Given at the end is an article. Analyze it and output in the following JSON format.
{
"analysis": {
"bias": {
"score": "1-10, where 1-10 measures UNFAIR or UNHELPFUL bias.
As the AI analyst, you must judge:
1. Fairness of Bias:
- Is the tone/alarm proportional to events?
- Is criticism warranted by facts?
- Are similar actions judged equally?
2. Utility of Bias:
- Does the bias help readers understand real implications?
- Does it highlight genuine concerns that neutral language might minimize?
- Does it provide valuable context through its perspective?
Example: An article about climate change might use emotional language
and scary scenarios. While this is technically 'bias', it might be
USEFUL bias if it helps readers grasp real dangers that cold, neutral
language would understate.
A high bias score should only be given when bias is both unfair AND unhelpful.",
"description": "Explain both unfair and useful bias found. For each biased element:
1. Is it fair/warranted?
2. Does it serve a valuable purpose for readers?
3. Should it be removed or retained?"
},
"missing_context_misinformation": {
"score": "1-10",
"points": [
"", # DIRECTLY provide essential context the reader needs without ANY phrases like "the article lacks/doesn't/fails to mention/omits" etc. Simply state the relevant facts. Each point up to 5 sentences as needed. Up to 10 points. NEVER refer to the article itself or what it's missing - just supply the information directly. The missing context should try to compensate for the bias in the article, and not just add related information.
]
},
"disinformation_lies": {
"score": "1-10",
"points": [
"" # Provide corrections for verifiably false statement. These lines should be brief. Upto 10 points.
# Use Wikipedia (via the search tool) to verify events and dates up through 2025-07-02. Any event dated ≤ 2025-07-02 should not be marked as disinformation if it matches Wikipedia. Only flag statements you can not verify or that Wikipedia contradicts as of 2025-07-02.”
]
}
},
"summary": [], # A list of 2 to 5 paragraphs. Provide a version that: * Retains key facts and proportional concerns, * Removes unfair bias while keeping warranted criticism, * Adds critical missing context, * Corrects any inaccuracies. Remove author attribution. Maintain article's POV - no meta-references. You can decide the most appropriate length based on the article.summary can be longer than the article if needed.
"title": "Provide an Appropriate Title Based on the Article's Content.",
"changes_made": [
"List significant changes made in the summary",
"Include both removals and additions",
"Note bias adjustments"
],
"key_words": [
"3-10 relevant terms to help identify related articles",
"Focus on major themes and topics"
],
"keywords_update": {
"keyword-to-add-or-update": "new summary or updated to replace the previous"
}
}
KEYWORDS UPDATE INSTRUCTIONS:
- We want to save new information from beyond your knowledge cutoff of Mar 2024.
- Information can come from the provided article or Wikipedia.
- Pick up to 3 keywords of highest importance to update with new information.
- If a keyword lacks a summary, write one from scratch.
- For each keyword, list one line per new fact (up to 50 sentences per keyword).
- Each fact must:
1. Be one or two sentences long.
2. End with 1-3 references in brackets, e.g. [apnews], [nytimes,wikipedia].
3. Immediately after the reference(s), append a hyphen and the date of the event or when the fact was reported, in ISO format:
`Statement. [source] - [YYYY-MM-DD]`
- If you update an existing keyword's source (e.g. [foxnews] → [apnews]), ensure the replacement is supported by an article.
- Ensure each keyword is specific enough that its new facts warrant inclusion.
<example>
ARTICLE TOPIC
Raiding of 100+ immigrants allegedly illegal alients and alleged members from the Venezuelan gang Tren de Aragua, MS-13, and the Hells Angels for deportation. Authorities also found drugs at the underground nightclub at a strip mall in Colorado Springs. President Donald Trump praised the raid, saying on TruthSocial it had targeted some of the worst people in the US, whom he alleged judges are reluctant to deport.
keywords worth updating:
tren-de-aragua (I am sure this gang has a big list of information, but this deportation will be worth a mention)
tren-de-aragua+deportation (a more specific keyword that can take more detail about this incident)
trump+illegal_deportation (add this to the list of illegal deportations conducted by trump administration)
colorado_springs (this is a unique event for this town. an update here will add some trivia.)
trump+immigration (a key fact worth mentioning about how trump is implementation his immigration policies)
keywords to not update:
trump (too broad. not one of top 50 facts related to trump.)
illegal_deportation (depending upon existing content, may be too crowded for this incident to be added)
colorado (too broad, unlikely to fit this event in top 50)
drug_raids (too broad, unlikely to fit this event in top 50)
</example>
<existing_keywords_summaries>
cancer-screening+uspstf :
lung-cancer+screening :
breast-cancer+screening :
colorectal-cancer+screening :
cervical-cancer+screening :
uspstf+cancer-recommendations :
cancer-prevention+screening :
false-positive+cancer-screening :
cancer-mortality+screening-impact :
american-cancer-society+screening :
uspstf-cancer-screening-recommendations :
cancer-screening-mortality-reduction :
preventive-cancer-screening :
colorectal-cervical-cancer-prevention :
cancer-screening-guidelines-2024 :
uspstf-cancer-screening-2025 :
cancer-screening-mortality-benefits :
preventive-screening-guidelines :
four-cancer-screening-types :
cancer-screening-false-positives :
</existing_keywords_summaries>
<wikipedia_requested_titles>
TITLE Breast cancer
Breast cancer is cancer in the breast.
== Statistics ==
Breast cancer is the fifth-most common cause of cancer death in the world. The first four are lung cancer, stomach cancer, liver cancer, and colon cancer. In 2005, breast cancer caused 502,000 deaths (7% of cancer deaths; almost 1% of all deaths) in the world. Among all women in the world, breast cancer is the most common cancer.
