Publications by authors named "Arzu Baygul"

9 Publications

  • Page 1 of 1

Course of vitamin D levels before and after liver transplantation in pediatric patients.

Pediatr Transplant 2021 Jun 2:e14049. Epub 2021 Jun 2.

Pediatric Gastroenterology-Hepatology, Koç University, Istanbul, Turkey.

Background: 25-hydroxy VD insufficiency is known in children undergoing LT but the serial post-transplant VD course and supplementation modalities in the peri-transplant period are lacking. We aimed to determine the pre-VD status and the post-transplant VD status course following VD supplementation and to elucidate its relationship with post-transplant outcome parameters such as infection and survival.

Methods: Pre- and post-VD levels were monitored in parallel with interventions to adjust VD levels in LT patients. VD status was categorized as circulating levels <30-21 ng/ml (insufficiency), 20-10 ng/ml (deficiency), and <10 ng/ml (severe deficiency). Patients received stoss (300000IU) VD3 within the pretransplant period if serum levels were <20 ng/ml.

Results: 135 transplanted children were included. The age at LT was 22 months (IQR: 8-60). The pretransplant median VD level was 14 ng/ml. Despite stoss dose, post-transplant median VD level was 1.8 ng/ml (day one), 4 ng/ml (week one), 19 ng/ml (month one), 33 ng/ml (month three), 38 ng/ml (months 6-12), and 40 ng/ml (month 24). After 6 months, VD status reached >30 ng/ml in 98% of patients. Only at pre-LT, higher infection rate (18.7%) in the severe VD deficiency group was observed compared to the VD deficiency group (2.9%, p = .04). Survival was not affected by serum VD levels.

Conclusion: VD levels fell substantially after LT but are rectifiable by stoss dose, which was well tolerated. Only the infection rate was associated with the VD status.
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June 2021

A Phase II Study of the Combination of Oxaliplatin, Capecitabine, and Trastuzumab and Chemoradiotherapy in the Adjuvant Setting in Operated Patients With HER2-positive Gastric or Gastroesophageal Junction Cancer (TOXAG Study): A Turkish Oncology Group Study.

Am J Clin Oncol 2021 Jul;44(7):301-307

Department of Biostatistics and Medical Informatics, Koc University/MedStats Consulting, Istanbul.

Background: Trastuzumab prolonged the overall survival in patients with advanced gastric cancer with human epidermal growth factor receptor 2 (HER2) overexpression in combination with chemotherapy. In this phase II open-label prospective study, the tolerability and safety of trastuzumab with chemotherapy, and chemoradiotherapy for curatively resected patients with HER2-positive gastric carcinoma was investigated.

Methods: The patients with HER2-positive gastric, or gastroesophageal junction adenocarcinoma, after gastrectomy plus D2 dissection, were included. They received 3 cycles of oxaliplatin (100 mg/m2 intravenously day 1) plus capecitabine (850 mg/m2 orally days 1 to 14), trastuzumab (8 mg/kg intravenously day 1 in cycle 1, 6 mg/kg thereafter) every 21 days, followed by chemoradiotherapy. Trastuzumab was given for 1 year.

Results: Of the 212 patients screened, 35 were eligible, and 34 were treated. The median age was 56 years (minimum to maximum: 35 to 75 y), male patients constituted 73.5% (n=25), and 33 (97.1%) had gastric adenocarcinoma. R0 resection was performed in 30 (88.2%). The majority (26, 61.7%) were in stage III disease. Most of the adverse events were grade I/II, the most frequent grade III side effects were nausea (3, 8.8%), vomiting (3, 8.8%), diarrhea (2, 5.9%), and weight loss (n=2, 5.9%). Two patients died during the first 3 cycles of chemotherapy and chemoradiotherapy; 1 secondary to pulmonary thromboembolism, and the other due to cerebral ischemia. After excluding 2 with early progression and 1 consent withdrawal, of the remaining 31 patients, 28 (90.3%) were able to complete the chemotherapy and chemoradiotherapy part of the trial. After the 25 months follow-up period, 21 patients (61.8%) were alive. Overall survival at 12 and 24 months was 75.0% and 58.0%, while disease-free survival at 12 and 24 months was 65.7% and 55.0%, respectively.

