Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: patient recorded as having no known allergies to drugs attending: chief complaint: gi bleed major surgical or invasive procedure: esophago-gastro-duodenoscopy (egd), with clipping of duodenal ulcer history of present illness: this is a 55yo jehovah's witness trasferred from cape code hospital for further care after an upper gi tract bleed. the patient was admitted to cape code hospital on for 4 days of melena, shortness of breath, fatigue, and dizziness. the patient was noted to have a hct of 18 on that admission, dropping to 13 on the night of admission. egd on revealed a superficial gastric ulcer and a duodenal ulcer, neither of which were bleeding. repeat endoscopy on revealed a small oozing gastric ulcer which was cauterized and a small dot of bleeding on the duodenal ulcer. the pt has reported use of excessive excedrin for treatment of his carpal tunnel (1000 mg q6hr). the pt was maintained on protonix, iv ferrous gluconate, epogen, and sucralfate. while at the outside hospital, the patient was noted to be persistently febrile to 100.8 on and 101.8 upon transfer. last labs at outside hospital from : plt 228, wbc 8.3, hct 15, inr 1, troponin i of 0.66 on . the pt currently denies chest pain, abdominal pain, shortness of breath. he does feel feverish. he also denies nausea, hematemesis, bleeding from the rectum. he denies headache, congestion, cough, dysuria. past medical history: duodenal ulcer at age 24 carpal tunnel borderline hypertension social history: denies illicit drug or cigarette use, drinks alcohol only occasionally with 1 glass of wine q1-2 weeks. lives with his wife and children in . works as a builder. family history: father died of myocardial infarction at the age of 53, mother has hypertension, children are healthy, no history of gi malignancy. physical exam: vitals: t 102.3, hr 105, bp 130/53 r 12 sat 100%2lnc gen: wdwn man, lying in bed, nad, pale appearing heent: pale conjunctivae, perrl, no sinus ttp, op clear neck: no jvd, no cervical/supraclavicular lad chest: ctab cv: tachy, nl s1/s2, no m/r/g ab: soft, ntnd, nabs extrem: no c/c/e, cool toes, 1+radial and dp/pt pulses neuro: a and ox 3. rectal: guaiac + with melena pertinent results: ---------- studies ---------- cxr: no acute cardiopulm process . ekg: leftward axis, prolonged qtc at 487 ms, , u waves present, . egd results: multiple large cratered non-bleeding ulcers were found in the stomach body and antrum. four were found in the body and one large ulcer was found in the antrum. there were no active bleeding, visible vessels or adherent clots seen. duodenum: excavated lesions two large cratered ulcers were found in the duodenal bulb. there was no active bleeding seen. however, there was a red dot seen in one of the ulcers. two resolution clips were applied to the red dot. . carotid u/s: 1. increased velocities in the bilateral internal carotid artery, external carotid artery, and common carotid artery. this may be the result of a hyperdynamic state related to the hematocrit of 10. 2. 40 to 59% hemodynamically significant stenosis in the right carotid artery. 3. no carotid stenosis was demonstrated on the left. . tte: conclusions: the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). tissue velocity imaging demonstrates an e/e' <8 suggesting a normal left ventricular filling pressure. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened. there is no valvular aortic stenosis. the increased transaortic gradient is likely related to high cardiac output. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. ---------- labs ---------- 07:03pm blood wbc-10.0 rbc-0.94* hgb-3.3* hct-9.7* mcv-104* mch-35.0* mchc-33.7 rdw-23.5* plt ct-317 05:56am blood wbc-6.5 rbc-1.96* hgb-6.4* hct-21.3* mcv-109* mch-32.5* mchc-29.9* rdw-19.2* plt ct-541* 07:03pm blood ret man-18.6* 05:56am blood ret man-37.7* 07:03pm blood caltibc-215* ferritn-55 trf-165* 06:13am blood hapto-213* 04:24am blood pt-11.8 ptt-25.0 inr(pt)-1.0 07:03pm blood glucose-107* urean-15 creat-0.8 na-141 k-3.2* cl-107 hco3-27 angap-10 05:56am blood glucose-84 urean-10 creat-0.8 na-143 k-3.8 cl-108 hco3-25 angap-14 05:56am blood calcium-8.2* phos-3.9 mg-2.0 08:11am blood %hba1c-5.2 -done -done 07:03pm blood ck(cpk)-715* 