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Bostan C, Randleman JB. Unilateral Granular Type 2 Corneal Dystrophy With Exacerbation After LASIK. Cornea 2024; 43:648-651. [PMID: 38300218 DOI: 10.1097/ico.0000000000003490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE The aim of this study was to report a case of unilateral granular corneal dystrophy type 2 (GCD2) with exacerbation after bilateral laser in situ keratomileusis (LASIK). METHODS Clinical evaluation, Scheimpflug imaging, anterior segment optical coherence tomography (AS-OCT), cytology, and genetic testing were used to confirm the diagnosis of unilateral GCD2 with exacerbation after bilateral LASIK. Detailed literature review for possible unilateral GCD2 presentations was performed. RESULTS A 54-year-old White woman presented with blurred vision in her left eye and a history of bilateral LASIK performed 8 years before. Examination revealed dense opacities in the left cornea only, which were confirmed to be confined to the LASIK interface and adjacent corneal stromal tissue, as determined by AS-OCT. The patient underwent flap lift, interface debris removal, and stromal bed phototherapeutic keratectomy. Cytological analysis showed eosinophilic corneal stromal deposits that stained with trichrome stain and were congophilic on Congo red stain. Genetic testing was positive for heterozygous GCD2 transforming growth factor β-induced gene ( TGFBI ), c.371G>A, p.R124H mutation. There were no opacities identifiable in the right eye on serial slit-lamp examination, Scheimpflug imaging, or OCT imaging at 4 or 8 years after bilateral LASIK. Literature review failed to identify any previous reports of unilateral GCD2. CONCLUSIONS This is the first known reported case of unilateral granular corneal dystrophy type 2. LASIK is contraindicated in eyes with corneal stromal dystrophies related to mutations in TGFBI as both flap creation and laser ablation can exacerbate visually significant opacity formation. Scheimpflug and AS-OCT imaging are useful to identify opacities in GCD2.
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Affiliation(s)
- Cristina Bostan
- Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - J Bradley Randleman
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH; and
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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Bostan C, Bernier M, Boutin T, Slim E, Mabon M, Brunette I, Choremis J, Talajic JC. Intracameral Fibrinous Reaction During Descemet's Membrane Endothelial Keratoplasty. Ocul Immunol Inflamm 2023:1-7. [PMID: 38109198 DOI: 10.1080/09273948.2023.2287057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/18/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE To determine the outcomes and predisposing factors of Descemet's membrane endothelial keratoplasty (DMEK) complicated by intraoperative fibrinous reaction. METHODS Retrospective cohort study of 346 DMEKs. Medical charts were reviewed for recipient demographics, surgical indications, donor characteristics, and potential predisposing ocular and systemic factors. For DMEKs complicated by fibrin, surgeons' notes on events leading to fibrin formation and on its intraoperative management, occurrence of graft detachment, primary failure, re-bubbling or regrafting, time to graft clearing, and endothelial cell density were additionally collected. RESULTS Fifteen (4.3%) DMEKs were complicated by fibrin, which interfered with and protracted graft unfolding in all cases. Median surgical time was longer than for uncomplicated DMEKs (p = 0.001). Graft positioning at the end of surgery was suboptimal in seven eyes (47%) and failed in three (20%). Re-bubbling, primary failure, and regraft rates were of 40%, 33% and 53%, respectively. The corneas that cleared did so in three to eight weeks, with median endothelial cell loss of 53% at 12 months. Use of anticoagulants was a preoperative risk factor (p = 0.01). Surgeon-identified intraoperative factors included beginner surgeons (87%), prolonged AC shallowing (47%) and graft manipulations (33%), intraocular bleeding (27%), new injector (20%), tight donor scroll (13%), and floppy iris (13%). CONCLUSION Fibrinous reaction is a rare intraoperative complication of DMEK that interferes with graft unfolding and results in poor outcomes. Anticoagulant use appears to be a risk factor and may be compounded by surgical trauma to vascular tissues and prolonged surgical maneuvers.
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Affiliation(s)
- Cristina Bostan
- Centre Universitaire d'Ophtalmologie (CUO) de l'Université de Montréal, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mikaël Bernier
- Centre Universitaire d'Ophtalmologie (CUO) de l'Université de Montréal, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Tanguy Boutin
- Centre Universitaire d'Ophtalmologie (CUO) de l'Université de Montréal, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Elise Slim
- Centre Universitaire d'Ophtalmologie (CUO) de l'Université de Montréal, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Michèle Mabon
- Centre Universitaire d'Ophtalmologie (CUO) de l'Université de Montréal, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Isabelle Brunette
- Centre Universitaire d'Ophtalmologie (CUO) de l'Université de Montréal, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Johanna Choremis
- Centre Universitaire d'Ophtalmologie (CUO) de l'Université de Montréal, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Julia C Talajic
- Centre Universitaire d'Ophtalmologie (CUO) de l'Université de Montréal, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
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Bostan C, Nayman T, Szigiato AA, Morfeq H, Harissi-Dagher M. Endophthalmitis in Eyes With the Boston Type I Keratoprosthesis: Incidence, Recurrence, Risk Factors, and Outcomes. Cornea 2021; 40:1258-1266. [PMID: 33394754 DOI: 10.1097/ico.0000000000002641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the incidence and recurrence of Boston type I keratoprosthesis (KPro)-associated endophthalmitis, and its microbiological profile, risk factors, and outcomes. METHODS This is a retrospective study of 158 consecutive KPro procedures with a median follow-up of 78.4 months. Medical charts were reviewed for ocular history, contact lens and topical antibiotic use, visual acuity, and complications. For eyes with endophthalmitis, time to infection, culture results, and recurrences were collected. Cox regression analyses identified risk factors for endophthalmitis and compared the risk for visual failure, KPro retention, and globe loss between eyes with and without endophthalmitis. RESULTS The incidence and recurrence rates of endophthalmitis were of 1.7% and 6.0% per procedure-year, respectively. First episodes occurred at a median of 18.6 months. Eight of 18 episodes (44%) were culture positive, isolating mainly Gram-positive bacteria (7 [88%]). Previous ocular burn (hazard ratio: 7.34, 95% confidence interval: 1.91-28.15), infectious keratitis (5.09, 1.70-15.22), corneal melt (4.55, 1.50-13.83), and postoperative contact lens wear (4.19, 1.17-15.04) were risk factors. Eyes with endophthalmitis did not have a higher risk for visual failure (1.74, 0.78-3.91) but were more likely to not retain the KPro (2.81, 1.15-6.88) and undergo evisceration (2.81, 1.15-6.88). All eyes lost ≥ 2 lines of vision during the endophthalmitis episode. CONCLUSIONS Endophthalmitis is rare but vision and globe threatening in eyes with KPro. Given the increased associated risk, corneal melts and infectious keratitis must be promptly treated, postoperative contact lenses should be considered on a case-by-case basis, and patients with ocular burns might require more aggressive antimicrobial prophylaxis.
