CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 51 year old
male who presents following a witnessed aspiration at his
nursing home and ensuing hypoxia.  The patient has a notable
past medical history for paroxysmal atrial fibrillation,
congestive heart failure, cerebrovascular accident in [**2189**]
resulting in left hemiparesis and chronic nursing home
residence, who was witnessed to have an aspiration at
[**Hospital3 2558**] where he lives.  He was apparently being fed
during the aspiration.  Afterwards, he became congested with
copious purulent sputum.  His O2 saturation was 48 to 59%.
he was suctioned and his oxygen saturation went up to the
80s.  His blood pressure was 90/62; his heart rate was in the
40s to 50s, which is his baseline and respirations were 24 to
28.  He was also noted to be more lethargic and somnolent.
He moaned in pain (he has chronic pain from an unrepaired hip
fracture and unrepaired femur fracture).  He was taken to the
Emergency Room by EMS.

MEDICAL HISTORY: 1.  Paroxysmal atrial fibrillation status post DC
    cardioversion in [**2193-7-21**]; status post amiodarone
    therapy curarines on Coumadin, followed by Dr. [**Last Name (STitle) **];
    congestive heart failure with an ejection fraction of 30
    to 35% measured in [**2193-8-21**] by echocardiogram.
    Also noted were moderate global left ventricular
    hypokinesis, mild global right ventricular free wall
    hypokinesis, one plus aortic regurgitation, two plus
    mitral regurgitation and left ventricular hypertrophy.
2.  Cerebrovascular accident secondary to atrial fibrillation
    in [**2189**] resulting in residual left hemiparesis.
3.  History of Methicillin resistant Staphylococcus aureus
    pneumonia and bacteremia.
4.  History of multiple fractures:  1) Left hip fracture
    status post hemirepair in [**2189**] in a fall suffered
    secondary to his stroke; 2) right hip fracture not
    repaired; 3) femoral neck fracture in [**2193-7-21**].
5.  Hypertension.
6.  Non-insulin dependent diabetes mellitus.
7.  History of endocarditis.
8.  History of urinary tract infection.
9.  Seizure disorder.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Unknown.

SOCIAL HISTORY: Prior to the stroke, the patient practiced
as a rabbi [**First Name8 (NamePattern2) **] [**Name (NI) 4288**], [**Name (NI) 531**].  He suffered his stroke
while in [**Location (un) 35240**].  He lives currently at the [**Hospital3 2558**].
No ethanol or tobacco use.  His mother and brother are in the
[**Name (NI) 86**] area.
Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Other specified cardiac dysrhythmias,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side
Food/vomit pneumonitis,Acute respiratry failure,Cardiac dysrhythmias NEC,Urin tract infection NOS,CHF NOS,DMII wo cmp nt st uncntr,Late ef-hemplga side NOS
Admission Date:  [**2194-2-6**]       Discharge Date:  [**2194-2-15**]

Date of Birth:   [**2142-2-10**]       Sex:  M

Service:  MED-ICU

HISTORY OF PRESENT ILLNESS:  The patient is a 51 year old
male who presents following a witnessed aspiration at his
nursing home and ensuing hypoxia.  The patient has a notable
past medical history for paroxysmal atrial fibrillation,
congestive heart failure, cerebrovascular accident in [**2189**]
resulting in left hemiparesis and chronic nursing home
residence, who was witnessed to have an aspiration at
[**Hospital3 2558**] where he lives.  He was apparently being fed
during the aspiration.  Afterwards, he became congested with
copious purulent sputum.  His O2 saturation was 48 to 59%.
he was suctioned and his oxygen saturation went up to the
80s.  His blood pressure was 90/62; his heart rate was in the
40s to 50s, which is his baseline and respirations were 24 to
28.  He was also noted to be more lethargic and somnolent.
He moaned in pain (he has chronic pain from an unrepaired hip
fracture and unrepaired femur fracture).  He was taken to the
Emergency Room by EMS.

