PHOTOTHERAPY-A REVIEW.pptVIP

PHOTOTHERAPY-A REVIEW WILLIAM OH, MD BROWN MEDICAL SCHOOL FDA CONFERENCE, JUNE 11,2003 OUTLINE HISTORICAL NOTES MECHANISM-HOW IT WORKS EFFICACY DATA SIDE EFFECTS LONG TERM OUTCOME HISTORICAL NOTE FIRST PAPER ON PHOTOTHERAPY PUBLISHED IN 1958 (CREMER,LANCET) BASED ON THEIR IN VITRO OBSERVATION OF FALLING VALUES OF BILIRUBIN WHEN SERUM SAMPLES WERE EXPOSED TO LIGHT HISTORICAL NOTES-CONT’D SEVERAL CLINICAL TRIALS IN THE ’60s CONFIRMED THE EFFICACY OF PHOTOTHERAPY LEADING TO ITS USE AS STANDARD CARETRIALS ALSO SHOWED MORE EFFICACY AMONG LOW BIRTH WEIGHT INFANTS MECHANISM BILIRUBIN ABSORS PHOTON FROM LIGHT AT 450 nm ( IN VITRO) PHOTOCHEMICAL REACTIONS FORMATION OF THREE MAJOR PRODUCTS THAT ENHANCES ELIMINATION ABSORPTION SPECTRUM OF BILIRUBIN ABSORPTION OF LIGHT BY BILIRUBIN IN VIVO BECAUSE BILIRUBIN IN VIVO IS BOUND TO ALBUMIN ,SPECTRUM OF MAXIMUM ABSORPTION IS SHIFTED TO THE RIGHT ( 450 TO 475 nm) THIS EXPLAINS THE VARIABLE EFFICACY OF LIGHT USED IN CLINICAL SETTING PHOTO-OXIDATION SINCE CREMER’S REPORT(1958), IT HAS BEEN ASSUMED THAT PHOTO-OXIDATION IS THE MECHANISM FOR ? BILIRUBIN EXCRETION 1984, ISOMERE FORMATION FOUND TO BE THE MAJOR MECHNISM CONFIGURATIONAL ISOMERIZATION (4Z,15E) STRUCTURAL ISOMERIZATION (LUMIRUBIN) PHYSICAL PROPERTY OF BILIRUBIN AND ITS PRODUCT NATIVE BILIRUBIN ( 4Z,15Z) HYDROPHOBIC AND LIPOPHYLIC BILIRUBIN ISOMERES ARE LESS LIPOPHYLIC AND HYDROPHOBIC ENHANCE ELIMINATION VIA BILE AND URINE RATE OF FORMATION ELIMINATION OF BILIRUBIN RATE OF FORMATION:4Z,15E ISOMERES LUMIRUBIN PHOTO-OXIDATION PRODUCTS RATE OF EXCRETION:LUMRUBIN 4Z,15E PHOTOOXIDATION PRODUCTS LUMIRUBIN APPEARS TO BE THE MAJOR FORM OF ELIMIATION  PHOTO-CHEMICAL REACTION ELIMINATION OF BILIRUBIN FACTORS AFFECTING EFFICACY OF PHOTOTHERY DEPENDENT ON TYPE OF LIGHT USED LIGHT INTENSITY SURFACE AREA OF SKIN EXPOSED TO LIGHT DISTANCE FROM LIGHT TO BABY TYPES OF PHOTOTHERAPY DEVICE FLUORESCENT TUBES DAYLIGHT(WHITE) BLUE GREEN HALOGEN LAMPS