Efficacy and Safety of Low Dose Ketamine and Midazolam Combination for Diagnostic Upper Gastrointestinal Endoscopyin Children

Ulas Emre Akbulut,Ulas Emre Akbulut 대한소아소화기영양학회 2015 Pediatric gastroenterology, hepatology & nutrition Vol.18 No.3

Purpose: We aimed to analyze the effectiveness and safety of low-dose midazolam and ketamine combination for upper gastrointestinal endoscopy (UGIE) in children.Methods: The study included the children (n=425, 10.78±3.81 years) who underwent UGIE for diagnostic purpose during 1 year period. All children were sedated with low dose midazolam (0.1 mg/kg) and ketamine (0.5 mg/kg) intravenously. Effectiveness of the sedation and complications during the procedure and recovery period were recorded. Results: Endoscopic procedure was successfully completed in 414 patients (97.4%; 95% confidence interval, 95.8-98.9). Mean±standard deviation (SD) duration of procedure was 6.36±1.64 minutes (median, 6.0 minutes; range, 4-12 minutes). Minor complications occurred during the procedure in 39.2% of the patients. The most common complication was increased oral secretion (33.1%). No major complications were observed in any patient. Age and Ramsay sedation scores of patients with complications during the procedure were lower than the others (9.49±4.05years vs. 11.61±3.43 years, p=0.002 and 2.10±1.46 vs. 4.37±1.16, p=0.001). Mean recovery time was 22 minutes (range, 10-90 minutes; mean±SD, 25±12.32 minutes). Minor complications developed during recovery in 60.1% of the patients. The most common complication was transient double vision (n=127, 30.7%). Emergence reaction was observed in 5 patients (1.2%). Conclusion: The procedure was completed with high level of success without any major complication in our study. Combination of low-dose midazolam and ketamine is a suitable sedation protocol for pediatric endoscopists in UGIE.

Efficacy and Safety of Low Dose Ketamine and Midazolam Combination for Diagnostic Upper Gastrointestinal Endoscopy in Children

Akbulut, Ulas Emre,Cakir, Murat The Korean Society of Pediatric Gastroenterology 2015 Pediatric gastroenterology, hepatology & nutrition Vol.18 No.3

Purpose: We aimed to analyze the effectiveness and safety of low-dose midazolam and ketamine combination for upper gastrointestinal endoscopy (UGIE) in children. Methods: The study included the children (n=425, $10.78{\pm}3.81years$) who underwent UGIE for diagnostic purpose during 1 year period. All children were sedated with low dose midazolam (0.1 mg/kg) and ketamine (0.5 mg/kg) intravenously. Effectiveness of the sedation and complications during the procedure and recovery period were recorded. Results: Endoscopic procedure was successfully completed in 414 patients (97.4%; 95% confidence interval, 95.8-98.9). $Mean{\pm}standard$ deviation (SD) duration of procedure was $6.36{\pm}1.64minutes$ (median, 6.0 minutes; range, 4-12 minutes). Minor complications occurred during the procedure in 39.2% of the patients. The most common complication was increased oral secretion (33.1%). No major complications were observed in any patient. Age and Ramsay sedation scores of patients with complications during the procedure were lower than the others ($9.49{\pm}4.05years$ vs. $11.61{\pm}3.43years$, p=0.002 and $2.10{\pm}1.46$ vs. $4.37{\pm}1.16$, p=0.001). Mean recovery time was 22 minutes (range, 10-90 minutes; $mean{\pm}SD$, $25{\pm}12.32minutes$). Minor complications developed during recovery in 60.1% of the patients. The most common complication was transient double vision (n=127, 30.7%). Emergence reaction was observed in 5 patients (1.2%). Conclusion: The procedure was completed with high level of success without any major complication in our study. Combination of low-dose midazolam and ketamine is a suitable sedation protocol for pediatric endoscopists in UGIE.

