International Journal of Medical Science and Clinical Research Studies

Bilioenteric Fistula: A Rare Complication of Biliary Disease. A Case Report

2026-10-23T01:29:28+00:00

Bilioenteric fistulas are a rare complication of chronic gallstone disease and are characterized by the formation of an abnormal communication between the biliary tract and the gastrointestinal tract. Persistent inflammation, adhesion formation, and progressive erosion caused by gallstones may promote the development of a fistulous tract and allow gallstones to migrate into the intestinal lumen. When a large gallstone becomes impacted and causes mechanical intestinal obstruction, the condition is known as gallstone ileus. We present the case of a 68-year-old woman with a long-standing history of cholelithiasis who presented with colicky abdominal pain, nausea, vomiting, abdominal distension, and decreased bowel movements and passage of flatus. Abdominal computed tomography revealed dilated small-bowel loops, pneumobilia, and an ectopic gallstone impacted in the distal ileum, findings consistent with Rigler's triad. Based on the diagnosis of gallstone ileus, surgical treatment was indicated. Intraoperative exploration revealed a gallstone impacted in the distal ileum, which was removed through an enterotomy, as well as an intense inflammatory process in the right upper quadrant and an abnormal communication between the gallbladder and the duodenum, consistent with a cholecystoduodenal fistula. The intestinal obstruction was relieved, and the underlying biliary disease was managed according to the intraoperative findings. The patient had a favorable postoperative course, with restoration of bowel function and adequate tolerance of oral intake. Bilioenteric fistula complicated by gallstone ileus should be considered in the differential diagnosis of patients presenting with intestinal obstruction, particularly in those with a history of biliary disease. Computed tomography plays a fundamental role in establishing the diagnosis and determining the level of obstruction, while treatment should be individualized according to the patient's clinical condition and intraoperative findings.

Acute Complicated Stanford Type B Aortic Dissection with Left Renal Artery Involvement: Diagnostic Contribution of CT Angiography — A Case Report

2026-11-04T16:19:34+00:00

Background: Acute Stanford type B aortic dissection requires prompt identification of complications, particularly branch-vessel involvement and malperfusion. Cross-sectional imaging defines the anatomical extent of dissection, while echocardiography provides complementary information about cardiac function and selected aortic abnormalities.

Case presentation: A 59-year-old man with chronic hypertension presented to CHU Ibn Rochd with sudden interscapular pain radiating to the back, progressive dyspnea and severe hypertension (220/110 mmHg). Examination showed bilateral basal crackles without focal neurological deficits. Serum creatinine was 28 mg/L and urea 2 g/L. Electrocardiography demonstrated sinus rhythm, complete right bundle branch block and left ventricular hypertrophy. Computed tomography angiography (CTA) showed Stanford type B dissection extending from distal to the left subclavian artery to the aortic bifurcation, with partial false-lumen thrombosis and left renal artery ostial involvement with reported impaired perfusion. Bedside echocardiography reportedly showed concentric left ventricular hypertrophy and a left ventricular ejection fraction of 35%. Initial management included intravenous nicardipine, beta-blockade, analgesia, a loop diuretic and monitoring. The patient was transferred to Cheikh Khalifa International University Hospital for specialized care and was subsequently reportedly discharged. The receiving hospital discharge record was unavailable for review.

Conclusion: Acute type B aortic dissection with renal artery involvement warrants urgent CTA-based anatomical assessment, hemodynamic management and specialist referral. Echocardiography can complement assessment of cardiac function. The post-transfer care and discharge status were not independently verified against the receiving hospital records.

Choice of Treatment Supporter and Its Association with Treatment Interruption and Outcomes Among Multidrug-Resistant Tuberculosis Patients in Southeast Nigeria

