CHIEF COMPLAINT: rigors, chest pain

PRESENT ILLNESS: This is an 83 year-old man with CAD, left ventricular
dysfunction with EF, atrial fibrillation on amiodorone, complete
heart block s/p pacer, history of GI bleeding who presents with
rigors and chest pain to [**Hospital1 18**] ER.  Patient returned from
outpatient visit for AAA, was watching television [**4-14**] afternoon
and had acute onset of rigors followed by chest pain.  Chest
pain was different from chest pain with MI in past-sharp,
non-exertional.  Recounts story of trauma to chest while sitting
in chair recently over same area.  No other pulmonary, gi,
genitourinary complaints.  No history of lines etc. (Did have
dye study for AAA on [**4-10**]). Pacer interrogated a few days ago
and was ok.
.
In Emergency room, hypotensive, started on levophed and
dopamine, given 6 liters of normal saline.  Mentating well
throughout, at baseline.  Labs initially with ? of neutropenia
but thought to be spurious as no apparent cause of neutropenia
and repeat CBC's with luekocytosis, left shift, bandemia.  Found
to have GNR in blood.  Source unclear as chest x-ray, ct chest
abd pelvis, urine and RUQ u/S unrevealing and no localizing
symptoms other than chest pain.
.
No EKG changes, positive trop in setting of renal failure,
negative CK's and MB's.

MEDICAL HISTORY: 1. CAD: IMI thrombolyzed in [**2163**]. He underwent a cardiac
catheterization on [**2170-5-16**] that showed normal
hemodynamics.  His left ventricular pressureswere 138/8,
pulmonary artery 21/6 and a pulmonary capillary wedgepressure of
9.  His ejection fraction was 35% with evidence ofapical and
inferior akinesis.  Coronary angiogram revealedmoderate
nonobstructive coronary artery disease.  There was a 60%medial
LAD lesion, 60% second diagonal lesion and a 70% proximal
RCA lesion, which was pressure-wired and shown to be
nonsignificant.
2. CHF: left ventricular dysfunction, last cath as above, most
recent echo: [**9-21**] ef 35%, The left atrium is mildly dilated.
Left ventricular wall thicknesses and  cavity size are normal
with moderate global left ventricular hypokinesis.  Right
ventricular chamber size and free wall motion are normal. The
aortic
root is mildly dilated. The aortic valve leaflets (3) are mildly
thickened but  not stenotic. Mild (1+) aortic regurgitation is
seen. The mitral valve appears  structurally normal with trivial
mitral regurgitation. There is no mitral  valve prolapse. The
pulmonary artery systolic pressure could not be  determined.
There is no pericardial effusion.
Compared with the report of the prior study (tape unavailable
for review) of  [**2170-4-12**], global left ventricular systolic
function is improved (though LV  fractional shortenting was
previously low normal) and left ventricular cavity
size is now top normal.
3. Atrial fibrillation on amiodorone
4. Complete heart block in [**2163**] s/p pacer
5. GI bleeding in [**2170**]--requiring multiple blood
transfusions-had EGD, [**Last Name (un) **], capsule, no clear source
identified--did have multiple diverticuli and grade 1 internal
hemorroid but no active bleeding at time of scopes.
6. Anemia
7. Osteoarthritis
8. Abdominal Aortic Aneurysm
9. Spinal Compression Fractures

MEDICATION ON ADMISSION: AMIODARONE HCL 200MG--Every day
LASIX 20 mg--1 tablet(s) by mouth once a day for swelling and
blood pressure
LIPITOR 10MG--Every day
NAPROSYN 250 mg--1 tablet(s) by mouth three times a day as
needed for pain
PERCOCET 5-325 mg--1 or 2 tablet(s) by mouth four times a day as
needed for pain
PROTONIX 40MG--One by mouth every day
TOPROL XL 50MG--Every day

ALLERGIES: Ace Inhibitors

PHYSICAL EXAM: Temp: 98.4     BP: 115  /59 off pressors   HR:82   RR:16
97%3litersO2sat