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Affiliation(s)
- Cristina Bostan
- Department of Ophthalmology, Centre hospitalier de l'Université de Montréal, Montreal, Canada; and
| | - Taylor Nayman
- Department of Ophthalmology, Centre hospitalier de l'Université de Montréal, Montreal, Canada; and
| | | | - Hussein Morfeq
- Department of Ophthalmology, Centre hospitalier de l'Université de Montréal, Montreal, Canada; and
- Department of Ophthalmology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mona Harissi-Dagher
- Department of Ophthalmology, Centre hospitalier de l'Université de Montréal, Montreal, Canada; and
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Ghaffari R, Bonnet C, Yung M, Bostan C, Harissi-Dagher M, Aldave AJ. Infectious Keratitis After Boston Type 1 Keratoprosthesis Implantation. Cornea 2021; 40:1298-1308. [PMID: 33630813 DOI: 10.1097/ico.0000000000002649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/23/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify the incidence, risk factors, and outcomes of infectious keratitis after Boston type 1 keratoprosthesis (kpro) implantation. METHODS Retrospective case series of kpro procedures at the Stein Eye Institute and the Centre Hospitalier de l'Université de Montréal between May 1, 2004, and December 31, 2018. Data were collected regarding ocular history, operative details, postoperative management, microbiologic profile, treatment, and outcomes. Log-rank test and Cox proportional hazard ratio (HR) were used to evaluate for an association between risk factors and outcomes. RESULTS A total of 349 kpro procedures were performed in 295 eyes of 268 patients. Fifty-seven cases of presumed infectious keratitis were identified after 53 procedures (15.2%) in 50 eyes (16.9%) of 49 patients (18.3%). The incidences of culture-positive bacterial and fungal keratitis were 0.014 and 0.004 per eye-year, respectively. Persistent corneal epithelial defect formation (P < 0.001) and cicatricial disease (HR: 1.98, 95% confidence interval, 1.02-3.83) were associated with a significantly higher incidence of infectious keratitis. For the 53 cases with a known outcome, medical therapy achieved resolution of infection in 34 cases (64.2%), whereas kpro explantation was required in 19 cases (35.8%). Infectious keratitis was associated with an increased risk for kpro explantation (HR: 3.09, 95% confidence interval, 1.92-4.79). CONCLUSIONS Infectious keratitis develops in approximately 17% of eyes after kpro implantation, with a higher rate of culture-positive bacterial than fungal keratitis. The observed rate of microbial keratitis suggests the need for additional topical antimicrobial prophylaxis in eyes at higher risk, such as those with preexisting cicatricial disease or postoperative persistent corneal epithelial defect formation.
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Affiliation(s)
- Reza Ghaffari
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Clemence Bonnet
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA
- Ophthalmology Department, Paris University, Cochin Hospital, Paris, France; and
| | - Madeline Yung
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Cristina Bostan
- Department of Ophthalmology, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Mona Harissi-Dagher
- Department of Ophthalmology, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Anthony J Aldave
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA
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Bostan C, Mitchell G, Ellezam B, Soucy JF, Harissi-Dagher M, Hamel P. Corneal imaging with optical coherence tomography assisting the diagnosis of mucolipidosis type IV. Can J Ophthalmol 2021; 56:e120-e121. [PMID: 33741364 DOI: 10.1016/j.jcjo.2021.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/31/2021] [Accepted: 02/15/2021] [Indexed: 11/15/2022]
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Nayman T, Bostan C, Szigiato AA, Harissi-Dagher M. Long-term outcomes following primary versus secondary Boston keratoprosthesis type 1 implantation. Br J Ophthalmol 2021; 106:935-940. [PMID: 33622700 DOI: 10.1136/bjophthalmol-2020-317606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/23/2020] [Accepted: 02/05/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To compare long-term outcomes of primary versus secondary (postgraft failure) Boston keratoprosthesis type 1 (KPro) implantation. METHODS Medical records of patients at the Centre hospitalier de l'Université de Montréal having undergone KPro implantation between 2008 and 2017 were reviewed and included if they had a preoperative Snellen best-corrected visual acuity (BCVA) of 20/100 or worse and a minimum of 5 years of follow-up. Eighty-two eyes were separated into two cohorts (40 primary, 42 secondary KPro) and BCVA, complications and device retention were evaluated between groups. RESULTS BCVA improved from baseline in both groups at each year; this was significant at all five postoperative years in the primary group and the first 3 years in the secondary group (p<0.05). Mean BCVA was similar between groups at 5 years (logarithm of minimal angle resolution 1.3±0.8 in the primary group vs 1.5±0.8 p<0.05). Idiopathic vitritis, choroidal detachment and new glaucoma occurred more after primary KPro (n=7, 17.5% vs n=1, 2.4%; n=11, 27.5% vs n=3, 7.14% and n=14, 35% vs n=6, 14%, respectively; p<0.05). Primary KPro had lower retention (n=28, 70% vs n=38, 91%, p<0.05) at final follow-up. There was more aniridia in the primary group (n=19, 48% vs n=6, 14%, p<0.01). Within each group, 50% of removals occurred in aniridic eyes. CONCLUSION Primary KPro yielded favourable long-term visual outcomes but had more complications and lower retention rates than secondary KPro, likely explained by preoperative indications. Primary device implantation represents a favourable option for patients for whom grafts are likely to fail.
