Healthcare online Keeping you up-to-date
VOL.  20     ISSUE:  5   May 2022 Medical Services Department

SQUARE Pharmaceuticals Ltd.





P G Dip. Business Management









Welcome to this edition of the online healthcare bulletin.

Our current issue focused on some interesting features like -

"Robotic Surgery !", "IBS & IBD !", "ADHD Alert !", "Protein Supplement & DM !",  "Alcoholic Cardiomyopathy !", "Heart Health ! ".

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.

 Robotic Surgery !

Robotic surgery can lead to quicker recovery and less pain

Treatment Using robotic surgery for major abdominal operations leads to quicker recovery and reduced time in the hospital. Robotics is simply a more precise way to minimize invasion, which makes for quicker healing. Researchers from University College London and the University of Sheffield in England reported that people who had robot-assisted bladder cancer surgery recovered more quickly and were sent home sooner than those having traditional surgery that involves large incisions in the skin and muscle. They added that robotic surgery reduced the chance of re-admission to the hospital by 52 percent as well as reduced the chance of blood clots by 77 percent. The researchers said their findings challenged the idea that traditional “open” surgery is the “gold standard” for major operations. The study participants’ physical activity, which was tracked by a wearable smart sensor, showed stamina and quality of life also increased. Robotic surgery will only grow in practice. More and more physician residency and fellowship programs are incorporating robotics into their core training because of the added benefits to the patient and advancements in technology that allow surgeons to do complex cases minimally invasively. The added safety components of the technology allow the surgeons to perform these complex procedures with better visualization and precision, which translates to the better recovery times and less pain post-operatively. The only downside that is a learning curve to master this modality. Surgeons who are good at laparoscopic surgery should have an easy time converting to robotic procedures. Having more familiarity with open procedures can also help when learning robotic techniques, as people would have the same feel with the instruments during the procedure. Experts note that less-invasive robotic procedures can mean less pain during recovery, which means less pain medication. The improved recovery times also translate to a shorter length of stay. After robotic colon surgery, patients often go home the first or second day after surgery. With open surgery, patients would often stay 5 to 7 days in the hospital after surgery. There are even centers that are performing outpatient robotic colectomies where patients are going home the same day as their colon operation. The scarring after robotic surgery is also minimal given the size of the trocars, so patients are able to wear bathing suits without having to feel self-conscious or having to be reminded of whatever reason they had to require an operation. The trust between the surgeon and the patient comes from the surgeon. If the surgeon explains the benefits and the drawbacks, which are negligible, the vast majority of the patients select the robotic surgery.

SOURCE: Healthline, May 2022

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 IBS & IBD !

