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Objective Insufficient access to anticancer medicines may contribute to the wide survival differences of children with cancers across the globe. We developed a tool to estimate the volume of medicines and budget requirements to provide chemotherapy to children with acute lymphoblastic leukaemia (ALL).Design Development and application of an estimation tool.Setting Paediatric oncology hospital departments in Thailand.Participants 318 children aged 0–14 years diagnosed with ALL and 215 children with undiagnosed ALL.Interventions Estimates of volume and budget requirements for administering a full course of chemotherapy for ALL and a further course for children who relapse, according to National Treatment Guidelines.Primary and secondary outcome measures Primary outcome measures were the volume (mg) and cost (US$) of medicines needed to treat children with ALL. For medicines whose main indication is paediatric ALL (asparaginase and 6-mercaptopurine), we estimated the difference between volume needed and actual sales in 2017 (secondary outcome).Results Ten anticancer medicines and four chemoprotective agents are needed for the treatment of paediatric ALL according to the Thai treatment guidelines. Of these 14 medicines, 13 are included in the WHO essential medicines list for children. All are available as generics. We estimated that essential chemotherapy and chemoprotective agents to treat all children diagnosed with ALL in Thailand in 2017 would cost US$ 814 952 (US$ 1 365 422 for diagnosed and undiagnosed children), which corresponds to 0.005% (0.008%) of the country’s total health expenditure. The volumes of asparaginase and 6-mercaptopurine available on the Thai market in 2017 were more than sufficient (2.3 and 1.5 times the amounts needed, respectively) to treat all children diagnosed with ALL.Conclusions Procuring sufficient quantities of essential medicines to treat children with ALL requires relatively modest resources. Medicine cost should not be a major barrier to ALL treatment in similar settings.

Background Evidence of the context-specific challenges related to childhood cancer drug (CCD) access is vital to improving outcomes for children with cancer in low- and middle-income countries, such as Ghana. We sought to determine the availability and cost of essential CCD in Ghana and identify the underlying determinants of access.Methods Our study integrated quantitative data on drug prices and availability with qualitative insights into health system and sociopolitical determinants of CCD access in Ghana. We analysed retrospective monthly price and stock data for 41 cancer and supportive care drugs on the WHO Essential Medicines List (EML) from private retail and public institutional pharmacies. Non-parametric analyses evaluated relationships between drug price and availability, and impacts of drug class and formulation on availability and procurement efficiency. We assessed the determinants of drug access through thematic analysis of policy documents and semi-structured interviews (n=21) with key health system stakeholders.Results Ghana lists only 47% of essential CCD on its National EML, revealing gaps in domestic formulary inclusion. Stock-outs occurred for 88% of essential CCD, with a 70-day median stock-out duration; 32% had median price ratios above internationally-accepted efficiency thresholds. Drugs procured inefficiently were more susceptible to stock-outs (p=0.0003). Principal determinants of drug access included: (1) lack of sociopolitical priority afforded childhood cancer and (2) the impact of policy and regulatory environments on drug affordability, availability and quality. Establishment of a population-based cancer registry, a nationally-coordinated procurement strategy for CCD, public financing for childhood cancer care and policies to control drug costs emerged as priority interventions to improve drug access in Ghana.Conclusion Our study provides context-specific evidence to enable responsive policy development for efficient drug procurement and supply management in Ghana and establishes a rigorous approach to the analysis of childhood cancer drug access in similar health system settings.

Purpose: Limited data describe the delivery of pediatric cancer care in Mexico. We report a nationwide survey of pediatric cancer units. Methods: An electronic survey was distributed to 74 pediatric cancer units in Mexico to describe case volumes; organization of care; and availability of medical/surgical specialists, supportive care, complex therapies, and diagnostic services. Centers were classified as low (< 30 new patients/year), medium (30 to 59/year) and high (≥ 60/year). Results: Sixty-two centers completed the survey (response rate, 84%). The median annual new case volume per center was 50 (interquartile range [IQR], 23 to 81). Thirty-four percent (n = 21), 26% (n = 16), and 40% (n = 25) of units were low-, medium-, and high-volume centers, respectively. Treatment units reported a median of two pediatric oncologists (IQR, 2) and one pediatric hematologist (IQR, 1 to 2). Availability of medical and surgical subspecialists varied by center size, with substantially more specialist support at higher-volume centers (P < .01). Multidisciplinary tumor boards are available at 29% (six of 21), 56% (nine of 16), and 76% (19 of 25) of low- to high-volume centers, respectively (P = .005). Radiation and palliative care services are available at 42% (n = 26) and 63% (n = 36) of all centers, which did not vary by center volume. Educational support for hospitalized children and school reintegration programs are available at 56% (n = 36) and 58% (n = 36) of centers, respectively. One third (38% [n = 23]) of centers reported that at least one half of patients were lost to follow-up during the transition from pediatric to adult programs. Conclusion: A large variation exists in annual case volumes across Mexican pediatric cancer centers. Additional efforts to increase access to multidisciplinary, supportive, and palliative care across all pediatric cancer units in Mexico are required.

