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Re: Early treatment with rasburicase and risk of kidney replacement therapy and death in adults with tumour lysis syndrome: emulated target trial
Agreement: I Agree Body: Dear Editor Shenoy and colleagues have produced the most credible evidence yet that early rasburicase improves hard outcomes in tumour lysis syndrome (TLS), closing a gap left open since the drug's approval in 2001, when registration trials measured only the fall in uric acid.[1-3] The target trial emulation is done properly: time zero anchored at TLS onset, late-treated patients analysed as controls to mimic crossover, and moribund patients excluded to remove immortal time.[1,4] Manual chart abstraction with under 3% missing data stands in welcome contrast to one-click database studies, in which a diagnosis code can never say at what hour a syndrome began. Five caveats, however, deserve attention before the number needed to treat of 11 enters routine decision-making. First, residual confounding is acknowledged but not quantified. Weighting balances measured covariates,[5] not the clinical trajectory between TLS onset and the treatment decision, which is what actually drives the timing of rasburicase. The E-value[6] is about 2.3 for the point estimate of 0.67, but only about 1.5 for the confidence limit of 0.88: a confounder of modest strength could pull the interval across the null. Second, the intention-to-treat strategy has a cost specific to acute care. A patient treated at hour 20 is usually not an untreated patient but a rescue after failed conservative management, whose deterioration was invisible at baseline. Counting that patient's events against the control strategy will flatter early treatment. The authors' own window analysis, with the association holding at 18 hours but attenuating to non-significance at 24,[1] is compatible with both a genuine time-gradient of drug effect and a sicker-rescue-patient gradient, and the paper does not separate the two. Third, earlier anticancer therapy in the rasburicase group (adjusted hazard ratio 1.36) is presented as supporting benefit.[1] The reverse reading is equally plausible: aggressive tumours such as Burkitt lymphoma cause more TLS, demand rasburicase sooner, and require urgent chemotherapy regardless. This endpoint belongs in the descriptive column. Fourth, competing risks are handled for hospital-free days but not for the decomposed kidney outcomes. Death before kidney replacement therapy could distort those estimates; a Fine-Gray sensitivity analysis[7] would settle this within a revision cycle. Fifth, generalisability receives one sentence. Thirty-six tertiary centres achieved a median time to rasburicase of 5 hours. Where laboratory turnaround is slow and the drug is not stocked, a 12-hour window may not exist, and the attenuation of benefit by 24 hours then becomes the central implementation question rather than a footnote. None of this diminishes the study's achievement. In a field where the randomised trial will never come, an observational study this honest about its own construction is close to the best answer available. But the estimate carries the fingerprint of the centres that produced it, and replication in community settings should precede any change to guidelines. References [1] Shenoy T, Sanchez-Almanzar D, Dias JA, et al. Early treatment with rasburicase and risk of kidney replacement therapy and death in adults with tumour lysis syndrome: emulated target trial. BMJ. 2026;394:e100040. doi:10.1136/bmj-2026-100040 [2] Pui CH, Mahmoud HH, Wiley JM, et al. Recombinant urate oxidase for the prophylaxis or treatment of hyperuricemia in patients with leukemia or lymphoma. J Clin Oncol. 2001;19(3):697-704. [3] Cortes J, Moore JO, Maziarz RT, et al. Control of plasma uric acid in adults at risk for tumor lysis syndrome: efficacy and safety of rasburicase alone and rasburicase followed by allopurinol. J Clin Oncol. 2010;28(25):4207-4213. [4] Hernán MA, Robins JM. Using big data to emulate a target trial when a randomized trial is not available. Am J Epidemiol. 2016;183(8):758-764. [5] Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med. 2015;34(28):3661-3679. [6] VanderWeele TJ, Ding P. Sensitivity analysis in observational research: introducing the E-value. Ann Intern Med. 2017;167(4):268-274. [7] Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94(446):496-509. No competing Interests: Yes The following competing Interests: Electronic Publication Date: Friday, July 24, 2026 - 05:35 AI use: No, I have not used AI Highwire Comment Subject: Early treatment with rasburicase and risk of kidney replacement therapy and death in adults with tumour lysis syndrome: emulated target trial Workflow State: Released Full Title: Re: Early treatment with rasburicase and risk of kidney replacement therapy and death in adults with tumour lysis syndrome: emulated target trial Highwire Comment Response to: Early treatment with rasburicase and risk of kidney replacement therapy and death in adults with tumour lysis syndrome: emulated target trial Check this box if you would like your letter to appear anonymously:: Last Name: Tuersun First name and middle initial: Adili Email: 25111030024@m.fudan.edu.cn Address: Shanghai 201203, PR China Occupation: PhD Affiliation: School of Pharmaceutical Sciences, Fudan University BMJ: Additional Article Info: Rapid response
2026-07-24 05:38:48

