The overall rate of SPMs was not significantly increased after a minimum interval of 3 years from the first I-131 treatment; however, the chance of this event may be radically increased in patients who had received a cumulative activity of I-131 exceeding 40 GBq (1.08 Ci).

IntroductionMultiple endocrine neoplasia 2B, a rare autosomal dominant syndrome, is characterized by early onset of medullary thyroid carcinoma, pheochromocytoma, marfanoid habitus and mucosal neuromas of the tongue, lips, inner cheeks and inner eyelids. Gangliomatosis of the gastrointestinal tract and its complications may also occur in patients with this disease.Case presentationWe present the case of a 16-year-old Persian man diagnosed as having a non-invasive form of multiple endocrine neoplasia 2B (medullary thyroid cancer, mucosal neuroma of the tongue, lips and inner eyelids). Our patient, who had a positive family history of medullary thyroid cancer, was of normal height with no signs of marfanoid habitus.ConclusionsOphthalmological and oral manifestations of multiple endocrine neoplasia 2B, as in the case of our patient, are rare presentations of the disease; unfortunately in the case of our patient his condition had not been noted and acted upon until he presented to our department. The diagnosis in our patient's case was made only after his mother presented with the same condition. As a result, we emphasize that physicians should pay more attention to the oral and ocular signs of multiple endocrine neoplasia 2B in order to diagnose this fatal syndrome at an earlier phase.

Background: Obsessive-compulsive disorder (OCD) is a common neurotic disorder, In 2018 Application of repetitive transcranial magnetic stimulation (rTMS) for treating obsessive-compulsive disorder (OCD) has been approved by the Food and Drug Administration (28), since 2020 different methods has been tested, this study was designed to evaluate the effectiveness of adjunctive low frequency repetitive transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in refractory to treatment patients suffering from obsessive compulsive disorder (OCD) Methods: This clinical trial was performed on 30 patients with OCD referred from the psychiatry clinic of 22 Bahman Hospital in Qazvin province from 2018 to 2020. Patients were randomly assigned to two groups. Intervention group received rTMS treatment at 1 Hz for 20 min (1200 (pulses / day) over the left DLPFC region as adjunctive to their medical treatment for 3 times a week and for 5 weeks while the control group received only sham condition in addition to their medical treatment. All the patients filled out the Yale Brown Questionnaire (YBOCS) Before the study, after sessions 5 and 10 during treatment, at the end of the treatment and 3 to 6 months after the treatment. The results were compared between the two groups using SPSS software version 16.Results: The mean score of post-intervention Yale Brown score was significantly lower in the intervention group. (P <0.05), it was also significant by gender (females), marital status ,taking antipsychotic agents in addition to the serotonergic agents and with more treatment sessions, within 3 to 6 months after intervention. Conclusion: adjunctive low frequency (1 Hz)rtms over the left DLPFC can be effective in reducing Yale Brown score in refractory to treatment patients suffering from OCD after 15 sessions. Gender, treatment sessions, usage of antipsychotic agents as adjuvant with standard treatment regiments, and marital status were identified as predictors for response to adjunctive rTMS therapy.

Background: Obsessive-compulsive disorder (OCD) is a common neurotic disorder, In 2018 Application of repetitive transcranial magnetic stimulation (rTMS) for treating obsessive-compulsive disorder (OCD) has been approved by the Food and Drug Administration (28), since 2020 different methods has been tested, this study was designed to evaluate the effectiveness of adjunctive low frequency repetitive transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in refractory to treatment patients suffering from obsessive compulsive disorder (OCD) Methods: This clinical trial was performed on 30 patients with OCD referred from the psychiatry clinic of 22 Bahman Hospital in Qazvin province from 2018 to 2020. Patients were randomly assigned to two groups. Intervention group received rTMS treatment at 1 Hz for 20 min (1200 (pulses / day) over the left DLPFC region as adjunctive to their medical treatment for 3 times a week and for 5 weeks while the control group received only sham condition in addition to their medical treatment. All the patients filled out the Yale Brown Questionnaire (YBOCS) Before the study, after sessions 5 and 10 during treatment, at the end of the treatment and 3 to 6 months after the treatment. The results were compared between the two groups using SPSS software version 16.Results: The mean score of post-intervention Yale Brown score was significantly lower in the intervention group. (P <0.05), it was also significant by gender (females), marital status ,taking antipsychotic agents in addition to the serotonergic agents and with more treatment sessions, within 3 to 6 months after intervention. Conclusion: adjunctive low frequency (1 Hz)rtms over the left DLPFC can be effective in reducing Yale Brown score in refractory to treatment patients suffering from OCD after 15 sessions. Gender, treatment sessions, usage of antipsychotic agents as adjuvant with standard treatment regiments, and marital status were identified as predictors for response to adjunctive rTMS therapy.