Purpose: No published study to date has examined total cost and cost-effectiveness of maintaining a pediatric oncology treatment center in an African setting, thus limiting childhood cancer advocacy and policy efforts. Methods: Within the Korle Bu Teaching Hospital in Accra, Ghana, costing data were gathered for all inputs related to operating a pediatric cancer unit. Cost and volume data for relevant clinical services (eg, laboratory, pathology, medications) were obtained retrospectively or prospectively. Salaries were determined and multiplied by proportion of time dedicated toward pediatric patients with cancer. Costs associated with inpatient bed use, outpatient clinic use, administrative fees, and overhead were estimated. Costs were summed for a total annual operating cost. Cost-effectiveness was calculated based on annual patients with newly diagnosed disease, survival rates, and life expectancy. Results: The Korle Bu Teaching Hospital pediatric cancer unit treats on average 170 new diagnoses annually. Total operating cost was $1.7 million/y. Personnel salaries and operating room costs were the most expensive inputs, contributing 45% and 21% of total costs. Together, medications, imaging, radiation, and pathology services accounted for 7%. The cost per disability-adjusted life-year averted was $1,034, less than the Ghanaian per capita income, and thus considered very cost effective as per WHO-CHOICE methodology. Conclusion: To our knowledge, this study is the first to examine institution-level costs and cost-effectiveness of a childhood cancer program in an African setting, demonstrating that operating such a program in this setting is very cost effective. These results will inform national childhood cancer strategies in Africa and other low- and middle-income country settings.

IntroductionA major barrier to improving childhood cancer survival is the perception that paediatric oncology services are too costly for low-income and middle-income country (LMIC) health systems. We conducted a systematic review to synthesise existing evidence on the costs and cost-effectiveness of treating childhood cancers in LMICs.MethodsWe searched multiple databases from their inception to March 2019. All studies reporting costs or cost-effectiveness of treating any childhood cancer in an LMIC were included. We appraised included articles using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Where possible, we extracted or calculated the cost per disability-adjusted life year (DALY) averted using reported survival and country-specific life expectancy. Cost/DALY averted was compared with per capita gross domestic product (GDP) as per WHO-Choosing Interventions that are Cost-Effective guidelines to determine cost-effectiveness.ResultsOf 2802 studies identified, 30 met inclusion criteria. Studies represented 22 countries and nine different malignancies. The most commonly studied cancers were acute lymphoblastic leukaemia (n=10), Burkitt lymphoma (n=4) and Wilms tumour (n=3). The median CHEERS checklist score was 18 of 24. Many studies omitted key cost inputs. Notably, only 11 studies included healthcare worker salaries. Cost/DALY averted was extracted or calculated for 12 studies and ranged from US$22 to US$4475, although the lower-end costs were primarily from studies that omitted key cost components. In all 12, cost/DALY averted through treatment was substantially less than country per capita GDP, and therefore considered very cost-effective.ConclusionMany included studies did not account for key cost inputs, thus underestimating true treatment costs. Costs/DALY averted were nonetheless substantially lower than per capita GDP, suggesting that even if all relevant inputs are included, LMIC childhood cancer treatment is consistently very cost-effective. While additional rigorous economic evaluations are required, our results can inform the development of LMIC national childhood cancer strategies.

