Background/Objectives: Transcranial magnetic stimulation (TMS) is a non-invasive and well-tolerated treatment, offering an effective alternative for elderly patients with depression, especially when side effects or comorbidities limit medication. Methods: This scoping review analyzes 16 studies published over the past seven years, to evaluate the efficacy, safety, and clinical applications of TMS in older adults with depression. Results: The review examines various TMS modalities, including repetitive TMS (rTMS), deep TMS, and theta burst stimulation (TBS), with most protocols targeting the dorsolateral prefrontal cortex (DLPFC). Adverse effects were rare, mild, and transient, supporting the treatment’s safety profile. Pharmacological co-treatment was common but not essential for clinical improvement, highlighting TMS’s potential as a standalone therapy. A subset of studies used neuroplasticity (SICI, ICF, CSP) or neuroimaging measures (MRI and MRI-based neuronavigation), revealing that age-related cortical inhibition may limit plasticity rather than depression itself. Conclusions: Overall, TMS demonstrates promising effectiveness and tolerability in managing late-life depression. Across studies, remission rates varied from 20% to 63%, with higher efficacy generally observed in bilateral stimulation or high-frequency protocols. Standardization of protocols and further research into individualized targeting and long-term outcomes are warranted to support broader clinical adoption.

Background/Objectives: Therapeutic drug monitoring (TDM) of antipsychotic medications plays an important role in optimizing treatment efficacy, reducing adverse effects, and supporting adherence. While Ultra-High Performance Liquid Chromatography–Tandem Mass Spectrometry (UHPLC–MS/MS) has long been the gold standard for antipsychotic quantification, recent advances in automated platforms and microsampling raise questions about its current clinical practicality. This systematic review evaluated the clinical applicability and analytical performance of UHPLC-based methods for monitoring antipsychotic drugs, focusing on precision, recovery, matrix effects, and suitability across various biological matrices. Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted for studies published between 2013 and 2024 involving UHPLC-based quantification of antipsychotics in clinical samples from adult patients. Data on analytical parameters, sample matrices, and study characteristics were extracted. A custom quality checklist was used to assess methodological rigor. In addition to qualitative synthesis, non-traditional quantitative approaches were applied, including descriptive aggregation of recovery, matrix effects, and precision across studies, as well as correlation analyses to explore relationships among performance parameters. Results: Twelve studies were included, spanning a range of typical and atypical antipsychotics and metabolites. Plasma and serum demonstrated the highest analytical reliability (recovery >90%, minimal matrix effects), while dried blood spots (DBSs), whole blood, and oral fluid showed greater variability. Clinically, UHPLC–MS/MS enabled more accurate dose adjustments and identification of non-adherence, outperforming immunoassays in sensitivity, specificity, and metabolite detection. Microsampling methods showed promise for outpatient and decentralized care but require further clinical validation. Conclusions: UHPLC–MS/MS remains the most robust and reliable method for TDM of antipsychotics, especially when quantification of active metabolites is required. While logistical barriers remain, technological advances may enhance feasibility and support broader integration into routine psychiatric care.

This study investigates the correlation between anatomical variants of the Circle of Willis (CoW) and the presence of intracranial aneurysms (IcAs), a relationship insufficiently addressed in current literature. We conducted a 12-year retrospective observational study on 221 adult autopsied patients admitted to the “Prof. Dr. N. Oblu” Emergency Clinical Hospital in Iași, Romania. Demographic data, aneurysm morphology (location, diameter), and CoW anatomical variants were analyzed. IcAs were found in 29 cases (13.12%), most frequently located at the Anterior Communicating Artery (55.2%), with a majority measuring under 10 mm in diameter. A strong association was observed between IcAs and atypical CoW configurations (96.55%), particularly when three or four anatomical variants coexisted. No gender predisposition was identified. The mean age of patients increased with aneurysm size, yet larger aneurysms were less often associated with progression to death. Our findings suggest that the presence of multiple CoW variants significantly increases the likelihood of developing IcAs. These results may enhance prognosis and support clinical decision-making frameworks for managing cerebral aneurysms.

