Tetralogy of Fallot is a type of critical congenital heart disease that reduces the amount of oxygen delivered to the body in which adults usually live past the age of 21. Despite the fact that the average life span of a patient with Tetralogy of Fallot who does not have surgery is 12 years, it is believed that approximately 10% of patients live to be 21 years old. Tetralogy of Fallot affects around 3.5% of newborns with congenital cardiac disease, or one in 3600 or 0.28 out of every 1000 live births. Males and females are similarly affected. The majority of patients begin to show symptoms in childhood such as fatigue, shortness of breath and cyanosis needing early intervention. We described a case of a man in his early 20s who postponed the operational procedure despite being identified with Tetralogy of Fallot at the earliest possible stage. A few instances of asymptomatic middle-aged individuals surviving have been documented, and the number is declining as a result of early detection. The example demonstrates the viability of detecting such events in an adult patient despite breakthroughs and growth in medicine.

Background: Streptococcus mutans (S. mutans) are present in the bacterial biofilm involved in the onset and progression of childhood caries, favoring acid production and dental demineralization. Sugar consumption favors the high incidence of caries in childhood, from 5 to 12 years old. A chewable lozenge incorporated with natural antimicrobial agents of recognized potency, such as red propolis and xylitol, would be an adjuvant to control caries. Materials and Methods: This is a randomized, placebo-controlled, cross-sectional clinical trial. 40 participants were divided into four groups: Placebo (group I), Red Propolis 2.5% (group II); Red propolis 6.4% (group III) and Xylitol 15% (group IV). They had saliva collected at different times of the trial for analysis of antimicrobial action. The study was registered with REBEC. Results: In the group I there were variations before and after the administration of the tablets, but no statistical significance, in relation to the group II it was found a significant reduction in the salivary concentration of S. mutans in all salivary dilutions (34,25% - 63,65%), fact observed with the group III (38,42% - 45,02%) and group IV (50,72% - 42,92%). Conclusion: With encouraging results, further studies are needed for a longitudinal follow-up, being a low-cost alternative with anticariogenic potential.

Background: This work is envisaged to understand the use of various superdisintegrants and their drug release effect in the formulation of Ranolazine fast-dissolving tablets (FDTs). Materials and Methods: The FDTs were formulated by using direct compression methods using different superdisintegrants like sodium starch glycolate, croscarmellose sodium and crospovidone. The superdisintegrant's effect at different concentrations was studied with help of precompression studies such as Hausner's ratio, compressibility index, differential scanning calorimetry (DSC) and post-compression studies like friability, disintegration and dissolution studies. Results: The effect of various superdisintegrants on desired drug release was studied and its concentrations were optimized. Based on the evaluation results of various trials, the effective concentration was found to be 15mg/tab of crospovidone. It has a disintegration time of 25 sec and a cumulative percentage drug release of 99.77±0.41. Conclusion: In this study, Ranolazine FDTs were developed and successfully optimized. The ideal superdisintegrant and its concentration were selected. Among the various superdisintegrants, crospovidone was more effective compared to other superdisintegrants. Hence, it is recommended to use crospovidone as an ideal superdisintegrant in the Ranolazine FDTs formulations.

Background: Knowledge of a disease is an important component of health literacy, that can minimize the mortality and morbidity associated with the problem. Lack of knowledge of a disease leads to the emergence of complications associated with clinical conditions. Hence, a prospective cross-sectional study was conducted to evaluate the knowledge of diabetes mellitus (DM) among the rural residents of Erode district, Tamil Nadu, India. Materials and Methods: The diabetes knowledge was examined using modified version of the Michigan DM questionnaire. The questionnaire includes 10 questions about general DM awareness, diabetic complications, prevention, and control. It also includes information about the socio-demographic characteristics of the participants. Results: In the current study, there were 974 individuals participated and completed the study. The findings showed that there is no statistically significant difference in knowledge of DM across different genders, educational levels, or occupation (p=0.470), However, there is a statistically significant difference in age-related knowledge of DM (p=0.006). The majority of the study participants are well known about the disease condition (66.6 %), the best method to monitor blood glucose at home (54.1 %), and complications of diabetes (53.8 %). Whereas, the overall diabetes knowledge was average (46.3 %) to good (40.9 %), with very least have excellent knowledge DM (5.0 %). Conclusion: According to this research, there is no statistically significant variation in gender, educational attainment, or employment situation when it comes to the various age groups understanding of diabetes mellitus. To raise awareness of DM among the general public, there is a need for well-organized educational interventional program(s) that target the weak points.

