The role of N-acetylcysteine in the management of acute and chronic pulmonary complications of sulfur mustard: a literature review.

CONTEXT: Sulfur mustard exposure, as the most widely used chemical weapon, can lead to acute and long-term pulmonary complications via various pathways, such as triggering an imbalance between the oxidant and antioxidant system. Currently, there is no validated antidote, chemoprophylaxis and curative modality for pulmonary toxicities secondary to sulfur mustard exposure. OBJECTIVE: The aim of this literature review is to collect available experimental and clinical data on the efficacy of N-acetylcysteine (NAC), as a prominent antioxidant agent, in the prevention and/or treatment of sulfur mustard-induced acute and chronic pulmonary toxicities. METHODS: A literature search was performed by the relevant keywords like "N-acetyl cysteine", "Sulfur mustard" and "Lung injury" in databases such as Scopus, Medline, Embase and ISI Web of Knowledge. No time limitation was considered. Nineteen articles were selected for review. RESULTS: A number of in vitro and experimental studies concluded that oral, intravenous, intraperitoneal and intra-tracheal administration of NAC is effective in the management of sulfur mustard-induced acute lung injury, in a time-dependent manner, via direct scavenging, inhibition of oxidative stress, inflammatory responses and apoptosis. In addition, oral NAC alone (1200 or 1800 mg/day for 4 months) or at a dose 600 mg/day for 6 months in combination with clarithromycin (500 mg/day) have led to improvements of clinical and paraclinical pulmonary parameters of patients with bronchiolitis obliterans due to sulfur mustard, through undetermined mechanisms. CONCLUSION: Despite limitations of relevant experimental and clinical studies, NAC can be considered as a candidate agent for prevention and/or treatment of sulfur mustard-induced acute lung injuries, as well as its long-term pulmonary toxicities, especially bronchiolitis obliterans.

The role of serum level of interleukin-6 in severity of pulmonary complications of sulfur mustard injuries.

Diverse studies suggest that interleukin-6 (IL6), as a member of cytokines family, has a major role in inflammatory processes of airways and lungs. In this study, an attempt was made to determine the serum level of IL6 in sulfur mustard (SM) injured patients and its comparison with controls. The measured IL6 mean level in patients with chemical injuries (0.76±0.3 ng/ml) was significantly higher than the control group's mean level (0.34±0.12 ng/ml). Furthermore, patients with moderate to severe symptoms had a serum level of (0.95±0.92 ng/ml) which was significantly higher than mild (0.47±0.54) and control (0.34±0.12) groups. The outcome of this research program demonstrates that an increase in serum level of IL6 can have a role in pulmonary complications of SM, similar to other well defined pulmonary diseases.  However, further studies are required to clarify the role and mechanism of IL6 in such patients.

Characterization of chitosan/Persian gum nanoparticles for encapsulation of Nigella sativa extract as an antiviral agent against avian coronavirus.

The aim of this study was to investigate the physicochemical characteristics of nanoparticles formed by the ionic gelation method between chitosan and water-soluble fraction of Persian gum (WPG) for encapsulation of Nigella sativa extract (NSE) as an antiviral agent. Our findings revealed that the particle size, polydispersity index (PDI), and zeta potential of the particles were in the range of 316.7-476.6 nm, 0.259-0.466, and 37.0-58.1 mV, respectively. The amounts of chitosan and WPG as the wall material and the NSE as the core had a considerable impact on the nanoparticle properties. The proper samples were detected at 1:1 chitosan:WPG mixing ratio (MR) and NSE concentration of 6.25 mg/mL. Fourier-transformed infrared (FTIR) spectroscopy proved the interactions between the two biopolymers. The effect of NSE on infectious bronchitis virus (IBV) known as avian coronavirus, was performed by the in-ovo method determining remarkable antiviral activity of NSE (25 mg/mL) and its enhancement through encapsulation in the nanoparticles. These nanoparticles containing NSE could have a promising capability for application in both poultry industry and human medicine as an antiviral product.

Systemic complications of trinitrotoluene (TNT) in exposed workers.

