Clovis Foguem

Conceptual graph-based knowledge representation for supporting reasoning in African traditional medicine

Although African patients use both conventional or modern and traditional healthcare simultaneously, it has been proven that 80% of people rely on African traditional medicine (ATM). ATM includes medical activities stemming from practices, customs and traditions which were integral to the distinctive African cultures. It is based mainly on the oral transfer of knowledge, with the risk of losing critical knowledge. Moreover, practices differ according to the regions and the availability of medicinal plants. Therefore, it is necessary to compile tacit, disseminated and complex knowledge from various Tradi-Practitioners (TP) in order to determine interesting patterns for treating a given disease. Knowledge engineering methods for traditional medicine are useful to model suitably complex information needs, formalize knowledge of domain experts and highlight the effective practices for their integration to conventional medicine. The work described in this paper presents an approach which addresses two issues. First it aims at proposing a formal representation model of ATM knowledge and practices to facilitate their sharing and reusing. Then, it aims at providing a visual reasoning mechanism for selecting best available procedures and medicinal plants to treat diseases. The approach is based on the use of the Delphi method for capturing knowledge from various experts which necessitate reaching a consensus. Conceptual graph formalism is used to model ATM knowledge with visual reasoning capabilities and processes. The nested conceptual graphs are used to visually express the semantic meaning of Computational Tree Logic (CTL) constructs that are useful for formal specification of temporal properties of ATM domain knowledge. Our approach presents the advantage of mitigating knowledge loss with conceptual development assistance to improve the quality of ATM care (medical diagnosis and therapeutics), but also patient safety (drug monitoring).

Using conceptual graphs for clinical guidelines representation and knowledge visualization

The intrinsic complexity of the medical domain requires the building of some tools to assist the clinician and improve the patient’s health care. Clinical practice guidelines and protocols (CGPs) are documents with the aim of guiding decisions and criteria in specific areas of healthcare and they have been represented using several languages, but these are difficult to understand without a formal background. This paper uses conceptual graph formalism to represent CGPs. The originality here is the use of a graph-based approach in which reasoning is based on graph-theory operations to support sound logical reasoning in a visual manner. It allows users to have a maximal understanding and control over each step of the knowledge reasoning process in the CGPs exploitation. The application example concentrates on a protocol for the management of adult patients with hyperosmolar hyperglycemic state in the Intensive Care Unit.

Adverse drug reactions in some African herbal medicine: literature review and stakeholders' interview

Background In view of the large consumption of herbal medicine in Africa countries, it is likely that many adverse drugs reactions go unrecorded with either patients failing to present to health services, or no pharmacovigilance analysis being made, or the analysis not being reported centrally. This problem is of interest especially for those who are working in the general area of adverse drug reactions or stakeholders in the domain of herbal medicine for considering safety issues. Methods We are particularly interested in the way that the use of very well-known and highly valued plants is linked to the observation of adverse drug reactions in African countries. We investigated, through a literature review and using the Internet (with a semantic search strategy), some well-known or popular medicinal plants used in African herbal medicine (AHM). Other information on the properties related to use, and characteristics of medicinal plants was complemented by some interviews with stakeholders. Results Although substantial progress has been made in elucidating the mechanisms of action of many drugs, the pharmacological actions of many medicinal plants are generally not well understood. The results of a literature review suggest that the reported adverse drug reactions of herbal remedies are often due to a lack of understanding of their preparation and appropriate use. The results of stakeholders’ interviews suggest that there is a growing need to provide patients with correct information about the herbal medicines they consume. Conclusion An important aspect of herbal medicine is the correct, timely, and integrated communication of emerging data on risk as an essential part of pharmacovigilance, which could actually improve the health and safety of patients. This calls for improved collaboration between traditional practitioners and modern healthcare professionals, researchers, and drug regulatory authorities. In addition, there is a need for an adverse drug reaction reporting system to facilitate the collection, monitoring, and evaluation of adverse drug events.