Background: Liver transplantation is a procedure used worldwide; however, after a surgery many changes are necessary for this outcome; therefore, the objective of this study is to evaluate the quality of life of liver transplant patients in the recent, and intermediate post-operative periods. Materials and Methods: A cross–sectional study with a quantitative approach conducted in the Liver Transplant Outpatient Service of the Walter Cantidio University Hospital (Hospital Universitário Walter Cantídio, HUWC) belonging to the Federal University of Ceará (Universidade Federal do Ceará, UFC). Data collection was carried out between July 2019 and August 2021. A total of 30 patients met the study inclusion criteria and were therefore characterised regarding gender, age, marital status, family income, origin, and reason for the transplant. The quality of life results were obtained through the Liver Disease Quality of Life (LDQOL) questionnaire. The Research Electronic Data Capture (REDCap) programme was used to store and analyse the data. Results: There was predominance of the male gender (n=20; 66.7%). The predominant age group was from 50 to 59 years old (n=9; 30%), and most of the interviewees were married (n=15; 50%). The most frequent family income was between 2 and 4 minimum wages (11; 36.6%), and most of the patients were from the Northeast region (n=21; 70%). In turn, regarding the cause of the liver disease, alcohol abuse was the reason for the transplants in a total of 9 (30%) patients. The quality of life analysis through LDQOL showed an increase in the scores from the recent post-transplant period to the intermediate post-transplant period, with significant scores (p<0.05) for the following domains: symptoms, effects of the liver disease, social issues, concern about the disease, sexual function, sleep, and isolation. Conclusion: There was a significant and positive difference in quality of life in the intermediate post-transplant period when compared to the initial phase of the transplant, with liver transplant considered as the best definitive treatment option for chronic, and irreversible liver diseases.

Background: Psychological problems of a person have a direct physiological effect on the elicitation of cardiac disease and these mental disorders add burden in managing cardiovascular diseases. There is a high incidence of mental disorders predominantly Depression, Anxiety and Stress in patients with cardiovascular disease. Few behavioral and biological factors are recognized as mechanisms causing the depression, which may further lead to cardiac complications. Chronic stress or severe psychological trauma can intensify the risk of developing CVD. Materials and Methods: We have made an attempt to determine the prevalence of Anxiety, Depression and Stress in patients diagnosed with cardiovascular diseases. It is a prospective observational study performed in Cardiology ward of Mahatma Gandhi Memorial Hospital (MGMH), Warangal, India. The duration of the study was six months and includes 961 patients with different cardiovascular diseases. Standardized questionnaires were used to assess the Depression, Anxiety and Stress conditions. From the study, it is evident that all the three psychological symptoms were present in patients diagnosed with cardiac problems. Results and Conclusion: The prevalence of depression was observed as Mild depression-32.6%, Severe depression- 39%, No depression- 28.3%; Anxiety at a pattern of Minimal anxiety-18%, Mild anxiety-26.3%, Moderate anxiety- 27.2%, Severe anxiety-28.4%; and whereas Stress at 30% likelihood of developing an illness in near future was 46.7%, 50% likelihood of developing an illness in near future was 44.3%, 80% likelihood of developing an illness in near future was observed as 8.9%. Prevalence of Severe depression, severe anxiety and 30% likelihood of developing an illness in near future in patients diagnosed with various CVDs was 39%, 28.4%, 46.7% respectively.