Red kidney beans are a staple pulse crop well known for its unique flavor characterized by kidney bean like, smoky, sulfury and earthy aroma notes. However, nature of compounds responsible for the unique beany odor of the cooked pulse has not been established. Steam distillation extracts of red kidney beans were subjected to Gas-chromatography olfactometry (GC-O) techniques namely detection frequency and aroma extract dilution analysis (AEDA). GC-O results suggest that methional with flavor dilution (FD) factor 21 is responsible for imparting the characteristic odor of the cooked red kidney beans. Apart from this p-vinyl guaiacol (FD 13) was identified as most important contributor towards smoky odor note. Sulfury note was mainly contributed by diethyl sulfide (FD 10) while 2-ethyl-3-methyl pyrazine (FD 13) was identified to be responsible for earthy note in cooked red kidney beans. Contribution of these compounds in characteristic aroma of cooked red kidney beans is reported here for the first time.

Objective: Temporomandibular joint ankylosis (TMJa) is a distressing condition, but can be surgically managed by gap or interpositional arthroplasty, with an aim to restore joint function and prevent re-ankylosis. The aim of this paper is to compare two interposition materials used in management of TMJ ankylosis. Methods: 15 patients with TMJa were randomly allocated to two groups: group A (n = 6), interposition material used was medical-grade silicon elastomer, and group B (n = 9) where the interposition material used was temporalis fascia. Patients were followed up at regular intervals of 1 and 2 weeks, 1 month, 3 months, and 6 months and were assessed on following parameters: pain by VAS Scale, maximal mouth opening (MMO), implant rejection, and recurrence. Results: The results showed a loss of 4.6% and 7.9% in maximal interincisal mouth opening at 3rd and 6th months in Group A while Group B had a mean loss of 9% and 10% at 3rd and 6th months respectively without any significant difference. None of our cases showed recurrence or implant rejection. Conclusion: We conclude that silicone is comparable to temporalis fascia in terms of stability, surgical ease, and adaptability. It not only restores the function of mandible and ensures good maximum interincisal opening but also maintains the vertical ramal height. Also, it requires less operating time and is easy to handle but is not economical. It might be an effective way to restore function and prevent re-ankylosis.

Introduction Adolescents and young adults (AYA) are an understudied population in cancer research. The Initiative to Maximize Progress in Adolescent and Young Adult Cancer Therapy (IMPACT) cohort includes Ontario individuals aged 15-21 years, diagnosed with a malignancy during 1992-2011. This cohort contains a rich source of patient, disease, and treatment data. Objectives and Approach The IMPACT cohort was created using chart review and linkages to population-based health services databases. The cohort is comprised of AYA with a primary diagnosis of acute leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma, sarcoma, or testicular cancer. For the current study, we focused on acute lymphoblastic leukemia (ALL) patients, and examined survival outcomes of those treated at pediatric vs adult centers, with adult vs pediatric protocols. We assessed 5-year event-free survival (first of relapse, progression, secondary malignant neoplasm, or death) and overall survival. Results The IMPACT cohort contains 2,963 patients, of which 152/271 ALL patients were treated at adult centers. The 5-year event-free survival (EFS ± standard error) among those treated at a pediatric vs. adult center was 72%±4% vs. 56%±4% (p = 0.03), respectively. The 5-year overall survival (OS) was 82%±4% vs. 64%±4% (p Conclusion/Implications ALL patients treated with a pediatric protocol at a pediatric center experienced better, crude survival outcomes compared to those at an adult center. The IMPACT cohort offers the opportunity to study a myriad of questions on different cancer groups, with the ultimate goal of improving outcomes among the AYA population.

Coronal fractures of distal femur are complex intra articular fractures. Various cases of unicondylar and bicondylar Hoffa fractures have been reported in literature. Bilateral unicondylar Hoffa fracture is a very rare injury and it is not reported in literature to best of our knowledge. We report a case of bilateral unicondylar Hoffa fracture associated with tibial spine avulsion in right knee and possible mechanism of injury in same patient.

The aim of this paper was to present a user friendly numerical algorithm based on homotopy perturbation transform method for solving various linear and nonlinear convection-diffusion problems arising in physical phenomena where particles, energy, or other physical quantities are transferred inside a physical system due to two processes: diffusion and convection. The homotopy perturbation transform method is a combined form of the homotopy perturbation method and Laplace transform method. The nonlinear terms can be easily obtained by the use of He’s polynomials. The technique presents an accurate methodology to solve many types of partial differential equations The approximate solutions obtained by proposed scheme in a wide range of the problem’s domain were compared with those results obtained from the actual solutions. The comparison shows a precise agreement between the results.

