The effects of early corticosteroid therapy on the skin eruption and pain of herpes zoster.

JAMA

Chronic kidney disease (CKD) is a major global health issue that significantly impacts patients' quality of life and places a substantial burden on healthcare systems. Overactivation of the mineralocorticoid receptor (MR) plays a crucial role in kidney damage by promoting inflammation, fibrosis, and functional deterioration. Finerenone, a third-generation highly selective non-steroidal MR antagonist (MRA), has emerged as a promising therapeutic option for CKD. In this review, we discuss the mechanisms through which MR overactivation contributes to renal damage, the structural and pharmacokinetic characteristics of finerenone, and compare it with first- and second-generation MRAs. We also focus on the safety and efficacy of finerenone in clinical applications for CKD. Notably, finerenone demonstrated a reduction in the risk of hyperkalemia during treatment, with its high selectivity minimising treatment-related hormonal imbalances, offering a novel perspective. Furthermore, we explore the promising future of finerenone in both diabetic kidney disease (DKD) and non-diabetic CKD, presenting updates from recent clinical trials and new insights into its potential role in these populations. In clinical practice, combining finerenone with sodium-glucose cotransporter-2 (SGLT-2) inhibitors and renin-angiotensin system (RAS) inhibitors has demonstrated strong cardiorenal protective effects. However, further clinical evidence is needed regarding direct combinations of finerenone with RAS inhibitors. Future studies on their synergistic effects may provide valuable insights. Ultimately, we hope this review offers new perspectives on finerenone's clinical applications and its future therapeutic prospects.

Finerenone in Chronic Kidney Disease: A Comprehensive Review of Mechanisms, Efficacy and Safety.

Diabetes/metabolism Research and Reviews

Hepatocellular carcinoma (HCC) is the sixth most common malignancy globally and remains one of the leading causes of cancer-related mortality. Its incidence continues to rise worldwide, and it is currently the fastest-growing cancer by incidence in the United States. HCC most often arises in the context of chronic liver disease, particularly cirrhosis. While chronic viral hepatitis (hepatitis B and C) has traditionally been the primary etiologic factor, recent advances in antiviral therapies and prevention strategies have shifted the epidemiological landscape. Metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-related liver disease are increasingly prominent risk factors, especially in Western populations. This shift underscores the need for targeted risk factor modification, improved early detection, and enhanced surveillance protocols. The management of HCC necessitates a multidisciplinary approach, incorporating locoregional therapies, surgical resection, liver transplantation, and systemic therapies for advanced-stage disease. Recent advances in systemic treatments, including immune checkpoint inhibitors and combination therapies, have transformed the therapeutic landscape. Despite these developments, significant challenges persist in optimizing treatment, identifying predictive biomarkers, and personalizing therapy. Ongoing research is focused on refining molecular classifications and advancing precision medicine strategies to improve outcomes. This review provides a comprehensive overview of the etiology, surveillance strategies, diagnostic approaches, molecular features, and current treatment modalities for HCC.

Hepatocellular Carcinoma: A Comprehensive Review.

Diseases (Basel)

Obesity is a rapidly growing epidemic affecting &gt;15% of the global adult population and has considerable clinical consequences and comorbidities, including hypertension, diabetes mellitus, cardiovascular and cerebrovascular diseases and chronic kidney disease. There is a strong association between obesity or body mass index and high blood pressure (BP) in epidemiological studies while the underlying pathophysiological events linking those conditions are not fully elucidated. Hypothetical mechanisms include a sedentary lifestyle and excess intake of processed foods that contribute to obesity, overactivation of the renin-angiotensin-aldosterone and sympathetic nervous systems, inflammation, altered adipokine homeostasis and the fatty kidney hypothesis involving adipose tissue accumulation in the renal sinus and perirenal space. There are multiple pharmacotherapeutic and surgical approaches for the management of obesity, including dual and triple agonist drugs targeting glucagon-like peptide-1, gastric inhibitory peptide and glucagon receptors and endoscopic bariatric procedures. Despite promising results with such therapeutic approaches in terms of body weight reduction and BP control, it is unclear whether such BP reduction may completely be attributable to weight loss. Confirmation of the adiposity dependence would lead to a major paradigm shift in our understanding of hypertension, potentially leading to a major shift in the causes of hypertension from primary hypertension to adiposity-dependent hypertension, leading to a shift from symptomatic treatment with antihypertensive medication to cause-focused treatment with weight loss medication. In this narrative review, the aim is to evaluate the potential pathophysiological mechanisms linking hypertension and obesity and the efficiency of potential therapeutic approaches on BP.

From pathophysiology to novel approaches for obesity-associated hypertension.

