Healthcare online Keeping you up-to-date
VOL.  13     ISSUE:  10    October  2015 Medical Services Department

SQUARE Pharmaceuticals Ltd.





P G Dip. Business Management





Dear Doctor,

Welcome to this edition of 'e-SQUARE'.

In this issue, we focused on some interesting features like -"Antibiotics Alert !", "Painkillers !", "Vit-B & Skin Ca !",  "Knee Replacement !",  "Exercise & Pregnancy !", "Job Stress Alert !".

In our regular feature, we have some new 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.

Antibiotics Alert !

                                                                                Antibiotics Might Cause Weight Gain In Kids

Repeated antibiotic use is linked to greater weight gains in children, and it could affect their weight for the rest of their lives, a new study suggests. Researchers from the Johns Hopkins Bloomberg School of Public Health in Baltimore analyzed data from nearly 164,000 youngsters in the United States, and found that about 21 percent of them received seven or more prescriptions for antibiotics during childhood. At age 15, those who took antibiotics seven or more times at earlier ages weighed about 3 pounds more than those who took no antibiotics. This weight gain among those who frequently took antibiotics was likely underestimated due to lack of complete data, the researchers said. "BMI may be forever altered by the antibiotics when take as a child," study leader said. "Our data suggest that every time we give an antibiotic to kids they gain weight faster over time." But the study only showed an association, and not cause-and-effect relationship, between antibiotic use and weight gain. The findings were published online Oct. 21 in the International Journal of Obesity. "While the magnitude of the weight increase attributable to antibiotics may be modest by the end of childhood, our finding that the effects are cumulative raises the possibility that these effects continue and are compounded into adulthood," study leader added. Prior research suggests that repeated antibiotic use permanently changes the balance of bacteria in the digestive tract, the researchers said. This alters the way food is broken down and increases the amount of calories absorbed, resulting in greater weight gain, they noted. "Systematic antibiotics should be avoided, except when strongly indicated. From everything we are learning, it is more important than ever for physicians to be the gatekeepers and keep their young patients from getting drugs that not only won't help them but may hurt them in the long run," lead researcher concluded.

SOURCE: HealthDay News, October 2015

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Painkillers !

                      Prescription Naproxen As Good As Narcotic Painkillers For Low Back Pain: Study

Naproxen -- a drug available over-the-counter and by prescription -- appears to provide as much relief for low back pain as a narcotic painkiller or a muscle relaxant, a new study suggests. The study compared the use of prescription-strength naproxen alone to the use of naproxen with the narcotic painkiller oxycodone with acetaminophen, or the muscle relaxant cyclobenzaprine. Patients who took a combination of drugs fared no better than when they took naproxen alone, the researchers said. "Acute low back pain is a frustrating condition," lead researcher said. Many patients have already taken over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen, before they arrive in the emergency room, he said. Some people may have taken insufficient doses at incorrect intervals and could be advised to optimize their NSAID regimen, he said. "But for those patients who have already optimized their NSAID regimen, there are no additional medical therapies available," he said. "We don't have good medical treatment for acute low back pain," he added. The report was published Oct. 20 in the Journal of the American Medical Association. For the study, researcher and colleagues randomly assigned just over 300 patients who came to an emergency room complaining of lower back pain to 10 days of treatment with one of three combinations. The combinations included 500 mg of naproxen plus a placebo pill; 500 mg of naproxen plus 5 mg of cyclobenzaprine; or 500 mg naproxen plus a pill containing 5 mg oxycodone and 325 mg acetaminophen. All of the study participants were given a 10-minute education session on low back pain before leaving the hospital, the study authors noted. Adding the narcotics or muscle relaxants to naproxen therapy didn't help pain or function any more than naproxen alone, he said. "Nearly 50 percent of patients were still suffering one week later. Nearly 25 percent of the patients were still suffering three months later," he said. But regardless of the treatment, nearly two-thirds of patients had significantly less pain and better movement one week after starting treatment, the investigators found. "Some type of complementary therapy such as stretching, yoga, or massage may be more appropriate for many patients," he added. "The solution to lower back pain is not potent medication."

SOURCE:  HealthDay News, October 2015

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Vit-B & Skin Ca !