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Affiliation(s)
- Taylor Nayman
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada .,Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Cristina Bostan
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Andrei-Alexandru Szigiato
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Mona Harissi-Dagher
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
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Bonnet C, Chehaibou I, Ghaffari R, Jackson NJ, Bostan C, Hubschman JP, Harissi-Dagher M, Aldave AJ. Idiopathic Vitritis after Boston Type 1 Keratoprosthesis Implantation: Incidence, Risk Factors and Outcomes in a Multicentric Cohort. Ocul Immunol Inflamm 2020; 30:769-775. [DOI: 10.1080/09273948.2020.1826541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Clemence Bonnet
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Ophthalmology Department, AP-HP, Cochin Hospital, Paris University, Paris, France
| | - Ismael Chehaibou
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Ophthalmology Department, Université De Paris, AP-HP, Hôpital Lariboisière, Paris, France
| | - Reza Ghaffari
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Nicholas J. Jackson
- Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, California, USA
| | - Cristina Bostan
- Department of Ophthalmology, Centre Hospitalier De l’Université De Montréal, Montréal, Québec, Canada
| | - Jean-Pierre Hubschman
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Mona Harissi-Dagher
- Department of Ophthalmology, Centre Hospitalier De l’Université De Montréal, Montréal, Québec, Canada
| | - Anthony J. Aldave
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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Abstract
BACKGROUND/AIMS To evaluate long-term visual outcomes of Boston type I keratoprosthesis (KPro) surgery and identify risk factors for visual failure. METHODS Single surgeon retrospective cohort study including 85 eyes of 74 patients who underwent KPro implantation to treat severe ocular surface disease, including limbal stem cell deficiency, postinfectious keratitis, aniridia and chemical burns. Procedures were performed at the Centre hospitalier de l'Université de Montréal from October 2008 to May 2012. All patients with at least 5 years of follow-up were included in the analysis, including eyes with repeated KPro. Main outcome measures were visual acuity (VA), visual failure, defined as a sustained worse than preoperative VA, postoperative complications, and device retention. RESULTS Mean follow-up was 7.2±1.3 years (±SD). Mean VA was 2.1±0.7 (logarithm of minimal angle resolution) preoperatively and 1.9±1.2 at last follow-up. There were 2.4% of patients with VA better than 20/200 preoperatively and 36.5% at last follow-up. Maintenance of improved postoperative VA was seen in 61.8% of eyes at 7 years. Preoperative factors associated with visual failure were known history of glaucoma (HR=2.7 (1.2 to 5.9), p=0.02) and Stevens-Johnson syndrome (HR=7.3 (2.5 to 21.4) p<0.01). Cumulative 8-year complication rates were 38.8% retroprosthetic membrane formation, 25.9% hypotony, 23.5% new onset glaucoma, 17.6% retinal detachment, 8.2% device extrusion and 5.9% endophthalmitis. The majority (91.8%) of eyes retained the device 8 years after implantation. CONCLUSION Almost two-thirds of patients had improved VA 7 years after KPro implantation. Preoperative risk factors for visual failure were known glaucoma and Stevens-Johnson syndrome.
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Affiliation(s)
| | - Cristina Bostan
- Department of Ophthalmology, Montreal University, Montreal, Quebec, Canada
| | - Taylor Nayman
- Department of Ophthalmology, Montreal University, Montreal, Quebec, Canada
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Szigiato AA, Bostan C, Nayman T, Harissi-Dagher M. Long-term visual outcomes of the Boston type I keratoprosthesis in Canada. Br J Ophthalmol 2020; 104:1601-1607. [PMID: 32066560 DOI: 10.1136/bjophthalmol-2019-315345] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/08/2020] [Accepted: 01/28/2020] [Indexed: 11/04/2022]
Abstract
Background/aimsTo evaluate long-term visual outcomes of Boston type I keratoprosthesis (KPro) surgery and identify risk factors for visual failure.MethodsSingle surgeon retrospective cohort study including 85 eyes of 74 patients who underwent KPro implantation to treat severe ocular surface disease, including limbal stem cell deficiency, postinfectious keratitis, aniridia and chemical burns. Procedures were performed at the Centre hospitalier de l'Université de Montréal from October 2008 to May 2012. All patients with at least 5 years of follow-up were included in the analysis, including eyes with repeated KPro. Main outcome measures were visual acuity (VA), visual failure, defined as a sustained worse than preoperative VA, postoperative complications, and device retention.ResultsMean follow-up was 7.2±1.3 years (±SD). Mean VA was 2.1±0.7 (logarithm of minimal angle resolution) preoperatively and 1.9±1.2 at last follow-up. There were 2.4% of patients with VA better than 20/200 preoperatively and 36.5% at last follow-up. Maintenance of improved postoperative VA was seen in 61.8% of eyes at 7 years. Preoperative factors associated with visual failure were known history of glaucoma (HR=2.7 (1.2 to 5.9), p=0.02) and Stevens-Johnson syndrome (HR=7.3 (2.5 to 21.4) p<0.01). Cumulative 8-year complication rates were 38.8% retroprosthetic membrane formation, 25.9% hypotony, 23.5% new onset glaucoma, 17.6% retinal detachment, 8.2% device extrusion and 5.9% endophthalmitis. The majority (91.8%) of eyes retained the device 8 years after implantation.ConclusionAlmost two-thirds of patients had improved VA 7 years after KPro implantation. Preoperative risk factors for visual failure were known glaucoma and Stevens-Johnson syndrome.
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Affiliation(s)
| | - Cristina Bostan
- Department of Ophthalmology, Montreal University, Montreal, Quebec, Canada
| | - Taylor Nayman
- Department of Ophthalmology, Montreal University, Montreal, Quebec, Canada
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Bostan C, Robert MC. Severe inflammatory reaction following corneal collagen cross-linking in a patient with glucose-6-phosphate dehydrogenase deficiency. Can J Ophthalmol 2019; 54:e234-e237. [PMID: 31564364 DOI: 10.1016/j.jcjo.2018.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/07/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Cristina Bostan
- Centre Hospitalier de l'Université de Montréal, Montreal, Que..
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Bostan C, Slim E, Choremis J, Boutin T, Brunette I, Mabon M, Talajic JC. Successful management of severe post-LASIK Mycobacterium abscessus keratitis with topical amikacin and linezolid, flap ablation, and topical corticosteroids. J Cataract Refract Surg 2019; 45:1032-1035. [PMID: 31182265 DOI: 10.1016/j.jcrs.2019.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 10/26/2022]
Abstract
This is a case report of post-laser in situ keratomileusis (LASIK) multidrug-resistant Mycobacterium abscessus keratitis managed with combined topical amikacin and linezolid, flap amputation, and corticosteroids. A 34-year-old woman presented with a corneal interface infiltrate 3 weeks after LASIK. Cultures isolated mycobacteria. The infiltrate did not improve under intensive topical therapy and interface irrigation with empiric antibiotics over 5 weeks, and the infiltrate progressed to severe inflammation and stromal neovascularization. After identification of M abscessus susceptible only to amikacin and linezolid, antimicrobials were adjusted and the flap was ablated. Cultures repeated 1 week later came back negative. However, stromal inflammation and neovascularization persisted. Topical steroids achieved regression of the inflammation within 1 week. Identification of the mycobacterial pathogen and its susceptibilities is essential given the possibility of multidrug resistance. Topical linezolid can be effective in susceptible species. Corticosteroids can be helpful in cases with severe inflammation.
