Introduction: Brain contusions can range from mild to severe. In recent years, complementary and alternative therapies have attracted attention as adjunctive strategies to support patient recovery. This study aimed to evaluate the effects of acupressure on arterial oxygen saturation and end-tidal carbon dioxide levels in mechanically ventilated patients with brain injury. Methods: This randomized clinical trial was conducted in 2019 at the Intensive Care Unit of Ayatollah Kashani Hospital in Shahrekord, Iran. A total of 64 patients admitted to the intensive care unit following brain injury were enrolled using convenience sampling. Participants were randomly assigned to either the intervention or control group using simple randomization with colored cards. Baseline demographic characteristics, oxygen saturation, and EtCO₂ values were recorded for both groups. In the intervention group, acupressure was applied to the Pericardium-6 (P6) point on both wrists for 10 minutes, twice daily, over two consecutive days. The control group received pressure at a non-acupoint following the same schedule. Oxygen saturation and EtCO₂ were measured at multiple time intervals using pulse oximetry and capnography. Statistical analyses were performed using SPSS (version 21), and the data were analyzed with an independent t-test, a chi-square test, and Fisher’s exact test. Results: Oxygen saturation levels on both intervention days, as well as 12 hours after completion, were significantly higher in the acupressure group compared with the control group (MD = 7.7%, 95% CI: 7.0–8.4, d = 5.10, P < 0.01). EtCO₂ values also differed substantially between the groups during the intervention period (MD = 16.0 mmHg, 95% CI: 12.5–19.5, d = 1.35, P < 0.04), with the difference remaining significant at the 12-hour follow-up (MD = 16.0 mmHg, 95% CI: 11.8-20.2, d = 1.48, P < 0.003). Conclusion: The results showed that Acupressure improves oxygen saturation and stabilizes EtCO₂ levels in mechanically ventilated patients with brain injury. These findings suggest that acupressure may serve as an effective complementary approach in the management of critically ill patients with neurological injuries.
Introduction: The central Pyrenees form the natural border between France and Spain and attract many outdoor enthusiasts. Cross-border mountain rescues are frequent, yet their medical and logistical consequences remain poorly described. We aimed to determine the number of cross-border rescue victims and assess their hospital pathways, satisfaction, and practical difficulties during care abroad. Methods: We conducted a retrospective two-center study (RESCAPYR study) in 2021, including all consecutive cross-border mountain rescue patients from 2018 to 2019 (N = 150). Follow-up telephone interviews were conducted between 2022 and 2023 with patients who were referred to hospitals following the rescue operation to assess satisfaction and self-reported difficulties. Data were obtained from rescue and hospital records. Categorical variables were compared using the chi-square or Fisher’s exact test, continuous variables using the Mann–Whitney U test, and paired satisfaction scores using the Wilcoxon signed-rank test. Results: In France, 54 Spanish nationals were rescued over two years (5.1–5.6% of annual rescues). In Spain, 96 French nationals were rescued in the same period (12.0–17.2%). Approximately two-thirds required hospitalization in the neighboring country. Median hospital stay was 2 days [1–4] for Spanish patients and 1 day [1–2] for French patients. Satisfaction significantly decreased between the prehospital and hospital phases (P = 0.01 and P < 0.01), in both groups. Patients from both countries reported similar difficulties, mainly language barriers, financial concerns, and repatriation challenges. Conclusion: Cross-border mountain rescues frequently result in hospitalization outside patients’ national healthcare systems and expose them to administrative and communication barriers. Improved cross-border coordination and structured emergency transfer agreements are needed in border regions.
