CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

In recent years, The rising Web-services technology has been manipulated to provide various
services to mankind which has been making life easier by the day. Computer technology also has
gone through significant changes which have influenced many areas of the human race. One of
this aspect of life that has been affected positively by the use and application of computer
technology is medicine and healthcare through the application of a branch of artificial
intelligence (AI) called Expert System (Nohria, 2015). Alan Turing described intelligent
behavior as the ability to achieve human-level performance in all cognitive tasks (Daniel and
Udo, 2017; Abu Naser and Alawar, 2016). An expert system is an intelligent computer program
which captures the knowledge of a human expert as depicted. This information is then used to
solve real-world problems in an automated fashion. The mode of operation of these systems is
simply that expertise on a specific subject is transferred from a human to a computer. The main
purpose of knowledge-based expert systems is to make the knowledge of a human expert and
their experiences to be more commonly available, particularly in areas where they are not readily
available. The quality, efficiency, and competitive control of expert system operations have
increased over the years. Expert systems are applied in many diverse areas such as medicine,
education, and engineering (Nohria, 2015). An Expert system has brought about many positive
changes to the field of medicine ranging from the data and file processing of patient’s record, use
of robotics in performing surgical operations to the use of Wireless Body Area Networks for
sensing and sending information on the health of the patients. Medical expert systems have
helped in creating various types of application systems to complement and support the duties of a
doctor in effectively performing their duties. The main advantage of the expert system is the
ready availability and easy access of patients to expert knowledge and advice at all times
(Amarathunga et al., 2015).

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1.2 STATEMENTS OF THE PROBLEM

Human diseases should be treated on time; otherwise the patients might die if there is delay in
attending to such patient or scarcity of medical practitioners only a few parts of the world are not
making good use of computers to the full. Sickle cell anaemia has been with man for a long time,
a lot myth surrounds its occurrence and management. In recent times science and technology had
laid bear on those traditional beliefs. It is now known to all and sundry that it is a disease that is
inherited from once parents. Resulting in a sickle shape of the red blood cells. This cause a
reduction in the amount of oxygen absorbed into the body by the red blood cells. Aside the
disease the traumatic or psychological trauma it causes is another side of the problem entirely.

1.3 AIM AND OBJECTIVES OF THE STUDY

The aim of this study is to design an expert system on sickle cell anemia and Gonorrhea
diagnosis.

The objectives of this research work are:

1. To determine the procedurals for test analysis for sickle cell disease and Gonorrhea.
2. To determine the symptoms, causes and prevention for sickle cell anemia and Gonorrhea.
3. Develop a user-friendly Web-based Medical Diagnostic Expert System for sickle cell
anemia and Gonorrhea.
4. Evaluate the Web-based Medical Diagnostic Expert System in terms of accuracy of
diagnosis, correctness, functionality and usability.

1.4 SIGNIFICANCE OF THE STUDY

This study would help to provide solutions to lingering psychological assault on people
living with sickle cell disease and Gonorrhea, It will also provide a contextual and
theoretical understanding of sickle cell anaemia and Gonorrhea. The fining of the study will
be an advantageous to the hospital and clinical care. Successful applications result in
numerous benefits such as: reduced decision-making time, consistency in decision-making,
improved service levels and better use of human expert time. Flexible, and easy to use and is
designed and developed to deliver real conceivable benefits to hospitals and clinics, this will

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 improve its effectiveness and quality of work as well as, analyze the key processes well to
increase the success of sickle cell anemia treatment. In the process this system will help the
student on the basis of expertise. The world's education use expert systems to help the
learning process.

1.6 SCOPE OF THE STUDY

The scope of this study follows a chain of conditions and derivations; the work is divided in
three parts. In the first one, we show the different steps of a physician’s diagnosis of a patient.
The second part is related to the architecture of the expert system, including the application of
the method of data analysis. The results thus obtained are made more precise by the application
of them interference engine which itself uses the knowledge base system. The knowledge base
also interfaces to the User interface this component is essential for a non-expert user to
interact with the expert system and find solutions. Interpreting inputs and providing relevant
outputs, Predicting results, Assistance in human decision making, so doing it uses various
types of reasoning strategies to infer solutions from both Knowledge Base supplied information
and user supplied information In the third part we give the clinical conclusion.

