Great Debates: Surgery or Watch and Wait After Total Neoadjuvant Therapy for Rectal Cancer.

Locally advanced rectal cancer has traditionally been treated with multimodal therapy including neoadjuvant chemoradiotherapy followed by surgical resection. More recent data suggests that in appropriate patients, total neoadjuvant treatment (TNT) makes it possible to adopt a "watch and wait" approach. Advocates for watch and wait argue that patients with a complete or near-complete clinical response to TNT have comparable overall and disease-free survival to their counterparts who undergo surgical resection, and also have a better quality of life, fewer complications, and potentially avoid a stoma. The dogma of surgery as regional curative intent therapy has been challenged by similar recurrence rates among those treated with total mesorectal excision (TME) and those treated with watch and wait. Furthermore, those who develop local recurrence in the watch and wait groups are equally salvageable, either by surgery, brachytherapy, or chemotherapy. While watch and wait is not appropriate in all patients, this manuscript highlights the benefits and drawbacks of both therapeutic modalities.

The nature and prevalence of psychiatric disorders in a Sudanese juvenile correctional facility.

High morbidity of mental disorders among juvenile offenders has been confirmed by several studies, thus challenging both the juvenile justice system and the mental health system. Data from developed countries may not reflect the situation in low-income countries and therefore cannot form a basis for intervention. No similar study has been done in Sudan. The objective to determine prevalence of psychiatric disorders among incarcerated youth in Al-Juref juvenile correctional facility. All juveniles (forty eight) were studied utilizing a descriptive cross-sectional study design. Data was collected using a socio-demographic questionnaire and the MINI-KID 6.0 and was analyzed using the SPSS v.20. Most respondents were males (Forty six) with a mean age of fifteen (±1.6 years SD). Most were living with both parents (75%) and were school dropouts (41.7%). The majority was arrested for theft (33.3%) and rape (29.2%). Prevalence of psychiatric disorders was high (60.4%) with conduct disorder (CD) being the most common (47.9%), followed by anxiety disorders (31.1%) and major depressive disorder (14.6%). Comorbid psychiatric disorders rate was high (31%). Even after subtracting CD, prevalence was still common (39%). New information can help mental health providers and policy makers in the juvenile justice system make effective interventions in provision of mental health services. We recommend clinical assessment for juveniles when they appear at court and training of workers in the justice system on how to detect features of psychopathology.