Upon arrival, he had a heart rate in the 40s.  EKG showed
atrial fibrillation with bradycardia.  His systolic blood
pressure was 110 to the 130s.  His oxygen saturation was in
the 80s and went up to the mid-90s with O2 by nasal cannula.
He denied lightheadedness, shortness of breath and chest
pain.  His potassium was 5.7 so he was treated with insulin,
glucose and calcium.  His INR was 10.2, so he was treated
with 1 mg of Vitamin K intravenously.

He was seen by the Cardiology fellow who felt that there was
no immediate indication for pacemaker as he was
hemodynamically stable.

PAST MEDICAL HISTORY:
1.  Paroxysmal atrial fibrillation status post DC
    cardioversion in [**2193-7-21**]; status post amiodarone
    therapy curarines on Coumadin, followed by Dr. [**Last Name (STitle) **];
    congestive heart failure with an ejection fraction of 30
    to 35% measured in [**2193-8-21**] by echocardiogram.
    Also noted were moderate global left ventricular
    hypokinesis, mild global right ventricular free wall
    hypokinesis, one plus aortic regurgitation, two plus
    mitral regurgitation and left ventricular hypertrophy.
2.  Cerebrovascular accident secondary to atrial fibrillation
    in [**2189**] resulting in residual left hemiparesis.
3.  History of Methicillin resistant Staphylococcus aureus
    pneumonia and bacteremia.
4.  History of multiple fractures:  1) Left hip fracture
    status post hemirepair in [**2189**] in a fall suffered
    secondary to his stroke; 2) right hip fracture not
    repaired; 3) femoral neck fracture in [**2193-7-21**].
5.  Hypertension.
6.  Non-insulin dependent diabetes mellitus.
7.  History of endocarditis.
8.  History of urinary tract infection.
9.  Seizure disorder.

ALLERGIES:  No known drug allergies.

MEDICATIONS:
1.  Depakote EC 750 mg p.o. at noon, 500 mg p.o. twice a day.
2.  Enulose 30 ml p.o. q.o.d.
3.  Colace 100 mg p.o. twice a day.
4.  Multivitamin 1 p.o. q. day.
5.  Metoprolol Syrup 6.25 mg p.o. twice a day.
6.  Oramorph SR 30 mg p.o. q. a.m., 15 mg p.o. q. p.m.
7.  Zantac one tablet p.o. twice a day.
8.  Potassium chloride 20 mEq p.o. q. day.
9.  BuSpar one tablet p.o. q. day.
10. Roxicodone 5 mg p.o. q. four hours p.r.n.
11. Senna two tablets p.o. q. day.
12. Captopril 75 mg p.o. three times a day.
13. Serax 10 mg p.o. q. h.s. p.r.n.
14. Vitamin C 500 mg p.o. q. day.
15. Milk of Magnesia p.r.n.
16. Dulcolax 10 mg p.o. q. day p.r.n.
17. Zoloft 200 mg p.o. q. day.
18. Amantadine 100 mg p.o. twice a day.
19. Nitroglycerin sublingual p.r.n.
20. Atrovent nebulizer q. four hours p.r.n.
21. Citracal plus D 350 mg p.o. twice a day.
22. Coumadin 1 mg p.o. q. day.

SOCIAL HISTORY:  Prior to the stroke, the patient practiced
as a rabbi [**First Name8 (NamePattern2) **] [**Name (NI) 4288**], [**Name (NI) 531**].  He suffered his stroke
while in [**Location (un) 35240**].  He lives currently at the [**Hospital3 2558**].
No ethanol or tobacco use.  His mother and brother are in the
[**Name (NI) 86**] area.

FAMILY HISTORY:  Unknown.

REVIEW OF SYSTEMS:  Difficult to obtain secondary to
dysarthria.  He denies shortness of breath, nausea and
vomiting, lightheadedness and dizziness.  No chest pain.

