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This study aimed to investigate the association between mandatory post-call rest regulation in Türkiye and residency preferences in cardiovascular surgery. This retrospective study was conducted using publicly available data from the official websites of governmental institutions in Türkiye. The primary reference was the ''Regulation on Specialty Training in Medicine and Dentistry'', published in the Official Gazette on September 3, 2022 (Issue No. 31942). The five residency placement periods before and after the enactment of the regulation were categorized as "pre-regulation" and "post-regulation" groups, respectively. Institutions were subgrouped as Ministry of Health hospitals and university medical faculties, while cities were categorized as Istanbul-Ankara-Izmir and other cities. Istanbul-Ankara-Izmir were additionally analyzed as major metropolitan centers with distinct sociodemographic characteristics and advanced healthcare infrastructures. The total number of cardiovascular surgery residency slots and the number of unfilled slots were obtained from the Assessment, Selection and Placement Center (OSYM) reports. The mean unfilled slot rate for total cardiovascular surgery residency positions was 36.16 ± 6.88% in the pre-regulation group and 12.43 ± 10.08% in the post-regulation group (p = 0.002). For Istanbul-Ankara-Izmir was 13.33 ± 8.6% in the pre-regulation period and 5.84 ± 5.06% in the post-regulation period (p = 0.132). For other cities, the rates were 57.1 ± 11.19% and 20.91 ± 18.25%, respectively (p = 0.005). In university medical faculties, the rates were 45.55 ± 9.3% before and 20.41 ± 18.45% after the regulation (p = 0.026). In Ministry of Health hospitals, the respective rates were 22.9 ± 10.05% and 6.43 ± 5.88% (p = 0.013). The post-regulation period was associated with a lower rate of unfilled cardiovascular surgery residency positions compared with the pre-regulation period.

For much of the 20th century, the South African mining industry had a statutory compensation system for pneumoconiosis and tuberculosis characterized by gross racial inequality. This study examines the impact of inflation over the period 1973-2024 on the real value of miners' lung disease compensation, including the effect of the dropping of formal racial discrimination after 1993. Sources of information included legislation, government reports, notices, and Gazettes, and mining industry reports. From 1973 to 1993, high rates of inflation hollowed out the value of compensation for all miners, greater in absolute terms for white miners. From 1994, inflation continued to erode both the real value of compensation payments, and, with the rise in earnings for all miners, the percentage of annual earnings covered by these payments. Until 2017 there were a few sporadic increases in statutory payment amounts, but a cap on "allowable earnings" used to calculate compensation severely limited any gain. Underlying factors include historic underfunding of the Compensation Fund via the statutory employer levy, administrative disarray in the state compensation agency, and unanticipated political, economic and epidemic disruptions. Recent years have seen a restoration of financial and administrative stability, with some degree of reversal of long-term trends. Although formal Apartheid racial discrimination ended in 1994, inflation, and until recently legislative stasis, continued to disadvantage all miners with compensatable occupational lung disease. The system is currently undergoing legislative reform-including proper funding of operations but also with limitation on civil liability against employers. The question therefore remains open as to whether a fair and equitable system of compensation for miners will be achieved and sustained.

India's medical education system is undergoing rapid expansion, yet notable variations in teaching quality, assessment methods, and institutional accountability continue to affect student outcomes. The National Exit Test (NExT), mandated under the National Medical Commission Act, 2019, and detailed in the 2023 Gazette notification, is designed to create a unified, competency-based national assessment that simultaneously functions as the MBBS exit exam, licensure examination, and postgraduate (PG) eligibility-cum-ranking test. Despite a clear regulatory mandate, its rollout has been repeatedly delayed. This editorial outlines why the implementation of NExT is urgently needed, how it addresses the shortcomings of existing university and PG entrance examinations, and how it benefits students, medical colleges, and the broader health system. A phased, student-centred implementation strategy is proposed to ensure a smooth transition and build confidence among stakeholders.

