Mistakes In Diagnosis Research Articles

Allergic bronchopulmonary mycosis due to Schizophyllum commune in a patient with chronic hepatitis B.

Schizophyllum commune (S. commune) is an opportunistic pathogenic fungus and can cause infection of the respiratory system in immunocompromised hosts. Allergic bronchopulmonary mycosis (ABPM) is the major disease caused by S. commune. However, identification of S. commune using routine mycological diagnostic methods is difficult. It is easy to make mistakes in diagnosis and treatment, resulting in deterioration of the disease. We report the first case of ABPM due to S. commune in a Chinese patient with chronic hepatitis B. The patient presented cough, sputum and dyspnea for six months. The pathogen was missed during routine laboratory workup. We performed bronchoscopy examination and bronchoalveolar lavage. S. commune was identified by metagenomic next-generation sequencing (mNGS) of bronchial alveolar lavage fluid (BALF). Hence, the patient was immediately treated with 200 mg voriconazole twice daily (intravenous infusion) and 20 mg prednisone once a day (oral therapy), along with oral entecavir for hepatitis B. There was no recurrence of infection after the medication was discontinued. S. commune infection should be considered in the diagnosis of patients with refractory cough, sputum and dyspnea, especially in immunocompromised individuals. The mNGS technique is an effective supplementary technique for the diagnosis of S. commune infection, enabling precise clinical decision-making and appropriate treatment. Most patients have good prognosis with a combination of proper antifungal therapy and hormonal therapy.

Ease of Proof Responsibility for Causal Relationship of Medical Injury Infringement

Medical injury infringement is usually allocated based on the principle of "who claims, who provides evidence". The result of the patient's infringement damage is more easily proven by the medical treatment behavior of the doctor. The focus of the conflict between the doctor and the patient usually focuses on the degree of participation in the causal relationship between the infringement damage result and the medical treatment behavior of the doctor. After analyzing the causal relationship proof content of different types of medical disputes, this article believes that the application of the burden of proof mitigation should be limited to medical technology damage disputes and informed consent damage disputes involving diagnosis and treatment behavior, and should only be used to demonstrate whether there is a causal relationship between medical behavior and patient damage. At the same time, when determining whether there is a causal relationship, judges also need to consider whether the medical institution's treatment has fulfilled its diagnostic and treatment obligations under existing objective technical conditions, whether the doctor has made mistakes in diagnosis and treatment, and ultimately determine whether the causal relationship between the medical behavior and patient’s damage is established.

The course of congenital listeriosis in a newborn child on the example of a clinical case

The topic of intrauterine infections in newborns does not lose its relevance from year to year. Listeriosis in newborns often occurs in severe form, leading to neonatal sepsis, often with a fatal outcome. Awareness of this disease will allow obstetrician-gynecologist and neonatologist to avoid mistakes in diagnosis and exclude congenital listeriosis at the birth of a child with manifestations of intrauterine infection. The aim of the work is to describe a clinical case of transplacental infection with listeriosis of a newborn. The analysis of medical documentation, the course of the neonatal period of a child with a diagnosis of “neonatal disseminated listeriosis” was carried out. In this paper, using the example of the presented clinical case, the main manifestations of congenital listeriosis in a newborn child are described. The main content of the work is a description of clinical forms of pathology, in particular, listeriosis of pregnant women and newborns. Special attention is paid to the consideration of the diagnosis and treatment tactics of the disease. Listeriosis is a disease with the absence of specific clinical symptoms in pregnant women, and therefore, difficulties arise in its diagnosis. If signs of ARVI are detected in pregnant women or an appropriate history, it is necessary to conduct a timely examination, including for lystriosis. Prevention of the disease includes informing the population about the path of transmission of infection, about the threat associated with the use of non-heat-treated dairy products.