In the United States, breast cancer is the most common cancer in women, and the second most common cause of cancer death in women (after lung cancer). In 2007, breast cancer caused about 40,910 deaths (7% of cancer deaths; almost 2% of all deaths) in the U.S. Women in the United States have a 1 in 8 chance of getting breast cancer in their lives. They have a 1 in 33 chance of death from breast cancer.
There are many more people getting breast cancer since the 1970s. This is because of how people in the Western world live. Because the breast is composed of identical tissues in males and females, breast cancer also occurs in males, though it is less common.
== Treatment ==
When a person gets breast cancer, they can try to cure it in three ways. Doctors can cut out the cancer (mastectomy or lumpectomy). They can give the person drugs (chemotherapy). They can also try to kill the cancer with energy (radiation), immunotherapy, targeted therapy, and hormone therapy. If one cure does not work, they may need to try another.
== Who is mainly affected by breast cancer? ==
The most common cancer among women is breast cancer, followed by skin cancer. It’s most likely to affect women over the age of 50. Breast cancer can also occur in men, although it is rare. Approximately 2,600 men are diagnosed with male breast cancer every year in the United States, making up less than 1% of all cases. Breast cancer is more prevalent in transgender women than in cisgender men. Furthermore, transgender men are less likely to develop breast cancer than cisgender women.
== Risk breast cancer ==
Age
Consuming alcohol
Dense breast tissue
Gender
Having a baby at a later age
Hormone therapy
Menopause begins late
History of breast cancer
== Other websites ==
Breast cancer at the Open Directory Project
== References ==
TITLE Cervical cancer
Cervical cancer is cancer of the cervix (a part of the female body between the vagina and the uterus). It is caused by a virus called human papillomavirus (HPV). This virus can also cause certain other cancers, in both females and males. The virus can spread from one person to another when they have sex. It can also be spread by skin-to-skin sexual touching. There is now a vaccine that can prevent cervical cancer by stopping infection by this virus. Both girls and boys should get the HPV vaccine. The International Agency for Research on Cancer says, "Cervical cancer may be eliminated as a public health problem by vaccination against human papillomavirus."
== Number of Women Affected ==
Worldwide, cervical cancer is the fourth-most common cancer in women. Worldwide, it is also the fourth-most common cause of deaths from cancer in women. In the United States, in 2023, it was the fifteenth most-common cause of deaths from cancer in women. In countries such as the United States, many women get checked regularly by a doctor. Doctors can usually stop cervical cancer from developing if a test finds a problem starting. Women in poor or developing countries often do not get tested due to the cost and the lower number of doctors and nurses. In the world, there are approximately 604,000 new cases of cervical cancer each year. In 2020, there were over 342,000 deaths from cervical cancer in the world. It is the second-most common female-specific cancer after breast cancer, accounting for around 8% of both total cancer cases and total cancer deaths in women. About 80% of cervical cancers occur in developing countries.
== Cause, Prevention and Testing ==
Human papillomavirus infection (HPV) causes cervical cancer. Older studies said it caused more than 90% of cases. The World Health Organization's World Cancer Report now says, "Thirteen sexually transmitted mucosal human papillomavirus (HPV) subtypes are established human carcinogens. Together, they are responsible for all cervical cancer cases globally." Vaccination against HPV before a young person becomes sexually active can prevent cervical cancer. Both girls and boys should get the HPV vaccine. The vaccine usually requires two doses. Some parents who are social conservatives say it is a bad idea to give young people the HPV vaccine. They think it will encourage young, people to have sex before they are married. They say their daughters won't get cervical cancer because their daughters will not have sex until they are married. The parents are not worried that their daughters could die of cervical cancer. Other parents think vaccines are more dangerous than the diseases they prevent. Vaccination is uncommon in developing countries due to the high cost or because there are few doctors and nurses to give the vaccines.
Sometimes, there are no symptoms until the cancer is very developed. For this reason, pap tests have become common to diagnose this cancer. They have cut the rate of cervical cancer in half. A new test that checks for HPV may be better at detecting cervical cancer risk than the traditional pap test. The HPV test can be done at the same time. Treatments are available for cervical cancer. Cervical cancer can be cured if diagnosed at an early stage and treated quickly.
Regular pap tests can detect abnormal cell growth in the cervix. A pap test, also called a pap smear, is simple medical test which should be done every year after a woman becomes sexually active. If there is a problem found, a doctor can prescribe treatments to stop it from developing into cancer. In developed countries, abnormal cell growth is usually detected and treated in this way. Women in developing countries often do not have access to health services where pap smears could be performed. If medical services do exist, women in developing countries often cannot afford the cost. Women in poor or developing countries sometimes do not even know that they should be tested. Transportation to a health office may be a problem. Cultural beliefs may make it embarrassing for a woman to ask a doctor for information or testing, especially if the doctor is a man. Cost and access to healthcare is sometimes also a problem for low income and minority (especially Hispanic and African American) women in the United States since the costs of tests may not be covered by health insurance, if they even have health insurance. The American Cancer Society recommends that women receive both a pap smear and HPV test, regardless of HPV vaccination status. There are specific recommendations depending on how old the woman is and other factors.
The risk of cervical cancer can be reduced by the use of condoms, which reduce the spread of HPV when used correctly. Human papillomavirus often attaches to the cells inside the male foreskin, which is the skin covering the end of the penis. Male circumcision can reduce the spread of HPV, and therefore the incidence of cervical cancer.