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Affiliation(s)
- Cristina Bostan
- Centre universitaire d'ophtalmologie de l'Université de Montréal, Maisonneuve-Rosemont Hospital, Montreal, Canada
| | - Elise Slim
- Centre universitaire d'ophtalmologie de l'Université de Montréal, Maisonneuve-Rosemont Hospital, Montreal, Canada
| | - Johanna Choremis
- Centre universitaire d'ophtalmologie de l'Université de Montréal, Maisonneuve-Rosemont Hospital, Montreal, Canada
| | - Tanguy Boutin
- Centre universitaire d'ophtalmologie de l'Université de Montréal, Maisonneuve-Rosemont Hospital, Montreal, Canada
| | - Isabelle Brunette
- Centre universitaire d'ophtalmologie de l'Université de Montréal, Maisonneuve-Rosemont Hospital, Montreal, Canada
| | - Michèle Mabon
- Centre universitaire d'ophtalmologie de l'Université de Montréal, Maisonneuve-Rosemont Hospital, Montreal, Canada
| | - Julia C Talajic
- Centre universitaire d'ophtalmologie de l'Université de Montréal, Maisonneuve-Rosemont Hospital, Montreal, Canada.
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Abstract
PURPOSE There is currently no clinical risk-assessment tool allowing identification of patients at risk for developing uveal melanoma (UM) who might benefit from regular screening. As a first step toward the elaboration of such a tool, we systematically reviewed UM risk factors already established by meta-analysis. METHODS Two reviewers independently screened Pubmed, Medline, Embase, and Web of Science from their respective inception dates until July 2016 using a combination of keywords and MeSH terms. Eligible studies were meta-analyses or systematic reviews providing pooled odds ratios (ORs) of risk factors for UM development or sufficient information to calculate them. Methodological quality was evaluated using the Assessment of Multiple Systematic Reviews tool. RESULTS Four meta-analyses with a mean methodological quality score of 65.9% (min: 54.5%; max: 72.7%) were included. The following significant risk factors were identified: atypical cutaneous nevi (OR 2.82, 95% CI 1.10-7.26), welding (OR 2.05, 95% CI 1.20-3.51), occupational cooking (OR 1.81, 95% CI 1.33-2.46), fair skin color (OR 1.80, 95% CI 1.31-2.47), light eye color (OR 1.75, 95% CI 1.31-2.34), common cutaneous nevi (OR 1.74, 95% CI 1.27-2.39), propensity to sunburn (OR 1.64, 95% CI 1.29-2.09), iris nevi (OR 1.53, 95% CI 1.03-2.27), and cutaneous freckles (OR 1.27, 95% CI 1.09-1.49). Non-significant factors included outdoor leisure activity, occupational sunlight exposure, latitude of birth, and hair color. CONCLUSION Moderate quality of evidence determined nine significant risk factors for developing UM. Knowledge of these variables will assist researchers in the elaboration of a formal risk-assessment tool allowing clinicians to estimate susceptibility to the disease and necessity of regular screening.
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Affiliation(s)
- Taylor Nayman
- a The Henry C. Witelson Ocular Pathology Laboratory , McGill University , Montreal , QC , Canada.,b Faculty of Medicine , McGill University , Montreal , QC , Canada
| | - Cristina Bostan
- a The Henry C. Witelson Ocular Pathology Laboratory , McGill University , Montreal , QC , Canada.,c Department of Ophthalmology , University of Montreal , Montreal , QC , Canada
| | - Patrick Logan
- a The Henry C. Witelson Ocular Pathology Laboratory , McGill University , Montreal , QC , Canada
| | - Miguel N Burnier
- a The Henry C. Witelson Ocular Pathology Laboratory , McGill University , Montreal , QC , Canada.,d Department of Ophthalmology , McGill University , Montreal , QC , Canada
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Bostan C, Thériault M, Forget KJ, Doyon C, Cameron JD, Proulx S, Brunette I. In Vivo Functionality of a Corneal Endothelium Transplanted by Cell-Injection Therapy in a Feline Model. Invest Ophthalmol Vis Sci 2016; 57:1620-34. [PMID: 27046125 PMCID: PMC4824382 DOI: 10.1167/iovs.15-17625] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To evaluate the functionality of a corneal endothelium reconstituted by injection of corneal endothelial cells (CEC) in the anterior chamber of a feline model. METHODS We operated the right eyes of 16 animals. Eight underwent central endothelial scraping and injection with 2 × 10(5) (n = 4) or 1 × 10(6) (n = 4) feline CEC supplemented with Y-27632 and labeled with 3,3'-Dioctadecyl-5,5'-Di(4-Sulfophenyl)Oxacarbocyanine (SP-DiOC18[3] or DiOC). After total endothelial scraping, two eyes were injected with 1 × 10(6) labeled CEC and Y-27632. The central (n = 3) or entire (n = 3) endothelium was scraped in six eyes followed by Y-27632 injection without CEC. Subjects were positioned eyes down for 3 hours. Outcomes included graft transparency, pachymetry, CEC morphometry, histology, electron microscopy, and function and wound healing-related protein immunostaining. RESULTS Postoperatively, corneas grafted with 2 × 10(5) CEC and centrally scraped controls displayed the best transparency and pachymetry. Corneas grafted with 1 × 10(6) CEC yielded intermediate results. Entirely scraped controls remained hazy and thick. Histopathology revealed a confluent endothelial monolayer expressing sodium-potassium adenosine triphosphatase (Na(+)/K(+)-ATPase) and zonula occludens-1 (ZO-1) in corneas grafted with 2 × 10(5) CEC and centrally scraped controls, a nonuniform endothelial multilayer without expression of functional proteins in centrally scraped corneas grafted with 1 × 10(6) CEC, and a nonfunctional fibrotic endothelium in entirely scraped grafts and controls. Expression of DiOC in grafts was scarce. CONCLUSIONS Injected CEC contributed little to the incompletely functional endothelium of grafted corneas. Y-27632 injection without CEC following scraping reconstituted the healthiest endothelium. Further studies investigating the therapeutic effect of Y-27632 alone are needed to validate these conclusions.
