HER2-positive breast cancers constitute 25-30% of breast cancers in women. These cancers have a different natural history, clinical course, and prognosis. After the discovery of HER2 amplification, various molecules have been developed to manipulate the activity of this biomarker. In this review, an attempt has been made to understand the possible ways of managing HER2-positive breast cancers in women in an era where we have a number of monoclonal antibodies and small molecule inhibitor to manipulate the activity of HER2.

Background and Aims: Intraperitoneal (IP) instillation of local anesthetics has been shown to minimize postoperative pain after laparoscopic surgeries. We compared the antinociceptive effects of IP dexmedetomidine combined with ropivacaine with that of IP ropivacaine alone in the patients undergoing laparoscopic hysterectomy. Materials and Methods: At the end of laparoscopic hysterectomy, in a double-blind, randomized manner, one of the following injections was given intraperitoneally. The patients were allocated into the following two groups: The patients in ropivacaine group (R group) (N = 30) were given 30 mL of 0.2% ropivacaine plus 2 mL of normal saline; the patients in ropivacaine plus dexmedetomidine group (RD group) (N = 30) were given 30 mL of 0.2% ropivacaine combined with 1 μg/kg dexmedetomidine (diluted in 2 mL normal saline) through trocars. All the patients were given diclofenac sodium when they had pain [visual analogue scale (VAS) 3]. Results: VAS score at different time intervals, overall VAS in 24 h was significantly lower (1.86 ± 0.46 vs 4.7 ± 0.94), time to first request of analgesia (min) was longest (126 ± 24 vs 59 ± 13) and total analgesic consumption (mg) was lowest (95 ± 15 vs 175 ± 75) in RD group than in R group. Conclusion: The antinociceptive effects of the intraperitoneal instillation of ropivacaine in combination with dexmedetomidine is superior to ropivacaine alone.

Background: Approach for surgical treatment of thoracolumbar tuberculosis (TB) has been controversial. The aim of the study is to compare the clinical, radiological and functional outcome of anterior versus posterior debridement and spinal fixation for the thoracic and thoracolumbar TBs. Materials and Methods: Thirty-four patients with dorsal spinal TB treated surgically between September 2011 and December 2013 were included in this study. Sixteen patients (Group 1) with a mean age of 34.5 years underwent anterior debridement, decompression, and instrumentation by anterior transthoracic, transpleural, and /or retroperitoneal diaphragm cutting approaches. Eighteen patients (Group 2) with a mean age of 35.4 years underwent posterolateral (extracavitary) decompression/posterior decompression and posterior instrumentation. Various parameters such as neurological recovery, improvement of symptoms, and prevention of kyphosis progression were compared. Neurological outcome is assessed by Nurick grade and Frankel grade. The mean follow-up is 12 months. Results: In the present study, 87.5% of the patients had neurological improvement in Group 1 and 61% had improvement in Group 2. In Group 1, 93% of the patients had reduction of back pain and in Group 2, 83% of the patients had reduction of back pain. In follow-up, both groups had equal fusion rates, and no implant displacement on x-rays. Except for one patient in Group 2, no patient had a worsening of deformity. Conclusion: Anterior approach is better for debridement and decompression of the spinal cord and stabilization than posterior approach.

Aim: The aim of study was to determine the antimicrobial efficacy of alcoholic neem and Aloe vera leaf extracts against Enterococcus faecalis and Candida albicans in comparison with 3% sodium hypochlorite (3% NaOCl) and 2% chlorhexidine (2% CHX). Materials and Methods: In the present study, indigenously prepared neem and Aloe vera leaf extracts were serially diluted to determine the minimum inhibitory concentration (MIC) at which the E. faecalis and C. albicans were sensitive, and compared it with 3% NaOCl and 2% CHX by the agar-well diffusion method. Results: The MICs of the alcoholic neem extract to E. faecalis and C. albicans were determined as 0.94% and 1.88%, and for Aloe vera extracts they were 1.88% and 3.75%, respectively and the zones of diffusions that were formed around the extracts in the respective agar plates were significantly greater than with 3% NaOCl and 2% CHX within the groups when analyzed statistically by one-way analysis of variance (ANOVA). Conclusion: The antimicrobial efficacy of extracts was well demonstrated from the present in vitro observation of the agar-well diffusion method, and hence it may be advantageous if we use these extracts as irrigating solutions in endodontics. However, it requires further preclinical and clinical evaluation.

