| You are an expert in health communication. Your task is to judge the health literacy level of a target text based on its original medical source. |
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| Classify the text into one of three categories: |
| 1. low_health_literacy: Uses common words (everyday language), very short sentences, and eliminates all medical jargon. |
| 2. intermediate_health_literacy: Uses some medical terms with explanation, standard sentence length, requires basic health knowledge. |
| 3. proficient_health_literacy: Uses high-level medical jargon, technical language, and academic or professional structures. |
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| ### Few-Shot Examples: |
| Original 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. |
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| A 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. |
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| On 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." |
| Target Text: "A 78-year-old man from the Amhara region of Ethiopia had a permanent heart pacemaker because of a complete heart block. He was scheduled for prostate surgery. Before surgery, the anesthesia and heart doctors advised switching his pacemaker to a steady, fixed beat to lower the chance of problems. He could not afford that change. He chose to go ahead with the operation. He signed consent for the plan. After surgery, he also gave permission to share his case. For anesthesia, he got a numbing injection in the lower back (a combined spinal–epidural). The team used 2.5 ml of strong numbing medicine (0.5% bupivacaine) and a tiny dose of fentanyl (50 micrograms). Standard monitors were used, and his heart was watched closely. His vital signs stayed steady, with only small changes. His blood pressure stayed good with IV salt water. After surgery, he went to the recovery room. He got pain medicine after 4 hours and an extra dose through the epidural. Six hours after surgery, he moved to the ward in stable condition. The epidural pain control continued for 72 hours. He went home in stable condition about 88 hours after surgery." |
| Reasoning: The Target Text replaces jargon with plain words (e.g., “heart pacemaker,” “numbing injection in the lower back,” “IV salt water”), drops acronyms and risk scores (RCRI, MET, ASA, ECG/lab details), and often swaps precise metrics for simple descriptors (“tiny dose,” “small changes”). It uses short, direct sentences in a clear sequence, reducing clause complexity and cognitive load—hallmarks of low health literacy adaptation. |
| Label: low_health_literacy |
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| Original 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. |
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| Target Text: "A 36-year-old woman had trouble swallowing. Tests found she was born with an unusual shape of the main body artery in her chest. The artery curves to the right in a mirror-image pattern. It wraps around a main branch of the airway. The side branches of the artery come off in the reverse order from normal. Most people with this have no symptoms. Problems happen only if the artery squeezes the space in the middle of the chest. This can press on the food pipe or the windpipe. Surgery may be needed if there is strong pressure on these tubes, a bulge or a tear in the chest artery, or a pouch on the artery bigger than 2 cm. There is no one-size-fits-all treatment. Care is tailored to the person’s symptoms and body anatomy. This patient did not receive any treatment." |
| Reasoning: The Target Text replaces technical terms with plain words (e.g., “dysphagia” → “trouble swallowing,” “congenital anomaly of the aortic arch” → “unusual shape of the main body artery”), removes detailed anatomy (e.g., Kommerell diverticulum, brachiocephalic/subclavian arteries), and omits precise measurements and percentages. It uses short, simple sentences and everyday terms (“squeezes,” “food pipe,” “windpipe”), avoiding dense jargon and complex clause structures, which fits low health literacy. |
| Label: low_health_literacy |
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| Original 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. |
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| Eight 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. |
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| After 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. |
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| On 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. |
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| After 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. |
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| According 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. |
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| Based 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." |
| Target Text: "A 59-year-old man with type 1 diabetes came to the hospital with heart failure. A heart ultrasound showed big clumps of germs stuck to two heart valves, the mitral and the aortic valves. His blood test grew a germ called Staphylococcus warneri. This is a kind of staph that usually lives on the skin and is normally harmless. Doctors found he had an infection on his own heart valves (native valve endocarditis). He later had surgery to replace both the mitral and the aortic valves. Looking back, small lab changes and weight loss that began about four months earlier may have been early warning signs. He had not been on immune-weakening medicines and did not have any implanted medical devices." |