Effects of four novel root-end filling materials on the viability of periodontal ligament fibroblasts

Akbulut, Makbule Bilge,Arpaci, Pembegul Uyar,Eldeniz, Ayce Unverdi The Korean Academy of Conservative Dentistry 2018 Restorative Dentistry & Endodontics Vol.43 No.3

Objectives: The aim of this in vitro study was to evaluate the biocompatibility of newly proposed root-end filling materials, Biodentine, Micro-Mega mineral trioxide aggregate (MM-MTA), polymethylmethacrylate (PMMA) bone cement, and Smart Dentin Replacement (SDR), in comparison with contemporary root-end filling materials, intermediate restorative material (IRM), Dyract compomer, ProRoot MTA (PMTA), and Vitrebond, using human periodontal ligament (hPDL) fibroblasts. Materials and Methods: Ten discs from each material were fabricated in sterile Teflon molds and 24-hour eluates were obtained from each root-end filling material in cell culture media after 1- or 3-day setting. hPDL fibroblasts were plated at a density of $5{\times}10^3/well$, and were incubated for 24 hours with 1:1, 1:2, 1:4, and 1:8 dilutions of eluates. Cell viability was evaluated by XTT assay. Data was statistically analysed. Apoptotic/necrotic activity of PDL cells exposed to material eluates was established by flow cytometry. Results: The Vitrebond and IRM were significantly more cytotoxic than the other root-end filling materials (p < 0.05). Those cells exposed to the Biodentine and Dyract compomer eluates showed the highest survival rates (p < 0.05), while the PMTA, MM-MTA, SDR, and PMMA groups exhibited similar cell viabilities. Three-day samples were more cytotoxic than 1-day samples (p < 0.05). Eluates from the cements at 1:1 dilution were significantly more cytotoxic (p < 0.05). Vitrebond induced cell necrosis as indicated by flow cytometry. Conclusions: This in vitro study demonstrated that Biodentine and Compomer were more biocompatible than the other root-end filling materials. Vitrebond eluate caused necrotic cell death.

An investigation of non-linear optimization methods on composite structures under vibration and buckling loads

Akbulut, Mustafa,Sarac, Abdulhamit,Ertas, Ahmet H. Techno-Press 2020 Advances in computational design Vol.5 No.3

In order to evaluate the performance of three heuristic optimization algorithms, namely, simulated annealing (SA), genetic algorithm (GA) and particle swarm optimization (PSO) for optimal stacking sequence of laminated composite plates with respect to critical buckling load and non-dimensional natural frequencies, a multi-objective optimization procedure is developed using the weighted summation method. Classical lamination theory and first order shear deformation theory are employed for critical buckling load and natural frequency computations respectively. The analytical critical buckling load and finite element calculation schemes for natural frequencies are validated through the results obtained from literature. The comparative study takes into consideration solution and computational time parameters of the three algorithms in the statistical evaluation scheme. The results indicate that particle swarm optimization (PSO) considerably outperforms the remaining two methods for the special problem considered in the study.

The push-out bond strength of BIOfactor mineral trioxide aggregate, a novel root repair material

Akbulut, Makbule Bilge,Bozkurt, Durmus Alperen,Terlemez, Arslan,Akman, Melek The Korean Academy of Conservative Dentistry 2019 Restorative Dentistry & Endodontics Vol.44 No.1

Objectives: The aim of this in vitro study was to evaluate the push-out bond strength of a novel calcium silicate-based root repair material-BIOfactor MTA to root canal dentin in comparison with white MTA-Angelus (Angelus) and Biodentine (Septodont). Materials and Methods: The coronal parts of 12 central incisors were removed and the roots were embedded in acrylic resin blocks. Midroot dentin of each sample was horizontally sectioned into 1.1 mm slices and 3 slices were obtained from each root. Three canal-like standardized holes having 1 mm in diameter were created parallel to the root canal on each dentin slice with a diamond bur. The holes were filled with MTA-Angelus, Biodentine, or BIOfactor MTA. Wet gauze was placed over the specimens and samples were stored in an incubator at $37^{\circ}C$ for 7 days to allow complete setting. Then samples were subjected to the push-out test method using a universal test machine with the loading speed of 1 mm/min. Data was statistically analyzed using Friedman test and post hoc Wilcoxon signed rank test with Bonferroni correction. Results: There were no significant differences among the push-out bond strength values of MTA-Angelus, Biodentine, and BIOfactor MTA (p > 0.017). Most of the specimens exhibited cohesive failure in all groups, with the highest rate found in Biodentine group. Conclusions: Based on the results of this study, MTA-Angelus, Biodentine, and BIOfactor MTA showed similar resistances to the push-out testing.

