The sources, nature, and scale of data are changing, and computing is deeply affecting the very nature of research from exploration, hypothesis creation, and literature review to collection, generation, and analysis of data, as well as reporting of results. In many fields no large-scale experiments are funded unless computer simulation shows high likelihood for results to turn out as expected. What is more, sensor technology and communication technology are making information technology ubiquitous, embedded in all sectors of life. As health care practitioners too have become generators of data, users of data-driven decisions, and researchers using data, there is a need to re-think our curricula. Medical curricula should embrace the fundamentals of big data, the info-computational paradigm of science, modern inferential techniques, and algorithmic thinking principles. By understanding such principles, healthcare practitioners will have improved skills for problem solving in computerized research, they will better understand the insights generated by the devices they use, will be able to design better research, and most importantly will deliver a better service to patients. That understanding is also important from the perspective of bottom-up innovation: The better healthcare practitioners understand the potential and caveats of computational thinking and big data, the better they are able to suggest new and improved ways of collecting data and dealing with it.

Background: Breast cancer (BC) is a heterogeneous disease characterized with diverse genetic and ethnic/racial variations that may influence tumor characteristics and prognosis. We studied different histological types of BC and their prognostic indicators in part of Southwestern Nigeria. Materials and Methods: A 10-year retrospective study of archival tissue-paraffin blocks and records of surgical cases (documented as BCs) between January 2005 and December 2014 was done. Tumor classification was made after the World Health Organization guidelines. Modified Bloom-Richardson score and TNM staging system were used in grading and staging the tumors. Nottingham prognostic index was employed in scoring the prognosis. Results: The mean age was 49.7 years (20–89 years). The age group from 50 to 59 years was most affected. Out of 343 total cases, the most common histological type was invasive ductal carcinoma of no special type (88.9%). The majority (51.9%) had tumor sizes ranging 2–5 cm (pT2) and some (39.1%) with >5 cm (pT3) were all at palpable stages. The tumors were mostly Grades II and III types. Observation for lymph node metastasis confirmed that 261 (76.1%) were pN0 (negative), 77 (22.4%) were pN1, and 5 (1.5%) were pN2. Prediction of a chance of survival showed moderate prognosis in the majority (48.7%) of the cases. Conclusion: Although early detection of BC in this region was considerably poor, there was a better outcome compared with some other black populations. Clinical presentation, histological type, and prognostic indices varied from existing reports in many ethnic/racial groups. Indexing of BC pattern on a regional standpoint may serve a new direction toward better management considering the associated geographic disparity.

Objective: The life expectancy of women increases with the advancement in modern medicine, leading them to spent about two decades in menopausal state along with its associated complications. The process of aging triggers a deleterious cascade of physiological changes in the body. Hence, the aim of our study is to determine the effects of both aerobic and anaerobic exercises on estrogen level in postmenopausal osteoporotic females. Methodology: A randomized control trial was conducted among 94 postmenopausal osteoporotic females, randomly divided into two equal groups. The participants in Group A were assigned to perform aerobic exercise, whereas Group B performed resistance exercises. Each group performed exercises for 12 weeks, whereas reading was collected for blood estrogen level, fat mass, and muscle mass before exercise training and after 12 weeks of training. Results: Twelve weeks of aerobic and anaerobic exercise program based on the American College of Sports Medicine (ACSM); frequency, intensity, time, and type protocol has beneficial effect on estradiol level and lean mass, whereas inversely correlated with fat mass of postmenopausal osteoporotic female. Conclusion: The study concluded that 12 weeks of exercise programs was found to be effective in improving estradiol level of postmenopausal osteoporotic female. The efficacy of anaerobic exercise was found to be more potent on estradiol level and lean mass than aerobic exercises as only 36 sessions of resisted exercises performed during a period of 12 weeks provided more significant result than 72 session of aerobic exercises.

Objectives: This study aimed at evaluating the effect of Legalon 70, a standard hepatic drug of silymarin, in reducing the toxic effects of hydrogen peroxide (H2O2) in broiler chickens. Methods: Twenty Ross broiler chickens of 30-day old were divided into four groups, Group 1 control, received drinking tap water, Group 2 treated with 0.5% H2O2 in drinking water, Group 3 treated with 0.5% H2O2 and 3 mg/Kg Legalon 70 daily, and Group 4 treated with a single oral dose of 3 mg/Kg Legalon 70 daily. After 4 weeks of the treatment, chickens were killed and the serum collected for the measuring of liver functions parameters, and the liver tissues used for processing the histological examination. Results: The results indicated that H2O2 treatment significantly elevated serum aspartate aminotransferase and alanine aminotransferase, and bilirubin level (direct and total) and decreased level of serum albumin comparing with control group. Treatment with Legalon 70 significantly reversed the H2O2-induced alteration and has positive effects on the liver functions parameters. Results of histopathology of H2O2-treated group showed severe vascular congestion, alveolar damage, and inflammatory cell infiltration, silymarin treatment blocked these changes and reduced the toxic effects of H2O2 toward liver cells. Conclusion: We concluded that silymarin induces the liver function recovery and considered in the treatment of liver injury. Silymarin, a major component of milk thistle, has been used as a hepatoprotector.

