Background/Objectives: Ischemic heart disease (IHD) significantly affects mental health, with gender-specific differences being observed in psychological responses. This pilot study aimed to explore these differences in the demographic, clinical, psychological, psychiatric, and social profile of patients diagnosed with IHD. Methods: A descriptive, cross-sectional design was used, recruiting 183 adult patients diagnosed with coronary artery disease and depression at the Psychiatry Department of Arad County Emergency Hospital, Romania, between May 2021 and May 2024. Data were collected using a self-developed tool, named the Depression Assessment in Ischemic Heart Disease Questionnaire (DA-IHDQ), alongside standardized assessments. Statistical analysis was performed using JASP statistical software (Version 0.19.1, University of Amsterdam, Amsterdam, Netherlands), employing binomial and multinomial tests for categorical data, and Cronbach’s alpha was used to assess internal consistency. Results: This study found significant demographic differences, with female patients exhibiting higher levels of emotional distress and severe depression compared with the male subjects. Women reported greater social isolation and a stronger desire to seek for psychological or psychiatric support. Furthermore, a positive correlation between depression severity and physical symptoms was observed in both genders. Conclusions: These findings highlight the importance of recognizing gender-specific responses to IHD, emphasizing the need for tailored interventions in mental healthcare and cardiac rehabilitation. Future research should further explore these differences to enhance the understanding of the psychosocial/psychiatric aspects of IHD and improve patient outcomes.

Background/Objectives: Ischemic heart disease (IHD) is a major cause of morbidity and mortality worldwide, and it is frequently associated with depression, which can negatively impact both clinical outcomes and quality of life. The relationship between IHD and depression is complex, with gender differences influencing the severity of depression and willingness to seek psychological support. This study aims to evaluate the prevalence and severity of depression in IHD patients using the Depression Assessment in Ischemic Heart Disease Questionnaire (DA-IHDQ) and to explore gender differences in depression severity and help-seeking behavior. Methods: This cross-sectional study involved 103 patients diagnosed with IHD (62 males, 41 females), with data collected from two general practice clinics in Arad, Romania, between November 2023 and November 2024. Participants completed the DA-IHDQ, a self-developed questionnaire designed to screen for depression in IHD patients. The questionnaire categorizes depression severity into four grades: minimal to no depression, mild depression, moderate depression, and severe depression. The study also assessed participants’ interest in receiving psychological support. Descriptive and inferential statistical analyses were performed, and the psychometric properties of DA-IHDQ, including its reliability (Cronbach’s α = 0.957) and diagnostic accuracy (sensitivity = 90.0%, specificity = 98.8%), were evaluated. Results: Mild depression was the most common grade in both male and female IHD patients, while severe depression was the least prevalent. Males had a higher overall frequency of depression, with more cases of mild depression, whereas females had a higher proportion of moderate and severe depression. Additionally, males demonstrated significantly lower interest in psychological or psychiatric help, while females showed greater willingness to seek mental health support. The DA-IHDQ exhibited strong internal consistency and high diagnostic accuracy in identifying depressive symptoms in IHD patients. The DA-IHDQ exhibited strong internal consistency and high diagnostic accuracy in identifying depressive symptoms in IHD patients. Conclusions: The findings highlight the high prevalence of depression in IHD patients and the gender disparities in mental health engagement, emphasizing the need for targeted psychological interventions. The DA-IHDQ demonstrated strong psychometric properties and could serve as an effective screening tool for depression in IHD care. The DA-IHDQ demonstrated strong psychometric properties and could serve as an effective screening tool for depression in IHD care. Future research should explore the barriers to help-seeking among male IHD patients and develop gender-sensitive strategies to improve access to mental health services.

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.