Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 5 4 2021 01 16 98 100 Nasim Shokouhi Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Yas Hospital, Tehran, Iran. Zeenat Ghanbari Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Vali-e-Asr Hospital, Tehran, Iran. Nafiseh Saedi Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Yas Hospital, Tehran, Iran. 2019 10 06 2020 05 10 Uterine prolapse and cervical elongation are rare conditions that can complicate pregnancy, labor, and its management. To minimize complications, proper management of this condition is necessary. A 26-year-old woman referred to our outpatient clinic with a lump protruding from her vagina. She was 16 weeks pregnant. Physical examination revealed uterine prolapse and cervical elongation, so to prevent the complications of the protruded cervix, a pessary was inserted. She had the pessary during the first stage of labor until the rupture of membranes (at 6 cm cervical dilatation). After removal of the pessary, although the cervix was out of introitus, the active phase of labor initiated and a normal vaginal delivery was done. New- onset prolapse during pregnancy with more probability is due to cervical elongation. During labor and delivery, this condition could be managed with conservative methods, including pessary placement. and this condition could be managed with conservative methods including pessary placement during pregnancy and labor. https://crcp.tums.ac.ir/index.php/crcp/article/view/304 https://crcp.tums.ac.ir/index.php/crcp/article/download/304/367

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 5 4 2021 01 16 128 130 Narjes Zarei Jalalabadi Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Morteza Daraei Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Samaneh Parsa Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Neda Faraji Department of Internal Medicine, Baharlo Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2020 05 24 2020 07 03 A 28-year-old woman with a history of transfusion-dependent thalassemia major who did not receive any iron-chelating agent presented with symptoms of iron overload with marked diffuse increased liver density. Eventually, the diagnosis of secondary hemochromatosis was done based on the aforementioned history, laboratory, and imaging findings. https://crcp.tums.ac.ir/index.php/crcp/article/view/358 https://crcp.tums.ac.ir/index.php/crcp/article/download/358/374

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 5 4 2021 01 16 101 105 Azam Tarafdari Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Sedigheh Borna Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Sheida Janatrostami Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Fatemeh Farajzadeh Vajari Obstetrician & Gynecologist, Fellowship in IVF & Infertility, Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran 2020 02 07 2020 06 26 Being considered as an important life-threatening condition, Cervical Pregnancy (CP) is defined as the implantation and growth of the gestational sac in the endocervical canal. Due to high maternal mortality and morbidity expectant management is not recommended. There is no definite treatment for this complication. During this case series study, we used an algorithm for CP treatment according to gestational age, presence of fetal heart activity, hemodynamic stability, and patients desire for future fertility in 8 patients. We used a combination of several modalities such as fetal heart reduction, systemic methotrexate, and uterine artery embolization to successfully treat all of them. Reproductivity ability of all patients has been reserved and 3 pregnancies including 2 terms and 1 preterm occurred during the follow-up period. https://crcp.tums.ac.ir/index.php/crcp/article/view/336 https://crcp.tums.ac.ir/index.php/crcp/article/download/336/368

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 5 4 2021 01 16 106 109 Pantea Tajik Dapartment of pediatricsSemnan University of Medical Sciences, Semnan, Iran. Amir Hossein Goudarzian Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran. Zeinab Pourzahabi Department of Pediatrics, Amiralmomenin Hospital, Semnan University of Medical Sciences, Semnan, IranDepartment of Pediatrics, Amiralmomenin Hospital, Semnan University of Medical Sciences, Semnan, Iran. 2020 03 26 2020 05 05 Background: Carnitine palmitoyltransferase-1 (CPT-1) deficiency is a rare autosomal recessive disorder of mitochondrial long-chain fatty acid oxidation with fewer than 30 case reports.  Case report: A 30-month-old child with fever and loss of consciousness was referred to our hospital. She had symptoms of colds for three days that were treated, but she had anorexia. Her abdomen was soft and hepatomegaly 5 cm below the edge of the rib was detected. According to a neurological consultation, with the probability of a seizure, the patient began to receive levetiracetam. The patient was treated with sodium benzoate due to her decreased level of consciousness and increased blood ammonia (300). In the acylcarnitine profile, mildly elevated levels of single acylcarnitine were seen to confirm the diagnosis of CPT-1 deficiency. Conclusions: CPT-1 deficiency is a rare autosomal recessive defect of mitochondrial long- chain fatty acid oxidation that presents as an acute “Reye-like” hepatic encephalopathy and non-ketotic hypoglycemia, developmental delay, and hepatomegaly. https://crcp.tums.ac.ir/index.php/crcp/article/view/344 https://crcp.tums.ac.ir/index.php/crcp/article/download/344/369

