Search Results (1,620)

Introduction: Sudden cardiac death in children and adolescents is a devastating yet potentially preventable event. There is, therefore, an urgent need for early recognition of young patients at elevated cardiac risk. Electrocardiographic screening may play a central role in this effort. However, interpreting paediatric ECGs requires advanced diagnostic skills. Checklists have been advocated to mitigate errors in a number of complex fields, both medical and non-medical; however, their effectiveness in interpreting paediatric ECGs remains uncertain. Objective: To evaluate whether the use of a structured checklist improves primary care paediatricians’ performance in interpreting paediatric ECGs, and to assess the influence of professional experience on diagnostic accuracy. Methods: We conducted a prospective, parallel-group study involving primary care paediatricians in the Balearic Islands (Spain). Participants were randomly assigned to interpret paediatric ECGs, either using routine unstructured interpretation or with checklist support. Outcomes included diagnostic validity ratios, and appropriateness of referral to paediatric cardiologists. Performance was analysed according to checklist use or years of clinical experience. It was also analysed whether diagnostic accuracy varied according to whether the ECG was classified as normal, or abnormal with or without an increased risk of sudden cardiac death. Results: Thirty-one paediatricians completed the study, generating 310 ECG interpretations. Checklist use did not significantly improve sensitivity, specificity, or likelihood ratios for detecting ECG abnormalities associated with sudden cardiac death risk, nor did it increase appropriate referral rates. We report a trend towards higher specificity and likelihood ratios among paediatricians with fewer than 20 years of professional experience than among their more senior counterparts. Significantly, this study found true positive rates of normal ECGs, and of abnormal ECGs with risk of sudden cardiac death, to be around 90%, as opposed to true positive rates of around 60% for abnormal ECGs without risk of sudden cardiac death (91% vs. 85% vs. 59%, respectively). Conclusions: In this study, checklist support did not enhance diagnostic performance in paediatric ECG interpretation. This finding highlights the need for targeted efforts to improve diagnostic accuracy in this sensitive subset. We also report that mid-career paediatricians appear to achieve the highest ECG diagnostic accuracy, and we show a particularly high rate of correct interpretation of both simple ECGs and high-risk abnormal ECGs. Full article

Background/Objectives: Candida species are among the leading causes of fungal infections, especially in immunosuppressed patients. In recent years, the increase in non-albicans species has altered the epidemiological landscape, requiring updated local surveillance data. Therefore, this study aims to analyze the epidemiological pattern of Candida spp. involved in various clinical manifestations. Methods: This was a retrospective observational descriptive study of clinical Candida isolates recovered from patients at a single tertiary care hospital in Puebla, Mexico, between 2021 and 2022. Sociodemographic and clinical data were collected from medical records. Candida spp. isolates were recovered from the hospital’s clinical specimen collection and identified using conventional methods and phylogenetic analysis. Results: Ninety isolates were recovered from a total of 88 patients during the study period. The majority of patients were women (60.2%), and among the age groups, the largest proportion corresponded to older adults (≥60 years, 25%). Candida was most frequently isolated from the urinary tract (47.7%), followed by the respiratory tract (19.3%) and the vulvovaginal tract (14.7%). Candida albicans was the predominant species (51.1%), followed by Nakaseomyces glabratus (32.2%) and other species such as Pichia kudriavzevii (5.5%), Candida tropicalis (3.3%), Candida dubliniensis (3.3%), Candida parapsilosis (2.2%), and Candida orthopsilosis (1.1%). The study showed discrepancies between conventional identification methods and molecular analysis. Of the 33 isolates evaluated using culture methods, only 21 matched the identification by PCR and phylogenetic analysis. In the case of the BD Phoenix automated system, 20 matches with and 13 discrepancies from the molecular tests were recorded. Conclusions: Our findings revealed the significant presence of species belonging to the non-albicans family in specific clinical contexts, highlighting the urgent need to monitor the epidemiological profile. The observed discrepancies between phenotypic and molecular identification methods suggest that species identification based solely on phenotypic approaches should be interpreted with caution. Full article