| Reasoning: The Target Text replaces technical jargon with plain words (e.g., 'heart ultrasound' for echocardiography, 'clumps of germs' for vegetations, 'infection on his own heart valves' for native valve endocarditis) and omits complex numbers, lab values, and guideline details. It uses short, simple sentences and familiar explanations (e.g., staph that 'usually lives on the skin and is normally harmless'), making it accessible to readers with low health literacy. |
| Label: low_health_literacy |
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| Original 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. |
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| The 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. |
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| The 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. |
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| These 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. |
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| Target Text: "She is 34 years old and pregnant. She had a seizure and trouble speaking clearly. She was sent right away for a head MRI scan. The scan showed a pattern doctors call the “Medusa head.” This means the veins in her brain are arranged in an unusual way that she was born with. There is a small blood clot at the outer part of this vein pattern. The blood is also moving slowly closer to the main vein." |
| Reasoning: The Target Text uses short, simple sentences and common words, replacing jargon like “dysarthria,” “postcritical period,” and detailed MRI sequences (T1, FLAIR, diffusion) with plain terms like “trouble speaking clearly” and “head MRI scan.” It explains technical concepts in lay language (e.g., “venous anomaly of development” becomes “veins… arranged in an unusual way she was born with,” and “partial thrombosis and slow flow” becomes “small blood clot” and “blood is also moving slowly”), which aligns with low health literacy. |
| Label: low_health_literacy |
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| Original 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. |
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| After 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. |
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| At 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. |
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| After 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. |
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| At 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. |
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| A 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." |
| Target Text: "At 32 weeks of pregnancy, a routine scan found one small lump inside the baby’s heart. It caused no symptoms. This was the only problem seen. Doctors watched it with clinic visits until 39 weeks plus 1 day. Then the baby was delivered by C-section (a surgery to deliver the baby). After birth, the child had checkups on day 1, day 7, day 30, month 7, and month 12. At each visit, the child’s growth and behavior were healthy for age. The heart lump stayed the same size; it did not grow or shrink. By 1 year old, there were no signs of a related condition called tuberous sclerosis complex." |
| Reasoning: The Target Text replaces jargon and acronyms (e.g., VDRL, HBsAg, LVOT/RVOT, echocardiography) and precise measurements with everyday words (“lump,” “checkups”) and short, simple sentences, and it defines the one technical term it keeps (“C-section” explained as surgery). It focuses on a clear timeline and outcomes rather than detailed anatomy or test results, making it easier for readers with low health literacy to understand. |
| Label: low_health_literacy |
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| Original 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. |
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| Coronary 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. |
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| Dyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea." |
| Target Text: "A 69-year-old man with prior coronary bypass surgery presented with two months of severe shortness of breath with mild activity (NYHA class III). He was diagnosed with heart failure due to ischemia after failure of a saphenous vein graft to the right coronary artery. This was supported by an abnormal ECG, elevated NT-proBNP, and a coronary angiogram; echocardiography also showed reduced pumping function. The team reopened a chronic total occlusion in the native right coronary artery using a retrograde approach through septal channels (septal surfing). To enable that route, they first re-opened the totally occluded left coronary artery. After the procedure, his dyspnea improved before discharge, and at 6 months he had no recurrence of shortness of breath." |
| Reasoning: The Target Text replaces heavy jargon and brand/device lists with simpler, common terms and shorter sentences (e.g., “shortness of breath” instead of “dyspnea,” summarizes the procedure without wire/catheter names), but still includes some specialized concepts/acronyms like NYHA class III, NT‑proBNP, “chronic total occlusion,” and “retrograde approach.” This balance of simplification with retained medical terminology fits an intermediate health literacy level. |
