Multiple sclerosis (MS) is a chronic, debilitating neurological condition for which current treatments often focus on managing symptoms without curing the underlying disease. Recent studies have suggested that dietary supplements could potentially modify disease progression and enhance quality of life. This systematic review aims to evaluate the efficacy and safety of epigallocatechin-3-gallate (EGCG) as a dietary supplement in patients with MS, with a specific focus on its impact on disease progression, symptom management, and overall quality of life. We conducted a comprehensive systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, utilizing an exhaustive search across the databases PubMed, Scopus, and Web of Science up to 23 February 2024. Eligible studies were randomized controlled trials. Nine clinical trials involving 318 participants were analyzed, with dosages ranging from 600 mg to 1200 mg of EGCG daily, although most studies had only a 4-month follow-up period. Results indicated that EGCG supplementation, particularly when combined with coconut oil, led to significant improvements in metabolic health markers and functional abilities such as gait speed and balance. One trial observed significant improvements in the Berg balance scale score from an average of 49 to 52 after four months of treatment with 800 mg of EGCG daily. Additionally, interleukin-6 levels significantly decreased, suggesting anti-inflammatory effects. Measures of quality of life such as the Beck Depression Inventory (BDI) scale showed significant improvements after EGCG supplementation. However, primary outcomes like disease progression measured by the Expanded Disability Status Scale (EDSS) and Magnetic Resonance Imaging (MRI) of lesion activities showed minimal or no significant changes across most studies. EGCG supplementation appears to provide certain symptomatic and functional benefits in MS patients, particularly in terms of metabolic health and physical functionality. However, it does not significantly impact the primary disease progression markers such as EDSS scores and MRI lesions. These findings underscore the potential of EGCG as a supportive treatment in MS management, though its role in altering disease progression remains unclear. Future research should focus on long-term effects and optimal dosing to further elucidate its therapeutic potential.

The elevated risk of severe COVID-19 outcomes in patients with diabetes underscores the need for effective predictive tools. This study aimed to assess the predictive accuracy of APACHE II, CURB-65, SOFA, and NEWS2 scores at critical time points in diabetic patients diagnosed with COVID-19, aiming to guide early and potentially life-saving interventions. In a prospective cohort study conducted from January 2021 to December 2023, adult patients with type 1 or type 2 diabetes and confirmed SARS-CoV-2 infection were evaluated. Clinical scores were calculated at admission and five days post-symptom onset, with data analyzed using receiver operating characteristic (ROC) curves and logistic regression to determine areas under the curve (AUC) and hazard ratios (HR) for severe outcomes. Among the 141 diabetic patients studied, ROC analysis revealed high AUC values for SOFA (0.771 at admission, 0.873 at day five) and NEWS2 (0.892 at admission, 0.729 at day five), indicating strong predictive accuracy for these scores. The APACHE II score’s AUC improved from 0.698 at admission to 0.806 on day five, reflecting worsening patient conditions. Regression analysis showed significant HRs associated with exceeding threshold scores: The SOFA score HR at day five was 3.07 (95% CI: 2.29–4.12, p < 0.001), indicating a threefold risk of severe outcomes. Similarly, the APACHE II score showed an HR of 2.96 (95% CI: 2.21–3.96, p < 0.001) at day five, highlighting its utility in predicting severe disease progression. The SOFA and NEWS2 scores demonstrated excellent early predictive accuracy for severe COVID-19 outcomes in diabetic patients, with significant AUC and HR findings. Continuous score monitoring, especially of APACHE II and SOFA, is crucial for managing and potentially mitigating severe complications in this vulnerable population. These tools can effectively assist in the timely escalation of care, thus potentially reducing morbidity and mortality among diabetic patients during the COVID-19 pandemic.

Background/Objective: Tuberculosis (TB) is associated with significant psychological distress, including anxiety and depression, which may be influenced by coping styles. This study aimed to evaluate the relationship between coping mechanisms, psychological outcomes, and sociodemographic factors in TB patients. Methods: A total of 100 TB patients admitted to the Victor Babeș Clinical Hospital of Infectious Diseases and Pneumophtisiology, Timișoara, were assessed using the COPE questionnaire for coping styles and the GAD7 and PHQ9 scales for anxiety and depression. The Wilcoxon signed-rank test analyzed the changes in the psychological scores between admission and discharge. Results: Multinomial and linear regression analyses identified the predictors of coping styles based on psychological and sociodemographic factors. Anxiety and depression significantly improved during hospitalization (PHQ9: p < 0.001, GAD7: p < 0.001). Social-support-focused coping showed the largest depression reduction (PHQ9: from 13 to 4), while avoidant coping had the lowest residual distress (PHQ9 = 0.5, GAD7 = 0). Age and marital status were significant predictors of problem-focused coping, with older and married patients being more likely to adopt this strategy (β = 0.08, p = 0.008). Coping styles significantly influence psychological outcomes in TB patients. Problem-focused coping was associated with better psychological recovery, while social-support-focused coping was linked to persistent distress. Conclusions: Integrating mental health screening into TB care and tailoring interventions to coping styles may enhance psychological resilience and potentially support treatment adherence, a relationship that should be further explored in future research.

