Emerging data on finerenone have drawn significant interest from nephrologists and cardiologists for its clinical potential in patient management. Its nonsteroidal structure, greater receptor selectivity, and reduced risk of hyperkalemia make it a distinctive choice for clinicians. Mineralocorticoid receptors (MRs) are expressed in the collecting ducts, endothelial and vascular smooth muscle cells of the interlobar arteries, as well as in podocytes, mesangial cells, and renal fibroblasts. These receptors are also present in cardiovascular and inflammatory cells. MR activation contributes to ischemia-reperfusion injury (IRI) and mediates calcineurin inhibitor (CNI) toxicity, proteinuria, and fibrosis in both the cardiovascular system and kidneys. Blocking MR activation with finerenone may exert therapeutic effects in renal allografts by mitigating IRI, preventing CNI toxicity, reducing proteinuria and renal fibrosis, and lowering the risk of renal and cardiovascular events. Preclinical and clinical studies in the general population with diabetes have demonstrated that finerenone effectively reduces proteinuria and improves renal and cardiovascular outcomes. However, clinical evidence in kidney transplant recipients remains extremely limited, and the efficacy and safety of finerenone in this population are yet to be established. To date, no clinical trials specifically investigating finerenone in kidney transplantation have been published, with only the EFFEKTOR trial currently underway. This review discusses the mechanistic rationale, extrapolates evidence from nontransplant populations, identifies key knowledge gaps, and proposes future research directions to evaluate the safety and efficacy of finerenone in kidney transplant recipients.

Enterococcus species are Gram-positive cocci normally found in the gut but have emerged as opportunistic pathogens in healthcare settings, with rising multidrug resistance, particularly vancomycin-resistant Enterococci (VRE) posing major therapeutic challenges. This study evaluated the antibacterial and synergistic effects of plant-derived stilbenes from Reynoutria japonica against clinical VRE isolates. Ten clinical Enterococcus faecalis isolates were identified using standard morphological, biochemical, and Gram-staining methods, and antibiotic susceptibility testing. The antibacterial activity of polydatin, resveratroloside, and trans-resveratrol was assessed by agar well diffusion, and evaluation of minimum inhibitory concentrations (MICs) and evaluation of bactericidal activity concentrations (MBCs), with synergistic effects tested in combination with vancomycin.Molecular docking was performed with DapF, vanA, and gelE proteins. All isolates were resistant to vancomycin, ampicillin, imipenem, gentamicin, and ciprofloxacin but sensitive to linezolid. All three stilbenes displayed antibacterial activity. Notably, trans-resveratrol was the most active compound, with a MIC value of 0.156 mM and bactericidal activity (an MBC value equal to the MIC). Furthermore, all compounds exhibited synergistic effects when combined with vancomycin. Phytochemical analysis confirmed these stilbenes as major constituents in the root extract of R. japonica. Molecular docking studies revealed strong binding affinities of the compounds to key virulence and resistance-associated proteins (DapF, VanA, and GelE). These results indicate that transresveratrol and related stilbenes are promising candidates for development as alternative or adjunct therapeutic agents against VRE infections. Additionally, this study substantiates the traditional use of R. japonica as a source of bioactive antimicrobial compounds.

A new generation of smart nanocarriers offers excellent safety, efficiency, and targeted drug delivery for cancer immunotherapy. Conventional cancer treatments, such as radiation and chemotherapy, are often associated with severe systemic toxicity and extensive collateral damage to healthy tissues. In contrast, the enhanced permeability and retention effect and active targeting mechanisms of certain nanocarriers, such as liposomes, dendrimers, polymeric nanoparticles, and lipid-based systems, enable precise drug delivery. Therapeutic agents can be encapsulated within nanoscale delivery systems, protected from early degradation, and released in response to specific signals within the tumor microenvironment, such as changes in pH or enzyme concentrations. Targeting accuracy is further improved through surface modifications, including ligands, antibodies, or aptamers, which facilitate intracellular uptake and mitigate off-target effects. Additionally, the wide variety of nanocarrier structures available—from polymersomes and micelles to nanospheres and nanocapsules—allows customized applications tailored to different cancer types and stages. Current research highlights the potential for immunomodulatory drugs loaded into nanocarriers to enhance antitumor immunity and overcome mechanisms of immunoresistance. This review discusses the classification, processes, and biological applications of smart nanocarriers, with particular emphasis on how they can advance cancer immunotherapy by addressing challenges related to drug loading, targeted delivery, and biocompatibility.

Kidney transplantation is the treatment of choice for the majority of patients with Kidney Failure in an ideal world and is preferred over dialysis on the basis of evidence that demonstrate improvement in health-related quality of life and prolongation of life expectancy. However, shortage of suitable organs remains a limiting factor for program expansion. In Brunei Darussalam, despite having conducted over 16 cases of successful living related donor-recipient kidney transplantation over a period of 8 years, the program is still considered at its infancy state. This review article discusses the evolution of our program and the problems associated with setting up such a nationwide kidney transplantation program and elaborate our plans to increase the scope of services in the future, towards ‘Wawasan 2035’.