Background: The COVID-19 pandemic and its associated movement control orders have directly impacted various supply chains, including food and healthcare. While the early impacts of the pandemic on health have been widely documented, little data exist on how movement restrictions may continue to affect Malaysians after the pandemic responses have changed, evolved, and diminished. Essential questions concerning any continued effect of COVID-19 prevention measures on diet and exercise patterns and the long-term risk of food insecurity on the overall quality of life. This preliminary study aimed to examine any lasting impact of COVID-19 prevention measures on the diet and exercise habits among a small group of university adults in Malaysia. Materials and Methods: Two cohorts of Malaysian third-year undergraduate pharmacy students were provided with a questionnaire and a two-day food diary. The questionnaire consisted of four sections to examine demographics, lifestyle, and diet, together with a small section examining knowledge of diabetes. The cohorts were separated in time by the COVID-19 pandemic, specifically the movement control orders associated with the pandemic. Results: A total of 226 completed questionnaires were received, 113 from each cohort. Interestingly, 95% of students in the pre-pandemic group consumed fewer calories than adults' recommended intake, with an average daily sugar intake of 36.9g. Within the post-pandemic group, the average daily sugar intake was higher at 41.5g, and fewer students (74%) ate less than the Malaysian recommended intake. Food choices made by students were very similar before and after the pandemic and strongly dictated by their environment, in this case, the university campus, where all students from both cohorts resided. Most participants regularly ate a substantial lunch, which seems to be the most important meal of the day for most in terms of calorie intake. Breakfast and dinner choices were often unsubstantial. Approximately 30% ate breakfast and almost 60% ate dinner. Breakfast usually consisted of white sliced bread and dinner options range from white rice and fried chicken to sliced white bread with water. Participants preferred sweetened drinks to accompany meals, and in most cases, snacks consisted of cakes, biscuits, and crisps. In conclusion, students within both cohorts ate one substantial daily meal for lunch. Breakfast and dinner, in general, demonstrated poor food choices, possibly due to lack of choice. Conclusion: The COVID-19 pandemic did not substantially change the trends in eating habits. However, an increase in calorie intake is observed going from the pre-pandemic to the post-pandemic group. Unfortunately, this increase appears to be in the form of sugar and processed foods.

Background: Non-communicable Diseases (NCDs) are increasing rapidly all over the world, on the other hand, curcumin has various medicinal properties against NCDs and it is a major ingredient in the Indian household/recipes. Another important factor for the selection of this study was the outbreak of COVID-19 and people had increased awareness about turmeric/ curcumin use during this pandemic situation. So this study aims to find out the prevalence of non-communicable diseases across various centers and correlate them with the usage of curcumin in these centers. Materials and Methods: A descriptive cross-sectional study was performed at 4 centers in the state of Tamil Nadu, India. A self-structured questionnaire has been given to collect the details like demographic and disease status with turmeric use and their awareness status. Results: A total of 1276 households were included with 4495 family members. Among the population, the prevalence of non-communicable diseases is cardiovascular diseases (7.7%) followed by diabetes (7.6%), arthritis (3.6%), asthma (0.9%), cancer (0.1%), Alzheimer’s disease (0.2%), psoriasis (0.5%) and others (1.5%). The average years of turmeric use (42.8 years) among the households and the average amount (1.8 grams) of curcumin in their daily recipes were found along with the average daily curcumin use of 0.54 grams. By applying the Mann-Whitney U test, there was a significant association between diabetes and arthritis with curcumin use was verified. Conclusion: This study highlights that the prevalence of diabetes and arthritis was significantly associated with curcumin use. On the other side, people in India were more aware of curcumin as a medicinal herb and consumed higher amounts, particularly during the COVID-19 pandemic.

