Safety and efficacy of the mesenchymal stem cell in feline eosinophilic keratitis treatment.

BACKGROUND: Feline eosinophilic keratitis (FEK) is a chronic keratopathy caused by a suspected immune mediated response to an unknown antigenic stimulus. The purpose of this study was to investigate the safety and therapeutic effects of allogeneic feline adipose-derived mesenchymal stromal cells (fAd-MSCs) implanted subconjunctival around the ocular surface lesion in five cats with FEK refractory to current available treatments. RESULTS: FEK was diagnosed by clinical appearance and evidence of eosinophil and/or mast cells in corneal cytology. Each animal was treated with two applications of 2 × 106 million of fAd-MSCs 2 months apart. Ocular surface integrity was assessed before treatment and at 1, 3, 6 and 11 months after treatment. Clinical signs showed a significant change during the follow-up with resolution of the corneal and conjunctiva lesions and there were no signs of regression or worsening. CONCLUSIONS: Implanted cells were well-tolerated and effective reducing clinical signs of FEK with a sustained effect during the study period. None of the animals showed systemic or local complications during the study. To our knowledge, this is the first time in literature that local implantation of allogeneic fAd-MSCs has been found as an effective therapeutic alternative to treat cats with FEK.

Regenerative Therapies in Dry Eye Disease: From Growth Factors to Cell Therapy.

Dry eye syndrome is a complex and insidious pathology with a high level of prevalence among the human population and with a consequently high impact on quality of life and economic cost. Currently, its treatment is symptomatic, mainly based on the control of lubrication and inflammation, with significant limitations. Therefore, the latest research is focused on the development of new biological strategies, with the aim of regenerating affected tissues, or at least restricting the progression of the disease, reducing scar tissue, and maintaining corneal transparency. Therapies range from growth factors and cytokines to the use of different cell sources, in particular mesenchymal stem cells, due to their multipotentiality, trophic, and immunomodulatory properties. We will review the state of the art and the latest advances and results of these promising treatments in this pathology.

Are birds more afraid in urban parks or cemeteries? A Latin American study contrasts with results from Europe.

The escape behaviour, measured as flight initiation distance (FID; the distance at which individuals take flight when approached by a potential predator, usually a human in the study systems), is a measure widely used to study fearfulness and risk-taking in animals. Previous studies have shown significant differences in the escape behaviour of birds inhabiting cemeteries and urban parks in European cities, where birds seem to be shyer in the latter. We collected a regional dataset of the FID of birds inhabiting cemeteries and parks across Latin America in peri-urban, suburban and urban parks and cemeteries. FIDs were recorded for eighty-one bird species. Mean species-specific FIDs ranged from 1.9 to 19.7 m for species with at least two observations (fifty-seven species). Using Bayesian regression modelling and controlling for the phylogenetic relatedness of the FID among bird species and city and country, we found that, in contrast to a recent publication from Europe, birds escape earlier in cemeteries than parks in the studied Latin American cities. FIDs were also significantly shorter in urban areas than in peri-urban areas and in areas with higher human density. Our results indicate that some idiosyncratic patterns in animal fearfulness towards humans may emerge among different geographic regions, highlighting difficulties with scaling up and application of regional findings to other ecosystems and world regions. Such differences could be associated with intrinsic differences between the pool of bird species from temperate European and mostly tropical Latin American cities, characterized by different evolutionary histories, but also with differences in the historical process of urbanization.

Long-term follow-up of a supradescemetic keratoprosthesis in rabbits: an immunofluorescence study.

OBJECTIVE: To evaluate the long-term clinical and immunohistological outcome of two different non-penetrating keratoprosthesis (KPro) implanted in non-injured rabbit corneas. MATERIALS AND METHODS: Three rabbits underwent implantation of a pHEMA-MMA(34) synthetic cornea in the supradescemetic space, and PMMA synthetic corneas in the supradescemetic space and within the central stroma. Animals were followed for at least 24 months before euthanasia. Periodic evaluation was performed with slit-lamp examination and photography. At the end of the follow-up, histological examination including hematoxylin eosin staining and immunocharacterization against collagen IV, alpha smooth muscle actin (α-SMA) and macrophages was performed. RESULTS: The pHEMA-MMA(34) implant was not extruded, and remained transparent until the end of follow-up. This material did not induce any cell infiltration, corneal scarring or tissue remodeling in the surrounding stroma as shown by immunofluorescence. In contrast, synthetic corneas made of PMMA-induced myofibroblast differentiation, stromal remodeling and macrophage infiltration. This reaction was even more significant in the rabbit with the PMMA implant within the corneal stroma. CONCLUSION: pHEMA-MMA(34) was clinically biocompatible, and did not induce any inflammatory reaction or scarring when implanted in the supradescemetic space. This material showed more promising biocompatibility results than for PMMA, whether implanted within the central cornea stroma or in the supradescemetic space.