INTRODUCTION: 2,4,6-trinitrotoluene (TNT) has been widely used as an explosive. TNT can induce some well-recognized toxic impacts comprising toxic hepatitis, aplastic anemia and cataract. The aim of study was evaluation of TNT exposed workers for systemic complication. METHODS: In a cross-sectional study, we carried out Liver Function Test (LFT), complete blood count (CBC) and slit lamp biomicroscopy to compare the prevalence and severity of these 3 complications between 47 male TNT exposed workers (with at least one year continuous experience of TNT exposure) and 43 unexposed male hospital worker who hadn't had any previous contacts with TNT. We also performed Pulmonary Function Test (PFT) to assess the probable obstructive/restrictive abnormalities, caused by TNT. RESULTS: Mean alkaline phosphatase (ALP) level of TNT exposed group was significantly higher than the unexposed group (p = 0.023) Forced Expiratory Volume in one second to Forced Vital Capacity (FEV1/FVC) ratios of both groups were in the range of restrictive pattern (82.03% and 81.42% for the exposed and unexposed group, respectively) with no meaningful difference. We didn't find out any specific TNT induced cataract and general cortical cataract (CC) and nuclear sclerotic cataract (NSC) prevalence was not significantly different. DISCUSSION: we haven't found TNT as a chemical, causing toxic hepatitis or aplastic anemia; neither did we find it as a compound, responsible for a meaningful increase in cataract prevalence. However, due to the increased ALP serum levels and FEV1/FVC ratios among TNT workers, safety precautions are advised.

Combination therapy for airflow limitation in COPD.

UNLABELLED: Background and the purpose of the study Existing evidence confirms that no pharmacologic agent ameliorates the decline in the lung function or changes the prognosis of chronic obstructive pulmonary disease (COPD). We tried a critical combination therapy for management of COPD. METHODS: Current or past smoker (passive or active) COPD patients with moderate to severe COPD who did not respond to primitive therapy (i.e., oral prednisolone (50 mg in the morning) for 5 days; with Beclomethasone Fort (3 puff q12h, totally 1500 micrograms/day), Salmeterol (2 puffs q12h, 50 micrograms/puff) and ipratropium bromide (4 puffs q8h) for two months, enrolled to study. Furthermore they were received N-Acetylcysteine (1200 mg/daily), Azithromycin (tablet 250 mg/every other day) and Theophylline (100 mg BD). RESULTS: The study group consisted of 44 men and 4 women, with a mean age and standard deviation of 63.6 ± 12.7 years (range 22-86 years). Thirteen of 48 patients (27.0%) was responder based on 15% increasing in FEV 1 (27.7 ± 7.9) after 6.7 ± 6.1 months (57.9 ± 12.9 year old). There were statistically significant differences in age and smoking between responders and non-responders (P value was 0.05 and 0.04 respectively). There was no difference in emphysema and air trapping between two groups (p = 0.13). CONCLUSION: Interestingly considerable proportion of patients with COPD can be reversible using combination drug therapy and patients will greatly benefit from different and synergic action of the drugs. The treatment was more effective in younger patients who smoke less.

Loss of expression of TGF-ßs and their receptors in chronic skin lesions induced by sulfur mustard as compared with chronic contact dermatitis patients.

BACKGROUND: Sulfur mustard (SM) is a blister-forming agent that has been used as a chemical weapon. Sulfur mustard can cause damage in various organs, especially the skin, respiratory system, and eyes. Generally, the multiple complications of mustard gas result from its alkalizing potency; it reacts with cellular components like DNA, RNA, proteins, and lipid membranes.TGF-ß is a multi-functional cytokine with multiple biological effects ranging from cell differentiation and growth inhibition to extracellular matrix stimulation, immunosuppression, and immunomodulation. TGF-ß has 3 isoforms (TGF-ß 1, 2, 3) and its signaling is mediated by its receptors: R1, R2 and intracellular Smads molecules.TGF-ß has been shown to have anti-inflammatory effects. TGF-ßs and their receptors also have an important role in modulation of skin inflammation, proliferation of epidermal cells, and wound healing, and they have been implicated in different types of skin inflammatory disorders. METHODS: Seventeen exposed SM individuals (48.47 ± 9.3 years), 17 chronic dermatitis patients (46.52 ± 14.6 years), and 5 normal controls (44.00 ± 14.6 years) were enrolled in this study.Evaluation of TGF-ßs and their receptors expressions was performed by semiquantitative RT-PCR. Only TGF1 was analyzed immunohistochemically. RESULTS: Our results showed significant decreases in the expression percentages of TGF-ß 1, 2 and R1, R2 in chemical victims in comparison with chronic dermatitis and normal subjects and significant decreases in the intensity of R1 and R2 expressions in chemical victims in comparison with chronic dermatitis and normal controls. (P value < 0.05) CONCLUSIONS: TGF-ßs and their receptors appear to have a noticeable role in chronic inflammatory skin lesions caused by sulfur mustard.

