Podcasts about keratitis

Acanthamoeba keratitis can be one of the most devastating diagnoses in ophthalmology, as it can wreak havoc on the cornea unlike few other microbes.  On the same token, if caught early, acanthamoeba can be treated quite efficiently and effectively, and patients can have minimal, if any, long-term visual sequelae.  Given acanthamoeba is such a dreaded diagnosis, just the thought of it can invoke fear into the ophthalmologist.  And while many of us might have a basic approach to acanthamoeba, we also surely have blind spots in our diagnosis and management of this condition, as evidenced by many patients being diagnosed weeks after it occurs. Dr. Chris Rapuano joins the podcast to discuss this important condition. This episode is sponsored by Thea Pharma Canada - https://www.theapharma.ca Become a supporter of this podcast: https://www.spreaker.com/podcast/blind-spot-the-eye-doctor-s-podcast--5819306/support.

The RID-MyC assay, a CRISPR/Cas12a-based test, offers swift and reliable detection of Fungal Keratitis, enhancing diagnostic capabilities at point-of-care settings. Dr. Rajesh Rao interviews Dr. Siddharth Narendran on the development of this assay from his Ophthalmology Science article, “Development and Clinical Evaluation of a CRISPR/Cas12a-Based Nucleic Acid Detection Platform for the Diagnosis of Keratomycoses.” Development and Clinical Evaluation of a CRISPR/Cas12a-Based Nucleic Acid Detection Platform for the Diagnosis of Keratomycoses. Deivarajan, Hanith Raj et al. Ophthalmology Science, Volume 4, Issue 5. Join Ophthalmology's Editor-in-Chief, Russell Van Gelder, as he presents “The Year in Literature: Editor's Choice Highlights From the Ophthalmology Journal Family”  in Chicago at AAO 2024 on Sunday October 20, 2024, at 2pm local time in McCormick Place South Building Room S406A. Search “SYM48” in the Mobile Meeting Guide for more information.

Liebe GAY OVER Fam, heute spreche ich über mein erstes Mal bei einem Drug-Check hier in Berlin und teile euch auch das Ergebnis mit. Es geht aber auch um meine neue Coronaerkrankung und der sich anschließenden Keratitis. Außerdem wartet eine riesengroße Ankündigung für den 15. September auf euch. Viel Spaß beim Lauschen & einen dicken Knutscher aus der Hauptstadt! GREY YOUNG ◾ FOLLOW ME: https://www.instagram.com/gay.over.podcast/ ◾ PAYPAL: Unterstütze meinen PODCAST mit einer Spende, wenn DU magst ♡: https://bit.ly/3HxpeAJ ◾ WEBSITE: https://www.gay-over.de Diese Episode wird präsentiert von ANUUX, deinen vegangen Kapseln aus Berlin für mehr Spontanität bei der schönsten Nebensache der Welt – ganz ohne Spülen. Spare 15% mit dem Code "gay over" auf www.anuux.de

Etwa 20 Prozent aller Menschen knirschen regelmäßig mit den Zähnen. Die Zahnmedizin nennt dieses Verhalten Bruxismus. Anne Wolowski ist Professorin für Zahnmedizin am Universitätsklinikum Münster. Sie erklärt, warum Menschen mit den Zähnen knirschen, was die Folgen sind – und was sich dagegen tun lässt. Außerdem klären wir, ob Kontaktlinsen schädlich für die Augen sind. Studien Bruxismus: https://franklinsusanibar.com/wp-content/uploads/2021/05/2019-Melo-Bruxism-An-umbrella-review-of-systematic-reviews.pdf, https://link.springer.com/article/10.1007/s00784-023-05302-w Studien Kontaktlinsen: https://www.tandfonline.com/doi/pdf/10.1080/08164622.2021.2003693, https://www.aerzteblatt.de/archiv/227870/Kontaktlinsen-assoziierte-Keratitis-eine-haeufig-unterschaetzte-Gefahr Unsere AHA!-Folge zum Augenlasern: https://www.welt.de/podcasts/aha-zehn-minuten-alltags-wissen/article251859112/Augenlasern-Endlich-scharf-sehen-Alles-ueber-Chancen-und-Risiken-Podcast.html Hier können Sie alle Bonus-Folgen bei WELTplus hören: https://www.welt.de/podcasts/aha-zehn-minuten-alltags-wissen/plus246844328/Noch-mehr-Alltagswissen-Aha-Bonus-Folgen-fuer-Abonnenten-Podcast.html. "Aha! Zehn Minuten Alltags-Wissen" ist der Wissenschafts-Podcast von WELT. Wir freuen uns über Feedback an wissen@welt.de. Redaktion: Juliane Nora Schneider Produktion: Sebastian Pankau Impressum: https://www.welt.de/services/article7893735/Impressum.html Datenschutz: https://www.welt.de/services/article157550705/Datenschutzerklaerung-WELT-DIGITAL.html

Dr. Cremers reviews a talk she presented at the Women in Ophthalmology Conference on Keratitis.

William Trattler, MD, joins Sila Bal, MD, MPH, to discuss a case of a 31-year-old woman who presented with pain and decreased vision in her right eye. Slit lamp examination revealed conjunctival injection and a unifocal area of stromal haze with no epithelial defects. Dr. Trattler explains further diagnostic strategies for this case to help determine the best treatment. He also reviews approaches to suppress inflammation in different forms of keratitis.

What are blepharitis, conjunctivitis, meibomitis, iritis, uveitis, keratitis, retinitis, neuritis, and meningitis? Dr. Cremers reviews eye anatomy and diseases related to the different parts of the eye

This episode covers herpes simplex keratitis.Written notes can be found at https://zerotofinals.com/medicine/ophthalmology/herpeskeratitis/ or in the ophthalmology section of the 2nd edition of the Zero to Finals medicine book.The audio in the episode was expertly edited by Harry Watchman.

CME credits: 1.00 Valid until: 20-12-2024 Claim your CME credit at https://reachmd.com/programs/cme/hiding-in-plain-sight-a--effort-to-improve-identification-and-treatment-of-thyroid-eye-disease/16477/ Management of neurotrophic keratitis (NK) is based on disease severity. During this webinar, the faculty members discuss updated viewpoints on what truly constitutes stage 1 disease as well as NK diagnostic strategies, treatment of stage 1 NK to prevent progression, and novel therapies. This content was captured during a synchronous virtual symposium. Polling took place during the symposium.=