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Retired bricklayer, construction.  Quit smoking 45 years ago, no
alcohol, no drug use.
Septicemia due to escherichia coli [E. coli],Septic shock,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction,Atrial fibrillation,Abdominal aneurysm without mention of rupture,Cardiac pacemaker in situ,Hypovolemia,Anemia of other chronic disease
E coli septicemia,Septic shock,Acute kidney failure NOS,CHF NOS,SIRS-noninf w ac org dys,Atrial fibrillation,Abdom aortic aneurysm,Status cardiac pacemaker,Hypovolemia,Anemia-other chronic dis
Admission Date:  [**2172-4-15**]              Discharge Date:   [**2172-4-19**]


Service: MEDICINE

Allergies:
Ace Inhibitors

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
rigors, chest pain

Major Surgical or Invasive Procedure:
right internal jugular central line placed

History of Present Illness:
This is an 83 year-old man with CAD, left ventricular
dysfunction with EF, atrial fibrillation on amiodorone, complete
heart block s/p pacer, history of GI bleeding who presents with
rigors and chest pain to [**Hospital1 18**] ER.  Patient returned from
outpatient visit for AAA, was watching television [**4-14**] afternoon
and had acute onset of rigors followed by chest pain.  Chest
pain was different from chest pain with MI in past-sharp,
non-exertional.  Recounts story of trauma to chest while sitting
in chair recently over same area.  No other pulmonary, gi,
genitourinary complaints.  No history of lines etc. (Did have
dye study for AAA on [**4-10**]). Pacer interrogated a few days ago
and was ok.
.
In Emergency room, hypotensive, started on levophed and
dopamine, given 6 liters of normal saline.  Mentating well
throughout, at baseline.  Labs initially with ? of neutropenia
but thought to be spurious as no apparent cause of neutropenia
and repeat CBC's with luekocytosis, left shift, bandemia.  Found
to have GNR in blood.  Source unclear as chest x-ray, ct chest
abd pelvis, urine and RUQ u/S unrevealing and no localizing
symptoms other than chest pain.
.
No EKG changes, positive trop in setting of renal failure,
negative CK's and MB's.


Past Medical History:
1. CAD: IMI thrombolyzed in [**2163**]. He underwent a cardiac
catheterization on [**2170-5-16**] that showed normal
hemodynamics.  His left ventricular pressureswere 138/8,
pulmonary artery 21/6 and a pulmonary capillary wedgepressure of
9.  His ejection fraction was 35% with evidence ofapical and
inferior akinesis.  Coronary angiogram revealedmoderate
nonobstructive coronary artery disease.  There was a 60%medial
LAD lesion, 60% second diagonal lesion and a 70% proximal
RCA lesion, which was pressure-wired and shown to be
nonsignificant.
2. CHF: left ventricular dysfunction, last cath as above, most
recent echo: [**9-21**] ef 35%, The left atrium is mildly dilated.
Left ventricular wall thicknesses and  cavity size are normal
with moderate global left ventricular hypokinesis.  Right
ventricular chamber size and free wall motion are normal. The
aortic
root is mildly dilated. The aortic valve leaflets (3) are mildly
thickened but  not stenotic. Mild (1+) aortic regurgitation is
seen. The mitral valve appears  structurally normal with trivial
mitral regurgitation. There is no mitral  valve prolapse. The
pulmonary artery systolic pressure could not be  determined.
There is no pericardial effusion.
Compared with the report of the prior study (tape unavailable
for review) of  [**2170-4-12**], global left ventricular systolic
function is improved (though LV  fractional shortenting was
previously low normal) and left ventricular cavity
size is now top normal.
3. Atrial fibrillation on amiodorone
4. Complete heart block in [**2163**] s/p pacer
5. GI bleeding in [**2170**]--requiring multiple blood
transfusions-had EGD, [**Last Name (un) **], capsule, no clear source
identified--did have multiple diverticuli and grade 1 internal
hemorroid but no active bleeding at time of scopes.
6. Anemia
7. Osteoarthritis
8. Abdominal Aortic Aneurysm
9. Spinal Compression Fractures


Social History:
Retired bricklayer, construction.  Quit smoking 45 years ago, no
alcohol, no drug use.