| Label: intermediate_health_literacy |
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| Original 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. |
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| He 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. |
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| The 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. |
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| An 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. |
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| Laboratory 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. |
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| Cardiac 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. |
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| Computed 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. |
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| Within 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). |
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| Takayasu 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. |
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| Target Text: "A 36-year-old woman with ulcerative colitis developed a week of worsening chest pressure with autonomic symptoms (such as sweating and nausea). Her electrocardiogram showed ST-segment elevation in the inferior leads, consistent with an inferior-wall heart attack. She also reported several months of fatigue and night sweats. |
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| Urgent coronary angiography found severe two-vessel coronary artery disease. The right coronary artery was the culprit lesion and was opened successfully with a stent. Because the interventional team suspected inflammation of the aorta (aortitis), additional workup was done. Inflammatory markers were mildly elevated, and CT angiography showed fibrotic thickening around the aorta with significant narrowing in multiple arteries, pointing to Takayasu arteritis. |
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| She started treatment with prednisone and methotrexate. After stabilization, she underwent delayed coronary bypass surgery and did well." |
| Reasoning: The Target Text simplifies and condenses the original by removing most numbers, acronyms, and detailed lab/imaging values, using shorter sentences and plain explanations (e.g., “autonomic symptoms” with examples, summarizing tests as “inflammatory markers were mildly elevated”). It still retains some essential medical terms (angiography, stent, bypass, Takayasu arteritis) with context, making it understandable to readers with moderate health knowledge—appropriate for intermediate health literacy. |
| Label: intermediate_health_literacy |
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| Original 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. |
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| On 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. |
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| His 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%. |
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| Emergency 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). |
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| Percutaneous 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. |
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| His 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). |
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| Following 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. |
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| We 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. |
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| On 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. |
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| Over 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. |
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| On 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" |
| Target Text: "A 23-year-old man came to the emergency department with a sudden severe headache, nausea, vomiting, and chest heaviness. His initial vital signs showed high blood pressure and a fast breathing rate. An emergency ECG showed a heart attack pattern (STEMI), so he was urgently sent for percutaneous coronary intervention; the angiogram revealed normal coronary arteries. Further evaluation with a brain CT identified a cisternal subarachnoid hemorrhage (bleeding around the brain). Despite coordinated care by multiple teams, his condition rapidly worsened, leading to cardiac arrest and death." |
| Reasoning: The Target Text simplifies sentence structure and omits dense details (e.g., specific vitals, exam findings, and lab values), while retaining key medical terms with brief explanations in plain language (e.g., “heart attack pattern (STEMI)” and “subarachnoid hemorrhage (bleeding around the brain)”). It still uses some necessary jargon like “percutaneous coronary intervention” and “angiogram,” which suits an intermediate audience that can handle common clinical terms when context is provided. |
| Label: intermediate_health_literacy |
| ------------------------------ |
| Original 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. |
