CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 37 year old
gentleman with a history of end stage AIDS complicated by
multiple opportunistic infections and long history of
cardiomyopathy of unclear etiology who had been managed for
several weeks as an outpatient with increasing episodes of
diarrhea and a weight loss of approximately ten pounds.

MEDICAL HISTORY: 1.  HIV complicated by end stage AIDS first diagnosed [**2142**],
presumably secondary to heterosexual sex with wife
complicated by multiple opportunistic infections including
PCP times five, MAC and HSV, also with [**Doctor First Name **] brain abscess
leading to seizure disorder complicated by DDI induced
pancreatitis and complicated by peripheral neuropathy.
2.  Questionable history of hypercoagulability, status post
axillary vein thrombosis associated with PICC line in [**2154**],
and status post deep vein thrombosis in [**2157-12-29**].
3.  History of cardiomyopathy of unclear etiology, status
post echocardiogram [**2-/2157**], showing ejection fraction of 25%
with focal wall motion abnormalities.
4.  Hypertension.

MEDICATION ON ADMISSION: 1.  Acyclovir 400 mg p.o. b.i.d.
2.  Atenolol 50 mg p.o. q.d.
3.  Augmentin one tablet p.o. b.i.d.
4.  Azithromycin 250 mg p.o. b.i.d.
5.  Ciprofloxacin 500 mg p.o. b.i.d.
6.  Claritin 10 mg p.o. q.d.
7.  Dilaudid 2 mg p.o. q3hours p.r.n.
8.  Erythropoietin 20,000 units subcutaneous q.week.
9.  Ethambutol 400 mg p.o. t.i.d.
10. Flonase two sprays to each nostril b.i.d.
11. Glimepiride 150 mg p.o. b.i.d.
12. Lomotil p.r.n.
13. Mepron 250 mg p.o. q.d.
14. M.S. Contin 30 mg p.o. t.i.d. p.r.n.
15. Mycelex 10 t.i.d. used p.r.n. for thrush.
16. Neupogen 300 mcg subcutaneous biweekly.
17. Neurontin 800 mg p.o. t.i.d.
18. Tincture of Opium 10% strength 1 cc p.o. q.i.d. p.r.n.
19. Paxil 20 mg p.o. q.d.
20. Aerosolized Pentamidine 300 units q.month.
21. Keletra three capsules p.o. b.i.d.
22. Sporanox 200 mg p.o. q.d.
23. Stavudine 400 mg p.o. b.i.d.
24. Ultrase two capsules t.i.d. with meals.
25. Warfarin 5 mg p.o. q.d.

ALLERGIES: Bactrim which leads to an aseptic meningitis.

PHYSICAL EXAM: 

FAMILY HISTORY: Unremarkable.

SOCIAL HISTORY: The patient lives in an apartment with his
girlfriend and has visiting nurses once a week.  He is a
current smoker of one pack per week, occasional alcohol and
denies any intravenous drug use.
Acute myocardial infarction of other inferior wall, initial episode of care,Other primary cardiomyopathies,Coronary atherosclerosis of native coronary artery,Pneumonia, organism unspecified,Infection and inflammatory reaction due to other vascular device, implant, and graft,Diarrhea,Candidiasis of mouth,Human immunodeficiency virus [HIV] disease,Other pulmonary embolism and infarction
AMI inferior wall, init,Prim cardiomyopathy NEC,Crnry athrscl natve vssl,Pneumonia, organism NOS,React-oth vasc dev/graft,Diarrhea,Thrush,Human immuno virus dis,Pulm embol/infarct NEC
Admission Date:  [**2158-5-26**]     Discharge Date:  [**2158-6-12**]

Date of Birth:   [**2121-2-5**]     Sex:  M

Service:  MEDICINE

HISTORY OF PRESENT ILLNESS:  The patient is a 37 year old
gentleman with a history of end stage AIDS complicated by
multiple opportunistic infections and long history of
cardiomyopathy of unclear etiology who had been managed for
several weeks as an outpatient with increasing episodes of
diarrhea and a weight loss of approximately ten pounds.

