Search

Women has been faced several obstacles for surviving and empowering themselves in emerging countries like an India, because social taboos and mind sets of male dominated society have been responsible for her secondary position. Moreover, India is a welfare state where equality provided to men and women under the law but still far away from reality to overcome this matter. So, government started enormous policies or programmes for wellbeing of vulnerable sections of society like SC, BC, OBC, children and women. Punjab state has been also introduced several policies and schemes to upgrade the livelihood of economic trodden sections. In this section, main focus is on women welfare schemes launched by Indian and Punjab Government.

Background: Routinely, patient’s planning scans are acquired after administration of iodinized contrast media but they will be treated in the absence of that. Similarly, high energy photons have a better penetrating power, while low energy photons will result in tighter dose distribution and negligible neutron contamination. The aim of the study was to investigate a suitable photon beam energy in the presence of intravenous contrast medium. Materials and methods: An indigenously made original-contrast (OC) phantom was mentioned as virtual-contrast (VC) and virtual-without-contrast (VWC) phantom were generated by assigning the Hounsfield Units (HU) to different structures. Intensity-modulated (IMRT) and volumetric-modulated-arc (VMAT) plans were generated as per criteria of the TG-119 protocol. Results: It was observed that the maximum dose to the spinal cord was better with 6 mega-voltage (MV) in IMRT. The coverage of Prostate PTV (PR PTV) was similar with all the photon energies and was comparable with TG-119, except for original-contrast (OC) phantom using the VMAT technique. Homogeneity-index (HI) was comparatively better for VMAT plans. Conclusion: The contrast CT images lower the dose to targets. IMRT or VMAT plans, generated on such CT images will be delivered with higher doses than evaluated. However, the overdose remains non-significant

Background: Uveitis encompasses many conditions, all characterized by inflammation of the uvealtract either directly or indirectly. It can occur at any age but predominantly affects patients in theworking-age group. Objective: To report the clinical pattern of Uveitis in North India. Settings andDesign: A prospective study in a regional eye institute. Methods: After taking informed consent,100 patients with Uveitis aged 20–60 years were recruited from eye OPD between 2012- 2014.Detailed history, complete ophthalmic examination, standard diagnostic laboratory tests andradiographic studies wherever required were made. Statistical analysis used: Descriptive.Results: The mean age being 41.55 years. There were 57% males and 43% females with 32%acute uveitis and 68% chronic uveitis cases. Anterior Uveitis was seen in 83% of patients, followedby posterior Uveitis (7%), pan-uveitis (6%) and intermediate Uveitis (4%). A definite associationwith the systemic disease was determined in 27% of cases. The most frequently observed systemicdiseases were ankylosing spondylitis, Tuberculosis and herpes zoster ophthalmicus (6% cases each).This was followed by HIV (3%), sarcoidosis (3%), ulcerative colitis (2%) and endophthalmitis (1%).No specific aetiology or association with systemic diseases could be established in 73% of cases. Inmost cases, the systemic disease was not suspected before eye involvement and was recognizedonly after the subsequent diagnostic procedures. Conclusion: The etiological diagnosis of Uveitis isoften challenging as there are marked variations in ocular and systemic signs and symptoms. Asignificant number of cases may unfold with the evolution of advanced techniques.

Background: Sleep-disordered breathing (SDB) is accompanied by large swings in blood pressureand the repetitive hypoxic period during sleep, which may accelerate anoxic optic nerve damageseen in glaucoma. There are many associated risk factors in primary open-angle glaucoma (POAG),but recently, SDB, though a neglected one, is coming up as a risk factor. However, various studieshave reported controversial findings. Objective: To evaluate the relationship between SDB andPOAG. Design: A hospital-based case-control study. Methods: A total of 400 patients between 30–70 years were recruited from eye OPD between 2008- 2010. They were divided into two groups, 200cases with established POAG and 200 age and sex-matched healthy subjects with normal IOP in thecontrol group. Detailed history, complete ophthalmic and ENT examination was made along withBMI, blood pressure and neck girth measurement. Both groups were interviewed with aquestionnaire regarding SDB and were recorded on the Epworth sleepiness scale (ESS). Results:The mean age being 55.02 ± 8.66 in the POAG group and male predominance noted both in POAGand SDB patients with ESS> 10 was statistically significant (p < 0.05). Also, patients in the POAGgroup with ESS > 10 had more IOP and BMI, greater neck girth, high BP and more ENT problemswith p-value < 0,001, which is highly significant, thus showing the relationship between SDB andPOAG. Conclusions: Increased community awareness and earlier detection of glaucoma and itscorrelation with SDB results in decreased morbidity.

