The current coronavirus disease 2019 (COVID-19) pandemic is one example of the scores of zoonotic diseases responsible for various outbreaks resulting in the deaths of millions of people for centuries. The COVID-19 pandemic has broken the age-old healthcare infrastructure and led to utter chaos. In the shadow of this pandemic, other zoonotic infections like the nipah virus, monkeypox, and langya virus, to name a few, have been neglected. Hence, outbreaks caused by such zoonotic viruses are rising in their endemic areas, like the Indian subcontinent. The mortality and morbidity due to such zoonoses are greater than usual due to the shortage of healthcare professionals caused by the COVID-19 crisis. Due to the lack of vaccines and therapeutics directed against this viral infection, treatment of patients is limited to supportive management and prevention, making preparedness for these potential zoonotic viral outbreaks essential. This paper highlights some of these zoonotic infections, which perpetuated and wreaked havoc while the world was occupied with containing the COVID-19 pandemic.

Disease X is caused by pathogen X, an unknown infectious agent that can potentially trigger an epidemic or pandemic. Pathogen X might be any pathogen, including bacteria, viruses, parasites, fungi, and prions. WHO uses the term ‘Disease X’ for any new emerging disease caused by an unknown pathogen X. Disease X stands for any possible future pandemic in WHO’s shortlist of high-priority diseases. This review looks at the manifestations of the recent COVID-19 epidemic as the first Disease X to evaluate what has happened and to learn from what went wrong in India and worldwide. To this end, a summary is presented of response measures by governments, often lacking flows of information, discrepancies in the views of experts and decisions of policymakers, and undesirable variations in individual and collective behavior and their consequences. The elements of combating Disease X in a world with considerable inequalities in relevant knowledge, expertise, information, quality of governance, and financial possibilities are discussed. Based on this, recommendations are given for an innovative global pandemic preparedness system.

Objective: Evaluate the safety and efficacy of zavegepant (BHV-3500), a recently approved nasal spray containing a third-generation calcitonin gene-related peptide receptor antagonist, for treating acute migraine attacks. Methods: A comprehensive search was conducted across various databases up to 06/26/2023 to identify relevant randomized clinical trials (RCTs) on zavegepant's efficacy and safety in treatment of acute migraine attacks. Primary outcome: freedom from pain at 2 hours postdose. Safety outcomes were evaluated based on adverse events (AEs), with zavegepant 10 mg and placebo groups compared for incidence of AEs. Results: Two RCTs, involving 2061 participants (1014 receiving zavegepant and 1047 receiving placebo), were quantitatively analyzed. An additional trial was included for qualitative synthesis. Zavegepant 10 mg exhibited a significantly higher likelihood of achieving freedom from pain at 2 hours postdose compared with the placebo group (risk ratio [RR] 1.54, 95% confidence interval [CI] 1.28 to 1.84). It also showed superior relief from the most bothersome symptoms at 2 hours postdose compared with placebo (RR 1.26, 95% CI 1.13 to 1.42). However, the zavegepant 10 mg group experienced a higher incidence of AEs compared with placebo (RR 1.78, 95% CI 1.5 to 2.12), with dysgeusia being the most reported AE (RR 4.18, 95% CI 3.05 to 5.72). Conclusion: Zavegepant 10 mg is more effective than placebo in treating acute migraine attacks, providing compelling evidence of its efficacy in relieving migraine pain and most bothersome associated symptoms. Further trials are necessary to confirm its efficacy, tolerability, and safety in diverse clinic-based settings with varied patient populations.

Background: Asbestos, a durable fibrous silicate once widely used for its thermal resistance, remains in use in countries like India and China despite being banned in over 70 nations and classified as a Group 1 carcinogen by IARC. Prolonged occupational exposure causes asbestosis, lung cancer, and malignant pleural mesothelioma, but in Low and Middle-Income Countries (LMICs) the true burden is underreported due to weak regulation, low awareness, limited diagnostics, and inadequate occupational health systems. Objectives: This review aimed to examine the epidemiological patterns and diagnostic challenges of Asbestos-Related Disease (ARDs) in emerging economies, with a focus on the applicability and limitations of existing and emerging diagnostic strategies. Methods: We conducted a narrative review of peer-reviewed literature, global databases (WHO, IARC), and recent cohort and cross-sectional studies, sourcing articles through structured keyword searches in PubMed, Scopus, and Google Scholar. Diagnostic approaches were compared across diverse healthcare settings, emphasizing radiological, histopathological, and functional tools. The review also assessed the utility of newer technologies, including low-dose CT (LDCT), ultra-low-dose CT (ULDCT), magnetic resonance imaging (MRI), FDG-PET is Fluorodeoxyglucose Positron Emission Tomography (FDG-PET), breath biomarkers using gas chromatography-mass spectrometry (GC-MS), and digital tomosynthesis (DTS). Findings: LDCT and ULDCT showed superior sensitivity for early detection of pleural abnormalities like circumscribed pleural plaques and diffuse thickening, yet distinguishing benign from malignant lesions remains difficult without biopsy. Diffusion capacity of the lungs for carbon monoxide (DLCO) emerged as a sensitive but nonspecific pulmonary function marker. Histopathological confirmation of mesothelioma remains the gold standard but is rarely accessible in low-resource settings. Conclusion: Addressing the diagnostic gap in ARDs in LMICs requires systemic strengthening of occupational health surveillance, better regulatory enforcement, expanded access to advanced diagnostic tools, and targeted clinician training. Without urgent intervention, the burden of asbestos exposure will remain an escalating public health crisis.

Background: Several studies have reported a reduced risk of COVID-19-related mortality in patients taking antidiabetic medications. This is an umbrella review, meta-analysis, and Bayesian sensitivity assessment of SGLT2 inhibitors (SGLT2is) in COVID-19 patients with type 2 diabetes mellitus (T2DM). Methods: A search was conducted on the MEDLINE (PubMed), EMBASE, Cochrane, and ClinicalTrials.gov databases on 5/12/2023. We performed an umbrella review of systematic reviews and meta-analyses on the effects of SGLT2is in T2DM patients with COVID-19 and critically appraised them using AMSTAR 2.0. Trials investigating SGLT2i use in COVID-19 patients post-hospitalisation and observational studies on prior SGLT2i use among COVID-19 patients were included in the meta-analysis, adhering to the PRISMA guidelines. Results: SGLT2is exhibited significantly lower odds of mortality (OR 0.67, 95% CI 0.53–0.84) and hospitalisation (OR 0.84, 0.75–0.94) in COVID-19 patients with T2DM. Bayesian sensitivity analyses corroborated most of the findings, with differences observed in hospitalisation and mortality outcomes. SGLT-2 inhibitors showed an OR of 1.20 (95% CI 0.64–2.27) for diabetic ketoacidosis. Publication bias was observed for hospitalisation, but not for mortality. The GRADE assessment indicated a low to very low quality of evidence because of the observational studies included. Conclusions: The prophylactic use of SGLT2is reduces mortality and hospitalisation among COVID-19 patients, particularly in patients with diabetes. The utility of SGLT2is after hospitalisation is uncertain and warrants further investigation. A limited efficacy has been observed under critical conditions. Individualised assessment is crucial before integration into COVID-19 management.