Background: Over the past few years, the use of probiotics increased remarkably, along with the increase in antibiotics resistance. With the wide variety of probiotic strains and different brands available in the Lebanese market, a major concern has arisen regarding prescriber awareness and knowledge of probiotics and their use. The goal of this study is to assess Lebanese pediatricians’ probiotic knowledge, attitudes, and practice patterns. Materials and Methods: A multicenter cross-sectional observational study was carried out. It included Lebanese pediatricians who were chosen by convenience. Participants were required to complete a four-part questionnaire that included demographics; knowledge about probiotics, attitude and practice, and a total of 12 points knowledge score was estimated. Results: The questionnaire was completed by 126 of the 149 eligible pediatricians. 89.7% of participants were familiar with the correct definition of probiotics. The calculated median knowledge score was 8 [6-9] points. According to the bivariate analysis, pediatricians prescribing probiotics showed higher knowledge score in comparison to those who do not (P value=0.007); In terms of consultations per day, those who examined 10-20 patients per day had a significantly higher knowledge score than those with less than 10 and more than 20 patients per day. (P value=0.004). Conclusion: The data showed a good knowledge, that is positively affecting the pattern of prescription of probiotics, yet it could be further improved.

Background: Infection on surgical sites has become a major concern in the field of healthcare. Infection on the surgical site may occur up to 30 days from surgery and up to one year in patients receiving implants. Methods like excellent sterilisation techniques, surgical procedures, and availability of prophylactic antimicrobials are foremost needed. The present study was focused to assess bacteriological analysis and antibiotics consumption in various types of surgeries. Materials and Methods: An observational prospective study was conducted for three months in a tertiary care hospital. All subjects undergoing either clean, clean–contaminated, or contaminated surgeries admitted to the inpatient surgery, and gynaecology department were recruited. Microbial culture and antibiogram results of surgical site infection were recorded and analysed after IEC approval. Results: In this study, around one-third (50 patients; 31.25%), out of 160 patients were found with surgical site infection (SSI). The prevalence of SSI in females as compared to males was high. Furthermore, patients who had undergone clean–contaminated surgery were more prevalent in surgical site infections rather than patients undergoing other types of surgeries. The most frequently prescribed antibiotics by physicians were metronidazole, gentamycin, amikacin, ceftriaxone, and piperacillin with tazobactam. The most predominant pathogens were E. coli and Staphylococcus aureus at SSI. Moreover, E. coli, Staphylococcus aureus, Klebsiella pneumoniae, and Acinetobacter baumannii were resistant to most of the prescribed antibiotics but highly sensitive against ertapenem, imipenem, amikacin, gentamicin, tigecycline, colistin, linezolid, vancomycin, and teicoplanin. Conclusion: Gram-negative bacteria (E. coli) were the most common isolates associated with post-operative SSIs, followed by Staphylococcus aureus a gram-positive bacillus. Observation of high antibiotic resistance in the current study suggests the necessity for routine microbiological investigation of samples and their antibiogram in order to break the disease spread cycle of resistant microbes.

Background: The biothesiometer allows for a quick and accurate measurement of vibration thresholds, which, when combined with centile charts, provides an objective estimate of diabetic peripheral neuropathy progression. The goal of the current study was to assess diabetic patients’ early detection of peripheral neuropathy and associated consequences. Materials and Methods: Study was conducted on diabetes patients of medicine department of Maharishi Markandeshwar Super Speciality Hospital, MMIMSR, MM (DU), Mullana, after approval by the Institutional Ethics Committee (IEC). Patients were analysed for the vibration perception threshold (VPT) using Biothesiometer. After receiving their consent, socio-demographic parameters and previous medical history were noted on a case report form and patient’s QoL (Quality of Life) was analyzed using Diabetic Neuropathy (DN) 22 QoL questionnaire. The DN4 questionnaire was used to assess the presence of peripheral neuropathy pain. Results: In this research study total of 100 patients participated, of whom 55 were male patients and 45 were female patients The ages of these patients ranged from 26 to 86 years and mean of these patients was 55 years. The patients were divided into two distinct age groups: those under 50 and those above 50. Only 15 patients reported numbness, while the remaining 85 patients reported no abnormal sensations in their feet. However, when left foot and right foot readings were valuate on the biothesiometer, 9 patients had grade 1 say normal (15 volts), 12 patients had grade 2 (16-25 volts), and 79 patients had grade 3 (>25 volts). Conclusion: It was concluded that VPT was determined to be the gold standard or say best fit for detection of peripheral neuropathic pain in diabetes patients. Measuring VPT in diabetic patients with a biothesiometer may reduce the risk of developing neuropathic foot ulcers and foot amputations.