Рossibility of using European (HFA-PEFF) and American (H2FPEF) algorithms for diagnosing heart failure with preserved ejection fraction in Russian clinical practice

This article focuses on the significance of a unified approach to diagnosing heart failure with preserved left ventricular ejection fraction (HFpEF). The key hemodynamic index of HFpEF is increased left ventricular filling pressure (LVFP) and its noninvasive marker, the E / e' value obtained by tissue Doppler echocardiography (EchoCG). The modern verified algorithms for HFpEF diagnosis, HFA-PEFF and Н2FPEF, mandatorily take into account the E / e' value. However, the routing use of these algorithms in the Russian practice may be complicated since even among "advanced" specialists who are interested in heart failure, 38% of the interviewed do not use or do not know how to use tissue Doppler EchoCG or the algorithm for diagnosing HFpEF with E / e'. In addition to the obvious way of overcoming this problem by equipping respective medical facilities with ultrasonic apparatuses with tissue Doppler EchoCG software and educating physicians, a possibility of using simplified HFA algorithm without the E / e' value is being considered. However, such approach will inevitably lead to erroneous estimation of the probability of HFpEF and, at the best, to underestimation of this probability with ensuing mistakes in diagnosis and treatment. Simplifying the HFA-PEFF and H2FPEF algorithms by omitting one or more parameters is possible but this requires a special investigation to develop a new rating scale and actually a new algorithm, which, in turn, will require a new validation.

Decision-Making in Diagnosis and Management of Extraintestinal Manifestations of Inflammatory Bowel Disease

In the absence of certainty regarding the causes of both inflammatory bowel disease (IBD) and its extraintestinal manifestations (EIMs), there is necessarily ambiguity in both academic and clinical arenas concerning the diagnosis, classifications, and treatments of EIMs. While the “true” EIMs are considered extensions of the IBD gut pathogenesis with an immunologically mediated inflammatory consequence, other EIMs are considered to be complications of IBD itself or its treatment. A third group of IBD EIMs includes those disorders which seem to occur more often in IBD but for which an etiologic or pathophysiologic connection to IBD is highly theoretical. Patients with IBD and EIMs tend to have more severe, long-duration disease, and a reduced quality of life. EIMs presentation may or may not parallel IBD gut inflammatory activity. The clinical decision-making processes necessary for successfully managing simultaneously the gut component of IBD and its EIMs are presented. Based upon clinical experience and review of leading publications, the consensus of best practices, differential diagnoses for EIMs, and current management programs are presented with enumeration of specific decisions and considerations required for successful management of EIMs. EIMs of inflammatory bowel disease reflect the immunopathologic common ground and hence the systemic nature of the IBD. A defined decision-making process is offered which includes consultations and attention to the differential diagnosis to avoid not uncommon mistakes in diagnosis. Management of all EIMs requires assessment of both the clinical and pathologic status of the gut component of IBD combined with judicious selection of general and /or immunosuppression therapy for the EIMs.

Factors Associated with Revision Surgery in Long Bones Metastases

Background. Bones as an organ are one of the most common targets for tumor metastasis. Currently, the number of patients undergoing surgical treatment for metastatic bone lesions is steadily increasing. In most patients, after surgical treatment, the manifestation of clinical symptoms decreases, primarily pain syndrome, which improves their quality of life. However, it should be noted that the number of patients with bone metastases who underwent revision surgery is also increasing. This article retrospectively analyzes the factors leading to revision after surgical treatment of metastases in long bones.
 The aim of this study was to identify factors leading to revision after surgical treatment of patients with metastases in long bones.
 Methods. A retrospective medical records analysis of 247 patients who underwent surgical treatment for metastases in long bones on the basis of the P.A. Herzen Moscow Research Institute of Oncology in 20062020 was performed. Of these, 33 patients underwent revision surgery. The median age was 62 years. The localization of the primary tumor was as follows: breast cancer 10 cases, kidney cancer 13, lung cancer 3, prostate cancer 2, rectal cancer 3, liver cancer and Ewings sarcoma with bone metastases 1 case each.
 Results. The following factors led to revision surgery: mistakes in preoperative diagnosis (3 patients); postoperative infectious complication (6 patients); dislocation of the endoprosthesis (4 patients); continued growth of solitary metastasis after osteosynthesis (5 cases); aseptic instability after intramedullary osteosynthesis (14 patients); traumatic fracture of the endoprosthesis stem (1 patient).
 Conclusions. Revision after surgical treatment of metastases in long bones, in addition to postoperative complications, lead to mistakes in diagnosis and incorrect choice of surgical treatment method. To reduce the risk of revision surgical interventions, a multidisciplinary approach is needed with the development of surgical treatment tactics in consultation and the use of specialized scales of oncological prognosis.

