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[Comment] A new era of novel immunotherapies for multiple myeloma

Mer, 11/08/2021 - 00:30
Multiple myeloma is the second most common haematological malignancy globally, with an estimated prevalence of 450 579 cases in 2020.1 Although curative therapy is not yet available, in the past two decades an incremental increase in survival of patients with multiple myeloma due to novel therapies has occurred. In 2016, the first antibody-based immunotherapies, daratumumab and elotuzumab, were approved in the USA.2,3 Over the past decade, of the ten approved therapies, the most efficacious and transformative drugs have been those harnessing the immune system.

[Articles] Teclistamab, a B-cell maturation antigen × CD3 bispecific antibody, in patients with relapsed or refractory multiple myeloma (MajesTEC-1): a multicentre, open-label, single-arm, phase 1 study

Mer, 11/08/2021 - 00:30
Teclistamab is a novel treatment approach for relapsed or refractory multiple myeloma. At the recommended phase 2 dose, teclistamab showed promising efficacy, with durable responses that deepened over time, and was well tolerated, supporting further clinical development.

[Correspondence] Indonesia's second wave crisis: medical doctors' political role is needed more than ever

Mar, 10/08/2021 - 00:30
Indonesia is facing its worst crisis in the COVID-19 pandemic as various parties named it the new epicenter of the pandemic. In mid-July, WHO reported that half of the provinces of Indonesia experienced a surge of cases by 50% or more.1 As of Aug 6, 2021, the situation has not improved. Public discourse is plagued with debates against policy makers' decisions, viewed often as neglecting principles of evidence-informed practice. Issues were number of under-reported deaths, misuse of medications, and the then-cancelled paid vaccine plan.

[Comment] Salmonella Typhi Vi polysaccharide conjugate vaccine protects infants and children against typhoid fever

Mar, 10/08/2021 - 00:30
The past decade has seen remarkable progress in our understanding of the scale of the global typhoid fever problem,1 the alarming emergence in south Asia of extensively drug-resistant Salmonella enterica serovar Typhi (S Typhi) threatening effective treatment,2 and the WHO prequalification of a typhoid conjugate vaccine,3 a new tool to prevent disease. In The Lancet, Firdausi Qadri and colleagues report the analysis to 18 months of follow-up of a cluster-randomised trial of the WHO prequalified S Typhi Vi polysaccharide tetanus toxoid conjugate vaccine (Vi-TT; Tybar TCV, Bharat Biotech International, Hyderabad, India) among infants and children aged 9 months to younger than 16 years in the densely populated and highly mobile urban area of Mirpur, Dhaka, Bangladesh.

[Correspondence] Towards a European strategy to address the COVID-19 pandemic

Mar, 10/08/2021 - 00:30
Reduction of COVID-19 incidence across Europe in the early spring months of 2021 led to substantial relaxation of restrictions in summer, despite the emergence and spread of the more transmissible SARS-CoV-2 delta variant. As expected, this relaxation led to a renewed increase in incidence. How should Europe act, what strategies should it adopt, and what specific risks should it consider moving forward?1 These questions become even more pressing, since emerging data indicates the delta variant is more infectious and partially evades immune response.

[Articles] Protection by vaccination of children against typhoid fever with a Vi-tetanus toxoid conjugate vaccine in urban Bangladesh: a cluster-randomised trial

Mar, 10/08/2021 - 00:30
Vi-TT provided protection against typhoid fever to children vaccinated between 9 months and less than 16 years. Longer-term follow-up will be needed to assess the duration of protection and the need for booster doses.

[Comment] Optimising SARS-CoV-2 vaccination schedules

Sab, 07/08/2021 - 00:30
The objective of any vaccination strategy is to achieve long-term protection against infection and also to reduce the mortality and morbidity associated with the eventual development of disease. This dual perspective usually requires repeated immunisations. Several factors affect the immunological outcome of repeated immunisations, such as the antigen selected, the time between doses, and the type of vector.1 Once the initial vaccination schedules have been approved, trials must be designed to optimise immunological outcomes by adjusting these parameters and others.

[Articles] Safety and immunogenicity of heterologous versus homologous prime-boost schedules with an adenoviral vectored and mRNA COVID-19 vaccine (Com-COV): a single-blind, randomised, non-inferiority trial

Sab, 07/08/2021 - 00:30
Despite the BNT/ChAd regimen not meeting non-inferiority criteria, the SARS-CoV-2 anti-spike IgG concentrations of both heterologous schedules were higher than that of a licensed vaccine schedule (ChAd/ChAd) with proven efficacy against COVID-19 disease and hospitalisation. Along with the higher immunogenicity of ChAd/BNT compared with ChAD/ChAd, these data support flexibility in the use of heterologous prime-boost vaccination using ChAd and BNT COVID-19 vaccines.

[Comment] Twincretin therapy for type 2 diabetes: how do two do?

