Could subcutaneous rifampicin administration be an effective approach for reducing episiotomy infections?

OBJECTIVE

The aim of this prospective cross-sectional study was to investigate whether cleaning the episiotomy line with rifampicin solution before suturing will reduce infection and wound dehiscence in women who had vaginal delivery with episiotomy.

PATIENTS AND METHODS

A prospective cross-sectional study was conducted with a total of 400 primigravida patients. In the study group, irrigation with rifampicin of the subcutaneous tissue of the episiotomy incision was applied, and in the control group, there was no irrigation. Patients were evaluated for infection at the 1st, 3rd week, and 1-month controls. The groups were compared according to episiotomy infection and wound dehiscence rates.

RESULTS

The episiotomy infection rate of the whole group was 8.5%, the wound dehiscence rate was 3.75%, and the average time of occurrence of the infection was 5.35±2.21 days. The most common infection findings were local pain and purulent discharge at 4.75%. In the control group, where the infection occurred earlier, the infection and wound dehiscence rates were significantly higher [11.5% vs. 5.5%; 6.0% vs. 1.5% (p<0.05)]. Purulent discharge was the most common finding in the control group, and local pain in the study group, but no significant difference was found between the two groups in terms of findings (p<0.05). When only the patients who developed episiotomy infection were evaluated among themselves, the only significant difference was found in wound dehiscence, which was higher in the control group (p<0.05).

CONCLUSIONS

Considering the high rates of episiotomy in our country, subcutaneous irrigation with rifampicin is a good option that can be kept in the foreground due to its low cost and ease of application.

AB0672 PATIENT CHARACTERISTICS AND DISEASE ACTIVITY, BUT NOT THE CRANIOCERVICAL POSTURE ABNORMALITIES PREDICT TEMPOROMANDIBULAR DISORDERS IN ANKYLOSING SPONDYLITIS PATIENTS: A CROSS-SECTIONAL, OBSERVATIONAL STUDY

Background:

There are contradictory results in the relevant literature about the relationship between objective determinants of craniocervical posture and temporomandibular disorder (TMD), whereas no study has worked on AS and TMD relationship.

Objectives:

To evaluate the predictors of TMD in AS patients and its relationship with craniocervical posture, we conducted this study

Methods:

AS patients aged between 18-50 years and consecutively admitted to our outpatient clinics were recruited. TMD was diagnosed by ‘Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)’ criteria. Spinal mobility was assessed by BASMI; disease activity by ASDAS-CRP and neck disability by Neck Disability Index. We measured the craniocervical angle, cervical curvature angle, suboccipital distance, atlas-axis distance, anterior translation distance by using the lateral cervical X-rays (Figure).

Results:

A total of 98 (58.2% female) patients with a mean age of 37.4 ±48.2 years was recruited (Table 1). TMD was diagnosed in 58 (59,2%) patients. Spinal mobility and craniocervical posture measurements were similar among the two groups (Table2). Smoking, bruxism (in females), neck disability and AS activity (in males) were higher in TMD patients (Table 1). Multivariate analysis revealed active smoking (aOR 6.86; CI: 1.83-25.60; p=0.004), bruxism in females (aOR 17.87; CI: 2.0-159.20; p=0.01), high ASDAS in males (aOR 11.82; CI: 1.14-122.5; p=0.038) and neck disability (aOR 12.67; CI: 3.75-42.85; p<0.001) as independent risk factors for TMD in AS patients.

Table 1.

The clinical and demographical data of the study population

ParameterAll patientsTMD (+)(n=58)TMD(-)(n=40)PvalueGender (Female)57 (58.2)38 (65.5)19 (47.5)0.076Age37.4±8.237.8±7.736.9±8.90.57Smoking Smoker33 (33.7)25 (43.1)8 (20.0)0.017 Non-smoker65 (66.3)33 (56.9)32 (80.0)AS disease duration (year)8.1±5.77.8±6.28.6±5.00.47AS treatment NSAID0.52  Regular13 (13.2)8 (13.8)5 (12.5)  On-demand49 (50.0)31 (53.4)18 (45.0) Sulphasalazine38 (38.7)24 (41.4)14 (35.0)0.67 Anti-TNF agents59 (60.0)33 (56.9)26 (65.0)0.42Bruxism Present61 (62.2)43 (74.1)18 (45.0)0.003  Nighttime18 (29.5)11 (25.6)7 (38.9)  Daytime15 (24.6)10 (23.3)5 (27.8)  Whole day28 (45.9)22 (51.2)6 (33.3) Absent37 (37.8)15 (25.9)22 (55.0)Table 2.

Comparison of AS-related and craniocervical posture measurements

ParameterAll patientsTMD (+)(n=58)TMD(-)(n=40)P valueAS-related measurementsASDAS2.4±0.952.7±0.932.0±0.850.001 Male2.3±1.32.7±1.141.7±0.850.007 Female2.5±0.92.7±0.822.4±0.780.11Tragus-wall distance (cm)11.7±2.5511.6±1.9712.0±3.240.41Cervical rotation (angle)71.6±12.7871.6±12.3271.5±13.590.94Chin-thorax distance (cm)2.1±1.642.1±1.442.1±1.910.90BASMI2.0±1.192.0±1.112.1±1.310.76mSASSS3.5±4.843.4±3.883.8±6.030.70Measurements of craniocervical postureCraniovercival angle79.6±10.3178.9±10.4780.6±10.110.41Cervical curvature angle165.4±12.42165.6±12.89165.0±11.840.82Suboccipital distance (mm)6.3±3.976.2±4.046.5±3.910.71Atlas-axis distance (mm)5.2±2.435.3±2.475.0±2.400.62Anterior translation distance (mm)10.9±13.7411.4±11.7910.1±16.350.66

Conclusion:

No relationship between the craniocervical posture measurements and TMD was found in AS patients. Active smoking, high disease activity in males, bruxism in females and neck disability were found as predictors of TMD in AS patients.

Figure.

Disclosure of Interests:

Esra Bilgin: None declared, Emre Bilgin: None declared, Oya Özdemir: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

Comparison of Rai and Binet Classifications in Chronic Lymphocytic Leukemia

Staging systems are essential for understanding disease, in predicting the outcome, and therapeutic decision making in any tumor as well as chronic lymphocytic leukemia (CLL). In this study, we compared the clinical correlation of the Rai and Binet classification systems in 133 CLL patients. The distribution of 133 patients according to the Rai system was as follows, stage 0:17, I:13, II:45, III:30, IV:28, and in the Binet system stage A:35, B:40, C:58 patients. Median survival of patients according to the Rai staging system was >67.0, >91.0, 63.8, 20.9 and 9.8 months, and >91.0, 63.4, 16.0 months according to Binet, respectively. Although no difference was found between Rai stages 0, I, II (p > 0.05) in terms of median survival, the difference between these stages and stages III and IV was statistically significant (p < 0.05). In the Binet staging system statistically significant survival difference was found between all stages (p < 0.05). We concluded that although both systems are comparable in terms of staging and predicting the outcome of patients with CLL, the Rai staging system appears to have an advantage over the Binet system by defining a subset of patients with excellent prognosis (stage 0) which is included within stage A of the latter.