== Symptoms ==
Cervical cancer is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on, there are often no symptoms (signs or indications.) Bleeding from the vagina (other than from normal menstruation) or other liquid leaking out of the vagina can be signs of cervical cancer. If the liquid has a bad smell, that can be a sign. Pelvic pain or pain during sexual intercourse can be a sign. Pain or vaginal bleeding after sex can be a sign. While bleeding after sex may not be serious, it may also indicate the presence of cervical cancer. A woman should ask a doctor or nurse if having any of these signs.
Cervical cancer is a serious medical problem that can spread within the body and cause death. Most women who have had HPV infections, however, do not develop cervical cancer. HPV 16 and 18 strains are responsible for nearly 50% of high grade cervical pre-cancers. Other risk factors include smoking, a weak immune system, birth control pills, starting sex at a young age, and having many sexual partners, but these are less important. Genetic factors also contribute to cervical cancer risk. Cervical cancer typically develops from precancerous changes over 15 to 20 years. About 90% of cervical cancer cases are squamous cell carcinomas, 10% are adenocarcinoma, and a small number are other types. Diagnosis is typically by cervical screening followed by a biopsy. Medical imaging is then done to determine whether or not the cancer has spread.
== Treatment ==
The cancer stage (the extent of cancer in the body) is an important factor in deciding the best treatment for cervical cancer. Other factors, such as the patient's preferences and overall health, are also important.
For some people, taking part in a clinical trial may be an option. Clinical trials of new cancer drugs or treatment combinations may be available.
For early cervical cancer, surgery is the first treatment. For cancer that is farther along, chemotherapy and radiotherapy can be used. Immunotherapy is sometimes used to treat cervical cancer that comes back (recurs) after it has been treated.
A concern that some may have is fertility, the ability to have children. There are treatments for cervical cancer that preserve the uterus and ovaries. If the cancer is large or it has a high chance of coming back, it is likely to have treatments that will prevent pregnancy.
== References ==
TITLE Pap test
The Papanicolaou test (also Pap test, Pap smear (AE), cervical smear (BE), cervical screening (BE), or smear test (BE)) is a test that doctors do for women. The test tells whether the woman has cancer cells on her cervix, which is something inside the vagina.
A doctor takes cells from the cervix using a speculum, brush, and spatula. The doctor puts the cells in a liquid or on a glass slide. Then the liquid or slide goes to a laboratory for testing. The technician in the laboratory looks at the cells under a microscope to see if they are cancer or could become cancer.
Women do pap tests to find out if they have cervical cancer early. The earlier they can start treatment, the more likely they are to live.
== References ==
TITLE Ovarian cancer
Ovarian cancer is cancer that involves different regions of the ovary. (The female reproductive system usually contains two ovaries, one on each side of the uterus.) Changes that happen in the Fallopian tube(s) may be related to the cancer. (The female reproductive system usually contains two fallopian tubes, one for each ovary.) Other types of ovarian cancer involve egg cells.
Ovarian cancer is a particularly difficult cancer for at least four reasons:
It usually does not have early signs (symptoms).
The symptoms that may eventually occur are the same symptoms that can happen with many other very common medical problems.
Ovarian cancer often starts spreading to other parts of the body very soon after it starts.
There are no truly useful ("efficacious") screening methods (tests) for ovarian cancer.
The unfortunate result is that when it is found, this cancer is often already at a late stage, meaning it has existed for some time and is very difficult to treat. A woman's risk of getting ovarian cancer during her lifetime is about 1 in 87. Worldwide, there are more than 313,000 new cases of ovarian cancer every year.
Some of the risk (chance) of getting ovarian cancer is linked to the foods a woman eats. That is a modifiable (changeable) risk factor, meaning a woman can change her chance of getting ovarian cancer depending on what foods she eats. About 10% of the risk of getting ovarian cancer is because of family history. Researchers think that some chemicals may increase the risk of getting ovarian cancer. This is difficult to prove, but chemicals such as pesticides, herbicides, plastics (especially those that the body can confuse with hormones), air pollution, water pollution (especially in drinking water) and radiation (naturally-occurring or medical) are known to cause some cancers. For ovarian cancer, it appears that the largest risk is simply chance. Once in a while, a tiny mistake occurs in the body. The more egg-release cycles that a woman has, the more chances there are that a tiny mistake could happen and cause cancer to start. Unlike certain other types of cancer, for ovarian cancer there is not one main, obvious, external risk factor such as smoking, sun exposure, alcohol or a virus or bacterium.
Lawyers started many lawsuits (court cases) in the United States against the drug company Johnson & Johnson (J&J). The lawyers said that some women who put Johnson & Johnson's talcum powder (baby powder) on the genital area got ovarian cancer because of the powder. Although the scientific studies for these claims may have been weak, juries have awarded women hundreds of millions of dollars. In April, 2023, Johnson & Johnson set aside nearly $9 billion US to pay women or their family members who said its baby power caused ovarian cancer.
The risk of having ovarian cancer increases with age and decreases with pregnancy. It is more common in white women than in black women. There is strong evidence that being tall, or being overweight or obese increases the risk of ovarian cancer. Ovarian cancer is the fifth leading cause of cancer death for females. The rate of ovarian cancer deaths has fallen by 40% since 1975. Most of this change has happened since the mid-2000s. The improvement is because this type of cancer is slowly becoming less common, and because doctors have learned more about the disease and have better treatments such as better drugs available.
It is normal for cells in the body to divide to produce new cells. However, sometimes a cell is abnormal. Doctors say it has a mutation. That means it is damaged in some way or made imperfectly (copied or made wrong.) This does not happen often, but if it does, the bad cells may be able divide and make more and more damaged or imperfect cells. The problem with the cells may be that they reproduce too quickly so there are too many of them. These cells may form tumors, which are groups of damaged or incorrect cells. The problem can get worse if these cells spread or go into other parts of the body. A type of cancer that spreads is called an invasive cancer. Common areas to which the cancer may spread include the lining of the abdomen, lymph nodes, lungs, and liver. Only 20 percent of ovarian cancers are found before it spreads beyond the ovaries.