Are we justified attributing a mistake in diagnosis to an AI diagnostic system?

Responsible professional use of AI implies the readiness to respond to and address—in ethically appropriate manner—harm that may be associated with such use. This presupposes the ownership of mistakes. In this paper, I ask if a mistake in AI-enhanced decision making—such as AI-aided medical diagnosis—can be attributed to the AI system itself, and answer this question negatively. I will explore two options. If AI systems are merely tools, then we are never justified to attribute mistakes to them, because their failing does not meet rational constraints on being mistaken. If, for the sake of the argument, we assume that AI systems are not (mere) tools, then we are faced with certain challenges. The first is the burden to explain what this more-than-a-tool role of an AI system is, and to establish justificatory reasons for the AI system to be considered as such. The second is to prove that medical diagnosis can be reduced to the calculations by AI system without any significant loss to the purpose and quality of the diagnosis as a procedure. I will conclude that the problem of the ownership of mistakes in hybrid decision making necessitates new forms of epistemic responsibilities.

An Enhanced Transfer Learning Based Classification for Diagnosis of Skin Cancer.

Skin cancer is the most commonly diagnosed and reported malignancy worldwide. To reduce the death rate from cancer, it is essential to diagnose skin cancer at a benign stage as soon as possible. To save lives, an automated system that can detect skin cancer in its earliest stages is necessary. For the diagnosis of skin cancer, various researchers have performed tasks using deep learning and transfer learning models. However, the existing literature is limited in terms of its accuracy and its troublesome and time-consuming process. As a result, it is critical to design an automatic system that can deliver a fast judgment and considerably reduce mistakes in diagnosis. In this work, a deep learning-based model has been designed for the identification of skin cancer at benign and malignant stages using the concept of transfer learning approach. For this, a pre-trained VGG16 model is improved by adding one flatten layer, two dense layers with activation function (LeakyReLU) and another dense layer with activation function (sigmoid) to enhance the accuracy of this model. This proposed model is evaluated on a dataset obtained from Kaggle. The techniques of data augmentation are applied in order to enhance the random-ness among the input dataset for model stability. The proposed model has been validated by considering several useful hyper parameters such as different batch sizes of 8, 16, 32, 64, and 128; different epochs and optimizers. The proposed model is working best with an overall accuracy of 89.09% on 128 batch size with the Adam optimizer and 10 epochs and outperforms state-of-the-art techniques. This model will help dermatologists in the early diagnosis of skin cancers.

A late-onset Ornitin Transcabamylase deficiency case as an organic psychosis

IntroductionOrnithine transcarbamylase (OTC) deficiency is the most frequent congenital defect among the urea cycle enzymatic disorders, due to mutations a!ecting the OTC gen (Xp21.1) that are inherited with an X-linked pattern. As it happens with sex-linked genetic disorders, late-onset OTC deficiency is more prevalent among women, so that females may be asymptomatic over the years and manifest symptoms only when they are submitted under severe metabolic stress, such as pregnancy, infections or new medications. The enzymatic defect involves a blockage a!ecting the main biochemical route that converts ammonia into urea. This leads to analytic hyperammonemia and the outburst of gastrointestinal, neurological and psychiatric symptoms with variable severity.ObjectivesExpounding the importance of inborn errors of metabolism as possible causes of a psychotic episode.MethodsDescribing the case, supporting our data with a bibliographic research made on PubMed.ResultsWe describe a psychiatric adult-onset OTC deficiency in a 37-year-old woman with borderline intellectual functioning and a psychotic episode in the context of an infection that was wrongly diagnosed at first as schizophrenia, until the genetic study was carried out. The woman’s familiar history shown an OTC deficiency among some family members, a mutation- carrier sister and at least two male children death by the first month of life.ConclusionsOrganic psychosis can be caused by a large number of medical diseases. A di!erential diagnosis of possible cerebral, toxic or metabolic causes of psychosis is necessary to avoid mistakes in diagnosis.DisclosureNo significant relationships.