Visual disability leads to functional impairment and limits an individual's activities of daily living, causing emotional, social, and economic hardship. The visual disability certificate issued by the Government of India is an important document through which social security services for persons with disability (PwDs) can be provided seamlessly. It ensures equal opportunities for PwDs and their full participation in nation building. New guidelines were formulated via "The Gazette of India," dated January 4, 2018 for disability certification. The purpose of the current review is to highlight the modifications in the 2018 and 2024 guidelines and compare the newer rules with those promulgated in 2001. The important changes in disability certification guidelines are increase in the number of disabilities from 7 to 21, increase in the visual disability categories from 6 to 10 and changes in the definition of blindness and low vision. The criteria for benchmark disability has been kept the same as 40%. The various benefits of having disability certificates are reservation of seats in government jobs for PwDs, right to free education for those aged 6-18 years, upper age relaxation of 5 years for admission in school and 10 years for government jobs, scholarships under various schemes, assistive devices under various schemes, free travel on buses, 50% concessions on air fare for blind, 75% concession for blind and their escort in Indian railways, income tax concessions, bank loans at 1% interest and so on. There is an urgent need to educate PwDs about these multiple social security benefits that they can avail based on a certificate of benchmark disability.

Surgical site infections (SSI) is a leading cause of healthcare-associated morbidity and cost globally. However, contemporary data on SSI incidence and economic burden in Malaysia are scarce. This study aimed to estimate the incidence and healthcare costs associated with SSI following caesarean section (C-section) in a Malaysian public hospital. A retrospective cohort study was conducted at a tertiary mother and children public hospital in Malaysia, involving patients aged 18 and above who underwent C-section from January 2019 to May 2024. Patients were followed for 30 days postoperatively. Clinical and cost data were obtained from medical records, hospital databases, government gazettes and published literatures. Total direct costs were calculated by matching patient-level resource use with unit cost data. Among 19,736 C-section, 295 SSI were identified, resulting in an incidence of 1.49 per 100 C-sections. Most infections were superficial and observed in emergency C-section. Obesity (49.5%) and diabetes (39.0%) were the commonly observed risk factors. The mean postoperative length of stay was 4.33 days. SSI-related costs totalled RM 714,776 [Ringgit Malaysia (RM) 1 = United States Dollar (USD) 0.23], with procedures and facility-based care being major cost drivers. The mean hospitalization cost per patient was RM 4,178. Although the incidence was lower than global estimates, the rising trend and associated healthcare burden highlight the need for enhanced infection prevention strategies such as optimising surgical techniques, strengthening SSI surveillance and implementing evidence-based care bundles. Investing in targeted preventive interventions is essential to improving maternal outcomes and reducing the economic strain on Malaysia's public healthcare system.

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Maternal serum biomarkers, primarily introduced for aneuploidy screening, have also been investigated as predictors of adverse pregnancy outcomes. However, their value in late-preterm and term pregnancies remains unclear. In this retrospective cohort study, 592 singleton pregnancies screened at a tertiary perinatology center between 2020 and 2025 were analyzed. Participants underwent either the first-trimester combined test (n&#x2009;=&#x2009;461) or the second-trimester triple test (n&#x2009;=&#x2009;131). Serum biomarker multiples of the median (MoM) were categorized as low (<&#x2009;0.5), normal (0.5&#x2013;2.0), or high (>&#x2009;2.0). Perinatal outcomes&#x2014;including Apgar scores, umbilical artery pH, neonatal intensive care unit (NICU) admission, and preterm premature rupture of membranes (PPROM)&#x2014;were assessed using predefined group comparisons, multivariate adjustment, and ROC curve analysis. Low first-trimester free &#x3b2;-hCG was significantly associated with reduced Apgar scores at 1 and 5&#xa0;min in term neonates (p&#x2009;=&#x2009;0.025 and p&#x2009;=&#x2009;0.005, respectively). In the second trimester, infants with normal AFP levels demonstrated lower umbilical artery pH compared to those with elevated AFP (p&#x2009;=&#x2009;0.013), and low AFP was associated with an increased risk of NICU admission (p&#x2009;=&#x2009;0.041). ROC analysis identified an AFP threshold&#x2009;&#x2265;&#x2009;1.075 MoM as predictive of PPROM with 75.0% sensitivity and 69.3% specificity (AUC&#x2009;=&#x2009;0.723, p&#x2009;=&#x2009;0.035). No significant associations were observed for PAPP-A. First-trimester low free &#x3b2;-hCG and second-trimester AFP abnormalities showed modest associations with neonatal outcomes and PPROM in late-preterm and term pregnancies, whereas PAPP-A did not. These findings suggest limited standalone predictive capacity of serum biomarkers, underscoring the need for integrated multiparametric models in risk stratification. The online version contains supplementary material available at 10.1186/s12884-026-08758-2.

