An Audit for Radiotherapy Planning and Treatment Errors From a Low-Middle-Income Country Centre.

AIMS: To report the findings of an audit for radiotherapy errors from a low-middle-income country (LMICs) centre. This would serve as baseline data for radiotherapy error rates, their severity and causes, in such centres where modern error reporting and learning processes still do not exist. MATERIALS AND METHODS: A planned cross-sectional weekly audit of electronic radiotherapy charts at the radiotherapy planning and delivery step for all patients treated with curative intent was conducted. Detailed analysis was carried out to determine the step of origin of error, time and contributing factors. They were graded as per indigenous institutional (TMC) radiotherapy error grading (TREG) system and the contributing factors identified were prioritised using the product of frequency, severity and ease of detection. RESULTS: In total, 1005 consecutive radically treated patients' charts were audited, 67 radiotherapy errors affecting 60 patients, including 42 incidents and 25 near-misses were identified. Transcriptional errors (29%) were the most common type. Most errors occurred at the time of treatment planning (59.7%), with "plan information transfer to the radiation oncology information system" being the most frequently affected sub-step of the radiotherapy process (47.8%). More errors were noted at cobalt units (52/67; 77.6%) than at linear accelerators. Trend analysis showed an increased number of radiotherapy incidents on Fridays and near-misses on Mondays. Trend for increased radiotherapy errors noted in the evening over other shifts. On severity grading, most of the errors (54/60; 90%) were clinically insignificant (grade I/II). Inadequacies and non-adherence towards standard operating procedures, poor documentation and lack of continuing education were the three most prominent causes. CONCLUSION: Preliminary data suggest a vulnerability of LMIC set-up to radiotherapy errors and emphasises the need for the development of longitudinal prospective processes, such as voluntary reporting and a continued education system, to ensure robust and comprehensive safe practises on par with centres in developed countries.

Additional synthesis on thiophene-containing trisubstituted methanes (TRSMs) as inhibitors of M. tuberculosis and 3D-QSAR studies.

We earlier reported thiophene-containing trisubstituted methanes (TRSMs) as novel cores carrying anti-tubercular activity, and identified S006-830 as the phenotypic lead with potent bactericidal activity against single- and multi-drug resistant clinical isolates of Mycobacterium tuberculosis (M. tb). In this work, we carried out additional synthesis of several TRSMs. The reaction scheme essentially followed the Grignard reaction and Friedel-Crafts alkylation, followed by insertion of a dialkylaminoethyl chain. We also performed microbiological evaluations including in vitro screening against the virulent strain M. tb H37Rv, cytotoxicity assessment in the Vero C-1008 cell line, and 3D-QSAR studies with comparative molecular field analysis (CoMFA) and comparative molecular similarity index analysis (CoMSIA). CoMFA and CoMSIA models yielded good statistical results in terms of q2 and r2 values, suggesting the validity of the models. It was concluded that a para-substituted benzene ring with bulkier electron-donating groups and aminoalkyl chains are required for higher inhibitory capacity against M. tuberculosis. We believe that these insights will rationally guide the design of newer, optimal, TRSMs.

Biosorption of cadmium and nickel by functionalized husk of Lathyrus sativus.

The husk of Lathyrus sativus (HLS) has been functionalized by introducing thio groups with the help of carbon disulphide treatment in alkaline environment. Elemental analysis indicates that sulphur content of the functionalized biomass increases to 3.7% from 0.36% of the pristine biomass suggesting the incorporation of thio group on HLS. A conspicuous change in the surface morphology of the biomass due to functionalization is depicted by SEM images. EDX data support the introduction of sulphur group on the HLS. The involvement of the hydroxyl groups mainly in the functionalization process is demonstrated by Fourier transform infrared (FTIR) spectroscopic study. The adsorption capacity of the functionalized biomass with respect to cadmium and nickel is observed to increase by about 50% compared to that of pristine one. Similar to the case of unmodified HLS the adsorption process involving the functionalized one obeys Langmuir isotherm model and attains equilibrium in 10 min compared with 60 min in the case of unmodified biomass.

Adsorption of nickel on husk of Lathyrus sativus: behavior and binding mechanism.

Husk of Lathyrus sativus (HLS) has been found to be a good sorbent for the removal of nickel(II) from its aqueous solution. The adsorption process depends on pH of the solution with an optimum at 5.0, and follows Langmuir isotherm model (correlation coefficient 0.998). Initial adsorption rate is very fast and reaches equilibrium following pseudo-second order kinetics within 60 min. Amino, carboxyl, hydroxyl and phosphate groups of the biomass are involved in chemical interaction with nickel ions as revealed from SEM-EDX and FTIR studies. Chemical modifications of the functional groups of the biosorbent show that amino groups contribute largely (approximately 57%) for the binding of nickel ions and probably undergo chelation through dative bond formation. HLS biomass has been found to adsorb both nickel and cadmium equally from their mixed solution to the extent of approximately 70% indicating the importance of this sorbent in industrial effluent treatment.