Safa clarifies Bafana coach Hugo Broos’ contract situation
The South African Football Association (Safa) has moved quickly to quell the rumours that it has offered Bafana Bafana head coach Hugo Broos a one-year contract extension. Bafana have just returned from a successful Fifa 2026 World Cup campaign, where they rewrote history books by qualifying for the knockout stage for the first time ever. SA was knocked out in heartbreaking fashion by Canada in the Last-32 round of the competition. Media reports circulated on Monday night that the national association was extending Broos’ stay for another year because the qualifiers for the 2027 Africa Cup of Nations (Afcon) were starting pretty soon. But Safa, through a statement, denied that it had offered Broos a one-year contract extension. ‘No decision has been taken’ Reads the statement from Safa: “To set the record straight, Safa has not issued any contract to any coach in respect of the Bafana head coach position. Coach Hugo Broos remains under contract with Safa until the end of July 2026, in accordance with his existing agreement.” “The association’s governance processes regarding the Bafana technical team have not yet been concluded. Therefore, no decision has been taken, and no contract has been issued or approved by the National Executive Committee. “It is therefore regrettable that reports have been published alleging that coach Broos has already received a contract extension, with some publications further attributing these claims to unnamed sources. Such reporting creates unnecessary speculation, misinforms the football public and undermines the association’s established decision-making processes. The association thanks its stakeholders and the public for their continued support and encourages them to rely only on official Safa communication channels for accurate information regarding national team matters,” adds the statement. The mother body explained further that it would make an official announcement on the Bafana coaching positions once the appropriate internal processes had been completed and the relevant decisions had been taken by the association’s structures. Subscribe To Our Newsletter
2026-07-23 04:00:06

Moloto granted R50k bail over alleged torching of ex-partner’s bakkie
Polokwane businessman and rehabilitation centre owner Tsebe Phillimon Moloto has been granted R50 000 bail after appearing in the Polokwane Magistrate’s Court on charges of malicious damage to property linked to the alleged torching of his former girlfriend and business partner’s vehicle and business sign. The 51-year-old faces two counts of malicious damage to property. He made a brief appearance in the Seshego Magistrate’s Court before his matter was transferred to the Polokwane Magistrate’s Court. According to the National Prosecuting Authority (NPA), Moloto and the complainant were previously in a romantic relationship and jointly operated the LADGAC Rehabilitation Centre in Seshego. The relationship later broke down, both personally and professionally, after which the complainant allegedly opened her own rehabilitation centre. Vehicle set alight The state alleges that on 28 June 2026, Moloto poured a flammable substance onto the complainant’s Toyota Hilux while it was parked outside her parents’ home in Seshego Zone 3, before setting it alight. The blaze destroyed the vehicle and spread to part of the house, where seven people were asleep at the time. Neighbours managed to extinguish the fire before anyone was injured. Police have estimated the damage at approximately R800,000. In a second incident on the same day, Moloto is accused of setting fire to a signboard advertising the complainant’s newly established rehabilitation business in Ladanna. His arrest on Monday followed an intelligence-driven operation conducted by the Limpopo Provincial Tracking Team and the Provincial Investigation Unit. Police also seized a Toyota Fortuner believed to have been used during the alleged commission of the offences. Call for bail denial Earlier on Tuesday, members of Limpopo Anti-Drugs, Gangsterism and Crime (LADGAC) gathered outside the Seshego Magistrate’s Court, urging the court to deny Moloto bail. LADGAC-Lebo manager Daniel Lekganyane said members feared for their safety and believed Moloto should remain in custody. “We believe he poses a danger to the community, and members fear for their safety,” Lekganyane said. Despite the objections, the court granted Moloto bail of R50 000. The case has been postponed to September 22 2026 for further police investigations. Subscribe To Our Newsletter Visit SW YouTube Channel for our video content
2026-07-14 15:30:29