Background: Sickle cell anemia is a genetic hematological disorder characterized by red blood cell abnormalities including rigidity and sickling. Once a sufficient number of rigid sickle cells are formed, microvascular occlusion would result that leads to tissue ischemia and infarction and progressive end organ damage. Aim: The aim of this study was to analyze 16 teenage patients with sickle cell disease to determine the pattern of musculoskeletal complications during 2 years. Materials and Methods: This is a retrospective study of cases of musculoskeletal complications among sickle cell anemic patients who referred to the rheumatologic clinic of Mazandaran University of Medical Sciences from January 2010 to December 2012 (during a 2-year period). Data were analyzed using the SPSS version 20. Variables analyzed included age, sex, and kind of musculoskeletal complications. Results: There were 16 sickle cell patients referring to our rheumatologic clinic for musculoskeletal complications during the study period. All were teenage patients, aged between 12 and 17 years, with a median age of 14.6 years. Twelve patients were male and four patients were female. The most common musculoskeletal complications were: Acute painful crisis in 10 (62.5%), osteomyelitis in 3 (18.5%), dactilitis in 4 (25%), avascular necrosis of bones in 6 (37.5%), stress fractures and vertebral collapse in 2 (12.5%), septic arthritis in 1 (0.6%) patient, and hyperuricemia/gout arthritis in 3 (18.5%) patients. Conclusion: Serious musculoskeletal complications of sickle cell anemia are very important and must be considered in these patients. Painful crisis and avascular necrosis of bones are the common rheumatologic complications of this disorder.

Objective: Varicosities in the lower limbs are the most important afflictions of the venous system, as well as of the peripheral vascular disorders. They are always caused by a fault in the valves inside the veins at the point where the superficial veins communicate with the deep veins. If the valve leaks, the blood flows backwards and this increases the pressure in the superficial veins, which, as blood stagnates, becomes swollen and varicose. The treatment of these varicose veins is surgery, for which the surgeons should have a sound knowledge of the anatomy of the great saphenous vein (GSV). So, the aim of our study was to establish palpable anatomical markers for its exploration and surgical approach. Materials and Methods: In this study, 25 inguinofemoral regions of lower limbs were dissected. After exposing the arch of the GSV, we took the following measurements using a calliper - the distance separating the top of the arch of the GSV a) from the ventral-cranial iliac spine, b) from the pubic tubercle, and c) from the inguinal ligament. Statistical analysis of the measurements was done. Results: The mean distance of the arch of the GSV from the ventral cranial iliac spine, pubic tubercle, and the inguinal ligament was 9.46 cm, 4.66 cm, and 2.75 cm respectively. In addition, we found in one case a duplication of the GSV just above the knee. Conclusion: These measurements will help the surgeons in identifying the arch of the GSV before it opens into the anterior-internal surface of the femoral vein.

Context: Calretinin is a protein associated with cellular differentiation and proliferation and is an inhibitor of apoptosis. Cytokeratin is a protein associated with odontogenic epithelial cell, and ameloblasts being epithelial derivative also express some cytokeratin. This study was done to ascertain if calretinin and cytokeratin could be responsible for the differences between aggressiveness of certain odontogenic cysts and tumors. Aims: To evaluate the expression of calretinin and cytokeratin 19 (CK19) in odontogenic cysts and ameloblastoma. Materials and Methods: Sixty samples of formalin-fixed paraffin embedded tissue specimens [15 radicular cysts, dentigerous, odontogenic keratocysts (OKCs), and ameloblastoma] were evaluated for the expression of CK19 and calretinin using immunohistochemistry. Statistical Analysis: Data entry and statistical analysis using Statistical Package for the Social Sciences (SPSS) ^TM software (version 10.05) were done. Chi-square test was done to compare tissue localization of stain, nature of stain, intensity of stain, and the percentage of cells stained among the study groups. P value less than 0.05 was considered to be statistically significant. Results: Calretinin showed positive expression in all cases of ameloblastoma. Among the samples of OKC, 13% of the cases showed positivity. All the cases of radicular and dentigerous cysts were completely negative for calretinin. CK19 was negative in all cases of radicular cyst and OKC, whereas among the dentigerous cyst two cases showed mild expression and one case showed moderate staining intensity for CK19. Only one case of ameloblastoma showed moderate staining for CK19. Conclusion: The results of this study showed that calretinin can be an immunohistochemical marker for neoplastic ameloblastic epithelium and the difference of expression among the lesions is probably due to their diverse histopathological characteristics and their developmental origin. CK19 a marker of simple epithelia and its absence could probably be due to absence of CK19 epitope, superimposition of other cytokeratins, or masking of the epitopes.

