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Acute necrotizing encephalopathy (ANEC) is a rare illness with high incidence in East Asia. It is accompanied with respiratory infection, gastrointestinal infections, and high fever with quick impaired consciousness, and convulsion. In this case report, Turkmen 6 month's girl that was introduced after an infection with no disease or clinical abnormalities. She was vaccinated accordingly; initially she had fever with generalized tonic-clonic convulsion (seizures) for 5 to 10 minutes level of consciousness decreased later on. She was transferred to Talghani Medicat Education center in nortern Iran. At the time of admition her vital signs were as below: RR: 30, GCS: 8-9, RP: 110, BP: 90/80. In the patient's history, there was neither Trauma history, nor food or drug poisoning, also no clinical history. After convulsion, the level of consciousness decreased and serum biochemistry showed normal electrolytes concentration. In further follow - up, AST increased to 98 units, ALT to 58 units, and ammonium to 215 units. In CSF Sample, protein level increased to 330 units, without any avidences of pleocytosis, blood, or Serum glucose drop. In CT without contract, hypodensity the cornea in thalamus and caudate cores were seen in 2 sides. The ventricles were normal and there were no signs of bleeding and pressure. In brain M.R.I, abnormal signal in 2 sides, blood samples cultivation, CSF, and testing urine for bacterial infection were negative. The patient was diagnosed with necrotizing encephalopathy and subsequently was treated with metyle prednisolone (20 mg daily). During hospitalization, level of consciousness increased and fever stopped. There was not recurrence of convulsion, but the patients still had some problems in moving, verbal and communication.

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Visceral leishmaniasis, also known as Kala-azar, is one of the main parasitic vector borne diseases, which transmitted by sand fly. The current study reported the seven positive cases of Kala-azar in Maravetapeh county in Golestan province, Iran from 2007-15. Using geographic information system, villages which had confirmed cases of Kala-azar were identified and their geographical information was registered. Villages with confirmed cases of Kala-azar were introduced as at risk villages for visceral leishmaniasis. All of these cases were aged under 6 years and in all of them fever and splenomegaly was reported. All subjects had lower normal range of hemoglobin and plateles. These cases were reported from 6 villages in 3 districts of Maraveh Tapeh County. All of these villages are in hot and dry areas of county and they have mountainous and semi-mountainous geographical status with higher altitude compare to other villages. Fifty two villages of county were recognized as at-risk villages for Kala-azar. Kala-azar presented in sporadic condition in Maravetapeh County. Continuous case finding of Kala-azar for early diagnosis and treatment is necessary.

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Neurofibromatosis type1 (NF1) with the incidence of 1 in 3500 births, is the most common disorder which affects skin and peripheral nervous system. NF1 results from mutations in NF1 gene. The NF1 gene spans 350kbp and to date, nearly 2434 mutations in it were reported. The gene with 100 percent penetrance is located on chromosome 17 encoding neurofibromin protein. Recently, many challenges of its genetic analysis have been overcome through the application of new sequencing techniques. In present study patients with neurofibromatosis type 1 have been characterized from clinical symptoms such as presence of café au lait spot, plexiform neurofibroma, optic nerves involvement, presence of several patients in first degree relatives. These patients were in different ages including 73, 63, 44, 20 with different symptoms and severities of disease. In this communication, a NF1 family with 4 cases in 3 generations has been presented.

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Fibrodysplasia ossificans progressiva (FOP) is an extremely rare autosomal dominant disorder having variable expressivity with complete penetrance. FOP incidence has been estimated to be 1 per 2 million. FOP caused by mutations in ACVR1 gene encoding bone morphogenetic protein type-1 receptor. To date, 15 types of mutations have been reported. The majority of cases were determined to be the rsult of a new mutation occuring sporadically. Here we report a 20 years old girl who's suffering FOP for 11 years.

