Diclofenac is one of the most prescribed non-steroidal anti-inflammatory drugs (NSAIDs) for acute and chronic inflammatory conditions. Taking into consideration the extensive use of diclofenac, the crucial role of inflammation in tumorigenesis and data on the effects of NSAIDs on cancer cell lines, we investigated the cytotoxic potential of diclofenac on a panel of human cell lines originating from breast (MCF-7), cervical (HeLa) and colorectal cancer (HT-29). The cytotoxicity was assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) dye reduction assay and the half maximal inhibitory concentrations (IC₅₀) were determined. Diclofenac had higher potency against MCF-7 and HT-29 than against HeLa. The cellular and nuclear changes were examined by fluorescent microscopy using 4′,6′-diamino-2-phenylindole (DAPI) stain and acridine orange/ethidium bromide (AO/EB). The wound-healing scratch assay showed significant reduction in the migration capacity of all tested cancer cell lines. The observed antineoplastic activity implies that the anticancer potential of NSAIDs and diclofenac, in particular, necessitates further investigation.

Background and Objectives: The objective is to evaluate medication adherence level (MA) and the relevant determinants of MA among patients with type 2 diabetes mellitus (T2DM) monitored in ambulatory settings by general practitioners. Materials and Methods: A cross-sectional study was conducted among patients with T2DM monitored in a GP practice in Sofia, Bulgaria (September–December 2022). All patients were interviewed according to a predesigned questionnaire after granting informed consent. MA level was evaluated through the Morisky–Green four-item questionnaire, and health-related quality of life was evaluated by EQ-5D-5L and VAS (visual analogue scale). Data were aggregated and statistically evaluated. Results: The total number of observed patients was 93. Around 48.4% of patients were female, and 90.3% of patients were between 50 and 80 years of age. Multimorbidity was identified among 70% (n = 65) of the respondents. High and medium levels of MA were revealed in 64.51% and 33.3% of respondents, respectively. Patients treated with insulin secretagogues were most adherent to the therapy (n = 83.3%) in comparison with the other treatment groups. The onset of the disease, professional status, age, gender, number of therapies, and quality of life did not affect the level of MA (p > 0.05). VAS scores among nonsmokers (VAS = 63.16 ± 20.45 vs. 72.77 ± 14.3) and non-consumers of alcohol (VAS = 63.91 ± 19.34 vs. VAS = 72.54 ± 15.98) were statistically significant lower (p < 0.05). A significant related factor for MA was years lived with diabetes (OR = 3.039, 95% CI 1.1436–8.0759, p = 0.0258). The longer the disease duration, the more the odds for a high MA level increased. Conclusions: The number of nonadherent diabetic patients in Bulgaria is low, which might be evidence of patients’ concern about their own health and understanding about the importance of prescribed therapy. Further comprehensive study with additional patients is required to confirm the results and investigate the predicting factors for a high level of MA.

Alpha-lipoic acid (ALA, also known as thioctic acid) was discovered nearly 90 years ago and began to be used in clinical practice in the late 1950s. Numerous nonclinical and clinical studies have investigated ALA for treating diabetic peripheral neuropathy (DPN) and various other diseases. The rising global prevalence of DPN necessitates timely treatment; however, there is currently no effective cure. Current guideline-recommended therapies for DPN provide symptom relief rather than modifying the disease. Among the pathogenesis-oriented therapies, ALA holds a unique position as a universal antioxidant, essential for every cell in the body. This review highlights the ongoing issues and challenges in using ALA to treat DPN. While confronting a complex disease with poorly understood pathophysiology, we also have an endogenous substance with pleiotropic effects on all cells in the human body. It becomes clear that this is a highly multifactorial process that will likely never be precisely defined. This does not diminish the significance of ALA in treating DPN but underscores the need for a deeper understanding of when to start therapy, dosage, duration, and monitoring. In this comprehensive review, we evaluate the achievements of the past 70 years and highlight gaps in ALA’s role in treating DPN.