Introduction: Decompressive craniectomy is one of the treatment options in severe traumatic brain injury. However, there is no specific recommendation on the optimal size of craniectomy to achieve the desired outcome. We tried to determine the most appropriate size of craniectomy to prevent mortality. Methods: The patients included in this study had undergone unilateral decompressive craniectomy for posttraumatic ASDH, cerebral contusion, ICH, or a combination of these, with mass effect detected either on initial or follow-up CT scan. We used a retrospective consecutive sampling method, in which all eligible patients were identified from hospital records to reduce selection bias. Patients with diffuse cerebral edema who had undergone bilateral decompressive craniectomy were excluded to ensure focus on the target group. Applying these criteria, a total of 67 patients were selected from the hospital records of Coimbatore Medical College Hospital (CMCH) from July to December 2021. Clinical outcomes, primarily mortality, were evaluated using the Glasgow Outcome Scale (GOS). The surface area, maximal AP diameter, and CC diameter of decompressive craniectomy were analyzed using receiver operating characteristic (ROC) curves to determine the optimal cut-off values that maximize sensitivity and specificity. Results: A total of 67 (55 male and 12 female) patients satisfying the criteria, with a mean age of 44.1 ± 13.3 years, were included in the study. Road traffic accidents were the most common mechanism of injury, followed by falls and assault. The initial GCS of the patients was 7 ± 3. At the end of the six-month follow-up, 45 patients (37 males and 8 females) survived, and 22 people (18 males and 4 females) succumbed. The average surface area of decompressive craniectomy estimated for surviving patients was 118.49 cm2, the maximum AP diameter was 22.93 cm, and the maximum craniocaudal diameter was 7.2 cm. The cut-off value for better survival in the ROC curve analysis was 98.27 cm2 for craniectomy surface area (P = 0.0006) and 18.23 cm for AP diameter (P = 0.007). Conclusion: We have clearly demonstrated that patients with a decompressive craniectomy surface area of 98.27 cm2 or greater had better survival.
Introduction: This case report presents the diagnosis and surgical management of a case of malunited mandibular fracture in a pediatric patient. It highlights the challenges associated with restoring facial symmetry and occlusion while preserving future mandibular growth. Case Presentation: A 5-year-old female presented with facial asymmetry, mandibular deviation, malocclusion, and difficulty in mastication two months following a road traffic accident. Clinical examination and panoramic radiography revealed a malunited fracture involving the right parasymphysis region of the mandible with hypertrophic bone formation and displacement of the fracture segments. Surgical management consisted of osteotomy at the malunited site, anatomical reduction, occlusal realignment, and internal fixation using titanium miniplates while carefully avoiding the developing tooth buds. The miniplates were removed six months postoperatively. Follow-up demonstrated restoration of facial symmetry, improved occlusion, normal mandibular function, and satisfactory healing without complications. Conclusion: Malunited mandibular fractures in children are uncommon but may result in significant functional and aesthetic impairment if left untreated. Careful diagnosis, appropriate surgical planning, and long-term follow-up are essential to achieve satisfactory outcomes while minimizing the risk of growth disturbances. This case suggests that surgical correction may yield favorable short-term functional and aesthetic outcomes in selected pediatric patients.
Introduction: This study aimed to compare the epidemiological and clinical characteristics of traffic accidents in urban and rural areas using prehospital emergency data. Methods: This retrospective case series analyzed electronic records of traffic accident victims who were attended by prehospital emergency services in East Azerbaijan Province, Iran, from December 2024 to May 2025. All eligible cases registered in the Asayar integrated information system during the study period were included in the analysis using census sampling (N=9591). Data on demographic variables, temporal indicators, and clinical parameters were extracted. Statistical analysis was performed using SPSS version 26. Results: Response time was significantly longer in rural areas compared to urban areas (12.92 vs. 9.13 minutes, P<0.001). Light vehicles predominated in rural accidents (84.5%), whereas motorcycles accounted for the largest share in urban accidents (38.8%) (P<0.001). The clinical condition of victims was significantly worse in rural accidents, with a higher proportion of severe Glasgow Coma Scale scores (3.6% vs. 1.3%, P<0.001) and a greater percentage of low peripheral oxygen saturation (SpO₂<95%; 8.6% vs. 4.6%, P<0.001). Conclusion: Rural traffic accidents are associated with more severe injuries, worse physiological status, and longer prehospital response times. These findings underscore the urgent need for targeted improvements in prehospital emergency services for rural road networks.
