Analysis of google trends and search results for ophthalmic symptoms of monkeypox.

PURPOSE: In July 2022, the World Health Organization (WHO) declared monkeypox virus's global spread a "public health emergency of international concern." About a quarter of monkeypox cases feature ophthalmic symptoms. We assessed trends in worldwide search interest in monkeypox ophthalmic involvement and inclusion in online search engine queries. METHODS: The following keywords were searched on Google Trends from April 1, 2022, to August 12, 2022: monkeypox + eye, pink eye, eye infection, eyelid, vision, blurry vision, vision loss, blindness, eye symptoms, eye problems, eye pain, eye redness, conjunctivitis, conjunctiva, cornea, keratitis, corneal ulcer, and blepharitis. We analyzed trends, correlated search interest with case count data, and compared popularity of search terms via nonparametric Mann-Whitney-U analysis. Inclusion of ophthalmic symptoms in Google search results for "monkeypox symptoms" was assessed. RESULTS: "Monkeypox eye" had the highest average search interest worldwide and in the United States. Search interest peaked between mid-May and late July 2022. When compared to interest in "monkeypox rash," the most searched monkeypox symptom, the average interest in "monkeypox eye" was lower (p < 0.01). Of the first 50 results from the Google search of "monkeypox symptoms," 10/50 (20%) mentioned ophthalmic symptoms. 6/50 (12%) mentioned the eye as a route of virus transmission. CONCLUSION: Search interest in monkeypox ophthalmic symptoms corresponds with geographic and temporal trends, i.e., timing and location of the first reported non-endemic cases and WHO announcement. Although ophthalmic symptoms are not as widely searched currently, inclusion in public health messaging is key for diagnosis, appropriate management, and reduction of further transmission.

Epidemiology of United States tennis-related ocular injuries from 2000 to 2019.

PURPOSE: To characterize trends in ocular tennis injuries over the last 20 years. METHODS: The National Electronic Injury Surveillance System was utilized to characterize tennis-related eye injuries in a nationally representative sample of emergency department visits. Data were divided into 5 age groups, and various demographic information was obtained. RESULTS: Approximately 16,000 tennis-related ocular injuries were identified with males being affected nearly 2:1 compared to females. The youngest age group (0-20) had the greatest proportion of injuries, with most injuries in boys 11-15 years old. Injuries occurred most often during the spring season. Most patients were treated and released from the ED. Of those patients who were hospitalized, one-third had an open globe injury. CONCLUSIONS: The overall number of injuries trended downward during the timespan of the study. Although most patients did not experience serious visual consequences, the greatest proportion of ocular tennis injuries occurred in the pediatric age group in whom the risk of amblyopia is high. Primary care providers and tennis regulatory bodies should consider recommending eye safety sports goggles in children to mitigate the potential for significant visual morbidity.

Epidemiology of ocular injuries associated with landscaping tools.

The purpose of this retrospective, cross-sectional study was to determine and analyze the trends in ocular injuries related to landscaping activities and equipment from 2010 to 2019. A total of 168,845 ocular injuries were associated with landscaping activities with the majority of cases occurring in men (80.4%) between the ages of 41-60 during the summer months of June, July, and August. The majority of ocular injuries did not require admission (97.8%) but of those that were admitted 42% had an open globe injury (n = 399). The results of this investigation provide useful information for emergency room physicians and ophthalmologists in understanding the prevalence of these landscaping-associated ocular injuries and further draw suspicion for the incidence of open globe injuries in this population.

Aluminum Leaching from Fluid Warmers: Regulatory Deferral to Clinicians' Decision.

