Surgical Site Infections in Trauma Exploratory Laparotomies Preoperative Ceftriaxone and Metronidazole Versus Cefoxitin.

Surgical site infections (SSIs) remain a significant cause of morbidity and mortality in patients undergoing traumatic exploratory laparotomy. The goal of this study was to compare antibiotic usage and subsequent outcomes in patients undergoing traumatic exploratory laparotomy. A retrospective chart analysis and a chi-square test of independence were performed to examine the relation between preoperative cefoxitin versus ceftriaxone and metronidazole and the rate of SSI development. 323 patients were analyzed, 111 patients receiving cefoxitin and 212 patients receiving ceftriaxone and metronidazole. The proportion of patients who developed SSI was 16.2% for the cefoxitin group and 9.9% for the ceftriaxone and metronidazole group, X2 (1, N = 323) = 2.7, P = .098, thus displaying no statistical difference in the development of SSIs between patients in the cefoxitin group when compared to the ceftriaxone and metronidazole group.

Inhalant misuse reported to America's Poison Centers, 2001-2021.

CONTEXT/OBJECTIVE: This study investigated characteristics and trends of inhalant misuse reported to United States poison centers from 2001 through 2021. METHODS: Using data from the National Poison Data System and the United States Census Bureau, analyses were conducted of demographic and other characteristics, inhalant category, level of health care received, and medical outcome, and population-based rate trends were assessed. RESULTS: United States poison centers managed 26,446 inhalant misuse cases from 2001 through 2021, which equaled an annual average of 1,259 cases. Most inhalant misuse involved males (73.0%) or a single substance (91.0%). Teenagers accounted for 39.7% of cases. Among inhalant misuse cases, 41.4% were associated with a serious medical outcome and 27.7% were admitted to a healthcare facility. Overall, the rate of inhalant misuse per 1,000,000 United States population increased by 9.6% (P = 0.0031) from 5.33 in 2001 to 5.84 in 2010, followed by a decrease to 2.60 (-55.5%, P < 0.001) in 2021. "Freon and other propellants" showed the largest change in rate, increasing from 1.28 in 2001 to 3.55 in 2010 (P < 0.001), before decreasing to 1.36 in 2021 (P < 0.001). This trend was driven by the 13-19-year-old age group, and the trend reversal in 2010 among teenagers coinciding with an almost complete ban on FreonTM by the United States Environmental Protection Agency, which it implemented under the Clean Air Act. CONCLUSIONS: Although the annual rate of inhalant misuse reported to United States poison centers has been decreasing since 2010, it remains an important public health problem. The United States Environmental Protection Agency's 2010 regulation of FreonTM may have been an important contributor to the dramatic trend reversal and decrease in inhalant misuse rates starting in that year. This may exemplify the potential effect that regulatory efforts can have on public health.

Region of Interest Densitometry Analysis of Descemet Membrane Endothelial Keratoplasty Dehiscence on Anterior Segment Optical Coherence Tomography.

Purpose: To evaluate a region of interest (ROI) method of analyzing anterior segment optical coherence tomography (AS-OCT) corneal densitometry (CD) in the setting of Descemet membrane endothelial keratoplasty (DMEK) dehiscence. Methods: Retrospective chart review of eyes that underwent (1) DMEK for Fuchs dystrophy (2) between 2018 to 2020 with (3) a partial DMEK dehiscence on AS-OCT, (4) involvement of only one side of the graft, (5) high-quality corneal AS-OCT scan, and (6) location of dehiscence within the central 5.5 mm of the cornea. Image analysis of the ROIs with ImageJ compared the total edematous area, mean stromal CD, and ratio of anterior-to-posterior (A/P) stromal CD for regions of DMEK dehiscence compared to the contralateral side with an attached DMEK graft. Control regions (with no dehiscence) and postdehiscence resolution images were also analyzed. Results: Seventy sectors of the 21 images from 21 eyes with DMEK dehiscence were included. Compared to the contralateral side, regions of DMEK dehiscence had larger total areas (P < 0.0001), lower mean stromal CD (P = 0.0003), and higher A/P stromal CD (P < 0.0001). All control regions and postdehiscence resolution images did not show any significant differences compared to the contralateral sides. Conclusions: This technique to analyze multiple ROIs on AS-OCT can be useful to evaluate CD of specific regions of corneal pathology. Lower mean stromal CD and higher A/P stromal CD may specify corneal edema. Translational Relevance: Analyzing CD via multiple specific ROIs may be more suitable than measuring the CD of the full cornea and has broader applications extending to other corneal pathologies.