2026-10-29T17:11:30+00:00

Community-based management of multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) relies substantially on treatment supporters to supervise directly observed treatment (DOT), promote adherence and provide psychosocial support. Effective DOT supervision and interventions are crucial to improving treatment success rates and mitigating the spread of drug-resistant tuberculosis strains. This study assessed treatment interruption, outcomes, and satisfaction with care among MDR/RR-TB patients in Southeast Nigeria based on their choice of treatment supporter. An analytical cross-sectional study was conducted among a cohort of ambulatory MDR/RR-TB patients initiated on treatment between January 2015 and December 2019 across all Southeast Nigeria states. A total of 249 patient records were reviewed and a telephone-administered satisfaction survey was completed by 169 respondents. Descriptive and inferential analysis at the 5% significance level were done. The most frequent treatment supporters were family members (70.7%). Treatment interruption rates were similar during the intensive (32.5%) and continuation (33.7%) phases. Treatment success rate was 74.7%. Choice of treatment supporter was significantly associated with treatment interruption during the continuation phase (χ² = 25.28, p < 0.0001). Family treatment supporters were associated with a lower treatment success rate (69.9%) compared to other supporters. This study demonstrated that family members were the predominant treatment supporter choice. However, treatment interruption remained substantial, with a significant association between treatment supporter type and interruption during the continuation phase. Strengthening training, supervision, follow-up and referral systems for treatment supporters are recommended for improved adherence and treatment outcomes.

Targeted Exosomal Cargo Delivery Versus Complex Growth Factor Profiles of Platelet-Rich Plasma Via Energy-Based Microchannels for Cutaneous Regeneration: A Systematic Review and Meta-Analysis

2026-10-21T00:02:52+00:00

Introduction

Exosome-based therapy and platelet-rich plasma (PRP) are competing regenerative modalities for cutaneous remodeling when delivered through energy-based microchannel devices, yet head-to-head comparative evidence across dermatologic indications remains fragmented. This systematic review and meta-analysis evaluated the relative efficacy of device-assisted exosome therapy versus device-assisted PRP versus energy-based device alone for atrophic acne scarring, facial photoaging, and pigmentary disorders.

Method

PubMed, EMBASE, Scopus, and Web of Science were searched from inception to 10 April 2026 following the PRISMA 2020 guideline. Randomized and non-randomized studies of adults receiving exosomes or PRP via fractional laser, radiofrequency microneedling, mechanical microneedling, or related devices were eligible. Study selection, extraction, and risk-of-bias appraisal (RoB 2; ROBINS-I) were performed independently and blindly. Random-effects meta-analyses with Hartung–Knapp–Sidik–Jonkman adjustment were conducted in R, with heterogeneity quantified by τ² and I².

Results

Thirteen studies (n = 354) were included. For atrophic acne scarring, the pooled standardized mean difference (SMD) was −0.28 (95% CI: −1.17 to 0.62; I² = 78.6%). For facial photoaging and rejuvenation, the pooled SMD favored treatment at 0.75 (95% CI: 0.45 to 1.05; I² = 0%; P = 0.0041). For pigmentation, the pooled SMD was 2.20 (95% CI: −1.91 to 6.32; I² = 93.9%). Overall risk of bias was low to moderate.

Conclusion

Device-assisted regenerative therapy consistently improves photoaging outcomes, whereas effects on acne scarring and pigmentation remain heterogeneous.

High-Dose Corticosteroid-Assited Conservative Management of Orbital Blow Out Fractures Without Extraocular Muscle Entrapment: A Two-Case Series

2026-10-26T15:21:40+00:00

Introduction: Orbital blowout fractures may be accompanied by substantial edema and soft-tissue injury that complicate assessment of extraocular muscle involvement. Distinguishing true mechanical entrapment from potentially reversible post-traumatic soft-tissue restriction is important to avoid unnecessary orbital exploration.

Case Illustration: Two patients presented following blunt facial trauma with right orbital blowout fractures, marked periorbital swelling, and orbital fat herniation into the maxillary sinus. Diplopia was absent in both cases, and the second patient had no rectus muscle entrapment on computed tomography. Both were managed conservatively with cold compresses and high-dose intravenous methylprednisolone 125 mg every six hours followed by tapering. After five and six days, respectively, facial and periorbital swelling markedly decreased, ocular movements were documented in all directions, and neither patient reported diplopia or blurred vision. No orbital surgical exploration was performed.

Discussion: Orbital fat herniation and severe edema should not automatically be interpreted as extraocular muscle entrapment. Serial clinical assessment after reduction of acute swelling may better identify patients who truly require reconstruction. Although corticosteroids may facilitate edema resolution, improvement cannot be attributed solely to steroid therapy in this uncontrolled case series.

Conclusion: Corticosteroid-assisted conservative management may support reassessment of selected orbital blowout fractures without definite muscle entrapment and may help avoid premature surgery.

