This pilot study is the first in Iran that evaluates the effectiveness of thermotherapy compared to intralesional Glucantime® in the treatment of cutaneous leishmaniasis caused by Leishmania tropica. Forty patients with cutaneous leishmaniasis were separated into two groups, each consisting of 20 patients. The control group received intralesional Glucantime® weekly for 8 weeks, while the other group received a single session of thermotherapy for each lesion using ThermoMedTM model 1.8. The patients were monitored for 6 months, during which the outcomes were evaluated by considering the dimensions, consistency, and rates of remission of the lesions. The terms “initial remission” and “complete remission” were clearly defined, and any instances of therapy failure were documented. The statistical analysis was conducted using SPSS 24.0, employing independent t-tests, chi-square tests, and ANOVA. Both treatment groups exhibited considerable decreases in lesion size and enhanced texture, with no statistically significant differences. Nevertheless, the group that underwent thermotherapy demonstrated a more significant decrease in lesion size and improvement in texture after 6 months. The remission rates were similar; however, Glucantime® achieved a faster remission. No significant side effects were recorded in either group. The present study showed that thermotherapy was equally effective as intralesional Glucantime® in treating anthroponotic leishmaniasis. Thermotherapy can be considered as an alternative, especially when Glucantime® cannot be used, even though it requires further research. Graphical abstract

Rapid and accurate identification of Leishmania species is important for the diagnosis and epidemiological surveillance of cutaneous leishmaniasis (CL). High-resolution melting (HRM) analysis has emerged as a rapid molecular approach for species discrimination. This study aimed to preliminarily evaluate a quantitative real-time PCR coupled with HRM (qPCR-HRM) assay targeting kinetoplast minicircle DNA (kDNA) for differentiation of Leishmania major and Leishmania tropica in northeastern Iran. A qPCR-HRM assay targeting the kDNA region was developed using species-specific primers. Clinical samples from 60 patients with suspected CL in North Khorasan and Razavi Khorasan provinces were examined microscopically and cultured. DNA extracted from cultured promastigotes was analyzed using qPCR-HRM, and the results were compared with conventional PCR and ITS1-rDNA sequencing. In addition, ITS1-rDNA sequence analysis was performed to evaluate the genetic diversity of L. major isolates. Among the 60 suspected CL samples, 13 were positive by molecular analysis. qPCR-HRM successfully differentiated reference strains of L. major and L. tropica based on distinct melting temperature profiles, with a mean ΔTm of approximately 0.86 °C (L. major: 84.13 °C; L. tropica: 83.27 °C). All clinical isolates were identified as L. major by qPCR-HRM and confirmed by ITS1 sequencing, showing complete agreement between the two methods. ITS1-rDNA analysis of the 13 L. major isolates identified nine sequence types and seven haplotypes. The qPCR-HRM assay demonstrated promising performance for rapid differentiation of L. major and L. tropica under the conditions evaluated in this study. However, further validation using larger numbers of direct clinical specimens representing both species is required before routine diagnostic application.

Introduction and importance: Amniotic sheets are uncommon intrauterine membranous structures that arise from uterine synechiae and may alter placental morphology and implantation. Although generally considered benign, placental attachment to an amniotic sheet can mimic abnormal placental invasion disorders, pose diagnostic challenges, and potentially lead to unnecessary obstetric interventions. Case presentation: We report the case of a 35-year-old gravida four, para two woman who presented at 36 weeks and 4 days of gestation with labor pains and vaginal bleeding. Prenatal ultrasound and magnetic resonance imaging revealed a posterior placenta intersected by a thick, transverse amniotic sheet, creating a hammock-like placental appearance and raising suspicion for placenta accreta. Due to a history of prior cesarean section and abnormal placentation, a cesarean delivery was performed. A healthy male neonate was delivered. Intraoperative findings confirmed placental adhesion to the amniotic sheet without evidence of deep placental invasion. Both maternal and neonatal outcomes were favorable. Clinical discussion: Placental implantation on an amniotic sheet may closely resemble placenta accreta spectrum disorders on imaging, particularly in the presence of prior uterine surgery. Careful interpretation of prenatal imaging, combined with awareness of this rare entity, is essential to avoid misdiagnosis and overtreatment. Conclusion: This case highlights that amniotic sheets with placental attachment can mimic abnormal placental invasion on prenatal imaging. Accurate recognition of this condition is crucial for appropriate surgical planning and may help prevent unnecessary radical interventions while ensuring optimal maternal and fetal outcomes.

