Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2012 | Month : May | Volume : 6 | Issue : 4 | Page : 674 - 677

Paediatric Malignancies

Niharika Pattnaik, Mobarak Ahemad Khan, Ep ari Sanjeeva Rao, B. Rama Mohan Rao

1. Assistant Professor, Department of Pathology, KIMS, Amalapuram, A.P., India. 2. Professor, Department of Pathology, KIMS, KIIT University, Bhubaneswar, India. 3. Professor, Department of Pathology, KIMS, Amalapuram, A.P., India. 4. Professor & Head, Department of Pathology, KIMS, Amalapuram, A.P., India.

Correspondence Address :
Niharika Pattnaik
Assistant Professor of Pathology,
Konaseema Institute of Medical Sciences,
Amalapuram - 533201
East Godavari Dist, Andhra Pradesh, India.
Phone: 09000269074.
E-mail: debnit2005@yahoo.co.in

Abstract

Objective: Paediatric malignancies, being a significant cause of death among children, this study was performed with an aim to find out the profile of childhood cancers in western Orissa, India for a period of two years (2005-2007).

Materials and Methods: The paediatric population (0-14 yrs of age), which was diagnosed to have malignancy, in the Department of Pathology, V.S.S Medical College, Sambalpur, Orissa, India was the study group.

Result: Paediatric malignancies comprise 4.4% of the cancer load of all the age groups. The incidence of different variants, based on the International Classification of Childhood Cancer (ICCC), showed laeukaemia as the commonest cancer, to constitute 45.45% of the total cancer load, followed by soft tissue sarcomas -11.82%, malignant bone tumours- 10%, lymphomas- 8.17%, retinoblastomas- 5.45%, neuroblastomas- 4.55%, Wilms’ tumour- 4.55%, germ cell tumours -4.55%, CNS neoplasms- 3.64%, hepatoblastomas- 0.91% and squamous cell carcinomas of the skin- 0.91%, in the decreasing order of their frequencies. The age distribution showed an incidence of 31.82% in the 0-4 years age group, 24.55% in the 5-9 years age group and 43.64% in the 10-14 years age group. The sex ratio showed a male predominance.

Conclusion: The frequency of different diseases which are detected at a particular centre is not an exact reflection of the disease spectrum of that population, but it can give a rough estimation of the trend. There exist regional and geographic differences in the incidence and the histologic types of paediatric cancers.

Keywords

Paediatric, Malignancy, Cancer, Profile

Introduction
The paediatric population (0-14 years of age) constitutes 32.4% of the total population of India (1). Cancer in children is an emerging major childhood killer. Malignant neoplasms are the third commonest causes of death in the 1 to 4 years age group and the second commonest causes of death in the 5 to 14 years age group (2). These are histologically very diverse and it has been firmly established that the classification of childhood cancer should be based on the morphology of the cancer cells. Birch and Marsden, in 1987, presented the classification of childhood cancer, which was widely accepted as a standard (3). They divided childhood neoplasms into 12 major diagnostic groups. In 1996, Kramarova and Stiller modified this classification and they presented the International Classification of Childhood Cancer (ICCC), based on the ICD-0-2 (International Classification of Diseases for Oncology) (4). Paediatric neoplasms constituted 3.7-4% of all the cancers, according to data which was available from the population based cancer registries at Bangalore, Bombay and Madras, as was studied by Kusumakumary et al., (5). In US, it is about 2%, according to Singh and Silverman (6).

Geographic differences in the occurrence of childhood cancers have also been described by some authors (5),(7). From the viewpoint of cancer control, particularly in the context of developing countries like India, there is a need to detect cancers at an early, curable stage of the disease. The five year survival rate for certain cancers like Hodgkin’s lymphoma and retinoblastoma is now 95% in resource-rich countries (8). Their late presentations may be due to many factors which include lack of awareness and socioeconomic conditions, to some extent.

The purpose of the present study was to give an insight into the pattern of distribution of childhood cancer. It provided the incidence figures for the types, age and sex distribution of childhood malignant tumours. Hospital registries are the only available sources of information for assessing the disease pattern in the community.