PHYSICAL EXAMINATION:  Temperature was 96.4 F.; blood
pressure is 110-120/60-70; heart rate was 40 to 50 and
irregular; respiratory rate was 14 to 20; the oxygen
saturation was 94% on three liters.  In general, he is a
chronically ill-appearing lethargic gentleman that was able
to respond to questions.  His responses were difficult to
understand secondary to dysarthria.  HEENT:  Extraocular
muscles are intact.  Pupils equally round and reactive to
light.  Sclerae anicteric.  Mucous membranes dry; poor
dentition.  His left eye was deviated to the left.  Neck:
Jugular venous pressure approximately 7 cm above the sternal
notch; it is 45 degrees.  Neck was supple.  Chest:  Diffuse
rhonchi, no rales or wheezes.  Cardiac:  Noted bradycardia,
irregular, II/VI systolic murmur at the apex.  Abdomen:
Soft, positive bowel sounds.  It was difficult to determine
the degree of tenderness since the patient tended to shout in
pain wherever he was touched.  Extremities:  Current venous
stasis changes in the lower extremities bilaterally.  Two
plus lower extremity and upper extremity edema on the left.
According to the patient these are chronic changes.
Neurologic:  Cranial nerves II and III were intact.  There is
slight facial asymmetry.  There is left hemiparesis.  Four
plus out of five strength in the right lower extremity and
right upper extremity.  Sensation was intact in the right
upper extremity and lower extremity.  He had intermittent
tremor of his right upper extremity.

LABORATORY:  White blood cell count 7.9, hematocrit 32.9,
baseline 27 to 32.  Platelets 130.  Differential 72% polys,
11% bands, 6% lymphocytes, 1% monocytes.  PT was 38.6, PTT
51.4, INR was 10.2.

Chem-7, sodium was 140, potassium 6.5 and hemolyzed.  A
repeat was 5.7.  Chloride 104, bicarbonate 23, BUN 58,
creatinine 1.4, baseline is 0.5 to 0.6 and glucose was 107.
Calcium was 8.9, magnesium 2.8 and phosphorus was 6.1.  ALT
35, AST 78, amylase 42, alkaline phosphatase 114, total
bilirubin 1.1 and lipase 12.  Valproic level was 71 which was
normal.  CK was 109, CK MB was slightly elevated at 11 with
an index of 10.1.  The troponin was slightly elevated at
11.9.

Arterial blood gas showed a pH of 7.42, pCO2 of 39, and a pO2
of 145.

Urinalysis was notable for a specific gravity of 1.026.
Negative leukocyte esterase, large blood, negative nitrite,
trace protein, negative glucose.  There is greater than 50
red blood cells, 3 to 5 white blood cells, few bacteria.

Chest x-ray, quality of the study was poor due to poor
inspiratory effort and the patient rotation.  There is
elevation of the right hemidiaphragm, bilateral haziness and
perihilar cardiomegaly.

EKG showed atrial fibrillation with a rate of 48.  There is a
left bundle branch block pattern.  There is left axis
deviation.  There was sloping 2-[**Street Address(2) 2051**] depressions in leads
V2 through V6 that were seen on prior EKG.

IMPRESSION:  This is a 51 year old gentleman who suffered a
stroke in [**2189**], has history of aspiration pneumonia and MRSA
who presents with witnessed aspiration with resulting
hypoxia, hypotension, bradycardia.  Also had elevated INR and
positive troponin.

HOSPITAL COURSE BY SYSTEM:
1.      Cardiovascular:  A) Coronary artery disease.  The
patient presented with elevated troponin, likely enzyme leak
secondary to increased myocardial demand in the setting of
hypoxia in this patient with known congestive heart failure.
No percutaneous coronary intervention was recommended.  He
remains chest pain free.  We continued his aspirin.

B) Congestive heart failure:  The patient has a known
ejection fraction of 30 to 35%.  X-rays performed during the
hospitalization showed varying degrees of congestive heart
failure, so we diuresed him intermittently and at one point
had him on a Lasix drip for more aggressive diuresis.  We
were concerned about his presentation with hypotension, so we
started him on low dose Captopril and titrated up as his
blood pressure allowed.