Approximately ten days prior to admission, he had also begun
to develop some shortness of breath associated with some
chest tightness and coughing.  He had been seen in the
Emergency Department where a CT angiogram of his chest had
been performed and revealed a pneumonia and he was treated
over the next week with Augmentin for this.  However, he
continued to have pleuritic chest pain, shortness of breath
and temperature of 102.

On follow-up office visit to his primary care physician, [**Name10 (NameIs) **]
was found to have collapse of the right middle lobe on chest
x-ray.  Given his ongoing pulmonary complaints as well as
diarrhea and poor nutritional status, he was admitted to the
hospital for further workup.

PAST MEDICAL HISTORY:
1.  HIV complicated by end stage AIDS first diagnosed [**2142**],
presumably secondary to heterosexual sex with wife
complicated by multiple opportunistic infections including
PCP times five, MAC and HSV, also with [**Doctor First Name **] brain abscess
leading to seizure disorder complicated by DDI induced
pancreatitis and complicated by peripheral neuropathy.
2.  Questionable history of hypercoagulability, status post
axillary vein thrombosis associated with PICC line in [**2154**],
and status post deep vein thrombosis in [**2157-12-29**].
3.  History of cardiomyopathy of unclear etiology, status
post echocardiogram [**2-/2157**], showing ejection fraction of 25%
with focal wall motion abnormalities.
4.  Hypertension.

MEDICATIONS ON ADMISSION:
1.  Acyclovir 400 mg p.o. b.i.d.
2.  Atenolol 50 mg p.o. q.d.
3.  Augmentin one tablet p.o. b.i.d.
4.  Azithromycin 250 mg p.o. b.i.d.
5.  Ciprofloxacin 500 mg p.o. b.i.d.
6.  Claritin 10 mg p.o. q.d.
7.  Dilaudid 2 mg p.o. q3hours p.r.n.
8.  Erythropoietin 20,000 units subcutaneous q.week.
9.  Ethambutol 400 mg p.o. t.i.d.
10. Flonase two sprays to each nostril b.i.d.
11. Glimepiride 150 mg p.o. b.i.d.
12. Lomotil p.r.n.
13. Mepron 250 mg p.o. q.d.
14. M.S. Contin 30 mg p.o. t.i.d. p.r.n.
15. Mycelex 10 t.i.d. used p.r.n. for thrush.
16. Neupogen 300 mcg subcutaneous biweekly.
17. Neurontin 800 mg p.o. t.i.d.
18. Tincture of Opium 10% strength 1 cc p.o. q.i.d. p.r.n.
19. Paxil 20 mg p.o. q.d.
20. Aerosolized Pentamidine 300 units q.month.
21. Keletra three capsules p.o. b.i.d.
22. Sporanox 200 mg p.o. q.d.
23. Stavudine 400 mg p.o. b.i.d.
24. Ultrase two capsules t.i.d. with meals.
25. Warfarin 5 mg p.o. q.d.

ALLERGIES:  Bactrim which leads to an aseptic meningitis.

SOCIAL HISTORY:  The patient lives in an apartment with his
girlfriend and has visiting nurses once a week.  He is a
current smoker of one pack per week, occasional alcohol and
denies any intravenous drug use.

FAMILY HISTORY:  Unremarkable.

PHYSICAL EXAMINATION:  On admission, temperature was 98.1,
pulse 70, blood pressure 118/80, respiratory rate 18, oxygen
saturation 97% in room air.  Weight is 64.7 kilograms.  On
examination, he was awake, alert and oriented, thin and
comfortable in no acute distress. On head, eyes, ears, nose
and throat examination, the pupils are equal, round, and
reactive to light and accommodation.  Extraocular movements
are intact.  Moist mucous membranes.  He had thrush in his
oropharynx.  The neck was supple with lymphadenopathy and no
masses.  His lung examination revealed decreased breath
sounds at the right base with a few scattered crackles and
otherwise clear.  His cardiovascular examination revealed a
regular rate and rhythm, normal S1 and S2 with no murmurs,
rubs or gallops appreciated.  The abdomen was soft,
nontender, nondistended with positive bowel sounds.  Spleen
tip was palpable.  Extremity examination revealed a palpable
cord over the left medial thigh which was nontender.  He had
no edema and had 2+ pulses.

