مجله دانشکده پزشکی اصفهان
پیاپی 416 (هفته چهارم اسفند 1395)

The migraine headache is a kind of most populated headache which its prevalence rate is so high. The first step for starting the treatment is the recognition stage. In addition, the fuzzy logic has good power for describing enigmatic and imprecise aspects; so, this tool could be used for the system modeling. This research aimed to recognize the migraine via using fuzzy logic and systems.
A fuzzy expert system for diagnosis of migraine via Learning from Examples (LFE) algorithm was presented. Mamdani model was used in fuzzy inference engine using Max-Min as Or-And operators and Centroid method was used as defuzzification technique.
Findings: Using the data of 148 patients, the migraine diagnostic system was trained by LFE algorithm and in average, 80 pieces of If-Then rules were produced for fuzzy system. The accuracy, precision, sensitivity, and specificity of the system were 97%, 80%, 70%, and 94%, respectively. Using the migraine diagnostic system by human experts, it was proved that the system had the ability of correct recognition by the rate of 81%.
As the linguistic rules may be incomplete when human expert express their knowledge and according to importance of early diagnosis and favorable results, the LFE training algorithm is more effective than human experts system for recognition of migraine headache.

Nonarteritic anterior ischemic optic neuropathy (NA-AION) is a disease with serious complications that already does not have any standard treatment. Some studies and experiences had shown that intravitreal erythropoietin injection has a neuroprotective effect. But there are some different and inconsistent results in those studies. So, the aim of this study was determining the effect of intravitreal injection of erythropoietin in treatment of the disease.
In a clinical trial study, 40 eyes (from 38 patients) were selected and randomly divided in two groups. In the first group, 2000 IU erythropoietin was injected in vitreous and the second group did not receive erythropoietin. Visual acuity and visual field were measured before and three months after the treatment and compared between the two groups.
Findings: The mean visual acuity was improved in the treatment group (P Intravitreal injection of erythropoietin in patients with nonarteritic anterior ischemic optic neuropathy leads to remarkable and significant improvement of visual acuity and field 3 months after the injection. So, this treatment strategy is advised in patients with suitable condition and without any contraindication by ophthalmologists. To evaluate the long-term effects, further studies are recommended.

Despite the increasing developments in treatment of skin diseases, leishmaniasis is still considered as one of the major health problems. Despite the spontaneously improving of the disease, its scars can highly create emotional and social problems for the patients. In this study, the effect of combination therapy of intralesional glucantime plus glycolic acid 70% and salicylic 20% was compared with intralesional glucantime alone in reducing scars of this disease.
75 patients with cutaneous leishmaniasis, which had 2 lesions at the same anatomical location, participated in the study (150 lesions). 75 lesions were treated with combination therapy and 75 with intralesional glucantime alone. For each patient a questionnaire was filled. All the data were analyzed using SPSS software.
Findings: After 8 weeks of treatment, 37.3% of lesions cured completely with intralesional glucantime and 42.7% with combination therapy. There was no statistically significant difference between the improvements among the two groups (P > 0.05).
Intralesional glucantime plus glycolic acid 70% and salicylic 20% was not more effective in cutaneous leishmaniasis compared to intralesional glucantime alone and did not reduce the mean time of improvement.

Vitiligo is an acquired multifactorial disorder. Different treatments are used for it and all of them have adverse side-effects. Vitiligo is an autoimmune disease associated with other autoimmune diseases such as hypothyroidism, hyperthyroidism, rheumatoid arthritis, diabetes mellitus, and so on. In these diseases, deficiency of vitamin D and B12 are proposed. So in this study, treatment response and remission in patients taking oral vitamin D and B12 was administered.
60 patients with active vitiligo were randomly divided into three groups. Group I received topical PUVA for 6 months; group II received topical PUVA and 1 cc oral drops of vitamin D3 daily for 2 months, and then topical PUVA alone for following 4 months; and group III received topical PUVA and 1 cc oral drops of vitamin D3 daily and sublingual tablets of vitamin B12 daily for 2 months, and then treated with topical PUVA for following 4months. Cure rate and side effects were evaluated using Vitiligo Area Scoring Index (VASI) at the third and sixth months.
Findings: In each of the three treated groups at different times, the average changes in the area and extent of the lesion were not significantly different. Pruritus and erythema occurred in some patients.
In this study, the reduction in the extent and area of lesions in the group receiving vitamin D compared to the control group were higher that indicated the role of vitamin D in preventing progression of active vitiligo.

Congenital hypothyroidism is the most common preventable cause of mental retardation in children and should be diagnosed and treated at the earliest time. The prevalence of congenital hypothyroidism is high in preterm infants with low and very low birth weight.
A systematic literature review was conducted using PubMed, Scopus and Google Scholar databases to 19 April 2014. We did not consider any time limitation; English-language papers were included. Irrelevant studies were set aside after studying their title, abstract, and full text. Two reviewers extracted the data; besides, the third reviewer checked their extracted data. In final, the data extracted from related studies.
Findings: Normal serum thyroid-stimulating hormone (TSH) at third to sixth days of birth in low- and very-low-birth-weight preterm infants did not indicate normal thyroid function. In addition, TSH level of more than 10 mIu/l at the second week of the birth did not have a diagnostic value. A TSH level of 10-15 mIu/l, after a normal TSH value, posed the diagnosis of hypothyroidism with delayed TSH rise. Serum levels of free-T4 (FT4) and T4 would be normal at 2 to 8 weeks after the birth.
It is recommended to repeat the screening of preterm newborns with low and very low birth weight by measuring TSH and FT4 levels simultaneously at two, six and ten weeks after the birth; the threshold of TSH = 10 mIu/l should be considered to select positive and suspected cases of the disease.