Verifying a medical protocol with temporal graphs: The case of a nosocomial disease

OBJECTIVE Our contribution focuses on the implementation of a formal verification approach for medical protocols with graphical temporal reasoning paths to facilitate the understanding of verification steps. MATERIALS AND METHODS Formal medical guideline specifications and background knowledge are represented through conceptual graphs, and reasoning is based on graph homomorphism. These materials explain the underlying principles or rationale that guide the functioning of verifications. RESULTS An illustration of this proposal is made using a medical protocol defining guidelines for the monitoring and prevention of nosocomial infections. Such infections, which are acquired in the hospital, increase morbidity and mortality and add noticeably to economic burden. An evaluation of the use of the graphical verification found that this method aids in the improvement of both clinical knowledge and the quality of actions made. DISCUSSION As conceptual graphs, representations based on diagrams can be translated into computational tree logic. However, diagrams are much more natural and explicitly human, emphasizing a theoretical and practical consistency. CONCLUSION The proposed approach allows for the visual modeling of temporal reasoning and a formalization of knowledge that can assist in the diagnosis and treatment of nosocomial infections and some clinical problems. This is the first time that one emphasizes the temporal situation modeling in conceptual graphs. It will also deliver a formal verification method for clinical guideline analyses.

Modeling for effective collaboration in telemedicine

Requirements and modeling for supporting collaborative activities in telemedicine.Identification of types of exchanged data for information sharing in telemedicine.Functional specifications associated with achieving an effective telemedicine work.Semantic formalization to give good meaning and substance to shared information.Management of the acquired knowledge through the capitalization of the reasoning. Telemedicine is a remote medical practice, which utilizes advanced telecommunications and information technologies for the delivery of healthcare and the exchange of heath information across distances. The development of telemedicine has significantly changed the medical collaborative decision making and doctor-patient relationships and has an impact on the responsibilities of physicians to patients and how to treat them. Moreover, in the chain of medical care information exchanged between a requesting physician and medical expert should assist in decision making. In this regard, we propose means for the formalization of exchanges, which is very important because it facilitates a transparent and traceable understanding of the remote process. So, we engage knowledge-based modeling for supporting collaborative activities in telemedicine. This includes the engagement of formal ontologies to ensure structuration of terminology and identification across all entities in a domain so that multiple sources of data can be aggregated through comparable reference terms. The provided benefit is the generated support for logic-based intelligent applications that are able to perform complex reasoning tasks such as checking for errors and inconsistencies and deriving logical inferences.

Argumentative reasoning and taxonomic analysis for the identification of medical errors

Telemedicine consists of the use of information and communication technologies (ICTs) in the practice of medicine. The massive digitalisation of the society is changing the behaviour of ordinary people even in medical sectors. The impact of digitisation is also having impacts on teleexpertise, where a medical professional can remotely ask some advices through the use of ICTs to provide treatment to a patient in critical conditions in remote environment. However, sometimes the outcome of such advice obtained remotely can lead to medical errors. In these situations, it is important to determine whether the causes of the errors could have been avoidable or not for the purposes of establishing the truth and assuring justice for the victims of medical errors. The proposed work fits this perspective with the objective to formalise elements of argumentation in collaborative medical organisations using telemedicine. In other words, a technique that extends the Dungs argumentation framework in order to bring out the errors committed following a remote medical procedure has been proposed. The proposed technique is underpinned by graphical reasoning. The reasoning is represented through a directed graph in which the extended nodes specify the arguments with their source(s) and the identification of errors is done according to the Makehams and Tempos taxonomies. To illustrate the functioning of the proposed technique or solution, an example of the practice of teleexpertise (between two French hospitals) that leads to litigation is presented. HighlightsKnowledge representation and reasoning with a logic-based argumentation framework.Semantics of acceptance to enlighten the collaborative decision making processes.Support the identification of errors according to Makehams and Tempos taxonomies.Configurable procedures for indexing medical documents and information retrieval.Case study: telemedicine with a teleexpertise for treatment of a subdural haematoma.

