e-SQUARE, February 2023

Features

Antibiotic Resistance !

Advance Cancer Treatment !

Artificial Pancreas !

Oral Bacteria !

Eczema Treatment !

Migraines During Menstruation !

Products of SQUARE Pharmaceuticals Ltd.

EDITORIAL TEAM

OMAR AKRAMUR RAB

MBBS, FCGP, FIAGP,

P G Dip. Business Management

MAHFUZUR RAHMAN

MBBS, MBA

Rubyeat Adnan

MBBS, MPH, CCD

Mushfiqur Rahman

MBBS

EDITORIAL

Dear Doctor:

Welcome to online bulletin 'e-SQUARE' !

Our current issue focused on some interesting features like

"Antibiotic Resistance !", "Advance Cancer Treatment !", "Artificial Pancreas !", "Oral Bacteria !", "Eczema Treatment !", "Migraines During Menstruation !".

In our regular feature, we have some new products information of SQUARE Pharmaceuticals Ltd. as well.

We will appreciate your feedback !

Click on to reply mode.

Yours sincerely,

Editorial Team

Reply Mode : e-square@squaregroup.com

The views expressed in this publication do not necessarily reflect those of its editor or SQUARE PHARMACEUTICALS LTD.

Antibiotic Resistance !
Spread of antibiotic resistance
Antibiotic resistance represents one of the largest threats to global public health, food security and global development faced today. Due to the spread of antibiotic resistance, a growing number of infections, such as pneumonia and tuberculosis, are becoming harder to treat, leading to longer hospital stays, greater costs and increased mortality. Many public health agencies have recommended reducing antibiotic use in response to the challenges caused by resistance. However, there are cases where developed countries have reduced their antibiotic consumption and not halted the spread of antibiotic resistance genes across bacterial populations, implying other factors are at play said by lead researcher. Researcher set out to describe the genetic, geographical and ecological distribution of resistances to a class of antibiotics called aminoglycosides, and from this information, quantify the relative contribution of different factors driving the spread of antibiotic resistance. Aminoglycosides have limited clinical use in humans, but are often a last resort for treating multi-resistant infections. They are also commonly used in the treatment of farmyard animals, meaning that resistance to them poses a significant threat to global food security. The findings suggest that the largest cause of AME (Aminoglycoside-modifying enzymes) gene spread is through the movement of antibiotic-resistant bacteria between ecosystems and biomes. This spread is aided by mobile genetic elements, which increase the likelihood for a genome to carry several copies of the same AME gene. This increases the expression of transferred AME genes and allows bacteria to evolve new antibiotic resistance functions through the duplicated sequences. These findings are preliminary, as limited by the use of publicly available data, rather than deploying a dedicated sampling method. In addition, the genetic data sourced from multiple different research projects caused a sampling bias towards industrialised countries and biomes with clinical interest, leading to some locations and biomes being over-represented.
SOURCE: Science Daily News, February 2023	Return to top

Advance Cancer Treatment !
Intravenous mistletoe extract to treat advanced cancer
Mistletoe extract has been widely used to support cancer therapy and improve quality of life, but there has been a lack of clinical trials and data to support its use. Researchers completed what is believed to be the first phase I trial of intravenous Helixor M in the U.S. aimed at determining dosing for subsequent clinical trials and to evaluate safety. Mistletoe extract (ME), known as Helixor M, was studied in 21 patients with advanced and treatment-resistant cancers of various types. The phase I trial used dose escalation to determine the maximum dose that could be safely tolerated by patients. ME was delivered intravenously three times per week until disease progression or until toxicity. The study concluded that dose to be 600 milligrams of ME. The median follow-up duration on mistletoe was 15.3 weeks. Stable disease was observed in five patients and lasted, on average, for 15 weeks. Tumors in three participants decreased in size, and remained stable for two to five months, however, this did not meet official criteria for partial response. Patients also reported overall improved quality of life via a questionnaire. The most common side effects reported were fatigue, nausea, and chills and they were noted as manageable. Mistletoe extract is a semi-parasitic plant with several active ingredients that, in preclinical studies, appear to directly cause the death of tumor cells and stimulate an immune response. It has been used in Europe for several decades as a complementary medicine approach to cancer treatment alone or in combination with chemotherapy and radiation therapy, but it has not been evaluated in clinical trials. ME is not currently FDA approved for cancer treatment in the U.S. but is listed in the Homeopathic Pharmacopoeia and is offered in integrative care clinics.
SOURCE: Science Daily News, February 2023	Return to top

Artificial Pancreas !
Artificial pancreas successfully trialed for use by type-2 diabetes patient
Type 2 diabetes causes levels of glucose blood sugar to become too high. Ordinarily, blood sugar levels are controlled by the release of insulin, but in type 2 diabetes insulin production is disrupted. Researchers have developed an artificial pancreas that can help maintain healthy glucose levels. The device combines an off-the-shelf glucose monitor and insulin pump with an app developed by the team, known as CamPS HX. This app is run by an algorithm that predicts how much insulin is required to maintain glucose levels in the target range. The researchers have previously shown that an artificial pancreas run by a similar algorithm is effective for patients living with type 1 diabetes, from adults through to very young children. The researchers recruited 26 patients. They used several measures to assess how effectively the artificial pancreas worked. The first was the proportion of time that patients spent with their glucose levels within a target range of between 3.9 and 10.0mmol/L. On average, patients using the artificial pancreas spent two-thirds (66%) of their time within the target range - double that while on the control (32%). A second measure was the proportion of time spent with glucose levels above 10.0mmol/L. Over time, high glucose levels raise the risk of potentially serious complications. Patients taking the control therapy spent two-thirds (67%) of their time with high glucose levels - this was halved to 33% when using the artificial pancreas. The app also reduced levels of a molecule known as glycated haemoglobin, or HbA1c. No patients experienced hypoglycaemia during the study.
SOURCE: Science Daily News, February 2023	Return to top

