A Novel Retinal Blood Vessel Segmentation Algorithm using Fuzzy segmentation

Assessment of blood vessels in retinal images is an important factor for many medical disorders. The changes in the retinal vessels due to the pathologies can be easily identified by segmenting the retinal vessels. Segmentation of retinal vessels is done to identify the early diagnosis of the disease like glaucoma, diabetic retinopathy, macular degeneration, hypertensive retinopathy and arteriosclerosis. In this paper, we propose an automatic blood vessel segmentation method. The proposed algorithm starts with the extraction of blood vessel centerline pixels. The final segmentation is obtained using an iterative region growing method that merges the binary images resulting from centerline detection part with the image resulting from fuzzy vessel segmentation part. In this proposed algorithm, the blood vessel is enhanced using modified morphological operations and the salt and pepper noises are removed from retinal images using Adaptive Fuzzy Switching Median filter. This method is applied on two publicly available databases, the DRIVE and the STARE and the experimental results obtained by using green channel images have been presented and compared with recently published methods. The results demonstrate that our algorithm is very effective method to detect retinal blood vessels.DOI:http://dx.doi.org/10.11591/ijece.v4i4.625

Two Novel Retinal Blood Vessel Segmentation Algorithms

Assessment of blood vessels in retinal images is an important factor for many medical disorders. The changes in the retinal vessels due to the pathologies can be easily identified by segmenting the retinal vessels. Segmentation of retinal vessels is done to identify the early diagnosis of the disease like glaucoma, diabetic retinopathy, macular degeneration, hypertensive retinopathy and arteriosclerosis. In this paper, we propose two automatic blood vessel segmentation methods. The first proposed algorithm starts with the extraction of blood vessel centerline pixels. The final segmentation is obtained using an iterative region growing method that merges the contents of several binary images resulting from vessel width dependent modified morphological filters on normalized retinal images. In the second proposed algorithm the blood vessel is segmented using normalized modified morphological operations and neuro fuzzy classifier. Normalized morphological operations are used to enhance the vessels and neuro fuzzy classifier is used to segment retinal blood vessels. These methods are applied on the publicly available DRIVE database and the experimental results obtained by using green channel images have been presented and their results are compared with recently published methods. The results demonstrate that our algorithms are very effective methods to detect retinal blood vessels.DOI:http://dx.doi.org/10.11591/ijece.v4i3.582

Recurrence of Febrile Seizures in Yazd Shahid Sadoughi Hospital

ObjectiveFebrile seizure is the most common problem in pediatric neurology that occurs in 3- 4 % of children. The purpose of this study was to determine febrile seizure recurrence frequency and to evaluate its risk factors.Materials & MethodsIn a descriptive prospective study, 139 children (6 months to 6 years) with first febrile seizure were admitted to Yazd Shaheed Sadoughi Hospital between March 2004 and August 2005 and were followed up for at least 15 months for febrile seizure recurrence.ResultsSeventy six boys and 63 girls with a mean age of 2.03 ± 1.21 years were followed up for 25.1±5.5 months. About 30% of them had complex febrile seizures and 37.4% had febrile seizure recurrence with a mean recurrence time of 6.7 ± 5.9 months. About 65% of the children younger than one year and 30% of those older than one year had febrile seizure recurrence. (P value= 0.0001) Recurrence of seizure was seen in 63% of those who had seizure within an hour from the onset of fever and in 33% of those who had seizure after one hour from the onset of fever. (P value = 0.005) Seizures in children younger than one year old and seizures occurring in association with a fever lasting less than an hour were risk factors of febrile seizure recurrence.ConclusionFebrile seizure is more disturbing in children younger than one year old. Antipyretic usage was not effective in preventing seizure recurrence but may reduce discomfort and is reassuring.