Myopia is a widespread and complex refractive error in which a person's ability to see distant objects clearly is impaired. Its prevalence rate is increasing worldwide, and as per WHO, it is projected to increase from 22% in 2000 to 52% by 2050. It is more prevalent in developed, industrial areas and affects individuals of all ages. There are a number of treatments available for the control of myopia, such as glasses, contact lenses, laser surgery, and pharmaceuticals agents. However, these treatments are less beneficial and have significant side effects. A novel molecule, 7-methylxanthine (7-MX), has been found to be a highly beneficial alternate in the treatment of myopia and excessive eye elongation. Many preclinical and clinical studies showed that 7-MX is effective for the treatment of myopia and is presently under phase II of clinical investigation. We have also investigated preclinical toxicity studies such as acute, sub-acute, sub-chronic, and chronic on rats. In these studies, 7-MX was found to be non-toxic as compared to other reported anti-myopic agents. Moreover, as an ideal drug, 7-MX is observed to have no or low toxicity, brain permeability, non-allergic, higher oral administration efficacy, and low treatment costs and thus qualifies for the long-term treatment of myopia. This review article on 7-MX as an alternative to myopia treatment will highlight recent findings from well-designed preclinical and clinical trials and propose a potential future therapy.

Fungal choroidal abscesses are rarely reported entities on routine retinopathy of prematurity screenings done on neonates. With the increasing use of broad-spectrum intravenous antibiotics on preterm neonates during their stay in neonatal intensive care unit who are already immunodeficient, we hereby bring this case into notice so as to keep fungal etiologies as a close differential in comparison to bacterial choroidal abscesses, the latter being more common in the older age group. The late diagnosis of fungal choroidal abscess and the lack of systemic treatment for the same could possibly lead to acquired hydrocephalus and other systemic complications.

Introduction: This is the case of a Malaysian-Chinese man who was suffering from androgenic alopecia. Seeking to treat the condition, he went to a hair transplant clinic and unknowingly agreed to the implantation of synthetic hair, which is a harmful solution. As a result, he suffered from necrosis on the frontotemporal recess area. Methods: A pre-operative evaluation was carried out for the assessment of his situation. The necrotic tissue was removed primarily with forceps. After letting the scalp heal for the next 12 months, follicular unit excision (FUE) was performed on the patient. Results: Synthetic hair implant led to infection and tissue damage of the scalp. Damaged tissue then left permanent scarring. Conclusion: The original treating surgeon should have not risked the patient’s well-being for quick results. Synthetic hair implantation has been controversial for many reasons and to suggest it to a patient who, if fully informed of the risks would have chosen a better and safer option such as FUE, is irresponsible.

Myopia (nearsightedness) is a vision disorder with a blurring of far objects, affect millions worldwide. 7-methylxanthine (7-MX) is a molecule that is presently under clinical investigation for the treatment of myopia. In the present study, we have investigated sub-chronic and chronic toxicity of 7-MX in comparison to other clinically used methylxanthines i.e., caffeine and theobromine as per OECD guidelines 408 and 452. 7-MX was administered orally for 90 days at three different doses of 250, 500, and 1000 mg/kg for sub-chronic toxicity evaluation, and at a limit dose of 1000 mg/kg in 180 days chronic toxicity evaluation in rats. In sub-chronic treatment, 7-MX showed no mortality and signs for toxicity in any group, whereas 10% and 40% mortality with signs for toxicity were observed in caffeine and theobromine treated groups, respectively. A similar, safety profile was observed with 7-MX in 180 days of chronic toxicity study. Further, to confirm any morphological changes in organs; ultrasound and X-rays analysis were performed and no changes in the size of organs, cyst formation, fluid retention, or crystal formation was observed. Thus, the repeated dose study of 7-MX for 180 days may augment the possibility of using 7-MX clinically for the safe and effective treatment of myopia.

