[Different doses of ibuprofen in the treatment of patent ductus arteriosus: a randomized clinical trial]

Patent ductus arteriosus [PDA] is a common finding among premature or low-birth-weight infants and it often does not close. Nowadays, drugs used for its treatment include indomethacin and more commonly ibuprofen. Oral ibuprofen was recently shown to be as effective and have several important advantages in preterm infants. Studies performed to find the best dose of ibuprofen for PDA treatment are limited; hence, we compared the effects of two different doses of ibuprofen in this interventional study. In this randomized controlled clinical trial, we randomly divided 60 patients with echocardiographically confirmed PDA into two groups of 30. This study was done in NICU of Valiasr hospital in 1387-89 years. In the first group, we administered a loading dose of 10 mg/kg ibuprofen on the first day, followed by two doses of 5 mg/kg in the next two days. In the second group, we administered a loading dose of 15 mg/kg ibuprofen on the first day followed by two doses of 7.5 mg/kg in next two days. Eventually, we compared PDA closure rates and complications of therapy between the two groups. Thirty [100%] patients in 15-mg/kg group and 23 [76.7%] patients in 10 mg/kg group had successful PDA closure with no need for surgery. The two groups had a statistically significant difference [P=0.011] and the highest response to treatment was seen within the first 24 hours of treatment. We may conclude that higher doses of ibuprofen [15 and 2x7.5 mg/kg] would offer better outcomes for PDA closure without gastrointestinal or renal complications and less need for surgery.

Effect of vitamin E succinate as a differentiation agent on the efficacy of 5-ALA-PDT on prostate cancer cells in culture

Photodynamic Therapy [PDT] using 5-aminolevulinic acid [5-ALA]-induced protoporphyrin IX [PpIX] has been considered as a new method for treating neoplasms. However, ALA-PDT is suboptimal for thick tumors. Searching for new approaches, we investigated the effect of adding differentiation therapy [DT] with Vitamin E succinate [VES] to PDT in human prostate LN-CaP-FGC10 cancer cells in vitro. The purpose of DT was to reverse the lack of differentiation in cancer cells and to enhance the effectiveness of ALA- dependent PDT. Three groups of cells were grown on RPMI1640 culture medium supplemented with 10% FBS. The cells included: ALA-PDT cells, which received 0.3 mM ALA for 4 hours at dark, and exposed to 532 nm, 50 mW Nd-YAG laser beam for 3 min; DT+ALA-PDT cells, which received 6 micro g/ml VES for 24, 48 and 72 hours, followed by the addition of 0.3 mM ALA for 4 h and exposure to Nd-YAG laser beam for 3 min; control cells which were untreated. After 24 h, the percentage of cell viability was determined by MTT assay. Accumulation of PpIX was measured by spectrophotometry and fluorescent microscopy. Mechanism of induced cell death was investigated via Hoechst staining. The combination of both factors [VES and 5-ALA] lead to a significant increase in cell death after 72 h. Induction of differentiation augmented PpIX accumulation in cells treated with ALA. Elevated intracellular PpIX levels resulted in an enhanced lethal photodynamic sensitization of VES plus ALA-treated cells after 72 h. Apoptotic cell death by both ALA-PDT and VES-ALA-PDT was confirmed by Hoechst staining. Our data suggest that VES used in combination with 5-ALA may provide a new combinatorial approach for treating certain cancers

Listeriosis in a premature neonate with meconium staining

This report describes a preterm newborn 32 weeks gestation and listeriosis that present with meconium staining. The passage of meconium on response to stress in seldom observed before a gestational age of 34 weeks. so, with the meconium staining appearance in this gestational age or less, should prompt a high index of suspicion for listeriosis