Evaluation of activity and phenotype of alpha1-antitrypsin in a civil population with respiratory complications following exposure to sulfur mustard 20 years ago.

BACKGROUND AND AIMS: The reduced alpha1-antitrypsin (AAT) activities of some phenotypes have been suggested as contributing to the development of respiratory diseases. MATERIALS AND METHODS: One hundred patients with respiratory disease following exposure to sulfur mustard were divided into two groups of 50 based on their respiratory symptoms and compared with a healthy control group. AAT phenotypes were determined in the plasma of all patient and control subjects by isoelectric focusing (IEF). RESULTS: Mean AAT activities in patient and control groups were 3.4 +/- 0.3 and 4.2 +/- 0.1 micromol min(-1) ml(-1), respectively (p < 0.001). No phenotypic alterations were detected. CONCLUSIONS: The difference in the clinical pulmonary symptoms of the two groups was attributed to reduced AAT activity, but this was not manifested as phenotypic changes identifiable by IEF.

Overexpression of transforming growth factor (TGF)-beta1 and TGF-beta3 genes in lung of toxic-inhaled patients.

Iraq frequently used toxic inhalants during the war with Iran, exposing over 100,000 people to chemical reagents. Bronchiolitis obliterans (BO) is a major pulmonary disease caused by exposure to harmful gases. Recently defect in clearance of apoptotic cells (efferocytosis) has been suggested as a mechanism that leads to several lung diseases. Transforming growth factor (TGF)-beta, a cytokine produced by efferocytotic macrophages, suppresses the inflammation and enhances the regeneration of tissue. In this study, the authors compared the expression of these 3 isoforms of TGF-beta at mRNA level in lung biopsies of Iranian victims of chemical gases with lung biopsies of control healthy volunteers. Semiquantitative reverse transcriptase-polymerase chain reaction (RT-PCR) technique was used to examine the expression level of TGF-beta isoforms using glyceraldehyde 3-phosphate dehydrogenase (GAPDH) gene as an internal control. The results indicated that that levels of TGF-beta1 and TGF-beta3 mRNAs were significantly higher in chemical gas-injured patients than noninjured group (P < .05). Therefore, the authors speculate that TGF-beta1 and TGFbeta3, but not TGF-beta2, secretion is a result of efficient efferocytosis in chemically injured patients, playing a protective role by improving airway remodeling and lung homeostasis in this group. These properties of TGF-beta are consistent with long-time survival of chemical-injured people suffering from BO.

Glutathione and malondialdehyde levels in late pulmonary complications of sulfur mustard intoxication.

It has been hypothesized that antioxidant and oxidant capacities may be related to the severity of obstructive lung impairment in patients with sulfur mustard (SM)-induced lung injuries. Our study was designed to measure the level of glutathione (GSH) and malondialdehyde (MDA) activities in patients intoxicated with SM and to evaluate the relationship between their activity and the severity of pulmonary dysfunction. A total of 250 patients with a history of exposure to a single high dose of SM gas and also 60 healthy nonsmoking individuals with no history of exposure to SM were selected. All patients underwent spirometry; based on its indices they were divided into two groups: mild (n = 140) and moderate-to-severe (n = 110) pulmonary dysfunction. Also, serum GSH and MDA concentration measurements were performed for all patients and controls. The mean GSH level in controls was 29.85 +/- 3.26 micromol/ml, which was significantly higher than in patients with mild and moderate-to-severe pulmonary dysfunction (19.02 +/- 2.36 and 17.89 +/- 2.16 micromol/ml, respectively). Also, the mean MDA level in controls was 0.69 +/- 0.09 micromol/ml, which was significantly lower than in patients with mild and moderate-to-severe pulmonary dysfunction (0.74 +/- 0.05 and 0.75 +/- 0.05 micromol/ml, respectively). There was a weak linear correlation between GSH level and some of the pulmonary function indices. On the other hand, there was no significant relationship between the MDA level and pulmonary indices. Our study confirmed important alterations in the oxidative-antioxidative system in patients suffering from SM-induced lung injuries, as shown by a decreased serum level of GSH and an increased level of MDA. Individuals with moderate-to-severe SM-induced lung injuries show a greater tendency for a decreased level of GSH and an increased level of MDA than those with mild injuries; however, there is only minimal association between pulmonary function parameters and the serum level of MDA and GSH. These findings encourage us to examine therapeutic measures to correct such imbalances in future studies.

