This study supports a care pathway strategy advocating conservative management of high-grade renal injuries in children. However, patients may experience a relative decline in renal function with higher grade injuries indicating the need for monitoring and follow-up.

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If gallstone disease is on the increase in children, what does this mean for paediatric surgeons?

IntroductionSuction rectal biopsy (SRB) is a key diagnostic tool in Hirschsprung’s disease. The original Noblett device has been superseded by modern alternatives including the Rbi2 rectal biopsy gun. We describe a comparison of biopsy results from the Noblett device and the Rbi2 gun and an investigation into significant post-biopsy bleeding episodes with the latter.MethodsA retrospective review of SRB episodes between 2006 and 2014 was undertaken to audit biopsy success rates. Significant post-procedure bleeding after SRB with the Rbi2 gun prompted further investigations.ResultsBiopsies taken with the Noblett gun were more likely to be inadequate (Noblett 82/197 (40%) vs Rbi2 77/438 (18%)). After biopsy with the Rbi2 gun, 2 infants suffered from significant bleeding requiring resuscitation, blood product support and multiple theater episodes. As there were no reported cases of bleeding with the Rbi2 gun, a report was made to the Medicines & Healthcare products Regulatory Agency who identified incorrect biopsy technique as a potential contributing factor. A questionnaire of trainees and consultants found unexpected individual variation in SRB technique, with some users applying excessive suction.ConclusionsSignificant bleeding occurred after SRB with the Rbi2 gun, excessive suction was thought to be the cause.

BACKGROUND Mauritius has not had any community acquired SARS-COV-2 case for 6 months and is continuing to maintain control over the disease so far. In this study we discuss how the disease initially spread and use New Zealand, another SARS-COV-2 success story, as the comparator. OBJECTIVE This study aims to explore how the initial wave progressed in Mauritius, by looking at who was most affected, who were most likely to transmit the disease, what were the most effective measures and how the authorities can be best prepared going forward. METHODS Exploratory retrospective analysis of all confirmed cases in Mauritius between 18th March and 30th August 2020. Additionally, a comparative cross-sectional study for confirmed cases between New Zealand and Mauritius. RESULTS There were 355 confirmed cases, 62.0% males, median age = 38 years. The majority (64.8%) were asymptomatic during their infection. New Zealanders in the age-group 10-19 years of age were more prone to infections in contrast to the same age category in Mauritius (P=.006). Contact-tracing was effective in both countries, with 65.3% and 66.3% case detection rates in Mauritius and New Zealand respectively. There were 5 major case clusters in Mauritius and there was an association between delay in notification to authorities and spread from each index case. Health sector workers who were infected, made up of 10.4% of Mauritian cases and 14.3% in New Zealand. The geographical coverage of SARS-COV-2 transmission was 67 percent in Mauritius compared to 45 percent in New Zealand. The test positivity rate was above five percent for only the first three weeks of the outbreak in Mauritius whilst it remained below five percent throughout the outbreak in New Zealand. CONCLUSIONS Mauritius over-achieved in its fight against SARS-COV-2. Application of the lessons learnt will help better face further waves of the pandemic. We outline five recommendations to attain this objective.