LABORATORY DATA:  Sodium 142, potassium 4.1, chloride 102,
bicarbonate 23, blood urea nitrogen 25, creatinine 1.1,
glucose 97.  Calcium 9.2, magnesium 1.9, phosphorus 3.4.
White count 4.2, hematocrit 49.9, platelets 206,000.  INR
2.6.  Partial thromboplastin time 33.7.

HOSPITAL COURSE:  The patient was admitted to the Medical
Service for workup of pneumonia and diarrhea and was treated
for a number of complications throughout his hospitalization.

1.  Pulmonary - The patient had been treated as an outpatient
for approximately ten days with Augmentin for presumed right
middle lobe pneumonia which had not been improving.  His
medical regimen at the time of admission included Augmentin,
Ciprofloxacin and Azithromycin.  During his stay, however, he
was found to have bilateral deep vein thrombosis and upon
reread of his CT concern was raised for potential pulmonary
embolism.

For this reason, he underwent a CT angiogram on [**2158-6-6**],
which revealed a large left pulmonary artery embolism as well
as possible right sided pulmonary emboli.  Given his likely
hypercoagulable state and evidence of thrombus despite
presumably therapeutic INR levels, both the pulmonary and
hematology teams were consulted to help guide his therapy.

Placement of an inferior vena caval filter was entertained
given his tenuous respiratory status, known bilateral deep
vein thrombosis and concern that subsequent deep vein
thrombosis could be fatal.  The issues were discussed with
the patient as well as among his attendings and it was felt
that a filter would likely present a nidus for infection as
well as further clot and was generally not worth the risks of
the procedure.

Instead, the patient was placed on Lovenox therapy given
presumed failure to Coumadin therapy although it was noted
that he may have required higher doses of Coumadin, i.e.,
levels greater than 3.5 in order to truly be anticoagulated
with Coumadin. He will, however, be discharged on Lovenox
therapy.

The hematology and pulmonary teams were also concerned about
the use of Epogen and whether a hematocrit of greater than
50.0 may be associated with high risk of thrombosis.  It was
decided to continue Epogen therapy with goal hematocrit to be
maintained less than 40.0.

Throughout his hospital stay, the patient continued to
require intermittent oxygen with saturation documented well
below 88.  For this reason, arrangements were made for him to
continue to receive oxygen therapy at home upon his
discharge.  He was also treated for presumed pneumonia with
Azithromycin and Ciprofloxacin to finish out fourteen day
courses.

2.  Cardiovascular = During his hospital stay, the patient
experienced acute episode of shortness of breath associated
with left sided chest pain.  Electrocardiogram was obtained
which showed significant ST elevations in the inferior leads,
and the patient was transported urgently to the
catheterization laboratory for presumed acute myocardial
infarction.  At catheterization, the patient was found to
have an occluded right coronary artery and received 99
millimeters of stents with good final result.

He subsequently underwent an echocardiogram which showed a
preserved ejection fraction of 50% although he continued to
have right ventricular hypertrophy, right ventricular
dilatation and severe global right ventricular hypokinesis as
a result of his inferior myocardial infarction.  He was also
noted to have a small atrial septal defect of unclear
significance.

He was placed on Aspirin and Plavix and slowly introduced to
an ace inhibitor as his blood pressure tolerated.

3.  Infectious disease - The patient has a long history of
HIV, now end stage AIDS and CD4 count of 2.  His course has
been complicated by multiple opportunistic infections as
detailed above.  During his course, he was treated for
presumed pneumonia which is felt to complicate his pulmonary
emboli.  He was otherwise continued on his extensive
outpatient antiretroviral regimen given his highly resistant
viral strain.  He was also continued on Azithromycin, Mepron
and Ciprofloxacin for prophylaxis.

During his hospital stay, he was noted to have question of a
line infection in the CCU and was treated with a fourteen day
course of intravenous Vancomycin to cover for any true
infection, although his blood cultures remained negative.

4.  Gastrointestinal - On admission, the patient had been
complaining of several week history of persistent diarrhea
complicated by a ten pound weight loss.  He had undergone an
extensive outpatient workup for infections which had been
negative and this was again repeated during his
hospitalization.  He also underwent a colonoscopy with
biopsies which was unremarkable.  The biopsies were all
negative.  He continued to have episodes of diarrhea and was
ultimately placed on Kaopectate for symptomatic relief given
no infectious source.  His etiology is presumably related to
medications which cannot be altered at this time.