Objective: The objective of this study was to evaluate the sensitivity and specificity of total bilirubin (serum) in determining thyroid status in clinically euthyroid non-obese, overweight, and obese type 2 diabetics. Subjects and Methods: Three anthropometry specific groups of clinically euthyroid type 2 diabetics were enabled, following enrolment: 153 non-obese (body mass index [BMI] = 18.5–24.99), 291 overweight (BMI = 25–29.99), and 126 obese type 2 diabetes mellitus (BMI ≥30). Total bilirubin (serum), glycemic status, insulin resistance (IR), and thyroid hormones, besides routine biochemistry, were estimated, as per International Federation of Clinical Chemistry approved procedures. Results: Receiver operating characteristic curves for non-obese, overweight, and obese were plotted to assess the role of total bilirubin (serum) in determining thyroid status in clinically euthyroid type 2 diabetics. In overweight, the area under curve (AUC) for FT3 and postprandial sugar showed 0.621 and 0.531 with cutoff values of 2.02 pg/ml and 147.5 mg/dl, respectively, whereas for aspartate aminotransferase/alanine aminotransferase (De Ritis ratio), the AUC was 0.583. As regards, obese diabetics and the AUC for insulin and homeostatic model assessment IR were 0.657 and 0.709, respectively, with cutoff values of 16.06 mIU/L and 7.274, respectively, and for postprandial sugar 0.727, in the same group (obese) with cutoff value of 208.5 mg/dl. Conclusion: Total bilirubin could predict thyroid status and IR in anthropometry specific clinically euthyroid type 2 diabetics.

Objective: The high mortality associated with cervical cancer is due to low uptake of Pap smear test, lack of early diagnostic biomarkers and less-invasive approach, and late presentation of the disease. This study evaluated the expression of hsa-miR-let-7b, hsa-miR-21, hsa-miR-125b, hsa-miR-143, hsa-miR-145, hsa-miR-146a, hsa-miR-155, hsa-miR-182, hsa-miR-200c, and p53 in serum and cervix in relation to classes of Pap smear, in a bid to identify a serum panel for early diagnosis of cervical lesions. Methodology: This study included 329 women; 159 healthy women (HW), 46 cervicitis, 46 atypical squamous cells of undetermined significance (ASCUS), 40 low-grade squamous cell intraepithelial lesion (LSIL), 28 high-grade squamous cell intraepithelial lesion (HSIL), and 10 squamous cell carcinoma (SCC). Expression of microRNAs (miRNAs) and p53 was assessed using reverse transcriptase polymerase chain reaction. Results: Except for miR-143 and miR-146a, significant correlations were observed between serum and cervix expression of miRNAs and p53 in relation to levels and classes of Pap smear (P < 0.05). Relatively, higher expression of miR-21, miR-146a, miR-155, miR-182, and miR-200c and lower expression of let-7b and miR-145 were observed in sera associated with cervical abnormalities than in sera associated with normal cervix (P < 0.0001, P = 0.001, P < 0.0001, P = 0.003, P = 0.007, P = 0.036, and P = 0.046, respectively). Higher and lower expression of p53 was observed in women diagnosed of LSIL and SCC, respectively, than in HW (P < 0.0001). Conclusion: This study suggests that serum expression of miR-21, miR-182, let-7b, miR-145, and p53 is comparable to cervical cell expression and could be useful in differentiating abnormal cervix from the healthy cervix.

