SNOMED CT Templates

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Descriptions:

Termdescription typeLanguage/acceptabilityLanguage/acceptabilityCase significance
[X] Botulism (disorder)FSNus:Pgb:Pci
[X] Botulism SYNus:Psmgb:Pci

Concept model:

Attribute cardinalityAttributeValuerole group numberRole group cardinality
1..1

116680003 |Is a (attribute)|

<< 64572001 |Disease (disorder)|

0N/A
1..1

116680003 |Is a (attribute)|

39157001 |Flaccid paralysis (finding)|

0N/A
1..1

363698007 |Finding site (attribute)|

<< 71616004 |Skeletal and/or smooth muscle structure (body structure)|

0N/A
0..1

42752001 |Due to (attribute)|

781249001 |Consumption of contaminated food (event)|  OR  785340007 |Inhalation of substance (event)|

0N/A
1..1

363714003 |Interprets (attribute)|

249893002 |Gross movement of body and limbs (observable entity)|

11..1
1..1

363713009 |Has interpretation (attribute)|

2667000 |Absent (qualifier value)|

1
0..1

21..1


1..1

370135005 |Pathological process (attribute)|


878838000 |Neurotransmitter release inhibitory process (qualifier value)| 

2
1..1

246075003 |Causative agent (attribute)|


<< 11894001 |Clostridium botulinum toxin (substance)| 

2
1..1

363698007 |Finding site (attribute)|

31627007 |Neuromuscular junction (cell structure)|

2
0..1

30..1
0..1

363698007 |Finding site (attribute)|

3
0..1

116676008 |Associated morphology (attribute)|

3
1..1

370135005 |Pathological process (attribute)|

3
1..1

246075003 |Causative agent (attribute)|

3

Definition status:  


900000000000073002 |Defined (core metadata concept)|

Applies to

<< 414531002 |Intoxication with Clostridium botulinum toxin (disorder)|

Template Language

116223007 |Complication (disorder)|  : [[~0..1]]   263502005 |Clinical course (attribute)|   = [[ +id (<   288524001 |Courses (qualifier value)|   ) @course]] , [[~1..1]]  42752001 |Due to (attribute)|  = [[+id (<<  64572001 |Disease (disorder)|  OR <<  71388002 |Procedure (procedure)| ) @dueto ]], [[~1..1 @rolegroup]]{ [[~0..1]]   116676008 |Associated morphology (attribute)|   = [[+id(<<  49755003 |Morphologically abnormal structure (morphologic abnormality)|   ) @morphology ]], [[~0..1]]   363698007 |Finding site (attribute)|   = [[+id(<   123037004 |Body structure (body structure)|   )]], [[~0..1]]   246454002 |Occurrence (attribute)|   = [[ +id(<   282032007 |Periods of life (qualifier value)|   ) @occur]], [[~0..1]]   370135005 |Pathological process (attribute)|   = [[ +id ( <   308489006 |Pathological process (qualifier value)|   ) @proc]], [[~0..1]]   246075003 |Causative agent (attribute)|   = [[ +id (<   410607006 |Organism (organism)|   OR <   105590001 |Substance (substance)|   OR <   78621006 |Physical force (physical force)|  OR <   260787004 |Physical object (physical object)|   ) @causative]] }

Link to the misaligned concept report

Due to Disease - https://docs.google.com/spreadsheets/d/1I_Bv8OZAFwikvpGorX03XqKplzbCdsrxIi4UG6u85AQ/edit#gid=0

Due to Disease or Procedure - https://docs.google.com/spreadsheets/d/10P1850T9c8PtmKL4EfiGEPZDSgbf6WFdDFckl1Xixzw/edit#gid=0

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17 Comments

  1. Nicola Ingram

    Hello Penni Hernandez Bruce Goldberg Jim Case

    As discussed at the QI meeting on Wed 11 March I have a CRS request in a task in progress about the botulism synonyms (Matt Cordell) and I have been working on this task CRSJUL20-582 with Penni as first reviewer and I have now added Bruce and Jim as requested.

    Yesterday (prior to viewing this template) I researched the area and based on my findings have created a new concept 863964005 |Neuroparalytic syndrome caused by Clostridium botulinum toxin (disorder)| with the Due to relationship of Intoxication with Clostridium botulinum toxin (disorder). For 409562009 |Inhalational botulism (disorder)|I have added an After relationship to Inhalation of substance (event). The 398523009 |Foodborne botulism (disorder)| and subtypes have been modelled with a Due to relationship of Consumption of contaminated food (event) and isa Poisoning (disorder) in addition to the stated parent Neuromuscular junction disorder (disorder).

    There are definite similarities to the template model Bruce has developed here and  based on research evidence (colonisation) 398530003 |Wound botulism (disorder)| and 409563004 |Intestinal botulism (disorder)| have been modelled with Pathological process Infectious process (qualifier value). 

    With agreement from Jim 38719000 |Toxicoinfectious botulism (disorder)| has been inactivated in a separate task just promoted as non-human content.

    Ref: https://www.uptodate.com/contents/botulism?search=botulism%20immune%20globulin&source=search_result&selectedTitle=2~7&usage_type=default&display_rank=1



    1. Bruce Goldberg

      The best model I could come up with for the top level "botulism" concept based on information from UpToDate is below. There is no morphology for this disorder. It is due to inhibition of acetlycholine release that occurs after the toxin binds to presynaptic receptors and is internalized. There is undoubtedly a pathological process going on but I am having a hard time identifying what it is. I am going to delete my task and start over if you agree with the model. I will modify the template after my testing is completed to everyone's satisfaction.