5.  Hematology - The patient has a history of clots in the
past although a partial hypercoagulability workup had been
unrevealing.  During his hospital stay, he was also found to
have bilateral lower extremity deep vein thrombosis as well
as a left jugular vein deep vein thrombosis associated with a
line.  Hematology consultation was ordered as above and a
hypercoagulability workup was sent off.  Given presumed
failure to Coumadin although his doses had been only dosed in
the 2.5 to 3.5 range, the patient was switched to Lovenox
therapy which he will continue as an outpatient.

CODE STATUS:  The patient had previously indicated his wishes
not to undergo emergency treatment should he decompensate
acutely, however, in the setting of his chest pain and
presumed myocardial infarction, the patient had decided to
pursue aggressive measures and so his Code Status was
reversed to full code for his hospitalization.  This can be
readdressed as an outpatient.

DISCHARGE STATUS:  At the time of this dictation, it is
presumed that the patient will be discharged with extensive
VNA help and on oxygen.

Medications will be delineated in a further dictation to
follow on the day of discharge.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 9561**], M.D.  [**MD Number(1) 9562**]

Dictated By:[**Name8 (MD) 15231**]

MEDQUIST36

D:  [**2158-6-10**]  12:27
T:  [**2158-6-10**]  14:10
JOB#:  [**Job Number 15232**]


Name:  [**Known lastname 2417**], [**Known firstname 33**]                        Unit No:  [**Numeric Identifier 2418**]

Admission Date:  [**2158-5-26**]     Discharge Date:  [**2158-6-14**]

Date of Birth:   [**2121-2-5**]     Sex:  M

Service:

ADDENDUM:  Mr. [**Known lastname **] continued to do well between [**6-10**] and
his discharge on [**2158-6-14**].  He was gradually weaned off
his oxygen requirement by face mask and by discharge was not
requiring any oxygen.  His on room air saturations ran at 96%
and he did not desaturate with ambulation.  Physical Therapy
noted that the patient had increased exercise tolerance by
[**6-14**].

DISCHARGE CONDITION:  On discharge, the patient was feeling
well and was afebrile.

DISCHARGE STATUS:  Discharge arrangements were made for the
patient to return to his mother's home with daily visiting
nurse assistance.

DISCHARGE INSTRUCTIONS:  [**First Name (Titles) 1346**] [**Last Name (Titles) 2419**]
are to draw a PT and INR each day for the next several days,
until the patient's Coumadin becomes therapeutic (with an INR
greater than 3.0).  At that time, the instructions are that
the Lovenox which the patient is taking currently, is to be
discontinued.  The daily INR result is to be phoned to Dr.
[**Last Name (STitle) **] at [**Telephone/Fax (1) 496**].  A prescription for an alternating
pressure mattress pad with pump was also given.

DIET:  Regular.

ACTIVITY:  No restrictions.

DISCHARGE MEDICATIONS:  Coumadin 15 mg po q day, Neurontin
800 mg po tid, Plavix 75 mg po q day, Lovenox 60 mg
subcutaneous q twelve hours, Zofran 8.0 mg po bid, Captopril
6.25 mg po tid, Kaletra / ritonavir / Lopinavir 33.3 / 133.3
three capsules po bid, Mepron 750 mg po q day, Pancrease two
tablets po with meals, Beconase two sprays intranasally [**Hospital1 **],
Paxil 20 mg po q day, aspirin 325 mg po q day, Sporanox 200
mg po q day, Keppra 500 mg po bid, Claritin 10 mg po q day,
MS Contin 30 mg po tid, azithromycin 250 mg po bid,
ciprofloxacin 500 mg po bid, ethambutol 400 mg po tid,
acyclovir 400 mg po bid, lamivudine 150 mg po bid, stavudine
40 mg po bid, G-CSF 300 mcg subcutaneous qod.

