Healthcare online Keeping you up-to-date
VOL.  19     ISSUE:  3  March    2021 Medical Services Department

SQUARE Pharmaceuticals Ltd.





P G Dip. Business Management



Rubyeat Adnan




Dear Doctor:

Welcome to this edition of "e- SQUARE" !

Hope you are enjoying this online healthcare bulletin !

This issue features a variety of articles including-

 "New Target & Treatment !", "Insulin Adherence !", "Dementia Risk !", "Lung Cancer Screening !", "Dyslexia Risk !", "CVD Death !".

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

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Editorial Team

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

 New Target & Treatment !

                                      Pancreatic cancer tumors use multiple mechanisms to avoid starvation

Pancreatic cancer is especially deadly once it metastasizes, with the number of people who are alive five years later declining from 37 percent to just 3 percent. All cancer cells require a constant supply of nutrients. Some types of cancer achieve this by creating their own vascular networks to pull in nutrients from the host's blood supply. But other cancers, notably pancreatic ductal adenocarcinoma, are surrounded by a thick layer of connective tissue and extracellular molecules (the so-called tumor stroma) that act not just as a sort of a dividing line between malignant cells and normal host tissues, but also as a hindrance to cancer cells obtaining sufficient resources, including blood supply. As a result, pancreatic and other nutritionally stressed cancers employ a number of adaptive mechanisms to avoid death by starvation, a risk particularly high in rapidly growing tumors. One such mechanism is autophagy or self-eating. Autophagy allows nutritionally stressed cancers to digest intracellular proteins, especially denatured or damaged proteins, and use the liberated amino acid building blocks as an energy source to fuel their metabolism. Past research indicating autophagy is elevated in pancreatic cancer gave rise to the idea that inhibiting self-eating might be used to starve tumors. Yet, multiple clinical trials using compounds that inhibit autophagic protein degradation combined with traditional chemotherapy, did not produce any added therapeutic benefit compared to chemotherapy alone. In the new study, researcher investigated why pancreatic cancers survive autophagy and, in fact, appear to thrive & found that inhibition of autophagy resulted in rapid upregulation or increased activity of a different nutrient procurement pathway called macropinocytosis, derived from the Greek for "large drinking or gulping." Macropinocytosis enables autophagy-compromised and nutritionally stressed cancer cells to take up exogenous proteins (found outside the cell), digest them and use their amino acids for energy generation. In experiments using mouse cancer models and human pancreatic cancers grown in mice, researcher found that a combination of autophagy and macropinocytosis inhibitors resulted in rapid and nearly complete tumor regression. These results provide another example of the plastic nature of pancreatic cancer metabolism. It also shows that combined inhibition of the two major nutrient procurement pathways can result in a successful blockade of energy supply resulting in tumor starvation and consequent shrinkage.

SOURCE: Science Daily News, March 2021 

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 Insulin Adherence !

                             Diabetes: Weekly Insulin Instead of Daily

A new once-weekly basal insulin injection demonstrated similar efficacy and safety and a lower rate of low blood sugar episodes compared with a daily basal insulin, according to a phase 2 clinical trial. The study results, which will be presented at ENDO 2021, the Endocrine Society's annual meeting, compared an investigational drug called basal insulin Fc (BIF) with insulin degludec, a commercially available long-lasting daily insulin, in patients with type 2 diabetes. These study results demonstrate that BIF has promise as a once-weekly basal insulin and could be an advancement in insulin therapy, said by lead researcher. The reduced number of injections with weekly insulin may improve adherence to insulin therapy, which could result in better patient outcomes than for daily basal insulins. Once-weekly dosing also may increase the willingness of patients with type 2 diabetes to start insulin therapy when oral medication alone no longer gives adequate blood glucose control, he added. The 32-week clinical trial was conducted in 399 patients & All patients had type 2 diabetes and were previous users of basal insulin combined with oral antidiabetic medications. The patients received random assignments to one of three treatment groups: once-weekly injections of BIF at one of two different dosing algorithms (with different goals for fasting blood glucose levels) or the standard once-daily injections of insulin degludec. Study participants had an average A1c of 8.1 percent at the beginning of the study and at the end of the study had an average improvement in A1c of 0.6 percent for BIF and 0.7 percent for insulin degludec, the data showed. Additionally, BIF use resulted in significantly lower rates of hypoglycemia, or low blood sugar (less than 70 mg/dL). Regarding safety, BIF had a generally comparable adverse event profile to that of insulin degludec.