Changes in microbial community composition in the lung of patients suffering from moderate to severe COPD have been well documented. However, knowledge about specific microbiome structures in the human lung associated with CT defined abnormalities is limited.Bacterial community composition derived from brush samples from lungs of 16 patients suffering from different CT defined subtypes of COPD and 9 healthy subjects was analyzed using a cultivation independent barcoding approach applying 454-pyrosequencing of 16S rRNA gene fragment amplicons.We could show that bacterial community composition in patients with changes in CT (either airway or emphysema type changes, designated as severe subtypes) was different from community composition in lungs of patients without visible changes in CT as well as from healthy subjects (designated as mild COPD subtype and control group) (PC1, Padj = 0.002). Higher abundance of Prevotella in samples from patients with mild COPD subtype and from controls and of Streptococcus in the severe subtype cases mainly contributed to the separation of bacterial communities of subjects. No significant effects of treatment with inhaled glucocorticoids on bacterial community composition were detected within COPD cases with and without abnormalities in CT in PCoA. Co-occurrence analysis suggests the presence of networks of co-occurring bacteria. Four communities of positively correlated bacteria were revealed. The microbial communities can clearly be distinguished by their associations with the CT defined disease phenotype.Our findings indicate that CT detectable structural changes in the lung of COPD patients, which we termed severe subtypes, are associated with alterations in bacterial communities, which may induce further changes in the interaction between microbes and host cells. This might result in a changed interplay with the host immune system.

Traumatized anterior teeth with sub-gingival crown fractures are a challenge to treat. The management of sub-gingival fractures includes exposing the cervical margin followed by appropriate coronal restoration. The treatment modalities, which involve exposing the cervical margin, are surgical crown lengthening and orthodontic extrusion. This paper reports a case of fractured maxillary anterior tooth at the sub-gingival level that was managed by forced orthodontic extrusion after endodontic treatment followed by esthetic rehabilitation, a much forgotten technique not utilized routinely yet conservative and cost-effective.

In this paper, by means of the homotopy analysis method (HAM), the solutions of some nonlinear Cauchy problem of parabolic-hyperbolic type are exactly obtained in the form of convergent Taylor series. The HAM contains the auxiliary parameter \hbar that provides a convenient way of controlling the convergent region of series solutions. This analytical method is employed to solve linear examples to obtain the exact solutions. The results reveal that the proposed method is very effective and simple.

ABSTRACT: Introduction: Oral submucous fibrosis (OSMF), a chronic debilitating condition of the mouth, has been treated both surgically and non-surgically, but non-surgical methods yield inconsistent results. The surgical methods essentially comprise of bilateral sectioning of fibrous bands with or without coronoidectomy followed by covering of the surgical defect with a graft or a wound dressing material such as collagen sheet. Materials and Methods: This study comprised 30 clinically diagnosed cases of OSMF. This study compared transposition of buccal pad fat graft with collagen sheet to cover the defect within the following parameters: pain, swelling, mouth opening, color of mucosa, palpability of fibrous bands, and suppleness of mucosa. Results: We found significant difference in the postoperative mouth opening, an insignificant difference for post surgical morbidity and higher grades of surgical convenience in using collagen sheet as a wound dressing material. Conclusion: Collagen membrane is a superior method compared to transposition of the buccal pad of fat as a graft to cover the surgical wound in the treatment of OSMF of grade III and above.

BACKGROUND: Caspofungin is an echinocandin class antifungal medication that is commonly used empirically in immunocompromised patients at high risk for invasive fungal disease.

Objectives: To evaluate and compare the antibacterial efficiency of MTAD, Oxytetracycline, 5% NaOCl, and 2% chlorhexidine when used as root canal irrigants against Enterococcus faecalis. Materials and Methods: Fifty extracted human single rooted anterior teeth were selected. The decoronated sterilized root samples were infected with 10μl of 24 hours pure culture suspension of E. faecalis for 48 hours except for 10 teeth in negative control group (Group V). The test samples were divided into four groups (n = 10) as: Group I- 5% Sodium Hypochlorite, Group II- MTAD, Group III- Oxytetracycline and Group IV- 2% Chlorhexidine. The root canals were instrumented while using respective root canal irrigant solution. The bacterial cultures were taken from each root canal and colony forming units were counted on agar plates. The data was statistically analyzed. Results: It was observed that Group-III (Oxytetracycline) showed the maximum antibacterial efficacy against E. faecalis followed by Group II (MTAD), Group IV (2% Chlorhexidine), Group I (5% Sodium hypochlorite). Conclusion: Oxytetracycline has a great potential as a root canal irrigating agent because of its superior antimicrobial efficacy against E. faecalis, easy availability and cost effectiveness.