Background: Anticoagulants must be provided with careful monitoring and adjusted individual dose due to their narrow therapeutic index due to significant risk of medication-drug interactions, drug-food interactions, and adverse drug reactions. Regular monitoring of INR, adequate knowledge and adherence to oral anticoagulant therapy plays a vital role in achieving better therapeutic outcomes. Thus, our study aims to assess level of adherence and knowledge of the patients. Materials and Methods: A prospective interventional study, enrolled 66 patients (control 33) and intervention (33) of both IPD (Inpatient Department) or OPD (Outpatient Department) patients with thromboembolic disorders between the age of 18-65 years and who were on oral anti-coagulant therapy. Utilization of Morisky medication adherence scale (MMAS-8) and Oral Anticoagulant Knowledge (OAK) questionnaire to assess adherence and knowledge on oral anti coagulation therapy. Results: Out of 66 patients, 56.1% male patients predominate over the 43.9% female patients, most of them were of age between 41-50 years. Majority of the patients of the intervention group were highly adhered (27.3%), moderately adhered (51.5%) and have adequate knowledge (90.9%) at follow ups after providing pharmaceutical care. Therapeutic INR has been improved among 36.4% patients. Most common cause for non-adherence is forgetfulness. Conclusion: Collaboration with clinical pharmacists can increase anticoagulant adherence and provide necessary information. Anticoagulant clinics run by pharmacists have shown to be helpful in managing anticoagulation treatment for both hospitalized and outpatient patients.

Background: In the management of bleeding disorders, a synthetic lysine analogue Tranexamic acid is one of the drugs commonly used. Synthetic lysine analogue used in the management of bleeding disorders. The main purpose of the research aimed at developing and validating the new, simple, and cost–effective solid phase extraction method for evaluating tranexamic acid (TX) in human plasma by Ultra–performance liquid chromatography–Mass spectrometry (UPLC–MS/MS) using tranexamic acid as Internal Standard. Materials and Methods: Excellent separation and elution was fulfilled using acetonitrile: 100mM ammonium formate pH 3.5(60:40 v/v) as the mobile phase, at a flow rate of 0.300 mL/min with the injection volume of 5µL. Chromatographic analysis of the analyte and IS was initiated under isocratic conditions with an aim to develop a simple separation process with a short run time. Results: The method showed a calibration curve range from 150.00ng/ml- 15,004.00ng/ml. validation of method was determined by using various supporting data of precision and accuracy with percentage recovery of 76.01% and 78.61% for TX and TXD2 respectively. Conclusion: An easy and sensitive UPLC–MS/MS method has been developed for the evaluation of TX in human plasma. This developed method provides excellent linearity over a wide range of TX, sensitive, and precise. Hence this technique is ideal and suitable for clinical pharmacokinetic studies of tranexamic acid.