Diabetes mellitus remission in a cat with hyperadrenocorticism after cabergoline treatment.

CASE SUMMARY: A 7-year-old spayed female domestic shorthair cat weighing 5 kg was referred with polyuria, polydipsia, lethargy, abdominal distension and dermatologic abnormalities. Diabetes mellitus was diagnosed and treatment was started with a diet for diabetic cats and insulin glargine (1 IU q12h SC). Hyperadrenocorticism (HAC) was suspected and diagnosed based on clinical signs, increased urinary cortisol:creatinine ratio, lack of suppression on low-dose dexamethasone suppression test and abdominal ultrasonography demonstrating bilateral adrenal enlargement. Oral cabergoline (10 µg/kg every other day) was initiated. After the second administration of cabergoline, the cat suffered from clinical hypoglycemia and no longer required insulin. One month after insulin withdrawal, blood work and urine analysis results showed normoglycemia, a normal serum fructosamine concentration (244 µmol/l) and normal urine analysis without glycosuria. Diabetic remission persisted until its death 7 months later. In addition, cabergoline treatment was associated with improvement in clinical signs such as lethargy, seborrhea, alopecia and abdominal distension. RELEVANCE AND NOVEL INFORMATION: To our knowledge, this is the first reported case of the use of cabergoline in a cat with HAC, as well as the first reported case of diabetic remission in a cat with HAC after cabergoline treatment. Cabergoline could be an alternative treatment for diabetic cats with pituitary-dependent HAC. Further work should focus on different protocols with greater number of cases.

Characterization of the secretory profile and exosomes of limbal stem cells in the canine species.

Limbal stem cells (LSCs) are a quiescent cell population responsible for the renewal of the corneal epithelium. Their deficiency is responsible for the conjunctivization of the cornea that is seen in different ocular pathologies, both in humans and in the canine species. The canine species represents an interesting preclinical animal model in ocular surface pathologies. However, the role of LSCs in physiological and pathological conditions in canine species is not well understood. Our objective was to characterize for the first time the soluble factors and the proteomic profile of the secretome and exosomes of canine LSCs (cLSCs). In addition, given the important role that fibroblasts play in the repair of the ocular surface, we evaluated the influence of the secretome and exosomes of cLSCs on their proliferation in vitro. Our results demonstrated a secretory profile of cLSCs with high concentrations of MCP-1, IL-8, VEGF-A, and IL-10, as well as significant production of exosomes. Regarding the proteomic profile, 646 total proteins in the secretome and 356 in exosomes were involved in different biological processes. Functionally, the cLSC secretome showed an inhibitory effect on the proliferation of fibroblasts in vitro, which the exosomes did not. These results open the door to new studies on the possible use of the cLSC secretome or some of its components to treat certain pathologies of the ocular surface in canine species.

Water and sediment quality assessment in the Colastiné-Corralito stream system (Santa Fe, Argentina): impact of industry and agriculture on aquatic ecosystems.

The present study focuses on the evaluation of metal (chromium, copper, and lead), arsenic, and pesticide (atrazine and endosulfan) contamination in freshwater streams of one of the most important agricultural and industrial areas of central-eastern Argentina, which has not been reported earlier. The environmental fate of inorganic microcontaminants and pesticides was assessed. Samples were collected monthly for a year. Pesticide concentrations were measured in water; metal and arsenic concentrations were measured in water and sediments, and physicochemical variables were analyzed. In most cases, metals and arsenic in water exceeded the established guideline levels for the protection of aquatic biota: 98 and 56.25% of the samples showed higher levels of Cr and Pb, while 81.25 and 85% of the samples presented higher values for Cu and As, respectively. Cr, Pb, Cu, and As exceeded 181.5 times, 41.6 times, 57.5 times, and 12.9 times, respectively, the guideline level values. In sediment samples, permitted levels were also surpassed by 40% for Pb, 15% for As, 4% for Cu, and 2% for Cr. Geoaccumulation Index (Igeo) demonstrated that most of the sediment samples were highly polluted by Cr and Cu and very seriously polluted by Pb, which indicates progressive deterioration of the sediment quality. Atrazine never exceeded them, but 27% of the 48 water samples contained total endosulfan that surpassed the guidelines. The findings of this study suggest risk to the freshwater biota over prolong periods and possible risk to humans if such type of contaminated water is employed for recreation or human use. Improper disposal of industrial effluents and agricultural runoffs need to be controlled, and proper treatment should be done before disposal to avoid further deterioration of the aquifers of this area.