Drs. Hope Rugo and Nancy Davidson discuss the next generation of endocrine therapy in hormone receptor-positive breast cancer – SERDs, SERMs, CERANs, and PROTACs – and challenges relating to the optimal sequence of therapeutic options. TRANSCRIPT Dr. Hope Rugo: Hello, I'm Dr. Hope Rugo, your guest host of the ASCO Daily News Podcast today. I'm a professor of medicine and director of breast oncology and clinical trials education at the University of California San Francisco's Comprehensive Cancer Center. Hormone receptor-positive (HR+) breast cancer is the most common subset of this disease and breast cancer is the most common cancer diagnosed in women worldwide. Endocrine therapy (ET) is the cornerstone of management in hormone receptor-positive breast cancer and may involve suppressing estrogen production with aromatase inhibitors in the cancer cell itself, or directly blocking the estrogen receptor pathway through selective estrogen receptor modulators, such as tamoxifen, or the injectable selective estrogen receptor degrader, fulvestrant. However, despite the availability of these therapies, the largest unmet need lies in treatment of HR-positive HER-negative disease lies after progression on endocrine therapy. On today's episode, we'll be discussing the emerging generation of endocrine therapies in breast cancer, some of which were designed to overcome common mechanisms of endocrine resistance, and the challenges relating to the optimal sequence of therapeutic options. Today, I'm delighted to welcome the world-renowned breast cancer researcher, Dr. Nancy Davidson, to the podcast. She's a professor and the executive vice president for clinical affairs at the Fred Hutchinson Cancer Center and professor of medicine at the University of Washington as well as past president of ASCO and AACR. You'll find our full disclosures in the transcript of this episode and disclosures of all guests on the podcast can be found in our transcripts at asco.org/DNpod. Nancy, it's great to have you on the podcast today. Thanks so much for being here. Dr. Nancy Davidson: Thank you so much, Hope, for the opportunity. Dr. Hope Rugo:  You've done incredible work in the area of treating HR+ disease, but also in understanding some of the agents and pathways that are most important to our understanding of how we treat and really think about developing new drugs for HR+ breast cancer. The first generation of anti-estrogen drugs really included selective estrogen receptor modulators, but now we have a new generation of these anti-estrogen drugs. And there's also orally administered selective estrogen receptor degraders, so-called SERDs, that we hope someday will be an alternative with already one approved for the injectable SERD, fulvestrant. But there's a whole additional class of drugs, complete estrogen receptor antagonists, referred to as CERANs, and proteolysis targeting chimerics, PROTACs. These agents are all at various stages of development in both early and metastatic settings and really represent, I think, a confusing array of different treatments that are being studied, some of which of course are approved. Nancy, it would be great if you could tell us some about these exciting new agents, starting with our approved drugs and moving on to the agents that we're studying in clinical trials. Dr. Nancy Davidson: Hope, this is a terrific example of how basic science has really begun to inform clinical practice. For us as breast cancer practitioners, it was really easy for a long time because we only had tamoxifen. And then things like the aromatase inhibitors as a means of decreasing the estrogen ligand came into practice, as did fulvestrant, as you mentioned, a selective estrogen receptor degrader. Thanks though to a lot of understanding about estrogen receptor biology, and specifically, the discovery about a decade ago of estrogen receptor mutations, something that we didn't think exist ed for a long time, but which we now know exists in maybe a third to a half of breast cancers after exposure to aromatase inhibitors, that's led to really an explosion, this alphabet soup of possibilities that you talked about. SERMs, selective estrogen receptor modulators, tamoxifen is the classic one—something that acts as an agonist and as an antagonist, depending on the tissue. The SERDs, the selective estrogen receptor degraders, lead to estrogen receptor destruction. Fulvestrant is the classic example of this right now. But we're very excited that a second one has been FDA approved. That's elacestrant that was approved earlier this year, and it has specifically been developed to try to target those estrogen receptor mutant breast cancers because those are the ones that are particularly resistant. So that's the first of this new generation of SERDs that's coming on the market, has come on the market. As you say, a key advantage there is that it's oral, unlike  fulvestrant, which requires 2 monthly injections and is very, very inconvenient and uncomfortable for patients. Other SERDs are coming along. I think another one that is well along in clinical development is giredestrant, which is in the same family and being tested in clinical trials of the classic varieties. It's been tested in a window trial, looking at its ability to down-regulate Ki67. It's being tested against standard of care in first-line metastatic breast cancer. And there are some studies that are going to begin looking at it in the adjuvant setting as well. There are other members of this particular family, but I think that elacestrant is the one that we have at our fingertips right now, and giredestrant is one that's certainly coming along in clinical trials, and we should look forward to those results. For those who are interested in the giredestrant, the trials in question right now that are going on are persevERA, which is in stage 4 breast cancer, and lidERA, which is in the adjuvant setting. Now that's one new category, or it's an old category with a new twist. A second is these agents that are called complete estrogen receptor antagonists, CERANs, as you talked about them. The key here is that what they do is, the estrogen receptor has a couple of domains, and in particular, it has 2 different activation domains, AFT1 and AFT2. And these CERANs are complete estrogen receptor antagonists, so they block both of those domains. And the hope would be that they might end up being more effective than the other agents that we have available to us right now. So those are also in clinical trial at the present time, and we're waiting to see whether or not there's going be any value in that particular area that's going to able to go forward for us.   Another area that I think we want to talk about is the PROTACs, as you mentioned. These are proteolysis targeting chimeric entities. So, this is a kind of a complicated situation where you have a kind of bivalent situation where you have something that binds both to the estrogen receptor and then also to E3 ubiquinase. So, it leads to degradation again of the agents; that's another area for us to be watching. And then finally the SERCAs. So those are the selective estrogen receptor covalent antagonists, and what they do is they bind very specifically to a cysteine 530 that exists in the estrogen receptor but not in other steroid receptors. So that's where the selective part of this comes along. Now these are all in various stages of clinical investigation. Some of them are pretty early at this point, but I think the ones that are well established are elacestrant, giredestrant is coming along as we just talked about. Camizestrant is also coming along through the SERENA series of trials, and imlunestrant is also coming on through the EMBER series of trials. Hope, I would also be remiss if I didn't go back to an old drug that's a new drug, and that's lasofoxifene, which is also in the SERM family. Those who have been in our field for a while will remember that lasofoxifene was actually originally kind of tested in the prevention setting, where it seemed to have some activity. It came back into our interest because it has really strong activity against estrogen receptor mutant breast cancer models in the laboratory. And as a consequence of that, it's coming back into the clinic through a series of trials that are called the ELAINE trials, where we're looking to see whether or not it might also be better than fulvestrant. It too is an oral agent, so that's a real plus for us, and the first set of ELAINE trials would suggest that there's some nice activity without a lot of toxicity. So, lots going on in this field. You know, I think for all of these things, obviously, we're also working very hard to think about the toxicities. All of these, as I recall, are oral agents. So that gets rid of  1 huge toxicity, which is you don't have the need for some sort of injection. But they all do have some side effects. Frequently, [the toxicities] are like GI side effects or fatigue. In a couple of cases, there might be some concern about cardiac arrhythmias, but I think GI turns out to be one of the most important things that we have seen in some of these trials. Generally, it's very well tolerated, though. I think another important question, which I'm sure is in your head and is in mine, is that how are we going to integrate these into what we already have? And so, I think a lot of the work right now is looking at patients who have already received an aromatase inhibitor plus a CDK4/6 inhibitor and are now going on to one of these new agents. But you might wonder, if they turn out to be effective and well-tolerated, whether they too should be perhaps combined with CDK4/6 inhibitors in place of the aromatase inhibitors or the fulvestrant that we use now. So, I think that we can imagine that those clinical trials are either in progress in some cases or will be coming on as we try to think about how to integrate these new approaches into our existing standard of care, which is already quite complicated, right? We've gone far from tamoxifen, which was good for everybody, to now a really complex algorithm about how we think about hormone therapy, both in early breast cancer and in metastatic breast cancer.  Dr. Hope Rugo: Well, that was a fabulous discussion about the new agents and our existing agents and both the exciting aspects, as well as the challenges. One question that comes up, I think a lot, and this is of course a huge question in many ways, but for ER-positive metastatic breast cancer, where these drugs are first being tested, maybe we'll talk about that first. There's one trial at SERENA-6, looking at camizestrant in patients who have developed evidence of an ESR1 mutation in circulating tumor DNA, who are on first-line therapy with an AI and a CDK4/6 inhibitor. What do you think about that study and where do you think that progress might go? Of course, that's based on data from another trial, which wasn't definitive, but suggested, had sort of a suggestion, you know, without studying the sequencing in detail that maybe you would have improved progression-free survival with that approach. Dr. Nancy Davidson: Yeah, by which you mean the idea of monitoring pre-ESR1 mutations and circulating DNA and then making therapy changes based on that? Is that what you're talking about? Dr. Hope Rugo:  The PADA-1 trial, yes, and that led to this huge SERENA-6 trial, which of course is now accruing. Dr. Nancy Davidson: So, you know, we would love that, right? I think that obviously breast cancer for many years has been interested in trying to have circulating markers that we could use to help to guide our therapy in a more meaningful way than we have in the past. And I think that the trial that you've talked about is certainly one that's trying to make that see whether that's a possibility for us based on information like the PADA trial. I'm hopeful it's going to work out. I would say, let's see what that looks like, whether it's going to be useful or not. It seems to me in some cases, some of these trials have not been quite what we hoped for, but I don't think we necessarily had the molecular techniques or the sensitivity, nor did we necessarily have other things to move to because, you know, those two approaches require both a really good test, but also the ability to use the test to define a new therapy that's going to lead to improved patient outcomes. And I think that these are ingredients that we now have available to us at our fingertips more than we did, say, a decade or 2 decades ago. Exciting approach. Dr. Hope Rugo:  I do think there's a lot of challenges inherent in this process, monitoring blood on a regular basis and following up and then randomizing based on results. But I think [SERENA-6] is an incredibly important trial, as you have mentioned, to try and think about moving past using circulating tumor cells, which didn't work, to just change blindly to the next therapy, but more have a rational reason to change to a drug that may be more effective before the disease itself progresses. And just for our listeners, the unique aspect of trials like this in SERENA-6 is that you change therapy before you have evidence of disease progression, but only this molecular evidence of a mutation that is associated with resistance to the therapy you're on. So, it's a really important question. We'll see what happens, as you mentioned, sometimes we're not clever enough to really get around the fact that there are multiple mutations driving resistance in this setting, so we'll see how straightforward this is. The question also comes up, and I think that's a question with many of these trials now, is they're randomizing patients after a progression on an AI and CDK4/6 inhibitor to receive the novel endocrine therapy or fulvestrant. One of, I think, the concerns of treating oncologists is that then you're sort of eliminating the possibility of a targeted agent in that setting. And of course, we have new targeted agents we're studying as well, AKT inhibitors and new inhibitors of the PI3 kinase pathway. So, the newer trials are now combining, as you mentioned. There's a lot of concerns about drug-drug interactions here and how you might really combine them. And then there are triplet studies looking at CDK4/6 inhibitors, oral SERDs primarily, and pi3-kinase and CDK4/6 inhibitors. What's your thought on these and will they really help to move the needle forward? Dr. Nancy Davidson: I think that's a really interesting question, Hope, is whether or not we're going to find that combination therapies from the get-go are the way to go, or whether we're going to end up having to use maybe more serial therapies. Because not only is it a question about whether or not you can tackle all of these different resistance mechanisms simultaneously, but I think the other question is, as you say, are there negative drug-drug interactions, and are there toxicities that are intolerable? Although these are targeted in all cases and they're relatively benign in terms of side effects from the breast cancer perspective, they're not devoid of toxicity. And so, I think that's going to be another issue for us – whether they're well tolerated during the time that patients are taking them. I guess the other thing I always think about, Hope,  is that it's hard to know about value of cancer care, but you know, we are talking about agents that are not inexpensive. You know, when you think about the financial toxicity, in addition to the side effect toxicity that you and I just talked about, trying to think about what that value is going to look like is going to be very important for us. Also, as somebody who worked for a long time in the lab and in the clinic, you know, there are an infinite number of combinations that you and I could think about that are rational. And so, the question is, how are we going to pick the ones that are the most rational, if you will, the ones that seem to be the most promising, and take them forward into clinical trials? Because