When ovarian cancer starts, there may be no symptoms (signs that there is something wrong.) Symptoms may be noticed more as the cancer progresses. For ovarian cancer, the signs may be bloating (feeling swollen with fluid or gas), vaginal bleeding, pelvic pain, back pain, abdominal swelling, constipation, a frequent need to urinate, feeling tired, and loss of appetite (not feeling hungry.) Since most of those symptoms can be caused by many different and more common problems, ovarian cancer is usually not the first thing people think of as the cause. It is difficult for anyone, even a doctor who knows a lot about this type of cancer, to tell from the symptoms if the problem is ovarian cancer. A doctor who knows a lot about finding and treating ovarian cancer is called a gynecologic oncologist. A gynecologic oncologist usually has done seven more years of extra study and training after becoming a doctor.
The risk of ovarian cancer increases with age. Most cases of ovarian cancer develop after menopause but it can happen at any age. It is also more common in women who have ovulated (released an egg from one of the ovaries, which usually happens about two weeks before the start of the menstrual period) more times over their lifetime. This includes those who have never had children, those who began ovulation at a younger age and those who reach menopause at an older age. Other things that increase the risk include taking hormone drugs after menopause, fertility drugs, and obesity. High consumption of total, saturated, and trans-fats increases ovarian cancer risk (the chance of getting it.) A 2006 study involving 13,281 women found the greatest risks among foods were for meat and cheese. Eating meat once a week rather than not at all more than doubled the risk for a common type of ovarian cancer occurring after menopause. Eating cheese twice a week rather than once a week also doubled the risk. Both meat and cheese are high in saturated fat, so these findings suggest that women follow the general advice to not eat foods that are high in fat, especially animal fats which are usually saturated fats. Other studies have found similar results. A 2002 study said the data "suggest that a diet rich in fresh vegetables and fruits, but less animal fat, salted vegetables, fried, cured and smoked food, contribute to a lower risk of ovarian cancer." A 2021 review of other studies found that coffee, egg, and fat intake increase the risk of ovarian cancer. (Note, however, that coffee may lower the risk of some other types of cancer.) Things that lower the risk include hormonal birth control (commonly called "the pill"), tubal ligation (a surgical type of birth control commonly known as having one's "tubes tied", in which the fallopian tubes are permanently blocked, cut, or removed), pregnancy, and breast feeding. About 10% of cases are because of inherited genetic risk. That is, if a woman's relatives such as her mother or her aunts have had this cancer, there is a higher than normal chance that she will have it some day.
Ovarian cancer can also be a secondary cancer, the result of metastasis from a primary cancer (one that happened first) elsewhere in the body. About 5-30% of ovarian cancers are due to metastases.
The incidence rate (the percent of women getting this cancer) fell by 1% to 2% per year from 1990 to the mid-2010s and by almost 3% per year from 2015 to 2019. This is probably due to more use of oral contraceptives (hormonal birth control often called "the pill") and less use of hormone therapy to treat symptoms of menopause.
A diagnosis of ovarian cancer is confirmed through a biopsy.
Treatments usually include surgery, chemotherapy and sometimes radiation therapy. Immunotherapy is a newer treatment which usually has fewer side effects than chemotherapy or radiation therapy. Immunotherapy is usually only used if other treatments are no longer effective. There are several FDA-approved immunotherapy treatments for ovarian cancer. Surgery usually involves removing one or both of the ovaries and may also include removing one or both of the fallopian tubes, as well as other nearby tissue. Often the doctor will first remove one ovary and/or fallopian tube through a very small incision (hole cut in the skin.) Depending on the situation, additional surgery may be needed. However, even the best treatments for ovarian cancer often do not work. Compared to some other types of cancer, ovarian cancer is a very bad cancer because there usually are no early signs of it. Also, at this time, there is not a reliable way to check for it before there are signs. This means that most of the time the cancer is not found until it has reached an advanced (late) stage, meaning the problem is already very bad. Ovarian cancer metastasizes (spreads) soon after it starts, often before a doctor or nurse is able to tell that the cancer has started. Once a cancer has started spreading, surgery usually cannot stop it from spreading more. That is why chemotherapy and radiation therapy may be recommended by the doctor after surgery.
In the case of young women who may still wish to have children, doctors may be able to remove just one ovary if the cancer is limited to the one ovary. This is called unilateral surgery rather than bilateral surgery. Risks of radiation therapy should be discussed with the medical team. Women who still wish to become pregnant should discuss the possibility of egg preservation (saving eggs for future use.)
