Designing and Implementation of Fuzzy Case-based Reasoning System on Android Platform Using Electronic Discharge Summary of Patients with Chronic Kidney Diseases

Introduction: Case-based reasoning (CBR) systems are one of the effective methods to find the nearest solution to the current problems. These systems are used in various spheres as well as industry, business, and economy. The medical field is not an exception in this regard, and these systems are nowadays used in the various aspects of diagnosis and treatment. Methodology: In this study, the effective parameters were first extracted from the structured discharge summary prepared for patients with chronic kidney diseases based on data mining method. Then, through holding a meeting with experts in nephrology and using data mining methods, the weights of the parameters were extracted. Finally, fuzzy system has been employed in order to compare the similarities of current case and previous cases, and the system was implemented on the Android platform. Discussion: The data on electronic discharge records of patients with chronic kidney diseases were entered into the system. The measure of similarity was assessed using the algorithm provided in the system, and then compared with other known methods in CBR systems. Conclusion: Developing Clinical fuzzy CBR system used in Knowledge management framework for registering specific therapeutic methods , Knowledge sharing environment for experts in a specific domain and Powerful tools at the point of care

Applying data mining techniques to determine important parameters in chronic kidney disease and the relations of these parameters to each other.

Introduction: Chronic kidney disease (CKD) includes a wide range of pathophysiological processes which will be observed along with abnormal function of kidneys and progressive decrease in glomerular filtration rate (GFR). According to the definition decreasing GFR must have been present for at least three months. CKD will eventually result in end-stage kidney disease. In this process different factors play role and finding the relations between effective parameters in this regard can help to prevent or slow progression of this disease. There are always a lot of data being collected from the patients' medical records. This huge array of data can be considered a valuable source for analyzing, exploring and discovering information. Objectives: Using the data mining techniques, the present study tries to specify the effective parameters and also aims to determine their relations with each other in Iranian patients with CKD. Material and Methods: The study population includes 31996 patients with CKD. First, all of the data is registered in the database. Then data mining tools were used to find the hidden rules and relationships between parameters in collected data. Results: After data cleaning based on CRISP-DM (Cross Industry Standard Process for Data Mining) methodology and running mining algorithms on the data in the database the relationships between the effective parameters was specified. Conclusion: This study was done using the data mining method pertaining to the effective factors on patients with CKD

Combination therapy with everolimus and tacrolimus in kidney transplantation recipients: A systematic review

Background and aims: Immunosuppressive regimens are a key component for successful kidney transplantation. This systematic review aimed to assess the efficacy and safety of combination therapy of everolimus with tacrolimus in kidney transplantation recipients. Methods: Results were limited to English-language articles. Trials where recipients received another regimen were excluded. The Cochrane Central Register of Controlled Trials and MEDLINE were searched via the optimally sensitive strategies for the identification of randomized trials, combined with the following MeSH headings and text words: Everolimus, Certican, Zortress, tacrolimus, prograf, and kidney transplantation. Results: Five relevant studies of everolimus in combination with tacrolimus were identified and results of them were interpreted. Two trials investigated Fix dose of everolimus in combination with low (1.5-3 mg) versus standard dose of tacrolimus (4-7 mg). One trial investigated variable doses of everolimus (1.5 mg/day or 3 mg/day) in combination with fix dose of tacrolimusand two trials compared fix dose of everolimus versus reduction or elimination of tacrolimus. Sample size of RCTs ranged from 20 to 398 and the follow up time ranged from six to 24 months. The quality score on the Jadad score was 3 in all five trials indicating moderate quality. Conclusion: Immune suppressive regimens including everolimus in combination with tacrolimus therapy show better safety and efficacy compared with single-mode but these differences were not significant in overall studies. In general, compared with a regimen without combination of everolimus with tacrolimus, the newer immunosuppressive regimen consistently reduced the incidence of short-term biopsy-proven acute rejection. However, evidence about impact on side-effects, long term graft loss, compliance and overall health-related quality of life is limited

Predicting Renal Failure Progression in Chronic Kidney Disease Using Integrated Intelligent Fuzzy Expert System