08:11am blood ck(cpk)-552* 06:13am blood alt-18 ast-20 ld(ldh)-149 ck(cpk)-360* totbili-0.2 07:03pm blood ck-mb-3 ctropnt-0.03* 08:11am blood ck-mb-7 ctropnt-0.12* 06:13am blood ck-mb-3 ctropnt-0.17* 08:11am blood triglyc-121 hdl-32 chol/hd-3.6 ldlcalc-58 04:24am blood crp-26.1* 05:46pm urine color-yellow appear-clear sp -1.015 05:46pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 05:52pm urine hours-random creat-60 na-123 k-11 05:52pm urine osmolal-391 ---------- micro ---------- serology/blood helicobacter pylori antibody test -- positive stool fecal culture-final; campylobacter culture-final; clostridium difficile toxin assay -- all studies negative influenza a/b by dfa direct influenza a antigen test-final; direct influenza b antigen test-final -- all studies negative blood culture aerobic bottle-final; anaerobic bottle- all studies negative brief hospital course: briefly, this is a 55 year old jehovah's witness trasferred from cape code hospital for further care after an upper gi tract bleed, who underwent emergent endoscopy upon arrival. no actively bleeding ulcers were found. the patient developed ischemic optic neuropathy of the right eye and myocardial ischemia (non st elevation), also likely related to his low hematocrit. . #upper gi tract bleed: the patient had a history of bleeding gastric and duodenal ulcers at the outside hospital. his hematocrit was 11% on admission. the gi service was consulted and decided to perform endoscopy upon arrival to evaluate for active gi bleed. on emergent endoscopy on this admission, patient was found to have nonbleeding gastric and duodenal bulb ulcers with a clip applied to one of the duodenal ulcers. underlying etiology was likely excessive nonsteroidal use. the pt was started on an iv protonix drip. given the patient's religion, he was unable to receive any blood products. h. pylori antibody was sent, found to be positive, so patient was begun on appropriate treatment to eradicate this infection. . #anemia: the patient had a hematocrit of 11% on admission, related to his gi bleed. iron and ferritin were both low normal, but transferrin was also low, consistent with anemia from iron deficiency and from chronic inflammation. reticulocyte count was 18% with low rpi. hemolysis labs were negative. the hematology/oncology service was consulted, and per their recs the patient received iv dextran, vitamin b12 injections, folate, epogen 20,000 units three times per week. his anemia slowly resolved over the course of his hospital stay, and his energy level improved concurrently. . #fever: the pt had fevers at the outside hospital and presented to with a temp of 102f of unclear source. his chest x-ray was negative for infiltrate and urinalysis was negative for infection. patient had mild nasal congestion, but no significant cough or sore throat. an echocardiogram was performed on and showed normal left ventricular filling pressures but hyperdynamic ejection fraction of 75%, mildly thickened aortic valve leaflets. vegetations were felt to be unlikely. the patient was started on unasyn and vanc on admission, but these were discontinued after 2 days given that the pt continued to have low grade fevers while on the antibiotics (which were chosen to cover gi sources). . #elevated cardiac enzymes: myocardial ischemia felt to be secondary to demand in the setting of profound anemia. ck level trended down as his hematocrit improved. patient was instructed to undergo outpatient cardiac stress testing once his hematocrit normalized to investigate the possibility of coronary artery disease. he was instructed to start on a beta blocker, metoprolol, until he can arrange for the cardiac stress test. a prescription was given to the patient for this medication. given his recent bleeding, he was instructed not to start on aspirin until he consulted with his pcp. . #prolonged qt: the patient's initial ekg had a prolonged qt, likely related to hypokalemia. this resolved with potassium repletion. . #right visual loss: on the morning after admission the patient complained of loss of vision in inferior and superior fields which started at the outside hospital. per neurology and ophthamology, this was likely due to his low red blood cell count resulting in an ischemic retina and