Background. Antitumor drug therapy plays a significant role in the treatment of metastatic colorectal cancer, increasing patient survival. The use of immuno-oncology agents in this treatment is limited, as most colorectal tumors are characterized by low immunogenicity. Cytokine gene therapy agents are gaining attention as agents capable of activating the antitumor immune response. Materials and methods. Patient T., 76, was followed up with a diagnosis of cT3N1M1 cecal cancer, multiple liver metastases, and peritoneal carcinomatosis. Histologically, adenocarcinoma, G3, was confirmed, with no signs of microsatellite instability, KRAS mut, NRAS wt, HER2/neu wt, and BRAF wt. A local oncology board decided to schedule courses of drug therapy according to the XELOX regimen. A contrast-enhanced computed tomography scan revealed a cecal neoplasm, regional lymphadenopathy, peritoneal carcinomatosis, and multiple liver lesions. Wishing to complete the prescribed treatment without developing significant toxicity, the patient voluntarily presented to the clinic to receive cyclophosphamide medications. Changes in Karnofsky performance status were monitored throughout the patient's treatment. Levels of tumor necrosis factor-alpha, carcinoembryonic antigen, and cancer antigen 19-9 were assessed using enzyme-linked immunosorbent assay. Contrast-enhanced computed tomography was used for imaging. Results. During therapy, the patient reported improved well-being, increased productivity and physical activity, and normalized sleep and appetite. Her Karnofsky performance status improved, tumor necrosis factor-alpha levels increased, and tumor markers decreased: carcinoembryonic antigen by 4.2 times and cancer antigen 19-9 by 2.4 times. According to the computed tomography scan with contrast, the patient showed increasing stabilization of the tumor process. The patient has now completed six courses of recombinant tumor necrosis factor-thymosin-α1 therapy in combination with chemotherapy, and treatment is ongoing. Overall survival since diagnosis is 7+ months. Conclusion. The combination of polychemotherapy according to the XELOX regimen and the cytokine genetic therapy drug tumor necrosis factor-thymosin-α1 recombinant is not accompanied by an increase in the toxicity of cytostatics, but has a synergistic antitumor effect.
Background. Aging processes affecting all organs and systems of the body, including connective tissue, supporting joints and spine, significantly reduce the quality of life of patients of elderly and senile age. Senescent cells are resistant to apoptosis, they have increased metabolic activity, without suppression of which the accumulation of senescent cells occurs, and leads to chronic inflammation and connective tissue dysfunction. Senescent cells have a powerful senescence-associated secretory phenotype, which can enhance the aging process by suppressing the function of stem cells, disrupting tissue homeostasis, and increasing aseptic inflammation. Senolytic drugs, which have the ability to suppress pro-inflammatory cytokines, transcription factors, growth factors, and kinases, can be used to delay the aging of connective tissue and the development of the age-dependent phenotype of osteoarthritis. Conclusion. One of the promising areas is the use of therapy that includes undenatured type II collagen in a standard dosage of 40 mg. Undenatured type II collagen can be considered as a potential geroprotector, as it has an immunomodulatory effect by inhibiting pro-inflammatory cytokines (tumor necrosis factor alpha, metalloproteinase-1 and -13, interleukin-1 and -6), increasing the synthesis of anti-inflammatory mediators (transforming growth factor beta, interleukin-4, interleukin-10), and thus reducing joint inflammation and promoting cartilage regeneration. Oral forms of undenatured type II collagen are used in the Russian market as part of the domestic Chondroguard TRIO. The experience of oral use of dietary supplements in patients with osteoarthritis and lower back pain with comorbid diseases is presented. The clinical efficacy and safety of auxiliary support with pharmaconutrient in patients of different age groups with different osteoarthritis phenotypes (post-traumatic, metabolic), in elderly patients with osteoarthritis of the knee joints are demonstrated.