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 5 4 2021 01 16 110 112 Reza Bidaki Department of Psychiatry, Research Center of Addicton and Behavioral Sciences, School of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran AND Diabetes Research Center, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran. Sina Negintaji Student Research Commitee, School of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Mohammad Javad Dehqan Student Research Commitee, School of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Fatemeh Saghafi Student Research Commitee, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Maryam Naseri Bafrouie Department of Medical Student, School of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Iran. Amir Mohammadi Student Research Commitee, School of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. 2020 03 30 2020 05 05 Psychotic disorders are a group of severe mental disorders that can remarkably affect brain functions by altering beliefs and perceptions. There are different types of psychotic disorders, including schizophrenia, delusional disorder, paraphrenia, etc. The symptoms of a psychotic disorder include delusions, mood swings, difficulty concentrating, unusual behavior, altered feelings, and so on. Symptoms may vary from person to person and change with time. Antipsychotic drugs and psychotherapy can be used in the treatment of psychotic disorders. In this case report, we describe a 39-year-old woman who suffered from methamphetamine- induced delusional parasitosis. https://crcp.tums.ac.ir/index.php/crcp/article/view/345 https://crcp.tums.ac.ir/index.php/crcp/article/download/345/370

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 5 4 2021 01 16 113 117 Niloufar Johari Varnoosfaderani Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Sahar Karimpour Reihan Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Mahsa Abbaszadeh Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Nasim Khajavirad Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2020 04 01 2020 05 05 One of the critical factors with a broad impact on health is obesity. Besides its cardiovascular comorbidities, obesity’s probable association with hypogonadotropic hypogonadism in men will be discussed in this article by reporting a severely obese boy, presenting with the absence of secondary sexual characteristics and hypertension. The hypothalamus-pituitary- gonadal axis can be influenced by several mechanisms at different levels of the axis. Some of these pathophysiological mechanisms, related to our case are explained to explore the association of obesity with reproductive disorders. Adipose tissue plays a prominent role in the metabolism of hormones that are secreted by other glands. Obesity as a preventable risk factor is valuable to be researched, to decrease the burden of its morbidity and mortality. Thus more studies should be done in the future to determine the complex network of factors contributing to hormonal imbalances seen in obese people. https://crcp.tums.ac.ir/index.php/crcp/article/view/347 https://crcp.tums.ac.ir/index.php/crcp/article/download/347/371

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 5 4 2021 01 16 118 120 EN Elham Zare Department of Internal Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran. Maryam Panahi School of Medicine,Tehran University of Medical Sciences, Tehran, Iran. Zahra Mahboubi Fooladi Department of Radiology, School of Medicine, Shahid Behesht University of Medical Sciences, Tehran, Iran. 2020 05 07 2020 07 03 We report a case of laboratory-confirmed COVID-19 with an unusual presentation of fever and rash without any respiratory symptoms. Skin manifestations can help physicians to rapidly diagnose and control this pandemic disease. https://crcp.tums.ac.ir/index.php/crcp/article/view/353 https://crcp.tums.ac.ir/index.php/crcp/article/download/353/372

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 5 4 2021 01 16 121 123 Behshad Pazooki Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Shahrzad Shojaie Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2020 05 24 2020 07 03 Reactive arthritis is clinically defined as inflammatory aseptic arthritis which develops shortly after an extra-articular infection. The classic triad of conjunctivitis, urethritis, and arthritis is found in a minority of patients. Patiepresent with an asymmetric mono- or oligoarthritis that predominantly affect lower limbs. Here, we present a case of reactive arthritis with inadequate primary response to Nonsteroidants Usually  l Non-SteroidalAnti-inflammatory Drugs (NSAIDs).  https://crcp.tums.ac.ir/index.php/crcp/article/view/357 https://crcp.tums.ac.ir/index.php/crcp/article/download/357/373

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 5 4 2021 01 16 124 127 Nasim Eftekhari Department of Microbiology, Kerman Branch, Islamic Azad University, Kerman, Iran. Reza Rezaeizadeh Private Clinic, Kerman, Iran. Shayan Shahabinejad Department of Microbiology,School of Medicine, Kerman University of Medical Sciences, Kerman, Iran. 2020 06 27 2020 07 12 The Lowenstein-Jensen is an egg-based microbiology medium that was designed for selective isolation of Mycobacterium spp. The main inhibitory composition in this medium is a synthetic dye called malachite green. Mycobacterium spp. is resistant to the dye by de-colorization and oxidation of it. Some non-tuberculosis organisms may also overcome this inhibitory ingredient by similar enzymatic activity. In the final inspection of the bone TB culture of a teenage patient, the blind smear revealed the Pseudomonas talus osteomyelitis. According to the present and similar experiences, the preparation of 1-2 blind smears from TB culture- negative specimens taken from sterile sites of the body may unmask mycobacteria with the atypical colony and non-tuberculosis microorganisms. https://crcp.tums.ac.ir/index.php/crcp/article/view/370 https://crcp.tums.ac.ir/index.php/crcp/article/download/370/375