patients are our most precious resource. And so, we want to make sure that we are bringing forward only those things that really seem to have a very strong foundation and the opportunity to improve outcomes over time. Tough, tough question for us to try to think about, as you've talked about. The other thing is that, you know, these trials are not only for postmenopausal women, who are the majority of patients, but we also want to target them to premenopausal women. So, in those women, we're also looking at using an LHRH agonist on top of this, right, because many of these things are really at least so far designed for the postmenopausal state. So stay tuned. Lots of work going on. I think one of the interesting things will be making the leap from using these in metastatic disease at time of progression to taking them forward into the early breast cancer space. And several of the agents are now beginning to do that because of very strong preclinical and clinical data to date. Dr. Hope Rugo: So, we have new agents that we're studying in the metastatic setting, and we've seen a trend to move fairly rapidly from phase 1B trials directly into phase 3 trials, because as you pointed out so clearly, there are a number of drugs in this setting, and we don't really know not only which agent is better, but even what class of agents is better. So, as we move more quickly from phase 1B to phase 3, the question comes up about how we're going to study these agents optimally in the early-stage setting. They, I think we all thought that maybe changing based on ctDNA evidence of a mutation might be an approach, but that's complicated. A big question for you is whether or not you think that's ready for prime time as it's being marketed as such. And then the second question is really, are we better changing our whole approach upfront in high-risk disease or should we wait until after patients are exposed to their endocrine therapy and then switch as we go along; the EMBER-4 trial is looking at that switching approach? Dr. Nancy Davidson: Yeah, I think that this is obviously the billion-dollar question for many companies and for many of us as investigators. I don't know that I have a crystal ball into what the best approach might be. We know that already some of these have been abandoned. For example, amcenestrant. So, I don't even have to learn how to say it because it has been abandoned. It did go to phase 3, as you pointed out, in the advanced setting, looking at it with palbo vs letrozole plus palbo, and it didn't really show a whole lot that the company wanted to pursue.  So, I think that sometimes these things are going to be abandoned based on the metastatic setting, which is a large trial, and that's a trial where obviously it might be a little easier to the circulating markers, as you talked about, than maybe in the early-stage breast cancer setting.  I think that probably these early-stage trials are going to end up being big; they're going to have be clean. I'm guessing that most companies and most investigators will want to target them towards high-risk individuals, as you talked about, for 2 reasons. One is that ethically, I think we feel more comfortable with that. These are individuals where standard therapies are maybe not serving them as well as we would like and where we have information to think that we can at least have equipoise about a new approach. And the second is that from a trial design point of view, the event rate is likely to be higher, and therefore you might get answers earlier and with a smaller clinical trial. So that's where I suspect we're going to go. But it's a challenging question, and I think that many investigators and many companies are really trying to struggle with that right now because we do have so many options. And we're not quite sure how to, first, develop these new drugs, but then really importantly, put them in the context of our existing drugs. And as you say, we're also simultaneously trying to develop superior molecular or circulating markers to guide us. So, there's so many variables that are going on right now in this field that, from my point of view, itmakes it really exciting, but it also makes it pretty complicated, both for investigators and for pharma as we try to think about how to position these going forward. But what a great problem to have, Hope, because remember when you and I started in breast cancer, pretty much all you needed to know was tamoxifen. And I think you and I also probably started at the tail end of the time when we were using androgens and progestins and agents that now have basically completely fallen out of favor. Dr. Hope Rugo: Estrogen Dr. Nancy Davidson: Estrogen, yeah, and your side effect profiles were not as good. So, it's a good problem to have. It's a nice situation when science can inform our clinical investigation, our clinical practice. Dr. Hope Rugo: Yes, I think it'll be fascinating to see where we end up at the end, but of course, the complexities of this include the fact that sometimes just the clinical trial design leads to a less than positive result because of the way the trial itself has been designed, which I think is the nice part about moving these earlier into treatment of high-risk disease, but also brings up the question of all sorts of areas we're not really a place to discuss today, like how the statistical design is made, et cetera, that can sometimes result in poor evaluation of excellent agents. One of the questions that comes up, and you brought this up earlier, which I think is really important, is that we are in the era of combining our endocrine agents with targeted agents, and, oral agents, in a fascinating way, really bring up drug-drug interactions in a way that the injectable fulvestrant hasn't, and aromatase inhibitors were kind of quiet on the impacting metabolism, unlike tamoxifen. But we are seeing some drug-drug interactions and certainly the discussions about using these agents may include the question about whether or not you're having more diarrhea or nausea or fatigue or one drug causes photopsia, flashing lights, things like that. Keratitis is becoming a new toxicity to follow.  How are we going to figure out how to sequence these drugs and are they only going to work better all of them as a class in patients with ESR1 mutations in their tumors? Dr. Nancy Davidson: I think we don't know the answer to the second question yet. That's something that really needs to be sorted out. Even if they do, that's still a really important subset of patients, assuming that we continue to start with the aromatase inhibitors, right? That's where those things really seem to emerge right now. I don't know how we're going to figure those things out. I guess that I'm hoping that maybe a couple of agents in these classes will become kind of the lead agents. And so, we'll be able to do this work with a handful of things as opposed to a whole array of things. But we'll see. I think that even within classes, obviously, these agents are going be slightly different, probably. And so it may be that one member of a class may be slightly better from a, maybe not from an efficacy point of view, but from a toxicity point of view. And we'll just have to see how it goes. I don't think I have any magic answers about that. Dr. Hope Rugo: Yes, it'll be interesting to see whether or not the agents work in sequence too. You know, could you use a PROTAC after an oral SERD, for example, or a CERAN? That'll be fascinating to see. Dr. Nancy Davidson:  I'm hoping that preclinical modeling may help with that a little bit, though of course we all know that there are plenty of things that do well in preclinical models, GEMS and rodent models and PDXs, and sometimes those things translate nicely into clinical practice, but sometimes they don't. Dr. Hope Rugo: You mentioned, Nancy, that when we started out, that it was a fairly simple decision about what endocrine therapies, and we ran out very quickly. We're seeing some of those old classes come up with new agents. And you mentioned lasofoxifene, the oral SERM that seems to have some benefits and works in the later-line setting and also can be combined with a CDK4/6 inhibitor; [and also] has data with abemaciclib. There's also a new androgen receptor agonist, enobosarm, that's being tested as well. Do you think that these older mechanisms have a future as well? Dr. Nancy Davidson: I do. I think that because we'll be able to understand the biology better than we did in the past. A lot of our hormone therapy was pretty empiric several decades ago. But I think with better understanding of mechanisms and better understanding of what the patterns of resistance might be for a particular tumor, that we might be able to think about those things. You're right that there's a whole parallel universe right now in androgen receptor targeted therapies that we're not talking about today, both in perhaps in hormone-responsive breast cancers, but also in triple-negative breast cancers in a certain subset. And so that's an area where we probably need to be watching what our prostate cancer colleagues are doing as they develop these agents and thinking about where they might mechanistically make sense to apply in the breast cancer field. It won't be the first time that we've received insights from them because remember, prostate cancer people knew about androgen receptor mutations a really long time before we figured out that they existed in estrogen receptor as well. So, there's a nice cross talk, I think, between the prostate cancer field and the breast cancer field in that regard. Dr. Hope Rugo:  That's an excellent point. And we learn a lot from our colleagues studying other malignancies, and prostate cancer has been a big area there for us and hopefully will help us with studying these agents because there's different toxicity profiles, of course, as well. And then you mentioned the approval of elacestrant, the first oral SERD to have regulatory approval, and it's approved in patients who have ESR1 mutations in their tumors. We're also studying it in the ELEVATE trial in combination with all of the different targeted agents, the CDK4/6 inhibitors, mTOR inhibitor, everolimus, and the PI3 kinase inhibitor, alpelisib, to really try and understand how these can be optimally combined. Would you check for ESR1 mutations at diagnosis of metastatic disease, or would you do this more after progression or start of progression of disease on an aromatase inhibitor? Dr. Nancy Davidson: I tend to be a conservative, Hope, and so unless there's a clinical trial that might be able to be considered, I would tend to check it only after progression on the aromatase inhibitor. But I think some people are earlier adopters, and I suppose it's possible that they might want to know from the get-go. Having said that, I do think elacestrant has an approval after aromatase inhibitor, as I recall. So, presumably the patient would have to have that exposure before you would be able to act on the ESR1 mutation by administering the oral SERD. This is also a new area that may well change with time, right? You know, as we develop different agents, as the agents have different requirements or different indications, and as we perhaps have better tests, it may be things that we don't do routinely now will become very routine in the future. And perhaps in series like you talked about in a serial fashion. Dr. Hope Rugo: Absolutely. I think that's a really important comment about how we're going to think about treating hormone receptor positive disease and potentially, you know, we have new chemo options, of course, not part of our talk discussion today and antibody drug conjugates. So, the future is certainly challenging in terms of understanding this appropriate sequencing. We need data, but it's exciting to have these options. As you pointed out, this is this is a great problem to have, you know, too many drugs with efficacy to try and understand how to use these in the most appropriate way. And as you also pointed out, the use in young women is particularly important. Whether or not you need to suppress the ovaries with all of these new agents is going to be important to understand as well as a next step. I don't know if you have specific thoughts on that area as well. I mean, that may reduce toxicity for younger women. Dr. Nancy Davidson: I guess our approach right now has been to suppress them, but I agree with you; you wonder if you look at some of the mechanisms of action, whether that's really a requirement biologically and medically, or whether it's something that's kind of a leftover from the approval process. You know, that for the drug approval, these women were suppressed. I think we need to work that out because that's another area where certainly women could have ovaries removed. That's pretty straightforward, although it requires a surgical procedure. But otherwise use of LHRH agonists continues to be injections, right? And so, if we're trying to minimize convenience or maximize convenience and minimize toxicity for women with any stage of breast cancer, anything we can do, it seems to me to eliminate an injection is going to be a good thing. So important for us to be able to work that out as well, even though numerically it's a smaller number of women, it's obviously a very important number. population of women. Dr. Hope Rugo: Last question for you. One question that comes up and sent to me and panels all the time is, if you have done your next generation sequencing and you see an ESR1 mutation and a P13CA mutation, what do you prioritize in terms of your choice of treatment, because we have the choice of either using elacestrant or a fulvestrant in combination with an agent targeting the PI3 kinase pathway? Dr. Nancy Davidson: I don't know that there's a right answer to that medically right now. So, when I talk about it with patients, I suggest to them that it's probably not one or the other. It's kind of the question of which one to use first. So, we talk a little bit about side effect profiles. We talk a little bit about patient preference and neither of these drugs is devoid of problems, but sometimes patients have pretty strong feelings about which set of side effects seems the least unattractive to them or the possibility of having those side effects. And I know that if one isn't well tolerated, you can swap over to the other. Dr. Hope Rugo: Absolutely. I think that's a very important way to think about next therapies in our era of not really knowing what's right. And this idea of shared decision-making is so incredibly important. Nancy, thank you so much for sharing your insights and knowledge with us today. I could talk to you for hours about this. Dr. Nancy Davidson: Hope, thank you so much for the opportunity. It is an exciting area and I really enjoyed talking with you about what we know and the many things that we don't yet know, but we're working on. Dr. Hope Rugo: Indeed, it's certainly an exciting time. Thank you to our listeners for joining us today. And thanks to the ASCO Daily News Podcast for highlighting this important area. You'll find a link to all of the studies discussed today in the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. Thanks so much.   Disclaimer:    The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.    Follow today's speakers:     Dr. Hope Rugo  @hoperugo  Dr. Nancy Davidson     Follow ASCO on social media:     @ASCO on Twitter    ASCO on Facebook    ASCO on LinkedIn      Disclosures:     Dr. Hope Rugo:  Consulting or Advisory Role: Napo Pharmaceuticals, Puma Biotechnology, Mylan, Eisai, Daiichi Sankyo Research Funding (Inst.): OBI Pharma, Pfizer, Novartis, Lilly, Genentech, Merck, Daiichi Sankyo, Sermonix Pharmaceuticals, AstraZeneca, Gilead Sciences, Astellas Pharma, Talho Oncology, Veru, GlaxoSmithKline, Hoffmann-LaRoche AG/Genentech, Inc Travel, Accommodations, Expenses: Merck, AstraZeneca   Dr. Nancy Davidson: No Relationships to Disclose    