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| The patient was asymptomatic from a gynecological standpoint, but primarily complained of headaches before undergoing brain surgery. She had no significant family or psychosocial history. |
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| Her surgical history included |
| 2021: A non-operable tumor (6 cm) of the left petrous bone endolymphatic sac, managed with radiotherapy. |
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| 2021: Left adrenalectomy for a 6 cm pheochromocytoma. Pathological examination revealed pheochromocytoma. |
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| 2021: Left nephrectomy for a ruptured left renal tumor. Microscopy showed multifocal clear-cell renal carcinoma of nuclear grade 2. |
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| 2022: Cephalic duodenopancreatectomy for a mass in the pancreas. Histological examination confirmed three serous cystadenomas and two well-differentiated neuroendocrine tumors. |
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| In 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). |
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| Gynecological examination and surgical history |
| Physical examination: No abdominal–pelvic mass detected. |
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| Speculum examination: Healthy cervix observed. |
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| Surgical scars from previous left nephrectomy and cephalic duodenopancreatectomy were noted. |
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| A 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. |
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| Cytology 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. |
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| Histological 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. |
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| The 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." |
| Target Text: "A 62-year-old white North African woman with Von Hippel–Lindau (VHL) disease diagnosed in 2021 developed several VHL-related tumors: a left petrous bone tumor, a left pheochromocytoma, left renal cell carcinoma, a multicystic right kidney, and pancreatic masses. She was treated with radiotherapy to the petrous bone lesion, left adrenalectomy, left nephrectomy, and cephalic duodenopancreatectomy for the pancreatic tumors. During surveillance, ultrasound and MRI showed a solid–cystic mass in the left adnexal (ovary/tube) region. Laparoscopy then identified cystic tumors in the mesosalpinx on both the right and left sides. She underwent hysterectomy with removal of both adnexa. Pathology confirmed bilateral clear-cell papillary cystadenomas of the mesosalpinx and broad ligament, a pattern consistent with VHL." |
| Reasoning: The Target Text condenses complex timelines and omits dense diagnostics (e.g., O-RADS scores, nuclear grades, intraoperative cytology details), uses shorter, simpler sentences, and occasionally defines jargon (e.g., “adnexal (ovary/tube)”) while keeping essential terms (VHL, hysterectomy, cystadenomas). This balance—reduced technical detail but retention of some medical vocabulary—matches intermediate health literacy. |
| Label: intermediate_health_literacy |
| ------------------------------ |
| Original 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. |
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| One 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. |
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| The 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." |
| Target Text: "A 20‑year‑old woman had a 12‑year history of idiopathic nephrotic syndrome that initially presented with extensive cerebral venous thrombosis and pulmonary embolism. She was treated with anticoagulation and oral corticosteroids, then mycophenolate mofetil as a steroid‑sparing agent. A comprehensive thrombophilia work‑up was negative. She experienced multiple relapses controlled with steroids until 2017, then remained in remission; anticoagulation and MMF were discontinued. One year later, she developed sudden diffuse abdominal pain with postprandial vomiting and bilateral leg edema. Laboratory tests confirmed a relapse of nephrotic syndrome. Abdominal CT showed acute superior mesenteric artery thrombosis causing acute mesenteric ischemia. At surgery, there was extensive small‑bowel necrosis not compatible with survival. She died 48 hours later." |
| Reasoning: The Target Text condenses long, complex passages into shorter sentences and replaces dense jargon and numeric data with clearer summaries (e.g., “comprehensive thrombophilia work‑up was negative,” “steroid‑sparing agent”), omitting exhaustive lab values and test lists. It still uses core medical terms like nephrotic syndrome, mesenteric ischemia, and pulmonary embolism, signaling it’s written for readers with some medical familiarity but not specialist expertise—consistent with intermediate health literacy. |
| Label: intermediate_health_literacy |
| ------------------------------ |
| Original 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. |
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| A 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. |
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| On 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." |