Comparative study of skin sebum and elasticity level in patients with sulfur mustard-induced dermatitis and healthy controls.

BACKGROUND: Sulfur mustard (SM) - a chemical agent - has both acute and chronic effects on skin. Xerosis, which is deemed to be due to the damage of hydrolipidic barrier of the skin, is the most common complaint of veterans exposed to the chemical. This study was designed to evaluate skin sebum and elasticity in veterans with a history of SM contact. METHODS: Three hundred and ten subjects were enrolled in this study and were divided into four groups: SM-exposed patients with current skin lesions (n=87); SM-exposed patients without skin lesions (n=71); patients with dermatitis (n=78); and normal controls (n=74). The skin sebum and elasticity were measured in four areas (forehead, suprasternal, palm and back of the hands) using a Sebumeter and a Reviscometer. RESULTS: Skin sebum was higher in participants who presented with dermatitis and had history of contact with SM than others; the difference was only statistically significant on the forehead. There was no significant difference in the skin elasticity between the four groups. CONCLUSION: While SM may increase skin sebum in long term, there is no evidence that it has a substantial effect on skin elasticity.

Skin hydration and transepidermal water loss in patients with a history of sulfur mustard contact: a case-control study.

BACKGROUND: Skin lesions are among the most common complications of contact with sulfur mustard. OBJECTIVE: This study was aimed to measure skin water content and transepidermal water loss (TEWL) in patients with a history of sulfur mustard contact. METHODS: Three hundred ten male participants were included in this study: 87 (28.1%) sulfur mustard-exposed patients with current skin lesions (group 1), 71 (22.9%) sulfur mustard-exposed patients without skin lesions (group 2), 78 (25.2%) patients with dermatitis (group 3) and 74 (23.8%) normal controls (group 4) The water content and TEWL of skin was measured at four different locations of the body: forehead, suprasternal, palm and dorsum of hand. Nonparametric statistical tests (Kruskal-Wallis) were used to compare the four groups, and P < 0.05 was considered statistically significant. RESULTS: The mean age of participants were 44.0 +/- 6.7, 41.9 +/- 5.9, 43.8 +/- 9.3 and 44.8 +/- 8.9 years in groups 1 to 4, respectively (P = 0.146). Xerosis, post-lesional hyperpigmentation and lichenification were significantly more common in either sulfur mustard-exposed participants or non-exposed participants with dermatitis (P < 0.05). Skin hydration was higher in subjects with sulfur mustard contact than in non-injured participants (P < 0.05) in the dorsum and palm of hands and forehead. TEWL was significantly higher in participants only in suprasternal area and dorsum of hand. CONCLUSION: Contact with sulfur mustard agent can alter biophysical properties of the skin--especially the function of stratum corneum as a barrier to water loss-several years after exposure.

Activity and function in lung injuries due to sulphur mustard.

AIM: Pulmonary complications are known to occur in over half the patients exposed to sulphur mustard. Many studies have focused on the clinical complications, often ignoring the pathogenesis of sulphur mustard. Also, the reasons for the variable severity of lung injuries caused by sulphur mustard are unclear. Hence, the current study was performed to evaluate the correlation between superoxide dismutase (SOD) and catalase (CAT) activity and pulmonary function in patients exposed to sulphur mustard. METHODS: Our study was a comparative cross-sectional survey. Two hundred and fifty incident survivors were selected from the Sardasht population who were exposed to sulphur mustard in 1987. A control group from non-exposed civilians was also selected. We used a pulmonary function test, and SOD and CAT activity was measured in these groups. RESULTS: The mean SOD activity in the healthy control group (70.5+/-10.8 U ml(-1)) was higher than in the moderate-to-severe group (67.0+/-6.1 U ml(-1)) (p <0.001, one-tail ANOVA, least significant difference (LSD) post hoc). The mean activity in the mild group (72.5+/-6.9 U ml(-1)) was no higher than in the healthy control group (70.5+/-10.8 U ml(-1)) (p=0.095 one-tail ANOVA, LSD post hoc). The mean CAT activity in the healthy control group (4.9+/-1.5 U ml(-1)) was lower than in the moderate-to-severe group (8.0+/-1.8 U ml(-1)) (p <0.001, one-tail ANOVA, LSD post hoc) and in the mild group (7.5+/-1.5 U ml(-1)) (p=0.012 one-tail ANOVA, LSD post hoc). CONCLUSION: According to our findings, it is reasonable to hypothesize that re-establishment of the activation-inactivation or oxidant-antioxidant balance in favour of the activation and antioxidant balances would be useful as a therapeutic strategy to suppress pathological mechanisms underlying lung injuries.