Intervención psicoeducativa para prevenir el embarazo en adolescentes en condiciones de COVID-19

Introducción: la adolescencia constituye una etapa de riesgos. Actualmente, la tendencia al embarazo en este grupo etario es frecuente, por lo que resulta oportuno realizar intervenciones psicoeducativas para los padres, los familiares y la comunidad. Objetivo: realizar una intervención psicoeducativa para prevenir el embarazo en adolescentes, bajo condiciones de COVID 19, desde la multidisciplinariedad. Métodos: se realizó una intervención psicoeducativa multidisciplinaria con adolescentes desde enero a diciembre de 2021 en el área de salud Policlínico Joaquín de Agüero y Agüero de la ciudad de Camagüey. El universo de estudio estuvo integrado por las 127 adolescentes, pertenecientes al consultorio médico 7; se seleccionó una muestra de 93 mediante un muestreo aleatorio simple. El procesamiento se realizó utilizando el paquete estadístico SPSS versión 21 y se efectuó la validación y revisión de la misma. Como medida de resumen de la información se utilizaron los porcentajes (%) y como medida de significación estadística Mc Nemar. Resultados: predominó el grupo de edad entre 17 a 19 años, con un nivel de escolaridad de preuniversitario. El diagnóstico evidenció que las adolescentes al inicio de la investigación no tenían información sobre el embarazo, métodos anticonceptivos, repercusiones y complicaciones del mismo. La implementación de la intervención psicoeducativa logró incrementar su nivel de información respecto a estos aspectos. Existió diferencia estadísticamente significativa al evaluar el nivel de información general antes y después de la intervención. Discusión: en las investigaciones acerca del embarazo en la adolescencia, existió un predominio del grupo de edad de 17 a 19 años y esta es la edad promedio de la fecundidad, lo que coincide con los resultados del estudio realizado en esta localidad por este equipo multidisciplinario, evidenciando un problema de salud. Se constató la necesidad de realizar acciones psicoeducativas para incrementar la información y evitar embarazos en este grupo etario.

Introduction: adolescence is a stage of risks. Currently, the tendency to get pregnant in this age group is frequent, so it is opportune to carry out psychoeducational interventions for parents, family members and the community. Objective: to carry out a psychoeducational intervention to prevent pregnancy in adolescents, under conditions of COVID 19, from multidisciplinarity. Methods: a multidisciplinary psychoeducational intervention was carried out with adolescents from January to December 2021 in the Joaquín de Agüero y Agüero Polyclinic health area in the city of Camagüey. The universe of study was made up of 127 adolescents, belonging to medical office 7; a sample of 93 was selected by simple random sampling. The processing was carried out using the statistical package SPSS version 21 and its validation and revision was carried out. Percentages (%) were used as a summary measure of the information and Mc Nemar as a measure of statistical significance. Results: the age group between 17 to 19 years predominated, with a pre-university level of education. The diagnosis showed that the adolescents at the beginning of the investigation did not have information about the pregnancy, contraceptive methods, its repercussions and complications. The implementation of the psychoeducational intervention managed to increase their level of information regarding these aspects. There was a statistically significant difference when evaluating the level of general information before and after the intervention. Discussion: in the investigations about pregnancy in adolescence, there was a predominance of the age group of 17 to 19 years and this is the average age of fertility, which coincides with the results of the study carried out in this locality by this multidisciplinary team, evidencing a health problem. The need to carry out psychoeducational actions to increase information and prevent pregnancies in this age group was verified.

Long-term outcomes of the aphakic snap-on Boston type I keratoprosthesis at the Bascom Palmer Eye Institute.