At present, there is no cure for the human genetic disorder ataxia-telangiectasia (A-T), which is managed by supportive care. This disorder arises due to mutations in the ATM (ataxia-telangiectasia mutated) gene and is characterised by a defect in the response to DNA damage, oxidative stress, mitochondrial dysfunction and immune deficiency. The ATM protein is activated by DNA damage, reactive oxygen species (ROS), and a variety of other stimuli, which leads to the phosphorylation or altered cellular localisation of multiple protein substrates that participate in cellular defence pathways. ATM plays a central role in orchestrating cellular defence against stress, which forms a focal point for approaches to treating the symptoms in this disorder. These strategies involve boosting mitochondrial function and dampening the inflammatory response. A more direct approach to treatment is gene therapy, yet the leading method using Adeno-Associated Virus (AAV) is hampered by the large size of the ATM gene itself. The use of antisense oligonucleotides (ASO) as an alternative gene therapeutic approach to treat patients has been increasingly utilised. However, only certain mutations fit the criteria for ASO-based intervention, which encourages rescue through readthrough of premature truncation mutations. For this reason, small-molecule-based therapies addressing the multi-system nature of the disease are urgently required. We address these different approaches to therapy and the outcome of numerous recent clinical trials with A-T patients, as well as ongoing research that has potential to lead to therapy. Full article

As population aging intensifies, older adults who are bedridden or have limited mobility often experience strong restraint and poor comfort during defecation nursing; therefore, an unrestrained defecation-assisting device is urgently required. This study aims to design a novel unrestrained defecation-assisting posture transformation mechanism and defecation-receiving protective cover mechanism to improve the defecation experience of older adults. Firstly, a posture adjustment mechanism composed of a translation module and a back-elevation, leg-flexion, and leg-abduction module is proposed. The degrees of freedom of the system are calculated to ensure proper and coordinated motion. Furthermore, the human body slip displacement during the posture transformation process is analyzed. Secondly, a defecation-assisting coordinated docking mechanism is developed. Inspired by the pangolin model, a protective cover mechanism is designed. Through kinematic and workspace analyses, the driving lengths of the four-section keel are determined as 34 mm, 19 mm, 38 mm, and 40 mm, respectively. Thirdly, the control system for the entire nursing device is established, the control method of human body translation motion based on visual sensing is analyzed, and the control method of the protective cover mechanism based on the fuzzy adaptive control algorithm is conducted. Lastly, experiments are conducted and the results show that the motion error of the translation module is ≤7.6 mm. The posture transformation mechanism demonstrates excellent operational performance, the back-slip compensation effect is significant, the working trajectory of the mechanism meets human body requirements, and the protective cover accurately conforms to the human body with a reasonable contact pressure distribution. The results indicate that the proposed device effectively alleviates the sense of restraint associated with a conventional wearable excretion-care device, and provides a feasible solution for the application of intelligent nursing device. Full article

Background: Pediatric head trauma is a common reason for emergency department presentation. Although most children have minor injuries, a small proportion harbor clinically important traumatic brain injuries requiring urgent intervention. Artificial intelligence (AI) may offer structured support in computed tomography (CT) decision making, but evidence regarding the performance of general-purpose large language models in pediatric head trauma remains limited. Objective: To evaluate the association between AI-based cranial CT recommendations and clinically meaningful outcomes in pediatric patients with blunt head trauma and to assess the diagnostic performance and clinical utility of the model. Methods: This retrospective single-center observational study included pediatric patients younger than 18 years with blunt head trauma who underwent cranial CT imaging and had complete outcome data. A general-purpose large language model generated binary CT recommendations (“CT recommended” or “CT not recommended”) using structured clinical information available at the time of emergency department presentation. The primary outcome was a composite adverse clinical outcome defined as the occurrence of at least one of the following: emergency surgical intervention, intensive care unit admission, intubation, neurological sequelae or mortality. Diagnostic performance metrics, calibration analysis and decision curve analysis were performed. Results: A total of 819 pediatric patients were included, and the AI model recommended CT in 530 patients (64.7%). The primary outcome occurred in 143 patients (17.5%) and was significantly more frequent in the CT-recommended group than in the CT-not recommended group (24.5% vs. 4.5%; OR 6.90, 95% CI 3.82–12.45; p < 0.001). Abnormal CT findings, emergency surgery, intubation and neurological sequelae were also significantly more common in patients for whom CT was recommended by the AI system. For the primary outcome, the AI recommendation demonstrated a sensitivity of 90.9%, specificity of 40.8%, positive predictive value of 24.5% and negative predictive value of 95.5%. Calibration analysis showed acceptable agreement between predicted probabilities and observed event rates. Decision curve analysis demonstrated greater net benefit than both the “treat-all” and “treat-none” strategies across a range of threshold probabilities. Conclusions: In this clinically selected cohort of pediatric patients with blunt head trauma who underwent cranial CT imaging, AI-based CT recommendations were strongly associated with adverse clinical outcomes and demonstrated high sensitivity and negative predictive value for identifying children at risk of clinically important events. These findings suggest that, within a clinically selected cohort of children who underwent cranial CT imaging, AI-generated CT recommendations were associated with clinically meaningful outcomes. However, these results should not be interpreted as validation of CT decision making in the broader pediatric head trauma population and require prospective validation in unselected cohorts. Full article