C)  Rate and rhythm:  The patient presented with atrial
fibrillation with bradycardic ventricular response.  This is
apparently his baseline.  We consulted the Cardiology Service
in order to answer the question whether we should restart his
amiodarone and/or reconsider pacemaker placement.  The
Cardiology Service felt neither option would be appropriate
in this setting.  The patient should follow-up with Dr.
[**Last Name (STitle) 8857**] as an outpatient.  We held the patient's beta
blocker in the setting of bradycardia.  In addition, his rate
was in the 40s on admission but increased to the 70s to 80s
for the majority of his hospitalization.

2.      Pulmonary:  The patient initially was doing well from
a pulmonary standpoint on nasal cannula.  However, on the
evening of [**2-7**], the patient had a sudden desaturation
secondary to secretions that he could not clear by coughing.
He required increasing amounts of supplemental oxygen.
Therefore, on the morning of [**2-8**], it was decided to
electively intubate.  The intubation was uncomplicated and he
remained on pressure support ventilation for several days in
order for aggressive suctioning to be performed.  His
secretions were extremely thick but became less tenacious
after several days.  In the morning of [**2-13**], the
patient was successfully extubated, after which he was doing
much better with coughing to clear his own secretions.  We
treated his pneumonia with Levofloxacin and Flagyl for
intended total course of 14 days.  We changed his
Levofloxacin to Ceftriaxone in the setting of
thrombocytopenia which we thought could have perhaps been
secondary to Levofloxacin.

3.      Genitourinary:  The patient's urinalysis did not
raise a suspicion for infection, however, the urine culture
grew Levofloxacin resistant Morganella.  This bacteria was
sensitive to Ceftriaxone which we had already switched the
patient to.  Therefore, he received adequate treatment for
his urinary tract infection and the second urinalysis and
culture was checked and the culture was sterile.

4.      Methicillin resistant Staphylococcus aureus:  The
patient carried a history of MRSA colonization.  Nasal and
rectal swabs were taken which grew Oxicillin resistant
Staphylococcus aureus.  Precautions were instituted.

5.      Endocrine:  The patient carried a diagnosis of
diabetes mellitus, type 2.  However, his blood glucose level
was within normal limits over the course of his hospital stay
so we discontinued finger sticks to check his blood glucose.

6.      Gastrointestinal:  The patient was treated with
Prevacid.  He was noted to have some crusted blood in his
mouth, so an NG tube was placed and diagnostic lavage was
performed.  Gastroccult positive thick material was removed.
The lavage cleared after approximately 1000 cc.  There was no
active bleeding.  We assumed that he probably had some
gastritis in the setting of high INR which was causing some
bleeding.  In addition, since his pulmonary secretions were
grossly bloody, it was probable that he was swallowing some
of these to cause the heme positive gastric contents.

7.      Hematology:  The patient had a downward trending
platelet count that settled at approximately 40,000.  Since
Levofloxacin can cause thrombocytopenia this was changed to
Ceftriaxone.  An HIT antibody was sent and this was positive.
His platelet count was trending upward by the time of
discharge.  DIC was ruled out by laboratory results and a
smear showed just thrombocytopenia and anemia.  There were no
schistocytes.  In light of the above, we assumed that the
patient had received some heparin in the course of his
hospitalization although none was actually prescribed.  He
should not receive heparin again as he has HIT antibody.

We anti-coagulated the patient for his atrial fibrillation
with a goal INR of 2 to 3.  His initial elevated INR
corrected with the 1 mg of Vitamin K he received in the
Emergency Room.
8.      Fluids, electrolytes and nutrition:  A post-pyloric
feeding tube was placed by Interventional Radiology and the
patient received tube feeds throughout his hospitalization.
He was briefly hyponatremic so he was treated with D5W.

9.      Renal:  The patient's creatinine was elevated on
admission.  His excretion of sodium was less than 1 percent
and he was dry on examination.  Therefore, we repleted his
fluid initially and his creatinine elevation resolved
completely.

10.     Neurologic/Psychiatric:  The patient had notably
waxing and [**Doctor Last Name 688**] mental status over the course of his
hospitalization.  This can likely be explained by the fact
that the patient has compromised neuro-psychiatric reserves
secondary to his cerebrovascular accident and in the setting
of medical illness, his mental status is impaired.  A head CT
scan was considered but was not performed; in fact, after his
extubation, the patient's mental status was at the best it
had been during his hospitalization which supported the above
theory.