| Target Text: "A 78-year-old male from the Amhara region of Ethiopia with a 7-year history of a permanent pacemaker for complete heart block was scheduled for retropubic prostatectomy for BPH after prior TURP 3 months earlier. Comorbidities included long-standing hypertension (amlodipine 5 mg daily, enalapril 10 mg BID, atorvastatin 10 mg daily) and type 2 diabetes mellitus (metformin 500 mg BID; NPH insulin 20 IU AM/10 IU PM). Preoperative evaluation showed complete bundle branch block on ECG; electrophysiology assessment demonstrated LVH due to hypertensive heart disease with mild diastolic dysfunction and an EF of 62%. Abdominal ultrasound showed an 82-ml prostate; AP chest X-ray was normal with a left-sided pacemaker in situ; electrolytes and troponin were normal. He had a frailty score of 5.5, METs 3.4, and an RCRI class III, indicating an estimated 10.1% risk of major adverse cardiac events within 30 days and intermediate surgical risk. Multidisciplinary planning recommended reprogramming the dual-chamber, rate‑modulated pacemaker to an asynchronous mode to mitigate intraoperative electromagnetic interference risk. Due to financial and logistical constraints, reprogramming was not performed; risks were disclosed, and he consented to proceed. Preoperatively, usual medications were continued (with a lower morning NPH dose at two‑thirds); diazepam 5 mg PO was given at midnight for anxiolysis. On the day of surgery, random blood glucose was checked and managed with a sliding scale. Team communication emphasized CIED precautions (electrosurgery pad positioned away from the device; emergency drugs and defibrillator immediately available). Dexamethasone was given for PONV prophylaxis and paracetamol for preemptive analgesia. ASA standard monitoring was applied and baselines recorded. An L3–L4 combined epidural–spinal anesthetic was performed using 0.5% isobaric bupivacaine 12.5 mg (2.5 ml) plus fentanyl 50 µg, achieving a sensory level to T7. The procedure used a midline infraumbilical incision; monopolar cautery at low voltage (20 mA) with bipolar low‑voltage cautery for hemostasis. Intraoperative hemodynamics remained within 10% of baseline without cardiorespiratory events; blood pressure was maintained with isotonic saline. Postoperatively, he was transferred to PACU with vigilant monitoring; analgesia was administered at 4 hours with an epidural top‑up, and he was transferred to the ward approximately 6 hours after surgery in stable condition. Epidural analgesia was continued for 72 hours. He was discharged at the 88th postoperative hour in stable condition, with cardiology follow‑up advised. Informed consent was obtained, and permission for case report publication was granted after the operation." |
| Reasoning: The Target Text uses dense clinical jargon and numerous unexplained abbreviations (e.g., RCRI, METs, LVH, EF, CIED, PONV, ASA), and reports precise dosages and device settings, assuming the reader understands perioperative and cardiology concepts. Its compact, multi-clause sentences and chronological, data-heavy structure reflect professional communication suited to readers with proficient health literacy rather than lay audiences. |
| Label: proficient_health_literacy |
| ------------------------------ |
| Original 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. |
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| On 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." |
| Target Text: "A 54-year-old male with membranous nephropathy II and nephrotic syndrome on long-term oral glucocorticoids and immunosuppressants (immunocompromised) presented to the Department of Respiratory Medicine with 5 days of fever, cough, expectoration, and progressive dyspnea. He had a 20 pack-year smoking history and no family history of hereditary disease. A chest x-ray one month prior was normal. On admission (August 8, 2016): BMI 24.5 kg/m2, T 39.0°C, tachypnea 35 breaths/min, severe hypoxemia (SaO2 86%). Auscultation revealed good bilateral air entry with scattered diffuse crackles and rhonchi. Chest CT demonstrated multiple bilateral ground-glass opacities. Initial labs showed a normal WBC count with elevated neutrophils and increased inflammatory markers (CRP, ESR) and elevated (1→3)-β-D-glucan. Serology was positive for RSV antibodies on hospital day 4; other pathogen testing was negative. He had laboratory evidence of immunosuppression with decreased total IgG and reduced CD4 and CD8 T-lymphocyte counts, consistent with chronic exposure to corticosteroids and immunosuppressants. |
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| Management: Immediate respiratory monitoring and supplemental oxygen were initiated. Empiric anti-infective therapy included antibiotics (moxifloxacin for 4 days, then cefminoxine for 8 days) and antifungal therapy (voriconazole for 10 days). The glucocorticoid and immunosuppressant doses were largely unchanged. After 10 days, clinical status and oxygenation worsened with radiographic progression. He was transferred to the Emergency ICU for noninvasive mechanical ventilation, broad-spectrum antibiotics (i.v. meropenem, oral moxifloxacin, cotrimoxazole), antifungal therapy (micafungin), systemic corticosteroids (methylprednisolone 40 mg bid i.v.), and supportive care. Ganciclovir was added for possible viral coinfection (e.g., CMV). Five days later, chest x-ray showed further aggravation. Despite escalation to invasive ventilator-assisted ventilation, higher-dose methylprednisolone (80 mg bid), additional antibacterials (cefoperazone-sulbactam, tigecycline, cotrimoxazole), and continued micafungin, he developed rapid progression culminating in respiratory failure and death two days later. |