PURPOSE: To determine the indications, long-term clinical and visual outcomes, and complications of the aphakic snap-on type I Boston keratoprosthesis (KPro). DESIGN: Retrospective, non-comparative case series. METHODS: Forty-five eyes of 43 patients with type I aphakic snap-on KPros with at least 1 year of follow-up were included. The past medical histories, preoperative indications, best-corrected visual acuities (BCVAs), postoperative complications, and retention rates were analyzed. RESULTS: The most common indication for KPro implantation was a failed corneal graft (89%). The mean preoperative BCVA was count fingers-hand motion (2.14±0.45 logarithm of minimum angle of resolution [logMAR]), which initially improved to 20/200 (1.04±0.85 logMAR; P<0.0001). At the last examination, 24 eyes (53%) maintained some visual gain, 22% retained their preoperative visual acuity, and 24% lost vision due to postoperative events and underlying ocular comorbidities. Postoperative complications included retroprosthetic membranes (8/45, 18%), corneal melts (5/45, 11%), glaucoma progression (6/45, 13%), and endophthalmitis or sterile vitritis (6/45, 13%). The KPro retention rate was 89%, with a mean follow-up of 51 months. The mean BCVA at the last visit was 20/1,400 (1.82±0.92 logMAR). CONCLUSION: Most patients experienced improved visual acuity after the implantation of the aphakic, snap-on type I KPro; however, the visual gains were not sustained over time, correlating with the onset of postoperative complications.

Allogeneic adipose-derived mesenchymal stem cell therapy in dogs with refractory atopic dermatitis: clinical efficacy and safety.

Canine atopic dermatitis (AD) is a common skin disease with a 10-15 per cent prevalence. Current treatments vary in their efficacy and safety. The immunomodulatory properties of mesenchymal stem cells (MSCs) make them a promising alternative treatment. The aim of this study was to evaluate the therapeutic efficacy and safety of allogeneic canine adipose MSCs (cAd-MSCs) in dogs with refractory AD. Twenty-six dogs, suffering from AD for at least 12 months, not responding to conventional therapy, received an intravenous dose of 1.5×106 cAd-MSCs/kg bodyweight. Clinical signs, haematological and biochemistry profiles, and AD severity were assessed in a six-month follow-up using a validated scoring system (Canine Atopic Dermatitis Extent and Severity Index, version 4 (CADESI-04)). The degree of pruritus was quantified using a validated visual analogue scale, and also owner's global assessment of treatment efficacy. Twenty-two animals completed the study. Pruritus and CADESI-04 scores decreased significantly after one week or month of treatment, respectively, and remained stable for six months. Owner's global assessment score was 2.15±1.15 for all the animals in the study. In conclusion, systemic administration of allogeneic cAd-MSCs appeared to be a simple therapy with positive outcome in the remission of clinical signs for AD refractory to conventional medications, for at least six months and with no adverse events.

Macrophytes as potential biomonitors in peri-urban wetlands of the Middle Parana River (Argentina).

The aims of this study were to measure the concentrations of nutrients and pollutants in peri-urban wetlands, to analyze the plant morphology of the most representative macrophyte species, and to determine their potential use as biomonitors. Four wetlands in the Middle Paraná River floodplain evidencing contamination or anthropogenic impact were studied. The studied species were Typha domingensis Pers., Eichhornia crassipes (Mart.) Solms., Alternanthera philoxeroides (Mart.) Griseb., and Pistia stratiotes L. Besides, the same plant species from an uncontaminated wetland considered as control were studied. A. philoxeroides showed the highest total phosphorus (TP) concentration in leaves throughout the study, while the other species showed a higher TP concentration in roots than in leaves. Since metal concentration in A. philoxeroides tissues was always higher than in sediment, further studies focused on its phytoremediation capacity should be carried out. T. domingensis exhibited the highest Zn concentrations in roots followed by Pb, and E. crassipes presented the highest values of Pb concentrations in roots. The aerial part height of the plants from peri-urban wetlands was significantly higher than that of the plants from the control, while the root length was significantly lower. The root length of P. stratiotes showed a negative correlation with soluble reactive phosphorus (SRP) concentration in water. All the root anatomical parameters of T. domingensis and E. crassipes showed a positive correlation with nitrate and ammonium concentrations in water. The studied macrophytes evidenced a high tolerance, enabling them to grow and survive in peri-urban wetlands that receive pollution from different sources. The use of aquatic and wetland plants as contaminant bioindicators and bioaccumulators in the Middle Paraná River floodplain is completely feasible.