The present study entails the toxicity evaluation of 7-methyl xanthine (7-MX), first of its kind molecule found effective in phase II clinical trials for the treatment of myopia, in comparison to other clinically used xanthines i.e., caffeine and theobromine. For acute toxicity evaluation, 7-MX was administered orally in two rodent species (rat and mice) at the doses of 300 mg/kg and 2000 mg/kg and for repeated dose 28-d oral toxicity, at 250, 500, and 1000 mg/kg in rats. Further, cellular toxicity was evaluated in normal breast epithelial (fR2), rat brain C6 glioma (C6 glioma) and human colorectal (Caco-2) cell lines. Also, the cell uptake assay to determine the intestinal permeability of drug was performed in Caco-2 cells. In acute toxicity, 7-MX treatment showed no mortality and toxicity, whereas 66.6% (mice) and 33.3% (rat) mortality was observed in both caffeine and theobromine treatment groups. In repeated dose 28-d oral toxicity, 7-MX treatment was found to have no-observed-adverse-effect level up to the dose of 1000 mg/kg in the present study conducted as per OECD guidelines 407. Also, very high IC

Introduction To evaluate the dosimetric effect of photon energies on fixed field intensity-modulated radiotherapy (IMRT) and dual arc (DA) planning and to compare the dosimetric differences between conventional IMRT and DA radiotherapy planning. Materials and Methods IMRT and DA plans were generated for 15 patients having cervical cancer using different photon energies. IMRT and DA plans were generated using seven fields and double arcs, respectively. Dosimetric comparison was done in terms of planning target volume (PTV) coverage, sparing of organ at risk (OAR), homogeneity index (HI), conformity index (CI), and monitor units (MUs). Photo-neutron (energy ≤10MV) contribution was not considered for this study. Near region (NR) and far region (FR) were contoured to evaluate the dose deposited in nontarget area. Results No significant difference was observed (p > 0.05) in PTV coverage for conventional IMRT and DA; however, 6 MV yielded significantly better coverage over 15 MV (p < 0.05) for both the treatment modalities. Mean bladder dose was significantly more for conventional IMRT compared with DA. For rectal mean dose, p-value was nonsignificant for IMRT in comparison to DA, while significant difference was observed for change in photon energies for both treatment modalities respectively, except for 10 MV versus 15 MV DA plans. Significant improvements in HI (except 6 MV vs. 10 MV DA), CI (except 6 MV vs. 10 MV IMRT and DA), MUs, NR, and FR were noted. Conclusion DA generates more conformal, homogenous plans, requires less numbers of MUs, and deposits fewer doses to NR and FR regions of nontarget tissues in comparison to conventional IMRT. Although increase in photon energy for IMRT and DA plans reduces numbers of MUs and dose deposited to NR and FR regions, yet the choice for treatment of carcinoma cervix remains 6 MV due to production of photo-neutrons at higher energies.

Taxes are imperative for the economy and businesses for better growth and development. Understanding the taxes and having the right approach towards them can make a vast difference between the success and failure of businesses. Therefore, the present paper aims to examine the impact of tax knowledge on business performance. The study is based on the primary survey of 450 registered Indian MSMEs. The empirical findings from the Partial Least Square Structure Equation Modeling highlight that tax knowledge enhanced operational efficiency and prevented firms from tax fraud. In addition, the technological advancement in the tax system and its knowledge led to proper tax administration and governance by firms which enhanced their productivity. The results may prove beneficial for policymakers, governments, and businesses because in-depth tax knowledge would lead to timely tax compliance and reduced tax evasion, avoidance, and scams.