Family History:
Non-contributory

Physical Exam:
Temp: 98.4     BP: 115  /59 off pressors   HR:82   RR:16
97%3litersO2sat

general: pleasant, comfortable, NAD
HEENT: PERLLA, EOMI, anicteric, no sinus tenderness, MMM, op
without lesions, no supraclavicular or cervical lymphadenopathy,
no jvd, no carotid bruits, no thyromegaly or thyroid nodules
chest: pacer in place--non-tender, no erythema
lungs: crackles at bases
heart: RR, S1 and S2 wnl, no murmurs, rubs or gallops
appreciated
abdomen: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
extremities: 2+edema, chronic venous insuff changes
skin/nails: no rashes
neuro: AAOx3.  Cn II-XII intact.  5/5 strength throughout.  .

Pertinent Results:
[**4-14**] CXR:
Portable erect AP radiograph of the chest is reviewed, and
compared with the previous study of 8:54 p.m.
The right subclavian IV catheter terminates at cavoatrial
junction.  Pacemaker leads remain in place.  No pneumothorax is
identified.  There is continued mild cardiomegaly and tortuosity
of the thoracic aorta.  Again note is made of a 7-mm calcified
granuloma in the right lower lobe.  The lungs are clear
otherwise.  There is no evidence of pneumothorax.
..
..
FINDINGS:
CHEST: The evaluation of aorta and thoracic and abdominal organs
are somewhat limited due to lack of intravenous contrast [**Doctor Last Name 360**].
Note is made of aneurysmal dilatation of ascending aorta,
measuring 4.5 cm in diameter.  Thoracic aorta is tortuous and
calcified.  Note is made of coronary artery calcification. There
is no evidence of pericardial effusion.  There is small
bilateral pleural effusion with atelectasis.  Note is made of
centrilobular emphysema.
There is 7-mm calcified granuloma in the right lower lobe.

ABDOMEN:  There is a ill-defined focal liver lesion in segment
6, which cannot be further characterized. Note is made of small
gallstones, possible small pericholecystic fluid, however,
gallbladder is not distended.  Note is made of
numerous calcified granulomas in the spleen. Bilateral kidneys
are atrophic. No mass lesion is seen in pancreas and adrenal
glands, on this non- contrast CT study, which is limited. Note
is made of large abdominal aortic aneurysm with calcification,
measuring 4.2 cm in diameter, in infrarenal level.
There is no dilatation of large and small intestines.  No
significant
lymphadenopathy.

PELVIS:  Note is made of sigmoid diverticulosis.  The visualized
portion of small bowel is within normal limits.  No ascites.  No
significant lymphadenopathy.  Note is made of marked
degenerative changes of thoracolumbar spine, with multiple wedge
compression fractures involving T12, L2 and L4.

IMPRESSION:
1.  Limited study due to lack of intravenous contrast [**Doctor Last Name 360**].
2.  4.2-cm infrarenal abdominal aortic aneurysm with wall
calcification.
3.  Aneurysmal dilatation of ascending aorta, measuring 4.2 cm.
4.  Small gallstones, with possible pericholecystic fluid,
without evidence of
gallbladder dilatation.  Clinical correlation is recommended.
5.  Sigmoid diverticulosis.
6.  Coronary artery calcification.
7.  Compression fractures of the thoracolumbar spine as
described above.
8.  Ill-defined liver lesion in segment 6, which cannot be
further
characterized. Further evaluation by ultrasound is recommended.
Dr. [**Last Name (STitle) **] has
been informed.
..
..
RUQ U/S:
Several stones are noted in the nondistended gallbladder.  The
gallbladder wall is thickened and irregular consistent with
adenomyomatosis.  The common duct is not dilated.  Limited views
of the liver reveal no focal or textural abnormalities.

