ডান দিকে বাঁকানো ছিল এবং ডিওডেনো-জেজুনাল জাংশন এবং জেজুনাম আবার ডান হেমী-অ্যাবডোমেনে অবস্থিত ছিল। পরিপাকতন্ত্রের উপরের অংশে এন্ডোস্কোপিতে গ্যাস্ট্রিক কার্ডিয়ার অংশে একটি ল্যাক্সারেশন দেখা যায়, যা আগের এন্ডোস্কোপির মতোই ছিল এবং এটিকে ম্যালরি-ওয়েইস সিনড্রোম হিসেবে গণ্য করা হয়।\n\nদ্বিতীয়বার রক্তবমি হওয়ার দুই মাস পর, রোগী বমি বমি ভাব নিয়ে জরুরি বিভাগে আসেন। নন-কন্ট্রাস্ট-এনহ্যান্সড সিটি স্ক্যানে ডিওডেনামের অবস্থানে কোনো অস্বাভাবিকতা দেখা যায়নি, তবে ডিওডেনামের দ্বিতীয় অংশে ইডিমেটাস প্রাচীর দেখা যায়। যদি আমাদের কাছে আগের সিটি স্ক্যানের ছবি না থাকত, তবে আমরা ডিওডেনাইটিস সন্দেহ করতাম, কিন্তু সিটি স্ক্যানের সমস্ত ফলাফলের ভিত্তিতে, আমরা মনে করি যে ছোট অন্ত্রের ডান দিকে স্থানচ্যুতি স্বাভাবিক হওয়ার পরে অন্য কোনো অন্তর্নিহিত সমস্যা থাকতে পারে।\n\nসংক্ষেপে, ৫ মাসের মধ্যে ৪ বার সিটি স্ক্যান করা হয়েছিল। ডিওডেনামের তৃতীয় এবং চতুর্থ অংশ এবং জেজুনাম বারবার স্থানচ্যুত হয়েছিল, কিন্তু এটি নিজে থেকেই স্বাভাবিক হয়ে যায়, যা অন্ত্রের স্থানচ্যুতি নির্দেশ করে না। তাই, আমরা ট্রেইটজের লিগামেন্টের ডিসপ্লাসিয়া নির্ণয় করি।\n\nক্লিনিক্যাল ফলাফল\nরোগীর ল্যাপারোটমি করা হয়, যেখানে ডিওডেনাম এবং জেজুনামের আপেক্ষিক অবস্থানে কোনো অস্বাভাবিকতা দেখা যায়নি। এছাড়াও, জেজুনাম রোগীর বাম দিকে অবস্থিত ছিল এবং অন্ত্রের কোনো স্থানচ্যুতি ছিল না। ট্রেইটজের লিগামেন্ট গঠিত হয়েছিল; তবে, এটি ডিওডেনামের সাথে সংযুক্ত থাকায় উপরের জেজুনামে এর স্থিতিশীলতা অসম্পূর্ণ ছিল। ডিওডেনো-জেজুনাল জাংশনটি রেট্রোপেরিটোনিয়ামের সাথে যুক্ত ছিল না এবং জেজুনাম ট্রেইটজের লিগামেন্টকে কেন্দ্র করে সহজেই ভাঁজ হতে পারত। অস্ত্রোপচারের মাধ্যমে, উপরের জেজুনামকে ৪টি সেলাই দিয়ে রোগীর বাম দিকের রেট্রোপেরিটোনিয়ামের সাথে যুক্ত করা হয়। অস্ত্রোপচারের পরবর্তী অবস্থা ভালো ছিল এবং রোগী উপসর্গমুক্ত রয়েছেন।",
+    "translated_summary": "একজন ৭৭ বছর বয়সী মহিলা রক্তবমি হওয়ার কারণ নির্ণয়ের জন্য সিটি স্ক্যান করান। ছবিতে দেখা যায়, ডিওডেনামের তৃতীয় অংশটি অ্যাওর্টার ডান দিকে খাড়াভাবে বাঁকানো এবং কডালি দিকে বিস্তৃত, কিন্তু অ্যাওর্টার সামনের দিক দিয়ে যায়নি। ডিওডেনো-জেজুন্যাল জাংশন এবং জেজুন্যাম রোগীর ডান দিকে অবস্থিত ছিল। ঊর্ধ্ব গ্যাস্ট্রোইনটেস্টাইনাল এন্ডোস্কোপিতে গ্যাস্ট্রিক কার্ডিয়ার কাছে একটি ক্ষত দেখা যায় এবং ম্যালরি-ওয়েইস সিনড্রোমের রোগ নির্ণয় করা হয়। সাত দিন পর পুনরায় সিটি স্ক্যান করে দেখা যায়, অন্ত্রের অস্বাভাবিক অবস্থানটি আপনাআপনি ঠিক হয়ে গেছে। দুই মাস পর, রোগীর আবার রক্তবমি হয় এবং সিটি স্ক্যানে দেখা যায় ডিওডেনো-জেজুন্যাল জাংশন এবং জেজুন্যাম আবার ডান দিকে সরে গেছে। ঊর্ধ্ব গ্যাস্ট্রোইনটেস্টাইনাল এন্ডোস্কোপিতে গ্যাস্ট্রিক কার্ডিয়ার কাছে আরেকটি ক্ষত দেখা যায়, যা আগের পরীক্ষার মতোই ছিল। প্রাথমিক সিটি স্ক্যানের ফলাফলে ডিওডেনো-জেজুন্যাল জাংশনটি ডান হেমী-অ্যাবডোমেনে দেখা যাওয়ায় অন্ত্রের স্থানচ্যুতি সন্দেহ করা হয়েছিল। তবে, যেহেতু জেজুন্যাম বারবার ডান দিকে সরে যাচ্ছিল কিন্তু আপনাআপনি ঠিক হয়ে যাচ্ছিল, তাই আমরা ট্রেইটজের লিগামেন্টের ডিসপ্লাসিয়া নির্ণয় করি। ল্যাপারোটমিতে একটি গঠিত ট্রেইটজের লিগামেন্ট দেখা যায়; তবে, ঊর্ধ্ব জেজুন্যামে এর সংযুক্তি অসম্পূর্ণ ছিল। এছাড়াও, সিটি স্ক্যানে দেখা যায় যে অ্যানটেরিয়র প্যারারেনাল স্থানটি আলগাভাবে সংযুক্ত এবং নড়াচড়া করতে পারে। এই কারণগুলো সম্ভবত ক্ষুদ্রান্ত্রের ডান দিকে স্থানচ্যুতির কারণ হতে পারে।"
+  },
+  {
+    "id": "multiclinsum_gs_en_40.txt",
+    "fulltext": "A 12-year-old boy with Down Syndrome and motoric disorders was referred from the Pediatric Department to the Oral Medicine Department of RS Hasan Sadikin Bandung. The patient was diagnosed with Down Syndrome and myeloradiculopathy. The patient’s mother said that the patient was admitted to the hospital because of weakness in both patient’s hands and feet. The patient had a history of falling down about one year ago. The patient’s mother also had a difficulty in cleaning the patient’s oral cavity regularly.\n\nIn the extraoral examination, the patient had a dysmorphic face. The patient also had a cracking and desquamative condition of the vermillion border of the lips. Lymph node examination could not be assessed because the patient wore a cervical collar. The intraoral examination showed an irregular ulcer with 1×0.7 cm in diameter, indurated margin, and white-yellowish base at the right lateral border of the tongue. There was dentinal caries on 63 tooth and also the tooth remnants on 55, 62, 74, and 85 teeth. The upper and lower tooth remnants were suggested to be extracted by pediatric dentist. The space of the extracted teeth will be maintained using a space maintainer. The 55 tooth was sharp and caused an occlusion trauma to the right lateral border of the tongue.\n\nLaboratory examination showed a decrease in sodium value (130 mEq/L) and an increase in lymphocyte value (46%). The MRI examination was performed in the Radiology Department to determine the presence of abnormalities in the cervical spine. The results of the MRI examination showed a dislocation of the patient’s cervical spine. The patient’s mother provided informed consent to publish the patient’s case details and any accompanying images.\n\nBased on the history review, the clinical examination, and appropriate investigation, the patient was diagnosed with a chronic traumatic ulcer mimicking OSCC, exfoliative cheilitis, reversible pulpitis of 63 teeth, and radix gangrene on 55, 62, 74, and 85 teeth. The diagnosis of the chronic ulcer was based on clinical examination. There was an indurated margin in the traumatic lesion, which mimicked Oral Squamous Cell Carcinoma clinically. The patient has been hospitalized for 4 days and was given paracetamol 120 mg/5 mL oral suspension and amoxicillin 125 mg/5 mL oral suspension from the Pediatric Department. The patient also was given sodium chloride 0.9% solution, povidone-iodine mouthwash 1%, and petroleum jelly from the Oral Medicine Department. The patient’s mother was instructed to clean the patient’s oral cavity using gauze soaked in sodium chloride 0.9% solution, compress the ulcer using povidone-iodine mouthwashes 1% three times a day as an antiseptic and anti-inflammatory agent to the oral ulcer, and apply petroleum jelly to moisturize the patient’s lips. The patient was also suggested to extract the 55, 62, 74, and 85 teeth.\n\nIn the second visit (3 days follow-up), oral lesions already showed improvement. In the third visit (1-week follow-up), the size of the oral ulcer at the lateral border of the tongue was getting smaller and the lesion of the lips had some improvement.\n\nIn the fourth visit (10 days follow-up), the size of the oral ulcer at the lateral border of the tongue already had significant improvement. Two days after the fourth visit, the patient underwent neurosurgery. The patient was observed in the Pediatric Intensive Care Unit postoperatively. After two weeks of observation in the Pediatric Intensive Care Unit, the experienced respiratory failure and was declared dead.",
+    "summary": "A 12-year-old boy with Down Syndrome and motoric disorders was referred to Oral Medicine Department. In the extraoral examination, the patient had a dysmorphic face and dry lips. Lymph node examination could not be assessed because the patient wore a cervical collar. The intraoral examination showed an irregular ulcer with 1×0.7 cm in diameter, indurated margin, and white-yellowish base at the right lateral border of the tongue. The 55 teeth were sharp and caused an occlusion trauma to the right lateral border of the tongue. The patient was diagnosed with a chronic traumatic ulcer mimicking OSCC based on clinical examination. The medication given to the patient were sodium chloride 0.9%, povidone-iodine mouthwash 1%, and petroleum jelly.",
+    "translated_fulltext": "ডাউন সিনড্রোম এবং মোটরজনিত সমস্যায় আক্রান্ত ১২ বছর বয়সী একটি ছেলেকে আরএস হাসান সাডিকিন বান্দুং-এর শিশু বিভাগ থেকে ওরাল মেডিসিন বিভাগে পাঠানো হয়। রোগীকে ডাউন সিনড্রোম এবং মায়েলোরাডিকুলোপ্যাথি নির্ণয় করা হয়। রোগীর মা জানান যে রোগীর হাত ও পায়ে দুর্বলতার কারণে তাকে হাসপাতালে ভর্তি করা হয়েছে। রোগীর এক বছর আগে পড়ে গিয়ে আঘাত লেগেছিল। রোগীর মায়ের রোগীর মুখের ভেতরের অংশ নিয়মিত পরিষ্কার করতে অসুবিধা হতো।\n\nবাহ্যিক পরীক্ষায় দেখা যায় রোগীর মুখে ডিসমরফিক বৈশিষ্ট্য রয়েছে। রোগীর ঠোঁটের চারপাশে চামড়া ফেটে যাওয়া এবং খসে পড়ার মতো সমস্যা ছিল। রোগীর গলায় একটি সারভাইকাল কলার থাকায় লিম্ফ নোড পরীক্ষা করা যায়নি। মুখের ভেতরের পরীক্ষায় দেখা যায়, জিভের ডান পাশের প্রান্তে ১×০.৭ সেমি আকারের একটি অনিয়মিত আলসার রয়েছে, যার কিনারা শক্ত এবং ভেতরের অংশ সাদা-হলুদ। ৬৩ নম্বর দাঁতে ডেন্টিনাল ক্যারিজ এবং ৫৫, ৬২, ৭৪ ও ৮৫ নম্বর দাঁতের অবশিষ্টাংশ দেখা যায়। শিশু বিভাগের একজন ডেন্টিস্ট পরামর্শ দেন যে উপরের ও নিচের দাঁতের অবশিষ্টাংশগুলো তুলে ফেলতে হবে। দাঁত তোলার পরে স্থানটি একটি স্পেস মেইনটেইনার দিয়ে ঠিক রাখা হবে। ৫৫ নম্বর দাঁতটি ধারালো ছিল এবং এটি জিভের ডান পাশের প্রান্তে আঘাত করছিল।\n\nল্যাবরেটরি পরীক্ষায় দেখা যায়, রোগীর শরীরে সোডিয়ামের মাত্রা কমে গেছে (১৩০ এমইকিউ/এল) এবং লিম্ফোসাইটের মাত্রা বেড়ে গেছে (৪৬%)। সারভাইকাল স্পাইনে কোনো অস্বাভাবিকতা আছে কিনা, তা জানার জন্য রেডিওলজি বিভাগে এমআরআই করা হয়। এমআরআই পরীক্ষায় দেখা যায়, রোগীর সারভাইকাল স্পাইন স্থানচ্যুত হয়েছে। রোগীর মা রোগীর চিকিৎসার বিবরণ এবং ছবি প্রকাশ করার জন্য সম্মতি দেন।\n\nইতিহাস, ক্লিনিক্যাল পরীক্ষা এবং অন্যান্য পরীক্ষার ফলাফলের ভিত্তিতে রোগীকে ক্রনিক ট্রমাটিক আলসার (যা ওরাল স্কোয়ামাস সেল কার্সিনোমার মতো), এক্সফোলিয়েটিভ কেইলিটিস, ৬৩ নম্বর দাঁতের রিভার্সিবল পালপাইটিস এবং ৫৫, ৬২, ৭৪ ও ৮৫ নম্বর দাঁতের রেডিক্স গ্যাংগ্রিন রোগ নির্ণয় করা হয়। ক্রনিক আলসারের রোগ নির্ণয় ক্লিনিক্যাল পরীক্ষার ওপর ভিত্তি করে করা হয়। ট্রমাটিক ক্ষতটিতে শক্ত কিনারা দেখা যায়, যা দেখতে ওরাল স্কোয়ামাস সেল কার্সিনোমার মতো। রোগীকে ৪ দিন হাসপাতালে রাখা হয় এবং শিশু বিভাগ থেকে প্যারাসিটামল ১২০ মিগ্রা/৫ মিলি ওরাল সাসপেনশন এবং অ্যামোক্সিসিলিন ১২৫ মিগ্রা/৫ মিলি ওরাল সাসপেনশন দেওয়া হয়। ওরাল মেডিসিন বিভাগ থেকে সোডিয়াম ক্লোরাইড ০.৯% দ্রবণ, পোভিডোন-আয়োডিন মাউথওয়াশ ১% এবং পেট্রোলিয়াম জেলি দেওয়া হয়। রোগীর মাকে নির্দেশ দেওয়া হয়, সোডিয়াম ক্লোরাইড ০.৯% দ্রবণে ভেজানো গজ দিয়ে রোগীর মুখের ভেতরের অংশ পরিষ্কার করতে, পোভিডোন-আয়োডিন মাউথওয়াশ ১% দিয়ে দিনে তিনবার আলসারটিতে অ্যান্টিসেপটিক ও অ্যান্টি-ইনফ্ল্যামেটরি হিসেবে ব্যবহার করতে এবং পেট্রোলিয়াম জেলি দিয়ে রোগীর ঠোঁট ময়েশ্চারাইজ করতে। এছাড়াও, ৫৫, ৬২, ৭৪ ও ৮৫ নম্বর দাঁতগুলো তুলে ফেলার পরামর্শ দেওয়া হয়।\n\nদ্বিতীয় ভিজিটে (৩ দিন পর), মুখের ক্ষতগুলোতে উন্নতি দেখা যায়। তৃতীয় ভিজিটে (১ সপ্তাহ পর), জিভের পাশের প্রান্তে মুখের আলসারের আকার ছোট হয়ে আসে এবং ঠোঁটের ক্ষতগুলোতেও কিছু উন্নতি দেখা যায়।\n\nচতুর্থ ভিজিটে (১০ দিন পর), জিভের পাশের প্রান্তে মুখের আলসারের আকারে উল্লেখযোগ্য উন্নতি হয়। চতুর্থ ভিজিটের দুই দিন পর, রোগীর নিউরোসার্জারি করা হয়। অস্ত্রোপচারের পর রোগীকে পেডিয়াট্রিক ইনটেনসিভ কেয়ার ইউনিটে রাখা হয়। পেডিয়াট্রিক ইনটেনসিভ কেয়ার ইউনিটে দুই সপ্তাহ পর্যবেক্ষণে রাখার পর, রোগীর শ্বাসকষ্ট দেখা দেয় এবং তাকে মৃত ঘোষণা করা হয়।",
+    "translated_summary": "ডাউন সিনড্রোম এবং মোটরজনিত সমস্যায় আক্রান্ত ১২ বছর বয়সী একটি ছেলেকে ওরাল মেডিসিন বিভাগে পাঠানো হয়। বহিঃপরীক্ষায় দেখা যায়, রোগীর মুখে অস্বাভাবিক গঠন এবং ঠোঁট শুষ্ক। রোগীর গলায় একটি সারভাইকাল কলার থাকায় লিম্ফ নোড পরীক্ষা করা সম্ভব হয়নি। অন্তঃপরীক্ষায় দেখা যায়, জিবের ডান পাশের প্রান্তে ১×০.৭ সেমি আকারের একটি অনিয়মিত আলসার রয়েছে, যার কিনারা শক্ত এবং রং সাদা-হলুদ। রোগীর দাঁতগুলো তীক্ষ্ণ ছিল এবং এর কারণে জিবের ডান পাশের প্রান্তে আঘাত লাগছিল। ক্লিনিক্যাল পরীক্ষার মাধ্যমে রোগীকে ক্রনিক ট্রমাটিক আলসার হিসেবে নির্ণয় করা হয়, যা ওএসসি-র (OSCC) মতো দেখাচ্ছিল। রোগীকে ০.৯% সোডিয়াম ক্লোরাইড, ১% পোভিডোন-আয়োডিন মাউথওয়াশ এবং পেট্রোলিয়াম জেলি দেওয়া হয়েছিল।"
+  },
+  {
+    "id": "multiclinsum_gs_en_3.txt",
+    "fulltext": "We present a case of a 59-year-old lady with a twelve-year history of secondary progressive multiple sclerosis who was referred to ophthalmology with a few weeks’ history of bilateral blurring of vision.\n\nThe patient had no past ophthalmic history and no drug history other than the anti-epileptic medications related to her multiple sclerosis. Previously documented ophthalmic examinations did not reveal any signs of Fuchs' endothelial corneal dystrophy, and the patient has no family history of corneal pathology.\n\nThe patient had been on amantadine therapy at a dose of 100mg twice daily for the past 7 years and was started on levetiracetam 250mg twice daily as an add-on agent. Visual deterioration was experienced shortly after commencement of levetiracetam therapy for a breakthrough seizure.\n\nOn examination, the patient’s best corrected visual acuity was 0.5 logMAR right eye and 0.5 logMAR left eye. Slit-lamp examination revealed corneal edema involving both eyes and absence of uveitis. Corrected intraocular pressures were 16mmHg right eye and 18mmHg left eye. Corneal topography was performed which confirmed bilateral significant corneal thickening with a right central corneal thickness of 936μm and left central corneal thickness of 1134μm. The rest of the eye examination was normal.\n\nSince amantadine is a known cause of corneal edema, it was agreed with the patient and her caring neurologist to switch from amantadine to lamotrigine. Levetiracetam therapy was continued at this stage. No improvement in vision was noted two months after this change in treatment. The patient expressed the wish to temporarily stop levetiracetam on a trial basis in view of the direct temporal association between the onset of symptoms and the commencement of the medication.\n\nAmantadine was re-introduced, while levetiracetam dose was tapered. Improvement in vision was noted a few days after levetiracetam dose reduction. Levetiracetam was stopped altogether, and the patient remained on amantadine and lamotrigine. A provisional diagnosis of levetiracetam-induced corneal edema was made at this stage. Her vision normalized and repeat corneal topography six months after stopping the levetiracetam showed a right central corneal thickness of 567μm and a left central corneal thickness of 573μm, and a visual acuity of 0.2 logMAR both eyes. Slit-lamp examination confirmed clear cornea and the absence of corneal guttata in either eye.\n\nThe patient was examined again thirteen months after the first presentation. No further changes in her medications were made, and her vision had remained stable at 0.2 logMAR in both eyes. Repeat corneal topography showed no further changes.",
+    "summary": "A 59-year-old woman was referred to the ophthalmology department with a few weeks’ history of bilateral blurring of vision. She is a known case of secondary progressive multiple sclerosis, and she was started on levetiracetam by her neurologist a few weeks prior to referral in view of new seizure activity. Examination revealed bilateral clinically evident corneal edema, which was documented on corneal topography.\n\nResults\nUpon levetiracetam dose reduction, symptoms started to improve and eventually the medication was stopped altogether. The patient’s vision and corneal edema normalized on follow-up.",
+    "translated_fulltext": "আমরা এখানে ৫৯ বছর বয়সী একজন মহিলার ঘটনা তুলে ধরছি, যিনি ১২ বছর ধরে সেকেন্ডারি প্রগ্রেসিভ মাল্টিপল স্ক্লেরোসিসে ভুগছেন এবং কয়েক সপ্তাহ ধরে উভয় চোখের দৃষ্টি ঝাপসা হওয়ার কারণে চক্ষু বিভাগে রেফার করা হয়েছিলেন।\n\nরোগীর পূর্বে কোনো চক্ষু সংক্রান্ত সমস্যা ছিল না এবং মাল্টিপল স্ক্লেরোসের কারণে ব্যবহৃত অ্যান্টি-এপিলেপটিক ওষুধ ছাড়া অন্য কোনো ওষুধের ইতিহাসও ছিল না। পূর্বে করা চক্ষু পরীক্ষার নথিতে ফুচসের এন্ডোথেলিয়াল কর্নিয়াল ডিস্ট্রফির কোনো লক্ষণ পাওয়া যায়নি এবং রোগীর পরিবারে কর্নিয়ার কোনো রোগ ছিল না।\n\nগত ৭ বছর ধরে রোগী প্রতিদিন দুবার ১০০ মিলিগ্রাম করে অ্যামান্টাডিন গ্রহণ করছিলেন এবং একটি অতিরিক্ত ওষুধ হিসেবে প্রতিদিন দুবার ২৫০ মিলিগ্রাম করে লেভেтираসেটাম দেওয়া শুরু করা হয়। লেভেтираসেটাম থেরাপি শুরু করার অল্প সময়ের মধ্যেই, একটি আকস্মিক খিঁচুনির পরে দৃষ্টিশক্তি হ্রাস পায়।\n\nপরীক্ষায় দেখা যায়, রোগীর সবচেয়ে ভালো দৃষ্টিশক্তি ছিল ডান চোখে ০.৫ লগমার এবং বাম চোখে ০.৫ লগমার। স্লিট-ল্যাম্প পরীক্ষায় উভয় চোখের কর্নিয়াল ইডিমা এবং ইউভাইটিসের অনুপস্থিতি দেখা যায়। সঠিক ইন্ট্রাওকুলার চাপ ছিল ডান চোখে ১৬ মিমি Hg এবং বাম চোখে ১৮ মিমি Hg। কর্নিয়াল টপোগ্রাফি করা হয়, যেখানে উভয় চোখের কর্নিয়ার উল্লেখযোগ্য পুরুত্ব দেখা যায়; ডান চোখের কেন্দ্রীয় কর্নিয়ার পুরুত্ব ছিল ৯৩৬ মাইক্রোমিটার এবং বাম চোখের কেন্দ্রীয় কর্নিয়ার পুরুত্ব ছিল ১১৩৪ মাইক্রোমিটার। চোখের বাকি পরীক্ষা স্বাভাবিক ছিল।\n\nযেহেতু অ্যামান্টাডিন কর্নিয়াল ইডিমার একটি পরিচিত কারণ, তাই রোগীর সাথে এবং তার তত্ত্বাবধায়ক নিউরোলজিস্টের সাথে আলোচনা করে অ্যামান্টাডিন থেকে ল্যামোট্রিজিনে পরিবর্তন করার সিদ্ধান্ত নেওয়া হয়। এই পর্যায়ে লেভেтираসেটাম থেরাপি চালিয়ে যাওয়া হয়। এই পরিবর্তনের পর দুই মাস পর্যন্ত দৃষ্টিশক্তিতে কোনো উন্নতি দেখা যায়নি। রোগী সাময়িকভাবে লেভেтираসেটাম বন্ধ করার ইচ্ছা প্রকাশ করেন, কারণ লক্ষণ শুরু হওয়ার সাথে ওষুধের ব্যবহার শুরু করার একটি সরাসরি সম্পর্ক ছিল।\n\nঅ্যামান্টাডিন পুনরায় শুরু করা হয়, এবং লেভেтираসেটামের ডোজ কমানো হয়। লেভেтираসেটামের ডোজ কমানোর কয়েক দিন পর দৃষ্টিশক্তিতে উন্নতি দেখা যায়। লেভেтираসেটাম সম্পূর্ণরূপে বন্ধ করে দেওয়া হয়, এবং রোগী অ্যামান্টাডিন ও ল্যামোট্রিজিন গ্রহণ করতে থাকেন। এই পর্যায়ে লেভেтираসেটাম-এর কারণে কর্নিয়াল ইডিমা হয়েছে বলে প্রাথমিকভাবে ধারণা করা হয়। এরপর, লেভেтираসেটাম বন্ধ করার ছয় মাস পর পুনরায় কর্নিয়াল টপোগ্রাফি করা হলে দেখা যায়, ডান চোখের কেন্দ্রীয় কর্নিয়ার পুরুত্ব ৫৬৭ মাইক্রোমিটার এবং বাম চোখের কেন্দ্রীয় কর্নিয়ার পুরুত্ব ৫৭৩ মাইক্রোমিটার, এবং উভয় চোখের দৃষ্টিশক্তি ০.২ লগমার। স্লিট-ল্যাম্প পরীক্ষায় কর্নিয়া পরিষ্কার এবং উভয় চোখেই কর্নিয়াল গুটাটার অনুপস্থিতি দেখা যায়।\n\nপ্রথমবার দেখার পর ত্রয়োদশ মাসে রোগীকে আবার পরীক্ষা করা হয়। তার ওষুধে আর কোনো পরিবর্তন করা হয়নি এবং উভয় চোখের দৃষ্টিশক্তি ০.২ লগমার-এ স্থিতিশীল ছিল। পুনরায় কর্নিয়াল টপোগ্রাফি করা হলে আর কোনো পরিবর্তন দেখা যায়নি।",
+    "translated_summary": "৫৯ বছর বয়সী এক মহিলাকে চোখের সমস্যা নিয়ে চক্ষু বিভাগে পাঠানো হয়। কয়েক সপ্তাহ ধরে তার উভয় চোখের দৃষ্টি ঝাপসা হয়ে যাচ্ছিল। তিনি সেকেন্ডারি প্রগ্রেসিভ মাল্টিপল স্ক্লেরোসিসে আক্রান্ত, এবং কয়েক সপ্তাহ আগে তার স্নায়ুরোগ বিশেষজ্ঞ নতুন খিঁচুনি দেখা দেওয়ার কারণে তাকে লেভেтираসেটাম ওষুধ দেওয়া শুরু করেন। পরীক্ষায় দেখা যায়, তার উভয় চোখের কর্নিয়ায় দৃশ্যমানভাবে ফোলাভাব রয়েছে, যা কর্নিয়াল টপোগ্রাফিতে নথিভুক্ত করা হয়েছে।\n\nফলাফল\nলেভেтираসেটামের ডোজ কমানোর পর, তার উপসর্গগুলো ধীরে ধীরে উন্নতি হতে শুরু করে এবং অবশেষে ওষুধটি সম্পূর্ণরূপে বন্ধ করে দেওয়া হয়। ফলো-আপে দেখা যায়, রোগীর দৃষ্টি এবং কর্নিয়ার ফোলাভাব স্বাভাবিক হয়ে গেছে।"
+  },
+  {
+    "id": "multiclinsum_gs_en_346.txt",
+    "fulltext": "A 19-month-old boy was admitted to the Emergency Department because he fell from his baby feeding highchair. This fall occurred in apparent well-being, without the presence of anticipatory signs or symptoms. First, he fell on his gluteus and then he banged his head (occiput) on the ground. He presented with vomiting (three episodes) and he was very irritable. His respiratory rate and heart rate were >60 breaths and >150 beats per minute, while oxygen saturation was <80%. Upon physical examination, the child was hydrated and conscious, but irritable. More importantly, we noted subcostal retractions, and, at the auscultation, decreased breath sounds in the left basal part of chest. The patient was ventilated with an AMBU balloon connected to an oxygen source and monitored with a pulse oximeter. Despite our intervention, oxygen saturation fell below 70% and the more we ventilated, the more the saturation dropped down. The lung ultrasound showed the absence of the typical A lines and the consolidation of the lung, which was directly visualized as a solid parenchyma. On the basis of the poor clinical condition, the patient underwent orotracheal intubation with a cuffed endotracheal tube. After the baby was stabilized, he underwent a chest computed tomography (CT) showing complete atelectasis of the left lung with an interruption of the main left bronchus at 12 cm from bronchial bifurcation. An FBA was suspected as the mother also stated that the baby in the previous days had an intensive cough attack and disappeared within 24 h without any treatment. Therefore, a rigid bronchoscopy was performed and an almond of 2 cm in diameter in the main left bronchus was found and promptly removed.\n\nThe patient had never consumed almonds or other nuts before and in this circumstance ingested the almond by chance.\n\nThe baby had a progressive clinical improvement, and after 24 h, he was extubated and discharged from intensive care to be admitted to the general pediatrics ward for a few days with gradual and a total respiratory function recovery.",
+    "summary": "We describe the case of a 19-month-old boy who accessed the emergency room initially for a head trauma. The clinical evaluation, however, revealed an unexplained serious respiratory distress needing tracheal intubation. After our evaluation, we hypothesized that the severe respiratory distress determined an altered state of consciousness with following head trauma. The radiological findings raised the suspicion of foreign body aspiration for the presence of an atelectasis of the entire left lung. The computed tomography showed an abrupt interruption of the main bronchus at 12 mm from the hull. The following bronchoscopy identified an almond of 2 cm.",
+    "translated_fulltext": "১৯ মাস বয়সী একটি শিশুকে জরুরি বিভাগে ভর্তি করা হয়েছিল, কারণ সে তার খাবার চেয়ার থেকে পড়ে গিয়েছিল। আপাতদৃষ্টিতে সুস্থ অবস্থায় এই ঘটনা ঘটে, এবং এর আগে কোনো সতর্কতামূলক লক্ষণ বা উপসর্গ দেখা যায়নি। প্রথমে সে নিতম্বে পড়ে এবং তারপর তার মাথা (পশ্চাৎ করোটি) মাটিতে লাগে। এরপর সে তিনবার বমি করে এবং খুব অস্থির হয়ে পড়ে। তার শ্বাস-প্রশ্বাস এবং হৃদস্পন্দন প্রতি মিনিটে ৬০ বারের বেশি এবং হৃদস্পন্দন প্রতি মিনিটে ১৫০ বারের বেশি ছিল, যেখানে অক্সিজেনের মাত্রা ছিল ৮০% এর কম। শারীরিক পরীক্ষায় দেখা যায় শিশুটি যথেষ্ট পরিমাণে তরল গ্রহণ করেছে এবং সচেতন, কিন্তু অস্থির। সবচেয়ে গুরুত্বপূর্ণ বিষয় হলো, আমরা তার পাঁজর খাঁচার নিচে দেবে যাওয়া দেখতে পাই এবং স্টেথোস্কোপ দিয়ে শোনার সময় বুকের বাম দিকের নিচের অংশে শ্বাস-প্রশ্বাসের শব্দ কমে যাওয়া লক্ষ্য করি। রোগীকে একটি অ্যামবু বেলুনের মাধ্যমে অক্সিজেন সরবরাহ করা হয় এবং পালস অক্সিমিটার দিয়ে তার অবস্থা পর্যবেক্ষণ করা হয়। আমাদের চেষ্টা সত্ত্বেও, অক্সিজেনের মাত্রা ৭০% এর নিচে নেমে যায় এবং যত বেশি আমরা অক্সিজেন সরবরাহ করি, অক্সিজেনের মাত্রা ততই কমতে থাকে। ফুসফুসের আলট্রাসাউন্ডে দেখা যায় যে, ফুসফুসের স্বাভাবিক ‘এ’ লাইন অনুপস্থিত এবং ফুসফুস সংকুচিত হয়ে গেছে, যা সরাসরি একটি কঠিন প্যারেনকাইমা হিসেবে দেখা যায়। রোগীর শারীরিক অবস্থার অবনতি দেখে, তাকে একটি কাফযুক্ত এন্ডোট্রাকিয়াল টিউবের মাধ্যমে ওরোট্রাকিয়াল ইন্টিউবেশন করা হয়। শিশুটির অবস্থা স্থিতিশীল হওয়ার পরে, বুকের একটি সিটি স্ক্যান করা হয়, যেখানে দেখা যায় বাম ফুসফুস সম্পূর্ণরূপে সংকুচিত হয়ে গেছে এবং ব্রঙ্কিয়াল বাইফারকেশন থেকে ১২ সেন্টিমিটার দূরে প্রধান বাম ব্রঙ্কাসে বাধা সৃষ্টি হয়েছে। যেহেতু শিশুটির মা জানান যে, আগের কয়েক দিনে শিশুটির তীব্র কাশি হয়েছিল এবং কোনো চিকিৎসা ছাড়াই ২৪ ঘণ্টার মধ্যে তা সেরে যায়, তাই একটি বিদেশি বস্তু (FBA) গ্রহণের সন্দেহ করা হয়। এরপর একটি রিজিড ব্রঙ্কোস্কোপি করা হয় এবং প্রধান বাম ব্রঙ্কাসে ২ সেন্টিমিটার ব্যাসের একটি কাঠবাদাম পাওয়া যায়, যা দ্রুত অপসারণ করা হয়।\n\nশিশুটির আগে কখনো কাঠবাদাম বা অন্য কোনো বাদাম খাওয়ার অভ্যাস ছিল না এবং এই পরিস্থিতিতে সে ভুল করে কাঠবাদামটি খেয়ে ফেলেছিল।\n\nশিশুটির শারীরিক অবস্থার ধীরে ধীরে উন্নতি হয় এবং ২৪ ঘণ্টা পর, তাকে ইন্টেনসিভ কেয়ার থেকে সরিয়ে সাধারণ পেডিয়াট্রিক ওয়ার্ডে কয়েক দিনের জন্য ভর্তি করা হয়, যেখানে তার শ্বাস-প্রশ্বাস ধীরে ধীরে স্বাভাবিক অবস্থায় ফিরে আসে।",
+    "translated_summary": "আমরা একটি ১৯ মাস বয়সী ছেলের ঘটনা বর্ণনা করছি, যে প্রথমে মাথায় আঘাত লাগার কারণে জরুরি বিভাগে আসে। তবে, ক্লিনিক্যাল মূল্যায়নে দেখা যায় যে তার শ্বাসকষ্টের একটি গুরুতর কারণ রয়েছে, যার জন্য শ্বাসনালীতে টিউব প্রবেশ করানো প্রয়োজন। আমাদের মূল্যায়নের পর, আমরা অনুমান করি যে গুরুতর শ্বাসকষ্টের কারণে তার চেতনা পরিবর্তিত হয়েছে এবং এর পরেই মাথায় আঘাতটি লাগে। রেডিওলজিক্যাল পরীক্ষায় দেখা যায় যে বাম ফুসফুসের সম্পূর্ণ অংশ সংকুচিত হয়ে গেছে, যা কোনো বহিরাগত বস্তু শ্বাসনালীতে আটকে থাকার কারণে হয়েছে বলে সন্দেহ করা হয়। কম্পিউটেড টমোগ্রাফিতে দেখা যায় যে প্রধান শ্বাসনালীটি ১২ মিমি দূরত্বে হঠাৎ করে বন্ধ হয়ে গেছে। এরপর ব্রঙ্কোস্কোপি করে দেখা যায় যে সেখানে ২ সেন্টিমিটার আকারের একটি বাদামের টুকরা আটকে আছে।"
+  },
+  {
+    "id": "multiclinsum_gs_en_151.txt",
+    "fulltext": "The patient was a 4-month-old male from central Mexico with two healthy male siblings. His mother was hypothyroid during the first trimester of pregnancy and took drugs. The infant was born with normal weight and size, was breast-fed, and received the BCG vaccine with no scarring. The mother of the patient was a prisoner in a jail cell with the infant in a crowded cell with two others.At 4 months, the patient was medically evaluated for a painful tumor in the left axilla. A chest X-ray showed suggestive images of rib fractures; the mother was suspected of child abuse, and the infant was admitted to a pediatric hospital. The infant was weighed (4,190 g) and measured (58 cm) below the third percentile, oxygen saturation of 70%, fever, cough, increased volume in the left axilla, and pain, redness, and warmth. The blood count showed: hemoglobin of 8.8 g/dL (11.0-12.6), 29.3 × 109 leukocytes/L (6.0-17.5), 18.4 × 109 neutrophils/L (1.0-8.5), 7.0 × 109 lymphocytes/L (4.0-13.5), 3.5 × 109 monocytes/L, 459 × 109 platelets/L (150-350), and C-reactive protein of 16 mg/L (< 3.0). The first thoracoabdominal tomography showed an abscess in the left axilla, lytic lesions in ribs 3-6, left apical pneumonia, pulmonary nodules in both lungs, and enlarged cervical and mediastinal lymph nodes. The biopsy of the left axilla abscess reported myositis and suppurative panniculitis. Only the culture for bacteria from the bronchoalveolar liquid was negative, and the PCR for the Mycobacterium tuberculosis complex was negative. After 41 days of hospitalization and receiving two antimicrobial regimens of ceftriaxone-clindamycin and cefepime-vancomycin, the patient was discharged.\n\nTwo months later, at eight months of age, he was readmitted to hospital with a fever, irritability and a suppurating abscess in the left scapula. The blood count showed haemoglobin of 10.8 g/dl (10.5-12), 21.2 × 109 leukocytes/L (6-17), 12.2 × 109 neutrophils/L (1.5-8.5), 7.5 × 109 lymphocytes/L (4-10.5), 1.2 × 109 monocytes/L (600), and 583 × 109 platelets/L (150-350); the serum test for HIV was negative. A left apical consolidation, bronchiectasis, lytic lesions in ribs 2-7 and dorsal vertebrae 2-7, and a multilocular fluid collection were observed on a chest scan; ultrasound showed a fistula associated with the scapular abscess. The patient received piperacillin-tazobactam, which was later replaced with voriconazole after Aspergillus fumigatus was detected in the secretion sample culture. Given the recurrence and severity of the infection, an innate immunity defect was suspected. The dihydrorhodamine test showed no production of reactive oxygen species and the gp91phox expression in neutrophils was absent, establishing a diagnosis of X-linked chronic granulomatous disease. The pathogenic variant detected by next-generation sequencing was c.80_83del/Y (p.Val27Glyfs*33) in CYBB. The mother was a carrier of the variant (c.80_83del/WT). The two older male siblings, who were apparently healthy, could not be genetically tested. The patient was discharged after 65 days of hospitalisation and 28 days of voriconazole treatment. Daily antibiotic prophylaxis with trimethoprim-sulfamethoxazole and antifungal prophylaxis with fluconazole twice a week were initiated. Two months later, at one year of age, the infant was readmitted due to multifocal pneumonia, for which mechanical respiratory assistance was required. The galactomannan antigen was detected in the serum and A. fumigatus was detected in the culture of the lavage fluid, so treatment with voriconazole was initiated again. The patient suffered a multiple organ failure and died one month after admission.\n",
+    "summary": "A case of infant with chronic granulomatous disease and invasive aspergillosis is reported. The infant was a 4-month-old male infant living with his mother in a prison cell. The infant had tumors in the left axillary region and a chest X-ray suggested rib fractures; he was hospitalized on suspicion of child abuse. A chest X-ray showed an axillary abscess, osteolysis of ribs, pneumonia and pulmonary nodules; the patient received broad spectrum antibiotics and was discharged. At 8 months, he was readmitted with fever and extension of the purulent abscess to the left shoulder region; a chest X-ray showed worsening of the condition. Aspergillus fumigatus was isolated from the secretion of the abscess and invasive aspergillosis was diagnosed; voriconazole was initiated for 28 days. A dihydro rhodamine test was performed and a diagnosis of chronic granulomatous disease caused by the pathogenic variant c.80_83del/Y of the CYBB gene, carried by the mother (c.80_83del/WT), was made. At 12 months, the patient was readmitted with invasive aspergillosis, resistant to treatment, with fatal outcome.\n",
+    "translated_fulltext": "রোগীটি ছিল মেক্সিকোর মধ্য অঞ্চল থেকে আসা চার মাস বয়সী একটি ছেলে শিশু, যার আরও দুই জন সুস্থ ভাই ছিল। গর্ভাবস্থার প্রথম তিন মাসে তার মায়ের হাইপোথাইরয়েডিজম ছিল এবং তিনি ওষুধ সেবন করেছিলেন। শিশুটির স্বাভাবিক ওজন ও উচ্চতা নিয়ে জন্ম হয়েছিল, সে বুকের দুধ পান করত এবং बीसीजी টিকা দেওয়া হয়েছিল, যেখানে কোনো দাগ দেখা যায়নি। রোগীর মা একটি কারাগারে অন্য দুজনের সঙ্গে একটি ছোট কক্ষে বন্দী ছিলেন, যেখানে শিশুটিও ছিল। চার মাস বয়সে, রোগীর বাম বগলে একটি বেদনাদায়ক টিউমারের জন্য তাকে পরীক্ষা করা হয়। বুকের এক্স-রেতে পাঁজরের হাড়ে ফাটলের মতো কিছু ধরা পড়ে; মায়ের বিরুদ্ধে শিশু নির্যাতনের সন্দেহ করা হয় এবং শিশুটিকে একটি শিশু হাসপাতালে ভর্তি করা হয়। শিশুটির ওজন ছিল ৪,১৯০ গ্রাম এবং উচ্চতা ছিল ৫৮ সেন্টিমিটার, যা তৃতীয় পার্সেন্টাইলের নিচে ছিল। এছাড়াও তার অক্সিজেনের মাত্রা ছিল ৭০%, জ্বর, কাশি, বাম বগলে ফোলা, ব্যথা, লালচে ভাব এবং উষ্ণতা ছিল। রক্ত পরীক্ষায় দেখা যায়: হিমোগ্লোবিন ৮.৮ গ্রাম/ডিএল (স্বাভাবিক ১১.০-১২.৬), ২৯.৩ × ১০৯ লিউকোসাইট/এল (স্বাভাবিক ৬.০-১৭.৫), ১৮.৪ × ১০৯ নিউট্রোফিল/এল (স্বাভাবিক ১.০-৮.৫), ৭.০ × ১০৯ লিম্ফোসাইট/এল (স্বাভাবিক ৪.০-১৩.৫), ৩.৫ × ১০৯ মনোসাইট/এল, ৪৫৯ × ১০৯ প্লেটলেট/এল (স্বাভাবিক ১৫০-৩৫০), এবং সি-রিঅ্যাক্টিভ প্রোটিন ১৬ মিলিগ্রাম/এল (< ৩.০)। প্রথম থোরাকোঅ্যাবডোমিনাল টমোগ্রাফিতে বাম বগলে একটি ফোড়া, পাঁজরের হাড় ৩-৬-এ লাইটিক ক্ষত, বাম দিকের ফুসফুসের উপরের অংশে নিউমোনিয়া, উভয় ফুসফুসে পালমোনারি নডিউল এবং ঘাড় ও মধ্যবর্তী অঞ্চলের লিম্ফ নোডগুলির বৃদ্ধি দেখা যায়। বাম বগলের ফোড়ার বায়োপসিতে মায়োসাইটিস এবং সাপুরেটিভ প্যানিকুলাইটিস ধরা পড়ে। ব্রঙ্কোঅ্যালভিওলার তরল থেকে ব্যাকটেরিয়ার কালচারে কোনো জীবাণু পাওয়া যায়নি এবং মাইকোব্যাকটেরিয়াম টিউবারকুলোসিস কমপ্লেক্সের জন্য পিসিআর পরীক্ষাও নেগেটিভ ছিল। হাসপাতালে ৪১ দিন থাকার পর এবং সেফট্রিয়াক্সোন-ক্লিন্ডামাইসিন ও সেফেপাইম-ভ্যানকোমাইসিনের দুটি অ্যান্টিমাইক্রোবিয়াল ওষুধ দেওয়ার পর রোগীকে ছুটি দেওয়া হয়।\n\nদুই মাস পর, আট মাস বয়সে, জ্বর, বিরক্তি এবং বাম স্ক্যাপুলায় একটি পুঁজযুক্ত ফোড়ার কারণে তাকে আবার হাসপাতালে ভর্তি করা হয়। রক্ত পরীক্ষায় হিমোগ্লোবিন ১০.৮ গ্রাম/ডিএল (স্বাভাবিক ১০.৫-১২), ২১.২ × ১০৯ লিউকোসাইট/এল (স্বাভাবিক ৬-১৭), ১২.২ × ১০৯ নিউট্রোফিল/এল (স্বাভাবিক ১.৫-৮.৫), ৭.৫ × ১০৯ লিম্ফোসাইট/এল (স্বাভাবিক ৪-১০.৫), ১.২ × ১০৯ মনোসাইট/এল (স্বাভাবিক ৬০০), এবং ৫৮৩ × ১০৯ প্লেটলেট/এল (স্বাভাবিক ১৫০-৩৫০) পাওয়া যায়; এইচআইভি-এর সিরাম পরীক্ষাও নেগেটিভ ছিল। বুকের স্ক্যানে বাম দিকের ফুসফুসের উপরের অংশে ঘনত্ব, ব্রঙ্কিয়েক্টেসিস, পাঁজরের হাড় ২-৭ এবং ডরসাল ভার্টিব্রা ২-৭-এ লাইটিক ক্ষত এবং মাল্টিলোকুলার তরল সংগ্রহ দেখা যায়; আল্ট্রাসাউন্ডে স্ক্যাপুলার ফোড়ার সঙ্গে যুক্ত একটি ফিস্টুলা দেখা যায়। রোগীকে পাইপেরা সিলিন-ট্যাজোব্যাকটাম দেওয়া হয়েছিল, পরে অ্যাসপারগিলাস ফিউমিগাটাস নামক ছত্রাক সনাক্ত হওয়ার পর ভোরিকোনাজল দিয়ে প্রতিস্থাপন করা হয়। সংক্রমণের পুনরাবৃত্তি এবং তীব্রতা বিবেচনা করে, একটি সহজাত অনাক্রম্যতা ত্রুটি সন্দেহ করা হয়েছিল। ডাইহাইড্রোরোডাডামিন পরীক্ষায় দেখা যায় যে, রিঅ্যাক্টিভ অক্সিজেন প্রজাতি তৈরি হচ্ছে না এবং নিউট্রোফিলের মধ্যে জিপি৯১ফক্স-এর প্রকাশ অনুপস্থিত, যা এক্স-লিঙ্কড ক্রনিক গ্রানুলোমাটাস রোগের রোগ নির্ণয় নিশ্চিত করে। নেক্সট-জেনারেশন সিকোয়েন্সিংয়ের মাধ্যমে সনাক্ত করা প্যাথোজেনিক ভ্যারিয়েন্টটি ছিল সিওয়াইবিবি-তে সি.৮০_৮৩ডেল/ওয়াই (পি.ভ্যাল২৭গ্লাইএফএস*৩৩)। মা এই ভ্যারিয়েন্টের বাহক ছিলেন (সি.৮০_৮৩ডেল/ডব্লিউটি)।",
+    "translated_summary": "দীর্ঘস্থায়ী গ্রানুলোমাটাস রোগ এবং আক্রমণাত্মক অ্যাসপারগিলোসিস-এ আক্রান্ত একটি শিশুর ঘটনা এখানে তুলে ধরা হলো। শিশুটি চার মাস বয়সী একটি ছেলে শিশু, যে তার মায়ের সাথে একটি কারাগারের কক্ষে থাকত। শিশুটির বাম বগলে টিউমার ছিল এবং বুকের এক্স-রে-তে পাঁজর ভেঙে যাওয়ার লক্ষণ দেখা যায়; শিশুটিকে শিশু নির্যাতনের সন্দেহে হাসপাতালে ভর্তি করা হয়েছিল। বুকের এক্স-রে-তে বগলের একটি ফোড়া, পাঁজরের হাড়ের ক্ষয়, নিউমোনিয়া এবং ফুসফুসের ছোট ছোট দানা দেখা যায়; রোগীকে বিভিন্ন ধরনের অ্যান্টিবায়োটিক দেওয়া হয় এবং পরে ছুটি দেওয়া হয়। আট মাস বয়সে, জ্বর এবং ফোড়ার সংক্রমণ বাম কাঁধে ছড়িয়ে পড়লে তাকে আবার হাসপাতালে ভর্তি করা হয়; বুকের এক্স-রে-তে অবস্থার অবনতি দেখা যায়। ফোড়ার নিঃসরণ থেকে অ্যাসপারগিলাস ফিউমিগাটাস নামক ছত্রাক শনাক্ত করা হয় এবং আক্রমণাত্মক অ্যাসপারগিলোসিস নির্ণয় করা হয়; এরপর ২৮ দিনের জন্য ভোরিকোনাজল দেওয়া শুরু করা হয়। একটি ডাইহাইড্রোরোডামিন পরীক্ষা করা হয় এবং দেখা যায় যে, CYBB জিনের প্যাথোজেনিক ভ্যারিয়েন্ট c.80_83del/Y-এর কারণে দীর্ঘস্থায়ী গ্রানুলোমাটাস রোগ হয়েছে, যা মায়ের কাছ থেকে এসেছে (c.80_83del/WT)। বারো মাস বয়সে, রোগীকে আবার হাসপাতালে ভর্তি করা হয়, যেখানে দেখা যায় যে আক্রমণাত্মক অ্যাসপারগিলোসিস চিকিৎসায় সাড়া দিচ্ছে না এবং এর ফলস্বরূপ রোগীর মৃত্যু হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_83.txt",
+    "fulltext": "A 29-year-old woman, Para 1, with abnormal vaginal bleeding of one-month duration presented to the gynecology outpatient department of a level 2 hospital. She was HIV positive, commenced on antiretroviral treatment following diagnosis, but had defaulted the antiretroviral treatment for one month when she became ill with vaginal bleeding, resulting in virological and immunological failures (viral load 37400 copies/mL and CD4 count 26 cells/μL). Of note, it was unclear when the patient first started showing HIV symptoms. However, she was diagnosed with HIV about a year prior to presentation. Physical examination revealed a large mass on the cervix measuring 8 × 8 cm extending to the parametrium and to the pelvic side walls bilaterally. There was bleeding on contact and foul-smelling vaginal discharge. Ultrasonography detected a bulky cervix and bilateral hydronephrosis. The patient was clinically diagnosed with cervical malignancy stage 3B. She was recommenced on antiretroviral therapy with a treatment change from TLD (Tenofovir-Lamivudine-Dolutegravir combination) to a preferable renal friendly regimen (Lamivudine-Abacavir-Dolutegravir combination). A punch biopsy of the cervix was performed, and the histopathological report revealed the diagnosis of an extra-nodal BL. The immunohistochemical and in situ hybridization confirmed the diagnosis, with CD20, CD75a, CD10, PAX5 and Bcl-6 positive. In addition, the CD44 and c-Myc were positive, with the EBER-ISH demonstrating focal positivity. The Ki67 demonstrated a proliferation index of almost 100% and PAX5 moderately positive BCL6. She had white cell count of 2.67 x109/L, haemoglobin of 5.7g/dl and platelet count of 71 × 109/L. Results of other investigations were serum creatinine 187 mmol/L, urea 11.1 mmol/l, albumin 21 g/l, aspartate transaminase 41 U/l and alkaline phosphatase 100 U/l.\n\nFollowing histological confirmation of the diagnosis and review at an oncology multidisciplinary meeting, she spent 43 days waiting to start treatment at oncology unit. The delay was due to long waiting list. This delay exceeded the 48 hours waiting period during which oncological treatment for BL should commence following diagnosis. The treatment plan was chemo-radiation therapy, and the patient gave written informed consent for the case to be published. However, she demised in the gynaecological ward on the 43rd day while waiting to start the treatment. During the 43 days, further imaging could not be performed due to poor functionality of the available CT and MRI machines. In addition to antiretroviral therapy, the patient received other supportive care such as blood transfusion and analgesia. Again, the number of days between the diagnosis of the BL and her death was 43 days. Histopathological postmortem was not performed as the diagnoses (BL and retroviral disease) were known. We reckon that the main primary cause of death is challenging to assign because of the multiple principal diagnoses. Because BL has rapid progression and high mortality rate in persons living with HIV particularly with high viral load, the attending physician certifying the death assigned BL as the most likely cause of death. However, the secondary cause of death was multiple organ failure (renal and haematological inclusive).",
+    "summary": "The patient was a 29-year-old woman, Para 1, with abnormal vaginal bleeding for a month and living with HIV and had a CD4 of 26 cells/μL. The histological examination of the cervical biopsy confirmed an extra-nodal BL. She had International Federation of Gynecology and Obstetrics (FIGO) stage 3B cervical cancer based on presence of hydronephrosis and pelvic wall involvement. The patient was reviewed at the oncology multidisciplinary meeting and required chemoradiation. There was delay in her management due to a long waiting list for chemoradiation at oncology unit in the referral center and the patient demised 43 days after diagnosis and did not receive the treatment.",
+    "translated_fulltext": "২৯ বছর বয়সী একজন মহিলা, যিনি এক মাসের বেশি সময় ধরে অস্বাভাবিক যোনি থেকে রক্তক্ষরণ অনুভব করছিলেন, তিনি একটি ২য় স্তরের হাসপাতালের স্ত্রীরোগ বহির্বিভাগে আসেন। তার এইচআইভি পজিটিভ ছিল এবং রোগ নির্ণয়ের পর অ্যান্টিরেট্রোভাইরাল চিকিৎসা শুরু করা হয়েছিল, কিন্তু যোনি থেকে রক্তক্ষরণের কারণে অসুস্থ হওয়ার পর তিনি এক মাস ধরে অ্যান্টিরেট্রোভাইরাল চিকিৎসা বন্ধ করে দেন, যার ফলে ভাইরোলজিক্যাল এবং ইমিউনোলজিক্যাল ব্যর্থতা দেখা যায় (ভাইরাল লোড ৩৭,৪০০ কপি/মিলিলিটার এবং সিডি৪ কাউন্ট ২৬ সেল/মাইক্রোলিটার)। লক্ষণীয় বিষয় হলো, রোগীর মধ্যে এইচআইভি-এর লক্ষণ প্রথম কখন দেখা গিয়েছিল, তা স্পষ্ট নয়। তবে, হাসপাতালে আসার প্রায় এক বছর আগে তার এইচআইভি ধরা পড়ে। শারীরিক পরীক্ষায় দেখা যায়, জরায়ুতে ৮ × ৮ সেন্টিমিটার আকারের একটি বড় পিণ্ড রয়েছে, যা প্যারামেট্রিয়াম এবং উভয় পেলভিক প্রাচীরের দিকে বিস্তৃত। সামান্য স্পর্শে রক্তপাত হচ্ছিল এবং যোনি থেকে দুর্গন্ধযুক্ত স্রাব বের হচ্ছিল। আলট্রাসাউন্ডে জরায়ুর আকার বৃদ্ধি এবং উভয় কিডনিতে তরল জমা (হাইড্রোনেফ্রোসিস) ধরা পড়ে। ক্লিনিক্যালি রোগীর জরায়ুর ক্যান্সার ৩বি পর্যায়ে নির্ণয় করা হয়। তাকে টিএলডি (টেনোফোভির-ল্যামিভুডিন-ডলুটেগ্রাভির) থেকে একটি ভালো এবং কিডনির জন্য কম ক্ষতিকর চিকিৎসায় (ল্যামিভুডিন-অ্যাবাক্যাভির-ডলুটেগ্রাভির) পরিবর্তন করে অ্যান্টিরেট্রোভাইরাল থেরাপি পুনরায় শুরু করা হয়। জরায়ুর একটি বায়োপসি করা হয় এবং হিস্টোপ্যাথলজিক্যাল রিপোর্টে একটি অতিরিক্ত নোডাল বি-সেল লিম্ফোমার (বিএল) উপস্থিতি ধরা পড়ে। ইমিউনো হিস্টোকেমিক্যাল এবং ইন সিটু হাইব্রিডাইজেশন পরীক্ষার মাধ্যমে রোগ নির্ণয় নিশ্চিত করা হয়, যেখানে সিডি২০, সিডি৭৫এ, সিডি১০, পিএএক্স৫ এবং বিসিএল-৬ পজিটিভ পাওয়া যায়। এছাড়াও, সিডি৪৪ এবং সি-মাইক পজিটিভ ছিল এবং ইবিইআর-আইএসএইচ পরীক্ষায় স্থানীয়ভাবে পজিটিভিটি দেখা যায়। কি৬৭ পরীক্ষায় প্রায় ১০০% কোষ বিভাজন এবং পিএএক্স৫-এর মাঝারি পজিটিভিটি দেখা যায়। তার শ্বেত রক্তকণিকার সংখ্যা ছিল ২.৬৭ × ১০^৯/লিটার, হিমোগ্লোবিন ৫.৭ গ্রাম/ডেসিলিটার এবং প্লেটলেটের সংখ্যা ৭১ × ১০^৯/লিটার। অন্যান্য পরীক্ষার ফলাফলে সিরাম ক্রিয়েটিনিন ১৮৭ মিলিমোল/লিটার, ইউরিয়া ১১.১ মিলিমোল/লিটার, অ্যালবুমিন ২১ গ্রাম/লিটার, অ্যাসপার্টেট ট্রান্সঅ্যামিনেজ ৪১ ইউ/লিটার এবং অ্যালকালাইন ফসফেটেজ ১০০ ইউ/লিটার পাওয়া যায়।\n\nরোগ নির্ণয়ের হিস্টোলজিক্যাল নিশ্চিতকরণ এবং একটি ক্যান্সার বিশেষজ্ঞের বহুমাত্রিক সভায় পর্যালোচনার পর, তিনি অনকোলজি বিভাগে চিকিৎসা শুরু করার জন্য ৪৩ দিন অপেক্ষা করেন। এই বিলম্বের কারণ ছিল দীর্ঘ অপেক্ষার তালিকা। এই বিলম্ব ৪৮ ঘণ্টার বেশি ছিল, যার মধ্যে বিএল-এর জন্য ক্যান্সার চিকিৎসা শুরু করা উচিত ছিল। চিকিৎসার পরিকল্পনা ছিল কেমো-রেডিয়েশন থেরাপি, এবং রোগী এই বিষয়ে লিখিত সম্মতি দিয়েছিলেন। তবে, চিকিৎসার জন্য অপেক্ষা করার সময় ৪৩তম দিনে স্ত্রীরোগ বিভাগে তার মৃত্যু হয়। এই ৪৩ দিনের মধ্যে, বিদ্যমান সিটি এবং এমআরআই মেশিনের দুর্বল কার্যকারিতার কারণে আরও কোনো ইমেজিং করা সম্ভব হয়নি। অ্যান্টিরেট্রোভাইরাল থেরাপির পাশাপাশি, রোগীকে অন্যান্য সহায়ক চিকিৎসা যেমন রক্ত পরিসঞ্চালন এবং ব্যথানাশক ওষুধ দেওয়া হয়েছিল। আবারও, বিএল নির্ণয় এবং তার মৃত্যুর মধ্যেকার সময় ছিল ৪৩ দিন। যেহেতু রোগ নির্ণয় (বিএল এবং রেট্রোভাইরাল রোগ) ইতিমধ্যে জানা ছিল, তাই পোস্টমর্টেম হিস্টোপ্যাথলজিক্যাল পরীক্ষা করা হয়নি। আমরা মনে করি, একাধিক রোগ নির্ণয়ের কারণে মৃত্যুর প্রধান কারণ নির্ধারণ করা কঠিন। যেহেতু বিএল দ্রুত ছড়িয়ে পড়ে এবং এইচআইভি আক্রান্ত ব্যক্তিদের মধ্যে, বিশেষ করে যাদের ভাইরাল লোড বেশি, তাদের মধ্যে উচ্চ মৃত্যুহার দেখা যায়, তাই উপস্থিত চিকিৎসক মৃত্যুর কারণ হিসেবে বিএলকে সবচেয়ে সম্ভাব্য কারণ হিসেবে উল্লেখ করেছেন। তবে, দ্বিতীয় কারণ ছিল একাধিক অঙ্গের কার্যকারিতা হ্রাস (কিডনি এবং রক্ত সংক্রান্ত অঙ্গ)।",
+    "translated_summary": "রোগী ছিলেন ২৯ বছর বয়সী একজন মহিলা, যিনি এক মাস ধরে অস্বাভাবিক যোনি থেকে রক্তক্ষরণ, এইচআইভি পজিটিভ এবং তার সিডি৪ কোষের সংখ্যা ছিল ২৬টি/μL। জরায়ুর বায়োপসির হিস্টোলজিক্যাল পরীক্ষায় অতিরিক্ত নোডাল বি-সেল লিম্ফোমা (BL) নিশ্চিত করা হয়। হাইড্রোনফ্রোসিস এবং পেলভিক প্রাচীরের অন্তর্ভুক্তি দেখে আন্তর্জাতিক স্ত্রীরোগ ও প্রসূতিবিদ্যা ফেডারেশন (FIGO) অনুসারে তার জরায়ুর ক্যান্সারের পর্যায় ৩বি নির্ণয় করা হয়। রোগীকে অনকোলজি মাল্টিডিসিপ্লিনারি মিটিংয়ে পর্যালোচনা করা হয় এবং কেমোথেরাপি ও রেডিয়েশন থেরাপির প্রয়োজন ছিল। রেফারেল সেন্টারের অনকোলজি ইউনিটে কেমোথেরাপি ও রেডিয়েশন থেরাপির জন্য দীর্ঘ অপেক্ষার কারণে তার চিকিৎসায় বিলম্ব হয়। রোগ নির্ণয়ের ৪৩ দিন পর তিনি মারা যান এবং চিকিৎসা গ্রহণ করতে পারেননি।"
+  },
+  {
+    "id": "multiclinsum_gs_en_24.txt",
+    "fulltext": "Patient and observation\nPatient information (presentation of the patient): he is a 28-year-old single man without children, an active military. He has been present for 5 weeks with progressive abdominal pain, more marked in the epigastrium and the right hypochondrium, followed shortly after by a non-quantified fever, chills, profuse sweats in a context of anorexia and weight loss of 6 kg. Note that the patient is not a drinker or smoker, vaccinated with BCG and has no other contributing personal or family history.\n\nClinical findings: On admission, the physical examination found the patient in a general altered state, asthenic with a weight loss of 6 kg in one month. A clinical systemic inflammatory response syndrome was present with the following elements: a fever of 39.1 °C, tachycardia (124 beats/min), polypnea (22 cycles/min). The pulmonary examination and exploration of the superficial lymph node areas were without particularity. In the abdominal area, moderate sensitivity in the right hypochondrium with hepatomegaly was found.\n\nChronology: dates back to February 2022 with the onset of diffuse abdominal pain with diarrhea-constipation transit disorder, all in a context of preservation of general condition with low-grade fever predominantly at night. A syntagmatic treatment was unsuccessfully initiated. The evolution is marked by the persistence of low-grade fever associated with anorexia and progressive weight loss of 12 kg over three months. In the face of this transit disorder with unexplained fever and the deterioration of the general condition, the patient will be admitted to the emergency department for further investigation.\n\nDiagnostic approach: upon admission, a biological infectious syndrome was reported with a neutrophilic predominant hyperleucocytosis (17800 cells/mm3) and a high C-reactive protein of 323 mg/L.\n\nIn the face of his abdominal pain, the lipase and troponin tests were normal at 38 IU/L (VN: <3 78 IU/L) and 4 ng/L (VN: 2 to 16 ng/L) respectively. The liver function was stable with ALT (alanine amino transferase) at 22 IU/L (VN: < 40UI/L), AST (aspartate amino transferase) at 17 IU/L (VN: < 35UI/L), GGT (gamma glutamyl transferase) at 42 IU/L (VN: < 50UI/L), PAL (alkaline phosphatase) at 115 IU/L (VN: 40- 150 IU/L) and normal bilirubinemia. The liver function was normal with a prothrombin rate of 78% and an albuminemia of 39 g/L. The blood ionogram and renal function were normal. The chest radiograph and abdominal ultrasound were without particularity.\n\nWith a procalcitonin positive at 4.1 ng/L, an infectious disease assessment to search for the infectious focus was initiated, including a cytobacteriological examination of urine and blood cultures during the febrile peaks at 39°C, which were both negative. The hepatitis viral B, C and HIV serologies, as well as the syphilis serology performed in hospital were all negative. The lactate dehydrogenase (LDH) and beta-2 microglobulin were normal at 231 IU/L and 2.28 mg/L respectively. The GeneXpert to search for the Mycobacterium on these bioptic pieces was negative. The quantiferon was negative. The search for the Mycobacterium on the morning expectorations of 3 consecutive days was negative.\n\nOn the morphological level, a thoraco-abdomino-pelvic scan showed an enlarged liver (hepatic arrow at 17 cm), the site of multiple, well-defined, rounded hypodensities, which were not enhanced after injection of the contrast agent. The largest lesions were in segment I (21 x 16 mm) and segment V (36 x 27 mm). No suspicious lesions were detected in the thoracic and pelvic levels. The first liver biopsies obtained by echo-guided puncture revealed subacute, fibro-inflammatory liver lesions, with no histological evidence of specificity or malignancy.\n\nA liver MRI following the scan objectified a dysmorphic liver, the site of lesions in heterogeneous signal T2 surrounded by a wall in hyper signal T2, enhanced in the periphery after injection of the contrast agent, the largest of which is located in segment I (20 x 22 mm) and in segment V (33 x 31 mm). No deep lymphadenopathy had been objectified, either in the scan or in the MRI. A diagnostic laparoscopy performed on the hepatic nodules, the histological examination found epithelioid and gigantocellular granulomas of varying size with caseous necrosis in favour of a hepatic tuberculosis.\n\nTherapeutic intervention: the patient was put on anti-tuberculosis treatment according to the standard protocol for months: Phase 1: quadritherapy (Isoniazide + Rifampicine + Pyrazinamide + Ethambutol) in a single oral intake each morning on an empty stomach for 2 months. Phase 2: bithrapia (Isoniazide + Rifampicine) in a single oral intake each morning on an empty stomach for 4 months\n\nFollow-up and results of therapeutic interventions: from the first days of treatment, a good response was obtained with disappearance of the inflammatory syndrome with systemic response both clinically and biologically. After three months of treatment, a control scan of the liver showed a decrease in the number and volume of liver lesions.\n",
+    "summary": "This clinical case was reported in a young Moroccan, presenting a picture of hepatic colic that had been developing for a month, associated with subtle signs of tuberculous infection. Non-specific hepatic nodular lesions were revealed on the scanner and on the hepatic magnetic resonance imaging (MRI). The diagnosis of focal hepatic tuberculosis was confirmed after pathological analysis of hepatic nodule biopsies obtained after a laparoscopy. After the start of well-conducted anti-bacillary treatment, a good clinical-biological improvement was obtained.\n",
+    "translated_fulltext": "রোগীর বিবরণ ও পর্যবেক্ষণ:\n\nরোগীর তথ্য (রোগীর প্রাথমিক অবস্থা): তিনি ২৮ বছর বয়সী অবিবাহিত, নিঃসন্তান এবং সক্রিয় সামরিক সদস্য। তিনি ৫ সপ্তাহ ধরে পেটে ক্রমবর্ধমান ব্যথা অনুভব করছেন, যা মূলত পেটের উপরের অংশে এবং ডান দিকের অংশে বেশি। এর পরপরই জ্বর, কাঁপুনি এবং ক্ষুধামান্দ্য দেখা দেয়, যার ফলে ৬ কেজি ওজন হ্রাস পেয়েছে। উল্লেখ্য, রোগী ধূমপান বা মদ্যপান করেন না, বিসিজি টিকা নিয়েছেন এবং তার ব্যক্তিগত বা পারিবারিক অন্য কোনো উল্লেখযোগ্য স্বাস্থ্য ইতিহাস নেই।\n\nক্লিনিক্যাল লক্ষণ: হাসপাতালে ভর্তির সময়, শারীরিক পরীক্ষায় দেখা যায় রোগীর শারীরিক অবস্থা খারাপ, তিনি দুর্বল এবং এক মাসে ৬ কেজি ওজন হ্রাস পেয়েছে। নিম্নলিখিত লক্ষণগুলোর মাধ্যমে একটি ক্লিনিক্যাল সিস্টেমিক প্রদাহজনক প্রতিক্রিয়া সিনড্রোম (Clinical systemic inflammatory response syndrome) দেখা যায়: ৩৯.১ ডিগ্রি সেলসিয়াস জ্বর, ট্যাকিকার্ডিয়া (১২৪ বিট/মিনিট), পলিপনিয়া (২২ চক্র/মিনিট)। ফুসফুসের পরীক্ষা এবং অগভীর লিম্ফ নোড এলাকার অনুসন্ধানে বিশেষ কিছু পাওয়া যায়নি। পেটের অংশে, ডান দিকের অংশে মাঝারি সংবেদনশীলতা এবং হেপাটোমেগালি (যকৃতের বৃদ্ধি) দেখা যায়।\n\nসময়কাল: ফেব্রুয়ারি ২০২২ থেকে এর সূত্রপাত, যখন পেটে ব্যথা এবং ডায়রিয়া-কোষ্ঠকাঠিন্যের সমস্যা দেখা দেয়। একই সময়ে রোগীর সাধারণ শারীরিক অবস্থা স্থিতিশীল ছিল এবং রাতে হালকা জ্বর ছিল। একটি সমন্বিত চিকিৎসা শুরু করা হলেও তা সফল হয়নি। এরপর রোগীর অবস্থার অবনতি হতে থাকে, হালকা জ্বর, ক্ষুধামান্দ্য এবং তিন মাসে ১২ কেজি ওজন হ্রাস পায়। এই পেটের সমস্যা, ব্যাখ্যাতীত জ্বর এবং শারীরিক অবস্থার অবনতির কারণে রোগীকে আরও পরীক্ষার জন্য জরুরি বিভাগে ভর্তি করা হয়।\n\nরোগ নির্ণয়ের পদ্ধতি: হাসপাতালে ভর্তির সময়, একটি জৈবিক সংক্রমণ সিনড্রোম ধরা পড়ে, যেখানে নিউট্রোফিল-প্রাধান হাইপারলিউকোসাইটোসিস (17800 কোষ/মিমি3) এবং উচ্চ সি-রিঅ্যাক্টিভ প্রোটিন (323 মিগ্রা/লিটার) পাওয়া যায়।\n\nপেটের ব্যথার কারণে, লাইপেজ এবং ট্রোপোনিন পরীক্ষা করা হয়, যেখানে ফলাফল স্বাভাবিক ছিল: ৩৮ আইইউ/লিটার (স্বাভাবিক মান: <378 আইইউ/লিটার) এবং ৪ এনজি/লিটার (স্বাভাবিক মান: ২ থেকে ১৬ এনজি/লিটার)। লিভারের কার্যকারিতা স্থিতিশীল ছিল, যেখানে এএলটি (অ্যালানিন অ্যামিনোট্রান্সফারেজ) ২২ আইইউ/লিটার (স্বাভাবিক মান: <40 ইউ/লিটার), এএসটি (অ্যাসপার্টেট অ্যামিনোট্রান্সফারেজ) ১৭ আইইউ/লিটার (স্বাভাবিক মান: <35 ইউ/লিটার), জিজিটি (গামা গ্লুটামাইল ট্রান্সফারেজ) ৪২ আইইউ/লিটার (স্বাভাবিক মান: <50 ইউ/লিটার), পিএএল (অ্যালকালিন ফসফেটেজ) ১১৫ আইইউ/লিটার (স্বাভাবিক মান: ৪০-১৫০ আইইউ/লিটার) এবং স্বাভাবিক বিলিরুবিনেমিয়া পাওয়া যায়। প্রোথ্রোমবিন মাত্রা ৭৮% এবং অ্যালবুমিনেমিয়া ৩৯ গ্রাম/লিটার হওয়ায় লিভারের কার্যকারিতা স্বাভাবিক ছিল। রক্তে আয়ন এবং কিডনির কার্যকারিতা স্বাভাবিক ছিল। বুকের এক্স-রে এবং পেটের আল্ট্রাসাউন্ডে বিশেষ কিছু পাওয়া যায়নি।\n\nপ্রোক্যালসিটোনিনের মাত্রা ৪.১ এনজি/লিটার হওয়ায়, সংক্রমণের উৎস খুঁজে বের করার জন্য একটি সংক্রামক রোগ মূল্যায়ন শুরু করা হয়। এর মধ্যে মূত্র এবং রক্তের সাইটোব্যাকটেরিওলজিক্যাল পরীক্ষা করা হয়, যা ৩৯ ডিগ্রি সেলসিয়াসে জ্বরের সময় নেওয়া হয়েছিল, কিন্তু কোনো সংক্রমণ ধরা পড়েনি। হেপাটাইটিস বি, সি এবং এইচআইভি সিরোলজি, সেইসাথে হাসপাতালে করা সিফিলিস সিরোলজি পরীক্ষাও নেতিবাচক ছিল। ল্যাকটেট ডিহাইড্রোজেনেস (এলডিএইচ) এবং বিটা-২ মাইক্রোগ্লোবুলিনের মাত্রা স্বাভাবিক ছিল, যথাক্রমে ২৩১ আইইউ/লিটার এবং ২.২৮ মিগ্রা/লিটার। বায়োপটিক নমুনার উপর মাইকোব্যাকটেরিয়াম সনাক্ত করার জন্য জিনএক্সপার্ট পরীক্ষা করা হয়েছিল, কিন্তু ফলাফল নেতিবাচক ছিল। কোয়ান্টিফেরন পরীক্ষাও নেতিবাচক ছিল। পরপর ৩ দিনের সকালে থুতু থেকে মাইকোব্যাকটেরিয়াম পরীক্ষা করা হয়েছিল, কিন্তু কোনো সংক্রমণ পাওয়া যায়নি।\n\nশারীরিক স্তরে, থোরাকো-অ্যাবডোমিনো-পেলভিক স্ক্যানে দেখা যায় যকৃতের আকার বৃদ্ধি পেয়েছে (যকৃতের তীর ১৭ সেমি), যেখানে একাধিক, সুস্পষ্ট, গোলাকার হাইপোডেনসিটি রয়েছে। কনট্রাস্ট এজেন্ট দেওয়ার পরেও এগুলোর পরিবর্তন হয়নি। সবচেয়ে বড় ক্ষতগুলো সেগমেন্ট ১ (২১ x ১৬ মিমি) এবং সেগমেন্ট ৫ (৩৬ x ২৭ মিমি)-এ ছিল। থোরাসিক এবং পেলভিক স্তরে কোনো সন্দেহজনক ক্ষত পাওয়া যায়নি। ইকো-নির্দেশিত পাংচারের মাধ্যমে নেওয়া প্রথম লিভার বায়োপসিতে দেখা যায়, সেখানে সাবঅ্যাকিউট, ফাইব্রো-ইনফ্ল্যামেটরি লিভার ক্ষত রয়েছে, তবে কোনো নির্দিষ্ট বা ম্যালিগন্যান্ট (ক্যান্সার) কোষের প্রমাণ পাওয়া যায়নি।\n\nস্ক্যানের পরে লিভার এমআরআই-তে একটি ডিসমর্ফিক লিভার দেখা যায়, যেখানে বিভিন্ন সংকেত টি২-এর ক্ষতগুলো রয়েছে এবং টি২-এর একটি প্রাচীর দ্বারা বেষ্টিত, যা কনট্রাস্ট এজেন্ট দেওয়ার পরে প্রান্তের দিকে আরও স্পষ্ট হয়। সবচেয়ে বড় ক্ষতটি সেগমেন্ট ১ (২০ x ২২ মিমি) এবং সেগমেন্ট ৫ (৩৩ x ৩১ মিমি)-এ অবস্থিত। স্ক্যান বা এমআরআই-তে গভীর লিম্ফ্যাডেনোপ্যাথি (ফোলা লিম্ফ নোড) দেখা যায়নি। হেপাটিক নোডুলে (যকৃতের ছোট পিণ্ড) ডায়াগনস্টিক ল্যাপারোস্কোপি করা হয়, যেখানে হিস্টোলজিক্যাল পরীক্ষায় বিভিন্ন আকারের এপিথেলিয়য়েড এবং জায়ান্টোসেলুলার গ্রানুলোমাস পাওয়া যায়, যাতে ক্যাসিয়াস নেক্রোসিস রয়েছে, যা লিভারের যক্ষ্মা রোগের ইঙ্গিত দেয়।\n\nচিকিৎসা পদ্ধতি: রোগীকে স্ট্যান্ডার্ড প্রোটোকল অনুযায়ী যক্ষ্মা রোগের চিকিৎসার জন্য ওষুধ দেওয়া হয়: প্রথম পর্যায়: কোয়াড্রITHERAPY (আইসোনিয়াজিড + রিফাম্পিসিন + পাইরাজিনামাইড + ইথামবিউটল) প্রতিদিন সকালে খালি পেটে একবার করে ২ মাস ধরে। দ্বিতীয় পর্যায়: বাইথেরাপি (আইসোনিয়াজিড + রিফাম্পিসিন) প্রতিদিন সকালে খালি পেটে একবার করে ৪ মাস ধরে।\n\nফলো-আপ এবং চিকিৎসার ফলাফল: চিকিৎসার প্রথম দিন থেকেই রোগীর অবস্থার উন্নতি দেখা যায় এবং প্রদাহজনিত সিনড্রোম ও সিস্টেমিক প্রতিক্রিয়া হ্রাস পায়। তিন মাস চিকিৎসার পর, লিভারের একটি নিয়ন্ত্রণ স্ক্যানে দেখা যায় যে লিভারের ক্ষতগুলোর সংখ্যা এবং আকার কমে গেছে।",
+    "translated_summary": "এই ক্লিনিক্যাল ঘটনাটি একজন অল্পবয়সী মরোক্কান ব্যক্তির ক্ষেত্রে দেখা গিয়েছিল, যেখানে এক মাসের ধরে লিভারের ব্যথার লক্ষণ দেখা যাচ্ছিল এবং এর সঙ্গে যক্ষ্মা সংক্রমণের কিছু মৃদু উপসর্গ ছিল। স্ক্যানারে এবং লিভারের ম্যাগনেটিক রেজোন্যান্স ইমেজিং (এমআরআই)-এ লিভারের কিছু নির্দিষ্ট নয় এমন টিউমার-সদৃশ ক্ষত দেখা যায়। ল্যাপারোস্কোপির মাধ্যমে লিভারের টিউমার থেকে নেওয়া বায়োপসির প্যাথলজিক্যাল বিশ্লেষণের পর ফোকাল হেপাটিক যক্ষ্মার রোগ নির্ণয় নিশ্চিত করা হয়। ভালোভাবে পরিচালিত অ্যান্টি-ব্যাকটেরিয়াল চিকিৎসা শুরু করার পর রোগীর শারীরিক অবস্থার উল্লেখযোগ্য উন্নতি দেখা যায়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_362.txt",
+    "fulltext": "A 77-year-old male patient presented with a history of moderate cognitive impairment. The patient was admitted to the emergency department for a tonic-clonic seizure at home. The patient presented hemodynamically unstable in the context of a postcritical state and suspected intrapelvic bleeding. The code for a polytraumatized patient was activated, not because of the mechanism of injury, but because of the patient's hemodynamic status.  He was stabilized and optimized in the emergency department with intravenous fluid and transfusion of packed red blood cells. A pelvic girdle was placed. Once hemodynamic stability was achieved, a physical examination was performed. Clinically, the patient presented a shortening of the lower limb compared to the contralateral limb, external rotation and joint blockage when performing the log roll test in both limbs. He presented functional impotence in both hips. Given the patient's condition when he arrived at the emergency department, it was not possible to assess the neurological status. He had no signs of external injuries or bruises. Distal pulses were present at the foot level. He could move his upper limbs. A chest and anteroposterior pelvic radiograph was performed as part of the code for a polytraumatized patient, pending completion of an abdominal-pelvic computed tomography (CT) study. A bilateral femoral dislocation was diagnosed in the pelvic radiograph. The patient underwent a procedure to correct the dislocation.\n\n\n\nComputed tomography angiography to rule out vascular lesions given the instability in hemodynamic that presented itself on admission. Vascular lesions were ruled out after the angiography. In the 3D-CT reconstruction of the pelvis, a bilateral transverse acetabular fracture was found, according to the classification of Letournel and a bilateral longitudinal fracture of the iliac wing was found, along with intrapelvic protrusion of both femoral heads. After initial evaluation, supracondylar traction was placed on the femoral head in both extremities and the pelvic traction was removed. The patient was admitted to the recovery unit until surgery, where he remained with the traction supracondylar femoral head in both extremities and the pelvic traction was removed. The patient was operated on the eighth day of admission. In our service, the acetabular fractures were ruled out after seven days waiting for the formation of a fibrosis in the focus of fracture and the decrease of intraoperative bleeding during surgical procedures. It was decided to perform the surgery in two stages due to the long duration of each intervention. Both surgeries were performed with general anaesthesia, tranexamic acid was administered to prevent intraoperative bleeding and decrease blood transfusions in relation to the surgeries; and antibiotic (cefazolin 2 g preoperatively and 1 g of cefazolin every 8 hours postoperatively for 24 hours) as an intrahospital protocol. During the postoperative period, enoxaparin 40 mg was administered subcutaneously every 24 hours for seven weeks. Initially, the surgery of the left hemipelvis was performed since, at the radiographic level, it presented greater pelvic protrusion and it was not desirable that a hematoma in the soft tissue phase could generate complications at the time of extraction of the femoral head (vascular injuries, intraoperative bleeding). The supracondylar traction was removed. The patient was placed in lateral decubitus, and a posterior lateral approach was performed with a Moore's autograft in the acetabular background (fracture focus). Subsequently, the anti-protrusion ring was implanted (Burch SchneiderTM Reinforcement Cage, Zimmer Biomet) anchored to the ischium and ilium. Prior to the implantation of the ring, it was necessary to perform dissection of the gluteal musculature (gluteus minimus and medius) to correctly place the femoral head. The medial ischial fracture of the ring was also anchored with screws. The check was performed under the control of a scope to verify the correct implantation. Subsequently, a double mobility cementaed acetabular ring was implanted and then the non-cemented femoral stem was implanted. After finishing the placement of the components, the capsule and pelvic musculature were closed by means of transosseous trochanteric points. The surgery of the right hemipelvis was performed seven days later. The patient was placed in lateral decubitus. To address the longitudinal fracture of the iliac wing, the first window of the ilio-inguinal approach was performed. It was synthesised with a six-hole anatomical plate. Subsequently, the same procedure as the previous surgery was performed, using an anti-protrusion ring with a double mobility cemented femoral stem and non-cemented femoral stem. This type of anti-protrusion rings are used when there are acetabular fractures that could be equivalent to a pelvic disjunction (type IV classification of acetabular defects of the AAOS) and an anchorage in the ischium and ilium of the ring is needed to support the ring. They are not indicated for isolated fractures of the anterior or posterior wall of the acetabulum where there is no involvement of the acetabular background. During admission, the patient remained in bed and was mobilised to avoid decubitus ulcers. Once the second intervention was performed and when the patient tolerated it clinically, he began to transfer with the use of a wheelchair. In bed he was allowed to have a full range of motion without restriction. The patient was discharged four weeks later and did not begin to load or walk until six weeks. He began to load with the use of a walking stick. We decided to delay loading because, despite the use of arthroplasty as a treatment, it was decided to wait until there was an initial consolidation of the graft in the acetabular background that provided better support for the ring. It was also added that the patient presented bilateral involvement and it would be difficult to start partial loading, given that he did not have a healthy hip to support. During the follow-up of the patient, at 12 months of the intervention he was already doing full load with the use of a walking stick, with a Harris hip score of 79 in the left hip and 77 in the right hip; and a score of 12 on the WOMAC scale. He has not presented any postoperative complications to date. The patient is satisfied clinically, he reports occasional discomfort and a slight limp of the right side. He has a full range of motion in the examination and does not report having had any episode of instability since the surgery.\n",
+    "summary": "77-year-old patient with a history of moderate cognitive impairment who suffered bilateral central dislocation of the hip in the context of a generalized convulsive seizure. Clinically, upon arrival in the emergency department, the patient presented a shortening of the lower right limb compared to the contralateral limb, external rotation and joint blockage when performing the log roll test in both limbs. Imaging and clinical optimization study was performed prior to surgery. It was performed in two stages: first the left hip on the eighth day of admission and the right hip on the fifteenth. In both surgeries the same procedure was performed by implanting an anti-protrusive ring and prosthesis with double mobility acetabulum with non-cemented femoral stem. In the immediate postoperative period, the patient did not present any complications associated with the surgery. In the 12-month follow-up, the patient performed a full load with a Harris hip score (HHS) of 77 in the right hip and 79 in the left; 12 points in the WOMAC scale. He has not presented any postoperative complications to date.\n",
+    "translated_fulltext": "৭৭ বছর বয়সী পুরুষ রোগী মধ্যম মাত্রার কগনিটিভ ইমপেয়ারমেন্টের ইতিহাস নিয়ে উপস্থাপিত হন। রোগীকে বাড়িতে টনিক-ক্লোনিক সিজারের জন্য জরুরি বিভাগে ভর্তি করা হয়। রোগী পোস্টক্রিটিক্যাল অবস্থার প্রেক্ষিতে এবং সন্দেহজনক ইন্ট্রাপেলভিক রক্তক্ষরণের সাথে হেমোডাইনামিকভাবে অস্থিতিশীল অবস্থায় উপস্থাপিত হন। পলিট্রমাটাইজড রোগীর কোড সক্রিয় করা হয়েছিল, আঘাতের মেকানিজমের কারণে নয়, বরং রোগীর হেমোডাইনামিক স্ট্যাটাসের কারণে। তাকে ইনট্রাভেনাস ফ্লুইড এবং প্যাকড রেড ব্লাড সেলস ট্রান্সফিউশনের মাধ্যমে জরুরি বিভাগে স্থিতিশীল এবং অপ্টিমাইজ করা হয়। একটি পেলভিক গার্ডল স্থাপন করা হয়। হেমোডাইনামিক স্থিতিশীলতা অর্জিত হলে শারীরিক পরীক্ষা করা হয়। ক্লিনিক্যালি, রোগীর বিপরীত পার্শ্বের অঙ্গের তুলনায় নিম্ন অঙ্গের সংক্ষিপ্ততা, এক্সটার্নাল রোটেশন এবং উভয় অঙ্গে লগ রোল টেস্ট করার সময় জয়েন্ট ব্লকেজ ছিল। তার উভয় হিপে কার্যকরী অক্ষমতা ছিল। রোগী জরুরি বিভাগে পৌঁছানোর সময় তার অবস্থা বিবেচনায়, নিউরোলজিকাল স্ট্যাটাস মূল্যায়ন করা সম্ভব ছিল না। তার বাহ্যিক আঘাত বা ব্রুজের কোনো চিহ্ন ছিল না। পায়ের স্তরে ডিস্টাল পালস বিদ্যমান ছিল। তিনি তার ঊর্ধ্ব অঙ্গ নাড়াতে পারতেন। পলিট্রমাটাইজড রোগীর কোডের অংশ হিসেবে একটি চেস্ট এবং এন্টিরোপোস্টেরিয়র পেলভিক রেডিওগ্রাফ করা হয়, এবং অ্যাবডোমিনাল-পেলভিক কম্পিউটেড টমোগ্রাফি (CT) স্টাডি সম্পন্ন হওয়া পর্যন্ত অপেক্ষমাণ ছিল। পেলভিক রেডিওগ্রাফে দ্বিপার্শ্বিক ফেমোরাল ডিসলোকেশন নির্ণয় করা হয়। রোগীর ডিসলোকেশন সংশোধনের জন্য একটি প্রক্রিয়া করা হয়।\n\nভর্তির সময় যে হেমোডাইনামিক অস্থিতিশীলতা উপস্থিত ছিল, তা বিবেচনায় ভাসকুলার লেশন বাদ দিতে কম্পিউটেড টমোগ্রাফি অ্যাঞ্জিওগ্রাফি করা হয়। অ্যাঞ্জিওগ্রাফির পর ভাসকুলার লেশন বাদ দেওয়া হয়। পেলভিসের 3D-CT রিকনস্ট্রাকশনে, Letournel শ্রেণীবিভাগ অনুযায়ী একটি দ্বিপার্শ্বিক ট্রান্সভার্স এসিটাবুলার ফ্র্যাকচার এবং ইলিয়াক উইং-এর দ্বিপার্শ্বিক লংগিচ্যুডিনাল ফ্র্যাকচার পাওয়া যায়, সঙ্গে উভয় ফেমোরাল হেডের ইন্ট্রাপেলভিক প্রোট্রুশন। প্রাথমিক মূল্যায়নের পর, উভয় অঙ্গে ফেমোরাল হেডে সুপ্রাকনডিলার ট্র্যাকশন দেওয়া হয় এবং পেলভিক ট্র্যাকশন অপসারণ করা হয়। রোগীকে সার্জারি পর্যন্ত রেকভারি ইউনিটে ভর্তি রাখা হয়, যেখানে তিনি উভয় অঙ্গে সুপ্রাকনডিলার ফেমোরাল হেড ট্র্যাকশনসহ ছিলেন এবং পেলভিক ট্র্যাকশন অপসারণ করা হয়েছিল। ভর্তির অষ্টম দিনে রোগীর অপারেশন করা হয়। আমাদের সার্ভিসে, ফ্র্যাকচারের ফোকাসে ফাইব্রোসিস গঠনের জন্য এবং সার্জিকাল প্রক্রিয়ার সময় ইনট্রঅপারেটিভ রক্তক্ষরণ কমানোর জন্য সাত দিন অপেক্ষা করার পর এসিটাবুলার ফ্র্যাকচারসমূহ বাদ দেওয়া হয়। প্রতিটি ইন্টারভেনশনের দীর্ঘ স্থায়িত্বের কারণে সার্জারি দুই ধাপে করার সিদ্ধান্ত নেওয়া হয়। উভয় সার্জারি জেনারেল অ্যানাস্থেসিয়ার অধীনে করা হয়েছিল, ইনট্রঅপারেটিভ রক্তক্ষরণ প্রতিরোধ এবং সার্জারিগুলোর সাথে সম্পর্কিত রক্ত সঞ্চালন কমানোর জন্য tranexamic acid দেওয়া হয়েছিল; এবং অ্যান্টিবায়োটিক (cefazolin 2 g প্রিঅপারেটিভলি এবং পোস্টঅপারেটিভলি প্রতি 8 ঘন্টায় 1 g cefazolin 24 ঘন্টার জন্য) একটি ইন্ট্রাহসপিটাল প্রোটোকল হিসেবে। পোস্টঅপারেটিভ সময়কালে, enoxaparin 40 mg সাবকিউটেনিয়াসলি প্রতি 24 ঘন্টায় সাত সপ্তাহ ধরে দেওয়া হয়। প্রাথমিকভাবে, বাম হেমিপেলভিসের সার্জারি করা হয়, কারণ রেডিওগ্রাফিক স্তরে সেখানে অধিক পেলভিক প্রোট্রুশন ছিল এবং সফট টিস্যু পর্যায়ে একটি হেমাটোমা ফেমোরাল হেড অপসারণের সময় (ভাসকুলার ইনজুরি, ইনট্রঅপারেটিভ রক্তক্ষরণ) জটিলতা তৈরি করতে পারে—এটি কাম্য ছিল না। সুপ্রাকনডিলার ট্র্যাকশন অপসারণ করা হয়। রোগীকে ল্যাটেরাল ডিকিউবিটাসে রাখা হয়, এবং এসিটাবুলার ব্যাকগ্রাউন্ডে (ফ্র্যাকচার ফোকাস) মুর'স অটোগ্রাফট সহ একটি পোস্টেরিয়র ল্যাটেরাল অ্যাপ্রোচ করা হয়। পরবর্তীতে, অ্যান্টি-প্রোট্রুশন রিং (Burch SchneiderTM Reinforcement Cage, Zimmer Biomet) ইশিয়াম এবং ইলিয়ামে অ্যান্কার করে ইমপ্লান্ট করা হয়। রিং ইমপ্লান্টেশনের পূর্বে ফেমোরাল হেড সঠিকভাবে স্থাপন করতে গ্লুটিয়াল মাংসপেশীর (গ্লুটিয়াস মিনিমাস এবং গ্লুটিয়াস মিডিয়াস) ডিসেকশন করা প্রয়োজন ছিল। রিং-এর মিডিয়াল ইশিয়াল ফ্র্যাকচারও স্ক্রু দিয়ে অ্যান্কার করা হয়েছিল। সঠিক ইমপ্লান্টেশন যাচাই করতে স্কোপের নিয়ন্ত্রণে চেক করা হয়। পরবর্তীতে, একটি ডাবল মোবিলিটি সিমেন্টেড এসিটাবুলার রিং ইমপ্লান্ট করা হয় এবং তারপর নন-সিমেন্টেড ফেমোরাল স্টেম ইমপ্লান্ট করা হয়। কম্পোনেন্টগুলোর স্থাপন শেষ করার পর, ক্যাপসুল এবং পেলভিক মাংসপেশী ট্রান্সঅসিয়াস ট্রোক্যান্টেরিক পয়েন্টের মাধ্যমে বন্ধ করা হয়। ডান হেমিপেলভিসের সার্জারি সাত দিন পর করা হয়। রোগীকে ল্যাটেরাল ডিকিউবিটাসে রাখা হয়। ইলিয়াক উইং-এর লংগিচ্যুডিনাল ফ্র্যাকচার অ্যাড্রেস করতে, ইলিও-ইনগুইনাল অ্যাপ্রোচের প্রথম উইন্ডো করা হয়। এটি একটি ছয়-হোল অ্যানাটমিক্যাল প্লেট দিয়ে সিন্থেসাইজ করা হয়। পরবর্তীতে, পূর্ববর্তী সার্জারির মতোই একই প্রক্রিয়া সম্পন্ন করা হয়, একটি অ্যান্টি-প্রোট্রুশন রিং ব্যবহার করে ডাবল মোবিলিটি সিমেন্টেড ফেমোরাল স্টেম এবং নন-সিমেন্টেড ফেমোরাল স্টেম সহ। এই ধরনের অ্যান্টি-প্রোট্রুশন রিং ব্যবহার করা হয় যখন এমন এসিটাবুলার ফ্র্যাকচার থাকে যা পেলভিক ডিসজাঙ্কশনের সমতুল্য হতে পারে (AAOS-এর এসিটাবুলার ডিফেক্টের টাইপ IV শ্রেণীবিভাগ) এবং রিং সমর্থনের জন্য রিং-এর ইশিয়াম ও ইলিয়ামে অ্যানকারেজ প্রয়োজন। এসিটাবুলামের অ্যান্টেরিয়র বা পোস্টেরিয়র ওয়ালের আইসোলেটেড ফ্র্যাকচারের ক্ষেত্রে, যেখানে এসিটাবুলার ব্যাকগ্রাউন্ডের জড়িততা নেই, এগুলি নির্দেশিত নয়। ভর্তি অবস্থায়, রোগী বিছানায় ছিলেন এবং ডিকিউবিটাস আলসার এড়াতে মবিলাইজ করা হয়েছিল। দ্বিতীয় ইন্টারভেনশন সম্পন্ন হওয়ার পর এবং রোগী এটি ক্লিনিক্যালি সহ্য করলে, তিনি হুইলচেয়ার ব্যবহারের মাধ্যমে ট্রান্সফার শুরু করেন। বিছানায় তাকে কোনো বিধিনিষেধ ছাড়াই পূর্ণ রেঞ্জ অব মোশন করার অনুমতি দেওয়া হয়। রোগীকে চার সপ্তাহ পরে ডিসচার্জ করা হয় এবং ছয় সপ্তাহ পর্যন্ত লোড বা হাঁটা শুরু করেননি। তিনি একটি ওয়াকিং স্টিক ব্যবহার করে লোড শুরু করেন। আমরা লোডিং বিলম্বিত করার সিদ্ধান্ত নিয়েছিলাম, কারণ চিকিৎসা হিসেবে arthroplasty ব্যবহৃত হলেও, রিংয়ের জন্য আরও ভালো সমর্থন প্রদানকারী এসিটাবুলার ব্যাকগ্রাউন্ডে গ্রাফটের প্রাথমিক কনসোলিডেশন না হওয়া পর্যন্ত অপেক্ষা করার সিদ্ধান্ত নেওয়া হয়েছিল। এছাড়াও যোগ করা হয়েছিল যে রোগীর দ্বিপার্শ্বিক জড়িততা ছিল এবং তার সমর্থনের জন্য কোনো সুস্থ হিপ না থাকায় পার্শিয়াল লোডিং শুরু করা কঠিন হতো। রোগীর ফলো-আপের সময়, ইন্টারভেনশনের 12 মাসে তিনি একটি ওয়াকিং স্টিক ব্যবহার করে ইতিমধ্যেই ফুল লোড দিচ্ছিলেন, বাম হিপে Harris hip score 79 এবং ডান হিপে 77; এবং WOMAC স্কেলে স্কোর 12। এ পর্যন্ত তিনি কোনো পোস্টঅপারেটিভ জটিলতা উপস্থাপন করেননি। রোগী ক্লিনিক্যালি সন্তুষ্ট, তিনি মাঝে মাঝে অস্বস্তি এবং ডান পাশের হালকা খোঁড়া ভাবের কথা জানান। পরীক্ষায় তার পূর্ণ রেঞ্জ অব মোশন আছে এবং সার্জারির পর থেকে কোনো অস্থিরতার এপিসোড হয়েছে বলে তিনি জানান না।",
+    "translated_summary": "৭৭ বছর বয়সী একজন রোগীর পূর্বে হালকা থেকে মাঝারি মাত্রার স্মৃতিভ্রংশ ছিল। তিনি একটি সাধারণ খিঁচুনিজনিত আক্রমণের শিকার হন, যার ফলে উভয় নিতম্বের কেন্দ্রীয় স্থানচ্যুতি ঘটে। জরুরি বিভাগে আসার পর দেখা যায়, তার ডান পায়ের নিচের অংশটি বাম পায়ের তুলনায় ছোট হয়ে গেছে, উভয় পায়ে ঘোরানোর সময় বাইরের দিকে বেঁকে যাচ্ছে এবং নড়াচড়া করতে সমস্যা হচ্ছে। অস্ত্রোপচারের আগে ইমেজিং এবং ক্লিনিক্যাল অপটিমাইজেশন পরীক্ষা করা হয়। এটি দুটি পর্যায়ে করা হয়: প্রথমে হাসপাতালে ভর্তির অষ্টম দিনে বাম নিতম্বের এবং পরে পঞ্চদশ দিনে ডান নিতম্বের অস্ত্রোপচার করা হয়। উভয় অস্ত্রোপচারে একই পদ্ধতি অনুসরণ করা হয়, যেখানে একটি অ্যান্টি-প্রোট্রুসিভ রিং এবং ডাবল মোবিলিটি অ্যাসিটাবুলামসহ সিমেন্টবিহীন ফিমোরাল স্টেম স্থাপন করা হয়। অস্ত্রোপচারের পরপরই রোগীর কোনো জটিলতা দেখা যায়নি। ১২ মাস পর ফলোআপে দেখা যায়, রোগীর ডান নিতম্বের হ্যারিস হিপ স্কোর (এইচএইচএস) ৭৭ এবং বাম নিতম্বের স্কোর ৭৯, এবং WOMAC স্কেলে ১২ পয়েন্ট। এখন পর্যন্ত তার অস্ত্রোপচারের পরে কোনো জটিলতা দেখা যায়নি।"
+  },
+  {
+    "id": "multiclinsum_gs_en_133.txt",
+    "fulltext": "Male patient, 25 years old, Sundanese, presented at the Dental Hospital of the Faculty of Dentistry Universitas Padjadjaran with the chief complaint of mouth sores, which are painful on the upper and lower lips and exacerbated when eating and talking. Initially, four days ago, canker sores started in the oral cavity, then appeared on the lips two days later. The patient tried to self-medicate by applying petroleum jelly which he used to relieve his symptoms, but it did not improve. The patient replaced the drug with triamcinolone acetonide 0.1% in orabase ointment purchased at the pharmacy and applied it once a day. Canker sores were getting better but did not cure.\n\nThe patient had history a of fever for about a week before the canker sores appeared and there were no lesions on other parts of the body. He stated that the workload was quite heavy and he had not consumed a balanced nutritional diet for about one and a half months. He had no medical history, history of food allergies, or history of taking medication. He had no history of alcohol consumption or smoking, but he had a frequent habit of licking his lips. He also had a history of chickenpox when he was a child.\n\nThe patient had no fever with all vital signs within normal limits on general examination. Extra-oral examination showed no abnormalities in the lymph nodes. There were serosanguineous crusts that felt painful and bleed easily on the lips. Intra-oral examination revealed erythematous lesions, irregular in shape, and had diffuse borders, accompanied by pain in the upper and lower labial mucosa. Hyperkeratotic white plaque that could not be scraped off, irregular in shape, has diffuse borders, without pain in the region of tooth 38 left buccal mucosa. Yellowish-white plaques were seen on 1/3 of the posterior surface of the dorsal tongue, which could be scraped off without leaving an erythematous area, and there were indentations in the form of dental impressions without pain on the lateral right and left sides of the tongue. A painless hard nodule about 2×1 x 0.5 cm in size was seen in the midline of the hard palate. Several teeth were found in caries, radix, and edentulous conditions in all regions. The oral hygiene was poor.\n\nExamination of psychological conditions was evaluated using the DASS-21 questionnaire and showed normal depression level (score 0), normal anxiety level (score 6), and normal stress level (score 6). Based on history and clinical examination, the working diagnosis was suspected HAEM, accompanied by the coated tongue, frictional keratosis, crenated tongue, torus palatinus, reversible pulpitis of tooth 18, irreversible pulpitis of tooth 47, chronic apical periodontitis et causa radix of tooth 15, and edentulous teeth 28, 37, 36, and 46. The differential diagnosis of suspected HAEM lesions on the lips was exfoliative cheilitis. However, exfoliative cheilitis did not have herpes virus involvement. The patient was indicated for serological testing (IgG anti-HSV-1) to confirm the diagnosis. Oral health-related quality of life was measured, and the results of the OHIP-14 examination at the first visit were 35 (moderate OHRQol).\n\nThe non-pharmacological therapy included instruction to maintain oral hygiene by brushing the teeth and tongue using a soft-bristled toothbrush two times a day and using non-detergent toothpaste. Education was given such as increasing the intake of water by at least two liters per day, consuming a balanced nutritional diet, avoiding acidic, spicy, hard, and monosodium glutamate-containing foods, and stopping the bad habit of licking and peeling the skin of the lips. The pharmacological therapy included topical and systemic medications. The topical medications included instructions to compress the lips with gauze moistened with 0.9% NaCl solution at least three times a day and to apply a thin layer of triamcinolone acetonide 0.1% in orabase to the lips three times a day. The systemic medications included instruction to take a multivitamin once a day.\n\nThe progress of improvement was visible in the first follow-up, two days after the initial visit. The pain in the lips was reduced, but the canker sores have not healed. Extra-oral examination revealed serosanguinous crusts on the lips which were still painful and bled easily. The serological test result (IgG anti-HSV-1) was positive with a ratio of: 6.32 (positive: ratio > 1.1). The definitive diagnosis was established based on the history, clinical examination, and serological tests as HAEM. The non-pharmacological and pharmacological therapy was continued, and systemic medication was added in the form of instructions to consume acyclovir 200 mg tablets five times a day for one week.\n\nSignificant improvement was visible in the second follow-up, five days after the previous visit, showing excellent healing in all of the patient’s oral lesions. The OHIP-14 result at the last visit was 4 (good OHRQoL). The patient’s physical, psychological, and social conditions showed improvement and returned to normal after 7 days of treatment. Patient was referred to continue dental and oral care in the periodontics, dental conservation, oral surgery, and prosthodontics departments. The patient has approved and written informed consent for the case details to be published included publication of the images, and the institution has also approved for publication. This case had complied with the Declaration of Helsinki.",
+    "summary": "A 25-year-old male patient came to the Department of Oral Medicine with the chief complaint of painful canker sores on the lips. Extra-oral examination revealed serosanguineous crusts on the lips that were painful and easily bleed. Intra-oral examination showed diffused and painful irregular erythematous lesions on the upper and lower labial mucosa. The anti-HSV1 IgG test was positive. The patient was diagnosed with HAEM.\n\nCase management: Pharmacological therapy included triamcinolone acetonide 0.1% in orabase, acyclovir tablets, multivitamins, and 0.9% NaCl. Non-pharmacological therapy included advice on maintaining good oral hygiene, avoiding spicy and sour foods, and breaking the bad habit of licking the lips.",
+    "translated_fulltext": "একজন পুরুষ রোগী, বয়স ২৫ বছর, সুন্দানি বংশোদ্ভূত, পাজাজ্জারান বিশ্ববিদ্যালয়ের ডেন্টাল ফ্যাকাল্টির ডেন্টাল হাসপাতালে এসে প্রধান সমস্যা হিসেবে মুখের ঘা-এর কথা জানান। ঘাগুলো ওপরের এবং নিচের ঠোঁটে ব্যথাসহ দেখা দেয় এবং খাবার খাওয়া ও কথা বলার সময় আরও বাড়ে। প্রথমে, চার দিন আগে মুখের ভেতরে ঘা শুরু হয়, তারপর দুই দিন পর ঠোঁটে দেখা যায়। রোগী নিজে পেট্রোলিয়াম জেলি লাগিয়ে উপসর্গগুলো উপশম করার চেষ্টা করেছিলেন, কিন্তু তাতে কোনো উন্নতি হয়নি। এরপর তিনি ফার্মেসি থেকে কেনা ট্রায়ামসিনোলোন অ্যাসিটোনাইড ০.১% ওরবেস মলম দিনে একবার লাগিয়েছিলেন। ঘাগুলো কিছুটা ভালো হচ্ছিল, কিন্তু পুরোপুরি সেরে যায়নি।\n\nরোগীর জানান, ঘা শুরু হওয়ার প্রায় এক সপ্তাহ আগে তার জ্বর ছিল এবং শরীরের অন্য কোনো অংশে কোনো ক্ষত ছিল না। তিনি আরও জানান যে তার কাজের চাপ বেশ বেশি ছিল এবং প্রায় দেড় মাস ধরে তিনি সুষম খাবার খাননি। তার আগে কোনো রোগ ছিল না, কোনো খাবারে অ্যালার্জি ছিল না এবং কোনো ওষুধও সেবন করেননি। তিনি অ্যালকোহল পান বা ধূমপান করতেন না, তবে তার ঠোঁট চাটতে প্রায়ই দেখা যেত। ছোটবেলায় তার চিকেনপক্স হয়েছিল।\n\nশারীরিক পরীক্ষার সময় দেখা যায়, রোগীর জ্বর নেই এবং অন্যান্য শারীরিক লক্ষণগুলো স্বাভাবিক সীমার মধ্যে আছে। মুখের বাইরের অংশে কোনো অস্বাভাবিকতা দেখা যায়নি। ঠোঁটে সেরোস্যাঙ্গুইনাস ক্রাস্ট ছিল, যা স্পর্শ করলে ব্যথা লাগত এবং সহজে রক্তপাত হতো। মুখের ভেতরের পরীক্ষায় দেখা যায়, লালচে রঙের ক্ষত, যা আকারে অনিয়মিত এবং এর প্রান্তগুলো অস্পষ্ট, এবং ওপরের ও নিচের ঠোঁটের শ্লেষ্মা ঝিল্লিতে ব্যথা ছিল। একটি হাইপারকেরাটোটিক সাদা দাগ ছিল, যা ঘষে তোলার চেষ্টা করলেও উঠছিল না, এর আকার অনিয়মিত এবং প্রান্তগুলো অস্পষ্ট, তবে এই অংশে কোনো ব্যথা ছিল না। জিভের পেছনের দিকে এক-তৃতীয়াংশে হলুদাভ-সাদা দাগ দেখা যায়, যা ঘষে তুললে লালচে দাগ থাকত না এবং জিভের দুই পাশে দাঁতের ছাপের মতো কিছু খাঁজ ছিল, যেখানে কোনো ব্যথা ছিল না। কঠিন তালুর মাঝখানে প্রায় ২x১x০.৫ সেমি আকারের একটি ব্যথাহীন শক্ত পিণ্ড দেখা যায়। সব অংশে দাঁতের ক্ষয়, রুট এবং দাঁতবিহীন অবস্থা দেখা যায়। মুখের স্বাস্থ্যবিধি দুর্বল ছিল।\n\nরোগীর মানসিক অবস্থা মূল্যায়নের জন্য ডিএএসএস-২১ প্রশ্নাবলী ব্যবহার করা হয়, যেখানে দেখা যায় তার বিষণ্নতার মাত্রা স্বাভাবিক (স্কোর ০), উদ্বেগের মাত্রা স্বাভাবিক (স্কোর ৬) এবং মানসিক চাপের মাত্রাও স্বাভাবিক (স্কোর ৬)। ইতিহাস এবং শারীরিক পরীক্ষার ফলাফলের ভিত্তিতে, প্রাথমিক রোগ নির্ণয় হিসেবে সন্দেহ করা হয় যে রোগীর হেম (HAEM) হয়েছে, যার সাথে জিভের ওপরের অংশে সাদাটে আস্তরণ, ঘর্ষণের কারণে কেরাটোসিস, জিভের খাঁজ, টরাস প্যালাটিনাস, দাঁত ১৮-এর রিভার্সিবল পালপাইটিস, দাঁত ৪৭-এর ইরিভার্সিবল পালপাইটিস, দাঁত ১৫-এর ক্রনিক অ্যাপিক্যাল পেরিওডন্টাইটিস এবং দাঁত ২৮, ৩৭, ৩৬ এবং ৪৬-এর দাঁতবিহীন অবস্থার সম্পর্ক থাকতে পারে। ঠোঁটের সন্দেহজনক হেম (HAEM) ক্ষতের ডিফারেনশিয়াল ডায়াগনোসিস হলো এক্সফোলিয়েটিভ কেইলিটিস। তবে, এক্সফোলিয়েটিভ কেইলিটিসে হার্পিস ভাইরাসের সংক্রমণ ছিল না। রোগ নির্ণয় নিশ্চিত করার জন্য রোগীকে সেরোলজিক্যাল পরীক্ষা (আইজিজি অ্যান্টি-এইচএসভি-১) করার পরামর্শ দেওয়া হয়। মুখের স্বাস্থ্য সম্পর্কিত জীবনযাত্রার মান পরিমাপ করা হয় এবং প্রথম ভিজিটে ওএইচআইপি-১৪ পরীক্ষায় ৩৫ স্কোর পাওয়া যায় (যা মাঝারি ওএইচআরকিউওএল নির্দেশ করে)।\n\nঅ-ফার্মাকোলজিক্যাল থেরাপির মধ্যে ছিল দিনে দুবার নরম ব্রাশের টুথব্রাশ দিয়ে দাঁত ও জিভ ব্রাশ করে মুখের স্বাস্থ্যবিধি বজায় রাখার নির্দেশনা এবং ডিটারজেন্টবিহীন টুথপেস্ট ব্যবহার করার পরামর্শ। এছাড়াও, প্রতিদিন কমপক্ষে দুই লিটার জল পান করা, সুষম খাবার খাওয়া, অ্যাসিডিক, ঝাল, শক্ত এবং মনোসোডিয়াম গ্লুটামেটযুক্ত খাবার পরিহার করা এবং ঠোঁট চাটতে বা চামড়া তুলে ফেলার খারাপ অভ্যাস বন্ধ করার বিষয়ে শিক্ষা দেওয়া হয়। ফার্মাকোলজিক্যাল থেরাপির মধ্যে ছিল স্থানীয় এবং পদ্ধতিগত ওষুধ। স্থানীয় ওষুধের মধ্যে ছিল দিনে অন্তত তিনবার ০.৯% সোডিয়াম ক্লোরাইড দ্রবণ দিয়ে ভেজানো গজ দিয়ে ঠোঁট মুছিয়ে নেওয়া এবং দিনে তিনবার ট্রায়ামসিনোলোন অ্যাসিটোনাইড ০.১% ওরবেস মলম পাতলা করে ঠোঁটে লাগানো। পদ্ধতিগত ওষুধের মধ্যে ছিল দিনে একবার মাল্টিভিটামিন সেবনের পরামর্শ।\n\nপ্রাথমিক ভিজিটের দুই দিন পর প্রথম ফলো-আপে উন্নতির লক্ষণ দেখা যায়। ঠোঁটের ব্যথা কমে যায়, তবে ঘাগুলো পুরোপুরি সারেনি। মুখের বাইরের পরীক্ষায় দেখা যায়, ঠোঁটে সেরোস্যাঙ্গুইনাস ক্রাস্ট রয়েছে, যা এখনও ব্যথাযুক্ত এবং সহজে রক্তপাত করে। সেরোলজিক্যাল পরীক্ষার ফলাফল (আইজিজি অ্যান্টি-এইচএসভি-১) পজিটিভ ছিল, অনুপাত ৬.৩২ (পজিটিভ: অনুপাত > ১.১)। ইতিহাস, শারীরিক পরীক্ষা এবং সেরোলজিক্যাল পরীক্ষার ফলাফলের ভিত্তিতে চূড়ান্ত রোগ নির্ণয় করা হয় হেম (HAEM)। অ-ফার্মাকোলজিক্যাল এবং ফার্মাকোলজিক্যাল থেরাপি অব্যাহত রাখা হয় এবং পদ্ধতিগত ওষুধ হিসেবে অ্যাসাইক্লোভির ২০০ মিগ্রা ট্যাবলেট দিনে পাঁচবার করে এক সপ্তাহ সেবনের পরামর্শ দেওয়া হয়।\n\nদ্বিতীয় ফলো-আপে, আগের ভিজিট থেকে পাঁচ দিন পর, উল্লেখযোগ্য উন্নতি দেখা যায় এবং রোগীর মুখের সমস্ত ক্ষত দ্রুত সেরে যায়। শেষ ভিজিটে ওএইচআইপি-১৪ পরীক্ষায় ৪ স্কোর পাওয়া যায় (যা ভালো ওএইচআরকিউওএল নির্দেশ করে)। রোগীর শারীরিক, মানসিক এবং সামাজিক অবস্থার উন্নতি হয় এবং সাত দিনের চিকিৎসার পর তা স্বাভাবিক অবস্থায় ফিরে আসে। রোগীকে পেরিওডন্টিক্স, ডেন্টাল কনজারভেশন, ওরাল সার্জারি এবং প্রোস্থোডন্টিক্স বিভাগে দাঁতের এবং মুখের স্বাস্থ্যসেবা চালিয়ে যেতে বলা হয়। রোগী তার রোগের বিস্তারিত বিবরণ প্রকাশের জন্য এবং ছবি প্রকাশের জন্য লিখিত সম্মতি দিয়েছেন এবং প্রতিষ্ঠানও এটি প্রকাশের জন্য অনুমোদন দিয়েছে। এই ঘটনা হেলসিঙ্কি ঘোষণা মেনে চলে।",
+    "translated_summary": "একজন ২৫ বছর বয়সী পুরুষ রোগী মুখের রোগের বিভাগে এসে প্রধান সমস্যা হিসেবে ঠোঁটে ব্যথাসহ ছোট ছোট ঘা থাকার কথা জানান। বাহ্যিক পরীক্ষায় দেখা যায় ঠোঁটে রক্তমিশ্রিত শুকনো crust (ত্বকের ওপরের স্তর) রয়েছে, যা ব্যথাদায়ক এবং সহজে রক্তপাত করে। মুখের ভেতরের পরীক্ষায় দেখা যায় ওপরের এবং নিচের ঠোঁটের শ্লেষ্মা ঝিল্লিতে ছড়িয়ে থাকা এবং ব্যথাদায়ক অনিয়মিত লালচে ক্ষত রয়েছে। অ্যান্টি-এইচএসভি১ আইজিজি পরীক্ষা পজিটিভ এসেছে। রোগীকে এইচএইএম (HAEM) রোগ হিসেবে নির্ণয় করা হয়েছে।\n\nচিকিৎসা পদ্ধতি: ওষুধ হিসেবে ট্রায়ামসিনোলোন অ্যাসিটোনাইড ০.১% (orabase-এ মিশ্রিত), অ্যাসাইক্লোভির ট্যাবলেট, মাল্টিভিটামিন এবং ০.৯% NaCl ব্যবহার করা হয়েছে। ওষুধ ছাড়া অন্যান্য সহায়ক চিকিৎসায় ভালো মৌখিক স্বাস্থ্যবিধি বজায় রাখা, ঝাল এবং টক খাবার পরিহার করা এবং ঠোঁট চাটবার খারাপ অভ্যাস ত্যাগ করার পরামর্শ দেওয়া হয়েছে।"
+  },
+  {
+    "id": "multiclinsum_gs_en_164.txt",
+    "fulltext": "A 56-year-old female patient presented with complaints of dyspnea that required oxygen supplementation. Her medical history dates back to July 2013 when she was hospitalized in the chest ward for dyspnea and cough with yellow sputum. She was subsequently diagnosed with Sjogren’s syndrome complicated with interstitial lung disease (ILD) and PAH (Table I). Her chest X-ray at that time showed vascular markings with interstitial thickening, costophrenic (CP) angle blunting and cardiomegaly. An echocardiogram revealed a pulmonary arterial (PA) systolic pressure of 99 mmHg, enlargement of the right atrium and ventricle, D-shaped left ventricle (LV), and severe tricuspid regurgitation. Chest CNYCT showed no filling defects, excluding pulmonary embolism; it also displayed an enlarged pulmonary trunk, right atrium (RA), and right ventricle (RV), further evidencing pulmonary hypertension. Symptoms of dry mouth, dry eyes, and cracked tongue mucosa, with a Schirmer’s test showing <5 cm, oculus uterque (OU). A positive minor salivary gland biopsy, nuclear medicine scan showing impaired salivary gland function, and a positive anti-Ro test, confirmed Sjogren’s syndrome. She started on Revatio (Sildenafil) 20 mg three times a day (TID) for pulmonary hypertension control, adding Tracleer (Bosentan) in 2016 due to disease progression. A right heart catheterization (RHC) revealed a mean pulmonary arterial pressure (PAP) of 39 mmHg, pulmonary vascular resistance (PVR) nearly 15 Woods, and a wedge pressure of 4, indicating pre-capillary type, group I, CTD-related PAH in 2017. The right heart catheterization (RHC) report allowed for insurance coverage of Opsumit (Macitentan) 10 mg once a day (QD), replacing Tracleer (Bosentan) in 2017. From 2017 to 2020, she was hospitalized multiple times for steroid treatments to manage her underlying Sjogren’s syndrome.\n\nPulmonary hypertension treatment is risk-based, and until 2017, the patient was considered low to intermediate risk, controlled with two medications (Sildenafil + Macitentan). Her condition remained stable until October 2020, when she experienced worsened dyspnea accompanied by cough and expectoration of white sputum, suggestive of infection. On November 10, 2020, the patient experienced severe dyspnea, cold sweats, and cyanosis, with SpO2 dropping to 70%, necessitating 100% O2 via face tent. Blood gas and lab tests revealed a lactate level of 5.2 mmol/l and brain natriuretic peptide (BNP) over 10,000 pg/ml, strongly suggesting cardiogenic shock. She was prepped for intensive care unit (ICU) admission, intubated, and initiated on four pulmonary hypertension medications. Her condition stabilized and showed improvement, preventing further deterioration. On November 12, 2020, evaluation for heart-lung transplantation began. Her condition continued to improve with off vasopressors on November 13, 2020, and extubating on November 14, 2020, and transferred to a general ward on November 21, 2020, with O2 tapered to nasal cannula 2l/min. A follow-up RHC continued to show elevated pulmonary artery pressure, likely attributed to chronic hypertension leading to right heart strain and eventual failure. After intensive care unit (ICU) treatment, she was referred to National Taiwan University Hospital for evaluation for heart-lung transplant.\n\nReviewing the records since the onset of her illness, it was evident that pulmonary artery pressure had steadily increased, and the distance covered in the 6-minute walk test was progressively shortened. Currently, the patient is classified as high risk. She continues regular hospitalizations for control. Despite the relatively stable condition, her chief complaint during the admission is still dyspnea. The physical examination revealed mild rhonchi ILD and a pansystolic murmur indicative of severe valvular heart disease, with no other significant findings. Ventavis (Iloprost) 10 mcg/ml 2 ml was added in 2020. Molecular hydrogen therapy (1 capsule/day) was initiated in May 2023. Hydrogen capsules (PURE HYDROGEN) were purchased from HoHo Biotech Co., Ltd. (Taipei, Taiwan, ROC). Each capsule contained 170 mg of hydrogen-rich coral calcium containing 1.7×1,021 molecules of hydrogen, which is equivalent to 24 cups of water with 1,200 ppb of hydrogen or 0.6 mM of hydrogen per 200 ml of water. Adjuvant therapy with hydrogen capsules resulted in increased CD127 + Treg, decreased anti-Ro antibody, decreased B cell subsets, and stabilization of clinical symptoms and signs was observed following the addition of hydrogen therapy in this patient. No adverse reactions or events were observed following the administration of hydrogen capsules. Flow cytometry and serological examination were employed for whole-blood analysis to assess changes in immune cells and autoantibody before and after hydrogen therapy. For subsequent whole-blood analysis via flow cytometry, blood samples were prepared using standard fluorescent dye preparation methods and fluorescent antibody reagent kits with dried reagents (Beckman Coulter, Brea, CA, USA). The methods, steps, immunophenotypic analysis, and cell gating were conducted following previously described procedures. Our analysis of immunophenotypic markers before and after hydrogen therapy revealed increased CD127 + Treg and decreased B cell subsets after treatment. Moreover, this study adheres to the CARE reporting guidelines (2013 CARE Checklist).",
+    "summary": "We present the case of a 56-year-old female with CTD-PAH, diagnosed in 2013 with Sjogren’s syndrome complicated by interstitial lung disease (ILD) and PAH. Despite treatment with sildenafil, bosentan, macitentan, iloprost, and corticosteroids, her condition deteriorated, resulting in severe dyspnea and cardiogenic shock in 2020. In May 2023, molecular hydrogen therapy was initiated as an adjuvant treatment. The patient received daily hydrogen capsules, which led to increased CD127+ Treg cells, reduced anti-Ro antibodies, and decreased B cell subsets. Her clinical symptoms stabilized without adverse effects.",
+    "translated_fulltext": "একজন ৫৬ বছর বয়সী মহিলা রোগী শ্বাসকষ্টের অভিযোগ নিয়ে এসেছিলেন, যার কারণে তাকে অক্সিজেন দিতে হয়েছিল। তার রোগের ইতিহাস অনুসারে, জুলাই ২০১৩-তে তাকে বুকে ব্যথা এবং হলুদ কফসহ শ্বাসকষ্টের জন্য হাসপাতালে ভর্তি করা হয়েছিল। পরবর্তীতে তার শরীরে Sjögren’s syndrome ধরা পড়ে, যা ইন্টারস্টিশিয়াল লাং ডিজিজ (ILD) এবং পালমোনারি আর্টেরিয়াল হাইপারটেনশন (PAH)-এর সাথে জটিল ছিল (সারণী ১)। সেই সময়ে বুকের এক্স-রে-তে দেখা যায় যে, ইন্টারস্টিশিয়াল অঞ্চলে রক্তনালীগুলো দৃশ্যমান এবং পুরু হয়ে গেছে, কস্টোফ্রেনিক (CP) কোণ ভোঁতা হয়ে গেছে এবং হৃদপিণ্ড বড় হয়ে গেছে। ইকোকার্ডিওগ্রাম পরীক্ষায় দেখা যায় পালমোনারি ধমনীর (PA) সিস্টোলিক চাপ ৯৯ মিমি Hg, ডান অ্যাট্রিয়াম এবং ভেন্ট্রিকল বড় হয়ে গেছে, ডি-আকৃতির বাম ভেন্ট্রিকল (LV) এবং মারাত্মক ট্রিকাস্পিড রিগারজিটেশন রয়েছে। বুকের সিটি স্ক্যানে কোনো ভরাট হওয়ার মতো ত্রুটি দেখা যায়নি, যা পালমোনারি এম্বোলিজমকে বাতিল করে; এছাড়াও, পালমোনারি ট্রাঙ্ক, ডান অ্যাট্রিয়াম (RA) এবং ডান ভেন্ট্রিকল (RV) বড় দেখা যায়, যা পালমোনারি হাইপারটেনশনের প্রমাণ দেয়। রোগীর মুখের ভেতর শুষ্ক, চোখ শুষ্ক এবং জিভের মিউকাস ঝিল্লি ফেটে যাওয়ার মতো লক্ষণ দেখা যায়, এবং শির্মার পরীক্ষায় <৫ সেমি পাওয়া যায়, যা উভয় চোখে (OU) শুষ্কতা নির্দেশ করে। ছোট লালা গ্রন্থির বায়োপসি, নিউক্লিয়ার মেডিসিন স্ক্যান এবং অ্যান্টি-রো পরীক্ষায় ইতিবাচক ফলাফল পাওয়া যায়, যা Sjögren’s syndrome-এর বিষয়টি নিশ্চিত করে। পালমোনারি হাইপারটেনশন নিয়ন্ত্রণে রাখার জন্য তাকে রেভাটিও (সিলডেনাফিল) ২০ মিগ্রা দিনে তিনবার (TID) দেওয়া শুরু করা হয় এবং রোগের অগ্রগতির কারণে ২০১৬ সালে ট্র্যাক্লিয়ার (বোসেনটান) যুক্ত করা হয়। ডান হৃদপিণ্ডের ক্যাথেটারাইজেশন (RHC) পরীক্ষায় দেখা যায়, পালমোনারি ধমনীর গড় চাপ (PAP) ৩৯ মিমি Hg, পালমোনারি ভাস্কুলার রেজিস্ট্যান্স (PVR) প্রায় ১৫ উডস এবং ওয়েজ প্রেসার ৪, যা প্রি-ক্যাপি Larry টাইপ, গ্রুপ ১, সিটিডি-সম্পর্কিত পিএএইচ নির্দেশ করে (২০১৭)। ডান হৃদপিণ্ডের ক্যাথেটারাইজেশন (RHC) রিপোর্টের মাধ্যমে অপসুমিট (ম্যাসিটেনটান) ১০ মিগ্রা দিনে একবার (QD) দেওয়ার অনুমতি দেওয়া হয়, যা ২০১৭ সালে ট্র্যাক্লিয়ার (বোসেনটান)-এর বিকল্প হিসেবে ব্যবহার করা হয়। ২০১৭ থেকে ২০২০ সাল পর্যন্ত, তার Sjögren’s syndrome নিয়ন্ত্রণে রাখার জন্য তাকে বেশ কয়েকবার স্টেরয়েড দিয়ে চিকিৎসা করা হয়।\n\nপালমোনারি হাইপারটেনশনের চিকিৎসা ঝুঁকির ওপর ভিত্তি করে করা হয় এবং ২০১৭ সাল পর্যন্ত, রোগীকে কম থেকে মাঝারি ঝুঁকিপূর্ণ হিসেবে বিবেচনা করা হয়েছিল এবং দুটি ওষুধ (সিলডেনাফিল + ম্যাসিটেনটান) দিয়ে তার অবস্থা নিয়ন্ত্রণ করা হয়েছিল। ২০২০ সালের অক্টোবর মাস পর্যন্ত তার অবস্থা স্থিতিশীল ছিল, এরপর শ্বাসকষ্ট বেড়ে যায় এবং সাদা কফসহ কাশি দেখা যায়, যা সংক্রমণের ইঙ্গিত দেয়। ২০২০ সালের ১০ নভেম্বর, রোগীর তীব্র শ্বাসকষ্ট, ঠান্ডা লাগা এবং সায়ানোসিস দেখা যায়, SpO2-এর মাত্রা ৭০%-এ নেমে আসে, যার কারণে ফেস টেন্টের মাধ্যমে ১০০% অক্সিজেন দিতে হয়। রক্ত গ্যাস এবং ল্যাব পরীক্ষায় ল্যাকটেটের মাত্রা ৫.২ mmol/l এবং ব্রেইন ন্যাট্রিয়ুরেটিক পেপটাইড (BNP) ১০,০০০ pg/ml-এর বেশি পাওয়া যায়, যা কার্ডিওজেনিক শকের সম্ভাবনা নির্দেশ করে। তাকে ইনটেনসিভ কেয়ার ইউনিটে (ICU) ভর্তির জন্য প্রস্তুত করা হয়, ইন্টিউবেট করা হয় এবং চারটি পালমোনারি হাইপারটেনশন ওষুধ দেওয়া শুরু করা হয়। তার অবস্থা স্থিতিশীল হয় এবং উন্নতি দেখা যায়, যা আরও খারাপ হওয়া থেকে রক্ষা করে। ২০২০ সালের ১২ নভেম্বর, হৃদপিণ্ড-ফুসফুসের প্রতিস্থাপনের জন্য মূল্যায়ন শুরু করা হয়। নভেম্বরের ১৩, ২০২০ তারিখে ভ্যাসোপ্রেসর বন্ধ করে দেওয়া হয় এবং নভেম্বরের ১৪, ২০২০ তারিখে ইন্টিউবেশন টিউব সরিয়ে নেওয়া হয়, এরপর তাকে নভেম্বরের ২১, ২০২০ তারিখে একটি সাধারণ ওয়ার্ডে স্থানান্তর করা হয় এবং নাকের ক্যানুলা দিয়ে ২ লিটার/মিনিট অক্সিজেন দেওয়া হয়। ফলো-আপ আরএইচসি পরীক্ষায় পালমোনারি ধমনীর চাপ বেশি দেখা যায়, যা সম্ভবত দীর্ঘস্থায়ী উচ্চ রক্তচাপের কারণে ডান হৃদপিণ্ডের ওপর চাপ এবং পরবর্তীতে ব্যর্থতার কারণে হয়েছে। ইনটেনসিভ কেয়ার ইউনিট (আইসিইউ)-এ চিকিৎসার পর, তাকে হৃদপিণ্ড-ফুসফুসের প্রতিস্থাপনের জন্য ন্যাশনাল তাইওয়ান ইউনিভার্সিটি হাসপাতালে রেফার করা হয়।\n\nরোগের শুরু থেকে তার স্বাস্থ্য বিষয়ক রেকর্ড পর্যালোচনা করে দেখা যায়, পালমোনারি ধমনীর চাপ ধীরে ধীরে বেড়েছে এবং ৬ মিনিটের হাঁটা পরীক্ষায় আগের তুলনায় কম দূরত্ব অতিক্রম করতে পেরেছে। বর্তমানে, রোগীকে উচ্চ ঝুঁকিপূর্ণ হিসেবে বিবেচনা করা হচ্ছে। তার অবস্থা নিয়ন্ত্রণে রাখার জন্য নিয়মিত হাসপাতালে ভর্তি করা হয়। তুলনামূলকভাবে স্থিতিশীল অবস্থা সত্ত্বেও, হাসপাতালে ভর্তির সময় তার প্রধান অভিযোগ শ্বাসকষ্ট। শারীরিক পরীক্ষায় হালকা রনচাই (ILD) এবং মারাত্মক ভালভুলার হৃদরোগের ইঙ্গিতবাহী প্যানসিস্টোলিক মারমার শোনা যায়, অন্য কোনো উল্লেখযোগ্য লক্ষণ দেখা যায়নি। ২০২০ সালে ভেন্টাভিস (ইলপ্রোস্ট) ১০ mcg/ml 2 ml যুক্ত করা হয়। মে 2023-এ মলিকিউলার হাইড্রোজেন থেরাপি (1 ক্যাপসুল/দিন) শুরু করা হয়। হাইড্রোজেন ক্যাপসুল (পিউর হাইড্রোজেন) HoHo Biotech Co., Ltd. (তাইপেই, তাইওয়ান, आरओসি) থেকে কেনা হয়েছিল। প্রতিটি ক্যাপসুলে ১৭০ মিগ্রা হাইড্রোজেন-সমৃদ্ধ কোরাল ক্যালসিয়াম রয়েছে, যাতে 1.7×1,021 হাইড্রোজেন অণু রয়েছে, যা ১,২০০ পিপিবি হাইড্রোজেনযুক্ত ২৪ কাপ জলের সমান অথবা প্রতি ২০০ মিলি জলে ০.৬ এমএম হাইড্রোজেন। হাইড্রোজেন ক্যাপসুল দিয়ে সহায়ক থেরাপি দেওয়ার ফলে সিডি১২৭ + টিরেগ বৃদ্ধি পায়, অ্যান্টি-রো অ্যান্টিবডি হ্রাস পায়, বি কোষের সংখ্যা কমে যায় এবং ক্লিনিকাল লক্ষণ ও উপসর্গ স্থিতিশীল হয়। হাইড্রোজেন ক্যাপসুল দেওয়ার পর কোনো বিরূপ প্রতিক্রিয়া বা ঘটনা দেখা যায়নি। ইমিউন কোষ এবং অটোঅ্যান্টিবডির পরিবর্তন মূল্যায়ন করার জন্য পুরো রক্তের বিশ্লেষণ করার জন্য ফ্লো সাইটোমেট্রি এবং সেরোলজিক্যাল পরীক্ষা করা হয়েছিল। পরবর্তীকালে ফ্লো সাইটোমেট্রির মাধ্যমে পুরো রক্তের বিশ্লেষণ করার জন্য, রক্তের নমুনাগুলি স্ট্যান্ডার্ড ফ্লুরোসেন্ট ডাই প্রস্তুতি পদ্ধতি এবং শুকনো রিএজেন্টযুক্ত ফ্লুরোসেন্ট অ্যান্টিবডি রিএজেন্ট কিট ব্যবহার করে প্রস্তুত করা হয়েছিল (বেকম্যান কুল্টার, ব্রেয়া, সিএ, মার্কিন যুক্তরাষ্ট্র)। পদ্ধতি, ধাপ, ইমিউনোফেনোটাইপিক বিশ্লেষণ এবং কোষ গেটিং পূর্ববর্তীভাবে বর্ণিত পদ্ধতি অনুসরণ করে করা হয়েছিল। হাইড্রোজেন থেরাপির আগে এবং পরে ইমিউনোফেনোটাইপিক মার্কারের আমাদের বিশ্লেষণে দেখা যায় যে, সিডি১২৭ + টিরেগ বৃদ্ধি পেয়েছে এবং বি কোষের সংখ্যা কমেছে। উপরন্তু, এই গবেষণাটি CARE রিপোর্টিং নির্দেশিকা (2013 CARE চেকলিস্ট) মেনে চলে।",
+    "translated_summary": "আমরা একজন ৫৬ বছর বয়সী মহিলার ঘটনা তুলে ধরছি, যিনি সিটিডি-পিএএইচ-এ আক্রান্ত ছিলেন। ২০১৩ সালে তার শরীরে sjögren’s syndrome ধরা পড়ে, যা ইন্টারস্টিশিয়াল লাং ডিজিজ (আইএলডি) এবং পিএএইচ-এর কারণে জটিল আকার ধারণ করে। সিলডেনাফিল, বোসেনটান, ম্যাসিতেনটান, ইলপ্রোস্ট এবং কর্টিকোস্টেরয়েড দিয়ে চিকিৎসা করার পরেও তার অবস্থার অবনতি হয়, যার ফলে ২০২০ সালে গুরুতর শ্বাসকষ্ট এবং কার্ডিওজেনিক শক দেখা দেয়। ২০২৩ সালের মে মাসে, সহায়ক চিকিৎসা হিসেবে মলিকিউলার হাইড্রোজেন থেরাপি শুরু করা হয়। রোগীকে প্রতিদিন হাইড্রোজেন ক্যাপসুল দেওয়া হতো, যার ফলে সিডি১২৭+ টিরেগ কোষের সংখ্যা বৃদ্ধি পায়, অ্যান্টি-রো অ্যান্টিবডির পরিমাণ হ্রাস পায় এবং বি কোষের উপশ্রেণী কমে যায়। এর ফলে তার ক্লিনিক্যাল উপসর্গগুলো স্থিতিশীল হয় এবং কোনো বিরূপ প্রভাব দেখা যায় না।"
+  },
+  {
+    "id": "multiclinsum_gs_en_354.txt",
+    "fulltext": "The patient was a 45-year-old male born in Pakistan who had resided in Portugal for 7 years. He had a history of grade 3 obesity, with no other known personal history or usual pharmacological therapy.\n\nThe patient sought emergency care for fever, dry cough, dyspnea, chest pain, dysgeusia, headache and myalgia with 4 days of evolution. In the summary neurological examination at admission, there were no reported changes. In the evaluation of the respiratory system, tachypnea and pulmonary auscultation with bilateral rough vesicular murmur, without other adventitious sounds, were noted. The remainder of the objective examination showed no changes.\n\nOf the complementary diagnostic tests performed at admission, there was a slight increase in inflammatory parameters and in arterial blood gases under an inspired oxygen fraction (FiO2) of 21%, with type 1 respiratory failure and extensive predominant bilateral, peripheral and basal opacities on chest teleradiography. After a positive reverse-transcription real-time polymerase chain reaction (RT-PCR) test for SARS-CoV-2 (nasal and oropharyngeal exudate) and negative tests for influenza A and B, Streptococcus pneumoniae and Legionella pneumophila, a diagnosis of pneumonia by SARS-CoV-2 infection was established.\n\nOver the first 48 hours, progressive worsening of fatigue, dyspnea and type 1 respiratory failure, requiring an increase in supplemental oxygen therapy, were observed. Due to the lack of improvement, noninvasive mechanical ventilation was initiated; however, due to poor adherence, high-flow oxygen therapy was initiated through a nasal cannula, without a response to therapy.\n\nIn this context, the patient was admitted to the intensive care unit (ICU), level III, where he underwent sedoanalgesia and orotracheal intubation with connection to invasive mechanical ventilation.\n\nOn the eleventh day of hospitalization, treatment with remdesivir, dexamethasone, enoxaparin and empirical antibiotic therapy with amoxicillin/clavulanic acid and azithromycin, administered on suspicion of bacterial overinfection, was continued. During this period, sustained fever was observed, with a weak response to antipyretic therapy, with improvements in inflammatory parameters after the third day of hospitalization in the ICU.\n\nTo exclude any concomitant infectious etiology, intravenous devices were replaced, and blood cultures, cultures of the tip of the central catheter and bronchial secretions, urinalysis, urine culture and transthoracic echocardiography were performed. Among the cultures, the blood culture yielded the only positive result, i.e., Klebsiella pneumoniae, which is sensitive to amoxicillin/clavulanic acid, which the patient was already receiving. The summary echocardiogram did not reveal valve changes suggestive of endocarditis, but the patient presented hypokinesia of the lateral wall and left ventricular apex, as well as poor biventricular function. A slight increase in troponins (1.8ng/mL) and ST-segment depression in leads I and aVL were confirmed, suggesting the existence of acute coronary syndrome or septic cardiomyopathy.\n\nOther noninfectious causes of febrile symptoms in the critically ill patient were excluded, including treatment with neuroleptics or altered thyroid function.\n\nNotably, there was a need for inotropic support with dobutamine in the ventilatory weaning phase as well as noninvasive ventilatory support after orotracheal extubation, which occurred on the fifteenth day of hospitalization.\n\nOn the sixteenth day of hospitalization (nineteenth day of confirmed disease), there was an episode of altered state of consciousness, conjugated deviation of gaze to the right and myoclonus of the face and thoracic region to the left followed by a generalized tonic-clonic seizure crisis, which ceased after midazolam therapy. The hypothesis that the seizure occurred in the context of a hypoxic-ischemic event was excluded because the patient remained normotensive, there was never a peri-event or hypoxemia, serum lactate level was normal, and diuresis remained preserved. Any ionic or glycemic disorders that could explain the inaugural seizure episode were excluded.\n\nIn the post-critical period, there was an absence of eye opening, no verbal response, failure to localize to pain (coma scale of Glasgow 7), and persistent left hemiparesis grade 3 out of 5. Due to the need for airway protection, the patient was sedated, subjected to orotracheal intubation and started on anticonvulsant therapy.\n\nIn the process of diagnosis of the convulsive episode, after cranial computed tomography confirmed no changes, the patient was subjected to lumbar puncture, with turbid CSF output and mild proteinorrachia but without pleocytosis and with normal opening pressure. In the CSF, neurotropic virus and venereal disease research laboratory (VDRL), acid-alcohol resistant bacteria tests and an RT-PCR test for SARS-CoV-2 were requested, and samples were collected for culture. Electroencephalography was performed 1 hour after propofol suspension and under fentanyl, with a single record and total duration of 13 minutes; the findings indicated no changes.\n\nAfter confirmation of a positive RT-PCR test for SARS-CoV-2 RNA in the CSF, without CSF pleiocytosis, the hypothesis of bacterial but nonviral meningitis was excluded, considering the hypothesis of encephalitis. Magnetic resonance imaging (MRI) performed on the seventeenth day of hospitalization showed multiple image artifacts associated with patient movement during the procedure, suggesting the need to repeat the examination.\n\nAfter discontinuation of sedoanalgesia, a change in consciousness was observed, with a Glasgow coma scale score of 14, persistent left hemiparesis with muscle strength grade 4 in 5 and an absence of involuntary movements, allowing safe orotracheal extubation in 24 hours. Given the favorable clinical outcome, brain biopsy was excluded. On the twenty-first day of hospitalization, the patient was transferred to the ward.\n\nThe patient maintained apyrexia without altered state of consciousness. No new episodes of involuntary movements were observed, and on the twenty-sixth day of hospitalization, he underwent a reassessment MRI, which revealed no pathological changes. As he maintained a favorable clinical evolution, the patient was discharged on the thirty-first day of hospitalization without antiepileptic drugs and with an appointment for follow-up with the internal medicine department.\n",
+    "summary": "The authors present the clinical case of a 45-year-old man admitted for pneumonia with a positive result for SARS-CoV-2, with no neurological history, who, on the 16th day of admission, presented a sudden change in consciousness accompanied by a conjugate deviation of the gaze to the right and myoclonia of the face and thoracic region to the left, followed by a generalized tonic-clonic convulsive seizure, associated with persistent left hemiparesis. From the study carried out, the existence of RT-PCR for SARS-CoV-2 in the cerebrospinal fluid is highlighted. The patient presented a clinical evolution with gradual improvement, and the outcome was favourable.\n",
+    "translated_fulltext": "রোগী ছিলেন ৪৫ বছর বয়সী একজন পুরুষ, যিনি পাকিস্তানে জন্মগ্রহণ করেন এবং ৭ বছর ধরে পর্তুগালে বসবাস করেছেন। তার পূর্বে তৃতীয় স্তরের স্থূলতার ইতিহাস ছিল, তবে অন্য কোনো ব্যক্তিগত স্বাস্থ্যগত সমস্যা বা নিয়মিত ওষুধ সেবনের ইতিহাস ছিল না।\n\nরোগী জ্বর, শুকনো কাশি, শ্বাসকষ্ট, বুকে ব্যথা, স্বাদ হ্রাস, মাথাব্যথা এবং ৪ দিন ধরে চলা মাংসপেশীর ব্যথার জন্য জরুরি চিকিৎসা সহায়তা চান। হাসপাতালে ভর্তির সময় প্রাথমিক স্নায়বিক পরীক্ষায় কোনো পরিবর্তন দেখা যায়নি। শ্বাসযন্ত্রের মূল্যায়নে দেখা যায়, তার শ্বাস-প্রশ্বাস দ্রুত হচ্ছে এবং উভয় ফুসফুসে সামান্য শব্দ হচ্ছে, তবে অন্য কোনো অস্বাভাবিক শব্দ নেই। অন্যান্য শারীরিক পরীক্ষায় কোনো পরিবর্তন দেখা যায়নি।\n\nহাসপাতালে ভর্তির সময় করা সহায়ক রোগ নির্ণয় পরীক্ষায় সামান্য প্রদাহের মাত্রা বৃদ্ধি এবং ২১% অক্সিজেন সমৃদ্ধ পরিবেশে ধমনী রক্তে গ্যাসের মাত্রার সামান্য পরিবর্তন দেখা যায়, যা প্রথম ধরনের শ্বাসযন্ত্রের ব্যর্থতা নির্দেশ করে। বুকের রেডিওগ্রাফিতে উভয় ফুসফুসে বিস্তৃত এবং প্রধানত প্রান্তীয় ও নিচের অংশে অস্বচ্ছতা দেখা যায়। SARS-CoV-2 (নাক ও মুখগহ্বর থেকে সংগৃহীত নমুনা) এর জন্য করা রিভার্স ট্রান্সক্রিপশন রিয়েল-টাইম পলিমারেজ চেইন রিঅ্যাকশন (RT-PCR) পরীক্ষায় পজিটিভ ফলাফল আসে এবং ইনফ্লুয়েঞ্জা এ ও বি, স্ট্রেপ্টোকক্কাস নিউমোনিয়া এবং লেজিওনেলা নিউমোফিলা-র জন্য করা পরীক্ষায় নেগেটিভ ফলাফল আসে। এর ভিত্তিতে SARS-CoV-2 সংক্রমণের কারণে নিউমোনিয়া হয়েছে বলে রোগ নির্ণয় করা হয়।\n\nপ্রথম ৪৮ ঘন্টায় রোগীর ক্লান্তি, শ্বাসকষ্ট এবং প্রথম ধরনের শ্বাসযন্ত্রের ব্যর্থতা ক্রমশ বাড়তে থাকে, যার কারণে সহায়ক অক্সিজেন থেরাপির মাত্রা বাড়ানো হয়। অবস্থার উন্নতি না হওয়ায়, অ-আক্রমণাত্মক যান্ত্রিক বায়ুচলাচল শুরু করা হয়; তবে, রোগীর ஒத்துழைকতার অভাবে, নাকের ক্যানুলা দিয়ে উচ্চ-প্রবাহের অক্সিজেন থেরাপি শুরু করা হয়, কিন্তু তাতে কোনো সাড়া পাওয়া যায়নি।\n\nএই পরিস্থিতিতে, রোগীকে তৃতীয় স্তরের নিবিড় পরিচর্যা কেন্দ্রে (ICU) ভর্তি করা হয়, যেখানে তাকে সেডোঅ্যানালজেসিয়া এবং ওরোট্র্যাকিয়াল ইন্টিউবেশন করা হয় এবং আক্রমণাত্মক যান্ত্রিক বায়ুচলাচলের সাথে সংযোগ স্থাপন করা হয়।\n\nহাসপাতালে ভর্তির একাদশ দিনে, রেমডেসিভির, ডেক্সামেথাসোন, এনোক্সাপারিন এবং অ্যামোক্সিসিলিন/ক্ল্যাভুলানিক অ্যাসিড ও অ্যাজিথ্রোমাইসিন দিয়ে অভিজ্ঞতামূলক অ্যান্টিবায়োটিক থেরাপি চালিয়ে যাওয়া হয়, যা ব্যাকটেরিয়ার অতিরিক্ত সংক্রমণের সন্দেহের কারণে দেওয়া হয়েছিল। এই সময়ে, রোগীর জ্বর persist করে এবং অ্যান্টিপাইরেটিক থেরাপির প্রতি দুর্বল সাড়া পাওয়া যায়। তবে, ICU-তে ভর্তির তৃতীয় দিনের পর প্রদাহের মাত্রায় উন্নতি দেখা যায়।\n\nএকই সময়ে অন্য কোনো সংক্রমণ হয়েছে কিনা, তা জানার জন্য, শিরার ভেতরের ডিভাইস পরিবর্তন করা হয় এবং রক্ত কালচার, কেন্দ্রীয় ক্যাথেটারের অগ্রভাগের কালচার ও ব্রঙ্কিয়াল নিঃসরণ, প্রস্রাব পরীক্ষা, প্রস্রাব কালচার এবং ট্রান্সথোরাসিক ইকোকার্ডিওগ্রাফি করা হয়। কালচারের ফলাফলে, শুধুমাত্র রক্ত কালচারে Klebsiella pneumoniae পাওয়া যায়, যা অ্যামোক্সিসিলিন/ক্ল্যাভুলানিক অ্যাসিডের প্রতি সংবেদনশীল, এবং রোগী এই ওষুধটি গ্রহণ করছিল। ইকোকার্ডিওগ্রামের সারসংক্ষেপে এন্ডোকার্ডাইটিসের কোনো লক্ষণীয় পরিবর্তন দেখা যায়নি, তবে রোগীর বাম দিকের দেওয়াল এবং বাম নিলয়ের শীর্ষে দুর্বলতা দেখা যায়, সেই সাথে উভয় নিলয়ের কার্যকারিতা দুর্বল ছিল। ট্রোপোনিনের মাত্রা সামান্য বৃদ্ধি (১.৮ng/mL) এবং I এবং aVL লিডে ST-সেগমেন্টের অবনতি দেখা যায়, যা তীব্র করোনারি সিনড্রোম বা সেপটিক কার্ডিওমায়োপ্যাথির সম্ভাবনা নির্দেশ করে।\n\nগুরুতর অসুস্থ রোগীর ক্ষেত্রে জ্বর হওয়ার অন্যান্য অসংক্রামক কারণ, যেমন নিউরোলিপটিক ওষুধ ব্যবহার বা থাইরয়েড হরমোনের অস্বাভাবিকতা, বাদ দেওয়া হয়।\n\nগুরুত্বপূর্ণভাবে, ভেন্টিলেটরি উইনিং পর্যায়ে ডবুটামিন দিয়ে ইনোট্রপিক সহায়তার প্রয়োজন হয়েছিল, সেইসাথে ওরোট্র্যাকিয়াল এক্সটিউবেশনের পরে অ-আক্রমণাত্মক ভেন্টিলেটরি সহায়তাও দেওয়া হয়েছিল, যা হাসপাতালে ভর্তির পঞ্চদশ দিনে করা হয়েছিল।\n\nহাসপাতালে ভর্তির ষোড়শ দিনে (রোগ নির্ণয়ের উনিশতম দিনে), রোগীর মধ্যে চেতনা স্তরের পরিবর্তন, চোখের দিকে ডানদিকে বিচ্যুতি এবং মুখ ও বুকের বাম দিকে মায়োক্লোনাস দেখা যায়, এরপর একটি সাধারণ টনিক-ক্লোনিক খিঁচুনি হয়, যা মিডাজোলাম থেরাপির পরে বন্ধ হয়ে যায়। রোগীর হাইপক্সিক-ইস্কেমিক ঘটনার কারণে খিঁচুনি হয়েছে কিনা, তা পরীক্ষা করা হয়। দেখা যায়, রোগীর রক্তচাপ স্বাভাবিক ছিল, খিঁচুনির আগে বা পরে অক্সিজেনের অভাব ছিল না, সিরাম ল্যাকটেটের মাত্রা স্বাভাবিক ছিল এবং প্রস্রাবের পরিমাণ স্বাভাবিক ছিল। কোনো আয়নিক বা গ্লাইসেমিক সমস্যা, যা খিঁচুনির কারণ হতে পারত, তা বাদ দেওয়া হয়।\n\nগুরুতর অবস্থার পরে, রোগীর চোখের পাতা খুলতে দেখা যায়নি, কোনো মৌখিক প্রতিক্রিয়া ছিল না, ব্যথার প্রতি কোনো সাড়া পাওয়া যায়নি (গ্লাসগো কোমা স্কেলে ৭), এবং বাম দিকে শরীরের অর্ধেক অংশে দুর্বলতা ছিল (৫-এর মধ্যে ৩)। শ্বাসনালীর সুরক্ষার জন্য, রোগীকে পুনরায় সেডেট করা হয়, ওরোট্র্যাকিয়াল ইন্টিউবেশন করা হয় এবং অ্যান্টিকনভালসেন্ট থেরাপি শুরু করা হয়।\n\nখিঁচুনির কারণ নির্ণয়ের জন্য, মাথার সিটি স্ক্যানে কোনো পরিবর্তন দেখা যায়নি। এরপর রোগীকে লাম্বার পাংচার করা হয়, যেখানে ঘোলাটে CSF পাওয়া যায় এবং সামান্য প্রোটিনোরাকিয়া দেখা যায়, তবে প্লিউসাইটোসিস বা স্বাভাবিক চাপ ছিল না। CSF-এ নিউরোট্রপিক ভাইরাস এবং ভেনেরিয়াল ডিজিজ রিসার্চ ল্যাবরেটরি (VDRL), অ্যাসিড-অ্যালকোহল প্রতিরোধী ব্যাকটেরিয়া পরীক্ষা এবং SARS-CoV-2-এর জন্য RT-PCR পরীক্ষা করা হয়, এবং কালচারের জন্য নমুনা সংগ্রহ করা হয়। প্রোপোফলের ব্যবহার বন্ধ করার ১ ঘণ্টা পর এবং ফেন্টানিলের অধীনে ইলেক্ট্রোএনসেফালোগ্রাফি করা হয়, যেখানে একটিমাত্র রেকর্ডিং নেওয়া হয় এবং মোট সময়কাল ছিল ১৩ মিনিট; ফলাফলে কোনো পরিবর্তন দেখা যায়নি।\n\nCSF-এ SARS-CoV-2 RNA-এর পজিটিভ RT-PCR পরীক্ষার ফলাফলের পরে, CSF-এ প্লিউসাইটোসিস না থাকায়, ব্যাকটেরিয়াল কিন্তু ননভাইরাল মেনিনজাইটিসের সম্ভাবনা বাতিল করা হয় এবং এনসেফালাইটিসের সম্ভাবনা বিবেচনা করা হয়। হাসপাতালে ভর্তির সতেরতম দিনে করা ম্যাগনেটিক রেজোন্যান্স ইমেজিং (MRI)-তে রোগীর নড়াচড়ার কারণে একাধিক ইমেজ আর্টিফ্যাক্ট দেখা যায়, যা পুনরায় পরীক্ষা করার প্রয়োজনীয়তা নির্দেশ করে।\n\nসেডোঅ্যানালজেসিয়া বন্ধ করার পরে, রোগীর চেতনার পরিবর্তন দেখা যায়, গ্লাসগো কোমা স্কেলে স্কোর ছিল ১৪, বাম দিকে শরীরের অর্ধেক অংশে দুর্বলতা ছিল (৫-এর মধ্যে ৪), এবং অনৈচ্ছিক নড়াচড়া অনুপস্থিত ছিল, যা ২৪ ঘণ্টার মধ্যে নিরাপদে ওরোট্র্যাকিয়াল এক্সটিউবেশন করতে সাহায্য করে। অনুকূল ক্লিনিকাল ফলাফলের কারণে, মস্তিষ্কের বায়োপসি বাদ দেওয়া হয়। হাসপাতালে ভর্তির একবিংশ দিনে, রোগীকে ওয়ার্ডে স্থানান্তর করা হয়।\n\nরোগীর জ্বর ছিল না এবং চেতনার কোনো পরিবর্তন হয়নি। নতুন কোনো অনৈচ্ছিক নড়াচড়া দেখা যায়নি এবং হাসপাতালে ভর্তির ছাব্বিশতম দিনে, পুনরায় MRI করা হয়, যেখানে কোনো রোগগত পরিবর্তন দেখা যায়নি। অনুকূল ক্লিনিকাল উন্নতি বজায় থাকায়, রোগীকে একত্রিশতম দিনে হাসপাতালে থেকে ছাড়া হয় এবং অ্যান্টিএপিলেপটিক ওষুধ ছাড়াই অভ্যন্তরীণ চিকিৎসা বিভাগের সাথে ফলো-আপের জন্য একটি অ্যাপয়েন্টমেন্ট দেওয়া হয়।",
+    "translated_summary": "লেখকেরা ৪৫ বছর বয়সী একজন পুরুষের ক্লিনিক্যাল ঘটনা উপস্থাপন করেছেন, যিনি নিউমোনিয়ার জন্য হাসপাতালে ভর্তি হয়েছিলেন এবং তার SARS-CoV-2 পরীক্ষা পজিটিভ ছিল। তার পূর্বে কোনো স্নায়বিক সমস্যা ছিল না। হাসপাতালে ভর্তির ১৬তম দিনে, তিনি হঠাৎ করে চেতনা হারাতে শুরু করেন, যার সাথে ডানদিকে চোখের পাতার অস্বাভাবিক নড়াচড়া এবং মুখের ও বুকের বাম দিকে মাংসপেশির খিঁচুনি দেখা যায়। এরপর তার সারা শরীরে টনিক-ক্লোনিক খিঁচুনি হয় এবং বাম দিকের শরীরের দুর্বলতা দেখা যায়। এই গবেষণা থেকে জানা যায় যে, মেরুদণ্ডের তরলে SARS-CoV-2-এর আরটি-পিসিআর উপস্থিতি ছিল। রোগীর ধীরে ধীরে উন্নতি হয় এবং শেষ পর্যন্ত তিনি সুস্থ হয়ে ওঠেন।"
+  },
+  {
+    "id": "multiclinsum_gs_en_423.txt",
+    "fulltext": "A 23-month-old boy with hypoxic-ischaemic encephalopathy at birth with good brain motor potential and normal psychomotor development. He had a personal history of restrictive cardiomyopathy and was included in a cardiac transplant programme when he was 16 months old. He also required the implantation of an external Berlin Heart biventricular support device. In order to prevent embolic events, double antiplatelet and anticoagulant treatment was administered. When he was 23 month old presented with disconnection and right hemiparesis. A computerised tomography (CT) scan showed a hyperdense left middle cerebral artery (MCA), as well as a chronic right parietotemporal infarction. His blood analysis showed: red cells 4.16 × 106 µ/L; haemoglobin 11.4 g/gL; activated partial thromboplastin time (APTT) 93 seconds and international normalised ratio (INR) 1.08.\n\nIntravenous thrombolytic treatment was contraindicated due to double antiplatelet and anticoagulant treatment at full dose with heparin, so an intra-arterial thrombectomy was performed. Although the patient was 23 months old, he was in the third percentile of the weight curve (10 kg). Under general anaesthesia, the right femoral artery was punctured and an 11 cm long 4F sheath (Cordis, Ireland) was placed. A 4F vertebral Radiofocus catheter (Glidecath of Terumo, Belgium) was used to confirm the occlusion of the M1 segment of the left MCA. The artery was recanalised by mechanical thrombectomy with a stentriever using the 4F vertebral catheter as a tutor, positioning it in the petrous segment of the carotid artery. A 3 mm × 20 mm Trevo XP Pro Vue device (Stryker, The Netherlands) was used, with a straight Rapid Transit microcatheter (Codman Neurovascular, UK), opening the artery in one pass. The whole system was removed (tutor catheter, microcatheter and stentriever) simultaneously. In the control run, an iatrogenic dissection of the left internal carotid artery was detected, which had no clinical significance, however, as the left hemisphere was irrigated through the anterior communicant artery.\n\nOne month later, his heart transplant was carried out successfully. Neurologically, the only long-term sequel that came as a result of the stroke was a right upper limb spasticity.",
+    "summary": "A 16-month-old boy with restrictive cardiomyopathy who was listed for a cardiac transplant. At 20 months he required an implantation of an external biventricular support device (Berlin Heart) and had a left hemisphere stroke at 23 months. An intra-arterial approach was used and produced good clinical results. One month later, a heart transplant was performed successfully.",
+    "translated_fulltext": "জন্মের সময় হাইপোক্সিক-ইসকেমিক এনসেফালোপ্যাথি থাকা ২৩-মাস-বয়সী এক ছেলে, যার মস্তিষ্কের মোটর সম্ভাবনা ভালো এবং স্বাভাবিক সাইকোমোটর বিকাশ। তার ব্যক্তিগত রোগতত্ত্বে রেস্ট্রিকটিভ কার্ডিওমায়োপ্যাথি ছিল এবং ১৬ মাস বয়সে তাকে একটি কার্ডিয়াক ট্রান্সপ্লান্ট প্রোগ্রামে অন্তর্ভুক্ত করা হয়। তিনি একটি বাহ্যিক Berlin Heart বাইভেন্ট্রিকুলার সাপোর্ট ডিভাইসের ইমপ্লান্টেশনও প্রয়োজন করেছিলেন। এম্বোলিক ইভেন্ট প্রতিরোধের জন্য ডাবল অ্যান্টিপ্লেটলেট এবং অ্যান্টিকোঅ্যাগুল্যান্ট চিকিৎসা দেওয়া হয়েছিল। ২৩ মাস বয়সে তিনি ডিসকনেকশন এবং ডান হেমিপ্যারেসিস নিয়ে উপস্থিত হন। কম্পিউটারাইজড টোমোগ্রাফি (CT) স্ক্যানে হাইপারডেন্স বাম মিডল সেরিব্রাল আর্টারি (MCA), পাশাপাশি একটি ক্রনিক ডান প্যারিয়েটোটেমপরাল ইনফার্কশন দেখা যায়। তার রক্ত বিশ্লেষণে দেখা যায়: লাল রক্তকণিকা 4.16 × 106 µ/L; হিমোগ্লোবিন 11.4 g/gL; অ্যাক্টিভেটেড পার্শিয়াল থ্রম্বোপ্লাস্টিন টাইম (APTT) 93 seconds এবং ইন্টারন্যাশনাল নরমালাইজড রেশিও (INR) 1.08।\n\nহেপারিনসহ ফুল ডোজে ডাবল অ্যান্টিপ্লেটলেট এবং অ্যান্টিকোঅ্যাগুল্যান্ট চিকিৎসা চলমান থাকায় ইনট্রাভেনাস থ্রম্বোলাইটিক চিকিৎসা কনট্রাইন্ডিকেটেড ছিল, তাই একটি ইন্ট্রা-আর্টেরিয়াল থ্রম্বেকটমি করা হয়। যদিও রোগীর বয়স ২৩ মাস, তিনি ওজন কার্ভের তৃতীয় পারসেন্টাইলে ছিলেন (10 kg)। জেনারেল অ্যানেস্থেশিয়ার অধীনে, ডান ফেমোরাল ধমনীতে পাঙ্কচার করা হয় এবং 11 cm লম্বা 4F শিথ (Cordis, Ireland) স্থাপন করা হয়। বাম MCA-এর M1 সেগমেন্টের অবরোধ নিশ্চিত করতে 4F ভার্টিব্রাল Radiofocus ক্যাথেটার (Glidecath of Terumo, Belgium) ব্যবহার করা হয়। 4F ভার্টিব্রাল ক্যাথেটারকে টিউটর হিসেবে ব্যবহার করে, ক্যারোটিড ধমনীর পেট্রাস সেগমেন্টে সেটি পজিশন করে, একটি স্টেনট্রিভার দিয়ে মেকানিক্যাল থ্রম্বেকটমির মাধ্যমে ধমনীটি রিক্যানালাইজ করা হয়। একটি 3 mm × 20 mm Trevo XP Pro Vue ডিভাইস (Stryker, The Netherlands) ব্যবহার করা হয়, সোজা Rapid Transit মাইক্রোক্যাথেটার (Codman Neurovascular, UK) সহ, এক পাসেই ধমনীটি খোলা হয়। সমগ্র সিস্টেমটি (টিউটর ক্যাথেটার, মাইক্রোক্যাথেটার এবং স্টেনট্রিভার) একসঙ্গে অপসারণ করা হয়। কন্ট্রোল রানে বাম ইন্টারনাল ক্যারোটিড ধমনীতে একটি আইএট্রোজেনিক ডিসেকশন সনাক্ত করা হয়, যার কোন ক্লিনিক্যাল তাৎপর্য ছিল না, কারণ বাম হেমিস্ফিয়ারটি অ্যান্টেরিয়র কমিউনিক্যান্ট আর্টারির মাধ্যমে সেচিত হচ্ছিল।\n\nএক মাস পরে, তার হার্ট ট্রান্সপ্লান্ট সফলভাবে সম্পন্ন করা হয়েছিল। নিউরোলজিক্যালি, স্ট্রোকের ফলস্বরূপ যে একমাত্র দীর্ঘমেয়াদি সিকুয়েলা দেখা গেছে তা ছিল ডান ঊর্ধ্ব অঙ্গের স্প্যাস্টিসিটি।",
+    "translated_summary": "একটি ১৬ মাস বয়সী ছেলে, যার রেস্ট্রিক্টিভ কার্ডিওমায়োপ্যাথি ছিল, তাকে হৃদপিণ্ড প্রতিস্থাপনের জন্য তালিকাভুক্ত করা হয়েছিল। ২০ মাসে তার একটি বাহ্যিক বাইভেন্ট্রিকুলার সাপোর্ট ডিভাইস (বার্লিন হার্ট) প্রতিস্থাপন করার প্রয়োজন হয় এবং ২৩ মাসে তার মস্তিষ্কের বাম গোলার্ধে স্ট্রোক হয়। এক্ষেত্রে ইন্ট্রা-আর্টেরিয়াল পদ্ধতি ব্যবহার করা হয়েছিল এবং এর ফলে ভালো ক্লিনিক্যাল ফলাফল পাওয়া যায়। এক মাস পর, সফলভাবে তার হৃদপিণ্ড প্রতিস্থাপন করা হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_458.txt",
+    "fulltext": "A 12-year-old boy was brought to our department exhibiting sudden onset symptoms of headache and polyuria-polydipsia syndrome, which began one week prior to his initial visit. The child had no significant medical history. During the first clinical evaluation, he measured 146.5 cm in height (M) and weighed 30 kg (-1.4 SD). There were no observed signs of adrenal insufficiency or hypothyroidism. He was at the onset of puberty, with gonad sizes measuring 3.2 cm on each side and a penis length of 6.2 cm (M). Notably, the patient experienced polyuria-polydipsia syndrome, with fluid excretion reaching up to 113ml/kg/day, nocturnal enuresis, and an excessive liquid intake of 3.8 liters/m². Ophthalmologic examination yielded expected results, with no visual impairments detected and normal optical coherence tomography (OCT) findings.\n\nThe biological assessment revealed DI, with a serum sodium level of 140 mEq/l and plasma osmolality of 287 mosm/kg, while the urine osmolality was significantly low at 179 mosm/kg. Furthermore, his serum levels of insulin-like growth factor-1 (IGF1), prolactin (PRL), free T4, cortisol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were all within the normal range.\n\nMRI scans with and without contrast highlighted apoplexy in an RCC, showing a spontaneous hyperintensity on T1 and T2 sequences measuring 15x6x11 mm. The anterior pituitary gland displayed homogeneous contrast uptake. However, we observed a loss of the typical hyperintensity of the posterior pituitary gland, with no radiological indications of a craniopharyngioma. Therefore, during the initial hormonal evaluation, the only hormone deficiency identified in our case was DI, which showed significant improvement under vasopressin treatment. The case was reviewed in a multidisciplinary meeting, including an endocrinologist, neurosurgeon, and radiologist. Given the absence of clinical or biological signs other than DI and the stability of the RCC apoplexy over nine months of MRI monitoring—with measurements of 12 × 11 × 10 mm—a conservative management approach with regular follow-ups was chosen.\n\nThe child was monitored for three years, during which he displayed normal puberty development and maintained a stable hormonal profile (Table 1). Visual evaluations revealed no abnormalities. However, a decrease in growth velocity was noted, dropping from -0.8 SD to -1.1 SD. This necessitated an investigation for acquired growth hormone (GH) deficiency. At the age of 14 years and nine months, the child was readmitted to undergo two GH stimulation tests: A propranolol-glucagon test and an Insulin Tolerance Test, which indicated a partial GH deficiency with peaks of 19.3 µUI/ml and 10.0 µUI/ml, respectively. After receiving GH treatment, the patient experienced a notable increase in growth velocity, improving from -1.1 SD to 0.2 SD over one year.\n\nSubsequently, MRI monitoring showed a stable appearance of the RCC apoplexy after two years (11 × 12 × 11 mm), with a slight decrease in size observed at the three-year follow-up, measuring 7 × 10 × 6 mm. It is important to note that the radiological follow-up was consistently conducted at the same MRI center, with the same radiologist interpreting both recent and previous MRI findings during multidisciplinary meetings that included an endocrinologist and a neurosurgeon.",
+    "summary": "We present the case of a 12-year-old boy admitted due to the recent onset of headaches and diabetes insipidus. Magnetic resonance imaging revealed Rathke cleft cyst apoplexy. Given the absence of compressive symptoms in a child at the early stages of puberty and without abnormalities in basic endocrine tests, a conservative strategy was employed, involving regular clinical, biological, and radiological follow-ups. The child experienced normal puberty without any endocrine deficiencies except for a partial growth hormone deficiency.",
+    "translated_fulltext": "একটি ১২ বছর বয়সী ছেলেকে আমাদের বিভাগে আনা হয়েছিল, যার মধ্যে হঠাৎ করে মাথাব্যথা এবং পলিইউরিয়া-পলিডিপসিয়া সিনড্রোমের লক্ষণ দেখা যায়, যা তার প্রথম ভিজিটের এক সপ্তাহ আগে শুরু হয়েছিল। শিশুটির তেমন কোনো উল্লেখযোগ্য স্বাস্থ্য ইতিহাস ছিল না। প্রথম ক্লিনিক্যাল মূল্যায়নে, তার উচ্চতা ছিল ১৪৬.৫ সেমি (ছেলে) এবং ওজন ৩০ কেজি (-১.৪ এসডি)। অ্যাড্রিনাল অপ্রতুলতা বা হাইপোথাইরয়েডিজমের কোনো লক্ষণ দেখা যায়নি। সে বয়ঃসন্ধিকালে প্রবেশ করছিল, যেখানে উভয় দিকের গোনাডের আকার ছিল ৩.২ সেমি এবং লিঙ্গের দৈর্ঘ্য ৬.২ সেমি (ছেলে)। লক্ষণীয়ভাবে, রোগীর পলিইউরিয়া-পলিডিপসিয়া সিনড্রোম ছিল, যেখানে তরল নিঃসরণের পরিমাণ প্রতিদিন ১১৩ মিলি/কেজি পর্যন্ত ছিল, রাতের বেলা বিছানায় প্রস্রাব করা এবং অতিরিক্ত তরল গ্রহণের পরিমাণ ছিল ৩.৮ লিটার/মি²। চক্ষু পরীক্ষা স্বাভাবিক ফলাফল দেখায়, কোনো দৃষ্টি সমস্যা ধরা পড়েনি এবং অপটিক্যাল কোহেরেন্স টমোগ্রাফি (ওসিটি)-এর ফলাফল স্বাভাবিক ছিল।\n\nজৈবিক মূল্যায়নে ডিআই (ডায়াবেটিস ইনসিপিডাস) ধরা পড়ে, যেখানে সিরাম সোডিয়ামের মাত্রা ছিল ১৪০ এমইকিউ/লি এবং প্লাজমার অসমোলালিটি ছিল ২৮৭ মোসম/কেজি, যেখানে প্রস্রাবের অসমোলালিটি উল্লেখযোগ্যভাবে কম ছিল, ১৭৯ মোসম/কেজি। এছাড়াও, তার সিরামের ইনসুলিন-লাইক গ্রোথ ফ্যাক্টর-১ (আইজিএফ১), প্রোলাকটিন (পিআরএল), ফ্রি টি৪, কর্টিসল, ফলিকল-স্টিমুলেটিং হরমোন (এফএসএইচ) এবং লুটেইনাইজিং হরমোনের (এলএইচ) মাত্রা সবই স্বাভাবিক সীমার মধ্যে ছিল।\n\nকন্ট্রাস্টসহ এবং কন্ট্রাস্টবিহীন এমআরআই স্ক্যানে একটি আরসিসি-তে (রেনাল সেল কার্সিনোমা) অ্যাপোপ্লেক্সির চিত্র দেখা যায়, যেখানে টি১ এবং টি২ সিকোয়েন্সে স্বতঃস্ফূর্তভাবে ১৫x৬x১১ মিমি আকারের একটি হাইপারইনটেনসিটি দেখা যায়। সম্মুখ পিটুইটারি গ্রন্থিটিতে অভিন্ন কন্ট্রাস্ট গ্রহণ দেখা যায়। তবে, আমরা পশ্চাৎ পিটুইটারি গ্রন্থির সাধারণ হাইপারইনটেনসিটি হ্রাস দেখতে পাই, যেখানে ক্র্যানিওফ্যারিঞ্জিওমার কোনো রেডিওলজিক্যাল লক্ষণ ছিল না। তাই, প্রাথমিক হরমোন মূল্যায়নের সময়, আমাদের ক্ষেত্রে শুধুমাত্র ডিআই (ডায়াবেটিস ইনসিপিডাস)-এর অভাব দেখা যায়, যা ভ্যাসোপ্রেসিন চিকিৎসার মাধ্যমে উল্লেখযোগ্য উন্নতি দেখায়। এই ঘটনাটি একটি বহু-বিষয়ক সভায় আলোচনা করা হয়, যেখানে একজন এন্ডোক্রিনোলজিস্ট, নিউরোসার্জন এবং রেডিওলজিস্ট উপস্থিত ছিলেন। ডিআই ব্যতীত অন্য কোনো ক্লিনিক্যাল বা জৈবিক লক্ষণ না থাকায় এবং এমআরআই পর্যবেক্ষণে নয় মাস ধরে আরসিসি অ্যাপোপ্লেক্সির স্থিতিশীলতা বজায় থাকায় (মাপ ১২ × ১১ × ১০ মিমি), নিয়মিত ফলো-আপের সাথে একটি রক্ষণশীল ব্যবস্থাপনা পদ্ধতি বেছে নেওয়া হয়।\n\nশিশুটিকে তিন বছর ধরে পর্যবেক্ষণ করা হয়, এই সময়ে তার স্বাভাবিক বয়ঃসন্ধি বিকাশ ঘটে এবং হরমোনের মাত্রা স্থিতিশীল থাকে (সারণী ১)। দৃষ্টি মূল্যায়নে কোনো অস্বাভাবিকতা দেখা যায়নি। তবে, গ্রোথ ভেলোসিটিতে একটি হ্রাস লক্ষ্য করা যায়, যা -০.৮ এসডি থেকে -১.১ এসডি-তে নেমে আসে। এর ফলে অর্জিত গ্রোথ হরমোনের (জিএইচ) অভাবের জন্য একটি তদন্তের প্রয়োজন হয়। ১৪ বছর এবং নয় মাস বয়সে, শিশুটিকে দুটি জিএইচ স্টিমুলেশন পরীক্ষা করার জন্য পুনরায় হাসপাতালে ভর্তি করা হয়: একটি প্রোপ্রানোলল-গ্লুকাগন পরীক্ষা এবং একটি ইনসুলিন টলারেন্স পরীক্ষা, যা আংশিক জিএইচ অভাব নির্দেশ করে, যেখানে যথাক্রমে ১৯.৩ µUI/ml এবং ১০.০ µUI/ml-এর শিখর দেখা যায়। জিএইচ চিকিৎসা নেওয়ার পর, রোগীর গ্রোথ ভেলোসিটিতে উল্লেখযোগ্য বৃদ্ধি দেখা যায়, যা এক বছরে -১.১ এসডি থেকে ০.২ এসডি-তে উন্নতি লাভ করে।\n\nপরবর্তীকালে, এমআরআই পর্যবেক্ষণে দুই বছর পর আরসিসি অ্যাপোপ্লেক্সির স্থিতিশীল চিত্র দেখা যায় (১১ × ১২ × ১১ মিমি), এবং তিন বছরের ফলো-আপে সামান্য হ্রাস দেখা যায়, যেখানে আকার ছিল ৭ × ১০ × ৬ মিমি। এটা মনে রাখা গুরুত্বপূর্ণ যে রেডিওলজিক্যাল ফলো-আপ ধারাবাহিকভাবে একই এমআরআই কেন্দ্রে করা হয়েছিল, এবং একই রেডিওলজিস্ট সাম্প্রতিক এবং পূর্ববর্তী এমআরআই ফলাফল ব্যাখ্যা করেছিলেন, যেখানে একজন এন্ডোক্রিনোলজিস্ট এবং একজন নিউরোসার্জনও উপস্থিত ছিলেন।",
+    "translated_summary": "আমরা এখানে ১২ বছর বয়সী একটি ছেলের ঘটনা তুলে ধরছি, যাকে সম্প্রতি মাথাব্যথা এবং ডায়াবেটিস ইনসিপিডাস হওয়ার কারণে হাসপাতালে ভর্তি করা হয়েছিল। ম্যাগনেটিক রেজোন্যান্স ইমেজিং-এ দেখা যায় তার র‍্যাথকে ক্লিফট সিস্ট অ্যাপোপ্লেক্সি হয়েছে। বয়ঃসন্ধিকালের প্রাথমিক পর্যায়ে কোনো চাপজনিত উপসর্গ না থাকা এবং সাধারণ এন্ডোক্রাইন পরীক্ষায় কোনো অস্বাভাবিকতা না পাওয়ায়, একটি রক্ষণশীল পদ্ধতি অনুসরণ করা হয়, যেখানে নিয়মিত ক্লিনিক্যাল, বায়োলজিক্যাল এবং রেডিওলজিক্যাল ফলো-আপ করা হয়। ছেলেটি কোনো এন্ডোক্রাইন ঘাটতি ছাড়াই স্বাভাবিকভাবে বয়ঃসন্ধিকালে উত্তীর্ণ হয়, শুধুমাত্র সামান্য গ্রোথ হরমোনের ঘাটতি দেখা যায়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_474.txt",
+    "fulltext": "Patient and observation\nPatient information: This was a 67-year-old patient with no medical history who presented with dysphagia, dysphonia and altered general condition.\n\nClinical findings: initial clinical examination found a conscious patient with a Glasgow score of 15/15, apyrexia, blood pressure of 12/07 cmHg, oxygen saturation of 100%, heart rate of 80/min, conjunctivae of normal colour with a large mass in the cavum. There was no hepatomegaly or splenomegaly, the lymph node areas were free, the rest of the physical examination was normal.\n\nChronology: the patient had been experiencing difficulty swallowing with dysphonia for 6 months, the clinical picture worsened with the development of dysphagia for solids with a deterioration in general condition (weight loss of 15kg/6 months).\n\nDiagnostic approach: cervico-thoraco-abdomino-pelvic CT scan showed a 70 mm x 40 mm nasopharyngeal mass extending to 60 mm. The patient's blood work was normal (white blood cell count, renal and hepatic function, lactate dehydrogenase and HIV, HCV and HBV serologies). The histological and immunohistochemical study of the nasopharyngeal biopsy was in favour of a grade 1,2 CD20+; CD19+; CD79a+; CD10+ follicular B-cell NHL in 2 readings in 2 different laboratories. The bone marrow biopsy was normal as was the pre-therapeutic work-up.\n\nTherapeutic intervention: the patient received 4 RCHOP 21 cures (rituximab 375mg/m2 intravenous (iv), cyclophosphamide 750 mg/m2 iv, oncovin 2 mg iv, prednisolone 100 mg orally, and doxorubicin 50 mg/m2 (iv) with no response and then 3 RDHAOX cures (rituximab 375 mg/m2 intravenous (iv) on day 1, high dose aracytine 2 g/m2 x 2 iv on day 2, dexamethasone 40 mg from day 1 to day 4, and oxalipatine 100 mg/m2 on day 1) with no clinical response.\n\nFollow-up and results of therapeutic interventions: the persistence and increase of the nasopharyngeal mass led to the realization of the tracheotomy, the biopsy of the nasopharyngeal mass objectified the disappearance of the lymphoid B infiltration with presence of the amyloid deposits AL type kappa.\n\nImmune electrophoresis of plasma proteins showed the presence of immunoglobulin M kappa, the dosage of light chains was not performed due to lack of resources, the myelogram and a second bone marrow biopsy were normal, the TEP scan objectified a hypermetabolic nasopharyngeal process without other anomalies, the cardiac evaluation (ECG, natriuretic peptides, troponin, echocore) and renal were without particularities, the patient is currently under protocol bortezomib, prednisone and bendamustine with good clinical evolution after the first treatment.\n",
+    "summary": "We report the case of a 67-year-old patient without pathological CDDs who presented with a deterioration of general condition with progressive dysphonia and dysphagia with a large mass in the neck that was biopsy-proven to be a grade 1 and 2 follicular non-Hodgkin lymphoma. A cervico-thoraco-abdomino-pelvic CT scan showed a 70 mm x 40 mm nasopharyngeal mass extending to 60 mm. Bone marrow biopsy was normal and the pre-therapeutic evaluation was normal. The patient received 4 courses of rituximab plus CHOP (cyclophosphamide, adriamycin, prednisone and oncovin) without response and then 3 courses of rituximab plus DHAOX (dexamethasone, high dose ara-cytin and oxalipatin) with persistence of the mass. The biopsy of the latter showed the disappearance of the B lymphocyte infiltration with presence of the AL amyloid deposits. The immunoelectrophoresis of plasma proteins showed the presence of immunoglobulin M. A positron emission tomography (PET) scan showed a hypermetabolic nasopharyngeal process. The patient is currently receiving a protocol of bortezomib, prednisone and bendamustine.\n",
+    "translated_fulltext": "রোগী এবং পর্যবেক্ষণ\n\nরোগীর তথ্য: এই রোগী ৬৭ বছর বয়সী, পূর্বে কোনো স্বাস্থ্যগত সমস্যা ছিল না। তিনি গিলতে অসুবিধা, কণ্ঠস্বর পরিবর্তন এবং শারীরিক অবস্থার অবনতি নিয়ে এসেছিলেন।\n\nক্লিনিক্যাল ফলাফল: প্রাথমিক পরীক্ষায় দেখা যায় রোগী সচেতন, গ্লাসগো স্কোর ১৫/১৫, জ্বর নেই, রক্তচাপ ১২/০৭ সেমিএইচজি, অক্সিজেনের মাত্রা ১০০%, হৃদস্পন্দন ৮০/মিনিট, চোখের সাদা অংশ স্বাভাবিক, এবং গলায় একটি বড় পিণ্ড রয়েছে। যকৃত বা প্লীহায় কোনো অস্বাভাবিকতা ছিল না, লিম্ফ নোডগুলো স্বাভাবিক ছিল, এবং অন্যান্য শারীরিক পরীক্ষা স্বাভাবিক ছিল।\n\nসময়কাল: রোগীর ৬ মাস ধরে গিলতে অসুবিধা এবং কণ্ঠস্বর পরিবর্তনের সমস্যা ছিল। এরপর কঠিন খাবার গিলতে সমস্যা শুরু হয় এবং শারীরিক অবস্থার আরও অবনতি ঘটে (৬ মাসে ১৫ কেজি ওজন হ্রাস)।\n\nরোগ নির্ণয়ের পদ্ধতি: সারভিকো-থোরাকো-অ্যাবডোমিনো-পেলভিক সিটি স্ক্যানে দেখা যায়, নাকের পিছনের অংশে ৭০ মিমি x ৪০ মিমি আকারের একটি পিণ্ড রয়েছে, যা ৬০ মিমি পর্যন্ত বিস্তৃত। রোগীর রক্ত পরীক্ষা স্বাভাবিক ছিল (শ্বেত রক্তকণিকার সংখ্যা, কিডনি এবং যকৃতের কার্যকারিতা, ল্যাকটেট ডিহাইড্রোজেনেস, এইচআইভি, এইচসিভি এবং এইচবিভি)। নাকের পিছনের অংশের বায়োপসির হিস্টোলজিক্যাল এবং ইমিউনোহিস্টোকেমিক্যাল পরীক্ষায় দেখা যায়, এটি গ্রেড ১, ২ সিডি২০+; সিডি১৯+; সিডি৭৯এ+; সিডি১০+ ফলিকুলার বি-সেল এনএইচএল, যা দুটি ভিন্ন ল্যাবরেটরিতে দুটিবার পরীক্ষা করে নিশ্চিত করা হয়েছে। অস্থি মজ্জার বায়োপসি স্বাভাবিক ছিল এবং চিকিৎসার আগে করা পরীক্ষাগুলোতেও কোনো অস্বাভাবিকতা পাওয়া যায়নি।\n\nচিকিৎসা পদ্ধতি: রোগীকে ৪টি আরসিএইচওপি ২১ (রিটুক্সিম্যাব ৩৭৫ মিগ্রা/মি২ ইন্ট্রাভেনাস, সাইক্লোফসফামাইড ৭৫০ মিগ্রা/মি২ ইন্ট্রাভেনাস, অনকোভিন ২ মিগ্রা ইন্ট্রাভেনাস, প্রেডনিসোলোন ১০০ মিগ্রা মুখে এবং ডক্সোরুবিসিন ৫০ মিগ্রা/মি২ ইন্ট্রাভেনাস) দেওয়া হয়েছিল, কিন্তু কোনো উন্নতি হয়নি। এরপর ৩টি আরডিএইচএওএক্স (রিটুক্সিম্যাব ৩৭৫ মিগ্রা/মি২ ইন্ট্রাভেনাস, উচ্চ মাত্রার অ্যারাসাইটিন ২ গ্রাম/মি২ x ২ ইন্ট্রাভেনাস, ডেক্সামেথাসোন ৪০ মিগ্রা প্রথম দিন থেকে চতুর্থ দিন পর্যন্ত এবং অক্সালিপাটিন ১০০ মিগ্রা/মি২ প্রথম দিনে) দেওয়া হয়েছিল, কিন্তু তাতেও কোনো ক্লিনিক্যাল উন্নতি হয়নি।\n\nফলো-আপ এবং চিকিৎসার ফলাফল: নাকের পিছনের পিণ্ডটি বৃদ্ধি পাওয়ায় ট্র্যাকিওটমি করা হয়। বায়োপসিতে দেখা যায়, লিম্ফয়েড বি-কোষের অনুপ্রবেশ হ্রাস পেয়েছে এবং অ্যামাইলয়েড জমাটবদ্ধ হয়েছে, যা এএল টাইপ কাপ্পা।\n\nপ্লাজমা প্রোটিনের ইমিউন ইলেকট্রোফোরেসিসে ইমিউনোগ্লোবুলিন এম কাপ্পার উপস্থিতি দেখা যায়। আলোর শৃঙ্খলের পরিমাণ নির্ধারণ করা হয়নি, কারণ পর্যাপ্ত সরঞ্জাম ছিল না। অস্থি মজ্জার পরীক্ষা এবং দ্বিতীয় বায়োপসি স্বাভাবিক ছিল। টিইপি স্ক্যানে দেখা যায়, নাকের পিছনের অংশে অতিরিক্ত বিপাকীয় কার্যকলাপ রয়েছে, তবে অন্য কোনো অস্বাভাবিকতা নেই। হৃদরোগের মূল্যায়ন (ইসিজি, ন্যাট্রিয়ুরেটিক পেপটাইড, ট্রোপোনিন, ইকোকার্ডিওগ্রাম) এবং কিডনির পরীক্ষাতেও কোনো বিশেষত্ব পাওয়া যায়নি। বর্তমানে রোগীকে বর্টেজোমিব, প্রেডনিসোন এবং বেন্ডামুস্টিন প্রোটোকল অনুযায়ী চিকিৎসা দেওয়া হচ্ছে এবং প্রথম চিকিৎসার পর তার শারীরিক অবস্থার উন্নতি দেখা যাচ্ছে।",
+    "translated_summary": "আমরা একজন ৬৭ বছর বয়সী রোগীর ঘটনা বর্ণনা করছি, যার প্যাথলজিক্যাল সিডিডি (CDDs) ছিল না। তিনি ধীরে ধীরে কণ্ঠস্বর পরিবর্তন এবং গিলতে অসুবিধা নিয়ে এসেছিলেন, এবং তার ঘাড়ে একটি বড় পিণ্ড ছিল, যা বায়োপসির মাধ্যমে প্রথম এবং দ্বিতীয় গ্রেডের ফলিকুলার নন-হজকিন লিম্ফোমা হিসেবে শনাক্ত করা হয়েছে। একটি সারভাইকো-থোরাকো-অ্যাবডোমিনো-পেলভিক সিটি স্ক্যানে দেখা যায়, নাসোফ্যারিঞ্জিয়াল পিণ্ডটি ৭০ মিমি x ৪০ মিমি আকারের এবং এটি ৬০ মিমি পর্যন্ত বিস্তৃত। অস্থি মজ্জার বায়োপসি স্বাভাবিক ছিল এবং চিকিৎসার আগের মূল্যায়নও স্বাভাবিক ছিল। রোগীকে চারটি কোর্স রিটুক্সিম্যাব (rituximab) এবং সিএইচওপি (CHOP) (সাইক্লোফসফামাইড, অ্যাড্রিয়ামাইসিন, প্রেডনিসোন এবং ওনকোভিন) দেওয়া হয়েছিল, কিন্তু কোনো উন্নতি হয়নি। এরপর তাকে তিনটি কোর্স রিটুক্সিম্যাব (rituximab) এবং ডিএইচএওএক্স (DHAOX) (ডেক্সামেথাসোন, উচ্চ মাত্রার আরা-সাইটিন এবং অক্সালিপাটিন) দেওয়া হয়েছিল, কিন্তু পিণ্ডটি রয়ে গেছে। পরবর্তী বায়োপসিতে দেখা যায়, বি লিম্ফোসাইটের অনুপ্রবেশ হ্রাস পেয়েছে এবং এএল অ্যামাইলয়েড (AL amyloid) জমা হয়েছে। প্লাজমা প্রোটিনের ইমিউনোইলেক্ট্রোফোরেসিস (immunoelectrophoresis) পরীক্ষায় ইমিউনোগ্লোবুলিন এম (immunoglobulin M) এর উপস্থিতি দেখা যায়। একটি পজিট্রন এমিশন টমোগ্রাফি (পিইটি) স্ক্যানে দেখা যায়, নাসোফ্যারিঞ্জিয়াল অংশে অতিরিক্ত বিপাকীয় কার্যকলাপ রয়েছে। বর্তমানে রোগীকে বোর্টেজোমিব, প্রেডনিসোন এবং বেন্ডামুস্টিনের একটি প্রোটোকল অনুযায়ী চিকিৎসা দেওয়া হচ্ছে।"
+  },
+  {
+    "id": "multiclinsum_gs_en_539.txt",
+    "fulltext": "46-year-old Haitian male, residing in Chile for one year. In Haiti he was a livestock farmer. He presented a one-and-a-half-year history of a lesion that began as a papule on the anterior aspect of the right leg, which increased in size progressively. Initially asymptomatic, three months prior to the consultation he developed pruritus, pain, superficial ulceration and yellowish discharge. On physical examination, the patient was found to be of phototype V, with 1 x 1 cm, 2 x 2 cm and 3 x 2 cm warty plaques on the anterior aspect of the right leg. A dermatoscopy revealed a hyperkeratotic mass with ulcerated center, with reddish-black dots and congested hemorrhagic vessels. The general laboratory was normal; VDRL, HIV and PPD were non-reactive. Tissue samples were taken by a punch biopsy, including epidermis, dermis and subcutaneous tissue, and stained with Gram, routine bacteriological culture and anaerobic culture, which were negative. Bacilloscopy and Koch culture of the same tissue were also negative. The histopathological study was performed with hematoxylin and eosin stain, and showed a pseudoepitheliomatous epidermis with irregular hyperplasia, a dermis with abundant mixed inflammatory infiltrate with suppurative foci and giant cells of the foreign body type, some of which contained round cells with a thick brown wall, compatible with muriform cells; these cells were more evident when evaluated with PAS stain. Fungal culture was performed on Sabouraud dextrose agar at 25°C, which showed, after 15 days of incubation, the growth of black or dematiaceous, elevated, well-defined, velvety colonies. Direct microscopic examination with 20% KOH showed long, branched, sometimes tortuous, hyphae, and short chains of acropetal conidia, suggestive of Fonsecaea spp. Itraconazole was administered at 100 mg every 12 h for six months, in association with physical measures, which consisted of cryotherapy (liquid nitrogen) application to hypertrophic areas every six to eight weeks. Due to local complications, such as erosion or ulceration of the lesions, frequent healing was performed with application of mupirocin ointment topically for signs of bacterial superinfection.\n\nThe patient had a favorable evolution, with regression of the lesions and no evidence of relapses to date, remaining with a mild local hypopigmentation, expected in areas of treatment with cryotherapy.\n",
+    "summary": "A 46-year-old Haitian man, residing in Chile, presented with warty plaques in the anterior tibial region that had been present for one year. The diagnosis of chromoblastomycosis was confirmed by the presence of muriform cells in the histopathology and dematiaceous colonies in the mycological culture. In addition, conidia compatible with Fonsecaea spp. were observed in direct microscopy. After six months of treatment with systemic antimycotics and cryotherapy, complete remission of the lesions was achieved.\n",
+    "translated_fulltext": "৪৬ বছর বয়সী হাইতিয়ান পুরুষ, যিনি এক বছর ধরে চিলিতে বসবাস করছেন। হাইতিতে তিনি একজন পশু খামারি ছিলেন। তিনি প্রায় দেড় বছর ধরে একটি ত্বকের সমস্যার কথা জানান, যা প্রথমে ডান পায়ের সামনের দিকে একটি ছোট ফুসকুড়ি হিসেবে শুরু হয়েছিল এবং ধীরে ধীরে আকারে বাড়তে থাকে। প্রথমে কোনো উপসর্গ ছিল না, তবে পরামর্শের তিন মাস আগে তিনি চুলকানি, ব্যথা, অগভীর ক্ষত এবং হলুদাভ স্রাব অনুভব করেন। শারীরিক পরীক্ষায় দেখা যায়, তার ত্বকের ধরন ভি (V), এবং ডান পায়ের সামনের দিকে ১x১ সেমি, ২x২ সেমি এবং ৩x২ সেমি আকারের কয়েকটি উঁচু, চামড়ার মতো পিণ্ড রয়েছে। ডার্মাটোস্কোপি পরীক্ষায় দেখা যায়, এর কেন্দ্রে আলসার রয়েছে এবং এর চারপাশে লালচে-কালো রঙের ছোট ছোট বিন্দু ও ফোলা রক্তনালী রয়েছে। সাধারণ ল্যাবরেটরি পরীক্ষায় সবকিছু স্বাভাবিক ছিল; ভিডিআরএল, এইচআইভি এবং পিপিডি পরীক্ষাগুলোতে কোনো প্রতিক্রিয়া দেখা যায়নি। একটি পাঞ্চ বায়োপসির মাধ্যমে ত্বকের নমুনা নেওয়া হয়, যেখানে এপিডার্মিস, ডার্মিস এবং সাবকিউটেনিয়াস টিস্যু অন্তর্ভুক্ত ছিল। এরপর গ্রাম স্টেইন, সাধারণ ব্যাকটেরিয়োলজিক্যাল কালচার এবং অ্যানারোবিক কালচার করা হয়, যেগুলোতে কোনো জীবাণু পাওয়া যায়নি। একই টিস্যুর ব্যাসিলোস্কোপি এবং কোখ কালচারও নেতিবাচক ছিল। হিস্টোপ্যাথলজিক্যাল পরীক্ষায় হেমাটক্সিলিন এবং ইওসিন স্টেইন ব্যবহার করা হয়, যেখানে দেখা যায় এপিডার্মিসে ছদ্ম-এপিথেলিওমাটাস গঠন এবং অনিয়মিত হাইপারপ্লাসিয়া রয়েছে। ডার্মিসে প্রচুর পরিমাণে মিশ্র প্রদাহজনক কোষ এবং পুঁজপূর্ণ ফোকি রয়েছে, সেইসাথে কিছু জায়ান্ট সেলও দেখা যায়, যেগুলোর মধ্যে কয়েকটিতে পুরু বাদামী প্রাচীরযুক্ত গোলাকার কোষ রয়েছে, যা মুরফর্ম কোষের সাথে সামঞ্জস্যপূর্ণ। পিএএস স্টেইন দিয়ে পরীক্ষা করলে এই কোষগুলো আরও স্পষ্টভাবে দেখা যায়। সাবুরো ডেক্সট্রোজ অ্যাগারে ২৫ ডিগ্রি সেলসিয়াসে ছত্রাক কালচার করা হয়, যেখানে ১৫ দিন পর কালো বা ডেম্যাটিয়াস, উঁচু, সুস্পষ্ট এবং মখমলের মতো কলোনি দেখা যায়। ২০% কেওএইচ দিয়ে সরাসরি মাইক্রোস্কোপিক পরীক্ষায় লম্বা, শাখা-প্রশাখা যুক্ত এবং কিছুটা আঁকাবাঁকা হাইফি এবং অল্প সংখ্যক অ্যাক্রোপেটাল কনিডিয়া দেখা যায়, যা ফনসেকা ইয়া এসপিপি.-এর ইঙ্গিত দেয়। ছয় মাসের জন্য প্রতিদিন ১২ ঘণ্টা অন্তর ১০০ মিলিগ্রাম করে ইট্রাকোনাজল দেওয়া হয় এবং এর সাথে শারীরিক থেরাপি হিসেবে প্রতি ছয় থেকে আট সপ্তাহে ক্রায়োথেরাপি (তরল নাইট্রোজেন) প্রয়োগ করা হয়। স্থানীয় জটিলতা, যেমন - ক্ষত বা আলসার হওয়ার কারণে, ব্যাকটেরিয়ার সংক্রমণ এড়াতে নিয়মিতভাবে মিউপিরোসিন মলম প্রয়োগ করা হয়।\n\nরোগীর অবস্থা ধীরে ধীরে উন্নতি লাভ করে, ত্বকের ক্ষতগুলো সেরে যায় এবং এখন পর্যন্ত পুনরায় সংক্রমণের কোনো লক্ষণ দেখা যায়নি। ক্রায়োথেরাপির মাধ্যমে চিকিৎসা করা অংশে সামান্য হাইপো পিগমেন্টেশন দেখা যায়, যা স্বাভাবিক।",
+    "translated_summary": "চিলিতে বসবাসকারী ৪৬ বছর বয়সী একজন হাইতিয়ান ব্যক্তি, যার পায়ের সামনের দিকের অংশে এক বছর ধরে ফুসকুড়ি ছিল, তিনি চিকিৎসকের কাছে আসেন। হিস্টোপ্যাথলজি পরীক্ষায় মুরফর্ম কোষ এবং মাইকোলজিক্যাল কালচারে ডেম্যাটিয়াস কলোনি পাওয়া যাওয়ায় ক্রোমাব্লাস্টোমাইকোসিসের রোগ নির্ণয় নিশ্চিত করা হয়। এছাড়াও, সরাসরি মাইক্রোস্কোপিতে ফনসেকিয়া প্রজাতির সাথে সামঞ্জস্যপূর্ণ কনিডিয়া দেখা যায়। ছয় মাস ধরে সিস্টেমিক অ্যান্টিমাইকোটিক এবং ক্রায়োথেরাপি দিয়ে চিকিৎসার পর ফুসকুড়ি সম্পূর্ণরূপে সেরে যায়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_285.txt",
+    "fulltext": "Patient information: A 19-year-old male with no significant medical history was admitted to our department with a painful left scrotal mass that had been present for 8 months and had not improved with antibiotics for pyogenic organisms. The patient reported intermittent low grade fever, night sweats, anorexia and unexplained weight loss since the onset of symptoms. He did not have a cough, sputum or haemoptysis. There was no history of tuberculosis in his personal or family medical history. He was vaccinated against tuberculosis at birth.\n\nClinical findings: Physical examination revealed a large, painful, slightly hot left bursa and two elongated, poorly defined, firm, painful subcutaneous formations in the anterior thoracic wall, 3 to 4 cm long. There were no rales on auscultation. The remainder of the examination was normal. Laboratory studies revealed a high c-reactive protein of 90 mg/dl. The blood count, creatinine, blood glucose and liver function tests were within normal limits. The standard chest X-ray showed reticulonodular infiltrates in both lung fields.\n\nDiagnostic approach: In the presence of an ultrasound finding in favour of an epididymal tumour, the patient underwent a left orchidectomy. However, the pathological examination of the surgical specimen showed a granulomatous epitheloid necrosis of the epididymis, suggestive of active epididymal tuberculosis involving the body and tail of the epididymis and sparing the head and testicle. The intradermal tuberculin reaction was positive. The search for acid-fast bacilli (AFB) in sputum and urine for 3 consecutive days was negative on direct examination and culture. The serologies for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and Wright's stain were also negative. In search of other tuberculous sites, a thoraco-abdomino-pelvic tomodensitometry was performed, which showed a miliary tuberculosis, coelo-mesenteric necrotic adenopathies, two thoracic parietal collections (at the expense of the external oblique muscles measuring 33 × 10 mm on the right and 45 × 10 mm on the left) and a focal osteolysis of D11 and L5, suggestive of a spondylodiscitis in the early stages. The magnetic resonance imaging (MRI) of the spinal cord confirmed the existence of a spondylodiscitis at the level of D7, D11, L4 and L5. The diagnosis of disseminated tuberculosis with epididymal, pulmonary, parietal, ganglionary and osteo-articular sites was retained.\n\nTherapeutic intervention: a poly-chemotherapy for tuberculosis with isoniazid, rifampicin, ethambutol and pyrazinamide for 2 months, followed by the association of isoniazid and rifampicin, was initiated.\n\nFollow-up and results: however, at the 4th month of treatment, the patient had presented generalised tonic-clonic convulsive seizures. A brain MRI was performed, showing multiple nodular lesions above and below the tentorial membrane corresponding to tuberculomas. The patient was put on anticonvulsive treatment and anti-tuberculosis treatment was continued. The evolution was favourable with recovery of the general condition and weight gain from the first months of treatment as well as a disappearance of thoracic parietal formations, adenopathies and tuberculous milia on the tomodensitometry with absence of recurrence of convulsive seizures. However, the slow decrease of the size of the tuberculomas obliged us to continue the anti-tuberculosis treatment for a long period. Finally, the patient was declared cured, without sequelae, at the end of the 234th month of treatment with a 2-year follow-up.\n",
+    "summary": "A 19-year-old man with no significant history was admitted to hospital with a painful left scrotal mass that had been present for 8 months. He had undergone an orchidectomy and the pathological examination was in favour of epididymal tuberculosis. A radiological examination had shown other sites of infection: lymph nodes, lungs, parietal and osteoarticular. An anti-tuberculosis treatment was initiated. However, in the 4th month of treatment, the patient had convulsive seizures. A brain MRI was performed and concluded that there were brain tuberculomas. The anti-tuberculosis treatment was continued in association with an anticonvulsant with good clinical and radiological evolution.\n",
+    "translated_fulltext": "রোগীর তথ্য: উল্লেখযোগ্য চিকিৎসা-ইতিহাসবিহীন 19-year-old এক পুরুষকে 8 months ধরে বিদ্যমান এবং পায়োজেনিক অর্গানিজমের জন্য অ্যান্টিবায়োটিকেও উন্নতি না হওয়া বেদনাদায়ক বাম স্ক্রোটাল মাস নিয়ে আমাদের বিভাগে ভর্তি করা হয়। রোগী উপসর্গের সূচনালগ্ন থেকে অন্তরায়ী নিম্নমাত্রার জ্বর, রাতের ঘাম, অ্যানোরেক্সিয়া এবং অজানা কারণে ওজন হ্রাসের কথা জানিয়েছেন। তার কাশি, স্পুটাম বা হেমোপ্টাইসিস ছিল না। ব্যক্তিগত বা পারিবারিক চিকিৎসা-ইতিহাসে টিউবারকিউলোসিসের কোনো ইতিহাস ছিল না। জন্মের সময় তাকে টিউবারকিউলোসিসের বিরুদ্ধে টিকাদান করা হয়েছিল।\n\nক্লিনিক্যাল ফাইন্ডিংস: শারীরিক পরীক্ষায় বড়, বেদনাদায়ক, সামান্য উষ্ণ বাম বার্সা এবং অ্যান্টেরিয়র থোরাসিক ওয়ালে 3 to 4 cm লম্বা দুইটি দীর্ঘায়িত, অস্পষ্ট সীমানাযুক্ত, দৃঢ়, বেদনাদায়ক সাবকিউটেনিয়াস ফর্মেশন পাওয়া যায়। অস্কাল্টেশনে কোনো রালস শোনা যায়নি। পরীক্ষার বাকি অংশ স্বাভাবিক ছিল। ল্যাবরেটরি পরীক্ষায় উচ্চ c-reactive protein 90 mg/dl পাওয়া যায়। blood count, ক্রিয়াটিনিন, রক্তে গ্লুকোজ এবং লিভার ফাংশন টেস্ট স্বাভাবিক সীমার মধ্যে ছিল। স্ট্যান্ডার্ড চেস্ট X-ray-এ উভয় ফুসফুসক্ষেতে রেটিকুলোনডুলার ইনফিলট্রেটস দেখা যায়।\n\nডায়াগনস্টিক অ্যাপ্রোচ: এপিডিডাইমাল টিউমারের পক্ষে আল্ট্রাসাউন্ড ফাইন্ডিংস থাকার প্রেক্ষিতে রোগীর বাম অর্কিডেকটমি করা হয়। তবে, শল্য-নমুনার প্যাথোলজিকাল পরীক্ষায় এপিডিডিমিসে গ্র্যানুলোমাটাস এপিথেলয়েড নেক্রোসিস দেখা যায়, যা সক্রিয় এপিডিডাইমাল টিউবারকিউলোসিসের পক্ষে; এতে এপিডিডিমিসের বডি ও টেইল জড়িত এবং হেড ও টেস্টিকল অক্ষত ছিল। ইন্ট্রাডার্মাল টিউবারকুলিন রিঅ্যাকশন পজিটিভ ছিল। স্পুটাম ও ইউরিনে টানা 3 দিন অ্যাসিড-ফাস্ট ব্যাসিলাই (AFB) অনুসন্ধান ডাইরেক্ট এক্সামিনেশন ও কালচারে নেগেটিভ ছিল। Human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) এবং Wright's stain-এর সেরোলজি-ও নেগেটিভ ছিল। অন্যান্য টিউবারকিউলাস সাইটের অনুসন্ধানে একটি থোরাকো-অ্যাবডমিনো-পেলভিক টোমোডেনসিটোমেট্রি করা হয়, যাতে মিলিয়ারি টিউবারকিউলোসিস, কোয়েলো-মেসেন্টেরিক নেক্রোটিক অ্যাডেনোপ্যাথিসমূহ, দুইটি থোরাসিক প্যারিয়েটাল কালেকশন (external oblique muscles-সম্পর্কিত, ডানে 33 × 10 mm এবং বামে 45 × 10 mm মাপ) এবং D11 ও L5-এ ফোকাল অস্টিওলাইসিস দেখা যায়, যা প্রাথমিক পর্যায়ের স্পন্ডাইলোডিস্কাইটিসের পক্ষে। স্পাইনাল কর্ডের ম্যাগনেটিক রেজোন্যান্স ইমেজিং (MRI) D7, D11, L4 এবং L5 স্তরে স্পন্ডাইলোডিস্কাইটিসের অস্তিত্ব নিশ্চিত করে। এপিডিডাইমাল, পালমোনারি, প্যারিয়েটাল, গ্যাংলিওনারি এবং অস্টিও-আর্টিকুলার সাইটসহ ডিসেমিনেটেড টিউবারকিউলোসিসের নির্ণয় স্থির করা হয়।\n\nথেরাপিউটিক ইন্টারভেনশন: টিউবারকিউলোসিসের জন্য isoniazid, rifampicin, ethambutol এবং pyrazinamide সমন্বিত 2 months-এর একটি পলি-কেমোথেরাপি, পরবর্তীতে isoniazid এবং rifampicin-এর সমন্বয়ে, শুরু করা হয়।\n\nফলো-আপ এবং ফলাফল: তবে, চিকিৎসার 4th month-এ রোগীর জেনারালাইজড টনিক-ক্লোনিক কনভালসিভ খিঁচুনি হয়। একটি ব্রেইন MRI করা হয়, যাতে টেনটোরিয়াল মেমব্রেনের উপর ও নীচে একাধিক নড্যুলার লেজিয়ন দেখা যায়, যা টিউবারকুলোমার সঙ্গে সামঞ্জস্যপূর্ণ। রোগীকে অ্যান্টিকনভালসান্ট চিকিৎসায় রাখা হয় এবং অ্যান্টি-টিউবারকিউলোসিস চিকিৎসা চালু রাখা হয়। চিকিৎসার প্রথম কয়েক মাস থেকেই সাধারণ অবস্থা পুনরুদ্ধার ও ওজন বৃদ্ধি সহ অগ্রগতি অনুকূল ছিল, এবং টোমোডেনসিটোমেট্রিতে থোরাসিক প্যারিয়েটাল ফর্মেশনসমূহ, অ্যাডেনোপ্যাথিসমূহ এবং টিউবারকিউলাস মিলিয়া বিলুপ্ত হয়; কনভালসিভ খিঁচুনির পুনরাবৃত্তি অনুপস্থিত ছিল। তবে, টিউবারকুলোমার আকারের ধীর হ্রাস আমাদেরকে দীর্ঘ সময় অ্যান্টি-টিউবারকিউলোসিস চিকিৎসা চালিয়ে যেতে বাধ্য করে। অবশেষে, 234th month-এর চিকিৎসা শেষে 2-year ফলো-আপসহ রোগীকে সিকুয়েলাবিহীনভাবে আরোগ্যপ্রাপ্ত ঘোষণা করা হয়।",
+    "translated_summary": "১৯ বছর বয়সী একজন যুবক, যার পূর্বে তেমন কোনো উল্লেখযোগ্য স্বাস্থ্য ইতিহাস নেই, তাকে হাসপাতালে ভর্তি করা হয়। তার বাম দিকের অণ্ডকোষে একটি বেদনাদায়ক পিণ্ড দেখা যায়, যা প্রায় ৮ মাস ধরে ছিল। তার অণ্ডকোষ অপসারণ করা হয়েছিল এবং প্যাথলজিক্যাল পরীক্ষায় দেখা যায় যে এটি এপিডিডাইমাল যক্ষ্মা। রেডিওলজিক্যাল পরীক্ষায় সংক্রমণের অন্যান্য স্থান চিহ্নিত করা হয়: লিম্ফ নোড, ফুসফুস, প্যারাইটাল এবং অস্টিওআর্টিকুলার অঞ্চল। যক্ষ্মা রোগের জন্য চিকিৎসা শুরু করা হয়। তবে, চিকিৎসার চতুর্থ মাসে রোগীর খিঁচুনি হয়। মস্তিষ্কের এমআরআই করা হলে দেখা যায় মস্তিষ্কে যক্ষ্মার কারণে টিউমার হয়েছে। এরপর যক্ষ্মা রোগের চিকিৎসার পাশাপাশি খিঁচুনি কমানোর জন্য একটি ওষুধ দেওয়া হয়, এবং রোগীর শারীরিক ও রেডিওলজিক্যাল অবস্থার উন্নতি দেখা যায়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_508.txt",
+    "fulltext": "We present the case of a 10-year-old male diagnosed with high-risk early T-cell acute lymphoblastic leukaemia, who was treated according to the LAL SEHOP-PETHEMA 2013 protocol. Two years after diagnosis, he developed an early CNS relapse, so he was treated according to the InteReALL HR 2010 protocol with bortezomib. During induction, after being neutropenic for four weeks (20 neutrophils/μL), he was receiving prophylaxis with cefepime, cotrimoxazole and fluconazole. In addition, he was being treated with acyclovir for a herpes simplex virus 1 skin infection. In this context, he developed a severe headache that did not respond to usual analgesia. A cranial computed tomographic scan was performed that showed a hypodens lesion in the right temporal lobe. When the possibility of an infectious origin was considered, a lumbar puncture was performed and cefepime was replaced with meropenem and vancomycin.\n\nDespite remaining afebrile, he developed signs of septic shock on the first day after admission to the clinic and was transferred to the paediatric intensive care unit for inotropic and vasoactive support. In addition, the antimicrobial spectrum was extended with gentamicin and caspofungin.\n\nThe blood analysis showed a progressive increase in C-reactive protein and procalcitonin (up to 312 mg/L and 47.58 ng/mL, respectively, on the third day of evolution), with no other relevant biochemical alterations. The blood count showed pancytopenia due to chemotherapy. The blood cultures ruled out bacteremia and fungemia, and herpes virus serologies were negative. The urine culture and the fecal culture were also negative. The biochemical analysis of the cerebrospinal fluid was completely normal (glucose, 63 mg/dL; proteins, 16 mg/dL; leukocytes 1/µL), but the presence of B. cereus was detected in the microbiological study (sensitive to meropenem, vancomycin, linezolid and ciprofloxacin). The presence of herpes simplex 1 and 2, herpes virus 6, cytomegalovirus, varicella-zoster virus, enterovirus, parechovirus, toxoplasma, Neisseria meningitidis, Listeria monocytogenes, Streptococcus pneumoniae and Cryptococcus was ruled out in the cerebrospinal fluid.\n\nThe EEG showed diffuse slowing of brain activity with no clear epileptiform activity. On day 4, after the haemodynamic support was removed, a cranial MRI showed two hyperintense lesions in T2 and FLAIR that involved the subcortical region of the right temporal and parietal lobes. The parietal lesion had ring enhancement after administration of gadolinium and both lesions showed peripheral diffusion restriction. In addition, small haemorrhagic foci were observed scattered in the brain parenchyma. The image suggested a bacterial origin with an atypical germ, and these findings, together with those of the cerebrospinal fluid, led to the diagnosis of B. cereus abscess.\n\nAfter two weeks of treatment, the patient had a favorable outcome with resolution of the headache and no neurological findings. A follow-up MRI showed a decrease in the size of the lesions. Vancomycin and acyclovir were discontinued after three weeks and meropenem was continued for six weeks.\n",
+    "summary": "We present the case of a 10-year-old boy undergoing chemotherapy for acute lymphoblastic leukaemia. During the induction period he developed a cerebral abscess caused by B. cereus that was diagnosed by imaging tests and direct detection in the cerebrospinal fluid. His evolution was favourable with antibiotic treatment.\n",
+    "translated_fulltext": "আমরা ১০ বছর বয়সী একজন পুরুষের ঘটনা উপস্থাপন করছি, যাকে উচ্চ ঝুঁকিপূর্ণ আর্লি টি-সেল অ্যাকিউট লিম্ফোব্লাস্টিক লিউকেমিয়া নির্ণয় করা হয়েছিল এবং তাকে এলএএল এসইএইচওপি-পেথেমা ২০১৩ প্রোটোকল অনুযায়ী চিকিৎসা করা হয়েছিল। রোগ নির্ণয়ের দুই বছর পর, তার মধ্যে আর্লি সিএনএস রিলেপ্স দেখা যায়, তাই তাকে ইন্টেরিয়ালএল এইচআর ২০১০ প্রোটোকল অনুযায়ী বোরটেজোমিব দিয়ে চিকিৎসা করা হয়। ইন্ডাকশনের সময়, চার সপ্তাহ ধরে নিউট্রোপেনিক থাকার পর (২০টি নিউট্রোফিল/μL), তাকে সেফেপাইম, কোট্রিমোক্সাজল এবং ফ্লুকোনাজল দিয়ে প্রোফাইল্যাক্সিস দেওয়া হয়েছিল। এছাড়াও, হার্পিস সিমপ্লেক্স ভাইরাস ১-এর কারণে হওয়া ত্বকের সংক্রমণের জন্য তাকে অ্যাসাইক্লোভির দিয়ে চিকিৎসা করা হচ্ছিল। এই পরিস্থিতিতে, তার মধ্যে তীব্র মাথাব্যথা দেখা দেয়, যা সাধারণ ব্যথানাশক ওষুধে উপশম হয়নি। একটি ক্র্যানিয়াল কম্পিউটেড টমোগ্রাফিক স্ক্যান করা হয়, যেখানে ডান টেম্পোরাল লোবে একটি হাইপোডেনস ক্ষত দেখা যায়। সংক্রমণের সম্ভাবনা বিবেচনা করে, একটি লাম্বার পাংচার করা হয় এবং সেফেপাইমকে মেরোপেনেম ও ভ্যানকোমাইসিন দিয়ে প্রতিস্থাপন করা হয়।\n\nজ্বর না থাকা সত্ত্বেও, ক্লিনিকে ভর্তির প্রথম দিনেই সে সেপটিক শকের লক্ষণ দেখা দেয় এবং ইনোট্রপিক ও ভাসোঅ্যাকটিভ সহায়তার জন্য তাকে পেডিয়াট্রিক ইনটেনসিভ কেয়ার ইউনিটে স্থানান্তর করা হয়। এছাড়াও, অ্যান্টিমাইক্রোবিয়াল স্পেকট্রামকে জেন্টামাইসিন ও ক্যাসপোফাঙ্গিন দিয়ে প্রসারিত করা হয়।\n\nরক্ত পরীক্ষায় সি-রিঅ্যাক্টিভ প্রোটিন এবং প্রো ক্যালসিটোনিনের মাত্রা ধীরে ধীরে বৃদ্ধি পায় (যথাক্রমে তৃতীয় দিনে ৩১২ মিলিগ্রাম/লিটার এবং ৪৭.৫৮ ন্যানোগ্রাম/মিলিলিটার পর্যন্ত), তবে অন্য কোনো উল্লেখযোগ্য বায়োকেমিক্যাল পরিবর্তন দেখা যায়নি। রক্ত পরীক্ষায় কেমোথেরাপির কারণে প্যানসাইটোপেনিয়া দেখা যায়। রক্ত পরীক্ষায় ব্যাকটেরেমিয়া ও ফাংগেমিয়া এবং হার্পিস ভাইরাসের সেরোলজি নেগেটিভ ছিল। প্রস্রাব এবং মলের কালচারেও কোনো জীবাণু পাওয়া যায়নি। সেরিব্রোস্পাইনাল ফ্লুইডের বায়োকেমিক্যাল বিশ্লেষণে সবকিছু স্বাভাবিক ছিল (গ্লুকোজ, ৬৩ মিলিগ্রাম/ডিসিএল; প্রোটিন, ১৬ মিলিগ্রাম/ডিসিএল; লিউকোসাইট ১/μL), তবে মাইক্রোবায়োলজিক্যাল পরীক্ষায় বি. সেরিয়াসের উপস্থিতি সনাক্ত করা যায় (মেরোপেনেম, ভ্যানকোমাইসিন, লাইনেজোলাইড এবং সিপ্রোফ্লক্সাসিনের প্রতি সংবেদনশীল)। সেরিব্রোস্পাইনাল ফ্লুইডে হার্পিস সিমপ্লেক্স ১ এবং ২, হার্পিস ভাইরাস ৬, সাইটোমেগালোভাইরাস, ভ্যারিসেলা-জোস্টার ভাইরাস, এন্টারোভাইরাস, প্যারেকোভাইরাস, টক্সোপ্লাজমা, নাইসেরিয়া মেনিনজিটিডিস, লিস্টেরিয়া মনোসাইটোজেন্স, স্ট্রেপ্টোকক্কাস নিউমোনিয়া এবং ক্রিপ্টোকক্কাসের উপস্থিতি বাতিল করা হয়েছিল।\n\nইইজি-তে মস্তিষ্কের কার্যকলাপের একটি সাধারণ ধীরগতি দেখা যায়, তবে কোনো স্পষ্ট এপিলেপটিফর্ম কার্যকলাপ ছিল না। চতুর্থ দিনে, হেমোডাইনামিক সহায়তা সরানোর পর, ক্র্যানিয়াল এমআরআই-তে টি২ এবং এফএলএআইআর-এ দুটি হাইপারইনটেনস ক্ষত দেখা যায়, যা ডান টেম্পোরাল এবং প্যারাইটাল লোবের সাবকর্টিক্যাল অঞ্চলে বিস্তৃত ছিল। প্যারাইটাল ক্ষতটিতে গ্যাডোলিনিয়াম দেওয়ার পর রিং এনহ্যান্সমেন্ট দেখা যায় এবং উভয় ক্ষতেই পেরিফেরাল ডিফিউশন রেস্ট্রিকশন দেখা যায়। এছাড়াও, মস্তিষ্কের প্যারেনকাইমাতে ছোট ছোট হেমোরেজিক ফোকি বিক্ষিপ্তভাবে দেখা যায়। ছবিটি একটি ব্যাকটেরিয়াল উৎস এবং একটি অস্বাভাবিক জীবাণু নির্দেশ করে এবং এই ফলাফলগুলো, সেরিব্রোস্পাইনাল ফ্লুইডের ফলাফলের সাথে মিলিতভাবে, বি. সেরিয়াস অ্যাবসেসের রোগ নির্ণয় করতে সাহায্য করে।\n\nদু'সপ্তাহের চিকিৎসার পর, রোগীর অবস্থার উন্নতি হয়, মাথাব্যথা সেরে যায় এবং কোনো স্নায়বিক লক্ষণ দেখা যায় না। ফলো-আপ এমআরআই-তে দেখা যায় যে ক্ষতগুলোর আকার হ্রাস পেয়েছে। তিন সপ্তাহ পর ভ্যানকোমাইসিন এবং অ্যাসাইক্লোভির বন্ধ করে দেওয়া হয় এবং মেরোপেনেম আরও ছয় সপ্তাহ ধরে দেওয়া হয়।",
+    "translated_summary": "আমরা এখানে একটি ১০ বছর বয়সী ছেলের ঘটনা তুলে ধরছি, যে অ্যাকিউট লিম্ফোব্লাস্টিক লিউকেমিয়ার জন্য কেমোথেরাপি গ্রহণ করছে। চিকিৎসার শুরুতে, তার মস্তিষ্কে বি. সেরিউস নামক ব্যাকটেরিয়ার কারণে একটি ফোড়া দেখা দেয়, যা ইমেজিং পরীক্ষা এবং সেরিব্রোস্পাইনাল ফ্লুইডে সরাসরি পরীক্ষা করে শনাক্ত করা হয়েছিল। অ্যান্টিবায়োটিক চিকিৎসার মাধ্যমে তার শারীরিক অবস্থার উন্নতি হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_222.txt",
+    "fulltext": "Female patient, 16 years old, presenting a depressed gray plaque of 10.5 × 8.0 cm interspersed with hypochromic areas in the lower lateral part of the left thigh. Telangiectatic vessels overlap the lesion peripherally, with visible veins close to it. The plaque was present from birth, but was initially violaceous. It evolved with the passing of the years, with lightening and depression. There is no discrepancy in the length of the lower limbs.\n\nAngioresonance showed vascular malformations in the skin and subcutaneous tissue supplied by intermuscular branches of the popliteal artery. Early venous filling was found in both the region and the malformations, suggesting early venous shunting. Dilated draining veins were not documented, except for a superficial draining vein running along the subcutaneous cellular tissue of the anterior thigh. In addition, thinning of the subcutaneous tissue was noted in the topography of the vascular alteration, but without intramuscular or bone extension.\n",
+    "summary": "16-year-old girl with a depressed gray plaque on the left thigh, with a vascular malformation affecting the skin and subcutaneous tissue evident by angioresonance.\n",
+    "translated_fulltext": "একজন নারী রোগী, বয়স ১৬ বছর, বাম ঊরুর নিচের বাইরের অংশে ১০.৫ × ৮.০ সেমি আকারের একটি চাপা, ধূসর রঙের প্ল্যাক দেখা যাচ্ছে, যার মধ্যে কিছু অংশে বিবর্ণতা রয়েছে। প্ল্যাকটির চারপাশে ছোট ছোট রক্তনালী দেখা যায় এবং এর কাছাকাছি দৃশ্যমান শিরা রয়েছে। এই প্ল্যাকটি জন্ম থেকেই ছিল, তবে প্রথমে এটি বেগুনি রঙের ছিল। সময়ের সাথে সাথে এর রঙ হালকা হয়েছে এবং এটি আরও চাপা হয়ে গেছে। রোগীর দুই পায়ের দৈর্ঘ্যে কোনো পার্থক্য নেই।\n\nঅ্যাঙ্গিওরেসোনেন্স পরীক্ষায় দেখা যায়, ত্বকে এবং পপলাইটাল ধমনীর আন্তঃপেশী শাখা দ্বারা সরবরাহকৃত চর্বিযুক্ত টিস্যুতে রক্তনালীর ত্রুটি রয়েছে। উভয় স্থানে এবং ত্রুটিপূর্ণ অংশে দ্রুত শিরায় রক্ত ​​প্রবাহিত হতে দেখা যায়, যা প্রাথমিক পর্যায়ে শিরায় রক্ত ​​পরিবাহনের ইঙ্গিত দেয়। প্রসারিত নিষ্কাশনকারী শিরাগুলো তেমনভাবে দেখা যায়নি, তবে ঊরুর সামনের দিকের চর্বিযুক্ত টিস্যুর উপর দিয়ে যাওয়া একটি অগভীর নিষ্কাশনকারী শিরা দেখা গেছে। এছাড়াও, রক্তনালীর পরিবর্তনের স্থানে চর্বিযুক্ত টিস্যু পাতলা হয়ে গেছে, তবে পেশী বা হাড়ে এর বিস্তার দেখা যায়নি।",
+    "translated_summary": "বাম ঊরুতে একটি বিবর্ণ ধূসর রঙের দাগযুক্ত ১৬ বছর বয়সী একটি মেয়ে, যার ত্বকে এবং চর্মের নিচের টিস্যুতে রক্তনালীর ত্রুটি দেখা গেছে, যা অ্যাঞ্জিওরেসোনেন্সের মাধ্যমে স্পষ্ট বোঝা যায়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_491.txt",
+    "fulltext": "This is a 32-year-old patient, a baker, from Bamako, who was admitted to the Infectious and Tropical Diseases department of the CHU du Point G (Bamako, Mali) on 27 April 2023 for chronic productive cough, otalgia and a chronic right-sided purulent otorrhea.\n\nThe symptomatology would be of progressive installation in 1 month, initially treated in a medical center with artésunate, paracetamol and unspecified antibiotics for confirmed malaria and acute otitis media, without success. He is immunosuppressed by a HIV1 infection, diagnosed and put on a tritherapy antiretroviral (TARV) Tenofovir/Lamivudine/Dolutégravir 7 months ago, not observed due to denial of his illness.\n\nThe general physical examination found a fever (38.2 °C), altered general condition, otalgia, purulent right foul-smelling otorrhea, a right basal pulmonary condensation syndrome, a normal neurological examination, without the involvement of the cranial nerves, mainly the facial nerve VII and the VIII cochleovestibular nerve.\n\nIn the ENT examination, the otoscopy of the right ear showed an inflammatory external auditory canal with purulent secretions and the presence of a single tympanic perforation in the anterior-inferior quadrant. The left ear is normal. The Rinne and Weber test is in favor of a right conductive hearing loss.\n\nImmuno-virological evaluation shows a CD4 count of 118 cells/pl and a viral load of 12,370 copies/ml at the time of diagnosis of HIV infection, compared to a viral load of 9,460 copies/ml and a CD4 lymphocyte count of 193 cells/pl at the 6th month of antiretroviral treatment. At the time of diagnosis of tuberculosis at the 7th month, the immuno-virological evaluation shows a CD4 count of 89 cells/pl and a viral load of 10,230 copies/ml.\n\nThe Ziehl Neelsen bacilloscopy was positive with a cross in the gastric washings on admission and 19 days later in the right ear swab because of the persistent otorrhea. The Xpert-MTB/GeneXpert test did not detect rifampicin-resistant Mycobacterium tuberculosis.\n\nThe frontal chest radiograph shows a more accentuated bronchovascular network at the base of the right lung.\n\nThe diagnosis of tuberculosis of the middle ear concomitant to a pulmonary localization in the field of immunosuppression by HIV1 is therefore retained.\n\nThe patient is put on oral first-line anti-tuberculosis for 6 months, a fixed dose of a quadra-therapy in the intensive phase of isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months (2RHZE), followed by a bi-therapy in the maintenance phase of isoniazid and rifampicin for 4 months (4RH) at a dose of 3 tablets/day in the morning on an empty stomach, associated with vitamin B6 (1 tablet/day). He benefits from two sessions of therapeutic reinforcement with anti-retroviral drugs. The ART is restarted on 4 May 2023 with his consent, given the good tolerance of the anti-tuberculosis drugs, with the combination of tenofovir/lamivudine/dolutegravir at a dose of 1 tablet/day associated with dolutegravir 50 mg as a supplement (1 tablet/day) according to the protocol for the management of HIV/AIDS. A chemoprophylaxis with cotrimoxazole 960 mg (1 tablet/day) is undertaken as well as a cleaning of the external auditory canal by aspiration and the instillation of ciprofloxacin ear drops (2 drops 3 times a day) for 14 days.\n\nThe evolution is favorable after 14 days of treatment, marked by a pyrexia, a good general state, the amendment of the cough and otorrhea with the negativation of the bacilloscopy in the gastric tube liquid and the swab of the pus of the right ear. At the end of the maintenance anti-tuberculosis treatment, the clinical healing is complete with a normal ENT and neurological examination. The bacilloscopy associated with the Xpert-MTB/GeneXpert test at the end of the 2nd month of the intensive phase, during the 5th month and at the end of the 6th month of the maintenance phase were negative. The HIV viral load performed after 3 months of ART is 329 copies/ml.\n",
+    "summary": "The patient presented with a chronic productive cough, otalgia and a chronic right-sided purulent otorrhea. The search for acid-fast bacilli was positive by direct examination in the gastric tube liquid and the swab of the auricular pus.\n\nAn anti-tuberculosis treatment of 6 months, associated with adjuvants, led to the patient's complete recovery.\n",
+    "translated_fulltext": "এই রোগী ৩২ বছর বয়সী, একজন বেকারি কর্মী, যিনি বামাকো থেকে এসেছেন। তাকে ২০২৩ সালের ২৭শে এপ্রিল সিএইচইউ ডু পয়েন্ট জি (বামাকো, মালি)-এর সংক্রামক ও গ্রীষ্মমণ্ডলীয় রোগ বিভাগে ভর্তি করা হয়েছিল। তার সমস্যাগুলো হলো দীর্ঘস্থায়ী কাশি, কানে ব্যথা এবং ডান কানে দীর্ঘস্থায়ী পুঁজযুক্ত স্রাব।\n\nরোগের লক্ষণগুলো প্রায় এক মাসে ধীরে ধীরে বাড়তে থাকে। প্রথমে তাকে একটি চিকিৎসা কেন্দ্রে আর্টেসানেট, প্যারাসিটামল এবং অনির্দিষ্ট অ্যান্টিবায়োটিক দিয়ে চিকিৎসা করা হয়েছিল, কিন্তু ম্যালেরিয়া এবং তীব্র মধ্যকর্ণের প্রদাহের (অ্যাকিউট ওটিটিস মিডিয়া) কোনো উন্নতি হয়নি। তিনি এইচআইভি১ সংক্রমণে আক্রান্ত, যা ৭ মাস আগে নির্ণয় করা হয়েছিল এবং এরপর তাকে ট্রাইথেরাপি অ্যান্টিরেট্রোভাইরাল (টিএআরভি) টেনোফোভির/ল্যামিভুডিন/ডলুটেগ্রাভির ওষুধ দেওয়া হয়েছিল। তবে, তিনি নিজের অসুস্থতা অস্বীকার করার কারণে ওষুধ সেবন করেননি।\n\nশারীরিক পরীক্ষায় দেখা যায়, তার জ্বর (৩৮.২ ডিগ্রি সেলসিয়াস), শারীরিক অবস্থা খারাপ, কানে ব্যথা, ডান কানে পুঁজযুক্ত দুর্গন্ধযুক্ত স্রাব, ডান ফুসফুসের নিচের দিকে প্রদাহ এবং স্নায়বিক পরীক্ষা স্বাভাবিক ছিল, তবে করোটির স্নায়ু, বিশেষ করে সপ্তম (মুখের স্নায়ু) এবং অষ্টম (শ্রবণ ও ভারসাম্য স্নায়ু) স্নায়ু এতে জড়িত ছিল না।\n\nইএনটি (নাক, কান, গলা) পরীক্ষায় ডান কানের অটস্কোপি পরীক্ষায় দেখা যায়, বাইরের শ্রবণনালীতে প্রদাহ এবং পুঁজযুক্ত তরল রয়েছে, সেইসাথে সামনের দিকের নিচের অংশে একটিমাত্র টিম্পানিক ছিদ্র রয়েছে। বাম কান স্বাভাবিক। রিন এবং ওয়েবার পরীক্ষায় ডান কানে শ্রবণশক্তি হ্রাস পাওয়ার বিষয়টি নিশ্চিত হয়।\n\nইমিউনো-ভাইরোলজিক্যাল মূল্যায়নে দেখা যায়, এইচআইভি সংক্রমণ নির্ণয়ের সময় তার সিডি৪ কোষের সংখ্যা ছিল ১১৮টি/µl এবং ভাইরাল লোড ছিল ১২,৩৭০ কপি/ml। অ্যান্টিরেট্রোভাইরাল চিকিৎসার ৬ষ্ঠ মাসে এটি ছিল ৯,৪৬০ কপি/ml এবং সিডি৪ লিম্ফোসাইটের সংখ্যা ছিল ১৯৩টি/µl। যক্ষ্মা নির্ণয়ের সময়, অর্থাৎ ৭ম মাসে, ইমিউনো-ভাইরোলজিক্যাল মূল্যায়নে সিডি৪ কোষের সংখ্যা ছিল ৮৯টি/µl এবং ভাইরাল লোড ছিল ১০,২৩০ কপি/ml।\n\nজিহ্‌ল নিলসেন ব্যাসিলোস্কোপি পরীক্ষায় দেখা যায়, হাসপাতালে ভর্তির সময় এবং ১৯ দিন পরে ডান কানের সোয়াবেও ব্যাকটেরিয়া উপস্থিত ছিল, কারণ কানে তখনও পুঁজ বের হচ্ছিল। এক্সপার্ট-এমটিবি/জিনএক্সপার্ট পরীক্ষায় রিফাম্পিসিন-প্রতিরোধী মাইকোব্যাকটেরিয়াম টিউবারকিউলোসিস পাওয়া যায়নি।\n\nফ্রন্টাল বুকের রেডিওগ্রাফে দেখা যায়, ডান ফুসফুসের নিচের দিকে ব্রঙ্কোভ্যাস্কুলার নেটওয়ার্ক আরও বেশি স্পষ্ট।\n\nঅতএব, এইচআইভি১-এর কারণে সৃষ্ট ইমিউনোস suppression-এর প্রেক্ষাপটে মধ্যকর্ণের যক্ষ্মা এবং ফুসফুসে এর বিস্তার—এই রোগ নির্ণয় করা হয়।\n\nরোগীকে ৬ মাসের জন্য মুখে খাওয়ার অ্যান্টি-টিউবারকিউলোসিস ওষুধ দেওয়া হয়। এর মধ্যে প্রথম ২ মাস (2RHZE) একটি নির্দিষ্ট মাত্রায় চারটি ওষুধ (আইসোনিয়াজিড, রিফাম্পিসিন, পাইরাজিনামাইড এবং ইথামবিউটল) এবং পরবর্তী ৪ মাস (4RH) দুটি ওষুধ (আইসোনিয়াজিড এবং রিফাম্পিসিন) দেওয়া হয়। ওষুধগুলো প্রতিদিন সকালে খালি পেটে ৩টি করে ট্যাবলেট হিসেবে দেওয়া হয় এবং এর সাথে ভিটামিন বি৬ (১টি ট্যাবলেট/দিন) দেওয়া হয়। এছাড়াও, অ্যান্টি-রেট্রোভাইরাল ওষুধ দিয়ে থেরাপিউটিক রিইনফোর্সমেন্টের দুটি সেশন দেওয়া হয়। ২০২৩ সালের ৪ঠা মে তার সম্মতিতে অ্যান্টিরেট্রোভাইরাল থেরাপি পুনরায় শুরু করা হয়। অ্যান্টি-টিউবারকিউলোসিস ওষুধের ভালো সহনশীলতার কারণে টেনোফোভির/ল্যামিভুডিন/ডলুটেগ্রাভির (১টি ট্যাবলেট/দিন) এবং ডলুটেগ্রাভির ৫০ মিগ্রা (১টি ট্যাবলেট/দিন) সমন্বিত ওষুধ দেওয়া হয়। এছাড়াও, কোট্রিমোক্সাজল ৯৬০ মিগ্রা (১টি ট্যাবলেট/দিন) দিয়ে কেমোপ্রোফাইল্যাক্সিস করা হয় এবং অ্যাসপিরেশনের মাধ্যমে বাইরের শ্রবণনালী পরিষ্কার করা হয় এবং সাইপ্রোফ্লক্সাসিন কানের ড্রপ (দিনে ৩ বার, ২ ফোঁটা করে) ১৪ দিন ধরে দেওয়া হয়।\n\nচিকিৎসার ১৪ দিন পর রোগীর অবস্থার উন্নতি হয়। জ্বর কমে যায়, শারীরিক অবস্থা ভালো হয়, কাশি ও কানের স্রাব কমে যায় এবং পেটের তরল ও ডান কানের পুঁজ পরীক্ষায় ব্যাকটেরিয়া পাওয়া যায় না। অ্যান্টি-টিউবারকিউলোসিস চিকিৎসার শেষ পর্যায়ে, ক্লিনিক্যাল নিরাময় সম্পূর্ণ হয় এবং ইএনটি ও স্নায়বিক পরীক্ষায় সবকিছু স্বাভাবিক পাওয়া যায়। ২য় মাসের শেষের দিকে, ৫ম মাসে এবং ৬ষ্ঠ মাসের শেষের দিকে এক্সপার্ট-এমটিবি/জিনএক্সপার্ট পরীক্ষায় ব্যাকটেরিয়া পাওয়া যায়নি। অ্যান্টিরেট্রোভাইরাল থেরাপি শুরু করার ৩ মাস পর, ভাইরাল লোড ছিল ৩২৯ কপি/ml।",
+    "translated_summary": "রোগী দীর্ঘস্থায়ী কাশি, কানে ব্যথা এবং দীর্ঘস্থায়ী ডান পাশের পুঁজযুক্ত কান থেকে স্রাব নিয়ে এসেছিলেন। গ্যাস্ট্রিক টিউবের তরল এবং কানের পুঁজ থেকে নেওয়া সোয়াব পরীক্ষা করে অ্যাসিড-ফাস্ট ব্যাসিলি পাওয়া যায়।\n\nছয় মাসের অ্যান্টি-টিউবারকুলোসিস চিকিৎসা, সহায়ক ওষুধসহ, রোগীর সম্পূর্ণ সুস্থতা এনে দেয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_90.txt",
+    "fulltext": "52-year-old male patient with no medical history, transferred from a lower-level hospital to our institution due to a tonic-clonic seizure secondary to alcohol withdrawal and non-reduced right LFGHP. He was evaluated by a traumatologist 24 hours after admission, and was found to be conscious, with bilateral ecchymosis of the shoulders and severe limitation of passive external rotation on both sides. In addition, the patient was restrained physically at this point, with both feet and his left hand held down by intermittent psychomotor agitation.\n\nThe initial evaluation included a thorough review of the patient's admission radiographs, which showed a right LFGHP and a left simple posterior dislocation. This second injury (simple posterior dislocation of the left shoulder) was not diagnosed at the referring facility, and took approximately 48 hours to be diagnosed at our facility.\n\nComputed tomography (CT) of both shoulders was requested to better characterize the injuries. These images showed a marked worsening of the left shoulder injury since the time of the first radiographic study, possibly secondary to the physical restraint of the patient. This evidence of progression from a simple left posterior glenohumeral dislocation on admission radiographs to a LFGHP on the CT taken 48 hours later.\n\n\nPlanning\n\nThe preoperative study of the right shoulder showed bone indemnity of the glenoid and 40% involvement of the articular surface of the humerus, but with a large fragment with the possibility of osteosynthesis in continuity with the lesser tuberosity, so it was planned to fix this fragment by spongeous screw 4.0 mm partial thread and high strength sutures. In the left shoulder, no significant bone defect was evidenced in the glenoid and the defect of the articular surface of the humerus was 20%, so it was planned to fill the defect with the fragment of the lesser tuberosity at the time of osteosynthesis (imitating the surgery of McLaughlin).\n\n\nSurgical technique\n\nOpen reduction and internal fixation with bilateral locked-plate is decided. The patient is placed in a beach chair position and the surgical fields are prepared in the usual way for the right shoulder. The fracture focus is accessed by a classic deltopectoral approach. A digital maneuver is performed to reduce the posterior fragment of the humeral head with a posterior mini-open incision of the size of a standard diagnostic arthroscopy portal. A provisional reduction of the fracture is achieved using high-strength sutures and needles. A partial 4.0 mm spongy screw and high-strength sutures are used to fix both fragments of the humeral head. Definitive fixation of the fracture with a Philos (Depuy Synthes®) plate achieves adequate reduction and stability of fragments. Fixation is increased with high-strength sutures to the tendons of the rotator cuff that are tied to the plate. Closure by planes of the right shoulder, healing and immobilization of the extremity with a universal shoulder immobilizer.\nThe surgical field of the left shoulder is immediately prepared. Classic deltopectoral approach is performed again to reach the fracture focus using an accessory posterior portal for digital manipulation and reduction of the humeral head. Fixation and osteosynthesis are performed in the same way as described for the right shoulder with the exception of the spongiosa screw, as the anterior fragment could be adequately fixed only with the use of high strength sutures.\nPostoperative management consisted of the use of bilateral shoulder immobilizer for four weeks. A pendular exercise of flexion-extension of the elbow and exercises of the fist were given to be performed from the second postoperative week to tolerance (according to the level of pain). In the radiographic control of the first month, loss of reduction of the greater left tuberosity was observed. It was decided to perform revision surgery achieving adequate fixation of the fragment with high-strength sutures.\nThe patient is left with a shoulder immobilizer for an additional four weeks on the left shoulder. The self-administered exercise regimen is restarted as described previously from the second postoperative week on a bilateral basis. At the sixth week after the revision surgery, face-to-face kinesiological therapy is initiated twice a week. After 30 sessions of kinesiological rehabilitation, the patient is able to return to work five months after the initial injury.\nFollow-up one year after the initial surgery shows that the patient has recovered strength and mobility in the right shoulder. The left shoulder still has severe limitations in the range of motion, especially in external rotation. At this point, it is decided to perform arthroscopic joint release surgery and remove the osteosynthesis in the left shoulder.\nIn his last check-up two years after the trauma, the patient showed a favorable evolution, consistent with the functional scales evaluated.\n",
+    "summary": "52-year-old male patient, transferred to a high-complexity center for a tonic-clonic convulsion and a right LFGHP. In the initial study with radiographs, a right shoulder injury was confirmed and a simple posterior glenohumeral dislocation of the left shoulder was diagnosed, which had not been previously detected. The study was complemented with a computed tomography (CT) of both shoulders, showing a bilateral LFGHP, which demonstrated intrahospital aggravation of the injury of the left shoulder. An open reduction and osteosynthesis with a bilateral blocked plate was performed in one time. The left shoulder required two reinterventions, one for osteosynthesis failure and another for joint release. Two years after the procedure, the patient was satisfactorily progressing with a 5% on the Quick DASH scale and a score of 72 and 76 on the Constant scale in the left and right shoulder, respectively.\n",
+    "translated_fulltext": "52-বছর-বয়সী পুরুষ রোগী যার কোনো চিকিৎসাজনিত পূর্ব ইতিহাস নেই, অ্যালকোহল উইথড্রয়ালজনিত টনিক-ক্লোনিক সিজার এবং ডান পাশে নন-রিডিউসড LFGHP-এর কারণে তিনি এক নিম্ন-স্তরের হাসপাতাল থেকে আমাদের প্রতিষ্ঠানে স্থানান্তরিত হন। ভর্তির 24 ঘণ্টা পর একজন ট্রমা বিশেষজ্ঞ দ্বারা তাকে মূল্যায়ন করা হয়, এবং তাকে সচেতন অবস্থায় পাওয়া যায়, কাঁধে দ্বিপার্শ্বিক ইকাইমোসিস সহ এবং উভয় পাশে নিষ্ক্রিয় বাহ্যিক রোটেশনে গুরুতর সীমাবদ্ধতা ছিল। অতিরিক্তভাবে, এই সময়ে রোগীকে শারীরিকভাবে রেস্ট্রেইন করা হয়েছিল, উভয় পা এবং তার বাম হাতকে অন্তর্বর্তী সাইকোমোটর অ্যাজিটেশনের কারণে বেঁধে রাখা হয়েছিল।\n\nপ্রারম্ভিক মূল্যায়নে রোগীর ভর্তির সময়ের রেডিওগ্রাফগুলির সুসমীক্ষা অন্তর্ভুক্ত ছিল, যা ডান পাশে LFGHP এবং বাম পাশে একটি সিম্পল পোস্টেরিয়র ডিসলোকেশন দেখায়। এই দ্বিতীয় ইনজুরি (বাম কাঁধের সিম্পল পোস্টেরিয়র ডিসলোকেশন) রেফারিং প্রতিষ্ঠানটিতে নির্ণীত হয়নি, এবং আমাদের প্রতিষ্ঠানে নির্ণীত হতে আনুমানিক 48 ঘণ্টা সময় লেগেছিল।\n\nউভয় কাঁধের কম্পিউটেড টমোগ্রাফি (CT) ইনজুরিগুলিকে ভালোভাবে চরিত্রায়িত করার জন্য চাওয়া হয়েছিল। এই ইমেজগুলো প্রথম রেডিওগ্রাফিক স্টাডির সময় থেকে বাম কাঁধের ইনজুরিতে সুস্পষ্ট অবনতি দেখায়, যা সম্ভবত রোগীর শারীরিক রেস্ট্রেইনের সেকেন্ডারি। এই প্রমাণটি ভর্তির রেডিওগ্রাফে বাম পাশের সিম্পল পোস্টেরিয়র গ্লেনোহিউমেরাল ডিসলোকেশন থেকে 48 ঘণ্টা পরে নেওয়া CT-তে LFGHP-এ অগ্রগতিকে নির্দেশ করে।\n\nপরিকল্পনা\n\nডান কাঁধের প্রিঅপারেটিভ স্টাডিতে গ্লেনয়েডের অস্থি অক্ষততা এবং হিউমেরাসের আর্টিকুলার সারফেসের 40% ইনভলভমেন্ট দেখা যায়, তবে লেসার টিউবারোসিটির সাথে ধারাবাহিকতায় একটি বড় ফ্রাগমেন্ট ছিল যার অস্টিওসিন্থেসিসের সম্ভাবনা রয়েছে, তাই এই ফ্রাগমেন্টটি 4.0 mm পার্শিয়াল থ্রেড স্পঞ্জিয়াস স্ক্রু এবং উচ্চ-শক্তির স্যুচার দিয়ে ফিক্স করার পরিকল্পনা করা হয়। বাম কাঁধে, গ্লেনয়েডে কোনো উল্লেখযোগ্য অস্থি ডিফেক্ট প্রমাণিত হয়নি এবং হিউমেরাসের আর্টিকুলার সারফেসের ডিফেক্ট ছিল 20%, তাই অস্টিওসিন্থেসিসের সময় লেসার টিউবারোসিটির ফ্রাগমেন্ট দিয়ে ডিফেক্টটি পূরণ করার পরিকল্পনা করা হয় (McLaughlin-এর সার্জারির অনুকরণে)।\n\nসার্জিকাল টেকনিক\n\nবাইল্যাটারাল লকড-প্লেট দিয়ে ওপেন রিডাকশন অ্যান্ড ইন্টারনাল ফিক্সেশন করার সিদ্ধান্ত নেওয়া হয়। রোগীকে বিচ চেয়ার পজিশনে রাখা হয় এবং ডান কাঁধের জন্য প্রচলিত উপায়ে সার্জিকাল ফিল্ড প্রস্তুত করা হয়। ক্লাসিক ডেল্টোপেক্টোরাল অ্যাপ্রোচ দিয়ে ফ্র্যাকচারের ফোকাসে প্রবেশ করা হয়। স্ট্যান্ডার্ড ডায়াগনস্টিক আর্থ্রোস্কপি পোর্টালের আকারের একটি পোস্টেরিয়র মিনি-ওপেন ইনসিশন দিয়ে হিউমেরাল হেডের পোস্টেরিয়র ফ্রাগমেন্ট রিডিউস করতে একটি ডিজিটাল ম্যানুভার করা হয়। উচ্চ-শক্তির স্যুচার ও সুই ব্যবহার করে ফ্র্যাকচারের প্রভিশনাল রিডাকশন অর্জন করা হয়। হিউমেরাল হেডের উভয় ফ্রাগমেন্ট ফিক্স করতে আংশিক 4.0 mm স্পঞ্জিয়াস স্ক্রু এবং উচ্চ-শক্তির স্যুচার ব্যবহার করা হয়। Philos (Depuy Synthes®) প্লেট দিয়ে ফ্র্যাকচারের ডেফিনিটিভ ফিক্সেশন যথাযথ রিডাকশন ও ফ্রাগমেন্টের স্থিতিশীলতা অর্জিত হয়। রোটেটর কাফের টেন্ডনে প্লেটের সাথে টাই করা উচ্চ-শক্তির স্যুচারের মাধ্যমে ফিক্সেশন বৃদ্ধি করা হয়। ডান কাঁধে স্তরভিত্তিক ক্লোজার, ক্ষত নিরাময় এবং ইউনিভার্সাল শোল্ডার ইমোবিলাইজার দিয়ে অঙ্গ ইমোবিলাইজেশন করা হয়।\nবাম কাঁধের সার্জিকাল ফিল্ড অবিলম্বে প্রস্তুত করা হয়। ডিজিটাল ম্যানিপুলেশন ও হিউমেরাল হেডের রিডাকশনের জন্য একটি অ্যাক্সেসরি পোস্টেরিয়র পোর্টাল ব্যবহার করে আবার ক্লাসিক ডেল্টোপেক্টোরাল অ্যাপ্রোচের মাধ্যমে ফ্র্যাকচারের ফোকাসে পৌঁছানো হয়। স্পঞ্জিওসা স্ক্রু ব্যতীত, ডান কাঁধের জন্য বর্ণিত একই পদ্ধতিতে ফিক্সেশন ও অস্টিওসিন্থেসিস করা হয়, কারণ অ্যান্টেরিয়র ফ্রাগমেন্টটি কেবল উচ্চ-শক্তির স্যুচার ব্যবহারেই যথাযথভাবে ফিক্স করা সম্ভব হয়েছিল।\nপোস্টঅপারেটিভ ম্যানেজমেন্টে চার সপ্তাহের জন্য বাইল্যাটারাল শোল্ডার ইমোবিলাইজারের ব্যবহার অন্তর্ভুক্ত ছিল। দ্বিতীয় পোস্টঅপারেটিভ সপ্তাহ থেকে সহ্যক্ষমতা অনুযায়ী (ব্যথার মাত্রা অনুসারে) কনুইয়ের ফ্লেক্সন-এক্সটেনশনের পেন্ডুলার ব্যায়াম এবং মুষ্টির ব্যায়াম করতে দেওয়া হয়। প্রথম মাসের রেডিওগ্রাফিক কন্ট্রোলে বাম গ্রেটার টিউবারোসিটির রিডাকশনের লস লক্ষ্য করা হয়। উচ্চ-শক্তির স্যুচার দিয়ে ফ্রাগমেন্টের যথাযথ ফিক্সেশন অর্জন করে রিভিশন সার্জারি করার সিদ্ধান্ত নেওয়া হয়।\nবাম কাঁধে অতিরিক্ত চার সপ্তাহের জন্য রোগীকে শোল্ডার ইমোবিলাইজার দিয়ে রাখা হয়। আগে বর্ণিত অনুযায়ী বাইল্যাটারাল ভিত্তিতে দ্বিতীয় পোস্টঅপারেটিভ সপ্তাহ থেকে স্ব-প্রশাসিত ব্যায়াম রেজিমেন পুনরায় শুরু করা হয়। রিভিশন সার্জারির ছয় সপ্তাহ পর সপ্তাহে দুই বার সামনাসামনি কাইনেসিওলজিক্যাল থেরাপি শুরু করা হয়। কাইনেসিওলজিক্যাল রিহ্যাবিলিটেশনের 30টি সেশন শেষে, রোগী প্রাথমিক ইনজুরির পাঁচ মাস পর কাজে ফিরে যেতে সক্ষম হন।\nপ্রাথমিক সার্জারির এক বছর পর ফলো-আপে দেখা যায় যে রোগী ডান কাঁধে শক্তি ও মবিলিটি পুনরুদ্ধার করেছেন। তবে বাম কাঁধে এখনও রেঞ্জ অব মোশনে গুরুতর সীমাবদ্ধতা রয়েছে, বিশেষত এক্সটার্নাল রোটেশনে। এই পর্যায়ে, বাম কাঁধে আর্থ্রোস্কোপিক জয়েন্ট রিলিজ সার্জারি করা এবং অস্টিওসিন্থেসিস অপসারণ করার সিদ্ধান্ত নেওয়া হয়।\nট্রমার দুই বছর পর তার শেষ চেক-আপে, রোগী মূল্যায়িত ফাংশনাল স্কেলগুলির সাথে সামঞ্জস্যপূর্ণ অনুকূল অগ্রগতি প্রদর্শন করেন।",
+    "translated_summary": "৫২ বছর বয়সী একজন পুরুষ রোগী, যিনি টনিক-ক্লোনিক খিঁচুনি এবং ডান দিকের এলএফজিএইচপি-এর কারণে একটি উচ্চ-জটিলতা সম্পন্ন কেন্দ্রে স্থানান্তরিত হয়েছিলেন। প্রাথমিক এক্স-রে পরীক্ষায়, ডান কাঁধে আঘাতের বিষয়টি নিশ্চিত করা হয় এবং বাম কাঁধের একটি সাধারণ পোস্টেরিয়র গ্লেনোহিউমেরাল ডিসলোকেশন নির্ণয় করা হয়, যা আগে শনাক্ত করা যায়নি। এরপর উভয় কাঁধের সিটি স্ক্যান করা হয়, যেখানে উভয় দিকেই এলএফজিএইচপি দেখা যায়, যা বাম কাঁধের আঘাতের তীব্রতা বৃদ্ধি নির্দেশ করে। একটিমাত্র ধাপে উভয় কাঁধে ওপেন রিডাকশন এবং বাইলেটারাল ব্লকেড প্লেট দিয়ে অস্টিওসিন্থেসিস করা হয়। বাম কাঁধের জন্য দুটি অতিরিক্ত চিকিৎসার প্রয়োজন হয়েছিল, একটি অস্টিওসিন্থেসিসের ব্যর্থতার কারণে এবং অন্যটি জয়েন্ট রিলিজের জন্য। পদ্ধতির দুই বছর পর, রোগী কুইক ড্যাশ স্কেলে ৫% স্কোর এবং বাম ও ডান কাঁধে যথাক্রমে ৭২ এবং ৭৬ স্কোর নিয়ে সন্তোষজনকভাবে উন্নতি লাভ করেন।"
+  },
+  {
+    "id": "multiclinsum_gs_en_439.txt",
+    "fulltext": "A 70-year-old white man was treated for severe symptomatic aortic regurgitation due to healed endocarditis using TAVI from the apical approach. TAVI was performed at that time because he was considered a high-risk surgical patient due to secondary pulmonary hypertension, severely impaired left ventricular function with a left ventricular ejection fraction (LVEF) of 20%, chronic renal failure, and a logistic EuroSCORE I of 24.36%. At the time he was treated by diuretics (torasemide 20 mg once a day), an angiotensin-converting enzyme (ACE) inhibitor (ramipril 5 mg once a day), a ß-blocker (bisoprolol 2.5 mg twice a day), and an aldosterone antagonist (12.5 mg once a day). On admission he had cardiac decompensation and resulting dyspnea (temperature 36.7 °C, pulse 99/minute, blood pressure 109/48 mmHg) but his emotional status and neurological constitution were good. The laboratory results were unremarkable except for: a mild increase in liver enzymes, aspartate aminotransferase (AST) 59 U/l and alanine aminotransferase (ALT) 67 U/l; a known chronic renal insufficiency (creatinine 2.1 mg/dl); and a mild decrease in hemoglobin (Hb) 10.7 g/dl. No urine analysis was done. Due to normal C-reactive protein and normal count of leukocytes no microbiological examination was performed. After interdisciplinary discussion of the case (including a normal coronary angiography that was performed a few days before) and cardiac recompensation, he was initially treated with an implantation of a JenaValve 27 mm self-expandable valve. Despite a good result after implantation with the JenaValve and minimal transvalvular central insufficiency, he presented recurrent cardiac decompensation due to his severely impaired LVEF. His case was discussed again at an interdisciplinary meeting: 4 weeks after TAVI he underwent the implantation of a LVAD system (Thoratec® HeartMate II). His postoperative course was uneventful. He remained asymptomatic for 1 year until the LVAD system showed recurrent significant high flow alarms. Echocardiography examinations during this year showed a continuous increase in transvalvular central insufficiency to the level of a severe regurgitation without any sign for structural alteration of the leaflets of the JenaValve prosthesis. Treatment options were discussed and a new TAVI as valve-in-valve was decided.\n\nThe procedure was performed under general anesthesia using a CoreValve Evolut R 29 mm prosthesis. The prosthesis was implanted without prior valvuloplasty. The flow rate of LVAD was reduced to minimum and pacing with a frequency of 140 beats/minute was applied during placement of the valve prosthesis. Positioning was done with great care using fluoroscopic and transesophageal echocardiography (TEE) guidance with the aim of having the ventricular strut end of the CoreValve Evolut R prosthesis between the ventricular end and the “cusp feelers” of the JenaValve prosthesis. This position was obtained because of JenaValve structure and individual computed tomography analysis of our patient which had shown the ventricular edge of the JenaValve well positioned in left ventricular outflow tract (LVOT). The first positioning was successful with no need for repositioning. After the last fluoroscopic control the CoreValve Evolut R was released successfully in the planned position. Slow rapid pacing was stopped and the LVAD flow was increased and required good hemodynamic under normal LVAD flow. His postoperative course was uneventful and he has shown a very good recovery. A second TEE did not show any change regarding the performance of the valve-in-valve and only marginal residual insufficiency. At 12-month follow-up our patient had no complaints and had a satisfactory capacity in daily life. Echocardiography showed no relevant aortic regurgitation and an increase of LVEF to 33%. At that time the 6-minute walk test was significantly increased to 381 m (compared to 148 m on admission).",