Conclusions: Trastuzumab in combination with capecitabine, oxaliplatin following chemoradiotherapy as the adjuvant therapy for gastric or gastroesophageal junction adenocarcinoma was considered as safe and tolerable. The frequency of HER2 overexpression in curatively resected patients is comparable to that in patients with metastatic disease (trial registration: the identifier: NCT01748773, December 13, 2012,
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July 2021

Effect of High-Risk Obstructive Sleep Apnea on Clinical Outcomes in Adults with Coronavirus Disease 2019: A Multicenter, Prospective, Observational Cohort Study.

Ann Am Thorac Soc 2021 Feb 17. Epub 2021 Feb 17.

Koc University School of Medicine, Dept of Pulmonary Medicine, Istanbul, Turkey.

Obstructive sleep apnea (OSA) may contribute to poor outcomes in adults with Coronavirus Disease 2019 (COVID-19). To determine the effect of OSA on clinical outcomes in patients with COVID-19. The current prospective observational study was conducted in three hospitals in Istanbul, Turkey from March 10 to June 22, 2020. The participants were categorized as modified high-risk (mHR), or low-risk (mLR)-OSA according to a modified version of the Berlin questionnaire. Snoring patterns (intensity and/or frequency), breathing pauses and morning/daytime sleepiness, without taking obesity and hypertension into account, were used in the regression models. The primary outcome was clinical improvement defined as a decline of 2 categories from admission on a 7-category ordinal scale. Secondary outcomes included worsening (increase of 1 category), need for hospitalization, supplemental oxygen and intensive care. In total, 320 eligible patients were enrolled. According to the modified scoring, 70 (21.9%) had mHR-OSA. Among 242 patients requiring hospitalization, clinical improvement within 2 weeks occurred in 75.4 % of the mHR-OSA group compared to 88.4 % of the modified low-risk (mLR-OSA) group (P = 0.014). In multivariate regression analyses, mHR-OSA (adjusted OR 0.42; 95% CI 0.19-0.92) predicted the delayed clinical improvement. In the entire study population (n=320), mHR-OSA was associated with clinical worsening and need for supplemental oxygen. Snoring patterns, especially louder snoring, were significantly predicted delayed clinical improvement, worsening, need for hospitalization, supplemental oxygen, and intensive care. Adults with mHR-OSA in our Covid-19 cohort had poorer clinical outcomes than those with mLR OSA independent of age, sex and comorbidities. Clinical trial registered with (NCT04363333).
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February 2021

ABO and Rh Blood Groups and Risk of Myelomeningocele.

Turk Neurosurg 2020 ;30(3):449-453

Baskent University Istanbul Health Research and Application Center, Department of Neurosurgery, Istanbul, Turkey.

Aim: To investigate the relationship between the distribution of ABO or Rhesus (Rh) blood group antigens and the incidence of myelomeningocele.

Material And Methods: A retrospective data was reviewed for all myelomeningocele patients operated at a tertiary academic hospital between years 2014 and 2019. Age, sex, delivery method, physical and neurological examination findings, and radiological findings alongside with blood type of each patient were recorded. The data of blood group distribution among the study patients was compared to the data of healthy individuals in the same region.

Results: Patients with group B and AB showed a higher chance of developing myelomeningocele. Rh-positive blood group was associated with high incidence of myelomeningocele (93.5%), whereas Rh-negative blood group showed least association (6.5%). Rh-positive blood group was also found to be more frequent in patients with myelomeningocele with hydrocephalus and Chiari malformation.

Conclusion: The findings of this study show that ABO and Rh blood groups have an effect on the development of myelomeningocele under the influence of environmental or genetic factors.
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October 2020

Validity and Reliability of the Assessment Tool for Asthma (ATA) Questionnaire: the ATA Study.

Turk Thorac J 2020 03 1;21(2):93-99. Epub 2020 Mar 1.

Department of Pulmonary Diseases, Division of Allerrgy and Immunology, Ankara University School of Medicine, Ankara, Turkey.

