Patients with any laceration or wound over the hand need to be evaluated for tendon and neurovascular injuries. Patients with these injuries should receive urgent wound care as well as splinting and expeditious referral for surgical repair because lacerated tendons and nerves cannot heal without surgical approximation. Conversely, ligament injuries of the hand, such as disruption of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb, can sometimes be managed nonsurgically if the joint is stable and there is no Stener lesion. If nonsurgical management does not stabilize the joint, patients should be referred for surgery. Stener lesions, where the ulnar collateral ligament at the metacarpophalangeal joint of the thumb has torn and retracted proximal to the adductor pollicis, always require surgery for the ligament to heal and for the best outcomes; however, surgery is not urgent.Many finger fractures can be managed nonsurgically. Patients with fractures that include angulation, comminution, and malrotation must be referred expeditiously to a hand surgeon, preferably within 1 week. Some fractures, such as condylar fractures, appear nondisplaced at first but have a high propensity to displace and, therefore, also should be referred to a subspecialist. The management of mallet fractures is controversial, with studies supporting surgical and nonsurgical options.Metacarpal fractures are common. Many metacarpal fractures without malrotation, particularly fifth metacarpal neck fractures, can be managed nonsurgically. However, intraarticular and extraarticular metacarpal fractures of the thumb are subject to tendon forces and often displace. Patients with such fractures require referral to an orthopedic surgery subspecialist for possible surgical intervention, as do patients with metacarpal fractures that have intraarticular involvement, malrotation, shortening greater than 6 mm, or excessive angulation. Health care facilities in low- and middle-income countries are inadequately resourced to adhere to current COVID-19 prevention recommendations. Recommendations for surgical emergency trauma care measures need to be adequately informed by available evidence and adapt to particular settings. To inform future recommendations, we set to summarize the effects of different personal protective equipment (PPE) on the risk of COVID-19 infection in health personnel caring for trauma surgery patients. We conducted an umbrella review using Living Overview of Evidence platform for COVID-19, which performs regular automated searches in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and more than 30 other sources. selleck kinase inhibitor Systematic reviews of experimental and observational studies assessing the efficacy of PPE were included. Indirect evidence from other health care settings was also considered. Risk of bias was assessed with the AMSTAR II tool (Assessing the Methodological Quality of Systematic Reviews, Ottawprotection than surgical masks. Decontamination and reuse appear feasible to overcome PPE shortages and enhance the allocation of limited resources. These effects are applicable to emergency trauma care and should inform future recommendations. Review, level II.Review, level II. Chlamydia, gonorrhea, and syphilis are common, treatable sexually transmitted infections (STIs) that are highly prevalent in the general US population. Costs associated with diagnosing and treating these conditions for individual states' Medicaid participants are unknown. The purpose of this study was to estimate the cost of screening and treatment for 3 common STIs for state Medicaid program budgets in Maryland and South Carolina. A retrospective, cross-sectional study was conducted using Medicaid administrative claims data over a 2-year period. Claims were included based on the presence of one of the 3 study conditions in either diagnosis or procedure codes. Descriptive analyses were used to characterize the participant population and expenditures for services provided. Total Medicaid expenditures for STI care in state fiscal years 2016 and 2017 averaged $43.5 million and $22.3 million for each year in Maryland and South Carolina, respectively. Maryland had a greater proportion of costs associated with outpatient hospital and laboratory settings. Costs for care provided in the emergency department were highest in South Carolina. Diagnosis and treatment of commonly reported STIs may have a considerable financial impact on individual state Medicaid programs. Public health activities directed at STI prevention are important tools for reducing these costs to states.Diagnosis and treatment of commonly reported STIs may have a considerable financial impact on individual state Medicaid programs. Public health activities directed at STI prevention are important tools for reducing these costs to states. Carrageenan, an extract from red algae, was identified over a decade ago as a potent inhibitor of human papillomavirus (HPV) infection in vitro. After this discovery, several studies evaluated carrageenan's anti-HPV activity in cells, experimental animals, and humans. We reviewed the evidence for carrageenan's anti-HPV activity. Studies had to be in vitro, in vivo, or in humans and report on carrageenan's anti-HPV activity. Of the 39 records identified in PubMed and 29 records in Clinicaltrials.gov, 22 records were included after screening 8 in vitro (including 2 ex vivo), 3 in vivo, 5 in vitro and in vivo, 3 clinical studies, and 3 trial protocols. A total of 12 studies evaluated carrageenan exclusively, whereas 7 considered carrageenan combined with additional antiviral or other agents. One study protocol will evaluate carrageenan exclusively, and 2 others will evaluate carrageenan-combination products. Most clinical studies evaluated carrageenan's ability to prevent HPV acquisition (n = 4), whereas one sor in combination with other antiviral agents, might be a potential prevention strategy complementary to HPV vaccination for women. A pilot program was implemented to assess the feasibility of emergency department (ED) preexposure prophylaxis (PrEP) referral. Of 119 eligible patients approached and assessed, 39 (33%) expressed interest and were referred to peer navigators. Of these, 16 (41%) scheduled for appointments; four (10%) initiated PrEP, which demonstrated ED-based PrEP referral was feasible.A pilot program was implemented to assess the feasibility of emergency department (ED) preexposure prophylaxis (PrEP) referral. Of 119 eligible patients approached and assessed, 39 (33%) expressed interest and were referred to peer navigators. Of these, 16 (41%) scheduled for appointments; four (10%) initiated PrEP, which demonstrated ED-based PrEP referral was feasible.