Background and Objectives: The worldwide shift toward psychiatric deinstitutionalization has aimed to enhance patient autonomy, social integration, and overall quality of life. However, limited studies have examined how concurrent substance use—particularly alcohol, marijuana, and inhalable drugs—affects clinical outcomes in these populations. This study aimed to evaluate psychiatric patients with varying degrees of institutionalization and investigate whether substance use complicates or exacerbates treatment outcomes. We hypothesized that individuals using substances would demonstrate worse psychosocial functioning, higher healthcare costs, and increased readmission rates. Methods: We performed a cross-sectional study of 95 participants recruited from long-term care facilities. Participants completed the SF-36 survey validated in Romanian. Financial data were collected to gauge direct and indirect healthcare expenditures. Results: Results indicated that 34.7% of participants reported alcohol use, 12.6% used marijuana, and 9.5% used inhalable substances. Substance-using patients experienced higher mean hospitalization costs of approximately USD 3251.8, compared to non-users (USD 2743.6, p = 0.032). Quality-of-life scores were significantly lower among substance users (mean SF-36 score 58.4 vs. 66.7, p = 0.027). Rates of relapse and readmission were also notably higher in the substance-using cohort (42.1%) relative to non-users (29.8%, p = 0.041). Conclusions: To our knowledge, this is the first Romanian study—and one of only a handful in Europe—to quantify how specific substance-use profiles simultaneously alter quality of life and direct healthcare costs in a deinstitutionalized psychiatric population. Our findings highlight the need for integrated interventions targeting both mental health and substance abuse.

Background/Objectives: Community psychiatric care aims to support recovery, autonomy, and lower reliance on inpatient services, but co-occurring substance use may reduce these gains. This study examined associations between psychiatric care pathway, non-tobacco substance-use severity, recovery-related patient-reported outcomes, clinical instability, and direct mental health cost in adults with severe mental illness in Romania. Methods: This cross-sectional observational study included 128 adults receiving psychiatric hospital care, long-term residential care, or protected community housing within one regional psychiatric care network. Participants had at least 12 months of uninterrupted care in their current setting. Substance use was assessed with the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), excluding tobacco from the analytic severity score. Outcomes included SF-36 physical and mental scores, brief service-experience ratings of autonomy and perceived coercion, emergency department visits, relapse, readmission, inpatient days, outpatient visits, and annual direct mental health cost. Results: Any non-tobacco substance use was most common in hospital care, intermediate in residential care, and least common in community housing. Mental quality of life was lowest among hospital participants with substance use and highest among community participants without substance use. In multivariable models, ASSIST-derived severity was independently associated with a lower SF-36 mental score and a higher direct cost, while autonomy was independently associated with better mental quality of life and lower direct cost. The cost outcome was modeled primarily with a gamma generalized linear model with a log link because costs were positive and right-skewed. Because pathway allocation was clinically determined rather than randomized, and because autonomy, perceived coercion, and mental quality of life were all self-reported at a single assessment, every multivariable and path estimate is exploratory. Conclusions: Community psychiatric pathways were associated with more favorable recovery indicators, but non-tobacco substance use remained an important marker of poorer outcomes and greater service burden. The findings support addiction-sensitive community psychiatric care and routine monitoring of autonomy and perceived coercion as service-quality indicators. Because the design was cross-sectional and the care pathways were non-equivalent at baseline, these results are hypothesis-generating and do not establish that care pathway, substance use, or autonomy exerts a causal effect on any outcome measured.

Background and Objectives: Romania’s transition from long-stay psychiatric care to more balanced community-oriented care remains incomplete, and comparative patient-level data are limited. The primary objective was to compare mental health-related quality of life, autonomy, perceived coercion, and direct mental health costs across hospital, residential, and community care settings. Secondary objectives were (i) to compare hospital care with deinstitutionalized care taken together (residential + community), and (ii) to examine whether autonomy and perceived coercion were associated with mental health-related quality of life. Methods: In this cross-sectional study, 128 adults with severe mental illness (42 hospital, 43 residential, 43 community) completed the Romanian SF-36 v2.0 and two brief study-specific rating scales for autonomy and perceived coercion. Service-use and cost data for the previous 12 months were extracted from records. Results: Community participants had higher SF-36 mental scores than hospital patients (63.3 ± 7.6 vs. 52.8 ± 9.1) and higher autonomy (72.1 ± 10.0 vs. 53.0 ± 8.6), with lower perceived coercion (4.2 ± 1.3 vs. 6.4 ± 1.5; all p < 0.001). Mean combined direct costs in residential and community settings were approximately USD 1000 lower than in hospital care (USD 2671.6 vs. 3666.2; p < 0.001). When residential and community participants were analyzed together as a deinstitutionalized group, they also had higher SF-36 mental scores (59.7 ± 8.9 vs. 52.8 ± 9.1; p < 0.001). In multivariable models (R² = 0.316), each 10-point higher autonomy score was associated with a 2.8-point higher SF-36 mental score, whereas each 1-point higher coercion score was associated with a 1.3-point lower score. Exploratory mediation analysis suggested that autonomy statistically attenuated the association between deinstitutionalized care and mental quality of life. Conclusions: In this sample, residential and community arrangements outside hospital wards were associated with better mental health-related quality of life, higher autonomy, lower perceived coercion, and lower direct costs than long-stay hospital care. These findings support the study objective of comparing Romanian care settings and suggest that autonomy is an important correlate to target in future service reconfiguration and longitudinal research.