A Proposed Model to eliminate the Confusion of Hematological Diseases in Thin Blood Smear by Using Deep Learning-Pretrained Model

This research aimed to developing and designing a model for resolving the confusion between hematology in a thin blood smear by means of a pre-defined deep learning model for detection and identification of hematological diseases in thin blood smear images for accurate diagnosis of the different diseases that leukemia and malaria were performed as a sample. There are catastrophic consequences that may lead to death as a result of a mistake in diagnosis and confusion in the knowledge of the disease in particular, especially in hematology, where another disease that was not originally found in the sample is identified for the similarity, which results in surgery and sometimes the administration of drugs in error. In this work, an image processing system was developed to identify patients with malaria and leukemia. The techniques in deep learning have been implemented where the CNN (Alexnet and Resnet50) image recognition model was applied to detect patterns and extract features of the different types of malaria and leukemia from the images. And that is through developing algorithms to distinguish between the two diseases, discovering the presence of similarities in the patterns of stages and the different types of malaria and leukemia in blood images, and reaching to solve the problem of confusion by training, verification, and testing using the mutual verification system that uses three folds. The system achieved an accuracy of 94.3% for Resnet50 and 92.3 for Alexnet in detecting and classifying the types and stages of the two diseases (malaria and leukemia). And 100% to distinguish between them.

Special education teachers as a profession mirror the helping professions

Introduction. The scientific major, special pedagogy, is a relatively new field in the Czech Republic. It started growing in the second half of the 20th century. Therefore, it is still evolving its assumptions for personal and professional aspects that a special pedagogue should have. The influence and evolution of society should be reflected not only in the scientific field but in the profession as well. The aims of this paper are to describe the personality of a special pedagogue, to reflect one’s personality as a special pedagogue, and to highlight the importance of an individual who is transferred to a pedagogical-inclusive process which is initiated by a special pedagogue. Study participants and methods. The main of this research was to collect reflections on the profession of a special pedagogue in the working environment. This research was focused on special pedagogues in the first stage of primary schools. The target group was not eliminated by age, gender, colour, religion, education, or the length of working experience in the position of the special pedagogue. With regard to the established research goal, we chose qualitative research – specifically, the interview method. We conducted in total five semi-structured interviews with which the respondents agreed to be shared for purposes of the research. All interviews were recorded, and respondents knew about that and agreed with it. Results. The profession of the special pedagogue, similarly to any other profession which fits in the category of so-called ‘helping professions’ requires a higher level of responsibility, which for workers could be a bit of a burden. Furthermore, special pedagogues who do diagnoses are responsible for correct diagnosis which determinates further work with a child. Thus, a mistake in diagnosis could be fatal and could be discovered a few years later. All participants talked about some level of stress. However, all of them have defined it differently. On the other hand, all participants agreed on another stressful part which is to follow the pace of a child with a health handicap. Mainly they mentioned their ability to keep themselves in the background, calm themselves down, and be very patient sometimes. Sometimes it happens that it is hard for a special pedagogue to see a sense and future in their work. About this situation, four participants talked. The profession could lose its sense, or it could be seen as stereotypical. All of this is mostly because of low feedback from a student or a student’s family. This fact was reflected by all respondents. I n relation to the data that we collected all respondents see limitations within the administrative part of their profession which keeps others from “important” activities. Further, all respondents mentioned the problem of limit right during their work, and problematic of raise of modern technologies and cooperation with modern technologies during teaching. Cooperation with modern technologies was mentioned in the context of insufficient education and non-reflection of own abilities and skills. Practical significance. In respondents’ answers, diverse topics were detected which often correlate with each other, but the individual topics were detected as well. These individual topics might be interesting for further research. However, the purposes of this research were irrelevant. With regard to inclusive tendencies, it is necessary to reflect the individuality of pupils and still maintain an approach that stems from the essence of special pedagogy.

