Person: BALCAN, MEHMET BARAN
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BALCAN
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MEHMET BARAN
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Publication Open Access Impact of concomitant obstructive sleep apnea on pulmonary involvement and main pulmonary artery diameter in adults with scleroderma(SPRINGER HEIDELBERG, 2021-03) BALCAN, MEHMET BARAN; Yakut, Tugce; Balcan, Baran; Karakurt, Sait; Direskeneli, Haner; Yalcinkaya, Yasemin; Peker, YukselPurpose Pulmonary involvement is common in adults with scleroderma. The effect of concomitant obstructive sleep apnea (OSA) on risk for pulmonary hypertension in scleroderma is unknown. An enlarged main pulmonary artery diameter (mPAD) derived from chest computer tomography (CT) is a useful predictor of pulmonary hypertension. We addressed the effect of OSA on pulmonary involvement and enlarged mPAD in adults with scleroderma. Methods All participants underwent pulmonary function testing, carbon monoxide diffusion capacity, chest CT, and overnight sleep recording with home sleep apnea testing. OSA diagnosis was based on an apnea-hypopnea index (AHI) >= 15/h. Oxygen desaturation index (ODI) was also recorded. Scleroderma involvement of the lungs was defined as the Warrick score >= 7 based on the CT findings. Enlarged mPAD was defined as an mPAD >= 29 mm in men and >= 27 mm in women. Results After exclusions, 62 patients (58 women) were included. OSA was found among 20 (32%), 17/42 (38%) in the limited cutaneous type, and 3/20 (15%) in the diffuse cutaneous type (p = 0.08). Scleroderma involvement of the lungs was observed in 40 participants (65% in OSA vs 64% in no-OSA; n.s.). Enlarged mPAD was measured in 16 participants, 10 of 20 (50%) in the OSA group and 6 of 17 (14%) in the no-OSA group (p = 0.003). OSA was associated with enlarged mPAD (odds ratio 4.7, 95% confidence interval 1.1-20.9; p = 0.042) independent of age, body mass index, and pulmonary involvement. There was a linear relationship between mPAD and AHI (r = 0.37; p = 0.003) as well as ODI (r = 0.41; p < 0.001). Conclusions In this cohort, OSA was associated with risk for pulmonary hypertension independent of pulmonary involvement. These findings suggest that assessing the effect of therapy for concomitant OSA in patients with scleroderma is warranted.Publication Metadata only Altered pulmonary functions due to biomass smoke in a rural population of Turkish women: a descriptive study(TURKISH ASSOC TUBERCULOSIS & THORAX, 2018) CEYHAN, BERRİN; Balcan, Baran; Akan, Selcuk; Ozsancak Ugurlu, Aylin; Ceyhan, BerrinIntroduction: Wood or other organic sources of fuel are used as source of energy for heating or cooking particularly in developing countries. The aim of the current study was to evaluate the association between biomass exposure time and parameters of pulmonary function tests. Materials and Methods: Four hundred twenty-four consecutive women who lived and exposed to biomass smoke in a small province in Eastern Turkey were involved. This study was performed with women who had come to pulmonology out-patient clinic with symptom of dyspnea. Results: The independent variables assessed in the study patients were age, BMI, starting age of cooking, hours per day and weeks per month spent cooking, and cooking years; the dependent variables were PFT parameters. Ninety-two (21.6%) patients had an obstructive PFT pattern. Sixty-seven (73%) of these patients were classified as GOLD 2 and 25 (27%) patients were classified as GOLD 3. Seventy-five (17.6 %) of the patients had restrictive lung disease; 54 (72%) of these patients were found to have a mild and 21 (27%) had a moderate restrictive pattern. Increased number of years in cooking and to start cooking at younger ages were a risk factors for the development of obstructive and restrictive disease. There was a statistically significant and negative correlation between increased number of years and the value of FEV1 (r=-0.917; p=<0.001), FEV1/FVC (r=-0.739; p<0.001), and FVC (r=-0.906; p<0.001). The median time of cooking required was 23 years for the development of obstruction, and 25 years for restriction, respectively. Conclusion: Cumulative biomass exposure time is associated with impairment in PFT parameters; results in both obstructive and restrictive lung disease. Biomass exposure is a public health problem and pre-cautions should be taken in order to prevent impaired pulmonary functions.Publication Open Access Procalcitonin-Guided Antibiotic Treatment in Lower Respiratory Tract Infections(GALENOS YAYINCILIK, 2018-08-06) CEYHAN, BERRİN; Balci, Merih Kalamanoglu; Balcan, Baran; Yildizeli, Sehnaz Olgun; Ceyhan, BerrinObjective: Procalcitonin (PCT), C-reactive protein (CRP), and leukocyte count are important host response biomarkers to determine the presence of infection. The aim of the present study was to evaluate the usefulness of PCT with other markers in lower respiratory tract infections. Methods: A total of 78 patients with community-acquired pneumonia (CAP), chronic obstructive pulmonary disease (COPD) exacerbations, and healthy controls were evaluated. Baseline serum levels of PCT and CRP and leukocyte counts were assessed and repeated on day 7 of antibiotic treatment. Results: Procalcitonin levels and absolute neutrophil counts (ANCs) were higher in the CAP and COPD groups than in the control group. In the CAP and COPD exacerbation groups, the leukocyte count, ANC, and CRP and PCT levels decreased on day 7 of the treatment (p<0.001). In the CAP group, the baseline PCT levels were correlated with leukocyte counts (r=0.495, p<0.005), ANCs (r=0.426, p<0.019), and CRP levels (r=0.515, p<0.004). In receiver operating characteristic curve analysis, PCT threshold >0.12 ng/mL had a sensitivity of 70.4% and specificity of 68.7%, and CRP threshold >22.9 mg/L had a sensitivity of 85.2% and specificity of 75.0%. Conclusion: Procalcitonin is a useful marker to determine the initiation of antibiotic therapy and can also be used to cease the treatment.Publication Metadata only Association Between Severe Vitamin D Deficiency, Lung Function and Asthma Control(ELSEVIER ESPANA SLU, 2017) CEYHAN, BERRİN; Beyhan-Sagmen, Seda; Baykan, Ozgur; Balcan, Baran; Ceyhan, BerrinIntroduction: To examine the relationship between severe vitamin D deficiency, asthma control, and pulmonary function in Turkish adults with asthma. Methods: One hundred six asthmatic patients underwent pulmonary function tests skin prick test, peripheral blood eosinophil counts, IgE, body mass index and vitamin D levels were determined. Patients were divided into 2 subgroups according to vitamin D levels (vitamin D level < 10 ng/ml and vitamin D level >= 10 ng/ml). Asthma control tests were performed. Results: The mean age of subgroup I (vitamin D level < 10) was 37 +/- 10 and the mean age of subgroup II (vitamin D level >= 10 ng/ml) was 34 +/- 8. Sixty-six percent of patients had severe vitamin D deficiency (vitamin D level < 10 ng/m1). There was a significant trend towards lower absolute FEV1 (L) values in patients with lower vitamin D levels (P=.001). Asthma control test scores were significantly low in the severe deficiency group than the other group (P=.02). There were a greater number of patients with uncontrolled asthma (asthma control test scores < 20) in the severe vitamin D deficiency group (P=.040). Patients with severe vitamin D deficiency had a higher usage of inhaled corticosteroids than the group without severe vitamin D deficiency (P=.015). There was a significant trend towards lower absolute FEV1 (L) (P=.005, r =.272) values in patients with lower vitamin D levels. Vitamin D levels were inversely related with body mass index (P=.046). Conclusion: The incidence of severe vitamin D deficiency was high in adult Turkish asthmatics. In addition,lower vitamin D levels were associated with poor asthma control and decreased pulmonary function.