Fluid-warming systems are crucial in surgical and trauma settings because of their key role in preventing or treating hypothermia and enabling proper resuscitation of blood products that are stored cold. Recently, several manufacturers have issued warnings of the possibility of aluminum leaching from their fluid warmers and cautioned about the potential for aluminum toxicity in patients who underwent fluid resuscitation with these devices. Studies suggest that one of the main factors affecting aluminum leaching in this setting is the coating of the aluminum plate itself. Coating, often with a biocompatible material, appears to reduce aluminum leaching by 100- to 200-fold compared with an uncoated plate. Nonetheless, leaching with the coating is still at a level exceeding U.S. regulations. A few aluminum-free warming systems are available on the market, but these are not carried by all providers and some clinicians may be less familiar with their use. Medical device manufacturers will likely design future warming systems with less potential for aluminum blood contact. In the meantime, the risk of inadequate resuscitation, consequent to the proper fluid warmer no longer being available, is contrasted with the risk of potential toxicity. In the situation described here, the regulators deferred the ultimate decision of which fluid warmer to use in a given situation to the risk-benefit decision of the clinician.

Quality Fade in Medical Device Manufacturing: Thinness of Airway Breathing Circuit Plastic.

Mechanical respirators typically use a plastic circuit apparatus to pass gases from the ventilator to the patient. Structural integrity of these circuits is crucial for maintaining oxygenation. Anesthesiologists, respiratory therapists, and other critical care professionals rely on the circuit to be free of defects. The American Society for Testing and Materials maintains standards of medical devices and had a standard (titled Standard Specification for Anesthesia Breathing Tubes) that included circuits. This standard, which was last updated in 2008, has since been withdrawn. Lack of a defined standard can invite quality fade-the phenomenon whereby manufacturers deliberately but surreptitiously reduce material quality to widen profit margins. With plastics, this is often in the form of thinner material. A minimum thickness delineated in the breathing circuit standard would help ensure product quality, maintain tolerance to mechanical insults, and avert leaks. Our impression is that over the recent years, the plastic in many of the commercially available breathing circuits has gotten thinner. We experienced a circuit leak in the middle of a laminectomy due to compromised plastic tubing in a location that evaded the safety circuit leak check that is performed prior to surgery. This compromised ventilation and oxygenation in the middle of a surgery in which the patient is positioned prone and hence with a minimally accessible airway; it could have resulted in anoxic brain injury or death. The incident led us to reflect on the degree of thinness of the circuit's plastic.

Mechanisms of increased vascular stiffness down the aortic tree in aging, premenopausal female monkeys.

Protection against increased vascular stiffness in young women is lost after menopause. However, little is known about vascular stiffness in older, premenopausal females, because most of the prior work has been conducted in rodents, which live for only 1-3 yr and do not go through menopause. The goal of the current investigation was to quantitate differences in stiffness down the aortic tree and the mechanisms mediating those differences in older, premenopausal (24 ± 0.7 yr) versus young adult (7 ± 0.7 yr) female nonhuman primates. Aortic stiffness (ß), calculated from direct and continuous measurements of aortic diameter and pressure in chronically instrumented, conscious macaque monkeys, increased 2.5-fold in the thoracic aorta and fivefold in the abdominal aorta in old premenopausal monkeys. The aortic histological mechanisms mediating increased vascular stiffness, i.e., collagen/elastin ratio, elastin, and collagen disarray, and the number of breaks in elastin and collagen fibers were greater in the old premenopausal versus young monkeys and greater in the abdominal versus the thoracic aorta and greatest in the iliac artery. In addition, more immature and less cross-linked fibers of collagen were found in the aortas of young females. Aortic stiffness increased in old premenopausal female monkeys, more so in the abdominal aorta than in the thoracic aorta. Histological mechanisms mediating the increased aortic stiffness were augmented in the old premenopausal females, greater in the abdominal versus the thoracic aorta, and greatest in the iliac artery.NEW & NOTEWORTHY This is the first study to examine vascular stiffness down the aortic tree in aging premenopausal females (24 ± 0.7 yr old), whereas prior work studied mainly rodents, which are short-lived and do not undergo menopause. Histological mechanisms mediating vascular stiffness in older premenopausal females increased progressively down the aortic tree, with greater increases in the abdominal aorta compared with the thoracic aorta and with the greatest increases and differences observed in the iliac artery.

Secreted frizzled-related protein 2, a novel mechanism to induce myocardial ischemic protection through angiogenesis.