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Affiliation(s)
- Cristina Bostan
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada 2Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Mathieu Thériault
- Centre d'organogénèse expérimentale de l'Université Laval/LOEX, Québec City, Quebec, Canada, and Centre de recherche du CHU de Québec-UL, Axe Médecine régénératrice, Québec City, Quebec, Canada
| | - Karolyn J Forget
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada
| | - Christelle Doyon
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada 2Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - J Douglas Cameron
- Ophthalmology and Visual Neurosciences and Laboratory Medicine and Pathology, University of Minnesota School of Medicine, Minneapolis, Minnesota, United States
| | - Stéphanie Proulx
- Centre d'organogénèse expérimentale de l'Université Laval/LOEX, Québec City, Quebec, Canada, and Centre de recherche du CHU de Québec-UL, Axe Médecine régénératrice, Québec City, Quebec, Canada 5Department of Ophthalmology and ENT-Head and Neck Surgery, U
| | - Isabelle Brunette
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada 2Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
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Bertschy S, Bostan C, Meyer T, Pannek J. Medical complications during pregnancy and childbirth in women with SCI in Switzerland. Spinal Cord 2015; 54:183-7. [PMID: 26620876 DOI: 10.1038/sc.2015.205] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 10/13/2015] [Accepted: 10/16/2015] [Indexed: 12/14/2022]
Abstract
STUDY DESIGN A retrospective interview study of mothers with spinal cord injuries (SCIs) who gave birth over the last 15 years. OBJECTIVES To identify the medical complications of women with SCIs during pregnancy and childbirth in Switzerland and to describe how they dealt with these complications. SETTINGS Swiss Paraplegic Research in Nottwil, the University of Lausanne and participants' homes. METHODS Data were collected by self-reported questionnaires and descriptive analysis was conducted. RESULTS Seventeen women with SCIs who gave birth to 23 children were included. Thirteen of the women were paraplegics and four were tetraplegics. All of them practiced an independent bladder management. Three women changed their bladder management techniques during pregnancy. Five women reported an increased bladder evacuation frequency during pregnancy, and six women reported a new onset or increase in incontinence. We observed no significant increase in bowel dysfunction or skin breakdown due to their pregnancies. Ten women were hospitalised during the course of their pregnancies. Aside from urinary tract infections/pyelonephritis, women were hospitalised for falls, hypertension, pneumonia, preeclampsia, pre-term labour or tachycardia. CONCLUSION The results of our study clearly demonstrated that, although medical complications are not infrequent during pregnancy in women with SCIs, pregnancy and delivery in this group of women are possible without posing intolerable risks to the mothers or the children. Urological problems seemed to be the most frequent complication during pregnancy.
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Affiliation(s)
- S Bertschy
- Swiss Paraplegic Research (SPF), Nottwil, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne and SPF, Nottwil, Switzerland
| | - C Bostan
- Swiss Paraplegic Research (SPF), Nottwil, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne and SPF, Nottwil, Switzerland
| | - T Meyer
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
| | - J Pannek
- Neuro-Urology, Swiss Paraplegic Center (SPZ), Nottwil, Switzerland
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Bostan C, Oberhauser C, Stucki G, Bickenbach J, Cieza A. Which environmental factors are associated with lived health when controlling for biological health? - a multilevel analysis. BMC Public Health 2015; 15:508. [PMID: 26012695 PMCID: PMC4445791 DOI: 10.1186/s12889-015-1834-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 05/13/2015] [Indexed: 11/10/2022] Open
Abstract
Background Lived health and biological health are two different perspectives of health introduced by the International Classification of Functioning, Disability and Health (ICF). Since in the concept of lived health the impact of the environment on biological health is inherently included, it seems intuitive that when identifying the environmental determinants of health, lived health is the appropriate outcome. The Multilevel Item Response Theory (MLIRT) model has proven to be a successful method when dealing with the relation between a latent variable and observed variables. The objective of this study was to identify environmental factors associated with lived health when controlling for biological health by using the MLIRT framework. Methods We performed a psychometric study using cross-sectional data from the Spanish Survey on Disability, Independence and Dependency Situation. Data were collected from 17,303 adults living in 15,263 dwellings. The MLIRT model was used for each of the two steps of the analysis to: (1) calculate people’s biological health abilities and (2) estimate the association between lived health and environmental factors when controlling for biological health. The hierarchical structure of individuals in dwellings was considered in both models. Results Social support, being able to maintain one’s job, the extent to which one’s health needs are addressed and being discriminated against due to one’s health problems were the environmental factors identified as associated with lived health. Biological health also had a strong positive association with lived health. Conclusions This study identified environmental factors associated with people’s lived health differences within and between dwellings according to the MLIRT-model approach. This study paves the way for the future implementation of the MLIRT model when analysing ICF-based data.
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Affiliation(s)
- Cristina Bostan
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland. .,Swiss Paraplegic Research, Nottwil, Switzerland.
| | - Cornelia Oberhauser
- Department of Medical Informatics, Biometry and Epidemiology-IBE, Pettenkofer School of Public Health (PSPHLMU), Research Unit for Biopsychosocial Health, Ludwig Maximilian University (LMU), Munich, Germany.
| | - Gerold Stucki
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland. .,Swiss Paraplegic Research, Nottwil, Switzerland.
| | - Jerome Bickenbach
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland. .,Swiss Paraplegic Research, Nottwil, Switzerland.
| | - Alarcos Cieza
- Swiss Paraplegic Research, Nottwil, Switzerland. .,Department of Medical Informatics, Biometry and Epidemiology-IBE, Pettenkofer School of Public Health (PSPHLMU), Research Unit for Biopsychosocial Health, Ludwig Maximilian University (LMU), Munich, Germany. .,Faculty of Social and Human Sciences, School of Psychology, University of Southampton, Southampton, UK.
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Algurén B, Bostan C, Christensson L, Fridlund B, Cieza A. A Multidisciplinary Cross-Cultural Measurement of Functioning After Stroke: Rasch Analysis of the Brief ICF Core Set for Stroke. Top Stroke Rehabil 2015; 18 Suppl 1:573-86. [DOI: 10.1310/tsr18s01-573] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Finger ME, Escorpizo R, Bostan C, De Bie R. Work Rehabilitation Questionnaire (WORQ): development and preliminary psychometric evidence of an ICF-based questionnaire for vocational rehabilitation. J Occup Rehabil 2014; 24:498-510. [PMID: 24281830 DOI: 10.1007/s10926-013-9485-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE The International Classification of Functioning, Disability and Health (ICF) has proven to be a valuable framework for vocational rehabilitation (VR). No reliable and valid ICF-based instruments to capture work functioning is known, hence, the aims of this study were: (1) to outline the process for developing an ICF-based questionnaire, the Work Rehabilitation Questionnaire (WORQ) to assess functioning in VR and (2) to report preliminary psychometric evidence. METHODS ICF categories were selected from the ICF Core Sets for VR using explorative Rasch-analysis and VR literature review. Questions were worded to assess identified ICF categories. WORQ was translated from English to German. Psychometrics for the German version of WORQ was examined in one VR centre in Switzerland. RESULTS 44 ICF categories were selected which resulted in 36 questions related to functioning. The psychometric evaluation of WORQ showed high test-retest reliability (Spearman correlation 0.79) (n = 53) and good internal consistency (Cronbachs Alpha 0.88) (n = 74) WORQ showed moderate correlation with Beck Depression Inventory II (Spearman correlation 0.511) and low correlation (Spearman correlation -0.353) with SF-36. CONCLUSIONS WORQ appears to be a reliable, ICF-based questionnaire to evaluate functioning in VR, easy to administer by health or vocational professionals. The additional information gained when using WORQ would contribute to improving interdisciplinary understanding of the patient's situation and therefore support the integrative planning of the return-to-work process or engagement in gainful employment. However, further studies are needed to further examine its use in clinical practice and research, when validated in other patient populations and settings.