Clinical Kidney Journal

Cardiac disease remains a leading cause of maternal morbidity and mortality, particularly in developed countries where improved survival has increased the number of pregnant patients with congenital heart disease. The physiological changes of pregnancy, such as increased blood volume, cardiac output, and hypercoagulability, can exacerbate preexisting cardiac conditions, posing significant anesthetic challenges during cesarean delivery. This review outlines anesthetic strategies for parturients with structural or functional cardiac disease, emphasizing individualized, multidisciplinary care. We examine general and regional anesthesia approaches, intraoperative monitoring, and hemodynamic goals, including fluid balance, venous return optimization, and myocardial oxygen demand reduction. Preoperative risk stratification and coordination with cardiology and obstetric teams are essential. Future efforts should aim to standardize protocols and improve maternal-fetal outcomes through evidence-based anesthetic planning.

Anesthetic Management for Delivery in Parturients with Heart Disease: A Narrative Review.

Biomedicines

Assessment of left ventricular systolic function is essential for diagnosing and managing cardiac diseases and provides important prognostic information to the treating clinician. However, traditional methods for assessing left ventricular systolic function such as ejection fraction are limited by their reliance on geometric assumptions, subjective reader interpretation, sensitivity to loading conditions and volume, and reflection of a single plane of motion. In addition to interobserver and intraobserver variability and technical confounders, this evaluation is complicated by the complex 3-dimensional organization of the myocardial fibers, which are oriented longitudinally in the subendocardium, transversely in the midmyocardium, and obliquely in the subepicardium. Conversely, 2-dimensional speckle-tracking echocardiography measures left ventricular deformation as myocardial strain in the 3 planes of chamber motion: longitudinal, circumferential, and radial. From a clinical perspective, left ventricular global longitudinal strain offers superior diagnostic and prognostic value across the spectrum of cardiovascular disorders compared with ejection fraction, is highly reproducible, and detects subclinical dysfunction before the ejection fraction declines. Given the expanding clinical utility of speckle-tracking echocardiography and the incremental prognostic and therapeutic value of integrating global longitudinal strain into clinical practice as a potential biomarker, the objectives of this scientific statement are (1) to review the principles and technical aspects of speckle-tracking echocardiography strain imaging; (2) to provide a practical, evidence-based review of the application of speckle-tracking echocardiography in heart failure, cardiomyopathies, ischemic heart disease, valvular disease, and cardio-oncology; (3) to explore the potential utility of speckle-tracking echocardiography in cardiac resynchronization and implantable cardioverter defibrillator therapy; and (4) to outline the future directions of speckle-tracking echocardiography.

Speckle-Tracking Strain Echocardiography for the Assessment of Left Ventricular Structure and Function: A Scientific Statement From the American Heart Association.

Circulation

Background/Objectives : In diabetic ketoacidosis (DKA), absolute insulin deficiency and elevation of counter-regulatory hormones may cause osmotic diuresis and water and electrolyte loss, which may lead to dehydration and renal failure. Fluids with high Na content are preferred in the DKA fluid therapy algorithm due to the association of Na with &#x3b2;-Hydroxybutyrate (&#x3b2;-HB) and the renal excretion of Na-&#x3b2;-HB. However, these fluids may cause hyperchloremic metabolic acidosis due to their high chloride concentration. In the literature, base-excess chloride (BECl ) has been suggested as a better approach for assessing the effect of chloride on acid-base status. Our aim in this study was to investigate the effect of fluids with BECl values less than zero versus those with values equal to or greater than zero on the metabolic acid-base status in the first 6 h of DKA. Methods : This retrospective study included DKA cases managed in the tertiary intensive care units of five hospitals in the last 10 years. Patients were divided into two groups according to the Na-Cl difference of the administered fluids during the first 6 h of treatment: Group I [GI, fluids with Na-Cl difference = 0, chloride-rich group] and Group II [GII, fluids with Na-Cl difference &gt; 32 mmol, chloride non-rich group]. Demographic data, blood gas analysis results, types and amounts of administered fluids, urea-creatinine values, and urine ketone levels were recorded. Results : Thirty-five patients with DKA in the ICU were included in the study (GI; 22 patients, GII; 13 patients). There was no difference between the patients in the two groups in terms of age, gender, and LOS-ICU. According to the distribution of the administered fluids, the main fluid administered in GI was 0.9% NaCl, whereas in the GII, it was bicarbonate, Isolyte-S, and 0.9% NaCl. In GI, the chloride load administered was higher; the BECl level of the fluids was lower than in GII. At the end of the first 6 h, although sodium and strong ion gap values were similar, patients in GI were more acidotic due to iatrogenic hyperchloremia and, as a result, were more hypocapnic than GII. Conclusions : In conclusion, administering chloride-rich fluids in DKA may help reduce unmeasured anion acidosis. Still, risks cause iatrogenic hyperchloremic acidosis, which can hinder the expected resolution of acidosis and increase respiratory workload. Therefore, it is suggested that DKA guidelines be revised to recommend an individualized approach that avoids chloride-rich fluids and includes monitoring of metabolic parameters like Cl and BECl .

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