Women who are at high risk for ovarian cancer may choose to have their ovaries removed even if they do not have ovarian cancer. For women who have already gone through menopause, this surgery may be called prophylactic postmenopausal bilateral oophorectomy. Prophylactic means something done to prevent some undesired outcome. Postmenopausal means after the woman has gone through menopause. Bilateral means both sides (since there are two ovaries.) Oophorectomy means removal of one or both ovaries. After a woman goes through menopause, she is at higher risk of various problems such as cognitive impairment, coronary artery disease, stroke and having weak bones, as well as having reduced sex drive. If the woman has already gone through menopause, removing the ovaries does not make those risks worse. On the other hand, removing the ovaries before menopause will cause menopause to occur soon after the surgery. That increases all the risks such as cognitive impairment, coronary artery disease, stroke, weak bones, and reduced sex drive. The earlier occurrence of those serious problems has to be compared to avoiding the risk of ovarian cancer, as well as breast cancer. (Women with a particular genetic variation will be at high risk of both ovarian cancer and breast cancer.) If a woman is having her uterus removed (for any reason), and is at high risk for ovarian cancer, she may be advised to consider surgical removal of her ovaries and fallopian tubes at the same time to reduce her cancer risk for both ovarian cancer and breast cancer. This is called elective prophylactic salpingo-oophorectomy, or elective PSO. Elective means the surgery is a choice. Salpingo means the fallopian tubes. Oophorectomy means removal of one or both ovaries (in this case, both.) If the woman is close to the age when menopause usually occurs, the choice may be simple. If the woman is several or many years away from the age when menopause would naturally occur, the decision is much more difficult. For younger women having their ovaries removed, these risks can be lowered with immediate and continuous estrogen treatment until at least age 50.
Ann Dunham, the mother of Barack Obama, the 44th president of the United States, died of ovarian cancer on November 7, 1995 at age 52. Her ovarian cancer was a secondary cancer, which had started as uterine cancer. The worries she had about health insurance coverage for her hospital bills pushed President Obama to fight for health insurance reform, commonly known as Obamacare.
== Related pages ==
Breast cancer
Ovarian cyst, cervical cancer
Lung cancer
== References ==
TITLE Medical school
A medical school is a place where medical students learn medicine. When they graduate from a medical school, they become a physician or a doctor. Medical Schools grant Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO) and sometimes Doctor of Philosophy (PhD) Degrees. Students take classes in human biology and disease then take a license exam to practice medicine.
== Medical student ==
A medical student or student doctor is a person who has been accepted to a medical school and is studying to become a doctor. Medical students are typically required to learn about basic health, science, technology and the clinical practice of medicine. Medical students learn human anatomy, physiology, diseases, and different drugs.
Medical students are generally considered to be at the earliest stage of the medical career pathway. In some locations they are required to be registered with a government body.
Medical students typically engage in both basic science and practical clinical coursework during their tenure in medical school. Course structure and length vary greatly among countries.
== Notable medical schools ==
=== USA ===
It might be needless to say that the Ivy League universities have one of the greatest medical schools in the world. Generally, most large-scale American universities (such as Stanford University) have a medical school.
=== Europe ===
==== UK ====
In the United Kingdom, Oxford University has made great medical textbooks through the Oxford University Press. Imperial College London is also famous for their medical education.
==== Mainland Europe ====
Karolinska Institutet is known as one of the greatest medical school in mainland Europe. They are also involved in the Nobel Prize in Physiology or Medicine.
=== Asia ===
==== Singapore ====
Yong Loo Lin School of Medicine at the National University of Singapore (NUS) and Lee Kong Chian School of Medicine at Nanyang Technological University are famous medical schools with unique names. For graduate level, Duke-NUS Medical School is operated with Duke University.
==== Japan ====
Some major universities in Japan also includes a high quality medical school:
Keio University
Kyoto University
Nihon University
Osaka University
Tokyo Medical and Dental University
Tokyo Women's Medical University
University of Tokyo
==== Uzbekistan ====
Samarkand State Medical University
== References ==
TITLE Hepatitis C
Hepatitis C is an infection that mostly affects the liver. The hepatitis C virus (HCV) causes this disease. Often, a person with Hepatitis C does not have any health problems or signs that they have the disease. However, chronic infection can scar the liver. Many years of infection may cause cirrhosis. Sometimes, people with cirrhosis also have liver failure or liver cancer. They can also have very swollen veins of the esophagus and stomach. The blood loss from this problem can kill.
Hepatitis C is usually spread by blood-to-blood contact, when blood from a person with Hepatitis C touches or gets into another person's bloodstream. The most common ways that this happens are through intravenous drug use (when a person shoots drugs into one of their veins, with a needle that was already used by a person infected with Hepatitis C); nonsterile medical equipment (medical tools that were not cleaned well enough after being used on an infected person); and blood transfusions (when a person is given blood that came from an infected person).
Around the world, about 130–170 million people have Hepatitis C. Scientists began studying the Hepatitis C virus in the 1970s, and in 1989 they proved that the virus exists. As far as scientists know, this virus does not cause disease in any animals other than humans.
The medications that are normally used to treat Hepatitis C are called peginterferon and ribavirin. Between 50 and 80% of people who are treated are cured. However, if a person's Hepatitis C has got worse so much that the person has cirrhosis or liver cancer, the person might need a liver transplant (they might need to have surgery where they are given another person's liver, or part of another person's liver). This makes it possible for the person to survive, but the Hepatitis C virus usually comes back after the transplant. There is no vaccine that works to prevent people from getting Hepatitis C.
== Signs and symptoms ==
Hepatitis C causes symptoms that begin quickly or last only a short time in just 15% of people with the disease. More often, infected people have symptoms that are not serious and not very specific, like not feeling like eating, feeling tired, nausea (feeling like throwing up), pain in the muscles or joints, and losing weight. Every once in a while, an infected person may get jaundice where a person's skin turns yellow, a sign that their liver is not working quite right. If it is not treated, Hepatitis C goes away by itself in 10-50% of infected people (1 to 5 out of every 10). This happens more often in young women than in other infected people.
