We read with great interest the study by Yi Li and colleagues1 that reports the comparison
of bivalirudin plus high-dose infusion versus heparin monotherapy in patients with
ST-segment elevation myocardial infarction having percutaneous coronary intervention.
The authors conclude that bivalirudin reduced the 30-day composite rate of all-cause
mortality or Bleeding Academic Research Consortium types 3–5 major bleeding compared
with heparin. This large, well conducted study provides new data to the debate regarding
the appropriate anticoagulation for these patients.
Alain Braillon and Adam Edward Lang raise important questions about e-cigarettes and
harm reduction in response to our Comment.1 Here, we explain why a pragmatic approach
to maximising e-cigarettes’ harm reduction potential is important.
We thank Eilis Kennedy and Guy Skinner for highlighting the importance of the new
WHO recommendations for the care of preterm or low birthweight infants with particular
attention to immediate kangaroo mother care and family involvement and support and
for pointing out some key challenges to ensuring that the new recommendations are
carried out and achieve their potential benefits.1 Challenges in supporting families
in the care of preterm infants in neonatal intensive care units have been well documented.
In India, the use of smokeless tobacco, including gutkha, is a prevalent and dangerous
practice that poses serious health risks, especially for oral cancer. Despite being
banned by Indian states since 2012, gutkha remains widely used and available.1 Gutkha
is a mixture of areca nuts, slaked lime, catechu, tobacco, added flavourings, and
sweeteners.2 The ban on gutkha aimed to control addiction rates and adverse effects
on the oral mucosa. However, companies producing gutkha have found ways to circumvent
the ban by producing pan masala (a non-tobacco product containing areca nuts, slaked
lime, catechu, and seasonings) under the same brand name, with tobacco provided separately
in a packet for free, allowing users to prepare their own gutkha.