Taxation is a powerful tool to achieve sustainable development goals (SDG) as tax policies help strengthen economic growth and improve revenue capacity. So, after tax reform, it is vital to analyze their impact on the performance of enterprises. Keeping in mind the SDG, the present study was conducted in India after the major tax overhaul—Goods and Service Tax (GST) on 1 July 2017, to measure the impact on Return on Equity (ROE) and Return on Investment (ROI) as they are the barometers to measure performance (DuPont Analysis). We opted for tax reform determinants, the characteristics of firms, demographic variables, and drivers from DuPont analysis to conduct the research, as all these variables can help identify the different causes of factors impacting ROI and ROE among different types of firms and demographics across countries. An econometric analysis of 546 registered SMEs (small and micro enterprises) was conducted using the regression model, structured equation modeling, and exploratory and confirmatory factor analysis to achieve the objectives. The empirical findings highlighted that a firm’s size, turnover, and DuPont analysis drivers (earnings × asset to sales × asset turnover) positively enhanced the ROI and ROE. Further, the change in the tax system after the tax reforms has enabled the detection of tax fraud and wrong invoices, reducing the missing insolvent traders and increasing the working capital flow of the firms, which in turn has augmented financial performance.

Summary We present a global atlas of 4,728 metagenomic samples from mass-transit systems in 60 cities over 3 years, representing the first systematic, worldwide catalog of the urban microbial ecosystem. This atlas provides an annotated, geospatial profile of microbial strains, functional characteristics, antimicrobial resistance (AMR) markers, and genetic elements, including 10,928 viruses, 1,302 bacteria, 2 archaea, and 838,532 CRISPR arrays not found in reference databases. We identified 4,246 known species of urban microorganisms and a consistent set of 31 species found in 97% of samples that were distinct from human commensal organisms. Profiles of AMR genes varied widely in type and density across cities. Cities showed distinct microbial taxonomic signatures that were driven by climate and geographic differences. These results constitute a high-resolution global metagenomic atlas that enables discovery of organisms and genes, highlights potential public health and forensic applications, and provides a culture-independent view of AMR burden in cities., Graphical abstract, Highlights • Cities possess a consistent “core” set of non-human microbes • Urban microbiomes echo important features of cities and city-life • Antimicrobial resistance genes are widespread in cities • Cities contain many novel bacterial and viral species, This systematic, worldwide catalog of urban microbiomes represents a metagenomic atlas important for understanding the ecology, virulence, and antibiotic resistance of city-specific microbial communities.

Purpose The fund selection process of investors in a mutual fund needs to be understood for designing better marketing strategies. Knowledge and perception about the mutual funds can affect investor’s behaviour towards information search and selection criteria during the decision process. Therefore, this study aims to examine Indian mutual fund investors under the framework of Theory of Planned Behaviour and consumer’s behaviour model. Design/methodology/approach The data have been collected from mutual fund investors in the National Capital Region–Delhi, India, through structured questionnaire. The collected data were examined with relevant statistical tools. Findings Knowledge and perception affect information search behaviour of the investor. Investors having better knowledge of mutual funds access impersonal sources of information and performance of fund affects their choice, whereas investors having lesser knowledge of mutual fund take advice of experts and select funds based on fund characteristics. Investors with better return perception for mutual funds ignore performance as selection criteria, whereas investors having poor risk perception tend to reduce their bias by accessing personal sources of information. Education and income of investor affect knowledge and perception of mutual funds. Practical implications The financial advisor-driven investors ignore performance as selection criteria and could lead to dissatisfaction later. Therefore, to make the industry investor driven, mutual funds need to focus on improving the knowledge of investors. Originality/value This paper shows the unique effect of knowledge and perception on information search behaviour of investors towards mutual funds. The knowledgeable investor selects mutual funds by understanding all risks and benefits.