Dr. Cat Burkat, Dr. Mike Yen, Dr. Ilya Leyngold, and Dr. Andrea Kossler discuss the evolving technique of corneal neurotization in this episode of The Oculofacial Podcast. They explain how this procedure has revolutionized the treatment of neurotrophic keratitis, offering a viable solution to address the root cause of the condition. Our panel discusses everything from patient selection, surgical techniques and nuances, outcomes, potential complications, and further research directions in this field. They also emphasize the importance of early intervention and collaboration between ophthalmologists and subspecialists. Overall, corneal neurotization is seen as a game-changing procedure with promising outcomes for patients with neurotrophic keratitis. If you're an ASOPRS Member, Surgeon or Trainee and are interesting in hosting a podcast episode, please submit your idea by visiting: asoprs.memberclicks.net/podcast

What's the risk of contracting Acanthamoeba keratitis with daily disposable contact lenses compared with daily wear reusable lenses? Dr. Edmund Tsui explores this with Dr. John Dart, author of “Acanthamoeba Keratitis Risk Factors for Daily Wear Contact Lens Users.”  Acanthamoeba Keratitis Risk Factors for Daily Wear Contact Lens Users. Carnt, Nicole et al. Ophthalmology, Volume 130, Issue 1, 48 – 55.

How manageable is multidrug-resistant keratitis? Find out about this and more in today's PV Roundup podcast.

Dr. Guillermo Amescua joins host Jay Sridhar to discuss novel approaches to infectious keratitis, including surgical approaches and corneal cross-linking. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Jeff Varanelli, OD, FAAO, Dipl. AAO, ABO, ABCMOFrom his early days in laser surgery to working with an ophthalmologist, Dr. Varanelli found his passion for the anterior segment to help his patients improve their overall eye health. For more than a decade, Dr. Varanelli has been an enthusiastic educator on all things related to dry eye and ocular surface disease. He is now taking the lead in Neurotrophic Keratitis (NK). Beyond herpetic eye disease, learn about other causes of NK and how to detect it, classify stages, and treat it more proactively. The doctors also discuss how they find ways to work within the system to advocate for the patient, even though insurance hurdles can be extremely frustrating for both patient and practitioner. Hosted by Joseph Allen, OD, FAAO, Diplo ABODr. Joseph Allen may be most well known as @DoctorEyeHealth on YouTube where he shares tips and education about eyes and vision for the general public.  Now, with his Eye Give a Damn! Podcast series, Dr. Allen goes in depth with his colleagues to discuss the challenges and opportunities facing optometry. From finances, private equity and insurance headaches to specialty lenses and the frontlines of scope expansion, hear from leading optometrists and industry friends. They sit down with Dr. Allen to share their personal journeys in eye care, expertise and passions. Discover why so many of us give a damn about the future of optometry and the variety of ways we can drive our industry forward! Eye Give a Damn hosted by Dr. Joseph Allen is produced by FluoreSCENE Media.For more information on Dr. Joseph Allen visit https://doctoreyehealth.com/Visit https://odcommunity.com/ to learn more about FluoreSCENE Media.

Take Home Points: Fluorescein is an essential tool in the diagnosis of HSV keratitis Identifying the type of HSV keratitis is crucial, as it will guide treatment Update tetanus vaccination Consult ophthalmology if there is concern for HSV keratitis as these patients require close and frequent follow-up REBEL Core Cast 95.0 – Herpetic Keratitis Click ... Read more The post REBEL Core Cast 95.0 – Herpetic Keratitis appeared first on REBEL EM - Emergency Medicine Blog.

In this special live episode of Pupil Pod, hosted by YoungMD Connect, Sila Bal, MD, MPH, and Brent Kramer, MD, reviewed the unique case of an 18-year-old woman with decreased vision and recurrent corneal erosion as a manifestation of complex regional pain syndrome (CRPS)—a degenerative nerve condition. Dr. Kramer outlined his approach to the case, including the diagnostic testing he performed, and explained the pathogenesis and causes of neurotrophic keratitis (NK) and the association between NK and CRPS. Further, he describes how he managed this unique condition and the patient's outcome from treatment.

  Vidcast:  https://youtu.be/8qyNd-Is8Ts   Those wearing reusable contact lenses were nearly 4 times more likely to develop microbial keratitis, a corneal infection, in comparison to those using disposable lenses.  Ophthalmologists at University College London reviewed the cases of 205 contact lens wearers.   Compared with those using disposable lenses, the risk of amoeba-driven keratitis was 3.8 fold higher for those using reusable soft lenses and 4.6 fold higher for those using rigid reusables.  Other factors that drove increased keratititis rates included showering or swimming wearing lenses (3.3 fold increase), overnight lens wearing (3.9 fold increase, and infrequent professional eye exams (10 fold increase).   Amoebic keratitis is rare affecting only 1 in every 20,000 contact lens wearers.  Even so, it accounts for about 50% of eyesight loss, and 25% of those infected require corneal transplants to restore vision.  The sad fact: about 90% of these cases are avoidable.    https://www.aaojournal.org/article/S0161-6420(22)00594-2/fulltext   #keratitis #contactlenses #reusables #disposables #blindness  

A cikin wannan shirin, Azima Bashir Aminu ta yi nazari ne a kan cutar nan ta idanu da ke barazana ga al'umma. An yi kiyassin cewa a duk shekara, ana samun mutane dubu 3 da ke kamuwa da wannan cuta, wanda aka ce idan ba a kula ba tana makantarwa. Shirin ya tattauna da kwararre da kuma wadanda cutar ta addaba.

The Weekly Round Up: This week we discuss the intersection of OSD and glaucoma, and its evolution to neurotrophic keratitis. And finally our practical cataract surgery tips (min 23) learned from this week in the OR.

Drs. Fasika Woreta and Brenton Finklea review the disease stages of neurotrophic keratitis and treatment based on staging. Therapy options include traditional lubricants and therapeutic contact lenses, cryopreserved amniotic membrane, newer agents such as cenegermin (Oxervate), and surgical interventions such as corneal neurotization and tarsorrhaphy. For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

Rare disease treatments for Leishmaniasis, Acanthamoeba Keratitis, and the Brain Eating Amoeba combined with products for Dry Nose, natural healthcare and beauty form the basis for Profounda Health & Beauty’s mission to help patients improve the quality of life for patientsTodd MacLaughlan, the CEO of Profounda Inc. and Profounda Health and Beauty, Inc, was interviewed on the Mission Matters Business Podcast by Adam Torres. Spreading awareness about rare diseases and making treatments more readily available, Mr. Todd MacLaughlan, CEO at Profounda and his team at Profounda Health and Beauty, has had an exceptional journey of experience in the pharmaceutical industry. Working diligently for the welfare of the people and bringing the harmful potency of certain diseases to greater visibility, Todd has come a long way and aspires to go even further. Todd has diverse experience in various domains and credits his current success to the lessons learned all along the way and his strong family support. Follow Adam on Instagram at https://www.instagram.com/askadamtorres/​ for up to date information on book releases and tour schedule.Apply to be interviewed by Adam on our podcast:https://missionmatters.lpages.co/podc...​Visit our website:https://missionmatters.com/​

In this podcast, expert clinicians will discuss a challenging case in the staging and diagnosis of neurotrophic keratitis.

In this podcast, expert clinicians will discuss pathophysiology, diagnosis, and staging of neurotrophic keratitis.

In this podcast, expert clinicians will discuss different treatment options for neurotrophic keratitis.

In this podcast, expert clinicians will discuss a challenging case in the treatment of neurotrophic keratitis.

191. Fracgp - Kfp - Ophthalmology - Keratitis by Dr Thomas Perkins

In this episode I cover herpes keratitis.If you want to follow along with written notes on corneal abrasions go to https://zerotofinals.com/medicine/ophthalmology/herpeskeratitis/ or the ophthalmology section in the Zero to Finals medicine book.This episode covers features, presentation, diagnosis and management of herpes keratitis.The audio in the episode was expertly edited by Harry Watchman.

CME credits: 0.25 Valid until: 27-02-2021 Claim your CME credit at https://reachmd.com/programs/cme/using-a-biologic-in-a-patient-with-atopic-dermatitis-and-hsv-keratitis/11241/ A multidisiplinary panel is presented with a highly allergic, extremely refractory patient with atopic dermatitis. Her dermatologist wants to take the next step and start her on a biologic, but she's worried about the patient's occular history and dupilumab's conjunctivitis risk. Find out what the experts have to say about this doctor's dilemma.

CME credits: 0.25 Valid until: 27-02-2021 Claim your CME credit at https://reachmd.com/programs/cme/using-a-biologic-in-a-patient-with-atopic-dermatitis-and-hsv-keratitis/11241/ A multidisiplinary panel is presented with a highly allergic, extremely refractory patient with atopic dermatitis. Her dermatologist wants to take the next step and start her on a biologic, but she's worried about the patient's occular history and dupilumab's conjunctivitis risk. Find out what the experts have to say about this doctor's dilemma.