IBS & IBD can hamper the quality of life

Inflammatory bowel disease is often confused with the non-inflammatory condition irritable bowel syndrome (IBS). IBD and IBS are distinctly different conditions. Still, a person who has been diagnosed with one may display symptoms of the other. It’s also important to know that one can have both conditions at the same time. Both are considered chronic conditions. Although both conditions can occur in anyone at any age, they seem to run in families. Inflammatory bowel disease (IBD) is a term for a group of disorders characterized by prolonged inflammation in various parts of the digestive tract. The most common form of IBD is ulcerative colitis. Another form is named as Crohn’s disease. Whereas Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal tract, characterized by chronic abdominal pain and altered bowel habits. People with IBS show no clinical signs of a disease and often have normal test results. Depending on the main symptoms, people with IBS can be diagnosed as IBS with constipation (IBS-C), IBS with diarrhea (IBS-D) and IBS-mixed (IBS-M). Many of the symptoms for these conditions overlap, which sometimes makes diagnosis complex. IBS is characterized by a combination of abdominal pain and cramps constipation and bloating, sometimes diarrhea, bacterial overgrowth in the small intestine and a feeling of incomplete evacuation. IBD can cause the same symptoms as IBS, as well as extreme fatigue, intestinal scarring, joint pain, malnutrition, rectal bleeding and weight loss. Abdominal pain is the most common symptom reported in IBS. Research shows 3 out of 4 people with IBS report either continuous or frequent abdominal pain. The pain is most often felt in the lower abdomen, though it can occur anywhere in the abdomen. The type and severity of pain can vary, even within a single day. Pain associated with IBS includes both visceral pain  and functional pain. Abdominal pain is also a common symptom of IBD. The Crohn’s & Colitis Foundation estimates that 50 to 70 percent of people with IBD report gastrointestinal (GI) pain when their IBD symptoms first began and, later, whenever the disease is active. Diagnoses of IBS and IBD are very different. IBD is diagnosed through a variety of tests, whereas IBS is diagnosed largely by exclusion, or ruling out other diseases and conditions. IBS diagnosis is usually made on the basis of medical history, family history, physical exam, symptom report and ruling out other conditions. Diagnosis of IBD, unlike IBS, will require medical tests like stool studies, blood tests, biopsy, X-ray, MRI scan and sometimes barium contrast study. The exact causes of IBS and IBD are still the subject of clinical study. Genetics and family history are thought to play a part in both. Stress is known to make all GI disorders feel worse. There is a lot of truth when it is described a reaction as gut-wrenching. In fact, stress can have a lot of very real effects on the body. Both IBS and IBD can lead to complications, especially if left untreated. These conditions affect not only the digestive system but mental health as well. IBD and IBS may seem to share similar symptoms, but they are two different conditions with very different treatment requirements. With IBD, the goal is to reduce inflammation that causes symptoms. IBS, on the other hand, may not be treatable with medications because there’s not an identifiable bodily cause.

SOURCE: Healthline, May 2022

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 ADHD  Alert !

Attention deficit hyperactivity disorder (ADHD) can make life disorganized

Attention deficit hyperactivity disorder (ADHD) is a mental health condition that can cause unusual levels of hyperactivity and impulsive behaviors. People with ADHD may also have trouble focusing their attention on a single task or sitting still for long periods of time. Many people experience inattention and changes in energy levels. For a person with ADHD, this happens more often and to a greater extent compared with people who don’t have the condition. It can have a significant effect on their studies, work, and home life. Both adults and children can have ADHD. A wide range of behaviors are associated with ADHD. Some of the more common ones include having trouble focusing or concentrating on tasks, being forgetful about completing tasks, being easily distracted, having difficulty sitting still, interrupting people while they’re talking. Signs and symptoms can be specific to different aspects of ADHD, such as hyperactivity, impulsivity, or difficulty focusing. To make ADHD diagnoses more consistent, the American Psychological Association (APA) has grouped the condition into three types. These types are predominantly inattentive, predominantly hyperactivity-impulsive, and a combination of both. Predominantly inattentive type of ADHD has extreme difficulty in focusing, finishing tasks, and following any instructions. People with Predominantly hyperactive-impulsive type of ADHD primarily show hyperactive and impulsive behavior. This can include fidgeting, interrupting people while they’re talking, not being able to wait their turn. Combined hyperactive-impulsive and inattentive type is the most common type of ADHD. People with this combined type of ADHD display both inattentive and hyperactive symptoms. These include an inability to pay attention, a tendency toward impulsiveness, and above-average levels of activity and energy. Despite how common ADHD is, doctors and researchers still aren’t sure what causes the condition. It’s believed to have neurological origins. Genetics may also play a role. Research suggests that a reduction in dopamine is a factor in ADHD. Dopamine plays a role in triggering emotional responses and movements. Other research suggests a structural difference in the brain. Findings indicate that people with ADHD have less gray matter volume. There’s no single test that can tell if someone has ADHD. A study highlighted the benefits of a new test to diagnose adult ADHD, but many clinicians believe an ADHD diagnosis can’t be made based on one test. Treatment for ADHD typically includes behavioral therapies, medication, or both. Types of therapy include psychotherapy, or talk therapy. Another therapy type is behavioral therapy. This therapy can help someone to learn how to monitor and manage your behavior. Medication can also be very helpful when people living with ADHD. ADHD medications are designed to affect brain chemicals in a way that enables a patient to better control his or her impulses and actions. Central nervous system (CNS) stimulants are the most commonly prescribed ADHD medications. These drugs work by increasing the amounts of the brain chemicals dopamine and norepinephrine.