Sab, 07/08/2021 - 00:30
GLP-1 and glucose-dependent insulinotropic polypeptide (GIP), which are released from the intestines after meals, are responsible for augmenting insulin secretion (ie, the incretin effect). Because the insulinotropic effect of GIP is markedly attenuated in type 2 diabetes, therapeutic development to date has focused on GLP-1, which also lowers blood glucose by suppressing glucagon and energy intake, and slowing gastric emptying.1 Use of GLP-1 receptor agonists for the management of type 2 diabetes is increasing rapidly, and is associated with weight loss, negligible risk of hypoglycaemia, and potential cardiovascular protection.

[Articles] Once-weekly tirzepatide versus once-daily insulin degludec as add-on to metformin with or without SGLT2 inhibitors in patients with type 2 diabetes (SURPASS-3): a randomised, open-label, parallel-group, phase 3 trial

Sab, 07/08/2021 - 00:30
In patients with type 2 diabetes, tirzepatide (5, 10, and 15 mg) was superior to titrated insulin degludec, with greater reductions in HbA1c and bodyweight at week 52 and a lower risk of hypoglycaemia. Tirzepatide showed a similar safety profile to that of GLP-1 receptor agonists.

[Editorial] Attending to the threat of nuclear weapons

Sab, 07/08/2021 - 00:00
Aug 6 and Aug 9 mark the anniversaries of the atomic bombings of Hiroshima and Nagasaki, where roughly 140 000 and 74 000 people died, respectively. Last year saw the 75th anniversary, but it passed largely unnoticed by most of the world, which was perhaps understandably preoccupied with the all-too-present threat of COVID-19. Nuclear war is low in most people's priorities. But according to the World Economic Forum Global Risks Report 2021, weapons of mass destruction are still the greatest long-term existential threat to the world.

[World Report] Palestinian health NGO leader detained

Sab, 07/08/2021 - 00:00
Health and human rights organisations have requested the release of Shatha Odeh, director of the Palestinian Health Work Committees, who is being held by the Israeli military. Sharmila Devi reports.

[World Report] UN concern over health at site of former Zambian lead mine

Sab, 07/08/2021 - 00:00
A letter by UN special rapporteurs urges the Zambian Government to clean up the mine to protect thousands of nearby residents from pollution. Munyaradzi Makoni reports.

[World Report] Mediterranean migrants lacking health care

Sab, 07/08/2021 - 00:00
Hostile policies are putting lives at risk in the Mediterranean and migrants face a lack of access to health care. Sharmila Devi reports.

[Perspectives] Lucy Chappell: setting the agenda for UK research policy

Sab, 07/08/2021 - 00:00
Lucy Chappell, Professor of Obstetrics at King's College London, a National Institute for Health Research (NIHR) Senior Investigator, and obstetrician at Guy's and St Thomas’ NHS Foundation Trust in London, UK, became Chief Scientific Adviser (CSA) to the UK Department of Health and Social Care on Aug 1, 2021. As CSA, she is responsible for a budget of £1·3 billion and leads the research policy and management of the NIHR, a major medical research institute with impact in the UK and globally. Chappell brings extensive clinical, academic, and research expertise to her new role and her experience to date will inform her leadership.

[Perspectives] COVID-19, online shaming, and health-care professionals

Sab, 07/08/2021 - 00:00
Stigma and shame have been features of past pandemics. The stigma associated with disease can be experienced as shame by those who spread it. In almost all human cultures, there is shame attached to being “contaminated”, to the vulnerability inherent in illness, and to potentially spreading a disease to others. As previous pandemics have taught us, coming into contact with, or being associated with, a highly infectious and potentially deadly disease has social consequences. Hence, it is no surprise that stigma and shame have developed around COVID-19.

[Obituary] Jean Donald Wilson

Sab, 07/08/2021 - 00:00
Endocrinologist and revered clinician scientist. He was born in Wellington TX, USA, on Aug 26, 1932, and died in Dallas TX, USA, on June 13, 2021, aged 88 years.

[Correspondence] The fragility of abortion access in Europe: a public health crisis in the making

Sab, 07/08/2021 - 00:00
Poland is rightly being criticised for suppressing abortion services.1 Since January, 2021, abortion is only legal if the pregnancy is directly life-threatening or the result of rape or incest. However, countries with allegedly more progressive policies have reasons to be self-critical as well.

[Correspondence] Critically ill COVID-19 patients in Africa: it is time for quality registry data

Sab, 07/08/2021 - 00:00
The African COVID-19 Critical Care Outcomes Study (ACCCOS) Investigators are to be commended for providing the first multinational study reporting epidemiological, management, and outcome data of critically ill COVID-19 patients in Africa.1 However, this important effort lags behind other international cohorts in timing and included less than half of the countries expected by the study investigators.1,2

[Correspondence] Critically ill COVID-19 patients in Africa: it is time for quality registry data – Authors' reply

Sab, 07/08/2021 - 00:00
Luigi Pisani and colleagues highlight the potential and needed role of critical care registries in the COVID-19 pandemic response in low-income and middle-income countries (LMICs). Registry data are a powerful tool when operationalised at scale.1 However, despite funded collaborative efforts, the existing registries in LMICs alone have been insufficient in providing an adequate pandemic response, lamented as recently as May, 2021.2 In contrast, the African Perioperative Research Group (APORG), an unfunded network, pivoted to respond to the pandemic in Africa.