We continued the patient on BuSpar, Zoloft, Amantadine and
Depakote.

11.     Pain Control:  The patient was continued on morphine
p.r.n. for pain given his history of unrepaired hip and femur
fracture.

12.     Prophylaxis:  The patient had deep venous thrombosis
prophylaxis from Venodyne and Coumadin and GI prophylaxis was
provided with Prevacid.

13.     Code Status:  Code status was clarified with a
conversation held with the patient's mother.  It was stated
that if there was a chance for recovery, then all necessary
measures should be attempted to treat the patient no matter
how aggressive.  However, in the event of untreatable or
futile situation, then treatment should be held.  This was
interpreted as full code.

DISCHARGE MEDICATIONS and DISCHARGE INFORMATION will be
provided on a subsequently discharge summary addendum.



                            [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 292**]

Dictated By:[**Name8 (MD) 2734**]
MEDQUIST36

D:  [**2194-2-14**]  15:35
T:  [**2194-2-14**]  16:36
JOB#:  [**Job Number 35241**]


Admission Date:  [**2194-2-6**]       Discharge Date:  [**2194-2-17**]

Date of Birth:   [**2142-2-10**]       Sex:  M

Service:

ADDENDUM

ADDITIONAL PERTINENT EVENTS:  That occurred during
hospitalization are as follows.
1.  Neurology.  The patient's mental status cleared
completely and he was back to baseline by the time of
discharge.

2.  Hematology.  The patient was anti-coagulated with
Coumadin 1 mg p.o. q day and had a therapeutic INR of 2.1 on
the day of discharge.  In terms of his thrombocytopenia, this
resolved completely with holding Heparin given his known
Heparin induced thrombocytopenia.  His platelet count on the
day of discharge was 168.

3.  Pulmonary.  The patient's pneumonia improved daily and we
continued him on a 14 day course of Levofloxacin and Flagyl.
We maintained him on overnight BYPAP pressure of 8 and 5 and
he did well with this.  We recommend that this be continued
for about a week after discharge to improve his postop
recovery.

4.  Cardiovascular.  From the standpoint of his congestive
heart failure we initiated a standing dose of Lasix.  This
was 20 mg p.o. b.i.d.  We recommend that once his edema
resolves that his Lasix dose be decreased to 20 mg p.o. q
day.  We initiated standing potassium at 20 mEq p.o. q day.

5.  Nutrition.  The patient continued with tube feeds through
his feeding tube during this admission.  On the final day of
hospitalization we initiated p.o. feeding with thick pureed
solids and honey thick liquids.  He tolerated this moderately
well and tired quickly.  We recommended tube feeds be
continued and perhaps a swallowing study should be performed
at rehabilitation.  However, prior video swallow study
performed in [**Month (only) 205**] of last year showed he aspirated thin
liquids.  Therefore, it was the opinion of the Speech and
Swallow service that starting him on the aforementioned thick
liquids was the appropriate even in the absence of a repeat
swallow study.

DISCHARGE STATUS:  He was discharged to Pulmonary
Rehabilitation with the intention of return to [**Hospital3 2558**]
next week.

DISCHARGE CONDITION:  Good.