+    "summary": "We report the case of a 70-year-old white man who was treated for severe symptomatic aortic regurgitation using transcatheter aortic valve implantation from the apical approach. Because of recurrent cardiac decompensation 4 weeks after implantation he underwent the implantation of a left ventricular assist device system. A year later echocardiography showed a severe transvalvular central insufficiency. Our heart team decided to choose a valve-in-valve approach while reducing the flow rate of left ventricular assist device to minimum and pacing with a frequency of 140 beats/minute. There was an excellent result and our patient is doing well with no relevant insufficiency of the aortic valve at 12-month follow-up.",
+    "translated_fulltext": "একজন ৭০ বছর বয়সী শ্বেতাঙ্গ পুরুষকে গুরুতর উপসর্গযুক্ত অ্যাওর্টিক রিগারজিটেশন-এর জন্য চিকিৎসা করা হয়েছিল, যা নিরামিত এন্ডোকার্ডাইটিসের কারণে হয়েছিল। এক্ষেত্রে টিএভিআই (TAVI) পদ্ধতির মাধ্যমে চিকিৎসা করা হয়। রোগীর সেকেন্ডারি পালমোনারি হাইপারটেনশন, গুরুতরভাবে দুর্বল বাম নিলয়ের কার্যকারিতা (বাম নিলয়ের ইজেকশন ফ্র্যাকশন বা এলভিইএফ ২০%), দীর্ঘস্থায়ী কিডনি বিকল এবং ২৪.৩৬% লজিস্টিক ইউরোস্কোর I-এর কারণে তাকে উচ্চ ঝুঁকিপূর্ণ অস্ত্রোপচার রোগী হিসেবে বিবেচনা করা হয়েছিল। তাই টিএভিআই করা হয়। চিকিৎসার সময় তাকে ডায়ুরেটিক্স (টোরাসেমাইড ২০ মিগ্রা দিনে একবার), একটি অ্যাঞ্জিওটেনসিন-রূপান্তরকারী এনজাইম (এসিই) ইনহিবিটর (রামিপ্রিল ৫ মিগ্রা দিনে একবার), একটি বিটা-ব্লকার (বিসোপ্রোলল ২.৫ মিগ্রা দিনে দুবার) এবং একটি অ্যালডোস্টেরন অ্যান্টাগনিস্ট (১২.৫ মিগ্রা দিনে একবার) দেওয়া হয়েছিল। হাসপাতালে ভর্তির সময় তার কার্ডিয়াক ডি compensation এবং এর ফলে শ্বাসকষ্ট দেখা যায় (তাপমাত্রা ৩৬.৭ ডিগ্রি সেলসিয়াস, পালস ৯৯/মিনিট, রক্তচাপ ১০৯/৪৮ মিমি Hg)। তবে তার মানসিক অবস্থা এবং স্নায়বিক গঠন ভালো ছিল। ল্যাবরেটরি পরীক্ষায় সামান্য লিভার এনজাইমের বৃদ্ধি (অ্যাসপার্টেট অ্যামিনোট্রান্সফারেজ বা এএসটি ৫৯ ইউ/লি এবং অ্যালানিন অ্যামিনোট্রান্সফারেজ বা এএলটি ৬৭ ইউ/লি), দীর্ঘস্থায়ী কিডনি অপর্যাপ্ততা (ক্রিয়েটিনিন ২.১ মিগ্রা/ডিএল) এবং সামান্য হিমোগ্লোবিনের হ্রাস (১০.৭ গ্রাম/ডিএল) দেখা যায়। প্রস্রাব পরীক্ষা করা হয়নি। স্বাভাবিক সি-রিঅ্যাক্টিভ প্রোটিন এবং স্বাভাবিক শ্বেত রক্তকণিকার সংখ্যার কারণে কোনো জীবাণু পরীক্ষা করা হয়নি। আন্তঃবিভাগীয় আলোচনার পর (কয়েক দিন আগে করা একটি স্বাভাবিক করোনারি অ্যাঞ্জিওগ্রাফি সহ) এবং কার্ডিয়াক রিকম্পেনসেশনের পর, তাকে প্রথমে জেনাভালভ ২৭ মিমি স্ব-বিস্তৃত ভালভের প্রতিস্থাপন করে চিকিৎসা করা হয়। জেনাভালভের প্রতিস্থাপনের পরে ভালো ফল পাওয়া গেলেও এবং সামান্য ট্রান্সভালভুলার কেন্দ্রীয় অপর্যাপ্ততা দেখা গেলেও, তার গুরুতরভাবে দুর্বল এলভিইএফ-এর কারণে পুনরায় কার্ডিয়াক ডি compensation দেখা যায়। তার বিষয়টি আবার একটি আন্তঃবিভাগীয় সভায় আলোচনা করা হয়: টিএভিআই করার ৪ সপ্তাহ পর, তার একটি এলভিএডি (LVAD) সিস্টেম (থোরাটেক® হার্টমেট II) প্রতিস্থাপন করা হয়। অস্ত্রোপচারের পরবর্তী সময়কাল স্বাভাবিক ছিল। এলভিএডি সিস্টেমে পুনরায় উল্লেখযোগ্য উচ্চ প্রবাহের অ্যালার্ম দেখা না যাওয়া পর্যন্ত তিনি ১ বছর ধরে উপসর্গবিহীন ছিলেন। এই বছরকালে করা ইকোকার্ডিওগ্রাফি পরীক্ষায় ট্রান্সভালভুলার কেন্দ্রীয় অপর্যাপ্ততা ক্রমাগত বাড়তে দেখা যায়, যা গুরুতর রিগারজিটেশনের পর্যায়ে পৌঁছেছিল, কিন্তু জেনাভালভ প্রোস্থেসিসের লিফলেটের কাঠামোগত পরিবর্তনের কোনো লক্ষণ দেখা যায়নি। চিকিৎসার বিকল্প নিয়ে আলোচনা করা হয় এবং ভালভের মধ্যে ভালভ প্রতিস্থাপনের জন্য নতুন টিএভিআই করার সিদ্ধান্ত নেওয়া হয়।\n\nএই পদ্ধতিটি কোরভালভ ইভোলিউট আর ২৯ মিমি প্রোস্থেসিস ব্যবহার করে সাধারণ অ্যানেস্থেসিয়ার অধীনে করা হয়েছিল। প্রোস্থেসিসটি পূর্বে ভালভোপ্লাস্টি ছাড়াই প্রতিস্থাপন করা হয়েছিল। এলভিএডি-র প্রবাহ সর্বনিম্ন করে আনা হয় এবং ভালভ প্রোস্থেসিস স্থাপনের সময় ১৪০ বিট/মিনিটের ফ্রিকোয়েন্সিতে পেসিং করা হয়েছিল। ফ্লুরোস্কোপিক এবং ট্রান্সসোফেজিয়াল ইকোকার্ডিওগ্রাফি (টিইই) গাইডের মাধ্যমে খুব সতর্কতার সাথে ভালভের অবস্থান নির্ধারণ করা হয়েছিল, যাতে কোরভালভ ইভোলিউট আর প্রোস্থেসিসের ভেন্ট্রিকুলার স্ট্রাট প্রান্তটি ভেন্ট্রিকুলার প্রান্ত এবং জেনাভালভ প্রোস্থেসিসের \"কাস্প ফিলার\"-এর মধ্যে থাকে। জেনাভালভের গঠন এবং আমাদের রোগীর স্বতন্ত্র কম্পিউটেড টমোগ্রাফি বিশ্লেষণের কারণে এই অবস্থানটি নির্ধারণ করা হয়েছিল, যেখানে দেখা যায় জেনাভালভের ভেন্ট্রিকুলার প্রান্তটি বাম নিলয়ের বহিঃপ্রবাহ পথে (এলভিওটি) ভালোভাবে স্থাপন করা হয়েছে। প্রথম অবস্থানটি সফল ছিল এবং পুনরায় অবস্থান পরিবর্তনের প্রয়োজন হয়নি। শেষ ফ্লুরোস্কোপিক নিয়ন্ত্রণের পর কোরভালভ ইভোলিউট আর সফলভাবে পরিকল্পিত অবস্থানে স্থাপন করা হয়। ধীরগতির পেসিং বন্ধ করা হয় এবং এলভিএডি-র প্রবাহ বাড়ানো হয়, যার ফলে স্বাভাবিক এলভিএডি প্রবাহের অধীনে ভালো হেমোডাইনামিক অবস্থা তৈরি হয়। অস্ত্রোপচারের পরবর্তী সময়কাল স্বাভাবিক ছিল এবং তিনি খুব ভালো পুনরুদ্ধার করেছেন। দ্বিতীয় টিইই পরীক্ষায় ভালভের কার্যকারিতা এবং সামান্য অবশিষ্ট অপর্যাপ্ততা সম্পর্কে কোনো পরিবর্তন দেখা যায়নি। ১২ মাস ফলো-আপের পর আমাদের রোগীর কোনো অভিযোগ ছিল না এবং দৈনন্দিন জীবনে তার স্বাভাবিক কাজকর্ম করার ক্ষমতা ছিল। ইকোকার্ডিওগ্রাফিতে উল্লেখযোগ্য অ্যাওর্টিক রিগারজিটেশন দেখা যায়নি এবং এলভিইএফ-এর মান ৩৩%-এ উন্নীত হয়েছে। সেই সময়ে ৬ মিনিটের হাঁটা পরীক্ষা উল্লেখযোগ্যভাবে বৃদ্ধি পেয়ে ৩৮১ মিটারে পৌঁছেছিল (ভর্তির সময় ১৪৮ মিটার ছিল)।",
+    "translated_summary": "আমরা একজন ৭০ বছর বয়সী শ্বেতাঙ্গ পুরুষের ঘটনা বর্ণনা করছি, যিনি অ্যাপিক্যাল পদ্ধতির মাধ্যমে ট্রান্সক্যাথেটার অ্যাওর্টিক ভালভ ইমপ্লান্টেশনের মাধ্যমে গুরুতর অ্যাওর্টিক রিগারজিটেশনের চিকিৎসা করিয়েছিলেন। ইমপ্লান্টেশনের ৪ সপ্তাহ পর কার্ডিয়াক ডি compensation-এর পুনরাবৃত্তি হওয়ায়, তার বাম নিলয়ের সহায়ক ডিভাইস স্থাপন করা হয়। এক বছর পর ইকোকার্ডিওগ্রাফিতে গুরুতর ট্রান্সভালভুলার সেন্ট্রাল ইনসাফিসিয়েন্সি দেখা যায়। আমাদের হৃদরোগ বিশেষজ্ঞ দল ভালভের মধ্যে ভালভ স্থাপনের পদ্ধতি বেছে নেয়, একই সাথে বাম নিলয়ের সহায়ক ডিভাইসের প্রবাহের হার সর্বনিম্ন করে এবং প্রতি মিনিটে ১৪০ বিটের ফ্রিকোয়েন্সিতে পেসিং করে। এর ফলস্বরূপ চমৎকার উন্নতি দেখা যায় এবং ১২ মাস পর ফলো-আপে দেখা যায় আমাদের রোগী ভালো আছেন এবং অ্যাওর্টিক ভালভে উল্লেখযোগ্য কোনো দুর্বলতা নেই।"
+  },
+  {
+    "id": "multiclinsum_gs_en_59.txt",
+    "fulltext": "A 2-year-old female presented with a 1-year history of painless left progressive proptosis with no reported systemic diseases or family history. Ophthalmologic examination revealed light sensation as the only vision in the left eye, along with proptosis, inward and upward eyeball displacement, and restricted extraocular muscle movements in downward and outward directions. An irregularly shaped, well-defined soft mass was palpable in the inferior aspect of the left orbit, accompanied by left lower eyelid ectropion. The pupil was enlarged (4 mm in diameter), and pupillary reaction was absent. The remaining anterior segment examination showed no apparent abnormalities. Fundus examination was challenging due to the child’s size. Hertel exophthalmometry readings measured 10.5 mm in the right eye and 18 mm in the left. Magnetic resonance imaging (MRI) revealed a well-circumscribed mass, displaying hypointense signals on T1-weighted images and hyperintense signals on T2-weighted images. Contrast-enhanced imaging demonstrated no significant improvement. A transconjunctival approach via the inferior fornix with canthotomy and cantholysis was performed, revealing a grayish-white cystic mass with a distinct boundary from surrounding tissues. During posterior separation to the eyeballs’ posterior part, tight adhesion to the optic nerve was observed. Due to the mass’s substantial size and the restricted surgical field, volume reduction was necessary. Approximately 12.5 mL of the fluid was aspirated, and the mass was completely excised. Histopathological examination disclosed a fibrous capsule wall covered with squamous and glandular epithelium, along with visible brain tissue and a cartilage-like matrix consistent with orbital teratoma. One month postsurgery, the patient exhibited enophthalmos, conjunctival hyperemia, and keratitis on ocular examination. This was attributed to the mass’s prior enlargement of the orbital cavity, resulting in postoperative enophthalmos. The cornea could not adhere to the eyelids, creating a space and causing corneal inflammation. After obtaining the consent of the patient’s guardian, a second operation involved the implantation of an allogeneic sclera into the orbit to increase the orbital volume, alleviate fossa pitting and restore keratitis to normal. No recurrence of the teratomas was noted during the 1-year follow-up. The patient still had minor enophthalmos and outer canthus abnormality. The visual acuity remained consistent with pre-operation levels. Hertel exophthalmometry readings measured 10.5 mm in the right eye and 8 mm in the left. The remaining anterior segment examination showed no apparent abnormalities.",
+    "summary": "Patient concerns: A 2-year-old female child was presented exhibiting proptosis and inward and upward eyeball displacement. Enhanced magnetic resonance imaging revealed a well-circumscribed mass, persisting with hypointense signals on T1-weighted images (T1WI) and hyperintense signals on T2-weighted images (T2WI).\n\nDiagnoses: The diagnosis of teratoma was confirmed finally through histological and immunohistochemical exams.\n\nInterventions: A transconjunctival approach via the inferior fornix, coupled with canthotomy and cantholysis, was performed. However, a month postsurgery, the patient developed enophthalmos, conjunctival hyperemia, and keratitis upon ocular examination. A second operation involved the implantation of allogeneic sclera into the orbit to increase orbital volume, improve the pitting of the fossa, and restore keratitis to normal.\n\nOutcomes: No recurrence and other complications were noted during the 1-year follow-up.",
+    "translated_fulltext": "দুই বছর বয়সী একটি মেয়ে, যার বাম চোখে এক বছর ধরে ব্যথাহীনভাবে ধীরে ধীরে প্রোপটোসিস (চোখের গ্লোব সামনের দিকে প্রসারিত হওয়া) দেখা যাচ্ছিল, এবং যার কোনো সিস্টেমিক রোগ বা পারিবারিক ইতিহাস নেই, তাকে পরীক্ষা করা হয়েছিল। চক্ষু পরীক্ষায় দেখা যায়, বাম চোখে আলো অনুভব করা যায়, সেই সাথে প্রোপটোসিস, চোখের গ্লোবের ভেতরের দিকে এবং উপরের দিকে সরে যাওয়া, এবং নিচের দিকে ও বাইরের দিকে অতিরিক্ত চোখের পেশীর নড়াচড়া সীমিত ছিল। বাম চোখের নিচের অংশে একটি অনিয়মিত আকারের, স্পষ্ট সীমানাযুক্ত নরম পিণ্ড অনুভব করা যাচ্ছিল, এবং এর সাথে বাম চোখের নিচের চোখের পাতা বাইরের দিকে বেঁকে গিয়েছিল (একট্রোপিয়ন)। চোখের মণি বড় ছিল (প্রায় ৪ মিমি ব্যাস), এবং মণির আলো সংবেদী ক্ষমতা ছিল না। চোখের বাকি অংশের পরীক্ষায় কোনো দৃশ্যমান অস্বাভাবিকতা দেখা যায়নি। শিশুটির আকারের কারণে ফান্ডাস পরীক্ষা করা কঠিন ছিল। হার্টেল এক্সোফথালমোমেট্রি পরীক্ষায় ডান চোখে ১০.৫ মিমি এবং বাম চোখে ১৮ মিমি পরিমাপ করা হয়। ম্যাগনেটিক রেজোন্যান্স ইমেজিং (এমআরআই) পরীক্ষায় একটি সুস্পষ্ট পিণ্ড দেখা যায়, যা টি১-ওয়েটেড ছবিতে হাইপোইনটেন্স সংকেত এবং টি২-ওয়েটেড ছবিতে হাইপারইনটেন্স সংকেত প্রদর্শন করে। কন্ট্রাস্ট-এনহ্যান্সড ইমেজিংয়ে উল্লেখযোগ্য কোনো উন্নতি দেখা যায়নি। একটি ট্রান্সকনজাংটিভাল পদ্ধতির মাধ্যমে নিচের ফোরামিক্স, কান্থোটমি এবং কান্থোলাইসিস করে পিণ্ডটি অপসারণ করা হয়। এতে দেখা যায়, একটি ধূসর-সাদা সিস্টিক পিণ্ড, যার চারপাশের টিস্যু থেকে একটি স্পষ্ট সীমানা রয়েছে। চোখের গ্লোবের পেছনের অংশে পিণ্ডটি সরানোর সময়, অপটিক নার্ভের সাথে এর দৃঢ় সংযোগ দেখা যায়। পিণ্ডটির আকারের কারণে এবং সীমিত অস্ত্রোপচারের সুযোগের কারণে, এর আকার কমানো প্রয়োজন ছিল। প্রায় ১২.৫ মিলি তরল অপসারণ করা হয় এবং পিণ্ডটি সম্পূর্ণরূপে কেটে ফেলা হয়। হিস্টোপ্যাথলজিক্যাল পরীক্ষায় দেখা যায়, পিণ্ডটির বাইরের স্তরটি ফাইব্রাস ক্যাপসুল দিয়ে গঠিত, যা স্কোয়ামাস এবং গ্রন্থিময় এপিথেলিয়াম দ্বারা আবৃত, সেই সাথে মস্তিষ্কের টিস্যু এবং কার্টিলেজের মতো ম্যাট্রিক্স রয়েছে, যা অরবিটাল টেরাটোমার সাথে সামঞ্জস্যপূর্ণ। অস্ত্রোপচারের এক মাস পর, রোগীর চোখে এনওফথালমোস (চোখের গ্লোব ভেতরের দিকে দেবে যাওয়া), কনজাংটিভাল হাইপারেমিয়া (চোখের সাদা অংশ লাল হয়ে যাওয়া) এবং কেরাটাইটিস (কর্নিয়ার প্রদাহ) দেখা যায়। এটি পিণ্ডের কারণে চোখের গহ্বরের পূর্বের প্রসারণের ফলস্বরূপ ঘটেছিল, যার কারণে অস্ত্রোপচারের পরে এনওফথালমোস দেখা দেয়। কর্নিয়া চোখের পাতায় লেগে থাকতে পারছিল না, যার ফলে একটি ফাঁকা স্থান তৈরি হয় এবং কর্নিয়ার প্রদাহ হয়। রোগীর অভিভাবকের সম্মতি পাওয়ার পর, দ্বিতীয় অস্ত্রোপচারে একটি অ্যালোজেনিক স্ক্লেরা চোখের গহ্বরে স্থাপন করা হয়, যাতে চোখের গহ্বরের আকার বৃদ্ধি পায়, ফোসা পিটিং হ্রাস পায় এবং কেরাটাইটিস স্বাভাবিক অবস্থায় ফিরে আসে। এক বছরের ফলো-আপের সময় টেরাটোমার পুনরাবৃত্তি হয়নি। রোগীর সামান্য এনওফথালমোস এবং বাইরের ক্যান্থাসের অস্বাভাবিকতা তখনও ছিল। অস্ত্রোপচারের আগের মতো দৃষ্টিশক্তি একই ছিল। হার্টেল এক্সোফথালমোমেট্রি পরীক্ষায় ডান চোখে ১০.৫ মিমি এবং বাম চোখে ৮ মিমি পরিমাপ করা হয়। চোখের বাকি অংশের পরীক্ষায় কোনো দৃশ্যমান অস্বাভাবিকতা দেখা যায়নি।",
+    "translated_summary": "রোগীর সমস্যা: দুই বছর বয়সী একটি মেয়ে শিশুকে পরীক্ষা করে দেখা যায় তার চোখের মণি বাইরের দিকে এবং উপরের দিকে সরে গেছে। উন্নত ম্যাগনেটিক রেজোন্যান্স ইমেজিং-এ একটি সুস্পষ্ট পিণ্ড দেখা যায়, যা টি১-ওয়েটেড ইমেজে (টি১ডব্লিউআই) দুর্বল সংকেত এবং টি২-ওয়েটেড ইমেজে (টি২ডব্লিউআই) তীব্র সংকেত দেখাচ্ছিল।\n\nরোগ নির্ণয়: হিস্টোলজিক্যাল এবং ইমিউনোহিস্টোকেমিক্যাল পরীক্ষার মাধ্যমে অবশেষে টেরাটোমার রোগ নির্ণয় নিশ্চিত করা হয়।\n\nচিকিৎসা: নিচের কনজাংটিভার মাধ্যমে একটি ট্রান্সকনজাংটিভাল পদ্ধতি অবলম্বন করা হয়, যার সাথে ক্যান্থোটমি এবং ক্যান্থোলাইসিস করা হয়। তবে, অস্ত্রোপচারের এক মাস পর, চোখের পরীক্ষায় দেখা যায় রোগীর এনওফথালমোস, কনজাংটিভাল হাইপারেমিয়া এবং কেরাটাইটিস হয়েছে। দ্বিতীয় অস্ত্রোপচারে অ্যালোজেনিক স্ক্লেরা প্রতিস্থাপন করে চোখের গহ্বরের আয়তন বাড়ানো হয়, ফোসার আকার উন্নত করা হয় এবং কেরাটাইটিস স্বাভাবিক অবস্থায় ফিরিয়ে আনা হয়।\n\nফলাফল: এক বছরের ফলো-আপে কোনো পুনরাবৃত্তি বা অন্য কোনো জটিলতা দেখা যায়নি।"
+  },
+  {
+    "id": "multiclinsum_gs_en_443.txt",
+    "fulltext": "65-year-old woman with no relevant personal or family history. In August 2022, a posterior mediastinal tumour was found in the preoperative assessment for a knee surgery, which was why she was referred for evaluation and treatment. On admission, the physical examination was not relevant and the laboratory studies were within normal parameters. A chest CT scan was performed that showed a tumour located in the posterior right mediastinum measuring 6.5 × 4.2 cm, with well-defined borders, with a fat and solid density, with no evidence of bone erosion or infiltration of surrounding tissue. A biopsy of the lesion was performed using a 18G × 250 mm semiautomatic cutting needle, with image guidance, through a posterior approach. In the histopathological study, a benign neoplasm consisting of mature adipose tissue with areas of haemorrhage alternating with haematopoietic elements, predominantly precursors of the red series, was observed, as well as elements of the myeloid series in different stages of maturation and megakaryocytes, which established the diagnosis of MPM.  Finally, with the diagnosis established and the characteristics of the lesion, conservative management was decided. The patient evolved satisfactorily and was discharged without complications.\n",
+    "summary": "We present the case of a 65-year-old woman with a primary mediastinal myelolipoma. Computed tomography of the chest showed an ovoid, well-defined bordered tumor of 6.5 × 4.2 cm, located in the posterior mediastinum. A trans-thoracic biopsy of the lesion was performed and microscopic examination revealed haemopoietic elements and mature adipose tissue.\n",
+    "translated_fulltext": "৬৫ বছর বয়সী একজন মহিলার, যার ব্যক্তিগত বা পারিবারিক কোনো উল্লেখযোগ্য স্বাস্থ্য ইতিহাস নেই। ২০২২ সালের আগস্ট মাসে, হাঁটুতে অস্ত্রোপচারের আগে স্বাস্থ্য পরীক্ষা করার সময়, তার পেছনেরMediastinum-এ একটি টিউমার পাওয়া যায়। এই কারণে তাকে আরও পরীক্ষা এবং চিকিৎসার জন্য পাঠানো হয়। হাসপাতালে ভর্তির সময়, শারীরিক পরীক্ষায় তেমন কিছু ধরা পড়েনি এবং ল্যাবরেটরি পরীক্ষায় সবকিছু স্বাভাবিক ছিল। একটি বুকের সিটি স্ক্যান করা হয়, যেখানে দেখা যায় পেছনের ডানদিকে Mediastinum-এ ৬.৫ × ৪.২ সেমি আকারের একটি টিউমার রয়েছে। টিউমারটির কিনারাগুলো স্পষ্ট, এবং এতে চর্বি ও কঠিন উপাদান রয়েছে। হাড়ের ক্ষয় বা আশেপাশের টিস্যুতে কোনো সংক্রমণ দেখা যায়নি। একটি ১৮G × ২৫০ মিমি সেমি-অটোমেটিক কাটিং নিডেল ব্যবহার করে, পেছনের দিক থেকে ইমেজিং গাইডের মাধ্যমে টিউমারটির বায়োপসি করা হয়। হিস্টোপ্যাথলজিক্যাল পরীক্ষায় দেখা যায়, টিউমারটি মূলত পরিণত অ্যাডিপোজ টিস্যু দিয়ে গঠিত, যেখানে রক্তক্ষরণের কিছু অংশ রয়েছে এবং এর সাথে রক্ত উৎপাদনকারী উপাদানগুলো পর্যায়ক্রমে বিদ্যমান। এর মধ্যে লোহিত রক্তকণিকার অগ্রদূত এবং অস্থিমজ্জার বিভিন্ন পর্যায়ে থাকা উপাদান ও মেগাক্যারিওসাইটও দেখা যায়। এই পরীক্ষার মাধ্যমে MPM (Malignant Peritoneal Mesothelioma)-এর রোগ নির্ণয় করা হয়। অবশেষে, রোগ নির্ণয় এবং টিউমারের বৈশিষ্ট্য অনুযায়ী, রক্ষণশীল চিকিৎসার সিদ্ধান্ত নেওয়া হয়। রোগীর শারীরিক অবস্থার উন্নতি হয় এবং কোনো জটিলতা ছাড়াই তাকে হাসপাতাল থেকে ছেড়ে দেওয়া হয়।",
+    "translated_summary": "আমরা একজন ৬৫ বছর বয়সী মহিলার ঘটনা উপস্থাপন করছি, যার মধ্যে একটি প্রাইমারি মিডিাস্টিনাল মায়েলোলিপোমা ছিল। বুকের সিটি স্ক্যানে ৬.৫ × ৪.২ সেমি আকারের ডিম্বাকৃতির, স্পষ্টভাবে সীমাবদ্ধ একটি টিউমার দেখা যায়, যা পশ্চাৎবর্তী মিডিাস্টিনামে অবস্থিত ছিল। টিউমারটির একটি ট্রান্স-থোরাসিক বায়োপসি করা হয় এবং মাইক্রোস্কোপিক পরীক্ষায় হেমাটোপোয়েটিক উপাদান এবং পরিপক্ক অ্যাডিপোজ টিস্যু পাওয়া যায়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_590.txt",
+    "fulltext": "A 57-year-old woman with a 14-year history of asthma and allergic rhinitis, on salmeterol/fluticasone, was hospitalized for recurrent abdominal pain that began two months earlier. The pain was intermittent and dull, accompanied by nausea, anorexia, malaise, and a weight loss of 5 kg. There was no fever, blood / mucus in the stool, or respiratory symptoms (rhinorrhea, wheezing, coughing). She had no history of alcohol/tobacco use or traditional herbal medicines. Six weeks before admission, she was diagnosed with an intestinal infection in a local clinic after a complete blood count (CBC) revealed leukocytosis and significant eosinophilia (25.61 G/L, 77.8% eosinophils). She received antibiotics and mebendazole without relief of symptoms. At presentation, the patient was alerted and oriented with stable vitals (BP 110/70 mmHg, T 37°C, HR 88 bpm, RR 18 bpm). She had a BMI of 16.6 kg/m² and sarcopenia, but no skin rash, lymphadenopathy, or edema. The abdominal exam showed tenderness in the epigastric and umbilical regions without guarding. CBC revealed leukocytosis and significant eosinophilia (20.8 G/L, with a total white blood cell count of 26.8 G/L, comprising 77.8% eosinophils). Peripheral blood film examination showed normal eosinophils. Bone marrow aspiration reveals 48% eosinophils without blasts, atypical cells. Fluorescence in situ hybridization (FISH) for CHIC2 deletion as a surrogate marker for FIP1L1-PDGFRA showed no rearrangements of the PDGFRA gene. Autoimmune and vasculitis screenings (ANA, anti-dsDNA, p-ANCA, c-ANCA) were negative. Elevated serum IgG (2760 mg/dL; normal range, 700–1600 mg/dL) and IgG4 (1260 mg/dL; normal range, 3.9–86.4 mg/dL), slightly elevated IgE (137.5 IU/mL; normal range, <100 IU/mL) and high RF (144.4 IU/mL; normal range, <20 IU/mL) were observed. Other parameters were normal, including aminotransferase, blood urea nitrogen, serum creatinine, complement C3, complement C4, vitamin B12, serum cortisol, and NT-proBNP. ECG and echocardiogram were normal. Chest CT scans showed mild fibrosis and bronchiectasis. Sputum AFB smears and bronchoscopy were negative. The cytology of the bronchoalveolar lavage fluid showed 35% neutrophils, no eosinophils. Spirometry indicated severe obstruction with bronchodilator response. The fractional exhaled nitric oxide (FeNO) level was 15 ppb. Stool samples were tested positive for leukocytes, with no signs of ova or parasites. Serology tests were positive for toxocariasis (positive IgG of Toxocara canis at 54.2 NovaTec-Units) but negative for Strongyloides stercoralis, Fasciola sp., Toxoplasma gondii, Trichinella spiralis, Ancylostoma sp., Angiostrongylus cantonensis, Ascaris lumbricoides, Clonorchis sinensis, Paragonimus sp., Gnathostoma sp., Entamoeba histolytica, cysticercosis, filariasis, and HIV. An abdominal contrast-enhanced computed tomography scan revealed gallbladder stones without acute cholecystitis and showed no gastrointestinal tract abnormalities. The upper gastrointestinal endoscopy showed unremarkable results with a normal appearance. Colonoscopy showed mucosal inflammation in the sigmoid, left, transverse, and right colon with systemic biopsy. A five-day course of albendazole (400 mg twice daily) for suspected toxocariasis was ineffective. Colonic biopsies revealed significant eosinophilic infiltration (>85 eosinophils/High-power field (HPF) in the left colon, >100 eosinophils/HPF in the transverse and right colon). Given the patient’s nonresponse to toxocariasis treatment and the significant eosinophilic infiltration observed in the colon mucosa biopsy, a diagnosis of eosinophilic colitis was confirmed. The patient was treated with oral methylprednisolone (16 mg) and montelukast (5 mg). Symptoms resolved in two weeks and eosinophil counts normalized (0.3 G/L). The corticosteroid was reduced and discontinued, and the patient was maintained on montelukast for three months without symptom recurrence.",
+    "summary": "We present a unique case of a 57-year-old patient with a medical history of asthma and allergic rhinitis who presented recurrent abdominal pain, significant blood eosinophilia, and elevated levels of Immunoglobulin G4. After ruling out hematological and secondary causes of eosinophilia, a biopsy of the colon mucosa revealed an excess of tissue eosinophils, confirming the diagnosis of EoC. The patient responded well to corticosteroids and was subsequently maintained on montelukast, with no recurrence of symptoms over 3 months.",
+    "translated_fulltext": "57 বছর বয়সী একজন মহিলা, যিনি 14 বছর ধরে হাঁপানি ও অ্যালার্জিক রাইনাইটিসে ভুগছিলেন এবং স্যালমেটেরল/ফ্লুটিকাসোন গ্রহণ করছিলেন, তাকে দুই মাস আগে শুরু হওয়া পেটে বারবার ব্যথার জন্য হাসপাতালে ভর্তি করা হয়েছিল। ব্যথাটি মাঝে মাঝে হতো এবং তীব্রতা কম ছিল, এর সাথে বমি বমি ভাব, ক্ষুধামান্দ্য, দুর্বলতা এবং 5 কেজি ওজন হ্রাস দেখা যায়। তার জ্বর ছিল না, মলের সাথে রক্ত বা শ্লেষ্মা ছিল না, অথবা শ্বাসকষ্টের কোনো উপসর্গ (নাক দিয়ে পানি পড়া, শ্বাসকষ্ট, কাশি) ছিল না। তার অ্যালকোহল/তামাক ব্যবহারের বা ঐতিহ্যবাহী ভেষজ ওষুধ গ্রহণের কোনো ইতিহাস ছিল না। হাসপাতালে ভর্তির ছয় সপ্তাহ আগে, একটি স্থানীয় ক্লিনিকে তার অন্ত্রের সংক্রমণ ধরা পড়ে। সম্পূর্ণ রক্ত ​​গণনা (সিবিসি)-তে লিউকোসাইটোসিস এবং উল্লেখযোগ্য ইওসিনোফিলিয়া (25.61 জি/এল, 77.8% ইওসিনোফিল) দেখা যায়। উপসর্গ উপশমের জন্য তিনি অ্যান্টিবায়োটিক এবং মেবেনডাজল গ্রহণ করেন, কিন্তু কোনো উন্নতি হয়নি। হাসপাতালে আসার সময়, রোগীর শারীরিক অবস্থা স্থিতিশীল ছিল (বিপি 110/70 মিমি Hg, তাপমাত্রা 37°C, হৃদস্পন্দন 88 বিপিএম, শ্বাস-প্রশ্বাস 18 বিপিএম)। তার বিএমআই ছিল 16.6 কেজি/মি² এবং সারকোপেনিয়া ছিল, তবে ত্বকে ফুসকুড়ি, লিম্ফ্যাডেনোপ্যাথি বা শোথ ছিল না। পেটের পরীক্ষায় দেখা যায়, এপোগ্যাস্ট্রিক এবং নাভির আশেপাশে সামান্য ব্যথা আছে, তবে পেটে শক্তভাব নেই। সিবিসি-তে লিউকোসাইটোসিস এবং উল্লেখযোগ্য ইওসিনোফিলিয়া (20.8 জি/এল, যেখানে মোট শ্বেত রক্তকণিকার সংখ্যা 26.8 জি/এল, যার মধ্যে 77.8% ইওসিনোফিল) দেখা যায়। পেরিফেরাল রক্ত ​​ফিল্ম পরীক্ষায় স্বাভাবিক ইওসিনোফিল দেখা যায়। অস্থি মজ্জা অ্যাসপিরেশনে 48% ইওসিনোফিল পাওয়া যায়, তবে কোনো ব্লাস্ট বা অস্বাভাবিক কোষ ছিল না। এফআইপি1এল1-পিডিজিএফআরএ-এর বিকল্প মার্কার হিসেবে সিএইচআইসি2 ডিলেশনের জন্য ফ্লুরোসেন্স ইন সিটু হাইব্রিডাইজেশন (এফআইএসএইচ) পরীক্ষায় পিডিজিএফআরএ জিনের কোনো পরিবর্তন দেখা যায়নি। অটোইমিউন এবং ভাস্কুলাইটিস স্ক্রিনিং (এএনএ, অ্যান্টি-ডিএসডিএনএ, পি-এএনসিএ, সি-এএনসিএ) নেতিবাচক ছিল। সিরাম আইজিজি (2760 মিগ্রা/ডিএল; স্বাভাবিক পরিসীমা, 700–1600 মিগ্রা/ডিএল) এবং আইজিজি4 (1260 মিগ্রা/ডিএল; স্বাভাবিক পরিসীমা, 3.9–86.4 মিগ্রা/ডিএল) এর মাত্রা বেশি ছিল, সামান্য বেশি আইজিই (137.5 আইইউ/এমএল; স্বাভাবিক পরিসীমা, <100 আইইউ/এমএল) এবং উচ্চ আরএফ (144.4 আইইউ/এমএল; স্বাভাবিক পরিসীমা, <20 আইইউ/এমএল) পাওয়া যায়। অন্যান্য প্যারামিটারগুলি স্বাভাবিক ছিল, যার মধ্যে অ্যামিনোট্রান্সফারেজ, রক্তে ইউরিয়া নাইট্রোজেন, সিরাম ক্রিয়েটিনিন, কমপ্লিমেন্ট সি3, কমপ্লিমেন্ট সি4, ভিটামিন বি12, সিরাম কর্টিসল এবং এনটি-প্রোবিএনপি অন্তর্ভুক্ত। ইসিজি এবং ইকোকার্ডিওগ্রাম স্বাভাবিক ছিল। বুকের সিটি স্ক্যানে সামান্য ফাইব্রোসিস এবং ব্রঙ্কিয়েক্টেসিস দেখা যায়। কফ এএফবি স্মিয়ার এবং ব্রঙ্কোস্কোপি নেতিবাচক ছিল। ব্রঙ্কোআলভিওলার ল্যাভেজ তরলের সাইটোলজিতে 35% নিউট্রোফিল পাওয়া যায়, তবে কোনো ইওসিনোফিল ছিল না। স্পাইরোমেট্রি পরীক্ষায় ব্রঙ্কোডাইলেটর ব্যবহারের পর গুরুতর বাধার উপস্থিতি দেখা যায়। ফ্র্যাকশনাল এক্সহেলড নাইট্রিক অক্সাইড (FeNO) এর মাত্রা ছিল 15 পিপিবি। মলের নমুনাতে লিউকোসাইট পজিটিভ ছিল, তবে ডিম বা পরজীবী পাওয়া যায়নি। সেরোলজি পরীক্ষায় টক্সোকারিয়াসিসের জন্য পজিটিভ (টক্সোকারা ক্যানিসের জন্য পজিটিভ আইজিজি 54.2 নোভাটেক-ইউনিট) এবং স্ট্রংইলয়েডস স্টার্কোরালাইস, ফ্যাসসিওলা এসপি., টক্সোপ্লাজমা গন্ডি, ট্রাইকিনெல்ல স্পাইরালিস, অ্যাঙ্কাইলোস্টোমা এসপি., অ্যাঞ্জিওস্ট্রংগিলাস ক্যান্টোনেসিস, অ্যাসকারিস লুমব্রিকয়েডস, ক্লোনোরকিস সিনেনসিস, প্যারাগোনমাস এসপি., গ্নাথোস্টোমা এসপি., এন্টামিবা হিস্টোলাইটিকা, সিস্টিসারকোসিস, ফিলারিয়াসিস এবং এইচআইভি-এর জন্য নেতিবাচক ছিল। পেটের কনট্রাস্ট-এনহ্যান্সড কম্পিউটেড টমোগ্রাফি স্ক্যানে পিত্তথলিতে পাথর দেখা যায়, তবে তীব্র কোলেসিস্টাইটিস ছিল না এবং গ্যাস্ট্রোইনটেস্টাইনাল ট্র্যাক্টে কোনো অস্বাভাবিকতা দেখা যায়নি। উপরের গ্যাস্ট্রোইনটেস্টাইনাল এন্ডোস্কোপিতে স্বাভাবিক অবস্থা দেখা যায়। কোলনোস্কোপিতে সিগময়েড, বাম, ট্রান্সভার্স এবং ডান কোলনে মিউকোসাল প্রদাহ দেখা যায় এবং সিস্টেমিক বায়োপসি করা হয়। সন্দেহভাজন টক্সোকারিয়াসিসের জন্য পাঁচ দিনের অ্যালবেনডাজল (400 মিগ্রা দিনে দুবার) কোর্স কার্যকর ছিল না। কোলনিক বায়োপসিতে উল্লেখযোগ্য ইওসিনোফিলিক অনুপ্রবেশ দেখা যায় (>85 ইওসিনোফিল/উচ্চ-ক্ষমতার ক্ষেত্র (এইচপিএফ) বাম কোলনে, >100 ইওসিনোফিল/এইচপিএফ ট্রান্সভার্স এবং ডান কোলনে)। রোগীর টক্সোকারিয়াসিস চিকিৎসার প্রতি প্রতিক্রিয়ার অভাব এবং কোলন মিউকোসা বায়োপসিতে উল্লেখযোগ্য ইওসিনোফিলিক অনুপ্রবেশের কারণে, ইওসিনোফিলিক কোলাইটিসের রোগ নির্ণয় নিশ্চিত করা হয়। রোগীকে ওরাল মিথাইলপ্রেডনিসোলোন (16 মিগ্রা) এবং মন্টেলুকাস্ট (5 মিগ্রা) দিয়ে চিকিৎসা করা হয়। দুই সপ্তাহের মধ্যে উপসর্গগুলি সেরে যায় এবং ইওসিনোফিলের সংখ্যা স্বাভাবিক হয়ে যায় (0.3 জি/এল)। কর্টিকোস্টেরয়েড ধীরে ধীরে কমিয়ে বন্ধ করে দেওয়া হয় এবং রোগীকে তিন মাস ধরে মন্টেলুকাস্ট দিয়ে চিকিৎসা করা হয়, যার ফলে উপসর্গগুলি পুনরায় দেখা যায়নি।",
+    "translated_summary": "আমরা একজন ৫৭ বছর বয়সী রোগীর একটি বিশেষ ঘটনা তুলে ধরছি, যার পূর্বে হাঁপানি এবং অ্যালার্জিক রাইনাইটিসের চিকিৎসা ইতিহাস রয়েছে। তিনি বার বার পেটে ব্যথা, উল্লেখযোগ্য পরিমাণে রক্তে ইওসিনোফিলিয়ার উপস্থিতি এবং ইমিউনোগ্লোবুলিন জি৪-এর উচ্চ মাত্রা নিয়ে এসেছিলেন। রক্তরোগ এবং ইওসিনোফিলিয়ার অন্যান্য কারণগুলো বাদ দেওয়ার পরে, কোলন মিউকোসার বায়োপসি করে দেখা যায় টিস্যুতে অতিরিক্ত ইওসিনোফিল রয়েছে, যা ইওসিওফিলিক কোলাইটিসের রোগ নির্ণয় নিশ্চিত করে। রোগী কর্টিকোস্টেরয়েডের চিকিৎসায় ভালো সাড়া দেন এবং পরবর্তীতে মন্টেলুকাস্টের মাধ্যমে তার চিকিৎসা করানো হয়, এবং ৩ মাসের মধ্যে তার উপসর্গগুলো আর ফিরে আসেনি।"
+  },
+  {
+    "id": "multiclinsum_gs_en_569.txt",
+    "fulltext": "A 38-year-old male presented to the hospital with chest tightness and shortness of breath. Three years prior, he had experienced similar symptoms post-activity and received treatment at our hospital. Outpatient echocardiography indicated a left heart echomass suggestive of a myxoma, which led to his admission for further evaluation. Physical examination revealed pigmentation of the patient’s ears characterized by multiple small brown and black spots. Abdominal computed tomography (CT) showed multiple livers and small cysts in the left kidney. Genetic testing identified mutations in the TTN and PRKAR1A genes. The diagnosis of CNC was confirmed through clinical examination, imaging, and genetic testing. Following symptomatic treatment, the patient’s condition improved; however, he refused surgical intervention. On September 20, 2023, the patient presented to our hospital with exacerbated chest tightness and dyspnea. He reported difficulty lying supine and needing to sit upright to breathe. Physical examination revealed jugular vein distension, leftward and downward displacement of the heart boundary, irregular heart rhythm on auscultation, and a mitral valve murmur of intensity 2/6–3/6 in the fourth intercostal space along the left sternal margin. Wet rales were audible in both middle and lower lung fields. Palpation revealed a firm liver extending three fingers below the xiphoid process and two fingers below the rib cage, along with mild pitting edema in both lower limbs. Echocardiographic images indicated global heart enlargement, dilation of the aortic sinus and pulmonary artery, small-to-moderate mitral valve regurgitation, and an irregular echoic mass measuring 54 mm ×43 mm in the left chamber attached to the atrial septum. The left ventricular (LV) ejection fraction (EF) was 23.1%, with fractional shortening (FS) of 10.9%. Electrocardiography demonstrated atrial fibrillation (average ventricular rate, 150 beats/min) and abnormal Q waves in leads V1-V3. Based on the patient’s history, the diagnosis included DCM and CNC with cardiac myxoma. Given the presence of end-stage heart failure and concurrent cardiac myxoma, the patient was hospitalized, and heart transplantation was considered a viable therapeutic option to address both conditions simultaneously. A suitable donor heart became available for immediate transplantation on October 1, 2024.\n\n\nSurgical procedure\n\nThe skin and subcutaneous tissues were carefully incised layer-by-layer through a median sternotomy. The sternum was sawed longitudinally open, and bleeding was controlled using electrocoagulation and bone wax. Extracardiac exploration uncovered global heart enlargement, most prominent in the LV. The heart showed diminished contractile strength. The aorta and the main pulmonary artery (PA) were dissected from the supravalvular region. Some tissues were preserved for posterior suturing, whereas most diseased right atrium, left atrium(LA), right ventricle, and LV were excised. Resection revealed a greyish-white mucoid mass. The donor and residual recipient LA tissues were sutured using double continuous 3/0 Prolene threads. The anastomosis was meticulously inspected multiple times, and no significant bleeding was observed. Similarly, end-to-end anastomosis of the donor ascending aorta and recipient PA was performed using continuous 5/0 Prolene sutures, and careful inspection revealed no bleeding.\n\nFurthermore, the donor’s LA and recipient’s PA were securely closed using double continuous 5/0 Prolene sutures. The inferior vena cava tissues of both the donor and recipient were similarly sutured with 5/0 Prolene sutures, and several inspections were performed to confirm no significant bleeding was present. The left side of the heart was then deflated, and as rewarming commenced, oxygenation was restored, the ascending aorta was unclamped, and the heart spontaneously returned to sinus rhythm. Continuous suturing with 5/0 Prolene was applied to both the donor and recipient’s superior vena cava and diligently inspected to ensure the absence of significant bleeding. After the successful discontinuation of assisted circulation, the venous cavity was decannulated. Tissue samples from the patient’s left heart and gray matter were collected for histopathological examination, and the diagnosis of DCM and cardiac myxoma were confirmed.\n\n\nPostoperative management\n\nOn the first day after heart transplantation, the patient produced 1200 ml of urine. Laboratory tests revealed a hypersensitive troponin T level of 796.70ng/L and an NT-proBNP level of 10798pg/ml. The complete blood count showed white blood cells at 17.15 × 109/L, with no significant abnormalities in other test results. The echocardiograph displayed an LVEF of 65%, FS of 35%, normal ventricular wall thickness and echogenicity, and no discernible abnormalities in valve morphology and structure. After heart transplantation, Methylprednisolone Sodium Succinate (0.25 g)intravenous hormone therapy was administered to enhance immunity, and Cefoperazone and Sulbactam Sodium (2 g) intravenous anti-infection treatment was provided. The patient was given a nutrient solution and liver and tiopronin on the first day post-surgery. On postoperative day three, Methylprednisolone Sodium Succinate was replaced with oral Prednisone Acetate (25 mg). Mycophenolate Mofetil capsules (0.5 g) were administered orally to minimize heart rejection, and (50 mg) of Carpofungin Acetate was administered intravenously to prevent fungal infections. The patient’s urine output was 2000 ml, with hypersensitive troponin T levels of 390ng/L, NT-proBNP levels of 7877pg/ml, and a leukocyte count of 12.15 × 109/L. On the 7th day post-surgery, tacrolimus capsules were introduced at an oral dose of (1 mg) to minimize the patient’s rejection of the donor heart, with careful monitoring of blood concentrations. Subsequently, the oral dosage of Prednisone Acetate was gradually decreased to (10 mg) while adjusting the tacrolimus blood concentration to 10.90ng/ml. The patient’s recovery improved. On October 20, 2023, follow-up echocardiography (Fig. 6) indicated no abnormalities, with troponin levels of 85 ng/L, NT-proBNP of 210pg/ml, and all other test results within normal ranges. The patient exhibited excellent postoperative recovery and was discharged. Regular follow-up visits to our department after discharge showed that the patient remains in good condition.",
+    "summary": "Herein, we report a case of heart failure due to Carney syndrome that resulted in cardiac myxoma combined with dilated cardiomyopathy. A 35-year-old male was admitted to the hospital three years ago because of sudden chest tightness and shortness of breath. Echocardiography indicated myxoma, and a combination of genetic screening and physical examination confirmed Carney syndrome with cardiac myxoma. Following symptomatic management, he was discharged. Surgical interventions were not considered at the time. However, the patient’s chest tightness and shortness of breath symptoms worsened, and he returned to the hospital. A New York Heart Association grade IV heart function was confirmed, and echocardiography indicated the presence of dilated cardiomyopathy accompanied by cardiac myxoma. Ultimately, the patient’s heart failure was successfully treated with heart transplantation.",
+    "translated_fulltext": "একজন ৩৮ বছর বয়সী পুরুষ রোগী বুকে tightness এবং শ্বাসকষ্ট নিয়ে হাসপাতালে আসেন। তিন বছর আগে, তিনি একই ধরনের উপসর্গ অনুভব করেছিলেন এবং আমাদের হাসপাতালে চিকিৎসা নিয়েছিলেন। বহির্বিভাগে করা ইকোকার্ডিওগ্রাফিতে বাম হৃদপিণ্ডে একটি মিক্সোমার মতো কিছু ধরা পড়ে, যার কারণে আরও মূল্যায়নের জন্য তাকে হাসপাতালে ভর্তি করা হয়। শারীরিক পরীক্ষায় দেখা যায় রোগীর কানের চামড়ায় ছোট ছোট বাদামী ও কালো রঙের দাগ রয়েছে। পেটের সিটি স্ক্যানে একাধিক লিভার এবং বাম কিডনিতে ছোট সিস্ট দেখা যায়। জেনেটিক পরীক্ষায় TTN এবং PRKAR1A জিনে মিউটেশন ধরা পড়ে। ক্লিনিক্যাল পরীক্ষা, ইমেজিং এবং জেনেটিক পরীক্ষার মাধ্যমে সিএনসি-এর রোগ নির্ণয় নিশ্চিত করা হয়। উপসর্গভিত্তিক চিকিৎসার পর রোগীর অবস্থার উন্নতি হয়; তবে, তিনি অস্ত্রোপচারের জন্য রাজি হননি। ২০ সেপ্টেম্বর, ২০২৩ তারিখে, রোগী বুকে তীব্র tightness এবং শ্বাসকষ্ট নিয়ে আমাদের হাসপাতালে আসেন। তিনি শুয়ে থাকতে অসুবিধা বোধ করছিলেন এবং শ্বাস নেওয়ার জন্য সোজা হয়ে বসতে হচ্ছিল। শারীরিক পরীক্ষায় দেখা যায় jugular vein-এ চাপ, হৃদপিণ্ডের অবস্থান বাম দিকে এবং নিচের দিকে সরে গেছে, হৃদস্পন্দন স্বাভাবিক নেই এবং mitral valve-এ 2/6–3/6 তীব্রতার একটি murmur শোনা যাচ্ছিল, যা বাম sternal margin-এর চতুর্থ intercostal space-এ শোনা যায়। উভয় ফুসফুসের মাঝের এবং নিচের অংশে ভেজা শব্দ শোনা যাচ্ছিল। Palpation-এ দেখা যায় লিভারটি xiphoid process-এর নিচে তিনটি আঙুল এবং পাঁজর খাঁচার নিচে দুটি আঙুল পর্যন্ত বিস্তৃত, সেই সাথে উভয় পায়ে সামান্য pitting edema রয়েছে। ইকোকার্ডিওগ্রাফিক ছবিতে হৃদপিণ্ডের আকার বৃদ্ধি, aortic sinus এবং pulmonary artery-এর প্রসারণ, mitral valve-এর সামান্য থেকে মাঝারি regurgitation এবং বাম chamber-এ 54 মিমি × 43 মিমি আকারের একটি irregular echoic mass দেখা যায়, যা atrial septum-এর সাথে যুক্ত। বাম নিলয়ের (LV) ejection fraction (EF) ছিল 23.1%, এবং fractional shortening (FS) ছিল 10.9%। ইলেক্ট্রোকার্ডিওগ্রাফিতে atrial fibrillation (গড় ventricular rate, 150 beats/min) এবং V1-V3 lead-এ অস্বাভাবিক Q wave দেখা যায়। রোগীর ইতিহাস অনুযায়ী, রোগ নির্ণয়ে DCM এবং cardiac myxoma-সহ CNC অন্তর্ভুক্ত ছিল। শেষ পর্যায়ের হার্ট ফেইলিউর এবং একই সাথে cardiac myxoma থাকার কারণে, রোগীকে হাসপাতালে ভর্তি করা হয় এবং উভয় অবস্থার একই সাথে সমাধানের জন্য হার্ট ট্রান্সপ্লান্ট একটি কার্যকর চিকিৎসা বিকল্প হিসেবে বিবেচিত হয়। ১ অক্টোবর, ২০২৪ তারিখে, একটি উপযুক্ত donor heart পাওয়া যায় এবং দ্রুত ট্রান্সপ্লান্টের ব্যবস্থা করা হয়।\n\nসার্জিক্যাল পদ্ধতি\n\nএকটি median sternotomy-এর মাধ্যমে ত্বক এবং subcutaneous টিস্যু সাবধানে layer-by-layer কেটে খোলা হয়। sternum-টি লম্বালম্বিভাবে কাটা হয় এবং electrocoagulation এবং bone wax ব্যবহার করে রক্তপাত নিয়ন্ত্রণ করা হয়। হৃদপিণ্ডের বাইরের অংশ পরীক্ষা করে দেখা যায় হৃদপিণ্ডের আকার বৃদ্ধি পেয়েছে, বিশেষ করে LV-তে। হৃদপিণ্ডের সংকোচন ক্ষমতা কমে গেছে। aorta এবং প্রধান pulmonary artery (PA)-কে supravalvular অঞ্চল থেকে আলাদা করা হয়। কিছু টিস্যু পরবর্তী সেলাইয়ের জন্য সংরক্ষণ করা হয়, যেখানে বেশিরভাগ রোগাক্রান্ত ডান atrium, বাম atrium (LA), ডান ventricle এবং LV কেটে বাদ দেওয়া হয়। Resection-এর পর একটি ধূসর-সাদা mucoid mass দেখা যায়। donor এবং অবশিষ্ট recipient LA টিস্যু 3/0 Prolene thread দিয়ে double continuous সেলাই করে জোড়া লাগানো হয়। anastomosis-টি একাধিকবার মনোযোগ সহকারে পরীক্ষা করা হয় এবং উল্লেখযোগ্য রক্তপাত দেখা যায়নি। একইভাবে, donor ascending aorta এবং recipient PA-এর end-to-end anastomosis continuous 5/0 Prolene sutures ব্যবহার করে করা হয় এবং সতর্কভাবে পরীক্ষা করে দেখা যায় যে কোনো রক্তপাত হয়নি।\n\nএছাড়াও, donor-এর LA এবং recipient-এর PA double continuous 5/0 Prolene sutures ব্যবহার করে নিরাপদে বন্ধ করা হয়। donor এবং recipient উভয়ের inferior vena cava টিস্যু 5/0 Prolene sutures দিয়ে সেলাই করা হয় এবং উল্লেখযোগ্য রক্তপাত নেই তা নিশ্চিত করার জন্য বেশ কয়েকবার পরীক্ষা করা হয়। এরপর হৃদপিণ্ডের বাম দিকটি চুপসে দেওয়া হয় এবং পুনরায় গরম করার প্রক্রিয়া শুরু হলে, অক্সিজেন সরবরাহ পুনরুদ্ধার করা হয়, ascending aorta-র clamp খুলে দেওয়া হয় এবং হৃদপিণ্ড স্বাভাবিক sinus rhythm-এ ফিরে আসে। donor এবং recipient উভয়ের superior vena cava-তে 5/0 Prolene দিয়ে continuous সেলাই করা হয় এবং উল্লেখযোগ্য রক্তপাত নেই তা নিশ্চিত করার জন্য মনোযোগ সহকারে পরীক্ষা করা হয়। সফলভাবে assisted circulation বন্ধ করার পর, venous cavity থেকে cannula সরিয়ে নেওয়া হয়। রোগীর বাম হৃদপিণ্ড এবং gray matter থেকে টিস্যুর নমুনা সংগ্রহ করে histopathological পরীক্ষার জন্য পাঠানো হয় এবং DCM এবং cardiac myxoma-এর রোগ নির্ণয় নিশ্চিত করা হয়।\n\nপোস্টঅপারেটিভ পরিচর্যা\n\nহার্ট ট্রান্সপ্লান্টের পর প্রথম দিনে, রোগীর 1200 মিলি প্রস্রাব হয়। ল্যাবরেটরি পরীক্ষায় hypersensitive troponin T-এর মাত্রা 796.70ng/L এবং NT-proBNP-এর মাত্রা 10798pg/ml পাওয়া যায়। সম্পূর্ণ রক্ত গণনায় শ্বেত রক্তকণিকার সংখ্যা 17.15 × 109/L ছিল, অন্যান্য পরীক্ষার ফলাফলে উল্লেখযোগ্য কোনো অস্বাভাবিকতা ছিল না। ইকোকার্ডিওগ্রাফে LVEF 65%, FS 35%, ventricular wall-এর স্বাভাবিক পুরুত্ব এবং echogenicity দেখা যায় এবং valve-এর গঠন ও কাঠামোতে কোনো দৃশ্যমান অস্বাভাবিকতা ছিল না। হার্ট ট্রান্সপ্লান্টের পর, রোগ প্রতিরোধ ক্ষমতা বাড়ানোর জন্য Methylprednisolone Sodium Succinate (0.25 g) intravenous hormone therapy এবং Cefoperazone এবং Sulbactam Sodium (2 g) intravenous anti-infection treatment দেওয়া হয়। রোগীকে একটি nutrient solution এবং লিভার ও tiopronin দেওয়া হয়। পোস্টঅপারেটিভ তৃতীয় দিনে, Methylprednisolone Sodium Succinate-এর পরিবর্তে ওরাল Prednisone Acetate (25 mg) দেওয়া হয়। হৃদপিণ্ডের প্রত্যাখ্যান কমানোর জন্য Mycophenolate Mofetil capsules (0.5 g) মুখে খাওয়ানো হয় এবং ছত্রাক সংক্রমণ প্রতিরোধের জন্য (50 mg) Carpofungin Acetate intravenously দেওয়া হয়। রোগীর 2000 মিলি প্রস্রাব হয়, hypersensitive troponin T-এর মাত্রা 390ng/L, NT-proBNP-এর মাত্রা 7877pg/ml এবং শ্বেত রক্তকণিকার সংখ্যা 12.15 × 109/L ছিল। অস্ত্রোপচারের সপ্তম দিনে, tacrolimus capsules (1 mg) ওরাল ডোজে দেওয়া শুরু হয়, যাতে donor heart-এর প্রতি রোগীর প্রত্যাখ্যান কমানো যায় এবং রক্তের ঘনত্ব নিয়মিত পর্যবেক্ষণ করা হয়। এরপর, Prednisone Acetate-এর ওরাল ডোজ ধীরে ধীরে কমিয়ে (10 mg) করা হয় এবং tacrolimus-এর রক্তের ঘনত্ব 10.90ng/ml-এ রাখা হয়। রোগীর অবস্থার উন্নতি হয়। ২০ অক্টোবর, ২০২৩ তারিখে, ফলো-আপ ইকোকার্ডিওগ্রাফিতে (Fig. 6) কোনো অস্বাভাবিকতা দেখা যায়নি, troponin-এর মাত্রা ছিল 85 ng/L, NT-proBNP ছিল 210pg/ml এবং অন্যান্য পরীক্ষার ফলাফল স্বাভাবিক সীমার মধ্যে ছিল। রোগীর postoperative recovery খুব ভালো ছিল এবং তাকে হাসপাতাল থেকে ছেড়ে দেওয়া হয়। হাসপাতাল থেকে discharge-এর পর আমাদের বিভাগে নিয়মিত ফলো-আপ ভিজিটগুলোতে দেখা যায় যে রোগীর অবস্থা স্থিতিশীল রয়েছে।",
+    "translated_summary": "এখানে, আমরা কার্নি সিনড্রোমের কারণে হওয়া হৃদরোগের একটি ঘটনা তুলে ধরছি, যার ফলে হৃদপিণ্ডে মিক্সোমা এবং ডাইলেটেড কার্ডিওমায়োপ্যাথি দেখা দেয়। ৩৫ বছর বয়সী একজন পুরুষকে তিন বছর আগে হঠাৎ বুকে tightness এবং শ্বাসকষ্টের কারণে হাসপাতালে ভর্তি করা হয়েছিল। ইকোকার্ডিওগ্রাফিতে মিক্সোমা ধরা পড়ে এবং জেনেটিক স্ক্রিনিং এবং শারীরিক পরীক্ষার মাধ্যমে কার্নি সিনড্রোম এবং হৃদপিণ্ডে মিক্সোমার উপস্থিতি নিশ্চিত করা হয়। এরপর উপসর্গ অনুযায়ী চিকিৎসা করার পর তাকে হাসপাতাল থেকে ছুটি দেওয়া হয়। সেই সময় অস্ত্রোপচারের প্রয়োজন মনে করা হয়নি। তবে, রোগীর বুকে tightness এবং শ্বাসকষ্টের উপসর্গ আরও খারাপ হতে শুরু করে এবং তিনি আবার হাসপাতালে ফিরে আসেন। নিউ ইয়র্ক হার্ট অ্যাসোসিয়েশনের গ্রেড IV অনুযায়ী তার হৃদপিণ্ডের কার্যকারিতা দুর্বল ছিল এবং ইকোকার্ডিওগ্রাফিতে ডাইলেটেড কার্ডিওমায়োপ্যাথির পাশাপাশি হৃদপিণ্ডে মিক্সোমার উপস্থিতি দেখা যায়। অবশেষে, হৃদরোগ প্রতিস্থাপনের মাধ্যমে রোগীর হৃদরোগ সফলভাবে নিরাময় করা হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_324.txt",
+    "fulltext": "2 years 6 months old female pre-schooler with a previous diagnosis of NF1. She consulted due to a 4 week diarrhea with blood streaks (5 to 10 episodes a day). A week after the onset of the diarrhea she consulted the emergency department, where rotavirus (+) was detected, with low inflammatory parameters, negative coproculture and normal abdominal ultrasound. She was hospitalized for 3 days to manage dehydration and was discharged without bleeding, with persistence of semi-liquid stools. 10 days after discharge she presented diarrhea with blood streaks, associated with low intake and weight loss of 1 kg reported by parents. They consulted a pediatric gastroenterologist who requested a polymerase chain reaction (PCR) panel of gastrointestinal pathogens and PCR of Clostridium difficile (which were negative) and indicated hospitalization for study.\n\nOn direct questioning, the parents reported no fever, abdominal pain, vomiting, respiratory or urinary symptoms, arthralgia, or new skin lesions. They did not own pets, and there was no history of travel or recent dietary changes.\n\nThe patient was diagnosed with confirmed NF1 at 8 months of age by genetic testing with the heterozygous pathogenic variant c.5606_5627del (p.Gly1869Valfs*28). She has skin involvement (café con leche spots) and bone involvement. At 18 months she required ankle arthrodesis for tibial curvature. She has no family history of NF1 or inflammatory bowel disease.\n\nOn physical examination, the abdomen was soft and indistinct, with increased air-bubble murmurs, without masses or visceral enlargement. The perianal examination was normal. There were multiple brown-coffee stains on the lower extremities and back. General examinations were performed, including a blood count with moderate microcytic-hypochromic anaemia (Hb 9.6 g/dL), leukocytosis with left shift (leukocytes 13,900), and discretely elevated inflammatory parameters (CRP 1.37 mg/dL, normal value up to 0.5 mg/dL).\n\nA colonoscopy was performed, the rectum, sigmoid and various segments of the colon were examined up to the cecum, visualizing the ileocecal valve and the appendicular orifice. The last few centimeters of the distal ileum were also inspected. The mucosa from the anal margin to the cecum was observed to be erythematous, with loss of vascular transparency, unlike the cecal mucosa, which appeared normal. No lesions were identified in the anal canal or cecum.\n\nBiopsies of the small intestine (ileon) and large intestine were taken. Microscopic examination showed mucosa of ileal type with preserved villous architecture and adequate epithelial differentiation, with a non-inflamed lamina propria. The mucosa of the large intestine had a mild distortion of architecture and adequate epithelial differentiation, a swollen lamina propria with a mild mixed inflammatory infiltrate and hyperplasia of lymphoid follicles. Isolated foci of microabscesses were recognized. The biopsy was consistent with mild colitis, with signs suggesting chronicity.\n\nIn addition, a PCR study for cytomegalovirus (CMV) was requested in a colon biopsy, which was positive.\n\nGiven a positive PCR for CMV, CMV IgG and IgM and CMV viral load in blood were requested, resulting in a positive IgG, negative IgM, and CMV viral load of 79.7 IU/ml. Further laboratory studies included PCR for gastrointestinal pathogens and PCR for Clostridium difficile in stool, both of which were negative. In the colon biopsy, Gram stain microbiological studies were requested, which showed +++ leukocytes without bacteria; biopsy culture showed S. gallolyticus/equinus complex in very low amount (interpreted as bacterial flora); acridine orange, Ziehl-Neelsen, Koch culture, and ADV PCR were negative.\n\nEndoscopy and histology suggestive of UC was reported in the context of a patient with moderate symptoms (PUCAI 50) who was started on Mesalazine (70 mg/kg/day three times daily) and a request for a faecal calprotectin was made which was greater than 600 ug/g.\n\nThe immunology team evaluated the patient for suspected immunodeficiency. The parents did not report a history of infections, they reported that they were vaccinated, that they had good weight gain, no family history of immunodeficiencies, auto-immunity or early deaths. A study with lymphocyte subpopulations (normal), immunoglobulins (normal), HIV (negative), memory T lymphocytes (with alterations expected in the context of CMV viremia) and lymphoproliferation test (normal) was requested. In addition, a genetic panel of primary immunodeficiencies (Invitae) was performed, which contains 429 genes, of which 68 make up the panel of monogenic inflammatory intestinal disease. 7 variants of uncertain significance were obtained, none included in the panel of monogenic IBD.\n\nGanciclovir was initiated intravenous for CMV infection and continued for 15 days. The last PCR CMV control prior to discharge reported undetectable load.\n\nThe patient improved during the hospital stay with decreased frequency of stools and increased consistency, no rectal bleeding, no nocturnal stools and no abdominal pain, with PUCAI 0 at discharge.\n\nTwo months later, he presented with a reactivation of IBD with bloody diarrhea (PUCAI 35). A blood count was performed (normal), a panel of gastrointestinal pathogens was performed (–), PCR for Clostridium difficile was performed (+), and CMV load was undetectable. He was treated with oral metronidazole. However, he persisted with diarrhea with blood streaks, so he was hospitalized again.\n\nA colonoscopy was performed, where erythematous mucous was observed in a diffuse form from the rectum to the cecum, with nodularity and loss of vascular transparency in the submucosa, greater in the left and transverse colon segments. No focal lesions were observed. The mucosa of the ileum and anal canal were observed without lesions.\n\nBiopsy of the terminal ileum, right colon and left colon was performed. Microscopic examination of the ileal-type mucosa showed preserved villous architecture and adequate epithelial differentiation. The lamina propria showed no signs of inflammation. There were no aphthous erosions or granulomas. The mucosa of the large intestine showed mild distortion of architecture and epithelial dedifferentiation. The lamina propria was expanded by mixed inflammatory infiltrate, transmucosal distribution. Foci of cryptitis and cryptitic microabscesses and hyperplasia of reactive lymphoid follicles were recognized. No granulomas, viral or parasitic cytopathic changes were observed. All fragments of the left colon sample presented a similar histopathological picture.\n\nShe was given oral treatment with Vancomycin and Prednisone (1 mg/kg/day) with a good response and a favorable evolution. She was discharged with a decrease in the frequency of bowel movements. She persists with mild symptoms (PUCAI 5) in outpatient control, so the dose of corticosteroids is progressively decreased and she remains on treatment with Mesalazina.\n",
+    "summary": "2.5-year-old pre-schooler with a history of NF1 presenting with bloody diarrhea. On endoscopic examination, the mucosa from the anal margin to the cecum was erythematous with loss of vascular transparency. Colon mucosal biopsies showed signs of chronic inflammation consistent with a diagnosis of ulcerative colitis and CMV infection was diagnosed by PCR.\n",
+    "translated_fulltext": "২ বছর ৬ মাস বয়সী এক প্রাক্‌-বিদ্যালয় বয়সী কন্যাশিশু, যার পূর্বে NF1 (Neurofibromatosis type 1) নির্ণয় ছিল। তিনি ৪ সপ্তাহ ধরে রক্তের দাগযুক্ত ডায়রিয়ার (প্রতিদিন ৫–১০ বার) কারণে পরামর্শ নেন। ডায়রিয়া শুরুর এক সপ্তাহ পর তিনি জরুরি বিভাগে যান, যেখানে রোটাভাইরাস পজিটিভ পাওয়া যায়, প্রদাহজনক সূচক কম ছিল, কপ্রোকালচার নেগেটিভ ছিল এবং পেটের আল্ট্রাসাউন্ড স্বাভাবিক ছিল। ডিহাইড্রেশন ব্যবস্থাপনার জন্য তাকে ৩ দিন হাসপাতালে ভর্তি রাখা হয় এবং রক্তপাত ছাড়াই ছেড়ে দেওয়া হয়, যদিও আধা-তরল মল চলমান ছিল।\n\nডিসচার্জের ১০ দিন পর আবার রক্তের দাগযুক্ত ডায়রিয়া শুরু হয়, যার সঙ্গে খাদ্যগ্রহণ কমে যায় এবং অভিভাবকদের মতে ওজন ১ কেজি কমে যায়। তারা একজন শিশু গ্যাস্ট্রোএন্টারোলজিস্টের কাছে যান, যিনি গ্যাস্ট্রোইনটেস্টাইনাল প্যাথোজেনের জন্য PCR প্যানেল এবং Clostridium difficile-এর PCR পরীক্ষা দেন (দুটিই নেগেটিভ আসে) এবং পরবর্তী পরীক্ষার জন্য হাসপাতালে ভর্তি করার পরামর্শ দেন।\n\nসরাসরি জিজ্ঞাসাবাদে অভিভাবকরা জানান যে জ্বর, পেটব্যথা, বমি, শ্বাসতন্ত্র বা মূত্রতন্ত্রের উপসর্গ, আর্থ্রালজিয়া বা নতুন ত্বকের ক্ষত নেই। তাদের কোনো পোষা প্রাণী নেই এবং সাম্প্রতিক ভ্রমণ বা খাদ্যাভ্যাসে পরিবর্তনের ইতিহাস নেই।\n\nরোগীর NF1 নিশ্চিতভাবে ৮ মাস বয়সে জেনেটিক পরীক্ষার মাধ্যমে নির্ণয় করা হয়, যেখানে হেটেরোজাইগাস প্যাথোজেনিক ভ্যারিয়েন্ট c.5606_5627del (p.Gly1869Valfs*28) পাওয়া যায়। তার ত্বকে ক্যাফে-অ-লে দাগ এবং হাড়ের জড়িততা ছিল। ১৮ মাস বয়সে টিবিয়ার বক্রতার কারণে অ্যাঙ্কল আর্থ্রোডেসিস করতে হয়। তার পরিবারে NF1 বা ইনফ্ল্যামেটরি বাওয়েল ডিজিজের কোনো ইতিহাস নেই।\n\nশারীরিক পরীক্ষায় পেট নরম ও অস্পষ্ট ছিল, বায়ু-বুদবুদ শব্দ বৃদ্ধি পেয়েছিল, কোনো ম্যাস বা অঙ্গবৃদ্ধি ছিল না। পেরিয়ানাল পরীক্ষা স্বাভাবিক ছিল। নিচের অঙ্গ ও পিঠে একাধিক বাদামি-কফি রঙের দাগ ছিল। সাধারণ পরীক্ষায় দেখা যায় মাঝারি মাত্রার মাইক্রোসাইটিক-হাইপোক্রোমিক অ্যানিমিয়া (Hb 9.6 g/dL), লেফট শিফটসহ লিউকোসাইটোসিস (লিউকোসাইট ১৩,৯০০), এবং সামান্য বাড়তি প্রদাহজনক সূচক (CRP 1.37 mg/dL; স্বাভাবিক ≤ 0.5 mg/dL)।\n\nএকটি কোলোনোস্কপি করা হয়। রেকটাম, সিগময়েড ও কোলনের বিভিন্ন অংশ সেকাম পর্যন্ত পরীক্ষা করা হয়; ইলিওসেকাল ভালভ ও অ্যাপেন্ডিকুলার অরিফিস দেখা যায়। ডিস্টাল ইলিয়ামের শেষ কয়েক সেন্টিমিটারও পরিদর্শন করা হয়। অ্যানাল মার্জিন থেকে সেকাম পর্যন্ত মিউকোসা লালচে ও ভাসকুলার স্বচ্ছতা হারানো অবস্থায় দেখা যায়, তবে সেকামের মিউকোসা স্বাভাবিক ছিল। অ্যানাল ক্যানাল বা সেকামে কোনো ক্ষত পাওয়া যায়নি।\n\nক্ষুদ্রান্ত্র (ইলিয়াম) ও বৃহদান্ত্র থেকে বায়োপসি নেওয়া হয়। মাইক্রোস্কোপিক পরীক্ষায় ইলিয়াল টাইপ মিউকোসায় ভিলাস আর্কিটেকচার সংরক্ষিত ছিল এবং এপিথেলিয়াল ডিফারেনসিয়েশন স্বাভাবিক ছিল, ল্যামিনা প্রোপ্রিয়া অপ্রদাহিত ছিল। বৃহদান্ত্রের মিউকোসায় আর্কিটেকচারের হালকা বিকৃতি, উপযুক্ত এপিথেলিয়াল ডিফারেনসিয়েশন, ফোলা ল্যামিনা প্রোপ্রিয়া, হালকা মিশ্র প্রদাহজনক ইনফিলট্রেট এবং লিম্ফয়েড ফলিকলের হাইপারপ্লাসিয়া দেখা যায়। বিচ্ছিন্ন মাইক্রোঅ্যাবসেসের ফোকাস শনাক্ত হয়। এই বায়োপসি মৃদু কোলাইটিস, দীর্ঘস্থায়ীতার ইঙ্গিতসহ, এর সঙ্গে সামঞ্জস্যপূর্ণ।\n\nঅতিরিক্তভাবে, কোলন বায়োপসিতে CMV (Cytomegalovirus)-এর জন্য PCR পরীক্ষা করা হয়, যা পজিটিভ আসে। পরবর্তীতে CMV IgG, IgM এবং রক্তে CMV ভাইরাল লোড পরীক্ষা করা হয়—IgG পজিটিভ, IgM নেগেটিভ এবং ভাইরাল লোড ছিল 79.7 IU/ml। অন্যান্য পরীক্ষায় মলের গ্যাস্ট্রোইনটেস্টাইনাল প্যাথোজেন PCR ও Clostridium difficile PCR নেগেটিভ ছিল। কোলন বায়োপসিতে গ্রাম স্টেইনে +++ লিউকোসাইট দেখা যায় কিন্তু ব্যাকটেরিয়া নেই; কালচারে খুব অল্প মাত্রায় S. gallolyticus/equinus complex পাওয়া যায়, যা স্বাভাবিক ব্যাকটেরিয়াল ফ্লোরা হিসেবে ব্যাখ্যা করা হয়। অ্যাক্রিডিন অরেঞ্জ, জিহ্‌ল-নিলসেন, কখ কালচার এবং ADV PCR নেগেটিভ ছিল।\n\nএন্ডোস্কপি ও হিস্টোলজি আলসারেটিভ কোলাইটিস (UC)-এর ইঙ্গিত দেয়; মাঝারি উপসর্গযুক্ত (PUCAI 50) রোগী হিসেবে তাকে Mesalazine (70 mg/kg/day, দিনে তিনবার) শুরু করা হয়। ফিকাল ক্যালপ্রোটেক্টিন >600 µg/g পাওয়া যায়।\n\nইমিউনোলজি টিম সন্দেহভাজন ইমিউনোডেফিসিয়েন্সির জন্য রোগীকে মূল্যায়ন করে। সংক্রমণের উল্লেখযোগ্য ইতিহাস নেই, টিকাদান সম্পূর্ণ, ওজন বৃদ্ধি ভালো, পরিবারে ইমিউনোডেফিসিয়েন্সি, অটোইমিউনিটি বা অকালমৃত্যুর ইতিহাস নেই। লিম্ফোসাইট সাবপপুলেশন (স্বাভাবিক), ইমিউনোগ্লোবুলিন (স্বাভাবিক), HIV (নেগেটিভ), মেমরি T লিম্ফোসাইট (CMV ভিরেমিয়ার প্রেক্ষিতে প্রত্যাশিত পরিবর্তনসহ) এবং লিম্ফোপ্রোলিফারেশন টেস্ট (স্বাভাবিক) করা হয়। এছাড়া Invitae প্রাইমারি ইমিউনোডেফিসিয়েন্সি জেনেটিক প্যানেল (৪২৯ জিন; এর মধ্যে ৬৮টি মনোজেনিক IBD প্যানেলে) করা হয়। ৭টি ভ্যারিয়েন্ট অব আনসার্টেন সিগনিফিক্যান্স পাওয়া যায়, তবে কোনোটি মনোজেনিক IBD প্যানেলে অন্তর্ভুক্ত নয়।\n\nCMV সংক্রমণের জন্য ১৫ দিন ইনট্রাভেনাস গ্যানসাইক্লোভির দেওয়া হয়। ডিসচার্জের আগে শেষ CMV PCR-এ ভাইরাল লোড অনির্ধারিত (undetectable) ছিল।\n\nহাসপাতালে থাকার সময় রোগীর উন্নতি হয়—মলের সংখ্যা কমে, ঘনত্ব বাড়ে, রেকটাল ব্লিডিং, নকটার্নাল স্টুল ও পেটব্যথা থাকে না; ডিসচার্জে PUCAI ছিল 0।\n\nদুই মাস পরে IBD পুনরায় সক্রিয় হয়ে রক্তযুক্ত ডায়রিয়া দেখা দেয় (PUCAI 35)। রক্তপরীক্ষা স্বাভাবিক ছিল; গ্যাস্ট্রোইনটেস্টাইনাল প্যাথোজেন প্যানেল নেগেটিভ; Clostridium difficile PCR পজিটিভ; CMV লোড অনির্ধারিত ছিল। তাকে মুখে মেট্রোনিডাজল দেওয়া হয়। তবুও রক্তের দাগসহ ডায়রিয়া চলতে থাকায় তাকে আবার হাসপাতালে ভর্তি করা হয়।\n\nপুনরায় কোলোনোস্কপি করা হয়, যেখানে রেকটাম থেকে সেকাম পর্যন্ত বিস্তৃতভাবে লালচে মিউকোসা, নডুলারিটি ও সাবমিউকোসায় ভাসকুলার স্বচ্ছতার হ্রাস দেখা যায়—বিশেষ করে বাম ও ট্রান্সভার্স কোলনে বেশি। কোনো ফোকাল ক্ষত দেখা যায়নি। ইলিয়াম ও অ্যানাল ক্যানালের মিউকোসা স্বাভাবিক ছিল।\n\nটার্মিনাল ইলিয়াম, ডান কোলন ও বাম কোলন থেকে বায়োপসি নেওয়া হয়। ইলিয়াল মিউকোসায় ভিলাস আর্কিটেকচার ও এপিথেলিয়াল ডিফারেনসিয়েশন সংরক্ষিত ছিল; ল্যামিনা প্রোপ্রিয়ায় প্রদাহের চিহ্ন ছিল না; কোনো অ্যাফথাস ইরোশন বা গ্রানুলোমা ছিল না। বৃহদান্ত্রের মিউকোসায় হালকা আর্কিটেকচারাল বিকৃতি ও এপিথেলিয়াল ডিডিফারেনসিয়েশন ছিল। ল্যামিনা প্রোপ্রিয়া মিশ্র প্রদাহজনক ইনফিলট্রেটে প্রসারিত ছিল, ট্রান্সমিউকোসাল বিতরণসহ। ক্রিপ্টাইটিস, ক্রিপ্টিটিক মাইক্রোঅ্যাবসেস এবং রিঅ্যাকটিভ লিম্ফয়েড ফলিকলের হাইপারপ্লাসিয়া দেখা যায়। কোনো গ্রানুলোমা বা ভাইরাল/পরজীবী সাইটোপ্যাথিক পরিবর্তন ছিল না। বাম কোলনের সব নমুনায় একই হিস্টোপ্যাথোলজিক চিত্র দেখা যায়।\n\nতাকে মুখে ভ্যানকোমাইসিন ও প্রেডনিসোন (1 mg/kg/day) দেওয়া হয়, ভালো সাড়া পাওয়া যায় এবং রোগের অগ্রগতি অনুকূল হয়। মলের সংখ্যা কমে যাওয়ার পর তাকে ডিসচার্জ করা হয়। বহির্বিভাগীয় ফলো-আপে তার হালকা উপসর্গ (PUCAI 5) বজায় থাকায় কর্টিকোস্টেরয়েড ধীরে ধীরে কমানো হয় এবং তিনি মেসালাজিন চালিয়ে যাচ্ছেন।",
+    "translated_summary": "২.৫ বছর বয়সী একটি প্রিস্কুলার শিশু, যার আগে থেকে নিউরোফাইব্রোমাটোসিস টাইপ ১ (NF1)-এর ইতিহাস রয়েছে, সে রক্তমিশ্রিত ডায়রিয়া নিয়ে এসেছে। এন্ডোস্কোপিক পরীক্ষায় দেখা যায়, পায়ুপথ থেকে শুরু করে সিকামে পৌঁছানো পর্যন্ত মিউকোসা লালচে হয়ে গেছে এবং এর রক্তনালীগুলো আর স্পষ্টভাবে দেখা যাচ্ছে না। কোলন মিউকোসাল বায়োপসিতে দীর্ঘস্থায়ী প্রদাহের লক্ষণ দেখা যায়, যা আলসারেটিভ কোলাইটিসের সাথে সঙ্গতিপূর্ণ। পিসিআর (PCR) পরীক্ষার মাধ্যমে সাইটোমেগালোভাইরাস (CMV) সংক্রমণেরও নির্ণয় করা হয়েছে।"
+  },
+  {
+    "id": "multiclinsum_gs_en_459.txt",
+    "fulltext": "40-year-old HIV-positive man with regular adherence to treatment (viral load 4500/mm3 and CD4 70/mm3 from the previous year), consulted for intermittent fever of two years' evolution that did not respect the standard time and gave way to transient antinflammatory non-steroidal drugs. He added in the last two months diffuse abdominal pain with predominance in the upper right lobe where he acquired a configuration of a tree in bud and bilateral pleural effusion, and at the abdominal level, marked increase of hepato-splenomegaly associated with ascites. After 48 hours of his suspension, he presented fulminant hepatic failure and was transferred to the intensive care unit. Tracheal aspirate was performed and after transfusion support a liver biopsy was obtained by puncture.  The patient died a few hours later. The postmortem culture of the tracheal aspirate was positive for Mycobacterium tuberculosis and the liver biopsy was performed with non-necrotizing granulomas and the rest of the parenchyma preserved. This work was carried out in accordance with the principles laid out in the ethical code of the WHO (Helsinki Declaration).\n",
+    "summary": "We present the case of a 40-year-old HIV-positive man with regular adherence to treatment, who consulted for intermittent febrile episodes of two years' evolution, adding in the last two months progressive diffuse abdominal pain and generalized adenomegaly. In the laboratory, he presented pancytopenia, coagulopathy, hypoalbuminemia and increased acute phase reactants. The computed tomography (CT) of the thorax, abdomen and pelvis only showed hepato-splenomegaly and generalized adenomegaly. Multiple microbiological examinations were performed, including cultures for Mycobacterium sp. of different samples, all with negative results, with the exception of RT-PCR for HHV-8. A left iliac ganglion biopsy was performed with findings consistent with Castleman's disease. Despite restarting antiretroviral therapy, the symptomatology progressed, initiating treatment with corticosteroids and ganciclovir. After a week, he developed multiple organ failure and anasarca, which contraindicated the drugs initiated. A new chest CT was performed that showed infiltrates with a tree-like pattern in the upper right lobe associated with bilateral pleural effusion, and at the abdominal level, progression of hepato-splenomegaly and ascites. He passed to the intensive care unit 48 hours later due to fulminant hepatic failure. The patient died within a few hours. A postmortem culture of the tracheal aspirate was received positive for Mycobacterium tuberculosis and a liver biopsy with non-necrotizing granulomas.\n",
+    "translated_fulltext": "৪০ বছর বয়সী এইচআইভি পজিটিভ একজন ব্যক্তি, যিনি নিয়মিত চিকিৎসায় আছেন (ভাইরাল লোড ৪৫০০/মিমি³ এবং সিডি৪ ৭০/মিমি³, যা গত বছর থেকে পরিমাপ করা হয়েছে), দুই বছর ধরে মাঝে মাঝে জ্বর হওয়ার কারণে পরামর্শের জন্য এসেছিলেন। এই জ্বরের একটি নির্দিষ্ট সময় ছিল না এবং এর ফলে স্বল্পমেয়াদী প্রদাহরোধী ওষুধে সাময়িকভাবে উপশম পাওয়া যেত। গত দুই মাসে তার পেটে ছড়িয়ে পড়া ব্যথা দেখা যায়, বিশেষ করে পেটের উপরের ডান দিকে, যেখানে কুঁড়ির মতো দেখতে একটি গঠন তৈরি হয়েছিল এবং উভয় ফুসফুসে তরল জমেছিল। পেটের অংশে, যকৃত ও প্লীহার আকার উল্লেখযোগ্যভাবে বৃদ্ধি পায় এবং পেটে জল জমা হয়। ৪৮ ঘণ্টা ওষুধ বন্ধ রাখার পর, তার দ্রুত যকৃতের কার্যকারিতা হ্রাস পায় এবং তাকে নিবিড় পরিচর্যা কেন্দ্রে স্থানান্তর করা হয়। শ্বাসনালীর তরল সংগ্রহ করে পরীক্ষা করা হয় এবং রক্ত সঞ্চালনের পর, একটি সূঁচের মাধ্যমে যকৃতের বায়োপসি করা হয়। কয়েক ঘণ্টা পর রোগীর মৃত্যু হয়। মৃত্যুর পরে শ্বাসনালীর তরল পরীক্ষায় মাইকোব্যাকটেরিয়াম টিউবারকুলোসিসের উপস্থিতি পাওয়া যায় এবং যকৃতের বায়োপসিতে ক্ষয়বিহীন গ্রানুলোমাস দেখা যায়, যেখানে যকৃতের অন্যান্য অংশ অক্ষত ছিল। এই কাজটি বিশ্ব স্বাস্থ্য সংস্থার (ডব্লিউএইচও) নৈতিক বিধি অনুযায়ী করা হয়েছিল (হেলসিঙ্কি ঘোষণা)।",
+    "translated_summary": "আমরা ৪০ বছর বয়সী এইচআইভি-পজিটিভ একজন রোগীর ঘটনা তুলে ধরছি, যিনি নিয়মিত চিকিৎসায় ছিলেন। তিনি মাঝে মাঝে জ্বর অনুভব করতেন, যা প্রায় দুই বছর ধরে চলে আসছিল। সম্প্রতি গত দুই মাসে তার পেটে ধীরে ধীরে ব্যথা বাড়তে থাকে এবং সারা শরীরে লিম্ফ নোডগুলো ফুলে যায়। ল্যাবরেটরিতে দেখা যায়, তার প্যানসাইটোপেনিয়া, কোয়াগুলোপ্যাথি, হাইপোঅ্যালবুমিনেমিয়া এবং অ্যাকিউট ফেজ রিঅ্যাক্টেন্ট-এর মাত্রা বেড়ে গেছে। বুকের সিটি স্ক্যান, পেটের সিটি স্ক্যান এবং পেলভিসের সিটি স্ক্যানে শুধু হেপাটো-স্প্লেনোমেগালি এবং সারা শরীরে লিম্ফ নোড ফুলে যাওয়া দেখা যায়। বিভিন্ন ধরনের নমুনা থেকে মাইকোব্যাকটেরিয়াম স্প.-এর কালচারসহ একাধিক মাইক্রোবায়োলজিক্যাল পরীক্ষা করা হয়, যার ফল নেতিবাচক ছিল, তবে এইচএইচভি-৮-এর আরটি-পিসিআর পরীক্ষায় পজিটিভ ফলাফল পাওয়া যায়। এরপর বাম ইলিয়াক গ্যাংলিয়নের বায়োপসি করা হয়, যেখানে ক্যাসেলম্যান রোগের লক্ষণ দেখা যায়। অ্যান্টিরেট্রোভাইরাল থেরাপি পুনরায় শুরু করার পরেও তার শারীরিক অবস্থার উন্নতি হয়নি, তাই তাকে কর্টিকোস্টেরয়েড এবং গ্যানসিক্লোভির দিয়ে চিকিৎসা শুরু করা হয়। এক সপ্তাহ পর, তার একাধিক অঙ্গের কার্যকারিতা হ্রাস পায় এবং অ্যানাসার্কা দেখা দেয়, যার কারণে পূর্বে শুরু করা ওষুধগুলো ব্যবহার করা সম্ভব হয়নি। এরপর আবার বুকের সিটি স্ক্যান করা হয়, যেখানে দেখা যায় ফুসফুসের উপরের ডান অংশে গাছের মতো দেখতে কিছু ইনফিলট্রেট রয়েছে এবং উভয় পাশে প্লুরাল ইফিউশন হয়েছে। পেটের সিটি স্ক্যানে হেপাটো-স্প্লেনোমেগালি এবং অ্যাসাইটিসের progression দেখা যায়। এরপর তাকে নিবিড় পরিচর্যা কেন্দ্রে (আইসিইউ) স্থানান্তর করা হয় এবং ৪৮ ঘণ্টা পর তার দ্রুত লিভার ফেইলিউর হয়। রোগী কয়েক ঘণ্টার মধ্যেই মারা যান। মৃত্যুর পরে শ্বাসনালীর তরল থেকে নেওয়া নমুনার কালচারে মাইকোব্যাকটেরিয়াম টিউবারকুলোসিসের উপস্থিতি ধরা পড়ে এবং লিভারের বায়োপসিতে নন-নেক্রোটাইজিং গ্রানুলোমাস দেখা যায়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_41.txt",
+    "fulltext": "4-month-old indigenous lactating mother from the rural area of the interior of Panama, from the town of Urracá, 3 hours by canoe from the nearest health center. Her background included being the fourth daughter, born by vaginal delivery at home by a relative, without prenatal controls, her weight, height and Apgar score at birth are unknown. She did not breastfeed and was fed with powdered milk formula with iron for children under 6 months, receiving 3 ounces every 4 hours.\n\nThe nuclear family was composed of 6 people (parents and 4 children) who lived in a house with walls and floor of boards and palm roof, 2 rooms, without electricity, they were illuminated with kerosene lamps, water from a well, excreta in a river and they burned the garbage, their economic income came from subsistence agriculture.\n\nHe had no health care in his first 4 months of life and did not receive the vaccinations included in the national expanded programme of immunizations. According to his parents, his neurodevelopment was normal until his hospitalization.\n\nThe minor consulted in a health center with a history of 4 days of diarrhoea, without mucus or blood associated with vomiting of food content (the mother gave her tea because she could not tolerate milk), afebrile and without respiratory symptoms. Oral fluids and 4 doses of Enterogermina® (B. clausii: two billion spores/5 mL) were administered. Due to the lack of supplies (they did not have catheters, or intraosseous for the administration of intravenous fluids) she was transferred to a second-level hospital in the provincial capital and then to our institution in Panama City with a diagnosis of acute gastroenteritis and severe dehydration.\n\nHe presented to the emergency department with a consciousness compromise, dehydration characterised by a tearless cry, dry oral mucosa. He had oedema of +++ hands, feet, abdomen and face. He was afebrile and had signs of shock, capillary refill time > 2 seconds, cold extremities, filiform pulse and marble skin, heart rate 170 bpm, respiratory rate 55 bpm, blood pressure 91/37 mmHg, oxygen saturation 99%. He weighed 4.7 kg and was 56 cm tall at admission, Z-score height/age -2.52, weight/height and weight/age Z-scores were not quantifiable due to severe dehydration. On segmental examination, there were fine crepitus in both lung bases and erythematous-squamous lesions with desquamation of skin and others with hypopigmentation of trunk and upper limbs (interpreted as pellagroid dermatosis).\n\nLactate Ringer bolus was given at 10 ml/kg in the emergency department, followed by 5% Dextrose in 0.33% Saline 500 ml at an infusion rate of 29 ml/h over 6 hours without KCL until diuresis was obtained. She was started on Ceftriaxone 50 mg/kg/day for suspected sepsis, stabilised and sent to the ward where she continued to receive 500 ml of 5% Dextrose in 0.9% Saline at 20 ml/hr.\n\nAmong the examinations, a blood count revealed leukocytosis at 39.0 x 103/uL, severe anaemia 5.6 g/dL, thrombocytosis 502 x 103/uL, the rest of the results are detailed in. He was transfused with 50 ml of filtered and leuko-reduced red blood cells and 40 cc of fresh frozen plasma due to altered coagulation times. Enteral feeding was initiated by nasogastric tube and infusion was decreased to 15 ml/h of 5% Dextrose in 0.9% Saline 500 cc, and continued with negative water balance.\n\nOn day 2, initial peripheral blood culture was reported as Gram positive cocci in clusters, Oxacillin was added at 200 mg/kg/day, Ceftriaxone was increased to 75-100 mg/kg/day, total fluids to 120 ml/kg/day and calcium was corrected (value received 6.38 mg/dL).\n\nOn her 3rd day she lost venous access, so a central venous catheter (CVC) was placed. She was hypovolemic with subhydrated oral mucosa, increased respiratory work, cold extremities and capillary refill time of 3-4 seconds. Ringer's lactate was given at a load of 20 ml/kg in one hour. Arterial blood gas revealed uncompensated metabolic acidosis with pH 7.26, HCO3 13 mmol/L, PCO2 28.4 mmHg, PO2 39.2 mmHg, lactate 2.8 mmol/L. She was intubated and transferred to the paediatric intensive care unit (PICU) where she was placed on mechanical ventilation.\n\nTotal fluids of 100 cc/kg, infused epinephrine, low-salt albumin, and 10% calcium gluconate were administered, and fentanyl was changed to remifentanil due to elevated liver enzymes.\n\nThe blood culture of admission reported growth of methicillin-resistant Staphylococcus aureus (MRSA), Oxacillin was omitted and Clindamycin was added at 40 mg/kg/day; the blood culture of admission on the second day of admission to the ICU with Gram-negative bacillus smear was positive, and Ceftriaxone was changed to Ceftazidime at 150 mg/kg/day.\n\nOn his first day in the ICU, a substantial increase in serum biomarkers of cardiac damage was documented, the echocardiogram showed mild mitral and tricuspid regurgitation, left ventricular dilatation, left ventricular ejection fraction (LVEF) 58%, no evidence of thrombi, vegetations or pericardial effusion, and he was diagnosed with acute myocarditis. Milrinone was started at 0.4 mcg/kg/min, furosemide and IV immunoglobulin 1 g/kg single dose.\n\nThe second day blood culture the germ was identified as Bacillus clausii, identified by the system (VYTEK 2TM), the susceptibility profile was not performed because the team did not have cut points for this germ, for this reason the antibiotic coverage was adjusted, considering it was not a contaminant, Ceftazidime was changed to Ciprofloxacin at 30 mg/kg/day and Ceftaroline was added at 8 mg/kg every 8 hours along with Clindamycin for MRSA. The 3 subsequent blood cultures with intervals of 48 hours between each were positive in both peripheral blood and CVC for isolation of B. clausii.\n\nOn his 6th day in hospital, the gastrointestinal panel (Maripoc gastro test methodology) performed on the second day detected Clostridiodes difficile toxin A/B, the tests for Campylobacteryeyuni, Norovirus GI, Norovirus GII.4, Adenovirus and Rotavirus were negative. Following these findings, therapy was escalated to IV Vancomycin at a dose of 60 mg/kg/day and metronidazole was added orally. Ceftaroline, clindamycin and ciprofloxacin were omitted, covering both B. clausii and C. difficile and MRSA .\n\nHIV testing, serology for Chagas and SARS-CoV-2 antigen by immunofluorescence (FIA) were negative, immunoglobulins were within normal limits.\n\nOn the seventh day, arterial hypertension was reported and spirinolactone was added to the management.\n\nOn the 8th day, the laboratory tests showed altered coagulation times and increased azotaemia associated with anuria that had lasted for 12 hours. However, due to the patient's condition, a peritoneal catheter was not placed, the vancomycin dose was adjusted and vitamin K was administered. The patient continued to have anuria and anasarca, and she developed sustained hypotension. Noradrenaline was added, but her condition deteriorated with multisystem organ failure and she died twelve days after admission. No autopsy was performed because the mother refused permission for cultural reasons.\n",
+    "summary": "4-month-old lactating infant, indigenous ethnicity, from the rural interior of Panama, 3 hours by canoe from the nearest health subcenter, with protein-caloric malnutrition, who presented with acute diarrhea and moderate-severe dehydration, receiving Enterogermina as part of the initial treatment. She was transferred to a third-level hospital, where she arrived with respiratory distress and signs of shock. The initial blood culture reported growth of methicillin-resistant Staphylococcus aureus (MRSA), the gastrointestinal panel was positive for Clostridiodes difficile, and later growth was confirmed in serial blood cultures of peripheral blood and central venous catheter, of Bacillus clausii. With a torpid evolution and resistance to multiple antibiotic regimens, she died of multisystem organ failure twelve days after admission.\n",
+    "translated_fulltext": "৪ মাস বয়সী আদিবাসী দুগ্ধদানকারী মাতা, পানামার অভ্যন্তরীণ গ্রামীণ এলাকার উর্রাকা (Urracá) শহরের বাসিন্দা, নিকটতম স্বাস্থ্যকেন্দ্র থেকে নৌকায় ৩ ঘণ্টার দূরত্বে অবস্থিত। তার পটভূমিতে অন্তর্ভুক্ত ছিল—তিনি চতুর্থ কন্যা সন্তান, বাড়িতে আত্মীয়ের মাধ্যমে স্বাভাবিক প্রসবের মাধ্যমে জন্মগ্রহণ করেন, কোনো প্রি-নাটাল কন্ট্রোল ছাড়াই; জন্মের সময় তার ওজন, উচ্চতা এবং Apgar স্কোর অজানা। তিনি বুকের দুধ পান করেননি এবং ৬ মাসের কম বয়সী শিশুদের জন্য আয়রনযুক্ত গুঁড়া দুধের ফর্মুলা খাওয়ানো হতো, প্রতি ৪ ঘণ্টা অন্তর ৩ আউন্স করে গ্রহণ করতেন।\n\nনিউক্লিয়ার পরিবারে মোট ৬ জন সদস্য ছিল (মাতা-পিতা ও ৪ সন্তান), যারা কাঠের দেয়াল ও মেঝে এবং খেজুর পাতার ছাউনি দেওয়া একটি বাড়িতে বসবাস করতেন, ২টি কক্ষ ছিল, বিদ্যুৎ ছিল না, কেরোসিন ল্যাম্প দিয়ে আলো জ্বালানো হতো, কূপের পানি ব্যবহার করতেন, নদীতে মলত্যাগ করতেন এবং আবর্জনা পুড়িয়ে ফেলতেন; তাদের অর্থনৈতিক আয় ছিল জীবিকা নির্বাহমূলক কৃষি থেকে।\n\nজীবনের প্রথম ৪ মাসে তিনি কোনো স্বাস্থ্যসেবা পাননি এবং জাতীয় সম্প্রসারিত টিকাদান কর্মসূচির অন্তর্ভুক্ত টিকাগুলো গ্রহণ করেননি। তার পিতামাতার মতে, হাসপাতালে ভর্তি হওয়া পর্যন্ত তার নিউরোডেভেলপমেন্ট স্বাভাবিক ছিল।\n\nঅপ্রাপ্তবয়স্ক রোগী ৪ দিনের ডায়রিয়ার ইতিহাস নিয়ে একটি স্বাস্থ্যকেন্দ্রে আসেন, মিউকাস বা রক্ত ছাড়া, খাদ্যবস্তুর বমির সাথে যুক্ত ছিল (মাতা তাকে চা দিয়েছিলেন কারণ সে দুধ সহ্য করতে পারছিল না), জ্বর ছিল না এবং কোনো শ্বাসপ্রশ্বাসজনিত উপসর্গ ছিল না। মুখে খাওয়ার তরল এবং Enterogermina® (B. clausii: দুই বিলিয়ন স্পোর/৫ mL) এর ৪ ডোজ প্রদান করা হয়। সরঞ্জামের অভাবের কারণে (তাদের কাছে ক্যাথেটার বা ইনট্রাওসিয়াস লাইনের ব্যবস্থা ছিল না শিরায় তরল দেওয়ার জন্য) তাকে প্রাদেশিক রাজধানীর একটি দ্বিতীয় স্তরের হাসপাতালে এবং পরে পানামা সিটির আমাদের প্রতিষ্ঠানে স্থানান্তর করা হয়, তীব্র গ্যাস্ট্রোএন্টেরাইটিস এবং গুরুতর ডিহাইড্রেশনের নির্ণয়সহ।\n\nতিনি জরুরি বিভাগে আসেন চেতনার অবনতি নিয়ে, ডিহাইড্রেশন দ্বারা চিহ্নিত—অশ্রুহীন কান্না, শুষ্ক মুখগহ্বরের মিউকোসা। তার হাত, পা, উদর ও মুখে +++ এডিমা ছিল। তিনি জ্বরবিহীন ছিলেন এবং শকের লক্ষণ ছিল—ক্যাপিলারি রিফিল টাইম > ২ সেকেন্ড, ঠান্ডা অঙ্গপ্রত্যঙ্গ, ফিলিফর্ম পালস এবং মার্বেল ত্বক, হৃদস্পন্দন ১৭০ bpm, শ্বাসপ্রশ্বাসের হার ৫৫ bpm, রক্তচাপ ৯১/৩৭ mmHg, অক্সিজেন স্যাচুরেশন ৯৯%। ভর্তি সময় তার ওজন ছিল ৪.৭ কেজি এবং উচ্চতা ৫৬ সেমি, উচ্চতা/বয়স Z-স্কোর -২.৫২; গুরুতর ডিহাইড্রেশনের কারণে ওজন/উচ্চতা এবং ওজন/বয়স Z-স্কোর নির্ণয়যোগ্য ছিল না। সেগমেন্টাল পরীক্ষায় উভয় ফুসফুসের বেসে সূক্ষ্ম ক্রেপিটাস এবং ত্বকের এরিথেমাটাস-স্কোয়ামাস ক্ষত ও খোসা ওঠা, এবং ধড় ও উপরের অঙ্গে হাইপোপিগমেন্টেশনের ক্ষত দেখা যায় (পেলাগ্রয়েড ডার্মাটোসিস হিসেবে ব্যাখ্যা করা হয়)।\n\nজরুরি বিভাগে Lactate Ringer ১০ ml/kg বোলাস দেওয়া হয়, এরপর ৫% Dextrose in 0.33% Saline ৫০০ ml ৬ ঘণ্টায় ২৯ ml/h হারে ইনফিউশন দেওয়া হয়, ডায়ুরেসিস না হওয়া পর্যন্ত KCL ছাড়া। সম্ভাব্য সেপসিসের জন্য Ceftriaxone ৫০ mg/kg/day শুরু করা হয়, রোগী স্থিতিশীল করা হয় এবং ওয়ার্ডে পাঠানো হয়, যেখানে তিনি ৫% Dextrose in 0.9% Saline ৫০০ ml ২০ ml/hr হারে গ্রহণ অব্যাহত রাখেন।\n\nপরীক্ষাসমূহের মধ্যে রক্ত গণনায় লিউকোসাইটোসিস ৩৯.০ x ১০³/uL, গুরুতর অ্যানিমিয়া ৫.৬ g/dL, থ্রম্বোসাইটোসিস ৫০২ x ১০³/uL পাওয়া যায়; বাকি ফলাফলসমূহ বিস্তারিতভাবে উল্লেখ করা হয়েছে। কোয়াগুলেশন টাইম পরিবর্তিত থাকার কারণে তাকে ৫০ ml ফিল্টারকৃত ও লিউকো-রিডিউসড লাল রক্তকণিকা এবং ৪০ cc ফ্রেশ ফ্রোজেন প্লাজমা দেওয়া হয়। ন্যাসোগ্যাস্ট্রিক টিউবের মাধ্যমে এন্টারাল ফিডিং শুরু করা হয় এবং ইনফিউশন কমিয়ে ৫% Dextrose in 0.9% Saline ৫০০ cc ১৫ ml/h করা হয়, এবং নেগেটিভ ওয়াটার ব্যালান্স বজায় থাকে।\n\nদ্বিতীয় দিনে প্রাথমিক পারিফেরাল রক্ত কালচারে গ্রাম-পজিটিভ কক্কাই ইন ক্লাস্টারস রিপোর্ট হয়, Oxacillin ২০০ mg/kg/day যোগ করা হয়, Ceftriaxone বাড়িয়ে ৭৫–১০০ mg/kg/day করা হয়, মোট তরল ১২০ ml/kg/day করা হয় এবং ক্যালসিয়াম সংশোধন করা হয় (প্রাপ্ত মান ৬.৩৮ mg/dL)।\n\nতৃতীয় দিনে ভেনাস অ্যাক্সেস হারিয়ে যায়, ফলে একটি সেন্ট্রাল ভেনাস ক্যাথেটার (CVC) স্থাপন করা হয়। তিনি হাইপোভোলেমিক ছিলেন, মুখগহ্বরের মিউকোসা সাবহাইড্রেটেড, শ্বাসপ্রশ্বাসের কাজ বেড়েছিল, অঙ্গপ্রত্যঙ্গ ঠান্ডা ছিল এবং ক্যাপিলারি রিফিল টাইম ৩–৪ সেকেন্ড। Ringer’s lactate ২০ ml/kg এক ঘণ্টায় লোড হিসেবে দেওয়া হয়। আর্টেরিয়াল ব্লাড গ্যাসে আনকম্পেনসেটেড মেটাবলিক অ্যাসিডোসিস পাওয়া যায়—pH ৭.২৬, HCO3 ১৩ mmol/L, PCO2 ২৮.৪ mmHg, PO2 ৩৯.২ mmHg, ল্যাকটেট ২.৮ mmol/L। তাকে ইন্টুবেট করে পেডিয়াট্রিক ইনটেনসিভ কেয়ার ইউনিটে (PICU) স্থানান্তর করা হয় এবং মেকানিক্যাল ভেন্টিলেশনে রাখা হয়।\n\nমোট তরল ১০০ cc/kg, এপিনেফ্রিন ইনফিউশন, লো-সল্ট অ্যালবুমিন এবং ১০% ক্যালসিয়াম গ্লুকোনেট প্রদান করা হয়, এবং লিভার এনজাইম বৃদ্ধি পাওয়ায় fentanyl পরিবর্তন করে remifentanil দেওয়া হয়।\n\nভর্তির সময় নেওয়া রক্ত কালচারে মেথিসিলিন-রেজিস্ট্যান্ট Staphylococcus aureus (MRSA) বৃদ্ধি পাওয়া যায়, Oxacillin বাদ দেওয়া হয় এবং Clindamycin ৪০ mg/kg/day যোগ করা হয়; আইসিইউতে ভর্তির দ্বিতীয় দিনে নেওয়া রক্ত কালচারে গ্রাম-নেগেটিভ ব্যাসিলাস স্মিয়ার পজিটিভ হয়, এবং Ceftriaxone পরিবর্তন করে Ceftazidime ১৫০ mg/kg/day করা হয়।\n\nআইসিইউতে প্রথম দিনে কার্ডিয়াক ক্ষতির সিরাম বায়োমার্কার উল্লেখযোগ্যভাবে বৃদ্ধি পায়, ইকোকার্ডিওগ্রামে মাইল্ড মাইট্রাল ও ট্রাইকাসপিড রিগারজিটেশন, বাম ভেন্ট্রিকুলারের ডাইলাটেশন, বাম ভেন্ট্রিকুলার ইজেকশন ফ্র্যাকশন (LVEF) ৫৮% দেখা যায়; কোনো থ্রম্বাস, ভেজিটেশন বা পেরিকার্ডিয়াল ইফিউশনের প্রমাণ ছিল না, এবং তাকে তীব্র মায়োকার্ডাইটিস হিসেবে নির্ণয় করা হয়। Milrinone ০.৪ mcg/kg/min হারে শুরু করা হয়, furosemide এবং IV immunoglobulin ১ g/kg একক ডোজ দেওয়া হয়।\n\nদ্বিতীয় দিনের রক্ত কালচারে জীবাণুটি Bacillus clausii হিসেবে শনাক্ত হয়, (VYTEK 2TM) সিস্টেম দ্বারা চিহ্নিত; সংবেদনশীলতার প্রোফাইল করা হয়নি কারণ টিমের কাছে এই জীবাণুর জন্য কাট-পয়েন্ট ছিল না, এ কারণে অ্যান্টিবায়োটিক কভারেজ সমন্বয় করা হয়, এটিকে কনটামিন্যান্ট হিসেবে বিবেচনা না করে Ceftazidime পরিবর্তন করে Ciprofloxacin ৩০ mg/kg/day করা হয় এবং MRSA-এর জন্য Clindamycin-এর সাথে Ceftaroline ৮ mg/kg প্রতি ৮ ঘণ্টা অন্তর যোগ করা হয়। পরবর্তী ৩টি রক্ত কালচার, প্রতিটির মধ্যে ৪৮ ঘণ্টা ব্যবধান রেখে, পারিফেরাল রক্ত এবং CVC উভয় ক্ষেত্রেই B. clausii আইসোলেশনের জন্য পজিটিভ ছিল।\n\nহাসপাতালে ভর্তির ৬ষ্ঠ দিনে, দ্বিতীয় দিনে করা গ্যাস্ট্রোইনটেস্টাইনাল প্যানেল (Maripoc gastro test methodology) Clostridiodes difficile toxin A/B সনাক্ত করে; Campylobacteryeyuni, Norovirus GI, Norovirus GII.4, Adenovirus এবং Rotavirus পরীক্ষাগুলো নেগেটিভ ছিল। এই ফলাফলের পর চিকিৎসা বাড়িয়ে IV Vancomycin ৬০ mg/kg/day ডোজে দেওয়া হয় এবং মুখে metronidazole যোগ করা হয়। Ceftaroline, clindamycin এবং ciprofloxacin বাদ দেওয়া হয়, B. clausii, C. difficile এবং MRSA কভার করার জন্য।\n\nHIV পরীক্ষা, Chagas-এর সেরোলজি এবং SARS-CoV-2 অ্যান্টিজেন ইমিউনোফ্লুরোসেন্স (FIA) দ্বারা নেগেটিভ ছিল, ইমিউনোগ্লোবুলিন স্বাভাবিক সীমার মধ্যে ছিল।\n\nসপ্তম দিনে আর্টেরিয়াল হাইপারটেনশন রিপোর্ট হয় এবং ব্যবস্থাপনায় spirinolactone যোগ করা হয়।\n\nঅষ্টম দিনে ল্যাবরেটরি পরীক্ষায় কোয়াগুলেশন টাইম পরিবর্তিত এবং আজোটেমিয়া বৃদ্ধি পাওয়া যায়, যা ১২ ঘণ্টা স্থায়ী অ্যানুরিয়ার সাথে যুক্ত ছিল। তবে রোগীর অবস্থার কারণে পেরিটোনিয়াল ক্যাথেটার স্থাপন করা হয়নি, vancomycin ডোজ সমন্বয় করা হয় এবং ভিটামিন K প্রদান করা হয়। রোগীর অ্যানুরিয়া ও অ্যানাসার্কা অব্যাহত থাকে এবং তিনি স্থায়ী হাইপোটেনশন বিকাশ করেন। Noradrenaline যোগ করা হয়, কিন্তু তার অবস্থা মাল্টিসিস্টেম অর্গান ফেইলিউরের সাথে অবনতি ঘটে এবং ভর্তি হওয়ার ১২ দিন পর তিনি মৃত্যুবরণ করেন। সাংস্কৃতিক কারণে মাতা অনুমতি না দেওয়ায় কোনো ময়নাতদন্ত করা হয়নি।\n",
+    "translated_summary": "পানামার প্রত্যন্ত অঞ্চলের একজন ৪ মাস বয়সী স্তন্যপান করানো শিশু, যেখান থেকে নিকটতম স্বাস্থ্যকেন্দ্রে যেতে নৌকায় ৩ ঘণ্টা লাগে। শিশুটির প্রোটিন-ক্যালোরি অপুষ্টি ছিল এবং সে তীব্র ডায়রিয়া ও মাঝারি থেকে গুরুতর ডিহাইড্রেশনে ভুগছিল। প্রাথমিক চিকিৎসার অংশ হিসেবে তাকে এন্টারোজার্মিনা দেওয়া হয়েছিল। এরপর তাকে একটি তৃতীয় স্তরের হাসপাতালে স্থানান্তর করা হয়, যেখানে সে শ্বাসকষ্ট ও শকের লক্ষণ নিয়ে ভর্তি হয়। প্রাথমিক রক্ত পরীক্ষায় মেথিসিলিন-প্রতিরোধী স্ট্যাফাইলোকক্কাস অরিয়াস (এমআরএসএ)-এর উপস্থিতি ধরা পড়ে। গ্যাস্ট্রোইনটেস্টাইনাল প্যানেলে ক্লোস্ট্রিডিওডিস ডিফিকিলের উপস্থিতি শনাক্ত হয় এবং পরবর্তীতে পেরিফেরাল রক্ত ও কেন্দ্রীয় ভেনাস ক্যাথেটারের ধারাবাহিক রক্ত পরীক্ষায় ব্যাসিলুস ক্লসি-এর উপস্থিতি নিশ্চিত করা হয়। ধীরে ধীরে শারীরিক অবস্থার অবনতি এবং একাধিক অ্যান্টিবায়োটিক প্রতিরোধী হওয়ায়, হাসপাতালে ভর্তির বারো দিন পর মাল্টিসিস্টেম অর্গান ফেইলিউরের কারণে শিশুটি মারা যায়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_490.txt",
+    "fulltext": "A 78-year-old woman, who came to collect her blister pack with her medication reconstituted in a personalised dosage system (PDS) from the community pharmacy, informed us that for some months she had been suffering from tiredness, weakness, dizziness and confusion. These symptoms were preventing her from leaving her home to walk as often as she normally did. In view of this situation, she was invited to the personalised care area to review the degree of knowledge that the patient had of her medication and the use she made of it, to analyse whether any of her medication could be related to the health problem described.\n\nPharmacological treatment of the patient\n\nMedication  Dose  Dosage  Health issue  Start date\nDoxazosin  2 mg/24 h  0-0-1  Hypertension  2014\nLosartan  100 mg/24 h  1-0-0  Hypertension  2014\nManidipine  20 mg/24 h  0-1-0  Hypertension  2014\nSimvastatin  40 mg/24 h  0-0-1  Hypercholesterolemia  2014\nAcetylsalicylic acid  100 mg/24 h  1-0-0  Secondary prophylaxis  2014\nOmeprazole  20 mg/24 h  1-0-0  Prevention of peptic ulcer  2014\nPregabalin  100 mg/12 h  1-0-1  Neuralgia  2019\nTorasemide  10 mg/24 h  1-0-0  Edema  2023\nDulaglutide  1.5 mg/week  1 time/week  Diabetes  2014\nInsulin glargine  74 IU/24 h  1-0-0  Diabetes  2014\nInsulin lispro  20 IU/24 h  0-1-0  Diabetes  2014\nBrimonidine  1 drop/12 h  1-0-1  Ocular hypertension  2018\n\nStudy and evaluation\nThe interview revealed that there was no new medication and that it did not appear in the SPD service register. Given the suspicion of a possible hypotension, her blood pressure was measured with an Omron Complete device, with the following values: Systolic Blood Pressure (SBP) 96 mmHg, Diastolic Blood Pressure (DBP) 52 mmHg and Heart Rate (HR) 69 beats per minute. Given these values, it was suggested that her blood pressure be monitored and the influence of her medication on these values and the symptoms described by the patient be analysed.\n\nThe patient's medication doses, starting with antihypertensive medications, are reviewed to adjust to the patient's estimated glomerular filtration rate (eGFR) and to see if hypotension is related to the dosage of these medications. The patient's eGFR value, calculated using the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) formula, is 30 ml/min/1.73 m2.\n\nThe guidelines for the revision of the dose according to the value of the eGFR are the product information for the medicinal products and the consensus guidelines for the use of medicinal products in renal impairment of the teaching and research group in the field of practical pharmacy of the Faculty of Pharmacy of the University of Barcelona, which is available on the Internet. This guide has been prepared from the analysis of the most dispensed medicinal products in community pharmacies. They have been organised by therapeutic groups according to the ATC (Anatomical-Therapeutic-Chemical) classification, information on the symptoms of overdose has been included and it has been agreed to categorise the risk to the patient of taking these medicinal products according to their eGFR as low, moderate or high.\n\nAfter the medication review was performed according to the eGFR value of 30 ml/min/1.73 m2, the results were obtained.\n\nFollowing the study of the medication, our intervention focuses on the dosage of the following medicines: losartan, manidipine, torasemide and pregabalin. The antihypertensive medicines, losartan and manidipine, and pregabalin require a dose adjustment depending on the patient's eGFR value, while the diuretic torasemide can influence blood pressure values.\n\nInitially, it was decided to intervene in the dosage of losartan and manidipine. There is the possibility of reducing the dose of pregabalin, but the pharmaceutical team agreed with the patient to assess the influence of this medication after the possible adjustment of the dose of antihypertensive during the evolution and follow-up of the patient.\n\nIntervention\nThe information is used to prepare a report for the doctor (see annex), recommending a reduction in the dose of losartan and manidipine, as the available information recommends a reduction in the dose to 50-75% of losartan for eGFR of 30-59 ml/min/1.73 m2 and adjusting the dose of manidipine for eGFR of 15-30 ml/min/1.73 m2.\n\nThe proposed intervention was explained to the patient and the report was given to the primary care doctor, explaining the possibility of adjusting the dose of losartan and manidipine to improve the patient's condition (table 4). When this information reached the doctor, he opted to reduce the dose of losartan to 50 mg/24 hours and manidipine to 10 mg/24 hours. Pregabalin 100 mg/12 hours was also replaced with gabapentin 300 mg/12 hours.\n\nFollow-up\nFollowing this change in the patient's treatment and after a follow-up of two months, the patient showed an improvement in blood pressure values (table 5) and a remission of the symptoms described. It was reviewed whether the gabapentin dose of 300 mg/12 hours was adequate for the eGFR value of 30 ml/min/1.73 m2, and it was correct (eGFR between 30 and 60, recommended total daily dose 300-900 mg).\n\n",
+    "summary": "78-year-old patient, taking many medicines and included in the Personalised Medication Dosage System (SPD). When she came to collect her medication, she informed us that for some months she had been suffering from tiredness, weakness, dizziness and confusion. A review of the medication was carried out, focusing on the dosage of the medicines metabolised or eliminated by the kidneys, depending on the patient's estimated glomerular filtration rate (EGFR). A referral was made to the Primary Care Physician (PCP) by means of a report, in which the reduction of the dose of losartan and manidipine was recommended, depending on the patient's estimated glomerular filtration rate (EGFR). The PCP reduced the dose of the antihypertensive medicines. The case was monitored, which allowed us to observe that the patient no longer presented the symptoms described initially.\n",
+    "translated_fulltext": "একজন ৭৮ বছর বয়সী মহিলা, যিনি তার ব্যক্তিগতকৃত ডোজে (PDS) ওষুধ মিশ্রিত করে একটি কমিউনিটি ফার্মেসি থেকে ওষুধ নিতে এসেছিলেন, তিনি আমাদের জানান যে কয়েক মাস ধরে তিনি ক্লান্তি, দুর্বলতা, মাথা ঘোরা এবং বিভ্রান্তিতে ভুগছেন। এই উপসর্গগুলোর কারণে তিনি আগের মতো প্রায়ই বাইরে হাঁটতে যেতে পারছেন না। এই পরিস্থিতির পরিপ্রেক্ষিতে, তাকে ব্যক্তিগতকৃত পরিচর্যা কেন্দ্রে আমন্ত্রণ জানানো হয়, যেখানে তার ওষুধের বিষয়ে রোগীর জ্ঞান এবং তিনি ওষুধটি কীভাবে ব্যবহার করেন, তা পর্যালোচনা করা হয়। সেই সাথে, তার কোনো ওষুধের কারণে স্বাস্থ্য সমস্যা দেখা দিয়েছে কিনা, সেটিও বিশ্লেষণ করা হয়।\n\nরোগীর ওষুধ সংক্রান্ত চিকিৎসা\n\nওষুধের নাম ডোজ পরিমাণ স্বাস্থ্য সমস্যা শুরুর তারিখ\nডক্সাজোসিন ২ মিগ্রা/২৪ ঘণ্টা ০-০-১ উচ্চ রক্তচাপ ২০১৪\nলোসার্টান ১০০ মিগ্রা/২৪ ঘণ্টা ১-০-০ উচ্চ রক্তচাপ ২০১৪\nম্যানিডিপিন ২০ মিগ্রা/২৪ ঘণ্টা ০-১-০ উচ্চ রক্তচাপ ২০১৪\nসিমভাস্ট্যাটিন ৪০ মিগ্রা/২৪ ঘণ্টা ০-০-১ উচ্চ কোলেস্টেরল ২০১৪\nঅ্যাসিটাইলস্যালিসিলিক অ্যাসিড ১০০ মিগ্রা/২৪ ঘণ্টা ১-০-০ প্রতিরোধমূলক চিকিৎসা ২০১৪\nওমেপ্রাজল ২০ মিগ্রা/২৪ ঘণ্টা ১-০-০ পেপটিক আলসার প্রতিরোধ ২০১৪\nপ্রেগাবালিন ১০০ মিগ্রা/১২ ঘণ্টা ১-০-১ নিউরালজিয়া ২০১৯\nটোরাসেমাইড ১০ মিগ্রা/২৪ ঘণ্টা ১-০-০ শোথ ২০২৩\nডুলাগ্লুটাইড ১.৫ মিগ্রা/সপ্তাহ ১ বার/সপ্তাহ ডায়াবেটিস ২০১৪\nইনসুলিন গ্লারজিন ৭৪ আইইউ/২৪ ঘণ্টা ১-০-০ ডায়াবেটিস ২০১৪\nইনসুলিন লিসপ্রো ২০ আইইউ/২৪ ঘণ্টা ০-১-০ ডায়াবেটিস ২০১৪\nব্রিমোনিডিন ১ ফোঁটা/১২ ঘণ্টা ১-০-১ চোখের উচ্চ রক্তচাপ ২০১৮\n\nপর্যবেক্ষণ এবং মূল্যায়ন\nসাক্ষাৎকারে জানা যায় যে, নতুন কোনো ওষুধ নেই এবং এটি SPD পরিষেবা রেজিস্টারেও নেই। সম্ভাব্য নিম্ন রক্তচাপের সন্দেহের কারণে, রোগীর রক্তচাপ একটি Omron Complete ডিভাইস দিয়ে মাপা হয়, যেখানে নিম্নলিখিত মান পাওয়া যায়: সিস্টোলিক রক্তচাপ (SBP) ৯৬ মিমি Hg, ডায়াস্টোলিক রক্তচাপ (DBP) ৫২ মিমি Hg এবং হৃদস্পন্দন (HR) ৬৯ বিট প্রতি মিনিট। এই মানগুলোর ওপর ভিত্তি করে, রোগীর রক্তচাপ পর্যবেক্ষণ করা এবং তার ওষুধের প্রভাব এবং রোগীর বর্ণিত উপসর্গগুলো বিশ্লেষণ করার পরামর্শ দেওয়া হয়।\n\nরোগীর অ্যান্টিহাইপারটেনসিভ ওষুধসহ অন্যান্য ওষুধের ডোজ পর্যালোচনা করা হয়, যাতে রোগীর আনুমানিক গ্লোমেরুলার পরিস্রাবণ হার (eGFR)-এর সাথে সামঞ্জস্য করা যায় এবং দেখা যায় যে, এই ওষুধগুলোর ডোজের কারণে নিম্ন রক্তচাপ হচ্ছে কিনা। ক্রনিক কিডনি ডিজিজ-এপিডেমিওলজি কোলাবরেশন (CKD-EPI) সূত্র ব্যবহার করে রোগীর eGFR মান গণনা করা হয়, যা ৩০ মিলি/মিনিট/১.৭৩ মি২।\n\neGFR মানের উপর ভিত্তি করে ডোজ পরিবর্তনের নির্দেশিকা হলো ওষুধের পণ্যের তথ্য এবং বার্সেলোনার বিশ্ববিদ্যালয়ের ফার্মাসি অনুষদের ব্যবহারিক ফার্মাসি ক্ষেত্রের শিক্ষণ এবং গবেষণা গ্রুপের কিডনি রোগের ওষুধ ব্যবহারের বিষয়ে ঐকমত্যের নির্দেশিকা, যা ইন্টারনেটে পাওয়া যায়। এই নির্দেশিকাটি কমিউনিটি ফার্মেসিতে সবচেয়ে বেশি ব্যবহৃত ওষুধগুলোর বিশ্লেষণের মাধ্যমে তৈরি করা হয়েছে। এগুলোকে ATC (অ্যানাটমিক্যাল-থেরাপিউটিক-কেমিক্যাল) শ্রেণীবিভাগ অনুযায়ী থেরাপিউটিক গ্রুপে ভাগ করা হয়েছে, ওভারডোজের উপসর্গ সম্পর্কে তথ্য অন্তর্ভুক্ত করা হয়েছে এবং রোগীর eGFR-এর উপর ভিত্তি করে এই ওষুধগুলোর ঝুঁকি কম, মাঝারি বা উচ্চ হিসেবে নির্ধারণ করা হয়েছে।\n\neGFR মান ৩০ মিলি/মিনিট/১.৭৩ মি২ অনুযায়ী ওষুধ পর্যালোচনা করার পরে, ফলাফল পাওয়া যায়।\n\nওষুধের পর্যালোচনা করার পর, আমাদের হস্তক্ষেপের কেন্দ্রবিন্দু হলো নিম্নলিখিত ওষুধগুলোর ডোজ: লোসার্টান, ম্যানিডিপিন, টোরাসেমাইড এবং প্রেগাবালিন। অ্যান্টিহাইপারটেনসিভ ওষুধ লোসার্টান এবং ম্যানিডিপিন এবং প্রেগাবালিনের ডোজ রোগীর eGFR মানের উপর নির্ভর করে পরিবর্তন করতে হবে, যেখানে মূত্রবর্ধক টোরাসেমাইড রক্তচাপের মানকে প্রভাবিত করতে পারে।\n\nপ্রাথমিকভাবে, লোসার্টান এবং ম্যানিডিপিনের ডোজে পরিবর্তন করার সিদ্ধান্ত নেওয়া হয়। প্রেগাবালিনের ডোজ কমানোর সম্ভাবনা রয়েছে, তবে ফার্মাসিউটিক্যাল দল রোগীর সাথে আলোচনা করে এই ওষুধের প্রভাব মূল্যায়ন করতে রাজি হয়, যখন অ্যান্টিহাইপারটেনসিভের ডোজ পরিবর্তন করা হবে এবং রোগীর অবস্থার উন্নতি পর্যবেক্ষণ করা হবে।\n\nহস্তক্ষেপ\nএই তথ্য ব্যবহার করে ডাক্তারের জন্য একটি প্রতিবেদন তৈরি করা হয় (সংযুক্তি দেখুন), যেখানে লোসার্টান এবং ম্যানিডিপিনের ডোজ কমানোর সুপারিশ করা হয়, কারণ উপলব্ধ তথ্য অনুযায়ী, eGFR ৩০-৫৯ মিলি/মিনিট/১.৭৩ মি২ হলে লোসার্টানের ডোজ ৫০-৭৫% এ কমানো উচিত এবং eGFR ১৫-৩০ মিলি/মিনিট/১.৭৩ মি২ হলে ম্যানিডিপিনের ডোজ সমন্বয় করা উচিত।\n\nপ্রস্তাবিত হস্তক্ষেপ সম্পর্কে রোগীকে জানানো হয় এবং প্রাথমিক স্বাস্থ্যসেবা ডাক্তারকে প্রতিবেদনটি দেওয়া হয়, যেখানে লোসার্টান এবং ম্যানিডিপিনের ডোজ সমন্বয় করে রোগীর অবস্থার উন্নতির সম্ভাবনার কথা বলা হয় (সারণী ৪)। এই তথ্য পাওয়ার পর, ডাক্তার লোসার্টানের ডোজ ৫০ মিগ্রা/২৪ ঘণ্টা এবং ম্যানিডিপিনের ডোজ ১০ মিগ্রা/২৪ ঘণ্টা কমাতে রাজি হন। প্রেগাবালিন ১০০ মিগ্রা/১২ ঘণ্টা-এর পরিবর্তে গ্যাবাপেনটিন ৩০০ মিগ্রা/১২ ঘণ্টা ব্যবহার করা হয়।\n\nফলো-আপ\nরোগীর চিকিৎসায় এই পরিবর্তনের পর এবং দুই মাস পর্যবেক্ষণের পর, রোগীর রক্তচাপের মানে উন্নতি দেখা যায় (সারণী ৫) এবং বর্ণিত উপসর্গগুলো হ্রাস পায়। গ্যাবাপেনটিনের ৩০০ মিগ্রা/১২ ঘণ্টার ডোজ eGFR মান ৩০ মিলি/মিনিট/১.৭৩ মি২-এর জন্য উপযুক্ত কিনা, তা পর্যালোচনা করা হয় এবং এটি সঠিক ছিল (eGFR ৩০ থেকে ৬০-এর মধ্যে, প্রস্তাবিত দৈনিক ডোজ ৩০০-৯০০ মিগ্রা)।",
+    "translated_summary": "৭৮ বছর বয়সী একজন রোগী, যিনি অনেক ওষুধ গ্রহণ করেন এবং ব্যক্তিগতকৃত ওষুধ সেবন মাত্রা নির্ধারণী ব্যবস্থার (এসপিডি) অন্তর্ভুক্ত। যখন তিনি ওষুধ নিতে এসেছিলেন, তখন তিনি জানান যে কয়েক মাস ধরে তিনি ক্লান্তি, দুর্বলতা, মাথা ঘোরা এবং বিভ্রান্তিতে ভুগছেন। রোগীর আনুমানিক গ্লোমেরুলার পরিস্রাবণ হার (ইজিএফআর)-এর ওপর ভিত্তি করে, কিডনি দ্বারা বিপাক বা নির্গত হওয়া ওষুধগুলোর মাত্রা পর্যালোচনা করা হয়। একটি প্রতিবেদনের মাধ্যমে প্রাথমিক স্বাস্থ্যসেবা চিকিৎসকের (পিসিপি) কাছে তাকে পাঠানো হয়, যেখানে রোগীর আনুমানিক গ্লোমেরুলার পরিস্রাবণ হার (ইজিএফআর)-এর ওপর ভিত্তি করে লসারটান এবং মানিডিপিনের মাত্রা কমানোর সুপারিশ করা হয়। পিসিপি উচ্চ রক্তচাপের ওষুধগুলোর মাত্রা কমিয়ে দেন। এরপর রোগীর অবস্থা পর্যবেক্ষণ করা হয়, এবং দেখা যায় যে রোগীর মধ্যে পূর্বে যে উপসর্গগুলো দেখা যাচ্ছিল, সেগুলো আর নেই।"
+  },
+  {
+    "id": "multiclinsum_gs_en_483.txt",
+    "fulltext": "It is a case study, approved by the Research Ethics Committee (CEP) under number 1.012.635. The prior authorization of the relatives and the participant was requested from the signature of the Free and Informed Consent (TCLE) and the Free and Informed Consent (TALE).\n\nThe participant in this study is a female student in the 3rd year of elementary school. In the first evaluation, in 2018, the child was 8 years and 2 months old, while in the second evaluation, in 2019, she was 9 years and 6 months old. The interval between the evaluations occurred due to the fact that it is a public service. Thus, the laboratory was absent from activities during the holidays. In addition, it is important to consider that the appointments were only made once a week and, during that period, the participant was absent, which also prolonged the process. As for her history, she was born at term and presented adequate neuropsychomotor and linguistic development. The child was born and lived in a French-speaking country until the age of 2 years, but had exposure to another language at home, since her parents are Brazilian Portuguese speakers. However, her first words were in French. When she returned to Brazil, she went through two private schools. In the first school, she was unable to communicate, as she only expressed herself in French. After that experience, at the age of 3, she began studying in a French school, still in Brazil. Over the years, she presented difficulty in acquiring reading and writing; for that reason, she repeated the 1st year of elementary school, at the request of her mother. At the age of 6, she began studying in a bilingual Portuguese-English school. At the age of 8 years old, she underwent evaluation by an interdisciplinary team in the areas of speech therapy and neuropsychology, finding the diagnosis of developmental dyslexia (DD) and high abilities/giftedness (AH/S). Soon after, she was referred to the evaluation of reading and writing in the Laboratory of Written Language, Interdisciplinarity and Learning - LEIA/UFRN.\n\nPhases of the study: four assessment sessions for each moment - pre and post intervention (T1 and T2, respectively) - and 20 sessions of phonological remediation, once a week for 60 minutes. The intervention took place in the second semester of 2018, where parents were not very engaged due to work demands.\n\nAssessments were conducted individually over a one-hour period. They included tasks to assess performance in phonological processing - phonological working memory, phonological awareness and mental lexical access - reading and writing.\n\nThe following protocols were used to evaluate the child:\n\nPhonological awareness: to evaluate this ability, the Consciência Fonológica Instrumento de Avaliação Sequencial - CONFIAS (11) was used. This protocol proposes tasks of synthesis, segmentation, rhyme, alliteration, initial and final syllable identification, exclusion and transposition. First, syllabic awareness, formed by nine items, is analyzed, followed by phonemic awareness, formed by seven items. Each hit is equivalent to one point, with 40 for syllabic awareness and 30 for phonemic awareness, totaling 70 points. Its results should be compared with the expected writing hypotheses based on Ferreiro and Teberosky (12). In this way, the following normal values were used: for the syllabic-alphabetic writing hypothesis, 27, 12 and 39 for the syllabic, phonemic and total score, respectively; for the alphabetic writing hypothesis, 31, 15 and 46.\n\nPhonological working memory: The Phonological Working Memory Test was used (13). In the application of this protocol, the assessor should begin with the non-word test, which consists of 40 invented words. The assessor should then say each word in the list, asking the child to repeat it immediately. The child has two attempts to repeat the words correctly. In the first attempt, each correct answer is worth two points, in the second attempt, the child is awarded one point, and in the third attempt, the child is awarded zero points. After this, the assessor should move on to the test of digits in direct and reverse order, which is scored in the same way as the pseudo-words. Depending on the age of the participant at the time of the assessments, the normal values of 69, 13 and 6 were used for pseudo-words, direct and reverse digits, respectively.\n\nAccess to the mental lexicon: the Rapid Automatic Naming Test (RAN)(14) was used in the evaluation and the Automatic Naming Test (TENA)(15) in the re-evaluation. Both tests aim to estimate the individual's ability to name a sequence of stimuli, that is, to measure the speed at which the child can verbalize a visual stimulus quickly. Two protocols were used, since the TENA had not yet been published at the time of the first evaluation. In addition, the TENA is a current and more complete protocol for the verification of normality, as it allows analysis according to age and months. The two tests used have similar application and are divided into four boards, where the child must name colors, objects, letters and digits. The naming must be done with the same movement that is used for reading - from left to right and from top to bottom. For T1, which used the RAN, the normality values correspond to children aged between 8 years and 8 years and 11 months, due to the age of the participant in that period, thus, it should have a score of 28, 29, 52 and 46 seconds for the subtests of digits, letters, objects and colors, respectively. For T2, the normality values of the age of 9 years and 6 months of the protocol (TENA) were used, with an expected score of 35, 32, 50, 53 seconds for the subtests of digits, letters, objects and colors, respectively.\n\nReading: First, the Protocol for the Assessment of Reading of Words/Pseudowords Isolated – LPI(16) was used, in which the child is asked to read aloud words and pseudowords, which are scored. 19 regular words, 20 irregular words and 20 pseudowords are arranged in black Arial font, size 24 and white background. The child may obtain a total of 59 points, since each correct reading is worth one point. After this, the Protocol for the Assessment of Reading of Expository Texts was used(17). This instrument aims to assess reading comprehension through directed questions about texts compatible with the subject's school year. It assesses and times patterns of silent and oral reading. This allows the reading level to be verified and compared. In addition, the number of words read per minute is averaged, allowing the reading speed to be verified and compared.\n\nWriting: To evaluate the writing, the child was asked to produce a text on a topic of their interest. After finishing the story, the professional asked the child to read out loud what was written. Furthermore, the child was asked to write the target words of the LPI(16) on a separate sheet, in order to carry out a dictation of words and pseudo-words. With this, a qualitative investigation of the writing was carried out, based on the orthographic analysis of Zorzi and Ciasca(18).\n\nThe remediation was based on a program used for children with dyslexia(19) and included activities that aimed to improve phonological abilities, such as: identification of graphemes and phonemes, phoneme pairs, syllable pairs, word pairs, addition and subtraction of phonemes, syllabic and phonemic manipulation, rhymes, alliteration, access to mental lexicon, visual working memory, auditory working memory and reading training. In all sessions, these activities were explored in a playful way, mainly directed to the metalinguistic aspects of phonological awareness. In reading training, the child was exposed to children's books from the Mico Maneco collection. This collection has various stories that increase the level of complexity of words, so it is possible to follow the child's progress. The activities performed and the child's evolution were described in his/her medical record at the end of each session.\n\nAnalysing the results found, with regard to performance in phonological awareness, in both assessments the child presented performance consistent with the hypotheses of writing presented in each period. In the first assessment, he received the syllabic-alphabetic writing hypothesis and in the second, the alphabetic one, demonstrating progress. The performance score progressed in both categories of the skill, syllabic (T1 = 35; T2 = 37) and phonemic (T1 = 14; T2 = 20) (Table 1). The progress of 4 successes in the phonemic level is highlighted, which can be explained due to the phonological remediation having been performed with focus on the phonemic level.\n\nThe results of phonological working memory at the time prior to phonological remediation expressed below-expected performance for the pseudo-word category, with 66 points in T1, with expected performance for T1 (ET1) of 69, and for the reverse-order digits category (T1 = 04; ET1 = 06) (Table 1). Despite this, it presented results within the expected range for the reverse-order digits category (T1 = 20; ET1 = 13). In the post-intervention evaluation (T2), the results are adequate for the age. It is also possible to notice advances in this skill in all categories, pseudo-word (T1 = 66; T2 = 69), reverse-order digits (T1 = 04; T2 = 12) (Table 1), which requires aspects of executive functions that assist in the rapid storage of the response, a differential aspect in high abilities.\n\nAs for the automatic rapid naming, it is noted that in T1, the performance is inadequate for the standards of normality in all subtests. It is also possible to say that, in T2, the performance was below the expected for the categories of digits (T2 = 41; ET2 = 35), objects (T2 = 59; ET2 = 50) and colors (T2 = 56; ET2 = 53). Only the category of letters presented results within the expected (T2 = 29; ET2 = 32). On the other hand, the advance in the speed of naming is visible for the subtests of letters (T1 = 37; T2 = 29), objects (T1 = 62; T2 = 59) and colors (T1 = 60; T2 = 56), with the exception of digits (T1 = 37; T2 = 41) (Table 1). With the decrease of the time of naming of the stimuli, it is possible to say that the child becomes more effective to access the mental lexicon at the level of the phonological and visual representation, which is also not usual in isolated dyslexia.\n\nAs for reading, in T1 she presented an alphabetic level and in T2 an orthographic level. In the first test, it was noted that there was difficulty mainly with visually similar letters and phonologically close. In addition, the student used sub-vocal support to decode and had an average reading of 20 words per minute, which demonstrates extremely slow decoding and is far below what is expected for her schooling. In the reassessment, she had an average of 94.4 words per minute in oral reading, which is considered adequate for her schooling. She demonstrated presence of prosody, rhythm, global reading, interest and adequate understanding. Qualitatively, it is observed that the child, even with adequate performance, read with a low intensity of speech, still demonstrating insecurity in carrying out the task.\n\nIn writing, it can be observed that in T1 the child had inadequate pencil grip, imprecise writing, with letter changes, omissions, hyper and hyposegments, repetition of words and low use of cohesive elements. In this period, it was shown with writing in the transition from the syllabic-alphabetic phase to the alphabetic phase. In T2 no significant change was observed, since his writing continued to be imprecise, with little intelligibility of the content, visual similarities between letters (such as “d” and “b”) and lack of punctuation. According to the sample collected, it was shown in the alphabetic phase of writing, although difficulties not expected for his age persisted. Despite this, it is noted that he used a greater repertoire in the use of vocabulary for the lexicon of visual input.\n\nAfter the analysis of the results in their entirety, it can be observed that the written language skills advanced during the interval between the evaluations, despite the persistence of consonant characteristics with dyslexia, as it still presents performance below the expected in the access to the mental lexicon and in writing - with the presence of exchanges between phonemes that are audibly and visually similar in a persistent way, omission of letters and hypersegmentation.\n",
+    "summary": "This study is a case report of the evaluation and intervention process of a 9-year-old child with the paradoxical combination of high abilities associated with dyslexia. The objective was to compare the performance in the tasks of phonological processing, reading and writing before and after phonological remediation. In the first evaluation, the child presented an alphabetic level in reading, a transition phase between the syllabic-alphabetic and alphabetic levels in writing and a performance below the expected level in phonological processing abilities. After the intervention, there was an improvement in phonological processing abilities, consolidation of alphabetic writing and of the orthographic level of reading.\n",
+    "translated_fulltext": "এটি একটি কেস স্টাডি, যা গবেষণা নৈতিকতা কমিটি (CEP) কর্তৃক নম্বর 1.012.635 এর অধীনে অনুমোদিত। আত্মীয়স্বজন ও অংশগ্রহণকারীর পূর্বানুমতি Free and Informed Consent (TCLE) এবং Free and Informed Consent (TALE)-এ স্বাক্ষরের মাধ্যমে গ্রহণ করা হয়।\n\nএই গবেষণার অংশগ্রহণকারী হল প্রাথমিক বিদ্যালয়ের ৩য় শ্রেণির একজন নারী শিক্ষার্থী। প্রথম মূল্যায়নে, 2018 সালে, শিশুটির বয়স ছিল 8 বছর 2 মাস, এবং দ্বিতীয় মূল্যায়নে, 2019 সালে, তার বয়স ছিল 9 বছর 6 মাস। মূল্যায়নগুলোর মধ্যবর্তী সময়ের ব্যবধানটি ঘটেছে কারণ এটি একটি পাবলিক সার্ভিস। সুতরাং, ছুটির সময় ল্যাবরেটরি কার্যক্রম থেকে অনুপস্থিত ছিল। এছাড়াও, এটি বিবেচনা করা গুরুত্বপূর্ণ যে অ্যাপয়েন্টমেন্টগুলো সপ্তাহে মাত্র একবার করা হতো এবং সেই সময়ে অংশগ্রহণকারী অনুপস্থিত ছিল, যা প্রক্রিয়াটিকে আরও দীর্ঘায়িত করেছে। তার ইতিহাস অনুযায়ী, সে পূর্ণগর্ভে জন্মগ্রহণ করে এবং যথাযথ নিউরোসাইকোমোটর ও ভাষাগত বিকাশ প্রদর্শন করে। শিশুটি 2 বছর বয়স পর্যন্ত একটি ফরাসিভাষী দেশে জন্মগ্রহণ ও বসবাস করেছে, তবে ঘরে অন্য একটি ভাষার সংস্পর্শে ছিল, যেহেতু তার বাবা-মা ব্রাজিলিয়ান পর্তুগিজ ভাষাভাষী। তবে, তার প্রথম শব্দগুলো ছিল ফরাসিতে। ব্রাজিলে ফিরে আসার পর, সে দুটি বেসরকারি বিদ্যালয়ে পড়াশোনা করে। প্রথম বিদ্যালয়ে, সে যোগাযোগ করতে অক্ষম ছিল, কারণ সে শুধুমাত্র ফরাসিতে নিজেকে প্রকাশ করত। সেই অভিজ্ঞতার পর, 3 বছর বয়সে, সে ব্রাজিলেই একটি ফরাসি বিদ্যালয়ে পড়াশোনা শুরু করে। বছরগুলোর মধ্যে, তার পড়া ও লেখা অর্জনে অসুবিধা দেখা দেয়; এই কারণে, তার মায়ের অনুরোধে সে প্রাথমিক বিদ্যালয়ের 1ম শ্রেণি পুনরাবৃত্তি করে। 6 বছর বয়সে, সে একটি দ্বিভাষিক পর্তুগিজ-ইংরেজি বিদ্যালয়ে পড়াশোনা শুরু করে। 8 বছর বয়সে, সে স্পিচ থেরাপি ও নিউরোসাইকোলজি ক্ষেত্রে একটি আন্তঃবিভাগীয় দলের দ্বারা মূল্যায়িত হয়, যেখানে developmental dyslexia (DD) এবং high abilities/giftedness (AH/S) নির্ণয় পাওয়া যায়। শীঘ্রই, তাকে Laboratory of Written Language, Interdisciplinarity and Learning - LEIA/UFRN-এ পড়া ও লেখার মূল্যায়নের জন্য রেফার করা হয়।\n\nগবেষণার ধাপসমূহ: প্রতিটি সময়ের জন্য চারটি মূল্যায়ন সেশন – হস্তক্ষেপের পূর্বে ও পরে (ক্রমশ T1 এবং T2) – এবং 20টি ফোনোলজিক্যাল রিমেডিয়েশন সেশন, সপ্তাহে একবার 60 মিনিট করে। হস্তক্ষেপটি 2018 সালের দ্বিতীয় সেমিস্টারে সংঘটিত হয়, যেখানে কর্মসংক্রান্ত চাহিদার কারণে অভিভাবকদের সম্পৃক্ততা কম ছিল।\n\nমূল্যায়নগুলো এক ঘণ্টার সময়কালে ব্যক্তিগতভাবে পরিচালিত হয়। এতে ফোনোলজিক্যাল প্রসেসিংয়ের কর্মক্ষমতা মূল্যায়নের জন্য কাজ অন্তর্ভুক্ত ছিল – ফোনোলজিক্যাল ওয়ার্কিং মেমোরি, ফোনোলজিক্যাল সচেতনতা এবং মানসিক লেক্সিকাল অ্যাক্সেস – পাশাপাশি পড়া ও লেখা।\n\nশিশুটিকে মূল্যায়নের জন্য নিম্নলিখিত প্রোটোকলগুলো ব্যবহার করা হয়:\n\nফোনোলজিক্যাল সচেতনতা: এই দক্ষতা মূল্যায়নের জন্য Consciência Fonológica Instrumento de Avaliação Sequencial - CONFIAS (11) ব্যবহার করা হয়। এই প্রোটোকলটি সংশ্লেষণ, বিভাজন, ছড়া, অলিটারেশন, প্রাথমিক ও চূড়ান্ত সিলেবল সনাক্তকরণ, বর্জন এবং স্থানান্তরের কাজ প্রস্তাব করে। প্রথমে, নয়টি আইটেম নিয়ে গঠিত সিলেবলিক সচেতনতা বিশ্লেষণ করা হয়, এরপর সাতটি আইটেম নিয়ে গঠিত ফোনেমিক সচেতনতা। প্রতিটি সঠিক উত্তর এক পয়েন্টের সমান, সিলেবলিক সচেতনতার জন্য 40 এবং ফোনেমিক সচেতনতার জন্য 30, মোট 70 পয়েন্ট। এর ফলাফল Ferreiro এবং Teberosky (12)-এর ভিত্তিতে প্রত্যাশিত লেখন অনুমানের সাথে তুলনা করা উচিত। এইভাবে, নিম্নলিখিত স্বাভাবিক মানগুলো ব্যবহার করা হয়: সিলেবলিক-অ্যালফাবেটিক লেখন অনুমানের জন্য সিলেবলিক, ফোনেমিক এবং মোট স্কোর যথাক্রমে 27, 12 এবং 39; অ্যালফাবেটিক লেখন অনুমানের জন্য 31, 15 এবং 46।\n\nফোনোলজিক্যাল ওয়ার্কিং মেমোরি: Phonological Working Memory Test (13) ব্যবহার করা হয়। এই প্রোটোকলের প্রয়োগে, মূল্যায়নকারীকে নন-ওয়ার্ড পরীক্ষার মাধ্যমে শুরু করতে হয়, যা 40টি উদ্ভাবিত শব্দ নিয়ে গঠিত। এরপর মূল্যায়নকারী তালিকার প্রতিটি শব্দ উচ্চারণ করে শিশুকে তাৎক্ষণিকভাবে পুনরাবৃত্তি করতে বলে। শিশুটির সঠিকভাবে শব্দ পুনরাবৃত্তির জন্য দুইটি চেষ্টা থাকে। প্রথম চেষ্টায় প্রতিটি সঠিক উত্তর দুই পয়েন্ট, দ্বিতীয় চেষ্টায় এক পয়েন্ট এবং তৃতীয় চেষ্টায় শূন্য পয়েন্ট প্রদান করা হয়। এরপর, মূল্যায়নকারীকে সরাসরি ও বিপরীত ক্রমে সংখ্যার পরীক্ষায় অগ্রসর হতে হয়, যা ছদ্ম-শব্দের মতোই স্কোর করা হয়। মূল্যায়নের সময় অংশগ্রহণকারীর বয়স অনুযায়ী, ছদ্ম-শব্দ, সরাসরি সংখ্যা এবং বিপরীত সংখ্যার জন্য স্বাভাবিক মান যথাক্রমে 69, 13 এবং 6 ব্যবহার করা হয়।\n\nমানসিক লেক্সিকনে প্রবেশাধিকার: মূল্যায়নে Rapid Automatic Naming Test (RAN)(14) এবং পুনর্মূল্যায়নে Automatic Naming Test (TENA)(15) ব্যবহার করা হয়। উভয় পরীক্ষার লক্ষ্য হল উদ্দীপনার একটি ধারাবাহিকতা নামকরণ করার ব্যক্তির সক্ষমতা নিরূপণ করা, অর্থাৎ শিশুটি কত দ্রুত একটি ভিজ্যুয়াল উদ্দীপনাকে মৌখিকভাবে প্রকাশ করতে পারে তা পরিমাপ করা। প্রথম মূল্যায়নের সময় TENA প্রকাশিত না থাকায় দুটি প্রোটোকল ব্যবহার করা হয়। এছাড়াও, TENA একটি বর্তমান ও আরও সম্পূর্ণ প্রোটোকল, কারণ এটি বয়স ও মাস অনুযায়ী বিশ্লেষণ করতে দেয়। ব্যবহৃত উভয় পরীক্ষার প্রয়োগ পদ্ধতি অনুরূপ এবং চারটি বোর্ডে বিভক্ত, যেখানে শিশুটিকে রং, বস্তু, অক্ষর ও সংখ্যা নামকরণ করতে হয়। নামকরণ পড়ার সময় ব্যবহৃত একই গতিবিধিতে করতে হয় – বাম থেকে ডানে এবং উপর থেকে নিচে। T1-এর জন্য, যেখানে RAN ব্যবহৃত হয়, স্বাভাবিকতার মান 8 বছর থেকে 8 বছর 11 মাস বয়সী শিশুদের জন্য প্রযোজ্য, সুতরাং সংখ্যা, অক্ষর, বস্তু ও রং উপপরীক্ষার জন্য যথাক্রমে 28, 29, 52 এবং 46 সেকেন্ড স্কোর প্রত্যাশিত। T2-এর জন্য, প্রোটোকল (TENA)-এর 9 বছর 6 মাস বয়সের স্বাভাবিকতার মান ব্যবহার করা হয়, যেখানে সংখ্যা, অক্ষর, বস্তু ও রং উপপরীক্ষার জন্য প্রত্যাশিত স্কোর যথাক্রমে 35, 32, 50, 53 সেকেন্ড।\n\nপড়া: প্রথমে Protocol for the Assessment of Reading of Words/Pseudowords Isolated – LPI(16) ব্যবহার করা হয়, যেখানে শিশুটিকে শব্দ ও ছদ্ম-শব্দ জোরে পড়তে বলা হয় এবং সেগুলো স্কোর করা হয়। 19টি নিয়মিত শব্দ, 20টি অনিয়মিত শব্দ এবং 20টি ছদ্ম-শব্দ কালো Arial ফন্ট, সাইজ 24 এবং সাদা পটভূমিতে সাজানো থাকে। প্রতিটি সঠিক পড়ার জন্য এক পয়েন্ট হিসেবে মোট 59 পয়েন্ট অর্জন করা যায়। এরপর Protocol for the Assessment of Reading of Expository Texts(17) ব্যবহার করা হয়। এই যন্ত্রটি বিষয়ভিত্তিক শ্রেণির উপযোগী পাঠ্য সম্পর্কে নির্দেশিত প্রশ্নের মাধ্যমে পড়া বোঝার ক্ষমতা মূল্যায়ন করে। এটি নীরব ও মৌখিক পড়ার ধরন মূল্যায়ন ও সময় নির্ধারণ করে। এর মাধ্যমে পড়ার স্তর যাচাই ও তুলনা করা যায়। এছাড়াও, প্রতি মিনিটে পড়া শব্দের সংখ্যা গড় করে পড়ার গতি যাচাই ও তুলনা করা যায়।\n\nলেখা: লেখার মূল্যায়নের জন্য শিশুটিকে তার আগ্রহের একটি বিষয়ে একটি লেখা তৈরি করতে বলা হয়। গল্প শেষ করার পর, পেশাজীবী শিশুটিকে লিখিত অংশ জোরে পড়তে বলেন। এছাড়াও, শিশুটিকে LPI(16)-এর লক্ষ্য শব্দগুলো আলাদা কাগজে লিখতে বলা হয়, যাতে শব্দ ও ছদ্ম-শব্দের ডিকটেশন করা যায়। এর মাধ্যমে Zorzi এবং Ciasca(18)-এর বানান বিশ্লেষণের ভিত্তিতে লেখার একটি গুণগত তদন্ত পরিচালিত হয়।\n\nরিমেডিয়েশনটি ডিসলেক্সিয়া আক্রান্ত শিশুদের জন্য ব্যবহৃত একটি প্রোগ্রামের উপর ভিত্তি করে ছিল(19) এবং এতে ফোনোলজিক্যাল দক্ষতা উন্নত করার লক্ষ্যে কার্যক্রম অন্তর্ভুক্ত ছিল, যেমন: গ্রাফিম ও ফোনেম সনাক্তকরণ, ফোনেম জোড়া, সিলেবল জোড়া, শব্দ জোড়া, ফোনেম যোগ ও বিয়োগ, সিলেবলিক ও ফোনেমিক ম্যানিপুলেশন, ছড়া, অলিটারেশন, মানসিক লেক্সিকনে প্রবেশাধিকার, ভিজ্যুয়াল ওয়ার্কিং মেমোরি, শ্রবণ ওয়ার্কিং মেমোরি এবং পড়ার প্রশিক্ষণ। সব সেশনে, এই কার্যক্রমগুলো খেলাধুলার মাধ্যমে অনুসন্ধান করা হয়, প্রধানত ফোনোলজিক্যাল সচেতনতার মেটালিঙ্গুইস্টিক দিকগুলোর প্রতি লক্ষ্য রেখে। পড়ার প্রশিক্ষণে, শিশুটিকে Mico Maneco সংগ্রহের শিশুতোষ বইয়ের সংস্পর্শে আনা হয়। এই সংগ্রহে বিভিন্ন গল্প রয়েছে, যা শব্দের জটিলতার স্তর বৃদ্ধি করে, ফলে শিশুর অগ্রগতি অনুসরণ করা সম্ভব হয়। প্রতিটি সেশনের শেষে সম্পাদিত কার্যক্রম ও শিশুর অগ্রগতি তার মেডিকেল রেকর্ডে বর্ণনা করা হয়।\n\nপ্রাপ্ত ফলাফল বিশ্লেষণ করে দেখা যায়, ফোনোলজিক্যাল সচেতনতার কর্মক্ষমতার ক্ষেত্রে উভয় মূল্যায়নেই শিশুটি প্রতিটি সময়ে উপস্থাপিত লেখন অনুমানের সাথে সামঞ্জস্যপূর্ণ পারফরম্যান্স প্রদর্শন করেছে। প্রথম মূল্যায়নে সে সিলেবলিক-অ্যালফাবেটিক লেখন অনুমান পেয়েছে এবং দ্বিতীয়টিতে অ্যালফাবেটিক অনুমান, যা অগ্রগতি নির্দেশ করে। দক্ষতার উভয় বিভাগে স্কোর বৃদ্ধি পেয়েছে, সিলেবলিক (T1 = 35; T2 = 37) এবং ফোনেমিক (T1 = 14; T2 = 20) (টেবিল 1)। ফোনেমিক স্তরে 4টি অতিরিক্ত সাফল্যের অগ্রগতি উল্লেখযোগ্য, যা ফোনেমিক স্তরে কেন্দ্রীভূত ফোনোলজিক্যাল রিমেডিয়েশনের কারণে ব্যাখ্যা করা যায়।\n\nফোনোলজিক্যাল রিমেডিয়েশনের পূর্ববর্তী সময়ে ফোনোলজিক্যাল ওয়ার্কিং মেমোরির ফলাফল ছদ্ম-শব্দ শ্রেণিতে প্রত্যাশিতের নিচে পারফরম্যান্স প্রদর্শন করেছে, T1-এ 66 পয়েন্ট, যেখানে T1-এর প্রত্যাশিত মান (ET1) ছিল 69, এবং বিপরীত ক্রমের সংখ্যার শ্রেণিতে (T1 = 04; ET1 = 06) (টেবিল 1)। তা সত্ত্বেও, সরাসরি সংখ্যার শ্রেণিতে প্রত্যাশিত সীমার মধ্যে ফলাফল উপস্থাপন করেছে (T1 = 20; ET1 = 13)। হস্তক্ষেপ-পরবর্তী মূল্যায়নে (T2), ফলাফলগুলো বয়স অনুযায়ী উপযুক্ত। এছাড়াও, সব শ্রেণিতেই এই দক্ষতার অগ্রগতি লক্ষ্য করা যায়, ছদ্ম-শব্দ (T1 = 66; T2 = 69), বিপরীত ক্রমের সংখ্যা (T1 = 04; T2 = 12) (টেবিল 1), যা নির্বাহী কার্যাবলীর দিকগুলো প্রয়োজন করে, যা দ্রুত প্রতিক্রিয়া সংরক্ষণে সহায়তা করে, উচ্চ সক্ষমতার একটি ভিন্নতামূলক দিক।\n\nস্বয়ংক্রিয় দ্রুত নামকরণের ক্ষেত্রে, দেখা যায় যে T1-এ সব উপপরীক্ষায় স্বাভাবিকতার মানদণ্ড অনুযায়ী পারফরম্যান্স অপর্যাপ্ত। এছাড়াও বলা যায় যে T2-এ সংখ্যা (T2 = 41; ET2 = 35), বস্তু (T2 = 59; ET2 = 50) এবং রং (T2 = 56; ET2 = 53) শ্রেণিতে প্রত্যাশিতের নিচে পারফরম্যান্স ছিল। শুধুমাত্র অক্ষর শ্রেণিতে প্রত্যাশিতের মধ্যে ফলাফল পাওয়া যায় (T2 = 29; ET2 = 32)। অন্যদিকে, অক্ষর (T1 = 37; T2 = 29), বস্তু (T1 = 62; T2 = 59) এবং রং (T1 = 60; T2 = 56) উপপরীক্ষায় নামকরণের গতিতে অগ্রগতি দৃশ্যমান, সংখ্যার ক্ষেত্রে ব্যতিক্রম (T1 = 37; T2 = 41) (টেবিল 1)। উদ্দীপনা নামকরণের সময় হ্রাস পাওয়ায় বলা যায় যে শিশুটি ফোনোলজিক্যাল ও ভিজ্যুয়াল প্রতিনিধিত্বের স্তরে মানসিক লেক্সিকনে প্রবেশে আরও কার্যকর হয়েছে, যা বিচ্ছিন্ন ডিসলেক্সিয়ায় সাধারণত দেখা যায় না।\n\nপড়ার ক্ষেত্রে, T1-এ সে অ্যালফাবেটিক স্তর এবং T2-এ অরথোগ্রাফিক স্তর উপস্থাপন করেছে। প্রথম পরীক্ষায় লক্ষ্য করা যায় যে ভিজ্যুয়ালি সদৃশ এবং ফোনোলজিক্যালি নিকটবর্তী অক্ষরের ক্ষেত্রে প্রধানত অসুবিধা ছিল। এছাড়াও, শিক্ষার্থী ডিকোডিংয়ের জন্য সাব-ভোকাল সহায়তা ব্যবহার করেছিল এবং প্রতি মিনিটে গড়ে 20টি শব্দ পড়েছিল, যা অত্যন্ত ধীর ডিকোডিং নির্দেশ করে এবং তার শিক্ষাগত স্তরের জন্য প্রত্যাশিতের অনেক নিচে। পুনর্মূল্যায়নে, মৌখিক পড়ায় তার গড় ছিল প্রতি মিনিটে 94.4টি শব্দ, যা তার শিক্ষাগত স্তরের জন্য উপযুক্ত হিসেবে বিবেচিত। সে প্রোসোডি, ছন্দ, সামগ্রিক পড়া, আগ্রহ এবং উপযুক্ত বোধগম্যতা প্রদর্শন করেছে। গুণগতভাবে, পর্যবেক্ষণ করা যায় যে শিশু, উপযুক্ত পারফরম্যান্স সত্ত্বেও, কম স্বরের তীব্রতায় পড়েছে, যা এখনও কাজটি সম্পাদনে অনিরাপত্তা নির্দেশ করে।\n\nলেখার ক্ষেত্রে, দেখা যায় যে T1-এ শিশুটির পেন্সিল ধরার ভঙ্গি অপর্যাপ্ত ছিল, লেখা ছিল অনির্দিষ্ট, অক্ষর পরিবর্তন, বাদ পড়া, হাইপার ও হাইপোসেগমেন্টেশন, শব্দ পুনরাবৃত্তি এবং সংহত উপাদানের কম ব্যবহারসহ। এই সময়ে, তার লেখা সিলেবলিক-অ্যালফাবেটিক পর্যায় থেকে অ্যালফাবেটিক পর্যায়ে রূপান্তরের অবস্থায় ছিল। T2-এ উল্লেখযোগ্য পরিবর্তন দেখা যায়নি, কারণ তার লেখা অনির্দিষ্টই রয়ে গেছে, বিষয়বস্তুর কম বোধগম্যতা, অক্ষরের মধ্যে ভিজ্যুয়াল সাদৃশ্য (যেমন “d” এবং “b”) এবং যতিচিহ্নের অভাবসহ। সংগৃহীত নমুনা অনুযায়ী, তাকে লেখার অ্যালফাবেটিক পর্যায়ে দেখা গেছে, যদিও তার বয়সের জন্য প্রত্যাশিত নয় এমন অসুবিধা স্থায়ী ছিল। তা সত্ত্বেও, লক্ষ্য করা যায় যে সে ভিজ্যুয়াল ইনপুটের লেক্সিকনের জন্য শব্দভাণ্ডার ব্যবহারে বৃহত্তর রেপার্টরি ব্যবহার করেছে।\n\nফলাফলসমূহ সামগ্রিকভাবে বিশ্লেষণ করার পর, দেখা যায় যে মূল্যায়নগুলোর মধ্যবর্তী সময়ে লিখিত ভাষার দক্ষতায় অগ্রগতি হয়েছে, যদিও ডিসলেক্সিয়ার সাথে সামঞ্জস্যপূর্ণ বৈশিষ্ট্যগুলোর স্থায়িত্ব রয়েছে, কারণ মানসিক লেক্সিকনে প্রবেশাধিকার এবং লেখায় এখনও প্রত্যাশিতের নিচে পারফরম্যান্স দেখা যায় – যেখানে শ্রাব্য ও ভিজ্যুয়ালি সদৃশ ফোনেমের মধ্যে বিনিময় স্থায়ীভাবে উপস্থিত, অক্ষর বাদ পড়া এবং হাইপারসেগমেন্টেশন রয়েছে।\n",
+    "translated_summary": "এই গবেষণাটি একটি ৯ বছর বয়সী শিশুর ক্ষেত্রে ডিসলেক্সিয়ার সঙ্গে সম্পর্কিত উচ্চ ক্ষমতাগুলোর একটি বিশেষ সমন্বয়ের মূল্যায়ন এবং হস্তক্ষেপ প্রক্রিয়ার একটি দৃষ্টান্তমূলক প্রতিবেদন। এর উদ্দেশ্য ছিল ধ্বনিতাত্ত্বিক প্রক্রিয়াকরণ, পঠন এবং লিখন সম্পর্কিত কাজগুলোতে ধ্বনিতাত্ত্বিক সংশোধনীর আগে এবং পরের কর্মক্ষমতার তুলনা করা। প্রথম মূল্যায়নে দেখা যায়, শিশুটি পঠনে বর্ণভিত্তিক স্তরে দক্ষতা প্রদর্শন করে, লেখনে সিলেবল-বর্ণভিত্তিক এবং বর্ণভিত্তিক স্তরের মধ্যে একটি পরিবর্তনশীল পর্যায়ে ছিল এবং ধ্বনিতাত্ত্বিক প্রক্রিয়াকরণ ক্ষমতার ক্ষেত্রে প্রত্যাশিত স্তরের চেয়ে কম দক্ষতা দেখায়। হস্তক্ষেপের পরে, ধ্বনিতাত্ত্বিক প্রক্রিয়াকরণ ক্ষমতা, বর্ণভিত্তিক লেখার উন্নতি এবং পঠনের অর্থোগ্রাফিক স্তরে উন্নতি দেখা যায়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_180.txt",
+    "fulltext": "The 52-year-old man tested positive for SARS-CoV-2 using a self-test kit after having a cold. He returned to work without fever after resting for two days, but lost consciousness while working outdoors in an ambient temperature of 35°C for five hours. Upon admission to the local hospital’s emergency department, his core temperature (Tc) was recorded as 40°C. The patient presented with persistent coma, dyspnea and gastrointestinal hemorrhage. No underlying diseases and relative family history was noted. Based on the characteristic presentation of hyperpyrexia, coma and multiple organ damage, a diagnosis of HS was established. He was admitted to emergency intensive care unit (ICU) of the local hospital and then received mechanical ventilation. The test results indicated the presence of pulmonary infection, hepatic and renal dysfunction, myocardial ischemia and coagulation disorders. The patient received initial management including rehydration (intravenously infused Lactated Ringer’s solution and normal saline at a rate of 2.5mL/kg∙h), intravenous administration of Piperacillin Sodium and Tazobactam Sodium, vasoactive medications for blood pressure support, continuous mechanical ventilation, and continuous renal replacement therapy (CRRT) to manage subsequent anuria. The patient received plasma transfusion and was administered Tranexamic acid on day 5. The worsening of his condition led to his admission to the medical ICU of our hospital 7 days after HS.\n\nFollowing admission, Reverse-transcription polymerase chain reaction (RT-PCR) testing of a nasopharyngeal swab yielded positive results for SARS-CoV-2. The patient was diagnosed with HS and severe COVID-19 based on China’s COVID-19 Diagnosis and Treatment Program (trial version 10): 1. real-time fluorescent RT-PCR detection of SARS-CoV-2 nucleic acid is positive; 2. respiratory failure and requires mechanical ventilation; 3. shock; 4. combined with multiple organ failure requiring intensive care. The patient had no contact with COVID-19 diagnosed patients or healthcare workers in the hospital, indicating community-acquired infection. The physical examination showed a Glasgow Coma Scale (GCS) score of 3/15, with scores of 1 for eye-opening, verbal response, and motor response. Additionally, the pupils were symmetrical and non-reactive. The heart rate was recorded at 106 bpm and blood pressure was maintained at 126/77 mmHg by continuously infusing norepinephrine at a rate of 0.4 ug/kg·min. The laboratory test results indicated a severe infection, along with anemia, thrombocytopenia, disseminated intravascular coagulation (DIC), as well as acute liver and kidney injury. The white blood cell count (WBC) decreased from 3.55×109/L to 3.13×109/L, lymphocytes significantly decreased from 0.25×109/L to 0.1×109/L, and neutrophil percentage (N%) increased to 85.3%. The Procalcitonin level measured 2.81 ng/mL and C-reactive protein (CRP) level was 32.6 mg/L. Sputum culture testing yielded Stenotrophomonas Maltophilia and Candida lipolytica. The central venous catheter culture test detected Staphylococcus epidermidis, but the continuous blood culture test yielded no positive results. The Computed Tomography (CT) scan revealed bilateral frontal subdural effusion, consolidation and atelectasis in the lower lungs, inflammation in the right upper lobe, bilateral pleural effusion, and a small amount of abdominal fluid.\n\nThe patient received synchronized intermittent mandatory ventilation with a positive end expiratory pressure of 5 mmH2O and an oxygen concentration of 80% and continuous administration of norepinephrine and pituitrin to sustain normal blood pressure. Polyene phosphatidylcholine, adenosylmethionine budisulfonate, ulinastatin, and hemofiltration have been employed for the management of hepatic and renal dysfunction. The antibiotic was substituted with Meropenem and Thymalfasin was administered for 20 days to augment immune function. Mannitol was used to alleviate intracranial pressure for 3 days. To improve coagulation dysfunction, the patient received plasma and cryoprecipitate transfusions, continuous intravenous infusion of heparin sodium at 6000u/day and CRRT with sodium citrate for anticoagulant (8g/day) on day 7. Platelet transfusion was administered after 9 days of HS. His Tc fluctuated between 36 °C and 38.5 °C. CRRT was administered without anticoagulant on day 8. The patient had gastrointestinal hemorrhage and fever after 9 days of HS, but electronic gastroenteroscopy showed no signs of active bleeding. He underwent red blood cell suspension transfusion, hemostasis treatment and gastric acid suppression. Teicoplanin was added due to the presence of Methicillin-resistant Staphylococcus aureus isolated from sputum culture. The patient regained consciousness on day 13 with a GCS score of 14/15 and presented with a moderate fever. Gastrointestinal hemorrhage was not observed. Mechanical ventilation was discontinued and the tracheal tube was removed. But the creatinine levels increased following the suspension of CRRT on day 12.\n\nOn day 17, he developed sudden dyspnea with desaturation (oxygen saturation <85%) followed by a high fever (Tc: 39.3°C), necessitating reintubation and mechanical ventilation. Bronchoscopy revealed less sputum in both lungs and subbranches. He experienced a recurrence of coma, with a GCS score of 3/15. WBC increased to 14.94×109/L and NEU increased to 13.77×109/L. The levels of serum total bilirubin rose to 235.2 µmol/L, while creatinine increased to 441µmol/L. The brain CT scan revealed an ischemic stroke in the right frontal lobe and a hemorrhagic infarction in the right occipital lobe. The patient underwent cooling therapy using CRRT with ice-cold replacement fluid, along with persistent administration of Meropenem and Teicoplanin for anti-infection treatment. Carpofungin was added on day 18 due to the observed elevation in serum levels of Aspergillus galactomannan, Aspergillus IgG antibody, and Candida mannan. The RT-PCR testing for SARS-CoV-2 returned negative results.\n\nThe patient’s fever and infection improved on day 20, but he subsequently developed cerebral hemorrhage and hernia with bilateral dilated pupils. The dehydration therapy was used to reduce intracranial pressure, as surgery was refused by his family. On day 22, indicators of infection, levels of aspartate aminotransferase and creatinine increased again. Carbapenem-resistant Acinetobacter baumannii and A. fumigatus were cultured in the bronchoalveolar lavage fluid. The combination of Meropenem, Teicoplanin, and Carpofungine was administered for anti-infective therapy. The patient’s condition progressively worsened over the next 7 days, ultimately resulting in his demise on day 29. The patients’ inflammatory indicators, cytokines, and coagulation indicators are presented in Table 1.",
+    "summary": "We report the first case of heatstroke comorbid with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in a 52-year-old male. After receiving intravenous antibiotics, organ protection measures, and treatment for coagulation disorders, his fever and coma resolved. However, he developed dyspnea and cerebral hemorrhage after several days. This patient experienced a multi-pathogen pulmonary infection and an intractable coagulopathy that ultimately resulted in MODS and death.",
+    "translated_fulltext": "৫২ বছর বয়সী এই পুরুষ ব্যক্তি সর্দি হওয়ার পর একটি স্ব-পরীক্ষা কিট ব্যবহার করে SARS-CoV-2 পজিটিভ শনাক্ত হন। দুই দিন বিশ্রামের পর জ্বর না থাকায় তিনি কাজে ফিরে যান, কিন্তু ৩৫°C পরিবেষ্টিত তাপমাত্রায় টানা পাঁচ ঘণ্টা বাইরে কাজ করার সময় অজ্ঞান হয়ে পড়েন। স্থানীয় হাসপাতালের জরুরি বিভাগের ভর্তি হওয়ার সময় তার কোর তাপমাত্রা (Tc) ৪০°C রেকর্ড করা হয়। রোগী স্থায়ী কোমা, শ্বাসকষ্ট (dyspnea) এবং গ্যাস্ট্রোইনটেস্টিনাল হেমোরেজ নিয়ে উপস্থিত হন। কোনো অন্তর্নিহিত রোগ বা পারিবারিক রোগ ইতিহাস পাওয়া যায়নি। হাইপারপাইরেক্সিয়া, কোমা এবং একাধিক অঙ্গ ক্ষতির বৈশিষ্ট্যপূর্ণ উপস্থাপনার ভিত্তিতে HS নির্ণয় করা হয়। তাকে স্থানীয় হাসপাতালের জরুরি নিবিড় পরিচর্যা ইউনিটে (ICU) ভর্তি করা হয় এবং পরে মেকানিক্যাল ভেন্টিলেশন প্রদান করা হয়। পরীক্ষার ফলাফল ফুসফুসের সংক্রমণ, যকৃত ও কিডনি অকার্যকারিতা, মায়োকার্ডিয়াল ইস্কেমিয়া এবং জমাট বাঁধার ব্যাধির উপস্থিতি নির্দেশ করে। রোগী প্রাথমিক ব্যবস্থাপনা হিসেবে রিহাইড্রেশন (শিরায় Lactated Ringer’s solution এবং normal saline 2.5mL/kg∙h হারে), Piperacillin Sodium এবং Tazobactam Sodium-এর শিরায় প্রয়োগ, রক্তচাপ সমর্থনের জন্য ভ্যাসোঅ্যাকটিভ ওষুধ, ধারাবাহিক মেকানিক্যাল ভেন্টিলেশন এবং পরবর্তী অ্যানুরিয়া ব্যবস্থাপনার জন্য ধারাবাহিক রেনাল রিপ্লেসমেন্ট থেরাপি (CRRT) গ্রহণ করেন। পঞ্চম দিনে রোগীকে প্লাজমা ট্রান্সফিউশন দেওয়া হয় এবং Tranexamic acid প্রদান করা হয়। অবস্থার অবনতি হওয়ায় HS-এর ৭ দিন পর তাকে আমাদের হাসপাতালের মেডিকেল ICU-তে ভর্তি করা হয়।\n\nভর্তির পর ন্যাসোফ্যারিঞ্জিয়াল সোয়াবের রিভার্স-ট্রান্সক্রিপশন পলিমারেজ চেইন রিঅ্যাকশন (RT-PCR) পরীক্ষায় SARS-CoV-2 পজিটিভ পাওয়া যায়। চীনের COVID-19 Diagnosis and Treatment Program (trial version 10) অনুযায়ী রোগীকে HS এবং গুরুতর COVID-19 হিসেবে নির্ণয় করা হয়: ১. রিয়েল-টাইম ফ্লুরোসেন্ট RT-PCR দ্বারা SARS-CoV-2 নিউক্লিক অ্যাসিড পজিটিভ; ২. শ্বাসযন্ত্রের ব্যর্থতা এবং মেকানিক্যাল ভেন্টিলেশনের প্রয়োজন; ৩. শক; ৪. একাধিক অঙ্গ ব্যর্থতার সাথে যুক্ত যা নিবিড় পরিচর্যা প্রয়োজন। রোগীর হাসপাতালে COVID-19 নির্ণীত রোগী বা স্বাস্থ্যকর্মীর সঙ্গে কোনো সংস্পর্শ ছিল না, যা কমিউনিটি-অর্জিত সংক্রমণ নির্দেশ করে। শারীরিক পরীক্ষায় Glasgow Coma Scale (GCS) স্কোর ছিল ৩/১৫, যেখানে চোখ খোলা, মৌখিক প্রতিক্রিয়া এবং মোটর প্রতিক্রিয়ার জন্য প্রত্যেকটির স্কোর ছিল ১। এছাড়াও, পিউপিল সমমিত এবং প্রতিক্রিয়াহীন ছিল। হার্ট রেট ১০৬ bpm রেকর্ড করা হয় এবং 0.4 ug/kg·min হারে নরএপিনেফ্রিন ধারাবাহিকভাবে শিরায় প্রদান করে রক্তচাপ ১২৬/৭৭ mmHg বজায় রাখা হয়। ল্যাবরেটরি পরীক্ষায় তীব্র সংক্রমণ, অ্যানিমিয়া, থ্রম্বোসাইটোপেনিয়া, disseminated intravascular coagulation (DIC), পাশাপাশি তীব্র যকৃত ও কিডনি ক্ষতি নির্দেশ করে। শ্বেত রক্তকণিকা গণনা (WBC) 3.55×109/L থেকে কমে 3.13×109/L হয়, লিম্ফোসাইট উল্লেখযোগ্যভাবে 0.25×109/L থেকে 0.1×109/L-এ নেমে যায় এবং নিউট্রোফিল শতাংশ (N%) বেড়ে 85.3% হয়। Procalcitonin এর মাত্রা ছিল 2.81 ng/mL এবং C-reactive protein (CRP) এর মাত্রা ছিল 32.6 mg/L। স্পুটাম কালচারে Stenotrophomonas Maltophilia এবং Candida lipolytica পাওয়া যায়। সেন্ট্রাল ভেনাস ক্যাথেটার কালচারে Staphylococcus epidermidis শনাক্ত হয়, তবে ধারাবাহিক রক্ত কালচারে কোনো পজিটিভ ফল পাওয়া যায়নি। কম্পিউটেড টোমোগ্রাফি (CT) স্ক্যানে উভয় ফ্রন্টাল সাবডিউরাল ইফিউশন, নিম্ন ফুসফুসে কনসোলিডেশন ও অ্যাটেলেকটাসিস, ডান উপরের লোবে প্রদাহ, উভয় পার্শ্বে প্লুরাল ইফিউশন এবং অল্প পরিমাণ অ্যাবডোমিনাল ফ্লুইড দেখা যায়।\n\nরোগীকে synchronized intermittent mandatory ventilation দেওয়া হয়, যেখানে positive end expiratory pressure ছিল 5 mmH2O এবং অক্সিজেন কনসেন্ট্রেশন ছিল 80%, পাশাপাশি স্বাভাবিক রক্তচাপ বজায় রাখতে নরএপিনেফ্রিন ও পিটুইট্রিন ধারাবাহিকভাবে প্রদান করা হয়। Polyene phosphatidylcholine, adenosylmethionine budisulfonate, ulinastatin এবং হেমোফিল্ট্রেশন যকৃত ও কিডনি অকার্যকারিতা ব্যবস্থাপনায় ব্যবহৃত হয়। অ্যান্টিবায়োটিক পরিবর্তন করে Meropenem দেওয়া হয় এবং রোগ প্রতিরোধ ক্ষমতা বৃদ্ধির জন্য Thymalfasin ২০ দিন প্রদান করা হয়। ইনট্রাক্রানিয়াল চাপ কমাতে ৩ দিন Mannitol ব্যবহার করা হয়। কোয়াগুলেশন অকার্যকারিতা উন্নত করতে রোগীকে প্লাজমা ও ক্রায়োপ্রেসিপিটেট ট্রান্সফিউশন, শিরায় হেপারিন সোডিয়াম 6000u/day হারে ধারাবাহিক ইনফিউশন এবং সপ্তম দিনে সোডিয়াম সাইট্রেট (8g/day) অ্যান্টিকোয়াগুল্যান্টসহ CRRT প্রদান করা হয়। HS-এর ৯ দিন পর প্লেটলেট ট্রান্সফিউশন দেওয়া হয়। তার Tc 36°C থেকে 38.5°C এর মধ্যে ওঠানামা করে। অষ্টম দিনে কোনো অ্যান্টিকোয়াগুল্যান্ট ছাড়া CRRT প্রদান করা হয়। HS-এর ৯ দিন পর রোগীর গ্যাস্ট্রোইনটেস্টিনাল হেমোরেজ ও জ্বর দেখা দেয়, তবে ইলেকট্রনিক গ্যাস্ট্রোএন্টারোস্কোপিতে সক্রিয় রক্তপাতের কোনো চিহ্ন পাওয়া যায়নি। তাকে রেড ব্লাড সেল সাসপেনশন ট্রান্সফিউশন, হেমোস্ট্যাসিস চিকিৎসা এবং গ্যাস্ট্রিক অ্যাসিড সাপ্রেশন দেওয়া হয়। স্পুটাম কালচারে Methicillin-resistant Staphylococcus aureus পাওয়ায় Teicoplanin যোগ করা হয়। ১৩তম দিনে রোগী চেতনা ফিরে পান, GCS স্কোর হয় ১৪/১৫ এবং মাঝারি জ্বর থাকে। গ্যাস্ট্রোইনটেস্টিনাল হেমোরেজ দেখা যায়নি। মেকানিক্যাল ভেন্টিলেশন বন্ধ করা হয় এবং ট্র্যাকিয়াল টিউব অপসারণ করা হয়। তবে ১২তম দিনে CRRT বন্ধ করার পর ক্রিয়াটিনিনের মাত্রা বৃদ্ধি পায়।\n\n১৭তম দিনে তিনি হঠাৎ শ্বাসকষ্ট ও ডেস্যাচুরেশন (অক্সিজেন স্যাচুরেশন <85%) এবং পরবর্তীতে উচ্চ জ্বর (Tc: 39.3°C) নিয়ে আক্রান্ত হন, যার ফলে পুনরায় ইন্টুবেশন ও মেকানিক্যাল ভেন্টিলেশন প্রয়োজন হয়। ব্রঙ্কোস্কোপিতে উভয় ফুসফুস ও সাবব্রাঞ্চে অল্প পরিমাণ স্পুটাম দেখা যায়। তিনি পুনরায় কোমায় চলে যান, GCS স্কোর হয় ৩/১৫। WBC বেড়ে 14.94×109/L হয় এবং NEU বেড়ে 13.77×109/L হয়। সিরাম মোট বিলিরুবিনের মাত্রা বেড়ে 235.2 µmol/L হয়, আর ক্রিয়াটিনিন বেড়ে 441 µmol/L হয়। মস্তিষ্কের CT স্ক্যানে ডান ফ্রন্টাল লোবে ইস্কেমিক স্ট্রোক এবং ডান অক্সিপিটাল লোবে হেমোরেজিক ইনফার্কশন দেখা যায়। রোগীকে বরফ-ঠান্ডা রিপ্লেসমেন্ট ফ্লুইডসহ CRRT ব্যবহার করে কুলিং থেরাপি দেওয়া হয় এবং সংক্রমণবিরোধী চিকিৎসার জন্য Meropenem ও Teicoplanin ধারাবাহিকভাবে প্রদান করা হয়। ১৮তম দিনে সিরামে Aspergillus galactomannan, Aspergillus IgG antibody এবং Candida mannan এর মাত্রা বৃদ্ধির কারণে Carpofungin যোগ করা হয়। SARS-CoV-2 এর RT-PCR পরীক্ষা নেগেটিভ ফল দেয়।\n\n২০তম দিনে রোগীর জ্বর ও সংক্রমণের উন্নতি হয়, তবে পরবর্তীতে তিনি সেরিব্রাল হেমোরেজ ও হার্নিয়েশনে আক্রান্ত হন এবং উভয় পিউপিল প্রসারিত হয়। পরিবারের পক্ষ থেকে অস্ত্রোপচার প্রত্যাখ্যান করায় ইনট্রাক্রানিয়াল চাপ কমাতে ডিহাইড্রেশন থেরাপি ব্যবহার করা হয়। ২২তম দিনে সংক্রমণের সূচক, aspartate aminotransferase এবং ক্রিয়াটিনিনের মাত্রা পুনরায় বৃদ্ধি পায়। ব্রঙ্কোঅ্যালভিওলার ল্যাভাজ ফ্লুইডে Carbapenem-resistant Acinetobacter baumannii এবং A. fumigatus কালচার হয়। সংক্রমণবিরোধী চিকিৎসার জন্য Meropenem, Teicoplanin এবং Carpofungine এর সমন্বয় প্রদান করা হয়। পরবর্তী ৭ দিনে রোগীর অবস্থা ক্রমান্বয়ে অবনতি ঘটে এবং শেষ পর্যন্ত ২৯তম দিনে তার মৃত্যু হয়। রোগীর প্রদাহজনিত সূচক, সাইটোকাইন এবং কোয়াগুলেশন সূচকসমূহ টেবিল ১-এ উপস্থাপন করা হয়েছে।\n",
+    "translated_summary": "আমরা ৫২ বছর বয়সী একজন পুরুষের মধ্যে তীব্র শ্বাসযন্ত্রের সিনড্রোম করোনাভাইরাস ২ (SARS-CoV-2) সংক্রমণের সাথে হিটস্ট্রোকের প্রথম ঘটনাটি নথিভুক্ত করছি। শিরায় অ্যান্টিবায়োটিক, অঙ্গ-সুরক্ষার ব্যবস্থা এবং রক্ত জমাট বাঁধার সমস্যাগুলোর চিকিৎসার পর তার জ্বর এবং কোমা সেরে যায়। তবে, কয়েক দিন পর তার শ্বাসকষ্ট এবং মস্তিষ্কে রক্তক্ষরণ হয়। এই রোগী একাধিক প্যাথোজেন দ্বারা সৃষ্ট ফুসফুসের সংক্রমণ এবং জটিল রক্ত জমাট বাঁধার সমস্যায় ভুগছিলেন, যা শেষ পর্যন্ত মাল্টি-অর্গান ডিসফাংশন সিনড্রোম (MODS) এবং মৃত্যুর কারণ হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_91.txt",
+    "fulltext": "A 13-year-old adolescent male, with no significant previous medical history, presented to the emergency department with a 3-day history of acute bilateral pleuritic chest pain associated with mild non-productive cough and no dyspnea. Associated with this, he had mild rhinorrhea and a single febrile episode that day (temperature of 38ºC). Chest pain was localized to the costal margin region and worsened with cough, without diurnal variation. The patient-reported relief with paracetamol. There were no complaints of joint pain, weight loss, anorexia, fatigue, episodes of syncope or exercise restriction. In fact, he practiced sports regularly—canoeing 2 times a week. No evidence of an infectious exposure or contact with household or environmental fumes, dust, or mineral oils was described. There was no known family history of cardiopulmonary conditions. He had a chest radiograph taken 4 years earlier during an acute illness, which showed a marked interstitial infiltrate that was presumptively treated with azithromycin with no further clinical symptoms and no further follow-up.\n\nOn admission, the patient’s temperature was 37.8°C with normal peripheral oxygen saturation (99%) in room air. His heart (93 beats per minute) and respiratory rate (15 breaths per minute) were normal and blood pressure was on the 85th percentile (115/66 mmHg). Physical examination revealed diminished breath sounds in the lower two thirds of the chest with no adventitious sounds. No respiratory distress, finger clubbing, cyanosis, abnormal heart sounds, or other findings were present. Chest radiograph revealed a marked interstitial infiltrate, comparable with his previous examination. A thoracic computed tomography (CT) revealed multiple bilateral areas of ground-glass opacities involving > 65% of lung parenchyma, suggestive of PAP. Respiratory viral testing was negative, and he remained stable throughout his monitoring in the emergency department. He was discharged with empiric antibiotics (amoxicillin-clavulanic acid and azithromycin) to cover a potential respiratory infection, with clinical resolution of symptoms and was sent for follow-up at the pediatric respiratory clinic.\n\nUpon further investigation in the outpatient setting, positive antinuclear antibodies (ANAs) at a titer of 1/89 with a fine speckled pattern were detected, while other autoantibodies tested negative and immunoglobulin levels remained within normal limits. Bronchoalveolar lavage revealed fluid with a milky appearance and positive periodic acid-Schiff staining; microbiological examination, including for mycobacteria, returned negative results. Spirometry indicated a mild restrictive pattern with reduced forced vital capacity (FVC) at 2.92 L (77%) and forced expiratory volume in 1 second (FEV1) at 3.21 L (69.9%), alongside a normal FEV1/FVC ratio (109%). In addition, the DLCO single breath (SB) showed a moderate decrease at 13.8 ml/min/mmHg (48.6%). Suspecting PAP, a genetic panel was conducted, which showed no mutations associated with surfactant dysfunction. Subsequently, GM-CSF antibody testing was performed with a positive result, raising suspicion for AI-PAP. At 20 months of follow-up, the patient remains asymptomatic and continues to exercise regularly. He repeated spirometry testing with normal FVC at 4.03 L (81.3%); FEV1 at 3.71 L (87.5%); FEV1/FVC ratio at 91.96% and DLCO SB at 25.54 ml/min/mmHg (83.7%). As the patient remains stable with no respiratory symptoms, we decided to defer treatment and continue monitoring with regular clinic visits.",
+    "summary": "We describe the case of a 13-year-old adolescent male who presented to the emergency department with acute pleuritic chest pain not associated with systemic complaints. On examination, he had diminished breath sounds in the lower two thirds of the chest with no other abnormal findings; SpO2 (oxygen saturation) was 98% on room air. Chest radiograph revealed a marked interstitial infiltrate, comparable with the one taken 4 years earlier during an acute illness that was presumptively treated with azithromycin. A computed tomography (CT) scan revealed multiple bilateral areas of ground-glass opacities with areas of crazy paving, involving > 65% of lung parenchyma, suggestive of pulmonary alveolar proteinosis (PAP). Respiratory viral testing, including for coronavirus (SARS-CoV2), was negative. Bronchoalveolar lavage performed in the outpatient setting revealed a milky fluid and positive periodic acid-Schiff staining. Spirometry indicated a mild restrictive pattern (forced vital capacity [FVC] = 77%) and diffusing capacity of the lungs for carbon monoxide (DLCO) showed a moderate decrease at 48.6%. No mutations associated with surfactant dysfunction were found on the genetic panel. Anti-granulocyte macrophage colony-stimulating factor (GM-CSF) antibody testing was strongly positive, raising suspicion for autoimmune PAP. At 20 months of follow-up, the patient remains asymptomatic with a normal spirometry.",
+    "translated_fulltext": "তেরো বছর বয়সী একজন কিশোর, যার পূর্বে তেমন কোনো উল্লেখযোগ্য স্বাস্থ্য ইতিহাস নেই, সে তিনটি দিনের তীব্র বুকের ব্যথা নিয়ে জরুরি বিভাগে আসে। ব্যথার সাথে হালকা কাশি ছিল, তবে শ্বাসকষ্ট ছিল না। এর সাথে তার সামান্য নাক দিয়ে পানি পড়া এবং সেদিন একবার জ্বর (৩৮ ডিগ্রি সেলসিয়াস) হয়েছিল। বুকের ব্যথা বুকের নিচের অংশে সীমাবদ্ধ ছিল এবং কাশির সাথে বাড়তো, তবে দিনের বেলা কম বেশি হতো না। রোগী জানায় প্যারাসিটামল খেলে ব্যথা কমে যায়। তার গাঁটে ব্যথা, ওজন হ্রাস, ক্ষুধামান্দ্য, ক্লান্তি, অজ্ঞান হয়ে যাওয়া বা শারীরিক কার্যকলাপ সীমিত করার মতো কোনো সমস্যা ছিল না। আসলে, সে নিয়মিত খেলাধুলা করত—সপ্তাহে দুবার কায়াকিং করত। কোনো সংক্রামক পদার্থের সংস্পর্শে আসা বা বাড়ির ভেতরের বা বাইরের ধোঁয়া, ধুলো বা খনিজ তেলের সংস্পর্শে আসার কোনো প্রমাণ পাওয়া যায়নি। তার পরিবারে হৃদরোগ বা ফুসফুসের কোনো রোগের ইতিহাসও ছিল না। পূর্বে, তীব্র অসুস্থতার সময় চার বছর আগে তার বুকের একটি এক্স-রে করা হয়েছিল, যেখানে ফুসফুসে প্রদাহ দেখা যায় এবং অ্যাজিথ্রোমাইসিন দিয়ে চিকিৎসা করা হয়েছিল। এরপর আর কোনো উপসর্গ দেখা যায়নি এবং ফলো-আপের প্রয়োজন হয়নি।\n\nহাসপাতালে ভর্তির সময়, রোগীর শরীরের তাপমাত্রা ছিল ৩৭.৮ ডিগ্রি সেলসিয়াস এবং স্বাভাবিক অবস্থায় তার রক্তে অক্সিজেনের মাত্রা ছিল ৯৯%। তার হৃদস্পন্দন ছিল ৯৩ বিট প্রতি মিনিটে এবং শ্বাস-প্রশ্বাস ছিল ১৫ বার প্রতি মিনিটে, যা স্বাভাবিক ছিল। রক্তচাপ ছিল ৮৫তম পার্সেন্টাইলে (১১৫/৬৬ মিমি Hg)। শারীরিক পরীক্ষায় দেখা যায়, বুকের নিচের দুই-তৃতীয়াংশে শ্বাস-প্রশ্বাসের শব্দ দুর্বল হয়ে গেছে, তবে অন্য কোনো অস্বাভাবিক শব্দ ছিল না। শ্বাসকষ্ট, আঙুলের ডগায় ফোলাভাব, চামড়ার রঙ নীল হয়ে যাওয়া, হৃদস্পন্দনের অস্বাভাবিকতা বা অন্য কোনো উপসর্গ ছিল না। বুকের এক্স-রেতে ফুসফুসে প্রদাহ দেখা যায়, যা আগের পরীক্ষার সাথে তুলনীয়। বুকের সিটি স্ক্যানে ফুসফুসের প্রায় ৬৫% অংশে গ্রাউন্ড-গ্লাস অপাসিটির একাধিক ক্ষেত্র দেখা যায়, যা সম্ভবত PAP (Pulmonary Alveolar Proteinosis)-এর ইঙ্গিত দেয়। শ্বাসযন্ত্রের ভাইরাস পরীক্ষা করা হলে সেটি নেগেটিভ আসে এবং জরুরি বিভাগে থাকাকালীন তার অবস্থা স্থিতিশীল ছিল। সম্ভাব্য শ্বাসযন্ত্রের সংক্রমণ এড়াতে তাকে অ্যামোক্সিসিলিন-ক্ল্যাভুলানিক অ্যাসিড এবং অ্যাজিথ্রোমাইসিন দিয়ে চিকিৎসা করা হয় এবং উপসর্গগুলো ধীরে ধীরে কমতে শুরু করে। এরপর তাকে ফলো-আপের জন্য শিশু ফুসফুস ক্লিনিকে পাঠানো হয়।\n\nবহির্বিভাগে আরও পরীক্ষার পর, তার রক্তে অ্যান্টি-নিউক্লিয়ার অ্যান্টিবডি (ANA) পাওয়া যায়, যার মাত্রা ছিল ১/৮৯ এবং এটি সূক্ষ্ম ছোপযুক্ত প্যাটার্ন দেখায়। অন্যান্য অটোঅ্যান্টিবডি পরীক্ষা করা হলে সেগুলো নেগেটিভ আসে এবং ইমিউনোগ্লোবুলিনের মাত্রা স্বাভাবিক সীমার মধ্যে থাকে। ব্রঙ্কোআলভিওলার ল্যাভেজে (Bronchoalveolar lavage) দুগ্ধবর্ণের তরল পাওয়া যায় এবং পিরিয়ডিক অ্যাসিড-শিফ (periodic acid-Schiff) স্টেইনিং পজিটিভ ছিল। জীবাণু পরীক্ষা, যার মধ্যে মাইকোব্যাকটেরিয়াও অন্তর্ভুক্ত ছিল, নেগেটিভ ফলাফল দেয়। স্পাইরোমেট্রি (Spirometry) পরীক্ষায় সামান্যRestrictive প্যাটার্ন দেখা যায়, যেখানে forced vital capacity (FVC) ২.৯২ লিটার (৭৭%) এবং forced expiratory volume in 1 second (FEV1) ৩.২১ লিটার (৬৯.৯%) ছিল। FEV1/FVC অনুপাত ছিল স্বাভাবিক (১০৯%)। এছাড়াও, DLCO single breath (SB) পরীক্ষায় মাঝারি হ্রাস দেখা যায়, যা ছিল ১৩.৮ মিলি/মিনিট/মিমি Hg (৪৮.৬%)। PAP সন্দেহ করে, একটি জেনেটিক পরীক্ষা করা হয়, যেখানে সার্ফ্যাক্ট্যান্ট ডিসফাংশনের সাথে সম্পর্কিত কোনো মিউটেশন পাওয়া যায়নি। পরবর্তীতে, GM-CSF অ্যান্টিবডি পরীক্ষা করা হয়, যার ফলাফল পজিটিভ আসে, যা AI-PAP (Autoimmune Pulmonary Alveolar Proteinosis)-এর সম্ভাবনা বাড়িয়ে দেয়। ফলো-আপের ২০ মাস পর, রোগীর কোনো উপসর্গ নেই এবং সে নিয়মিত ব্যায়াম চালিয়ে যাচ্ছে। স্পাইরোমেট্রি পরীক্ষায় FVC ৪.০৩ লিটার (৮১.৩%), FEV1 ৩.৭১ লিটার (৮৭.৫%) এবং FEV1/FVC অনুপাত ৯১.৯৬% এবং DLCO SB ২৫.৫৪ মিলি/মিনিট/মিমি Hg (৮৩.৭%) পাওয়া যায়। যেহেতু রোগীর অবস্থা স্থিতিশীল এবং শ্বাসকষ্টের কোনো উপসর্গ নেই, তাই আমরা আপাতত চিকিৎসা স্থগিত করার সিদ্ধান্ত নিয়েছি এবং নিয়মিত ক্লিনিকে গিয়ে তার অবস্থা পর্যবেক্ষণ করা হবে।",
+    "translated_summary": "আমরা ১৩ বছর বয়সী একজন কিশোরের ঘটনা বর্ণনা করছি, যে বুকে তীব্র ব্যথা নিয়ে জরুরি বিভাগে আসে, তবে এই ব্যথা কোনো শারীরিক সমস্যার সঙ্গে সম্পর্কিত ছিল না। পরীক্ষায় দেখা যায়, তার বুকের নিচের দুই-তৃতীয়াংশে শ্বাস-প্রশ্বাসের শব্দ দুর্বল ছিল এবং অন্য কোনো অস্বাভাবিকতা ছিল না; স্বাভাবিক বাতাসে তার SpO2 (অক্সিজেন স্যাচুরেশন) ছিল ৯৮%। বুকের এক্স-রেতে দেখা যায়, ফুসফুসে উল্লেখযোগ্য পরিমাণে ইন্টারস্টিশিয়াল ইনফিল্ট্রেট রয়েছে, যা ৪ বছর আগে একটি তীব্র অসুস্থতার সময় তোলা এক্স-রের সাথে তুলনীয়, তখন অ্যাজিথ্রোমাইসিন দিয়ে চিকিৎসা করা হয়েছিল। কম্পিউটেড টমোগ্রাফি (সিটি) স্ক্যানে ফুসফুসের প্রায় ৬৫% অংশে একাধিক দ্বিপাক্ষিক গ্রাউন্ড-গ্লাস অপাসিটি এবং ক্রেজি পেভিংয়ের লক্ষণ দেখা যায়, যা পালমোনারি অ্যালভিওলার প্রোটিনোসিসের (পিএপি) ইঙ্গিত দেয়। শ্বাসযন্ত্রের ভাইরাস পরীক্ষা, যার মধ্যে করোনাভাইরাস (SARS-CoV2)-এর পরীক্ষাও অন্তর্ভুক্ত ছিল, তা নেগেটিভ ছিল। বহির্বিভাগে ব্রঙ্কোঅ্যালভিওলার ল্যাভেজ করার পর দেখা যায়, তরলটি দুধের মতো এবং পিরিয়ডিক অ্যাসিড-শিফ স্টেইনিং পজিটিভ। স্পাইরোমেট্রি পরীক্ষায় হালকাRestrictive প্যাটার্ন দেখা যায় (ফোর্সড ভাইটাল ক্যাপাসিটি [FVC] = ৭৭%) এবং কার্বন মনোক্সাইডের জন্য ফুসফুসের ডিফিউজিং ক্ষমতা (DLCO) মাঝারিভাবে হ্রাস পায়, যা ৪৮.৬%। জেনেটিক প্যানেলে সার্ফ্যাক্ট্যান্ট ডিসফাংশনের সাথে সম্পর্কিত কোনো মিউটেশন পাওয়া যায়নি। অ্যান্টি-গ্রানুলোসাইট ম্যাক্রোফেজ কলোনি-স্টিমুলেটিং ফ্যাক্টর (জিএম-সিএসএফ) অ্যান্টিবডি পরীক্ষা করে দেখা যায়, এটি প্রবলভাবে পজিটিভ, যা অটোইমিউন পিএপি-এর সন্দেহ তৈরি করে। ২০ মাস ফলো-আপের পর, রোগীর মধ্যে কোনো উপসর্গ দেখা যায়নি এবং স্পাইরোমেট্রি স্বাভাবিক ছিল।"
+  },
+  {
+    "id": "multiclinsum_gs_en_212.txt",
+    "fulltext": "27-year-old woman with a history of uncontrolled asthma, mild SARS-CoV-2 infection. In March 2021, she consulted a doctor for pain in the left hemicara and trismus. She reported having completed 48 hours before the antibiotic treatment with phenoxymethyl penicillin 1,000,000 IU daily orally for five days for a peritonsillar abscess. She was hemodynamically stable at the physical examination, without the need for supplemental oxygen, and without relevant findings in respiratory symptoms. The head and neck examination showed a soft, painful, cervical adenopathy, palpable and painful, predominantly homolateral and trismus. Complementary studies were performed. The admission laboratory reported leukocytosis, platelopenia, increased acute phase reactants and the rest of the parameters within normal values. An angiotomy of the craniofacial mass was performed, where a large thrombus was found in the internal and external carotid arteries. Studies were completed with a chest tomography and arterial Doppler ultrasound of neck vessels with no relevant findings. Early intravenous antibiotic treatment was initiated with ceftriaxone 1 g every 12 hours, clindamycin 300 mg every 6 hours and anticoagulation with enoxaparin adjusted to body weight and renal function, 60 mg subcutaneously every 12 hours. The patient evolved 72 hours after initiating the directed treatment with a fever of 38.5 °C and increased leukocytosis, so new complementary studies were performed, including a Doppler ultrasound of the heart without finding cardiac vegetations and a chest tomography where bilateral pulmonary septic emboli were found. With the admission hemocultures negative, a new admission of 3 units, culture of pharyngeal exudate and rotation of ceftriaxone to piperacillin tazobactam 4.5 g every 6 hours intravenous was decided. The patient evolved favorably, without rescue of germs in cultures. After 14 days of initiating the new therapeutic scheme, and with a control chest tomography without pulmonary lesions, it was decided to continue antibiotic treatment with oral clindamycin 300 mg every 6 hours, anticoagulation with acenocumarol adjusted to body weight and hospital discharge.\n",
+    "summary": "A 27-year-old woman presented with facial oedema and trismus 48 hours after completing treatment with phenoxymethylpenicillin for an odontogenic infection. A head and neck CT scan showed a large thrombus in the internal jugular vein and a chest CT scan showed pulmonary septic embolism. Treatment consisted of early intravenous broad spectrum antibiotics and anticoagulation.\n",
+    "translated_fulltext": "২৭ বছর বয়সী একজন মহিলার পূর্বে অনিয়ন্ত্রিত হাঁপানি এবং মৃদু SARS-CoV-2 সংক্রমণ ছিল। ২০২১ সালের মার্চ মাসে, তিনি বাম হেমিকারায় ব্যথা এবং ট্রিসমাসের জন্য একজন ডাক্তারের পরামর্শ নেন। তিনি জানান যে পেরিটনসিলার অ্যাবসেসের জন্য ফেনোক্সিমিথাইল পেনিসিলিন ১,০০০,০০০ আইইউ দৈনিক মুখে করে পাঁচ দিন সেবন করার ৪৮ ঘণ্টা পর তিনি অ্যান্টিবায়োটিক চিকিৎসা শুরু করেন। শারীরিক পরীক্ষায় দেখা যায়, তার অবস্থা স্থিতিশীল, অতিরিক্ত অক্সিজেনের প্রয়োজন নেই এবং শ্বাসযন্ত্রের উপসর্গে উল্লেখযোগ্য কিছু পাওয়া যায়নি। মাথা ও ঘাড়ের পরীক্ষায় নরম, বেদনাদায়ক, সারভাইকাল অ্যাডেনোপ্যাথি দেখা যায়, যা স্পর্শ করলে ব্যথা লাগে এবং প্রধানত একই দিকে থাকে, সেইসাথে ট্রিসমাসও ছিল। এরপর কিছু অতিরিক্ত পরীক্ষা করা হয়। হাসপাতালে ভর্তির সময় ল্যাবরেটরি রিপোর্টে লিউকোসাইটোসিস, প্লেটেলোপেনিয়া, তীব্র ফেজের রিঅ্যাক্টেন্টগুলির মাত্রা বৃদ্ধি এবং অন্যান্য প্যারামিটার স্বাভাবিক সীমার মধ্যে পাওয়া যায়। ক্র্যানিওফেসিয়াল ভরের একটি অ্যাঞ্জিওটমি করা হয়, যেখানে অভ্যন্তরীণ এবং বাহ্যিক ক্যারোটিড ধমনীতে একটি বড় থ্রম্বাস পাওয়া যায়। এরপর বুকের টমোগ্রাফি এবং ঘাড়ের রক্তনালীর আর্টেরিয়াল ডপলার আল্ট্রাসাউন্ড করা হয়, যেখানে উল্লেখযোগ্য কিছু পাওয়া যায়নি। দ্রুত শিরায় অ্যান্টিবায়োটিক চিকিৎসা শুরু করা হয়, যেখানে প্রতি ১২ ঘণ্টা পর সেফট্রিয়াক্সোন ১ গ্রাম, প্রতি ৬ ঘণ্টা পর ক্লিন্ডামাইসিন ৩০০ মিলিগ্রাম এবং শরীরের ওজন ও কিডনির কার্যকারিতা অনুযায়ী এনোক্সাপারিন দিয়ে অ্যান্টিকোয়াগুলেশন করা হয়, যা প্রতি ১২ ঘণ্টা পর ৬০ মিলিগ্রাম চর্মের নিচে দেওয়া হয়। চিকিৎসার শুরু হওয়ার ৭২ ঘণ্টা পর রোগীর জ্বর আসে (৩৮.৫ ডিগ্রি সেলসিয়াস) এবং লিউকোসাইটোসিসের মাত্রা বৃদ্ধি পায়। তাই নতুন করে কিছু পরীক্ষা করা হয়, যার মধ্যে হৃদপিণ্ডের ডপলার আল্ট্রাসাউন্ড করা হয়, যেখানে কার্ডিয়াক ভেজিটেশন পাওয়া যায়নি, এবং বুকের টমোগ্রাফিতে উভয় ফুসফুসে সেপটিক এমবোলি দেখা যায়। ভর্তির সময় হেমোকালচার নেগেটিভ হওয়ায়, আরও ৩ ইউনিট রক্ত নেওয়া হয়, গলার নিঃসরণ থেকে কালচার করা হয় এবং সেফট্রিয়াক্সোনের পরিবর্তে পাইপেরা সিলিন-ট্যাজোব্যাকটাম ৪.৫ গ্রাম প্রতি ৬ ঘণ্টা অন্তর শিরায় দেওয়ার সিদ্ধান্ত নেওয়া হয়। রোগীর অবস্থা ধীরে ধীরে উন্নতি হতে থাকে এবং কালচারে কোনো জীবাণু পাওয়া যায়নি। নতুন থেরাপিউটিক স্কিম শুরু করার ১৪ দিন পর এবং বুকের টমোগ্রাফিতে ফুসফুসের ক্ষত না পাওয়ায়, মুখে করে ক্লিন্ডামাইসিন ৩০০ মিলিগ্রাম প্রতি ৬ ঘণ্টা অন্তর এবং শরীরের ওজন ও কিডনির কার্যকারিতা অনুযায়ী এসেনোকুমারল দিয়ে অ্যান্টিকোয়াগুলেশন চালিয়ে যাওয়ার সিদ্ধান্ত নেওয়া হয়, এবং রোগীকে হাসপাতাল থেকে ছুটি দেওয়া হয়।",
+    "translated_summary": "২৭ বছর বয়সী একজন নারী মুখের ফোলা এবং ট্রিসমাস (চোয়ালের পেশী শক্ত হয়ে যাওয়া) নিয়ে হাজির হন, যা দাঁতের সংক্রমণ থেকে সৃষ্ট একটি রোগের চিকিৎসার ৪৮ ঘণ্টা পর দেখা যায়। মাথার এবং ঘাড়ের সিটি স্ক্যানে অভ্যন্তরীণ jugular শিরায় একটি বড় থ্রম্বাস এবং বুকের সিটি স্ক্যানে পালমোনারি সেপটিক এমবোলিজম দেখা যায়। এক্ষেত্রে প্রাথমিক পর্যায়ে শিরায় অ্যান্টিবায়োটিক এবং অ্যান্টিকোয়াগুলেশন ওষুধ দেওয়া হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_205.txt",
+    "fulltext": "A 5-year-old presented to the paediatric emergency department (ED) having ingested chlorpyriphos 13 hours prior to presentation, followed by abnormal jerks, fast breathing and difficulty with breathing. The history was also comprised of excessive sweating and urination, mouth secretions and involuntary movement of the limbs. Vomiting followed the ingestion of crushed charcoal and palm oil. The patient had lapsed into coma prior to presentation. The temperature at presentation was 38.3°C, Glasgow coma score was 3, pupils were pinpoint pupils and there was hypotonia in all limbs. In addition, the patient was severely dyspneic, tachypneic (respiratory rate of 48/minute with intermittent sighing breaths), a saturation of 88% and widespread crackles. The pulse rate was 180/minute, blood pressure 120/80 mmHg, and random blood glucose 14 mg/dl. Serum lactate and cholinesterase tests were not done due to lack of facilities.\n\nThe patient was diagnosed with severe organophosphate poisoning (OPP) and aspiration pneumonitis. As ICU care was beyond the affordability of the parents, non-invasive ventilation (NIV) was administered using bubble continuous positive airway pressure (b-CPAP) causing his saturation to increase to 99%–100%. Hypoglycemia was corrected with a bolus of dextrose solution and tachycardia was treated with 20 ml/kg of normal saline. Intravenous Dexamethasone, Mannitol and IV Atropine at 0.02 mg/kg/dose were also administered. Empirical intravenous antibiotics were administered for aspiration pneumonitis. Pralidoxime was not given due to unavailability. Within 3 hours of presentation, the patient had fresh-whole-blood exchange-blood-transfusion (FWB-EBT) with 500mls of blood.\n\nThe patient’s GCS appreciated to 9/15 but IV Atropine was discontinued after the first dose due to a rapid increase in the heart rate. The blood glucose fluctuated between 41 to 259 mg/dl in the first 15 hours of admission and subsequently normalized with treatment. By the second day on admission, the patient developed thready pulses and hypotension for which another bolus of normal saline was administered. Dopamine infusion was commenced at 5mcg/kg/min using a peripheral vein and IV Mannitol discontinued. A second aliquot of FWB-EBT was administered with 500mls of blood.\n\nOver the first 30 hours of admission, the consciousness level improved and respiratory distress slowly declined. However, the patient developed rhonchi which was treated with nebulized Salbutamol and Budesonide and was subsequently transited to Oxygen therapy with nasal prongs with clinical improvement. The saturation remained stable at 97%. On Day 2 of admission, a chest radiograph was done which showed bilateral infiltrates in keeping with pneumonia.\n\nThe patient regained full consciousness by the 39th hour of admission. Intravenous Vitamin C and B, as well as oral Vitamin E and Zinc were commenced for their antioxidant effects, and regular diet was recommenced in a graded manner over the subsequent 48 hours. The patient’s clinical condition progressively improved and was discharged home after 10 days but was subsequently lost to follow-up.",
+    "summary": "We present the case of a 5-year-old with severe organophosphate poisoning from ingestion of chlorpyrifos, further worsened by aspiration of a charcoal-palm oil mixture. The clinical illness was marked by respiratory failure, shock, coma and type I paralysis. The patient was treated in the emergency department with noninvasive ventilation, multiple episodes of exchange transfusion, intravenous atropine, inotrope infusion, antibiotics and steroids. The patient responded rapidly to treatment, did not develop intermediate syndrome and was discharged after 10 days of admission.",
+    "translated_fulltext": "পাঁচ বছর বয়সী একটি শিশু ক্লোরপাইরিফস নামক কীটনাশক গ্রহণের ১৩ ঘণ্টা পর পেডিয়াট্রিক জরুরি বিভাগে (ইডি) আসে। এরপর তার অস্বাভাবিক খিঁচুনি, দ্রুত শ্বাস-প্রশ্বাস এবং শ্বাস নিতে অসুবিধা দেখা দেয়। রোগীর অতিরিক্ত ঘাম এবং প্রস্রাব, মুখ থেকে লালা ঝরা এবং অঙ্গপ্রত্যঙ্গগুলোর অনিয়ন্ত্রিত নড়াচড়ার ইতিহাসও পাওয়া যায়। পিষে নেওয়া কাঠকয়লা এবং পাম তেল খাওয়ার পর বমি হয়। হাসপাতালে আসার আগে রোগী কোমায় চলে গিয়েছিল। হাসপাতালে আসার সময় তার শরীরের তাপমাত্রা ছিল ৩৮.৩ ডিগ্রি সেলসিয়াস, গ্লাসগো কোমা স্কোর ছিল ৩, চোখের মণি ছোট হয়ে গিয়েছিল এবং সমস্ত অঙ্গপ্রত্যঙ্গে পেশী দুর্বলতা দেখা যায়। এছাড়াও, রোগীর শ্বাসকষ্ট ছিল, প্রতি মিনিটে ৪৮ বার শ্বাস নিত এবং মাঝে মাঝে দীর্ঘশ্বাস ফেলত, অক্সিজেনের মাত্রা ছিল ৮৮% এবং ফুসফুসে শব্দ শোনা যাচ্ছিল। তার হৃদস্পন্দন ছিল প্রতি মিনিটে ১৮০, রক্তচাপ ছিল ১২০/৮০ মিমি Hg এবং রক্তের গ্লুকোজের মাত্রা ছিল ১৪ মিলিগ্রাম/ডিসিএল। প্রয়োজনীয় সরঞ্জাম না থাকায় সিরাম ল্যাকটেট এবং কোলিনস্টেরেজ পরীক্ষা করা হয়নি।\n\nরোগীকে মারাত্মক অর্গানোফসফেট বিষক্রিয়া (ওপিপি) এবং অ্যাসপিরেশন নিউমোনাইটিস ধরা পড়ে। যেহেতু আইসিইউ-তে চিকিৎসা করানো অভিভাবকদের সামর্থ্যের বাইরে ছিল, তাই বাবল কন্টিনিউয়াস পজিটিভ এয়ারওয়ে প্রেসার (বি-সিপিএপি) ব্যবহার করে নন-ইনভেসিভ ভেন্টিলেশন (এনআইভি) দেওয়া হয়, যার ফলে তার অক্সিজেনের মাত্রা ৯৯%-১০০%-এ উন্নীত হয়। ডেক্সট্রোজ দ্রবণ দিয়ে দ্রুত ইনজেকশন দেওয়ার মাধ্যমে হাইপোগ্লাইসেমিয়া ঠিক করা হয় এবং স্বাভাবিক স্যালাইন ২০ মিলি/কেজি করে দিয়ে ট্যাকিকার্ডিয়ার চিকিৎসা করা হয়। এছাড়াও, ইন্ট্রাভেনাস ডেক্সামেথাসোন, ম্যানিটল এবং ০.০২ মিলিগ্রাম/কেজি/ডোজ হারে আইভি অ্যাট্রোপিন দেওয়া হয়। অ্যাসপিরেশন নিউমোনাইটিসের জন্য অভিজ্ঞতামূলক ইন্ট্রাভেনাস অ্যান্টিবায়োটিক দেওয়া হয়। প্র্যালিডক্সিম পাওয়া না যাওয়ায় দেওয়া হয়নি। হাসপাতালে আসার ৩ ঘণ্টার মধ্যে, রোগীকে ৫০০ মিলি রক্ত দিয়ে ফ্রেশ-হোল-ব্লাড এক্সচেঞ্জ-ব্লাড-ট্রান্সফিউশন (এফডব্লিউবি-ইবিটি) করা হয়।\n\nরোগীর গ্লাসগো কোমা স্কোর ৯/১৫-এ উন্নীত হয়, তবে প্রথম ডোজের পরে দ্রুত হৃদস্পন্দন বেড়ে যাওয়ায় আইভি অ্যাট্রোপিন বন্ধ করে দেওয়া হয়। হাসপাতালে ভর্তির প্রথম ১৫ ঘণ্টায় রক্তের গ্লুকোজের মাত্রা ৪১ থেকে ২৫৯ মিলিগ্রাম/ডিসিএল-এর মধ্যে ওঠানামা করে, পরে চিকিৎসার মাধ্যমে তা স্বাভাবিক হয়ে আসে। ভর্তির দ্বিতীয় দিনে, রোগীর দুর্বল নাড়ি এবং নিম্ন রক্তচাপ দেখা দেয়, যার জন্য আবার স্বাভাবিক স্যালাইন দেওয়া হয়। একটি পেরিফেরাল শিরায় ৫ মাইক্রোগ্রাম/কেজি/মিনিট হারে ডোপামিন ইনফিউশন শুরু করা হয় এবং আইভি ম্যানিটল বন্ধ করে দেওয়া হয়। ৫০০ মিলি রক্ত দিয়ে দ্বিতীয়বার এফডব্লিউবি-ইবিটি দেওয়া হয়।\n\nভর্তির প্রথম ৩০ ঘণ্টার মধ্যে, রোগীর চেতনা ধীরে ধীরে উন্নত হয় এবং শ্বাসকষ্ট কমতে শুরু করে। তবে, রোগীর শ্বাসকষ্টের কারণে বুকের মধ্যে সাঁই সাঁই শব্দ হতে থাকে, যার জন্য নেবুলাইজড সালবিউটামল এবং বুডেসোনাইড দিয়ে চিকিৎসা করা হয় এবং পরবর্তীতে নাকের মাধ্যমে অক্সিজেন থেরাপি দেওয়া হয়, যার ফলে রোগীর অবস্থার উন্নতি হয়। অক্সিজেনের মাত্রা ৯৭%-এ স্থিতিশীল থাকে। ভর্তির দ্বিতীয় দিনে, বুকের একটি এক্স-রে করা হয়, যেখানে নিউমোনিয়ার কারণে উভয় ফুসফুসে সংক্রমণ দেখা যায়।\n\nভর্তির ৩৯তম ঘণ্টার মধ্যে রোগী সম্পূর্ণরূপে চেতনা ফিরে পায়। অ্যান্টিঅক্সিডেন্ট প্রভাবের জন্য ইন্ট্রাভেনাস ভিটামিন সি এবং বি, সেইসাথে মুখে খাওয়ার জন্য ভিটামিন ই এবং জিঙ্ক দেওয়া শুরু হয় এবং পরবর্তী ৪৮ ঘণ্টার মধ্যে ধীরে ধীরে স্বাভাবিক খাবার দেওয়া শুরু হয়। রোগীর শারীরিক অবস্থার ধীরে ধীরে উন্নতি হয় এবং ১০ দিন পর তাকে বাড়ি ছেড়ে দেওয়া হয়, তবে পরবর্তীতে ফলো-আপের জন্য তাকে আর পাওয়া যায়নি।",
+    "translated_summary": "আমরা এখানে পাঁচ বছর বয়সী একটি শিশুর ঘটনা তুলে ধরছি, যে ক্লোরপাইরিফস নামক কীটনাশক গ্রহণের ফলে মারাত্মক অর্গানোফসফেট বিষক্রিয়ায় আক্রান্ত হয়েছিল, এবং কার্বন-পাম তেল মিশ্রণ শ্বাসের মাধ্যমে শরীরে প্রবেশ করায় পরিস্থিতি আরও খারাপ হয়েছিল। এই শিশুর শ্বাসকষ্ট, শক, কোমা এবং প্রথম ধরনের পক্ষাঘাতের মতো লক্ষণ দেখা যায়। জরুরি বিভাগে তাকে নন-ইনভেসিভ ভেন্টিলেশন, একাধিকবার রক্ত ​​পরিবর্তন, শিরায় অ্যাট্রোপিন, ইনোট্রপিক ইনফিউশন, অ্যান্টিবায়োটিক এবং স্টেরয়েড দিয়ে চিকিৎসা করা হয়। শিশুটি দ্রুত চিকিৎসার প্রতি সাড়া দেয়, মধ্যবর্তী সিনড্রোম তৈরি হয়নি এবং হাসপাতালে দশ দিন থাকার পর তাকে ছুটি দেওয়া হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_72.txt",
+    "fulltext": "A 17-year-old male with no significant past medical or family history was referred to our clinic from the dental department following an incidental finding of a NFB during preoperative orthodontic planning, including dental x-rays and cone beam computed tomography (CBCT) without contrast. The patient was entirely asymptomatic and denied any history of nasal obstruction, rhinorrhea, epistaxis, foul odor, hyposmia, halitosis, facial pain, discomfort, or sleep disturbances. The patient's parents recalled an event when their son was seven, where he inserted an object into his nose. They sought medical advice, where no imaging was performed and an anterior rhinoscopy was utilized for diagnoses but due to the child's non-cooperation during the examination, the physician recommended the removal of the foreign body under sedation. However, the family did not follow up, and since the child remained asymptomatic, they assumed the foreign body had fallen out on its own. On endoscopic examination of the right nasal cavity, a deviated nasal septum with inferior turbinate hypertrophy was noted. The mucosa appeared erythematous and slightly edematous. A foreign body was visualized, lodged, and adhered to the floor of the nasal cavity beneath the inferior turbinate. The object was partially covered with mucus and possibly some crusted material and had a shiny appearance, indicating a metallic nature. Radiographic evaluation, including lateral and frontal X-rays, revealed a circular radiopaque object consistent with a metallic snap button located along the floor of the nasal cavity. The surrounding bony structures appeared normal. A CBCT confirmed the presence of the foreign body with associated mild inflammation, but no significant bony damage or sinus involvement was observed. With informed consent from the patient's parent, the foreign body was removed under local anesthesia in a semi-sitting position to reduce the risk of dislodgment to the airway. After decongesting the nasal cavity with Xylometazoline 0.1 % and administering Lidocaine spray (10 mg/spray) in the right nostril, a hook was utilized to disengage the foreign body, which was then retrieved using bayonet forceps. The procedure was uncomplicated, with minimal bleeding, easily controlled with saline irrigation. Post-removal examination showed no significant tissue damage. The retrieved object, a metallic snap button measuring 1 cm in diameter, exhibited signs of long-term exposure, including substantial corrosion and biological deposits. The patient was discharged in stable condition and prescribed nasal rinses with a sodium chloride irrigation solution (0.9 %). The patient was doing well at his two-week follow-up with an unremarkable examination.",
+    "summary": "We present the case of a 17-year-old male with an asymptomatic NFB discovered incidentally during routine dental radiography. The patient denied any history of nasal obstruction, epistaxis, or discomfort. Imaging revealed a radiopaque object in the right nasal cavity, later identified as a metallic snap button embedded in the floor of the nasal cavity. The foreign body had likely been retained for over a decade.",
+    "translated_fulltext": "সতেরো বছর বয়সী একজন পুরুষ, যার পূর্বে উল্লেখযোগ্য কোনো স্বাস্থ্যগত সমস্যা বা পারিবারিক ইতিহাস নেই, তাকে আমাদের ক্লিনিকে ডেন্টাল বিভাগ থেকে রেফার করা হয়েছিল। এর কারণ হলো, প্রাক-সার্জিক্যাল অর্থোডন্টিক পরিকল্পনার সময়, যার মধ্যে ডেন্টাল এক্স-রে এবং কোণ বিম কম্পিউটেড টমোগ্রাফি (সিবিসিটি) অন্তর্ভুক্ত ছিল (যেখানে কোনো কন্ট্রাস্ট ব্যবহার করা হয়নি), একটি অপ্রত্যাশিতভাবে নাকের মধ্যে একটি বস্তু (এনএফবি) পাওয়া যায়। রোগী কোনো উপসর্গ অনুভব করেননি এবং নাকের পথে বাধা, রাইনোরাইয়া, এপিস্ট্যাক্সিস, দুর্গন্ধ, ঘ্রাণশক্তি হ্রাস, মুখের দুর্গন্ধ, মুখের ব্যথা, অস্বস্তি বা ঘুমের সমস্যা—এগুলোর কোনো ইতিহাসও তিনি দেননি। রোগীর বাবা-মা মনে করতে পারছিলেন, যখন তাদের ছেলে সাত বছর বয়সী ছিল, তখন সে নাকের মধ্যে একটি বস্তু ঢুকিয়েছিল। তারা ডাক্তারের পরামর্শ নিয়েছিলেন, যেখানে কোনো ইমেজিং করা হয়নি এবং রোগ নির্ণয়ের জন্য একটি অ্যানটেরিয়র রাইনোস্কোপি ব্যবহার করা হয়েছিল। কিন্তু পরীক্ষার সময় শিশুটির অসহযোগিতার কারণে, চিকিৎসক sedation-এর মাধ্যমে সেই বস্তু অপসারণের পরামর্শ দেন। তবে, পরিবারটি সেই পরামর্শ অনুসরণ করেনি এবং যেহেতু শিশুটির কোনো উপসর্গ ছিল না, তাই তারা ধরে নিয়েছিল যে বস্তুটা আপনাআপনি নাক থেকে পড়ে গেছে। ডান নাকের গহ্বরের এন্ডোস্কোপিক পরীক্ষায়, একটি বাঁকা নাসারন্ধ্র এবং নিম্ন টার্বিনেটের অতিরিক্ত বৃদ্ধি দেখা যায়। শ্লেষ্মা ঝিল্লি লালচে এবং সামান্য ফোলা দেখাচ্ছিল। একটি বিদেশি বস্তু দেখা যায়, যা নাকের গহ্বরের নীচে, নিম্ন টার্বিনেটের কাছাকাছি আটকে ছিল এবং লেগে ছিল। বস্তুটির কিছু অংশ শ্লেষ্মা এবং সম্ভবত কিছু শুকনো পদার্থ দিয়ে ঢাকা ছিল এবং এটি চকচকে দেখাচ্ছিল, যা একটি ধাতব বস্তুর ইঙ্গিত দেয়। ল্যাটারাল এবং ফ্রন্টাল এক্স-রেসহ রেডিওগ্রাফিক মূল্যায়নে একটি বৃত্তাকার রেডিওopaque বস্তু দেখা যায়, যা নাকের গহ্বরের নীচে অবস্থিত একটি ধাতব স্ন্যাপ বাটনের সাথে সামঞ্জস্যপূর্ণ। আশেপাশের হাড়ের গঠন স্বাভাবিক দেখাচ্ছিল। একটি সিবিসিটি পরীক্ষায় হালকা প্রদাহের সাথে বিদেশি বস্তুর উপস্থিতি নিশ্চিত করা হয়, তবে উল্লেখযোগ্য কোনো হাড়ের ক্ষতি বা সাইনাসের সমস্যা দেখা যায়নি। রোগীর বাবা-মায়ের কাছ থেকে সম্মতি নিয়ে, স্থানীয় অ্যানেস্থেসিয়ার অধীনে একটি আধা-বসা অবস্থানে বিদেশি বস্তু অপসারণ করা হয়, যাতে শ্বাসনালীতে এটি সরে যাওয়ার ঝুঁকি কমানো যায়। জাইলোমেটাজোলিন ০.১% দিয়ে নাকের গহ্বর পরিষ্কার করার পরে এবং ডান নাকের ছিদ্রে লিডোকেন স্প্রে (১০ মিগ্রা/স্প্রে) দেওয়ার পরে, একটি হুক ব্যবহার করে বিদেশি বস্তুটি আলগা করা হয় এবং পরে বানেট ফোরসেপস দিয়ে সেটি বের করা হয়। পদ্ধতিটি জটিলতা ছাড়াই সম্পন্ন হয় এবং সামান্য রক্তপাত দেখা যায়, যা স্যালাইন দিয়ে ধুয়ে সহজেই নিয়ন্ত্রণ করা যায়। অপসারণের পরে পরীক্ষায় উল্লেখযোগ্য কোনো টিস্যুর ক্ষতি দেখা যায়নি। যে বস্তুটিকে অপসারণ করা হয়েছিল, সেটি ছিল ১ সেন্টিমিটার ব্যাসের একটি ধাতব স্ন্যাপ বাটন, যার মধ্যে দীর্ঘমেয়াদী ব্যবহারের লক্ষণ, যেমন—উল্লেখযোগ্য ক্ষয় এবং জৈবিক অবক্ষেপণ দেখা যায়। রোগীকে স্থিতিশীল অবস্থায় ছেড়ে দেওয়া হয় এবং ০.৯% সোডিয়াম ক্লোরাইড দ্রবণ দিয়ে নাকের গহ্বর পরিষ্কার করার পরামর্শ দেওয়া হয়। দুই সপ্তাহ পর ফলো-আপে দেখা যায়, রোগীর অবস্থা ভালো আছে এবং পরীক্ষায় কোনো অস্বাভাবিকতা ধরা পড়েনি।",
+    "translated_summary": "আমরা একজন ১৭ বছর বয়সী পুরুষের ঘটনা উপস্থাপন করছি, যার কোনো উপসর্গ ছিল না, কিন্তু রুটিন ডেন্টাল রেডিওগ্রাফির সময় একটি এনএফবি (NFB) পাওয়া যায়। রোগী নাক বন্ধ, নাক থেকে রক্তপাত বা অস্বস্তির কোনো পূর্ব ইতিহাস অস্বীকার করেছেন। ইমেজিং-এ নাকের ডান দিকে একটি রেডিওopaque বস্তু দেখা যায়, যা পরে একটি ধাতব স্ন্যাপ বোতাম হিসেবে শনাক্ত করা হয় এবং এটি নাকের গহ্বরের তলায় আটকে ছিল। সম্ভবত, এই বিদেশি বস্তুটি এক দশকের বেশি সময় ধরে সেখানে ছিল।"
+  },
+  {
+    "id": "multiclinsum_gs_en_405.txt",
+    "fulltext": "We report a rare case of euthyroid unilateral GO with early massive mono-muscular fibrosis in a 50-year-old male patient. The patient had a family history of cardiovascular disease, type 2 diabetes mellitus, and myasthenia gravis but no family or personal history of thyroid autoimmune disease. The patient was a smoker of 20 cigarettes a day from the age of 30 and presented dyslipidemia for several years. Since June 2020, he experienced rapid and progressive swelling of the soft tissues in the right orbit, moderate pain during ocular globe movements, redness of eyelids and diplopia. Visual acuity was normal in both eyes. In October 2020, the patient was evaluated in our outpatient clinic. Moderate right orbit active inflammation was confirmed by Clinical Activity Score 3/7 (CAS),3 and eyelid edema was moderate. The eyelid aperture was 14 mm in the right orbit and 10 mm in the left orbit, and the Hertel measurements were 24 mm and 18 mm in the right and left orbits, respectively. In addition, the patient presented a severe reduction in elevation, persistent depression in the primary position of the right ocular globe and constant diplopia, as scored according to the Gorman score.4 The quality of life evaluated by Graves’ Ophthalmopathy quality of life questionnaire (GO-QOL)5 was reduced in both appearance and functional subscales. However, the functional subscale was reduced with respect to the appearance subscale, as the values were 12.5 and 50, respectively (considering 0 = worse condition and 100 = the best health state). Visual acuity was normal, and color vision by Ishihara tables was 16/17 and 17/17 in the right and left eyes, respectively. Evaluation of extraocular muscles by computer tomography (CT) scan (contiguous 1.25 mm thick slices, 200 mA, 120 kV, pitch 0.5) showed severe enlargement of the lower rectal body to the edge of the insertion tendon in the right orbit. Remarkably, the morphology of the other extraocular muscles in both orbits was normal. The muscle orbit area ratio measured in the right eyes was 0.25 Autocad units (in-house method; vn ≤ 0.20±0.03).6 Thyroid function was normal with a slight increase in TSH-R-Ab: 1.75 mU/l (n.v. < 1.5 mU/l). The amplitude of the p100 wave was slightly reduced by electrophysiology evaluation in the right eye. A thyroid ultrasound scan of the thyroid gland showed a thyroiditis pattern. Biochemical and clinical evaluations were negative for hematological or other systemic diseases. Routine clinical tests were normal, but the total cholesterol levels that were 220 mg/dl, triglyceride levels were 297 mg/dl, and high-density lipoprotein cholesterol (HDL) levels were 38 mg/dl.\n\nThe patient was treated by intravenous corticosteroid pulse therapy (Solumedrol; Pfizer, Karlsruhe, Germany) with a cumulative dose of 4500 mg over 12 weeks, leading to the resolution of inflammatory signs and symptoms. However, GO-QOL, Hertel measurements and diplopia remained unchanged; in contrast, electrophysiology evaluation and visual acuity worsened. Two-wall orbital surgical decompression plus parenteral glucocorticoids was chosen as the second-line treatment for GO. In that context, a biopsy of the right inferior rectus muscle revealed massive fibrosis with adipose tissue infiltration of this extraocular muscle.",
+    "summary": "Here, we present a rare case of euthyroid single muscular GO in a 50-year-old patient who was a smoker and had dyslipidemia for several years. The patient experienced a very rapid and severe depression of ocular motility of the right eye that caused uncorrectable and constant diplopia, severely affecting his quality of life. He was euthyroid, and TSH-R-Ab plasmatic levels were only slightly elevated. Intravenous corticosteroid pulse therapy was partially effective, and two rounds of wall orbital surgical decompression were necessary. Massive mono-muscular fibrosis was evidenced by biopsy of the right inferior rectus muscle.",
+    "translated_fulltext": "আমরা ৫০ বছর বয়সী একজন পুরুষ রোগীর বিরল একটি ঘটনার কথা জানাচ্ছি, যেখানে দেখা গেছে তার একটি চোখের চারপাশে (একপাশে) থাইরয়েড গ্রন্থির সমস্যা (গ্রাফ’স অফথালমোপ্যাথি) রয়েছে এবং একই সাথে চোখের পেশীতে ব্যাপক ফাইব্রোসিস (তন্তুযুক্ত টিস্যু বৃদ্ধি) দেখা গেছে। রোগীর পরিবারে হৃদরোগ, টাইপ ২ ডায়াবেটিস এবং মায়াস্থেনিয়া গ্রাভিসের ইতিহাস রয়েছে, তবে থাইরয়েড অটোইমিউন রোগের কোনো পারিবারিক বা ব্যক্তিগত ইতিহাস নেই। রোগী ৩০ বছর বয়স থেকে প্রতিদিন ২০টি সিগারেট খেতেন এবং কয়েক বছর ধরে ডিসলিপিডেমিয়া (রক্তে অস্বাভাবিক লিপিড বা ফ্যাটের মাত্রা) ছিল। ২০২০ সালের জুন মাস থেকে, তিনি ডান চোখের চারপাশে দ্রুত এবং ক্রমাগত ফোলাভাব, চোখের নড়াচড়ার সময় মাঝারি ব্যথা, চোখের পাতা লাল হওয়া এবং ডাবল ভিশন (ডিপ্লোপিয়া) অনুভব করতে শুরু করেন। উভয় চোখের দৃষ্টি স্বাভাবিক ছিল। ২০২০ সালের অক্টোবরে, রোগীকে আমাদের বহির্বিভাগে পরীক্ষা করা হয়। ক্লিনিক্যাল অ্যাক্টিভিটি স্কোর ৩/৭ (সিএএস) অনুসারে, ডান চোখের চারপাশে মাঝারি প্রদাহ নিশ্চিত করা হয় এবং চোখের পাতার ফোলাভাবও মাঝারি ছিল। ডান চোখের পাতার আকার ছিল ১৪ মিমি এবং বাম চোখের পাতার আকার ছিল ১০ মিমি। হার্টেল পরিমাপ অনুসারে, ডান চোখের প্রোমিনেন্স ছিল ২৪ মিমি এবং বাম চোখের প্রোমিনেন্স ছিল ১৮ মিমি। এছাড়াও, রোগীর চোখের উপরের দিকে তাকানোর ক্ষমতা কমে গিয়েছিল, ডান চোখের প্রাথমিক অবস্থানে ক্রমাগত অবনতি দেখা যাচ্ছিল এবং ডাবল ভিশন ছিল, যা গোরম্যান স্কোর অনুযায়ী মূল্যায়ন করা হয়েছিল। গ্র্যাভস’ অফথালমোপ্যাথি কোয়ালিটি অফ লাইফ প্রশ্নপত্র (জিও-কিউওএল) ব্যবহার করে জীবনযাত্রার মান মূল্যায়ন করা হলে দেখা যায় যে, রোগীর বাহ্যিক এবং কার্যকরী উভয় ক্ষেত্রেই জীবনযাত্রার মান হ্রাস পেয়েছে। তবে, কার্যকরী দিকের মান বাহ্যিক দিকের মানের তুলনায় বেশি হ্রাস পেয়েছে, যেখানে মান ছিল যথাক্রমে ১২.৫ এবং ৫০ (০ = খারাপ অবস্থা এবং ১০০ = সেরা স্বাস্থ্য)। দৃষ্টি স্বাভাবিক ছিল এবং ইশিহারা চার্ট ব্যবহার করে রঙের দৃষ্টি পরীক্ষা করে দেখা যায়, ডান চোখে ১৬/১৭ এবং বাম চোখে ১৭/১৭। কম্পিউটার টমোগ্রাফি (সিটি) স্ক্যান (১.২৫ মিমি পুরু স্লাইস, ২০০ এমএ, ১২০ কেভি, পিচ ০.৫) করে অতিরিক্ত চোখের পেশীগুলির মূল্যায়ন করা হলে দেখা যায়, ডান চোখের নিচের রেক্টাস পেশীটি প্রান্ত পর্যন্ত প্রসারিত হয়েছে। উল্লেখযোগ্যভাবে, উভয় চোখের অন্যান্য অতিরিক্ত পেশীগুলির গঠন স্বাভাবিক ছিল। ডান চোখে পেশী এবং চোখের এলাকার অনুপাত ছিল ০.২৫ অটোকাড ইউনিট (অভ্যন্তরীণ পদ্ধতি; ভিএন ≤ ০.২০ ± ০.০৩)। থাইরয়েড ফাংশন স্বাভাবিক ছিল, তবে টিএসএইচ-আর-এবি-এর মাত্রা সামান্য বৃদ্ধি পেয়েছিল: ১.৭৫ এমইউ/এল (স্বাভাবিক মান < ১.৫ এমইউ/এল)। ডান চোখে ইলেক্ট্রোফিজিওলজি মূল্যায়নে পি১০০ তরঙ্গের বিস্তার সামান্য হ্রাস পায়। থাইরয়েড গ্রন্থির আলট্রাসাউন্ড স্ক্যানে থাইরয়েডাইটিসের লক্ষণ দেখা যায়। রক্ত এবং অন্যান্য সিস্টেমিক রোগের জন্য বায়োকেমিক্যাল এবং ক্লিনিক্যাল মূল্যায়ন করা হলে কোনো অস্বাভাবিকতা পাওয়া যায়নি। সাধারণ ক্লিনিক্যাল পরীক্ষাগুলি স্বাভাবিক ছিল, তবে মোট কোলেস্টেরলের মাত্রা ছিল ২২০ মিলিগ্রাম/ডিসিএল, ট্রাইগ্লিসারাইডের মাত্রা ছিল ২৯৭ মিলিগ্রাম/ডিসিএল এবং উচ্চ ঘনত্বের লাইপোপ্রোটিন কোলেস্টেরলের (এইচডিএল) মাত্রা ছিল ৩৮ মিলিগ্রাম/ডিসিএল।\n\nরোগীকে ইন্ট্রাভেনাস কর্টিকোস্টেরয়েড পালস থেরাপি (সোলামেডরল; ফাইজার, কার্লসরুহে, জার্মানি) দিয়ে চিকিৎসা করা হয়, যেখানে ১২ সপ্তাহের মধ্যে মোট ৪৫০০ মিলিগ্রাম ওষুধ দেওয়া হয়। এর ফলে প্রদাহের লক্ষণ ও উপসর্গগুলি হ্রাস পায়। তবে, জিও-কিউওএল, হার্টেল পরিমাপ এবং ডাবল ভিশন অপরিবর্তিত থাকে; বিপরীতে, ইলেক্ট্রোফিজিওলজি মূল্যায়ন এবং দৃষ্টিশক্তি আরও খারাপ হয়। গ্রাফ’স অফথালমোপ্যাথির জন্য দ্বিতীয় সারির চিকিৎসা হিসেবে দুই দিকের কক্ষপথের সার্জিক্যাল ডিকম্প্রেশন এবং প্যারেন্টারাল গ্লুকোকর্টিকয়েড বেছে নেওয়া হয়। সেই প্রেক্ষাপটে, ডান চোখের নিচের রেক্টাস পেশীর বায়োপসি করে দেখা যায়, অতিরিক্ত চোখের পেশীতে ব্যাপক ফাইব্রোসিস এবং চর্বিযুক্ত টিস্যু প্রবেশ করেছে।",
+    "translated_summary": "এখানে, আমরা ৫০ বছর বয়সী একজন রোগীর বিরল একটি ঘটনার কথা উল্লেখ করছি, যিনি ধূমপান করতেন এবং কয়েক বছর ধরে ডিসলিপিডেমিয়াতে ভুগছিলেন। তার থাইরয়েড হরমোনের মাত্রা স্বাভাবিক ছিল। রোগীর ডান চোখের অকুলার মুভমেন্টে খুব দ্রুত এবং মারাত্মক অবনতি দেখা যায়, যার ফলে স্থায়ী এবং সংশোধন করা যায় না এমন ডায়প্লোপিয়া (ডাবল ভিশন) দেখা দেয় এবং এটি তার জীবনযাত্রার মানকে মারাত্মকভাবে প্রভাবিত করে। তার টিএসএইচ-আর-এবি-এর মাত্রা সামান্য বেশি ছিল। ইন্ট্রাভেনাস কর্টিকোস্টেরয়েড পালস থেরাপি আংশিকভাবে কার্যকর ছিল এবং দুটি ধাপে ওয়াল অরবিটাল সার্জিক্যাল ডিকম্প্রেশন করার প্রয়োজন হয়েছিল। ডান চোখের নিচের রেক্টাস পেশীর বায়োপসিতে ব্যাপক মনো-মাসকুলার ফাইব্রোসিস দেখা যায়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_345.txt",
+    "fulltext": "We present the clinical case of a 15-year-old male with no medical history or previous interventions, who presented to the paediatric emergency department with a history of vomiting and epigastric abdominal pain of four days' duration, remaining afebrile during the course of the illness.\n\nInitially treated as gastroenteritis, but with no improvement, and with persistence of epigastric abdominal pain and biliary vomiting, he was admitted to the emergency department for further evaluation.\n\nOn physical examination, the patient was in acceptable general condition, afebrile, with mild signs of dehydration. The abdomen was distended, without signs of peritonism and with decreased hydroaerolic sounds. The laboratory tests did not present significant findings, and an abdominal radiograph was performed with findings suggestive of intestinal obstruction.\n\nGiven the evolution, an urgent computed tomography was performed, which showed the presence of ascites and significant dilation of small intestine loops, suggesting the interposition of a small intestine loop at the beginning of the transcavity of the epiplons, with a change in caliber at the level of the hiatus of Winslow.\n\nUrgent surgical intervention was performed, initially by exploratory laparoscopy. Dilated loops of small intestine and terminal ileum, cecum and ascending colon of normal calibre but located in the right hypochondrium, with the cecum very mobile and without presenting adhesions to the right parietocolic space, were observed. Following the terminal ileum proximally, loops of small intestine of different calibre were observed from the depth of the theoretical location of the hiatus of Winslow. It was possible to pull the cecum and terminal ileum until they were displaced to the right iliac fossa, but without correctly identifying the point of change of calibre, since the interposition of the lower edge of the liver and the distension of loops of small intestine hampered the technique. An attempt was made to improve visualization by percutaneous puncture of a dilated loop to empty the gas, without improvement. To ensure the resolution of the obstructive picture, a supraumbilical mid-laparotomy was decided. When accessing the cavity, the change of calibre in the ileum was evident, about 40 centimetres from the ileocecal valve, with signs compatible with hernia of a section of about five centimetres of the ileum through the hiatus of Winslow. In both ends of the herniated loop, we observed the congestive imprint of the hiatus on the loop (Fig. 3). The normal calibre of the hiatus of Winslow was identified, so no preventive technique was performed to reduce the risk of recurrence.\n\nDuring the first days of the postoperative period, the patient presented a paralytic ileus, and the nasogastric tube could be removed five days after surgery and oral tolerance was initiated with a good response. Simultaneously, he developed a pelvic collection that was managed conservatively with antibiotics, with a good evolution. Finally, the patient was discharged ten days after the intervention, with preserved transit, remaining afebrile and with a good general state.\n\nThe patient is currently being followed up in the outpatient department of paediatric surgery.\n",
+    "summary": "We present the clinical case of a 15-year-old adolescent male with no previous surgical history, who presented with abdominal pain and vomiting, and whose computed tomography suggested a picture of intestinal obstruction due to internal hernia at the level of the Winslow hiatus. He required surgical intervention by exploratory laparoscopy, converted to a supraumbilical midline laparotomy due to poor visualization, for reduction of the herniated ileal loop. This presented a good appearance and intestinal resection was not necessary. No preventive technique was performed to reduce the risk of recurrence. Postoperatively, the patient presented a pelvic collection managed conservatively with antibiotics. He is currently being monitored in outpatient paediatric surgery.\n",
+    "translated_fulltext": "আমরা ১৫ বছর বয়সী একজন পুরুষের ক্লিনিক্যাল ঘটনা উপস্থাপন করছি, যার পূর্বে কোনো স্বাস্থ্যগত সমস্যা বা চিকিৎসার ইতিহাস নেই। সে পেডিয়াট্রিক জরুরি বিভাগে বমি এবং পেটের উপরের অংশে চার দিন ধরে ব্যথা নিয়ে আসে, তবে অসুস্থতার সময় তার জ্বর ছিল না।\n\nপ্রথমে তাকে গ্যাস্ট্রোএন্টারাইটিস হিসেবে চিকিৎসা করা হয়, কিন্তু অবস্থার উন্নতি না হওয়ায় এবং পেটের উপরের অংশে ব্যথা ও পিত্তরসযুক্ত বমি অব্যাহত থাকায়, আরও মূল্যায়নের জন্য তাকে জরুরি বিভাগে ভর্তি করা হয়।\n\nশারীরিক পরীক্ষায় দেখা যায়, রোগীর শারীরিক অবস্থা স্থিতিশীল, জ্বর নেই এবং সামান্য ডিহাইড্রেশনের লক্ষণ রয়েছে। পেট ফোলা ছিল, পেরিটোনাইটিসের কোনো লক্ষণ ছিল না এবং হাইড্রোক্লোরিক শব্দ কমে গিয়েছিল। ল্যাবরেটরি পরীক্ষায় উল্লেখযোগ্য কিছু পাওয়া যায়নি এবং পেটের একটি এক্স-রে করা হয়, যেখানে অন্ত্রের বাধার ইঙ্গিত পাওয়া যায়।\n\nরোগের অগ্রগতির কারণে, দ্রুত একটি সিটি স্ক্যান করা হয়, যেখানে অ্যাসিটিস এবং ক্ষুদ্রান্ত্রের লুপগুলোর উল্লেখযোগ্য প্রসারণ দেখা যায়। এটি ইঙ্গিত করে যে, ক্ষুদ্রান্ত্রের একটি লুপ এপিপ্লনের ট্রান্সক্যাভিটির শুরুতে আটকে গেছে, যার ফলে উইন্সলোর হাইয়েটাসের কাছে লুপের ব্যাস পরিবর্তিত হয়েছে।\n\nজরুরি ভিত্তিতে অস্ত্রোপচার করা হয়, প্রথমে ল্যাপারোস্কোপির মাধ্যমে রোগ নির্ণয় করা হয়। এরপর দেখা যায়, প্রসারিত ক্ষুদ্রান্ত্রের লুপ এবং টার্মিনাল ইলিয়াম, সিকাম এবং ঊর্ধ্ব কোলন স্বাভাবিক আকারে রয়েছে, তবে এগুলো ডান দিকের হাইপোকন্ড্রিয়ামে অবস্থিত। সিকাম খুব সহজে নড়াচড়া করতে পারছিল এবং ডান প্যারিয়েটোকলিক স্পেসে কোনো আঠালোতা ছিল না। টার্মিনাল ইলিয়াম থেকে শুরু করে, বিভিন্ন আকারের ক্ষুদ্রান্ত্রের লুপগুলো উইন্সলোর হাইয়েটাসের তাত্ত্বিক অবস্থানের গভীর থেকে দেখা যায়। সিকাম এবং টার্মিনাল ইলিয়ামকে ডান ইলিয়াক ফোসাতে স্থানান্তরিত করা সম্ভব হয়েছিল, কিন্তু লুপের আকারের পরিবর্তনের সঠিক স্থানটি চিহ্নিত করা যায়নি, কারণ লিভারের নিচের প্রান্তের আন্তঃক্ষেপণ এবং ক্ষুদ্রান্ত্রের লুপের প্রসারণ কৌশলটিকে কঠিন করে তোলে। প্রসারিত লুপে ছিদ্র করে গ্যাস বের করার চেষ্টা করা হয়, কিন্তু কোনো উন্নতি হয়নি। বাধার সমস্যা সমাধান করার জন্য, একটি সুপ্রা-অ্যাম্বিলিক্যাল মিড-ল্যাপারোটমি করার সিদ্ধান্ত নেওয়া হয়। পেটের মধ্যে প্রবেশ করার পর, ইলিয়ামের আকারের পরিবর্তন স্পষ্ট হয়ে ওঠে, যা ইলিয়োসেকাল ভালভ থেকে প্রায় ৪০ সেন্টিমিটার দূরে অবস্থিত। এখানে প্রায় পাঁচ সেন্টিমিটার দীর্ঘ ইলিয়ামের একটি অংশ উইন্সলোর হাইয়েটাসের মাধ্যমে হার্নিয়ার মতো দেখাচ্ছিল। হার্নিয়ার দুটি প্রান্তে, লুপের উপর হাইয়েটাসের চাপের চিহ্ন দেখা যায় (চিত্র ৩)। উইন্সলোর হাইয়েটাসের স্বাভাবিক আকার চিহ্নিত করা হয়, তাই পুনরাবৃত্তির ঝুঁকি কমাতে কোনো প্রতিরোধমূলক ব্যবস্থা নেওয়া হয়নি।\n\nঅস্ত্রোপচারের পরবর্তী প্রথম কয়েক দিনে, রোগীর প্যারালাইটিক ইলিয়াস দেখা যায়। পাঁচ দিন পর নাogastric টিউব সরিয়ে নেওয়া হয় এবং মুখে খাবার দেওয়ার মাধ্যমে ধীরে ধীরে স্বাভাবিক খাদ্য গ্রহণ শুরু করা হয়, যার ফলস্বরূপ ভালো সাড়া পাওয়া যায়। একই সময়ে, তার পেলভিক অঞ্চলে একটি তরল জমাট বাঁধে, যা অ্যান্টিবায়োটিকের মাধ্যমে রক্ষণশীলভাবে চিকিৎসা করা হয় এবং ধীরে ধীরে অবস্থার উন্নতি হয়। অবশেষে, অস্ত্রোপচারের দশ দিন পর রোগীকে হাসপাতাল থেকে ছেড়ে দেওয়া হয়, তার অন্ত্রের স্বাভাবিক কার্যক্রম বজায় থাকে, জ্বর থাকে না এবং তার শারীরিক অবস্থা ভালো থাকে।\n\nবর্তমানে, রোগীকে পেডিয়াট্রিক সার্জারির বহির্বিভাগে নিয়মিত ফলোআপের জন্য রাখা হয়েছে।",