Objective: The long-term management of cardiovascular diseases (CVDs) requires comprehensive rehabilitation strategies aimed at optimizing functional recovery and promoting behavioral changes. These interventions may include digital technologies that emerged as promising approaches to facilitate lifestyle changes, such as dietary behavior and physical activity (PA). Aim: This review aimed to synthesize the current evidence for the potential impact of remotely delivered nutrition interventions with or without a combination of PA interventions on biochemical biomarkers, cardiovascular indexes, anthropometric parameters, levels of PA, exercise and functional capacity, adherence to the Mediterranean Diet (MD), diet quality and quality of life, rehospitalization, urgent visits, death and acute events in adults (≥18 years) with CVDs. Secondary outcomes were accessibility, safety, usability, and adherence. Methods: The PubMed, Web of Science, and Scopus databases were comprehensively searched up to 2026 for Randomized Controlled Trials (RCTs) published in English, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The methodological quality was assessed using the revised Cochrane Risk of bias tool for RCTs (RoB2). Results: 11 RCTs met the inclusion criteria. Sample sizes ranged from 66 to 879 participants. The duration of the interventions varied from 4 weeks to 12 months. The interventions were delivered remotely using a range of digital health technologies, including web-based programs, mobile phones, wearable devices, smartphone applications, and mini-apps. Favorable changes were observed in diet quality and in adherence to MD and PA levels, with no intervention-related adverse events reported. The RoB2 assessment indicated that the majority of included studies (6 out of 11) were classified as having some concerns regarding risk of bias. Conclusions: Remotely combined nutrition and PA interventions are a feasible and effective approach for improving mainly patient-reported outcomes in adults with CVDs. These findings support integrating remote multimodal rehabilitation into routine cardiovascular care and highlight the potential of telehealth-based models to enhance patients’ access to rehabilitation services. Full article

Background and Clinical Significance: Ruptured common iliac artery aneurysms may mimic urological disease, particularly when retroperitoneal bleeding causes ureteral compression and secondary hydronephrosis. This case is clinically relevant because the first symptom was acute stabbing testicular pain, followed by lumbar discomfort and ultrasound findings suggestive of obstructive uropathy. Case Presentation: A 73-year-old man with arterial hypertension and active smoking presented to the Emergency Department with sudden left lumbar pain that initially radiated to, or was perceived in, the left testicle. The testicular pain resolved spontaneously, but persistent poorly localized lumbar pain continued. He was afebrile and initially hemodynamically stable. Point-of-care ultrasound showed left hydronephrosis, while the abdominal aorta appeared unremarkable. Because the patient looked clinically unwell and the abrupt, stabbing onset was not fully explained by uncomplicated renal colic, contrast-enhanced abdominal and pelvic computed tomography was performed. CT revealed a fissured saccular aneurysm of the left common iliac artery with active contrast extravasation and a large retroperitoneal hematoma compressing the ipsilateral ureter, thereby causing secondary hydronephrosis. The patient underwent urgent endovascular treatment with percutaneous transluminal angioplasty and Bentley stent. Post-revascularization CT showed no further contrast extravasation, and the patient was discharged after seven days without complications. Conclusions: In older patients with cardiovascular risk factors, sudden testicular, flank, or lumbar pain may warrant consideration of retroperitoneal vascular emergencies, even when initial ultrasound suggests a urological diagnosis. In this patient, discordance between the clinical presentation and the initial ultrasound findings prompted contrast-enhanced CT, which enabled diagnosis and timely vascular management. Full article