Objectives: A multicenter trial was designed to validate the "Assessment Tools for Asthma (ATA)" questionnaire, a newly developed questionnaire, which evaluates both asthma control and risk factors associated with asthma control with a single instrument.

Materials And Methods: This cross-sectional study involved 810 cases from 14 clinics in 9 Turkish cities. The ATA questionnaire and Asthma Control Test (ACT) were administered. The Visual Analog Scale (VAS) was used to evaluate the control status of 100 randomized cases. ATA is an eight-item physician-administered questionnaire. It comprises the following two sections-ATA1, assesses symptomatic control criteria, and the remaining section, queries the flare-up of asthma, control of comorbidities, treatment adherence, and inhaler technique.

Results: The mean scores for ATA1, ATA total, VAS, and ACT were 24.7±14.8, 53.8±19, 7.1±3, and 18.8±5.5, respectively. According to the ATA questionnaire, among all patients, 34.3% had controlled, 18.8% had partly controlled, and 46.9% had uncontrolled asthma. Furthermore, 16.6% patients had flare-ups between visits, 96.4% patients had uncontrolled comorbidity, 17% patients had irregular asthma treatment, and only 8.4% patients used the incorrect inhaler technique. The ATA questionnaire showed internal consistency (Cronbach's alpha coefficient=0.683). ACT, ATA1, and two specialists' evaluations using VAS correlated strongly with the ATA total scores (Spearman correlation coefficient (r) values: 0.776, 0.783, and 0.909, respectively; p-values: p<0.001, p<0.001, and p<0.001, respectively). According to Receiver Operating Characteristic analysis, the cut-off value of ATA was 50 (sensitivity=84.4%, specificity=82.40%).

Conclusion: The validated ATA questionnaire may be a practical tool for physicians in asthma management.
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March 2020

Association between parity and lumbar spine degenerative disorders in young women.

Br J Neurosurg 2020 Apr 18;34(2):172-175. Epub 2019 Dec 18.

Department of Neurosurgery, School of Medicine, Koç University, İstanbul, Turkey.

Estrogen helps to maintain the health of collagen-containing tissues including the intervertebral disc. Estrogen deficiency after menopause negatively affects the quality of vertebral end plates and induces development of degenerative disc disease (DDD). However, there is no study examining the relationship between parity and spinal degeneration in young women. The aim of this study was to define the relationship between parity and development of vertebral endplate signal changes and DDD in young premenopausal women. This case-control case study included 224 patients aged 20-40 years with a history of low back pain for at least 3 months. Pfirrmann's grade, Modic changes (MCs), and Schmorl's nodes (SNs) were graded based on magnetic resonance images. Patients' parity, demographics, body mass index, physical activity level, and disability scores were assessed using a questionnaire. The prevalence of abnormal total Pfirrmann's score (>10) and MCs was higher in primiparous patients than multiparous and grand-multiparous; however, it was not statistically significant. The presence of SN was statistically significantly associated with low parity. According to multivariate logistic regression analysis, it was found that the number of births increases by 1 unit, the abnormality in Pfirrmann's score decreases by 1.36 times. This cross-sectional study shows that parity is associated with DDD and vertebral end plate changes. SNs were significantly associated with parity. Modic changes and DDD were less common in grand multipara and multipara young women than in primipara women. These results indicate that low parity may possibly be associated with the development of spinal degeneration.
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April 2020

Association between sarcopenia and erectile dysfunction in males with type II diabetes mellitus.

Aging Male 2019 Mar 22;22(1):20-27. Epub 2018 Feb 22.

d Department of Biostatistics and Medical Informatics , Beykent University Faculty of Medicine , Istanbul , Turkey.

Background: The prevalence rates for both sarcopenia and erectile dysfunction (ED) gradually increase in middle-aged and elderly diabetic male population and they impair physical functioning, sexual functioning, and quality of life. The aim of the present study was to evaluate the sarcopenia in patients with diabetic ED.