                                                                        B Vitamin May Help Ward Off Some Skin Cancers

A form of vitamin B3 called nicotinamide appears to reduce non-melanoma skin cancers by 23 percent when taken twice daily, the Australian researchers reported. "It's safe, it's almost obscenely inexpensive and it's already widely commercially available," senior study author said. Nicotinamide costs less than $10 for a month's supply and is available at pharmacies and health food stores, she said. However, more study is needed before researchers can say whether everyone would benefit from the supplement. "It's not something we'd recommend at this stage for the general population," she added. Ultraviolet rays from the sun cause most skin cancers by damaging the DNA of skin cells, she said. UV radiation also hampers the body's ability to fight off cancer, depleting the energy that skin cells need to repair damaged DNA and profoundly suppressing the skin's immune system, she explained. Earlier studies had indicated that nicotinamide can provide skin cells with an energy boost, enhancing DNA repair and strengthening the skin's immune system, she said. To see whether this would help protect against skin cancer, researchers launched a clinical trial involving nearly 400 high-risk patients who'd had at least two non-melanoma skin cancers during the previous five years. Their average age was 66 and two-thirds were men. Many also had chronic health conditions, such as arthritis, high blood pressure, or heart or lung disease, according to the researchers. Half of the group took nicotinamide twice daily for a year. The other half took a placebo. Dermatologists checked for skin cancer every three months. The people taking nicotinamide showed immediate benefits. "This reduction in skin cancers seemed to start as early as the first three-month visit," she said. By the end of the one-year study period, new non-melanoma skin cancer rates were down 23 percent in the nicotinamide group compared to the placebo group, the researchers found. The vitamin supplement also appeared to reduce the numbers of thick, scaly patches of skin that can become cancer. Those patches were reduced in the nicotinamide group by 11 percent at three months, and by 20 percent at nine months of treatment. However, those benefits quickly disappeared during the study's follow-up period. "When people stopped taking their tablets after 12 months, the benefit was no longer seen," she said. "In other words, you need to continue taking the tablets in order for them to be effective." Nicotinamide did not appear to cause any more adverse events than the placebo, the researchers added. Study author said that nicotinamide is very different from a more commonly known form of B3 called niacin. People who take high doses of niacin can suffer from headaches, flushed skin and low blood pressure. "These side effects are not and were not seen with nicotinamide," she said. Further studies are planned to determine if nicotinamide can help reduce skin cancers in people with suppressed immune systems, such as organ transplant recipients who have to take lifelong immune suppressants, researchers said. People with suppressed immune systems have skin cancer rates up to 50 times higher than those with normal immune systems, the researchers noted.

SOURCE: HealthDay News, October 2015

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Knee Replacement !

                                                                  Knee Replacement Brings Less Pain, Better Function

Total knee replacement usually results in greater pain relief and better joint function after a year than nonsurgical arthritis treatment, researchers report. But baby boomers shouldn't automatically rule out physical therapy for moderate to severe knee arthritis, the authors of the new study said. "There are nearly 700,000 knee replacements done in the United States each year, but evidence of their benefit has been lacking," lead author said. For the study, research team randomly assigned 100 patients with moderate to severe knee arthritis to either total knee replacement plus 12 weeks of nonsurgical treatment or to nonsurgical treatment only. The nonsurgical group received physical therapy, diet advice, shoe insoles and pain medication. After one year, 85 percent of the joint replacement patients reported clinically significant improvement in pain compared to 68 percent of the nonsurgical group, the study found. Quality of life was boosted in the joint replacement group as well, and these surgical patients made bigger gains in ability to walk, climb stairs and perform other daily activities. However, complications were much less likely in the nonsurgical group. Those risks include the possibility of blood clots in the legs (deep vein thrombosis) and knee stiffness that requires manipulation to restore normal motion, the study authors said. He recommended discussing the procedure with doctor to determine if the risks are worth the potential benefits. Patients can try nonsurgical options such as weight loss and physical therapy, and then see if a knee replacement is necessary, he said. "A lot of patients do not need the surgery," he added. Patients should also be warned that current replacements last 10 to 15 years, he said. When the artificial joint wears out, another operation will be needed. The second replacement is less likely to be as effective as the first, he said. "If one can postpone the first surgery, then he/she may be able to prevent the second surgery," he added. Another consideration: Surgery is irreversible, while nonsurgical treatment leaves the surgical option open, he pointed out. The report was published Oct. 22 in the New England Journal of Medicine.

SOURCE: HealthDay News, October 2015

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Exercise & Pregnancy !