Glioblastoma multiform with primitive neuronal component, radiological and histology features: a case report

BackgroundGlioblastoma multiform with primitive neuronal component (GBM-PNC) has been recently defined as a rare variant of glioblastoma multiform (GBM), which shows characteristically pathological pattern of less differentiated areas with small blue cell morphology and neuroectodermic immunophenotype. New studies emphasize its characteristics and differences, which have become vitally important due to the changes in therapeutic management.Case presentationWe present the case of 57-year-old male patient who onset symptoms were secondarily widespread partial seizures and expression aphasia. Brain magnetic resonance imaging (MRI) reported left enhanced temporal infiltrating lesion, requiring surgery twice throughout two years. At first surgery, pathological samples revealed embryonic tumor of the central nervous system (grade IV, WHO 2016), so PACKER protocol consisting of CSRT (craniospinal radiation) plus weekly vincristine followed by 8 cycles of cisplatin, lomustine and vincristine usually used for medulloblastomas or other primitive neuroectodermal tumors was started. However, due to reappearance of symptoms and progression in MRI, reoperation was performed with definitive diagnosis of GBM-PNC (Grade IV, WHO 2016) and switched to STUPP protocol.ConclusionsIt is important to take into account the chance of this entity when histological, radiological and intraoperative findings orient toward a primitive neural tumor since the presence of GBM could be overlooked leading to mistakes in diagnosis and the therapeutic orientation.

Лекарственные поражения печени как осложнение терапии гестагенами при невынашивании беременности

An increase of liver function scores may be related to rarely diagnosed drug-induced liver injuries. Their frequency of pregnant women is increasing against the background of therapy of miscarriage with gestagens, which have potential heptotoxicity. The clinical case with the progression of acute hepatitis caused by the use of dydrogesterone and micronized progesterone was analyzed according to the criteria of the European Association for the Study of the Liver and the RUCAM scale, taking into account the physiological growth of alkaline phosphatase activity during gestation. The probability of drug damage to the liver, risk factors, variant, severity were determined. Typical mistakes in diagnosis and treatment are shown, recommendations are given on the use of hepatoprotectors in women with this pathology. An opinion about the genetic relationship of gestagen-induced liver damage and intrahepatic cholestasis of pregnancy and the need to create clinical guidelines for the management of pregnant women with drug-induced liver injuries was expressed

Problems of Diagnosis, Conservative Treatment and Long-Term Results of “Mallet Finger” Fracture

Summary. Distal phalanx dorsal edge fracture is treated in a relatively simple closed manner during the first weeks after injury. The role of the distal interphalangeal joint in the upper extremity integral function reaches conventionally only a few percent. This may lead to insufficient attention and a large number of mistakes in diagnosis and treatment of such injuries, which in turn provokes complications that are much more difficult to treat than the primary injury. This article considers the most common problems of diagnosis and treatment of “mallet finger” fractures. Advantages and disadvantages of various techniques used in the treatment of such fractures in acute and neglected cases are considered and analyzed.
 Objective: to study the effect of distal phalanx dorsal edge avulsive fractures on function of the upper limb, quality of life, and depression rate in long term period after injury.
 Materials and Methods. Data from 11 patients (8 (88%) males and 3 (12%) females) with neglected cases of distal phalanx dorsal edge avulsive fractures were studied. QuickDASH questionnaire and visual analog scales were used to study impaired quality of life and depression rate in such patients. Indicators that lead to the need for surgery in long term period after injury have been identified.
 Results. It was determined that in long term period, in patients with a “mallet finger” fracture, function of the upper extremity suffered significantly and was 29.2±20.2 points (range 2.3-75) according to QuickDASH scale. This condition also significantly affected the general well-being of the patient. Average value of impaired quality of life was 43.6±24.6 (range 0-90 points), and depression rate due to upper extremity dysfunction was 44.6±22.7 (range 0-90 points).
 Conclusions. Despite the relatively minor injury, high rates of dysfunction, impact on quality of life and depression rate indicate the need to restore finger function even in long term period after injury.