Oral Bacteria !
Oral bacteria may increase heart disease risk
The study suggests another potential risk factor that physicians might screen for to identify individuals at risk of heart disease. It may also indicate that treatments for colonisation or infection with the oral bacterium Fusobacterium nucleatum may help reduce heart disease risk. A combination of genetic and environmental risk factors contributes to heart disease, which is responsible for about one-third of all deaths worldwide. A build-up of plaque in the arteries that supply the heart with blood causes coronary heart disease, the most common type of heart disease, and can also lead to blockages that cause heart attacks. Researchers said, Although enormous progress has been made in understanding how coronary heart disease develops, our understanding of how infections, inflammation, and genetic risk factors contribute is still incomplete & wanted to help fill some of the gaps in our understanding of coronary heart disease by taking a more comprehensive look at the role of infections. Once the authors adjusted the results for known cardiovascular risk factors, they found that antibodies against F. nucleatum, a sign of previous or current infection by the bacterium were linked with a slightly increased risk of a cardiovascular event. "F. nucleatum might contribute to cardiovascular risk through increased systemic inflammation due to bacterial presence in the mouth, or through direct colonisation of the arterial walls or plaque lining the arterial walls," researchers explain. They also confirmed that individuals with high genetic risk scores for coronary heart disease are at elevated risk for cardiovascular events, as previous studies have shown.
SOURCE: Science Daily News, February 2023	Return to top

Eczema Treatment !
Novel approach for treating eczema
Researchers have identified a key enzyme that contributes to eczema, which may lead to better treatment to prevent the skin disorder's debilitating effects. The Granzyme B enzyme is positively correlated with itchiness and disease severity in eczema. Researchers found that Granzyme B weakens the skin barrier by cleaving through the proteins holding cells together making it easier for allergens to penetrate across & they found that by knocking out Granzyme B with genetic modification, or inhibiting it with a topical gel, they could prevent it from damaging the skin barrier and significantly reduce the severity of AD (Atopic dermatitis). Previous work had suggested that Granzyme B levels correlate with the degree of itchiness and disease severity in patients with atopic dermatitis. AD is also associated with an increased risk of developing a host of other inflammatory conditions, including food allergies, asthma and allergic rhinitis. AD typically follows an itch-scratch cycle in which itchiness is followed by scratching and more itchiness. This cycle usually occurs during flare-ups, which can appear anytime, and sometimes weeks, months or years apart. Corticosteroid creams are a common treatment for individuals with AD who experience more severe itching and rashes. However, these can thin the skin when used over a prolonged period of time, which can make skin more prone to damage and infection. A gel or cream that stops or limits Granzyme B, thereby reducing the severity of AD, could be a safer and more effective long-term treatment.
SOURCE: Science Daily News, February 2023	Return to top

Migraines During Menstruation !
Low estrogen levels paired with higher CGRP levels may jump start migraine
As estrogen levels fluctuate, a new study has found for female participants with migraine, their levels of the protein calcitonin gene-related peptide (CGRP) that plays a key role in starting the migraine process also fluctuate. This elevated level of CGRP following hormonal fluctuations could help to explain why migraine attacks are more likely during menstruation and why migraine attacks gradually decline after menopause. The study involved three groups of female participants with episodic migraine. All had at least three days with migraine in the month before the study. The groups were those with a regular menstrual cycle, those taking oral contraceptives, and those who had gone through menopause. Each group was compared to a group of female participants of similar ages who did not have migraine. Each group had 30 people, for a total of 180. Researchers collected blood and tear fluid to determine CGRP levels. In those with regular menstrual cycles, the samples were taken during menstruation when estrogen levels are low and around the time of ovulation, when levels are the highest. In those taking oral contraceptives, samples were taken during the hormone-free time and the hormone-intake time. Samples were taken once from postmenopausal participants at a random time. The study found that female participants with migraine and a regular menstrual cycle had higher CGRP concentrations during menstruation than those without migraine. In contrast, female participants taking oral contraceptives and in postmenopause had similar CGRP levels in the migraine and non-migraine groups. The study also suggests that measuring CGRP levels through tear fluid is feasible and warrants further investigation, as accurate measurement in the blood is challenging due to its very short half-life.
SOURCE: Science Daily News, February 2023	Return to top

Products of SQUARE Pharmaceuticals Ltd.

	Product	Magnide^TM
	Generic Name	Magnesium Oxide
	Strength	365 mg
	Dosage form	Tablet
	Therapeutic Category	Mineral
	Product	Axlovir^TM
	Generic Name	Nirmatrelvir and Ritonavir
	Strength	2x150mg+100 mg
	Dosage form	Combipack
	Therapeutic Category	Antiviral (COVID)
	Product	Diliner ^TMDR
	Generic Name	Duloxetine
	Strength	20 mg
	Dosage form	Capsule
	Therapeutic Category	Antidepressant

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Healthcare online	Keeping you up-to-date
*VOL. 21 ISSUE: 2 February 2023*	Medical Services Department **SQUARE Pharmaceuticals Ltd.**