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Sarı S, Özkan AA, Yiğit S, Canbolat İ, Döventaş Y, Koldaş M, Bostan C, Gürmen T. OP-331 Association between Serum Pentraxin Levels and Coronary Artery Plaque Morphology in Patients with Unstable Angina Pectoris. Am J Cardiol 2014. [DOI: 10.1016/j.amjcard.2014.01.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bostan C, Oberhauser C, Stucki G, Bickenbach J, Cieza A. Biological health or lived health: which predicts self-reported general health better? BMC Public Health 2014; 14:189. [PMID: 24555764 PMCID: PMC3943451 DOI: 10.1186/1471-2458-14-189] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 02/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lived health is a person's level of functioning in his or her current environment and depends both on the person's environment and biological health. Our study addresses the question whether biological health or lived health is more predictive of self-reported general health (SRGH). METHODS This is a psychometric study using cross-sectional data from the Spanish Survey on Disability, Independence and Dependency Situation. Data was collected from 17,739 people in the community and 9,707 from an institutionalized population. The following analysis steps were performed: (1) a biological health and a lived health score were calculated for each person by constructing a biological health scale and a lived health scale using Samejima's Graded Response Model; and (2) variable importance measures were calculated for each study population using Random Forest, with SRGH as the dependent variable and the biological health and the lived health scores as independent variables. RESULTS The levels of biological health were higher for the community-dwelling population than for the institutionalized population. When technical assistance, personal assistance or both were received, the difference in lived health between the community-dwelling population and institutionalized population was smaller. According to Random Forest's variable importance measures, for both study populations, lived health is a more important predictor of SRGH than biological health. CONCLUSIONS In general, people base their evaluation of their own health on their lived health experience rather than their experience of biological health. This study also sheds light on the challenges of assessing biological health and lived health at the general population level.
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Affiliation(s)
- Cristina Bostan
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland.
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Kiltz U, van der Heijde D, Boonen A, Cieza A, Stucki G, Khan MA, Maksymowych WP, Marzo-Ortega H, Reveille J, Stebbings S, Bostan C, Braun J. Development of a health index in patients with ankylosing spondylitis (ASAS HI): final result of a global initiative based on the ICF guided by ASAS. Ann Rheum Dis 2014; 74:830-5. [PMID: 24399232 DOI: 10.1136/annrheumdis-2013-203967] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 12/10/2013] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The burden of disease in patients with ankylosing spondylitis (AS) can be considerable. However, no agreement has been reached among expert members of Assessment of SpondyloArthritis International Society (ASAS) to define severity of AS. Based on the International Classification of Functioning, Disability and Health (ICF), a core set of items for AS has been selected to represent the entire spectrum of possible problems in functioning. Based on this, the objective of this study was to develop a tool to quantify health in AS, the ASAS Health Index. METHODS First, based on a literature search, experts' and patients' opinion, a large item pool covering the categories of the ICF core set was generated. In several steps this item pool was reduced based on reliability, Rasch analysis and consensus building after two cross-sectional surveys to come up with the best fitting items representing most categories of the ICF core set for AS. RESULTS After the first survey with 1754 patients, the item pool of 251 items was reduced to 82. After selection by an expert committee, 50 items remained which were tested in a second cross-sectional survey. The results were used to reduce the number of items to a final set of 17 items. This selection showed the best reliability and fit to the Rasch model, no residual correlation, and absence of consistent differential item function and a Person Separation Index of 0.82. CONCLUSIONS In this long sequential study, 17 items which cover most of the ICF core set were identified that showed the best representation of the health status of patients with AS. The ASAS Health Index is a linear composite measure which differs from other measures in the public domain.
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Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Herne, Germany
| | - D van der Heijde
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - A Boonen
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, and Caphri Research Institute, Maastricht, The Netherlands
| | - A Cieza
- eFaculty of Social and Human Sciences, Schools of Psychology, University of Southampton, Southampton, UK
| | - G Stucki
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland Swiss Paraplegic Research, Nottwil, Switzerland ICF Research Branch in cooperation with the WHO Family of International Classifications Collaborating Centre in Germany (at DIMDI), Munich, Germany
| | - M A Khan
- Case Western Reserve University, Cleveland, Ohio, USA
| | - W P Maksymowych
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - H Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - J Reveille
- Division of Rheumatology and Clinical Immunogenetics, Department of Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - S Stebbings
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - C Bostan
- Swiss Paraplegic Research, Nottwil, Switzerland ICF Research Branch in cooperation with the WHO Family of International Classifications Collaborating Centre in Germany (at DIMDI), Munich, Germany
| | - J Braun
- Rheumazentrum Ruhrgebiet, Herne, Germany
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Bostan C, Oberhauser C, Stucki G, Bickenbach J, Cieza A. Which environmental factors are associated with performance when controlling for capacity? J Rehabil Med 2014; 46:806-13. [DOI: 10.2340/16501977-1839] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kocas C, Abaci O, Oktay V, Coskun U, Bostan C, Yildiz A, Arat Ozkan A, Gurmen T, Ersanli M. Percutaneous coronary intervention vs. optimal medical therapy--the other side of the coin: medication adherence. J Clin Pharm Ther 2013; 38:476-9. [PMID: 23992279 DOI: 10.1111/jcpt.12091] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 07/18/2013] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Although many studies have examined medication adherence in patients with coronary artery disease (CAD), no prospective trial has compared medication adherence between patients treated with percutaneous coronary intervention (PCI) or with optimal medical therapy (OMT) in real life. This study sought to compare the adherence to evidence-based secondary preventive medications in patients with documented CAD treated with PCI and OMT, or OMT alone. METHODS We evaluated adherence to statins, beta-blockers, and angiotensin converting enzyme inhibitors (ACEI) during a 6-month follow-up in 232 patients with documented CAD, comparing patients treated with PCI and those receiving medical therapy alone. Medication adherence was measured with reference to national reimbursement database records. RESULTS AND DISCUSSION Of the 232 patients who survived the 6-month follow-up, the percentages of adherent patients according to prescription records (prespecified primary endpoint) were 53·6% (n = 82) in the PCI group and 33·8% (n = 27) in the OMT group (P = 0·004). Analysis of the individual medication classes revealed similar results for beta-blockers (86·0% in PCI group vs. 72·5% in OMT group, P = 0·006) and statins (64·5% in PCI group vs. 44·0% in OMT group, P = 0·003). Adherence to ACEI was also higher in the PCI group, but the difference was not statistically significant (77·6% vs. 69·3%, P = 0·17). By logistic regression analysis, belonging to the PCI group was an independent predictor of medication adherence [B = 2·20 (1·06-4·50), P = 0·03)]. WHAT IS NEW AND CONCLUSION In the present study we demonstrated that adherence to evidence-based medication therapies in patients treated with PCI is significantly higher than in patients treated with OMT alone. Medication adherence should be followed carefully in CAD patients treated with OMT.