Material and Methods

With an aim to study the profile of childhood malignant tumours in western Orissa, the present study which was entitled “Paediatric Malignancies”, was conducted. The study group consisted of paediatric patients (0-14 years of age) who were diagnosed to have cancer, in the Department of Pathology, V.S.S. Medical College Hospital, Sambalpur, Orissa. The study period was of two years duration from 2005 to 2007. After a thorough clinical examination and after correlating its findings with the history, a provisional diagnosis was made and investigations were done accordingly. A detailed haematological examination, which included peripheral smear and bone marrow studies and special stains whenever they were required, were done in case of haematological malignancies. Patients with palpable lumps were subjected to FNAC and cytological studies. A histopathological diagnosis was made for the biopsy specimens.

Several different classification systems were used in the past. We followed the International Classification of Childhood Cancer (ICCC) which was given by Kramarova and Stiller in 1996, which was modified and which was based on the ICD-0-2 (International Classification of Diseases for Oncology) (4).

Results

During the two year study (2005-2007) which was carried out in the Department of Pathology, V.S.S. Medical College, Burla,110 paediatric malignancies (0-14years) were diagnosed, which comprised 4.4% of the total cancer load i.e 2,500 malignancies in all the age groups. Haematological malignancies [50 cases (45.5%)] and malignant solid tumours [60 cases (54.5%)] were observed respectively. The most common malignancy in children was leukaemia, which constituted 45.45% of the cancer load, followed by soft tissue sarcomas -11.82%, malignant bone tumours -10.00%, lymphomas- 8.17%, retinoblastomas- 5.45%, neuroblastomas- 4.55%, Wilms’ tumour- 4.55%, germ cell tumours- 4.55%, CNS neoplasms -3.64%, hepatoblastoma s-0.91% and squamous cell carcinomas of the skin -0.91% in the decreasing order of their frequencies (Table/Fig 1).

The commonest paediatric malignancies which were observed were acute lymphoblastic leukemia (ALL) among the haematological malignancies, rhabdomyosarcoma among the soft tissue sarcomas and osteogenic sarcoma among the bone tumours. Stratification by the age group (5 years interval) in the present study delineated an incidence of 31.82% in the 0-4 years age group, 24.55% in the 5-9 years age group and 43.64% in the 10-14 years age group respectively.

The most common cancer in all the three age groups was leukaemia. The second most common cancer in the 0-4 years age group was retinoblastoma, in the 5-9 years age group, it was lymphoma and in the 10-14 years age group, it was soft tissue sarcoma. On estimation of the sex incidence, a higher frequency was seen in males over females, with a ratio of 2.34:1.

Discussion

In the present study, 110 cases of paediatric malignancies were detected, which constituted 4.4% of the total cancer cases in all the age groups, which was comparable to the findings of other studies, like 4.5% in Kusumakumari et al’s study and Jussawalla and Yeole’s study which showed that they formed 3.5% of the total cancer load (5),(9). But in the literature which was reviewed by Bhalodia et al, in 2011, paediatric tumours were found to constitute 2% of all the malignancies (10). According to Arora et al, in 2009, the incidence of cancer in India varied between 1.6-4.8% (8). So, our finding fell in this range. In contrast to this, the incidence in the United States was found to be only 2% (6).The international comparison of the cancer frequency and the incidence varies due to a variability in the diagnosis, classification and the differential access to the medical care and due to incomplete registration of the cases (5). The maximum number of paediatric malignancy cases were observed in the first and the third age groups, which was at par with the findings of other studies (9),(11).

The diversity in the age distribution in our study, as compared to that which was found by other authors, is due to the difference in the environment and the molecular mechanisms (12),(13),(14),(15). In all the paediatric age groups, leukaemia was found to be the most common type of cancer, which was similar to that which was reported by most of other literatures (5),(11),(14),(16),(17). Retinoblastoma and lymphoma were the second most common malignancies in the 0-4 years and the 5-9 years age groups respectively (14).