As needed medications: Kaopectate 60 mL po after a loose
bowel movement (maximum four per day), Mycelex 10 mg po tid
prn for oral thrush, Ativan 1.0 mg to 2.0 mg po prn, Dilaudid
2.0 mg po q three hours prn pain, Tylenol 650 mg po q four to
six hours prn (maximum four doses per day).





Dictated By:[**Last Name (NamePattern1) 30**]

MEDQUIST36

D:  [**2158-6-14**]  16:20
T:  [**2158-6-15**]  09:46
JOB#:  [**Job Number 2420**]

cc:[**Last Name (NamePattern1) 2421**]
{'Acute myocardial infarction of other inferior wall, initial episode of care,Other primary cardiomyopathies,Coronary atherosclerosis of native coronary artery,Pneumonia, organism unspecified,Infection and inflammatory reaction due to other vascular device, implant, and graft,Diarrhea,Candidiasis of mouth,Human immunodeficiency virus [HIV] disease,Other pulmonary embolism and infarction'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 37 year old
gentleman with a history of end stage AIDS complicated by
multiple opportunistic infections and long history of
cardiomyopathy of unclear etiology who had been managed for
several weeks as an outpatient with increasing episodes of
diarrhea and a weight loss of approximately ten pounds.

MEDICAL HISTORY: 1.  HIV complicated by end stage AIDS first diagnosed [**2142**],
presumably secondary to heterosexual sex with wife
complicated by multiple opportunistic infections including
PCP times five, MAC and HSV, also with [**Doctor First Name **] brain abscess
leading to seizure disorder complicated by DDI induced
pancreatitis and complicated by peripheral neuropathy.
2.  Questionable history of hypercoagulability, status post
axillary vein thrombosis associated with PICC line in [**2154**],
and status post deep vein thrombosis in [**2157-12-29**].
3.  History of cardiomyopathy of unclear etiology, status
post echocardiogram [**2-/2157**], showing ejection fraction of 25%
with focal wall motion abnormalities.
4.  Hypertension.

MEDICATION ON ADMISSION: 1.  Acyclovir 400 mg p.o. b.i.d.
2.  Atenolol 50 mg p.o. q.d.
3.  Augmentin one tablet p.o. b.i.d.
4.  Azithromycin 250 mg p.o. b.i.d.
5.  Ciprofloxacin 500 mg p.o. b.i.d.
6.  Claritin 10 mg p.o. q.d.
7.  Dilaudid 2 mg p.o. q3hours p.r.n.
8.  Erythropoietin 20,000 units subcutaneous q.week.
9.  Ethambutol 400 mg p.o. t.i.d.
10. Flonase two sprays to each nostril b.i.d.
11. Glimepiride 150 mg p.o. b.i.d.
12. Lomotil p.r.n.
13. Mepron 250 mg p.o. q.d.
14. M.S. Contin 30 mg p.o. t.i.d. p.r.n.
15. Mycelex 10 t.i.d. used p.r.n. for thrush.
16. Neupogen 300 mcg subcutaneous biweekly.
17. Neurontin 800 mg p.o. t.i.d.
18. Tincture of Opium 10% strength 1 cc p.o. q.i.d. p.r.n.
19. Paxil 20 mg p.o. q.d.
20. Aerosolized Pentamidine 300 units q.month.
21. Keletra three capsules p.o. b.i.d.
22. Sporanox 200 mg p.o. q.d.
23. Stavudine 400 mg p.o. b.i.d.
24. Ultrase two capsules t.i.d. with meals.
25. Warfarin 5 mg p.o. q.d.

ALLERGIES: Bactrim which leads to an aseptic meningitis.

PHYSICAL EXAM: 

FAMILY HISTORY: Unremarkable.

SOCIAL HISTORY: The patient lives in an apartment with his
girlfriend and has visiting nurses once a week.  He is a
current smoker of one pack per week, occasional alcohol and
denies any intravenous drug use. 

### Response:
{'Acute myocardial infarction of other inferior wall, initial episode of care,Other primary cardiomyopathies,Coronary atherosclerosis of native coronary artery,Pneumonia, organism unspecified,Infection and inflammatory reaction due to other vascular device, implant, and graft,Diarrhea,Candidiasis of mouth,Human immunodeficiency virus [HIV] disease,Other pulmonary embolism and infarction'}
