Background: This study investigates the association between depression and ischemic heart disease (IHD), conditions that often coexist and complicate patient management. Understanding the impact of demographic factors, risk factors, symptoms, and medical approaches in these patients is essential to develop effective clinical strategies. Objectives: The aim of this study is to investigate how demographic characteristics, risk factors, symptoms, and treatment methods differ between patients with depression alone and those with both depression and IHD. It seeks to identify how these factors influence patient outcomes, providing insights to improve management and treatment approaches for this complex patient group. Materials and Methods: This cross-sectional study included a sample of 332 patients diagnosed with depression, with a specific subgroup consisting of individuals who also had comorbid IHD. Statistical analyses were performed to compare the patients with depression, focusing on those with IHD. Data on demographic characteristics (e.g., gender, environment, social status), risk factors (e.g., hypertension, diabetes), symptom severity, and treatments (e.g., antidepressants, antipsychotics, anxiolytics, hypnotics) were analyzed. The study also evaluated the frequency of cardiac examinations and emergency hospitalizations. Results: Significant demographic differences were found between the two groups. Patients with both depression and IHD had higher rates of hypertension and diabetes mellitus and experienced more severe depressive symptoms, including reduced mood, energy, and activity levels. The treatment patterns were similar in terms of antidepressant use, but the IHD group had a higher use of antipsychotics, anxiolytics, and hypnotics. Additionally, these patients required more cardiac examinations and emergency hospitalizations. Conclusions: Comorbidity between depression and IHD presents complex clinical challenges, and it is crucial to implement an integrated management approach that addresses both mental and physical health. This study highlights the need for comprehensive therapeutic strategies to improve the quality of life and outcomes for patients with these coexisting conditions.

Background/Objectives: Hypersensitivity pneumonitis (HP), a subtype of interstitial lung disease (ILD), is often misdiagnosed as idiopathic pulmonary fibrosis (IPF), particularly when the causative antigen cannot be identified. Typically resulting from chronic exposure to inhaled organic particles smaller than 5 microns, HP presents a diagnostic challenge. This report outlines a case of fibrotic HP initially misclassified as asthma. No triggering antigen was identified despite extensive investigation. The disease progressed despite corticosteroid, immunosuppressive, and antifibrotic therapy, ultimately leading to an advanced fibrotic stage and requiring lung transplantation. This clinical course is rare and infrequently reported, particularly in cases requiring lung transplantation without an identifiable causative antigen. Such progression is uncommon and underreported, especially in patients initially misclassified as having asthma. Methods: Medical records of 24 patients diagnosed with HP were reviewed. Only one case demonstrated progression to fibrotic HP; this case was selected for detailed analysis. Results: Clinical and functional deterioration occurred despite standard therapy. Given the advanced stage of fibrosis and treatment resistance, lung transplantation was deemed the next appropriate therapeutic option. Conclusions: HP remains underdiagnosed due to difficulties in identifying the causative antigen and overlapping features with other ILDs. Early and accurate differentiation from IPF is essential, particularly in progressive fibrotic forms unresponsive to conventional therapies.

Background/Objectives: Psychiatric inpatient care varies substantially in its clinical goals, resource demands, and financial implications. Acute units focus on short-term crisis stabilization, whereas chronic units provide prolonged supervision for patients with persistent functional impairment. Limited evidence exists from Eastern Europe on how these differing service models impact both hospital costs and clinical outcomes such as early rehospitalization. This study aimed to compare the economic and operational performance of Acute versus Chronic Psychiatry and to identify predictors of 30-day readmission following acute psychiatric hospitalization. Methods: This retrospective observational study analyzed routinely collected data from a Romanian public hospital. All adult admissions to Acute and Chronic Psychiatry recorded between 1 January 2024 and 31 December 2024 were included. Standardized financial indicators were derived from administrative data, while clinical variables and readmission outcomes were extracted from electronic medical records. Between-group comparisons of economic and operational indicators were performed using t-tests. Multivariable logistic regression was used to determine independent predictors of 30-day readmission in Acute Psychiatry, reporting adjusted odds ratios (aOR) with 95% confidence intervals (CI). Model performance was evaluated with area under the curve (AUC), Hosmer–Lemeshow tests, and Nagelkerke R². Results: Acute Psychiatry demonstrated significantly higher mean cost per bed-day (798.76 vs. 373.75 lei; p < 0.001), but a lower mean cost per patient due to shorter hospitalization (10.17 vs. 53.32 days). A total of 188 acute patients (13.7%) were readmitted within 30 days. No early readmissions occurred in Chronic Psychiatry, consistent with its long-stay care model. Independent predictors of readmission included psychotic disorder diagnosis (aOR = 1.62, 95% CI: 1.18–2.23), multiple prior admissions (aOR = 1.35, 95% CI: 1.18–1.54), shorter length of stay (LOS) (aOR = 0.88 per 5-day increase, p = 0.006), and absence of a post-discharge plan (aOR = 0.54, 95% CI: 0.39–0.76). Model discrimination was acceptable (AUC = 0.74). Conclusions: Acute and chronic psychiatric services differ markedly in cost structures and care pathways. Early rehospitalization is a clinically relevant outcome within acute psychiatric care and is influenced by both patient-level and continuity-of-care factors. Enhancing discharge coordination, expanding continuity-of-care strategies, and optimizing resource allocation toward community-based support may reduce early rehospitalizations while improving hospital cost-efficiency.