Investigation of the prevalence and main features of skull-base anomalies and characteristics of the sphenoid sinus using cone-beam computed tomography

Akbulut Aslıhan,Demirel Oğuzhan,Orhan Kaan 대한구강악안면외과학회 2022 대한구강악안면외과학회지 Vol.48 No.4

Objectives: This study aimed to define the prevalence and characteristics of skull base anomalies and the features of sphenoid sinus pneumatization (SSP). Materials and Methods: Five hundred cone-beam computed tomography scans were evaluated retrospectively for the presence of fossa navicularis magna (FNM), canalis basilaris medianus (CBM), sphenoid emissary foramen (SEF), and/or Onodi cells (OC). Patterns of the SSP and sphenoid sinus mucosa dimensions (SSMD) were also recorded. Results: The prevalence of FNM, CBM, SEF, and OC was 26.0%, 22.4%, 47.4%, and 18.4%, respectively. Two hundred sixty-two (52.4%) sellar-type SSP were defined, followed by post-sellar 191 (38.2%), pre-sellar 31 (6.2%), and conchal 16 (3.2%) types. The frequency of SSMD less than 1 mm, 1-3 mm, and greater than 3 mm was 40.6%, 38.4%, and 21.0%, respectively. An SEF was detected more frequently in females, while SSMD greater than 3 mm was more frequent in males. An FNM was more prevalent in the 18-29 and 30-39 age groups and SEF was significantly less fre-quent in patients over 60 years of age compared to other age groups. A sinus mucosa larger than 3 mm was more common in the younger than 18 year group. The frequency of post-sellar-type pneumatization was lower in patients younger than 18 years. Conclusion: Skull-base anomalies are common and may be detected incidentally during imaging procedures. The sphenoid sinus, its variations, and pneumatization patterns should also be taken into consideration in imaging procedures performed for various purposes.

Propofol with and without Midazolam for Diagnostic Upper Gastrointestinal Endoscopies in Children

Akbulut, Ulas Emre,Kartal, Seyfi,Dogan, Ufuk,Akcali, Gulgun Elif,Kalayci, Serap,Kirci, Hulya The Korean Society of Pediatric Gastroenterology 2019 Pediatric gastroenterology, hepatology & nutrition Vol.22 No.3

Purpose: Various publications on the use of sedation and anesthesia for diagnostic procedures in children have demonstrated that no ideal agent is available. Although propofol has been widely used for sedation during esophagogastroduodenoscopy in children, adverse events including hypoxia and hypotension, are concerns in propofol-based sedation. Propofol is used in combination with other sedatives in order to reduce potential complications. We aimed to analyze whether the administration of midazolam would improve the safety and efficacy of propofol-based sedation in diagnostic esophagogastroduodenoscopies in children. Methods: We retrospectively reviewed the hospital records of children who underwent diagnostic esophagogastroduodenoscopies during a 30-month period. Demographic characteristics, vital signs, medication dosages, induction times, sedation times, recovery times, and any complications observed, were examined. Results: Baseline characteristics did not differ between the midazolam-propofol and propofol alone groups. No differences were observed between the two groups in terms of induction times, sedation times, recovery times, or the proportion of satisfactory endoscopist responses. No major procedural complications, such as cardiac arrest, apnea, or laryngospasm, occurred in any case. However, minor complications developed in 22 patients (10.7%), 17 (16.2%) in the midazolam-propofol group and five (5.0%) in the propofol alone group (p=0.010). Conclusion: The sedation protocol with propofol was safe and efficient. The administration of midazolam provided no additional benefit in propofol-based sedation.