Guest: John Dart, MD Professor and Deputy Director of Research Moorfields Eye Hospital London, UK

In this episode, resourceful Rajshree speaks from Nepal about studying for Step 1 as an international medical graduate. She discusses how she balances her school and social life, work and studying for step 1 while dealing with unexpected setbacks. She shares some innovative study strategies, including audio lectures and a color-coded post-it note system and her personal 6 phase plan for tackling such a daunting test.Phase 1   a.Materials: Kaplan books, Pathoma, 1st round First Aid (FA),   b.Color code on FA: Bluesticky notes or blue pen   a.Time duration: 3.5 months during internshipPhase 2   a.Materials: 1st round Uworld system wise (73 %), 2nd round FA, BRS physiology, 100 clinical cases of medical Ethics by Conrad Fischer, Goljan Audio lectures from Spotify (1 week when I had Keratitis)   a.Color code on FA: Yellow sticky notes and black pen   a.Time duration: 2.5 monthsPhase 3   a.Materials: 2nd round Uworld Random (89%), ANKI cards (24K cards), 3rd round FA (removed low yield sticky notes)   a.Color code on FA: Yellow sticky notes and black pen   b.Time duration: 2 monthsPhase 4   a.Materials: Uworld marked questions, 4th round FA with circling high yield texts, Physeo videos in weaker topics of physiology, Boards & Beyond (B&B only difficult topics), ANKI 7K cards (couldn’t finish)   a.Color code in FA: Green pen or Green Sticky note for NBME & UWSA, 6-B Pencil for circling (glossy papers need darker pencil), Red pens and red sticky notes for Physeo, B&B, internet/forum resources   b.Time duration: 20 daysPhase 5   a.Materials: 5th round FA reading only the circled text, Qmax 7 day free trial –8 blocks/day for endurance   a.Color code in FA: Subject-wise color coded index sticky notes to marking topics to revise day before test   b.Time duration: 10 daysPhase 6   a.Materials: 6th round FA reading selected topics in indexed sticky note   b.Time duration: 10 hours

Guests: Jessica B. Ciralsky, M.D. Associate Professor of Clinical Ophthalmology Weill Cornell Medical College, Cornell University New York William B. Trattler, M.D. Center For Excellence In Eye Care Miami

Make no mistake, if your dog or cat has a problem with their eye then it can go from being a minor inconvenience or irritation to something really serious within a day or two. It could even result in permanent blindness or loss of the eye.You definitely want to make sure that they are being given the right treatment for keratitis or any other form of eye disease!Keratitis is an inflammation of the surface of the eye - the cornea. There are 2 main categories: ulcerative and non-ulcerativeKeratitis in cats is most often caused by infection with herpesvirus, but can also be due to other causes including trauma, irritation, immune system dysfunction, increased intraocular pressure (glaucoma), and dry eyeThe surface of the eye becomes pink/white/chalky with raised lesions, you may also notice new blood vessels growing over the eyeSo long as no ulceration of cornea then steroid drops are the most common treatment of keratitis in cats, although this will depend on your cat’s history and the suspected underlying keratitis cause.If a corneal ulcer is present - something your vet will check using fluorescein stain - then antibiotics will be given first to allow the eye ulcer to healAdditional treatment may be needed alongside the steroid eye drop. These can include oral or injectible steroids and antiviral medicationTreatment may be needed lifelong. Once a cat has herpesvirus then it is often with them for life and may cause a permanent or intermittent keratitis (as well as other problems)If your cat is receiving steroid eye drops and any discharge is geting worse or their eye becoming painful then stop the medication and get your cat’s eye checked over straight away. If an ulcer is present and steroid eye drops are continues then it is possible for a deep ulcer to form that can then burstCalendar hereCheck out the full show notes here

The cover focus of the June issue of Modern Optometry is on diabetic eye disease, and this episode of The MOD Pod offers you two articles on this topic in audio form. Listen as Cecelia Koetting, OD, FAAO, runs through the four stages of diabetic retinopathy. Nate R. Lighthizer, OD, FAAO, talks about a new ally in the diagnosis and management of diabetic retinopathy, OCT angiography, as he reads the article he co-wrote with Sergiu Picioreanu, OD. Not interested in diabetic eye disease? Then skip to the last featured article, in which Alison Bozung, OD, gives a primer on herpes simplex keratitis.

The cover focus of the June issue of Modern Optometry is on diabetic eye disease, and this episode of The MOD Pod offers you two articles on this topic in audio form. Listen as Cecelia Koetting, OD, FAAO, runs through the four stages of diabetic retinopathy. Nate R. Lighthizer, OD, FAAO, talks about a new ally in the diagnosis and management of diabetic retinopathy, OCT angiography, as he reads the article he co-wrote with Sergiu Picioreanu, OD. Not interested in diabetic eye disease? Then skip to the last featured article, in which Alison Bozung, OD, gives a primer on herpes simplex keratitis.

Welcome to our second episode of Eyes for Ears, our ophthalmology/OKAPS review podcast, where we delve into the many flavors of infectious keratitis.

The Swan Rabbit Breed This is a now extinct rabbit breed, and may heave been a mixed or mongrel derived from Giant Breeds, and in particular the Patagonian. They have been extinct since about 1885, and there has been very little documented about this very unusual breed. It seems to have been indigenous to the Isle of Man, or at least that is where several breeders located stock to take to the British mainland. It was a very large rabbit that was not particularly handsome. It weighed in at 16-20lbs, with a brown-grey fur color, on a large frame. The ears were only 2 inches long, with the hollow insides pointed towards the front, and not towards the sides of the head. It is written that when you cross the Swan Rabbit with the Patagonian, the progeny's ears would be of a much shorter length. It was like the Patagonian, a useful meat and fur rabbit. https://books.google.com/books?id=O069kBAETeIC&pg=PA148&lpg=PA148&dq=%22swan+rabbit%22+breed&source=bl&ots=B6LFvVnBhB&sig=9cJ0mvEvCic5iGcqyL24hRQRQ04&hl=en&sa=X&ved=2ahUKEwifjKWttbPdAhWmTt8KHTUDC2AQ6AEwCXoECAQQAQ#v=onepage&q=%22swan%20rabbit%22%20breed&f=false Hyperemia and Red Eye in Rabbits Red eye is a relatively common condition which causes swelling or irritation in the rabbit's eye or eyelid. This appearance of blood vessels in the eyeball can develop because of various reasons, including many systemic or body diseases. If your rabbit has red eye, seek veterinary advice immediately, as it is generally a secondary symptom to a more serious condition. Symptoms and Types The signs and symptoms of red eye and related conditions often depend on the underlying cause. For example, if the red eye is due to a dental disorder, there may be signs of tooth decay or dental disease in the animal. Other common signs and symptoms may include: Impaired vision Swollen eyelids Eye discharge Extra tissue around the eyes Nasal discharge and upper respiratory infection or cold Hair loss and crusting in the mucous membrane, especially around the eyes, nasal area and cheeks Lethargy Depression Abnormal posture Facial masses Causes Because there are many causes to rabbit red eye, it is often difficult to identify the exact cause. However, some factors may include: Bacterial infections, including Treponema cuniculi (or rabbit syphilis), which can cause swollen eyelids Conjunctivitis, a common disorder causing red eye that can result from allergies, bacterial or viral irritants; sometimes occurring as a side-effect of a respiratory tract infection Keratitis, which is usually a fungal infection of the eye, and which can follow an injury to the eye Glaucoma, which if left untreated, can cause blindness Dental diseases, which can bring debris in the eye, causing inflammation or blocking a tear duct Diagnosis The veterinarian will run a variety of laboratory tests to diagnose the cause for the rabbit's red eye. This includes skin and other type of cultures, as well as exams testing for cataracts and other ocular diseases that can impair vision and health. If the veterinarian is still unable to diagnose the condition, they may run special tests including: Tonometry – measures the eye pressure in order to diagnose glaucoma and other related disorders Schirmer tear test – detects dry eye , a condition which can lead to red eye Cytologic examinations – identifies infections within the tear ducts and surrounding tissues Fluorescein stains – helps rule out ulcerative keratitis, a condition which can lead to red eye. Treatment is almost always dependent on the underlying cause of the condition. For example, if the rabbit's red eye is due to a dental disease, a tooth extraction may be necessary; whereas a case of bacterial-caused red eye may require an antibiotic prescription. To alleviate the rabbit's pain, the veterinarian will prescribe topical anti-inflammatory medication. In some cases, animals will require a short-course of topical steroid agents, especially rabbits with ulcers, delayed wound healing, and those with certain infections. Living and Management Some animals may require long-term pain management. Still others may require repeat eye exams to help ensure the rabbit's eye inflammation is managed properly, and that eye pressure remains stable to help prevent blindness. https://www.petmd.com/rabbit/conditions/eyes/c_rb_red_eye The Swan There was once a young Norwegian girl who lived in the village of Ranrike in the time of the Vikings. She was a pretty little girl, with curly golden blonde hair that shined as bright as the Goddess Sunna herself. Her name was Bekkhild, and she loved to play outdoors in the fresh air, and bright sunshine. That is until one day when a spider crawled up her arm and bit her ! The bite from the horribly ugly spider hurt, and made the little girl feel sick. A few days later she felt better, but from that time on she was afraid of all of nature's creatures whether they were big or small. Little Bekkhild was terrified by the birds in the air, the furry animals that scurried about, and of course by the bugs that crawled upon the ground, or flew with tiny wings. Little Bekkhild did, however, love flowers. She loved big flowers, little flowers, and especially the ones that bloomed into pretty colors like red, blue, orange, or yellow. Often she would venture out to look at these beautiful blossoms that surrounded her home, but as soon as she saw a bee, or an animal, she would run home to the safety of her house. Her parents took her down to the meadow often to see the flowers in bloom there, but unless they held her hand to protect her from the insects and animals, she would cry, and want to go home. One day her mother and father brought her to the pond at the edge of the meadow, and laid out a large blanket for them to sit upon. After a while her mother and father fell asleep in the warm sunshine. Bekkhild had been told to stay away from the water, but she had seen beautiful white flowers floating in the pond among the green leaves, and she hoped to get a closer look at them . Her mother had told her that they were called pond lilies, and they were so pretty that she wanted to pick one. Bekkhild cautiously walked down to the edge of the pond, keeping her eyes wide open for any creatures that might attack her. She turned around from time to time to make sure that her mother and father were still there to protect her. With her parents safely in sight, and the lovely flower within reach, she leaned over to snatch up the beautiful bloom. Just as she was about to get hold of the flower a large pure white swan swam around the corner right in front of her ! Bekkhild was so scared she did not even scream as she fell backwards onto the ground . As tears welled up in the little girls eyes the swan stopped and turned its neck as if it were examining her. Bekkhild was about to get up, and run back to her parents, when the swan began to sparkle. To Bekkhild's astonishment the swan turned into a beautiful woman, who was wearing a dress as white as the feathers on the swan. Her hair was as golden blonde as hers, and the woman had a pleasant ,friendly smile. The swan - woman reached out with her hand, and wiped away the little girls tears, before asking : " Why are you afraid of me princess ? " Bekkhild stuttered as she replied : " I..I...I am scared of aminals! " The swan - woman laughed, and corrected her. " You mean a-n-i-m-a-l-s, don' t you little princess ? " Bekkhild stood up, and put her hands on her hips. " That is what I said ! Aminals ! " she said with a frown. " What are you ? " asked Bekkhild . " I am a Valkyrie, little princess. My name is Swanhild, and I ride with Odin ! " The Valkyrie said boldly. " My name is Bekkhild ! " The little girl blurted out. The Valkyrie laughed a little when she replied : " Well, that is a pretty name for a little princess. " The Valkyrie reached down, and held the little girl's hand. " You should not be afraid of the animals that walk or fly. Nor should you fear insects that crawl, or take to the sky on tiny wings. They are all a part of nature's beauty, and are a gift from the Gods. " Swanhild said in a soothing tone. " Come with me, and I will show you, little princess." she added. They walked holding hands for only a moment before they spotted a rabbit feeding in the grass. Bekkhild quickly retreated behind Swanhild's leg for protection ! The Valkyrie, however, gently pulled her to her side, and then knelt down to pick up some fresh green grass. She handed it to Bekkhild, and motioned for her to give it to the rabbit. Bekkhild trembled as the rabbit slowly crept over to the leafy meal she held out to the furry little creature. The Valkyrie held her hand even tighter, to give the little girl strength, as the rabbit began to feed on the grass. As the rabbit chewed the munching motion made its little nose wriggle back and forth. Bekkhild giggled, and without even realizing it she had stopped shaking, and was no longer afraid. When the rabbit finished its meal it slowly hopped away back into the grass. Bekkhild jumped up and down, and laughed as it went to feed in another part of the meadow. Next the Valkyrie held out her finger up into the air, and a beautiful yellow bird flew over and landed on it. The bird was so pretty that Bekkhild just stood there staring up at the tiny bird for a moment. It had a pretty yellow head, a yellow breast, and the feathers on its back were black and yellow. As the bird sat nervously on her finger the Valkyrie told Bekkhild in a whisper : " This little bird is known as the Yellow Hammer. It comes here from the Germanic lands in the summer, and then it returns south to warmer lands in the winter." Bekkhild was flushed with joy ! She had never seen anything so beautiful ! " It is so pretty : " she said in a low whisper so as not to scare away the little bird. The Valkyrie placed her finger over her lips and said : " Shhh . Listen little princess ! " The Yellow Hammer suddenly started to chirp a lovely little song. A moment later, from off in the distance, another Yellow Hammer sang the same tune. The tiny bird then took to its wings, and flew off in the direction of the other bird. " You see little princess you do not have to fear nature' s creatures. They will not harm you if you do not try to harm them. " Swanhild said with a smile. " Yes, they are pretty, but it was a nasty bug that bit me ! " Bekkhild replied in a whining tone. " Not all insects are harmful little princess. " The Valkyrie said in response. The woman in white held out her hand and a beautiful butterfly fluttered onto her palm. It had a black body, and beautiful orange wings, with black spots on them. It flapped its wings a few times, and then held them upright as if it were showing Bekkhild exactly how beautiful it was. " I know that butterflies are pretty, but most bugs are ugly. " Bekkhild complained. The Valkyrie allowed the butterfly to fly away, and then took Bekkhild over to an old oak tree. On one of the lower limb's leaves there was a small multi - legged creature that was chewing on the edge of the leaf. " This is what a butterfly looks like before it becomes a butterfly princess. " Swanhild said as she showed the insect to her. Bekkhild looked at the bug in disbelief. " But... but...., that is ugly ! " replied the little girl. " How can that turn into a pretty butterfly? " she asked. The Valkyrie broke off the branch, with the insect on it, and told Bekkhild : " Well princess, this little insect is called a caterpillar, and it eats a lot to give itself enough energy to turn itself into a butterfly. When it is ready it builds itself a little house, called a cocoon, and it lives in there while it changes. When it is ready, it comes out, dries its wings, and then flies away. " Bekkhild put her hands to her mouth, and smiled from ear to ear as she said in amazement : " Oh my ! " The Valkyrie then walked Bekkhild back over to the edge of the pond. As they reached the water's edge Swanhild reached down, and picked a beautiful large white lily from among the pads growing there, and handed it to Bekkhild. " I have to go now princess my sisters are waiting for me. " Swanhild pointed to three swans swimming a short way off in the pond as she spoke. Bekkhild looked sad as she said : " Can I ask you a question ? " Swanhild nodded her approval. " Why do you call me princess ? My name is Bekkhild . " As the Valkyrie began to sparkle, and turn back into a swan, she told Bekkhild : " Because one day you will be Princess Bekkhild ! " - Glenn Bergen http://www.anindependentasatru.com/-blog/short-children-s-story-the-swan © Copyrighted