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Affiliation(s)
- C Kocas
- Department of Cardiology, Istanbul University Institute of Cardiology, Istanbul, Turkey
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Kocas C, Abaci O, Oktay V, Bostan C, Coskun U, Ozkan AA, Gurmen T, Ersanli M. PCI vs Optimal medical therapy - the other side of the coin: medication adherence. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kiltz U, van der Heijde D, Boonen A, Cieza A, Stucki G, Bostan C, Braun J. SAT0572 Including Contextual Factors in the Development of a Self Report Questionnaire: the Case of Environmental Factors in the Asas Health Index. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kiltz U, van der Heijde D, Boonen A, Cieza A, Stucki G, Khan M, Maksymowych W, Marzo-Ortega H, Reveille J, Taylor W, Bostan C, Braun J. OP0251 Development of a health index to assess the burden of disease in patients with ankylosing spondylitis – first steps of a global initiative based on the ICF guided by ASAS. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kiltz U, van der Heijde D, Boonen A, Cieza A, Stucki G, Khan MA, Maksymowych W, Marzo-Ortega H, Reveille J, Taylor W, Bostan C, Braun J. OP0214 Development of a Health Index in Patients with Ankylosing Spondylitis (ASAS HI) – Final Result of a Global Initiative Based on the ICF Guided by ASAS. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cieza A, Bostan C, Ayuso-Mateos JL, Oberhauser C, Bickenbach J, Raggi A, Leonardi M, Vieta E, Chatterji S. The psychosocial difficulties in brain disorders that explain short term changes in health outcomes. BMC Psychiatry 2013; 13:78. [PMID: 23497332 PMCID: PMC3637532 DOI: 10.1186/1471-244x-13-78] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 03/04/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study identifies a set of psychosocial difficulties that are associated with short term changes in health outcomes across a heterogeneous set of brain disorders, neurological and psychiatric. METHODS Longitudinal observational study over approximately 12 weeks with three time points of assessment and 741 patients with bipolar disorders, depression, migraine, multiple sclerosis, parkinson's disease, stroke and traumatic brain injury. The data on disability was collected with the checklist of the International Classification of Functioning, Disability and Health. The selected health outcomes were the Short Form 36 and the World Health Organization Disability Assessment Schedule. Multilevel models for change were applied controlling for age, gender and disease severity. RESULTS The psychosocial difficulties that explain the variability and change over time of the selected health outcomes were energy and drive, sleep, and emotional functions, and a broad range of activities and participation domains, such as solving problems, conversation, areas of mobility and self-care, relationships, community life and recreation and leisure. CONCLUSIONS Our findings are of interest to researchers and clinicians for interventions and health systems planning as they show that in addition to difficulties that are diagnostic criteria of these disorders, there are other difficulties that explain small changes in health outcomes over short periods of time.
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Affiliation(s)
- Alarcos Cieza
- Faculty of Social and Human Sciences, School of Psychology (Building 44), University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK,Department of Medical Informatics, Biometry and Epidemiology – IBE, Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-University (LMU), Munich, Germany,Swiss Paraplegic Research, Nottwil, Switzerland
| | | | - Jose Luis Ayuso-Mateos
- Department of Psychiatry, Hospital Universitario de la Princesa, Universidad Autonoma de Madrid, CIBERSAM, Madrid, Spain
| | - Cornelia Oberhauser
- Department of Medical Informatics, Biometry and Epidemiology – IBE, Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-University (LMU), Munich, Germany
| | | | - Alberto Raggi
- Neurological Institute C. Besta IRRCS Foundation – Neurology, Public Health and Disability Unit, Milan, Italy
| | - Matilde Leonardi
- Neurological Institute C. Besta IRRCS Foundation – Neurology, Public Health and Disability Unit, Milan, Italy
| | - Eduard Vieta
- Bipolar Disorders Program, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Somnath Chatterji
- Multi-Country Studies, Department of Measurement and Health Information Systems, World Health Organization, Geneva, Switzerland
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Akın F, Coşkun U, Kose N, Bostan C. PP-115 COMPARISON OF P-WAVE DISPERSION AND CRP IN NON-DIPPER VERSUS DIPPER HYPERTENSIVE SUBJECTS. Int J Cardiol 2013. [DOI: 10.1016/s0167-5273(13)70319-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sabariego C, Barrera AE, Neubert S, Stier-Jarmer M, Bostan C, Cieza A. Evaluation of an ICF-based patient education programme for stroke patients: a randomized, single-blinded, controlled, multicentre trial of the effects on self-efficacy, life satisfaction and functioning. Br J Health Psychol 2012; 18:707-28. [PMID: 23252844 DOI: 10.1111/bjhp.12013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 11/05/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE There is a current need for interventions that provide information to stroke survivors in a patient-centred, interactive, personalized and flexible manner. To this purpose, a standardized but content-flexible patient education programme based on the International Classification of Functioning, Disability and Health (ICF) was developed. This study evaluated the effect of this programme on perceived self-efficacy. DESIGN Single-blind, randomized, multi-centre controlled trial. METHODS Stroke patients undergoing neurological rehabilitation were enrolled. Perceived self-efficacy was measured with the Liverpool Self-Efficacy Scale. Secondary outcomes were life satisfaction and self-perception of the impact of the stroke on life, measured with the WHOQOL and the Stroke Impact Scale, respectively. Data obtained at baseline, post-intervention and 6-month follow-up were analysed using multi-level models of change. RESULTS Two hundred and thirteen patients received either the ICF-based patient education (n = 110) or an attention-placebo (n = 103) control intervention. Over time, patients' self-efficacy (p < .01) and participation (p < .01) improved, while emotional functioning (p < .01) deteriorated, although no significant between-group differences were observed. Explorative analyses showed that gender, loci of control, difficulty in accessing health services after discharge and life satisfaction were significant predictors of self-efficacy. CONCLUSION There was no significant benefit of the ICF-based patient education in comparison with an attention-placebo control group. Considering the importance of the programme for the further implementation of the ICF and the need of developing effective health education interventions for stroke, the methodology used was reviewed and an updated version proposed.