1.6 LIMITATIONS OF THE STUDY

The reason for restriction was to identify the available relevant resources and time within the
framework of the study in order to accomplish the study. Furthermore it is evident that no
technology is entirely perfect to offer easy and complete solutions. Larger systems are not
only expensive but also require a significant amount of development time and computer
resources. Limitations include:

 Difficult knowledge acquisition

 Maintenance costs
 Development costs
 Requires constant manual updates, it cannot learn by itself.
 It is incapable of providing logic behind the decisions.

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1.7 CHAPTER ORGANIZATION

This project report is organized in five chapters which are:

Chapter one – the introduction: it covers the following headings; Background of the
study, Problem statement, Aims and Objectives of the study, Scope and limitation of the
study, Organization of the work
Chapter two – literature review: in this chapter, a review of existing literature on the
related works will be carried out. It gives an overview of existing digital library models
and related works deploying similar technology. From the review of related literatures, a
number of research gaps in the study area were highlighted.
Chapter three – design methodology and implementation: this chapter describes the
methodology adopted in implementing the design. It explains the equipment used and the
development techniques used.
Chapter four – result and discussion: in this chapter, the result of the work done in
chapter three is presented and discussed.
Chapter five – conclusion, limitation and recommendation: from the result of the
presented in chapter three, a conclusion is drawn. This chapter highlights the conclusion
drawn, the limitations of the project and recommendations.

1.8 OPERATIONAL DEFINITIONS OF BASIC TERMS

Expert: a person who is very knowledgeable about or skilful in a particular area.

Diagnoses: identify the nature of (an illness or other problem) by examination of the symptoms.

Analysis: detailed examination of the elements or structure of something.

Causes: a person or thing that gives rise to an action, phenomenon, or condition.
Prevention: is a leading provider of trustworthy health information, empowering readers with
practical strategies to improve their physical, mental

Sickle cell anemia: A group of disorders that cause red blood cells to become misshapen and
break down or An inherited disease in which the red blood cells have an abnormal crescent
shape, block small blood vessels, and do not last as long as normal red blood cells.

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Red blood cells: also referred to as red cells, red blood corpuscles, haematids, erythroid cells or
erythrocytes, are the most common type of blood cell and the vertebrate's principal means of
delivering oxygen to the body tissues—via blood flow through the circulatory system.

Cell: is a mass of cytoplasm that is bound externally by a cell membrane. Usually microscopic in
size, cells are the smallest structural units of living matter and compose all living things

STD: Sexually transmitted diseases (STDs), or sexually transmitted infections (STIs), are
infections that are passed from one person to another through sexual contact. The contact is
usually vaginal, oral, or anal sex. But sometimes they can spread through other intimate physical
contact

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 CHAPTER TWO

LITERATURE REVIEW

2.0 INTRODUCTION

This chapter is organized under the following Sub-headings, Introduction, Review of the related
literature, Review of related system, the Mycin program for infectious diseases, Pneumoconiosis
x-ray diagnosis expert system, XDIS, Brief history of expert systems, Review of related tool.

2.1 REVIEW OF RELATED LITERATURE

Sickle cell disease (SCD) is a lifelong, multisystem condition characterized by hemoglobin