+    "translated_summary": "আমরা এখানে একজন ১৫ বছর বয়সী কিশোরের ক্লিনিক্যাল কেস উপস্থাপন করছি, যার আগে কোনো অস্ত্রোপচারের ইতিহাস ছিল না। সে পেটে ব্যথা এবং বমি নিয়ে আসে। তার সিটি স্ক্যানে দেখা যায়, উইন্সলোর ছিদ্রের কাছে অভ্যন্তরীণ হার্নিয়ার কারণে অন্ত্রে বাধার সৃষ্টি হয়েছে। দুর্বল দৃশ্যমানতার কারণে প্রথমে ল্যাপারোস্কোপির মাধ্যমে অস্ত্রোপচার করার চেষ্টা করা হয়, কিন্তু পরে এটিকে একটি সুপ্রা-নাবিলাল মিডলাইন ল্যাপারোটমিতে পরিবর্তন করা হয়, যাতে হার্নিয়েটেড ইলিয়াল লুপটিকে সারানো যায়। অস্ত্রোপচারের পর দেখা যায়, পরিস্থিতি ভালো আছে এবং অন্ত্রের কোনো অংশ অপসারণ করার প্রয়োজন নেই। পুনরায় সমস্যা হওয়ার ঝুঁকি কমাতে কোনো প্রতিরোধমূলক ব্যবস্থা নেওয়া হয়নি। অস্ত্রোপচারের পরে, রোগীর পেলভিক অঞ্চলে তরল জমা হয়েছিল, যা অ্যান্টিবায়োটিক দিয়ে রক্ষণশীলভাবে চিকিৎসা করা হয়। বর্তমানে, তাকে বহির্বিভাগে শিশু সার্জারিতে পর্যবেক্ষণে রাখা হয়েছে।"
+  },
+  {
+    "id": "multiclinsum_gs_en_583.txt",
+    "fulltext": "A 19-year-old female presented to our hospital’s emergency room with a chief complaint of a two-day history of headache, accompanied by recurrent nausea, vomiting, and a one-day fever. On admission, her physical examination revealed a high fever of 39.1°C, elevated blood pressure at 189/120 mmHg, and a pulse rate of 148 beats per minute. Laboratory results indicated an elevated white blood cell count of 14.77×10^9/L and a neutrophil count of 13.55×10^9/L, suggesting a possible infection or inflammatory response. Initial empirical treatment with antibiotics was administered due to suspected infection, but her symptoms persisted. Given her abnormal vital signs, elevated inflammatory markers, and lack of symptom improvement, the patient was admitted for further diagnostic evaluation and transferred to the intensive care unit for close monitoring. A year prior, the patient had presented with similar symptoms and was diagnosed with myocarditis at a local hospital based on clinical findings at that time. During that hospitalization, she was also diagnosed with hypertension and prescribed antihypertensive medications. However, after discharge, the patient did not adhere to the prescribed antihypertensive therapy and did not regularly monitor her blood pressure. Additionally, it is notable that her father had a history of sudden, unexplained death.\n\nTo investigate the underlying etiology of the patient’s symptoms, a chest computed tomography (CT) scan was performed. Incidentally, this scan revealed a left adrenal mass with soft tissue density, measuring 43 mm × 36 mm. No pathological findings were observed in the head and chest CT scans. The electrocardiogram demonstrated sinus tachycardia with a shortened PR interval and tall, peaked P-waves in leads II, III, and aVF. Transthoracic echocardiography did not reveal any significant abnormalities.\n\nOn the second day of admission, the patient exhibited rising levels of brain natriuretic peptide (BNP) and Troponin I (TnI). The cardiologist provisionally diagnosed the patient with myocarditis of uncertain etiology, based on clinical presentation, elevated cardiac biomarkers (BNP and TnI), and supportive electrocardiogram findings. Treatment was initiated with methylprednisolone (0.25 g daily) to address potential myocardial inflammation due to suspected myocarditis. Furosemide (20 mg every 12 hours) and spironolactone (20 mg every 12 hours) were administered as diuretics to manage fluid retention and reduce cardiac workload. Perindopril amlodipine (10 mg: 5 mg daily) was prescribed as an angiotensin-converting enzyme inhibitor and calcium channel blocker combination to control blood pressure and reduce afterload. Metoprolol tartrate (25 mg every 12 hours) was used to manage heart rate and decrease myocardial oxygen demand, while esmolol (0.2 g/hour intravenous infusion), a short-acting beta-blocker, was administered for additional acute heart rate control due to sinus tachycardia. Due to concerns about a potential infection, moxifloxacin was added as empiric antibiotic therapy.\n\nGiven the patient’s presentation with an adrenal mass and hypertension, the endocrinologist recommended an evaluation of the aldosterone-to-renin ratio, plasma cortisol, plasma catecholamines, and 24-hour urinary catecholamines along with their metabolites. In the recumbent position, plasma and urinary catecholamine levels were markedly elevated (Table 1), including plasma dopamine at 524.5 pmol/L, norepinephrine at 83975 pmol/L, and epinephrine at 10579.3 pmol/L. Additionally, the 24-hour urinary levels showed free adrenaline at 4368.89 nmol/24 hours, free norepinephrine exceeding 12697.60 nmol/24 hours, normetanephrine at 8312 nmol/24 hours, metanephrines at 4078 nmol/24 hours, and vanillylmandelic acid at 58.1 mg/24 hours. These findings supported a clinical diagnosis of pheochromocytoma. On the fifth day post-admission, glucocorticoid therapy was discontinued, and perindopril amlodipine was substituted with terazosin for more targeted blood pressure management.\n\nAn enhanced abdominal CT scan further confirmed a left adrenal mass, highly suggestive of pheochromocytoma. Additionally, after obtaining informed consent, whole-exome sequencing was performed, revealing a heterozygous missense mutation, c.1900T > C: p. Cys634Arg, in the RET gene, leading to a substitution of cysteine with arginine at codon 634. This mutation raised suspicion for multiple endocrine neoplasia syndrome, prompting further evaluation of the thyroid and parathyroid glands. Thyroid color Doppler ultrasound identified a hypoechoic mass measuring 6 mm × 4 mm in the left thyroid lobe, and a mild elevation in calcitonin levels was noted. No additional significant abnormalities were detected.\n\nAs the patient’s condition gradually improved, plasma cortisol and ACTH levels returned to normal. The patient was subsequently discharged with a prescription for metoprolol tartrate (100 mg every 12 hours) and ivabradine hydrochloride (5 mg every 12 hours) for home management. Three months later, after achieving stable clinical status, the patient underwent resection of the left adrenal tumor, which measured 50 mm × 40 mm × 30 mm. Immunohistochemical analysis confirmed positive staining for Vim, CD56, Syn, CgA, and NSE, with S-100 positive in Sertoli cells, while CKpan, CD10, MART-1/Melan-A, and Melan-A were negative. The Ki67 index was 1%, leading to a definitive diagnosis of adrenal pheochromocytoma. The patient was discharged without further medications and has since been regularly followed up postoperatively without recurrence of symptoms. Over a 15-month postoperative follow-up, the patient exhibited persistently mild hypercalcitoninemia with stable thyroid nodule size, while PTH and serum calcium levels showed a progressive increase (Table 2). Further parathyroid scintigraphy using 99mTc-MIBI was performed, and the conclusion was a negative result for parathyroid adenoma.",
+    "summary": "We report the case of a 19-year-old female who presented with pheochromocytoma without experiencing a crisis, despite having a significant adrenal mass and undergoing high-dose glucocorticoid treatment. Genetic testing revealed a heterozygous missense mutation in the RET gene (c.1900T > C: p. Cys634Arg), associated with MEN2A. Further endocrine evaluation identified a thyroid nodule with mildly elevated calcitonin levels, but normal electrolyte and parathyroid hormone levels. Over a 15-month postoperative follow-up, the patient exhibited persistently mild hypercalcitoninemia with stable thyroid nodule size, while PTH and serum calcium levels showed a progressive increase. Further parathyroid scintigraphy using 99mTc-MIBI was performed, yielding a negative result for parathyroid adenoma.",
+    "translated_fulltext": "১৯ বছর বয়সী এক নারী দুই দিনের মাথাব্যথা, সঙ্গে পুনরাবৃত্ত বমিভাব ও বমি, এবং এক দিনের জ্বরের প্রধান অভিযোগ নিয়ে আমাদের হাসপাতালের জরুরি বিভাগে উপস্থিত হন। ভর্তি হওয়ার সময় শারীরিক পরীক্ষায় তার উচ্চ জ্বর 39.1°C, রক্তচাপ 189/120 mmHg, এবং পালস রেট 148 বিট প্রতি মিনিট পাওয়া যায়। ল্যাবরেটরি পরীক্ষায় শ্বেত রক্তকণিকার সংখ্যা 14.77×10^9/L এবং নিউট্রোফিল সংখ্যা 13.55×10^9/L পাওয়া যায়, যা সম্ভাব্য সংক্রমণ বা প্রদাহজনিত প্রতিক্রিয়ার ইঙ্গিত দেয়। সন্দেহজনক সংক্রমণের কারণে প্রাথমিকভাবে এম্পিরিক অ্যান্টিবায়োটিক চিকিৎসা শুরু করা হয়, তবে উপসর্গগুলো স্থায়ী থাকে। অস্বাভাবিক ভিটাল সাইন, প্রদাহজনিত মার্কার বৃদ্ধি এবং উপসর্গের উন্নতি না হওয়ার কারণে রোগীকে আরও ডায়াগনস্টিক মূল্যায়নের জন্য ভর্তি করা হয় এবং নিবিড় পর্যবেক্ষণের জন্য ইনটেনসিভ কেয়ার ইউনিটে স্থানান্তর করা হয়। এক বছর আগে রোগী অনুরূপ উপসর্গ নিয়ে উপস্থিত হয়েছিলেন এবং সেই সময় একটি স্থানীয় হাসপাতালে ক্লিনিক্যাল ফাইন্ডিংসের ভিত্তিতে myocarditis নির্ণয় করা হয়েছিল। ঐ হাসপাতালে ভর্তি অবস্থায় তার hypertension নির্ণয় হয় এবং antihypertensive ওষুধ দেওয়া হয়। তবে ছাড়পত্রের পর রোগী নির্ধারিত antihypertensive চিকিৎসা অনুসরণ করেননি এবং নিয়মিত রক্তচাপ পরিমাপও করেননি। এছাড়াও, উল্লেখযোগ্য যে তার পিতার আকস্মিক ও অজানা মৃত্যুর ইতিহাস ছিল।\n\nরোগীর উপসর্গের অন্তর্নিহিত কারণ অনুসন্ধানের জন্য একটি chest computed tomography (CT) স্ক্যান করা হয়। আকস্মিকভাবে, এই স্ক্যানে বাম adrenal গ্রন্থিতে soft tissue density সহ একটি mass শনাক্ত হয়, যার আকার ছিল 43 mm × 36 mm। head এবং chest CT স্ক্যানে কোনো প্যাথলজিক্যাল ফাইন্ডিংস পাওয়া যায়নি। ইলেক্ট্রোকার্ডিওগ্রামে sinus tachycardia, সংক্ষিপ্ত PR interval এবং lead II, III ও aVF-এ উঁচু, তীক্ষ্ণ P-wave দেখা যায়। Transthoracic echocardiography-তে কোনো উল্লেখযোগ্য অস্বাভাবিকতা পাওয়া যায়নি।\n\nভর্তির দ্বিতীয় দিনে রোগীর brain natriuretic peptide (BNP) এবং Troponin I (TnI) এর মাত্রা বৃদ্ধি পায়। কার্ডিওলজিস্ট ক্লিনিক্যাল উপস্থাপনা, উঁচু cardiac biomarkers (BNP ও TnI) এবং সহায়ক ইলেক্ট্রোকার্ডিওগ্রাম ফাইন্ডিংসের ভিত্তিতে অনিশ্চিত ইটিওলজির myocarditis হিসেবে প্রাথমিক নির্ণয় করেন। সন্দেহজনক myocarditis-জনিত myocardial প্রদাহের চিকিৎসার জন্য methylprednisolone (0.25 g দৈনিক) শুরু করা হয়। তরল সঞ্চয় নিয়ন্ত্রণ ও কার্ডিয়াক ওয়ার্কলোড কমানোর জন্য diuretic হিসেবে furosemide (20 mg প্রতি 12 ঘণ্টা) এবং spironolactone (20 mg প্রতি 12 ঘণ্টা) দেওয়া হয়। রক্তচাপ নিয়ন্ত্রণ ও afterload কমানোর জন্য angiotensin-converting enzyme inhibitor ও calcium channel blocker সংমিশ্রণ হিসেবে perindopril amlodipine (10 mg: 5 mg দৈনিক) প্রেসক্রাইব করা হয়। হৃদস্পন্দন নিয়ন্ত্রণ ও myocardial অক্সিজেন চাহিদা কমাতে metoprolol tartrate (25 mg প্রতি 12 ঘণ্টা) ব্যবহার করা হয়, এবং sinus tachycardia-র কারণে অতিরিক্ত তীব্র হৃদস্পন্দন নিয়ন্ত্রণের জন্য স্বল্পমেয়াদি beta-blocker esmolol (0.2 g/hour intravenous infusion) প্রয়োগ করা হয়। সম্ভাব্য সংক্রমণের আশঙ্কায় এম্পিরিক অ্যান্টিবায়োটিক হিসেবে moxifloxacin যোগ করা হয়।\n\nAdrenal mass ও hypertension-এর প্রেক্ষিতে এন্ডোক্রিনোলজিস্ট aldosterone-to-renin ratio, plasma cortisol, plasma catecholamines এবং 24-hour urinary catecholamines ও তাদের metabolites মূল্যায়নের পরামর্শ দেন। শোয়া অবস্থায় plasma ও urinary catecholamine এর মাত্রা উল্লেখযোগ্যভাবে বৃদ্ধি পেয়েছিল (Table 1), যার মধ্যে plasma dopamine 524.5 pmol/L, norepinephrine 83975 pmol/L এবং epinephrine 10579.3 pmol/L ছিল। এছাড়াও, 24-hour urinary পরীক্ষায় free adrenaline 4368.89 nmol/24 hours, free norepinephrine 12697.60 nmol/24 hours-এর বেশি, normetanephrine 8312 nmol/24 hours, metanephrines 4078 nmol/24 hours এবং vanillylmandelic acid 58.1 mg/24 hours পাওয়া যায়। এই ফলাফলগুলো pheochromocytoma-র একটি ক্লিনিক্যাল নির্ণয়কে সমর্থন করে। ভর্তি হওয়ার পঞ্চম দিনে glucocorticoid থেরাপি বন্ধ করা হয় এবং আরও লক্ষ্যভিত্তিক রক্তচাপ নিয়ন্ত্রণের জন্য perindopril amlodipine পরিবর্তে terazosin শুরু করা হয়।\n\nEnhanced abdominal CT স্ক্যান বাম adrenal mass-কে আরও নিশ্চিত করে, যা pheochromocytoma-র প্রতি অত্যন্ত সন্দেহজনক ছিল। এছাড়াও, informed consent গ্রহণের পর whole-exome sequencing করা হয়, যেখানে RET gene-এ একটি heterozygous missense mutation, c.1900T > C: p. Cys634Arg, শনাক্ত হয়, যা codon 634-এ cysteine এর পরিবর্তে arginine প্রতিস্থাপন ঘটায়। এই mutation multiple endocrine neoplasia syndrome-এর সন্দেহ জাগায়, ফলে thyroid ও parathyroid গ্রন্থির আরও মূল্যায়ন করা হয়। Thyroid color Doppler ultrasound-এ বাম thyroid lobe-এ 6 mm × 4 mm আকারের একটি hypoechoic mass শনাক্ত হয় এবং calcitonin এর মাত্রায় হালকা বৃদ্ধি লক্ষ্য করা যায়। অন্য কোনো উল্লেখযোগ্য অস্বাভাবিকতা পাওয়া যায়নি।\n\nরোগীর অবস্থা ধীরে ধীরে উন্নত হওয়ার সাথে সাথে plasma cortisol ও ACTH এর মাত্রা স্বাভাবিক অবস্থায় ফিরে আসে। পরবর্তীতে রোগীকে metoprolol tartrate (100 mg প্রতি 12 ঘণ্টা) এবং ivabradine hydrochloride (5 mg প্রতি 12 ঘণ্টা) সহ বাড়িতে ব্যবস্থাপনার জন্য ছাড়পত্র দেওয়া হয়। তিন মাস পরে, স্থিতিশীল ক্লিনিক্যাল অবস্থায় পৌঁছানোর পর রোগীর বাম adrenal tumor অপসারণ করা হয়, যার আকার ছিল 50 mm × 40 mm × 30 mm। Immunohistochemical বিশ্লেষণে Vim, CD56, Syn, CgA ও NSE-এর জন্য positive staining পাওয়া যায়, Sertoli cell-এ S-100 positive ছিল, এবং CKpan, CD10, MART-1/Melan-A ও Melan-A negative ছিল। Ki67 index ছিল 1%, যা adrenal pheochromocytoma-র চূড়ান্ত নির্ণয় নিশ্চিত করে। রোগীকে কোনো অতিরিক্ত ওষুধ ছাড়াই ছাড়পত্র দেওয়া হয় এবং এরপর থেকে postoperative নিয়মিত ফলো-আপে উপসর্গের পুনরাবৃত্তি ছাড়াই পর্যবেক্ষণে রয়েছে। ১৫ মাসের postoperative ফলো-আপে রোগীর স্থায়ীভাবে হালকা hypercalcitoninemia লক্ষ্য করা যায় এবং thyroid nodule-এর আকার স্থিতিশীল থাকে, তবে PTH ও serum calcium এর মাত্রা ধীরে ধীরে বৃদ্ধি পায় (Table 2)। পরবর্তীতে 99mTc-MIBI ব্যবহার করে parathyroid scintigraphy করা হয়, যার ফলাফল parathyroid adenoma-র জন্য negative ছিল।\n",
+    "translated_summary": "আমরা একজন ১৯ বছর বয়সী মহিলার ঘটনা বর্ণনা করছি, যিনি উল্লেখযোগ্য অ্যাড্রিনাল টিউমার এবং উচ্চ মাত্রার গ্লুকোকর্টিকয়েড চিকিৎসা সত্ত্বেও কোনো সংকট অনুভব না করেই ফিওক্রোমোসাইটোমা নিয়ে এসেছিলেন। জেনেটিক পরীক্ষায় দেখা যায় যে RET জিনে একটি হেটেরোজাইগাস মিসসেন্স মিউটেশন রয়েছে (c.1900T > C: p. Cys634Arg), যা MEN2A-এর সঙ্গে সম্পর্কিত। আরও এন্ডোক্রাইন মূল্যায়নে সামান্য পরিমাণে ক্যালসিটোনিনের মাত্রা বৃদ্ধি পাওয়া একটি থাইরয়েড নডিউল শনাক্ত করা হয়, তবে ইলেক্ট্রোলাইট এবং প্যারাথাইরয়েড হরমোনের মাত্রা স্বাভাবিক ছিল। ১৫ মাস ধরে পোস্টঅপারেটিভ ফলো-আপের সময়, রোগীর ক্যালসিটোনিনের মাত্রা সামান্য বেশি ছিল এবং থাইরয়েড নডিউলের আকার স্থিতিশীল ছিল, তবে পিটিএইচ এবং সিরাম ক্যালসিয়ামের মাত্রা ধীরে ধীরে বাড়তে থাকে। এরপর 99mTc-MIBI ব্যবহার করে আরও প্যারাথাইরয়েড সিন্টিগ্রাফি করা হয়, যেখানে প্যারাথাইরয়েড অ্যাডেনোমার কোনো লক্ষণ পাওয়া যায়নি।"
+  },
+  {
+    "id": "multiclinsum_gs_en_515.txt",
+    "fulltext": "February 2020, a 36-year-old with no significant past medical history presented with 5 years history of left sided penoscrotal mass. He has no lower urinary tract symptoms. No History of trauma or infections and he denied any history of weight loss, anorexia or fever. On examination, there is a smooth surface, tender cystic lesion around 20 mm ∗ 20 mm attached to the left side of the bulbar urethra at the penoscrotal junction, it was deep without any skin tethering and not related to the left spermatic cord and it was partially mobile.\n\nDoppler ultrasonography showed a well-defined hypoechoic mass measuring 2.7 ∗ 3.1 ∗ 2.0 cm with significantly increased vascularity at the left of penoscrotal junction. Pelvis Magnetic resonance imaging revealed a mass in the left inferolateral side of the base of the penis with a clear fat plane, which is isointense to the testes in the T2 weighted imaging, T1 weighted imaging and Diffusion-weighted imaging and it was connected to the vas deferens, no lymphadenopathy was noted. Alpha fetoprotein and beta-human chronic gonadotrophin levels were all in the normal range. Given the results of workup and the pain experienced by the patient, a decision was made to proceed with surgical removal of the mass for both diagnostic and therapeutic purposes. During surgery, a mass was seen in the left posterolateral of the scrotum and it was resected completely and sent for histopathology.\n\nHistopathology of the mass showed cellular spindle cell tumour arranged into interlacing fascicle, the cells have spindle to oval vesicular nuclei with evenly dispersed chromatin and inconspicuous nucleoli. The tumour showed high mitotic activity reaching up to 3/High-power field. Immunohistochemistry analysis was consistent with synovial sarcoma, revealing a positive TLE-1, CD99, B-cell lymphoma 2 (BLC2), Focal cytokeratin and focal epithelial membrane antigen (EMA). The material was sent for Fluorescence in situ hybridization (FISH) and reported a rearrangement of the SS18 gene at 18q11.2 which has been observed in synovial sarcomas. The mass margins were difficult to be assessed by histopathology as the sample had fragmented margins.\n\nThe patient presented to the clinic after 2 weeks and given the histopathology report, a re-resection with wider margin was discussed with the patient and he agreed. Positron emission tomography – Computed tomography (PET/CT) was done for Head and Neck, Chest, Abdomen, Pelvis and musculoskeletal structures. Only a 29 ∗ 27 mm thyroid nodule in the lower pole of the left thyroid lobe with moderate hypermetabolism at standardized uptake values (SUVs) of 4.9. Thyroid US showed a solid isoechoic well-defined nodule in the lower pole of the left thyroid lobe with no echogenic foci, Thyroid Imaging Reporting and Data System (TIRADS) was TR3.\n\nA second resection was made 3 weeks from the first one. The whole specimen was resected from both cords bilaterally which was deepened until reaching the corpus spongiosum which was shaved superiorly up to the urethra. The specimen was sent for histopathology. The resected mass was 6.0 ∗ 6.0 ∗ 3.0 cm in size, and it was negative for any pathology. The patient then went into active surveillance and after 16 months of active surveillance he was found to have metastatic lesions in the sixth liver segment and L1 vertebral body. Oncology team started chemotherapy regimen of Ifosfamide and Doxorubicin for 6 cycles with no improvement in the liver lesion. Surgical resection was made for the Fifth and Sixth liver sections with cholecystectomy. Patient then developed a new lung lesion and was started on Pazopanib and Stereotactic Body Radiation Therapy SBRT. The patient then underwent surveillance for 6 months then developed new liver and lung lesions then chemotherapy regimen of Gemcitabine and Docetaxel combination for 3 cycles and progressed then he was started 2 cycles of Dacarbazine and progressed then 2 cycles of Pembrolizumab and progressed. The patient then was shifted to palliative care, and he stopped following up.",
+    "summary": "A 36-year-old man presented with a tender penoscrotal mass for 5 years. The patient underwent surgical resection of the mass. Histopathology revealed cellular spindle cell tumour arranged into interlacing fascicle, Immunohistochemistry analysis revealed a positive TLE-1, CD99, B-cell lymphoma 2 (BLC2), Focal cytokeratin and focal epithelial membrane antigen (EMA). In our case, the patient was aggressively treated with two surgical resections and still progressed and metastasized and continued progressing even after different chemotherapy regimens.",
+    "translated_fulltext": "ফেব্রুয়ারি ২০২০-এ, উল্লেখযোগ্য কোনো পূর্ববর্তী চিকিৎসা ইতিহাস নেই এমন ৩৬ বছর বয়সী একজন রোগী বাম পাশের পেনোস্ক্রোটাল মাসের ৫ বছরের ইতিহাস নিয়ে উপস্থিত হন। তার কোনো নিম্ন মূত্রনালীর উপসর্গ ছিল না। আঘাত বা সংক্রমণের কোনো ইতিহাস ছিল না এবং তিনি ওজন হ্রাস, অ্যানোরেক্সিয়া বা জ্বরের কোনো ইতিহাস অস্বীকার করেন। শারীরিক পরীক্ষায়, পেনোস্ক্রোটাল জংশনে বালবার ইউরেথ্রার বাম পাশে সংযুক্ত প্রায় ২০ mm ∗ ২০ mm আকারের মসৃণ পৃষ্ঠবিশিষ্ট, স্পর্শকাতর সিস্টিক ক্ষত পাওয়া যায়; এটি গভীরে অবস্থিত ছিল, ত্বকের সঙ্গে কোনো টেথারিং ছিল না এবং বাম স্পার্মাটিক কর্ডের সঙ্গে সম্পর্কিত ছিল না এবং আংশিকভাবে মোবাইল ছিল।\n\nডপলার আল্ট্রাসোনোগ্রাফিতে পেনোস্ক্রোটাল জংশনের বাম পাশে উল্লেখযোগ্যভাবে বৃদ্ধি পাওয়া ভাসকুলারিটির সঙ্গে ২.৭ ∗ ৩.১ ∗ ২.০ cm মাপের সুস্পষ্ট সীমানাযুক্ত হাইপোইকোইক মাস দেখা যায়। পেলভিস ম্যাগনেটিক রেজোন্যান্স ইমেজিং-এ লিঙ্গের বেসের বাম ইনফেরোল্যাটারাল পাশে একটি মাস দেখা যায়, যার একটি পরিষ্কার ফ্যাট প্লেন ছিল, যা T2 weighted imaging, T1 weighted imaging এবং Diffusion-weighted imaging-এ টেস্টিসের সঙ্গে আইসোইনটেন্স ছিল এবং এটি ভাস ডিফেরেন্সের সঙ্গে সংযুক্ত ছিল; কোনো লিম্ফ্যাডেনোপ্যাথি লক্ষ্য করা যায়নি। আলফা ফিটোপ্রোটিন এবং বিটা-হিউম্যান ক্রনিক গোনাডোট্রফিনের মাত্রা স্বাভাবিক সীমার মধ্যে ছিল। ওয়ার্কআপের ফলাফল এবং রোগীর অভিজ্ঞ ব্যথার পরিপ্রেক্ষিতে, ডায়াগনস্টিক ও থেরাপিউটিক উভয় উদ্দেশ্যে মাসটি সার্জিক্যাল অপসারণের সিদ্ধান্ত নেওয়া হয়। অস্ত্রোপচারের সময়, স্ক্রোটামের বাম পোস্টেরোল্যাটারাল অংশে একটি মাস দেখা যায় এবং এটি সম্পূর্ণরূপে রিসেক্ট করে হিস্টোপ্যাথোলজির জন্য পাঠানো হয়।\n\nমাসটির হিস্টোপ্যাথোলজিতে ইন্টারলেসিং ফ্যাসিকলে বিন্যস্ত সেলুলার স্পিন্ডল সেল টিউমার দেখা যায়; কোষগুলিতে স্পিন্ডল থেকে ওভাল ভেসিকুলার নিউক্লিয়াস ছিল, সমানভাবে বিতরণকৃত ক্রোমাটিন এবং অস্পষ্ট নিউক্লিওলাই সহ। টিউমারটিতে উচ্চ মাইটোটিক কার্যকলাপ দেখা যায় যা প্রতি High-power field-এ সর্বোচ্চ ৩ পর্যন্ত পৌঁছায়। ইমিউনোহিস্টোকেমিস্ট্রি বিশ্লেষণ সিনোভিয়াল সারকোমার সঙ্গে সামঞ্জস্যপূর্ণ ছিল, যেখানে TLE-1, CD99, B-cell lymphoma 2 (BLC2), ফোকাল সাইটোকেরাটিন এবং ফোকাল এপিথেলিয়াল মেমব্রেন অ্যান্টিজেন (EMA) পজিটিভ পাওয়া যায়। উপাদানটি Fluorescence in situ hybridization (FISH)-এর জন্য পাঠানো হয় এবং 18q11.2 অবস্থানে SS18 জিনের একটি রি-অ্যারেঞ্জমেন্ট রিপোর্ট করা হয়, যা সিনোভিয়াল সারকোমায় পর্যবেক্ষিত হয়েছে। নমুনাটির প্রান্তগুলি ফ্র্যাগমেন্টেড হওয়ায় হিস্টোপ্যাথোলজির মাধ্যমে মাসের মার্জিন নির্ণয় করা কঠিন ছিল।\n\n২ সপ্তাহ পর রোগী ক্লিনিকে উপস্থিত হন এবং হিস্টোপ্যাথোলজি রিপোর্টের ভিত্তিতে, বৃহত্তর মার্জিনসহ পুনরায় রিসেকশনের বিষয়ে রোগীর সঙ্গে আলোচনা করা হয় এবং তিনি সম্মতি দেন। মাথা ও গলা, বুক, উদর, পেলভিস এবং মাস্কিউলোস্কেলেটাল স্ট্রাকচারের জন্য Positron emission tomography – Computed tomography (PET/CT) করা হয়। শুধুমাত্র বাম থাইরয়েড লোবের নিম্ন পোল-এ ২৯ ∗ ২৭ mm আকারের একটি থাইরয়েড নডিউল পাওয়া যায়, যার standardized uptake values (SUVs) ৪.৯ সহ মাঝারি হাইপারমেটাবোলিজম ছিল। থাইরয়েড US-এ বাম থাইরয়েড লোবের নিম্ন পোল-এ কোনো ইকোজেনিক ফোকাই ছাড়াই একটি সলিড আইসোইকোইক সুস্পষ্ট সীমানাযুক্ত নডিউল দেখা যায়; Thyroid Imaging Reporting and Data System (TIRADS) ছিল TR3।\n\nপ্রথম রিসেকশনের ৩ সপ্তাহ পর দ্বিতীয় রিসেকশন করা হয়। সম্পূর্ণ নমুনাটি উভয় পাশে উভয় কর্ড থেকে রিসেক্ট করা হয়, যা গভীরতর করা হয় কর্পাস স্পঞ্জিওসম পর্যন্ত পৌঁছানো পর্যন্ত এবং এটি ইউরেথ্রা পর্যন্ত ঊর্ধ্বদিকে শেভ করা হয়। নমুনাটি হিস্টোপ্যাথোলজির জন্য পাঠানো হয়। রিসেক্ট করা মাসটির আকার ছিল ৬.০ ∗ ৬.০ ∗ ৩.০ cm এবং এতে কোনো প্যাথোলজি নেগেটিভ ছিল। এরপর রোগীকে অ্যাকটিভ সার্ভেইল্যান্সে রাখা হয় এবং ১৬ মাসের অ্যাকটিভ সার্ভেইল্যান্সের পর তার লিভারের ষষ্ঠ সেগমেন্ট এবং L1 ভার্টিব্রাল বডিতে মেটাস্ট্যাটিক ক্ষত পাওয়া যায়। অনকোলজি দল Ifosfamide এবং Doxorubicin-এর কেমোথেরাপি রেজিমেন ৬ সাইকেলের জন্য শুরু করে, তবে লিভার লেশনে কোনো উন্নতি হয়নি। পঞ্চম ও ষষ্ঠ লিভার সেকশনের জন্য সার্জিক্যাল রিসেকশন চোলেসিস্টেকটমিসহ করা হয়। পরবর্তীতে রোগীর একটি নতুন ফুসফুসের লেশন তৈরি হয় এবং তাকে Pazopanib এবং Stereotactic Body Radiation Therapy SBRT শুরু করা হয়। এরপর রোগী ৬ মাস সার্ভেইল্যান্সে থাকেন, তারপর নতুন লিভার এবং ফুসফুসের লেশন তৈরি হয়; এরপর Gemcitabine এবং Docetaxel কম্বিনেশনের কেমোথেরাপি রেজিমেন ৩ সাইকেলের জন্য দেওয়া হয় এবং রোগ অগ্রগতি হয়; তারপর তাকে Dacarbazine-এর ২ সাইকেল দেওয়া হয় এবং রোগ অগ্রগতি হয়; এরপর Pembrolizumab-এর ২ সাইকেল দেওয়া হয় এবং রোগ অগ্রগতি হয়। পরবর্তীতে রোগীকে প্যালিয়েটিভ কেয়ারে স্থানান্তর করা হয় এবং তিনি ফলো-আপ বন্ধ করে দেন।\n",
+    "translated_summary": "৩৬ বছর বয়সী একজন ব্যক্তি ৫ বছর ধরে পুরুষাঙ্গ এবং অণ্ডকোষের মধ্যে একটি ব্যথাসহ ফোলা অনুভব করছিলেন। রোগীর ফোলা অংশটি অস্ত্রোপচারের মাধ্যমে অপসারণ করা হয়। হিস্টোপ্যাথলজি পরীক্ষায় দেখা যায়, কোষগুলো স্পিন্ডল আকৃতির এবং একটি জটিল বিন্যাসে সজ্জিত। ইমিউনোহিস্টোকেমিস্ট্রি বিশ্লেষণে টিএলই-১, সিডি৯৯, বি-সেল লিম্ফোমা ২ (বিএলসি২), ফোকাল সাইটকেরাটিন এবং ফোকাল এপিথেলিয়াল মেমব্রেন অ্যান্টিজেন (ইএমএ)-এর উপস্থিতি ধরা পড়ে। আমাদের ক্ষেত্রে, রোগীকে দুটি অস্ত্রোপচারের মাধ্যমে এবং পরবর্তীতে বিভিন্ন কেমোথেরাপি পদ্ধতির মাধ্যমে চিকিৎসা করা হলেও, রোগের বিস্তার অব্যাহত ছিল এবং এটি শরীরের অন্যান্য অংশে ছড়িয়ে পড়েছিল।"
+  },
+  {
+    "id": "multiclinsum_gs_en_76.txt",
+    "fulltext": "A 19-year-old woman presented to the emergency department of our institution for acute onset of palpitations. An electrocardiogram (ECG) showed ventricular tachycardia, with right branch bundle block associated to left posterior hemiblock, and T waves inversion in the inferior and precordial leads. Blood test showed elevated troponin (27 ng/L, normal values <14 ng/L) and NT-pro BNP (aminoterminal pro B-Type Natriuretic Peptide) levels (2225 pg/mL, normal values <130 pg/mL). Hence, she was admitted to the coronary care unit.\n\nAbout 5 years before, she had already presented to the emergency department with cardiogenic shock due to fascicular ventricular tachycardia; she was subsequently hospitalized and underwent cardiac magnetic resonance (CMR) and a transoesophageal electrophysiological study, both with inconclusive results. She was discharged with a diagnosis of tachycardiomiopathy, with the prescription of a standard medical therapy (angiotensin-converting enzyme inhibitors, mineralocorticoid receptor antagonist, and beta blockers), and a follow-up was planned. Her subsequent clinical history was uneventful.\n\nDuring the present hospitalization, no further episodes of hyperkinetic arrhythmias were detected. Basal 12-lead ECG. Echocardiography showed diffuse hypokinesia of both the left and the right ventricles, and CMR was once again inconclusive. Then, the patient was advised to undergo cardiac computed tomography angiography (CCTA) to evaluate the anatomy of the coronary tree, under the suspicion of an undiagnosed congenital cardiac anomaly. CCTA was performed with a GE Lightspeed unit (GE HealthCare, Chicago, United States), with retrospective gating, at 100 kVp and 696 mAs, with a gantry rotation time of 0.35 s, and 0.625 mm slice thickness, with intravenous injection of 70 mL of Iomeron 400 mgI/mL (Bracco Imaging, Milan, Italy).\n\nDifferential diagnosis\nCardiogenic shock, namely a shock caused by inadequate blood flow, may be caused by different pathologies such as myocardial infarction, arrhythmias, or other cardiomyopathies. Undiagnosed congenital heart disease is a non-negligible cause of cardiogenic shock in otherwise healthy adult patients. Once myocardial infarction is ruled out by a 12-lead ECG, and an underlying cardiomyopathy has been excluded by an inconclusive CMR examination, CCTA is the technique of choice for the differential diagnosis among diverse causes of cardiogenic shock.\n\nInvestigations/imaging findings\nThe CCTA examination showed regular origin of the left main coronary artery, the left anterior descending artery, which presented a wide ramus intermedium, 2 diagonal branches, and the left circumflex artery, which appeared thin and non-dominant. Among all these vessels, there was no evidence of obstructive coronary artery disease. However, the ostium and the proximal portion of the right coronary artery (RCA) were absent, whereas its mid and distal portions were supplied by a wide collateral branch originating from the distal left anterior descending artery, which then surrounded the lateral wall of the right ventricle, ran through the distal part of the atrioventricular groove, finally giving rise to thin posterior interventricular and posterolateral arteries. Furthermore, a thin branch going from the mid left anterior descending artery to the sinoatrial node was observed.\n\nTreatment, outcome, and follow-up\nIn view of the CCTA findings, the patient underwent an echo-stress test, which confirmed the presence of inducible myocardial ischaemia in the inferior wall, in line with the positioning of the arrhythmic focus. After being transferred to a specialized centre for the diagnosis and treatment of congenital heart disease, the patient underwent transcatheter radiofrequency ablation of sustained ventricular tachycardia originating by the posteromedial papillary muscle. Then, she was discharged with medical therapy (Acetylsalicylic acid and Verapamil). At her 6-month follow-up, she has always been asymptomatic, with no further signs of arrhythmias.",
+    "summary": "A 19-year-old woman presented to the emergency department with arrhythmia and signs of cardiogenic shock. After a 12-lead electrocardiogram ruled out acute myocardial infarction, and cardiac magnetic resonance showed no sign of cardiomyopathy, cardiac computed tomography angiography (CCTA) was performed, displaying ostial atresia of the right coronary artery. She was thus referred to a specialist centre for congenital cardiovascular disease, where an electrophysiological study observed an arrhythmogenic focus on the posteromedial papillary muscle, which was ablated, and she has been asymptomatic since.",
+    "translated_fulltext": "একজন ১৯ বছর বয়সী মহিলা আমাদের প্রতিষ্ঠানে হৃদস্পন্দন বেড়ে যাওয়ার কারণে জরুরি বিভাগে আসেন। তাঁর ইলেক্ট্রোকার্ডিওগ্রাম (ইসিজি)-এ দেখা যায় ভেন্ট্রিকুলার ট্যাকিকার্ডিয়া হয়েছে, যেখানে ডান শাখা বান্ডেল ব্লকের সঙ্গে বাম পোস্টেরিয়র হেমিব্লক যুক্ত ছিল এবং নিম্ন ও প্রি-কর্ডিয়াল লিডে টি ওয়েভের পরিবর্তন দেখা যায়। রক্ত পরীক্ষায় ট্রোপোনিনের মাত্রা বেশি (২৭ এনজি/এল, স্বাভাবিক মাত্রা <১৪ এনজি/এল) এবং এনটি-প্রো বিএনপি (অ্যামিনোটার্মিনাল প্রো বি-টাইপ ন্যাট্রিয়ুরেটিক পেপটাইড)-এর মাত্রা বেশি (২২২৫ পিজি/এমএল, স্বাভাবিক মাত্রা <১৩০ পিজি/এমএল) পাওয়া যায়। তাই তাঁকে করোনারি কেয়ার ইউনিটে ভর্তি করা হয়।\n\nপ্রায় ৫ বছর আগে, তিনি ফ্যাসিকুলার ভেন্ট্রিকুলার ট্যাকিকার্ডিয়ার কারণে কার্ডিওজেনিক শকে আক্রান্ত হয়ে জরুরি বিভাগে এসেছিলেন। এরপর তাঁকে হাসপাতালে ভর্তি করা হয় এবং কার্ডিয়াক ম্যাগনেটিক রেজোন্যান্স (সিএমআর) এবং ট্রান্সওসোফেজিয়াল ইলেক্ট্রোফিজিওলজিক্যাল স্টাডি করা হয়, কিন্তু কোনোটিই নিশ্চিত ফলাফল দিতে পারেনি। তাঁকে ট্যাকিকার্ডিওমায়োপ্যাথির রোগ নির্ণয় করে স্ট্যান্ডার্ড চিকিৎসা (অ্যাঞ্জিওটেনসিন-রূপান্তরকারী এনজাইম ইনহিবিটর, মিনারেলোকোর্টিকয়েড রিসেপ্টর অ্যান্টাগনিস্ট এবং বিটা ব্লকার) দেওয়া হয় এবং ফলো-আপের পরিকল্পনা করা হয়। এরপর তাঁর শারীরিক অবস্থা স্থিতিশীল ছিল।\n\nবর্তমান হাসপাতালে থাকাকালীন, অতিরিক্ত হাইপারকিনেটিক অ্যারিথমিয়ার কোনো ঘটনা ঘটেনি। বেসাল ১২-লিড ইসিজি করা হয়। ইকোকার্ডিওগ্রাফিতে দেখা যায় বাম এবং ডান উভয় ভেন্ট্রিকলের ডিফিউজ হাইপোকাইনেসিয়া রয়েছে এবং সিএমআর আবারও নিশ্চিত ফলাফল দিতে পারেনি। এরপর রোগীর করোনারি গাছের গঠন মূল্যায়ন করার জন্য কার্ডিয়াক কম্পিউটেড টমোগ্রাফি অ্যাঞ্জিওগ্রাফি (সিসিটিএ) করার পরামর্শ দেওয়া হয়, কারণ সন্দেহ করা হচ্ছিল যে তাঁর জন্মগত হৃদরোগ রয়েছে। সিসিটিএ করার জন্য জিই লাইটস্পিড ইউনিট (জিই হেলথকেয়ার, শিকাগো, মার্কিন যুক্তরাষ্ট্র) ব্যবহার করা হয়, যেখানে রেট্রোস্পেক্টিভ গেটিং, ১০০ কিলো ভোল্ট পিক (কেভিপি) এবং ৬৯৬ মিলিঅ্যাম্পিয়ার সেকেন্ড (এমএএস), ০.৩৫ সেকেন্ডের গ্যান্ট্রি রোটেশন টাইম এবং ০.৬২৫ মিমি স্লাইস থিকনেস ব্যবহার করা হয়। এছাড়া, ইন্ট্রাভেনাস ইনজেকশনের মাধ্যমে ৭০ মিলি আয়োমেরন ৪০০ মিলিগ্রাম/এমএল (ব্রাক্কো ইমেজিং, মিলান, ইতালি) দেওয়া হয়।\n\nরোগ নির্ণয়\nকার্ডিওজেনিক শক, অর্থাৎ অপর্যাপ্ত রক্ত প্রবাহের কারণে সৃষ্ট শক, বিভিন্ন কারণে হতে পারে, যেমন মায়োকার্ডিয়াল ইনফার্কশন, অ্যারিথমিয়া বা অন্যান্য কার্ডিওমায়োপ্যাথি। আপাতদৃষ্টিতে সুস্থ প্রাপ্তবয়স্ক রোগীদের ক্ষেত্রে কার্ডিওজেনিক শকের একটি কারণ হলো নির্ণয় করা যায়নি এমন জন্মগত হৃদরোগ। যখন ১২-লিড ইসিজি-র মাধ্যমে মায়োকার্ডিয়াল ইনফার্কশন বাতিল করা হয় এবং একটি অ-নিশ্চিত সিএমআর পরীক্ষার মাধ্যমে অন্তর্নিহিত কার্ডিওমায়োপ্যাথি বাদ দেওয়া হয়, তখন কার্ডিওজেনিক শকের বিভিন্ন কারণের মধ্যে পার্থক্য করার জন্য সিসিটিএ হলো পছন্দের কৌশল।\n\nপরীক্ষা/ইমেজিংয়ের ফলাফল\nসিসিটিএ পরীক্ষায় দেখা যায় বাম প্রধান করোনারি ধমনী, বাম সম্মুখবর্তী নিম্নগামী ধমনী, যার একটি প্রশস্ত রামাস ইন্টারমিডিয়াম, দুটি তির্যক শাখা এবং বাম সার্কামফ্লেক্স ধমনী, যা সরু এবং প্রভাবশালী নয়, তা স্বাভাবিকভাবে শুরু হয়েছে। এই সমস্ত রক্তনালীর মধ্যে, কোনোটিতেই করোনারি ধমনীতে বাধার লক্ষণ দেখা যায়নি। তবে, ডান করোনারি ধমনীর (আরসিএ) মুখ এবং প্রক্সিমাল অংশ অনুপস্থিত ছিল, যেখানে এর মধ্যবর্তী এবং দূরবর্তী অংশে একটি প্রশস্ত কোলাটেরাল শাখা থেকে রক্ত সরবরাহ করা হতো, যা বাম সম্মুখবর্তী নিম্নগামী ধমনীর দূরবর্তী অংশ থেকে উৎপন্ন হয়েছিল। এরপর এটি ডান ভেন্ট্রিকলের পাশের দেয়ালকে ঘিরে রেখে অ্যাট্রিওভেন্ট্রিকুলার খাঁজের দূরবর্তী অংশ দিয়ে প্রবাহিত হয়ে অবশেষে সরু পোস্টেরিয়র ইন্টারভেন্ট্রিকুলার এবং পোস্টেরোলাটেরাল ধমনী তৈরি করে। এছাড়াও, মধ্যবর্তী বাম সম্মুখবর্তী নিম্নগামী ধমনী থেকে সাইনোএট্রিয়াল নোডে একটি সরু শাখা দেখা যায়।\n\nচিকিৎসা, ফলাফল এবং ফলো-আপ\nসিসিটিএ পরীক্ষার ফলাফলের ভিত্তিতে, রোগীর একটি ইকো-স্ট্রেস পরীক্ষা করা হয়, যা নিশ্চিত করে যে নিম্নবর্তী দেয়ালে প্ররোচিত মায়োকার্ডিয়াল ইস্কেমিয়া রয়েছে, যা অ্যারিথমিক ফোকাসের অবস্থানের সঙ্গে সঙ্গতিপূর্ণ। এরপর রোগীকে জন্মগত হৃদরোগের নির্ণয় এবং চিকিৎসার জন্য একটি বিশেষ কেন্দ্রে স্থানান্তর করা হয়, যেখানে পোস্টেরোমিডিয়াল প্যাপিলারি পেশী থেকে উৎপন্ন ভেন্ট্রিকুলার ট্যাকিকার্ডিয়ার রেডিওফ্রিকোয়েন্সি অ্যাবলেশন করা হয়। এরপর তাঁকে ওষুধ (অ্যাসিটাইলস্যালিসিলিক অ্যাসিড এবং ভেরাপামিল) দিয়ে ছুটি দেওয়া হয়। ৬ মাসের ফলো-আপে, তিনি সম্পূর্ণরূপে উপসর্গমুক্ত ছিলেন এবং অ্যারিথমিয়ার আর কোনো লক্ষণ দেখা যায়নি।",
+    "translated_summary": "১৯ বছর বয়সী একজন নারী অ্যারিথমিয়া এবং কার্ডিওজেনিক শকের লক্ষণ নিয়ে জরুরি বিভাগে আসেন। ১২-লিড ইলেক্ট্রোকার্ডিওগ্রামের মাধ্যমে তীব্র মায়োকার্ডিয়াল ইনফার্কশন বাতিল করার পরে এবং কার্ডিয়াক ম্যাগনেটিক রেজোন্যান্স পরীক্ষায় কার্ডিওমায়োপ্যাথির কোনো লক্ষণ না পাওয়ায়, কার্ডিয়াক কম্পিউটেড টমোগ্রাফি অ্যাঞ্জিওগ্রাফি (সিসিটিএ) করা হয়, যেখানে ডান করোনারি ধমনীর অস্টিয়াল অ্যাট্রেসিয়া দেখা যায়। এরপর তাকে জন্মগত হৃদরোগের জন্য একটি বিশেষায়িত কেন্দ্রে পাঠানো হয়, যেখানে একটি ইলেক্ট্রোফিজিওলজিক্যাল স্টাডিতে পোস্টেরোমেডিয়াল প্যাপিলারি পেশীতে অ্যারিথমোজেনিক ফোকাস দেখা যায়, যা পরে অপসারণ করা হয়। এরপর থেকে তিনি উপসর্গমুক্ত আছেন।"
+  },
+  {
+    "id": "multiclinsum_gs_en_293.txt",
+    "fulltext": "An 18-year-old hispanic male patient with no significant medical history presents to the emergency department (ED) complaining of substernal, non-radiated chest pain, orthopnoea, dry and non-productive cough, and subjective fevers at home, for the last 3–4 days. Family history remarkable for paternal grandfather diagnosed with non-ischaemic cardiomyopathy and a pacemaker at age 86 years old. Patient lives with both parents and denies any smoking, ethanol consumption, recreational drug use, abuse or neglect at home. He worked at auto-part shop and planned to start college soon.\n\n\nInvestigations\n\n\nIn the ED, serum troponin I levels were found to be elevated and ECG showed diffuse ST-segment elevation. He was admitted to the local hospital and initial workup was remarkable for an enlarged cardiac silhouette and mild pulmonary oedema observed on chest X-ray, a transthoracic echocardiogram (TTE) demonstrating left ventricular ejection fraction (LVEF) of 40%, with severe left ventricular (LV) concentric hypertrophy and mild posterior pericardial effusion. Additionally, the patient was found to have elevated titres for Coxsackie virus A and B. His symptoms initially improved with the initiation of ibuprofen and colchicine. Cardiac catheterisation was performed, which revealed no evidence of coronary artery disease. Repeat TTE showed an LVEF of 40%–45%, hypokinesis of anteroapical and inferolateral wall, with an elevated LV end-diastolic pressure, consistent with diastolic dysfunction. Chest CT angiogram showed evidence of pneumonitis and a pericardial effusion. And at this point, the constellation of symptoms was thought to be secondary to Coxsackie myopericarditis, for which he continued to receive medical treatment as previously mentioned.\n\nOn the fourth day of admission, the patient became diaphoretic, tachycardic and hypotensive with an undetectable blood pressure. Emergent TTE showed large pericardial effusion with impending cardiac tamponade features, and pericardiocentesis was performed. During the procedure, the patient developed pulseless electrical activity (PEA) cardiac arrest and received advanced cardiovascular support for 30 min. Ultimately patient was intubated, placed on venous-arterial extracorporeal membrane oxygenation (VA ECMO) and started on vasopressor support (norepinephrine 5 mcg/min and vasopressin 0.05 units/min), with numerous transfusions (9 packed red bloodcells, 10 units of platelets, 10 units of cryoprecipitate and 4 units of fresh frozen plasma) due to significant oozing of blood from the ECMO cannula. He was transferred to our hospital where endomyocardial biopsy (EMB) was then obtained due to concern of fulminant myocarditis and to test for other infiltrative cardiomyopathies. Pathology reports showed no signs suggestive of inflammatory or infiltrative process in the endomyocardium. Coxsackie Abs were repeated and were positive for Cox A type 9, Coxsackie B2 and Coxsackie B6, and an elevated Epstein-Barr virus (EBV) DNA quantitative PCR at 133 000 IU/mL. At this point, another TTE was done, which showed a severely decreased ejection fraction (EF) of 10%–15% with previously noted severe LV concentric hypertrophy (1.9 cm septum and 2.2 cm in the inferolateral wall).\n\nThe patient was started on intravenous immunoglobulin (IVIG) for treatment of Coxsackie myocarditis, and broad-spectrum antibiotics due to worsening leucocytosis, but with no identified infectious focus. Colchicine was discontinued due to concern for rhabdomyolysis, with elevation of serum creatine kinase level to 2874 unit/L. Vasopressors were then discontinued and the patient was extubated. He also developed episode of flushing, fever, dyspnoea and decreasing oxygen saturation, with chest X-ray showing congested lung parenchyma with concerns for ARDS, therefore, IVIG was stopped.\n\nGiven improvement of cardiac function in another TTE with LVEF of 25%–30%, it was decided to attempt to remove the ECMO, which was unsuccessful. The patient remained on ECMO support and emergent discussion with heart failure team took place to determine best approach. The patient was evaluated for possible left ventricle assist device, however, deemed not a candidate due to significant global concentric LV hypertrophy, and the multidisciplinary team agreed to facilitate emergency listing for heart transplantation, with consideration to transition to another cardiovascular support such as intra-aortic balloon pump, with potential inotrope support.\n\nDuring further evaluation for possible heart transplant, an incisional biopsy of a 1×1 inch palpable, painless, rubbery, mobile mass in the right arm was done and sent for pathology. The patient mentioned he first noticed this lesion approximately 2–3 months before presenting to the ED. Pathology report of the right upper extremity mass showed aggressive EBV (+) NK/T-cell lymphoma with a cytotoxic immunophenotype (positive for CD 2, CD3, CD56, BCL2, granzyme B, TIA1, MUM1 and diffuse coexpression of Epstein-Barr virus-encoded small RNAs by in situ hybridisation), and a modified SMILE (Steroids, Methotrexate with leucovorin, Ifosfamide with mesna, L-asparaginase and Etoposide) chemotherapy regimen was started. In situ hybridisation of the EMB previously obtained were negative for EBV-RNA.\n\nCardiac MRI was obtained, which revealed hypokinesis of the inferolateral and anterolateral wall, as previously described by TTE, delayed enhancement in the subendocardial and transmural distribution in these regions, with relative sparing of the septum. Additionally, avid enhancement and thickening of the pericardium, without a mass identified, and a pocket of pericardial fluid with septations, concerning for loculations, were also noted.\n\n\nDifferential diagnosis\n\nThe constellation of symptoms (shortness of breath, orthopnoea, hypotension and subjective fevers), with findings such as diffuse ST-segment elevation on ECG, leakages of cardiac markers (troponin), elevated Coxsackie virus titres (both of serotype A and B), as well as echocardiographic findings of pericardial effusion; all seemed to correlate with a classic presentation of viral pericarditis clinical due to Coxackie virus. However, despite medical treatment with colchicine, the patient continued to decompensate and eventually required pericardiocentesis due to cardiac tamponade, then developed cardiac arrest and ultimately requires ECMO support, for what seems acute onset heart failure. In this setting, fulminant myocarditis secondary to Coxsackie virus was considered. Cardiotropic RNA virus, such as Coxackie viruses, induce receptor-mediated endocytosis, with viral replication contributing to cellular dysfunction and ultimately apoptosis of the cell.1 When susceptible individuals are infected with highly virulent viral strains, maladaptive immunologic activity can occur, leading to persistent activation of T cells and continued antibody-mediated myocyte destruction, which can ultimately lead to fulminant myocarditis. EBV myocarditis could also explain the rapid deterioration in the setting of a positive EBV PCR, which is a more sensitivity test than traditional serologies for detection of acute infection.2 However, in situ hybridisation was negative for EBV-RNA.\n\nNevertheless, the significant concentric hypertrophy observed on the initial TTEs and the atypical delayed enhancement observed on the cardiac MRI are not explained by this diagnosis. Additionally, the EMB did not show an inflammatory process.\n\nFortuitous finding of EBV (+) NK/T-cell lymphoma by incisional biopsy of the right upper extremity allowed for a more fitting diagnosis for this case. The pericardial effusion, unresponsive to initial medical treatment and new acute heart failure with concentric hypertrophic cardiomyopathy, in the setting of newly diagnosed NK/T-cell lymphoma, raises the possibility of NK/T-cell lymphoma with involvement of the myocardium and pericardium as the most adequate diagnosis in this scenario, which englobes all the features previously mentioned in this case.\n\nOther differentials taken into consideration include infiltrative cardiomyopathy such as amyloidosis. However, Congo red staining of the EMB samples failed to demonstrate deposition of amyloid.\n\n\nTreatment\n\nGiven the diagnosis of extranodal NK/T-cell lymphoma (ENKTCL) with suspected pericardial involvement and no bone marrow involvement, modified SMILE regimen was desired as the first-line chemotherapy regimen. This regimen includes dexamethasone, ifosfamide, mesna and etoposide, and excluded methotrexate, due to evidence of third-spacing and effusions, which could lead to delayed excretion and increased risk of toxicity.\n\nHowever, due to his compromised cardiac function, it was believed that the patient would not tolerate cytotoxic chemotherapy which requires aggressive intravenous, and alternatively, emergent chemotherapy regimen was instituted: carboplatin (day 1–day 3), etoposide (day 1–day 5) and dexamethasone. Peg-asparaginase was later introduced in the regimen (day 7–day 21). This regimen proved effective, as evidenced by rapid recovery of the LV function and overall haemodynamic stability, and decision was made to incorporate a modified SMILE chemotherapy regimen, of which he received two cycles. Then chemotherapy regimen was changed to dexamethasone, gemcitabine, carboplatin and peg-asparaginase (DDGP). The patient received two cycles of DDGP. A full body positron emission tomography (PET) scan was negative for lymphoma. The plan is to continue two more cycles of chemotherapy (to complete six total cycles of chemotherapy). Currently, the patient is considering radiation therapy and possible stem cell transplant, after completion of the chemotherapy regimen. Additionally, the patient is currently on guideline-directed medical therapy for heart failure and has completed cardiac rehabilitation.\n\n\nOutcome and follow-up\n\nThe patient has completed five out of six chemotherapy sessions with the previously mentioned regimens. After initiation of chemotherapy and optimal medical treatment for heart failure, the patient has recovered much of his cardiac function, as evidenced by an LVEF of 55%, no wall motion abnormalities and normal myocardial wall thickness on his most recent TTE. He continues to be followed by heart failure/cardiology team and oncology team in clinic.",
+    "summary": "An 18-year-old male patient presented to the emergency department complaining of new onset chest pain, fever and orthopnoea. Initial workup was remarkable for elevated troponin, diffuse ST-segment elevation on ECG and chest X-ray with enlarged cardiac silhouette. Transthoracic echocardiogram (TTE) demonstrates severe biventricular concentric hypertrophy and pericardial effusion. Also, Coxsackie virus A and B titres were positive, concerning for a classic viral pericarditis. However, despite medical management, the patient became dyspnoeic and hypotensive. Impending cardiac tamponade was observed on repeat TTE, and pericardiocentesis was performed, complicated by pulseless electrical activity cardiac arrest, and ultimately patient requiring venoarterial extracorporeal membrane oxygenation support. Emergent endomyocardial biopsy showed no inflammatory process, and a skin biopsy of a small lesion in the right arm showed unexpected diagnosis of Epstein-Barr virus (+) natural killer/T-cell lymphoma. On initiation of chemotherapy, clinical improvement was observed as evidenced by improving ejection fraction, resolution of pericardial effusion and gradual decrease in myocardial hypertrophy.",
+    "translated_fulltext": "একজন ১৮ বছর বয়সী হিস্পানিক পুরুষ রোগী, যার কোনো উল্লেখযোগ্য পূর্ববর্তী চিকিৎসা ইতিহাস নেই, জরুরি বিভাগে (ED) উপস্থিত হন সাবস্টার্নাল, বিকিরণহীন বুকে ব্যথা, অর্থোপনিয়া, শুষ্ক ও অউৎপাদনশীল কাশি এবং বাড়িতে অনুভূত জ্বরের অভিযোগ নিয়ে, যা গত ৩–৪ দিন ধরে চলছে। পারিবারিক ইতিহাসে উল্লেখযোগ্য যে পিতামহের নন-ইস্কেমিক কার্ডিওমায়োপ্যাথি নির্ণয় হয়েছিল এবং ৮৬ বছর বয়সে তার পেসমেকার স্থাপন করা হয়। রোগী উভয় পিতামাতার সঙ্গে বসবাস করেন এবং ধূমপান, ইথানল গ্রহণ, বিনোদনমূলক মাদক ব্যবহার, বাড়িতে নির্যাতন বা অবহেলার কোনো ইতিহাস অস্বীকার করেন। তিনি একটি অটো-পার্টস দোকানে কাজ করতেন এবং শিগগিরই কলেজে ভর্তি হওয়ার পরিকল্পনা ছিল।\n\nতদন্তসমূহ\n\nED-তে সিরাম ট্রোপোনিন I মাত্রা বৃদ্ধি পাওয়া যায় এবং ECG-তে বিস্তৃত ST-সেগমেন্ট এলিভেশন দেখা যায়। তাকে স্থানীয় হাসপাতালে ভর্তি করা হয় এবং প্রাথমিক ওয়ার্কআপে বুকে এক্স-রে-তে বর্ধিত কার্ডিয়াক সিলুয়েট ও মৃদু পালমোনারি ইডিমা লক্ষ্য করা যায়, ট্রান্সথোরাসিক ইকোকার্ডিওগ্রাম (TTE)-এ বাম ভেন্ট্রিকুলার ইজেকশন ফ্র্যাকশন (LVEF) ৪০% পাওয়া যায়, সঙ্গে তীব্র বাম ভেন্ট্রিকুলার (LV) কনসেন্ট্রিক হাইপারট্রফি এবং মৃদু পশ্চাৎস্থ পেরিকার্ডিয়াল ইফিউশন। অতিরিক্তভাবে, রোগীর Coxsackie virus A এবং B-এর টাইটার বৃদ্ধি পাওয়া যায়। আইবুপ্রোফেন ও কোলচিসিন শুরু করার পর তার উপসর্গ প্রাথমিকভাবে উন্নত হয়। কার্ডিয়াক ক্যাথেটারাইজেশন করা হয়, যাতে করোনারি আর্টারি ডিজিজের কোনো প্রমাণ পাওয়া যায়নি। পুনরায় TTE-তে LVEF ৪০%–৪৫%, অ্যান্টেরোএপিকাল ও ইনফেরোল্যাটারাল দেয়ালের হাইপোকিনেসিস এবং বর্ধিত LV এন্ড-ডায়াস্টোলিক প্রেসার দেখা যায়, যা ডায়াস্টোলিক ডিসফাংশনের সঙ্গে সামঞ্জস্যপূর্ণ। চেস্ট CT অ্যাঞ্জিওগ্রামে নিউমোনাইটিস ও পেরিকার্ডিয়াল ইফিউশনের প্রমাণ পাওয়া যায়। এই পর্যায়ে উপসর্গসমূহের সমষ্টিকে Coxsackie মায়োপেরিকার্ডাইটিসের ফল হিসেবে বিবেচনা করা হয়, যার জন্য পূর্বে উল্লেখিত চিকিৎসা চালু রাখা হয়।\n\nভর্তির চতুর্থ দিনে রোগী ডায়াফোরেটিক, ট্যাকিকার্ডিক ও হাইপোটেনসিভ হয়ে পড়েন এবং রক্তচাপ অনির্ণেয় হয়ে যায়। জরুরি TTE-তে বড় পেরিকার্ডিয়াল ইফিউশন ও আসন্ন কার্ডিয়াক ট্যাম্পোনেডের বৈশিষ্ট্য দেখা যায় এবং পেরিকার্ডিওসেন্টেসিস করা হয়। প্রক্রিয়ার সময় রোগীর পালসলেস ইলেকট্রিক্যাল অ্যাক্টিভিটি (PEA) কার্ডিয়াক অ্যারেস্ট হয় এবং তাকে ৩০ মিনিট ধরে অ্যাডভান্সড কার্ডিওভাসকুলার সাপোর্ট দেওয়া হয়। শেষ পর্যন্ত রোগীকে ইন্টুবেট করা হয়, ভেনাস-আর্টেরিয়াল এক্সট্রাকরপোরিয়াল মেমব্রেন অক্সিজেনেশন (VA ECMO)-এ স্থাপন করা হয় এবং ভ্যাসোপ্রেসর সাপোর্ট (নোরএপিনেফ্রিন 5 mcg/min এবং ভ্যাসোপ্রেসিন 0.05 units/min) শুরু করা হয়, সঙ্গে উল্লেখযোগ্য রক্তক্ষরণের কারণে ECMO ক্যানুলা থেকে রক্তক্ষরণজনিত অবস্থায় একাধিক রক্তসঞ্চালন (৯ ইউনিট প্যাকড রেড ব্লাড সেল, ১০ ইউনিট প্লেটলেট, ১০ ইউনিট ক্রাইওপ্রেসিপিটেট এবং ৪ ইউনিট ফ্রেশ ফ্রোজেন প্লাজমা) দেওয়া হয়। তাকে আমাদের হাসপাতালে স্থানান্তর করা হয়, যেখানে ফুলমিন্যান্ট মায়োকার্ডাইটিসের আশঙ্কা এবং অন্যান্য ইনফিলট্রেটিভ কার্ডিওমায়োপ্যাথি মূল্যায়নের জন্য এন্ডোমায়োকার্ডিয়াল বায়োপসি (EMB) নেওয়া হয়। প্যাথলজি রিপোর্টে এন্ডোমায়োকার্ডিয়ামে কোনো প্রদাহজনিত বা ইনফিলট্রেটিভ প্রক্রিয়ার ইঙ্গিত পাওয়া যায়নি। Coxsackie অ্যান্টিবডি পুনরায় পরীক্ষা করা হলে Cox A টাইপ 9, Coxsackie B2 এবং Coxsackie B6 পজিটিভ পাওয়া যায়, এবং Epstein-Barr virus (EBV) DNA কোয়ান্টিটেটিভ PCR 133 000 IU/mL পর্যন্ত বৃদ্ধি পাওয়া যায়। এই পর্যায়ে আরেকটি TTE করা হয়, যাতে ইজেকশন ফ্র্যাকশন (EF) গুরুতরভাবে কমে ১০%–১৫% পাওয়া যায়, সঙ্গে পূর্বে উল্লেখিত তীব্র LV কনসেন্ট্রিক হাইপারট্রফি (সেপ্টাম ১.৯ সেমি এবং ইনফেরোল্যাটারাল দেয়ালে ২.২ সেমি)।\n\nরোগীকে Coxsackie মায়োকার্ডাইটিসের চিকিৎসার জন্য ইনট্রাভেনাস ইমিউনোগ্লোবুলিন (IVIG) শুরু করা হয় এবং লিউকোসাইটোসিস বৃদ্ধির কারণে, যদিও কোনো সংক্রমণের উৎস চিহ্নিত হয়নি, ব্রড-স্পেকট্রাম অ্যান্টিবায়োটিক দেওয়া হয়। র‌্যাবডোমায়োলাইসিসের আশঙ্কায় কোলচিসিন বন্ধ করা হয়, কারণ সিরাম ক্রিয়েটিন কিনেজ মাত্রা 2874 unit/L পর্যন্ত বৃদ্ধি পায়। পরবর্তীতে ভ্যাসোপ্রেসর বন্ধ করা হয় এবং রোগীকে এক্সটিউবেট করা হয়। তার ফ্লাশিং, জ্বর, ডিসপনিয়া ও অক্সিজেন স্যাচুরেশন হ্রাসের একটি পর্ব হয়, এবং চেস্ট এক্স-রে-তে ফুসফুসের প্যারেনকাইম কনজেস্টেড দেখা যায় ARDS-এর আশঙ্কাসহ; তাই IVIG বন্ধ করা হয়।\n\nপরবর্তী TTE-তে LVEF ২৫%–৩০% পর্যন্ত উন্নতি দেখা যাওয়ায় ECMO অপসারণের চেষ্টা করার সিদ্ধান্ত নেওয়া হয়, তবে তা সফল হয়নি। রোগী ECMO সাপোর্টে থেকেই যান এবং সর্বোত্তম ব্যবস্থাপনা নির্ধারণের জন্য হার্ট ফেলিউর টিমের সঙ্গে জরুরি আলোচনা হয়। সম্ভাব্য লেফট ভেন্ট্রিকল অ্যাসিস্ট ডিভাইসের জন্য রোগীকে মূল্যায়ন করা হয়, তবে উল্লেখযোগ্য গ্লোবাল কনসেন্ট্রিক LV হাইপারট্রফির কারণে তাকে প্রার্থী হিসেবে উপযুক্ত মনে করা হয়নি, এবং মাল্টিডিসিপ্লিনারি টিম জরুরি হার্ট ট্রান্সপ্লান্ট তালিকাভুক্তির সিদ্ধান্ত নেয়, সঙ্গে ইনট্রা-অর্টিক বেলুন পাম্পের মতো অন্য কার্ডিওভাসকুলার সাপোর্টে রূপান্তর এবং সম্ভাব্য ইনোট্রোপ সাপোর্ট বিবেচনা করা হয়।\n\nহার্ট ট্রান্সপ্লান্টের সম্ভাব্যতার আরও মূল্যায়নের সময় ডান বাহুতে ১×১ ইঞ্চি আকারের একটি স্পর্শযোগ্য, ব্যথাহীন, রাবারি ও চলনশীল মাংসপিণ্ডের ইনসিশনাল বায়োপসি করা হয় এবং প্যাথলজিতে পাঠানো হয়। রোগী জানান যে তিনি এই ক্ষতটি ED-তে আসার প্রায় ২–৩ মাস আগে প্রথম লক্ষ্য করেছিলেন। ডান উপরের অঙ্গের এই মাংসপিণ্ডের প্যাথলজি রিপোর্টে আগ্রাসী EBV (+) NK/T-cell লিম্ফোমা পাওয়া যায়, সাইটোটক্সিক ইমিউনোফেনোটাইপসহ (CD 2, CD3, CD56, BCL2, গ্র্যানজাইম B, TIA1, MUM1 পজিটিভ এবং ইন সিটু হাইব্রিডাইজেশনে Epstein-Barr virus-এনকোডেড স্মল RNA-এর বিস্তৃত কো-এক্সপ্রেশন), এবং একটি পরিবর্তিত SMILE (Steroids, Methotrexate with leucovorin, Ifosfamide with mesna, L-asparaginase এবং Etoposide) কেমোথেরাপি রেজিমেন শুরু করা হয়। পূর্বে সংগৃহীত EMB-এর ইন সিটু হাইব্রিডাইজেশন EBV-RNA-এর জন্য নেগেটিভ ছিল।\n\nকার্ডিয়াক MRI করা হয়, যাতে TTE-তে পূর্বে বর্ণিত ইনফেরোল্যাটারাল ও অ্যান্টেরোল্যাটারাল দেয়ালের হাইপোকিনেসিস, এই অঞ্চলগুলোতে সাবএন্ডোকার্ডিয়াল ও ট্রান্সমিউরাল বণ্টনে ডিলেইড এনহান্সমেন্ট, এবং সেপ্টামের তুলনামূলক সুরক্ষা দেখা যায়। অতিরিক্তভাবে, কোনো মাংসপিণ্ড শনাক্ত না হলেও পেরিকার্ডিয়ামের তীব্র এনহান্সমেন্ট ও পুরুত্ব বৃদ্ধি, এবং সেপটেশনসহ পেরিকার্ডিয়াল তরলের একটি পকেট দেখা যায়, যা লোকুলেশনের আশঙ্কা সৃষ্টি করে।\n\nডিফারেনশিয়াল ডায়াগনোসিস\n\nউপসর্গসমূহের সমষ্টি (শ্বাসকষ্ট, অর্থোপনিয়া, হাইপোটেনশন এবং অনুভূত জ্বর), সঙ্গে ECG-তে বিস্তৃত ST-সেগমেন্ট এলিভেশন, কার্ডিয়াক মার্কার (ট্রোপোনিন) লিকেজ, Coxsackie ভাইরাস টাইটার বৃদ্ধি (A ও B উভয় সেরোটাইপ), এবং ইকোকার্ডিওগ্রাফিতে পেরিকার্ডিয়াল ইফিউশনের উপস্থিতি—সবকিছুই Coxsackie ভাইরাসজনিত ভাইরাল পেরিকার্ডাইটিসের একটি ক্লাসিক ক্লিনিক্যাল উপস্থাপনার সঙ্গে সামঞ্জস্যপূর্ণ মনে হয়েছিল। তবে কোলচিসিন দিয়ে চিকিৎসা সত্ত্বেও রোগীর অবস্থা ক্রমশ অবনতি ঘটে এবং শেষ পর্যন্ত কার্ডিয়াক ট্যাম্পোনেডের কারণে পেরিকার্ডিওসেন্টেসিসের প্রয়োজন হয়, এরপর কার্ডিয়াক অ্যারেস্ট ঘটে এবং শেষ পর্যন্ত ECMO সাপোর্ট প্রয়োজন হয়, যা তীব্র সূচনাযুক্ত হার্ট ফেলিউরের মতো প্রতীয়মান হয়। এই প্রেক্ষাপটে Coxsackie ভাইরাসজনিত ফুলমিন্যান্ট মায়োকার্ডাইটিস বিবেচনা করা হয়। কার্ডিওট্রপিক RNA ভাইরাস, যেমন Coxsackie ভাইরাস, রিসেপ্টর-মধ্যস্থ এন্ডোসাইটোসিসের মাধ্যমে কোষে প্রবেশ করে, যেখানে ভাইরাল রিপ্লিকেশন কোষীয় ডিসফাংশন এবং শেষ পর্যন্ত কোষের অ্যাপোপটোসিস ঘটায়।¹ যখন সংবেদনশীল ব্যক্তিরা অত্যন্ত ভিরুলেন্ট ভাইরাল স্ট্রেইনে সংক্রমিত হন, তখন ম্যালঅ্যাডাপটিভ ইমিউনোলজিক কার্যকলাপ ঘটতে পারে, যার ফলে T সেলের স্থায়ী সক্রিয়তা এবং অব্যাহত অ্যান্টিবডি-মধ্যস্থ মায়োসাইট ধ্বংস হয়, যা শেষ পর্যন্ত ফুলমিন্যান্ট মায়োকার্ডাইটিসে রূপ নিতে পারে। EBV মায়োকার্ডাইটিসও পজিটিভ EBV PCR-এর প্রেক্ষাপটে দ্রুত অবনতির ব্যাখ্যা দিতে পারে, কারণ এটি তীব্র সংক্রমণ শনাক্তকরণে প্রচলিত সেরোলজির তুলনায় বেশি সংবেদনশীল পরীক্ষা।² তবে ইন সিটু হাইব্রিডাইজেশন EBV-RNA-এর জন্য নেগেটিভ ছিল।\n\nতবুও, প্রাথমিক TTE-তে দেখা উল্লেখযোগ্য কনসেন্ট্রিক হাইপারট্রফি এবং কার্ডিয়াক MRI-তে দেখা অস্বাভাবিক ডিলেইড এনহান্সমেন্ট এই ডায়াগনোসিস দ্বারা ব্যাখ্যা করা যায় না। এছাড়া, EMB-তে কোনো প্রদাহজনিত প্রক্রিয়া দেখা যায়নি।\n\nডান উপরের অঙ্গের ইনসিশনাল বায়োপসিতে EBV (+) NK/T-cell লিম্ফোমার আকস্মিক আবিষ্কার এই কেসের জন্য আরও উপযুক্ত ডায়াগনোসিস প্রদান করে। প্রাথমিক চিকিৎসায় সাড়া না দেওয়া পেরিকার্ডিয়াল ইফিউশন এবং নতুনভাবে সৃষ্ট কনসেন্ট্রিক হাইপারট্রফিক কার্ডিওমায়োপ্যাথিসহ তীব্র হার্ট ফেলিউর, সদ্য নির্ণীত NK/T-cell লিম্ফোমার প্রেক্ষাপটে, মায়োকার্ডিয়াম ও পেরিকার্ডিয়াম জড়িত NK/T-cell লিম্ফোমার সম্ভাবনাকে সবচেয়ে উপযুক্ত ডায়াগনোসিস হিসেবে নির্দেশ করে, যা এই কেসে পূর্বে উল্লেখিত সব বৈশিষ্ট্যকে অন্তর্ভুক্ত করে।\n\nঅন্যান্য বিবেচিত ডিফারেনশিয়ালের মধ্যে ইনফিলট্রেটিভ কার্ডিওমায়োপ্যাথি, যেমন অ্যামাইলয়ডোসিস অন্তর্ভুক্ত ছিল। তবে EMB নমুনার কঙ্গো রেড স্টেইনিং অ্যামাইলয়ড জমার কোনো প্রমাণ দেখাতে ব্যর্থ হয়।\n\nচিকিৎসা\n\nএক্সট্রানোডাল NK/T-cell লিম্ফোমা (ENKTCL) নির্ণয়ের প্রেক্ষিতে, পেরিকার্ডিয়াল জড়িত থাকার সন্দেহ থাকলেও বোন ম্যারো জড়িত না থাকায়, পরিবর্তিত SMILE রেজিমেনকে প্রথম সারির কেমোথেরাপি হিসেবে বিবেচনা করা হয়। এই রেজিমেনে ডেক্সামেথাসোন, ইফোসফামাইড, মেসনা এবং ইটোপোসাইড অন্তর্ভুক্ত ছিল, এবং তৃতীয়-স্পেসিং ও ইফিউশনের প্রমাণ থাকার কারণে মেথোট্রেক্সেট বাদ দেওয়া হয়, কারণ এতে বিলম্বিত নির্গমন ও টক্সিসিটির ঝুঁকি বাড়তে পারে।\n\nতবে, কার্ডিয়াক ফাংশন মারাত্মকভাবে ক্ষতিগ্রস্ত থাকায় ধারণা করা হয় যে রোগী আক্রমণাত্মক ইনট্রাভেনাস প্রয়োজনীয় সাইটোটক্সিক কেমোথেরাপি সহ্য করতে পারবেন না, এবং বিকল্প হিসেবে জরুরি কেমোথেরাপি রেজিমেন শুরু করা হয়: কার্বোপ্লাটিন (দিন ১–দিন ৩), ইটোপোসাইড (দিন ১–দিন ৫) এবং ডেক্সামেথাসোন। পরে রেজিমেনে পেগ-অ্যাসপারাজিনেজ যুক্ত করা হয় (দিন ৭–দিন ২১)। এই রেজিমেন কার্যকর প্রমাণিত হয়, কারণ LV ফাংশনের দ্রুত পুনরুদ্ধার ও সামগ্রিক হেমোডাইনামিক স্থিতিশীলতা অর্জিত হয়, এবং পরিবর্তিত SMILE কেমোথেরাপি রেজিমেন অন্তর্ভুক্ত করার সিদ্ধান্ত নেওয়া হয়, যার দুটি সাইকেল তিনি গ্রহণ করেন। পরবর্তীতে কেমোথেরাপি রেজিমেন পরিবর্তন করে ডেক্সামেথাসোন, জেমসিটাবিন, কার্বোপ্লাটিন এবং পেগ-অ্যাসপারাজিনেজ (DDGP) দেওয়া হয়। রোগী DDGP-এর দুটি সাইকেল গ্রহণ করেন। সম্পূর্ণ দেহের পজিট্রন এমিশন টোমোগ্রাফি (PET) স্ক্যান লিম্ফোমার জন্য নেগেটিভ ছিল। মোট ছয়টি কেমোথেরাপি সাইকেল সম্পন্ন করার লক্ষ্যে আরও দুটি সাইকেল চালিয়ে যাওয়ার পরিকল্পনা রয়েছে। বর্তমানে, কেমোথেরাপি রেজিমেন সম্পন্নের পর রোগী রেডিয়েশন থেরাপি এবং সম্ভাব্য স্টেম সেল ট্রান্সপ্লান্ট বিবেচনা করছেন। অতিরিক্তভাবে, রোগী বর্তমানে হার্ট ফেলিউরের জন্য গাইডলাইন-ডিরেক্টেড মেডিক্যাল থেরাপিতে আছেন এবং কার্ডিয়াক রিহ্যাবিলিটেশন সম্পন্ন করেছেন।\n\nফলাফল ও ফলো-আপ\n\nরোগী পূর্বে উল্লেখিত রেজিমেন অনুযায়ী ছয়টির মধ্যে পাঁচটি কেমোথেরাপি সেশন সম্পন্ন করেছেন। কেমোথেরাপি শুরু এবং হার্ট ফেলিউরের জন্য সর্বোত্তম মেডিক্যাল চিকিৎসার পর রোগীর কার্ডিয়াক ফাংশনের উল্লেখযোগ্য পুনরুদ্ধার হয়েছে, যা সাম্প্রতিক TTE-তে LVEF ৫৫%, কোনো ওয়াল মোশন অ্যাবনরমালিটি না থাকা এবং স্বাভাবিক মায়োকার্ডিয়াল ওয়াল থিকনেস দ্বারা প্রমাণিত। তিনি নিয়মিতভাবে হার্ট ফেলিউর/কার্ডিওলজি টিম এবং অনকোলজি টিমের তত্ত্বাবধানে ক্লিনিকে ফলো-আপে আছেন।\n",
+    "translated_summary": "একজন ১৮ বছর বয়সী পুরুষ রোগী জরুরি বিভাগে এসে নতুন করে বুকে ব্যথা, জ্বর এবং শ্বাসকষ্টের কথা জানান। প্রাথমিক পরীক্ষায় দেখা যায় তার ট্রোপোনিনের মাত্রা বেশি, ইসিজিতে এসটি সেগমেন্টের ব্যাপক পরিবর্তন এবং বুকের এক্স-রেতে হৃদপিণ্ডের আকার স্বাভাবিকের চেয়ে বড় দেখা যায়। ট্রান্সথোরাসিক ইকোকার্ডিওগ্রাম (টিটিই)-এ গুরুতর বাইভেন্ট্রিকুলার কনসেন্ট্রিক হাইপারট্রফি এবং পেরিকার্ডিয়াল ইফিউশন দেখা যায়। এছাড়াও, কক্সস্যাকি ভাইরাস এ এবং বি-এর অ্যান্টিবডি পজিটিভ পাওয়া যায়, যা একটি ক্লাসিক ভাইরাল পেরিকার্ডাইটিসের ইঙ্গিত দেয়। তবে, চিকিৎসার পরেও রোগীর শ্বাসকষ্ট এবং রক্তচাপ কমে যায়। পুনরায় টিটিই করার সময় দেখা যায় যে কার্ডিয়াক ট্যাম্পোনেড হওয়ার সম্ভাবনা রয়েছে, তাই পেরিকার্ডিওসেন্টেসিস করা হয়। এর ফলে পালসলেস ইলেকট্রিক্যাল অ্যাক্টিভিটি কার্ডিয়াক অ্যারেস্ট হয় এবং শেষ পর্যন্ত রোগীকে ভেনোআর্টেরিয়াল এক্সট্রাকর্পোরিয়াল মেমব্রেন অক্সিজেনেশন সাপোর্টের প্রয়োজন হয়। জরুরি ভিত্তিতে এন্ডোমায়োকার্ডিয়াল বায়োপসি করে কোনো প্রদাহজনক প্রক্রিয়া পাওয়া যায়নি। রোগীর ডান হাতের ছোট একটি ক্ষত থেকে নেওয়া ত্বকের বায়োপসিতে অপ্রত্যাশিতভাবে এপস্টাইন-বার ভাইরাস (+) ন্যাচারাল কিলার/টি-সেল লিম্ফোমার উপস্থিতি ধরা পড়ে। কেমোথেরাপি শুরু করার পর রোগীর অবস্থার উন্নতি দেখা যায়, যেমন—ইজেকশন ফ্র্যাকশনের উন্নতি, পেরিকার্ডিয়াল ইফিউশন হ্রাস এবং মায়োকার্ডিয়াল হাইপারট্রফির ধীরে ধীরে হ্রাস।"
+  },
+  {
+    "id": "multiclinsum_gs_en_325.txt",
+    "fulltext": "This is a 75-year-old para 6 patient from Western Ethiopia who saw her last menses 25 years back. Her age at giving birth to her 1st child and menopause were 18 and 50 years, respectively. She had occasional pelvic pain for the last 3 years for which she was visiting different health facilities. Currently, she presented to Nekemte Specialized Hospital with exacerbation of lower abdominal pain for 3 weeks. She feels discomfort in her vagina but no protrusion of mass through her vagina. She has no history of fever, abdominal swelling, vaginal discharge, or bleeding. All her previous deliveries were normal vaginal deliveries. Upon enquiring about the history of family planning utilization, she reported that the intrauterine device was inserted 40 years back at a public hospital. Since then, she had no history of gynecologic evaluation for a checkup. She had no history of gynecologic procedures, pelvic or abdominal surgery. The patient has no history of medical problems like diabetes mellitus, hypertension, cardiac or renal problems.\n\nOn examination, she was acutely sick-looking. Her vital signs were blood pressure (BP) = 120/80mmHg, pulse rate (PR) = 82 beats per minute, respiratory rate (RR) = 18 breaths per minute, and temperature of 37.1°C. She had pink conjunctivae. Lymph glandular system, chest, and cardiovascular system were normal. On abdominal examination, there was no mass, organomegaly, area of tenderness, or signs of fluid collection. Inspection of external genitalia showed no vulvar mass or lesion. On speculum examination, there is a foreign body at the external cervical os. However, there is no other cervical mass or lesion. On bimanual examination, the uterus was not enlarged and there was no adnexal mass or tenderness. On the integumentary system, she had no palmar pallor. On neurologic examination, she was oriented to time, person, and place. She had normal reflexes and no neurologic deficits.\n\nOn laboratory investigation, an ultrasound examination was done by a radiologist and showed unremarkable pelvic findings. Urinalysis, complete blood count, and serum blood glucose level were normal. With the final diagnosis of postmenopausal pelvic pain secondary to the retained intrauterine device, the patient was prepared and taken to the gynecology procedure room. In the lithotomy position, the speculum was inserted and the intrauterine device was easily removed with spongy forceps. The mother was observed for 4 hours and discharged with analgesia and doxycycline 100 mg PO twice a day for three days. Upon follow-up, the pelvic pain was resolved.",
+    "summary": "We present the case of retained Lippes loop IUD for 40 years in a 75-year-old postmenopausal patient from Western Ethiopia. The patient presented to the hospital with postmenopausal pelvic pain. Speculum exam showed part of loop at external cervical os. The loop was easily removed with spongy forceps. The patient was discharged with analgesia and doxycycline twice a day for 3 days.",
+    "translated_fulltext": "এই রোগী পশ্চিম ইথিওপিয়ার একজন ৭৫ বছর বয়সী প্যারা ৬-এর রোগী, যিনি ২৫ বছর আগে শেষবার মাসিক হয়েছিলেন। তার প্রথম সন্তান জন্মদানের সময় বয়স ছিল ১৮ বছর এবং মেনোপজ হয়েছিল ৫০ বছর বয়সে। গত ৩ বছর ধরে তিনি মাঝে মাঝে পেটের নিচের দিকে ব্যথা অনুভব করতেন, যার কারণে তিনি বিভিন্ন স্বাস্থ্যকেন্দ্রে গিয়েছেন। বর্তমানে, তিনি নেকেমটে স্পেশালাইজড হাসপাতালে পেটের নিচের দিকে তীব্র ব্যথা নিয়ে এসেছেন, যা ৩ সপ্তাহ ধরে চলছে। তিনি যোনিপথে অস্বস্তি অনুভব করেন, তবে যোনিপথের মাধ্যমে কোনো ফোলা বা পিণ্ড দেখা যায় না। তার জ্বর, পেটে ফোলা, যোনি থেকে স্রাব বা রক্তপাতের কোনো ইতিহাস নেই। তার আগের সব সন্তান প্রসব স্বাভাবিকভাবে হয়েছিল। পরিবার পরিকল্পনা ব্যবহারের বিষয়ে জিজ্ঞাসা করলে, তিনি জানান যে ৪০ বছর আগে একটি সরকারি হাসপাতালে তার জরায়ুতে একটি ইন্ট্রাইউটেরাইন ডিভাইস (আইইউডি) স্থাপন করা হয়েছিল। এরপর থেকে, তিনি কোনো স্ত্রীরোগ সংক্রান্ত পরীক্ষার জন্য যাননি। তার স্ত্রীরোগ সংক্রান্ত কোনো অস্ত্রোপচার বা পেটের কোনো অস্ত্রোপচারের ইতিহাস নেই। রোগীর ডায়াবেটিস, উচ্চ রক্তচাপ, হৃদরোগ বা কিডনির সমস্যার কোনো ইতিহাস নেই।\n\nশারীরিক পরীক্ষায় দেখা যায়, তিনি অসুস্থ দেখাচ্ছেন। তার ভাইটাল সাইনগুলো হলো: রক্তচাপ (বিপি) = ১২০/৮০ মিমি Hg, পালস রেট (পিআর) = প্রতি মিনিটে ৮২ বিট, শ্বাস-প্রশ্বাস হার (আরআর) = প্রতি মিনিটে ১৮ বার এবং তাপমাত্রা ৩৭.১ ডিগ্রি সেলসিয়াস। তার চোখের কনজাংটিভা গোলাপি। লিম্ফ গ্রন্থি, বুক এবং কার্ডিওভাসকুলার সিস্টেম স্বাভাবিক ছিল। পেটের পরীক্ষায় কোনো ফোলা, অঙ্গের বৃদ্ধি, ব্যথার স্থান বা তরল জমা হওয়ার লক্ষণ দেখা যায়নি। বাহ্যিক যৌনাঙ্গের পরীক্ষায় কোনো ভলভার পিণ্ড বা ক্ষত দেখা যায়নি। স্পেকুলাম পরীক্ষায়, বাহ্যিক জরায়ুমুখে একটি বিদেশি বস্তু দেখা যায়। তবে, অন্য কোনো জরায়ুর পিণ্ড বা ক্ষত নেই। বাইম্যানুয়াল পরীক্ষায়, জরায়ু স্বাভাবিক আকারের ছিল এবং কোনো অ্যাডনেক্সাল পিণ্ড বা ব্যথার অনুভূতি ছিল না। তার চামড়ায় কোনো ফ্যাকাসে ভাব ছিল না। স্নায়বিক পরীক্ষায়, তিনি সময়, স্থান এবং ব্যক্তি সম্পর্কে সচেতন ছিলেন। তার স্বাভাবিক রিফ্লেক্স ছিল এবং কোনো স্নায়বিক দুর্বলতা ছিল না।\n\nল্যাবরেটরি পরীক্ষায়, একজন রেডিওলজিস্ট আলট্রাসাউন্ড করে দেখেন এবং তাতে পেটের তেমন কোনো অস্বাভাবিকতা দেখা যায়নি। প্রস্রাব পরীক্ষা, সম্পূর্ণ রক্ত গণনা এবং সিরাম গ্লুকোজের মাত্রা স্বাভাবিক ছিল। অবশেষে, জরায়ুতে স্থাপিত আইইউডি-এর কারণে মেনোপজের পরের পেটের ব্যথা হয়েছে বলে রোগ নির্ণয় করা হয়। এরপর রোগীকে অস্ত্রোপচারের জন্য প্রস্তুত করা হয় এবং গাইনী বিভাগে নিয়ে যাওয়া হয়। লিথোটমি অবস্থানে, স্পেকুলাম প্রবেশ করানো হয় এবং স্পঞ্জি ফোরসেপসের সাহায্যে আইইউডিটি সহজে অপসারণ করা হয়। এরপর রোগীকে ৪ ঘণ্টা পর্যবেক্ষণ করা হয় এবং ব্যথানাশক ওষুধ ও ডক্সিসাইক্লিন ১০০ মিগ্রা, দিনে দুবার করে তিন দিন সেবনের পরামর্শ দেওয়া হয়। ফলোআপে দেখা যায়, পেটের ব্যথা সেরে গেছে।",
+    "translated_summary": "পশ্চিম ইথিওপিয়ার একজন ৭৫ বছর বয়সী মেনোপজ-পরবর্তী রোগীর ক্ষেত্রে ৪০ বছর ধরে লিপ্পেস লুপযুক্ত আইইউডি ( intrauterine device) থাকার ঘটনাটি আমরা তুলে ধরছি। রোগী হাসপাতালে এসে মেনোপজ-পরবর্তী পেলভিক ব্যথার কথা জানান। স্পেকুলাম পরীক্ষার মাধ্যমে দেখা যায় লুপের একটি অংশ বাহ্যিক জরায়ুমুখে রয়েছে। স্পঞ্জি ফোরসেপসের সাহায্যে লুপটি সহজেই অপসারণ করা হয়। রোগীকে ব্যথানাশক ওষুধ এবং দিনে দুবার ডক্সিসাইক্লিন সেবনের পরামর্শ দিয়ে ৩ দিনের জন্য ছুটি দেওয়া হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_418.txt",
+    "fulltext": "A 71-year-old patient with a history of untreated vitiligo presented with visual loss in the right eye 6 months prior to admission accompanied by bilateral hearing loss with a predominance in the right ear. Chronic headaches and intermittent fever were also reported, although the patient denied a history of drug use or prior infections. He was evaluated by our department due to the presence of significant and unintentional weight loss, generalized weakness and thickening of the skin. On initial ophthalmologic examination, visual acuity in the right eye (RO) was reduced to light perception and color discrimination, and visual acuity in the left eye (LO) was 20/200 with afferent pupillary defect in both eyes with hyperemic margins of the eyelid. On examination of the RO, it was found to have a hyperemic bulbar conjunctiva, ciliary injection, cornea with peripheral, nummular, subepithelial infiltrates, aqueous anterior chamber (AAC) without cellularity, normal iris and lens with nuclear opacities. On examination of the left eye, it was found to have a hyperemic bulbar conjunctiva, ciliary injection, cornea with peripheral, nummular, subepithelial infiltrates, AAC, aqueous without cellularity, normal iris and lens with nuclear opacities. On examination of the right fundus, a round, pale ++ papilla was found with a 50% excavation, slightly blunt nasal border, with a raised and thinned vascular pattern, with macular area and scattered pigment. On the left fundus, a vitreous haze 2+ was found with edematous papilla, blurred borders, hyperemic, peripapillary, streaked hemorrhages, and an unevaluable excavation with a thinned vascular pattern and macular area with scattered pigment, with right optic atrophy and left anterior optic neuritis.\n\nDue to ocular involvement, weight loss and neurological symptoms, additional testing was performed to rule out causes such as tuberculosis, herpes, ANCA and non-ANCA vasculitis, and sarcoidosis. As for the management of the neurological condition, a lumbar puncture was performed and an opening pressure within normal limits and a proteinocracy of 54 mg/dL was found. Due to distal symmetric polyneuropathy, nerve conduction velocities (NCV) were performed, which showed a pattern of polyradiculoneuropathy with moderate to severe axonal degeneration, involving all 4 extremities with a predominance of the lower extremities; the contrasted magnetic resonance imaging (MRI) of the skull and orbit did not show enhancement of the optic nerve or brain tumors; however, it did show sinusitis and meningeal enhancement. Within the management, sarcoidosis was ruled out, with angiotensin converting enzyme (ACE) within normal parameters, as well as a whole body gamma scan, without enhancement or boosting. After all the study and clinical evaluation of the patient, a second ophthalmological assessment was performed in which persistence and progression of the ocular condition was found, with optic atrophy in the right eye and anterior optic neuritis in the left eye. Because of this, high dose pulse steroid treatment was initiated, followed by a gradual reduction of the dose and the patient was referred for follow-up in the Outpatient Department. A clinical and functional improvement was observed, mainly at the neurological and ophthalmological level.\n",
+    "summary": "A 71-year-old man with a history of long-standing vitiligo who had experienced visual loss in his right eye six months prior to admission, along with bilateral hearing loss, predominantly in the right ear. During his hospital stay, he presented with chronic headaches, fever, and significant involuntary weight loss. On ophthalmologic examination, the right eye was light sensitive with hyperemic bulbar conjunctiva, while the left eye had a visual acuity of 20/200. The fundus of the right eye had scattered pigmentation, while the left eye had a swollen optic disc and right optic atrophy.\n",
+    "translated_fulltext": "একজন ৭১ বছর বয়সী রোগী, যার আগে চিকিৎসা না করা ভিটিলিগোর ইতিহাস রয়েছে, তিনি হাসপাতালে ভর্তির ছয় মাস আগে ডান চোখে দৃষ্টিশক্তি হ্রাস এবং উভয় কানে শ্রবণশক্তি হ্রাসের (বিশেষ করে ডান কানে) উপসর্গ নিয়ে এসেছিলেন। রোগীর দীর্ঘস্থায়ী মাথাব্যথা এবং মাঝে মাঝে জ্বর হওয়ার কথাও জানান, যদিও তিনি মাদক দ্রব্য ব্যবহার বা পূর্বে কোনো সংক্রমণ হয়েছে বলে অস্বীকার করেন। উল্লেখযোগ্য এবং অনিচ্ছাকৃত ওজন হ্রাস, সাধারণ দুর্বলতা এবং ত্বকের পুরু হয়ে যাওয়ার কারণে আমাদের বিভাগ তাকে পরীক্ষা করে। প্রাথমিক চক্ষু পরীক্ষায় দেখা যায়, ডান চোখের (আরও) দৃষ্টিশক্তি কমে আলো অনুভব করার পর্যায়ে নেমে এসেছে এবং রঙের পার্থক্য করতে অসুবিধা হচ্ছে। বাম চোখের (এলও) দৃষ্টিশক্তি ২০/২০০-এ নেমে এসেছে, উভয় চোখের পিউপিলের প্রতিক্রিয়া দুর্বল হয়ে গেছে এবং চোখের পাতার চারপাশের অংশ লাল হয়ে গেছে। ডান চোখের পরীক্ষায় দেখা যায়, চোখের সাদা অংশ (বালবার কনজাংটিভা) লাল হয়ে গেছে, সিলিয়ারি ইনজেকশন হয়েছে, কর্নিয়ার চারপাশে ছোট ছোট সাদা দাগ (পেরipheral, নামুলার, সাবএপিথেলিয়াল ইনফিল্ট্রেট) দেখা গেছে, অ্যাকুয়াস অ্যানটেরিয়র চেম্বারে (এএসি) কোনো কোষ নেই, আইরিস এবং লেন্স স্বাভাবিক আছে, তবে লেন্সের কেন্দ্রে ঘোলাটে ভাব দেখা গেছে। বাম চোখের পরীক্ষায় একই ধরনের লক্ষণ দেখা যায়—লালচে বালবার কনজাংটিভা, সিলিয়ারি ইনজেকশন, কর্নিয়ার চারপাশে ছোট ছোট সাদা দাগ, এএসি, অ্যাকুয়াসে কোনো কোষ নেই, আইরিস এবং লেন্স স্বাভাবিক, তবে লেন্সের কেন্দ্রে ঘোলাটে ভাব আছে। ডান চোখের ফান্ডাসে একটি গোলাকার, ফ্যাকাসে ++ প্যাপিলা দেখা যায়, যেখানে ৫০% মতো অংশ দেবে গেছে, নাকের দিকের প্রান্ত সামান্য ভোঁতা, রক্তনালীগুলো উঁচু হয়ে গেছে এবং পাতলা হয়ে গেছে, ম্যাকুলার অঞ্চলে এবং চারপাশে ছোপ ছোপ পিগমেন্ট ছড়িয়ে আছে। বাম চোখের ফান্ডাসে হালকা ঘোলাটে ভাব (ভিট্রেয়াস হেজ ২+) দেখা যায়, প্যাপিলায় ফোলাভাব, প্রান্তগুলো অস্পষ্ট, চোখের চারপাশে লালচে ভাব, এবং কিছু অংশে রক্তক্ষরণ হয়েছে। রক্তনালীগুলো পাতলা হয়ে গেছে এবং ম্যাকুলার অঞ্চলে ছোপ ছোপ পিগমেন্ট ছড়িয়ে আছে। এছাড়াও, ডান অপটিক অ্যাট্রোফি এবং বাম চোখের সামনের অংশে অপটিক নিউরাইটিস দেখা যায়।\n\nচক্ষু সংক্রান্ত সমস্যা, ওজন হ্রাস এবং স্নায়বিক উপসর্গগুলোর কারণে যক্ষ্মা, হার্পিস, এএনসিএ এবং নন-এএনসিএ ভাস্কুলাইটিস এবং সারকোইডোসিসের মতো কারণগুলো নিশ্চিত করার জন্য অতিরিক্ত পরীক্ষা করা হয়। স্নায়বিক অবস্থার চিকিৎসার জন্য, লাম্বার পাংচার করা হয় এবং দেখা যায় তরলের চাপ স্বাভাবিক সীমার মধ্যে আছে এবং প্রোটিনের মাত্রা ৫৪ মিলিগ্রাম/ডিসিএল। ডিস্টাল সিমেট্রিক পলিনিউরোপ্যাথির কারণে নার্ভ কন্ডাকশন ভেলোসিটি (এনসিভি) পরীক্ষা করা হয়, যেখানে দেখা যায় মাঝারি থেকে গুরুতর অ্যাক্সোনাল ডিজেনারেশনসহ পলিরাডিকুলোনিউরোপ্যাথির লক্ষণ রয়েছে, যা চারটি অঙ্গের (বিশেষ করে নিচের দিকের অঙ্গ) সাথে জড়িত। মাথার খুলি এবং চোখের কক্ষপথের কন্ট্রাস্ট ম্যাগনেটিক রেজোন্যান্স ইমেজিং (এমআরআই) পরীক্ষায় অপটিক নার্ভ বা মস্তিষ্কের টিউমার দেখা যায়নি, তবে সাইনাসাইটিস এবং মেনিনজিয়াল এনহ্যান্সমেন্ট দেখা গেছে। চিকিৎসার অংশ হিসেবে, সারকোইডোসিস বাতিল করা হয়, অ্যাঞ্জিওটেনসিন কনভার্টিং এনজাইম (এসিই)-এর মাত্রা স্বাভাবিক সীমার মধ্যে পাওয়া যায় এবং পুরো শরীরের গামা স্ক্যানেও কোনো অস্বাভাবিকতা দেখা যায়নি। রোগীর সমস্ত পরীক্ষা এবং ক্লিনিক্যাল মূল্যায়নের পর, দ্বিতীয়বার চক্ষু পরীক্ষা করা হয়, যেখানে চোখের অবস্থার স্থিতিশীলতা এবং ক্রমবৃদ্ধি দেখা যায়। ডান চোখে অপটিক অ্যাট্রোফি এবং বাম চোখে সামনের অংশে অপটিক নিউরাইটিস ধরা পড়ে। এর ফলে, উচ্চ মাত্রার স্টেরয়েড দিয়ে চিকিৎসা শুরু করা হয়, এরপর ধীরে ধীরে ডোজ কমানো হয় এবং রোগীকে বহির্বিভাগে ফলো-আপের জন্য পাঠানো হয়। ক্লিনিক্যাল এবং কার্যকরী উন্নতি দেখা যায়, বিশেষ করে স্নায়বিক এবং চক্ষু সংক্রান্ত ক্ষেত্রে।",
+    "translated_summary": "৭১ বছর বয়সী একজন ব্যক্তি, যিনি দীর্ঘদিনের ভিটিলিগোতে ভুগছিলেন এবং হাসপাতালে ভর্তির ছয় মাস আগে তার ডান চোখে দৃষ্টিশক্তি হ্রাস পেয়েছিল, সেই সাথে উভয় কানেই শ্রবণশক্তি কমে গিয়েছিল, বিশেষ করে ডান কানে। হাসপাতালে থাকাকালীন, তিনি দীর্ঘস্থায়ী মাথাব্যথা, জ্বর এবং উল্লেখযোগ্য পরিমাণে অনিচ্ছাকৃত ওজন হ্রাস অনুভব করেন। চক্ষু পরীক্ষা করার সময় দেখা যায়, ডান চোখ আলো সংবেদনশীল এবং এর bulbous conjunctiva-তে hyperemia রয়েছে, যেখানে বাম চোখের দৃষ্টিশক্তি 20/200। ডান চোখের fundus-এ বিক্ষিপ্ত পিগমেন্টেশন দেখা যায়, যেখানে বাম চোখে ফোলা অপটিক ডিস্ক এবং ডান অপটিক অ্যাট্রোফি ছিল।"
+  },
+  {
+    "id": "multiclinsum_gs_en_406.txt",
+    "fulltext": "A 39-year-old woman with a diagnosis of peripartum cardiomyopathy who received a heart transplant in October 2014. She received induction with Basiliximab and methylprednisolone. She also received maintenance treatment with tacrolimus XL prolonged release 7 mg daily, everolimus 1 mg twice daily, and prednisolone 5 mg/day. She had two episodes of acute rejection during the first year post-transplant, and was controlled with methylprednisolone pulse therapy with good results. There was no history of renal disease and her renal function was stable with creatinine of 0.88 mg/dL and a glomerular filtration rate (GFR) of 102 mL/min/1.73m2 during the first year post-transplant. Follow-up was done exclusively by the heart transplant group and routine polyomavirus viral load BK or urinary cytology was not performed. In 2016, she presented a creatinine serum elevation of up to 1.9 mg/dL, with a GFR of 32.6 mL/min/1.73m2. At that time, the minimum tacrolimus level was 7.2 ng/mL and everolimus, 5.2 ng/mL. Anticalcineurin toxicity was suspected; therefore, tacrolimus was reduced to 4 mg daily and creatinine returned to near baseline (creatinine 1.25 mg/dL, GFR 54.1 mL/min/1.73m2); no renal biopsy was performed. In March 2017, creatinine increased to 2.69 mg/dL, with a GFR of 21.4 mL/min/1.73m2, for which she was hospitalized. The patient stated that she did not have any symptoms. During physical examination, she was in good general condition, heart rate of 80 beats per minute, blood pressure of 130/90 mmHg, respiratory rate of 15 per minute, afebrile. Further studies were performed: renal tract ultrasound showed normal renal size but increased echogenicity; urinalysis and urine cultures were negative, without haematuria, pyuria or casts; echocardiogram with adequate cardiac function; HIV, syphilis, hepatitis B and C serologic tests were negative; minimum tacrolimus level of 5.2 ng/mL, and everolimus of 5.98 ng/mL. Control was initiated with intravenous hydration, and tacrolimus XL dose was reduced to 2 mg daily, but there was no improvement in renal function; a renal biopsy was planned.\n\nRenal biopsy revealed active chronic interstitial nephritis associated with advanced poliomyelitis virus nephritis. BK virus PCR was performed and was positive at 33,800 copies/mL in blood (log 4.5). Tacrolimus was discontinued; creatinine levels stabilized between 2.2 and 2.4 mg/dL, with no further elevation in post-discharge controls. Her viral load began to decline to undetectable levels. The patient did not have episodes of cardiac rejection in 3 years of follow-up; the last creatinine measurement was 2.5 mg/dL, corresponding to a GFR of 23.4 mL/min/1.73m2.\n",
+    "summary": "We report a case of BK virus nephropathy in a patient who underwent heart transplantation due to peripartum cardiomyopathy. The renal biopsy reported active chronic tubulointerstitial nephritis associated with late-stage BK virus nephritis and the blood viral load for BK virus was positive (log 4.5). The immunosuppressive treatment was reduced, and after two years of follow-up, the patient had stable renal function with serum creatinine of 2.5 mg/dL (GFR of 23.4 mL/min/1.73m2).\n",
+    "translated_fulltext": "৩৯ বছর বয়সী একজন মহিলার পেরিপার্টাম কার্ডিওমায়োপ্যাথি ধরা পড়ে এবং ২০১৪ সালের অক্টোবরে তার হৃদপিণ্ড প্রতিস্থাপন করা হয়। তাকে ব্যাসিলিক্সিম্যাব এবং মিথাইলপ্রেডনিসোলোন দিয়ে ইন্ডাকশন থেরাপি দেওয়া হয়েছিল। এছাড়াও, তাকে ট্যাক্রোলিমাস এক্সএল (দৈনিক ৭ মিগ্রা), এভারোলিমাস (দিনে দুবার ১ মিগ্রা) এবং প্রেডনিসোলোন (দিনে ৫ মিগ্রা) দিয়ে রক্ষণাবেক্ষণ চিকিৎসা দেওয়া হয়েছিল। প্রতিস্থাপন করার পর প্রথম বছরে তার শরীরে দুবার তীব্র প্রত্যাখ্যানের লক্ষণ দেখা যায়, কিন্তু মিথাইলপ্রেডনিসোলোন পালস থেরাপির মাধ্যমে তা নিয়ন্ত্রণ করা হয় এবং ভালো ফল পাওয়া যায়। তার কিডনি রোগের কোনো ইতিহাস ছিল না এবং প্রতিস্থাপন করার পর প্রথম বছরে তার কিডনির কার্যকারিতা স্থিতিশীল ছিল, ক্রিয়েটিনিনের মাত্রা ছিল ০.৮৮ মিগ্রা/ডিএল এবং গ্লোমেরুলার পরিস্রাবণ হার (জিএফআর) ছিল ১০২ মিলি/মিনিট/১.৭৩মি২। শুধুমাত্র হৃদপিণ্ড প্রতিস্থাপনকারী দল তার ফলো-আপ করত এবং নিয়মিত পলিওমায়োভাইরাস ভাইরাল লোড (বিকে) অথবা প্রস্রাবের সাইটোলজি পরীক্ষা করা হয়নি। ২০১৬ সালে, তার ক্রিয়েটিনিনের মাত্রা বেড়ে ১.৯ মিগ্রা/ডিএল হয়, এবং জিএফআর কমে ৩২.৬ মিলি/মিনিট/১.৭৩মি২ হয়। সেই সময়, ট্যাক্রোলিমাসের সর্বনিম্ন মাত্রা ছিল ৭.২ এনজি/এমএল এবং এভারোলিমাসের মাত্রা ছিল ৫.২ এনজি/এমএল। অ্যান্টি-ক্যালসিনুরিন বিষক্রিয়ার সন্দেহ করা হয়েছিল; তাই, ট্যাক্রোলিমাসের ডোজ কমিয়ে দৈনিক ৪ মিগ্রা করা হয় এবং ক্রিয়েটিনিনের মাত্রা প্রায় স্বাভাবিক অবস্থায় ফিরে আসে (ক্রিয়েটিনিন ১.২৫ মিগ্রা/ডিএল, জিএফআর ৫৪.১ মিলি/মিনিট/১.৭৩মি২); কোনো কিডনি বায়োপসি করা হয়নি। ২০১৭ সালের মার্চ মাসে, ক্রিয়েটিনিনের মাত্রা বেড়ে ২.৬৯ মিগ্রা/ডিএল হয়, এবং জিএফআর কমে ২১.৪ মিলি/মিনিট/১.৭৩মি২ হয়, যার কারণে তাকে হাসপাতালে ভর্তি করা হয়। রোগী জানান যে তার কোনো উপসর্গ ছিল না। শারীরিক পরীক্ষায় দেখা যায়, তার সাধারণ শারীরিক অবস্থা ভালো, হৃদস্পন্দন প্রতি মিনিটে ৮০, রক্তচাপ ১৩০/৯০ মিমিএইচজি, শ্বাস-প্রশ্বাস প্রতি মিনিটে ১৫, এবং জ্বর নেই। এরপর আরও কিছু পরীক্ষা করা হয়: কিডনির আলট্রাসাউন্ডে কিডনির স্বাভাবিক আকার দেখা যায়, তবে ইকোজেনিসিটি বেড়ে যায়; প্রস্রাব এবং প্রস্রাবের কালচারে কোনো সংক্রমণ, রক্ত, পুঁজ বা কাস্ট পাওয়া যায়নি; ইকোকার্ডিওগ্রামে হৃদপিণ্ডের কার্যকারিতা স্বাভাবিক ছিল; এইচআইভি, সিফিলিস, হেপাটাইটিস বি এবং সি-এর সিরামলজিক্যাল পরীক্ষাগুলো নেগেটিভ ছিল; ট্যাক্রোলিমাসের সর্বনিম্ন মাত্রা ছিল ৫.২ এনজি/এমএল এবং এভারোলিমাসের মাত্রা ছিল ৫.৯৮ এনজি/এমএল। শিরায় তরল দিয়ে তার চিকিৎসা শুরু করা হয় এবং ট্যাক্রোলিমাস এক্সএল-এর ডোজ কমিয়ে দৈনিক ২ মিগ্রা করা হয়, কিন্তু কিডনির কার্যকারিতার উন্নতি হয়নি; একটি কিডনি বায়োপসির পরিকল্পনা করা হয়।\n\nকিডনি বায়োপসিতে সক্রিয় ক্রনিক ইন্টারস্টিশিয়াল নেফ্রাইটিস এবং উন্নত পোলিওমায়োলাইটিস ভাইরাস নেফ্রাইটিসের প্রমাণ পাওয়া যায়। বিকে ভাইরাস পিসিআর পরীক্ষা করা হয় এবং রক্তে ৩৩,৮০০ কপি/এমএল (লগ ৪.৫) পজিটিভ ফলাফল পাওয়া যায়। ট্যাক্রোলিমাস বন্ধ করে দেওয়া হয়; ক্রিয়েটিনিনের মাত্রা ২.২ থেকে ২.৪ মিগ্রা/ডিএল-এর মধ্যে স্থিতিশীল থাকে এবং হাসপাতাল থেকে discharge-এর পর আর কোনো উন্নতি হয়নি। তার ভাইরাল লোড ধীরে ধীরে কমতে শুরু করে এবং undetectable স্তরে পৌঁছায়। ফলো-আপের ৩ বছরে রোগীর হৃদপিণ্ডে প্রত্যাখ্যানের কোনো ঘটনা ঘটেনি; শেষ ক্রিয়েটিনিন পরিমাপ ছিল ২.৫ মিগ্রা/ডিএল, যা জিএফআর ২৩.৪ মিলি/মিনিট/১.৭৩মি২-এর সাথে সামঞ্জস্যপূর্ণ।",
+    "translated_summary": "আমরা একটি রোগীর ক্ষেত্রে বিকে ভাইরাস নেফ্রোপ্যাথির ঘটনা বর্ণনা করছি, যিনি প্রসব-পরবর্তী কার্ডিওমায়োপ্যাথির কারণে হৃদপিণ্ড প্রতিস্থাপন করিয়েছিলেন। রেনাল বায়োপসিতে সক্রিয় ক্রনিক টিউবুলোইন্টারস্টিশিয়াল নেফ্রাইটিস দেখা যায়, যা বিকে ভাইরাস নেফ্রাইটিসের শেষ পর্যায়ে দেখা যায় এবং রক্তে বিকে ভাইরাসের পরিমাণ ইতিবাচক ছিল (লগ ৪.৫)। ইমিউনোসাপ্রেসিভ চিকিৎসা কমানো হয় এবং দুই বছর পর ফলো-আপে দেখা যায় রোগীর রেনাল ফাংশন স্থিতিশীল আছে এবং সিরাম ক্রিয়েটিনিনের মাত্রা ২.৫ মিলিগ্রাম/ডেসিলিটার (জিএফআর ২৩.৪ মিলি/মিনিট/১.৭৩মি২)।"
+  },
+  {
+    "id": "multiclinsum_gs_en_88.txt",
+    "fulltext": "The patient was a 42-year-old woman with a history of menstrual migraine, Hashimoto Thyroiditis, Familial Mediterian Fever (FMF), and dyspepsia. She was taking 75 mg of levothyroxine, 30 mg of lansoprazole, and 1.5 mg of colchicine daily. In February of 2023, she was diagnosed with acute bronchitis, which was treated with antibiotics and bronchodilators. She developed a daily headache after two weeks, manifesting as more than ten short-lasting attacks per day provoked by coughing, straining, and lifting. The duration of each attack was 30 minutes, and the pain was bilaterally distributed from the neck to the top of the head. The headache was sharp and severe. She described the attack as a sensation of storm-like fluid movement in the head. She did not suffer any of the symptoms associated with previous migraine attacks, such as phonophobia, photophobia, vomiting, or throbbing. The severity of the attack was determined using a numeric rating scale (NRS) with a score of 9 out of 10. These attacks typically necessitated a visit to the emergency room. The results of her physical and neurological exams were unremarkable. The laboratory tests, including those for thyroid hormones, electrolytes, liver and kidney function, and serology, were negative. Brain and cervical spinal magnetic resonance imaging (MRI) with and without contrast, magnetic resonance venography (MRV), and angiography (MRA) were all normal. She did not give consent for a lumbar puncture. When we first encountered her in the clinic, she was taking 25 mg of indomethacin per day. Her attacks stopped after putting her on 60 mg of lansoprazole and increasing her daily dose of indomethacin to 150 mg. However, she encountered gastrointestinal side effects, so the indomethacin was discontinued on day three. Due to the adverse effects, she was unable to take topiramate and propranolol.\n\nShe came to the clinic 15 days after her initial visit with an NRS score of 9/10. She was taken to the local operating room. We used a GE Healthcare, Voluson™ E6, ultrasonography system with a linear 13–5 MHz probe for unilateral PGONB. The patient’s neck was prone to flexion. The linear probe was initially transversely positioned on the occipital protuberance and then advanced caudally, demonstrating that the C2 spinous process resembled the two horns. Through lateral probe movement, the inferior muscles of the obliquus capitis and semispinalis capitis were located. Here, the superior to the inferior oblique capitis muscle and beneath the semispinalis capitis muscle were identified to be the greater occipital neuron (GON). From this location, a 22-gauge spinal needle and 3 ccs of bupivacaine at a concentration of 0.5% were used to perform GON blocking. The intensity of her attack decreased from 9/10 to 2/10 after the first 20 minutes of the block. Throughout a month, the blocks were repeated once a week. In the second month, the frequency of her attacks decreased to two per month, with an intensity of 4/10. She did not encounter any attacks in the sixth month.\n\n",
+    "summary": "Herein, we report that a 42-year-old female patient with PCH who could not use the oral medication because of side effects. When she came to the pain clinic with an attack with intensity of 9/10 , we took her to the local operating room. The ultrasound (US) guided proximal greater occipital nerve block with bupivacaine was performed and the intensity of the attack was reduced to 2/10. The blockage was repeated once a week for a month. After two months, both the intensity of headache and number of attacks decreased and no adverse effect was observed.",
+    "translated_fulltext": "রোগী ছিলেন ৪২ বছর বয়সী একজন মহিলা, যিনি মাসিককালীন মাইগ্রেন, হাশিমোটো থাইরয়েডাইটিস, ফ্যামিলিয়াল মেডিটেরানিয়ান ফিভার (এফএমএফ) এবং ডিসপেপসিয়ায় ভুগছিলেন। তিনি প্রতিদিন ৭৫ মিলিগ্রাম লেভোথাইরক্সিন, ৩০ মিলিগ্রাম ল্যানসোপ্রাজল এবং ১.৫ মিলিগ্রাম কোলচিসিন গ্রহণ করতেন। ২০২৩ সালের ফেব্রুয়ারিতে, তাকে তীব্র ব্রঙ্কাইটিসে আক্রান্ত হিসেবে নির্ণয় করা হয়, যার চিকিৎসায় অ্যান্টিবায়োটিক এবং ব্রঙ্কোডাইলেটর ব্যবহার করা হয়। দুই সপ্তাহ পর তার প্রতিদিন মাথাব্যথা শুরু হয়, যা কাশি, চাপ এবং কোনো কিছু তোলার সময় আরও তীব্র হতো এবং দিনে দশটির বেশিবার অল্প সময়ের জন্য এই ব্যথা হতো। প্রতিটি ব্যথার স্থায়িত্ব ছিল ৩০ মিনিট, এবং ব্যথা ঘাড় থেকে মাথার উপরের অংশে উভয় দিকে ছড়িয়ে যেত। মাথাব্যথা ছিল তীব্র এবং অসহ্য। তিনি ব্যথার অনুভূতিকে ঝড়ের মতো তরল পদার্থের প্রবাহের সাথে তুলনা করেছিলেন। আগের মাইগ্রেনের সময় যেমন শব্দভীতি, আলোভীতি, বমি বা ধড়ফড়ানি হতো, তেমন কোনো উপসর্গ তার মধ্যে দেখা যায়নি। ব্যথার তীব্রতা একটি সংখ্যাসূচক রেটিং স্কেল (এনআরএস) ব্যবহার করে পরিমাপ করা হয়, যেখানে ১০-এর মধ্যে ৯ স্কোর পাওয়া যায়। এই ধরনের ব্যথার কারণে প্রায়শই তাকে জরুরি বিভাগে যেতে হতো। তার শারীরিক এবং স্নায়বিক পরীক্ষার ফলাফল স্বাভাবিক ছিল। থাইরয়েড হরমোন, ইলেক্ট্রোলাইট, লিভার এবং কিডনির কার্যকারিতা এবং সেরোলজি সহ ল্যাবরেটরি পরীক্ষাগুলোর ফলাফল নেতিবাচক ছিল। মস্তিষ্কের এবং ঘাড়ের মেরুদণ্ডের ম্যাগনেটিক রেজোন্যান্স ইমেজিং (এমআরআই), ম্যাগনেটিক রেজোন্যান্স ভেনোগ্রাফি (এমআরভি) এবং অ্যাঞ্জিওগ্রাফি (এমআরএ) স্বাভাবিক ছিল। তিনি লাম্বার পাংচারের জন্য সম্মতি দেননি। যখন আমরা প্রথম তাকে ক্লিনিকে দেখি, তখন তিনি প্রতিদিন ২৫ মিলিগ্রাম ইন্ডোমেথাসিন গ্রহণ করছিলেন। ৬০ মিলিগ্রাম ল্যানসোপ্রাজল এবং দৈনিক ১৫০ মিলিগ্রাম ইন্ডোমেথাসিন দেওয়ার পর তার ব্যথা কমে যায়। তবে, তিনি গ্যাস্ট্রোইনটেস্টাইনাল পার্শ্বপ্রতিক্রিয়া অনুভব করেন, তাই তৃতীয় দিনে ইন্ডোমেথাসিন বন্ধ করে দেওয়া হয়। প্রতিকূল প্রভাবের কারণে, তিনি টপিরামেট এবং প্রোপ্রানোলল গ্রহণ করতে পারেননি।\n\nতিনি প্রাথমিক ভিজিটের ১৫ দিন পর ৯/১০ এনআরএস স্কোর নিয়ে ক্লিনিকে আসেন। তাকে স্থানীয় অপারেশন থিয়েটারে নিয়ে যাওয়া হয়। আমরা জিই হেলথকেয়ার, ভলিউসন™ ই৬ আল্ট্রাসাউন্ড সিস্টেম এবং একটি লিনিয়ার ১৩-৫ মেগাহার্টজ প্রোব ব্যবহার করে একতরফা পিজিওএনবি করি। রোগীর ঘাড় সামান্য বাঁকানো ছিল। লিনিয়ার প্রোবটি প্রথমে অক্সিপিটাল প্রোটুবারেন্সের উপর লম্বভাবে স্থাপন করা হয় এবং তারপর কডালি দিকে সরানো হয়, যেখানে দেখা যায় যে সি২ স্পাইনাস প্রক্রিয়াটি দুটি শিংয়ের মতো। প্রোবের পার্শ্বীয় মুভমেন্টের মাধ্যমে, অব্লিকিউস ক্যাপিটিস এবং সেমিস্পিনালিস ক্যাপিটিসের নিচের পেশীগুলো সনাক্ত করা হয়। এখানে, উপরের অব্লিক ক্যাপিটিস পেশীর উপরে এবং সেমিস্পিনালিস ক্যাপিটিস পেশীর নীচে বৃহত্তর অক্সিপিটাল নিউরন (জিওএন) চিহ্নিত করা হয়। এই স্থান থেকে, একটি ২২-গেজ স্পাইনাল নিডেল এবং ০.৫% ঘনত্বে ৩ সিসি বুপিভাকেন ব্যবহার করে জিওএন ব্লকিং করা হয়। ব্লকিংয়ের প্রথম ২০ মিনিটের মধ্যে তার ব্যথার তীব্রতা ৯/১০ থেকে ২/১০-এ নেমে আসে। এক মাস ধরে, সপ্তাহে একবার এই ব্লকিং করা হয়। দ্বিতীয় মাসে, তার ব্যথার ফ্রিকোয়েন্সি মাসে দুটিতে নেমে আসে, এবং তীব্রতা ছিল ৪/১০। ষষ্ঠ মাসে তার আর কোনো ব্যথা হয়নি।",
+    "translated_summary": "এখানে, আমরা জানাচ্ছি যে, একজন ৪২ বছর বয়সী নারী রোগী, যিনি পিসিএইচ-এ আক্রান্ত, তিনি পার্শ্বপ্রতিক্রিয়ার কারণে মুখে খাওয়ার ওষুধ ব্যবহার করতে পারছিলেন না। যখন তিনি তীব্রতা ৯/১০ মাত্রার ব্যথার সাথে পেইন ক্লিনিকে আসেন, তখন আমরা তাকে স্থানীয় অপারেশন থিয়েটারে নিয়ে যাই। বুপিভাকেন ব্যবহার করে আলট্রাসাউন্ডের (ইউএস) মাধ্যমে গ্রেটার অক্সিপিটাল নার্ভ ব্লকের কাছাকাছি অংশে চিকিৎসা করা হয় এবং ব্যথার তীব্রতা কমে ২/১০-এ নেমে আসে। এই ব্লকেজটি এক মাস ধরে সপ্তাহে একবার করে পুনরাবৃত্তি করা হয়। দুই মাস পর, মাথাব্যথার তীব্রতা এবং ব্যথার পুনরাবৃত্তি উভয়ই কমে যায় এবং কোনো বিরূপ প্রভাব দেখা যায়নি।"
+  },
+  {
+    "id": "multiclinsum_gs_en_504.txt",
+    "fulltext": "14-year-old previously healthy adolescent who presented to the Primary Emergency Care Service (PEC) of Osorno with a 11-day history of a predominantly nocturnal irritative cough. Symptomatic treatment was indicated, evolving with dyspnoea and orthopnoea. He presented to the Emergency Department of the Osorno Base Hospital (OBH), with severe respiratory distress, intolerance to supine position, and abdominal pain. He was admitted to the Paediatric Intensive Care Unit (PICU), tachycardic, hypertensive, polypneic, oxygen saturation 96% with FiO2 35%, rosy, hydrated and well perfused, with flat jugular veins, small bilateral supraclavicular lymphadenopathies. The thorax was without retraction of soft tissue, maintained in a genupectoral position, with decreased pulmonary murmurs in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The soft abdomen was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and\n\nA nephrological evaluation was performed, which confirmed renal failure secondary to tumor lysis syndrome, without dialysis urgency and tendency to hypertension, with creatinine 1.54 mg/dL, phosphemia 11 mg/dL, without hypernatremia. It continued with hyperhydration, diuretic (furosemide) and antihypertensive (amlodipine). From the respiratory point of view, it presented oxygen requirement, with FIO2 35% by mask of Venturi, suspending this supply on the third day of admission. It evolved with episodes of psychomotor agitation, associated to the diagnosis in process, which was treated according to the institutional protocol of psychomotor agitation, with psychological and psychiatric support, with satisfactory evolution. On the third day of admission and treatment a CT scan of the thorax, abdomen and pelvis was performed with contrast, observing an increase in the size of the thymus, of homogeneous aspect, probably in the context of a lymphoproliferative process and findings suggestive of pulmonary thromboembolism. The angioCT of the thorax showed thrombosis of the jugular vein, extensive bilateral pleural effusion associated to atelectatic phenomena in both bases, with signs of medical bilateral nephrosis. Anticoagulation with enoxaparin (1 mg/kg dose, every 12 hours) was indicated for twenty days. Then the angioCT of control showed resolution of the thrombosis.On the fourth day of admission and treatment, a diagnostic and extension study was performed, which included, among others, a complete biochemical profile including lipid profile, granulopoietic hyperplasia of the bone marrow (myelogram), flow cytometry (bone marrow) in which no cells with a predominant clonal or neoplastic immunophenotype of haemological lineage were observed, flow cytometry in peripheral blood negative for neoplastic cells, cytological of pleural fluid negative for neoplastic cells, flow cytometry of pleural fluid without evidence of haemological neoplasia. It was presented to the paediatric oncological committee, highlighting that it was not possible to take a biopsy of the tumour given that the mediastinal mass disappeared with the cytoreductive treatment, assuming the diagnosis of lymphoblastic lymphoma by the clinical picture and the response to treatment, according to the PINDA 0516 protocol. This protocol contemplates in Induction IA eight doses of Lasp E. coli of 10,000 IU/m2. Having received seven doses of L-asp and with a cumulative dose of ninety thousand international units plus glucocorticoid (prednisone), presented a picture of decline, vomiting, abdominal pain and mild dehydration. There was suspicion of pancreatitis, which was ruled out by normal amylase/lipase values and normal hepatic tests. At that time it had plasma electrolyte profile with hyponatraemia of 126 mOsm/kg and urinary osmolality of 510 mOsm/kg, both normal values. With hyponatraemia and hypertriglyceridaemia, there was suspicion of RAM of pseudohyponatraemia secondary to hypertriglyceridaemia associated to L-asp. It was evaluated by Gastroenterology and Endocrinology, indicating a diet low in refined sugars and rich in fiber, fibrates (ciprofibrato 100 mg oral daily) and omega 3 (4 g oral daily), until triglyceride values of 300 mg/dL were achieved. Two weeks later the triglycerides had a value of 79 mg/dL. Ciprofibrato and omega3 were suspended, indicating prophylactic use associated to corticoid and L-asp treatment. A total of twelve doses of L-asp were completed with a cumulative dose of one hundred and eighty four thousand international units corresponding to the induction protocol. The suspicion of RAM was subjected to causality evaluation, with the modified Karch and Lasagna algorithm by WHO5, which resulted in “Definitive” RAM for the association of L-asp and Prednisone\n",
+    "summary": "A teenager who developed pseudohyponatraemia and hypertriglyceridaemia during treatment for non-Hodgkin lymphoma (NHL) was suspected to have a drug reaction (ADR). This suspicion of ADR was evaluated according to the modified causality algorithm (Karch and Lasagna), resulting in a \"definitive\" ADR for the association of L-asp and corticosteroids. He received treatment with a low-fat diet and lipid-modifying medicines. L-asp and prednisone were not discontinued due to the end of the indication, according to the protocol. The hypertriglyceridaemia recovered without complications after 14 days of treatment.\n",
+    "translated_fulltext": "১৪ বছর বয়সী পূর্বে সুস্থ এক কিশোর, যিনি Osorno-এর Primary Emergency Care Service (PEC)-এ উপস্থিত হন প্রধানত নিশাচর প্রকৃতির ১১ দিনের ইতিহাসবিশিষ্ট একটি উত্তেজক কাশির কারণে। উপসর্গভিত্তিক চিকিৎসা নির্দেশ করা হয়, যার পরবর্তী সময়ে শ্বাসকষ্ট (dyspnoea) ও শোয়া অবস্থায় শ্বাসকষ্ট (orthopnoea) বিকশিত হয়। তিনি Osorno Base Hospital (OBH)-এর জরুরি বিভাগে উপস্থিত হন তীব্র শ্বাসপ্রশ্বাসজনিত কষ্ট, চিৎ হয়ে শোয়া অবস্থায় অসহিষ্ণুতা এবং উদর ব্যথাসহ। তাকে Paediatric Intensive Care Unit (PICU)-এ ভর্তি করা হয়; তিনি ছিলেন ট্যাকিকার্ডিক, হাইপারটেনসিভ, পলিপনিয়িক, FiO2 35% সহ অক্সিজেন স্যাচুরেশন 96%, গোলাপি বর্ণের, হাইড্রেটেড ও ভালোভাবে পারফিউজড, সমতল জুগুলার ভেইনসহ, উভয় পাশে ছোট সুপ্রাক্লাভিকুলার লিম্ফ্যাডেনোপ্যাথি বিদ্যমান। বক্ষদেশে নরম টিস্যুর কোনো রিট্র্যাকশন ছিল না, genupectoral অবস্থানে রক্ষিত ছিল, উভয় বেসে পালমোনারি মার্মার হ্রাসপ্রাপ্ত ছিল, এবং কার্ডিয়াক অস্কালটেশনে শব্দ মৃদু ছিল, শ্বাসধ্বনি অনুপস্থিত। নরম উদর সহজে চাপা যাচ্ছিল না এবং উভয় হাইপোকন্ড্রিয়ামে সংবেদনশীল ছিল, সন্দেহজনক ভিসেরাল বর্ধনসহ এবং কোনো আঘাত ছিল না। বক্ষ রেডিওগ্রাফিতে সুপিরিয়র মিডিয়াস্টাইনাল মাস এবং ডান মধ্য লোবের এটেলেকটাসিসের সাথে সমপাক্ষিক প্লুরাল ইফিউশন দেখা যায়। অ্যানেস্থেশিয়ার কন্ট্রা-ইন্ডিকেশনের কারণে কনট্রাস্ট-এনহ্যান্সড বক্ষ এক্স-রে করা হয়নি, যেমনটি OBH থেকে স্থানান্তরের সারাংশে উল্লেখ ছিল। তাকে গুরুতর অবস্থায় PICU HBV-তে স্থানান্তর করা হয়, Mediastinal Compression Syndrome সহ, non-Hodgkin lymphoma-এর ক্লিনিক্যাল সন্দেহ নিয়ে। তাকে পেডিয়াট্রিক হেমাটো-অঙ্কোলজি, পেডিয়াট্রিক সার্জারি, পেডিয়াট্রিক ইনটেনসিভ কেয়ার, ইমেজিং, রেডিওথেরাপি ও পেডিয়াট্রিক অঙ্কোলজি টিম দ্বারা মূল্যায়ন করা হয়, যেখানে উভয় বেসে পালমোনারি মার্মার স্বাভাবিক ছিল এবং কার্ডিয়াক অস্কালটেশনে শব্দ মৃদু ছিল, শ্বাসধ্বনি অনুপস্থিত। উদরের নরম টিস্যু সহজে চাপা যাচ্ছিল না এবং উভয় হাইপোকন্ড্রিয়ামে সংবেদনশীল ছিল, সন্দেহজনক ভিসেরাল বর্ধনসহ এবং কোনো আঘাত ছিল না। বক্ষ রেডিওগ্রাফিতে সুপিরিয়র মিডিয়াস্টাইনাল মাস এবং ডান মধ্য লোবের এটেলেকটাসিসের সাথে সমপাক্ষিক প্লুরাল ইফিউশন দেখা যায়। অ্যানেস্থেশিয়ার কন্ট্রা-ইন্ডিকেশনের কারণে কনট্রাস্ট-এনহ্যান্সড বক্ষ এক্স-রে করা হয়নি, যেমনটি OBH থেকে স্থানান্তরের সারাংশে উল্লেখ ছিল। তাকে গুরুতর অবস্থায় PICU HBV-তে স্থানান্তর করা হয়, Mediastinal Compression Syndrome সহ, non-Hodgkin lymphoma-এর ক্লিনিক্যাল সন্দেহ নিয়ে। তাকে পেডিয়াট্রিক হেমাটো-অঙ্কোলজি, পেডিয়াট্রিক সার্জারি, পেডিয়াট্রিক ইনটেনসিভ কেয়ার, ইমেজিং, রেডিওথেরাপি ও পেডিয়াট্রিক অঙ্কোলজি টিম দ্বারা মূল্যায়ন করা হয়, যেখানে উভয় বেসে পালমোনারি মার্মার স্বাভাবিক ছিল এবং কার্ডিয়াক অস্কালটেশনে শব্দ মৃদু ছিল, শ্বাসধ্বনি অনুপস্থিত।\n\nএকটি নেফ্রোলজিক্যাল মূল্যায়ন করা হয়, যা টিউমার লাইসিস সিনড্রোমের সেকেন্ডারি রেনাল ফেলিউর নিশ্চিত করে, ডায়ালাইসিসের তাৎক্ষণিক প্রয়োজন ছাড়াই এবং হাইপারটেনশনের প্রবণতাসহ; ক্রিয়াটিনিন 1.54 mg/dL, ফসফেমিয়া 11 mg/dL, হাইপারনাট্রেমিয়া ছাড়াই। হাইপারহাইড্রেশন, ডিউরেটিক (furosemide) এবং অ্যান্টিহাইপারটেনসিভ (amlodipine) চালু রাখা হয়। শ্বাসপ্রশ্বাসের দৃষ্টিকোণ থেকে, এটি অক্সিজেনের প্রয়োজনীয়তা উপস্থাপন করে, Venturi মাস্ক দ্বারা FIO2 35% সহ, ভর্তি তৃতীয় দিনে এই সরবরাহ বন্ধ করা হয়। এটি সাইকোমোটর উত্তেজনার পর্বসহ বিকশিত হয়, চলমান ডায়াগনোসিসের সাথে সম্পর্কিত, যা সাইকোমোটর উত্তেজনার জন্য প্রাতিষ্ঠানিক প্রোটোকল অনুযায়ী চিকিৎসা করা হয়, মনোবৈজ্ঞানিক ও মনোরোগ বিশেষজ্ঞ সহায়তাসহ, সন্তোষজনক উন্নতির সাথে। ভর্তি ও চিকিৎসার তৃতীয় দিনে কনট্রাস্টসহ থোরাক্স, উদর ও পেলভিসের একটি CT স্ক্যান করা হয়, যেখানে থাইমাসের আকার বৃদ্ধি, সমজাতীয় চেহারা, সম্ভবত একটি লিম্ফোপ্রোলিফারেটিভ প্রক্রিয়ার প্রেক্ষাপটে এবং পালমোনারি থ্রম্বোএম্বোলিজমের ইঙ্গিতপূর্ণ ফলাফল পর্যবেক্ষণ করা হয়। থোরাক্সের angioCT-তে জুগুলার ভেইনের থ্রম্বোসিস, উভয় বেসে এটেলেকটাটিক ঘটনাসহ বিস্তৃত দ্বিপাক্ষিক প্লুরাল ইফিউশন এবং দ্বিপাক্ষিক মেডিক্যাল নেফ্রোসিসের লক্ষণ দেখা যায়। এনোক্সাপারিন দিয়ে অ্যান্টিকোয়াগুলেশন (1 mg/kg ডোজ, প্রতি 12 ঘণ্টা অন্তর) বিশ দিনের জন্য নির্দেশ করা হয়। পরবর্তীতে কন্ট্রোল angioCT-তে থ্রম্বোসিসের সমাধান দেখা যায়।\n\nভর্তি ও চিকিৎসার চতুর্থ দিনে একটি ডায়াগনস্টিক ও এক্সটেনশন স্টাডি করা হয়, যার মধ্যে অন্তর্ভুক্ত ছিল অন্যান্যদের মধ্যে একটি সম্পূর্ণ বায়োকেমিক্যাল প্রোফাইলসহ লিপিড প্রোফাইল, অস্থিমজ্জার গ্রানুলোপোয়েটিক হাইপারপ্লাসিয়া (মাইয়েলোগ্রাম), ফ্লো সাইটোমেট্রি (অস্থিমজ্জা) যেখানে হেমাটোলজিকাল লাইনেজের প্রধান ক্লোনাল বা নিওপ্লাস্টিক ইমিউনোফেনোটাইপবিশিষ্ট কোনো কোষ পর্যবেক্ষণ করা হয়নি, পেরিফেরাল রক্তে ফ্লো সাইটোমেট্রি নিওপ্লাস্টিক কোষের জন্য নেগেটিভ, প্লুরাল তরলের সাইতোলজি নিওপ্লাস্টিক কোষের জন্য নেগেটিভ, প্লুরাল তরলের ফ্লো সাইটোমেট্রি হেমাটোলজিকাল নিওপ্লাসিয়ার কোনো প্রমাণ ছাড়াই। এটি পেডিয়াট্রিক অঙ্কোলজিক্যাল কমিটিতে উপস্থাপন করা হয়, যেখানে উল্লেখ করা হয় যে মিডিয়াস্টাইনাল মাস সাইটো-রিডাকটিভ চিকিৎসার সাথে অদৃশ্য হয়ে যাওয়ায় টিউমারের বায়োপসি নেওয়া সম্ভব হয়নি, ক্লিনিক্যাল চিত্র ও চিকিৎসার প্রতিক্রিয়ার ভিত্তিতে lymphoblastic lymphoma-এর ডায়াগনোসিস অনুমান করা হয়, PINDA 0516 প্রোটোকল অনুযায়ী। এই প্রোটোকলে Induction IA-তে Lasp E. coli-এর 10,000 IU/m2-এর আটটি ডোজ অন্তর্ভুক্ত। L-asp-এর সাতটি ডোজ গ্রহণ এবং গ্লুকোকর্টিকয়েড (prednisone) সহ মোট নব্বই হাজার আন্তর্জাতিক ইউনিটের সমষ্টিগত ডোজ গ্রহণের পর, অবনতি, বমি, উদর ব্যথা এবং মৃদু ডিহাইড্রেশনের একটি চিত্র উপস্থাপন করে। প্যানক্রিয়াটাইটিসের সন্দেহ করা হয়, যা স্বাভাবিক amylase/lipase মান এবং স্বাভাবিক হেপাটিক পরীক্ষার মাধ্যমে বাতিল করা হয়। সে সময় প্লাজমা ইলেক্ট্রোলাইট প্রোফাইলে 126 mOsm/kg হাইপোনাট্রেমিয়া এবং 510 mOsm/kg ইউরিনারি অসমোলালিটি ছিল, উভয়ই স্বাভাবিক মান। হাইপোনাট্রেমিয়া ও হাইপারট্রাইগ্লিসারাইডেমিয়াসহ, L-asp-এর সাথে সম্পর্কিত হাইপারট্রাইগ্লিসারাইডেমিয়ার সেকেন্ডারি pseudohyponatraemia-এর RAM-এর সন্দেহ করা হয়। গ্যাস্ট্রোএন্টারোলজি ও এন্ডোক্রিনোলজি দ্বারা মূল্যায়ন করা হয়, যেখানে পরিশোধিত চিনিতে কম ও ফাইবারসমৃদ্ধ খাদ্য, ফাইব্রেটস (ciprofibrato 100 mg oral daily) এবং omega 3 (4 g oral daily) নির্দেশ করা হয়, যতক্ষণ না ট্রাইগ্লিসারাইড মান 300 mg/dL অর্জিত হয়। দুই সপ্তাহ পর ট্রাইগ্লিসারাইডের মান ছিল 79 mg/dL। Ciprofibrato ও omega3 বন্ধ করা হয়, কর্টিকয়েড ও L-asp চিকিৎসার সাথে সম্পর্কিত প্রোফাইল্যাকটিক ব্যবহারের নির্দেশ দেওয়া হয়। Induction প্রোটোকলের সাথে সামঞ্জস্যপূর্ণভাবে মোট বারোটি L-asp ডোজ সম্পন্ন করা হয়, মোট সমষ্টিগত ডোজ এক লক্ষ চুরাশি হাজার আন্তর্জাতিক ইউনিট। RAM-এর সন্দেহকে কারণমূলক মূল্যায়নের আওতায় আনা হয়, WHO5 দ্বারা সংশোধিত Karch and Lasagna অ্যালগরিদম অনুযায়ী, যার ফলাফল ছিল L-asp ও Prednisone-এর সংযুক্তির জন্য “Definitive” RAM।\n",
+    "translated_summary": "একজন কিশোর, যার নন-হজকিন্স লিম্ফোমা (NHL)-এর চিকিৎসাকালীন সিউডোহাইপোনাট্রিমিয়া এবং হাইপারট্রাইগ্লিসারাইডেমিয়া দেখা দেয়, তার ক্ষেত্রে ওষুধের প্রতিক্রিয়ার (এডিআর) সন্দেহ করা হয়েছিল। পরিবর্তিত কার্যকারণ অ্যালগরিদম (কার্চ এবং লাসাগনা) অনুসারে এই এডিআর-এর সন্দেহ মূল্যায়ন করা হয়, যার ফলে এল-অ্যাসপ এবং কর্টিকোস্টেরয়েডের মধ্যে সম্পর্ককে একটি \"নিশ্চিত\" এডিআর হিসেবে গণ্য করা হয়। তাকে কম ফ্যাটযুক্ত খাবার এবং লিপিড-সংশোধনকারী ওষুধ দিয়ে চিকিৎসা করা হয়েছিল। প্রোটোকল অনুসারে, চিকিৎসার কারণ শেষ হওয়ার কারণে এল-অ্যাসপ এবং প্রেডনিসোন বন্ধ করা হয়নি। ১৪ দিন চিকিৎসার পর কোনো জটিলতা ছাড়াই হাইপারট্রাইগ্লিসারাইডেমিয়া সেরে যায়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_54.txt",
+    "fulltext": "A 56-year-old Italian female patient with β-thalassemia major presented to the radiology department to undergo MRI to quantify myocardial, hepatic, and pancreatic iron deposition. The clinical history of the patient included a transfusion-dependent β-thalassemia condition (genotype HBB:c.118C > T/ HBB:c.93-21G > A), diagnosed at the age of 7 years, despite the fact that the first transfusion was carried out at 2 years. As a consequence of β-thalassemia, the patient underwent splenectomy and cholecystectomy.\n\nAt the moment of MRI, she had a negative HCV-RNA (Hepatitis C virus-Ribonucleic acid) test, no osteoporosis or other endocrine, cardiac, or hepatic complications, and good iron levels. The patient’s therapy included iron chelation with deferasirox, vitamin D, and luspatercept, an erythropoiesis modulator started 2 years before the MRI examination (good response, with an increase of about 35% of transfusion interval duration). Transfusion therapy included two units of concentrated and filtered red blood cells every 25 days with pre-transfusion hemoglobin values of 10–10.5 g/dl.\n\nOn MRI, a solid mass with lobulated and regular contours was incidentally identified within the prevascular compartment of the mediastinum.\n\nThe lesion was mildly hyperintense on T2-weighted images (T2-wi) and isointense on T1-wi. The mediastinal mass in question was discernible in a prior MRI examination conducted for the same purpose in 2020 before starting luspatercept therapy, albeit with a marginal enlargement.\n\nThere were no other apparent abnormalities observed in the remaining mediastinal compartments. No pleural or pericardial effusions were present.\n\nThe neurological examination was unremarkable, and in the preceding months, the patient exhibited no symptoms of mediastinal syndrome associated with compression of the adjacent neurovascular structures. Moreover, she did not exhibit any fever or experience any weight loss.\n\nFor further evaluation, the patient underwent 18F-deoxyglucose (18FDG) positron emission tomography (PET)-computed tomography (CT) and chest CT with contrast media. On PET-CT, the mediastinal mass showed only mild FDG uptake (SUVmax = 4.3); no other sites of abnormal radiotracer uptake were reported in the neck, chest, abdomen, and skeleton. On CT images, the lesion presented regular margins, solid density, and mild contrast enhancement. The adjacent structures did not exhibit any signs of invasion, and lymphadenopathies or extra-thoracic disease were not present. Such radiological features, the indolent behaviour over time, the absence of systemic symptoms, and the lack of avid FDG uptake on PET-CT scan made the diagnosis of thymoma probable.\n\nHowever, on lung window visualization, multiple rounded areas of parenchymal lucency, consistent with thin-walled cysts distributed symmetrically throughout both lungs, with normal intervening parenchyma, were evident.\n\nNo nodules or other interstitial abnormalities were associated with the cysts. No pneumothorax was detected. Coherently with thalassemic bone disease, the ribs appeared widened, and the spine displayed mild platyspondyly. The remaining portion of the chest and visible upper abdomen were unremarkable. The radiological findings were consistent with cystic lung disease, most likely LAM.\n\nThe patient was then referred to the pulmonary clinic for further evaluation. She was a never-smoker and did not report any respiratory symptoms. In particular, she denied a history of chronic cough, recurrent respiratory infections, or pneumothorax. No cutaneous lesions, notably facial fibrofolliculomas, were evident. On chest examination, the lung fields were clear. Peripheral capillary oxygen saturation was normal (98%), with a heart rate of 75 beats per minute. Pulmonary function tests revealed a substantial reduction in diffusing capacity of the lungs for carbon monoxide (DLCO; 42% of the predicted value), partly imputable to the condition of anemia, with a carbon monoxide transfer coefficient (KCO) of 73% of the predicted value. After discussion in a multidisciplinary tumor board setting, including a pulmonologist, the patient underwent left thoracoscopic thymectomy and concomitant lingual segment wedge resection. The histopathological report revealed a morphological finding and immunohistochemical pattern referable to type B2 thymoma with focal infiltration of the capsule. Extracapsular extension was not evident. However, the lesion was present at the resection margin (stage IIa according to Masaoka–Koga; stage 1a according to the tumor, node, metastasis [TNM] classification).\n\nRegarding the lung parenchyma, histopathologic analysis described lung parenchyma with cysts of variable size lined by spindle cells in myoid habit with immunohistochemical reactivity for actin, estrogen, progesterone receptors, and HMB45 (focal positivity). Modest chronic interstitial inflammation, vascular congestion, and recent blood extravasation were evident. These morphological findings were compatible with pulmonary LAM.\n\nA final histological diagnosis of thymoma and pulmonary LAM was made. For the neoplastic condition, the patient was a candidate for adjuvant radiation therapy due to the microscopically incomplete resection (R1). For LAM with concomitant β-thalassemia, treatment with sirolimus was recommended.",
+    "summary": "A 56-year-old Italian female patient with β-thalassemia major underwent magnetic resonance imaging to quantify myocardial, hepatic, and pancreatic iron deposition. Her medical history included transfusion-dependent β-thalassemia, splenectomy, and cholecystectomy. At the time of magnetic resonance imaging, she had no significant endocrine, cardiac, or hepatic complications and was on deferasirox, vitamin D, and luspatercept. Magnetic resonance imaging revealed a lobulated mass in the prevascular mediastinum, which showed mild radiotracer uptake on positron emission tomography. Chest computed tomography revealed multiple thin-walled cysts in the lungs, indicating lymphangioleiomyomatosis. Following multidisciplinary evaluation, the patient underwent thoracoscopic thymectomy and lung wedge resection. Histopathology confirmed type B2 thymoma and pulmonary lymphangioleiomyomatosis. Post-surgery, the patient was recommended for adjuvant radiation therapy and sirolimus treatment.",
+    "translated_fulltext": "৫৬ বছর বয়সী ইতালীয় নারী রোগী, যার β-থ্যালাসেমিয়া মেজর রয়েছে, মায়োকার্ডিয়াল, হেপাটিক এবং প্যানক্রিয়াটিক আয়রন ডিপোজিশন পরিমাপের উদ্দেশ্যে এমআরআই করার জন্য রেডিওলজি বিভাগে উপস্থিত হন। রোগীর ক্লিনিক্যাল ইতিহাসে ট্রান্সফিউশন-নির্ভর β-থ্যালাসেমিয়া অবস্থা (জিনোটাইপ HBB:c.118C > T/ HBB:c.93-21G > A) অন্তর্ভুক্ত ছিল, যা ৭ বছর বয়সে নির্ণয় করা হয়, যদিও প্রথম ট্রান্সফিউশন ২ বছর বয়সে করা হয়েছিল। β-থ্যালাসেমিয়ার পরিণতিস্বরূপ রোগীর স্প্লেনেকটমি এবং কোলেসিস্টেকটমি করা হয়েছিল।\n\nএমআরআই করার সময় রোগীর HCV-RNA (Hepatitis C virus-Ribonucleic acid) পরীক্ষা নেগেটিভ ছিল, কোনো অস্টিওপোরোসিস বা অন্যান্য এন্ডোক্রাইন, কার্ডিয়াক বা হেপাটিক জটিলতা ছিল না এবং আয়রনের মাত্রা ভালো ছিল। রোগীর চিকিৎসায় ডেফেরাসিরক্স দিয়ে আয়রন কেলেশন, ভিটামিন D এবং লুসপাটারসেপ্ট অন্তর্ভুক্ত ছিল, যা একটি এরিথ্রোপয়েসিস মডুলেটর এবং এমআরআই পরীক্ষার ২ বছর আগে শুরু করা হয়েছিল (ভালো সাড়া, ট্রান্সফিউশন ইন্টারভালের সময়কাল প্রায় ৩৫% বৃদ্ধি পেয়েছিল)। ট্রান্সফিউশন থেরাপিতে প্রতি ২৫ দিনে দুই ইউনিট কনসেন্ট্রেটেড ও ফিল্টারড লাল রক্তকণিকা অন্তর্ভুক্ত ছিল, প্রি-ট্রান্সফিউশন হিমোগ্লোবিন মান ১০–১০.৫ g/dl।\n\nএমআরআই-তে, মিডিয়াস্টিনামের প্রিভাসকুলার কম্পার্টমেন্টের মধ্যে লোবুলেটেড ও নিয়মিত কনট্যুরসহ একটি সলিড ম্যাস আকস্মিকভাবে সনাক্ত করা হয়।\n\nলেশনটি T2-weighted images (T2-wi)-এ মৃদু হাইপারইনটেন্স এবং T1-wi-এ আইসোইনটেন্স ছিল। সংশ্লিষ্ট মিডিয়াস্টিনাল ম্যাসটি ২০২০ সালে একই উদ্দেশ্যে করা পূর্ববর্তী এমআরআই পরীক্ষায়, লুসপাটারসেপ্ট থেরাপি শুরু করার আগে, দৃশ্যমান ছিল, যদিও সামান্য আকার বৃদ্ধি পেয়েছিল।\n\nবাকি মিডিয়াস্টিনাল কম্পার্টমেন্টগুলোতে অন্য কোনো সুস্পষ্ট অস্বাভাবিকতা দেখা যায়নি। কোনো প্লুরাল বা পেরিকার্ডিয়াল ইফিউশন উপস্থিত ছিল না।\n\nনিউরোলজিক্যাল পরীক্ষা স্বাভাবিক ছিল এবং পূর্ববর্তী মাসগুলোতে রোগীর কোনো মিডিয়াস্টিনাল সিন্ড্রোমের উপসর্গ দেখা যায়নি যা পার্শ্ববর্তী নিউরোভাসকুলার গঠনগুলোর চাপে সম্পর্কিত। তদুপরি, তার কোনো জ্বর ছিল না বা ওজন হ্রাসের অভিজ্ঞতা ছিল না।\n\nআরও মূল্যায়নের জন্য রোগীর 18F-deoxyglucose (18FDG) পজিট্রন এমিশন টোমোগ্রাফি (PET)-কম্পিউটেড টোমোগ্রাফি (CT) এবং কনট্রাস্ট মিডিয়া সহ চেস্ট CT করা হয়। PET-CT-তে মিডিয়াস্টিনাল ম্যাসে শুধুমাত্র মৃদু FDG আপটেক দেখা যায় (SUVmax = 4.3); গলা, বুক, উদর এবং কঙ্কালে অন্য কোনো অস্বাভাবিক রেডিওট্রেসার আপটেক রিপোর্ট করা হয়নি। CT ইমেজে লেশনটি নিয়মিত মার্জিন, সলিড ডেনসিটি এবং মৃদু কনট্রাস্ট এনহান্সমেন্ট প্রদর্শন করে। পার্শ্ববর্তী গঠনগুলোতে কোনো ইনভেশনের চিহ্ন ছিল না এবং লিম্ফ্যাডেনোপ্যাথি বা এক্সট্রা-থোরাসিক রোগ উপস্থিত ছিল না। এই রেডিওলজিক বৈশিষ্ট্যগুলো, সময়ের সাথে অলস আচরণ, সিস্টেমিক উপসর্গের অনুপস্থিতি এবং PET-CT স্ক্যানে উল্লেখযোগ্য FDG আপটেকের অভাব থাইমোমার সম্ভাব্য নির্ণয় নির্দেশ করে।\n\nতবে, লাং উইন্ডো ভিজুয়ালাইজেশনে উভয় ফুসফুস জুড়ে সমানভাবে বিতরণকৃত, পাতলা প্রাচীরবিশিষ্ট সিস্টের সাথে সামঞ্জস্যপূর্ণ একাধিক গোলাকার প্যারেনকাইমাল লুসেন্সি এলাকা দেখা যায়, যেখানে মধ্যবর্তী প্যারেনকাইমা স্বাভাবিক ছিল।\n\nসিস্টগুলোর সাথে কোনো নডিউল বা অন্যান্য ইন্টারস্টিশিয়াল অস্বাভাবিকতা যুক্ত ছিল না। কোনো নিউমোথোরাক্স শনাক্ত করা হয়নি। থ্যালাসেমিক বোন ডিজিজের সাথে সামঞ্জস্য রেখে, পাঁজরগুলো প্রশস্ত দেখাচ্ছিল এবং মেরুদণ্ডে মৃদু প্লাটিসপন্ডাইলি ছিল। বক্ষের অবশিষ্ট অংশ এবং দৃশ্যমান ঊর্ধ্ব উদর স্বাভাবিক ছিল। রেডিওলজিক ফলাফলগুলো সিস্টিক লাং ডিজিজের সাথে সামঞ্জস্যপূর্ণ ছিল, সম্ভবত LAM।\n\nপরবর্তীতে রোগীকে আরও মূল্যায়নের জন্য পালমোনারি ক্লিনিকে রেফার করা হয়। তিনি কখনো ধূমপান করেননি এবং কোনো শ্বাসযন্ত্রজনিত উপসর্গের কথা জানাননি। বিশেষ করে, তিনি দীর্ঘস্থায়ী কাশি, পুনঃপুন শ্বাসযন্ত্র সংক্রমণ বা নিউমোথোরাক্সের ইতিহাস অস্বীকার করেন। কোনো ত্বকের ক্ষত, বিশেষত মুখমণ্ডলের ফাইব্রোফলিকুলোমা, দেখা যায়নি। চেস্ট পরীক্ষায় ফুসফুসের ক্ষেত্রগুলো পরিষ্কার ছিল। পেরিফেরাল ক্যাপিলারি অক্সিজেন স্যাচুরেশন স্বাভাবিক ছিল (৯৮%), হার্ট রেট ছিল প্রতি মিনিটে ৭৫ বিট। পালমোনারি ফাংশন টেস্টে কার্বন মনোক্সাইডের জন্য ফুসফুসের ডিফিউজিং ক্যাপাসিটিতে উল্লেখযোগ্য হ্রাস দেখা যায় (DLCO; পূর্বাভাসিত মানের ৪২%), যা আংশিকভাবে অ্যানিমিয়ার অবস্থার জন্য দায়ী, এবং কার্বন মনোক্সাইড ট্রান্সফার কোইফিশিয়েন্ট (KCO) ছিল পূর্বাভাসিত মানের ৭৩%। পালমোনোলজিস্টসহ মাল্টিডিসিপ্লিনারি টিউমার বোর্ডে আলোচনার পর, রোগীর বাম থোরাকোস্কোপিক থাইমেকটমি এবং একই সঙ্গে লিঙ্গুয়াল সেগমেন্ট ওয়েজ রিসেকশন করা হয়। হিস্টোপ্যাথোলজিক রিপোর্টে ক্যাপসুলের ফোকাল ইনফিলট্রেশনসহ টাইপ B2 থাইমোমার সাথে সম্পর্কিত মর্ফোলজিক ফাইন্ডিং এবং ইমিউনোহিস্টোকেমিক্যাল প্যাটার্ন পাওয়া যায়। এক্সট্রাক্যাপসুলার এক্সটেনশন দেখা যায়নি। তবে, রিসেকশন মার্জিনে লেশন উপস্থিত ছিল (Masaoka–Koga অনুযায়ী স্টেজ IIa; টিউমার, নোড, মেটাস্টাসিস [TNM] শ্রেণিবিন্যাস অনুযায়ী স্টেজ 1a)।\n\nলাং প্যারেনকাইমার ক্ষেত্রে, হিস্টোপ্যাথোলজিক বিশ্লেষণে বিভিন্ন আকারের সিস্টসহ ফুসফুসের প্যারেনকাইমা বর্ণনা করা হয়, যা মায়য়েড স্বভাবের স্পিন্ডল সেল দ্বারা আবৃত এবং অ্যাক্টিন, ইস্ট্রোজেন, প্রোজেস্টেরন রিসেপ্টর এবং HMB45 (ফোকাল পজিটিভিটি) এর জন্য ইমিউনোহিস্টোকেমিক্যাল রিঅ্যাক্টিভিটি প্রদর্শন করে। মৃদু ক্রনিক ইন্টারস্টিশিয়াল ইনফ্ল্যামেশন, ভাসকুলার কনজেশন এবং সাম্প্রতিক রক্ত এক্সট্রাভাসেশন দেখা যায়। এই মর্ফোলজিক ফলাফলগুলো পালমোনারি LAM-এর সাথে সামঞ্জস্যপূর্ণ ছিল।\n\nথাইমোমা এবং পালমোনারি LAM-এর চূড়ান্ত হিস্টোলজিক নির্ণয় করা হয়। নিওপ্লাস্টিক অবস্থার জন্য, মাইক্রোস্কোপিক্যালি অসম্পূর্ণ রিসেকশন (R1) হওয়ায় রোগী অ্যাডজুভ্যান্ট রেডিয়েশন থেরাপির উপযুক্ত প্রার্থী ছিলেন। LAM এবং সহ-বিদ্যমান β-থ্যালাসেমিয়ার জন্য সাইরোলিমাস দিয়ে চিকিৎসার সুপারিশ করা হয়।\n",
+    "translated_summary": "একজন ৫৬ বছর বয়সী ইতালীয় নারী রোগী, যিনি বিটা-থ্যালাসেমিয়া মেজর-এ ভুগছিলেন, তার হৃদপিণ্ড, যকৃত এবং অগ্ন্যাশয়ে লোহার জমাট পরিমাপ করার জন্য ম্যাগনেটিক রেজোন্যান্স ইমেজিং করা হয়েছিল। তার পূর্বের স্বাস্থ্য সংক্রান্ত তথ্যে ট্রান্সফিউশন-নির্ভর বিটা-থ্যালাসেমিয়া, প্লীহা অপসারণ এবং পিত্তথলি অপসারণের ইতিহাস ছিল। ম্যাগনেটিক রেজোন্যান্স ইমেজিং করার সময়, তার উল্লেখযোগ্য কোনো এন্ডোক্রাইন, হৃদরোগ বা যকৃতের জটিলতা ছিল না এবং তিনি ডেফারাসিরক্স, ভিটামিন ডি এবং লুসপ্যাটারসেপ্ট গ্রহণ করছিলেন। ম্যাগনেটিক রেজোন্যান্স ইমেজিং-এ দেখা যায়, প্রিভাস্কুলার মিডিয়াস্টিনামে একটি লোবুলেটেড পিণ্ড রয়েছে, যা পজিট্রন এমিশন টমোগ্রাফিতে সামান্য রেডিওট্রেসার গ্রহণ করেছে। বুকের সিটি স্ক্যানে ফুসফুসে একাধিক পাতলা প্রাচীরযুক্ত সিস্ট দেখা যায়, যা লিম্ফ্যাঞ্জিওলেইওমায়োমাটোসিস নির্দেশ করে। বহু-বিষয়ক মূল্যায়নের পর, রোগীর থোরাকোস্কোপিক থাইমেকটমি এবং ফুসফুসের ওয়েজ রিসেকশন করা হয়। হিস্টোপ্যাথলজি পরীক্ষায় টাইপ বি২ থাইমোমা এবং পালমোনারি লিম্ফ্যাঞ্জিওলেইওমায়োমাটোসিস নিশ্চিত করা হয়। অস্ত্রোপচারের পরে, রোগীকে সহায়ক রেডিয়েশন থেরাপি এবং সিরোলিমাস চিকিৎসার পরামর্শ দেওয়া হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_235.txt",
+    "fulltext": "We present a case of a 49-year-old woman with renal and heart failure following a long-term (lasting from 13 years of age) SLE prepared for kidney transplantation. Due to LN (class III, then IV), starting at childhood, she was treated with steroids, together with cyclophosphamide, replaced later by methotrexate and then azathioprine. Hence, the partial remission of nephrotic syndrome was achieved and from 2002 the patient did not receive any immunosuppressive therapy. She was also HBV and HCV positive. SLE involvement of circulatory system presented with early coronary atherosclerosis, ischemic heart disease, and myocardial infarction at the age of 20. In 2007, because of deterioration of kidney function with a serum creatinine concentration of 2.2 mg/dL and proteinuria of 2 g/day, the kidney biopsy was performed. The biopsy showed active and sclerotic focal proliferative lupus nephritis nevertheless immunosuppressive therapy was not introduced for the reason of active replication of HCV. The kidney function was gradually deteriorating over time. Despite cardiac intervention (PCI RCA), the patient developed severe post-infarction and dilated cardiomyopathy and required ICD implantation in primary prevention in 2009. Later, on lupus and secondary cardiomyopathic background, the patient developed severe MV and TV regurgitation. For this reason, the patient underwent mitral and tricuspid valve repair and left ventricle volume reduction surgery complicated by low cardiac output syndrome with a need for intra-aortic balloon pump use (2014). In the postoperative period, the kidney function deteriorated, requiring the initiation of renal replacement therapy. The patient has been on dialysis for 4 years. While being on active waiting list for kidney transplantation presented remission of laboratory indices of lupus (complement splits within normal limits: C3–0,93 g/l, C4–0,4 g/l, ANA negative) and persisting circulatory insufficiency with markedly reduced stair-climbing capacity (to one flight of stairs) with elevated BNP 619 pg/ml (n. 0–100). In transthoracic echocardiography, performed before renal transplantation, the left ventricle and the left atrium were significantly enlarged and the left ventricular systolic function was significantly reduced with LVEF 26% and GLS -3. Due to the implantation of the mitral ring, it was not possible to assess the left ventricular diastolic function. The high tricuspid regurgitant flow gradient with widened and poorly respiratory mobile inferior vena cava indicated a high probability of pulmonary hypertension. Furthermore, while preparing the patient for the surgical procedure, it was decided to include cardioprotective therapy with Levosimendan. Due to the time frame associated with the transplantation procedure, the drug infusion was started as soon as possible after cross-match results were known, immediately after the dialysis session. The infusion at a dose of 0.1 μg/kg/min was continued after surgery for a total of 24 h. The patient’s anesthesia for kidney transplantation and perioperative care included the aspect of optimizing transplanted kidney perfusion, avoiding the use of renal toxic drugs and those excreted by properly functioning kidneys, as well as the use of nephroprotective agents. Because of the patient’s cardiological burden, including recurrent episodes of extrasystole proceeding with decompensation of the circulatory system, together with the need of ICD turning off for the transplantation period, the Swan-Ganz catheter for hemodynamic assessment was not used. Anesthesia monitoring was limited the to ECG, central catheter with CVP assessment, direct blood pressure measurement from the cannula inserted into the radial artery, and cardiac ultrasound. In the perioperative period the CVP parameter was used to assess the volatility, and in the postoperative period, a cardiac ultrasound was used along with the assessment of VCI respiratory fill and motility. The therapy was aimed at the standard of fluid therapy called Goal Directed Therapy (GDT). During general anesthesia, fentanyl, triacrium, propofol, desflurane, antibiotic therapy, and standard immunosuppressive treatment were used as well as 25 g of mannitol infusion was administered as a nephroprotective treatment and 0.9% NaCl as a fluid therapy. In the course of postoperative immunosuppression, she received steroids, tacrolimus with mycophenolate mofetil which was stopped due to persistent leukopenia and cytomegalovirus infection. Furthermore delayed graft function was observed with a need for hemodialysis for almost 6 weeks (mostly due to fluid retention). BNP levels raised to 2996 pg/ml and then slowly decreased. The kidney biopsy performed 2 weeks after transplantation revealed acute rejection (AR II B Banff 2015) with ATN. Finally, the patient was discharged from the hospital on the 67th POD with the serum creatinine concentration of 1.4 mg/dL and BNP level of 1794 pg/ml. One month after kidney transplantation, there was a reduction in left ventricular dimensions, improved systolic function in the EF (increase to 30%) and GLS (decrease to − 6) assessment. In addition, there was a decrease in the tricuspid regurgitant flow gradient with normal width and respiratory motility of the IVC, which indicates a low probability of pulmonary hypertension. The improvement of echocardiographic parameters also reflected the simultaneous improvement of exercise capacity in the recipient from NYHA III/IV to NYHA II. In the 5-month observation, further improvement of heart function with a drop of BNP to 1066 pg/ml and normal kidney function were noted.",
+    "summary": "We present a case of a 49-year-old woman with renal and heart failure following a long-term SLE prepared for kidney transplantation. During the SLE course, the function of the heart and kidneys gradually deteriorated. The patient required the initiation of renal replacement therapy and was dialyzed until a kidney transplantation for 4 years. In the preparation of the patient for the surgical procedure, due to the extremely low ejection fraction, it was decided to include cardioprotective treatment with Levosimendan. The postoperative period was not straightforward but successful. In the monthly and five-month follow-up, a continuous improvement of heart function with normal renal function was noted.",
+    "translated_fulltext": "আমরা একটি ৪৯ বছর বয়সী নারীর কেস উপস্থাপন করছি, যিনি দীর্ঘমেয়াদি (১৩ বছর বয়স থেকে শুরু) SLE-পরবর্তী কিডনি ও হার্ট ফেইলিউরে ভুগছিলেন এবং কিডনি প্রতিস্থাপনের জন্য প্রস্তুত ছিলেন। LN (প্রথমে ক্লাস III, পরে IV) শৈশবকাল থেকেই শুরু হওয়ার কারণে তাকে স্টেরয়েডের সাথে সাইক্লোফসফামাইড দিয়ে চিকিৎসা করা হয়, যা পরে মেথোট্রেক্সেট এবং তারপর আজাথিওপ্রিন দ্বারা প্রতিস্থাপিত হয়। এর ফলে নেফ্রোটিক সিনড্রোমের আংশিক রেমিশন অর্জিত হয় এবং ২০০২ সাল থেকে রোগী কোনো ইমিউনোসাপ্রেসিভ থেরাপি গ্রহণ করেননি। তিনি HBV এবং HCV পজিটিভও ছিলেন। SLE-এর সার্কুলেটরি সিস্টেমে জড়িত থাকা অবস্থায় প্রারম্ভিক করোনারি অ্যাথেরোস্ক্লেরোসিস, ইস্কেমিক হার্ট ডিজিজ এবং ২০ বছর বয়সে মায়োকার্ডিয়াল ইনফার্কশন দেখা যায়। ২০০৭ সালে, সিরাম ক্রিয়াটিনিন ২.২ mg/dL এবং প্রোটিনিউরিয়া ২ g/day সহ কিডনি ফাংশনের অবনতি হওয়ায় কিডনি বায়োপসি করা হয়। বায়োপসিতে অ্যাক্টিভ এবং স্ক্লেরোটিক ফোকাল প্রোলিফারেটিভ লুপাস নেফ্রাইটিস দেখা যায়; তবে HCV-এর সক্রিয় প্রতিলিপনের কারণে ইমিউনোসাপ্রেসিভ থেরাপি শুরু করা হয়নি। সময়ের সাথে সাথে কিডনি ফাংশন ধীরে ধীরে অবনতি হতে থাকে। কার্ডিয়াক ইন্টারভেনশন (PCI RCA) সত্ত্বেও রোগীর তীব্র পোস্ট-ইনফার্কশন ও ডাইলেটেড কার্ডিওমায়োপ্যাথি বিকাশ হয় এবং ২০০৯ সালে প্রাইমারি প্রিভেনশনে ICD ইমপ্লান্টেশনের প্রয়োজন হয়। পরবর্তীতে, লুপাস ও সেকেন্ডারি কার্ডিওমায়োপ্যাথিক পটভূমিতে রোগীর তীব্র MV এবং TV রিগার্জিটেশন দেখা দেয়। এ কারণে রোগীর মিত্রাল ও ট্রাইকাস্পিড ভালভ রিপেয়ার এবং বাম ভেন্ট্রিকলের ভলিউম রিডাকশন সার্জারি করা হয়, যা লো কার্ডিয়াক আউটপুট সিনড্রোমে জটিল হয় এবং ইনট্রা-অর্টিক বেলুন পাম্প ব্যবহারের প্রয়োজন হয় (২০১৪)। পোস্টঅপারেটিভ পর্যায়ে কিডনি ফাংশন আরও অবনতি হয়, যার ফলে রেনাল রিপ্লেসমেন্ট থেরাপি শুরু করতে হয়। রোগী ৪ বছর ধরে ডায়ালাইসিসে রয়েছেন। কিডনি প্রতিস্থাপনের জন্য সক্রিয় অপেক্ষমাণ তালিকায় থাকাকালীন লুপাসের ল্যাবরেটরি সূচকগুলির রেমিশন দেখা যায় (কমপ্লিমেন্ট স্প্লিট স্বাভাবিক সীমার মধ্যে: C3–0,93 g/l, C4–0,4 g/l, ANA নেগেটিভ) এবং একই সঙ্গে স্থায়ী সার্কুলেটরি ইনসাফিসিয়েন্সি বিদ্যমান ছিল, সিঁড়ি ভাঙার সক্ষমতা উল্লেখযোগ্যভাবে কমে গিয়েছিল (এক তলা পর্যন্ত), BNP বৃদ্ধি পেয়ে ৬১৯ pg/ml (n. 0–100) ছিল। রেনাল ট্রান্সপ্লান্টেশনের আগে করা ট্রান্সথোরাসিক ইকোকার্ডিওগ্রাফিতে বাম ভেন্ট্রিকল ও বাম এট্রিয়াম উল্লেখযোগ্যভাবে বড় ছিল এবং বাম ভেন্ট্রিকুলার সিস্টোলিক ফাংশন গুরুতরভাবে হ্রাস পেয়েছিল, LVEF ২৬% এবং GLS −৩। মিত্রাল রিং ইমপ্লান্টেশনের কারণে বাম ভেন্ট্রিকুলার ডায়াস্টোলিক ফাংশন মূল্যায়ন করা সম্ভব হয়নি। উচ্চ ট্রাইকাস্পিড রিগার্জিট্যান্ট ফ্লো গ্রেডিয়েন্ট এবং প্রশস্ত ও কম শ্বাসপ্রশ্বাসগত গতিশীল ইনফেরিয়র ভেনা কাভা পালমোনারি হাইপারটেনশনের উচ্চ সম্ভাবনা নির্দেশ করে। এছাড়াও, সার্জিকাল প্রক্রিয়ার প্রস্তুতির সময় কার্ডিওপ্রোটেক্টিভ থেরাপি হিসেবে লেভোসিমেনডান অন্তর্ভুক্ত করার সিদ্ধান্ত নেওয়া হয়। ট্রান্সপ্লান্টেশন প্রক্রিয়ার সাথে সম্পর্কিত সময়সীমার কারণে, ক্রস-ম্যাচের ফলাফল জানা যাওয়ার সাথে সাথেই, ডায়ালাইসিস সেশনের অবিলম্বে ওষুধের ইনফিউশন শুরু করা হয়। ০.১ μg/kg/min ডোজে ইনফিউশন সার্জারির পর মোট ২৪ ঘন্টা পর্যন্ত চালু রাখা হয়। কিডনি প্রতিস্থাপনের জন্য রোগীর অ্যানেস্থেশিয়া ও পেরিওপারেটিভ কেয়ারে ট্রান্সপ্লান্টকৃত কিডনির পারফিউশন অপ্টিমাইজ করা, রেনাল টক্সিক ও স্বাভাবিকভাবে কার্যকর কিডনি দ্বারা নিঃসৃত ওষুধ এড়িয়ে চলা এবং নেফ্রোপ্রোটেক্টিভ এজেন্ট ব্যবহারের বিষয়টি অন্তর্ভুক্ত ছিল। রোগীর কার্ডিওলজিকাল বোঝার কারণে—যার মধ্যে এক্সট্রাসিস্টোলের পুনরাবৃত্ত এপিসোড সার্কুলেটরি সিস্টেমের ডিকম্পেনসেশনের দিকে অগ্রসর হওয়া এবং ট্রান্সপ্লান্টেশন সময়কালে ICD বন্ধ করার প্রয়োজন—হেমোডাইনামিক মূল্যায়নের জন্য সোয়ান-গ্যাঞ্জ ক্যাথেটার ব্যবহার করা হয়নি। অ্যানেস্থেশিয়া মনিটরিং সীমাবদ্ধ ছিল ECG, CVP মূল্যায়নসহ সেন্ট্রাল ক্যাথেটার, রেডিয়াল আর্টারিতে প্রবেশ করানো ক্যানুলা থেকে সরাসরি রক্তচাপ মাপা এবং কার্ডিয়াক আল্ট্রাসাউন্ডে। পেরিওপারেটিভ সময়ে CVP প্যারামিটার ব্যবহার করে ভলাটিলিটি মূল্যায়ন করা হয় এবং পোস্টঅপারেটিভ সময়ে VCI-এর শ্বাসপ্রশ্বাসগত পূরণ ও গতিশীলতা মূল্যায়নের সাথে কার্ডিয়াক আল্ট্রাসাউন্ড ব্যবহার করা হয়। থেরাপি স্ট্যান্ডার্ড ফ্লুইড থেরাপি, যাকে Goal Directed Therapy (GDT) বলা হয়, অনুসরণ করে পরিচালিত হয়। জেনারেল অ্যানেস্থেশিয়ার সময় ফেন্টানিল, ট্রায়াকিউরিয়াম, প্রোপোফল, ডেসফ্লুরেন, অ্যান্টিবায়োটিক থেরাপি এবং স্ট্যান্ডার্ড ইমিউনোসাপ্রেসিভ চিকিৎসা ব্যবহৃত হয়; পাশাপাশি নেফ্রোপ্রোটেক্টিভ চিকিৎসা হিসেবে ২৫ g ম্যানিটল ইনফিউশন এবং ফ্লুইড থেরাপি হিসেবে ০.৯% NaCl প্রদান করা হয়। পোস্টঅপারেটিভ ইমিউনোসাপ্রেশনের ধারাবাহিকতায় তিনি স্টেরয়েড, ট্যাক্রোলিমাস ও মাইকোফেনোলেট মোফেটিল গ্রহণ করেন, যা স্থায়ী লিউকোপেনিয়া ও সাইটোমেগালোভাইরাস সংক্রমণের কারণে বন্ধ করা হয়। এছাড়া বিলম্বিত গ্রাফট ফাংশন দেখা যায় এবং প্রায় ৬ সপ্তাহ হেমোডায়ালাইসিসের প্রয়োজন হয় (মূলত ফ্লুইড রিটেনশনের কারণে)। BNP স্তর বৃদ্ধি পেয়ে ২৯৯৬ pg/ml হয় এবং পরে ধীরে ধীরে কমে। ট্রান্সপ্লান্টেশনের ২ সপ্তাহ পর করা কিডনি বায়োপসিতে ATN সহ অ্যাকিউট রিজেকশন (AR II B Banff 2015) ধরা পড়ে। অবশেষে, ৬৭তম POD-এ রোগী হাসপাতাল থেকে ডিসচার্জ হন, তখন সিরাম ক্রিয়াটিনিন ছিল ১.৪ mg/dL এবং BNP স্তর ১৭৯৪ pg/ml। কিডনি প্রতিস্থাপনের এক মাস পর বাম ভেন্ট্রিকলের মাত্রা হ্রাস পায়, EF (৩০% পর্যন্ত বৃদ্ধি) ও GLS (−৬ এ হ্রাস) মূল্যায়নে সিস্টোলিক ফাংশনের উন্নতি দেখা যায়। এছাড়াও ট্রাইকাস্পিড রিগার্জিট্যান্ট ফ্লো গ্রেডিয়েন্ট কমে যায় এবং IVC-এর প্রস্থ ও শ্বাসপ্রশ্বাসগত গতিশীলতা স্বাভাবিক হয়, যা পালমোনারি হাইপারটেনশনের নিম্ন সম্ভাবনা নির্দেশ করে। ইকোকার্ডিওগ্রাফিক প্যারামিটারের এই উন্নতি একই সঙ্গে গ্রহীতার এক্সারসাইজ ক্যাপাসিটির উন্নতিও প্রতিফলিত করে, NYHA III/IV থেকে NYHA II-এ পরিবর্তিত হয়। ৫ মাসের পর্যবেক্ষণে BNP কমে ১০৬৬ pg/ml হওয়া এবং স্বাভাবিক কিডনি ফাংশনসহ হৃদ্‌ক্রিয়ার আরও উন্নতি লক্ষ্য করা যায়।\n",
+    "translated_summary": "আমরা একজন ৪৯ বছর বয়সী মহিলার একটি ঘটনা তুলে ধরছি, যিনি দীর্ঘমেয়াদী এসএলই-এর কারণে কিডনি এবং হৃদরোগে আক্রান্ত হয়েছিলেন এবং তার কিডনি প্রতিস্থাপনের জন্য প্রস্তুতি নেওয়া হচ্ছিল। এসএলই-এর সময়, হৃদপিণ্ড এবং কিডনির কার্যকারিতা ধীরে ধীরে হ্রাস পায়। রোগীর কিডনি প্রতিস্থাপন থেরাপি শুরু করা এবং ৪ বছর ধরে ডায়ালাইসিস করার প্রয়োজন ছিল। অস্ত্রোপচারের জন্য রোগীকে প্রস্তুত করার সময়, অত্যন্ত কম ইজেকশন ফ্র্যাকশনের কারণে, লেভোসিমেন্ডান দিয়ে কার্ডিওপ্রোটেক্টিভ চিকিৎসা শুরু করার সিদ্ধান্ত নেওয়া হয়। অস্ত্রোপচারের পরবর্তী সময়টি সহজ ছিল না, তবে সফল ছিল। মাসিক এবং পাঁচ মাস পর ফলো-আপে, হৃদপিণ্ডের কার্যকারিতার ক্রমাগত উন্নতি এবং স্বাভাবিক কিডনির কার্যকারিতা দেখা যায়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_172.txt",
+    "fulltext": "Patient information\nA 20-year-old male Arabic martial artist (weight 91.5 kg, height 180 cm, and body mas index (BMI) 28.24) presented with pain in the back of the left thigh for the past 5 weeks and underwent pharmacological and physiotherapeutic intervention; however, he did not responded well to symptomatic treatment. He reported that the symptoms first appeared during a short sprint while playing soccer and heard a pop in the back of his thigh. The pain was so bad that he withdrew from the game soon after his injury and noted no bruising on the back of his thigh or significant swelling in that area. However, he reported progressive loss of flexibility in the left knee and inability to flex and extend the knee joint while the knee remained flexed at a 15° angle, whether standing or having the leg in the air. He denied any previous history of lower back pain but could barely support the weight of the affected limb. There was no history of alcohol, smoking, diabetes, high blood pressure, or other serious genetic diseases.\n\nClinical findings and diagnostic assessment\nThe patient reported having received icing and elevation of the affected leg while lying down following the injury as therapeutic interventions. He had a crepe bandage applied to his affected thigh to support him while standing and walking. He used crutches for ambulation and to go for a little longer distance. To climb the stairs, he had to use one step at a time, relying on his right lower extremity. He also reported adopting a sitting position at the edge of the chair as direct pressure on the thigh from the chair caused him discomfort. He denied ever hurting his legs or back in sports. As a result, the patient withdrew from all activities, such as playing sports, owing to the pain, and his knee was mildly bent most of the time. Despite taking medication (nonsteroidal antiinflammatory drugs (NSAIDs)), the pain worsened over time. Since the patient did not respond well to cryotherapy, compression bandages, and medications, he decided to see a doctor for further diagnosis and treatment before meeting with us.\n\nOn further evaluation, he presented with limited knee extension and flexion and exhibited an analgesic gait with a reduced heel strike phase. Active range of motion (AROM) of the left knee was 10–15° compared with 0–130°degrees in the right knee. Palpation revealed tenderness and firmness in the middle third of the semimembranosus and semitendinosus muscles.\n\nManual muscle testing and isometrics could not be performed owing to persistent discomfort. The patient reported pain at rest, rated 5/10, and during activity it was rated 7/10. Further, clinical evaluation rule out lumbar disc involvement or gluteal and ischial tunnel syndrome [4, 6].\n\nThe best way to screen nerve tension for peripheral pain in the lower extremities is with a slump test [17]. However, the result of the slump test in this patient was negative.\n\nTherapeutic interventions\nDespite the patient’s current clinical presentation, which was suggestive of HSI, the authors decided to treat him with neural glide technique on the basis of the structural and functional proximity of nerve to the lower limb flexibility through a novel neurodynamic tension technique [18, 19]. The scientific rationale for this neural approach was detailed to the patient and consent was obtained.\n\nThe patient was directed to sit with arms folded behind his back and knees and ankles held in extension and dorsiflexion, respectively, while a therapist guided the patient to flex his thoracic and cervical spine and extend his knee joint to the maximum tolerable limit. Next, the patient was instructed to move his neck forward and backward as much as possible while also moving his ankle up and down 15 times to help with nerve glide.\n\nThis was done in three sets each day. The therapist then helped the patient bend their middle and upper back as much as possible until the patient felt pain in the knee area. Then, the process was repeated. By the 3rd day, the patient’s active knee extension improved from 5° to 10° and then to a 15° degree bent position. In addition, the standing posture also got better.\n\nSubsequently, the patient was instructed in executing a set of posture re-education workouts, which involved doing active chin flexion, engaging in passive stretching of the cervical extensors while lying down in prone, and building up the shoulder retractors, arm from positions T to Y, then from Y to W with the limb’s weight while lying down.\n\nTo address the kyphotic posture, active chest stretches were taught at wall corners. The patient was instructed to increase the duration of the exercises from 5 to 10 seconds, doing 10 reps and 3 sets daily.\n\nOutcomes and follow-up\nThe results were assessed using a numeric pain rating scale (NPRS) and Knee Society score (KSS). Substantial enhancement in clinical outcome measures such as pain and function were achieved within 3 successive days of therapy. The use of pain medication was discontinued.\n\nThe patient continued his self-neural glides and postural reduction exercises at home and was advised for a follow-up after 4 weeks or to contact us if symptoms worsened. On the 3rd follow-up day, the patient’s NPRS from 5 at rest and 7 with activity to 2 at rest and 4 with activity. The KSS increased from 22 to 61 and from 30 to 80 in the functional domain. At the end of the 2-week home program, the patient reported to have full active straight leg raise (SLR). The patient had fully recovered from his knee dysfunction and pain at the 2-month follow-up.",
+    "summary": "A 20-year-old male Arabic martial artist had a history of left hamstring strain for the past 5 weeks. He had undergone pharmacological and physiotherapeutic interventions for his clinical conditions but had not responded favorably. Further clinical assessment had ruled out hamstring syndrome. The patient refrained from all sports activities.\n\nIntervention: The patient was treated using a modified slump mobilization technique with four repetitions for 3 consecutive days, together with postural retraining. Results of the numeric pain rating scale and Knee Society score before and after the interventions were obtained.\n\nResults and discussion: Pre-intervention score of the numeric pain rating scale was 5/10 and 7/10 at rest and with activity, respectively. Assessment on the 3rd consecutive day of intervention, the numeric pain rating scale decreased to 2/10 and 4/10 at rest and with activity, respectively. Similarly, the pre- and post-intervention Knee Society score improved from 22 to 61 in pain and from 30 to 80 in function. At the 2-month follow-up, the patient reported a complete recovery from symptoms and resumed his sports activities without any disruption.",
+    "translated_fulltext": "রোগীর তথ্য\n২০ বছর বয়সী একজন পুরুষ আরব মার্শাল আর্টিস্ট (ওজন ৯১.৫ কেজি, উচ্চতা ১৮০ সেমি, এবং বডি মাস ইনডেক্স (BMI) ২৮.২৪) গত ৫ সপ্তাহ ধরে বাম উরুর পশ্চাৎভাগে ব্যথা নিয়ে উপস্থিত হন এবং ফার্মাকোলজিক্যাল ও ফিজিওথেরাপিউটিক হস্তক্ষেপ গ্রহণ করেন; তবে তিনি উপসর্গভিত্তিক চিকিৎসায় ভালো সাড়া দেননি। তিনি জানান, ফুটবল খেলার সময় একটি স্বল্প দূরত্বের স্প্রিন্টের সময় প্রথম উপসর্গ দেখা দেয় এবং উরুর পেছনে একটি “পপ” শব্দ শোনা যায়। ব্যথা এতটাই তীব্র ছিল যে আঘাতের পরপরই তিনি খেলা থেকে সরে যান এবং উরুর পেছনে কোনো কালশিটে দাগ বা উল্লেখযোগ্য ফোলা লক্ষ্য করেননি। তবে তিনি বাম হাঁটুর নমনীয়তা ক্রমাগত কমে যাওয়া এবং হাঁটুর জয়েন্ট ভাঁজ ও সোজা করতে অক্ষমতার কথা জানান, যেখানে হাঁটু দাঁড়ানো অবস্থায় বা পা বাতাসে থাকাকালীন ১৫° কোণে ভাঁজ অবস্থায় থাকত। তিনি পূর্বে নিম্ন পিঠে ব্যথার কোনো ইতিহাস অস্বীকার করেন, তবে আক্রান্ত অঙ্গের ওজন বহন করা তাঁর জন্য প্রায় অসম্ভব ছিল। অ্যালকোহল গ্রহণ, ধূমপান, ডায়াবেটিস, উচ্চ রক্তচাপ, বা অন্যান্য গুরুতর জেনেটিক রোগের কোনো ইতিহাস ছিল না।\n\nক্লিনিক্যাল ফাইন্ডিংস এবং ডায়াগনস্টিক মূল্যায়ন\nরোগী জানান যে আঘাতের পর শুয়ে থাকা অবস্থায় চিকিৎসামূলক হস্তক্ষেপ হিসেবে আক্রান্ত পায়ে বরফ প্রয়োগ ও উঁচু করে রাখা হয়েছিল। দাঁড়ানো ও হাঁটার সময় সহায়তার জন্য আক্রান্ত উরুতে একটি ক্রেপ ব্যান্ডেজ লাগানো হয়েছিল। চলাচলের জন্য এবং কিছুটা দীর্ঘ দূরত্ব অতিক্রম করতে তিনি ক্রাচ ব্যবহার করতেন। সিঁড়ি ভাঙার সময়, তাঁকে এক ধাপ করে উঠতে হতো এবং ডান নিম্ন অঙ্গের ওপর নির্ভর করতে হতো। তিনি আরও জানান যে চেয়ারে বসার সময় চেয়ারের কিনারায় বসতে হতো, কারণ চেয়ার থেকে উরুর ওপর সরাসরি চাপ পড়লে অস্বস্তি হতো। খেলাধুলার সময় কখনো পা বা পিঠে আঘাত পাওয়ার ইতিহাস তিনি অস্বীকার করেন। ফলে ব্যথার কারণে রোগী সব ধরনের কার্যকলাপ, যেমন খেলাধুলা, থেকে বিরত থাকেন এবং তাঁর হাঁটু অধিকাংশ সময় সামান্য ভাঁজ অবস্থায় থাকত। ওষুধ গ্রহণ (ননস্টেরয়েডাল অ্যান্টি-ইনফ্ল্যামেটরি ড্রাগস (NSAIDs)) সত্ত্বেও সময়ের সাথে সাথে ব্যথা বেড়ে যায়। যেহেতু রোগী ক্রায়োথেরাপি, কম্প্রেশন ব্যান্ডেজ এবং ওষুধে ভালো সাড়া পাননি, তাই আমাদের সাথে সাক্ষাতের আগে আরও নির্ণয় ও চিকিৎসার জন্য তিনি একজন ডাক্তারের শরণাপন্ন হওয়ার সিদ্ধান্ত নেন।\n\nপরবর্তী মূল্যায়নে দেখা যায় যে তাঁর হাঁটু সোজা করা ও ভাঁজ করার ক্ষমতা সীমিত ছিল এবং হিল স্ট্রাইক ফেজ কমে যাওয়াসহ একটি অ্যানালজেসিক গেইট প্রদর্শিত হচ্ছিল। বাম হাঁটুর অ্যাকটিভ রেঞ্জ অব মোশন (AROM) ছিল ১০–১৫°, যেখানে ডান হাঁটুর ক্ষেত্রে ছিল ০–১৩০° ডিগ্রি। প্যালপেশনে সেমিমেমব্রানোসাস এবং সেমিটেন্ডিনোসাস মাংসপেশির মধ্য তৃতীয়াংশে স্পর্শকাতরতা ও দৃঢ়তা পাওয়া যায়।\n\nস্থায়ী অস্বস্তির কারণে ম্যানুয়াল মাসল টেস্টিং এবং আইসোমেট্রিক্স করা যায়নি। রোগী বিশ্রাম অবস্থায় ব্যথার মাত্রা ৫/১০ এবং কার্যকলাপের সময় ৭/১০ হিসেবে জানান। এছাড়া, ক্লিনিক্যাল মূল্যায়নের মাধ্যমে লাম্বার ডিস্ক জড়িত থাকা বা গ্লুটিয়াল ও ইশিয়াল টানেল সিনড্রোম বাতিল করা হয় [4, 6]।\n\nনিম্ন অঙ্গপ্রত্যঙ্গে পারিফেরাল ব্যথার ক্ষেত্রে নার্ভ টেনশন স্ক্রিন করার সর্বোত্তম উপায় হলো স্লাম্প টেস্ট [17]। তবে এই রোগীর ক্ষেত্রে স্লাম্প টেস্টের ফলাফল নেতিবাচক ছিল।\n\nথেরাপিউটিক হস্তক্ষেপ\nরোগীর বর্তমান ক্লিনিক্যাল উপস্থাপনা HSI-এর ইঙ্গিতপূর্ণ হওয়া সত্ত্বেও, লেখকরা নিম্ন অঙ্গের নমনীয়তার সাথে স্নায়ুর গঠনগত ও কার্যকর নিকটতার ভিত্তিতে একটি নতুন নিউরোডাইনামিক টেনশন টেকনিক ব্যবহার করে নিউরাল গ্লাইড টেকনিক দিয়ে তাঁকে চিকিৎসা করার সিদ্ধান্ত নেন [18, 19]। এই নিউরাল পদ্ধতির বৈজ্ঞানিক যুক্তি রোগীকে বিস্তারিতভাবে জানানো হয় এবং তাঁর সম্মতি নেওয়া হয়।\n\nরোগীকে হাত পেছনে ভাঁজ করে বসতে বলা হয় এবং হাঁটু ও গোড়ালি যথাক্রমে এক্সটেনশন ও ডরসিফ্লেক্সন অবস্থায় রাখতে বলা হয়, এ সময় থেরাপিস্ট রোগীকে থোরাসিক ও সার্ভাইকাল স্পাইন ফ্লেক্স করতে এবং হাঁটুর জয়েন্ট সর্বোচ্চ সহনীয় সীমা পর্যন্ত সোজা করতে নির্দেশনা দেন। পরবর্তীতে, নার্ভ গ্লাইডে সহায়তার জন্য রোগীকে ঘাড় সামনে ও পেছনে যতটা সম্ভব নাড়াতে এবং একই সময়ে গোড়ালি উপরে ও নিচে ১৫ বার নাড়াতে বলা হয়।\n\nএই প্রক্রিয়া প্রতিদিন তিন সেট করে করা হয়। এরপর থেরাপিস্ট রোগীকে মধ্য ও উপরের পিঠ যতটা সম্ভব ভাঁজ করতে সহায়তা করেন যতক্ষণ না রোগী হাঁটুর অঞ্চলে ব্যথা অনুভব করেন। তারপর প্রক্রিয়াটি পুনরাবৃত্তি করা হয়। তৃতীয় দিনে রোগীর অ্যাকটিভ হাঁটু এক্সটেনশন ৫° থেকে ১০° এবং পরে ১৫° ডিগ্রি ভাঁজ অবস্থায় উন্নত হয়। এছাড়াও, দাঁড়ানো ভঙ্গিমারও উন্নতি হয়।\n\nপরবর্তীতে, রোগীকে পোস্টার রি-এডুকেশন ওয়ার্কআউটের একটি সেট শেখানো হয়, যার মধ্যে ছিল অ্যাকটিভ চিন ফ্লেক্সন করা, প্রোন অবস্থায় শুয়ে সার্ভাইকাল এক্সটেনসরগুলোর প্যাসিভ স্ট্রেচিং করা, এবং শোল্ডার রিট্র্যাক্টরগুলোকে শক্তিশালী করা—বাহুকে T থেকে Y এবং তারপর Y থেকে W অবস্থানে নিয়ে, অঙ্গের নিজের ওজন ব্যবহার করে শুয়ে থাকা অবস্থায়।\n\nকাইফোটিক ভঙ্গি সমাধানের জন্য দেয়ালের কোণায় অ্যাকটিভ চেস্ট স্ট্রেচ শেখানো হয়। রোগীকে প্রতিটি ব্যায়ামের সময়কাল ৫ থেকে ১০ সেকেন্ডে বাড়াতে, ১০ রিপিটিশন এবং দৈনিক ৩ সেট করতে নির্দেশ দেওয়া হয়।\n\nফলাফল এবং ফলো-আপ\nফলাফল মূল্যায়ন করা হয় নিউমেরিক পেইন রেটিং স্কেল (NPRS) এবং Knee Society Score (KSS) ব্যবহার করে। থেরাপির ধারাবাহিক ৩ দিনের মধ্যে ব্যথা ও কার্যকারিতার মতো ক্লিনিক্যাল আউটকাম মেজারগুলোতে উল্লেখযোগ্য উন্নতি অর্জিত হয়। ব্যথানাশক ওষুধের ব্যবহার বন্ধ করা হয়।\n\nরোগী বাড়িতে নিজের নিউরাল গ্লাইড এবং পোস্টারাল রিডাকশন এক্সারসাইজ চালিয়ে যান এবং ৪ সপ্তাহ পর ফলো-আপের জন্য অথবা উপসর্গ বেড়ে গেলে আমাদের সাথে যোগাযোগ করতে পরামর্শ দেওয়া হয়। তৃতীয় ফলো-আপ দিনে রোগীর NPRS বিশ্রামে ৫ এবং কার্যকলাপে ৭ থেকে কমে বিশ্রামে ২ এবং কার্যকলাপে ৪ হয়। KSS কার্যকরী ডোমেইনে ২২ থেকে ৬১ এবং ৩০ থেকে ৮০-তে উন্নীত হয়। ২ সপ্তাহের হোম প্রোগ্রামের শেষে রোগী পূর্ণ অ্যাকটিভ স্ট্রেইট লেগ রেইজ (SLR) অর্জনের কথা জানান। ২-মাসের ফলো-আপে রোগী তাঁর হাঁটুর কার্যহানি ও ব্যথা থেকে সম্পূর্ণ সুস্থ হয়ে ওঠেন।\n",
+    "translated_summary": "একজন ২০ বছর বয়সী পুরুষ অ্যারাবিক মার্শাল আর্টিস্টের গত ৫ সপ্তাহ ধরে বাম হ্যামস্ট্রিংয়ে টান লাগার সমস্যা ছিল। তিনি তার শারীরিক অবস্থার জন্য ওষুধ এবং ফিজিওথেরাপি গ্রহণ করেছিলেন, কিন্তু তাতে তেমন কোনো উন্নতি হয়নি। আরও পরীক্ষা করে দেখা গেছে যে তার হ্যামস্ট্রিং সিনড্রোম নেই। রোগী সমস্ত খেলাধুলা থেকে নিজেকে দূরে রেখেছিলেন।\n\nচিকিৎসা পদ্ধতি: রোগীকে একটি পরিবর্তিত স্লাмп মোবিলিাইজেশন কৌশল ব্যবহার করে চিকিৎসা করা হয়, যেখানে পরপর ৩ দিন ধরে ৪ বার করে এই পদ্ধতি প্রয়োগ করা হয়, এবং এর সাথে সঠিক অঙ্গবিন্যাস সম্পর্কে প্রশিক্ষণ দেওয়া হয়। চিকিৎসার আগে এবং পরে নিউমেরিক পেইন রেটিং স্কেল এবং নী সোসাইটি স্কোর পরিমাপ করা হয়।\n\nফলাফল এবং আলোচনা: চিকিৎসার আগে নিউমেরিক পেইন রেটিং স্কেলে তার স্কোর ছিল ৫/১০ (বিশ্রামে) এবং ৭/১০ (শারীরিক কার্যকলাপের সময়)। তৃতীয় দিনে, নিউমেরিক পেইন রেটিং স্কেলে স্কোর কমে ২/১০ (বিশ্রামে) এবং ৪/১০ (শারীরিক কার্যকলাপের সময়) হয়। একইভাবে, চিকিৎসার আগে এবং পরে নী সোসাইটি স্কোর ব্যথার ক্ষেত্রে ২২ থেকে ৬১ এবং কার্যকারিতার ক্ষেত্রে ৩০ থেকে ৮০-তে উন্নীত হয়। ২ মাস পর ফলো-আপে, রোগী জানান যে তার উপসর্গগুলো সম্পূর্ণভাবে সেরে গেছে এবং তিনি কোনো বাধা ছাড়াই খেলাধুলা শুরু করেছেন।"
+  },
+  {
+    "id": "multiclinsum_gs_en_313.txt",
+    "fulltext": "A male was born via an emergency cesarean section due to fetal distress at 40 weeks of gestational age. The mother's age was 33 years, with gravida 1 and para 1 parity. Both the parents and brother had no family history of congenital anomalies, aortic-related diseases, or sudden death. Based on the results of the prenatal ultrasonography at the end of the second trimester, the femur length of the fetus was found to be 1 to 3 weeks longer than the supposed length of the actual gestational age. Fetal echocardiography showed cardiomegaly with a fetal cardiothoracic circumference ratio of 0.5 or higher based on the baby's term. Moreover, the size of the foramen ovale was larger than normal, and left aortic constriction was seen next to the subclavian artery basin. Furthermore, no other abnormalities were found on prenatal ultrasound.\n\nAt birth, the weight was 3560 g (75 percentile), the length was 56.5 cm (over 90 percentile), and the head circumference was 36 cm (over 90 percentile). Apgar scores at 1 and 5 minutes were 4 and 6 points, respectively. In the delivery room, the patient had no spontaneous breathing and had bradycardia and cyanosis. After being admitted to the neonatal intensive care unit, various musculoskeletal malformations were confirmed via physical examination. Severe arachnodactyly and camptodactyly were observed in both hands and feet, and the soles of the feet were flat. The elbow and knee joints were not fully extended. The face had malar hypoplasia with senile facial appearance. The eye was deeply settled with a down-slanting palpebral fissure, and the ear with hypoplastic cartilage was poorly settled and crumpled. The patient presented with a sagging mouth, prominent coronal suture, and brachycephaly. A grade V/VI systolic murmur was heard at both the upper sternal border and left lower sternal border with grade III parasternal heave. Echocardiography showed poor cardiac contractility, severe pulmonary hypertension, dilated aortic sinus (20.2 mm) (Z-score; 8.08 by Boston, 6.37 by Detroit, or 5.97 by Halifax), and multiple intracardiac valvular dysfunction with valve prolapses (moderate aortic regurgitation, severe mitral regurgitation, moderate tricuspid regurgitation, and moderate pulmonary valve regurgitation). And the ophthalmologic examination results showed ectopia lentis in both eyes as well as lens subluxation. Liver herniation was confirmed using abdominal X-ray and ultrasound. The systemic score of the musculoskeletal manifestation was 11 points, according to the Ghent criteria (international diagnostic criteria for MFS).\n\nFor genetic diagnosis, Sanger sequencing and polymerase chain reaction were performed on the nucleotide sequence as reference for the FBN1 gene. As a result, a mutation in which G, the first base of the 32nd intron in the form of a heterogeneous mutation, was substituted with T (c.3964 + 1G > T). This was confirmed as the likely pathogen variant based on the 2015 ACMG/AMP guideline. The location of the mutation was included in the site previously known as the neonatal region of MFS (exons 24–32). The patient could be diagnosed with neonatal MFS with a novel FBN1 gene mutation within 2 weeks of life.\n\nOn the first day of life, differential cyanosis was found to show refractory hypoxemia despite more than 60% oxygen supply and signs of low cardiac output. The patient was managed medically for improving the low cardiac output according to severe mitral regurgitation and aortic regurgitation. Afterload reduction including milrinone continuous infusion, full sedation using fentanyl continuous infusion, and use of diuretic were attempt to improve the oliguria and heart failure. Despite the medical management, the patient presented with respiratory failure, heart failure, and severe pulmonary hypertension requiring continuous invasive mechanical ventilation. Aortic regurgitation, mitral regurgitation, pulmonary hypertension, and cardiac contractility got worse. After several consultations with the patient's family and medical staff about the treatment plan, palliative care was continued instead of surgical treatment. As a result, hepatic and pulmonary congestion accompanied by pulmonary hemorrhage had progressed as well. Eventually, it had progressed to multiple organ dysfunction syndrome, and the patient died 32 days after the birth.",
+    "summary": "Patient concerns:\nA newborn with neonatal MFS and severe cardiac involvement. He presented various severe clinical features such as arachnodactyly, camptodactyly, elbow and knee joint contracture, senile facial appearance, and deep settling with down-slanting palpebral fissure, hypoplastic ear cartilage, sagging mouth, brachycephaly, and ectopia lentis.\n\nDiagnosis:\nGenetic analysis revealed a novel mutation at nucleotide 3964 (c.3964 + 1 G > T) in intron 32 of the fibrillin-1 gene. This mutation is identified to be in the so-called neonatal region of fibrillin-1 exon 24 to 32, as reported previously.\n\nInterventions:\nThe patient was managed medically for improving the low cardiac output according to severe mitral regurgitation and aortic regurgitation. Afterload reduction, full sedation, and use of diuretic were attempted to improve the oliguria and heart failure.\n\nOutcomes:\nDespite the medical management, aortic regurgitation, mitral regurgitation, pulmonary hypertension, and cardiac contractility got worse. Surgical treatment is essential to prolong the patient's life, however, considerations for the grave progression of the disease make families decide to continue palliative care instead of surgical treatment. A few months after birth, he presented with rapidly progressive aortic regurgitation, mitral regurgitation, and congestive heart failure leading to death.",
+    "translated_fulltext": "গর্ভধারণের ৪০ সপ্তাহে ভ্রূণের কষ্টের কারণে জরুরি সিজারিয়ান সেকশনের মাধ্যমে একটি ছেলে শিশুর জন্ম হয়। মায়ের বয়স ছিল ৩৩ বছর, এবং এটি ছিল তার প্রথম গর্ভধারণ ও প্রথম সন্তান। বাবা, মা এবং ভাইয়ের কারো মধ্যেই জন্মগত ত্রুটি, মহাধমনী-সম্পর্কিত রোগ বা আকস্মিক মৃত্যুর পারিবারিক ইতিহাস ছিল না। গর্ভাবস্থার দ্বিতীয় ত্রৈমাসিকের শেষে করা প্রসবপূর্ব আল্ট্রাসাউন্ডের ফলাফলের ভিত্তিতে দেখা যায়, ভ্রূণের ফিমারের দৈর্ঘ্য প্রত্যাশিত দৈর্ঘ্যের চেয়ে ১ থেকে ৩ সপ্তাহ বেশি ছিল। ভ্রূণের ইকোকার্ডিওগ্রাফিতে কার্ডিওমেগালি দেখা যায়, যেখানে ভ্রূণের কার্ডিওথোরাসিক পরিধির অনুপাত ছিল ০.৫ বা তার বেশি। এছাড়াও, ফোরামেন ওভালের আকার স্বাভাবিকের চেয়ে বড় ছিল এবং সাবক্লেভিয়ান ধমনীর কাছাকাছি বাম মহাধমনীতে সংকীর্ণতা দেখা যায়। প্রসবপূর্ব আল্ট্রাসাউন্ডে অন্য কোনো অস্বাভাবিকতা পাওয়া যায়নি।\n\nজন্মের সময় শিশুর ওজন ছিল ৩৫৬০ গ্রাম (৭৫তম পার্সেন্টাইল), দৈর্ঘ্য ছিল ৫৬.৫ সেমি (৯০তম পার্সেন্টাইলের বেশি), এবং মাথার পরিধি ছিল ৩৬ সেমি (৯০তম পার্সেন্টাইলের বেশি)। ১ এবং ৫ মিনিটে অ্যাপগার স্কোর ছিল যথাক্রমে ৪ এবং ৬। প্রসব কক্ষে, শিশুটি স্বতঃস্ফূর্তভাবে শ্বাস নিতে পারেনি এবং তার হৃদস্পন্দন কমে গিয়েছিল ও শরীরে সায়ানোসিস দেখা দেয়। নিওনেটাল ইনটেনসিভ কেয়ার ইউনিটে ভর্তির পর শারীরিক পরীক্ষার মাধ্যমে বিভিন্ন ধরনের মাস্কুলোস্কেলিটাল ত্রুটি নিশ্চিত করা হয়। উভয় হাত ও পায়ে গুরুতর অ্যারাকনোড্যাকটিলি এবং ক্যাম্পটোড্যাকটিলি দেখা যায়, এবং পায়ের পাতাগুলো চ্যাপ্টা ছিল। কনুই এবং হাঁটুর জয়েন্টগুলো সম্পূর্ণরূপে প্রসারিত ছিল না। মুখের ম্যালার হাইপোপ্লাসিয়া ছিল এবং চেহারায় বার্ধক্যের ছাপ দেখা যায়। চোখটি গভীরভাবে বসে ছিল এবং চোখের পাতা সামান্য নিচের দিকে ছিল, কানের কার্টিলেজ কম বিকশিত ছিল এবং কুঁচকে গিয়েছিল। শিশুটির মুখ ঝুলে ছিল, করোনার সিউচারটি স্পষ্ট ছিল এবং ব্রাকিসেফালি দেখা যায়। উভয় দিকের ঊর্ধ্ব স্টার্নাল বর্ডার এবং বাম দিকের নিম্ন স্টার্নাল বর্ডারে গ্রেড V/VI সিস্টোলিক মারমার শোনা যায়, সেই সাথে গ্রেড III প্যারাস্টার্নাল হিভও ছিল। ইকোকার্ডিওগ্রাফিতে দুর্বল কার্ডিয়াক সংকোচনশীলতা, গুরুতর পালমোনারি হাইপারটেনশন, প্রসারিত মহাধমনী সাইনাস (২০.২ মিমি) (বোস্টন অনুযায়ী জেড-স্কোর: ৮.০৮, ডেট্রয়েট অনুযায়ী ৬.৩৭, অথবা হ্যালিফ্যাক্স অনুযায়ী ৫.৯৭) এবং একাধিক ইন্ট্রাকার্ডিয়াক ভাল্ভের কর্মহীনতা দেখা যায় (যেমন - মাঝারি অ্যাওর্টিক রিগারজিটেশন, গুরুতর মাইট্রাল রিগারজিটেশন, মাঝারি ট্রিকাস্পিড রিগারজিটেশন এবং মাঝারি পালমোনারি ভাল্ভ রিগারজিটেশন)। চক্ষু পরীক্ষার ফলাফলে উভয় চোখে একটোপিয়া লেন্টিস এবং লেন্স সাবলাক্সেশন দেখা যায়। পেটের এক্স-রে এবং আল্ট্রাসাউন্ডের মাধ্যমে লিভারের হার্নিয়া নিশ্চিত করা হয়। মাস্কুলোস্কেলিটাল সমস্যার তীব্রতা অনুযায়ী জেন্ট ক্রাইটেরিয়া অনুসারে সিস্টেমিক স্কোর ছিল ১১।\n\nজেনেটিক রোগ নির্ণয়ের জন্য, এফবিএন১ জিনের রেফারেন্স হিসেবে নিউক্লিওটাইড সিকোয়েন্সে স্যাংগার সিকোয়েন্সিং এবং পলিমারেজ চেইন রিঅ্যাকশন করা হয়। এর ফলে, একটি মিউটেশন শনাক্ত হয়, যেখানে ৩০তম ইন্ট্রনের প্রথম বেস জি, একটি হেটেরোজেনাস মিউটেশনের আকারে টি দ্বারা প্রতিস্থাপিত হয়েছে (c.3964 + 1G > T)। ২০২০ সালের এসিএমজি/এএমপি নির্দেশিকা অনুসারে, এটি সম্ভবত রোগ সৃষ্টিকারী ভ্যারিয়েন্ট হিসেবে নিশ্চিত করা হয়। মিউটেশনটির অবস্থান পূর্বে পরিচিত ছিল এবং এটি এমএফএস-এর নিওনেটাল অঞ্চলের (এক্সন ২৪-৩২) অন্তর্ভুক্ত ছিল। জন্মের ২ সপ্তাহের মধ্যে, নতুন এফবিএন১ জিন মিউটেশনসহ শিশুটিকে নিওনেটাল এমএফএস হিসেবে নির্ণয় করা হয়।\n\nজন্মের প্রথম দিনেই, দেখা যায় যে শিশুটি ৬০% এর বেশি অক্সিজেন সরবরাহ করা সত্ত্বেও এবং কম কার্ডিয়াক আউটপুটের লক্ষণ থাকা সত্ত্বেও প্রতিকারহীন হাইপোক্সেমিয়া দেখাচ্ছে। গুরুতর মাইট্রাল রিগারজিটেশন এবং অ্যাওর্টিক রিগারজিটেশনের কারণে কম কার্ডিয়াক আউটপুট উন্নত করার জন্য রোগীকে ওষুধ দিয়ে চিকিৎসা করা হয়। অলিগুরিয়া এবং হার্ট ফেইলিউর উন্নত করার জন্য মিলরিনোন ইনফিউশন, ফেন্টানিল ইনফিউশন দিয়ে সম্পূর্ণ সিডেশন এবং মূত্রবর্ধক ওষুধ ব্যবহার করা হয়। চিকিৎসার পরেও, শিশুটি শ্বাসকষ্ট, হার্ট ফেইলিউর এবং গুরুতর পালমোনারি হাইপারটেনশনে ভুগতে থাকে, যার কারণে ক্রমাগত ইনভেসিভ মেকানিক্যাল ভেন্টিলেশনের প্রয়োজন হয়। অ্যাওর্টিক রিগারজিটেশন, মাইট্রাল রিগারজিটেশন, পালমোনারি হাইপারটেনশন এবং কার্ডিয়াক সংকোচনশীলতা আরও খারাপ হতে থাকে। রোগীর পরিবারের সদস্য এবং চিকিৎসা কর্মীদের সাথে আলোচনার পর, অস্ত্রোপচারের পরিবর্তে উপশমমূলক চিকিৎসা চালিয়ে যাওয়া হয়। এর ফলস্বরূপ, পালমোনারি হেমোরেজের সাথে সাথে লিভার এবং ফুসফুসে রক্ত জমা হতে শুরু করে এবং তা আরও বাড়তে থাকে। অবশেষে, এটি মাল্টিপল অর্গান ডিসফাংশন সিনড্রোমে পরিণত হয় এবং জন্মের ৩২ দিন পর শিশুটি মারা যায়।",
+    "translated_summary": "রোগীর সমস্যা:\nনবজাতকের মধ্যে নবজাতকীয় এমএফএস (MFS) এবং গুরুতর হৃদরোগের লক্ষণ দেখা যায়। তার মধ্যে বিভিন্ন গুরুতর ক্লিনিক্যাল বৈশিষ্ট্য ছিল, যেমন – অ্যারাকনোড্যাকটিলি, ক্যাম্পটোড্যাকটিলি, কনুই এবং হাঁটুর জয়েন্টে সংকোচন, বার্ধক্যজনিত মুখের বৈশিষ্ট্য, চোখের পাতা সামান্য নিচের দিকে বাঁকানো, কানের তরুণাস্থির স্বল্প বিকাশ, মুখের মাংস পেশী দুর্বল হয়ে যাওয়া, ব্রাকিসেফালি এবং একটোপিয়া লেন্টিস।\n\nরোগ নির্ণয়:\nজিনগত বিশ্লেষণে দেখা যায় ফাইব্রিলাইন-১ জিনের ইন্ট্রন ৩২-এর ৩৯৬৪ নম্বর নিউক্লিওটাইডে একটি নতুন মিউটেশন হয়েছে (c.3964 + 1 G > T)। এই মিউটেশনটি ফাইব্রিলাইন-১-এর ২৩ থেকে ৩২ নম্বর এক্সনের cosiddetto নবজাতকীয় অঞ্চলে অবস্থিত, যা আগে রিপোর্ট করা হয়েছিল।\n\nচিকিৎসা:\nরোগীর গুরুতর মাইট্রাল রিগারজিটেশন এবং অ্যাওর্টিক রিগারজিটের কারণে কম কার্ডিয়াক আউটপুট উন্নত করার জন্য ওষুধ দিয়ে চিকিৎসা করা হয়। অলিগুরিয়া এবং হৃদরোগের উন্নতি ঘটানোর জন্য আফটারলোড কমানো, সম্পূর্ণভাবে অচেতন করা এবং মূত্রবর্ধক ওষুধ ব্যবহার করা হয়।\n\nফলাফল:\nওষুধের মাধ্যমে চিকিৎসা করা সত্ত্বেও, অ্যাওর্টিক রিগারজিটেশন, মাইট্রাল রিগারজিটেশন, পালমোনারি হাইপারটেনশন এবং হৃদপিণ্ডের সংকোচন ক্ষমতা আরও খারাপ হয়ে যায়। রোগীর জীবন দীর্ঘায়িত করার জন্য অস্ত্রোপচার অপরিহার্য, তবে রোগের মারাত্মক অগ্রগতির কারণে পরিবারগুলো অস্ত্রোপচারের পরিবর্তে উপশমমূলক চিকিৎসা চালিয়ে যেতে সিদ্ধান্ত নেয়। জন্মের কয়েক মাস পর, তার দ্রুত অবনতি হতে থাকে এবং অ্যাওর্টিক রিগারজিটেশন, মাইট্রাল রিগারজিটেশন এবং কনজেস্টিভ হার্ট ফেইলিউর দেখা দেয়, যার ফলে তার মৃত্যু হয়।"
+  },
+  {
+    "id": "multiclinsum_gs_en_86.txt",
+    "fulltext": "A 27-year-old woman with beta-thalassemia major since 24 years and 16 weeks of pregnancy was referred from the Internal Medicine Department to the Oral Medicine Department with complaints of swelling, bleeding gums since early pregnancy, and bad breath. The patient was hospitalized with complaints of pain in her knee so he could not move. She was admitted to hospital with complaints of pain in her knees so she could not move and was diagnosed with Arthritis ar Genue Sinistra related to Thalassemia by an internal medicine specialist, sub division of rheumatology. General condition patient was weak, sick, and difficult to move during the approximately two weeks, when she was hospitalized. Patient has never visited a dentist, either before or now, with complaints about her oral cavity. The patient had a splenectomy in 2009. Her beta-thalassemia major was treated with routine blood transfusions once a month and iron anti- chelation drugs (deferoxamine); however, it was stopped due to pregnancy. There was no history of other systemic disease in this patient. A family history of the same disease was ruled out. History of recurrent stomatitis and drug or food allergies was ruled out.\n\nThe patient’s general condition weak, with normal vital signs; however, the patient had fever. Intraoral examination revealed gingival hyperplasia; erythema; soft consistency; a dark red, rounded gingival margin; tendencies to bleed on the labial, buccal, palatal, and lingual areas; and pain. Oral hygiene index-simplified (OHIS) score was poor (5.7) and there were true pockets in all regions. Peripheral blood morphology result: (1) erythrocytes: polychromacy in anisochrome populations (hypochrome, normochrome), anisopoikilocytosis (ovalocytes, target); (2) leukocytes: sufficient quantity, hypersegmentation (+); (3) platelet count: numbers increase, spread out; Interpretation: moderate anemia et causa thalassemia major accompanied by signs of increased erythropoiesis activity with suspected infection. The diagnosis was made based on the history, clinical features, and examination, as well as additional examinations, namely gingival enlargement accompanied by chronic periodontitis associated to pregnancy with β-thalassemia major and exfoliative cheilitis of the lips. The classification of periodontal disease in this patient is chronic periodontitis with gingival enlargement associated with pregnancy and beta-thalassemia major. The prognosis in this case was good because the patient was cooperative and followed the directions of the Oral Medicine Department. In this case, multidisciplinary therapy was a collaboration between an oral medicine specialist, a periodontist, and an internist. Dental therapy consisted of spooling with 3% hydrogen peroxide (H2O2) solution, chlorine dioxide spray mouthwash (Oxyfresh®, USA), antibiotics (amoxicillin 500 mg tablet, and metronidazole 300 mg tablet), and scaling/root planning. Spooling of H2O2 3% solution was performed at every visit; chlorine dioxide spray mouthwash was used three times a day after meals, and antibiotics were administered for seven days at third visit. Scaling and root planning were performed by the periodontist after the general condition was controlled and after the gingival hyperplasia and spontaneous bleeding improved. Blood transfusions to remove packed red cell buffy coat (PRC BCR) are also carried out routinely once a month. Non-pharmacological therapy, including oral hygiene instructions, was still given to patients. Oral complaints in this case occurred due to the poor oral hygiene, β-thalassemia major, and pregnancy, were also informed to the patient as education.\n\nThis patient had eight follow-up visits, consisting of two inpatient and six outpatient visits, with the following details:\n\nFirst Visit\nThe first visit was carried out one day after the initial inpatient visit (day +1). Intraoral bleeding still exists in the lingual-anterior part of the mandible, but bleeding in the anterior part of the maxilla has stopped. The patient still had a fever. Medications previously provided were used accordingly. Pharmacological were continued, including spooling 3% H2O2 on all parts of the gingiva, using chlorine dioxide as a mouthwash, and applying a thin layer of petroleum jelly to the lips. A blood transfusion was carried out last night. Oral hygiene instructions are still given to patients.\n\nSecond Visit\nThe second visit was performed two days after the initial visit (day +2). Intraoral bleeding Follow-up visits should be conducted in outpatient settings. Pharmacological therapy including spooling 3% H2O2 on all parts of the gingiva, using chlorine dioxide as a mouthwash, and applying a thin layer of petroleum jelly to the lips. A blood transfusion was carried out last night. Oral hygiene instructions are still given to patients.\n\nThird Visit\nNine days after the initial visit (Day+9). First outpatient treatment. Oral symptoms appeared to improve; bad breath was greatly reduced, but the gums were still swollen. The chlorine dioxide spray mouthwash was still being used and had run out. The patient could brush her teeth with a soft toothbrush but still experienced bleeding. Spooling was performed with 3% H2O2. The previous therapy was continued, antibiotics were prescribed 3x/day for seven days, and a blood transfusion was planned as a preparation for scaling the dental calculus. Oral hygiene instructions are still given to patients.\n\nFourth Visit\nOne month after the first visit (Day+30). Oral complaints improved significantly, bad breath was absent, gingiva enlargement decreased, and spontaneous bleeding ceased. The patient did not experience bleeding when brushing her teeth. Transfusions were performed between visits H+9 and H+30. During this visit, laboratory hematology tests and subsequent blood transfusions were performed. Antibiotics were no longer administered, 3% H2O2, chlorine dioxide, petroleum jelly and oral hygiene instructions were continued.\n\nFifth Visit\nOne week after the 4th visit (day +37), the oral complaints improved, but pharmacological and non-pharmacological therapy continued, including spooling 3% H2O2 on all parts of the gingiva, chlorine dioxide as a mouthwash, and applying a thin layer of petroleum jelly to the lips. Oral hygiene instructions are still given to patients. Supragingival scaling was planned two weeks later or after routine transfusions were administered.\n\nSixth Visit\nTwo months after the initial visit (day +60), the oral complaints improved. The gingival hyperplasia in some areas was no longer present, although in other areas still present, but they have undergone improvement. The transfusion had already been performed one week previously. Pharmacological therapy was continued, including 3% H2O2 spooling, chlorine dioxide spray mouthwash, and petroleum jelly. Non-pharmacological therapy namely oral hygiene instructions and an interdental toothbrush was suggested. Supra- and subgival scaling were performed.\n\nSeventh Visit\nTwo weeks after the 6th visit (Day+74), all the complaints improved. Gingival hyperplasia mostly resolved after scaling. Pharmacological includes 3% H2O2 spooling, chlorine dioxide spray mouthwash, and petroleum jelly as well as non-pharmacological therapy, consisting of oral hygiene instructions and the use of an interdental toothbrush.\n\nEighth Visit\nThree months after the initial visit (day +90), routine blood transfusions were performed one week before the visit. The patient is no longer presented with any oral complaints. All patients with gingival hyperplasia recovered optimally. The spooling process was stopped with 3% H2O2. Supra- and subgival scaling were performed again in all maxillary and mandibular regions. Instructions for the use of an interdental toothbrush, chlorine dioxide spray mouthwash, and petroleum jelly are still provided.",
+    "summary": "A 27-year-old woman, suffering from beta thalassemia major who is undergoing therapy in the form of routine blood transfusions every month and taking anti-chelation drugs but is currently stopping this because she is pregnant, currently 16 weeks pregnant, complains complained of swollen gums, bleeding, and bad breath. Extraoral examination revealed dry, exfoliative lips. Intraoral examination revealed gingival hyperplasia with erythema, soft consistency, dark red rounded gingival margins, bleeding, true pockets and pain throughout the labial, buccal, palatal, and lingual. There was no history of systemic disease in this patient. Patient has never visited a dentist, either before or now, with complaints about her oral cavity. Hematological parameters showed abnormalities, and peripheral blood examination revealed an infection. The oral diagnoses included gingival enlargement and chronic periodontitis associated with pregnancy and β- thalassemia major.\n\nCase Management\nDental management consisted of spooling with 3% hydrogen peroxide (H2O2) spooling, chlorine dioxide spray mouthwash, antibiotics, calculus removal, and oral hygiene instructions. Blood transfusions were administered once a month, and anti-chelation therapy was stopped during pregnancy. After three months of multidisciplinary management, the results were satisfactory.",
+    "translated_fulltext": "২৪ বছর ধরে বিটা-থ্যালাসেমিয়া মেজর রোগে আক্রান্ত এবং ১৬ সপ্তাহের গর্ভাবস্থায় থাকা ২৭ বছর বয়সী এক নারীকে ইন্টারনাল মেডিসিন বিভাগ থেকে ওরাল মেডিসিন বিভাগে রেফার করা হয়, প্রারম্ভিক গর্ভাবস্থা থেকে মাড়ি ফুলে যাওয়া, মাড়ি থেকে রক্তপাত এবং মুখে দুর্গন্ধের অভিযোগ নিয়ে। রোগী হাঁটুর ব্যথার অভিযোগে হাসপাতালে ভর্তি ছিলেন, যার কারণে তিনি নড়াচড়া করতে পারছিলেন না। তিনি হাঁটুতে ব্যথার কারণে নড়াচড়া করতে না পারার অভিযোগে হাসপাতালে ভর্তি হন এবং ইন্টারনাল মেডিসিন বিশেষজ্ঞ, রিউমাটোলজি সাব-ডিভিশন দ্বারা থ্যালাসেমিয়ার সাথে সম্পর্কিত Arthritis ar Genue Sinistra নির্ণয় করা হয়। প্রায় দুই সপ্তাহ হাসপাতালে থাকার সময় রোগীর সাধারণ অবস্থা দুর্বল, অসুস্থ এবং চলাচলে অসুবিধাজনক ছিল। রোগী আগে বা এখন কখনোই তার মুখগহ্বর সংক্রান্ত কোনো অভিযোগ নিয়ে দন্ত চিকিৎসকের কাছে যাননি। রোগীর ২০০৯ সালে স্প্লেনেকটমি করা হয়েছিল। তার বিটা-থ্যালাসেমিয়া মেজরের চিকিৎসা হিসেবে প্রতি মাসে একবার নিয়মিত রক্তসঞ্চালন এবং আয়রন অ্যান্টি-চেলেশন ড্রাগ (deferoxamine) দেওয়া হতো; তবে গর্ভাবস্থার কারণে তা বন্ধ করা হয়। এই রোগীর অন্য কোনো সিস্টেমিক রোগের ইতিহাস ছিল না। একই রোগের পারিবারিক ইতিহাস বাতিল করা হয়েছে। পুনরাবৃত্ত স্টোমাটাইটিস এবং ওষুধ বা খাদ্য অ্যালার্জির ইতিহাসও বাতিল করা হয়েছে।\n\nরোগীর সাধারণ অবস্থা দুর্বল ছিল, ভিটাল সাইন স্বাভাবিক ছিল; তবে রোগীর জ্বর ছিল। ইনট্রা-ওরাল পরীক্ষায় জিঞ্জাইভাল হাইপারপ্লাসিয়া; ইরিথেমা; নরম কনসিস্টেন্সি; গাঢ় লাল, গোলাকার জিঞ্জাইভাল মার্জিন; ল্যাবিয়াল, বুক্কাল, প্যালাটাল এবং লিঙ্গুয়াল এলাকায় রক্তপাতের প্রবণতা; এবং ব্যথা পাওয়া যায়। Oral hygiene index-simplified (OHIS) স্কোর ছিল খারাপ (৫.৭) এবং সকল অঞ্চলে ট্রু পকেট উপস্থিত ছিল। পারিফেরাল ব্লাড মর্ফোলজি ফলাফল: (১) ইরিথ্রোসাইট: পলিক্রোমেসি ইন অ্যানিসোক্রোম জনসংখ্যা (হাইপোক্রোম, নর্মোক্রোম), অ্যানিসোপয়কিলোসাইটোসিস (ওভালোসাইট, টার্গেট); (২) লিউকোসাইট: পরিমাণ যথেষ্ট, হাইপারসেগমেন্টেশন (+); (৩) প্লেটলেট কাউন্ট: সংখ্যা বৃদ্ধি, বিস্তৃতভাবে ছড়ানো; ইন্টারপ্রিটেশন: থ্যালাসেমিয়া মেজর-এর কারণে মাঝারি অ্যানিমিয়া et causa, বৃদ্ধি পাওয়া এরিথ্রোপোইসিস কার্যকলাপের লক্ষণসহ সন্দেহভাজন সংক্রমণ বিদ্যমান। ইতিহাস, ক্লিনিকাল বৈশিষ্ট্য এবং পরীক্ষার ভিত্তিতে, পাশাপাশি অতিরিক্ত পরীক্ষার মাধ্যমে নির্ণয় করা হয়, যথা গর্ভাবস্থার সাথে সম্পর্কিত জিঞ্জাইভাল এনলার্জমেন্ট এবং β-থ্যালাসেমিয়া মেজরের সাথে সংশ্লিষ্ট ক্রনিক পেরিওডোনটাইটিস ও ঠোঁটের এক্সফোলিয়েটিভ চেইলাইটিস। এই রোগীর পেরিওডোনটাল রোগের শ্রেণিবিন্যাস হলো গর্ভাবস্থা ও বিটা-থ্যালাসেমিয়া মেজরের সাথে সম্পর্কিত জিঞ্জাইভাল এনলার্জমেন্টসহ ক্রনিক পেরিওডোনটাইটিস। এই ক্ষেত্রে প্রগনোসিস ভালো ছিল কারণ রোগী সহযোগিতামূলক ছিলেন এবং ওরাল মেডিসিন বিভাগের নির্দেশনা অনুসরণ করেছিলেন। এই ক্ষেত্রে মাল্টিডিসিপ্লিনারি থেরাপি ছিল একজন ওরাল মেডিসিন বিশেষজ্ঞ, একজন পেরিওডোন্টিস্ট এবং একজন ইন্টারনিস্টের সমন্বয়ে। ডেন্টাল থেরাপিতে অন্তর্ভুক্ত ছিল ৩% হাইড্রোজেন পারঅক্সাইড (H2O2) সলিউশন দ্বারা স্পুলিং, ক্লোরিন ডাইঅক্সাইড স্প্রে মাউথওয়াশ (Oxyfresh®, USA), অ্যান্টিবায়োটিক (amoxicillin 500 mg tablet, এবং metronidazole 300 mg tablet), এবং স্কেলিং/রুট প্ল্যানিং। ৩% H2O2 সলিউশন দ্বারা স্পুলিং প্রতিটি ভিজিটে করা হয়; ক্লোরিন ডাইঅক্সাইড স্প্রে মাউথওয়াশ খাবারের পরে দিনে তিনবার ব্যবহার করা হয়, এবং তৃতীয় ভিজিটে সাত দিনের জন্য অ্যান্টিবায়োটিক প্রদান করা হয়। সাধারণ অবস্থা নিয়ন্ত্রণে আসার পর এবং জিঞ্জাইভাল হাইপারপ্লাসিয়া ও স্বতঃস্ফূর্ত রক্তপাতের উন্নতির পর পেরিওডোন্টিস্ট দ্বারা স্কেলিং ও রুট প্ল্যানিং করা হয়। packed red cell buffy coat (PRC BCR) অপসারণের জন্য রক্তসঞ্চালনও নিয়মিতভাবে প্রতি মাসে একবার করা হয়। নন-ফার্মাকোলজিকাল থেরাপি, যার মধ্যে ওরাল হাইজিন নির্দেশনা অন্তর্ভুক্ত, রোগীকে এখনও প্রদান করা হয়। এই ক্ষেত্রে ওরাল অভিযোগসমূহ খারাপ ওরাল হাইজিন, β-থ্যালাসেমিয়া মেজর এবং গর্ভাবস্থার কারণে হয়েছে—এ বিষয়গুলোও রোগীকে শিক্ষার অংশ হিসেবে জানানো হয়।\n\nএই রোগীর মোট আটটি ফলো-আপ ভিজিট ছিল, যার মধ্যে দুইটি ইনপেশেন্ট এবং ছয়টি আউটপেশেন্ট ভিজিট, যার বিস্তারিত নিম্নরূপ:\n\nFirst Visit\nপ্রথম ভিজিটটি প্রাথমিক ইনপেশেন্ট ভিজিটের এক দিন পর (day +1) সম্পন্ন হয়। ম্যান্ডিবলের লিঙ্গুয়াল-অ্যান্টেরিয়র অংশে ইনট্রা-ওরাল রক্তপাত এখনও বিদ্যমান ছিল, তবে ম্যাক্সিলার অ্যান্টেরিয়র অংশে রক্তপাত বন্ধ হয়ে গিয়েছিল। রোগীর এখনও জ্বর ছিল। পূর্বে প্রদানকৃত ওষুধ যথাযথভাবে ব্যবহার করা হয়। ফার্মাকোলজিক্যাল চিকিৎসা চালু রাখা হয়, যার মধ্যে জিঞ্জাইভার সকল অংশে ৩% H2O2 স্পুলিং, মাউথওয়াশ হিসেবে ক্লোরিন ডাইঅক্সাইড ব্যবহার, এবং ঠোঁটে পাতলা স্তরে পেট্রোলিয়াম জেলি প্রয়োগ অন্তর্ভুক্ত ছিল। গত রাতে একটি রক্তসঞ্চালন করা হয়। ওরাল হাইজিন নির্দেশনা এখনও রোগীকে দেওয়া হয়।\n\nSecond Visit\nদ্বিতীয় ভিজিটটি প্রাথমিক ভিজিটের দুই দিন পর (day +2) করা হয়। ইনট্রা-ওরাল রক্তপাত। ফলো-আপ ভিজিট আউটপেশেন্ট সেটিংয়ে করা উচিত। ফার্মাকোলজিকাল থেরাপি হিসেবে জিঞ্জাইভার সকল অংশে ৩% H2O2 স্পুলিং, মাউথওয়াশ হিসেবে ক্লোরিন ডাইঅক্সাইড ব্যবহার, এবং ঠোঁটে পাতলা স্তরে পেট্রোলিয়াম জেলি প্রয়োগ করা হয়। গত রাতে একটি রক্তসঞ্চালন করা হয়। ওরাল হাইজিন নির্দেশনা এখনও রোগীকে দেওয়া হয়।\n\nThird Visit\nপ্রাথমিক ভিজিটের নয় দিন পর (Day +9)। প্রথম আউটপেশেন্ট চিকিৎসা। ওরাল উপসর্গগুলোর উন্নতি দেখা যায়; মুখের দুর্গন্ধ উল্লেখযোগ্যভাবে কমে যায়, তবে মাড়ি এখনও ফোলা ছিল। ক্লোরিন ডাইঅক্সাইড স্প্রে মাউথওয়াশ এখনও ব্যবহার করা হচ্ছিল এবং তা শেষ হয়ে গিয়েছিল। রোগী নরম টুথব্রাশ দিয়ে দাঁত ব্রাশ করতে পারছিলেন কিন্তু এখনও রক্তপাত হচ্ছিল। ৩% H2O2 দিয়ে স্পুলিং করা হয়। পূর্ববর্তী থেরাপি চালু রাখা হয়, সাত দিনের জন্য দিনে ৩ বার অ্যান্টিবায়োটিক নির্ধারণ করা হয়, এবং ডেন্টাল ক্যালকুলাস স্কেলিং-এর প্রস্তুতি হিসেবে একটি রক্তসঞ্চালনের পরিকল্পনা করা হয়। ওরাল হাইজিন নির্দেশনা এখনও রোগীকে দেওয়া হয়।\n\nFourth Visit\nপ্রথম ভিজিটের এক মাস পর (Day +30)। ওরাল অভিযোগ উল্লেখযোগ্যভাবে উন্নত হয়, মুখের দুর্গন্ধ অনুপস্থিত ছিল, জিঞ্জাইভাল এনলার্জমেন্ট কমে যায় এবং স্বতঃস্ফূর্ত রক্তপাত বন্ধ হয়ে যায়। দাঁত ব্রাশ করার সময় রোগীর কোনো রক্তপাত হয়নি। H+9 এবং H+30 ভিজিটের মধ্যবর্তী সময়ে রক্তসঞ্চালন করা হয়। এই ভিজিটে ল্যাবরেটরি হেমাটোলজি পরীক্ষা এবং পরবর্তী রক্তসঞ্চালন করা হয়। অ্যান্টিবায়োটিক আর প্রদান করা হয়নি, ৩% H2O2, ক্লোরিন ডাইঅক্সাইড, পেট্রোলিয়াম জেলি এবং ওরাল হাইজিন নির্দেশনা চালু রাখা হয়।\n\nFifth Visit\nচতুর্থ ভিজিটের এক সপ্তাহ পর (day +37), ওরাল অভিযোগের উন্নতি হয়, তবে ফার্মাকোলজিকাল এবং নন-ফার্মাকোলজিকাল থেরাপি চালু রাখা হয়, যার মধ্যে জিঞ্জাইভার সকল অংশে ৩% H2O2 স্পুলিং, মাউথওয়াশ হিসেবে ক্লোরিন ডাইঅক্সাইড, এবং ঠোঁটে পাতলা স্তরে পেট্রোলিয়াম জেলি প্রয়োগ অন্তর্ভুক্ত ছিল। ওরাল হাইজিন নির্দেশনা এখনও রোগীকে দেওয়া হয়। নিয়মিত রক্তসঞ্চালন দেওয়ার পর অথবা দুই সপ্তাহ পরে সুপ্রাজিঞ্জাইভাল স্কেলিং করার পরিকল্পনা করা হয়।\n\nSixth Visit\nপ্রাথমিক ভিজিটের দুই মাস পর (day +60), ওরাল অভিযোগের উন্নতি হয়। কিছু এলাকায় জিঞ্জাইভাল হাইপারপ্লাসিয়া আর ছিল না, যদিও অন্যান্য এলাকায় এখনও উপস্থিত ছিল, তবে উন্নতি হয়েছে। রক্তসঞ্চালন এক সপ্তাহ আগে সম্পন্ন করা হয়েছিল। ফার্মাকোলজিকাল থেরাপি চালু রাখা হয়, যার মধ্যে ৩% H2O2 স্পুলিং, ক্লোরিন ডাইঅক্সাইড স্প্রে মাউথওয়াশ, এবং পেট্রোলিয়াম জেলি অন্তর্ভুক্ত। নন-ফার্মাকোলজিকাল থেরাপি হিসেবে ওরাল হাইজিন নির্দেশনা এবং ইন্টারডেন্টাল টুথব্রাশ ব্যবহারের পরামর্শ দেওয়া হয়। সুপ্রা- এবং সাবজিঞ্জাইভাল স্কেলিং করা হয়।\n\nSeventh Visit\nষষ্ঠ ভিজিটের দুই সপ্তাহ পর (Day +74), সকল অভিযোগের উন্নতি হয়। স্কেলিংয়ের পর জিঞ্জাইভাল হাইপারপ্লাসিয়া অধিকাংশ ক্ষেত্রেই সেরে যায়। ফার্মাকোলজিকাল থেরাপির মধ্যে ছিল ৩% H2O2 স্পুলিং, ক্লোরিন ডাইঅক্সাইড স্প্রে মাউথওয়াশ, এবং পেট্রোলিয়াম জেলি; পাশাপাশি নন-ফার্মাকোলজিকাল থেরাপি হিসেবে ওরাল হাইজিন নির্দেশনা এবং ইন্টারডেন্টাল টুথব্রাশ ব্যবহার।\n\nEighth Visit\nপ্রাথমিক ভিজিটের তিন মাস পর (day +90), ভিজিটের এক সপ্তাহ আগে নিয়মিত রক্তসঞ্চালন করা হয়। রোগীর আর কোনো ওরাল অভিযোগ ছিল না। জিঞ্জাইভাল হাইপারপ্লাসিয়াযুক্ত সকল রোগীর সর্বোত্তমভাবে আরোগ্য হয়। ৩% H2O2 দিয়ে স্পুলিং প্রক্রিয়া বন্ধ করা হয়। সকল ম্যাক্সিলারি ও ম্যান্ডিবুলার অঞ্চলে পুনরায় সুপ্রা- এবং সাবজিঞ্জাইভাল স্কেলিং করা হয়। ইন্টারডেন্টাল টুথব্রাশ ব্যবহার, ক্লোরিন ডাইঅক্সাইড স্প্রে মাউথওয়াশ, এবং পেট্রোলিয়াম জেলি ব্যবহারের নির্দেশনা এখনও প্রদান করা হয়।\n",
+    "translated_summary": "২৭ বছর বয়সী একজন মহিলা, যিনি বিটা থ্যালাসেমিয়া মেজর-এ ভুগছেন, তিনি প্রতি মাসে নিয়মিত রক্ত পরিসঞ্চালনের মাধ্যমে চিকিৎসা নিচ্ছেন এবং অ্যান্টি-চিলেশন ওষুধ সেবন করছেন, কিন্তু বর্তমানে তিনি গর্ভবতী হওয়ায় এই চিকিৎসা বন্ধ রেখেছেন। তিনি বর্তমানে ১৬ সপ্তাহ গর্ভবতী এবং তার মাড়ি ফুলে যাওয়া, রক্তপাত এবং দুর্গন্ধযুক্ত শ্বাস-প্রশ্বাসের সমস্যা হচ্ছে। বহির্ভাগে পরীক্ষা করে দেখা যায় তার ঠোঁট শুষ্ক এবং খসখসে। মুখের ভেতরে পরীক্ষা করে দেখা যায় মাড়িতে অতিরিক্ত বৃদ্ধি, লালচে ভাব, নরম গঠন, গাঢ় লাল রঙের গোলাকার মাড়ির প্রান্ত, রক্তপাত, এবং ঠোঁট, গাল, তালু এবং জিহ্বার সর্বত্র ফোলা ও ব্যথা রয়েছে। এই রোগীর পূর্বে কোনো systemic রোগ ছিল না। রোগী আগে কখনো ডেন্টিস্টের কাছে যাননি, এমনকি বর্তমানেও যাননি এবং তার মুখের সমস্যা নিয়ে অভিযোগ করেছেন। রক্ত পরীক্ষার ফলাফলে কিছু অস্বাভাবিকতা দেখা যায় এবং পেরিফেরাল রক্ত পরীক্ষায় সংক্রমণের প্রমাণ পাওয়া যায়। মুখের রোগ নির্ণয়ের মধ্যে রয়েছে গর্ভাবস্থা এবং বিটা থ্যালাসেমিয়া মেজরের কারণে মাড়ির বৃদ্ধি এবং দীর্ঘস্থায়ী পেরিওডন্টাইটিস।\n\nচিকিৎসা পদ্ধতি\nদন্তচিকিৎসায় ৩% হাইড্রোজেন পারক্সাইড (H2O2) দিয়ে কুলকুচি করানো, ক্লোরিন ডাই অক্সাইড স্প্রে দিয়ে মুখ ধোয়া, অ্যান্টিবায়োটিক, দাঁতের পাথর অপসারণ এবং মুখের স্বাস্থ্যবিধি সম্পর্কে নির্দেশনা দেওয়া হয়। প্রতি মাসে একবার রক্ত পরিসঞ্চালন করা হতো, কিন্তু গর্ভাবস্থায় অ্যান্টি-চিলেশন থেরাপি বন্ধ রাখা হয়। তিনটি মাস ধরে বিভিন্ন ধরনের চিকিৎসার পর, ফলাফল সন্তোষজনক ছিল।"
+  }
+]
\ No newline at end of file
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+[
+    {
+        "id": "multiclinsum_gs_en_27.txt",
+        "fulltext": "A 20-year-old woman was followed up since the age of eight for idiopathic NS inaugurated by cerebral venous thrombosis extended to the right jugular vein with a massive pulmonary embolism. The patient did not have any sequelae. She had no other medical or surgical history. A family history of thrombosis has not been reported. The patient was not biopsied because she had no kidney failure nor gross hematuria, or hypertension at first presentation; added to that, she had no extra renal signs suggestive of a secondary nephrotic syndrome. She was accordingly put on anticoagulant therapy (Oral vitamin K antagonist) and oral corticosteroid therapy with good evolution. Thereafter, the patient received several cures of high-dose corticosteroids for steroid-dependent relapses of NS. She was, hence, put on mycophenolate mofetil (MMF) as a background therapy to avoid corticosteroids and ensure normal growth. An exhaustive assessment of thrombophilia was performed and did not show any abnormality. Homocysteine rate, blood fibrinogen rate, Protein C, protein S, antithrombin III, factor V Leiden mutation, JAK-2 mutation, cryoglobulins, anticardiolipin antibodies, lupus anticoagulant and beta-1-glycoprotein antibodies were normal. The anticoagulant treatment was stopped after nine years. The evolution was enameled by the occurrence of several relapses of her disease controlled by oral corticosteroid therapy. Remission of NS has been noted since 2017, so MMF was gradually stopped in 2019 and the patient remained asymptomatic and without any relapse.\n\nOne year later, the patient came up to our emergency department for acute intense diffuse abdominal pain without any particular irradiation associated with postprandial vomiting and bilateral lower limb edema for the last six hours. The physical examination revealed an intense epigastric tenderness with normal vital signs (arterial pressure of 120/70 mm Hg, heart rate of 83 bpm, and oxygen saturation at 100% on room air). The patient was afebrile with normal consciousness. The rest of the physical examination was unremarkable. The urinalysis with labstix revealed proteinuria. The hemogasanalysis results showed metabolic acidosis with respiratory compensation. Further laboratory tests revealed hypoalbuminemia, hypercholesterolemia, a prothrombin time at 90%, high levels of D-dimer, lactate dehydrogenase, and creatine phosphokinase as well as a biological inflammatory syndrome with a CRP of 37 mg/L, and leucocytosis at 26.4 x 103/µL. Renal and liver functions were normal.\n\nThe patient was hospitalized in an intensive care unit with close monitoring of vital signs and initiation of resuscitation measures. An abdominal ultrasound was performed urgently showing an intra-abdominal effusion of low to moderate abundance. An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery with acute mesenteric ischemia. The patient was immediately routed to the operating room. Intraoperative exploration confirmed mesenteric ischemia with extensive necrosis of almost entirely of the small bowel making their resections incompatible with life shown in Figure 3. The patient died after 48 hours.",
+        "summary": "We present the case of a 20-year-old woman with a 12-year history of idiopathic NS revealed by extensive cerebral venous thrombosis with pulmonary embolism treated with anticoagulation therapy and oral corticosteroid therapy followed by mycophenolate mofetil (MMF). The thrombophilia assessment did not show any abnormalities. The evolution was marked by the occurrence of several NS relapses controlled by oral corticosteroid therapy until 2017. Subsequently, the patient had not presented a relapse of her disease. The anticoagulant treatment and the MMF were therefore stopped. One year later, the patient presented with severe diffuse acute abdominal pain associated with postprandial vomiting and bilateral lower limb edema. Laboratory results confirmed a NS relapse. An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery with acute mesenteric ischemia. Intraoperative exploration showed mesenteric ischemia with extensive necrosis of the small intestine making their resections incompatible with life. The patient died after 48 hours.",
+        "translated_fulltext": "Một phụ nữ 20 tuổi đã được theo dõi từ năm 8 tuổi vì bệnh hội chứng thận hư không rõ nguyên nhân, khởi phát bằng tắc nghẽn tĩnh mạch não lan đến tĩnh mạch cảnh phải, kèm theo thuyên tắc phổi lớn. Bệnh nhân không có di chứng nào. Cô không có tiền sử bệnh lý hoặc phẫu thuật nào khác. Không có tiền sử gia đình mắc bệnh huyết khối. Bệnh nhân không được sinh thiết vì ban đầu không có suy thận, không có tiểu ra máu rõ rệt hoặc tăng huyết áp; hơn nữa, cô không có dấu hiệu ngoài thận gợi ý hội chứng thận hư thứ phát. Do đó, bệnh nhân được điều trị bằng thuốc chống đông (vitamin K đường uống) và corticosteroid đường uống, và tình trạng bệnh tiến triển tốt. Sau đó, bệnh nhân được điều trị bằng nhiều đợt corticosteroid liều cao để điều trị các đợt tái phát phụ thuộc vào corticosteroid của bệnh hội chứng thận hư. Vì vậy, bệnh nhân được dùng mycophenolate mofetil (MMF) như một liệu pháp nền để tránh sử dụng corticosteroid và đảm bảo sự phát triển bình thường. Một đánh giá toàn diện về tình trạng huyết khối đã được thực hiện và không phát hiện bất thường nào. Nồng độ homocysteine, nồng độ fibrinogen trong máu, protein C, protein S, antithrombin III, đột biến yếu tố V Leiden, đột biến JAK-2, cryoglobulin, kháng thể kháng cardiolipin, chất chống đông lupus và kháng thể beta-1-glycoprotein đều bình thường. Việc điều trị bằng thuốc chống đông đã được ngừng sau chín năm. Quá trình điều trị diễn biến với nhiều đợt tái phát của bệnh, được kiểm soát bằng liệu pháp corticosteroid đường uống. Bệnh hội chứng thận hư đã thuyên giảm kể từ năm 2017, vì vậy MMF được ngừng dần vào năm 2019 và bệnh nhân vẫn không có triệu chứng và không tái phát.\n\nMột năm sau, bệnh nhân đến phòng cấp cứu của chúng tôi vì đau bụng dữ dội, lan tỏa, không có vị trí cụ thể, kèm theo nôn sau ăn và phù hai chân dưới trong sáu giờ qua. Khám lâm sàng cho thấy đau vùng thượng vị dữ dội, các dấu hiệu sinh tồn bình thường (huyết áp 120/70 mmHg, nhịp tim 83 lần/phút và độ bão hòa oxy là 100% khi thở không khí bình thường). Bệnh nhân không sốt và tỉnh táo. Các phần còn lại của khám lâm sàng không có gì đặc biệt. Phân tích nước tiểu bằng que thử cho thấy có protein niệu. Kết quả phân tích khí máu cho thấy nhiễm toan chuyển hóa với bù hô hấp. Các xét nghiệm trong phòng thí nghiệm tiếp theo cho thấy giảm albumin máu, tăng cholesterol máu, thời gian prothrombin là 90%, mức D-dimer, lactate dehydrogenase và creatine phosphokinase cao, cũng như hội chứng viêm sinh học với CRP là 37 mg/L và số lượng bạch cầu là 26,4 x 103/µL. Chức năng thận và gan bình thường.\n\nBệnh nhân được nhập viện vào khoa hồi sức tích cực, theo dõi sát các dấu hiệu sinh tồn và bắt đầu các biện pháp hồi sức. Siêu âm bụng được thực hiện khẩn cấp, cho thấy có dịch trong ổ bụng với lượng từ ít đến vừa. Chụp CT bụng cho thấy tắc nghẽn động mạch mạc treo trên cấp tính, gây thiếu máu mạc treo cấp tính. Bệnh nhân được đưa ngay vào phòng mổ. Khám nghiệm trong mổ xác nhận tình trạng thiếu máu mạc treo với hoại tử lan rộng, gần như toàn bộ ruột non, khiến việc cắt bỏ không thể duy trì sự sống, như được minh họa trong Hình 3. Bệnh nhân đã tử vong sau 48 giờ.",
+        "translated_summary": "Chúng tôi xin trình bày trường hợp của một phụ nữ 20 tuổi, có tiền sử bệnh thần kinh cột sống không rõ nguyên nhân kéo dài 12 năm, được chẩn đoán bằng hình ảnh tắc nghẽn tĩnh mạch não lan rộng kèm theo thuyên tắc phổi. Bệnh nhân được điều trị bằng liệu pháp chống đông máu và liệu pháp corticosteroid đường uống, sau đó là mycophenolate mofetil (MMF). Đánh giá về tình trạng tăng đông máu không cho thấy bất thường nào. Quá trình bệnh diễn biến với nhiều đợt tái phát bệnh thần kinh cột sống, được kiểm soát bằng liệu pháp corticosteroid đường uống cho đến năm 2017. Sau đó, bệnh nhân không có đợt tái phát nào. Do đó, liệu pháp chống đông máu và MMF đã được ngừng. Một năm sau, bệnh nhân xuất hiện các triệu chứng đau bụng cấp tính lan tỏa nghiêm trọng, kèm theo nôn sau ăn và phù hai chân. Kết quả xét nghiệm xác nhận bệnh thần kinh cột sống tái phát. Chụp CT ổ bụng cho thấy tắc nghẽn động mạch mạc treo trên cấp tính, gây thiếu máu mạc treo cấp tính. Khám nghiệm trong phẫu thuật cho thấy thiếu máu mạc treo với hoại tử lan rộng của ruột non, khiến việc cắt bỏ ruột không thể duy trì sự sống. Bệnh nhân đã tử vong sau 48 giờ."