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Affiliation(s)
- Carla Sabariego
- Department of Medical Informatics, Biometry and Epidemiology (IBE), Research Unit for Biopsychosocial Health, Ludwig-Maximilians-University, Munich, Germany
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Fayed N, de Camargo OK, Kerr E, Rosenbaum P, Dubey A, Bostan C, Faulhaber M, Raina P, Cieza A. Generic patient-reported outcomes in child health research: a review of conceptual content using World Health Organization definitions. Dev Med Child Neurol 2012; 54:1085-95. [PMID: 22913566 DOI: 10.1111/j.1469-8749.2012.04393.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Our aims were to (1) describe the conceptual basis of popular generic instruments according to World Health Organization (WHO) definitions of functioning, disability, and health (FDH), and quality of life (QOL) with health-related quality of life (HRQOL) as a subcomponent of QOL; (2) map the instruments to the International Classification of Functioning, Disability and Health (ICF); and (3) provide information on how the analyzed instruments were used in the literature. This should enable users to make valid choices about which instruments have the desired content for a specific context or purpose. METHOD Child health-based literature over a 5-year period was reviewed to find research employing health status and QOL/HRQOL instruments. WHO definitions of FDH and QOL were applied to each item of the 15 most used instruments to differentiate measures of FDH and QOL/HRQOL. The ICF was used to describe the health and health-related content (if any) in those instruments. Additional aspects of instrument use were extracted from these articles. RESULTS Many instruments that were used to measure QOL/HRQOL did not reflect WHO definitions of QOL. The ICF domains within instruments were highly variable with respect to whether body functions, activities and participation, or environment were emphasized. INTERPRETATION There is inconsistency among researchers about how to measure HRQOL and QOL. Moreover, when an ICF content analysis is applied, there is variability among instruments in the health components included and emphasized. Reviewing content is important for matching instruments to their intended purpose.
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Affiliation(s)
- Nora Fayed
- Department of Pediatrics at McMaster University, Hamilton, ON, Canada.
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Baskurt M, Baydar O, Coskun U, Bostan C, Ökçun B, Ozkan A, Gurmen T, Ersanli M. OP-113 SELECTIVE t-PA ADMINISTRATION IN RENAL ARTERY THROMBOEMBOLISM. Int J Cardiol 2012. [DOI: 10.1016/s0167-5273(12)70060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Coskun U, Bostan C, Baskurt M, Ökçun B, Yildiz A, Yildiz C, Çetinkal G, Arat A, Ersanli M, Çetin G, Mert M, Gurmen A. OP-247 CASE REPORT: UNCOMMON CAUSE OF ANGINA PECTORIS, VERTIGO AND SYNCOPE ATTACKS; CORONARY SUBCLAVIAN STEAL SYNDROME. Int J Cardiol 2012. [DOI: 10.1016/s0167-5273(12)70162-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Algurén B, Bostan C, Christensson L, Fridlund B, Cieza A. A multidisciplinary cross-cultural measurement of functioning after stroke: Rasch analysis of the brief ICF Core Set for stroke. Top Stroke Rehabil 2011. [PMID: 22120027 DOI: 10.1310/tsr18s01-573)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate the possibility of constructing a multiprofessional cross-cultural measure of functioning after stroke across categories of the International Classification of Functioning, Disability and Health (ICF). METHOD Data on 757 stroke survivors from China, Germany, Italy, and Sweden, including ratings of 15 categories from the Brief ICF Core Set for stroke, were analyzed using the Rasch model. Unidimensionality, reliability, fit of the ICF categories to the model, ordering of response options of the ICF qualifier, and presence of differential item functioning (DIF) were studied. RESULTS Of the 15 ICF categories, response options for 7 categories were collapsed, 5 categories were deleted due to misfit, and 4 ICF categories showed DIF for country and were accordingly split into country-specific categories. The proposed final clinical measure consists of 20 ICF categories (6 categories were country-common) with an overall fit statistic of χ2180 = 184.87, P = .386, and a person separation index of r = 0.72, which indicates good reliability. Based on an individual's functioning after stroke, the ratings across the different ICF categories can be summed on an interval scale ranging from 0 to 100. CONCLUSION A construction of a cross-cultural clinical measure after stroke based on ICF categories across body functions, structures, and activities and participation was possible. With this kind of clinical measure, stroke survivors' functional levels can be compared even across countries. Despite the promising results, further studies are necessary to develop definitive measures based on ICF categories.
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Affiliation(s)
- Beatrix Algurén
- Department of Nursing Sciences, Jönköping University, Jönköping, Sweden
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Zaniolo K, Bostan C, Rochette Drouin O, Deschambeault A, Perron MC, Brunette I, Proulx S. Culture of human corneal endothelial cells isolated from corneas with Fuchs endothelial corneal dystrophy. Exp Eye Res 2011; 94:22-31. [PMID: 22134119 DOI: 10.1016/j.exer.2011.10.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 10/21/2011] [Accepted: 10/31/2011] [Indexed: 12/13/2022]
Abstract
The purpose of this study was to assess the feasibility of initiating primary cultures of corneal endothelial cells from patients suffering from Fuchs endothelial corneal dystrophy (FECD; MIM# 1036800). We also evaluated which conditions yielded the best results for culture. Twenty-nine patients undergoing Descemet stripping automated endothelial keratoplasty consented to the use of their excised Descemet's membrane for this study. Out of the 29 specimens, 18 successfully initiated a culture. Cell morphology varied between endothelial (rounded, slightly elongated cells, n = 12) and fibroblastic-like (thin and very elongated cells, n = 6). These differences in cell morphology were also observed with the normal human corneal endothelial cell cultures. The cultures that initially presented an endothelial morphology maintained their shape in subcultures. Clusterin expression was similar in FECD and normal endothelial cells. Transmission electron microscopy of FECD Descemet's membranes showed a high degree of various abnormalities generally found in this disease, such as a thickened Descemet's membrane, presence of a posterior banded layer, presence of a fibrillar layer and striated bodies of various sizes and periodicities. Patient's age was predictive of culture success, all younger FECD donors generating cultures of endothelial morphology. The absence of a fibrillar layer was also a factor associated with greater success. Culture success was not dependent on specimen size, specimen pigmentation, or patient's preoperative central corneal thickness. In conclusion, this paper shows for the first time that central Descemet's membranes of patients suffering from FECD possess proliferative endothelial cells that can be isolated and cultured without viral transduction, opening the way for new in vitro studies of this disease.
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Affiliation(s)
- Karine Zaniolo
- Centre LOEX de l'Université Laval, Génie Tissulaire et Régénération: LOEX-Centre de Recherche FRSQ du Centre Hospitalier affilié Universitaire de Québec, Québec, QC, Canada
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Cieza A, Bostan C, Oberhauser C, Bickenbach JE. Explaining functioning outcomes across musculoskeletal conditions: a multilevel modelling approach. Disabil Rehabil 2010; 32 Suppl 1:S85-93. [DOI: 10.3109/09638288.2010.515702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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