polymerization that leads to erythrocyte rigidity, hemolysis, and vaso-occlusion. Prevalence
estimates for the United States (US) in 2016 suggest that between 70,000 and 100,000 people
had SCD (Miller et al 2007). Also, a further estimated 3.5 million individuals had the sickle cell
trait, meaning they were carriers of one of several autosomal recessive alleles responsible for the
disease. The most common SCD genotype is HbSS, and the disease is most prevalent in people
of African ancestry (Yawn, et al 2014).Vaso-occlusive crises (VOC) and pain associated with
such crises are hallmark symptoms in SCD, and typically first manifest in infants around the age
of 5 months. These painful episodes can occur without warning and have been described as
sharp, intense stabbing or throbbing. The pain can be debilitating, resulting in frequent
emergency department (ED) and hospital visits. Furthermore, complications of SCD, such as
anemia, infection, and stroke can have major physiological, cognitive, and emotional effects on
patients. Current US guidelines for SCD management focus mainly on health maintenance and
treatment of acute and chronic complications (Puffer, et al 2006). Health maintenance
recommendations include prophylactic penicillin treatment and pneumococcal vaccination in
patients with asplenia. And screening or diagnostic tests for SCD-related complications; and
supportive management includes treatment with antibiotics, pain crisis management, and blood
transfusions. Stem cell transplantation is the intervention most likely to be curative, but has many
risks and is not performed frequently (Hsieh, et al 2009).

Because there is currently no pharmacotherapeutic cure for SCD, and in most cases management
of the disease is palliative, a key therapeutic goal is to reduce the occurrence of painful crises.

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For this, the traditional mainstay treatment has been the antineoplastic agent hydroxyurea. This
drug helps prevent crises in both adults and children by increasing the amount of fetal
hemoglobin found in patients’ red blood cells (RBCs), thus leading to various beneficial effects
on RBC structure, content, and function (Wang, et al. 2011). In turn, this reduces the need for
transfusion and the likelihood of organ damage. More recently, an alternative therapy, L
glutamine was also approved by the US Food and Drug Administration (FDA) for the treatment
of SCD in children and adults, with the aim of reducing severe SCD-related complications (Fatil,
et al 2018).

Despite the availability and use of hydroxyurea and L-glutamine, SCD remains a disease
with major unmet needs, with many patients experiencing poor clinical outcomes in both the
short and longer term. There is also substantial evidence suggesting that SCD is associated with a
considerable impairment of patients’ burden with SCD. However, characterizing the nature and
extent of this humanistic deficit, and whether or how it differs between patient subgroups or with
disease stage, is hampered by a lack of clarity about which (if any) of the patient-reported
outcome (PRO) instruments used to-date are best able to capture patients’ experience of SCD.
This lack of clarity has major implications for the investigation into potential new treatments for
SCD. In particular, it raises questions about how best to assess whether, or to what extent, such
interventions affect humanistic outcomes. Therefore, to inform recommendations of PROs that
might be suitable for use in future SCD clinical trials, a systematic literature review (SLR) was
conducted to identify, summarize, and evaluate PRO instruments that have been developed
and/or validated in previous US trials and observational studies of SCD. The condition of having
sickle cell disease will be defined as occurring in one or the other of the two following states:
sickle cell anemia-a severe, uncorrectable, and often fatal anemia with many clinical
manifestations, and sickle cell trait--a relatively benign condition with symptom atology
occurring only under extraordinary circumstances.

Hemoglobin functions as the oxygen carrying substance of the blood, and is responsible
for the pigmentation of the erythrocytes or red blood cells. The condition of sickle cell anemia
results from the presence of an abnormal hemoglobin, known as Hb-S, in the erythrocytes. The
presence of this hemoglobin is hypothesized to have been an asset in protecting· its bearer from
the effects of malaria in those countries where the occurrence of malaria is common. (Levitan et

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al 2011), proposed, that the· heterpgygote AS was less susceptible· than the normal
homozygotes to Falciparum malaria, an often fatal· malaria constantly reinfecting its victims
with severe and prolonged disease. However, for that segment of the population carry in the
abnormal hemoglobins, but residing in no malaria environments, the advantage of hemoglobin S
disappears. In the United States, sickle cell anemia is found predominantly (Wintrobe et al
2014), the "frequency of occurrence of sickle cell trait is 8.5 per cent of the black population.
Approximately one out of four hundred blacks (National Sickle Cell Prevention Act, experiences
the anemia itself. The incidence of the disease in other races is quite rare, and when it does occur
in members of other races, it is usually experienced by persons of Greek, Italian, and East Indian,
South American and Middle Eastern origins.

