Rapid-acting fentanyl formulations are superior to oral morphine (OM) syrup in controlling breakthrough pain among patients with cancer, but they are expensive and unavailable in many countries. Objective: To evaluate the efficacy of reconstituted intravenous fentanyl to sublingual solution (IFS) in relieving breakthrough pain as compared with OM. Methods: In this randomized, double-blind, double-dummy, placebo-controlled trial, patients with gynecologic cancer aged ≥18 years experiencing chronic cancer pain with breakthrough pain were enrolled. Patients were randomly allocated (1:1) to receive either 50 μg IFS or 5 mg OM. Pain intensity level was assessed at 5, 15, 30, 45, 60, and 120 min after treatment. The primary outcome was the reduction in pain intensity at 15 min in the intention-to-treat population (ClinicalTrials.gov, NCT05037539). Results: Between June 15, 2021 and December 30, 2021, 40 participants were equally and randomly assigned to receive IFS or OM. The primary outcome was significantly higher in the IFS group (4.25 vs. 1.05, p < 0.0001). The secondary outcomes also showed higher reduction in pain intensity at 5 min in the IFS group. Subsequent breakthrough pain did not differ between the two groups. However, the reduction in pain was lower in the IFS group at 45, 60, and 120 min, where pain was classified as mild. No severe adverse effects were observed in both groups. Burning sensation without noticeable lesion was found in 20% of the IFS group. Conclusion: IFS can reduce early breakthrough pain. IFS may be considered for breakthrough pain when rapid-acting fentanyl formulations are unavailable.

Objective: To evaluate the effect of dexamethasone on the rate of respiratory distress syndrome in late preterm infants Materials and Methods: One hundred ninety-four singleton pregnant women at risk for late preterm delivery were randomly allocated into two groups. Ninety-seven patients received 6 mg dexamethasone (group 1) and 97 patients received 1.5 mL normal saline (group 2), intramuscularly every 12 hours for four doses or until delivery. The primary outcome was the rate of neonatal respiratory distress syndrome. The secondary outcomes were the need for continuous positive airway pressure (CPAP), the neonatal intensive care unit admission, the Apgar scores at 1 minute and 5 minutes, the rate of transient tachypnea of the newborn (TTN), intraventricular hemorrhage, neonatal hypoglycemia, neonatal sepsis, and adverse effects. Results: The rate of neonatal respiratory distress syndrome was lower in group 1, five cases (5.2%), compared with group 2, six cases (6.2%) (p=0.756, relative risk 0.83, 95% CI 0.26 to 2.64). The need for CPAP, NICU admission, rate of TTN, and intraventricular hemorrhage were not significantly different. Group1 had significantly higher Apgar scores at 1 minute and 5 minutes (p=0.021 and 0.043, respectively). No adverse effects were reported. Conclusion: Administration of dexamethasone in late preterm birth did not decrease the rate of neonatal respiratory distress and the need for CPAP and NICU admission but statistically significantly improved the Apgar scores at 1 minute and 5 minutes. More research in the future is needed to correct the limitation in the present study. Keywords: Late preterm, Dexamethasone, Respiratory distress syndrome, Apgar scores