Plant growth, habitat of various microorganisms, sustenance conditions for the fauna and flora, are determined by the quality of soil. However, alteration in the properties of soil leads to various deficiencies/diseases in plants and thereby affects dependent fauna. The alkalinity and acidity of the soil refer to the change in pH value of the soil. In the North East India, most of the soils lack calcium (Ca) and are acidic. Therefore, majority of the fauna and flora have lower availability of Ca due to leaching, caused by the heavy rainfall. The present study hypothesizes that the life originating from areas deficient in Ca, impacts their bone concentration and facial formation. This makes them phenotypically distinct from their counterparts residing in the other regions which have alkaline soils or have the optimum pH value of soil. Strongly acidic soils, might have led to the formation of the major Mongolian Race in humans.

A 61-year-old homeless man was brought to Ophthalmology OPD, sadly after having been refused admission at various healthcare facilities due to gravity of his diseased condition. Upon arrival, his face was completely disfigured, and he complained of itching, crawling sensation on the face and foul-smelling discharge since 4 weeks. His other major concern was bilateral diminution of vision (LE > RE) since 3 weeks back. That was gradual in onset and progressive in nature. Patient himself was not in a condition to communicate much due to marked involvement of face. People who brought him to the hospital mentioned that he was picked from roadside, after being spotted in very unhygienic surroundings, adjoining a garbage dumping ground. Past medical and surgical history was insignificant and moreover limited. Examination revealed enormous facial swelling and defacement. Particularly left side of the face showed nodules, ulcers, necrotic tissue, extensive swelling, blood stained discharge and was teeming with maggots. No detail of left eye could be appreciated, just maggots and necrotic tissue was seen. Left orbital region seemed to be composed of a mass of flesh with many white larvae in it. Right eye, though less severely affected, still revealed presence of maggots, lid oedema and hazy cornea. Visual acuity was difficult to ascertain in such condition (Figure 1).

The investors of mutual funds can reduce their selection risk by selecting the mutual funds based on certain criteria. One such criterion could be the educational credentials of fund managers. The present study has examined whether performance of mutual funds could be attributed to differentials in educational credentials of fund managers and thereby can provide necessary signals to investors. The study has compared performance and investment strategy of fund managers having management degree from premier management institutions with others having CA/CFA/ICMA qualification. The results show that the performance between these two groups of fund managers does not differ significantly. However, the difference in performance became significant after controlling for various fund characteristics, such as size, expense ratio, liquidity ratio and flow of funds. This suggests that the relation between fund performance and educational credentials may be moderated by control variables. The results showed that the fund managers with a premier management degree were performing better than the other group and that they also followed a more extreme investment strategy. Further, the study has examined whether the relation between educational credentials of fund managers and performance and investment strategy has been impacted by different time periods of economic cycle. The examination in different sub-periods of economic cycle provided better performance of fund managers with premier management education, particularly during crisis period of economy. This performance differential due to educational credentials during the crisis period have been independent of the investment strategy of fund managers.

Background The electronic health record is expected to improve the quality and efficiency of health care. Many novel functionalities have been introduced in order to improve medical decision making and communication between health care personnel. There is however limited evidence on whether these new functionalities are useful. The aim of our study was to investigate how well the electronic health record system supports physicians in performing basic clinical tasks. Methods Physicians of three prominent Norwegian hospitals participated in the survey. They were asked, in an online questionnaire, how well the hospital’s electronic health record system DIPS supported 49 clinical tasks as well as how satisfied they were with the system in general, including the technical performance. Two hundred and eight of 402 physicians (52%) submitted a completely answered questionnaire. Results Seventy-two percent of the physicians had their work interrupted or delayed because the electronic health record hangs or crashes at least once a week, while 22% had experienced this problem daily. Fifty-three percent of the physicians indicated that the electronic health record is cumbersome to use and adds to their workload. The majority of physicians were satisfied with managing tests, e.g., requesting laboratory tests, reading test results and managing radiological investigations and electrocardiograms. Physicians were less satisfied with managing referrals. There was high satisfaction with some of the decision support functionalities available for prescribing drugs. This includes drug interaction alerts and drug allergy warnings, which are displayed automatically. However, physicians were less satisfied with other aspects of prescribing drugs, including getting an overview of the ongoing drug therapy. Conclusions In the survey physicians asked for improvements of certain electronic health record functionalities like medication, clinical workflow support including planning and better overviews. In addition, there is apparently a need to focus on system stability, number of logins, reliability and better instructions on available electronic health record features. Considerable development is needed in current electronic health record systems to improve usefulness and satisfaction.