Background: Klebsiella pneumoniae is a leading cause of healthcare-associated infections and a major vehicle for the dissemination of antimicrobial resistance (AMR). Romania ranks among the most affected European countries for carbapenem-resistant K. pneumoniae (CRKP), yet data from specialized pulmonology–critical care settings remain limited. Objective: This study aimed to characterize the antimicrobial resistance profiles of K. pneumoniae clinical isolates—including MDR/XDR/PDR classification, carbapenem and colistin resistance rates, specimen and ward distribution, and category-specific resistance patterns—at a tertiary pulmonology–critical care institution in Bucharest, Romania. Methods: A retrospective, single-centre analysis of 203 K. pneumoniae clinical isolates from critical patients, which were collected at the Institute of Pneumology Marius Nasta, Bucharest, between July 2021 and May 2026. Susceptibility testing was performed using the VITEK^®2 system (bioMérieux), with results interpreted per EUCAST breakpoints. Results: Of 203 isolates, 112 (55.2%) were PDR, 36 (17.7%) XDR, six (3.0%) MDR, and 49 (24.1%) non-MDR. Carbapenem resistance was present in 134 isolates (66.0%); colistin resistance was present in 49 of 73 isolates tested (67.1%). Bronchial/tracheal aspirate was the dominant specimen source (61.1%), and intensive care units accounted for 61.1% of isolates. Resistance rates exceeded 75% for monobactams, first/second-generation cephalosporins, and fluoroquinolones. Conclusions: This cohort demonstrates severe AMR burden in this setting, consistent with the most concerning reports for K. pneumoniae in the literature. The findings underscore the urgent need for enhanced antimicrobial stewardship, strengthened infection control in ICU settings, and molecular surveillance of carbapenemase-producing high-risk clonal lineages in Romanian tertiary care. Full article

(1) Background: Lead exposure is an important preventable environmental health concern among children, especially in low- and middle-income countries. In Indonesia, evidence from routine health service settings remains limited. (2) Methods: This cross-sectional study assessed blood lead levels (BLLs) and associated factors among children aged 1–5 years attending 12 primary health care facilities in Bogor City and Bogor Regency between December 2025 and January 2026. A total of 420 children were recruited consecutively during routine services. Environmental and household risk factors were collected using structured questionnaires, and venous blood samples were analyzed using inductively coupled plasma mass spectrometry. Elevated BLL was defined as ≥5 µg/dL. (3) Results: The mean BLL was 2.24 µg/dL, and 21.9% of children had elevated BLLs. Prevalence was higher in Bogor Regency than in Bogor City (41.2% vs. 2.4%; p < 0.001) and among children residing near lead-processing activities (44.2% vs. 16.2%; p < 0.001). One child had a BLL of 66.82 µg/dL. Results were returned to caregivers and facilities; children with BLL ≥ 5 µg/dL received counselling, exposure-reduction advice, nutritional support, and follow-up planning, while the child with BLL > 45 µg/dL was urgently referred for confirmatory assessment and specialist management. (4) Conclusions: Primary healthcare–based screening can identify vulnerable children and trigger clinical, nutritional, environmental, and referral responses, although longitudinal follow-up and environmental source testing are needed. Full article

Background: Emergency services in urban areas are overcrowded due to a rise in mild-to-moderate acuity consultations, and physician-led home visits are less common. In response, a home-based urgent care model in an urban setting (Docadom) was developed. Consultation requests via a dedicated mobile application or phone call are triaged by a trained emergency nurse. Physicians travel to the patient via an electric cargo bike that has storage for medical equipment. During home visits, physicians perform testing/diagnosis and advanced procedures (e.g., intravenous medication delivery) and prescribe treatment (if needed). This descriptive analysis reports activities during the first 12 months of Docadom. Methods: Data from all patients seen during the first 12 months of Docadom activity (1 May 2023–30 April 2024) were analysed. Outcomes analysed included: age, sex, diagnosis, and whether the patient was referred to the hospital. Patient satisfaction (from 1 [worst] to 5 [best]) is also reported. Each outcome was analysed in two subgroups based on patient age (<75 or ≥75 years) because the Swiss health insurance system distinguishes between these two age groups, using Wilcoxon or chi-square tests as appropriate. Results: A total of 1736 patients requested a consultation (66% female; median age 70 years [interquartile range 36, 84]; 43% aged ≥75 years). The five most frequent clinical presentations were: ear, nose and throat infection, epistaxis and bronchitis (25.7%); soft tissue trauma (7.8%); acute cervical or lower back pain syndrome (5.6%); gastroenteritis and dehydration (5.0%); and cancer and general decline in the elderly (4.6%). Only 4.7% of the patients were referred to the hospital. The mean satisfaction score was 4.97 (response rate: 207/422 patients [49%] who requested a consultation via the app). Conclusions: These data highlight the feasibility and acceptability of a home-based urgent care model in an urban setting. The service effectively addressed a wide range of acute conditions, especially in elderly patients. The low hospital referral rate and high patient satisfaction are encouraging, but as a single-arm descriptive analysis without post-consultation outcome data or a comparator group, this study cannot establish clinical safety or an effect on emergency department use; these questions require a future comparative study. Full article