(C) 2016 SEPAR. Published by Elsevier Espana, S.L.U. All rights reserved.Publication Open Access CPAP and Health-Related Quality of Life in Adults With Coronary Artery Disease and Nonsleepy Obstructive Sleep Apnea in the RICCADSA Trial(AMER ACAD SLEEP MEDICINE, 2019-09-15) BALCAN, MEHMET BARAN; Wallstrom, Sara; Balcan, Baran; Thunstrom, Erik; Wolf, Axel; Peker, YukselStudy Objectives: To determine the effect of continuous positive airway pressure (CPAP) treatment on health-related quality of life (HRQoL) in adults with coronary artery disease (CAD) and nonsleepy obstructive sleep apnea (OSA). Methods: This was a secondary outcome analysis of the RICCADSA trial, conducted in Sweden between 2005 and 2013. Adults with CAD, nonsleepy OSA (apnea-hypopnea index [AHI] >= 15 events/h; Epworth Sleepiness Scale [ESS] score < 10) and complete Short-Form (SF)-36 questionnaires at baseline and after 12 months were included. Patients were randomized to CPAP (n = 102) or no CPAP (n = 104). The primary outcome was the between-group difference in absolute change in the SF-36 components. Within-group changes as well as variables associated with absolute change in the domains in the entire population were also tested. Results: Mean SF-36 scores were similar at baseline, ranging from 44.9 +/- 9.6 to 92.2 +/- 15.8 in various domains, and between-group changes from baseline were not statistically significant at 1 year. There was a significant increase in Role physical, Vitality, Role emotional, Mental health and Mental Component Summary (MCS), and a decrease in Bodily pain and General health scores in the CPAP group. The change in Physical Component Summary (PCS) was determined by female sex (beta coefficient -0.19, 95% confidence interval [CI] -7.25 to -0.98, P = .010), baseline AHI (beta coefficient -0.19, 95% CI -0.21 to -0.03, P = .009), CPAP use (h/night) (beta coefficient -0.16, 95% CI -0.93 to -0.06, P = .028), and acute myocardial infarction at baseline (beta coefficient 0.18, 95% CI 0.59 to 5.19, P = .014). Determinants of the change in MCS from baseline were change in the ESS score (beta coefficient -0.14, 95% CI -0.87 to -0.01, P =.054) and change in the Zung Self-rated Depression Scale scores (beta coefficient -0.33, 95% CI -0.58 to -0.24, P < .001). Conclusions: Assignment to CPAP treatment compared to no CPAP had no significant effect on HRQoL as measured by the SF-36 in adults with CAD and nonsleepy OSA. Although several components of the SF-36 scores were improved within the CPAP group, CPAP use was associated with a decrease in PCS. The improvement in MCS was determined by the improvement in daytime sleepiness and depressive mood.Publication Open Access Determination of Factors Affecting Mortality of Patients with Sepsis in a Tertiary Intensive Care Unit(BILIMSEL TIP PUBLISHING HOUSE, 2015-07-06) BALCAN, MEHMET BARAN; Balcan, Baran; Olgun, Sehnaz; Torlak, Fatih; Sagmen, Seda Beyhan; Eryuksel, Emel; Karakurt, SaitOBJECTIVES: Sepsis is a disease with high mortality that is frequently observed in intensive care units. This study aimed to determine the risk factors affecting mortality of patients with sepsis who were followed up in the intensive care unit (ICU). We aimed to contribute to literature by evaluating the relationship between mortality and pro-brain natriuretic peptide (pro-BNP9), C-reactive protein (CRP), thrombocyte count, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, duration of hospitalization in the intensive care unit, and the presence of multidrug-resistant microorganism. MATERIAL AND METHODS: Patients hospitalized in ICU because of the diagnosis of sepsis and septic shock between December 2010 and June 2012 were included in this retrospective study. RESULTS: A total of 141 patients, including 74 male (52.5%) and 67 female (47.5%) patients, were involved in the study, and the median age was 66.8 +/- 17.9 years. Sixty-nine patients (48.9%) were discharged from the ICU; however, 72 patients (51.1%) were exitus. Multi-drug-resistant microorganism was detected in 34 patients (24.1%). The patients' median SOFA score was 9.16 +/- 3.16, median APACHE-II score was 24.9 +/- 7.83, and median duration of hospitalization in the ICU was 8.44 +/- 11.61 days. It was found that mortality rate significantly increased in patients with the APACHE-II score of 24.5 and over, SOFA score of 8.5 and over, pro BNP value of 7241 ng/L and over, and CRP value of 96.5 mg/dL and over. Mortality rate was detected to be higher in patients undergoing invasive mechanical ventilation than in patients undergoing non-invasive mechanical ventilation. When thrombocyte count and mortality were associated with each other, it was found that the median value was 86000 mg/dL in exitus patients, whereas it was 185000 mg/dL in patients discharged from the ICU. CONCLUSION: It was revealed that increased APACHE-II score, increased SOFA score, increased pro BNP score, increased CRP, the presence of multidrug-resistant microorganism, and decreased thrombocyte count elevated the rate of mortality. However, no relationship was observed between the duration of hospitalization in the ICU and mortality.Publication Metadata only Night-to-night variability of polygraphy in children with obstructive sleep apnea(EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2020) ERDEM ERALP, ELA; Eralp, Ela Erdem; Yegit, Cansu Yilmaz; Gokdemir, Yasemin; Ergenekon, Pinar; Yilmaz, Meltem; Ay, Pinar; Balcan, Baran; Karadag, Bulent; Ersu, RefikaPublication Open Access Impact of Gender on Symptoms and Comorbidities in Obstructive Sleep Apnea(AVES, 2021-02-22) BALCAN, MEHMET BARAN; Bostan, Ozge Can; Akcan, Beyza; Saydam, Cihan Durmus; Tekin, Muhammet; Dasci, Omur; Balcan, BaranObjective: Obstructive sleep apnea (OSA) is more common in men than in women. In this study, we aimed to address the impact of gender on symptoms and comorbidities in patients with OSA. Materials and Methods: This cross-sectional study was conducted among 1,317 consecutive patients, who were admitted to the Sleep Apnea Clinic of the Marmara University Hospital between November 2015 and October 2018, and who completed questionnaires and a sleep study with cardiorespiratory polygraphy. OSA was defined as Apnea Hypopnea Index (AHI) >= 15/hour. Results: In all, 1,042 patients (334 women) fulfilled the inclusion criteria. OSA was observed in 589 patients (56.5%). Women were older than men (50.2 +/- 12.5 versus 45.6 +/- 15.1 years) and had lower AHI (22.1 +/- 20.1 versus 26.8 +/- 21.9 events/h). In the OSA group, women were older (53.7 +/- 11.5 versus 47.8 +/- 12.8 years) and more obese (BMI 34.6 versus 31.8 kg/m(2)). Symptoms were categorized as frequent/very frequent, and women with OSA complained more about daytime fatigue (74.6% versus 63.7%), nocturia (69.7% versus 51.8%), headache in the morning (50.0% versus 28.4%), depressive mood (49.0% versus 19.5%), and restless legs symptoms (43.1% versus 17.2%), than did men (all p values <0.05). Comorbidities were observed more in women than in men (lung disease [25.4% versus 13.7%], hypertension [29.6% versus 15.0%], diabetes [20.3% versus 11.3%], and hypothyroidism [14.0 % versus 4.1%]). In regression analysis, age (OR 1.03, p<0.001), BMI (OR 1.13, p<0.001), and male sex (OR 2.08, p<0.001) were significantly predictive for OSA while history of tonsillectomy was protective (OR 0.48, p=0.033). Conclusion: Fatigue, nocturia, headache, depressive mood, restless leg, and comorbidities were observed more in women. OSA-related symptoms develop late and/or the referral of women for diagnostic evaluation of OSA is delayed. Symptoms and comorbidities in women should be evaluated more attentively for earlier referral and diagnosis of OSA.Publication Metadata only Clinical impact of depression and anxiety in patients with non-cystic fibrosis bronchiectasis(TURKISH ASSOC TUBERCULOSIS & THORAX, 2020) CEYHAN, BERRİN; Bekir, Melahat; Kocakaya, Derya; Balcan, Baran; Olgun Yildizeli, Sehnaz; Eryuksel, Emel; Ceyhan, BerrinIntroduction: Bronchiectasis is a chronic suppurative disease characterized by abnormal bronchial dilatation. The nature of