This study aimed to analyze the composition of grape seed oil (GSO) derived from an alternative source after traditional fermentation processes and its potential anti-inflammatory effects using an in vivo model of carrageenan-induced inflammation in mice. Gas chromatography high-resolution electron ionization mass spectrometry (GC-HR-EIMS) analysis identified eight main components in the GSO extract, including myristic acid methyl ester, palmitoleic acid methyl ester, methyl isoheptadecanoate, cis-linoleic acid, oleic acid methyl ester, linoleic acid stereoisomer, linoleic acid ethyl ester, and methyl (6E, 9E, 12E, 15E)-docose-6,9,12,15-tetraenoate. No significant differences were observed in the main fatty acids between commercially available grape seed oil and GSO extract obtained from fermented grape seeds. In the carrageenan-induced inflammation model, treatment with GSO resulted in a significant reduction in paw edema at 180 min, as in the reduction observed with diclofenac treatment. Combined treatment with GSO and diclofenac showed enhanced anti-inflammatory effects. Additionally, GSO exhibited antioxidative effects by decreasing the levels of glutathione (GSH) and malondialdehyde (MDA) in the serum. Chronic treatment with GSO for ten days did not provide a protective effect on inflammation. These findings suggest that GSO could be used as an alternative raw material and could possess anti-inflammatory and antioxidative properties. Further studies are needed to explore its potential therapeutic applications.

The purpose was to assess the level of medication adherence (MA) and related factors among individuals with acromegaly. The secondary goal was to assess the quality of life of patients and whether and how it correlates with the level of adherence. A prospective one-year study was conducted among patients with acromegaly diagnosed, treated, and monitored in the reference center for rare endocrine diseases in Bulgaria in 2021. Clinical data, patients reported outcomes, and health economics data were collected to define the predictors of non-adherence to medicines. Medication adherence level was assessed through a free Morisky–Green 4-item questionnaire. A total of 179 patients with acromegaly were observed. Approximately 62% were female, 50% were between 41 and 60 years, and the mean age at diagnosis was 40.4 years. The response rate to the questionnaires was 53% (n = 95; mean age 53.5 years, 73% female and 26% male). Patients with high levels of MA reported higher median values for the 36-Item Short Form Health Survey (SF-36) in comparison with those with low levels: 65.5 vs. 48.5 (p = 0.017). Similar results for EQ-5D-3L (3-level EuroQol 5D version) values and the level of MA were found: 0.656 vs. 0.796 (p = 0.0123). A low level of adherence was revealed in 34.7% of the patients, with no difference among different age groups. A significant positive determinant for adherence was years lived with acromegaly (OR = 5.625, 95% CI 1.7401–18.1832, p = 0.0039), as shorter duration was related to higher odds for high level of adherence. The current study demonstrates the importance of MA assessment for patients with acromegaly in Bulgaria. The medication adherence to the prescribed therapy among the observed group of patients with acromegaly varied as the percentage of adherent patients was around 65%. Still, there are low-adherent patients, and the responsible factors should be further investigated.

Oxidative stress is one of the key factors responsible for many diseases–neurodegenerative (Parkinson and Alzheimer) diseases, diabetes, atherosclerosis, etc. Creatine, a natural amino acid derivative, is capable of exerting mild, direct antioxidant activity in cultured mammalian cells acutely injured with an array of different reactive oxygen species (ROS) generating compounds. The aim of the study was in vitro (on isolated rat brain sub-cellular fractions–synaptosomes, mitochondria and microsomes) evaluation of newly synthetized creatine derivatives for possible antioxidant and neuroprotective activity. The synaptosomes and mitochondria were obtained by multiple centrifugations with Percoll, while microsomes–only by multiple centrifugations. Varying models of oxidative stress were used to study the possible antioxidant and neuroprotective effects of the respective compounds: on synaptosomes–6-hydroxydopamine; on mitochondria–tert-butyl hydroperoxide; and on microsomes–iron/ascorbate (non-enzyme-induced lipid peroxidation). Administered alone, creatine derivatives and creatine (at concentration 38 µM) revealed neurotoxic and pro-oxidant effects on isolated rat brain subcellular fractions (synaptosomes, mitochondria and microsomes). In models of 6-hydroxydopamine (on synaptosomes), tert-butyl hydroperoxide (on mitochondria) and iron/ascorbate (on microsomes)-induced oxidative stress, the derivatives showed neuroprotective and antioxidant effects. These effects may be due to the preservation of the reduced glutathione level, ROS scavenging and membranes’ stabilizers against free radicals. Thus, they play a role in the antioxidative defense system and have a promising potential as therapeutic neuroprotective agents for the treatment of neurodegenerative disorders, connected with oxidative stress, such as Parkinson’s disease.