+    },
+    {
+        "id": "multiclinsum_gs_en_523.txt",
+        "fulltext": "We present the case of a 34-year-old woman, eight weeks pregnant with no other personal history of interest, who presents to the emergency department with generalized convulsions with dysarthria in the postcritical period, which resolve progressively in less than two hours. On physical examination, she is conscious, oriented, with no language or motor or sensory deficits. Only signs of a right lateral tongue bite are observed.\n\nThe complementary tests, such as blood tests or the electrocardiogram, are normal. Given that the episode corresponds with a first epileptic seizure and the patient is pregnant, an urgent magnetic resonance of the skull is requested.\n\nThe usual protocol was performed and 3D T1 sequences without and with intravenous contrast were obtained in axial, coronal and sagital planes, axial FLAIR, axial T2, VEN BOLD and magnetic susceptibility sequences, as well as axial diffusion and apparent diffusion coefficient map. The MRI identified multiple venous cortico-medullary vascular structures converging centripetally to a large central venous structure draining through the inferior anastomotic vein into the left transverse sinus, forming the classic ‘Medusa head’ sign. In the T1 sequences, the drainage vein was seen to be increased in signal with central hyphocaptation after contrast administration, suggesting partial thrombosis versus slow flow. In addition, in T2 and FLAIR sequences, the brain tissue surrounding the drainage vein was seen to be hyperintense, without diffusion restriction and compatible with edema.\n\nThese findings are suggestive of a venous anomaly of development with signs of partial peripheral thrombosis and slow flow more proximal, which cause edema of the surrounding tissue. She is started on clexane 60 mg/12 hours and levetiracetam 500 mg/12 hours and the patient shows improvement and symptomatic stability after one week.\n",
+        "summary": "A 34-year-old pregnant woman presents with seizures and dysarthria and is urgently referred for a cranial MRI. The classic ‘Medusa head’ sign is seen and the diagnosis is made as a venous anomaly of development with peripheral partial thrombosis and proximal slow flow.\n",
+        "translated_fulltext": "Chúng tôi xin trình bày trường hợp của một phụ nữ 34 tuổi, đang mang thai 8 tuần và không có tiền sử bệnh lý đáng chú ý, đến phòng cấp cứu với các cơn co giật toàn thân kèm theo khó phát âm trong giai đoạn sau cơn, và các cơn co giật này giảm dần trong vòng chưa đầy hai giờ. Khi khám lâm sàng, bệnh nhân tỉnh táo, định hướng tốt, không có dấu hiệu rối loạn ngôn ngữ, vận động hoặc cảm giác. Chỉ thấy dấu hiệu cắn phải bên phải của lưỡi.\n\nCác xét nghiệm bổ sung, chẳng hạn như xét nghiệm máu hoặc điện tâm đồ, đều cho kết quả bình thường. Vì đây là cơn động kinh đầu tiên và bệnh nhân đang mang thai, nên được chỉ định chụp cộng hưởng từ (MRI) sọ não khẩn cấp.\n\nThực hiện quy trình chụp MRI thông thường và thu được các chuỗi hình ảnh 3D T1 có và không có thuốc cản quang tiêm tĩnh mạch ở các mặt phẳng trục, vành và dọc, các chuỗi hình ảnh FLAIR trục, T2 trục, VEN BOLD và các chuỗi hình ảnh về độ nhạy từ, cũng như các chuỗi hình ảnh khuếch tán và bản đồ hệ số khuếch tán biểu kiến. MRI cho thấy nhiều cấu trúc mạch máu tĩnh mạch vỏ não-tủy hội tụ theo hướng tâm vào một cấu trúc tĩnh mạch trung tâm lớn, dẫn lưu qua tĩnh mạch nối dưới vào xoang ngang bên trái, tạo thành dấu hiệu \"đầu Medusa\" điển hình. Trong các chuỗi hình ảnh T1, tĩnh mạch dẫn lưu cho thấy tín hiệu tăng lên với sự tăng cường tín hiệu trung tâm sau khi tiêm thuốc cản quang, gợi ý tắc nghẽn một phần hoặc lưu lượng chậm. Ngoài ra, trong các chuỗi hình ảnh T2 và FLAIR, mô não xung quanh tĩnh mạch dẫn lưu cho thấy tín hiệu tăng lên, không có hạn chế khuếch tán và phù hợp với tình trạng phù.\n\nNhững phát hiện này gợi ý một dị tật tĩnh mạch phát triển với các dấu hiệu của tắc nghẽn ngoại vi một phần và lưu lượng chậm ở vị trí gần hơn, gây ra tình trạng phù ở mô xung quanh. Bệnh nhân được bắt đầu điều trị bằng clexane 60mg/12 giờ và levetiracetam 500mg/12 giờ, và bệnh nhân có dấu hiệu cải thiện và ổn định về mặt triệu chứng sau một tuần.",
+        "translated_summary": "Một phụ nữ 34 tuổi đang mang thai đến khám với các triệu chứng co giật và khó phát âm, và được chuyển khẩn cấp để chụp cộng hưởng từ (MRI) sọ não. Hình ảnh “đầu Medusa” đặc trưng được phát hiện, và chẩn đoán được đưa ra là dị tật tĩnh mạch bẩm sinh với tình trạng tắc nghẽn cục bộ ở vùng ngoại vi và lưu lượng máu chậm ở vùng gần."
+    },
+    {
+        "id": "multiclinsum_gs_en_587.txt",
+        "fulltext": "A 22-year-old woman came to the Department of Oral Medicine with complaints of mouth ulcers causing pain and eating and drinking difficulty persisting for a duration of one month. This condition begins with a fever and appears like pimples on the lips. Based on the anamnesis, it was discovered that she had been using pod-type vapes for about a year but had never experienced complaints like when she came for treatment. She had never smoked traditional cigarettes before starting to vape. She said the reason for trying vaping was out of curiosity, and she quite often tried different types of e-liquid with different flavors. Before her complaint, she had simply changed the type of e-liquid to a different flavor without mentioning the brand. She vapes almost every day, but not all day, only in her free time or with friends. She was a healthy individual, and before this condition appeared, she had no history of taking medications, including antibiotics, analgesics, anticonvulsants, non-steroidal anti-inflammatory drugs, and antifungals. She also had no history of drug or food allergies, but the patient has unhealthy eating habits (eating irregularly and not consuming vegetables and fruit). Extraoral examination showed no lesions on other parts of the body, while the lips of the patient had serosanguineous crusts and an erosive area at the corner of the mouth, and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges, irregular, varying sizes, and pain on the labial, buccal, lateral, and ventral mucosa of the tongue and floor of the mouth.\n\nBased on the medical history of the patient and physical examination, which revealed oral mucosal involvement but no symptoms elsewhere in the body, as well as the non-reactive anti-HSV1 IgG results, the diagnosis of vaping-related oral erythema multiforme was established. The medical condition has been classified as minor erythema multiforme. The oral conditions were treated with 0.9% NaCl, which was moistened in gauze and placed on the lips three times a day. The patient was instructed to gargle 1 mg of dexamethasone in 10 mL of hyaluronic acid three times a day and avoid eating or drinking for at least 30 minutes after gargling. She was also given 2% miconazole cream applied to the wound in the right corner of the mouth twice a day, as well as vaseline album cream for dry lips. To maintain good oral hygiene, she was advised to brush her teeth and tongue twice a day, after breakfast and before bed. She was also instructed to stop vaping and avoid foods containing monosodium glutamate (MSG). The control was carried out after a week following therapy and showed that oral condition had improved. Written informed consent for the publication of details was obtained from the patient. This case report conformed with the Helsinki Declaration. The publication of this case report has also been approved by the institution.",
+        "summary": "A 22-year-old woman came to the Oral Medicine Department with complaints of stomatitis causing pain, eating, and drinking difficulty, which started with fever and pimple-like on the lips. She was an active vape user for one year. Extraoral examination revealed no lesions on other body parts. The serosanguinolent crusts on the lips, an erosive area on the labial commissures and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges and irregular, varying sizes in several parts of the oral mucosa. The anti-HSV-1 IgG laboratory results showed non-reactive, leading to a diagnosis of oral erythema multiforme. Management of oral conditions using 0.9% NaCl compress, dexamethasone mouthwash, and hyaluronic acid, applying 2% miconazole cream on labial commissures and vaseline album cream on the dry lips, and stopping vaping. Oral condition improved in a week of therapy.",
+        "translated_fulltext": "Một phụ nữ 22 tuổi đến Khoa Y học Răng miệng với các triệu chứng loét miệng gây đau, khó khăn trong việc ăn uống, kéo dài trong một tháng. Tình trạng này bắt đầu bằng sốt và xuất hiện như những nốt mụn trên môi. Dựa trên thông tin bệnh sử, được biết cô ấy đã sử dụng thuốc lá điện tử loại pod trong khoảng một năm, nhưng trước đây chưa từng gặp phải các triệu chứng như khi đến khám. Cô ấy chưa từng hút thuốc lá truyền thống trước khi bắt đầu sử dụng thuốc lá điện tử. Cô ấy cho biết lý do thử sử dụng thuốc lá điện tử là vì tò mò, và cô ấy thường xuyên thử các loại tinh dầu khác nhau với nhiều hương vị khác nhau. Trước khi có các triệu chứng, cô ấy chỉ đơn giản là thay đổi loại tinh dầu sang một hương vị khác mà không đề cập đến nhãn hiệu. Cô ấy sử dụng thuốc lá điện tử gần như mỗi ngày, nhưng không phải cả ngày, chỉ khi có thời gian rảnh hoặc khi ở cùng bạn bè. Cô ấy là một người khỏe mạnh, và trước khi tình trạng này xuất hiện, cô ấy không có tiền sử dùng thuốc, bao gồm cả thuốc kháng sinh, thuốc giảm đau, thuốc chống co giật, thuốc chống viêm không steroid và thuốc chống nấm. Cô ấy cũng không có tiền sử dị ứng với thuốc hoặc thực phẩm, nhưng bệnh nhân có thói quen ăn uống không lành mạnh (ăn uống không đều và không ăn rau củ quả). Khám bên ngoài miệng cho thấy không có tổn thương ở các bộ phận khác của cơ thể, trong khi môi của bệnh nhân có vảy màu vàng và một vùng bị xói mòn ở góc miệng, và có xu hướng chảy máu. Khám bên trong miệng cho thấy các vết loét màu trắng với viền màu vàng, hình dạng không đều, kích thước khác nhau và gây đau ở niêm mạc môi, má, bên và mặt dưới của lưỡi và sàn miệng.\n\nDựa trên bệnh sử và khám lâm sàng của bệnh nhân, cho thấy có tổn thương niêm mạc miệng nhưng không có triệu chứng nào khác ở các bộ phận khác của cơ thể, cũng như kết quả xét nghiệm kháng thể anti-HSV1 IgG âm tính, chẩn đoán bệnh viêm đa dạng niêm mạc miệng liên quan đến việc sử dụng thuốc lá điện tử đã được xác định. Tình trạng bệnh được phân loại là viêm đa dạng niêm mạc miệng nhẹ. Các tổn thương ở miệng được điều trị bằng dung dịch NaCl 0,9%, được thấm vào gạc và đặt lên môi ba lần một ngày. Bệnh nhân được hướng dẫn súc miệng bằng dung dịch dexamethasone 1 mg trong 10 mL dung dịch hyaluronic acid ba lần một ngày và tránh ăn hoặc uống trong ít nhất 30 phút sau khi súc miệng. Cô ấy cũng được kê đơn kem miconazole 2% bôi lên vết thương ở góc phải của miệng hai lần một ngày, cũng như kem vaseline album để làm dịu môi khô. Để duy trì vệ sinh răng miệng tốt, cô ấy được khuyên nên chải răng và lưỡi hai lần một ngày, sau khi ăn sáng và trước khi đi ngủ. Cô ấy cũng được hướng dẫn ngừng sử dụng thuốc lá điện tử và tránh các loại thực phẩm chứa glutamate mononatri (MSG). Sau một tuần điều trị, tình trạng bệnh đã được kiểm tra và cho thấy tình trạng ở miệng đã cải thiện. Sự đồng ý bằng văn bản để công bố thông tin chi tiết đã được lấy từ bệnh nhân. Báo cáo ca bệnh này tuân thủ Tuyên bố Helsinki. Việc công bố báo cáo ca bệnh này cũng đã được chấp thuận bởi cơ sở y tế.",
+        "translated_summary": "Một phụ nữ 22 tuổi đến khoa Y học Răng miệng với các triệu chứng viêm miệng gây đau, khó khăn khi ăn uống, bắt đầu bằng sốt và các nốt sần trên môi. Cô ấy đã sử dụng thuốc lá điện tử trong một năm. Khám bên ngoài không phát hiện tổn thương ở các bộ phận khác của cơ thể. Các vết loét trên môi có màu vàng nhạt, khu vực bị xói mòn ở góc miệng và dễ chảy máu. Khám bên trong miệng cho thấy các vết loét màu trắng với viền màu vàng và kích thước không đều, khác nhau ở nhiều vị trí trên niêm mạc miệng. Kết quả xét nghiệm máu để kiểm tra kháng thể IgG chống lại virus Herpes simplex loại 1 (HSV-1) cho thấy không có phản ứng, dẫn đến chẩn đoán bệnh viêm đa dạng niêm mạc miệng. Điều trị các bệnh về miệng bằng cách chườm dung dịch NaCl 0,9%, súc miệng bằng dexamethasone và hyaluronic acid, bôi kem miconazole 2% lên góc miệng và kem vaseline album lên môi khô, đồng thời ngừng sử dụng thuốc lá điện tử. Tình trạng bệnh ở miệng cải thiện sau một tuần điều trị."
+    },
+    {
+        "id": "multiclinsum_gs_en_274.txt",
+        "fulltext": "A 29-year-old gravida V par IV (all alive, 3 spontaneous vaginal deliveries, and the last child was delivered by cesarean section for the indication of a failed induction 4 years prior to the current pregnancy) came for ANC follow-up at a gestational age of 32 weeks from her LNMP.\n\nAfter taking a medical history, it was discovered that all four of her children are healthy, doing well in school, and have no known history of genetic or seizure disorders. She was investigated with the Venereal Disease Research Laboratory (VDRL), Hepatitis B surface antigen (HBSag), and urine analysis, all of which were negative. All cell lines in the CBC were normal, her blood group is A, and Rh is positive, according to the Complete Blood Count (CBC), blood group, and RH. Obstetric ultrasound was also performed showing normal anatomical scan of the all body parts of the fetus except the heart. Detailed fetal echocardiography evaluation was done with findings of: both atria have comparable size and normal situs. Both atrioventricular and semilunar valves are normally positioned with normal opening and closure. Both ventricles are comparable in size and contractility; in both 2D and color flow, the left ventricle forms the apex of the heart without any ventricular septal defect. But on the papillary muscles of the left ventricle there were two circumscribed, round, echogenic mass measuring 18.2 mm by 8.3mm and 13.5mm by 8.3 mm. Upon evaluation of the outflow tract, both the LVOT (left ventricular outflow tract) and RVOT (right ventricular outflow tract) have normal anatomy and function using 2D and CF ultrasound evaluation. According to the fetal echo finding, a diagnosis of cardiac rhabdomyoma was made. Since there is a high chance of tuberous sclerosis in cardiac rhabdomyoma, detailed neurosonography and other system exams were done to look for other signs of tuberous sclerosis. Despite searching for the other features of tuberous sclerosis, no other sign of it was found other than the tumor. She had regular ANC follow-up from 32 weeks of gestation up to 39 weeks without any complications.\n\nAt gestational age of 39 weeks plus 1 day, she underwent a cesarean section for the indication of full-term pregnancy plus a request for a repeat cesarean section, with the outcome of a 3200-gram female with an APGAR score of 10 and 10 at the 1st and 5th minutes. Both the mother and the neonate had a smooth post-operative period and were discharged on the third day.\n\nAfter delivery, the neonate was evaluated on the 1st, 7th, and 30th days for any regression or increment of the mass, emergence of skin lesions, or seizure. All physical examination results were normal, and the mass size was similar to the antepartal evaluation.\n\nAt her 7th month, the child was evaluated again, and upon history inquiries, the infant was doing great developmentally for her age group. The infant was examined for neurodevelopmental delay, and the child was growing appropriately for her age. An echocardiography study by a pediatric cardiologist revealed well-circumscribed hyperechoic masses on both left ventricular papillary muscles, each measuring 21.8 mm by 9.2 mm and 14.7 mm by 8.5 mm and creating no left ventricular inflow obstruction.\n\nA history from the family was obtained, and a physical examination with anthropometric measurements was performed to assess her developmental condition during her first-year evaluation. The child was developing normally, as other children her age were. Except for the heart, all of the systems examined were unremarkable. An echocardiography study has revealed well-circumscribed hyperechoic masses on both left ventricular papillary muscles with no size increment and creating no left ventricular inflow obstruction.",
+        "summary": "We are reporting an isolated, asymptomatic fetal intra-cardiac mass (rhabdomyoma) that was discovered at 32 weeks of gestation and was followed as an outpatient until 39 weeks plus one day, at which point a cesarean section was performed. After delivery, the child underwent evaluations at the 1st day, 7th day, 30th day, 7th month, and 12th month of age. Following a checkup, the child's anthropometric and neurobehavioral growth were both healthy. Except for the tumor, which was neither growing nor shrinking in size, none of the clinical diagnostic criteria for tuberous sclerosis complex were met for this child up to the age of one year.",
+        "translated_fulltext": "Một phụ nữ 29 tuổi, đã mang thai lần thứ 5 và sinh được 4 con (đều còn sống, 3 lần sinh thường và lần sinh cuối cùng là sinh mổ do không đáp ứng với việc kích thích chuyển dạ 4 năm trước khi mang thai lần này) đến khám và theo dõi thai kỳ ở tuần thứ 32.\n\nSau khi khai thác tiền sử bệnh, được biết cả bốn người con của cô đều khỏe mạnh, học giỏi và không có tiền sử mắc các bệnh di truyền hoặc bệnh động kinh. Cô được làm các xét nghiệm sàng lọc bệnh lây truyền qua đường tình dục (VDRL), kháng nguyên bề mặt viêm gan B (HBSag) và phân tích nước tiểu, tất cả đều cho kết quả âm tính. Các chỉ số trong công thức máu toàn phần (CBC) đều bình thường, nhóm máu của cô là A, và Rh dương tính. Siêu âm sản khoa cũng được thực hiện, cho thấy hình thái giải phẫu của tất cả các bộ phận của thai nhi đều bình thường, ngoại trừ tim. Đánh giá siêu âm tim chi tiết cho thấy cả hai tâm nhĩ có kích thước tương đương và vị trí bình thường. Cả hai van nhĩ thất và van bán nguyệt đều ở vị trí bình thường, mở và đóng bình thường. Cả hai tâm thất có kích thước và khả năng co bóp tương đương; trên cả hình ảnh 2D và hình ảnh màu, tâm thất trái tạo thành đỉnh của tim mà không có bất kỳ khuyết tật vách liên thất nào. Tuy nhiên, trên các cơ nhú của tâm thất trái có hai khối tròn, giới hạn rõ, tăng âm, kích thước 18,2 mm x 8,3 mm và 13,5 mm x 8,3 mm. Đánh giá đường thoát thất cho thấy cả đường thoát thất trái (LVOT) và đường thoát thất phải (RVOT) đều có hình thái và chức năng bình thường khi đánh giá bằng siêu âm 2D và siêu âm màu. Dựa trên kết quả siêu âm tim, chẩn đoán bệnh u cơ tim. Vì bệnh u cơ tim có khả năng cao liên quan đến bệnh xơ cứng củ, nên đã tiến hành siêu âm não chi tiết và các xét nghiệm khác để tìm kiếm các dấu hiệu khác của bệnh xơ cứng củ. Mặc dù đã tìm kiếm các dấu hiệu khác của bệnh xơ cứng củ, nhưng chỉ phát hiện duy nhất khối u. Cô được theo dõi thai kỳ định kỳ từ tuần thứ 32 đến tuần thứ 39 mà không gặp bất kỳ biến chứng nào.\n\nỞ tuần thứ 39 cộng 1 ngày, cô được phẫu thuật mổ lấy thai do thai đủ tháng và có yêu cầu mổ lấy thai lần hai, kết quả là một bé gái nặng 3200 gram, điểm APGAR là 10 ở phút thứ nhất và phút thứ năm. Cả mẹ và con đều có giai đoạn hậu phẫu ổn định và được xuất viện vào ngày thứ ba.\n\nSau khi sinh, bé được đánh giá vào ngày thứ 1, ngày thứ 7 và ngày thứ 30 để theo dõi xem khối u có thay đổi về kích thước hay không, có xuất hiện các tổn thương da hay không, hoặc có bị động kinh hay không. Tất cả các kết quả khám lâm sàng đều bình thường, và kích thước của khối u tương tự như kết quả đánh giá trước khi sinh.\n\nỞ tháng thứ 7, bé được đánh giá lại, và qua khai thác tiền sử, bé phát triển rất tốt so với lứa tuổi. Bé được kiểm tra về sự chậm phát triển thần kinh, và bé phát triển bình thường so với lứa tuổi. Một bác sĩ tim mạch nhi khoa đã thực hiện siêu âm tim, kết quả cho thấy có các khối tăng âm, giới hạn rõ trên cả hai cơ nhú của tâm thất trái, mỗi khối có kích thước 21,8 mm x 9,2 mm và 14,7 mm x 8,5 mm, và không gây tắc nghẽn dòng chảy vào tâm thất trái.\n\nTiền sử gia đình được thu thập, và một cuộc khám lâm sàng với các phép đo nhân trắc học được thực hiện để đánh giá tình trạng phát triển của bé trong lần đánh giá đầu tiên. Bé phát triển bình thường, giống như những đứa trẻ khác cùng tuổi. Ngoại trừ tim, tất cả các hệ thống khác được kiểm tra đều bình thường. Một nghiên cứu siêu âm tim đã phát hiện ra các khối tăng âm, giới hạn rõ trên cả hai cơ nhú của tâm thất trái, không có sự thay đổi về kích thước và không gây tắc nghẽn dòng chảy vào tâm thất trái.",
+        "translated_summary": "Chúng tôi báo cáo về một trường hợp khối u nội tâm thất ở thai nhi không gây triệu chứng, được phát hiện ở tuần thứ 32 của thai kỳ và được theo dõi ngoại trú cho đến tuần thứ 39 cộng một ngày, sau đó được thực hiện mổ lấy thai. Sau khi sinh, trẻ được đánh giá vào ngày thứ 1, ngày thứ 7, ngày thứ 30, tháng thứ 7 và tháng thứ 12. Sau khi kiểm tra, sự phát triển về mặt thể chất và thần kinh của trẻ đều bình thường. Ngoại trừ khối u, khối u này không tăng hoặc giảm kích thước, không có tiêu chí chẩn đoán lâm sàng nào của hội chứng xơ cứng mạch não được đáp ứng ở trẻ này cho đến khi trẻ được một tuổi."
+    },
+    {
+        "id": "multiclinsum_gs_en_124.txt",
+        "fulltext": "13-year-old boy from Cusco with a history of laryngeal papillomatosis since the age of two (at the age of three he required a tracheostomy) and a mother with a history of genital papilloma. The patient was admitted to the San Borja National Institute of Child Health in Lima, after a 16-day illness characterised by respiratory difficulties predominantly at night, inspiratory laryngeal stridor and moderate dysphonia; he previously received azithromycin and oxygen support, without improvement.\n\nThe physical examination revealed mild subcostal retraction, decreased vesicular murmurs in the left hemithorax and scanty wheezy breath sounds with predominance in the right hemithorax, which required oxygen support with a binasal cannula at 4 liters. The rest of the evaluation had no relevant findings. At the laboratory level, leukocytes were found at 8.03 × 103/u, platelets 209 × 103/u, hemoglobin 13.2 g/dL, C-reactive protein at 36.6 mg/L. As part of the imaging studies, a chest radiograph and a head and neck tomography were performed.\n\n48 hours after admission, she presented with increased stridor and respiratory difficulty, so admission to the emergency operating room for tracheostomy, microsurgery and excision of papillomatosis lesions was decided. An appendicular tumour of papillomatose appearance with ventricular bands in the epiglottis, glottic face, vocal cords, subglottis and trachea up to ring 5 was evident. The anatomopathological report reported coilocitic atypia due to HPV and mild focal dysplasia.\n\nIn the immediate postoperative period, he was transferred to the paediatric intensive care unit for respiratory monitoring, with weaning from oxygen at 48 hours. He received a single dose of bevacizumab 400 mg intravenous and subsequently improved clinically. The patient remained hospitalised for seven days, achieving clinical stability through normalisation of oxygen saturation levels and progressive weaning from oxygen, and was subsequently referred to the hospital in Breña to continue his management. Telemonitoring was carried out after eight months and the family indicated that there was no evidence of relapse or other intercurrences.\n",
+        "summary": "A 13-year-old boy with a history of laryngeal papillomatosis since the age of two years was presented. The patient presented respiratory distress and multiple stenosing nodules in the larynx and trachea, and several pulmonary cysts were visualized on a chest tomography. The patient underwent exeresis of the papillomatosis lesions and tracheostomy. He received a single dose of 400 mg bevacizumab intravenous and respiratory therapy with a favorable evolution, without recurrence in the follow-up.\n",
+        "translated_fulltext": "Một cậu bé 13 tuổi đến từ Cusco, có tiền sử bị u nhú thanh quản từ năm hai tuổi (đến năm ba tuổi phải phẫu thuật mở khí quản) và mẹ có tiền sử bị u nhú bộ phận sinh dục. Bệnh nhân được đưa vào Viện Sức khỏe Nhi quốc gia San Borja ở Lima sau 16 ngày bị bệnh, với các triệu chứng bao gồm khó thở, đặc biệt vào ban đêm, tiếng rít khi hít vào và khàn giọng vừa phải; trước đó, bệnh nhân đã được dùng azithromycin và hỗ trợ oxy, nhưng không thấy cải thiện.\n\nKhám lâm sàng cho thấy có tình trạng co rút nhẹ dưới xương sườn, tiếng rì rào phế nang giảm ở nửa lồng ngực bên trái và tiếng thở khò khè nhẹ, chủ yếu ở nửa lồng ngực bên phải, cần hỗ trợ oxy bằng ống thông mũi kép với lưu lượng 4 lít. Các kết quả kiểm tra khác không có gì đặc biệt. Xét nghiệm máu cho thấy số lượng bạch cầu là 8,03 × 103/u, số lượng tiểu cầu là 209 × 103/u, hemoglobin là 13,2 g/dL và protein phản ứng C là 36,6 mg/L. Trong quá trình chẩn đoán hình ảnh, bệnh nhân được chụp X-quang phổi và chụp cắt lớp đầu và cổ.\n\nSau 48 giờ nhập viện, bệnh nhân có các triệu chứng rít và khó thở tăng lên, do đó, quyết định đưa bệnh nhân vào phòng phẫu thuật cấp cứu để mở khí quản, phẫu thuật vi mạch và loại bỏ các tổn thương u nhú. Kết quả cho thấy có một khối u hình đuôi phụ, có hình dạng u nhú, với các dải trong tâm thất ở thanh quản, mặt thanh quản, dây thanh quản, dưới thanh quản và khí quản, kéo dài đến sụn số 5. Báo cáo giải phẫu bệnh cho thấy có sự bất thường tế bào koilocytic do HPV và loạn sản nhẹ khu trú.\n\nTrong giai đoạn hậu phẫu sớm, bệnh nhân được chuyển đến khoa hồi sức tích cực nhi để theo dõi hô hấp, và được giảm dần lượng oxy sau 48 giờ. Bệnh nhân được tiêm một liều duy nhất bevacizumab 400 mg đường tĩnh mạch và sau đó tình trạng lâm sàng được cải thiện. Bệnh nhân ở lại bệnh viện trong bảy ngày, đạt được sự ổn định lâm sàng thông qua việc bình thường hóa mức độ bão hòa oxy và giảm dần lượng oxy, sau đó được chuyển đến bệnh viện ở Breña để tiếp tục điều trị. Sau tám tháng, bệnh nhân được theo dõi từ xa và gia đình cho biết không có dấu hiệu tái phát hoặc các biến chứng khác.",
+        "translated_summary": "Một bé trai 13 tuổi, có tiền sử bị bệnh u nhú thanh quản từ năm hai tuổi, đã được đưa đến khám. Bệnh nhân có biểu hiện khó thở và nhiều nốt sần gây hẹp ở thanh quản và khí quản, đồng thời, chụp cắt lớp ngực cho thấy có nhiều nang phổi. Bệnh nhân đã được phẫu thuật cắt bỏ các tổn thương u nhú và mở khí quản. Sau đó, bệnh nhân được truyền tĩnh mạch một liều duy nhất 400mg bevacizumab và điều trị hỗ trợ hô hấp, tình trạng bệnh tiến triển tốt, không tái phát trong quá trình theo dõi."
+    },
+    {
+        "id": "multiclinsum_gs_en_412.txt",
+        "fulltext": "A 54-year-old male who had a medical history of membranous nephropathy II with nephrotic syndrome was administered with long-term oral glucocorticoids and immunosuppressants. The patient had a 20 pack-year history of smoking, and denied a family history of hereditary diseases. Chest x-ray demonstrated normal findings at one month before admission. On August 8, 2016, the patient was hospitalized for fever accompanied by progressive dyspnea, cough, and expectoration for 5 days. On admission, the BMI of the patient was 24.5 kg/m2, and his body temperature was 39.0°C. Furthermore, the patient had symptoms of tachypnea (35 bpm) and severe hypoxemia (SaO2 86%). On auscultation, the patient had good air entrance bilaterally with scattered diffuse crackles and rhonchi. Furthermore, the chest CT scan revealed multiple ground-glass opacities, and laboratory tests revealed normal white blood cell (WBC) count, but with elevated neutrophil count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and (1→3)-β-D-glucan. The patient was diagnosed as RSV infection on the fourth day of hospitalization when positive RSV-Ab was detected.\n\nOn admission, the patient was immediately given respiratory monitoring and supplemental oxygen to improve the low oxygen saturation, as well as antibiotics (moxifloxacin for 4 days, followed by cefminoxine for 8 days), and antifungal therapy (voriconazole for 10 days). The dose of the glucocorticoids and immunosuppressants remained largely unchanged. After 10 days of treatment, the patient's condition became worse. Chest CT revealed the progression of the disease, and oxygen partial pressure was further decreased. The patient was transferred to the Emergency Intensive Care Unit, where the patient was intensively treated, including noninvasive mechanical ventilation, broad-spectrum antibiotics (i.v. meropenem, oral moxifloxacin, and cotrimoxazole), antifungal therapy (micafungin), corticosteroids (methylprednisolone 40 mg bid iv) to relieve the inflammation, and other supportive treatment. Ganciclovir was also prescribed due to a possibility of viral infection, such as cytomegalovirus. Five days later, the patient's condition was further aggravated based on the chest x-ray evaluation. Despite receiving another round of treatments, including invasive ventilator-assisted ventilation therapy, methylprednisolone (80 mg bid), antibacterial agents (cefoperazone sulbactam, tigecycline, and cotrimoxazole) and antifungal (micafungin) therapy, the patient eventually died after 2 days.",
+        "summary": "Patient concerns:\nA 54-year-old male patient with chronic nephropathy, who received long-term immunosuppressants, was admitted to the Department of Respiratory Medicine due to the symptoms of fever, cough, expectoration, and dyspnea.\n\nDiagnoses:\nPulmonary radiology revealed multiple bilateral ground-glass opacity. Laboratory tests revealed elevated inflammation indicators, implying infection with bacteria, viruses, and/or fungi. Furthermore, the patient was positive for RSV antibodies, without positive results for other pathogens. Moreover, the patient was immunocompromised due to the long-term use of corticosteroids and immunosuppressants, as evidenced by decreased total IgG levels and reduced CD4 and CD8 T-lymphocyte counts.\n\nInterventions and outcome:\nDespite the intensive anti-infection treatment and respiratory support, the patient developed rapid progression, and subsequently died of respiratory failure.",
+        "translated_fulltext": "Một bệnh nhân nam 54 tuổi, có tiền sử bệnh viêm cầu thận màng, giai đoạn II, kèm theo hội chứng thận hư, đã được điều trị bằng glucocorticoid đường uống và thuốc ức chế miễn dịch trong thời gian dài. Bệnh nhân có thói quen hút thuốc lá 20 gói/năm và không có tiền sử gia đình mắc các bệnh di truyền. Kết quả chụp X-quang phổi cho thấy các chỉ số bình thường một tháng trước khi nhập viện. Vào ngày 8 tháng 8 năm 2016, bệnh nhân nhập viện vì sốt, kèm theo khó thở tăng dần, ho và khạc đờm trong 5 ngày. Khi nhập viện, chỉ số BMI của bệnh nhân là 24,5 kg/m2 và nhiệt độ cơ thể là 39,0°C. Ngoài ra, bệnh nhân còn có các triệu chứng như thở nhanh (35 lần/phút) và giảm oxy máu nghiêm trọng (SaO2 86%). Khi nghe phổi, thấy có tiếng thở đều hai bên, kèm theo tiếng ran và tiếng rít rào rạc. Kết quả chụp CT ngực cho thấy nhiều vùng mờ như thủy tinh mờ, và các xét nghiệm trong phòng thí nghiệm cho thấy số lượng bạch cầu bình thường, nhưng số lượng bạch cầu trung tính, protein phản ứng C (CRP), tốc độ lắng máu (ESR) và (1→3)-β-D-glucan tăng cao. Bệnh nhân được chẩn đoán nhiễm virus hợp bào hô hấp (RSV) vào ngày thứ tư nhập viện khi phát hiện kháng thể RSV dương tính.\n\nKhi nhập viện, bệnh nhân được theo dõi hô hấp và cung cấp oxy để cải thiện tình trạng thiếu oxy, cũng như dùng kháng sinh (moxifloxacin trong 4 ngày, sau đó là cefminoxine trong 8 ngày) và thuốc chống nấm (voriconazole trong 10 ngày). Liều lượng glucocorticoid và thuốc ức chế miễn dịch vẫn được duy trì. Sau 10 ngày điều trị, tình trạng bệnh nhân trở nên tồi tệ hơn. Chụp CT ngực cho thấy bệnh tiến triển và áp lực oxy giảm thêm. Bệnh nhân được chuyển đến Khoa Hồi sức tích cực, nơi bệnh nhân được điều trị tích cực, bao gồm thở máy không xâm lấn, kháng sinh phổ rộng (meropenem tiêm tĩnh mạch, moxifloxacin đường uống và cotrimoxazole), thuốc chống nấm (micafungin), corticosteroid (methylprednisolone 40 mg hai lần mỗi ngày tiêm tĩnh mạch) để giảm viêm và các biện pháp hỗ trợ khác. Ganciclovir cũng được kê đơn do khả năng nhiễm virus, chẳng hạn như cytomegalovirus. Năm ngày sau, tình trạng bệnh nhân trở nên nghiêm trọng hơn dựa trên đánh giá từ kết quả chụp X-quang phổi. Mặc dù đã được điều trị thêm, bao gồm liệu pháp thở máy xâm lấn, methylprednisolone (80 mg hai lần mỗi ngày), thuốc kháng khuẩn (cefoperazone sulbactam, tigecycline và cotrimoxazole) và liệu pháp chống nấm (micafungin), bệnh nhân cuối cùng đã tử vong sau 2 ngày.",
+        "translated_summary": "Thông tin về bệnh nhân:\nMột bệnh nhân nam 54 tuổi, mắc bệnh thận mãn tính và đã dùng thuốc ức chế miễn dịch trong thời gian dài, nhập viện vào Khoa Hô hấp với các triệu chứng sốt, ho, khạc đờm và khó thở.\n\nChẩn đoán:\nChụp X-quang phổi cho thấy nhiều vùng mờ dạng kính mờ hai bên phổi. Các xét nghiệm trong phòng thí nghiệm cho thấy các chỉ số viêm tăng cao, cho thấy có khả năng nhiễm vi khuẩn, virus và/hoặc nấm. Ngoài ra, bệnh nhân có kháng thể RSV dương tính, nhưng các xét nghiệm khác về các tác nhân gây bệnh khác đều âm tính. Hơn nữa, bệnh nhân bị suy giảm miễn dịch do sử dụng corticosteroid và thuốc ức chế miễn dịch trong thời gian dài, được chứng minh bằng việc giảm nồng độ IgG tổng thể và giảm số lượng tế bào lympho T CD4 và CD8.\n\nCan thiệp và kết quả:\nMặc dù đã được điều trị tích cực bằng thuốc kháng nhiễm và hỗ trợ hô hấp, bệnh nhân vẫn tiến triển nhanh chóng và sau đó tử vong do suy hô hấp."
+    },
+    {
+        "id": "multiclinsum_gs_en_301.txt",
+        "fulltext": "A 34-year-old patient with a disease duration of four weeks. Two months earlier, she had a cesarean section in the 37th week of pregnancy and had persistent bleeding from the surgical wound. She denied a history of bleeding in childhood or adolescence. Three years earlier, she had given birth to her first child (also by cesarean section), who died due to a chromosome disorder (referred to by the patient). She also stated that she was allergic to tramadol.\n\nThe clinical picture began with lower back pain due to bilateral renal lithiasis. Subsequently, he managed to expel a stone and after that he presented haematuria for three days, for which he received tranexamic acid c/12 h. Three weeks later, he presented pain in the lower region of the left thigh that increased in intensity, with hardening of the area. Due to persistence of the symptoms, he was given diclofenac intramuscularly, which caused ecchymosis and bleeding in the gluteal area and persists despite the compression with gauze.\n\nThe patient underwent a particular Doppler ultrasound that revealed deep venous thrombosis of the left lower limb, and went to the hospital in her locality with these results. She was given anticoagulation with enoxaparin 30 mg/24 h subcutaneously, in addition to morphine for pain management and was hospitalized. The next day, she presented epigastralgia, blurred vision, heart rate of 117 beats/min, blood pressure of 113/85 mmHg and saturation of 93%. It was decided to discontinue enoxaparin. The blood count revealed a hemoglobin of 6.4 g/dl, which represented a difference of 4 g/dl from the result one day before admission, which was 10.4 g/dl. Because of the above, two blood transfusions were given. Due to the suspicion of vasculitis, methylprednisolone was indicated and she was referred to our hospital for further study.\n\nOn admission, the physical examination revealed severe pallor, extensive ecchymosis on the left thigh and lateral knee, and a haematoma on the right thigh. The haemogram showed moderate anaemia (Hb = 9.8 g/dl), normocytic and normochromic. The biochemical examination showed glucose values of 160 mg/dl. The liver enzymes AST and ALT were at 52 U/L and 86 U/L, respectively. The coagulation profile showed a prolonged activated partial thromboplastin time (APTT) of 91.2 s. The rest of the haemogram, biochemical, electrolyte, liver profile and coagulation profile were normal. The ultrasound of soft parts of the right gluteal region revealed a collection at the level of the subcutaneous cellular tissue (TCSC) and oedema up to the upper third of the thigh. The Doppler ultrasound in the left lower limb showed adequate flowometry without signs of thrombosis in the common femoral vein, superficial and deep.\n\nSymptomatic treatment was initiated and blood and urine cultures were requested and were negative. Antinuclear antibody (ANA) values, complement C3 and C4 and ferritin were within the reference range.\n\nIn the face of suspected acquired haemophilia, studies were requested for confirmation, where a partial correction of aPTT was found in the mixing test. Factor VIII was measured and its activity was found to be decreased (<1.0 U/dl) and the presence of a factor VIII inhibitor was demonstrated: 8.64 Bethesda units/ml. The above allowed the diagnosis of acquired haemophilia to be confirmed, which was related to the postpartum period due to the onset of symptoms.\n\nPrednisone 50 mg orally at breakfast and 10 mg orally at lunch, cyclophosphamide 50 mg 2 tablets orally every 24 hours and anti-inhibitor coagulant complex for haemophilia (FEIBA) were initiated. Five days later, the latter was discontinued due to chest tightness, dyspnoea and nausea (possible adverse drug reaction) and replaced with activated recombinant factor VII (NovoSeven).\n\nThe patient's clinical evolution was favorable, with a decrease in ecchymosis and no other symptoms, so she was discharged from the hospital.\n",
+        "summary": "A 34-year-old female patient presented with lower back pain, haematuria and a haematoma in the right gluteal region, with no previous history of bleeding. Due to the extent of the haemorrhagic manifestations, she was transferred to the emergency department. The coagulation profile, mixing test and measurement of the factor VIII inhibitor titres confirmed the diagnosis.\n",
+        "translated_fulltext": "Một bệnh nhân 34 tuổi, thời gian mắc bệnh kéo dài bốn tuần. Hai tháng trước, cô đã trải qua phẫu thuật mổ lấy thai ở tuần thứ 37 của thai kỳ và bị chảy máu liên tục từ vết mổ. Cô phủ nhận tiền sử chảy máu trong thời thơ ấu hoặc tuổi thiếu niên. Ba năm trước, cô sinh con đầu lòng (cũng bằng phương pháp mổ lấy thai), nhưng đứa trẻ đã qua đời do rối loạn nhiễm sắc thể (theo lời khai của bệnh nhân). Cô cũng cho biết mình bị dị ứng với tramadol.\n\nTình trạng lâm sàng bắt đầu với đau lưng dưới do sỏi thận hai bên. Sau đó, cô đã tống được viên sỏi ra và sau đó bị tiểu ra máu trong ba ngày, và cô đã được dùng tranexamic acid mỗi 12 giờ. Ba tuần sau, cô bị đau ở vùng dưới đùi trái, cơn đau tăng dần và vùng đó bị cứng. Do các triệu chứng vẫn tiếp diễn, cô được tiêm bắp diclofenac, gây ra bầm tím và chảy máu ở vùng mông, tình trạng này vẫn tiếp diễn mặc dù đã chườm gạc.\n\nBệnh nhân được thực hiện siêu âm Doppler đặc biệt, kết quả cho thấy tắc mạch tĩnh mạch sâu ở chi dưới trái, và cô đã đến bệnh viện ở địa phương với kết quả này. Cô được dùng thuốc chống đông máu bằng enoxaparin 30 mg/24 giờ tiêm dưới da, ngoài ra còn dùng morphine để giảm đau và được nhập viện. Ngày hôm sau, cô bị đau vùng thượng vị, mờ mắt, nhịp tim 117 lần/phút, huyết áp 113/85 mmHg và độ bão hòa oxy là 93%. Quyết định ngừng sử dụng enoxaparin. Xét nghiệm máu cho thấy nồng độ hemoglobin là 6,4 g/dL, giảm 4 g/dL so với kết quả một ngày trước khi nhập viện, là 10,4 g/dL. Do đó, cô đã được truyền hai đơn vị máu. Do nghi ngờ bị viêm mạch, cô được chỉ định dùng methylprednisolone và được chuyển đến bệnh viện của chúng tôi để tiếp tục điều trị.\n\nKhi nhập viện, khám lâm sàng cho thấy da xanh xao nghiêm trọng, bầm tím lan rộng ở đùi trái và đầu gối bên, và một khối máu tụ ở đùi phải. Xét nghiệm máu cho thấy thiếu máu vừa phải (Hb = 9,8 g/dL), hồng cầu có kích thước và màu sắc bình thường. Xét nghiệm sinh hóa cho thấy nồng độ glucose là 160 mg/dL. Các enzym gan AST và ALT lần lượt là 52 U/L và 86 U/L. Xét nghiệm đông máu cho thấy thời gian thromboplastin từng phần hoạt hóa (APTT) kéo dài là 91,2 giây. Các xét nghiệm máu, sinh hóa, điện giải, chức năng gan và đông máu khác đều bình thường. Siêu âm các mô mềm của vùng mông phải cho thấy có một khối ở lớp mô liên kết dưới da (TCSC) và phù lan đến phần trên của đùi. Siêu âm Doppler ở chi dưới trái cho thấy lưu lượng máu tốt, không có dấu hiệu tắc nghẽn ở tĩnh mạch đùi chung, tĩnh mạch nông và tĩnh mạch sâu.\n\nĐiều trị triệu chứng được bắt đầu và các mẫu máu và nước tiểu được gửi đi xét nghiệm, kết quả đều âm tính. Nồng độ kháng thể kháng nhân (ANA), bổ thể C3 và C4, và ferritin nằm trong phạm vi tham chiếu.\n\nTrước tình trạng nghi ngờ bệnh máu khó đông mắc phải, các xét nghiệm đã được yêu cầu để xác nhận, và kết quả cho thấy có sự cải thiện một phần về APTT trong xét nghiệm trộn. Nồng độ yếu tố VIII được đo và thấy hoạt tính giảm (<1,0 U/dL) và có sự hiện diện của chất ức chế yếu tố VIII: 8,64 đơn vị Bethesda/mL. Kết quả trên cho phép xác định chẩn đoán bệnh máu khó đông mắc phải, có liên quan đến giai đoạn hậu sản do sự khởi phát của các triệu chứng.\n\nPrednisone 50 mg uống vào buổi sáng và 10 mg uống vào buổi trưa, cyclophosphamide 50 mg, 2 viên uống mỗi 24 giờ và phức hợp chống đông máu cho bệnh máu khó đông (FEIBA) được bắt đầu. Năm ngày sau, thuốc sau đó đã được ngừng do bệnh nhân bị khó thở, khó thở và buồn nôn (có thể là phản ứng bất lợi của thuốc) và được thay thế bằng yếu tố VII tái tổ hợp hoạt hóa (NovoSeven).\n\nTình trạng lâm sàng của bệnh nhân tiến triển tốt, với việc giảm bầm tím và",
+        "translated_summary": "Một bệnh nhân nữ 34 tuổi đến khám với các triệu chứng đau lưng dưới, tiểu ra máu và có khối máu tụ ở vùng mông phải, bệnh nhân không có tiền sử chảy máu trước đó. Do mức độ nghiêm trọng của các triệu chứng xuất huyết, bệnh nhân được chuyển đến khoa cấp cứu. Các xét nghiệm về khả năng đông máu, xét nghiệm trộn và đo nồng độ chất ức chế yếu tố VIII đã xác nhận chẩn đoán."
+    },
+    {
+        "id": "multiclinsum_gs_en_47.txt",
+        "fulltext": "We present here the case of a two-day old neonate with in-born right scrotal swelling admitted at Children’s hospital. The patient was born at term via cesarean section at a private hospital. He was kept in the nursery for one day. The examining doctor referred them for urgent surgical care, but it took them one day to arrive at our hospital. Upon arrival in the emergency department, he was well hydrated, pink at room temperature with good perfusion. Upon examination, the right testis was found to be enlarged, tense, non-tender visibly reddish with overlying skin excoriation. Trans-illumination was negative in the right but positive in the contralateral testis. Both hernial orifices were normal. All the laboratory investigations were performed with an urgent Doppler ultrasound of the inguinoscrotal area. The ultrasound examination found the right testis to be enlarged (15.6*9.4 mm) and showed heterogeneous hypoechoic texture with prominent rete testis and no flow on color Doppler analysis. Left testis appeared normal in size, shape and echotexture with minimal hydrocele. An urgent scrotal exploration was undertaken. Intra-operatively, there was frank necrotic right testis with intravaginal torsion of the testis with minimal hydrocele. A right orchidectomy and contralateral orchidopexy was then performed.",
+        "summary": "We present here the case of a two-day old neonate with in-born right scrotal swelling admitted at Children’s hospital. The patient was born at term via cesarean section at a private hospital. Upon arrival in the emergency department, he was well hydrated, pink at room temperature with good perfusion. Upon examination, the right testis was found to be enlarged, tense, non-tender visibly reddish with overlying skin excoriation. Trans-illumination was negative in right but positive in the contralateral testis. Both hernial orifices were normal. Doppler ultrasound of the inguinoscrotal area found the right testis to be enlarged (15.6*9.4 mm) and showed heterogeneous hypoechoic texture with prominent rete testis and no flow on color doppler analysis. An urgent scrotal exploration was undertaken. Intra-operatively there was frank necrotic right testis with intravaginal torsion of the testis and minimal hydrocele. A right orchidectomy and contralateral orchidopexy were performed.",
+        "translated_fulltext": "Chúng tôi xin trình bày trường hợp của một trẻ sơ sinh hai ngày tuổi bị sưng bướu ở tinh hoàn phải từ khi sinh, được đưa vào bệnh viện Nhi. Bệnh nhân được sinh ra bằng phương pháp mổ lấy thai tại một bệnh viện tư nhân. Bé được giữ lại phòng chăm sóc đặc biệt trong một ngày. Bác sĩ khám đã giới thiệu bé đến để được phẫu thuật cấp cứu, nhưng phải mất một ngày nữa mới đến được bệnh viện của chúng tôi. Khi đến phòng cấp cứu, bé có tình trạng hydrat hóa tốt, da có màu hồng bình thường ở nhiệt độ phòng và tuần hoàn tốt. Khi khám, tinh hoàn phải được phát hiện là sưng to, căng, không đau khi chạm vào và có màu đỏ, cùng với tình trạng trầy xước da ở vùng da bao quanh. Kiểm tra bằng đèn chiếu xuyên qua cho thấy tinh hoàn phải không có bất thường, nhưng tinh hoàn đối diện lại có. Cả hai lỗ thoát vị bẹn đều bình thường. Tất cả các xét nghiệm trong phòng thí nghiệm đã được thực hiện, cùng với đó là siêu âm Doppler khẩn cấp vùng bẹn-tinh hoàn. Kết quả siêu âm cho thấy tinh hoàn phải bị sưng to (15,6*9,4 mm) và có cấu trúc không đồng nhất, giảm độ vang, với mạng lưới tinh hoàn nổi bật và không có dòng chảy khi phân tích bằng siêu âm Doppler màu. Tinh hoàn trái có kích thước, hình dạng và cấu trúc siêu âm bình thường, chỉ có một lượng nhỏ dịch màng tinh hoàn. Một cuộc phẫu thuật thăm dò tinh hoàn khẩn cấp đã được thực hiện. Trong quá trình phẫu thuật, tinh hoàn phải bị hoại tử rõ ràng, với tình trạng xoắn tinh hoàn trong bao tinh hoàn và có một lượng nhỏ dịch màng tinh hoàn. Sau đó, phẫu thuật cắt bỏ tinh hoàn phải và cố định tinh hoàn đối diện đã được thực hiện.",
+        "translated_summary": "Chúng tôi xin trình bày trường hợp của một trẻ sơ sinh hai ngày tuổi bị sưng bướu ở tinh hoàn phải từ khi sinh, được đưa vào bệnh viện Nhi. Bệnh nhân được sinh ra đúng ngày dự sinh bằng phương pháp mổ lấy thai tại một bệnh viện tư. Khi đến phòng cấp cứu, trẻ có tình trạng hydrat hóa tốt, da có màu hồng bình thường ở nhiệt độ phòng và tuần hoàn tốt. Khi khám, tinh hoàn phải được phát hiện là to, căng, không đau khi sờ, có màu đỏ và da xung quanh bị trầy xước. Kiểm tra bằng đèn chiếu xuyên qua cho thấy tinh hoàn phải không có bất thường, nhưng tinh hoàn đối diện lại có. Cả hai lỗ bẹn đều bình thường. Siêu âm Doppler vùng bẹn-tinh hoàn cho thấy tinh hoàn phải to (15,6*9,4 mm) và có cấu trúc không đồng nhất, giảm độ vang, với mạng lưới tinh hoàn nổi bật và không có dòng chảy khi phân tích bằng Doppler màu. Một cuộc phẫu thuật cấp cứu để khám vùng tinh hoàn đã được thực hiện. Trong quá trình phẫu thuật, tinh hoàn phải bị hoại tử rõ ràng, với tình trạng xoắn tinh hoàn trong bao và có một lượng nhỏ dịch màng tinh hoàn. Phẫu thuật cắt bỏ tinh hoàn phải và cố định tinh hoàn đối diện đã được thực hiện."
+    },
+    {
+        "id": "multiclinsum_gs_en_289.txt",
+        "fulltext": "4-year-old male patient with a history of nasal impetigo two weeks before admission (treated with topical mupirocin and oral cefadroxil; dose, duration and adherence to treatment unknown), with no other morbid history, who presented macroscopic glomerular haematuria associated with oedema of the lower extremities of 5 days' evolution, with the last 12 hours prior to the consultation adding headaches, nausea and vomiting. He went to the emergency department (ED) in convulsive status, after 20 minutes of generalised tonic-clonic convulsions.\n\nOn admission to the ED, the patient was afebrile, with non-evaluable blood pressure, with quantitative consciousness impairment associated with generalized hypertonia and bilateral and pretibial oedema. Endotracheal intubation was decided and phenobarbital (10 mg/kg) was administered to manage the convulsive status.\n\nOn physical examination in the intensive care unit (ICU), blood pressure was 134/94 mmHg (BP 110 mmHg) (p95 for patient 108/66 mmHg, p95+12 120/78 mmHg).\n\nInitial laboratory parameters included: complete urine with haematuria (> 100 erythrocytes per field), proteinuria 3+ and leucocyturia 10-25 per field, creatinemia 0.3 mg/dL, anaemia with haematocrit (HTO) 21%, haemoglobin (Hb) 7 g/dL, with normal mean corpuscular volume (VCM) and mean corpuscular haemoglobin concentration (CHCM), leukocytosis of 23,900 cells/mm3, thrombocytosis of 756,000/mm3, without elevation of acute phase reactants, hypocomplementemia with complement C3 level at 25 mg/dL (normal value, VN: 80-150 mg/dL) and normal C4. The rapid antigen test for Streptococcus beta-haemolytic group A (Streptococcus pyogenes) in pharynx was positive and the Anti-streptolysin O (ASO) was (+). The non-contrast brain computed tomography showed no acute changes. The renal ultrasound concluded bilateral nephromegaly with increased cortical echogenicity and decreased corticomedullar differentiation.\n\nThe patient was diagnosed with nephritic syndrome due to complicated GNAPE with hypertensive emergency - convulsive status.\n\nWithin the first 24 hours of his ICU stay, the patient required mechanical ventilation (MV) and anticonvulsant therapy with phenobarbital. He progressed without seizures, with a normal electroencephalogram (EEG) (on the day following admission) and a normal cerebrospinal fluid study. Antibiotic therapy was initiated for eradication of Streptococcus pyogenes with cefotaxime and diuretic therapy with furosemide.\n\nThe next day, he developed renal impairment with creatinine elevation to 0.99 mg/dL, hypertension and 24 hour proteinuria of 36.6 mg/m2/h, without oliguria. He initiated antihypertensive therapy with amlodipine and intravenous labetalol, with good initial control.\n\nWith favorable evolution, extubation was performed at 48 hours, which was well tolerated from the ventilatory point of view. However, after 24 hours of extubation, the patient's consciousness deteriorated, with both ocular opening and withdrawal of limb only in response to painful stimulus and poor verbal response (Glasgow Coma Scale 8), and developed blood pressure figures > p95+12 despite receiving therapy with labetalol in continuous infusion (up to 3 mg/kg/h), amlodipine (10 mg/day) and furosemide, which required the reintroduction of mechanical ventilation and infusion of sodium nitroprusside (up to 3 mcg/kg/min), with the aim of achieving gradual reduction of blood pressure figures (25% daily) to prevent secondary neurological damage. Given the presence of acute neurological symptomatology associated with HTA in a patient with glomerulonephritis, the diagnosis of PRES was suspected, which was confirmed by magnetic resonance imaging (MRI) of the brain (day 5), which showed an increase in the subcortical signal in bilateral and symmetric occipital region, without restriction in diffusion, which was compatible with vasogenic edema (PRES). Ophthalmological evaluation was normal and a new EEG evidenced occasional episodes of generalized voltage depression.\n\nAdding enalapril to the treatment. Finally, after 10 days with a slow pharmacological weaning, normalization of blood pressure was achieved. The control MRI (day 12) revealed regression of the previously described findings. Successful extubation was achieved after 5 days.\n\nDuring his stay in the ICU, the hemoglobin level dropped to 5 g/dL, with normal mean corpuscular volume and mean corpuscular hemoglobin concentration, without plateletopenia, so hemolytic anemia was suspected given a positive direct Coombs test and hemoglobinuria. He required red blood cell transfusions twice. Steroid therapy with methylprednisolone (1 mg/kg/d) was initiated for 72 hours. The coproculture was negative, as was the urinary antigen for Streptococcus pneumoniae. Epstein-Barr virus and Parvovirus B19 serology, extractable nuclear antigen (ENA) profile, anti-neutrophil cytoplasmic antibodies (ANCA), anti-DNA antibodies, anti-B2 glycoprotein 1 antibodies, anti-cardiolipin antibodies and lupus anticoagulant were all negative. All cultures were negative (blood cultures, urine cultures, cultures of endotracheal aspirate and pharyngeal cultures). ANA (antinuclear antibodies) was positive 1/160.\n\nThe patient improved with blood pressure normalization, increased complement levels, and a urine test without proteinuria or hematuria. The direct Coombs test remained positive on the 9th day of hospitalization.\n\nOn day 31, the patient was discharged normotensive, without anaemia, with preserved renal function, without proteinuria or haematuria, with normalisation of C3 levels and asymptomatic from the neurological point of view. He was discharged with pharmacological therapy with prednisone, amlodipine, enalapril and folic acid. The patient did not present recurrence and remained asymptomatic 6 months after discharge.\n",
+        "summary": "4-year-old male patient with a history of 5 days of haematuria and oedema, with additional headaches, nausea and vomiting, who entered a convulsive state and hypertensive crisis. Laboratory tests showed hypocomplementemia C3 and elevated Anti-Streptolysin O titers, which was interpreted as GNAPE. He developed encephalopathy, which led to suspicion of secondary PRES due to hypertensive emergency, which was finally confirmed by magnetic resonance of the brain. He also developed autoimmune haemolytic anaemia with haemoglobin up to 5 g/dL. His treatment was based on antihypertensive therapy, neuroprotection measures and steroid treatment. He was discharged after 31 days of hospitalisation, asymptomatic 6 months after discharge.\n",
+        "translated_fulltext": "Bệnh nhân nam 4 tuổi, tiền sử bị viêm da do liên cầu khuẩn ở mũi hai tuần trước khi nhập viện (điều trị bằng mupirocin bôi tại chỗ và cefadroxil đường uống; liều lượng, thời gian và mức độ tuân thủ điều trị không rõ), không có bệnh sử khác, nhập viện với biểu hiện tiểu ra máu vi thể kèm theo phù ở hai chân, kéo dài 5 ngày, trong 12 giờ trước khi khám, bệnh nhân còn bị đau đầu, buồn nôn và nôn. Bệnh nhân được đưa đến khoa cấp cứu trong tình trạng co giật, sau 20 phút co giật toàn thân.\n\nKhi nhập khoa cấp cứu, bệnh nhân không sốt, huyết áp không đo được, ý thức suy giảm kèm theo tăng trương lực cơ toàn thân và phù hai bên, phù trước xương chày. Quyết định đặt nội khí quản và dùng phenobarbital (10 mg/kg) để kiểm soát tình trạng co giật.\n\nTrong quá trình thăm khám lâm sàng tại khoa hồi sức tích cực (ICU), huyết áp là 134/94 mmHg (BP 110 mmHg) (p95 của bệnh nhân là 108/66 mmHg, p95+12 là 120/78 mmHg).\n\nCác chỉ số xét nghiệm ban đầu bao gồm: tổng phân tích nước tiểu có tiểu ra máu (> 100 hồng cầu mỗi trường), protein niệu 3+ và bạch cầu niệu 10-25 mỗi trường, creatinin máu 0,3 mg/dL, thiếu máu với tỷ lệ hồng cầu (HTO) 21%, hemoglobin (Hb) 7 g/dL, thể tích hồng cầu trung bình (VCM) và nồng độ hemoglobin trung bình trong hồng cầu (CHCM) bình thường, tăng bạch cầu 23.900 tế bào/mm3, tăng tiểu cầu 756.000/mm3, không tăng các chất phản ứng pha cấp tính, giảm bổ thể với nồng độ C3 là 25 mg/dL (giá trị bình thường, VN: 80-150 mg/dL) và C4 bình thường. Xét nghiệm nhanh tìm kháng nguyên liên cầu khuẩn nhóm A (Streptococcus pyogenes) trong họng dương tính và kháng thể Anti-streptolysin O (ASO) dương tính. Chụp cắt lớp vi tính não không dùng thuốc cản quang cho thấy không có thay đổi cấp tính. Siêu âm thận cho thấy thận to hai bên, tăng độ vang của vỏ thận và giảm sự phân biệt giữa vỏ và tủy thận.\n\nBệnh nhân được chẩn đoán mắc hội chứng viêm cầu thận do viêm cầu thận sau nhiễm liên cầu khuẩn, kèm theo tăng huyết áp cấp cứu - tình trạng co giật.\n\nTrong 24 giờ đầu nằm ở ICU, bệnh nhân cần thở máy và điều trị bằng thuốc chống co giật phenobarbital. Tình trạng bệnh nhân tiến triển tốt, không bị co giật, điện não đồ (EEG) bình thường (vào ngày hôm sau khi nhập viện) và kết quả xét nghiệm dịch não tủy bình thường. Bắt đầu điều trị bằng kháng sinh để loại bỏ Streptococcus pyogenes bằng cefotaxime và điều trị bằng thuốc lợi tiểu furosemide.\n\nNgày hôm sau, bệnh nhân bị suy thận với creatinin tăng lên 0,99 mg/dL, tăng huyết áp và protein niệu 24 giờ là 36,6 mg/m2/h, không có thiểu niệu. Bắt đầu điều trị bằng thuốc hạ huyết áp amlodipine và labetalol tiêm tĩnh mạch, kiểm soát tốt ban đầu.\n\nVới diễn biến tốt, bệnh nhân được rút ống nội khí quản sau 48 giờ, và bệnh nhân dung nạp tốt về mặt hô hấp. Tuy nhiên, sau 24 giờ rút ống nội khí quản, ý thức của bệnh nhân suy giảm, chỉ mở mắt và rút chi khi có kích thích đau và phản ứng bằng lời nói kém (Thang điểm Glasgow 8), và huyết áp tăng > p95+12 mặc dù đã được điều trị bằng labetalol truyền liên tục (tối đa 3 mg/kg/giờ), amlodipine (10 mg/ngày) và furosemide, điều này đòi hỏi phải tái khởi động thở máy và truyền natri nitroprusside (tối đa 3 mcg/kg/phút), với mục tiêu giảm dần huyết áp (25% mỗi ngày) để ngăn ngừa tổn thương thần kinh thứ phát. Do có các triệu chứng thần kinh cấp tính liên quan đến tăng huyết áp ở bệnh nhân bị viêm cầu thận, nghi ngờ chẩn đoán PRES, và điều này được xác nhận bằng chụp cộng hưởng từ (MRI) não (ngày",
+        "translated_summary": "Bệnh nhân nam, 4 tuổi, có tiền sử 5 ngày tiểu ra máu và phù, kèm theo đau đầu, buồn nôn và nôn, sau đó xuất hiện tình trạng co giật và tăng huyết áp cấp tính. Các xét nghiệm trong phòng thí nghiệm cho thấy nồng độ C3 thấp và nồng độ kháng thể Anti-Streptolysin O tăng cao, được chẩn đoán là hội chứng viêm cầu thận cấp sau nhiễm liên cầu khuẩn (GNAPE). Bệnh nhân phát triển bệnh não, dẫn đến nghi ngờ về hội chứng PRES thứ phát do tăng huyết áp cấp tính, và điều này cuối cùng được xác nhận bằng cộng hưởng từ não. Bệnh nhân cũng bị thiếu máu tan máu tự miễn với mức hemoglobin giảm xuống 5 g/dL. Điều trị bao gồm liệu pháp hạ huyết áp, các biện pháp bảo vệ thần kinh và điều trị bằng steroid. Bệnh nhân được xuất viện sau 31 ngày nằm viện và không có triệu chứng trong vòng 6 tháng sau khi xuất viện."
+    },
+    {
+        "id": "multiclinsum_gs_en_564.txt",
+        "fulltext": "A 69-year-old male with prior history of CABG presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration was admitted in our center. The electrocardiogram showed ST depression in leads II, III, aVF, and V4-6, and blood examination revealed elevation of plasma N-terminal pro-B-type natriuretic peptide levels (2640 pg/mL). Echocardiogram showed left ventricular systolic dysfunction and low left ventricular ejection fraction (30%). The patient had inferior ST-segment-elevation myocardial infarction in 2009, when he was 59 years old, with angiographic evidence of severe 3 vessels disease (coronary angiography showed CTO in proximal left anterior descending artery (LAD), 90% stenosis in mid and distal left circumflex artery, and 95% stenosis in mid RCA. The patient underwent CABG with left internal mammary artery (LIMA) to LAD, and sequential SVG to 1st obtuse marginal branch (OM1), 2nd obtuse marginal branch (OM2), and posterolateral branch (PL) in 2009.\n\nCoronary angiography was performed via 6 French (Fr) left radial artery access and demonstrated patency of LIMA to LAD and SVG to OM1, OM2 conduits, but a complete occlusion of sequential SVG to PL conduit. Native left main coronary artery was occluded in ostium and native RCA was occluded in the mid portion with bridging collaterals. We decided to treat the native RCA CTO. Dual arterial access was achieved with another 6 Fr sheath in right femoral artery. The left and right coronary arteries were intubated with 6 Fr AL 0.75 (Launcher; Medtronic; USA) and 6 Fr EBU 3.5 (Launcher; Medtronic; USA) guide catheters, respectively. An antegrade approach via left radial artery was attempted; however, neither Fielder XTR wire (Asahi Intec, Japan) nor Gaia 3 wire (Asahi Intec, Japan) with Finecross microcatheter (Terumo, Japan) reached the true lumen in distal RCA. Then, parallel wire technique with Crusade microcatheter (Kaneka, Japan) and two Gaia 3 wires (Asahi Intec, Japan) were attempted, but also failed. We therefore switched to the retrograde approach using septal channel from LAD through occluded left coronary artery. Gaia 3 wire (Asahi Intec, Japan) crossed occluded left main (LM) and LAD, and finally reached true lumen in distal LAD. Sion wire was exchanged by Finecross microcatheter (Terumo, Japan) into dital LAD, and dilation of LM and proximal LAD with a 2.0 × 15 mm balloon was performed. Then, septal surfing technique (SST) was used for septal crossing. We tried different septal channels originating from proximal to distal LAD, and delivered Sion wire (Asahi Intec, Japan) retrogradely through distal septal branch into distal RCA supported by a 150-cm Finecross microcatheter (Terumo, Japan). Gaia 3 wire (Asahi Intec, Japan) crossed CTO lesion retrogradely into the true lumen in proximal RCA, and was advanced into Guidezilla guide extension catheter (Boston Scientific, USA) positioned in the antegrade guiding catheter. The Finecross microcatheter (Terumo, Japan) was delivered to the antegrade catheter and a RG3 wire (Asahi Intec, Japan) was externalized. The CTO was then predilated by a 2.0 × 15 mm balloon and stented with 2 overlapping drug-eluting stents (2.5 × 38 mm and 3.0 × 38 mm) with excellent angiographic result and TIMI3 flow in all distal branches.\n\nDyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea.",
+        "summary": "Patient concerns:\nThis is a 69-year-old male with prior history of coronary artery bypass grafting presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration.\n\nDiagnosis:\nThe patient was diagnosed as heart failure caused by ischemia after SVG failure (SVG to right coronary artery) according to electrocardiogram, plasma N-terminal pro-B-type natriuretic peptide levels, and coronary angiogram.\n\nInterventions:\nWe recanalized native right coronary artery CTO by retrograde approach using septal collaterals by surfing technique after recanalization of totally occluded left coronary artery.\n\nOutcomes:\nDyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea.",
+        "translated_fulltext": "Một bệnh nhân nam 69 tuổi, tiền sử đã từng phẫu thuật bắc cầu động mạch vành (CABG), nhập viện tại trung tâm của chúng tôi với tình trạng khó thở nghiêm trọng khi gắng sức nhẹ (NYHA III), kéo dài trong 2 tháng. Điện tâm đồ cho thấy ST chênh xuống ở các chuyển đạo II, III, aVF và V4-6, và xét nghiệm máu cho thấy nồng độ peptide natriuretic loại B đầu N trong huyết tương tăng cao (2640 pg/mL). Siêu âm tim cho thấy rối loạn chức năng co bóp thất trái và phân suất tống máu thất trái thấp (30%). Bệnh nhân bị nhồi máu cơ tim ST chênh lên vùng dưới vào năm 2009, khi ông 59 tuổi, với bằng chứng chụp mạch vành cho thấy bệnh mạch vành nghiêm trọng ở 3 mạch (chụp mạch vành cho thấy tắc hoàn toàn động mạch vành trước trái (LAD) gần, hẹp 90% ở động mạch vành trái bên và xa, và hẹp 95% ở động mạch vành phải (RCA) giữa). Bệnh nhân đã được phẫu thuật CABG bằng cách sử dụng động mạch vú trong trái (LIMA) để nối với LAD, và sử dụng tĩnh mạch ghép tuần tự (SVG) để nối với nhánh bên màng ngoài thứ nhất (OM1), nhánh bên màng ngoài thứ hai (OM2) và nhánh sau bên (PL) vào năm 2009.\n\nChụp mạch vành được thực hiện qua đường động mạch quay trái 6 French (Fr) và cho thấy LIMA nối với LAD và SVG nối với OM1, OM2 thông suốt, nhưng có tắc hoàn toàn SVG nối với PL. Động mạch vành trái gốc bị tắc ở lỗ và động mạch vành phải bị tắc ở phần giữa với các nhánh nối. Chúng tôi quyết định điều trị tắc hoàn toàn động mạch vành phải (RCA CTO). Tiếp cận hai động mạch được thực hiện bằng cách sử dụng một ống thông 6 Fr khác ở động mạch đùi phải. Động mạch vành trái và phải được đặt ống thông bằng ống thông dẫn đường 6 Fr AL 0.75 (Launcher; Medtronic; USA) và 6 Fr EBU 3.5 (Launcher; Medtronic; USA), tương ứng. Một phương pháp tiếp cận thuận chiều qua động mạch quay trái đã được thử, tuy nhiên, cả dây dẫn Fielder XTR (Asahi Intec, Nhật Bản) và dây dẫn Gaia 3 (Asahi Intec, Nhật Bản) với ống thông vi mạch Finecross (Terumo, Nhật Bản) đều không thể tiếp cận được lòng mạch thực sự ở RCA xa. Sau đó, kỹ thuật sử dụng song song dây dẫn với ống thông vi mạch Crusade (Kaneka, Nhật Bản) và hai dây dẫn Gaia 3 (Asahi Intec, Nhật Bản) đã được thử, nhưng cũng không thành công. Do đó, chúng tôi chuyển sang phương pháp tiếp cận ngược chiều bằng cách sử dụng kênh vách liên thất từ LAD qua động mạch vành trái bị tắc. Dây dẫn Gaia 3 (Asahi Intec, Nhật Bản) vượt qua động mạch vành trái gốc (LM) và LAD bị tắc, và cuối cùng tiếp cận được lòng mạch thực sự ở LAD xa. Dây dẫn Sion được thay thế bằng ống thông vi mạch Finecross (Terumo, Nhật Bản) vào LAD xa, và nong lòng mạch LM và LAD gần bằng bóng 2.0 × 15 mm. Sau đó, kỹ thuật lướt vách liên thất (SST) được sử dụng để vượt qua vách liên thất. Chúng tôi thử nghiệm các kênh vách liên thất khác nhau bắt nguồn từ LAD gần đến xa, và đưa dây dẫn Sion (Asahi Intec, Nhật Bản) ngược chiều qua nhánh vách liên thất xa vào RCA xa, được hỗ trợ bởi ống thông vi mạch Finecross 150 cm (Terumo, Nhật Bản). Dây dẫn Gaia 3 (Asahi Intec, Nhật Bản) vượt qua tổn thương CTO ngược chiều vào lòng mạch thực sự ở RCA gần, và được đưa vào ống thông dẫn đường Guidezilla (Boston Scientific, USA) được đặt ở ống thông dẫn đường thuận chiều. Ống thông vi mạch Finecross (Terumo, Nhật Bản) được đưa vào ống thông thuận chiều và dây dẫn RG3 (Asahi Intec, Nhật Bản) được đưa ra ngoài. Sau đó, CTO được nong trước bằng bóng 2.0 × 15 mm và đặt hai stent giải phóng thuốc chồng lên nhau (2.5 × 38 mm và 3.0 × 38 mm) với kết quả chụp mạch vành tuyệt vời và lưu lượng TIMI3 ở tất cả các nhánh xa.\n\nTình",
+        "translated_summary": "Thông tin về bệnh nhân:\nBệnh nhân là nam, 69 tuổi, có tiền sử phẫu thuật bắc cầu động mạch vành, nhập viện vì khó thở nghiêm trọng khi gắng sức nhẹ (mức độ III theo phân loại NYHA), tình trạng này kéo dài trong 2 tháng.\n\nChẩn đoán:\nBệnh nhân được chẩn đoán suy tim do thiếu máu cơ tim sau khi cầu nối mạch máu suy yếu (cầu nối đến động mạch vành phải), dựa trên kết quả điện tâm đồ, nồng độ peptide natriuretic loại B ở đầu tận huyết tương và chụp mạch vành.\n\nCan thiệp:\nChúng tôi đã tái thông động mạch vành phải bị tắc hoàn toàn bằng phương pháp tiếp cận ngược dòng, sử dụng các nhánh nối bên thông qua kỹ thuật \"surfing\" sau khi tái thông động mạch vành trái bị tắc hoàn toàn.\n\nKết quả:\nTình trạng khó thở của bệnh nhân thuyên giảm khi xuất viện. Sau 6 tháng theo dõi, bệnh nhân không bị tái phát khó thở."
+    },
+    {
+        "id": "multiclinsum_gs_en_399.txt",
+        "fulltext": "A 51-year-old male patient presented to us with acute painful visual loss of his left eye (LE) from 3 days ago. The best-corrected distance visual acuity (BCDVA) was 20/20, and hand motion (HM) detection for the right eye (RE) and LE, respectively. The ocular movement was normal in both eyes. Anterior segment examination was unremarkable for both eyes. The LE fundus examination showed ONH swelling, choroidal bulging, multiple patches of subretinal fluid accumulation, and retinal pigment epithelial (RPE) corrugations. Fundus examination of the RE was unremarkable.\n\nWe used multimodal imaging including Optical coherence tomography (OCT) (OptoVue, Inc., Fremont, CA, USA, software version: 2018,0,0,18), fundus blue-autofluorescence (BAF), fluorescein angiography (FA) (Heidelberg Eye Explorer version 1.9.13.0, Spectralis Viewing Module 6.5.2.0; Heidelberg Engineering), Indocyanin green angiography (ICGA), and B-scan ultrasonography for further evaluation. Besides, orbital and brain MRIs with gadolinium enhancement were ordered. The OCT image revealed a mild RPE and choroidal bulging, RPE hyper-reflectivity with back shadowing, subretinal and intraretinal fluid accumulation, and mild retinal thickening. A geographic area of macular hypocyanescence was apparent in the ICGA image of the left eye. BAF showed a geographic area with a speckled autofluorescence pattern at the macula. Optic nerve enlargement was found in the B-scan ultrasonography. In FA images, vascular leakage was apparent at the ONH (hot disc). Besides, a geographic patchy hypofluorescent area with speckled hyperfluorescent margins with a size of three disc diameters (DD) was detected. Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement at the junction of the optic nerve and sclera. An oncology consultation was done with no remarkable finding.\n\nConsidering the suspicion of malignancy and the presence of an enhancing nodular mass in the orbit, the patient underwent transconjunctival lateral orbitotomy one week after the presentation. A pink localized scleral nodule with edematous tenon was found. Sub-tenon triamcinolone acetonide was injected with the clinical diagnosis of nodular posterior scleritis. The patient refused admission and intravenous corticosteroid injection as the treatment order. Oral prednisolone 50 mg/Kg was started. Rheumatology consultation and screening lab results, including PPD test (tuberculosis), chest X-ray, serum ACE level (sarcoidosis), and C-ANCA level (Wegner granulomatosis), were unremarkable. At the last follow-up examination (one week after the surgery), the patient’s BCDVA was 20/20, and counting fingers at 2 meters for the RE and LE, respectively. Furthermore, SRF was absorbed, and the macula became atrophic. Oral prednisolone was tapered off slowly for three months.",
+        "summary": "A 51-year-old male patient presented to us with acute painful visual loss of his left eye (LE) from 3 days ago. The best-corrected distance visual acuity (BCDVA) was 20/20 and hand motion (HM) for the right eye (RE) and LE, respectively. Fundus examination of the LE showed ONH swelling, choroidal bulging, multiple patches of subretinal fluid accumulation, and retinal pigment epithelial (RPE) corrugations. Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement at the optic nerve and sclera junction. Oncology and rheumatology work-ups were unremarkable. With the clinical diagnosis of nodular posterior scleritis oral prednisolone 50 mg/Kg was started.",
+        "translated_fulltext": "Một bệnh nhân nam 51 tuổi đến khám với tình trạng mất thị lực đột ngột và đau ở mắt trái (ME) bắt đầu cách đây 3 ngày. Thị lực tốt nhất sau khi điều chỉnh (BCDVA) là 20/20, và khả năng nhận biết cử động tay (HM) ở mắt phải (ME) và mắt trái (MT) tương ứng. Chuyển động của nhãn cầu bình thường ở cả hai mắt. Khám phân đoạn trước của mắt không phát hiện bất thường ở cả hai mắt. Khám đáy mắt của mắt trái cho thấy phù dây thần kinh thị giác (ONH), phồng màng mạch, nhiều vùng tích tụ dịch dưới võng mạc và các nếp gấp ở lớp biểu mô sắc tố võng mạc (RPE). Khám đáy mắt của mắt phải không phát hiện bất thường.\n\nChúng tôi sử dụng các phương pháp chẩn đoán hình ảnh đa mô, bao gồm chụp cắt lớp quang học (OCT) (OptoVue, Inc., Fremont, CA, USA, phiên bản phần mềm: 2018,0,0,18), chụp đáy mắt bằng phương pháp tự phát quang xanh (BAF), chụp mạch huỳnh quang (FA) (Heidelberg Eye Explorer phiên bản 1.9.13.0, Mô-đun xem Spectralis 6.5.2.0; Heidelberg Engineering), chụp mạch bằng thuốc nhuộm xanh indocyanine (ICGA) và siêu âm quét B để đánh giá thêm. Ngoài ra, chụp cộng hưởng từ (MRI) ổ mắt và não có sử dụng chất cản từ gadolinium cũng được chỉ định. Hình ảnh OCT cho thấy phồng nhẹ RPE và màng mạch, tăng phản xạ của RPE với bóng mờ phía sau, tích tụ dịch dưới và trong võng mạc, và tăng độ dày nhẹ của võng mạc. Một vùng địa lý giảm độ huỳnh quang ở hoàng điểm xuất hiện trong hình ảnh ICGA của mắt trái. BAF cho thấy một vùng địa lý với kiểu tự phát quang dạng đốm ở hoàng điểm. Siêu âm quét B cho thấy dây thần kinh thị giác bị phì đại. Trong hình ảnh FA, rò rỉ mạch máu rõ rệt ở ONH (vùng đĩa nóng). Ngoài ra, một vùng địa lý giảm huỳnh quang dạng đám với các đường viền tăng huỳnh quang dạng đốm, có kích thước bằng ba đường kính đĩa thị (DD), cũng được phát hiện. MRI ổ mắt và não cho thấy một khối u dạng nốt sau nhãn cầu với sự tăng cường gadolinium tại vị trí giao giữa dây thần kinh thị giác và củng mạc. Một cuộc tư vấn với bác sĩ chuyên khoa ung thư đã được thực hiện, nhưng không phát hiện điều gì đáng chú ý.\n\nDo nghi ngờ có khối u ác tính và có sự hiện diện của một khối u dạng nốt tăng cường trong ổ mắt, bệnh nhân đã được phẫu thuật mở ổ mắt qua đường kết mạc bên một tuần sau khi đến khám. Một nốt củng mạc màu hồng, khu trú, có phù bao Tenon đã được phát hiện. Triamcinolone acetonide dưới bao Tenon đã được tiêm với chẩn đoán lâm sàng là viêm củng mạc sau dạng nốt. Bệnh nhân từ chối nhập viện và tiêm corticosteroid tĩnh mạch theo chỉ định điều trị. Bệnh nhân bắt đầu dùng prednisolone đường uống với liều 50 mg/kg. Tư vấn với bác sĩ chuyên khoa thấp khớp và các xét nghiệm sàng lọc, bao gồm xét nghiệm PPD (lao), chụp X-quang phổi, nồng độ ACE huyết thanh (sarcoidosis) và nồng độ C-ANCA (granulomatosis Wegner), không cho thấy kết quả bất thường. Tại lần khám theo dõi cuối cùng (một tuần sau phẫu thuật), BCDVA của bệnh nhân là 20/20, và khả năng đếm ngón tay ở khoảng cách 2 mét ở mắt phải và mắt trái, tương ứng. Hơn nữa, dịch dưới võng mạc đã được hấp thụ và hoàng điểm trở nên teo. Prednisolone đường uống được giảm liều dần trong ba tháng.",
+        "translated_summary": "Một bệnh nhân nam 51 tuổi đến khám với tình trạng mất thị lực đột ngột và đau ở mắt trái, bắt đầu từ 3 ngày trước. Thị lực tốt nhất sau khi điều chỉnh (BCDVA) là 20/20 ở mắt phải (RE) và chỉ nhận biết được cử động tay (HM) ở mắt trái (LE). Khám đáy mắt của mắt trái cho thấy phù dây thần kinh thị giác, phồng màng mạch, nhiều vùng tích tụ dịch dưới võng mạc và các nếp gấp ở lớp biểu mô sắc tố võng mạc (RPE). Chụp MRI ổ mắt và não cho thấy một khối u dạng nốt sau nhãn cầu, có tăng cường độ tương phản với gadolinium tại vị trí giao thoa giữa dây thần kinh thị giác và củng mạc. Các xét nghiệm về ung thư và bệnh tự miễn không cho thấy bất thường. Dựa trên chẩn đoán lâm sàng là viêm màng cứng sau nhãn cầu dạng nốt, bệnh nhân được bắt đầu điều trị bằng prednisolone đường uống với liều 50 mg/kg."
+    },
+    {
+        "id": "multiclinsum_gs_en_55.txt",
+        "fulltext": "An elderly 78-year-old patient from the Amhara region of Ethiopia, who has had a permanent cardiac pacemaker for 7 years, was scheduled for retropubic prostatectomy due to benign prostatic hyperplasia (BPH). This condition developed following a previous transurethral resection of the prostate 3 months earlier. The patient in the preoperative anesthesia evaluation was fully evaluated, and all the routine investigations required for the proposed surgery, which were within normal limits, were investigated. The patient presented with a history of frequency, urgency, nocturia, and dribbling for the past 2 months. Additionally, the patient had been known to have hypertension for the past 16 years and was taking amlodipine 5 mg orally daily, enalapril 10 mg orally twice daily (BID), and atorvastatin 10 mg orally daily. He had also been known to have type II diabetes mellitus for the past 25 years and was on metformin 500 mg orally BID and neutral protamine Hagedorn (NPH) 20 IU and 10 IU. He was admitted to a hospital for further evaluation, and complete bundle branch block (BBB) was detected via electrocardiogram (ECG). In an electrophysiology study, the patient was diagnosed with left ventricular hypertrophy secondary to hypertensive heart disease, mild diastolic dysfunction, and an ejection fraction of 62%. Abdominal ultrasound revealed an enlarged prostate size of 82 ml; anterior–posterior (AP) chest X-ray revealed a normal chest region with a left-side pacemaker in situ, and all the other blood parameters, including electrolytes and serum troponin levels, were within normal limits.\n\nA cardiologist was involved preoperatively as a multidisciplinary approach and risk determination tool for cardiac risk assessment. The patient had a frailty score of 5.5 with a poor functional cardiopulmonary reserve of metabolic equivalent (MET) = 3.4 and Revised Cardiac Risk Index (RCRI) class III, which accounts for 10.1% of major cardiac adverse events (myocardial infarction [MI], cardiac arrest, or death) within 30 days of the postoperative period, and intermediate risk on the basis of surgery type and patient risk factors. After preoperative evaluation and risk disclosure regarding the un-reprogrammed pacemaker and the associated complications during anesthesia and surgery, the patient was unable to afford the necessary health coverage for pacemaker reprogramming. This is because the cardiac surgery was performed in Addis Ababa, Ethiopia, which has a long waiting list with few cardiac surgeons for millions of people and is a considerable distance from the patient’s home institution, and there is a period of monitoring after pacemaker reprogramming for considerable post-reprogramming complication. As a result, the patient chose to proceed with the surgery, accepting the potential risks and harm associated with the situation. Continuous cardiac monitoring during the intraoperative period is highly advocated. Despite these factors, the patient did not experience cardiorespiratory failure, and he was stable. The patient continued on medication until the day of surgery, which included amlodipine, enalapril, atorvastatin, and a morning lower dose of two-thirds of the NPH. He also took 5 mg of diazepam orally for anxiolytics at midnight before the day of surgery.\n\nOn the day of surgery, the patient’s random blood sugar (RBS) was measured, and sliding scale glycemic control was implemented. Communication among the anesthetist, surgeon, and nurses was emphasized, ensuring that the cautery pad was placed away from the pacemaker, and that emergency drugs and a defibrillator were ready. The patient was premedicated with dexamethasone for nausea prophylaxis and paracetamol for pain relief as preemptive analgesia. American Society of Anesthesiology (ASA) standard monitoring was applied, and baseline parameters were recorded. Combined epidural–spinal anesthesia was administered via 0.5% isobaric bupivacaine (12.5 mg) and 50 µg fentanyl at the L3–L4 interspace. The block achieved anesthesia up to the umbilicus, and the sensory block was performed at T7. The surgery involved a midline incision below the umbilicus, with monopolar cautery used at low voltage (20 mA). Hemostasis was achieved through bipolar low-voltage cautery. Throughout the procedure, the patient’s vital signs remained stable. The patient’s vital signs did not change by more than 10% from the baseline vital signs. The intravenous fluid was resuscitated intraoperatively. During the postoperative period, the patient was transferred to the postanesthesia care unit (PACU) with vigilant monitoring, and 10 ml of 0.125% epidural top-up analgesia was given. Postop investigations were within normal limits. The patient was observed in the PACU for 12 hours and later transferred to the ward in stable condition with regular follow-up with the cardiology team. After 88th day of postsurgery the patient was discharged and advised to have regular checkups for pacemaker’s in situ status.",
+        "summary": "A 78-year-old male from the Amhara region, Ethiopia, with a permanent pacemaker for complete heart block was scheduled for retropubic prostatectomy. Preoperative assessments by the anesthetist and cardiologist recommended reprogramming the pacemaker to asynchronous mode to reduce risks related to its dual-chamber, rate-modulated mode setting. However, the patient could not afford reprogramming and opted to proceed with the existing perioperative plan. Informed consent was obtained, and case report publication permission was obtained after operation. The patient received combined epidural-spinal anesthesia with 2.50 ml of 0.5% isobaric bupivacaine and 50 µg fentanyl at the L3-L4 interspace. Standard American Society of Anesthesiology monitoring was applied, with a focus on cardiac stability. The patient remained stable with minimal vital sign fluctuations and maintained adequate blood pressure using isotonic saline. Postoperatively, the patient was transferred to the postanesthesia care unit, receiving analgesia after 4 hours and an epidural top-up. After 6 hours, he was transferred to the ward in stable condition. Epidural analgesia was continued for 72 hours, and the patient was discharged on the 88th postoperative hour in stable condition.",
+        "translated_fulltext": "Một bệnh nhân lớn tuổi, 78 tuổi, đến từ vùng Amhara của Ethiopia, đã được cấy máy tạo nhịp tim vĩnh viễn trong 7 năm, được lên lịch phẫu thuật cắt bỏ tuyến tiền liệt qua đường sau xương mu do phì đại tuyến tiền liệt lành tính (BPH). Tình trạng này phát triển sau khi bệnh nhân đã trải qua phẫu thuật cắt bỏ tuyến tiền liệt qua niệu đạo 3 tháng trước đó. Bệnh nhân đã được đánh giá toàn diện trước phẫu thuật, và tất cả các xét nghiệm thường quy cần thiết cho ca phẫu thuật dự kiến, đều nằm trong giới hạn bình thường. Bệnh nhân có tiền sử đi tiểu thường xuyên, tiểu gấp, tiểu đêm và tiểu són trong 2 tháng qua. Ngoài ra, bệnh nhân đã được chẩn đoán mắc bệnh tăng huyết áp trong 16 năm qua và đang dùng amlodipine 5mg đường uống mỗi ngày, enalapril 10mg đường uống hai lần mỗi ngày và atorvastatin 10mg đường uống mỗi ngày. Bệnh nhân cũng mắc bệnh tiểu đường loại II trong 25 năm qua và đang dùng metformin 500mg đường uống hai lần mỗi ngày và neutral protamine Hagedorn (NPH) 20 IU và 10 IU. Bệnh nhân được đưa vào bệnh viện để đánh giá thêm, và trên điện tâm đồ (ECG) phát hiện ra tình trạng block nhánh bó hoàn toàn (BBB). Trong quá trình nghiên cứu điện sinh lý, bệnh nhân được chẩn đoán mắc chứng phì đại thất trái thứ phát do bệnh tim tăng huyết áp, rối loạn chức năng tâm trương nhẹ và phân suất tống máu là 62%. Siêu âm bụng cho thấy kích thước tuyến tiền liệt tăng lên 82 ml; chụp X-quang ngực trước-sau (AP) cho thấy vùng ngực bình thường với máy tạo nhịp tim ở bên trái, và tất cả các chỉ số máu khác, bao gồm cả điện giải và nồng độ troponin trong huyết thanh, đều nằm trong giới hạn bình thường.\n\nMột bác sĩ tim mạch đã tham gia vào quá trình chuẩn bị trước phẫu thuật như một phần của phương pháp tiếp cận đa ngành và là công cụ để xác định rủi ro đánh giá rủi ro tim mạch. Bệnh nhân có điểm đánh giá tình trạng suy yếu là 5,5 với khả năng dự trữ chức năng tim phổi kém, tương đương chuyển hóa (MET) = 3,4 và chỉ số rủi ro tim mạch sửa đổi (RCRI) loại III, điều này chiếm 10,1% các biến cố tim mạch nghiêm trọng (nhồi máu cơ tim, ngừng tim hoặc tử vong) trong vòng 30 ngày sau phẫu thuật, và mức độ rủi ro trung bình dựa trên loại phẫu thuật và các yếu tố rủi ro của bệnh nhân. Sau khi đánh giá trước phẫu thuật và thông báo về rủi ro liên quan đến máy tạo nhịp tim chưa được lập trình lại và các biến chứng liên quan trong quá trình gây mê và phẫu thuật, bệnh nhân không đủ khả năng chi trả cho bảo hiểm y tế cần thiết để lập trình lại máy tạo nhịp tim. Điều này là do phẫu thuật tim mạch được thực hiện ở Addis Ababa, Ethiopia, nơi có danh sách chờ đợi dài và số lượng bác sĩ phẫu thuật tim mạch hạn chế cho hàng triệu người, đồng thời đây là một khoảng cách đáng kể so với nơi ở của bệnh nhân, và cần có một khoảng thời gian theo dõi sau khi lập trình lại máy tạo nhịp tim để theo dõi các biến chứng sau khi lập trình lại. Do đó, bệnh nhân đã chọn tiếp tục phẫu thuật, chấp nhận những rủi ro và tác hại tiềm ẩn liên quan đến tình hình này. Việc theo dõi tim liên tục trong quá trình phẫu thuật được khuyến khích. Mặc dù có những yếu tố này, bệnh nhân không bị suy tim và hô hấp, và tình trạng của bệnh nhân ổn định. Bệnh nhân tiếp tục dùng thuốc cho đến ngày phẫu thuật, bao gồm amlodipine, enalapril, atorvastatin và liều thấp hơn hai phần ba NPH vào buổi sáng. Bệnh nhân cũng dùng 5mg diazepam đường uống để giảm lo lắng vào nửa đêm trước ngày phẫu thuật.\n\nVào ngày phẫu thuật, lượng đường trong máu ngẫu nhiên (RBS) của bệnh nhân được đo và kiểm soát đường huyết theo thang trượt được thực hiện. Việc giao tiếp giữa bác sĩ gây mê, bác sĩ phẫu thuật và y tá được nhấn mạnh, đảm bảo rằng miếng đệm đốt điện được đặt cách xa máy tạo nhịp tim và các loại thuốc cấp cứu và máy khử rung sẵn sàng. Bệnh nhân được dùng dexamethasone trước phẫu thuật để phòng ngừa buồn nôn và paracetamol để giảm đau như một biện pháp giảm đau dự phòng",
+        "translated_summary": "Một bệnh nhân nam 78 tuổi, đến từ vùng Amhara, Ethiopia, được cấy máy tạo nhịp tim vĩnh viễn để điều trị chứng rối loạn nhịp tim hoàn toàn, đã được lên lịch phẫu thuật cắt bỏ tuyến tiền liệt qua đường sau xương mu. Các đánh giá tiền phẫu của bác sĩ gây mê và bác sĩ tim mạch cho thấy nên điều chỉnh lại máy tạo nhịp tim sang chế độ không đồng bộ để giảm thiểu rủi ro liên quan đến chế độ hai buồng và điều chỉnh nhịp tim. Tuy nhiên, bệnh nhân không đủ khả năng tài chính để điều chỉnh lại máy và quyết định tiếp tục theo kế hoạch phẫu thuật hiện tại. Sau khi được thông báo đầy đủ và đồng ý, bệnh nhân đã được phẫu thuật. Sau phẫu thuật, bệnh nhân đã được cấp phép để công bố báo cáo ca bệnh. Bệnh nhân được gây mê kết hợp ngoài màng cứng-tủy sống với 2,50 ml dung dịch bupivacaine 0,5% đẳng trương và 50 µg fentanyl tại khoảng gian đốt sống L3-L4. Bệnh nhân được theo dõi theo tiêu chuẩn của Hội Gây mê Hoa Kỳ, tập trung vào sự ổn định của tim. Bệnh nhân duy trì tình trạng ổn định với sự thay đổi tối thiểu về các dấu hiệu sinh tồn và duy trì huyết áp thích hợp bằng dung dịch muối đẳng trương. Sau phẫu thuật, bệnh nhân được chuyển đến phòng hồi sức sau gây mê, được giảm đau sau 4 giờ và tiêm thêm thuốc giảm đau ngoài màng cứng. Sau 6 giờ, bệnh nhân được chuyển đến phòng bệnh trong tình trạng ổn định. Thuốc giảm đau ngoài màng cứng được tiếp tục trong 72 giờ và bệnh nhân được xuất viện vào giờ thứ 88 sau phẫu thuật trong tình trạng ổn định."
+    },
+    {
+        "id": "multiclinsum_gs_en_317.txt",
+        "fulltext": "A 52-year-old woman referred to the urology clinic with urinary complaints. Her symptoms began three years ago with frequency, dysuria and dribbling. She also mentioned the frequent passage of red and black thread-like substances in her urine. Moreover, during these discharges, she had headache, fever and chills. Intermittent periurethral and genital itching was another complaint of hers. She had been treated by several specialists with the diagnosis of recurrent urinary tract infections, with no clinical improvement. The patient denied recent travel, camping, hiking, farming, swimming and insect bites. She had positive history of pilonidal sinus surgery and hysterectomy, 8 and 7 years earlier, respectively. Two years prior to the current visit, she had been hospitalized for assessment. On physical examination, she was well-appearing with normal vital signs. All her laboratory tests, including cell blood count, urine analysis and biochemistries were in normal ranges. Abdominopelvic computed tomography (CT) scan revealed no abnormalities. Hence, she underwent cystoscopy, which demonstrated erythema and hyperemia of the bladder mucosa, suspended debris, and dilation of the left ureteral orifice. During consultation with an infectious diseases’ specialist, schistosomiasis was suspected, Therefore, she was treated with Praziquantel with the appropriate dose and duration and was discharged from the hospital.\n\nHowever, her symptoms did not subside. She was revisited by another infectious disease specialist, who prescribed her ivermectin due to suspicion to urinary myiasis. Nevertheless, no improvement was observed. She was readmitted to undergo bladder irrigation with polyethylene glycol, but the bladder washfluid did not contain any visible larvae. This procedure was followed by a two-day hematuria with spontaneous cessation. She was discharged home and advised to repeat the urine analysis one months later. Her random urine analysis was normal, so she collected her 24-h urine and sent it to the laboratory for analysis, in which a live larva was demonstrated under light microscope by the pathologist. The larva was isolated and sent to an entomologist to be identified morphologically. Finally, it was determined that the larva belonged to the species Sarcophaga. The patient was advised to take personal hygiene and consume at least 3 L of water daily.",
+        "summary": "We report a 52-year-old woman with persistent dysuria, frequency despite multiple treatments for suspected infections. Cystoscopy revealed erythema and debris, but imaging and laboratory tests were unremarkable. A live larva was identified in urine analysis, confirming the diagnosis. Treatment involved improved hygiene and hydration.",
+        "translated_fulltext": "Một phụ nữ 52 tuổi đến khám tại phòng khám tiết niệu vì các vấn đề về đường tiết niệu. Các triệu chứng của bà bắt đầu cách đây ba năm với các biểu hiện như tiểu nhiều lần, tiểu khó và tiểu són. Bà cũng đề cập đến việc thường xuyên thấy các chất giống như sợi chỉ màu đỏ và đen trong nước tiểu. Hơn nữa, trong thời gian có các triệu chứng này, bà bị đau đầu, sốt và ớn lạnh. Ngứa ngáy không liên tục ở vùng niệu đạo và bộ phận sinh dục là một triệu chứng khác của bà. Bà đã được nhiều bác sĩ chuyên khoa điều trị với chẩn đoán nhiễm trùng đường tiết niệu tái phát, nhưng tình trạng không cải thiện. Bệnh nhân phủ nhận việc đi du lịch, cắm trại, đi bộ đường dài, làm nông, bơi lội hoặc bị côn trùng cắn gần đây. Bà có tiền sử phẫu thuật nang lông cùng cụt và cắt tử cung, lần lượt là 8 và 7 năm trước. Hai năm trước khi đến khám lần này, bà đã nhập viện để được đánh giá. Trong quá trình khám lâm sàng, bà có vẻ khỏe mạnh với các dấu hiệu sinh tồn bình thường. Tất cả các xét nghiệm trong phòng thí nghiệm của bà, bao gồm công thức máu, phân tích nước tiểu và các xét nghiệm sinh hóa đều nằm trong phạm vi bình thường. Chụp cắt lớp vi tính (CT) vùng bụng và khung chậu không phát hiện bất thường. Do đó, bà được thực hiện nội soi bàng quang, kết quả cho thấy niêm mạc bàng quang bị viêm và sung huyết, có các mảnh vụn lơ lửng và lỗ niệu quản bên trái bị giãn. Trong quá trình tư vấn với bác sĩ chuyên khoa về bệnh truyền nhiễm, bác sĩ nghi ngờ bệnh giun sán. Do đó, bà được điều trị bằng Praziquantel với liều lượng và thời gian thích hợp, sau đó được xuất viện.\n\nTuy nhiên, các triệu chứng của bà không thuyên giảm. Bà được một bác sĩ chuyên khoa về bệnh truyền nhiễm khác khám lại và được kê đơn ivermectin vì nghi ngờ bệnh ấu trùng ruồi trong đường tiết niệu. Tuy nhiên, không có sự cải thiện nào được ghi nhận. Bà được nhập viện lại để thực hiện rửa bàng quang bằng polyethylene glycol, nhưng chất lỏng rửa bàng quang không chứa ấu trùng nào. Thủ thuật này được theo sau bởi tình trạng tiểu ra máu kéo dài hai ngày, sau đó tự khỏi. Bà được xuất viện và được khuyên nên làm lại xét nghiệm nước tiểu sau một tháng. Kết quả xét nghiệm nước tiểu ngẫu nhiên của bà bình thường, vì vậy bà đã thu thập nước tiểu trong 24 giờ và gửi đến phòng thí nghiệm để phân tích, và kết quả cho thấy có một ấu trùng sống được phát hiện dưới kính hiển vi bởi bác sĩ giải phẫu bệnh. ấu trùng được phân lập và gửi đến nhà côn trùng học để xác định hình thái. Cuối cùng, kết quả xác định ấu trùng thuộc loài Sarcophaga. Bệnh nhân được khuyên nên chú trọng vệ sinh cá nhân và uống ít nhất 3 lít nước mỗi ngày.",
+        "translated_summary": "Chúng tôi báo cáo về một trường hợp bệnh nhân nữ 52 tuổi bị tiểu khó kéo dài và đi tiểu thường xuyên, mặc dù đã được điều trị nhiều lần vì nghi ngờ nhiễm trùng. Nội soi bàng quang cho thấy niêm mạc bị viêm và có mảnh vụn, nhưng các xét nghiệm hình ảnh và xét nghiệm trong phòng thí nghiệm không cho thấy bất thường. Phân tích nước tiểu xác định được một ấu trùng sống, từ đó xác nhận chẩn đoán. Điều trị bao gồm cải thiện vệ sinh cá nhân và tăng cường hydrat hóa."
+    },
+    {
+        "id": "multiclinsum_gs_en_79.txt",
+        "fulltext": "A 36-year-old female patient with a history of ulcerative colitis and good disease control on sulfasalazine, ferrous fumarate and intermittent prednisone for flare-ups is presented.\n\nHe was admitted to the emergency unit with a 1 week history of progressive oppressive precordial pain associated with dyspnea and neurovegetative symptoms. On admission, an electrocardiogram was performed in sinus rhythm, with finding of supradesnivel of the ST segment in the lower wall.\n\nThe patient reported a 6-month history of general disorders, fatigue and night sweats. She had previously presented episodes of precordial pain in relation to effort that progressed to rest. The physical examination was without murmurs or alterations of the peripheral pulses.\n\nAn emergency coronary angiography was performed, which revealed severe 2-vessel disease: severe ostial lesion 90% in the left coronary trunk and severe subocclusive lesion 99-100% at the ostial level in the right coronary artery (culprit vessel). Primary angioplasty of the right coronary artery was performed with successful installation of a medicated stent. The hemodynamicist was impressed by a possible aortitis due to involvement of the arch and friability of the vessels when the balloon was advanced, so he suggested an etiological study oriented to inflammatory disease, prior to surgical resolution of the lesion of the left coronary trunk.\n\nLaboratory tests showed mild anaemia (haemoglobin: 11.6 g/dL), mild leukocytosis (13,800/mm3), elevated erythrocyte sedimentation rate (ESR): 42 mm/h and C-reactive protein (CRP): 4.9 mg/L (normal value <1) and elevated ultrasensitive troponin. From the autoimmunity study, normal levels of complement C3 and C4, negative anti-nuclear antibodies (ANA), anti-DNA, negative extracellular nuclear antigen (ENA) profile and non-reactive VDRL were rescued.\n\nCardiac magnetic resonance (MRI) with contrast was completed with findings of acute infarction of the left ventricular inferior wall non-transmural myocardium and subendocardial ischemia in the anteroseptoapical resting of the left ventricle. Mild aortic and mitral insufficiency. Preserved biventricular systolic function.\n\nComputed tomography angiography (CTA) of the chest, abdomen and pelvis showed periaortic fibrotic wall thickening involving the root, aortic arch and abdominal aorta with severe left coronary trunk stenosis and mild left subclavian, left vertebral artery stenosis and severe lower mesenteric artery stenosis. Immune globulin G (IgG) 4 deposition disease or Takayasu's arteritis was suggested.\n\nWithin the differential diagnosis study, IgG levels were performed at 1,600 mg/dl (reference values: 700-1,600), and its subclasses: IgG1: 1024 mg/dl (elevated), and the rest in normal range (IgG2: 456 mg/dl; IgG3: 98.8 mg/dl and IgG4: 13.6 mg/dl).\n\nTakayasu arteritis was diagnosed clinically and by imaging and treatment was initiated with prednisone 60 mg daily, methotrexate 20 mg weekly by injection and folic acid 1 mg daily. After 3 weeks of treatment she underwent myocardial revascularisation surgery with use of the left internal mammary artery (LIMA) as a graft to the descending anterior artery (DA) and aortocoronary bypass to circumflex artery. It was noted intraoperatively that the root of the aorta and the ascending aorta presented a healthy appearance. The patient is currently at home in good general condition and under ambulatory follow-up.\n",
+        "summary": "A 36-year-old woman with ulcerative colitis presented with progressive precordial pain and neurovegetative symptoms. The electrocardiogram showed a ST segment elevation in the inferior wall. The patient had a history of fatigue and night sweats. She underwent a coronary angiography that revealed severe disease in two coronary arteries, with successful primary angioplasty of the culprit artery. Aortitis was suspected, which led to additional studies, including a mild elevation of inflammatory activity indices and a computed tomographic angiography with periaortic fibrotic thickening and significant stenosis in multiple arteries, suggesting Takayasu arteritis. She was treated with prednisone, methotrexate, and underwent delayed myocardial revascularization surgery with good results.\n",
+        "translated_fulltext": "Một bệnh nhân nữ 36 tuổi, tiền sử viêm loét đại tràng và kiểm soát bệnh tốt bằng sulfasalazine, fumarate sắt và prednisone dùng ngắt quãng trong các đợt bùng phát, được đưa vào bệnh viện.\n\nBệnh nhân nhập viện tại khoa cấp cứu với tiền sử đau thắt ngực ngày càng tăng trong 1 tuần, kèm theo khó thở và các triệu chứng thần kinh thực vật. Khi nhập viện, điện tâm đồ cho thấy nhịp xoang bình thường, với dấu hiệu ST chênh lên ở thành dưới tim.\n\nBệnh nhân cho biết có tiền sử các triệu chứng toàn thân, mệt mỏi và đổ mồ hôi đêm trong 6 tháng. Trước đây, bệnh nhân đã từng bị đau thắt ngực khi gắng sức, sau đó cơn đau xuất hiện ngay cả khi nghỉ ngơi. Khám thực thể không phát hiện tiếng thổi hoặc bất thường về mạch ngoại vi.\n\nMột cuộc chụp mạch vành cấp cứu được thực hiện, cho thấy bệnh mạch vành hai nhánh nghiêm trọng: tổn thương nghiêm trọng ở gốc động mạch vành trái, gây tắc nghẽn 90% và tổn thương bán tắc nghẽn nghiêm trọng, gây tắc nghẽn 99-100% ở gốc động mạch vành phải (động mạch gây bệnh). Phẫu thuật nong mạch vành phải được thực hiện, và một stent có thuốc đã được đặt thành công. Các bác sĩ nhận thấy có khả năng bị viêm động mạch chủ do tổn thương cung động mạch chủ và sự giòn của các mạch máu khi bóng được đưa vào, vì vậy họ đề nghị thực hiện các xét nghiệm để xác định nguyên nhân, hướng tới bệnh viêm, trước khi tiến hành phẫu thuật để giải quyết tổn thương của động mạch vành trái.\n\nCác xét nghiệm trong phòng thí nghiệm cho thấy thiếu máu nhẹ (hemoglobin: 11,6 g/dL), tăng bạch cầu nhẹ (13.800/mm3), tốc độ máu lắng (ESR) tăng cao: 42 mm/giờ và protein phản ứng C (CRP): 4,9 mg/L (giá trị bình thường <1) và troponin nhạy cảm cao tăng. Các xét nghiệm về tự miễn cho thấy nồng độ bổ thể C3 và C4 bình thường, kháng thể kháng nhân (ANA), kháng thể kháng DNA âm tính, hồ sơ kháng nguyên nhân tế bào ngoại (ENA) âm tính và xét nghiệm VDRL không phản ứng.\n\nChụp cộng hưởng từ tim (MRI) có sử dụng thuốc cản quang cho thấy nhồi máu cấp tính ở thành dưới tâm thất trái, không lan qua thành và thiếu máu dưới nội tâm mạc ở vùng trước vách liên thất của tâm thất trái. Suy van hai lá và van động mạch chủ nhẹ. Chức năng co bóp hai tâm thất được bảo tồn.\n\nChụp cắt lớp vi tính mạch máu (CTA) của ngực, bụng và vùng chậu cho thấy thành xơ hóa quanh động mạch chủ, ảnh hưởng đến gốc, cung động mạch chủ và động mạch chủ bụng, kèm theo hẹp nghiêm trọng động mạch vành trái, hẹp nhẹ động mạch dưới đòn trái, động mạch đốt sống trái và hẹp nghiêm trọng động mạch mạc treo dưới. Bệnh lắng đọng immunoglobulin G (IgG) 4 hoặc viêm động mạch Takayasu được gợi ý.\n\nTrong quá trình chẩn đoán phân biệt, nồng độ IgG được đo là 1.600 mg/dL (giá trị tham khảo: 700-1.600), và các phân nhóm của nó: IgG1: 1.024 mg/dL (tăng cao), và các phân nhóm còn lại nằm trong phạm vi bình thường (IgG2: 456 mg/dL; IgG3: 98,8 mg/dL và IgG4: 13,6 mg/dL).\n\nViêm động mạch Takayasu được chẩn đoán lâm sàng và bằng hình ảnh, và điều trị được bắt đầu bằng prednisone 60 mg mỗi ngày, methotrexate 20 mg mỗi tuần bằng đường tiêm và axit folic 1 mg mỗi ngày. Sau 3 tuần điều trị, bệnh nhân đã trải qua phẫu thuật tái tưới máu cơ tim bằng cách sử dụng động mạch ngực trong trái (LIMA) làm cầu nối đến động mạch trước xuống (DA) và cầu nối động mạch chủ - vành đến động mạch mũ. Trong quá trình phẫu thuật, người ta nhận thấy gốc động mạch chủ và động mạch chủ lên có vẻ ngoài khỏe mạnh. Hiện tại, bệnh nhân đang ở nhà, tình trạng sức khỏe tổng thể tốt và đang được theo dõi ngoại trú.",
+        "translated_summary": "Một phụ nữ 36 tuổi bị viêm loét đại tràng đến khám với các triệu chứng đau vùng trước tim ngày càng tăng và các triệu chứng thần kinh thực vật. Điện tâm đồ cho thấy đoạn ST nâng lên ở thành dưới tim. Bệnh nhân có tiền sử mệt mỏi và đổ mồ hôi đêm. Cô được chụp mạch vành, kết quả cho thấy bệnh nặng ở hai động mạch vành, và đã được thực hiện thủ thuật nong mạch vành chính thành công. Nghi ngờ bệnh viêm động mạch chủ, dẫn đến các xét nghiệm bổ sung, bao gồm chỉ số hoạt động viêm tăng nhẹ và chụp mạch máu bằng phương pháp chụp cắt lớp vi tính, cho thấy tình trạng xơ hóa quanh động mạch chủ và hẹp đáng kể ở nhiều động mạch, gợi ý bệnh viêm động mạch Takayasu. Cô được điều trị bằng prednisone, methotrexate và phẫu thuật tái tạo mạch máu cơ tim muộn, kết quả tốt."
+    },
+    {
+        "id": "multiclinsum_gs_en_194.txt",
+        "fulltext": "A 36-year-old female patient complained of dysphagia with longstanding cervical and upper thoracic pain. She also had a multinodular goiter with no other significant history. Esophagogastroduodenal transit was performed. It showed a posterior and lateral right impression of the proximal esophagus after ingestion of baryte, extending 3.5 cm cephalocaudal. A maximum esophageal stenosis of 60% was estimated. A cervical and thoracic CT scan revealed a congenital anomaly of the aortic arch: a mirror image of the right aortic arch. The aortic arch originates from the root of the aorta and runs above the right stem bronchus, giving rise to the three supra-aortic trunks as follows: the first is the left brachiocephalic artery (which gives rise to the left common carotid artery and the left subclavian artery); the second is the right common carotid artery; and the third is the right subclavian artery. The aortic arch then enters posteriorly to the esophagus and gives rise to a small anterior saccule of 1.3 cm, known as the Kommerell diverticulum. This configuration forms a ring around the tracheo-esophageal pair, whose edges are formed posterior-lateral to the right by the aortic arch, posterior-lateral to the left by the Kommerell diverticulum, lateral to the left by the arteriosum ligamentum (or arterial ligament), and anteriorly by the left brachiocephalic artery. A gastroscopy confirmed the endoluminal impact of extrinsic compression. In view of minimal clinical repercussions and the absence of nutritional disorders, no surgical cure was ultimately performed. The evolution was favorable with, according to the patient, a spontaneous amelioration of symptoms.\n",
+        "summary": "We report the case of a 36-year-old female patient whose dysphagia presented a congenital anomaly of the thoracic aorta: the right aortic arch with mirror image. This is a rare anomaly of embryonic development where the aorta winds around the right stem bronchus and the supra-aortic trunks emerge from the crown in the reverse and opposite order to normal. The vast majority of patients are asymptomatic unless there is a compression of the mediastinal structures. Major compression of the esophagus or trachea, aneurysmal disease, thoracic aortic dissection or the presence of a Kommerell diverticulum of more than 2 cm may warrant surgical intervention. There is no standard treatment and it must be adapted to the clinical presentation and anatomical configuration of the patient. Our patient did not receive any treatment for her condition.\n",
+        "translated_fulltext": "Một bệnh nhân nữ 36 tuổi than phiền về chứng khó nuốt kèm theo đau vùng cổ và phần trên ngực kéo dài. Cô cũng bị bướu giáp đa nhân nhưng không có tiền sử bệnh lý đáng kể khác. Bệnh nhân được thực hiện nội soi thực quản - dạ dày - tá tràng. Kết quả cho thấy có một vùng ấn ở phía sau và bên phải của phần trên thực quản sau khi uống baryte, kéo dài 3,5 cm theo chiều dọc. Ước tính mức độ hẹp thực quản tối đa là 60%. Chụp CT vùng cổ và ngực cho thấy một dị tật bẩm sinh của cung động mạch chủ: hình ảnh đối xứng của cung động mạch chủ bên phải. Cung động mạch chủ bắt nguồn từ gốc động mạch chủ và chạy phía trên phế quản gốc bên phải, tạo ra ba thân động mạch trên như sau: thân động mạch cảnh tay trái (tạo ra động mạch cảnh chung trái và động mạch dưới đòn trái); thân động mạch cảnh chung phải; và thân động mạch dưới đòn phải. Sau đó, cung động mạch chủ đi vào phía sau thực quản và tạo ra một túi nhỏ phía trước, dài 1,3 cm, được gọi là túi Kommerell. Cấu trúc này tạo thành một vòng bao quanh cặp khí quản - thực quản, với các cạnh được tạo thành ở phía sau - bên phải bởi cung động mạch chủ, phía sau - bên trái bởi túi Kommerell, bên trái bởi dây chằng động mạch (hoặc dây chằng động mạch), và phía trước bởi động mạch cảnh tay trái. Nội soi dạ dày xác nhận tác động nội quản do chèn ép từ bên ngoài. Do ít ảnh hưởng lâm sàng và không có rối loạn dinh dưỡng, cuối cùng không thực hiện phẫu thuật. Tình trạng bệnh tiến triển tốt, theo lời bệnh nhân, các triệu chứng thuyên giảm tự nhiên.",
+        "translated_summary": "Chúng tôi báo cáo về trường hợp của một bệnh nhân nữ 36 tuổi bị khó nuốt, và tình trạng này cho thấy một dị tật bẩm sinh của động mạch chủ ngực: cung động mạch chủ bên phải với hình ảnh đối xứng. Đây là một dị tật hiếm gặp trong quá trình phát triển phôi thai, trong đó động mạch chủ uốn quanh phế quản gốc bên phải và các nhánh động mạch trên cùng xuất phát từ vị trí ngược và đối diện so với bình thường. Phần lớn bệnh nhân không có triệu chứng trừ khi có sự chèn ép các cấu trúc trung thất. Sự chèn ép đáng kể vào thực quản hoặc khí quản, bệnh phình động mạch, bóc tách động mạch chủ ngực hoặc sự hiện diện của túi Kommerell lớn hơn 2 cm có thể cần phải can thiệp phẫu thuật. Không có phương pháp điều trị tiêu chuẩn và cần phải điều chỉnh theo tình trạng lâm sàng và cấu trúc giải phẫu của bệnh nhân. Bệnh nhân của chúng tôi không được điều trị cho tình trạng này."
+    },
+    {
+        "id": "multiclinsum_gs_en_419.txt",
+        "fulltext": "A 62-year-old Tunisian Arab postmenopausal female diagnosed with Von Hippel–Lindau disease in 2021 presented with various manifestations related to the disease. She had a history of multiple surgeries, primarily for renal, adrenal, and pancreatic tumors, with incidental findings of ovarian masses.\n\nThe patient was asymptomatic from a gynecological standpoint, but primarily complained of headaches before undergoing brain surgery. She had no significant family or psychosocial history.\n\nHer surgical history included\n2021: A non-operable tumor (6 cm) of the left petrous bone endolymphatic sac, managed with radiotherapy.\n\n2021: Left adrenalectomy for a 6 cm pheochromocytoma. Pathological examination revealed pheochromocytoma.\n\n2021: Left nephrectomy for a ruptured left renal tumor. Microscopy showed multifocal clear-cell renal carcinoma of nuclear grade 2.\n\n2022: Cephalic duodenopancreatectomy for a mass in the pancreas. Histological examination confirmed three serous cystadenomas and two well-differentiated neuroendocrine tumors.\n\nIn January 2021, during postoperative surveillance with an abdominal–pelvic computed tomography (CT) scan, a 4 cm solid cystic left adnexal mass was incidentally discovered, which raised suspicion of malignancy. The mass was confirmed by transvaginal ultrasound and pelvic MRI, classified as Ovarian-Adnexal Reporting and Data System (O-RADS) 5 (high suspicion for malignancy).\n\nGynecological examination and surgical history\nPhysical examination: No abdominal–pelvic mass detected.\n\nSpeculum examination: Healthy cervix observed.\n\nSurgical scars from previous left nephrectomy and cephalic duodenopancreatectomy were noted.\n\nA multidisciplinary staff meeting concluded that surgery was necessary. A laparotomy was performed via a midline incision below the umbilicus, revealing a well-defined solid cystic mass in the left adnexa. No ascites or signs of peritoneal carcinomatosis were present, and the right adnexa appeared normal, with no macroscopic signs of malignancy observed intraoperatively, including the absence of exocystic vegetations.\n\nCytology was performed along with left adnexectomy, and the specimen was sent for frozen section examination. The results were inconclusive, raising the possibility of borderline tumors or tumors specific to Von Hippel–Lindau syndrome. Considering the patient’s postmenopausal status, a right adnexectomy and total hysterectomy were performed.\n\nHistological examination later revealed bilateral clear-cell papillary cystadenomas of the Fallopian Tubes and broad ligament, characteristic of Von Hippel–Lindau disease (0.5 cm on the right side and 4 cm on the left side).The tumors consisted of tightly packed papillae with fibrous cores, covered by monolayered epithelium.\n\nThe immediate postoperative period was uneventful, and at the 1-month follow-up, no abnormalities were detected. The patient has since been followed up with every 4 months with normal pelvic ultrasounds. During these 2 years of follow-up, no complications have arisen, but the patient was recently readmitted to the neurosurgery department for recurrence of a brain tumor.",
+        "summary": "A 62-year-old white North African woman diagnosed with Von Hippel-Lindau disease in 2021 presented with multiple manifestations, including a left petrous bone tumor, left pheochromocytoma, left renal cell carcinoma, multi-cystic right kidney, and pancreatic masses. She underwent various treatments, including radiotherapy, adrenalectomy, nephrectomy, and cephalic duodenopancreatectomy. Ultrasonographic and magnetic resonance imaging examinations revealed a solid cystic mass in the left adnexal region. Laparoscopy identified cystic tumors in the right and left mesosalpinx. Following a hysterectomy with bilateral adnexectomy, histological examination revealed bilateral clear-cell papillary cystadenomas of the mesosalpinx and broad ligament, consistent with Von Hippel-Lindau disease.",
+        "translated_fulltext": "Một phụ nữ người Ả Rập gốc Tunisia, 62 tuổi, đã mãn kinh và được chẩn đoán mắc bệnh Von Hippel–Lindau vào năm 2021, đã đến khám với nhiều triệu chứng liên quan đến bệnh. Bà có tiền sử phẫu thuật nhiều lần, chủ yếu để điều trị các khối u ở thận, tuyến thượng thận và tuyến tụy, đồng thời phát hiện thêm các khối u ở buồng trứng.\n\nBệnh nhân không có triệu chứng về mặt phụ khoa, nhưng chủ yếu than phiền về đau đầu trước khi phẫu thuật não. Bà không có tiền sử gia đình hoặc tâm lý xã hội đáng kể.\n\nTiền sử phẫu thuật của bà bao gồm:\n2021: Một khối u không thể phẫu thuật (6 cm) ở túi nội dịch của xương đá bên trái, được điều trị bằng xạ trị.\n\n2021: Cắt bỏ tuyến thượng thận bên trái để loại bỏ một u tủy thượng thận 6 cm. Kết quả kiểm tra bệnh lý cho thấy u tủy thượng thận.\n\n2021: Cắt bỏ thận trái để loại bỏ một khối u thận bị vỡ. Soi kính hiển vi cho thấy ung thư biểu mô tế bào thận đa ổ, độ ác tính 2.\n\n2022: Phẫu thuật cắt bỏ phần đầu tụy và tá tràng để loại bỏ một khối u ở tuyến tụy. Kiểm tra mô học xác nhận ba khối u nang thanh dịch và hai khối u thần kinh nội tiết biệt hóa tốt.\n\nVào tháng 1 năm 2021, trong quá trình theo dõi sau phẫu thuật bằng chụp cắt lớp vi tính (CT) ổ bụng – vùng chậu, một khối u đặc dạng nang 4 cm ở phần phụ bên trái đã được phát hiện, gây nghi ngờ về khả năng ác tính. Khối u được xác nhận bằng siêu âm qua âm đạo và chụp cộng hưởng từ (MRI) vùng chậu, được phân loại theo Hệ thống Báo cáo và Dữ liệu về Buồng trứng – Phần phụ (O-RADS) 5 (nghi ngờ cao về khả năng ác tính).\n\nKhám phụ khoa và tiền sử phẫu thuật:\nKhám lâm sàng: Không phát hiện khối u ở ổ bụng – vùng chậu.\n\nKhám bằng mỏ vịt: Cổ tử cung khỏe mạnh.\n\nCác vết sẹo phẫu thuật từ các lần cắt bỏ thận trái và cắt bỏ phần đầu tụy – tá tràng trước đó được ghi nhận.\n\nMột cuộc họp của đội ngũ đa chuyên khoa đã kết luận rằng cần phải phẫu thuật. Một cuộc mổ mở bụng đã được thực hiện qua một đường rạch giữa bụng dưới rốn, cho thấy một khối u đặc dạng nang rõ ràng ở phần phụ bên trái. Không có dịch màng bụng hoặc dấu hiệu của di căn phúc mạc, và phần phụ bên phải có vẻ bình thường, không có dấu hiệu vĩ mô nào về khối u ác tính, bao gồm cả việc không có các cấu trúc thực thể bên ngoài.\n\nĐồng thời với việc cắt bỏ phần phụ bên trái, mẫu bệnh phẩm đã được gửi đi để kiểm tra bằng phương pháp cắt lát đông lạnh. Kết quả không rõ ràng, làm dấy lên khả năng về các khối u cận ác tính hoặc các khối u đặc trưng cho hội chứng Von Hippel–Lindau. Xem xét tình trạng mãn kinh của bệnh nhân, một cuộc phẫu thuật cắt bỏ phần phụ bên phải và cắt tử cung toàn bộ đã được thực hiện.\n\nKiểm tra mô học sau đó cho thấy các khối u nang nhú tế bào thận hai bên ở ống dẫn trứng và dây chằng rộng, đặc trưng cho bệnh Von Hippel–Lindau (0,5 cm ở bên phải và 4 cm ở bên trái). Các khối u bao gồm các nhú xếp chặt với lõi xơ, được bao phủ bởi một lớp biểu mô đơn.\n\nGiai đoạn hậu phẫu ban đầu diễn ra suôn sẻ, và trong lần theo dõi sau 1 tháng, không phát hiện bất thường nào. Kể từ đó, bệnh nhân được theo dõi cứ sau 4 tháng bằng siêu âm vùng chậu. Trong 2 năm theo dõi này, không có biến chứng nào xảy ra, nhưng gần đây bệnh nhân đã được nhập viện lại vào khoa phẫu thuật thần kinh để điều trị tái phát khối u não.",
+        "translated_summary": "Một phụ nữ da trắng, người Bắc Phi, 62 tuổi, được chẩn đoán mắc bệnh Von Hippel-Lindau vào năm 2021, đã đến khám với nhiều triệu chứng, bao gồm một khối u ở xương đá bên trái, u tủy thượng thận bên trái, ung thư tế bào thận bên trái, thận phải có nhiều nang và các khối u ở tuyến tụy. Bà đã trải qua nhiều phương pháp điều trị, bao gồm xạ trị, cắt bỏ tuyến thượng thận, cắt bỏ thận và cắt bỏ phần đầu tá tràng và tuyến tụy. Các xét nghiệm siêu âm và cộng hưởng từ cho thấy một khối u nang đặc ở vùng phụ bên trái. Nội soi ổ bụng xác định các khối u nang ở ống dẫn trứng bên phải và bên trái. Sau khi cắt tử cung và cắt bỏ cả hai buồng trứng, kết quả kiểm tra mô học cho thấy có u nang nhú tế bào trong ống dẫn trứng và dây chằng rộng ở cả hai bên, phù hợp với bệnh Von Hippel-Lindau."
+    },
+    {
+        "id": "multiclinsum_gs_en_30.txt",
+        "fulltext": "The patient was a 59-year-old Japanese man with a 28-year history of type 1 diabetes. He visited our hospital monthly for management of diabetes with intensive therapy employing multiple-dose insulin injections. His height and body weight were 168 cm and 52 kg (body mass index: 18.4 kg/m2), respectively. He showed depleted insulin secretion (serum C-peptide level was below the limit of detection), such that his blood glucose levels fluctuated severely, and his hemoglobin A1c (HbA1c) level was around 9.0% despite intensive insulin therapy. He had been diagnosed with asymptomatic chronic severe (grade III) aortic regurgitation (AR) 16 years before the current presentation but had declined follow-up for the AR. He had never undergone surgery nor the implantation of any prosthetic devices.\n\nEight days after his regular hospital visit, he visited an emergency clinic complaining of breathing difficulty and had a fever above 38℃. Until that day, he had not noticed any fever, chills, weakness, or any other symptoms. His blood pressure and pulse rate were 192/82 mmHg and 118/min, respectively. He showed orthopnea, and his oxygen saturation (SpO2) was 80%. He was transported to the emergency department of our hospital. A physical examination revealed a Levine 3/6 systolic murmur, although his cardiac murmur had not been checked at regular hospital visits. No physical findings suggesting IE, such as Osler nodes, Janeway lesions, or conjunctival petechiae, were recognized. His white blood cell (WBC) count was markedly increased to 20,800 /μL, and his C-reactive protein (CRP) was elevated to 6.06 mg/dL. Serum creatine phosphokinase MB was within the normal range, at 6.0 IU/L, and troponin T was negative. Chest X-ray showed pulmonary congestion with cardiac enlargement (cardiothoracic ratio: 55%). Electrocardiography revealed ST elevation on V1-V4, but emergency echocardiography showed no dysfunction of cardiac contractility. He was diagnosed with acute heart failure due to valvular disease, and treatment with non-invasive positive pressure ventilation and nitrates was initiated.\n\nAfter hospital admission, a detailed examination by transthoracic echocardiography showed severe aortic regurgitation, severe mitral regurgitation, and a mobile vegetation on the mitral valve. Transesophageal echocardiography revealed a 16.5×6-mm mobile vegetation on the anterior leaflet of the mitral valve and an 11.2×5-mm nonmobile vegetation on the noncoronary cusp of the aortic valve. These findings raised strong suspicion of NVE. In this case, head computed tomography (CT) and magnetic resonance imaging revealed no cerebral infarction or hemorrhaging, although a mobile vegetation was detected.\n\nOn reviewing the clinical course until hospitalization, we noted that at the visit four months before admission, his WBC count had been slightly elevated. The following month, his albumin (Alb) level decreased to 3.0 g/dL, and his hemoglobin (Hb) level had shown a gradual decline over the 2 months prior to admission. During this period, he had experienced a 4-kg weight loss. Esophagogastroduodenoscopy and whole-body CT were performed, but no abnormalities were detected. One month later, he had regained some weight, and the laboratory findings had nearly normalized, except for a slightly elevated CRP level (0.54 mg/dL). At the last visit (8 days before admission), his WBC count had again risen to 9,300 /μL, while his Hb and Alb levels had again decreased to 13.1 g/dL and 3.0 g/dL, respectively. Furthermore, his CRP level had increased to 4.18 mg/dL. At that time, his diastolic blood pressure has shown an obvious decrease. Thus far, he had not experienced a fever or any symptoms other than weight loss. We suspected diseases of infectious and/or malignant origin and initiated comprehensive examinations to identify the source of his clinical findings.\n\nAfter heart failure treatment had been started, his clinical symptoms showed rapid improvement, and his hemodynamic stability was maintained during the first six hours. He initially received empirical intravenous antibiotic therapy consisting of 12 g/day of ampicillin sulbactam (ABPC/S) and 120 mg/day of gentamycin (GM). Three blood culture sets were obtained on the admission, and all were positive for S. warneri [minimum inhibitory concentration (MIC) to ABPC/S ≤8 μg/mL; MIC to GM ≤1 μg/mL; MIC to cefazolin (CEZ) ≤2 μg/mL]. Thus, IE caused by this organism was diagnosed.\n\nAccording to the clinical guideline established by the Japanese Circulation Society, emergency surgery is generally recommended for heart failure of NYHA III to IV or urgent surgery for NVE mobile vegetation exceeding 10 mm and severe valve dysfunction. In this case, however, his heart failure was successfully improved. Based on the guideline, the risk of embolism was considered to have been reduced by the administration of appropriate antibiotic therapy. In addition, the patient had type 1 diabetes, and his glycemic control was so poor that we were concerned that double-valve surgery would be a high-risk procedure. Therefore, we planned elective surgery after sufficient control of both infection and diabetes.\n\nBased on the blood culture results, the antibiotic regimen was switched to 6 g/day of CEZ. A detailed dental examination revealed no abnormalities, such as periodontitis. After four weeks of antibiotic therapy, he underwent surgical therapy. His aortic valve was found to be bicuspid, and the aortic and mitral annuli were intact without abscess formation. Large vegetations were exenterated, and the mitral and aortic valves were both replaced with mechanical valves. He experienced no postoperative complications and was discharged on the 22nd day after the operation without apparent embolism. He has not had any recurrence in over two years since the operation.",
+        "summary": "A 59-year-old man with type 1 diabetes presented with heart failure. Echocardiography showed large vegetations on the mitral and aortic valves. Blood bacterial culture was positive for Staphylococcus warneri, a coagulase-negative staphylococcus (CoNS) family member. He was diagnosed with native valve endocarditis (NVE) induced by the resident bacteria and ultimately underwent double valve replacement. Retrospectively, slight laboratory data abnormalities and weight loss beginning four months before may have been signs of NVE. He had no history of immunosuppressive therapies or medical device implantation. ",
+        "translated_fulltext": "Bệnh nhân là một người đàn ông Nhật Bản 59 tuổi, mắc bệnh tiểu đường loại 1 trong 28 năm. Ông đến bệnh viện của chúng tôi hàng tháng để điều trị bệnh tiểu đường bằng liệu pháp chuyên sâu, bao gồm tiêm insulin nhiều lần. Chiều cao và cân nặng của ông lần lượt là 168 cm và 52 kg (chỉ số khối cơ thể: 18,4 kg/m2). Ông có dấu hiệu giảm tiết insulin (nồng độ C-peptide trong huyết thanh dưới ngưỡng phát hiện), dẫn đến lượng đường trong máu dao động mạnh và nồng độ hemoglobin A1c (HbA1c) khoảng 9,0% mặc dù đã được điều trị bằng insulin chuyên sâu. Ông được chẩn đoán mắc bệnh hở van động mạch chủ mạn tính không có triệu chứng (mức độ III) 16 năm trước khi nhập viện, nhưng đã từ chối theo dõi. Ông chưa từng phẫu thuật hoặc cấy ghép bất kỳ thiết bị hỗ trợ nào.\n\nTám ngày sau khi đến bệnh viện, ông đến phòng cấp cứu với các triệu chứng khó thở và sốt trên 38℃. Cho đến thời điểm đó, ông không nhận thấy bất kỳ triệu chứng nào như sốt, ớn lạnh, mệt mỏi hoặc các triệu chứng khác. Huyết áp và nhịp tim của ông lần lượt là 192/82 mmHg và 118/phút. Ông có dấu hiệu khó thở khi nằm và độ bão hòa oxy (SpO2) là 80%. Ông được đưa đến khoa cấp cứu của bệnh viện. Khám lâm sàng cho thấy tiếng thổi tâm thu Levine 3/6, mặc dù tiếng thổi tim của ông chưa được kiểm tra trong các lần khám bệnh thường xuyên. Không có dấu hiệu lâm sàng gợi ý viêm nội tâm mạc (IE), chẳng hạn như các nốt Osler, tổn thương Janeway hoặc xuất huyết kết mạc. Số lượng bạch cầu (WBC) của ông tăng đáng kể lên 20.800/μL và protein phản ứng C (CRP) tăng lên 6,06 mg/dL. Creatine phosphokinase MB trong huyết thanh nằm trong phạm vi bình thường, là 6,0 IU/L, và troponin T âm tính. Chụp X-quang ngực cho thấy tình trạng sung huyết phổi và tim to (tỷ lệ tim-ngực: 55%). Điện tâm đồ cho thấy ST tăng trên V1-V4, nhưng siêu âm tim cấp cứu không cho thấy rối loạn chức năng co bóp tim. Ông được chẩn đoán mắc suy tim cấp do bệnh van tim và bắt đầu điều trị bằng thông khí dương áp không xâm lấn và nitrat.\n\nSau khi nhập viện, siêu âm tim qua thành ngực chi tiết cho thấy hở van động mạch chủ nặng, hở van hai lá nặng và một khối sùi di động trên van hai lá. Siêu âm tim qua thực quản cho thấy một khối sùi di động kích thước 16,5×6 mm trên lá trước của van hai lá và một khối sùi không di động kích thước 11,2×5 mm trên lá không động mạch vành của van động mạch chủ. Những phát hiện này làm tăng đáng kể nghi ngờ về viêm nội tâm mạc do vi khuẩn không gây nhiễm trùng (NVE). Trong trường hợp này, chụp cắt lớp vi tính (CT) và cộng hưởng từ (MRI) sọ não không cho thấy nhồi máu não hoặc xuất huyết, mặc dù đã phát hiện một khối sùi di động.\n\nKhi xem xét diễn biến lâm sàng cho đến khi nhập viện, chúng tôi nhận thấy rằng trong lần khám bốn tháng trước khi nhập viện, số lượng WBC của ông đã tăng nhẹ. Tháng tiếp theo, nồng độ albumin (Alb) của ông giảm xuống 3,0 g/dL và nồng độ hemoglobin (Hb) của ông giảm dần trong hai tháng trước khi nhập viện. Trong thời gian này, ông bị sụt cân 4 kg. Nội soi thực quản - dạ dày - tá tràng và chụp CT toàn thân được thực hiện, nhưng không phát hiện bất thường. Một tháng sau, ông đã tăng cân trở lại và các kết quả xét nghiệm trong phòng thí nghiệm gần như trở lại bình thường, ngoại trừ nồng độ CRP tăng nhẹ (0,54 mg/dL). Trong lần khám cuối cùng (8 ngày trước khi nhập viện), số lượng WBC của ông lại tăng lên 9.300/μL, trong khi nồng độ Hb và Alb của ông lại giảm xuống 13,1 g/dL và 3,0 g/dL. Hơn nữa, nồng độ CRP của ông đã tăng lên 4,18 mg/dL. Vào thời điểm đó, huyết áp tâm trương của ông",
+        "translated_summary": "Một người đàn ông 59 tuổi mắc bệnh tiểu đường loại 1 nhập viện vì suy tim. Siêu âm tim cho thấy có nhiều khối sùi lớn trên van hai lá và van động mạch chủ. Kết quả cấy máu cho thấy có vi khuẩn Staphylococcus warneri, một loại vi khuẩn thuộc họ Staphylococcus không sản xuất coagulase (CoNS). Ông được chẩn đoán mắc bệnh viêm nội tâm mạc van tim tự nhiên (NVE) do vi khuẩn cư trú gây ra và cuối cùng đã trải qua phẫu thuật thay cả hai van tim. Nhìn lại, những bất thường nhẹ trong các chỉ số xét nghiệm và tình trạng sụt cân bắt đầu bốn tháng trước có thể là dấu hiệu của NVE. Ông không có tiền sử điều trị bằng thuốc ức chế miễn dịch hoặc cấy ghép thiết bị y tế."
+    },
+    {
+        "id": "multiclinsum_gs_en_383.txt",
+        "fulltext": "A 27-year-old woman with multiple colorectal cancers on a background of FAP was presented to our department. Notably, a large lesion was detected in the ascending, transverse, and sigmoid colon and the upper rectum, and pathological examination confirmed some of them as adenocarcinoma. Preoperative computed tomography revealed multiple lymph node swellings along the inferior mesenteric artery (IMA) and middle colic artery, without any evidence of distant metastases. After a comprehensive evaluation by a multidisciplinary cancer board, we decided to perform TPC with lymph node dissection of the entire colorectal region, using the Hugo RAS system as a surgical device.\n\nRobot-assisted TPC using the Hugo RAS system was approved by the Evaluating Committee for Highly Difficult New Medical Technologies (approval number H-0051) and the Institutional Review Board at Kyoto University.\n\nUnder general anesthesia, the patient was placed in a lithotomy position with the arms tucked. After a 5-cm vertical skin incision was made at the umbilicus, a wound-protecting device was applied. After pneumoperitoneum, 4 robotic trocars and 2 assistant trocars were placed. The instruments used in robot-assisted TPC with Hugo were a camera, monopolar curved shears for the right hand, bipolar fenestrated forceps for the left hand, and Cadiere/double fenestrated forceps for the reserve arm. Robot-assisted TPC with Hugo consists of 3 distinct steps, followed by transanal specimen extraction, ileal pouch construction through a small laparotomy, and ileal pouch-anus anastomosis (IPAA). Two table positions, Trendelenburg and flat, were required, each with specific docking tilts but the same angles of the arm carts throughout the robotic procedure. The detailed operative procedure is presented in Supplementary Videos.\n\nStep 1: Ascending colon complete mesocolic excision (CME)\n\nThe ascending colon CME from the caudal approach proceeded until the completion of the hepatic flexure mobilization (Supplementary Video S1).\n\nStep 2: Central vessel ligation (CVL) of the IMA, descending colon CME, and total mesorectal excision (TME)\n\nAfter CVL of the IMA, descending colon CME proceeded until the completion of splenic flexure mobilization, followed by TME until the intersphincteric space was fully exposed (Supplementary Video S2).\n\nStep 3: CVL along the superior mesenteric artery (SMA)\n\nAfter undocking all the robotic arms, the patient was placed in a flat position. Then, CVL along the SMA was performed to ligate the ileocolic, right colic, and middle colic vessels (Supplementary Video S3). The final step of this procedure was the ligation of the inferior mesenteric vein (IMV) at its root, which was exposed in Step 2.\n\nTransanal and small laparotomy procedures\nAfter transection of the terminal ileum, we extracted the specimen transanally by excising the rectal mucosa entirely from just below the dentate line because of multiple adenomas in the anal canal. After constructing the ileal pouch through the small umbilical incision and confirming that the ileal pouch could reach the bottom of the anal canal for anastomosis, transanal hand-sewn IPAA was performed. A diverting ileostomy was not performed.\n\nAll 3 steps were completed without conversion to open surgery. After undocking Hugo when we finished Step 3, we performed a laparoscopy to confirm hemostasis, specimen extraction, and appropriate anastomosis. The operative time was 632 min (36 min for Step 1, 160 min for Step 2, 188 min for Step 3, and 248 min for other procedures such as positioning, docking, specimen extraction, and anastomosis), with a minimal intraoperative estimated blood loss of 20 mL. The patient exhibited an uneventful postoperative recovery, with gas passage and initiation of liquid nutrition on postoperative day 1 (POD 1) and a solid diet on POD 3 with a functional ileal pouch and satisfactory anal function. Pathological examination revealed 2 sigmoid colon cancers (S1, Type 0-Ip, 55 × 50 mm, tub1, T1b, ly0, v0; S2, Type 0-Isp, 55 × 50 mm, tub1, Tis, ly0, v0) and 1 rectal cancer (R1, Type 0-Ip, 40 × 35 mm, tub1, Tis, ly0, v0). It also revealed 18 out of 89 positive lymph nodes, all of which belonged to the sigmoid colon and rectosigmoid lesions (stations #241, 242, and 251), resulting in UICC pT1bN2b stage.",
+        "summary": "A 27-year-old woman with multiple colorectal cancers with a background of familial adenomatous polyposis underwent robot-assisted TPC, including lymph node dissection of the entire colorectal region using the Hugo RAS system. The robotic procedure was divided into 3 steps: 1) Trendelenburg position to perform ascending colon complete mesocolic excision (CME) to the hepatic flexure, 2) descending colon CME and total mesorectal excision with D3 lymph node dissection, and 3) flat position to perform central vessel ligation along the superior mesenteric artery. After undocking, the specimen was extracted transanally, and an ileal pouch was constructed from a small laparotomy at the umbilical incision, followed by ileal pouch-anal anastomosis. The operative time was 632 min, and the estimated blood loss was minimal. The postoperative period was uneventful.",
+        "translated_fulltext": "Một bệnh nhân nữ 27 tuổi, có nhiều khối u đại trực tràng trên nền bệnh đa polyp đại tràng gia đình (FAP), đã được đưa vào khoa của chúng tôi. Đáng chú ý, một khối u lớn được phát hiện ở đại tràng lên, đại tràng ngang và đại tràng sigma, cũng như phần trên của trực tràng, và kết quả kiểm tra mô học xác nhận một số khối u là ung thư biểu mô tuyến. Chụp cắt lớp vi tính trước phẫu thuật cho thấy nhiều hạch bạch huyết sưng dọc theo động mạch mạc treo dưới (IMA) và động mạch đại tràng giữa, không có bằng chứng về di căn xa. Sau khi đánh giá toàn diện bởi một hội đồng đa chuyên khoa về ung thư, chúng tôi quyết định thực hiện phẫu thuật cắt bỏ khối u bằng kỹ thuật TPC, kết hợp với việc nạo vét hạch toàn bộ vùng đại trực tràng, sử dụng hệ thống phẫu thuật robot Hugo RAS.\n\nPhẫu thuật TPC hỗ trợ robot bằng hệ thống Hugo RAS đã được Ủy ban Đánh giá các Công nghệ Y tế Mới có Độ khó Cao phê duyệt (số phê duyệt H-0051) và Hội đồng Đánh giá Tổ chức tại Đại học Kyoto.\n\nTrong khi gây mê toàn thân, bệnh nhân được đặt ở tư thế nằm ngửa, hai tay duỗi dọc theo thân. Sau khi thực hiện một đường rạch da dọc 5 cm tại rốn, một thiết bị bảo vệ vết thương được đặt vào. Sau khi tạo khoang phúc mạc bằng khí, 4 cổng robot và 2 cổng hỗ trợ được đặt vào. Các dụng cụ được sử dụng trong phẫu thuật TPC hỗ trợ robot với hệ thống Hugo bao gồm một camera, kéo cong một cực cho tay phải, kẹp hai cực có lỗ cho tay trái và kẹp Cadiere/kẹp hai cực để dự phòng. Phẫu thuật TPC hỗ trợ robot với hệ thống Hugo bao gồm 3 bước riêng biệt, sau đó là lấy mẫu qua đường hậu môn, tạo túi hồi tràng qua một vết mổ nhỏ ở bụng và nối túi hồi tràng-hậu môn (IPAA). Hai tư thế trên bàn mổ, tư thế Trendelenburg và tư thế nằm thẳng, được yêu cầu, mỗi tư thế có góc nghiêng riêng nhưng góc của các cánh tay robot không thay đổi trong suốt quá trình phẫu thuật. Quy trình phẫu thuật chi tiết được trình bày trong các video bổ sung.\n\nBước 1: Cắt bỏ hoàn toàn mạc treo đại tràng lên (CME)\n\nPhẫu thuật CME đại tràng lên từ đường tiếp cận phía dưới được tiến hành cho đến khi hoàn thành việc giải phóng gấp gan (Video bổ sung S1).\n\nBước 2: Thắt nút mạch máu trung tâm (CVL) của động mạch mạc treo dưới (IMA), phẫu thuật CME đại tràng xuống và cắt bỏ hoàn toàn mạc treo trực tràng (TME)\n\nSau khi thực hiện CVL của động mạch mạc treo dưới (IMA), phẫu thuật CME đại tràng xuống được tiến hành cho đến khi hoàn thành việc giải phóng gấp lách, sau đó là TME cho đến khi khoang giữa các cơ vòng được mở hoàn toàn (Video bổ sung S2).\n\nBước 3: CVL dọc theo động mạch mạc treo trên (SMA)\n\nSau khi tháo tất cả các cánh tay robot, bệnh nhân được đặt ở tư thế nằm thẳng. Sau đó, CVL dọc theo động mạch mạc treo trên (SMA) được thực hiện để thắt các mạch máu hồi tràng-đại tràng, đại tràng phải và đại tràng giữa (Video bổ sung S3). Bước cuối cùng của quy trình này là thắt tĩnh mạch mạc treo dưới (IMV) tại gốc của nó, nơi đã được mở trong Bước 2.\n\nCác thủ thuật qua đường hậu môn và mở bụng nhỏ\n\nSau khi cắt ngang hồi tràng tận cùng, chúng tôi lấy mẫu qua đường hậu môn bằng cách cắt bỏ toàn bộ niêm mạc trực tràng ngay dưới đường răng, do có nhiều khối u tuyến ở ống hậu môn. Sau khi tạo túi hồi tràng qua vết rạch nhỏ ở rốn và xác nhận rằng túi hồi tràng có thể tiếp cận đáy ống hậu môn để nối, phẫu thuật nối IPAA bằng tay qua đường hậu môn đã được thực hiện. Một lỗ nối hồi tràng dẫn lưu không được thực hiện.\n\nCả 3 bước đều được hoàn thành mà không cần chuyển sang phẫu thuật mở. Sau khi tháo hệ thống Hugo sau khi hoàn thành Bước 3, chúng tôi thực hiện một cuộc phẫu thuật nội soi ổ bụng để xác nhận cầm máu, lấy mẫu và nối mạch máu phù hợp. Thời gian phẫu thuật là 632 phút (36 phút cho Bước 1",
+        "translated_summary": "Một phụ nữ 27 tuổi, mắc nhiều khối u ung thư đại trực tràng và có tiền sử đa polyp tuyến gia đình, đã được phẫu thuật cắt bỏ khối u bằng phương pháp hỗ trợ robot (TPC), bao gồm việc cắt bỏ hạch bạch huyết của toàn bộ vùng đại trực tràng bằng hệ thống robot Hugo RAS. Quá trình phẫu thuật bằng robot được chia thành 3 bước: 1) Tư thế Trendelenburg để thực hiện cắt bỏ hoàn toàn mạc treo đại tràng lên đến chỗ uốn gan, 2) cắt bỏ mạc treo đại tràng xuống và cắt bỏ hoàn toàn mạc trực tràng cùng với việc cắt bỏ hạch bạch huyết D3, và 3) tư thế nằm để thực hiện thắt các mạch máu trung tâm dọc theo động mạch mạc treo trên. Sau khi kết thúc phẫu thuật bằng robot, mẫu vật được lấy ra qua đường hậu môn, và một túi hồi tràng được tạo ra từ một vết rạch nhỏ ở vị trí rốn, sau đó tiến hành nối túi hồi tràng với hậu môn. Thời gian phẫu thuật là 632 phút và lượng máu mất ước tính là rất ít. Giai đoạn hậu phẫu diễn ra bình thường."
+    },
+    {
+        "id": "multiclinsum_gs_en_462.txt",
+        "fulltext": "A 65-year-old male presented with swelling and boutonniere deformity on the right middle finger for six months after a motorcycle accident on January 1st, 2023. Initially, he managed the injury with painkillers and did not seek medical attention. After six months of persistent symptoms, including an inability to fully extend the finger and noticeable edema, he sought treatment.\n\nClinical findings\nThe inspection of the right hand showed the presence of deformity with edema. The active range of motion (ROM) was impaired in PIP joint in digiti III of the right hand. The active ROM of PIP joint digiti III of the right hand 45–110 degrees. The passive ROM of PIP joint digiti III of the right hand within normal.\n\nDiagnostic assessment\nWe performed X-ray of the right hand AP/Lateral which showed there are no abnormality in the bone and we diagnosed the deformity from soft tissue which is central slip injury.\n\nSurgical technique\nA central slip defect reconstruction utilizing partial ulnar side of flexor digitorum superficial tendon was performed. Under anesthesia, the patient was positioned supine with a tourniquet applied to the upper arm. A midlateral incision was made on the ulnar aspect of the right middle phalanx, centered at the PIP joint. The incision extended dorsally in an oblique manner. A transverse incision was made over the MCP joint flexion crease, just proximal to the A1 pulley. The procedure involves identifying and protecting the ulnar digital neurovascular bundle, exposing the central slip and extensor tendon to the PIPJ, full-thickness dorsal flaps are elevated. Scar tissue and pseudotendinous tissue is identified and excised. The central slip cannot be repaired primarily, so the ulnar slip of the FDS tendon is used for reconstruction. The ulnar neurovascular bundle is mobilized to visualize the periosteal insertion of the A3 pulley.\n\nThe extensor tendon is mobilized and tenolyzed, followed by incision of the dorsal capsule of the PIP joint and removal of interposed tissue. The A3 pulley's periosteal insertion is incised longitudinally, and the PIP joint's volar capsule is incised longitudinally. The ulnar slip of the FDS tendon is identified and a 2–0 non-absorbable, monofilament suture is placed around it. A transverse incision is made at the MCP joint flexion crease, proximal to the A1 pulley revealing the flexor tendon sheath. The tendon sheath and A1 pulley are incised longitudinally. The FDS tendon is identified. The ulnar slip of the FDS tendon is isolated and transected to release the ulnar slip, avoiding entrapment or catching of the radial slip. The 2–0 suture that was placed around the ulnar slip at the level of the PIP joint is used to release distally based FDS tendon slip and deliver the ulnar slip of the FDS tendon distally.\n\nA 2.8-mm drill is used to create a vertically oriented bone tunnel dorsal to volar. An elevator is placed between the flexor digitorum profundus tendon, volar plate, and volar aspect of the base of the middle phalanx protecting the volar anatomic structures. The FDS tendon slip passes through the tunnel while maintaining the PIP joint in extension and reduced position. The FDS tendon slip passed through the intact proximal section of the central slip and extensor tendon. A tendon weaver completes a Pulvertaft weave, confirming the appropriate tension with the PIPJ in the reduced, full extension position. A 3–0 non-absorbable suture secures the pulvertaft weave. The margins of the capsule and central slip reconstruction are approximated across the PIP joint, and adhesions are released and the lateral bands mobilized.\n\nThe overall posture, stability, and motion with tenodesis assessed. All the incisions are copiously irrigated. The tourniquet is deflated and hemostasis is obtained. Capillary refill of all fingers is assessed. The skin is closed using horizontal mattress stiches. A sterile dressing is applied with an appropriately padded PIP joint extension splint to allow for early DIP joint and MCP joint motion.\n\nFollow-up and outcomes\nFirst follow-up was done 4 days after for wound treatment. The patient was given oral meloxicam 7,5 mg twice a day and doxycycline 100 mg twice a day for 3 days. The second follow-up was done 3 days after for wound treatment. After 2 weeks, we remove the back slab, remove the external suture and begin the active and passive ROM exercise. After 3 weeks, the wound was healed, and we found the ROM of PIP joint 0 to 90 degrees. And after a month, the patient came with improved ROM of PIP joint 0 to 100 degrees, and improved functional outcome. After 7 weeks of physical rehabilitation, patients already back to work with improve ROM of PIP joint 0 to 110 degrees. The function of the patient's right hand is evaluated with DASH score, which improves significantly from 50 to 4.2.",
+        "summary": "A 65-year-old male patient presented with swelling and boutonniere deformity on the digiti III of the right hand. The patient had previously fallen from a motorcycle, and the patient's right middle finger got was by a motorcycle six months ago. After the incident, the patient's right middle finger cannot be fully extended. The patient's right hand showed edema with flexion of the interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint. The Range of Motion (ROM) of the PIP joint right middle finger was 45-110 degrees. The X-ray of the right hand AP/oblique showed no bone involvement in the deformity. The patient underwent central slip defect reconstruction utilizing the partial ulnar side of the flexor digitorum superficial tendon. A PIP joint extension splint was applied for 2 weeks. Active and passive exercise of the ROM of the PIP joint began after 2 weeks of PIP extension joint splinting. The patient's ROM of the PIP joint (0-90 degrees) significantly improved 1 month after surgery. The patient's ROM of the PIP joint returned to normal after 2 months after surgery. The function of the patient's right hand is evaluated with the DASH score, which improves significantly from 50 to 4.2.",
+        "translated_fulltext": "Một bệnh nhân nam 65 tuổi đến khám với tình trạng sưng và biến dạng kiểu \"boutonniere\" ở ngón giữa bên phải, kéo dài trong sáu tháng sau một tai nạn xe máy vào ngày 1 tháng 1 năm 2023. Ban đầu, bệnh nhân tự điều trị bằng thuốc giảm đau và không đi khám bác sĩ. Sau sáu tháng với các triệu chứng dai dẳng, bao gồm tình trạng không thể duỗi hoàn toàn ngón tay và phù rõ rệt, bệnh nhân đã đi khám.\n\nKết quả lâm sàng\nKhám bàn tay phải cho thấy có biến dạng kèm theo phù. Phạm vi vận động chủ động (ROM) bị hạn chế ở khớp liên đốt gần (PIP) của ngón III ở bàn tay phải. Phạm vi vận động chủ động của khớp PIP ngón III ở bàn tay phải là 45–110 độ. Phạm vi vận động thụ động của khớp PIP ngón III ở bàn tay phải nằm trong giới hạn bình thường.\n\nĐánh giá chẩn đoán\nChúng tôi thực hiện chụp X-quang bàn tay phải theo tư thế trước-sau/bên, cho thấy không có bất thường ở xương và chúng tôi chẩn đoán biến dạng là do tổn thương phần mềm, cụ thể là tổn thương phần trung tâm của gân duỗi.\n\nKỹ thuật phẫu thuật\nChúng tôi thực hiện tái tạo phần trung tâm của gân duỗi bằng cách sử dụng một phần gân ulnar của gân uốn ngón tay nông. Trong khi gây mê, bệnh nhân được đặt ở tư thế nằm ngửa và một băng ép được đặt ở cánh tay trên. Một đường rạch giữa-bên được thực hiện ở mặt ulnar của đốt giữa ngón giữa bên phải, tập trung ở khớp PIP. Đường rạch kéo dài theo hướng xiên về phía sau. Một đường rạch ngang được thực hiện trên nếp gấp uốn của khớp liên đốt bàn tay (MCP), ngay phía trên ròng rọc A1. Thủ thuật bao gồm việc xác định và bảo vệ bó mạch thần kinh ngón ulnar, bộc lộ phần trung tâm của gân duỗi và gân duỗi đến khớp PIP, sau đó nâng các lớp da toàn phần ở phía lưng. Mô sẹo và mô hình gân được xác định và loại bỏ. Phần trung tâm của gân duỗi không thể được khâu lại trực tiếp, vì vậy phần ulnar của gân uốn ngón tay nông (FDS) được sử dụng để tái tạo. Bó mạch thần kinh ulnar được di chuyển để quan sát vị trí bám màng xương của ròng rọc A3.\n\nGân duỗi được di chuyển và làm dài, sau đó thực hiện rạch bao khớp phía lưng của khớp PIP và loại bỏ mô xen giữa. Vị trí bám màng xương của ròng rọc A3 được rạch theo chiều dọc, và bao khớp phía lòng bàn tay của khớp PIP cũng được rạch theo chiều dọc. Phần ulnar của gân FDS được xác định và một chỉ khâu không tiêu, đơn sợi 2-0 được đặt xung quanh nó. Một đường rạch ngang được thực hiện ở nếp gấp uốn của khớp MCP, phía trên ròng rọc A1, để lộ bao gân uốn. Bao gân và ròng rọc A1 được rạch theo chiều dọc. Gân FDS được xác định. Phần ulnar của gân FDS được cô lập và cắt đứt để giải phóng phần ulnar, tránh tình trạng kẹt hoặc vướng víu của phần trụ. Chỉ khâu 2-0 được đặt xung quanh phần ulnar ở vị trí khớp PIP được sử dụng để giải phóng phần gân FDS ở phía xa và đưa phần ulnar của gân FDS đến vị trí xa.\n\nMột mũi khoan 2,8 mm được sử dụng để tạo một đường hầm xương theo chiều dọc, từ phía lưng đến phía lòng bàn tay. Một dụng cụ nâng được đặt giữa gân uốn ngón tay sâu, tấm lòng bàn tay và mặt lòng của gốc đốt giữa, để bảo vệ các cấu trúc giải phẫu phía lòng bàn tay. Phần gân FDS đi qua đường hầm trong khi duy trì khớp PIP ở tư thế duỗi và giảm. Phần gân FDS đi qua phần gần còn nguyên vẹn của gân duỗi và gân duỗi trung tâm. Một dụng cụ đan gân hoàn thành kỹ thuật đan Pulvertaft, xác nhận độ căng phù hợp khi khớp PIP ở tư thế duỗi hoàn toàn. Một chỉ khâu không tiêu 3-0 được sử dụng để cố định kỹ thuật đan Pulvertaft. Các bờ của bao khớp và phần tái tạo của gân duỗi trung tâm được đưa lại gần nhau qua khớp PIP, các dính được giải phóng và các dải bên được di chuyển.\n\nĐánh giá tư thế tổng thể, độ ổn định và phạm vi vận động với kỹ thuật tenodesis. Tất cả các vết rạch đều được rửa sạch kỹ lưỡng. Băng ép được tháo và cầm máu được thực hiện. Lưu lượng mao mạch của tất cả các ngón tay được đánh giá. Da được khâu lại bằng mũi khâu hình nệm ngang. Một băng vô trùng được băng lại với một nẹp hỗ trợ khớp PIP để cho phép vận động sớm của khớp liên đốt ngón (DIP) và khớp MCP.\n\nTheo dõi và kết quả\nLần theo dõi đầu tiên được thực hiện 4 ngày sau để điều trị vết thương. Bệnh nhân được dùng meloxicam 7,5 mg đường uống hai lần một ngày và doxycycline 100 mg đường uống hai lần một ngày trong 3 ngày. Lần theo dõi thứ hai được thực hiện 3 ngày sau để điều trị vết thương. Sau 2 tuần, chúng tôi tháo nẹp, tháo chỉ bên ngoài và bắt đầu các bài tập vận động chủ động và thụ động. Sau 3 tuần, vết thương đã lành, và chúng tôi nhận thấy phạm vi vận động của khớp PIP là từ 0 đến 90 độ. Và sau một tháng, bệnh nhân đến khám với phạm vi vận động của khớp PIP được cải thiện từ 0 đến 100 độ và chức năng được cải thiện. Sau 7 tuần phục hồi chức năng, bệnh nhân đã có thể đi làm trở lại với phạm vi vận động của khớp PIP được cải thiện từ 0 đến 110 độ. Chức năng của bàn tay phải của bệnh nhân được đánh giá bằng thang điểm DASH, cho thấy sự cải thiện đáng kể từ 50 xuống 4,2.",
+        "translated_summary": "Một bệnh nhân nam 65 tuổi đến khám với triệu chứng sưng và biến dạng kiểu “nút thắt” ở ngón tay III của bàn tay phải. Bệnh nhân từng bị ngã từ xe máy và ngón tay giữa bên phải bị xe máy cán cách đây sáu tháng. Sau sự cố, bệnh nhân không thể duỗi hoàn toàn ngón tay giữa bên phải. Bàn tay phải của bệnh nhân có dấu hiệu phù nề, khớp liên đốt giữa (PIP) bị gấp và khớp liên đốt cuối (DIP) bị duỗi quá mức. Phạm vi cử động (ROM) của khớp PIP ở ngón tay giữa bên phải là 45-110 độ. Chụp X-quang bàn tay phải theo tư thế trước-sau/chéo cho thấy không có tổn thương xương ở vùng biến dạng. Bệnh nhân được phẫu thuật tái tạo phần trung tâm của gân uốn ngón tay nông, sử dụng một phần gân ở phía trụ. Một nẹp hỗ trợ duỗi khớp PIP được đặt trong 2 tuần. Các bài tập vận động chủ động và thụ động để cải thiện phạm vi cử động của khớp PIP bắt đầu sau 2 tuần sử dụng nẹp. Phạm vi cử động của khớp PIP của bệnh nhân (0-90 độ) cải thiện đáng kể sau 1 tháng phẫu thuật. Phạm vi cử động của khớp PIP của bệnh nhân trở lại bình thường sau 2 tháng phẫu thuật. Chức năng của bàn tay phải của bệnh nhân được đánh giá bằng thang điểm DASH, và điểm số cải thiện đáng kể từ 50 xuống 4,2."
+    },
+    {
+        "id": "multiclinsum_gs_en_382.txt",
+        "fulltext": "A 23-year-old male patient presented to the emergency department with a sudden onset of severe frontal headache lasting for 2 h. He experienced associated symptoms of nausea, vomiting, and chest heaviness. He has a unremarkable medical record and denies the use of illicit drugs. However, he is a smoker with a history of 23 pack-years but does not consume alcohol.\n\nOn physical examination, the young male appeared distressed but was fully conscious and oriented to time, place, and person. Chest auscultation revealed normal vesicular breathing sounds, while cardiovascular and abdominal examinations were inconclusive. Neurological examinations demonstrated neck stiffness, dilated pupils reactive to light, normal plantar reflexes, and no focal neurological deficits.\n\nHis vital signs were as follows: blood pressure 178/103 mmHg, respiratory rate 26 breaths/min, temperature 38.9°C, heart rate 87 beats/min, and oxygen saturation of 94%.\n\nEmergency tests were initiated. An ECG revealed ST segment elevation >2 mm in leads V2-V5, consistent with STEMI as the top of our differential diagnosis, requiring confirmation by cardiac markers. With prompt referral to a tertiary cardiac centre implemented, the patient received a 300 mg aspirin load while being transferred to the catheter lab. Troponin levels were significantly elevated at 1.48 mg/dl (normal <0.16 mg/dl).\n\nPercutaneous coronary intervention was performed via the femoral artery, and the result showed normal coronary arteries with thrombolysis in myocardial infarction (TIMI) flow grade of 3.\n\nHis ECG after coronary angiography revealed normal sinus rhythm with left ventricular hypertrophy LVH. An echocardiogram was performed, revealing normal ventricular function with no regional wall motion abnormalities (RWMA).\n\nFollowing coronary intervention, he was admitted to the medical ward for further assessment and investigation. Blood samples were drawn for a complete blood count, random blood sugar, renal function tests, and CRP. The results revealed lymphocytosis and mildly elevated CRP.\n\nWe proceeded further with CT brain to exclude serious cause of headache. His brain CT showed cisternal subarachnoid haemorrhage SAH with extension anterior to the right temporal lobe. Abdominal ultrasound screening was performed to rule out polycystic kidney disease which was negative and cerebral CT angiography was scheduled to exclude cerebral aneurysm Nimodipine 60 mg every 4 h was initiated, with a target blood pressure of 160/100 mmHg.\n\nOn the second day, his condition suddenly deteriorated, culminating with cardiac arrest. Therefore, cardiopulmonary resuscitation (CPR), resulting in a Glasgow Coma Scale score (GCS) of 6. The patient was subsequently, intubated and placed on mechanical ventilation in the Intensive Care Unit (ICU). Due to his unstable condition in the ICU, we could not perform a repeated CT brain scan or the planned cerebral CT angiography.\n\nOver the next 7 days, we diligently monitored him with a strict multidisciplinary team. A nasogastric tube was inserted for feeding and fluid replacement. His medications included intravenous fluids, antibiotics, proton pump inhibitors, and nimodipine.\n\nOn the 8th day, he suddenly developed ventricular fibrillation, and despite CPR with more than five defibrillations, we were unable to revive him and death was the final outcome.39734686",
+        "summary": "We present a case detailing the diagnostic challenges of a 23-year-old male presenting with a sudden severe headache, nausea, vomiting, and chest heaviness. Initial evaluation showed elevated blood pressure and respiratory rate. An emergency electrocardiogram (ECG) indicated ST-segment elevation myocardial infarction (STEMI), leading to immediate referral for percutaneous coronary intervention, which revealed normal coronary arteries. Further investigations identified a cisternal subarachnoid haemorrhage (SAH) on CT brain imaging. Despite multidisciplinary management, the patient's condition rapidly deteriorated, resulting in cardiac arrest and mortality.",
+        "translated_fulltext": "Một bệnh nhân nam 23 tuổi nhập khoa cấp cứu với triệu chứng đau đầu dữ dội ở vùng trán, khởi phát đột ngột và kéo dài trong 2 giờ. Bệnh nhân có các triệu chứng đi kèm như buồn nôn, nôn mửa và cảm giác nặng ngực. Tiền sử bệnh của bệnh nhân không đáng kể và bệnh nhân phủ nhận việc sử dụng các chất kích thích. Tuy nhiên, bệnh nhân là người hút thuốc với tiền sử hút 23 gói thuốc mỗi năm nhưng không uống rượu.\n\nKhi khám lâm sàng, bệnh nhân trẻ có vẻ lo lắng nhưng tỉnh táo hoàn toàn và nhận thức được thời gian, địa điểm và bản thân. Nghe phổi cho thấy âm thổi phế nang bình thường, trong khi khám tim mạch và bụng không cho thấy kết quả rõ ràng. Khám thần kinh cho thấy cứng cổ, đồng tử giãn và phản ứng với ánh sáng, phản xạ gan bàn chân bình thường và không có dấu hiệu thần kinh khu trú.\n\nCác chỉ số sinh tồn của bệnh nhân như sau: huyết áp 178/103 mmHg, nhịp thở 26 lần/phút, nhiệt độ 38,9°C, nhịp tim 87 lần/phút và độ bão hòa oxy là 94%.\n\nCác xét nghiệm cấp cứu đã được tiến hành. Điện tâm đồ (ECG) cho thấy đoạn ST tăng >2 mm ở các chuyển đạo V2-V5, phù hợp với hội chứng mạch vành cấp không ST (NSTEMI) là chẩn đoán hàng đầu, cần được xác nhận bằng các xét nghiệm marker tim. Bệnh nhân được chuyển nhanh chóng đến trung tâm tim mạch chuyên khoa và được dùng liều 300 mg aspirin trong khi được chuyển đến phòng thông tim. Nồng độ troponin tăng đáng kể lên 1,48 mg/dl (bình thường <0,16 mg/dl).\n\nCan thiệp mạch vành qua da được thực hiện qua động mạch đùi, kết quả cho thấy động mạch vành bình thường với mức độ lưu lượng TIMI là 3.\n\nĐiện tâm đồ sau chụp mạch vành cho thấy nhịp xoang bình thường với phì đại thất trái. Siêu âm tim được thực hiện, cho thấy chức năng thất bình thường và không có bất thường vận động thành vùng.\n\nSau can thiệp mạch vành, bệnh nhân được chuyển đến khoa nội để theo dõi và điều tra thêm. Mẫu máu được lấy để làm công thức máu, đường huyết ngẫu nhiên, xét nghiệm chức năng thận và CRP. Kết quả cho thấy tăng bạch cầu lympho và CRP tăng nhẹ.\n\nChúng tôi tiếp tục thực hiện chụp CT não để loại trừ các nguyên nhân nghiêm trọng gây đau đầu. Chụp CT não của bệnh nhân cho thấy xuất huyết dưới nhện ở bể não, lan rộng ra phía trước thùy thái dương phải. Siêu âm bụng được thực hiện để loại trừ bệnh thận đa nang, kết quả âm tính và chụp CT mạch não được lên kế hoạch để loại trừ phình mạch não. Nimodipine 60 mg mỗi 4 giờ được bắt đầu, với mục tiêu huyết áp là 160/100 mmHg.\n\nVào ngày thứ hai, tình trạng bệnh nhân đột ngột xấu đi, dẫn đến ngừng tim. Do đó, hồi sức tim phổi (CPR) được thực hiện, kết quả là điểm Glasgow Coma Scale (GCS) là 6. Sau đó, bệnh nhân được đặt nội khí quản và thở máy trong Khoa Hồi sức tích cực (ICU). Do tình trạng bệnh nhân không ổn định trong ICU, chúng tôi không thể thực hiện lại chụp CT não hoặc chụp CT mạch não theo kế hoạch.\n\nTrong 7 ngày tiếp theo, chúng tôi theo dõi bệnh nhân một cách cẩn thận với sự phối hợp chặt chẽ của đội ngũ đa chuyên khoa. Một ống thông dạ dày được đặt để nuôi ăn và bù nước. Các loại thuốc của bệnh nhân bao gồm dịch truyền tĩnh mạch, kháng sinh, thuốc ức chế bơm proton và nimodipine.\n\nVào ngày thứ 8, bệnh nhân đột ngột bị rung thất, và mặc dù đã thực hiện CPR với hơn năm lần sốc điện, chúng tôi không thể hồi sinh bệnh nhân và bệnh nhân đã tử vong.",
+        "translated_summary": "Chúng tôi trình bày một trường hợp điển hình, nêu bật những thách thức trong chẩn đoán của một bệnh nhân nam 23 tuổi, với các triệu chứng bao gồm đau đầu dữ dội đột ngột, buồn nôn, nôn mửa và cảm giác nặng ngực. Đánh giá ban đầu cho thấy huyết áp và nhịp thở tăng cao. Điện tâm đồ cấp cứu (ECG) cho thấy nhồi máu cơ tim cấp có đoạn ST chênh lên (STEMI), dẫn đến việc chuyển bệnh nhân ngay lập tức để can thiệp mạch vành qua da, và kết quả cho thấy các động mạch vành bình thường. Các xét nghiệm tiếp theo xác định tình trạng xuất huyết dưới nhện trong bể não (SAH) trên phim chụp cắt lớp não. Mặc dù đã được điều trị đa chuyên khoa, tình trạng của bệnh nhân nhanh chóng trở nên tồi tệ hơn, dẫn đến ngừng tim và tử vong."
+    },
+    {
+        "id": "multiclinsum_gs_en_58.txt",
+        "fulltext": "Patient A.P., female, born in 1979, has been diagnosed with dilatation cardiomyopathy in 1996. Anamnestically, disease started with tonsillitis, possible myocarditis (which was never proven), with pronounced symptoms of heart failure and general symptoms. She was hospitalized and after one month, the left ventricular ejection fraction was 10% with the aforementioned signs of congestive heart failure. She was hospitalized for 10 months and 9 days, with standard therapy for vitally endangered patient, oxygen support, numerous adjuvant therapy, and intensive monitoring. Therapy was administered (ACE inhibitor - ramipril, cardiotonic - digoxin, beta-blockers - metoprolol and combination of diuretics - furosemide and spironolactone), with the indication of heart transplantation. Clinical improvement occured with an ejection fraction that was gradually increasing and at the age of 21 she entered in remission or stabilization phase, with the ejection fraction value of 48-57% (regular echocardiography was performed every three months). For the following four years therapy remained the same, but in Jun 2004 (after an episode of low immunity), ejection fraction fell to 25%, with a clinical deterioration of the disease. The patient was hospitalized for a period of two months, and the condition stabilized, and she was discharged with therapy that was the same but without cardiotonic. Ejection fraction was stabilized, and in year 2006 it was 50%. At the age of 27, the patient decided on the first pregnancy that was successful with beta blocker (metoprolol) in therapy. After the first pregnancy, the ejection fraction was 40% and she was treated with the same therapy with eplerenone (25 mg) instead of spironolactone. The ejection fraction was controlled and did not fall below 45%. At the end of 2015 the patient became pregnant for the second time, and the pregnancy went neatly until eighth month (35 weeks), when she was urgently admitted to hospital, due to sense of suffocation and inability to walk. Ejection fraction decreased to 18% (brain natriuretic peptide (BNP) was 2600 pg/ mL (reference values are 100-400 pg/ mL)). During pregnancy she received only metoprolol in therapy. Physicians decide to continue with her pregnancy, in the 39th week they performed c-section, and the condition stabilized again after twenty days. In October 2016 new mode of therapy was administered, ramipril (2.5 mg, in the morning), metoprolol (47.5 mg, in the morning), spironolactone (50 mg, once a day) and ivabradine (5 mg, twice a day) with torasemide (5 mg, once a day). LifeVest Defibrillator was carried from 06 December 2016 until 27 February 2017 when it was removed. When removed and after examination (ejection fraction was 44%) she continued with ramipril therapy (1.25 mg) metoprolol (23.75 mg), torasemide (5 mg), spironolactone (25 mg) and ivabradine (7.5 mg, twice a day) with potassium supplements, and compliance with non-pharmacological measures (fluid intake restricted to 1.5 L/ day). The echocardiographic finding in March 2017 showed left ventricular dilatation with moderately reduced left ventricular function and left ventricular wall hypokinesia with ejection fraction of 44% (insignificant pericardial effusion was present, inferior vena cava with physiological flow, preserved valves function - Dopler sonography showed slight insufficiency of mitral valve with dilatation of anulus). Evaluation of a patient with ejection fraction 44% showed no indication for an implantable cardioverter defibrillator (ICD), and conservative procedure and medication therapy were recommended. Regular check-ups and body mass reduction, regular control of renal function parameters and electrolytes were recommended. She is led under the diagnosis of dilated cardiomyopathy and heart failure NYHA stage II without any indication for the ICD prophylactic implantation.",
+        "summary": "Patient A.P., female, 38 years old, had symptoms of dilated cardiomyopathy (with possible infectious myocarditis in the background) at age 17. After hospitalization for ten months and ten days, while waiting for heart transplantation (with threatening death outcome), without a clearly pronounced threatening arrhythmia, but with a low ejection fraction and a poor general condition, remission occurred. The therapy focused primarily on the treatment of heart failure, prevention of arrhythmia and thromboembolism. Normalization of the disease by improving the function of the left ventricle (expected in 16% of patients) occurred and lasted for 4 years, followed by an exacerbation of the disease that lasted for two years. In the next few years the patient was stable, had a first child with normal pregnancy. During the second trimester of the second pregnancy, there was an exacerbation (postpartum dilatation cardiomyopathy) lasting for couple of months. At the time of case report (May 2017), the patient is stable on therapy (ACE inhibitor, beta blocker, diuretics, If channel blocker), without limitation of physical capacity, mother of two children, unemployed.",
+        "translated_fulltext": "Bệnh nhân A.P., nữ, sinh năm 1979, được chẩn đoán mắc bệnh cơ tim giãn nở vào năm 1996. Theo khai thác tiền sử, bệnh khởi phát với viêm amidan, có thể kèm theo viêm cơ tim (nhưng chưa được chứng minh), với các triệu chứng rõ rệt của suy tim và các triệu chứng toàn thân. Bệnh nhân nhập viện và sau một tháng, phân suất tống máu thất trái là 10% với các dấu hiệu suy tim sung huyết như đã đề cập. Bệnh nhân nằm viện trong 10 tháng và 9 ngày, được điều trị theo phác đồ chuẩn cho bệnh nhân nguy kịch, hỗ trợ oxy, nhiều liệu pháp hỗ trợ và theo dõi sát sao. Phác đồ điều trị bao gồm (thuốc ức chế men chuyển - ramipril, thuốc tăng cường co bóp cơ tim - digoxin, thuốc chẹn beta - metoprolol và kết hợp thuốc lợi tiểu - furosemide và spironolactone), với chỉ định ghép tim. Tình trạng lâm sàng cải thiện với phân suất tống máu tăng dần, và ở tuổi 21, bệnh nhân bước vào giai đoạn thuyên giảm hoặc ổn định, với phân suất tống máu đạt 48-57% (siêu âm tim được thực hiện định kỳ mỗi ba tháng). Trong bốn năm tiếp theo, phác đồ điều trị vẫn giữ nguyên, nhưng vào tháng 6 năm 2004 (sau một đợt suy giảm miễn dịch), phân suất tống máu giảm xuống 25%, tình trạng bệnh trở nên tồi tệ hơn. Bệnh nhân nhập viện trong hai tháng, tình trạng ổn định và được xuất viện với phác đồ điều trị tương tự nhưng không dùng thuốc tăng cường co bóp cơ tim. Phân suất tống máu ổn định và vào năm 2006 đạt 50%. Ở tuổi 27, bệnh nhân quyết định mang thai lần đầu và thai kỳ diễn ra thành công với việc sử dụng thuốc chẹn beta (metoprolol) trong phác đồ điều trị. Sau lần mang thai đầu tiên, phân suất tống máu là 40% và bệnh nhân được điều trị bằng phác đồ tương tự, thay spironolactone bằng eplerenone (25mg). Phân suất tống máu được kiểm soát và không giảm xuống dưới 45%. Vào cuối năm 2015, bệnh nhân mang thai lần thứ hai và thai kỳ diễn ra bình thường cho đến tháng thứ tám (35 tuần), khi bệnh nhân được đưa vào bệnh viện cấp cứu vì cảm giác khó thở và không thể đi lại. Phân suất tống máu giảm xuống 18% (peptit lợi niệu não (BNP) là 2600 pg/mL (giá trị tham khảo là 100-400 pg/mL)). Trong thời kỳ mang thai, bệnh nhân chỉ dùng metoprolol trong phác đồ điều trị. Các bác sĩ quyết định tiếp tục theo dõi thai kỳ, và vào tuần thứ 39, bệnh nhân được mổ lấy thai, tình trạng bệnh ổn định trở lại sau hai mươi ngày. Vào tháng 10 năm 2016, phác đồ điều trị mới được áp dụng, bao gồm ramipril (2,5 mg, vào buổi sáng), metoprolol (47,5 mg, vào buổi sáng), spironolactone (50 mg, mỗi ngày một lần) và ivabradine (5 mg, hai lần mỗi ngày) cùng với torasemide (5 mg, mỗi ngày một lần). Bệnh nhân được gắn máy khử rung LifeVest từ ngày 06 tháng 12 năm 2016 đến ngày 27 tháng 2 năm 2017, sau đó máy được tháo ra. Sau khi tháo máy và sau khi kiểm tra (phân suất tống máu là 44%), bệnh nhân tiếp tục điều trị bằng ramipril (1,25 mg), metoprolol (23,75 mg), torasemide (5 mg), spironolactone (25 mg) và ivabradine (7,5 mg, hai lần mỗi ngày) cùng với các chất bổ sung kali, đồng thời tuân thủ các biện pháp không dùng thuốc (hạn chế lượng nước uống xuống 1,5 lít/ngày). Kết quả siêu âm tim vào tháng 3 năm 2017 cho thấy thất trái giãn nở với chức năng thất trái giảm vừa phải và giảm động tâm thu thành thất trái với phân suất tống máu là 44% (có tràn dịch màng ngoài tim không đáng kể, tĩnh mạch chủ dưới có dòng chảy sinh lý, chức năng van tim được bảo tồn - siêu âm Doppler cho thấy suy van hai lá nhẹ với giãn vòng van). Đánh giá bệnh nhân với phân suất",
+        "translated_summary": "Bệnh nhân A.P., nữ, 38 tuổi, có các triệu chứng của bệnh cơ tim giãn nở (có thể kèm theo viêm cơ tim do nhiễm trùng) từ năm 17 tuổi. Sau 10 tháng 10 ngày nằm viện, trong thời gian chờ ghép tim (với nguy cơ tử vong cao), bệnh nhân không có các triệu chứng rối loạn nhịp tim rõ ràng, nhưng có chỉ số tống máu thấp và tình trạng sức khỏe tổng thể kém, bệnh đã thuyên giảm. Quá trình điều trị tập trung chủ yếu vào việc điều trị suy tim, ngăn ngừa rối loạn nhịp tim và huyết khối. Tình trạng bệnh được cải thiện nhờ chức năng tâm thất trái được phục hồi (điều này xảy ra ở 16% bệnh nhân) và kéo dài trong 4 năm, sau đó bệnh tái phát và kéo dài trong hai năm. Trong vài năm tiếp theo, bệnh nhân ổn định, sinh con đầu lòng và quá trình mang thai diễn ra bình thường. Trong giai đoạn thứ hai của lần mang thai thứ hai, bệnh tái phát (bệnh cơ tim giãn nở sau sinh) và kéo dài trong vài tháng. Tại thời điểm báo cáo ca bệnh (tháng 5 năm 2017), bệnh nhân ổn định nhờ điều trị bằng thuốc (thuốc ức chế men chuyển, thuốc chẹn beta, thuốc lợi tiểu, thuốc chẹn kênh If), không có hạn chế về khả năng vận động, là mẹ của hai con và hiện không có việc làm."
+    },
+    {
+        "id": "multiclinsum_gs_en_81.txt",
+        "fulltext": "27-year-old male patient with a history of fibrous dysplasia in the right proximal femur, which was managed prophylactically to reduce the risk of fracture 20 years ago by curettage (intralesional resection), application of bone graft and fixation with osteosynthesis material, which was removed one year after the fixation. Two weeks before admission to hospital, the patient experienced pain after a fall with low energy mechanism characterised by axial load and rotational component of the right hip, which resulted in pain intensity 8/10 on the visual analogue scale (VAS) at the level of the inguinal fold and right thigh, which incapacitated him for walking. Radiological control was performed at four weeks, observing all prosthetic components adequately. The patient was discharged clinically and haemodynamically stable, without the need for transfusion of blood products. During his follow-up in the postoperative period (612 weeks), the patient continued with partial support until day 20, in which he began with full support even accompanied by a walker. Radiological control was performed at four weeks, observing all prosthetic components adequately. The patient is currently carrying out daily activities with slight limitation due to claudicatio intermittens caused by the incision in the middle gluteus. However, he was able to participate in low-impact sports activities, such as walking and expressed great satisfaction with the functional outcome of the procedure.\n",
+        "summary": "We present the case of a 27-year-old male patient who presented to the emergency department with a fracture of the right femur at the base of the neck in pathological ground Garden II Pauwells III AO 31B2.3r, after a low energy mechanism of injury characterized by axial load with rotational component of the right hip. The patient had a history of intralesional resection, application of bone graft and prophylactic fixation with unspecified osteosynthesis material in the pertrochanteric region 20 years ago; the biopsy later showed DF; one year later, the osteosynthesis material was removed. Due to the characteristics of the fracture and as a definitive and curative therapeutic method, it was decided to carry out a wide resection of the proximal femur and total arthroplasty of the hip with a modular prosthesis with placement of cerclage, as well as a excisional biopsy that later corroborated that it was the same DF treated in childhood.\n",
+        "translated_fulltext": "Bệnh nhân nam, 27 tuổi, có tiền sử loạn sản xơ ở phần trên của xương đùi phải. Cách đây 20 năm, bệnh nhân đã được điều trị dự phòng bằng phương pháp nạo vét (cắt bỏ khối u), ghép xương và cố định bằng vật liệu tổng hợp xương để giảm nguy cơ gãy xương, sau đó vật liệu này đã được loại bỏ một năm sau khi cố định. Hai tuần trước khi nhập viện, bệnh nhân bị đau sau khi bị ngã với lực tác động nhẹ, đặc trưng bởi tải trọng dọc trục và thành phần xoay của khớp háng phải, dẫn đến mức độ đau 8/10 trên thang đo tương tự trực quan (VAS) ở vùng bẹn và đùi phải, khiến bệnh nhân không thể đi lại. Kiểm tra bằng phương pháp chẩn đoán hình ảnh được thực hiện sau bốn tuần, cho thấy tất cả các bộ phận của bộ phận giả đều hoạt động tốt. Bệnh nhân được xuất viện trong tình trạng ổn định về lâm sàng và huyết động, không cần truyền máu. Trong quá trình theo dõi sau phẫu thuật (612 tuần), bệnh nhân tiếp tục được hỗ trợ một phần cho đến ngày thứ 20, sau đó bắt đầu đi lại bình thường và sử dụng thêm một chiếc gậy. Kiểm tra bằng phương pháp chẩn đoán hình ảnh được thực hiện sau bốn tuần, cho thấy tất cả các bộ phận của bộ phận giả đều hoạt động tốt. Hiện tại, bệnh nhân có thể thực hiện các hoạt động hàng ngày với một số hạn chế do chứng khập khiễng gián đoạn do vết mổ ở cơ mông giữa. Tuy nhiên, bệnh nhân có thể tham gia các hoạt động thể thao cường độ thấp, chẳng hạn như đi bộ, và bày tỏ sự hài lòng lớn với kết quả chức năng của thủ thuật.",
+        "translated_summary": "Chúng tôi xin trình bày trường hợp của một bệnh nhân nam 27 tuổi, đến khoa cấp cứu với chấn thương gãy xương đùi phải ở phần gốc cổ xương, được phân loại theo hệ thống Garden II Pauwells III AO 31B2.3r, do một chấn thương với lực tác động nhỏ, đặc trưng bởi tải trọng dọc trục kết hợp với chuyển động xoay của khớp háng phải. Bệnh nhân có tiền sử cắt bỏ khối u trong xương, ghép xương và cố định dự phòng bằng vật liệu cố định xương không xác định ở vùng quanh mấu chuyển lớn cách đây 20 năm; kết quả sinh thiết sau đó cho thấy đó là u xơ thần kinh (DF); một năm sau, vật liệu cố định xương đã được loại bỏ. Do đặc điểm của vết gãy và để có một phương pháp điều trị dứt điểm và hiệu quả, quyết định được đưa ra là thực hiện phẫu thuật cắt bỏ rộng phần gần xương đùi và thay khớp háng toàn phần bằng một bộ phận giả mô-đun, đồng thời đặt vòng cố định, cũng như thực hiện sinh thiết cắt bỏ, kết quả sau đó xác nhận rằng đây là cùng một khối u xơ thần kinh đã được điều trị từ thời thơ ấu."
+    },
+    {
+        "id": "multiclinsum_gs_en_280.txt",
+        "fulltext": "A 4-year-old boy with stage IV neuroblastoma received four cycles of chemotherapy, including high-dose chemotherapy including busulfan and melphalan, followed by autologous peripheral blood stem cell transplantation with autologous bone marrow supplementation. After eight additional cycles of chemotherapy consisting of temozolomide and irinotecan, which led to stable disease, the patient underwent preparative conditioning with fludarabine (150 mg/m2), melphalan (140 mg/m2), and 12 Gy of TBI for subsequent allogeneic CBT. The patient received tacrolimus and a short-term course of methotrexate for GVHD prophylaxis. The patient underwent engraftment on day 17. He then developed grade 3 GVHD, which was managed by increasing the prednisolone dose and was later discharged on day 85. The patient also received proton beam therapy (39.6 Gy) from days 121 to 150 post-transplantation for a right supra-mediastinum tumor with residual I123-MIBG accumulation in the right adrenal gland.\n\nThe patient remained healthy with no evidence of GVHD until presentation at our hospital with a productive cough on day 159. As his older brother displayed similar cold symptoms, a rapid antigen test for RSV was performed, which revealed a positive result. His respiratory symptoms gradually worsened, and he revisited our hospital on day 194 with dyspnea and intercostal retractions. Upon admission, he was given 0.7-1.0 mg/kg of prednisolone, which failed to improve his respiratory condition. Chest computed tomography on day 231 revealed infiltration, ground-glass opacity, and septal thickening in the bilateral lung fields along with right pleural effusion. Echocardiography showed an elevated tricuspid regurgitation peak velocity of 4.1 m/s and an interventricular septum close to the isobaric, indicating the presence of PH. In addition, pericardial effusion was detected. On day 231, the patient was transferred to the pediatric intensive care unit, where mechanical ventilation and inhaled nitric oxide (NO) were initiated. Thoracoscopic lung biopsy on day 244 revealed diffuse intra-alveolar hemorrhage and edema on hematoxylin-eosin (HE)-stained samples. Elastica van Gieson staining revealed diffuse obstructive lesions due to fibrocellular components with plump endothelial cells in the pre-septal pulmonary veins and venules. While pulmonary muscular arteries and arterioles showed mild medial hypertrophy and focal intimal thickening (Heath-Edwards Grade 2), severe stenosis with concentric intimal fibrosis or plexiform lesions was present. Based on these results, the patient was diagnosed with PVOD with mild pulmonary arterial/arteriolar lesions. Of note, HE staining also revealed enlarged type II pneumocytes with multinucleated and giant cell-like features, indicating the presence of prior lung injury that was likely attributable to his preceding viral infection.",
+        "summary": "A 4-year-old boy was diagnosed with metastatic neuroblastoma and underwent intensive chemotherapy, autologous HSCT, and allogeneic cord blood transplantation (CBT). He experienced PVOD on day 194 following CBT after displaying upper respiratory symptoms and positive RSV antigen test results approximately one month prior. Pathological examination of a lung biopsy specimen revealed lung injury suspected to be associated with viral infection in addition to PVOD-related findings, suggesting that RSV infection might have contributed to the onset of PVOD.",
+        "translated_fulltext": "Một bé trai 4 tuổi bị u thần kinh bào giai đoạn IV đã trải qua bốn đợt hóa trị, bao gồm hóa trị liều cao với busulfan và melphalan, sau đó là ghép tế bào gốc máu ngoại vi tự thân kết hợp với bổ sung tủy xương tự thân. Sau tám đợt hóa trị bổ sung, bao gồm temozolomide và irinotecan, giúp tình trạng bệnh ổn định, bệnh nhân được điều trị chuẩn bị bằng fludarabine (150 mg/m2), melphalan (140 mg/m2) và 12 Gy xạ trị toàn thân để chuẩn bị cho việc ghép tế bào gốc dị ghép tiếp theo. Bệnh nhân được dùng tacrolimus và một đợt methotrexate ngắn hạn để phòng ngừa bệnh mảnh ghép chống lại vật chủ (GVHD). Bệnh nhân bắt đầu phục hồi vào ngày thứ 17. Sau đó, bệnh nhân bị GVHD độ 3, được điều trị bằng cách tăng liều prednisolone và sau đó được xuất viện vào ngày thứ 85. Bệnh nhân cũng được điều trị bằng liệu pháp chùm proton (39,6 Gy) từ ngày 121 đến ngày 150 sau ghép để điều trị khối u ở vùng thượng trung thất bên phải, kèm theo sự tích tụ I123-MIBG còn sót lại ở tuyến thượng thận phải.\n\nBệnh nhân vẫn khỏe mạnh và không có dấu hiệu của GVHD cho đến khi nhập viện vào ngày thứ 159 với các triệu chứng ho có đờm. Vì anh trai của bệnh nhân có các triệu chứng cảm lạnh tương tự, nên đã tiến hành xét nghiệm kháng nguyên nhanh để kiểm tra virus hợp bào hô hấp (RSV), kết quả dương tính. Các triệu chứng hô hấp của bệnh nhân dần trở nên nghiêm trọng hơn, và bệnh nhân tái nhập viện vào ngày thứ 194 với khó thở và co rút các cơ liên sườn. Khi nhập viện, bệnh nhân được dùng 0,7-1,0 mg/kg prednisolone, nhưng không cải thiện được tình trạng hô hấp. Chụp cắt lớp vi tính ngực vào ngày thứ 231 cho thấy tình trạng thâm nhiễm, mờ màng như thủy tinh mờ và dày vách ở cả hai lá phổi, cùng với tràn dịch màng phổi bên phải. Siêu âm tim cho thấy vận tốc đỉnh của hở van ba lá tăng lên 4,1 m/s và vách liên thất gần như đẳng áp, cho thấy có bệnh tăng áp phổi (PH). Ngoài ra, còn phát hiện tràn dịch màng tim. Vào ngày thứ 231, bệnh nhân được chuyển đến khoa hồi sức tích cực nhi, nơi bắt đầu thở máy và hít nitric oxide (NO). Sinh thiết phổi bằng nội soi lồng ngực vào ngày thứ 244 cho thấy tình trạng xuất huyết và phù phế nang lan tỏa trên các mẫu nhuộm hematoxylin-eosin (HE). Nhuộm Elastica van Gieson cho thấy các tổn thương tắc nghẽn lan tỏa do các thành phần xơ-tế bào, với các tế bào nội mô phồng lên trong các tĩnh mạch và tiểu tĩnh mạch phổi trước vách liên tiểu thùy. Trong khi các động mạch và tiểu động mạch phổi cho thấy tình trạng phì đại lớp giữa nhẹ và dày lớp nội mạc khu trú (mức độ 2 theo thang Heath-Edwards), thì có tình trạng hẹp nghiêm trọng với xơ nội mạc đồng tâm hoặc các tổn thương dạng lưới. Dựa trên các kết quả này, bệnh nhân được chẩn đoán mắc bệnh tắc mạch phổi nguyên phát (PVOD) với các tổn thương động mạch/tiểu động mạch phổi nhẹ. Đáng chú ý, nhuộm HE cũng cho thấy các tế bào phế nang loại II mở rộng với các đặc điểm đa nhân và giống tế bào khổng lồ, cho thấy có tổn thương phổi trước đó, có thể là do nhiễm virus trước đó.",
+        "translated_summary": "Một bé trai 4 tuổi được chẩn đoán mắc bệnh u thần kinh bào di căn và đã trải qua quá trình hóa trị tích cực, ghép tế bào gốc tự thân và ghép tế bào gốc dây rốn đồng loại. Bé bị bệnh mạch máu phổi tắc nghẽn (PVOD) vào ngày thứ 194 sau khi ghép tế bào gốc dây rốn, sau khi trước đó khoảng một tháng bé có các triệu chứng nhiễm trùng đường hô hấp trên và kết quả xét nghiệm kháng nguyên RSV dương tính. Kết quả kiểm tra mô bệnh học của mẫu sinh thiết phổi cho thấy tổn thương phổi, có thể liên quan đến nhiễm virus, cùng với các dấu hiệu liên quan đến PVOD, cho thấy nhiễm RSV có thể đã góp phần vào sự khởi phát của PVOD."
+    },
+    {
+        "id": "multiclinsum_gs_en_160.txt",
+        "fulltext": "65-year-old male with no personal or family history of pathology of relevance. His condition began in 2020 with productive cough that intensified and was accompanied by shortness of breath with small to medium effort; as well as loss of 10 kg of weight in a period of 4 months. He went to a doctor who requested a chest X-ray that showed massive, multilocular right pleural effusion with right bronchial obstruction and mediastinal lymphadenopathy. A thoracocentesis was performed with a biopsy of the right lung and parietal pleura. The histopathological study reported an adeno-squamous carcinoma. His evolution was bad, which is why he was referred to our institution. On admission, a physical examination found him cachectic, with right pulmonary hypoventilation, 92% oxygen saturation and pneumokoccal dysfunction, with no evidence of systemic or haemodynamic compromise. A chest X-ray was performed that showed complete opacity of the right hemithorax, and a pleural catheter was placed with a serohematic flow. In the histopathological study of the revision material, the lung parenchyma was replaced by a poorly differentiated neoplasm with a solid mantle and syncytia, surrounded by abundant lymphocytes and plasma cells. The neoplastic cells had large, ovoid nuclei, fine chromatin, prominent nucleolus and wide, poorly defined cytoplasm. An immunohistochemical study was performed that was positive for CKAE1/AE3, CK 5/6, p63, EBER ISH, and negative for Napsina A, TTF-1 and CK 7, which ruled out the reference diagnosis of adeno-squamous carcinoma and established the diagnosis of CTLP. Molecular study in the paraffin block was positive for PD-L1 (SP263) +++ in approximately 100% of the neoplastic cells, and negative for EGFR, K-RAS, ALK, ROS1. In order to confirm the pulmonary origin of the neoplasm, a nasopharyngeal examination was performed that was negative. In April 2021, a PET-CT was performed that reported a heterogeneous parahilary pulmonary lesion that compromised the main bronchus and caused atelectasis; as well as multiple cervical, mediastinal and peri-gastric lymphadenopathies. The catheter was removed due to partial resolution of the effusion and chemotherapy treatment with gemcitabine/cisplatin was initiated. He received 6 cycles, however, the patient reported hearing loss and AKIN I acute renal failure was documented, so cisplatin was changed to carboplatin, and maintenance durvalumab was continued. In December 2021, disease progression was documented and he died in January 2022 due to respiratory failure.\n",
+        "summary": "We report the case of a 65-year-old man with a pulmonary lymphoepithelioma-like carcinoma, who presented with cough, dyspnea, and weight loss. A chest CT scan showed a poorly defined nodule located in the right lung. A trans-thoracic biopsy of the lesion was performed, and microscopic examination revealed large polygonal cells arranged in sheets, infiltrated by abundant lymphocytes and plasma cells, around the interstitium. The neoplastic cells were positive for cytokeratin 5/6 and p63, and negative for Napsina A and thyroid transcription factor 1 (TTF-1). PD-L1 expression was positive (approximately 100%) by immunohistochemistry; as was the nucleus of the neoplastic cells by in situ hybridization for Epstein-Barr virus-encoded RNA (EBER-ISH). The patient received six cycles of a combination chemotherapy regimen based on platinum (gemcitabine/cisplatin) plus durvalumab. He progressed and ultimately died 9 months after diagnosis.\n",
+        "translated_fulltext": "Một bệnh nhân nam 65 tuổi, không có tiền sử bệnh cá nhân hoặc gia đình liên quan. Bệnh của ông bắt đầu vào năm 2020 với các triệu chứng ho có đờm, ngày càng nặng hơn, kèm theo khó thở khi gắng sức vừa phải; đồng thời, ông bị sụt mất 10 kg trong vòng 4 tháng. Ông đến khám bác sĩ và được yêu cầu chụp X-quang ngực, kết quả cho thấy tràn dịch màng phổi phải diện rộng, nhiều ngăn, kèm theo tắc nghẽn phế quản phải và hạch bạch huyết trung thất. Bác sĩ đã thực hiện chọc hút dịch màng phổi và lấy mẫu sinh thiết phổi phải và màng phổi thành. Kết quả phân tích mô bệnh học cho thấy ung thư biểu mô tuyến - vảy. Tình trạng bệnh của ông diễn biến xấu, vì vậy ông được chuyển đến bệnh viện của chúng tôi. Khi nhập viện, khám lâm sàng cho thấy ông gầy yếu, suy hô hấp phổi phải, độ bão hòa oxy 92% và rối loạn chức năng phổi do nhiễm trùng, không có dấu hiệu suy giảm hệ thống hoặc huyết động. Chụp X-quang ngực cho thấy hình ảnh mờ hoàn toàn của nửa lồng ngực phải, và một ống dẫn lưu màng phổi được đặt vào, dịch dẫn lưu có màu vàng nhạt. Trong quá trình phân tích mô bệnh học của mẫu sinh thiết, mô phổi bị thay thế bởi một khối u kém biệt hóa với cấu trúc đặc và các tế bào liên kết, được bao quanh bởi nhiều tế bào lympho và tế bào plasma. Các tế bào ung thư có nhân lớn, hình bầu dục, nhiễm sắc thể mịn, nhân nhỏ nổi bật và tế bào chất rộng, không rõ ràng. Một nghiên cứu hóa mô miễn dịch được thực hiện, cho thấy dương tính với CKAE1/AE3, CK 5/6, p63, EBER ISH và âm tính với Napsina A, TTF-1 và CK 7, điều này loại trừ chẩn đoán ban đầu là ung thư biểu mô tuyến - vảy và xác định chẩn đoán là CTLP. Nghiên cứu phân tử trên mẫu mô paraffin cho thấy dương tính với PD-L1 (SP263) +++ ở khoảng 100% các tế bào ung thư và âm tính với EGFR, K-RAS, ALK, ROS1. Để xác nhận nguồn gốc của khối u từ phổi, một cuộc kiểm tra xoang mũi họng đã được thực hiện và kết quả âm tính. Vào tháng 4 năm 2021, một cuộc chụp PET-CT được thực hiện, cho thấy một tổn thương phổi không đồng nhất ở vùng rốn phổi, ảnh hưởng đến phế quản chính và gây ra xẹp phổi; đồng thời, có nhiều hạch bạch huyết ở cổ, trung thất và xung quanh dạ dày. Ống dẫn lưu được rút ra do tình trạng tràn dịch giảm một phần và điều trị hóa trị bằng gemcitabine/cisplatin được bắt đầu. Ông đã trải qua 6 chu kỳ điều trị, tuy nhiên, bệnh nhân báo cáo bị giảm thính lực và được chẩn đoán suy thận cấp AKIN I, vì vậy cisplatin được thay thế bằng carboplatin và tiếp tục điều trị duy trì bằng durvalumab. Vào tháng 12 năm 2021, bệnh tiến triển và ông qua đời vào tháng 1 năm 2022 do suy hô hấp.",
+        "translated_summary": "Chúng tôi báo cáo về một trường hợp bệnh nhân nam 65 tuổi mắc bệnh ung thư biểu mô hạch phổi, với các triệu chứng ho, khó thở và sụt cân. Chụp CT ngực cho thấy một khối u không rõ hình dạng ở phổi phải. Một mẫu sinh thiết xuyên lồng ngực đã được thực hiện, và kết quả kiểm tra dưới kính hiển vi cho thấy các tế bào đa giác lớn được sắp xếp thành các đám, với nhiều tế bào lympho và tế bào plasma xâm nhập xung quanh mô kẽ. Các tế bào ung thư dương tính với cytokeratin 5/6 và p63, và âm tính với Napsina A và yếu tố phiên mã tuyến giáp 1 (TTF-1). Biểu hiện PD-L1 dương tính (khoảng 100%) thông qua phương pháp hóa mô miễn dịch; tương tự, nhân của các tế bào ung thư cũng dương tính thông qua phương pháp lai tại chỗ để phát hiện RNA được mã hóa bởi virus Epstein-Barr (EBER-ISH). Bệnh nhân đã được điều trị bằng liệu pháp hóa trị kết hợp gồm sáu đợt, dựa trên bạch kim (gemcitabine/cisplatin) kết hợp với durvalumab. Tình trạng bệnh tiến triển và bệnh nhân cuối cùng đã tử vong sau 9 tháng kể từ khi được chẩn đoán."
+    },
+    {
+        "id": "multiclinsum_gs_en_436.txt",
+        "fulltext": "A 13-year-old male patient was admitted to the Children’s Hospital in Damascus after noticing a palpable enlarged mass in the left inguinal region. His medical history was unremarkable except for a surgical intervention on his spine 6 years ago due to an accident, which resulted in the loss of motor function and sensation in both of his lower extremities.\n\nDue to the long period he had spent in bed, the patient developed decubitus sores on his left foot. The only finding on clinical examination was a mass in the left inguinal area, which was movable on deep structures and so was the overlaying skin on it. The mass was not tender on palpation, and no signs of local inflammation were observed.\n\nLaboratory tests revealed an Elevated ESR (119 mm/h in the first hour). Other Basic Laboratory tests including (Complete Blood Count, Liver function tests, electrolytes, Urea, Creatinine and LDH) were ordered and were within normal ranges for age. Ordering these tests was essential to rule out systemic diseases. Given the absence of indicative physical findings for systemic disorders or immunodeficiencies, additional tests like those for HIV or Direct Antiglobulin were deemed unnecessary.\n\nA CT of the abdomen, chest, and pelvis showed enlarged lymph nodes inferior to the inguinal ligament, with the largest measuring approximately (3.5 × 2.4 cm). Other organs and nodes were within normal limits.\n\nAll of the above-mentioned investigations were essential to rule other high-risk diagnosis including lymphoma and leukemia. However, these were not sufficient to reach the definite diagnosis, so a decision of surgical resection of the nodes was taken.\n\nTo confirm the diagnoses and exclude other potential differentials presenting with enlarged lymph nodes, surgical removal of all of these enlarged nodes was performed under general anesthesia, and biopsies were sent for microscopic study.\n\nThe biopsy showed hyperplastic nodal architecture with proliferation of histiocytes and plasma cells with vascular proliferation, consistent with Plasma cell subtype of Castleman’s Disease.\n\nThe patient was discharged from the hospital after 14-day period after ensuring that there were no remaining enlarged lymph nodes. The only recommendation was oral prednisolone. The patient underwent follow-up using a whole-body CT scan every three months. During each hospital visit, a comprehensive clinical examination and laboratory tests (e.g. Complete Blood Test, ESR, C-reactive protein, liver function tests, renal function tests) were performed in addition to the CT scan. After a 12-month follow-up period, the patient reported no new symptoms or enlarged lymph nodes. Additionally, no abnormalities were observed during clinical examination or in laboratory tests.",
+        "summary": "We report a unique case of a 13-year-old boy who presented with a palpable enlarged mass in the left inguinal region without any constitutional symptoms. Surgical removal of this mass was essential to exclude worrying causes. Pathologic examination revealed proliferative changes consistent with Castleman's disease plasma cell type which is one of the rarest forms of the disease in children. To our knowledge, this case is the first reported case of Unicentric Castleman Disease (UCD) in the inguinal area. During a 12-month-period of follow-up, no additional lymph node enlargements or other symptoms were reported.",
+        "translated_fulltext": "Một bệnh nhân nam 13 tuổi được đưa vào Bệnh viện Nhi ở Damascus sau khi phát hiện một khối phồng lớn có thể sờ thấy ở vùng bẹn trái. Tiền sử bệnh của bệnh nhân không có gì đặc biệt, ngoại trừ một lần phẫu thuật cột sống cách đây 6 năm do tai nạn, dẫn đến mất chức năng vận động và cảm giác ở cả hai chi dưới.\n\nDo thời gian nằm viện kéo dài, bệnh nhân bị loét do tì đè ở bàn chân trái. Kết quả khám lâm sàng cho thấy chỉ có một khối ở vùng bẹn trái, có thể di chuyển trên các cấu trúc sâu và cả lớp da phía trên. Khối này không gây đau khi sờ và không có dấu hiệu viêm nhiễm tại chỗ.\n\nCác xét nghiệm trong phòng thí nghiệm cho thấy chỉ số ESR tăng cao (119 mm/giờ trong giờ đầu tiên). Các xét nghiệm cơ bản khác, bao gồm (công thức máu toàn phần, xét nghiệm chức năng gan, điện giải, ure, creatinine và LDH) cũng được thực hiện và nằm trong phạm vi bình thường so với độ tuổi. Việc thực hiện các xét nghiệm này là cần thiết để loại trừ các bệnh lý toàn thân. Do không có các dấu hiệu lâm sàng rõ ràng cho thấy các rối loạn toàn thân hoặc suy giảm miễn dịch, các xét nghiệm bổ sung như xét nghiệm HIV hoặc xét nghiệm kháng thể trực tiếp được coi là không cần thiết.\n\nChụp CT ổ bụng, ngực và vùng chậu cho thấy các hạch bạch huyết mở rộng ở phía dưới dây chằng bẹn, với hạch lớn nhất có kích thước khoảng (3,5 × 2,4 cm). Các cơ quan và hạch khác nằm trong giới hạn bình thường.\n\nTất cả các xét nghiệm trên là cần thiết để loại trừ các chẩn đoán có nguy cơ cao khác, bao gồm u lympho và bệnh bạch cầu. Tuy nhiên, những kết quả này không đủ để đưa ra chẩn đoán xác định, do đó, quyết định phẫu thuật cắt bỏ các hạch đã được thực hiện.\n\nĐể xác nhận chẩn đoán và loại trừ các chẩn đoán phân biệt tiềm ẩn khác có biểu hiện bằng các hạch bạch huyết mở rộng, tất cả các hạch mở rộng này đã được phẫu thuật cắt bỏ dưới gây mê toàn thân, và các mẫu sinh thiết đã được gửi đi để nghiên cứu dưới kính hiển vi.\n\nKết quả sinh thiết cho thấy cấu trúc hạch tăng sinh với sự tăng sinh của tế bào histiocyte và tế bào plasma, cùng với sự tăng sinh mạch máu, phù hợp với loại tế bào plasma của bệnh Castleman.\n\nBệnh nhân được xuất viện sau 14 ngày, sau khi đảm bảo rằng không còn hạch bạch huyết mở rộng. Khuyến nghị duy nhất là sử dụng prednisolone đường uống. Bệnh nhân được theo dõi bằng cách chụp CT toàn thân mỗi ba tháng. Trong mỗi lần tái khám, một cuộc khám lâm sàng toàn diện và các xét nghiệm trong phòng thí nghiệm (ví dụ: công thức máu toàn phần, ESR, protein C phản ứng, xét nghiệm chức năng gan, xét nghiệm chức năng thận) được thực hiện, ngoài chụp CT. Sau 12 tháng theo dõi, bệnh nhân không báo cáo bất kỳ triệu chứng mới hoặc hạch bạch huyết mở rộng nào. Ngoài ra, không có bất thường nào được phát hiện trong quá trình khám lâm sàng hoặc trong các xét nghiệm trong phòng thí nghiệm.",
+        "translated_summary": "Chúng tôi báo cáo một trường hợp độc đáo của một bé trai 13 tuổi, đến khám với một khối u lớn có thể sờ thấy ở vùng bẹn trái, không có bất kỳ triệu chứng toàn thân nào. Việc phẫu thuật loại bỏ khối u này là rất quan trọng để loại trừ các nguyên nhân đáng lo ngại. Kết quả kiểm tra bệnh lý cho thấy những thay đổi tăng sinh phù hợp với bệnh Castleman, loại tế bào plasma, đây là một trong những dạng hiếm gặp nhất của bệnh này ở trẻ em. Theo hiểu biết của chúng tôi, đây là trường hợp đầu tiên được báo cáo về bệnh Castleman đơn thuần (UCD) ở vùng bẹn. Trong thời gian theo dõi 12 tháng, không có thêm hạch bạch huyết nào bị sưng to hoặc các triệu chứng khác được ghi nhận."
+    },
+    {
+        "id": "multiclinsum_gs_en_116.txt",
+        "fulltext": "The medical records of patients with a diagnosis of congenital myotonia studied and followed in the pediatric neurology consultation in a third-level hospital between 2015 and 2020 were reviewed. The inclusion criteria were to present a clinical diagnosis – myotonia, warm-up phenomenon, characteristic electromyographic pattern and/or family history – and/or a molecular diagnosis (mutation in the CLCN1 gene). The clinical signs and symptoms, as well as the results of the complementary explorations and the genetic mutation found, were collected by reviewing the medical record. Demographic variables (age and sex), course of the disease (age of onset, symptoms and signs, time elapsed until diagnosis and clinical evolution), family history and evaluation of the response to treatment were collected.\n\nFive cases with clinical diagnosis of congenital myotonia were identified (three with Becker's disease and two with Thomsen's disease). The incidence in relation to the number of births was estimated at 1:15,000 newborns for cases with Becker's phenotype and 1:21,000 newborns for Thomsen's phenotypes.\n\nMost of our patients were female, and the male was the only one who started before the age of six. The initial clinical presentation included myotonia in the lower limbs in four of the five patients and in the upper limbs in all but one. The age at onset ranged from 22 months to 12 years, with a median of 6 years. Genetic diagnosis was performed in all cases approximately two years after onset, and the family of one patient refused to have it performed. All had a worsening with cold, but the warming phenomenon was only in those with the Becker phenotype.\n\nPatients with recessive congenital myotonia showed some progression. As a family history, it is worth noting that patients 2 and 3 were sisters, without the parents showing any clinical signs, and that the mother of patient 1 showed mild clinical signs that were doubtful with the cold. The patient who refused the study had a history of myotonia in the maternal branch.\n\nBlood tests did not show elevated creatine kinase in any of the patients. The electromyogram was abnormal in all patients except the first one at 2.8/12 years of age. The test was not repeated later because it was not considered necessary.\n\nThe most used treatment initially was oxcarbazepine (in patients with recessive form), with a good response in general. In case 2 it lost efficacy with time and mexiletine was initiated. Patient 4 initiated several drugs without success due to loss of efficacy or side effects. Patient 5 rejected treatment due to mild clinical presentation.\n\nPatient 1 had a previously undescribed, likely pathogenic mutation (CLCN1: c.824T>C) inherited from his mother. Cases 1 to 3 had the Becker phenotype with composite heterozygosity mutations, and cases 4 and 5 had the Thomsen phenotype. Case 5 declined genetic testing.\n",
+        "summary": "The medical records of patients with a diagnosis of congenital myotonia studied and followed in the pediatric neurology consultation in a third-level hospital between 2015 and 2020 were reviewed. Demographic variables (age and sex), course of the disease (age of onset, symptoms and signs, time elapsed until diagnosis and clinical evolution), family history and evaluation of the response to treatment were collected. Five cases with a clinical diagnosis of congenital myotonia were identified (three with Becker disease and two with Thomsen disease). The incidence in relation to the number of births was estimated at 1:15,000 newborns for cases with a Becker phenotype and 1:21,000 newborns for Thomsen phenotypes. We found a probably pathogenic mutation not previously described (CLCN1: c.824T>C).\n",
+        "translated_fulltext": "Hồ sơ bệnh án của những bệnh nhân được chẩn đoán mắc chứng co cứng cơ bẩm sinh, những người đã được theo dõi và điều trị tại khoa thần kinh nhi của một bệnh viện tuyến ba trong giai đoạn từ năm 2015 đến năm 2020, đã được xem xét. Tiêu chí lựa chọn bao gồm: có chẩn đoán lâm sàng – chứng co cứng cơ, hiện tượng làm ấm cơ, đặc điểm điện cơ học đặc trưng và/hoặc tiền sử gia đình – và/hoặc chẩn đoán phân tử (đột biến trong gen CLCN1). Các dấu hiệu và triệu chứng lâm sàng, cũng như kết quả của các xét nghiệm bổ sung và đột biến gen được tìm thấy, đã được thu thập bằng cách xem xét hồ sơ bệnh án. Các biến số nhân khẩu học (tuổi và giới tính), diễn biến bệnh (tuổi khởi phát, triệu chứng và dấu hiệu, thời gian trôi qua cho đến khi chẩn đoán và diễn biến lâm sàng), tiền sử gia đình và đánh giá về đáp ứng với điều trị đã được thu thập.\n\nNăm trường hợp có chẩn đoán lâm sàng là chứng co cứng cơ bẩm sinh đã được xác định (ba trường hợp mắc bệnh Becker và hai trường hợp mắc bệnh Thomsen). Tỷ lệ mắc bệnh liên quan đến số lượng trẻ sơ sinh ước tính là 1:15.000 trẻ sơ sinh đối với các trường hợp có kiểu hình Becker và 1:21.000 trẻ sơ sinh đối với các kiểu hình Thomsen.\n\nHầu hết bệnh nhân của chúng tôi là nữ, và bệnh nhân nam là người duy nhất khởi phát bệnh trước sáu tuổi. Triệu chứng lâm sàng ban đầu bao gồm chứng co cứng cơ ở chi dưới ở bốn trong số năm bệnh nhân và ở chi trên ở tất cả trừ một bệnh nhân. Tuổi khởi phát dao động từ 22 tháng đến 12 tuổi, với độ tuổi trung bình là 6 tuổi. Chẩn đoán di truyền được thực hiện ở tất cả các trường hợp khoảng hai năm sau khi khởi phát, và gia đình của một bệnh nhân từ chối thực hiện xét nghiệm này. Tất cả đều có tình trạng bệnh trở nên tồi tệ hơn khi trời lạnh, nhưng hiện tượng làm ấm cơ chỉ xảy ra ở những bệnh nhân có kiểu hình Becker.\n\nBệnh nhân mắc chứng co cứng cơ bẩm sinh lặn cho thấy một số tiến triển. Về tiền sử gia đình, điều đáng lưu ý là bệnh nhân 2 và 3 là chị em, trong khi cha mẹ không có bất kỳ dấu hiệu lâm sàng nào, và mẹ của bệnh nhân 1 có các dấu hiệu lâm sàng nhẹ, không rõ ràng khi trời lạnh. Bệnh nhân từ chối xét nghiệm có tiền sử mắc chứng co cứng cơ trong dòng họ mẹ.\n\nXét nghiệm máu không cho thấy nồng độ creatine kinase tăng cao ở bất kỳ bệnh nhân nào. Điện cơ đồ bất thường ở tất cả bệnh nhân, ngoại trừ bệnh nhân đầu tiên ở tuổi 2,8/12. Xét nghiệm không được lặp lại sau đó vì không được coi là cần thiết.\n\nThuốc được sử dụng phổ biến nhất ban đầu là oxcarbazepine (ở bệnh nhân mắc dạng lặn), với hiệu quả tốt nói chung. Ở trường hợp 2, thuốc mất tác dụng theo thời gian và mexiletine được bắt đầu sử dụng. Bệnh nhân 4 đã dùng một số loại thuốc mà không có kết quả do mất tác dụng hoặc tác dụng phụ. Bệnh nhân 5 từ chối điều trị do triệu chứng lâm sàng nhẹ.\n\nBệnh nhân 1 có một đột biến có khả năng gây bệnh chưa từng được mô tả trước đây (CLCN1: c.824T>C) được di truyền từ mẹ. Các trường hợp 1 đến 3 có kiểu hình Becker với các đột biến dị hợp phức tạp, và các trường hợp 4 và 5 có kiểu hình Thomsen. Trường hợp 5 từ chối xét nghiệm di truyền.",
+        "translated_summary": "Hồ sơ bệnh án của những bệnh nhân được chẩn đoán mắc chứng co cứng cơ bẩm sinh, những người đã được theo dõi và điều trị tại khoa thần kinh nhi của một bệnh viện tuyến ba trong khoảng thời gian từ năm 2015 đến năm 2020, đã được xem xét. Các yếu tố nhân khẩu học (tuổi và giới tính), diễn biến của bệnh (tuổi khởi phát, các triệu chứng và dấu hiệu, thời gian từ khi khởi phát đến khi chẩn đoán và diễn biến lâm sàng), tiền sử gia đình và đánh giá về đáp ứng với điều trị đã được thu thập. Năm trường hợp được chẩn đoán lâm sàng mắc chứng co cứng cơ bẩm sinh đã được xác định (ba trường hợp mắc bệnh Becker và hai trường hợp mắc bệnh Thomsen). Tỷ lệ mắc bệnh được ước tính là 1/15.000 trẻ sơ sinh đối với các trường hợp có kiểu hình Becker và 1/21.000 trẻ sơ sinh đối với các trường hợp có kiểu hình Thomsen. Chúng tôi đã phát hiện ra một đột biến có khả năng gây bệnh chưa từng được mô tả trước đây (CLCN1: c.824T>C)."
+    },
+    {
+        "id": "multiclinsum_gs_en_322.txt",
+        "fulltext": "A 67-year-old female patient presented with a six-year history of recurrent swelling in the left lower limb. One year prior, she was diagnosed with an AVM in the lower limb at another hospital. Two months before hospitalization, the patient underwent embolization treatment, which included the placement of two coils (20 mm x 40 cm, BSX, USA). Despite this intervention, the patient’s left lower limb swelling did not show any improvement. The patient has been experiencing fatigue and difficulty of breathing for a month. As these symptoms of heart failure progressed and worsened, the patient was transferred to Chengdu University of Traditional Chinese Medicine Hospital for further evaluation and treatment. The patient had no prior history of cardiovascular diseases, injuries, or surgeries. However, she reported a history of oral estrogen use for menopausal syndrome seven years ago.\n\nShe exhibited significant edema and skin sclerosis in the left lower limb. Additionally, absent pulses were observed in the popliteal artery and distal regions. A noticeable tremor was also present in the left thigh. The patient was seated during the examination. Echocardiography revealed cardiac enlargement, along with moderate mitral regurgitation and severe tricuspid regurgitation. The left ventricular ejection fraction (EF) was measured at 60%, and there was an elevation in b-type natriuretic peptide (BNP) levels to 2853 ng/L. The electrocardiogram showed a sinus rhythm with a heart rate of 105 beats per minute and evidence of left atrial enlargement. Chest CT scans confirmed cardiac enlargement, while no respiratory system abnormalities were detected. Preoperative computed tomography angiography (CTA) provided further insights, revealing a left iliac artery aneurysm, a significantly enlarged femoral artery, and complex AVMs in the superficial femoral artery. Additionally, the femoral and superficial veins appeared significantly enlarged on arterial phase imaging. Notably, the left lower limb popliteal artery and anterior tibial artery were not visualized. Based on these findings, the patient was diagnosed with complex congenital lower limb AVMs, acute exacerbation of chronic heart failure, and classified as NYHA Class IV.\n\nThe patient exhibits distinct symptoms of acute heart failure, and preoperative ultrasound assessment has revealed a volume flow of 3400 ml/min in the CFA. Given that embolization using coils may not effectively reduce the flow rate of the AVMs, the utilization of covered stents is a viable option. These stents effectively decrease the flow of lower limb AVMs, thereby improving the patient’s heart failure condition. Additionally, staged embolization treatment can further enhance the treatment outcome by improving the nidus of the lower limb AVMs.\n\nCTA of the patient revealed significant dilatation of blood vessels, with a maximum diameter of 32 mm for the iliac artery, 27 mm for the common femoral artery (CFA), and 22 mm for the superficial femoral artery (SFA). To minimize access site complications, antegrade access was achieved through a surgical approach of the CFA. Under general anesthesia, intravascular covered stents were inserted through an open femoral artery approach, utilizing 14 F (Cook Medical, USA) catheter sheaths intraoperatively. complex AVMs were visualized in the superficial femoral artery and profunda femoris artery, accompanied by early visualization of an enlarged femoral vein.\n\nPreoperative CTA measurements indicated a diameter of 19 mm for the middle segment of the SFA, leading to the selection of a 20 mm–12 mm/120 mm aorto-uni-iliac covered stent (MicroPort, China). A 0.035 guidewire, in conjunction with a single-curve catheter, was used to access the popliteal artery. Subsequently, it was replaced with a 0.035 super-hard guidewire to provide support during the implantation of the stent graft. The stent was deployed precisely at the distal end of the superficial femoral artery, the location with the highest concentration of AVMs. Completion angiography revealed a significant reduction in venous opacification around the stent and clear visualization of the popliteal artery. Postoperatively, the left femoral artery was sutured using a 6 − 0 vascular risk suture, resulting in a significant improvement in the patient’s heart failure symptoms. The patient has heart failure, so the surgery duration should not be excessive. It is planned to perform embolization treatment in the second phase.\n\nOne week post-treatment, ultrasound examination revealed a reduction in volume flow to 1600 ml/min in the CFA, with a BNP level of 1198ug/l. Targeting the nidus with embolization therapy is expected to further decrease the flow velocity of arteriovenous malformations. The right CFA was punctured, allowing the insertion of a 5 F arterial sheath and a 5 F catheter for angiographic examination. Guided by ultrasound, the drainage vein of the AVM was punctured, and a 5 F vascular sheath was introduced. The contrast agent confirmed the presence of a nidus and its draining veins. The embolization procedure of the draining veins involved the use of a coil (18–20 mm x 40 cm, BSX, USA), two microcoils (4 mm x 42 mm, 5 mm x 10 mm, USA), 3% polidocanol (6 mL Kruelle, Germany), and 99% anhydrous ethanol (10 mL).\n\nCompletion angiography showed a significant reduction in the visualization of AVMs and draining veins, indicating their disappearance. During the one-year follow-up, the patient exhibited notable improvement in lower limb swelling and cardiac function. The volume flow in the CFA decreased to 780 ml/min. Echocardiography revealed minor enlargement of the left and right atria, slight mitral and tricuspid regurgitation, and a left ventricular ejection fraction (EF) of 71%. Notably, BNP levels decreased significantly.",
+        "summary": "We present a case involving a patient with congenital AVMs in the lower limb, who had suffered from prolonged swelling in the left lower limb and recently developed symptoms of heart failure. At the age of 67, the patient was definitively diagnosed with a complex congenital AVMs in the lower limb. This article delves into the practical experiences and limitations encountered in employing an abdominal aortic stent graft, coupled with embolization, to address acute heart failure caused by complex congenital AVMs in the lower limb.",
+        "translated_fulltext": "Một bệnh nhân nữ 67 tuổi nhập viện với tiền sử sưng tái phát ở chi dưới trái trong sáu năm. Một năm trước, bệnh nhân được chẩn đoán mắc chứng AVM ở chi dưới tại một bệnh viện khác. Hai tháng trước khi nhập viện, bệnh nhân đã trải qua điều trị tắc mạch, bao gồm việc đặt hai vòng xoắn (20 mm x 40 cm, BSX, Hoa Kỳ). Mặc dù đã can thiệp như vậy, tình trạng sưng chi dưới trái của bệnh nhân không có dấu hiệu cải thiện. Bệnh nhân bị mệt mỏi và khó thở trong một tháng. Khi các triệu chứng suy tim tiến triển và trở nên nghiêm trọng hơn, bệnh nhân được chuyển đến Bệnh viện Y học Cổ truyền Thành Đô để đánh giá và điều trị thêm. Bệnh nhân không có tiền sử bệnh tim mạch, chấn thương hoặc phẫu thuật trước đây. Tuy nhiên, bệnh nhân cho biết đã sử dụng estrogen đường uống để điều trị hội chứng mãn kinh bảy năm trước.\n\nBệnh nhân có phù đáng kể và xơ cứng da ở chi dưới trái. Ngoài ra, mạch đập không rõ ở động mạch khoeo và các vùng xa. Một cơn run rõ rệt cũng xuất hiện ở đùi trái. Bệnh nhân ngồi trong quá trình khám. Siêu âm tim cho thấy tim to, cùng với hở van hai lá vừa phải và hở van ba lá nghiêm trọng. Phân suất tống máu thất trái (EF) được đo là 60% và có sự gia tăng nồng độ peptide lợi niệu loại B (BNP) lên 2853 ng/L. Điện tâm đồ cho thấy nhịp xoang với tần số tim 105 nhịp mỗi phút và có bằng chứng về sự phì đại tâm nhĩ trái. Chụp CT ngực xác nhận tim to, trong khi không phát hiện bất thường nào ở hệ hô hấp. Chụp mạch máu bằng máy tính (CTA) trước phẫu thuật cung cấp thêm thông tin chi tiết, cho thấy phình động mạch chậu trái, động mạch đùi mở rộng đáng kể và các AVM phức tạp ở động mạch đùi nông. Ngoài ra, động mạch đùi và tĩnh mạch nông có vẻ mở rộng đáng kể trên hình ảnh pha động mạch. Đáng chú ý, động mạch khoeo và động mạch chày trước của chi dưới trái không được hình dung rõ. Dựa trên những phát hiện này, bệnh nhân được chẩn đoán mắc chứng AVM chi dưới bẩm sinh phức tạp, đợt cấp tính của suy tim mãn tính và được phân loại là NYHA loại IV.\n\nBệnh nhân có các triệu chứng rõ ràng của suy tim cấp tính và đánh giá siêu âm trước phẫu thuật cho thấy lưu lượng máu là 3400 ml/phút ở động mạch đùi chung (CFA). Vì việc tắc mạch bằng vòng xoắn có thể không làm giảm hiệu quả tốc độ dòng chảy của AVM, nên việc sử dụng ống đỡ có lớp phủ là một lựa chọn khả thi. Các ống đỡ này làm giảm hiệu quả dòng chảy của AVM chi dưới, do đó cải thiện tình trạng suy tim của bệnh nhân. Ngoài ra, điều trị tắc mạch theo giai đoạn có thể nâng cao hơn nữa kết quả điều trị bằng cách cải thiện vùng trung tâm của AVM chi dưới.\n\nCTA của bệnh nhân cho thấy sự giãn nở đáng kể của mạch máu, với đường kính tối đa là 32 mm đối với động mạch chậu, 27 mm đối với động mạch đùi chung (CFA) và 22 mm đối với động mạch đùi nông (SFA). Để giảm thiểu các biến chứng tại vị trí tiếp cận, lối vào theo hướng thuận dòng đã được thực hiện thông qua phương pháp phẫu thuật của động mạch đùi chung. Trong khi gây mê toàn thân, ống đỡ có lớp phủ trong lòng mạch được đưa vào thông qua phương pháp tiếp cận động mạch đùi mở, sử dụng ống thông 14 F (Cook Medical, Hoa Kỳ) trong quá trình phẫu thuật. Các AVM phức tạp được hình dung trong động mạch đùi nông và động mạch đùi sâu, cùng với hình ảnh sớm của tĩnh mạch đùi mở rộng.\n\nCác phép đo CTA trước phẫu thuật cho thấy đường kính 19 mm của đoạn giữa của động mạch đùi nông (SFA), dẫn đến việc lựa chọn ống đỡ có lớp phủ động mạch chậu-đùi đơn (20 mm–12 mm/120 mm, MicroPort, Trung Quốc). Một dây dẫn 0,035, kết hợp với ống thông cong đơn, được sử dụng để tiếp cận động mạch khoeo. Sau đó, nó được thay thế bằng một dây dẫn siêu cứng 0,035 để cung cấp sự hỗ trợ trong quá trình cấy ghép ống đỡ. Ống đỡ được đặt chính xác ở đầu xa của động mạch đùi nông, vị trí có nồng độ AVM cao nhất. Chụp mạch máu sau khi hoàn thành cho thấy sự giảm đáng kể độ cản quang của tĩnh mạch xung quanh ống đỡ và hình ảnh rõ ràng của động mạch khoeo. Sau phẫu thuật, động mạch đùi trái được khâu bằng chỉ khâu mạch máu 6-0, dẫn đến sự cải thiện đáng kể các triệu chứng suy tim của bệnh nhân. Bệnh nhân bị suy tim, vì vậy thời gian phẫu thuật không nên quá dài. Kế hoạch thực hiện điều trị tắc mạch trong giai đoạn thứ hai.\n\nMột tuần sau khi điều trị, siêu âm cho thấy lưu lượng máu giảm xuống 1600 ml/phút ở động mạch đùi chung (CFA), với mức BNP là 1198ug/l. Việc nhắm mục tiêu vào vùng trung tâm bằng liệu pháp tắc mạch dự kiến sẽ làm giảm hơn nữa tốc độ dòng chảy của các dị dạng động tĩnh mạch. Động mạch đùi phải được chọc thủng, cho phép đưa ống thông động mạch 5 F và ống thông 5 F để kiểm tra bằng chụp mạch. Được hướng dẫn bởi siêu âm, tĩnh mạch dẫn lưu của AVM được chọc thủng và ống thông mạch máu 5 F được đưa vào. Chất cản quang xác nhận sự hiện diện của vùng trung tâm và các tĩnh mạch dẫn lưu của nó. Thủ thuật tắc mạch của các tĩnh mạch dẫn lưu bao gồm việc sử dụng một vòng xoắn (18–20 mm x 40 cm, BSX, Hoa Kỳ), hai vòng xoắn nhỏ (4 mm x 42 mm, 5 mm x 10 mm, Hoa Kỳ), 3% polidocanol (6 mL Kruelle, Đức) và 99% ethanol khan (10 mL).\n\nChụp mạch máu sau khi hoàn thành cho thấy sự giảm đáng kể hình ảnh của AVM và các tĩnh mạch dẫn lưu, cho thấy chúng đã biến mất. Trong quá trình theo dõi một năm, bệnh nhân có sự cải thiện đáng kể về tình trạng sưng chi dưới và chức năng tim. Lưu lượng máu trong động mạch đùi chung giảm xuống 780 ml/phút. Siêu âm tim cho thấy sự phì đại nhẹ của tâm nhĩ trái và phải, hở van hai lá và van ba lá nhẹ, và phân suất tống máu thất trái (EF) là 71%. Đáng chú ý, mức BNP giảm đáng kể.",
+        "translated_summary": "Chúng tôi trình bày một trường hợp bệnh nhân bị dị dạng động-tĩnh mạch bẩm sinh ở chi dưới, người này đã bị sưng kéo dài ở chi dưới bên trái và gần đây xuất hiện các triệu chứng của suy tim. Ở tuổi 67, bệnh nhân được chẩn đoán xác định mắc dị dạng động-tĩnh mạch bẩm sinh phức tạp ở chi dưới. Bài viết này đi sâu vào những kinh nghiệm thực tế và những hạn chế gặp phải khi sử dụng phương pháp đặt ống ghép động mạch chủ trong ổ bụng kết hợp với tắc mạch để điều trị suy tim cấp tính do dị dạng động-tĩnh mạch bẩm sinh phức tạp ở chi dưới."
