Nasal route presents an alternative avenue for achieving local or systemic drug effects owing to its non-invasiveness, expansive surface area, rapid drug absorption, and circumvention of first-pass effect. It offers a promising route for brain targeting too, as it bypasses the blood-brain barrier, thus facilitating direct nose to brain drug delivery. However, traditional routes of administering anti-emetic drugs, primarily oral or parenteral, suffer from drawbacks like poor patient compliance and low drug bioavailability. The nasal route is a favorable alternative, albeit limited by the short retention time due to mucociliary clearance. This can be overcome by application of in situ gelling systems that undergo gelation within the nasal cavity in response to physiological cues, thereby prolonging drug retention and enhancing bioavailability. This facilitates dose reduction, reduced frequency and controlled drug release, thereby improving patient acceptance. Presently, various formulations utilizing intranasal in situ gelling approaches are under development for anti-emetic drugs. These formulations employ stimuli-responsive mechanisms such as thermosensitivity, ion responsiveness, and pH sensitivity for in situ gel formation, with a focus on employing specific polymers tailored to these stimuli. The article highlights importance of nasal delivery of anti-emetic drugs and studies done on this topic till date. Intranasal in situ gelling systems hold promise due to their ease of administration, prolonged nasal retention, improved patient compliance and enhanced bioavailability, positioning them as efficient alternatives to conventional routes of administration.

Acute normovolemic hemodilution (ANH) is a blood conservation strategy used in cardiac surgery, but its efficacy in reducing allogeneic blood transfusion remains debated. This systematic review and meta-analysis updates the existing evidence by incorporating recent randomized controlled trials (RCTs) to provide a contemporary assessment of ANH's impact on perioperative transfusion outcomes. We searched PubMed/MEDLINE, Scopus, and Cochrane Central up to August 2025 for RCTs comparing ANH to standard care in adult cardiac surgery. Primary outcomes were the number of allogeneic red blood cell units transfused, the rate of allogeneic blood transfusion, and estimated total blood loss. Data were pooled using random-effects models, and subgroup analyses were performed by type of surgery. Thirty-one RCTs involving 4426 patients (ANH = 2242, control = 2184) were included. ANH significantly reduced the rate of allogeneic blood transfusion (risk ratio 0.75, 95% confidence interval [CI] 0.66-0.87; P < 0.0001), the number of allogeneic red blood cell units transfused (standardized mean difference -0.42, 95% CI -0.64 to -0.20; P = 0.0001), and estimated total blood loss (standardized mean difference -0.42, 95% CI -0.63 to -0.21; P < 0.0001). Substantial heterogeneity was observed. Subgroup analysis demonstrated that benefits were most consistent in patients undergoing coronary artery bypass grafting. In patients undergoing cardiac surgery, particularly coronary artery bypass grafting, ANH reduces exposure to allogeneic blood transfusion and decreases perioperative blood loss. Despite significant heterogeneity across studies, these findings support the inclusion of ANH within multimodal blood management protocols. Further large, high-quality RCTs with standardized protocols are warranted to confirm its role in modern practice.

Despite widespread recognition of its carcinogenicity and bans in many countries, asbestos remains a persistent global public health challenge. Regulatory fragmentation, transnational trade, and the rapid expansion of digital marketplaces continue to facilitate the circulation of asbestos-containing materials (ACM) across national borders. While all forms of asbestos, including chrysotile are prohibited in several jurisdictions, chrysotile is still mined, manufactured, and extensively used in major economies, including Russia and China, and remains incorporated into construction materials throughout large parts of Asia, the Middle East, and other regions. This regulatory asymmetry undermines national bans and compromises efforts to achieve zero exposure. In this Comment, we examine the consequences of the absence of a global asbestos ban and the continued failure to include chrysotile in Annex III of the Rotterdam Convention. We discuss how these regulatory gaps contribute to unrecognized exposure among the general population, create legal and economic liabilities for industries, and exacerbate environmental health risks in conflict zones and during large-scale construction and demolition activities. To illustrate the practical implications of these shortcomings, we present a case study demonstrating the ease with which asbestos-containing consumer products can be purchased through international e-commerce platforms. Laboratory analyses confirmed the presence of regulated chrysotile fibres in heat-resistant gloves purchased online, highlighting substantial deficiencies in product disclosure, regulatory enforcement, and cross-border accountability. This finding demonstrates how digital trade can bypass existing regulatory safeguards and expose unsuspecting consumers to carcinogenic materials. Asbestos should no longer be viewed as a legacy hazard but as an evolving global risk sustained by economic globalization, regulatory inconsistency, and technological change. Addressing this challenge will require coordinated international action, greater supply-chain transparency, and regulatory frameworks capable of responding to the realities of twenty-first century commerce.