Acute diarrhea is a leading cause of dehydration-related morbidity. Oral rehydration solution (ORS) remains the cornerstone of treatment, while probiotics have shown additional gut health benefits. This study evaluated the efficacy and safety of a novel probiotic-enriched ORS compared with a standard ORS in Indian patients with acute diarrhea. In this randomized, parallel-group study, patients with diarrhea were enrolled and assigned to receive either novel ORS or traditional ORS. Treatment was administered for five days, followed by a four-day observation period and a safety follow-up call. Group 1 received the novel ORS (200 mL/day) for five days, and Group 2 received traditional ORS (200 mL/day) for a similar duration. Efficacy outcomes measured included resolution of diarrhea, time to recovery, patient-reported satisfaction and preference, and Clinical Global Impression-Improvement (CGI-I) score. In this randomized, parallel-group study, 60 patients with diarrhea were enrolled and assigned (3:1) to receive either novel ORS (n = 45) or traditional ORS (n = 15). Both groups showed clinical improvement; however, the novel ORS group demonstrated faster resolution. By visit 3, the mean diarrhea episodes were 0.4 (0.62) in the novel ORS group, while 0.9 (0.86) in the traditional group. Higher satisfaction was reported in the novel ORS group (42.2% "very satisfied") along with quicker improvement on the CGI-I score (mean score 1.3 vs. 1.9; p = 0.0120). The novel ORS containing probiotics showed faster symptom resolution, higher patient satisfaction, and comparable safety, supporting its potential as a preferred treatment option for diarrhea management.

Vertical garden systems represent an innovative approach that simulates rocky habitats, which are often characterized by high species diversity and endemism. In this study, we experimentally evaluated the performance of two vertical garden systems as an ex situ conservation strategy to ensure the sustainability of Seseli resinosum, a local endemic species of D&#xfc;zce Province. In the first phase of this four-stage study, S. resinosum was monitored in its natural ecosystem for one vegetation period, and relevant data were collected. In the second phase, the species was collected and cultivated under controlled conditions. During the third and fourth phases, individuals were transplanted into two different vertical garden modules, where subsequent monitoring was conducted. Ecological trait analyses revealed that S. resinosum exhibits strong similarities with rocky-habitat species such as Hypericum perforatum, Silene italica, and Scabiosa columbaria, and Origanum vulgare. The results demonstrated that felt-based systems are unsuitable for the ex situ conservation of S. resinosum due to insufficient moisture retention and thermal buffering. In contrast, pot-based vertical garden systems supported successful vegetative and reproductive development. These findings indicate that modular pot-based vertical systems should be preferred over felt-based designs for the ex situ conservation of endemic drought-tolerant species under comparable changing climatic conditions.

The aim of this randomized clinical trial was to evaluate the 18-month clinical performance of alkasite and glass-hybrid restorations compared with resin composite in Class II restorations. A total of 50 patients requiring at least three Class II restorations in premolar and molar teeth were recruited. Each patient received three restorations, which were randomly assigned to one of the following materials: an alkasite (Cention N, Ivoclar Vivadent), a glass-hybrid (Equia Forte HT, GC Corp.), or a resin composite (Gradia Direct Posterior, GC Corp.). Alkasite and glass-hybrid served as test groups while resin composite served as the control group. During the 18-month follow-up, restorations were scored at baseline, 6, 12, and 18 months using the FDI criteria. Data were analyzed using the Chi-square and Cochran's Q tests (&#x3b1; = 0.05). No significant differences were detected among the groups for esthetic, functional, or biological criteria over 18 months (p > 0.05). Regarding esthetic properties, the control group showed 100% success for all esthetic criteria at all recall visits, while the alkasite group maintained a 96% success rate at all time points, and glass-hybrid showed 98% success at 6 and 12 months and 92% at 18 months. Minor score-2 changes in color match and gloss were detected in the glass-hybrid and alkasite groups but were not significant (p > 0.05). For functional and biological outcomes, all groups achieved 100% success rates for all evaluated parameters. Alkasite and glass-hybrid groups exhibited clinical performance comparable to resin composite over the 18-month follow-up in Class II cavities. All materials demonstrated excellent functional and biological stability while achieving clinically acceptable aesthetic results.

