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Background: Torus (buckle) fractures of the wrist are the most common fractures in children, involving the distal radius and/or ulna. It is unclear if children require rigid immobilisation and follow-up, or would equally recover by being discharged without any immobilisation or a bandage. Given the large number of these injuries, identifying the optimal treatment strategy could have important effects on the child, school absences and NHS costs. Objectives: To establish whether treating children with a distal radius torus fracture with the offer of a soft bandage and immediate discharge (“offer of bandage”), provides the same recovery, in terms of pain, function, complications, acceptability, school absence and resource use, as treatment with rigid immobilisation and follow-up as per usual practice (“rigid immobilisation”). Design: A pragmatic, multicentre, randomised controlled equivalence trial. Setting: 23 UK Emergency Departments. Participants: 965 children (4-15 years) with a distal radius torus fracture were randomised from January 2019 to July 2020 using a secure, centralised, online encrypted randomisation service. Exclusion criteria included presentation >36 hours after injury, multiple injuries and inability to complete follow-up. Interventions: Offer of bandage (n= 489) of whom the bandage was applied in 458, versus rigid immobilisation (n= 476). Participants and clinicians were not blinded to the treatment allocation. Main outcome measures: Pain at 3-days post-randomisation measured using the WongBaker FACES Pain Rating Scale. Secondary outcomes were the PROMIS Upper Extremity score for children, health related quality of life (QoL), complications, school absence, analgesia use and resource use collected up to 6 weeks post-randomisation. Results: 94% of participants provided primary outcome data. Pain was equivalent at the 3 day primary outcome for both groups. With reference to the pre-specified equivalence margin of 1.0, the adjusted difference in the intention-to-treat population was -0.10; 95% CI -0.37 to 0.17 and the per-protocol population was -0.06; 95% CI -0.34 to 0.21. There was equivalence in pain for both age subgroups (4-7 and 8–15 years). There was no difference in the rate of complications, with five (1.0%) in the offer of bandage group and three (0.6%) in the rigid immobilisation group. There were no differences between treatment groups in functional recovery, QoL or school absence at any point during follow-up. Analgesia use was marginally higher at Day 1 in the offer of bandage group (83% vs 78% participants), though was no different at other times. The offer of bandage significantly reduced the cost of treatment, and had a high probability of cost-effectiveness. Limitations: Families had a strong pre-existing preference for rigid immobilisation. Given this, and the inability to blind families to the treatment allocation, observer bias was a concern. However, there was clear evidence of equivalence. Conclusions: The study findings support the offer of bandage in children with a distal radius torus fracture.

The estimated prevalence of food allergy amongst children in the west is around 6-8% but there is paucity of data in the Indian population. There is a complex interplay of environmental influences and genetic factors in the immuno-pathogenesis and manifestations of food allergy. A reliable thorough clinical history, combined with positive skin prick tests or food-specific IgE, is essential for a more precise diagnosis of food allergy. Currently there is no cure for food allergy. The management of food allergy usually includes strict avoidance, patient education and provision of emergency medication (adrenaline-autoinjectors). Emerging therapies based on evolving research are focused on a more active approach to management which includes early introduction of potentially allergenic foods, anticipatory testing and desensitisation to food allergens. Lack of food labelling policy and non availability of adrenaline auto-injectors is a huge limiting factor for effective management of food allergy among children in India. The present review focuses on IgE mediated food allergy.

Aim: The clinical outcome and optimal treatment methodology for pTaG3 transitional cell carcinoma (TCC) of the urinary bladder remains controversial. We retrospectively evaluate the clinical behaviour and final outcome of 64 patients diagnosed with primary pTaG3 TCC bladder and evaluate the role of early re-resection following initial diagnosis. Patients and methods: Between January 2000 and December 2008, 64 patients were diagnosed with primary pTaG3 TCC of the urinary bladder at our institution. Following a careful retrospective review of their medical records, clinical parameters including patient age, gender, tumour morphology, operating surgeon's experience and adjuvant therapies were entered into a database. The outcome of re-resection, recurrence rate, progression and overall survival were recorded. All patients had their upper tracts screened with an ultrasound and intravenous urogram (IVU). Results: The mean age at time of diagnosis was 78 years (range 59–98). Seventy seven percent (49) of patients underwent an early re-resection (group 1). Residual tumour was identified in 49% (24) patients and the incidence of tumour upstaging was 10% (7). At re-resection 3% (2) of patients were found to have muscle-invasive disease. Twenty three percent (15) of patients did not have an early re-resection (group 2). There was a significant reduction in the incidence of recurrent TCC in group 1 in comparison to group 2 (5% vs. 62%) [ p < 0.05]. At a mean follow up of 48.9 months (range 12–124), 48 patients (75%) were alive; 25% (16) of patients had died of causes unrelated to bladder cancer. Disease-specific survival in both groups was 100%. Conclusion: pTaG3 TCC of the urinary bladder shows a variable clinical course and early re-resection significantly reduces the risk of recurrence. We strongly recommend treatment with early re-resection and subsequent treatment as per histology at re-resection. All patients with primary pTaG3 TCC of the urinary bladder should be followed up with further close surveillance using a strict follow up as these patients have a potential for disease progression.