Background and Clinical Significance: Extrapulmonary tuberculosis (TB) remains a diagnostic challenge, particularly when affecting rare sites such as the oral cavity and digestive tract. We report the case of a 55-year-old woman with disseminated (miliary) tuberculosis presenting with atypical oral lesions initially suspected to represent a malignant tumor. Case Presentation: The patient had a history of recurrent depressive disorder, cognitive impairment, sleep disturbances, and nicotine/alcohol dependence. She presented with painful ulcerations of the oral cavity, dysphagia, odynophagia, and glossodynia. Otolaryngologic examination revealed reduced tongue mobility and an ulceroinfiltrative lesion involving the floor of the mouth and the lower alveolar ridge. Fibroscopic evaluation confirmed infiltrative ulcerative lesions, and biopsy samples were obtained. Histopathologic examination revealed a chronic necrotizing granulomatous inflammation with multinucleated giant cells, consistent with a mycobacterial infection. Further investigations confirmed disseminated (miliary) tuberculosis with oral and digestive involvement. Antituberculous therapy was initiated; however, despite temporary stabilization, the patient’s condition progressively worsened and the outcome was fatal. Conclusions: Oral and digestive tuberculosis, although rare, should be considered in the differential diagnosis of ulceroinfiltrative lesions of the oral cavity, particularly in patients with systemic symptoms or risk factors for TB. Early histopathologic confirmation and initiation of specific therapy are essential for favorable outcomes and prevention of misdiagnosis as malignant disease.

Background: Tuberculous cervical lymphadenitis (scrofula) is the most common form of extrapulmonary tuberculosis, although its coexistence with massive pleural effusion is uncommon and may delay diagnosis because of its nonspecific clinical presentation. We report the case of a 47-year-old man presenting with a large right-sided pleural effusion associated with a suppurative cervical lymphadenitis, in whom rapid molecular testing established the diagnosis of disseminated extrapulmonary tuberculosis. Case Presentation: A 47-year-old male presented with progressive right-sided chest pain, exertional dyspnea, intermittent fever, night sweats, weight loss, and a progressively enlarging left laterocervical mass. Physical examination revealed multiple enlarged, fluctuant cervical lymph nodes and clinical signs of a massive right pleural effusion. Thoracic computed tomography demonstrated a large right pleural effusion with compressive atelectasis and enlarged cervical and mediastinal lymph nodes. Ultrasound-guided cervical lymph node drainage and tube thoracostomy were performed, followed by repeated pleural fluid evacuations through the chest tube. Purulent material obtained from the cervical abscess and pleural fluid were subjected to microbiological, cytological, and molecular investigations, including Xpert MTB/RIF (GeneXpert MTB/RIF). GeneXpert MTB/RIF detected Mycobacterium tuberculosis complex in both the drained cervical purulent material and pleural fluid, with no evidence of rifampicin resistance. Conventional bacterial cultures remained negative, while mycobacterial cultures were subsequently positive for M. tuberculosis. Pleural fluid analysis was consistent with an exudative lymphocytic effusion with elevated adenosine deaminase levels. Histopathological examination of the cervical tissue demonstrated necrotizing granulomatous inflammation with central caseous necrosis, epithelioid histiocytes, and Langhans-type multinucleated giant cells, supporting the diagnosis of tuberculous lymphadenitis. HIV serology was negative, and no additional immunodeficiency was identified. Standard first-line antituberculous therapy (isoniazid, rifampicin, pyrazinamide, and ethambutol) was initiated promptly following microbiological confirmation, leading to progressive regression of the cervical lesions, complete resolution of the pleural effusion, and favorable clinical evolution during follow-up. Conclusions: The simultaneous occurrence of tuberculous cervical lymphadenitis and massive pleural tuberculosis represents an uncommon presentation of extrapulmonary tuberculosis that requires a high index of clinical suspicion. The combination of histopathological examination and rapid molecular testing of extrapulmonary specimens allowed definitive and timely confirmation of tuberculosis and facilitated prompt initiation of appropriate therapy. Clinicians should consider tuberculosis in patients presenting with cervical suppurative lymphadenitis and unexplained pleural effusion, even in the absence of microbiologically confirmed pulmonary disease, to avoid diagnostic delay and improve clinical outcomes.

