Erythropoietin monotherapy in perinatal asphyxia with moderate to severe encephalopathy: a randomized placebo-controlled trial.

OBJECTIVE: Erythropoietin (EPO) is neuroprotective after asphyxia in animal studies. The efficacy and safety of EPO monotherapy in term neonates with hypoxic ischemic encephalopathy (HIE) is uncertain. STUDY DESIGN: Hundred term neonates with moderate or severe HIE were randomized by random permuted block algorithm to receive either EPO 500 U kg-1 per dose in 2 ml saline intravenously (50 neonates) on alternate days for a total of five doses with the first dose given by 6 h of age (treatment group) or 2 ml of normal saline (50 neonates) similarly for a total of five doses (placebo group) in a double-blind study. No hypothermia was given. The primary outcome was combined end point of death or moderate or severe disability at mean age of 19 months (s.d., 0.61). RESULTS: Death or moderate or severe disability occurred in 40% of neonates in the treatment group vs 70% in the placebo group (risk ratio, 0.57; 95% confidence interval (CI) 0.38 to 0.85; P=0.003). Death occurred in 16% of patients in both the groups (risk ratio, 1.0; 95% CI 0.33 to 2.9; P=0.61). The risk of cerebral palsy was lower among survivors in the treatment group (risk ratio, 0.52; 95% CI 0.25 to 1.03; P=0.04) and lesser number of babies were on anticonvulsants at assessment (risk ratio, 0.47; 95% CI 0.20 to 1.01; P=0.03). Neonatal brain magnetic resonance imaging showed more abnormalities in the placebo group (relative risk, 0.66; 95% CI 0.42 to 1.03; P=0.04)). Improvement in other neurological outcomes was not significant. CONCLUSION: EPO monotherapy reduces the risk of death or disability in term neonates with moderate or severe encephalopathy.

Profile of lung cancer in Kashmir, India: a five-year study.

AIM: To study the clinico-pathological aspects of lung cancer, and the outcome of various treatment modalities. METHODS: A retrospective review of histopathologically confirmed lung cancer patients who were registered and treated at our institution over a period of five years was carried out. RESULTS: A total of 321 patients were studied. There was a preponderance of males (91.9%) as compared to females (8.1%). Smoking history was present in 88% of the male patients. Cough was the main presenting feature in 71.6% of patients. Diagnosis was established by bronchoscopy in 94% of cases. Squamous cell carcinoma was observed in 77.3%, while 17.1% had small cell carcinoma. Radiotherapy formed the main treatment modality alone (22.4%) and in combination (27%). Out of the 321 patients, 206 were evaluable on follow-up. Local failure and distant metastasis were seen in 9.2% and 19.9% of cases, respectively. The overall survival rate of 2, 3 and 5 years was 19.9%, 13.59% and 6.79%, respectively. CONCLUSIONS: . The outcome of lung cancer is poor. Increased survival is possible if the disease is detected early, treated adequately with multi modality approach.