Our hypothesis is that Secreted Frizzled-Related Protein 2 (sFPR2) is an important mechanism mediating ischemic cardioprotection, since it is the most upregulated gene in the third window of ischemic preconditioning. One week after permanent coronary artery occlusion (CAO), sFRP2 TG mice exhibited a 49% higher LV ejection fraction and a 36% reduction in infarct size, p < 0.05, and reduced fibrosis in both adjacent and remote zones, along with an increase in collagen type III and a decrease in the collagen type I/III ratio compared with WTL. The ischemic cardioprotection was associated with increased angiogenesis and arteriogenesis, reflected by increased capillary and arteriolar proliferation in the ischemic zone, thereby preserving blood flow after CAO. The angiogenesis and arteriogenesis were mediated by cross talk between myocytes and endothelial cells. The mechanism for cardioprotection and angiogenesis/arteriogenesis did not involve a traditional vascular growth hormone, e.g., VEGF or FGF, but rather cTGF, and ATF6 through the stress signaling pathway. The ATF6 inhibitor, AEBSF, blocked the upregulation of cTGF and both the angiogenesis and arteriogenesis, resulting in abolition of the reduced infarct size and protection of cardiac function in the sFRP2 TG mouse following permanent CAO. sFRP2 is a novel mechanism to induce angiogenesis/arteriogenesis, mediated through the endoplasmatic reticulum (ER) stress signaling pathway, ATF6 and cTGF, which protects the heart from myocardial ischemia.

Rats are protected from the stress of chronic pressure overload compared with mice.

The goal of this investigation was to compare the effects of chronic (4 wk) transverse aortic constriction (TAC) in Sprague-Dawley rats and C57BL/6J mice. TAC, after 1 day, induced similar left ventricular (LV) pressure gradients in both rats (n = 7) and mice (n = 7) (113 ± 5.4 vs. 103 ± 11.5 mmHg), and after 4 wk, the percent increase in LV hypertrophy, as reflected by LV/tibial length (51% vs 49%), was similar in rats (n = 12) and mice (n = 12). After 4 wk of TAC, LV systolic and diastolic function were preserved in TAC rats. In contrast, in TAC mice, LV ejection fraction decreased by 31% compared with sham, along with increases in LV end-diastolic pressure (153%) and LV systolic wall stress (86%). Angiogenesis, as reflected by Ki67 staining of capillaries, increased more in rats (n = 6) than in mice (n = 6; 10 ± 2 vs. 6 ± 1 Ki67-positive cells/field). Myocardial blood flow fell by 55% and coronary reserve by 28% in mice with TAC (n = 4), but they were preserved in rats (n = 4). Myogenesis, as reflected by c-kit-positive myocytes staining positively for troponin I, is another mechanism that can confer protection after TAC. However, the c-kit-positive cells in rats with TAC were all negative for troponin I, indicating the absence of myogenesis. Thus, rats showed relative tolerance to severe pressure overload compared with mice, with mechanisms involving angiogenesis but not myogenesis.

Mechanisms of sex differences in exercise capacity.

Sex differences are an important component of National Institutes of Health rigor. The goal of this investigation was to test the hypothesis that female mice have greater exercise capacity than male mice, and that it is due to estrogen, nitric oxide, and myosin heavy chain expression. Female C57BL6/J wild-type mice exhibited greater (P < 0.05) maximal exercise capacity for running distance (489 ± 15 m) than age-matched male counterparts (318 ± 15 m), as well as 20% greater work to exhaustion. When matched for weight or muscle mass, females still maintained greater exercise capacity than males. Increased type I and decreased type II myosin heavy chain fibers in the soleus muscle from females are consistent with fatigue resistance and better endurance in females compared with males. After ovariectomy, female mice no longer demonstrated enhanced exercise, and treatment of male mice with estrogen resulted in exercise capacity similar to that of intact females (485 ± 37 m). Nitric oxide synthase, a downstream target of estrogen, exhibited higher activity in female mice compared with male mice, P < 0.05, whereas ovariectomized females exhibited nitric oxide synthase levels similar to males. Nitric oxide synthase activity also increased in males treated with chronic estrogen to levels of intact females. Nitric oxide synthase blockade with Nω-nitro-l-arginine methyl ester eliminated the sex differences in exercise capacity. Thus estrogen, nitric oxide, and myosin heavy chain expression are important mechanisms mediating the enhanced exercise performance in females.