Aim: The purpose of this in vitro study was to assess the apical sealing ability of Epiphany/Resilon, AH Plus/gutta-percha and their cross combinations-AH Plus + Resilon and Epiphany+gutta-percha. Materials and Methods: Fifty eight extracted human single-rooted mandibular premolars were used and obturated with different combinations of core material and sealer using lateral compaction technique. The groups were as follows: Group-1: Epiphany + Resilon; Group-2: AH Plus + Gutta-percha; Group-3: AH Plus + Resilon; Group-4: Epiphany + Gutta-percha; Group-5: Negative control group. Apical microleakage was assessed with dye penetration method using stereomicroscope. Statistical analysis was performed using one-way ANOVA followed by post hoc test (Bonferroni test), with significance level set at P < 0.05. Results: Results indicated that AH Plus + Resilon had the least microleakage than all the other groups, followed by Epiphany + Gutta-percha group while Epiphany + Resilon group demonstrated the greatest amount of microleakage. Statistical analysis showed significant results (P < 0.05) except for comparison between Group 1-2 and Group 3-4 (P > 0.05). Conclusions: Resilon + AH Plus showed significantly least amount of microleakage and better apical sealing ability as compared to other groups.

ABSTRACT: Introduction: Bone grafts are frequently used for the treatment of bone defects, but can cause postoperative complications, and sometimes a sufficient quantity of bone is not available. Hence, synthetic biomaterials have been used as an alternative to autogenous bone grafts. Recent clinical reports suggest that application of autologous blood plasma enriched with platelets can enhance the formation of new bone. There are very few in vitro or in vivo studies published on the efficiency of platelet-rich plasma (PRP). The objective of this study was to evaluate the alloplastic bone substitute for its osteogenic potential with or without PRP. Materials and Methods: Twenty-three patients with periapical bony defects were selected for this study. Clinical parameters such as pain visual analog scale (VAS), swelling, infection, graft migration, rejection, radiographical interpretations at regular interval and scintigraphic evaluation were done to evaluate osteogenic potential of alloplastic bone substitute with or without PRP. Results: The highest acceleration in bone formation was observed in groups where alloplastic bone substitute was used with PRP. There were no statistically significant differences between the two groups regarding other outcome variables throughout the postoperative period. Conclusion: Addition of PRP significantly accelerates vascularization of the graft, improves soft tissue healing, reduces postoperative morbidity and enhances bone regeneration.

The objective of this study was to develop a noncontact, noninvasive, imaging system for monitoring the strain and deformation states of osseointegrated prostheses. The proposed sensing methodology comprised of two parts. First, a passive thin film was designed such that its electrical permittivity increases in tandem with applied tensile loading and decreases while unloading. It was found that patterning the thin films could enhance their dielectric property’s sensitivity to strain. The film can be deposited onto prosthesis surfaces as an external coating prior to implant. Second, an electrical capacitance tomography (ECT) measurement technique and reconstruction algorithm were implemented to capture strain-induced changes in the dielectric property of nanocomposite-coated prosthesis phantoms when subjected to different loading scenarios. The preliminary results showed that ECT, when coupled with strain-sensitive nanocomposites, could quantify the strain-induced changes in the dielectric property of thin film-coated prosthesis phantoms. The results suggested that ECT coupled with embedded thin films could serve as a new noncontact strain sensing method for scenarios when tethered strain sensors cannot be used or instrumented, especially in the case of osseointegrated prostheses.