SOURCE: Healthline, May 2022 News

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 Protein Supplement & DM !

                                      Protein supplement helps control Type 2 Diabetes Mellitus

In a study, which holds potential for dietary management of the condition, people with type 2 diabetes drank a pre-made shot before meals which contained a low dose of whey protein. They were monitored for a week as they went about normal daily life. To compare the potential benefits of whey protein, the same participants also spent a week drinking a control shot that contained no protein in order to measure the results against each other. Results from continuous glucose monitoring revealed that glucose levels were much better controlled when taking the whey supplement before meals. On average, they had two hours extra per day of normal blood sugar levels compared to the no protein week. In addition, their daily blood glucose levels were 0.6 mmol/L lower compared to when they consumed the supplement without any protein. Few previous studies in the lab have shown the potential for this dietary intervention, this is the first time that people have been monitored as they go about normal life. Researchers told that the whey protein works in two ways, firstly, by slowing down how quickly food passes through the digestive system and secondly, by stimulating a number of important hormones that prevent the blood sugars climbing so high. As growing numbers of people around the world developing diabetes, investigating the potential of alternatives to drugs such as food supplements becomes more important. 18 people with type 2 diabetes consumed a small drink - in a 100 ml shot with 15 grams of protein 10 minutes before breakfast, lunch and dinner over seven days and remained on their prescribed diabetes medication. Continuous glucose monitoring automatically tracked blood glucose levels over the course of the week. Researchers oversaw the glucose monitoring and analyzed the data and said: "People were able to stick to the regime and liked the idea of having a convenient, tasty, small pre-made drink that could be carried with them and taken before meals." The team intend to further explore the benefits of non-medical interventions running the study on a larger scale and for a longer period of up to six months. They also plan to look at alternative proteins, such as those that come from plant sources like peas, fungi and potatoes to open up options for vegan and religious dietary needs.

SOURCE: Science Daily, May 2022

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 Alcoholic Cardiomyopathy !

                       Alcohol may be riskier to the heart than previously thought

It is well recognized that long-term heavy alcohol use can cause a type of heart failure called alcoholic cardiomyopathy, evidence from Asian populations suggests that lower amounts may also be detrimental. As there are genetic and environmental differences between Asian and European populations this study investigated if there was a similar relationship between alcohol and cardiac changes in Europeans at risk of heart failure or with pre-heart failure. This was a secondary analysis of the STOP-HF trial. The study included 744 adults over 40 years of age either at risk of developing heart failure due to risk factors (e.g. high blood pressure, diabetes, obesity) or with pre-heart failure (risk factors and heart abnormalities but no symptoms). The average age was 66.5 years and 53% were women. The study excluded former drinkers and heart failure patients with symptoms (e.g. shortness of breath, tiredness, reduced ability to exercise, swollen ankles). Heart function was measured with echocardiography at baseline and follow up. The study used the Irish definition of one standard drink (i.e. one unit), which is 10 grams of alcohol. Participants were categorized according to their weekly alcohol intake: 1) none; 2) low (less than seven units; up to one 750 ml bottle of 12.5% wine or three-and-a-half 500 ml cans of 4.5% beer); 3) moderate (7-14 units; up to two bottles of 12.5% wine or seven 500 mL cans of 4.5% beer); 4) high (above 14 units; more than two bottles of 12.5% wine or seven 500 ml cans of 4.5% beer). The researchers analyzed the association between alcohol use and heart health over a median of 5.4 years. The results were reported separately for the at-risk and pre-heart failure groups. In the at-risk group, worsening heart health was defined as progression to pre-heart failure or to symptomatic heart failure. For the pre-heart failure group, worsening heart health was defined as deterioration in the squeezing or relaxation functions of the heart or progression to symptomatic heart failure. The analyses were adjusted for factors that can affect heart structure including age, gender, obesity, high blood pressure, diabetes, and vascular disease. A total of 201 (27%) patients reported no alcohol usage, while 356 (48%) were low users and 187 (25%) had moderate or high intake. Compared to the low intake group, those with moderate or high use were younger, more likely to be male, and had a higher body mass index. In the pre-heart failure group, compared with no alcohol use, moderate or high intake was associated with a 4.5-fold increased risk of worsening heart health. The relationship was also observed when moderate and high levels were analyzed separately. In the at-risk group, there was no association between moderate or high alcohol use with progression to pre-heart failure or to symptomatic heart failure. No protective associations were found for low alcohol intake. Study suggests that drinking more than 70 g of alcohol per week is associated with worsening pre-heart failure or progression to symptomatic heart failure in Europeans. Results indicate that countries should advocate lower limits of safe alcohol intake in pre-heart failure patients.