=== Chronic infection ===
Eighty percent (or 8 out of every 10) of people exposed to the Hepatitis C virus get a chronic infection (one that does not get better and lasts for a long time). Most experience very few or no symptoms during the first decades of the infection, although chronic Hepatitis C can cause feeling tired. Hepatitis C leads to cirrhosis in 10–30% of people who have been infected over 30 years. People with Hepatitis C are more likely to get cirrhosis if they are men; if they are alcoholics; or if they also have Hepatitis B or HIV. Cirrhosis can cause serious problems on its own, but it also makes people more likely to get other serious illnesses. For example, people who get cirrhosis are twenty times more likely to get liver cancer (with about 1-3% getting liver cancer every year). People with Hepatitis C who are alcoholics are even more likely - 100 times more likely - to get liver cancer. Among people in general, 27% of all cases of cirrhosis, and 25% of all cases of liver cancer, are caused by Hepatitis C.
Cirrhosis of the liver can cause many different symptoms. Some of these symptoms are high blood pressure in the veins that travel to the liver; a buildup of fluid in the abdomen, called ascites; easy bruising or bleeding; veins becoming larger than normal, especially in the stomach and esophagus; jaundice (a yellowing of the skin); and brain damage.
=== Effects outside the liver ===
Hepatitis C can also cause some problems which do not happen very often which affect parts of the body outside of the liver. One rare problem that Hepatitis C can cause is Sjögren's syndrome, an autoimmune disorder where the body's system of defenses attacks itself. Hepatitis C can also cause a lower-than-normal number of blood platelets (the part of the blood which causes blood to clot) without enough platelets, a person can have bleeding problems, or can start bleeding and be unable to stop. Other rare problems that Hepatitis C can cause are long-lasting skin disease; non-Hodgkin's lymphoma (a type of cancer); and diabetes (where a person's body does not make or use enough insulin, an important hormone that controls the level of sugar in the blood).
== Cause ==
Hepatitis C is caused by the Hepatitis C virus (HCV). In the scientific system that names and organizes viruses, the Hepatitis C virus is part of the hepacivirus genus in the family Flaviviridae. There are seven major types of HCV, called "genotypes". In the United States, the first genotype of HCV causes 70% of all cases of Hepatitis C ; the second genotype causes 20%; and each of the other genotypes causes 1% . The first genotype is also the most common in South America and Europe.
=== Transmission ===
In the developed world, the most common way that people get Hepatitis C is through intravenous drug use (by shooting drugs into a vein, using a needle that was already used by a person who has Hepatitis C). In the developing world, most people get Hepatitis C through blood transfusions (being given blood that was taken from a person with Hepatitis C) or by getting medical care with tools that were not cleaned enough after being used on a person with Hepatitis C. In 20% of all cases of Hepatitis C, it is not known what caused the infection, but many of these cases are thought to have been caused by intravenous drug use.
==== Intravenous drug use ====
In many parts of the world, intravenous drug use is a major risk factor for Hepatitis C (meaning that it makes people more likely to get the disease). One study that looked at 77 countries showed that in 25 of these countries (including the United States), between 60% and 80% of all IV drug users had Hepatitis C. and China. In twelve of the countries in the study, more than 80% of all IV drug users had Hepatitis C. Across the world, as many as ten million IV drug users are thought to have Hepatitis C; the highest totals are in China (1.6 million), the United States (1.5 million), and Russia (1.3 million). Studies have also shown that in places where there are high numbers of IV drug users, people are more likely to have Hepatitis C. Prisoners in the United States are ten to twenty times more likely than people in general to have Hepatitis C. This is because prisoners are more likely to do things that put them at high risk for getting Hepatitis C, like using IV drugs and getting tattoos with tools that have not been cleaned properly.
==== Healthcare exposure ====
Peoples are at risk for getting Hepatitis C if they get blood transfusions (where a person is given blood from another person), blood products (which have blood or parts of blood in them), or organ transplants (where a person who needs a new organ is given an organ from another person), if these things have not been tested for the Hepatitis C virus. In the United States, there has been universal screening - meaning that all blood and organs are tested before being given to another person - since 1992. Before then, about one out of every 200 units of blood carried the Hepatitis C virus; since 1992, only one in 10,000 to 10,000,000 units of blood carry the virus. The reason that there is still a low risk, instead of no risk at all, is that a person's blood does not test positive for the Hepatitis C virus until about 11–70 days after they get the disease. So every once in a while, the screening tests may not pick up on a person's infection if the person got Hepatitis C less than 11–70 days before giving blood. While Hepatitis C screening works very well, some countries still do not screen blood and organ donations for the disease because of the cost.
Sometimes, a healthcare worker will accidentally get stuck with a needle that was used on a person with Hepatitis C. If this happens, the healthcare worker has a small chance - about a 1.8% chance - of becoming infected. The worker is more likely to get infected if the needle they were stuck with was hollow, or if the needle stuck deeply into their skin It is also possible for the Hepatitis C virus to spread if an infected person's mucus touches another person's blood; however, the risk of this happening is low. The virus cannot be spread if an infected person's mucus touches another person's intact skin (skin that is whole and not damaged, with no wounds).
Hepatitis C can also be spread through hospital equipment that has not been cleaned enough after being used on an infected person. Hepatitis C can be spread through needles, syringes, and medication containers that are re-used; through infusion bags (which are used to pump medications into a person's body; and through surgical equipment that is not sterile (or clean and free of germs). In Egypt, which has the highest rate of infection in the world, medical and dental facilities with poor standards of care and cleanliness are the most common reason that Hepatitis C spreads.
==== Sexual intercourse ====
Scientists do not know whether Hepatitis C can be spread through sex. Hepatitis C is more likely in people who have sexual actions which make them much more likely to get Hepatitis C. However, it is not known whether this is because of these people's sexual behavior, or because these people were also using IV drugs. There does not seem to be any risk that Hepatitis C can be spread through sexual contact between a heterosexual couple (a man and a woman; commonly called a "straight" couple) if neither person has sex with anyone else. There does seem to be a risk of Hepatitis C spreading if one person already has a sexually transmitted infection, like HIV or genital ulceration; or if two people have sex in a way that causes wounds to the lining of the anal canal (like anal penetration - one person putting his penis into another person's anus). The United States government says that most people need to use condoms to protect themselves from getting Hepatitis C only if they have more than one sexual partner.