Open, Laparoscopic, and Robotic Inguinal Hernia Repair: Comparative Outcomes, Mesh Selection, and Individualized Surgical Decision-Making

2026-11-07T03:05:10+00:00

Inguinal hernia repair is among the most frequently performed general surgical procedures worldwide. Current operative strategies include open anterior mesh repair, laparo-endoscopic posterior repair, robotic preperitoneal repair, and selected non-mesh tissue reconstruction. Comparative evidence suggests that laparoscopic transabdominal preperitoneal and totally extraperitoneal repair can reduce postoperative pain and accelerate return to normal activity relative to open Lichtenstein repair, whereas recurrence outcomes are generally similar when techniques are performed by experienced surgeons. Robotic approaches offer technical flexibility but have not consistently demonstrated superior patient-centered outcomes sufficient to offset higher costs. Mesh-based repair remains standard for most adults, while Shouldice repair is a reasonable alternative in selected patients and expert hands. This narrative review summarizes operative principles, comparative clinical outcomes, chronic postoperative inguinal pain, recurrence, mesh selection, and factors influencing choice of repair. The optimal strategy should be adapted to laterality, recurrence, prior operations, comorbidity, patient preference, surgical resources, and surgeon experience.

Acute Bacterial Meningitis due to Haemophilus influenzae Associated with Cerebrospinal Fluid Fistula Secondary to Recurrent Olfactory Esthesioneuroblastoma and Skull Base Radiotherapy: A Case Report

2026-10-13T18:43:04+00:00

Background: Acute bacterial meningitis remains a life-threatening neurological emergency requiring rapid diagnosis and immediate antimicrobial therapy [1,2]. In the post–Haemophilus influenzae type b (Hib) vaccination era, invasive H. influenzae infections have shifted toward adult populations with structural skull base abnormalities or other predisposing conditions [3,4].

Case Presentation: We report a 47-year-old woman with a history of recurrent olfactory esthesioneuroblastoma treated with multiple skull base surgeries and radiotherapy. She presented with acute bacterial meningitis preceded by four months of intermittent positional clear rhinorrhea, suggestive of cerebrospinal fluid (CSF) leakage [5,6]. Cerebrospinal fluid analysis demonstrated neutrophilic pleocytosis, hypoglycorrhachia, and elevated protein levels. PCR isolated Haemophilus influenzae. Imaging revealed extensive anterior skull base defects and pansinusitis. The patient received intravenous ceftriaxone and adjunctive dexamethasone, achieving full neurological recovery [7].

Conclusions : Delayed cerebrospinal fluid fistula following skull base oncologic treatment represents an important and potentially underrecognized risk factor for bacterial meningitis. Early identification and definitive surgical repair, in addition to antimicrobial therapy, are essential to prevent recurrence and improve outcomes [5,8,9].

Surgical Techniques in Upper Eyelid Reconstruction: A Review of Current Concepts and A Defect-Based Algorithm

2026-11-01T17:03:41+00:00

Reconstruction of the upper eyelid is more demanding than that of the lower eyelid because the upper lid must remain thin, mobile and lined by mucosa in order to protect the cornea, distribute the tear film and clear the visual axis. Defects arise mainly after tumor excision and trauma, and the choice of technique depends on the lamellae involved, the horizontal extent of the defect, the amount of residual tarsus and the integrity of the canthal attachments. This review summarizes the surgical anatomy and the principles that govern upper eyelid repair, and analyses the techniques available for anterior lamellar and full-thickness defects: secondary intention healing, direct closure with canthotomy and cantholysis, local skin and myocutaneous flaps, full-thickness skin grafts, the Tenzel semicircular flap, composite grafts, advancement and sliding tarsoconjunctival flaps, the Cutler-Beard and Mustardé eyelid-sharing procedures, free posterior lamellar grafts and substitutes, the orbicularis sandwich flap and distal pedicled flaps. Reported outcomes and complications are discussed, with attention to the points on which the published sources disagree.

Bipolar Depression with Secondary Psychosis Triggered by Polysubstance and Hyperhomocysteinemia: A Case Report

2026-11-01T20:39:46+00:00

The intersection between early-onset mood disorders, substance use, and the development of psychotic conditions in adolescence represents a diagnostic and therapeutic challenge in psychiatric practice. This article presents a case report of a 17-year-old male with a history of persistent depressive disorder, hyperactivity, and multiple suicide attempts, who progressed to severe psychic disorganization ("schizophrenization") associated with cocaine use and severe nicotine dependence. The clinical evolution illustrates the complexity of differentiating between substance-induced psychosis and the prodrome of a primary psychotic disorder, as well as the impact of delirium secondary to nicotine withdrawal on mental disorganization. Therapeutic management required multiple pharmacological approaches, culminating in the consideration of atypical strategies due to refractoriness. We discuss the hypothesis of schizophrenization as an interpretative matrix, expanded by the concepts of self-medication of distress, alexithymia, limbic hypersignification in patients with Bipolar Affective Disorder, and Autism Spectrum Disorder (ASD) traits, offering a model to understand progressive destructuring in adolescents with multiple vulnerabilities.