Sustainability means meeting the needs of the present without compromising the ability of future generations to meet their own needs, and Sustainable Waste Management is using waste produced efficiently so that use of amount of material resources get reduced. India, is the second amongst cement producers in the world with a total capacity of 245.40 Million Tonnes (MT), has a huge cement industry and produces about 7% of world’s total production. The Indian cement industry has on one hand, enormous pressure to increase profit and margins, while on other; there is considerable public interest on a sustainable and environment friendly usage of natural resources. The objective of this paper is to pursue sustainable waste management for a cement industry through replacement of coal with some alternative fuel, which actually belongs to the group of hazardous wastes and which could benefit the plant economically and environmentally, and improve sustainability of plant. The use of alternative fuels will help in reducing energy costs and providing a competitive edge for a cement plant. Furthermore, this will reduce the burden of waste disposal considerably. So, it also supports to fulfilling Sustainable Waste Management issues

Poorly differentiated (insular) thyroid carcinoma (PDITC) is an uncommon thyroglobulin producing neoplasm intermediate in aggressiveness between well-differentiated carcinomas of follicular cell origin and undifferentiated anaplastic carcinoma. Its cytomorphological recognition is essential for planning surgery and subsequent management as it is known for its aggressive behavior, advanced stage at presentation, local recurrences and rapid dissemination. We report a case of PDITC arising in a long-standing goiter, in which presence of microfollicular structures and minimal necrosis resulted in difficulty in distinguishing it from a follicular neoplasm of thyroid.

Background & aim: To identify the variations in site of origin and level of the origin of the superior thyroid artery and its relation with external laryngeal nerve. Material & Method: A study was undertaken on 33 donated cadavers and through dissection was performed in neck region and both sides of superior thyroid artery were considered. Results: in present study superior thyroid artery arise from external carotid artery in 66.67% cases, from carotid bifurcation in 31.81% cases and from common carotid artery in 1.51% cases. While in 86.36 % cases level of the origin was above the thyroid cartilage and in 13.64% cases level of the origin was at the same level of thyroid cartilage. The external laryngeal nerve crossed the superior thyroid artery within 1cm above the upper pole of the thyroid gland in 27.27% of cases and more than 1 cm in 72.73% of cases. Conclusion: The information will be useful as reference for surgical procedures such as - total bilateral lobectomy, total unilateral with partial contralateral lobectomy and partial or subtotal lobectomy & others like catheterization, reconstruction of aneurysm, carotid endarterectomy and intervention radiology which is helpful to prevent complications such as bleeding or damage to laryngeal nerves.

Introduction: sacrum is an important bone for identification of sex of an individual by using skeletal material among anatomist, anthropologist and forensic experts. Aim: to find out diagnostic efficacy of sacral index and Kimura’s base wing index methods of sex determination of sacrum. Material and method: 100 fully ossified adult sacrum of known sex were used and data were collected by using vernier caliper. Both sacral index and Kimura’s base wing index methods of sex determination were applied and analyzed by using Z-test. Conclusion: The results were compared with the available literatures and it was found that sacral index is more reliable than Kimura’s base wing index for establishing sex of a sacrum.

Introduction: The suture closure of skull has a time and sequence of their union and study of suture closure can be correlated to its age and the obliteration of sutures is affected by sex, race, climate, heredity and diet Aims: To study the closure of vault sutures on both inner and outer surface of skull and its correlation with age. Methods: Total 200 skulls in autopsy cases (157 males and 43 females) from all age groups were studied. Results: In males the minimal age of fusion in endocranium were 40 years for both sagittal suture (SS) and coronal suture (CS) & 50 years for lambdoid suture (LS). In females it was 40, 33 and 53 years for SS, CS & LS respectively. The maximum age of non-union of suture on endocranium in males was 42, 45, 55 years for SC, CS & LS respectively. In females it was 45, 45 and 55 years for SC, CS and LS respectively. 2 males (1% of all cases) showed nonfusion of vault sutures at the age of 70 years at ectocranium. Among the females maximum age of non-union of ectocranium was observed to be 59, 58 and 69 years for SS, CS and LS respectively. Conclusion: The fusion of endocranial vault sutures occurred 5-10 years earlier as compared to ectocranium and it is more reliable. The obliteration sets little early and proceeds more slowly in the females than in males.