Nigeria repatriation demand remains high
Nigeria repatriation demand remains high Zandile.Khumalo
Nigerians being repatriated. Photo: AFP

PRETORIA - Nigeria says demand for voluntary repatriation from South Africa remains high.

The Nigeria Union South Africa says hundreds more have indicated their wish to return home.

Citizens have been camping outside the country's embassy in Pretoria, waiting for assistance.

According to the Nigeria Union South Africa, another group of 288 Nigerians will fly back home from South Africa on Tuesday evening as part of the repatriation process.

The union's president, Nwobi Smart, says there are more people seeking to leave South Africa.

"There's still a lot of Nigerians willing to be evacuated. We are hopeful that after these 288 are gone, then we'll have to take inventory as to how many people still remain.

"But from our union, we still have about 300 has indicated interest that they want to be evacuated,"

Swart adds that engagements with the South African Government and Department of International Relations and Cooperation (DIRCO) continue to ensure that there is cooperation with the Nigerian embassy.


2026-07-14 15:30:10

Roelofse accepts SCA ruling to nullify appointment as judge
The Supreme Court of Appeal overturned the recommendation of a Mpumalanga advocate for appointment as a High Court judge after finding that the Judicial Service Commission (JSC) failed to properly consider concerns over his unpaid debts and judicial temperament. The appeal court ruled that the JSC acted unlawfully when it recommended Adv Johannes Hendrikus Roelofse for appointment to the Mpumalanga High Court in 2021 without adequately considering evidence that he owed the Mpumalanga Society of Advocates (MSA) more than R241 000 in unpaid bar fees and had failed to disclose a school fees debt that resulted in a civil judgment of just over R31 000. The MSA contended that the commissioners did not properly consider its objections to the appointment. The unanimous judgment, however, does not find that Roelofse is unfit to become a judge. Instead, it concludes that the JSC failed to fulfil its constitutional duty by recommending him without properly interrogating all the relevant information. The matter has now been sent back to the commission for reconsideration. Roelofse, who has served as an acting judge in the Mpumalanga High Court since 2018 and whose final stint on the bench last year included a landmark ruling in the R40-million estate dispute involving former deputy president David “DD” Mabuza, told Sunday World he would not challenge the judgment. “I have read the judgment with much anguish. Of course, I am disappointed. To tell you otherwise would be untruthful,” he said. “I accept the judgment because the law has spoken.” Reflecting on the criticism of his conduct during the JSC interview, Roelofse acknowledged he could have responded differently. “I reacted in the extreme situation of the interview. I could have handled it better, and perhaps that moment may not have been a reflection of who I really am. After all, judges are also human.” He said he would not pursue any further legal challenge. “I do not envisage any further steps to challenge the judgment. The process must run its course. I am a servant of the law, and I shall comply.” Writing for a unanimous court, Judge Tati Makgoka said the appeal was not about whether Roelofse deserved judicial office but whether the JSC had discharged its constitutional obligation to make an informed decision. “The JSC’s decision to recommend the respondent following the October 2021 interview is flawed in two respects,” Makgoka wrote, referring to the commission’s failure to properly consider concerns over Roelofse’s judicial temperament and financial disclosures. Although the court stressed that financial hardship alone does not disqualify a candidate from judicial office, it also presented that the JSC can only properly assess a candidate when it has all the relevant information before it. It also examined concerns about Roelofse’s judicial temperament. The MSA had complained that he frequently interrupted counsel, behaved abrasively in court and was not readily open to persuasion. Those concerns resurfaced during his October 2021 JSC interview, where Roelofse repeatedly interrupted commissioner Thandazani Madonsela SC while answering questions about his unpaid bar fees. The appeal court said the exchange reflected the concerns previously raised by the advocates’ body. The MSA welcomed the judgment but declined to comment further while the matter returns to the JSC. Judges Matter, a civil society watchdog, described the ruling as a significant step for judicial accountability. Research and advocacy officer at the watchdog, Mbekezeli Benjamin, said the ruling confirms that submissions from organisations familiar with judicial candidates strengthen the appointment process. The JSC said it had noted the SCA ruling and would take it into consideration.
2026-07-12 12:30:14