Optomechanical response of human and monkey lenses in a lens stretcher.

PURPOSE: To quantify the forces necessary to change the shape and optical power of human and monkey lenses. METHODS: Cynomolgus monkey (n = 48; age: 3.8-11 years), rhesus monkey (n = 35; age: 0.7-17 years) and human (n = 20, age 8-70 years) eyes obtained postmortem, including the lens, capsule, zonules, ciliary body, and sclera were mounted in an optomechanical lens-stretching system. Starting at zero load, the lenses were symmetrically stretched in a stepwise fashion in 0.25- or 0.5-mm steps. The load, lens diameter, inner ciliary body diameter, and lens power were measured at each step and the diameter- and power-load responses were quantified. RESULTS: The diameter- and power-load responses were found to be linear in the physiologically relevant range of stretching. The average change in cynomolgus, rhesus, and human lens diameter, respectively, was 0.094, 0.109, and 0.069 mm/g in young lenses, and 0.069, 0.067, and 0.036, mm/g in older lenses. For the same lenses, the average change in lens power was -3.73, -2.83, and -1.22 D/g in young lenses and -2.46, -2.16, and -0.49 D/g in older lenses. CONCLUSIONS: The force necessary to change the lens diameter and lens power increases with age in human and monkey lenses. The results agree with the Helmholtz theory of accommodation and with presbyopia theories that predict that the force required to disaccommodate the lens increases with age.

In vitro dimensions and curvatures of human lenses.

The purpose of this study was to determine dimensions and curvatures of excised human lenses using the technique of shadowphotogrammetry. A modified optical comparator and digital camera were used to photograph magnified sagittal and coronal lens profiles. Equatorial diameter, anterior and posterior sagittal thickness, anterior and posterior curvatures, and shape factors were obtained from these images. The data were used to calculate lens volumes, which were compared with the lens weights. Measurements were made on 37 human lenses ranging in age from 20 to 99 years. These showed that lens dimensions and the anterior radius of curvature increase linearly throughout adult life while posterior curvature remains constant. The relative shape (or aspect ratio) of the posterior lens is unchanged through adult life since both equatorial diameter and posterior thickness increase at the same rate. The ratio of anterior thickness to posterior thickness is constant at 0.70. It is suggested that in vivo forces alter the apparent location of the lens equator, that the in vitro lens shape corresponds to the maximally accommodated shape in vivo and that the shapes of the accommodated and unaccommodated lens progressively converge toward each other due to lens growth with age, with a convergence point located near the age of total loss of accommodation (55-60 years). Together, these observations provide additional support for the Helmholtz theory of accommodation.

Assessment of the strength of minicapsulorhexes.

PURPOSE: To evaluate the effect of age, size, position, and species on the strength of minicapsulorhexes. SETTING: Surgical Suite and Laser Laboratory, Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA. METHODS: Capsulorhexes 0.7 to 2.3 mm in diameter were made centrally or peripherally in 35 eye-bank eyes and 32 rabbit eyes. A custom-made instrument stretched the capsulorhexes until rupture. Load and stretch at rupture were recorded. RESULTS: Maximum load and stretch were 26.3 mN +/- 20.3 (SD) and 50% +/- 18% for central and 50.8 +/- 20.5 mN and 69% +/- 17% for peripheral capsulorhexes in eye-bank eyes and 19.8 +/- 15.2 mN and 38% +/- 13% for central and 13.5 +/- 9.5 mN and 30% +/- 7% for peripheral capsulorhexes in rabbit eyes. Peripheral capsulorhexes were stronger and more elastic than central capsulorhexes in eye-bank eyes, and maximum load and stretch increased statistically with the capsulorhexis diameter. CONCLUSIONS: Peripheral minicapsulorhexes were more resistant to rupture than central capsulorhexes in eye-bank eyes, probably because of increased lens capsule thickness at the periphery. An increase in capsulorhexis diameter increased the resistance to rupture.

Biocompatibility of a nonpenetrating synthetic cornea in vascularized rabbit corneas.