SOURCE: Science Daily, May 2022

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Heart Health !

             Eggs boost heart health

The findings suggest that eating up to one egg per day may help lower the risk of developing cardiovascular disease. Eggs are a rich source of dietary cholesterol, but they also contain a variety of essential nutrients. There is conflicting evidence as to whether egg consumption is beneficial or harmful to heart health. A 2018 study published in the journal Heart, which included approximately half a million adults in China, found that those who ate eggs daily (about one egg per day) had a substantially lower risk of heart disease and stroke than those who ate eggs less frequently. Now, to better understand this relationship, the authors of this work have carried out a population-based study exploring how egg consumption affects markers of cardiovascular health in the blood. Few studies have looked at the role that plasma cholesterol metabolism plays in the association between egg consumption and the risk of cardiovascular diseases, so we wanted to help address this gap, explains first author Lang Pan, MSc at the Department of Epidemiology and Biostatistics, Peking University, Beijing, China. Pan and the team selected 4,778 participants from the China Kadoorie Biobank, of whom 3,401 had a cardiovascular disease and 1,377 did not. They used a technique called targeted nuclear magnetic resonance to measure 225 metabolites in plasma samples taken from the participants' blood. Of these metabolites, they identified 24 that were associated with self-reported levels of egg consumption. Their analyses showed that individuals who ate a moderate amount of eggs had higher levels of a protein in their blood called apolipoprotein A1- a building-block of high-density lipoprotein (HDL), also known as good lipoprotein. These individuals especially had more large HDL molecules in their blood, which help clear cholesterol from the blood vessels and thereby protect against blockages that can lead to heart attacks and stroke. The researchers further identified 14 metabolites that are linked to heart disease. They found that participants who ate fewer eggs had lower levels of beneficial metabolites and higher levels of harmful ones in their blood, compared to those who ate eggs more regularly. "Together, our results provide a potential explanation for how eating a moderate amount of eggs can help protect against heart disease, says author Canqing Yu, Associate Professor at the Department of Epidemiology and Biostatistics, Peking University. More studies are needed to verify the causal roles that lipid metabolites play in the association between egg consumption and the risk of cardiovascular disease. This study may also have implications for Chinese national dietary guidelines, adds author, Boya Distinguished Professor at the Department of Epidemiology and Biostatistics, Peking University. Current health guidelines in China suggest eating one egg a day, but data indicate that the average consumption is lower than this. Our work highlights the need for more strategies to encourage moderate egg consumption among the population, to help lower the overall risk of cardiovascular disease.

SOURCE: Science Daily, May 2022

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New Products of SQUARE Pharmaceuticals Ltd.

  Product Nafodil TM
  Generic Name Naftidrofuryl

100 mg

Dosage form Capsule
Therapeutic Category Cardiovascular Preparation
Product Aclitol TM
Generic Name

Aclidinium Bromide + Formoterol Fumarate Dihydrate Anticholinergic + Beta-2 stimulant

Dosage form Cozycap
Therapeutic Category Antiasthma
  Product Fliban TM
Generic Name Flibanserin
  Strength 100mg
Dosage form Tablet
  Therapeutic Category HSDD (Hypoactive Sexual Desire Disorder)

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