Prevalence of raised body mass index in paediatric sickle cell disease.

AIM: Children with sickle cell disease (SCD) have historically weighed less than their healthy peers. More recently, a retrospective chart review from six institutions in New England reported nearly one-quarter of children and adolescents with SCD had raised body mass index (BMI). This study aimed to examine rates of children with SCD with raised BMI in Mississippi compared to state and national norms and assess the correlation between haemoglobin and BMI. METHODS: A retrospective chart review of paediatric patients with SCD at the University of Mississippi Medical Center (UMMC) was conducted using data from the most recent clinic visit. Mississippi and national weight status estimates for youth 10-17 years were obtained from the 2016-2017 National Survey of Children's Health. RESULTS: For youth 10-17 years with SCD (n = 345), 21.4.% of children with SS/Sß° and 36.1% with SC/Sß+ had raised BMI compared to Mississippi and national rates, 39.2 and 31%, respectively. The prevalence of children with raised BMI with SC/Sß+ did not differ from state and national rates, while children with SS/Sß° were half as likely as their Mississippi peers to have raised BMI. Haemoglobin levels were different among children with SCD who had low BMI (8.80 g/dL), average BMI (9.2 g/dL) and raised BMI (10.5 g/dL) (P < 0.001). CONCLUSIONS: Children with SCD evaluated at UMMC have similar rates of raised BMI compared to state and national norms. Children with raised BMI have higher mean haemoglobin levels compared to children with SCD with low or average BMI. IMPLICATIONS AND CONTRIBUTION: Historically, patients with SCD have been underweight and normal weight. Our paediatric and adolescent patients with SCD now have prevalence rates of raised BMI that approach state and national rates. Further work must be done to determine whether this reflects healthier children with SCD or raises concerns about life-style-related comorbidities.

A randomized trial of secondary closure of superficial wound dehiscence by surgical tape or suture.

OBJECTIVE: : Evaluate secondary closure of superficial wound dehiscence with suture versus tape. METHODS: : Postoperative obstetrics and gynecologic patients with superficial wound dehiscence were eligible. Wounds were opened for their entire length, debrided, and irrigated. They were packed with moistened gauze until the granulation tissue covered the wound. Randomization occurred when the patient selected a sealed envelope containing a closure technique. Demographic data and wound characteristics were recorded. Pain was determined by using a 100-mm visual analogue scale, which the patient marked immediately after the procedure. Wound closure was measured in minutes. Healing time was measured in days from wound closure to complete wound epithelialization and no need for further wound care. Reopening a closed wound defined treatment failure. Time for complete healing was the primary outcome. RESULTS: : Fifteen patients were randomized to each arm over a 20-month period. Demographics and wound characteristics were similar between groups. Pain scores were significantly less in the tape group (21.4 ± 17.0 vs 60.7 ± 23.0 mm, P < 0.001) as was time for closure (12.3 ± 3.6 vs 31.0 ± 6.8 minutes, P < 0.001). Time for complete healing was significantly less in the suture group (23.0 ± 7.9 vs 16.1 ± 3.36 days, P < 0.001). One wound (7%) in each group was reopened. CONCLUSIONS: : Suture closure seems to be the superior technique for secondary closure of wound dehiscence based on the primary outcome of time to complete healing for this study. Therefore, suture closure seems to be the best option for secondary closure of superficial wound dehiscence.However, both suture and surgical tape are effective treatments when historically compared with second intention.