Objectives: Worldwide, health-care students, including occupational therapy students undergo ethics training. Ethics training facilitates students’ critical thinking, objective analysis and clinical reasoning skills to promote impartiality and minimize bias in decision-making. The aim of the study was to explore and describe similarities and differences in occupational therapy students’ perceptions and experiences of an ethical dilemma. Methods: The study employed a descriptive qualitative approach. Eighty occupational therapy students from South Africa and the United States of America (USA) participated in the study as part of an online international ethics module. Data were collected from students’ written analyses of a case study engaging them in an ethics reasoning process and were analyzed thematically. Results: Three themes emerged: Personal views and biases, ethical approaches, and practical alternatives and implications. Both groups of students from South Africa and the USA approached the case in a similar manner using their knowledge of ethics, principles, and approaches. They also applied the steps of an ethics reasoning process to guide their decision-making. All occupational therapy students from both countries highlighted Ethics of Care as an integral basis for their reasoning. Conclusion: There is a need amongst educators to identify, share, and discuss similarities and differences in how health-care practitioners address ethical issues, using the ethics reasoning process as a guide. The international occupational therapy community needs to further the profession’s meta-ethical discourse to guide clinical application within a diverse and globally connected workforce.

Background: Effective antibiotic therapy is crucial in sepsis management. Studies have emphasized on antibiotic administration timing more than dosing. We evaluated the frequency and risk factors of antibiotic dosing errors in sepsis. Materials and Methods: This prospective observational study compared the doses of intravenous empirical antibiotics in the 1st day of sepsis diagnosis with those recommended by Micromedex, considering sepsis source and glomerular filtration rate estimated by the modification of diet in renal disease equation. The doses were classified as under-dosed, over-dosed, or appropriate. We excluded antibiotics which did not need a dose adjustment. The under-dosing rate was retrospectively evaluated according to the creatinine clearance estimated by the Cockcroft-Gault equation. Results: Between October 1, 2013, and April 30, 2014, 189 patients were evaluated (age 61.6 ± 18.6 years, acute physiology and chronic health evaluation II score 22.8 ± 7.0, 58.7% septic shock) with 415 antibiotic prescriptions (2.2 ± 0.9 prescriptions per patient). Antibiotic dosing was appropriate in 50.8% of patients; under-dosing in 30.7% and overdosing in 25.9%. Under-dosing prevalence was 39.4% when kidney function was assessed by the Cockcroft-Gault equation. Vancomycin was associated with the highest under-dosing rate (39.4%), followed by piperacillin/tazobactam (12.1%). The cohort mortality was 35.4%. Age, shock, chronic kidney disease, and cirrhosis independently predicted mortality on multivariable logistic regression analysis. Antibiotic dosing error was not associated with mortality: Over-versus appropriate dosing (odds ratio [OR], 1.41; 95% confidence interval [CI], 0.57–3.47), under-versus appropriate dosing (OR, 0.57; 95% CI, 0.24–1.35). Conclusions: Antibiotic dosing errors were common in patients with sepsis. Vancomycin had the highest under-dosing rate. Antibiotic dosing errors were not associated with increased mortality.

Introduction: There is limited evidence of studying the associated factors of acute kidney injury (AKI) among patients with influenza A (H1N1) virus infection pandemic in 2009. AKI is one of the most prevalent complications in the intensive care unit. Its incidence is associated with high mortality and negative impacts on long-term survival. The aim of this narrative review was to determine the prevalence and mortality due to AKI, among patients admitted with the H1N1 virus. Materials and Methods: A narrative review of studies reporting about treatment measures and mortality associated with AKI during the H1N1 pandemic over a 10-year period (from September 2009 to August 2018), was performed. We searched the following databases; EMBASE, Medline/PubMed, NHS evidence, Google Scholar, and the Cochrane Library. Our inclusion revealed 20 studies of patients (n = 3579) who were admitted with H1N1 infection and developed AKI. Results: In this study, 33% of patients (n = 1164) who were admitted with H1N1 infection had developed AKI. Within the first 5 years (2009 to 2013), 36% of patients (n = 1013) developed AKI. Within the next 5 years (2014–2018), 812 patients were admitted with the H1N1 infection and 18% of patients (n = 150) had developed AKI. Over the 10 years, there was a 50% reduction in the number of patients who developed AKI (2009 and 2018) (P < 0.0001). Conclusion: Patients showed varied responses to treatment measures, depending on their geographical location, comorbidities, and other characteristics. Despite a reasonable prevalence of AKI among patients with the H1N1 virus infection, the mortality over the last 10 years was reduced, with renal replacement therapy as a common therapy in most studies.

Peripheral ossifying fibroma (POF) is a reactive, inflammatory, hyperplastic soft tissue growth of the gingiva. Lesions are usually labial and small with an anterior maxillary presentation, occurring commonly in the younger population. We present an unusual case of a large POF in a 68-year-old woman that presented on the posterior palate with a unique radiographic appearance. Various differential diagnoses of POF and such palatal lesions, etiopathogenesis of POF, and the surgical management of these lesions have been discussed in detail. Close post-operative follow-up of these lesions is mandatory due to the high recurrence rates.