Methods: The study included 98 male patients with type II diabetes mellitus (DM) aged 18-80 years. Blood chemistry and hormone levels were obtained. The International Index of Erectile Function (IIEF-5) questionnaire was administered to the patients. The patients were divided into three groups according to the IIEF-5 score; a score of 5-10 points indicated severe ED, a score of 11-20 indicated moderate ED, and a score of 21-25 points indicated no ED. The muscle mass, handgrip strength, timed up and go test, upper mid-arm circumference, calf circumference, and body mass index were obtained. The statistical analysis was performed using MedCalc Statistical Software version 12.7.7. All parameters were compared between the three groups.

Results: Of 98 patients included in the study, 84 patients had severe sarcopenia, 13 had moderate sarcopenia, while only one patient had normal muscle mass. The mean age was 56.59 ± 11.46 years. When patients were divided into three groups according to IIEF-5 score, 38 had severe ED, 39 had moderate ED, and 21 had no ED. There was a significant difference between the three groups in terms of handgrip strength, timed up and go test scores, upper mid-arm circumference, and calf circumference (p < .05 for all).

Conclusions: Although muscle mass remains unchanged, muscle strength and physical performance decrease in diabetic ED patients. Diabetic patients with severe and moderate ED have lower muscle strength and physical performance.
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March 2019

The Reliability and Validation of the Turkish Version of the Asthma Self-Management Knowledge Questionnaire.

Turk Thorac J 2017 Oct 1;18(4):125-130. Epub 2017 Oct 1.

Department of Biostatistics, İstanbul University Institute of Health Sciences, İstanbul, Turkey.

Objectives: There is no validated questionnaire in Turkish to assess asthma knowledge. In this study, we aimed to evaluate the reliability and validity of the Turkish version of the Asthma Self-Management Knowledge Questionnaire (AKQ) among asthmatic adults.

Material And Methods: The AKQ was translated into Turkish by two medical-text translators, followed by back translation and final review by two clinicians with experience in asthma management. The Turkish Asthma Self-Management Questionnaire was then applied to 202 adult asthma patients, and additional demographic and clinical features of the patients were collected for analysis.

Results: The internal reliability of the 24-item AKQ was not high (Cronbach's alpha=0.55). Tukey's test of additivity was significant (p<0.001). This result revealed that all questions are consistent and measure the same concepts. Factor analysis demonstrated a probable structure of 10 factors that together explained 63.7% of total variance in results. Intra-class reliability of the AKQ was quite high.

Conclusion: This study shows that AKQ seems to be a suitable instrument to evaluate the effect of different components of asthma knowledge - such as triggers, medications, asthma exacerbations, and avoidance measures - in adult asthmatics.
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October 2017

The role of dermoscopy in the diagnosis of distal lateral subungual onychomycosis.

Arch Dermatol Res 2018 Jan 24;310(1):57-69. Epub 2017 Nov 24.

Department of Dermatology, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, İstanbul, Turkey.

Recently dermoscopic patterns, that can be useful in the diagnosis of distal and lateral subungual onychomycosis, were identified. In this study, we aimed to determine the frequency of the defined patterns so far and additionally to identify other patterns that were observed and to investigate the place of these patterns in the diagnosis of Distal Lateral Subungual Onychomycosis (DLSO) in the dermoscopic examination of the patients with pre-diagnosis of DLSO. Patients admitted dermatology outpatient clinic of Haydarpasa Numune Training and Research Hospital with the complaint of nail disturbance suspicious for DLSO (97 patients) between the August 2015 and February 2016. Clinical and dermoscopic photographs of the cases with a pre-diagnosis of DLSO were taken and their nails were cut for pathological examination and culture. In hematoxylin and eosin, and periodic acid schiff examination, hyphe and/or spore were observed in 134 (65.4%) and fungal growth was detected in 99 (48.3%) of the nail samples. As a result of logistic regression model analysis, the p values of the 'ruin appearance', 'homogeneous leukonychia', 'punctate leukonychia', and 'black discoloration' patterns preserved their statistical significance (p = 0.015, p = 0.009, p = 0.026, p = 0.040, respectively). We believe that in nail disorders clinically resembling DLSO patients, the presence of dermoscopic patterns of ruin appearance, homogenous leuconychia, punctate leuconychia, and black discoloration strongly supports the clinical diagnosis of DLSO.
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January 2018