The ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and the associated coronavirus disease 2019 (COVID-19) have had profound global and personal implications, with 5,701,337 confirmed cases and 357,688 confirmed deaths across 213 countries, areas, and territories at the time of writing (1). A concerted international response to the outbreak has focused on social distancing and quarantine measures through the closure of schools, workplaces, and community centers, in addition to household isolation, as a means of limiting humanto-human transmission and disease progression, thereby reducing the strain on the healthcare system. The novelty of the virus accompanied by its asymptomatic transmission and lack of a current treatment or vaccine highlights the importance of self-isolation to reduce global infection rates (2-4). Such techniques for the control of communicable diseases are not novel and have been successfully employed in previous outbreaks, notably the 1918 H1N1 pandemic and the 2003 SARS pandemic (5-8). Their efficacy has not only been shown in clinical studies but also in simulations and pandemic models (9,10). A modelling study conducted by Prem et al. investigated the efficacy of social distancing on the current SARS-CoV-2 pandemic and determined a projective reduction in median infection rates of 24% by the end of 2020 following a staggered return to work commencing at the beginning of April 2020 (11). Despite the demonstrated efficacy of social distancing measures, their use imposes significant economic costs and psychosocial challenges (8,12). Of significant concern is the disruption to education and training, with The United Nations Educational, Scientific and Cultural Organization estimating that 87.6% of enrolled learners have been affected by the pandemic (13). Many institutions, including our own, are turning to online teaching and educational platforms, many of which rely on synchronous videoconferencing (14). Due to the nature of medicine and the need to maintain the standard of patient care, maintaining the integrity and continuity of medical teaching is paramount when possible (15). We posit that videoconferencing tools are part of the solution towards this goal through their provision of educational content to students globally. Videoconferencing is defined as "a conference in which participants in different locations are able to communicate with each other with both sound and vision" (16). This broader term encapsulates both meetings and web-based seminars (also known as webinars).
Background Migraines are a chronic disease for millions worldwide and have been hypothesized to be hormonally mediated due to their higher prevalence in females and menstrual associations. Estrogen has been commonly implicated in migraine pathogenesis, yet its exact role in the pathophysiology of migraines has yet to be fully understood. Method We conducted a scoping review of the literature regarding estrogen’s role in migraine pathogenesis and included 19 studies out of an initial 202 in the final review. Two independent reviewers screened and extracted data from included studies based on predetermined inclusions and exclusion criteria. Results The estrogen withdrawal hypothesis, discussed by 12 of the reviewed studies, is the most discussed theory about estrogen’s role in migraine physiology and describes the association of migraine onset with natural declines in estrogen levels, particularly when estrogen levels fall below 45–50 pg/mL after an extended period of priming. Additional findings suggest that women with a history of migraine have an increased sensitivity to physiologic fluctuations in estradiol levels. Several studies suggest that migraines are associated with menstruation. Conclusion It appears that estrogen is very likely to play a key role in migraine pathogenesis, but seems to affect patients in different ways depending on their past medical history, age, and use of hormonal therapy. Further research is warranted to isolate the effects of estrogen in each unique patient population, and we believe that studies comparing menstruating women to postmenopausal women could help shed light in this area.
Social media has become increasingly prevalent among the general population in the past decade. We examined the current prevalence of social media use among academic orthopedic-trained and plastic surgery-trained hand surgeons in the United States. Methods: All publicly available hand surgery faculty across the nation were analyzed for their public social media usage, including Instagram, Facebook, Twitter, LinkedIn, and personal websites. Comparisons of social media usage between orthopedic-trained and plastic surgery-trained hand surgeons, male and female academic hand surgeons, hand surgeons from different regions of the United States (East, West, Midwest, and South), and years of experience were analyzed. Results: A total of 469 academic hand surgeons were included. Among academic hand surgeons in the United States, LinkedIn was the most common platform used (40.3%), followed by Facebook (15.78%), a personal website (13.86%), Twitter (12.37%), and Instagram (4.05%). Plastic surgery hand surgeons had more of a presence than orthopedic hand surgeons on Instagram (8.26% vs 2.59%, P < .01)) and Twitter (19.01% vs 10.06%, P < .01). Male hand surgeons were more likely than female hand surgeons to use LinkedIn (41.19% vs 34.85%, P ¼ .04). Southern (18.89%) and Eastern (14.36%) surgeons used personal websites more than Western (6.52%) and Midwestern (4.60%) surgeons (P ¼ .03). Conclusions: Despite the widely known use of social media among plastic and aesthetic surgeons, this study shows the use of web-based marketing strategies to be quite rare in the academic hand surgery setting. Clinical Relevance: Our study shows that throughout the United States, academic hand surgeons use social media at low rates. We suggest that academic plastic surgery and orthopedic hand surgeons throughout the United States consider having a larger social media presence to expand advertising, improve patient education, and enhance networking among their practices. Social media can be a valuable tool and will likely only increase in popularity in the coming years.
Background:Migraine headaches are a chronic and complex medical issue for millions of patients worldwide. Despite how common migraines are, there is much to be unveiled regarding their pathogenesis due to the numerous factors implicated in the pathophysiology of migraines. Migraines are significantly more common in women and many female migrainers notice menstrual associations of their headaches. Because of this, migraines have popularly been hypothesized to be largely hormonally mediated. Estrogen has been commonly implicated in migraine pathogenesis yet its exact role in the pathophysiology of migraines has yet to be fully understood. Methods: We conducted a scoping review of the literature regarding estrogen’s role in migraine pathogenesis and included 11 studies out of an initial 199 in the final review. Results: The estrogen withdrawal hypothesis is the most discussed theory about estrogen’s role in migraine physiology and describes the association of migraine onset with natural declines in estrogen levels. Estrogen is also implicated in biochemical pain pathways, and specifically effects pain processing, trigeminal nociception, and neural inflammatory peptides. Human studies have been conducted in female populations such as pregnant women and postmenopausal women, and these studies have supported the estrogen withdrawal hypothesis.Conclusions: Hormone replacement therapy remains to treat migraines is promising, yet still lacks definitive evidence in its efficacy. More primary research into estrogen’s mechanisms in migraine pathogenesis is needed, as its specific roles are still unclear. While human-based, clinical trials on the subject are rare, they would provide great insight into migraines and would allow clinicians to better treat patients. Systematic Review registrations: none
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