Hello Listener! Thank you for listening.  If you would like to support the podcast, and keep the lights on, you can support us whenever you use Amazon through the link below: It will not cost you anything extra, and I can not see who purchased what. Or you can become a Fluffle Supporter by donating through Patreon.com at the link below: Patreon/Hare of the Rabbit What's this Patreon? Patreon is an established online platform that allows fans to provide regular financial support to creators. Patreon was created by a musician who needed a easy way for fans to support his band. What do you need? Please support Hare of the Rabbit Podcast financially by becoming a Patron. Patrons agree to a regular contribution, starting at $1 per episode. Patreon.com takes a token amount as a small processing fee, but most of your money will go directly towards supporting the Hare of the Rabbit Podcast. You can change or stop your payments at any time. You can also support by donating through PayPal.com at the link below: Hare of the Rabbit PayPal Thank you for your support, Jeff Hittinger.   English Spots are a very old breed of rabbit. There are 7 recognized varieties (colors): Black, Blue, Chocolate, Gold, Grey, Lilac, and Tortoise. Adult English Spots weigh 5 to 8 pounds, between 2.3 and 3.6 kg. They are a fully arched breed and are allowed to run up and down the table to show off their type and markings while being judged. This week we traveled to a few family events including a second year birthday party and a graduation party. We traveled through 5 states and the District of Columbia all in one day! We were not sure if we were able to get out of our development. We have experienced some extreme rain, and the bridge to get into our development was washed out, as well as the road was washed away in another place. The counties to the North and South were looking for people that were washed away in the flooding. The main road to get to town is still closed, and we need to take side roads. Now enough about our adventures this week, and on with the English Spot. English Spot Rabbit Breed History/Origin English Spots are believed to have been developed in the late 1800s, of course, in England. Though spotted (broken pattern) rabbits had roamed England for well over 200 years, they were nothing special until the beginning of the 1800s. They generally weighed 7-10 pounds, and were the average spotted meat rabbit, several in every barn. In the early 1820’s, as the general interest in rabbits began to increase, extensive descriptions of the “perfect” spotting patterns was made. It was difficult to get all the various markings aggregated correctly in the same rabbit, which was fine, because farmers rose to the challenge for the next 100 years. In 1893, a drawing of “the perfect English Spot” was published in Britain’s Fur & Feather. The same standard is in use today, and describes the herringbone, butterfly, eye circle, cheek spot, ears and ear base, leg marking, and the chain and hip spots that together make up the side pattern. Ten years after the drawing was published, the winning rabbits in English shows more and more closely approximated that ideal. Photos in 1905 showed rabbits that were clearly Eng. Spot rabbits, though their hip markings were still blotchy and congested. Saddle markings had given way to the desired herringbone stripe. The breed was imported to Germany in 1889, and from there to other countries in Europe. According to the AESRC (American English Spot Rabbit Club) 1947 guidebook, 1890 was the first time English were on the table across the pond. In 1891 the National English Rabbit Club was formed and the markings we all know and love were standardized. The English Spot Rabbit is one of the oldest rabbit breeds, dating back to the mid-19th century. The main purpose for developing this particular breed of rabbit was for show purposes, which back in those days, was uncommon since rabbits were mainly used for meat and fur purposes. It is suggested that they may have come from the Great Lorrainese which is now known as the Giant Papillon, although it is also said that they may have descended from the English Butterfly and/or the Checkered Giant. According to the 1975 guidebook English Spots were in America by 1910. In 1910, the English Spot Rabbit was imported to North America and 12 years later in 1924, the American Rabbit Breeders Association (ARBA) accepted it as a recognized breed, and subsequently, the American English Spot Rabbit Club was established. The AESRC was founded in 1924. The first group of members organized the club at the Trenton Inter-State Fair in Trenton, NJ. The first National All English show was held in 1952 in Louisville, KY. In the UK, the breed is known simply as the "English" rabbit. The French named the breed "Lapin Papillon Anglais", or the English Butterfly Rabbit from the butterfly marking on the nose. Previous generations of the breed entailed a white rabbit with patches of color and through the years has acquired clearly defined markings. English Spots have a specific marking pattern and must meet certain marking requirements to be showable in ARBA sanctioned shows. The Eng. Spot is a medium-sized breed with an arched body type. Its weight has been set at 6 - 8 pounds (2.72 - 3.62 kg) in the UK, and 6 - 8 pounds in the USA. The standard for the markings remains the same since 1893. Their markings consist of a butterfly marking on the muzzle; eye circles; cheek spot which is a small spot on the cheek wisker; colored ears; a spine marking which is a stripe from the nape of the neck to the tip of the tail that widends above the hips with a herring bone effect meaning jagged marks on each side; and a sweep of side spot markings consisting of a chain, body markings, and hip markings. The side marking spots should start out small in the chain and gradually get larger with the largest spot in the center of the hip markings. The spots should start out with two chain spots at the nape and sweep down, increasing in number, along the belly then swirl up around the hip. All spots should be round and separated from other spots or markings. The rabbits should be free of stray spots on the head and stray spots near the spine. The markings should also be balanced - meaning the two sides of the body and head should be mirror image in size, shape, and placement of the markings. Two other breeds have similar markings (Rhinelander and Checkered Giant), but the English Spot is the only one of the three to have spots on the shoulder. Some of the English Spot marking disqualifications include: more than one break in the spine marking or a break that exceeds 1/4 inch; a missing cheek spot; more than one stray spot on the head; any head markings that touch each other; and white spots in the upper half of the ears. It is permissible for Spots to have colored/mismatched toenails. English Spots that do the best in competition have good type and like to show off and have clean sharp markings with round spots and are free of stray spots. Character English Spots are a very active breed. They are very friendly and love attention. They make a good pet or 4-H project for older children and are a challenging breed for rabbit raisers to breed and show. The English Spot rabbit is an active and hardy breed. They are noted for being very friendly, inquisitive rabbit breed with an engaging personality. They are very lively and energetic and as an active breed they require plenty of exercise with enough space to run and jump. They are very playful and display some entertaining acrobatics most of the time. They are usually sweet in nature and are very good with children, and also excellent as pets. As a playful breed, the English Spot rabbit needs some toys for playing and exercising. The average lifespan of an English Spot rabbit is about 5 to 8 years. Like the majority of rabbits, the most important component of the diet of an English Spot rabbit is hay, a roughage that reduces the chance of blockages and malocclusion whilst providing indigestible fiber necessary to keep the gut moving. Grass hays such as timothy are generally preferred over legume hays like clover and alfalfa. Legume hays are higher in protein, calories, and calcium, which in excess can cause kidney stones and loose stool. This type of hay should be reserved for young kits or lactating does. Some of the vegetables that rabbits enjoy are parsley, thyme, cilantro, dandelion, and basil. The green, leafy tops of radishes and carrots also are excellent sources of nutrients—more than the vegetable itself. New vegetables should be introduced slowly due to the delicate digestive systems of rabbits. It is recommended that cauliflower, broccoli, lettuce and cabbage be avoided, as they cause gas and can lead to gastrointestinal stasis, which can be fatal. Vegetables such as potatoes and corn should also avoided due to their high starch content. All breeds of rabbits also require an unlimited amount of fresh water, usually provided for in a water crock, tip-proof ceramic pet dish, or hanging water bottle. It is challenging to breed a well marked English Spot because not all babies in a litter will be marked, not to mention showable, or marked well. When a pair of marked English Spots are bred together the litter will consist of 1/2 marked, 1/4 Solid (solid colored with no white), and 1/4 Charlie (mostly white with colored ears, partial butterfly, and some other partial markings). Although they can not be shown, the Solids and Charlies can be used in breeding programs. If a Solid is bred to a Charlie, the entire litter will be marked; and when a Self or a Charlie is bred to a marked English Spot, 1/2 the litter will be marked. Breeding English Spots English Spots are a challenging breed to raise because not all English Spots are marked and it is very difficult to get an English Spot that is marked very well. Marked Spots may have marking disqualifications. Markings (as well as type, fur, and color) can be improved by careful selection at breeding and thoughtful selection of breeding stock. Because there are 7 recognized varieties of English Spots, breeding can become more complicated when unrecognized colors or Spots with poor color are part of the litter. Even though they can be difficult, the challenge of deciding which rabbits to breed together and the excitement of looking in the nest box to see what the doe has makes them a lot of fun. Their playful and active temperament also makes them fun. English Spot does are supposed to be very good mothers - they produce a lot of milk for the babies, make good nests and take good care of the babies. Most of the time they have large litters with 6-9 babies and the does are very good about taking on foster babies. Markings English Spots are either Solid, Charlies, or Marked. A Solid is a colored rabbit with no white. A Charlie is a mostly white rabbit with colored ears, a partial butterfly sort of like a mustache, and some other partial marking like a thin spine marking, cheek spots, and sometimes a few side spots. The partially marked babies "typically have a mustache similar to Charlie Chaplin" and therefore are called 'charlies'. A Marked Spot usually has a full butterfly marking and a spine marking that extends all the way to the tail. A Marked Spot is not necessarily showable. Spots are only showable based on their markings when they meet all the requirements in the Standard. Although Solid and Charlies are not showable, they can be useful in a breeding program. A very plainly marked Spot is not a true Charlie - Charlies has very little color. A true Charlie in a breeding program will never have a Solid baby. The butterfly should be faulted for irregularly shaped wings, drags of color, runs of white, nose fork out of proportion, or blunt/crooked/off centered nose fork. Disqualify for split butterfly or white spots in the butterfly. The English Spot pattern is caused by the broken gene. In fact, the symbol for the broken gene is “En” referring to “English Spotting.” When you breed broken to broken – or spot to spot – about 50% of the offspring will be broken colored, 25% will be solid, and 25% will be very lightly marked rabbits known as “charlies.” You can predict the percentages of Solids, Charlies, and Marked Spots in a litter of English Spots - at least theoretically. Marked X Marked = 50% Marked, 25% Solid, and 25% Charlie. Marked X Charlie = 50% Marked & 50% Charlie Marked X Solid = 50% Marked & 50% Solid Solid X Charlie = 100% Marked Charlie X Charlie = 100% Charlie Solid X Solid = 100% Solid Even though you can predict the percentage of marked babies (genetically), individual litters vary. When 2 Marked rabbits are bred together