      I can now see (based on the UpToDate) info where Neuroparalytic syndrome caused by Clostridium botulinum toxin is distinct from other possible manifestations of botulism but I wonder if it is necessary to call this out as paralysis is an integral part of the syndrome?


  2. Bruce Goldberg

    Thanks Niki. This brings up a question:

    I am wondering what is the difference between 840421000 |Disorder of neuromuscular junction caused by botulinum toxin (disorder)|, 863964005 |Neuroparalytic syndrome caused by Clostridium botulinum toxin (disorder)| and just plain old 414531002 |Intoxication with Clostridium botulinum toxin (disorder)|? Why not just call this botulism which I think is universally understandable? I will update the template to reflect the paralysis and neuromuscular junction disorder. I have to determine an appropriate morphology for the finding site of neuromuscular junction  as I am not sure damage is correct.


  3. Nicola Ingram

    Hello Bruce Goldberg  agree Damage may not be the best morphology I did try to find something better but you are right there probably is no morphology. Parent would be 17940001 |Toxic neuromuscular junction disorder (disorder)|

    Would the causative agent and finding site be role-grouped in the screenshot examples above?

    Re your question: I wonder if it is necessary to call this out as paralysis is an integral part of the syndrome?

    For 'Neuroparalytic syndrome caused by Clostridium botulinum toxin' my thinking is that, similar to Orphanet modelling, where if a manifestation is named in the FSN and is always present then it is modelled in SNOMED.


  4. Bruce Goldberg

    Hi Nicola Ingram. I don't think causative agent and finding site should be role-grouped without including a morphology and/or pathological process. 


    Yes, the inferred parent would be 17940001 |Toxic neuromuscular junction disorder (disorder)|

    I guess my question was the reason for creating, Neuroparalytic syndrome caused by Clostridium botulinum toxin (disorder). Was a specific request? As you note, this is the clinical hallmark of botulism.


    Bruce

    1. Jim Case

      Bruce Goldberg , there is no inherent difficulty in grouping CAUSATIVE AGENT and FINDING SITE without the other attributes you mention.  As a matter of modeling consistency, they would need to be or subtypes that DO contain the other attributes would not classify under the proposed parent.  

      As noted in  the prior messages here, we now have lots of ways of representing different aspects of Botulism, but from a pragmatic view, they are all botulism.  Even iatrogenic....  Paralysis is a clinical manifestation  in the vast majority of cases, but it may present initially as cranial nerve dysfunction  without motor paralysis, so it might not be correct to make this a defining characteristic.

      1. Bruce Goldberg

        I noted that 388980004 |Third cranial nerve weakness (disorder)| has no relation to either 784289008 |Nerve palsy (disorder)|44695005 |Paralysis (finding)| or to 26544005 |Muscle weakness (finding)|. Perhaps if oculomotor palsy were a subtype of Nerve palsy and nerve palsy was a parent of botulism, this would be a defining characteristic. I question the current modeling of nerve palsy however as absent movement of body and limbs with a finding site of nerve structure. I think the finding site should be 71616004 |Skeletal and/or smooth muscle structure (body structure)| with a due to 7386033004 |Neuropathy (disorder)| relationship.

        1. Jim Case

          Bruce,

          I came across an older inception document related to paralysis and palsy (Content Project Tracker Documents), but it does not address the modeling issue you brought up.

  5. Nicola Ingram

    Hi Bruce Goldbergno specific request, the originating CRS request refers only to duplication of 'botulism' as a synonym so just my attempt to clean up the hierarchy but if not appropriate feel free to ignore/change.

  6. Jim Case

    Is this still the template we are revising for botulism?  I have some questions if it is...

  7. Bruce Goldberg

    Jim, I have created a new task,  AUTHORTEST-180 and marked it for review by you and Nikki. If approved, I will revise the existing template.


    Bruce




  8. Nicola Ingram

    Hello Bruce Goldberg after discussing with Monica I have deleted my CRS task in the authoring platform as the debate  has now moved on between yourself and Jim Case regarding this Template for botulism and the task AUTHORTEST-180 (not able to access but no need as Jim is reviewer)and I will view the results after you have finalised.


  9. Bruce Goldberg

    Thank you Nicola Ingram. Yongsheng Gao recently made some changes to the anatomy hierarchy around muscles to help support my model so I will resume work on this task next week o the week after.

  10. Bruce Goldberg

    Jim Case and Nicola Ingram . I finally got around to this again. I revised the template based on updates I made to task 

    • AUTHORTEST-211. I have marked it for re-review.

    Bruce

  11. Jim Case

    Bruce Goldberg,

    For the OCCURRENCE attribute, is there any reason we could not use <767023003 |Period of life beginning after birth and ending before death (qualifier value)|?

    The second optional RG is confusing to me (it is me, not you).  Are you trying to include all of the routes of infection in the RG, and  do we need the second OCCURRENCE relationship in the optional RG if it is included in the mandatory one?

    1. Bruce Goldberg

      Jim Case

      The only occurrences that need to be captured as relevant to botulism are adult, neonatal and infant but I guess the FSN would state these so that the author would know which specific descendant of 767023003 to choose?

      The 2nd optional role group is related specifically to the model for those forms of botulism (intestinal, infant and neonatal) for which the toxin is generated in situ. A 2nd role is required for the additional causative agent relationship to the organism. I concede maybe this is too complicated and perhaps a 2nd template for these kinds of botulism should be created?

  12. Bruce Goldberg

    The additional occurrence relationship in the 2nd role group could be removed.