Background: Gallstone ileus is a rare cause of bowel obstruction, often presenting with nonspecific symptoms that delay diagnosis. This study assessed the diagnostic value of CT imaging and its correlation with histopathological findings in confirmed cases. Methods: A retrospective analysis of 14 patients with surgically confirmed gallstone ileus was performed. All underwent abdominal radiography, ultrasound, and CT. Imaging findings were evaluated for calcification type, impaction site, and fistula presence. Histopathology from surgical specimens was used for correlation. Relative risk (RR) and 95% confidence intervals (CIs) were calculated, with adjustments for small sample size. Results: Rim-calcified gallstones were the most common (50%) and significantly associated with chronic inflammation (RR 1.42, 95% CI: 1.05–1.93). Cholecystoduodenal fistulas were most frequent (57.1%), with a 92.8% imaging-pathology concordance. Ileal impaction (35.7%) was linked to increased risk of bowel necrosis (RR 2.0, 95% CI: 1.1–3.6). All stones were >3 cm; two patients had recurrence. No perioperative mortality occurred. Conclusions: CT imaging demonstrates high diagnostic accuracy and strong correlation with histopathological findings in gallstone ileus. Identifying calcification patterns and impaction sites aids early diagnosis and surgical planning.

Background: Dilated cardiomyopathy (DCM) is a major contributor to heart failure-related morbidity and mortality. While type 2 diabetes mellitus (T2DM), obesity, and thyroid dysfunction are individually linked to cardiovascular disease, their combined effects on DCM remain poorly understood. Objective: To evaluate the independent and synergistic associations of diabetes (stratified by treatment), thyroid dysfunction, and obesity with the prevalence of DCM and 30-day hospital readmission. We further examined the utility of a composite Metabolic Burden Score for risk stratification. Methods: In this retrospective cohort study, electronic health record data from 1079 adult patients at a tertiary care center were analyzed. Multivariable logistic regression, including ridge regularization, was used to identify predictors of DCM. Endocrine phenotypes were stratified by diabetes and thyroid status. A Metabolic Burden Score (range: 0–3) based on diabetes, obesity, and thyroid dysfunction was developed and correlated with clinical outcomes. Results: DCM was diagnosed in 46% of the cohort. Non-insulin-treated diabetes (OR: 6.93; 95% CI: 3.78–12.73), hypothyroidism (OR: 1.78; 95% CI: 1.02–3.11), and male sex (OR: 2.33; 95% CI: 1.36–4.00) were independently associated with increased DCM risk. Obesity was not independently predictive but contributed to DCM prevalence when assessed within the Metabolic Burden Score. DCM prevalence increased across burden strata, reaching 50% in the high-risk group. Notably, the moderate-risk group had the highest 30-day readmission rate (42.8%). Conclusions: Non-insulin-treated diabetes and hypothyroidism are key metabolic drivers of DCM. A simple composite burden score offers a clinically useful tool for stratifying risk of DCM and early readmission. These findings support integrated endocrine–cardiac screening strategies to improve early identification and prevention of structural heart disease.

Background: Human cutaneous reactivity exhibits marked inter-individual variability, yet the contribution of constitutional pigmentation traits to short-term skin responses remains incompletely characterized. Fitzpatrick skin phototype reflects stable differences in pigmentation-related traits and may therefore act as a phenotypic modifier of early cutaneous reactivity following topical exposure. Methods: In this controlled human study, 239 healthy volunteers were stratified by Fitzpatrick skin phototype into three groups: I–II (n = 138), III (n = 72), and IV–V (n = 29). A standardized emulgel-based topical provocation model was applied under occlusion to the volar forearm, and cutaneous responses were assessed at 20 min (Test A), 24 h (Test B), and 96 h (Test C) using standardized visual scoring. Group comparisons, multivariable linear regression models adjusted for age, sex, country of origin, and experimental lot, and stratified analyses by country of origin, were performed. Results: Early and short-term cutaneous responses differed significantly across phototype groups. Participants with phototypes I–II exhibited higher response scores at both 20 min and 24 h compared with phototype III (p < 0.001). In adjusted models, phototype III remained independently associated with significantly lower reactivity relative to phototypes I–II at 20 min (β = −1.61, p < 0.001) and 24 h (β = −0.98, p < 0.001). Responses among phototypes IV–V were minimal to absent; however, this subgroup was underrepresented, and findings for IV–V are descriptive. Age was a significant positive predictor of response intensity, whereas sex showed no independent association. No persistent reactions were observed at 96 h in any phototype group. Stratified analyses confirmed that the reduced reactivity associated with phototype III was independent of country of origin. Conclusions: Fitzpatrick skin phototype is independently associated with early and short-term cutaneous reactivity following standardized topical provocation in humans. Lighter phototypes (I–II) demonstrate increased susceptibility to transient inflammatory responses, whereas phototype III shows markedly reduced reactivity. These findings support the role of skin phototype as a constitutional modifier of short-term cutaneous responses and highlight the importance of considering pigmentation-related phenotypes in the design and interpretation of dermatological testing, cosmetic tolerability studies, and safety assessments of topical formulations.