IMPRESSION:  Cholelithiasis and adenomyomatosis.  No evidence of

cholecystitis.
..


Brief Hospital Course:
Mr. [**Known lastname **] is an 83 year-old man with history of CAD, AAA, GI
bleed who presented with rigors and L sided chest pain (which
responded to SL NTG x 1 in the ambulance) and was found to have
GNR sepsis as well as hypotension with SBP 70s in the ER, where
he remained for over 24 hours and was treated with sepsis
protocol. He was initially started on pressors and insulin drip,
which were weaned off while still in the ER.  He was bolused
with 6L of fluids there.  He was started on ceftriaxone and
levofloxacin.  The pt was eventually transferred to the [**Hospital Unit Name 153**]. On
arrival there he was normotensive and afebrile.  He was
continued on antibiotics.  He had no obvious source for
bacteremia.  He denied any symptoms and had a nonfocal physical
examination, as well as nonfocal imaging.  The working diagnosis
at the time of his discharge from the [**Hospital Unit Name 153**] was potential
diverticulitis, as CT scan showed diverticulosis, however it was
a non contrast scan.  The pt's only localizing symptom was chest
pain, which resolved prior to arrival in the ambulance. The pt
did not have mental status changes throughout his stay.  He had
a R IJ central line placed in the ER and this was discontinued
prior to transfer from the unit to the floor. On arrival to the
floor, the pt remained afebrile. His blood cultures grew Ecoli,
but no obvious source was identified for the bacteremia. He was
treated with antibiotics and was discharged home on Levaquin.
The pt was diuresed with IV Lasix and transitioned to PO Lasix
at the time of discharge.
.
Ecoli bacteremia: The patient was noted to have E.coli
bacteremia (noted on blood cultures drawn in the ED). No obvious
source was identified for the pt's bacteremia. The pt was noted
to have persistent prominence of the left intrahepatic and
extrahepatic biliary ductal system; no distal obstructing stone,
lesion, or area of stenosis was detected. The abdomen CT also
showed some ill-defined hypodense lesions in segment V/VI and in
segment II of the liver. The lesions in the inferior right lobe
appeared slightly larger and more prominent than on the prior
CT, and given the underlying septic history were concerning for
hepatic abscesses. The pt was offered an ERCP for further
evaluation of this prominent ductal system. However, he refused
the ERCP. He was treated empirically with
Ceftriaxone/Levofloxacin. However, the final culture result
showed pan-sensitive Ecoli, thus the pt was transitioned to
Levaquin when the final sensitivities were back.
.
Cardiac: In the unit the patient's beta blocker was held, given
hypotension. He has a past history of hypotension with ace
inhibitors. He likely had a troponin leak in the setting of
sepsis and acute renal failure, but CK and MB remained negative
and the patient did not have any EKG changes. He is not on ASA
secondary to h/o GI bleed. He also has atrial fibrillation but
is not anti-coagulated b/c of gastrointestinal  bleeding
history. We continued his outpatient amiodarone and his
beta-blocker was titrated up (to Toprol XL 50mg QD). He has a
functioning pacemaker.
.
Renal: The patient's baseline creatinine is unclear at this
time, as it is last in our records in [**2170**] and was normal at
that time. The beta-blocker resolved with treatment of the pt's
bacteremia and was close to baseline (Cr 1.1) at the time of
discharge. He was noted to have bilateral moderately atrophic
kidneys on abdomen CT.
.
Anemia: The patient's iron studies in the unit were consistent
with anemia of chronic disease. Vitamin B12 was low normal.  His
B12 and folate were repleted in the ICU and he received one unit
of PRBCs to keep his hematocrit over 25 given his cardiac
history.
.
AAA: The patient is being followed as an outpatient for his AAA
by Dr. [**First Name (STitle) **]. The AAA was noted to be, which is 4.5 cm. There
was no evidence of rupture on CT as cause for hypotension and no
evidence of dissection of the ascending aortic aneurysm. The CT
did show evidence of a large aneurysmal ectatic abdominal aorta
within a large partially thrombosed infrarenal aneurysm.


