Objective(s): Neoadjuvant chemotherapy (NAC) is a standard of care for locally advanced breast cancers. Adjuvant radiotherapy (RT) after NAC is an area of active research. We hypothesize overall survival (OS) is not altered by omitting RT in women with a pathologic complete response (pCR) to NAC after breast conserving survery (BCS). Methods: Patients from the National Cancer Database who underwent NAC, BCS, and had a pCR were included. Inflammatory disease, <6 months follow up, and unknown variables were excluded. Descriptive statistics characterized the retained cohort. Logistic regression analyzed the influence of variables on the rate of RT omission. Cox proportional hazard modeling analyzed the influence of prognostic variables on OS. Results: Of 5383 women included, 364 (7%) omitted RT. 5-year OS was 94.1% with RT, 93% without. RT omission was most likely in women >70yo (adjusted OR2.4,
Guidelines for neonatal skin care are scarce, and there is no consensus on the best management practices for neonatal skin breakdown. This review presents the pathology and phases of wound healing, reasons for neonatal skin fragility, and approaches to recognition of commonly encountered neonatal wounds. This review also provides general strategies for neonatal wound prevention, care, dressing, and management to avoid further damage to the fragile neonatal skin. The importance and role of retaining moisture in expediting wound healing is discussed, as well as updated classifications on how to grade and assess pressure ulcers and the role of negative pressure wound therapy and silver dressings. Lastly, this review discusses prevention and treatment options for surgical wounds, intravenous extravasation wounds, congenital wounds, and thermal injuries, in addition to how to differentiate these wounds from the common diaper dermatitis and contact dermatitis.
Background
IgAvasculitis (IgAV) is the commonest cause of vasculitis in childhood.
It is characterized by small vessel vasculitis of the skin, gastrointestinal tract, kidneys, joints, and, rarely, the lungs and the central nervous system. There is paucity of international guidelines for management of IgA V. the Objective is to develop guidelines specific for Egyptian children with IgA vasculitis.
Method
This study was carried out to achieve an Egyptian expert consensus on a treat-to-target management strategy for IgA vasculitis using Delphi technique. The preliminary scientific committee identified a total of 16 key clinical questions according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) approach. Delphi process was implemented (2-rounds) to reach a consensus.
Results
An online questionnaire were sent to expert panel (n = 26) who participated in the two rounds. At the end of round 2, a total of 20 recommendation items, categorized into 2 sections were obtained. Agreement with the recommendations (rank 7–9) ranged from 91.7–100%. Consensus was reached (i.e. ≥75% of respondents strongly agreed or agreed) on the wording of all the 20 clinical standards identified by the scientific committee. Algorithms for the management have been suggested.
Conclusion
This was an expert, consensus recommendations for the diagnosis and treatment of IgA V and IgA V nephritis, based on best available evidence and expert opinion.
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