Mothers’ Experience Regarding the Relationship between Dairy Products and Their Children’s Seizures

ObjectiveEpilepsy is one of the most important problems in neurology. The purpose of this study was to evaluate the relationship between dairy products and seizures of the epileptic children based on their mothers' experience.Materials & MethodsIn a descriptive- analytic study, mothers' experience regarding the relationship between dairy products and seizures of their children was evaluated via a questionnaire. This research was done in the pediatric neurology clinic of Shaheed Sadoughi Medical Sciences University- Yazd- Iran in 2007.ResultsOne hundred and forty eight mothers with an age range of 17-52 years (mean ± SD: 31.6 ± 6.6 years) were evaluated. Their children were 58.5% boys and 41.5% girls with an age range of 1-18 years (mean ± SD: 6.6 ± 4.2 years).The most common dairy products which provoked seizure based on mothers' experience, were milk and ice cream. The effect of different kinds of dairy products was not different between males and female children. Mothers who experienced the effect of dried whey (kashk in Persian) on seizure were younger than others. Lack of correlation between milk and ice cream on seizures was reported in educated mothers.ConclusionParent education on the diet of their epileptic children is necessary. On the other hand, extracting of suspicious food ingredients and testing them on animal models, should be done by other researches.

The Efficacy and Safety of Topiramate for Prophylaxis of Migraine in Children

How to Cite This Article: Fallah R, Akhavan Karbasi S, Shajari A, Fromandi M. The Efficacy and Safety of Topiramate for Prophylaxis of Migraine in Children. Iran J Child Neurol. 2013 Autumn; 7(4):7-11.Objective Migraine is the most common acute intermittent primary headache in children and prophylactic therapy is indicated in children with frequent or disabling headaches. The purpose of this study was to evaluate the efficacy and safety of topiramate (TPM) for migraine prophylaxis in children. Materials & Methods In a quasi-experimental study, monthly frequency, severity and duration of headache, migraine disability, and side-effects were evaluated in 100 children who were referred to the Pediatric Neurology Clinic of Shahid Sadoughi University of Medical Sciences, Yazd, Iran from April 2011 to March 2012, and were treated with 3 mg/kg/day of TPM for three months. Results Fifty eight (57.4%) girls and 42 (41.6%) boys with the mean age of 10.46±2.11 years were evaluated. Monthly frequency, severity, and duration of headache decreased with treatment from 15.34±7.28 to 6.07±3.16 attacks, from 6.21±1.74 to 3.15±2.22, and from 2.28±1.55 to 0.94±0.35 hours, respectively, and the Pediatric Migraine Disability Assessment score reduced with TPM from 32.48±9.33 to 15.54±6.16. Transient side-effects were seen in 21% of the patients, including hyperthermia in 11%, anorexia and weight loss in 6%, and drowsiness in 4%. No serious side-effects were reported.  Conclusion TPM could be considered as a safe and effective drug in pediatric migraine prophylaxis. ReferencesHershey AD. Migraine. In: Kliegman RM, Stanton BF, Schor NF, St. Geme JW, Behrman RE, editors Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Saunders; 2011. p. 2040-5.The International Classification of Headache Disorders:2nd ed. Headache Classification Subcommittee of the International Headache Society. Cephalalgia 2004;24 Suppl 1:9-160.Hershey AD, Winner PK. Pediatric migraine: recognition and treatment. J Am Osteopath Assoc 2005;105(4 Suppl 2):2S-8S.Jayapal S, Maheshwari N. Question 3. Topiramate for chronic migraine in children. Arch Dis Child  2011;96(3):318-21.Fallah R. Topiramate as a new antiepileptic drug in epileptic children in Iran. Indian J Pediatr 2006;73(12):1073-5.Hershey AD, Powers SW, Vockell ALB, LeCates SL, Kabbouche MA, Maynard MK. PedMIDAS: Development of a questionnaire to assess disability of migraines in children. Neurology 2001;57(11):2034-9.Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 1990;13(4):227-36.Ashtari F, Shaygannejad V, Akbari M. A doubleblind, randomized trial of low-dose topiramate vs propranolol in migraine prophylaxis. Acta Neurol Scand 2008;118(5):301-5.Tonekaboni SH, Ghazavi A, Fayyazi A, Khajeh A, Taghdiri MM, Abdollah Gorji F, Azargashb E.Prophylaxis of childhood migraine: Topiramate versus Propranolol. Iran J Child Neurol 2013 ; 7(1):9-14.Winner P, Pearlman EM, Linder SL, Jordan DM, Fisher AC, Hulihan J; Topiramate Pediatric Migraine Study Investigators. Topiramate for migraine prevention in children: a randomized, double-blind, placebo-controlled trial. Headache 2005;45(10):1304-12.Lewis D, Winner P, Saper J, Ness S, Polverejan E, Wang S, et al. Randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of topiramate for migraine prevention in pediatric subjects 12 to 17 years of age. Pediatrics 2009;123(3):924-34.Borzy JC, Koch TK, Schimschock JR. Effectiveness of topiramate in the treatment of pediatric chronic daily headache. Pediatr Neurol 2005;33(5):314-6.Campistol J, Campos J, Casas C, Herranz JL. Topiramate in the prophylactic treatment of migraine in children. J Child Neurol 2005;20(3):251-3.Cruz MJ, Valencia I, Legido A, Kothare SV, Khurana DS, Yum S, et al. Efficacy and tolerability of topiramate in pediatric migraine. Pediatr Neurol 2009;41(3):167-70.Aydin M, Kabakus N, Bozdag S, Ertugrul S. Profile of children with migraine. Indian J Pediatr 2010;77(11):1247-51.Unalp A, Uran N, Oztürk A. Comparison of the effectiveness of topiramate and sodium valproate in pediatric migraine. J Child Neurol 2008;23(12):1377-81. Lakshmi CV, Singhi P, Malhi P, Ray M. Topiramate in the prophylaxis of pediatric migraine: a double-blind placebo-controlled trial. J Child Neurol 2007;22(7):829-35.Vollono C, Ferraro D, Valeriani M. Antiepileptic drugs in the preventive treatment of migraine in children and adolescents. Drug Development Research 2007;68:355-9.  19. Ferraro D, Di Trapani G. Topiramate in the prevention of pediatric migraine: literature review. J Headache Pain 2008;9(3):147-50