SOURCE: Science Daily News, March 2021

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 Dementia Risk !

                                                                                Processed meat could increase dementia risk

Scientists discovering that consuming a 25g serving of processed meat a day, the equivalent to one rasher of bacon, is associated with a 44% increased risk of developing the disease. But their findings also show eating some unprocessed red meat, such as beef, pork or veal, could be protective, as people who consumed 50g a day were 19% less likely to develop dementia.  The researchers were exploring whether there is a link between consumption of meat and development of dementia, a health condition which affects 5%-8% of over 60s worldwide. The team studied data provided by UK Biobank, a database containing in-depth genetic and health information from half a million UK participants aged 40 to 69, to investigate associations between consuming different types of meat and risk of developing dementia.  The data included how often participants consumed different kinds of meat, with six options from never to once or more daily, collected in 2006-2010 by the UK Biobank. The study did not specifically assess the impact of a vegetarian or vegan diet on dementia risk, but it included data from people who said they did not eat red meat.  These people were generally older, more economically deprived, less educated, more likely to smoke, less physically active, more likely to have stroke history and family dementia history, and more likely to be carriers of a gene which is highly associated with dementia. More men than women were diagnosed with dementia in the study population.  Some people were three to six times more likely to develop dementia due to well established genetic factors, but the findings suggest the risks from eating processed meat were the same whether or not a person was genetically predisposed to developing the disease.  Those who consumed higher amounts of processed meat were more likely to be male, less educated, smokers, overweight or obese, had lower intakes of vegetables and fruits, and had higher intakes of energy, protein, and fat (including saturated fat).  Meat consumption has previously been associated with dementia risk, but this is believed to be the first large-scale study of participants over time to examine a link between specific meat types and amounts, and the risk of developing the disease. There are around 50 million dementia cases globally, with around 10 million new cases diagnosed every year. Alzheimer's Disease makes up 50% to 70% of cases, and vascular dementia around 25%. Its development and progression are associated with both genetic and environmental factors, including diet and lifestyle.

SOURCE: Science Daily News, March 2021 

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 Lung Cancer Screening !

                                                                                Benefits and harms for lung cancer screening

The results of the decade long National Lung Screening Trial (NLST) showed that LDCT could detect lung cancer better than conventional X-rays in current or previous heavy smokers. Based on those results, the United States Preventive Services Task Force (USPSTF) initially recommended low-dose CT screening for people ages 55 to 80 with a 30 pack-year smoking history. Subsequently, other screening trial results have been published, including a European trial called NELSON, the next-largest study to the NLST. NELSON also found a reduction in deaths due to lung cancer because of screening. New recommendations, based on this evidence review, broaden the criteria for screening eligibility by lowering the screening age from 55 to 50 and reducing the pack-year requirement from 30 to 20 pack-years. There were several reasons for this change in eligibility according to the reviewers; one was to promote health equity, in part because African Americans have higher lung cancer risk even with lower levels of smoking exposure. Two large studies have now confirmed that screening can lower the chance of dying of lung cancer in high-risk people. In screening with CT scans, doctors are looking for lung spots or nodules that might represent early lung cancer. Harms from screening can come from the fact that the large majority of the nodules found on screening are not cancer. These findings are known as false positives, and patients with these results usually require additional scans to see if the spots are growing over time. In some cases, these false positives lead to unnecessary surgery and procedures. Throughout the process, patients may experience the mental distress of a possible cancer diagnosis. Researcher note that, encouragingly, lung cancer rates are declining, reflecting changing smoking patterns in recent decades. Therefore, the population eligible for screening is also projected to decline. At this point, however, they don't foresee these trends changing screening recommendations during the next decade or so.