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| Interpretation: The presentation is consistent with severe viral pneumonia due to RSV in an immunocompromised host, with imaging showing multifocal ground-glass opacities and laboratory evidence of systemic inflammation. Elevated (1→3)-β-D-glucan prompted antifungal coverage, while broad-spectrum antibacterial and antiviral regimens addressed possible coinfections. Profound immunosuppression (low IgG, reduced CD4/CD8 T cells) likely contributed to rapid deterioration and refractory hypoxemic respiratory failure despite intensive anti-infective therapy and advanced respiratory support." |
| Reasoning: The Target Text retains and accurately uses dense medical jargon and abbreviations (e.g., ground-glass opacities, CRP/ESR, SaO2, bid, i.v., RSV serology, immunocompromised), and assumes familiarity with therapeutic classes and diagnostics without lay explanations—hallmarks of proficient health literacy. It also employs a concise, structured format (chronology, “Management” and “Interpretation” sections) with multi-clause sentences and parenthetical clarifications that synthesize data and infer pathophysiology, suitable for readers comfortable with complex clinical prose. |
| Label: proficient_health_literacy |
| ------------------------------ |
| Original 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. |
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| On 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. |
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| On 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). |
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| Initial 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. |
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| The patient was diagnosed with nephritic syndrome due to complicated GNAPE with hypertensive emergency - convulsive status. |
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| Within 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. |
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| The 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. |
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| With 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. |
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| Adding 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. |
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| During 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. |
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| The 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. |
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| On 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. |
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| Target Text: "A 4-year-old male, two weeks post nasal impetigo treated with topical mupirocin and oral cefadroxil (dose/duration/adherence unknown), presented with 5 days of macroscopic glomerular haematuria and lower-extremity oedema, followed by 12 hours of headache, nausea, and vomiting, and arrived to the ED in convulsive status after 20 minutes of generalized tonic–clonic seizures. On ED arrival he was afebrile, with non-evaluable BP, depressed consciousness, generalized hypertonia, and bilateral pretibial oedema. He was intubated and loaded with phenobarbital 10 mg/kg. In the ICU, BP was 134/94 mmHg (p95 for age 108/66; p95+12 120/78), consistent with hypertensive emergency. Initial labs: urinalysis with haematuria (>100 RBC/hpf), proteinuria 3+, leucocyturia 10–25/hpf; creatinine 0.3 mg/dL; anaemia Hct 21%, Hb 7 g/dL with normocytic, normochromic indices; leukocytosis 23,900/mm3; thrombocytosis 756,000/mm3; no elevation of acute-phase reactants; hypocomplementemia with C3 25 mg/dL (VN 80–150) and normal C4. Throat rapid antigen for group A Streptococcus was positive and ASO positive. Non-contrast head CT was unremarkable. Renal ultrasound showed bilateral nephromegaly with increased cortical echogenicity and decreased corticomedullary differentiation. The working diagnosis was nephritic syndrome due to complicated GNAPE with hypertensive emergency and status epilepticus. He required mechanical ventilation and phenobarbital; EEG the next day was normal; CSF was normal. Cefotaxime was started for Streptococcus pyogenes eradication and furosemide for diuresis. By day 2 he developed AKI (creatinine 0.99 mg/dL), hypertension, and 24-hour proteinuria 36.6 mg/m2/h without oliguria. Antihypertensive therapy included amlodipine and IV labetalol with initial control. After extubation at 48 hours, he deteriorated neurologically within 24 hours (GCS 8) with BP > p95+12 despite labetalol infusion up to 3 mg/kg/h, amlodipine 10 mg/day, and furosemide, necessitating reintubation and sodium nitroprusside infusion up to 3 mcg/kg/min with a planned gradual BP reduction of 25% per day to mitigate secondary neurologic injury. Given acute neurologic deficits with severe HTN in GN, PRES was suspected and confirmed by brain MRI on day 5 showing increased subcortical T2/FLAIR signal in bilateral symmetric occipital regions without diffusion restriction, consistent with vasogenic edema. Ophthalmologic exam was normal; repeat EEG showed occasional generalized voltage depression. Enalapril