DISCHARGE MEDICATIONS:
1.  Zoloft 200 mg p.o. q day.
2.  Zinc Sulfate 220 mg q day.
3.  Zestril 5 mg p.o. q day.
4.  Ecasa 325 mg p.o. q day.
5.  Vitamin C 500 mg p.o. q day.
6.  Calcium carbonate 500 mg p.o. b.i.d.
7.  Amantadine 100 mg p.o. b.i.d.
8.  Multivitamin one p.o. q day.
9.  Buspar 10 mg p.o.q day.
10. Coumadin 1 mg p.o. q h.s. with goal INR of 2 to 3.
11. Flagyl 500 mg p.o. t.i.d., last dose on [**2194-2-18**].
12. Levofloxacin 500 mg p.o. q day, last dose on [**2194-2-18**].
13. MS Contin 15 mg p.o. b.i.d.
14. Colace 100 mg p.o. b.i.d.
15. [**Doctor Last Name **] two tabs p.o. q day.
16. Milk of Magnesia 30 cc's p.o. q.i.d p.r.n.
17. Lactulose 30 cc's p.o. q o.d., hold if diarrhea
    is present on the previous day.
18. Zantac 150 mg p.o. b.i.d.
19. Nitroglycerin 0.4 mg sublingually q 5 minutes with
    three maximum doses p.r.n. for chest pain.
20. Atrovent nebulizer q 4 hours p.r.n.
21. Dulcolax suppository/p.o. 10 mg q day p.r.n.
22. Depakote 500 mg p.o. q AM, 750 mg p.o.q noon and
    500 mg p.o. q PM.
23. Lasix 20 mg p.o. b.i.d. can be decreased to q day
    in one week.
24. KCL 20 mEq p.o. q day.

DIET:  Thick puree with honey thick liquids.  Feed slowly
while sitting upright.

DISCHARGE DIAGNOSIS:
1.  Pneumonia secondary to aspiration.






                            [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 292**]

Dictated By:[**Name8 (MD) 2734**]
MEDQUIST36

D:  [**2194-2-17**]  15:05
T:  [**2194-2-17**]  15:33
JOB#:  [**Job Number 35242**]
{'Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Other specified cardiac dysrhythmias,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side'}


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 51 year old
male who presents following a witnessed aspiration at his
nursing home and ensuing hypoxia.  The patient has a notable
past medical history for paroxysmal atrial fibrillation,
congestive heart failure, cerebrovascular accident in [**2189**]
resulting in left hemiparesis and chronic nursing home
residence, who was witnessed to have an aspiration at
[**Hospital3 2558**] where he lives.  He was apparently being fed
during the aspiration.  Afterwards, he became congested with
copious purulent sputum.  His O2 saturation was 48 to 59%.
he was suctioned and his oxygen saturation went up to the
80s.  His blood pressure was 90/62; his heart rate was in the
40s to 50s, which is his baseline and respirations were 24 to
28.  He was also noted to be more lethargic and somnolent.
He moaned in pain (he has chronic pain from an unrepaired hip
fracture and unrepaired femur fracture).  He was taken to the
Emergency Room by EMS.

MEDICAL HISTORY: 1.  Paroxysmal atrial fibrillation status post DC
    cardioversion in [**2193-7-21**]; status post amiodarone
    therapy curarines on Coumadin, followed by Dr. [**Last Name (STitle) **];
    congestive heart failure with an ejection fraction of 30
    to 35% measured in [**2193-8-21**] by echocardiogram.
    Also noted were moderate global left ventricular
    hypokinesis, mild global right ventricular free wall
    hypokinesis, one plus aortic regurgitation, two plus
    mitral regurgitation and left ventricular hypertrophy.
2.  Cerebrovascular accident secondary to atrial fibrillation
    in [**2189**] resulting in residual left hemiparesis.
3.  History of Methicillin resistant Staphylococcus aureus
    pneumonia and bacteremia.
4.  History of multiple fractures:  1) Left hip fracture
    status post hemirepair in [**2189**] in a fall suffered
    secondary to his stroke; 2) right hip fracture not
    repaired; 3) femoral neck fracture in [**2193-7-21**].
5.  Hypertension.
6.  Non-insulin dependent diabetes mellitus.
7.  History of endocarditis.
8.  History of urinary tract infection.
9.  Seizure disorder.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Unknown.

SOCIAL HISTORY: Prior to the stroke, the patient practiced
as a rabbi [**First Name8 (NamePattern2) **] [**Name (NI) 4288**], [**Name (NI) 531**].  He suffered his stroke
while in [**Location (un) 35240**].  He lives currently at the [**Hospital3 2558**].
No ethanol or tobacco use.  His mother and brother are in the
[**Name (NI) 86**] area. 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Other specified cardiac dysrhythmias,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side'}