+    },
+    {
+        "id": "multiclinsum_gs_en_384.txt",
+        "fulltext": "28-year-old male patient with no significant history presented to the dermatology department with a 48-hour history of a skin condition characterized by two erythematous plaques with central vesicles and superficial ulceration located on the flexor surface of the right arm and forearm equidistant from the elbow crease, accompanied by a burning sensation and pruritus at the site of the lesions. He did not have systemic symptoms or self-medicate. As a background, he reported that he was on vacation in the coastal region of Ecuador at the time of the lesions. An incisional biopsy was performed that reported epidermis with acanthosis, parakeratosis and spongiosis, neutrophils in the stratum corneum and perivascular lymphocyte infiltration in the superficial, middle and deep dermis. Based on the clinical characteristics, the background of travel to a tropical region and the histological findings, a diagnosis of Paederus dermatitis was made. Treatment with antihistamines, topical steroids and cold compresses was indicated. After 8 days of treatment, the lesions resolved, leaving a post-inflammatory hyperpigmentation.\n",
+        "summary": "The case of a 28-year-old male patient who presented to the dermatology department with a 48-hour history of two erythematous plaques with central vesicles and superficial ulceration located on the flexor surface of the right arm and forearm, accompanied by a burning sensation and pruritus at the site of the lesions, without accompanying symptoms, is reported. As a background, he stated that he was on vacation in the coastal region of Ecuador at the time of the lesions. An incisional biopsy was performed and, due to the clinical characteristics and the background of travel to a tropical region, the diagnosis was made as dermatitis by Paederus and treatment with antihistamines, topical steroids and cold compresses was indicated. After 8 days of treatment, the lesions subsided, leaving a post-inflammatory hyperpigmentation.\n",
+        "translated_fulltext": "Một bệnh nhân nam 28 tuổi, không có tiền sử bệnh lý đáng kể, đến khoa da liễu với các triệu chứng bệnh ngoài da kéo dài 48 giờ, biểu hiện bằng hai mảng da đỏ có các bóng nước ở trung tâm và vết loét nông, nằm ở mặt trước của cánh tay và cẳng tay phải, cách đều nếp gấp khuỷu tay, kèm theo cảm giác nóng rát và ngứa tại vị trí tổn thương. Bệnh nhân không có các triệu chứng toàn thân và không tự ý dùng thuốc. Bệnh nhân cho biết, vào thời điểm xuất hiện các tổn thương, anh ta đang đi nghỉ ở vùng ven biển Ecuador. Một mẫu sinh thiết đã được lấy và kết quả cho thấy biểu bì có tình trạng tăng sừng, tăng sừng không hoàn toàn và phù nề, bạch cầu trung tính ở lớp sừng và tình trạng xâm nhập tế bào lympho quanh mạch máu ở lớp biểu bì, lớp trung bì và lớp hạ bì. Dựa trên các đặc điểm lâm sàng, tiền sử đi du lịch đến vùng nhiệt đới và kết quả mô bệnh học, bệnh nhân được chẩn đoán mắc bệnh viêm da do bọ Paederus. Điều trị bằng thuốc kháng histamine, steroid bôi ngoài da và chườm lạnh được chỉ định. Sau 8 ngày điều trị, các tổn thương đã khỏi, để lại tình trạng tăng sắc tố sau viêm.",
+        "translated_summary": "Trường hợp của một bệnh nhân nam 28 tuổi đến khám tại khoa da liễu với tiền sử hai mảng da đỏ, có các mụn nước ở trung tâm và loét nông, xuất hiện trong vòng 48 giờ, nằm ở mặt trước của cánh tay và cẳng tay phải, kèm theo cảm giác nóng rát và ngứa tại vị trí tổn thương, không có các triệu chứng đi kèm khác, được báo cáo. Bệnh nhân cho biết, vào thời điểm xuất hiện các tổn thương, anh ta đang đi nghỉ ở vùng ven biển Ecuador. Một mẫu mô đã được lấy để xét nghiệm và, dựa trên các đặc điểm lâm sàng cũng như tiền sử du lịch đến vùng nhiệt đới, chẩn đoán được đưa ra là viêm da do bọ Paederus, và bệnh nhân được điều trị bằng thuốc kháng histamine, steroid bôi ngoài da và chườm lạnh. Sau 8 ngày điều trị, các tổn thương giảm dần và để lại tình trạng tăng sắc tố sau viêm."
+    },
+    {
+        "id": "multiclinsum_gs_en_268.txt",
+        "fulltext": "Technique\nInformation about the procedure of TFD.\nThe patient receives intravenous photosensitizer (Photogen®, King of Prussia, PA, USA - 1.5 mg/kg) 24 h before the procedure. Its peak light absorption is at the wavelength of 630 nm. The procedure begins with standard duodenoscopy (Olympus TJF-180) under general anesthesia. After the identification of the greater duodenal papilla and the retrograde cannulation, the digital cholangioscope (SpyGlassTM DS, Boston Scientific, Natick, MA) is introduced into the common bile duct. Then the cholangioscopic examination helps to identify the neoplastic stenosis. Under direct visualization, the illumination catheter (Medlight S.A., RD10-323, Switzerland) is advanced through the cholangioscope. This consists of a typical three-way cannula. The first port has a 1 cm long cylindrical light diffuser at the end. Two black radiopaque marks demarcate the limits of the diffuser. The second port accommodates a 0.025 inch guidewire and the third is a portal for injection. After positioning under cholangioscopic guidance, illumination is initiated. The dose is 90 J/cm², with a power of 70 mW/cm². Repositioning is recommended every centimeter to cover the entire stenosed area. At the end of the procedure, new cholangioscopy evaluates the bile duct for immediate outcome and adverse events.\n\nPost-procedure care\nThe patient is fasted for the next 24 h. If no adverse event is detected, oral diet is initiated. Discharge from hospital is done under strict guidance on photoprotection (prevention of exposure to light and use of sunglasses), especially during the first week after the session of TFD.\n\nRESULTS\nThis procedure was performed in an 82-year-old man who presented to our tertiary center with obstructive jaundice and weight loss over the previous two months. Endoscopic ultrasound (EUS) revealed severe dilation of the common bile duct associated with choledocholithiasis. ERCP confirmed these findings but was unable to remove the stones due to the disproportionate dilation of the common bile duct. Therefore, a plastic biliary stent was chosen. The patient showed improvement in his clinical condition, but the cholestasis returned 45 days after the first procedure. Two other ERCPs failed to remove the stones. During the third procedure, a long irregular stenosis of the common hepatic duct was apparent and he was referred for another echoendoscopic evaluation.\n\nIn addition to the choledocholithiasis, the new EUS revealed a dilated common hepatic duct with a well-circumscribed hypoechoic solid mass measuring 1.8x2 cm, which was compressing the common hepatic duct. The mass appeared to also involve the common hepatic artery. An ultrasound-guided needle biopsy confirmed the diagnosis of moderately differentiated cholangiocarcinoma (Bismuth I).\n\nAfter staging, the mass was considered inoperable and the patient was referred for palliative treatment. After a multidisciplinary meeting with the oncology team, adjunctive PDT was proposed to treat the recurrent biliary obstruction. The procedure went without complications and lasted 150 minutes. At the end, a biliary drainage was performed with a 10 Fr plastic stent, since a self-expanding metal stent was not available at that time.\n\nThe patient showed no signs or symptoms of photosensitivity in the following week. There was, however, early recurrence of cholestasis complicated with cholangitis. ERCP revealed obstruction of the stent with debris and biliary sludge secondary to tumor necrosis. A biliary scan followed by new drainage resolved the patient's acute condition. Subsequently, he remained asymptomatic for three months, the longest period since the onset of the disease. At his next recurrence, he was drained with a self-expanding metal stent. He continued with systemic treatment and eventually required a duodenal stent for palliation of dysphagia. He died due to complications of pulmonary metastases two years after the onset of symptoms and 15 months after the session of TFD.\n",
+        "summary": "Patient receives intravenous photosensitizer 24 h before the procedure which begins with regular duodenoscopy. After identification of the main papilla and retrograde cannulation, the digital cholangioscope is introduced into the common bile duct. Then the cholangioscopic examination helps to identify neoplastic stenosis. Under direct visualization, the illumination catheter is advanced through the cholangioscope. Repositioning is done every centimeter. At the end of cholangioscopy, the bile duct is evaluated for immediate outcome and adverse events.\n\nResult: This procedure was performed in an 82-year-old man with obstructive jaundice for the past two months. EUS and ERCP revealed severe dilation of the common bile duct associated with choledocholithiasis. In addition, there was dilation of the hepatic duct to a well-circumscribed hypoechoic solid mass measuring 1.8x2 cm, compressing the common hepatic duct. It was considered inoperable and the patient was referred for palliative treatment with PDT, which remained asymptomatic for three months. He died of complications 15 months after the PDT session.\n",
+        "translated_fulltext": "Kỹ thuật\nThông tin về quy trình TFD.\nBệnh nhân được truyền tĩnh mạch chất nhạy cảm với ánh sáng (Photogen®, King of Prussia, PA, Hoa Kỳ - 1,5 mg/kg) 24 giờ trước khi thực hiện quy trình. Bước sóng hấp thụ ánh sáng tối đa của chất này là 630 nm. Quy trình bắt đầu bằng nội soi tá tràng tiêu chuẩn (Olympus TJF-180) dưới gây mê toàn thân. Sau khi xác định được nhú tá tràng lớn và thực hiện thông ống ngược dòng, ống nội soi mật (SpyGlassTM DS, Boston Scientific, Natick, MA) được đưa vào ống mật chủ. Sau đó, việc kiểm tra bằng ống nội soi mật giúp xác định vị trí hẹp do khối u. Dưới sự quan sát trực tiếp, ống dẫn ánh sáng (Medlight S.A., RD10-323, Thụy Sĩ) được đưa qua ống nội soi mật. Ống này có cấu trúc ống thông ba ngả điển hình. Ngả đầu tiên có một bộ khuếch tán ánh sáng hình trụ dài 1 cm ở đầu. Hai dấu chấm đen, có khả năng hấp thụ tia X, đánh dấu giới hạn của bộ khuếch tán. Ngả thứ hai chứa một dây dẫn có đường kính 0,025 inch và ngả thứ ba là cổng để tiêm. Sau khi định vị dưới sự hướng dẫn của ống nội soi mật, việc chiếu sáng được bắt đầu. Liều lượng là 90 J/cm², với công suất 70 mW/cm². Việc điều chỉnh vị trí được khuyến nghị cứ mỗi centimet để bao phủ toàn bộ khu vực bị hẹp. Vào cuối quy trình, nội soi mật mới được thực hiện để đánh giá ống mật chủ về kết quả tức thì và các biến chứng.\n\nChăm sóc sau quy trình\nBệnh nhân được nhịn ăn trong 24 giờ tiếp theo. Nếu không phát hiện thấy bất kỳ biến chứng nào, chế độ ăn uống qua đường miệng được bắt đầu. Bệnh nhân được xuất viện với hướng dẫn nghiêm ngặt về việc bảo vệ da khỏi ánh sáng (ngăn ngừa tiếp xúc với ánh sáng và sử dụng kính râm), đặc biệt là trong tuần đầu tiên sau khi thực hiện TFD.\n\nKẾT QUẢ\nQuy trình này được thực hiện trên một người đàn ông 82 tuổi, đến trung tâm điều trị của chúng tôi với các triệu chứng vàng da do tắc nghẽn và sụt cân trong hai tháng trước đó. Siêu âm nội soi (EUS) cho thấy ống mật chủ giãn rộng nghiêm trọng, liên quan đến sỏi mật. Nội soi ngược dòng đường mật (ERCP) xác nhận những phát hiện này nhưng không thể loại bỏ các viên sỏi do ống mật chủ giãn rộng không cân xứng. Do đó, một ống thông mật bằng nhựa đã được lựa chọn. Tình trạng lâm sàng của bệnh nhân được cải thiện, nhưng tình trạng ứ mật tái phát 45 ngày sau lần điều trị đầu tiên. Hai lần ERCP khác không thành công trong việc loại bỏ các viên sỏi. Trong lần điều trị thứ ba, một đoạn hẹp dài, không đều của ống gan chung đã được phát hiện và bệnh nhân được chuyển đến để đánh giá bằng siêu âm nội soi.\n\nNgoài sỏi mật, EUS mới cho thấy ống gan chung giãn rộng với một khối rắn giảm âm, có ranh giới rõ ràng, kích thước 1,8x2 cm, đang chèn ép ống gan chung. Khối u dường như cũng ảnh hưởng đến động mạch gan chung. Sinh thiết bằng kim dưới hướng dẫn siêu âm xác nhận chẩn đoán là ung thư đường mật biệt hóa vừa phải (Bismuth I).\n\nSau khi đánh giá giai đoạn bệnh, khối u được coi là không thể phẫu thuật và bệnh nhân được chuyển đến để điều trị giảm nhẹ. Sau một cuộc họp đa chuyên khoa với nhóm bác sĩ ung thư, liệu pháp quang động (PDT) bổ trợ đã được đề xuất để điều trị tình trạng tắc nghẽn đường mật tái phát. Quy trình diễn ra suôn sẻ, không có biến chứng và kéo dài 150 phút. Vào cuối quy trình, một ống dẫn lưu mật được đặt bằng một ống thông nhựa 10 Fr, vì một ống thông kim loại tự giãn nở không có sẵn vào thời điểm đó.\n\nBệnh nhân không có dấu hiệu hoặc triệu chứng của nhạy cảm với ánh sáng trong tuần tiếp theo. Tuy nhiên, tình trạng ứ mật tái phát sớm, kèm theo viêm đường mật. ERCP cho thấy tắc nghẽn ống thông do mảnh vụn và cặn đường mật thứ phát do hoại tử khối u. Một xét nghiệm quét đường mật, sau đó là đặt ống dẫn lưu mới, đã giải quyết tình trạng cấp tính của bệnh nhân. Sau đó, bệnh nhân không có triệu chứng trong ba tháng, đây là khoảng thời gian dài nhất kể từ khi bệnh bắt đầu. Khi tái phát lần tiếp theo, bệnh nhân được đặt ống dẫn lưu bằng ống thông kim loại tự giãn nở. Bệnh nhân tiếp tục điều trị toàn thân và cuối cùng cần phải đặt ống thông tá tràng để giảm bớt chứng khó nuốt. Bệnh nhân qua đời do các biến chứng của di căn phổi hai năm sau khi bắt đầu các triệu chứng và 15 tháng sau khi thực hiện TFD.",
+        "translated_summary": "Bệnh nhân được truyền chất nhạy cảm với ánh sáng qua đường tĩnh mạch 24 giờ trước khi thực hiện thủ thuật, bắt đầu bằng nội soi tá tràng thông thường. Sau khi xác định được nhú Vater chính và thực hiện kỹ thuật can thiệp ngược dòng, ống nội soi đường mật kỹ thuật số được đưa vào ống mật chủ. Sau đó, việc kiểm tra bằng nội soi đường mật giúp xác định các chỗ hẹp do khối u. Trong quá trình quan sát trực tiếp, ống dẫn ánh sáng được đưa vào qua ống nội soi đường mật. Việc điều chỉnh vị trí được thực hiện mỗi centimet. Vào cuối quá trình nội soi đường mật, ống mật được đánh giá để xem kết quả ngay lập tức và các biến chứng có thể xảy ra.\n\nKết quả: Thủ thuật này được thực hiện trên một bệnh nhân nam 82 tuổi bị vàng da tắc nghẽn trong hai tháng qua. Siêu âm nội soi và nội soi ngược dòng đường mật cho thấy ống mật chủ giãn rộng nghiêm trọng, kèm theo sỏi đường mật. Ngoài ra, còn có sự giãn nở của ống gan thành một khối rắn giảm âm, có đường viền rõ ràng, kích thước 1,8x2 cm, gây chèn ép ống gan chung. Khối u được xác định là không thể phẫu thuật và bệnh nhân được chuyển đến để điều trị giảm nhẹ bằng liệu pháp quang động (PDT), và bệnh nhân không có triệu chứng trong ba tháng. Bệnh nhân đã qua đời do các biến chứng 15 tháng sau khi thực hiện liệu pháp PDT."
+    },
+    {
+        "id": "multiclinsum_gs_en_201.txt",
+        "fulltext": "A 77-year-old woman with haematemesis presented to the emergency room. Her medical history included only hypertension and dyslipidaemia. When she presented to the emergency room, her vital signs indicated shock (heart rate: 100 beats/min, blood pressure: 79/56 mmHg), and blood tests revealed anaemia (haemoglobin: 9.6 g/dL), which suggested upper gastrointestinal bleeding.\n\nNon-contrast-enhanced CT was performed immediately because of renal dysfunction. CT revealed that the third part of the duodenum flexed steeply on the right side of the aorta and ran caudally, without crossing anterior to the aorta. The jejunum was located on the patient’s right side. The second part of the duodenum and the stomach were dilated, and there were high-density gastric contents that were considered to indicate a haematoma.\n\nUpper gastrointestinal endoscopy was performed following the CT examination, which revealed a mucosal laceration at the gastric cardia. Bleeding from lacerations of the cardia of the stomach as a result of forceful vomiting was first reported by Mallory and Weiss in 1929.1 In our case, the third part of the duodenum flexed steeply, and the lumen was narrowed, which caused an obstruction. As a result, repeat vomiting was considered to have caused Mallory–Weiss syndrome.\n\nOn the basis of the CT findings showing that the duodenal-jejunal junction was located in the right hemi-abdomen, intestinal malrotation was suspected.2 However, 7 days later, when CT was repeated, spontaneous resolution of the malpositioned jejunum was seen. The patient was then discharged from the hospital. However, months later, she was rushed to the emergency room for repeat haematemesis. Dynamic CT was performed before upper gastrointestinal endoscopy, on admission, and revealed contrast extravasation in the dilated stomach. Additionally, the third part of the duodenum was flexed on the right side of the aorta, and the duodenal-jejunal junction and jejunum were again located in the right hemi-abdomen. Upper gastrointestinal endoscopy revealed a laceration at the gastric cardia, as in the previous endoscopy, which was considered Mallory–Weiss syndrome.\n\nTwo months after the second episode of haematemesis, the patient presented to the emergency room with nausea. Non-contrast-enhanced CT revealed no abnormalities in the duodenal positioning, but there was oedematous wall thickening in the second part of the duodenum. If we had not had previous CT images, we would have suspected duodenitis, but on the basis of all of the CT findings, we suspected the possibility of an underlying condition after the right-sided deviation of the small intestine had resolved spontaneously.\n\nIn summary, CT was performed 4 times over 5 months. The third and fourth parts of the duodenum and the jejunum deviated repeatedly, but this resolved spontaneously, which is not indicative of intestinal malrotation. Therefore, we diagnosed dysplasia of the ligament of Treitz.\n\nClinical outcomes\nThe patient underwent laparotomy, which revealed no abnormalities in the relative position of the duodenum to the jejunum. Additionally, the jejunum was located on the patient’s left side, and there was no intestinal malrotation. The ligament of Treitz was formed; however, its fixation in the upper jejunum was incomplete as it was attached only to the duodenum. The duodenal-jejunal junction was not fixed to the retroperitoneum, and the jejunum folded easily with the ligament of Treitz as a fulcrum. Surgically, the upper jejunum was fixed with 4 sutures to the retroperitoneum on the patient’s left side. The postoperative course was good, and the patient has remained symptom-free.",
+        "summary": "A 77-year-old woman underwent CT to evaluate haematemesis. The images showed that the third part of the duodenum flexed steeply on the right side of the aorta and ran caudally, without crossing anterior to the aorta. The duodenal-jejunal junction and jejunum were located on the patient's right side. Upper gastrointestinal endoscopy revealed a laceration at the gastric cardia, and a diagnosis of Mallory-Weiss syndrome was made. Repeat CT 7 days later revealed that the abnormal positioning of the intestinal tract had resolved spontaneously. Two months later, the patient experienced another episode of haematemesis, and CT revealed repeat deviation of the duodenal-jejunal junction and jejunum to her right side. Upper gastrointestinal endoscopy revealed another laceration at the gastric cardia, as in the previous study. On the basis of the initial CT findings showing the duodenal-jejunal junction in the right hemi-abdomen, intestinal malrotation was suspected. However, because the jejunum deviated repeatedly to the right side but resolved spontaneously, we diagnosed dysplasia of the ligament of Treitz. Laparotomy revealed a formed ligament of Treitz; however, fixation in the upper jejunum was incomplete. Additionally, CT revealed that the anterior pararenal space was loosely fixed and mobile. These factors may have caused the right-sided deviation of the small intestine.",
+        "translated_fulltext": "Một phụ nữ 77 tuổi bị nôn ra máu đã đến phòng cấp cứu. Tiền sử bệnh của bà chỉ bao gồm tăng huyết áp và rối loạn lipid máu. Khi đến phòng cấp cứu, các dấu hiệu sinh tồn của bà cho thấy tình trạng sốc (nhịp tim: 100 nhịp/phút, huyết áp: 79/56 mmHg), và các xét nghiệm máu cho thấy thiếu máu (hemoglobin: 9,6 g/dL), điều này gợi ý tình trạng xuất huyết đường tiêu hóa trên.\n\nChụp CT không sử dụng thuốc cản quang được thực hiện ngay lập tức do có rối loạn chức năng thận. Kết quả chụp CT cho thấy đoạn thứ ba của tá tràng bị uốn cong mạnh về phía bên phải của động mạch chủ và chạy xuống dưới, không cắt ngang phía trước động mạch chủ. Ruột non được đặt ở phía bên phải của bệnh nhân. Đoạn thứ hai của tá tràng và dạ dày bị giãn, và có chứa nhiều chất có mật độ cao trong dạ dày, được cho là dấu hiệu của một khối máu tụ.\n\nNội soi đường tiêu hóa trên được thực hiện sau khi chụp CT, cho thấy một vết rách niêm mạc ở tâm vị. Tình trạng xuất huyết từ các vết rách ở tâm vị của dạ dày do nôn mửa mạnh đã được Mallory và Weiss báo cáo lần đầu tiên vào năm 1929. Trong trường hợp này, đoạn thứ ba của tá tràng bị uốn cong mạnh, và lòng tá tràng bị hẹp, gây tắc nghẽn. Do đó, việc nôn mửa lặp đi lặp lại được cho là nguyên nhân gây ra hội chứng Mallory-Weiss.\n\nDựa trên kết quả chụp CT cho thấy chỗ nối tá tràng-hỗng tràng nằm ở nửa bụng phải, nghi ngờ có tình trạng xoắn ruột. Tuy nhiên, 7 ngày sau, khi chụp CT lại, tình trạng xoắn ruột non đã tự khỏi. Sau đó, bệnh nhân được xuất viện. Tuy nhiên, vài tháng sau, bà lại được đưa đến phòng cấp cứu vì nôn ra máu. Chụp CT động được thực hiện trước khi nội soi đường tiêu hóa trên, khi nhập viện, và cho thấy thuốc cản quang rò rỉ trong dạ dày bị giãn. Ngoài ra, đoạn thứ ba của tá tràng bị uốn cong về phía bên phải của động mạch chủ, và chỗ nối tá tràng-hỗng tràng và ruột non lại nằm ở nửa bụng phải. Nội soi đường tiêu hóa trên cho thấy một vết rách ở tâm vị, tương tự như lần nội soi trước, và được chẩn đoán là hội chứng Mallory-Weiss.\n\nHai tháng sau lần nôn ra máu thứ hai, bệnh nhân đến phòng cấp cứu vì buồn nôn. Chụp CT không sử dụng thuốc cản quang không cho thấy bất thường nào về vị trí của tá tràng, nhưng có tình trạng dày thành do phù ở đoạn thứ hai của tá tràng. Nếu không có hình ảnh CT trước đó, chúng tôi có thể nghi ngờ viêm tá tràng, nhưng dựa trên tất cả các kết quả chụp CT, chúng tôi nghi ngờ có một bệnh lý tiềm ẩn sau khi tình trạng lệch phải của ruột non tự khỏi.\n\nTóm lại, CT đã được thực hiện 4 lần trong vòng 5 tháng. Đoạn thứ ba và thứ tư của tá tràng và ruột non bị lệch lặp đi lặp lại, nhưng tình trạng này tự khỏi, điều này không cho thấy tình trạng xoắn ruột. Do đó, chúng tôi chẩn đoán là loạn sản dây chằng Treitz.\n\nKết quả lâm sàng\nBệnh nhân đã trải qua phẫu thuật mở bụng, cho thấy không có bất thường nào về vị trí tương đối của tá tràng so với ruột non. Ngoài ra, ruột non được đặt ở phía bên trái của bệnh nhân, và không có tình trạng xoắn ruột. Dây chằng Treitz đã hình thành; tuy nhiên, sự cố định của nó ở ruột non trên là không hoàn toàn vì nó chỉ được gắn vào tá tràng. Chỗ nối tá tràng-hỗng tràng không được cố định vào khoang sau phúc mạc, và ruột non dễ dàng gấp lại với dây chằng Treitz làm điểm tựa. Trong phẫu thuật, ruột non trên được cố định bằng 4 mũi khâu vào khoang sau phúc mạc ở phía bên trái của bệnh nhân. Tình trạng sau phẫu thuật diễn biến tốt, và bệnh nhân không còn triệu chứng.",
+        "translated_summary": "Một phụ nữ 77 tuổi được chụp CT để đánh giá tình trạng nôn ra máu. Hình ảnh cho thấy đoạn thứ ba của tá tràng bị uốn cong mạnh về phía bên phải của động mạch chủ và kéo dài xuống phía dưới, không cắt ngang phía trước động mạch chủ. Vị trí nối giữa tá tràng và hồi tràng, cũng như hồi tràng, nằm ở phía bên phải của bệnh nhân. Nội soi đường tiêu hóa trên cho thấy có một vết rách ở tâm vị, và chẩn đoán hội chứng Mallory-Weiss được đưa ra. Chụp CT lại sau 7 ngày cho thấy vị trí bất thường của ống tiêu hóa đã tự khỏi. Hai tháng sau, bệnh nhân lại bị nôn ra máu, và chụp CT cho thấy vị trí nối giữa tá tràng và hồi tràng, cũng như hồi tràng, lại bị lệch về phía bên phải. Nội soi đường tiêu hóa trên cho thấy một vết rách khác ở tâm vị, tương tự như lần trước. Dựa trên kết quả chụp CT ban đầu cho thấy vị trí nối giữa tá tràng và hồi tràng nằm ở nửa bụng phải, nghi ngờ có tình trạng xoắn ruột. Tuy nhiên, vì hồi tràng liên tục bị lệch về phía bên phải nhưng sau đó tự khỏi, chúng tôi chẩn đoán là có sự phát triển bất thường của dây chằng Treitz. Phẫu thuật mở bụng cho thấy dây chằng Treitz đã hình thành; tuy nhiên, sự cố định ở phần trên của hồi tràng là không hoàn toàn. Ngoài ra, chụp CT cho thấy khoang trước thận phía trước bị cố định lỏng lẻo và có thể di chuyển. Các yếu tố này có thể đã gây ra sự lệch về phía bên phải của ruột non."
+    },
+    {
+        "id": "multiclinsum_gs_en_24.txt",
+        "fulltext": "Patient and observation\nPatient information (presentation of the patient): he is a 28-year-old single man without children, an active military. He has been present for 5 weeks with progressive abdominal pain, more marked in the epigastrium and the right hypochondrium, followed shortly after by a non-quantified fever, chills, profuse sweats in a context of anorexia and weight loss of 6 kg. Note that the patient is not a drinker or smoker, vaccinated with BCG and has no other contributing personal or family history.\n\nClinical findings: On admission, the physical examination found the patient in a general altered state, asthenic with a weight loss of 6 kg in one month. A clinical systemic inflammatory response syndrome was present with the following elements: a fever of 39.1 °C, tachycardia (124 beats/min), polypnea (22 cycles/min). The pulmonary examination and exploration of the superficial lymph node areas were without particularity. In the abdominal area, moderate sensitivity in the right hypochondrium with hepatomegaly was found.\n\nChronology: dates back to February 2022 with the onset of diffuse abdominal pain with diarrhea-constipation transit disorder, all in a context of preservation of general condition with low-grade fever predominantly at night. A syntagmatic treatment was unsuccessfully initiated. The evolution is marked by the persistence of low-grade fever associated with anorexia and progressive weight loss of 12 kg over three months. In the face of this transit disorder with unexplained fever and the deterioration of the general condition, the patient will be admitted to the emergency department for further investigation.\n\nDiagnostic approach: upon admission, a biological infectious syndrome was reported with a neutrophilic predominant hyperleucocytosis (17800 cells/mm3) and a high C-reactive protein of 323 mg/L.\n\nIn the face of his abdominal pain, the lipase and troponin tests were normal at 38 IU/L (VN: <3 78 IU/L) and 4 ng/L (VN: 2 to 16 ng/L) respectively. The liver function was stable with ALT (alanine amino transferase) at 22 IU/L (VN: < 40UI/L), AST (aspartate amino transferase) at 17 IU/L (VN: < 35UI/L), GGT (gamma glutamyl transferase) at 42 IU/L (VN: < 50UI/L), PAL (alkaline phosphatase) at 115 IU/L (VN: 40- 150 IU/L) and normal bilirubinemia. The liver function was normal with a prothrombin rate of 78% and an albuminemia of 39 g/L. The blood ionogram and renal function were normal. The chest radiograph and abdominal ultrasound were without particularity.\n\nWith a procalcitonin positive at 4.1 ng/L, an infectious disease assessment to search for the infectious focus was initiated, including a cytobacteriological examination of urine and blood cultures during the febrile peaks at 39°C, which were both negative. The hepatitis viral B, C and HIV serologies, as well as the syphilis serology performed in hospital were all negative. The lactate dehydrogenase (LDH) and beta-2 microglobulin were normal at 231 IU/L and 2.28 mg/L respectively. The GeneXpert to search for the Mycobacterium on these bioptic pieces was negative. The quantiferon was negative. The search for the Mycobacterium on the morning expectorations of 3 consecutive days was negative.\n\nOn the morphological level, a thoraco-abdomino-pelvic scan showed an enlarged liver (hepatic arrow at 17 cm), the site of multiple, well-defined, rounded hypodensities, which were not enhanced after injection of the contrast agent. The largest lesions were in segment I (21 x 16 mm) and segment V (36 x 27 mm). No suspicious lesions were detected in the thoracic and pelvic levels. The first liver biopsies obtained by echo-guided puncture revealed subacute, fibro-inflammatory liver lesions, with no histological evidence of specificity or malignancy.\n\nA liver MRI following the scan objectified a dysmorphic liver, the site of lesions in heterogeneous signal T2 surrounded by a wall in hyper signal T2, enhanced in the periphery after injection of the contrast agent, the largest of which is located in segment I (20 x 22 mm) and in segment V (33 x 31 mm). No deep lymphadenopathy had been objectified, either in the scan or in the MRI. A diagnostic laparoscopy performed on the hepatic nodules, the histological examination found epithelioid and gigantocellular granulomas of varying size with caseous necrosis in favour of a hepatic tuberculosis.\n\nTherapeutic intervention: the patient was put on anti-tuberculosis treatment according to the standard protocol for months: Phase 1: quadritherapy (Isoniazide + Rifampicine + Pyrazinamide + Ethambutol) in a single oral intake each morning on an empty stomach for 2 months. Phase 2: bithrapia (Isoniazide + Rifampicine) in a single oral intake each morning on an empty stomach for 4 months\n\nFollow-up and results of therapeutic interventions: from the first days of treatment, a good response was obtained with disappearance of the inflammatory syndrome with systemic response both clinically and biologically. After three months of treatment, a control scan of the liver showed a decrease in the number and volume of liver lesions.\n",
+        "summary": "This clinical case was reported in a young Moroccan, presenting a picture of hepatic colic that had been developing for a month, associated with subtle signs of tuberculous infection. Non-specific hepatic nodular lesions were revealed on the scanner and on the hepatic magnetic resonance imaging (MRI). The diagnosis of focal hepatic tuberculosis was confirmed after pathological analysis of hepatic nodule biopsies obtained after a laparoscopy. After the start of well-conducted anti-bacillary treatment, a good clinical-biological improvement was obtained.\n",
+        "translated_fulltext": "Tiền sử bệnh và thăm khám\n\nThông tin bệnh nhân (tóm tắt tình trạng bệnh): Bệnh nhân là nam, 28 tuổi, độc thân, chưa có con, là quân nhân. Bệnh nhân nhập viện với các triệu chứng đau bụng ngày càng tăng, kéo dài trong 5 tuần, đau nhiều nhất ở vùng thượng vị và hạ sườn phải, sau đó là sốt không rõ mức độ, ớn lạnh, đổ mồ hôi nhiều, kèm theo chán ăn và sụt cân 6 kg. Bệnh nhân không hút thuốc, không uống rượu, đã được tiêm phòng BCG và không có tiền sử bệnh cá nhân hoặc gia đình đáng kể.\n\nKết quả thăm khám lâm sàng: Khi nhập viện, bệnh nhân có biểu hiện suy nhược, sụt cân 6 kg trong một tháng. Các dấu hiệu của hội chứng đáp ứng viêm hệ thống (SIRS) bao gồm: sốt 39,1°C, nhịp tim nhanh (124 lần/phút), thở nhanh (22 lần/phút). Khám phổi và các hạch bạch huyết nông không phát hiện bất thường. Ở vùng bụng, bệnh nhân có cảm giác đau nhẹ ở hạ sườn phải và gan to.\n\nDiễn biến bệnh: Bệnh bắt đầu vào tháng 2 năm 2022 với các triệu chứng đau bụng lan tỏa, kèm theo rối loạn tiêu hóa (tiêu chảy xen kẽ táo bón), trong bối cảnh tình trạng chung vẫn ổn định và sốt nhẹ, chủ yếu vào ban đêm. Bệnh nhân đã được điều trị ban đầu nhưng không hiệu quả. Diễn biến bệnh cho thấy sốt nhẹ kéo dài, kèm theo chán ăn và sụt cân liên tục, tổng cộng 12 kg trong ba tháng. Do tình trạng rối loạn tiêu hóa, sốt không rõ nguyên nhân và tình trạng sức khỏe suy giảm, bệnh nhân được đưa vào khoa cấp cứu để chẩn đoán và điều trị thêm.\n\nHướng tiếp cận chẩn đoán: Khi nhập viện, các xét nghiệm cho thấy có hội chứng nhiễm trùng với bạch cầu tăng cao, chủ yếu là bạch cầu trung tính (17800 tế bào/mm3) và protein C phản ứng cao (323 mg/L).\n\nĐối với tình trạng đau bụng, các xét nghiệm lipase và troponin đều bình thường, lần lượt là 38 IU/L (giá trị bình thường: <378 IU/L) và 4 ng/L (giá trị bình thường: 2 đến 16 ng/L). Chức năng gan ổn định với ALT (alanine aminotransferase) là 22 IU/L (giá trị bình thường: <40 IU/L), AST (aspartate aminotransferase) là 17 IU/L (giá trị bình thường: <35 IU/L), GGT (gamma-glutamyl transferase) là 42 IU/L (giá trị bình thường: <50 IU/L), PAL (alkaline phosphatase) là 115 IU/L (giá trị bình thường: 40-150 IU/L) và bilirubin bình thường. Các chỉ số đông máu bình thường với tỷ lệ prothrombin là 78% và albumin là 39 g/L. Các chỉ số điện giải máu và chức năng thận bình thường. Chụp X-quang ngực và siêu âm bụng không phát hiện bất thường.\n\nVới procalcitonin dương tính (4,1 ng/L), các xét nghiệm đánh giá bệnh truyền nhiễm để tìm ổ nhiễm trùng đã được thực hiện, bao gồm xét nghiệm tế bào và vi sinh vật của nước tiểu và cấy máu trong thời điểm sốt cao (39°C), kết quả đều âm tính. Các xét nghiệm huyết thanh học về viêm gan B, C và HIV, cũng như xét nghiệm giang mai được thực hiện tại bệnh viện đều âm tính. Lactate dehydrogenase (LDH) và beta-2 microglobulin bình thường, lần lượt là 231 IU/L và 2,28 mg/L. Xét nghiệm GeneXpert để tìm Mycobacterium trên các mẫu sinh thiết đều âm tính. Xét nghiệm Quantiferon âm tính. Xét nghiệm tìm Mycobacterium trên mẫu đờm vào buổi sáng trong 3 ngày liên tiếp đều âm tính.\n\nVề mặt hình thái học, chụp cắt lớp ngực-bụng-chậu cho thấy gan to (đường kính ngang của gan là 17 cm), có nhiều vùng giảm mật độ, tròn, ranh giới rõ, không tăng độ cản quang sau khi tiêm thuốc cản quang. Các tổn thương lớn nhất nằm ở phân thùy I (21 x 16 mm) và phân thùy V (36 x 27 mm). Không phát hiện tổn thương đáng ngờ",
+        "translated_summary": "Trường hợp lâm sàng này được báo cáo ở một người trẻ tuổi gốc Maroc, với các triệu chứng đau quặn gan kéo dài trong một tháng, kèm theo các dấu hiệu nhẹ của nhiễm trùng lao. Các tổn thương dạng nốt không đặc hiệu ở gan được phát hiện qua hình ảnh quét và hình ảnh cộng hưởng từ (MRI) của gan. Chẩn đoán lao gan khu trú được xác nhận sau khi phân tích bệnh lý các mẫu sinh thiết nốt gan thu được sau phẫu thuật nội soi ổ bụng. Sau khi bắt đầu điều trị kháng vi khuẩn toàn diện, bệnh nhân có dấu hiệu cải thiện đáng kể về mặt lâm sàng và sinh học."
+    },
+    {
+        "id": "multiclinsum_gs_en_40.txt",
+        "fulltext": "A 12-year-old boy with Down Syndrome and motoric disorders was referred from the Pediatric Department to the Oral Medicine Department of RS Hasan Sadikin Bandung. The patient was diagnosed with Down Syndrome and myeloradiculopathy. The patient’s mother said that the patient was admitted to the hospital because of weakness in both patient’s hands and feet. The patient had a history of falling down about one year ago. The patient’s mother also had a difficulty in cleaning the patient’s oral cavity regularly.\n\nIn the extraoral examination, the patient had a dysmorphic face. The patient also had a cracking and desquamative condition of the vermillion border of the lips. Lymph node examination could not be assessed because the patient wore a cervical collar. The intraoral examination showed an irregular ulcer with 1×0.7 cm in diameter, indurated margin, and white-yellowish base at the right lateral border of the tongue. There was dentinal caries on 63 tooth and also the tooth remnants on 55, 62, 74, and 85 teeth. The upper and lower tooth remnants were suggested to be extracted by pediatric dentist. The space of the extracted teeth will be maintained using a space maintainer. The 55 tooth was sharp and caused an occlusion trauma to the right lateral border of the tongue.\n\nLaboratory examination showed a decrease in sodium value (130 mEq/L) and an increase in lymphocyte value (46%). The MRI examination was performed in the Radiology Department to determine the presence of abnormalities in the cervical spine. The results of the MRI examination showed a dislocation of the patient’s cervical spine. The patient’s mother provided informed consent to publish the patient’s case details and any accompanying images.\n\nBased on the history review, the clinical examination, and appropriate investigation, the patient was diagnosed with a chronic traumatic ulcer mimicking OSCC, exfoliative cheilitis, reversible pulpitis of 63 teeth, and radix gangrene on 55, 62, 74, and 85 teeth. The diagnosis of the chronic ulcer was based on clinical examination. There was an indurated margin in the traumatic lesion, which mimicked Oral Squamous Cell Carcinoma clinically. The patient has been hospitalized for 4 days and was given paracetamol 120 mg/5 mL oral suspension and amoxicillin 125 mg/5 mL oral suspension from the Pediatric Department. The patient also was given sodium chloride 0.9% solution, povidone-iodine mouthwash 1%, and petroleum jelly from the Oral Medicine Department. The patient’s mother was instructed to clean the patient’s oral cavity using gauze soaked in sodium chloride 0.9% solution, compress the ulcer using povidone-iodine mouthwashes 1% three times a day as an antiseptic and anti-inflammatory agent to the oral ulcer, and apply petroleum jelly to moisturize the patient’s lips. The patient was also suggested to extract the 55, 62, 74, and 85 teeth.\n\nIn the second visit (3 days follow-up), oral lesions already showed improvement. In the third visit (1-week follow-up), the size of the oral ulcer at the lateral border of the tongue was getting smaller and the lesion of the lips had some improvement.\n\nIn the fourth visit (10 days follow-up), the size of the oral ulcer at the lateral border of the tongue already had significant improvement. Two days after the fourth visit, the patient underwent neurosurgery. The patient was observed in the Pediatric Intensive Care Unit postoperatively. After two weeks of observation in the Pediatric Intensive Care Unit, the experienced respiratory failure and was declared dead.",
+        "summary": "A 12-year-old boy with Down Syndrome and motoric disorders was referred to Oral Medicine Department. In the extraoral examination, the patient had a dysmorphic face and dry lips. Lymph node examination could not be assessed because the patient wore a cervical collar. The intraoral examination showed an irregular ulcer with 1×0.7 cm in diameter, indurated margin, and white-yellowish base at the right lateral border of the tongue. The 55 teeth were sharp and caused an occlusion trauma to the right lateral border of the tongue. The patient was diagnosed with a chronic traumatic ulcer mimicking OSCC based on clinical examination. The medication given to the patient were sodium chloride 0.9%, povidone-iodine mouthwash 1%, and petroleum jelly.",
+        "translated_fulltext": "Một bé trai 12 tuổi mắc hội chứng Down và các rối loạn vận động đã được chuyển từ Khoa Nhi đến Khoa Y học Răng miệng của Bệnh viện RS Hasan Sadikin Bandung. Bệnh nhân được chẩn đoán mắc hội chứng Down và bệnh lý tủy sống - rễ thần kinh. Mẹ của bệnh nhân cho biết bệnh nhân nhập viện vì yếu cả hai tay và hai chân. Bệnh nhân có tiền sử bị ngã khoảng một năm trước. Mẹ của bệnh nhân cũng gặp khó khăn trong việc vệ sinh khoang miệng cho bệnh nhân thường xuyên.\n\nTrong quá trình khám ngoài miệng, bệnh nhân có khuôn mặt dị dạng. Bệnh nhân cũng có tình trạng nứt và bong tróc ở viền môi. Việc kiểm tra hạch bạch huyết không thể thực hiện được vì bệnh nhân đang đeo vòng cổ. Trong quá trình khám trong miệng, phát hiện một vết loét không đều, đường kính 1×0,7 cm, viền cứng và nền màu trắng vàng ở bờ bên phải của lưỡi. Có sâu răng ở răng 63 và các mảnh răng còn sót lại ở răng 55, 62, 74 và 85. Các mảnh răng trên và dưới được đề nghị nhổ bởi bác sĩ nha khoa nhi. Khoảng trống do răng bị nhổ sẽ được duy trì bằng dụng cụ giữ khoảng. Răng 55 sắc nhọn và gây chấn thương khi cắn vào bờ bên phải của lưỡi.\n\nKết quả xét nghiệm máu cho thấy nồng độ natri giảm (130 mEq/L) và nồng độ bạch cầu tăng (46%). Chụp cộng hưởng từ (MRI) được thực hiện tại Khoa Chẩn đoán hình ảnh để xác định xem có bất thường ở cột sống cổ hay không. Kết quả chụp MRI cho thấy có sự trật khớp cột sống cổ của bệnh nhân. Mẹ của bệnh nhân đã đồng ý cho phép công bố chi tiết về trường hợp của bệnh nhân và bất kỳ hình ảnh liên quan nào.\n\nDựa trên việc xem xét bệnh sử, khám lâm sàng và các xét nghiệm phù hợp, bệnh nhân được chẩn đoán mắc vết loét do chấn thương mãn tính, có biểu hiện giống với ung thư biểu mô tế bào vảy miệng (OSCC), viêm loét môi, viêm tủy răng 63 có thể hồi phục và hoại tử tủy ở răng 55, 62, 74 và 85. Chẩn đoán về vết loét mãn tính dựa trên khám lâm sàng. Có một viền cứng ở vùng tổn thương do chấn thương, có biểu hiện giống với ung thư biểu mô tế bào vảy miệng về mặt lâm sàng. Bệnh nhân đã nhập viện được 4 ngày và được dùng paracetamol 120 mg/5 mL dạng siro uống và amoxicillin 125 mg/5 mL dạng siro uống từ Khoa Nhi. Bệnh nhân cũng được dùng dung dịch natri clorua 0,9%, nước súc miệng povidone-iodine 1% và vaseline từ Khoa Y học Răng miệng. Mẹ của bệnh nhân được hướng dẫn vệ sinh khoang miệng cho bệnh nhân bằng gạc tẩm dung dịch natri clorua 0,9%, băng vết loét bằng nước súc miệng povidone-iodine 1% ba lần một ngày như một chất khử trùng và chống viêm cho vết loét trong miệng, và bôi vaseline để giữ ẩm cho môi của bệnh nhân. Bệnh nhân cũng được đề nghị nhổ răng 55, 62, 74 và 85.\n\nTrong lần tái khám thứ hai (sau 3 ngày), các tổn thương trong miệng đã có dấu hiệu cải thiện. Trong lần tái khám thứ ba (sau 1 tuần), kích thước của vết loét trong miệng ở bờ bên của lưỡi nhỏ hơn và tổn thương ở môi cũng có một số cải thiện.\n\nTrong lần tái khám thứ tư (sau 10 ngày), kích thước của vết loét trong miệng ở bờ bên của lưỡi đã có sự cải thiện đáng kể. Hai ngày sau lần tái khám thứ tư, bệnh nhân đã trải qua phẫu thuật thần kinh. Bệnh nhân được theo dõi tại Khoa Hồi sức tích cực Nhi sau phẫu thuật. Sau hai tuần theo dõi tại Khoa Hồi sức tích cực Nhi, bệnh nhân bị suy hô hấp và được xác định là đã tử vong.",
+        "translated_summary": "Một bé trai 12 tuổi mắc hội chứng Down và các rối loạn vận động đã được chuyển đến Khoa Y học Răng miệng. Trong quá trình khám ngoài miệng, bệnh nhân có khuôn mặt biến dạng và môi khô. Việc kiểm tra hạch bạch huyết không thể thực hiện được vì bệnh nhân đang đeo vòng cổ. Quá trình khám trong miệng cho thấy một vết loét không đều, có đường kính 1 × 0,7 cm, bờ sần sùi và nền màu trắng vàng ở bờ bên phải của lưỡi. Răng số 55 sắc nhọn và gây chấn thương cho bờ bên phải của lưỡi. Dựa trên kết quả khám lâm sàng, bệnh nhân được chẩn đoán mắc chứng loét do chấn thương mãn tính, có các triệu chứng tương tự như ung thư biểu mô tế bào vảy miệng (OSCC). Các loại thuốc được kê đơn cho bệnh nhân bao gồm dung dịch natri clorua 0,9%, nước súc miệng povidone-iodine 1% và vaseline."
+    },
+    {
+        "id": "multiclinsum_gs_en_3.txt",
+        "fulltext": "We present a case of a 59-year-old lady with a twelve-year history of secondary progressive multiple sclerosis who was referred to ophthalmology with a few weeks’ history of bilateral blurring of vision.\n\nThe patient had no past ophthalmic history and no drug history other than the anti-epileptic medications related to her multiple sclerosis. Previously documented ophthalmic examinations did not reveal any signs of Fuchs' endothelial corneal dystrophy, and the patient has no family history of corneal pathology.\n\nThe patient had been on amantadine therapy at a dose of 100mg twice daily for the past 7 years and was started on levetiracetam 250mg twice daily as an add-on agent. Visual deterioration was experienced shortly after commencement of levetiracetam therapy for a breakthrough seizure.\n\nOn examination, the patient’s best corrected visual acuity was 0.5 logMAR right eye and 0.5 logMAR left eye. Slit-lamp examination revealed corneal edema involving both eyes and absence of uveitis. Corrected intraocular pressures were 16mmHg right eye and 18mmHg left eye. Corneal topography was performed which confirmed bilateral significant corneal thickening with a right central corneal thickness of 936μm and left central corneal thickness of 1134μm. The rest of the eye examination was normal.\n\nSince amantadine is a known cause of corneal edema, it was agreed with the patient and her caring neurologist to switch from amantadine to lamotrigine. Levetiracetam therapy was continued at this stage. No improvement in vision was noted two months after this change in treatment. The patient expressed the wish to temporarily stop levetiracetam on a trial basis in view of the direct temporal association between the onset of symptoms and the commencement of the medication.\n\nAmantadine was re-introduced, while levetiracetam dose was tapered. Improvement in vision was noted a few days after levetiracetam dose reduction. Levetiracetam was stopped altogether, and the patient remained on amantadine and lamotrigine. A provisional diagnosis of levetiracetam-induced corneal edema was made at this stage. Her vision normalized and repeat corneal topography six months after stopping the levetiracetam showed a right central corneal thickness of 567μm and a left central corneal thickness of 573μm, and a visual acuity of 0.2 logMAR both eyes. Slit-lamp examination confirmed clear cornea and the absence of corneal guttata in either eye.\n\nThe patient was examined again thirteen months after the first presentation. No further changes in her medications were made, and her vision had remained stable at 0.2 logMAR in both eyes. Repeat corneal topography showed no further changes.",
+        "summary": "A 59-year-old woman was referred to the ophthalmology department with a few weeks’ history of bilateral blurring of vision. She is a known case of secondary progressive multiple sclerosis, and she was started on levetiracetam by her neurologist a few weeks prior to referral in view of new seizure activity. Examination revealed bilateral clinically evident corneal edema, which was documented on corneal topography.\n\nResults\nUpon levetiracetam dose reduction, symptoms started to improve and eventually the medication was stopped altogether. The patient’s vision and corneal edema normalized on follow-up.",
+        "translated_fulltext": "Chúng tôi xin trình bày một trường hợp bệnh nhân nữ 59 tuổi, có tiền sử 12 năm mắc bệnh xơ cứng đa bào tiến triển thứ phát, được giới thiệu đến khoa nhãn khoa vì thị lực hai mắt bị mờ trong vài tuần.\n\nBệnh nhân không có tiền sử bệnh lý nhãn khoa và không sử dụng thuốc nào khác ngoài các loại thuốc chống động kinh liên quan đến bệnh xơ cứng đa bào của cô. Các lần khám mắt trước đây không cho thấy bất kỳ dấu hiệu nào của bệnh loạn dưỡng nội mô giác mạc Fuchs, và bệnh nhân không có tiền sử gia đình mắc bệnh lý giác mạc.\n\nBệnh nhân đã dùng amantadine với liều 100mg hai lần mỗi ngày trong 7 năm qua và được bắt đầu dùng thêm levetiracetam 250mg hai lần mỗi ngày. Thị lực suy giảm ngay sau khi bắt đầu điều trị bằng levetiracetam để kiểm soát các cơn co giật đột ngột.\n\nKhi khám, thị lực tốt nhất của bệnh nhân sau khi điều chỉnh là 0,5 logMAR ở mắt phải và 0,5 logMAR ở mắt trái. Khám bằng đèn khe cho thấy phù giác mạc ở cả hai mắt và không có dấu hiệu viêm màng bồ đào. Áp lực nội nhãn sau khi điều chỉnh là 16mmHg ở mắt phải và 18mmHg ở mắt trái. Phân tích hình thái giác mạc được thực hiện, xác nhận tình trạng giác mạc dày đáng kể ở cả hai mắt, với độ dày giác mạc trung tâm bên phải là 936μm và độ dày giác mạc trung tâm bên trái là 1134μm. Các phần còn lại của khám mắt đều bình thường.\n\nVì amantadine là một nguyên nhân đã biết gây phù giác mạc, nên đã thống nhất với bệnh nhân và bác sĩ thần kinh điều trị của cô để chuyển từ amantadine sang lamotrigine. Điều trị bằng levetiracetam được tiếp tục ở giai đoạn này. Không có sự cải thiện nào về thị lực được ghi nhận hai tháng sau khi thay đổi phương pháp điều trị này. Bệnh nhân bày tỏ mong muốn tạm dừng sử dụng levetiracetam trong một thời gian thử nghiệm, do có mối liên hệ trực tiếp về thời gian giữa thời điểm khởi phát các triệu chứng và thời điểm bắt đầu sử dụng thuốc.\n\nAmantadine được đưa trở lại, trong khi liều levetiracetam được giảm dần. Sự cải thiện về thị lực được ghi nhận vài ngày sau khi giảm liều levetiracetam. Levetiracetam được ngừng hoàn toàn, và bệnh nhân tiếp tục dùng amantadine và lamotrigine. Một chẩn đoán sơ bộ về phù giác mạc do levetiracetam gây ra được đưa ra ở giai đoạn này. Thị lực của cô trở lại bình thường và phân tích hình thái giác mạc lặp lại sáu tháng sau khi ngừng sử dụng levetiracetam cho thấy độ dày giác mạc trung tâm bên phải là 567μm và độ dày giác mạc trung tâm bên trái là 573μm, và thị lực là 0,2 logMAR ở cả hai mắt. Khám bằng đèn khe xác nhận giác mạc trong và không có dấu hiệu của các nốt giác mạc ở cả hai mắt.\n\nBệnh nhân được khám lại mười ba tháng sau lần khám đầu tiên. Không có thay đổi nào khác về thuốc của cô được thực hiện, và thị lực của cô vẫn ổn định ở mức 0,2 logMAR ở cả hai mắt. Phân tích hình thái giác mạc lặp lại không cho thấy bất kỳ thay đổi nào khác.",
+        "translated_summary": "Một phụ nữ 59 tuổi được chuyển đến khoa nhãn khoa vì tình trạng mờ mắt hai bên kéo dài vài tuần. Bà được chẩn đoán mắc bệnh xơ cứng đa bào tiến triển thứ phát và đã được bác sĩ thần kinh kê đơn thuốc levetiracetam vài tuần trước khi chuyển đến khoa nhãn khoa do xuất hiện các cơn co giật mới. Khám lâm sàng cho thấy tình trạng phù giác mạc rõ ràng ở cả hai mắt, và kết quả này được ghi lại trong quá trình đo vẽ giác mạc.\n\nKết quả\nSau khi giảm liều levetiracetam, các triệu chứng bắt đầu cải thiện và cuối cùng, việc sử dụng thuốc đã được ngừng hẳn. Tình trạng thị lực và phù giác mạc của bệnh nhân trở lại bình thường trong quá trình theo dõi."
+    },
+    {
+        "id": "multiclinsum_gs_en_346.txt",
+        "fulltext": "A 19-month-old boy was admitted to the Emergency Department because he fell from his baby feeding highchair. This fall occurred in apparent well-being, without the presence of anticipatory signs or symptoms. First, he fell on his gluteus and then he banged his head (occiput) on the ground. He presented with vomiting (three episodes) and he was very irritable. His respiratory rate and heart rate were >60 breaths and >150 beats per minute, while oxygen saturation was <80%. Upon physical examination, the child was hydrated and conscious, but irritable. More importantly, we noted subcostal retractions, and, at the auscultation, decreased breath sounds in the left basal part of chest. The patient was ventilated with an AMBU balloon connected to an oxygen source and monitored with a pulse oximeter. Despite our intervention, oxygen saturation fell below 70% and the more we ventilated, the more the saturation dropped down. The lung ultrasound showed the absence of the typical A lines and the consolidation of the lung, which was directly visualized as a solid parenchyma. On the basis of the poor clinical condition, the patient underwent orotracheal intubation with a cuffed endotracheal tube. After the baby was stabilized, he underwent a chest computed tomography (CT) showing complete atelectasis of the left lung with an interruption of the main left bronchus at 12 cm from bronchial bifurcation. An FBA was suspected as the mother also stated that the baby in the previous days had an intensive cough attack and disappeared within 24 h without any treatment. Therefore, a rigid bronchoscopy was performed and an almond of 2 cm in diameter in the main left bronchus was found and promptly removed.\n\nThe patient had never consumed almonds or other nuts before and in this circumstance ingested the almond by chance.\n\nThe baby had a progressive clinical improvement, and after 24 h, he was extubated and discharged from intensive care to be admitted to the general pediatrics ward for a few days with gradual and a total respiratory function recovery.",
+        "summary": "We describe the case of a 19-month-old boy who accessed the emergency room initially for a head trauma. The clinical evaluation, however, revealed an unexplained serious respiratory distress needing tracheal intubation. After our evaluation, we hypothesized that the severe respiratory distress determined an altered state of consciousness with following head trauma. The radiological findings raised the suspicion of foreign body aspiration for the presence of an atelectasis of the entire left lung. The computed tomography showed an abrupt interruption of the main bronchus at 12 mm from the hull. The following bronchoscopy identified an almond of 2 cm.",
+        "translated_fulltext": "Một bé trai 19 tháng tuổi được đưa vào khoa Cấp cứu vì bị ngã từ ghế ăn cho bé. Vụ tai nạn xảy ra khi bé có vẻ khỏe mạnh, không có dấu hiệu hay triệu chứng báo trước. Ban đầu, bé ngã đập mông xuống đất, sau đó đầu (phần chẩm) va vào mặt đất. Bé có biểu hiện nôn mửa (ba lần) và rất khó chịu. Tần số thở và nhịp tim của bé là trên 60 lần/phút và trên 150 nhịp/phút, trong khi độ bão hòa oxy là dưới 80%. Khi khám lâm sàng, bé tỉnh táo và đủ nước, nhưng vẫn khó chịu. Quan trọng hơn, chúng tôi nhận thấy có dấu hiệu co rút các cơ liên sườn và khi nghe phổi, âm thanh hô hấp giảm ở phần dưới bên trái của lồng ngực. Bệnh nhân được hỗ trợ hô hấp bằng bóng AMBU kết nối với nguồn oxy và được theo dõi bằng máy đo độ bão hòa oxy. Mặc dù đã can thiệp, độ bão hòa oxy vẫn giảm xuống dưới 70% và càng hỗ trợ hô hấp, độ bão hòa càng giảm. Siêu âm phổi cho thấy không có các đường A điển hình và có sự đông đặc của phổi, được nhìn thấy trực tiếp như một mô phổi đặc. Dựa trên tình trạng lâm sàng kém, bệnh nhân được đặt nội khí quản qua đường miệng bằng ống nội khí quản có bóng chèn. Sau khi tình trạng của bé ổn định, bé được chụp cắt lớp vi tính (CT) lồng ngực, cho thấy tình trạng xẹp phổi hoàn toàn ở phổi trái, với sự gián đoạn của phế quản chính bên trái tại vị trí cách chỗ chia đôi phế quản 12 cm. Chúng tôi nghi ngờ bé bị dị vật đường thở, vì mẹ của bé cũng cho biết những ngày trước đó, bé bị ho dữ dội và dị vật biến mất sau 24 giờ mà không cần điều trị. Do đó, chúng tôi đã thực hiện nội soi phế quản cứng và phát hiện một quả hạnh nhân có đường kính 2 cm trong phế quản chính bên trái, sau đó được lấy ra ngay lập tức.\n\nBé chưa từng ăn hạnh nhân hoặc các loại hạt khác trước đây và trong trường hợp này, bé đã vô tình nuốt phải quả hạnh nhân.\n\nTình trạng lâm sàng của bé dần cải thiện và sau 24 giờ, bé được rút ống nội khí quản và chuyển từ phòng chăm sóc đặc biệt đến khoa nhi để theo dõi thêm vài ngày, trong thời gian này chức năng hô hấp của bé dần hồi phục hoàn toàn.",
+        "translated_summary": "Chúng tôi mô tả trường hợp của một bé trai 19 tháng tuổi được đưa vào phòng cấp cứu ban đầu vì bị chấn thương đầu. Tuy nhiên, đánh giá lâm sàng cho thấy bé bị suy hô hấp nghiêm trọng không rõ nguyên nhân, cần phải đặt nội khí quản. Sau khi đánh giá, chúng tôi đưa ra giả thuyết rằng tình trạng suy hô hấp nghiêm trọng đã dẫn đến sự thay đổi trạng thái ý thức, sau đó là chấn thương đầu. Kết quả chụp X-quang phổi cho thấy có dấu hiệu của dị vật đường thở, với tình trạng xẹp phổi toàn bộ phổi trái. Chụp cắt lớp vi tính cho thấy sự gián đoạn đột ngột của phế quản chính, cách gốc phế quản 12 mm. Sau đó, nội soi phế quản xác định được một dị vật hình hạt hạnh nhân có kích thước 2 cm."
+    },
+    {
+        "id": "multiclinsum_gs_en_83.txt",
+        "fulltext": "A 29-year-old woman, Para 1, with abnormal vaginal bleeding of one-month duration presented to the gynecology outpatient department of a level 2 hospital. She was HIV positive, commenced on antiretroviral treatment following diagnosis, but had defaulted the antiretroviral treatment for one month when she became ill with vaginal bleeding, resulting in virological and immunological failures (viral load 37400 copies/mL and CD4 count 26 cells/μL). Of note, it was unclear when the patient first started showing HIV symptoms. However, she was diagnosed with HIV about a year prior to presentation. Physical examination revealed a large mass on the cervix measuring 8 × 8 cm extending to the parametrium and to the pelvic side walls bilaterally. There was bleeding on contact and foul-smelling vaginal discharge. Ultrasonography detected a bulky cervix and bilateral hydronephrosis. The patient was clinically diagnosed with cervical malignancy stage 3B. She was recommenced on antiretroviral therapy with a treatment change from TLD (Tenofovir-Lamivudine-Dolutegravir combination) to a preferable renal friendly regimen (Lamivudine-Abacavir-Dolutegravir combination). A punch biopsy of the cervix was performed, and the histopathological report revealed the diagnosis of an extra-nodal BL. The immunohistochemical and in situ hybridization confirmed the diagnosis, with CD20, CD75a, CD10, PAX5 and Bcl-6 positive. In addition, the CD44 and c-Myc were positive, with the EBER-ISH demonstrating focal positivity. The Ki67 demonstrated a proliferation index of almost 100% and PAX5 moderately positive BCL6. She had white cell count of 2.67 x109/L, haemoglobin of 5.7g/dl and platelet count of 71 × 109/L. Results of other investigations were serum creatinine 187 mmol/L, urea 11.1 mmol/l, albumin 21 g/l, aspartate transaminase 41 U/l and alkaline phosphatase 100 U/l.\n\nFollowing histological confirmation of the diagnosis and review at an oncology multidisciplinary meeting, she spent 43 days waiting to start treatment at oncology unit. The delay was due to long waiting list. This delay exceeded the 48 hours waiting period during which oncological treatment for BL should commence following diagnosis. The treatment plan was chemo-radiation therapy, and the patient gave written informed consent for the case to be published. However, she demised in the gynaecological ward on the 43rd day while waiting to start the treatment. During the 43 days, further imaging could not be performed due to poor functionality of the available CT and MRI machines. In addition to antiretroviral therapy, the patient received other supportive care such as blood transfusion and analgesia. Again, the number of days between the diagnosis of the BL and her death was 43 days. Histopathological postmortem was not performed as the diagnoses (BL and retroviral disease) were known. We reckon that the main primary cause of death is challenging to assign because of the multiple principal diagnoses. Because BL has rapid progression and high mortality rate in persons living with HIV particularly with high viral load, the attending physician certifying the death assigned BL as the most likely cause of death. However, the secondary cause of death was multiple organ failure (renal and haematological inclusive).",
+        "summary": "The patient was a 29-year-old woman, Para 1, with abnormal vaginal bleeding for a month and living with HIV and had a CD4 of 26 cells/μL. The histological examination of the cervical biopsy confirmed an extra-nodal BL. She had International Federation of Gynecology and Obstetrics (FIGO) stage 3B cervical cancer based on presence of hydronephrosis and pelvic wall involvement. The patient was reviewed at the oncology multidisciplinary meeting and required chemoradiation. There was delay in her management due to a long waiting list for chemoradiation at oncology unit in the referral center and the patient demised 43 days after diagnosis and did not receive the treatment.",
+        "translated_fulltext": "Một phụ nữ 29 tuổi, đã từng mang thai một lần, đến khám tại khoa phụ khoa của bệnh viện hạng 2 vì tình trạng chảy máu âm đạo bất thường kéo dài một tháng. Cô được chẩn đoán nhiễm HIV và bắt đầu điều trị bằng thuốc kháng virus sau khi được chẩn đoán, nhưng đã ngừng điều trị trong một tháng khi cô bị chảy máu âm đạo, dẫn đến tình trạng virus không kiểm soát được và suy giảm miễn dịch (tải lượng virus 37400 bản sao/mL và số lượng tế bào CD4 là 26 tế bào/μL). Điều đáng lưu ý là thời điểm bệnh nhân bắt đầu xuất hiện các triệu chứng HIV vẫn chưa rõ ràng. Tuy nhiên, cô được chẩn đoán nhiễm HIV khoảng một năm trước khi đến khám. Khám lâm sàng cho thấy một khối lớn ở cổ tử cung, kích thước 8 × 8 cm, lan đến mô xung quanh cổ tử cung và thành bên của vùng chậu. Có chảy máu khi chạm vào và dịch âm đạo có mùi hôi. Siêu âm phát hiện cổ tử cung phì đại và tình trạng giãn đường tiết niệu hai bên. Bệnh nhân được chẩn đoán lâm sàng là ung thư cổ tử cung giai đoạn 3B. Cô được tiếp tục điều trị bằng thuốc kháng virus, với sự thay đổi phác đồ điều trị từ TLD (Tenofovir-Lamivudine-Dolutegravir) sang một phác đồ thân thiện hơn với thận (Lamivudine-Abacavir-Dolutegravir). Một mẫu sinh thiết cổ tử cung được thực hiện và kết quả giải phẫu bệnh cho thấy bệnh nhân bị u lympho tế bào B ngoài hạch. Các xét nghiệm hóa mô miễn dịch và lai tại chỗ xác nhận chẩn đoán, với các dấu ấn CD20, CD75a, CD10, PAX5 và Bcl-6 dương tính. Ngoài ra, CD44 và c-Myc cũng dương tính, và xét nghiệm EBER-ISH cho thấy dương tính cục bộ. Chỉ số Ki67 cho thấy tỷ lệ tăng sinh gần 100% và PAX5 dương tính vừa phải với BCL6. Cô có số lượng bạch cầu là 2,67 x10^9/L, hemoglobin là 5,7 g/dL và số lượng tiểu cầu là 71 x10^9/L. Kết quả của các xét nghiệm khác cho thấy creatinine huyết thanh là 187 mmol/L, ure là 11,1 mmol/L, albumin là 21 g/L, aspartate transaminase là 41 U/L và alkaline phosphatase là 100 U/L.\n\nSau khi xác nhận chẩn đoán bằng giải phẫu bệnh và thảo luận tại cuộc họp đa ngành về ung thư, cô phải chờ 43 ngày để bắt đầu điều trị tại khoa ung thư. Sự chậm trễ này là do danh sách chờ đợi quá dài. Thời gian chờ đợi này vượt quá 48 giờ, là khoảng thời gian cần thiết để bắt đầu điều trị ung thư cho bệnh nhân bị u lympho tế bào B sau khi chẩn đoán. Kế hoạch điều trị là hóa trị kết hợp xạ trị, và bệnh nhân đã đồng ý bằng văn bản để trường hợp của cô được công bố. Tuy nhiên, cô đã qua đời tại khoa phụ khoa vào ngày thứ 43 trong khi chờ đợi bắt đầu điều trị. Trong 43 ngày này, không thể thực hiện thêm các xét nghiệm chẩn đoán hình ảnh do máy CT và MRI không hoạt động tốt. Ngoài điều trị bằng thuốc kháng virus, bệnh nhân còn được cung cấp các biện pháp hỗ trợ khác như truyền máu và giảm đau. Một lần nữa, số ngày giữa thời điểm chẩn đoán u lympho tế bào B và thời điểm cô qua đời là 43 ngày. Không thực hiện giải phẫu tử thi vì các chẩn đoán (u lympho tế bào B và bệnh do virus retro) đã được biết. Chúng tôi nhận thấy rằng việc xác định nguyên nhân chính gây tử vong là rất khó khăn do có nhiều chẩn đoán chính. Vì u lympho tế bào B tiến triển nhanh và có tỷ lệ tử vong cao ở những người nhiễm HIV, đặc biệt là những người có tải lượng virus cao, bác sĩ điều trị đã xác định u lympho tế bào B là nguyên nhân có khả năng gây tử vong nhất. Tuy nhiên, nguyên nhân thứ hai gây tử vong là suy đa tạng (bao gồm cả suy thận và rối loạn tạo máu).",
+        "translated_summary": "Bệnh nhân là một phụ nữ 29 tuổi, đã từng mang thai một lần, bị chảy máu âm đạo bất thường trong một tháng, nhiễm HIV và có số lượng tế bào CD4 là 26 tế bào/μL. Kết quả xét nghiệm mô học của mẫu sinh thiết cổ tử cung xác nhận có khối u lympho ngoài hạch. Dựa trên sự hiện diện của thủy niệu quản và sự xâm lấn thành chậu, bệnh nhân được chẩn đoán mắc bệnh ung thư cổ tử cung giai đoạn 3B theo phân loại của Liên đoàn Phụ khoa và Sản khoa Quốc tế (FIGO). Bệnh nhân đã được thảo luận trong cuộc họp đa ngành về ung thư và cần được điều trị bằng hóa trị kết hợp xạ trị. Việc điều trị của bệnh nhân bị trì hoãn do thời gian chờ đợi kéo dài để được hóa trị kết hợp xạ trị tại khoa ung thư của trung tâm điều trị. Bệnh nhân đã qua đời sau 43 ngày kể từ khi được chẩn đoán và không được điều trị."
+    },
+    {
+        "id": "multiclinsum_gs_en_362.txt",
+        "fulltext": "A 77-year-old male patient presented with a history of moderate cognitive impairment. The patient was admitted to the emergency department for a tonic-clonic seizure at home. The patient presented hemodynamically unstable in the context of a postcritical state and suspected intrapelvic bleeding. The code for a polytraumatized patient was activated, not because of the mechanism of injury, but because of the patient's hemodynamic status.  He was stabilized and optimized in the emergency department with intravenous fluid and transfusion of packed red blood cells. A pelvic girdle was placed. Once hemodynamic stability was achieved, a physical examination was performed. Clinically, the patient presented a shortening of the lower limb compared to the contralateral limb, external rotation and joint blockage when performing the log roll test in both limbs. He presented functional impotence in both hips. Given the patient's condition when he arrived at the emergency department, it was not possible to assess the neurological status. He had no signs of external injuries or bruises. Distal pulses were present at the foot level. He could move his upper limbs. A chest and anteroposterior pelvic radiograph was performed as part of the code for a polytraumatized patient, pending completion of an abdominal-pelvic computed tomography (CT) study. A bilateral femoral dislocation was diagnosed in the pelvic radiograph. The patient underwent a procedure to correct the dislocation.\n\n\n\nComputed tomography angiography to rule out vascular lesions given the instability in hemodynamic that presented itself on admission. Vascular lesions were ruled out after the angiography. In the 3D-CT reconstruction of the pelvis, a bilateral transverse acetabular fracture was found, according to the classification of Letournel and a bilateral longitudinal fracture of the iliac wing was found, along with intrapelvic protrusion of both femoral heads. After initial evaluation, supracondylar traction was placed on the femoral head in both extremities and the pelvic traction was removed. The patient was admitted to the recovery unit until surgery, where he remained with the traction supracondylar femoral head in both extremities and the pelvic traction was removed. The patient was operated on the eighth day of admission. In our service, the acetabular fractures were ruled out after seven days waiting for the formation of a fibrosis in the focus of fracture and the decrease of intraoperative bleeding during surgical procedures. It was decided to perform the surgery in two stages due to the long duration of each intervention. Both surgeries were performed with general anaesthesia, tranexamic acid was administered to prevent intraoperative bleeding and decrease blood transfusions in relation to the surgeries; and antibiotic (cefazolin 2 g preoperatively and 1 g of cefazolin every 8 hours postoperatively for 24 hours) as an intrahospital protocol. During the postoperative period, enoxaparin 40 mg was administered subcutaneously every 24 hours for seven weeks. Initially, the surgery of the left hemipelvis was performed since, at the radiographic level, it presented greater pelvic protrusion and it was not desirable that a hematoma in the soft tissue phase could generate complications at the time of extraction of the femoral head (vascular injuries, intraoperative bleeding). The supracondylar traction was removed. The patient was placed in lateral decubitus, and a posterior lateral approach was performed with a Moore's autograft in the acetabular background (fracture focus). Subsequently, the anti-protrusion ring was implanted (Burch SchneiderTM Reinforcement Cage, Zimmer Biomet) anchored to the ischium and ilium. Prior to the implantation of the ring, it was necessary to perform dissection of the gluteal musculature (gluteus minimus and medius) to correctly place the femoral head. The medial ischial fracture of the ring was also anchored with screws. The check was performed under the control of a scope to verify the correct implantation. Subsequently, a double mobility cementaed acetabular ring was implanted and then the non-cemented femoral stem was implanted. After finishing the placement of the components, the capsule and pelvic musculature were closed by means of transosseous trochanteric points. The surgery of the right hemipelvis was performed seven days later. The patient was placed in lateral decubitus. To address the longitudinal fracture of the iliac wing, the first window of the ilio-inguinal approach was performed. It was synthesised with a six-hole anatomical plate. Subsequently, the same procedure as the previous surgery was performed, using an anti-protrusion ring with a double mobility cemented femoral stem and non-cemented femoral stem. This type of anti-protrusion rings are used when there are acetabular fractures that could be equivalent to a pelvic disjunction (type IV classification of acetabular defects of the AAOS) and an anchorage in the ischium and ilium of the ring is needed to support the ring. They are not indicated for isolated fractures of the anterior or posterior wall of the acetabulum where there is no involvement of the acetabular background. During admission, the patient remained in bed and was mobilised to avoid decubitus ulcers. Once the second intervention was performed and when the patient tolerated it clinically, he began to transfer with the use of a wheelchair. In bed he was allowed to have a full range of motion without restriction. The patient was discharged four weeks later and did not begin to load or walk until six weeks. He began to load with the use of a walking stick. We decided to delay loading because, despite the use of arthroplasty as a treatment, it was decided to wait until there was an initial consolidation of the graft in the acetabular background that provided better support for the ring. It was also added that the patient presented bilateral involvement and it would be difficult to start partial loading, given that he did not have a healthy hip to support. During the follow-up of the patient, at 12 months of the intervention he was already doing full load with the use of a walking stick, with a Harris hip score of 79 in the left hip and 77 in the right hip; and a score of 12 on the WOMAC scale. He has not presented any postoperative complications to date. The patient is satisfied clinically, he reports occasional discomfort and a slight limp of the right side. He has a full range of motion in the examination and does not report having had any episode of instability since the surgery.\n",
+        "summary": "77-year-old patient with a history of moderate cognitive impairment who suffered bilateral central dislocation of the hip in the context of a generalized convulsive seizure. Clinically, upon arrival in the emergency department, the patient presented a shortening of the lower right limb compared to the contralateral limb, external rotation and joint blockage when performing the log roll test in both limbs. Imaging and clinical optimization study was performed prior to surgery. It was performed in two stages: first the left hip on the eighth day of admission and the right hip on the fifteenth. In both surgeries the same procedure was performed by implanting an anti-protrusive ring and prosthesis with double mobility acetabulum with non-cemented femoral stem. In the immediate postoperative period, the patient did not present any complications associated with the surgery. In the 12-month follow-up, the patient performed a full load with a Harris hip score (HHS) of 77 in the right hip and 79 in the left; 12 points in the WOMAC scale. He has not presented any postoperative complications to date.\n",
+        "translated_fulltext": null,
+        "translated_summary": "Bệnh nhân 77 tuổi, có tiền sử suy giảm nhận thức mức độ vừa, bị trật khớp háng hai bên trong bối cảnh co giật toàn thân. Khi nhập viện, bệnh nhân có biểu hiện chân phải ngắn hơn so với chân trái, xoay ngoài và hạn chế vận động khi thực hiện nghiệm pháp lăn người ở cả hai chân. Trước phẫu thuật, bệnh nhân được chụp hình ảnh và đánh giá lâm sàng để tối ưu hóa tình trạng. Phẫu thuật được thực hiện làm hai giai đoạn: phẫu thuật khớp háng trái vào ngày thứ tám sau khi nhập viện và khớp háng phải vào ngày thứ mười lăm. Trong cả hai ca phẫu thuật, cùng một quy trình được thực hiện bằng cách đặt vòng chống trượt và khớp nhân tạo với ổ cối có khả năng vận động kép và chỏm xương đùi không gắn xi măng. Trong giai đoạn hậu phẫu sớm, bệnh nhân không gặp bất kỳ biến chứng nào liên quan đến phẫu thuật. Trong quá trình theo dõi 12 tháng, bệnh nhân có thể chịu tải hoàn toàn, với điểm số Harris Hip Score (HHS) là 77 ở khớp háng phải và 79 ở khớp háng trái; 12 điểm trên thang điểm WOMAC. Đến nay, bệnh nhân chưa gặp bất kỳ biến chứng nào sau phẫu thuật."
+    },
+    {
+        "id": "multiclinsum_gs_en_151.txt",
+        "fulltext": "The patient was a 4-month-old male from central Mexico with two healthy male siblings. His mother was hypothyroid during the first trimester of pregnancy and took drugs. The infant was born with normal weight and size, was breast-fed, and received the BCG vaccine with no scarring. The mother of the patient was a prisoner in a jail cell with the infant in a crowded cell with two others.At 4 months, the patient was medically evaluated for a painful tumor in the left axilla. A chest X-ray showed suggestive images of rib fractures; the mother was suspected of child abuse, and the infant was admitted to a pediatric hospital. The infant was weighed (4,190 g) and measured (58 cm) below the third percentile, oxygen saturation of 70%, fever, cough, increased volume in the left axilla, and pain, redness, and warmth. The blood count showed: hemoglobin of 8.8 g/dL (11.0-12.6), 29.3 × 109 leukocytes/L (6.0-17.5), 18.4 × 109 neutrophils/L (1.0-8.5), 7.0 × 109 lymphocytes/L (4.0-13.5), 3.5 × 109 monocytes/L, 459 × 109 platelets/L (150-350), and C-reactive protein of 16 mg/L (< 3.0). The first thoracoabdominal tomography showed an abscess in the left axilla, lytic lesions in ribs 3-6, left apical pneumonia, pulmonary nodules in both lungs, and enlarged cervical and mediastinal lymph nodes. The biopsy of the left axilla abscess reported myositis and suppurative panniculitis. Only the culture for bacteria from the bronchoalveolar liquid was negative, and the PCR for the Mycobacterium tuberculosis complex was negative. After 41 days of hospitalization and receiving two antimicrobial regimens of ceftriaxone-clindamycin and cefepime-vancomycin, the patient was discharged.\n\nTwo months later, at eight months of age, he was readmitted to hospital with a fever, irritability and a suppurating abscess in the left scapula. The blood count showed haemoglobin of 10.8 g/dl (10.5-12), 21.2 × 109 leukocytes/L (6-17), 12.2 × 109 neutrophils/L (1.5-8.5), 7.5 × 109 lymphocytes/L (4-10.5), 1.2 × 109 monocytes/L (600), and 583 × 109 platelets/L (150-350); the serum test for HIV was negative. A left apical consolidation, bronchiectasis, lytic lesions in ribs 2-7 and dorsal vertebrae 2-7, and a multilocular fluid collection were observed on a chest scan; ultrasound showed a fistula associated with the scapular abscess. The patient received piperacillin-tazobactam, which was later replaced with voriconazole after Aspergillus fumigatus was detected in the secretion sample culture. Given the recurrence and severity of the infection, an innate immunity defect was suspected. The dihydrorhodamine test showed no production of reactive oxygen species and the gp91phox expression in neutrophils was absent, establishing a diagnosis of X-linked chronic granulomatous disease. The pathogenic variant detected by next-generation sequencing was c.80_83del/Y (p.Val27Glyfs*33) in CYBB. The mother was a carrier of the variant (c.80_83del/WT). The two older male siblings, who were apparently healthy, could not be genetically tested. The patient was discharged after 65 days of hospitalisation and 28 days of voriconazole treatment. Daily antibiotic prophylaxis with trimethoprim-sulfamethoxazole and antifungal prophylaxis with fluconazole twice a week were initiated. Two months later, at one year of age, the infant was readmitted due to multifocal pneumonia, for which mechanical respiratory assistance was required. The galactomannan antigen was detected in the serum and A. fumigatus was detected in the culture of the lavage fluid, so treatment with voriconazole was initiated again. The patient suffered a multiple organ failure and died one month after admission.\n",
+        "summary": "A case of infant with chronic granulomatous disease and invasive aspergillosis is reported. The infant was a 4-month-old male infant living with his mother in a prison cell. The infant had tumors in the left axillary region and a chest X-ray suggested rib fractures; he was hospitalized on suspicion of child abuse. A chest X-ray showed an axillary abscess, osteolysis of ribs, pneumonia and pulmonary nodules; the patient received broad spectrum antibiotics and was discharged. At 8 months, he was readmitted with fever and extension of the purulent abscess to the left shoulder region; a chest X-ray showed worsening of the condition. Aspergillus fumigatus was isolated from the secretion of the abscess and invasive aspergillosis was diagnosed; voriconazole was initiated for 28 days. A dihydro rhodamine test was performed and a diagnosis of chronic granulomatous disease caused by the pathogenic variant c.80_83del/Y of the CYBB gene, carried by the mother (c.80_83del/WT), was made. At 12 months, the patient was readmitted with invasive aspergillosis, resistant to treatment, with fatal outcome.\n",
+        "translated_fulltext": null,
+        "translated_summary": "Một trường hợp trẻ sơ sinh mắc bệnh hạt u hạt mãn tính và bệnh nấm xâm nhập Aspergillus được báo cáo. Trẻ là một bé trai 4 tháng tuổi, sống cùng mẹ trong một phòng giam. Bé có khối u ở vùng nách trái và chụp X-quang ngực cho thấy có dấu hiệu gãy xương sườn; bé được nhập viện vì nghi ngờ bị bạo hành trẻ em. Chụp X-quang ngực cho thấy có áp xe ở vùng nách, tiêu xương sườn, viêm phổi và các nốt phổi; bệnh nhân được dùng kháng sinh phổ rộng và sau đó được xuất viện. Đến tháng thứ 8, bé được nhập viện lại vì sốt và áp xe mủ lan rộng đến vùng vai trái; chụp X-quang ngực cho thấy tình trạng bệnh trở nên nghiêm trọng hơn. Aspergillus fumigatus được phân lập từ dịch của áp xe và chẩn đoán bệnh nấm xâm nhập Aspergillus; bệnh nhân được điều trị bằng voriconazole trong 28 ngày. Một xét nghiệm dihydro rhodamine được thực hiện và chẩn đoán bệnh hạt u hạt mãn tính do biến thể gây bệnh c.80_83del/Y của gen CYBB, được di truyền từ mẹ (c.80_83del/WT). Đến tháng thứ 12, bệnh nhân được nhập viện lại vì bệnh nấm xâm nhập Aspergillus, không đáp ứng với điều trị và dẫn đến tử vong."
+    },
+    {
+        "id": "multiclinsum_gs_en_133.txt",
+        "fulltext": "Male patient, 25 years old, Sundanese, presented at the Dental Hospital of the Faculty of Dentistry Universitas Padjadjaran with the chief complaint of mouth sores, which are painful on the upper and lower lips and exacerbated when eating and talking. Initially, four days ago, canker sores started in the oral cavity, then appeared on the lips two days later. The patient tried to self-medicate by applying petroleum jelly which he used to relieve his symptoms, but it did not improve. The patient replaced the drug with triamcinolone acetonide 0.1% in orabase ointment purchased at the pharmacy and applied it once a day. Canker sores were getting better but did not cure.\n\nThe patient had history a of fever for about a week before the canker sores appeared and there were no lesions on other parts of the body. He stated that the workload was quite heavy and he had not consumed a balanced nutritional diet for about one and a half months. He had no medical history, history of food allergies, or history of taking medication. He had no history of alcohol consumption or smoking, but he had a frequent habit of licking his lips. He also had a history of chickenpox when he was a child.\n\nThe patient had no fever with all vital signs within normal limits on general examination. Extra-oral examination showed no abnormalities in the lymph nodes. There were serosanguineous crusts that felt painful and bleed easily on the lips. Intra-oral examination revealed erythematous lesions, irregular in shape, and had diffuse borders, accompanied by pain in the upper and lower labial mucosa. Hyperkeratotic white plaque that could not be scraped off, irregular in shape, has diffuse borders, without pain in the region of tooth 38 left buccal mucosa. Yellowish-white plaques were seen on 1/3 of the posterior surface of the dorsal tongue, which could be scraped off without leaving an erythematous area, and there were indentations in the form of dental impressions without pain on the lateral right and left sides of the tongue. A painless hard nodule about 2×1 x 0.5 cm in size was seen in the midline of the hard palate. Several teeth were found in caries, radix, and edentulous conditions in all regions. The oral hygiene was poor.\n\nExamination of psychological conditions was evaluated using the DASS-21 questionnaire and showed normal depression level (score 0), normal anxiety level (score 6), and normal stress level (score 6). Based on history and clinical examination, the working diagnosis was suspected HAEM, accompanied by the coated tongue, frictional keratosis, crenated tongue, torus palatinus, reversible pulpitis of tooth 18, irreversible pulpitis of tooth 47, chronic apical periodontitis et causa radix of tooth 15, and edentulous teeth 28, 37, 36, and 46. The differential diagnosis of suspected HAEM lesions on the lips was exfoliative cheilitis. However, exfoliative cheilitis did not have herpes virus involvement. The patient was indicated for serological testing (IgG anti-HSV-1) to confirm the diagnosis. Oral health-related quality of life was measured, and the results of the OHIP-14 examination at the first visit were 35 (moderate OHRQol).\n\nThe non-pharmacological therapy included instruction to maintain oral hygiene by brushing the teeth and tongue using a soft-bristled toothbrush two times a day and using non-detergent toothpaste. Education was given such as increasing the intake of water by at least two liters per day, consuming a balanced nutritional diet, avoiding acidic, spicy, hard, and monosodium glutamate-containing foods, and stopping the bad habit of licking and peeling the skin of the lips. The pharmacological therapy included topical and systemic medications. The topical medications included instructions to compress the lips with gauze moistened with 0.9% NaCl solution at least three times a day and to apply a thin layer of triamcinolone acetonide 0.1% in orabase to the lips three times a day. The systemic medications included instruction to take a multivitamin once a day.\n\nThe progress of improvement was visible in the first follow-up, two days after the initial visit. The pain in the lips was reduced, but the canker sores have not healed. Extra-oral examination revealed serosanguinous crusts on the lips which were still painful and bled easily. The serological test result (IgG anti-HSV-1) was positive with a ratio of: 6.32 (positive: ratio > 1.1). The definitive diagnosis was established based on the history, clinical examination, and serological tests as HAEM. The non-pharmacological and pharmacological therapy was continued, and systemic medication was added in the form of instructions to consume acyclovir 200 mg tablets five times a day for one week.\n\nSignificant improvement was visible in the second follow-up, five days after the previous visit, showing excellent healing in all of the patient’s oral lesions. The OHIP-14 result at the last visit was 4 (good OHRQoL). The patient’s physical, psychological, and social conditions showed improvement and returned to normal after 7 days of treatment. Patient was referred to continue dental and oral care in the periodontics, dental conservation, oral surgery, and prosthodontics departments. The patient has approved and written informed consent for the case details to be published included publication of the images, and the institution has also approved for publication. This case had complied with the Declaration of Helsinki.",
+        "summary": "A 25-year-old male patient came to the Department of Oral Medicine with the chief complaint of painful canker sores on the lips. Extra-oral examination revealed serosanguineous crusts on the lips that were painful and easily bleed. Intra-oral examination showed diffused and painful irregular erythematous lesions on the upper and lower labial mucosa. The anti-HSV1 IgG test was positive. The patient was diagnosed with HAEM.\n\nCase management: Pharmacological therapy included triamcinolone acetonide 0.1% in orabase, acyclovir tablets, multivitamins, and 0.9% NaCl. Non-pharmacological therapy included advice on maintaining good oral hygiene, avoiding spicy and sour foods, and breaking the bad habit of licking the lips.",
+        "translated_fulltext": null,
+        "translated_summary": "Một bệnh nhân nam 25 tuổi đến khoa Răng miệng với triệu chứng chính là bị loét miệng đau ở môi. Khám bên ngoài cho thấy có các mảng đóng vảy chứa dịch và máu trên môi, gây đau và dễ chảy máu. Khám bên trong miệng cho thấy các tổn thương đỏ, không đều, lan rộng và gây đau ở niêm mạc môi trên và môi dưới. Xét nghiệm kháng thể IgG chống lại virus Herpes simplex loại 1 (HSV1) cho kết quả dương tính. Bệnh nhân được chẩn đoán mắc bệnh viêm loét miệng do virus Herpes.\n\nPhương pháp điều trị: Điều trị bằng thuốc bao gồm bôi kem triamcinolone acetonide 0,1% trong orabase, uống thuốc acyclovir, bổ sung vitamin tổng hợp và súc miệng bằng dung dịch NaCl 0,9%. Các biện pháp không dùng thuốc bao gồm tư vấn về việc duy trì vệ sinh răng miệng tốt, tránh các loại thực phẩm cay và chua, và từ bỏ thói quen xấu là liếm môi."
+    },
+    {
+        "id": "multiclinsum_gs_en_164.txt",
+        "fulltext": "A 56-year-old female patient presented with complaints of dyspnea that required oxygen supplementation. Her medical history dates back to July 2013 when she was hospitalized in the chest ward for dyspnea and cough with yellow sputum. She was subsequently diagnosed with Sjogren’s syndrome complicated with interstitial lung disease (ILD) and PAH (Table I). Her chest X-ray at that time showed vascular markings with interstitial thickening, costophrenic (CP) angle blunting and cardiomegaly. An echocardiogram revealed a pulmonary arterial (PA) systolic pressure of 99 mmHg, enlargement of the right atrium and ventricle, D-shaped left ventricle (LV), and severe tricuspid regurgitation. Chest CNYCT showed no filling defects, excluding pulmonary embolism; it also displayed an enlarged pulmonary trunk, right atrium (RA), and right ventricle (RV), further evidencing pulmonary hypertension. Symptoms of dry mouth, dry eyes, and cracked tongue mucosa, with a Schirmer’s test showing <5 cm, oculus uterque (OU). A positive minor salivary gland biopsy, nuclear medicine scan showing impaired salivary gland function, and a positive anti-Ro test, confirmed Sjogren’s syndrome. She started on Revatio (Sildenafil) 20 mg three times a day (TID) for pulmonary hypertension control, adding Tracleer (Bosentan) in 2016 due to disease progression. A right heart catheterization (RHC) revealed a mean pulmonary arterial pressure (PAP) of 39 mmHg, pulmonary vascular resistance (PVR) nearly 15 Woods, and a wedge pressure of 4, indicating pre-capillary type, group I, CTD-related PAH in 2017. The right heart catheterization (RHC) report allowed for insurance coverage of Opsumit (Macitentan) 10 mg once a day (QD), replacing Tracleer (Bosentan) in 2017. From 2017 to 2020, she was hospitalized multiple times for steroid treatments to manage her underlying Sjogren’s syndrome.\n\nPulmonary hypertension treatment is risk-based, and until 2017, the patient was considered low to intermediate risk, controlled with two medications (Sildenafil + Macitentan). Her condition remained stable until October 2020, when she experienced worsened dyspnea accompanied by cough and expectoration of white sputum, suggestive of infection. On November 10, 2020, the patient experienced severe dyspnea, cold sweats, and cyanosis, with SpO2 dropping to 70%, necessitating 100% O2 via face tent. Blood gas and lab tests revealed a lactate level of 5.2 mmol/l and brain natriuretic peptide (BNP) over 10,000 pg/ml, strongly suggesting cardiogenic shock. She was prepped for intensive care unit (ICU) admission, intubated, and initiated on four pulmonary hypertension medications. Her condition stabilized and showed improvement, preventing further deterioration. On November 12, 2020, evaluation for heart-lung transplantation began. Her condition continued to improve with off vasopressors on November 13, 2020, and extubating on November 14, 2020, and transferred to a general ward on November 21, 2020, with O2 tapered to nasal cannula 2l/min. A follow-up RHC continued to show elevated pulmonary artery pressure, likely attributed to chronic hypertension leading to right heart strain and eventual failure. After intensive care unit (ICU) treatment, she was referred to National Taiwan University Hospital for evaluation for heart-lung transplant.\n\nReviewing the records since the onset of her illness, it was evident that pulmonary artery pressure had steadily increased, and the distance covered in the 6-minute walk test was progressively shortened. Currently, the patient is classified as high risk. She continues regular hospitalizations for control. Despite the relatively stable condition, her chief complaint during the admission is still dyspnea. The physical examination revealed mild rhonchi ILD and a pansystolic murmur indicative of severe valvular heart disease, with no other significant findings. Ventavis (Iloprost) 10 mcg/ml 2 ml was added in 2020. Molecular hydrogen therapy (1 capsule/day) was initiated in May 2023. Hydrogen capsules (PURE HYDROGEN) were purchased from HoHo Biotech Co., Ltd. (Taipei, Taiwan, ROC). Each capsule contained 170 mg of hydrogen-rich coral calcium containing 1.7×1,021 molecules of hydrogen, which is equivalent to 24 cups of water with 1,200 ppb of hydrogen or 0.6 mM of hydrogen per 200 ml of water. Adjuvant therapy with hydrogen capsules resulted in increased CD127 + Treg, decreased anti-Ro antibody, decreased B cell subsets, and stabilization of clinical symptoms and signs was observed following the addition of hydrogen therapy in this patient. No adverse reactions or events were observed following the administration of hydrogen capsules. Flow cytometry and serological examination were employed for whole-blood analysis to assess changes in immune cells and autoantibody before and after hydrogen therapy. For subsequent whole-blood analysis via flow cytometry, blood samples were prepared using standard fluorescent dye preparation methods and fluorescent antibody reagent kits with dried reagents (Beckman Coulter, Brea, CA, USA). The methods, steps, immunophenotypic analysis, and cell gating were conducted following previously described procedures. Our analysis of immunophenotypic markers before and after hydrogen therapy revealed increased CD127 + Treg and decreased B cell subsets after treatment. Moreover, this study adheres to the CARE reporting guidelines (2013 CARE Checklist).",
+        "summary": "We present the case of a 56-year-old female with CTD-PAH, diagnosed in 2013 with Sjogren’s syndrome complicated by interstitial lung disease (ILD) and PAH. Despite treatment with sildenafil, bosentan, macitentan, iloprost, and corticosteroids, her condition deteriorated, resulting in severe dyspnea and cardiogenic shock in 2020. In May 2023, molecular hydrogen therapy was initiated as an adjuvant treatment. The patient received daily hydrogen capsules, which led to increased CD127+ Treg cells, reduced anti-Ro antibodies, and decreased B cell subsets. Her clinical symptoms stabilized without adverse effects.",
+        "translated_fulltext": null,
+        "translated_summary": "Chúng tôi xin trình bày trường hợp của một bệnh nhân nữ 56 tuổi mắc bệnh tăng huyết áp phổi liên quan đến bệnh tự miễn (CTD-PAH), được chẩn đoán mắc hội chứng Sjogren vào năm 2013, kèm theo bệnh phổi kẽ (ILD) và tăng huyết áp phổi (PAH). Mặc dù đã được điều trị bằng sildenafil, bosentan, macitentan, iloprost và corticosteroid, tình trạng của bệnh nhân vẫn trở nên tồi tệ hơn, dẫn đến chứng khó thở nghiêm trọng và sốc tim vào năm 2020. Vào tháng 5 năm 2023, liệu pháp hydro phân tử được bắt đầu như một phương pháp điều trị hỗ trợ. Bệnh nhân được dùng viên nang hydro hàng ngày, giúp tăng số lượng tế bào CD127+ Treg, giảm kháng thể kháng Ro và giảm số lượng các nhóm tế bào B. Các triệu chứng lâm sàng của bệnh nhân ổn định mà không có tác dụng phụ."
+    },
+    {
+        "id": "multiclinsum_gs_en_354.txt",
+        "fulltext": "The patient was a 45-year-old male born in Pakistan who had resided in Portugal for 7 years. He had a history of grade 3 obesity, with no other known personal history or usual pharmacological therapy.\n\nThe patient sought emergency care for fever, dry cough, dyspnea, chest pain, dysgeusia, headache and myalgia with 4 days of evolution. In the summary neurological examination at admission, there were no reported changes. In the evaluation of the respiratory system, tachypnea and pulmonary auscultation with bilateral rough vesicular murmur, without other adventitious sounds, were noted. The remainder of the objective examination showed no changes.\n\nOf the complementary diagnostic tests performed at admission, there was a slight increase in inflammatory parameters and in arterial blood gases under an inspired oxygen fraction (FiO2) of 21%, with type 1 respiratory failure and extensive predominant bilateral, peripheral and basal opacities on chest teleradiography. After a positive reverse-transcription real-time polymerase chain reaction (RT-PCR) test for SARS-CoV-2 (nasal and oropharyngeal exudate) and negative tests for influenza A and B, Streptococcus pneumoniae and Legionella pneumophila, a diagnosis of pneumonia by SARS-CoV-2 infection was established.\n\nOver the first 48 hours, progressive worsening of fatigue, dyspnea and type 1 respiratory failure, requiring an increase in supplemental oxygen therapy, were observed. Due to the lack of improvement, noninvasive mechanical ventilation was initiated; however, due to poor adherence, high-flow oxygen therapy was initiated through a nasal cannula, without a response to therapy.\n\nIn this context, the patient was admitted to the intensive care unit (ICU), level III, where he underwent sedoanalgesia and orotracheal intubation with connection to invasive mechanical ventilation.\n\nOn the eleventh day of hospitalization, treatment with remdesivir, dexamethasone, enoxaparin and empirical antibiotic therapy with amoxicillin/clavulanic acid and azithromycin, administered on suspicion of bacterial overinfection, was continued. During this period, sustained fever was observed, with a weak response to antipyretic therapy, with improvements in inflammatory parameters after the third day of hospitalization in the ICU.\n\nTo exclude any concomitant infectious etiology, intravenous devices were replaced, and blood cultures, cultures of the tip of the central catheter and bronchial secretions, urinalysis, urine culture and transthoracic echocardiography were performed. Among the cultures, the blood culture yielded the only positive result, i.e., Klebsiella pneumoniae, which is sensitive to amoxicillin/clavulanic acid, which the patient was already receiving. The summary echocardiogram did not reveal valve changes suggestive of endocarditis, but the patient presented hypokinesia of the lateral wall and left ventricular apex, as well as poor biventricular function. A slight increase in troponins (1.8ng/mL) and ST-segment depression in leads I and aVL were confirmed, suggesting the existence of acute coronary syndrome or septic cardiomyopathy.\n\nOther noninfectious causes of febrile symptoms in the critically ill patient were excluded, including treatment with neuroleptics or altered thyroid function.\n\nNotably, there was a need for inotropic support with dobutamine in the ventilatory weaning phase as well as noninvasive ventilatory support after orotracheal extubation, which occurred on the fifteenth day of hospitalization.\n\nOn the sixteenth day of hospitalization (nineteenth day of confirmed disease), there was an episode of altered state of consciousness, conjugated deviation of gaze to the right and myoclonus of the face and thoracic region to the left followed by a generalized tonic-clonic seizure crisis, which ceased after midazolam therapy. The hypothesis that the seizure occurred in the context of a hypoxic-ischemic event was excluded because the patient remained normotensive, there was never a peri-event or hypoxemia, serum lactate level was normal, and diuresis remained preserved. Any ionic or glycemic disorders that could explain the inaugural seizure episode were excluded.\n\nIn the post-critical period, there was an absence of eye opening, no verbal response, failure to localize to pain (coma scale of Glasgow 7), and persistent left hemiparesis grade 3 out of 5. Due to the need for airway protection, the patient was sedated, subjected to orotracheal intubation and started on anticonvulsant therapy.\n\nIn the process of diagnosis of the convulsive episode, after cranial computed tomography confirmed no changes, the patient was subjected to lumbar puncture, with turbid CSF output and mild proteinorrachia but without pleocytosis and with normal opening pressure. In the CSF, neurotropic virus and venereal disease research laboratory (VDRL), acid-alcohol resistant bacteria tests and an RT-PCR test for SARS-CoV-2 were requested, and samples were collected for culture. Electroencephalography was performed 1 hour after propofol suspension and under fentanyl, with a single record and total duration of 13 minutes; the findings indicated no changes.\n\nAfter confirmation of a positive RT-PCR test for SARS-CoV-2 RNA in the CSF, without CSF pleiocytosis, the hypothesis of bacterial but nonviral meningitis was excluded, considering the hypothesis of encephalitis. Magnetic resonance imaging (MRI) performed on the seventeenth day of hospitalization showed multiple image artifacts associated with patient movement during the procedure, suggesting the need to repeat the examination.\n\nAfter discontinuation of sedoanalgesia, a change in consciousness was observed, with a Glasgow coma scale score of 14, persistent left hemiparesis with muscle strength grade 4 in 5 and an absence of involuntary movements, allowing safe orotracheal extubation in 24 hours. Given the favorable clinical outcome, brain biopsy was excluded. On the twenty-first day of hospitalization, the patient was transferred to the ward.\n\nThe patient maintained apyrexia without altered state of consciousness. No new episodes of involuntary movements were observed, and on the twenty-sixth day of hospitalization, he underwent a reassessment MRI, which revealed no pathological changes. As he maintained a favorable clinical evolution, the patient was discharged on the thirty-first day of hospitalization without antiepileptic drugs and with an appointment for follow-up with the internal medicine department.\n",
+        "summary": "The authors present the clinical case of a 45-year-old man admitted for pneumonia with a positive result for SARS-CoV-2, with no neurological history, who, on the 16th day of admission, presented a sudden change in consciousness accompanied by a conjugate deviation of the gaze to the right and myoclonia of the face and thoracic region to the left, followed by a generalized tonic-clonic convulsive seizure, associated with persistent left hemiparesis. From the study carried out, the existence of RT-PCR for SARS-CoV-2 in the cerebrospinal fluid is highlighted. The patient presented a clinical evolution with gradual improvement, and the outcome was favourable.\n",
+        "translated_fulltext": null,
+        "translated_summary": "Các tác giả trình bày một trường hợp lâm sàng của một người đàn ông 45 tuổi nhập viện vì viêm phổi, xét nghiệm SARS-CoV-2 cho kết quả dương tính, không có tiền sử bệnh thần kinh. Vào ngày thứ 16 kể từ khi nhập viện, bệnh nhân đột ngột thay đổi trạng thái ý thức, kèm theo hiện tượng lệch hướng nhìn sang phải và co giật cơ mặt và vùng ngực bên trái, sau đó là co giật toàn thân, đồng thời xuất hiện tình trạng yếu nửa người bên trái kéo dài. Nghiên cứu cho thấy có sự hiện diện của RT-PCR đối với SARS-CoV-2 trong dịch não tủy. Bệnh nhân có diễn biến lâm sàng với sự cải thiện dần dần và kết quả điều trị là tốt."
+    },
+    {
+        "id": "multiclinsum_gs_en_423.txt",
+        "fulltext": "A 23-month-old boy with hypoxic-ischaemic encephalopathy at birth with good brain motor potential and normal psychomotor development. He had a personal history of restrictive cardiomyopathy and was included in a cardiac transplant programme when he was 16 months old. He also required the implantation of an external Berlin Heart biventricular support device. In order to prevent embolic events, double antiplatelet and anticoagulant treatment was administered. When he was 23 month old presented with disconnection and right hemiparesis. A computerised tomography (CT) scan showed a hyperdense left middle cerebral artery (MCA), as well as a chronic right parietotemporal infarction. His blood analysis showed: red cells 4.16 × 106 µ/L; haemoglobin 11.4 g/gL; activated partial thromboplastin time (APTT) 93 seconds and international normalised ratio (INR) 1.08.\n\nIntravenous thrombolytic treatment was contraindicated due to double antiplatelet and anticoagulant treatment at full dose with heparin, so an intra-arterial thrombectomy was performed. Although the patient was 23 months old, he was in the third percentile of the weight curve (10 kg). Under general anaesthesia, the right femoral artery was punctured and an 11 cm long 4F sheath (Cordis, Ireland) was placed. A 4F vertebral Radiofocus catheter (Glidecath of Terumo, Belgium) was used to confirm the occlusion of the M1 segment of the left MCA. The artery was recanalised by mechanical thrombectomy with a stentriever using the 4F vertebral catheter as a tutor, positioning it in the petrous segment of the carotid artery. A 3 mm × 20 mm Trevo XP Pro Vue device (Stryker, The Netherlands) was used, with a straight Rapid Transit microcatheter (Codman Neurovascular, UK), opening the artery in one pass. The whole system was removed (tutor catheter, microcatheter and stentriever) simultaneously. In the control run, an iatrogenic dissection of the left internal carotid artery was detected, which had no clinical significance, however, as the left hemisphere was irrigated through the anterior communicant artery.\n\nOne month later, his heart transplant was carried out successfully. Neurologically, the only long-term sequel that came as a result of the stroke was a right upper limb spasticity.",
+        "summary": "A 16-month-old boy with restrictive cardiomyopathy who was listed for a cardiac transplant. At 20 months he required an implantation of an external biventricular support device (Berlin Heart) and had a left hemisphere stroke at 23 months. An intra-arterial approach was used and produced good clinical results. One month later, a heart transplant was performed successfully.",
+        "translated_fulltext": "Một bé trai 23 tháng tuổi bị bệnh não do thiếu oxy và thiếu máu cục bộ khi sinh, nhưng có tiềm năng vận động não tốt và phát triển tâm thần vận động bình thường. Bé có tiền sử bệnh cơ tim hạn chế và đã được đưa vào chương trình ghép tim khi 16 tháng tuổi. Bé cũng cần được cấy ghép thiết bị hỗ trợ tim hai tâm thất Berlin Heart bên ngoài. Để ngăn ngừa các biến cố tắc mạch, bé đã được điều trị bằng thuốc chống kết tập tiểu cầu và thuốc chống đông máu liều cao. Khi bé 23 tháng tuổi, bé xuất hiện tình trạng mất kết nối và liệt nửa người bên phải. Chụp cắt lớp vi tính (CT) cho thấy động mạch não giữa bên trái có mật độ cao, cũng như một vùng nhồi máu màng não thái dương bên phải mãn tính. Kết quả phân tích máu của bé cho thấy: số lượng hồng cầu 4,16 × 106 µ/L; hemoglobin 11,4 g/dL; thời gian hoạt hóa thromboplastin từng phần (APTT) 93 giây và tỷ số quốc tế chuẩn hóa (INR) 1,08.\n\nViệc điều trị bằng thuốc làm tan cục máu đông đường tĩnh mạch là chống chỉ định do bé đã được điều trị bằng thuốc chống kết tập tiểu cầu và thuốc chống đông máu liều cao bằng heparin, vì vậy đã tiến hành phẫu thuật lấy cục máu đông qua đường động mạch. Mặc dù bé 23 tháng tuổi, nhưng bé chỉ nằm ở phần trăm thứ ba trên đường cong tăng trưởng về cân nặng (10 kg). Trong khi gây mê toàn thân, động mạch đùi phải được chọc và một ống thông 4F dài 11 cm (Cordis, Ireland) được đặt vào. Một ống thông Radiofocus cột sống 4F (Glidecath của Terumo, Bỉ) được sử dụng để xác nhận tình trạng tắc nghẽn đoạn M1 của động mạch não giữa bên trái. Động mạch được tái thông bằng phương pháp lấy cục máu đông cơ học bằng một ống thông stent, sử dụng ống thông cột sống 4F làm hướng dẫn, đặt nó vào đoạn đá của động mạch cảnh. Một thiết bị Trevo XP Pro Vue 3 mm × 20 mm (Stryker, Hà Lan) được sử dụng, cùng với một ống thông vi mô Rapid Transit thẳng (Codman Neurovascular, Vương quốc Anh), mở động mạch trong một lần. Toàn bộ hệ thống (ống thông hướng dẫn, ống thông vi mô và ống thông stent) được lấy ra cùng một lúc. Trong quá trình kiểm tra, một vết rách iatrogenic của động mạch cảnh trong bên trái đã được phát hiện, nhưng không có ý nghĩa lâm sàng, vì bán cầu não trái được tưới máu thông qua động mạch giao tiếp trước.\n\nMột tháng sau, ca ghép tim của bé đã được thực hiện thành công. Về mặt thần kinh, di chứng lâu dài duy nhất do đột quỵ gây ra là tình trạng co cứng chi trên bên phải.",
+        "translated_summary": "Một bé trai 16 tháng tuổi bị bệnh cơ tim hạn chế và đã được đưa vào danh sách chờ để ghép tim. Đến 20 tháng tuổi, bé cần được cấy ghép một thiết bị hỗ trợ tim hai tâm thất bên ngoài (Berlin Heart) và bị đột quỵ ở bán cầu não trái vào tháng thứ 23. Phương pháp tiếp cận qua động mạch được sử dụng và mang lại kết quả lâm sàng tốt. Một tháng sau, ca ghép tim đã được thực hiện thành công."
+    },
+    {
+        "id": "multiclinsum_gs_en_439.txt",
+        "fulltext": "A 70-year-old white man was treated for severe symptomatic aortic regurgitation due to healed endocarditis using TAVI from the apical approach. TAVI was performed at that time because he was considered a high-risk surgical patient due to secondary pulmonary hypertension, severely impaired left ventricular function with a left ventricular ejection fraction (LVEF) of 20%, chronic renal failure, and a logistic EuroSCORE I of 24.36%. At the time he was treated by diuretics (torasemide 20 mg once a day), an angiotensin-converting enzyme (ACE) inhibitor (ramipril 5 mg once a day), a ß-blocker (bisoprolol 2.5 mg twice a day), and an aldosterone antagonist (12.5 mg once a day). On admission he had cardiac decompensation and resulting dyspnea (temperature 36.7 °C, pulse 99/minute, blood pressure 109/48 mmHg) but his emotional status and neurological constitution were good. The laboratory results were unremarkable except for: a mild increase in liver enzymes, aspartate aminotransferase (AST) 59 U/l and alanine aminotransferase (ALT) 67 U/l; a known chronic renal insufficiency (creatinine 2.1 mg/dl); and a mild decrease in hemoglobin (Hb) 10.7 g/dl. No urine analysis was done. Due to normal C-reactive protein and normal count of leukocytes no microbiological examination was performed. After interdisciplinary discussion of the case (including a normal coronary angiography that was performed a few days before) and cardiac recompensation, he was initially treated with an implantation of a JenaValve 27 mm self-expandable valve. Despite a good result after implantation with the JenaValve and minimal transvalvular central insufficiency, he presented recurrent cardiac decompensation due to his severely impaired LVEF. His case was discussed again at an interdisciplinary meeting: 4 weeks after TAVI he underwent the implantation of a LVAD system (Thoratec® HeartMate II). His postoperative course was uneventful. He remained asymptomatic for 1 year until the LVAD system showed recurrent significant high flow alarms. Echocardiography examinations during this year showed a continuous increase in transvalvular central insufficiency to the level of a severe regurgitation without any sign for structural alteration of the leaflets of the JenaValve prosthesis. Treatment options were discussed and a new TAVI as valve-in-valve was decided.\n\nThe procedure was performed under general anesthesia using a CoreValve Evolut R 29 mm prosthesis. The prosthesis was implanted without prior valvuloplasty. The flow rate of LVAD was reduced to minimum and pacing with a frequency of 140 beats/minute was applied during placement of the valve prosthesis. Positioning was done with great care using fluoroscopic and transesophageal echocardiography (TEE) guidance with the aim of having the ventricular strut end of the CoreValve Evolut R prosthesis between the ventricular end and the “cusp feelers” of the JenaValve prosthesis. This position was obtained because of JenaValve structure and individual computed tomography analysis of our patient which had shown the ventricular edge of the JenaValve well positioned in left ventricular outflow tract (LVOT). The first positioning was successful with no need for repositioning. After the last fluoroscopic control the CoreValve Evolut R was released successfully in the planned position. Slow rapid pacing was stopped and the LVAD flow was increased and required good hemodynamic under normal LVAD flow. His postoperative course was uneventful and he has shown a very good recovery. A second TEE did not show any change regarding the performance of the valve-in-valve and only marginal residual insufficiency. At 12-month follow-up our patient had no complaints and had a satisfactory capacity in daily life. Echocardiography showed no relevant aortic regurgitation and an increase of LVEF to 33%. At that time the 6-minute walk test was significantly increased to 381 m (compared to 148 m on admission).",
+        "summary": "We report the case of a 70-year-old white man who was treated for severe symptomatic aortic regurgitation using transcatheter aortic valve implantation from the apical approach. Because of recurrent cardiac decompensation 4 weeks after implantation he underwent the implantation of a left ventricular assist device system. A year later echocardiography showed a severe transvalvular central insufficiency. Our heart team decided to choose a valve-in-valve approach while reducing the flow rate of left ventricular assist device to minimum and pacing with a frequency of 140 beats/minute. There was an excellent result and our patient is doing well with no relevant insufficiency of the aortic valve at 12-month follow-up.",
+        "translated_fulltext": "Một bệnh nhân nam da trắng, 70 tuổi, được điều trị bệnh hở van động mạch chủ nghiêm trọng gây ra các triệu chứng do viêm nội tâm mạc đã khỏi bằng phương pháp TAVI (cấy ghép van động mạch chủ qua da) từ đường tiếp cận đỉnh tim. TAVI được thực hiện vào thời điểm đó vì bệnh nhân được coi là có nguy cơ phẫu thuật cao do tăng huyết áp phổi thứ phát, chức năng thất trái suy giảm nghiêm trọng với phân suất tống máu thất trái (LVEF) là 20%, suy thận mạn tính và điểm EuroSCORE I là 24,36%. Vào thời điểm điều trị, bệnh nhân được dùng thuốc lợi tiểu (torasemide 20mg mỗi ngày một lần), thuốc ức chế men chuyển (ACE) (ramipril 5mg mỗi ngày một lần), thuốc chẹn beta (bisoprolol 2,5mg hai lần mỗi ngày) và thuốc đối kháng aldosterone (12,5mg mỗi ngày một lần). Khi nhập viện, bệnh nhân có dấu hiệu suy tim và khó thở (nhiệt độ 36,7°C, mạch 99 lần/phút, huyết áp 109/48 mmHg), nhưng tình trạng cảm xúc và thần kinh của bệnh nhân ổn định. Kết quả xét nghiệm cho thấy không có gì đáng chú ý, ngoại trừ: tăng nhẹ men gan, aspartate aminotransferase (AST) 59 U/l và alanine aminotransferase (ALT) 67 U/l; suy thận mạn tính đã biết (creatinine 2,1 mg/dl); và giảm nhẹ hemoglobin (Hb) 10,7 g/dl. Không thực hiện phân tích nước tiểu. Do protein C phản ứng bình thường và số lượng bạch cầu bình thường, không thực hiện xét nghiệm vi sinh. Sau khi thảo luận liên ngành về trường hợp này (bao gồm cả kết quả chụp mạch vành bình thường được thực hiện vài ngày trước) và tình trạng suy tim được cải thiện, bệnh nhân ban đầu được điều trị bằng cách cấy ghép van tự giãn nở JenaValve 27 mm. Mặc dù kết quả tốt sau khi cấy ghép van JenaValve và có ít tình trạng hở van trung tâm, bệnh nhân vẫn bị suy tim tái phát do LVEF suy giảm nghiêm trọng. Trường hợp của bệnh nhân được thảo luận lại trong một cuộc họp liên ngành: 4 tuần sau khi thực hiện TAVI, bệnh nhân được cấy ghép hệ thống LVAD (Thoratec® HeartMate II). Quá trình hồi phục sau phẫu thuật của bệnh nhân diễn ra suôn sẻ. Bệnh nhân không có triệu chứng trong 1 năm cho đến khi hệ thống LVAD báo hiệu tái phát các cảnh báo lưu lượng cao đáng kể. Các xét nghiệm siêu âm tim trong năm này cho thấy tình trạng hở van trung tâm liên tục tăng lên đến mức hở van nghiêm trọng mà không có dấu hiệu thay đổi cấu trúc của lá van của van nhân tạo JenaValve. Các lựa chọn điều trị đã được thảo luận và quyết định thực hiện TAVI mới theo phương pháp van trong van.\n\nThủ thuật được thực hiện dưới gây mê toàn thân bằng cách sử dụng van nhân tạo CoreValve Evolut R 29 mm. Van nhân tạo được cấy ghép mà không cần nong van trước. Lưu lượng của LVAD được giảm xuống mức tối thiểu và nhịp tim với tần số 140 nhịp/phút được áp dụng trong quá trình đặt van nhân tạo. Vị trí được điều chỉnh cẩn thận bằng cách sử dụng hướng dẫn bằng chụp X-quang và siêu âm tim qua thực quản (TEE) với mục tiêu đặt phần cuối của khung thất của van nhân tạo CoreValve Evolut R nằm giữa phần cuối của thất và \"cảm biến lá van\" của van nhân tạo JenaValve. Vị trí này được xác định do cấu trúc của JenaValve và phân tích chụp cắt lớp vi tính cá nhân của bệnh nhân, cho thấy bờ thất của van JenaValve được đặt tốt trong đường thoát thất trái (LVOT). Lần định vị đầu tiên thành công mà không cần điều chỉnh lại. Sau khi kiểm tra X-quang cuối cùng, van CoreValve Evolut R được đặt thành công ở vị trí đã định. Nhịp tim nhanh chậm được dừng lại và lưu lượng LVAD được tăng lên, cho thấy tình trạng huyết động tốt với lưu lượng LVAD bình thường. Quá trình hồi phục sau phẫu thuật của bệnh nhân diễn ra suôn sẻ và bệnh nhân có dấu hiệu phục hồi rất tốt. Siêu âm tim lần thứ hai không cho thấy bất kỳ thay đổi nào liên quan đến hiệu suất của van trong van và chỉ có tình trạng hở van còn lại rất nhỏ. Sau 12 tháng theo dõi, bệnh nhân không có bất kỳ khiếu nại nào và có khả năng hoạt động tốt trong cuộc sống hàng ngày. Siêu âm tim cho thấy không có hở van động mạch chủ đáng kể và LVEF tăng lên 33%. Vào thời điểm đó, bài kiểm tra đi bộ trong 6 phút tăng đáng kể lên 381 m (so với 148 m khi nhập viện).",
+        "translated_summary": "Chúng tôi báo cáo về trường hợp của một bệnh nhân nam da trắng, 70 tuổi, được điều trị suy van động mạch chủ nghiêm trọng có triệu chứng bằng phương pháp cấy ghép van động mạch chủ qua đường ống thông từ đường tiếp cận đỉnh tim. Do tình trạng suy tim tái phát 4 tuần sau khi cấy ghép, bệnh nhân đã được cấy ghép hệ thống hỗ trợ thất trái. Một năm sau, siêu âm tim cho thấy tình trạng hở van động mạch chủ trung tâm nghiêm trọng. Nhóm bác sĩ tim mạch của chúng tôi quyết định chọn phương pháp cấy van trong van, đồng thời giảm lưu lượng của hệ thống hỗ trợ thất trái xuống mức tối thiểu và điều chỉnh nhịp tim ở mức 140 nhịp/phút. Kết quả đạt được rất tốt và bệnh nhân hiện đang hồi phục tốt, không có dấu hiệu suy van động mạch chủ đáng kể trong quá trình theo dõi sau 12 tháng."
+    },
+    {
+        "id": "multiclinsum_gs_en_458.txt",
+        "fulltext": "A 12-year-old boy was brought to our department exhibiting sudden onset symptoms of headache and polyuria-polydipsia syndrome, which began one week prior to his initial visit. The child had no significant medical history. During the first clinical evaluation, he measured 146.5 cm in height (M) and weighed 30 kg (-1.4 SD). There were no observed signs of adrenal insufficiency or hypothyroidism. He was at the onset of puberty, with gonad sizes measuring 3.2 cm on each side and a penis length of 6.2 cm (M). Notably, the patient experienced polyuria-polydipsia syndrome, with fluid excretion reaching up to 113ml/kg/day, nocturnal enuresis, and an excessive liquid intake of 3.8 liters/m². Ophthalmologic examination yielded expected results, with no visual impairments detected and normal optical coherence tomography (OCT) findings.\n\nThe biological assessment revealed DI, with a serum sodium level of 140 mEq/l and plasma osmolality of 287 mosm/kg, while the urine osmolality was significantly low at 179 mosm/kg. Furthermore, his serum levels of insulin-like growth factor-1 (IGF1), prolactin (PRL), free T4, cortisol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were all within the normal range.\n\nMRI scans with and without contrast highlighted apoplexy in an RCC, showing a spontaneous hyperintensity on T1 and T2 sequences measuring 15x6x11 mm. The anterior pituitary gland displayed homogeneous contrast uptake. However, we observed a loss of the typical hyperintensity of the posterior pituitary gland, with no radiological indications of a craniopharyngioma. Therefore, during the initial hormonal evaluation, the only hormone deficiency identified in our case was DI, which showed significant improvement under vasopressin treatment. The case was reviewed in a multidisciplinary meeting, including an endocrinologist, neurosurgeon, and radiologist. Given the absence of clinical or biological signs other than DI and the stability of the RCC apoplexy over nine months of MRI monitoring—with measurements of 12 × 11 × 10 mm—a conservative management approach with regular follow-ups was chosen.\n\nThe child was monitored for three years, during which he displayed normal puberty development and maintained a stable hormonal profile (Table 1). Visual evaluations revealed no abnormalities. However, a decrease in growth velocity was noted, dropping from -0.8 SD to -1.1 SD. This necessitated an investigation for acquired growth hormone (GH) deficiency. At the age of 14 years and nine months, the child was readmitted to undergo two GH stimulation tests: A propranolol-glucagon test and an Insulin Tolerance Test, which indicated a partial GH deficiency with peaks of 19.3 µUI/ml and 10.0 µUI/ml, respectively. After receiving GH treatment, the patient experienced a notable increase in growth velocity, improving from -1.1 SD to 0.2 SD over one year.\n\nSubsequently, MRI monitoring showed a stable appearance of the RCC apoplexy after two years (11 × 12 × 11 mm), with a slight decrease in size observed at the three-year follow-up, measuring 7 × 10 × 6 mm. It is important to note that the radiological follow-up was consistently conducted at the same MRI center, with the same radiologist interpreting both recent and previous MRI findings during multidisciplinary meetings that included an endocrinologist and a neurosurgeon.",
+        "summary": "We present the case of a 12-year-old boy admitted due to the recent onset of headaches and diabetes insipidus. Magnetic resonance imaging revealed Rathke cleft cyst apoplexy. Given the absence of compressive symptoms in a child at the early stages of puberty and without abnormalities in basic endocrine tests, a conservative strategy was employed, involving regular clinical, biological, and radiological follow-ups. The child experienced normal puberty without any endocrine deficiencies except for a partial growth hormone deficiency.",
+        "translated_fulltext": "Một bé trai 12 tuổi được đưa đến khoa của chúng tôi với các triệu chứng khởi phát đột ngột gồm đau đầu và hội chứng tiểu nhiều - khát nhiều, bắt đầu một tuần trước khi bé đến khám. Tiền sử bệnh của bé không có gì đặc biệt. Trong lần đánh giá lâm sàng đầu tiên, chiều cao của bé là 146,5 cm (trung bình) và cân nặng là 30 kg (-1,4 độ lệch chuẩn). Không có dấu hiệu nào cho thấy suy tuyến thượng thận hoặc suy giáp. Bé đang trong giai đoạn dậy thì, với kích thước tinh hoàn đo được là 3,2 cm mỗi bên và chiều dài dương vật là 6,2 cm (trung bình). Đáng chú ý, bé bị hội chứng tiểu nhiều - khát nhiều, với lượng nước tiểu bài tiết lên tới 113ml/kg/ngày, tiểu dầm ban đêm và lượng chất lỏng tiêu thụ quá nhiều, lên tới 3,8 lít/m². Khám mắt cho thấy kết quả như mong đợi, không phát hiện bất kỳ suy giảm thị lực nào và kết quả chụp cắt lớp quang học (OCT) bình thường.\n\nĐánh giá sinh học cho thấy bé bị tiểu đường không có nguồn gốc, với nồng độ natri trong huyết thanh là 140 mEq/l và độ thẩm thấu huyết tương là 287 mosm/kg, trong khi độ thẩm thấu nước tiểu lại thấp đáng kể, chỉ là 179 mosm/kg. Hơn nữa, nồng độ các chất trong huyết thanh như yếu tố tăng trưởng giống insulin-1 (IGF1), prolactin (PRL), T4 tự do, cortisol, hormone kích thích nang trứng (FSH) và hormone hoàng thể hóa (LH) đều nằm trong phạm vi bình thường.\n\nChụp MRI có và không có chất cản quang cho thấy có tổn thương xuất huyết trong khối u tuyến yên, với vùng tăng tín hiệu tự phát trên chuỗi T1 và T2, kích thước 15x6x11 mm. Tuyến yên trước có sự hấp thụ chất cản quang đồng nhất. Tuy nhiên, chúng tôi nhận thấy sự mất đi tín hiệu tăng đặc trưng của tuyến yên sau, không có dấu hiệu nào cho thấy có khối u vòm yên. Do đó, trong quá trình đánh giá nội tiết ban đầu, chỉ có một loại hormone bị thiếu hụt được xác định trong trường hợp này là tiểu đường không có nguồn gốc, và tình trạng này đã cải thiện đáng kể khi được điều trị bằng vasopressin. Trường hợp này đã được thảo luận trong một cuộc họp đa ngành, bao gồm một bác sĩ nội tiết, một bác sĩ phẫu thuật thần kinh và một bác sĩ chẩn đoán hình ảnh. Do không có dấu hiệu lâm sàng hoặc sinh học nào khác ngoài tiểu đường không có nguồn gốc và sự ổn định của tổn thương xuất huyết trong khối u tuyến yên trong chín tháng theo dõi bằng MRI - với kích thước đo được là 12 × 11 × 10 mm - nên đã chọn phương pháp điều trị bảo tồn với các lần theo dõi định kỳ.\n\nBé được theo dõi trong ba năm, trong thời gian này, bé có sự phát triển bình thường trong giai đoạn dậy thì và duy trì hồ sơ hormone ổn định (Bảng 1). Đánh giá thị lực không cho thấy bất kỳ bất thường nào. Tuy nhiên, có sự giảm tốc độ tăng trưởng, giảm từ -0,8 độ lệch chuẩn xuống -1,1 độ lệch chuẩn. Điều này đòi hỏi phải tiến hành điều tra để xác định xem có bị thiếu hụt hormone tăng trưởng (GH) hay không. Ở tuổi 14 và chín tháng, bé được nhập viện lại để thực hiện hai xét nghiệm kích thích hormone tăng trưởng: xét nghiệm propranolol-glucagon và xét nghiệm dung nạp insulin, kết quả cho thấy có tình trạng thiếu hụt hormone tăng trưởng một phần, với đỉnh điểm là 19,3 µUI/ml và 10,0 µUI/ml, tương ứng. Sau khi được điều trị bằng hormone tăng trưởng, bệnh nhân có sự tăng đáng kể về tốc độ tăng trưởng, cải thiện từ -1,1 độ lệch chuẩn lên 0,2 độ lệch chuẩn trong vòng một năm.\n\nSau đó, theo dõi bằng MRI cho thấy tổn thương xuất huyết trong khối u tuyến yên ổn định sau hai năm (11 × 12 × 11 mm), với sự giảm nhẹ về kích thước được ghi nhận trong lần theo dõi sau ba năm, đo được là 7 × 10 × 6 mm. Điều quan trọng cần lưu ý là việc theo dõi bằng hình ảnh được thực hiện liên tục tại cùng một trung tâm MRI, với cùng một bác sĩ chẩn đoán hình ảnh đánh giá cả kết quả MRI gần đây và trước đó trong các cuộc họp đa ngành, có sự tham gia của bác sĩ nội tiết và bác sĩ phẫu thuật thần kinh.",
+        "translated_summary": "Chúng tôi xin trình bày trường hợp của một bé trai 12 tuổi nhập viện vì gần đây xuất hiện các triệu chứng đau đầu và tiểu đường không có đường. Chụp cộng hưởng từ (MRI) cho thấy có tình trạng vỡ nang Rathke. Do không có các triệu chứng chèn ép ở giai đoạn đầu của tuổi dậy thì và không có bất thường trong các xét nghiệm nội tiết cơ bản, chúng tôi đã áp dụng phương pháp điều trị bảo tồn, bao gồm việc theo dõi lâm sàng, sinh học và chụp X-quang định kỳ. Bé trai trải qua quá trình dậy thì bình thường mà không có bất kỳ thiếu hụt nội tiết nào, ngoại trừ tình trạng thiếu hụt hormone tăng trưởng một phần."
+    },
+    {
+        "id": "multiclinsum_gs_en_474.txt",
+        "fulltext": "Patient and observation\nPatient information: This was a 67-year-old patient with no medical history who presented with dysphagia, dysphonia and altered general condition.\n\nClinical findings: initial clinical examination found a conscious patient with a Glasgow score of 15/15, apyrexia, blood pressure of 12/07 cmHg, oxygen saturation of 100%, heart rate of 80/min, conjunctivae of normal colour with a large mass in the cavum. There was no hepatomegaly or splenomegaly, the lymph node areas were free, the rest of the physical examination was normal.\n\nChronology: the patient had been experiencing difficulty swallowing with dysphonia for 6 months, the clinical picture worsened with the development of dysphagia for solids with a deterioration in general condition (weight loss of 15kg/6 months).\n\nDiagnostic approach: cervico-thoraco-abdomino-pelvic CT scan showed a 70 mm x 40 mm nasopharyngeal mass extending to 60 mm. The patient's blood work was normal (white blood cell count, renal and hepatic function, lactate dehydrogenase and HIV, HCV and HBV serologies). The histological and immunohistochemical study of the nasopharyngeal biopsy was in favour of a grade 1,2 CD20+; CD19+; CD79a+; CD10+ follicular B-cell NHL in 2 readings in 2 different laboratories. The bone marrow biopsy was normal as was the pre-therapeutic work-up.\n\nTherapeutic intervention: the patient received 4 RCHOP 21 cures (rituximab 375mg/m2 intravenous (iv), cyclophosphamide 750 mg/m2 iv, oncovin 2 mg iv, prednisolone 100 mg orally, and doxorubicin 50 mg/m2 (iv) with no response and then 3 RDHAOX cures (rituximab 375 mg/m2 intravenous (iv) on day 1, high dose aracytine 2 g/m2 x 2 iv on day 2, dexamethasone 40 mg from day 1 to day 4, and oxalipatine 100 mg/m2 on day 1) with no clinical response.\n\nFollow-up and results of therapeutic interventions: the persistence and increase of the nasopharyngeal mass led to the realization of the tracheotomy, the biopsy of the nasopharyngeal mass objectified the disappearance of the lymphoid B infiltration with presence of the amyloid deposits AL type kappa.\n\nImmune electrophoresis of plasma proteins showed the presence of immunoglobulin M kappa, the dosage of light chains was not performed due to lack of resources, the myelogram and a second bone marrow biopsy were normal, the TEP scan objectified a hypermetabolic nasopharyngeal process without other anomalies, the cardiac evaluation (ECG, natriuretic peptides, troponin, echocore) and renal were without particularities, the patient is currently under protocol bortezomib, prednisone and bendamustine with good clinical evolution after the first treatment.\n",
+        "summary": "We report the case of a 67-year-old patient without pathological CDDs who presented with a deterioration of general condition with progressive dysphonia and dysphagia with a large mass in the neck that was biopsy-proven to be a grade 1 and 2 follicular non-Hodgkin lymphoma. A cervico-thoraco-abdomino-pelvic CT scan showed a 70 mm x 40 mm nasopharyngeal mass extending to 60 mm. Bone marrow biopsy was normal and the pre-therapeutic evaluation was normal. The patient received 4 courses of rituximab plus CHOP (cyclophosphamide, adriamycin, prednisone and oncovin) without response and then 3 courses of rituximab plus DHAOX (dexamethasone, high dose ara-cytin and oxalipatin) with persistence of the mass. The biopsy of the latter showed the disappearance of the B lymphocyte infiltration with presence of the AL amyloid deposits. The immunoelectrophoresis of plasma proteins showed the presence of immunoglobulin M. A positron emission tomography (PET) scan showed a hypermetabolic nasopharyngeal process. The patient is currently receiving a protocol of bortezomib, prednisone and bendamustine.\n",
+        "translated_fulltext": "Thông tin bệnh nhân: Bệnh nhân 67 tuổi, không có tiền sử bệnh lý, nhập viện với các triệu chứng khó nuốt, khàn tiếng và tình trạng sức khỏe tổng thể suy giảm.\n\nKết quả thăm khám lâm sàng: Khám lâm sàng ban đầu cho thấy bệnh nhân tỉnh táo, điểm Glasgow là 15/15, không sốt, huyết áp 120/70 mmHg, độ bão hòa oxy 100%, nhịp tim 80 lần/phút, kết mạc có màu bình thường, có một khối lớn trong hốc mũi. Không có gan to hoặc lách to, các vùng hạch bạch huyết không sưng, các kết quả thăm khám thể chất khác đều bình thường.\n\nDiễn biến bệnh: Bệnh nhân đã gặp khó khăn khi nuốt và bị khàn tiếng trong 6 tháng, tình trạng bệnh trở nên tồi tệ hơn với sự xuất hiện của chứng khó nuốt thức ăn đặc và tình trạng sức khỏe tổng thể suy giảm (giảm 15kg trong 6 tháng).\n\nPhương pháp chẩn đoán: Chụp CT vùng cổ, ngực, bụng và vùng chậu cho thấy một khối u vùng họng mũi kích thước 70 mm x 40 mm, kéo dài đến 60 mm. Các xét nghiệm máu của bệnh nhân đều bình thường (số lượng bạch cầu, chức năng thận và gan, lactate dehydrogenase, xét nghiệm HIV, HCV và HBV). Nghiên cứu mô bệnh học và hóa mô miễn dịch của mẫu sinh thiết vùng họng mũi cho thấy khối u là u lympho tế bào B nang loại 1, 2, CD20+, CD19+, CD79a+, CD10+, được xác nhận qua hai lần xét nghiệm tại hai phòng thí nghiệm khác nhau. Sinh thiết tủy xương và các xét nghiệm tiền điều trị đều bình thường.\n\nCan thiệp điều trị: Bệnh nhân được điều trị bằng 4 đợt hóa trị RCHOP 21 (rituximab 375mg/m2 tiêm tĩnh mạch, cyclophosphamide 750 mg/m2 tiêm tĩnh mạch, oncovin 2 mg tiêm tĩnh mạch, prednisolone 100 mg uống, và doxorubicin 50 mg/m2 tiêm tĩnh mạch), nhưng không có đáp ứng, sau đó được điều trị bằng 3 đợt hóa trị RDHAOX (rituximab 375 mg/m2 tiêm tĩnh mạch vào ngày 1, aracytine liều cao 2 g/m2 x 2 tiêm tĩnh mạch vào ngày 2, dexamethasone 40 mg từ ngày 1 đến ngày 4, và oxalipatine 100 mg/m2 vào ngày 1), nhưng cũng không có đáp ứng lâm sàng.\n\nTheo dõi và kết quả điều trị: Do khối u vùng họng mũi vẫn tiếp tục phát triển, bệnh nhân được phẫu thuật mở khí quản. Sinh thiết khối u vùng họng mũi cho thấy sự biến mất của sự xâm nhập tế bào B lympho và sự xuất hiện của các lắng đọng amyloid loại kappa.\n\nĐiện di miễn dịch protein huyết tương cho thấy sự hiện diện của immunoglobulin M kappa. Việc định lượng chuỗi nhẹ không được thực hiện do thiếu nguồn lực. Kết quả xét nghiệm tủy xương và sinh thiết tủy xương lần hai đều bình thường. Chụp PET cho thấy một quá trình trao đổi chất tăng cao ở vùng họng mũi, không có bất thường khác. Đánh giá tim mạch (điện tâm đồ, peptide lợi niệu, troponin, siêu âm tim) và chức năng thận đều bình thường. Hiện tại, bệnh nhân đang được điều trị theo phác đồ bortezomib, prednisone và bendamustine và có tiến triển lâm sàng tốt sau đợt điều trị đầu tiên.",
+        "translated_summary": "Chúng tôi báo cáo về trường hợp của một bệnh nhân 67 tuổi, không có tiền sử bệnh lý về các bệnh liên quan đến rối loạn chức năng hệ thần kinh trung ương, người đến khám với tình trạng sức khỏe suy giảm, kèm theo chứng khàn tiếng và khó nuốt ngày càng nặng, đồng thời có một khối lớn ở vùng cổ. Kết quả sinh thiết cho thấy khối u này là u lympho không Hodgkin dạng nang, độ 1 và độ 2. Chụp CT vùng cổ, ngực, bụng và vùng chậu cho thấy khối u vùng họng mũi có kích thước 70 mm x 40 mm, lan rộng đến 60 mm. Kết quả sinh thiết tủy xương bình thường và đánh giá trước điều trị cũng cho thấy không có bất thường. Bệnh nhân đã được điều trị bằng 4 đợt rituximab kết hợp với CHOP (cyclophosphamide, adriamycin, prednisone và oncovin) nhưng không có hiệu quả, sau đó là 3 đợt rituximab kết hợp với DHAOX (dexamethasone, ara-cytin liều cao và oxalipatin), nhưng khối u vẫn không giảm. Sinh thiết khối u sau đó cho thấy sự biến mất của các tế bào lympho B và sự xuất hiện của các lắng đọng amyloid AL. Xét nghiệm điện di miễn dịch protein huyết tương cho thấy có sự hiện diện của immunoglobulin M. Chụp PET cho thấy có một quá trình trao đổi chất tăng cao ở vùng họng mũi. Hiện tại, bệnh nhân đang được điều trị theo phác đồ bortezomib, prednisone và bendamustine."
+    },
+    {
+        "id": "multiclinsum_gs_en_539.txt",
+        "fulltext": "46-year-old Haitian male, residing in Chile for one year. In Haiti he was a livestock farmer. He presented a one-and-a-half-year history of a lesion that began as a papule on the anterior aspect of the right leg, which increased in size progressively. Initially asymptomatic, three months prior to the consultation he developed pruritus, pain, superficial ulceration and yellowish discharge. On physical examination, the patient was found to be of phototype V, with 1 x 1 cm, 2 x 2 cm and 3 x 2 cm warty plaques on the anterior aspect of the right leg. A dermatoscopy revealed a hyperkeratotic mass with ulcerated center, with reddish-black dots and congested hemorrhagic vessels. The general laboratory was normal; VDRL, HIV and PPD were non-reactive. Tissue samples were taken by a punch biopsy, including epidermis, dermis and subcutaneous tissue, and stained with Gram, routine bacteriological culture and anaerobic culture, which were negative. Bacilloscopy and Koch culture of the same tissue were also negative. The histopathological study was performed with hematoxylin and eosin stain, and showed a pseudoepitheliomatous epidermis with irregular hyperplasia, a dermis with abundant mixed inflammatory infiltrate with suppurative foci and giant cells of the foreign body type, some of which contained round cells with a thick brown wall, compatible with muriform cells; these cells were more evident when evaluated with PAS stain. Fungal culture was performed on Sabouraud dextrose agar at 25°C, which showed, after 15 days of incubation, the growth of black or dematiaceous, elevated, well-defined, velvety colonies. Direct microscopic examination with 20% KOH showed long, branched, sometimes tortuous, hyphae, and short chains of acropetal conidia, suggestive of Fonsecaea spp. Itraconazole was administered at 100 mg every 12 h for six months, in association with physical measures, which consisted of cryotherapy (liquid nitrogen) application to hypertrophic areas every six to eight weeks. Due to local complications, such as erosion or ulceration of the lesions, frequent healing was performed with application of mupirocin ointment topically for signs of bacterial superinfection.\n\nThe patient had a favorable evolution, with regression of the lesions and no evidence of relapses to date, remaining with a mild local hypopigmentation, expected in areas of treatment with cryotherapy.\n",
+        "summary": "A 46-year-old Haitian man, residing in Chile, presented with warty plaques in the anterior tibial region that had been present for one year. The diagnosis of chromoblastomycosis was confirmed by the presence of muriform cells in the histopathology and dematiaceous colonies in the mycological culture. In addition, conidia compatible with Fonsecaea spp. were observed in direct microscopy. After six months of treatment with systemic antimycotics and cryotherapy, complete remission of the lesions was achieved.\n",
+        "translated_fulltext": "Một bệnh nhân nam người Haiti, 46 tuổi, đã sống ở Chile được một năm. Trước đây, ở Haiti, ông làm nghề chăn nuôi gia súc. Ông kể về một tổn thương kéo dài một năm rưỡi, bắt đầu bằng một nốt sần ở mặt trước của chân phải, sau đó tổn thương này ngày càng lớn dần. Ban đầu không có triệu chứng, nhưng ba tháng trước khi đến khám, ông bị ngứa, đau, loét nông và tiết dịch màu vàng. Khi khám lâm sàng, bệnh nhân có kiểu da V, với các mảng sần kích thước 1 x 1 cm, 2 x 2 cm và 3 x 2 cm ở mặt trước của chân phải. Soi da cho thấy một khối tăng sừng với trung tâm bị loét, có các chấm màu đỏ đen và các mạch máu bị sung huyết. Các xét nghiệm tổng quát cho kết quả bình thường; xét nghiệm VDRL, HIV và PPD đều âm tính. Các mẫu mô được lấy bằng phương pháp sinh thiết bằng dụng cụ, bao gồm biểu bì, lớp bì và mô dưới da, sau đó được nhuộm bằng phương pháp Gram, nuôi cấy vi khuẩn thông thường và nuôi cấy kỵ khí, tất cả đều cho kết quả âm tính. Soi trực tiếp và nuôi cấy Koch trên cùng một mẫu mô cũng cho kết quả âm tính. Nghiên cứu mô bệnh học được thực hiện bằng phương pháp nhuộm hematoxylin và eosin, cho thấy biểu bì có hình thái giả biểu mô với sự tăng sinh không đều, lớp bì có nhiều tế bào viêm hỗn hợp với các ổ mủ và tế bào khổng lồ thuộc loại tế bào ngoại lai, một số tế bào này chứa các tế bào hình tròn với thành màu nâu dày, phù hợp với tế bào muriform; các tế bào này rõ ràng hơn khi được đánh giá bằng phương pháp nhuộm PAS. Nuôi cấy nấm được thực hiện trên môi Sabouraud dextrose ở 25°C, sau 15 ngày ủ, cho thấy sự phát triển của các khuẩn lạc màu đen hoặc dematiaceous, nhô cao, có đường viền rõ ràng, có bề mặt nhung. Soi trực tiếp dưới kính hiển vi với dung dịch KOH 20% cho thấy các sợi nấm dài, phân nhánh, đôi khi uốn lượn, và các chuỗi ngắn bào tử acropetal, gợi ý đến loài Fonsecaea. Bệnh nhân được dùng itraconazole với liều 100 mg mỗi 12 giờ trong sáu tháng, kết hợp với các biện pháp vật lý, bao gồm việc bôi dung dịch nitơ lỏng lên các vùng phì đại cứ sáu đến tám tuần một lần. Do các biến chứng tại chỗ, chẳng hạn như xói mòn hoặc loét các tổn thương, nên thường xuyên điều trị bằng cách bôi thuốc mỡ mupirocin tại chỗ để điều trị các dấu hiệu của nhiễm trùng thứ phát do vi khuẩn.\n\nBệnh nhân có tiến triển tốt, các tổn thương giảm dần và không có dấu hiệu tái phát cho đến nay, chỉ còn lại một vùng giảm sắc tố nhẹ tại chỗ, điều này được mong đợi ở các vùng được điều trị bằng phương pháp đông lạnh.",
+        "translated_summary": "Một người đàn ông Haiti 46 tuổi, hiện đang sinh sống ở Chile, đến khám với các mảng da sần sùi ở vùng cẳng chân trước, tình trạng này đã kéo dài một năm. Chẩn đoán bệnh nấm sắc tố (chromoblastomycosis) được xác nhận thông qua việc phát hiện các tế bào hình thành vách ngăn trong kết quả phân tích mô bệnh học và các khuẩn lạc màu đen trong kết quả nuôi cấy nấm. Ngoài ra, các bào tử nấm có đặc điểm tương đồng với loài Fonsecaea spp. cũng được quan sát trong quá trình soi tươi. Sau sáu tháng điều trị bằng thuốc kháng nấm toàn thân và liệu pháp lạnh, các tổn thương đã hoàn toàn thuyên giảm."
+    },
+    {
+        "id": "multiclinsum_gs_en_508.txt",
+        "fulltext": "We present the case of a 10-year-old male diagnosed with high-risk early T-cell acute lymphoblastic leukaemia, who was treated according to the LAL SEHOP-PETHEMA 2013 protocol. Two years after diagnosis, he developed an early CNS relapse, so he was treated according to the InteReALL HR 2010 protocol with bortezomib. During induction, after being neutropenic for four weeks (20 neutrophils/μL), he was receiving prophylaxis with cefepime, cotrimoxazole and fluconazole. In addition, he was being treated with acyclovir for a herpes simplex virus 1 skin infection. In this context, he developed a severe headache that did not respond to usual analgesia. A cranial computed tomographic scan was performed that showed a hypodens lesion in the right temporal lobe. When the possibility of an infectious origin was considered, a lumbar puncture was performed and cefepime was replaced with meropenem and vancomycin.\n\nDespite remaining afebrile, he developed signs of septic shock on the first day after admission to the clinic and was transferred to the paediatric intensive care unit for inotropic and vasoactive support. In addition, the antimicrobial spectrum was extended with gentamicin and caspofungin.\n\nThe blood analysis showed a progressive increase in C-reactive protein and procalcitonin (up to 312 mg/L and 47.58 ng/mL, respectively, on the third day of evolution), with no other relevant biochemical alterations. The blood count showed pancytopenia due to chemotherapy. The blood cultures ruled out bacteremia and fungemia, and herpes virus serologies were negative. The urine culture and the fecal culture were also negative. The biochemical analysis of the cerebrospinal fluid was completely normal (glucose, 63 mg/dL; proteins, 16 mg/dL; leukocytes 1/µL), but the presence of B. cereus was detected in the microbiological study (sensitive to meropenem, vancomycin, linezolid and ciprofloxacin). The presence of herpes simplex 1 and 2, herpes virus 6, cytomegalovirus, varicella-zoster virus, enterovirus, parechovirus, toxoplasma, Neisseria meningitidis, Listeria monocytogenes, Streptococcus pneumoniae and Cryptococcus was ruled out in the cerebrospinal fluid.\n\nThe EEG showed diffuse slowing of brain activity with no clear epileptiform activity. On day 4, after the haemodynamic support was removed, a cranial MRI showed two hyperintense lesions in T2 and FLAIR that involved the subcortical region of the right temporal and parietal lobes. The parietal lesion had ring enhancement after administration of gadolinium and both lesions showed peripheral diffusion restriction. In addition, small haemorrhagic foci were observed scattered in the brain parenchyma. The image suggested a bacterial origin with an atypical germ, and these findings, together with those of the cerebrospinal fluid, led to the diagnosis of B. cereus abscess.\n\nAfter two weeks of treatment, the patient had a favorable outcome with resolution of the headache and no neurological findings. A follow-up MRI showed a decrease in the size of the lesions. Vancomycin and acyclovir were discontinued after three weeks and meropenem was continued for six weeks.\n",
+        "summary": "We present the case of a 10-year-old boy undergoing chemotherapy for acute lymphoblastic leukaemia. During the induction period he developed a cerebral abscess caused by B. cereus that was diagnosed by imaging tests and direct detection in the cerebrospinal fluid. His evolution was favourable with antibiotic treatment.\n",
+        "translated_fulltext": "Chúng tôi xin trình bày trường hợp của một bệnh nhân nam 10 tuổi được chẩn đoán mắc bệnh bạch cầu tế bào lympho T cấp tính có nguy cơ cao, và bệnh nhân đã được điều trị theo phác đồ LAL SEHOP-PETHEMA 2013. Hai năm sau khi chẩn đoán, bệnh nhân bị tái phát sớm ở hệ thần kinh trung ương, vì vậy bệnh nhân được điều trị theo phác đồ InteReALL HR 2010 kết hợp với bortezomib. Trong giai đoạn điều trị ban đầu, sau bốn tuần bị giảm bạch cầu trung tính (20 bạch cầu trung tính/µL), bệnh nhân được dùng thuốc dự phòng bằng cefepime, cotrimoxazole và fluconazole. Ngoài ra, bệnh nhân còn được điều trị bằng acyclovir để điều trị nhiễm trùng da do virus herpes simplex 1. Trong bối cảnh này, bệnh nhân bị đau đầu dữ dội không đáp ứng với các loại thuốc giảm đau thông thường. Một chụp cắt lớp vi tính sọ não được thực hiện cho thấy một tổn thương giảm mật độ ở thùy thái dương phải. Khi khả năng nguyên nhân do nhiễm trùng được xem xét, một thủ thuật chọc dò tủy sống được thực hiện và cefepime được thay thế bằng meropenem và vancomycin.\n\nMặc dù không bị sốt, bệnh nhân xuất hiện các dấu hiệu của sốc nhiễm trùng vào ngày đầu tiên nhập viện và được chuyển đến khoa hồi sức tích cực nhi để được hỗ trợ bằng các loại thuốc tăng co mạch và thuốc tác động lên mạch máu. Ngoài ra, phổ kháng sinh được mở rộng bằng gentamicin và caspofungin.\n\nKết quả phân tích máu cho thấy protein C phản ứng và procalcitonin tăng dần (lên đến 312 mg/L và 47,58 ng/mL, tương ứng, vào ngày thứ ba), không có các thay đổi sinh hóa đáng kể khác. Kết quả xét nghiệm máu cho thấy giảm toàn bộ các loại tế bào máu do hóa trị. Các xét nghiệm nuôi cấy máu không phát hiện vi khuẩn hoặc nấm trong máu, và các xét nghiệm huyết thanh học virus herpes đều âm tính. Các xét nghiệm nuôi cấy nước tiểu và phân cũng đều âm tính. Phân tích sinh hóa dịch não tủy hoàn toàn bình thường (glucose, 63 mg/dL; protein, 16 mg/dL; bạch cầu 1/µL), nhưng sự hiện diện của B. cereus được phát hiện trong nghiên cứu vi sinh (nhạy cảm với meropenem, vancomycin, linezolid và ciprofloxacin). Sự hiện diện của herpes simplex 1 và 2, virus herpes 6, cytomegalovirus, virus varicella-zoster, enterovirus, parechovirus, toxoplasma, Neisseria meningitidis, Listeria monocytogenes, Streptococcus pneumoniae và Cryptococcus đều bị loại trừ trong dịch não tủy.\n\nĐiện não đồ (EEG) cho thấy sự chậm lại lan tỏa của hoạt động não, không có hoạt động co giật rõ ràng. Vào ngày thứ 4, sau khi ngừng hỗ trợ huyết động, chụp cộng hưởng từ (MRI) sọ não cho thấy hai tổn thương tăng cường độ tín hiệu trong T2 và FLAIR, ảnh hưởng đến vùng dưới vỏ của thùy thái dương và thùy đỉnh phải. Tổn thương ở thùy đỉnh có sự tăng cường vòng sau khi tiêm gadolinium và cả hai tổn thương đều cho thấy sự hạn chế khuếch tán ở vùng ngoại vi. Ngoài ra, các điểm xuất huyết nhỏ được quan sát rải rác trong nhu mô não. Hình ảnh gợi ý nguồn gốc vi khuẩn với một loại vi khuẩn không điển hình, và những phát hiện này, cùng với những phát hiện của dịch não tủy, dẫn đến chẩn đoán áp xe B. cereus.\n\nSau hai tuần điều trị, bệnh nhân có kết quả tốt với việc giảm đau đầu và không có các dấu hiệu thần kinh. Một lần chụp MRI theo dõi cho thấy kích thước của các tổn thương giảm. Vancomycin và acyclovir được ngừng sau ba tuần và meropenem được tiếp tục trong sáu tuần.",
+        "translated_summary": "Chúng tôi xin trình bày trường hợp của một bé trai 10 tuổi đang được điều trị hóa trị để chữa bệnh bạch cầu lympho cấp tính. Trong giai đoạn điều trị ban đầu, bé bị áp xe não do vi khuẩn B. cereus, được chẩn đoán bằng các xét nghiệm hình ảnh và phát hiện trực tiếp trong dịch não tủy. Tình trạng của bé đã cải thiện tốt nhờ điều trị bằng kháng sinh."
+    },
+    {
+        "id": "multiclinsum_gs_en_222.txt",
+        "fulltext": "Female patient, 16 years old, presenting a depressed gray plaque of 10.5 × 8.0 cm interspersed with hypochromic areas in the lower lateral part of the left thigh. Telangiectatic vessels overlap the lesion peripherally, with visible veins close to it. The plaque was present from birth, but was initially violaceous. It evolved with the passing of the years, with lightening and depression. There is no discrepancy in the length of the lower limbs.\n\nAngioresonance showed vascular malformations in the skin and subcutaneous tissue supplied by intermuscular branches of the popliteal artery. Early venous filling was found in both the region and the malformations, suggesting early venous shunting. Dilated draining veins were not documented, except for a superficial draining vein running along the subcutaneous cellular tissue of the anterior thigh. In addition, thinning of the subcutaneous tissue was noted in the topography of the vascular alteration, but without intramuscular or bone extension.\n",
+        "summary": "16-year-old girl with a depressed gray plaque on the left thigh, with a vascular malformation affecting the skin and subcutaneous tissue evident by angioresonance.\n",
+        "translated_fulltext": "Bệnh nhân nữ, 16 tuổi, có một mảng da màu xám, lõm xuống, kích thước 10,5 × 8,0 cm, xen kẽ với các vùng da nhạt màu ở phần dưới bên ngoài của đùi trái. Các mạch máu giãn nở bao quanh mảng da, với các tĩnh mạch nổi rõ gần đó. Mảng da này đã xuất hiện từ khi sinh, nhưng ban đầu có màu tím. Theo thời gian, mảng da này dần trở nên nhạt màu và lõm xuống. Không có sự khác biệt về chiều dài giữa hai chân.\n\nKết quả chụp cộng hưởng mạch máu cho thấy có các dị dạng mạch máu ở da và mô dưới da, được nuôi dưỡng bởi các nhánh mạch liên cơ của động mạch khoeo. Có sự đổ đầy tĩnh mạch sớm ở cả vùng và các dị dạng, cho thấy có sự chuyển hướng tĩnh mạch sớm. Các tĩnh mạch dẫn lưu giãn nở không được ghi nhận, ngoại trừ một tĩnh mạch dẫn lưu nông chạy dọc theo mô tế bào dưới da của mặt trước đùi. Ngoài ra, còn ghi nhận sự mỏng đi của mô dưới da ở vị trí dị dạng mạch máu, nhưng không có sự lan rộng vào cơ hoặc xương.",
+        "translated_summary": "Một cô gái 16 tuổi có một vùng da màu xám, bị lõm ở đùi trái, kèm theo dấu hiệu của một dị dạng mạch máu ảnh hưởng đến da và mô dưới da, được phát hiện qua phương pháp chụp cộng hưởng mạch máu."
+    },
+    {
+        "id": "multiclinsum_gs_en_491.txt",
+        "fulltext": "This is a 32-year-old patient, a baker, from Bamako, who was admitted to the Infectious and Tropical Diseases department of the CHU du Point G (Bamako, Mali) on 27 April 2023 for chronic productive cough, otalgia and a chronic right-sided purulent otorrhea.\n\nThe symptomatology would be of progressive installation in 1 month, initially treated in a medical center with artésunate, paracetamol and unspecified antibiotics for confirmed malaria and acute otitis media, without success. He is immunosuppressed by a HIV1 infection, diagnosed and put on a tritherapy antiretroviral (TARV) Tenofovir/Lamivudine/Dolutégravir 7 months ago, not observed due to denial of his illness.\n\nThe general physical examination found a fever (38.2 °C), altered general condition, otalgia, purulent right foul-smelling otorrhea, a right basal pulmonary condensation syndrome, a normal neurological examination, without the involvement of the cranial nerves, mainly the facial nerve VII and the VIII cochleovestibular nerve.\n\nIn the ENT examination, the otoscopy of the right ear showed an inflammatory external auditory canal with purulent secretions and the presence of a single tympanic perforation in the anterior-inferior quadrant. The left ear is normal. The Rinne and Weber test is in favor of a right conductive hearing loss.\n\nImmuno-virological evaluation shows a CD4 count of 118 cells/pl and a viral load of 12,370 copies/ml at the time of diagnosis of HIV infection, compared to a viral load of 9,460 copies/ml and a CD4 lymphocyte count of 193 cells/pl at the 6th month of antiretroviral treatment. At the time of diagnosis of tuberculosis at the 7th month, the immuno-virological evaluation shows a CD4 count of 89 cells/pl and a viral load of 10,230 copies/ml.\n\nThe Ziehl Neelsen bacilloscopy was positive with a cross in the gastric washings on admission and 19 days later in the right ear swab because of the persistent otorrhea. The Xpert-MTB/GeneXpert test did not detect rifampicin-resistant Mycobacterium tuberculosis.\n\nThe frontal chest radiograph shows a more accentuated bronchovascular network at the base of the right lung.\n\nThe diagnosis of tuberculosis of the middle ear concomitant to a pulmonary localization in the field of immunosuppression by HIV1 is therefore retained.\n\nThe patient is put on oral first-line anti-tuberculosis for 6 months, a fixed dose of a quadra-therapy in the intensive phase of isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months (2RHZE), followed by a bi-therapy in the maintenance phase of isoniazid and rifampicin for 4 months (4RH) at a dose of 3 tablets/day in the morning on an empty stomach, associated with vitamin B6 (1 tablet/day). He benefits from two sessions of therapeutic reinforcement with anti-retroviral drugs. The ART is restarted on 4 May 2023 with his consent, given the good tolerance of the anti-tuberculosis drugs, with the combination of tenofovir/lamivudine/dolutegravir at a dose of 1 tablet/day associated with dolutegravir 50 mg as a supplement (1 tablet/day) according to the protocol for the management of HIV/AIDS. A chemoprophylaxis with cotrimoxazole 960 mg (1 tablet/day) is undertaken as well as a cleaning of the external auditory canal by aspiration and the instillation of ciprofloxacin ear drops (2 drops 3 times a day) for 14 days.\n\nThe evolution is favorable after 14 days of treatment, marked by a pyrexia, a good general state, the amendment of the cough and otorrhea with the negativation of the bacilloscopy in the gastric tube liquid and the swab of the pus of the right ear. At the end of the maintenance anti-tuberculosis treatment, the clinical healing is complete with a normal ENT and neurological examination. The bacilloscopy associated with the Xpert-MTB/GeneXpert test at the end of the 2nd month of the intensive phase, during the 5th month and at the end of the 6th month of the maintenance phase were negative. The HIV viral load performed after 3 months of ART is 329 copies/ml.\n",
+        "summary": "The patient presented with a chronic productive cough, otalgia and a chronic right-sided purulent otorrhea. The search for acid-fast bacilli was positive by direct examination in the gastric tube liquid and the swab of the auricular pus.\n\nAn anti-tuberculosis treatment of 6 months, associated with adjuvants, led to the patient's complete recovery.\n",
+        "translated_fulltext": "Đây là một bệnh nhân 32 tuổi, làm nghề thợ làm bánh, đến từ Bamako, nhập viện vào khoa Bệnh Truyền nhiễm và Bệnh Nhiệt đới của CHU du Point G (Bamako, Mali) vào ngày 27 tháng 4 năm 2023 vì ho kéo dài, đau tai và tình trạng chảy dịch mủ từ tai phải.\n\nCác triệu chứng bắt đầu tăng dần trong vòng 1 tháng, ban đầu bệnh nhân được điều trị tại một trung tâm y tế bằng artesunate, paracetamol và các loại kháng sinh không xác định để điều trị sốt rét và viêm tai giữa cấp tính, nhưng không hiệu quả. Bệnh nhân bị suy giảm miễn dịch do nhiễm HIV1, được chẩn đoán và bắt đầu điều trị bằng phác đồ kết hợp ba loại thuốc kháng virus (TARV) Tenofovir/Lamivudine/Dolutégravir cách đây 7 tháng, nhưng không tuân thủ điều trị do phủ nhận bệnh tật.\n\nKhám lâm sàng tổng quát cho thấy bệnh nhân bị sốt (38,2°C), tình trạng sức khỏe tổng thể suy giảm, đau tai, chảy dịch mủ có mùi hôi từ tai phải, hội chứng đông đặc phổi ở đáy phổi phải, khám thần kinh bình thường, không có tổn thương dây thần kinh sọ, đặc biệt là dây thần kinh mặt VII và dây thần kinh thính giác VIII.\n\nTrong quá trình khám tai mũi họng, soi tai phải cho thấy ống tai ngoài bị viêm, có dịch mủ và một lỗ thủng màng nhĩ duy nhất ở phần trước dưới. Tai trái bình thường. Kết quả kiểm tra Rinne và Weber cho thấy có tình trạng giảm thính lực dẫn truyền ở tai phải.\n\nĐánh giá miễn dịch học và virus học cho thấy số lượng tế bào CD4 là 118 tế bào/µl và tải lượng virus là 12.370 bản sao/ml tại thời điểm chẩn đoán nhiễm HIV, so với tải lượng virus là 9.460 bản sao/ml và số lượng tế bào lympho CD4 là 193 tế bào/µl sau 6 tháng điều trị bằng thuốc kháng virus. Tại thời điểm chẩn đoán bệnh lao sau 7 tháng, đánh giá miễn dịch học và virus học cho thấy số lượng tế bào CD4 là 89 tế bào/µl và tải lượng virus là 10.230 bản sao/ml.\n\nKết quả soi tìm trực khuẩn Ziehl Neelsen dương tính, có vi khuẩn trong dịch rửa dạ dày khi nhập viện và 19 ngày sau đó trong mẫu dịch từ tai phải do tình trạng chảy dịch mủ kéo dài. Xét nghiệm Xpert-MTB/GeneXpert không phát hiện vi khuẩn lao kháng rifampicin.\n\nChụp X-quang phổi thẳng cho thấy mạng lưới phế quản và mạch máu phổi rõ hơn ở đáy phổi phải.\n\nDo đó, chẩn đoán bệnh lao ở tai giữa kết hợp với tổn thương phổi trong bối cảnh suy giảm miễn dịch do HIV1 được xác nhận.\n\nBệnh nhân được điều trị bằng thuốc chống lao đường uống, phác đồ bậc nhất trong 6 tháng, sử dụng liều cố định của phác đồ bốn loại thuốc trong giai đoạn cường độ, bao gồm isoniazid, rifampicin, pyrazinamide và ethambutol trong 2 tháng (2RHZE), sau đó là phác đồ hai loại thuốc trong giai đoạn duy trì, bao gồm isoniazid và rifampicin trong 4 tháng (4RH) với liều 3 viên/ngày vào buổi sáng lúc đói, kết hợp với vitamin B6 (1 viên/ngày). Bệnh nhân được hỗ trợ bằng hai đợt điều trị tăng cường bằng thuốc kháng virus. Điều trị ART được bắt đầu lại vào ngày 4 tháng 5 năm 2023 với sự đồng ý của bệnh nhân, do bệnh nhân dung nạp tốt thuốc chống lao, sử dụng kết hợp tenofovir/lamivudine/dolutegravir với liều 1 viên/ngày, kết hợp với dolutegravir 50 mg như một chất bổ sung (1 viên/ngày) theo phác đồ điều trị HIV/AIDS. Bệnh nhân cũng được dùng thuốc dự phòng bằng cotrimoxazole 960 mg (1 viên/ngày) và được làm sạch ống tai ngoài bằng cách hút và nhỏ thuốc nhỏ tai ciprofloxacin (2 giọt, 3 lần/ngày) trong 14 ngày.\n\nSau 14 ngày điều trị, tình trạng bệnh tiến triển tốt, với các triệu chứng giảm sốt, sức khỏe tổng thể cải thiện, ho và chảy dịch tai giảm, kết quả soi tìm trực khuẩn trong dịch rửa dạ dày và mẫu dịch từ tai phải âm tính. Sau khi kết thúc điều trị chống lao duy trì, tình trạng bệnh được chữa khỏi hoàn toàn, với kết quả khám tai mũi họng và thần kinh bình thường. Kết quả soi tìm trực khuẩn kết hợp với xét nghiệm Xpert-MTB/GeneXpert vào cuối tháng thứ 2 của giai đoạn cường độ, trong tháng thứ 5 và vào cuối tháng thứ 6 của giai đoạn duy trì đều âm tính. Tải lượng virus HIV được đo sau 3 tháng điều trị ART là 329 bản sao/ml.",
+        "translated_summary": "Bệnh nhân có các triệu chứng ho kéo dài, đau tai và chảy dịch mủ từ tai phải. Xét nghiệm tìm trực khuẩn kháng axit cho kết quả dương tính khi kiểm tra trực tiếp mẫu dịch từ ống thông dạ dày và mẫu dịch mủ từ tai.\n\nViệc điều trị bằng thuốc chống lao trong 6 tháng, kết hợp với các liệu pháp hỗ trợ, đã giúp bệnh nhân khỏi bệnh hoàn toàn."
+    },
+    {
+        "id": "multiclinsum_gs_en_90.txt",
+        "fulltext": "52-year-old male patient with no medical history, transferred from a lower-level hospital to our institution due to a tonic-clonic seizure secondary to alcohol withdrawal and non-reduced right LFGHP. He was evaluated by a traumatologist 24 hours after admission, and was found to be conscious, with bilateral ecchymosis of the shoulders and severe limitation of passive external rotation on both sides. In addition, the patient was restrained physically at this point, with both feet and his left hand held down by intermittent psychomotor agitation.\n\nThe initial evaluation included a thorough review of the patient's admission radiographs, which showed a right LFGHP and a left simple posterior dislocation. This second injury (simple posterior dislocation of the left shoulder) was not diagnosed at the referring facility, and took approximately 48 hours to be diagnosed at our facility.\n\nComputed tomography (CT) of both shoulders was requested to better characterize the injuries. These images showed a marked worsening of the left shoulder injury since the time of the first radiographic study, possibly secondary to the physical restraint of the patient. This evidence of progression from a simple left posterior glenohumeral dislocation on admission radiographs to a LFGHP on the CT taken 48 hours later.\n\n\nPlanning\n\nThe preoperative study of the right shoulder showed bone indemnity of the glenoid and 40% involvement of the articular surface of the humerus, but with a large fragment with the possibility of osteosynthesis in continuity with the lesser tuberosity, so it was planned to fix this fragment by spongeous screw 4.0 mm partial thread and high strength sutures. In the left shoulder, no significant bone defect was evidenced in the glenoid and the defect of the articular surface of the humerus was 20%, so it was planned to fill the defect with the fragment of the lesser tuberosity at the time of osteosynthesis (imitating the surgery of McLaughlin).\n\n\nSurgical technique\n\nOpen reduction and internal fixation with bilateral locked-plate is decided. The patient is placed in a beach chair position and the surgical fields are prepared in the usual way for the right shoulder. The fracture focus is accessed by a classic deltopectoral approach. A digital maneuver is performed to reduce the posterior fragment of the humeral head with a posterior mini-open incision of the size of a standard diagnostic arthroscopy portal. A provisional reduction of the fracture is achieved using high-strength sutures and needles. A partial 4.0 mm spongy screw and high-strength sutures are used to fix both fragments of the humeral head. Definitive fixation of the fracture with a Philos (Depuy Synthes®) plate achieves adequate reduction and stability of fragments. Fixation is increased with high-strength sutures to the tendons of the rotator cuff that are tied to the plate. Closure by planes of the right shoulder, healing and immobilization of the extremity with a universal shoulder immobilizer.\nThe surgical field of the left shoulder is immediately prepared. Classic deltopectoral approach is performed again to reach the fracture focus using an accessory posterior portal for digital manipulation and reduction of the humeral head. Fixation and osteosynthesis are performed in the same way as described for the right shoulder with the exception of the spongiosa screw, as the anterior fragment could be adequately fixed only with the use of high strength sutures.\nPostoperative management consisted of the use of bilateral shoulder immobilizer for four weeks. A pendular exercise of flexion-extension of the elbow and exercises of the fist were given to be performed from the second postoperative week to tolerance (according to the level of pain). In the radiographic control of the first month, loss of reduction of the greater left tuberosity was observed. It was decided to perform revision surgery achieving adequate fixation of the fragment with high-strength sutures.\nThe patient is left with a shoulder immobilizer for an additional four weeks on the left shoulder. The self-administered exercise regimen is restarted as described previously from the second postoperative week on a bilateral basis. At the sixth week after the revision surgery, face-to-face kinesiological therapy is initiated twice a week. After 30 sessions of kinesiological rehabilitation, the patient is able to return to work five months after the initial injury.\nFollow-up one year after the initial surgery shows that the patient has recovered strength and mobility in the right shoulder. The left shoulder still has severe limitations in the range of motion, especially in external rotation. At this point, it is decided to perform arthroscopic joint release surgery and remove the osteosynthesis in the left shoulder.\nIn his last check-up two years after the trauma, the patient showed a favorable evolution, consistent with the functional scales evaluated.\n",
+        "summary": "52-year-old male patient, transferred to a high-complexity center for a tonic-clonic convulsion and a right LFGHP. In the initial study with radiographs, a right shoulder injury was confirmed and a simple posterior glenohumeral dislocation of the left shoulder was diagnosed, which had not been previously detected. The study was complemented with a computed tomography (CT) of both shoulders, showing a bilateral LFGHP, which demonstrated intrahospital aggravation of the injury of the left shoulder. An open reduction and osteosynthesis with a bilateral blocked plate was performed in one time. The left shoulder required two reinterventions, one for osteosynthesis failure and another for joint release. Two years after the procedure, the patient was satisfactorily progressing with a 5% on the Quick DASH scale and a score of 72 and 76 on the Constant scale in the left and right shoulder, respectively.\n",
+        "translated_fulltext": null,
+        "translated_summary": "Bệnh nhân nam, 52 tuổi, được chuyển đến một trung tâm chuyên khoa để điều trị tình trạng co giật toàn thân và tổn thương khớp vai phải. Trong quá trình thăm khám ban đầu bằng chụp X-quang, xác nhận có tổn thương vai phải và chẩn đoán trật khớp vai sau đơn giản ở vai trái, tình trạng này trước đó chưa được phát hiện. Quá trình thăm khám được bổ sung bằng chụp cắt lớp vi tính (CT) cả hai vai, cho thấy tổn thương khớp vai phải ở cả hai bên, đồng thời cho thấy tình trạng tổn thương vai trái trở nên nghiêm trọng hơn trong quá trình nằm viện. Bệnh nhân được phẫu thuật mở để cố định và tái tạo xương bằng cách sử dụng tấm cố định hai bên trong một lần phẫu thuật. Vai trái cần phải can thiệp thêm hai lần, một lần do thất bại trong việc cố định xương và một lần để giải phóng khớp. Hai năm sau phẫu thuật, bệnh nhân có tiến triển tốt, đạt 5% trên thang điểm Quick DASH và điểm số 72 và 76 trên thang điểm Constant ở vai trái và vai phải, tương ứng."
+    },
+    {
+        "id": "multiclinsum_gs_en_285.txt",
+        "fulltext": "Patient information: A 19-year-old male with no significant medical history was admitted to our department with a painful left scrotal mass that had been present for 8 months and had not improved with antibiotics for pyogenic organisms. The patient reported intermittent low grade fever, night sweats, anorexia and unexplained weight loss since the onset of symptoms. He did not have a cough, sputum or haemoptysis. There was no history of tuberculosis in his personal or family medical history. He was vaccinated against tuberculosis at birth.\n\nClinical findings: Physical examination revealed a large, painful, slightly hot left bursa and two elongated, poorly defined, firm, painful subcutaneous formations in the anterior thoracic wall, 3 to 4 cm long. There were no rales on auscultation. The remainder of the examination was normal. Laboratory studies revealed a high c-reactive protein of 90 mg/dl. The blood count, creatinine, blood glucose and liver function tests were within normal limits. The standard chest X-ray showed reticulonodular infiltrates in both lung fields.\n\nDiagnostic approach: In the presence of an ultrasound finding in favour of an epididymal tumour, the patient underwent a left orchidectomy. However, the pathological examination of the surgical specimen showed a granulomatous epitheloid necrosis of the epididymis, suggestive of active epididymal tuberculosis involving the body and tail of the epididymis and sparing the head and testicle. The intradermal tuberculin reaction was positive. The search for acid-fast bacilli (AFB) in sputum and urine for 3 consecutive days was negative on direct examination and culture. The serologies for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and Wright's stain were also negative. In search of other tuberculous sites, a thoraco-abdomino-pelvic tomodensitometry was performed, which showed a miliary tuberculosis, coelo-mesenteric necrotic adenopathies, two thoracic parietal collections (at the expense of the external oblique muscles measuring 33 × 10 mm on the right and 45 × 10 mm on the left) and a focal osteolysis of D11 and L5, suggestive of a spondylodiscitis in the early stages. The magnetic resonance imaging (MRI) of the spinal cord confirmed the existence of a spondylodiscitis at the level of D7, D11, L4 and L5. The diagnosis of disseminated tuberculosis with epididymal, pulmonary, parietal, ganglionary and osteo-articular sites was retained.\n\nTherapeutic intervention: a poly-chemotherapy for tuberculosis with isoniazid, rifampicin, ethambutol and pyrazinamide for 2 months, followed by the association of isoniazid and rifampicin, was initiated.\n\nFollow-up and results: however, at the 4th month of treatment, the patient had presented generalised tonic-clonic convulsive seizures. A brain MRI was performed, showing multiple nodular lesions above and below the tentorial membrane corresponding to tuberculomas. The patient was put on anticonvulsive treatment and anti-tuberculosis treatment was continued. The evolution was favourable with recovery of the general condition and weight gain from the first months of treatment as well as a disappearance of thoracic parietal formations, adenopathies and tuberculous milia on the tomodensitometry with absence of recurrence of convulsive seizures. However, the slow decrease of the size of the tuberculomas obliged us to continue the anti-tuberculosis treatment for a long period. Finally, the patient was declared cured, without sequelae, at the end of the 234th month of treatment with a 2-year follow-up.\n",
+        "summary": "A 19-year-old man with no significant history was admitted to hospital with a painful left scrotal mass that had been present for 8 months. He had undergone an orchidectomy and the pathological examination was in favour of epididymal tuberculosis. A radiological examination had shown other sites of infection: lymph nodes, lungs, parietal and osteoarticular. An anti-tuberculosis treatment was initiated. However, in the 4th month of treatment, the patient had convulsive seizures. A brain MRI was performed and concluded that there were brain tuberculomas. The anti-tuberculosis treatment was continued in association with an anticonvulsant with good clinical and radiological evolution.\n",
+        "translated_fulltext": "Thông tin bệnh nhân: Một nam giới 19 tuổi, không có tiền sử bệnh lý đáng kể, nhập viện tại khoa của chúng tôi với một khối u đau ở vùng bìu bên trái, đã xuất hiện trong 8 tháng và không cải thiện sau khi dùng kháng sinh cho các vi khuẩn gây mủ. Bệnh nhân cho biết có sốt nhẹ không liên tục, đổ mồ hôi đêm, chán ăn và sụt cân không rõ nguyên nhân kể từ khi bắt đầu các triệu chứng. Bệnh nhân không bị ho, khạc đờm hoặc ho ra máu. Không có tiền sử bệnh lao trong bệnh sử cá nhân hoặc gia đình. Bệnh nhân đã được tiêm phòng lao khi mới sinh.\n\nKết quả lâm sàng: Khám thực thể cho thấy một khối u lớn, đau, hơi nóng ở vùng bìu bên trái và hai khối dưới da kéo dài, không rõ ranh giới, chắc, đau ở thành ngực trước, dài từ 3 đến 4 cm. Không có tiếng ran khi nghe phổi. Các phần còn lại của quá trình khám đều bình thường. Các xét nghiệm trong phòng thí nghiệm cho thấy nồng độ protein C phản ứng cao là 90 mg/dL. Các chỉ số về số lượng tế bào máu, creatinine, đường huyết và các xét nghiệm chức năng gan đều nằm trong giới hạn bình thường. Chụp X-quang phổi tiêu chuẩn cho thấy các tổn thương dạng lưới và nốt ở cả hai lá phổi.\n\nPhương pháp chẩn đoán: Khi có kết quả siêu âm gợi ý khối u mào tinh hoàn, bệnh nhân đã được phẫu thuật cắt bỏ tinh hoàn bên trái. Tuy nhiên, kết quả kiểm tra mô bệnh học của mẫu phẫu thuật cho thấy hoại tử dạng hạt của mào tinh hoàn, gợi ý bệnh lao mào tinh hoàn đang hoạt động, ảnh hưởng đến thân và đuôi mào tinh hoàn, nhưng không ảnh hưởng đến đầu và tinh hoàn. Phản ứng tuberculin dưới da cho kết quả dương tính. Tìm kiếm trực khuẩn kháng axit (AFB) trong đờm và nước tiểu trong 3 ngày liên tiếp cho kết quả âm tính khi kiểm tra trực tiếp và nuôi cấy. Các xét nghiệm huyết thanh học để phát hiện virus gây suy giảm miễn dịch ở người (HIV), virus viêm gan B (HBV), virus viêm gan C (HCV) và nhuộm Wright cũng cho kết quả âm tính. Để tìm kiếm các vị trí lao khác, đã thực hiện chụp cắt lớp vi tính ngực-bụng-chậu, cho thấy bệnh lao dạng hạt, viêm hạch hoại tử khoang bụng, hai khối ở thành ngực (ảnh hưởng đến cơ xiên ngoài, kích thước 33 × 10 mm bên phải và 45 × 10 mm bên trái) và một vùng tiêu xương khu trú ở đốt sống D11 và L5, gợi ý viêm đĩa đệm giai đoạn sớm. Chụp cộng hưởng từ (MRI) tủy sống xác nhận sự tồn tại của viêm đĩa đệm ở mức đốt sống D7, D11, L4 và L5. Chẩn đoán lao lan tỏa với các vị trí ở mào tinh hoàn, phổi, thành ngực, hạch và xương khớp được xác định.\n\nCan thiệp điều trị: Bắt đầu điều trị bằng hóa trị đa thuốc cho bệnh lao, bao gồm isoniazid, rifampicin, ethambutol và pyrazinamide trong 2 tháng, sau đó tiếp tục dùng isoniazid và rifampicin.\n\nTheo dõi và kết quả: Tuy nhiên, sau 4 tháng điều trị, bệnh nhân xuất hiện các cơn co giật toàn thân. Chụp MRI não cho thấy nhiều tổn thương dạng nốt ở trên và dưới màng lều, tương ứng với các khối u lao. Bệnh nhân được điều trị bằng thuốc chống co giật và tiếp tục điều trị chống lao. Tình trạng bệnh tiến triển tốt, bệnh nhân hồi phục sức khỏe và tăng cân từ những tháng đầu điều trị, đồng thời các khối ở thành ngực, hạch và các nốt lao trên chụp cắt lớp vi tính biến mất, không có cơn co giật tái phát. Tuy nhiên, sự giảm kích thước chậm của các khối u lao khiến chúng tôi phải tiếp tục điều trị chống lao trong một thời gian dài. Cuối cùng, bệnh nhân được tuyên bố khỏi bệnh, không có di chứng, sau 234 tháng điều trị và được theo dõi trong 2 năm.",
+        "translated_summary": "Một người đàn ông 19 tuổi, không có tiền sử bệnh lý đáng kể, đã nhập viện vì một khối u đau ở tinh hoàn trái, kéo dài trong 8 tháng. Anh ta đã trải qua phẫu thuật cắt bỏ tinh hoàn và kết quả kiểm tra bệnh lý cho thấy có dấu hiệu của bệnh lao mào tinh hoàn. Chụp chiếu cho thấy các vị trí nhiễm trùng khác: hạch bạch huyết, phổi, màng xương và khớp. Việc điều trị bằng thuốc chống lao đã được bắt đầu. Tuy nhiên, trong tháng thứ tư của quá trình điều trị, bệnh nhân bị co giật. Chụp cộng hưởng từ (MRI) não được thực hiện và kết quả cho thấy có các khối u lao ở não. Việc điều trị bằng thuốc chống lao được tiếp tục kết hợp với thuốc chống co giật, và tình trạng bệnh nhân có tiến triển tốt cả về lâm sàng lẫn trên phim chụp."
+    },
+    {
+        "id": "multiclinsum_gs_en_459.txt",
+        "fulltext": "40-year-old HIV-positive man with regular adherence to treatment (viral load 4500/mm3 and CD4 70/mm3 from the previous year), consulted for intermittent fever of two years' evolution that did not respect the standard time and gave way to transient antinflammatory non-steroidal drugs. He added in the last two months diffuse abdominal pain with predominance in the upper right lobe where he acquired a configuration of a tree in bud and bilateral pleural effusion, and at the abdominal level, marked increase of hepato-splenomegaly associated with ascites. After 48 hours of his suspension, he presented fulminant hepatic failure and was transferred to the intensive care unit. Tracheal aspirate was performed and after transfusion support a liver biopsy was obtained by puncture.  The patient died a few hours later. The postmortem culture of the tracheal aspirate was positive for Mycobacterium tuberculosis and the liver biopsy was performed with non-necrotizing granulomas and the rest of the parenchyma preserved. This work was carried out in accordance with the principles laid out in the ethical code of the WHO (Helsinki Declaration).\n",
+        "summary": "We present the case of a 40-year-old HIV-positive man with regular adherence to treatment, who consulted for intermittent febrile episodes of two years' evolution, adding in the last two months progressive diffuse abdominal pain and generalized adenomegaly. In the laboratory, he presented pancytopenia, coagulopathy, hypoalbuminemia and increased acute phase reactants. The computed tomography (CT) of the thorax, abdomen and pelvis only showed hepato-splenomegaly and generalized adenomegaly. Multiple microbiological examinations were performed, including cultures for Mycobacterium sp. of different samples, all with negative results, with the exception of RT-PCR for HHV-8. A left iliac ganglion biopsy was performed with findings consistent with Castleman's disease. Despite restarting antiretroviral therapy, the symptomatology progressed, initiating treatment with corticosteroids and ganciclovir. After a week, he developed multiple organ failure and anasarca, which contraindicated the drugs initiated. A new chest CT was performed that showed infiltrates with a tree-like pattern in the upper right lobe associated with bilateral pleural effusion, and at the abdominal level, progression of hepato-splenomegaly and ascites. He passed to the intensive care unit 48 hours later due to fulminant hepatic failure. The patient died within a few hours. A postmortem culture of the tracheal aspirate was received positive for Mycobacterium tuberculosis and a liver biopsy with non-necrotizing granulomas.\n",
+        "translated_fulltext": "Một người đàn ông 40 tuổi, dương tính với HIV, tuân thủ điều trị đều đặn (tải lượng virus 4500/mm3 và CD4 70/mm3 từ năm trước), đến khám vì sốt không liên tục kéo dài hai năm, không theo một chu kỳ nhất định và chỉ thuyên giảm khi dùng thuốc kháng viêm không steroid. Trong hai tháng gần đây, ông còn bị đau bụng lan tỏa, đặc biệt ở vùng bụng trên bên phải, kèm theo hình ảnh \"cây nảy chồi\" và tràn dịch màng phổi hai bên. Ngoài ra, còn có sự tăng đáng kể kích thước gan và lách, kèm theo cổ trướng. Sau 48 giờ ngừng điều trị, ông bị suy gan cấp và được chuyển đến khoa hồi sức tích cực. Bác sĩ đã hút dịch khí quản và sau khi truyền máu hỗ trợ, tiến hành sinh thiết gan bằng phương pháp chọc hút. Bệnh nhân đã qua đời vài giờ sau đó. Kết quả cấy dịch khí quản sau khi chết cho thấy có vi khuẩn Mycobacterium tuberculosis. Kết quả sinh thiết gan cho thấy có các hạt u hạt không gây hoại tử và phần mô gan còn lại được bảo tồn. Nghiên cứu này được thực hiện theo các nguyên tắc được quy định trong quy tắc đạo đức của WHO (Tuyên bố Helsinki).",
+        "translated_summary": "Chúng tôi xin trình bày trường hợp của một người đàn ông 40 tuổi, dương tính với HIV, tuân thủ điều trị đều đặn, đến khám vì các đợt sốt không liên tục kéo dài hai năm, kèm theo đau bụng lan tỏa ngày càng tăng và tình trạng hạch to toàn thân trong hai tháng gần đây. Các xét nghiệm trong phòng thí nghiệm cho thấy bệnh nhân bị giảm toàn bộ tế bào máu, rối loạn đông máu, giảm albumin máu và tăng các chất phản ứng cấp tính. Chụp cắt lớp vi tính (CT) ngực, bụng và vùng chậu chỉ cho thấy gan lách to và hạch to toàn thân. Nhiều xét nghiệm vi sinh đã được thực hiện, bao gồm nuôi cấy các mẫu khác nhau để tìm Mycobacterium sp., tất cả đều cho kết quả âm tính, ngoại trừ xét nghiệm RT-PCR cho HHV-8. Một mẫu sinh thiết hạch vùng hố chậu trái được thực hiện và kết quả phù hợp với bệnh Castleman. Mặc dù đã bắt đầu lại liệu pháp điều trị bằng thuốc kháng virus, các triệu chứng vẫn tiến triển, và bệnh nhân được điều trị bằng corticosteroid và ganciclovir. Sau một tuần, bệnh nhân bị suy đa tạng và phù toàn thân, khiến việc tiếp tục sử dụng các loại thuốc đã bắt đầu trở nên chống chỉ định. Một lần nữa, chụp CT ngực được thực hiện và cho thấy các đám thâm nhiễm có hình dạng giống như cây ở thùy trên bên phải, kèm theo tràn dịch màng phổi hai bên, và ở vùng bụng, tình trạng gan lách to và cổ trướng tiến triển. Bệnh nhân được chuyển đến khoa hồi sức tích cực sau 48 giờ vì suy gan cấp tính. Bệnh nhân đã qua đời trong vòng vài giờ. Sau khi qua đời, mẫu nuôi cấy dịch hút từ khí quản cho kết quả dương tính với Mycobacterium tuberculosis và mẫu sinh thiết gan cho thấy các khối u hạt không gây hoại tử."
+    },
+    {
+        "id": "multiclinsum_gs_en_59.txt",
+        "fulltext": "A 2-year-old female presented with a 1-year history of painless left progressive proptosis with no reported systemic diseases or family history. Ophthalmologic examination revealed light sensation as the only vision in the left eye, along with proptosis, inward and upward eyeball displacement, and restricted extraocular muscle movements in downward and outward directions. An irregularly shaped, well-defined soft mass was palpable in the inferior aspect of the left orbit, accompanied by left lower eyelid ectropion. The pupil was enlarged (4 mm in diameter), and pupillary reaction was absent. The remaining anterior segment examination showed no apparent abnormalities. Fundus examination was challenging due to the child’s size. Hertel exophthalmometry readings measured 10.5 mm in the right eye and 18 mm in the left. Magnetic resonance imaging (MRI) revealed a well-circumscribed mass, displaying hypointense signals on T1-weighted images and hyperintense signals on T2-weighted images. Contrast-enhanced imaging demonstrated no significant improvement. A transconjunctival approach via the inferior fornix with canthotomy and cantholysis was performed, revealing a grayish-white cystic mass with a distinct boundary from surrounding tissues. During posterior separation to the eyeballs’ posterior part, tight adhesion to the optic nerve was observed. Due to the mass’s substantial size and the restricted surgical field, volume reduction was necessary. Approximately 12.5 mL of the fluid was aspirated, and the mass was completely excised. Histopathological examination disclosed a fibrous capsule wall covered with squamous and glandular epithelium, along with visible brain tissue and a cartilage-like matrix consistent with orbital teratoma. One month postsurgery, the patient exhibited enophthalmos, conjunctival hyperemia, and keratitis on ocular examination. This was attributed to the mass’s prior enlargement of the orbital cavity, resulting in postoperative enophthalmos. The cornea could not adhere to the eyelids, creating a space and causing corneal inflammation. After obtaining the consent of the patient’s guardian, a second operation involved the implantation of an allogeneic sclera into the orbit to increase the orbital volume, alleviate fossa pitting and restore keratitis to normal. No recurrence of the teratomas was noted during the 1-year follow-up. The patient still had minor enophthalmos and outer canthus abnormality. The visual acuity remained consistent with pre-operation levels. Hertel exophthalmometry readings measured 10.5 mm in the right eye and 8 mm in the left. The remaining anterior segment examination showed no apparent abnormalities.",
+        "summary": "Patient concerns: A 2-year-old female child was presented exhibiting proptosis and inward and upward eyeball displacement. Enhanced magnetic resonance imaging revealed a well-circumscribed mass, persisting with hypointense signals on T1-weighted images (T1WI) and hyperintense signals on T2-weighted images (T2WI).\n\nDiagnoses: The diagnosis of teratoma was confirmed finally through histological and immunohistochemical exams.\n\nInterventions: A transconjunctival approach via the inferior fornix, coupled with canthotomy and cantholysis, was performed. However, a month postsurgery, the patient developed enophthalmos, conjunctival hyperemia, and keratitis upon ocular examination. A second operation involved the implantation of allogeneic sclera into the orbit to increase orbital volume, improve the pitting of the fossa, and restore keratitis to normal.\n\nOutcomes: No recurrence and other complications were noted during the 1-year follow-up.",
+        "translated_fulltext": "Một bệnh nhân nữ 2 tuổi được đưa đến khám với tiền sử 1 năm bị lồi nhãn cầu tiến triển không đau ở mắt trái, không có bệnh lý toàn thân hoặc tiền sử gia đình nào được ghi nhận. Khám mắt cho thấy chỉ có cảm giác ánh sáng ở mắt trái, cùng với lồi nhãn cầu, lồi nhãn cầu hướng vào và lên, và hạn chế vận động các cơ ngoại nhãn theo hướng xuống và ra ngoài. Một khối mềm, hình dạng không đều, có đường viền rõ ràng có thể sờ thấy ở phần dưới của hốc mắt trái, kèm theo tình trạng mí mắt dưới trái bị lộn ra ngoài. Đồng tử giãn (đường kính 4 mm) và không có phản ứng đồng tử. Khám phần trước của mắt còn lại không cho thấy bất kỳ bất thường nào. Việc khám đáy mắt gặp khó khăn do kích thước của trẻ. Kết quả đo độ lồi nhãn cầu bằng phương pháp Hertel cho thấy 10,5 mm ở mắt phải và 18 mm ở mắt trái. Chụp cộng hưởng từ (MRI) cho thấy một khối có đường viền rõ ràng, có tín hiệu giảm trên ảnh T1 và tín hiệu tăng trên ảnh T2. Chụp ảnh có sử dụng chất cản quang không cho thấy sự cải thiện đáng kể. Một phương pháp tiếp cận qua kết mạc thông qua hố dưới, kết hợp với rạch và giải phóng góc mắt, đã được thực hiện, cho thấy một khối dạng nang màu xám trắng với đường viền rõ ràng so với các mô xung quanh. Trong quá trình tách khối ra khỏi phần sau của nhãn cầu, người ta nhận thấy khối dính chặt vào dây thần kinh thị giác. Do kích thước lớn của khối và không gian phẫu thuật hạn chế, việc giảm thể tích là cần thiết. Khoảng 12,5 ml chất lỏng đã được hút ra và khối u đã được cắt bỏ hoàn toàn. Kết quả kiểm tra mô bệnh học cho thấy một lớp vỏ xơ bao phủ bởi biểu mô vảy và biểu mô tuyến, cùng với mô não và một chất nền giống sụn, phù hợp với u quái ở hốc mắt. Một tháng sau phẫu thuật, bệnh nhân có biểu hiện lồi mắt, sung huyết kết mạc và viêm giác mạc khi khám mắt. Điều này được cho là do khối u trước đó đã làm tăng kích thước hốc mắt, dẫn đến tình trạng lồi mắt sau phẫu thuật. Giác mạc không thể bám vào mí mắt, tạo ra một khoảng trống và gây viêm giác mạc. Sau khi có sự đồng ý của người giám hộ của bệnh nhân, một cuộc phẫu thuật thứ hai đã được thực hiện, bao gồm việc cấy ghép một mảnh đồng tử vào hốc mắt để tăng thể tích hốc mắt, giảm tình trạng lõm và phục hồi giác mạc về trạng thái bình thường. Trong quá trình theo dõi 1 năm, không ghi nhận bất kỳ sự tái phát nào của u quái. Bệnh nhân vẫn còn lồi mắt nhẹ và bất thường ở góc ngoài mắt. Thị lực vẫn ổn định so với mức trước phẫu thuật. Kết quả đo độ lồi nhãn cầu bằng phương pháp Hertel cho thấy 10,5 mm ở mắt phải và 8 mm ở mắt trái. Khám phần trước của mắt còn lại không cho thấy bất kỳ bất thường nào.",
+        "translated_summary": "Các vấn đề của bệnh nhân: Một bé gái 2 tuổi được đưa đến khám với các triệu chứng lồi mắt, đồng thời mắt bị lệch vào trong và lên trên. Chụp cộng hưởng từ (MRI) cho thấy một khối u có ranh giới rõ ràng, vẫn còn tín hiệu giảm trên ảnh T1 và tín hiệu tăng trên ảnh T2.\n\nChẩn đoán: Chẩn đoán cuối cùng là u quái, được xác nhận thông qua các xét nghiệm mô học và hóa mô miễn dịch.\n\nCan thiệp: Phương pháp tiếp cận qua kết mạc, thông qua hố lệ dưới, kết hợp với rạch và giải phóng góc mắt, đã được thực hiện. Tuy nhiên, một tháng sau phẫu thuật, bệnh nhân xuất hiện các triệu chứng lõm mắt, xung huyết kết mạc và viêm giác mạc khi khám mắt. Một cuộc phẫu thuật thứ hai bao gồm việc cấy ghép củng mạc đồng loại vào hốc mắt để tăng thể tích hốc mắt, cải thiện hình dạng hốc mắt và phục hồi giác mạc về trạng thái bình thường.\n\nKết quả: Không có dấu hiệu tái phát hoặc các biến chứng khác trong quá trình theo dõi 1 năm."
+    },
+    {
+        "id": "multiclinsum_gs_en_443.txt",
+        "fulltext": "65-year-old woman with no relevant personal or family history. In August 2022, a posterior mediastinal tumour was found in the preoperative assessment for a knee surgery, which was why she was referred for evaluation and treatment. On admission, the physical examination was not relevant and the laboratory studies were within normal parameters. A chest CT scan was performed that showed a tumour located in the posterior right mediastinum measuring 6.5 × 4.2 cm, with well-defined borders, with a fat and solid density, with no evidence of bone erosion or infiltration of surrounding tissue. A biopsy of the lesion was performed using a 18G × 250 mm semiautomatic cutting needle, with image guidance, through a posterior approach. In the histopathological study, a benign neoplasm consisting of mature adipose tissue with areas of haemorrhage alternating with haematopoietic elements, predominantly precursors of the red series, was observed, as well as elements of the myeloid series in different stages of maturation and megakaryocytes, which established the diagnosis of MPM.  Finally, with the diagnosis established and the characteristics of the lesion, conservative management was decided. The patient evolved satisfactorily and was discharged without complications.\n",
+        "summary": "We present the case of a 65-year-old woman with a primary mediastinal myelolipoma. Computed tomography of the chest showed an ovoid, well-defined bordered tumor of 6.5 × 4.2 cm, located in the posterior mediastinum. A trans-thoracic biopsy of the lesion was performed and microscopic examination revealed haemopoietic elements and mature adipose tissue.\n",
+        "translated_fulltext": "Một phụ nữ 65 tuổi, không có tiền sử bệnh cá nhân hoặc gia đình liên quan. Vào tháng 8 năm 2022, trong quá trình đánh giá tiền phẫu để chuẩn bị cho phẫu thuật đầu gối, phát hiện một khối u ở vùng sau trung thất, và vì vậy, bệnh nhân được chuyển đến để đánh giá và điều trị. Khi nhập viện, kết quả khám lâm sàng không có gì đặc biệt và các xét nghiệm trong phòng thí nghiệm đều nằm trong giới hạn bình thường. Một chụp CT ngực được thực hiện, cho thấy một khối u nằm ở vùng sau trung thất bên phải, kích thước 6,5 × 4,2 cm, có đường viền rõ ràng, có cả mô mỡ và mô đặc, không có dấu hiệu xâm thực xương hoặc xâm lấn các mô xung quanh. Một mẫu sinh thiết của khối u được lấy bằng kim cắt bán tự động 18G × 250 mm, có hướng dẫn hình ảnh, qua đường tiếp cận phía sau. Trong nghiên cứu mô bệnh học, người ta quan sát thấy một khối u lành tính bao gồm mô mỡ trưởng thành, có các vùng xuất huyết xen kẽ với các yếu tố tạo máu, chủ yếu là các tiền chất của dòng tế bào hồng cầu, cũng như các yếu tố của dòng tế bào tủy ở các giai đoạn trưởng thành khác nhau và các tế bào khổng lồ, từ đó xác định chẩn đoán là u trung thất nguyên phát (MPM). Cuối cùng, với chẩn đoán đã được xác định và các đặc điểm của khối u, quyết định áp dụng phương pháp điều trị bảo tồn. Tình trạng bệnh nhân tiến triển tốt và được xuất viện mà không có biến chứng.",
+        "translated_summary": "Chúng tôi xin trình bày trường hợp của một phụ nữ 65 tuổi bị khối u tủy mỡ nguyên phát ở vùng trung thất. Chụp cắt lớp vi tính vùng ngực cho thấy một khối u hình bầu dục, có đường viền rõ ràng, kích thước 6,5 × 4,2 cm, nằm ở vùng trung thất sau. Một mẫu sinh thiết xuyên lồng ngực đã được thực hiện và kết quả kiểm tra dưới kính hiển vi cho thấy có các tế bào tạo máu và mô mỡ trưởng thành."
+    },
+    {
+        "id": "multiclinsum_gs_en_590.txt",
+        "fulltext": "A 57-year-old woman with a 14-year history of asthma and allergic rhinitis, on salmeterol/fluticasone, was hospitalized for recurrent abdominal pain that began two months earlier. The pain was intermittent and dull, accompanied by nausea, anorexia, malaise, and a weight loss of 5 kg. There was no fever, blood / mucus in the stool, or respiratory symptoms (rhinorrhea, wheezing, coughing). She had no history of alcohol/tobacco use or traditional herbal medicines. Six weeks before admission, she was diagnosed with an intestinal infection in a local clinic after a complete blood count (CBC) revealed leukocytosis and significant eosinophilia (25.61 G/L, 77.8% eosinophils). She received antibiotics and mebendazole without relief of symptoms. At presentation, the patient was alerted and oriented with stable vitals (BP 110/70 mmHg, T 37°C, HR 88 bpm, RR 18 bpm). She had a BMI of 16.6 kg/m² and sarcopenia, but no skin rash, lymphadenopathy, or edema. The abdominal exam showed tenderness in the epigastric and umbilical regions without guarding. CBC revealed leukocytosis and significant eosinophilia (20.8 G/L, with a total white blood cell count of 26.8 G/L, comprising 77.8% eosinophils). Peripheral blood film examination showed normal eosinophils. Bone marrow aspiration reveals 48% eosinophils without blasts, atypical cells. Fluorescence in situ hybridization (FISH) for CHIC2 deletion as a surrogate marker for FIP1L1-PDGFRA showed no rearrangements of the PDGFRA gene. Autoimmune and vasculitis screenings (ANA, anti-dsDNA, p-ANCA, c-ANCA) were negative. Elevated serum IgG (2760 mg/dL; normal range, 700–1600 mg/dL) and IgG4 (1260 mg/dL; normal range, 3.9–86.4 mg/dL), slightly elevated IgE (137.5 IU/mL; normal range, <100 IU/mL) and high RF (144.4 IU/mL; normal range, <20 IU/mL) were observed. Other parameters were normal, including aminotransferase, blood urea nitrogen, serum creatinine, complement C3, complement C4, vitamin B12, serum cortisol, and NT-proBNP. ECG and echocardiogram were normal. Chest CT scans showed mild fibrosis and bronchiectasis. Sputum AFB smears and bronchoscopy were negative. The cytology of the bronchoalveolar lavage fluid showed 35% neutrophils, no eosinophils. Spirometry indicated severe obstruction with bronchodilator response. The fractional exhaled nitric oxide (FeNO) level was 15 ppb. Stool samples were tested positive for leukocytes, with no signs of ova or parasites. Serology tests were positive for toxocariasis (positive IgG of Toxocara canis at 54.2 NovaTec-Units) but negative for Strongyloides stercoralis, Fasciola sp., Toxoplasma gondii, Trichinella spiralis, Ancylostoma sp., Angiostrongylus cantonensis, Ascaris lumbricoides, Clonorchis sinensis, Paragonimus sp., Gnathostoma sp., Entamoeba histolytica, cysticercosis, filariasis, and HIV. An abdominal contrast-enhanced computed tomography scan revealed gallbladder stones without acute cholecystitis and showed no gastrointestinal tract abnormalities. The upper gastrointestinal endoscopy showed unremarkable results with a normal appearance. Colonoscopy showed mucosal inflammation in the sigmoid, left, transverse, and right colon with systemic biopsy. A five-day course of albendazole (400 mg twice daily) for suspected toxocariasis was ineffective. Colonic biopsies revealed significant eosinophilic infiltration (>85 eosinophils/High-power field (HPF) in the left colon, >100 eosinophils/HPF in the transverse and right colon). Given the patient’s nonresponse to toxocariasis treatment and the significant eosinophilic infiltration observed in the colon mucosa biopsy, a diagnosis of eosinophilic colitis was confirmed. The patient was treated with oral methylprednisolone (16 mg) and montelukast (5 mg). Symptoms resolved in two weeks and eosinophil counts normalized (0.3 G/L). The corticosteroid was reduced and discontinued, and the patient was maintained on montelukast for three months without symptom recurrence.",
+        "summary": "We present a unique case of a 57-year-old patient with a medical history of asthma and allergic rhinitis who presented recurrent abdominal pain, significant blood eosinophilia, and elevated levels of Immunoglobulin G4. After ruling out hematological and secondary causes of eosinophilia, a biopsy of the colon mucosa revealed an excess of tissue eosinophils, confirming the diagnosis of EoC. The patient responded well to corticosteroids and was subsequently maintained on montelukast, with no recurrence of symptoms over 3 months.",
+        "translated_fulltext": null,
+        "translated_summary": "Chúng tôi xin trình bày một trường hợp đặc biệt của một bệnh nhân 57 tuổi có tiền sử bệnh hen suyễn và viêm mũi dị ứng, người này xuất hiện các triệu chứng đau bụng tái phát, tăng đáng kể số lượng bạch cầu ái toan trong máu và nồng độ Immunoglobulin G4 cao. Sau khi loại trừ các nguyên nhân về huyết học và các nguyên nhân thứ phát gây tăng bạch cầu ái toan, kết quả sinh thiết niêm mạc đại tràng cho thấy có số lượng lớn bạch cầu ái toan trong mô, xác nhận chẩn đoán viêm đại tràng ái toan (EoC). Bệnh nhân đáp ứng tốt với liệu pháp corticosteroid và sau đó được duy trì bằng montelukast, không có triệu chứng tái phát trong vòng 3 tháng."
+    },
+    {
+        "id": "multiclinsum_gs_en_569.txt",
+        "fulltext": "A 38-year-old male presented to the hospital with chest tightness and shortness of breath. Three years prior, he had experienced similar symptoms post-activity and received treatment at our hospital. Outpatient echocardiography indicated a left heart echomass suggestive of a myxoma, which led to his admission for further evaluation. Physical examination revealed pigmentation of the patient’s ears characterized by multiple small brown and black spots. Abdominal computed tomography (CT) showed multiple livers and small cysts in the left kidney. Genetic testing identified mutations in the TTN and PRKAR1A genes. The diagnosis of CNC was confirmed through clinical examination, imaging, and genetic testing. Following symptomatic treatment, the patient’s condition improved; however, he refused surgical intervention. On September 20, 2023, the patient presented to our hospital with exacerbated chest tightness and dyspnea. He reported difficulty lying supine and needing to sit upright to breathe. Physical examination revealed jugular vein distension, leftward and downward displacement of the heart boundary, irregular heart rhythm on auscultation, and a mitral valve murmur of intensity 2/6–3/6 in the fourth intercostal space along the left sternal margin. Wet rales were audible in both middle and lower lung fields. Palpation revealed a firm liver extending three fingers below the xiphoid process and two fingers below the rib cage, along with mild pitting edema in both lower limbs. Echocardiographic images indicated global heart enlargement, dilation of the aortic sinus and pulmonary artery, small-to-moderate mitral valve regurgitation, and an irregular echoic mass measuring 54 mm ×43 mm in the left chamber attached to the atrial septum. The left ventricular (LV) ejection fraction (EF) was 23.1%, with fractional shortening (FS) of 10.9%. Electrocardiography demonstrated atrial fibrillation (average ventricular rate, 150 beats/min) and abnormal Q waves in leads V1-V3. Based on the patient’s history, the diagnosis included DCM and CNC with cardiac myxoma. Given the presence of end-stage heart failure and concurrent cardiac myxoma, the patient was hospitalized, and heart transplantation was considered a viable therapeutic option to address both conditions simultaneously. A suitable donor heart became available for immediate transplantation on October 1, 2024.\n\n\nSurgical procedure\n\nThe skin and subcutaneous tissues were carefully incised layer-by-layer through a median sternotomy. The sternum was sawed longitudinally open, and bleeding was controlled using electrocoagulation and bone wax. Extracardiac exploration uncovered global heart enlargement, most prominent in the LV. The heart showed diminished contractile strength. The aorta and the main pulmonary artery (PA) were dissected from the supravalvular region. Some tissues were preserved for posterior suturing, whereas most diseased right atrium, left atrium(LA), right ventricle, and LV were excised. Resection revealed a greyish-white mucoid mass. The donor and residual recipient LA tissues were sutured using double continuous 3/0 Prolene threads. The anastomosis was meticulously inspected multiple times, and no significant bleeding was observed. Similarly, end-to-end anastomosis of the donor ascending aorta and recipient PA was performed using continuous 5/0 Prolene sutures, and careful inspection revealed no bleeding.\n\nFurthermore, the donor’s LA and recipient’s PA were securely closed using double continuous 5/0 Prolene sutures. The inferior vena cava tissues of both the donor and recipient were similarly sutured with 5/0 Prolene sutures, and several inspections were performed to confirm no significant bleeding was present. The left side of the heart was then deflated, and as rewarming commenced, oxygenation was restored, the ascending aorta was unclamped, and the heart spontaneously returned to sinus rhythm. Continuous suturing with 5/0 Prolene was applied to both the donor and recipient’s superior vena cava and diligently inspected to ensure the absence of significant bleeding. After the successful discontinuation of assisted circulation, the venous cavity was decannulated. Tissue samples from the patient’s left heart and gray matter were collected for histopathological examination, and the diagnosis of DCM and cardiac myxoma were confirmed.\n\n\nPostoperative management\n\nOn the first day after heart transplantation, the patient produced 1200 ml of urine. Laboratory tests revealed a hypersensitive troponin T level of 796.70ng/L and an NT-proBNP level of 10798pg/ml. The complete blood count showed white blood cells at 17.15 × 109/L, with no significant abnormalities in other test results. The echocardiograph displayed an LVEF of 65%, FS of 35%, normal ventricular wall thickness and echogenicity, and no discernible abnormalities in valve morphology and structure. After heart transplantation, Methylprednisolone Sodium Succinate (0.25 g)intravenous hormone therapy was administered to enhance immunity, and Cefoperazone and Sulbactam Sodium (2 g) intravenous anti-infection treatment was provided. The patient was given a nutrient solution and liver and tiopronin on the first day post-surgery. On postoperative day three, Methylprednisolone Sodium Succinate was replaced with oral Prednisone Acetate (25 mg). Mycophenolate Mofetil capsules (0.5 g) were administered orally to minimize heart rejection, and (50 mg) of Carpofungin Acetate was administered intravenously to prevent fungal infections. The patient’s urine output was 2000 ml, with hypersensitive troponin T levels of 390ng/L, NT-proBNP levels of 7877pg/ml, and a leukocyte count of 12.15 × 109/L. On the 7th day post-surgery, tacrolimus capsules were introduced at an oral dose of (1 mg) to minimize the patient’s rejection of the donor heart, with careful monitoring of blood concentrations. Subsequently, the oral dosage of Prednisone Acetate was gradually decreased to (10 mg) while adjusting the tacrolimus blood concentration to 10.90ng/ml. The patient’s recovery improved. On October 20, 2023, follow-up echocardiography (Fig. 6) indicated no abnormalities, with troponin levels of 85 ng/L, NT-proBNP of 210pg/ml, and all other test results within normal ranges. The patient exhibited excellent postoperative recovery and was discharged. Regular follow-up visits to our department after discharge showed that the patient remains in good condition.",
+        "summary": "Herein, we report a case of heart failure due to Carney syndrome that resulted in cardiac myxoma combined with dilated cardiomyopathy. A 35-year-old male was admitted to the hospital three years ago because of sudden chest tightness and shortness of breath. Echocardiography indicated myxoma, and a combination of genetic screening and physical examination confirmed Carney syndrome with cardiac myxoma. Following symptomatic management, he was discharged. Surgical interventions were not considered at the time. However, the patient’s chest tightness and shortness of breath symptoms worsened, and he returned to the hospital. A New York Heart Association grade IV heart function was confirmed, and echocardiography indicated the presence of dilated cardiomyopathy accompanied by cardiac myxoma. Ultimately, the patient’s heart failure was successfully treated with heart transplantation.",
+        "translated_fulltext": null,
+        "translated_summary": "Trong bài báo này, chúng tôi trình bày một trường hợp suy tim do hội chứng Carney, dẫn đến u nhầy tim kết hợp với bệnh cơ tim giãn nở. Một bệnh nhân nam 35 tuổi đã nhập viện cách đây ba năm vì đột ngột bị tức ngực và khó thở. Siêu âm tim cho thấy có u nhầy, và kết hợp với sàng lọc di truyền và khám lâm sàng đã xác nhận hội chứng Carney kèm theo u nhầy tim. Sau khi được điều trị triệu chứng, bệnh nhân đã được xuất viện. Vào thời điểm đó, không cân nhắc đến việc phẫu thuật. Tuy nhiên, các triệu chứng tức ngực và khó thở của bệnh nhân trở nên nghiêm trọng hơn, và ông đã quay lại bệnh viện. Chức năng tim được xác định là mức độ IV theo phân loại của Hiệp hội Tim mạch New York, và siêu âm tim cho thấy có bệnh cơ tim giãn nở kèm theo u nhầy tim. Cuối cùng, suy tim của bệnh nhân đã được điều trị thành công bằng phương pháp ghép tim."
+    },
+    {
+        "id": "multiclinsum_gs_en_324.txt",
+        "fulltext": "2 years 6 months old female pre-schooler with a previous diagnosis of NF1. She consulted due to a 4 week diarrhea with blood streaks (5 to 10 episodes a day). A week after the onset of the diarrhea she consulted the emergency department, where rotavirus (+) was detected, with low inflammatory parameters, negative coproculture and normal abdominal ultrasound. She was hospitalized for 3 days to manage dehydration and was discharged without bleeding, with persistence of semi-liquid stools. 10 days after discharge she presented diarrhea with blood streaks, associated with low intake and weight loss of 1 kg reported by parents. They consulted a pediatric gastroenterologist who requested a polymerase chain reaction (PCR) panel of gastrointestinal pathogens and PCR of Clostridium difficile (which were negative) and indicated hospitalization for study.\n\nOn direct questioning, the parents reported no fever, abdominal pain, vomiting, respiratory or urinary symptoms, arthralgia, or new skin lesions. They did not own pets, and there was no history of travel or recent dietary changes.\n\nThe patient was diagnosed with confirmed NF1 at 8 months of age by genetic testing with the heterozygous pathogenic variant c.5606_5627del (p.Gly1869Valfs*28). She has skin involvement (café con leche spots) and bone involvement. At 18 months she required ankle arthrodesis for tibial curvature. She has no family history of NF1 or inflammatory bowel disease.\n\nOn physical examination, the abdomen was soft and indistinct, with increased air-bubble murmurs, without masses or visceral enlargement. The perianal examination was normal. There were multiple brown-coffee stains on the lower extremities and back. General examinations were performed, including a blood count with moderate microcytic-hypochromic anaemia (Hb 9.6 g/dL), leukocytosis with left shift (leukocytes 13,900), and discretely elevated inflammatory parameters (CRP 1.37 mg/dL, normal value up to 0.5 mg/dL).\n\nA colonoscopy was performed, the rectum, sigmoid and various segments of the colon were examined up to the cecum, visualizing the ileocecal valve and the appendicular orifice. The last few centimeters of the distal ileum were also inspected. The mucosa from the anal margin to the cecum was observed to be erythematous, with loss of vascular transparency, unlike the cecal mucosa, which appeared normal. No lesions were identified in the anal canal or cecum.\n\nBiopsies of the small intestine (ileon) and large intestine were taken. Microscopic examination showed mucosa of ileal type with preserved villous architecture and adequate epithelial differentiation, with a non-inflamed lamina propria. The mucosa of the large intestine had a mild distortion of architecture and adequate epithelial differentiation, a swollen lamina propria with a mild mixed inflammatory infiltrate and hyperplasia of lymphoid follicles. Isolated foci of microabscesses were recognized. The biopsy was consistent with mild colitis, with signs suggesting chronicity.\n\nIn addition, a PCR study for cytomegalovirus (CMV) was requested in a colon biopsy, which was positive.\n\nGiven a positive PCR for CMV, CMV IgG and IgM and CMV viral load in blood were requested, resulting in a positive IgG, negative IgM, and CMV viral load of 79.7 IU/ml. Further laboratory studies included PCR for gastrointestinal pathogens and PCR for Clostridium difficile in stool, both of which were negative. In the colon biopsy, Gram stain microbiological studies were requested, which showed +++ leukocytes without bacteria; biopsy culture showed S. gallolyticus/equinus complex in very low amount (interpreted as bacterial flora); acridine orange, Ziehl-Neelsen, Koch culture, and ADV PCR were negative.\n\nEndoscopy and histology suggestive of UC was reported in the context of a patient with moderate symptoms (PUCAI 50) who was started on Mesalazine (70 mg/kg/day three times daily) and a request for a faecal calprotectin was made which was greater than 600 ug/g.\n\nThe immunology team evaluated the patient for suspected immunodeficiency. The parents did not report a history of infections, they reported that they were vaccinated, that they had good weight gain, no family history of immunodeficiencies, auto-immunity or early deaths. A study with lymphocyte subpopulations (normal), immunoglobulins (normal), HIV (negative), memory T lymphocytes (with alterations expected in the context of CMV viremia) and lymphoproliferation test (normal) was requested. In addition, a genetic panel of primary immunodeficiencies (Invitae) was performed, which contains 429 genes, of which 68 make up the panel of monogenic inflammatory intestinal disease. 7 variants of uncertain significance were obtained, none included in the panel of monogenic IBD.\n\nGanciclovir was initiated intravenous for CMV infection and continued for 15 days. The last PCR CMV control prior to discharge reported undetectable load.\n\nThe patient improved during the hospital stay with decreased frequency of stools and increased consistency, no rectal bleeding, no nocturnal stools and no abdominal pain, with PUCAI 0 at discharge.\n\nTwo months later, he presented with a reactivation of IBD with bloody diarrhea (PUCAI 35). A blood count was performed (normal), a panel of gastrointestinal pathogens was performed (–), PCR for Clostridium difficile was performed (+), and CMV load was undetectable. He was treated with oral metronidazole. However, he persisted with diarrhea with blood streaks, so he was hospitalized again.\n\nA colonoscopy was performed, where erythematous mucous was observed in a diffuse form from the rectum to the cecum, with nodularity and loss of vascular transparency in the submucosa, greater in the left and transverse colon segments. No focal lesions were observed. The mucosa of the ileum and anal canal were observed without lesions.\n\nBiopsy of the terminal ileum, right colon and left colon was performed. Microscopic examination of the ileal-type mucosa showed preserved villous architecture and adequate epithelial differentiation. The lamina propria showed no signs of inflammation. There were no aphthous erosions or granulomas. The mucosa of the large intestine showed mild distortion of architecture and epithelial dedifferentiation. The lamina propria was expanded by mixed inflammatory infiltrate, transmucosal distribution. Foci of cryptitis and cryptitic microabscesses and hyperplasia of reactive lymphoid follicles were recognized. No granulomas, viral or parasitic cytopathic changes were observed. All fragments of the left colon sample presented a similar histopathological picture.\n\nShe was given oral treatment with Vancomycin and Prednisone (1 mg/kg/day) with a good response and a favorable evolution. She was discharged with a decrease in the frequency of bowel movements. She persists with mild symptoms (PUCAI 5) in outpatient control, so the dose of corticosteroids is progressively decreased and she remains on treatment with Mesalazina.\n",
+        "summary": "2.5-year-old pre-schooler with a history of NF1 presenting with bloody diarrhea. On endoscopic examination, the mucosa from the anal margin to the cecum was erythematous with loss of vascular transparency. Colon mucosal biopsies showed signs of chronic inflammation consistent with a diagnosis of ulcerative colitis and CMV infection was diagnosed by PCR.\n",
+        "translated_fulltext": null,
+        "translated_summary": "Một trẻ nhỏ 2,5 tuổi, tiền sử mắc hội chứng NF1, nhập viện vì tiêu chảy ra máu. Trong quá trình nội soi, niêm mạc từ rìa hậu môn đến manh tràng có màu đỏ và mất độ trong của mạch máu. Kết quả sinh thiết niêm mạc đại tràng cho thấy dấu hiệu viêm mãn tính, phù hợp với chẩn đoán viêm loét đại tràng, và nhiễm CMV được chẩn đoán bằng phương pháp PCR."
+    },
+    {
+        "id": "multiclinsum_gs_en_41.txt",
+        "fulltext": "4-month-old indigenous lactating mother from the rural area of the interior of Panama, from the town of Urracá, 3 hours by canoe from the nearest health center. Her background included being the fourth daughter, born by vaginal delivery at home by a relative, without prenatal controls, her weight, height and Apgar score at birth are unknown. She did not breastfeed and was fed with powdered milk formula with iron for children under 6 months, receiving 3 ounces every 4 hours.\n\nThe nuclear family was composed of 6 people (parents and 4 children) who lived in a house with walls and floor of boards and palm roof, 2 rooms, without electricity, they were illuminated with kerosene lamps, water from a well, excreta in a river and they burned the garbage, their economic income came from subsistence agriculture.\n\nHe had no health care in his first 4 months of life and did not receive the vaccinations included in the national expanded programme of immunizations. According to his parents, his neurodevelopment was normal until his hospitalization.\n\nThe minor consulted in a health center with a history of 4 days of diarrhoea, without mucus or blood associated with vomiting of food content (the mother gave her tea because she could not tolerate milk), afebrile and without respiratory symptoms. Oral fluids and 4 doses of Enterogermina® (B. clausii: two billion spores/5 mL) were administered. Due to the lack of supplies (they did not have catheters, or intraosseous for the administration of intravenous fluids) she was transferred to a second-level hospital in the provincial capital and then to our institution in Panama City with a diagnosis of acute gastroenteritis and severe dehydration.\n\nHe presented to the emergency department with a consciousness compromise, dehydration characterised by a tearless cry, dry oral mucosa. He had oedema of +++ hands, feet, abdomen and face. He was afebrile and had signs of shock, capillary refill time > 2 seconds, cold extremities, filiform pulse and marble skin, heart rate 170 bpm, respiratory rate 55 bpm, blood pressure 91/37 mmHg, oxygen saturation 99%. He weighed 4.7 kg and was 56 cm tall at admission, Z-score height/age -2.52, weight/height and weight/age Z-scores were not quantifiable due to severe dehydration. On segmental examination, there were fine crepitus in both lung bases and erythematous-squamous lesions with desquamation of skin and others with hypopigmentation of trunk and upper limbs (interpreted as pellagroid dermatosis).\n\nLactate Ringer bolus was given at 10 ml/kg in the emergency department, followed by 5% Dextrose in 0.33% Saline 500 ml at an infusion rate of 29 ml/h over 6 hours without KCL until diuresis was obtained. She was started on Ceftriaxone 50 mg/kg/day for suspected sepsis, stabilised and sent to the ward where she continued to receive 500 ml of 5% Dextrose in 0.9% Saline at 20 ml/hr.\n\nAmong the examinations, a blood count revealed leukocytosis at 39.0 x 103/uL, severe anaemia 5.6 g/dL, thrombocytosis 502 x 103/uL, the rest of the results are detailed in. He was transfused with 50 ml of filtered and leuko-reduced red blood cells and 40 cc of fresh frozen plasma due to altered coagulation times. Enteral feeding was initiated by nasogastric tube and infusion was decreased to 15 ml/h of 5% Dextrose in 0.9% Saline 500 cc, and continued with negative water balance.\n\nOn day 2, initial peripheral blood culture was reported as Gram positive cocci in clusters, Oxacillin was added at 200 mg/kg/day, Ceftriaxone was increased to 75-100 mg/kg/day, total fluids to 120 ml/kg/day and calcium was corrected (value received 6.38 mg/dL).\n\nOn her 3rd day she lost venous access, so a central venous catheter (CVC) was placed. She was hypovolemic with subhydrated oral mucosa, increased respiratory work, cold extremities and capillary refill time of 3-4 seconds. Ringer's lactate was given at a load of 20 ml/kg in one hour. Arterial blood gas revealed uncompensated metabolic acidosis with pH 7.26, HCO3 13 mmol/L, PCO2 28.4 mmHg, PO2 39.2 mmHg, lactate 2.8 mmol/L. She was intubated and transferred to the paediatric intensive care unit (PICU) where she was placed on mechanical ventilation.\n\nTotal fluids of 100 cc/kg, infused epinephrine, low-salt albumin, and 10% calcium gluconate were administered, and fentanyl was changed to remifentanil due to elevated liver enzymes.\n\nThe blood culture of admission reported growth of methicillin-resistant Staphylococcus aureus (MRSA), Oxacillin was omitted and Clindamycin was added at 40 mg/kg/day; the blood culture of admission on the second day of admission to the ICU with Gram-negative bacillus smear was positive, and Ceftriaxone was changed to Ceftazidime at 150 mg/kg/day.\n\nOn his first day in the ICU, a substantial increase in serum biomarkers of cardiac damage was documented, the echocardiogram showed mild mitral and tricuspid regurgitation, left ventricular dilatation, left ventricular ejection fraction (LVEF) 58%, no evidence of thrombi, vegetations or pericardial effusion, and he was diagnosed with acute myocarditis. Milrinone was started at 0.4 mcg/kg/min, furosemide and IV immunoglobulin 1 g/kg single dose.\n\nThe second day blood culture the germ was identified as Bacillus clausii, identified by the system (VYTEK 2TM), the susceptibility profile was not performed because the team did not have cut points for this germ, for this reason the antibiotic coverage was adjusted, considering it was not a contaminant, Ceftazidime was changed to Ciprofloxacin at 30 mg/kg/day and Ceftaroline was added at 8 mg/kg every 8 hours along with Clindamycin for MRSA. The 3 subsequent blood cultures with intervals of 48 hours between each were positive in both peripheral blood and CVC for isolation of B. clausii.\n\nOn his 6th day in hospital, the gastrointestinal panel (Maripoc gastro test methodology) performed on the second day detected Clostridiodes difficile toxin A/B, the tests for Campylobacteryeyuni, Norovirus GI, Norovirus GII.4, Adenovirus and Rotavirus were negative. Following these findings, therapy was escalated to IV Vancomycin at a dose of 60 mg/kg/day and metronidazole was added orally. Ceftaroline, clindamycin and ciprofloxacin were omitted, covering both B. clausii and C. difficile and MRSA .\n\nHIV testing, serology for Chagas and SARS-CoV-2 antigen by immunofluorescence (FIA) were negative, immunoglobulins were within normal limits.\n\nOn the seventh day, arterial hypertension was reported and spirinolactone was added to the management.\n\nOn the 8th day, the laboratory tests showed altered coagulation times and increased azotaemia associated with anuria that had lasted for 12 hours. However, due to the patient's condition, a peritoneal catheter was not placed, the vancomycin dose was adjusted and vitamin K was administered. The patient continued to have anuria and anasarca, and she developed sustained hypotension. Noradrenaline was added, but her condition deteriorated with multisystem organ failure and she died twelve days after admission. No autopsy was performed because the mother refused permission for cultural reasons.\n",
+        "summary": "4-month-old lactating infant, indigenous ethnicity, from the rural interior of Panama, 3 hours by canoe from the nearest health subcenter, with protein-caloric malnutrition, who presented with acute diarrhea and moderate-severe dehydration, receiving Enterogermina as part of the initial treatment. She was transferred to a third-level hospital, where she arrived with respiratory distress and signs of shock. The initial blood culture reported growth of methicillin-resistant Staphylococcus aureus (MRSA), the gastrointestinal panel was positive for Clostridiodes difficile, and later growth was confirmed in serial blood cultures of peripheral blood and central venous catheter, of Bacillus clausii. With a torpid evolution and resistance to multiple antibiotic regimens, she died of multisystem organ failure twelve days after admission.\n",
+        "translated_fulltext": null,
+        "translated_summary": "Bé gái 4 tháng tuổi đang bú sữa mẹ, thuộc dân tộc bản địa, đến từ vùng nông thôn hẻo lánh của Panama, cách trung tâm y tế gần nhất 3 giờ đi thuyền, bị suy dinh dưỡng do thiếu protein và calo, nhập viện vì tiêu chảy cấp và mất nước vừa đến nặng, được điều trị ban đầu bằng Enterogermina. Bé được chuyển đến bệnh viện tuyến ba, nơi bé nhập viện trong tình trạng khó thở và có dấu hiệu sốc. Kết quả cấy máu ban đầu cho thấy có sự phát triển của vi khuẩn Staphylococcus aureus kháng methicillin (MRSA), xét nghiệm phân cho thấy có Clostridiodes difficile, và sau đó, kết quả cấy máu liên tiếp từ máu ngoại vi và catheter tĩnh mạch trung tâm xác nhận sự hiện diện của vi khuẩn Bacillus clausii. Do tình trạng bệnh tiến triển chậm và kháng nhiều loại kháng sinh, bé đã tử vong do suy đa tạng mười hai ngày sau khi nhập viện."
+    },
+    {
+        "id": "multiclinsum_gs_en_490.txt",
+        "fulltext": "A 78-year-old woman, who came to collect her blister pack with her medication reconstituted in a personalised dosage system (PDS) from the community pharmacy, informed us that for some months she had been suffering from tiredness, weakness, dizziness and confusion. These symptoms were preventing her from leaving her home to walk as often as she normally did. In view of this situation, she was invited to the personalised care area to review the degree of knowledge that the patient had of her medication and the use she made of it, to analyse whether any of her medication could be related to the health problem described.\n\nPharmacological treatment of the patient\n\nMedication  Dose  Dosage  Health issue  Start date\nDoxazosin  2 mg/24 h  0-0-1  Hypertension  2014\nLosartan  100 mg/24 h  1-0-0  Hypertension  2014\nManidipine  20 mg/24 h  0-1-0  Hypertension  2014\nSimvastatin  40 mg/24 h  0-0-1  Hypercholesterolemia  2014\nAcetylsalicylic acid  100 mg/24 h  1-0-0  Secondary prophylaxis  2014\nOmeprazole  20 mg/24 h  1-0-0  Prevention of peptic ulcer  2014\nPregabalin  100 mg/12 h  1-0-1  Neuralgia  2019\nTorasemide  10 mg/24 h  1-0-0  Edema  2023\nDulaglutide  1.5 mg/week  1 time/week  Diabetes  2014\nInsulin glargine  74 IU/24 h  1-0-0  Diabetes  2014\nInsulin lispro  20 IU/24 h  0-1-0  Diabetes  2014\nBrimonidine  1 drop/12 h  1-0-1  Ocular hypertension  2018\n\nStudy and evaluation\nThe interview revealed that there was no new medication and that it did not appear in the SPD service register. Given the suspicion of a possible hypotension, her blood pressure was measured with an Omron Complete device, with the following values: Systolic Blood Pressure (SBP) 96 mmHg, Diastolic Blood Pressure (DBP) 52 mmHg and Heart Rate (HR) 69 beats per minute. Given these values, it was suggested that her blood pressure be monitored and the influence of her medication on these values and the symptoms described by the patient be analysed.\n\nThe patient's medication doses, starting with antihypertensive medications, are reviewed to adjust to the patient's estimated glomerular filtration rate (eGFR) and to see if hypotension is related to the dosage of these medications. The patient's eGFR value, calculated using the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) formula, is 30 ml/min/1.73 m2.\n\nThe guidelines for the revision of the dose according to the value of the eGFR are the product information for the medicinal products and the consensus guidelines for the use of medicinal products in renal impairment of the teaching and research group in the field of practical pharmacy of the Faculty of Pharmacy of the University of Barcelona, which is available on the Internet. This guide has been prepared from the analysis of the most dispensed medicinal products in community pharmacies. They have been organised by therapeutic groups according to the ATC (Anatomical-Therapeutic-Chemical) classification, information on the symptoms of overdose has been included and it has been agreed to categorise the risk to the patient of taking these medicinal products according to their eGFR as low, moderate or high.\n\nAfter the medication review was performed according to the eGFR value of 30 ml/min/1.73 m2, the results were obtained.\n\nFollowing the study of the medication, our intervention focuses on the dosage of the following medicines: losartan, manidipine, torasemide and pregabalin. The antihypertensive medicines, losartan and manidipine, and pregabalin require a dose adjustment depending on the patient's eGFR value, while the diuretic torasemide can influence blood pressure values.\n\nInitially, it was decided to intervene in the dosage of losartan and manidipine. There is the possibility of reducing the dose of pregabalin, but the pharmaceutical team agreed with the patient to assess the influence of this medication after the possible adjustment of the dose of antihypertensive during the evolution and follow-up of the patient.\n\nIntervention\nThe information is used to prepare a report for the doctor (see annex), recommending a reduction in the dose of losartan and manidipine, as the available information recommends a reduction in the dose to 50-75% of losartan for eGFR of 30-59 ml/min/1.73 m2 and adjusting the dose of manidipine for eGFR of 15-30 ml/min/1.73 m2.\n\nThe proposed intervention was explained to the patient and the report was given to the primary care doctor, explaining the possibility of adjusting the dose of losartan and manidipine to improve the patient's condition (table 4). When this information reached the doctor, he opted to reduce the dose of losartan to 50 mg/24 hours and manidipine to 10 mg/24 hours. Pregabalin 100 mg/12 hours was also replaced with gabapentin 300 mg/12 hours.\n\nFollow-up\nFollowing this change in the patient's treatment and after a follow-up of two months, the patient showed an improvement in blood pressure values (table 5) and a remission of the symptoms described. It was reviewed whether the gabapentin dose of 300 mg/12 hours was adequate for the eGFR value of 30 ml/min/1.73 m2, and it was correct (eGFR between 30 and 60, recommended total daily dose 300-900 mg).\n\n",
+        "summary": "78-year-old patient, taking many medicines and included in the Personalised Medication Dosage System (SPD). When she came to collect her medication, she informed us that for some months she had been suffering from tiredness, weakness, dizziness and confusion. A review of the medication was carried out, focusing on the dosage of the medicines metabolised or eliminated by the kidneys, depending on the patient's estimated glomerular filtration rate (EGFR). A referral was made to the Primary Care Physician (PCP) by means of a report, in which the reduction of the dose of losartan and manidipine was recommended, depending on the patient's estimated glomerular filtration rate (EGFR). The PCP reduced the dose of the antihypertensive medicines. The case was monitored, which allowed us to observe that the patient no longer presented the symptoms described initially.\n",
+        "translated_fulltext": null,
+        "translated_summary": "Bệnh nhân 78 tuổi, đang dùng nhiều loại thuốc và được theo dõi trong Hệ thống Điều chỉnh Liều lượng Thuốc Cá nhân hóa (SPD). Khi đến nhận thuốc, bà thông báo rằng trong vài tháng gần đây, bà cảm thấy mệt mỏi, yếu ớt, chóng mặt và lẫn lộn. Các bác sĩ đã xem xét lại các loại thuốc đang dùng, tập trung vào liều lượng của các loại thuốc được chuyển hóa hoặc đào thải qua thận, dựa trên ước tính tốc độ lọc cầu thận (EGFR) của bệnh nhân. Một báo cáo đã được gửi đến bác sĩ điều trị ban đầu (PCP), trong đó đề xuất giảm liều losartan và manidipine, tùy thuộc vào ước tính tốc độ lọc cầu thận (EGFR) của bệnh nhân. Bác sĩ điều trị ban đầu đã giảm liều các loại thuốc hạ huyết áp. Tình trạng của bệnh nhân được theo dõi và kết quả cho thấy bệnh nhân không còn các triệu chứng như đã mô tả ban đầu."
+    },
+    {
+        "id": "multiclinsum_gs_en_483.txt",
+        "fulltext": "It is a case study, approved by the Research Ethics Committee (CEP) under number 1.012.635. The prior authorization of the relatives and the participant was requested from the signature of the Free and Informed Consent (TCLE) and the Free and Informed Consent (TALE).\n\nThe participant in this study is a female student in the 3rd year of elementary school. In the first evaluation, in 2018, the child was 8 years and 2 months old, while in the second evaluation, in 2019, she was 9 years and 6 months old. The interval between the evaluations occurred due to the fact that it is a public service. Thus, the laboratory was absent from activities during the holidays. In addition, it is important to consider that the appointments were only made once a week and, during that period, the participant was absent, which also prolonged the process. As for her history, she was born at term and presented adequate neuropsychomotor and linguistic development. The child was born and lived in a French-speaking country until the age of 2 years, but had exposure to another language at home, since her parents are Brazilian Portuguese speakers. However, her first words were in French. When she returned to Brazil, she went through two private schools. In the first school, she was unable to communicate, as she only expressed herself in French. After that experience, at the age of 3, she began studying in a French school, still in Brazil. Over the years, she presented difficulty in acquiring reading and writing; for that reason, she repeated the 1st year of elementary school, at the request of her mother. At the age of 6, she began studying in a bilingual Portuguese-English school. At the age of 8 years old, she underwent evaluation by an interdisciplinary team in the areas of speech therapy and neuropsychology, finding the diagnosis of developmental dyslexia (DD) and high abilities/giftedness (AH/S). Soon after, she was referred to the evaluation of reading and writing in the Laboratory of Written Language, Interdisciplinarity and Learning - LEIA/UFRN.\n\nPhases of the study: four assessment sessions for each moment - pre and post intervention (T1 and T2, respectively) - and 20 sessions of phonological remediation, once a week for 60 minutes. The intervention took place in the second semester of 2018, where parents were not very engaged due to work demands.\n\nAssessments were conducted individually over a one-hour period. They included tasks to assess performance in phonological processing - phonological working memory, phonological awareness and mental lexical access - reading and writing.\n\nThe following protocols were used to evaluate the child:\n\nPhonological awareness: to evaluate this ability, the Consciência Fonológica Instrumento de Avaliação Sequencial - CONFIAS (11) was used. This protocol proposes tasks of synthesis, segmentation, rhyme, alliteration, initial and final syllable identification, exclusion and transposition. First, syllabic awareness, formed by nine items, is analyzed, followed by phonemic awareness, formed by seven items. Each hit is equivalent to one point, with 40 for syllabic awareness and 30 for phonemic awareness, totaling 70 points. Its results should be compared with the expected writing hypotheses based on Ferreiro and Teberosky (12). In this way, the following normal values were used: for the syllabic-alphabetic writing hypothesis, 27, 12 and 39 for the syllabic, phonemic and total score, respectively; for the alphabetic writing hypothesis, 31, 15 and 46.\n\nPhonological working memory: The Phonological Working Memory Test was used (13). In the application of this protocol, the assessor should begin with the non-word test, which consists of 40 invented words. The assessor should then say each word in the list, asking the child to repeat it immediately. The child has two attempts to repeat the words correctly. In the first attempt, each correct answer is worth two points, in the second attempt, the child is awarded one point, and in the third attempt, the child is awarded zero points. After this, the assessor should move on to the test of digits in direct and reverse order, which is scored in the same way as the pseudo-words. Depending on the age of the participant at the time of the assessments, the normal values of 69, 13 and 6 were used for pseudo-words, direct and reverse digits, respectively.\n\nAccess to the mental lexicon: the Rapid Automatic Naming Test (RAN)(14) was used in the evaluation and the Automatic Naming Test (TENA)(15) in the re-evaluation. Both tests aim to estimate the individual's ability to name a sequence of stimuli, that is, to measure the speed at which the child can verbalize a visual stimulus quickly. Two protocols were used, since the TENA had not yet been published at the time of the first evaluation. In addition, the TENA is a current and more complete protocol for the verification of normality, as it allows analysis according to age and months. The two tests used have similar application and are divided into four boards, where the child must name colors, objects, letters and digits. The naming must be done with the same movement that is used for reading - from left to right and from top to bottom. For T1, which used the RAN, the normality values correspond to children aged between 8 years and 8 years and 11 months, due to the age of the participant in that period, thus, it should have a score of 28, 29, 52 and 46 seconds for the subtests of digits, letters, objects and colors, respectively. For T2, the normality values of the age of 9 years and 6 months of the protocol (TENA) were used, with an expected score of 35, 32, 50, 53 seconds for the subtests of digits, letters, objects and colors, respectively.\n\nReading: First, the Protocol for the Assessment of Reading of Words/Pseudowords Isolated – LPI(16) was used, in which the child is asked to read aloud words and pseudowords, which are scored. 19 regular words, 20 irregular words and 20 pseudowords are arranged in black Arial font, size 24 and white background. The child may obtain a total of 59 points, since each correct reading is worth one point. After this, the Protocol for the Assessment of Reading of Expository Texts was used(17). This instrument aims to assess reading comprehension through directed questions about texts compatible with the subject's school year. It assesses and times patterns of silent and oral reading. This allows the reading level to be verified and compared. In addition, the number of words read per minute is averaged, allowing the reading speed to be verified and compared.\n\nWriting: To evaluate the writing, the child was asked to produce a text on a topic of their interest. After finishing the story, the professional asked the child to read out loud what was written. Furthermore, the child was asked to write the target words of the LPI(16) on a separate sheet, in order to carry out a dictation of words and pseudo-words. With this, a qualitative investigation of the writing was carried out, based on the orthographic analysis of Zorzi and Ciasca(18).\n\nThe remediation was based on a program used for children with dyslexia(19) and included activities that aimed to improve phonological abilities, such as: identification of graphemes and phonemes, phoneme pairs, syllable pairs, word pairs, addition and subtraction of phonemes, syllabic and phonemic manipulation, rhymes, alliteration, access to mental lexicon, visual working memory, auditory working memory and reading training. In all sessions, these activities were explored in a playful way, mainly directed to the metalinguistic aspects of phonological awareness. In reading training, the child was exposed to children's books from the Mico Maneco collection. This collection has various stories that increase the level of complexity of words, so it is possible to follow the child's progress. The activities performed and the child's evolution were described in his/her medical record at the end of each session.\n\nAnalysing the results found, with regard to performance in phonological awareness, in both assessments the child presented performance consistent with the hypotheses of writing presented in each period. In the first assessment, he received the syllabic-alphabetic writing hypothesis and in the second, the alphabetic one, demonstrating progress. The performance score progressed in both categories of the skill, syllabic (T1 = 35; T2 = 37) and phonemic (T1 = 14; T2 = 20) (Table 1). The progress of 4 successes in the phonemic level is highlighted, which can be explained due to the phonological remediation having been performed with focus on the phonemic level.\n\nThe results of phonological working memory at the time prior to phonological remediation expressed below-expected performance for the pseudo-word category, with 66 points in T1, with expected performance for T1 (ET1) of 69, and for the reverse-order digits category (T1 = 04; ET1 = 06) (Table 1). Despite this, it presented results within the expected range for the reverse-order digits category (T1 = 20; ET1 = 13). In the post-intervention evaluation (T2), the results are adequate for the age. It is also possible to notice advances in this skill in all categories, pseudo-word (T1 = 66; T2 = 69), reverse-order digits (T1 = 04; T2 = 12) (Table 1), which requires aspects of executive functions that assist in the rapid storage of the response, a differential aspect in high abilities.\n\nAs for the automatic rapid naming, it is noted that in T1, the performance is inadequate for the standards of normality in all subtests. It is also possible to say that, in T2, the performance was below the expected for the categories of digits (T2 = 41; ET2 = 35), objects (T2 = 59; ET2 = 50) and colors (T2 = 56; ET2 = 53). Only the category of letters presented results within the expected (T2 = 29; ET2 = 32). On the other hand, the advance in the speed of naming is visible for the subtests of letters (T1 = 37; T2 = 29), objects (T1 = 62; T2 = 59) and colors (T1 = 60; T2 = 56), with the exception of digits (T1 = 37; T2 = 41) (Table 1). With the decrease of the time of naming of the stimuli, it is possible to say that the child becomes more effective to access the mental lexicon at the level of the phonological and visual representation, which is also not usual in isolated dyslexia.\n\nAs for reading, in T1 she presented an alphabetic level and in T2 an orthographic level. In the first test, it was noted that there was difficulty mainly with visually similar letters and phonologically close. In addition, the student used sub-vocal support to decode and had an average reading of 20 words per minute, which demonstrates extremely slow decoding and is far below what is expected for her schooling. In the reassessment, she had an average of 94.4 words per minute in oral reading, which is considered adequate for her schooling. She demonstrated presence of prosody, rhythm, global reading, interest and adequate understanding. Qualitatively, it is observed that the child, even with adequate performance, read with a low intensity of speech, still demonstrating insecurity in carrying out the task.\n\nIn writing, it can be observed that in T1 the child had inadequate pencil grip, imprecise writing, with letter changes, omissions, hyper and hyposegments, repetition of words and low use of cohesive elements. In this period, it was shown with writing in the transition from the syllabic-alphabetic phase to the alphabetic phase. In T2 no significant change was observed, since his writing continued to be imprecise, with little intelligibility of the content, visual similarities between letters (such as “d” and “b”) and lack of punctuation. According to the sample collected, it was shown in the alphabetic phase of writing, although difficulties not expected for his age persisted. Despite this, it is noted that he used a greater repertoire in the use of vocabulary for the lexicon of visual input.\n\nAfter the analysis of the results in their entirety, it can be observed that the written language skills advanced during the interval between the evaluations, despite the persistence of consonant characteristics with dyslexia, as it still presents performance below the expected in the access to the mental lexicon and in writing - with the presence of exchanges between phonemes that are audibly and visually similar in a persistent way, omission of letters and hypersegmentation.\n",
+        "summary": "This study is a case report of the evaluation and intervention process of a 9-year-old child with the paradoxical combination of high abilities associated with dyslexia. The objective was to compare the performance in the tasks of phonological processing, reading and writing before and after phonological remediation. In the first evaluation, the child presented an alphabetic level in reading, a transition phase between the syllabic-alphabetic and alphabetic levels in writing and a performance below the expected level in phonological processing abilities. After the intervention, there was an improvement in phonological processing abilities, consolidation of alphabetic writing and of the orthographic level of reading.\n",
+        "translated_fulltext": null,
+        "translated_summary": "Nghiên cứu này là một báo cáo điển hình về quá trình đánh giá và can thiệp đối với một trẻ 9 tuổi có sự kết hợp nghịch lý giữa khả năng vượt trội và chứng khó đọc. Mục tiêu là so sánh kết quả thực hiện các bài tập về xử lý âm vị, đọc và viết trước và sau khi can thiệp bằng phương pháp phục hồi âm vị. Trong lần đánh giá đầu tiên, trẻ thể hiện trình độ đọc ở mức bảng chữ cái, giai đoạn chuyển tiếp giữa mức âm tiết-bảng chữ cái và mức bảng chữ cái trong kỹ năng viết, và kết quả dưới mức kỳ vọng trong khả năng xử lý âm vị. Sau khi can thiệp, khả năng xử lý âm vị được cải thiện, kỹ năng viết bảng chữ cái được củng cố và trình độ đọc đạt mức chính tả."