bronchiectasis may have negative impact on psychological status, however it is poorly studied in relation to clinical indices, particularly the severity of disease. Primary aim of this study is to detect depression and anxiety in patients with non-cystic fibrosis bronchiectasis and to evaluate its relationship with disease severity indexes. Materials and Methods: Ninety (male/female= 37/53; median age 45 years) stable non-cystic fibrosis bronchiectatic adult patients were enrolled into this study. Dyspnea scores, number of exacerbations and hospital admissions within the last year, body-mass index, pulmonary function tests, sputum cultures, bronchiectasis disease severity indexes (BSI and FACED) were assessed. Anxiety and depression were evaluated by using the Turkish version of the hospital anxiety and depression scale questionaire. Results: Anxiety was diagnosed in 30% of patients and depression was diagnosed in 41% of the participants. Female participants had significantly higher rates of depression (55% vs. 22%; p= 0.002). Exacerbation rates within the last year were higher among the subjects with anxiety, moreover, patients with depression had shorter duration of disease. 851 and FACED severity indexes increased with longer duration of disease (5.6 +/- 5.0 yrs in mild group vs. 10.1 +/- 9.2 yrs in moderate-to-severe group, p= 0.035 and 5.7 +/- 5.4 yrs in mild group vs. 12.1 +/- 9.7 yrs in moderate-to-severe group, p= 0.001, respectively), however, anxiety and depression were not related with BSI and FACED severity indexes. Conclusion: Patients with non-cystic fibrosis bronchiectasis have an increased risk for depression and anxiety. Duration of disease and higher exacerbation rate are related with psychological status and indexes increased with longer duration of disease. Lady detection and taking the necessary measures to improve the psychological state is necessary for the overall management of these patients.Publication Metadata only Impact of CPAP treatment on leptin and adiponectin in adults with coronary artery disease and nonsleepy obstructive sleep apnoea in the RICCADSA trial(ELSEVIER, 2020) BALCAN, MEHMET BARAN; Balcan, Baran; Thunstrom, Erik; Yucel-Lindberg, Tulay; Lindberg, Kristin; Ay, Pinar; Peker, YukselBackground: Increased leptin and decreased adiponectin levels are reported in coronary artery disease (CAD) as well as in obstructive sleep apnoea (OSA). Less is known regarding the impact of continuous positive airway pressure (CPAP) on these biomarkers. We aimed to determine variables associated with leptin and adiponectin in adults with CAD and nonsleepy OSA, and evaluate the effect of CPAP adjusted for confounding factors. Methods: This was one of the secondary outcomes of the RICCADSA trial, conducted in Sweden between 2005 and 2013. From 244 revascularized CAD and OSA patients (apnoeaehypopnoea index > 15/h) without excessive daytime sleepiness (Epworth Sleepiness Scale score <10), 196 with blood samples at baseline, after 3, and 12 months were included in the randomized controlled trial arm; of those, 98 were allocated to auto-titrating CPAP, and 98 to no-CPAP. Results: No significant changes in leptin and adiponectin levels were observed during follow-up, whereas Body-Mass-Index and waist circumference increased in both CPAP and no-CPAP groups with no significant between-group differences. Alterations in plasma leptin were determined by changes in waist circumference (beta coefficient 2.47; 95% confidence interval 0.77-4.40), whereas none of the analyzed parameters was predictive for changes in adiponectin levels. No association was found with CPAP adherence. Conclusions: CPAP had no significant effect on leptin and adiponectin in this cohort of nonsleepy OSA patients. An increase in waist circumference predicted an increase in plasma levels of leptin after 12 months, suggesting that lifestyle modifications should be given priority in adults with CAD and OSA regardless of CPAP treatment. (C) 2019 Elsevier B.V. All rights reserved.