Ravi Thadhani

OPTIMIZING ERYTHROPOIETIN THERAPY

Much attention has been focused in recent years on ways of optimizing the use and cost-effectiveness of erythropoietin therapy. The balance of evidence suggests that the subcutaneous route allows lower doses to be used compared with the intravenous route, and dosing should be two to three times weekly. Concomitant use of intravenous iron potently enhances the response to erythropoietin, and more recently other adjuvant therapies such as ascorbic acid, L-carnitine, folic acid, vitamin D, androgens, and other cytokines and growth factors have been investigated. Many factors can affect the response to erythropoietin, and underdialysis and co-administration of angiotensin converting enzyme inhibitors have attracted much recent interest. Controversy regarding the optimum target hemoglobin concentration in patients with renal failure remains, but three multicenter studies are providing useful data on this issue.

Screening for Preeclampsia

AbstractPre-eclampsia, still continues to be a major cause of maternal and fetal morbidity and mortality, inspite of being an active area of research. The importance of early prediction of pre-eclampsia lies in the fact that it allows for timely initiation of preventive therapy. A combination of biophysical and biochemical markers are superior to other tests for early prediction of the development of pre-eclampsia. With the inversion of pyramid of antenatal care, preeclampsia screening in the first trimester needs to become the standard of care. Researchers now talk of predicting preeclampsia even in the third trimester to increase surveillance.n