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VOL.  14     ISSUE:  3  March    2016 Medical Services Department

SQUARE Pharmaceuticals Ltd.





P G Dip. Business Management





Dear Doctor:

Welcome to healthcare bulletin "e- SQUARE" !

Hope you are enjoying this online healthcare bulletin !

This issue features a variety of articles including "Antibiotic Resistance !", "Coffee & MS !", "Dengue Vaccine !", "Diabetes & Infection !", "New Tests !", "Poverty Alert !".

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

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

 Antibiotic Resistance !

                                                      Antibiotic Resistance Common in Kids' Urinary Tract Infections

Many kids who develop urinary tract infections tied to the E. coli bacteria are now failing to respond to antibiotic treatment, a new review warns. The culprit, according to the British researchers: Drug resistance, following years of over-prescribing and misusing antibiotics. "Antimicrobial resistance is an internationally recognized threat to health," study author noted. And that threat is of particular concern among young patients, the authors said, given that E. coli-driven urinary tract infections (UTIs) are one of the most common forms of pediatric bacterial infections. Young children are more vulnerable to complications including kidney scarring and kidney failure, so they require prompt, appropriate treatment, researchers added. "Bacterial infections resistant to antibiotics can limit the availability of effective treatment options," ultimately doubling a patient's risk of death, they noted. The findings are published in the March 15 issue of BMJ. The study team reviewed 58 prior investigations conducted in 26 countries that collectively looked at more than 77,000 E. coli samples. Across industrialized nations, 53 percent of the pediatric UTI cases were found to be resistant to amoxicillin, one of the most often prescribed primary care antibiotics. Nearly a quarter of young patients in industrialized nations were resistant to the antibiotic trimethoprim. More than 8 percent were resistant to the antibiotic co-amoxiclav. Among children in developing nations, resistance was even higher. Nearly 80 percent of childhood UTI cases in poorer countries were resistant to amoxicillin, and 60 percent were resistant to co-amoxiclav. More than a quarter were resistant to ciprofloxacin and 17 percent to nitrofurantoin. Why? The study team said it could not make any definitive conclusions about cause and effect. But researchers said the problem in wealthier countries probably relates to primary care doctors' routine and excessive prescription of antibiotics to children. In poorer nations, "one possible explanation is the availability of antibiotics over the counter," they said, making the medications too easy to access and abuse. "If left unaddressed, antibiotic resistance could re-create a world in which invasive surgeries are impossible and people routinely die from simple bacterial infections," they added.  

SOURCE: HealthDay News, March 2016 

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 Coffee & MS !

                                                       Heavy Coffee Drinkers Show Lower Risk of Multiple Sclerosis

People who drink a lot of coffee may have a lower risk of developing multiple sclerosis (MS), a new large study suggests. Researchers found that among more than 6,700 adults, those who downed about six cups of coffee a day were almost one-third less likely to develop MS than non-drinkers were. And the link was not explained away by factors such as people's age, education or income levels, or smoking and drinking habits. Still, experts stressed that the findings do not prove that coffee, or big doses of caffeine, fight MS. Nor is anyone suggesting that people drink more java to ward off the disease, lead researcher said. She said the findings do add to evidence that coffee "may have beneficial effects on our health" -- but there is no way to make any specific recommendations. In previous research, scientists have found that caffeine can protect lab mice from developing an MS-like condition -- by blocking part of the inflammatory process that damages nerves in the brain and spine. In humans, MS arises when the immune system mistakenly attacks the protective sheath around nerve fibers in the brain and spinal cord. Depending on where the damage occurs, people can suffer muscle weakness, numbness, vision problems and difficulty with balance and coordination. A number of studies have linked higher coffee intake to lower risk of diseases that involve degeneration in brain cells, including Parkinson's disease and Alzheimer's. When it comes to MS, the evidence has been mixed, possibly, in part, because many studies have been small, she explained. So, her team looked at two study groups: a Swedish group that included 1,620 people with MS and 2,788 without the disease; and a U.S. group of 1,159 MS patients and 1,172 adults free of the disease. Overall, people who'd averaged 30 ounces of coffee a day -- around six standard cups -- were almost one-third less likely to have MS than non-drinkers were. The results were similar when the researchers looked at people's coffee habits five to 10 years before their MS symptoms had begun (or, for people without MS, coffee habits during that same time period).