Medications on Admission:
AMIODARONE HCL 200MG--Every day
LASIX 20 mg--1 tablet(s) by mouth once a day for swelling and
blood pressure
LIPITOR 10MG--Every day
NAPROSYN 250 mg--1 tablet(s) by mouth three times a day as
needed for pain
PERCOCET 5-325 mg--1 or 2 tablet(s) by mouth four times a day as
needed for pain
PROTONIX 40MG--One by mouth every day
TOPROL XL 50MG--Every day


Discharge Medications:
1. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day.
3. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Toprol XL 50 mg Tablet Sustained Release 24HR Sig: One (1)
Tablet Sustained Release 24HR PO once a day.
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
6. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 9 days: last day [**2172-4-28**].
Disp:*9 Tablet(s)* Refills:*0*
7. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Cyanocobalamin 500 mcg Tablet Sig: Four (4) Tablet PO DAILY
(Daily).
9. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO TID W/MEALS (3 TIMES A DAY WITH MEALS): Take
at least 1 hour apart from your antibiotic.
10. Ferrous Sulfate 325 (65) mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
11. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Primary Diagnosis:
1. E. coli Sepsis

Secondary Diagnosis:
1. CAD
2. systolic CHF, EF 35%
3. atrial fibrillation
4. complete heart block s/p pacemaker
5. history of GI bleed
6. anemia
7. osteoarthritis


Discharge Condition:
good. Pt is doing well. He is afebrile, ambulatory, and satting
in the upper 90s.


Discharge Instructions:
Please resume all prior medications.  You should take Levaquin
to complete a 14-day course for your infection.

Please go to all follow up appointments

Call Dr. [**Last Name (STitle) 8499**] or go to the ER if you experience any
fevers, chills, rigors, chest pain, abdominal pain, nausea,
vomiting, diarrhea, headaches or anything else that concerns
you.

-Your CT scan showed possible liver abscess and ductal
dilatation. YOu declined ERCP to evaluate this further. You will
likely need repeat imaging of your abdomen and blood work
including LFTs at Dr. [**Last Name (STitle) 12525**] office. You may also require
a bone scan.

Followup Instructions:
1. PACEMAKER CALL Phone:[**Telephone/Fax (1) 59**] Date/Time:[**2172-4-23**] 10:00

2. DR. [**First Name (STitle) 110318**] [**Name (STitle) 23093**] Date/Time:[**2172-4-27**] 8:00

3. [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 10134**], MD Phone:[**Telephone/Fax (1) 7976**]
Date/Time:[**2172-5-5**] 9:30. Please call Dr.[**Name (NI) 11509**] office to
speak with him and you will likely need an appt in the next
week.

- As above. Your CT scan showed possible liver abscess and
ductal dilatation. YOu declined ERCP to evaluate this further.
You will likely need repeat imaging of your abdomen and blood
work including LFTs at Dr. [**Last Name (STitle) 12525**] office. You may also
require a bone scan.


                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]

Completed by:[**2172-4-20**]
{'Septicemia due to escherichia coli [E. coli],Septic shock,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction,Atrial fibrillation,Abdominal aneurysm without mention of rupture,Cardiac pacemaker in situ,Hypovolemia,Anemia of other chronic disease'}