PURPOSE: This study was designed to assess feasibility and biocompatibility of a lamellar, nonperforating supraDescemetic Synthetic Cornea (sDSC) implanted in rabbit eyes after a corneal injury. METHODS: Corneal vascularization and scarring was induced in the right eye of 15 rabbits by application of 1-heptanol and complete surgical removal of the limbus. An sDSC (7-mm diameter, 450-microm-thick optical zone, 100-microm-thick outer flange) was implanted after 45 +/- 5 days. The keratoprostheses were implanted with their central optic part positioned on a completely exposed Descemet's membrane (DM) while the outer flange was located in deep stroma. Three different materials were tested: hydrophobic PMMA (n = 5) and hydrophilic HEMA-MMA (n = 5) and HEMA-NVP (n = 5) with a water content of 34% and 75%, respectively. The corneal surface was covered with a conjunctiva-Tenon flap. Central flap trephination was performed after 63 +/- 7 days. DM vascularization and scarring was assessed and graded after flap opening and weekly thereafter. RESULTS: In all 15 consecutive cases implantation could be completed successfully without perforation of DM. Repair of the conjunctival flap had to be performed in five rabbits. Four months postoperatively, the flaps were opened. Four of five corneas (80%) with a PMMA implant and three of five (60%) with a HEMA-NVP75 implant had retained their original transparency. The others had developed significant neovascularization in the Descemet-sDSC optic interface. All corneas (100%) that received an sDSC made of HEMA-MMA34 displayed a completely clear DM without any vessels or scarring. DM was found firmly attached to the posterior surface of the optic. CONCLUSION: Implantation of a nonperforating synthetic cornea on top of an exposed DM is feasible. HEMA-MMA34 showed the most promising results. Because opening of the anterior chamber is not required, a lamellar supraDescemetic Synthetic Cornea would theoretically reduce some of the risks attributed to penetrating keratoprostheses.

Trabecular meshwork alteration and intraocular pressure change following pulsed near-infrared laser trabeculoplasty in cats.

BACKGROUND AND OBJECTIVE: To comparatively assess the safety and variation in intraocular pressure (IOP) of two pulsed near-infrared lasers (titanium:sapphire and alexandrite) for laser trabeculoplasty versus conventional blue-green argon laser trabeculoplasty in an animal model. MATERIALS AND METHODS: The left eyes of 15 healthy cats received a 180 degree laser trabeculoplasty treatment: 5 with a titanium:sapphire laser, 5 with an alexandrite laser, and 5 with an argon laser. Preoperatively and postoperatively, all animals underwent tonometry, gonioscopy, and slit-lamp examination. The cats were observed up to 12 weeks. Scanning electron microscopy and histologic examination were performed to evaluate potential alterations in the trabecular meshwork structure. RESULTS: IOP at 1 hour, 1 day, and 1 week following treatment was remarkably lower, irrespective of the laser source used. Following treatment with both near-infrared lasers, gonioscopy showed depigmentation underneath the area of the treated trabecular meshwork and histologic evaluation showed a decrease in pigment density. On scanning electron microscopy, damage to the trabecular meshwork structure could not be detected after treatment with near-infrared lasers. CONCLUSIONS: Near-infrared laser trabeculoplasty was found to be effective to temporarily lower IOP in cats. The lasers selectively altered pigment-containing cells, avoiding structural damage of the trabecular meshwork anatomy.

Consideraciones sobre la relación entre la variación dialectal y el abordaje terapéutico de los trastornos del habla / Considerations on the relationship between dialectal variation and therapeutic approaches to speech disorders

En el ámbito de la salud, se consideran normales los fenómenos frecuentes y esperados en una comunidad o cultura; sin embargo los actuales criterios para definir cuándo intervenir los sonidos del habla se alejan de esta norma al no considerar los aspectos psicosociales del usuario, aproximándose de este modo al modelo biomédico. Tras una revisión de la literatura relevante, se propone la necesidad de establecer nuevos criterios de evaluación e intervención de la articulación con un equipo multidisciplinario, formado por profesionales de la salud, la educación y las ciencias sociales, con perspectiva descriptiva, que se ajuste al modelo biopsicosocial.

In healthcare, phenomena which are frequent and expected in a given community or culture are considered normal. However, the criteria currently used to determine when speech sound interventions should be performed do not adhere to this standard, and do not take into account patients' psychosocial characteristics, but rather continue to follow the biomedical model. After a review of the relevant literature, we propose that new criteria for speech sound evaluation and intervention are needed. We argue that such criteria should be developed by a multidisciplinary group made up of experts in healthcare, education and the social sciences, using a descriptivist framework and adhering to the biopsychosocial model.