Anaphylaxis in Children: Experience of an Egyptian Center

Abstract Introduction Anaphylaxis is a potentially life threatening allergic reaction that is rapid in onset and multisystemic in nature. Distribution of anaphylaxis tends to fluctuate based on age, gender, race, geographical residence and socioeconomic status of the involved subjects. Diagnosis of anaphylaxis in children is generally underestimated particularly in developing countries, and when diagnosed, proper management is occasionally lacking. Aim of the study to evaluate the frequency and pattern of anaphylaxis and mistakes in diagnosis and treatment among a group of Egyptian children and adolescents. Subjects and methods This observational study was conducted over 12 months duration, from 1st of March 2019 to the end of February 2020, in Children’s hospital, Ain Shams University, Cairo, Egypt, on children presenting to emergency department (ED). Anaphylaxis frequency, clinical presentation, triggers, diagnosis, management and long term follow up were assessed. Results frequency rate of anaphylaxis among children and adolescents was 0.43% (80/18816) over a year. Sixty percent of patients were infants. Biphasic reactions were reported in 11.3% of patients. The commonest trigger was food (22.5%) followed by medications (8.8%). Appropriate diagnosis of anaphylaxis by junior pediatricians was reported in all patients, with epinephrine given in most occasions in proper dosage and method (78.7%). Education of children and their caregivers, providing written plan, ready-to-use epinephrine and follow up appointment were deficient. In conclusion Anaphylaxis in children was relatively high particularly in infants, with food being the most common trigger. Diagnosis and early management of anaphylaxis in our University hospital was satisfactory, however, long term management and follow up were defective.

Improvement of grey wolf optimizer with adaptive middle filter to adjust support vector machine parameters to predict diabetes complications

In medical science, collecting and classifying data from various diseases is a vital task. The confused and large amounts of data are problems that prevent us from achieving acceptable results. One of the major problems for diabetic patients is a failure to properly diagnose the disease. As a result of this mistake in diagnosis or failure in early diagnosis, the patient may suffer from complications such as blindness, kidney failure, and cutting off the toes. Nowadays, doctors diagnose the disease by relying on their experience and knowledge and performing complex and time-consuming tests. One of the problems with current diabetic, diagnostic methods is the lack of appropriate features to diagnose the disease and consequently the weakness in its diagnosis, especially in its early stages. Since diabetes diagnosis relies on large amounts of data with many parameters, it is necessary to use machine learning methods such as support vector machine (SVM) to predict the complications of diabetes. One of the disadvantages of SVM is its parameter adjustment, which can be accomplished using metaheuristic algorithms such as particle swarm optimization algorithm (PSO), genetic algorithm, or grey wolf optimizer (GWO). In this paper, after preprocessing and preparing the dataset for data mining, we use SVM to predict complications of diabetes based on selected parameters of a patient acquired by laboratory test using improved GWO. We improve the selection process of GWO by employing dynamic adaptive middle filter, a nonlinear filter that assigns appropriate weight to each value based on the data value. Comparison of the final results of the proposed algorithm with classification methods such as a multilayer perceptron neural network, decision tree, simple Bayes, and temporal fuzzy min–max neural network (TFMM-PSO) shows the superiority of the proposed method over the comparable ones.

Посткоитальный цистит: хирургическое лечение

Introduction. Urinary tract infection is one of the most common urological infectious diseases. An important risk factor for uncomplicated urinary tract infection in women is sexual intercourse. Post-coital cystitis is a special form of recurrent cystitis, associated with a low location of the external urethral orifice. This condition is called vestibulo-vaginal dislocation of the urethra. Materials and methods. PubMed and Elibrary (Scientific Electronic Library) databases were searched for studies describing surgical treatment of recurrent post-coital cystitis in women. Based on the relevance and reliability of the sources, 23 articles in peer-reviewed medical journals were selected. All of the selected studies contained data on evolution of surgical treatment approaches for post-coital cystitis. Results. In the middle of the 20th century the interest of medical community in surgical treatment of post-coital cystitis has gradually faded. Such trend was caused by imperfect surgical techniques of existing procedures (O'Donnell and Hirschhorn operations). Subsequent accumulation of experience, over several decades, allowed to establish possible mistakes in diagnosis and operation techniques. Furthermore, a constant search for new techniques and improvement of existing ones minimized potential risk of complications. Great hopes are pinned on the works of B.K. Komyakov et al., who proposed extravaginal transposition of the urethra, that implies the transposition of the urethra and its external orifice as high as possible toward the clitoris. The technique is characterized by high efficacy and a low number of complications, as demonstrated by the treatment results of 228 patients diagnosed with post-coital cystitis. Conclusions. Various curative procedures for post-coital cystitis show the need to determine and standardize the optimal amount of surgical intervention for urethral dystopia in women.