+    },
+    {
+        "id": "multiclinsum_gs_en_180.txt",
+        "fulltext": "The 52-year-old man tested positive for SARS-CoV-2 using a self-test kit after having a cold. He returned to work without fever after resting for two days, but lost consciousness while working outdoors in an ambient temperature of 35°C for five hours. Upon admission to the local hospital’s emergency department, his core temperature (Tc) was recorded as 40°C. The patient presented with persistent coma, dyspnea and gastrointestinal hemorrhage. No underlying diseases and relative family history was noted. Based on the characteristic presentation of hyperpyrexia, coma and multiple organ damage, a diagnosis of HS was established. He was admitted to emergency intensive care unit (ICU) of the local hospital and then received mechanical ventilation. The test results indicated the presence of pulmonary infection, hepatic and renal dysfunction, myocardial ischemia and coagulation disorders. The patient received initial management including rehydration (intravenously infused Lactated Ringer’s solution and normal saline at a rate of 2.5mL/kg∙h), intravenous administration of Piperacillin Sodium and Tazobactam Sodium, vasoactive medications for blood pressure support, continuous mechanical ventilation, and continuous renal replacement therapy (CRRT) to manage subsequent anuria. The patient received plasma transfusion and was administered Tranexamic acid on day 5. The worsening of his condition led to his admission to the medical ICU of our hospital 7 days after HS.\n\nFollowing admission, Reverse-transcription polymerase chain reaction (RT-PCR) testing of a nasopharyngeal swab yielded positive results for SARS-CoV-2. The patient was diagnosed with HS and severe COVID-19 based on China’s COVID-19 Diagnosis and Treatment Program (trial version 10): 1. real-time fluorescent RT-PCR detection of SARS-CoV-2 nucleic acid is positive; 2. respiratory failure and requires mechanical ventilation; 3. shock; 4. combined with multiple organ failure requiring intensive care. The patient had no contact with COVID-19 diagnosed patients or healthcare workers in the hospital, indicating community-acquired infection. The physical examination showed a Glasgow Coma Scale (GCS) score of 3/15, with scores of 1 for eye-opening, verbal response, and motor response. Additionally, the pupils were symmetrical and non-reactive. The heart rate was recorded at 106 bpm and blood pressure was maintained at 126/77 mmHg by continuously infusing norepinephrine at a rate of 0.4 ug/kg·min. The laboratory test results indicated a severe infection, along with anemia, thrombocytopenia, disseminated intravascular coagulation (DIC), as well as acute liver and kidney injury. The white blood cell count (WBC) decreased from 3.55×109/L to 3.13×109/L, lymphocytes significantly decreased from 0.25×109/L to 0.1×109/L, and neutrophil percentage (N%) increased to 85.3%. The Procalcitonin level measured 2.81 ng/mL and C-reactive protein (CRP) level was 32.6 mg/L. Sputum culture testing yielded Stenotrophomonas Maltophilia and Candida lipolytica. The central venous catheter culture test detected Staphylococcus epidermidis, but the continuous blood culture test yielded no positive results. The Computed Tomography (CT) scan revealed bilateral frontal subdural effusion, consolidation and atelectasis in the lower lungs, inflammation in the right upper lobe, bilateral pleural effusion, and a small amount of abdominal fluid.\n\nThe patient received synchronized intermittent mandatory ventilation with a positive end expiratory pressure of 5 mmH2O and an oxygen concentration of 80% and continuous administration of norepinephrine and pituitrin to sustain normal blood pressure. Polyene phosphatidylcholine, adenosylmethionine budisulfonate, ulinastatin, and hemofiltration have been employed for the management of hepatic and renal dysfunction. The antibiotic was substituted with Meropenem and Thymalfasin was administered for 20 days to augment immune function. Mannitol was used to alleviate intracranial pressure for 3 days. To improve coagulation dysfunction, the patient received plasma and cryoprecipitate transfusions, continuous intravenous infusion of heparin sodium at 6000u/day and CRRT with sodium citrate for anticoagulant (8g/day) on day 7. Platelet transfusion was administered after 9 days of HS. His Tc fluctuated between 36 °C and 38.5 °C. CRRT was administered without anticoagulant on day 8. The patient had gastrointestinal hemorrhage and fever after 9 days of HS, but electronic gastroenteroscopy showed no signs of active bleeding. He underwent red blood cell suspension transfusion, hemostasis treatment and gastric acid suppression. Teicoplanin was added due to the presence of Methicillin-resistant Staphylococcus aureus isolated from sputum culture. The patient regained consciousness on day 13 with a GCS score of 14/15 and presented with a moderate fever. Gastrointestinal hemorrhage was not observed. Mechanical ventilation was discontinued and the tracheal tube was removed. But the creatinine levels increased following the suspension of CRRT on day 12.\n\nOn day 17, he developed sudden dyspnea with desaturation (oxygen saturation <85%) followed by a high fever (Tc: 39.3°C), necessitating reintubation and mechanical ventilation. Bronchoscopy revealed less sputum in both lungs and subbranches. He experienced a recurrence of coma, with a GCS score of 3/15. WBC increased to 14.94×109/L and NEU increased to 13.77×109/L. The levels of serum total bilirubin rose to 235.2 µmol/L, while creatinine increased to 441µmol/L. The brain CT scan revealed an ischemic stroke in the right frontal lobe and a hemorrhagic infarction in the right occipital lobe. The patient underwent cooling therapy using CRRT with ice-cold replacement fluid, along with persistent administration of Meropenem and Teicoplanin for anti-infection treatment. Carpofungin was added on day 18 due to the observed elevation in serum levels of Aspergillus galactomannan, Aspergillus IgG antibody, and Candida mannan. The RT-PCR testing for SARS-CoV-2 returned negative results.\n\nThe patient’s fever and infection improved on day 20, but he subsequently developed cerebral hemorrhage and hernia with bilateral dilated pupils. The dehydration therapy was used to reduce intracranial pressure, as surgery was refused by his family. On day 22, indicators of infection, levels of aspartate aminotransferase and creatinine increased again. Carbapenem-resistant Acinetobacter baumannii and A. fumigatus were cultured in the bronchoalveolar lavage fluid. The combination of Meropenem, Teicoplanin, and Carpofungine was administered for anti-infective therapy. The patient’s condition progressively worsened over the next 7 days, ultimately resulting in his demise on day 29. The patients’ inflammatory indicators, cytokines, and coagulation indicators are presented in Table 1.",
+        "summary": "We report the first case of heatstroke comorbid with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in a 52-year-old male. After receiving intravenous antibiotics, organ protection measures, and treatment for coagulation disorders, his fever and coma resolved. However, he developed dyspnea and cerebral hemorrhage after several days. This patient experienced a multi-pathogen pulmonary infection and an intractable coagulopathy that ultimately resulted in MODS and death.",
+        "translated_fulltext": null,
+        "translated_summary": "Chúng tôi báo cáo trường hợp đầu tiên về một bệnh nhân nam 52 tuổi bị sốc nhiệt đồng thời nhiễm virus gây hội chứng hô hấp cấp tính nghiêm trọng 2 (SARS-CoV-2). Sau khi được truyền kháng sinh tĩnh mạch, áp dụng các biện pháp bảo vệ các cơ quan và điều trị các rối loạn đông máu, tình trạng sốt và hôn mê của bệnh nhân đã được cải thiện. Tuy nhiên, sau vài ngày, bệnh nhân xuất hiện khó thở và xuất huyết não. Bệnh nhân này bị nhiễm trùng phổi do nhiều loại vi khuẩn và rối loạn đông máu nghiêm trọng, cuối cùng dẫn đến hội chứng suy đa tạng và tử vong."
+    },
+    {
+        "id": "multiclinsum_gs_en_91.txt",
+        "fulltext": "A 13-year-old adolescent male, with no significant previous medical history, presented to the emergency department with a 3-day history of acute bilateral pleuritic chest pain associated with mild non-productive cough and no dyspnea. Associated with this, he had mild rhinorrhea and a single febrile episode that day (temperature of 38ºC). Chest pain was localized to the costal margin region and worsened with cough, without diurnal variation. The patient-reported relief with paracetamol. There were no complaints of joint pain, weight loss, anorexia, fatigue, episodes of syncope or exercise restriction. In fact, he practiced sports regularly—canoeing 2 times a week. No evidence of an infectious exposure or contact with household or environmental fumes, dust, or mineral oils was described. There was no known family history of cardiopulmonary conditions. He had a chest radiograph taken 4 years earlier during an acute illness, which showed a marked interstitial infiltrate that was presumptively treated with azithromycin with no further clinical symptoms and no further follow-up.\n\nOn admission, the patient’s temperature was 37.8°C with normal peripheral oxygen saturation (99%) in room air. His heart (93 beats per minute) and respiratory rate (15 breaths per minute) were normal and blood pressure was on the 85th percentile (115/66 mmHg). Physical examination revealed diminished breath sounds in the lower two thirds of the chest with no adventitious sounds. No respiratory distress, finger clubbing, cyanosis, abnormal heart sounds, or other findings were present. Chest radiograph revealed a marked interstitial infiltrate, comparable with his previous examination. A thoracic computed tomography (CT) revealed multiple bilateral areas of ground-glass opacities involving > 65% of lung parenchyma, suggestive of PAP. Respiratory viral testing was negative, and he remained stable throughout his monitoring in the emergency department. He was discharged with empiric antibiotics (amoxicillin-clavulanic acid and azithromycin) to cover a potential respiratory infection, with clinical resolution of symptoms and was sent for follow-up at the pediatric respiratory clinic.\n\nUpon further investigation in the outpatient setting, positive antinuclear antibodies (ANAs) at a titer of 1/89 with a fine speckled pattern were detected, while other autoantibodies tested negative and immunoglobulin levels remained within normal limits. Bronchoalveolar lavage revealed fluid with a milky appearance and positive periodic acid-Schiff staining; microbiological examination, including for mycobacteria, returned negative results. Spirometry indicated a mild restrictive pattern with reduced forced vital capacity (FVC) at 2.92 L (77%) and forced expiratory volume in 1 second (FEV1) at 3.21 L (69.9%), alongside a normal FEV1/FVC ratio (109%). In addition, the DLCO single breath (SB) showed a moderate decrease at 13.8 ml/min/mmHg (48.6%). Suspecting PAP, a genetic panel was conducted, which showed no mutations associated with surfactant dysfunction. Subsequently, GM-CSF antibody testing was performed with a positive result, raising suspicion for AI-PAP. At 20 months of follow-up, the patient remains asymptomatic and continues to exercise regularly. He repeated spirometry testing with normal FVC at 4.03 L (81.3%); FEV1 at 3.71 L (87.5%); FEV1/FVC ratio at 91.96% and DLCO SB at 25.54 ml/min/mmHg (83.7%). As the patient remains stable with no respiratory symptoms, we decided to defer treatment and continue monitoring with regular clinic visits.",
+        "summary": "We describe the case of a 13-year-old adolescent male who presented to the emergency department with acute pleuritic chest pain not associated with systemic complaints. On examination, he had diminished breath sounds in the lower two thirds of the chest with no other abnormal findings; SpO2 (oxygen saturation) was 98% on room air. Chest radiograph revealed a marked interstitial infiltrate, comparable with the one taken 4 years earlier during an acute illness that was presumptively treated with azithromycin. A computed tomography (CT) scan revealed multiple bilateral areas of ground-glass opacities with areas of crazy paving, involving > 65% of lung parenchyma, suggestive of pulmonary alveolar proteinosis (PAP). Respiratory viral testing, including for coronavirus (SARS-CoV2), was negative. Bronchoalveolar lavage performed in the outpatient setting revealed a milky fluid and positive periodic acid-Schiff staining. Spirometry indicated a mild restrictive pattern (forced vital capacity [FVC] = 77%) and diffusing capacity of the lungs for carbon monoxide (DLCO) showed a moderate decrease at 48.6%. No mutations associated with surfactant dysfunction were found on the genetic panel. Anti-granulocyte macrophage colony-stimulating factor (GM-CSF) antibody testing was strongly positive, raising suspicion for autoimmune PAP. At 20 months of follow-up, the patient remains asymptomatic with a normal spirometry.",
+        "translated_fulltext": "Một nam thiếu niên 13 tuổi, không có tiền sử bệnh lý đáng kể, đến khoa cấp cứu với các triệu chứng đau ngực hai bên cấp tính kéo dài 3 ngày, kèm theo ho khan nhẹ và không khó thở. Đồng thời, bệnh nhân có triệu chứng sổ mũi nhẹ và một đợt sốt trong ngày (nhiệt độ 38°C). Đau ngực tập trung ở vùng sườn và tăng lên khi ho, không thay đổi theo thời gian trong ngày. Bệnh nhân cho biết cảm thấy dễ chịu hơn khi dùng paracetamol. Bệnh nhân không có các triệu chứng đau khớp, sụt cân, chán ăn, mệt mỏi, các đợt ngất hoặc hạn chế vận động. Trên thực tế, bệnh nhân thường xuyên tập thể thao – chèo thuyền 2 lần một tuần. Không có bằng chứng về việc tiếp xúc với các tác nhân gây nhiễm trùng hoặc tiếp xúc với khói, bụi hoặc dầu khoáng trong gia đình hoặc môi trường. Không có tiền sử gia đình mắc các bệnh lý tim phổi. Bệnh nhân đã chụp X-quang ngực cách đây 4 năm trong một đợt bệnh cấp tính, cho thấy hình ảnh thâm nhiễm kẽ rõ rệt, được điều trị bằng azithromycin và không có thêm triệu chứng lâm sàng cũng như không cần theo dõi thêm.\n\nKhi nhập viện, nhiệt độ của bệnh nhân là 37,8°C, độ bão hòa oxy ngoại vi bình thường (99%) trong không khí phòng. Nhịp tim (93 nhịp/phút) và nhịp thở (15 nhịp/phút) bình thường, huyết áp ở mức phân vị thứ 85 (115/66 mmHg). Khám thực thể cho thấy âm phế giảm ở hai phần ba dưới của phổi, không có âm bất thường. Không có dấu hiệu khó thở, ngón tay phì đại, tím tái, tiếng tim bất thường hoặc các dấu hiệu khác. Chụp X-quang ngực cho thấy hình ảnh thâm nhiễm kẽ rõ rệt, tương tự như lần khám trước. Chụp cắt lớp vi tính (CT) lồng ngực cho thấy nhiều vùng mờ dạng kính mờ hai bên, ảnh hưởng đến hơn 65% nhu mô phổi, gợi ý bệnh phổi liên quan đến protein (PAP). Xét nghiệm virus đường hô hấp cho kết quả âm tính, và bệnh nhân vẫn ổn định trong suốt thời gian theo dõi tại khoa cấp cứu. Bệnh nhân được xuất viện với kháng sinh theo kinh nghiệm (amoxicillin-clavulanic acid và azithromycin) để điều trị nhiễm trùng đường hô hấp có thể xảy ra, các triệu chứng thuyên giảm và được chuyển đến phòng khám hô hấp nhi để theo dõi.\n\nTrong quá trình thăm khám thêm tại phòng khám ngoại trú, xét nghiệm kháng thể kháng nhân (ANA) dương tính với tỷ lệ 1/89 và kiểu hình đốm mịn, trong khi các kháng thể tự động khác cho kết quả âm tính và nồng độ immunoglobulin vẫn nằm trong giới hạn bình thường. Rửa phế nang - phế quản cho thấy dịch có màu trắng sữa và dương tính với thuốc nhuộm periodic acid-Schiff; xét nghiệm vi sinh, bao gồm cả xét nghiệm tìm vi khuẩn lao, cho kết quả âm tính. Thử nghiệm chức năng hô hấp cho thấy kiểu hạn chế nhẹ với dung tích sống gắng sức (FVC) giảm xuống 2,92 L (77%) và thể tích thở ra gắng sức trong 1 giây (FEV1) là 3,21 L (69,9%), cùng với tỷ lệ FEV1/FVC bình thường (109%). Ngoài ra, xét nghiệm DLCO (khí dung) cho thấy sự giảm vừa phải ở mức 13,8 ml/phút/mmHg (48,6%). Nghi ngờ bệnh PAP, một xét nghiệm di truyền đã được thực hiện, cho thấy không có đột biến liên quan đến rối loạn chức năng chất hoạt động bề mặt. Sau đó, xét nghiệm kháng thể GM-CSF được thực hiện và cho kết quả dương tính, làm tăng nghi ngờ về bệnh PAP tự miễn (AI-PAP). Sau 20 tháng theo dõi, bệnh nhân vẫn không có triệu chứng và tiếp tục tập thể dục thường xuyên. Bệnh nhân đã lặp lại xét nghiệm chức năng hô hấp với FVC bình thường là 4,03 L (81,3%); FEV1 là 3,71 L (87,5%); tỷ lệ FEV1/FVC là 91,96% và DLCO là 25,54 ml/phút/mmHg (83,7%). Vì bệnh nhân vẫn ổn định và không có triệu chứng hô hấp, chúng tôi quyết định trì hoãn điều trị và tiếp tục theo dõi bằng các lần khám định kỳ.",
+        "translated_summary": "Chúng tôi mô tả trường hợp của một nam thiếu niên 13 tuổi đến phòng cấp cứu với cơn đau ngực cấp tính, có tính chất viêm màng phổi, không kèm theo các triệu chứng toàn thân. Khi khám, thấy âm thổi phổi giảm ở hai phần dưới của lồng ngực, không có dấu hiệu bất thường khác; độ bão hòa oxy (SpO2) là 98% khi thở không khí bình thường. Chụp X-quang phổi cho thấy tình trạng thâm nhiễm kẽ rõ rệt, tương tự như hình ảnh chụp cách đây 4 năm trong đợt bệnh cấp tính, khi bệnh nhân được điều trị bằng azithromycin. Chụp cắt lớp vi tính (CT) cho thấy nhiều vùng mờ dạng kính mờ hai bên phổi, kèm theo các vùng có hình ảnh lát gạch, ảnh hưởng đến hơn 65% nhu mô phổi, gợi ý bệnh protein lắng đọng phế nang (PAP). Xét nghiệm virus đường hô hấp, bao gồm cả xét nghiệm coronavirus (SARS-CoV2), đều cho kết quả âm tính. Rửa phế nang – phế quản được thực hiện trong môi trường ngoại trú cho thấy dịch màu trắng sữa và kết quả nhuộm acid định kỳ Schiff dương tính. Thử nghiệm chức năng hô hấp cho thấy có tình trạng hạn chế nhẹ (dung tích sống gắng sức [FVC] = 77%) và khả năng khuếch tán của phổi đối với carbon monoxide (DLCO) giảm vừa phải ở mức 48,6%. Không phát hiện đột biến liên quan đến rối loạn chức năng chất hoạt động bề mặt trong xét nghiệm di truyền. Xét nghiệm kháng thể chống yếu tố kích thích thuộc dòng tế bào hạt trung tính – đại thực bào (GM-CSF) cho kết quả dương tính mạnh, làm dấy lên nghi ngờ về bệnh PAP tự miễn. Sau 20 tháng theo dõi, bệnh nhân vẫn không có triệu chứng và kết quả thử nghiệm chức năng hô hấp bình thường."
+    },
+    {
+        "id": "multiclinsum_gs_en_212.txt",
+        "fulltext": "27-year-old woman with a history of uncontrolled asthma, mild SARS-CoV-2 infection. In March 2021, she consulted a doctor for pain in the left hemicara and trismus. She reported having completed 48 hours before the antibiotic treatment with phenoxymethyl penicillin 1,000,000 IU daily orally for five days for a peritonsillar abscess. She was hemodynamically stable at the physical examination, without the need for supplemental oxygen, and without relevant findings in respiratory symptoms. The head and neck examination showed a soft, painful, cervical adenopathy, palpable and painful, predominantly homolateral and trismus. Complementary studies were performed. The admission laboratory reported leukocytosis, platelopenia, increased acute phase reactants and the rest of the parameters within normal values. An angiotomy of the craniofacial mass was performed, where a large thrombus was found in the internal and external carotid arteries. Studies were completed with a chest tomography and arterial Doppler ultrasound of neck vessels with no relevant findings. Early intravenous antibiotic treatment was initiated with ceftriaxone 1 g every 12 hours, clindamycin 300 mg every 6 hours and anticoagulation with enoxaparin adjusted to body weight and renal function, 60 mg subcutaneously every 12 hours. The patient evolved 72 hours after initiating the directed treatment with a fever of 38.5 °C and increased leukocytosis, so new complementary studies were performed, including a Doppler ultrasound of the heart without finding cardiac vegetations and a chest tomography where bilateral pulmonary septic emboli were found. With the admission hemocultures negative, a new admission of 3 units, culture of pharyngeal exudate and rotation of ceftriaxone to piperacillin tazobactam 4.5 g every 6 hours intravenous was decided. The patient evolved favorably, without rescue of germs in cultures. After 14 days of initiating the new therapeutic scheme, and with a control chest tomography without pulmonary lesions, it was decided to continue antibiotic treatment with oral clindamycin 300 mg every 6 hours, anticoagulation with acenocumarol adjusted to body weight and hospital discharge.\n",
+        "summary": "A 27-year-old woman presented with facial oedema and trismus 48 hours after completing treatment with phenoxymethylpenicillin for an odontogenic infection. A head and neck CT scan showed a large thrombus in the internal jugular vein and a chest CT scan showed pulmonary septic embolism. Treatment consisted of early intravenous broad spectrum antibiotics and anticoagulation.\n",
+        "translated_fulltext": "Một phụ nữ 27 tuổi có tiền sử bệnh hen suyễn không kiểm soát được và bị nhiễm SARS-CoV-2 nhẹ. Vào tháng 3 năm 2021, cô đến khám bác sĩ vì đau ở vùng bên trái của hàm và khó há miệng. Cô cho biết đã hoàn thành liệu trình điều trị bằng kháng sinh phenoxymethyl penicillin 1.000.000 IU đường uống mỗi ngày trong năm ngày để điều trị áp xe quanh amidan, bắt đầu 48 giờ trước khi đến khám. Trong quá trình khám lâm sàng, cô có tình trạng huyết động ổn định, không cần hỗ trợ oxy và không có triệu chứng hô hấp đáng kể. Khám đầu và cổ cho thấy hạch cổ mềm, đau, có thể sờ thấy và đau khi chạm vào, chủ yếu ở cùng bên và khó há miệng. Các xét nghiệm bổ sung đã được thực hiện. Kết quả xét nghiệm máu khi nhập viện cho thấy tăng bạch cầu, giảm tiểu cầu, tăng các chất phản ứng cấp tính và các chỉ số khác nằm trong giới hạn bình thường. Một phẫu thuật angiotomy khối u vùng sọ mặt đã được thực hiện, trong đó phát hiện một cục máu đông lớn trong động mạch cảnh trong và động mạch cảnh ngoài. Các xét nghiệm bổ sung bao gồm chụp cắt lớp ngực và siêu âm Doppler động mạch cổ, không phát hiện bất thường. Điều trị kháng sinh đường tĩnh mạch sớm được bắt đầu với ceftriaxone 1g mỗi 12 giờ, clindamycin 300mg mỗi 6 giờ và chống đông máu bằng enoxaparin, điều chỉnh theo cân nặng và chức năng thận, 60mg tiêm dưới da mỗi 12 giờ. Sau 72 giờ bắt đầu điều trị, bệnh nhân sốt 38,5°C và tăng bạch cầu, do đó, các xét nghiệm bổ sung mới đã được thực hiện, bao gồm siêu âm Doppler tim, không phát hiện các nốt viêm tim và chụp cắt lớp ngực, trong đó phát hiện các cục tắc mạch phổi hai bên. Vì các mẫu máu nuôi cấy không phát hiện vi khuẩn, quyết định nhập viện lại, lấy 3 mẫu máu, nuôi cấy dịch họng và chuyển sang sử dụng piperacillin tazobactam 4,5g mỗi 6 giờ đường tĩnh mạch. Bệnh nhân tiến triển tốt, không phát hiện vi khuẩn trong các mẫu nuôi cấy. Sau 14 ngày bắt đầu phác đồ điều trị mới và với kết quả chụp cắt lớp ngực kiểm tra không có tổn thương phổi, quyết định tiếp tục điều trị kháng sinh bằng clindamycin 300mg đường uống mỗi 6 giờ, chống đông máu bằng acenocumarol, điều chỉnh theo cân nặng và cho bệnh nhân xuất viện.",
+        "translated_summary": "Một phụ nữ 27 tuổi đến khám với các triệu chứng phù mặt và khó há miệng 48 giờ sau khi kết thúc điều trị bằng phenoxymethylpenicillin cho một bệnh nhiễm trùng có nguồn gốc từ răng. Chụp CT vùng đầu và cổ cho thấy một cục máu đông lớn trong tĩnh mạch cảnh trong, và chụp CT ngực cho thấy tình trạng tắc mạch phổi do nhiễm trùng. Điều trị bao gồm việc sử dụng sớm các loại kháng sinh phổ rộng bằng đường tĩnh mạch và thuốc chống đông máu."
+    },
+    {
+        "id": "multiclinsum_gs_en_205.txt",
+        "fulltext": "A 5-year-old presented to the paediatric emergency department (ED) having ingested chlorpyriphos 13 hours prior to presentation, followed by abnormal jerks, fast breathing and difficulty with breathing. The history was also comprised of excessive sweating and urination, mouth secretions and involuntary movement of the limbs. Vomiting followed the ingestion of crushed charcoal and palm oil. The patient had lapsed into coma prior to presentation. The temperature at presentation was 38.3°C, Glasgow coma score was 3, pupils were pinpoint pupils and there was hypotonia in all limbs. In addition, the patient was severely dyspneic, tachypneic (respiratory rate of 48/minute with intermittent sighing breaths), a saturation of 88% and widespread crackles. The pulse rate was 180/minute, blood pressure 120/80 mmHg, and random blood glucose 14 mg/dl. Serum lactate and cholinesterase tests were not done due to lack of facilities.\n\nThe patient was diagnosed with severe organophosphate poisoning (OPP) and aspiration pneumonitis. As ICU care was beyond the affordability of the parents, non-invasive ventilation (NIV) was administered using bubble continuous positive airway pressure (b-CPAP) causing his saturation to increase to 99%–100%. Hypoglycemia was corrected with a bolus of dextrose solution and tachycardia was treated with 20 ml/kg of normal saline. Intravenous Dexamethasone, Mannitol and IV Atropine at 0.02 mg/kg/dose were also administered. Empirical intravenous antibiotics were administered for aspiration pneumonitis. Pralidoxime was not given due to unavailability. Within 3 hours of presentation, the patient had fresh-whole-blood exchange-blood-transfusion (FWB-EBT) with 500mls of blood.\n\nThe patient’s GCS appreciated to 9/15 but IV Atropine was discontinued after the first dose due to a rapid increase in the heart rate. The blood glucose fluctuated between 41 to 259 mg/dl in the first 15 hours of admission and subsequently normalized with treatment. By the second day on admission, the patient developed thready pulses and hypotension for which another bolus of normal saline was administered. Dopamine infusion was commenced at 5mcg/kg/min using a peripheral vein and IV Mannitol discontinued. A second aliquot of FWB-EBT was administered with 500mls of blood.\n\nOver the first 30 hours of admission, the consciousness level improved and respiratory distress slowly declined. However, the patient developed rhonchi which was treated with nebulized Salbutamol and Budesonide and was subsequently transited to Oxygen therapy with nasal prongs with clinical improvement. The saturation remained stable at 97%. On Day 2 of admission, a chest radiograph was done which showed bilateral infiltrates in keeping with pneumonia.\n\nThe patient regained full consciousness by the 39th hour of admission. Intravenous Vitamin C and B, as well as oral Vitamin E and Zinc were commenced for their antioxidant effects, and regular diet was recommenced in a graded manner over the subsequent 48 hours. The patient’s clinical condition progressively improved and was discharged home after 10 days but was subsequently lost to follow-up.",
+        "summary": "We present the case of a 5-year-old with severe organophosphate poisoning from ingestion of chlorpyrifos, further worsened by aspiration of a charcoal-palm oil mixture. The clinical illness was marked by respiratory failure, shock, coma and type I paralysis. The patient was treated in the emergency department with noninvasive ventilation, multiple episodes of exchange transfusion, intravenous atropine, inotrope infusion, antibiotics and steroids. The patient responded rapidly to treatment, did not develop intermediate syndrome and was discharged after 10 days of admission.",
+        "translated_fulltext": "Một bệnh nhân 5 tuổi được đưa đến khoa cấp cứu nhi sau khi vô tình nuốt phải chlorpyriphos 13 giờ trước đó, sau đó xuất hiện các cơn co giật bất thường, thở nhanh và khó thở. Tiền sử bệnh cũng bao gồm đổ mồ hôi và đi tiểu quá nhiều, tiết dịch miệng và cử động không tự chủ của các chi. Sau khi nuốt phải than hoạt tính nghiền và dầu cọ, bệnh nhân bị nôn. Bệnh nhân đã rơi vào trạng thái hôn mê trước khi nhập viện. Nhiệt độ lúc nhập viện là 38,3°C, điểm Glasgow là 3, đồng tử co nhỏ và tất cả các chi đều bị giảm trương lực. Ngoài ra, bệnh nhân bị khó thở nghiêm trọng, thở nhanh (tần số thở 48 lần/phút, thở ngắt quãng), độ bão hòa oxy là 88% và có tiếng ran rít lan rộng. Nhịp tim là 180 lần/phút, huyết áp 120/80 mmHg và đường huyết ngẫu nhiên là 14 mg/dL. Các xét nghiệm lactate huyết thanh và cholinesterase không được thực hiện do thiếu điều kiện.\n\nBệnh nhân được chẩn đoán mắc chứng ngộ độc organophosphate (OPP) nghiêm trọng và viêm phổi do hít phải. Vì việc chăm sóc tại đơn vị chăm sóc đặc biệt (ICU) vượt quá khả năng chi trả của gia đình, bệnh nhân được hỗ trợ hô hấp không xâm lấn (NIV) bằng phương pháp tạo áp lực dương liên tục bằng bóng (b-CPAP), giúp độ bão hòa oxy tăng lên 99%–100%. Hạ đường huyết được điều chỉnh bằng cách truyền một lượng lớn dung dịch dextrose và nhịp tim nhanh được điều trị bằng 20 ml/kg dung dịch muối sinh lý. Bệnh nhân cũng được truyền tĩnh mạch Dexamethasone, Mannitol và Atropine với liều 0,02 mg/kg/lần. Thuốc kháng sinh tĩnh mạch được sử dụng để điều trị viêm phổi do hít phải. Pralidoxime không được sử dụng do không có sẵn. Trong vòng 3 giờ sau khi nhập viện, bệnh nhân được truyền máu toàn phần (FWB-EBT) với 500ml máu.\n\nĐiểm Glasgow của bệnh nhân cải thiện lên 9/15, nhưng Atropine tĩnh mạch được ngừng sau liều đầu tiên do nhịp tim tăng nhanh. Đường huyết dao động từ 41 đến 259 mg/dL trong 15 giờ đầu nhập viện và sau đó trở lại bình thường nhờ điều trị. Đến ngày thứ hai nhập viện, bệnh nhân xuất hiện mạch yếu và hạ huyết áp, và một lượng lớn dung dịch muối sinh lý khác được truyền. Thuốc Dopamine được bắt đầu truyền với liều 5mcg/kg/phút qua đường tĩnh mạch ngoại vi và Mannitol tĩnh mạch được ngừng. Một lượng FWB-EBT thứ hai được truyền với 500ml máu.\n\nTrong 30 giờ đầu nhập viện, mức độ ý thức của bệnh nhân cải thiện và tình trạng khó thở giảm dần. Tuy nhiên, bệnh nhân xuất hiện tiếng ran rít, được điều trị bằng cách xông khí dung Salbutamol và Budesonide, sau đó bệnh nhân được chuyển sang liệu pháp oxy qua ống thông mũi và tình trạng lâm sàng được cải thiện. Độ bão hòa oxy duy trì ổn định ở mức 97%. Vào ngày thứ 2 nhập viện, chụp X-quang ngực cho thấy có các đám mờ hai bên phổi, phù hợp với viêm phổi.\n\nBệnh nhân tỉnh táo hoàn toàn vào giờ thứ 39 nhập viện. Bệnh nhân được bắt đầu truyền tĩnh mạch Vitamin C và B, cũng như uống Vitamin E và Kẽm để tăng cường tác dụng chống oxy hóa, và chế độ ăn uống bình thường được bắt đầu lại một cách từ từ trong 48 giờ tiếp theo. Tình trạng lâm sàng của bệnh nhân dần cải thiện và được xuất viện sau 10 ngày, nhưng sau đó không được theo dõi tiếp.",
+        "translated_summary": "Chúng tôi xin trình bày trường hợp của một bệnh nhân 5 tuổi bị ngộ độc nghiêm trọng do organophosphate, nguyên nhân là do nuốt phải chlorpyrifos, tình trạng bệnh trở nên nghiêm trọng hơn do hít phải hỗn hợp than hoạt tính và dầu cọ. Các triệu chứng lâm sàng bao gồm suy hô hấp, sốc, hôn mê và liệt kiểu I. Bệnh nhân được điều trị tại khoa cấp cứu bằng cách hỗ trợ hô hấp không xâm lấn, thực hiện nhiều lần truyền máu thay thế, truyền atropine tĩnh mạch, truyền thuốc cường tim, kháng sinh và steroid. Bệnh nhân đáp ứng nhanh với điều trị, không phát triển hội chứng trung gian và được xuất viện sau 10 ngày nằm viện."
+    },
+    {
+        "id": "multiclinsum_gs_en_76.txt",
+        "fulltext": "A 19-year-old woman presented to the emergency department of our institution for acute onset of palpitations. An electrocardiogram (ECG) showed ventricular tachycardia, with right branch bundle block associated to left posterior hemiblock, and T waves inversion in the inferior and precordial leads. Blood test showed elevated troponin (27 ng/L, normal values <14 ng/L) and NT-pro BNP (aminoterminal pro B-Type Natriuretic Peptide) levels (2225 pg/mL, normal values <130 pg/mL). Hence, she was admitted to the coronary care unit.\n\nAbout 5 years before, she had already presented to the emergency department with cardiogenic shock due to fascicular ventricular tachycardia; she was subsequently hospitalized and underwent cardiac magnetic resonance (CMR) and a transoesophageal electrophysiological study, both with inconclusive results. She was discharged with a diagnosis of tachycardiomiopathy, with the prescription of a standard medical therapy (angiotensin-converting enzyme inhibitors, mineralocorticoid receptor antagonist, and beta blockers), and a follow-up was planned. Her subsequent clinical history was uneventful.\n\nDuring the present hospitalization, no further episodes of hyperkinetic arrhythmias were detected. Basal 12-lead ECG. Echocardiography showed diffuse hypokinesia of both the left and the right ventricles, and CMR was once again inconclusive. Then, the patient was advised to undergo cardiac computed tomography angiography (CCTA) to evaluate the anatomy of the coronary tree, under the suspicion of an undiagnosed congenital cardiac anomaly. CCTA was performed with a GE Lightspeed unit (GE HealthCare, Chicago, United States), with retrospective gating, at 100 kVp and 696 mAs, with a gantry rotation time of 0.35 s, and 0.625 mm slice thickness, with intravenous injection of 70 mL of Iomeron 400 mgI/mL (Bracco Imaging, Milan, Italy).\n\nDifferential diagnosis\nCardiogenic shock, namely a shock caused by inadequate blood flow, may be caused by different pathologies such as myocardial infarction, arrhythmias, or other cardiomyopathies. Undiagnosed congenital heart disease is a non-negligible cause of cardiogenic shock in otherwise healthy adult patients. Once myocardial infarction is ruled out by a 12-lead ECG, and an underlying cardiomyopathy has been excluded by an inconclusive CMR examination, CCTA is the technique of choice for the differential diagnosis among diverse causes of cardiogenic shock.\n\nInvestigations/imaging findings\nThe CCTA examination showed regular origin of the left main coronary artery, the left anterior descending artery, which presented a wide ramus intermedium, 2 diagonal branches, and the left circumflex artery, which appeared thin and non-dominant. Among all these vessels, there was no evidence of obstructive coronary artery disease. However, the ostium and the proximal portion of the right coronary artery (RCA) were absent, whereas its mid and distal portions were supplied by a wide collateral branch originating from the distal left anterior descending artery, which then surrounded the lateral wall of the right ventricle, ran through the distal part of the atrioventricular groove, finally giving rise to thin posterior interventricular and posterolateral arteries. Furthermore, a thin branch going from the mid left anterior descending artery to the sinoatrial node was observed.\n\nTreatment, outcome, and follow-up\nIn view of the CCTA findings, the patient underwent an echo-stress test, which confirmed the presence of inducible myocardial ischaemia in the inferior wall, in line with the positioning of the arrhythmic focus. After being transferred to a specialized centre for the diagnosis and treatment of congenital heart disease, the patient underwent transcatheter radiofrequency ablation of sustained ventricular tachycardia originating by the posteromedial papillary muscle. Then, she was discharged with medical therapy (Acetylsalicylic acid and Verapamil). At her 6-month follow-up, she has always been asymptomatic, with no further signs of arrhythmias.",
+        "summary": "A 19-year-old woman presented to the emergency department with arrhythmia and signs of cardiogenic shock. After a 12-lead electrocardiogram ruled out acute myocardial infarction, and cardiac magnetic resonance showed no sign of cardiomyopathy, cardiac computed tomography angiography (CCTA) was performed, displaying ostial atresia of the right coronary artery. She was thus referred to a specialist centre for congenital cardiovascular disease, where an electrophysiological study observed an arrhythmogenic focus on the posteromedial papillary muscle, which was ablated, and she has been asymptomatic since.",
+        "translated_fulltext": "Một phụ nữ 19 tuổi nhập viện khoa cấp cứu của bệnh viện chúng tôi vì tình trạng tim đập nhanh đột ngột. Điện tâm đồ (ECG) cho thấy nhịp nhanh thất, kèm theo tình trạng tắc nghẽn nhánh phải và block nhánh sau trái, cùng với sự đảo ngược sóng T ở các đạo trình dưới và trước tim. Xét nghiệm máu cho thấy nồng độ troponin tăng cao (27 ng/L, giá trị bình thường <14 ng/L) và nồng độ NT-pro BNP (peptit natri lợi tiểu loại B aminoterminal) tăng cao (2225 pg/mL, giá trị bình thường <130 pg/mL). Do đó, bệnh nhân được đưa vào khoa hồi sức tích cực tim mạch.\n\nKhoảng 5 năm trước, bệnh nhân đã từng nhập viện khoa cấp cứu vì sốc tim do nhịp nhanh thất; sau đó, bệnh nhân được nhập viện và thực hiện cộng hưởng từ tim (CMR) và nghiên cứu điện sinh lý qua thực quản, cả hai đều cho kết quả không rõ ràng. Bệnh nhân được xuất viện với chẩn đoán bệnh cơ tim do nhịp nhanh, được kê đơn điều trị nội khoa tiêu chuẩn (thuốc ức chế men chuyển angiotensin, thuốc đối kháng thụ thể mineralocorticoid và thuốc chẹn beta), và được lên kế hoạch theo dõi. Sau đó, bệnh nhân không gặp thêm vấn đề gì về sức khỏe.\n\nTrong lần nhập viện này, không phát hiện thêm các đợt rối loạn nhịp tim. ECG 12 đạo trình cơ bản. Siêu âm tim cho thấy tình trạng giảm động lan tỏa ở cả tâm thất trái và tâm thất phải, và CMR một lần nữa cho kết quả không rõ ràng. Sau đó, bệnh nhân được khuyên thực hiện chụp cắt lớp vi tính mạch vành (CCTA) để đánh giá cấu trúc của hệ thống mạch vành, với nghi ngờ về một dị tật tim bẩm sinh chưa được chẩn đoán. CCTA được thực hiện bằng máy GE Lightspeed (GE HealthCare, Chicago, Hoa Kỳ), với kỹ thuật gating hồi cứu, ở 100 kVp và 696 mAs, với thời gian quay gantry là 0,35 giây và độ dày lát cắt là 0,625 mm, với tiêm tĩnh mạch 70 mL Iomeron 400 mgI/mL (Bracco Imaging, Milan, Ý).\n\nChẩn đoán phân biệt\nSốc tim, tức là tình trạng sốc do lưu lượng máu không đủ, có thể do nhiều bệnh lý khác nhau như nhồi máu cơ tim, rối loạn nhịp tim hoặc các bệnh cơ tim khác. Bệnh tim bẩm sinh chưa được chẩn đoán là một nguyên nhân không thể bỏ qua gây sốc tim ở những bệnh nhân trưởng thành có sức khỏe tương đối tốt. Khi đã loại trừ nhồi máu cơ tim bằng ECG 12 đạo trình và loại trừ bệnh cơ tim tiềm ẩn bằng xét nghiệm CMR không rõ ràng, CCTA là kỹ thuật lựa chọn để chẩn đoán phân biệt giữa các nguyên nhân khác nhau gây sốc tim.\n\nKết quả thăm khám/chẩn đoán hình ảnh\nKết quả CCTA cho thấy nguồn gốc bình thường của động mạch vành trái chính, động mạch vành trái trước, có một nhánh trung gian rộng, 2 nhánh chéo và động mạch vành trái sau, có vẻ mỏng và không chiếm ưu thế. Trong tất cả các mạch máu này, không có bằng chứng về bệnh động mạch vành tắc nghẽn. Tuy nhiên, lỗ và phần gần của động mạch vành phải (RCA) bị thiếu, trong khi phần giữa và phần xa của nó được cung cấp bởi một nhánh bên lớn xuất phát từ phần xa của động mạch vành trái trước, sau đó bao quanh thành bên của tâm thất phải, đi qua phần xa của rãnh nhĩ thất, cuối cùng tạo ra các động mạch liên thất sau và động mạch liên thất sau bên mỏng. Ngoài ra, một nhánh mỏng đi từ phần giữa của động mạch vành trái trước đến hạch xoang nhĩ cũng được quan sát thấy.\n\nĐiều trị, kết quả và theo dõi\nDựa trên kết quả CCTA, bệnh nhân được thực hiện xét nghiệm gắng sức bằng siêu âm tim, kết quả xác nhận sự hiện diện của thiếu máu cơ tim có thể gây ra ở thành dưới, phù hợp với vị trí của ổ loạn nhịp. Sau khi được chuyển đến một trung tâm chuyên khoa để chẩn đoán và điều trị bệnh tim bẩm sinh, bệnh nhân được thực hiện đốt sóng cao tần qua da để điều trị nhịp nhanh thất kéo dài, có nguồn gốc từ cơ nhú sau giữa. Sau đó, bệnh nhân được xuất viện với điều trị nội khoa (axit acetylsalicylic và verapamil). Trong lần theo dõi 6 tháng, bệnh nhân luôn không có triệu chứng và không có dấu hiệu rối loạn nhịp tim nào khác.",
+        "translated_summary": "Một phụ nữ 19 tuổi nhập viện cấp cứu với các triệu chứng rối loạn nhịp tim và dấu hiệu của sốc tim. Sau khi điện tâm đồ 12 đạo loại trừ nhồi máu cơ tim cấp tính và cộng hưởng từ tim cho thấy không có dấu hiệu của bệnh cơ tim, chụp cắt lớp mạch vành (CCTA) được thực hiện, cho thấy tình trạng tắc nghẽn gốc động mạch vành phải. Do đó, bệnh nhân được chuyển đến một trung tâm chuyên khoa về bệnh tim mạch bẩm sinh, nơi một nghiên cứu điện sinh lý phát hiện ra một vùng gây rối loạn nhịp tim ở cơ nhú sau-giữa, và vùng này đã được đốt bỏ. Kể từ đó, bệnh nhân không còn triệu chứng."
+    },
+    {
+        "id": "multiclinsum_gs_en_72.txt",
+        "fulltext": "A 17-year-old male with no significant past medical or family history was referred to our clinic from the dental department following an incidental finding of a NFB during preoperative orthodontic planning, including dental x-rays and cone beam computed tomography (CBCT) without contrast. The patient was entirely asymptomatic and denied any history of nasal obstruction, rhinorrhea, epistaxis, foul odor, hyposmia, halitosis, facial pain, discomfort, or sleep disturbances. The patient's parents recalled an event when their son was seven, where he inserted an object into his nose. They sought medical advice, where no imaging was performed and an anterior rhinoscopy was utilized for diagnoses but due to the child's non-cooperation during the examination, the physician recommended the removal of the foreign body under sedation. However, the family did not follow up, and since the child remained asymptomatic, they assumed the foreign body had fallen out on its own. On endoscopic examination of the right nasal cavity, a deviated nasal septum with inferior turbinate hypertrophy was noted. The mucosa appeared erythematous and slightly edematous. A foreign body was visualized, lodged, and adhered to the floor of the nasal cavity beneath the inferior turbinate. The object was partially covered with mucus and possibly some crusted material and had a shiny appearance, indicating a metallic nature. Radiographic evaluation, including lateral and frontal X-rays, revealed a circular radiopaque object consistent with a metallic snap button located along the floor of the nasal cavity. The surrounding bony structures appeared normal. A CBCT confirmed the presence of the foreign body with associated mild inflammation, but no significant bony damage or sinus involvement was observed. With informed consent from the patient's parent, the foreign body was removed under local anesthesia in a semi-sitting position to reduce the risk of dislodgment to the airway. After decongesting the nasal cavity with Xylometazoline 0.1 % and administering Lidocaine spray (10 mg/spray) in the right nostril, a hook was utilized to disengage the foreign body, which was then retrieved using bayonet forceps. The procedure was uncomplicated, with minimal bleeding, easily controlled with saline irrigation. Post-removal examination showed no significant tissue damage. The retrieved object, a metallic snap button measuring 1 cm in diameter, exhibited signs of long-term exposure, including substantial corrosion and biological deposits. The patient was discharged in stable condition and prescribed nasal rinses with a sodium chloride irrigation solution (0.9 %). The patient was doing well at his two-week follow-up with an unremarkable examination.",
+        "summary": "We present the case of a 17-year-old male with an asymptomatic NFB discovered incidentally during routine dental radiography. The patient denied any history of nasal obstruction, epistaxis, or discomfort. Imaging revealed a radiopaque object in the right nasal cavity, later identified as a metallic snap button embedded in the floor of the nasal cavity. The foreign body had likely been retained for over a decade.",
+        "translated_fulltext": "Một nam thanh niên 17 tuổi, không có tiền sử bệnh lý hoặc tiền sử gia đình đáng kể, đã được chuyển đến phòng khám của chúng tôi từ khoa nha khoa sau khi phát hiện ngẫu nhiên một vật lạ trong mũi (NFB) trong quá trình lập kế hoạch điều trị chỉnh nha trước phẫu thuật, bao gồm chụp X-quang răng và chụp cắt lớp vi tính chùm nón (CBCT) không sử dụng chất cản quang. Bệnh nhân hoàn toàn không có triệu chứng và không có tiền sử nghẹt mũi, chảy nước mũi, chảy máu cam, mùi hôi, giảm khứu giác, hôi miệng, đau mặt, khó chịu hoặc rối loạn giấc ngủ. Cha mẹ của bệnh nhân nhớ lại một sự việc khi con trai họ lên bảy tuổi, khi cậu bé đã đưa một vật vào mũi. Họ đã tìm kiếm lời khuyên y tế, nhưng không thực hiện chụp ảnh và sử dụng phương pháp nội soi mũi trước để chẩn đoán. Tuy nhiên, do sự không hợp tác của trẻ trong quá trình khám, bác sĩ đã đề nghị loại bỏ vật lạ khi gây mê. Tuy nhiên, gia đình không thực hiện theo, và vì trẻ vẫn không có triệu chứng, họ cho rằng vật lạ đã tự rơi ra. Trong quá trình nội soi khoang mũi phải, người ta nhận thấy vách ngăn mũi bị lệch và cuốn mũi dưới phì đại. Niêm mạc có vẻ đỏ và hơi phù. Một vật lạ được nhìn thấy, mắc kẹt và dính vào sàn khoang mũi, bên dưới cuốn mũi dưới. Vật này được bao phủ một phần bởi chất nhầy và có thể có một số chất đóng váng, đồng thời có vẻ ngoài bóng loáng, cho thấy nó có bản chất kim loại. Đánh giá bằng hình ảnh, bao gồm chụp X-quang bên và trước, cho thấy một vật tròn, cản quang, phù hợp với một nút bấm kim loại nằm dọc theo sàn khoang mũi. Các cấu trúc xương xung quanh có vẻ bình thường. Chụp CBCT xác nhận sự hiện diện của vật lạ cùng với tình trạng viêm nhẹ, nhưng không thấy tổn thương xương đáng kể hoặc liên quan đến xoang. Sau khi được sự đồng ý của cha mẹ bệnh nhân, vật lạ đã được loại bỏ dưới gây tê tại chỗ ở tư thế ngồi nửa người để giảm nguy cơ vật lạ rơi vào đường thở. Sau khi làm thông thoáng khoang mũi bằng Xylometazoline 0,1% và sử dụng bình xịt Lidocaine (10 mg/lần xịt) vào lỗ mũi phải, một móc đã được sử dụng để gỡ vật lạ ra, sau đó được lấy ra bằng kẹp nhọn. Thủ thuật diễn ra suôn sẻ, với ít chảy máu, dễ dàng kiểm soát bằng cách rửa bằng nước muối. Khám sau khi loại bỏ cho thấy không có tổn thương mô đáng kể. Vật được lấy ra, một nút bấm kim loại có đường kính 1 cm, có dấu hiệu tiếp xúc lâu dài, bao gồm sự ăn mòn đáng kể và các chất lắng đọng sinh học. Bệnh nhân được xuất viện trong tình trạng ổn định và được kê đơn rửa mũi bằng dung dịch tưới muối (0,9%). Bệnh nhân có tình trạng tốt trong lần tái khám sau hai tuần, với kết quả khám không đáng kể.",
+        "translated_summary": "Chúng tôi xin trình bày trường hợp của một nam thanh niên 17 tuổi, phát hiện ngẫu nhiên một vật thể lạ trong khoang mũi khi chụp X-quang răng thông thường, nhưng bệnh nhân không có bất kỳ triệu chứng nào. Bệnh nhân phủ nhận tiền sử nghẹt mũi, chảy máu cam hoặc khó chịu. Hình ảnh cho thấy một vật thể cản quang trong khoang mũi phải, sau đó được xác định là một cúc kim loại bị mắc kẹt ở đáy khoang mũi. Có khả năng vật thể lạ này đã mắc kẹt trong khoang mũi hơn một thập kỷ."
+    },
+    {
+        "id": "multiclinsum_gs_en_405.txt",
+        "fulltext": "We report a rare case of euthyroid unilateral GO with early massive mono-muscular fibrosis in a 50-year-old male patient. The patient had a family history of cardiovascular disease, type 2 diabetes mellitus, and myasthenia gravis but no family or personal history of thyroid autoimmune disease. The patient was a smoker of 20 cigarettes a day from the age of 30 and presented dyslipidemia for several years. Since June 2020, he experienced rapid and progressive swelling of the soft tissues in the right orbit, moderate pain during ocular globe movements, redness of eyelids and diplopia. Visual acuity was normal in both eyes. In October 2020, the patient was evaluated in our outpatient clinic. Moderate right orbit active inflammation was confirmed by Clinical Activity Score 3/7 (CAS),3 and eyelid edema was moderate. The eyelid aperture was 14 mm in the right orbit and 10 mm in the left orbit, and the Hertel measurements were 24 mm and 18 mm in the right and left orbits, respectively. In addition, the patient presented a severe reduction in elevation, persistent depression in the primary position of the right ocular globe and constant diplopia, as scored according to the Gorman score.4 The quality of life evaluated by Graves’ Ophthalmopathy quality of life questionnaire (GO-QOL)5 was reduced in both appearance and functional subscales. However, the functional subscale was reduced with respect to the appearance subscale, as the values were 12.5 and 50, respectively (considering 0 = worse condition and 100 = the best health state). Visual acuity was normal, and color vision by Ishihara tables was 16/17 and 17/17 in the right and left eyes, respectively. Evaluation of extraocular muscles by computer tomography (CT) scan (contiguous 1.25 mm thick slices, 200 mA, 120 kV, pitch 0.5) showed severe enlargement of the lower rectal body to the edge of the insertion tendon in the right orbit. Remarkably, the morphology of the other extraocular muscles in both orbits was normal. The muscle orbit area ratio measured in the right eyes was 0.25 Autocad units (in-house method; vn ≤ 0.20±0.03).6 Thyroid function was normal with a slight increase in TSH-R-Ab: 1.75 mU/l (n.v. < 1.5 mU/l). The amplitude of the p100 wave was slightly reduced by electrophysiology evaluation in the right eye. A thyroid ultrasound scan of the thyroid gland showed a thyroiditis pattern. Biochemical and clinical evaluations were negative for hematological or other systemic diseases. Routine clinical tests were normal, but the total cholesterol levels that were 220 mg/dl, triglyceride levels were 297 mg/dl, and high-density lipoprotein cholesterol (HDL) levels were 38 mg/dl.\n\nThe patient was treated by intravenous corticosteroid pulse therapy (Solumedrol; Pfizer, Karlsruhe, Germany) with a cumulative dose of 4500 mg over 12 weeks, leading to the resolution of inflammatory signs and symptoms. However, GO-QOL, Hertel measurements and diplopia remained unchanged; in contrast, electrophysiology evaluation and visual acuity worsened. Two-wall orbital surgical decompression plus parenteral glucocorticoids was chosen as the second-line treatment for GO. In that context, a biopsy of the right inferior rectus muscle revealed massive fibrosis with adipose tissue infiltration of this extraocular muscle.",
+        "summary": "Here, we present a rare case of euthyroid single muscular GO in a 50-year-old patient who was a smoker and had dyslipidemia for several years. The patient experienced a very rapid and severe depression of ocular motility of the right eye that caused uncorrectable and constant diplopia, severely affecting his quality of life. He was euthyroid, and TSH-R-Ab plasmatic levels were only slightly elevated. Intravenous corticosteroid pulse therapy was partially effective, and two rounds of wall orbital surgical decompression were necessary. Massive mono-muscular fibrosis was evidenced by biopsy of the right inferior rectus muscle.",
+        "translated_fulltext": "Chúng tôi báo cáo một trường hợp hiếm gặp của bệnh cường giáp không điển hình một bên với xơ cơ đơn độc và tiến triển nhanh ở một bệnh nhân nam 50 tuổi. Bệnh nhân có tiền sử gia đình mắc bệnh tim mạch, tiểu đường loại 2 và nhược cơ, nhưng không có tiền sử gia đình hoặc cá nhân về bệnh tự miễn tuyến giáp. Bệnh nhân hút 20 điếu thuốc mỗi ngày từ năm 30 tuổi và có tình trạng rối loạn lipid máu trong nhiều năm. Từ tháng 6 năm 2020, bệnh nhân bị sưng nhanh và tiến triển của các mô mềm ở hốc mắt phải, đau vừa phải khi cử động nhãn cầu, đỏ mí mắt và song thị. Thị lực bình thường ở cả hai mắt. Vào tháng 10 năm 2020, bệnh nhân được thăm khám tại phòng khám ngoại trú của chúng tôi. Viêm hoạt động vừa phải ở hốc mắt phải được xác nhận bằng Điểm hoạt động lâm sàng 3/7 (CAS), và phù mí mắt ở mức độ vừa phải. Khoảng cách mở mí mắt là 14 mm ở hốc mắt phải và 10 mm ở hốc mắt trái, và các phép đo Hertel là 24 mm và 18 mm ở hốc mắt phải và trái, tương ứng. Ngoài ra, bệnh nhân có sự giảm đáng kể về khả năng nâng, tình trạng trũng kéo dài ở vị trí ban đầu của nhãn cầu phải và song thị liên tục, được đánh giá theo thang điểm Gorman. Chất lượng cuộc sống được đánh giá bằng bảng câu hỏi chất lượng cuộc sống của bệnh cường giáp (GO-QOL) giảm ở cả hai khía cạnh về ngoại hình và chức năng. Tuy nhiên, khía cạnh chức năng giảm so với khía cạnh ngoại hình, với các giá trị tương ứng là 12,5 và 50 (trong đó 0 = tình trạng xấu nhất và 100 = trạng thái sức khỏe tốt nhất). Thị lực bình thường, và thị lực màu sắc theo bảng Ishihara là 16/17 và 17/17 ở mắt phải và mắt trái, tương ứng. Đánh giá các cơ ngoại nhãn bằng chụp cắt lớp vi tính (CT) (các lát cắt liên tục dày 1,25 mm, 200 mA, 120 kV, bước 0,5) cho thấy sự phì đại đáng kể của phần dưới của cơ trực tràng đến mép gân bám ở hốc mắt phải. Đáng chú ý, hình thái của các cơ ngoại nhãn khác ở cả hai hốc mắt đều bình thường. Tỷ lệ diện tích cơ trên hốc mắt được đo ở mắt phải là 0,25 đơn vị Autocad (phương pháp nội bộ; vn ≤ 0,20 ± 0,03). Chức năng tuyến giáp bình thường với sự gia tăng nhẹ của TSH-R-Ab: 1,75 mU/l (giá trị bình thường < 1,5 mU/l). Biên độ của sóng p100 giảm nhẹ khi đánh giá bằng điện sinh lý ở mắt phải. Siêu âm tuyến giáp cho thấy hình ảnh viêm tuyến giáp. Các đánh giá sinh hóa và lâm sàng cho thấy không có bệnh lý về máu hoặc các bệnh lý hệ thống khác. Các xét nghiệm lâm sàng thông thường bình thường, nhưng mức cholesterol toàn phần là 220 mg/dL, mức triglyceride là 297 mg/dL và mức cholesterol lipoprotein mật độ cao (HDL) là 38 mg/dL.\n\nBệnh nhân được điều trị bằng liệu pháp corticosteroid tĩnh mạch (Solumedrol; Pfizer, Karlsruhe, Đức) với liều tích lũy 4500 mg trong 12 tuần, dẫn đến việc giảm các dấu hiệu và triệu chứng viêm. Tuy nhiên, GO-QOL, các phép đo Hertel và song thị vẫn không thay đổi; trái lại, đánh giá bằng điện sinh lý và thị lực trở nên xấu hơn. Giải phẫu hốc mắt hai thành kết hợp với glucocorticoid đường tiêm tĩnh mạch được chọn làm phương pháp điều trị thứ hai cho bệnh cường giáp. Trong bối cảnh đó, sinh thiết cơ trực dưới phải cho thấy xơ cơ đáng kể với sự xâm nhập của mô mỡ vào cơ ngoại nhãn này.",
+        "translated_summary": "Ở đây, chúng tôi trình bày một trường hợp hiếm gặp về bệnh cơ mắt đơn độc không liên quan đến rối loạn chức năng tuyến giáp ở một bệnh nhân 50 tuổi, người có tiền sử hút thuốc và bị rối loạn lipid máu trong nhiều năm. Bệnh nhân bị giảm đáng kể và nhanh chóng khả năng vận động của mắt phải, gây ra song thị không thể điều chỉnh và liên tục, ảnh hưởng nghiêm trọng đến chất lượng cuộc sống của ông. Bệnh nhân có chức năng tuyến giáp bình thường và nồng độ TSH-R-Ab trong huyết tương chỉ tăng nhẹ. Liệu pháp corticosteroid tiêm tĩnh mạch cho thấy hiệu quả một phần, và cần phải thực hiện hai lần phẫu thuật giải ép hốc mắt. Sự xơ hóa cơ đơn độc đáng kể được xác nhận thông qua sinh thiết cơ vận nhãn dưới bên phải."
+    },
+    {
+        "id": "multiclinsum_gs_en_345.txt",
+        "fulltext": "We present the clinical case of a 15-year-old male with no medical history or previous interventions, who presented to the paediatric emergency department with a history of vomiting and epigastric abdominal pain of four days' duration, remaining afebrile during the course of the illness.\n\nInitially treated as gastroenteritis, but with no improvement, and with persistence of epigastric abdominal pain and biliary vomiting, he was admitted to the emergency department for further evaluation.\n\nOn physical examination, the patient was in acceptable general condition, afebrile, with mild signs of dehydration. The abdomen was distended, without signs of peritonism and with decreased hydroaerolic sounds. The laboratory tests did not present significant findings, and an abdominal radiograph was performed with findings suggestive of intestinal obstruction.\n\nGiven the evolution, an urgent computed tomography was performed, which showed the presence of ascites and significant dilation of small intestine loops, suggesting the interposition of a small intestine loop at the beginning of the transcavity of the epiplons, with a change in caliber at the level of the hiatus of Winslow.\n\nUrgent surgical intervention was performed, initially by exploratory laparoscopy. Dilated loops of small intestine and terminal ileum, cecum and ascending colon of normal calibre but located in the right hypochondrium, with the cecum very mobile and without presenting adhesions to the right parietocolic space, were observed. Following the terminal ileum proximally, loops of small intestine of different calibre were observed from the depth of the theoretical location of the hiatus of Winslow. It was possible to pull the cecum and terminal ileum until they were displaced to the right iliac fossa, but without correctly identifying the point of change of calibre, since the interposition of the lower edge of the liver and the distension of loops of small intestine hampered the technique. An attempt was made to improve visualization by percutaneous puncture of a dilated loop to empty the gas, without improvement. To ensure the resolution of the obstructive picture, a supraumbilical mid-laparotomy was decided. When accessing the cavity, the change of calibre in the ileum was evident, about 40 centimetres from the ileocecal valve, with signs compatible with hernia of a section of about five centimetres of the ileum through the hiatus of Winslow. In both ends of the herniated loop, we observed the congestive imprint of the hiatus on the loop (Fig. 3). The normal calibre of the hiatus of Winslow was identified, so no preventive technique was performed to reduce the risk of recurrence.\n\nDuring the first days of the postoperative period, the patient presented a paralytic ileus, and the nasogastric tube could be removed five days after surgery and oral tolerance was initiated with a good response. Simultaneously, he developed a pelvic collection that was managed conservatively with antibiotics, with a good evolution. Finally, the patient was discharged ten days after the intervention, with preserved transit, remaining afebrile and with a good general state.\n\nThe patient is currently being followed up in the outpatient department of paediatric surgery.\n",
+        "summary": "We present the clinical case of a 15-year-old adolescent male with no previous surgical history, who presented with abdominal pain and vomiting, and whose computed tomography suggested a picture of intestinal obstruction due to internal hernia at the level of the Winslow hiatus. He required surgical intervention by exploratory laparoscopy, converted to a supraumbilical midline laparotomy due to poor visualization, for reduction of the herniated ileal loop. This presented a good appearance and intestinal resection was not necessary. No preventive technique was performed to reduce the risk of recurrence. Postoperatively, the patient presented a pelvic collection managed conservatively with antibiotics. He is currently being monitored in outpatient paediatric surgery.\n",
+        "translated_fulltext": "Chúng tôi xin trình bày một trường hợp lâm sàng của một bệnh nhân nam 15 tuổi, không có tiền sử bệnh lý hoặc các can thiệp y tế trước đây, đến khoa cấp cứu nhi với các triệu chứng nôn mửa và đau bụng vùng thượng vị kéo dài bốn ngày, không sốt trong suốt quá trình bệnh.\n\nBan đầu, bệnh nhân được điều trị như viêm dạ dày ruột, nhưng tình trạng không cải thiện, và các triệu chứng đau bụng vùng thượng vị và nôn ra dịch mật vẫn tiếp diễn, bệnh nhân được đưa vào khoa cấp cứu để đánh giá thêm.\n\nKhi khám lâm sàng, bệnh nhân có tình trạng chung chấp nhận được, không sốt, có dấu hiệu mất nước nhẹ. Bụng phình to, không có dấu hiệu viêm phúc mạc và âm thanh ruột giảm. Các xét nghiệm trong phòng thí nghiệm không cho thấy kết quả đáng kể, và chụp X-quang bụng được thực hiện, cho thấy dấu hiệu gợi ý tắc ruột.\n\nDựa trên diễn biến bệnh, chụp cắt lớp vi tính khẩn cấp được thực hiện, cho thấy có dịch trong ổ bụng và giãn đáng kể các quai ruột non, gợi ý một quai ruột non bị kẹt ở đầu của khoang phúc mạc, với sự thay đổi về đường kính tại vị trí lỗ Winslow.\n\nCan thiệp phẫu thuật khẩn cấp được thực hiện, ban đầu bằng phương pháp nội soi ổ bụng để thăm dò. Các quai ruột non và hồi tràng cuối, manh tràng và đại tràng lên có đường kính bình thường nhưng nằm ở vùng hạ sườn phải, manh tràng rất linh hoạt và không có dấu hiệu dính vào khoang phúc mạc bên phải, được quan sát thấy. Tiếp theo hồi tràng cuối về phía trên, các quai ruột non có đường kính khác nhau được quan sát thấy từ sâu bên trong vị trí lý thuyết của lỗ Winslow. Có thể kéo manh tràng và hồi tràng cuối cho đến khi chúng bị đẩy vào hố chậu phải, nhưng không xác định được chính xác điểm thay đổi đường kính, vì sự kẹt của bờ dưới gan và sự giãn của các quai ruột non đã cản trở kỹ thuật. Một nỗ lực đã được thực hiện để cải thiện khả năng quan sát bằng cách chọc thủng một quai ruột giãn để giải phóng khí, nhưng không có cải thiện. Để đảm bảo giải quyết tình trạng tắc nghẽn, quyết định thực hiện phẫu thuật mở bụng trên rốn. Khi tiếp cận khoang bụng, sự thay đổi đường kính ở hồi tràng trở nên rõ ràng, cách van hồi manh tràng khoảng 40 centimet, với các dấu hiệu tương thích với thoát vị một đoạn khoảng năm centimet của hồi tràng qua lỗ Winslow. Ở cả hai đầu của quai ruột bị thoát vị, chúng tôi quan sát thấy dấu hiệu chèn ép do lỗ Winslow gây ra (Hình 3). Đường kính bình thường của lỗ Winslow được xác định, vì vậy không có kỹ thuật phòng ngừa nào được thực hiện để giảm nguy cơ tái phát.\n\nTrong những ngày đầu của giai đoạn hậu phẫu, bệnh nhân bị liệt ruột, và ống thông dạ dày có thể được rút ra sau năm ngày phẫu thuật và bắt đầu cho bệnh nhân ăn uống qua đường miệng với kết quả tốt. Đồng thời, bệnh nhân xuất hiện một khối dịch trong vùng chậu, được điều trị bảo tồn bằng kháng sinh, với diễn biến tốt. Cuối cùng, bệnh nhân được xuất viện sau mười ngày can thiệp, với chức năng tiêu hóa được bảo tồn, không sốt và có tình trạng chung tốt.\n\nHiện tại, bệnh nhân đang được theo dõi tại phòng khám ngoại trú của khoa phẫu thuật nhi.",
+        "translated_summary": "Chúng tôi xin trình bày một trường hợp lâm sàng của một nam thanh thiếu niên 15 tuổi, không có tiền sử phẫu thuật trước đây, đến khám vì đau bụng và nôn mửa. Kết quả chụp cắt lớp cho thấy có dấu hiệu tắc ruột do thoát vị nội tạng tại vị trí lỗ Winslow. Bệnh nhân cần phải phẫu thuật bằng phương pháp nội soi ổ bụng để thăm dò, sau đó chuyển sang phẫu thuật mở đường giữa trên rốn do hình ảnh quan sát không rõ, nhằm mục đích giải phóng đoạn ruột non bị thoát vị. Sau phẫu thuật, tình trạng bệnh nhân cải thiện và không cần phải cắt bỏ ruột. Không có biện pháp phòng ngừa nào được thực hiện để giảm nguy cơ tái phát. Sau phẫu thuật, bệnh nhân có tình trạng tích tụ dịch trong vùng chậu, được điều trị bảo tồn bằng kháng sinh. Hiện tại, bệnh nhân đang được theo dõi ngoại trú tại khoa phẫu thuật nhi."
+    },
+    {
+        "id": "multiclinsum_gs_en_583.txt",
+        "fulltext": "A 19-year-old female presented to our hospital’s emergency room with a chief complaint of a two-day history of headache, accompanied by recurrent nausea, vomiting, and a one-day fever. On admission, her physical examination revealed a high fever of 39.1°C, elevated blood pressure at 189/120 mmHg, and a pulse rate of 148 beats per minute. Laboratory results indicated an elevated white blood cell count of 14.77×10^9/L and a neutrophil count of 13.55×10^9/L, suggesting a possible infection or inflammatory response. Initial empirical treatment with antibiotics was administered due to suspected infection, but her symptoms persisted. Given her abnormal vital signs, elevated inflammatory markers, and lack of symptom improvement, the patient was admitted for further diagnostic evaluation and transferred to the intensive care unit for close monitoring. A year prior, the patient had presented with similar symptoms and was diagnosed with myocarditis at a local hospital based on clinical findings at that time. During that hospitalization, she was also diagnosed with hypertension and prescribed antihypertensive medications. However, after discharge, the patient did not adhere to the prescribed antihypertensive therapy and did not regularly monitor her blood pressure. Additionally, it is notable that her father had a history of sudden, unexplained death.\n\nTo investigate the underlying etiology of the patient’s symptoms, a chest computed tomography (CT) scan was performed. Incidentally, this scan revealed a left adrenal mass with soft tissue density, measuring 43 mm × 36 mm. No pathological findings were observed in the head and chest CT scans. The electrocardiogram demonstrated sinus tachycardia with a shortened PR interval and tall, peaked P-waves in leads II, III, and aVF. Transthoracic echocardiography did not reveal any significant abnormalities.\n\nOn the second day of admission, the patient exhibited rising levels of brain natriuretic peptide (BNP) and Troponin I (TnI). The cardiologist provisionally diagnosed the patient with myocarditis of uncertain etiology, based on clinical presentation, elevated cardiac biomarkers (BNP and TnI), and supportive electrocardiogram findings. Treatment was initiated with methylprednisolone (0.25 g daily) to address potential myocardial inflammation due to suspected myocarditis. Furosemide (20 mg every 12 hours) and spironolactone (20 mg every 12 hours) were administered as diuretics to manage fluid retention and reduce cardiac workload. Perindopril amlodipine (10 mg: 5 mg daily) was prescribed as an angiotensin-converting enzyme inhibitor and calcium channel blocker combination to control blood pressure and reduce afterload. Metoprolol tartrate (25 mg every 12 hours) was used to manage heart rate and decrease myocardial oxygen demand, while esmolol (0.2 g/hour intravenous infusion), a short-acting beta-blocker, was administered for additional acute heart rate control due to sinus tachycardia. Due to concerns about a potential infection, moxifloxacin was added as empiric antibiotic therapy.\n\nGiven the patient’s presentation with an adrenal mass and hypertension, the endocrinologist recommended an evaluation of the aldosterone-to-renin ratio, plasma cortisol, plasma catecholamines, and 24-hour urinary catecholamines along with their metabolites. In the recumbent position, plasma and urinary catecholamine levels were markedly elevated (Table 1), including plasma dopamine at 524.5 pmol/L, norepinephrine at 83975 pmol/L, and epinephrine at 10579.3 pmol/L. Additionally, the 24-hour urinary levels showed free adrenaline at 4368.89 nmol/24 hours, free norepinephrine exceeding 12697.60 nmol/24 hours, normetanephrine at 8312 nmol/24 hours, metanephrines at 4078 nmol/24 hours, and vanillylmandelic acid at 58.1 mg/24 hours. These findings supported a clinical diagnosis of pheochromocytoma. On the fifth day post-admission, glucocorticoid therapy was discontinued, and perindopril amlodipine was substituted with terazosin for more targeted blood pressure management.\n\nAn enhanced abdominal CT scan further confirmed a left adrenal mass, highly suggestive of pheochromocytoma. Additionally, after obtaining informed consent, whole-exome sequencing was performed, revealing a heterozygous missense mutation, c.1900T > C: p. Cys634Arg, in the RET gene, leading to a substitution of cysteine with arginine at codon 634. This mutation raised suspicion for multiple endocrine neoplasia syndrome, prompting further evaluation of the thyroid and parathyroid glands. Thyroid color Doppler ultrasound identified a hypoechoic mass measuring 6 mm × 4 mm in the left thyroid lobe, and a mild elevation in calcitonin levels was noted. No additional significant abnormalities were detected.\n\nAs the patient’s condition gradually improved, plasma cortisol and ACTH levels returned to normal. The patient was subsequently discharged with a prescription for metoprolol tartrate (100 mg every 12 hours) and ivabradine hydrochloride (5 mg every 12 hours) for home management. Three months later, after achieving stable clinical status, the patient underwent resection of the left adrenal tumor, which measured 50 mm × 40 mm × 30 mm. Immunohistochemical analysis confirmed positive staining for Vim, CD56, Syn, CgA, and NSE, with S-100 positive in Sertoli cells, while CKpan, CD10, MART-1/Melan-A, and Melan-A were negative. The Ki67 index was 1%, leading to a definitive diagnosis of adrenal pheochromocytoma. The patient was discharged without further medications and has since been regularly followed up postoperatively without recurrence of symptoms. Over a 15-month postoperative follow-up, the patient exhibited persistently mild hypercalcitoninemia with stable thyroid nodule size, while PTH and serum calcium levels showed a progressive increase (Table 2). Further parathyroid scintigraphy using 99mTc-MIBI was performed, and the conclusion was a negative result for parathyroid adenoma.",
+        "summary": "We report the case of a 19-year-old female who presented with pheochromocytoma without experiencing a crisis, despite having a significant adrenal mass and undergoing high-dose glucocorticoid treatment. Genetic testing revealed a heterozygous missense mutation in the RET gene (c.1900T > C: p. Cys634Arg), associated with MEN2A. Further endocrine evaluation identified a thyroid nodule with mildly elevated calcitonin levels, but normal electrolyte and parathyroid hormone levels. Over a 15-month postoperative follow-up, the patient exhibited persistently mild hypercalcitoninemia with stable thyroid nodule size, while PTH and serum calcium levels showed a progressive increase. Further parathyroid scintigraphy using 99mTc-MIBI was performed, yielding a negative result for parathyroid adenoma.",
+        "translated_fulltext": null,
+        "translated_summary": "Chúng tôi báo cáo về trường hợp của một bệnh nhân nữ 19 tuổi bị u tủy thượng thận nhưng không gặp phải tình trạng khủng hoảng, mặc dù bệnh nhân có khối u tuyến thượng thận đáng kể và đã được điều trị bằng glucocorticoid liều cao. Xét nghiệm di truyền cho thấy có một đột biến thay thế đơn nucleotide dị hợp tử trong gen RET (c.1900T > C: p. Cys634Arg), có liên quan đến hội chứng MEN2A. Đánh giá nội tiết tiếp theo cho thấy có một nốt tuyến giáp với mức calcitonin tăng nhẹ, nhưng mức điện giải và hormone tuyến cận giáp bình thường. Trong quá trình theo dõi sau phẫu thuật kéo dài 15 tháng, bệnh nhân vẫn có tình trạng tăng calcitonin nhẹ liên tục với kích thước nốt tuyến giáp ổn định, trong khi mức PTH và canxi huyết thanh tăng dần. Tiếp tục thực hiện chụp xạ hình tuyến cận giáp bằng 99mTc-MIBI, kết quả cho thấy không có dấu hiệu của u tuyến cận giáp."
+    },
+    {
+        "id": "multiclinsum_gs_en_515.txt",
+        "fulltext": "February 2020, a 36-year-old with no significant past medical history presented with 5 years history of left sided penoscrotal mass. He has no lower urinary tract symptoms. No History of trauma or infections and he denied any history of weight loss, anorexia or fever. On examination, there is a smooth surface, tender cystic lesion around 20 mm ∗ 20 mm attached to the left side of the bulbar urethra at the penoscrotal junction, it was deep without any skin tethering and not related to the left spermatic cord and it was partially mobile.\n\nDoppler ultrasonography showed a well-defined hypoechoic mass measuring 2.7 ∗ 3.1 ∗ 2.0 cm with significantly increased vascularity at the left of penoscrotal junction. Pelvis Magnetic resonance imaging revealed a mass in the left inferolateral side of the base of the penis with a clear fat plane, which is isointense to the testes in the T2 weighted imaging, T1 weighted imaging and Diffusion-weighted imaging and it was connected to the vas deferens, no lymphadenopathy was noted. Alpha fetoprotein and beta-human chronic gonadotrophin levels were all in the normal range. Given the results of workup and the pain experienced by the patient, a decision was made to proceed with surgical removal of the mass for both diagnostic and therapeutic purposes. During surgery, a mass was seen in the left posterolateral of the scrotum and it was resected completely and sent for histopathology.\n\nHistopathology of the mass showed cellular spindle cell tumour arranged into interlacing fascicle, the cells have spindle to oval vesicular nuclei with evenly dispersed chromatin and inconspicuous nucleoli. The tumour showed high mitotic activity reaching up to 3/High-power field. Immunohistochemistry analysis was consistent with synovial sarcoma, revealing a positive TLE-1, CD99, B-cell lymphoma 2 (BLC2), Focal cytokeratin and focal epithelial membrane antigen (EMA). The material was sent for Fluorescence in situ hybridization (FISH) and reported a rearrangement of the SS18 gene at 18q11.2 which has been observed in synovial sarcomas. The mass margins were difficult to be assessed by histopathology as the sample had fragmented margins.\n\nThe patient presented to the clinic after 2 weeks and given the histopathology report, a re-resection with wider margin was discussed with the patient and he agreed. Positron emission tomography – Computed tomography (PET/CT) was done for Head and Neck, Chest, Abdomen, Pelvis and musculoskeletal structures. Only a 29 ∗ 27 mm thyroid nodule in the lower pole of the left thyroid lobe with moderate hypermetabolism at standardized uptake values (SUVs) of 4.9. Thyroid US showed a solid isoechoic well-defined nodule in the lower pole of the left thyroid lobe with no echogenic foci, Thyroid Imaging Reporting and Data System (TIRADS) was TR3.\n\nA second resection was made 3 weeks from the first one. The whole specimen was resected from both cords bilaterally which was deepened until reaching the corpus spongiosum which was shaved superiorly up to the urethra. The specimen was sent for histopathology. The resected mass was 6.0 ∗ 6.0 ∗ 3.0 cm in size, and it was negative for any pathology. The patient then went into active surveillance and after 16 months of active surveillance he was found to have metastatic lesions in the sixth liver segment and L1 vertebral body. Oncology team started chemotherapy regimen of Ifosfamide and Doxorubicin for 6 cycles with no improvement in the liver lesion. Surgical resection was made for the Fifth and Sixth liver sections with cholecystectomy. Patient then developed a new lung lesion and was started on Pazopanib and Stereotactic Body Radiation Therapy SBRT. The patient then underwent surveillance for 6 months then developed new liver and lung lesions then chemotherapy regimen of Gemcitabine and Docetaxel combination for 3 cycles and progressed then he was started 2 cycles of Dacarbazine and progressed then 2 cycles of Pembrolizumab and progressed. The patient then was shifted to palliative care, and he stopped following up.",
+        "summary": "A 36-year-old man presented with a tender penoscrotal mass for 5 years. The patient underwent surgical resection of the mass. Histopathology revealed cellular spindle cell tumour arranged into interlacing fascicle, Immunohistochemistry analysis revealed a positive TLE-1, CD99, B-cell lymphoma 2 (BLC2), Focal cytokeratin and focal epithelial membrane antigen (EMA). In our case, the patient was aggressively treated with two surgical resections and still progressed and metastasized and continued progressing even after different chemotherapy regimens.",
+        "translated_fulltext": "Tháng 2 năm 2020, một bệnh nhân 36 tuổi, không có tiền sử bệnh lý đáng kể, đến khám với tình trạng khối u ở vùng bìu bên trái kéo dài 5 năm. Bệnh nhân không có các triệu chứng liên quan đến đường tiết niệu dưới. Không có tiền sử chấn thương hoặc nhiễm trùng, và bệnh nhân phủ nhận bất kỳ tiền sử giảm cân, chán ăn hoặc sốt nào. Khi khám, phát hiện một khối u nang trơn, ấn đau, kích thước khoảng 20 mm x 20 mm, bám vào phía bên trái của niệu đạo bóng tại vị trí nối liền với bìu, khối u nằm sâu, không dính vào da và không liên quan đến dây thừng tinh bên trái, và có tính di động một phần.\n\nSiêu âm Doppler cho thấy một khối u có ranh giới rõ ràng, giảm độ hồi âm, kích thước 2,7 x 3,1 x 2,0 cm, với sự gia tăng đáng kể lưu lượng máu ở phía bên trái của vị trí nối liền với bìu. Chụp cộng hưởng từ vùng chậu cho thấy một khối u ở phía dưới bên trái của gốc dương vật, có một lớp mỡ rõ ràng, và có độ tín hiệu tương đương với tinh hoàn trong hình ảnh T2, T1 và hình ảnh khuếch tán, khối u này liên kết với ống dẫn tinh, không có hạch bạch huyết. Nồng độ alpha-fetoprotein và beta-human chorionic gonadotropin đều nằm trong giới hạn bình thường. Dựa trên kết quả thăm khám và tình trạng đau của bệnh nhân, quyết định được đưa ra là tiến hành phẫu thuật cắt bỏ khối u để chẩn đoán và điều trị. Trong quá trình phẫu thuật, một khối u được phát hiện ở phía sau bên trái của tinh hoàn và được cắt bỏ hoàn toàn, sau đó được gửi đi để phân tích mô bệnh học.\n\nKết quả phân tích mô bệnh học của khối u cho thấy một khối u tế bào hình thoi, các tế bào được sắp xếp thành các bó xen kẽ, các tế bào có nhân hình thoi hoặc hình bầu dục, chứa chromatin phân tán đều và nhân nhỏ. Khối u có hoạt tính phân bào cao, đạt tới 3/trường quan sát có độ phóng đại cao. Phân tích hóa mô miễn dịch phù hợp với u mô liên kết, cho thấy dương tính với TLE-1, CD99, B-cell lymphoma 2 (BLC2), cytokeratin khu trú và kháng nguyên màng biểu mô khu trú (EMA). Mẫu vật được gửi đi để thực hiện kỹ thuật lai tại chỗ bằng huỳnh quang (FISH) và kết quả cho thấy sự sắp xếp lại của gen SS18 tại vị trí 18q11.2, một đặc điểm thường thấy ở u mô liên kết. Ranh giới của khối u khó đánh giá bằng phương pháp mô bệnh học vì mẫu vật có ranh giới không rõ ràng.\n\nBệnh nhân tái khám sau 2 tuần và, dựa trên báo cáo mô bệnh học, việc cắt bỏ lại với phạm vi rộng hơn đã được thảo luận với bệnh nhân và bệnh nhân đồng ý. Chụp cắt lớp phát xạ positron - chụp cắt lớp vi tính (PET/CT) được thực hiện cho vùng đầu và cổ, ngực, bụng, vùng chậu và các cấu trúc cơ xương. Chỉ phát hiện một nốt tuyến giáp kích thước 29 x 27 mm ở cực dưới của thùy tuyến giáp trái, có mức độ tăng chuyển hóa vừa phải, với giá trị hấp thụ tiêu chuẩn (SUV) là 4,9. Siêu âm tuyến giáp cho thấy một nốt rắn, đồng nhất, có ranh giới rõ ràng ở cực dưới của thùy tuyến giáp trái, không có vùng giảm âm, hệ thống báo cáo và dữ liệu hình ảnh tuyến giáp (TIRADS) là TR3.\n\nLần cắt bỏ thứ hai được thực hiện 3 tuần sau lần đầu. Toàn bộ mẫu vật được cắt bỏ từ cả hai dây thừng hai bên, và việc cắt được thực hiện sâu hơn cho đến khi chạm đến thể xốp, sau đó được cạo bỏ lên phía trên đến niệu đạo. Mẫu vật được gửi đi để phân tích mô bệnh học. Khối u được cắt bỏ có kích thước 6,0 x 6,0 x 3,0 cm và không có dấu hiệu bệnh lý nào. Sau đó, bệnh nhân được theo dõi tích cực và sau 16 tháng theo dõi tích cực, phát hiện có các tổn thương di căn ở phân thùy thứ sáu của gan và thân đốt sống L1. Nhóm điều trị ung thư bắt đầu phác đồ hóa trị bằng Ifosfamide và Doxorubicin trong 6 chu kỳ, nhưng không thấy cải thiện ở tổn thương gan. Phẫu thuật cắt bỏ được thực hiện cho các phân thùy thứ năm và thứ sáu của gan, đồng thời cắt bỏ túi mật. Sau đó, bệnh nhân xuất hiện một tổn thương phổi mới và được điều trị bằng Pazopanib và liệu pháp xạ trị cơ thể định vị (SBRT). Sau đó, bệnh nhân được theo dõi trong 6 tháng, sau đó xuất hiện các tổn thương gan và phổi mới, và được điều trị bằng phác đồ hóa trị kết hợp Gemcitabine và Docetaxel trong 3 chu kỳ, nhưng bệnh tiến triển, sau đó được điều trị bằng 2 chu kỳ Dacarbazine, nhưng bệnh vẫn tiến triển, sau đó được điều trị bằng 2 chu kỳ Pembrolizumab, nhưng bệnh vẫn tiến triển. Sau đó, bệnh nhân được chuyển sang chăm sóc giảm nhẹ và ngừng tái khám.",
+        "translated_summary": "Một người đàn ông 36 tuổi đến khám vì có một khối u ở vùng bìu và thân dương vật gây đau, kéo dài trong 5 năm. Bệnh nhân đã được phẫu thuật cắt bỏ khối u. Kết quả giải phẫu bệnh cho thấy khối u là một loại u tế bào hình thoi, các tế bào sắp xếp thành các bó xen kẽ. Phân tích hóa mô miễn dịch cho thấy có phản ứng dương tính với TLE-1, CD99, B-cell lymphoma 2 (BLC2), cytokeratin khu trú và kháng nguyên màng biểu mô khu trú (EMA). Trong trường hợp này, bệnh nhân đã được điều trị tích cực bằng hai lần phẫu thuật cắt bỏ khối u, nhưng bệnh vẫn tiến triển và di căn, tiếp tục tiến triển ngay cả sau khi đã trải qua nhiều phác đồ hóa trị khác nhau."
+    },
+    {
+        "id": "multiclinsum_gs_en_293.txt",
+        "fulltext": "An 18-year-old hispanic male patient with no significant medical history presents to the emergency department (ED) complaining of substernal, non-radiated chest pain, orthopnoea, dry and non-productive cough, and subjective fevers at home, for the last 3–4 days. Family history remarkable for paternal grandfather diagnosed with non-ischaemic cardiomyopathy and a pacemaker at age 86 years old. Patient lives with both parents and denies any smoking, ethanol consumption, recreational drug use, abuse or neglect at home. He worked at auto-part shop and planned to start college soon.\n\n\nInvestigations\n\n\nIn the ED, serum troponin I levels were found to be elevated and ECG showed diffuse ST-segment elevation. He was admitted to the local hospital and initial workup was remarkable for an enlarged cardiac silhouette and mild pulmonary oedema observed on chest X-ray, a transthoracic echocardiogram (TTE) demonstrating left ventricular ejection fraction (LVEF) of 40%, with severe left ventricular (LV) concentric hypertrophy and mild posterior pericardial effusion. Additionally, the patient was found to have elevated titres for Coxsackie virus A and B. His symptoms initially improved with the initiation of ibuprofen and colchicine. Cardiac catheterisation was performed, which revealed no evidence of coronary artery disease. Repeat TTE showed an LVEF of 40%–45%, hypokinesis of anteroapical and inferolateral wall, with an elevated LV end-diastolic pressure, consistent with diastolic dysfunction. Chest CT angiogram showed evidence of pneumonitis and a pericardial effusion. And at this point, the constellation of symptoms was thought to be secondary to Coxsackie myopericarditis, for which he continued to receive medical treatment as previously mentioned.\n\nOn the fourth day of admission, the patient became diaphoretic, tachycardic and hypotensive with an undetectable blood pressure. Emergent TTE showed large pericardial effusion with impending cardiac tamponade features, and pericardiocentesis was performed. During the procedure, the patient developed pulseless electrical activity (PEA) cardiac arrest and received advanced cardiovascular support for 30 min. Ultimately patient was intubated, placed on venous-arterial extracorporeal membrane oxygenation (VA ECMO) and started on vasopressor support (norepinephrine 5 mcg/min and vasopressin 0.05 units/min), with numerous transfusions (9 packed red bloodcells, 10 units of platelets, 10 units of cryoprecipitate and 4 units of fresh frozen plasma) due to significant oozing of blood from the ECMO cannula. He was transferred to our hospital where endomyocardial biopsy (EMB) was then obtained due to concern of fulminant myocarditis and to test for other infiltrative cardiomyopathies. Pathology reports showed no signs suggestive of inflammatory or infiltrative process in the endomyocardium. Coxsackie Abs were repeated and were positive for Cox A type 9, Coxsackie B2 and Coxsackie B6, and an elevated Epstein-Barr virus (EBV) DNA quantitative PCR at 133 000 IU/mL. At this point, another TTE was done, which showed a severely decreased ejection fraction (EF) of 10%–15% with previously noted severe LV concentric hypertrophy (1.9 cm septum and 2.2 cm in the inferolateral wall).\n\nThe patient was started on intravenous immunoglobulin (IVIG) for treatment of Coxsackie myocarditis, and broad-spectrum antibiotics due to worsening leucocytosis, but with no identified infectious focus. Colchicine was discontinued due to concern for rhabdomyolysis, with elevation of serum creatine kinase level to 2874 unit/L. Vasopressors were then discontinued and the patient was extubated. He also developed episode of flushing, fever, dyspnoea and decreasing oxygen saturation, with chest X-ray showing congested lung parenchyma with concerns for ARDS, therefore, IVIG was stopped.\n\nGiven improvement of cardiac function in another TTE with LVEF of 25%–30%, it was decided to attempt to remove the ECMO, which was unsuccessful. The patient remained on ECMO support and emergent discussion with heart failure team took place to determine best approach. The patient was evaluated for possible left ventricle assist device, however, deemed not a candidate due to significant global concentric LV hypertrophy, and the multidisciplinary team agreed to facilitate emergency listing for heart transplantation, with consideration to transition to another cardiovascular support such as intra-aortic balloon pump, with potential inotrope support.\n\nDuring further evaluation for possible heart transplant, an incisional biopsy of a 1×1 inch palpable, painless, rubbery, mobile mass in the right arm was done and sent for pathology. The patient mentioned he first noticed this lesion approximately 2–3 months before presenting to the ED. Pathology report of the right upper extremity mass showed aggressive EBV (+) NK/T-cell lymphoma with a cytotoxic immunophenotype (positive for CD 2, CD3, CD56, BCL2, granzyme B, TIA1, MUM1 and diffuse coexpression of Epstein-Barr virus-encoded small RNAs by in situ hybridisation), and a modified SMILE (Steroids, Methotrexate with leucovorin, Ifosfamide with mesna, L-asparaginase and Etoposide) chemotherapy regimen was started. In situ hybridisation of the EMB previously obtained were negative for EBV-RNA.\n\nCardiac MRI was obtained, which revealed hypokinesis of the inferolateral and anterolateral wall, as previously described by TTE, delayed enhancement in the subendocardial and transmural distribution in these regions, with relative sparing of the septum. Additionally, avid enhancement and thickening of the pericardium, without a mass identified, and a pocket of pericardial fluid with septations, concerning for loculations, were also noted.\n\n\nDifferential diagnosis\n\nThe constellation of symptoms (shortness of breath, orthopnoea, hypotension and subjective fevers), with findings such as diffuse ST-segment elevation on ECG, leakages of cardiac markers (troponin), elevated Coxsackie virus titres (both of serotype A and B), as well as echocardiographic findings of pericardial effusion; all seemed to correlate with a classic presentation of viral pericarditis clinical due to Coxackie virus. However, despite medical treatment with colchicine, the patient continued to decompensate and eventually required pericardiocentesis due to cardiac tamponade, then developed cardiac arrest and ultimately requires ECMO support, for what seems acute onset heart failure. In this setting, fulminant myocarditis secondary to Coxsackie virus was considered. Cardiotropic RNA virus, such as Coxackie viruses, induce receptor-mediated endocytosis, with viral replication contributing to cellular dysfunction and ultimately apoptosis of the cell.1 When susceptible individuals are infected with highly virulent viral strains, maladaptive immunologic activity can occur, leading to persistent activation of T cells and continued antibody-mediated myocyte destruction, which can ultimately lead to fulminant myocarditis. EBV myocarditis could also explain the rapid deterioration in the setting of a positive EBV PCR, which is a more sensitivity test than traditional serologies for detection of acute infection.2 However, in situ hybridisation was negative for EBV-RNA.\n\nNevertheless, the significant concentric hypertrophy observed on the initial TTEs and the atypical delayed enhancement observed on the cardiac MRI are not explained by this diagnosis. Additionally, the EMB did not show an inflammatory process.\n\nFortuitous finding of EBV (+) NK/T-cell lymphoma by incisional biopsy of the right upper extremity allowed for a more fitting diagnosis for this case. The pericardial effusion, unresponsive to initial medical treatment and new acute heart failure with concentric hypertrophic cardiomyopathy, in the setting of newly diagnosed NK/T-cell lymphoma, raises the possibility of NK/T-cell lymphoma with involvement of the myocardium and pericardium as the most adequate diagnosis in this scenario, which englobes all the features previously mentioned in this case.\n\nOther differentials taken into consideration include infiltrative cardiomyopathy such as amyloidosis. However, Congo red staining of the EMB samples failed to demonstrate deposition of amyloid.\n\n\nTreatment\n\nGiven the diagnosis of extranodal NK/T-cell lymphoma (ENKTCL) with suspected pericardial involvement and no bone marrow involvement, modified SMILE regimen was desired as the first-line chemotherapy regimen. This regimen includes dexamethasone, ifosfamide, mesna and etoposide, and excluded methotrexate, due to evidence of third-spacing and effusions, which could lead to delayed excretion and increased risk of toxicity.\n\nHowever, due to his compromised cardiac function, it was believed that the patient would not tolerate cytotoxic chemotherapy which requires aggressive intravenous, and alternatively, emergent chemotherapy regimen was instituted: carboplatin (day 1–day 3), etoposide (day 1–day 5) and dexamethasone. Peg-asparaginase was later introduced in the regimen (day 7–day 21). This regimen proved effective, as evidenced by rapid recovery of the LV function and overall haemodynamic stability, and decision was made to incorporate a modified SMILE chemotherapy regimen, of which he received two cycles. Then chemotherapy regimen was changed to dexamethasone, gemcitabine, carboplatin and peg-asparaginase (DDGP). The patient received two cycles of DDGP. A full body positron emission tomography (PET) scan was negative for lymphoma. The plan is to continue two more cycles of chemotherapy (to complete six total cycles of chemotherapy). Currently, the patient is considering radiation therapy and possible stem cell transplant, after completion of the chemotherapy regimen. Additionally, the patient is currently on guideline-directed medical therapy for heart failure and has completed cardiac rehabilitation.\n\n\nOutcome and follow-up\n\nThe patient has completed five out of six chemotherapy sessions with the previously mentioned regimens. After initiation of chemotherapy and optimal medical treatment for heart failure, the patient has recovered much of his cardiac function, as evidenced by an LVEF of 55%, no wall motion abnormalities and normal myocardial wall thickness on his most recent TTE. He continues to be followed by heart failure/cardiology team and oncology team in clinic.",
+        "summary": "An 18-year-old male patient presented to the emergency department complaining of new onset chest pain, fever and orthopnoea. Initial workup was remarkable for elevated troponin, diffuse ST-segment elevation on ECG and chest X-ray with enlarged cardiac silhouette. Transthoracic echocardiogram (TTE) demonstrates severe biventricular concentric hypertrophy and pericardial effusion. Also, Coxsackie virus A and B titres were positive, concerning for a classic viral pericarditis. However, despite medical management, the patient became dyspnoeic and hypotensive. Impending cardiac tamponade was observed on repeat TTE, and pericardiocentesis was performed, complicated by pulseless electrical activity cardiac arrest, and ultimately patient requiring venoarterial extracorporeal membrane oxygenation support. Emergent endomyocardial biopsy showed no inflammatory process, and a skin biopsy of a small lesion in the right arm showed unexpected diagnosis of Epstein-Barr virus (+) natural killer/T-cell lymphoma. On initiation of chemotherapy, clinical improvement was observed as evidenced by improving ejection fraction, resolution of pericardial effusion and gradual decrease in myocardial hypertrophy.",
+        "translated_fulltext": null,
+        "translated_summary": "Một bệnh nhân nam 18 tuổi đến khoa cấp cứu với các triệu chứng đau ngực mới xuất hiện, sốt và khó thở khi nằm. Các xét nghiệm ban đầu cho thấy mức troponin tăng cao, đoạn ST trên điện tâm đồ (ECG) có sự thay đổi lan tỏa và chụp X-quang ngực cho thấy bóng tim to. Siêu âm tim qua thành ngực (TTE) cho thấy tình trạng phì đại đồng tâm nghiêm trọng của cả hai tâm thất và tràn dịch màng ngoài tim. Ngoài ra, xét nghiệm virus Coxsackie A và B cho kết quả dương tính, cho thấy khả năng mắc viêm màng ngoài tim do virus. Tuy nhiên, mặc dù đã được điều trị bằng thuốc, bệnh nhân vẫn khó thở và tụt huyết áp. TTE lặp lại cho thấy dấu hiệu của tình trạng chèn ép tim cấp tính, và thủ thuật chọc hút dịch màng ngoài tim đã được thực hiện, nhưng sau đó bệnh nhân bị ngừng tim do hoạt động điện tim không có mạch và cuối cùng cần được hỗ trợ bằng phương pháp oxy hóa màng ngoài cơ thể tĩnh mạch-động mạch (VA-ECMO). Sinh thiết nội màng cơ tim cấp cứu không cho thấy dấu hiệu viêm, và sinh thiết da của một tổn thương nhỏ ở cánh tay phải cho thấy chẩn đoán bất ngờ là u lympho tế bào NK/T liên quan đến virus Epstein-Barr (+). Sau khi bắt đầu điều trị hóa trị, tình trạng lâm sàng của bệnh nhân đã cải thiện, được chứng minh bằng sự cải thiện của phân suất tống máu, giảm dịch màng ngoài tim và giảm dần tình trạng phì đại cơ tim."
+    },
+    {
+        "id": "multiclinsum_gs_en_325.txt",
+        "fulltext": "This is a 75-year-old para 6 patient from Western Ethiopia who saw her last menses 25 years back. Her age at giving birth to her 1st child and menopause were 18 and 50 years, respectively. She had occasional pelvic pain for the last 3 years for which she was visiting different health facilities. Currently, she presented to Nekemte Specialized Hospital with exacerbation of lower abdominal pain for 3 weeks. She feels discomfort in her vagina but no protrusion of mass through her vagina. She has no history of fever, abdominal swelling, vaginal discharge, or bleeding. All her previous deliveries were normal vaginal deliveries. Upon enquiring about the history of family planning utilization, she reported that the intrauterine device was inserted 40 years back at a public hospital. Since then, she had no history of gynecologic evaluation for a checkup. She had no history of gynecologic procedures, pelvic or abdominal surgery. The patient has no history of medical problems like diabetes mellitus, hypertension, cardiac or renal problems.\n\nOn examination, she was acutely sick-looking. Her vital signs were blood pressure (BP) = 120/80mmHg, pulse rate (PR) = 82 beats per minute, respiratory rate (RR) = 18 breaths per minute, and temperature of 37.1°C. She had pink conjunctivae. Lymph glandular system, chest, and cardiovascular system were normal. On abdominal examination, there was no mass, organomegaly, area of tenderness, or signs of fluid collection. Inspection of external genitalia showed no vulvar mass or lesion. On speculum examination, there is a foreign body at the external cervical os. However, there is no other cervical mass or lesion. On bimanual examination, the uterus was not enlarged and there was no adnexal mass or tenderness. On the integumentary system, she had no palmar pallor. On neurologic examination, she was oriented to time, person, and place. She had normal reflexes and no neurologic deficits.\n\nOn laboratory investigation, an ultrasound examination was done by a radiologist and showed unremarkable pelvic findings. Urinalysis, complete blood count, and serum blood glucose level were normal. With the final diagnosis of postmenopausal pelvic pain secondary to the retained intrauterine device, the patient was prepared and taken to the gynecology procedure room. In the lithotomy position, the speculum was inserted and the intrauterine device was easily removed with spongy forceps. The mother was observed for 4 hours and discharged with analgesia and doxycycline 100 mg PO twice a day for three days. Upon follow-up, the pelvic pain was resolved.",
+        "summary": "We present the case of retained Lippes loop IUD for 40 years in a 75-year-old postmenopausal patient from Western Ethiopia. The patient presented to the hospital with postmenopausal pelvic pain. Speculum exam showed part of loop at external cervical os. The loop was easily removed with spongy forceps. The patient was discharged with analgesia and doxycycline twice a day for 3 days.",
+        "translated_fulltext": "Đây là một bệnh nhân 75 tuổi, đã sinh 6 con, đến từ vùng Tây Ethiopia, và lần kinh nguyệt cuối cùng của bà là cách đây 25 năm. Tuổi của bà khi sinh con đầu lòng và tuổi mãn kinh lần lượt là 18 và 50. Trong 3 năm qua, bà thường xuyên bị đau vùng chậu và đã đến nhiều cơ sở y tế khác nhau để khám. Hiện tại, bà đến Bệnh viện Chuyên khoa Nekemte với tình trạng đau bụng dưới tăng lên trong 3 tuần. Bà cảm thấy khó chịu ở âm đạo nhưng không có khối u nào lồi ra. Bà không có tiền sử sốt, sưng bụng, dịch tiết âm đạo hoặc chảy máu. Tất cả các lần sinh trước đây của bà đều là sinh thường. Khi được hỏi về việc sử dụng các biện pháp tránh thai, bà cho biết đã được đặt vòng tránh thai tại một bệnh viện công cách đây 40 năm. Kể từ đó, bà không đi khám phụ khoa định kỳ. Bà không có tiền sử phẫu thuật phụ khoa, phẫu thuật vùng chậu hoặc bụng. Bệnh nhân không có tiền sử các bệnh lý như tiểu đường, tăng huyết áp, bệnh tim hoặc bệnh thận.\n\nKhi khám, bà trông rất mệt mỏi. Các chỉ số sinh tồn của bà là huyết áp (HA) = 120/80mmHg, nhịp tim = 82 nhịp/phút, nhịp thở = 18 nhịp/phút và nhiệt độ 37,1°C. Niêm mạc mắt của bà có màu hồng. Hệ bạch huyết, hệ hô hấp và hệ tim mạch bình thường. Khi khám bụng, không có khối u, phì đại tạng, vùng đau hoặc dấu hiệu tích tụ dịch. Quan sát bộ phận sinh dục ngoài cho thấy không có khối u hoặc tổn thương ở âm hộ. Khi khám bằng ống soi, có một vật lạ ở lỗ ngoài cổ tử cung. Tuy nhiên, không có khối u hoặc tổn thương nào khác ở cổ tử cung. Khi khám bằng tay, tử cung không bị phì đại và không có khối u hoặc đau ở vùng phụ. Khi khám da, không có tình trạng da xanh xao. Khi khám thần kinh, bà tỉnh táo về thời gian, địa điểm và bản thân. Phản xạ của bà bình thường và không có dấu hiệu thần kinh.\n\nTrong quá trình xét nghiệm, bác sĩ X-quang đã thực hiện siêu âm và kết quả cho thấy không có bất thường nào ở vùng chậu. Xét nghiệm nước tiểu, công thức máu toàn phần và nồng độ đường huyết đều bình thường. Với chẩn đoán cuối cùng là đau vùng chậu sau mãn kinh do vòng tránh thai còn sót lại, bệnh nhân được chuẩn bị và đưa đến phòng thủ thuật phụ khoa. Ở tư thế nằm ngửa, ống soi được đưa vào và vòng tránh thai được lấy ra dễ dàng bằng kẹp. Bệnh nhân được theo dõi trong 4 giờ và xuất viện với thuốc giảm đau và doxycycline 100mg uống hai lần mỗi ngày trong ba ngày. Trong quá trình theo dõi, tình trạng đau vùng chậu đã giảm.",
+        "translated_summary": "Chúng tôi xin trình bày một trường hợp bệnh nhân nữ 75 tuổi, đã mãn kinh, sống ở vùng Tây Ethiopia, đã sử dụng vòng tránh thai Lippes trong 40 năm. Bệnh nhân đến bệnh viện vì đau vùng chậu sau mãn kinh. Khám bằng ống soi cho thấy một phần của vòng tránh thai nằm ở lỗ ngoài cổ tử cung. Vòng tránh thai được lấy ra dễ dàng bằng kẹp có đầu bọc mút. Bệnh nhân được xuất viện và kê đơn thuốc giảm đau cùng với doxycycline, uống hai lần mỗi ngày trong 3 ngày."
+    },
+    {
+        "id": "multiclinsum_gs_en_418.txt",
+        "fulltext": "A 71-year-old patient with a history of untreated vitiligo presented with visual loss in the right eye 6 months prior to admission accompanied by bilateral hearing loss with a predominance in the right ear. Chronic headaches and intermittent fever were also reported, although the patient denied a history of drug use or prior infections. He was evaluated by our department due to the presence of significant and unintentional weight loss, generalized weakness and thickening of the skin. On initial ophthalmologic examination, visual acuity in the right eye (RO) was reduced to light perception and color discrimination, and visual acuity in the left eye (LO) was 20/200 with afferent pupillary defect in both eyes with hyperemic margins of the eyelid. On examination of the RO, it was found to have a hyperemic bulbar conjunctiva, ciliary injection, cornea with peripheral, nummular, subepithelial infiltrates, aqueous anterior chamber (AAC) without cellularity, normal iris and lens with nuclear opacities. On examination of the left eye, it was found to have a hyperemic bulbar conjunctiva, ciliary injection, cornea with peripheral, nummular, subepithelial infiltrates, AAC, aqueous without cellularity, normal iris and lens with nuclear opacities. On examination of the right fundus, a round, pale ++ papilla was found with a 50% excavation, slightly blunt nasal border, with a raised and thinned vascular pattern, with macular area and scattered pigment. On the left fundus, a vitreous haze 2+ was found with edematous papilla, blurred borders, hyperemic, peripapillary, streaked hemorrhages, and an unevaluable excavation with a thinned vascular pattern and macular area with scattered pigment, with right optic atrophy and left anterior optic neuritis.\n\nDue to ocular involvement, weight loss and neurological symptoms, additional testing was performed to rule out causes such as tuberculosis, herpes, ANCA and non-ANCA vasculitis, and sarcoidosis. As for the management of the neurological condition, a lumbar puncture was performed and an opening pressure within normal limits and a proteinocracy of 54 mg/dL was found. Due to distal symmetric polyneuropathy, nerve conduction velocities (NCV) were performed, which showed a pattern of polyradiculoneuropathy with moderate to severe axonal degeneration, involving all 4 extremities with a predominance of the lower extremities; the contrasted magnetic resonance imaging (MRI) of the skull and orbit did not show enhancement of the optic nerve or brain tumors; however, it did show sinusitis and meningeal enhancement. Within the management, sarcoidosis was ruled out, with angiotensin converting enzyme (ACE) within normal parameters, as well as a whole body gamma scan, without enhancement or boosting. After all the study and clinical evaluation of the patient, a second ophthalmological assessment was performed in which persistence and progression of the ocular condition was found, with optic atrophy in the right eye and anterior optic neuritis in the left eye. Because of this, high dose pulse steroid treatment was initiated, followed by a gradual reduction of the dose and the patient was referred for follow-up in the Outpatient Department. A clinical and functional improvement was observed, mainly at the neurological and ophthalmological level.\n",
+        "summary": "A 71-year-old man with a history of long-standing vitiligo who had experienced visual loss in his right eye six months prior to admission, along with bilateral hearing loss, predominantly in the right ear. During his hospital stay, he presented with chronic headaches, fever, and significant involuntary weight loss. On ophthalmologic examination, the right eye was light sensitive with hyperemic bulbar conjunctiva, while the left eye had a visual acuity of 20/200. The fundus of the right eye had scattered pigmentation, while the left eye had a swollen optic disc and right optic atrophy.\n",
+        "translated_fulltext": "Một bệnh nhân 71 tuổi, có tiền sử bệnh bạch biến chưa được điều trị, nhập viện với tình trạng giảm thị lực ở mắt phải 6 tháng trước đó, kèm theo tình trạng giảm thính lực hai bên, nổi bật hơn ở tai phải. Bệnh nhân cũng báo cáo về tình trạng đau đầu mãn tính và sốt không liên tục, mặc dù bệnh nhân phủ nhận tiền sử sử dụng ma túy hoặc các bệnh nhiễm trùng trước đó. Bệnh nhân được khoa của chúng tôi thăm khám do có tình trạng sụt cân đáng kể và không chủ ý, suy nhược toàn thân và da dày lên. Trong quá trình khám mắt ban đầu, thị lực ở mắt phải (RO) giảm xuống mức chỉ nhận biết được ánh sáng và khả năng phân biệt màu sắc, trong khi thị lực ở mắt trái (LO) là 20/200, kèm theo tình trạng khuyết tật đồng tử ở cả hai mắt và viền mí mắt bị xung huyết. Khi khám mắt phải, phát hiện có kết mạc bóng mắt bị xung huyết, tiêm mạch ciliary, giác mạc có các đám viêm nhỏ, hình tròn, nằm dưới biểu mô ở vùng ngoại vi, buồng trước chứa dịch trong, không có tế bào, mống mắt và thủy tinh thể bình thường với các đục nhân. Khi khám mắt trái, cũng phát hiện có kết mạc bóng mắt bị xung huyết, tiêm mạch ciliary, giác mạc có các đám viêm nhỏ, hình tròn, nằm dưới biểu mô ở vùng ngoại vi, buồng trước chứa dịch trong, không có tế bào, mống mắt và thủy tinh thể bình thường với các đục nhân. Khi khám đáy mắt phải, phát hiện có đĩa thị hình tròn, nhạt màu, mức độ đào hố 50%, bờ mũi hơi tù, có các mạch máu nổi rõ và mỏng, vùng hoàng điểm và các sắc tố rải rác. Khi khám đáy mắt trái, phát hiện có tình trạng mờ thủy tinh thể mức độ 2+, đĩa thị phù nề, bờ mờ, xung huyết, các vệt xuất huyết quanh đĩa thị, không thể đánh giá mức độ đào hố, các mạch máu mỏng và vùng hoàng điểm có các sắc tố rải rác, kèm theo teo thần kinh thị giác bên phải và viêm thần kinh thị giác trước bên trái.\n\nDo có tổn thương mắt, sụt cân và các triệu chứng thần kinh, các xét nghiệm bổ sung đã được thực hiện để loại trừ các nguyên nhân như lao, herpes, ANCA và viêm mạch không phải ANCA, và bệnh sarcoidosis. Về việc điều trị tình trạng thần kinh, một thủ thuật chọc dò tủy sống đã được thực hiện, kết quả cho thấy áp lực dịch não tủy nằm trong giới hạn bình thường và nồng độ protein là 54 mg/dL. Do có bệnh lý thần kinh ngoại biên đối xứng, tốc độ dẫn truyền thần kinh (NCV) đã được thực hiện, cho thấy tình trạng bệnh lý rễ thần kinh và thần kinh ngoại biên với mức độ thoái hóa trục thần kinh từ trung bình đến nặng, ảnh hưởng đến cả 4 chi, nổi bật hơn ở chi dưới; chụp cộng hưởng từ (MRI) có thuốc cản quang của hộp sọ và hốc mắt không cho thấy sự tăng cường tín hiệu của dây thần kinh thị giác hoặc khối u não; tuy nhiên, lại cho thấy tình trạng viêm xoang và viêm màng não. Trong quá trình điều trị, bệnh sarcoidosis đã được loại trừ, với nồng độ enzyme chuyển angiotensin (ACE) nằm trong giới hạn bình thường, cũng như quét gamma toàn thân, không có sự tăng cường hoặc kích thích. Sau khi đánh giá toàn diện và lâm sàng bệnh nhân, một lần nữa đánh giá chuyên khoa mắt được thực hiện, kết quả cho thấy tình trạng bệnh ở mắt vẫn tiếp tục và tiến triển, với tình trạng teo thần kinh thị giác ở mắt phải và viêm thần kinh thị giác trước ở mắt trái. Do đó, điều trị bằng steroid liều cao đã được bắt đầu, sau đó giảm dần liều và bệnh nhân được giới thiệu để theo dõi tại phòng khám ngoại trú. Một sự cải thiện về mặt lâm sàng và chức năng đã được quan sát thấy, chủ yếu ở mức độ thần kinh và nhãn khoa.",
+        "translated_summary": "Một người đàn ông 71 tuổi, có tiền sử bệnh bạch biến kéo dài, đã bị giảm thị lực ở mắt phải sáu tháng trước khi nhập viện, kèm theo tình trạng giảm thính lực ở cả hai tai, đặc biệt là tai phải. Trong thời gian nằm viện, ông bị đau đầu mãn tính, sốt và sụt cân đáng kể. Khi khám mắt, mắt phải nhạy cảm với ánh sáng và có kết mạc nhãn cầu bị xung huyết, trong khi mắt trái có thị lực 20/200. Quỹ đáy mắt phải có các đốm sắc tố rải rác, còn mắt trái có đĩa thị giác sưng và teo dây thần kinh thị giác bên phải."
+    },
+    {
+        "id": "multiclinsum_gs_en_406.txt",
+        "fulltext": "A 39-year-old woman with a diagnosis of peripartum cardiomyopathy who received a heart transplant in October 2014. She received induction with Basiliximab and methylprednisolone. She also received maintenance treatment with tacrolimus XL prolonged release 7 mg daily, everolimus 1 mg twice daily, and prednisolone 5 mg/day. She had two episodes of acute rejection during the first year post-transplant, and was controlled with methylprednisolone pulse therapy with good results. There was no history of renal disease and her renal function was stable with creatinine of 0.88 mg/dL and a glomerular filtration rate (GFR) of 102 mL/min/1.73m2 during the first year post-transplant. Follow-up was done exclusively by the heart transplant group and routine polyomavirus viral load BK or urinary cytology was not performed. In 2016, she presented a creatinine serum elevation of up to 1.9 mg/dL, with a GFR of 32.6 mL/min/1.73m2. At that time, the minimum tacrolimus level was 7.2 ng/mL and everolimus, 5.2 ng/mL. Anticalcineurin toxicity was suspected; therefore, tacrolimus was reduced to 4 mg daily and creatinine returned to near baseline (creatinine 1.25 mg/dL, GFR 54.1 mL/min/1.73m2); no renal biopsy was performed. In March 2017, creatinine increased to 2.69 mg/dL, with a GFR of 21.4 mL/min/1.73m2, for which she was hospitalized. The patient stated that she did not have any symptoms. During physical examination, she was in good general condition, heart rate of 80 beats per minute, blood pressure of 130/90 mmHg, respiratory rate of 15 per minute, afebrile. Further studies were performed: renal tract ultrasound showed normal renal size but increased echogenicity; urinalysis and urine cultures were negative, without haematuria, pyuria or casts; echocardiogram with adequate cardiac function; HIV, syphilis, hepatitis B and C serologic tests were negative; minimum tacrolimus level of 5.2 ng/mL, and everolimus of 5.98 ng/mL. Control was initiated with intravenous hydration, and tacrolimus XL dose was reduced to 2 mg daily, but there was no improvement in renal function; a renal biopsy was planned.\n\nRenal biopsy revealed active chronic interstitial nephritis associated with advanced poliomyelitis virus nephritis. BK virus PCR was performed and was positive at 33,800 copies/mL in blood (log 4.5). Tacrolimus was discontinued; creatinine levels stabilized between 2.2 and 2.4 mg/dL, with no further elevation in post-discharge controls. Her viral load began to decline to undetectable levels. The patient did not have episodes of cardiac rejection in 3 years of follow-up; the last creatinine measurement was 2.5 mg/dL, corresponding to a GFR of 23.4 mL/min/1.73m2.\n",
+        "summary": "We report a case of BK virus nephropathy in a patient who underwent heart transplantation due to peripartum cardiomyopathy. The renal biopsy reported active chronic tubulointerstitial nephritis associated with late-stage BK virus nephritis and the blood viral load for BK virus was positive (log 4.5). The immunosuppressive treatment was reduced, and after two years of follow-up, the patient had stable renal function with serum creatinine of 2.5 mg/dL (GFR of 23.4 mL/min/1.73m2).\n",
+        "translated_fulltext": "Một phụ nữ 39 tuổi được chẩn đoán mắc bệnh cơ tim chu sản và đã trải qua ca ghép tim vào tháng 10 năm 2014. Cô được dùng Basiliximab và methylprednisolone để bắt đầu quá trình điều trị. Cô cũng được điều trị duy trì bằng tacrolimus XL liều kéo dài 7mg mỗi ngày, everolimus 1mg hai lần mỗi ngày và prednisolone 5mg/ngày. Trong năm đầu tiên sau ghép, cô bị hai đợt thải ghép cấp tính và được kiểm soát bằng liệu pháp methylprednisolone liều cao, cho kết quả tốt. Cô không có tiền sử bệnh thận và chức năng thận của cô ổn định với mức creatinine là 0,88 mg/dL và tốc độ lọc cầu thận (GFR) là 102 mL/phút/1,73m2 trong năm đầu tiên sau ghép. Việc theo dõi được thực hiện hoàn toàn bởi nhóm ghép tim và không thực hiện xét nghiệm tải lượng virus polyomavirus BK hoặc tế bào học nước tiểu thường quy. Năm 2016, cô xuất hiện tình trạng tăng creatinine trong huyết thanh lên đến 1,9 mg/dL, với GFR là 32,6 mL/phút/1,73m2. Vào thời điểm đó, mức tacrolimus tối thiểu là 7,2 ng/mL và everolimus là 5,2 ng/mL. Nghi ngờ độc tính do calcineurin; do đó, liều tacrolimus được giảm xuống 4mg mỗi ngày và mức creatinine trở lại gần mức ban đầu (creatinine 1,25 mg/dL, GFR 54,1 mL/phút/1,73m2); không thực hiện sinh thiết thận. Vào tháng 3 năm 2017, creatinine tăng lên 2,69 mg/dL, với GFR là 21,4 mL/phút/1,73m2, và cô được nhập viện. Bệnh nhân cho biết cô không có bất kỳ triệu chứng nào. Trong quá trình khám lâm sàng, cô có tình trạng sức khỏe tổng thể tốt, nhịp tim 80 lần mỗi phút, huyết áp 130/90 mmHg, nhịp thở 15 lần mỗi phút, không sốt. Các xét nghiệm bổ sung được thực hiện: siêu âm đường tiết niệu cho thấy kích thước thận bình thường nhưng độ phản âm tăng; phân tích nước tiểu và cấy nước tiểu âm tính, không có máu trong nước tiểu, mủ trong nước tiểu hoặc trụ; siêu âm tim cho thấy chức năng tim đầy đủ; các xét nghiệm huyết thanh HIV, giang mai, viêm gan B và C đều âm tính; mức tacrolimus tối thiểu là 5,2 ng/mL và everolimus là 5,98 ng/mL. Việc điều trị được bắt đầu bằng cách truyền dịch tĩnh mạch và liều tacrolimus XL được giảm xuống 2mg mỗi ngày, nhưng không có sự cải thiện về chức năng thận; một cuộc sinh thiết thận đã được lên kế hoạch.\n\nSinh thiết thận cho thấy viêm thận kẽ mãn tính hoạt động liên quan đến viêm thận do virus bại liệt tiến triển. Xét nghiệm PCR virus BK được thực hiện và cho kết quả dương tính với 33.800 bản sao/mL trong máu (log 4,5). Tacrolimus đã được ngừng; mức creatinine ổn định trong khoảng từ 2,2 đến 2,4 mg/dL, không có sự gia tăng thêm trong các lần kiểm tra sau khi xuất viện. Tải lượng virus của cô bắt đầu giảm xuống mức không phát hiện được. Bệnh nhân không bị các đợt thải ghép tim trong 3 năm theo dõi; lần đo creatinine cuối cùng là 2,5 mg/dL, tương ứng với GFR là 23,4 mL/phút/1,73m2.",
+        "translated_summary": "Chúng tôi báo cáo một trường hợp bệnh nhân bị bệnh thận do virus BK sau khi trải qua ca phẫu thuật ghép tim do bệnh cơ tim chu sản. Kết quả sinh thiết thận cho thấy tình trạng viêm ống thận kẽ mãn tính đang hoạt động, liên quan đến bệnh viêm thận do virus BK giai đoạn muộn, và tải lượng virus BK trong máu dương tính (log 4.5). Liều lượng thuốc ức chế miễn dịch đã được giảm, và sau hai năm theo dõi, chức năng thận của bệnh nhân ổn định với mức creatinine huyết thanh là 2,5 mg/dL (tốc độ lọc cầu thận là 23,4 mL/phút/1,73m2)."
+    },
+    {
+        "id": "multiclinsum_gs_en_88.txt",
+        "fulltext": "The patient was a 42-year-old woman with a history of menstrual migraine, Hashimoto Thyroiditis, Familial Mediterian Fever (FMF), and dyspepsia. She was taking 75 mg of levothyroxine, 30 mg of lansoprazole, and 1.5 mg of colchicine daily. In February of 2023, she was diagnosed with acute bronchitis, which was treated with antibiotics and bronchodilators. She developed a daily headache after two weeks, manifesting as more than ten short-lasting attacks per day provoked by coughing, straining, and lifting. The duration of each attack was 30 minutes, and the pain was bilaterally distributed from the neck to the top of the head. The headache was sharp and severe. She described the attack as a sensation of storm-like fluid movement in the head. She did not suffer any of the symptoms associated with previous migraine attacks, such as phonophobia, photophobia, vomiting, or throbbing. The severity of the attack was determined using a numeric rating scale (NRS) with a score of 9 out of 10. These attacks typically necessitated a visit to the emergency room. The results of her physical and neurological exams were unremarkable. The laboratory tests, including those for thyroid hormones, electrolytes, liver and kidney function, and serology, were negative. Brain and cervical spinal magnetic resonance imaging (MRI) with and without contrast, magnetic resonance venography (MRV), and angiography (MRA) were all normal. She did not give consent for a lumbar puncture. When we first encountered her in the clinic, she was taking 25 mg of indomethacin per day. Her attacks stopped after putting her on 60 mg of lansoprazole and increasing her daily dose of indomethacin to 150 mg. However, she encountered gastrointestinal side effects, so the indomethacin was discontinued on day three. Due to the adverse effects, she was unable to take topiramate and propranolol.\n\nShe came to the clinic 15 days after her initial visit with an NRS score of 9/10. She was taken to the local operating room. We used a GE Healthcare, Voluson™ E6, ultrasonography system with a linear 13–5 MHz probe for unilateral PGONB. The patient’s neck was prone to flexion. The linear probe was initially transversely positioned on the occipital protuberance and then advanced caudally, demonstrating that the C2 spinous process resembled the two horns. Through lateral probe movement, the inferior muscles of the obliquus capitis and semispinalis capitis were located. Here, the superior to the inferior oblique capitis muscle and beneath the semispinalis capitis muscle were identified to be the greater occipital neuron (GON). From this location, a 22-gauge spinal needle and 3 ccs of bupivacaine at a concentration of 0.5% were used to perform GON blocking. The intensity of her attack decreased from 9/10 to 2/10 after the first 20 minutes of the block. Throughout a month, the blocks were repeated once a week. In the second month, the frequency of her attacks decreased to two per month, with an intensity of 4/10. She did not encounter any attacks in the sixth month.\n\n",
+        "summary": "Herein, we report that a 42-year-old female patient with PCH who could not use the oral medication because of side effects. When she came to the pain clinic with an attack with intensity of 9/10 , we took her to the local operating room. The ultrasound (US) guided proximal greater occipital nerve block with bupivacaine was performed and the intensity of the attack was reduced to 2/10. The blockage was repeated once a week for a month. After two months, both the intensity of headache and number of attacks decreased and no adverse effect was observed.",
+        "translated_fulltext": "Bệnh nhân là một phụ nữ 42 tuổi, có tiền sử đau nửa đầu liên quan đến chu kỳ kinh nguyệt, viêm tuyến giáp Hashimoto, sốt Địa Trung Hải gia đình (FMF) và khó tiêu. Bà đang dùng 75mg levothyroxine, 30mg lansoprazole và 1,5mg colchicine mỗi ngày. Vào tháng 2 năm 2023, bà được chẩn đoán mắc viêm phế quản cấp, được điều trị bằng thuốc kháng sinh và thuốc giãn phế quản. Sau hai tuần, bà bắt đầu bị đau đầu hàng ngày, biểu hiện bằng hơn mười cơn đau ngắn, mỗi cơn xuất hiện khi ho, rặn hoặc nâng vật nặng. Mỗi cơn đau kéo dài khoảng 30 phút, và cơn đau lan ra hai bên từ cổ lên đỉnh đầu. Cơn đau đầu sắc và dữ dội. Bà mô tả cơn đau như một cảm giác dòng chảy dữ dội trong đầu. Bà không gặp bất kỳ triệu chứng nào liên quan đến các cơn đau nửa đầu trước đây, chẳng hạn như sợ ánh sáng, sợ tiếng ồn, nôn mửa hoặc đau nhói. Mức độ nghiêm trọng của cơn đau được đánh giá bằng thang điểm số (NRS) với điểm số 9 trên 10. Những cơn đau này thường cần phải đến phòng cấp cứu. Kết quả khám lâm sàng và thần kinh không có gì đặc biệt. Các xét nghiệm trong phòng thí nghiệm, bao gồm xét nghiệm hormone tuyến giáp, điện giải, chức năng gan và thận, và xét nghiệm huyết thanh học đều cho kết quả âm tính. Chụp cộng hưởng từ (MRI) não và cột sống cổ có và không có chất cản quang, chụp cộng hưởng từ mạch máu (MRV) và chụp mạch máu (MRA) đều bình thường. Bà không đồng ý thực hiện chọc dò tủy sống. Khi chúng tôi gặp bà lần đầu tại phòng khám, bà đang dùng 25mg indomethacin mỗi ngày. Các cơn đau của bà đã giảm sau khi tăng liều lansoprazole lên 60mg và tăng liều indomethacin hàng ngày lên 150mg. Tuy nhiên, bà gặp các tác dụng phụ về đường tiêu hóa, vì vậy indomethacin đã được ngừng sử dụng vào ngày thứ ba. Do các tác dụng phụ, bà không thể dùng topiramate và propranolol.\n\nBà đến phòng khám 15 ngày sau lần khám đầu tiên với điểm NRS là 9/10. Bà được đưa đến phòng phẫu thuật của bệnh viện. Chúng tôi sử dụng hệ thống siêu âm GE Healthcare, Voluson™ E6 với đầu dò tuyến tính 13–5 MHz để thực hiện chặn thần kinh chẩm lớn (PGONB) một bên. Cổ của bệnh nhân được giữ ở tư thế gập. Đầu dò tuyến tính ban đầu được đặt theo chiều ngang trên mỏm chẩm và sau đó được di chuyển xuống dưới, cho thấy mỏm gai của đốt sống C2 có hình dạng giống hai sừng. Thông qua chuyển động đầu dò sang một bên, các cơ dưới của cơ xiên cổ và cơ bán chũm cổ được xác định. Tại đây, vị trí phía trên cơ xiên cổ dưới và phía dưới cơ bán chũm cổ được xác định là dây thần kinh chẩm lớn (GON). Từ vị trí này, một kim tiêm cột sống cỡ 22 và 3cc bupivacaine với nồng độ 0,5% được sử dụng để thực hiện chặn thần kinh GON. Cường độ cơn đau của bà giảm từ 9/10 xuống 2/10 sau 20 phút đầu tiên của quá trình chặn. Trong suốt một tháng, quá trình chặn được lặp lại một lần mỗi tuần. Trong tháng thứ hai, tần suất các cơn đau của bà giảm xuống còn hai cơn mỗi tháng, với cường độ 4/10. Bà không gặp bất kỳ cơn đau nào trong tháng thứ sáu.",
+        "translated_summary": "Ở đây, chúng tôi báo cáo về một bệnh nhân nữ 42 tuổi mắc chứng PCH, người không thể dùng thuốc uống do tác dụng phụ. Khi bệnh nhân đến phòng khám giảm đau với cơn đau có cường độ 9/10, chúng tôi đưa bệnh nhân đến phòng phẫu thuật của bệnh viện. Chúng tôi đã thực hiện kỹ thuật chặn dây thần kinh chẩm lớn gần bằng siêu âm, sử dụng thuốc bupivacaine, và cường độ cơn đau giảm xuống còn 2/10. Thủ thuật chặn dây thần kinh được lặp lại một lần mỗi tuần trong một tháng. Sau hai tháng, cả cường độ đau đầu và số lần xuất hiện cơn đau đều giảm, và không có tác dụng phụ nào được ghi nhận."
+    },
+    {
+        "id": "multiclinsum_gs_en_504.txt",
+        "fulltext": "14-year-old previously healthy adolescent who presented to the Primary Emergency Care Service (PEC) of Osorno with a 11-day history of a predominantly nocturnal irritative cough. Symptomatic treatment was indicated, evolving with dyspnoea and orthopnoea. He presented to the Emergency Department of the Osorno Base Hospital (OBH), with severe respiratory distress, intolerance to supine position, and abdominal pain. He was admitted to the Paediatric Intensive Care Unit (PICU), tachycardic, hypertensive, polypneic, oxygen saturation 96% with FiO2 35%, rosy, hydrated and well perfused, with flat jugular veins, small bilateral supraclavicular lymphadenopathies. The thorax was without retraction of soft tissue, maintained in a genupectoral position, with decreased pulmonary murmurs in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The soft abdomen was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and\n\nA nephrological evaluation was performed, which confirmed renal failure secondary to tumor lysis syndrome, without dialysis urgency and tendency to hypertension, with creatinine 1.54 mg/dL, phosphemia 11 mg/dL, without hypernatremia. It continued with hyperhydration, diuretic (furosemide) and antihypertensive (amlodipine). From the respiratory point of view, it presented oxygen requirement, with FIO2 35% by mask of Venturi, suspending this supply on the third day of admission. It evolved with episodes of psychomotor agitation, associated to the diagnosis in process, which was treated according to the institutional protocol of psychomotor agitation, with psychological and psychiatric support, with satisfactory evolution. On the third day of admission and treatment a CT scan of the thorax, abdomen and pelvis was performed with contrast, observing an increase in the size of the thymus, of homogeneous aspect, probably in the context of a lymphoproliferative process and findings suggestive of pulmonary thromboembolism. The angioCT of the thorax showed thrombosis of the jugular vein, extensive bilateral pleural effusion associated to atelectatic phenomena in both bases, with signs of medical bilateral nephrosis. Anticoagulation with enoxaparin (1 mg/kg dose, every 12 hours) was indicated for twenty days. Then the angioCT of control showed resolution of the thrombosis.On the fourth day of admission and treatment, a diagnostic and extension study was performed, which included, among others, a complete biochemical profile including lipid profile, granulopoietic hyperplasia of the bone marrow (myelogram), flow cytometry (bone marrow) in which no cells with a predominant clonal or neoplastic immunophenotype of haemological lineage were observed, flow cytometry in peripheral blood negative for neoplastic cells, cytological of pleural fluid negative for neoplastic cells, flow cytometry of pleural fluid without evidence of haemological neoplasia. It was presented to the paediatric oncological committee, highlighting that it was not possible to take a biopsy of the tumour given that the mediastinal mass disappeared with the cytoreductive treatment, assuming the diagnosis of lymphoblastic lymphoma by the clinical picture and the response to treatment, according to the PINDA 0516 protocol. This protocol contemplates in Induction IA eight doses of Lasp E. coli of 10,000 IU/m2. Having received seven doses of L-asp and with a cumulative dose of ninety thousand international units plus glucocorticoid (prednisone), presented a picture of decline, vomiting, abdominal pain and mild dehydration. There was suspicion of pancreatitis, which was ruled out by normal amylase/lipase values and normal hepatic tests. At that time it had plasma electrolyte profile with hyponatraemia of 126 mOsm/kg and urinary osmolality of 510 mOsm/kg, both normal values. With hyponatraemia and hypertriglyceridaemia, there was suspicion of RAM of pseudohyponatraemia secondary to hypertriglyceridaemia associated to L-asp. It was evaluated by Gastroenterology and Endocrinology, indicating a diet low in refined sugars and rich in fiber, fibrates (ciprofibrato 100 mg oral daily) and omega 3 (4 g oral daily), until triglyceride values of 300 mg/dL were achieved. Two weeks later the triglycerides had a value of 79 mg/dL. Ciprofibrato and omega3 were suspended, indicating prophylactic use associated to corticoid and L-asp treatment. A total of twelve doses of L-asp were completed with a cumulative dose of one hundred and eighty four thousand international units corresponding to the induction protocol. The suspicion of RAM was subjected to causality evaluation, with the modified Karch and Lasagna algorithm by WHO5, which resulted in “Definitive” RAM for the association of L-asp and Prednisone\n",
+        "summary": "A teenager who developed pseudohyponatraemia and hypertriglyceridaemia during treatment for non-Hodgkin lymphoma (NHL) was suspected to have a drug reaction (ADR). This suspicion of ADR was evaluated according to the modified causality algorithm (Karch and Lasagna), resulting in a \"definitive\" ADR for the association of L-asp and corticosteroids. He received treatment with a low-fat diet and lipid-modifying medicines. L-asp and prednisone were not discontinued due to the end of the indication, according to the protocol. The hypertriglyceridaemia recovered without complications after 14 days of treatment.\n",
+        "translated_fulltext": null,
+        "translated_summary": "Một thiếu niên bị giả hạ natri huyết và tăng triglyceride huyết trong quá trình điều trị bệnh u lympho không phải Hodgkin (NHL) được cho là có phản ứng với thuốc (ADR). Nghi ngờ về ADR này được đánh giá theo thuật toán đánh giá nguyên nhân đã được điều chỉnh (Karch và Lasagna), và kết quả cho thấy có một ADR \"rõ ràng\" liên quan đến việc sử dụng L-asp và corticosteroid. Cậu bé được điều trị bằng chế độ ăn ít chất béo và các loại thuốc điều chỉnh lipid. Theo quy trình, L-asp và prednisone không được ngừng sử dụng vì đã đến thời điểm kết thúc chỉ định. Tình trạng tăng triglyceride huyết thuyên giảm mà không có biến chứng sau 14 ngày điều trị."
+    },
+    {
+        "id": "multiclinsum_gs_en_54.txt",
+        "fulltext": "A 56-year-old Italian female patient with β-thalassemia major presented to the radiology department to undergo MRI to quantify myocardial, hepatic, and pancreatic iron deposition. The clinical history of the patient included a transfusion-dependent β-thalassemia condition (genotype HBB:c.118C > T/ HBB:c.93-21G > A), diagnosed at the age of 7 years, despite the fact that the first transfusion was carried out at 2 years. As a consequence of β-thalassemia, the patient underwent splenectomy and cholecystectomy.\n\nAt the moment of MRI, she had a negative HCV-RNA (Hepatitis C virus-Ribonucleic acid) test, no osteoporosis or other endocrine, cardiac, or hepatic complications, and good iron levels. The patient’s therapy included iron chelation with deferasirox, vitamin D, and luspatercept, an erythropoiesis modulator started 2 years before the MRI examination (good response, with an increase of about 35% of transfusion interval duration). Transfusion therapy included two units of concentrated and filtered red blood cells every 25 days with pre-transfusion hemoglobin values of 10–10.5 g/dl.\n\nOn MRI, a solid mass with lobulated and regular contours was incidentally identified within the prevascular compartment of the mediastinum.\n\nThe lesion was mildly hyperintense on T2-weighted images (T2-wi) and isointense on T1-wi. The mediastinal mass in question was discernible in a prior MRI examination conducted for the same purpose in 2020 before starting luspatercept therapy, albeit with a marginal enlargement.\n\nThere were no other apparent abnormalities observed in the remaining mediastinal compartments. No pleural or pericardial effusions were present.\n\nThe neurological examination was unremarkable, and in the preceding months, the patient exhibited no symptoms of mediastinal syndrome associated with compression of the adjacent neurovascular structures. Moreover, she did not exhibit any fever or experience any weight loss.\n\nFor further evaluation, the patient underwent 18F-deoxyglucose (18FDG) positron emission tomography (PET)-computed tomography (CT) and chest CT with contrast media. On PET-CT, the mediastinal mass showed only mild FDG uptake (SUVmax = 4.3); no other sites of abnormal radiotracer uptake were reported in the neck, chest, abdomen, and skeleton. On CT images, the lesion presented regular margins, solid density, and mild contrast enhancement. The adjacent structures did not exhibit any signs of invasion, and lymphadenopathies or extra-thoracic disease were not present. Such radiological features, the indolent behaviour over time, the absence of systemic symptoms, and the lack of avid FDG uptake on PET-CT scan made the diagnosis of thymoma probable.\n\nHowever, on lung window visualization, multiple rounded areas of parenchymal lucency, consistent with thin-walled cysts distributed symmetrically throughout both lungs, with normal intervening parenchyma, were evident.\n\nNo nodules or other interstitial abnormalities were associated with the cysts. No pneumothorax was detected. Coherently with thalassemic bone disease, the ribs appeared widened, and the spine displayed mild platyspondyly. The remaining portion of the chest and visible upper abdomen were unremarkable. The radiological findings were consistent with cystic lung disease, most likely LAM.\n\nThe patient was then referred to the pulmonary clinic for further evaluation. She was a never-smoker and did not report any respiratory symptoms. In particular, she denied a history of chronic cough, recurrent respiratory infections, or pneumothorax. No cutaneous lesions, notably facial fibrofolliculomas, were evident. On chest examination, the lung fields were clear. Peripheral capillary oxygen saturation was normal (98%), with a heart rate of 75 beats per minute. Pulmonary function tests revealed a substantial reduction in diffusing capacity of the lungs for carbon monoxide (DLCO; 42% of the predicted value), partly imputable to the condition of anemia, with a carbon monoxide transfer coefficient (KCO) of 73% of the predicted value. After discussion in a multidisciplinary tumor board setting, including a pulmonologist, the patient underwent left thoracoscopic thymectomy and concomitant lingual segment wedge resection. The histopathological report revealed a morphological finding and immunohistochemical pattern referable to type B2 thymoma with focal infiltration of the capsule. Extracapsular extension was not evident. However, the lesion was present at the resection margin (stage IIa according to Masaoka–Koga; stage 1a according to the tumor, node, metastasis [TNM] classification).\n\nRegarding the lung parenchyma, histopathologic analysis described lung parenchyma with cysts of variable size lined by spindle cells in myoid habit with immunohistochemical reactivity for actin, estrogen, progesterone receptors, and HMB45 (focal positivity). Modest chronic interstitial inflammation, vascular congestion, and recent blood extravasation were evident. These morphological findings were compatible with pulmonary LAM.\n\nA final histological diagnosis of thymoma and pulmonary LAM was made. For the neoplastic condition, the patient was a candidate for adjuvant radiation therapy due to the microscopically incomplete resection (R1). For LAM with concomitant β-thalassemia, treatment with sirolimus was recommended.",
+        "summary": "A 56-year-old Italian female patient with β-thalassemia major underwent magnetic resonance imaging to quantify myocardial, hepatic, and pancreatic iron deposition. Her medical history included transfusion-dependent β-thalassemia, splenectomy, and cholecystectomy. At the time of magnetic resonance imaging, she had no significant endocrine, cardiac, or hepatic complications and was on deferasirox, vitamin D, and luspatercept. Magnetic resonance imaging revealed a lobulated mass in the prevascular mediastinum, which showed mild radiotracer uptake on positron emission tomography. Chest computed tomography revealed multiple thin-walled cysts in the lungs, indicating lymphangioleiomyomatosis. Following multidisciplinary evaluation, the patient underwent thoracoscopic thymectomy and lung wedge resection. Histopathology confirmed type B2 thymoma and pulmonary lymphangioleiomyomatosis. Post-surgery, the patient was recommended for adjuvant radiation therapy and sirolimus treatment.",
+        "translated_fulltext": null,
+        "translated_summary": "Một bệnh nhân nữ người Ý, 56 tuổi, mắc bệnh thalassemia beta nặng, đã được chụp cộng hưởng từ (MRI) để định lượng lượng sắt tích tụ trong cơ tim, gan và tuyến tụy. Tiền sử bệnh của bà bao gồm bệnh thalassemia beta cần truyền máu thường xuyên, cắt lách và cắt túi mật. Tại thời điểm chụp MRI, bà không có các biến chứng nội tiết, tim mạch hoặc gan đáng kể và đang dùng deferasirox, vitamin D và luspatercept. Kết quả chụp MRI cho thấy một khối có nhiều thùy ở vùng trước mạch máu trung thất, khối này có khả năng hấp thụ chất đánh dấu phóng xạ nhẹ trên chụp cắt lớp phát xạ positron (PET). Chụp cắt lớp vi tính ngực cho thấy nhiều nang mỏng thành trong phổi, cho thấy bệnh u cơ trơn mạch bạch huyết phổi (lymphangioleiomyomatosis). Sau khi được đánh giá bởi một nhóm chuyên gia đa ngành, bệnh nhân đã trải qua phẫu thuật cắt bỏ tuyến ức bằng phương pháp nội soi lồng ngực và cắt một phần phổi. Kết quả giải phẫu bệnh xác nhận bệnh u tuyến ức loại B2 và bệnh u cơ trơn mạch bạch huyết phổi. Sau phẫu thuật, bệnh nhân được khuyến nghị điều trị bằng xạ trị bổ trợ và sirolimus."
+    },
+    {
+        "id": "multiclinsum_gs_en_235.txt",
+        "fulltext": "We present a case of a 49-year-old woman with renal and heart failure following a long-term (lasting from 13 years of age) SLE prepared for kidney transplantation. Due to LN (class III, then IV), starting at childhood, she was treated with steroids, together with cyclophosphamide, replaced later by methotrexate and then azathioprine. Hence, the partial remission of nephrotic syndrome was achieved and from 2002 the patient did not receive any immunosuppressive therapy. She was also HBV and HCV positive. SLE involvement of circulatory system presented with early coronary atherosclerosis, ischemic heart disease, and myocardial infarction at the age of 20. In 2007, because of deterioration of kidney function with a serum creatinine concentration of 2.2 mg/dL and proteinuria of 2 g/day, the kidney biopsy was performed. The biopsy showed active and sclerotic focal proliferative lupus nephritis nevertheless immunosuppressive therapy was not introduced for the reason of active replication of HCV. The kidney function was gradually deteriorating over time. Despite cardiac intervention (PCI RCA), the patient developed severe post-infarction and dilated cardiomyopathy and required ICD implantation in primary prevention in 2009. Later, on lupus and secondary cardiomyopathic background, the patient developed severe MV and TV regurgitation. For this reason, the patient underwent mitral and tricuspid valve repair and left ventricle volume reduction surgery complicated by low cardiac output syndrome with a need for intra-aortic balloon pump use (2014). In the postoperative period, the kidney function deteriorated, requiring the initiation of renal replacement therapy. The patient has been on dialysis for 4 years. While being on active waiting list for kidney transplantation presented remission of laboratory indices of lupus (complement splits within normal limits: C3–0,93 g/l, C4–0,4 g/l, ANA negative) and persisting circulatory insufficiency with markedly reduced stair-climbing capacity (to one flight of stairs) with elevated BNP 619 pg/ml (n. 0–100). In transthoracic echocardiography, performed before renal transplantation, the left ventricle and the left atrium were significantly enlarged and the left ventricular systolic function was significantly reduced with LVEF 26% and GLS -3. Due to the implantation of the mitral ring, it was not possible to assess the left ventricular diastolic function. The high tricuspid regurgitant flow gradient with widened and poorly respiratory mobile inferior vena cava indicated a high probability of pulmonary hypertension. Furthermore, while preparing the patient for the surgical procedure, it was decided to include cardioprotective therapy with Levosimendan. Due to the time frame associated with the transplantation procedure, the drug infusion was started as soon as possible after cross-match results were known, immediately after the dialysis session. The infusion at a dose of 0.1 μg/kg/min was continued after surgery for a total of 24 h. The patient’s anesthesia for kidney transplantation and perioperative care included the aspect of optimizing transplanted kidney perfusion, avoiding the use of renal toxic drugs and those excreted by properly functioning kidneys, as well as the use of nephroprotective agents. Because of the patient’s cardiological burden, including recurrent episodes of extrasystole proceeding with decompensation of the circulatory system, together with the need of ICD turning off for the transplantation period, the Swan-Ganz catheter for hemodynamic assessment was not used. Anesthesia monitoring was limited the to ECG, central catheter with CVP assessment, direct blood pressure measurement from the cannula inserted into the radial artery, and cardiac ultrasound. In the perioperative period the CVP parameter was used to assess the volatility, and in the postoperative period, a cardiac ultrasound was used along with the assessment of VCI respiratory fill and motility. The therapy was aimed at the standard of fluid therapy called Goal Directed Therapy (GDT). During general anesthesia, fentanyl, triacrium, propofol, desflurane, antibiotic therapy, and standard immunosuppressive treatment were used as well as 25 g of mannitol infusion was administered as a nephroprotective treatment and 0.9% NaCl as a fluid therapy. In the course of postoperative immunosuppression, she received steroids, tacrolimus with mycophenolate mofetil which was stopped due to persistent leukopenia and cytomegalovirus infection. Furthermore delayed graft function was observed with a need for hemodialysis for almost 6 weeks (mostly due to fluid retention). BNP levels raised to 2996 pg/ml and then slowly decreased. The kidney biopsy performed 2 weeks after transplantation revealed acute rejection (AR II B Banff 2015) with ATN. Finally, the patient was discharged from the hospital on the 67th POD with the serum creatinine concentration of 1.4 mg/dL and BNP level of 1794 pg/ml. One month after kidney transplantation, there was a reduction in left ventricular dimensions, improved systolic function in the EF (increase to 30%) and GLS (decrease to − 6) assessment. In addition, there was a decrease in the tricuspid regurgitant flow gradient with normal width and respiratory motility of the IVC, which indicates a low probability of pulmonary hypertension. The improvement of echocardiographic parameters also reflected the simultaneous improvement of exercise capacity in the recipient from NYHA III/IV to NYHA II. In the 5-month observation, further improvement of heart function with a drop of BNP to 1066 pg/ml and normal kidney function were noted.",
+        "summary": "We present a case of a 49-year-old woman with renal and heart failure following a long-term SLE prepared for kidney transplantation. During the SLE course, the function of the heart and kidneys gradually deteriorated. The patient required the initiation of renal replacement therapy and was dialyzed until a kidney transplantation for 4 years. In the preparation of the patient for the surgical procedure, due to the extremely low ejection fraction, it was decided to include cardioprotective treatment with Levosimendan. The postoperative period was not straightforward but successful. In the monthly and five-month follow-up, a continuous improvement of heart function with normal renal function was noted.",
+        "translated_fulltext": null,
+        "translated_summary": "Chúng tôi xin trình bày một trường hợp bệnh nhân nữ 49 tuổi bị suy thận và suy tim do bệnh lupus ban đỏ hệ thống (SLE) kéo dài, và bệnh nhân đã được chuẩn bị cho việc ghép thận. Trong quá trình diễn biến của bệnh SLE, chức năng tim và thận của bệnh nhân dần suy giảm. Bệnh nhân cần được bắt đầu điều trị thay thế chức năng thận và được lọc máu trong 4 năm cho đến khi được ghép thận. Trong quá trình chuẩn bị cho phẫu thuật, do chỉ số thể tích tống máu rất thấp, quyết định được đưa ra là sử dụng liệu pháp bảo vệ tim bằng Levosimendan. Giai đoạn hậu phẫu không diễn ra suôn sẻ nhưng cuối cùng đã thành công. Trong quá trình theo dõi hàng tháng và sau 5 tháng, chức năng tim liên tục được cải thiện và chức năng thận trở lại bình thường."
+    },
+    {
+        "id": "multiclinsum_gs_en_172.txt",
+        "fulltext": "Patient information\nA 20-year-old male Arabic martial artist (weight 91.5 kg, height 180 cm, and body mas index (BMI) 28.24) presented with pain in the back of the left thigh for the past 5 weeks and underwent pharmacological and physiotherapeutic intervention; however, he did not responded well to symptomatic treatment. He reported that the symptoms first appeared during a short sprint while playing soccer and heard a pop in the back of his thigh. The pain was so bad that he withdrew from the game soon after his injury and noted no bruising on the back of his thigh or significant swelling in that area. However, he reported progressive loss of flexibility in the left knee and inability to flex and extend the knee joint while the knee remained flexed at a 15° angle, whether standing or having the leg in the air. He denied any previous history of lower back pain but could barely support the weight of the affected limb. There was no history of alcohol, smoking, diabetes, high blood pressure, or other serious genetic diseases.\n\nClinical findings and diagnostic assessment\nThe patient reported having received icing and elevation of the affected leg while lying down following the injury as therapeutic interventions. He had a crepe bandage applied to his affected thigh to support him while standing and walking. He used crutches for ambulation and to go for a little longer distance. To climb the stairs, he had to use one step at a time, relying on his right lower extremity. He also reported adopting a sitting position at the edge of the chair as direct pressure on the thigh from the chair caused him discomfort. He denied ever hurting his legs or back in sports. As a result, the patient withdrew from all activities, such as playing sports, owing to the pain, and his knee was mildly bent most of the time. Despite taking medication (nonsteroidal antiinflammatory drugs (NSAIDs)), the pain worsened over time. Since the patient did not respond well to cryotherapy, compression bandages, and medications, he decided to see a doctor for further diagnosis and treatment before meeting with us.\n\nOn further evaluation, he presented with limited knee extension and flexion and exhibited an analgesic gait with a reduced heel strike phase. Active range of motion (AROM) of the left knee was 10–15° compared with 0–130°degrees in the right knee. Palpation revealed tenderness and firmness in the middle third of the semimembranosus and semitendinosus muscles.\n\nManual muscle testing and isometrics could not be performed owing to persistent discomfort. The patient reported pain at rest, rated 5/10, and during activity it was rated 7/10. Further, clinical evaluation rule out lumbar disc involvement or gluteal and ischial tunnel syndrome [4, 6].\n\nThe best way to screen nerve tension for peripheral pain in the lower extremities is with a slump test [17]. However, the result of the slump test in this patient was negative.\n\nTherapeutic interventions\nDespite the patient’s current clinical presentation, which was suggestive of HSI, the authors decided to treat him with neural glide technique on the basis of the structural and functional proximity of nerve to the lower limb flexibility through a novel neurodynamic tension technique [18, 19]. The scientific rationale for this neural approach was detailed to the patient and consent was obtained.\n\nThe patient was directed to sit with arms folded behind his back and knees and ankles held in extension and dorsiflexion, respectively, while a therapist guided the patient to flex his thoracic and cervical spine and extend his knee joint to the maximum tolerable limit. Next, the patient was instructed to move his neck forward and backward as much as possible while also moving his ankle up and down 15 times to help with nerve glide.\n\nThis was done in three sets each day. The therapist then helped the patient bend their middle and upper back as much as possible until the patient felt pain in the knee area. Then, the process was repeated. By the 3rd day, the patient’s active knee extension improved from 5° to 10° and then to a 15° degree bent position. In addition, the standing posture also got better.\n\nSubsequently, the patient was instructed in executing a set of posture re-education workouts, which involved doing active chin flexion, engaging in passive stretching of the cervical extensors while lying down in prone, and building up the shoulder retractors, arm from positions T to Y, then from Y to W with the limb’s weight while lying down.\n\nTo address the kyphotic posture, active chest stretches were taught at wall corners. The patient was instructed to increase the duration of the exercises from 5 to 10 seconds, doing 10 reps and 3 sets daily.\n\nOutcomes and follow-up\nThe results were assessed using a numeric pain rating scale (NPRS) and Knee Society score (KSS). Substantial enhancement in clinical outcome measures such as pain and function were achieved within 3 successive days of therapy. The use of pain medication was discontinued.\n\nThe patient continued his self-neural glides and postural reduction exercises at home and was advised for a follow-up after 4 weeks or to contact us if symptoms worsened. On the 3rd follow-up day, the patient’s NPRS from 5 at rest and 7 with activity to 2 at rest and 4 with activity. The KSS increased from 22 to 61 and from 30 to 80 in the functional domain. At the end of the 2-week home program, the patient reported to have full active straight leg raise (SLR). The patient had fully recovered from his knee dysfunction and pain at the 2-month follow-up.",
+        "summary": "A 20-year-old male Arabic martial artist had a history of left hamstring strain for the past 5 weeks. He had undergone pharmacological and physiotherapeutic interventions for his clinical conditions but had not responded favorably. Further clinical assessment had ruled out hamstring syndrome. The patient refrained from all sports activities.\n\nIntervention: The patient was treated using a modified slump mobilization technique with four repetitions for 3 consecutive days, together with postural retraining. Results of the numeric pain rating scale and Knee Society score before and after the interventions were obtained.\n\nResults and discussion: Pre-intervention score of the numeric pain rating scale was 5/10 and 7/10 at rest and with activity, respectively. Assessment on the 3rd consecutive day of intervention, the numeric pain rating scale decreased to 2/10 and 4/10 at rest and with activity, respectively. Similarly, the pre- and post-intervention Knee Society score improved from 22 to 61 in pain and from 30 to 80 in function. At the 2-month follow-up, the patient reported a complete recovery from symptoms and resumed his sports activities without any disruption.",
+        "translated_fulltext": null,
+        "translated_summary": "Một vận động viên võ thuật người Ả Rập, 20 tuổi, có tiền sử bị căng cơ gân kheo bên trái trong 5 tuần qua. Anh ta đã được điều trị bằng thuốc và vật lý trị liệu cho tình trạng bệnh, nhưng không có nhiều cải thiện. Đánh giá lâm sàng sâu hơn đã loại trừ hội chứng gân kheo. Bệnh nhân ngừng tất cả các hoạt động thể thao.\n\nPhương pháp điều trị: Bệnh nhân được điều trị bằng kỹ thuật vận động cột sống đã được điều chỉnh, thực hiện bốn lần trong ba ngày liên tiếp, kết hợp với việc điều chỉnh tư thế. Kết quả của thang điểm đánh giá mức độ đau và điểm số của Hiệp hội Đầu gối trước và sau khi điều trị đã được ghi lại.\n\nKết quả và thảo luận: Điểm số trước khi điều trị trên thang điểm đánh giá mức độ đau là 5/10 khi nghỉ ngơi và 7/10 khi vận động. Đến ngày thứ ba của quá trình điều trị, điểm số trên thang điểm đánh giá mức độ đau giảm xuống còn 2/10 khi nghỉ ngơi và 4/10 khi vận động. Tương tự, điểm số của Hiệp hội Đầu gối trước và sau khi điều trị đã cải thiện từ 22 lên 61 về mức độ đau và từ 30 lên 80 về chức năng. Sau 2 tháng theo dõi, bệnh nhân cho biết các triệu chứng đã hoàn toàn thuyên giảm và anh ta đã quay trở lại các hoạt động thể thao mà không gặp bất kỳ vấn đề gì."
+    },
+    {
+        "id": "multiclinsum_gs_en_313.txt",
+        "fulltext": "A male was born via an emergency cesarean section due to fetal distress at 40 weeks of gestational age. The mother's age was 33 years, with gravida 1 and para 1 parity. Both the parents and brother had no family history of congenital anomalies, aortic-related diseases, or sudden death. Based on the results of the prenatal ultrasonography at the end of the second trimester, the femur length of the fetus was found to be 1 to 3 weeks longer than the supposed length of the actual gestational age. Fetal echocardiography showed cardiomegaly with a fetal cardiothoracic circumference ratio of 0.5 or higher based on the baby's term. Moreover, the size of the foramen ovale was larger than normal, and left aortic constriction was seen next to the subclavian artery basin. Furthermore, no other abnormalities were found on prenatal ultrasound.\n\nAt birth, the weight was 3560 g (75 percentile), the length was 56.5 cm (over 90 percentile), and the head circumference was 36 cm (over 90 percentile). Apgar scores at 1 and 5 minutes were 4 and 6 points, respectively. In the delivery room, the patient had no spontaneous breathing and had bradycardia and cyanosis. After being admitted to the neonatal intensive care unit, various musculoskeletal malformations were confirmed via physical examination. Severe arachnodactyly and camptodactyly were observed in both hands and feet, and the soles of the feet were flat. The elbow and knee joints were not fully extended. The face had malar hypoplasia with senile facial appearance. The eye was deeply settled with a down-slanting palpebral fissure, and the ear with hypoplastic cartilage was poorly settled and crumpled. The patient presented with a sagging mouth, prominent coronal suture, and brachycephaly. A grade V/VI systolic murmur was heard at both the upper sternal border and left lower sternal border with grade III parasternal heave. Echocardiography showed poor cardiac contractility, severe pulmonary hypertension, dilated aortic sinus (20.2 mm) (Z-score; 8.08 by Boston, 6.37 by Detroit, or 5.97 by Halifax), and multiple intracardiac valvular dysfunction with valve prolapses (moderate aortic regurgitation, severe mitral regurgitation, moderate tricuspid regurgitation, and moderate pulmonary valve regurgitation). And the ophthalmologic examination results showed ectopia lentis in both eyes as well as lens subluxation. Liver herniation was confirmed using abdominal X-ray and ultrasound. The systemic score of the musculoskeletal manifestation was 11 points, according to the Ghent criteria (international diagnostic criteria for MFS).\n\nFor genetic diagnosis, Sanger sequencing and polymerase chain reaction were performed on the nucleotide sequence as reference for the FBN1 gene. As a result, a mutation in which G, the first base of the 32nd intron in the form of a heterogeneous mutation, was substituted with T (c.3964 + 1G > T). This was confirmed as the likely pathogen variant based on the 2015 ACMG/AMP guideline. The location of the mutation was included in the site previously known as the neonatal region of MFS (exons 24–32). The patient could be diagnosed with neonatal MFS with a novel FBN1 gene mutation within 2 weeks of life.\n\nOn the first day of life, differential cyanosis was found to show refractory hypoxemia despite more than 60% oxygen supply and signs of low cardiac output. The patient was managed medically for improving the low cardiac output according to severe mitral regurgitation and aortic regurgitation. Afterload reduction including milrinone continuous infusion, full sedation using fentanyl continuous infusion, and use of diuretic were attempt to improve the oliguria and heart failure. Despite the medical management, the patient presented with respiratory failure, heart failure, and severe pulmonary hypertension requiring continuous invasive mechanical ventilation. Aortic regurgitation, mitral regurgitation, pulmonary hypertension, and cardiac contractility got worse. After several consultations with the patient's family and medical staff about the treatment plan, palliative care was continued instead of surgical treatment. As a result, hepatic and pulmonary congestion accompanied by pulmonary hemorrhage had progressed as well. Eventually, it had progressed to multiple organ dysfunction syndrome, and the patient died 32 days after the birth.",
+        "summary": "Patient concerns:\nA newborn with neonatal MFS and severe cardiac involvement. He presented various severe clinical features such as arachnodactyly, camptodactyly, elbow and knee joint contracture, senile facial appearance, and deep settling with down-slanting palpebral fissure, hypoplastic ear cartilage, sagging mouth, brachycephaly, and ectopia lentis.\n\nDiagnosis:\nGenetic analysis revealed a novel mutation at nucleotide 3964 (c.3964 + 1 G > T) in intron 32 of the fibrillin-1 gene. This mutation is identified to be in the so-called neonatal region of fibrillin-1 exon 24 to 32, as reported previously.\n\nInterventions:\nThe patient was managed medically for improving the low cardiac output according to severe mitral regurgitation and aortic regurgitation. Afterload reduction, full sedation, and use of diuretic were attempted to improve the oliguria and heart failure.\n\nOutcomes:\nDespite the medical management, aortic regurgitation, mitral regurgitation, pulmonary hypertension, and cardiac contractility got worse. Surgical treatment is essential to prolong the patient's life, however, considerations for the grave progression of the disease make families decide to continue palliative care instead of surgical treatment. A few months after birth, he presented with rapidly progressive aortic regurgitation, mitral regurgitation, and congestive heart failure leading to death.",
+        "translated_fulltext": null,
+        "translated_summary": "Các vấn đề của bệnh nhân:\nMột trẻ sơ sinh mắc hội chứng Marfan ở trẻ sơ sinh và có các vấn đề nghiêm trọng về tim mạch. Bệnh nhi có nhiều triệu chứng lâm sàng nghiêm trọng như ngón tay và ngón chân dài, co rút các ngón, co rút khớp khuỷu và khớp gối, khuôn mặt già nua, hốc mắt sâu và mí mắt xếch xuống, sụn vành tai kém phát triển, miệng trễ, đầu ngắn và thủy tinh thể lệch.\n\nChẩn đoán:\nPhân tích di truyền cho thấy một đột biến mới ở nucleotide 3964 (c.3964 + 1 G > T) trong intron 32 của gen fibrillin-1. Đột biến này được xác định là nằm trong vùng được gọi là vùng sơ sinh của exon 24 đến 32 của fibrillin-1, như đã được báo cáo trước đó.\n\nĐiều trị:\nBệnh nhi được điều trị bằng thuốc để cải thiện lượng máu bơm ra từ tim do suy van hai lá và suy van động mạch chủ nghiêm trọng. Các biện pháp giảm hậu gánh, gây mê toàn thân và sử dụng thuốc lợi tiểu đã được thực hiện để cải thiện tình trạng thiểu niệu và suy tim.\n\nKết quả:\nMặc dù đã được điều trị bằng thuốc, nhưng tình trạng suy van động mạch chủ, suy van hai lá, tăng huyết áp phổi và khả năng co bóp của tim vẫn trở nên tồi tệ hơn. Phẫu thuật là cần thiết để kéo dài tuổi thọ của bệnh nhân, tuy nhiên, do tình trạng bệnh tiến triển nghiêm trọng, các gia đình quyết định tiếp tục điều trị giảm nhẹ thay vì phẫu thuật. Vài tháng sau khi sinh, bệnh nhi có tình trạng suy van động mạch chủ, suy van hai lá tiến triển nhanh chóng và suy tim sung huyết, dẫn đến tử vong."
+    },
+    {
+        "id": "multiclinsum_gs_en_86.txt",
+        "fulltext": "A 27-year-old woman with beta-thalassemia major since 24 years and 16 weeks of pregnancy was referred from the Internal Medicine Department to the Oral Medicine Department with complaints of swelling, bleeding gums since early pregnancy, and bad breath. The patient was hospitalized with complaints of pain in her knee so he could not move. She was admitted to hospital with complaints of pain in her knees so she could not move and was diagnosed with Arthritis ar Genue Sinistra related to Thalassemia by an internal medicine specialist, sub division of rheumatology. General condition patient was weak, sick, and difficult to move during the approximately two weeks, when she was hospitalized. Patient has never visited a dentist, either before or now, with complaints about her oral cavity. The patient had a splenectomy in 2009. Her beta-thalassemia major was treated with routine blood transfusions once a month and iron anti- chelation drugs (deferoxamine); however, it was stopped due to pregnancy. There was no history of other systemic disease in this patient. A family history of the same disease was ruled out. History of recurrent stomatitis and drug or food allergies was ruled out.\n\nThe patient’s general condition weak, with normal vital signs; however, the patient had fever. Intraoral examination revealed gingival hyperplasia; erythema; soft consistency; a dark red, rounded gingival margin; tendencies to bleed on the labial, buccal, palatal, and lingual areas; and pain. Oral hygiene index-simplified (OHIS) score was poor (5.7) and there were true pockets in all regions. Peripheral blood morphology result: (1) erythrocytes: polychromacy in anisochrome populations (hypochrome, normochrome), anisopoikilocytosis (ovalocytes, target); (2) leukocytes: sufficient quantity, hypersegmentation (+); (3) platelet count: numbers increase, spread out; Interpretation: moderate anemia et causa thalassemia major accompanied by signs of increased erythropoiesis activity with suspected infection. The diagnosis was made based on the history, clinical features, and examination, as well as additional examinations, namely gingival enlargement accompanied by chronic periodontitis associated to pregnancy with β-thalassemia major and exfoliative cheilitis of the lips. The classification of periodontal disease in this patient is chronic periodontitis with gingival enlargement associated with pregnancy and beta-thalassemia major. The prognosis in this case was good because the patient was cooperative and followed the directions of the Oral Medicine Department. In this case, multidisciplinary therapy was a collaboration between an oral medicine specialist, a periodontist, and an internist. Dental therapy consisted of spooling with 3% hydrogen peroxide (H2O2) solution, chlorine dioxide spray mouthwash (Oxyfresh®, USA), antibiotics (amoxicillin 500 mg tablet, and metronidazole 300 mg tablet), and scaling/root planning. Spooling of H2O2 3% solution was performed at every visit; chlorine dioxide spray mouthwash was used three times a day after meals, and antibiotics were administered for seven days at third visit. Scaling and root planning were performed by the periodontist after the general condition was controlled and after the gingival hyperplasia and spontaneous bleeding improved. Blood transfusions to remove packed red cell buffy coat (PRC BCR) are also carried out routinely once a month. Non-pharmacological therapy, including oral hygiene instructions, was still given to patients. Oral complaints in this case occurred due to the poor oral hygiene, β-thalassemia major, and pregnancy, were also informed to the patient as education.\n\nThis patient had eight follow-up visits, consisting of two inpatient and six outpatient visits, with the following details:\n\nFirst Visit\nThe first visit was carried out one day after the initial inpatient visit (day +1). Intraoral bleeding still exists in the lingual-anterior part of the mandible, but bleeding in the anterior part of the maxilla has stopped. The patient still had a fever. Medications previously provided were used accordingly. Pharmacological were continued, including spooling 3% H2O2 on all parts of the gingiva, using chlorine dioxide as a mouthwash, and applying a thin layer of petroleum jelly to the lips. A blood transfusion was carried out last night. Oral hygiene instructions are still given to patients.\n\nSecond Visit\nThe second visit was performed two days after the initial visit (day +2). Intraoral bleeding Follow-up visits should be conducted in outpatient settings. Pharmacological therapy including spooling 3% H2O2 on all parts of the gingiva, using chlorine dioxide as a mouthwash, and applying a thin layer of petroleum jelly to the lips. A blood transfusion was carried out last night. Oral hygiene instructions are still given to patients.\n\nThird Visit\nNine days after the initial visit (Day+9). First outpatient treatment. Oral symptoms appeared to improve; bad breath was greatly reduced, but the gums were still swollen. The chlorine dioxide spray mouthwash was still being used and had run out. The patient could brush her teeth with a soft toothbrush but still experienced bleeding. Spooling was performed with 3% H2O2. The previous therapy was continued, antibiotics were prescribed 3x/day for seven days, and a blood transfusion was planned as a preparation for scaling the dental calculus. Oral hygiene instructions are still given to patients.\n\nFourth Visit\nOne month after the first visit (Day+30). Oral complaints improved significantly, bad breath was absent, gingiva enlargement decreased, and spontaneous bleeding ceased. The patient did not experience bleeding when brushing her teeth. Transfusions were performed between visits H+9 and H+30. During this visit, laboratory hematology tests and subsequent blood transfusions were performed. Antibiotics were no longer administered, 3% H2O2, chlorine dioxide, petroleum jelly and oral hygiene instructions were continued.\n\nFifth Visit\nOne week after the 4th visit (day +37), the oral complaints improved, but pharmacological and non-pharmacological therapy continued, including spooling 3% H2O2 on all parts of the gingiva, chlorine dioxide as a mouthwash, and applying a thin layer of petroleum jelly to the lips. Oral hygiene instructions are still given to patients. Supragingival scaling was planned two weeks later or after routine transfusions were administered.\n\nSixth Visit\nTwo months after the initial visit (day +60), the oral complaints improved. The gingival hyperplasia in some areas was no longer present, although in other areas still present, but they have undergone improvement. The transfusion had already been performed one week previously. Pharmacological therapy was continued, including 3% H2O2 spooling, chlorine dioxide spray mouthwash, and petroleum jelly. Non-pharmacological therapy namely oral hygiene instructions and an interdental toothbrush was suggested. Supra- and subgival scaling were performed.\n\nSeventh Visit\nTwo weeks after the 6th visit (Day+74), all the complaints improved. Gingival hyperplasia mostly resolved after scaling. Pharmacological includes 3% H2O2 spooling, chlorine dioxide spray mouthwash, and petroleum jelly as well as non-pharmacological therapy, consisting of oral hygiene instructions and the use of an interdental toothbrush.\n\nEighth Visit\nThree months after the initial visit (day +90), routine blood transfusions were performed one week before the visit. The patient is no longer presented with any oral complaints. All patients with gingival hyperplasia recovered optimally. The spooling process was stopped with 3% H2O2. Supra- and subgival scaling were performed again in all maxillary and mandibular regions. Instructions for the use of an interdental toothbrush, chlorine dioxide spray mouthwash, and petroleum jelly are still provided.",
+        "summary": "A 27-year-old woman, suffering from beta thalassemia major who is undergoing therapy in the form of routine blood transfusions every month and taking anti-chelation drugs but is currently stopping this because she is pregnant, currently 16 weeks pregnant, complains complained of swollen gums, bleeding, and bad breath. Extraoral examination revealed dry, exfoliative lips. Intraoral examination revealed gingival hyperplasia with erythema, soft consistency, dark red rounded gingival margins, bleeding, true pockets and pain throughout the labial, buccal, palatal, and lingual. There was no history of systemic disease in this patient. Patient has never visited a dentist, either before or now, with complaints about her oral cavity. Hematological parameters showed abnormalities, and peripheral blood examination revealed an infection. The oral diagnoses included gingival enlargement and chronic periodontitis associated with pregnancy and β- thalassemia major.\n\nCase Management\nDental management consisted of spooling with 3% hydrogen peroxide (H2O2) spooling, chlorine dioxide spray mouthwash, antibiotics, calculus removal, and oral hygiene instructions. Blood transfusions were administered once a month, and anti-chelation therapy was stopped during pregnancy. After three months of multidisciplinary management, the results were satisfactory.",
+        "translated_fulltext": null,
+        "translated_summary": "Một phụ nữ 27 tuổi, mắc bệnh thalassemia beta nặng, đang được điều trị bằng cách truyền máu định kỳ hàng tháng và dùng thuốc chống quá tải sắt, nhưng hiện tại đã ngừng điều trị vì đang mang thai, hiện đã được 16 tuần, phàn nàn về tình trạng nướu sưng, chảy máu và hôi miệng. Khám bên ngoài cho thấy môi khô và bong tróc. Khám bên trong miệng cho thấy tình trạng phì đại nướu với các dấu hiệu viêm, kết cấu mềm, bờ nướu màu đỏ sẫm, tròn, chảy máu, có các túi sâu và đau ở vùng môi, má, vòm miệng và lưỡi. Bệnh nhân không có tiền sử mắc các bệnh toàn thân. Bệnh nhân chưa từng đi khám nha khoa, cả trước đây lẫn hiện tại, và không có phàn nàn nào về tình trạng răng miệng. Các chỉ số huyết học cho thấy có bất thường, và xét nghiệm máu ngoại vi cho thấy có nhiễm trùng. Các chẩn đoán về răng miệng bao gồm tình trạng phì đại nướu và viêm nha chu mãn tính liên quan đến thai kỳ và bệnh thalassemia beta nặng.\n\nQuản lý ca bệnh:\nĐiều trị nha khoa bao gồm súc miệng bằng dung dịch 3% hydrogen peroxide (H2O2), sử dụng nước súc miệng chứa chlorine dioxide, dùng thuốc kháng sinh, làm sạch vôi răng và hướng dẫn vệ sinh răng miệng. Truyền máu được thực hiện một lần mỗi tháng, và liệu pháp chống quá tải sắt đã được ngừng trong thời kỳ mang thai. Sau ba tháng điều trị đa chuyên khoa, kết quả đạt được là tốt."