This study presents the results of a year-long project focused on analysis and reflection on working with comics by Year One students in Hulu Langat districts. This study presents the use of science, technology, engineering and mathematics (STEM) comics to help children understand certain physical phenomena and try to make students interested in mathematics and science subject. Thirteen excellent teachers of science and mathematics from the Hulu Langat district were involved in the analysis of syllabus Year One science and mathematics subjects and the preparation of scripts while the STEM comic illustrator was created by two lecturers from the Faculty of Art, Computing and Creative Industry from Universiti Pendidikan Sultan Idris, Perak Malaysia. The study is based on observations of changing perception of phenomena by children as a result of the use of comics. As a result, a STEM comic that contains ten series for Year One science and mathematics subjects has been successfully developed. This comic is expected to attract and enhance the achievement of Year One students in science and mathematics. Implication of this study, STEM comics can be used by teachers as science and mathematics teaching aids. Comics are proven to be a modern pedagogical strategy, which is starting to gain its popularity in teaching about mathematics and science. Comics can be very helpful tools in making science and mathematics concepts interesting, fun learning and comprehensible for a Year One children.

Introduction: Ocular involvement in rheumatoid arthritis (RA) is significant as sometimes if missed can be potentially blinding.Their presence also aids in making the final diagnosis of RA with atypical presentation. During the course of treatment of RA ,flaring of ocular signs and symptoms may signal impending deterioration or relapse of RA . Thus the study was undertaken in our tertiary care hospital to know the prevalence of ocular manifestations in patients of RA and their correlation with disease activity. Material and Methods: The present prospective observational study was conducted in Regional Institute of ophthalmology on 139 patients of rheumatoid arthritis. Detailed ocular examination was done and besides routine investigations RA factor(RF) and anti cyclic citrullinated peptide antibodies(ACCP) of each patient was recorded.Chi-square test was used to correlate their significance to ocular manifestations. Probability (p) value less than 0.05 was considered significant. Results: Among 139 patients of rheumatoid arthritis included in our study , 53(38%) patients had ocular signs and symptoms. 31(22 %) patients had dry eye,13(9%) had keratoconjunctivitis sicca(KCS), 7 (5%) had anterior uveitis , 4(3%) had episcleritis, 3(2%) had scleritis, 2(1.4%) had peripheral ulcerative keratitis(PUK), 2(1.4%) had sclerosing keratitis, 5(3.5%) had cataract,and1(0.7%) had rental vasculitis. The prevalence of ocular manifestations was significantly higher in patients with positive serology than those with negative serology (p .05) Conclusion: Patients of rheumatoid arthritis need to get routine ocular examination for the early diagnosis and timely management so as to prevent permanent irreparable loss of vision. The presence of anti CCP antibodies and RF provides effective clue to ophthalmologists for identifying patients at risk for vision threatening inflammatory ocular complications.

Introduction: Presbyopia is a progressive condition where the ability to focus on near objects is gradually lost as part of the natural aging process. Similarly, hearing loss is the most widespread sensory impairment in aging people. Thus, the present study was conducted to study the demographic profile of patients with presbyopia and presbycusis. Material and methods: The Study was conducted on 60 patients reporting to the Eye OPD of Regional Eye institute, Amritsar. Examination of total 120 eyes and 120 ears were conducted to evaluate presbyopia and presbycusis. To check the status of vascular system the investigations done were blood pressure, haemoglobin, total leucocytes count, differential leucocytes count, fasting blood sugar, lipid profile, ECG and urine complete examination. Obtained data was arranged according to characteristics and was expressed as a number and percentage of respondents and were analyzed using the SPSS Version 17 software. Results: Females dominated among the cases of presbyopia while males were dominated among the cases having presbycusis. Maximum cases of presbyopia were seen in service class while no significant difference in hearing was observed among cases in various occupations. No significant difference in near vision and hearing was observed in smokers and alcoholics. Conclusion: Both the condition of presbyopia and presbycusis increased gradually with the age but no relationship was found between arterial hypertension, blood sugar level, serum cholesterol level and consumption of tobacco and