Opioid drugs are the first line of defense in severe pain but the adverse effects associated with opioids are considered as a serious issue worldwide. Acupuncture/electroacupuncture is a type of Chinese medicine therapy which is an effective analgesic therapy, well documented in animals and human studies. Electroacupuncture stimulation could release endogenous opioid peptides causing analgesia in a variety of pain models. It can be used as an alternative therapy to control the opioid crisis.

Epidermal cyst is the most common type of cyst to occur in subcutaneous tissue. It is usually small, asymptomatic, and solitary in lesion. When the size is greater than 5 cm, it is classified as a giant epidermal cyst. If the size is big, it may sometimes mimic a soft tissue sarcoma, hence requiring further evaluation with imaging or histopathological studies. We report a case series of two patients whom presented with a huge swelling at different body regions, involving gluteal and chest. Both patients underwent different modes of imaging to delineate the anatomical extent of the lesion. Excision biopsy was done and the histopathological report confirmed epidermal cyst with no malignancy. The purpose of this case series is to describe the rare occurrence of giant epidermal cyst and to elaborate the methods of approach to arrive at the diagnosis.
Sarcoma

Objective To report the indigenous people's uses of plants from a multidimensional perspective in a remote area where strong ethnobotanical cultural practices prevail. Methods An ethnobotanical survey was conducted in the field during 2014–2016. Ethnobotanical data were gathered from 182 informants through oral interviews and semi-structured questionnaires. The distribution of plants was explored using both descriptive and graphical methods. Further, a Multinomial Logit Specification was applied to find out the probability of the occurrence of diverse utilization of plants in multipurpose domains. Results The study identified 202 plant species distributed among 71 families and 156 genera. Ethnobotanical data indicate that there are more medicinal (36.96%) uses of plants as compared to all other use categories. The output from the Multinomial Logit Specifications (MLS) model reveals that perennial and non-woody plants are exploited more for medicinal and food uses than annual and woody plants. In the context of ethnomedicinal uses, aerial plant parts particularly leaves are more extensively used for the preparation of herbal recipes as compared to underground parts. Conclusions The results of the study emphasize the need to create awareness among the local communities about the conservation status of plant species in order to maintain a sustainable resource of plant-derived materials into the future. The novel econometric approach employed in this study adds a new insightful methodology to the existing body of literature in the field of ethnobotany. We strongly recommend conservation measures, alongside phytochemical and pharmacological studies on the useful plant species identified in this study in order to ensure their sustainable and effective utilization.

This study presents the intercomparison of the outdoor environmental gamma dose rates measured using a NaI (Tl) based survey meter along with thermoluminescent dosimeters (TLDs) and estimation of excess lifetime cancer risk (ELCR), for the inhabitants of Poonch division of the Azad Kashmir, Pakistan. CaF2: Dy (TLD-200) card dosimeters were installed at height of 1 m from ground at fifteen different locations covering the entire Poonch division comprising of three districts. During three distinct two month time periods within the six month study period, all the installed dosimeters were exposed to outdoor environmental gamma radiations, retrieved and read out at Radiation Dosimetry Laboratory, Health Physics Division, PINSTECH laboratory, Islamabad. The ambient outdoor gamma dose rate measurements were also taken with NaI (Tl) based portable radiometric instrument at 1 m above the ground. To estimate the annual gamma doses, NaI (Tl) based survey data were used for one complete year following the deployment of the dosimeters. The mean annual gamma dose rates measured by TLDs and survey meter were found as 1.47±0.10 and 0.862±0.003 mGy/y respectively. Taking into account a 29% outdoor occupancy factor, the annual average effective dose rate for individuals was estimated as 0.298±0.04 and 0.175±0.03 mSv/y by TLDs and survey meter, respectively. For outdoor exposure, the ELCR was calculated from the TLD and survey meter measurements. The environmental outdoor average annual effective dose obtained in present study are less than the estimated world average terrestrial and cosmic gamma ray dose rate of 0.9 mSv/y reported in UNSCEAR 2000. The possible origins of gamma doses in the area and incompatibilities of results obtained from the two different measurement techniques are also discussed.
Gamma Rays ; adverse effects ; Humans ; Neoplasms ; etiology ; Pakistan ; Radiation Monitoring ; instrumentation

Objective: To report the relationship of vegetation structure and environmental gradient and physiochemical properties of soil at Nikyal valley, Azad Jammu and Kashmir Methods: A survey of natural vegetation and soil of Nikyal valley was undertaken. Phytosociological survey was conducted by using Braun-Blanquet's approach. The study also investigated the vegetation structure and its relationship with altitude and edaphic factors. The floristic data was analyzed by cluster anlaysis, detrended correspondence analysis and canonical correspondence analysis using CANACOO 5.0. Results: A total of 110 plant species and 13 stands were merged into five major associations as dema rcated by cluster analysis and detrended correspondence analysis. The associations were Olea- Pinus- Themeda association, Myrsine- Rhus- Quercus association, Quercus- Rubus- Pinus association and Quercus association. Soil organic matter, saturation, pH and altitude play the major role in distribution of species. Conclusions: The variation in vegetation structure is controlled by the altitudinal gradient and physiochemical properties of soil. These results indicate a deteriorated forest structure and reduced regeneration pattern, demanding immediate attention of forest management authorities.