Background: Obsessive-compulsive disorder (OCD) is a common mental illness. The Food and Drug Administration (FDA) approved repetitive transcranial magnetic stimulation (rMS) to treat OCD in 2018. So far, various approaches have been evaluated. We evaluated the effect of adjunctive low-frequency rMS over the left dorsolateral prefrontal cortex in patients with OCD refractory to treatment. Methods: The present clinical trial was done on 30 patients with OCD referring from the psychiatry clinic, 22 Bahman Hospital, Qazvin province, between 2018 and 2020 and patients were randomly divided into two groups. The intervention group received rTMS treatment at 1 Hz for 20 min (1200 pulses/day) over the left DLPFC area as adjunctive to the medical treatment three times a week and for five weeks, whereas those in the control group were subjected to only the sham condition plus their medical treatment. The Yale-Brown Obsessive-Compulsive Scale (y-BOC.S) was completed by patients before the study, following sessions 5 and 10 during the intervention, at the end of the intervention, and three to six months after the intervention under the direct supervision of a psychiatrist. SPSS software version 26 was used to compare the results between the two groups. Results: The intervention group showed significantly lower mean Y-BOCS scores after the intervention and at follow-up (P <0.05) and all patients of the intervention group showed significantly lower Y-BOCS scores than their own baseline scores (P <0.05). Also, using antipsychotic agents along with the serotonergic agents caused significantly lower scores in the intervention group at the end of the intervention (P <0.05). All the patients were found with higher follow-up scores than their scores at the end of the intervention; however, this difference was not significant (p>0.05). Conclusion: Adjunctive low-frequency (1 Hz) rTMS over the left DLPFC is able to effectively reduce Y-BOCS score in OCD patients refractory to treatment following 15 sessions, and the reduction was durable even after three to six months. Using antipsychotic agents as an adjuvant with serotonergic agents was identified as a possible predictor for response to adjunctive rTMS therapy.

Background: Obsessive-compulsive disorder (OCD) is a common mental illness.The Food and Drug Administration (FDA) approved repetitive transcranial magneticstimulation (rMS) to treat OCD in 2018. So far, various approaches have beenevaluated. We evaluated the effect of adjunctive low-frequency rMS over the leftdorsolateral prefrontal cortex in patients with OCD refractory to treatment. Methods: The present clinical trial was done on 30 patients with OCD referring fromthe psychiatry clinic, 22 Bahman Hospital, Qazvin province, between 2018 and 2020and patients were randomly divided into two groups. The intervention group received rTMStreatment at 1 Hz for 20 min (1200 pulses/day) over the left DLPFC area as adjunctiveto the medical treatment three times a week and for five weeks, whereas those in thecontrol group were subjected to only the sham condition plus their medical treatment.The Yale-Brown Obsessive-Compulsive Scale (y-BOC.S) was completed by patientsbefore the study, following sessions 5 and 10 during the intervention, at the end of theintervention, and three to six months after the intervention under the direct supervisionof a psychiatrist. SPSS software version 26 was used to compare the results betweenthe two groups. Results: The intervention group showed significantly lower mean Y-BOCS scores afterthe intervention and at follow-up (P <0.05) and all patients of the intervention groupshowed significantly lower Y-BOCS scores than their own baseline scores (P <0.05). Also, using antipsychotic agents along with the serotonergic agents caused significantly lower scores in the intervention group at the end of the intervention (P <0.05). All the patients were found with higher follow-up scores than their scores at the end of the intervention; however, this difference was not significant (p>0.05). Conclusion: Adjunctive low-frequency (1 Hz) rTMS over the left DLPFC is able toeffectively reduce Y-BOCS score in OCD patients refractory to treatment following 15sessions, and the reduction was durable even after three to six months. Usingantipsychotic agents as an adjuvant with serotonergic agents was identified as apossible predictor for response to adjunctive rTMS therapy.

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