Background/Objectives: Mechanical alignment (MA) has traditionally been the reference alignment strategy in total knee arthroplasty (TKA), whereas kinematic alignment (KA) has emerged as an individualized alternative intended to approximate patient-specific knee anatomy. However, the relationship between postoperative mechanical-axis alignment and functional recovery remains incompletely understood. This study aimed to compare short-term functional outcomes and postoperative mechanical-axis alignment between MA and KA following primary TKA and to investigate the relationship between measured postoperative alignment parameters and functional outcomes. Methods: This single-center retrospective comparative cohort study included 120 patients who underwent primary unilateral TKA for end-stage knee osteoarthritis (KOA) between January 2022 and December 2024; 51 underwent MA and 69 underwent KA. Radiographic assessment included the hip–knee–ankle (HKA) angle, mechanical-axis deviation (MAD), residual varus deformity, and radiographic knee extension deficit. Functional outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Knee Society Score (KSS). Preoperative, postoperative, and change-from-baseline (Δ) functional scores were evaluated. Analysis of covariance (ANCOVA) was used to assess associations between alignment strategy and postoperative functional outcomes after adjustment for baseline functional scores and relevant covariates. Associations between postoperative radiographic parameters and functional outcomes were additionally assessed. Results: Both alignment groups demonstrated substantial preoperative-to-postoperative functional improvement. MA achieved postoperative HKA alignment closer to the neutral mechanical axis than KA (179.63 ± 1.23° vs. 178.24 ± 2.32°; p < 0.001; FDR-adjusted p < 0.001). Absolute HKA deviation from neutral was lower with MA (0.97 ± 0.83° vs. 2.42 ± 1.62°; FDR-adjusted p < 0.001), as was postoperative absolute MAD (5.19 ± 4.53 mm vs. 7.86 ± 6.76 mm; p = 0.011; FDR-adjusted p = 0.018). KA was associated with a higher unadjusted postoperative KOOS score than MA (84.04 ± 12.33 vs. 77.12 ± 15.65; p = 0.010), whereas postoperative WOMAC (p = 0.206) and KSS (p = 0.843) did not differ significantly between groups. Between-group differences in change from baseline were not statistically significant for KOOS (p = 0.227), WOMAC (p = 0.130), or KSS (p = 0.427). After multivariable adjustment, no statistically significant between-group associations were observed for postoperative KOOS (adjusted β = 2.42; 95% CI, −0.93 to 5.77; p = 0.155), WOMAC (adjusted β = −2.80; 95% CI, −6.73 to 1.14; p = 0.162), or KSS (adjusted β = 1.09; 95% CI, −2.05 to 4.24; p = 0.492). Associations between the postoperative radiographic parameters and functional outcomes were negligible to weak, with none remaining statistically significant after FDR correction. Conclusions: Both MA and KA were associated with substantial short-term functional improvement, with no significant between-group differences in the magnitude of improvement from baseline. MA achieved postoperative alignment closer to the neutral mechanical axis, while the higher unadjusted postoperative KOOS score observed with KA was not statistically significant after adjustment for baseline characteristics and potential confounders. No significant postoperative differences in WOMAC or KSS were observed. The generally weak associations between measured postoperative mechanical-axis parameters and functional outcomes suggest that mechanical-axis alignment alone may not adequately explain short-term functional recovery. Because patient-specific coronal alignment parameters and achievement of the individualized KA target were not quantitatively assessed, the present findings cannot determine whether restoration of patient-specific anatomy was associated with functional outcomes.