SOURCE: Science Daily News, March 2021

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 Dyslexia Risk !

                              Difficulty learning nonsense words may indicate a child's high risk of dyslexia

Researchers have used neuroimaging to pinpoint where the brain activates or doesn't activate among children identified as having a high risk of dyslexia. Magnetoencephalography (MEG) has rarely been used to study the reading disorder in children. The brain study was carried out at Aalto University by measuring brain activity with MEG, which measures the weak magnetic fields arising from electrical activity in the brain, over a period of two days. Earlier studies have shown that difficulties in processing sounds may be partly responsible for dyslexia, and that these challenges may relate to the left auditory cortex which processes language. During the study, the children listened to nonsensical four-syllable words from a loudspeaker and were asked to repeat them. The researchers then asked the children if they had heard the word before. Neural activation in the right cerebral hemisphere of the children at a high risk of dyslexia was comparable to that of children in the control group. Problems in processing the sound content of speech, and in learning new words was focused in activity of the left-hemisphere auditory cortex the area of the brain that specializes in processing language and speech, and where word memory support is located. Study participants were in their first and second years of school and had been identified, with the help of a teacher, as high risk. The research team performed neuropsychological examinations, tested reading and writing skills and cognitive abilities, and measured brain functions. The children were also asked about their motivation, including their beliefs about their own reading skills. Children were asked to read out both words and meaningless pseudowords that they could not guess.

SOURCE: Science Daily News, March 2021

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 CVD Death !

                                              In women, higher body fat may protect against heart disease death

A new study shows that while men and women who have high muscle mass are less likely to die from heart disease, it also appears that women who have higher levels of body fat regardless of their muscle mass have a greater degree of protection than women with less fat. The researchers analyzed national health survey data collected over a 15-year period and found that heart disease-related death in women with high muscle mass and high body fat was 42% lower than in a comparison group of women with low muscle mass and low body fat. However, women who had high muscle mass and low body fat did not appear have a significant advantage over the comparison group. Among men, on the other hand, while having high muscle mass and high body fat decreased their risk by 26% (compared to those with low muscle mass and low body fat), having high muscle mass and low body fat decreased their risk by 60%. Recent research has found that women have significantly higher levels of risk factors associated with adverse heart disease than men. The researchers analyzed body composition data from the National Health and Nutrition Examination Survey 1999-2004 and cardiovascular disease data from the National Health and Nutrition Examination Survey 1999-2014. They evaluated 11,463 individuals aged 20 and older, who were then divided into four body-composition groups: low muscle mass and low body fat, low muscle and high fat, high muscle and low fat, and high muscle and high fat. Heart disease-related mortality rates where then calculated for each of these groups. The findings highlight the importance of recognizing physiological differences between women and men when considering body composition and the risk of death from heart disease, particularly when it comes to how differences in body fat may modify that risk. The research also underscores the need to develop sex-appropriate guidelines with respect to exercise and nutrition as preventive strategies against the development of cardiovascular disease. Even with the current emphasis by health experts on reducing fat to lower disease risk, it may be important for women to focus more on building muscle mass than losing weight, the study researcher say.

SOURCE: Science Daily News, March 2021

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New Products of SQUARE Pharmaceuticals Ltd.

  Product Dulamet TM
  Generic Name Mometasone & Formoterol
  Strength Mometasone 100 mcg + Formoterol 5 mcg/puff
Mometasone 200 mcg + Formoterol 5 mcg/puff
  Dosage form Metered Dose Inhaler
  Therapeutic Category Inhaled corticosteroid + Beta-2 agonist
  Product Vertina-DXTM
Generic Name

Doxylamine Succinate + Pyridoxine Hydrochloride


20 mg + 20 mg

Dosage form Extended Release Tablet
Therapeutic Category Antiemetic + Antinauseant
  Product DarborenTM
Generic Name Darbepoetin alfa 
Strength 25 mcg/0.42 ml, 40 mcg/0.40 ml &
60 mcg/0.30 ml
  Dosage form Pre-filled Syringe (IV/Subcutaneous Injection)
Therapeutic Category Erythropoietin Products

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