BACKGROUND: While low socioeconomic status (SES) has been associated with inferior cancer outcome among adults, its impact in pediatric oncology is unclear. Our objective was therefore to conduct a systematic review to determine the impact of SES upon outcome in children with cancer. METHODS: We searched Ovid Medline, EMBASE and CINAHL from inception to December 2012. Studies for which survival-related outcomes were reported by socioeconomic subgroups were eligible for inclusion. Two reviewers independently assessed articles and extracted data. Given anticipated heterogeneity, no quantitative meta-analyses were planned a priori. RESULTS: Of 7,737 publications, 527 in ten languages met criteria for full review; 36 studies met final inclusion criteria. In low- and middle-income countries (LMIC), lower SES was uniformly associated with inferior survival, regardless of the measure chosen. The majority of associations were statistically significant. Of 52 associations between socioeconomic variables and outcome among high-income country (HIC) children, 38 (73.1%) found low SES to be associated with worse survival, 15 of which were statistically significant. Of the remaining 14 (no association or high SES associated with worse survival), only one was statistically significant. Both HIC studies examining the effect of insurance found uninsured status to be statistically associated with inferior survival. CONCLUSIONS: Socioeconomic gradients in which low SES is associated with inferior childhood cancer survival are ubiquitous in LMIC and common in HIC. Future studies should elucidate mechanisms underlying these gradients, allowing the design of interventions mediating socioeconomic effects. Targeting the effect of low SES will allow for further improvements in childhood cancer survival.

Introduction: Metopic suture which is placed between frontal bone and usually disappear during infancy and childhood, may persist from nasion to anterior angle of bregma, this is called metopism. Objective: To find the incidence of metopism in western Rajasthan and to compare it with other study in other parts of India and Abroad. Methodology: Present study was autopsy done on 200 dead bodies of all age group who were brought to J L N Medical college, Ajmer for autopsy during the period of 6 months. Vault was observed morphological for presence of metopism on both outer and inner side after removal of periosteum. Results: The incidence of metopism was 6.5% in all observed skull in this study. The incidence of metopism was observed more in child age group i.e. 100% in 0-5 years & 80% in 6-10 years as compare to the adults and old age groups i.e. 3.4% in 41-50 years. Conclusion: The presence of metopic suture simulates the fracture of frontal bone, therefore it should be properly ruled out in x-rays by radiologists and neurosurgeons.

Asymmetric bilateral dislocations of the hips are rare injuries. Among the small number of reports in the literature, most have attributed the cause to high-velocity motor crashes. These dislocations are often seen to be associated with fractures of the proximal femur or the acetabulum. We present a case of a 45-year-old man with bilateral asymmetric dislocation of hips which were purely ligamentous in nature, without any fracture. He sustained his injuries due to a fall while getting on a moving bus. It was an unusual mechanism of injury as compared to the other cases of asymmetric hip dislocations reported in published studies. Both hips were reduced under general anaesthesia within three hours of the trauma. Skin traction and non-weight-bearing rehabilitation were continued for six weeks. After 35 months of followup, the patient remains asymptomatic. Early diagnosis and timely reduction of such dislocations under anaesthesia are necessary for prevention of complications.

Objectives: To provide anatomical information on the position, morphological variations and incidence of mental foramen and accessory mental foramen as they are important for dental surgeons, anaesthetists in nerve block and surgical procedures to avoid injury to neurovascular bundle in mental foramen area. Method: The present study was conducted using 120 dried human mandibles of both sexes. Size, shape and position of mental foramen and accessory mental foramen were determined using digital vernier calliper. Results: Mental foramen was present in all observed mandibles and it was bilateral in position. Accessory mental foramen was present in 8 mandibles and was unilateral in position. Conclusion: The knowledge about variation in size, shape and position of mental foramen and presence of accessory mental foramen may be helpful to the dental surgeons to achieve full anaesthesia after nerve block.

Objectives: To study the overall and individual incidence of clinically detectable congenital malformations in newborns delivered at a tertiary hospital and to find out the associated maternal factors. Methodology: The present study is a prospective study of all the newborns delivered at Obstetrics and Gynecology Department, SSG Hospital, Baroda for a period of one year in which total 4058 consecutively born babies were examined for all visible structural anomalies and associated maternal factors were studied. Results: Incidence of malformed babies was 1.53% (62 malformations out of 4058 babies) of which the anomalies of CNS were the most frequent .In associated maternal factors, anaemia and diabetes were found to be relevant. Conclusion: The incidence of congenital anomalies of CNS was highest amongst all types of congenital anomalies (neural tube defects being the commonest). More stress should be laid on prevention by regular antenatal care and avoidance of known teratogens and probable teratogenic agents.