Malignant melanoma is an aggressive skin cancer with significant metastatic potential. Immune checkpoint inhibitors (ICIs), particularly those targeting the PD-1 pathway, have revolutionized treatment, improving survival rates. A PD-1 inhibitor, Nivolumab, has demonstrated durable responses in advanced melanoma patients. However, response variability necessitates predictive biomarkers for patient stratification. The Gustave Roussy Immune Score (GRIm Score) is a prognostic tool integrating lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR), and albumin levels to predict ICI efficacy. This retrospective study evaluated the association between the GRIm Score and response to nivolumab monotherapy in 40 patients with stage IV malignant melanoma treated between 2020 and 2024. Patients were classified into low-risk (score 0-1) and high-risk (score 2-3) groups. Results showed that patients with a low GRIm Score had significantly longer median progression-free survival (21.4 vs. 6.3 months, p&#x2009;=&#x2009;0.003) and overall survival (26.5 vs. 7.2 months, p&#x2009;<&#x2009;0.001). Multivariate analysis confirmed the GRIm Score as an independent prognostic factor (HR: 1.593, 95% CI: 1.156-2.197, p&#x2009;=&#x2009;0.004), surpassing the predictive power of its components. This study is the first to validate the GRIm Score in malignant melanoma, suggesting it is a valuable biomarker for patient selection in immunotherapy trials. The findings highlight its potential in refining treatment decisions, though further validation in larger, multicenter cohorts is required.

Colorectal cancer is a leading cause of cancer-related mortality, and chemotherapy resistance remains a major challenge. We investigated whether inhibiting glutathione could enhance the efficacy of 5-fluorouracil (5-FU) in colorectal cancer. Three small-molecule inhibitors targeting glutathione metabolism were tested in HCT-116 cells: CB-839 (glutaminase inhibitor), IKE (xCT transporter inhibitor), and Polydatin (glucose-6-phosphate dehydrogenase inhibitor). Their effects on glutathione levels, ROS accumulation, and cell viability were first evaluated. CB-839 decreased cell viability, Polydatin had no effect, and IKE reduced cystine uptake and increased ROS, although none of the inhibitors alone induced marked cell death. We next examined whether they could enhance 5-FU activity. Although CB-839 and Polydatin did not improve 5-FU efficacy, IKE increased ROS levels and reduced viability when combined with 5-FU. In an in ovo model, the combination of IKE and 5-FU reduced tumor growth, whereas each agent alone had a limited effect. These findings suggest that targeting xCT-mediated cystine uptake may enhance chemotherapy response and could be a promising approach for treating colorectal cancer. The online version contains supplementary material available at 10.1038/s41598-026-41179-x.

Although a relationship has been demonstrated between prostate cancer (PCa), benign prostatic hyperplasia (BPH), and insulin resistance, the results are inconclusive. The aim of this study was to investigate the potential value of the fasting blood glucose-to-high-density lipoprotein cholesterol ratio (GHR) in classifying PCa and BPH risks. This retrospective analysis examined 185 patients who were recently diagnosed with PCa and 185 age-matched patients with BPH. Preoperative blood test and biopsy results were obtained, and patients with PCa were divided into low-, intermediate-, and high-risk groups using the D&#x2019;Amico risk classification. The fasting blood glucose (FBG), total cholesterol, triglycerides, HbA1c, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), hemogram parameters, lipid ratios, and GHR levels of the two groups and prostate risk groups were compared. FBG levels and GHR were significantly higher in patients with PCa than in those with BPH (P&#x2009;<&#x2009;0.001). No significant differences were found between the two groups in terms of total cholesterol, LDL-C, HDL-C, triglyceride levels, or lipid ratios. FBG and GHR levels were significantly higher in the intermediate- and high-risk PCa groups than in the low-risk group (p&#x2009;<&#x2009;0.001). Spearman&#x2019;s correlation analysis revealed weak but significant positive correlations between PCa risk and FBG (r&#x2009;=&#x2009;0.242, p&#x2009;=&#x2009;0.001) and GHR (r&#x2009;=&#x2009;0.158, p&#x2009;=&#x2009;0.031). These findings suggest that glycemic dysfunction may play a more prominent role in PCa development than lipid parameters and that GHR may serve as a potential biomarker for PCa risk stratification. However, further research is needed in the form of larger prospective studies to confirm these results and determine the clinical utility of GHR in PCa risk assessment and disease progression monitoring.