Most of the studies. including the present study. revealed a male predominance (Table/Fig 3). The male predominance in our country could be due to the extra at-tention which is given to the male child as a result of cultural factors (8). According to Kusumakumary et al, male predominance is a salient feature of many childhood tumours. The male excess is particularly marked in the neoplasms of lymphoid origin, possiblydue to the genetic differences in the immune function. However, the female excess which was seen in germ cell tumours may be due to the earlier development of ovarian tumours than the testicular tumours (5). Comparison of the relative frequencies of childhood cancer with those of other studies in India and outside India has been depicted in (Table/Fig 4) and (Table/Fig 5) respectively. Leukaemia was the commonest of the childhood cancers in most of the studies from India and also from abroad.

The incidence of lymphoma in the present study was 8.17%, which was comparable to that in other studies, which had an approximately 10% incidence (5),(13),(16),(17). The incidence of neuroblastoma, nephroblastoma, soft tissue sarcomas, germ cell tumours and hepatoblastoma in the pre- sent study was comparable with that of other studies (Table/Fig 4) and (Table/Fig 5). The percentage of the CNS neoplasms in present study was 3.64%, which was comparable to the finding of Mangal et al, but a higher incidence was observed in other studies from India and other countries (18). This is probably due to the inadequate facility for paediatric neurosurgery at our hospital.

The incidence of retinoblastoma in present study (5.5%) was in accordance with that which was observed by Jussawalla et al., (6.3%), Nandakumar et al (3.8%), Kusumakumary et al (4.5%) and Ocana et al., who found a 4.3% incidence (5),(9),(11),(14). The studies from West Bengal showed significantly higher frequencies of 32.6% and 19.2% which were observed by Das et al. and Chaudhuri et al respectively (16),(17). Retinoblastoma runs in families and a higher incidence was associated with older paternal age, which increased the frequency of the mutation (16). Most of the studies from outside India showed a lower frequency of retinoblastoma. It was found to be more prevalent in India than in the western countries (Breslow et al.,) (7).

Malignant bone tumours constituted 10% of the cases in the present study and this finding was at par with Jussawalla et al’s finding, whereas it was slightly higher than that in most of the other studies, where it was found to vary from 2.32%-5.8% (9). Our study revealed a lone case of squamous cell carcinoma of the skin (0.9%), which was similar to that which was found by others [14,19,20,21]. Sharma et al., also had reported a case of squamous cell carcinoma of the skin (22).

Conclusion

To conclude, the frequency of different diseases which are detected at a particular centre is not an exact reflection of the disease spectrum of that population, but it can give a rough estimation of the trend. The incidence data are important in the planning and in the evaluation of health strategies. Population based statistical data on childhood cancer will help in assessing the magnitude of the cancer problem in our country. Hence, an early diagnosis which is made by applying advanced technologies and an improved treatment modality will increase the survival rate in these children. In general, it is important to remember that when a child is affected by cancer, it creates a deep emotional impact on the entire family and they need special care and education.

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Martin AA, Alert JA, Reno JS, Lonchong M, et al. Incidence of childhood cancer in Cuba (1986-1990). International Journal Cancer 1997;72: 551-55.
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Ries LAG, Smith MA, Gurney JG, Linct M, et al. Cancer incidence and survival among children and adolescents: the United States SEER Programme 1975-99, Nat. Cancer Institute, SEER Program. NIH Pub. No. 99-4646. Bethesda, MD, 1999.
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Ocana SJ, Miranda GG, Arangure JMM, Madias MER, et al. The frequency of cancer in children who reside in Mexico City and who are treated in the hospitals of the Instituto Mexicano del Segurosocial (1996-2001). BMC Cancer 2004; 4: 50-58.
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Miller RW, Young JL, PH, Novakovic B. Childhood cancer. Cancer 1995; 75(1): 395-405.
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Das S, Chakraborty AK, Mukharjee K, Kundu BK, et al. The profile of malignant lesions amongst children in north Bengal. Indian Paediatrics 1994; 31: 1281-85.
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