Randomised Clinical Efficacy Trial of Topiramate and Nitrazepam in Treatment of Infantile Spasms

How to Cite This Article: Fallah R, Salor F, Akhavan Karbasi S, Motaghipisheh H. Randomised Clinical Efficacy Trial of Topiramate and Nitrazepam in Treatment of Infantile Spasms. Iran J Child Neurol. 2014 Winter; 8(1):12-19.ObjectiveInfantile spasms (IS) are among the most catastrophic epileptic syndromes of infancy. The purpose of this study was to compare efficacy and safety of topiramate (TPM) and nitrazepam (NZP) as first-line drugs in the treatment ofIS.Materials & MethodsIn a parallel single-blinded randomized clinical trial, 50 patients with IS referred to Pediatric Neurology Clinic of Shahid Sadoughi University of Medical Sciences, Yazd, Iran, were evaluated from September 2008 to March 2010.Patients were randomly assigned to two groups to be treated with TPM or with NZP for 6 months. The primary endpoint was efficacy in cessation of all spasms or reduction of more than 50% in weekly seizure frequency, which was evaluatedbefore and 6 months after the drug use. Secondary outcome was clinical sideeffects of the drugs.ResultsTwenty boys (40%) and 30 girls (60%) with the mean age of 9.4±3.8 months were evaluated. Cessation of all spasms occurred in 12 (48%) infants in TPM group and 4(16%) in NZP group. Eight (32%) children in TPM group and 7 (28%) in NZP group had more than 50% reduction in spasms frequency. So,TPM was more effective. Side effects were seen in 32% of TPM and in 36% of NZP groups.ConclusionTopiramate is an effective and safe drug, which might be considered as the firstline drug for the treatment of ISs.References:Watemberg N. Infantile spasms: treatment challenges. Curr Treat Options Neurol 2012;14(4):322-31.Tsao CY. Current trends in the treatment of infantile spasms. Neuropsychiatr Dis Treat 2009;5:289-99.Sankar R, Koh S, Wu J, Menkes JH. Paroxysmal disorders. In: Menkes JH, Sarnat HB, Maria BL, editors Child Neurology,7th ed. Philadelphia: Lippincott; 2006.p. 877.Engel J Jr. International League against Epilepsy (ILAE). A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: a report of the ILEA task force on classification and terminology. Epilepsia 2001; 42(6):796–803.Riikonen RS. Favourable prognostic factors with infantile spasms. Eur J Paediatr Neurol 2010;14(1):13-18.Lagae L, Verhelst H, Ceulemans B, De Meirleir L, Nassogne MC, De Borchgrave V, et al. Treatment and long term outcome in West syndrome: the clinical reality. A multicentre follow up study. Seizure 2010;19(3):159-64.Fois A. Infantile spasms: review of the literature and personal experience. Ital J Pediatr 2010;36:15-21.Jaseja H. Justification of vigabatrin administration in West syndrome patients? Warranting a re-consideration for improvement in their quality of life. Clin Neurol Neurosurg 2009;111(2):111-14.Hwang H, Kim KJ. New antiepileptic drugs in pediatric epilepsy. Brain Dev 2008,30(9);549–55.Mikaeloff Y, de Saint-Martin A, Mancini J, Peudenier S, Pedespan JM, Vallée L, et al. Topiramate: efficacy and tolerability in children according to epilepsy syndromes. Epilepsy Res 2003;53(3):225-32.Peltzer B, Alonso WD, Porter BE. Topiramate and Adrenal-Cortico-tropic Hormone as Initial Treatment of Infantile Spasms. J Child Neurol 2009;24(4):400-5.Zou LP, Lin Q, Qin J, Cai FC, Liu ZS, Mix E. Evaluation of open-label topiramate as primary or adjunctive therapy in infantile spasms. Clin Neuropharmacol 2008;31(2):86-92.Korinthenberg R, Schreiner A. Topiramate in children with west syndrome: a retrospective multicenter evaluation of 100 patients. J Child Neurol 2007;22(3):302-6.14. Kwon YS, Jun YH, Hong YJ, Son BK. Topiramate monotherapy in infantile spasm. Yonsei Med J 2006;47(4):498-504.Hosain SA, Merchant S, Solomon GE, Chutorian A. Topiramate for the treatment of infantile spasms. J Child Neurol 2006;21(1):17-9.Glauser TA, Clark PO, McGee K. Long-term response to topiramate in patients with West syndrome. Epilepsia 2000;41(Suppl. 1):S91-4.Albsoul-Younes AM, Salem HA, Ajlouni SF, Al-Safi SA. Topiramate slow dose titration: improved efficacy and tolerability. Pediatr Neurol 2004;31(5):349-52.Hsieh MY, Lin KL, Wang HS, Chou ML, Hung PC, Chang MY. Low-dose topiramate is effective in the treatment of infantile spasms. Chang Gung Med J 2006;29(3):291-6.Auvichayapat N, Tassniyom S, Treerotphon S, Auvichayapat P. Treatment of infantile spasms with sodium valproate followed by benzodiazepines. J Med Assoc Thai 2007;90(9):1809-14.Karvelas G, Lortie A, Scantlebury MH, Duy PT, Cossette P, Carmant L. A retrospective study on aetiology based outcome of infantile spasms. Seizure 2009;18(3):197-201.Chen CC, Chen TF, Lin HC, Oon PC, Wu HM, Wang PJ, et al. Estimation of prevalence and incidence of infantile spasms in Taiwan using capture–recapture method. Epilepsy Res 2004;58(1):37–42.Parisi P, Bombardieri R, Curatolo P. Current role of vigabatrin in infantile spasms. Eur J Paediatr Neurol 2007;11(6):331-6.Cvitanović-Sojat L, Gjergja R, Sabol Z, Hajnzić TF, Sojat T. Treatment of West syndrome. Acta Med Croatica 2005;59(1):19-29. (Full text in Croatian)Watemberg N, Goldberg-Stern H, Ben-Zeev B, Berger I, Straussberg R, Kivity S, et al. Clinical experience with open-label topiramate use in infants younger than 2 years of age. J Child Neurol 2003;18(4):258-62.Grosso S, Franzoni E, Iannetti P, Incorpora G, Cardinali C, Toldo I, et al. Efficacy and safety of topiramate in refractory epilepsy of childhood: long-term follow-up study. J Child Neurol 2005;20(11):893-7.Capovilla G, Beccaria F, Montagnini A, Cusmai R, Franzoni E, Moscano F, et al. Short-term nonhormonal and nonsteroid treatment in West syndrome. Epilepsia 2003;44(8):1085-8.Chamberlain MC. Nitrazepam for refractory infantile spasms and the Lennox-Gastaut syndrome. J Child Neurol 1996;11(1):31-4.28. Hosain SA, Green NS, Solomon GE, Chutorian A. Nitrazepam for the treatment of Lennox-Gastaut syndrome. Pediatr Neurol 2003;28(1):16-9.Rintahaka PJ, Nakegawa JA, Shewmom DA, Kyynnem P, Shields WD. Incidence of death in patients with intractable epilepsy, during nitrazepam treatment. Epilepsia 1994;40(4):492-6.Djurić M, Marjanović B, Zamurović D. West syndrome--new therapeutic approach. Srp Arh Celok Lek 2001;129(Suppl.1):72-7. (Full text in Serbian