optic nerve. the patient was noted to have a right afferent pupil defect as well as right eye pain, consistent with ischemic optic neuropathy. he was taken for slit lamp examination by ophthalmology. per neurology recs, carotid ultrasound was performed, which revealed 40 to 59% hemodynamically significant stenosis in the right carotid artery. discussed with neurology resident dr. who spoke with her attending, who both felt that patient should be followed for now to see if his optic symptoms return once his hematocrit normalizes. it seems likely that his carotid artery narrowing is asymptomatic and hence does not require surgical intervention at this time. patient was instructed to return to the emergency room for evaluation if he developed stroke symptoms. esr and crp were ordered to rule out temporal arteritis, which they effectively did. the patient was given the number to set up an appointment with ophthalmology 1-2 weeks after discharge for follow up. . #prophylaxis: protonix twice a day; no bowel regimen given gi bleed; pneumoboots . #fen: clear liquid diet; encourage po intake . #communication: wife . #access: 3 peripheral ivs . #code: full medications on admission: excedrin tylenol discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily) for 4 weeks. disp:*28 tablet(s)* refills:*0* 2. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours) for 1 months. disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 4. sucralfate 1 g tablet sig: one (1) tablet po qid (4 times a day) for 1 months. disp:*120 tablet(s)* refills:*0* 5. clarithromycin 500 mg tablet sig: one (1) tablet po twice a day for 12 days. disp:*24 tablet(s)* refills:*0* 6. amoxicillin 500 mg capsule sig: two (2) capsule po q12h (every 12 hours) for 12 days. disp:*48 capsule(s)* refills:*0* 7. metoprolol tartrate 25 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: 1. gastric ulcers, likely related to nsaid use 2. duodenal ulcers 3. acute blood loss anemia 4. non st elevation myocardial infarction 5. ischemic optic neuritis/retinitis 6. prolonged qt syndrome discharge condition: hemodynamically stable with increasing hematocrit and guaiac negative stool. discharge instructions: please take all your medications as ordered. return to the nearest emergency room if you develop any bleeding from your rectum, lightheadedness, shortness of breath, chest pain, visual changes, difficulty speaking or understanding speech, numbness or tingling, weakness, or any other concerning symptoms. avoid taking any medications that can thin your blood or irritate your stomach lining, including ibuprofen, naproxsyn and aspirin. tylenol is safe for you to take. if you have any questions about which meds are safe, please call your doctor. until you have a stress test that evaluates your coronary arteries, you should take a medication known as a beta blocker to protect you from further heart injury. in several months, if you have no further issues from your gastric ulcers, it would also be reasonable to consider starting on a low dose buffered aspirin after discussing this with your doctor. followup instructions: please call to schedule follow up appointments with the following physicians: 1. pcp call to set up an appointment with a new primary care doctor. 2. ophthalmology - ( your new pcp should check your hematocrit to make sure that it has returned to baseline. you should also have an outpatient stress test arranged in several months if your bleeding does not recur. this test will let us know if you have any significant coronary artery disease, as this will change your health management. procedure: venous catheterization, not elsewhere classified endoscopic control of gastric or duodenal bleeding diagnoses: subendocardial infarction, initial episode of care anemia, unspecified unspecified essential hypertension acute posthemorrhagic anemia hypotension, unspecified chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction chronic gastric ulcer without mention of hemorrhage or perforation, without mention of obstruction refusal of treatment for reasons of religion or conscience optic neuritis, unspecified chorioretinitis, unspecified long-term (current) use of non-steroidal anti-inflammatories (nsaid) 

Answer: The patient is high likely exposed to