2.1.2 CLINICAL MANIFESTATIONS

Sickle cell anemia has been referred to as "the great mimicry" due to the 'multiphasic
manifestations and complexities of its symptoms. Consequently, the risk of incorrect early
diagnosis is high. (Lin-Fu et al 1965), in infants, symptom atology, particularly in the first few
months of life, is bizarre and non-specific'. Major complaints 'usually include colic, failure to
thrive, jaundice, nausea and vomiting, recurrent fever, and swelling in hands and feet. In older
children, periodic occurrences of acute episodes with various manifestations facilitate
recognition of sickle cell anemia. These episodes, known 8S "crises", are brought about when the
erythrocytes or red blood cells begin to sickle. Sickling is the term used to describe the change
that occurs within the cells under conditions of reduced oxygenation. The cells elongate and
twist into distorted shapes that prohibit free flowing movement of the blood. It is proposed that
"logjams" of these rigid cells form, resulting in impeded circulation in the smaller vessels, thus
inhibiting the flow of oxygen to the affected part of the body. This blood flow obstruction causes
tissue death, which produces acute, incapacitating pain in any part of the body, fever, and many
other non-specific symptoms. This symptom complex comprises the sickle cell crisis." Other
manifestations include necrosis, which might occur resulting in chronic leg ulcers; however, this
is less common among those children afflicted with sickle cell anemia than for adults. Incipient
blindness from retinal detachment might also result from sickling and reduced. Oxygenation in
the cells of the eyes. The result is an overall retarded growth and development, and increased
susceptibility to infections and pneumonia are further manifestations of the anemia. The

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childhood victim of this illness is usually characterized by a. barrel-shaped chest, enlarged
protruding abdomen; and thin extremities. Sickle cell disease, in both its forms, is a genetically
acquired condition. (Song, ibid) Inherited as an autosomal recessive, pattern Fraser, sickle cell
anemia is the homogygos state of the abnormal hemoglobin S gene. The mating of two persons
with the sickle cell trait would imply a 25 per cent probability that each offspring will inherit two
abnormal genes (Hb-s) ,8 25 per cent probability that the offspring will inherit two normal genes,
and a 50 per cent probability that the offspring will inherit one normal gene and one abnormal
gene. In other words, based on statistical calculation using 'a Mendelian model, (Fraser et al
2011).

2.1.3 INHERITANCE PATTERNS OF SICKLE CELL DISEASE

During crisis situations, treatment is largely supportive and symptomatic. Oxygen administration
and the use of analgesics and sedatives seem to be somewhat effective in reducing the painful
symptoms of the acute sickling periods. Management and care must extend beyond medical
treatment. Optimal nutrition, satisfactory dental and hygienic care, and avoidance of "exposure to
infection and crisis precipitating factors are essential in the care of the individual during
quiescent periods. The use "of urea has received considerable recent interest "in the treatment of
sickle cell anemia, and feasibility studies are currently underway to determine the extent that
urea is effective as a prophylactiC measure in the prevention of crisis.- Unfortunately, no
treatment has been universally demonstrated or accepted as an effective combatant of sickle cell
disease (Peter, et al 2007)

2.3 REVIEW OF RELATED SYSTEM

This review of related system paper presented different expert systems for diagnosis of medical
conditions associate with human health. A lot of researches on artificial intelligence and expert
systems have been conducted and has led to the development of many expert systems for
application in medicine. The structure of expert systems is diverse according to different
underlining technologies. The very first medical expert system is the MYCIN developed to
diagnose blood diseases. MYCIN utilizes the Backward Chaining Inference method to identify
bacteria causing infections and to recommend a line of treatment (Buchanan et al 1984). In

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(Mrouf et al 2017), an expert system for long-term abdominal pain was proposed which was able
to give probable causes and cure for the diseases. A medical expert system for diagnosis and
treatment of hypertension among pregnant women who are patients of the Reproductive Health
Division, Moi Teaching Hospital in Kenya was developed, tested and found to be effective and
accurate (Gudu et al., 2012). Furthermore, (Asabere 2012) presented a mobile-based medical
expert system deployed for medical institutions across the nation in Ghana. With the deployment
of the system, it has resulted in fast and quality service delivery as licensed medical practitioners
can accelerate diagnosis and attend to patient on-the-go. This work aims to improve the health
service delivery within the university’s health centre especially for students who are based off-
campus and in need of emergence care as the medical expert system is web-based. The system
has been designed for use of the students prior to getting medical attention from professional
medical practitioners.