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Obsessive-compulsive disorder is manifested by a group of symptoms including intrusive thoughts, rituals, mental obsessions and compulsions which creates great distress for the individual. Traumatic brain injurie known as one of the rare reasons of obsessive-compulsive disorder. This report is about 3 patients that suffer from obsessive-compulsive disorder after a traumatic brain injury and loss of consciousness. All 3 patients had no sign of obsessive-compulsive disorder before the trauma. Information on these reports, examine the relationship between obsessive-compulsive disorder and traumatic brain injury. Findings from the neuroimaging methods for these patients have been reported. In this study, all the reported cases that had sever traumatic brain injuries were assessed by neuroimaging methods and brain injuries were obsereved in the right temporal in first case, in the right temporal and both frontal sides in second case, in the splenium corpus callosum and the right brain tegmentums and diffused axonal injury and extra-axial hematoma in the left temporal lobein the thirtd patient. Based on the findings of this study obsessive-compulsive disorder can rarely be developed after a traumatic brain injury and by assessing the neuroimaging findings, we can conclude that there is a relationship between the brain injuries and the symptoms of obsessive-compulsive.

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Arachnoid cysts have primary and secondary types. The prevalence of Arachnoid cysts is about 1% of all tumors in cranial cavity. Based on anatomic position, arachnoid cyst can cause different clinical manifestations including hemiparesis, increase intracranial pressure, macrocephaly and isolated headache and stop body growth. The natural course of the disease is not exactly clear. Some of patients have no symptoms during life and some of them may show some symptoms after a while. This case report is about a 10 years boy who had no sign except generalized headache. Anatomic position of the cyst was in right temporal lobe of the brain on the temporal, parietal and the great wing of sphenoid bones. Arachnoid cyst diagnosed through MRI and CT-Scan. Patient treated with ibuprofen for three days and then patient followed up to treat with surgery method when other clinical symptoms appeare in the patient.

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Trazodone is a weak inhibitor of serotonin reuptake and a potent antagonist of serotonin 5HT2A and 5HT2C receptors. Urinary incontinence is a rare side effect of anti-depressant drugs. Side effects of antidepressants can cause delay in treatment of patient and ultimately non-compliance in patients who take this medicinal drug. Here we present a case of trazodone induced urinary incontinence in a woman at menopause period. The patient was a retired woman with 63 years old. She reported a history of bladder prolapsuse and history of consumption of quetiapine and propranolol. But the patient had no history of other somatic illnesses, drug and urinary incontinence before administering the medicinal drug. Psychiatrist prescrided trazodone with dose of 50 mg, orally per day when appearence of the depression, anxiety and insomnia. But, the patient suddenly suffered from urinary incontinence, despite this situation the patient had continued taking the drug for three days. Due to the uncertainty of the above complications patient, was forced to discontinue the drug and follwoing drug discontinuation the side effect disappeard. After the improvement of the urine incontinence and full recovery, re-treatment was began with the same dose of 50 mg trazodone for the patient, but immediately after drug administration to the patient, urinary incontinence appeared once again. Trazodone can be considered as important factor to cause urinary incontinence. Therefore, this issue should be considered whenever this pharmaceutical drug is prescribed.

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The proximal radioulnar joint plays an important role in elbow and forearm movements. Radial head fracture involves about 20% of the elbow fractures, which is most often accompanied by other damage to the soft or bone tissue. Isolated form is about 2% and bilateral form is rare. Most radial head fractures are the result of low energy and falling down with outstretched hands. Heavy sports injuries, high energy trauma and crashes cause a breakdown with displacement and the possibility of further complications.In this article we  reported a woman  nurse with 35 years old whom suffered pain and swelling of both elbows due to simple falling down with outstretched hands. In the clinical examination, there was a bilateral tenderness and swelling of the elbows. Movements were decreased in right side. There was no nerve defect. In the Xray radiography, bilateral radial head fractures, Mason-type 3 at right and type 1 at left elbow were observed. Right elbow treated by open reduction and internal fixation by mini plate and screws and left side treated by conservative method. The patient was discharged with indomethacin 25 mg 3 times a day for 6 weeks and bilateral long arm splint for 5 to 7 days, active movements were begun. Subsequently, the patient was not adviced for physiotherapy. Complete movements of elbow joints were obtained in right side and left side after 8 and 4 weeks due to teratment. Precise clinical examinations and correct radiographs are necessary to diagnose the bilateral radial head fractures. Early diagnosis and proper treatment and, if necessary, physiotherapy leads to proper improvement and acceptable movements and function.

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Pediatric femoral neck fracture is rare and account for less than 1% of all fractures in childhood. The proximal femur in children is extremely strong, and high-energy forces in 80-90%, following the axial force associated with hip rotation or direct blow are necessary to cause fracture. In this report, the method of femoral neck fracture fixation in eight-year-old girl after car accident is reported. During the operation, we noted a severe femoral neck fracture that was irreparable with the available tools (pin, screw, plate and DHS), which inevitably had to be used by Transosseous method with fiber wire #2, used in proximal humeral fracture fixation. Then, we obtained a fairly satisfactory result with a distal femoral pin inserting it into two-sided spica cast. Although, this kind of fracture is rare, but with a qualified clinical examination, early diagnosis, proper treatment, familiarity with surgical techniques and fixation reduces the complications and this method can be effective in obtaining the desired result.

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Osteoid osteoma is benign bone tumor, in which talus bone involvement is rare. This case was a 17 year old man with a right ankle pain and reduced range of motion since one year ago. Following clinical evaluation and radiological studies (X-ray, CT scan, and MRI), a bone tumor was detected in the talus with a possible diagnosis of Osteoid osteoma. The patient was operated with ankle anterior approach and the tumor was resected from the site. The patient was discharged after two days. The patient's pain was eliminated after surgery. Ankle movements are back after two months. Due to the rare nature of the disease and clinical diagnostic problems and its unusual radiographic manifestations, osteoid osteoma in chronic ankle pain in young patients, is included in the list of differential diagnosis.

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Late postpartum hemorrhage (PPH), as an unpredictable obstetrics emergency, is characterized as a leading cause of mortality and maternal complications worldwide. Uterine artery pseudoaneurysm (UAP) is a rare cause of PPH, which may develop after uncomplicated cesarean and Gynecologic surgeries, including dilatation and curettage, hysterectomy, and myomectomy. Uterine artery embolization has become a popular treatment for postpartum hemorrhage. In this case report, we present a patient with PPH due to UAP who was treated by endovascular embolization of the uterine artery. A 39-years-old woman was admitted 55 days after her third cesarean section due to massive vaginal bleeding resulting in severe hemodynamic derangements. After initial resuscitative measures, diagnostic studies revealed the UAP, and soon after, the coil embolization of the uterine artery was performed. When conservative managements fail to control massive late postpartum hemorrhage, angiography and embolization of the uterine artery can be the modality of choice, rather than hysterectomy (with its potential complications) which preserves the patient's fertility.

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Lycanthropy is a delusive belief that the affected person or others transform into a wolf or other animals. Lycanthropy has been known for over 2000 years. This paper introduces a 51-year-old married woman who has had symptoms of depressive disorder for the past four years, following forced marriage and has recently been diagnosed with lycanthropic syndrome. The patient was diagnosed with depression along with lycanthropy symptoms (psychotic depression) and was treated with antipsychotics, antidepressants, and individual psychotherapy. Over a 16-weeks follow-up, her lycanthropy was reduced and symptoms of depression improved relatively.

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Kawasaki disease is a medium-size vasculitis with peak incidence among infants of 9 to 11 month age. This case report represents a female infant of 18-month age whom was admitted to the Taleghani Pediatric Center of Gorgan, Iran; with referral for admission due to persistent fever for roughly 2 weeks despite various outpatient treatments. Upon the admission, Echocardiographic study was performed to assess whether the patient fulfils cardiac criteria of Kawaski disease which was consistent with the diagnosis and also positive for serious coronary complications in the infant. General condition of the patient improved as the treatment with both IVIG and Corticosteroids was initiated and carditis seemed to vanish in echocardiographic studies but as expected aneurysmal growth can last for over 80 days and in this case serial echocardiographic studies confirmed the formation of giant coronary aneurysms. Diagnosis of Kawasaki disease is based on persistent fever and consistency with clinical criteria and the main purpose of this case report was to emphasize the need to consider this disease in cases of persistent fever to avoid the serious following complications.

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Myocardial infarction is characterized by the interruption of blood supply to part of the myocardium, leading to tissue damage. Acute myocardial infarction rarely affects young adults. However, considering the possibility of its occurrence, particularly in the presence of risk factors such as obesity and smoking, can help provide appropriate and timely diagnostic and therapeutic measures. Herein, were present a case of acute myocardial infarction in a young adult male.
 

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Understanding maxillary sinus hypoplasia (MSH) and associated sinonasal variants is crucial for the success of diagnostic and therapeutic procedures in maxillary sinus and maxillary dental implant surgery. The aim of this study was to investigate a rare case of unilateral maxillary sinus hypoplasia associated with lower orbital floor displacement, without involving the Uncinate process. A 31-year-old woman presented to the Department of Oral and Maxillofacial Surgery at Babol Dental School for rhinoplasty without any complaints of headache or nasal congestion. She had no history of trauma, congenital or bone diseases/abnormalities. Cone Beam Computed Tomography (CBCT) images revealed left maxillary sinus hypoplasia, lower orbital floor, and increased thickening of the sinus mucosa. The patient's photograph also showed lower displacement of the orbital floor. The diagnosis of unilateral maxillary sinus hypoplasia in this study was based on clinical manifestations and coronal views of CBCT and CT scans. Symptoms of hypoplastic sinus include chronic headache, facial pain, voice problems, or may sometimes be asymptomatic. If the surgeon is not aware of the hypoplasticity of the sinus, complications during surgery may increase, including post-surgery complications such as visibility of the low orbital floor and resulting patient confusion. This study highlights the importance of using CBCT as a valuable diagnostic tool to identify anatomical variations and details of the hypoplastic sinus. This approach helps the surgeon to inform the patient and provide an appropriate treatment plan, especially in cases involving dental implants or sinus surgery.
 

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Unusual chest pain is often observed in older women with diabetes, high blood pressure, and heart disease. Some unusual manifestations of myocardial infarction have so far been reported, including earache, flank pain, fatigue, neck pain, nausea and vomiting, shortness of breath, and shoulder pain. In this article, we report a case of rare symptoms of cardiovascular disease with referral symptoms, including abdominal colic pain. The patient was a 55-year-old man with a history of diabetes under treatment with insulin who had abdominal colic pain, periodic epigastric tenderness, and frequent nausea and vomiting for 2 days. At first, he was suspected of pancreatitis, but considering that his amylase and lipase enzymes were normal and no evidence of the existence of free abdominal and pelvic fluid was observed according to ultrasound results, the hypothesis of pancreatitis was rejected. Despite the normality of the initial ECG until the night before the visit by the cardiologist, the patient experienced more severe pain and, as a result, was referred to the cardiac internal ward until the end of the same night, after angiography, it was found that the obtuse marginal (OM1) branch of coronary arteries had severe narrowing (90-99%). Abdominal tenderness and colic pain are among the unusual manifestations of myocardial infarction. In patients with cardiac risk factors, such as diabetes and chronic kidney disease, despite the existence of a normal ECG, uncommon manifestations should be checked.

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Renal cavernous hemangioma is a rare benign tumor. This case report describes a 44-year-old male who was incidentally found to have a renal mass during an abdominal and pelvic ultrasound. The patient's abdominal ultrasound revealed a mass, which was further evaluated with a CT scan. The CT findings suggested renal cell carcinoma. Suspecting malignancy, the patient underwent radical nephrectomy. Histopathological and immunohistochemical examinations ultimately diagnosed the mass as a cavernous hemangioma. Despite its benign nature, the patient was followed up with a control ultrasound three months post-surgery. This case is presented due to the significant clinical and radiological resemblance of this tumor to renal carcinomas, highlighting the importance of considering benign tumors in differential diagnoses.

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Posterior shoulder fracture dislocation (PSFD) is a rare and challenging injury. Early diagnosis and treatment can prevent serious complications and disability, reducing the risk of avascular necrosis of the humeral head and joint destruction. Several treatment options have been proposed, depending on the patient’s age, duration of dislocation, humeral head bone defect, length of the metaphysis attached to the reverse Hill-Sachs, osteopenia and functional demand, and concomitant diseases. Open anatomic reduction and internal fixation is a suitable option, particularly in young and active individuals. Humeral joint replacement is recommended for non-fixable 3- or 4-part fractures, particularly in elderly individuals with low demand and osteoporosis. This article reports a case of closed, irreducible PSFD that was treated with open reduction and internal fixation using a plate and deltopectoral approach.

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Trichotillomania disorder, or hair pulling disorder, is a condition in which patients unconsciously engage in hair-pulling, which reinforces compulsive hair pulling behaviors, culminating in conscious and deliberate hair pulling. Behavioral therapy is a common treatment approach for this disorder. Habit-reversal training (HRT) is a particularly effective treatment method for children with intellectual disabilities who exhibit this disorder. This case report presents the efficacy of HRT in reducing trichotillomania-associated severity and distress. The patient was a 13-year-old girl with intellectual disability who met the diagnostic criteria for trichotillomania according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). She received eight sessions of HRT techniques over one month. The Massachusetts General Hospital Hair Pulling Scale (MGH-HPS) was employed to measure the severity and distress of the hair pulling behavior. Given the patient’s intellectual disability (intelligence quotient [IQ]=65) and limited ability to respond to self-report questions about the nature of self-interests, the parent-report version of the scale was used both during the treatment and the one-month follow-up. The effectiveness of the intervention was evaluated using visual analysis of graphs, percentage of improvement, effect size, and photographs of the eyebrow hair pulling before and after treatment. The results indicated that the HRT significantly reduced both the severity (effect size=1.75) and distress (effect size=1.77) of the trichotillomania disorder, and the patient exhibited a high percentage of improvement. The one-month follow-up demonstrated that the results were maintained.
 

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Autism is a neurodevelopmental disorder characterized by deficits in communication skills as one of its most prominent diagnostic criteria, and the initiation of intensive early interventions is a critical determinant in the prognosis of this disorder and the reduction of its severity. This study was conducted to determine the effect of the Parent-Implemented Early Start Denver Model (P-ESDM) interventions in improving communication skills and reducing the severity of symptoms in children with autism. This experimental case report with an A-B design was conducted on 4 children (3 boys and 1 girl) under the age of 60 months diagnosed with autism, who were referred to the Shekoufeha Autism Center in the city of Mahshahr, Iran during 2021. Initially, their parents received training in the P-ESDM interventions through 12 individual, one-hour, weekly sessions. The Autism Treatment Evaluation Checklist (ATEC) was used to assess communication skills, and the Gilliam Autism Rating Scale-Second Edition (GARS-2) was employed to assess autism severity. Assessments were conducted in 7 phases (2 baseline assessments, 3 assessments during the intervention, and 2 follow-up assessments). Data analysis involved descriptive statistics, within-condition and between-condition analyses, and an examination of the percentage of overlapping data (POD) and the percentage of non-overlapping data (PND). The implementation of the P-ESDM training culminated in the decreased mean scores, improved communication challenges, and decreased autism severity scores across all 4 subjects. In the within-condition analysis, the subjects’ communication challenges and autism severity scores exhibited a descending and stable trend. Moreover, in the between-condition analysis, the PND at the baseline and intervention phases was at its maximum (100%), and the POD was at its minimum (0%). The observed changes persisted until the follow-up stage. The findings of this study demonstrated that the implementation of the P-ESDM interventions could significantly reduce communication challenges and the severity of symptoms in children with autism, leading to improvements in their communicative skills.