was added. Over 10 days, BP normalized with slow pharmacologic weaning; follow-up MRI on day 12 showed radiologic regression, and he was successfully extubated after 5 days. During the ICU course, Hb fell to 5 g/dL with normocytic, normochromic indices and no thrombocytopenia; hemolytic anemia was diagnosed given a positive direct Coombs test and hemoglobinuria. He required two packed RBC transfusions. Methylprednisolone 1 mg/kg/day was given for 72 hours. Stool culture and urinary antigen for Streptococcus pneumoniae were negative. Serologies for EBV and Parvovirus B19, ENA profile, ANCA, anti-dsDNA, anti-β2 glycoprotein I, anticardiolipin, and lupus anticoagulant were all negative; all cultures (blood, urine, endotracheal aspirate, pharyngeal) were negative. ANA was positive at 1:160. Clinical status improved with BP control, rising complement levels, and resolution of proteinuria and haematuria; the direct Coombs remained positive on hospital day 9. He was discharged on day 31 normotensive, non-anaemic, with preserved renal function, no proteinuria or haematuria, normalized C3, and asymptomatic neurologically. Discharge medications: prednisone, amlodipine, enalapril, and folic acid. He remained asymptomatic with no recurrence at 6 months. Overall, the case represents GNAPE with hypocomplementemia (low C3) and elevated ASO complicated by hypertensive emergency causing encephalopathy and secondary PRES, plus autoimmune hemolytic anemia with Hb nadir 5 g/dL, successfully managed with antihypertensives, neuroprotective measures, and corticosteroids, with full clinical and radiologic recovery." |
| Reasoning: The Target Text preserves medical jargon and standard abbreviations (e.g., PRES, AKI, GCS, C3, p95) and uses precise numeric data with parenthetical benchmarks, which suits readers who can interpret clinical terms. Its sentence structure is concise and logically sequenced (ED → ICU → diagnostics → treatment → outcome), improving clarity without simplifying terminology, consistent with proficient health literacy. |
| Label: proficient_health_literacy |
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| Original 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. |
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| We 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. |
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| Considering 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." |
| Target Text: "A 51-year-old male presented with acute, painful visual loss of the left eye (LE) for 3 days. Best-corrected distance visual acuity (BCDVA) was 20/20 OD and hand motion (HM) OS. Ocular motility and anterior segment were unremarkable OU. Fundus OS showed optic nerve head (ONH) swelling, choroidal bulging, multiple patches of subretinal fluid (SRF), and retinal pigment epithelial (RPE) corrugations; OD fundus was unremarkable. |
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| Multimodal imaging was obtained: OCT (OptoVue, Inc., Fremont, CA, USA; software version 2018.0.0.18) demonstrated mild RPE and choroidal bulging, RPE hyper-reflectivity with back shadowing, subretinal and intraretinal fluid, and mild retinal thickening. Indocyanine green angiography (ICGA) showed a geographic macular hypocyanescent area OS. Blue-autofluorescence (BAF) revealed a geographic macular area with speckled autofluorescence. B-scan ultrasonography showed optic nerve enlargement. Fluorescein angiography (FA) demonstrated vascular leakage at the ONH (hot disc) and a geographic patchy hypofluorescent area with speckled hyperfluorescent margins measuring approximately three disc diameters. Orbital and brain MRI with gadolinium revealed a retrobulbar nodular enhancing mass at the optic nerve–sclera junction. Oncology consultation was unremarkable. |
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| Given concern for malignancy and the enhancing orbital nodule, the patient underwent transconjunctival lateral orbitotomy one week after presentation. Intraoperatively, a pink localized scleral nodule with edematous Tenon was identified. With a clinical diagnosis of nodular posterior scleritis, sub-Tenon triamcinolone acetonide was administered. The patient declined admission and intravenous corticosteroids; oral prednisolone 50 mg/Kg was initiated. Rheumatologic and infectious work-up, including PPD (tuberculosis), chest X-ray, serum ACE (sarcoidosis), and C-ANCA (Wegener granulomatosis), was unremarkable. |
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| At the one-week postoperative follow-up, BCDVA was 20/20 OD and counting fingers at 2 meters OS. SRF had resolved, and the macula was atrophic. Oral prednisolone was tapered over three months." |
| Reasoning: The Target Text streamlines the original with short, clearly structured sentences and logical sections (presentation, imaging, treatment, outcome), while defining key abbreviations on first use (e.g., ONH, SRF) and using consistent terminology. This concise yet technical style—with standard ophthalmic acronyms (OD/OS, FA/OCT/ICGA) used after clarification—matches the needs of readers with proficient health literacy. |
| Label: proficient_health_literacy |
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| Original 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. |
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| He 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. |