STRONG AND Δ-CONVERGENCE OF A FASTER ITERATION PROCESS IN HYPERBOLIC SPACE

AKBULUT, SEZGIN,GUNDUZ, BIROL Korean Mathematical Society 2015 대한수학회논문집 Vol.30 No.3

In this article, we first give metric version of an iteration scheme of Agarwal et al. [1] and approximate fixed points of two finite families of nonexpansive mappings in hyperbolic spaces through this iteration scheme which is independent of but faster than Mann and Ishikawa scheme. Also we consider case of three finite families of nonexpansive mappings. But, we need an extra condition to get convergence. Our convergence theorems generalize and refine many know results in the current literature.

Coeliac Disease-Associated Antibodies in Psoriasis

Sabiye Akbulut,Engin Senel,Günes Gür,Firdevs Topal,Fatih Esad Topal,Department of Gastroenterology, Medicana International Hospital, Anka,Nuran Alli 대한피부과학회 2013 Annals of Dermatology Vol.25 No.3

Background: The possible relationship between psoriasis and coeliac disease (CD) has been attributed to the common pathogenic mechanisms of the two diseases and the presence of antigliadin antibodies in patients has been reported to increase the incidence of CD. Objective: The aim of this report was to study CD-associated antibodies serum antigliadin antibody immunoglobulin (Ig)A, IgG, anti-endomysial antibody IgA and anti-transglutaminase antibody IgA and to demonstrate whether there is an increase in the frequency of those markers of CD in patients with psoriasis. Methods: Serum antigliadin antibody IgG and IgA, antiendomysial antibody IgA and anti-transglutaminase antibody IgA were studied in 37 (19 males) patients with psoriasis and 50 (23 males) healthy controls. Upper gastrointestinal endoscopy and duodenal biopsies were performed in patients with at least one positive marker. Results: Antigliadin IgA was statistically higher in the psoriasis group than in the controls (p<0.05). Serological markers were found positive in 6patients with psoriasis and 1 person from the control group. Upper gastrointestinal endoscopy was performed in all these persons, with biopsies collected from the duodenum. The diagnosis of CD was reported in only one patient with psoriasis following the pathological examination of the biopsies. Whereas one person of the control group was found to be positive for antigliadin antibody IgA, pathological examination of the duodenal biopsies obtain from this patient were found to be normal. Conclusion: Antigliadin IgA prominently increases in patients diagnosed with psoriasis. Patients with psoriasis should be investigated for latent CD and should be followed up.

Elevated Temperature Effect on the Dynamic Characteristics of Steel Columns and Frames

Yunus Emrahan Akbulut,Ahmet Can Altunişik,Hasan Basri Başağa,Sara Mostofi,Ayman Mosallam,Louai F. Wafa 한국강구조학회 2021 International Journal of Steel Structures Vol.21 No.3

Fire performance of load bearing elements in steel buildings such as columns and frames has major importance for structural designers. This study aims to assess the elevated temperature eff ect on dynamic characteristics of steel columns and frames by conducting sequential heat transfer and modal analyses. A series of fi nite element analyses including heat transfer analysis aere performed on 62 diff erent steel columns and frames. Three-hour part of ISO 834 fi re curve is taken into consideration in the analysis. Modal analyses are conducted for the purpose of providing a more comprehensive image of dynamic characteristics in specifi c duration of elevated temperature. The presented study accommodates the eff ect of various steel profi le types, cross-sectional dimensions and exposure durations on changes in dynamic characteristics. The outcomes of the performed parametric study revealed the decrease in natural frequencies with the temperature growth. The research has also shown the existence of a correlation between temperature variations and changes in mode shapes. The change in mode shapes depends on the profi le type. Mode shapes do not change depending on the temperature in some profi le types, while in some profi le types they change after a certain temperature. The obtained results of the performed sequential analyses are presented in forms of tabulated data and approximate formulas. They can facilitate the damage detection process and contribute in required structural health monitoring measurements while enhance the accuracy of damage assessment for fi re exposed steel structures.