Adsorption of cadmium on husk of Lathyrus sativus: physico-chemical study.

Adsorption of cadmium (II) from aqueous solution by low-cost biosorbents was investigated. Husk of Lathyrus sativus (HLS) was found to be the most efficient in this respect and removed approximately 95% of the metal. The influence of pH, temperature, contact time and metal ion concentration on the adsorption process by HLS was studied. Hydrogen ion concentration of the solution greatly influenced the process with an optimum at pH 5.0-6.0, whereas temperature had no significant effect. The process was very fast and more than 90% of the total adsorption took place within the first 5 min and was found to follow pseudo-second order rate kinetics. The adsorption data can better be explained by Langmuir isotherm model and the calculated maximum adsorption capacity was 35 mg/g of HLS at pH 5.0 and 30 degrees C. Scanning electron micrographs showed that cadmium was present as micro precipitate on the surface of the adsorbent. Cadmium replaced calcium of the biomass as revealed from the EDX analysis indicating that the adsorption proceeds through ion exchange mechanism. Cadmium could be desorbed from the loaded biomass by lowering pH approximately 1.0 with mineral acid.

Metabolic transformation and mechanism of action of mononitroso caffeidine- a new interpretation.

Although caffeine is not carcinogenic, its hydrolysed product, caffeidine causes human cancer, possibly through endogenous nitrosation to form mononitroso caffeidine (MNC). MNC undergoes enzymatic demethylation and reacts with cellular nucleophiles, notably DNA, via the formation of a putative imidazole diazonium ion. Its interaction with proteins has not been reported. The present work is based on the hypothesis that some active metabolites of MNC covalently interact with cellular DNA and/or proteins to initiate carcinogenesis. We report here the synthesis of a possible reactive metabolite of MNC, viz., N, 1-methyl-4(N-methyl-N-nitrosamino)-imidazole-5-carboxylic acid (MNIC). Its structure has been determined by uv, ir, nmr and mass spectral analyses and its interaction with egg albumin and human serum protein has been examined by uv and CD spectroscopy. We concluded that metabolic activation of MNC occurs through the formation of MNIC. Avoiding consumption of salted tea or coffee that prevents the intake of caffeidine will possibly eliminate the risk of MNC carcinogenicity.

Identification of nonlinear dynamic systems using functional link artificial neural networks.

We have presented an alternate ANN structure called functional link ANN (FLANN) for nonlinear dynamic system identification using the popular backpropagation algorithm. In contrast to a feedforward ANN structure, i.e., a multilayer perceptron (MLP), the FLANN is basically a single layer structure in which nonlinearity is introduced by enhancing the input pattern with nonlinear functional expansion. With proper choice of functional expansion in a FLANN, this network performs as good as and in some cases even better than the MLP structure for the problem of nonlinear system identification.

Nonlinear channel equalization for QAM signal constellation using artificial neural networks.

Application of artificial neural networks (ANN's) to adaptive channel equalization in a digital communication system with 4-QAM signal constellation is reported in this paper. A novel computationally efficient single layer functional link ANN (FLANN) is proposed for this purpose. This network has a simple structure in which the nonlinearity is introduced by functional expansion of the input pattern by trigonometric polynomials. Because of input pattern enhancement, the FLANN is capable of forming arbitrarily nonlinear decision boundaries and can perform complex pattern classification tasks. Considering channel equalization as a nonlinear classification problem, the FLANN has been utilized for nonlinear channel equalization. The performance of the FLANN is compared with two other ANN structures [a multilayer perceptron (MLP) and a polynomial perceptron network (PPN)] along with a conventional linear LMS-based equalizer for different linear and nonlinear channel models. The effect of eigenvalue ratio (EVR) of input correlation matrix on the equalizer performance has been studied. The comparison of computational complexity involved for the three ANN structures is also provided.

Genetic analysis of adult-onset cataract in a city-based ophthalmic hospital.

Adult-onset cataract (AOC) is a major ocular health problem and is the number one cause of blindness in the world. It is interesting to note that if the development of cataract is delayed by 10 years, the number of cataract surgeries needed would decrease by 45%. To prevent or delay cataract, the molecular pathological mechanisms underlying the lens change have to be understood, and this requires that the genes involved in such mechanisms should be identified. Hence, in this study we aim to identify AOC families which show a clear mendelian inheritance pattern, as only these families would be ideal for mapping the genes responsible. Over a period of 8 months, from September 1995-April 1996, 17 families with two or more affected members were identified. Segregation analysis showed autosomal dominant inheritance in multiple affected families. We propose to map the genes responsible for cataract in these families by linkage analysis and mutational screening of candidate genes.

Beta hemolytic streptococcal carriers among school children in western Orissa.

Detection of carriers of Beta hemolytic streptococci and serogrouping of the strains isolated from throat of School Children helps in the epidemiological serosurveillance of the disease. With this in view the carriers among otherwise healthy school children in and around Buria, a small town in western Orissa, have been detected and the Streptococci isolated are grouped and typed.