SOURCE: HealthDay News, March 2016

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 Dengue Vaccine !

                                                                                    New Dengue Virus Vaccine Shows Promise

An experimental vaccine against dengue -- the mosquito-borne virus behind a very painful illness -- was found effective in a new study. In the small trial involving just 41 healthy volunteers, one dose of the "TV003" vaccine offered 100 percent protection against a particularly tricky strain of the disease that scientists initially thought might be outwitting the vaccine. Coupled with earlier indications that the vaccine also offers strong protection against three other strains of dengue, the results bode well for ongoing efforts to control the most widespread mosquito-transmitted virus in the world, the researchers said. "Development of vaccines for dengue has been complicated, since disease can be caused by any of four dengue virus serotypes [strains]," author explained. And a truly effective vaccine must provide "equal protection against all four," she added. That's because if someone who has been sick with one strain of dengue gets infected with a different strain, the second strain will cause more serious illness, she explained. Study author described the current findings as "encouraging," though she stressed that more research, on a larger scale, will be needed to confirm the vaccine's promise. The study was published online March 16 in the journal Science Translational Medicine. Dengue strikes roughly 390 million people each year, primarily in tropical and sub-tropical environments, according to the study authors. Most infections are actually mild or without symptoms, the researchers noted. But upwards of 2 million of those infected end up with dengue hemorrhagic fever, the study authors said. Symptoms include a very high fever, severe headaches, muscle and joint pain, blood vessel leakage and circulatory failure, according to the U.S. Centers for Disease Control and Prevention. For roughly 25,000 patients a year, the disease is fatal. The new vaccine covers all four strains of dengue. It was first tried out in early 2016, with availability confined to just three countries: Mexico, the Philippines and Brazil, according to the study authors. Early tests suggested the vaccine triggered a robust immune response for three of the strains. But, it first looked as if the vaccine might be less effective at producing antibodies for the "dengue 2" strain. Research team decided to retest the vaccine, focusing not only immune responses but also on infection rates. The researchers recruited 41 healthy American adults (average age of about 30). The researchers tested the vaccine on people in the United States because dengue doesn't often occur in the United States, which means study volunteers wouldn't have been infected with any of the strains in the past. Just over half the group was vaccinated with a single dose of TV003, while the remainder was given a placebo vaccine. A half-year later, all were exposed to a genetically modified version of the dengue 2 strain, the study said. The test strain was fashioned to prompt what study author described as only a "minimal health risk," meaning mild and almost symptomless infections. None of the vaccinated patients developed rashes or reduced white blood cell counts, or showed any signs of virus in their blood, the study showed. By contrast, all of those given a placebo vaccine had the dengue 2 virus in their blood. Four out of five developed mild rashes, and one in five saw their white blood cell count drop, the researchers found. They now plan to study the vaccine in countries where dengue is widespread. The current findings are raising hopes not only in the battle against dengue, but also for efforts to get ahead of other major health concerns such as the Zika virus. "The dengue virus is closely related to Zika virus," study author noted. "The team working on this dengue vaccine is now leveraging their experience in efforts to develop a Zika vaccine."

SOURCE: HealthDay News, March 2016 

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 Diabetes & Infection !