Multiple Cerebral Tuberculomas in an Immunocompetent Individual

2026-10-21T10:41:33+00:00

Tuberculosis remains a major public health issue in Morocco and a highly endemic disease. While pulmonary involvement is the most common and frequent clinical presentation, CNS tuberculosis accounts for only a small percentage of extrapulmonary cases, carrying the highest rates of mortality and neurological morbidity. We present the case of a 66-year-old male patient with no remarkable medical history, notably no recent tuberculosis exposure, who was admitted to our Trauma Center for an afebrile acute altered mental status, GCS of 13/15. Notably, the clinical neurological examination revealed no meningeal signs or neck rigidity, along with the absence of any respiratory symptoms.

At first, the brain CT scan revealed multiple parenchymal lesions in both the supratentorial and infratentorial compartments, which were exerting a mass effect causing a subfalcine herniation. The lesions were in favor of three diagnoses: tuberculomas, abscess or a brain tumor. Later on, the chest X-ray showed no significant abnormality and the GeneXpert testing that had been conducted confirmed the tuberculous origins.

The patient was immediately started on anti-tuberculosis therapy and high-dose intravenous corticosteroids to control the vasogenic edema, while awaiting further advanced neuroimaging (contrast-enhanced CT and MR spectroscopy). In the following days, the patient’s symptoms significantly improved and he regained consciousness.

Psychoactive Substance Use Among Anesthesiology and Intensive Care Residents: A Descriptive Cross-Sectional Study of 50 Residents

2026-11-03T22:49:48+00:00

Introduction: Anesthesiology and intensive care residents face heavy workloads, repeated on-call duties, occupational stress, sleep deprivation, and access to potentially addictive medications. These conditions may contribute to psychoactive substance use. This study aimed to describe substance use behaviors and non-medical medication use among residents and characterize their working conditions.

Materials and Methods: A descriptive cross-sectional study was conducted among 50 anesthesiology and intensive care residents using self-administered questionnaires. Information collected included age, sex, on-call duties, weekly working hours, perceived workload, stress, sleep, burnout symptoms, access to medications, education about related risks, and use of nicotine, alcohol, recreational substances, or medications and anesthetic agents for non-medical purposes. The survey also assessed residents’ awareness of medication-related risks and professional exposure. The primary outcome was at least one substance use behavior during residency. Findings were summarized as counts and percentages.

Results: Mean age was 28.9 ± 2.4 years, and 50% were male. Thirty residents (60%) performed at least seven on-call shifts per month, while 29 (58%) worked at least 60 hours weekly. High or very high workload was reported by 47 (94%), high or very high stress by 44 (88%), and fewer than six hours of sleep per night by 29 (58%). Burnout symptoms were reported by 46 (92%). Easy or very easy access to medications was reported by 33 (66%); 28 (56%) had received no formal education about associated risks. Nicotine use affected 29 residents (58%): conventional cigarettes in 14 (28%), electronic cigarettes in 16 (32%), and waterpipe smoking in 8 (16%). Alcohol consumption was reported by 27 (54%). Ten residents (20%) reported recreational substance use, including cannabis in 7 (14%), cocaine in 4 (8%), and MDMA or related substances in 3 (6%). Seventeen residents (34%) reported non-medical use of at least one medication or anesthetic agent, including benzodiazepines (8%), fentanyl (8%), propofol (6%), opioid analgesics (6%), psychostimulants (6%), and ketamine (4%). No non-medical use of nitrous oxide/oxygen mixtures (MEOPA) was reported. Overall, 44 of 50 residents (88%) met the primary outcome. Categories of substance use were not mutually exclusive.

Conclusion: Among surveyed residents, reported psychoactive substance use was frequent, particularly nicotine and alcohol use, in a context of substantial occupational stress, heavy workloads, sleep restriction, and burnout symptoms. As a descriptive cross-sectional study, these findings do not establish causality. They support the value of confidential screening, prevention, education about medication-related risks, and accessible psychological support tailored to anesthesiology and intensive care residents.