Background. Listeriosis is primarily a foodborne infection of sporadic nature, associated with the consumption of contaminated products. The clinical picture of the infection depends on the immune response of the infected individual. Healthy people with a normal immune response may experience acute listerial gastroenteritis without generalization of the infection. In immunocompetent individuals, self-limiting gastroenteritis, sepsis, and severe meningoencephalitis may develop. Listeriosis poses a serious threat in obstetrics and neonatology due to the high virulence of Listeria monocytogenes and its ability to cross the placental barrier. In pregnant women, listeriosis often runs mildly or asymptomatically but carries a high risk of miscarriage, stillbirth, premature birth, and severe forms in newborns – sepsis and meningoencephalitis. Neonatal listeriosis is divided into early (within 6 days after birth) and late (7-28 days after birth). Early neonatal listeriosis is most often transmitted transplacentally, while late listeriosis may result from infection during delivery or in a medical facility. Upon detection of listeriosis cases in maternity institutions, investigation of infection sources and strict sanitary-epidemiological measures are required. In Russia, there are no methodological guidelines for investigating listeriosis cases or clinical recommendations for managing pregnant women and newborns with this infection. Conclusion. This article presents a clinical example of neonatal listeriosis to demonstrate the importance of knowledge about this infection in routine clinical practice. It describes a case of premature birth in a 38-year-old pregnant woman at 31 weeks of gestation, resulting in a preterm girl with respiratory failure. In the NICU, the child was diagnosed with severe septic neonatal listeriosis with meningitis. After comprehensive drug therapy, the child showed symptom regression and positive laboratory dynamics. On day 45, the child was discharged from the hospital in satisfactory condition.
Objective. This study aims to evaluate the effect of Thiocetam on cognitive function in patients with type 2 diabetes mellitus in real-world clinical practice. Material and methods. The TIOKON observational, non-interventional, comparative study of Thiocetam in patients with type 2 diabetes mellitus and cognitive impairment in real-world clinical practice included 438 patients with type 2 diabetes mellitus, metabolic syndrome, and mild cognitive impairment. Group 1 patients (n = 133) received standard therapy alone for type 2 diabetes mellitus and comorbidities; Group 2 patients (n = 147) received therapy incorporating of a drug containing piracetam and thiotriazoline into the treatment regimen (intramuscularly for 2 weeks, followed by 2 tablets 3 times daily for 6 weeks); Group 3 patients (n = 158) received Thiocetam (2 tablets 3 times daily) for 8 weeks. The nature of complaints, cognitive functions, carbohydrate and lipid metabolism parameters, and the occurrence of adverse events were assessed. Results. During treatment, patients in Groups 2 and 3 exhibited improvements in memory, concentration, and cognitive performance. Subjective improvement, manifested as a reduction in the number and severity of complaints, occurred earlier in Group 2 patients (upon completion of the intramuscular injection course). MoCA scores increased from 22.3 ± 1.9 to 27.5 ± 0.9 in Group 2 (p < 0.05) and to 27.9 ± 0.8 in Group 3 (p < 0.05). Statistically significant differences compared to baseline and Group 1 were observed in Groups 2 and 3 at Visit 3 (with no significant differences found between Groups 2 and 3). By the end of the follow-up period, levels of glycated hemoglobin (p < 0.05), capillary blood glucose (p < 0.05), and low-density lipoprotein cholesterol (p < 0.05) had significantly decreased. An earlier onset of effect was observed in patients who underwent intramuscular therapy. Regardless of the route of administration, no serious adverse events occurred. The majority of Group 2 patients rated the treatment outcomes as good or very good. Conclusion. The drug has demonstrated efficacy and safety in patients with type 2 diabetes mellitus, metabolic syndrome, and mild cognitive impairment and can be widely utilised for the management of this patient population.
Background. Chronic heart failure and type 2 diabetes mellitus remain among the most common chronic diseases, characterized by a progressive and prognostically unfavorable course. The comorbidity of type 2 diabetes mellitus and chronic heart failure represents one of the most complex diagnostic and therapeutic challenges in modern cardiology and endocrinology, representing one of the most pressing issues in modern clinical medicine. Epidemiological data from recent years indicate a steady increase in the number of patients with this combination of pathologies, driven by a common pathogenetic continuum. Comorbidity significantly alters the natural history of both diseases; in this case, type 2 diabetes mellitus not only increases the risk of chronic heart failure developing by 4-8 times compared to the general population but also modifies its phenotype. Moreover, the clinical picture is often subtle or atypical due to the presence of autonomic cardiovascular neuropathy and the phenomenon of "silent" myocardial ischemia secondary to hyperglycemia. Traditional diagnostic approaches, primarily relying on left ventricular ejection fraction, have low sensitivity for detecting preclinical stages of cardiovascular disease in this patient population. This leads to delayed initiation of therapy and a high rate of hospitalization. Therefore, studying biomarkers of inflammation, endothelial dysfunction, and fibrosis in patients with type 2 diabetes mellitus and chronic heart failure is an important research objective for early diagnosis, accurate risk stratification, and monitoring the effectiveness of prescribed therapy. Objective. The present study aims to synthesize available evidence by conducting a comprehensive analysis of the diagnostic value of routine and advanced laboratory parameters in patients with verified type 2 diabetes mellitus and concomitant chronic heart failure of varying severity, in order to optimize screening and prognostic algorithms.