                                                                  Diabetes May Raise Risk for Dangerous Staph Infection

People with diabetes may be significantly more likely to develop potentially deadly "staph" blood infections than those without diabetes, a new study suggests. As the Danish researchers explained, Staphyloccus aureus bacteria live on the skin and are normally harmless. However, the germs can cause dangerous infections if they enter the bloodstream. In fact, the 30-day death rate from such infections is 20 percent to 30 percent, according to the research team. In their new study, the researchers tracked the medical records of 30,000 people in Denmark over 12 years. Overall, they found that people with any form of diabetes were almost three times more likely to acquire a staph blood infection outside of a hospital, compared to those without diabetes. The risk jumped to more than seven times higher among people with type 1 diabetes, and almost three times higher for those with type 2 diabetes. About 95 percent of people with diabetes have the type 2 form of the disease, which is often (but not always) linked to obesity and involves a dysfunction in the body's ability to use insulin. About 5 percent of diabetes is type 1, where the body has lost its ability to produce insulin, the hormone that converts blood sugar to energy for cells. The new study also found that the combination of diabetes and related kidney problems boosted the odds for staph blood infection by more than fourfold, compared to people without these conditions. People with other diabetes-linked complications, such as heart and circulation problems and diabetic ulcers, were also at increased risk. The study was published March 10 in the European Journal of Endocrinology. "It has long been a common clinical belief that diabetes increases the risk of S. aureus infection, but until now this has been supported by scant evidence," study author said. His team also found that the risk of staph bloodstream infection rose with the number of years a person had diabetes. Poor control of diabetes was another factor that upped the infection risk. The findings suggest that long-term diabetes patients may require closer monitoring for infections, research team said. "Poor management of diabetes can lead to an impaired immune response," he explained. "This may be the reason why diabetes patients are at higher risk of infection. Similarly, diabetic patients often suffer associated illnesses -- the burden of multiple health care problems can also increase susceptibility to infection."  

SOURCE: HealthDay News, March 2016

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New Tests !

                                                                      New Tests May Help Combat Melanoma, Expert Says

Genetic and molecular tests can be valuable in helping to diagnose and treat deadly melanoma skin cancer, a dermatologist says. The tests are widely available in the United States, and many are covered by insurance or offered at no extra cost, study author said. Melanoma rates in the United States have doubled over the past three decades, according to the U.S. Centers for Disease Control and Prevention. Tissue biopsy is typically used to diagnose skin cancer, but biopsy results aren't always definitive. In such cases, genetic and molecular tests can help determine if a patient has skin cancer, she said. She also added that such tests may also help identify the most effective treatments for patients with advanced melanoma. Continuing research into specific melanoma mutations and targeted treatments could lead to more effective therapies in the future, the researcher said. "Although genetic and molecular testing for melanoma has advanced in recent years, it's still an emerging field. I think it will only get better," study author said. While genetic and molecular tests are helpful, she explained that their results have to be considered along with other information. "Genetic and molecular tests are a valuable tool in our arsenal for fighting melanoma," she said. "When used appropriately, these tests can provide dermatologists with important information to assist them in melanoma diagnosis and treatment, allowing them to provide patients with the best possible care."

SOURCE: HealthDay News, March 2016

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 Poverty Alert !

                                                                                 Poverty Linked to Asthma, Allergy Treatment

People with asthma or food allergies who are poor have worse treatment outcomes, two new studies suggest. "We found that patients who have asthma and come from lower income households -- making less than $50,000 every year -- are one and a half times more likely to see treatment fail. They are also almost twice as likely to have an asthma exacerbation," study co-author said. Study co-author and his research team surveyed nearly 400 people with asthma. They found that lower income was strongly linked with poor treatment outcomes, regardless of race, stress and education levels. "Income is an independent risk factor for worse asthma outcomes," he said. But the study did not show a cause-and-effect relationship between income and asthma and allergy treatment failure. A second study, led by another researcher from Northwestern Medicine and Lurie Children's Hospital in Chicago, looked at families with food allergies. Families of children with food allergies in the poorest households spent two and a half times more on costs related to ER visits and hospitalizations, the study showed. The researchers found families with lower incomes spend less money on specialists. But, these families end up paying a lot more in out-of-pocket medication expenses. "The first line of treatment for anaphylaxis is epinephrine, but costs can be a barrier for many families," she said. "Some patients may keep expired autoinjectors or cannot afford to fill their prescription in the first place." She said mandates are needed to ensure life-saving medications for anaphylaxis are more accessible and available, particularly in public places.

SOURCE: HealthDay News, March 2016

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New Products of SQUARE Pharmaceuticals Ltd.

  Product Virux HC Cream
  Generic Name Acyclovir + Hydrocortisone
  Strength 5%+1%
  Dosage form Cream
  Therapeutic Category Topical Antiviral
  Product Tilex Max
Generic Name

Glucosamine Sulphate +Diacerin


750 mg+ 50 mg

Dosage form Tablet
Therapeutic Category Antiosteoarthritic
  Product Canaglif
Generic Name Canagliflozin
  Strength 100 mg
  Dosage form Tablet
Therapeutic Category Antidiabetic

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