2.3.1 THE MYCIN PROGRAM FOR INFECTIOUS DISEASES

MYCIN is one of the earliest medical expert systems developed. It was designed to diagnose
and prescribe treatment for infectious diseases particularly spinal meningitis and bacterial
infections of the blood. It first decides what bacterium caused the disease and then based on this
decision; it suggests what antibiotic to give the patient. It is very helpful for physicians that lack
expertise at certain diseases (Ukpebor 2012).

2.3.2 PNEUMOCONIOSIS X-RAY DIAGNOSIS EXPERT SYSTEM

This expert system, developed by (Herzner et al 1992), incorporates the inference engine to
examine the shadows on the x-ray. The shadows are used to determine the type and degree of
pneumoconiosis (a lung disease). The system also includes three other modes: the knowledge
base (which contains the data of X-ray representations of various stages of the disease), the
explanation interface (which details the conclusions) and the knowledge acquisition mode
(which allows experts to add or change information in the system).

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2.3.4 XDIS

This is an expert system that was designed to assist physicians in making diagnosis. The system
contains information of more than 300 internal diseases and pathologic syndromes most
frequently met in general practice. For each set of symptoms entered for a case, the system gets
the full list of possible diagnosis ranking from the most probable to the least probable. The time
to work out a diagnosis is usually less than 10 minutes (Musharraf Y et al 2006). XDIS helps
make preliminary diagnosis on the first visit of a patient to the physician and at the same time
decide on the necessity of referring the patient to a specialist and to select medical tests to make
a more exact diagnosis.

2.4 REVIEW OF RELATED TOOLS

Expert Systems have two integral components: a knowledge base and a mechanism for drawing
inferences. Both need to be represented within the computer. ES have usually been designed
using programming languages like LISP (List Processing), a language specifically designed for
symbolic and list manipulation, or PROLOG (Programming in Logic), a language which
facilitates specification of facts and inferences that may be drawn from it. LISP and PROLOG
are referred to as AI languages. These naturally lend themselves to design of knowledge systems.
Often designers of knowledge systems may also want access to a prepackaged code that
facilitates the programming task. Packages which allow access to such a code is called
programming environments. INTERLISP, a version of LISP which contains a large number of
prepackaged routines is an example of programming environment. A number of ES (e.g. DRILL
ADVISOR) (Kubiska et al., 2005).have been implemented using INTERLISP. However, if rapid
development of ES is to take place, the designer must have access to what are known as
Knowledge Engineering Tools or Shells. Shells are packages that contain elementary constructs
for modeling and specific strategies for representing knowledge, inference, and control. The
extent to which a shell facilitates development of a knowledge system will depend on how
closely and accurately the problem domain can be modeled by the constructs available in the
shell.

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2.5.2 PROGRAMMING LANGUAGES

The expert system tools are programming systems which simplify the job of constructing an
expert system. They range from very high-level programming language to low-level support
facilities (David et al 2014). Most important programming languages used for expert system
applications are generally either problem-oriented languages, such as FORTRAN and PASCAL,
or symbol manipulation languages, such as LISP and PROLOG. Problem oriented languages are
designed for particular classes of problems; e.g., FORTRAN has convenient features for
performing algebraic calculations and is most applicable to scientific, mathematical and
statistical problem area.