A novel adenylyl cyclase type 5 inhibitor that reduces myocardial infarct size even when administered after coronary artery reperfusion.

We developed a novel adenylyl cyclase type 5 (AC5) inhibitor, C90, that reduces myocardial infarct size even when administered after coronary reperfusion. This is key, since it is not practical to administer a drug to a patient with myocardial infarction before revascularization, and is one reason why so many prior drugs, which reduced infarct in experimental animals, failed in clinical trials. C90 is the most potent AC5 inhibitor, as exhibited by its IC50 value for AC5 inhibition, which was 5 times lower than the next most potent AC5 inhibitor. C90 reduced cAMP in response to forskolin in wild type mice by 42%, but no longer reduced cAMP in response to forskolin in mice with disruption of AC5, indicating that the mechanism of C90 was specific for AC5 inhibition. Compared with vehicle treatment, C90 reduced infarct size by 64% at a dose of 0.6 mg/kg. Thus, C90 is a novel, selective and potent AC5 inhibitor that reduces infarct size, when delivered after coronary artery reperfusion, rendering it potentially clinically useful. It also reduces beta-adrenergic receptor signaling, which will provide additional benefit to patients with coronary artery disease or heart failure.

Disruption of adenylyl cyclase type 5 mimics exercise training.

Exercise training is key to healthful longevity. Since exercise training compliance is difficult, it would be useful to have a therapeutic substitute that mimicked exercise training. We compared the effects of exercise training in wild-type (WT) littermates with adenylyl cyclase type 5 knock out (AC5 KO) mice, a model of enhanced exercise performance. Exercise performance, measured by maximal distance and work to exhaustion, was increased in exercise-trained WT to levels already attained in untrained AC5 KO. Exercise training in AC5 KO further enhanced their exercise performance. The key difference in untrained AC5 KO and exercise-trained WT was the ß-adrenergic receptor signaling, which was decreased in untrained AC5 KO compared to untrained WT but was increased in WT with exercise training. Despite this key difference, untrained AC5 KO and exercise-trained WT mice shared similar gene expression, determined by deep sequencing, in their gastrocnemius muscle with 183 genes commonly up or down-regulated, mainly involving muscle contraction, metabolism and mitochondrial function. The SIRT1/PGC-1α pathway partially mediated the enhanced exercise in both AC5 KO and exercise-trained WT mice, as reflected in the reduced exercise responses after administering a SIRT1 inhibitor, but did not abolish the enhanced exercise performance in the AC5 KO compared to untrained WT. Increasing oxidative stress with paraquat attenuated exercise performance more in untrained WT than untrained AC5 KO, reflecting the augmented oxidative stress protection in AC5 KO. Blocking nitric oxide actually reduced the enhanced exercise performance in untrained AC5 KO and trained WT to levels below untrained WT, demonstrating the importance of this mechanism. These results suggest that AC5 KO mice, without exercise training, share similar mechanisms responsible for enhanced exercise capacity with chronic exercise training, most importantly increased nitric oxide, and demonstrate more reserve with the addition of exercise training. A novel feature of the enhanced exercise performance in untrained AC5 KO mice is their decreased sympathetic tone, which is also beneficial to patients with cardiovascular disease.

Corneal Hysteresis as a Marker for Patients with Secondary Glaucoma.