+    }
+]
\ No newline at end of file
diff --git a/data/translated_data/translation_wo_judge/multiclinsum_gs_train_en2zh_gemma(0_200).json b/data/translated_data/translation_wo_judge/multiclinsum_gs_train_en2zh_gemma(0_200).json
new file mode 100644
index 0000000000000000000000000000000000000000..c2b6d5287bb6cfe61f94202bbb34934b20094284
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@@ -0,0 +1,562 @@
+[
+  {
+    "id": "multiclinsum_gs_en_27.txt",
+    "fulltext": "A 20-year-old woman was followed up since the age of eight for idiopathic NS inaugurated by cerebral venous thrombosis extended to the right jugular vein with a massive pulmonary embolism. The patient did not have any sequelae. She had no other medical or surgical history. A family history of thrombosis has not been reported. The patient was not biopsied because she had no kidney failure nor gross hematuria, or hypertension at first presentation; added to that, she had no extra renal signs suggestive of a secondary nephrotic syndrome. She was accordingly put on anticoagulant therapy (Oral vitamin K antagonist) and oral corticosteroid therapy with good evolution. Thereafter, the patient received several cures of high-dose corticosteroids for steroid-dependent relapses of NS. She was, hence, put on mycophenolate mofetil (MMF) as a background therapy to avoid corticosteroids and ensure normal growth. An exhaustive assessment of thrombophilia was performed and did not show any abnormality. Homocysteine rate, blood fibrinogen rate, Protein C, protein S, antithrombin III, factor V Leiden mutation, JAK-2 mutation, cryoglobulins, anticardiolipin antibodies, lupus anticoagulant and beta-1-glycoprotein antibodies were normal. The anticoagulant treatment was stopped after nine years. The evolution was enameled by the occurrence of several relapses of her disease controlled by oral corticosteroid therapy. Remission of NS has been noted since 2017, so MMF was gradually stopped in 2019 and the patient remained asymptomatic and without any relapse.\n\nOne year later, the patient came up to our emergency department for acute intense diffuse abdominal pain without any particular irradiation associated with postprandial vomiting and bilateral lower limb edema for the last six hours. The physical examination revealed an intense epigastric tenderness with normal vital signs (arterial pressure of 120/70 mm Hg, heart rate of 83 bpm, and oxygen saturation at 100% on room air). The patient was afebrile with normal consciousness. The rest of the physical examination was unremarkable. The urinalysis with labstix revealed proteinuria. The hemogasanalysis results showed metabolic acidosis with respiratory compensation. Further laboratory tests revealed hypoalbuminemia, hypercholesterolemia, a prothrombin time at 90%, high levels of D-dimer, lactate dehydrogenase, and creatine phosphokinase as well as a biological inflammatory syndrome with a CRP of 37 mg/L, and leucocytosis at 26.4 x 103/µL. Renal and liver functions were normal.\n\nThe patient was hospitalized in an intensive care unit with close monitoring of vital signs and initiation of resuscitation measures. An abdominal ultrasound was performed urgently showing an intra-abdominal effusion of low to moderate abundance. An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery with acute mesenteric ischemia. The patient was immediately routed to the operating room. Intraoperative exploration confirmed mesenteric ischemia with extensive necrosis of almost entirely of the small bowel making their resections incompatible with life shown in Figure 3. The patient died after 48 hours.",
+    "summary": "We present the case of a 20-year-old woman with a 12-year history of idiopathic NS revealed by extensive cerebral venous thrombosis with pulmonary embolism treated with anticoagulation therapy and oral corticosteroid therapy followed by mycophenolate mofetil (MMF). The thrombophilia assessment did not show any abnormalities. The evolution was marked by the occurrence of several NS relapses controlled by oral corticosteroid therapy until 2017. Subsequently, the patient had not presented a relapse of her disease. The anticoagulant treatment and the MMF were therefore stopped. One year later, the patient presented with severe diffuse acute abdominal pain associated with postprandial vomiting and bilateral lower limb edema. Laboratory results confirmed a NS relapse. An abdominal CT scan revealed acute thrombosis of the superior mesenteric artery with acute mesenteric ischemia. Intraoperative exploration showed mesenteric ischemia with extensive necrosis of the small intestine making their resections incompatible with life. The patient died after 48 hours.",
+    "translated_fulltext": "一位20岁的女性，自8岁起开始接受随访，患有特发性肾病综合征，其病因是脑静脉血栓，血栓延伸至右颈静脉，并伴有大面积肺栓塞。患者没有出现任何后遗症，也没有其他既往病史或手术史。家族中没有血栓形成的病史。由于患者最初就诊时没有肾功能衰竭、肉眼可见血尿或高血压，因此没有进行活检。此外，她也没有其他肾外表现，这些表现可能提示继发性肾病综合征。因此，她接受了抗凝治疗（口服维生素K拮抗剂）和口服皮质类固醇治疗，并取得了良好的疗效。此后，患者接受了几次高剂量皮质类固醇治疗，以控制对皮质类固醇依赖的肾病综合征复发。因此，她开始接受霉酚酸酯（MMF）作为基础治疗，以避免使用皮质类固醇，并确保正常生长。对患者进行了全面的血栓倾向评估，结果未发现任何异常。同型半胱氨酸水平、血浆纤维蛋白原水平、蛋白C、蛋白S、抗凝血酶III、V因子Leiden突变、JAK-2突变、冷凝集蛋白、抗心磷脂抗体、狼疮抗凝剂和β-1糖蛋白抗体均正常。抗凝治疗在九年后停止。此后，患者的病情经历了多次复发，但通过口服皮质类固醇治疗得到了控制。自2017年起，肾病综合征的症状得到缓解，因此，2019年逐渐停止使用MMF，患者保持无症状，且未出现任何复发。\n\n一年后，患者因突发剧烈弥漫性腹痛，伴有餐后呕吐和双下肢水肿，症状持续了六小时，来到我院急诊科。体格检查显示，上腹部有剧烈压痛，生命体征正常（动脉血压120/70 mmHg，心率83 bpm，在室内空气中氧饱和度为100%）。患者没有发烧，意识正常。其余体格检查结果无异常。尿液分析显示蛋白尿。血气分析结果显示代谢性酸中毒，并伴有呼吸代偿。进一步的实验室检查显示低白蛋白血症、高胆固醇血症、凝血酶原时间为90%，D-二聚体、乳酸脱氢酶和肌酸激酶水平升高，以及生物炎症综合征，C反应蛋白为37 mg/L，白细胞计数为26.4 x 103/µL。肾功能和肝功能正常。\n\n患者被收治入院，进入重症监护室，密切监测生命体征，并开始进行复苏措施。紧急进行腹部超声检查，显示腹腔内有少量至中等量的积液。腹部CT扫描显示上肠系膜动脉急性血栓形成，伴有急性肠系膜缺血。患者立即被送往手术室。术中探查证实肠系膜缺血，几乎整个小肠出现广泛坏死，这使得切除手术与生命不相容，如图3所示。患者在术后48小时死亡。",
+    "translated_summary": "我们报告了一例20岁女性的病例，该患者患有特发性肾病综合征，病史长达12年。该患者曾出现广泛的脑静脉血栓形成，并伴有肺栓塞，接受了抗凝治疗和口服皮质类固醇治疗，随后又接受了霉酚酸酯（MMF）治疗。血栓形成倾向评估未发现任何异常。此后，该患者病情反复，多次出现肾病综合征复发，通过口服皮质类固醇治疗得以控制，直至2017年。此后，该患者未再出现疾病复发。因此，停止了抗凝治疗和MMF治疗。一年后，该患者出现严重的弥漫性急性腹痛，伴有餐后呕吐和双侧下肢水肿。实验室检查结果证实肾病综合征复发。腹部CT扫描显示上肠系膜动脉出现急性血栓形成，并伴有急性肠系膜缺血。术中探查显示肠系膜缺血，小肠出现广泛坏死，导致切除手术与生命不相容。患者在术后48小时内死亡。"
+  },
+  {
+    "id": "multiclinsum_gs_en_523.txt",
+    "fulltext": "We present the case of a 34-year-old woman, eight weeks pregnant with no other personal history of interest, who presents to the emergency department with generalized convulsions with dysarthria in the postcritical period, which resolve progressively in less than two hours. On physical examination, she is conscious, oriented, with no language or motor or sensory deficits. Only signs of a right lateral tongue bite are observed.\n\nThe complementary tests, such as blood tests or the electrocardiogram, are normal. Given that the episode corresponds with a first epileptic seizure and the patient is pregnant, an urgent magnetic resonance of the skull is requested.\n\nThe usual protocol was performed and 3D T1 sequences without and with intravenous contrast were obtained in axial, coronal and sagital planes, axial FLAIR, axial T2, VEN BOLD and magnetic susceptibility sequences, as well as axial diffusion and apparent diffusion coefficient map. The MRI identified multiple venous cortico-medullary vascular structures converging centripetally to a large central venous structure draining through the inferior anastomotic vein into the left transverse sinus, forming the classic ‘Medusa head’ sign. In the T1 sequences, the drainage vein was seen to be increased in signal with central hyphocaptation after contrast administration, suggesting partial thrombosis versus slow flow. In addition, in T2 and FLAIR sequences, the brain tissue surrounding the drainage vein was seen to be hyperintense, without diffusion restriction and compatible with edema.\n\nThese findings are suggestive of a venous anomaly of development with signs of partial peripheral thrombosis and slow flow more proximal, which cause edema of the surrounding tissue. She is started on clexane 60 mg/12 hours and levetiracetam 500 mg/12 hours and the patient shows improvement and symptomatic stability after one week.\n",
+    "summary": "A 34-year-old pregnant woman presents with seizures and dysarthria and is urgently referred for a cranial MRI. The classic ‘Medusa head’ sign is seen and the diagnosis is made as a venous anomaly of development with peripheral partial thrombosis and proximal slow flow.\n",
+    "translated_fulltext": "我们报告了一例34岁女性的病例。该患者怀孕八周，既往病史无特殊，因出现全身性抽搐，伴有构音障碍，于危重期后到急诊科就诊，症状在不到两小时内逐渐缓解。体格检查显示，患者意识清醒，定向力正常，语言、运动和感觉功能均无异常。仅观察到右侧舌头有咬伤迹象。\n\n辅助检查，如血液检查和心电图，结果均正常。考虑到该患者的症状与首次癫痫发作相符，且患者正处于怀孕状态，因此要求进行紧急颅部磁共振检查。\n\n按照常规流程进行检查，并获取了轴位、冠状位和矢状位的3D T1序列（有和无静脉注射对比剂）、轴位FLAIR序列、轴位T2序列、VEN BOLD序列和磁敏感性序列，以及轴位弥散序列和表观弥散系数图。MRI显示，多条静脉皮质-髓质血管结构汇聚，呈向心性，最终汇入一个大的中央静脉结构，并通过下部吻合静脉流入左侧横窦，形成典型的“美杜莎头”征象。在T1序列中，可以看到引流静脉在注射对比剂后，信号增强，中心区域出现强化，提示可能存在部分血栓形成或血流缓慢。此外，在T2和FLAIR序列中，可以看到引流静脉周围的脑组织信号增强，但没有弥散受限，与水肿相符。\n\n这些发现提示存在一种发育性静脉异常，伴有部分周围血栓形成和更近端的血流缓慢，导致周围组织水肿。患者开始接受克лекса宁60毫克，每12小时一次，以及左乙拉西坦500毫克，每12小时一次，治疗一周后，患者的症状得到改善，病情稳定。",
+    "translated_summary": "一位34岁的孕妇出现癫痫和构音障碍，情况紧急，被立即转诊进行颅部MRI检查。检查结果显示出经典的“美杜莎头”征象，诊断为一种发育性静脉异常，伴有周围部分血栓形成和近端血流缓慢。"
+  },
+  {
+    "id": "multiclinsum_gs_en_587.txt",
+    "fulltext": "A 22-year-old woman came to the Department of Oral Medicine with complaints of mouth ulcers causing pain and eating and drinking difficulty persisting for a duration of one month. This condition begins with a fever and appears like pimples on the lips. Based on the anamnesis, it was discovered that she had been using pod-type vapes for about a year but had never experienced complaints like when she came for treatment. She had never smoked traditional cigarettes before starting to vape. She said the reason for trying vaping was out of curiosity, and she quite often tried different types of e-liquid with different flavors. Before her complaint, she had simply changed the type of e-liquid to a different flavor without mentioning the brand. She vapes almost every day, but not all day, only in her free time or with friends. She was a healthy individual, and before this condition appeared, she had no history of taking medications, including antibiotics, analgesics, anticonvulsants, non-steroidal anti-inflammatory drugs, and antifungals. She also had no history of drug or food allergies, but the patient has unhealthy eating habits (eating irregularly and not consuming vegetables and fruit). Extraoral examination showed no lesions on other parts of the body, while the lips of the patient had serosanguineous crusts and an erosive area at the corner of the mouth, and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges, irregular, varying sizes, and pain on the labial, buccal, lateral, and ventral mucosa of the tongue and floor of the mouth.\n\nBased on the medical history of the patient and physical examination, which revealed oral mucosal involvement but no symptoms elsewhere in the body, as well as the non-reactive anti-HSV1 IgG results, the diagnosis of vaping-related oral erythema multiforme was established. The medical condition has been classified as minor erythema multiforme. The oral conditions were treated with 0.9% NaCl, which was moistened in gauze and placed on the lips three times a day. The patient was instructed to gargle 1 mg of dexamethasone in 10 mL of hyaluronic acid three times a day and avoid eating or drinking for at least 30 minutes after gargling. She was also given 2% miconazole cream applied to the wound in the right corner of the mouth twice a day, as well as vaseline album cream for dry lips. To maintain good oral hygiene, she was advised to brush her teeth and tongue twice a day, after breakfast and before bed. She was also instructed to stop vaping and avoid foods containing monosodium glutamate (MSG). The control was carried out after a week following therapy and showed that oral condition had improved. Written informed consent for the publication of details was obtained from the patient. This case report conformed with the Helsinki Declaration. The publication of this case report has also been approved by the institution.",
+    "summary": "A 22-year-old woman came to the Oral Medicine Department with complaints of stomatitis causing pain, eating, and drinking difficulty, which started with fever and pimple-like on the lips. She was an active vape user for one year. Extraoral examination revealed no lesions on other body parts. The serosanguinolent crusts on the lips, an erosive area on the labial commissures and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges and irregular, varying sizes in several parts of the oral mucosa. The anti-HSV-1 IgG laboratory results showed non-reactive, leading to a diagnosis of oral erythema multiforme. Management of oral conditions using 0.9% NaCl compress, dexamethasone mouthwash, and hyaluronic acid, applying 2% miconazole cream on labial commissures and vaseline album cream on the dry lips, and stopping vaping. Oral condition improved in a week of therapy.",
+    "translated_fulltext": "一位22岁的女性因口腔溃疡引起疼痛，且进食和饮水困难，症状持续了一个月，前来口腔科就诊。她的病情始于发烧，并在嘴唇上出现类似丘疹的症状。根据病史询问，她大约一年前开始使用烟弹式电子烟，但在此之前从未出现过类似此次就诊的症状。在开始使用电子烟之前，她从未吸过传统香烟。她说，她尝试电子烟的原因是出于好奇，并且经常尝试不同口味的电子烟油。在出现症状之前，她只是更换了电子烟油的口味，而没有提及品牌。她几乎每天都使用电子烟，但不是全天候，只在空闲时间或与朋友一起使用。她身体健康，在此之前没有服用过任何药物，包括抗生素、止痛药、抗惊厥药、非甾体抗炎药和抗真菌药。她也没有药物或食物过敏史，但患者的饮食习惯不健康（饮食不规律，不摄入蔬菜和水果）。体外检查显示，身体其他部位没有病变，但患者的嘴唇上有血清性渗出性结痂，且嘴角处有糜烂区域，容易出血。口腔检查显示，口腔内有白色溃疡，边缘呈黄色，形状不规则，大小不一，且在舌唇、颊、侧面和舌底的黏膜上出现疼痛。\n\n根据患者的病史和体格检查结果，显示口腔黏膜受累，但身体其他部位没有症状，并且抗HSV1 IgG结果为阴性，因此诊断为与电子烟相关的口腔多形红斑。该疾病被归类为轻度多形红斑。对口腔病变进行治疗，使用0.9%的生理盐水，将其浸湿在纱布上，每天在嘴唇上涂抹三次。患者被告知每天用10毫升透明质酸溶液漱口，每次使用1毫克地塞米松，并在漱口后至少30分钟内避免进食或饮水。此外，她还被给予2%的咪康唑乳膏，每天涂抹在右嘴角伤口上两次，并使用凡士林软膏来缓解嘴唇干燥。为了保持良好的口腔卫生，建议她每天早晚刷牙和刷舌头。她还被告知停止使用电子烟，并避免食用含有谷氨酸钠（味精）的食物。治疗一周后进行复查，结果显示口腔状况有所改善。已从患者处获得书面知情同意，允许发表相关细节。本病例报告符合《赫尔辛基宣言》。本病例报告的发表也已获得相关机构的批准。",
+    "translated_summary": "一位22岁的女性因口腔黏膜炎引起疼痛、进食和饮水困难而来到口腔医学科就诊。她的症状始于发烧，并在嘴唇上出现类似丘疹的病灶。她已经吸电子烟一年。体外检查显示，身体其他部位没有病灶。嘴唇上有血清性渗出性结痂，唇角处有糜烂区域，且容易出血。口腔内检查显示，口腔黏膜的多个部位有白色溃疡，边缘呈黄色，形状不规则，大小不一。抗HSV-1 IgG实验室结果显示为阴性，因此诊断为口腔多形红斑。治疗方案包括：使用0.9%生理盐水湿敷，漱口含地塞米松，涂抹透明质酸，在唇角处涂抹2%咪康唑霜，在干燥的嘴唇上涂抹凡士林软膏，并停止吸电子烟。经过一周的治疗，口腔状况有所改善。"
+  },
+  {
+    "id": "multiclinsum_gs_en_274.txt",
+    "fulltext": "A 29-year-old gravida V par IV (all alive, 3 spontaneous vaginal deliveries, and the last child was delivered by cesarean section for the indication of a failed induction 4 years prior to the current pregnancy) came for ANC follow-up at a gestational age of 32 weeks from her LNMP.\n\nAfter taking a medical history, it was discovered that all four of her children are healthy, doing well in school, and have no known history of genetic or seizure disorders. She was investigated with the Venereal Disease Research Laboratory (VDRL), Hepatitis B surface antigen (HBSag), and urine analysis, all of which were negative. All cell lines in the CBC were normal, her blood group is A, and Rh is positive, according to the Complete Blood Count (CBC), blood group, and RH. Obstetric ultrasound was also performed showing normal anatomical scan of the all body parts of the fetus except the heart. Detailed fetal echocardiography evaluation was done with findings of: both atria have comparable size and normal situs. Both atrioventricular and semilunar valves are normally positioned with normal opening and closure. Both ventricles are comparable in size and contractility; in both 2D and color flow, the left ventricle forms the apex of the heart without any ventricular septal defect. But on the papillary muscles of the left ventricle there were two circumscribed, round, echogenic mass measuring 18.2 mm by 8.3mm and 13.5mm by 8.3 mm. Upon evaluation of the outflow tract, both the LVOT (left ventricular outflow tract) and RVOT (right ventricular outflow tract) have normal anatomy and function using 2D and CF ultrasound evaluation. According to the fetal echo finding, a diagnosis of cardiac rhabdomyoma was made. Since there is a high chance of tuberous sclerosis in cardiac rhabdomyoma, detailed neurosonography and other system exams were done to look for other signs of tuberous sclerosis. Despite searching for the other features of tuberous sclerosis, no other sign of it was found other than the tumor. She had regular ANC follow-up from 32 weeks of gestation up to 39 weeks without any complications.\n\nAt gestational age of 39 weeks plus 1 day, she underwent a cesarean section for the indication of full-term pregnancy plus a request for a repeat cesarean section, with the outcome of a 3200-gram female with an APGAR score of 10 and 10 at the 1st and 5th minutes. Both the mother and the neonate had a smooth post-operative period and were discharged on the third day.\n\nAfter delivery, the neonate was evaluated on the 1st, 7th, and 30th days for any regression or increment of the mass, emergence of skin lesions, or seizure. All physical examination results were normal, and the mass size was similar to the antepartal evaluation.\n\nAt her 7th month, the child was evaluated again, and upon history inquiries, the infant was doing great developmentally for her age group. The infant was examined for neurodevelopmental delay, and the child was growing appropriately for her age. An echocardiography study by a pediatric cardiologist revealed well-circumscribed hyperechoic masses on both left ventricular papillary muscles, each measuring 21.8 mm by 9.2 mm and 14.7 mm by 8.5 mm and creating no left ventricular inflow obstruction.\n\nA history from the family was obtained, and a physical examination with anthropometric measurements was performed to assess her developmental condition during her first-year evaluation. The child was developing normally, as other children her age were. Except for the heart, all of the systems examined were unremarkable. An echocardiography study has revealed well-circumscribed hyperechoic masses on both left ventricular papillary muscles with no size increment and creating no left ventricular inflow obstruction.",
+    "summary": "We are reporting an isolated, asymptomatic fetal intra-cardiac mass (rhabdomyoma) that was discovered at 32 weeks of gestation and was followed as an outpatient until 39 weeks plus one day, at which point a cesarean section was performed. After delivery, the child underwent evaluations at the 1st day, 7th day, 30th day, 7th month, and 12th month of age. Following a checkup, the child's anthropometric and neurobehavioral growth were both healthy. Except for the tumor, which was neither growing nor shrinking in size, none of the clinical diagnostic criteria for tuberous sclerosis complex were met for this child up to the age of one year.",
+    "translated_fulltext": "一位29岁的女性，已生育四次（四次均存活，三次自然分娩，最后一次因四年前的引产失败而进行了剖腹产），在妊娠32周时前来进行产前检查。\n\n在进行病史询问后，发现她的四个孩子都健康，在学校表现良好，并且没有已知的遗传性疾病或癫痫病史。她接受了梅毒血清学试验（VDRL）、乙型肝炎表面抗原（HBSag）和尿液分析，结果均为阴性。全血细胞计数（CBC）显示所有细胞系均正常，她的血型为A型，Rh为阳性。还进行了产科超声检查，结果显示胎儿所有身体部位的解剖结构均正常，除了心脏。对胎儿心脏进行了详细的超声心动图检查，结果显示：两个心房大小相似，位置正常。两个房室瓣和半月瓣的位置正常，开合功能正常。两个心室大小和收缩力相似；在二维和彩色多普勒超声检查中，左心室形成心脏的顶点，没有室间隔缺损。但在左心室的乳头肌上，有两个界限清晰、圆形、强回声的肿块，尺寸分别为18.2毫米×8.3毫米和13.5毫米×8.3毫米。对流出道进行评估后，发现左心室流出道（LVOT）和右心室流出道（RVOT）的解剖结构和功能均正常，二维和彩色多普勒超声检查结果一致。根据胎儿超声心动图结果，诊断为心脏横纹肌肉瘤。由于心脏横纹肌肉瘤有较高的结节性硬化症风险，因此进行了详细的神经超声检查和其他系统检查，以寻找结节性硬化症的其他迹象。尽管进行了检查，但除了肿瘤外，没有发现结节性硬化症的其他迹象。她从妊娠32周开始，一直到妊娠39周，定期进行产前检查，期间没有出现任何并发症。\n\n在妊娠39周零1天时，她因足月妊娠以及要求再次进行剖腹产而进行了剖腹产，结果是出生了一个3200克的女婴，APGAR评分在第1分钟和第5分钟均为10分。母亲和新生儿术后恢复顺利，并在第三天出院。\n\n分娩后，对新生儿进行了第1天、第7天和第30天的评估，以观察肿块是否有缩小或增大，是否有皮肤病变或癫痫发作。所有体格检查结果均正常，肿块大小与产前评估时相似。\n\n在孩子7个月大的时候，再次进行了评估，病史询问显示，该婴儿在发育方面表现出色，符合其年龄段的正常发育水平。对该婴儿进行了神经发育迟缓的检查，结果显示该儿童的发育与同龄儿童的发育水平相符。儿科心脏病专家进行的心脏超声检查显示，在两个左心室乳头肌上，有界限清晰、强回声的肿块，每个肿块的尺寸分别为21.8毫米×9.2毫米和14.7毫米×8.5毫米，且没有造成左心室流入道梗阻。\n\n对该家庭进行了病史询问，并进行了体格检查和人体测量，以评估该儿童在出生后第一年的发育状况。该儿童的发育与其他同龄儿童的发育水平相符。除了心脏，其他所有检查的系统均未发现异常。心脏超声检查显示，两个左心室乳头肌上存在界限清晰、强回声的肿块，肿块大小没有增加，且没有造成左心室流入道梗阻。",
+    "translated_summary": "我们报告了一例在妊娠 32 周时发现的、孤立的、无症状的胎儿心内肿块（横纹肌肉瘤），该患儿在妊娠 39 周零 1 天时进行了剖腹产，之后作为门诊患者进行了随访。分娩后，该患儿分别在出生后第 1 天、第 7 天、第 30 天、满 7 个月和满 12 个月时进行了评估。检查结果显示，该患儿的身体测量指标和神经行为发育均正常。除了该肿瘤，该肿瘤的大小既没有增大也没有缩小，在该患儿出生后的一年内，均未满足结节性硬化综合征的任何临床诊断标准。"
+  },
+  {
+    "id": "multiclinsum_gs_en_124.txt",
+    "fulltext": "13-year-old boy from Cusco with a history of laryngeal papillomatosis since the age of two (at the age of three he required a tracheostomy) and a mother with a history of genital papilloma. The patient was admitted to the San Borja National Institute of Child Health in Lima, after a 16-day illness characterised by respiratory difficulties predominantly at night, inspiratory laryngeal stridor and moderate dysphonia; he previously received azithromycin and oxygen support, without improvement.\n\nThe physical examination revealed mild subcostal retraction, decreased vesicular murmurs in the left hemithorax and scanty wheezy breath sounds with predominance in the right hemithorax, which required oxygen support with a binasal cannula at 4 liters. The rest of the evaluation had no relevant findings. At the laboratory level, leukocytes were found at 8.03 × 103/u, platelets 209 × 103/u, hemoglobin 13.2 g/dL, C-reactive protein at 36.6 mg/L. As part of the imaging studies, a chest radiograph and a head and neck tomography were performed.\n\n48 hours after admission, she presented with increased stridor and respiratory difficulty, so admission to the emergency operating room for tracheostomy, microsurgery and excision of papillomatosis lesions was decided. An appendicular tumour of papillomatose appearance with ventricular bands in the epiglottis, glottic face, vocal cords, subglottis and trachea up to ring 5 was evident. The anatomopathological report reported coilocitic atypia due to HPV and mild focal dysplasia.\n\nIn the immediate postoperative period, he was transferred to the paediatric intensive care unit for respiratory monitoring, with weaning from oxygen at 48 hours. He received a single dose of bevacizumab 400 mg intravenous and subsequently improved clinically. The patient remained hospitalised for seven days, achieving clinical stability through normalisation of oxygen saturation levels and progressive weaning from oxygen, and was subsequently referred to the hospital in Breña to continue his management. Telemonitoring was carried out after eight months and the family indicated that there was no evidence of relapse or other intercurrences.\n",
+    "summary": "A 13-year-old boy with a history of laryngeal papillomatosis since the age of two years was presented. The patient presented respiratory distress and multiple stenosing nodules in the larynx and trachea, and several pulmonary cysts were visualized on a chest tomography. The patient underwent exeresis of the papillomatosis lesions and tracheostomy. He received a single dose of 400 mg bevacizumab intravenous and respiratory therapy with a favorable evolution, without recurrence in the follow-up.\n",
+    "translated_fulltext": "这位13岁的男孩来自库斯科，自两岁起就患有喉乳头状瘤病（三岁时曾进行气管切开术），其母亲也曾患有生殖器乳头状瘤。该患者因出现持续16天的疾病，主要表现为夜间呼吸困难、吸气性喉部喘鸣和中度发声困难，被送往利马的圣博尔哈国家儿童健康研究所。此前，他曾接受过阿奇霉素和吸氧治疗，但病情未见好转。\n\n体格检查显示，轻度肋间凹陷，左侧胸腔的呼吸音减弱，右侧胸腔出现少量喘鸣音，需要使用双鼻导管以4升/分钟的流量进行吸氧。其余检查结果无明显异常。实验室检查结果显示，白细胞计数为8.03×103/μL，血小板计数为209×103/μL，血红蛋白为13.2 g/dL，C反应蛋白为36.6 mg/L。作为影像学检查的一部分，进行了胸部X光检查和头部及颈部CT扫描。\n\n入院48小时后，患者出现喉部喘鸣和呼吸困难加重，因此决定将其送入急诊手术室进行气管切开术、显微手术和切除乳头状瘤病病灶。检查发现，在会厌、声门面、声带、喉下部和气管（直至第五环）存在一种具有乳头状外观的阑尾状肿瘤，并伴有室性带。病理报告显示，存在由人乳头瘤病毒（HPV）引起的空泡细胞异常和轻度局灶性发育不良。\n\n术后立即，患者被转入儿科重症监护室进行呼吸监测，并在48小时后逐渐停止吸氧。他接受了一次性静脉注射贝伐珠单抗400毫克，随后临床症状得到改善。患者住院七天，通过恢复正常的血氧饱和度水平和逐步停止吸氧，病情趋于稳定，之后被转到布雷尼亚的医院继续治疗。八个月后进行了远程监测，家属表示没有复发或其他并发症的迹象。",
+    "translated_summary": "一位13岁的男孩，自2岁起就患有喉乳头状瘤病。该患者出现呼吸窘迫，喉部和气管内有多处狭窄的结节，胸部CT扫描显示有多个肺囊肿。患者接受了乳头状瘤病病灶的切除术和气管切开术。他接受了一次性静脉注射400毫克贝伐珠单抗，并接受了呼吸治疗，病情好转，随访期间未见复发。"
+  },
+  {
+    "id": "multiclinsum_gs_en_412.txt",
+    "fulltext": "A 54-year-old male who had a medical history of membranous nephropathy II with nephrotic syndrome was administered with long-term oral glucocorticoids and immunosuppressants. The patient had a 20 pack-year history of smoking, and denied a family history of hereditary diseases. Chest x-ray demonstrated normal findings at one month before admission. On August 8, 2016, the patient was hospitalized for fever accompanied by progressive dyspnea, cough, and expectoration for 5 days. On admission, the BMI of the patient was 24.5 kg/m2, and his body temperature was 39.0°C. Furthermore, the patient had symptoms of tachypnea (35 bpm) and severe hypoxemia (SaO2 86%). On auscultation, the patient had good air entrance bilaterally with scattered diffuse crackles and rhonchi. Furthermore, the chest CT scan revealed multiple ground-glass opacities, and laboratory tests revealed normal white blood cell (WBC) count, but with elevated neutrophil count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and (1→3)-β-D-glucan. The patient was diagnosed as RSV infection on the fourth day of hospitalization when positive RSV-Ab was detected.\n\nOn admission, the patient was immediately given respiratory monitoring and supplemental oxygen to improve the low oxygen saturation, as well as antibiotics (moxifloxacin for 4 days, followed by cefminoxine for 8 days), and antifungal therapy (voriconazole for 10 days). The dose of the glucocorticoids and immunosuppressants remained largely unchanged. After 10 days of treatment, the patient's condition became worse. Chest CT revealed the progression of the disease, and oxygen partial pressure was further decreased. The patient was transferred to the Emergency Intensive Care Unit, where the patient was intensively treated, including noninvasive mechanical ventilation, broad-spectrum antibiotics (i.v. meropenem, oral moxifloxacin, and cotrimoxazole), antifungal therapy (micafungin), corticosteroids (methylprednisolone 40 mg bid iv) to relieve the inflammation, and other supportive treatment. Ganciclovir was also prescribed due to a possibility of viral infection, such as cytomegalovirus. Five days later, the patient's condition was further aggravated based on the chest x-ray evaluation. Despite receiving another round of treatments, including invasive ventilator-assisted ventilation therapy, methylprednisolone (80 mg bid), antibacterial agents (cefoperazone sulbactam, tigecycline, and cotrimoxazole) and antifungal (micafungin) therapy, the patient eventually died after 2 days.",
+    "summary": "Patient concerns:\nA 54-year-old male patient with chronic nephropathy, who received long-term immunosuppressants, was admitted to the Department of Respiratory Medicine due to the symptoms of fever, cough, expectoration, and dyspnea.\n\nDiagnoses:\nPulmonary radiology revealed multiple bilateral ground-glass opacity. Laboratory tests revealed elevated inflammation indicators, implying infection with bacteria, viruses, and/or fungi. Furthermore, the patient was positive for RSV antibodies, without positive results for other pathogens. Moreover, the patient was immunocompromised due to the long-term use of corticosteroids and immunosuppressants, as evidenced by decreased total IgG levels and reduced CD4 and CD8 T-lymphocyte counts.\n\nInterventions and outcome:\nDespite the intensive anti-infection treatment and respiratory support, the patient developed rapid progression, and subsequently died of respiratory failure.",
+    "translated_fulltext": "一位54岁的男性患者，既往有膜性肾病II型伴肾病综合征病史，长期口服糖皮质激素和免疫抑制剂。患者有20年的吸烟史，否认家族中有遗传性疾病史。入院前一个月胸部X光检查结果正常。2016年8月8日，患者因发热伴进行性呼吸困难、咳嗽和咳痰5天而入院。入院时，患者的BMI为24.5 kg/m2，体温为39.0°C。此外，患者还出现呼吸急促（35次/分钟）和严重的低氧血症（SaO2 86%）。听诊时，患者双侧呼吸音良好，伴有散在的弥漫性啰音和哮鸣音。胸部CT扫描显示多处磨玻璃样阴影，实验室检查显示白细胞计数正常，但中性粒细胞计数、C反应蛋白（CRP）、红细胞沉降率（ESR）和（1→3）-β-D-葡聚糖升高。患者住院第四天，检测到阳性RSV-Ab，诊断为RSV感染。\n\n入院时，患者立即接受呼吸监测和吸氧治疗，以改善低氧饱和度，并给予抗生素（莫西沙星，疗程4天，之后改为头孢米诺昔，疗程8天）和抗真菌治疗（伏立康唑，疗程10天）。糖皮质激素和免疫抑制剂的剂量基本保持不变。治疗10天后，患者病情恶化。胸部CT显示病情进展，氧分压进一步降低。患者转入急诊重症监护室，接受强化治疗，包括无创机械通气、广谱抗生素（静脉注射美罗培南、口服莫西沙星和复方磺胺甲噁唑）、抗真菌治疗（米卡芬宁）、皮质类固醇（甲泼尼龙40 mg，每日两次静脉注射），以缓解炎症，以及其他支持性治疗。由于可能存在病毒感染，如巨细胞病毒，也开了更昔洛韦。五天后，根据胸部X光检查，患者病情进一步恶化。尽管接受了另一轮治疗，包括有创呼吸机辅助通气治疗、甲泼尼龙（80 mg，每日两次）、抗菌药物（头孢哌酮舒巴坦、替格acycline和复方磺胺甲噁唑）和抗真菌治疗（米卡芬宁），但患者最终在两天后死亡。",
+    "translated_summary": "患者主诉：\n\n一位54岁的男性患者，患有慢性肾病，长期服用免疫抑制剂，因出现发热、咳嗽、咳痰和呼吸困难等症状而入院，接受呼吸内科的治疗。\n\n诊断：\n\n肺部影像学检查显示双侧多处磨玻璃样阴影。实验室检查显示炎症指标升高，提示可能感染细菌、病毒和/或真菌。此外，患者的呼吸道合胞病毒（RSV）抗体呈阳性，但其他病原体的检测结果均为阴性。而且，由于长期使用皮质类固醇和免疫抑制剂，患者免疫功能受损，表现为总IgG水平降低以及CD4和CD8 T淋巴细胞计数减少。\n\n干预和结果：\n\n尽管进行了积极的抗感染治疗和呼吸支持，患者病情迅速恶化，最终因呼吸衰竭而死亡。"
+  },
+  {
+    "id": "multiclinsum_gs_en_301.txt",
+    "fulltext": "A 34-year-old patient with a disease duration of four weeks. Two months earlier, she had a cesarean section in the 37th week of pregnancy and had persistent bleeding from the surgical wound. She denied a history of bleeding in childhood or adolescence. Three years earlier, she had given birth to her first child (also by cesarean section), who died due to a chromosome disorder (referred to by the patient). She also stated that she was allergic to tramadol.\n\nThe clinical picture began with lower back pain due to bilateral renal lithiasis. Subsequently, he managed to expel a stone and after that he presented haematuria for three days, for which he received tranexamic acid c/12 h. Three weeks later, he presented pain in the lower region of the left thigh that increased in intensity, with hardening of the area. Due to persistence of the symptoms, he was given diclofenac intramuscularly, which caused ecchymosis and bleeding in the gluteal area and persists despite the compression with gauze.\n\nThe patient underwent a particular Doppler ultrasound that revealed deep venous thrombosis of the left lower limb, and went to the hospital in her locality with these results. She was given anticoagulation with enoxaparin 30 mg/24 h subcutaneously, in addition to morphine for pain management and was hospitalized. The next day, she presented epigastralgia, blurred vision, heart rate of 117 beats/min, blood pressure of 113/85 mmHg and saturation of 93%. It was decided to discontinue enoxaparin. The blood count revealed a hemoglobin of 6.4 g/dl, which represented a difference of 4 g/dl from the result one day before admission, which was 10.4 g/dl. Because of the above, two blood transfusions were given. Due to the suspicion of vasculitis, methylprednisolone was indicated and she was referred to our hospital for further study.\n\nOn admission, the physical examination revealed severe pallor, extensive ecchymosis on the left thigh and lateral knee, and a haematoma on the right thigh. The haemogram showed moderate anaemia (Hb = 9.8 g/dl), normocytic and normochromic. The biochemical examination showed glucose values of 160 mg/dl. The liver enzymes AST and ALT were at 52 U/L and 86 U/L, respectively. The coagulation profile showed a prolonged activated partial thromboplastin time (APTT) of 91.2 s. The rest of the haemogram, biochemical, electrolyte, liver profile and coagulation profile were normal. The ultrasound of soft parts of the right gluteal region revealed a collection at the level of the subcutaneous cellular tissue (TCSC) and oedema up to the upper third of the thigh. The Doppler ultrasound in the left lower limb showed adequate flowometry without signs of thrombosis in the common femoral vein, superficial and deep.\n\nSymptomatic treatment was initiated and blood and urine cultures were requested and were negative. Antinuclear antibody (ANA) values, complement C3 and C4 and ferritin were within the reference range.\n\nIn the face of suspected acquired haemophilia, studies were requested for confirmation, where a partial correction of aPTT was found in the mixing test. Factor VIII was measured and its activity was found to be decreased (<1.0 U/dl) and the presence of a factor VIII inhibitor was demonstrated: 8.64 Bethesda units/ml. The above allowed the diagnosis of acquired haemophilia to be confirmed, which was related to the postpartum period due to the onset of symptoms.\n\nPrednisone 50 mg orally at breakfast and 10 mg orally at lunch, cyclophosphamide 50 mg 2 tablets orally every 24 hours and anti-inhibitor coagulant complex for haemophilia (FEIBA) were initiated. Five days later, the latter was discontinued due to chest tightness, dyspnoea and nausea (possible adverse drug reaction) and replaced with activated recombinant factor VII (NovoSeven).\n\nThe patient's clinical evolution was favorable, with a decrease in ecchymosis and no other symptoms, so she was discharged from the hospital.\n",
+    "summary": "A 34-year-old female patient presented with lower back pain, haematuria and a haematoma in the right gluteal region, with no previous history of bleeding. Due to the extent of the haemorrhagic manifestations, she was transferred to the emergency department. The coagulation profile, mixing test and measurement of the factor VIII inhibitor titres confirmed the diagnosis.\n",
+    "translated_fulltext": "一位34岁的女性患者，患病已四周。两个月前，她在妊娠37周时进行了剖腹产，术后伤口持续出血。她否认有儿童期或青春期出血史。三年前，她生下了她的第一个孩子（也是通过剖腹产），但孩子因染色体异常而去世（患者自述）。她还表示自己对曲马多过敏。\n\n该患者的临床症状始于双侧肾结石引起的腰痛。随后，她成功排出了结石，之后出现了持续三天的血尿，并接受了每12小时一次的氨甲环酸治疗。三周后，她左大腿下部出现疼痛，疼痛程度加剧，该区域出现硬化。由于症状持续，她接受了肌肉注射双氯芬酸，导致臀部出现瘀伤和出血，即使用纱布加压也无法缓解。\n\n该患者接受了特殊的超声多普勒检查，结果显示左下肢深静脉血栓形成，并带着这些结果前往当地医院。她接受了依诺肝素皮下注射，剂量为30毫克/24小时，同时还接受了吗啡止痛，并住院治疗。第二天，她出现了上腹部疼痛、视力模糊、心率117次/分钟、血压113/85毫米汞柱，血氧饱和度为93%。医生决定停止使用依诺肝素。血液检查显示血红蛋白为6.4克/分升，与入院前一天的结果（10.4克/分升）相比，下降了4克/分升。因此，进行了两次输血。由于怀疑血管炎，医生建议使用甲基强的松龙，并将她转到我院进行进一步检查。\n\n入院时，体格检查显示患者面色苍白，左大腿和膝关节外侧有广泛的瘀伤，右大腿有血肿。血常规显示中度贫血（血红蛋白=9.8克/分升），红细胞大小和颜色正常。生化检查显示血糖值为160毫克/分升。肝酶AST和ALT分别为52 U/L和86 U/L。凝血功能检查显示激活部分凝血活酶时间（APTT）延长至91.2秒。其余的血常规、生化、电解质、肝功能和凝血功能均正常。右臀部软组织超声显示皮下结缔组织（TCSC）处有积液，并向上延伸至大腿上三分之一处。左下肢超声多普勒显示血流良好，股静脉、浅静脉和深静脉均无血栓形成迹象。\n\n开始进行对症治疗，并进行了血液和尿液培养，结果均为阴性。抗核抗体（ANA）值、补体C3和C4以及铁蛋白均在参考范围内。\n\n考虑到患者可能患有获得性血友病，进行了相关检查以进行确认，结果显示混合试验中APTT部分恢复正常。测量了第八因子，发现其活性降低（<1.0 U/dl），并证实存在第八因子抑制剂：8.64贝塞斯达单位/毫升。以上结果证实了获得性血友病的诊断，该病与产后有关，因为症状是在产后出现的。\n\n开始口服泼尼松50毫克，早餐时服用，午餐时服用10毫克；口服环磷酰胺50毫克，每天2次，每次2片；并使用抗抑制剂凝血复合物（FEIBA）治疗血友病。五天后，由于出现胸闷、呼吸困难和恶心（可能是药物不良反应），停止使用后者，并更换为重组活性因子VII（诺和七）。\n\n患者的临床状况有所好转，瘀伤减轻，没有其他症状，因此出院。",
+    "translated_summary": "一位34岁的女性患者因腰痛、血尿以及右侧臀部区域的血肿就诊，既往无出血病史。由于出血症状严重，她被转至急诊科。凝血功能检查、混合试验以及VIII因子抑制物滴度测定结果证实了诊断。"
+  },
+  {
+    "id": "multiclinsum_gs_en_47.txt",
+    "fulltext": "We present here the case of a two-day old neonate with in-born right scrotal swelling admitted at Children’s hospital. The patient was born at term via cesarean section at a private hospital. He was kept in the nursery for one day. The examining doctor referred them for urgent surgical care, but it took them one day to arrive at our hospital. Upon arrival in the emergency department, he was well hydrated, pink at room temperature with good perfusion. Upon examination, the right testis was found to be enlarged, tense, non-tender visibly reddish with overlying skin excoriation. Trans-illumination was negative in the right but positive in the contralateral testis. Both hernial orifices were normal. All the laboratory investigations were performed with an urgent Doppler ultrasound of the inguinoscrotal area. The ultrasound examination found the right testis to be enlarged (15.6*9.4 mm) and showed heterogeneous hypoechoic texture with prominent rete testis and no flow on color Doppler analysis. Left testis appeared normal in size, shape and echotexture with minimal hydrocele. An urgent scrotal exploration was undertaken. Intra-operatively, there was frank necrotic right testis with intravaginal torsion of the testis with minimal hydrocele. A right orchidectomy and contralateral orchidopexy was then performed.",
+    "summary": "We present here the case of a two-day old neonate with in-born right scrotal swelling admitted at Children’s hospital. The patient was born at term via cesarean section at a private hospital. Upon arrival in the emergency department, he was well hydrated, pink at room temperature with good perfusion. Upon examination, the right testis was found to be enlarged, tense, non-tender visibly reddish with overlying skin excoriation. Trans-illumination was negative in right but positive in the contralateral testis. Both hernial orifices were normal. Doppler ultrasound of the inguinoscrotal area found the right testis to be enlarged (15.6*9.4 mm) and showed heterogeneous hypoechoic texture with prominent rete testis and no flow on color doppler analysis. An urgent scrotal exploration was undertaken. Intra-operatively there was frank necrotic right testis with intravaginal torsion of the testis and minimal hydrocele. A right orchidectomy and contralateral orchidopexy were performed.",
+    "translated_fulltext": "我们在此介绍一例两日大的新生儿，因先天性右侧阴囊肿胀而入院，该患儿在儿童医院接受治疗。患儿在一家私立医院通过剖腹产足月出生。他曾在新生儿病房待了一天。检查医生建议立即进行手术治疗，但他们花费了一天时间才到达我院。抵达急诊科时，患儿水合状态良好，在室温下皮肤呈粉红色，循环良好。检查发现，右侧睾丸肿大、紧张，可见呈红色的表面，且有皮肤破损。右侧睾丸透光试验为阴性，而对侧睾丸为阳性。两个腹股沟孔均正常。所有实验室检查均已完成，并紧急进行了腹股沟-阴囊区域的多普勒超声检查。超声检查显示，右侧睾丸肿大（15.6*9.4毫米），呈现出不均匀的低回声组织，睾丸网状结构明显，彩色多普勒分析显示无血流。左侧睾丸大小、形状和回声结构均正常，并伴有轻微的阴囊积液。随后进行了紧急的阴囊探查。术中发现，右侧睾丸出现明显的坏死，并伴有阴囊内睾丸扭转，且阴囊积液较少。随后进行了右侧睾丸切除术和对侧睾丸固定术。",
+    "translated_summary": "本文介绍了一例在儿童医院就诊的、出生仅两天的新生儿，其右侧阴囊出现先天性肿胀。该患儿在一家私立医院通过剖腹产分娩，足月出生。抵达急诊科时，患儿水合状态良好，体温正常，皮肤颜色正常，循环良好。检查发现，右侧睾丸肿大、紧张，可见表面的皮肤有红斑和擦伤，触诊无明显疼痛。透光试验显示，右侧睾丸透光性为阴性，而对侧睾丸透光性为阳性。两个腹股沟孔均正常。对腹股沟阴囊区域进行多普勒超声检查，结果显示右侧睾丸肿大（15.6*9.4毫米），呈现出不均匀的低回声结构，睾网结构明显，彩色多普勒分析显示无血流。随后立即进行了紧急阴囊探查。术中发现，右侧睾丸出现明显坏死，并伴有睾丸鞘内扭转，以及少量阴囊积液。遂行右侧睾丸切除术和对侧睾丸固定术。"
+  },
+  {
+    "id": "multiclinsum_gs_en_289.txt",
+    "fulltext": "4-year-old male patient with a history of nasal impetigo two weeks before admission (treated with topical mupirocin and oral cefadroxil; dose, duration and adherence to treatment unknown), with no other morbid history, who presented macroscopic glomerular haematuria associated with oedema of the lower extremities of 5 days' evolution, with the last 12 hours prior to the consultation adding headaches, nausea and vomiting. He went to the emergency department (ED) in convulsive status, after 20 minutes of generalised tonic-clonic convulsions.\n\nOn admission to the ED, the patient was afebrile, with non-evaluable blood pressure, with quantitative consciousness impairment associated with generalized hypertonia and bilateral and pretibial oedema. Endotracheal intubation was decided and phenobarbital (10 mg/kg) was administered to manage the convulsive status.\n\nOn physical examination in the intensive care unit (ICU), blood pressure was 134/94 mmHg (BP 110 mmHg) (p95 for patient 108/66 mmHg, p95+12 120/78 mmHg).\n\nInitial laboratory parameters included: complete urine with haematuria (> 100 erythrocytes per field), proteinuria 3+ and leucocyturia 10-25 per field, creatinemia 0.3 mg/dL, anaemia with haematocrit (HTO) 21%, haemoglobin (Hb) 7 g/dL, with normal mean corpuscular volume (VCM) and mean corpuscular haemoglobin concentration (CHCM), leukocytosis of 23,900 cells/mm3, thrombocytosis of 756,000/mm3, without elevation of acute phase reactants, hypocomplementemia with complement C3 level at 25 mg/dL (normal value, VN: 80-150 mg/dL) and normal C4. The rapid antigen test for Streptococcus beta-haemolytic group A (Streptococcus pyogenes) in pharynx was positive and the Anti-streptolysin O (ASO) was (+). The non-contrast brain computed tomography showed no acute changes. The renal ultrasound concluded bilateral nephromegaly with increased cortical echogenicity and decreased corticomedullar differentiation.\n\nThe patient was diagnosed with nephritic syndrome due to complicated GNAPE with hypertensive emergency - convulsive status.\n\nWithin the first 24 hours of his ICU stay, the patient required mechanical ventilation (MV) and anticonvulsant therapy with phenobarbital. He progressed without seizures, with a normal electroencephalogram (EEG) (on the day following admission) and a normal cerebrospinal fluid study. Antibiotic therapy was initiated for eradication of Streptococcus pyogenes with cefotaxime and diuretic therapy with furosemide.\n\nThe next day, he developed renal impairment with creatinine elevation to 0.99 mg/dL, hypertension and 24 hour proteinuria of 36.6 mg/m2/h, without oliguria. He initiated antihypertensive therapy with amlodipine and intravenous labetalol, with good initial control.\n\nWith favorable evolution, extubation was performed at 48 hours, which was well tolerated from the ventilatory point of view. However, after 24 hours of extubation, the patient's consciousness deteriorated, with both ocular opening and withdrawal of limb only in response to painful stimulus and poor verbal response (Glasgow Coma Scale 8), and developed blood pressure figures > p95+12 despite receiving therapy with labetalol in continuous infusion (up to 3 mg/kg/h), amlodipine (10 mg/day) and furosemide, which required the reintroduction of mechanical ventilation and infusion of sodium nitroprusside (up to 3 mcg/kg/min), with the aim of achieving gradual reduction of blood pressure figures (25% daily) to prevent secondary neurological damage. Given the presence of acute neurological symptomatology associated with HTA in a patient with glomerulonephritis, the diagnosis of PRES was suspected, which was confirmed by magnetic resonance imaging (MRI) of the brain (day 5), which showed an increase in the subcortical signal in bilateral and symmetric occipital region, without restriction in diffusion, which was compatible with vasogenic edema (PRES). Ophthalmological evaluation was normal and a new EEG evidenced occasional episodes of generalized voltage depression.\n\nAdding enalapril to the treatment. Finally, after 10 days with a slow pharmacological weaning, normalization of blood pressure was achieved. The control MRI (day 12) revealed regression of the previously described findings. Successful extubation was achieved after 5 days.\n\nDuring his stay in the ICU, the hemoglobin level dropped to 5 g/dL, with normal mean corpuscular volume and mean corpuscular hemoglobin concentration, without plateletopenia, so hemolytic anemia was suspected given a positive direct Coombs test and hemoglobinuria. He required red blood cell transfusions twice. Steroid therapy with methylprednisolone (1 mg/kg/d) was initiated for 72 hours. The coproculture was negative, as was the urinary antigen for Streptococcus pneumoniae. Epstein-Barr virus and Parvovirus B19 serology, extractable nuclear antigen (ENA) profile, anti-neutrophil cytoplasmic antibodies (ANCA), anti-DNA antibodies, anti-B2 glycoprotein 1 antibodies, anti-cardiolipin antibodies and lupus anticoagulant were all negative. All cultures were negative (blood cultures, urine cultures, cultures of endotracheal aspirate and pharyngeal cultures). ANA (antinuclear antibodies) was positive 1/160.\n\nThe patient improved with blood pressure normalization, increased complement levels, and a urine test without proteinuria or hematuria. The direct Coombs test remained positive on the 9th day of hospitalization.\n\nOn day 31, the patient was discharged normotensive, without anaemia, with preserved renal function, without proteinuria or haematuria, with normalisation of C3 levels and asymptomatic from the neurological point of view. He was discharged with pharmacological therapy with prednisone, amlodipine, enalapril and folic acid. The patient did not present recurrence and remained asymptomatic 6 months after discharge.\n",
+    "summary": "4-year-old male patient with a history of 5 days of haematuria and oedema, with additional headaches, nausea and vomiting, who entered a convulsive state and hypertensive crisis. Laboratory tests showed hypocomplementemia C3 and elevated Anti-Streptolysin O titers, which was interpreted as GNAPE. He developed encephalopathy, which led to suspicion of secondary PRES due to hypertensive emergency, which was finally confirmed by magnetic resonance of the brain. He also developed autoimmune haemolytic anaemia with haemoglobin up to 5 g/dL. His treatment was based on antihypertensive therapy, neuroprotection measures and steroid treatment. He was discharged after 31 days of hospitalisation, asymptomatic 6 months after discharge.\n",
+    "translated_fulltext": "该患者为一名 4 岁男性，入院前两周曾患有鼻部脓疱病（使用外用莫匹罗星和口服头孢氨苄治疗；剂量、疗程和治疗依从性未知），无其他病史。入院时出现大量肾小球性血尿，伴有下肢水肿，症状持续 5 天。在就诊前的 12 小时内，患者出现头痛、恶心和呕吐。患者出现全身性强直-阵挛性发作后，被送往急诊科，发作持续 20 分钟。\n\n入院时，患者无发热，血压无法评估，意识受损，伴有全身性肌张力增高以及双侧胫前水肿。决定进行气管插管，并给予苯巴比妥（10 毫克/公斤）以控制抽搐。\n\n在重症监护室（ICU）进行体格检查时，血压为 134/94 mmHg（BP 110 mmHg）（患者的 p95 为 108/66 mmHg，p95+12 为 120/78 mmHg）。\n\n初步实验室检查结果包括：尿液分析显示大量血尿（每视野大于 100 个红细胞）、蛋白尿 3+ 和白细胞尿 10-25 个/视野，肌酐 0.3 毫克/分升，贫血，血细胞比容（HTO）21%，血红蛋白（Hb）7 克/分升，平均红细胞体积（VCM）和平均红细胞血红蛋白浓度（CHCM）正常，白细胞计数 23,900 个/立方毫米，血小板计数 756,000 个/立方毫米，急性期反应物未升高，补体 C3 水平为 25 毫克/分升（正常值：80-150 毫克/分升），C4 正常。咽拭子快速抗原检测显示 A 组溶血性链球菌（化脓性链球菌）阳性，抗链球菌溶血素 O（ASO）阳性。无对比剂脑部计算机断层扫描未显示急性改变。肾脏超声检查显示双侧肾脏肿大，皮质回声增强，皮质-髓质分界线减弱。\n\n患者被诊断为复杂性 GNAPE 引起的肾炎综合征，伴有高血压危象和抽搐。\n\n在入住 ICU 的最初 24 小时内，患者需要机械通气（MV）和苯巴比妥抗惊厥治疗。患者病情稳定，没有出现抽搐，脑电图（EEG）正常（入院后第二天），脑脊液检查结果正常。开始使用头孢他啶进行抗生素治疗，以清除化脓性链球菌，并使用呋塞米进行利尿治疗。\n\n第二天，患者出现肾功能不全，肌酐升高至 0.99 毫克/分升，血压升高，24 小时蛋白尿量为 36.6 毫克/平方米/小时，没有少尿。开始使用氨氯地平和静脉注射拉贝洛尔进行降压治疗，初步效果良好。\n\n病情好转后，48 小时后进行了拔管，从呼吸角度来看，患者耐受性良好。然而，拔管后 24 小时，患者的意识恶化，仅在疼痛刺激下才能睁眼和肢体撤退，言语反应差（格拉斯哥昏迷量表 8 分），尽管接受了拉贝洛尔持续输注（最高 3 毫克/公斤/小时）、氨氯地平（10 毫克/天）和呋塞米治疗，血压仍然高于 p95+12，因此需要重新进行机械通气，并输注硝普钠（最高 3 微克/公斤/分钟），目的是逐步降低血压（每天降低 25%），以防止继发性神经损伤。鉴于患者出现与高血压相关的急性神经系统症状，且患有肾小球肾炎，因此怀疑患有 PRES，并通过脑部磁共振成像（MRI）（第 5 天）进行了确认，结果显示双侧对称的枕叶区域皮层下信号增强，没有弥散受限，这与血管源性水肿（PRES）相符。眼科检查结果正常，新的脑电图显示偶发性全身性电压降低。\n\n在治疗中添加了依那普利。最终，经过 10 天的缓慢药物减量，血压恢复正常。控制性 MRI（第 12",
+    "translated_summary": "患者为一名4岁男性，有5天血尿和水肿病史，并伴有头痛、恶心和呕吐，随后进入惊厥状态并出现高血压危象。实验室检查显示C3水平降低，抗链球菌溶血素O滴度升高，诊断为GNAPE（链球菌感染后肾小球肾炎）。患者发展为脑病，这引发了对继发性PRES（高血压脑病综合征）的怀疑，最终通过脑部磁共振成像确诊。此外，患者还发展为自身免疫性溶血性贫血，血红蛋白水平低至5克/分升。他的治疗方案包括降压治疗、神经保护措施和类固醇治疗。住院31天后出院，出院后6个月无症状。"
+  },
+  {
+    "id": "multiclinsum_gs_en_564.txt",
+    "fulltext": "A 69-year-old male with prior history of CABG presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration was admitted in our center. The electrocardiogram showed ST depression in leads II, III, aVF, and V4-6, and blood examination revealed elevation of plasma N-terminal pro-B-type natriuretic peptide levels (2640 pg/mL). Echocardiogram showed left ventricular systolic dysfunction and low left ventricular ejection fraction (30%). The patient had inferior ST-segment-elevation myocardial infarction in 2009, when he was 59 years old, with angiographic evidence of severe 3 vessels disease (coronary angiography showed CTO in proximal left anterior descending artery (LAD), 90% stenosis in mid and distal left circumflex artery, and 95% stenosis in mid RCA. The patient underwent CABG with left internal mammary artery (LIMA) to LAD, and sequential SVG to 1st obtuse marginal branch (OM1), 2nd obtuse marginal branch (OM2), and posterolateral branch (PL) in 2009.\n\nCoronary angiography was performed via 6 French (Fr) left radial artery access and demonstrated patency of LIMA to LAD and SVG to OM1, OM2 conduits, but a complete occlusion of sequential SVG to PL conduit. Native left main coronary artery was occluded in ostium and native RCA was occluded in the mid portion with bridging collaterals. We decided to treat the native RCA CTO. Dual arterial access was achieved with another 6 Fr sheath in right femoral artery. The left and right coronary arteries were intubated with 6 Fr AL 0.75 (Launcher; Medtronic; USA) and 6 Fr EBU 3.5 (Launcher; Medtronic; USA) guide catheters, respectively. An antegrade approach via left radial artery was attempted; however, neither Fielder XTR wire (Asahi Intec, Japan) nor Gaia 3 wire (Asahi Intec, Japan) with Finecross microcatheter (Terumo, Japan) reached the true lumen in distal RCA. Then, parallel wire technique with Crusade microcatheter (Kaneka, Japan) and two Gaia 3 wires (Asahi Intec, Japan) were attempted, but also failed. We therefore switched to the retrograde approach using septal channel from LAD through occluded left coronary artery. Gaia 3 wire (Asahi Intec, Japan) crossed occluded left main (LM) and LAD, and finally reached true lumen in distal LAD. Sion wire was exchanged by Finecross microcatheter (Terumo, Japan) into dital LAD, and dilation of LM and proximal LAD with a 2.0 × 15 mm balloon was performed. Then, septal surfing technique (SST) was used for septal crossing. We tried different septal channels originating from proximal to distal LAD, and delivered Sion wire (Asahi Intec, Japan) retrogradely through distal septal branch into distal RCA supported by a 150-cm Finecross microcatheter (Terumo, Japan). Gaia 3 wire (Asahi Intec, Japan) crossed CTO lesion retrogradely into the true lumen in proximal RCA, and was advanced into Guidezilla guide extension catheter (Boston Scientific, USA) positioned in the antegrade guiding catheter. The Finecross microcatheter (Terumo, Japan) was delivered to the antegrade catheter and a RG3 wire (Asahi Intec, Japan) was externalized. The CTO was then predilated by a 2.0 × 15 mm balloon and stented with 2 overlapping drug-eluting stents (2.5 × 38 mm and 3.0 × 38 mm) with excellent angiographic result and TIMI3 flow in all distal branches.\n\nDyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea.",
+    "summary": "Patient concerns:\nThis is a 69-year-old male with prior history of coronary artery bypass grafting presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration.\n\nDiagnosis:\nThe patient was diagnosed as heart failure caused by ischemia after SVG failure (SVG to right coronary artery) according to electrocardiogram, plasma N-terminal pro-B-type natriuretic peptide levels, and coronary angiogram.\n\nInterventions:\nWe recanalized native right coronary artery CTO by retrograde approach using septal collaterals by surfing technique after recanalization of totally occluded left coronary artery.\n\nOutcomes:\nDyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea.",
+    "translated_fulltext": "一位69岁男性患者，既往有冠状动脉搭桥术（CABG）病史，因轻度活动后出现严重呼吸困难（NYHA III级），症状持续2个月，被收入我院。心电图显示II、III、aVF和V4-6导联出现ST段压低，血液检查显示血浆N-末端脑钠肽（NT-proBNP）水平升高（2640 pg/mL）。超声心动图显示左心室收缩功能障碍，左心室射血分数低（30%）。该患者于2009年（59岁时）发生下壁ST段抬高型心肌梗死，血管造影显示存在严重的3支血管病变（冠状动脉造影显示近端左前降支（LAD）完全闭塞，中段和远端左回旋支（LCx）90%狭窄，中段右冠状动脉（RCA）95%狭窄）。2009年，该患者接受了CABG手术，采用左侧内乳动脉（LIMA）搭桥至LAD，并采用连续血管吻合，将静脉移植物（SVG）分别连接到第一钝缘支（OM1）、第二钝缘支（OM2）和后外侧支（PL）。\n\n通过6F左桡动脉入路进行冠状动脉造影，结果显示LIMA至LAD和SVG至OM1、OM2的吻合处通畅，但连续SVG至PL的吻合处完全闭塞。原位左主干冠状动脉在开口处闭塞，原位RCA在中段闭塞，并存在桥接侧支循环。我们决定对原位RCA进行介入治疗。通过在右股动脉插入另一根6F鞘管，实现了双动脉入路。分别使用6F AL 0.75（Launcher；美敦力；美国）和6F EBU 3.5（Launcher；美敦力；美国）导管对左、右冠状动脉进行插管。尝试通过左桡动脉进行顺行入路，但无论是Fielder XTR导丝（朝日英特克，日本）还是Gaia 3导丝（朝日英特克，日本）与Finecross微导管（照和，日本）都未能到达远端RCA的真腔。随后，尝试使用Crusade微导管（兼贺，日本）和两条Gaia 3导丝（朝日英特克，日本）进行平行导丝技术，但同样失败。因此，我们改为使用逆行入路，通过LAD的间隔支进入闭塞的左冠状动脉。Gaia 3导丝（朝日英特克，日本）穿过闭塞的左主干（LM）和LAD，最终到达远端LAD的真腔。使用Finecross微导管（照和，日本）将Sion导丝置换到远端LAD，并使用2.0 × 15 mm球囊扩张LM和近端LAD。然后，使用间隔“冲浪”技术（SST）进行间隔穿行。我们尝试了从近端到远端LAD的不同间隔支，并将Sion导丝（朝日英特克，日本）逆行通过远端间隔支送入远端RCA，并使用150 cm的Finecross微导管（照和，日本）进行支撑。Gaia 3导丝（朝日英特克，日本）逆行穿过RCA的闭塞病变，进入近端RCA的真腔，并进一步送入放置在顺行导管中的Guidezilla导管延长套管（波士顿科学，美国）。将Finecross微导管（照和，日本）送入顺行导管，并引出RG3导丝（朝日英特克，日本）。然后，使用2.0 × 15 mm球囊对闭塞病变进行预扩张，并植入2枚重叠的药物洗脱支架（2.5 × 38 mm和3.0 × 38 mm），血管造影结果良好，所有远端分支的TIMI血流评分均为3级。\n\n出院时，患者的呼吸困难症状得到缓解。在6个月的随访中，患者未出现呼吸困难复发。",
+    "translated_summary": "患者主诉：\n该患者为69岁男性，既往有冠状动脉搭桥手术史，现因轻微活动后出现严重呼吸困难（NYHA III级），症状持续2个月。\n\n诊断：\n根据心电图、血浆N端脑钠肽前体水平和冠状动脉造影结果，诊断为因血管内膜剥离后搭桥血管（搭桥至右冠状动脉）功能衰竭所致的心力衰竭。\n\n干预：\n我们采用逆行入路，利用室间隔侧支血管，通过“冲浪”技术，成功开通了原位右冠状动脉的完全闭塞部位，此前已成功开通了完全闭塞的左冠状动脉。\n\n结果：\n患者出院时呼吸困难症状已缓解。6个月随访时，患者未出现呼吸困难复发。"
+  },
+  {
+    "id": "multiclinsum_gs_en_399.txt",
+    "fulltext": "A 51-year-old male patient presented to us with acute painful visual loss of his left eye (LE) from 3 days ago. The best-corrected distance visual acuity (BCDVA) was 20/20, and hand motion (HM) detection for the right eye (RE) and LE, respectively. The ocular movement was normal in both eyes. Anterior segment examination was unremarkable for both eyes. The LE fundus examination showed ONH swelling, choroidal bulging, multiple patches of subretinal fluid accumulation, and retinal pigment epithelial (RPE) corrugations. Fundus examination of the RE was unremarkable.\n\nWe used multimodal imaging including Optical coherence tomography (OCT) (OptoVue, Inc., Fremont, CA, USA, software version: 2018,0,0,18), fundus blue-autofluorescence (BAF), fluorescein angiography (FA) (Heidelberg Eye Explorer version 1.9.13.0, Spectralis Viewing Module 6.5.2.0; Heidelberg Engineering), Indocyanin green angiography (ICGA), and B-scan ultrasonography for further evaluation. Besides, orbital and brain MRIs with gadolinium enhancement were ordered. The OCT image revealed a mild RPE and choroidal bulging, RPE hyper-reflectivity with back shadowing, subretinal and intraretinal fluid accumulation, and mild retinal thickening. A geographic area of macular hypocyanescence was apparent in the ICGA image of the left eye. BAF showed a geographic area with a speckled autofluorescence pattern at the macula. Optic nerve enlargement was found in the B-scan ultrasonography. In FA images, vascular leakage was apparent at the ONH (hot disc). Besides, a geographic patchy hypofluorescent area with speckled hyperfluorescent margins with a size of three disc diameters (DD) was detected. Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement at the junction of the optic nerve and sclera. An oncology consultation was done with no remarkable finding.\n\nConsidering the suspicion of malignancy and the presence of an enhancing nodular mass in the orbit, the patient underwent transconjunctival lateral orbitotomy one week after the presentation. A pink localized scleral nodule with edematous tenon was found. Sub-tenon triamcinolone acetonide was injected with the clinical diagnosis of nodular posterior scleritis. The patient refused admission and intravenous corticosteroid injection as the treatment order. Oral prednisolone 50 mg/Kg was started. Rheumatology consultation and screening lab results, including PPD test (tuberculosis), chest X-ray, serum ACE level (sarcoidosis), and C-ANCA level (Wegner granulomatosis), were unremarkable. At the last follow-up examination (one week after the surgery), the patient’s BCDVA was 20/20, and counting fingers at 2 meters for the RE and LE, respectively. Furthermore, SRF was absorbed, and the macula became atrophic. Oral prednisolone was tapered off slowly for three months.",
+    "summary": "A 51-year-old male patient presented to us with acute painful visual loss of his left eye (LE) from 3 days ago. The best-corrected distance visual acuity (BCDVA) was 20/20 and hand motion (HM) for the right eye (RE) and LE, respectively. Fundus examination of the LE showed ONH swelling, choroidal bulging, multiple patches of subretinal fluid accumulation, and retinal pigment epithelial (RPE) corrugations. Orbital and brain MRI showed a retrobulbar nodular mass with gadolinium enhancement at the optic nerve and sclera junction. Oncology and rheumatology work-ups were unremarkable. With the clinical diagnosis of nodular posterior scleritis oral prednisolone 50 mg/Kg was started.",
+    "translated_fulltext": "一位51岁的男性患者因左眼（LE）出现急性、剧烈视力丧失，症状持续3天，前来就诊。最佳矫正远视力（BCDVA）为20/20，右眼（RE）和LE的视力检测结果均为手势识别（HM）。双眼眼球运动正常。双眼前节检查结果均无异常。LE眼底检查显示视神经乳头（ONH）水肿、脉络膜隆起、多个视网膜下积液斑块以及视网膜色素上皮（RPE）皱褶。RE眼底检查结果无异常。\n\n我们使用了多模态成像技术，包括光学相干断层扫描（OCT）（OptoVue公司，美国加利福尼亚州弗里蒙特，软件版本：2018,0,0,18）、眼底蓝光自荧光（BAF）、荧光素血管造影（FA）（海德堡眼科探查仪版本1.9.13.0，Spectralis观察模块6.5.2.0；海德堡工程公司）、吲哚菁绿血管造影（ICGA）和B型超声扫描，以进行进一步评估。此外，还进行了增强型眼眶和脑部MRI检查。OCT图像显示轻度RPE和脉络膜隆起，RPE高反射，伴有背阴影，视网膜下和视网膜内积液，以及轻度视网膜增厚。ICGA图像显示左眼黄斑区域存在地理状低荧光区。BAF显示黄斑区域存在地理状斑点状自荧光模式。B型超声扫描显示视神经增粗。FA图像显示ONH处存在血管渗漏（热盘）。此外，还检测到一片地理状斑块状低荧光区，边缘呈斑点状高荧光，大小为三个视盘直径（DD）。眼眶和脑部MRI显示视神经和巩膜交界处存在增强型结节状肿块。进行了肿瘤科会诊，结果无明显异常。\n\n考虑到患者可能存在恶性肿瘤，并且眼眶内存在增强型结节状肿块，患者在就诊一周后接受了经结膜外侧眼眶切开术。术中发现一个粉红色、局限性的巩膜结节，周围有水肿的腱膜。诊断为结节型后巩膜炎，并进行了结膜下注射曲安奈德。患者拒绝住院和静脉注射皮质类固醇治疗。开始口服泼尼松50毫克/公斤。进行了风湿病科会诊，并进行了相关实验室检查，包括结核菌素试验（结核病）、胸部X光片、血清血管紧张素转化酶（ACE）水平（结节病）和C-ANCA水平（韦格纳肉芽肿），结果均无异常。在最后一次随访检查（术后一周）中，患者的最佳矫正远视力为20/20，RE和LE的视力均为2米处能数手指。此外，视网膜下积液被吸收，黄斑区域出现萎缩。口服泼尼松在三个月内逐渐减量。",
+    "translated_summary": "一位51岁的男性患者因左眼（LE）出现急性、剧烈视力丧失，症状持续3天，前来就诊。经过最佳矫正后，右眼（RE）和左眼的远距离视力分别为20/20和手势辨别（HM）。左眼眼底检查显示视神经乳头水肿、脉络膜隆起、多个视网膜下积液斑块以及视网膜色素上皮（RPE）皱褶。眼眶和脑部MRI显示，在视神经和巩膜交界处存在一个后球后结节状肿块，且该肿块在注射钆剂后增强。肿瘤科和风湿病科的检查结果均无异常。根据临床诊断为结节型后巩膜炎，开始口服泼尼松50毫克/公斤。"
+  },
+  {
+    "id": "multiclinsum_gs_en_55.txt",
+    "fulltext": "An elderly 78-year-old patient from the Amhara region of Ethiopia, who has had a permanent cardiac pacemaker for 7 years, was scheduled for retropubic prostatectomy due to benign prostatic hyperplasia (BPH). This condition developed following a previous transurethral resection of the prostate 3 months earlier. The patient in the preoperative anesthesia evaluation was fully evaluated, and all the routine investigations required for the proposed surgery, which were within normal limits, were investigated. The patient presented with a history of frequency, urgency, nocturia, and dribbling for the past 2 months. Additionally, the patient had been known to have hypertension for the past 16 years and was taking amlodipine 5 mg orally daily, enalapril 10 mg orally twice daily (BID), and atorvastatin 10 mg orally daily. He had also been known to have type II diabetes mellitus for the past 25 years and was on metformin 500 mg orally BID and neutral protamine Hagedorn (NPH) 20 IU and 10 IU. He was admitted to a hospital for further evaluation, and complete bundle branch block (BBB) was detected via electrocardiogram (ECG). In an electrophysiology study, the patient was diagnosed with left ventricular hypertrophy secondary to hypertensive heart disease, mild diastolic dysfunction, and an ejection fraction of 62%. Abdominal ultrasound revealed an enlarged prostate size of 82 ml; anterior–posterior (AP) chest X-ray revealed a normal chest region with a left-side pacemaker in situ, and all the other blood parameters, including electrolytes and serum troponin levels, were within normal limits.\n\nA cardiologist was involved preoperatively as a multidisciplinary approach and risk determination tool for cardiac risk assessment. The patient had a frailty score of 5.5 with a poor functional cardiopulmonary reserve of metabolic equivalent (MET) = 3.4 and Revised Cardiac Risk Index (RCRI) class III, which accounts for 10.1% of major cardiac adverse events (myocardial infarction [MI], cardiac arrest, or death) within 30 days of the postoperative period, and intermediate risk on the basis of surgery type and patient risk factors. After preoperative evaluation and risk disclosure regarding the un-reprogrammed pacemaker and the associated complications during anesthesia and surgery, the patient was unable to afford the necessary health coverage for pacemaker reprogramming. This is because the cardiac surgery was performed in Addis Ababa, Ethiopia, which has a long waiting list with few cardiac surgeons for millions of people and is a considerable distance from the patient’s home institution, and there is a period of monitoring after pacemaker reprogramming for considerable post-reprogramming complication. As a result, the patient chose to proceed with the surgery, accepting the potential risks and harm associated with the situation. Continuous cardiac monitoring during the intraoperative period is highly advocated. Despite these factors, the patient did not experience cardiorespiratory failure, and he was stable. The patient continued on medication until the day of surgery, which included amlodipine, enalapril, atorvastatin, and a morning lower dose of two-thirds of the NPH. He also took 5 mg of diazepam orally for anxiolytics at midnight before the day of surgery.\n\nOn the day of surgery, the patient’s random blood sugar (RBS) was measured, and sliding scale glycemic control was implemented. Communication among the anesthetist, surgeon, and nurses was emphasized, ensuring that the cautery pad was placed away from the pacemaker, and that emergency drugs and a defibrillator were ready. The patient was premedicated with dexamethasone for nausea prophylaxis and paracetamol for pain relief as preemptive analgesia. American Society of Anesthesiology (ASA) standard monitoring was applied, and baseline parameters were recorded. Combined epidural–spinal anesthesia was administered via 0.5% isobaric bupivacaine (12.5 mg) and 50 µg fentanyl at the L3–L4 interspace. The block achieved anesthesia up to the umbilicus, and the sensory block was performed at T7. The surgery involved a midline incision below the umbilicus, with monopolar cautery used at low voltage (20 mA). Hemostasis was achieved through bipolar low-voltage cautery. Throughout the procedure, the patient’s vital signs remained stable. The patient’s vital signs did not change by more than 10% from the baseline vital signs. The intravenous fluid was resuscitated intraoperatively. During the postoperative period, the patient was transferred to the postanesthesia care unit (PACU) with vigilant monitoring, and 10 ml of 0.125% epidural top-up analgesia was given. Postop investigations were within normal limits. The patient was observed in the PACU for 12 hours and later transferred to the ward in stable condition with regular follow-up with the cardiology team. After 88th day of postsurgery the patient was discharged and advised to have regular checkups for pacemaker’s in situ status.",
+    "summary": "A 78-year-old male from the Amhara region, Ethiopia, with a permanent pacemaker for complete heart block was scheduled for retropubic prostatectomy. Preoperative assessments by the anesthetist and cardiologist recommended reprogramming the pacemaker to asynchronous mode to reduce risks related to its dual-chamber, rate-modulated mode setting. However, the patient could not afford reprogramming and opted to proceed with the existing perioperative plan. Informed consent was obtained, and case report publication permission was obtained after operation. The patient received combined epidural-spinal anesthesia with 2.50 ml of 0.5% isobaric bupivacaine and 50 µg fentanyl at the L3-L4 interspace. Standard American Society of Anesthesiology monitoring was applied, with a focus on cardiac stability. The patient remained stable with minimal vital sign fluctuations and maintained adequate blood pressure using isotonic saline. Postoperatively, the patient was transferred to the postanesthesia care unit, receiving analgesia after 4 hours and an epidural top-up. After 6 hours, he was transferred to the ward in stable condition. Epidural analgesia was continued for 72 hours, and the patient was discharged on the 88th postoperative hour in stable condition.",
+    "translated_fulltext": "这位患者是一位78岁的埃塞俄比亚阿姆哈拉地区的男性，他已安装永久心脏起搏器7年，因良性前列腺增生（BPH）而计划进行耻骨后前列腺切除术。此前3个月，他曾接受过经尿道前列腺切除术，导致了这种病情。在术前麻醉评估中，对患者进行了全面评估，并检查了所有拟行手术所需的常规检查项目，结果均在正常范围内。患者主诉近2个月来出现尿频、尿急、夜尿和尿滴沥等症状。此外，患者过去16年来一直患有高血压，每天口服氨氯地平5毫克、依那普利10毫克，每日两次，以及阿托伐他汀10毫克。他还患有II型糖尿病25年，目前服用二甲双胍500毫克，每日两次，以及中性鱼精蛋白Hagedorn（NPH）20 IU和10 IU。他被送往医院进行进一步评估，心电图（ECG）显示存在完全性束支传导阻滞（BBB）。在心电生理学研究中，患者被诊断为继发于高血压性心脏病的左心室肥厚、轻度舒张功能障碍，以及62%的射血分数。腹部超声显示前列腺增大至82毫升；前-后（AP）胸部X光显示胸部区域正常，左侧起搏器就位，所有其他血液指标，包括电解质和血清肌钙蛋白水平，均在正常范围内。\n\n在术前，一位心脏病专家参与其中，作为一种多学科方法和风险评估工具，以评估心脏风险。患者的虚弱评分是5.5，代谢当量（MET）=3.4，功能性心肺储备较差，修订版心脏风险指数（RCRI）为III级，这意味着术后30天内发生重大心脏不良事件（心肌梗死[MI]、心脏骤停或死亡）的风险为10.1%，并且根据手术类型和患者风险因素，风险为中等。在术前评估和风险告知后，告知患者关于未重新编程的起搏器以及麻醉和手术期间可能出现的并发症，但患者无力承担重新编程起搏器所需的医疗费用。这是因为心脏手术是在埃塞俄比亚的亚的斯亚贝巴进行的，那里有大量的等待名单，只有少数心脏外科医生为数百万人口服务，并且距离患者的所在地有相当远的距离，而且在起搏器重新编程后，需要进行一段时间的监测，以应对可能出现的并发症。因此，患者选择继续进行手术，并接受与这种情况相关的潜在风险和危害。强烈建议在术中进行持续的心脏监测。尽管存在这些因素，患者没有出现心肺衰竭，并且情况稳定。患者在手术当天继续服用药物，包括氨氯地平、依那普利、阿托伐他汀，以及早晨较低剂量的三分之二的NPH。他还口服5毫克地西泮，以缓解术前焦虑。\n\n在手术当天，测量了患者的随机血糖（RBS），并实施了滑动刻度血糖控制。强调了麻醉师、外科医生和护士之间的沟通，确保电凝垫远离起搏器，并准备好急救药物和除颤器。患者在术前服用地塞米松，以预防恶心，并服用对乙酰氨基酚以缓解疼痛。应用了美国麻醉医师协会（ASA）的标准监测，并记录了基线参数。通过0.5%等张布比卡因（12.5毫克）和50微克芬太尼，在L3-L4椎间隙进行联合硬膜外-蛛网膜下腔麻醉。麻醉效果达到脐部，感觉阻滞达到T7。手术包括在脐部下方进行正中切口，并使用单极电凝，电压较低（20毫安）。通过双极低压电凝实现止血。在整个手术过程中，患者的生命体征保持稳定。患者的生命体征与基线生命体征的偏差不超过10%。在术中补充静脉输液。术后，患者被转移到麻醉后护理室（PACU），并进行严密监测，并给予10毫升0.125%的硬膜外补充镇痛。术后检查结果在正常范围内。患者在PACU观察了12小时，然后转到病房，情况稳定，并由心脏科团队进行定期随访。术后第88天，患者出院，并建议定期",
+    "translated_summary": "一位来自埃塞俄比亚阿姆哈拉地区的78岁男性患者，因完全性心脏传导阻滞而植入了永久起搏器，原定接受耻骨后前列腺切除术。麻醉师和心脏病专家在术前评估后，建议将起搏器重新编程为非同步模式，以降低与双腔、频率调节模式相关的风险。然而，患者无力承担重新编程的费用，因此决定继续执行原有的围手术期方案。在获得患者知情同意后，并在术后获得了发表病例报告的许可。患者接受了联合硬膜外-椎管内麻醉，使用了2.50毫升0.5%的等渗布比卡因和50微克的芬太尼，注射部位为L3-L4椎间隙。采用了标准的美国麻醉学会监测方案，重点关注心脏稳定性。患者的生命体征保持稳定，波动很小，并通过使用等渗盐水维持了足够的血压。术后，患者被转入麻醉后护理室，并在4小时后接受镇痛，并进行了硬膜外麻醉的补充。6小时后，患者被转入病房，情况稳定。硬膜外镇痛持续了72小时，患者在术后第88小时出院，情况稳定。"
+  },
+  {
+    "id": "multiclinsum_gs_en_317.txt",
+    "fulltext": "A 52-year-old woman referred to the urology clinic with urinary complaints. Her symptoms began three years ago with frequency, dysuria and dribbling. She also mentioned the frequent passage of red and black thread-like substances in her urine. Moreover, during these discharges, she had headache, fever and chills. Intermittent periurethral and genital itching was another complaint of hers. She had been treated by several specialists with the diagnosis of recurrent urinary tract infections, with no clinical improvement. The patient denied recent travel, camping, hiking, farming, swimming and insect bites. She had positive history of pilonidal sinus surgery and hysterectomy, 8 and 7 years earlier, respectively. Two years prior to the current visit, she had been hospitalized for assessment. On physical examination, she was well-appearing with normal vital signs. All her laboratory tests, including cell blood count, urine analysis and biochemistries were in normal ranges. Abdominopelvic computed tomography (CT) scan revealed no abnormalities. Hence, she underwent cystoscopy, which demonstrated erythema and hyperemia of the bladder mucosa, suspended debris, and dilation of the left ureteral orifice. During consultation with an infectious diseases’ specialist, schistosomiasis was suspected, Therefore, she was treated with Praziquantel with the appropriate dose and duration and was discharged from the hospital.\n\nHowever, her symptoms did not subside. She was revisited by another infectious disease specialist, who prescribed her ivermectin due to suspicion to urinary myiasis. Nevertheless, no improvement was observed. She was readmitted to undergo bladder irrigation with polyethylene glycol, but the bladder washfluid did not contain any visible larvae. This procedure was followed by a two-day hematuria with spontaneous cessation. She was discharged home and advised to repeat the urine analysis one months later. Her random urine analysis was normal, so she collected her 24-h urine and sent it to the laboratory for analysis, in which a live larva was demonstrated under light microscope by the pathologist. The larva was isolated and sent to an entomologist to be identified morphologically. Finally, it was determined that the larva belonged to the species Sarcophaga. The patient was advised to take personal hygiene and consume at least 3 L of water daily.",
+    "summary": "We report a 52-year-old woman with persistent dysuria, frequency despite multiple treatments for suspected infections. Cystoscopy revealed erythema and debris, but imaging and laboratory tests were unremarkable. A live larva was identified in urine analysis, confirming the diagnosis. Treatment involved improved hygiene and hydration.",
+    "translated_fulltext": "一位52岁的女性因泌尿系统症状来到泌尿科门诊。她的症状始于三年前，表现为尿频、排尿困难和尿滴沥。她还提到，尿液中经常出现红色和黑色的细丝状物质。此外，在排尿时，她还会出现头痛、发烧和寒战。间歇性的尿道周围和生殖器瘙痒也是她的另一个症状。她曾接受过几位专家的治疗，诊断为复发性尿路感染，但临床症状并未得到改善。患者否认近期有旅行、露营、徒步、务农、游泳或被昆虫叮咬的经历。她8年前和7年前分别接受过尾椎窦手术和子宫切除术。在本次就诊前两年，她曾因相关问题住院接受检查。体格检查显示，她状态良好，各项生命体征正常。她的所有实验室检查结果，包括血常规、尿液分析和生化指标，均在正常范围内。腹盆部计算机断层扫描（CT）未发现任何异常。因此，她接受了膀胱镜检查，结果显示膀胱黏膜发红、充血，有悬浮的碎屑，以及左输尿管口扩张。在与传染病专家的会诊中，怀疑为血吸虫病，因此，她接受了吡喹酮治疗，剂量和疗程均符合要求，并出院。\n\n然而，她的症状并未缓解。她再次接受了另一位传染病专家的诊治，该专家因怀疑为尿路蝇蛆病，给她开了伊维菌素。但结果仍未见好转。她再次入院，接受了聚乙二醇膀胱冲洗，但冲洗液中未发现可见的幼虫。随后进行了为期两天的血尿，并自行停止。她出院后，被建议一个月后复查尿液。她的随机尿液分析结果正常，因此她收集了24小时尿液，送往实验室进行分析，病理学家在显微镜下观察到活的幼虫。该幼虫被分离出来，并送给昆虫学家进行形态学鉴定。最终确定，该幼虫属于腐生蝇属。医生建议患者注意个人卫生，并每天饮用至少3升水。",
+    "translated_summary": "我们报告了一例52岁女性，她长期存在排尿困难和尿频症状，尽管已多次接受针对疑似感染的治疗，但症状仍未缓解。膀胱镜检查显示膀胱内有红斑和碎屑，但影像学检查和实验室检查结果均无异常。尿液分析中发现活的幼虫，从而确诊。治疗方案包括改善卫生习惯和增加水分摄入。"
+  },
+  {
+    "id": "multiclinsum_gs_en_79.txt",
+    "fulltext": "A 36-year-old female patient with a history of ulcerative colitis and good disease control on sulfasalazine, ferrous fumarate and intermittent prednisone for flare-ups is presented.\n\nHe was admitted to the emergency unit with a 1 week history of progressive oppressive precordial pain associated with dyspnea and neurovegetative symptoms. On admission, an electrocardiogram was performed in sinus rhythm, with finding of supradesnivel of the ST segment in the lower wall.\n\nThe patient reported a 6-month history of general disorders, fatigue and night sweats. She had previously presented episodes of precordial pain in relation to effort that progressed to rest. The physical examination was without murmurs or alterations of the peripheral pulses.\n\nAn emergency coronary angiography was performed, which revealed severe 2-vessel disease: severe ostial lesion 90% in the left coronary trunk and severe subocclusive lesion 99-100% at the ostial level in the right coronary artery (culprit vessel). Primary angioplasty of the right coronary artery was performed with successful installation of a medicated stent. The hemodynamicist was impressed by a possible aortitis due to involvement of the arch and friability of the vessels when the balloon was advanced, so he suggested an etiological study oriented to inflammatory disease, prior to surgical resolution of the lesion of the left coronary trunk.\n\nLaboratory tests showed mild anaemia (haemoglobin: 11.6 g/dL), mild leukocytosis (13,800/mm3), elevated erythrocyte sedimentation rate (ESR): 42 mm/h and C-reactive protein (CRP): 4.9 mg/L (normal value <1) and elevated ultrasensitive troponin. From the autoimmunity study, normal levels of complement C3 and C4, negative anti-nuclear antibodies (ANA), anti-DNA, negative extracellular nuclear antigen (ENA) profile and non-reactive VDRL were rescued.\n\nCardiac magnetic resonance (MRI) with contrast was completed with findings of acute infarction of the left ventricular inferior wall non-transmural myocardium and subendocardial ischemia in the anteroseptoapical resting of the left ventricle. Mild aortic and mitral insufficiency. Preserved biventricular systolic function.\n\nComputed tomography angiography (CTA) of the chest, abdomen and pelvis showed periaortic fibrotic wall thickening involving the root, aortic arch and abdominal aorta with severe left coronary trunk stenosis and mild left subclavian, left vertebral artery stenosis and severe lower mesenteric artery stenosis. Immune globulin G (IgG) 4 deposition disease or Takayasu's arteritis was suggested.\n\nWithin the differential diagnosis study, IgG levels were performed at 1,600 mg/dl (reference values: 700-1,600), and its subclasses: IgG1: 1024 mg/dl (elevated), and the rest in normal range (IgG2: 456 mg/dl; IgG3: 98.8 mg/dl and IgG4: 13.6 mg/dl).\n\nTakayasu arteritis was diagnosed clinically and by imaging and treatment was initiated with prednisone 60 mg daily, methotrexate 20 mg weekly by injection and folic acid 1 mg daily. After 3 weeks of treatment she underwent myocardial revascularisation surgery with use of the left internal mammary artery (LIMA) as a graft to the descending anterior artery (DA) and aortocoronary bypass to circumflex artery. It was noted intraoperatively that the root of the aorta and the ascending aorta presented a healthy appearance. The patient is currently at home in good general condition and under ambulatory follow-up.\n",
+    "summary": "A 36-year-old woman with ulcerative colitis presented with progressive precordial pain and neurovegetative symptoms. The electrocardiogram showed a ST segment elevation in the inferior wall. The patient had a history of fatigue and night sweats. She underwent a coronary angiography that revealed severe disease in two coronary arteries, with successful primary angioplasty of the culprit artery. Aortitis was suspected, which led to additional studies, including a mild elevation of inflammatory activity indices and a computed tomographic angiography with periaortic fibrotic thickening and significant stenosis in multiple arteries, suggesting Takayasu arteritis. She was treated with prednisone, methotrexate, and underwent delayed myocardial revascularization surgery with good results.\n",
+    "translated_fulltext": "现有一位36岁女性患者，既往有溃疡性结肠炎病史，且使用柳氮磺胺、富马酸亚铁和间歇性强的松治疗后，病情得到良好控制。\n\n患者因出现持续加重的胸痛，伴有呼吸困难和神经植物症状，症状持续1周，因此被送往急诊科。入院时，心电图显示窦性心律，下壁ST段抬高。\n\n患者自述有6个月的全身不适、疲劳和夜间盗汗病史。此前，她曾出现过与活动相关的胸痛，且疼痛会持续到休息时。体格检查未发现杂音或周围脉搏异常。\n\n进行了紧急冠状动脉造影，结果显示存在严重的双支血管病：左冠状动脉主干处有严重的狭窄病变，狭窄程度为90%；右冠状动脉近段处有严重的亚闭塞性病变，狭窄程度为99-100%（为主要病变血管）。对右冠状动脉进行了原位球囊扩张术，并成功植入药物洗脱支架。在球囊扩张过程中，由于主动脉弓受累且血管壁脆弱，可能存在主动脉炎，因此医生建议在手术解决左冠状动脉主干病变之前，进行针对炎症性疾病的病因学研究。\n\n实验室检查显示轻度贫血（血红蛋白：11.6 g/dL）、轻度白细胞增多（13,800/mm3）、红细胞沉降率（ESR）升高：42 mm/h，C反应蛋白（CRP）：4.9 mg/L（正常值<1），以及超敏C反应蛋白升高。自身免疫学检查显示，补体C3和C4水平正常，抗核抗体（ANA）、抗DNA均为阴性，细胞外核抗原（ENA）谱为阴性，VDRL试验未见反应。\n\n进行了心脏磁共振（MRI）增强扫描，结果显示左心室下壁急性心肌梗死，未累及全层心肌，以及左心室前间隔尖端区域的亚心内膜缺血。轻度主动脉瓣和二尖瓣关闭不全。双心室收缩功能良好。\n\n胸部、腹部和盆腔的计算机断层扫描血管造影（CTA）显示，主动脉周围纤维性壁增厚，累及主动脉根部、主动脉弓和腹主动脉，同时伴有严重的左冠状动脉主干狭窄，以及轻度的左锁骨下动脉、左椎动脉狭窄和严重的下系膜动脉狭窄。提示可能为免疫球蛋白G（IgG）4沉积病或高安氏动脉炎。\n\n在鉴别诊断研究中，IgG水平为1600 mg/dl（参考值：700-1600），其亚类分别为：IgG1：1024 mg/dl（升高），其余亚类水平正常（IgG2：456 mg/dl；IgG3：98.8 mg/dl；IgG4：13.6 mg/dl）。\n\n根据临床表现和影像学检查，诊断为高安氏动脉炎，并开始使用强的松60 mg每日、甲氨蝶呤20 mg每周注射、叶酸1 mg每日进行治疗。治疗3周后，患者接受了心肌血管重建手术，使用左侧内乳动脉（LIMA）作为移植血管，连接到下降前支（DA），并进行主动脉冠状动脉旁路移植术，连接到回旋支。术中发现，主动脉根部和升主动脉外观健康。目前，患者已出院，一般情况良好，并接受门诊随访。",
+    "translated_summary": "一位36岁的患有溃疡性结肠炎的女性患者，因逐渐加重的胸前疼痛和神经植物症状就诊。心电图显示下壁ST段抬高。患者既往有疲劳和夜间盗汗病史。她接受了冠状动脉造影，结果显示两条冠状动脉存在严重病变，并成功进行了罪犯动脉的原位血管成形术。怀疑存在主动脉炎，因此进行了进一步检查，包括炎症活性指标轻度升高，以及计算机断层扫描血管造影，显示主动脉周围纤维性增厚，多条动脉存在显著狭窄，提示为高桥动脉炎。她接受了泼尼松、甲氨蝶呤治疗，并进行了延迟的心肌血管重建手术，结果良好。"
+  },
+  {
+    "id": "multiclinsum_gs_en_194.txt",
+    "fulltext": "A 36-year-old female patient complained of dysphagia with longstanding cervical and upper thoracic pain. She also had a multinodular goiter with no other significant history. Esophagogastroduodenal transit was performed. It showed a posterior and lateral right impression of the proximal esophagus after ingestion of baryte, extending 3.5 cm cephalocaudal. A maximum esophageal stenosis of 60% was estimated. A cervical and thoracic CT scan revealed a congenital anomaly of the aortic arch: a mirror image of the right aortic arch. The aortic arch originates from the root of the aorta and runs above the right stem bronchus, giving rise to the three supra-aortic trunks as follows: the first is the left brachiocephalic artery (which gives rise to the left common carotid artery and the left subclavian artery); the second is the right common carotid artery; and the third is the right subclavian artery. The aortic arch then enters posteriorly to the esophagus and gives rise to a small anterior saccule of 1.3 cm, known as the Kommerell diverticulum. This configuration forms a ring around the tracheo-esophageal pair, whose edges are formed posterior-lateral to the right by the aortic arch, posterior-lateral to the left by the Kommerell diverticulum, lateral to the left by the arteriosum ligamentum (or arterial ligament), and anteriorly by the left brachiocephalic artery. A gastroscopy confirmed the endoluminal impact of extrinsic compression. In view of minimal clinical repercussions and the absence of nutritional disorders, no surgical cure was ultimately performed. The evolution was favorable with, according to the patient, a spontaneous amelioration of symptoms.\n",
+    "summary": "We report the case of a 36-year-old female patient whose dysphagia presented a congenital anomaly of the thoracic aorta: the right aortic arch with mirror image. This is a rare anomaly of embryonic development where the aorta winds around the right stem bronchus and the supra-aortic trunks emerge from the crown in the reverse and opposite order to normal. The vast majority of patients are asymptomatic unless there is a compression of the mediastinal structures. Major compression of the esophagus or trachea, aneurysmal disease, thoracic aortic dissection or the presence of a Kommerell diverticulum of more than 2 cm may warrant surgical intervention. There is no standard treatment and it must be adapted to the clinical presentation and anatomical configuration of the patient. Our patient did not receive any treatment for her condition.\n",
+    "translated_fulltext": "一位36岁的女性患者主诉长期存在吞咽困难，并伴有颈部和上胸部疼痛。她还患有结节性甲状腺肿，但没有其他重要的病史。进行了食道-胃-十二指肠通透性检查，结果显示，钡剂摄入后，近端食道后部和右侧出现压痕，长度为3.5厘米。估计食道最大狭窄程度为60%。颈部和胸部的CT扫描显示，患者患有先天性主动脉弓异常，表现为右侧主动脉弓的镜像。主动脉弓起源于主动脉根部，位于右侧主支气管上方，并分出三个位于主动脉上方的血管分支，具体如下：第一支是左无名动脉（分出左侧颈总动脉和左侧锁骨下动脉）；第二支是右侧颈总动脉；第三支是右侧锁骨下动脉。然后，主动脉弓从食道后方进入，形成一个1.3厘米的小前部囊状结构，称为科默雷尔憩室。这种结构围绕着气管-食管对形成一个环，其边缘由以下结构构成：右侧为主动脉弓，后外侧；左侧为科默雷尔憩室，后外侧；左侧为动脉韧带（或动脉血管韧带），外侧；前方为左无名动脉。胃镜检查证实了食道内腔受到外部压迫。考虑到临床症状轻微，且没有营养障碍，最终没有进行手术治疗。患者表示，病情逐渐好转，症状得到缓解。",
+    "translated_summary": "我们报告了一例36岁女性患者的病例，该患者出现吞咽困难，经检查发现其患有先天性胸主动脉异常：右侧主动脉弓呈镜像状。这是一种罕见的胚胎发育异常，表现为主动脉绕右侧主支气管盘绕，且超主动脉干从冠部以与正常情况相反的顺序发出。大多数患者没有症状，除非胸腔内结构受到压迫。如果食道或气管受到严重压迫，或出现动脉瘤性疾病、胸主动脉夹层，或者存在超过2厘米的科默雷尔憩室，则可能需要进行手术干预。目前尚无标准治疗方案，必须根据患者的临床表现和解剖结构进行调整。我们的患者未接受任何治疗。"
+  },
+  {
+    "id": "multiclinsum_gs_en_419.txt",
+    "fulltext": "A 62-year-old Tunisian Arab postmenopausal female diagnosed with Von Hippel–Lindau disease in 2021 presented with various manifestations related to the disease. She had a history of multiple surgeries, primarily for renal, adrenal, and pancreatic tumors, with incidental findings of ovarian masses.\n\nThe patient was asymptomatic from a gynecological standpoint, but primarily complained of headaches before undergoing brain surgery. She had no significant family or psychosocial history.\n\nHer surgical history included\n2021: A non-operable tumor (6 cm) of the left petrous bone endolymphatic sac, managed with radiotherapy.\n\n2021: Left adrenalectomy for a 6 cm pheochromocytoma. Pathological examination revealed pheochromocytoma.\n\n2021: Left nephrectomy for a ruptured left renal tumor. Microscopy showed multifocal clear-cell renal carcinoma of nuclear grade 2.\n\n2022: Cephalic duodenopancreatectomy for a mass in the pancreas. Histological examination confirmed three serous cystadenomas and two well-differentiated neuroendocrine tumors.\n\nIn January 2021, during postoperative surveillance with an abdominal–pelvic computed tomography (CT) scan, a 4 cm solid cystic left adnexal mass was incidentally discovered, which raised suspicion of malignancy. The mass was confirmed by transvaginal ultrasound and pelvic MRI, classified as Ovarian-Adnexal Reporting and Data System (O-RADS) 5 (high suspicion for malignancy).\n\nGynecological examination and surgical history\nPhysical examination: No abdominal–pelvic mass detected.\n\nSpeculum examination: Healthy cervix observed.\n\nSurgical scars from previous left nephrectomy and cephalic duodenopancreatectomy were noted.\n\nA multidisciplinary staff meeting concluded that surgery was necessary. A laparotomy was performed via a midline incision below the umbilicus, revealing a well-defined solid cystic mass in the left adnexa. No ascites or signs of peritoneal carcinomatosis were present, and the right adnexa appeared normal, with no macroscopic signs of malignancy observed intraoperatively, including the absence of exocystic vegetations.\n\nCytology was performed along with left adnexectomy, and the specimen was sent for frozen section examination. The results were inconclusive, raising the possibility of borderline tumors or tumors specific to Von Hippel–Lindau syndrome. Considering the patient’s postmenopausal status, a right adnexectomy and total hysterectomy were performed.\n\nHistological examination later revealed bilateral clear-cell papillary cystadenomas of the Fallopian Tubes and broad ligament, characteristic of Von Hippel–Lindau disease (0.5 cm on the right side and 4 cm on the left side).The tumors consisted of tightly packed papillae with fibrous cores, covered by monolayered epithelium.\n\nThe immediate postoperative period was uneventful, and at the 1-month follow-up, no abnormalities were detected. The patient has since been followed up with every 4 months with normal pelvic ultrasounds. During these 2 years of follow-up, no complications have arisen, but the patient was recently readmitted to the neurosurgery department for recurrence of a brain tumor.",
+    "summary": "A 62-year-old white North African woman diagnosed with Von Hippel-Lindau disease in 2021 presented with multiple manifestations, including a left petrous bone tumor, left pheochromocytoma, left renal cell carcinoma, multi-cystic right kidney, and pancreatic masses. She underwent various treatments, including radiotherapy, adrenalectomy, nephrectomy, and cephalic duodenopancreatectomy. Ultrasonographic and magnetic resonance imaging examinations revealed a solid cystic mass in the left adnexal region. Laparoscopy identified cystic tumors in the right and left mesosalpinx. Following a hysterectomy with bilateral adnexectomy, histological examination revealed bilateral clear-cell papillary cystadenomas of the mesosalpinx and broad ligament, consistent with Von Hippel-Lindau disease.",
+    "translated_fulltext": "一位62岁的突尼斯阿拉伯女性，已绝经，于2021年被诊断出患有冯·希佩尔-林道病，并出现了与该疾病相关的多种症状。她曾接受过多次手术，主要针对肾脏、肾上腺和胰腺肿瘤，同时发现卵巢有肿块。\n\n从妇科角度来看，患者没有症状，但在接受脑部手术前，主要抱怨头痛。她没有显著的家族或社会心理病史。\n\n她的手术史包括：\n\n2021年：左侧岩骨内耳囊的6厘米不可手术肿瘤，采用放射治疗进行处理。\n\n2021年：左侧肾上腺切除术，切除6厘米的嗜铬细胞瘤。病理检查显示为嗜铬细胞瘤。\n\n2021年：左侧肾切除术，切除破裂的左侧肾肿瘤。显微镜检查显示为多灶性透明细胞肾细胞癌，核等级为2级。\n\n2022年：胰十二指肠切除术，切除胰腺肿块。组织学检查证实存在三个浆液性囊腺瘤和两个分化良好的神经内分泌肿瘤。\n\n2021年1月，在术后随访期间，通过腹盆部计算机断层扫描（CT），偶然发现左侧附件区有一个4厘米的实性囊性肿块，引起了对恶性肿瘤的怀疑。通过经阴道超声和盆腔MRI证实了该肿块，并将其归类为卵巢-附件报告和数据系统（O-RADS）5级（高度怀疑为恶性肿瘤）。\n\n妇科检查和手术史：\n\n体格检查：未发现腹盆部肿块。\n\n阴道镜检查：观察到健康的宫颈。\n\n注意到之前左侧肾切除术和胰十二指肠切除术的切口疤痕。\n\n多学科团队会议得出结论，需要进行手术。通过脐下正中切口进行剖腹探查，发现左侧附件区有一个清晰的实性囊性肿块。没有腹水或腹膜癌转移的迹象，右侧附件看起来正常，术中未观察到任何肉眼可见的恶性肿瘤迹象，包括没有外囊性赘生物。\n\n同时进行了细胞学检查和左侧附件切除术，并将标本送去进行冰冻切片检查。结果尚无定论，提示可能存在边界性肿瘤或与冯·希佩尔-林道综合征相关的肿瘤。考虑到患者已绝经，进行了右侧附件切除术和全子宫切除术。\n\n后来的组织学检查显示，双侧输卵管和阔韧带存在双侧透明细胞乳头状囊腺瘤，这是冯·希佩尔-林道病的特征（右侧0.5厘米，左侧4厘米）。这些肿瘤由紧密排列的乳头组成，乳头中心有纤维组织，表面覆盖单层上皮细胞。\n\n术后早期恢复顺利，并在1个月的随访中，未发现任何异常。此后，患者每4个月进行一次随访，盆腔超声检查结果正常。在过去的2年中，没有出现并发症，但患者最近因脑肿瘤复发而再次入院神经外科。",
+    "translated_summary": "一位62岁的白人北非女性，于2021年被诊断出患有冯·希佩尔-林道病，并出现了多种症状，包括左侧岩骨肿瘤、左侧嗜铬细胞瘤、左侧肾细胞癌、多囊性右肾以及胰腺肿块。她接受了多种治疗，包括放射治疗、肾上腺切除术、肾切除术以及头尾胰十二指肠切除术。超声检查和磁共振成像显示，左侧附件区域存在一处实性囊性肿块。腹腔镜检查发现右侧和左侧输卵管阔韧带上存在囊性肿瘤。在进行双侧附件切除术和子宫切除术后，组织病理学检查显示双侧输卵管阔韧带上存在双侧透明细胞乳头状囊腺瘤，与冯·希佩尔-林道病的诊断结果相符。"
+  },
+  {
+    "id": "multiclinsum_gs_en_30.txt",
+    "fulltext": "The patient was a 59-year-old Japanese man with a 28-year history of type 1 diabetes. He visited our hospital monthly for management of diabetes with intensive therapy employing multiple-dose insulin injections. His height and body weight were 168 cm and 52 kg (body mass index: 18.4 kg/m2), respectively. He showed depleted insulin secretion (serum C-peptide level was below the limit of detection), such that his blood glucose levels fluctuated severely, and his hemoglobin A1c (HbA1c) level was around 9.0% despite intensive insulin therapy. He had been diagnosed with asymptomatic chronic severe (grade III) aortic regurgitation (AR) 16 years before the current presentation but had declined follow-up for the AR. He had never undergone surgery nor the implantation of any prosthetic devices.\n\nEight days after his regular hospital visit, he visited an emergency clinic complaining of breathing difficulty and had a fever above 38℃. Until that day, he had not noticed any fever, chills, weakness, or any other symptoms. His blood pressure and pulse rate were 192/82 mmHg and 118/min, respectively. He showed orthopnea, and his oxygen saturation (SpO2) was 80%. He was transported to the emergency department of our hospital. A physical examination revealed a Levine 3/6 systolic murmur, although his cardiac murmur had not been checked at regular hospital visits. No physical findings suggesting IE, such as Osler nodes, Janeway lesions, or conjunctival petechiae, were recognized. His white blood cell (WBC) count was markedly increased to 20,800 /μL, and his C-reactive protein (CRP) was elevated to 6.06 mg/dL. Serum creatine phosphokinase MB was within the normal range, at 6.0 IU/L, and troponin T was negative. Chest X-ray showed pulmonary congestion with cardiac enlargement (cardiothoracic ratio: 55%). Electrocardiography revealed ST elevation on V1-V4, but emergency echocardiography showed no dysfunction of cardiac contractility. He was diagnosed with acute heart failure due to valvular disease, and treatment with non-invasive positive pressure ventilation and nitrates was initiated.\n\nAfter hospital admission, a detailed examination by transthoracic echocardiography showed severe aortic regurgitation, severe mitral regurgitation, and a mobile vegetation on the mitral valve. Transesophageal echocardiography revealed a 16.5×6-mm mobile vegetation on the anterior leaflet of the mitral valve and an 11.2×5-mm nonmobile vegetation on the noncoronary cusp of the aortic valve. These findings raised strong suspicion of NVE. In this case, head computed tomography (CT) and magnetic resonance imaging revealed no cerebral infarction or hemorrhaging, although a mobile vegetation was detected.\n\nOn reviewing the clinical course until hospitalization, we noted that at the visit four months before admission, his WBC count had been slightly elevated. The following month, his albumin (Alb) level decreased to 3.0 g/dL, and his hemoglobin (Hb) level had shown a gradual decline over the 2 months prior to admission. During this period, he had experienced a 4-kg weight loss. Esophagogastroduodenoscopy and whole-body CT were performed, but no abnormalities were detected. One month later, he had regained some weight, and the laboratory findings had nearly normalized, except for a slightly elevated CRP level (0.54 mg/dL). At the last visit (8 days before admission), his WBC count had again risen to 9,300 /μL, while his Hb and Alb levels had again decreased to 13.1 g/dL and 3.0 g/dL, respectively. Furthermore, his CRP level had increased to 4.18 mg/dL. At that time, his diastolic blood pressure has shown an obvious decrease. Thus far, he had not experienced a fever or any symptoms other than weight loss. We suspected diseases of infectious and/or malignant origin and initiated comprehensive examinations to identify the source of his clinical findings.\n\nAfter heart failure treatment had been started, his clinical symptoms showed rapid improvement, and his hemodynamic stability was maintained during the first six hours. He initially received empirical intravenous antibiotic therapy consisting of 12 g/day of ampicillin sulbactam (ABPC/S) and 120 mg/day of gentamycin (GM). Three blood culture sets were obtained on the admission, and all were positive for S. warneri [minimum inhibitory concentration (MIC) to ABPC/S ≤8 μg/mL; MIC to GM ≤1 μg/mL; MIC to cefazolin (CEZ) ≤2 μg/mL]. Thus, IE caused by this organism was diagnosed.\n\nAccording to the clinical guideline established by the Japanese Circulation Society, emergency surgery is generally recommended for heart failure of NYHA III to IV or urgent surgery for NVE mobile vegetation exceeding 10 mm and severe valve dysfunction. In this case, however, his heart failure was successfully improved. Based on the guideline, the risk of embolism was considered to have been reduced by the administration of appropriate antibiotic therapy. In addition, the patient had type 1 diabetes, and his glycemic control was so poor that we were concerned that double-valve surgery would be a high-risk procedure. Therefore, we planned elective surgery after sufficient control of both infection and diabetes.\n\nBased on the blood culture results, the antibiotic regimen was switched to 6 g/day of CEZ. A detailed dental examination revealed no abnormalities, such as periodontitis. After four weeks of antibiotic therapy, he underwent surgical therapy. His aortic valve was found to be bicuspid, and the aortic and mitral annuli were intact without abscess formation. Large vegetations were exenterated, and the mitral and aortic valves were both replaced with mechanical valves. He experienced no postoperative complications and was discharged on the 22nd day after the operation without apparent embolism. He has not had any recurrence in over two years since the operation.",
+    "summary": "A 59-year-old man with type 1 diabetes presented with heart failure. Echocardiography showed large vegetations on the mitral and aortic valves. Blood bacterial culture was positive for Staphylococcus warneri, a coagulase-negative staphylococcus (CoNS) family member. He was diagnosed with native valve endocarditis (NVE) induced by the resident bacteria and ultimately underwent double valve replacement. Retrospectively, slight laboratory data abnormalities and weight loss beginning four months before may have been signs of NVE. He had no history of immunosuppressive therapies or medical device implantation. ",
+    "translated_fulltext": "患者是一名 59 岁的日本男性，患有 1 型糖尿病 28 年。他每月来我院进行糖尿病管理，采用强化疗法，包括多次胰岛素注射。他的身高和体重分别为 168 厘米和 52 公斤（体重指数：18.4 公斤/平方米）。他的胰岛素分泌减少（血清 C-肽水平低于检测限），导致血糖水平严重波动，尽管进行了强化胰岛素治疗，但他的糖化血红蛋白 (HbA1c) 水平约为 9.0%。在本次就诊前 16 年，他曾被诊断出患有无症状的慢性严重（III 级）主动脉瓣关闭不全 (AR)，但之后未进行后续随访。他从未接受过手术，也没有植入任何人工装置。\n\n在例行就诊八天后，他因呼吸困难和发烧（超过 38℃）来到急诊科。在此之前，他没有注意到任何发烧、寒战、虚弱或其他症状。他的血压和脉搏分别为 192/82 mmHg 和 118 次/分钟。他出现体位性呼吸困难，血氧饱和度 (SpO2) 为 80%。他被转运到我院的急诊科。体格检查显示，他有 3/6 级的收缩期杂音，尽管在例行就诊中没有检查过他的心脏杂音。没有发现任何提示感染性心内膜炎 (IE) 的体征，如 Osler 结节、Janeway 损害或结膜出血点。他的白细胞 (WBC) 计数显著增加到 20,800/μL，C 反应蛋白 (CRP) 升高到 6.06 mg/dL。血清肌酸激酶 MB 在正常范围内，为 6.0 IU/L，肌钙蛋白 T 为阴性。胸部 X 光显示肺部充血，心脏增大（心胸比：55%）。心电图显示 V1-V4 导联 ST 段抬高，但急诊超声心动图显示心脏收缩功能没有异常。他被诊断为因瓣膜疾病引起的急性心力衰竭，并开始使用无创正压通气和硝酸盐进行治疗。\n\n住院后，通过经胸超声心动图进行的详细检查显示，他患有严重的主动脉瓣关闭不全、严重的心脏二尖瓣关闭不全，以及二尖瓣上有一个活动的赘生物。经食管超声心动图显示，二尖瓣前叶上有一个 16.5×6 毫米的活动赘生物，非冠状动脉瓣叶上有一个 11.2×5 毫米的非活动赘生物。这些发现强烈提示存在非静脉源性感染性心内膜炎 (NVE)。在本例中，头部计算机断层扫描 (CT) 和磁共振成像显示没有脑梗塞或出血，但检测到活动性赘生物。\n\n在回顾住院前的临床病程时，我们注意到在入院前四个月的就诊中，他的白细胞计数略有升高。在接下来的一个月里，他的白蛋白 (Alb) 水平下降到 3.0 克/分升，并且在入院前的两个月里，他的血红蛋白 (Hb) 水平逐渐下降。在此期间，他体重减轻了 4 公斤。进行了食管胃十二指肠镜检查和全身 CT 扫描，但没有发现任何异常。一个月后，他恢复了一些体重，实验室检查结果几乎恢复正常，除了 CRP 水平略有升高（0.54 毫克/分升）。在最后一次就诊（入院前 8 天），他的白细胞计数再次上升到 9,300/μL，而他的 Hb 和 Alb 水平再次下降到 13.1 克/分升和 3.0 克/分升。此外，他的 CRP 水平增加到 4.18 毫克/分升。当时，他的舒张压明显下降。到目前为止，他没有出现发烧或任何其他症状，除了体重减轻。我们怀疑存在感染性和/或恶性疾病，并开始进行全面的检查，以确定他临床症状的来源。\n\n在开始心力衰竭治疗后，他的临床症状迅速改善，并在最初的六个小时内维持了血液动力学稳定。他最初接受了经验性静脉注射抗生素治疗，包括每天 12 克氨苄西林舒巴坦 (ABPC/S) 和每天 120 毫克庆大霉素 (GM)。入院时采集了三组血培养，所有培养结果",
+    "translated_summary": "一位59岁的1型糖尿病患者出现心力衰竭。超声心动图显示，其二尖瓣和主动脉瓣上存在大量赘生物。血液细菌培养结果显示为华纳氏葡萄球菌，该细菌属于非凝固酶阳性葡萄球菌（CoNS）家族。经诊断为由常驻细菌引起的自生瓣心内膜炎（NVE），最终接受了双瓣置换术。回顾性分析显示，术前四个月开始出现的轻微实验室检查数据异常和体重减轻，可能都是NVE的早期迹象。患者既往无免疫抑制治疗或植入医疗器械的病史。"
+  },
+  {
+    "id": "multiclinsum_gs_en_383.txt",
+    "fulltext": "A 27-year-old woman with multiple colorectal cancers on a background of FAP was presented to our department. Notably, a large lesion was detected in the ascending, transverse, and sigmoid colon and the upper rectum, and pathological examination confirmed some of them as adenocarcinoma. Preoperative computed tomography revealed multiple lymph node swellings along the inferior mesenteric artery (IMA) and middle colic artery, without any evidence of distant metastases. After a comprehensive evaluation by a multidisciplinary cancer board, we decided to perform TPC with lymph node dissection of the entire colorectal region, using the Hugo RAS system as a surgical device.\n\nRobot-assisted TPC using the Hugo RAS system was approved by the Evaluating Committee for Highly Difficult New Medical Technologies (approval number H-0051) and the Institutional Review Board at Kyoto University.\n\nUnder general anesthesia, the patient was placed in a lithotomy position with the arms tucked. After a 5-cm vertical skin incision was made at the umbilicus, a wound-protecting device was applied. After pneumoperitoneum, 4 robotic trocars and 2 assistant trocars were placed. The instruments used in robot-assisted TPC with Hugo were a camera, monopolar curved shears for the right hand, bipolar fenestrated forceps for the left hand, and Cadiere/double fenestrated forceps for the reserve arm. Robot-assisted TPC with Hugo consists of 3 distinct steps, followed by transanal specimen extraction, ileal pouch construction through a small laparotomy, and ileal pouch-anus anastomosis (IPAA). Two table positions, Trendelenburg and flat, were required, each with specific docking tilts but the same angles of the arm carts throughout the robotic procedure. The detailed operative procedure is presented in Supplementary Videos.\n\nStep 1: Ascending colon complete mesocolic excision (CME)\n\nThe ascending colon CME from the caudal approach proceeded until the completion of the hepatic flexure mobilization (Supplementary Video S1).\n\nStep 2: Central vessel ligation (CVL) of the IMA, descending colon CME, and total mesorectal excision (TME)\n\nAfter CVL of the IMA, descending colon CME proceeded until the completion of splenic flexure mobilization, followed by TME until the intersphincteric space was fully exposed (Supplementary Video S2).\n\nStep 3: CVL along the superior mesenteric artery (SMA)\n\nAfter undocking all the robotic arms, the patient was placed in a flat position. Then, CVL along the SMA was performed to ligate the ileocolic, right colic, and middle colic vessels (Supplementary Video S3). The final step of this procedure was the ligation of the inferior mesenteric vein (IMV) at its root, which was exposed in Step 2.\n\nTransanal and small laparotomy procedures\nAfter transection of the terminal ileum, we extracted the specimen transanally by excising the rectal mucosa entirely from just below the dentate line because of multiple adenomas in the anal canal. After constructing the ileal pouch through the small umbilical incision and confirming that the ileal pouch could reach the bottom of the anal canal for anastomosis, transanal hand-sewn IPAA was performed. A diverting ileostomy was not performed.\n\nAll 3 steps were completed without conversion to open surgery. After undocking Hugo when we finished Step 3, we performed a laparoscopy to confirm hemostasis, specimen extraction, and appropriate anastomosis. The operative time was 632 min (36 min for Step 1, 160 min for Step 2, 188 min for Step 3, and 248 min for other procedures such as positioning, docking, specimen extraction, and anastomosis), with a minimal intraoperative estimated blood loss of 20 mL. The patient exhibited an uneventful postoperative recovery, with gas passage and initiation of liquid nutrition on postoperative day 1 (POD 1) and a solid diet on POD 3 with a functional ileal pouch and satisfactory anal function. Pathological examination revealed 2 sigmoid colon cancers (S1, Type 0-Ip, 55 × 50 mm, tub1, T1b, ly0, v0; S2, Type 0-Isp, 55 × 50 mm, tub1, Tis, ly0, v0) and 1 rectal cancer (R1, Type 0-Ip, 40 × 35 mm, tub1, Tis, ly0, v0). It also revealed 18 out of 89 positive lymph nodes, all of which belonged to the sigmoid colon and rectosigmoid lesions (stations #241, 242, and 251), resulting in UICC pT1bN2b stage.",
+    "summary": "A 27-year-old woman with multiple colorectal cancers with a background of familial adenomatous polyposis underwent robot-assisted TPC, including lymph node dissection of the entire colorectal region using the Hugo RAS system. The robotic procedure was divided into 3 steps: 1) Trendelenburg position to perform ascending colon complete mesocolic excision (CME) to the hepatic flexure, 2) descending colon CME and total mesorectal excision with D3 lymph node dissection, and 3) flat position to perform central vessel ligation along the superior mesenteric artery. After undocking, the specimen was extracted transanally, and an ileal pouch was constructed from a small laparotomy at the umbilical incision, followed by ileal pouch-anal anastomosis. The operative time was 632 min, and the estimated blood loss was minimal. The postoperative period was uneventful.",
+    "translated_fulltext": "一位27岁的女性患者，因家族性腺瘤性息肉病（FAP）病史，并伴有多个结直肠癌，被收治入院。检查发现，其升结肠、横结肠、乙状结肠和上直肠均存在大面积病灶，病理检查证实其中部分为腺癌。术前计算机断层扫描（CT）显示，沿下系膜动脉（IMA）和中结肠动脉分布着多个淋巴结肿大，但未见远处转移的证据。在多学科肿瘤委员会的综合评估后，我们决定采用机器人辅助的全结肠切除术（TPC），并进行整个结直肠区域的淋巴结清扫，手术器械选用Hugo RAS系统。\n\n采用Hugo RAS系统进行的机器人辅助TPC手术，已获得评估委员会（批准编号H-0051）和京都大学伦理委员会的批准。\n\n在全身麻醉下，患者采取截石位，双臂置于体侧。在脐部做一个5厘米长的垂直皮肤切口后，使用伤口保护装置。建立气腹后，放置4个机器人端口和2个助手端口。机器人辅助TPC手术中使用的器械包括：摄像头、右手使用的单极弯曲剪刀、左手使用的双极带孔镊、以及备用臂使用的Cadiere/双带孔镊。采用Hugo RAS系统进行的机器人辅助TPC手术包括3个不同的步骤，随后进行经肛门标本取出、通过小切口进行回肠囊的构建，以及回肠囊-肛门吻合术（IPAA）。手术过程中需要调整两次体位，分别是Trendelenburg位和水平位，每次调整都有特定的对接角度，但机器人手臂的角度保持不变。详细的手术步骤将在补充视频中展示。\n\n步骤1：升结肠完全系膜切除术（CME）\n\n从尾部方向开始进行升结肠CME，直至完成肝曲的游离（补充视频S1）。\n\n步骤2：IMA中央血管结扎（CVL）、降结肠CME和完全直肠系膜切除术（TME）\n\n在IMA进行CVL后，进行降结肠CME，直至完成脾曲的游离，然后进行TME，直至完全暴露括约肌间隙（补充视频S2）。\n\n步骤3：沿上系膜动脉（SMA）进行CVL\n\n在所有机器人手臂脱离对接后，将患者置于水平位。然后，沿SMA进行CVL，结扎回结肠动脉、右结肠动脉和中结肠动脉（补充视频S3）。此步骤的最后一步是在其根部结扎下系膜静脉（IMV），该静脉在步骤2中被暴露。\n\n经肛门和微小腹腔镜手术\n\n在切断末端回肠后，由于肛管内存在多个腺瘤，我们通过完全切除齿状线下方的直肠黏膜，经肛门取出标本。通过脐部小切口构建回肠囊，并确认回肠囊可以到达肛管底部进行吻合后，进行经肛门手工缝合的IPAA。未进行引流回肠造口术。\n\n所有3个步骤均顺利完成，无需转换为开放手术。在完成步骤3后，我们进行了腹腔镜检查，以确认止血情况、标本取出情况以及吻合情况。手术时间为632分钟（步骤1：36分钟，步骤2：160分钟，步骤3：188分钟，其他步骤，如体位调整、对接、标本取出和吻合：248分钟），术中估计失血量最少为20毫升。患者术后恢复良好，术后第1天（POD 1）开始排气，并开始流质饮食，术后第3天（POD 3）开始进食固体食物，回肠囊功能良好，肛门功能满意。病理检查显示，乙状结肠有2个癌（S1，0-Ip型，55×50毫米，tub1，T1b，ly0，v0；S2，0-Isp型，55×50毫米，tub1，Tis，ly0，v0），直肠有1个癌（R1，0-Ip型，40×35毫米，tub1，Tis，ly0，v0）。此外，89个淋巴结中有18个呈阳性，这些淋巴结均位于乙状结肠和直乙状结肠病灶（#241、242和251号站），最终诊断为UICC pT1bN2b期。",
+    "translated_summary": "一位27岁的女性患者，患有多发性结直肠癌，且有家族性腺瘤性息肉病史，接受了机器人辅助的全结肠切除术（TPC），包括使用Hugo机器人手术系统对整个结直肠区域进行淋巴结清扫。机器人手术分为三个步骤：1）采用Trendelenburg体位，对升结肠进行完全系膜切除术（CME），直至肝曲；2）对降结肠进行CME，并进行D3淋巴结清扫的全系膜直肠切除术；3）采用平躺体位，沿上肠系膜动脉进行中央血管结扎。手术结束后，通过经肛门取出标本，并在脐部切口处进行一个小型的腹腔镜手术，以构建回肠囊，然后进行回肠囊-肛门吻合术。手术时间为632分钟，估计失血量极少。术后恢复顺利。"
+  },
+  {
+    "id": "multiclinsum_gs_en_462.txt",
+    "fulltext": "A 65-year-old male presented with swelling and boutonniere deformity on the right middle finger for six months after a motorcycle accident on January 1st, 2023. Initially, he managed the injury with painkillers and did not seek medical attention. After six months of persistent symptoms, including an inability to fully extend the finger and noticeable edema, he sought treatment.\n\nClinical findings\nThe inspection of the right hand showed the presence of deformity with edema. The active range of motion (ROM) was impaired in PIP joint in digiti III of the right hand. The active ROM of PIP joint digiti III of the right hand 45–110 degrees. The passive ROM of PIP joint digiti III of the right hand within normal.\n\nDiagnostic assessment\nWe performed X-ray of the right hand AP/Lateral which showed there are no abnormality in the bone and we diagnosed the deformity from soft tissue which is central slip injury.\n\nSurgical technique\nA central slip defect reconstruction utilizing partial ulnar side of flexor digitorum superficial tendon was performed. Under anesthesia, the patient was positioned supine with a tourniquet applied to the upper arm. A midlateral incision was made on the ulnar aspect of the right middle phalanx, centered at the PIP joint. The incision extended dorsally in an oblique manner. A transverse incision was made over the MCP joint flexion crease, just proximal to the A1 pulley. The procedure involves identifying and protecting the ulnar digital neurovascular bundle, exposing the central slip and extensor tendon to the PIPJ, full-thickness dorsal flaps are elevated. Scar tissue and pseudotendinous tissue is identified and excised. The central slip cannot be repaired primarily, so the ulnar slip of the FDS tendon is used for reconstruction. The ulnar neurovascular bundle is mobilized to visualize the periosteal insertion of the A3 pulley.\n\nThe extensor tendon is mobilized and tenolyzed, followed by incision of the dorsal capsule of the PIP joint and removal of interposed tissue. The A3 pulley's periosteal insertion is incised longitudinally, and the PIP joint's volar capsule is incised longitudinally. The ulnar slip of the FDS tendon is identified and a 2–0 non-absorbable, monofilament suture is placed around it. A transverse incision is made at the MCP joint flexion crease, proximal to the A1 pulley revealing the flexor tendon sheath. The tendon sheath and A1 pulley are incised longitudinally. The FDS tendon is identified. The ulnar slip of the FDS tendon is isolated and transected to release the ulnar slip, avoiding entrapment or catching of the radial slip. The 2–0 suture that was placed around the ulnar slip at the level of the PIP joint is used to release distally based FDS tendon slip and deliver the ulnar slip of the FDS tendon distally.\n\nA 2.8-mm drill is used to create a vertically oriented bone tunnel dorsal to volar. An elevator is placed between the flexor digitorum profundus tendon, volar plate, and volar aspect of the base of the middle phalanx protecting the volar anatomic structures. The FDS tendon slip passes through the tunnel while maintaining the PIP joint in extension and reduced position. The FDS tendon slip passed through the intact proximal section of the central slip and extensor tendon. A tendon weaver completes a Pulvertaft weave, confirming the appropriate tension with the PIPJ in the reduced, full extension position. A 3–0 non-absorbable suture secures the pulvertaft weave. The margins of the capsule and central slip reconstruction are approximated across the PIP joint, and adhesions are released and the lateral bands mobilized.\n\nThe overall posture, stability, and motion with tenodesis assessed. All the incisions are copiously irrigated. The tourniquet is deflated and hemostasis is obtained. Capillary refill of all fingers is assessed. The skin is closed using horizontal mattress stiches. A sterile dressing is applied with an appropriately padded PIP joint extension splint to allow for early DIP joint and MCP joint motion.\n\nFollow-up and outcomes\nFirst follow-up was done 4 days after for wound treatment. The patient was given oral meloxicam 7,5 mg twice a day and doxycycline 100 mg twice a day for 3 days. The second follow-up was done 3 days after for wound treatment. After 2 weeks, we remove the back slab, remove the external suture and begin the active and passive ROM exercise. After 3 weeks, the wound was healed, and we found the ROM of PIP joint 0 to 90 degrees. And after a month, the patient came with improved ROM of PIP joint 0 to 100 degrees, and improved functional outcome. After 7 weeks of physical rehabilitation, patients already back to work with improve ROM of PIP joint 0 to 110 degrees. The function of the patient's right hand is evaluated with DASH score, which improves significantly from 50 to 4.2.",
+    "summary": "A 65-year-old male patient presented with swelling and boutonniere deformity on the digiti III of the right hand. The patient had previously fallen from a motorcycle, and the patient's right middle finger got was by a motorcycle six months ago. After the incident, the patient's right middle finger cannot be fully extended. The patient's right hand showed edema with flexion of the interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint. The Range of Motion (ROM) of the PIP joint right middle finger was 45-110 degrees. The X-ray of the right hand AP/oblique showed no bone involvement in the deformity. The patient underwent central slip defect reconstruction utilizing the partial ulnar side of the flexor digitorum superficial tendon. A PIP joint extension splint was applied for 2 weeks. Active and passive exercise of the ROM of the PIP joint began after 2 weeks of PIP extension joint splinting. The patient's ROM of the PIP joint (0-90 degrees) significantly improved 1 month after surgery. The patient's ROM of the PIP joint returned to normal after 2 months after surgery. The function of the patient's right hand is evaluated with the DASH score, which improves significantly from 50 to 4.2.",
+    "translated_fulltext": "一位 65 岁的男性患者，在 2023 年 1 月 1 日发生摩托车事故后，右手中指出现肿胀和屈指关节挛缩，持续了六个月。起初，他仅用止痛药来缓解症状，并未就医。六个月后，由于症状持续存在，包括手指无法完全伸直和明显的肿胀，他开始寻求治疗。\n\n临床检查结果\n右手的检查显示存在肿胀和畸形。右手中指近指间关节的活动范围受限。右手中指近指间关节的活动范围为 45-110 度。右手中指近指间关节的被动活动范围在正常范围内。\n\n诊断评估\n我们对右手的正位和侧位进行了 X 光检查，结果显示骨骼没有异常。我们诊断为软组织损伤，即中央滑索损伤。\n\n手术技术\n采用部分尺侧屈指深屈肌腱来重建中央滑索缺损。在麻醉状态下，患者采取仰卧位，并在上臂上套上止血带。在右手中指近指间关节的尺侧，做一个从近指间关节开始的侧向切口。切口以斜向方式延伸至背侧。在远侧指间关节的屈曲皱襞处做一个横向切口，位于 A1 腱鞘的近侧。手术包括识别并保护尺侧数字神经血管束，暴露中央滑索和近指间关节的伸肌腱，并抬高全层背侧皮瓣。识别并切除疤痕组织和假性肌腱组织。由于中央滑索无法直接修复，因此使用屈指深屈肌腱的尺侧部分进行重建。将尺侧神经血管束游离，以观察 A3 腱鞘的骨膜附着点。\n\n游离并松解伸肌腱，然后切开近指间关节的背侧关节囊，并清除其中的组织。沿 A3 腱鞘的骨膜附着点做一个纵向切口，并沿近指间关节的掌侧关节囊做一个纵向切口。识别屈指深屈肌腱的尺侧部分，并用 2-0 号不可吸收的单丝缝线将其绕起来。在远侧指间关节的屈曲皱襞处做一个横向切口，位于 A1 腱鞘的近侧，从而暴露屈肌腱鞘。沿纵向切开屈肌腱鞘和 A1 腱鞘。识别屈指深屈肌腱。分离并切断屈指深屈肌腱的尺侧部分，以释放尺侧部分，避免桡侧部分的夹住或卡住。将之前绕在近指间关节尺侧部分的 2-0 号缝线用于释放远端部分的屈指深屈肌腱，并将屈指深屈肌腱的尺侧部分拉向远端。\n\n使用 2.8 毫米的钻头，在掌侧和背侧之间创建一个垂直的骨隧道。将一个扩张器放置在屈指深屈肌腱、掌板和中指基底的掌侧之间，以保护掌侧的解剖结构。屈指深屈肌腱的滑索穿过隧道，同时保持近指间关节处于伸展和复位状态。屈指深屈肌腱的滑索穿过中央滑索和伸肌腱的完整近端部分。使用肌腱编织器完成 Pulvertaft 编织，并在近指间关节处于复位和完全伸展的位置时，确认张力是否合适。使用 3-0 号不可吸收的缝线固定 Pulvertaft 编织。将关节囊和中央滑索重建的边缘在近指间关节上对合，释放粘连，并松解侧带。\n\n评估整体姿势、稳定性和活动范围，并进行肌腱固定术。彻底冲洗所有切口。放开止血带，并进行止血。评估所有手指的毛细血管再充盈。使用水平褥式缝合闭合皮肤。敷上无菌敷料，并使用适当的填充的近指间关节伸展夹板，以促进早期远指间关节和远侧指间关节的活动。\n\n随访和结果\n首次随访在伤口处理后 4 天进行。患者口服美洛昔康 7.5 毫克，每日两次，以及多西环素 100 毫克，每日两次，持续 3 天。第二次随访在伤口处理后 3 天进行。两周后，我们拆除背板，拆除外用缝线，并开始进行主动和被动活动范围锻炼。三周后，伤口愈合，我们发现",
+    "translated_summary": "一位65岁的男性患者，右手的第三指出现肿胀和屈指关节挛缩畸形。患者既往曾发生摩托车事故，六个月前，患者的右手中指被摩托车碾压。事故发生后，患者的右手中指无法完全伸直。检查发现，患者的右手出现水肿，指间关节（PIP）屈曲，远端指间关节（DIP）过度伸展。右手中指PIP关节的活动范围为45-110度。右手的AP/斜位X光片显示，畸形处没有骨骼受累。患者接受了中央滑索缺损修复术，使用了屈指肌浅腱的桡侧部分。术后为患者佩戴了PIP关节伸展夹板，持续2周。2周后，开始进行PIP关节的主动和被动活动训练。术后1个月，患者的PIP关节活动范围（0-90度）明显改善。术后2个月，患者的PIP关节活动范围恢复正常。通过DASH评分评估患者的右手功能，评分从50显著改善至4.2。"
+  },
+  {
+    "id": "multiclinsum_gs_en_382.txt",
+    "fulltext": "A 23-year-old male patient presented to the emergency department with a sudden onset of severe frontal headache lasting for 2 h. He experienced associated symptoms of nausea, vomiting, and chest heaviness. He has a unremarkable medical record and denies the use of illicit drugs. However, he is a smoker with a history of 23 pack-years but does not consume alcohol.\n\nOn physical examination, the young male appeared distressed but was fully conscious and oriented to time, place, and person. Chest auscultation revealed normal vesicular breathing sounds, while cardiovascular and abdominal examinations were inconclusive. Neurological examinations demonstrated neck stiffness, dilated pupils reactive to light, normal plantar reflexes, and no focal neurological deficits.\n\nHis vital signs were as follows: blood pressure 178/103 mmHg, respiratory rate 26 breaths/min, temperature 38.9°C, heart rate 87 beats/min, and oxygen saturation of 94%.\n\nEmergency tests were initiated. An ECG revealed ST segment elevation >2 mm in leads V2-V5, consistent with STEMI as the top of our differential diagnosis, requiring confirmation by cardiac markers. With prompt referral to a tertiary cardiac centre implemented, the patient received a 300 mg aspirin load while being transferred to the catheter lab. Troponin levels were significantly elevated at 1.48 mg/dl (normal <0.16 mg/dl).\n\nPercutaneous coronary intervention was performed via the femoral artery, and the result showed normal coronary arteries with thrombolysis in myocardial infarction (TIMI) flow grade of 3.\n\nHis ECG after coronary angiography revealed normal sinus rhythm with left ventricular hypertrophy LVH. An echocardiogram was performed, revealing normal ventricular function with no regional wall motion abnormalities (RWMA).\n\nFollowing coronary intervention, he was admitted to the medical ward for further assessment and investigation. Blood samples were drawn for a complete blood count, random blood sugar, renal function tests, and CRP. The results revealed lymphocytosis and mildly elevated CRP.\n\nWe proceeded further with CT brain to exclude serious cause of headache. His brain CT showed cisternal subarachnoid haemorrhage SAH with extension anterior to the right temporal lobe. Abdominal ultrasound screening was performed to rule out polycystic kidney disease which was negative and cerebral CT angiography was scheduled to exclude cerebral aneurysm Nimodipine 60 mg every 4 h was initiated, with a target blood pressure of 160/100 mmHg.\n\nOn the second day, his condition suddenly deteriorated, culminating with cardiac arrest. Therefore, cardiopulmonary resuscitation (CPR), resulting in a Glasgow Coma Scale score (GCS) of 6. The patient was subsequently, intubated and placed on mechanical ventilation in the Intensive Care Unit (ICU). Due to his unstable condition in the ICU, we could not perform a repeated CT brain scan or the planned cerebral CT angiography.\n\nOver the next 7 days, we diligently monitored him with a strict multidisciplinary team. A nasogastric tube was inserted for feeding and fluid replacement. His medications included intravenous fluids, antibiotics, proton pump inhibitors, and nimodipine.\n\nOn the 8th day, he suddenly developed ventricular fibrillation, and despite CPR with more than five defibrillations, we were unable to revive him and death was the final outcome.39734686",
+    "summary": "We present a case detailing the diagnostic challenges of a 23-year-old male presenting with a sudden severe headache, nausea, vomiting, and chest heaviness. Initial evaluation showed elevated blood pressure and respiratory rate. An emergency electrocardiogram (ECG) indicated ST-segment elevation myocardial infarction (STEMI), leading to immediate referral for percutaneous coronary intervention, which revealed normal coronary arteries. Further investigations identified a cisternal subarachnoid haemorrhage (SAH) on CT brain imaging. Despite multidisciplinary management, the patient's condition rapidly deteriorated, resulting in cardiac arrest and mortality.",
+    "translated_fulltext": "一名23岁的男性患者因突发严重前额头痛，持续2小时，来到急诊科。他同时伴有恶心、呕吐和胸闷等症状。他的病史无特殊之处，否认有使用非法药物。但他有吸烟史，吸烟量为23包/年，但不饮酒。\n\n体格检查显示，该年轻男性看起来很痛苦，但意识清醒，能辨认时间、地点和人物。听诊显示，胸部呼吸音正常，心血管和腹部检查结果不明确。神经系统检查显示颈部僵硬、瞳孔对光反应迟钝、足底反射正常，没有局灶性神经功能障碍。\n\n他的生命体征如下：血压178/103 mmHg，呼吸频率26次/分钟，体温38.9°C，心率87次/分钟，血氧饱和度94%。\n\n立即进行急诊检查。心电图显示V2-V5导联的ST段抬高>2 mm，与急性ST段抬高型心肌梗死（STEMI）相符，这是我们的首要诊断，需要通过心肌标志物进行确认。立即转诊至三级心脏中心，患者在转运至导管室时接受了300毫克阿司匹林负荷剂量。肌钙蛋白水平显著升高，达到1.48 mg/dl（正常值<0.16 mg/dl）。\n\n通过股动脉进行经皮冠状动脉介入治疗，结果显示冠状动脉正常，心肌梗死时冠状动脉血流分级（TIMI）为3级。\n\n冠状动脉造影后的心电图显示，窦性心律正常，左心室肥大（LVH）。进行超声心动图检查，显示心室功能正常，没有区域性室壁运动异常（RWMA）。\n\n冠状动脉介入治疗后，他被转入内科病房，进行进一步的评估和检查。抽取血液样本进行全血细胞计数、随机血糖、肾功能检查和C反应蛋白（CRP）检测。结果显示淋巴细胞增多，CRP轻度升高。\n\n为了排除头痛的严重原因，我们进一步进行了脑部CT扫描。他的脑部CT显示，脑池内蛛网膜下腔出血（SAH），并延伸至右颞叶前方。进行了腹部超声检查，以排除多囊肾病，结果为阴性，并计划进行脑部CT血管造影，以排除脑动脉瘤。开始使用尼莫地平，剂量为每4小时60毫克，目标血压为160/100 mmHg。\n\n第二天，他的病情突然恶化，最终导致心脏骤停。因此，进行了心肺复苏（CPR），格拉斯哥昏迷量表（GCS）评分达到6分。随后，患者被气管插管，并置于重症监护室（ICU）进行机械通气。由于他在ICU中的病情不稳定，我们无法进行重复的脑部CT扫描或计划的脑部CT血管造影。\n\n在接下来的7天里，我们由一个严格的多学科团队密切监测他的情况。插入鼻胃管进行喂养和补充液体。他的药物包括静脉输液、抗生素、质子泵抑制剂和尼莫地平。\n\n第八天，他突然出现心室颤动，尽管进行了超过五次除颤的心肺复苏，但我们未能使他苏醒，最终死亡。",
+    "translated_summary": "本文介绍了一例病例，详细描述了一位23岁男性患者，他突然出现剧烈头痛、恶心、呕吐和胸闷等症状，这给诊断带来了挑战。初步检查显示，患者血压和呼吸频率均升高。紧急心电图（ECG）显示ST段抬高型心肌梗死（STEMI），因此立即转诊进行经皮冠状动脉介入治疗，结果显示冠状动脉正常。进一步检查发现，CT脑部影像显示患者患有脑池蛛网膜下腔出血（SAH）。尽管进行了多学科综合治疗，患者的病情迅速恶化，最终导致心脏骤停并死亡。"
+  },
+  {
+    "id": "multiclinsum_gs_en_58.txt",
+    "fulltext": "Patient A.P., female, born in 1979, has been diagnosed with dilatation cardiomyopathy in 1996. Anamnestically, disease started with tonsillitis, possible myocarditis (which was never proven), with pronounced symptoms of heart failure and general symptoms. She was hospitalized and after one month, the left ventricular ejection fraction was 10% with the aforementioned signs of congestive heart failure. She was hospitalized for 10 months and 9 days, with standard therapy for vitally endangered patient, oxygen support, numerous adjuvant therapy, and intensive monitoring. Therapy was administered (ACE inhibitor - ramipril, cardiotonic - digoxin, beta-blockers - metoprolol and combination of diuretics - furosemide and spironolactone), with the indication of heart transplantation. Clinical improvement occured with an ejection fraction that was gradually increasing and at the age of 21 she entered in remission or stabilization phase, with the ejection fraction value of 48-57% (regular echocardiography was performed every three months). For the following four years therapy remained the same, but in Jun 2004 (after an episode of low immunity), ejection fraction fell to 25%, with a clinical deterioration of the disease. The patient was hospitalized for a period of two months, and the condition stabilized, and she was discharged with therapy that was the same but without cardiotonic. Ejection fraction was stabilized, and in year 2006 it was 50%. At the age of 27, the patient decided on the first pregnancy that was successful with beta blocker (metoprolol) in therapy. After the first pregnancy, the ejection fraction was 40% and she was treated with the same therapy with eplerenone (25 mg) instead of spironolactone. The ejection fraction was controlled and did not fall below 45%. At the end of 2015 the patient became pregnant for the second time, and the pregnancy went neatly until eighth month (35 weeks), when she was urgently admitted to hospital, due to sense of suffocation and inability to walk. Ejection fraction decreased to 18% (brain natriuretic peptide (BNP) was 2600 pg/ mL (reference values are 100-400 pg/ mL)). During pregnancy she received only metoprolol in therapy. Physicians decide to continue with her pregnancy, in the 39th week they performed c-section, and the condition stabilized again after twenty days. In October 2016 new mode of therapy was administered, ramipril (2.5 mg, in the morning), metoprolol (47.5 mg, in the morning), spironolactone (50 mg, once a day) and ivabradine (5 mg, twice a day) with torasemide (5 mg, once a day). LifeVest Defibrillator was carried from 06 December 2016 until 27 February 2017 when it was removed. When removed and after examination (ejection fraction was 44%) she continued with ramipril therapy (1.25 mg) metoprolol (23.75 mg), torasemide (5 mg), spironolactone (25 mg) and ivabradine (7.5 mg, twice a day) with potassium supplements, and compliance with non-pharmacological measures (fluid intake restricted to 1.5 L/ day). The echocardiographic finding in March 2017 showed left ventricular dilatation with moderately reduced left ventricular function and left ventricular wall hypokinesia with ejection fraction of 44% (insignificant pericardial effusion was present, inferior vena cava with physiological flow, preserved valves function - Dopler sonography showed slight insufficiency of mitral valve with dilatation of anulus). Evaluation of a patient with ejection fraction 44% showed no indication for an implantable cardioverter defibrillator (ICD), and conservative procedure and medication therapy were recommended. Regular check-ups and body mass reduction, regular control of renal function parameters and electrolytes were recommended. She is led under the diagnosis of dilated cardiomyopathy and heart failure NYHA stage II without any indication for the ICD prophylactic implantation.",
+    "summary": "Patient A.P., female, 38 years old, had symptoms of dilated cardiomyopathy (with possible infectious myocarditis in the background) at age 17. After hospitalization for ten months and ten days, while waiting for heart transplantation (with threatening death outcome), without a clearly pronounced threatening arrhythmia, but with a low ejection fraction and a poor general condition, remission occurred. The therapy focused primarily on the treatment of heart failure, prevention of arrhythmia and thromboembolism. Normalization of the disease by improving the function of the left ventricle (expected in 16% of patients) occurred and lasted for 4 years, followed by an exacerbation of the disease that lasted for two years. In the next few years the patient was stable, had a first child with normal pregnancy. During the second trimester of the second pregnancy, there was an exacerbation (postpartum dilatation cardiomyopathy) lasting for couple of months. At the time of case report (May 2017), the patient is stable on therapy (ACE inhibitor, beta blocker, diuretics, If channel blocker), without limitation of physical capacity, mother of two children, unemployed.",
+    "translated_fulltext": "患者A.P.，女性，1979年出生，1996年被诊断为扩张型心肌病。根据病史，疾病始于扁桃体炎，可能伴有心肌炎（但未得到证实），并出现明显的心力衰竭症状和全身症状。她住院治疗，一个月后，左心室射血分数降至10%，并伴有上述心力衰竭的体征。她住院治疗了10个月零9天，接受了针对危重患者的标准治疗，包括氧气支持、多种辅助治疗和密切监测。治疗方案包括：血管紧张素转化酶抑制剂（雷米普利）、强心剂（地高辛）、β受体阻滞剂（美托洛尔）以及利尿剂的联合使用（呋塞米和螺内酯），并考虑进行心脏移植。临床症状有所改善，射血分数逐渐增加，21岁时，她进入缓解期或稳定期，射血分数达到48-57%（每三个月进行一次常规超声心动图检查）。在接下来的四年里，治疗方案保持不变，但在2004年6月（一次免疫力下降后），射血分数降至25%，疾病的临床症状恶化。患者住院治疗了两个月，病情稳定后出院，出院时使用的治疗方案与之前相同，但不再使用强心剂。射血分数稳定，2006年达到50%。27岁时，患者决定怀孕，第一次怀孕成功，并在治疗中使用了β受体阻滞剂（美托洛尔）。第一次怀孕后，射血分数降至40%，她继续接受相同的治疗方案，但将螺内酯替换为依普利酮（25毫克）。射血分数得到控制，未降至45%以下。2015年底，患者再次怀孕，妊娠进展顺利，直到第八个月（35周），由于出现呼吸困难和无法行走，她被紧急送往医院。射血分数降至18%（脑钠肽（BNP）为2600 pg/mL，参考值为100-400 pg/mL）。在怀孕期间，她仅接受美托洛尔治疗。医生决定继续妊娠，在第39周进行了剖腹产，术后20天病情再次稳定。2016年10月，新的治疗方案开始实施，包括雷米普利（2.5毫克，早晨服用）、美托洛尔（47.5毫克，早晨服用）、螺内酯（50毫克，每天一次）和伊伐布雷定（5毫克，每天两次），以及托拉塞米（5毫克，每天一次）。从2016年12月6日到2017年2月27日，患者佩戴了LifeVest除颤器，之后取下。取下除颤器并进行检查后（射血分数44%），她继续接受雷米普利（1.25毫克）、美托洛尔（23.75毫克）、托拉塞米（5毫克）、螺内酯（25毫克）和伊伐布雷定（7.5毫克，每天两次）的治疗，并补充钾，同时遵循非药物治疗措施（限制液体摄入量至每天1.5升）。2017年3月的超声心动图检查显示，左心室扩张，左心室功能中度降低，左心室壁运动减弱，射血分数44%（存在轻微的心包积液，下腔静脉血流正常，瓣膜功能良好——多普勒超声显示二尖瓣轻度关闭不全，瓣环扩张）。对射血分数44%的患者进行评估，未发现植入式心脏复律除颤器（ICD）的指征，建议采取保守治疗和药物治疗。建议定期检查，并减少体重，定期监测肾功能指标和电解质。患者被诊断为扩张型心肌病和纽约心脏协会（NYHA）II期心力衰竭，但未发现植入ICD的预防性指征。",
+    "translated_summary": "患者A.P.，女性，38岁，17岁时出现扩张型心肌病（可能伴有感染性心肌炎）的症状。住院治疗十个月零十天后，在等待心脏移植期间（病情危重，有生命危险），虽然没有出现明显的危及生命的Arrhythmia（心律失常），但由于射血分数低、整体状况不佳，病情得到了缓解。治疗主要集中在治疗心力衰竭、预防心律失常和血栓栓塞。通过改善左心室功能，病情得到控制（预计在16%的患者中发生），并持续了4年，之后病情再次恶化，持续了两年。在接下来的几年里，患者病情稳定，并顺利生下第一个孩子。在第二次怀孕的第二孕期，病情再次恶化（产后扩张型心肌病），持续了几个月。截至病例报告时（2017年5月），患者通过药物治疗（ACE抑制剂、β受体阻滞剂、利尿剂、If通道阻滞剂）病情稳定，身体活动能力没有受到限制，并且有两个孩子，目前没有工作。"
+  },
+  {
+    "id": "multiclinsum_gs_en_81.txt",
+    "fulltext": "27-year-old male patient with a history of fibrous dysplasia in the right proximal femur, which was managed prophylactically to reduce the risk of fracture 20 years ago by curettage (intralesional resection), application of bone graft and fixation with osteosynthesis material, which was removed one year after the fixation. Two weeks before admission to hospital, the patient experienced pain after a fall with low energy mechanism characterised by axial load and rotational component of the right hip, which resulted in pain intensity 8/10 on the visual analogue scale (VAS) at the level of the inguinal fold and right thigh, which incapacitated him for walking. Radiological control was performed at four weeks, observing all prosthetic components adequately. The patient was discharged clinically and haemodynamically stable, without the need for transfusion of blood products. During his follow-up in the postoperative period (612 weeks), the patient continued with partial support until day 20, in which he began with full support even accompanied by a walker. Radiological control was performed at four weeks, observing all prosthetic components adequately. The patient is currently carrying out daily activities with slight limitation due to claudicatio intermittens caused by the incision in the middle gluteus. However, he was able to participate in low-impact sports activities, such as walking and expressed great satisfaction with the functional outcome of the procedure.\n",
+    "summary": "We present the case of a 27-year-old male patient who presented to the emergency department with a fracture of the right femur at the base of the neck in pathological ground Garden II Pauwells III AO 31B2.3r, after a low energy mechanism of injury characterized by axial load with rotational component of the right hip. The patient had a history of intralesional resection, application of bone graft and prophylactic fixation with unspecified osteosynthesis material in the pertrochanteric region 20 years ago; the biopsy later showed DF; one year later, the osteosynthesis material was removed. Due to the characteristics of the fracture and as a definitive and curative therapeutic method, it was decided to carry out a wide resection of the proximal femur and total arthroplasty of the hip with a modular prosthesis with placement of cerclage, as well as a excisional biopsy that later corroborated that it was the same DF treated in childhood.\n",
+    "translated_fulltext": "患者为27岁男性，既往右侧股骨近端曾患纤维性骨发育不良。20年前，为了降低骨折风险，曾采用刮除术（病灶内切除）、植骨和使用骨合成材料进行固定，以进行预防性治疗，并在固定一年后将植入物移除。入院前两周，患者因低能量机制导致的跌倒，右髋关节承受轴向负荷和旋转力，出现疼痛。疼痛程度在视觉模拟评分（VAS）中达到8/10，疼痛部位位于腹股沟和右大腿，导致患者无法行走。术后四周进行影像学检查，所有假体部件均显示良好。患者临床和血流动力学稳定，无需输血。术后随访期间（612周），患者在术后20天前仍需部分负重，之后开始完全负重，并使用助行器。术后四周进行影像学检查，所有假体部件均显示良好。目前，患者可以进行日常活动，但由于中臀肌切口引起的间歇性跛行，活动能力略有受限。然而，他可以参加低强度运动，如步行，并且对手术的治疗效果表示非常满意。",
+    "translated_summary": "我们介绍了一位27岁男性患者的病例。该患者因右股骨颈部基底处发生病理性骨折，骨折类型为Garden II型、Pauwells III型、AO 31B2.3r型，前来急诊科就诊。骨折是由低能量外伤引起的，其特征是右髋关节承受轴向负荷并伴有旋转。患者20年前曾在股骨转子周围接受过病灶内切除术、骨移植术以及预防性内固定术，但使用的内固定材料未明确。术后活检结果显示为纤维组织瘤。一年后，内固定材料被移除。考虑到骨折的特点，并为了采取一种明确且具有治疗效果的方法，我们决定进行广泛的近端股骨切除术，并采用模块化假体进行全髋关节置换术，同时进行钢丝环扎固定，以及切除性活检，以确认该病灶与患者童年时期的纤维组织瘤为同一病灶。"
+  },
+  {
+    "id": "multiclinsum_gs_en_280.txt",
+    "fulltext": "A 4-year-old boy with stage IV neuroblastoma received four cycles of chemotherapy, including high-dose chemotherapy including busulfan and melphalan, followed by autologous peripheral blood stem cell transplantation with autologous bone marrow supplementation. After eight additional cycles of chemotherapy consisting of temozolomide and irinotecan, which led to stable disease, the patient underwent preparative conditioning with fludarabine (150 mg/m2), melphalan (140 mg/m2), and 12 Gy of TBI for subsequent allogeneic CBT. The patient received tacrolimus and a short-term course of methotrexate for GVHD prophylaxis. The patient underwent engraftment on day 17. He then developed grade 3 GVHD, which was managed by increasing the prednisolone dose and was later discharged on day 85. The patient also received proton beam therapy (39.6 Gy) from days 121 to 150 post-transplantation for a right supra-mediastinum tumor with residual I123-MIBG accumulation in the right adrenal gland.\n\nThe patient remained healthy with no evidence of GVHD until presentation at our hospital with a productive cough on day 159. As his older brother displayed similar cold symptoms, a rapid antigen test for RSV was performed, which revealed a positive result. His respiratory symptoms gradually worsened, and he revisited our hospital on day 194 with dyspnea and intercostal retractions. Upon admission, he was given 0.7-1.0 mg/kg of prednisolone, which failed to improve his respiratory condition. Chest computed tomography on day 231 revealed infiltration, ground-glass opacity, and septal thickening in the bilateral lung fields along with right pleural effusion. Echocardiography showed an elevated tricuspid regurgitation peak velocity of 4.1 m/s and an interventricular septum close to the isobaric, indicating the presence of PH. In addition, pericardial effusion was detected. On day 231, the patient was transferred to the pediatric intensive care unit, where mechanical ventilation and inhaled nitric oxide (NO) were initiated. Thoracoscopic lung biopsy on day 244 revealed diffuse intra-alveolar hemorrhage and edema on hematoxylin-eosin (HE)-stained samples. Elastica van Gieson staining revealed diffuse obstructive lesions due to fibrocellular components with plump endothelial cells in the pre-septal pulmonary veins and venules. While pulmonary muscular arteries and arterioles showed mild medial hypertrophy and focal intimal thickening (Heath-Edwards Grade 2), severe stenosis with concentric intimal fibrosis or plexiform lesions was present. Based on these results, the patient was diagnosed with PVOD with mild pulmonary arterial/arteriolar lesions. Of note, HE staining also revealed enlarged type II pneumocytes with multinucleated and giant cell-like features, indicating the presence of prior lung injury that was likely attributable to his preceding viral infection.",
+    "summary": "A 4-year-old boy was diagnosed with metastatic neuroblastoma and underwent intensive chemotherapy, autologous HSCT, and allogeneic cord blood transplantation (CBT). He experienced PVOD on day 194 following CBT after displaying upper respiratory symptoms and positive RSV antigen test results approximately one month prior. Pathological examination of a lung biopsy specimen revealed lung injury suspected to be associated with viral infection in addition to PVOD-related findings, suggesting that RSV infection might have contributed to the onset of PVOD.",
+    "translated_fulltext": "一位患有 IV 期神经母细胞瘤的 4 岁男孩接受了四轮化疗，其中包括高剂量化疗，包括布苏藩和美法兰，随后进行了自体外周血干细胞移植，并补充了自体骨髓。在进行了包含替莫唑胺和伊立替康的额外八轮化疗后，患者病情稳定。之后，患者接受了准备性调理，包括氟达拉滨（150 毫克/平方米）、美法兰（140 毫克/平方米）以及 12 Gy 的全身照射，为后续的异基因造血干细胞移植做准备。为了预防移植物抗宿主病 (GVHD)，患者接受了他克莫司和短期甲氨蝶呤治疗。患者在移植后第 17 天开始植入。之后，他出现了 3 级的 GVHD，通过增加泼尼松剂量进行治疗，并在第 85 天出院。此外，患者还接受了质子束治疗（39.6 Gy），从移植后第 121 天到第 150 天，用于治疗右侧上纵隔肿瘤，该肿瘤在右肾上腺中仍有 I123-MIBG 积聚。\n\n在第 159 天，患者因出现咳痰症状来到我院就诊，在此之前，患者的身体状况良好，且未出现 GVHD 迹象。由于他的哥哥也出现了类似的感冒症状，因此进行了快速抗原检测，结果显示为阳性。他的呼吸道症状逐渐恶化，并在第 194 天再次来到我院就诊，出现呼吸困难和肋间凹陷。入院后，给予他 0.7-1.0 毫克/公斤的泼尼松，但未能改善他的呼吸状况。在第 231 天进行的胸部计算机断层扫描显示，双侧肺部出现浸润、磨玻璃样混浊和间隔增厚，以及右侧胸腔积液。超声心动图显示，三尖瓣反流峰值速度升高至 4.1 米/秒，心室内隔接近等压线，表明存在肺动脉高压 (PH)。此外，还检测到心包积液。在第 231 天，患者被转入儿科重症监护室，并开始进行机械通气和吸入一氧化氮 (NO) 治疗。在第 244 天进行经胸腔镜肺活检，结果显示，在苏木精-伊红 (HE) 染色样本中，肺泡内出现弥漫性出血和水肿。弹性凡吉森染色显示，由于纤维细胞成分和肥大的内皮细胞，在肺静脉和静脉的间隔前区域存在弥漫性阻塞性病变。虽然肺动脉和细动脉显示出轻度中层肥厚和局灶性内膜增厚（希斯-爱德华分级 2 级），但存在严重的狭窄，伴有同心性内膜纤维化或丛状病变。根据这些结果，患者被诊断为肺静脉闭塞性疾病 (PVOD)，并伴有轻度肺动脉/细动脉病变。值得注意的是，HE 染色还显示 II 型肺泡细胞增大，具有多核和巨细胞样特征，表明存在先前肺损伤，这很可能与他之前的病毒感染有关。",
+    "translated_summary": "一位四岁的男孩被诊断出患有转移性神经母细胞瘤，并接受了强化化疗、自体造血干细胞移植和异基因脐带血移植。在接受脐带血移植后约一个月，他出现了上呼吸道症状，呼吸道合胞病毒抗原检测结果呈阳性，并在移植后的第194天出现了肺血管闭塞性疾病（PVOD）。对肺部活检样本的病理检查显示，除了与PVOD相关的病理发现外，还存在疑似与病毒感染相关的肺部损伤，这表明呼吸道合胞病毒感染可能导致了PVOD的发生。"
+  },
+  {
+    "id": "multiclinsum_gs_en_160.txt",
+    "fulltext": "65-year-old male with no personal or family history of pathology of relevance. His condition began in 2020 with productive cough that intensified and was accompanied by shortness of breath with small to medium effort; as well as loss of 10 kg of weight in a period of 4 months. He went to a doctor who requested a chest X-ray that showed massive, multilocular right pleural effusion with right bronchial obstruction and mediastinal lymphadenopathy. A thoracocentesis was performed with a biopsy of the right lung and parietal pleura. The histopathological study reported an adeno-squamous carcinoma. His evolution was bad, which is why he was referred to our institution. On admission, a physical examination found him cachectic, with right pulmonary hypoventilation, 92% oxygen saturation and pneumokoccal dysfunction, with no evidence of systemic or haemodynamic compromise. A chest X-ray was performed that showed complete opacity of the right hemithorax, and a pleural catheter was placed with a serohematic flow. In the histopathological study of the revision material, the lung parenchyma was replaced by a poorly differentiated neoplasm with a solid mantle and syncytia, surrounded by abundant lymphocytes and plasma cells. The neoplastic cells had large, ovoid nuclei, fine chromatin, prominent nucleolus and wide, poorly defined cytoplasm. An immunohistochemical study was performed that was positive for CKAE1/AE3, CK 5/6, p63, EBER ISH, and negative for Napsina A, TTF-1 and CK 7, which ruled out the reference diagnosis of adeno-squamous carcinoma and established the diagnosis of CTLP. Molecular study in the paraffin block was positive for PD-L1 (SP263) +++ in approximately 100% of the neoplastic cells, and negative for EGFR, K-RAS, ALK, ROS1. In order to confirm the pulmonary origin of the neoplasm, a nasopharyngeal examination was performed that was negative. In April 2021, a PET-CT was performed that reported a heterogeneous parahilary pulmonary lesion that compromised the main bronchus and caused atelectasis; as well as multiple cervical, mediastinal and peri-gastric lymphadenopathies. The catheter was removed due to partial resolution of the effusion and chemotherapy treatment with gemcitabine/cisplatin was initiated. He received 6 cycles, however, the patient reported hearing loss and AKIN I acute renal failure was documented, so cisplatin was changed to carboplatin, and maintenance durvalumab was continued. In December 2021, disease progression was documented and he died in January 2022 due to respiratory failure.\n",
+    "summary": "We report the case of a 65-year-old man with a pulmonary lymphoepithelioma-like carcinoma, who presented with cough, dyspnea, and weight loss. A chest CT scan showed a poorly defined nodule located in the right lung. A trans-thoracic biopsy of the lesion was performed, and microscopic examination revealed large polygonal cells arranged in sheets, infiltrated by abundant lymphocytes and plasma cells, around the interstitium. The neoplastic cells were positive for cytokeratin 5/6 and p63, and negative for Napsina A and thyroid transcription factor 1 (TTF-1). PD-L1 expression was positive (approximately 100%) by immunohistochemistry; as was the nucleus of the neoplastic cells by in situ hybridization for Epstein-Barr virus-encoded RNA (EBER-ISH). The patient received six cycles of a combination chemotherapy regimen based on platinum (gemcitabine/cisplatin) plus durvalumab. He progressed and ultimately died 9 months after diagnosis.\n",
+    "translated_fulltext": "患者为 65 岁男性，既往无个人或家族病史。2020 年，患者出现咯痰性咳嗽，症状逐渐加重，并伴有轻度至中度活动后呼吸困难，同时在 4 个月内体重减轻了 10 公斤。患者就医后，医生建议进行胸部 X 光检查，结果显示右侧胸腔内有大量多房性积液，伴有右侧支气管阻塞和纵隔淋巴结肿大。随后进行了胸腔穿刺，并对右肺和壁层胸膜进行了活检。组织病理学检查结果显示为腺鳞癌。患者病情恶化，因此被转诊至我院。入院时，体格检查显示患者消瘦，右肺通气不足，氧饱和度为 92%，并存在肺炎链球菌感染，但未见全身或血液动力学功能障碍。胸部 X 光检查显示右侧胸腔完全不透光，并放置了胸腔引流管，引流出血性液体。对活检标本进行组织病理学复查，结果显示肺实质被结构不良的肿瘤取代，肿瘤具有致密的包膜和合胞体，周围环绕着大量的淋巴细胞和浆细胞。肿瘤细胞具有大的卵圆形细胞核、细小的染色质、明显的核仁以及宽大且界限不清的细胞质。进行了免疫组织化学检查，结果显示 CKAE1/AE3、CK 5/6、p63、EBER ISH 呈阳性，而 Napsina A、TTF-1 和 CK 7 呈阴性，从而排除了腺鳞癌的诊断，并确诊为原发性胸膜间皮瘤（CTLP）。对石蜡块进行分子学研究，结果显示 PD-L1 (SP263) 在约 100% 的肿瘤细胞中呈 +++ 阳性，而 EGFR、K-RAS、ALK、ROS1 呈阴性。为了确认肿瘤的肺部起源，进行了鼻咽部检查，结果为阴性。2021 年 4 月，进行了 PET-CT 检查，结果显示在肺门周围存在异质性肺部病灶，该病灶侵犯了主支气管，并导致肺不张；此外，还存在多处颈部、纵隔和胃周淋巴结肿大。由于胸腔积液部分消退，因此拔除了引流管，并开始使用吉西他滨/顺铂进行化疗。患者接受了 6 个疗程的化疗，但随后出现听力下降，并记录到 AKIN I 级急性肾功能衰竭，因此将顺铂更换为卡铂，并继续进行度伐利尤单抗的维持治疗。2021 年 12 月，记录到疾病进展，患者于 2022 年 1 月因呼吸衰竭去世。",
+    "translated_summary": "我们报告了一例65岁男性患者的病例，该患者患有肺部淋巴上皮样癌，主要表现为咳嗽、呼吸困难和体重减轻。胸部CT扫描显示，右肺内有一个界限不清的结节。对该病灶进行了经胸穿刺活检，显微镜检查显示，大量多边形细胞呈片状排列，周围间质中浸润着大量的淋巴细胞和浆细胞。肿瘤细胞对细胞角蛋白5/6和p63呈阳性，对Napsina A和甲状腺转录因子1（TTF-1）呈阴性。通过免疫组织化学检测，PD-L1表达呈阳性（约100%）；通过原位杂交检测，肿瘤细胞的细胞核对EB病毒编码RNA（EBER-ISH）也呈阳性。该患者接受了六个疗程的铂类药物（吉西他滨/顺铂）联合度伐利单抗的联合化疗方案。病情恶化，最终在诊断后9个月去世。"
+  },
+  {
+    "id": "multiclinsum_gs_en_436.txt",
+    "fulltext": "A 13-year-old male patient was admitted to the Children’s Hospital in Damascus after noticing a palpable enlarged mass in the left inguinal region. His medical history was unremarkable except for a surgical intervention on his spine 6 years ago due to an accident, which resulted in the loss of motor function and sensation in both of his lower extremities.\n\nDue to the long period he had spent in bed, the patient developed decubitus sores on his left foot. The only finding on clinical examination was a mass in the left inguinal area, which was movable on deep structures and so was the overlaying skin on it. The mass was not tender on palpation, and no signs of local inflammation were observed.\n\nLaboratory tests revealed an Elevated ESR (119 mm/h in the first hour). Other Basic Laboratory tests including (Complete Blood Count, Liver function tests, electrolytes, Urea, Creatinine and LDH) were ordered and were within normal ranges for age. Ordering these tests was essential to rule out systemic diseases. Given the absence of indicative physical findings for systemic disorders or immunodeficiencies, additional tests like those for HIV or Direct Antiglobulin were deemed unnecessary.\n\nA CT of the abdomen, chest, and pelvis showed enlarged lymph nodes inferior to the inguinal ligament, with the largest measuring approximately (3.5 × 2.4 cm). Other organs and nodes were within normal limits.\n\nAll of the above-mentioned investigations were essential to rule other high-risk diagnosis including lymphoma and leukemia. However, these were not sufficient to reach the definite diagnosis, so a decision of surgical resection of the nodes was taken.\n\nTo confirm the diagnoses and exclude other potential differentials presenting with enlarged lymph nodes, surgical removal of all of these enlarged nodes was performed under general anesthesia, and biopsies were sent for microscopic study.\n\nThe biopsy showed hyperplastic nodal architecture with proliferation of histiocytes and plasma cells with vascular proliferation, consistent with Plasma cell subtype of Castleman’s Disease.\n\nThe patient was discharged from the hospital after 14-day period after ensuring that there were no remaining enlarged lymph nodes. The only recommendation was oral prednisolone. The patient underwent follow-up using a whole-body CT scan every three months. During each hospital visit, a comprehensive clinical examination and laboratory tests (e.g. Complete Blood Test, ESR, C-reactive protein, liver function tests, renal function tests) were performed in addition to the CT scan. After a 12-month follow-up period, the patient reported no new symptoms or enlarged lymph nodes. Additionally, no abnormalities were observed during clinical examination or in laboratory tests.",
+    "summary": "We report a unique case of a 13-year-old boy who presented with a palpable enlarged mass in the left inguinal region without any constitutional symptoms. Surgical removal of this mass was essential to exclude worrying causes. Pathologic examination revealed proliferative changes consistent with Castleman's disease plasma cell type which is one of the rarest forms of the disease in children. To our knowledge, this case is the first reported case of Unicentric Castleman Disease (UCD) in the inguinal area. During a 12-month-period of follow-up, no additional lymph node enlargements or other symptoms were reported.",
+    "translated_fulltext": "一名13岁的男性患者因发现左侧腹股沟区域有可触及的肿块而入院，接受治疗。他的病史并无特别之处，除了六年前因一次事故进行了脊柱手术，导致双下肢的运动功能和感觉丧失。\n\n由于长期卧床，患者左脚出现褥疮。临床检查中，仅发现左侧腹股沟区域有肿块，该肿块在深层组织中可移动，表面的皮肤也可移动。触诊时肿块无压痛，未观察到局部炎症的迹象。\n\n实验室检查显示，红细胞沉降率（ESR）升高（第一小时为119毫米/小时）。其他基本实验室检查，包括全血细胞计数、肝功能检查、电解质、尿素、肌酐和乳酸脱氢酶（LDH），结果均在年龄正常范围内。进行这些检查对于排除全身性疾病至关重要。鉴于缺乏提示全身性疾病或免疫缺陷的体格检查结果，因此认为进行HIV或直接抗球蛋白等额外检查没有必要。\n\n腹部、胸部和盆腔的CT扫描显示，腹股沟韧带下方的淋巴结增大，其中最大的约为（3.5×2.4厘米）。其他器官和淋巴结均在正常范围内。\n\n上述所有检查对于排除其他高危诊断，包括淋巴瘤和白血病，至关重要。然而，这些检查不足以得出明确的诊断，因此决定进行淋巴结的手术切除。\n\n为了确诊并排除其他可能表现为淋巴结肿大的潜在疾病，在全身麻醉下，对所有这些肿大的淋巴结进行了手术切除，并将切除的组织送去进行显微镜检查。\n\n活检结果显示，淋巴结结构增生，组织细胞和浆细胞增殖，血管增生，与卡斯尔曼病浆细胞亚型相符。\n\n在确保没有残留的肿大淋巴结后，患者在住院14天后出院。唯一的建议是口服泼尼松。患者每三个月进行一次全身CT扫描，以进行随访。每次就诊时，除了CT扫描外，还会进行全面的临床检查和实验室检查（例如，全血细胞计数、ESR、C反应蛋白、肝功能检查、肾功能检查）。在为期12个月的随访期间，患者报告没有新的症状或淋巴结肿大。此外，临床检查和实验室检查中均未发现异常。",
+    "translated_summary": "我们报告了一例罕见的病例，患者是一名13岁的男孩，他发现左侧腹股沟区域有一个可触及的肿块，但没有其他全身症状。为了排除潜在的严重病因，必须进行手术切除该肿块。病理检查显示，该肿块存在增生性改变，与卡斯尔曼病浆细胞型相符，而这种类型是儿童中极为罕见的卡斯尔曼病类型之一。据我们所知，这是首例报告的发生在腹股沟区域的单中心型卡斯尔曼病（UCD）病例。在随访的12个月内，未发现其他淋巴结肿大或其他症状。"
+  },
+  {
+    "id": "multiclinsum_gs_en_116.txt",
+    "fulltext": "The medical records of patients with a diagnosis of congenital myotonia studied and followed in the pediatric neurology consultation in a third-level hospital between 2015 and 2020 were reviewed. The inclusion criteria were to present a clinical diagnosis – myotonia, warm-up phenomenon, characteristic electromyographic pattern and/or family history – and/or a molecular diagnosis (mutation in the CLCN1 gene). The clinical signs and symptoms, as well as the results of the complementary explorations and the genetic mutation found, were collected by reviewing the medical record. Demographic variables (age and sex), course of the disease (age of onset, symptoms and signs, time elapsed until diagnosis and clinical evolution), family history and evaluation of the response to treatment were collected.\n\nFive cases with clinical diagnosis of congenital myotonia were identified (three with Becker's disease and two with Thomsen's disease). The incidence in relation to the number of births was estimated at 1:15,000 newborns for cases with Becker's phenotype and 1:21,000 newborns for Thomsen's phenotypes.\n\nMost of our patients were female, and the male was the only one who started before the age of six. The initial clinical presentation included myotonia in the lower limbs in four of the five patients and in the upper limbs in all but one. The age at onset ranged from 22 months to 12 years, with a median of 6 years. Genetic diagnosis was performed in all cases approximately two years after onset, and the family of one patient refused to have it performed. All had a worsening with cold, but the warming phenomenon was only in those with the Becker phenotype.\n\nPatients with recessive congenital myotonia showed some progression. As a family history, it is worth noting that patients 2 and 3 were sisters, without the parents showing any clinical signs, and that the mother of patient 1 showed mild clinical signs that were doubtful with the cold. The patient who refused the study had a history of myotonia in the maternal branch.\n\nBlood tests did not show elevated creatine kinase in any of the patients. The electromyogram was abnormal in all patients except the first one at 2.8/12 years of age. The test was not repeated later because it was not considered necessary.\n\nThe most used treatment initially was oxcarbazepine (in patients with recessive form), with a good response in general. In case 2 it lost efficacy with time and mexiletine was initiated. Patient 4 initiated several drugs without success due to loss of efficacy or side effects. Patient 5 rejected treatment due to mild clinical presentation.\n\nPatient 1 had a previously undescribed, likely pathogenic mutation (CLCN1: c.824T>C) inherited from his mother. Cases 1 to 3 had the Becker phenotype with composite heterozygosity mutations, and cases 4 and 5 had the Thomsen phenotype. Case 5 declined genetic testing.\n",
+    "summary": "The medical records of patients with a diagnosis of congenital myotonia studied and followed in the pediatric neurology consultation in a third-level hospital between 2015 and 2020 were reviewed. Demographic variables (age and sex), course of the disease (age of onset, symptoms and signs, time elapsed until diagnosis and clinical evolution), family history and evaluation of the response to treatment were collected. Five cases with a clinical diagnosis of congenital myotonia were identified (three with Becker disease and two with Thomsen disease). The incidence in relation to the number of births was estimated at 1:15,000 newborns for cases with a Becker phenotype and 1:21,000 newborns for Thomsen phenotypes. We found a probably pathogenic mutation not previously described (CLCN1: c.824T>C).\n",
+    "translated_fulltext": "回顾性分析了2015年至2020年期间，某三级医院儿科神经科门诊中，经诊断为先天性肌强直症的患者的病历资料。纳入标准为：临床诊断（肌强直症、热身现象、特征性肌电图表现和/或家族史）和/或分子诊断（CLCN1基因突变）。通过查阅病历，收集了患者的临床体征和症状，以及辅助检查结果和发现的基因突变。收集了人口学变量（年龄和性别）、疾病病程（发病年龄、症状和体征、确诊时间以及临床进展）、家族史以及对治疗的反应评估。\n\n共识别出5例临床诊断为先天性肌强直症的病例（3例为贝克氏病，2例为汤姆森氏病）。根据出生人数估算，贝克氏表型病例的发生率为1/15,000，汤姆森氏表型病例的发生率为1/21,000。\n\n大多数患者为女性，唯一的男性患者在6岁之前发病。最初的临床表现包括：5例患者中有4例出现下肢肌强直，其余患者均出现上肢肌强直。发病年龄在22个月至12岁之间，中位数为6岁。所有病例均在发病后约两年进行了基因诊断，但有一位患者的家属拒绝进行基因诊断。所有患者在寒冷环境下病情加重，但热身现象仅出现在贝克氏表型患者中。\n\n患有隐性先天性肌强直症的患者病情有所进展。值得注意的是，患者2和患者3是姐妹，父母均未出现任何临床症状；患者1的母亲出现轻微的临床症状，但在寒冷环境下症状不明显。拒绝进行检查的患者，其母系家族中存在肌强直症病史。\n\n所有患者的血液检查均未显示肌酸激酶升高。除第一例患者（2.8岁/12岁时）外，所有患者的肌电图均显示异常。由于认为没有必要，因此没有重复进行该检查。\n\n最初最常用的治疗方法是奥卡巴嗪（用于隐性型患者），总体效果良好。在第二例患者中，随着时间的推移，奥卡巴嗪的疗效降低，因此开始使用美西拉嗪。第四例患者尝试了多种药物，但均未成功，原因是疗效降低或出现副作用。第五例患者由于临床症状轻微，拒绝接受治疗。\n\n第一例患者携带了一种先前未描述的、可能具有致病性的突变（CLCN1: c.824T>C），该突变是从其母亲那里遗传的。1至3例患者为贝克氏表型，具有复合杂合子突变；4和5例患者为汤姆森氏表型。第五例患者拒绝进行基因检测。",
+    "translated_summary": "回顾性分析了2015年至2020年期间，某三级医院儿科神经科门诊中，经诊断为先天性肌强直症的患者的病历资料。收集了患者的人口学变量（年龄和性别）、疾病病程（发病年龄、症状和体征、确诊时间以及临床进展）、家族史以及对治疗的反应评估。共识别出5例临床诊断为先天性肌强直症的病例（其中3例为贝克氏病，2例为汤姆森氏病）。根据出生人数估算，贝克氏表型病例的发生率为1/15,000，汤姆森氏表型病例的发生率为1/21,000。我们发现了一种可能具有致病性的、此前未被描述过的突变（CLCN1: c.824T>C）。"
+  },
+  {
+    "id": "multiclinsum_gs_en_322.txt",
+    "fulltext": "A 67-year-old female patient presented with a six-year history of recurrent swelling in the left lower limb. One year prior, she was diagnosed with an AVM in the lower limb at another hospital. Two months before hospitalization, the patient underwent embolization treatment, which included the placement of two coils (20 mm x 40 cm, BSX, USA). Despite this intervention, the patient’s left lower limb swelling did not show any improvement. The patient has been experiencing fatigue and difficulty of breathing for a month. As these symptoms of heart failure progressed and worsened, the patient was transferred to Chengdu University of Traditional Chinese Medicine Hospital for further evaluation and treatment. The patient had no prior history of cardiovascular diseases, injuries, or surgeries. However, she reported a history of oral estrogen use for menopausal syndrome seven years ago.\n\nShe exhibited significant edema and skin sclerosis in the left lower limb. Additionally, absent pulses were observed in the popliteal artery and distal regions. A noticeable tremor was also present in the left thigh. The patient was seated during the examination. Echocardiography revealed cardiac enlargement, along with moderate mitral regurgitation and severe tricuspid regurgitation. The left ventricular ejection fraction (EF) was measured at 60%, and there was an elevation in b-type natriuretic peptide (BNP) levels to 2853 ng/L. The electrocardiogram showed a sinus rhythm with a heart rate of 105 beats per minute and evidence of left atrial enlargement. Chest CT scans confirmed cardiac enlargement, while no respiratory system abnormalities were detected. Preoperative computed tomography angiography (CTA) provided further insights, revealing a left iliac artery aneurysm, a significantly enlarged femoral artery, and complex AVMs in the superficial femoral artery. Additionally, the femoral and superficial veins appeared significantly enlarged on arterial phase imaging. Notably, the left lower limb popliteal artery and anterior tibial artery were not visualized. Based on these findings, the patient was diagnosed with complex congenital lower limb AVMs, acute exacerbation of chronic heart failure, and classified as NYHA Class IV.\n\nThe patient exhibits distinct symptoms of acute heart failure, and preoperative ultrasound assessment has revealed a volume flow of 3400 ml/min in the CFA. Given that embolization using coils may not effectively reduce the flow rate of the AVMs, the utilization of covered stents is a viable option. These stents effectively decrease the flow of lower limb AVMs, thereby improving the patient’s heart failure condition. Additionally, staged embolization treatment can further enhance the treatment outcome by improving the nidus of the lower limb AVMs.\n\nCTA of the patient revealed significant dilatation of blood vessels, with a maximum diameter of 32 mm for the iliac artery, 27 mm for the common femoral artery (CFA), and 22 mm for the superficial femoral artery (SFA). To minimize access site complications, antegrade access was achieved through a surgical approach of the CFA. Under general anesthesia, intravascular covered stents were inserted through an open femoral artery approach, utilizing 14 F (Cook Medical, USA) catheter sheaths intraoperatively. complex AVMs were visualized in the superficial femoral artery and profunda femoris artery, accompanied by early visualization of an enlarged femoral vein.\n\nPreoperative CTA measurements indicated a diameter of 19 mm for the middle segment of the SFA, leading to the selection of a 20 mm–12 mm/120 mm aorto-uni-iliac covered stent (MicroPort, China). A 0.035 guidewire, in conjunction with a single-curve catheter, was used to access the popliteal artery. Subsequently, it was replaced with a 0.035 super-hard guidewire to provide support during the implantation of the stent graft. The stent was deployed precisely at the distal end of the superficial femoral artery, the location with the highest concentration of AVMs. Completion angiography revealed a significant reduction in venous opacification around the stent and clear visualization of the popliteal artery. Postoperatively, the left femoral artery was sutured using a 6 − 0 vascular risk suture, resulting in a significant improvement in the patient’s heart failure symptoms. The patient has heart failure, so the surgery duration should not be excessive. It is planned to perform embolization treatment in the second phase.\n\nOne week post-treatment, ultrasound examination revealed a reduction in volume flow to 1600 ml/min in the CFA, with a BNP level of 1198ug/l. Targeting the nidus with embolization therapy is expected to further decrease the flow velocity of arteriovenous malformations. The right CFA was punctured, allowing the insertion of a 5 F arterial sheath and a 5 F catheter for angiographic examination. Guided by ultrasound, the drainage vein of the AVM was punctured, and a 5 F vascular sheath was introduced. The contrast agent confirmed the presence of a nidus and its draining veins. The embolization procedure of the draining veins involved the use of a coil (18–20 mm x 40 cm, BSX, USA), two microcoils (4 mm x 42 mm, 5 mm x 10 mm, USA), 3% polidocanol (6 mL Kruelle, Germany), and 99% anhydrous ethanol (10 mL).\n\nCompletion angiography showed a significant reduction in the visualization of AVMs and draining veins, indicating their disappearance. During the one-year follow-up, the patient exhibited notable improvement in lower limb swelling and cardiac function. The volume flow in the CFA decreased to 780 ml/min. Echocardiography revealed minor enlargement of the left and right atria, slight mitral and tricuspid regurgitation, and a left ventricular ejection fraction (EF) of 71%. Notably, BNP levels decreased significantly.",
+    "summary": "We present a case involving a patient with congenital AVMs in the lower limb, who had suffered from prolonged swelling in the left lower limb and recently developed symptoms of heart failure. At the age of 67, the patient was definitively diagnosed with a complex congenital AVMs in the lower limb. This article delves into the practical experiences and limitations encountered in employing an abdominal aortic stent graft, coupled with embolization, to address acute heart failure caused by complex congenital AVMs in the lower limb.",
+    "translated_fulltext": "一位 67 岁的女性患者，主诉左下肢反复肿胀，病史长达六年。一年前，她在另一家医院被诊断出患有下肢动静脉畸形 (AVM)。在住院前两个月，患者接受了栓塞治疗，包括放置两个弹簧圈（20 毫米 x 40 厘米，BSX，美国）。尽管进行了上述干预，但患者左下肢的肿胀并未得到改善。患者已经出现疲劳和呼吸困难，持续了一个月。随着这些心力衰竭症状的进展和恶化，患者被转至成都中医药大学附属医院，以进行进一步的评估和治疗。患者既往没有心血管疾病、外伤或手术史。然而，她表示七年前曾因更年期综合征服用过口服雌激素。\n\n患者左下肢出现明显的浮肿和皮肤硬化。此外，在腘动脉和远端区域观察到搏动消失。左大腿也出现明显的震颤。检查时，患者处于坐位。超声心动图显示心脏扩大，伴有中度二尖瓣反流和严重三尖瓣反流。左心室射血分数 (EF) 测量值为 60%，B 型利钠肽 (BNP) 水平升高至 2853 ng/L。心电图显示窦性心律，心率为每分钟 105 次，并显示左心房扩大。胸部 CT 扫描证实心脏扩大，但未发现呼吸系统异常。术前计算机断层血管造影 (CTA) 提供了更多信息，显示左髂动脉瘤、明显扩大的股动脉以及浅股动脉中的复杂 AVM。此外，在动脉期成像中，股动脉和浅静脉也显示出明显扩大。值得注意的是，左下肢的腘动脉和胫前动脉未显示。根据这些发现，患者被诊断为患有复杂的先天性下肢 AVM，并伴有慢性心力衰竭的急性加重，并被归类为 NYHA III 级。\n\n患者表现出明显的心力衰竭症状，术前超声评估显示股总动脉 (CFA) 的血流量为 3400 毫升/分钟。考虑到使用弹簧圈进行栓塞可能无法有效降低 AVM 的血流量，因此使用覆膜支架是一种可行的选择。这些支架有效地降低了下肢 AVM 的血流量，从而改善了患者的心力衰竭状况。此外，分阶段的栓塞治疗可以通过改善下肢 AVM 的病灶来进一步提高治疗效果。\n\n患者的 CTA 显示血管明显扩张，髂动脉最大直径为 32 毫米，股总动脉 (CFA) 为 27 毫米，浅股动脉 (SFA) 为 22 毫米。为了尽量减少穿刺部位的并发症，通过 CFA 的外科入路实现了顺向穿刺。在全身麻醉下，通过开放的股动脉入路插入了血管内覆膜支架，术中使用了 14 F（库克医疗，美国）导管鞘。在浅股动脉和深股动脉中观察到复杂的 AVM，并伴有扩大的股静脉的早期显影。\n\n术前 CTA 测量显示 SFA 中段的直径为 19 毫米，因此选择了 20 毫米–12 毫米/120 毫米的腹主动脉-单髂动脉覆膜支架（美迪克，中国）。使用 0.035 导丝，并结合单曲线导管，对腘动脉进行穿刺。随后，将其替换为 0.035 超硬导丝，以在支架移植物植入过程中提供支撑。支架被精确地植入在浅股动脉的远端，该部位是 AVM 浓度最高的部位。完成血管造影显示支架周围的静脉造影显着减少，并且可以清楚地看到腘动脉。术后，使用 6-0 血管缝线缝合左股动脉，从而显着改善了患者的心力衰竭症状。患者患有心力衰竭，因此手术时间不宜过长。计划在第二阶段进行栓塞治疗。\n\n治疗后一周，超声检查显示 CFA 的血流量减少到 1600 毫升/分钟，BNP 水平为 1198 ug/l。通过栓塞治疗靶向病灶，预计可以进一步降低动静脉畸形的血流速度。对右 CFA 进行穿刺，插入 5 F 动脉鞘和 5 F 导管，进行血管造影检查。在超声的引导下，对 AVM 的引",
+    "translated_summary": "本文介绍了一例患者，该患者患有先天性下肢动静脉畸形，长期出现左下肢肿胀，并最近出现了心力衰竭的症状。该患者现年 67 岁，最终被确诊为患有复杂的先天性下肢动静脉畸形。本文深入探讨了在治疗由复杂先天性下肢动静脉畸形引起的心力衰竭时，采用腹主动脉支架植入术并结合栓塞术所遇到的实际经验和局限性。"
+  },
+  {
+    "id": "multiclinsum_gs_en_384.txt",
+    "fulltext": "28-year-old male patient with no significant history presented to the dermatology department with a 48-hour history of a skin condition characterized by two erythematous plaques with central vesicles and superficial ulceration located on the flexor surface of the right arm and forearm equidistant from the elbow crease, accompanied by a burning sensation and pruritus at the site of the lesions. He did not have systemic symptoms or self-medicate. As a background, he reported that he was on vacation in the coastal region of Ecuador at the time of the lesions. An incisional biopsy was performed that reported epidermis with acanthosis, parakeratosis and spongiosis, neutrophils in the stratum corneum and perivascular lymphocyte infiltration in the superficial, middle and deep dermis. Based on the clinical characteristics, the background of travel to a tropical region and the histological findings, a diagnosis of Paederus dermatitis was made. Treatment with antihistamines, topical steroids and cold compresses was indicated. After 8 days of treatment, the lesions resolved, leaving a post-inflammatory hyperpigmentation.\n",
+    "summary": "The case of a 28-year-old male patient who presented to the dermatology department with a 48-hour history of two erythematous plaques with central vesicles and superficial ulceration located on the flexor surface of the right arm and forearm, accompanied by a burning sensation and pruritus at the site of the lesions, without accompanying symptoms, is reported. As a background, he stated that he was on vacation in the coastal region of Ecuador at the time of the lesions. An incisional biopsy was performed and, due to the clinical characteristics and the background of travel to a tropical region, the diagnosis was made as dermatitis by Paederus and treatment with antihistamines, topical steroids and cold compresses was indicated. After 8 days of treatment, the lesions subsided, leaving a post-inflammatory hyperpigmentation.\n",
+    "translated_fulltext": "一位28岁的男性患者，既往病史不明显，因出现持续48小时的皮肤问题而就诊于皮肤科。该皮肤问题表现为：在右臂和前臂的屈侧表面，肘部皱褶处等距离的位置出现两块红斑样斑块，斑块中央有水疱，表面有浅表溃疡，伴有灼烧感和瘙痒。患者没有全身症状，也没有自行用药。他表示，在出现皮损时，他正在厄瓜多尔的沿海地区度假。进行了切取活检，结果显示表皮有棘状增生、角化不全和海绵状水肿，角质层中有中性粒细胞，浅层、中层和深层真皮中有血管周围淋巴细胞浸润。根据临床特征、旅行史（前往热带地区）和组织病理学结果，诊断为蝽蟓性皮炎。建议使用抗组胺药、外用类固醇和冷敷进行治疗。治疗8天后，皮损消退，仅留下炎症后色素沉着。",
+    "translated_summary": "本文报道了一例28岁男性患者，该患者因出现持续48小时的皮疹而就诊于皮肤科。皮疹表现为位于右臂和前臂屈侧的两个红斑斑块，伴有中央水疱和表浅溃疡，同时伴有灼烧感和瘙痒，但没有其他伴随症状。患者自述，皮疹出现时，他正在厄瓜多尔沿海地区度假。进行了切取活检，考虑到临床特征以及患者有去热带地区旅行的病史，诊断为由Paederus昆虫引起的皮炎，并建议使用抗组胺药、外用类固醇和冷敷进行治疗。治疗8天后，皮疹消退，仅留下炎症后色素沉着。"
+  },
+  {
+    "id": "multiclinsum_gs_en_268.txt",
+    "fulltext": "Technique\nInformation about the procedure of TFD.\nThe patient receives intravenous photosensitizer (Photogen®, King of Prussia, PA, USA - 1.5 mg/kg) 24 h before the procedure. Its peak light absorption is at the wavelength of 630 nm. The procedure begins with standard duodenoscopy (Olympus TJF-180) under general anesthesia. After the identification of the greater duodenal papilla and the retrograde cannulation, the digital cholangioscope (SpyGlassTM DS, Boston Scientific, Natick, MA) is introduced into the common bile duct. Then the cholangioscopic examination helps to identify the neoplastic stenosis. Under direct visualization, the illumination catheter (Medlight S.A., RD10-323, Switzerland) is advanced through the cholangioscope. This consists of a typical three-way cannula. The first port has a 1 cm long cylindrical light diffuser at the end. Two black radiopaque marks demarcate the limits of the diffuser. The second port accommodates a 0.025 inch guidewire and the third is a portal for injection. After positioning under cholangioscopic guidance, illumination is initiated. The dose is 90 J/cm², with a power of 70 mW/cm². Repositioning is recommended every centimeter to cover the entire stenosed area. At the end of the procedure, new cholangioscopy evaluates the bile duct for immediate outcome and adverse events.\n\nPost-procedure care\nThe patient is fasted for the next 24 h. If no adverse event is detected, oral diet is initiated. Discharge from hospital is done under strict guidance on photoprotection (prevention of exposure to light and use of sunglasses), especially during the first week after the session of TFD.\n\nRESULTS\nThis procedure was performed in an 82-year-old man who presented to our tertiary center with obstructive jaundice and weight loss over the previous two months. Endoscopic ultrasound (EUS) revealed severe dilation of the common bile duct associated with choledocholithiasis. ERCP confirmed these findings but was unable to remove the stones due to the disproportionate dilation of the common bile duct. Therefore, a plastic biliary stent was chosen. The patient showed improvement in his clinical condition, but the cholestasis returned 45 days after the first procedure. Two other ERCPs failed to remove the stones. During the third procedure, a long irregular stenosis of the common hepatic duct was apparent and he was referred for another echoendoscopic evaluation.\n\nIn addition to the choledocholithiasis, the new EUS revealed a dilated common hepatic duct with a well-circumscribed hypoechoic solid mass measuring 1.8x2 cm, which was compressing the common hepatic duct. The mass appeared to also involve the common hepatic artery. An ultrasound-guided needle biopsy confirmed the diagnosis of moderately differentiated cholangiocarcinoma (Bismuth I).\n\nAfter staging, the mass was considered inoperable and the patient was referred for palliative treatment. After a multidisciplinary meeting with the oncology team, adjunctive PDT was proposed to treat the recurrent biliary obstruction. The procedure went without complications and lasted 150 minutes. At the end, a biliary drainage was performed with a 10 Fr plastic stent, since a self-expanding metal stent was not available at that time.\n\nThe patient showed no signs or symptoms of photosensitivity in the following week. There was, however, early recurrence of cholestasis complicated with cholangitis. ERCP revealed obstruction of the stent with debris and biliary sludge secondary to tumor necrosis. A biliary scan followed by new drainage resolved the patient's acute condition. Subsequently, he remained asymptomatic for three months, the longest period since the onset of the disease. At his next recurrence, he was drained with a self-expanding metal stent. He continued with systemic treatment and eventually required a duodenal stent for palliation of dysphagia. He died due to complications of pulmonary metastases two years after the onset of symptoms and 15 months after the session of TFD.\n",
+    "summary": "Patient receives intravenous photosensitizer 24 h before the procedure which begins with regular duodenoscopy. After identification of the main papilla and retrograde cannulation, the digital cholangioscope is introduced into the common bile duct. Then the cholangioscopic examination helps to identify neoplastic stenosis. Under direct visualization, the illumination catheter is advanced through the cholangioscope. Repositioning is done every centimeter. At the end of cholangioscopy, the bile duct is evaluated for immediate outcome and adverse events.\n\nResult: This procedure was performed in an 82-year-old man with obstructive jaundice for the past two months. EUS and ERCP revealed severe dilation of the common bile duct associated with choledocholithiasis. In addition, there was dilation of the hepatic duct to a well-circumscribed hypoechoic solid mass measuring 1.8x2 cm, compressing the common hepatic duct. It was considered inoperable and the patient was referred for palliative treatment with PDT, which remained asymptomatic for three months. He died of complications 15 months after the PDT session.\n",
+    "translated_fulltext": "技术\n关于光动力疗法（TFD）的流程信息。\n\n患者在手术前24小时静脉注射光敏剂（Photogen®，美国宾夕法尼亚州金斯普鲁斯，1.5毫克/公斤）。其峰值光吸收波长为630纳米。手术从标准十二指肠镜检查（奥林巴斯TJF-180）开始，并在全身麻醉下进行。在确定十二指肠大乳头并进行逆行插管后，将数字胆管镜（SpyGlassTM DS，波士顿科学公司，马萨诸塞州纳蒂克）插入到总胆管中。然后，通过胆管镜检查来帮助确定肿瘤性狭窄。在直接观察下，将光照导管（Medlight S.A.，RD10-323，瑞士）通过胆管镜推进。该导管由一个典型的三通套管组成。第一个端口的末端有一个1厘米长的圆柱形光扩散器。两个黑色不透光的标记标示出扩散器的范围。第二个端口用于放置0.025英寸的导丝，第三个端口是注射通道。在胆管镜引导下进行定位后，开始进行光照。剂量为90焦耳/平方厘米，功率为70毫瓦/平方厘米。建议每隔一厘米重新定位，以覆盖整个狭窄区域。在手术结束时，进行新的胆管镜检查，以评估胆管的即时效果和不良事件。\n\n术后护理\n患者在接下来的24小时内禁食。如果没有发现任何不良事件，则开始进行口服饮食。患者在严格的光保护指导下出院（防止暴露在光线下，并使用太阳镜），尤其是在TFD治疗后的第一周。\n\n结果\n该手术在一个82岁的男性患者身上进行，该患者因过去两个月出现梗阻性黄疸和体重减轻而来到我们的三级中心。内镜超声（EUS）显示总胆管严重扩张，并伴有胆总管结石。ERCP证实了这些发现，但由于总胆管不成比例的扩张，无法取出结石。因此，选择了一个塑料胆管支架。患者的临床状况有所改善，但在第一次手术后45天，胆汁淤积再次出现。另外两次ERCP手术未能取出结石。在第三次手术中，发现总肝管存在长而不规则的狭窄，并将患者转诊进行另一次超声内镜检查。\n\n除了胆总管结石外，新的EUS还显示总肝管扩张，并伴有一个边界清晰的低回声实性肿块，大小为1.8x2厘米，该肿块正在压迫总肝管。该肿块似乎也累及了总肝动脉。超声引导下的针刺活检证实了中度分化的胆管癌（Bismuth I）。\n\n分期后，该肿块被认为无法手术切除，并将患者转诊进行姑息治疗。在与肿瘤科团队进行多学科会议后，建议采用辅助光动力疗法来治疗复发性胆道梗阻。手术顺利进行，持续了150分钟。在手术结束时，使用10 Fr塑料支架进行胆道引流，因为当时没有可用的自扩张金属支架。\n\n在接下来的一个星期里，患者没有表现出任何光敏感的迹象或症状。然而，出现了早期胆汁淤积复发，并伴有胆管炎。ERCP显示支架被碎屑和胆汁淤积物阻塞，这是由于肿瘤坏死所致。随后进行胆道扫描并进行新的引流，以解决患者的急性症状。此后，患者在三个月内没有症状，这是自疾病发病以来持续时间最长的一段时间。在下一次复发时，使用自扩张金属支架进行引流。他继续接受全身治疗，并最终需要使用十二指肠支架来缓解吞咽困难。在症状出现两年后和TFD治疗15个月后，由于肺部转移的并发症，患者去世。",
+    "translated_summary": "患者在手术前24小时接受静脉注射光敏剂，手术以常规十二指肠镜检查开始。在确定主乳头并进行逆行导管插入术后，将数字胆管镜插入到总胆管中。然后，通过胆管镜检查来帮助识别肿瘤性狭窄。在直接观察下，将光照导管通过胆管镜推进。每隔一厘米进行一次调整。在胆管镜检查结束时，评估胆管以了解即时效果和不良事件。\n\n结果：该手术在一名82岁男性患者身上进行，该患者在过去两个月里患有梗阻性黄疸。内镜超声和内镜逆行胰胆管造影术显示，总胆管严重扩张，并伴有胆总管结石。此外，肝管也扩张，形成一个边界清晰、低回声的实性肿块，大小为1.8×2厘米，压迫了总肝管。经评估后，认为该患者不适合手术，因此转诊至进行姑息性光动力疗法，患者在治疗后三个月内没有出现任何症状。在光动力疗法后15个月，患者因并发症去世。"
+  },
+  {
+    "id": "multiclinsum_gs_en_201.txt",
+    "fulltext": "A 77-year-old woman with haematemesis presented to the emergency room. Her medical history included only hypertension and dyslipidaemia. When she presented to the emergency room, her vital signs indicated shock (heart rate: 100 beats/min, blood pressure: 79/56 mmHg), and blood tests revealed anaemia (haemoglobin: 9.6 g/dL), which suggested upper gastrointestinal bleeding.\n\nNon-contrast-enhanced CT was performed immediately because of renal dysfunction. CT revealed that the third part of the duodenum flexed steeply on the right side of the aorta and ran caudally, without crossing anterior to the aorta. The jejunum was located on the patient’s right side. The second part of the duodenum and the stomach were dilated, and there were high-density gastric contents that were considered to indicate a haematoma.\n\nUpper gastrointestinal endoscopy was performed following the CT examination, which revealed a mucosal laceration at the gastric cardia. Bleeding from lacerations of the cardia of the stomach as a result of forceful vomiting was first reported by Mallory and Weiss in 1929.1 In our case, the third part of the duodenum flexed steeply, and the lumen was narrowed, which caused an obstruction. As a result, repeat vomiting was considered to have caused Mallory–Weiss syndrome.\n\nOn the basis of the CT findings showing that the duodenal-jejunal junction was located in the right hemi-abdomen, intestinal malrotation was suspected.2 However, 7 days later, when CT was repeated, spontaneous resolution of the malpositioned jejunum was seen. The patient was then discharged from the hospital. However, months later, she was rushed to the emergency room for repeat haematemesis. Dynamic CT was performed before upper gastrointestinal endoscopy, on admission, and revealed contrast extravasation in the dilated stomach. Additionally, the third part of the duodenum was flexed on the right side of the aorta, and the duodenal-jejunal junction and jejunum were again located in the right hemi-abdomen. Upper gastrointestinal endoscopy revealed a laceration at the gastric cardia, as in the previous endoscopy, which was considered Mallory–Weiss syndrome.\n\nTwo months after the second episode of haematemesis, the patient presented to the emergency room with nausea. Non-contrast-enhanced CT revealed no abnormalities in the duodenal positioning, but there was oedematous wall thickening in the second part of the duodenum. If we had not had previous CT images, we would have suspected duodenitis, but on the basis of all of the CT findings, we suspected the possibility of an underlying condition after the right-sided deviation of the small intestine had resolved spontaneously.\n\nIn summary, CT was performed 4 times over 5 months. The third and fourth parts of the duodenum and the jejunum deviated repeatedly, but this resolved spontaneously, which is not indicative of intestinal malrotation. Therefore, we diagnosed dysplasia of the ligament of Treitz.\n\nClinical outcomes\nThe patient underwent laparotomy, which revealed no abnormalities in the relative position of the duodenum to the jejunum. Additionally, the jejunum was located on the patient’s left side, and there was no intestinal malrotation. The ligament of Treitz was formed; however, its fixation in the upper jejunum was incomplete as it was attached only to the duodenum. The duodenal-jejunal junction was not fixed to the retroperitoneum, and the jejunum folded easily with the ligament of Treitz as a fulcrum. Surgically, the upper jejunum was fixed with 4 sutures to the retroperitoneum on the patient’s left side. The postoperative course was good, and the patient has remained symptom-free.",
+    "summary": "A 77-year-old woman underwent CT to evaluate haematemesis. The images showed that the third part of the duodenum flexed steeply on the right side of the aorta and ran caudally, without crossing anterior to the aorta. The duodenal-jejunal junction and jejunum were located on the patient's right side. Upper gastrointestinal endoscopy revealed a laceration at the gastric cardia, and a diagnosis of Mallory-Weiss syndrome was made. Repeat CT 7 days later revealed that the abnormal positioning of the intestinal tract had resolved spontaneously. Two months later, the patient experienced another episode of haematemesis, and CT revealed repeat deviation of the duodenal-jejunal junction and jejunum to her right side. Upper gastrointestinal endoscopy revealed another laceration at the gastric cardia, as in the previous study. On the basis of the initial CT findings showing the duodenal-jejunal junction in the right hemi-abdomen, intestinal malrotation was suspected. However, because the jejunum deviated repeatedly to the right side but resolved spontaneously, we diagnosed dysplasia of the ligament of Treitz. Laparotomy revealed a formed ligament of Treitz; however, fixation in the upper jejunum was incomplete. Additionally, CT revealed that the anterior pararenal space was loosely fixed and mobile. These factors may have caused the right-sided deviation of the small intestine.",
+    "translated_fulltext": "一位 77 岁的女性因呕血被送往急诊室。她的病史仅包括高血压和血脂异常。当她到达急诊室时，她的生命体征显示出现休克（心率：100 次/分钟，血压：79/56 mmHg），血液检查显示贫血（血红蛋白：9.6 g/dL），提示上消化道出血。\n\n由于存在肾功能障碍，立即进行了无增强 CT 扫描。CT 扫描显示，十二指肠的第三部分在主动脉的右侧急剧弯曲，并向尾侧延伸，没有穿过主动脉的前方。空肠位于患者的右侧。十二指肠的第二部分和胃扩张，并且存在高密度胃内容物，被认为是血肿的迹象。\n\n在 CT 检查后进行了上消化道内窥镜检查，结果显示胃心部存在黏膜撕裂。由于剧烈呕吐导致胃心部撕裂而出血，这种现象最早由 Mallory 和 Weiss 于 1929 年报道。1 在本例中，十二指肠的第三部分急剧弯曲，腔道变窄，导致梗阻。因此，重复呕吐被认为是导致 Mallory-Weiss 综合征的原因。\n\n根据 CT 结果显示，十二指肠-空肠连接位于右侧腹腔，因此怀疑存在肠道旋转异常。2 然而，7 天后，重复进行 CT 扫描，发现空肠的异常位置自行恢复。患者随后出院。但是，几个月后，她再次因呕血被紧急送往急诊室。在上消化道内窥镜检查前，进行了动态 CT 扫描，结果显示扩张的胃内有造影剂外渗。此外，十二指肠的第三部分在主动脉的右侧弯曲，十二指肠-空肠连接和空肠再次位于右侧腹腔。上消化道内窥镜检查显示胃心部存在撕裂，与之前的内窥镜检查结果相同，被认为是 Mallory-Weiss 综合征。\n\n在第二次呕血事件发生后两个月，患者因恶心被送往急诊室。无增强 CT 扫描显示十二指肠位置没有异常，但十二指肠的第二部分存在水肿性壁增厚。如果之前没有 CT 图像，我们会怀疑是十二指肠炎，但根据所有 CT 结果，我们怀疑在小肠右侧偏移自行恢复后，可能存在潜在的疾病。\n\n总而言之，在 5 个月内进行了 4 次 CT 扫描。十二指肠的第三部分和第四部分以及空肠反复偏移，但这种偏移会自行恢复，这并不表明存在肠道旋转异常。因此，我们诊断为 Treitz 韧带发育不良。\n\n临床结果\n患者接受了剖腹探查术，结果显示十二指肠与空肠的相对位置没有异常。此外，空肠位于患者的左侧，没有肠道旋转异常。Treitz 韧带已形成；但是，它在空肠上方的固定不完全，因为它仅附着在十二指肠上。十二指肠-空肠连接未固定在腹膜后，空肠可以以 Treitz 韧带为支点轻松折叠。手术中，将空肠的上部用 4 针缝合固定在患者左侧的腹膜后。术后恢复良好，患者一直没有症状。",
+    "translated_summary": "一位77岁的女性患者因呕血接受了CT检查，以评估病情。影像显示，十二指肠的第三部分在主动脉的右侧呈陡峭弯曲，并向尾侧延伸，未穿过主动脉前方。十二指肠-空肠连接处和空肠位于患者的右侧。上消化道内镜检查显示，胃心部有一处撕裂伤，诊断为马洛里-魏斯综合征。7天后复查CT，结果显示肠道异常位置已自行恢复。两个月后，患者再次出现呕血，CT检查显示十二指肠-空肠连接处和空肠再次向右侧偏移。上消化道内镜检查再次显示胃心部有一处撕裂伤，与之前的检查结果一致。基于最初的CT结果，显示十二指肠-空肠连接处位于右侧腹腔，怀疑存在肠道旋转异常。然而，由于空肠反复向右侧偏移但又自行恢复，因此诊断为特雷茨韧带发育不良。剖腹探查显示，特雷茨韧带已形成，但其在上空肠的固定不完全。此外，CT显示，前肾周间隙固定不牢，活动性较大。这些因素可能导致小肠向右侧偏移。"
+  },
+  {
+    "id": "multiclinsum_gs_en_40.txt",
+    "fulltext": "A 12-year-old boy with Down Syndrome and motoric disorders was referred from the Pediatric Department to the Oral Medicine Department of RS Hasan Sadikin Bandung. The patient was diagnosed with Down Syndrome and myeloradiculopathy. The patient’s mother said that the patient was admitted to the hospital because of weakness in both patient’s hands and feet. The patient had a history of falling down about one year ago. The patient’s mother also had a difficulty in cleaning the patient’s oral cavity regularly.\n\nIn the extraoral examination, the patient had a dysmorphic face. The patient also had a cracking and desquamative condition of the vermillion border of the lips. Lymph node examination could not be assessed because the patient wore a cervical collar. The intraoral examination showed an irregular ulcer with 1×0.7 cm in diameter, indurated margin, and white-yellowish base at the right lateral border of the tongue. There was dentinal caries on 63 tooth and also the tooth remnants on 55, 62, 74, and 85 teeth. The upper and lower tooth remnants were suggested to be extracted by pediatric dentist. The space of the extracted teeth will be maintained using a space maintainer. The 55 tooth was sharp and caused an occlusion trauma to the right lateral border of the tongue.\n\nLaboratory examination showed a decrease in sodium value (130 mEq/L) and an increase in lymphocyte value (46%). The MRI examination was performed in the Radiology Department to determine the presence of abnormalities in the cervical spine. The results of the MRI examination showed a dislocation of the patient’s cervical spine. The patient’s mother provided informed consent to publish the patient’s case details and any accompanying images.\n\nBased on the history review, the clinical examination, and appropriate investigation, the patient was diagnosed with a chronic traumatic ulcer mimicking OSCC, exfoliative cheilitis, reversible pulpitis of 63 teeth, and radix gangrene on 55, 62, 74, and 85 teeth. The diagnosis of the chronic ulcer was based on clinical examination. There was an indurated margin in the traumatic lesion, which mimicked Oral Squamous Cell Carcinoma clinically. The patient has been hospitalized for 4 days and was given paracetamol 120 mg/5 mL oral suspension and amoxicillin 125 mg/5 mL oral suspension from the Pediatric Department. The patient also was given sodium chloride 0.9% solution, povidone-iodine mouthwash 1%, and petroleum jelly from the Oral Medicine Department. The patient’s mother was instructed to clean the patient’s oral cavity using gauze soaked in sodium chloride 0.9% solution, compress the ulcer using povidone-iodine mouthwashes 1% three times a day as an antiseptic and anti-inflammatory agent to the oral ulcer, and apply petroleum jelly to moisturize the patient’s lips. The patient was also suggested to extract the 55, 62, 74, and 85 teeth.\n\nIn the second visit (3 days follow-up), oral lesions already showed improvement. In the third visit (1-week follow-up), the size of the oral ulcer at the lateral border of the tongue was getting smaller and the lesion of the lips had some improvement.\n\nIn the fourth visit (10 days follow-up), the size of the oral ulcer at the lateral border of the tongue already had significant improvement. Two days after the fourth visit, the patient underwent neurosurgery. The patient was observed in the Pediatric Intensive Care Unit postoperatively. After two weeks of observation in the Pediatric Intensive Care Unit, the experienced respiratory failure and was declared dead.",
+    "summary": "A 12-year-old boy with Down Syndrome and motoric disorders was referred to Oral Medicine Department. In the extraoral examination, the patient had a dysmorphic face and dry lips. Lymph node examination could not be assessed because the patient wore a cervical collar. The intraoral examination showed an irregular ulcer with 1×0.7 cm in diameter, indurated margin, and white-yellowish base at the right lateral border of the tongue. The 55 teeth were sharp and caused an occlusion trauma to the right lateral border of the tongue. The patient was diagnosed with a chronic traumatic ulcer mimicking OSCC based on clinical examination. The medication given to the patient were sodium chloride 0.9%, povidone-iodine mouthwash 1%, and petroleum jelly.",
+    "translated_fulltext": "一名患有唐氏综合征和运动障碍的 12 岁男孩，由儿科转诊至 RS Hasan Sadikin Bandung 牙科。该患者被诊断为唐氏综合征和脊髓神经根病。患者的母亲表示，患者因双手和双脚无力而入院。患者在一年前曾摔倒过。患者的母亲还表示，她很难定期清洁患者的口腔。\n\n在口腔外检查中，患者面部畸形。患者的嘴唇边缘也出现裂纹和脱屑现象。由于患者佩戴颈托，无法进行淋巴结检查。口腔内检查显示，舌右侧边缘有一个不规则的溃疡，直径为 1×0.7 厘米，边缘硬化，底部呈白色或淡黄色。63 号牙齿有牙本质龋，55、62、74 和 85 号牙齿也有残余。儿科医生建议拔除上下颌的残余牙齿。拔牙后的间隙将使用保持器来维持。55 号牙齿尖锐，导致舌右侧边缘出现咬合创伤。\n\n实验室检查显示，钠含量降低（130 mEq/L），淋巴细胞含量增加（46%）。在放射科进行了 MRI 检查，以确定颈椎是否存在异常。MRI 检查结果显示，患者的颈椎发生了脱位。患者的母亲同意公开患者的病例详情和相关图片。\n\n根据病史回顾、临床检查和适当的检查，患者被诊断为慢性创伤性溃疡，外观类似于口腔鳞状细胞癌，伴有剥脱性唇炎、63 号牙齿的可逆性牙髓炎，以及 55、62、74 和 85 号牙齿的牙根坏死。慢性溃疡的诊断基于临床检查。创伤性病灶的边缘硬化，在临床上类似于口腔鳞状细胞癌。患者已住院 4 天，儿科给予对乙酰氨基酚 120 毫克/5 毫升口服混悬液和阿莫西林 125 毫克/5 毫升口服混悬液。牙科还给予患者 0.9% 氯化钠溶液、1% 聚维酮碘漱口水和凡士林。患者的母亲被告知使用浸泡在 0.9% 氯化钠溶液中的纱布清洁患者的口腔，每天用 1% 聚维酮碘漱口水压缩溃疡三次，作为一种局部消毒剂和抗炎剂，并涂抹凡士林以滋润患者的嘴唇。还建议患者拔除 55、62、74 和 85 号牙齿。\n\n在第二次复诊（3 天后），口腔病灶已有所改善。在第三次复诊（1 周后），舌侧边缘的口腔溃疡面积变小，嘴唇的病灶也有所改善。\n\n在第四次复诊（10 天后），舌侧边缘的口腔溃疡面积已显著改善。在第四次复诊后两天，患者接受了神经外科手术。术后，患者在儿科重症监护室接受观察。在儿科重症监护室观察了两个星期后，患者出现呼吸衰竭，并被宣告死亡。",
+    "translated_summary": "一位患有唐氏综合征和运动障碍的 12 岁男孩被转诊至口腔医学科。在口腔外检查中，患者面部畸形，嘴唇干燥。由于患者佩戴颈托，无法进行淋巴结检查。口腔内检查显示，舌右侧缘有一处不规则溃疡，直径为 1×0.7 厘米，边缘硬化，底部呈白色或淡黄色。第 55 颗牙齿尖锐，导致舌右侧缘出现咬合创伤。根据临床检查，患者被诊断为慢性创伤性溃疡，其表现类似于口腔鳞状细胞癌。患者接受的药物治疗包括 0.9% 氯化钠溶液、1% 聚维酮碘漱口水和凡士林。"
+  },
+  {
+    "id": "multiclinsum_gs_en_3.txt",
+    "fulltext": "We present a case of a 59-year-old lady with a twelve-year history of secondary progressive multiple sclerosis who was referred to ophthalmology with a few weeks’ history of bilateral blurring of vision.\n\nThe patient had no past ophthalmic history and no drug history other than the anti-epileptic medications related to her multiple sclerosis. Previously documented ophthalmic examinations did not reveal any signs of Fuchs' endothelial corneal dystrophy, and the patient has no family history of corneal pathology.\n\nThe patient had been on amantadine therapy at a dose of 100mg twice daily for the past 7 years and was started on levetiracetam 250mg twice daily as an add-on agent. Visual deterioration was experienced shortly after commencement of levetiracetam therapy for a breakthrough seizure.\n\nOn examination, the patient’s best corrected visual acuity was 0.5 logMAR right eye and 0.5 logMAR left eye. Slit-lamp examination revealed corneal edema involving both eyes and absence of uveitis. Corrected intraocular pressures were 16mmHg right eye and 18mmHg left eye. Corneal topography was performed which confirmed bilateral significant corneal thickening with a right central corneal thickness of 936μm and left central corneal thickness of 1134μm. The rest of the eye examination was normal.\n\nSince amantadine is a known cause of corneal edema, it was agreed with the patient and her caring neurologist to switch from amantadine to lamotrigine. Levetiracetam therapy was continued at this stage. No improvement in vision was noted two months after this change in treatment. The patient expressed the wish to temporarily stop levetiracetam on a trial basis in view of the direct temporal association between the onset of symptoms and the commencement of the medication.\n\nAmantadine was re-introduced, while levetiracetam dose was tapered. Improvement in vision was noted a few days after levetiracetam dose reduction. Levetiracetam was stopped altogether, and the patient remained on amantadine and lamotrigine. A provisional diagnosis of levetiracetam-induced corneal edema was made at this stage. Her vision normalized and repeat corneal topography six months after stopping the levetiracetam showed a right central corneal thickness of 567μm and a left central corneal thickness of 573μm, and a visual acuity of 0.2 logMAR both eyes. Slit-lamp examination confirmed clear cornea and the absence of corneal guttata in either eye.\n\nThe patient was examined again thirteen months after the first presentation. No further changes in her medications were made, and her vision had remained stable at 0.2 logMAR in both eyes. Repeat corneal topography showed no further changes.",
+    "summary": "A 59-year-old woman was referred to the ophthalmology department with a few weeks’ history of bilateral blurring of vision. She is a known case of secondary progressive multiple sclerosis, and she was started on levetiracetam by her neurologist a few weeks prior to referral in view of new seizure activity. Examination revealed bilateral clinically evident corneal edema, which was documented on corneal topography.\n\nResults\nUpon levetiracetam dose reduction, symptoms started to improve and eventually the medication was stopped altogether. The patient’s vision and corneal edema normalized on follow-up.",
+    "translated_fulltext": "我们报告了一例59岁女性患者，她患有继发性进展型多发性硬化症，病史长达十二年，因双眼视力模糊，持续数周，被转诊至眼科。\n\n该患者既往无眼科病史，除了与她的多发性硬化症相关的抗癫痫药物外，没有其他用药史。既往的眼科检查未发现福氏内皮角膜营养不良的任何迹象，患者也没有角膜病史的家族史。\n\n过去7年来，患者一直服用阿曼他定，剂量为每天两次，每次100毫克，并开始额外服用左乙拉西坦，剂量为每天两次，每次250毫克。在开始服用左乙拉西坦治疗突破性癫痫发作后不久，患者的视力开始下降。\n\n检查结果显示，患者的最佳矫正视力为右眼0.5 logMAR，左眼0.5 logMAR。裂隙灯检查显示双眼均存在角膜水肿，且无葡萄膜炎。矫正后的眼内压为右眼16毫米汞柱，左眼18毫米汞柱。进行了角膜地形图检查，结果证实双眼角膜明显增厚，右眼中央角膜厚度为936微米，左眼中央角膜厚度为1134微米。其余眼部检查结果正常。\n\n由于阿曼他定是已知引起角膜水肿的原因，因此与患者及其主治神经科医生商议，决定将阿曼他定更换为拉莫三嗪。此时，继续使用左乙拉西坦治疗。在改变治疗方案后两个月，患者的视力没有改善。考虑到症状出现与药物开始使用之间存在直接的时间关联，患者表示希望暂时停止使用左乙拉西坦，进行试验性治疗。\n\n重新开始使用阿曼他定，同时逐渐减少左乙拉西坦的剂量。在减少左乙拉西坦剂量后几天，患者的视力有所改善。完全停止使用左乙拉西坦，患者继续服用阿曼他定和拉莫三嗪。此时，初步诊断为左乙拉西坦引起的角膜水肿。她的视力恢复正常，在停止使用左乙拉西坦后六个月，重复进行角膜地形图检查，结果显示右眼中央角膜厚度为567微米，左眼中央角膜厚度为573微米，双眼视力均为0.2 logMAR。裂隙灯检查证实角膜清晰，双眼均未发现角膜小点。\n\n在首次就诊后的十三个月，再次对患者进行了检查。未对她的药物进行进一步调整，双眼视力保持稳定，均为0.2 logMAR。重复进行角膜地形图检查，未发现进一步变化。",
+    "translated_summary": "一位 59 岁的女性因双眼视力模糊，症状持续数周，被转诊至眼科。她确诊为继发性进展型多发性硬化症，在转诊前几周，她的神经科医生开始给她服用左乙拉西坦，以控制新出现的癫痫发作。检查显示，双眼均有临床上明显的角膜水肿，并在角膜地形图检查中得到证实。\n\n结果\n在减少左乙拉西坦的剂量后，症状开始好转，最终完全停止了该药物的服用。随访期间，患者的视力和角膜水肿均恢复正常。"
+  },
+  {
+    "id": "multiclinsum_gs_en_346.txt",
+    "fulltext": "A 19-month-old boy was admitted to the Emergency Department because he fell from his baby feeding highchair. This fall occurred in apparent well-being, without the presence of anticipatory signs or symptoms. First, he fell on his gluteus and then he banged his head (occiput) on the ground. He presented with vomiting (three episodes) and he was very irritable. His respiratory rate and heart rate were >60 breaths and >150 beats per minute, while oxygen saturation was <80%. Upon physical examination, the child was hydrated and conscious, but irritable. More importantly, we noted subcostal retractions, and, at the auscultation, decreased breath sounds in the left basal part of chest. The patient was ventilated with an AMBU balloon connected to an oxygen source and monitored with a pulse oximeter. Despite our intervention, oxygen saturation fell below 70% and the more we ventilated, the more the saturation dropped down. The lung ultrasound showed the absence of the typical A lines and the consolidation of the lung, which was directly visualized as a solid parenchyma. On the basis of the poor clinical condition, the patient underwent orotracheal intubation with a cuffed endotracheal tube. After the baby was stabilized, he underwent a chest computed tomography (CT) showing complete atelectasis of the left lung with an interruption of the main left bronchus at 12 cm from bronchial bifurcation. An FBA was suspected as the mother also stated that the baby in the previous days had an intensive cough attack and disappeared within 24 h without any treatment. Therefore, a rigid bronchoscopy was performed and an almond of 2 cm in diameter in the main left bronchus was found and promptly removed.\n\nThe patient had never consumed almonds or other nuts before and in this circumstance ingested the almond by chance.\n\nThe baby had a progressive clinical improvement, and after 24 h, he was extubated and discharged from intensive care to be admitted to the general pediatrics ward for a few days with gradual and a total respiratory function recovery.",
+    "summary": "We describe the case of a 19-month-old boy who accessed the emergency room initially for a head trauma. The clinical evaluation, however, revealed an unexplained serious respiratory distress needing tracheal intubation. After our evaluation, we hypothesized that the severe respiratory distress determined an altered state of consciousness with following head trauma. The radiological findings raised the suspicion of foreign body aspiration for the presence of an atelectasis of the entire left lung. The computed tomography showed an abrupt interruption of the main bronchus at 12 mm from the hull. The following bronchoscopy identified an almond of 2 cm.",
+    "translated_fulltext": "一名19个月大的男孩因从婴儿餐椅上摔下被送往急诊科。摔倒时，孩子看起来状态良好，没有出现任何预警症状。他先是臀部着地，然后头部（后枕部）撞击地面。他出现了呕吐（三次），并且非常烦躁。他的呼吸频率和心率分别超过60次/分钟和150次/分钟，而血氧饱和度低于80%。体格检查显示，孩子身体水分充足，意识清醒，但烦躁。更重要的是，我们观察到肋间隙凹陷，并且在听诊时，发现左侧胸部下部呼吸音减弱。我们使用连接到氧气源的AMBU球囊为患者进行人工呼吸，并使用脉搏血氧仪进行监测。尽管我们采取了干预措施，但血氧饱和度仍降至70%以下，而且我们进行的人工呼吸越多，饱和度下降得越快。肺部超声显示，没有典型的A线，并且肺组织出现实变，直接显示为实性肺实质。考虑到患者的病情恶化，我们为患者进行了气管插管，使用带有气囊的内管。在稳定婴儿的状况后，我们进行了胸部计算机断层扫描（CT），结果显示左肺完全无气，并且在距离气管分叉处12厘米的主支气管处出现中断。考虑到患者的母亲也表示，孩子在之前的几天里曾出现剧烈的咳嗽，并在24小时内自行消失，没有进行任何治疗，因此我们怀疑是异物吸入。因此，我们进行了硬式支气管镜检查，发现左侧主支气管内有一颗直径2厘米的杏仁，并立即将其取出。\n\n该患者此前从未食用过杏仁或其他坚果，这次是偶然吞食了杏仁。\n\n婴儿的临床状况逐渐好转，24小时后，我们拔除了气管插管，并将他从重症监护室转到普通儿科病房，在那里他接受了几天治疗，呼吸功能逐渐恢复。",
+    "translated_summary": "我们描述了一位19个月大的男孩的病例，他最初因头部外伤而来到急诊室。然而，临床评估显示，他出现了无法解释的严重呼吸窘迫，需要进行气管插管。经过我们的评估，我们推测，严重的呼吸窘迫导致了意识状态的改变，随后发生了头部外伤。放射学检查结果表明，可能存在异物吸入，因为左肺完全萎陷。计算机断层扫描显示，主支气管在距离气管起始处12毫米的地方突然中断。随后的支气管镜检查发现了一颗2厘米的杏仁。"
+  },
+  {
+    "id": "multiclinsum_gs_en_83.txt",
+    "fulltext": "A 29-year-old woman, Para 1, with abnormal vaginal bleeding of one-month duration presented to the gynecology outpatient department of a level 2 hospital. She was HIV positive, commenced on antiretroviral treatment following diagnosis, but had defaulted the antiretroviral treatment for one month when she became ill with vaginal bleeding, resulting in virological and immunological failures (viral load 37400 copies/mL and CD4 count 26 cells/μL). Of note, it was unclear when the patient first started showing HIV symptoms. However, she was diagnosed with HIV about a year prior to presentation. Physical examination revealed a large mass on the cervix measuring 8 × 8 cm extending to the parametrium and to the pelvic side walls bilaterally. There was bleeding on contact and foul-smelling vaginal discharge. Ultrasonography detected a bulky cervix and bilateral hydronephrosis. The patient was clinically diagnosed with cervical malignancy stage 3B. She was recommenced on antiretroviral therapy with a treatment change from TLD (Tenofovir-Lamivudine-Dolutegravir combination) to a preferable renal friendly regimen (Lamivudine-Abacavir-Dolutegravir combination). A punch biopsy of the cervix was performed, and the histopathological report revealed the diagnosis of an extra-nodal BL. The immunohistochemical and in situ hybridization confirmed the diagnosis, with CD20, CD75a, CD10, PAX5 and Bcl-6 positive. In addition, the CD44 and c-Myc were positive, with the EBER-ISH demonstrating focal positivity. The Ki67 demonstrated a proliferation index of almost 100% and PAX5 moderately positive BCL6. She had white cell count of 2.67 x109/L, haemoglobin of 5.7g/dl and platelet count of 71 × 109/L. Results of other investigations were serum creatinine 187 mmol/L, urea 11.1 mmol/l, albumin 21 g/l, aspartate transaminase 41 U/l and alkaline phosphatase 100 U/l.\n\nFollowing histological confirmation of the diagnosis and review at an oncology multidisciplinary meeting, she spent 43 days waiting to start treatment at oncology unit. The delay was due to long waiting list. This delay exceeded the 48 hours waiting period during which oncological treatment for BL should commence following diagnosis. The treatment plan was chemo-radiation therapy, and the patient gave written informed consent for the case to be published. However, she demised in the gynaecological ward on the 43rd day while waiting to start the treatment. During the 43 days, further imaging could not be performed due to poor functionality of the available CT and MRI machines. In addition to antiretroviral therapy, the patient received other supportive care such as blood transfusion and analgesia. Again, the number of days between the diagnosis of the BL and her death was 43 days. Histopathological postmortem was not performed as the diagnoses (BL and retroviral disease) were known. We reckon that the main primary cause of death is challenging to assign because of the multiple principal diagnoses. Because BL has rapid progression and high mortality rate in persons living with HIV particularly with high viral load, the attending physician certifying the death assigned BL as the most likely cause of death. However, the secondary cause of death was multiple organ failure (renal and haematological inclusive).",
+    "summary": "The patient was a 29-year-old woman, Para 1, with abnormal vaginal bleeding for a month and living with HIV and had a CD4 of 26 cells/μL. The histological examination of the cervical biopsy confirmed an extra-nodal BL. She had International Federation of Gynecology and Obstetrics (FIGO) stage 3B cervical cancer based on presence of hydronephrosis and pelvic wall involvement. The patient was reviewed at the oncology multidisciplinary meeting and required chemoradiation. There was delay in her management due to a long waiting list for chemoradiation at oncology unit in the referral center and the patient demised 43 days after diagnosis and did not receive the treatment.",
+    "translated_fulltext": "一位29岁的女性，为Para 1，出现持续一个月的异常阴道出血，前往一家二级医院的妇科门诊就诊。她感染了艾滋病毒，诊断后开始接受抗逆转录病毒治疗，但在出现阴道出血后，她停止了抗逆转录病毒治疗一个月，导致病毒学和免疫学治疗失败（病毒载量为37400拷贝/毫升，CD4细胞计数为26个/微升）。值得注意的是，患者首次出现艾滋病毒症状的时间尚不清楚。然而，她在就诊前大约一年被诊断出感染了艾滋病毒。体格检查显示，宫颈上有一个大的肿块，大小为8厘米×8厘米，延伸至子宫旁组织和双侧盆壁。接触时有出血，并伴有恶臭的阴道分泌物。超声检查显示宫颈肿大，双侧肾盂扩张。临床诊断为宫颈恶性肿瘤3B期。她重新开始接受抗逆转录病毒治疗，治疗方案从TLD（替诺福韦-拉米夫定-多替拉韦组合）改为更适合肾脏的方案（拉米夫定-阿巴卡韦-多替拉韦组合）。对宫颈进行了穿刺活检，组织病理学报告显示诊断为淋巴结外弥漫大B细胞淋巴瘤（BL）。免疫组织化学和原位杂交证实了诊断，CD20、CD75a、CD10、PAX5和Bcl-6呈阳性。此外，CD44和c-Myc也呈阳性，EBER-ISH显示局灶性阳性。Ki67显示增殖指数接近100%，PAX5中度阳性，BCL6阳性。她的白细胞计数为2.67 x 10^9/升，血红蛋白为5.7克/分升，血小板计数为71 x 10^9/升。其他检查结果显示，血清肌酐为187毫摩尔/升，尿素为11.1毫摩尔/升，白蛋白为21克/升，天冬氨酸氨基转移酶为41单位/升，碱性磷酸酶为100单位/升。\n\n在组织病理学确诊并于肿瘤科多学科会议上进行讨论后，她等待了43天才能开始在肿瘤科接受治疗。延迟的原因是等待名单过长。这种延迟超过了48小时的等待期，在此期间应在诊断出BL后开始进行肿瘤治疗。治疗方案为化放疗，患者签署了书面知情同意书，同意将此病例发表。然而，她在等待开始治疗的第43天在妇科病房去世。在这43天里，由于现有的CT和MRI设备的性能不佳，无法进行进一步的影像学检查。除了抗逆转录病毒治疗外，患者还接受了其他支持性治疗，如输血和镇痛。再次强调，从诊断出BL到她去世之间的时间为43天。由于已知诊断结果（BL和逆转录病毒疾病），因此没有进行尸检。我们认为，由于存在多种主要诊断，因此很难确定死亡的主要原因。由于BL进展迅速，且在感染艾滋病毒的患者中，特别是病毒载量高的患者中，死亡率很高，因此负责开具死亡证明的医生将BL作为最可能的原因。然而，次要的死亡原因是多器官衰竭（包括肾脏和血液系统）。",
+    "translated_summary": "该患者为29岁女性，已生育一次，出现异常阴道出血已持续一个月，同时感染了艾滋病毒，CD4细胞计数为26个/μL。宫颈活检的组织病理学检查证实为淋巴结外弥漫大B细胞淋巴瘤。根据是否存在肾积水和盆壁受累情况，该患者的国际妇产科联合会（FIGO）分期为3B期宫颈癌。在肿瘤多学科会议上对该患者进行了讨论，并确定需要进行化疗和放疗。由于转诊中心的肿瘤科化疗放疗等待名单较长，导致治疗有所延误，该患者在确诊后43天去世，未能接受治疗。"
+  },
+  {
+    "id": "multiclinsum_gs_en_24.txt",
+    "fulltext": "Patient and observation\nPatient information (presentation of the patient): he is a 28-year-old single man without children, an active military. He has been present for 5 weeks with progressive abdominal pain, more marked in the epigastrium and the right hypochondrium, followed shortly after by a non-quantified fever, chills, profuse sweats in a context of anorexia and weight loss of 6 kg. Note that the patient is not a drinker or smoker, vaccinated with BCG and has no other contributing personal or family history.\n\nClinical findings: On admission, the physical examination found the patient in a general altered state, asthenic with a weight loss of 6 kg in one month. A clinical systemic inflammatory response syndrome was present with the following elements: a fever of 39.1 °C, tachycardia (124 beats/min), polypnea (22 cycles/min). The pulmonary examination and exploration of the superficial lymph node areas were without particularity. In the abdominal area, moderate sensitivity in the right hypochondrium with hepatomegaly was found.\n\nChronology: dates back to February 2022 with the onset of diffuse abdominal pain with diarrhea-constipation transit disorder, all in a context of preservation of general condition with low-grade fever predominantly at night. A syntagmatic treatment was unsuccessfully initiated. The evolution is marked by the persistence of low-grade fever associated with anorexia and progressive weight loss of 12 kg over three months. In the face of this transit disorder with unexplained fever and the deterioration of the general condition, the patient will be admitted to the emergency department for further investigation.\n\nDiagnostic approach: upon admission, a biological infectious syndrome was reported with a neutrophilic predominant hyperleucocytosis (17800 cells/mm3) and a high C-reactive protein of 323 mg/L.\n\nIn the face of his abdominal pain, the lipase and troponin tests were normal at 38 IU/L (VN: <3 78 IU/L) and 4 ng/L (VN: 2 to 16 ng/L) respectively. The liver function was stable with ALT (alanine amino transferase) at 22 IU/L (VN: < 40UI/L), AST (aspartate amino transferase) at 17 IU/L (VN: < 35UI/L), GGT (gamma glutamyl transferase) at 42 IU/L (VN: < 50UI/L), PAL (alkaline phosphatase) at 115 IU/L (VN: 40- 150 IU/L) and normal bilirubinemia. The liver function was normal with a prothrombin rate of 78% and an albuminemia of 39 g/L. The blood ionogram and renal function were normal. The chest radiograph and abdominal ultrasound were without particularity.\n\nWith a procalcitonin positive at 4.1 ng/L, an infectious disease assessment to search for the infectious focus was initiated, including a cytobacteriological examination of urine and blood cultures during the febrile peaks at 39°C, which were both negative. The hepatitis viral B, C and HIV serologies, as well as the syphilis serology performed in hospital were all negative. The lactate dehydrogenase (LDH) and beta-2 microglobulin were normal at 231 IU/L and 2.28 mg/L respectively. The GeneXpert to search for the Mycobacterium on these bioptic pieces was negative. The quantiferon was negative. The search for the Mycobacterium on the morning expectorations of 3 consecutive days was negative.\n\nOn the morphological level, a thoraco-abdomino-pelvic scan showed an enlarged liver (hepatic arrow at 17 cm), the site of multiple, well-defined, rounded hypodensities, which were not enhanced after injection of the contrast agent. The largest lesions were in segment I (21 x 16 mm) and segment V (36 x 27 mm). No suspicious lesions were detected in the thoracic and pelvic levels. The first liver biopsies obtained by echo-guided puncture revealed subacute, fibro-inflammatory liver lesions, with no histological evidence of specificity or malignancy.\n\nA liver MRI following the scan objectified a dysmorphic liver, the site of lesions in heterogeneous signal T2 surrounded by a wall in hyper signal T2, enhanced in the periphery after injection of the contrast agent, the largest of which is located in segment I (20 x 22 mm) and in segment V (33 x 31 mm). No deep lymphadenopathy had been objectified, either in the scan or in the MRI. A diagnostic laparoscopy performed on the hepatic nodules, the histological examination found epithelioid and gigantocellular granulomas of varying size with caseous necrosis in favour of a hepatic tuberculosis.\n\nTherapeutic intervention: the patient was put on anti-tuberculosis treatment according to the standard protocol for months: Phase 1: quadritherapy (Isoniazide + Rifampicine + Pyrazinamide + Ethambutol) in a single oral intake each morning on an empty stomach for 2 months. Phase 2: bithrapia (Isoniazide + Rifampicine) in a single oral intake each morning on an empty stomach for 4 months\n\nFollow-up and results of therapeutic interventions: from the first days of treatment, a good response was obtained with disappearance of the inflammatory syndrome with systemic response both clinically and biologically. After three months of treatment, a control scan of the liver showed a decrease in the number and volume of liver lesions.\n",
+    "summary": "This clinical case was reported in a young Moroccan, presenting a picture of hepatic colic that had been developing for a month, associated with subtle signs of tuberculous infection. Non-specific hepatic nodular lesions were revealed on the scanner and on the hepatic magnetic resonance imaging (MRI). The diagnosis of focal hepatic tuberculosis was confirmed after pathological analysis of hepatic nodule biopsies obtained after a laparoscopy. After the start of well-conducted anti-bacillary treatment, a good clinical-biological improvement was obtained.\n",
+    "translated_fulltext": "患者与观察\n患者信息（患者介绍）：他是一名 28 岁未婚、未育的现役军人。起病 5 周来出现进行性腹痛，上腹部和右季肋部更为明显，随后不久出现未量化的发热、寒战、大量出汗，伴厌食和体重减轻 6 kg。注意到患者不饮酒、不吸烟，接种过 BCG，且无其他相关个人或家族史。\n\n临床发现：入院时，体格检查见患者一般情况改变，乏力，1 个月内体重减轻 6 kg。存在临床全身炎症反应综合征，表现为：发热 39.1 °C，心动过速（124 次/分），呼吸急促（22 次/分）。肺部检查及浅表淋巴结区检查无特殊。腹部方面，可见右季肋部中度压痛，伴肝大。\n\n时间顺序：可追溯至 2022 年 2 月，起病表现为弥漫性腹痛，伴腹泻-便秘交替的肠道通行障碍，整体一般情况尚可，低热以夜间为主。曾启动[syntagmatic]治疗但未成功。病程演变表现为低热持续，伴厌食及 3 个月内进行性体重减轻 12 kg。面对该肠道通行障碍伴不明原因发热及一般情况恶化，患者收入急诊进一步检查。\n\n诊断途径：入院时，报告生物学感染综合征，表现为以中性粒细胞为主的白细胞增多（17800 cells/mm3）及 C 反应蛋白升高至 323 mg/L。\n\n针对其腹痛，脂肪酶和肌钙蛋白检查分别为 38 IU/L（VN: <3 78 IU/L）和 4 ng/L（VN: 2 to 16 ng/L），均正常。肝功能稳定，ALT（alanine amino transferase）22 IU/L（VN: < 40UI/L），AST（aspartate amino transferase）17 IU/L（VN: < 35UI/L），GGT（gamma glutamyl transferase）42 IU/L（VN: < 50UI/L），PAL（alkaline phosphatase）115 IU/L（VN: 40- 150 IU/L），胆红素水平正常。肝功能正常，凝血酶原活动度 78%，白蛋白水平 39 g/L。血电解质和肾功能正常。胸片和腹部超声未见异常。\n\n降钙素原阳性，为 4.1 ng/L，因而启动感染病学评估以寻找感染灶，包括尿液细胞-细菌学检查及发热高峰 39°C 时的血培养，二者均为阴性。乙肝、丙肝和 HIV 血清学，以及住院期间行梅毒血清学，均为阴性。乳酸脱氢酶（LDH）和 β-2 微球蛋白分别为 231 IU/L 和 2.28 mg/L，均正常。对这些活检标本进行 GeneXpert 检测以寻找分枝杆菌为阴性。QuantiFERON 阴性。连续 3 天晨痰寻找分枝杆菌阴性。\n\n形态学方面，胸-腹-盆腔扫描显示肝脏增大（肝矢状径 17 cm），肝内可见多个界限清楚的类圆形低密度影，造影剂注射后不强化。最大病灶位于 I 段（21 x 16 mm）和 V 段（36 x 27 mm）。胸部及盆腔未见可疑病灶。超声引导下首次肝穿刺获得的活检显示亚急性、纤维-炎性肝病变，组织学无特异性或恶性证据。\n\n随后行肝脏 MRI 客观显示肝形态异常，可见 T2 异质信号的病灶，周围有 T2 高信号的壁，注射对比剂后周边强化，最大者位于 I 段（20 x 22 mm）和 V 段（33 x 31 mm）。无论在扫描还是在 MRI 上均未见深部淋巴结肿大。对肝结节行诊断性腹腔镜检查，组织学检查发现不同大小的上皮样和巨细胞性肉芽肿，伴干酪样坏死，提示肝结核。\n\n治疗干预：根据标准方案给予抗结核治疗，疗程为数月：第 1 期：四联治疗（Isoniazide + Rifampicine + Pyrazinamide + Ethambutol），每日清晨空腹口服一次，共 2 个月。第 2 期：双联治疗（Isoniazide + Rifampicine），每日清晨空腹口服一次，共 4 个月。\n\n随访及治疗干预结果：治疗开始后的最初几天即取得良好反应，炎症综合征消失，临床及生物学均有全身性改善。治疗 3 个月后，肝脏复查扫描显示肝内病灶的数目和体积均减少。",
+    "translated_summary": "本病例报告了一位年轻的摩洛哥患者，该患者出现肝绞痛症状，持续约一个月，并伴有轻微的结核感染迹象。扫描和肝脏磁共振成像（MRI）显示，患者肝脏存在非特异性结节状病变。在腹腔镜检查后，对肝脏结节进行活检，并进行病理分析，最终确诊为局灶性肝结核。在开始规范的抗结核治疗后，患者的临床和生物学指标均得到明显改善。"
+  },
+  {
+    "id": "multiclinsum_gs_en_362.txt",
+    "fulltext": "A 77-year-old male patient presented with a history of moderate cognitive impairment. The patient was admitted to the emergency department for a tonic-clonic seizure at home. The patient presented hemodynamically unstable in the context of a postcritical state and suspected intrapelvic bleeding. The code for a polytraumatized patient was activated, not because of the mechanism of injury, but because of the patient's hemodynamic status.  He was stabilized and optimized in the emergency department with intravenous fluid and transfusion of packed red blood cells. A pelvic girdle was placed. Once hemodynamic stability was achieved, a physical examination was performed. Clinically, the patient presented a shortening of the lower limb compared to the contralateral limb, external rotation and joint blockage when performing the log roll test in both limbs. He presented functional impotence in both hips. Given the patient's condition when he arrived at the emergency department, it was not possible to assess the neurological status. He had no signs of external injuries or bruises. Distal pulses were present at the foot level. He could move his upper limbs. A chest and anteroposterior pelvic radiograph was performed as part of the code for a polytraumatized patient, pending completion of an abdominal-pelvic computed tomography (CT) study. A bilateral femoral dislocation was diagnosed in the pelvic radiograph. The patient underwent a procedure to correct the dislocation.\n\n\n\nComputed tomography angiography to rule out vascular lesions given the instability in hemodynamic that presented itself on admission. Vascular lesions were ruled out after the angiography. In the 3D-CT reconstruction of the pelvis, a bilateral transverse acetabular fracture was found, according to the classification of Letournel and a bilateral longitudinal fracture of the iliac wing was found, along with intrapelvic protrusion of both femoral heads. After initial evaluation, supracondylar traction was placed on the femoral head in both extremities and the pelvic traction was removed. The patient was admitted to the recovery unit until surgery, where he remained with the traction supracondylar femoral head in both extremities and the pelvic traction was removed. The patient was operated on the eighth day of admission. In our service, the acetabular fractures were ruled out after seven days waiting for the formation of a fibrosis in the focus of fracture and the decrease of intraoperative bleeding during surgical procedures. It was decided to perform the surgery in two stages due to the long duration of each intervention. Both surgeries were performed with general anaesthesia, tranexamic acid was administered to prevent intraoperative bleeding and decrease blood transfusions in relation to the surgeries; and antibiotic (cefazolin 2 g preoperatively and 1 g of cefazolin every 8 hours postoperatively for 24 hours) as an intrahospital protocol. During the postoperative period, enoxaparin 40 mg was administered subcutaneously every 24 hours for seven weeks. Initially, the surgery of the left hemipelvis was performed since, at the radiographic level, it presented greater pelvic protrusion and it was not desirable that a hematoma in the soft tissue phase could generate complications at the time of extraction of the femoral head (vascular injuries, intraoperative bleeding). The supracondylar traction was removed. The patient was placed in lateral decubitus, and a posterior lateral approach was performed with a Moore's autograft in the acetabular background (fracture focus). Subsequently, the anti-protrusion ring was implanted (Burch SchneiderTM Reinforcement Cage, Zimmer Biomet) anchored to the ischium and ilium. Prior to the implantation of the ring, it was necessary to perform dissection of the gluteal musculature (gluteus minimus and medius) to correctly place the femoral head. The medial ischial fracture of the ring was also anchored with screws. The check was performed under the control of a scope to verify the correct implantation. Subsequently, a double mobility cementaed acetabular ring was implanted and then the non-cemented femoral stem was implanted. After finishing the placement of the components, the capsule and pelvic musculature were closed by means of transosseous trochanteric points. The surgery of the right hemipelvis was performed seven days later. The patient was placed in lateral decubitus. To address the longitudinal fracture of the iliac wing, the first window of the ilio-inguinal approach was performed. It was synthesised with a six-hole anatomical plate. Subsequently, the same procedure as the previous surgery was performed, using an anti-protrusion ring with a double mobility cemented femoral stem and non-cemented femoral stem. This type of anti-protrusion rings are used when there are acetabular fractures that could be equivalent to a pelvic disjunction (type IV classification of acetabular defects of the AAOS) and an anchorage in the ischium and ilium of the ring is needed to support the ring. They are not indicated for isolated fractures of the anterior or posterior wall of the acetabulum where there is no involvement of the acetabular background. During admission, the patient remained in bed and was mobilised to avoid decubitus ulcers. Once the second intervention was performed and when the patient tolerated it clinically, he began to transfer with the use of a wheelchair. In bed he was allowed to have a full range of motion without restriction. The patient was discharged four weeks later and did not begin to load or walk until six weeks. He began to load with the use of a walking stick. We decided to delay loading because, despite the use of arthroplasty as a treatment, it was decided to wait until there was an initial consolidation of the graft in the acetabular background that provided better support for the ring. It was also added that the patient presented bilateral involvement and it would be difficult to start partial loading, given that he did not have a healthy hip to support. During the follow-up of the patient, at 12 months of the intervention he was already doing full load with the use of a walking stick, with a Harris hip score of 79 in the left hip and 77 in the right hip; and a score of 12 on the WOMAC scale. He has not presented any postoperative complications to date. The patient is satisfied clinically, he reports occasional discomfort and a slight limp of the right side. He has a full range of motion in the examination and does not report having had any episode of instability since the surgery.\n",
+    "summary": "77-year-old patient with a history of moderate cognitive impairment who suffered bilateral central dislocation of the hip in the context of a generalized convulsive seizure. Clinically, upon arrival in the emergency department, the patient presented a shortening of the lower right limb compared to the contralateral limb, external rotation and joint blockage when performing the log roll test in both limbs. Imaging and clinical optimization study was performed prior to surgery. It was performed in two stages: first the left hip on the eighth day of admission and the right hip on the fifteenth. In both surgeries the same procedure was performed by implanting an anti-protrusive ring and prosthesis with double mobility acetabulum with non-cemented femoral stem. In the immediate postoperative period, the patient did not present any complications associated with the surgery. In the 12-month follow-up, the patient performed a full load with a Harris hip score (HHS) of 77 in the right hip and 79 in the left; 12 points in the WOMAC scale. He has not presented any postoperative complications to date.\n",
+    "translated_fulltext": "一名77岁男性患者，既往有中度认知障碍病史。患者因在家中发生强直-阵挛性发作被收入急诊科。患者处于发作后状态，血流动力学不稳定，并怀疑骨盆腔内出血。启动了多发伤患者处置代码，其原因不是损伤机制，而是患者的血流动力学状态。他在急诊科通过静脉补液和输注浓缩红细胞获得了稳定与优化。放置骨盆束带。在达到血流动力学稳定后，进行了体格检查。临床上，与对侧肢体相比可见下肢缩短，双侧肢体进行原木滚动试验时出现外旋及关节卡阻。双髋出现功能丧失。鉴于患者到达急诊科时的情况，无法评估其神经系统状态。无外伤或瘀斑体征。足部远端动脉搏动可触及。上肢可活动。作为多发伤患者处置代码的一部分，行胸部及骨盆正位X线检查，同时等待完成腹-骨盆计算机断层扫描（CT）检查。骨盆X线片诊断为双侧股骨头脱位。患者接受了脱位复位手术。\n\n鉴于入院时存在血流动力学不稳定，行计算机断层扫描血管造影以排除血管损伤。血管造影后排除了血管损伤。骨盆三维CT重建显示，根据Letournel分型为双侧髋臼横型骨折，并见双侧髂翼纵行骨折，伴双侧股骨头向骨盆腔内突入。初步评估后，在双侧肢体的股骨头上置入髁上牵引，并去除骨盆牵引。患者被收入恢复单元直至手术，在此期间，他仍然在双侧肢体的股骨头行髁上牵引，且骨盆牵引被去除。患者于入院第八天接受手术。在我们科，对髋臼骨折的处理会等待7天，以待骨折灶形成纤维化并在手术过程中减少术中出血。鉴于每次手术耗时较长，决定分两期进行手术。两次手术均在全身麻醉下进行，给予氨甲环酸以预防术中出血并减少与手术相关的输血；并按院内规范使用抗生素（术前头孢唑啉 2 g，术后每8小时头孢唑啉 1 g，共24小时）。术后期间给予依诺肝素 40 mg 皮下注射，每24小时一次，为期7周。首先行左半骨盆手术，因为影像学上其骨盆内突更明显，且不希望软组织期的血肿在取出股骨头时引发并发症（血管损伤、术中出血）。去除髁上牵引。患者取侧卧位，经后外侧入路，在髋臼底（骨折灶）行Moore自体骨移植。随后植入抗突入环（Burch SchneiderTM Reinforcement Cage, Zimmer Biomet），并锚定于坐骨和髂骨。在植入该环之前，需要对臀肌群（臀小肌和臀中肌）进行分离，以正确放置股骨头。该环在坐骨内侧也用螺钉加以锚定。在影像透视监控下进行检查以确认植入位置正确。随后植入双活动骨水泥髋臼环，之后植入非骨水泥股骨柄。组件置入完成后，通过经骨性大转子缝合点关闭关节囊及骨盆肌群。右半骨盆手术于7天后进行。患者取侧卧位。为处理髂翼纵行骨折，采用髂腹股沟入路第一窗。以六孔解剖型钢板行内固定重建。随后按前次手术相同步骤，使用抗突入环，配合双活动骨水泥髋臼环与非骨水泥股骨柄。这种抗突入环适用于相当于骨盆分离的髋臼骨折（AAOS髋臼缺损分型IV型），需要将该环锚定于坐骨和髂骨以提供支撑。若为仅累及髋臼前壁或后壁、且不累及髋臼底的孤立骨折，则不适用。住院期间，患者卧床并进行翻身与活动以避免压疮。第二次手术完成且患者临床耐受后，开始在轮椅辅助下进行转移。床上允许关节全范围活动，不作限制。患者于4周后出院，至第6周才开始负重或行走。其在拐杖辅助下开始负重。我们决定延迟负重，尽管采用了关节成形术作为治疗，但仍需等待髋臼底移植物出现初期骨性结合，以为该环提供更好的支撑。此外，患者为双侧累及，因无健康髋关节可支撑，开始部分负重亦较困难。在随访中，于术后12个月，患者在拐杖辅助下已能完全负重，左髋Harris髋关节评分为79分，右髋为77分；WOMAC量表评分为12分。迄今未出现任何术后并发症。患者临床上感到满意，报告偶有不适及右侧轻度跛行。查体关节活动度完全，术后未报告出现任何不稳事件。",
+    "translated_summary": "患者为 77 岁，既往有轻度认知障碍病史，因全身性强直性发作导致双侧髋关节中心性脱位。患者就诊时，与对侧肢体相比，右下肢缩短，双侧肢体在进行翻身试验时出现外旋和关节活动受限。术前进行了影像学检查和临床优化研究。手术分两个阶段进行：首先在入院后的第八天对左侧髋关节进行手术，然后在第十五天对右侧髋关节进行手术。两次手术均采用相同的手术方法，即植入抗突出环和具有双重活动度的髋臼假体，并使用非骨水泥固定股骨柄。术后早期，患者未出现与手术相关的任何并发症。12 个月随访期间，患者右侧髋关节的 Harris 髋关节评分 (HHS) 为 77 分，左侧髋关节为 79 分，WOMAC 评分 12 分，可以承受完全负重。截至目前，患者未出现任何术后并发症。"
+  },
+  {
+    "id": "multiclinsum_gs_en_151.txt",
+    "fulltext": "The patient was a 4-month-old male from central Mexico with two healthy male siblings. His mother was hypothyroid during the first trimester of pregnancy and took drugs. The infant was born with normal weight and size, was breast-fed, and received the BCG vaccine with no scarring. The mother of the patient was a prisoner in a jail cell with the infant in a crowded cell with two others.At 4 months, the patient was medically evaluated for a painful tumor in the left axilla. A chest X-ray showed suggestive images of rib fractures; the mother was suspected of child abuse, and the infant was admitted to a pediatric hospital. The infant was weighed (4,190 g) and measured (58 cm) below the third percentile, oxygen saturation of 70%, fever, cough, increased volume in the left axilla, and pain, redness, and warmth. The blood count showed: hemoglobin of 8.8 g/dL (11.0-12.6), 29.3 × 109 leukocytes/L (6.0-17.5), 18.4 × 109 neutrophils/L (1.0-8.5), 7.0 × 109 lymphocytes/L (4.0-13.5), 3.5 × 109 monocytes/L, 459 × 109 platelets/L (150-350), and C-reactive protein of 16 mg/L (< 3.0). The first thoracoabdominal tomography showed an abscess in the left axilla, lytic lesions in ribs 3-6, left apical pneumonia, pulmonary nodules in both lungs, and enlarged cervical and mediastinal lymph nodes. The biopsy of the left axilla abscess reported myositis and suppurative panniculitis. Only the culture for bacteria from the bronchoalveolar liquid was negative, and the PCR for the Mycobacterium tuberculosis complex was negative. After 41 days of hospitalization and receiving two antimicrobial regimens of ceftriaxone-clindamycin and cefepime-vancomycin, the patient was discharged.\n\nTwo months later, at eight months of age, he was readmitted to hospital with a fever, irritability and a suppurating abscess in the left scapula. The blood count showed haemoglobin of 10.8 g/dl (10.5-12), 21.2 × 109 leukocytes/L (6-17), 12.2 × 109 neutrophils/L (1.5-8.5), 7.5 × 109 lymphocytes/L (4-10.5), 1.2 × 109 monocytes/L (600), and 583 × 109 platelets/L (150-350); the serum test for HIV was negative. A left apical consolidation, bronchiectasis, lytic lesions in ribs 2-7 and dorsal vertebrae 2-7, and a multilocular fluid collection were observed on a chest scan; ultrasound showed a fistula associated with the scapular abscess. The patient received piperacillin-tazobactam, which was later replaced with voriconazole after Aspergillus fumigatus was detected in the secretion sample culture. Given the recurrence and severity of the infection, an innate immunity defect was suspected. The dihydrorhodamine test showed no production of reactive oxygen species and the gp91phox expression in neutrophils was absent, establishing a diagnosis of X-linked chronic granulomatous disease. The pathogenic variant detected by next-generation sequencing was c.80_83del/Y (p.Val27Glyfs*33) in CYBB. The mother was a carrier of the variant (c.80_83del/WT). The two older male siblings, who were apparently healthy, could not be genetically tested. The patient was discharged after 65 days of hospitalisation and 28 days of voriconazole treatment. Daily antibiotic prophylaxis with trimethoprim-sulfamethoxazole and antifungal prophylaxis with fluconazole twice a week were initiated. Two months later, at one year of age, the infant was readmitted due to multifocal pneumonia, for which mechanical respiratory assistance was required. The galactomannan antigen was detected in the serum and A. fumigatus was detected in the culture of the lavage fluid, so treatment with voriconazole was initiated again. The patient suffered a multiple organ failure and died one month after admission.\n",
+    "summary": "A case of infant with chronic granulomatous disease and invasive aspergillosis is reported. The infant was a 4-month-old male infant living with his mother in a prison cell. The infant had tumors in the left axillary region and a chest X-ray suggested rib fractures; he was hospitalized on suspicion of child abuse. A chest X-ray showed an axillary abscess, osteolysis of ribs, pneumonia and pulmonary nodules; the patient received broad spectrum antibiotics and was discharged. At 8 months, he was readmitted with fever and extension of the purulent abscess to the left shoulder region; a chest X-ray showed worsening of the condition. Aspergillus fumigatus was isolated from the secretion of the abscess and invasive aspergillosis was diagnosed; voriconazole was initiated for 28 days. A dihydro rhodamine test was performed and a diagnosis of chronic granulomatous disease caused by the pathogenic variant c.80_83del/Y of the CYBB gene, carried by the mother (c.80_83del/WT), was made. At 12 months, the patient was readmitted with invasive aspergillosis, resistant to treatment, with fatal outcome.\n",
+    "translated_fulltext": "患者为来自墨西哥中部的4个月大男性婴儿，有两名健康的男性兄弟。其母亲在妊娠第一孕期甲状腺功能减退并用药。婴儿出生时体重和身长正常，母乳喂养，接种了BCG疫苗但无瘢痕。患儿之母为在押人员，与婴儿在牢房中关押，牢房拥挤，与另外两人同住。在4个月时，因左腋窝疼痛性肿块接受医学评估。胸部X线显示提示肋骨骨折的影像；母亲被怀疑虐待儿童，婴儿被收入儿科医院。测得体重（4,190 g）和身长（58 cm）低于第3百分位，氧饱和度70%，发热、咳嗽、左腋窝体积增大，以及疼痛、发红和温热。血常规显示：血红蛋白8.8 g/dL (11.0-12.6)，白细胞29.3 × 109/L (6.0-17.5)，中性粒细胞18.4 × 109/L (1.0-8.5)，淋巴细胞7.0 × 109/L (4.0-13.5)，单核细胞3.5 × 109/L，血小板459 × 109/L (150-350)，C-反应蛋白16 mg/L (< 3.0)。首次胸腹部断层扫描显示左腋窝脓肿、第3-6肋骨溶骨性病变、左肺尖肺炎、双肺肺结节，以及颈部和纵隔淋巴结肿大。左腋窝脓肿活检报告为肌炎和化脓性脂膜炎。仅支气管肺泡液的细菌培养为阴性，结核分枝杆菌复合体的PCR为阴性。住院41天并接受两种抗微生物方案ceftriaxone-clindamycin和cefepime-vancomycin后，患儿出院。\n\n两个月后，8个月大时，因发热、易激惹及左肩胛部化脓性脓肿再次入院。血常规显示：血红蛋白10.8 g/dl (10.5-12)，白细胞21.2 × 109/L (6-17)，中性粒细胞12.2 × 109/L (1.5-8.5)，淋巴细胞7.5 × 109/L (4-10.5)，单核细胞1.2 × 109/L (600)，血小板583 × 109/L (150-350)；HIV血清学检测为阴性。胸部扫描可见左肺尖实变、支气管扩张、第2-7肋骨及第2-7胸椎溶骨性病变，以及多房性液体聚集；超声显示与肩胛部脓肿相关的瘘管。给予piperacillin-tazobactam，分泌物标本培养检出Aspergillus fumigatus后改用voriconazole。鉴于感染的复发和严重程度，怀疑固有免疫缺陷。二氢罗丹明试验显示无活性氧产生，且中性粒细胞gp91phox表达缺失，确立X连锁慢性肉芽肿病的诊断。下一代测序检测到CYBB中的致病变异为c.80_83del/Y (p.Val27Glyfs*33)。母亲为该变异的携带者 (c.80_83del/WT)。两名看似健康的年长男性兄弟无法进行遗传学检测。住院65天并接受voriconazole治疗28天后出院。开始每日应用trimethoprim-sulfamethoxazole进行抗生素预防，以及每周两次应用fluconazole进行抗真菌预防。两个月后，1岁时，因多灶性肺炎再次入院，并需要机械通气支持。血清检出半乳甘露聚糖抗原，灌洗液培养检出A. fumigatus，因而再次启动voriconazole治疗。患儿发生多器官衰竭，并于入院后1个月死亡。",
+    "translated_summary": "本文报道了一例患有慢性肉芽肿病并伴有侵袭性曲霉菌病的婴儿病例。该婴儿为一名四个月大的男孩，与母亲一同居住在监狱的牢房里。该婴儿左腋窝区域有肿瘤，胸部X光片显示肋骨骨折，因此被送往医院，怀疑是虐待儿童。胸部X光片显示腋窝脓肿、肋骨骨质溶解、肺炎和肺部结节；该患者接受了广谱抗生素治疗后出院。8个月时，该婴儿因发烧和脓肿蔓延至左肩区域而再次入院；胸部X光片显示病情恶化。从脓肿分泌物中分离出烟曲霉菌，确诊为侵袭性曲霉菌病，并开始使用伏立康唑治疗，疗程为28天。进行了二氢罗丹明测试，并诊断为慢性肉芽肿病，该疾病是由CYBB基因上的致病变异c.80_83del/Y引起的，该变异由母亲携带（c.80_83del/WT）。12个月时，该患者因对治疗产生耐药性的侵袭性曲霉菌病再次入院，最终导致死亡。"
+  },
+  {
+    "id": "multiclinsum_gs_en_133.txt",
+    "fulltext": "Male patient, 25 years old, Sundanese, presented at the Dental Hospital of the Faculty of Dentistry Universitas Padjadjaran with the chief complaint of mouth sores, which are painful on the upper and lower lips and exacerbated when eating and talking. Initially, four days ago, canker sores started in the oral cavity, then appeared on the lips two days later. The patient tried to self-medicate by applying petroleum jelly which he used to relieve his symptoms, but it did not improve. The patient replaced the drug with triamcinolone acetonide 0.1% in orabase ointment purchased at the pharmacy and applied it once a day. Canker sores were getting better but did not cure.\n\nThe patient had history a of fever for about a week before the canker sores appeared and there were no lesions on other parts of the body. He stated that the workload was quite heavy and he had not consumed a balanced nutritional diet for about one and a half months. He had no medical history, history of food allergies, or history of taking medication. He had no history of alcohol consumption or smoking, but he had a frequent habit of licking his lips. He also had a history of chickenpox when he was a child.\n\nThe patient had no fever with all vital signs within normal limits on general examination. Extra-oral examination showed no abnormalities in the lymph nodes. There were serosanguineous crusts that felt painful and bleed easily on the lips. Intra-oral examination revealed erythematous lesions, irregular in shape, and had diffuse borders, accompanied by pain in the upper and lower labial mucosa. Hyperkeratotic white plaque that could not be scraped off, irregular in shape, has diffuse borders, without pain in the region of tooth 38 left buccal mucosa. Yellowish-white plaques were seen on 1/3 of the posterior surface of the dorsal tongue, which could be scraped off without leaving an erythematous area, and there were indentations in the form of dental impressions without pain on the lateral right and left sides of the tongue. A painless hard nodule about 2×1 x 0.5 cm in size was seen in the midline of the hard palate. Several teeth were found in caries, radix, and edentulous conditions in all regions. The oral hygiene was poor.\n\nExamination of psychological conditions was evaluated using the DASS-21 questionnaire and showed normal depression level (score 0), normal anxiety level (score 6), and normal stress level (score 6). Based on history and clinical examination, the working diagnosis was suspected HAEM, accompanied by the coated tongue, frictional keratosis, crenated tongue, torus palatinus, reversible pulpitis of tooth 18, irreversible pulpitis of tooth 47, chronic apical periodontitis et causa radix of tooth 15, and edentulous teeth 28, 37, 36, and 46. The differential diagnosis of suspected HAEM lesions on the lips was exfoliative cheilitis. However, exfoliative cheilitis did not have herpes virus involvement. The patient was indicated for serological testing (IgG anti-HSV-1) to confirm the diagnosis. Oral health-related quality of life was measured, and the results of the OHIP-14 examination at the first visit were 35 (moderate OHRQol).\n\nThe non-pharmacological therapy included instruction to maintain oral hygiene by brushing the teeth and tongue using a soft-bristled toothbrush two times a day and using non-detergent toothpaste. Education was given such as increasing the intake of water by at least two liters per day, consuming a balanced nutritional diet, avoiding acidic, spicy, hard, and monosodium glutamate-containing foods, and stopping the bad habit of licking and peeling the skin of the lips. The pharmacological therapy included topical and systemic medications. The topical medications included instructions to compress the lips with gauze moistened with 0.9% NaCl solution at least three times a day and to apply a thin layer of triamcinolone acetonide 0.1% in orabase to the lips three times a day. The systemic medications included instruction to take a multivitamin once a day.\n\nThe progress of improvement was visible in the first follow-up, two days after the initial visit. The pain in the lips was reduced, but the canker sores have not healed. Extra-oral examination revealed serosanguinous crusts on the lips which were still painful and bled easily. The serological test result (IgG anti-HSV-1) was positive with a ratio of: 6.32 (positive: ratio > 1.1). The definitive diagnosis was established based on the history, clinical examination, and serological tests as HAEM. The non-pharmacological and pharmacological therapy was continued, and systemic medication was added in the form of instructions to consume acyclovir 200 mg tablets five times a day for one week.\n\nSignificant improvement was visible in the second follow-up, five days after the previous visit, showing excellent healing in all of the patient’s oral lesions. The OHIP-14 result at the last visit was 4 (good OHRQoL). The patient’s physical, psychological, and social conditions showed improvement and returned to normal after 7 days of treatment. Patient was referred to continue dental and oral care in the periodontics, dental conservation, oral surgery, and prosthodontics departments. The patient has approved and written informed consent for the case details to be published included publication of the images, and the institution has also approved for publication. This case had complied with the Declaration of Helsinki.",
+    "summary": "A 25-year-old male patient came to the Department of Oral Medicine with the chief complaint of painful canker sores on the lips. Extra-oral examination revealed serosanguineous crusts on the lips that were painful and easily bleed. Intra-oral examination showed diffused and painful irregular erythematous lesions on the upper and lower labial mucosa. The anti-HSV1 IgG test was positive. The patient was diagnosed with HAEM.\n\nCase management: Pharmacological therapy included triamcinolone acetonide 0.1% in orabase, acyclovir tablets, multivitamins, and 0.9% NaCl. Non-pharmacological therapy included advice on maintaining good oral hygiene, avoiding spicy and sour foods, and breaking the bad habit of licking the lips.",
+    "translated_fulltext": "男性患者，25 岁，巽他族，就诊于巴查查兰大学牙科学院牙科医院，主诉口腔溃疡，位于上下唇，疼痛，进食和说话时加重。起初于 4 天前，阿弗他溃疡首先出现在口腔内，随后于 2 天后出现在唇部。患者自行在患处外用凡士林以缓解症状，但未见好转。随后患者改用在药房购买的曲安奈德 0.1% Orabase 软膏，每日一次外用。阿弗他溃疡有所好转但未痊愈。\n\n患者在阿弗他溃疡出现前约一周有发热病史，且身体其他部位无皮损。其自述工作负荷较重，约一个半月来未摄入均衡营养饮食。无既往病史、食物过敏史或用药史。无饮酒或吸烟史，但有经常舔唇的习惯。儿童期患过水痘病史。\n\n一般检查无发热，生命体征均在正常范围内。口外检查未见淋巴结异常。唇部可见浆血性痂皮，触痛，且易出血。口内检查见上下唇黏膜有红斑性病变，形态不规则，边界弥漫，伴有疼痛。左侧 38 牙区颊黏膜可见白色过度角化斑块，形态不规则，边界弥漫，不可刮除，且无疼痛。舌背后 1/3 表面可见黄白色斑块，可刮除且不留下红斑区；舌两侧缘（右、左）可见齿印样压痕，无疼痛。硬腭中线可见约 2×1 x 0.5 cm 的无痛硬性结节。各区可见部分牙齿存在龋坏、残根（radix）及缺牙情况。口腔卫生差。\n\n心理状况评估采用 DASS-21 问卷，结果显示抑郁水平正常（得分 0）、焦虑水平正常（得分 6）、应激水平正常（得分 6）。根据病史与临床检查，初步工作诊断为疑诊 HAEM，伴有舌苔、摩擦性角化症、齿痕舌、腭隆突，18 牙可逆性牙髓炎，47 牙不可逆性牙髓炎，15 牙残根所致的慢性根尖周炎，以及 28、37、36、46 号牙缺失。对于唇部疑似 HAEM 病变的鉴别诊断为脱屑性唇炎。然而，脱屑性唇炎不涉及疱疹病毒。为明确诊断，建议进行血清学检测（IgG anti-HSV-1）。评估了口腔健康相关生活质量，初诊时 OHIP-14 检查结果为 35（中等 OHRQol）。\n\n非药物治疗包括：指导使用软毛牙刷每日 2 次刷牙及刷舌，并使用不含清洁剂的牙膏以维持口腔卫生。进行健康教育，如每日增加饮水量至至少 2 升，摄入均衡营养饮食，避免食用酸性、辛辣、坚硬及含谷氨酸钠的食物，并纠正舔唇和撕剥唇部皮肤的不良习惯。药物治疗包括局部与全身用药。局部用药包括：嘱用 0.9% NaCl 溶液湿润的纱布每日至少 3 次湿敷唇部，并每日 3 次在唇部薄薄涂抹曲安奈德 0.1% Orabase。全身用药包括：每日服用 1 次复合维生素。\n\n初诊后 2 天进行第一次复诊时可见病情有改善。唇部疼痛减轻，但阿弗他溃疡尚未痊愈。口外检查仍见唇部浆血性痂皮，仍有疼痛且易出血。血清学检测结果（IgG anti-HSV-1）为阳性，比例为：6.32（阳性：ratio > 1.1）。结合病史、临床检查及血清学检测，明确诊断为 HAEM。继续原非药物与药物治疗，并加用全身用药：嘱口服阿昔洛韦 200 mg 片，每日 5 次，疗程 1 周。\n\n在第二次复诊（较前一次复诊后 5 天）时可见显著改善，患者所有口腔病变均愈合良好。最后一次复诊时 OHIP-14 结果为 4（良好 OHRQoL）。经过 7 天治疗后，患者的躯体、心理及社会状况均改善并恢复正常。患者被转诊至牙周科、牙体牙髓科、口腔颌面外科及修复科继续口腔牙科治疗。患者已同意并签署书面知情同意，允许病例细节发表，包括影像资料的发表；机构亦已批准发表。本病例符合《赫尔辛基宣言》。",
+    "translated_summary": "一位25岁的男性患者因主诉嘴唇上有疼痛的口腔溃疡来到口腔科就诊。体外检查显示，嘴唇上有血清性渗出性结痂，触痛明显，且容易出血。口内检查显示，上唇和下唇黏膜上有弥漫性、不规则的、红斑状、疼痛的病灶。抗HSV1 IgG检测结果为阳性。该患者被诊断为复发性阿弗他性口炎（HAEM）。\n\n病例管理：药物治疗包括0.1%的三丁烯醇丙酸软膏、阿昔洛韦片、多种维生素和0.9%的生理盐水。非药物治疗包括建议患者保持良好的口腔卫生，避免食用辛辣和酸性食物，并纠正舔嘴唇的坏习惯。"
+  },
+  {
+    "id": "multiclinsum_gs_en_164.txt",
+    "fulltext": "A 56-year-old female patient presented with complaints of dyspnea that required oxygen supplementation. Her medical history dates back to July 2013 when she was hospitalized in the chest ward for dyspnea and cough with yellow sputum. She was subsequently diagnosed with Sjogren’s syndrome complicated with interstitial lung disease (ILD) and PAH (Table I). Her chest X-ray at that time showed vascular markings with interstitial thickening, costophrenic (CP) angle blunting and cardiomegaly. An echocardiogram revealed a pulmonary arterial (PA) systolic pressure of 99 mmHg, enlargement of the right atrium and ventricle, D-shaped left ventricle (LV), and severe tricuspid regurgitation. Chest CNYCT showed no filling defects, excluding pulmonary embolism; it also displayed an enlarged pulmonary trunk, right atrium (RA), and right ventricle (RV), further evidencing pulmonary hypertension. Symptoms of dry mouth, dry eyes, and cracked tongue mucosa, with a Schirmer’s test showing <5 cm, oculus uterque (OU). A positive minor salivary gland biopsy, nuclear medicine scan showing impaired salivary gland function, and a positive anti-Ro test, confirmed Sjogren’s syndrome. She started on Revatio (Sildenafil) 20 mg three times a day (TID) for pulmonary hypertension control, adding Tracleer (Bosentan) in 2016 due to disease progression. A right heart catheterization (RHC) revealed a mean pulmonary arterial pressure (PAP) of 39 mmHg, pulmonary vascular resistance (PVR) nearly 15 Woods, and a wedge pressure of 4, indicating pre-capillary type, group I, CTD-related PAH in 2017. The right heart catheterization (RHC) report allowed for insurance coverage of Opsumit (Macitentan) 10 mg once a day (QD), replacing Tracleer (Bosentan) in 2017. From 2017 to 2020, she was hospitalized multiple times for steroid treatments to manage her underlying Sjogren’s syndrome.\n\nPulmonary hypertension treatment is risk-based, and until 2017, the patient was considered low to intermediate risk, controlled with two medications (Sildenafil + Macitentan). Her condition remained stable until October 2020, when she experienced worsened dyspnea accompanied by cough and expectoration of white sputum, suggestive of infection. On November 10, 2020, the patient experienced severe dyspnea, cold sweats, and cyanosis, with SpO2 dropping to 70%, necessitating 100% O2 via face tent. Blood gas and lab tests revealed a lactate level of 5.2 mmol/l and brain natriuretic peptide (BNP) over 10,000 pg/ml, strongly suggesting cardiogenic shock. She was prepped for intensive care unit (ICU) admission, intubated, and initiated on four pulmonary hypertension medications. Her condition stabilized and showed improvement, preventing further deterioration. On November 12, 2020, evaluation for heart-lung transplantation began. Her condition continued to improve with off vasopressors on November 13, 2020, and extubating on November 14, 2020, and transferred to a general ward on November 21, 2020, with O2 tapered to nasal cannula 2l/min. A follow-up RHC continued to show elevated pulmonary artery pressure, likely attributed to chronic hypertension leading to right heart strain and eventual failure. After intensive care unit (ICU) treatment, she was referred to National Taiwan University Hospital for evaluation for heart-lung transplant.\n\nReviewing the records since the onset of her illness, it was evident that pulmonary artery pressure had steadily increased, and the distance covered in the 6-minute walk test was progressively shortened. Currently, the patient is classified as high risk. She continues regular hospitalizations for control. Despite the relatively stable condition, her chief complaint during the admission is still dyspnea. The physical examination revealed mild rhonchi ILD and a pansystolic murmur indicative of severe valvular heart disease, with no other significant findings. Ventavis (Iloprost) 10 mcg/ml 2 ml was added in 2020. Molecular hydrogen therapy (1 capsule/day) was initiated in May 2023. Hydrogen capsules (PURE HYDROGEN) were purchased from HoHo Biotech Co., Ltd. (Taipei, Taiwan, ROC). Each capsule contained 170 mg of hydrogen-rich coral calcium containing 1.7×1,021 molecules of hydrogen, which is equivalent to 24 cups of water with 1,200 ppb of hydrogen or 0.6 mM of hydrogen per 200 ml of water. Adjuvant therapy with hydrogen capsules resulted in increased CD127 + Treg, decreased anti-Ro antibody, decreased B cell subsets, and stabilization of clinical symptoms and signs was observed following the addition of hydrogen therapy in this patient. No adverse reactions or events were observed following the administration of hydrogen capsules. Flow cytometry and serological examination were employed for whole-blood analysis to assess changes in immune cells and autoantibody before and after hydrogen therapy. For subsequent whole-blood analysis via flow cytometry, blood samples were prepared using standard fluorescent dye preparation methods and fluorescent antibody reagent kits with dried reagents (Beckman Coulter, Brea, CA, USA). The methods, steps, immunophenotypic analysis, and cell gating were conducted following previously described procedures. Our analysis of immunophenotypic markers before and after hydrogen therapy revealed increased CD127 + Treg and decreased B cell subsets after treatment. Moreover, this study adheres to the CARE reporting guidelines (2013 CARE Checklist).",
+    "summary": "We present the case of a 56-year-old female with CTD-PAH, diagnosed in 2013 with Sjogren’s syndrome complicated by interstitial lung disease (ILD) and PAH. Despite treatment with sildenafil, bosentan, macitentan, iloprost, and corticosteroids, her condition deteriorated, resulting in severe dyspnea and cardiogenic shock in 2020. In May 2023, molecular hydrogen therapy was initiated as an adjuvant treatment. The patient received daily hydrogen capsules, which led to increased CD127+ Treg cells, reduced anti-Ro antibodies, and decreased B cell subsets. Her clinical symptoms stabilized without adverse effects.",
+    "translated_fulltext": "一名56岁女性患者以需氧气补充的呼吸困难为主诉就诊。其病史可追溯至2013年7月，当时因呼吸困难及咳黄痰入住胸腔科病房。随后被诊断为干燥综合征并发间质性肺病(ILD)及PAH(Table I)。当时胸部X线显示肺纹理增多伴间质增厚、肋膈角(CP)变钝及心影增大。超声心动图示肺动脉(PA)收缩压99 mmHg，右心房和右心室扩大，左心室(LV)呈D形，重度三尖瓣返流。胸部CNYCT未见充盈缺损，排除肺栓塞；同时显示肺动脉干、右心房(RA)和右心室(RV)扩大，进一步提示肺动脉高压。出现口干、眼干、舌黏膜裂纹的症状，Schirmer试验显示<5 cm，oculus uterque (OU)。小唾液腺活检阳性、核医学扫描显示唾液腺功能受损以及抗Ro检测阳性，确诊干燥综合征。开始使用Revatio (Sildenafil) 20 mg 一日三次(TID)以控制肺动脉高压，因病情进展于2016年加用Tracleer (Bosentan)。2017年右心导管术(RHC)显示平均肺动脉压(PAP)39 mmHg，肺血管阻力(PVR)近15 Woods，楔压4，提示毛细血管前型I组CTD相关PAH。RHC报告使其于2017年获批由保险给付Opsumit (Macitentan) 10 mg 每日一次(QD)，取代Tracleer (Bosentan)。2017至2020年间多次住院接受类固醇治疗以控制其基础的干燥综合征。\n\n肺动脉高压的治疗基于风险分层，至2017年前患者被认为为低至中等风险，使用两种药物(Sildenafil + Macitentan)控制。其病情一直稳定直至2020年10月，出现呼吸困难加重，伴咳嗽及咳白痰，提示感染。于2020年11月10日患者出现严重呼吸困难、冷汗及发绀，SpO2降至70%，需以面罩帐给予100% O2。血气与实验室检查显示乳酸5.2 mmol/l、脑利钠肽(BNP)>10,000 pg/ml，强烈提示心源性休克。准备入住重症监护病房(ICU)，气管插管，并开始四种肺动脉高压药物治疗。病情稳定并好转，避免了进一步恶化。于2020年11月12日开始评估心肺移植。病情继续改善，2020年11月13日停用血管加压药，2020年11月14日拔管，2020年11月21日转入一般病房，氧疗减至鼻导管2l/min。复查RHC仍示肺动脉压升高，可能归因于慢性高压导致右心负荷增加并最终衰竭。ICU治疗后，转介至国立台湾大学医院评估心肺移植。\n\n回顾自疾病起病以来的病历，可见肺动脉压持续升高，6分钟步行试验行走距离逐渐缩短。目前患者被归为高风险。仍定期住院以控制病情。尽管病情相对稳定，此次入院的主诉仍为呼吸困难。体格检查提示轻度干啰音，ILD，以及提示重度瓣膜性心脏病的全收缩期杂音，其余无明显异常。于2020年加用Ventavis (Iloprost) 10 mcg/ml 2 ml。2023年5月开始分子氢治疗(1 capsule/day)。氢胶囊(PURE HYDROGEN)购自HoHo Biotech Co., Ltd. (Taipei, Taiwan, ROC)。每粒含170 mg富氢珊瑚钙，含有1.7×1,021个氢分子，相当于24杯含1,200 ppb氢的水，或每200 ml水中0.6 mM的氢。在本患者加用氢胶囊的辅助治疗后，观察到CD127 + Treg增加、抗Ro抗体降低、B细胞亚群减少以及临床症状和体征的稳定。给予氢胶囊后未观察到不良反应或事件。采用流式细胞术和血清学检查进行全血分析，以评估氢治疗前后免疫细胞和自身抗体的变化。随后通过流式细胞术进行全血分析时，采用标准荧光染料制备方法和含干试剂的荧光抗体试剂盒(Beckman Coulter, Brea, CA, USA)制备血样。方法、步骤、免疫表型分析和细胞门控均依照先前描述的程序进行。我们对氢治疗前后免疫表型标志物的分析显示，治疗后CD127 + Treg增加，B细胞亚群减少。此外，本研究遵循CARE报告指南(2013 CARE Checklist)。",
+    "translated_summary": "我们介绍了一位56岁女性患者的病例，该患者患有结缔组织病相关的肺动脉高压（CTD-PAH），于2013年被诊断出患有干燥综合征，并伴有间质性肺病（ILD）和肺动脉高压。尽管接受了西地那非、博森坦、马西替坦、伊洛前列素和皮质类固醇等药物治疗，但她的病情仍在恶化，导致2020年出现严重的呼吸困难和心源性休克。2023年5月，开始采用分子氢疗法作为辅助治疗。患者每日服用氢气胶囊，结果显示CD127+调节性T细胞数量增加，抗Ro抗体减少，B细胞亚群数量下降。她的临床症状得到稳定，且未出现不良反应。"
+  },
+  {
+    "id": "multiclinsum_gs_en_354.txt",
+    "fulltext": "The patient was a 45-year-old male born in Pakistan who had resided in Portugal for 7 years. He had a history of grade 3 obesity, with no other known personal history or usual pharmacological therapy.\n\nThe patient sought emergency care for fever, dry cough, dyspnea, chest pain, dysgeusia, headache and myalgia with 4 days of evolution. In the summary neurological examination at admission, there were no reported changes. In the evaluation of the respiratory system, tachypnea and pulmonary auscultation with bilateral rough vesicular murmur, without other adventitious sounds, were noted. The remainder of the objective examination showed no changes.\n\nOf the complementary diagnostic tests performed at admission, there was a slight increase in inflammatory parameters and in arterial blood gases under an inspired oxygen fraction (FiO2) of 21%, with type 1 respiratory failure and extensive predominant bilateral, peripheral and basal opacities on chest teleradiography. After a positive reverse-transcription real-time polymerase chain reaction (RT-PCR) test for SARS-CoV-2 (nasal and oropharyngeal exudate) and negative tests for influenza A and B, Streptococcus pneumoniae and Legionella pneumophila, a diagnosis of pneumonia by SARS-CoV-2 infection was established.\n\nOver the first 48 hours, progressive worsening of fatigue, dyspnea and type 1 respiratory failure, requiring an increase in supplemental oxygen therapy, were observed. Due to the lack of improvement, noninvasive mechanical ventilation was initiated; however, due to poor adherence, high-flow oxygen therapy was initiated through a nasal cannula, without a response to therapy.\n\nIn this context, the patient was admitted to the intensive care unit (ICU), level III, where he underwent sedoanalgesia and orotracheal intubation with connection to invasive mechanical ventilation.\n\nOn the eleventh day of hospitalization, treatment with remdesivir, dexamethasone, enoxaparin and empirical antibiotic therapy with amoxicillin/clavulanic acid and azithromycin, administered on suspicion of bacterial overinfection, was continued. During this period, sustained fever was observed, with a weak response to antipyretic therapy, with improvements in inflammatory parameters after the third day of hospitalization in the ICU.\n\nTo exclude any concomitant infectious etiology, intravenous devices were replaced, and blood cultures, cultures of the tip of the central catheter and bronchial secretions, urinalysis, urine culture and transthoracic echocardiography were performed. Among the cultures, the blood culture yielded the only positive result, i.e., Klebsiella pneumoniae, which is sensitive to amoxicillin/clavulanic acid, which the patient was already receiving. The summary echocardiogram did not reveal valve changes suggestive of endocarditis, but the patient presented hypokinesia of the lateral wall and left ventricular apex, as well as poor biventricular function. A slight increase in troponins (1.8ng/mL) and ST-segment depression in leads I and aVL were confirmed, suggesting the existence of acute coronary syndrome or septic cardiomyopathy.\n\nOther noninfectious causes of febrile symptoms in the critically ill patient were excluded, including treatment with neuroleptics or altered thyroid function.\n\nNotably, there was a need for inotropic support with dobutamine in the ventilatory weaning phase as well as noninvasive ventilatory support after orotracheal extubation, which occurred on the fifteenth day of hospitalization.\n\nOn the sixteenth day of hospitalization (nineteenth day of confirmed disease), there was an episode of altered state of consciousness, conjugated deviation of gaze to the right and myoclonus of the face and thoracic region to the left followed by a generalized tonic-clonic seizure crisis, which ceased after midazolam therapy. The hypothesis that the seizure occurred in the context of a hypoxic-ischemic event was excluded because the patient remained normotensive, there was never a peri-event or hypoxemia, serum lactate level was normal, and diuresis remained preserved. Any ionic or glycemic disorders that could explain the inaugural seizure episode were excluded.\n\nIn the post-critical period, there was an absence of eye opening, no verbal response, failure to localize to pain (coma scale of Glasgow 7), and persistent left hemiparesis grade 3 out of 5. Due to the need for airway protection, the patient was sedated, subjected to orotracheal intubation and started on anticonvulsant therapy.\n\nIn the process of diagnosis of the convulsive episode, after cranial computed tomography confirmed no changes, the patient was subjected to lumbar puncture, with turbid CSF output and mild proteinorrachia but without pleocytosis and with normal opening pressure. In the CSF, neurotropic virus and venereal disease research laboratory (VDRL), acid-alcohol resistant bacteria tests and an RT-PCR test for SARS-CoV-2 were requested, and samples were collected for culture. Electroencephalography was performed 1 hour after propofol suspension and under fentanyl, with a single record and total duration of 13 minutes; the findings indicated no changes.\n\nAfter confirmation of a positive RT-PCR test for SARS-CoV-2 RNA in the CSF, without CSF pleiocytosis, the hypothesis of bacterial but nonviral meningitis was excluded, considering the hypothesis of encephalitis. Magnetic resonance imaging (MRI) performed on the seventeenth day of hospitalization showed multiple image artifacts associated with patient movement during the procedure, suggesting the need to repeat the examination.\n\nAfter discontinuation of sedoanalgesia, a change in consciousness was observed, with a Glasgow coma scale score of 14, persistent left hemiparesis with muscle strength grade 4 in 5 and an absence of involuntary movements, allowing safe orotracheal extubation in 24 hours. Given the favorable clinical outcome, brain biopsy was excluded. On the twenty-first day of hospitalization, the patient was transferred to the ward.\n\nThe patient maintained apyrexia without altered state of consciousness. No new episodes of involuntary movements were observed, and on the twenty-sixth day of hospitalization, he underwent a reassessment MRI, which revealed no pathological changes. As he maintained a favorable clinical evolution, the patient was discharged on the thirty-first day of hospitalization without antiepileptic drugs and with an appointment for follow-up with the internal medicine department.\n",
+    "summary": "The authors present the clinical case of a 45-year-old man admitted for pneumonia with a positive result for SARS-CoV-2, with no neurological history, who, on the 16th day of admission, presented a sudden change in consciousness accompanied by a conjugate deviation of the gaze to the right and myoclonia of the face and thoracic region to the left, followed by a generalized tonic-clonic convulsive seizure, associated with persistent left hemiparesis. From the study carried out, the existence of RT-PCR for SARS-CoV-2 in the cerebrospinal fluid is highlighted. The patient presented a clinical evolution with gradual improvement, and the outcome was favourable.\n",
+    "translated_fulltext": "患者为45岁男性，出生于巴基斯坦，已在葡萄牙居住7年。既往有3级肥胖史，无其他已知个人病史或平素常规药物治疗。\n\n患者因发热、干咳、呼吸困难、胸痛、味觉障碍、头痛和肌痛就诊急诊，病程4天。入院时的简要神经系统检查未见异常。呼吸系统评估中，见呼吸急促，肺部听诊可闻双侧粗糙的肺泡呼吸音，无其他附加音。其余客观检查未见异常。\n\n入院时所行的辅助诊断检查显示炎症指标轻度升高，且在吸入氧分数(FiO2)为21%的条件下动脉血气提示I型呼吸衰竭，胸部远距摄片可见广泛、以双侧、外周及基底部为主的阴影。在SARS-CoV-2（鼻腔及口咽分泌物）逆转录实时聚合酶链反应(RT-PCR)检测阳性、甲型和乙型流感、肺炎链球菌及嗜肺军团菌检测阴性后，确立为SARS-CoV-2感染所致肺炎的诊断。\n\n前48小时内，疲劳、呼吸困难及I型呼吸衰竭进行性加重，需要增加补充氧疗。由于缺乏改善，开始无创机械通气；然而因耐受性差，改为通过鼻导管进行高流量氧疗，仍无疗效。\n\n在此背景下，患者收入重症监护病房(ICU)，III级，在此接受镇静镇痛及口腔气管插管，并接入有创机械通气。\n\n住院第11天，继续使用remdesivir、dexamethasone、enoxaparin，并因怀疑细菌继发感染而给予amoxicillin/clavulanic acid和azithromycin的经验性抗生素治疗。其间出现持续发热，对解热治疗反应较弱；在ICU住院第3天后炎症指标有所改善。\n\n为排除任何并存的感染病因，更换了静脉装置，并进行了血培养、中心静脉导管尖端和支气管分泌物培养、尿常规、尿培养及经胸超声心动图检查。在诸培养中，仅血培养为阳性，即肺炎克雷伯菌，对amoxicillin/clavulanic acid敏感，患者已在使用该药。简要超声心动图未见提示心内膜炎的瓣膜改变，但可见左心室侧壁及心尖运动减弱，并伴双心室功能不良。证实肌钙蛋白轻度升高(1.8ng/mL)及导联I和aVL的ST段压低，提示存在急性冠状动脉综合征或败血症性心肌病。\n\n同时排除了危重患者发热的其他非感染性原因，包括使用神经安定剂治疗或甲状腺功能异常。\n\n值得注意的是，在撤机阶段需要以dobutamine进行正性肌力支持，且在口腔气管拔管后需要无创通气支持；拔管发生于住院第15天。\n\n住院第16天（确诊后第19天），出现一次意识状态改变、右侧共同凝视偏斜及左侧面部和胸部肌阵挛，随后发生全面强直-阵挛性发作，经midazolam治疗后停止。由于患者始终血压正常、围发作期从未出现低氧血症、血清乳酸水平正常且尿量保持，排除了在低氧缺血性事件背景下发作的假设。并已排除任何可解释此次首发癫痫发作的离子或血糖紊乱。\n\n在发作后期，出现无睁眼、无言语反应、对疼痛刺激不能定位（格拉斯哥昏迷评分7分），并持续左侧偏瘫，肌力3/5级。因需要气道保护，给予镇静、行口腔气管插管并开始抗惊厥治疗。\n\n在对该癫痫发作的诊断过程中，颅脑计算机断层扫描证实无异常后，行腰椎穿刺，CSF外观混浊，轻度蛋白增多，但无细胞增多，开放压正常。在CSF中，申请了神经嗜性病毒和性病研究实验室（VDRL）检测、抗酸-酒精耐受细菌检测以及SARS-CoV-2的RT-PCR检测，并采集标本进行培养。在停用propofol 1小时、在fentanyl下行脑电图检查，仅记录一次，总时长13分钟；结果未见异常。\n\n在证实CSF中SARS-CoV-2 RNA的RT-PCR阳性且无CSF细胞增多后，排除了细菌性（而非病毒性）脑膜炎的假设，考虑脑炎的可能。住院第17天行磁共振成像(MRI)显示多发与检查过程中患者移动相关的图像伪影，提示需重复检查。\n\n停用镇静镇痛后，观察到意识改变，格拉斯哥昏迷评分14分，持续左侧偏瘫，肌力4/5级，且无不自主运动，因而可于24小时内安全行口腔气管拔管。鉴于临床转归良好，未行脑活检。住院第21天，患者转入普通病房。\n\n患者维持无发热且无意识状态改变。未再见不自主运动发作，住院第26天复评MRI，未见病理性改变。鉴于其临床病程持续向好，住院第31天在未使用抗癫痫药物的情况下出院，并预约内科随访。",
+    "translated_summary": "本文介绍了一位45岁男性患者的临床病例。该患者因肺炎入院，SARS-CoV-2检测结果呈阳性，既往无神经系统疾病史。入院第16天，患者突然出现意识改变，伴有双眼向右偏斜，以及面部和胸部区域的左侧肌阵挛，随后出现全身性强直-阵挛性癫痫发作，并伴有持续的左侧肢体无力。研究结果显示，脑脊液中存在SARS-CoV-2的RT-PCR阳性结果。患者的病情逐渐好转，预后良好。"
+  },
+  {
+    "id": "multiclinsum_gs_en_423.txt",
+    "fulltext": "A 23-month-old boy with hypoxic-ischaemic encephalopathy at birth with good brain motor potential and normal psychomotor development. He had a personal history of restrictive cardiomyopathy and was included in a cardiac transplant programme when he was 16 months old. He also required the implantation of an external Berlin Heart biventricular support device. In order to prevent embolic events, double antiplatelet and anticoagulant treatment was administered. When he was 23 month old presented with disconnection and right hemiparesis. A computerised tomography (CT) scan showed a hyperdense left middle cerebral artery (MCA), as well as a chronic right parietotemporal infarction. His blood analysis showed: red cells 4.16 × 106 µ/L; haemoglobin 11.4 g/gL; activated partial thromboplastin time (APTT) 93 seconds and international normalised ratio (INR) 1.08.\n\nIntravenous thrombolytic treatment was contraindicated due to double antiplatelet and anticoagulant treatment at full dose with heparin, so an intra-arterial thrombectomy was performed. Although the patient was 23 months old, he was in the third percentile of the weight curve (10 kg). Under general anaesthesia, the right femoral artery was punctured and an 11 cm long 4F sheath (Cordis, Ireland) was placed. A 4F vertebral Radiofocus catheter (Glidecath of Terumo, Belgium) was used to confirm the occlusion of the M1 segment of the left MCA. The artery was recanalised by mechanical thrombectomy with a stentriever using the 4F vertebral catheter as a tutor, positioning it in the petrous segment of the carotid artery. A 3 mm × 20 mm Trevo XP Pro Vue device (Stryker, The Netherlands) was used, with a straight Rapid Transit microcatheter (Codman Neurovascular, UK), opening the artery in one pass. The whole system was removed (tutor catheter, microcatheter and stentriever) simultaneously. In the control run, an iatrogenic dissection of the left internal carotid artery was detected, which had no clinical significance, however, as the left hemisphere was irrigated through the anterior communicant artery.\n\nOne month later, his heart transplant was carried out successfully. Neurologically, the only long-term sequel that came as a result of the stroke was a right upper limb spasticity.",
+    "summary": "A 16-month-old boy with restrictive cardiomyopathy who was listed for a cardiac transplant. At 20 months he required an implantation of an external biventricular support device (Berlin Heart) and had a left hemisphere stroke at 23 months. An intra-arterial approach was used and produced good clinical results. One month later, a heart transplant was performed successfully.",
+    "translated_fulltext": "一名23个月大的男孩，出生时患有缺氧缺血性脑病，但大脑运动功能良好，精神运动发育正常。他有束带型心肌病的病史，并在16个月大时被纳入心脏移植计划。他还接受了外部柏林心脏双心室辅助装置的植入。为了预防栓塞事件，他接受了双重抗血小板和抗凝治疗。在他23个月大时，出现了肢体无力，右侧半身麻痹。计算机断层扫描（CT）显示，左侧中脑动脉（MCA）密度增高，同时还发现慢性右侧顶颞叶梗死。他的血液分析结果显示：红细胞4.16×106/L；血红蛋白11.4 g/L；活化部分凝血活酶时间（APTT）93秒；国际标准化比值（INR）1.08。\n\n由于他正在接受双重抗血小板和抗凝治疗，且剂量已达最大，因此不适合进行静脉溶栓治疗，于是进行了动脉内血栓切除术。尽管患者只有23个月大，但他的体重处于体重曲线的第三百分位数（10公斤）。在全身麻醉下，穿刺右股动脉，放置一根11厘米长的4F导管（科迪斯公司，爱尔兰）。使用4F椎动脉导管（特鲁莫公司Glidecath，比利时），确认左侧MCA的M1段发生闭塞。通过使用4F椎动脉导管作为引导，采用支架取栓器进行机械血栓切除术，将导管放置在颈动脉岩状段，从而使动脉重新通畅。使用3毫米×20毫米的Trevo XP Pro Vue装置（斯特莱克公司，荷兰），并配合直型Rapid Transit微导管（科德曼神经血管公司，英国），一次性打开了动脉。整个系统（引导导管、微导管和支架取栓器）同时被移除。在随访检查中，发现左侧颈内动脉发生了医源性撕裂，但由于左半球通过前交通动脉得到灌注，因此该撕裂没有临床意义。\n\n一个月后，他成功接受了心脏移植。神经系统方面，由于中风引起的唯一长期后遗症是右侧上肢痉挛。",
+    "translated_summary": "一位16个月大的患有限制性心肌病的男孩，已被列入心脏移植的候补名单。在20个月大时，他需要植入一台外部双心室辅助装置（柏林之心），并在23个月大时发生了左半球中风。采用经动脉穿刺的方法，取得了良好的临床效果。一个月后，成功进行了心脏移植。"
+  },
+  {
+    "id": "multiclinsum_gs_en_458.txt",
+    "fulltext": "A 12-year-old boy was brought to our department exhibiting sudden onset symptoms of headache and polyuria-polydipsia syndrome, which began one week prior to his initial visit. The child had no significant medical history. During the first clinical evaluation, he measured 146.5 cm in height (M) and weighed 30 kg (-1.4 SD). There were no observed signs of adrenal insufficiency or hypothyroidism. He was at the onset of puberty, with gonad sizes measuring 3.2 cm on each side and a penis length of 6.2 cm (M). Notably, the patient experienced polyuria-polydipsia syndrome, with fluid excretion reaching up to 113ml/kg/day, nocturnal enuresis, and an excessive liquid intake of 3.8 liters/m². Ophthalmologic examination yielded expected results, with no visual impairments detected and normal optical coherence tomography (OCT) findings.\n\nThe biological assessment revealed DI, with a serum sodium level of 140 mEq/l and plasma osmolality of 287 mosm/kg, while the urine osmolality was significantly low at 179 mosm/kg. Furthermore, his serum levels of insulin-like growth factor-1 (IGF1), prolactin (PRL), free T4, cortisol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were all within the normal range.\n\nMRI scans with and without contrast highlighted apoplexy in an RCC, showing a spontaneous hyperintensity on T1 and T2 sequences measuring 15x6x11 mm. The anterior pituitary gland displayed homogeneous contrast uptake. However, we observed a loss of the typical hyperintensity of the posterior pituitary gland, with no radiological indications of a craniopharyngioma. Therefore, during the initial hormonal evaluation, the only hormone deficiency identified in our case was DI, which showed significant improvement under vasopressin treatment. The case was reviewed in a multidisciplinary meeting, including an endocrinologist, neurosurgeon, and radiologist. Given the absence of clinical or biological signs other than DI and the stability of the RCC apoplexy over nine months of MRI monitoring—with measurements of 12 × 11 × 10 mm—a conservative management approach with regular follow-ups was chosen.\n\nThe child was monitored for three years, during which he displayed normal puberty development and maintained a stable hormonal profile (Table 1). Visual evaluations revealed no abnormalities. However, a decrease in growth velocity was noted, dropping from -0.8 SD to -1.1 SD. This necessitated an investigation for acquired growth hormone (GH) deficiency. At the age of 14 years and nine months, the child was readmitted to undergo two GH stimulation tests: A propranolol-glucagon test and an Insulin Tolerance Test, which indicated a partial GH deficiency with peaks of 19.3 µUI/ml and 10.0 µUI/ml, respectively. After receiving GH treatment, the patient experienced a notable increase in growth velocity, improving from -1.1 SD to 0.2 SD over one year.\n\nSubsequently, MRI monitoring showed a stable appearance of the RCC apoplexy after two years (11 × 12 × 11 mm), with a slight decrease in size observed at the three-year follow-up, measuring 7 × 10 × 6 mm. It is important to note that the radiological follow-up was consistently conducted at the same MRI center, with the same radiologist interpreting both recent and previous MRI findings during multidisciplinary meetings that included an endocrinologist and a neurosurgeon.",
