MEDICAL SERVICES DEPARTMENT

SQUARE Pharmaceuticals Ltd.

Cholesterol Pill with Grapefruit Cause Rhabdomyolysis

Taking certain cholesterol-lowering drugs at the same time as grapefruit juice can increase the risk of potentially life-threatening muscle toxicity, British regulators warned. The Medicines and Healthcare Products Regulatory Agency said the risk was greatest with simvastatin and atorvastatin. The problem occurs because grapefruit contains a chemical that inactivates a liver enzyme involved in drug metabolism. As a result, regular consumption of grapefruit juice can lead to excessively high levels of medicine in the blood. The risk of serious muscle problems also increases when these cholesterol pills, or statins, are taken along with some other drugs, including HIV protease inhibitors, the agency said in an update. The grapefruit hazard is not significant for other statins, such as Fluvastatin, Pravastatin and Rosuvastatin. But muscle toxicity is still a recognized adverse reaction with high doses of all statins, leading in rare cases to rhabdomyolysis.

SOURCE: Heart Center Online Newsletter, November, 2004

e-SQUARE

e-SQUARE

e-SQUARE

e-SQUARE

e-SQUARE

Ultrasound Improves Stroke Recovery

Stroke patients treated with ultrasound therapy in addition to medication show an improved clinical recovery compared to patients only treated with medication, according to a new study. Researchers from the University of Texas Medical School at Houston and elsewhere examined 126 patients who suffered acute ischemic stroke due to a blockage in the middle cerebral artery. All the patients were treated with tissue plasminogen activator (t-PA) within three hours of symptom onset. According to the study, 63 patients were randomly assigned to receive continuous ultrasound therapy (2-MHz transcranial Doppler ultrasonography) in addition to the medication. The other 63 patients received a placebo. Results show 49 percent of those treated with ultrasound therapy combined with t-PA administration within two hours showed dramatic clinical recovery, compared to a 30-percent recovery in the group who only received t-PA. At three months, 42 percent of the group who received ultrasound had favorable outcomes, compared to 29 percent of the placebo group. Researchers conclude continuous transcranial Doppler ultrasonography can enhance the effects of t-PA in acute ischemic stroke.

SOURCE: The New England Journal of Medicine, 2004;351:2170-2178

e-SQUARE

e-SQUARE

Snoring May Affect Kids' Mental Abilities

Five-year-old children who snore or have sleep apnea -- the more serious disorder in which breathing stops intermittently while they sleep-- score worse on tests of memory and intelligence than unaffected kids, investigators report. Researchers of Boston University School of Medicine studied a population-based sample of 205 five-year-old children. According to questionnaires filled out by parents, 30 percent of the children experienced sleep-disordered breathing, defined as habitual snoring, loud or noisy breathing when asleep or witnessed sleep apnea. When the children were tested, general intellectual ability appeared to be significantly worse in those with sleep-disordered breathing. The difference in IQ seen with the condition was "more than twice that associated with ... modest childhood lead exposure," research team points out in the Journal  of Pediatrics. Other measures that were significantly worse included scores on memory tests, attention/executive functioning and behavioral control.

SOURCE: Journal of Pediatrics, October 2004.

e-SQUARE

e-SQUARE

Inhaled Insulin as Effective as Injection

Two new research shows inhaled insulin is effective and well tolerated in patients with type 1 and type 2 diabetes. The treatment also provides glycemic control comparable to a conventional insulin regimen. In one study, 335 type 1 diabetic patients randomly received either inhaled insulin with bedtime Ultralente or two to three injections of regular insulin for six months. Another study involved 299 type 2 diabetic patients who previously had to make at least two daily insulin injections to keep blood sugar under control. Results showed that blood sugar levels improved to a similar degree in the inhaled and subcutaneous insulin groups. However, more patients in the inhaled insulin group than in the subcutaneous insulin group achieved target glucose levels. Researchers observed a trend toward less weight gain in the inhaled insulin group. Overall patient satisfaction, which included convenience, flexibility, hassle, and pain, improved significantly for the inhaled group and decreased significantly for the injection group. According to the articles, inhaled insulin is absorbed more rapidly and is cleared at a faster rate than human regular insulin that is injected. Episodes of excessively low glucose occurred slightly less often in the inhaled insulin group, and there were no differences in severe adverse events, the investigators report in the journal Diabetes Care. Nevertheless, cough of mild-to-moderate severity was reported more frequently in the inhaled insulin group, but it occurred less often as the study progressed. Further long-term studies of inhaled insulin are currently underway.

SOURCE: Diabetes Care, October 2004.

e-SQUARE

e-SQUARE

Combined Treatment, Longer Life for Thyroid Cancer Patients

Combining radiation, surgery and chemotherapy helps patients with rare forms of thyroid cancer live longer, according to a new study. Anaplastic thyroid carcinoma is a rare and aggressive form of thyroid cancer, afflicting less than 5 percent of those diagnosed with thyroid cancer. Most patients with the rare thyroid cancer lived less than six months after diagnosis. Researchers at the M.D. Anderson Cancer Center in Houston find an aggressive strategy combining surgery, chemotherapy, and accelerated radiation therapy improves survival for patients with this type of cancer. Previously, most of the thyroid tumors could not be surgically removed and radiation and chemotherapy proved ineffective. In the study, researchers treated 30 patients, with an average age of 59, from 1990 to 2000. Patients who received all three treatments had an average survival rate of 10 months. Overall, 27 percent had a survival rate of three years. Lead author of the study concludes, "The problem with this type of cancer is the rapid evolution in the neck. However, since the tumors grow so quickly, we're hopeful that aggressive radiation therapy combined with surgery and chemotherapy can halt these fast-growing cancer cells before they can spread, allowing people with this disease to live longer."

SOURCE: International Journal of Radiation Oncology*Biology*Physics, 2004;60:1137-1143

e-SQUARE

e-SQUARE

Air Travel May be Risky for Lung Disease Patients

For people with lung problems, the air quality found in commercial airliners can produce a drop in blood oxygen below recommended levels, Australian researchers report. Previous reports have linked chronic obstructive pulmonary disease (COPD) such as emphysema with low blood oxygen levels while flying, but it was unclear if the same held true for interstitial lung disease -- a large group of disorders that involve inflammation of the lower respiratory tract and breakdown of the structures that transfer oxygen to the bloodstream. Researchers, from the Concord Repatriation General Hospital in Sydney, subjected 15 people with interstitial lung disease and 10 with COPD to a reduced-oxygen environment simulating the air in the cabin of a commercial aircraft during flight. At sea level, all of the subjects had acceptable blood oxygenation. Exposure to the simulated cabin atmosphere produced a significant drop in oxygen saturation in both groups of patients, according to the report in the medical journal Thorax. The COPD patients had significantly lower oxygen levels than the people with interstitial lung disease patients, but the average levels in both groups were below recommended limits. The team says that measuring blood oxygen levels at sea level probably should not be used to predict oxygen levels during air travel.

SOURCE: Thorax, November 2004.

Copyright ©2004 SQUARE Pharmaceuticals Ltd. All rights reserved