Necessary expert information was collected using structured interview and through the
internet. The waterfall software development model was adopted primarily because this model is
simple to understand, implement and it prescribes a systematic approach to software
development (Yogi et al 2012). The software development environment includes Hypertext Pre-
Processor (PHP - scripting language for connection to the database), Structured Query Language
(SQL), Hypertext Mark-up Language (HTML - used for the user interface functionality) with
Java Script (JS) and Cascading Style Sheet (CSS) to produce an interactive user interface that
connects to a database. Unit and integrated system testing of the codes were done. Black box
system testing was also performed. Symbol-manipulation languages are designed for artificial
intelligence applications; e.g., LISP has mechanism for manipulating symbols in the form of list
structures. A list is simply a collection of items enclosed by parenthesis, where each item can be
either a symbol or another list. List structures are useful building blocks for representing
complex concepts. The most popular and widely used programming language for expert system
applications is LISP, although PROLOG has also gained popularity. Symbol- manipulation
languages like these are more suitable for work in artificial intelligence, although a few expert
systems have been written in problem-oriented languages like FORTRAN and PASCAL. E.S.
are typically written in languages like LISP and PROLOG or even CLIPS (C language Integrated
Production System Developed in mid 1980s). The use of these languages in the development of
an e.s. simplifies the coding process. The major advantages of these languages as compared to
conventional programming languages, is the simplicity of the addition, elimination or
substitution of new rules and memory management capabilities.

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2.5.3 KNOWLEDGE ENGINEERING LANGUAGES

Knowledge engineering language is a tool for developing expert systems, consisting of an expert
system building language integrated into an extensive support environment. A programming
language is an artificial language development to acquire knowledge, accept/reject knowledge to
control and direct the operation of a computer (Neelakandan et al 2010). A knowledge
engineering language is a type of programming language designed to construct and debug expert
system K.E. language provide certain faculties for building expert system; they are flexible than
less programming languages with regard to how knowledge can be represented and manipulated.
Knowledge engineering languages can be categorized as either skeletal systems or general-
purpose systems. AI researchers developed these languages expressly for building expert systems
(Dinesh et al 2015).

2.5 .4 SYSTEM-BUILDING AIDS

The system-building aids consist of programs which help acquire and represent the domain
expert’s knowledge and programs which help design the expert system under construction. These
programs address very difficult tasks; many are research tools just beginning to evolve into
practical and useful aids, although a few are offered as full-blown commercial systems.
Compared with programming and knowledge engineering languages, relatively few system-
building aids have been developed. Those which exist fall into two major categories; design aids
and knowledge acquisition aids. The AGE system exemplifies design aids, while TEIRSIAS,
MOLE and SALT exemplify knowledge acquisition, TIMM system construction and SEEK
knowledge refinement aids. A few of these are discussed below:

i. AGE

This software tool helps the knowledge engineer design and builds an expert system. AGE
provides the user with a set of components which, like building blocks, can be assembled to form
portions of an expert system. Each component, a collection of INTERLISP functions, supports
an expert system framework, such as forward chaining, backward chaining, or blackboard

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architecture. The term blackboard refers to a central data base used by systems, to coordinate
and, control the operation of independent groups of rules called knowledge sources. The
knowledge sources communicate by writing messages on the blackboard and reading messages
from other knowledge sources.

This architecture was first used in HEARSAY-II, a speech understanding system developed in
the mid-1970s, and led to HEARSAY-III, a knowledge engineering language for controlling
multiple knowledge sources. Blackboard systems are the foundations of modern user interface
architecture.

Knowledge engineers have used AGE to design and build HANNIBAL, an expert system which
performs situation assessment by interpreting enemy radio communication data. The system uses
information about the location and signal characteristics of the data to identify enemy
organizational units and their communications order of battle.

ii. MOLE:

This is a knowledge acquisition system for heuristic classification problem, such as diagnosing
diseases. In particular, it is used in conjunction with the cover-and- differentiates problem
solving method. The expert-system-produced by MOLE accepts input data, comes up with a set
of candidate explanations or classifications which cover the data, and then uses differentiating
knowledge to determine which one is best. The process is iterative, since explanations must
themselves be justified, until ultimate causes are ascertained. MOLE interacts with a domain
expert to produce a knowledge base which a system, called MOLE-p (for mole performance)
uses to solve problems.

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