Therapeutics effect of N-acetyl cysteine on mustard gas exposed patients: evaluating clinical aspect in patients with impaired pulmonary function test.

AIMS: Long-term prescription of N-acetyl cysteine (NAC) may be effective in diseases caused by active radicals of oxygen species. The aim of this study was to determine the effect of 2- and 4-month administration of NAC (1800 mg daily) on mustard induced bronchiolitis obliterans. METHODS AND MATERIALS: In a double blind clinical trial, 144 patients with bronchiolitis obliterans due to sulfur mustard in bronchiolitis obliterans syndrome (BOS) classes 1 and 2, randomly entered Group 1 (n=72, NAC) and Group 2 (n=72, placebo). Dyspnea, wake-up dyspnea, cough, and sputum were measured after 4 months. Spirometric findings were measured at the beginning of the trial, 2 months after and after 4 months of prescription of 1800 mg/day in three doses of NAC or placebo. RESULTS: Dyspnea, cough, sputum, and wake-up dyspnea improved after 4 months of NAC compared to the control group. After 4 months, spirometric components were significantly improved in NAC group compared to placebo group. CONCLUSION: Fourth months administration of NAC (1800 mg daily) can improve clinical conditions and spirometric findings in mustard exposed in BOS class 1 or 2.

Effect of Melatonin Administration on Sleep Quality in Sulfur Mustard Exposed Patients with Sleep Disorders.

Sulfur mustard (SM) is a toxic agent that targets several tissues. It is the leading cause of persistent lung disease, progressive deterioration in lung function, and mortality among injured patients. Disturbed sleep and poor quality of sleep are common in SM-exposed patients with chronic respiratory problems. Melatonin is an alternative medication that has been widely used to treat poor sleep quality caused by several specific conditions. This study aimed to evaluate the efficacy of melatonin administration in improvement of sleep quality in SM-injured patients. In this randomized, double-blind and placebo-controlled trial study a total of 30 SM-exposed male patients were recruited. Patients received 3 mg melatonin (N = 15) or placebo (N = 15), orally in a single dose, 1 h before bedtime for 56 consecutive days. Sleep quality was evaluated by Pittsburgh Sleep Quality Index (PSQI); daytime sleepiness was measured by Epworth Sleepiness Scale (ESS), and the risk of obstructive sleep apnea was determined by STOP-Bang questionnaire. Compared with placebo, melatonin administration significantly improved global PSQI score, particularly sleep latency (P = 0.03) and subjective sleep quality (P = 0.004). Mean of global PSQI score was declined significantly (P = 0.01) from 10.13 ± 3.44 to 6.66 ± 3.08 in melatonin group. No differences in ESS and STOP-Bang scores were observed between two groups. Melatonin was effective in improving global PSQI score and sleep latency, but not daytime sleepiness and obstructive sleep apnea in SM-exposed patients. Further long-term studies involving larger number of patients are needed before melatonin can be safely recommended for the management of sleep disturbances in these patients.

Inhaled corticosteroids and long-acting beta 2-agonists in treatment of patients with chronic bronchiolitis following exposure to sulfur mustard.

We examined the role of two regimens of combination inhaler therapy on amount of reversibility of chronic lung complications in mustard gas exposed patients. In a phase III, prospective, randomized clinical trial, 105 participants received either combination form of fluticasone propionate and salmetrol, 500/100 microg daily (group 1; n = 52) or beclomethasone, 1000 microg daily, and salbutamol inhaler, 800 microg daily (group 2; n = 53) for 12 wk. Pulmonary function test (PFT) indices and respiratory symptoms (including dyspnea, night awakening due to dyspnea and cough) were assessed at baseline and in each visit. Thirty-six patients in group 1 and 30 patients in group 2 completed study course. Both medication regimes increased pretreatment forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC%, and peak expiratory force (PEF) by the end of 12 wk. It seems that these improvements are more constant in group 1 than in group 2. Reversibility, that is, 10% increase of FEV1 in the second month was seen for 27% of patients in the group 1 and for 7% in the group 2. VAS scores have decreased in two groups during treatment period (p = .003) and after follow-up period it remained sustained in group 1 alone. Inhaled corticosteroids and long-acting beta 2-agonists are effective in treatment of patients with chronic bronchiolitis following exposure to sulfur mustard. However, a medium dose of fluticasone/salmeterol has the same effect on the airways reversibility, rather than a very high dose of beclomethasone with only the short-acting beta-agonist.

