Objectives Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs.Design A multicentre, international, collaborative cohort study.Setting 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020.Participants Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin’s lymphoma, Hodgkin lymphoma, Wilms’ tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer.Main outcome measure All-cause mortality at 30 days and 90 days.Results 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001).Conclusions The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally.Data are available on reasonable request. Deidentified date will be shared on request.

Objective.The objective of this study is to evaluatethe efficacy of image-guided
systems in nasal and skull base surgeries.Study design. This is a prospective case
control study. Material and methods. A total number of 24 patients were included in this
study. The relevant pre-operative, operative and post-operative records were collected
and analyzed. Results:The mean total operative time was greater for the imageguidance
surgery group (130 minutes; range 95-160 minutes) than for the control
group (119 minutes; range 85-150 minutes). However, the mean actual operative time
was less for the image-guidance surgery group (93 minutes; range 65-120 minutes)
than the control group (99 minutes; range 70-130 minutes).The image-guidance
surgery group had no major complications. However the control group had 3 major
complications (25%).The average estimated blood loss (EBL) was higher for the
image-guidance surgery group (395 mL; range 130-1100 mL) than the control group
(380 mL; range 100-950 mL).Conclusion: Image guided system may reduce the
complications associated with endoscopic sinus surgery and allow for a more thorough
operation

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