Background and Objectives: Human immunodeficiency virus (HIV) infection is characterized by a gradual reduction in the counts of cluster of differentiation (CD)4 ⁺ T-lymphocytes that in turn leads to opportunistic infections and specific neoplastic processes. The introduction of antiretroviral therapy (ART)/highly active ART (HAART) has led to a decrease in the morbidity and mortality associated with HIV infection. The aim of this study is to evaluate the prevalence of HIV-related oral lesions and to correlate these lesions with laboratory parameter such as CD4 ⁺ T-lymphocyte count before and after the administration of ART. Materials and Methods: In the present study, a total of 120 patients were evaluated, out of which 79 patients who presented with oral lesions were further assessed for oral lesions and respective CD4 ⁺ T-lymphocyte counts. The oral examination was carried out using presumptive criteria by European Community (EC) Clearinghouse and CD4 ⁺ T- lymphocyte counts was assessed by flow cytometry. Same group of patients were followed up for next 6 months to determine the changes in the CD4 ⁺ T-lymphocyte counts and oral lesions. Results: HIV-related oral lesions were found to be more prevalent in the age group of 31-40 years, with a relatively high frequency of occurrence in male patients. The CD4 ⁺ T-lymphocyte count was significantly increased after the administration of ART when compared to that before the administration of ART in all the patients. However, the lesions did not subside completely even after the increase in of CD4 ⁺ T-lymphocyte counts. Interpretation and Conclusion: The difference in the prevalence of oral manifestations may be the result of variations in data of the study population such as race, socioeconomic status, sex, drug therapy, genetics, oral habits, and degree of immune suppression and variation in diagnostic criteria.

Context: Even though dentistry is one of the very highly developed fields among the medical sciences, false traditional beliefs and nonscientific knowledge may seed myths that create hindrance in the recognition of scientific and modern dental treatments, thereby acting as a barrier against the utilization of oral health-care facilities. Aims: The present study was an attempt to evaluate various dental myths prevailing in a rural population. Settings and Design: The study sample comprised of 305 subjects aged 18 years and above, acquired from six randomly chosen villages of Guntur district in Andhra Pradesh, India. Materials and Methods: A cross-sectional questionnaire survey was carried out to assess the various dental myths. Statistical Analysis Used: The data were analyzed using chi-square and multinomial logistic regression tests in SPSS version 20. Results: The mean age of the study population was 38.03 ΁ 15.15 years, 57.4% of whom were males and 42.6% females. Of the subjects, 58.7% felt that deciduous teeth did not need any treatment procedures as they would be exfoliated anyway; 40% of those who had never visited a dentist before felt that extraction of the upper teeth affected eye vision. Of individuals aged 18-39 years, 47.6% believed that cleaning with salt made teeth white and shiny. Only a few (3.9%) believed absolutely no dental myths, whereas most (96.1%) believed one myth or another. Conclusions: The results of this study revealed that dental myths are still prevalent and that they need to be addressed to achieve optimal dental health.

Aim: The present cross-sectional study was conducted to determine the decayed, missing, filled primary and permanent teeth (dmft-DMFT) indices and its association with the type of disability in 856 disabled individuals attending special schools in twin cities of Hyderabad and Secunderabad, Andhra Pradesh State, India. Materials and Methods: Participants were grouped according to their disability such as: Mild, moderate, severe mental retardation, hearing and speech defect and others (39) (including Down's syndrome [20], autism [9], hyperactive [4], microcephaly [2], border line cases [4]). Examination was carried out at their schools, with participants seated in ordinary chairs and examined under natural light with mouth mirror and probe. Subjects were of different age groups ranging from 1 to 55 years. Statistical Analysis Used: Analysis of variance with post-hoc Games-Howell test was used for statistical analysis. Results: Mean dmft; DMFT scores were as follows: 2-6 years: 1.58 ± 1.9; 2.18 ± 2.94, 7-12 years: 1.1 ± 2.4; 1.9 ± 2.13, 13-30 years: 2.38 ± 2.5, 30+ years: 2.13 ± 3.2. Overall only 23% of subjects were caries free. "dmft" was statistically higher among moderate mentally retarded group while DMFT was statistically higher in mild and moderate mentally retarded groups. Conclusions: These findings emphasize the need of educating parents and caregivers of disabled individuals in preventive dental procedures, especially those of the mild and moderate mentally challenged group.