                                                           Exercise May Help Prevent Pregnancy-Linked Pelvic Pain

Women who routinely exercise in the three months prior to conceiving may help themselves avoid the pelvic pain that often occurs during pregnancy, Norwegian research suggests. The finding is focused on so-called "pelvic girdle pain," the researchers explained. The name reflects a constellation of joint and ligament pain often brought on by pregnancy, and for 2 percent to 3 percent of women, this pain can linger for as long as a year after delivery. According to the researchers, such pain typically occurs in the rear region of the pelvis, as well as at the juncture where the pubic bone meets up with the front section of the pelvis, the researchers explained. Would exercise help? To find out, investigators reviewed data on more than 39,000 women who had been enrolled in a national study between 1999 and 2008. Almost 57 percent said they exercised at least three times a week in the three months before becoming pregnant. And nine out of 10 of those exercising women said they had continued to exercise as late as 17 weeks into their pregnancy. While the study couldn't prove cause-and-effect, risk factors raising a mom-to-be's odds for pelvic girdle pain included smoking, obesity and having a prior history of depression or lower back pain. Young mothers-to-be (those under 25) also appeared to face a higher risk than older women, the study found. However, the risk was lower among those women who had exercised three to five times per week in the months prior to pregnancy, research team reported. Was any type of exercise more effective? After looking at 13 different types of exercise, research team found that high-impact exercise -- such as jogging, aerobics, and ball games -- were most strongly associated with a diminished risk for pelvic pain. Specifically, high-impact exercise performed three to five times a week prior to pregnancy was linked to a 14 percent dip in risk by the time the women had reached their 30th week of gestation, the researchers found. The findings were published online Oct. 4 in the British Journal of Sports Medicine.

SOURCE: HealthDay News , October 2015

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Job Stress Alert !

                                                                            Job Stress Tied To Stroke Risk, Study Suggests

Having a high-stress job, particularly one that is demanding but offers little personal control, may raise the risk for a stroke, Chinese researchers report. An analysis of six previously published studies from several countries included nearly 140,000 people who were followed for up to 17 years. It found those with high-stress jobs had a 22 percent higher risk of stroke than those with low-stress jobs. Among women, the increased risk was even higher -- 33 percent, the researchers reported. "Many mechanisms may be involved in the association between high-stress jobs and the risk of stroke," lead researcher said. Most important, high-stress jobs may lead to unhealthy behaviors, such as poor eating habits, smoking and a lack of exercise, lead researcher added. "It is vital for people with high-stress occupations to address these lifestyle issues," researcher said. The report was published online Oct. 14 in the journal Neurology. The studies that research team analyzed included one in the United States, three in Sweden, one in Japan and one in Finland. Lead researcher and colleagues grouped jobs into four categories based on how much control workers had over their job and how hard they worked or the psychological demands of the job. The categories included passive jobs, low-stress jobs, high-stress jobs and active jobs. Job factors included time pressure, mental demands and coordination burdens. Physical labor and total number of hours worked were not included. Those with passive jobs included janitors, miners and other manual laborers, who had little demand and little control. Low-stress jobs included scientists and architects, who had low demand and high control, according to the study. High-stress jobs, which have high demand and low control, included waitresses, nursing aides and other service industry workers. People with active jobs, like doctors, teachers and engineers, had high demand and high control, the researchers said. People in high-stress jobs were 58 percent more likely to have a stroke caused by a blood clot in the brain -- an ischemic stroke -- than those with low-stress jobs. Those with passive and active jobs did not have any increased risk of stroke, researcher said. The researchers said that more than 4 percent of overall stroke risk was caused by high-stress jobs. For women, however, high-stress jobs increased that risk to 6.5 percent. The study has some limitations, the researchers noted. First, job stress was measured only once in the original studies. Second, other risk factors for stroke, such as high blood pressure or high cholesterol, were not accounted for in the original studies.

SOURCE: HealthDay News, October 2015

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New Products of SQUARE Pharmaceuticals Ltd.

  Product Retabac
  Generic Name Retapamulin
  Strength 1%
  Dosage form Ointment
  Therapeutic Category Topical Antibacterial
  Product Cef-3  
Generic Name



100 mg/5ml

Dosage form Powder for Suspension
Therapeutic Category Cephalosporin
  Product Siglimet XR 100/1000
  Generic Name Sitagliptin+Metformin
Strength 100 mg+1000 mg
  Dosage form Extended Release Tablet
  Therapeutic Category Oral Antidiabetic

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