PURPOSE: To investigate and compare the association of corneal hysteresis (CH) in patients with secondary glaucoma to control patients and patients with primary open-angle glaucoma (POAG). Additionally, to determine the consistency of CH measurements in patients with secondary glaucoma. METHODS: A total of 84 patients (121 eyes) were prospectively included in this study. Twenty-three patients (46 eyes) were healthy controls, 24 patients (40 eyes) were diagnosed with POAG, and 27 patients (35 eyes) were diagnosed with a form of secondary glaucoma. CH and intraocular pressure (IOP) were measured using the Ocular Response Analyzer. Three measurements per eye were performed and used for the analysis and to determine fluctuations in CH data. One-way ANOVA with post-hoc Bonferroni analysis and Chi-Squared testing was done to determine differences between groups. RESULTS: All patients were matched for age. Patients in both POAG and secondary glaucoma groups were matched for age and IOP. All groups had similar sex and racial compositions as well as similar proportions of diabetes, hypertension, and hyperlipidemia. CH was lower (p < .05) in patients with POAG (9.32 ± 1.64) and secondary glaucoma (7.89 ± 3.18) when compared to healthy controls (11.16 ± 1.60). Fluctuations in CH measurements were minimal in all groups. Further analysis of the secondary glaucoma group revealed no differences in CH between different types of secondary glaucoma (p > .05). CONCLUSION: Patients with secondary glaucoma have lower CH when compared to POAG or control groups. The ORA exhibits precision of CH measurements for control, POAG, and secondary glaucoma groups, making it a reliable tool in management of secondary forms of glaucoma.

Comparison of Efficacy of Micropulse and Continuous Wave Cyclophotocoagulation in Patients With Pediatric Glaucoma.

PRCIS: Both micropulse (MP-CPC) and continuous wave (CW-CPC) cyclophotocoagulation exhibited short-term effectiveness in lowering IOP, followed by reversion to near baseline levels 12 months after laser treatment. OBJECTIVE: To determine and compare the effectiveness and safety of MP-CPC and CW-CPC in patients diagnosed with pediatric glaucoma. METHODS: A retrospective cohort study was conducted on a total of 28 patients (81 eyes) diagnosed with pediatric glaucoma either undergoing MP-CPC or CW-CPC. Intraocular pressure (IOP) measurements, number of glaucoma medications, and the onset of complications were collected at baseline, 1-month, 3-month, 6-month, and 12-month intervals. Success rate (SR) was defined as eyes achieving IOP ≤21 mm Hg and ≥5 mm Hg and a 20% reduction in IOP at the last follow-up visit. RESULTS: All patients either undergoing MP-CPC or CW-CPC were matched for age (mean ± SD; 1.76 ± 1.69 vs 1.56 ± 2.49 y). Patients undergoing MP-CPC had significant decreases in IOP from baseline IOP at 1, 3, and 6 months with a 22% SR at 12 months. CW-CPC had a significant decrease in IOP from baseline IOP at all follow-ups, with a 27% SR at 12 months. At the 12-month follow-up, the CW-CPC cohort exhibited a significantly larger overall drop in IOP when compared with the MP-CPC cohort, (7.99 ± 7.95 vs 1.78 ± 6.89, P < 0.05); however, the difference in SR between treatment groups (27% vs 22%) at 12 months was not significant ( P > 0.05). Complications were minimal for both groups. CONCLUSION: Both MP-CPC and CW-CPC exhibited short-term effectiveness in lowering IOP, followed by reversion to near baseline levels 12 months after laser treatment. Both MP-CPC and CW-CPC exhibited similar SR at 12 months, 22% and 27% respectively.

Bibliometric Analysis of the Top 100 Cited Articles in Pediatric Ophthalmology.

PURPOSE: To determine and analyze the 100 most cited articles in pediatric ophthalmology. METHODS: A literature search was conducted using the ISI Web of Science database on the top 100 most cited articles in pediatric ophthalmology. RESULTS: The 100 most cited articles were published between 1941 and 2018, with the greatest number published in both 2005 and 2012. A total of 29,731 citations were generated during the study period. There has been a significant increase in citations annually since 1941, with a peak number of citations in 2021 with 2,629 citations. Myopia, retinopathy of prematurity, and other forms of refractive error were the topics most studied and cited in these articles. Most of the articles were classified as either large cohort prospective/retrospective studies (34) or randomized clinical trials (19), with case reports/series being the least frequent (7). Investigative Ophthalmology & Visual Science (23), JAMA Ophthalmology (22), and Ophthalmology (22) published the majority of the articles. Institutions that conducted the majority of the studies presented include the National Eye Institute (10), the Ohio State University College of Optometry (9), and the Oregon Health & Science University (6). CONCLUSIONS: This bibliometric analysis provides a unique historical perspective of the literature in the field of pediatric ophthalmology that has not been studied before. The research in the field of pediatric ophthalmology is advancing quickly, with most articles and citations occurring within the past 15 years. The strong focus on prospective cohort studies and clinical trials reveals the importance of advancing the treatment of critical disease within the field of pediatric ophthalmology. [J Pediatr Ophthalmol Strabismus. 2023;60(5):330-336.].