Context: Sterilization will be effective only when all the bacterial spores are destroyed. The transmission of pathogens from one patient to another via contaminated devices has been a high-profile issue in infection control. Aims: The purpose of this study was to investigate the sterilization efficacy using two methods of sterilization using rotary endodontic files: Autoclave, chemical sterilization using two solutions (chlorhexidine and glutaraldehyde). Materials and Methods: The study was carried out on 60 new pre-sterilized rotary nickel titanium files contaminated with commercially available Bacillus stearothermophillus. The files were sterilized by the two methods and checked for sterility by incubating the files in test tubes containing thioglycollate medium. Statistical Analysis Used: The Kruskal-Wallis test was used to determine any significant difference between groups. The Mann-Whitney test was used to demonstrate any significant difference between the three agents. The level of significance was set at P < 0.05. Results: The files sterilized by autoclave were 100% sterile, and those sterilized by chlorhexidine showed 87% sterility and with glutaraldehyde showed only 60% sterility. Conclusions: The study concluded that the autoclave could be used as best reliable method of sterilization.

Background: The possible role of free radicals in pathogenesis of a disease and its prevention by antioxidants is well-known. Literature reveals an independent correlation between the risk factors and these disorders. The aim of the present study was to ascertain the values of vitamin A, vitamin E, superoxide dismutase (SOD), and malondialdehyde (MDA) in normal individuals and patients with potentially malignant and malignant disorders. Materials and Methods: In this study, serum vitamin A, E, SOD, and MDA levels were assessed in 80 patients divided into four groups marked as a group I normal individuals, group IIa individuals with habits but without any lesions, group IIb with potentially malignant disorders, and group III with malignant disorders. Results: The mean vitamin A level in the group I was 3.07 ± 0.27, group IIa was 1.48 ± 0.37, group IIb was 0.89 ± 0.21, and group III was 0.67 ± 0.17. The mean vitamin E level in group I was 9.89 ± 0.75, group IIa was 8.85 ± 0.42, group IIb was 7.63 ± 0.39, and group III was 6.43 ± 0.34. The mean MDA level in group I was 2.92 ± 0.36, group IIa was 6.05 ± 0.78, group IIb was 10.13 ± 0.75, and group III was 14.15 ± 0.47. The mean SOD activity level among group I was 189.45 ± 14.17, group IIa was 169.05 ± 4.98, group IIb was 115.65 ± 19.60, and group III was 52.63 ± 4.02. Conclusion: There was a significant reduction in serum Vitamin A, Vitamin E, and SOD levels whereas there was a significant increase in serum MDA levels in patients with potentially malignant and malignant disorders as compared to normal individuals.

Aspergillus species are well-known opportunistic pathogens that can cause different infections, and are commonly seen in immunocompromised hosts. Invasive aspergillosis in an immunocompetent patient with extension to the mediastinum has been reported rarely. We report a case of a young male patient who had a huge mass lesion that is seen at the right side of mediastinum at lower paratracheal region, extending up to the hilum and pretracheal location. It was primarily diagnosed as pericardial cyst/right ventricular thrombus. The patient was diagnosed with aspergillosis caused by Aspergillus flavus by histopathology, staining, and fungal culture. The patient was treated with voriconazole and he was discharged after clearly advising the need for therapy. The patient did not come for the follow-up checkup and later when communicated, we came to knew that the patient had expired due to breathlessness.

Caroli disease is a rare disorder characterized by congenital dilatation of the intrahepatic biliary tree and may be associated with polycystic kidney disease. Patients usually present with intermittent abdominal pain, hepatomegaly, and recurrent cholangitis. Renal failure as a presenting complaint of Caroli disease is rare. We present a child with Caroli disease who presented to us with renal failure.

Endocrine myopathy means muscle weakness in the presence of an abnormal endocrine state. Most of the endocrine disorders are associated with myopathy and it is usually reversible with correction of the underlying disturbance, though, there is an increasing knowledge of the metabolic effects of hormones, endocrine myopathy is a less recognized and often overlooked entity in clinical practice. Here, we describe this association in three of our patients, then, we discuss systematically about endocrine myopathy.