Southeast Asia's rapid growth of Universal Health Coverage (UHC) is increasingly hampered by growing healthcare costs and financial constraints. Although cost-containment instruments are widely implemented, their systemic trade-offs—particularly regarding health equity and service quality—remain poorly understood across the region's diverse health systems. This systematic review synthesizes empirical evidence on the effectiveness of supply-side and demand-side cost-containment instruments across five UHC outcome domains (financial protection, access, equity, quality, and efficiency) in Southeast Asian National Health Insurance schemes. Following PRISMA 2020 guidelines, we systematically searched Scopus and PubMed from inception to December 2025. Of 362 records, 21 empirical studies from five countries (Thailand, