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Background: Attention Deficit/Hyperactivity Disorder (ADHD) is a behavioral disorder in children which is characterized by one or a combination of three factors including hyperactivity, inattentiveness and impulsiveness. The purpose of present study was to investigate the effectiveness of ball and non-ball games on improvement of attention deficit/hyperactivity disorder in the 9-11 year old male students in Arak. Materials and Methods: In this pre/post-test designed clinical trial 60 male students with ADHD disorder, were randomly divided into three equal groups including ball games, non-ball games and control group. Practice groups had 12 weeks games therapy (3 sessions per week and 30-45 min per session). The symptoms of ADHD and Hyperactivity were evaluated through Child Symptom Inventory-4 (CSI-4) questionnaire before and after the 12-week practice programs. Results: The results of the present study revealed that after 12 weeks play therapy, both experimental groups had a significant decrease in ADHD symptoms in comparison with pre-test situation (p<0.05), but no significant difference was seen between ball games and non-ball games groups (p>0.05). Conclusion: Based on the obtained findings of the study it can be concluded that ball/ non-ball games, have a positive effect in improving and reduction of symptoms of ADHD.

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Background: Cerebral venous sinus thrombosis is a rare form of brain stroke caused by thrombosis in venous sinuses of Dura. This study reports on a patient with venous sinus thrombosis and brucellosis who presented with uncontrolled seizure. Case: A 33-year-old woman with past history of controlled complex partial seizure who presented with headache, asthenia, and uncontrolled seizure for one month is described in this study. She was febrile and in brain CT scan hemorrhagic focus in left posterioparietal and temporal lobe was reported. MRI and MRV proved venous sinus thrombosis in left transverse sinus. In laboratory assessment, brucellosis was confirmed as well. The patient treated with anticoagulant, anti-brucellosis, and antiepileptic agents and discharged in good condition with medication orders. Conclusion: Clinical suspicion and accurate evaluation is the most important clue in the diagnosis and treatment of brucellosis and venous sinus thrombosis, especially in uncontrolled seizure in patients who had previously been under control.

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Background: Gastric perforation is a rare occurrence in newborns with unknown etiology and risk factors. This study reports a case of acute gastric perforation in a preterm neonate and its risk factors. Case: The patient was a preterm neonate (26 weeks) with NG tube feeding with GI bleeding. The patient underwent abdominal surgery and gastric perforation in the anterior wall was reported. The risk factors for gastric perforation in this neonate were probably prematurity, low birth-weight, N-CPAP, and frequent insertion of NG tube. Conclusion: It can be concluded from this study that identification of risk factors and reducing or eliminating them are vital to the prevention of this complication.

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Background: Taxol is a diterpenoid compound that was first isolated from yew tree (Taxus brevifolia) and later from other plants such as Corylus avellana. Studies have shown that some of the endophytic fungi isolated from these plants are also capable of producing taxol. DBAT gene is one of the key genes in taxol biosynthesis pathway that catalyzes the synthesis of Baccatin III, one of the main precursors in taxol biosynthesis. The aim of this study was to investigate taxol production by endophytic fungi isolated from Corylus avellana.

Materials and Methods: In this case-control study, endophytic fungi were isolated from hazelnut trees in the Fandoghlo area, Ardabil province, and purified through hyphal tip method. Genomic DNA was extracted using CTAB method. The presence of DBAT gene was examined by polymerase chain reaction (PCR). Taxol production in fungal media was investigated via TLC (Thin Layer Chromatography) method.

Results: After purification, 60 fungi were isolated from different organs of hazelnut trees and the presence of DBAT genes in 12 isolates was proved by PCR with specific primers. Investigation of taxol production in culture of these isolates showed that 7 isolates were capable of producing taxol in laboratory conditions.

Conclusion: A group of endophytic fungi isolated from hazelnut, grown in the North West of Iran, had DBAT gene, encoding a key enzyme in the taxol biosynthesis pathway, and some were able to produce taxol in vitro.

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Background: Hydatid disease is a common infection caused by Echinococcus granulosus. Cerebral involvement is very rare and only occurs in 2% of all hydatidosis in endemic areas. We report a case of primary multiple cerebral hydatid cysts in a 23 years old patient. Case: A 23 years old female was admitted in our emergency ward with primary generalized tonic colonic seizure, left body and face hemiparesis and history of headache in last two months. Contrast enhanced CT and MRI showed a big well-defined, rounded, cystic lesion in the motor strip of right temporo-parietal region with mass effect causing midline shift which was diagnostic for brain hydatid cyst and several smaller cysts. There was no evidence of other organs involvement. The patient underwent the brain surgery. A big hydatid cyst (10cm in diameter) and some others adhering to brain parenchyma in different sizes were evacuated completely and without rupture using Dowling method. Patient received albendazole 400mg/two times a day for 2 months too. There was no cyst in patient’s MRI study in two years follow up.

Conclusion: Though low incidence, primary multiple cerebral hydatid cysts should be considered in endemic area using brain CT and MRI. Surgery is standard treatment of the disease.

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Background: Wolfram syndrome is a rare neurodegenerative autosomal recessive disorder. That occurs in association with diabetes mellitus, diabetes insipidus, and optic nerve atrophy, hearing loss, urinary tract infection and nervous complication.

Case: The present report belong to a 24 years old girl who was effected by diabetes mellitus in 10 years old & has been effected by Diabetes insipidus, recurrent UTI, hearing loss and other type of disorders in 20 years old.

Conclusion: Strict control of blood glucose and regular fundoscopy, for early detection of optic atrophy are important. Step in management of this syndrome and quality of life is improved with hearing and vision aid tools.

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Background: Sudden visual loss is one of the emergent problems that it may be a sign of a life-threatening disease. It should be quickly evaluated and identified the treatable causes.

Case report: A young man without any history of certain disease was referred to the emergency department with complaints of sudden blindness. He was presented with fever, coriza symptoms and progressive blurring of vision that ultimately led to his visual loss. After carefully evaluation, finally suspected diagnosis of acute fulminant multiple sclerosis was made.

Discussion: Multiple sclerosis is a chronic inflammatory disease that is associated with acute attacks of neurological dysfunction. Some of these attacks are an emergent situation and need to early detection and treatment. There is a variant of Multiple sclerosis that called Acute Fulminant Multiple sclerosis which can cause sudden visual loss.

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Background: Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcus. Man is an intermediate or accidental host of this parasite, and is infested by consuming contaminated plants or vegetables, or by contact with dogs. The larvae travel through the gut wall and 60-75% are filtered by the liver, and a few travel directly to the lungs to produce a hydatid cyst there. Growth of hydatid cysts has been reported in the spleen, muscles, bones, and brain. Hydatid cyst embolism to peripheral limb arteries is extremely rare.

Case: A 41-year-old gravided woman presented with sudden pain, erythema and warming of the olden infra-inguinal mass which existed from 1 year ago. The notable findings at physical examination included 40*20 mm diameter soft mass with warming and erythema in 4 cm below inguinal ligament of right lower limb. She didn’t mentioned any previous history hydatid cyst. Intraoperatively, Percutaneous aspiration of the mass was performed which demonstrate white turbid fluid. after the surgical incision we saw the white colored subcutaneous hydatid cyst and completely remove it and send it to pathological examination which confirmed hydatid cyst diagnosis. further liver ultrasound and chest radiography hasn’t shown any evidence of liver or lung involvement.

Conclusion: Cystic echinococcosis may affect all organs, but mostly settles in the liver and lungs. We do not have data on the means by which the larvae of echinococcosis reach the inguinal area without liver and lung involvement. Considering the anatomy of the groin and its lymphatic tissue, we can make an assumption about how the hydatid cysts settle in the groin space. Although it occurs rarely, larvae in the gastrointestinal tract may pass to the lymphatic circulation, and then settle in the groin space through the rich lymphatic flow of inguinal area.

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Background: Catamenial recurrent pneumothorax is spontaneous pneumothorax in women of reproductive age, which includes 1-30% of spontaneous pneumothoraces in women and is associated with the menstrual cycle.

 Case: A 39-year-old woman with sudden onset dyspnea, respiratory distress and decreased right side respiratory sounds with a history of spontaneous pneumothorax and chest tube placement one month ago. The patient's symptoms improved after chest tube placement and within less than 24 hours after onset, she began menstruating. Treatment was performed with chemical pleurodesis with tetracycline and oral danazol.

Conclusion: Catamenial pneumothorax and thoracic endometriosis should be considered in all women of childbearing age with spontaneous recurrent pneumothorax. Early detection of this syndrome can result in reduction of morbidity and mortality with recurrence episodes.

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Background: Hydatid disease is a zoonotic infestation by a tapeworm of the genus of Echinococcus that characterized by cystic lesions in the liver and lungs but rarely in other parts of the body.

Case: Known case of chronic Lymphocytic leukemia was a 56-years old man with several hydatid cysts of liver and lungs that was hospitalized because of ascites and abdominal pain. The patient received albendazol and surgical operation with diagnosis of peritonitis and complicated hydatid cyst in lungs and liver and Peritoneum. Patient expired with DIC and sepsis.

Conclusion: This case report provides evidence that complicated hydatid cysts in immunocopromised patients have a bad prognosis and can not be safely treated by medication and surgery.

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Background: Myelomeningocele is one of the common congenital malformation in childhood that has association with many disorders. in addition to routine management of associated disorders surgical repair of myelomeningocele has been considered in many cases . The aim of this study is to evaluate the role of myelomeningocele surgical repair in prognosis of children with myelomeningocele

Materials and Methods: This is a case-control study from 2001 to 2013 in 60 infants with myelomeningocele in two department of neurosurgery in Arak and Ilam cities (Vali Asr and Imam Khomeni hospitals, respectively). Infants were divided into two groups according to operable and inoperable cases (each group includes 30 cases). The prognosis of two groups was investigated with respect to mortality, and Stark and Drummond disability rating scale. Data were analyzed with SPSS 18 software.

Results: Case group had better prognoses compared to control with respect to handicap (p=0.003), urinary tract disorders (p=0.006), IQ (p=0.001), global disability(p=0.006) and mortality rate, but there was no difference between two groups with respect to hydrocephalus(p=0.3).

Conclusion: According to the results, mortality, disability and prognosis of infants with myelomeningocele that underwent operation were better. In conclusion, early myelomeningocele repair is advised for infants, because it affects the improvement of prognosis and the quality of patients' life.

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Background: This essay reports a case about tissue defect of heel due to melanoma excision.

Patient history: The patient was a man 60 years old with a heel ulcer that had reported malignant melanoma in biopsy. Then the ulcer was done under wide local excision.

Materials and Methods: We should use flap for tissue defect coverage that tendon and heel bone are exposed from it. It seems using skin graft is not useful, because skin graft in persistent contact with shoes will get chronic ulcer. Among different flaps (sural flap or medial plantar flap), we decided to use medial plantar flap. The advantage of this flap is its sensority and low volume.

Conclusion: Conclusion with due attention the results, The meial planter flap, as an efficient method, is adviced to teconstruct heed specially after excision of melanoma.

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Abstract

Background: The present research aimed to measure the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) on reducing the severity of symptoms of post-traumatic Stress Disorder (PTSD) and Stuttering in a four-year-old child post-traumatic stress disorder in children is one of the disorders relating to trauma and stressful factors, also, stutterring or word fluency disorder is a nerve growth disorder.

Materials and Methods: This research design was conducted as a case study with a multiple baseline design. Participant in this research was a four-year- old child with Diagnostic Posttraumatic Stress Disorder and Psychogenic Stuttering. He had been placed under the intervention with EMDR at Shahid Birjand Counseling Center. The instruments used for this research included demographic researcher-made questionnaire, the third edition of stuttering severity test, the scale of parents’ report of post-traumatic Symptoms and child’s report of posttraumatic Symptoms. Data analysis was done through graphic and descriptive analysis. The data was collected as base line and during the treatment as well as after the treatment and follow-up (in terms of 3 and 24 months).

Results: Means percentage improvement (MPI) to reducing the severity of post-traumatic symptoms was achieved as %74.66 and it was %56.06 for reduction of the severity of stuttering and they continued to maintain in the follow-up period.

Conclusion: Results showed that EMDR method had affected on reduction of the severity of post-traumatic stress disorder symptoms and stuttering intensity.

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Abstract

Introduction: Echinococcosis or hydatid cyst disease is one of the most common infectious diseases between animals and humans (zoonosis) that is endemic in all the countries of the Mediterranean region, including Iran. Pelvic involvement is rare, and the involvement of the uterus is very rare.