it is certainly possible to have an all marked litter or a litter with no marked babies at all. Color Because English Spots are most known for their markings and the markings are worth the most points when showing, it is tempting to breed rabbits based on their markings regardless of color. Pairing rabbits with incompatible color can cause problems in later generations - it could increase the chances of getting unrecognized colors and could ruin the quality of the color. Even though color is not worth a lot of points, poor color can detract from the general appearance of the rabbit or make markings look less defined. Even worse - you may have to cull some very well marked Spots from your breeding program because they are an unrecognized color or they have a color disqualification. In the USA, the accepted colors are black, blue chocolate, gold, gray, lilac, and tortoise. In the UK, English rabbits are recognized in black, blue, tortoiseshell, chocolate, and gray only. All other colors are specifically rejected as "inadmissible." When choosing breeding stock and making decisions about mating, it is important to look at the colors in the rabbits' pedigree and not just the color of the rabbits you want to breed. Although the colors in the pedigree give you an idea what colors rabbits likely carry, it does not tell you what colors the ancestors' siblings were. For instance there may be no dilutes (ie. Blue, Lilac) in the pedigree, but the rabbits could carry the gene and there are probably siblings of the rabbits in the pedigree that have been dilutes. Be wary of Chocolate in the pedigrees of Greys - if a Grey carries Chocolate, even when bred to Black it can produce Ambers (chocolate greys/chocolate agouti). Blue and Lilac appear to be similar colors, but if you compare good Blues and Lilacs, they are a very different color - they are just both dilutes (Blues are the dilute of Black and Lilacs are the dilute of Chocolate). Crossing Blues and Lilacs will lead to poor blue color and lilacs that are bluish. A pregnant English Spot will require adequate food to support her and her young. Three weeks into the pregnancy, it is common for breeders to provide the doe with a nest box filled with straw. The doe will burrow in the straw and begin lining the nest with hair she pulls from her stomach, in order to insulate her litter and keep them warm, and when ready, she will have her young in the nest. When the kits are 8 weeks of age, it is advised for the young to be separated from their mother. Type Type is very important in Spots and should always be considered when deciding which Spots to breed together. Avoid breeding Spots with the same type flaws together, especially the common type problems in English Spots like chopped hindquarters, short legs, and compact body types. Improving a marking problem through culling is easier than improving a type problem through culling. It can also be difficult to make the decision to cull a very well marked rabbit that does not have good type. Is there any rabbit so remarkable to look at and yet so difficult to produce as the English Spot? Sports, Charlies, and mis-marks all frustrate the English Spot breeder, but he or she keeps at it for the satisfaction of a seeing a well-marked “Spotted Beauty” running home to win. That’s right – English Spots, as well as other full-arch type breeds, do not pose on the show table but run the length of it, end to end and back again. This is the best way to show off their markings, and they are quite fun to watch and to judge. The ideal body type is long and lean, with the belly carried well off the table. Body type and marking are of nearly equal importance in the English Spot standard. Organizations National English Rabbit Club The American English Spot Rabbit Club (AESRC) The American Rabbit Breeders Association (ARBA) http://americanenglishspot.weebly.com/breed-history.html http://www.petguide.com/breeds/rabbit/english-spot-rabbit/ https://sites.google.com/site/watchmerunspots/englis-spots The US national club: www.AmericanEnglishSpot.weebly.com https://www.raising-rabbits.com/english-spot.html http://rabbitbreeders.us/english-spot-rabbits http://www.roysfarm.com/english-spot-rabbit/ http://americanenglishspot.weebly.com/standard.html Red Eye in Rabbits Hyperemia and Red Eye in Rabbits Red eye is a relatively common condition which causes swelling or irritation in the rabbit's eye or eyelid. This appearance of blood vessels in the eyeball can develop because of various reasons, including many systemic or body diseases. If your rabbit has red eye, seek veterinary advice immediately, as it is generally a secondary symptom to a more serious condition. Symptoms and Types The signs and symptoms of red eye and related conditions often depend on the underlying cause. For example, if the red eye is due to a dental disorder, there may be signs of tooth decay or dental disease in the animal. Other common signs and symptoms may include: Impaired vision Swollen eyelids Eye discharge Extra tissue around the eyes Nasal discharge and upper respiratory infection or cold Hair loss and crusting in the mucous membrane, especially around the eyes, nasal area and cheeks Lethargy Depression Abnormal posture Facial masses Causes: Because there are many causes to rabbit red eye, it is often difficult to identify the exact cause. However, some factors may include: Bacterial infections, including Treponema cuniculi (or rabbit syphilis), which can cause swollen eyelids Conjunctivitis, a common disorder causing red eye that can result from allergies, bacterial or viral irritants; sometimes occurring as a side-effect of a respiratory tract infection Keratitis, which is usually a fungal infection of the eye, and which can follow an injury to the eye Glaucoma, which if left untreated, can cause blindness Dental diseases, which can bring debris in the eye, causing inflammation or blocking a tear duct Diagnosis The veterinarian will run a variety of laboratory tests to diagnose the cause for the rabbit's red eye. This includes skin and other type of cultures, as well as exams testing for cataracts and other ocular diseases that can impair vision and health. If the veterinarian is still unable to diagnose the condition, they may run special tests including: Tonometry – measures the eye pressure in order to diagnose glaucoma and other related disorders Schirmer tear test – detects dry eye , a condition which can lead to red eye Cytologic examinations – identifies infections within the tear ducts and surrounding tissues Fluorescein stains – helps rule out ulcerative keratitis, a condition which can lead to red eye Treatment Treatment is almost always dependent on the underlying cause of the condition. For example, if the rabbit's red eye is due to a dental disease, a tooth extraction may be necessary; whereas a case of bacterial-caused red eye may require an antibiotic prescription. To alleviate the rabbit's pain, the veterinarian will prescribe topical anti-inflammatory medication. In some cases, animals will require a short-course of topical steroid agents, especially rabbits with ulcers, delayed wound healing, and those with certain infections. Living and Management Some animals may require long-term pain management. Still others may require repeat eye exams to help ensure the rabbit's eye inflammation is managed properly, and that eye pressure remains stable to help prevent blindness. https://www.petmd.com/rabbit/conditions/eyes/c_rb_red_eye The Story of the Perverted Message Hottentot Like many other [First Nation peoples], the Namaquas or Hottentots story of the associate the phases of the moon with the idea of immortality, the apparent waning and waxing of the luminary Moon and being understood by them as a real process of alternate disintegration and reintegration, of decay and growth repeated perpetually. Even the rising and setting of the moon is interpreted by them as its birth and death. They say that once on a time the Moon wished to send to mankind a message of immortality, and the hare undertook to act as messenger. So the Moon charged him to go to men and say, ” As I die and rise to life again, so shall you die and rise to life again.” Accordingly the hare went to men, but either out of forgetfulness or malice he reversed the message and said, ” As I die and do not rise to life again, so you shall also die and not rise to life again.” Then he went back to the Moon, and she asked him what he had said. He told her, and when she heard how he had given the wrong message, she was so angry that he threw a stick at him which split his lip. That is why the hare’s lip is still cloven. So the hare ran away and is still running to this day. Some people, however, say that before he fled he clawed the Moon’s face, which still bears the marks of the scratching, as anybody may see for himself on a clear moonlight night. But the Namaquas are still angry with the hare for robbing them of immortality. The old men of the tribe used to say, ” We are still enraged with the hare, because he brought such a bad message, and we will not eat him.” Hence from the day when a youth comes of age and takes his place among the men, he is forbidden to eat hare’s flesh, or even to come into contact with a fire on which a hare has been cooked. If a man breaks the rule, he is not infrequently banished the village. However, on the payment of a fine he may be readmitted to the community. A similar tale, with some minor differences, is told by Bushman the Bushmen). According to them, the Moon formerly said originally of death # to men, ” As I die and come to life again, so shall ye do ; [death# ] then when ye die, ye shall not die altogether but shall rise again.” the hare [relayed the message s-i-c]. But one man would not believe the glad tidings of immortality, and he would not consent to hold his tongue. For his mother had died, he loudly lamented her, and nothing, could persuade him that she would come to life again. A heated altercation ensued between him and the Moon on this painful subject. “Your mother’s asleep,” says, the Moon. # She’s dead,” says the man, and at it they went again, hammer and tongs, till at last the Moon lost patience and struck the man on the face with her fist, cleaving his mouth with the blow. And as she did so, she cursed him saying, ” His mouth shall be always like this, even when he is a hare. For a hare he shall be. He shall spring away, he shall come doubling back. The dogs shall chase him, and when they have caught him they shall tear him in pieces. He shall altogether die. And all men, when they die, shall die outright. For he would not agree with me, when I bid him not to weep for his mother, for she would live again. * No,’ says he to mc, * my mother will not live again.’ Therefore he shall altogether become a hare. And the people, they shall altogether die, because he contradicted me flat when I told him that the people would do as I do, returning to life after they were dead.” So a righteous retribution overtook the skeptic for his skepticism, for he was turned into a hare, and a hare he has been ever since. But still he has human flesh in his thigh, and that is why, when the Bushmen kill a hare, they will not eat that portion 6f the thigh, but cut it out, because it is human flesh. And still the Bushmen say, ” It was on account of the hare that the Moon cursed us, so that we die altogether. If it had not been for him, we should have come to life again when we died. But he would not believe what the Moon told him, he contradicted her flat.” In this Bushman version of the story the hare is not the animal messenger of God to men, but a human skeptic who, for doubting the gospel of eternal life, is turned into a hare and involves the whole human race in the doom of mortality. This may be an older form of the story than the Hottentot version, in which the hare is a hare and nothing more. https://japanesemythology.wordpress.com/moon-viewing-tradition/african-tales-of-how-the-hare-got-to-the-moon-and-how-mankind-lost-immortality/ In a pan–African story, the Moon sends Hare, her divine messenger, down to earth to give mankind the gift of immortality. “Tell them,” she says, “that just as the Moon dies and rises again, so shall you.” But Hare, in the role of trickster buffoon, manages to get the message wrong, bestowing mortality instead and bringing death to the human world. The Moon is so angry, she beats Hare with a stick, splitting his nose (as it remains today). It is Hare’s role to lead the dead to the Afterlife in penance for what he’s done. https://ronelthemythmaker.wordpress.com/2017/02/23/rabbits-and-hares-of-folklore-folklorethursday/ Word of the week: Latitude © Copyrighted