Herlyn–Werner–Wunderlich syndrome in the prepubescent period (literature review and clinical observations)

Herlyn–Werner–Wunderlich syndrome (OHVIRA syndrome) is a combined malformation of the genitourinary systeme, characterized by various combinations of uterus dydelphys with unilateral obstructed (or blind) hemivagina and ipsilateral renal agenesis. The causes of mistakes in diagnosis and treatment are common because of relative rarity of anomaly, insufficient awareness of practitioners about the syndrome and the lack of multidisciplinary approach. Untimely and tactically chaotic diagnosis of Herlyn–Werner–Wunderlich syndrome leads to a misconception about the clinical situation, wrong choice in treatment, and, as a consequence, to complications such as strictures, widespread adhesions and inflammation, as well as irreversible changes in the topography of organs of the small pelvis with a subsequent deterioration in reproductive status of patient. This article provides a review of the literature on the problem, considers the clinical cases of diagnosing this defect in prepubertal patients.

An Ontological Clinical Decision Support System Based on Clinical Guidelines for Diabetes Patients in Sri Lanka.

Health professionals should follow the clinical guidelines to decrease healthcare costs to avoid unnecessary testing and to minimize the variations among healthcare providers. In addition, this will minimize the mistakes in diagnosis and treatment processes. To this end, it is possible to use Clinical Decision Support Systems that implement the clinical guidelines. Clinical guidelines published by international associations are not suitable for developing countries such as Sri Lanka, due to the economic background, lack of resources, and unavailability of some laboratory tests. Hence, a set of clinical guidelines has been formulated based on the various published international professional organizations from a Sri Lankan context. Furthermore, these guidelines are usually presented in non-computer-interpretable narrative text or non-executable flow chart formats. In order to fill this gap, this research study finds a suitable approach to represent/organize the clinical guidelines in a Sri Lankan context that is suitable to be used in a clinical decision support system. To this end, we introduced a novel approach which is an ontological model based on the clinical guidelines. As it is revealed that there are 4 million diabetes patients in Sri Lanka, which is approximately twenty percent of the total population, we used diabetes-related guidelines in this research. Firstly, conceptual models were designed to map the acquired diabetes-related clinical guidelines using Business Process Model and Notation 2.0. Two models were designed in mapping the diagnosis process of Type 1 and Type 2 Diabetes, and Gestational diabetes. Furthermore, several conceptual models were designed to map the treatment plans in guidelines by using flowcharting. These designs were validated by domain experts by using questionnaires. Grüninger and Fox’s method was used to design and evaluate the ontology based on the designed conceptual models. Domain experts’ feedback and several real-life diabetic scenarios were used to validate and evaluate the developed ontology. The evaluation results show that all suggested answers based on the proposed ontological model are accurate and well addressed with respect to the real-world scenarios. A clinical decision support system was implemented based on the ontological knowledge base using the Jena Framework, and this system can be used to access the diabetic information and knowledge in the Sri Lankan context. However, this contribution is not limited to diabetes or a local context, and can be applied to any disease or any context.

Model of conjoint fault detection at metrological service of electronics

Three types of conjoint fault detection are usually employed at the diagnostic of electronic systems, namely: independent conjoint fault detection, compatible conjoint fault detection, and zone conjoint fault detection. We have performed comparative consideration of the employment of these three types of conjoint fault detections for the troubleshooting of electronic systems. Expressions for quantitative assessment of quality indices (average recovery time, mathematical expectation of deviation of a diagnosis with one error in evaluation of the inspection result, the probability of correct diagnosis and the probability of correct evaluation of the result of the test) for all three types of conjoint fault detections are derived. Basing on these expressions a generalized model, which combines all three types of conjoint fault detection and performs a selection of the most appropriate type of conjoint fault detection, is developed. The model is capable of predicting quantitative parameters of the quality of diagnostic procedure with the account for the metrological reliability of measuring instruments. The latter allows for lowering of the labor expenses at repairing of the electronic systems. The model is also designed for the account of a possible diagnosis mistake for three types of conjoint fault detections. In the final stage of the model, a conditional diagnostic algorithm is developed and qualitative indicators are specified.