A Comprehensive Evaluation of the Quality, Readability, and Technical Quality of Online Information on Glaucoma.

PURPOSE: To evaluate the quality and reliability of medical information, the technical quality of the presentation of information, and the readability of informational websites that publish content on the definition, causes, symptoms, and treatment of glaucoma. DESIGN: A cross-sectional study was conducted to assess information published on websites with regard to glaucoma. SUBJECTS: The top 150 websites populated on a Google search using the keywords glaucoma, high intraocular pressure, and high eye pressure were chosen for evaluation. METHODS: Two independent reviewers assessed quality and reliability of each website using the DISCERN, Health on the Net Code (HONcode), and Journal of the American Medical Association (JAMA) criteria. The reviewers also evaluated technical quality by determining each website's ability to satisfy 10 unique features. Readability was assessed using the Readability Studio software (Oleander Software). MAIN OUTCOME MEASURES: Quality of information was analyzed using the DISCERN, HONcode, and JAMA criteria. To assess readability, the Bormuth Cloze Mean, Bormuth Grade Placement, Flesch Kincaid Reading Ease, Coleman-Liau Index, Gunning Fog Score, Simple Measure of Gobbledygook Index, Readability Score, Fry Estimate, Raygor Estimate, and the Overall Mean Readability metrics were used. A separate subanalysis categorized websites into institutional and private categories. RESULTS: Readability was poor among all websites, with most websites requiring a reading level higher than the 11th grade. The overall mean DISCERN score ± standard deviation (SD) was 3.0 ± 0.4, the mean HONcode score ± SD was 9.6 ± 1.8, and the mean JAMA score ± SD was 2.1 ± 1.1. The reviewers had moderate to excellent interrater reliability. Institutional websites (n = 39) had a higher mean DISCERN score (3.18 ± 0.33 vs. 2.95 ± 0.39, P < 0.05) and mean HONcode score (10.18 ± 1.90 vs. 9.34 ± 1.71, P < 0.05) than those of private websites (n = 111). Technical quality was higher among institutional websites (P < 0.05). CONCLUSIONS: An overwhelming majority of websites presented information of low quality, reliability, and readability. Institutional websites generally received higher scores than those received by private websites; however, overall scores were still substandard, which necessitates improvement of online information on glaucoma.

Public Perception of Marijuana Use for the Treatment of Glaucoma.

The use of marijuana for the treatment of glaucoma has been widely debated amongst ophthalmologists and glaucoma specialists. Recent evidence suggests the majority of ophthalmologists do not support the use of marijuana as active treatment for glaucoma. However, there has been no investigation into understanding the public's direct perception of the efficacy of marijuana in glaucoma treatment. By using Twitter as a tool to understand the public's thoughts, tweets were analyzed over the last 2 years. Of the 700 tweets analyzed, 72% (n=503) of tweets were in favor of cannabis use in the treatment of glaucoma, whereas 18% (n=124) were evidently opposed. The majority of those in favor came from accounts of individual users (n=391; 56%) whereas those that opposed marijuana as a treatment came from accounts of health care media, ophthalmologists, and other health care workers. The discrepancy between the public and ophthalmologists and other health care professionals requires recognition and further action to better educate the public on the role of marijuana in glaucoma treatment.

Epidemiological Trends of Ocular Injuries in Infants.

Approximately 21,000 consumer product-related ocular injuries occurred in infants in the United States from 2009 to 2019; toys being the most common (12.9%) consumer product in the 1- to 4-month age cohort, detergents in the 5- to 8-month (21.6%) cohort, and chemicals for the 9- to 12-month (34.0%) age cohort. These results identify an important preventable consumer product-related public health problem in infants. [J Pediatr Ophthalmol Strabismus. 2023;60(4):e41-e44.].