Comparative study of Unna's Boot and betamethasone cream in the treatment of sulfur mustard-related pruritus.

Pruritus, as a chronic lesion caused by sulfur mustard, is a common problem among chemical weapons veterans. Numerous treatments like antihistamines, local anesthetics, and corticosteroids have been prescribed in order to control pruritus in these patients, while long- term and widespread use of each one of them has its own restrictions. Nowadays different mixtures, including Unna's Boot, are being used. They are effective and have limited adverse effects. So in this study we compared this product with corticosteroids. In this double-blind randomized clinical trial in Baqyiatallah hospital, 90 veterans were included and randomly divided into three groups. Subjects of each group received one of the Betamethasone %1 cream, Unna's Boot cream, or placebo cream for three weeks. They used their medication on an itching area of body, one finger tip unit every night. To evaluate the drugs' efficacy we used pruritus score index and Visual Analysis Score index. From 90 patients, 75 patients completely used the medication and the other 15 subjects were excluded from the study. All three drugs caused significant decrease in both pruritus score and VAS (p < .001). Betamethasone and Unna's Boot were significantly more effective than placebo and despite more efficacy of betamethasone rather than Unna's Boot, they did not have any significant differences (p > .05). Pruritus is a chronic lesion in veterans that needs long-term conservation treatment. Regarding definite side effects of local long-term therapy with corticosteroids and nearly equal efficacy of Unna's Boot and betamethasone, Unna's Boot seems to be a better choice in controlling sulfur mustard-related pruritus compared with betamethason.

Comparison of hydroxyzine and doxepin in treatment of pruritus due to sulfur mustard.

OBJECTIVE: To compare the safety and efficacy of doxepin and hydroxyzine in the treatment of chronic pruritus due to exposure to sulfur mustard. METHODS: In a randomized, double-blind safety and efficacy study, 50 patients with chronic pruritus were given either doxepin 10 mg/d or hydroxyzine 25 mg/d for 4 weeks. Pruritic score was calculated for each patient before treatment and 1 month after. RESULTS: After treatment, the mean pruritic scores +/- SD of the hydroxyzine and doxepin groups were 16.7+/-2.3 and 17.8+/-2.5, respectively. The severity of pruritus was decreased in 80% of patients in the hydroxyzine group and 75% in the doxepin group (P=.786). Eighteen patients in the hydroxyzine group and 14 patients in the doxepin group reported sedation. CONCLUSIONS: Both hydroxyzine and doxepin are effective and have equivalent results in controlling the symptoms of patients with chronic pruritus due to exposure to sulfur mustard.

Comparison of efficacy and safety of two available natural surfactants in Iran, Curosurf and Survanta in treatment of neonatal respiratory distress syndrome: A randomized clinical trial.

INTRODUCTION: The benefit of surfactant prescription for respiratory distress syndrome (RDS) has been approved. Curosurf and Survanta are two commonly used natural surfactants in Iran. Previous studies did not report priority for one of these two drugs. The present study aimed to compare the effectiveness and safety of Curosurf and Survanta in treatment of RDS. METHODS: In this randomized clinical trial, neonates were born with RDS diagnosis in two governmental and referral hospitals of Tehran (the capital of Iran) in 2014 were randomly selected. Neonates were randomly assigned into two groups receiving 100 mg/kg Curosurf or Survanta as soon as possible after randomization. Complications, mortality and needing the second dose were compared between the two groups. RESULTS: A total 112 patients with the mean gestational age of 32.59 ± 3.39 weeks were evaluated (56 patients in each group). There were no significant differences regarding birth weight, gestational age, delivery method, and parity between the two groups (P > 0.05). The complications were occurred in 18 neonates (32.1%) of Curosurf group and 20 neonates (35.7%) of Survanta group (RR = 0.922, 95% CI = 0.617-1.379). There were no significant differences regarding complications, mortality, and needing nasal CPAP and endotracheal tube between the two groups. In the neonates with gestational age of 29-32 weeks the IVH and NEC incidence were significantly more in Curosurf group compared to Survanta group (27.8% vs 0% and 22.3% vs 0%, P < 0.05). CONCLUSION: There was no significant difference in complications or mortality between those two groups; however Curosurf was associated with less need of ET tube (in >32 birth weeks subgroup) and NCPAP (in 29-32 birth weeks subgroup) (p = 0.008). Further evaluations with longer follow-up duration are needed for comparing these two surfactants.