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A prospective randomized study was conducted to compare the efficacy of long-term endoscopic sclerotherapy vs. propranolol in Child class B and C patients with variceal bleeds within the 30 days before the study. Forty-five and 46 patients were randomized to receive sclerotherapy and propranolol, respectively, after preentry stratification for Child scores. Sclerotherapy was administered with 1% polidocanol at 10-day intervals until obliteration of varices was achieved. Propranolol was administered to achieve a reduction in resting pulse rate of 25%. Rebleeding occurred in 19 patients undergoing sclerotherapy and in 31 receiving propranolol (p less than 0.05). The number of episodes of rebleeding was higher (p less than 0.05) in the propranolol group (n = 64) than in the sclerotherapy group (n = 35). The mean bleeding risk factor, number of hospitalizations for rebleeding and blood transfusion requirement were also significantly higher in the propranolol-treated patients. The median bleed-free period was more than 36 mo in the sclerotherapy group and 2.5 mo in the propranolol group (p less than 0.01). The median survival time was significantly longer in the sclerotherapy group (greater than 36 mo) than in the propranolol group (greater than 24 mo). We conclude that in decompensated cirrhotic patients, long-term endoscopic sclerotherapy is superior to propranolol in preventing rebleeding and improving survival.

This study was conducted to determine the optimum dose of supplemental iron for prophylaxis against pregnancy anemia. One hundred and ten pregnant women were randomly allocated to three groups: Group A receiving equivalent of 60 mg, group B 120 mg and Group C 240 mg, elemental iron as ferrous sulphate daily; the content of folic acid was constant in all the three groups (0.5 mg). These women had at least consumed 90 tablets in 100 +/- 10 days. Blood was drawn at the beginning and at the end of the treatment. Fifty percent were anemic (less than 11 g/100 ml). The hemoglobin levels rose similarly in all groups and the differences were statistically not significant. Fifty-six percent had depleted iron stores (serum ferritin value less than 12 micrograms/l) at the beginning of the study. Following therapy a statistically significant increase in iron stores was observed in group B and C as compared to group A. The difference between group B and C was not significant. The side effects increased with increasing doses of iron; 32.4%, 40.3% and 72% in group A, B and C respectively. Based on these findings, the authors advocate that optimum dose of iron should be 120 mg instead of 60 mg as is currently being used in the National Nutritional Anemia Prophylaxis Programme.

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I. The relative efficacy of oral and parenteral iron administration in the prophylaxis and treatment of Fe-deficiency anaemia of pregnancy has been studied.2 . Intravenous administration of Fe by total dose infusion of Fe dextran was not superior to oral Fe I 20 mg/d, 6 d/week for 1 0 -1 z weeks.3. Intramuscular Fe dextran, 100 mg twice per week for I~I Z weeks, produced a significantly greater rise in mean haemoglobin concentration than oral Fe therapy.4. The superiority of intramuscular Fe as compared with intravenous Fe is probably related to the different handling of the Fe dextran by the reticulo-endothelial system. 5.In spite of the better response to intramuscular Fe dextran, it is not recommended for public health practice because of the risks associated with its use and the much higher cost of the preparation and its delivery.In a previous study (Sood et al. 1975) it was observed that even after 10-12 weeks of daily oral supplementation with I 20-240 mg iron together with pteroylmonoglutamic acid and cyanocobalamin, a substantial proportion of pregnant women had a haemoglobin concentration of less than I 10 g/l; a serum Fe below 600 yg/l and transferrin saturation below 15% suggesting persisting Fe deficiency. It was suspected that this may have been due to an inadequate absorption of Fe. The present investigation was therefore undertaken to compare the effects of oral and parenteral Fe supplementation. M A T E R I A L S A N D M E T H O D SAs in the previous studies (Sood et al. 1975; Mathan et al. I979), this trial was also conducted in both Delhi in northern India and Vellore in southern India. Pregnant women who agreed to collaborate in the study were admitted to the trial at 26&2 weeks of gestation. Women with chronic illnesses, with haemoglobin concentration less than 50 g/l, and those who had received haematinics during the last 6 months were excluded. The participating women were divided into one of the three strata according to their haemoglobin concentration (50-79; 80-109; I I O or above). Within each stratum subjects were allocated at random to one of the following treatment groups: ( I ) oral ferrous sulphate (Fersolate; Glaxo Laboratories, India, Ltd) providing 120 mg elemental Fe, given once per day 6 d/ week; ( 2 ) Fe dextran complex (Imferon; Tata Fison, India, Ltd) providing IOO mg Fe given intramuscularly twice per week; (3) Fe as in group I fpteroylmonoglutamic acid (5 rng/d, 6 d/week)+cyanocobalamin (100 yg intramuscularly once per 14 d); (4) Fe intramuscularly as in group 2+pteroylmonoglutamic acid+cyanocobalamin as in group 3 ; (5) Fe