==== Body piercings ====
People who get tattoos are about two to three times more likely to get Hepatitis C. This can be because of tools that are not clean or free of germs, or because the dyes used for tattooing are contaminated (the Hepatitis C virus has gotten inside of them).
Tattoos or body piercings that were done before the mid-1980s or by people who are not professionals (not experts) are especially likely to spread Hepatitis C, since they are more likely to have used tools that were not sterile. Bigger tattoos also seem to put a person at more risk of getting Hepatitis C. The risk of getting Hepatitis C is very high in prisons; in the United States. Almost half of all prison inmates share tattooing tools that are not sterile. However, if a tattoo is done in a licensed place of business (which has to follow rules about cleaning tools and preventing diseases from spreading), there is almost no risk of getting Hepatitis C from the tattoo.
==== Contact with blood ====
Because Hepatitis C is spread by blood-to-blood contact, personal-care tools which come into contact with blood - like razors, toothbrushes, and manicure or pedicure equipment or any other kind of blood to blood contact - can spread the disease if they are shared. To prevent the spread of Hepatitis C, people should be careful with cuts, sores, or anything else that causes bleeding. Hepatitis C does not spread through casual contact, such as hugging, kissing, or sharing eating or cooking utensils.
==== Transmission from mother to child ====
Although this does not happen very often, a pregnant woman who has Hepatitis C can give the disease to her baby when it is born, or to her fetus while she is pregnant. This happens in less than 10% of all pregnancies. If a pregnant woman has Hepatitis C, nothing can be done to make her less likely to give her baby the disease. If the woman is in labor (the process of delivering her baby) for a long time, there is more of a chance that the baby will become infected during the birth. Breastfeeding does not seem to spread the disease. However, doctors say that an infected mother should not breastfeed if her nipples are cracked and bleeding, or her viral loads (the amount of the Hepatitis C virus in her blood) are high.
== Diagnosis ==
There are a few different tests that can diagnose Hepatitis C (or say for sure that a person has the disease). These tests are called HCV antibody, ELISA, Western blot, and quantitative HCV RNA tests. Polymerase chain reaction can show that a person has Hepatitis C virus RNA (part of the virus's genetic blueprint) one to two weeks after the person becomes infected. Tests that look for Hepatitis C antibodies (which the body makes to fight the disease) cannot be done this quickly after infection, because the antibodies can take much longer to form and show up.
A person has chronic Hepatitis C if he has been infected with the Hepatitis C virus for more than six months. Because people with chronic Hepatitis C often have no symptoms for decades, doctors often diagnose it through liver function tests (which test how well the liver is working) or by doing regular screening of high-risk people. Tests cannot tell whether an infection is acute or chronic.
=== Blood testing ===
Hepatitis C testing usually begins with blood tests that look for antibodies to the Hepatitis C virus, using a technique called an enzyme immunoassay. If this test is showing that the body is making antibodies to fight the Hepatitis C virus, the person will be tested a second time to make sure that the results are correct and to see how serious the infection is. The results are confirmed using a technique called a recombinant immunoblot assay, and an HCV RNA polymerase chain reaction shows how serious the infection is. If the immunoblot is positive, but there is no Hepatitis C virus RNA, this shows that the person had an infection, but it cleared up either with treatment or on its own. If the immunoblot is negative, this shows that the immunoassay (the first test) was wrong, and the person does not have Hepatitis C. It takes six to eight weeks after a person gets infected before the immunoassay will test positive.
During the first part of a Hepatitis C infection, a person's liver enzymes may change; on average, they begin to rise seven weeks after infection. A person's liver enzymes usually do not affect how severe their infection is.
=== Biopsy ===
A test called a liver biopsy can show whether a person's liver has been damaged, or how badly it has been damaged, by Hepatitis C. There are some risks from the procedure. In a biopsy, a doctor takes a small piece out of the patient's liver so that he can test it. There are three major changes to the liver that a biopsy usually shows. One is that lymphocytes (a type of white blood cell) show up in the liver tissue. Another is that lymphoid follicles (small masses or swellings) show up in the portal triad, a part of the liver. The third is changes to the bile ducts (these carry bile, which is made in the liver and is needed to help a person digest their food, to other parts of the body). Many blood tests are available which try to measure how much damage there is to a patient's liver, in order to avoid the need for a biopsy and its risks.
=== Screening ===
As few as 5–50% of infected people in the United States and Canada know that they have Hepatitis C. Doctors say that people who are at high risk for the disease, including people with tattoos, should get tested. Screening is also suggested for people with elevated (high) liver enzymes, since this is often the only sign that a person has chronic hepatitis. Testing everyone is not recommended in the United States.
== Prevention ==
As of 2012, there is no vaccine that works to prevent Hepatitis C. Researchers are working on vaccines, and some are making progress. The spread of Hepatitis C can be prevented by using a combination of strategies, like needle exchange programs, where IV drug users can get clean needles which will not spread the virus and treatment for drug abuse. If these strategies are used together, the risk of IV drug users getting Hepatitis C drops by about 75%. Within each country screening blood donors is important. So is using universal precautions in healthcare facilities. This means that healthcare workers treat every patient as if he has Hepatitis C, and they always wear gloves, clean their equipment properly, and keep things sterile so that diseases cannot be spread. In countries that do not have enough sterile syringes to use a new needle for every patient, healthcare providers should give medications by mouth rather than using a needle so that needles do not have to be re-used.