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| The 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. |
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| An 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. |
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| Laboratory 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. |
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| Cardiac 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. |
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| Computed 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. |
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| Within 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). |
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| Takayasu 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. |
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| Target Text: "A 36-year-old female with ulcerative colitis (well controlled on sulfasalazine, ferrous fumarate, and intermittent prednisone for flares) presented with 1 week of progressive oppressive precordial pain associated with dyspnea and neurovegetative symptoms. On admission, the ECG was in sinus rhythm with ST-segment elevation in the inferior wall. She endorsed a 6-month history of general malaise, fatigue, and night sweats, and had experienced exertional precordial pain that progressed to occur at rest. Physical examination revealed no murmurs or peripheral pulse abnormalities. |
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| Emergency coronary angiography demonstrated severe 2-vessel coronary disease: a severe 90% ostial lesion in the left coronary trunk (left main) and a severe 99–100% subocclusive ostial lesion in the right coronary artery (culprit vessel). Primary angioplasty of the right coronary artery was performed with successful placement of a drug-eluting stent. The hemodynamicist noted possible aortitis given arch involvement and vessel friability during balloon advancement and recommended an inflammatory/etiologic evaluation prior to definitive management of the left main lesion. |
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| Laboratory testing showed mild anemia (hemoglobin 11.6 g/dL), mild leukocytosis (13,800/mm3), elevated ESR 42 mm/h, CRP 4.9 mg/L (normal <1), and elevated high-sensitivity troponin. Autoimmunity panel: normal complement C3/C4, negative ANA, anti-DNA, and ENA profile; non-reactive VDRL. Cardiac MRI with contrast demonstrated acute non-transmural infarction of the left ventricular inferior wall and subendocardial ischemia in the anteroseptoapical region at rest, with mild aortic and mitral insufficiency and preserved biventricular systolic function. |
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| Computed tomographic angiography of the chest/abdomen/pelvis showed periaortic fibrotic wall thickening involving the aortic root, arch, and abdominal aorta, with severe left coronary trunk stenosis, mild left subclavian and left vertebral artery stenoses, and severe inferior mesenteric artery stenosis. The differential included IgG4-related disease versus Takayasu arteritis. Total IgG was 1,600 mg/dL (ref 700–1,600) with IgG1 1,024 mg/dL (elevated) and normal IgG2 456 mg/dL, IgG3 98.8 mg/dL, and IgG4 13.6 mg/dL, findings not supportive of IgG4-related aortitis. Takayasu arteritis was diagnosed clinically and by imaging. |
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| Immunosuppression was initiated with prednisone 60 mg daily and methotrexate 20 mg weekly (parenteral) with folic acid 1 mg daily. After 3 weeks of therapy, she underwent myocardial revascularization surgery using the left internal mammary artery graft to the descending anterior artery (LAD) and an aortocoronary bypass to the circumflex artery. Intraoperatively, the aortic root and ascending aorta appeared healthy. She was discharged home in good general condition and remains under ambulatory follow-up. |
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| Context: Takayasu arteritis is a large-vessel granulomatous vasculitis affecting the aorta and its major branches that can produce aorto-ostial coronary lesions (as in this case, involving the left main and right coronary ostia), leading to myocardial ischemia/infarction. The mildly elevated inflammatory indices, periaortic fibrotic thickening, and multifocal arterial stenoses on CTA are characteristic, and the lack of IgG4 elevation argues against IgG4-related aortitis. The staged approach—urgent culprit-vessel PCI followed by immunosuppression and delayed CABG—is consistent with management principles aiming to control vascular inflammation before definitive surgical revascularization." |
| Reasoning: The Target Text retains accurate medical terminology and abbreviations (e.g., ST-segment elevation, left main, drug-eluting stent, Takayasu arteritis) but adds brief clarifications and parentheticals (e.g., left main, findings not supportive of IgG4-related aortitis) and standardizes units and reference ranges. Information is organized into shorter, clear sentences that interpret key results, making it accessible to readers with proficient health literacy who can navigate technical terms when presented with concise explanations and structure. |
| Label: proficient_health_literacy |
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| ### Now judge this text: |
| Original Fulltext: "{fulltext}" |
| Target Text: "{input_text}" |
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