Guests: Kathleen Digre, MD Professor, Ophthalmology & Visual Science University of Utah Salt Lake City, UT Eduardo C. Alfonso, MD Professor and Chairman Bascom Palmer Eye Institute Miami, FL

No evidence-based treatment guidelines exist for any ophthalmic conditions of dogs and there is limited published evidence supporting treatments of feline herpes viral keratitis (FHVK). The aim of this study was to document current treatment patterns of canine prolapsed nictitans (PN) and FHVK through the use of a vignette-based survey administered to general practitioner (GP) and ophthalmic specialist (SP) veterinarians.  CW - Clinical Decision Maiking and Treatment Patterns in Canine Prolapsed Nictitans and Feline Herpetic Keratitis Veterinary Evidence TodayEdinburgh, 1-3 November 2016

Steven C. Kaufman, MD, PhD

Guests: Oliver Findl, M.D. Chair of the Department of Ophthalmology Hanusch Hospital Vienna , Austria Cordelia Chan, M.D. Visiting Senior Consultant Singapore National Eye Centre Singapore

James Chodosh, MD, MPH

Elmer Tu

Elmer Tu

Guest: Edmund Tsui, MD Department of Ophthalmology New York University School of Medicine New York, NY

Hosts: Vincent Racaniello and Dickson Despommier Vincent and Dickson review the biology and pathogenesis of the amoebae Naegleria fowlerii and Acanthamoeba castellani. Links for this episode: N. fowlerii life cycle (CDC) N. fowlerii at Artful Amoeba Naegleria and amoebic meningoencephalitis (MDPH) First case of Naegleria PAM in Italy (Emerg Inf Dis) N. fowlerii in well water (Emerg Inf Dis) Recent N. fowlerii case in Minnesota (Clin Inf Dis) Beat the holiday bug (Sydney Morning Herald) Is your neti pot safe? (Dallas News) Acanthamoeba keratitis fact sheet (CDC) Letters read on TWiP 39 Contact Send your questions and comments (email or mp3 file) to twip@twiv.tv.

Objective Canine chronic superficial keratitis (CSK) is chronic, progressive keratopathy, which is suspected to be caused by an immune mediated response triggered by ultraviolet light exposure. The purpose of this study was to evaluate the effect of UV-blocking soft contact lenses in treatment for CSK. Methods 26 dogs (26 eyes) with CSK were treated continuously with UV-blocking contact lenses (*Acri.Pat®-UV bandage lenses) for six months. A contact lens was placed on one eye of each dog; the other eye remained without a lens as a control eye. Then, five dogs were treated further on wearing now contact lenses on either eye. Continuously, all patients were treated topically with cyclosporine A on both eyes. The contact lenses were changed every four weeks and an ophthalmic examination was performed at each appointment. Evaluation criteria included corneal alterations as pigmentation, edema, pannus and vascularisation based on digital photographs and drawings. To determine the transmittance characteristics of the contact lenses before and after use, 32 contact lenses were measured with a UV-vis-NIR spectrophotometer. Results Pigmentation increased in eyes wearing contact lenses and in control eyes over the evaluation period of six months. Corneal edema increased in the eyes wearing lenses, but remained unaffected in the control eyes. A significant difference in the incidence of pannus and the extent of corneal vascularisation could not be evaluated. Side effects were noted in six cases (corneal edema and vascularisation, conjunctivitis, blepharospasm). All new lenses studied reduced UV-radiation to a safe level, whereas used lenses did not maintain their transmittance characteristics. Conclusion Extended wear of UV-blocking contact lenses is an ineffective treatment for canine CSK and bears the risk of severe side effects

Guest: John KG Dart MA DM FRCS FRCOphth Consultant Ophthalmologist, Corneal and External Disease Service Deputy Director of Research at Moorfields Honorary Reader, University College London Moorfields Eye Hospital London, UK

Guest: Eric D. Donnenfeld, M.D.Founding partner of Ophthalmic Consultants of Long Island Co-Chairman of CorneaNassau University Medical CenterLong Island, NY

An attempt was made to isolate equine adenoviruses from the conjuntival sacs of horses suffering from keratitis using the polymerase chain reaction (PCR) method of amplification for detection.

Bisher wurden lediglich einzelne Fälle veröffentlicht, in denen über okuläre Veränderungen bei Patienten mit kutaner und mukokutaner Leishmaniose berichtet wurde. Diese betrafen die vorderen Augenabschnitte und Adnexe, wobei Blepharitis, Liddeformationen, Konjunktivitis und Keratitis die am häufigsten beschriebenen Veränderungen waren. Von der viszeralen Leishmaniose (Kala-Azar) wußte man aus großangelegten Studien aus China [68,69] sowie aus Einzelberichten [47,54,58,65,83], dass sie in großer Regelmäßigkeit Veränderungen auch am Augenhintergrund hervorruft, nämlich insbesondere retinale Blutungen und anteriore Uveitis. Die vorliegende Arbeit sollte die Frage klären, ob sich bei der kutanen und mukokutanen Leishmaniose ebenso Veränderungen des Augenhintergrundes feststellen lassen und inwieweit bereits beschriebene Veränderungen der vorderen Augenabschnitte und Adnexe von epidemiologischer Relevanz sind. In einem fünfmonatigen Zeitraum wurden in Paraguay 55 Patienten ophthalmologisch untersucht. Die Untersuchung erfolgte größtenteils in den Endemiegebieten Paraguays. Desweiteren untersuchten wir vor Ort 39 nicht-infizierte Kontrollpersonen. Dies ermöglichte einen direkten Vergleich beider Gruppen, da sie gleiche äußere soziale und klimatische Bedingungen aufwiesen. Die Diagnose bzw. deren Ausschluß stellten wir klinisch, mit Hilfe des Intrakutantests nach Montenegro, mit serologischen Methoden bzw. durch Erregernachweis. Die Ergebnisse zeigen, dass zum einen entzündliche Veränderungen an vorderen Augenabschnitten sowie Adnexen weitaus häufiger in der Patientengruppe als im Kontrollkollektiv vorkommen. Andererseits finden sich die gleichen Veränderungen gehäuft bei den Patienten, welche noch aktive Läsionen aufweisen, im Vergleich zu jenen, deren Läsionen bereits vernarbt sind. Blepharitis und korneale Stromaveränderungen in Form weißlicher Eintrübungen finden sich nach dem χ 2 -Test statistisch signifikant gehäuft bei den Patienten mit aktiven Läsionen im Vergleich mit der Kontrollgruppe (p