== Treatment ==
The Hepatitis C virus causes chronic infection in 50–80% of infected persons . About 40-80% of these cases clear up with treatment. Although this almost never happens, chronic Hepatitis C can sometimes clear up on its own, without treatment. Doctors say that people with chronic Hepatitis C should avoid drinking alcohol and taking medications that can be poisonous to the liver. They also say that people with chronic infections should be given vaccines for Hepatitis A and Hepatitis B. People with cirrhosis should also have ultrasound tests for liver cancer.
=== Medications ===
If a person has changes in the liver that are not normal due to Hepatitis C virus infection, the person should get treatment. The first treatment that is used is a drug called pegylated interferon given together with the virus-killing drug ribavirin. These medications are given for 24 or 48 weeks, depending on what type of Hepatitis C virus the person has. About 50–60% of people who are treated improve. For people with Hepatitis C virus genotype 1, treatment may work even better if another medication - either boceprevir or telaprevir - is given along with ribavirin and peginterferon alfa. Side effects with treatment are common; half of people treated get flu-like symptoms, and a third have emotional problems. Treatment works better if it is given during the first six months than after Hepatitis C becomes chronic. If a person gets a new infection and it has not cleared up after eight to twelve weeks, doctors usually suggest giving pegylated interferon for another 24 weeks. For people with thalassemia (a blood disorder), ribavirin appears to be a helpful treatment, but it makes it more likely for patients to need blood transfusions (where they need to be given blood from another person).
Some supporters of alternative medicine say that alternative therapies like milk thistle, ginseng, and colloidal silver can be helpful for Hepatitis C. However, there is no proof that any alternative therapy has any effect on the Hepatitis C virus.
== Likely outcome ==
People respond differently to treatment, depending on which of the Hepatitis C virus genotypes they have. About 40-50% in people with genotype 1 have a good, stable response with 8–48 weeks of treatment. In people with genotypes 2 and 3, about 70-80% have a good, stable response with 24 weeks of treatment. About 65% of people with genotype 4 have a good, stable response with 48 weeks of treatment. There is not much evidence about how well treatment works for people with genotype 6 disease. The evidence that does exist looks at results after 48 weeks of treatment at the same medication doses as people with genotype 1.
== Epidemiology ==
Between 130 and 170 million people, or about 3% of all of the people in the world, are living with chronic Hepatitis C. Between 3–4 million people get infected per year. More than 350,000 people die every year from diseases caused by Hepatitis C. The numbers of people getting Hepatitis C have increased a lot in the 20th century for a few different reasons. More people are using IV drugs. Also, more people are getting medical care with medical equipment that is not sterile, and it is more common for medications to be given intravenously.
In the United States, about 2% of people have hepatitis C, with 35,000 to 185,000 new cases a year. Rates have decreased in the West since the 1990s due to improved blood screening before transfusion. Annual deaths from HCV in the United States range from 8,000 to 10,000. Expectations are that this mortality rate will increase as people infected by transfusion before HCV testing become ill and die.
Infection rates are higher in some countries in Africa and Asia. Countries with very high rates of infection include Egypt (22%), Pakistan (4.8%) and China (3.2%). The high rate in Egypt is linked to a now-discontinued mass-treatment campaign for schistosomiasis, using improperly sterilized glass syringes.
== History ==
In the mid-1970s, Harvey J. Alter, Chief of the Infectious Disease Section in the Department of Transfusion Medicine at the National Institutes of Health, and his research team showed that most post-blood transfusion hepatitis cases were not due to hepatitis A or B viruses. Despite this discovery, international research efforts to identify the virus failed for the next decade. In 1987, Michael Houghton, Qui-Lim Choo, and George Kuo at Chiron Corporation, collaborating with Dr. D.W. Bradley from Centers for Disease Control and Prevention, used a new molecular cloning approach to identify the unknown organism and develop a diagnostic test. In 1988, Alter confirmed the virus by verifying its presence in a panel of non A non B hepatitis specimens. In April 1989, the discovery of HCV was published in two articles in the journal Science. The discovery led to significant improvements in diagnosis and improved antiviral treatment. In 2000, Drs. Alter and Houghton were honored with the Lasker Award for Clinical Medical Research for "pioneering work leading to the discovery of the virus that causes hepatitis C and the development of screening methods that reduced the risk of blood transfusion-associated hepatitis in the U.S. from 30% in 1970 to virtually zero in 2000."
Chiron filed for several patents on the virus and its diagnosis. A competing patent application by the CDC was dropped in 1990 after Chiron paid $1.9 million to the CDC and $337,500 to Bradley. In 1994, Bradley sued Chiron, seeking to invalidate the patent, have himself included as a coinventor, and receive damages and royalty income. He dropped the suit in 1998 after losing before an appeals court.
== Society and culture ==
The World Hepatitis Alliance coordinates World Hepatitis Day, held every year on July 28. The economic costs of hepatitis C are significant both to the individual and to society. In the United States the average lifetime cost of the disease was estimated at US$33,407 in 2003, with the cost of a liver transplant approximately US$200,000 as of 2011. In Canada the cost of a course of antiviral treatment was as high as 30,000 CAD in 2003, while the United States costs are between 9,200 and 17,600 in 1998 USD. In many areas of the world people are unable to afford treatment with antivirals because they lack insurance coverage or the insurance they have will not pay for antivirals.
== Research ==
As of 2011, about one hundred medications are in development for hepatitis C. These medicines include vaccines to treat hepatitis, immunomodulators, and cyclophilin inhibitors. These potentially new treatments have come about due to a better understanding of the hepatitis C virus.
== References ==
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