Objective: This present study is focused on the development and validation of first order derivative spectrophotometric method for simultaneous quantification of Lamivudine and Dolutegravir sodium in dosage form. Materials and Methods: The solutions were prepared using distilled water as solvent and were scanned in UV region for first order derivative spectrum. The quantitation of drugs were done at 255.6 nm (ZCP (zero crossing point) of Dolutegravir Sodium) and 268.6 nm (ZCP of Lamivudine) over the concentration range 5–30 μg/ml and 1 – 30 μg/ml for Lamivudine and Dolutegravir Sodium respectively in tablet dosage form. Results: The Lamivudine and Dolutegravir Sodium showed linear response with a correlation coefficient of 0.9998 and 0.9999 correspondingly. The relative standard deviation for precision study was found less than 2 %. The accuracy study was determined to be between 98 and 102 % utilising standard addition method. The limit of detection for Lamivudine and Dolutegravir sodium was found 0.89 µg/ml and 0.28 µg/ml correspondingly. The limit of quantitation for Lamivudine and Dolutegravir sodium was found 2.70 µg/ml and 0.85 µg/ml correspondingly. Conclusion: The proposed approach, validated as per ICH Q2 (R1), was deemed to be accurate, repeatable and precise. The results of proposed method suggests that it can be effectively utilised for simultaneous quantitation of said drugs in formulation.

Objectives: In this study, a new brisk, efficient and precise method of first derivative UV spectrophotometric was developed and validated for the estimation of eugenol and scopoletin simultaneously from the in-house Avipattikar churna. Materials and Methods: The method involved estimation of eugenol and scopoletin by simultaneous equation of first derivative spectra at 296 nm and 278.66 nm respectively in 0.1 N HCl. As per the Beer-Lambert law, proportional absorbance (linearity) was recorded in the concentration limit of 20-100μg/mL for both eugenol and scopoletin. Results: The method validation was done in reference to ICH (International council for harmonisation of technical requirements for pharmaceuticals for human use) norms comprising of accuracy, linearity, precision, the limit of detection, and quantification of standard from churna. This method was found to be precise as % relative standard deviation was less than 2%. The mean recoveries of triplicate samples were found in the range of 98.52 – 101.30% and 100.51 – 100.56 % for eugenol and scopoletin respectively. The limit of detection and limit of quantification were found to be 2.62μg/mL and 7.96μg/mL for eugenol respectively. The limit of detection and limit of quantification were found to be 1.54μg/mL 4.66μg/mL for scopoletin respectively. Conclusion: The developed estimation method was found to be specific, rapid, precise, and accurate for the analysis of eugenol and scopoletin in the Ayurvedic churna and in formulation without showing any interference.

Background: Amnesia is the loss of memory that majorly affects middle-aged to older people with a prevalence (1.0 - 2.6%) of the overall population. Studies reported that scopolamine induction results in memory dysfunctions observed in demented patients. The current study evaluated the therapeutic potentials of armodafinil and its beneficial role in dementia, learning, and memory impairment. Armodafinil is the (-)-R enantiomer of modafinil. It is a nootropic used for the treatment of narcolepsy and the reversal of anesthetic effects. It binds to and thereafter inhibits the dopamine-reuptake pump, enhancing the concentration of dopamine in the synaptic gaps. Materials and Methods: 30 albino Wistar rats (250-300g) were included in the study, and they were randomly divided into five groups of six rats each (n = 6), two of which worked as controls: a control negative group and a control positive group. Scopolamine (3 mg/kg) was administered intraperitoneal to the control positive group on the 16^th day after receiving 200mg/ kg of Brahmi extract orally daily for 15 days. Armodafinil (15&30mg/kg) was given orally to the test groups for 15 days, and scopolamine (3mg/kg) was administered on the 16^th day. The behavioral measurements were performed at the end of the 16^th day, after which the animals were euthanized and brains were retrieved for biochemical assessments. Results: In the present study, armodafinil groups showed a significant increase in the % alterations in Y-maze, time spent in Morris water maze, motor activity on the spinning rod, and the response of steps climbed in the staircase test, and also substantial variation in levels of antioxidants and neurotransmitters in drug-treated groups were found. Both behavioral and biochemical analyses indicated the neuroprotective effects of armodafinil in memory dysfunction and are appreciated as a potential therapeutic approach for Parkinson’s disease (PD). Conclusion: From the study armodafinil-treated groups showed retrieval of memory when compared to control negative (scopolamine-treated) group which showed heavy alteration in memory. The current study explored the neurobehavioral and memory-enhancing effects of armodafinil in scopolamine-induced amnesia which can be an essential tool to current clinical approaches toward neuroprotection.