Epidermodysplasia verruciformis (EV) is a rare genodermatosis resulting from mutations in the EVER1/EVER2 genes, that increase vulnerability to beta-human papillomavirus (β-HPV) infection. The acquired form (AEV) develops in immunocompromised individuals, particularly organ transplant recipients, and typically manifests as pityriasis versicolor-like macules on sun-exposed areas. However, lesions confined to non-sun-exposed regions, especially the genitalia, are exceedingly uncommon and may be misdiagnosed. We report the case of a 38-year-old woman, nine years post-renal transplantation and on long-term triple immunosuppressive therapy (cyclosporine, mycophenolate mofetil, and prednisolone), who presented with progressive, non-pruritic, well-demarcated hypopigmented macules localized exclusively to her labia majora and mons pubis. The lesions were initially misdiagnosed and unsuccessfully treated as tinea versicolor. A skin biopsy revealed histopathologic features characteristic of EV, including enlarged keratinocytes with blue-gray cytoplasm and perinuclear halos and koilocytotic changes. This case emphasizes that AEV should be considered in the differential diagnosis of genital hypopigmented lesions in immunosuppressed patients. Accurate histopathologic evaluation is crucial for timely recognition, appropriate management, and ongoing surveillance to prevent missed malignant transformation.

Introduction and importance: Shoulder dystocia is a rare but serious obstetric emergency that can cause severe complications for both mother and baby. Rapid and effective intervention is crucial to avoid adverse outcomes. Case presentation: A 38-year-old woman with gestational diabetes and a history of two cesarean sections presented at 38 weeks and 6 days of gestation in labor. Despite risk factors for shoulder dystocia, vaginal delivery was attempted. After the head delivered, the fetal shoulder became impacted. Standard maneuvers, including McRoberts, suprapubic pressure, and the “All Fours” position, failed to resolve the dystocia. Ultimately, the Zavanelli maneuver was performed, returning the fetal head to the uterus, followed by an emergency cesarean section. The infant was born with a low Apgar score, requiring resuscitation and NICU admission, but was discharged in good condition after ten days, with no signs of Erb’s palsy. Clinical discussion: This case emphasizes the importance of anticipating shoulder dystocia in high-risk patients and being prepared for advanced interventions. Although the Zavanelli maneuver is rarely performed due to its technical difficulty and associated risks, it can be life-saving when executed promptly by an experienced team. Conclusion: This report demonstrates the successful use of the Zavanelli maneuver after all other methods failed. Timely and skilled application of this maneuver can prevent devastating complications and underscores the need for preparedness and training in managing severe shoulder dystocia.

Introduction and importance: Gestational trophoblastic neoplasia (GTN) represents a spectrum of rare tumors originating from trophoblastic tissue. While chemotherapy is the standard treatment, chemoresistance can present a major management challenge, particularly when standard surgical options like hysterectomy threaten future fertility. Conservative uterine-sparing surgery for localized disease offers an alternative strategy to achieve remission while preserving reproductive potential in young patients. Case presentation: We report the case of a 22-year-old woman with a history of complete molar pregnancy who developed low-risk GTN. After initial treatment with methotrexate and a subsequent switch to actinomycin D because of hepatotoxicity, her β-human chorionic gonadotropin (β-hCG) levels initially declined but later rebounded. Imaging revealed a hypervascular uterine mass consistent with chemoresistant GTN. Due to her desire for fertility preservation and the absence of metastasis, she underwent uterine-sparing treatment with wedge resection of the uterine cornu. Histopathology confirmed choriocarcinoma with negative surgical margins. The postoperative course was uneventful, and her β-hCG levels normalized within 4 weeks. She remained in complete remission at her 6-month follow-up. Clinical discussion: Managing chemoresistant GTN in young patients requires a balance between oncologic cure and fertility preservation. When chemoresistant disease is localized and non-metastatic, conservative surgical resection can be an effective alternative to hysterectomy, avoiding multi-agent chemotherapy toxicity while achieving complete local control. Conclusion: This case illustrates the possibility and effectiveness of conservative, uterine-sparing surgery in young women with localized chemoresistant GTN, highlighting the value of personalized treatment strategies in carefully selected non-metastatic cases.