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: rigors, chest pain

PRESENT ILLNESS: This is an 83 year-old man with CAD, left ventricular
dysfunction with EF, atrial fibrillation on amiodorone, complete
heart block s/p pacer, history of GI bleeding who presents with
rigors and chest pain to [**Hospital1 18**] ER.  Patient returned from
outpatient visit for AAA, was watching television [**4-14**] afternoon
and had acute onset of rigors followed by chest pain.  Chest
pain was different from chest pain with MI in past-sharp,
non-exertional.  Recounts story of trauma to chest while sitting
in chair recently over same area.  No other pulmonary, gi,
genitourinary complaints.  No history of lines etc. (Did have
dye study for AAA on [**4-10**]). Pacer interrogated a few days ago
and was ok.
.
In Emergency room, hypotensive, started on levophed and
dopamine, given 6 liters of normal saline.  Mentating well
throughout, at baseline.  Labs initially with ? of neutropenia
but thought to be spurious as no apparent cause of neutropenia
and repeat CBC's with luekocytosis, left shift, bandemia.  Found
to have GNR in blood.  Source unclear as chest x-ray, ct chest
abd pelvis, urine and RUQ u/S unrevealing and no localizing
symptoms other than chest pain.
.
No EKG changes, positive trop in setting of renal failure,
negative CK's and MB's.

MEDICAL HISTORY: 1. CAD: IMI thrombolyzed in [**2163**]. He underwent a cardiac
catheterization on [**2170-5-16**] that showed normal
hemodynamics.  His left ventricular pressureswere 138/8,
pulmonary artery 21/6 and a pulmonary capillary wedgepressure of
9.  His ejection fraction was 35% with evidence ofapical and
inferior akinesis.  Coronary angiogram revealedmoderate
nonobstructive coronary artery disease.  There was a 60%medial
LAD lesion, 60% second diagonal lesion and a 70% proximal
RCA lesion, which was pressure-wired and shown to be
nonsignificant.
2. CHF: left ventricular dysfunction, last cath as above, most
recent echo: [**9-21**] ef 35%, The left atrium is mildly dilated.
Left ventricular wall thicknesses and  cavity size are normal
with moderate global left ventricular hypokinesis.  Right
ventricular chamber size and free wall motion are normal. The
aortic
root is mildly dilated. The aortic valve leaflets (3) are mildly
thickened but  not stenotic. Mild (1+) aortic regurgitation is
seen. The mitral valve appears  structurally normal with trivial
mitral regurgitation. There is no mitral  valve prolapse. The
pulmonary artery systolic pressure could not be  determined.
There is no pericardial effusion.
Compared with the report of the prior study (tape unavailable
for review) of  [**2170-4-12**], global left ventricular systolic
function is improved (though LV  fractional shortenting was
previously low normal) and left ventricular cavity
size is now top normal.
3. Atrial fibrillation on amiodorone
4. Complete heart block in [**2163**] s/p pacer
5. GI bleeding in [**2170**]--requiring multiple blood
transfusions-had EGD, [**Last Name (un) **], capsule, no clear source
identified--did have multiple diverticuli and grade 1 internal
hemorroid but no active bleeding at time of scopes.
6. Anemia
7. Osteoarthritis
8. Abdominal Aortic Aneurysm
9. Spinal Compression Fractures

MEDICATION ON ADMISSION: AMIODARONE HCL 200MG--Every day
LASIX 20 mg--1 tablet(s) by mouth once a day for swelling and
blood pressure
LIPITOR 10MG--Every day
NAPROSYN 250 mg--1 tablet(s) by mouth three times a day as
needed for pain
PERCOCET 5-325 mg--1 or 2 tablet(s) by mouth four times a day as
needed for pain
PROTONIX 40MG--One by mouth every day
TOPROL XL 50MG--Every day

ALLERGIES: Ace Inhibitors

PHYSICAL EXAM: Temp: 98.4     BP: 115  /59 off pressors   HR:82   RR:16
97%3litersO2sat

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Retired bricklayer, construction.  Quit smoking 45 years ago, no
alcohol, no drug use. 

### Response:
{'Septicemia due to escherichia coli [E. coli],Septic shock,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction,Atrial fibrillation,Abdominal aneurysm without mention of rupture,Cardiac pacemaker in situ,Hypovolemia,Anemia of other chronic disease'}