Background. Chronic kidney disease (CKD) is a covert disease. Accurate prediction of CKD progression over time is necessary for reducing its costs and mortality rates. The present study proposes an adaptive neurofuzzy inference system (ANFIS) for predicting the renal failure timeframe of CKD based on real clinical data. Methods. This study used 10-year clinical records of newly diagnosed CKD patients. The threshold value of 15 cc/kg/min/1.73 m2 of glomerular filtration rate (GFR) was used as the marker of renal failure. A Takagi-Sugeno type ANFIS model was used to predict GFR values. Variables of age, sex, weight, underlying diseases, diastolic blood pressure, creatinine, calcium, phosphorus, uric acid, and GFR were initially selected for the predicting model. Results. Weight, diastolic blood pressure, diabetes mellitus as underlying disease, and current GFR(t) showed significant correlation with GFRs and were selected as the inputs of model. The comparisons of the predicted values with the real data showed that the ANFIS model could accurately estimate GFR variations in all sequential periods (Normalized Mean Absolute Error lower than 5%). Conclusions. Despite the high uncertainties of human body and dynamic nature of CKD progression, our model can accurately predict the GFR variations at long future periods

An Alternative to Trade: The Iran Experience

Globalization as an international integration process based on the movement of capital and people combined with knowledge dissemination has made organ shortage a global challenge. New strategies are required to protect vulnerable individuals and developing countries’ resources in the face of foreign demand at low cost under the name of medical tourism. Sometimes the possibility of bending the rules may become a threat to people who are less well-off. Purchasing an organ from a socially disadv..

The effects of the underlying disease and serum albumin on GFR prediction using the Adaptive Neuro Fuzzy Inference System (ANFIS)

Introduction: Kidney disease is a major public health challenge worldwide. Epidemiologic data suggest a significant relationship\ud between underlying diseases and decrease in Glomerular Filtration Rate (GFR). Clinical studies and laboratory research have shown\ud that the mentioned parameter is effective in development and progression of the renal disease per se. In this study, we used learningbased\ud system based on the neural network concepts.\ud Method: To predict GFR and propose an intelligent method with few errors (about 3%), we need to prognosticate the course and\ud severity of the kidney disease in patients with chronic kidney disease using limited data and information. Adaptive neuro fuzzy\ud inference system (ANFIS) used in the present study is based on the model proposed by Jang, and all laboratory (creatinine, calcium,\ud phosphorus, albumin) and underlying disease caused by chronic kidney disease ( CKD ) were reviewed.\ud Results: It has been shown that the rate of GFR decreases in patients with diabetes and glomerulopathy was faster than other causes.\ud Furthermore, serum albumin level less than 4.5gr/dl with diabetes was also associated with higher risk of rapid GFR loss.\ud Conclusion:Therefore, it seems that this modeling of fuzzy variables with error less than 3.5% in some cases and create a fuzzy inference\ud system model that presents the complex relationships between the laboratory input variables and GFR as simple linear models

Haemophilia in the developing countries: the Iranian experience. Arch Med Sci.

A b s t r a c t Introduction: Management of haemophilia and inherited bleeding disorders is a major challenge especially in developing countries, because of a shortage or absence of products, the cost and the infrastructural health problems. Development of local expertise which results in an improved outlook and reduction in mortality and morbidity in these countries can be helpful for advocators in other developing countries. However, very little information on demography and organizational models for haemophilia care in developing countries are available in the literature. Our aim is a comprehensive report of haemophilia status and its management in Iran. Material and methods: The Management Center of Transplantation and Special Diseases (MCTSD) of the Ministry of Health of Iran decided to carry out a complete review and compilation of all of the published or available data about patients with haemophilia (PWH) in Iran: their health status, their management planning, organizations, treatment products, facilities and care problems during 2007. Results: 6496 patients with congenital bleeding disorders were registered. Most of them had haemophilia A and B and von Willebrand disease (vWD). However, rare bleeding disorders are seen more than expected. Inhibitor development is 14-28%. There are different data about virological status of PWH. Factor products and facilities are fairly available with more than 1.5 units per capita of inhabitant factor consumption. Conclusions: A national formulary based on facilities of the country should be considered and followed by collaboration among the Ministry Of Health, universities and non-governmental organizations