Background: Endometriosis is a condition that is very challenging to diagnose and manage. Objectives: The purpose of this study is to assess the impacts of diagnosis and treatments in the journeys of endometriosis patients in Aotearoa New Zealand. Methods: Two online surveys were conducted with cohorts of 616 and 679 endometriosis patients to assess diagnosis and treatments, respectively. Results: In this exploratory study, the diagnosis cohort self-reported a median delay from symptom onset to confirmation of the diagnosis of 10 years, with a median delay from symptom onset to first seeing a doctor (“doctor delay”) of 4 years. Upon receiving their diagnosis, 53.7% indicated the “number one” emotion they felt was relief. In the treatment cohort, the only medical management strategy perceived as “effective” by over 75% of users was hysterectomy (84.3%), despite this not being a cure for endometriosis. Common first-line treatments were viewed poorly for their perceived effectiveness, with over-the-counter pain relief viewed as effective by 25.8% of users, combined oral contraceptive pills by 23.2% of users, progesterone-only pills by 42.8% of users, and intrauterine contraceptive devices by 49.7% of users. Conclusions: Endometriosis is a condition typified by challenges for patients with its delayed diagnosis, resistance to management, and a high prevalence of discouraging experiences in medical care settings. These large-sample cohorts highlight that improvements in the diagnosis and management of endometriosis warrant urgent attention by clinicians and policymakers alike. Full article

Background: Transmasculine people face distinct challenges in accessing and using contraceptive methods, influenced by gendered embodiment, healthcare systems, and identity-driven decision-making. UK-based qualitative research on this topic is minimal. This study aims to gain a deeper insight into the factors that influence transmasculine people’s experiences of contraceptive methods and services in the UK. Methods: A qualitative study of semi-structured one-to-one interviews (n = 6) and a focus group (n = 4) was conducted with transmasculine people aged 18+ in the UK, using reflexive thematic analysis informed by Braun and Clarke’s approach. The sample was small and demographically narrow (all participants were white British and based in one UK region), which is considered when interpreting the findings below. Findings: Three overarching themes were identified: (1) Gender Identity, Dysphoria, and Reproductive Embodiment; (2) Experiences of Healthcare Systems; and (3) Contraceptive Decision-Making and Use. Participants described profound interactions between dysphoria, bodily autonomy, and contraceptive choice, alongside widespread barriers within healthcare including misgendering, lack of knowledge, and systemic gatekeeping. Conclusions: Contraceptive methods are not neutral, they are deeply intertwined with experiences of gender, identity, and power. Findings underscore the urgent need for non-assumptive, person-centred care and contribute new UK-based evidence to inform more equitable reproductive healthcare. Full article

Workplace violence (WPV) is a major occupational hazard for nurses in Thailand, negatively affecting psychological well-being, professional confidence, and patient care. In this quantitative cross-sectional analytic study involving 415 nurses, 43.61% reported experiencing at least one incident of WPV during the previous 12 months. Verbal abuse (41.20%) and physical violence (13.25%) were the most frequently reported forms, with a higher prevalence observed in urban hospitals than in rural hospitals (53.66% vs. 33.81%). Higher WPV risk was associated with working in medical wards (adjusted incidence rate ratio [Adj IRR] 3.33) and emergency departments (Adj IRR 2.47), caring for male-only patients (Adj IRR 1.87), younger age (Adj IRR 3.31), divorced or separated status (Adj IRR 3.05), rotating day and night shifts (Adj IRR 2.03), and extreme concern about WPV (Adj IRR 4.57). The psychological impact was considerable. Hypervigilance was the most common response (66.30%), especially following physical violence (76.36%). More than 41% of affected nurses reported intentions to resign or transfer and reduced professional confidence. Reporting incidents was often perceived as ineffective, contributing to underreporting. Nurses identified clear disciplinary measures, increased staffing, improved workplace environments, stronger security systems, and organizational support as key prevention priorities. These findings highlight the urgent need for context-specific interventions, targeted staff training, and organizational strategies to protect nurse well-being, strengthen workforce resilience, and maintain quality patient care. Full article