A Comparative Analysis of Clinical Characteristics and Laboratory Findings of COVID-19 between Intensive Care Unit and Non-Intensive Care Unit Pediatric Patients: A Multicenter, Retrospective, Observational Study from Iranian Network for Research in Viral

Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs). Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings. Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran. Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively; p<0.001). Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions

Comparison of developmental status of 5-year-old singleton children born through assisted and natural conceptions

Background: Approximately one percent of current live births of the world are conceived via assisted reproductive technologies (ART). Objective: The purpose of this study was to compare the developmental status of children born through assisted and natural conceptions at the age of five years. Materials and Methods: In a retrospective cohort study, developmental status of 5 years old children was evaluated via Persian version of 60-month Ages and Stages Questionnaires. Case group consisted of 61 singletons, term babies whom were born through ART in the Research and Clinical Center for Infertility, Yazd, Iran in 2005. Control group consisted of 61 term, first child, singleton and spontaneously conceived born five years old children whom were referred to Shahid Akbari primary health care center in 2010. Results: 58 girls (47.5%) and 64 boys (52.5%) were evaluated. Frequency of developmental delay in domains of fine motor (47.5% vs. 24.6%, p=0.008) and problem solving (60.6% vs. 34.4%, p=0.004) were more in ART born children. On logistic regression, fine motor development state was independently affected by maternal educational level (OR: 5.3, 95% CI: 1.67-16.30, p=0.004) and developmental status in problem solving domains was independently affected by maternal educational level (OR: 4.88, 95% CI: 1.25-19.07, p=0.02) and birth weight (OR: 7.1, 95% CI: 1.78-29.01, p=0.006) Conclusion: Maternal educational level and birth weight are important factors that influenced developmental outcome of ART born children

The Prevalence of Speech Disorder in Primary School Students in Yazd-Iran

Communication disorder is a widespread disabling problems and associated with adverse, long term outcome that impact on individuals, families and academic achievement of children in the school years and affect vocational choices later in adulthood. The aim of this study was to determine prevalence of speech disorders specifically stuttering, voice, and speech-sound disorders in primary school students in Iran-Yazd. In a descriptive study, 7881 primary school students in Yazd evaluated in view from of speech disorders with use of direct and face to face assessment technique in 2005. The prevalence of total speech disorders was 14.8% among whom 13.8% had speech-sound disorder, 1.2% stuttering and 0.47% voice disorder. The prevalence of speech disorders was higher than in males (16.7%) as compared to females (12.7%). Pattern of prevalence of the three speech disorders was significantly different according to gender, parental education and by number of family member. There was no significant difference across speech disorders and birth order, religion and paternal consanguinity. These prevalence figures are higher than more studies that using parent or teacher reports