Background: Optimising maternal diet quality is among the most promising targets for public health interventions to improve the health of current and future generations. The aim of this study was to assess the construct validity of the Canadian Pregnancy Diet Quality Index (DQI-P _C ) in Romania by: (i) examining its associations with nutrient adequacy, including nutrients not included in the index (non-constituent nutrients), and (ii) evaluating whether DQI-P _C scores differ across sociodemographic characteristics known to influence diet quality. Methods: A cross-sectional study ( n = 647) was conducted to determine DQI-P _C and nutrient intake using a previously validated food-frequency questionnaire. DQI-P _C scores were assessed across categories of education, income, age, and parity. Furthermore, the relationship between DQI-P _C and macro- and micronutrients was examined using correlation coefficients. Results: Mean DQI-PC score was 42.1 out of 70. Inadequate intake (< 90%RDA, Recommended Dietary Allowance) of micronutrients, particularly important during pregnancy, such as vitamin D, iron, and folate, was observed, and all participants fell below recommendations. DQI-PC was strongly associated with higher nutrient adequacy across almost all micronutrients. A higher DQI-PC score was associated with significantly higher %RDA for nearly all vitamins (B1, B2, B6, B12, A, C, D and E; all p < 0.001). Spearman correlation analysis confirmed significant associations between DQI-PC and all dietary components (all p < 0.001). Strong positive correlations were observed for folate (rho = 0.65) and iron (rho = 0.53), while total fat intake showed a strong negative correlation (rho = − 0.55). Participants with higher income had significantly higher DQI-PC scores than those with lower income (42.66 vs 40.92, p = 0.007). Higher income was also linked to better adequacy for grain and iron (both p = 0.007 or less), while total fat intake (% of energy) and fruit consumption were notably higher in the lower income group (both p < 0.001). Conclusions: Despite the well-documented importance of nutrition during pregnancy, significant inadequacies persist in practice. The DQI-PC, originally developed in Canada, is a valuable tool for predicting intake of all major nutrients during pregnancy across multiple countries.

Background/Objectives: Hospital performance is a multidimensional construct that cannot be adequately assessed using isolated financial, clinical, organizational, or patient-reported indicators. This study aimed to develop and evaluate an Integrated Multidimensional Hospital Performance Assessment Framework combining organizational management, healthcare quality, patient satisfaction, and cost efficiency. Methods: An observational, descriptive, comparative study was conducted using data collected during 2018–2019 from two Romanian public hospitals with different organizational profiles: a multidisciplinary general hospital and a monospecialty hospital. Organizational, operational, financial, and clinical indicators were analyzed comparatively. Patient satisfaction was assessed in 184 hospitalized patients, including 130 from the general hospital and 54 from the monospecialty hospital, using a structured questionnaire with excellent internal consistency (Cronbach’s α = 0.92). Cost efficiency was estimated using Stochastic Frontier Analysis based on hospital expenditure, activity, resource utilization, case complexity, and quality-related variables. Results: Significant differences were identified between the hospitals in staff composition, bed occupancy, outpatient activity, case-mix complexity, surgical activity, healthcare quality, and financial performance. Patient satisfaction was generally high in both institutions, although several dimensions differed significantly, particularly overall satisfaction, waiting time, physician consultation, treatment received, and adherence to the prescribed medication schedule. The general hospital had a lower mean cost-inefficiency score than the monospecialty hospital (0.253 vs. 0.395), corresponding to higher estimated cost efficiency (0.747 vs. 0.605; p < 0.001). Conclusions: The proposed framework offers a comprehensive and practical approach to hospital performance assessment, and its application in two public hospitals provides a proof-of-concept demonstration of feasibility. Further multicenter studies are required for external validation and assessment of its generalizability across different hospital settings.

Background: Pregnancy is a vital period during which maternal nutrition profoundly influences both maternal health and fetal development. Carotenoids, predominantly found in fruits and vegetables, are bioactive compounds that enhance antioxidant defenses and facilitate vitamin A metabolism throughout pregnancy. However, assessing carotenoids intake presents challenges due to the lack of dietary assessment tools capable of quantifying individual carotenoids, coupled with limited data from populations in Eastern Europe. Methods: A cross-sectional study involving 621 pregnant women in Romania was conducted to estimate dietary carotenoids intake and investigate associations with dietary patterns and overall diet quality. Dietary data were obtained using the EPIC Food Frequency Questionnaire (EPIC-FFQ), adapted for Romanian populations. A dedicated carotenoid estimation model was developed utilizing the USDA Carotenoid Database. Principal component analysis (PCA) was employed to identify dietary patterns, and diet quality was evaluated using the Diet Quality Index during Pregnancy (DQI-P). Results: The findings revealed significant individual variability. The median intake was highest for β-carotene (2464 μg), and lycopene (1664 μg), followed by lutein and zeaxanthin (908 μg), α-carotene (615 μg), and β-cryptoxanthin (121 μg). The Vegetable-meal pattern exhibited the strongest positive correlation with carotenoids intake, whereas the Energy-dense pattern was primarily associated with vitamin E and tocopherols/tocotrienols, and the Mixed pattern with vitamins A and D. Higher DQI-P scores were consistently correlated with increased carotenoids consumption. Conclusions: Overall, maternal carotenoids intake during pregnancy was frequently insufficient and showed considerable variation among women. A diet rich in vegetables and higher overall diet quality were associated with elevated carotenoids intake levels. These findings enhance the understanding of dietary carotenoids intake among pregnant women in Eastern Europe.