Background/Objectives: Early risk stratification remains challenging in patients with non-ST-segment elevation myocardial infarction (NSTEMI). The present study evaluated the prognostic value of 24 h high-sensitivity cardiac troponin I (hs-Troponin I) and assessed whether combining biomarkers and echocardiographic parameters improves short-term risk prediction. Methods: This prospective observational cohort study included 170 consecutive adult patients with confirmed NSTEMI who were admitted to a Medical Intensive Care Unit and prospectively enrolled between February 2022 and January 2023. Clinical, routine biochemical, inflammatory, hematological, lipid, and echocardiographic data were collected during index hospitalization. High-sensitivity cardiac troponin I was measured at admission and again 24 h after hospitalization, with the 24 h value used as the principal marker of myocardial injury in the prediction analyses. The primary endpoint was major adverse cardiovascular events (MACEs), defined as cardiovascular death, recurrent myocardial infarction, ischemic stroke, urgent coronary revascularization, or hospitalization for worsening heart failure, within 3 months. Multivariable logistic regression, Cox regression, sequential prediction modeling, and internal bootstrap validation were performed. Results: MACEs occurred in 88 patients (51.8%). Twenty-four-hour hs-Troponin I, but not admission hs-Troponin I, was independently associated with MACEs (OR 1.57, 95% CI 1.09–2.26; p = 0.015) and a shorter time to the first MACE event (HR 1.38, 95% CI 1.07–1.78; p = 0.012). Lower left ventricular ejection fraction (LVEF) was also independently associated with adverse outcomes. The addition of 24 h hs-Troponin I, LVEF, and C-reactive protein improved discrimination from an AUC of 0.665 to 0.759 (optimism-corrected AUC, 0.717), with corresponding improvements in reclassification. A simplified multimarker score was independently associated with event-free survival (HR 2.36, 95% CI 1.53–3.64; p < 0.001). Conclusions: In patients admitted to a medical intensive care unit with NSTEMI, the integration of 24 h hs-Troponin I, LVEF, and C-reactive protein improved short-term risk prediction beyond that of clinical variables alone. A practical multimarker model based on routinely available parameters identified patients at increased risk of adverse cardiovascular outcomes during early follow-up. Full article

Background and Objectives: Non-traumatic spontaneous adrenal mass rupture (SAMR) is a rare and life-threatening surgical emergency. It has around a 32% mortality rate based on the underlying pathology. We aimed to explore the presentations, management, and outcomes of SAMR with various pathologies. Materials andMethods: We reviewed electronic and operative records over the last eight years to identify SAMR at our institute. Patients’ demographics, comorbidities, presentations, pathology, interventions, and outcomes were analyzed. Results: There were 14 unilateral SAMR patients who arrived at the emergency department (ED)presenting with abdominal pain. The median age at presentation was 34 years (range 27–56). In total, 12 patients were male (83.3%), and 2 were female, including a 32-week-pregnant woman. Ten were South Asians and four were Arabs. All the patients with SAMR did not have a history of prior adrenal disorders. Nine patients had hypotension at presentation. After the initial clinical examination, the patients underwent a computed tomography (CT) scan in the ED, which revealed unilateral SAMR. There was no medical history of adrenal mass or trauma prior to index admission. The CT scan size of the masses ranged from 5.5 to 23.6 cm (eight were right-sided and six left-sided). Time to intervention ranged from 1 to 11 days. Histopathology showed four pheochromocytomas, four myelolipomas, three normal adrenal tissues with hemorrhagic cysts, one adrenal gland hemorrhage, one pseudocyst, and one angiosarcoma. Six adrenal masses were non-functioning. All patients were managed with open adrenalectomy (two had pre-operative interventional radiological embolization). Blood transfusion was required in most cases. Ten patients required post-operative surgical intensive care with an average stay of 2.42 days. There were no perioperative deaths during the hospital course. Conclusions: Ruptured adrenal masses most commonly present with acute abdominal pain requiring urgent surgical intervention, particularly in patients with hemodynamic instability, insufficient initial conservative management or malignancy. Despite the dramatic presentation, outcomes are favorable in experienced centers when early diagnosis and hemodynamic optimization precede interventions and are accompanied by multidisciplinary team involvement. Full article