Background: Despite increasing acceptability and effectiveness, Unani Medicine has been widely criticized for lack of quality assurance and poor presentation. Therefore, in order to ensure the production of high-quality drugs, good manufacturing practices and the development of scientifically Standard Operating Procedures (SOPs) are necessary. The purpose of this study was to create SOPs for a polyherbal formulation Qurṣ-i Muṣaffī (QM) regarding its binder, temperature and duration of drying, as well as an assessment of its Mizāj (temperament). Materials and Methods: 18 batches of QM were prepared under different conditions (binder, temperature and duration of drying). Powder of particle sizes 150 μm, gum acacia mucilage (10%, 15% and 20% w/w) were used as a binder, at 60°C temperature for 20 and 30 min during the process of granulation and after compression 20 min only. Results: Data of the study revealed that the final batch of QM with particle size 150 μm, gum acacia (20 %) as the binder, temperature 60°C for 30 min for granules and 20 min after compression were found appropriate. The temperament (Mizāj) of the QM was assessed through method described by renowned Unani scholar Al-Kindῑ and found to be moderate degree in hot property and second degree in dry property. Conclusion: The obtained results of final batches of QM can be adopted as the SOPs for future references in terms of process standardization and reproducibility of the drug.

The overwhelming demand for plastics results in overproduction of plastics especially single-use or non-biodegradable plastics. Consequently, this has given rise to environmental concerns due to the addition of plastic waste in the environment where they may harm human, animals, and ecosystem. Due to this, the adoption of alternative sustainable packaging materials has gained more attention among the researchers and industries in developing biodegradable films in order to reduce plastic pollution. Chitosan is utilized for the formation of biodegradable films. Chitosan that is derived from chitin, is the second most abundant biopolymer after cellulose. It is known as a versatile polymer for many applications due to its excellent properties such as biodegradability, non-toxicity, antibacterial effects, and hydrophilicity. However, inherent drawbacks such as high sensitivity to humidity and low mechanical properties become the major limitation to its industrial application, particularly in food packaging applications. In this study, extensive review of the scientific literature addressing chitosan-based films, their properties, and strategies to enhance its physicochemical properties was conducted. The objective of this study is to provide a comprehensive literature review of the last 10 years (2020-2021) addressing chitosan-based films and strategies implemented for their performance to improve food packaging applications.

Hepatocellular Carcinoma (HCC) is the most common type of liver cancer and can lead to multiple complications if left untreated. Disease incidence has increased and is expected to continue doing so in the coming years. However, treatment is expensive, which limits its application in poorer communities. Consequently, this study aimed to evaluate the cost-effectiveness of the combination of atezolizumab and bevacizumab versus sorafenib in the treatment of HCC. We performed a systematic review of published economic evaluation studies investigating the cost-effectiveness of atezolizumab and bevacizumab versus sorafenib using the following databases: PubMed, NHS Economic Evaluation, Cochran, and Scopus. This study was conducted according to the PRISMA reporting guidelines. Three independent reviewers screened all relevant articles published before March 2022. The Cheers checklist was used to assess the quality of the selected studies, and all relevant outcomes were assessed. Six studies met the inclusion criteria. QALY ranged from 0.811 to 2.7 in the combination group, and from 0.84 to 1.021 in the sorafenib group. The incremental cost-effectiveness ratio varied from $104,242/LY to $250,907/LY and from $61,613/QALY to $322,500/QALY. We concluded that atezolizumab plus bevacizumab was no more cost-effective than sorafenib, with the major contributing factor being the price of medication; thus, a reduction in price may improve cost-effectiveness. Further studies are needed that consider a greater variety of middle-to-low income populations in both clinical trial and practice.