This retrospective cohort study aimed to evaluate the survival outcomes of intentional replantation (IR), an alternative endodontic treatment option when conventional and surgical approaches are not feasible, and to identify key prognostic indicators influencing tooth survival. A total of 55 teeth from 47 patients (36 females, 19 males) treated with IR were retrospectively analyzed. Clinical and radiographic data were collected over a mean follow-up period of 25.9&#x2009;&#xb1;&#x2009;18.7 months. Kaplan&#x2013;Meier survival analysis with Log-rank tests, Fisher&#x2019;s Exact test, and Cox regression were used to assess survival time, categorical associations, and independent prognostic factors including gender, percussion and palpation sensitivity, periapical lesion status, and splint type. The overall survival rate was 87.3% (48/55 teeth). The presence of preoperative periapical lesions significantly reduced survival (p&#x2009;=&#x2009;0.001), while teeth stabilized with fiber-reinforced splints exhibited significantly better outcomes than those with rigid wire-composite splints (p&#x2009;=&#x2009;0.003). Both factors remained independently associated with survival in Cox regression analysis. IR may represent a viable alternative option in selected cases, with splint type and preoperative periapical lesions emerging as factors associated with survival; however, findings should be interpreted considering the retrospective design and limited number of failure events. The online version contains supplementary material available at 10.1186/s12903-026-08179-9.

In India, eight civet species have been documented. Among these, the Asian palm civet and the Small Indian civet are most frequently reported in poaching incidents for bushmeat and other purposes. In this study, we examined four processed leg samples (n&#x2009;=&#x2009;4) seized by the Tamil Nadu Forest Department and suspected to be of civet origin. DNA was extracted and four partial mitochondrial genes (cytochrome b (cyt-b), 12&#xa0;S ribosomal RNA (12&#xa0;S rRNA), 16&#xa0;S ribosomal RNA (16&#xa0;S rRNA), and cytochrome c oxidase subunit 1 (COXI)) were amplified for species identification. Basic Local Alignment Search Tool (BLAST) analysis indicated that cyt-b provided clearer species-level resolution compared to the other genes, which showed ambiguous matches, likely due to limited reference data in the NCBI database. Phylogenetic analysis further confirmed that all samples originated from Paradoxurus jerdoni (brown palm civet).&#xa0;This case study shows that lesser-reported civet species may also be involved in wildlife trade and demonstrates that cyt-b is a practical genetic marker for forensic identification under current database limitations. The findings highlight the need for robust reference databases to improve species discrimination in wildlife forensic investigations and support enforcement efforts.

The acquisition of an early ether inhaler stimulated research into several inhalers classified as Bruck inhalers. Ludwig Hermann Bruck was a German migrant who arrived in Australia in 1873. He became a medical publisher, importer of medical instruments, and made unique contributions to early Australian medical publishing, most significantly as the first publisher of The Australasian Medical Gazette. He also published The Australian Medical Directory and Handbook which contained lists of unregistered medical practitioners and alternative therapists. In 1914, Bruck joined in business with Richard Thomson who had a company selling medical equipment to doctors and hospitals. During the First World War, both Bruck and Thomson were charged with trading with the enemy. Bruck committed suicide in August 1915 before the case was heard in court. We did not find any evidence that Bruck designed the inhaler later attributed to him. The Bruck inhaler is functionally similar to the Probyn-Williams inhaler and should therefore be regarded as a glass-domed version of this inhaler.