+    "summary": "We present the case of a 12-year-old boy admitted due to the recent onset of headaches and diabetes insipidus. Magnetic resonance imaging revealed Rathke cleft cyst apoplexy. Given the absence of compressive symptoms in a child at the early stages of puberty and without abnormalities in basic endocrine tests, a conservative strategy was employed, involving regular clinical, biological, and radiological follow-ups. The child experienced normal puberty without any endocrine deficiencies except for a partial growth hormone deficiency.",
+    "translated_fulltext": "一位 12 岁的男孩被送往我科，表现出突然出现的头痛和多尿-烦渴综合征症状，这些症状在他初次就诊前一周开始出现。该儿童没有明显的病史。在第一次临床评估中，他的身高为 146.5 厘米（平均值），体重为 30 公斤（-1.4 SD）。未观察到肾上腺功能不全或甲状腺功能减退的迹象。他正处于青春期，两侧睾丸大小均为 3.2 厘米，阴茎长度为 6.2 厘米（平均值）。值得注意的是，该患者出现了多尿-烦渴综合征，每日液体排泄量高达 113 毫升/公斤，并伴有夜尿症，液体摄入量过多，达到 3.8 升/平方米。眼科检查结果符合预期，未发现视力障碍，光学相干断层扫描（OCT）结果正常。\n\n生物学评估显示存在中枢性尿崩症，血清钠水平为 140 mEq/l，血浆渗透压为 287 mosm/kg，而尿液渗透压显著降低，为 179 mosm/kg。此外，他的血清胰岛素样生长因子-1 (IGF1)、催乳素 (PRL)、游离 T4、皮质醇、促卵泡激素 (FSH) 和黄体生成素 (LH) 水平均在正常范围内。\n\n增强和非增强 MRI 扫描显示肾细胞癌 (RCC) 发生卒中，在 T1 和 T2 序列中显示自发性高信号，大小为 15x6x11 毫米。前脑垂体显示均匀的造影剂吸收。然而，我们观察到后脑垂体典型的增强信号消失，但未发现颅咽管瘤的放射学迹象。因此，在初步激素评估期间，我们病例中仅发现一种激素缺乏，即中枢性尿崩症，在加压素治疗后症状得到显著改善。该病例在多学科会议中进行了讨论，包括内分泌科医生、神经外科医生和放射科医生。考虑到除中枢性尿崩症外，没有其他临床或生物学迹象，并且在九个月的 MRI 监测期间，RCC 卒中的情况保持稳定（测量值为 12 × 11 × 10 毫米），因此选择了保守治疗方法，并定期进行随访。\n\n该儿童接受了三年的监测，在此期间，他表现出正常的青春期发育，并维持了稳定的激素水平（表 1）。视力评估未发现异常。然而，观察到生长速度有所下降，从 -0.8 SD 降至 -1.1 SD。这需要进行生长激素 (GH) 缺乏症的检查。在 14 岁零九个月时，该儿童再次入院，接受了两次 GH 刺激试验：一种是普萘洛尔-胰高血糖素试验，另一种是胰岛素耐受试验，结果显示存在部分 GH 缺乏，峰值分别为 19.3 µUI/ml 和 10.0 µUI/ml。在接受 GH 治疗后，患者的生长速度显著增加，一年内从 -1.1 SD 改善到 0.2 SD。\n\n随后，MRI 监测显示，两年后 RCC 卒中的外观保持稳定（11 × 12 × 11 毫米），在三年随访时观察到大小略有减小，测量值为 7 × 10 × 6 毫米。重要的是，放射学随访始终在同一 MRI 中心进行，由同一放射科医生解读最近和之前的 MRI 结果，并在包括内分泌科医生和神经外科医生的多学科会议中进行讨论。",
+    "translated_summary": "我们报告了一例12岁男孩的病例，该男孩因近期出现头痛和尿崩症而入院。磁共振成像显示为Rathke裂隙囊肿破裂。考虑到该儿童正处于青春期早期，且未出现压迫症状，且基础内分泌检查结果正常，因此采取了保守治疗策略，包括定期进行临床、生物学和放射学随访。该儿童经历了正常的青春期，除了部分生长激素缺乏外，没有其他内分泌功能缺陷。"
+  },
+  {
+    "id": "multiclinsum_gs_en_474.txt",
+    "fulltext": "Patient and observation\nPatient information: This was a 67-year-old patient with no medical history who presented with dysphagia, dysphonia and altered general condition.\n\nClinical findings: initial clinical examination found a conscious patient with a Glasgow score of 15/15, apyrexia, blood pressure of 12/07 cmHg, oxygen saturation of 100%, heart rate of 80/min, conjunctivae of normal colour with a large mass in the cavum. There was no hepatomegaly or splenomegaly, the lymph node areas were free, the rest of the physical examination was normal.\n\nChronology: the patient had been experiencing difficulty swallowing with dysphonia for 6 months, the clinical picture worsened with the development of dysphagia for solids with a deterioration in general condition (weight loss of 15kg/6 months).\n\nDiagnostic approach: cervico-thoraco-abdomino-pelvic CT scan showed a 70 mm x 40 mm nasopharyngeal mass extending to 60 mm. The patient's blood work was normal (white blood cell count, renal and hepatic function, lactate dehydrogenase and HIV, HCV and HBV serologies). The histological and immunohistochemical study of the nasopharyngeal biopsy was in favour of a grade 1,2 CD20+; CD19+; CD79a+; CD10+ follicular B-cell NHL in 2 readings in 2 different laboratories. The bone marrow biopsy was normal as was the pre-therapeutic work-up.\n\nTherapeutic intervention: the patient received 4 RCHOP 21 cures (rituximab 375mg/m2 intravenous (iv), cyclophosphamide 750 mg/m2 iv, oncovin 2 mg iv, prednisolone 100 mg orally, and doxorubicin 50 mg/m2 (iv) with no response and then 3 RDHAOX cures (rituximab 375 mg/m2 intravenous (iv) on day 1, high dose aracytine 2 g/m2 x 2 iv on day 2, dexamethasone 40 mg from day 1 to day 4, and oxalipatine 100 mg/m2 on day 1) with no clinical response.\n\nFollow-up and results of therapeutic interventions: the persistence and increase of the nasopharyngeal mass led to the realization of the tracheotomy, the biopsy of the nasopharyngeal mass objectified the disappearance of the lymphoid B infiltration with presence of the amyloid deposits AL type kappa.\n\nImmune electrophoresis of plasma proteins showed the presence of immunoglobulin M kappa, the dosage of light chains was not performed due to lack of resources, the myelogram and a second bone marrow biopsy were normal, the TEP scan objectified a hypermetabolic nasopharyngeal process without other anomalies, the cardiac evaluation (ECG, natriuretic peptides, troponin, echocore) and renal were without particularities, the patient is currently under protocol bortezomib, prednisone and bendamustine with good clinical evolution after the first treatment.\n",
+    "summary": "We report the case of a 67-year-old patient without pathological CDDs who presented with a deterioration of general condition with progressive dysphonia and dysphagia with a large mass in the neck that was biopsy-proven to be a grade 1 and 2 follicular non-Hodgkin lymphoma. A cervico-thoraco-abdomino-pelvic CT scan showed a 70 mm x 40 mm nasopharyngeal mass extending to 60 mm. Bone marrow biopsy was normal and the pre-therapeutic evaluation was normal. The patient received 4 courses of rituximab plus CHOP (cyclophosphamide, adriamycin, prednisone and oncovin) without response and then 3 courses of rituximab plus DHAOX (dexamethasone, high dose ara-cytin and oxalipatin) with persistence of the mass. The biopsy of the latter showed the disappearance of the B lymphocyte infiltration with presence of the AL amyloid deposits. The immunoelectrophoresis of plasma proteins showed the presence of immunoglobulin M. A positron emission tomography (PET) scan showed a hypermetabolic nasopharyngeal process. The patient is currently receiving a protocol of bortezomib, prednisone and bendamustine.\n",
+    "translated_fulltext": "患者情况与观察\n\n患者信息：该患者为67岁，无既往病史，主诉为吞咽困难、声音嘶哑，且一般状况不佳。\n\n临床表现：初步临床检查显示，患者意识清醒，格拉斯哥评分15/15，无发热，血压12/07 cmHg，血氧饱和度100%，心率80次/分钟，结膜颜色正常，鼻咽部可见一巨大肿块。无肝脾肿大，淋巴结区域未见异常，其余体格检查结果正常。\n\n病程：患者出现吞咽困难和声音嘶哑症状已持续6个月，病情逐渐恶化，出现固体食物吞咽困难，且一般状况恶化（体重减轻15公斤/6个月）。\n\n诊断方法：颈-胸-腹-盆腔CT扫描显示，鼻咽部存在一个70毫米 x 40毫米的肿块，延伸至60毫米。患者的血液检查结果正常（白细胞计数、肾功能和肝功能、乳酸脱氢酶、HIV、HCV和HBV血清学检查）。鼻咽部活检的组织学和免疫组织化学研究结果提示，该肿块为1级、2级CD20+；CD19+；CD79a+；CD10+滤泡性B细胞非霍奇金淋巴瘤，在两个不同实验室的两次检查中均得到相同结果。骨髓活检结果正常，治疗前的各项检查结果也正常。\n\n治疗干预：患者接受了4个疗程的RCHOP方案（利妥昔单抗375毫克/平方米，静脉注射；环磷酰胺750毫克/平方米，静脉注射；长春新碱2毫克，静脉注射；泼尼松100毫克，口服；阿霉素50毫克/平方米，静脉注射），但未见疗效。随后，患者接受了3个疗程的RDHAOX方案（利妥昔单抗375毫克/平方米，静脉注射，第1天；阿糖胞苷高剂量2克/平方米，静脉注射，第2天；地塞米松40毫克，第1天至第4天；奥沙利铂100毫克/平方米，第1天），但仍未见临床疗效。\n\n随访及治疗干预结果：鼻咽部肿块持续存在并增大，因此进行了气管切开术。鼻咽部肿块的活检结果显示，淋巴B细胞浸润消失，但存在淀粉样蛋白沉积，类型为AL型κ链。\n\n血浆蛋白免疫电泳显示存在免疫球蛋白Mκ链。由于资源有限，未进行轻链定量。骨髓涂片和第二次骨髓活检结果均正常。PET扫描显示鼻咽部存在高代谢活动，但未见其他异常。心脏评估（心电图、利钠肽、肌钙蛋白、超声心动图）和肾功能检查结果均无特殊。目前，患者正在接受博妥珠单抗、泼尼松和苯达莫司汀的联合治疗，首次治疗后临床状况有所改善。",
+    "translated_summary": "我们报告了一例67岁患者的病例，该患者没有病理性的慢性黏膜-黏膜相关疾病（CDDs），表现为全身状况恶化，伴有进行性发声困难和吞咽困难，颈部有一个大肿块，活检结果显示为1级和2级的滤泡性非霍奇金淋巴瘤。颈-胸-腹-盆CT扫描显示，鼻咽部有一个70毫米×40毫米的肿块，延伸至60毫米。骨髓活检结果正常，治疗前的评估结果也正常。患者接受了4个疗程的利妥昔单抗联合CHOP方案（环磷酰胺、阿霉素、泼尼松和长春新碱），但未见疗效，随后又接受了3个疗程的利妥昔单抗联合DHAOX方案（地塞米松、大剂量阿糖胞苷和奥沙利铂），但肿块仍存在。对后者的活检显示，B淋巴细胞浸润消失，但存在AL淀粉样蛋白沉积。血浆蛋白免疫电泳显示存在M型免疫球蛋白。正电子发射断层扫描（PET）显示鼻咽部存在高代谢活动。目前，患者正在接受博妥珠单抗、泼尼松和苯达莫司汀的联合治疗方案。"
+  },
+  {
+    "id": "multiclinsum_gs_en_539.txt",
+    "fulltext": "46-year-old Haitian male, residing in Chile for one year. In Haiti he was a livestock farmer. He presented a one-and-a-half-year history of a lesion that began as a papule on the anterior aspect of the right leg, which increased in size progressively. Initially asymptomatic, three months prior to the consultation he developed pruritus, pain, superficial ulceration and yellowish discharge. On physical examination, the patient was found to be of phototype V, with 1 x 1 cm, 2 x 2 cm and 3 x 2 cm warty plaques on the anterior aspect of the right leg. A dermatoscopy revealed a hyperkeratotic mass with ulcerated center, with reddish-black dots and congested hemorrhagic vessels. The general laboratory was normal; VDRL, HIV and PPD were non-reactive. Tissue samples were taken by a punch biopsy, including epidermis, dermis and subcutaneous tissue, and stained with Gram, routine bacteriological culture and anaerobic culture, which were negative. Bacilloscopy and Koch culture of the same tissue were also negative. The histopathological study was performed with hematoxylin and eosin stain, and showed a pseudoepitheliomatous epidermis with irregular hyperplasia, a dermis with abundant mixed inflammatory infiltrate with suppurative foci and giant cells of the foreign body type, some of which contained round cells with a thick brown wall, compatible with muriform cells; these cells were more evident when evaluated with PAS stain. Fungal culture was performed on Sabouraud dextrose agar at 25°C, which showed, after 15 days of incubation, the growth of black or dematiaceous, elevated, well-defined, velvety colonies. Direct microscopic examination with 20% KOH showed long, branched, sometimes tortuous, hyphae, and short chains of acropetal conidia, suggestive of Fonsecaea spp. Itraconazole was administered at 100 mg every 12 h for six months, in association with physical measures, which consisted of cryotherapy (liquid nitrogen) application to hypertrophic areas every six to eight weeks. Due to local complications, such as erosion or ulceration of the lesions, frequent healing was performed with application of mupirocin ointment topically for signs of bacterial superinfection.\n\nThe patient had a favorable evolution, with regression of the lesions and no evidence of relapses to date, remaining with a mild local hypopigmentation, expected in areas of treatment with cryotherapy.\n",
+    "summary": "A 46-year-old Haitian man, residing in Chile, presented with warty plaques in the anterior tibial region that had been present for one year. The diagnosis of chromoblastomycosis was confirmed by the presence of muriform cells in the histopathology and dematiaceous colonies in the mycological culture. In addition, conidia compatible with Fonsecaea spp. were observed in direct microscopy. After six months of treatment with systemic antimycotics and cryotherapy, complete remission of the lesions was achieved.\n",
+    "translated_fulltext": "患者为一名46岁的海地男性，已在智利居住一年。在海地，他是一名畜牧业农民。他主诉病史有一年半，病灶最初表现为右腿前部的一个丘疹，并逐渐增大。起初无症状，但在就诊前三个月，他开始出现瘙痒、疼痛、表浅溃疡和黄色分泌物。体格检查显示，患者皮肤类型为V型，右腿前部有1×1厘米、2×2厘米和3×2厘米的疣状斑块。皮肤镜检查显示，病灶为角化过度，中心有溃疡，并伴有红黑色的斑点和充血的出血血管。一般实验室检查结果正常；VDRL、HIV和PPD均为阴性。通过穿刺活检取了组织样本，包括表皮、真皮和皮下组织，并进行了革兰染色、常规细菌培养和厌氧培养，结果均为阴性。对同一组织样本进行了细菌镜检和Koch培养，结果也均为阴性。组织病理学研究采用苏木精-伊红染色，显示表皮呈假上皮样增生，真皮内有丰富的混合性炎症浸润，并伴有脓性灶和异物型巨细胞，其中一些细胞包含具有厚棕色细胞壁的圆形细胞，与分节孢子菌细胞相符；在PAS染色下，这些细胞更为明显。在25℃下，将样本接种于Sabouraud葡萄糖琼脂培养基中，15天后，观察到黑色或深色、隆起、界限清晰、天鹅绒状的菌落生长。用20%氢氧化钾进行直接显微镜检查，显示出长而分枝、有时呈扭曲状的菌丝，以及短链状的向顶端排列的孢子，提示为 Fonsecaea 属。患者接受了伊曲康唑治疗，剂量为每12小时100毫克，疗程为六个月，并结合物理治疗，即每六到八周对肥厚区域进行冷冻治疗（液氮）。由于局部并发症，如病灶的糜烂或溃疡，因此频繁进行局部治疗，并涂抹莫匹罗星软膏，以治疗细菌继发感染的迹象。\n\n患者病情好转，病灶消退，至今未见复发，仅残留轻微的局部色素减退，这是冷冻治疗区域的预期结果。",
+    "translated_summary": "一位居住在智利的46岁海地男子，在胫骨前部出现疣状斑块，已持续一年。通过组织病理学检查发现存在多隔细胞，以及真菌培养中发现的黑色菌落，从而确诊为色素性孢子菌病。此外，在直接显微镜下观察到与 Fonsecaea 属相容的子实体。经过六个月的全身抗真菌药物治疗和冷冻疗法后，病灶完全消退。"
+  },
+  {
+    "id": "multiclinsum_gs_en_285.txt",
+    "fulltext": "Patient information: A 19-year-old male with no significant medical history was admitted to our department with a painful left scrotal mass that had been present for 8 months and had not improved with antibiotics for pyogenic organisms. The patient reported intermittent low grade fever, night sweats, anorexia and unexplained weight loss since the onset of symptoms. He did not have a cough, sputum or haemoptysis. There was no history of tuberculosis in his personal or family medical history. He was vaccinated against tuberculosis at birth.\n\nClinical findings: Physical examination revealed a large, painful, slightly hot left bursa and two elongated, poorly defined, firm, painful subcutaneous formations in the anterior thoracic wall, 3 to 4 cm long. There were no rales on auscultation. The remainder of the examination was normal. Laboratory studies revealed a high c-reactive protein of 90 mg/dl. The blood count, creatinine, blood glucose and liver function tests were within normal limits. The standard chest X-ray showed reticulonodular infiltrates in both lung fields.\n\nDiagnostic approach: In the presence of an ultrasound finding in favour of an epididymal tumour, the patient underwent a left orchidectomy. However, the pathological examination of the surgical specimen showed a granulomatous epitheloid necrosis of the epididymis, suggestive of active epididymal tuberculosis involving the body and tail of the epididymis and sparing the head and testicle. The intradermal tuberculin reaction was positive. The search for acid-fast bacilli (AFB) in sputum and urine for 3 consecutive days was negative on direct examination and culture. The serologies for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and Wright's stain were also negative. In search of other tuberculous sites, a thoraco-abdomino-pelvic tomodensitometry was performed, which showed a miliary tuberculosis, coelo-mesenteric necrotic adenopathies, two thoracic parietal collections (at the expense of the external oblique muscles measuring 33 × 10 mm on the right and 45 × 10 mm on the left) and a focal osteolysis of D11 and L5, suggestive of a spondylodiscitis in the early stages. The magnetic resonance imaging (MRI) of the spinal cord confirmed the existence of a spondylodiscitis at the level of D7, D11, L4 and L5. The diagnosis of disseminated tuberculosis with epididymal, pulmonary, parietal, ganglionary and osteo-articular sites was retained.\n\nTherapeutic intervention: a poly-chemotherapy for tuberculosis with isoniazid, rifampicin, ethambutol and pyrazinamide for 2 months, followed by the association of isoniazid and rifampicin, was initiated.\n\nFollow-up and results: however, at the 4th month of treatment, the patient had presented generalised tonic-clonic convulsive seizures. A brain MRI was performed, showing multiple nodular lesions above and below the tentorial membrane corresponding to tuberculomas. The patient was put on anticonvulsive treatment and anti-tuberculosis treatment was continued. The evolution was favourable with recovery of the general condition and weight gain from the first months of treatment as well as a disappearance of thoracic parietal formations, adenopathies and tuberculous milia on the tomodensitometry with absence of recurrence of convulsive seizures. However, the slow decrease of the size of the tuberculomas obliged us to continue the anti-tuberculosis treatment for a long period. Finally, the patient was declared cured, without sequelae, at the end of the 234th month of treatment with a 2-year follow-up.\n",
+    "summary": "A 19-year-old man with no significant history was admitted to hospital with a painful left scrotal mass that had been present for 8 months. He had undergone an orchidectomy and the pathological examination was in favour of epididymal tuberculosis. A radiological examination had shown other sites of infection: lymph nodes, lungs, parietal and osteoarticular. An anti-tuberculosis treatment was initiated. However, in the 4th month of treatment, the patient had convulsive seizures. A brain MRI was performed and concluded that there were brain tuberculomas. The anti-tuberculosis treatment was continued in association with an anticonvulsant with good clinical and radiological evolution.\n",
+    "translated_fulltext": "患者信息：一位19岁的男性，既往无重大病史，因左侧阴囊肿块疼痛，持续8个月，且抗生素治疗无效而入院。患者自述自症状出现以来，间歇性低烧、夜间盗汗、食欲不振和原因不明的体重减轻。他没有咳嗽、咳痰或咯血。个人及家族病史中均无结核病史。出生时已接种结核疫苗。\n\n临床表现：体格检查显示，左侧阴囊肿大、疼痛、轻微发热，且在左侧胸壁前方有两处细长、界限不清、坚硬、疼痛的皮下肿块，长3至4厘米。听诊时未闻及啰音。其余检查结果正常。实验室检查显示，C反应蛋白升高，为90毫克/分升。血常规、肌酐、血糖和肝功能检查结果均在正常范围内。标准胸部X光片显示双肺野有网状结节状浸润。\n\n诊断方法：鉴于超声检查结果提示附睾肿瘤，患者接受了左侧睾丸切除术。然而，手术标本的病理检查显示附睾有肉芽肿性坏死，提示附睾结核病累及附睾体和尾部，但不累及附睾头和睾丸。皮内结核菌素试验结果为阳性。连续3天对痰液和尿液进行抗酸杆菌（AFB）检测，直接涂片和培养结果均为阴性。人类免疫缺陷病毒（HIV）、乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）的血清学检测以及Wright染色结果也均为阴性。为了寻找其他结核病病灶，进行了胸腹盆部计算机断层扫描，结果显示有粟粒性结核、腹膜-肠系膜坏死性淋巴结肿大、两个胸壁旁集合（右侧33×10毫米，左侧45×10毫米，以腹外斜肌为基础）以及D11和L5的局灶性骨质溶解，提示早期脊髓炎。脊髓磁共振成像（MRI）证实了D7、D11、L4和L5水平存在脊髓炎。最终诊断为播散性结核病，累及附睾、肺、胸壁、淋巴结和骨关节。\n\n治疗干预：开始进行为期2个月的结核病多药联合化疗，包括异烟肼、利福平、乙胺丁醇和吡嗪酰胺，之后继续使用异烟肼和利福平联合治疗。\n\n随访和结果：然而，在治疗的第4个月，患者出现了全身性强直-阵挛性癫痫发作。进行了脑部MRI检查，显示脑幕上方和下方有多个结节状病灶，对应于结核瘤。患者开始接受抗惊厥治疗，并继续进行抗结核治疗。治疗效果良好，患者的整体状况得到改善，体重增加，并且在计算机断层扫描中，胸壁旁集合、淋巴结肿大和结核粟粒消失，且未出现癫痫复发。然而，结核瘤体积缓慢缩小，因此我们决定继续进行较长时间的抗结核治疗。最终，在治疗的第234个月结束时，患者被宣布治愈，且无后遗症，并进行了为期2年的随访。",
+    "translated_summary": "一位19岁的男性，既往病史不明显，因左侧阴囊出现持续8个月的疼痛性肿块而入院。他曾接受过睾丸切除术，病理检查结果提示为附睾结核。放射学检查显示，感染部位还包括淋巴结、肺部、壁层胸膜和骨关节。开始进行抗结核治疗。然而，在治疗的第4个月，患者出现了抽搐。进行了脑部MRI检查，结果显示脑内存在结核瘤。继续进行抗结核治疗，并联合使用抗惊厥药物，患者的临床和放射学表现均有改善。"
+  },
+  {
+    "id": "multiclinsum_gs_en_508.txt",
+    "fulltext": "We present the case of a 10-year-old male diagnosed with high-risk early T-cell acute lymphoblastic leukaemia, who was treated according to the LAL SEHOP-PETHEMA 2013 protocol. Two years after diagnosis, he developed an early CNS relapse, so he was treated according to the InteReALL HR 2010 protocol with bortezomib. During induction, after being neutropenic for four weeks (20 neutrophils/μL), he was receiving prophylaxis with cefepime, cotrimoxazole and fluconazole. In addition, he was being treated with acyclovir for a herpes simplex virus 1 skin infection. In this context, he developed a severe headache that did not respond to usual analgesia. A cranial computed tomographic scan was performed that showed a hypodens lesion in the right temporal lobe. When the possibility of an infectious origin was considered, a lumbar puncture was performed and cefepime was replaced with meropenem and vancomycin.\n\nDespite remaining afebrile, he developed signs of septic shock on the first day after admission to the clinic and was transferred to the paediatric intensive care unit for inotropic and vasoactive support. In addition, the antimicrobial spectrum was extended with gentamicin and caspofungin.\n\nThe blood analysis showed a progressive increase in C-reactive protein and procalcitonin (up to 312 mg/L and 47.58 ng/mL, respectively, on the third day of evolution), with no other relevant biochemical alterations. The blood count showed pancytopenia due to chemotherapy. The blood cultures ruled out bacteremia and fungemia, and herpes virus serologies were negative. The urine culture and the fecal culture were also negative. The biochemical analysis of the cerebrospinal fluid was completely normal (glucose, 63 mg/dL; proteins, 16 mg/dL; leukocytes 1/µL), but the presence of B. cereus was detected in the microbiological study (sensitive to meropenem, vancomycin, linezolid and ciprofloxacin). The presence of herpes simplex 1 and 2, herpes virus 6, cytomegalovirus, varicella-zoster virus, enterovirus, parechovirus, toxoplasma, Neisseria meningitidis, Listeria monocytogenes, Streptococcus pneumoniae and Cryptococcus was ruled out in the cerebrospinal fluid.\n\nThe EEG showed diffuse slowing of brain activity with no clear epileptiform activity. On day 4, after the haemodynamic support was removed, a cranial MRI showed two hyperintense lesions in T2 and FLAIR that involved the subcortical region of the right temporal and parietal lobes. The parietal lesion had ring enhancement after administration of gadolinium and both lesions showed peripheral diffusion restriction. In addition, small haemorrhagic foci were observed scattered in the brain parenchyma. The image suggested a bacterial origin with an atypical germ, and these findings, together with those of the cerebrospinal fluid, led to the diagnosis of B. cereus abscess.\n\nAfter two weeks of treatment, the patient had a favorable outcome with resolution of the headache and no neurological findings. A follow-up MRI showed a decrease in the size of the lesions. Vancomycin and acyclovir were discontinued after three weeks and meropenem was continued for six weeks.\n",
+    "summary": "We present the case of a 10-year-old boy undergoing chemotherapy for acute lymphoblastic leukaemia. During the induction period he developed a cerebral abscess caused by B. cereus that was diagnosed by imaging tests and direct detection in the cerebrospinal fluid. His evolution was favourable with antibiotic treatment.\n",
+    "translated_fulltext": "我们报告了一例10岁男性患者，确诊为高危早期T细胞急性淋巴细胞白血病，并按照LAL SEHOP-PETHEMA 2013方案进行治疗。诊断两年后，患者出现早期中枢神经系统复发，因此按照InteReALL HR 2010方案，并联合使用硼替佐米进行治疗。在诱导治疗期间，患者出现中性粒细胞减少（持续四周，中性粒细胞计数为20/μL），并接受头孢曲松、复方磺胺甲噁唑和氟康唑的预防性治疗。此外，患者还接受阿昔洛韦治疗，以控制单纯疱疹病毒1引起的皮肤感染。在此情况下，患者出现严重的头痛，且常规止痛药无效。进行了颅部计算机断层扫描，结果显示右颞叶存在低密度病灶。考虑到感染的可能性，进行了腰椎穿刺，并将头孢曲松更换为美罗培南和万古霉素。\n\n尽管患者没有发烧，但在入院第一天就出现了感染性休克的迹象，并被转入儿科重症监护室，接受正性肌力药和血管活性药物的支持。此外，抗菌谱扩大，增加了庆大霉素和卡泊芬净。\n\n血液分析显示C反应蛋白和降钙素原水平逐渐升高（第三天分别达到312 mg/L和47.58 ng/mL），但没有其他显著的生化改变。血常规显示因化疗导致的全血细胞减少。血液培养排除了细菌血症和真菌血症，单纯疱疹病毒的血清学检测结果为阴性。尿液培养和粪便培养结果也为阴性。脑脊液的生化分析结果完全正常（葡萄糖63 mg/dL；蛋白质16 mg/dL；白细胞1/μL），但在微生物学研究中检测到蜡样芽孢杆菌（对美罗培南、万古霉素、利奈唑胺和环丙沙星敏感）。脑脊液中排除了单纯疱疹病毒1和2、人巨细胞病毒、水痘-带状疱疹病毒、肠道病毒、人小病毒、弓形虫、脑膜炎奈瑟菌、单核细胞增生李斯特菌、肺炎链球菌和新型隐球菌。\n\n脑电图显示大脑活动弥漫性减慢，没有明显的癫痫样活动。在第四天，移除血液动力学支持后，颅部磁共振成像显示在T2和FLAIR序列中，右颞叶和顶叶皮层下区域存在两个高信号病灶。顶叶病灶在注射钆后出现环状强化，两个病灶均显示周围弥散受限。此外，在脑实质中还观察到小的出血灶。影像学提示病原体为非典型细菌，结合脑脊液的检查结果，诊断为蜡样芽孢杆菌脓肿。\n\n经过两周的治疗，患者病情好转，头痛缓解，没有神经系统症状。随访磁共振成像显示病灶大小减少。万古霉素和阿昔洛韦在三周后停用，美罗培南继续使用六周。",
+    "translated_summary": "我们介绍一例10岁男孩，他因急性淋巴细胞白血病接受化疗。在化疗的初始阶段，他出现了由蜡样芽孢杆菌引起的脑脓肿，通过影像学检查和脑脊液直接检测确诊。经过抗生素治疗，他的病情得到了良好的控制。"
+  },
+  {
+    "id": "multiclinsum_gs_en_222.txt",
+    "fulltext": "Female patient, 16 years old, presenting a depressed gray plaque of 10.5 × 8.0 cm interspersed with hypochromic areas in the lower lateral part of the left thigh. Telangiectatic vessels overlap the lesion peripherally, with visible veins close to it. The plaque was present from birth, but was initially violaceous. It evolved with the passing of the years, with lightening and depression. There is no discrepancy in the length of the lower limbs.\n\nAngioresonance showed vascular malformations in the skin and subcutaneous tissue supplied by intermuscular branches of the popliteal artery. Early venous filling was found in both the region and the malformations, suggesting early venous shunting. Dilated draining veins were not documented, except for a superficial draining vein running along the subcutaneous cellular tissue of the anterior thigh. In addition, thinning of the subcutaneous tissue was noted in the topography of the vascular alteration, but without intramuscular or bone extension.\n",
+    "summary": "16-year-old girl with a depressed gray plaque on the left thigh, with a vascular malformation affecting the skin and subcutaneous tissue evident by angioresonance.\n",
+    "translated_fulltext": "患者为女性，16岁，左大腿外侧下部有一块10.5×8.0厘米的灰白色斑块，其中夹杂着色素减退的区域。斑块周围有扩张的毛细血管，且可见靠近斑块的静脉。该斑块自出生时就存在，最初呈紫红色，随着时间的推移，颜色逐渐变浅，并出现凹陷。双侧下肢长度无明显差异。\n\n血管共振成像显示，皮肤和皮下组织存在血管畸形，这些畸形由腘动脉的肌间分支供血。在病灶区域和畸形组织中均观察到早期静脉充盈，提示存在早期静脉分流。除一条沿大腿前侧皮下组织走行的浅表引流静脉外，未见扩张的引流静脉。此外，在血管改变的部位，皮下组织变薄，但未见侵犯肌肉或骨骼。",
+    "translated_summary": "一位16岁的女孩，左大腿上有一块呈灰色的、凹陷的斑块，血管畸形影响了皮肤和皮下组织，血管造影显示这一点。"
+  },
+  {
+    "id": "multiclinsum_gs_en_491.txt",
+    "fulltext": "This is a 32-year-old patient, a baker, from Bamako, who was admitted to the Infectious and Tropical Diseases department of the CHU du Point G (Bamako, Mali) on 27 April 2023 for chronic productive cough, otalgia and a chronic right-sided purulent otorrhea.\n\nThe symptomatology would be of progressive installation in 1 month, initially treated in a medical center with artésunate, paracetamol and unspecified antibiotics for confirmed malaria and acute otitis media, without success. He is immunosuppressed by a HIV1 infection, diagnosed and put on a tritherapy antiretroviral (TARV) Tenofovir/Lamivudine/Dolutégravir 7 months ago, not observed due to denial of his illness.\n\nThe general physical examination found a fever (38.2 °C), altered general condition, otalgia, purulent right foul-smelling otorrhea, a right basal pulmonary condensation syndrome, a normal neurological examination, without the involvement of the cranial nerves, mainly the facial nerve VII and the VIII cochleovestibular nerve.\n\nIn the ENT examination, the otoscopy of the right ear showed an inflammatory external auditory canal with purulent secretions and the presence of a single tympanic perforation in the anterior-inferior quadrant. The left ear is normal. The Rinne and Weber test is in favor of a right conductive hearing loss.\n\nImmuno-virological evaluation shows a CD4 count of 118 cells/pl and a viral load of 12,370 copies/ml at the time of diagnosis of HIV infection, compared to a viral load of 9,460 copies/ml and a CD4 lymphocyte count of 193 cells/pl at the 6th month of antiretroviral treatment. At the time of diagnosis of tuberculosis at the 7th month, the immuno-virological evaluation shows a CD4 count of 89 cells/pl and a viral load of 10,230 copies/ml.\n\nThe Ziehl Neelsen bacilloscopy was positive with a cross in the gastric washings on admission and 19 days later in the right ear swab because of the persistent otorrhea. The Xpert-MTB/GeneXpert test did not detect rifampicin-resistant Mycobacterium tuberculosis.\n\nThe frontal chest radiograph shows a more accentuated bronchovascular network at the base of the right lung.\n\nThe diagnosis of tuberculosis of the middle ear concomitant to a pulmonary localization in the field of immunosuppression by HIV1 is therefore retained.\n\nThe patient is put on oral first-line anti-tuberculosis for 6 months, a fixed dose of a quadra-therapy in the intensive phase of isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months (2RHZE), followed by a bi-therapy in the maintenance phase of isoniazid and rifampicin for 4 months (4RH) at a dose of 3 tablets/day in the morning on an empty stomach, associated with vitamin B6 (1 tablet/day). He benefits from two sessions of therapeutic reinforcement with anti-retroviral drugs. The ART is restarted on 4 May 2023 with his consent, given the good tolerance of the anti-tuberculosis drugs, with the combination of tenofovir/lamivudine/dolutegravir at a dose of 1 tablet/day associated with dolutegravir 50 mg as a supplement (1 tablet/day) according to the protocol for the management of HIV/AIDS. A chemoprophylaxis with cotrimoxazole 960 mg (1 tablet/day) is undertaken as well as a cleaning of the external auditory canal by aspiration and the instillation of ciprofloxacin ear drops (2 drops 3 times a day) for 14 days.\n\nThe evolution is favorable after 14 days of treatment, marked by a pyrexia, a good general state, the amendment of the cough and otorrhea with the negativation of the bacilloscopy in the gastric tube liquid and the swab of the pus of the right ear. At the end of the maintenance anti-tuberculosis treatment, the clinical healing is complete with a normal ENT and neurological examination. The bacilloscopy associated with the Xpert-MTB/GeneXpert test at the end of the 2nd month of the intensive phase, during the 5th month and at the end of the 6th month of the maintenance phase were negative. The HIV viral load performed after 3 months of ART is 329 copies/ml.\n",
+    "summary": "The patient presented with a chronic productive cough, otalgia and a chronic right-sided purulent otorrhea. The search for acid-fast bacilli was positive by direct examination in the gastric tube liquid and the swab of the auricular pus.\n\nAn anti-tuberculosis treatment of 6 months, associated with adjuvants, led to the patient's complete recovery.\n",
+    "translated_fulltext": "这是一位32岁的男性患者，职业是面包师，来自巴马科。他于2023年4月27日因慢性咳嗽、耳痛和慢性右侧脓性耳漏而入院，接受传染病和热带病科的治疗（位于巴马科的CHU du Point G医院，马里）。\n\n症状逐渐加重，持续约1个月。最初，他在一家医疗中心接受了青蒿素、对乙酰氨基酚和未指明的抗生素治疗，以治疗已确诊的疟疾和急性中耳炎，但效果不佳。他感染了HIV1，免疫功能受损。7个月前，他被诊断出HIV感染，并开始接受三联抗逆转录病毒治疗（TARV），药物组合为替诺福韦/拉米夫定/多替拉韦。但他否认自己生病，因此未按医嘱进行治疗。\n\n一般体格检查显示，患者有发烧（38.2°C），全身状况不佳，耳痛，右侧耳道有脓性分泌物，右肺底部有肺部浸润，神经系统检查正常，颅神经未受累，特别是面神经（VII）和前庭蜗神经（VIII）。\n\n耳鼻喉科检查显示，右耳耳镜检查显示外耳道发炎，有脓性分泌物，并且在耳膜的前下象限有一个小孔。左耳正常。Rinne和Weber测试结果表明，患者右耳存在传导性听力损失。\n\n免疫病毒学评估显示，在诊断出HIV感染时，患者的CD4细胞计数为118个/微升，病毒载量为12,370个拷贝/毫升。与抗逆转录病毒治疗6个月时，病毒载量为9,460个拷贝/毫升，CD4淋巴细胞计数为193个/微升相比。在诊断出结核病（治疗7个月时），免疫病毒学评估显示，CD4细胞计数为89个/微升，病毒载量为10,230个拷贝/毫升。\n\nZiehl-Neelsen涂片显示，入院时胃液标本和19天后右耳拭子中均有结核杆菌，表明存在阳性结果，这是由于持续的耳漏所致。Xpert-MTB/GeneXpert检测未发现耐利福平的结核分枝杆菌。\n\n胸部正位X光片显示，右肺底部支气管血管网络更加明显。\n\n因此，诊断为中耳结核，同时伴有肺部病变，且患者因HIV1感染而免疫功能受损。\n\n患者接受为期6个月的口服一线抗结核药物治疗，包括强化期（2个月）的四联疗法，药物组合为异烟肼、利福平、吡嗪酰胺和乙胺丁醇（2RHZE），随后是维持期（4个月）的双联疗法，药物组合为异烟肼和利福平（4RH），剂量为每天早晨空腹服用3片。同时，患者还服用维生素B6（每天1片）。患者接受了两次抗逆转录病毒药物的强化治疗。考虑到患者对抗结核药物的良好耐受性，并根据HIV/AIDS的管理方案，于2023年5月4日重新开始抗逆转录病毒治疗，药物组合为替诺福韦/拉米夫定/多替拉韦，剂量为每天1片，并额外补充多替拉韦50毫克（每天1片）。此外，患者还接受了以复方磺胺甲噁唑960毫克（每天1片）进行的化学预防，以及通过吸除和滴用环丙沙星耳药水（每天3次，每次2滴）进行为期14天的外耳道清洁。\n\n治疗14天后，患者病情好转，表现为体温正常，全身状况良好，咳嗽和耳漏减轻，胃液标本和右耳脓液拭子中的涂片结果呈阴性。在完成维持性抗结核治疗后，患者的临床症状完全缓解，耳鼻喉科和神经系统检查结果均正常。在强化期第2个月末、第5个月和维持期第6个月末进行的涂片检查和Xpert-MTB/GeneXpert检测结果均为阴性。在开始抗逆转录病毒治疗3个月后，患者的HIV病毒载量为329个拷贝/毫升。",
+    "translated_summary": "患者出现慢性咳嗽，伴有咳痰，并伴有耳痛和慢性右侧化脓性耳漏。通过对胃管液和耳道脓液进行直接检查，发现抗酸杆菌呈阳性。\n\n经过六个月的抗结核治疗，并配合使用辅助药物，患者完全康复。"
+  },
+  {
+    "id": "multiclinsum_gs_en_90.txt",
+    "fulltext": "52-year-old male patient with no medical history, transferred from a lower-level hospital to our institution due to a tonic-clonic seizure secondary to alcohol withdrawal and non-reduced right LFGHP. He was evaluated by a traumatologist 24 hours after admission, and was found to be conscious, with bilateral ecchymosis of the shoulders and severe limitation of passive external rotation on both sides. In addition, the patient was restrained physically at this point, with both feet and his left hand held down by intermittent psychomotor agitation.\n\nThe initial evaluation included a thorough review of the patient's admission radiographs, which showed a right LFGHP and a left simple posterior dislocation. This second injury (simple posterior dislocation of the left shoulder) was not diagnosed at the referring facility, and took approximately 48 hours to be diagnosed at our facility.\n\nComputed tomography (CT) of both shoulders was requested to better characterize the injuries. These images showed a marked worsening of the left shoulder injury since the time of the first radiographic study, possibly secondary to the physical restraint of the patient. This evidence of progression from a simple left posterior glenohumeral dislocation on admission radiographs to a LFGHP on the CT taken 48 hours later.\n\n\nPlanning\n\nThe preoperative study of the right shoulder showed bone indemnity of the glenoid and 40% involvement of the articular surface of the humerus, but with a large fragment with the possibility of osteosynthesis in continuity with the lesser tuberosity, so it was planned to fix this fragment by spongeous screw 4.0 mm partial thread and high strength sutures. In the left shoulder, no significant bone defect was evidenced in the glenoid and the defect of the articular surface of the humerus was 20%, so it was planned to fill the defect with the fragment of the lesser tuberosity at the time of osteosynthesis (imitating the surgery of McLaughlin).\n\n\nSurgical technique\n\nOpen reduction and internal fixation with bilateral locked-plate is decided. The patient is placed in a beach chair position and the surgical fields are prepared in the usual way for the right shoulder. The fracture focus is accessed by a classic deltopectoral approach. A digital maneuver is performed to reduce the posterior fragment of the humeral head with a posterior mini-open incision of the size of a standard diagnostic arthroscopy portal. A provisional reduction of the fracture is achieved using high-strength sutures and needles. A partial 4.0 mm spongy screw and high-strength sutures are used to fix both fragments of the humeral head. Definitive fixation of the fracture with a Philos (Depuy Synthes®) plate achieves adequate reduction and stability of fragments. Fixation is increased with high-strength sutures to the tendons of the rotator cuff that are tied to the plate. Closure by planes of the right shoulder, healing and immobilization of the extremity with a universal shoulder immobilizer.\nThe surgical field of the left shoulder is immediately prepared. Classic deltopectoral approach is performed again to reach the fracture focus using an accessory posterior portal for digital manipulation and reduction of the humeral head. Fixation and osteosynthesis are performed in the same way as described for the right shoulder with the exception of the spongiosa screw, as the anterior fragment could be adequately fixed only with the use of high strength sutures.\nPostoperative management consisted of the use of bilateral shoulder immobilizer for four weeks. A pendular exercise of flexion-extension of the elbow and exercises of the fist were given to be performed from the second postoperative week to tolerance (according to the level of pain). In the radiographic control of the first month, loss of reduction of the greater left tuberosity was observed. It was decided to perform revision surgery achieving adequate fixation of the fragment with high-strength sutures.\nThe patient is left with a shoulder immobilizer for an additional four weeks on the left shoulder. The self-administered exercise regimen is restarted as described previously from the second postoperative week on a bilateral basis. At the sixth week after the revision surgery, face-to-face kinesiological therapy is initiated twice a week. After 30 sessions of kinesiological rehabilitation, the patient is able to return to work five months after the initial injury.\nFollow-up one year after the initial surgery shows that the patient has recovered strength and mobility in the right shoulder. The left shoulder still has severe limitations in the range of motion, especially in external rotation. At this point, it is decided to perform arthroscopic joint release surgery and remove the osteosynthesis in the left shoulder.\nIn his last check-up two years after the trauma, the patient showed a favorable evolution, consistent with the functional scales evaluated.\n",
+    "summary": "52-year-old male patient, transferred to a high-complexity center for a tonic-clonic convulsion and a right LFGHP. In the initial study with radiographs, a right shoulder injury was confirmed and a simple posterior glenohumeral dislocation of the left shoulder was diagnosed, which had not been previously detected. The study was complemented with a computed tomography (CT) of both shoulders, showing a bilateral LFGHP, which demonstrated intrahospital aggravation of the injury of the left shoulder. An open reduction and osteosynthesis with a bilateral blocked plate was performed in one time. The left shoulder required two reinterventions, one for osteosynthesis failure and another for joint release. Two years after the procedure, the patient was satisfactorily progressing with a 5% on the Quick DASH scale and a score of 72 and 76 on the Constant scale in the left and right shoulder, respectively.\n",
+    "translated_fulltext": "52岁男性患者，既往无病史，因酒精戒断引起的强直-阵挛性发作以及右肩关节前部不稳定（LFGHP）未缓解，从一家基层医院转入我院。入院后24小时，由骨科医生进行评估，发现患者意识清醒，双肩有瘀伤，双侧肩关节外旋受限。此外，患者当时受到物理约束，双脚和左手被间歇性地固定，以控制其精神运动激动。\n\n初步评估包括对患者入院X光片的详细审查，结果显示右肩关节前部不稳定，左肩关节后方半脱位。第二次损伤（左肩关节后方半脱位）在转诊医院未被诊断，在我院确诊大约需要48小时。\n\n为了更好地评估损伤情况，对双侧肩关节进行了计算机断层扫描（CT）。影像显示，与首次X光检查时相比，左肩关节的损伤明显加重，这可能是由于患者受到物理约束所致。影像资料显示，入院X光片显示左肩关节后方半脱位，而48小时后的CT扫描显示左肩关节前部不稳定。\n\n**治疗计划**\n\n术前检查显示，右肩关节盂骨无骨质损伤，肱骨关节面受累40%，但有一大块骨碎片，有可能通过与小结节连续的骨整合术进行固定。因此，计划使用4.0毫米部分螺纹海绵螺钉和高强度缝线固定该骨碎片。左肩关节盂骨无明显骨缺损，肱骨关节面缺损20%，因此计划在骨整合术时用小结节的骨碎片填充缺损（模拟麦克劳林手术）。\n\n**手术技术**\n\n决定采用开放复位和双侧锁定钢板内固定术。患者采用沙滩椅位，并以常规方式准备右肩关节的手术区域。通过经典的三角肌胸大肌入路进入骨折部位。通过数字操作，通过一个标准的诊断关节镜门洞大小的后方微小切口，将肱骨头后方的骨碎片复位。使用高强度缝线和针进行骨折的初步复位。使用部分4.0毫米海绵螺钉和高强度缝线固定肱骨头上的两个骨碎片。使用Philos（Depuy Synthes®）钢板进行最终的骨折固定，以实现骨碎片的充分复位和稳定性。通过将高强度缝线缝合到冈上肌腱等旋回袖肌腱上，并将其固定在钢板上，以增强固定效果。分层缝合右肩关节，并使用通用肩关节固定器进行肢体愈合和固定。\n\n立即准备左肩关节的手术区域。再次进行经典的三角肌胸大肌入路，通过辅助后方门洞进行数字操作和肱骨头复位，以到达骨折部位。固定和骨整合术的进行方式与右肩关节相同，但海绵螺钉除外，因为前方的骨碎片仅能通过使用高强度缝线进行充分固定。\n\n术后管理包括使用双侧肩关节固定器持续四周。从术后第二周开始，根据患者的疼痛程度，进行肘关节屈伸的摆动练习和握拳练习。在术后第一个月的X光检查中，观察到左肩大结节的复位丢失。决定进行翻修手术，使用高强度缝线对骨碎片进行充分固定。\n\n患者在左肩关节上额外使用肩关节固定器四周。从术后第二周开始，恢复之前描述的自主锻炼方案，并同时进行双侧锻炼。在翻修手术后的第六周，开始每周进行两次面对面的康复治疗。经过30次康复治疗后，患者可以在最初受伤后五个月恢复工作。\n\n最初手术后一年的随访显示，患者右肩关节的力量和活动范围已恢复。左肩关节的活动范围仍然受到严重限制，尤其是在外旋方面。此时，决定进行关节镜关节松解术，并切除左肩关节的骨整合固定物。\n\n在创伤发生两年后的最后一次检查中，患者的恢复情况良好，与评估的功能量表结果一致。",
+    "translated_summary": "患者为52岁男性，因强直-阵挛性抽搐和右侧肩袖撕裂被转至一家高水平的医疗中心。初步X光检查显示，患者右肩受伤，左肩为单纯的后方肩关节脱位，而此前未曾发现。进一步进行了双侧肩部的计算机断层扫描（CT），结果显示双侧均存在肩袖撕裂，且左肩的损伤在住院期间加重。随后，患者接受了单次手术，进行了开放复位和双侧锁板内固定。左肩需要进行两次复查手术，一次是由于骨固定失败，另一次是为了松解关节。手术后两年，患者恢复良好，Quick DASH评分仅为5%，左肩和右肩的Constant评分分别为72和76。"
+  },
+  {
+    "id": "multiclinsum_gs_en_439.txt",
+    "fulltext": "A 70-year-old white man was treated for severe symptomatic aortic regurgitation due to healed endocarditis using TAVI from the apical approach. TAVI was performed at that time because he was considered a high-risk surgical patient due to secondary pulmonary hypertension, severely impaired left ventricular function with a left ventricular ejection fraction (LVEF) of 20%, chronic renal failure, and a logistic EuroSCORE I of 24.36%. At the time he was treated by diuretics (torasemide 20 mg once a day), an angiotensin-converting enzyme (ACE) inhibitor (ramipril 5 mg once a day), a ß-blocker (bisoprolol 2.5 mg twice a day), and an aldosterone antagonist (12.5 mg once a day). On admission he had cardiac decompensation and resulting dyspnea (temperature 36.7 °C, pulse 99/minute, blood pressure 109/48 mmHg) but his emotional status and neurological constitution were good. The laboratory results were unremarkable except for: a mild increase in liver enzymes, aspartate aminotransferase (AST) 59 U/l and alanine aminotransferase (ALT) 67 U/l; a known chronic renal insufficiency (creatinine 2.1 mg/dl); and a mild decrease in hemoglobin (Hb) 10.7 g/dl. No urine analysis was done. Due to normal C-reactive protein and normal count of leukocytes no microbiological examination was performed. After interdisciplinary discussion of the case (including a normal coronary angiography that was performed a few days before) and cardiac recompensation, he was initially treated with an implantation of a JenaValve 27 mm self-expandable valve. Despite a good result after implantation with the JenaValve and minimal transvalvular central insufficiency, he presented recurrent cardiac decompensation due to his severely impaired LVEF. His case was discussed again at an interdisciplinary meeting: 4 weeks after TAVI he underwent the implantation of a LVAD system (Thoratec® HeartMate II). His postoperative course was uneventful. He remained asymptomatic for 1 year until the LVAD system showed recurrent significant high flow alarms. Echocardiography examinations during this year showed a continuous increase in transvalvular central insufficiency to the level of a severe regurgitation without any sign for structural alteration of the leaflets of the JenaValve prosthesis. Treatment options were discussed and a new TAVI as valve-in-valve was decided.\n\nThe procedure was performed under general anesthesia using a CoreValve Evolut R 29 mm prosthesis. The prosthesis was implanted without prior valvuloplasty. The flow rate of LVAD was reduced to minimum and pacing with a frequency of 140 beats/minute was applied during placement of the valve prosthesis. Positioning was done with great care using fluoroscopic and transesophageal echocardiography (TEE) guidance with the aim of having the ventricular strut end of the CoreValve Evolut R prosthesis between the ventricular end and the “cusp feelers” of the JenaValve prosthesis. This position was obtained because of JenaValve structure and individual computed tomography analysis of our patient which had shown the ventricular edge of the JenaValve well positioned in left ventricular outflow tract (LVOT). The first positioning was successful with no need for repositioning. After the last fluoroscopic control the CoreValve Evolut R was released successfully in the planned position. Slow rapid pacing was stopped and the LVAD flow was increased and required good hemodynamic under normal LVAD flow. His postoperative course was uneventful and he has shown a very good recovery. A second TEE did not show any change regarding the performance of the valve-in-valve and only marginal residual insufficiency. At 12-month follow-up our patient had no complaints and had a satisfactory capacity in daily life. Echocardiography showed no relevant aortic regurgitation and an increase of LVEF to 33%. At that time the 6-minute walk test was significantly increased to 381 m (compared to 148 m on admission).",
+    "summary": "We report the case of a 70-year-old white man who was treated for severe symptomatic aortic regurgitation using transcatheter aortic valve implantation from the apical approach. Because of recurrent cardiac decompensation 4 weeks after implantation he underwent the implantation of a left ventricular assist device system. A year later echocardiography showed a severe transvalvular central insufficiency. Our heart team decided to choose a valve-in-valve approach while reducing the flow rate of left ventricular assist device to minimum and pacing with a frequency of 140 beats/minute. There was an excellent result and our patient is doing well with no relevant insufficiency of the aortic valve at 12-month follow-up.",
+    "translated_fulltext": "一位70岁的白人男性，因既往患有心内膜炎并已痊愈，导致严重的有症状主动脉瓣关闭不全，接受了经心尖入路进行的经导管主动脉瓣置换术（TAVI）。当时选择TAVI是因为他被认为是高风险手术患者，原因包括继发性肺动脉高压、严重受损的左心室功能（左心室射血分数LVEF为20%）、慢性肾功能衰竭，以及Logistic EuroSCORE I评分为24.36%。治疗期间，他接受了利尿剂（托拉塞米 20毫克，每日一次）、血管紧张素转化酶（ACE）抑制剂（雷米普利 5毫克，每日一次）、β受体阻滞剂（比索洛尔 2.5毫克，每日两次）和醛固酮拮抗剂（12.5毫克，每日一次）的治疗。入院时，他出现心功能不全，并因此出现呼吸困难（体温36.7℃，脉搏99次/分钟，血压109/48 mmHg），但他的情绪状态和神经系统功能良好。实验室检查结果无明显异常，仅显示：肝酶轻度升高，天冬氨酸氨基转移酶（AST）59 U/l，丙氨酸氨基转移酶（ALT）67 U/l；已知存在慢性肾功能不全（肌酐2.1 mg/dl）；血红蛋白（Hb）轻度降低，为10.7 g/dl。未进行尿液分析。由于C反应蛋白正常，白细胞计数也正常，因此未进行微生物学检查。经过多学科讨论（包括几天前进行的正常冠状动脉造影），并考虑到患者的心功能得到改善，最初为其植入了JenaValve 27毫米自膨胀瓣。尽管使用JenaValve进行植入后效果良好，且瓣膜周围的中心性关闭不全程度很小，但他仍因左心室射血分数严重受损而出现反复的心功能不全。他的病例再次在多学科会议上进行了讨论：TAVI术后4周，他接受了左心室辅助装置（LVAD）系统（Thoratec® HeartMate II）的植入。术后恢复顺利。在一年内，他一直没有症状，直到LVAD系统出现反复的、显著的高流量警报。在这一年中进行的超声心动图检查显示，瓣膜周围的中心性关闭不全持续增加，达到严重关闭不全的程度，但没有发现JenaValve瓣膜的瓣叶结构发生任何改变。讨论了治疗方案，并决定进行新的TAVI术，采用“瓣膜内瓣”的方式。\n\n手术在全身麻醉下进行，使用CoreValve Evolut R 29毫米瓣膜。在没有进行瓣膜成形术的情况下植入了瓣膜。在放置瓣膜时，LVAD的流量降低到最低，并应用了频率为140次/分钟的起搏。通过透视和经食管超声心动图（TEE）引导，小心地进行定位，目标是将CoreValve Evolut R瓣膜的室性支架端置于室性端和JenaValve瓣膜的“瓣叶触感器”之间。之所以选择这个位置，是因为JenaValve的结构以及我们患者的个体化计算机断层扫描分析显示，JenaValve的室性边缘在左心室流出道（LVOT）中位置良好。第一次定位成功，无需重新定位。在最后一次透视检查后，CoreValve Evolut R成功地释放到预定的位置。停止快速起搏，增加LVAD的流量，并在正常的LVAD流量下，患者的血流动力学状况良好。术后恢复顺利，患者恢复良好。第二次TEE检查没有显示瓣膜内瓣的性能发生任何变化，仅显示轻微的残余关闭不全。在12个月的随访中，患者没有主诉，日常生活能力令人满意。超声心动图显示，主动脉瓣关闭不全不明显，左心室射血分数增加到33%。此时，6分钟步行测试显著增加到381米（与入院时148米相比）。",
+    "translated_summary": "我们报告了一例70岁白人男性患者的病例，该患者因严重的主动脉瓣反流而接受经导管主动脉瓣置入术，采用经心尖入路。由于术后4周出现复发性心脏功能不全，患者接受了左心室辅助装置系统的植入。一年后，超声心动图显示存在严重的主动脉瓣中心性反流。我们的心脏团队决定采用瓣膜内瓣置入术，同时将左心室辅助装置的流量降至最低，并以每分钟140次的频率进行起搏。结果非常理想，患者术后恢复良好，12个月的随访显示主动脉瓣无明显反流。"
+  },
+  {
+    "id": "multiclinsum_gs_en_459.txt",
+    "fulltext": "40-year-old HIV-positive man with regular adherence to treatment (viral load 4500/mm3 and CD4 70/mm3 from the previous year), consulted for intermittent fever of two years' evolution that did not respect the standard time and gave way to transient antinflammatory non-steroidal drugs. He added in the last two months diffuse abdominal pain with predominance in the upper right lobe where he acquired a configuration of a tree in bud and bilateral pleural effusion, and at the abdominal level, marked increase of hepato-splenomegaly associated with ascites. After 48 hours of his suspension, he presented fulminant hepatic failure and was transferred to the intensive care unit. Tracheal aspirate was performed and after transfusion support a liver biopsy was obtained by puncture.  The patient died a few hours later. The postmortem culture of the tracheal aspirate was positive for Mycobacterium tuberculosis and the liver biopsy was performed with non-necrotizing granulomas and the rest of the parenchyma preserved. This work was carried out in accordance with the principles laid out in the ethical code of the WHO (Helsinki Declaration).\n",
+    "summary": "We present the case of a 40-year-old HIV-positive man with regular adherence to treatment, who consulted for intermittent febrile episodes of two years' evolution, adding in the last two months progressive diffuse abdominal pain and generalized adenomegaly. In the laboratory, he presented pancytopenia, coagulopathy, hypoalbuminemia and increased acute phase reactants. The computed tomography (CT) of the thorax, abdomen and pelvis only showed hepato-splenomegaly and generalized adenomegaly. Multiple microbiological examinations were performed, including cultures for Mycobacterium sp. of different samples, all with negative results, with the exception of RT-PCR for HHV-8. A left iliac ganglion biopsy was performed with findings consistent with Castleman's disease. Despite restarting antiretroviral therapy, the symptomatology progressed, initiating treatment with corticosteroids and ganciclovir. After a week, he developed multiple organ failure and anasarca, which contraindicated the drugs initiated. A new chest CT was performed that showed infiltrates with a tree-like pattern in the upper right lobe associated with bilateral pleural effusion, and at the abdominal level, progression of hepato-splenomegaly and ascites. He passed to the intensive care unit 48 hours later due to fulminant hepatic failure. The patient died within a few hours. A postmortem culture of the tracheal aspirate was received positive for Mycobacterium tuberculosis and a liver biopsy with non-necrotizing granulomas.\n",
+    "translated_fulltext": "一位40岁的艾滋病毒感染者，坚持规律服药（病毒载量为4500/mm3，CD4细胞计数为70/mm3，数据来自前一年），因持续两年的间歇性发热前来就诊，发热时间不规律，且对常规的非甾体类抗炎药效果不佳。在过去的两个月里，他还出现了弥漫性腹痛，主要集中在上腹部右侧，并出现了类似树枝状的病灶和双侧胸腔积液。腹部检查显示，肝脾肿大明显，并伴有腹水。停药48小时后，患者出现急性肝功能衰竭，并被转入重症监护室。进行了气管吸取，并在输血支持后，通过穿刺进行了肝活检。患者在几小时后去世。尸检时，气管吸取培养结果显示结核分枝杆菌阳性，肝活检显示存在非坏死性肉芽肿，其余肝实质组织保存完好。本研究的开展符合世界卫生组织（《赫尔辛基宣言》）伦理规范中的相关原则。",
+    "translated_summary": "我们报告了一例40岁艾滋病毒感染男性患者，该患者坚持规律治疗，因间歇性发热症状持续两年，近两个月出现进行性弥漫性腹痛和全身淋巴结肿大，前来就诊。实验室检查显示，患者出现全细胞减少、凝血功能障碍、低白蛋白血症以及急性期反应物增高。胸部、腹部和盆腔的计算机断层扫描（CT）仅显示肝脾肿大和全身淋巴结肿大。进行了多次微生物学检查，包括对不同样本进行结核分枝杆菌培养，结果均为阴性，仅RT-PCR检测结果显示HHV-8阳性。对左髂淋巴结进行了活检，结果与卡斯尔曼病一致。尽管重新开始抗逆转录病毒治疗，但症状仍在加重，因此开始使用皮质类固醇和更昔洛韦进行治疗。一周后，患者出现多器官衰竭和全身性水肿，这使得先前使用的药物不宜继续使用。进行了新的胸部CT检查，显示右上肺叶出现树状浸润，并伴有双侧胸腔积液，腹部CT显示肝脾肿大和腹水加重。48小时后，患者因急性肝功能衰竭转入重症监护室。患者在数小时内死亡。尸检后，气管吸取物培养结果显示结核分枝杆菌阳性，肝脏活检显示非坏死性肉芽肿。"
+  },
+  {
+    "id": "multiclinsum_gs_en_59.txt",
+    "fulltext": "A 2-year-old female presented with a 1-year history of painless left progressive proptosis with no reported systemic diseases or family history. Ophthalmologic examination revealed light sensation as the only vision in the left eye, along with proptosis, inward and upward eyeball displacement, and restricted extraocular muscle movements in downward and outward directions. An irregularly shaped, well-defined soft mass was palpable in the inferior aspect of the left orbit, accompanied by left lower eyelid ectropion. The pupil was enlarged (4 mm in diameter), and pupillary reaction was absent. The remaining anterior segment examination showed no apparent abnormalities. Fundus examination was challenging due to the child’s size. Hertel exophthalmometry readings measured 10.5 mm in the right eye and 18 mm in the left. Magnetic resonance imaging (MRI) revealed a well-circumscribed mass, displaying hypointense signals on T1-weighted images and hyperintense signals on T2-weighted images. Contrast-enhanced imaging demonstrated no significant improvement. A transconjunctival approach via the inferior fornix with canthotomy and cantholysis was performed, revealing a grayish-white cystic mass with a distinct boundary from surrounding tissues. During posterior separation to the eyeballs’ posterior part, tight adhesion to the optic nerve was observed. Due to the mass’s substantial size and the restricted surgical field, volume reduction was necessary. Approximately 12.5 mL of the fluid was aspirated, and the mass was completely excised. Histopathological examination disclosed a fibrous capsule wall covered with squamous and glandular epithelium, along with visible brain tissue and a cartilage-like matrix consistent with orbital teratoma. One month postsurgery, the patient exhibited enophthalmos, conjunctival hyperemia, and keratitis on ocular examination. This was attributed to the mass’s prior enlargement of the orbital cavity, resulting in postoperative enophthalmos. The cornea could not adhere to the eyelids, creating a space and causing corneal inflammation. After obtaining the consent of the patient’s guardian, a second operation involved the implantation of an allogeneic sclera into the orbit to increase the orbital volume, alleviate fossa pitting and restore keratitis to normal. No recurrence of the teratomas was noted during the 1-year follow-up. The patient still had minor enophthalmos and outer canthus abnormality. The visual acuity remained consistent with pre-operation levels. Hertel exophthalmometry readings measured 10.5 mm in the right eye and 8 mm in the left. The remaining anterior segment examination showed no apparent abnormalities.",
+    "summary": "Patient concerns: A 2-year-old female child was presented exhibiting proptosis and inward and upward eyeball displacement. Enhanced magnetic resonance imaging revealed a well-circumscribed mass, persisting with hypointense signals on T1-weighted images (T1WI) and hyperintense signals on T2-weighted images (T2WI).\n\nDiagnoses: The diagnosis of teratoma was confirmed finally through histological and immunohistochemical exams.\n\nInterventions: A transconjunctival approach via the inferior fornix, coupled with canthotomy and cantholysis, was performed. However, a month postsurgery, the patient developed enophthalmos, conjunctival hyperemia, and keratitis upon ocular examination. A second operation involved the implantation of allogeneic sclera into the orbit to increase orbital volume, improve the pitting of the fossa, and restore keratitis to normal.\n\nOutcomes: No recurrence and other complications were noted during the 1-year follow-up.",
+    "translated_fulltext": "一名2岁的女童，主诉左眼无痛性进行性眼球突出，病史已有一年，未见全身性疾病或家族病史。眼科检查显示，左眼仅有光感，伴有眼球突出、眼球向内上方移位，以及向下和向外方向的眼外肌活动受限。在左眼眶的下部可触及一个形状不规则、边界清晰的柔软肿块，并伴有左下眼睑外翻。瞳孔扩大（直径4毫米），瞳孔对光的反应消失。其余前节检查未见明显异常。由于患儿年龄较小，眼底检查较为困难。Hertel眼球突出度测量显示，右眼为10.5毫米，左眼为18毫米。磁共振成像（MRI）显示，肿块边界清晰，在T1加权图像上呈现低信号，在T2加权图像上呈现高信号。增强成像显示，未见明显改善。采用经结膜下途径，经下穹窿进行手术，并进行外眼角切开和外眼角松解，结果显示，肿块呈灰白色，呈囊性，与周围组织之间有明显的边界。在将肿块与眼球后部分离时，观察到肿块与视神经紧密粘连。由于肿块体积较大，且手术视野受限，因此需要进行体积减小。抽取了约12.5毫升液体，并将肿块完全切除。组织病理学检查显示，肿块具有纤维性包膜，表面覆盖有鳞状上皮和腺体上皮，并可见脑组织和类似软骨的基质，与眼眶畸胎瘤的特征相符。术后一个月，患者眼科检查显示，出现眼球内陷、结膜充血和角膜炎。这被认为是由于肿块先前扩大了眼眶，导致术后出现眼球内陷。角膜无法与眼睑贴合，形成间隙，从而引起角膜炎症。在获得患者监护人的同意后，进行了第二次手术，将异体巩膜植入眼眶，以增加眼眶容积，减轻眼眶凹陷，并使角膜炎恢复正常。在为期一年的随访期间，未见畸胎瘤复发。患者仍有轻微的眼球内陷和外眼角异常。视力与术前水平保持一致。Hertel眼球突出度测量显示，右眼为10.5毫米，左眼为8毫米。其余前节检查未见明显异常。",
+    "translated_summary": "患者主诉：一名2岁的女婴出现眼球突出、眼球内移和向上移的症状。增强磁共振成像显示，病灶边界清晰，在T1加权图像（T1WI）上呈现低信号，在T2加权图像（T2WI）上呈现高信号。\n\n诊断：最终通过组织病理学和免疫组织化学检查确诊为畸胎瘤。\n\n治疗：采用经结膜下途径，通过下穹窿进行手术，并结合外眼角切开术和外眼角松解术。然而，术后一个月，患者在眼部检查中出现眼球内陷、结膜充血和角膜炎。第二次手术包括将异体巩膜植入眼眶，以增加眼眶容积，改善眼眶凹陷，并使角膜炎恢复正常。\n\n结果：在为期一年的随访期间，未观察到复发或其他并发症。"
+  },
+  {
+    "id": "multiclinsum_gs_en_590.txt",
+    "fulltext": "A 57-year-old woman with a 14-year history of asthma and allergic rhinitis, on salmeterol/fluticasone, was hospitalized for recurrent abdominal pain that began two months earlier. The pain was intermittent and dull, accompanied by nausea, anorexia, malaise, and a weight loss of 5 kg. There was no fever, blood / mucus in the stool, or respiratory symptoms (rhinorrhea, wheezing, coughing). She had no history of alcohol/tobacco use or traditional herbal medicines. Six weeks before admission, she was diagnosed with an intestinal infection in a local clinic after a complete blood count (CBC) revealed leukocytosis and significant eosinophilia (25.61 G/L, 77.8% eosinophils). She received antibiotics and mebendazole without relief of symptoms. At presentation, the patient was alerted and oriented with stable vitals (BP 110/70 mmHg, T 37°C, HR 88 bpm, RR 18 bpm). She had a BMI of 16.6 kg/m² and sarcopenia, but no skin rash, lymphadenopathy, or edema. The abdominal exam showed tenderness in the epigastric and umbilical regions without guarding. CBC revealed leukocytosis and significant eosinophilia (20.8 G/L, with a total white blood cell count of 26.8 G/L, comprising 77.8% eosinophils). Peripheral blood film examination showed normal eosinophils. Bone marrow aspiration reveals 48% eosinophils without blasts, atypical cells. Fluorescence in situ hybridization (FISH) for CHIC2 deletion as a surrogate marker for FIP1L1-PDGFRA showed no rearrangements of the PDGFRA gene. Autoimmune and vasculitis screenings (ANA, anti-dsDNA, p-ANCA, c-ANCA) were negative. Elevated serum IgG (2760 mg/dL; normal range, 700–1600 mg/dL) and IgG4 (1260 mg/dL; normal range, 3.9–86.4 mg/dL), slightly elevated IgE (137.5 IU/mL; normal range, <100 IU/mL) and high RF (144.4 IU/mL; normal range, <20 IU/mL) were observed. Other parameters were normal, including aminotransferase, blood urea nitrogen, serum creatinine, complement C3, complement C4, vitamin B12, serum cortisol, and NT-proBNP. ECG and echocardiogram were normal. Chest CT scans showed mild fibrosis and bronchiectasis. Sputum AFB smears and bronchoscopy were negative. The cytology of the bronchoalveolar lavage fluid showed 35% neutrophils, no eosinophils. Spirometry indicated severe obstruction with bronchodilator response. The fractional exhaled nitric oxide (FeNO) level was 15 ppb. Stool samples were tested positive for leukocytes, with no signs of ova or parasites. Serology tests were positive for toxocariasis (positive IgG of Toxocara canis at 54.2 NovaTec-Units) but negative for Strongyloides stercoralis, Fasciola sp., Toxoplasma gondii, Trichinella spiralis, Ancylostoma sp., Angiostrongylus cantonensis, Ascaris lumbricoides, Clonorchis sinensis, Paragonimus sp., Gnathostoma sp., Entamoeba histolytica, cysticercosis, filariasis, and HIV. An abdominal contrast-enhanced computed tomography scan revealed gallbladder stones without acute cholecystitis and showed no gastrointestinal tract abnormalities. The upper gastrointestinal endoscopy showed unremarkable results with a normal appearance. Colonoscopy showed mucosal inflammation in the sigmoid, left, transverse, and right colon with systemic biopsy. A five-day course of albendazole (400 mg twice daily) for suspected toxocariasis was ineffective. Colonic biopsies revealed significant eosinophilic infiltration (>85 eosinophils/High-power field (HPF) in the left colon, >100 eosinophils/HPF in the transverse and right colon). Given the patient’s nonresponse to toxocariasis treatment and the significant eosinophilic infiltration observed in the colon mucosa biopsy, a diagnosis of eosinophilic colitis was confirmed. The patient was treated with oral methylprednisolone (16 mg) and montelukast (5 mg). Symptoms resolved in two weeks and eosinophil counts normalized (0.3 G/L). The corticosteroid was reduced and discontinued, and the patient was maintained on montelukast for three months without symptom recurrence.",
+    "summary": "We present a unique case of a 57-year-old patient with a medical history of asthma and allergic rhinitis who presented recurrent abdominal pain, significant blood eosinophilia, and elevated levels of Immunoglobulin G4. After ruling out hematological and secondary causes of eosinophilia, a biopsy of the colon mucosa revealed an excess of tissue eosinophils, confirming the diagnosis of EoC. The patient responded well to corticosteroids and was subsequently maintained on montelukast, with no recurrence of symptoms over 3 months.",
+    "translated_fulltext": "一名57岁女性，既往有14年哮喘和过敏性鼻炎病史，正在使用 salmeterol/fluticasone，因两个月前开始出现反复腹痛而住院。疼痛为间歇性、隐痛，伴恶心、食欲减退、全身不适及体重减轻5 kg。无发热、粪便中血 / 黏液，或呼吸道症状（流涕、喘鸣、咳嗽）。无饮酒/吸烟或传统草药使用史。入院前六周，在当地诊所因全血细胞计数（CBC）显示白细胞增多和显著嗜酸性粒细胞增多（25.61 G/L, 77.8% eosinophils）而被诊断为肠道感染。给予抗生素和 mebendazole 治疗，症状未缓解。就诊时，患者清醒且定向力正常，生命体征平稳（BP 110/70 mmHg, T 37°C, HR 88 bpm, RR 18 bpm）。BMI 16.6 kg/m²，并存在肌少症，但无皮疹、淋巴结肿大或水肿。腹部查体示上腹部及脐周压痛，无腹肌紧张。CBC提示白细胞增多及显著嗜酸性粒细胞增多（20.8 G/L, with a total white blood cell count of 26.8 G/L, comprising 77.8% eosinophils）。外周血涂片检查示嗜酸性粒细胞形态正常。骨髓穿刺显示嗜酸性粒细胞占48%，未见原始细胞、非典型细胞。作为FIP1L1-PDGFRA替代标志的CHIC2缺失荧光原位杂交（FISH）检测未见PDGFRA基因重排。自身免疫及血管炎筛查（ANA, anti-dsDNA, p-ANCA, c-ANCA）均为阴性。观察到血清IgG升高（2760 mg/dL; normal range, 700–1600 mg/dL）和IgG4升高（1260 mg/dL; normal range, 3.9–86.4 mg/dL），IgE轻度升高（137.5 IU/mL; normal range, <100 IU/mL）以及RF偏高（144.4 IU/mL; normal range, <20 IU/mL）。其余参数正常，包括氨基转移酶、血尿素氮、血清肌酐、补体C3、补体C4、维生素B12、血清皮质醇和NT-proBNP。ECG和超声心动图正常。胸部CT显示轻度纤维化和支气管扩张。痰AFB涂片和支气管镜检查阴性。支气管肺泡灌洗液细胞学显示中性粒细胞35%，未见嗜酸性粒细胞。肺功能检查提示重度阻塞，并有支气管舒张反应。呼出一氧化氮分数（FeNO）为15 ppb。粪便标本白细胞阳性，未见卵或寄生虫。血清学检测提示弓蛔虫病阳性（Toxocara canis 的IgG阳性，54.2 NovaTec-Units），但对 Strongyloides stercoralis, Fasciola sp., Toxoplasma gondii, Trichinella spiralis, Ancylostoma sp., Angiostrongylus cantonensis, Ascaris lumbricoides, Clonorchis sinensis, Paragonimus sp., Gnathostoma sp., Entamoeba histolytica, cysticercosis, filariasis, 和 HIV 为阴性。腹部增强CT显示胆囊结石但无急性胆囊炎，且未见胃肠道异常。上消化道内镜检查结果无明显异常，外观正常。结肠镜显示乙状结肠、左侧结肠、横结肠和右侧结肠黏膜炎症，并行系统性活检。针对疑似弓蛔虫病给予为期五天的 albendazole（400 mg 每日两次）治疗无效。结肠活检显示显著嗜酸性粒细胞浸润（左侧结肠 >85 eosinophils/High-power field (HPF)，横结肠和右侧结肠 >100 eosinophils/HPF）。鉴于患者对弓蛔虫病治疗无反应且结肠黏膜活检见显著嗜酸性粒细胞浸润，确诊为嗜酸性粒细胞性结肠炎。给予口服 methylprednisolone（16 mg）和 montelukast（5 mg）治疗。症状于两周内缓解，嗜酸性粒细胞计数恢复正常（0.3 G/L）。皮质类固醇减量后停用，维持 montelukast 治疗三个月，未出现症状复发。",
+    "translated_summary": "我们报告了一例独特的病例，患者为 57 岁，既往有哮喘和过敏性鼻炎病史，表现为复发性腹痛、显著的血液嗜酸性粒细胞增多以及免疫球蛋白 G4 水平升高。在排除血液系统疾病和其他导致嗜酸性粒细胞增多的继发性原因后，对患者的结肠黏膜进行活检，结果显示组织中的嗜酸性粒细胞数量过多，从而确诊为嗜酸性粒细胞性结肠炎 (EoC)。患者对皮质类固醇反应良好，之后继续服用孟鲁司特，并在随后的 3 个月内未出现症状复发。"
+  },
+  {
+    "id": "multiclinsum_gs_en_569.txt",
+    "fulltext": "A 38-year-old male presented to the hospital with chest tightness and shortness of breath. Three years prior, he had experienced similar symptoms post-activity and received treatment at our hospital. Outpatient echocardiography indicated a left heart echomass suggestive of a myxoma, which led to his admission for further evaluation. Physical examination revealed pigmentation of the patient’s ears characterized by multiple small brown and black spots. Abdominal computed tomography (CT) showed multiple livers and small cysts in the left kidney. Genetic testing identified mutations in the TTN and PRKAR1A genes. The diagnosis of CNC was confirmed through clinical examination, imaging, and genetic testing. Following symptomatic treatment, the patient’s condition improved; however, he refused surgical intervention. On September 20, 2023, the patient presented to our hospital with exacerbated chest tightness and dyspnea. He reported difficulty lying supine and needing to sit upright to breathe. Physical examination revealed jugular vein distension, leftward and downward displacement of the heart boundary, irregular heart rhythm on auscultation, and a mitral valve murmur of intensity 2/6–3/6 in the fourth intercostal space along the left sternal margin. Wet rales were audible in both middle and lower lung fields. Palpation revealed a firm liver extending three fingers below the xiphoid process and two fingers below the rib cage, along with mild pitting edema in both lower limbs. Echocardiographic images indicated global heart enlargement, dilation of the aortic sinus and pulmonary artery, small-to-moderate mitral valve regurgitation, and an irregular echoic mass measuring 54 mm ×43 mm in the left chamber attached to the atrial septum. The left ventricular (LV) ejection fraction (EF) was 23.1%, with fractional shortening (FS) of 10.9%. Electrocardiography demonstrated atrial fibrillation (average ventricular rate, 150 beats/min) and abnormal Q waves in leads V1-V3. Based on the patient’s history, the diagnosis included DCM and CNC with cardiac myxoma. Given the presence of end-stage heart failure and concurrent cardiac myxoma, the patient was hospitalized, and heart transplantation was considered a viable therapeutic option to address both conditions simultaneously. A suitable donor heart became available for immediate transplantation on October 1, 2024.\n\n\nSurgical procedure\n\nThe skin and subcutaneous tissues were carefully incised layer-by-layer through a median sternotomy. The sternum was sawed longitudinally open, and bleeding was controlled using electrocoagulation and bone wax. Extracardiac exploration uncovered global heart enlargement, most prominent in the LV. The heart showed diminished contractile strength. The aorta and the main pulmonary artery (PA) were dissected from the supravalvular region. Some tissues were preserved for posterior suturing, whereas most diseased right atrium, left atrium(LA), right ventricle, and LV were excised. Resection revealed a greyish-white mucoid mass. The donor and residual recipient LA tissues were sutured using double continuous 3/0 Prolene threads. The anastomosis was meticulously inspected multiple times, and no significant bleeding was observed. Similarly, end-to-end anastomosis of the donor ascending aorta and recipient PA was performed using continuous 5/0 Prolene sutures, and careful inspection revealed no bleeding.\n\nFurthermore, the donor’s LA and recipient’s PA were securely closed using double continuous 5/0 Prolene sutures. The inferior vena cava tissues of both the donor and recipient were similarly sutured with 5/0 Prolene sutures, and several inspections were performed to confirm no significant bleeding was present. The left side of the heart was then deflated, and as rewarming commenced, oxygenation was restored, the ascending aorta was unclamped, and the heart spontaneously returned to sinus rhythm. Continuous suturing with 5/0 Prolene was applied to both the donor and recipient’s superior vena cava and diligently inspected to ensure the absence of significant bleeding. After the successful discontinuation of assisted circulation, the venous cavity was decannulated. Tissue samples from the patient’s left heart and gray matter were collected for histopathological examination, and the diagnosis of DCM and cardiac myxoma were confirmed.\n\n\nPostoperative management\n\nOn the first day after heart transplantation, the patient produced 1200 ml of urine. Laboratory tests revealed a hypersensitive troponin T level of 796.70ng/L and an NT-proBNP level of 10798pg/ml. The complete blood count showed white blood cells at 17.15 × 109/L, with no significant abnormalities in other test results. The echocardiograph displayed an LVEF of 65%, FS of 35%, normal ventricular wall thickness and echogenicity, and no discernible abnormalities in valve morphology and structure. After heart transplantation, Methylprednisolone Sodium Succinate (0.25 g)intravenous hormone therapy was administered to enhance immunity, and Cefoperazone and Sulbactam Sodium (2 g) intravenous anti-infection treatment was provided. The patient was given a nutrient solution and liver and tiopronin on the first day post-surgery. On postoperative day three, Methylprednisolone Sodium Succinate was replaced with oral Prednisone Acetate (25 mg). Mycophenolate Mofetil capsules (0.5 g) were administered orally to minimize heart rejection, and (50 mg) of Carpofungin Acetate was administered intravenously to prevent fungal infections. The patient’s urine output was 2000 ml, with hypersensitive troponin T levels of 390ng/L, NT-proBNP levels of 7877pg/ml, and a leukocyte count of 12.15 × 109/L. On the 7th day post-surgery, tacrolimus capsules were introduced at an oral dose of (1 mg) to minimize the patient’s rejection of the donor heart, with careful monitoring of blood concentrations. Subsequently, the oral dosage of Prednisone Acetate was gradually decreased to (10 mg) while adjusting the tacrolimus blood concentration to 10.90ng/ml. The patient’s recovery improved. On October 20, 2023, follow-up echocardiography (Fig. 6) indicated no abnormalities, with troponin levels of 85 ng/L, NT-proBNP of 210pg/ml, and all other test results within normal ranges. The patient exhibited excellent postoperative recovery and was discharged. Regular follow-up visits to our department after discharge showed that the patient remains in good condition.",
+    "summary": "Herein, we report a case of heart failure due to Carney syndrome that resulted in cardiac myxoma combined with dilated cardiomyopathy. A 35-year-old male was admitted to the hospital three years ago because of sudden chest tightness and shortness of breath. Echocardiography indicated myxoma, and a combination of genetic screening and physical examination confirmed Carney syndrome with cardiac myxoma. Following symptomatic management, he was discharged. Surgical interventions were not considered at the time. However, the patient’s chest tightness and shortness of breath symptoms worsened, and he returned to the hospital. A New York Heart Association grade IV heart function was confirmed, and echocardiography indicated the presence of dilated cardiomyopathy accompanied by cardiac myxoma. Ultimately, the patient’s heart failure was successfully treated with heart transplantation.",
+    "translated_fulltext": null,
+    "translated_summary": "在此，我们报告一例由卡尼综合征引起的充血性心力衰竭病例，该病例伴有心肌粘液瘤和扩张型心肌病。一位35岁的男性患者三年前因突发胸闷、呼吸困难入院。超声心动图显示存在心肌粘液瘤，结合基因筛查和体格检查，确诊为卡尼综合征，并伴有心肌粘液瘤。经过对症治疗后，患者出院。当时未考虑进行手术干预。然而，患者的胸闷和呼吸困难症状加重，再次入院。经检查，患者的心功能为纽约心脏协会IV级，超声心动图显示存在扩张型心肌病，并伴有心肌粘液瘤。最终，患者通过心脏移植成功治疗了心力衰竭。"
+  },
+  {
+    "id": "multiclinsum_gs_en_324.txt",
+    "fulltext": "2 years 6 months old female pre-schooler with a previous diagnosis of NF1. She consulted due to a 4 week diarrhea with blood streaks (5 to 10 episodes a day). A week after the onset of the diarrhea she consulted the emergency department, where rotavirus (+) was detected, with low inflammatory parameters, negative coproculture and normal abdominal ultrasound. She was hospitalized for 3 days to manage dehydration and was discharged without bleeding, with persistence of semi-liquid stools. 10 days after discharge she presented diarrhea with blood streaks, associated with low intake and weight loss of 1 kg reported by parents. They consulted a pediatric gastroenterologist who requested a polymerase chain reaction (PCR) panel of gastrointestinal pathogens and PCR of Clostridium difficile (which were negative) and indicated hospitalization for study.\n\nOn direct questioning, the parents reported no fever, abdominal pain, vomiting, respiratory or urinary symptoms, arthralgia, or new skin lesions. They did not own pets, and there was no history of travel or recent dietary changes.\n\nThe patient was diagnosed with confirmed NF1 at 8 months of age by genetic testing with the heterozygous pathogenic variant c.5606_5627del (p.Gly1869Valfs*28). She has skin involvement (café con leche spots) and bone involvement. At 18 months she required ankle arthrodesis for tibial curvature. She has no family history of NF1 or inflammatory bowel disease.\n\nOn physical examination, the abdomen was soft and indistinct, with increased air-bubble murmurs, without masses or visceral enlargement. The perianal examination was normal. There were multiple brown-coffee stains on the lower extremities and back. General examinations were performed, including a blood count with moderate microcytic-hypochromic anaemia (Hb 9.6 g/dL), leukocytosis with left shift (leukocytes 13,900), and discretely elevated inflammatory parameters (CRP 1.37 mg/dL, normal value up to 0.5 mg/dL).\n\nA colonoscopy was performed, the rectum, sigmoid and various segments of the colon were examined up to the cecum, visualizing the ileocecal valve and the appendicular orifice. The last few centimeters of the distal ileum were also inspected. The mucosa from the anal margin to the cecum was observed to be erythematous, with loss of vascular transparency, unlike the cecal mucosa, which appeared normal. No lesions were identified in the anal canal or cecum.\n\nBiopsies of the small intestine (ileon) and large intestine were taken. Microscopic examination showed mucosa of ileal type with preserved villous architecture and adequate epithelial differentiation, with a non-inflamed lamina propria. The mucosa of the large intestine had a mild distortion of architecture and adequate epithelial differentiation, a swollen lamina propria with a mild mixed inflammatory infiltrate and hyperplasia of lymphoid follicles. Isolated foci of microabscesses were recognized. The biopsy was consistent with mild colitis, with signs suggesting chronicity.\n\nIn addition, a PCR study for cytomegalovirus (CMV) was requested in a colon biopsy, which was positive.\n\nGiven a positive PCR for CMV, CMV IgG and IgM and CMV viral load in blood were requested, resulting in a positive IgG, negative IgM, and CMV viral load of 79.7 IU/ml. Further laboratory studies included PCR for gastrointestinal pathogens and PCR for Clostridium difficile in stool, both of which were negative. In the colon biopsy, Gram stain microbiological studies were requested, which showed +++ leukocytes without bacteria; biopsy culture showed S. gallolyticus/equinus complex in very low amount (interpreted as bacterial flora); acridine orange, Ziehl-Neelsen, Koch culture, and ADV PCR were negative.\n\nEndoscopy and histology suggestive of UC was reported in the context of a patient with moderate symptoms (PUCAI 50) who was started on Mesalazine (70 mg/kg/day three times daily) and a request for a faecal calprotectin was made which was greater than 600 ug/g.\n\nThe immunology team evaluated the patient for suspected immunodeficiency. The parents did not report a history of infections, they reported that they were vaccinated, that they had good weight gain, no family history of immunodeficiencies, auto-immunity or early deaths. A study with lymphocyte subpopulations (normal), immunoglobulins (normal), HIV (negative), memory T lymphocytes (with alterations expected in the context of CMV viremia) and lymphoproliferation test (normal) was requested. In addition, a genetic panel of primary immunodeficiencies (Invitae) was performed, which contains 429 genes, of which 68 make up the panel of monogenic inflammatory intestinal disease. 7 variants of uncertain significance were obtained, none included in the panel of monogenic IBD.\n\nGanciclovir was initiated intravenous for CMV infection and continued for 15 days. The last PCR CMV control prior to discharge reported undetectable load.\n\nThe patient improved during the hospital stay with decreased frequency of stools and increased consistency, no rectal bleeding, no nocturnal stools and no abdominal pain, with PUCAI 0 at discharge.\n\nTwo months later, he presented with a reactivation of IBD with bloody diarrhea (PUCAI 35). A blood count was performed (normal), a panel of gastrointestinal pathogens was performed (–), PCR for Clostridium difficile was performed (+), and CMV load was undetectable. He was treated with oral metronidazole. However, he persisted with diarrhea with blood streaks, so he was hospitalized again.\n\nA colonoscopy was performed, where erythematous mucous was observed in a diffuse form from the rectum to the cecum, with nodularity and loss of vascular transparency in the submucosa, greater in the left and transverse colon segments. No focal lesions were observed. The mucosa of the ileum and anal canal were observed without lesions.\n\nBiopsy of the terminal ileum, right colon and left colon was performed. Microscopic examination of the ileal-type mucosa showed preserved villous architecture and adequate epithelial differentiation. The lamina propria showed no signs of inflammation. There were no aphthous erosions or granulomas. The mucosa of the large intestine showed mild distortion of architecture and epithelial dedifferentiation. The lamina propria was expanded by mixed inflammatory infiltrate, transmucosal distribution. Foci of cryptitis and cryptitic microabscesses and hyperplasia of reactive lymphoid follicles were recognized. No granulomas, viral or parasitic cytopathic changes were observed. All fragments of the left colon sample presented a similar histopathological picture.\n\nShe was given oral treatment with Vancomycin and Prednisone (1 mg/kg/day) with a good response and a favorable evolution. She was discharged with a decrease in the frequency of bowel movements. She persists with mild symptoms (PUCAI 5) in outpatient control, so the dose of corticosteroids is progressively decreased and she remains on treatment with Mesalazina.\n",
+    "summary": "2.5-year-old pre-schooler with a history of NF1 presenting with bloody diarrhea. On endoscopic examination, the mucosa from the anal margin to the cecum was erythematous with loss of vascular transparency. Colon mucosal biopsies showed signs of chronic inflammation consistent with a diagnosis of ulcerative colitis and CMV infection was diagnosed by PCR.\n",
+    "translated_fulltext": null,
+    "translated_summary": "一位2岁半的学龄前儿童，既往有神经纤维瘤病1型（NF1）病史，现出现血性腹泻。内镜检查显示，从肛门缘到盲肠的黏膜呈红斑，血管透明度降低。结肠黏膜活检显示慢性炎症迹象，与溃疡性结肠炎的诊断相符，并通过PCR检测确诊为巨细胞病毒（CMV）感染。"
+  },
+  {
+    "id": "multiclinsum_gs_en_41.txt",
+    "fulltext": "4-month-old indigenous lactating mother from the rural area of the interior of Panama, from the town of Urracá, 3 hours by canoe from the nearest health center. Her background included being the fourth daughter, born by vaginal delivery at home by a relative, without prenatal controls, her weight, height and Apgar score at birth are unknown. She did not breastfeed and was fed with powdered milk formula with iron for children under 6 months, receiving 3 ounces every 4 hours.\n\nThe nuclear family was composed of 6 people (parents and 4 children) who lived in a house with walls and floor of boards and palm roof, 2 rooms, without electricity, they were illuminated with kerosene lamps, water from a well, excreta in a river and they burned the garbage, their economic income came from subsistence agriculture.\n\nHe had no health care in his first 4 months of life and did not receive the vaccinations included in the national expanded programme of immunizations. According to his parents, his neurodevelopment was normal until his hospitalization.\n\nThe minor consulted in a health center with a history of 4 days of diarrhoea, without mucus or blood associated with vomiting of food content (the mother gave her tea because she could not tolerate milk), afebrile and without respiratory symptoms. Oral fluids and 4 doses of Enterogermina® (B. clausii: two billion spores/5 mL) were administered. Due to the lack of supplies (they did not have catheters, or intraosseous for the administration of intravenous fluids) she was transferred to a second-level hospital in the provincial capital and then to our institution in Panama City with a diagnosis of acute gastroenteritis and severe dehydration.\n\nHe presented to the emergency department with a consciousness compromise, dehydration characterised by a tearless cry, dry oral mucosa. He had oedema of +++ hands, feet, abdomen and face. He was afebrile and had signs of shock, capillary refill time > 2 seconds, cold extremities, filiform pulse and marble skin, heart rate 170 bpm, respiratory rate 55 bpm, blood pressure 91/37 mmHg, oxygen saturation 99%. He weighed 4.7 kg and was 56 cm tall at admission, Z-score height/age -2.52, weight/height and weight/age Z-scores were not quantifiable due to severe dehydration. On segmental examination, there were fine crepitus in both lung bases and erythematous-squamous lesions with desquamation of skin and others with hypopigmentation of trunk and upper limbs (interpreted as pellagroid dermatosis).\n\nLactate Ringer bolus was given at 10 ml/kg in the emergency department, followed by 5% Dextrose in 0.33% Saline 500 ml at an infusion rate of 29 ml/h over 6 hours without KCL until diuresis was obtained. She was started on Ceftriaxone 50 mg/kg/day for suspected sepsis, stabilised and sent to the ward where she continued to receive 500 ml of 5% Dextrose in 0.9% Saline at 20 ml/hr.\n\nAmong the examinations, a blood count revealed leukocytosis at 39.0 x 103/uL, severe anaemia 5.6 g/dL, thrombocytosis 502 x 103/uL, the rest of the results are detailed in. He was transfused with 50 ml of filtered and leuko-reduced red blood cells and 40 cc of fresh frozen plasma due to altered coagulation times. Enteral feeding was initiated by nasogastric tube and infusion was decreased to 15 ml/h of 5% Dextrose in 0.9% Saline 500 cc, and continued with negative water balance.\n\nOn day 2, initial peripheral blood culture was reported as Gram positive cocci in clusters, Oxacillin was added at 200 mg/kg/day, Ceftriaxone was increased to 75-100 mg/kg/day, total fluids to 120 ml/kg/day and calcium was corrected (value received 6.38 mg/dL).\n\nOn her 3rd day she lost venous access, so a central venous catheter (CVC) was placed. She was hypovolemic with subhydrated oral mucosa, increased respiratory work, cold extremities and capillary refill time of 3-4 seconds. Ringer's lactate was given at a load of 20 ml/kg in one hour. Arterial blood gas revealed uncompensated metabolic acidosis with pH 7.26, HCO3 13 mmol/L, PCO2 28.4 mmHg, PO2 39.2 mmHg, lactate 2.8 mmol/L. She was intubated and transferred to the paediatric intensive care unit (PICU) where she was placed on mechanical ventilation.\n\nTotal fluids of 100 cc/kg, infused epinephrine, low-salt albumin, and 10% calcium gluconate were administered, and fentanyl was changed to remifentanil due to elevated liver enzymes.\n\nThe blood culture of admission reported growth of methicillin-resistant Staphylococcus aureus (MRSA), Oxacillin was omitted and Clindamycin was added at 40 mg/kg/day; the blood culture of admission on the second day of admission to the ICU with Gram-negative bacillus smear was positive, and Ceftriaxone was changed to Ceftazidime at 150 mg/kg/day.\n\nOn his first day in the ICU, a substantial increase in serum biomarkers of cardiac damage was documented, the echocardiogram showed mild mitral and tricuspid regurgitation, left ventricular dilatation, left ventricular ejection fraction (LVEF) 58%, no evidence of thrombi, vegetations or pericardial effusion, and he was diagnosed with acute myocarditis. Milrinone was started at 0.4 mcg/kg/min, furosemide and IV immunoglobulin 1 g/kg single dose.\n\nThe second day blood culture the germ was identified as Bacillus clausii, identified by the system (VYTEK 2TM), the susceptibility profile was not performed because the team did not have cut points for this germ, for this reason the antibiotic coverage was adjusted, considering it was not a contaminant, Ceftazidime was changed to Ciprofloxacin at 30 mg/kg/day and Ceftaroline was added at 8 mg/kg every 8 hours along with Clindamycin for MRSA. The 3 subsequent blood cultures with intervals of 48 hours between each were positive in both peripheral blood and CVC for isolation of B. clausii.\n\nOn his 6th day in hospital, the gastrointestinal panel (Maripoc gastro test methodology) performed on the second day detected Clostridiodes difficile toxin A/B, the tests for Campylobacteryeyuni, Norovirus GI, Norovirus GII.4, Adenovirus and Rotavirus were negative. Following these findings, therapy was escalated to IV Vancomycin at a dose of 60 mg/kg/day and metronidazole was added orally. Ceftaroline, clindamycin and ciprofloxacin were omitted, covering both B. clausii and C. difficile and MRSA .\n\nHIV testing, serology for Chagas and SARS-CoV-2 antigen by immunofluorescence (FIA) were negative, immunoglobulins were within normal limits.\n\nOn the seventh day, arterial hypertension was reported and spirinolactone was added to the management.\n\nOn the 8th day, the laboratory tests showed altered coagulation times and increased azotaemia associated with anuria that had lasted for 12 hours. However, due to the patient's condition, a peritoneal catheter was not placed, the vancomycin dose was adjusted and vitamin K was administered. The patient continued to have anuria and anasarca, and she developed sustained hypotension. Noradrenaline was added, but her condition deteriorated with multisystem organ failure and she died twelve days after admission. No autopsy was performed because the mother refused permission for cultural reasons.\n",
+    "summary": "4-month-old lactating infant, indigenous ethnicity, from the rural interior of Panama, 3 hours by canoe from the nearest health subcenter, with protein-caloric malnutrition, who presented with acute diarrhea and moderate-severe dehydration, receiving Enterogermina as part of the initial treatment. She was transferred to a third-level hospital, where she arrived with respiratory distress and signs of shock. The initial blood culture reported growth of methicillin-resistant Staphylococcus aureus (MRSA), the gastrointestinal panel was positive for Clostridiodes difficile, and later growth was confirmed in serial blood cultures of peripheral blood and central venous catheter, of Bacillus clausii. With a torpid evolution and resistance to multiple antibiotic regimens, she died of multisystem organ failure twelve days after admission.\n",
+    "translated_fulltext": null,
+    "translated_summary": "一名四个月大的正在哺乳的婴儿，为巴拿马内陆农村地区的土著民族，距离最近的基层卫生中心需要乘独木舟行驶 3 小时。该婴儿患有蛋白质-能量营养不良，并出现急性腹泻和中度至重度脱水症状，最初的治疗方案包括使用恩特罗热敏（Enterogermina）。之后，该婴儿被转往三级医院，抵达时出现呼吸窘迫和休克迹象。初步的血液培养结果显示，耐甲氧西林金黄色葡萄球菌（MRSA）有生长。胃肠道检测结果显示，艰难梭菌（Clostridiodes difficile）呈阳性。后续的多次血液培养结果，包括外周血和中心静脉导管的培养结果，均证实有闭氏芽孢杆菌（Bacillus clausii）生长。由于病情进展缓慢且对多种抗生素治疗方案无效，该婴儿在入院十二天后因多器官功能衰竭而死亡。"
+  },
+  {
+    "id": "multiclinsum_gs_en_490.txt",
+    "fulltext": "A 78-year-old woman, who came to collect her blister pack with her medication reconstituted in a personalised dosage system (PDS) from the community pharmacy, informed us that for some months she had been suffering from tiredness, weakness, dizziness and confusion. These symptoms were preventing her from leaving her home to walk as often as she normally did. In view of this situation, she was invited to the personalised care area to review the degree of knowledge that the patient had of her medication and the use she made of it, to analyse whether any of her medication could be related to the health problem described.\n\nPharmacological treatment of the patient\n\nMedication  Dose  Dosage  Health issue  Start date\nDoxazosin  2 mg/24 h  0-0-1  Hypertension  2014\nLosartan  100 mg/24 h  1-0-0  Hypertension  2014\nManidipine  20 mg/24 h  0-1-0  Hypertension  2014\nSimvastatin  40 mg/24 h  0-0-1  Hypercholesterolemia  2014\nAcetylsalicylic acid  100 mg/24 h  1-0-0  Secondary prophylaxis  2014\nOmeprazole  20 mg/24 h  1-0-0  Prevention of peptic ulcer  2014\nPregabalin  100 mg/12 h  1-0-1  Neuralgia  2019\nTorasemide  10 mg/24 h  1-0-0  Edema  2023\nDulaglutide  1.5 mg/week  1 time/week  Diabetes  2014\nInsulin glargine  74 IU/24 h  1-0-0  Diabetes  2014\nInsulin lispro  20 IU/24 h  0-1-0  Diabetes  2014\nBrimonidine  1 drop/12 h  1-0-1  Ocular hypertension  2018\n\nStudy and evaluation\nThe interview revealed that there was no new medication and that it did not appear in the SPD service register. Given the suspicion of a possible hypotension, her blood pressure was measured with an Omron Complete device, with the following values: Systolic Blood Pressure (SBP) 96 mmHg, Diastolic Blood Pressure (DBP) 52 mmHg and Heart Rate (HR) 69 beats per minute. Given these values, it was suggested that her blood pressure be monitored and the influence of her medication on these values and the symptoms described by the patient be analysed.\n\nThe patient's medication doses, starting with antihypertensive medications, are reviewed to adjust to the patient's estimated glomerular filtration rate (eGFR) and to see if hypotension is related to the dosage of these medications. The patient's eGFR value, calculated using the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) formula, is 30 ml/min/1.73 m2.\n\nThe guidelines for the revision of the dose according to the value of the eGFR are the product information for the medicinal products and the consensus guidelines for the use of medicinal products in renal impairment of the teaching and research group in the field of practical pharmacy of the Faculty of Pharmacy of the University of Barcelona, which is available on the Internet. This guide has been prepared from the analysis of the most dispensed medicinal products in community pharmacies. They have been organised by therapeutic groups according to the ATC (Anatomical-Therapeutic-Chemical) classification, information on the symptoms of overdose has been included and it has been agreed to categorise the risk to the patient of taking these medicinal products according to their eGFR as low, moderate or high.\n\nAfter the medication review was performed according to the eGFR value of 30 ml/min/1.73 m2, the results were obtained.\n\nFollowing the study of the medication, our intervention focuses on the dosage of the following medicines: losartan, manidipine, torasemide and pregabalin. The antihypertensive medicines, losartan and manidipine, and pregabalin require a dose adjustment depending on the patient's eGFR value, while the diuretic torasemide can influence blood pressure values.\n\nInitially, it was decided to intervene in the dosage of losartan and manidipine. There is the possibility of reducing the dose of pregabalin, but the pharmaceutical team agreed with the patient to assess the influence of this medication after the possible adjustment of the dose of antihypertensive during the evolution and follow-up of the patient.\n\nIntervention\nThe information is used to prepare a report for the doctor (see annex), recommending a reduction in the dose of losartan and manidipine, as the available information recommends a reduction in the dose to 50-75% of losartan for eGFR of 30-59 ml/min/1.73 m2 and adjusting the dose of manidipine for eGFR of 15-30 ml/min/1.73 m2.\n\nThe proposed intervention was explained to the patient and the report was given to the primary care doctor, explaining the possibility of adjusting the dose of losartan and manidipine to improve the patient's condition (table 4). When this information reached the doctor, he opted to reduce the dose of losartan to 50 mg/24 hours and manidipine to 10 mg/24 hours. Pregabalin 100 mg/12 hours was also replaced with gabapentin 300 mg/12 hours.\n\nFollow-up\nFollowing this change in the patient's treatment and after a follow-up of two months, the patient showed an improvement in blood pressure values (table 5) and a remission of the symptoms described. It was reviewed whether the gabapentin dose of 300 mg/12 hours was adequate for the eGFR value of 30 ml/min/1.73 m2, and it was correct (eGFR between 30 and 60, recommended total daily dose 300-900 mg).\n\n",
+    "summary": "78-year-old patient, taking many medicines and included in the Personalised Medication Dosage System (SPD). When she came to collect her medication, she informed us that for some months she had been suffering from tiredness, weakness, dizziness and confusion. A review of the medication was carried out, focusing on the dosage of the medicines metabolised or eliminated by the kidneys, depending on the patient's estimated glomerular filtration rate (EGFR). A referral was made to the Primary Care Physician (PCP) by means of a report, in which the reduction of the dose of losartan and manidipine was recommended, depending on the patient's estimated glomerular filtration rate (EGFR). The PCP reduced the dose of the antihypertensive medicines. The case was monitored, which allowed us to observe that the patient no longer presented the symptoms described initially.\n",
+    "translated_fulltext": null,
+    "translated_summary": "这位78岁的患者正在服用多种药物，并且参与了个性化药物剂量调整系统（SPD）。当她来领取药物时，她告诉我们，在过去的几个月里，她一直感到疲劳、虚弱、头晕和精神恍惚。我们对她的药物进行了评估，重点关注肾脏代谢或排出的药物的剂量，并根据患者的预计肾小球滤过率（EGFR）进行调整。我们通过一份报告将她转诊给初级保健医生（PCP），报告中建议根据患者的预计肾小球滤过率（EGFR）调整氯沙坦和氨氯地平的剂量。初级保健医生降低了降压药的剂量。我们对该病例进行了监测，结果表明，患者不再出现最初描述的症状。"
+  },
+  {
+    "id": "multiclinsum_gs_en_483.txt",
+    "fulltext": "It is a case study, approved by the Research Ethics Committee (CEP) under number 1.012.635. The prior authorization of the relatives and the participant was requested from the signature of the Free and Informed Consent (TCLE) and the Free and Informed Consent (TALE).\n\nThe participant in this study is a female student in the 3rd year of elementary school. In the first evaluation, in 2018, the child was 8 years and 2 months old, while in the second evaluation, in 2019, she was 9 years and 6 months old. The interval between the evaluations occurred due to the fact that it is a public service. Thus, the laboratory was absent from activities during the holidays. In addition, it is important to consider that the appointments were only made once a week and, during that period, the participant was absent, which also prolonged the process. As for her history, she was born at term and presented adequate neuropsychomotor and linguistic development. The child was born and lived in a French-speaking country until the age of 2 years, but had exposure to another language at home, since her parents are Brazilian Portuguese speakers. However, her first words were in French. When she returned to Brazil, she went through two private schools. In the first school, she was unable to communicate, as she only expressed herself in French. After that experience, at the age of 3, she began studying in a French school, still in Brazil. Over the years, she presented difficulty in acquiring reading and writing; for that reason, she repeated the 1st year of elementary school, at the request of her mother. At the age of 6, she began studying in a bilingual Portuguese-English school. At the age of 8 years old, she underwent evaluation by an interdisciplinary team in the areas of speech therapy and neuropsychology, finding the diagnosis of developmental dyslexia (DD) and high abilities/giftedness (AH/S). Soon after, she was referred to the evaluation of reading and writing in the Laboratory of Written Language, Interdisciplinarity and Learning - LEIA/UFRN.\n\nPhases of the study: four assessment sessions for each moment - pre and post intervention (T1 and T2, respectively) - and 20 sessions of phonological remediation, once a week for 60 minutes. The intervention took place in the second semester of 2018, where parents were not very engaged due to work demands.\n\nAssessments were conducted individually over a one-hour period. They included tasks to assess performance in phonological processing - phonological working memory, phonological awareness and mental lexical access - reading and writing.\n\nThe following protocols were used to evaluate the child:\n\nPhonological awareness: to evaluate this ability, the Consciência Fonológica Instrumento de Avaliação Sequencial - CONFIAS (11) was used. This protocol proposes tasks of synthesis, segmentation, rhyme, alliteration, initial and final syllable identification, exclusion and transposition. First, syllabic awareness, formed by nine items, is analyzed, followed by phonemic awareness, formed by seven items. Each hit is equivalent to one point, with 40 for syllabic awareness and 30 for phonemic awareness, totaling 70 points. Its results should be compared with the expected writing hypotheses based on Ferreiro and Teberosky (12). In this way, the following normal values were used: for the syllabic-alphabetic writing hypothesis, 27, 12 and 39 for the syllabic, phonemic and total score, respectively; for the alphabetic writing hypothesis, 31, 15 and 46.\n\nPhonological working memory: The Phonological Working Memory Test was used (13). In the application of this protocol, the assessor should begin with the non-word test, which consists of 40 invented words. The assessor should then say each word in the list, asking the child to repeat it immediately. The child has two attempts to repeat the words correctly. In the first attempt, each correct answer is worth two points, in the second attempt, the child is awarded one point, and in the third attempt, the child is awarded zero points. After this, the assessor should move on to the test of digits in direct and reverse order, which is scored in the same way as the pseudo-words. Depending on the age of the participant at the time of the assessments, the normal values of 69, 13 and 6 were used for pseudo-words, direct and reverse digits, respectively.\n\nAccess to the mental lexicon: the Rapid Automatic Naming Test (RAN)(14) was used in the evaluation and the Automatic Naming Test (TENA)(15) in the re-evaluation. Both tests aim to estimate the individual's ability to name a sequence of stimuli, that is, to measure the speed at which the child can verbalize a visual stimulus quickly. Two protocols were used, since the TENA had not yet been published at the time of the first evaluation. In addition, the TENA is a current and more complete protocol for the verification of normality, as it allows analysis according to age and months. The two tests used have similar application and are divided into four boards, where the child must name colors, objects, letters and digits. The naming must be done with the same movement that is used for reading - from left to right and from top to bottom. For T1, which used the RAN, the normality values correspond to children aged between 8 years and 8 years and 11 months, due to the age of the participant in that period, thus, it should have a score of 28, 29, 52 and 46 seconds for the subtests of digits, letters, objects and colors, respectively. For T2, the normality values of the age of 9 years and 6 months of the protocol (TENA) were used, with an expected score of 35, 32, 50, 53 seconds for the subtests of digits, letters, objects and colors, respectively.\n\nReading: First, the Protocol for the Assessment of Reading of Words/Pseudowords Isolated – LPI(16) was used, in which the child is asked to read aloud words and pseudowords, which are scored. 19 regular words, 20 irregular words and 20 pseudowords are arranged in black Arial font, size 24 and white background. The child may obtain a total of 59 points, since each correct reading is worth one point. After this, the Protocol for the Assessment of Reading of Expository Texts was used(17). This instrument aims to assess reading comprehension through directed questions about texts compatible with the subject's school year. It assesses and times patterns of silent and oral reading. This allows the reading level to be verified and compared. In addition, the number of words read per minute is averaged, allowing the reading speed to be verified and compared.\n\nWriting: To evaluate the writing, the child was asked to produce a text on a topic of their interest. After finishing the story, the professional asked the child to read out loud what was written. Furthermore, the child was asked to write the target words of the LPI(16) on a separate sheet, in order to carry out a dictation of words and pseudo-words. With this, a qualitative investigation of the writing was carried out, based on the orthographic analysis of Zorzi and Ciasca(18).\n\nThe remediation was based on a program used for children with dyslexia(19) and included activities that aimed to improve phonological abilities, such as: identification of graphemes and phonemes, phoneme pairs, syllable pairs, word pairs, addition and subtraction of phonemes, syllabic and phonemic manipulation, rhymes, alliteration, access to mental lexicon, visual working memory, auditory working memory and reading training. In all sessions, these activities were explored in a playful way, mainly directed to the metalinguistic aspects of phonological awareness. In reading training, the child was exposed to children's books from the Mico Maneco collection. This collection has various stories that increase the level of complexity of words, so it is possible to follow the child's progress. The activities performed and the child's evolution were described in his/her medical record at the end of each session.\n\nAnalysing the results found, with regard to performance in phonological awareness, in both assessments the child presented performance consistent with the hypotheses of writing presented in each period. In the first assessment, he received the syllabic-alphabetic writing hypothesis and in the second, the alphabetic one, demonstrating progress. The performance score progressed in both categories of the skill, syllabic (T1 = 35; T2 = 37) and phonemic (T1 = 14; T2 = 20) (Table 1). The progress of 4 successes in the phonemic level is highlighted, which can be explained due to the phonological remediation having been performed with focus on the phonemic level.\n\nThe results of phonological working memory at the time prior to phonological remediation expressed below-expected performance for the pseudo-word category, with 66 points in T1, with expected performance for T1 (ET1) of 69, and for the reverse-order digits category (T1 = 04; ET1 = 06) (Table 1). Despite this, it presented results within the expected range for the reverse-order digits category (T1 = 20; ET1 = 13). In the post-intervention evaluation (T2), the results are adequate for the age. It is also possible to notice advances in this skill in all categories, pseudo-word (T1 = 66; T2 = 69), reverse-order digits (T1 = 04; T2 = 12) (Table 1), which requires aspects of executive functions that assist in the rapid storage of the response, a differential aspect in high abilities.\n\nAs for the automatic rapid naming, it is noted that in T1, the performance is inadequate for the standards of normality in all subtests. It is also possible to say that, in T2, the performance was below the expected for the categories of digits (T2 = 41; ET2 = 35), objects (T2 = 59; ET2 = 50) and colors (T2 = 56; ET2 = 53). Only the category of letters presented results within the expected (T2 = 29; ET2 = 32). On the other hand, the advance in the speed of naming is visible for the subtests of letters (T1 = 37; T2 = 29), objects (T1 = 62; T2 = 59) and colors (T1 = 60; T2 = 56), with the exception of digits (T1 = 37; T2 = 41) (Table 1). With the decrease of the time of naming of the stimuli, it is possible to say that the child becomes more effective to access the mental lexicon at the level of the phonological and visual representation, which is also not usual in isolated dyslexia.\n\nAs for reading, in T1 she presented an alphabetic level and in T2 an orthographic level. In the first test, it was noted that there was difficulty mainly with visually similar letters and phonologically close. In addition, the student used sub-vocal support to decode and had an average reading of 20 words per minute, which demonstrates extremely slow decoding and is far below what is expected for her schooling. In the reassessment, she had an average of 94.4 words per minute in oral reading, which is considered adequate for her schooling. She demonstrated presence of prosody, rhythm, global reading, interest and adequate understanding. Qualitatively, it is observed that the child, even with adequate performance, read with a low intensity of speech, still demonstrating insecurity in carrying out the task.\n\nIn writing, it can be observed that in T1 the child had inadequate pencil grip, imprecise writing, with letter changes, omissions, hyper and hyposegments, repetition of words and low use of cohesive elements. In this period, it was shown with writing in the transition from the syllabic-alphabetic phase to the alphabetic phase. In T2 no significant change was observed, since his writing continued to be imprecise, with little intelligibility of the content, visual similarities between letters (such as “d” and “b”) and lack of punctuation. According to the sample collected, it was shown in the alphabetic phase of writing, although difficulties not expected for his age persisted. Despite this, it is noted that he used a greater repertoire in the use of vocabulary for the lexicon of visual input.\n\nAfter the analysis of the results in their entirety, it can be observed that the written language skills advanced during the interval between the evaluations, despite the persistence of consonant characteristics with dyslexia, as it still presents performance below the expected in the access to the mental lexicon and in writing - with the presence of exchanges between phonemes that are audibly and visually similar in a persistent way, omission of letters and hypersegmentation.\n",
+    "summary": "This study is a case report of the evaluation and intervention process of a 9-year-old child with the paradoxical combination of high abilities associated with dyslexia. The objective was to compare the performance in the tasks of phonological processing, reading and writing before and after phonological remediation. In the first evaluation, the child presented an alphabetic level in reading, a transition phase between the syllabic-alphabetic and alphabetic levels in writing and a performance below the expected level in phonological processing abilities. After the intervention, there was an improvement in phonological processing abilities, consolidation of alphabetic writing and of the orthographic level of reading.\n",
+    "translated_fulltext": null,
+    "translated_summary": "本研究是一份案例报告，记录了一位9岁患有阅读障碍，但同时又具备高度认知能力的儿童的评估和干预过程。研究目的是比较该儿童在语音处理、阅读和写作任务中的表现，以及在接受语音训练前后的差异。在首次评估中，该儿童的阅读能力处于字母识别阶段，写作能力处于音节-字母阶段和字母阶段之间的过渡阶段，语音处理能力低于预期水平。经过干预后，该儿童的语音处理能力有所提高，字母书写能力得到巩固，阅读能力也提升到了正字法水平。"
+  },
+  {
+    "id": "multiclinsum_gs_en_443.txt",
+    "fulltext": "65-year-old woman with no relevant personal or family history. In August 2022, a posterior mediastinal tumour was found in the preoperative assessment for a knee surgery, which was why she was referred for evaluation and treatment. On admission, the physical examination was not relevant and the laboratory studies were within normal parameters. A chest CT scan was performed that showed a tumour located in the posterior right mediastinum measuring 6.5 × 4.2 cm, with well-defined borders, with a fat and solid density, with no evidence of bone erosion or infiltration of surrounding tissue. A biopsy of the lesion was performed using a 18G × 250 mm semiautomatic cutting needle, with image guidance, through a posterior approach. In the histopathological study, a benign neoplasm consisting of mature adipose tissue with areas of haemorrhage alternating with haematopoietic elements, predominantly precursors of the red series, was observed, as well as elements of the myeloid series in different stages of maturation and megakaryocytes, which established the diagnosis of MPM.  Finally, with the diagnosis established and the characteristics of the lesion, conservative management was decided. The patient evolved satisfactorily and was discharged without complications.\n",
+    "summary": "We present the case of a 65-year-old woman with a primary mediastinal myelolipoma. Computed tomography of the chest showed an ovoid, well-defined bordered tumor of 6.5 × 4.2 cm, located in the posterior mediastinum. A trans-thoracic biopsy of the lesion was performed and microscopic examination revealed haemopoietic elements and mature adipose tissue.\n",
+    "translated_fulltext": "一位65岁的女性，既往无相关个人或家族病史。2022年8月，在膝关节手术术前评估中，发现其后纵隔存在一处肿瘤，因此她被转诊以进行评估和治疗。入院时，体格检查结果无特殊，实验室检查结果也在正常范围内。进行了胸部CT扫描，结果显示后部右侧纵隔存在一处肿瘤，大小为6.5×4.2厘米，边界清晰，呈脂肪和实性密度，没有骨质侵蚀或周围组织浸润的迹象。通过后部入路，在影像引导下，使用18G×250毫米半自动切割针对该病灶进行了活检。组织病理学研究显示，该病灶为良性肿瘤，由成熟的脂肪组织组成，并伴有出血区域，出血区域与造血元素交替出现，主要为红细胞系列的前体细胞，以及不同成熟阶段的髓细胞系列和巨核细胞，从而确诊为原发性胸膜间皮瘤（MPM）。最终，在确诊并了解病灶特征后，决定采取保守治疗。患者恢复良好，无并发症，并顺利出院。",
+    "translated_summary": "我们报告了一例65岁女性患者，其病例为原发性纵隔骨髓脂肪瘤。胸部计算机断层扫描显示，在后纵隔内有一个卵圆形、边界清晰的肿块，大小为6.5×4.2厘米。对该病灶进行了经胸穿刺活检，显微镜检查显示存在造血成分和成熟的脂肪组织。"
+  },
+  {
+    "id": "multiclinsum_gs_en_180.txt",
+    "fulltext": "The 52-year-old man tested positive for SARS-CoV-2 using a self-test kit after having a cold. He returned to work without fever after resting for two days, but lost consciousness while working outdoors in an ambient temperature of 35°C for five hours. Upon admission to the local hospital’s emergency department, his core temperature (Tc) was recorded as 40°C. The patient presented with persistent coma, dyspnea and gastrointestinal hemorrhage. No underlying diseases and relative family history was noted. Based on the characteristic presentation of hyperpyrexia, coma and multiple organ damage, a diagnosis of HS was established. He was admitted to emergency intensive care unit (ICU) of the local hospital and then received mechanical ventilation. The test results indicated the presence of pulmonary infection, hepatic and renal dysfunction, myocardial ischemia and coagulation disorders. The patient received initial management including rehydration (intravenously infused Lactated Ringer’s solution and normal saline at a rate of 2.5mL/kg∙h), intravenous administration of Piperacillin Sodium and Tazobactam Sodium, vasoactive medications for blood pressure support, continuous mechanical ventilation, and continuous renal replacement therapy (CRRT) to manage subsequent anuria. The patient received plasma transfusion and was administered Tranexamic acid on day 5. The worsening of his condition led to his admission to the medical ICU of our hospital 7 days after HS.\n\nFollowing admission, Reverse-transcription polymerase chain reaction (RT-PCR) testing of a nasopharyngeal swab yielded positive results for SARS-CoV-2. The patient was diagnosed with HS and severe COVID-19 based on China’s COVID-19 Diagnosis and Treatment Program (trial version 10): 1. real-time fluorescent RT-PCR detection of SARS-CoV-2 nucleic acid is positive; 2. respiratory failure and requires mechanical ventilation; 3. shock; 4. combined with multiple organ failure requiring intensive care. The patient had no contact with COVID-19 diagnosed patients or healthcare workers in the hospital, indicating community-acquired infection. The physical examination showed a Glasgow Coma Scale (GCS) score of 3/15, with scores of 1 for eye-opening, verbal response, and motor response. Additionally, the pupils were symmetrical and non-reactive. The heart rate was recorded at 106 bpm and blood pressure was maintained at 126/77 mmHg by continuously infusing norepinephrine at a rate of 0.4 ug/kg·min. The laboratory test results indicated a severe infection, along with anemia, thrombocytopenia, disseminated intravascular coagulation (DIC), as well as acute liver and kidney injury. The white blood cell count (WBC) decreased from 3.55×109/L to 3.13×109/L, lymphocytes significantly decreased from 0.25×109/L to 0.1×109/L, and neutrophil percentage (N%) increased to 85.3%. The Procalcitonin level measured 2.81 ng/mL and C-reactive protein (CRP) level was 32.6 mg/L. Sputum culture testing yielded Stenotrophomonas Maltophilia and Candida lipolytica. The central venous catheter culture test detected Staphylococcus epidermidis, but the continuous blood culture test yielded no positive results. The Computed Tomography (CT) scan revealed bilateral frontal subdural effusion, consolidation and atelectasis in the lower lungs, inflammation in the right upper lobe, bilateral pleural effusion, and a small amount of abdominal fluid.\n\nThe patient received synchronized intermittent mandatory ventilation with a positive end expiratory pressure of 5 mmH2O and an oxygen concentration of 80% and continuous administration of norepinephrine and pituitrin to sustain normal blood pressure. Polyene phosphatidylcholine, adenosylmethionine budisulfonate, ulinastatin, and hemofiltration have been employed for the management of hepatic and renal dysfunction. The antibiotic was substituted with Meropenem and Thymalfasin was administered for 20 days to augment immune function. Mannitol was used to alleviate intracranial pressure for 3 days. To improve coagulation dysfunction, the patient received plasma and cryoprecipitate transfusions, continuous intravenous infusion of heparin sodium at 6000u/day and CRRT with sodium citrate for anticoagulant (8g/day) on day 7. Platelet transfusion was administered after 9 days of HS. His Tc fluctuated between 36 °C and 38.5 °C. CRRT was administered without anticoagulant on day 8. The patient had gastrointestinal hemorrhage and fever after 9 days of HS, but electronic gastroenteroscopy showed no signs of active bleeding. He underwent red blood cell suspension transfusion, hemostasis treatment and gastric acid suppression. Teicoplanin was added due to the presence of Methicillin-resistant Staphylococcus aureus isolated from sputum culture. The patient regained consciousness on day 13 with a GCS score of 14/15 and presented with a moderate fever. Gastrointestinal hemorrhage was not observed. Mechanical ventilation was discontinued and the tracheal tube was removed. But the creatinine levels increased following the suspension of CRRT on day 12.\n\nOn day 17, he developed sudden dyspnea with desaturation (oxygen saturation <85%) followed by a high fever (Tc: 39.3°C), necessitating reintubation and mechanical ventilation. Bronchoscopy revealed less sputum in both lungs and subbranches. He experienced a recurrence of coma, with a GCS score of 3/15. WBC increased to 14.94×109/L and NEU increased to 13.77×109/L. The levels of serum total bilirubin rose to 235.2 µmol/L, while creatinine increased to 441µmol/L. The brain CT scan revealed an ischemic stroke in the right frontal lobe and a hemorrhagic infarction in the right occipital lobe. The patient underwent cooling therapy using CRRT with ice-cold replacement fluid, along with persistent administration of Meropenem and Teicoplanin for anti-infection treatment. Carpofungin was added on day 18 due to the observed elevation in serum levels of Aspergillus galactomannan, Aspergillus IgG antibody, and Candida mannan. The RT-PCR testing for SARS-CoV-2 returned negative results.\n\nThe patient’s fever and infection improved on day 20, but he subsequently developed cerebral hemorrhage and hernia with bilateral dilated pupils. The dehydration therapy was used to reduce intracranial pressure, as surgery was refused by his family. On day 22, indicators of infection, levels of aspartate aminotransferase and creatinine increased again. Carbapenem-resistant Acinetobacter baumannii and A. fumigatus were cultured in the bronchoalveolar lavage fluid. The combination of Meropenem, Teicoplanin, and Carpofungine was administered for anti-infective therapy. The patient’s condition progressively worsened over the next 7 days, ultimately resulting in his demise on day 29. The patients’ inflammatory indicators, cytokines, and coagulation indicators are presented in Table 1.",
+    "summary": "We report the first case of heatstroke comorbid with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in a 52-year-old male. After receiving intravenous antibiotics, organ protection measures, and treatment for coagulation disorders, his fever and coma resolved. However, he developed dyspnea and cerebral hemorrhage after several days. This patient experienced a multi-pathogen pulmonary infection and an intractable coagulopathy that ultimately resulted in MODS and death.",
+    "translated_fulltext": null,
+    "translated_summary": "我们报告了一例52岁男性患者，该患者同时患有中暑和重症急性呼吸综合征冠状病毒2（SARS-CoV-2）感染，这是首例此类病例。在接受静脉注射抗生素、器官保护措施以及针对凝血功能障碍的治疗后，他的发烧和昏迷症状得到了缓解。然而，几天后，他出现了呼吸困难和脑出血。该患者经历了多种病原体的肺部感染，并伴有顽固的凝血功能障碍，最终导致多器官功能衰竭并死亡。"
+  },
+  {
+    "id": "multiclinsum_gs_en_91.txt",
+    "fulltext": "A 13-year-old adolescent male, with no significant previous medical history, presented to the emergency department with a 3-day history of acute bilateral pleuritic chest pain associated with mild non-productive cough and no dyspnea. Associated with this, he had mild rhinorrhea and a single febrile episode that day (temperature of 38ºC). Chest pain was localized to the costal margin region and worsened with cough, without diurnal variation. The patient-reported relief with paracetamol. There were no complaints of joint pain, weight loss, anorexia, fatigue, episodes of syncope or exercise restriction. In fact, he practiced sports regularly—canoeing 2 times a week. No evidence of an infectious exposure or contact with household or environmental fumes, dust, or mineral oils was described. There was no known family history of cardiopulmonary conditions. He had a chest radiograph taken 4 years earlier during an acute illness, which showed a marked interstitial infiltrate that was presumptively treated with azithromycin with no further clinical symptoms and no further follow-up.\n\nOn admission, the patient’s temperature was 37.8°C with normal peripheral oxygen saturation (99%) in room air. His heart (93 beats per minute) and respiratory rate (15 breaths per minute) were normal and blood pressure was on the 85th percentile (115/66 mmHg). Physical examination revealed diminished breath sounds in the lower two thirds of the chest with no adventitious sounds. No respiratory distress, finger clubbing, cyanosis, abnormal heart sounds, or other findings were present. Chest radiograph revealed a marked interstitial infiltrate, comparable with his previous examination. A thoracic computed tomography (CT) revealed multiple bilateral areas of ground-glass opacities involving > 65% of lung parenchyma, suggestive of PAP. Respiratory viral testing was negative, and he remained stable throughout his monitoring in the emergency department. He was discharged with empiric antibiotics (amoxicillin-clavulanic acid and azithromycin) to cover a potential respiratory infection, with clinical resolution of symptoms and was sent for follow-up at the pediatric respiratory clinic.\n\nUpon further investigation in the outpatient setting, positive antinuclear antibodies (ANAs) at a titer of 1/89 with a fine speckled pattern were detected, while other autoantibodies tested negative and immunoglobulin levels remained within normal limits. Bronchoalveolar lavage revealed fluid with a milky appearance and positive periodic acid-Schiff staining; microbiological examination, including for mycobacteria, returned negative results. Spirometry indicated a mild restrictive pattern with reduced forced vital capacity (FVC) at 2.92 L (77%) and forced expiratory volume in 1 second (FEV1) at 3.21 L (69.9%), alongside a normal FEV1/FVC ratio (109%). In addition, the DLCO single breath (SB) showed a moderate decrease at 13.8 ml/min/mmHg (48.6%). Suspecting PAP, a genetic panel was conducted, which showed no mutations associated with surfactant dysfunction. Subsequently, GM-CSF antibody testing was performed with a positive result, raising suspicion for AI-PAP. At 20 months of follow-up, the patient remains asymptomatic and continues to exercise regularly. He repeated spirometry testing with normal FVC at 4.03 L (81.3%); FEV1 at 3.71 L (87.5%); FEV1/FVC ratio at 91.96% and DLCO SB at 25.54 ml/min/mmHg (83.7%). As the patient remains stable with no respiratory symptoms, we decided to defer treatment and continue monitoring with regular clinic visits.",
+    "summary": "We describe the case of a 13-year-old adolescent male who presented to the emergency department with acute pleuritic chest pain not associated with systemic complaints. On examination, he had diminished breath sounds in the lower two thirds of the chest with no other abnormal findings; SpO2 (oxygen saturation) was 98% on room air. Chest radiograph revealed a marked interstitial infiltrate, comparable with the one taken 4 years earlier during an acute illness that was presumptively treated with azithromycin. A computed tomography (CT) scan revealed multiple bilateral areas of ground-glass opacities with areas of crazy paving, involving > 65% of lung parenchyma, suggestive of pulmonary alveolar proteinosis (PAP). Respiratory viral testing, including for coronavirus (SARS-CoV2), was negative. Bronchoalveolar lavage performed in the outpatient setting revealed a milky fluid and positive periodic acid-Schiff staining. Spirometry indicated a mild restrictive pattern (forced vital capacity [FVC] = 77%) and diffusing capacity of the lungs for carbon monoxide (DLCO) showed a moderate decrease at 48.6%. No mutations associated with surfactant dysfunction were found on the genetic panel. Anti-granulocyte macrophage colony-stimulating factor (GM-CSF) antibody testing was strongly positive, raising suspicion for autoimmune PAP. At 20 months of follow-up, the patient remains asymptomatic with a normal spirometry.",
+    "translated_fulltext": "一位13岁的男性青少年，既往无明显病史，因出现持续3天的急性双侧胸膜性胸痛就诊于急诊科，伴有轻微的非 productive 性咳嗽，无呼吸困难。同时，他还出现轻微的鼻炎和当天一次发热（体温38℃）。胸痛局限于肋骨边缘区域，咳嗽时加重，但没有昼夜变化。患者表示服用对乙酰氨基酚后症状有所缓解。他没有关节疼痛、体重减轻、食欲不振、疲劳、晕厥或活动受限等症状。事实上，他经常进行体育锻炼，每周划船两次。没有发现任何感染暴露或接触家庭或环境中的烟雾、灰尘或矿物油。已知家族史中没有心肺疾病。四年前，他在一次急性疾病期间进行了胸部X光检查，结果显示有明显的间质浸润，当时他接受了阿奇霉素治疗，之后没有出现其他临床症状，也没有进行进一步的随访。\n\n入院时，患者体温为37.8℃，在室内空气中，外周血氧饱和度正常（99%）。他的心率（93次/分钟）和呼吸频率（15次/分钟）正常，血压在第85百分位数（115/66 mmHg）。体格检查显示，胸部下三分之二的呼吸音减弱，没有其他异常呼吸音。没有呼吸窘迫、杵状指、紫绀、异常心音或其他发现。胸部X光片显示有明显的间质浸润，与他之前的检查结果相似。胸部计算机断层扫描（CT）显示，双侧肺部有多处磨玻璃样混浊区域，占肺实质的65%以上，提示可能为肺泡蛋白沉积症（PAP）。呼吸道病毒检测结果为阴性，他在急诊科的观察期间病情保持稳定。他被开具了经验性抗生素（阿莫西林-克拉维酸和阿奇霉素）以治疗潜在的呼吸道感染，症状得到临床缓解，并被转诊至儿科呼吸科进行随访。\n\n在门诊进一步检查中，检测到阳性的抗核抗体（ANA），滴度为1/89，呈细点状。其他自身抗体检测结果为阴性，免疫球蛋白水平仍在正常范围内。支气管肺泡灌洗液显示液体呈乳白色，并呈阳性的过碘酸-希夫染色；包括结核分枝杆菌在内的微生物学检查结果均为阴性。肺功能检查显示轻度限制性模式，用力肺活量（FVC）降低至2.92 L（77%），一秒用力呼气容积（FEV1）降低至3.21 L（69.9%），同时FEV1/FVC比值正常（109%）。此外，单次呼吸（SB）的弥散功能（DLCO）也显示出中度降低，为13.8 ml/min/mmHg（48.6%）。考虑到可能为PAP，进行了基因检测，结果显示没有与表面活性物质功能障碍相关的突变。随后，进行了GM-CSF抗体检测，结果为阳性，这增加了对自身免疫性肺泡蛋白沉积症（AI-PAP）的怀疑。在随访20个月后，患者仍无症状，并继续进行规律的锻炼。他重复进行了肺功能检查，结果显示FVC正常，为4.03 L（81.3%）；FEV1为3.71 L（87.5%）；FEV1/FVC比值为91.96%，DLCO SB为25.54 ml/min/mmHg（83.7%）。由于患者病情稳定，没有呼吸道症状，我们决定推迟治疗，并继续通过定期门诊随访进行监测。",
+    "translated_summary": "我们描述了一位13岁男性青少年的病例，他因急性胸膜性胸痛来到急诊科，但没有伴有全身症状。检查发现，他的胸部下部三分之二的呼吸音减弱，没有其他异常发现；在常温下，血氧饱和度（SpO2）为98%。胸部X光片显示，肺间质有明显的浸润，与4年前因急性疾病进行阿奇霉素治疗时拍摄的X光片相似。计算机断层扫描（CT）显示，双侧肺部有多处磨玻璃样阴影，并伴有“鹅卵石路”样改变，累及超过65%的肺实质，提示可能为肺泡蛋白沉积症（PAP）。呼吸道病毒检测，包括新冠病毒（SARS-CoV2）检测，结果均为阴性。在门诊进行的支气管肺泡灌洗术显示，液体呈乳白色，且过碘酸-席夫染色呈阳性。肺功能检查显示，存在轻度限制性模式（用力肺活量[FVC]=77%），肺对一氧化碳的弥散能力（DLCO）中度下降，为48.6%。基因检测未发现与表面活性物质功能障碍相关的突变。抗粒细胞-巨噬细胞集落刺激因子（GM-CSF）抗体检测结果强烈阳性，提示可能为自身免疫性PAP。在随访20个月后，患者仍无症状，肺功能检查结果正常。"
+  },
+  {
+    "id": "multiclinsum_gs_en_212.txt",
+    "fulltext": "27-year-old woman with a history of uncontrolled asthma, mild SARS-CoV-2 infection. In March 2021, she consulted a doctor for pain in the left hemicara and trismus. She reported having completed 48 hours before the antibiotic treatment with phenoxymethyl penicillin 1,000,000 IU daily orally for five days for a peritonsillar abscess. She was hemodynamically stable at the physical examination, without the need for supplemental oxygen, and without relevant findings in respiratory symptoms. The head and neck examination showed a soft, painful, cervical adenopathy, palpable and painful, predominantly homolateral and trismus. Complementary studies were performed. The admission laboratory reported leukocytosis, platelopenia, increased acute phase reactants and the rest of the parameters within normal values. An angiotomy of the craniofacial mass was performed, where a large thrombus was found in the internal and external carotid arteries. Studies were completed with a chest tomography and arterial Doppler ultrasound of neck vessels with no relevant findings. Early intravenous antibiotic treatment was initiated with ceftriaxone 1 g every 12 hours, clindamycin 300 mg every 6 hours and anticoagulation with enoxaparin adjusted to body weight and renal function, 60 mg subcutaneously every 12 hours. The patient evolved 72 hours after initiating the directed treatment with a fever of 38.5 °C and increased leukocytosis, so new complementary studies were performed, including a Doppler ultrasound of the heart without finding cardiac vegetations and a chest tomography where bilateral pulmonary septic emboli were found. With the admission hemocultures negative, a new admission of 3 units, culture of pharyngeal exudate and rotation of ceftriaxone to piperacillin tazobactam 4.5 g every 6 hours intravenous was decided. The patient evolved favorably, without rescue of germs in cultures. After 14 days of initiating the new therapeutic scheme, and with a control chest tomography without pulmonary lesions, it was decided to continue antibiotic treatment with oral clindamycin 300 mg every 6 hours, anticoagulation with acenocumarol adjusted to body weight and hospital discharge.\n",
+    "summary": "A 27-year-old woman presented with facial oedema and trismus 48 hours after completing treatment with phenoxymethylpenicillin for an odontogenic infection. A head and neck CT scan showed a large thrombus in the internal jugular vein and a chest CT scan showed pulmonary septic embolism. Treatment consisted of early intravenous broad spectrum antibiotics and anticoagulation.\n",
+    "translated_fulltext": "一位27岁的女性，既往有未控制的哮喘病史，并感染了轻度SARS-CoV-2病毒。2021年3月，她因左侧颌面部疼痛和张口受限就医。她表示，在接受苯氧甲青霉素1,000,000 IU口服，每日一次，共五天，用于治疗扁桃体周围脓肿的抗生素治疗前48小时，症状已有所缓解。体格检查显示，她的血流动力学稳定，无需补充氧气，呼吸系统症状无明显异常。头部和颈部检查显示，颈部淋巴结肿大，触痛明显，主要位于同侧，并伴有张口受限。进行了进一步的检查。入院时实验室检查结果显示，白细胞计数升高，血小板减少，急性期反应物增加，其余指标均在正常范围内。对颅面部肿块进行了血管造影，发现内颈动脉和外颈动脉内存在大血栓。随后进行了胸部CT扫描和颈部血管动脉多普勒超声检查，结果无明显异常。开始进行早期静脉注射抗生素治疗，方案为：头孢曲松1克，每12小时一次；克林霉素300毫克，每6小时一次；并根据体重和肾功能调整依诺肝素的剂量，皮下注射，剂量为60毫克，每12小时一次。在开始有针对性治疗72小时后，患者出现体温38.5°C的发热，白细胞计数进一步升高，因此进行了新的检查，包括心脏多普勒超声检查，未发现心脏赘生物，以及胸部CT扫描，结果显示双侧肺部存在感染性栓塞。入院时血培养结果为阴性，决定再次进行3次血培养，并对咽拭子进行培养。同时，将头孢曲松更换为哌拉西林/他唑巴坦4.5克，每6小时静脉注射一次。患者病情好转，培养结果未发现细菌。在新治疗方案开始后14天，且复查胸部CT扫描未见肺部病变，决定继续口服克林霉素300毫克，每6小时一次，并根据体重调整阿塞诺香豆素的剂量，进行抗凝治疗，并允许患者出院。",
+    "translated_summary": "一位27岁的女性患者，在完成苯氧甲青霉素治疗牙源性感染后48小时，出现面部水肿和三叉神经麻痹。头部和颈部CT扫描显示内颈静脉内存在大血栓，胸部CT扫描显示肺部出现感染性栓塞。治疗方案包括早期静脉注射广谱抗生素和抗凝治疗。"
+  },
+  {
+    "id": "multiclinsum_gs_en_205.txt",
+    "fulltext": "A 5-year-old presented to the paediatric emergency department (ED) having ingested chlorpyriphos 13 hours prior to presentation, followed by abnormal jerks, fast breathing and difficulty with breathing. The history was also comprised of excessive sweating and urination, mouth secretions and involuntary movement of the limbs. Vomiting followed the ingestion of crushed charcoal and palm oil. The patient had lapsed into coma prior to presentation. The temperature at presentation was 38.3°C, Glasgow coma score was 3, pupils were pinpoint pupils and there was hypotonia in all limbs. In addition, the patient was severely dyspneic, tachypneic (respiratory rate of 48/minute with intermittent sighing breaths), a saturation of 88% and widespread crackles. The pulse rate was 180/minute, blood pressure 120/80 mmHg, and random blood glucose 14 mg/dl. Serum lactate and cholinesterase tests were not done due to lack of facilities.\n\nThe patient was diagnosed with severe organophosphate poisoning (OPP) and aspiration pneumonitis. As ICU care was beyond the affordability of the parents, non-invasive ventilation (NIV) was administered using bubble continuous positive airway pressure (b-CPAP) causing his saturation to increase to 99%–100%. Hypoglycemia was corrected with a bolus of dextrose solution and tachycardia was treated with 20 ml/kg of normal saline. Intravenous Dexamethasone, Mannitol and IV Atropine at 0.02 mg/kg/dose were also administered. Empirical intravenous antibiotics were administered for aspiration pneumonitis. Pralidoxime was not given due to unavailability. Within 3 hours of presentation, the patient had fresh-whole-blood exchange-blood-transfusion (FWB-EBT) with 500mls of blood.\n\nThe patient’s GCS appreciated to 9/15 but IV Atropine was discontinued after the first dose due to a rapid increase in the heart rate. The blood glucose fluctuated between 41 to 259 mg/dl in the first 15 hours of admission and subsequently normalized with treatment. By the second day on admission, the patient developed thready pulses and hypotension for which another bolus of normal saline was administered. Dopamine infusion was commenced at 5mcg/kg/min using a peripheral vein and IV Mannitol discontinued. A second aliquot of FWB-EBT was administered with 500mls of blood.\n\nOver the first 30 hours of admission, the consciousness level improved and respiratory distress slowly declined. However, the patient developed rhonchi which was treated with nebulized Salbutamol and Budesonide and was subsequently transited to Oxygen therapy with nasal prongs with clinical improvement. The saturation remained stable at 97%. On Day 2 of admission, a chest radiograph was done which showed bilateral infiltrates in keeping with pneumonia.\n\nThe patient regained full consciousness by the 39th hour of admission. Intravenous Vitamin C and B, as well as oral Vitamin E and Zinc were commenced for their antioxidant effects, and regular diet was recommenced in a graded manner over the subsequent 48 hours. The patient’s clinical condition progressively improved and was discharged home after 10 days but was subsequently lost to follow-up.",
+    "summary": "We present the case of a 5-year-old with severe organophosphate poisoning from ingestion of chlorpyrifos, further worsened by aspiration of a charcoal-palm oil mixture. The clinical illness was marked by respiratory failure, shock, coma and type I paralysis. The patient was treated in the emergency department with noninvasive ventilation, multiple episodes of exchange transfusion, intravenous atropine, inotrope infusion, antibiotics and steroids. The patient responded rapidly to treatment, did not develop intermediate syndrome and was discharged after 10 days of admission.",
+    "translated_fulltext": "一名 5 岁儿童因误食氯吡脲 13 小时后出现异常抽搐、呼吸急促和呼吸困难，被送至儿科急诊科。病史还包括大量出汗和排尿、口腔分泌物增多以及四肢不自主运动。在误食后，患者又服用了碾碎的活性炭和棕榈油，随后出现呕吐。在送医之前，患者已陷入昏迷。就诊时，体温为 38.3°C，格拉斯哥昏迷评分 (GCS) 为 3，瞳孔缩小，四肢肌张力低下。此外，患者呼吸困难，呼吸频率为每分钟 48 次，并伴有间歇性叹息，血氧饱和度为 88%，肺部有广泛的湿啰音。脉搏为每分钟 180 次，血压为 120/80 mmHg，随机血糖为 14 mg/dL。由于缺乏相关设备，未进行血清乳酸和胆碱酯酶检测。\n\n患者被诊断为重度有机磷中毒 (OPP) 和吸入性肺炎。由于重症监护室的治疗费用超出了患者家属的承受能力，因此采用了无创呼吸支持 (NIV)，使用气泡持续正压通气 (b-CPAP)，使患者的血氧饱和度增加到 99%–100%。通过静脉注射葡萄糖溶液来纠正低血糖，并使用 20 毫升/公斤的生理盐水来治疗心动过速。此外，还静脉注射地塞米松、甘露醇和阿托品（剂量为 0.02 毫克/公斤/次）。为了治疗吸入性肺炎，给予经验性静脉抗生素。由于无法获得，未给予吡啶肟。在就诊后的 3 小时内，患者接受了 500 毫升的全血交换输血 (FWB-EBT)。\n\n患者的 GCS 评分提高到 9/15，但在首次给药后，由于心率迅速增加，停止了静脉注射阿托品。入院后的最初 15 小时内，血糖波动在 41 至 259 mg/dL 之间，随后通过治疗恢复正常。入院第二天，患者出现细弱的脉搏和低血压，因此再次给予生理盐水静脉注射。通过外周静脉开始输注多巴胺，剂量为 5 微克/公斤/分钟，并停止静脉注射甘露醇。随后，再次给予 500 毫升的全血交换输血 (FWB-EBT)。\n\n在入院后的最初 30 小时内，患者的意识水平有所改善，呼吸窘迫逐渐减轻。然而，患者出现了哮鸣音，通过雾化吸入沙丁胺醇和布地奈德进行治疗，随后转为鼻导管吸氧，临床症状得到改善。血氧饱和度保持在 97%。入院第二天，进行了胸部 X 光检查，显示双侧肺部浸润，符合肺炎的特征。\n\n患者在入院的第 39 小时完全恢复意识。为了发挥其抗氧化作用，开始静脉注射维生素 C 和 B，并口服维生素 E 和锌，并在随后的 48 小时内逐步恢复正常饮食。患者的临床状况逐渐改善，并在 10 天后出院，但之后未能进行后续随访。",
+    "translated_summary": "我们报告了一例5岁儿童因误食毒死蜱而导致严重的有机磷中毒，病情因吸入活性炭和棕榈油混合物而进一步加重。该患儿的临床表现为呼吸衰竭、休克、昏迷和I型麻痹。在急诊科，该患儿接受了无创呼吸支持、多次进行血液置换、静脉注射阿托品、血管活性药物输注、抗生素和类固醇治疗。该患儿对治疗反应迅速，未出现中间综合征，并在住院10天后出院。"
+  },
+  {
+    "id": "multiclinsum_gs_en_76.txt",
+    "fulltext": "A 19-year-old woman presented to the emergency department of our institution for acute onset of palpitations. An electrocardiogram (ECG) showed ventricular tachycardia, with right branch bundle block associated to left posterior hemiblock, and T waves inversion in the inferior and precordial leads. Blood test showed elevated troponin (27 ng/L, normal values <14 ng/L) and NT-pro BNP (aminoterminal pro B-Type Natriuretic Peptide) levels (2225 pg/mL, normal values <130 pg/mL). Hence, she was admitted to the coronary care unit.\n\nAbout 5 years before, she had already presented to the emergency department with cardiogenic shock due to fascicular ventricular tachycardia; she was subsequently hospitalized and underwent cardiac magnetic resonance (CMR) and a transoesophageal electrophysiological study, both with inconclusive results. She was discharged with a diagnosis of tachycardiomiopathy, with the prescription of a standard medical therapy (angiotensin-converting enzyme inhibitors, mineralocorticoid receptor antagonist, and beta blockers), and a follow-up was planned. Her subsequent clinical history was uneventful.\n\nDuring the present hospitalization, no further episodes of hyperkinetic arrhythmias were detected. Basal 12-lead ECG. Echocardiography showed diffuse hypokinesia of both the left and the right ventricles, and CMR was once again inconclusive. Then, the patient was advised to undergo cardiac computed tomography angiography (CCTA) to evaluate the anatomy of the coronary tree, under the suspicion of an undiagnosed congenital cardiac anomaly. CCTA was performed with a GE Lightspeed unit (GE HealthCare, Chicago, United States), with retrospective gating, at 100 kVp and 696 mAs, with a gantry rotation time of 0.35 s, and 0.625 mm slice thickness, with intravenous injection of 70 mL of Iomeron 400 mgI/mL (Bracco Imaging, Milan, Italy).\n\nDifferential diagnosis\nCardiogenic shock, namely a shock caused by inadequate blood flow, may be caused by different pathologies such as myocardial infarction, arrhythmias, or other cardiomyopathies. Undiagnosed congenital heart disease is a non-negligible cause of cardiogenic shock in otherwise healthy adult patients. Once myocardial infarction is ruled out by a 12-lead ECG, and an underlying cardiomyopathy has been excluded by an inconclusive CMR examination, CCTA is the technique of choice for the differential diagnosis among diverse causes of cardiogenic shock.\n\nInvestigations/imaging findings\nThe CCTA examination showed regular origin of the left main coronary artery, the left anterior descending artery, which presented a wide ramus intermedium, 2 diagonal branches, and the left circumflex artery, which appeared thin and non-dominant. Among all these vessels, there was no evidence of obstructive coronary artery disease. However, the ostium and the proximal portion of the right coronary artery (RCA) were absent, whereas its mid and distal portions were supplied by a wide collateral branch originating from the distal left anterior descending artery, which then surrounded the lateral wall of the right ventricle, ran through the distal part of the atrioventricular groove, finally giving rise to thin posterior interventricular and posterolateral arteries. Furthermore, a thin branch going from the mid left anterior descending artery to the sinoatrial node was observed.\n\nTreatment, outcome, and follow-up\nIn view of the CCTA findings, the patient underwent an echo-stress test, which confirmed the presence of inducible myocardial ischaemia in the inferior wall, in line with the positioning of the arrhythmic focus. After being transferred to a specialized centre for the diagnosis and treatment of congenital heart disease, the patient underwent transcatheter radiofrequency ablation of sustained ventricular tachycardia originating by the posteromedial papillary muscle. Then, she was discharged with medical therapy (Acetylsalicylic acid and Verapamil). At her 6-month follow-up, she has always been asymptomatic, with no further signs of arrhythmias.",
+    "summary": "A 19-year-old woman presented to the emergency department with arrhythmia and signs of cardiogenic shock. After a 12-lead electrocardiogram ruled out acute myocardial infarction, and cardiac magnetic resonance showed no sign of cardiomyopathy, cardiac computed tomography angiography (CCTA) was performed, displaying ostial atresia of the right coronary artery. She was thus referred to a specialist centre for congenital cardiovascular disease, where an electrophysiological study observed an arrhythmogenic focus on the posteromedial papillary muscle, which was ablated, and she has been asymptomatic since.",
+    "translated_fulltext": "一位19岁的女性因突发心悸来到我院急诊科。心电图（ECG）显示为室性心动过速，伴有右束支传导阻滞和左后半束支阻滞，以及下壁和胸前导联的T波倒置。血液检查显示肌钙蛋白升高（27 ng/L，正常值<14 ng/L）和NT-pro BNP（氨基末端前脑钠肽）水平升高（2225 pg/mL，正常值<130 pg/mL）。因此，她被收治入院，进入冠状动脉监护室。\n\n大约5年前，她曾因束状室性心动过速导致心源性休克来到急诊科；之后她住院，并进行了心脏磁共振（CMR）和经食管电生理研究，但结果均无明确结论。她被诊断为心动过速性心肌病，并处方了标准药物治疗（血管紧张素转化酶抑制剂、盐皮质激素受体拮抗剂和β受体阻滞剂），并计划进行随访。此后，她的临床病史没有出现其他问题。\n\n在本次住院期间，未检测到进一步的快速性心律失常发作。基础12导联心电图。超声心动图显示左心室和右心室均存在弥漫性运动功能减退，而CMR再次未能得出明确结论。随后，医生建议患者进行心脏计算机断层扫描血管造影（CCTA），以评估冠状动脉的解剖结构，并怀疑存在未确诊的先天性心脏异常。CCTA使用GE Lightspeed设备（GE HealthCare，芝加哥，美国）进行，采用回顾性门控，电压为100 kVp，电流为696 mAs，旋转时间为0.35 s，切片厚度为0.625 mm，静脉注射70 mL的Iomeron 400 mgI/mL（Bracco Imaging，米兰，意大利）。\n\n鉴别诊断\n心源性休克，即由血液循环不足引起的一种休克，可能由多种病理原因引起，如心肌梗死、心律失常或其他心肌病。在其他方面健康的成年患者中，未确诊的先天性心脏病也是心源性休克的一个不可忽视的原因。一旦通过12导联心电图排除心肌梗死，并通过无明确结论的CMR检查排除潜在的心肌病，CCTA将成为鉴别心源性休克各种原因的首选技术。\n\n检查/影像学结果\nCCTA检查显示，左主冠状动脉、左前降支（其具有宽阔的中间支、2条对角支）以及左回旋支（其显得细小且不占优势）的起源均正常。在所有这些血管中，均未发现阻塞性冠状动脉疾病的证据。然而，右冠状动脉（RCA）的开口和近端部分缺失，而其中部和远端部分则由一条宽阔的侧支血管供血，该侧支血管起源于远端左前降支，然后围绕右心室的侧壁，穿过心房室沟的远端部分，最终形成细小的后间隔支和后外侧支。此外，还观察到一条从左前降支中部延伸至窦房结的细小分支。\n\n治疗、结果和随访\n鉴于CCTA结果，患者接受了超声心动应激试验，证实存在可诱发的下壁心肌缺血，与心律失常病灶的位置相符。在转至专门的先天性心脏病诊断和治疗中心后，患者接受了经导管射频消融术，消除了起源于后内侧乳头肌的持续性室性心动过速。之后，她出院，并继续接受药物治疗（阿司匹林和维拉帕米）。在6个月的随访中，她一直没有症状，也没有出现进一步的心律失常迹象。",
+    "translated_summary": "一位19岁的女性患者因心律失常和心源性休克的症状来到急诊科。经过12导联心电图检查，排除急性心肌梗死，心脏磁共振成像显示未见心肌病迹象，随后进行了心脏计算机断层血管造影（CCTA）检查，结果显示右冠状动脉开口处存在闭塞。因此，她被转诊至一家专门治疗先天性心血管疾病的中心，在该中心进行了一项电生理研究，结果显示后内侧乳头肌存在致心律失常的病灶，该病灶随后被消融，此后她一直没有出现任何症状。"
+  },
+  {
+    "id": "multiclinsum_gs_en_72.txt",
+    "fulltext": "A 17-year-old male with no significant past medical or family history was referred to our clinic from the dental department following an incidental finding of a NFB during preoperative orthodontic planning, including dental x-rays and cone beam computed tomography (CBCT) without contrast. The patient was entirely asymptomatic and denied any history of nasal obstruction, rhinorrhea, epistaxis, foul odor, hyposmia, halitosis, facial pain, discomfort, or sleep disturbances. The patient's parents recalled an event when their son was seven, where he inserted an object into his nose. They sought medical advice, where no imaging was performed and an anterior rhinoscopy was utilized for diagnoses but due to the child's non-cooperation during the examination, the physician recommended the removal of the foreign body under sedation. However, the family did not follow up, and since the child remained asymptomatic, they assumed the foreign body had fallen out on its own. On endoscopic examination of the right nasal cavity, a deviated nasal septum with inferior turbinate hypertrophy was noted. The mucosa appeared erythematous and slightly edematous. A foreign body was visualized, lodged, and adhered to the floor of the nasal cavity beneath the inferior turbinate. The object was partially covered with mucus and possibly some crusted material and had a shiny appearance, indicating a metallic nature. Radiographic evaluation, including lateral and frontal X-rays, revealed a circular radiopaque object consistent with a metallic snap button located along the floor of the nasal cavity. The surrounding bony structures appeared normal. A CBCT confirmed the presence of the foreign body with associated mild inflammation, but no significant bony damage or sinus involvement was observed. With informed consent from the patient's parent, the foreign body was removed under local anesthesia in a semi-sitting position to reduce the risk of dislodgment to the airway. After decongesting the nasal cavity with Xylometazoline 0.1 % and administering Lidocaine spray (10 mg/spray) in the right nostril, a hook was utilized to disengage the foreign body, which was then retrieved using bayonet forceps. The procedure was uncomplicated, with minimal bleeding, easily controlled with saline irrigation. Post-removal examination showed no significant tissue damage. The retrieved object, a metallic snap button measuring 1 cm in diameter, exhibited signs of long-term exposure, including substantial corrosion and biological deposits. The patient was discharged in stable condition and prescribed nasal rinses with a sodium chloride irrigation solution (0.9 %). The patient was doing well at his two-week follow-up with an unremarkable examination.",
+    "summary": "We present the case of a 17-year-old male with an asymptomatic NFB discovered incidentally during routine dental radiography. The patient denied any history of nasal obstruction, epistaxis, or discomfort. Imaging revealed a radiopaque object in the right nasal cavity, later identified as a metallic snap button embedded in the floor of the nasal cavity. The foreign body had likely been retained for over a decade.",
+    "translated_fulltext": "一位17岁的男性患者，既往无明显病史或家族病史，因术前正畸计划中偶然发现鼻内异物（NFB），包括牙科X光片和无对比剂的锥形束计算机断层扫描（CBCT），而被转诊至我诊所。患者没有任何症状，否认有鼻塞、鼻涕、鼻出血、异味、嗅觉减退、口臭、面部疼痛、不适或睡眠障碍等病史。患者的父母回忆起，当他们的儿子7岁时，曾将一个物体塞入鼻孔。他们寻求医疗建议，但未进行影像学检查，而是进行了前鼻镜检查以进行诊断。由于孩子在检查过程中不配合，医生建议在镇静状态下取出异物。然而，该家庭并未继续就医，并且由于孩子一直没有症状，他们认为异物已经自行脱落。在对右鼻腔进行内窥镜检查时，发现鼻中隔偏斜，下鼻甲肥大。黏膜呈红斑，并略有水肿。可见一异物，位于下鼻甲下方的鼻腔底部，并附着于此。该物体部分被黏液覆盖，可能还有一些结痂物质，并且表面光滑，表明其为金属材质。放射学评估，包括侧位和正位X光片，显示一个圆形、致密、不透光的物体，与位于鼻腔底部的金属按扣一致。周围的骨骼结构看起来正常。CBCT证实了异物的存在，并伴有轻微炎症，但未观察到明显的骨骼损伤或鼻窦受累。在获得患者父母的知情同意后，在半坐位状态下，使用局部麻醉取出异物，以降低异物脱落进入气道的风险。在用0.1%的羟甲唑啉进行鼻腔减充血，并在右鼻孔内喷洒利多卡因喷雾剂（10毫克/喷雾）后，使用钩状器将异物分离，然后使用弯头镊取出。手术过程顺利，出血量少，并能通过生理盐水冲洗轻松控制。术后检查显示没有明显的组织损伤。取出的物体是一个直径1厘米的金属按扣，显示出长期暴露的迹象，包括明显的腐蚀和生物沉积物。患者情况稳定，出院后处方使用氯化钠冲洗液（0.9%）进行鼻腔冲洗。两周后的随访检查显示，患者情况良好，检查结果无异常。",
+    "translated_summary": "我们报告了一例17岁男性患者的病例。该患者在常规牙科X光检查中偶然发现了一个无症状的鼻内异物。患者否认有鼻塞、鼻出血或不适的病史。影像学检查显示，右侧鼻腔内有一个致密物体，后来被确认为一个嵌入在鼻腔底部的金属纽扣。该异物可能已存在超过十年。"
+  },
+  {
+    "id": "multiclinsum_gs_en_405.txt",
+    "fulltext": "We report a rare case of euthyroid unilateral GO with early massive mono-muscular fibrosis in a 50-year-old male patient. The patient had a family history of cardiovascular disease, type 2 diabetes mellitus, and myasthenia gravis but no family or personal history of thyroid autoimmune disease. The patient was a smoker of 20 cigarettes a day from the age of 30 and presented dyslipidemia for several years. Since June 2020, he experienced rapid and progressive swelling of the soft tissues in the right orbit, moderate pain during ocular globe movements, redness of eyelids and diplopia. Visual acuity was normal in both eyes. In October 2020, the patient was evaluated in our outpatient clinic. Moderate right orbit active inflammation was confirmed by Clinical Activity Score 3/7 (CAS),3 and eyelid edema was moderate. The eyelid aperture was 14 mm in the right orbit and 10 mm in the left orbit, and the Hertel measurements were 24 mm and 18 mm in the right and left orbits, respectively. In addition, the patient presented a severe reduction in elevation, persistent depression in the primary position of the right ocular globe and constant diplopia, as scored according to the Gorman score.4 The quality of life evaluated by Graves’ Ophthalmopathy quality of life questionnaire (GO-QOL)5 was reduced in both appearance and functional subscales. However, the functional subscale was reduced with respect to the appearance subscale, as the values were 12.5 and 50, respectively (considering 0 = worse condition and 100 = the best health state). Visual acuity was normal, and color vision by Ishihara tables was 16/17 and 17/17 in the right and left eyes, respectively. Evaluation of extraocular muscles by computer tomography (CT) scan (contiguous 1.25 mm thick slices, 200 mA, 120 kV, pitch 0.5) showed severe enlargement of the lower rectal body to the edge of the insertion tendon in the right orbit. Remarkably, the morphology of the other extraocular muscles in both orbits was normal. The muscle orbit area ratio measured in the right eyes was 0.25 Autocad units (in-house method; vn ≤ 0.20±0.03).6 Thyroid function was normal with a slight increase in TSH-R-Ab: 1.75 mU/l (n.v. < 1.5 mU/l). The amplitude of the p100 wave was slightly reduced by electrophysiology evaluation in the right eye. A thyroid ultrasound scan of the thyroid gland showed a thyroiditis pattern. Biochemical and clinical evaluations were negative for hematological or other systemic diseases. Routine clinical tests were normal, but the total cholesterol levels that were 220 mg/dl, triglyceride levels were 297 mg/dl, and high-density lipoprotein cholesterol (HDL) levels were 38 mg/dl.\n\nThe patient was treated by intravenous corticosteroid pulse therapy (Solumedrol; Pfizer, Karlsruhe, Germany) with a cumulative dose of 4500 mg over 12 weeks, leading to the resolution of inflammatory signs and symptoms. However, GO-QOL, Hertel measurements and diplopia remained unchanged; in contrast, electrophysiology evaluation and visual acuity worsened. Two-wall orbital surgical decompression plus parenteral glucocorticoids was chosen as the second-line treatment for GO. In that context, a biopsy of the right inferior rectus muscle revealed massive fibrosis with adipose tissue infiltration of this extraocular muscle.",
+    "summary": "Here, we present a rare case of euthyroid single muscular GO in a 50-year-old patient who was a smoker and had dyslipidemia for several years. The patient experienced a very rapid and severe depression of ocular motility of the right eye that caused uncorrectable and constant diplopia, severely affecting his quality of life. He was euthyroid, and TSH-R-Ab plasmatic levels were only slightly elevated. Intravenous corticosteroid pulse therapy was partially effective, and two rounds of wall orbital surgical decompression were necessary. Massive mono-muscular fibrosis was evidenced by biopsy of the right inferior rectus muscle.",
+    "translated_fulltext": "我们报告了一例罕见的甲状腺功能正常、单侧眼眶病伴早期大范围单肌纤维化的病例，患者为50岁男性。该患者有心血管疾病、2型糖尿病和重症肌无力的家族史，但无甲状腺自身免疫疾病的家族史或个人史。患者自30岁起每天吸烟20支，并已患有高脂血症多年。自2020年6月起，他开始出现右侧眼眶软组织快速且持续肿胀、眼球运动时出现中度疼痛、眼睑发红和复视。双眼视力正常。2020年10月，患者在我院门诊就诊。临床活动评分（CAS）为3/7，证实右侧眼眶存在中度活动性炎症，眼睑水肿程度为中度。右侧眼眶眼睑裂为14毫米，左侧眼眶为10毫米，赫特尔测量值分别为右侧24毫米和左侧18毫米。此外，根据戈尔曼评分，患者表现出严重的眼球抬升受限、右侧眼球在原位持续下陷以及持续的复视。通过格雷夫斯眼病生活质量问卷（GO-QOL）评估，患者在外观和功能方面的生活质量均有所下降。然而，功能亚量表相对于外观亚量表有所下降，数值分别为12.5和50（其中0表示最差状态，100表示最佳健康状态）。视力正常，右眼和左眼通过石原色盲图的颜色识别能力分别为16/17和17/17。通过计算机断层扫描（CT）（连续1.25毫米厚度切片，200毫安，120千伏，螺距0.5）评估眼外肌，结果显示右侧眼眶下直肌严重增大，直至接近肌腱插入边缘。值得注意的是，双侧眼眶的其他眼外肌形态正常。右眼肌肉与眼眶面积比为0.25 AutoCAD单位（院内方法；vn ≤ 0.20±0.03）。甲状腺功能正常，TSH-R-Ab略有升高：1.75 mU/l（正常值<1.5 mU/l）。右眼通过电生理评估，p100波的振幅略有降低。甲状腺超声检查显示甲状腺炎模式。生化和临床评估结果显示，患者没有血液系统或其他全身性疾病。常规临床检查结果正常，但总胆固醇水平为220毫克/分升，甘油三酯水平为297毫克/分升，高密度脂蛋白胆固醇（HDL）水平为38毫克/分升。\n\n患者接受静脉注射皮质类固醇冲击疗法（索美德龙；辉瑞，德国卡尔斯鲁厄），累计剂量为4500毫克，疗程为12周，从而缓解了炎症的体征和症状。然而，GO-QOL、赫特尔测量值和复视均未发生变化；相反，电生理评估和视力恶化。因此，选择双壁眼眶手术减压术联合肠内皮质类固醇作为格雷夫斯眼病的二线治疗。在此背景下，对右侧下直肌进行活检，结果显示该眼外肌存在大范围纤维化，并伴有脂肪组织浸润。",
+    "translated_summary": "在此，我们报告一例罕见的甲状腺功能正常的单侧眼外肌受累病例，患者为50岁男性，有吸烟史，并已患有高脂血症数年。该患者右眼眼球运动能力迅速且严重下降，导致无法矫正的持续性复视，严重影响了他的生活质量。他的甲状腺功能正常，TSH-R-Ab血浆水平仅略有升高。静脉注射糖皮质激素冲击疗法效果有限，需要进行两次眶壁手术以进行眶内减压。右侧下斜肌活检显示存在大面积的单侧肌纤维化。"
+  },
+  {
+    "id": "multiclinsum_gs_en_345.txt",
+    "fulltext": "We present the clinical case of a 15-year-old male with no medical history or previous interventions, who presented to the paediatric emergency department with a history of vomiting and epigastric abdominal pain of four days' duration, remaining afebrile during the course of the illness.\n\nInitially treated as gastroenteritis, but with no improvement, and with persistence of epigastric abdominal pain and biliary vomiting, he was admitted to the emergency department for further evaluation.\n\nOn physical examination, the patient was in acceptable general condition, afebrile, with mild signs of dehydration. The abdomen was distended, without signs of peritonism and with decreased hydroaerolic sounds. The laboratory tests did not present significant findings, and an abdominal radiograph was performed with findings suggestive of intestinal obstruction.\n\nGiven the evolution, an urgent computed tomography was performed, which showed the presence of ascites and significant dilation of small intestine loops, suggesting the interposition of a small intestine loop at the beginning of the transcavity of the epiplons, with a change in caliber at the level of the hiatus of Winslow.\n\nUrgent surgical intervention was performed, initially by exploratory laparoscopy. Dilated loops of small intestine and terminal ileum, cecum and ascending colon of normal calibre but located in the right hypochondrium, with the cecum very mobile and without presenting adhesions to the right parietocolic space, were observed. Following the terminal ileum proximally, loops of small intestine of different calibre were observed from the depth of the theoretical location of the hiatus of Winslow. It was possible to pull the cecum and terminal ileum until they were displaced to the right iliac fossa, but without correctly identifying the point of change of calibre, since the interposition of the lower edge of the liver and the distension of loops of small intestine hampered the technique. An attempt was made to improve visualization by percutaneous puncture of a dilated loop to empty the gas, without improvement. To ensure the resolution of the obstructive picture, a supraumbilical mid-laparotomy was decided. When accessing the cavity, the change of calibre in the ileum was evident, about 40 centimetres from the ileocecal valve, with signs compatible with hernia of a section of about five centimetres of the ileum through the hiatus of Winslow. In both ends of the herniated loop, we observed the congestive imprint of the hiatus on the loop (Fig. 3). The normal calibre of the hiatus of Winslow was identified, so no preventive technique was performed to reduce the risk of recurrence.\n\nDuring the first days of the postoperative period, the patient presented a paralytic ileus, and the nasogastric tube could be removed five days after surgery and oral tolerance was initiated with a good response. Simultaneously, he developed a pelvic collection that was managed conservatively with antibiotics, with a good evolution. Finally, the patient was discharged ten days after the intervention, with preserved transit, remaining afebrile and with a good general state.\n\nThe patient is currently being followed up in the outpatient department of paediatric surgery.\n",
+    "summary": "We present the clinical case of a 15-year-old adolescent male with no previous surgical history, who presented with abdominal pain and vomiting, and whose computed tomography suggested a picture of intestinal obstruction due to internal hernia at the level of the Winslow hiatus. He required surgical intervention by exploratory laparoscopy, converted to a supraumbilical midline laparotomy due to poor visualization, for reduction of the herniated ileal loop. This presented a good appearance and intestinal resection was not necessary. No preventive technique was performed to reduce the risk of recurrence. Postoperatively, the patient presented a pelvic collection managed conservatively with antibiotics. He is currently being monitored in outpatient paediatric surgery.\n",
+    "translated_fulltext": "我们报告了一例15岁男性患者的临床病例。该患者既往无病史或接受过任何治疗，因呕吐和上腹部疼痛，持续四天，且在病程中未出现发热，因此来到儿科急诊科就诊。\n\n最初被诊断为胃肠炎，但病情未见好转，且上腹部疼痛和胆汁性呕吐持续存在，因此该患者被收入急诊科，以便进行进一步评估。\n\n体格检查显示，患者一般情况尚可，无发热，轻度脱水。腹部膨胀，无腹膜炎体征，肠鸣音减弱。实验室检查结果无明显异常，腹部X光检查显示肠梗阻的迹象。\n\n考虑到病情发展，立即进行了计算机断层扫描，结果显示存在腹水，小肠袢明显扩张，提示小肠袢位于横膈韧带的起始处，从而导致横膈韧带的起始处发生改变。\n\n立即进行了手术干预，首先进行了探查性腹腔镜检查。观察到扩张的小肠袢和末端回肠、盲肠和升结肠，这些器官的直径正常，但位于右侧肋骨下。盲肠活动性好，且未与右侧腹壁结肠间隙发生粘连。沿着末端回肠向上，观察到不同直径的小肠袢，这些小肠袢位于理论上横膈韧带的位置深处。可以拉动盲肠和末端回肠，使其移位到右髂窝，但由于肝脏下缘的插入和小肠袢的扩张阻碍了手术操作，因此无法正确确定直径改变的点。尝试通过对扩张的小肠袢进行经皮穿刺，以排出气体，但效果不佳。为了确保解决梗阻问题，决定进行上脐部正中剖腹术。进入腹腔后，发现回肠的直径发生改变，距离回盲瓣约40厘米，并伴有与回肠通过横膈韧带疝出的体征，疝出的回肠段长约五厘米。在疝出的小肠袢的两端，我们观察到横膈韧带对小肠袢的压迫痕迹（图3）。确定了横膈韧带的正常直径，因此没有采取预防性措施来降低复发的风险。\n\n术后最初几天，患者出现麻痹性肠梗阻，术后五天后可以拔除鼻胃管，并开始进行口服饮食，效果良好。同时，患者还出现了盆腔积液，通过保守治疗，使用抗生素进行管理，病情得到好转。最终，患者在术后十天出院，肠道功能恢复正常，无发热，一般情况良好。\n\n目前，该患者正在儿科外科门诊进行随访。",
+    "translated_summary": "我们报告了一例15岁男性青少年的临床病例。该患者既往无手术史，此次因腹痛和呕吐就诊。经计算机断层扫描显示，其肠道可能因温斯洛间隙处的内疝导致肠梗阻。患者接受了探查性腹腔镜手术，但由于视野不佳，手术中转为脐上正中开腹手术，以复位受压的肠袢。术后观察发现，肠道外观良好，无需进行肠道切除。术中未采取任何预防性措施以降低复发风险。术后，患者出现盆腔积液，采用保守治疗，并给予抗生素。目前，患者正在门诊儿科外科进行随访。"
+  },
+  {
+    "id": "multiclinsum_gs_en_583.txt",
+    "fulltext": "A 19-year-old female presented to our hospital’s emergency room with a chief complaint of a two-day history of headache, accompanied by recurrent nausea, vomiting, and a one-day fever. On admission, her physical examination revealed a high fever of 39.1°C, elevated blood pressure at 189/120 mmHg, and a pulse rate of 148 beats per minute. Laboratory results indicated an elevated white blood cell count of 14.77×10^9/L and a neutrophil count of 13.55×10^9/L, suggesting a possible infection or inflammatory response. Initial empirical treatment with antibiotics was administered due to suspected infection, but her symptoms persisted. Given her abnormal vital signs, elevated inflammatory markers, and lack of symptom improvement, the patient was admitted for further diagnostic evaluation and transferred to the intensive care unit for close monitoring. A year prior, the patient had presented with similar symptoms and was diagnosed with myocarditis at a local hospital based on clinical findings at that time. During that hospitalization, she was also diagnosed with hypertension and prescribed antihypertensive medications. However, after discharge, the patient did not adhere to the prescribed antihypertensive therapy and did not regularly monitor her blood pressure. Additionally, it is notable that her father had a history of sudden, unexplained death.\n\nTo investigate the underlying etiology of the patient’s symptoms, a chest computed tomography (CT) scan was performed. Incidentally, this scan revealed a left adrenal mass with soft tissue density, measuring 43 mm × 36 mm. No pathological findings were observed in the head and chest CT scans. The electrocardiogram demonstrated sinus tachycardia with a shortened PR interval and tall, peaked P-waves in leads II, III, and aVF. Transthoracic echocardiography did not reveal any significant abnormalities.\n\nOn the second day of admission, the patient exhibited rising levels of brain natriuretic peptide (BNP) and Troponin I (TnI). The cardiologist provisionally diagnosed the patient with myocarditis of uncertain etiology, based on clinical presentation, elevated cardiac biomarkers (BNP and TnI), and supportive electrocardiogram findings. Treatment was initiated with methylprednisolone (0.25 g daily) to address potential myocardial inflammation due to suspected myocarditis. Furosemide (20 mg every 12 hours) and spironolactone (20 mg every 12 hours) were administered as diuretics to manage fluid retention and reduce cardiac workload. Perindopril amlodipine (10 mg: 5 mg daily) was prescribed as an angiotensin-converting enzyme inhibitor and calcium channel blocker combination to control blood pressure and reduce afterload. Metoprolol tartrate (25 mg every 12 hours) was used to manage heart rate and decrease myocardial oxygen demand, while esmolol (0.2 g/hour intravenous infusion), a short-acting beta-blocker, was administered for additional acute heart rate control due to sinus tachycardia. Due to concerns about a potential infection, moxifloxacin was added as empiric antibiotic therapy.\n\nGiven the patient’s presentation with an adrenal mass and hypertension, the endocrinologist recommended an evaluation of the aldosterone-to-renin ratio, plasma cortisol, plasma catecholamines, and 24-hour urinary catecholamines along with their metabolites. In the recumbent position, plasma and urinary catecholamine levels were markedly elevated (Table 1), including plasma dopamine at 524.5 pmol/L, norepinephrine at 83975 pmol/L, and epinephrine at 10579.3 pmol/L. Additionally, the 24-hour urinary levels showed free adrenaline at 4368.89 nmol/24 hours, free norepinephrine exceeding 12697.60 nmol/24 hours, normetanephrine at 8312 nmol/24 hours, metanephrines at 4078 nmol/24 hours, and vanillylmandelic acid at 58.1 mg/24 hours. These findings supported a clinical diagnosis of pheochromocytoma. On the fifth day post-admission, glucocorticoid therapy was discontinued, and perindopril amlodipine was substituted with terazosin for more targeted blood pressure management.\n\nAn enhanced abdominal CT scan further confirmed a left adrenal mass, highly suggestive of pheochromocytoma. Additionally, after obtaining informed consent, whole-exome sequencing was performed, revealing a heterozygous missense mutation, c.1900T > C: p. Cys634Arg, in the RET gene, leading to a substitution of cysteine with arginine at codon 634. This mutation raised suspicion for multiple endocrine neoplasia syndrome, prompting further evaluation of the thyroid and parathyroid glands. Thyroid color Doppler ultrasound identified a hypoechoic mass measuring 6 mm × 4 mm in the left thyroid lobe, and a mild elevation in calcitonin levels was noted. No additional significant abnormalities were detected.\n\nAs the patient’s condition gradually improved, plasma cortisol and ACTH levels returned to normal. The patient was subsequently discharged with a prescription for metoprolol tartrate (100 mg every 12 hours) and ivabradine hydrochloride (5 mg every 12 hours) for home management. Three months later, after achieving stable clinical status, the patient underwent resection of the left adrenal tumor, which measured 50 mm × 40 mm × 30 mm. Immunohistochemical analysis confirmed positive staining for Vim, CD56, Syn, CgA, and NSE, with S-100 positive in Sertoli cells, while CKpan, CD10, MART-1/Melan-A, and Melan-A were negative. The Ki67 index was 1%, leading to a definitive diagnosis of adrenal pheochromocytoma. The patient was discharged without further medications and has since been regularly followed up postoperatively without recurrence of symptoms. Over a 15-month postoperative follow-up, the patient exhibited persistently mild hypercalcitoninemia with stable thyroid nodule size, while PTH and serum calcium levels showed a progressive increase (Table 2). Further parathyroid scintigraphy using 99mTc-MIBI was performed, and the conclusion was a negative result for parathyroid adenoma.",
+    "summary": "We report the case of a 19-year-old female who presented with pheochromocytoma without experiencing a crisis, despite having a significant adrenal mass and undergoing high-dose glucocorticoid treatment. Genetic testing revealed a heterozygous missense mutation in the RET gene (c.1900T > C: p. Cys634Arg), associated with MEN2A. Further endocrine evaluation identified a thyroid nodule with mildly elevated calcitonin levels, but normal electrolyte and parathyroid hormone levels. Over a 15-month postoperative follow-up, the patient exhibited persistently mild hypercalcitoninemia with stable thyroid nodule size, while PTH and serum calcium levels showed a progressive increase. Further parathyroid scintigraphy using 99mTc-MIBI was performed, yielding a negative result for parathyroid adenoma.",
+    "translated_fulltext": null,
+    "translated_summary": "我们报告了一例19岁女性的病例，该患者患有嗜铬细胞瘤，但并未出现危象。尽管她有明显的肾上腺肿块，并且接受了高剂量糖皮质激素治疗。基因检测显示，她的RET基因存在杂合性错义突变（c.1900T>C：p.Cys634Arg），该突变与MEN2A相关。进一步的内分泌评估发现，她患有甲状腺结节，降钙素水平略有升高，但电解质和甲状旁腺激素水平正常。在术后15个月的随访中，患者持续出现轻度高降钙素血症，甲状腺结节大小稳定，而甲状旁腺激素和血清钙水平则呈逐渐升高趋势。进一步进行了使用99mTc-MIBI的甲状旁腺闪烁扫描，结果显示甲状旁腺腺瘤为阴性。"
+  },
+  {
+    "id": "multiclinsum_gs_en_515.txt",
+    "fulltext": "February 2020, a 36-year-old with no significant past medical history presented with 5 years history of left sided penoscrotal mass. He has no lower urinary tract symptoms. No History of trauma or infections and he denied any history of weight loss, anorexia or fever. On examination, there is a smooth surface, tender cystic lesion around 20 mm ∗ 20 mm attached to the left side of the bulbar urethra at the penoscrotal junction, it was deep without any skin tethering and not related to the left spermatic cord and it was partially mobile.\n\nDoppler ultrasonography showed a well-defined hypoechoic mass measuring 2.7 ∗ 3.1 ∗ 2.0 cm with significantly increased vascularity at the left of penoscrotal junction. Pelvis Magnetic resonance imaging revealed a mass in the left inferolateral side of the base of the penis with a clear fat plane, which is isointense to the testes in the T2 weighted imaging, T1 weighted imaging and Diffusion-weighted imaging and it was connected to the vas deferens, no lymphadenopathy was noted. Alpha fetoprotein and beta-human chronic gonadotrophin levels were all in the normal range. Given the results of workup and the pain experienced by the patient, a decision was made to proceed with surgical removal of the mass for both diagnostic and therapeutic purposes. During surgery, a mass was seen in the left posterolateral of the scrotum and it was resected completely and sent for histopathology.\n\nHistopathology of the mass showed cellular spindle cell tumour arranged into interlacing fascicle, the cells have spindle to oval vesicular nuclei with evenly dispersed chromatin and inconspicuous nucleoli. The tumour showed high mitotic activity reaching up to 3/High-power field. Immunohistochemistry analysis was consistent with synovial sarcoma, revealing a positive TLE-1, CD99, B-cell lymphoma 2 (BLC2), Focal cytokeratin and focal epithelial membrane antigen (EMA). The material was sent for Fluorescence in situ hybridization (FISH) and reported a rearrangement of the SS18 gene at 18q11.2 which has been observed in synovial sarcomas. The mass margins were difficult to be assessed by histopathology as the sample had fragmented margins.\n\nThe patient presented to the clinic after 2 weeks and given the histopathology report, a re-resection with wider margin was discussed with the patient and he agreed. Positron emission tomography – Computed tomography (PET/CT) was done for Head and Neck, Chest, Abdomen, Pelvis and musculoskeletal structures. Only a 29 ∗ 27 mm thyroid nodule in the lower pole of the left thyroid lobe with moderate hypermetabolism at standardized uptake values (SUVs) of 4.9. Thyroid US showed a solid isoechoic well-defined nodule in the lower pole of the left thyroid lobe with no echogenic foci, Thyroid Imaging Reporting and Data System (TIRADS) was TR3.\n\nA second resection was made 3 weeks from the first one. The whole specimen was resected from both cords bilaterally which was deepened until reaching the corpus spongiosum which was shaved superiorly up to the urethra. The specimen was sent for histopathology. The resected mass was 6.0 ∗ 6.0 ∗ 3.0 cm in size, and it was negative for any pathology. The patient then went into active surveillance and after 16 months of active surveillance he was found to have metastatic lesions in the sixth liver segment and L1 vertebral body. Oncology team started chemotherapy regimen of Ifosfamide and Doxorubicin for 6 cycles with no improvement in the liver lesion. Surgical resection was made for the Fifth and Sixth liver sections with cholecystectomy. Patient then developed a new lung lesion and was started on Pazopanib and Stereotactic Body Radiation Therapy SBRT. The patient then underwent surveillance for 6 months then developed new liver and lung lesions then chemotherapy regimen of Gemcitabine and Docetaxel combination for 3 cycles and progressed then he was started 2 cycles of Dacarbazine and progressed then 2 cycles of Pembrolizumab and progressed. The patient then was shifted to palliative care, and he stopped following up.",
+    "summary": "A 36-year-old man presented with a tender penoscrotal mass for 5 years. The patient underwent surgical resection of the mass. Histopathology revealed cellular spindle cell tumour arranged into interlacing fascicle, Immunohistochemistry analysis revealed a positive TLE-1, CD99, B-cell lymphoma 2 (BLC2), Focal cytokeratin and focal epithelial membrane antigen (EMA). In our case, the patient was aggressively treated with two surgical resections and still progressed and metastasized and continued progressing even after different chemotherapy regimens.",
+    "translated_fulltext": "2020年2月，一位36岁的男性患者，既往无明显病史，主诉左侧阴茎阴囊部肿块已持续5年。患者无下尿路症状，无外伤或感染史，否认有体重减轻、食欲不振或发热等症状。体格检查显示，左侧阴茎阴囊部交界处有一个光滑、有压痛的囊性肿块，大小约为20毫米×20毫米，肿块深部，未与皮肤粘连，与左侧精索无关，且部分可移动。\n\n多普勒超声显示，左侧阴茎阴囊部交界处有一个边界清晰的低回声肿块，大小为2.7×3.1×2.0厘米，血管丰富。盆腔磁共振成像显示，阴茎基底部左侧下方有一个肿块，周围有清晰的脂肪组织，在T2加权成像、T1加权成像和弥散加权成像中，该肿块与睾丸信号强度相似，且与输精管相连，未见淋巴结肿大。甲胎蛋白和β-人绒毛膜促性腺激素水平均在正常范围内。考虑到检查结果和患者的疼痛，决定进行手术切除肿块，以达到诊断和治疗的目的。手术中，在左侧阴囊后外侧发现肿块，并将其完全切除，送往病理科进行组织病理学检查。\n\n组织病理学检查显示，肿块由细胞性梭形细胞肿瘤构成，这些细胞排列成交错的束状，细胞核呈梭形至卵圆形，含有均匀分布的染色质和不明显的核仁。肿瘤显示出较高的有丝分裂活性，达到每高倍视野3个。免疫组织化学分析结果与滑膜肉瘤一致，显示TLE-1、CD99、B细胞淋巴瘤2（BLC2）、局灶性细胞角蛋白和局灶性上皮膜抗原（EMA）呈阳性。将组织送往荧光原位杂交（FISH）进行检测，结果显示18q11.2位置的SS18基因发生重排，这种重排在滑膜肉瘤中常见。由于样本边缘碎片化，组织病理学难以评估肿块边缘。\n\n患者在2周后再次来到诊所，根据组织病理学报告，与患者讨论了进行二次切除，并扩大切除范围，患者同意。对头部和颈部、胸部、腹部、盆腔和骨骼肌肉结构进行了正电子发射断层扫描-计算机断层扫描（PET/CT）。结果仅显示左侧甲状腺下极有一个29×27毫米的甲状腺结节，标准化摄取值（SUV）为4.9，代谢活动中等。甲状腺超声显示，左侧甲状腺下极有一个实性等回声的、边界清晰的结节，无回声强烈的灶点，甲状腺影像报告和数据系统（TIRADS）评级为TR3。\n\n在第一次手术后的3周，进行了第二次手术。从双侧精索中切除了整个标本，切除深度直至到达海绵体，并向上切除至尿道。将标本送往病理科进行组织病理学检查。切除的肿块大小为6.0×6.0×3.0厘米，未发现任何病理改变。之后，患者进入了积极随访期，16个月后发现患者在第六肝段和L1椎体出现转移病灶。肿瘤科开始进行为期6个周期的依替环磷酰胺和阿霉素化疗，但肝脏病灶未见改善。对第五和第六肝段进行了手术切除，并同时进行了胆囊切除术。之后，患者出现新的肺部病灶，开始接受帕唑帕尼和立体定向放射治疗（SBRT）。患者随后接受了6个月的随访，之后出现新的肝脏和肺部病灶，随后进行了为期3个周期的吉西他滨和多西他赛联合化疗，但病情恶化，之后又进行了2个周期的达卡巴嗪化疗，但病情仍恶化，再进行了2个周期的帕博利珠单抗化疗，但病情继续恶化。之后，患者转为姑息治疗，并停止了随访。",
+    "translated_summary": "一位36岁的男性患者，主诉阴茎阴囊部出现一个触痛性肿块，病程已达5年。患者接受了手术切除肿块。病理组织学检查显示，肿块由细胞性梭形细胞肿瘤构成，细胞呈交错排列。免疫组织化学分析显示，肿瘤细胞呈TLE-1、CD99、B细胞淋巴瘤2（BLC2）、局灶性细胞角蛋白和局灶性上皮膜抗原（EMA）阳性。在本例中，患者接受了两次手术切除，但肿瘤仍持续进展并发生转移，即使在接受了不同的化疗方案后，肿瘤也继续进展。"
+  },
+  {
+    "id": "multiclinsum_gs_en_293.txt",
+    "fulltext": "An 18-year-old hispanic male patient with no significant medical history presents to the emergency department (ED) complaining of substernal, non-radiated chest pain, orthopnoea, dry and non-productive cough, and subjective fevers at home, for the last 3–4 days. Family history remarkable for paternal grandfather diagnosed with non-ischaemic cardiomyopathy and a pacemaker at age 86 years old. Patient lives with both parents and denies any smoking, ethanol consumption, recreational drug use, abuse or neglect at home. He worked at auto-part shop and planned to start college soon.\n\n\nInvestigations\n\n\nIn the ED, serum troponin I levels were found to be elevated and ECG showed diffuse ST-segment elevation. He was admitted to the local hospital and initial workup was remarkable for an enlarged cardiac silhouette and mild pulmonary oedema observed on chest X-ray, a transthoracic echocardiogram (TTE) demonstrating left ventricular ejection fraction (LVEF) of 40%, with severe left ventricular (LV) concentric hypertrophy and mild posterior pericardial effusion. Additionally, the patient was found to have elevated titres for Coxsackie virus A and B. His symptoms initially improved with the initiation of ibuprofen and colchicine. Cardiac catheterisation was performed, which revealed no evidence of coronary artery disease. Repeat TTE showed an LVEF of 40%–45%, hypokinesis of anteroapical and inferolateral wall, with an elevated LV end-diastolic pressure, consistent with diastolic dysfunction. Chest CT angiogram showed evidence of pneumonitis and a pericardial effusion. And at this point, the constellation of symptoms was thought to be secondary to Coxsackie myopericarditis, for which he continued to receive medical treatment as previously mentioned.\n\nOn the fourth day of admission, the patient became diaphoretic, tachycardic and hypotensive with an undetectable blood pressure. Emergent TTE showed large pericardial effusion with impending cardiac tamponade features, and pericardiocentesis was performed. During the procedure, the patient developed pulseless electrical activity (PEA) cardiac arrest and received advanced cardiovascular support for 30 min. Ultimately patient was intubated, placed on venous-arterial extracorporeal membrane oxygenation (VA ECMO) and started on vasopressor support (norepinephrine 5 mcg/min and vasopressin 0.05 units/min), with numerous transfusions (9 packed red bloodcells, 10 units of platelets, 10 units of cryoprecipitate and 4 units of fresh frozen plasma) due to significant oozing of blood from the ECMO cannula. He was transferred to our hospital where endomyocardial biopsy (EMB) was then obtained due to concern of fulminant myocarditis and to test for other infiltrative cardiomyopathies. Pathology reports showed no signs suggestive of inflammatory or infiltrative process in the endomyocardium. Coxsackie Abs were repeated and were positive for Cox A type 9, Coxsackie B2 and Coxsackie B6, and an elevated Epstein-Barr virus (EBV) DNA quantitative PCR at 133 000 IU/mL. At this point, another TTE was done, which showed a severely decreased ejection fraction (EF) of 10%–15% with previously noted severe LV concentric hypertrophy (1.9 cm septum and 2.2 cm in the inferolateral wall).\n\nThe patient was started on intravenous immunoglobulin (IVIG) for treatment of Coxsackie myocarditis, and broad-spectrum antibiotics due to worsening leucocytosis, but with no identified infectious focus. Colchicine was discontinued due to concern for rhabdomyolysis, with elevation of serum creatine kinase level to 2874 unit/L. Vasopressors were then discontinued and the patient was extubated. He also developed episode of flushing, fever, dyspnoea and decreasing oxygen saturation, with chest X-ray showing congested lung parenchyma with concerns for ARDS, therefore, IVIG was stopped.\n\nGiven improvement of cardiac function in another TTE with LVEF of 25%–30%, it was decided to attempt to remove the ECMO, which was unsuccessful. The patient remained on ECMO support and emergent discussion with heart failure team took place to determine best approach. The patient was evaluated for possible left ventricle assist device, however, deemed not a candidate due to significant global concentric LV hypertrophy, and the multidisciplinary team agreed to facilitate emergency listing for heart transplantation, with consideration to transition to another cardiovascular support such as intra-aortic balloon pump, with potential inotrope support.\n\nDuring further evaluation for possible heart transplant, an incisional biopsy of a 1×1 inch palpable, painless, rubbery, mobile mass in the right arm was done and sent for pathology. The patient mentioned he first noticed this lesion approximately 2–3 months before presenting to the ED. Pathology report of the right upper extremity mass showed aggressive EBV (+) NK/T-cell lymphoma with a cytotoxic immunophenotype (positive for CD 2, CD3, CD56, BCL2, granzyme B, TIA1, MUM1 and diffuse coexpression of Epstein-Barr virus-encoded small RNAs by in situ hybridisation), and a modified SMILE (Steroids, Methotrexate with leucovorin, Ifosfamide with mesna, L-asparaginase and Etoposide) chemotherapy regimen was started. In situ hybridisation of the EMB previously obtained were negative for EBV-RNA.\n\nCardiac MRI was obtained, which revealed hypokinesis of the inferolateral and anterolateral wall, as previously described by TTE, delayed enhancement in the subendocardial and transmural distribution in these regions, with relative sparing of the septum. Additionally, avid enhancement and thickening of the pericardium, without a mass identified, and a pocket of pericardial fluid with septations, concerning for loculations, were also noted.\n\n\nDifferential diagnosis\n\nThe constellation of symptoms (shortness of breath, orthopnoea, hypotension and subjective fevers), with findings such as diffuse ST-segment elevation on ECG, leakages of cardiac markers (troponin), elevated Coxsackie virus titres (both of serotype A and B), as well as echocardiographic findings of pericardial effusion; all seemed to correlate with a classic presentation of viral pericarditis clinical due to Coxackie virus. However, despite medical treatment with colchicine, the patient continued to decompensate and eventually required pericardiocentesis due to cardiac tamponade, then developed cardiac arrest and ultimately requires ECMO support, for what seems acute onset heart failure. In this setting, fulminant myocarditis secondary to Coxsackie virus was considered. Cardiotropic RNA virus, such as Coxackie viruses, induce receptor-mediated endocytosis, with viral replication contributing to cellular dysfunction and ultimately apoptosis of the cell.1 When susceptible individuals are infected with highly virulent viral strains, maladaptive immunologic activity can occur, leading to persistent activation of T cells and continued antibody-mediated myocyte destruction, which can ultimately lead to fulminant myocarditis. EBV myocarditis could also explain the rapid deterioration in the setting of a positive EBV PCR, which is a more sensitivity test than traditional serologies for detection of acute infection.2 However, in situ hybridisation was negative for EBV-RNA.\n\nNevertheless, the significant concentric hypertrophy observed on the initial TTEs and the atypical delayed enhancement observed on the cardiac MRI are not explained by this diagnosis. Additionally, the EMB did not show an inflammatory process.\n\nFortuitous finding of EBV (+) NK/T-cell lymphoma by incisional biopsy of the right upper extremity allowed for a more fitting diagnosis for this case. The pericardial effusion, unresponsive to initial medical treatment and new acute heart failure with concentric hypertrophic cardiomyopathy, in the setting of newly diagnosed NK/T-cell lymphoma, raises the possibility of NK/T-cell lymphoma with involvement of the myocardium and pericardium as the most adequate diagnosis in this scenario, which englobes all the features previously mentioned in this case.\n\nOther differentials taken into consideration include infiltrative cardiomyopathy such as amyloidosis. However, Congo red staining of the EMB samples failed to demonstrate deposition of amyloid.\n\n\nTreatment\n\nGiven the diagnosis of extranodal NK/T-cell lymphoma (ENKTCL) with suspected pericardial involvement and no bone marrow involvement, modified SMILE regimen was desired as the first-line chemotherapy regimen. This regimen includes dexamethasone, ifosfamide, mesna and etoposide, and excluded methotrexate, due to evidence of third-spacing and effusions, which could lead to delayed excretion and increased risk of toxicity.\n\nHowever, due to his compromised cardiac function, it was believed that the patient would not tolerate cytotoxic chemotherapy which requires aggressive intravenous, and alternatively, emergent chemotherapy regimen was instituted: carboplatin (day 1–day 3), etoposide (day 1–day 5) and dexamethasone. Peg-asparaginase was later introduced in the regimen (day 7–day 21). This regimen proved effective, as evidenced by rapid recovery of the LV function and overall haemodynamic stability, and decision was made to incorporate a modified SMILE chemotherapy regimen, of which he received two cycles. Then chemotherapy regimen was changed to dexamethasone, gemcitabine, carboplatin and peg-asparaginase (DDGP). The patient received two cycles of DDGP. A full body positron emission tomography (PET) scan was negative for lymphoma. The plan is to continue two more cycles of chemotherapy (to complete six total cycles of chemotherapy). Currently, the patient is considering radiation therapy and possible stem cell transplant, after completion of the chemotherapy regimen. Additionally, the patient is currently on guideline-directed medical therapy for heart failure and has completed cardiac rehabilitation.\n\n\nOutcome and follow-up\n\nThe patient has completed five out of six chemotherapy sessions with the previously mentioned regimens. After initiation of chemotherapy and optimal medical treatment for heart failure, the patient has recovered much of his cardiac function, as evidenced by an LVEF of 55%, no wall motion abnormalities and normal myocardial wall thickness on his most recent TTE. He continues to be followed by heart failure/cardiology team and oncology team in clinic.",
+    "summary": "An 18-year-old male patient presented to the emergency department complaining of new onset chest pain, fever and orthopnoea. Initial workup was remarkable for elevated troponin, diffuse ST-segment elevation on ECG and chest X-ray with enlarged cardiac silhouette. Transthoracic echocardiogram (TTE) demonstrates severe biventricular concentric hypertrophy and pericardial effusion. Also, Coxsackie virus A and B titres were positive, concerning for a classic viral pericarditis. However, despite medical management, the patient became dyspnoeic and hypotensive. Impending cardiac tamponade was observed on repeat TTE, and pericardiocentesis was performed, complicated by pulseless electrical activity cardiac arrest, and ultimately patient requiring venoarterial extracorporeal membrane oxygenation support. Emergent endomyocardial biopsy showed no inflammatory process, and a skin biopsy of a small lesion in the right arm showed unexpected diagnosis of Epstein-Barr virus (+) natural killer/T-cell lymphoma. On initiation of chemotherapy, clinical improvement was observed as evidenced by improving ejection fraction, resolution of pericardial effusion and gradual decrease in myocardial hypertrophy.",
+    "translated_fulltext": null,
+    "translated_summary": "一位18岁的男性患者因新发胸痛、发热和端坐呼吸困难来到急诊科。初步检查显示，患者的肌钙蛋白水平升高，心电图显示弥漫性ST段抬高，胸部X光片显示心脏轮廓增大。经胸超声心动图（TTE）显示，患者出现严重的双心室同心性肥厚和心包积液。此外，柯萨奇病毒A型和B型的抗体呈阳性，提示可能为典型的病毒性心包炎。然而，尽管进行了药物治疗，患者仍出现呼吸困难和低血压。重复进行TTE检查后，发现患者即将发生心脏压塞，遂进行了心包穿刺，但术中出现无脉搏电活动性心脏骤停，最终患者需要进行静脉动脉体外膜氧合（VA-ECMO）支持。紧急进行的心内膜活检未发现炎症过程，右臂一处小病灶的皮肤活检结果出乎意料，诊断为EB病毒（+）自然杀伤/T细胞淋巴瘤。开始化疗后，患者的临床症状得到改善，表现为射血分数提高、心包积液消退以及心肌肥厚逐渐减轻。"
+  },
+  {
+    "id": "multiclinsum_gs_en_325.txt",
+    "fulltext": "This is a 75-year-old para 6 patient from Western Ethiopia who saw her last menses 25 years back. Her age at giving birth to her 1st child and menopause were 18 and 50 years, respectively. She had occasional pelvic pain for the last 3 years for which she was visiting different health facilities. Currently, she presented to Nekemte Specialized Hospital with exacerbation of lower abdominal pain for 3 weeks. She feels discomfort in her vagina but no protrusion of mass through her vagina. She has no history of fever, abdominal swelling, vaginal discharge, or bleeding. All her previous deliveries were normal vaginal deliveries. Upon enquiring about the history of family planning utilization, she reported that the intrauterine device was inserted 40 years back at a public hospital. Since then, she had no history of gynecologic evaluation for a checkup. She had no history of gynecologic procedures, pelvic or abdominal surgery. The patient has no history of medical problems like diabetes mellitus, hypertension, cardiac or renal problems.\n\nOn examination, she was acutely sick-looking. Her vital signs were blood pressure (BP) = 120/80mmHg, pulse rate (PR) = 82 beats per minute, respiratory rate (RR) = 18 breaths per minute, and temperature of 37.1°C. She had pink conjunctivae. Lymph glandular system, chest, and cardiovascular system were normal. On abdominal examination, there was no mass, organomegaly, area of tenderness, or signs of fluid collection. Inspection of external genitalia showed no vulvar mass or lesion. On speculum examination, there is a foreign body at the external cervical os. However, there is no other cervical mass or lesion. On bimanual examination, the uterus was not enlarged and there was no adnexal mass or tenderness. On the integumentary system, she had no palmar pallor. On neurologic examination, she was oriented to time, person, and place. She had normal reflexes and no neurologic deficits.\n\nOn laboratory investigation, an ultrasound examination was done by a radiologist and showed unremarkable pelvic findings. Urinalysis, complete blood count, and serum blood glucose level were normal. With the final diagnosis of postmenopausal pelvic pain secondary to the retained intrauterine device, the patient was prepared and taken to the gynecology procedure room. In the lithotomy position, the speculum was inserted and the intrauterine device was easily removed with spongy forceps. The mother was observed for 4 hours and discharged with analgesia and doxycycline 100 mg PO twice a day for three days. Upon follow-up, the pelvic pain was resolved.",
+    "summary": "We present the case of retained Lippes loop IUD for 40 years in a 75-year-old postmenopausal patient from Western Ethiopia. The patient presented to the hospital with postmenopausal pelvic pain. Speculum exam showed part of loop at external cervical os. The loop was easily removed with spongy forceps. The patient was discharged with analgesia and doxycycline twice a day for 3 days.",
+    "translated_fulltext": "这位患者是一位来自埃塞俄比亚西部、已生育 6 次的 75 岁女性，她上次月经发生在 25 年前。她第一次生育的年龄是 18 岁，绝经年龄是 50 岁。在过去的 3 年里，她偶尔会出现盆腔疼痛，为此她曾多次就诊于不同的医疗机构。目前，她因下腹部疼痛加重，持续 3 周，来到内克姆特专科医院就诊。她感觉阴道不适，但没有肿块从阴道突出。她没有发烧、腹部肿胀、阴道分泌物或出血的病史。她之前的分娩均为正常阴道分娩。在询问她是否使用过避孕措施时，她表示 40 年前曾在一家公立医院放置了宫内节育器。此后，她没有进行过任何妇科检查。她没有进行过任何妇科手术、盆腔或腹部手术。该患者没有糖尿病、高血压、心脏或肾脏疾病等病史。\n\n检查时，她看起来非常虚弱。她的生命体征如下：血压 120/80 mmHg，脉搏 82 次/分钟，呼吸频率 18 次/分钟，体温 37.1°C。她的结膜呈粉红色。淋巴系统、胸部和心血管系统均正常。腹部检查显示，没有肿块、器官肿大、压痛区域或积液迹象。检查外阴时，没有发现外阴肿块或病变。使用窥镜检查时，发现宫颈外口处有一个异物。但没有其他宫颈肿块或病变。进行双合诊检查时，子宫没有增大，也没有附件肿块或压痛。检查皮肤时，她的手掌没有苍白。神经系统检查显示，她对时间、地点和人物的认知清晰。她的反射正常，没有神经系统缺陷。\n\n实验室检查显示，放射科医生进行了超声检查，结果显示盆腔没有异常发现。尿液分析、全血细胞计数和血清血糖水平均正常。最终诊断为：由于残留的宫内节育器引起的绝经后盆腔疼痛。医生为患者进行了准备，并将其送往妇科手术室。在仰卧位，插入窥镜，并使用海绵夹轻松取出宫内节育器。医生观察了患者 4 小时后，开具止痛药和多西环素 100 毫克，每日口服两次，共三天，然后让患者出院。随访时，患者的盆腔疼痛已缓解。",
+    "translated_summary": "本文介绍了一位来自埃塞俄比亚西部、已绝经的75岁女性，其体内留置了利佩斯宫内节育器（IUD）长达40年。该患者因绝经后盆腔疼痛来就诊。阴道镜检查显示，节育器的一部分位于宫颈外口。使用海绵镊轻松取出了节育器。患者出院时被处方止痛药，并嘱其每日服用多西环素两次，疗程为3天。"
+  },
+  {
+    "id": "multiclinsum_gs_en_418.txt",
+    "fulltext": "A 71-year-old patient with a history of untreated vitiligo presented with visual loss in the right eye 6 months prior to admission accompanied by bilateral hearing loss with a predominance in the right ear. Chronic headaches and intermittent fever were also reported, although the patient denied a history of drug use or prior infections. He was evaluated by our department due to the presence of significant and unintentional weight loss, generalized weakness and thickening of the skin. On initial ophthalmologic examination, visual acuity in the right eye (RO) was reduced to light perception and color discrimination, and visual acuity in the left eye (LO) was 20/200 with afferent pupillary defect in both eyes with hyperemic margins of the eyelid. On examination of the RO, it was found to have a hyperemic bulbar conjunctiva, ciliary injection, cornea with peripheral, nummular, subepithelial infiltrates, aqueous anterior chamber (AAC) without cellularity, normal iris and lens with nuclear opacities. On examination of the left eye, it was found to have a hyperemic bulbar conjunctiva, ciliary injection, cornea with peripheral, nummular, subepithelial infiltrates, AAC, aqueous without cellularity, normal iris and lens with nuclear opacities. On examination of the right fundus, a round, pale ++ papilla was found with a 50% excavation, slightly blunt nasal border, with a raised and thinned vascular pattern, with macular area and scattered pigment. On the left fundus, a vitreous haze 2+ was found with edematous papilla, blurred borders, hyperemic, peripapillary, streaked hemorrhages, and an unevaluable excavation with a thinned vascular pattern and macular area with scattered pigment, with right optic atrophy and left anterior optic neuritis.\n\nDue to ocular involvement, weight loss and neurological symptoms, additional testing was performed to rule out causes such as tuberculosis, herpes, ANCA and non-ANCA vasculitis, and sarcoidosis. As for the management of the neurological condition, a lumbar puncture was performed and an opening pressure within normal limits and a proteinocracy of 54 mg/dL was found. Due to distal symmetric polyneuropathy, nerve conduction velocities (NCV) were performed, which showed a pattern of polyradiculoneuropathy with moderate to severe axonal degeneration, involving all 4 extremities with a predominance of the lower extremities; the contrasted magnetic resonance imaging (MRI) of the skull and orbit did not show enhancement of the optic nerve or brain tumors; however, it did show sinusitis and meningeal enhancement. Within the management, sarcoidosis was ruled out, with angiotensin converting enzyme (ACE) within normal parameters, as well as a whole body gamma scan, without enhancement or boosting. After all the study and clinical evaluation of the patient, a second ophthalmological assessment was performed in which persistence and progression of the ocular condition was found, with optic atrophy in the right eye and anterior optic neuritis in the left eye. Because of this, high dose pulse steroid treatment was initiated, followed by a gradual reduction of the dose and the patient was referred for follow-up in the Outpatient Department. A clinical and functional improvement was observed, mainly at the neurological and ophthalmological level.\n",
+    "summary": "A 71-year-old man with a history of long-standing vitiligo who had experienced visual loss in his right eye six months prior to admission, along with bilateral hearing loss, predominantly in the right ear. During his hospital stay, he presented with chronic headaches, fever, and significant involuntary weight loss. On ophthalmologic examination, the right eye was light sensitive with hyperemic bulbar conjunctiva, while the left eye had a visual acuity of 20/200. The fundus of the right eye had scattered pigmentation, while the left eye had a swollen optic disc and right optic atrophy.\n",
+    "translated_fulltext": "一位71岁的患者，既往有未治疗的白癜病史，在入院前6个月出现右眼视力下降，并伴有双侧听力下降，以右耳更为明显。患者还报告了慢性头痛和间歇性发热，但否认有药物滥用或既往感染史。由于患者出现显著且非自愿的体重减轻、全身乏力和皮肤增厚，我科对其进行了评估。初步眼科检查显示，右眼（RO）视力下降至仅能感知光线和颜色，左眼（LO）视力为20/200，双眼均存在传入性瞳孔缺损，眼睑边缘充血。RO检查显示，球结膜充血，睫状充血，角膜周围有圆形、斑块状、上皮下浸润，前房水清澈，虹膜和晶状体正常，但晶状体核部有混浊。LO检查显示，球结膜充血，睫状充血，角膜周围有圆形、斑块状、上皮下浸润，前房水清澈，虹膜和晶状体正常，但晶状体核部有混浊。右眼底检查显示，圆形、苍白的视盘，有50%的凹陷，鼻侧边缘略钝，血管纹路隆起且变薄，黄斑区和散在色素。左眼底检查显示，有2+程度的玻璃体混浊，视盘水肿，边缘模糊，视盘周围有充血、条状出血，凹陷程度无法评估，血管纹路变薄，黄斑区有散在色素，右侧视神经萎缩，左侧视神经前部神经炎。\n\n由于眼部受累、体重减轻和神经系统症状，进行了额外的检查，以排除结核病、疱疹、ANCA和非ANCA血管炎以及肉芽肿病等原因。为了处理神经系统疾病，进行了腰椎穿刺，结果显示颅内压在正常范围内，蛋白质含量为54 mg/dL。由于存在远端对称性多发性神经病，进行了神经传导速度（NCV）检查，结果显示存在多根神经病，伴有中度至重度的轴突变性，累及所有四肢，以下肢为主；增强磁共振成像（MRI）扫描显示颅骨和眼眶未见视神经或脑肿瘤的增强，但显示有鼻窦炎和脑膜增强。在诊断过程中，排除了肉芽肿病，血管紧张素转化酶（ACE）水平在正常范围内，全身伽马扫描也未显示增强或异常。在对患者进行全面研究和临床评估后，进行了第二次眼科评估，结果显示眼部疾病持续并加重，右眼视神经萎缩，左眼视神经前部神经炎。因此，开始进行高剂量冲击性类固醇治疗，然后逐渐减少剂量，并将患者转诊至门诊部进行随访。观察到临床和功能方面有所改善，主要体现在神经系统和眼科方面。",
+    "translated_summary": "一位71岁的男性患者，既往有长期白癜病史，入院前六个月开始出现右眼视力下降，同时伴有双侧听力下降，以右耳更为明显。住院期间，他出现慢性头痛、发热以及显著的非自主性体重减轻。眼科检查显示，右眼对光敏感，球结膜充血，而左眼视力为20/200。右眼眼底可见散在色素沉着，左眼则出现视神经乳头水肿和右侧视神经萎缩。"
+  },
+  {
+    "id": "multiclinsum_gs_en_406.txt",
+    "fulltext": "A 39-year-old woman with a diagnosis of peripartum cardiomyopathy who received a heart transplant in October 2014. She received induction with Basiliximab and methylprednisolone. She also received maintenance treatment with tacrolimus XL prolonged release 7 mg daily, everolimus 1 mg twice daily, and prednisolone 5 mg/day. She had two episodes of acute rejection during the first year post-transplant, and was controlled with methylprednisolone pulse therapy with good results. There was no history of renal disease and her renal function was stable with creatinine of 0.88 mg/dL and a glomerular filtration rate (GFR) of 102 mL/min/1.73m2 during the first year post-transplant. Follow-up was done exclusively by the heart transplant group and routine polyomavirus viral load BK or urinary cytology was not performed. In 2016, she presented a creatinine serum elevation of up to 1.9 mg/dL, with a GFR of 32.6 mL/min/1.73m2. At that time, the minimum tacrolimus level was 7.2 ng/mL and everolimus, 5.2 ng/mL. Anticalcineurin toxicity was suspected; therefore, tacrolimus was reduced to 4 mg daily and creatinine returned to near baseline (creatinine 1.25 mg/dL, GFR 54.1 mL/min/1.73m2); no renal biopsy was performed. In March 2017, creatinine increased to 2.69 mg/dL, with a GFR of 21.4 mL/min/1.73m2, for which she was hospitalized. The patient stated that she did not have any symptoms. During physical examination, she was in good general condition, heart rate of 80 beats per minute, blood pressure of 130/90 mmHg, respiratory rate of 15 per minute, afebrile. Further studies were performed: renal tract ultrasound showed normal renal size but increased echogenicity; urinalysis and urine cultures were negative, without haematuria, pyuria or casts; echocardiogram with adequate cardiac function; HIV, syphilis, hepatitis B and C serologic tests were negative; minimum tacrolimus level of 5.2 ng/mL, and everolimus of 5.98 ng/mL. Control was initiated with intravenous hydration, and tacrolimus XL dose was reduced to 2 mg daily, but there was no improvement in renal function; a renal biopsy was planned.\n\nRenal biopsy revealed active chronic interstitial nephritis associated with advanced poliomyelitis virus nephritis. BK virus PCR was performed and was positive at 33,800 copies/mL in blood (log 4.5). Tacrolimus was discontinued; creatinine levels stabilized between 2.2 and 2.4 mg/dL, with no further elevation in post-discharge controls. Her viral load began to decline to undetectable levels. The patient did not have episodes of cardiac rejection in 3 years of follow-up; the last creatinine measurement was 2.5 mg/dL, corresponding to a GFR of 23.4 mL/min/1.73m2.\n",
+    "summary": "We report a case of BK virus nephropathy in a patient who underwent heart transplantation due to peripartum cardiomyopathy. The renal biopsy reported active chronic tubulointerstitial nephritis associated with late-stage BK virus nephritis and the blood viral load for BK virus was positive (log 4.5). The immunosuppressive treatment was reduced, and after two years of follow-up, the patient had stable renal function with serum creatinine of 2.5 mg/dL (GFR of 23.4 mL/min/1.73m2).\n",
+    "translated_fulltext": "一位39岁的女性，被诊断为围产期心肌病，于2014年10月接受了心脏移植。她接受了巴西利昔单抗和甲基强的松龙的诱导治疗。此外，她还接受了维持治疗，包括他克莫司缓释剂（7毫克，每日一次）、依维莫司（1毫克，每日两次）和泼尼松（5毫克/天）。移植后第一年，她出现了两次急性排斥反应，通过甲基强的松龙冲击疗法得到了控制，疗效良好。她没有肾脏疾病史，移植后第一年，她的肾功能稳定，肌酐值为0.88毫克/分升，肾小球滤过率（GFR）为102毫升/分钟/1.73平方米。随访完全由心脏移植团队进行，未进行常规的BK病毒载量或尿细胞学检查。2016年，她的血清肌酐升高至1.9毫克/分升，GFR降至32.6毫升/分钟/1.73平方米。当时，他克莫司的最低血药浓度为7.2毫克/升，依维莫司为5.2毫克/升。怀疑存在钙调神经磷酸酶抑制剂毒性；因此，他克莫司剂量减少至每日4毫克，肌酐值恢复到接近基线水平（肌酐1.25毫克/分升，GFR 54.1毫升/分钟/1.73平方米）；未进行肾活检。2017年3月，肌酐升高至2.69毫克/分升，GFR降至21.4毫升/分钟/1.73平方米，她因此住院。患者表示没有出现任何症状。体格检查显示，她一般情况良好，心率80次/分钟，血压130/90毫米汞柱，呼吸频率15次/分钟，无发热。进行了进一步的检查：肾脏超声显示肾脏大小正常，但回声增强；尿液分析和尿培养结果均为阴性，无血尿、脓尿或管型；超声心动图显示心脏功能良好；HIV、梅毒、乙型和丙型肝炎的血清学检测结果均为阴性；他克莫司的最低血药浓度为5.2毫克/升，依维莫司为5.98毫克/升。开始进行静脉补液治疗，并减少他克莫司缓释剂的剂量至每日2毫克，但肾功能没有改善；计划进行肾活检。\n\n肾活检显示，存在与晚期脊髓灰质炎病毒性肾炎相关的活动性慢性间质性肾炎。进行了BK病毒PCR检测，结果为阳性，血中病毒载量为33,800拷贝/毫升（对数值为4.5）。停用了他克莫司；肌酐值稳定在2.2至2.4毫克/分升之间，出院后复查未发现进一步升高。她的病毒载量开始下降至无法检测的水平。在随访的3年中，患者没有出现心脏排斥反应；最后一次肌酐检测值为2.5毫克/分升，对应的GFR为23.4毫升/分钟/1.73平方米。",
+    "translated_summary": "我们报告了一例围产期心肌病患者接受心脏移植后发生 BK 病毒肾病的病例。肾活检结果显示，患者患有活动性慢性肾小管间质性肾炎，并伴有晚期 BK 病毒肾炎，且血清 BK 病毒载量呈阳性（对数值为 4.5）。随后减少了免疫抑制治疗，经过两年的随访，患者的肾功能稳定，血清肌酐值为 2.5 mg/dL（肾小球滤过率 (GFR) 为 23.4 mL/min/1.73m2）。"
+  },
+  {
+    "id": "multiclinsum_gs_en_88.txt",
+    "fulltext": "The patient was a 42-year-old woman with a history of menstrual migraine, Hashimoto Thyroiditis, Familial Mediterian Fever (FMF), and dyspepsia. She was taking 75 mg of levothyroxine, 30 mg of lansoprazole, and 1.5 mg of colchicine daily. In February of 2023, she was diagnosed with acute bronchitis, which was treated with antibiotics and bronchodilators. She developed a daily headache after two weeks, manifesting as more than ten short-lasting attacks per day provoked by coughing, straining, and lifting. The duration of each attack was 30 minutes, and the pain was bilaterally distributed from the neck to the top of the head. The headache was sharp and severe. She described the attack as a sensation of storm-like fluid movement in the head. She did not suffer any of the symptoms associated with previous migraine attacks, such as phonophobia, photophobia, vomiting, or throbbing. The severity of the attack was determined using a numeric rating scale (NRS) with a score of 9 out of 10. These attacks typically necessitated a visit to the emergency room. The results of her physical and neurological exams were unremarkable. The laboratory tests, including those for thyroid hormones, electrolytes, liver and kidney function, and serology, were negative. Brain and cervical spinal magnetic resonance imaging (MRI) with and without contrast, magnetic resonance venography (MRV), and angiography (MRA) were all normal. She did not give consent for a lumbar puncture. When we first encountered her in the clinic, she was taking 25 mg of indomethacin per day. Her attacks stopped after putting her on 60 mg of lansoprazole and increasing her daily dose of indomethacin to 150 mg. However, she encountered gastrointestinal side effects, so the indomethacin was discontinued on day three. Due to the adverse effects, she was unable to take topiramate and propranolol.\n\nShe came to the clinic 15 days after her initial visit with an NRS score of 9/10. She was taken to the local operating room. We used a GE Healthcare, Voluson™ E6, ultrasonography system with a linear 13–5 MHz probe for unilateral PGONB. The patient’s neck was prone to flexion. The linear probe was initially transversely positioned on the occipital protuberance and then advanced caudally, demonstrating that the C2 spinous process resembled the two horns. Through lateral probe movement, the inferior muscles of the obliquus capitis and semispinalis capitis were located. Here, the superior to the inferior oblique capitis muscle and beneath the semispinalis capitis muscle were identified to be the greater occipital neuron (GON). From this location, a 22-gauge spinal needle and 3 ccs of bupivacaine at a concentration of 0.5% were used to perform GON blocking. The intensity of her attack decreased from 9/10 to 2/10 after the first 20 minutes of the block. Throughout a month, the blocks were repeated once a week. In the second month, the frequency of her attacks decreased to two per month, with an intensity of 4/10. She did not encounter any attacks in the sixth month.\n\n",
+    "summary": "Herein, we report that a 42-year-old female patient with PCH who could not use the oral medication because of side effects. When she came to the pain clinic with an attack with intensity of 9/10 , we took her to the local operating room. The ultrasound (US) guided proximal greater occipital nerve block with bupivacaine was performed and the intensity of the attack was reduced to 2/10. The blockage was repeated once a week for a month. After two months, both the intensity of headache and number of attacks decreased and no adverse effect was observed.",
+    "translated_fulltext": "患者是一位42岁的女性，既往有月经性偏头痛、桥本甲状腺炎、家族性地中海热（FMF）和消化不良病史。她每天服用75毫克左甲状腺素、30毫克兰索拉唑和1.5毫克秋水仙碱。2023年2月，她被诊断为急性支气管炎，并接受了抗生素和支气管扩张剂治疗。两周后，她开始出现每日头痛，表现为每天超过十次短暂发作，这些发作由咳嗽、用力或举重诱发。每次发作持续30分钟，疼痛从颈部延伸至头部顶部，呈双侧分布。头痛剧烈且刺痛。她描述这种发作时，感觉头部有像风暴般的液体流动。她没有出现与以往偏头痛发作相关的任何症状，如畏光、畏声、呕吐或搏动性疼痛。通过数字评分量表（NRS）评估发作的严重程度，评分结果为10分中的9分。这些发作通常需要去急诊室就诊。她的体格检查和神经系统检查结果均无异常。实验室检查，包括甲状腺激素、电解质、肝肾功能和血清学检查，结果均为阴性。脑部和颈椎的磁共振成像（MRI），包括有对比剂和无对比剂的成像，磁共振静脉造影（MRV）和血管造影（MRA）均显示正常。她没有同意进行腰椎穿刺。当我们第一次在诊所遇到她时，她每天服用25毫克吲哚美辛。在给她服用60毫克兰索拉唑并将她每天的吲哚美辛剂量增加到150毫克后，她的发作停止了。然而，她出现了胃肠道副作用，因此在第三天停止了吲哚美辛的服用。由于不良反应，她无法服用托吡酯和普萘洛尔。\n\n她在初次就诊15天后再次来到诊所，NRS评分仍为9/10。她被送往当地的手术室。我们使用GE Healthcare的Voluson™ E6超声系统，配备线性13-5 MHz探头，进行单侧枕大神经阻滞（PGONB）。患者的颈部处于屈曲状态。线性探头最初横向放置在枕骨结节上，然后向尾侧移动，显示C2椎体棘突类似于两个角。通过侧向移动探头，可以定位到斜方肌和半棘肌的下部肌肉。在此，在斜方肌的上方和半棘肌的下方，可以识别出大枕神经（GON）。从这个位置，使用22号脊髓针和3毫升浓度为0.5%的布比卡因，进行GON阻滞。在阻滞后的最初20分钟内，她的发作强度从9/10降低到2/10。在接下来的一个月里，阻滞每周重复一次。在第二个月，她的发作频率减少到每月两次，强度为4/10。在第六个月，她没有出现任何发作。",
+    "translated_summary": "在此，我们报告了一例42岁女性患者，她患有持续性头痛（PCH），由于药物副作用，无法口服药物。当她因疼痛发作（疼痛程度为9/10）来到疼痛诊所时，我们将其送至当地手术室。我们进行了超声引导下的局部大枕神经阻滞，并使用布比卡因。疼痛程度降低至2/10。之后，我们每周重复进行一次阻滞，持续一个月。两个月后，头痛的强度和发作次数均有所减少，且未观察到任何不良反应。"
+  },
+  {
+    "id": "multiclinsum_gs_en_313.txt",
+    "fulltext": "A male was born via an emergency cesarean section due to fetal distress at 40 weeks of gestational age. The mother's age was 33 years, with gravida 1 and para 1 parity. Both the parents and brother had no family history of congenital anomalies, aortic-related diseases, or sudden death. Based on the results of the prenatal ultrasonography at the end of the second trimester, the femur length of the fetus was found to be 1 to 3 weeks longer than the supposed length of the actual gestational age. Fetal echocardiography showed cardiomegaly with a fetal cardiothoracic circumference ratio of 0.5 or higher based on the baby's term. Moreover, the size of the foramen ovale was larger than normal, and left aortic constriction was seen next to the subclavian artery basin. Furthermore, no other abnormalities were found on prenatal ultrasound.\n\nAt birth, the weight was 3560 g (75 percentile), the length was 56.5 cm (over 90 percentile), and the head circumference was 36 cm (over 90 percentile). Apgar scores at 1 and 5 minutes were 4 and 6 points, respectively. In the delivery room, the patient had no spontaneous breathing and had bradycardia and cyanosis. After being admitted to the neonatal intensive care unit, various musculoskeletal malformations were confirmed via physical examination. Severe arachnodactyly and camptodactyly were observed in both hands and feet, and the soles of the feet were flat. The elbow and knee joints were not fully extended. The face had malar hypoplasia with senile facial appearance. The eye was deeply settled with a down-slanting palpebral fissure, and the ear with hypoplastic cartilage was poorly settled and crumpled. The patient presented with a sagging mouth, prominent coronal suture, and brachycephaly. A grade V/VI systolic murmur was heard at both the upper sternal border and left lower sternal border with grade III parasternal heave. Echocardiography showed poor cardiac contractility, severe pulmonary hypertension, dilated aortic sinus (20.2 mm) (Z-score; 8.08 by Boston, 6.37 by Detroit, or 5.97 by Halifax), and multiple intracardiac valvular dysfunction with valve prolapses (moderate aortic regurgitation, severe mitral regurgitation, moderate tricuspid regurgitation, and moderate pulmonary valve regurgitation). And the ophthalmologic examination results showed ectopia lentis in both eyes as well as lens subluxation. Liver herniation was confirmed using abdominal X-ray and ultrasound. The systemic score of the musculoskeletal manifestation was 11 points, according to the Ghent criteria (international diagnostic criteria for MFS).\n\nFor genetic diagnosis, Sanger sequencing and polymerase chain reaction were performed on the nucleotide sequence as reference for the FBN1 gene. As a result, a mutation in which G, the first base of the 32nd intron in the form of a heterogeneous mutation, was substituted with T (c.3964 + 1G > T). This was confirmed as the likely pathogen variant based on the 2015 ACMG/AMP guideline. The location of the mutation was included in the site previously known as the neonatal region of MFS (exons 24–32). The patient could be diagnosed with neonatal MFS with a novel FBN1 gene mutation within 2 weeks of life.\n\nOn the first day of life, differential cyanosis was found to show refractory hypoxemia despite more than 60% oxygen supply and signs of low cardiac output. The patient was managed medically for improving the low cardiac output according to severe mitral regurgitation and aortic regurgitation. Afterload reduction including milrinone continuous infusion, full sedation using fentanyl continuous infusion, and use of diuretic were attempt to improve the oliguria and heart failure. Despite the medical management, the patient presented with respiratory failure, heart failure, and severe pulmonary hypertension requiring continuous invasive mechanical ventilation. Aortic regurgitation, mitral regurgitation, pulmonary hypertension, and cardiac contractility got worse. After several consultations with the patient's family and medical staff about the treatment plan, palliative care was continued instead of surgical treatment. As a result, hepatic and pulmonary congestion accompanied by pulmonary hemorrhage had progressed as well. Eventually, it had progressed to multiple organ dysfunction syndrome, and the patient died 32 days after the birth.",
+    "summary": "Patient concerns:\nA newborn with neonatal MFS and severe cardiac involvement. He presented various severe clinical features such as arachnodactyly, camptodactyly, elbow and knee joint contracture, senile facial appearance, and deep settling with down-slanting palpebral fissure, hypoplastic ear cartilage, sagging mouth, brachycephaly, and ectopia lentis.\n\nDiagnosis:\nGenetic analysis revealed a novel mutation at nucleotide 3964 (c.3964 + 1 G > T) in intron 32 of the fibrillin-1 gene. This mutation is identified to be in the so-called neonatal region of fibrillin-1 exon 24 to 32, as reported previously.\n\nInterventions:\nThe patient was managed medically for improving the low cardiac output according to severe mitral regurgitation and aortic regurgitation. Afterload reduction, full sedation, and use of diuretic were attempted to improve the oliguria and heart failure.\n\nOutcomes:\nDespite the medical management, aortic regurgitation, mitral regurgitation, pulmonary hypertension, and cardiac contractility got worse. Surgical treatment is essential to prolong the patient's life, however, considerations for the grave progression of the disease make families decide to continue palliative care instead of surgical treatment. A few months after birth, he presented with rapidly progressive aortic regurgitation, mitral regurgitation, and congestive heart failure leading to death.",
+    "translated_fulltext": "一名男婴因胎儿窘迫，于妊娠 40 周时通过紧急剖腹产出生。母亲 33 岁，为初产妇，已生育 1 次。父母和兄弟均无先天性畸形、主动脉相关疾病或猝死的家族史。根据妊娠第二孕期末的产前超声检查结果，发现胎儿股骨长度比预期长度长 1 到 3 周。胎儿超声心动图显示心脏扩大，胎儿心胸围比为 0.5 或更高。此外，卵圆孔的尺寸比正常大，且在锁骨下动脉盆旁边可见左侧主动脉狭窄。此外，产前超声检查未发现其他异常。\n\n出生时，体重 3560 克（75 百分位数），身长 56.5 厘米（超过 90 百分位数），头围 36 厘米（超过 90 百分位数）。出生后 1 分钟和 5 分钟的阿普加评分分别为 4 分和 6 分。在分娩室，患者没有自发呼吸，并出现心动过缓和紫绀。入院新生儿重症监护室后，通过体格检查证实了各种肌肉骨骼畸形。双侧手脚均观察到严重的蜘蛛指（趾）和屈曲指（趾），足底扁平。肘关节和膝关节未完全伸展。面部颧骨发育不良，呈现老年面容。眼睛深陷，睑裂向下倾斜，耳廓软骨发育不良，位置不佳且皱缩。患者表现为口角下垂、额冠缝突出和短头畸形。在胸骨上部和左侧胸骨下部均可听到 V/VI 级的收缩期杂音，并伴有 III 级的胸骨旁搏动。超声心动图显示心脏收缩力差，严重肺动脉高压，主动脉窦扩张（20.2 毫米）（Z 值：波士顿 8.08，底特律 6.37，哈利法克斯 5.97），以及多处心内瓣功能障碍，伴有瓣膜脱垂（中度主动脉反流、严重二尖瓣反流、中度三尖瓣反流和中度肺动脉瓣反流）。眼科检查结果显示双眼晶状体脱位。通过腹部 X 光和超声检查证实肝脏疝。根据根特标准（MFS 的国际诊断标准），肌肉骨骼表现的系统评分是 11 分。\n\n为了进行基因诊断，对 FBN1 基因的核苷酸序列进行了桑格测序和聚合酶链式反应，作为参考。结果显示，在第 32 个内含子上，第一个碱基 G 以异质突变的形态被 T 取代（c.3964 + 1G > T）。根据 2015 年 ACMG/AMP 指南，这被确认为可能的致病变异。该突变位点位于先前已知为 MFS 新生儿区域（外显子 24-32）的位点。该患者可在出生后 2 周内诊断为新生儿 MFS，并具有新的 FBN1 基因突变。\n\n出生第一天，发现存在差异性紫绀，尽管给予超过 60% 的氧气，但仍出现难治性低氧血症，并出现心脏输出量低的迹象。根据严重二尖瓣反流和主动脉反流，对患者进行了药物治疗，以改善心脏输出量。通过包括米利农持续输注、使用芬太尼进行完全镇静以及使用利尿剂等方法，试图改善少尿和心力衰竭。尽管进行了药物治疗，但患者仍出现呼吸衰竭、心力衰竭和严重肺动脉高压，需要进行持续的侵入性机械通气。主动脉反流、二尖瓣反流、肺动脉高压和心脏收缩力均恶化。在与患者家属和医务人员就治疗方案进行了多次讨论后，决定继续进行姑息治疗，而不是手术治疗。结果，肺淤血和肺出血也随之加重。最终，病情发展为多器官功能衰竭综合征，患者在出生后 32 天死亡。",
+    "translated_summary": "患者主诉：\n\n一名患有新生儿马凡综合征（neonatal MFS）且心脏受累严重的婴儿。该患儿表现出多种严重的临床特征，包括蜘蛛指（arachnodactyly）、屈指挛缩（camptodactyly）、肘部和膝关节挛缩、老年样面容、眼睑裂向下倾斜、耳软骨发育不良、口角下垂、短头畸形（brachycephaly）和晶状体脱位（ectopia lentis）。\n\n诊断：\n\n基因分析显示，纤维蛋白-1基因的第32号内含子中存在一个新的突变，位于核苷酸3964位（c.3964 + 1 G > T）。该突变被确定位于纤维蛋白-1基因第24至32号外显子中的所谓新生儿区域，此前已有报道。\n\n干预措施：\n\n根据患儿严重的二尖瓣反流和主动脉瓣反流，采取药物治疗以改善心脏输出量。尝试通过降低后负荷、进行全身麻醉以及使用利尿剂来改善少尿和心力衰竭。\n\n结果：\n\n尽管采取了药物治疗，主动脉瓣反流、二尖瓣反流、肺动脉高压和心脏收缩力均恶化。手术治疗对于延长患者的生命至关重要，然而，考虑到疾病的严重进展，家属决定继续进行姑息治疗，而不是手术治疗。出生后几个月，患儿出现快速进展的主动脉瓣反流、二尖瓣反流和充血性心力衰竭，最终导致死亡。"
+  },
+  {
+    "id": "multiclinsum_gs_en_504.txt",
+    "fulltext": "14-year-old previously healthy adolescent who presented to the Primary Emergency Care Service (PEC) of Osorno with a 11-day history of a predominantly nocturnal irritative cough. Symptomatic treatment was indicated, evolving with dyspnoea and orthopnoea. He presented to the Emergency Department of the Osorno Base Hospital (OBH), with severe respiratory distress, intolerance to supine position, and abdominal pain. He was admitted to the Paediatric Intensive Care Unit (PICU), tachycardic, hypertensive, polypneic, oxygen saturation 96% with FiO2 35%, rosy, hydrated and well perfused, with flat jugular veins, small bilateral supraclavicular lymphadenopathies. The thorax was without retraction of soft tissue, maintained in a genupectoral position, with decreased pulmonary murmurs in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The soft abdomen was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and the cardiac auscultation had muffled tones, without breath sounds. The abdominal soft tissue was not easily depressible and sensitive in both hypochondria, with doubtful visceral enlargements and no injuries. The chest radiograph showed a superior mediastinal mass and atelectasis of the right middle lobe associated with ipsilateral pleural effusion. Contrast-enhanced chest X-ray was not performed due to contraindication of anaesthesia, as stated in the summary of transfer from OBH. He was transferred in a serious condition to the PICU HBV, with a Mediastinal Compression Syndrome, with clinical suspicion of non-Hodgkin lymphoma. He was evaluated by the paediatric haemato-oncology, paediatric surgery, paediatric intensive care, imaging, radiotherapy and paediatric oncology teams, with a normal pulmonary murmur in both bases, and\n\nA nephrological evaluation was performed, which confirmed renal failure secondary to tumor lysis syndrome, without dialysis urgency and tendency to hypertension, with creatinine 1.54 mg/dL, phosphemia 11 mg/dL, without hypernatremia. It continued with hyperhydration, diuretic (furosemide) and antihypertensive (amlodipine). From the respiratory point of view, it presented oxygen requirement, with FIO2 35% by mask of Venturi, suspending this supply on the third day of admission. It evolved with episodes of psychomotor agitation, associated to the diagnosis in process, which was treated according to the institutional protocol of psychomotor agitation, with psychological and psychiatric support, with satisfactory evolution. On the third day of admission and treatment a CT scan of the thorax, abdomen and pelvis was performed with contrast, observing an increase in the size of the thymus, of homogeneous aspect, probably in the context of a lymphoproliferative process and findings suggestive of pulmonary thromboembolism. The angioCT of the thorax showed thrombosis of the jugular vein, extensive bilateral pleural effusion associated to atelectatic phenomena in both bases, with signs of medical bilateral nephrosis. Anticoagulation with enoxaparin (1 mg/kg dose, every 12 hours) was indicated for twenty days. Then the angioCT of control showed resolution of the thrombosis.On the fourth day of admission and treatment, a diagnostic and extension study was performed, which included, among others, a complete biochemical profile including lipid profile, granulopoietic hyperplasia of the bone marrow (myelogram), flow cytometry (bone marrow) in which no cells with a predominant clonal or neoplastic immunophenotype of haemological lineage were observed, flow cytometry in peripheral blood negative for neoplastic cells, cytological of pleural fluid negative for neoplastic cells, flow cytometry of pleural fluid without evidence of haemological neoplasia. It was presented to the paediatric oncological committee, highlighting that it was not possible to take a biopsy of the tumour given that the mediastinal mass disappeared with the cytoreductive treatment, assuming the diagnosis of lymphoblastic lymphoma by the clinical picture and the response to treatment, according to the PINDA 0516 protocol. This protocol contemplates in Induction IA eight doses of Lasp E. coli of 10,000 IU/m2. Having received seven doses of L-asp and with a cumulative dose of ninety thousand international units plus glucocorticoid (prednisone), presented a picture of decline, vomiting, abdominal pain and mild dehydration. There was suspicion of pancreatitis, which was ruled out by normal amylase/lipase values and normal hepatic tests. At that time it had plasma electrolyte profile with hyponatraemia of 126 mOsm/kg and urinary osmolality of 510 mOsm/kg, both normal values. With hyponatraemia and hypertriglyceridaemia, there was suspicion of RAM of pseudohyponatraemia secondary to hypertriglyceridaemia associated to L-asp. It was evaluated by Gastroenterology and Endocrinology, indicating a diet low in refined sugars and rich in fiber, fibrates (ciprofibrato 100 mg oral daily) and omega 3 (4 g oral daily), until triglyceride values of 300 mg/dL were achieved. Two weeks later the triglycerides had a value of 79 mg/dL. Ciprofibrato and omega3 were suspended, indicating prophylactic use associated to corticoid and L-asp treatment. A total of twelve doses of L-asp were completed with a cumulative dose of one hundred and eighty four thousand international units corresponding to the induction protocol. The suspicion of RAM was subjected to causality evaluation, with the modified Karch and Lasagna algorithm by WHO5, which resulted in “Definitive” RAM for the association of L-asp and Prednisone\n",
+    "summary": "A teenager who developed pseudohyponatraemia and hypertriglyceridaemia during treatment for non-Hodgkin lymphoma (NHL) was suspected to have a drug reaction (ADR). This suspicion of ADR was evaluated according to the modified causality algorithm (Karch and Lasagna), resulting in a \"definitive\" ADR for the association of L-asp and corticosteroids. He received treatment with a low-fat diet and lipid-modifying medicines. L-asp and prednisone were not discontinued due to the end of the indication, according to the protocol. The hypertriglyceridaemia recovered without complications after 14 days of treatment.\n",
+    "translated_fulltext": null,
+    "translated_summary": "一位青少年在接受非霍奇金淋巴瘤（NHL）治疗期间，出现了假性低钠血症和高甘油三酯血症，怀疑是药物不良反应（ADR）。根据改良的因果关系算法（Karch和Lasagna），对这种ADR的怀疑进行了评估，结果显示L-天冬氨酸和皮质类固醇之间的关联被确认为“明确的”ADR。他接受了低脂饮食和降脂药物的治疗。根据治疗方案，由于治疗指征已结束，L-天冬氨酸和强的松未停止使用。经过14天的治疗后，高甘油三酯血症在没有并发症的情况下恢复正常。"
+  },
+  {
+    "id": "multiclinsum_gs_en_54.txt",
+    "fulltext": "A 56-year-old Italian female patient with β-thalassemia major presented to the radiology department to undergo MRI to quantify myocardial, hepatic, and pancreatic iron deposition. The clinical history of the patient included a transfusion-dependent β-thalassemia condition (genotype HBB:c.118C > T/ HBB:c.93-21G > A), diagnosed at the age of 7 years, despite the fact that the first transfusion was carried out at 2 years. As a consequence of β-thalassemia, the patient underwent splenectomy and cholecystectomy.\n\nAt the moment of MRI, she had a negative HCV-RNA (Hepatitis C virus-Ribonucleic acid) test, no osteoporosis or other endocrine, cardiac, or hepatic complications, and good iron levels. The patient’s therapy included iron chelation with deferasirox, vitamin D, and luspatercept, an erythropoiesis modulator started 2 years before the MRI examination (good response, with an increase of about 35% of transfusion interval duration). Transfusion therapy included two units of concentrated and filtered red blood cells every 25 days with pre-transfusion hemoglobin values of 10–10.5 g/dl.\n\nOn MRI, a solid mass with lobulated and regular contours was incidentally identified within the prevascular compartment of the mediastinum.\n\nThe lesion was mildly hyperintense on T2-weighted images (T2-wi) and isointense on T1-wi. The mediastinal mass in question was discernible in a prior MRI examination conducted for the same purpose in 2020 before starting luspatercept therapy, albeit with a marginal enlargement.\n\nThere were no other apparent abnormalities observed in the remaining mediastinal compartments. No pleural or pericardial effusions were present.\n\nThe neurological examination was unremarkable, and in the preceding months, the patient exhibited no symptoms of mediastinal syndrome associated with compression of the adjacent neurovascular structures. Moreover, she did not exhibit any fever or experience any weight loss.\n\nFor further evaluation, the patient underwent 18F-deoxyglucose (18FDG) positron emission tomography (PET)-computed tomography (CT) and chest CT with contrast media. On PET-CT, the mediastinal mass showed only mild FDG uptake (SUVmax = 4.3); no other sites of abnormal radiotracer uptake were reported in the neck, chest, abdomen, and skeleton. On CT images, the lesion presented regular margins, solid density, and mild contrast enhancement. The adjacent structures did not exhibit any signs of invasion, and lymphadenopathies or extra-thoracic disease were not present. Such radiological features, the indolent behaviour over time, the absence of systemic symptoms, and the lack of avid FDG uptake on PET-CT scan made the diagnosis of thymoma probable.\n\nHowever, on lung window visualization, multiple rounded areas of parenchymal lucency, consistent with thin-walled cysts distributed symmetrically throughout both lungs, with normal intervening parenchyma, were evident.\n\nNo nodules or other interstitial abnormalities were associated with the cysts. No pneumothorax was detected. Coherently with thalassemic bone disease, the ribs appeared widened, and the spine displayed mild platyspondyly. The remaining portion of the chest and visible upper abdomen were unremarkable. The radiological findings were consistent with cystic lung disease, most likely LAM.\n\nThe patient was then referred to the pulmonary clinic for further evaluation. She was a never-smoker and did not report any respiratory symptoms. In particular, she denied a history of chronic cough, recurrent respiratory infections, or pneumothorax. No cutaneous lesions, notably facial fibrofolliculomas, were evident. On chest examination, the lung fields were clear. Peripheral capillary oxygen saturation was normal (98%), with a heart rate of 75 beats per minute. Pulmonary function tests revealed a substantial reduction in diffusing capacity of the lungs for carbon monoxide (DLCO; 42% of the predicted value), partly imputable to the condition of anemia, with a carbon monoxide transfer coefficient (KCO) of 73% of the predicted value. After discussion in a multidisciplinary tumor board setting, including a pulmonologist, the patient underwent left thoracoscopic thymectomy and concomitant lingual segment wedge resection. The histopathological report revealed a morphological finding and immunohistochemical pattern referable to type B2 thymoma with focal infiltration of the capsule. Extracapsular extension was not evident. However, the lesion was present at the resection margin (stage IIa according to Masaoka–Koga; stage 1a according to the tumor, node, metastasis [TNM] classification).\n\nRegarding the lung parenchyma, histopathologic analysis described lung parenchyma with cysts of variable size lined by spindle cells in myoid habit with immunohistochemical reactivity for actin, estrogen, progesterone receptors, and HMB45 (focal positivity). Modest chronic interstitial inflammation, vascular congestion, and recent blood extravasation were evident. These morphological findings were compatible with pulmonary LAM.\n\nA final histological diagnosis of thymoma and pulmonary LAM was made. For the neoplastic condition, the patient was a candidate for adjuvant radiation therapy due to the microscopically incomplete resection (R1). For LAM with concomitant β-thalassemia, treatment with sirolimus was recommended.",
+    "summary": "A 56-year-old Italian female patient with β-thalassemia major underwent magnetic resonance imaging to quantify myocardial, hepatic, and pancreatic iron deposition. Her medical history included transfusion-dependent β-thalassemia, splenectomy, and cholecystectomy. At the time of magnetic resonance imaging, she had no significant endocrine, cardiac, or hepatic complications and was on deferasirox, vitamin D, and luspatercept. Magnetic resonance imaging revealed a lobulated mass in the prevascular mediastinum, which showed mild radiotracer uptake on positron emission tomography. Chest computed tomography revealed multiple thin-walled cysts in the lungs, indicating lymphangioleiomyomatosis. Following multidisciplinary evaluation, the patient underwent thoracoscopic thymectomy and lung wedge resection. Histopathology confirmed type B2 thymoma and pulmonary lymphangioleiomyomatosis. Post-surgery, the patient was recommended for adjuvant radiation therapy and sirolimus treatment.",
+    "translated_fulltext": null,
+    "translated_summary": "一位56岁的意大利女性患者，患有重型β-地中海贫血，接受了磁共振成像检查，以评估心肌、肝脏和胰腺中的铁沉积量。她的病史包括需要输血的β-地中海贫血、脾切除术和胆囊切除术。在进行磁共振成像时，她没有明显的内分泌、心脏或肝脏并发症，并且正在服用 deferasirox、维生素 D 和 luspatercept。磁共振成像显示，在血管前纵隔处有一个分叶状肿块，在正电子发射断层扫描中显示出轻微的放射性示踪剂吸收。胸部计算机断层扫描显示肺部有多个薄壁囊肿，提示淋巴血管平滑肌瘤病。经过多学科评估后，该患者接受了胸腔镜胸腺切除术和肺部楔形切除术。组织病理学检查证实为B2型胸腺瘤和肺淋巴血管平滑肌瘤病。术后，建议该患者接受辅助放疗和西罗莫司治疗。"
+  },
+  {
+    "id": "multiclinsum_gs_en_235.txt",
+    "fulltext": "We present a case of a 49-year-old woman with renal and heart failure following a long-term (lasting from 13 years of age) SLE prepared for kidney transplantation. Due to LN (class III, then IV), starting at childhood, she was treated with steroids, together with cyclophosphamide, replaced later by methotrexate and then azathioprine. Hence, the partial remission of nephrotic syndrome was achieved and from 2002 the patient did not receive any immunosuppressive therapy. She was also HBV and HCV positive. SLE involvement of circulatory system presented with early coronary atherosclerosis, ischemic heart disease, and myocardial infarction at the age of 20. In 2007, because of deterioration of kidney function with a serum creatinine concentration of 2.2 mg/dL and proteinuria of 2 g/day, the kidney biopsy was performed. The biopsy showed active and sclerotic focal proliferative lupus nephritis nevertheless immunosuppressive therapy was not introduced for the reason of active replication of HCV. The kidney function was gradually deteriorating over time. Despite cardiac intervention (PCI RCA), the patient developed severe post-infarction and dilated cardiomyopathy and required ICD implantation in primary prevention in 2009. Later, on lupus and secondary cardiomyopathic background, the patient developed severe MV and TV regurgitation. For this reason, the patient underwent mitral and tricuspid valve repair and left ventricle volume reduction surgery complicated by low cardiac output syndrome with a need for intra-aortic balloon pump use (2014). In the postoperative period, the kidney function deteriorated, requiring the initiation of renal replacement therapy. The patient has been on dialysis for 4 years. While being on active waiting list for kidney transplantation presented remission of laboratory indices of lupus (complement splits within normal limits: C3–0,93 g/l, C4–0,4 g/l, ANA negative) and persisting circulatory insufficiency with markedly reduced stair-climbing capacity (to one flight of stairs) with elevated BNP 619 pg/ml (n. 0–100). In transthoracic echocardiography, performed before renal transplantation, the left ventricle and the left atrium were significantly enlarged and the left ventricular systolic function was significantly reduced with LVEF 26% and GLS -3. Due to the implantation of the mitral ring, it was not possible to assess the left ventricular diastolic function. The high tricuspid regurgitant flow gradient with widened and poorly respiratory mobile inferior vena cava indicated a high probability of pulmonary hypertension. Furthermore, while preparing the patient for the surgical procedure, it was decided to include cardioprotective therapy with Levosimendan. Due to the time frame associated with the transplantation procedure, the drug infusion was started as soon as possible after cross-match results were known, immediately after the dialysis session. The infusion at a dose of 0.1 μg/kg/min was continued after surgery for a total of 24 h. The patient’s anesthesia for kidney transplantation and perioperative care included the aspect of optimizing transplanted kidney perfusion, avoiding the use of renal toxic drugs and those excreted by properly functioning kidneys, as well as the use of nephroprotective agents. Because of the patient’s cardiological burden, including recurrent episodes of extrasystole proceeding with decompensation of the circulatory system, together with the need of ICD turning off for the transplantation period, the Swan-Ganz catheter for hemodynamic assessment was not used. Anesthesia monitoring was limited the to ECG, central catheter with CVP assessment, direct blood pressure measurement from the cannula inserted into the radial artery, and cardiac ultrasound. In the perioperative period the CVP parameter was used to assess the volatility, and in the postoperative period, a cardiac ultrasound was used along with the assessment of VCI respiratory fill and motility. The therapy was aimed at the standard of fluid therapy called Goal Directed Therapy (GDT). During general anesthesia, fentanyl, triacrium, propofol, desflurane, antibiotic therapy, and standard immunosuppressive treatment were used as well as 25 g of mannitol infusion was administered as a nephroprotective treatment and 0.9% NaCl as a fluid therapy. In the course of postoperative immunosuppression, she received steroids, tacrolimus with mycophenolate mofetil which was stopped due to persistent leukopenia and cytomegalovirus infection. Furthermore delayed graft function was observed with a need for hemodialysis for almost 6 weeks (mostly due to fluid retention). BNP levels raised to 2996 pg/ml and then slowly decreased. The kidney biopsy performed 2 weeks after transplantation revealed acute rejection (AR II B Banff 2015) with ATN. Finally, the patient was discharged from the hospital on the 67th POD with the serum creatinine concentration of 1.4 mg/dL and BNP level of 1794 pg/ml. One month after kidney transplantation, there was a reduction in left ventricular dimensions, improved systolic function in the EF (increase to 30%) and GLS (decrease to − 6) assessment. In addition, there was a decrease in the tricuspid regurgitant flow gradient with normal width and respiratory motility of the IVC, which indicates a low probability of pulmonary hypertension. The improvement of echocardiographic parameters also reflected the simultaneous improvement of exercise capacity in the recipient from NYHA III/IV to NYHA II. In the 5-month observation, further improvement of heart function with a drop of BNP to 1066 pg/ml and normal kidney function were noted.",
+    "summary": "We present a case of a 49-year-old woman with renal and heart failure following a long-term SLE prepared for kidney transplantation. During the SLE course, the function of the heart and kidneys gradually deteriorated. The patient required the initiation of renal replacement therapy and was dialyzed until a kidney transplantation for 4 years. In the preparation of the patient for the surgical procedure, due to the extremely low ejection fraction, it was decided to include cardioprotective treatment with Levosimendan. The postoperative period was not straightforward but successful. In the monthly and five-month follow-up, a continuous improvement of heart function with normal renal function was noted.",
+    "translated_fulltext": null,
+    "translated_summary": "本文介绍了一例49岁女性患者，她长期患有系统性红斑狼疮（SLE），并因此导致肾功能衰竭和心功能衰竭，为进行肾脏移植做准备。在SLE病程中，患者的心脏和肾脏功能逐渐恶化。患者需要开始进行肾脏替代疗法，并进行了4年的透析。在为患者的手术做准备时，由于其射血分数极低，因此决定采用左西孟坦进行心脏保护治疗。术后恢复过程并非一帆风顺，但最终取得了成功。在术后1个月和5个月的随访中，观察到患者的心脏功能持续改善，肾功能恢复正常。"
+  },
+  {
+    "id": "multiclinsum_gs_en_172.txt",
+    "fulltext": "Patient information\nA 20-year-old male Arabic martial artist (weight 91.5 kg, height 180 cm, and body mas index (BMI) 28.24) presented with pain in the back of the left thigh for the past 5 weeks and underwent pharmacological and physiotherapeutic intervention; however, he did not responded well to symptomatic treatment. He reported that the symptoms first appeared during a short sprint while playing soccer and heard a pop in the back of his thigh. The pain was so bad that he withdrew from the game soon after his injury and noted no bruising on the back of his thigh or significant swelling in that area. However, he reported progressive loss of flexibility in the left knee and inability to flex and extend the knee joint while the knee remained flexed at a 15° angle, whether standing or having the leg in the air. He denied any previous history of lower back pain but could barely support the weight of the affected limb. There was no history of alcohol, smoking, diabetes, high blood pressure, or other serious genetic diseases.\n\nClinical findings and diagnostic assessment\nThe patient reported having received icing and elevation of the affected leg while lying down following the injury as therapeutic interventions. He had a crepe bandage applied to his affected thigh to support him while standing and walking. He used crutches for ambulation and to go for a little longer distance. To climb the stairs, he had to use one step at a time, relying on his right lower extremity. He also reported adopting a sitting position at the edge of the chair as direct pressure on the thigh from the chair caused him discomfort. He denied ever hurting his legs or back in sports. As a result, the patient withdrew from all activities, such as playing sports, owing to the pain, and his knee was mildly bent most of the time. Despite taking medication (nonsteroidal antiinflammatory drugs (NSAIDs)), the pain worsened over time. Since the patient did not respond well to cryotherapy, compression bandages, and medications, he decided to see a doctor for further diagnosis and treatment before meeting with us.\n\nOn further evaluation, he presented with limited knee extension and flexion and exhibited an analgesic gait with a reduced heel strike phase. Active range of motion (AROM) of the left knee was 10–15° compared with 0–130°degrees in the right knee. Palpation revealed tenderness and firmness in the middle third of the semimembranosus and semitendinosus muscles.\n\nManual muscle testing and isometrics could not be performed owing to persistent discomfort. The patient reported pain at rest, rated 5/10, and during activity it was rated 7/10. Further, clinical evaluation rule out lumbar disc involvement or gluteal and ischial tunnel syndrome [4, 6].\n\nThe best way to screen nerve tension for peripheral pain in the lower extremities is with a slump test [17]. However, the result of the slump test in this patient was negative.\n\nTherapeutic interventions\nDespite the patient’s current clinical presentation, which was suggestive of HSI, the authors decided to treat him with neural glide technique on the basis of the structural and functional proximity of nerve to the lower limb flexibility through a novel neurodynamic tension technique [18, 19]. The scientific rationale for this neural approach was detailed to the patient and consent was obtained.\n\nThe patient was directed to sit with arms folded behind his back and knees and ankles held in extension and dorsiflexion, respectively, while a therapist guided the patient to flex his thoracic and cervical spine and extend his knee joint to the maximum tolerable limit. Next, the patient was instructed to move his neck forward and backward as much as possible while also moving his ankle up and down 15 times to help with nerve glide.\n\nThis was done in three sets each day. The therapist then helped the patient bend their middle and upper back as much as possible until the patient felt pain in the knee area. Then, the process was repeated. By the 3rd day, the patient’s active knee extension improved from 5° to 10° and then to a 15° degree bent position. In addition, the standing posture also got better.\n\nSubsequently, the patient was instructed in executing a set of posture re-education workouts, which involved doing active chin flexion, engaging in passive stretching of the cervical extensors while lying down in prone, and building up the shoulder retractors, arm from positions T to Y, then from Y to W with the limb’s weight while lying down.\n\nTo address the kyphotic posture, active chest stretches were taught at wall corners. The patient was instructed to increase the duration of the exercises from 5 to 10 seconds, doing 10 reps and 3 sets daily.\n\nOutcomes and follow-up\nThe results were assessed using a numeric pain rating scale (NPRS) and Knee Society score (KSS). Substantial enhancement in clinical outcome measures such as pain and function were achieved within 3 successive days of therapy. The use of pain medication was discontinued.\n\nThe patient continued his self-neural glides and postural reduction exercises at home and was advised for a follow-up after 4 weeks or to contact us if symptoms worsened. On the 3rd follow-up day, the patient’s NPRS from 5 at rest and 7 with activity to 2 at rest and 4 with activity. The KSS increased from 22 to 61 and from 30 to 80 in the functional domain. At the end of the 2-week home program, the patient reported to have full active straight leg raise (SLR). The patient had fully recovered from his knee dysfunction and pain at the 2-month follow-up.",
+    "summary": "A 20-year-old male Arabic martial artist had a history of left hamstring strain for the past 5 weeks. He had undergone pharmacological and physiotherapeutic interventions for his clinical conditions but had not responded favorably. Further clinical assessment had ruled out hamstring syndrome. The patient refrained from all sports activities.\n\nIntervention: The patient was treated using a modified slump mobilization technique with four repetitions for 3 consecutive days, together with postural retraining. Results of the numeric pain rating scale and Knee Society score before and after the interventions were obtained.\n\nResults and discussion: Pre-intervention score of the numeric pain rating scale was 5/10 and 7/10 at rest and with activity, respectively. Assessment on the 3rd consecutive day of intervention, the numeric pain rating scale decreased to 2/10 and 4/10 at rest and with activity, respectively. Similarly, the pre- and post-intervention Knee Society score improved from 22 to 61 in pain and from 30 to 80 in function. At the 2-month follow-up, the patient reported a complete recovery from symptoms and resumed his sports activities without any disruption.",
+    "translated_fulltext": null,
+    "translated_summary": "一位20岁的阿拉伯男性武术家，在过去5周内曾出现过左侧腘绳肌拉伤。他曾接受过药物治疗和物理治疗，但效果不佳。进一步的临床评估排除了腘绳肌综合征。患者停止了所有运动活动。\n\n干预措施：患者接受了改良的“下斜位松动”手法，连续3天，每次重复4次，并配合姿势训练。记录了干预前后疼痛评分（数字疼痛评分量表）和膝关节协会评分。\n\n结果与讨论：干预前，患者在休息时和活动时的疼痛评分分别为5/10和7/10。在干预的第三天，患者在休息时和活动时的疼痛评分分别降低到2/10和4/10。同样，干预前后的膝关节协会评分，在疼痛方面从22分提高到61分，在功能方面从30分提高到80分。在2个月的随访中，患者报告症状完全缓解，并恢复了运动活动，没有出现任何问题。"
+  },
+  {
+    "id": "multiclinsum_gs_en_86.txt",
+    "fulltext": "A 27-year-old woman with beta-thalassemia major since 24 years and 16 weeks of pregnancy was referred from the Internal Medicine Department to the Oral Medicine Department with complaints of swelling, bleeding gums since early pregnancy, and bad breath. The patient was hospitalized with complaints of pain in her knee so he could not move. She was admitted to hospital with complaints of pain in her knees so she could not move and was diagnosed with Arthritis ar Genue Sinistra related to Thalassemia by an internal medicine specialist, sub division of rheumatology. General condition patient was weak, sick, and difficult to move during the approximately two weeks, when she was hospitalized. Patient has never visited a dentist, either before or now, with complaints about her oral cavity. The patient had a splenectomy in 2009. Her beta-thalassemia major was treated with routine blood transfusions once a month and iron anti- chelation drugs (deferoxamine); however, it was stopped due to pregnancy. There was no history of other systemic disease in this patient. A family history of the same disease was ruled out. History of recurrent stomatitis and drug or food allergies was ruled out.\n\nThe patient’s general condition weak, with normal vital signs; however, the patient had fever. Intraoral examination revealed gingival hyperplasia; erythema; soft consistency; a dark red, rounded gingival margin; tendencies to bleed on the labial, buccal, palatal, and lingual areas; and pain. Oral hygiene index-simplified (OHIS) score was poor (5.7) and there were true pockets in all regions. Peripheral blood morphology result: (1) erythrocytes: polychromacy in anisochrome populations (hypochrome, normochrome), anisopoikilocytosis (ovalocytes, target); (2) leukocytes: sufficient quantity, hypersegmentation (+); (3) platelet count: numbers increase, spread out; Interpretation: moderate anemia et causa thalassemia major accompanied by signs of increased erythropoiesis activity with suspected infection. The diagnosis was made based on the history, clinical features, and examination, as well as additional examinations, namely gingival enlargement accompanied by chronic periodontitis associated to pregnancy with β-thalassemia major and exfoliative cheilitis of the lips. The classification of periodontal disease in this patient is chronic periodontitis with gingival enlargement associated with pregnancy and beta-thalassemia major. The prognosis in this case was good because the patient was cooperative and followed the directions of the Oral Medicine Department. In this case, multidisciplinary therapy was a collaboration between an oral medicine specialist, a periodontist, and an internist. Dental therapy consisted of spooling with 3% hydrogen peroxide (H2O2) solution, chlorine dioxide spray mouthwash (Oxyfresh®, USA), antibiotics (amoxicillin 500 mg tablet, and metronidazole 300 mg tablet), and scaling/root planning. Spooling of H2O2 3% solution was performed at every visit; chlorine dioxide spray mouthwash was used three times a day after meals, and antibiotics were administered for seven days at third visit. Scaling and root planning were performed by the periodontist after the general condition was controlled and after the gingival hyperplasia and spontaneous bleeding improved. Blood transfusions to remove packed red cell buffy coat (PRC BCR) are also carried out routinely once a month. Non-pharmacological therapy, including oral hygiene instructions, was still given to patients. Oral complaints in this case occurred due to the poor oral hygiene, β-thalassemia major, and pregnancy, were also informed to the patient as education.\n\nThis patient had eight follow-up visits, consisting of two inpatient and six outpatient visits, with the following details:\n\nFirst Visit\nThe first visit was carried out one day after the initial inpatient visit (day +1). Intraoral bleeding still exists in the lingual-anterior part of the mandible, but bleeding in the anterior part of the maxilla has stopped. The patient still had a fever. Medications previously provided were used accordingly. Pharmacological were continued, including spooling 3% H2O2 on all parts of the gingiva, using chlorine dioxide as a mouthwash, and applying a thin layer of petroleum jelly to the lips. A blood transfusion was carried out last night. Oral hygiene instructions are still given to patients.\n\nSecond Visit\nThe second visit was performed two days after the initial visit (day +2). Intraoral bleeding Follow-up visits should be conducted in outpatient settings. Pharmacological therapy including spooling 3% H2O2 on all parts of the gingiva, using chlorine dioxide as a mouthwash, and applying a thin layer of petroleum jelly to the lips. A blood transfusion was carried out last night. Oral hygiene instructions are still given to patients.\n\nThird Visit\nNine days after the initial visit (Day+9). First outpatient treatment. Oral symptoms appeared to improve; bad breath was greatly reduced, but the gums were still swollen. The chlorine dioxide spray mouthwash was still being used and had run out. The patient could brush her teeth with a soft toothbrush but still experienced bleeding. Spooling was performed with 3% H2O2. The previous therapy was continued, antibiotics were prescribed 3x/day for seven days, and a blood transfusion was planned as a preparation for scaling the dental calculus. Oral hygiene instructions are still given to patients.\n\nFourth Visit\nOne month after the first visit (Day+30). Oral complaints improved significantly, bad breath was absent, gingiva enlargement decreased, and spontaneous bleeding ceased. The patient did not experience bleeding when brushing her teeth. Transfusions were performed between visits H+9 and H+30. During this visit, laboratory hematology tests and subsequent blood transfusions were performed. Antibiotics were no longer administered, 3% H2O2, chlorine dioxide, petroleum jelly and oral hygiene instructions were continued.\n\nFifth Visit\nOne week after the 4th visit (day +37), the oral complaints improved, but pharmacological and non-pharmacological therapy continued, including spooling 3% H2O2 on all parts of the gingiva, chlorine dioxide as a mouthwash, and applying a thin layer of petroleum jelly to the lips. Oral hygiene instructions are still given to patients. Supragingival scaling was planned two weeks later or after routine transfusions were administered.\n\nSixth Visit\nTwo months after the initial visit (day +60), the oral complaints improved. The gingival hyperplasia in some areas was no longer present, although in other areas still present, but they have undergone improvement. The transfusion had already been performed one week previously. Pharmacological therapy was continued, including 3% H2O2 spooling, chlorine dioxide spray mouthwash, and petroleum jelly. Non-pharmacological therapy namely oral hygiene instructions and an interdental toothbrush was suggested. Supra- and subgival scaling were performed.\n\nSeventh Visit\nTwo weeks after the 6th visit (Day+74), all the complaints improved. Gingival hyperplasia mostly resolved after scaling. Pharmacological includes 3% H2O2 spooling, chlorine dioxide spray mouthwash, and petroleum jelly as well as non-pharmacological therapy, consisting of oral hygiene instructions and the use of an interdental toothbrush.\n\nEighth Visit\nThree months after the initial visit (day +90), routine blood transfusions were performed one week before the visit. The patient is no longer presented with any oral complaints. All patients with gingival hyperplasia recovered optimally. The spooling process was stopped with 3% H2O2. Supra- and subgival scaling were performed again in all maxillary and mandibular regions. Instructions for the use of an interdental toothbrush, chlorine dioxide spray mouthwash, and petroleum jelly are still provided.",
+    "summary": "A 27-year-old woman, suffering from beta thalassemia major who is undergoing therapy in the form of routine blood transfusions every month and taking anti-chelation drugs but is currently stopping this because she is pregnant, currently 16 weeks pregnant, complains complained of swollen gums, bleeding, and bad breath. Extraoral examination revealed dry, exfoliative lips. Intraoral examination revealed gingival hyperplasia with erythema, soft consistency, dark red rounded gingival margins, bleeding, true pockets and pain throughout the labial, buccal, palatal, and lingual. There was no history of systemic disease in this patient. Patient has never visited a dentist, either before or now, with complaints about her oral cavity. Hematological parameters showed abnormalities, and peripheral blood examination revealed an infection. The oral diagnoses included gingival enlargement and chronic periodontitis associated with pregnancy and β- thalassemia major.\n\nCase Management\nDental management consisted of spooling with 3% hydrogen peroxide (H2O2) spooling, chlorine dioxide spray mouthwash, antibiotics, calculus removal, and oral hygiene instructions. Blood transfusions were administered once a month, and anti-chelation therapy was stopped during pregnancy. After three months of multidisciplinary management, the results were satisfactory.",
+    "translated_fulltext": null,
+    "translated_summary": "一位27岁的女性，患有重型β-地中海贫血，目前正在接受治疗，治疗方式为每月进行常规输血，并服用抗螯合药物，但由于她已怀孕，目前已停用这些药物，怀孕16周。她主诉牙龈肿胀、出血和口臭。体外检查显示嘴唇干燥、脱屑。口腔检查显示牙龈增生，伴有红斑、质地柔软、深红色、圆形的牙龈边缘，并有出血、真正的牙周袋以及唇、颊、腭和舌侧均有疼痛。该患者既往无全身性疾病史。患者从未去看过牙医，无论是过去还是现在，都未就口腔问题进行就诊。血液学指标显示异常，外周血检查显示存在感染。口腔诊断包括与妊娠和重型β-地中海贫血相关的牙龈增生和慢性牙周炎。\n\n病例管理\n牙科治疗包括使用3%过氧化氢（H2O2）漱口、使用二氧化氯喷雾漱口水、使用抗生素、清除牙结石以及进行口腔卫生指导。每月进行一次输血，并在怀孕期间停止抗螯合治疗。经过三个月的多学科综合治疗后，结果令人满意。"
+  }
+]
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