Grover disease (GD), or transient acantholytic dermatosis, is an acquired acantholytic dermatosis that classically affects the trunk of older men, although persistent, recurrent and atypically distributed forms are increasingly recognised. We report a 29-year-old man with chronic-recurrent, intensely pruritic GD, with an estimated onset approximately six months before his first documented dermatologic assessment. The eruption predominantly involved the upper and lower limbs, with limited truncal involvement. Because of the atypical age and distribution, and because acantholysis was focal and minimal in individual specimens, the diagnosis rested on clinicopathological correlation across serial biopsies obtained during separate disease episodes, which showed spongiotic and acanthotic changes, focal parakeratosis, lichenoid and perivascular inflammation, and focal acantholysis with dyskeratosis. Direct immunofluorescence, performed during topical corticosteroid treatment, was nonspecific and did not support an autoimmune blistering disorder, although this result must be interpreted with caution. Laboratory investigations were unremarkable apart from a moderately elevated total serum immunoglobulin E (IgE) (223.2 IU/mL), a nonspecific finding that does not establish a type 2 immune phenotype in this patient. A combined regimen of acitretin, an oral antihistamine, a topical corticosteroid and barrier-directed care was temporally associated with marked improvement, the Dermatology Life Quality Index falling from 17/30 to 5/30 over three months. We briefly review the histopathological patterns, differential diagnosis and management of GD and its emerging molecular and immunological context. This case illustrates the breadth of the clinical spectrum of GD, the diagnostic pitfalls of focal acantholysis and of immunofluorescence performed under treatment, and the need to consider GD in young patients with chronic-recurrent, predominantly extra-truncal eruptions.

Background and Clinical Significance: Pregnancy-associated melanoma (PAM) is clinically challenging because the physiological pigmentary and naevus changes in pregnancy can obscure early malignancy, and the long-standing assumption that the hormonal milieu of pregnancy drives melanocytic transformation continues to shape clinical expectations. We present a case of postpartum-persistent melanoma in situ and use it to anchor a molecular reappraisal of that hormonal hypothesis. Case Presentation: We describe the clinical, dermoscopic, histopathological, and immunohistochemical findings in a 32-year-old woman with a peri-umbilical naevus that changed during the third trimester and persisted twelve months postpartum, and we review the hormonal, immunological, and diagnostic literature relevant to PAM. Dermoscopy showed a multicomponent pattern with asymmetry, irregular structureless areas, peripheral pseudopods, and central regression; excisional biopsy demonstrated an atypical intraepidermal melanocytic proliferation without dermal invasion (melanoma in situ, pTis cN0 cM0, Stage 0), with Melan-A positivity and reduced p16. The reviewed evidence indicates that melanomas lack classical oestrogen/progesterone receptors and that the dominant oestrogen and α-MSH signals act through non-classical, differentiating pathways (GPER, MC1R) that are growth-suppressive rather than oncogenic, while pregnancy provides an immunologically permissive and diagnostically obscuring context. Conclusions: Pregnancy is better understood not as a hormonal driver of melanoma but as a permissive and obscuring state in which the principal preventable harm is diagnostic delay; suspicious lesions in pregnant or postpartum women warrant the same urgency as in other patients, and structured dermoscopic surveillance of at-risk women is the rational response.