Case Report: 26-year-old female patient complained of limb paresis, ataxia and progressive headaches diagnosed with hydatid cyst of the brain was undergone surgery. The pain and slight swelling in the area of the wrist occurred, one year later and with the same diagnosis, surgery was performed again. Abdominal ultrasound showed two cystic lesions in the suprapubic region with a diagnosis of hydatid cyst of the uterus, 3 years later, surgery was performed. In all cases, the diagnosis was confirmed by pathology.

Discussion: Follow-up of patients with radiologic and serologic methods is necessary.

Conclusion: In patients with any clinical manifestation of endemic areas, particularly if there is a previous history of hydatidosis, hydatid cyst should be considered in terms of risk.

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Background and Aim: Acquisition skill in sentence producing is one of the criteria for speech development. By developing and increasing the age, we are witnessing the emergence of compound sentences in speech. Clinical treatments for language disorders in Iran are mostly based on the experiences of Speech Language Therapists or in accordance with English language norms. We need to examine how the length of utterance and compound sentences develop in Persian. The study aimed to report the development of compound sentences and Mean Length of Utterance (MLU) for a Persian-speaking child from 15 to 34 months.
Methods & Materials: In this longitudinal case report, based on Developmental-Descriptive model, MLU and emergence of simple compound sentences of a Persian speaking girl sampled and described from 15 to 34 months by daily scripting. R software version 4.0.2 was used for data analysis. Correlation of age with linguistic variables through Pearson correlation coefficient was evaluated. 
Ethical Considerations: In this paper, the principles of publication ethics were considered.
Results: At the age of 21 months and 13 days, the child uttered her first simple two-word sentence, and at the age of 26 months and 29 days, she used a four-word compound sentence. With the emergence of compound sentences, the increase in the MLU has gained considerable speed. In a few days, we see the addition of a unit to the length of the sentence (word). There was a significant relationship between the MLU and age (r=‌0.925, P=‌0.001), Mean length of sentence and number of words in Persian speaking child (r‌=‌0.910, P=‌0.002) and total number of words and age (r‌=‌0.928, P<0.001). 
Conclusion: Although several longitudinal studies have been conducted on the development of MLU and number of words in other languages, similar studies are rare in Persian. It is important to conduct studies of this type in order to make cross-linguistic comparisons and to study the linguistic universality and language specificity. By increasing age, we see an increase in the number of words in a child's vocabulary, the emergence of compound sentences, and an increase MLU. At 27 to 28 months, there is a dramatic change in the development expressive language as the compound sentences appear. It seems that emergence of compound sentences in the language output, also plays a significant role in increasing the MLU and can be considered in clinical language assessments.

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Introduction: Some intracranial surgeries must be performed while the patient is awake. Awake craniotomy is an intracranial surgical procedure in which the patient remains in a state of controlled consciousness while the surgery is performed. The aim of this study was to present a case of intracranial surgery to remove a tumor in the right frontal cortex using awake craniotomy.
Case Report: This report describes the anesthetic management of a 22-year-old male undergoing craniotomy with a fully awake technique. This was the first case of craniotomy performed entirely awake (from the beginning to the end of the operation) at Arak University of Medical Sciences and Valiasr Hospital in Arak, After preoperative preparation and evaluation, scalp nerve blocks targeting the cranial nerves innervating the scalp and head muscles were administered at specific sites. Mild sedation was provided using oxygen supplementation, followed by surgical incision. The lesion was examined intraoperatively while the patient remained awake, and the tumor was safely excised under full wakefulness. A combination of local and regional anesthesia and light intravenous sedation was utilized. Two types of local anesthetics, lidocaine 1.5% and bupivacaine 2.5%, were used for anesthesia, as well as intravenous sedatives and anesthetics such as propofol, remifentanil, and dexmedetomidine were administered for sedation. Throughout the operation, the patient was awake and breathing spontaneously, and the function of the brain nerves during the operation could be evaluated. Finally, the patient's surgery was performed without any complications and in stable condition, and the patient was transferred to the intensive care unit in good general condition, awake and fully alert.
Conclusions: Although maintaining analgesia and hemodynamic and adequate ventilation during fully awake craniotomy poses challenges, this technique is critical for intraoperative monitoring of cranial nerve function and preventing neurological deficits. By precisely administering scalp nerve blocks and carefully titrating sedatives (propofol, remifentanil, dexmedetomidine), we successfully performed the procedure under full wakefulness. With this method, potential surgical complications are prevented, and the patient also experiences satisfactory painlessness. Applying this technique was satisfactory for our patient.