Developing SNOMED-CT for decision making and data gathering: a software prototype for low back pain

The issue of medical errors is currently a global concern which places a heavy financial and emotional burden on communities. A clinical decision support system [CDSS] is an electronic system designed to support clinical decision making. Considering the increasing importance and use of Systematized Nomenclature of Medicine-Clinical Terms [SNOMED-CT], we developed SNOMED-CT to implement it more efficiently in making smart history taking, decisions to perform lab tests and imaging, diagnosis and recommendations. To evaluate these capabilities in real clinical problems, a new CDSS was compiled, aimed at supporting decisions on patients with a chief complaint of low back pain [LBP]. A number of LBP differential diagnoses as well as some recommended indications and contraindications published by guidelines, were inputted to the database. Future software based on this model would help physicians to do necessary assessments and recommendations and might improve patients' safety.

[Molecular genetics and gene therapy in esophageal cancer: a review article]

With approximately 386,000 deaths per year, esophageal cancer is the 6th most common cause of death due to cancer in the world. This cancer, like any other cancer, is the outcome of genetic alterations or environmental factors such as tobacco smoke and gastro-esophageal reflux. Tobacco smoking is a major etiologic factor for esophageal squamous cell carcinoma in western countries, and it increases the risk by approximately 3 to 5 folds. Chronic gastro-esophageal reflux usually leads to the replacement of squamous mucosa by intestinal-type Barrett's metaplastic mucosa which is considered the most important factor causing esophageal adenocarcinoma. In contrast to esophageal adenocarcinoma, different risk factors and mechanisms, such as mutations in oncogenes and tumor suppressor genes, play an important role in causing esophageal squamous cell carcinoma. Molecular studies on esophageal cancers have revealed frequent genetic abnormalities in esophageal squamous cell carcinoma and adenocarcinoma, including altered expression of p53, p16, cyclin D1, EGFR, E-cadherin, COX-2, iNOS, RARs, Rb, hTERT, p21, APC, c-MYC, VEGF, TGT-alpha and NF-kappa B. Many studies have focused on the role of different polymorphisms such as aldehyde dehydrogenase 2 and alcohol dehydrogenase 2 in causing esophageal cancer. Different agents including bestatin, curcumin, black raspberries, 5-lipoxygenase [LOX] and COX-2 inhibitors have been found to play a role in inhibiting esophageal carcinogenesis. Different gene therapy approaches including p53 and p21WAF1 replacement gene therapies and therapy by suicide genes have also been experimented. Moreover, efforts have been made to use nanotechnology and aptamer technology in this regard