To evaluate the feasibility of flattening filter free beam (FFFB) for the treatment of gastric tumors and to review their benefits over 6MV flatten beam (6MV_FFB). Fifteen patients with histologically proven gastric carcinoma were selected. CT scans with slice thickness of 0.3 cm were acquired and planning target volume (PTV) and organ at risk (OAR) were delineated. Plans were made retrospectively for each patient for the prescription dose of 45 Gy/25 fractions to the PTV. Four isocentric plans were compared in the present study on Varian TrueBeam linear accelerator (Varian Medical Systems, Palo Alto, CA, USA). PTV D98% was 44.41 ± 0.12, 44.38 ± 0.13, 44.59 ± 0.14, and 44.49 ± 0.19 Gy for IMRT 6MV_FFB, IMRT 6MV_FFFB, VMAT 6MV_FFB, and VMAT 6MV_FFFB respectively. 6MV_FFFB beam minimizes the mean heart dose Dmean (P = 0.001). VMAT dominates over IMRT when it came to kidney doses V12Gy (P = 0.02), V23Gy (P = 0.015), V28Gy (P = 0.011), and Dmax (P

An in silico dosimetric evaluation of intensity-modulated radiation therapy (IMRT) vs 3-dimensional conventional radiation therapy (3D-CRT) treatment plans in postmastectomy radiation therapy (PMRT) to the chest wall and regional lymphatics was conducted. Twenty-five consecutive patients with breast cancer referred for locoregional PMRT, stages T2-4 with N1-3, were planned to receive 50 Gy in 25 fractions with IMRT. Additionally, a 3D-CRT plan was generated using identical contours for the clinical target volumes (CTV), planning target volumes (PTV), and organs at risk (OAR). Treatment plans were assessed using dose-volume histogram (DVH) parameters of D98, D95, D50, D2, and homogeneity index for individual CTVs and PTVs. OARs evaluated were ipsilateral and contralateral lungs, heart, spinal cord, and opposite breast. Most DVH parameters pertaining to CTVs and PTVs significantly favored IMRT. V20 for ipsilateral and contralateral lungs, D33 of heart and maximum dose to spinal cord favored IMRT (all p

Aim To study and explores the feasibility and efficacy of re-irradiation (Re-RT) for locally recurrent head and neck cancer (HNC) and second primary (SP) malignancies. Background The most common form of treatment failure after radiotherapy (RT) for HNC is loco-regional recurrence (LRR), and around 20–50% of patients develop LRR. Re-irradiation (Re-RT) has been the primary standard of care in the last decade for unresectable locally recurrent/SP HNC. Materials and methods It was a retrospective analysis in which we reviewed the medical records of 51 consecutive patients who had received Re-RT to the head and neck region at our institute between 2006 and 2015. Results Forty-eight patients were included for assessment of acute and late toxicities, response evaluation at 3 months post Re-RT, and analyses of locoregional control (LRC) and overall survival (OS). The median LRC was 11.2 months, and at 2 and 5 years the LRC rates were 41% and 21.2%, respectively. A multivariate analysis revealed two factors: initial surgical resection performed prior to Re-RT, and achievement of CR at 3 months after completion of Re-RT to be significantly associated with a better median LRC. The median OS was 28.2 months, and at 1, 2, and 5 years, OS were 71.1%, 55.9% and 18%, respectively. A multivariate analysis revealed initial surgical resection performed prior to Re-RT, and achievement of CR at 3 months post completion of Re-RT being only two factors significantly associated with a better median OS. Acute toxicity reports showed that no patients developed grade 5 toxicity, and 2 patients developed grade 4 acute toxicities. Conclusion Re-RT for the treatment of recurrent/SP head and neck tumors is feasible and effective, with acceptable toxicity. However, appropriate patient selection criteria are highly important in determining survival and treatment outcomes.