Use of adipose-derived mesenchymal stem cells in keratoconjunctivitis sicca in a canine model.

Keratoconjunctivitis sicca (KCS) or dry eye disease (DED) is an immune-mediated multifactorial disease, with high level of prevalence in humans and dogs. Our aim in this study was to investigate the therapeutic effects of allogeneic adipose-derived mesenchymal stromal cells (Ad-MSCs) implanted around the lacrimal glands in 12 dogs (24 eyes) with KCS, which is refractory to current available treatments. Schirmer tear test (STT) and ocular surface integrity were assessed at 0 (before treatment), 3, 6, and 9 months after treatment. Average STT values and all clinical signs showed a statistically significant change (P < 0.001) during the follow-up with reduction in all ocular parameters scored: ocular discharge, conjunctival hyperaemia, and corneal changes, and there were no signs of regression or worsening. Implanted cells were well tolerated and were effective reducing clinical signs of KCS with a sustained effect during the study period. None of the animals showed systemic or local complications during the study. To our knowledge, this is the first time in literature that implantation of allogeneic Ad-MSCs around lacrimal glands has been found as an effective therapeutic alternative to treat dogs with KCS. These results could reinforce a good effective solution to be extrapolated to future studies in human.

Biological response to a supraDescemetic synthetic cornea in rabbits.

OBJECTIVE: To evaluate the biocompatibility of a novel nonpenetrating keratoprosthesis (supraDescemetic synthetic cornea) in a rabbit model. METHODS: Seven rabbits received a supraDescemetic synthetic cornea (7-mm diameter, 350-microm-thick optical zone, 100-microm-thick peripheral flange) in their healthy right eyes. A surgical technique was developed that allowed implantation of the device on top of the bare Descemet membrane. Three rabbits received a supraDescemetic synthetic cornea made of hydroxyethyl methacrylate-methyl methacrylate(26), 1 received a hydroxyethyl methacrylate-N-vinyl pyrrolidone(75) mesoplant, and 3 were implanted with devices made of polymethyl methacrylate. All rabbits were euthanized after 8 weeks; the eyes were enucleated and examined by conventional histological and immunohistochemical evaluations. RESULTS: All eyes became quiet within several days. The Descemet membrane remained transparent during the observation period. Indirect ophthalmoscopy performed through the prosthesis allowed accurate examination of the posterior pole. Histological evaluation of the implanted corneas displayed no signs of an acute or chronic inflammatory reaction to the supraDescemetic synthetic cornea in 5 eyes; a few inflammatory cells were detected in the corneas of 2 rabbits. The interface between the Descemet membrane and the mesoplant displayed ingrowth of very thin (<10-microm) tissues colonized by keratocytes in 3 of the 7 corneas. CONCLUSIONS: This study validates the biocompatibility of this new type of nonpenetrating keratoprosthesis. Because opening of the anterior chamber is not required with the supraDescemetic synthetic cornea, the risk for intraocular infection is minimal, and the implantation procedure is less traumatic compared with a penetrating device.

Colletotrichum keratitis.

PURPOSE: To evaluate Colletotrichum keratitis and to report the risk factors and clinical course. DESIGN: Interventional case series. METHODS: In order to report the clinical course of Colletotichum keratitis, fungal keratitis cases between January 1980 and February 2001 in an institutional setting were retrospectively reviewed and 10 eyes of 9 patients with Colletotrichum keratitis were identified by positive cultures. RESULTS: Colletotrichum species were identified in 10 of 360 culture-proven fungal keratitis cases. All cases were sensitive to amphotericin B, three of the isolates showed resistance to natamycin, two isolates had intermediate sensitivity to natamycin, and one isolate was resistant to fluconazole. Natamycin 5% was used as the initial antifungal agent in eight microbiologically proven fungal keratitis cases. Two of nine patients continued the treatment with amphotericin B 0.15% after the sensitivity results were obtained. CONCLUSION: Colletotrichum is an infrequent cause of fungal keratitis. The risk factors are similar to the known fungal keratitis. Colletotrichum is resistant to natamycin in vitro; however, all our patients responded well to this treatment while resistance or intermediate sensitivity to natamycin and resistance to fluconazole was observed.