Combining conceptual graphs and argumentation for aiding in the teleexpertise

Current medical information systems are too complex to be meaningfully exploited. Hence there is a need to develop new strategies for maximising the exploitation of medical data to the benefit of medical professionals. It is against this backdrop that we want to propose a tangible contribution by providing a tool which combines conceptual graphs and Dung׳s argumentation system in order to assist medical professionals in their decision making process. The proposed tool allows medical professionals to easily manipulate and visualise queries and answers for making decisions during the practice of teleexpertise. The knowledge modelling is made using an open application programming interface (API) called CoGui, which offers the means for building structured knowledge bases with the dedicated functionalities of graph-based reasoning via retrieved data from different institutions (hospitals, national security centre, and nursing homes). The tool that we have described in this study supports a formal traceable structure of the reasoning with acceptable arguments to elucidate some ethical problems that occur very often in the telemedicine domain.

Argumentation graphs with constraint-based reasoning for collaborative expertise

Abstract Collaborative processes are very important in telemedicine domain since they allow for making right decisions in complex situations with multidisciplinary staff. When modelling these collaborative processes, some inconsistencies can appear. In semantic modelling (conceptual graphs), these inconsistencies are verified using constraints. In this work, collaborative processes are represented using an argumentation system modelled in a conceptual graph formalism where inconsistencies could be particular bad attack relation between arguments. To overcome these inconsistencies, two solutions are proposed. The first one is to weight the arguments evolving in the argumentation system on the basis of the competencies of the health professionals and the credibility of the sources justifying their advice (arguments), and the second one is to model some law concepts as constraints in order to check their compliance of the collaborative process.

Neurodegeneration in tauopathies and synucleinopathies

While increasing life expectancy is a major achievement, the global aging of societies raises a number of medical issues, such as the development of age-related disorders, including neurodegenerative diseases. The three main disease groups constituting the majority of neurodegenerative diseases are tauopathies, alpha-synucleinopathies and diseases due to repetitions of glutamine (including Huntingtons disease). In each neurodegenerative disease, the accumulation of one or more aggregated proteins has been identified as the molecular signature of the disease (as seen, for example, in Alzheimers disease, Parkinsons disease, dementia with Lewy bodies, amyotrophic lateral sclerosis and frontotemporal dementia). The etiology of neurodegenerative diseases is often multifactorial, and the known risk factors include, in addition to genetic polymorphisms and age, some other possible causes, such as certain immune and metabolic conditions, endocrine pathologies, gender, socioeconomic or professional status, oxidative stress or inflammation, vitamin deficiencies and environmental factors (chemical exposure, metals). However, innovative strategies to elaborate suitable diagnostic and therapeutic approaches (aiming to at least delay or possibly even reverse disease progression) require further knowledge of the genetic and adaptive immunological characteristics of neurodegenerative diseases.

Thrombotic thrombocytopenic purpura (TTP) leading to pseudotumour's autoimmune pancreatitis (AIP): A case report

INTRODUCTION Autoimmune pancreatitis is an idiopathic inflammatory disease that produces pancreatic masses and ductal strictures. This benign disease can be associated with extrapancreatic manifestations including cholangitis, sialadenitis, inflammatory bowel disease or retroperitoneal fibrosis, mediastinal adenopathy, interstitial nephritis mainly due to immunoglobulin G4 (Ig G4), and occasional association with other auto-immune diseases. OBSERVATION We report a 57-year-old woman who developed thrombotic thrombocytopenic purpura (TTP) and pseudo-tumours seronegative autoimmune pancreatitis (AIP) type 1. The patient was initially treated with pulse corticosteroids and plasmapheresis; afterwards two cures of i.v. Vincristin with inadequate response and subsequently with four weekly pulses dose of i.v. Rituximab, leading to full remission. CONCLUSION This case represents the first report of TTP associated to pseudo-tumours seronegative AIP type 1 successfully treat by Rituximab.