Re: Improving face-to-face communication can increase productivity
Agreement: I Agree Body: Dear Editor A doctor's face-to-face attention is central to humane medical care, not only for efficiency, but for the development of relational empathy. Face-to-face consultations allow a doctor to fully engage with a patient, helping them to feel understood and to retain their dignity. Sadly, distancing of doctors from their patients, which was essential during the COVID pandemic to control spread of the virus, has persisted with an increasing incidence of remote consultations. The picture is mirrored in medical undergraduate education with a decline in bedside teaching, exposure to clinician role models, and a rise in virtual learning and podcasts. In primary care there are now cohorts of patients and doctors who have never experience personalised care. Yours sincerely, David Jeffrey No competing Interests: Yes The following competing Interests: Electronic Publication Date: Saturday, July 11, 2026 - 10:24 AI use: No, I have not used AI Highwire Comment Subject: Improving face-to-face communication can increase productivity Workflow State: Released Full Title: Re: Improving face-to-face communication can increase productivity Highwire Comment Response to: Improving face-to-face communication can increase productivity Check this box if you would like your letter to appear anonymously:: Last Name: Jeffrey First name and middle initial: David Email: dijeffrey@btinternet.com Address: West Malvern Occupation: Retired palliative care consultant Affiliation: Retired BMJ: Additional Article Info: Rapid response
2026-07-11 10:44:43

‘The visit means nothing’ – family of Ratanda man killed during protests
‘The visit means nothing’ – family of Ratanda man killed during protests Siya Tsewu
Ratanda

RATANDA - A relative of one of the victims of the deadly protests in Ratanda, Gauteng, said the family is waiting for autopsy results before they decide their next move.

Sipho Motaung was killed this week after protests over water outages turned violent.

Gauteng Premier Panyaza Lesufi visited the families of the victims on Sunday.

Thapelo Motaung said they were not moved by the visit.

“For now, the visit means nothing to me. I'm waiting for feedback on Wednesday to hear if what they say will make sense to me.

“For now, I've heard nothing. I just listened to them out of respect. I'm just waiting for Wednesday's feedback. This isn't over. The deceased are not dogs. The protest will continue on Monday. We're going to shut down Ratanda again,” Motaung said.


2026-07-05 14:04:15

Air travel on edge ahead of shutdown
Air travel on edge ahead of shutdown Nokuthula Khanyile

JOHANNESBURG - Airlines are warning of possible flight delays and disruptions ahead of Tuesday's anti-immigrant protests.

CemAir says airport access, staffing levels, security screening and baggage handling could be affected.

The airline says it's working with airport authorities to limit disruption and is urging travellers to arrive early and monitor updates.

Officials have warned that violence and intimidation won't be tolerated.

READ | BUSA warns against repeat of July 2021 unrest

FlySafair meanwhile said it expects normal operations with measures in place to address delays or disruptions.

"We are expecting operations as normal at this stage, we don't foresee any particular issues at the airport. We're advised that the community has worked really hard to ensure that all of provisions are in place to ensure that things operate as they should," FlySafair's Kirby Gordon said.

"Of course, it's just prudent to advise our travellers and our customers to please arrive at the airport as soon as possible and to perhaps just plan for a little bit of extra time to get to the airport," he added.


2026-06-30 05:39:00

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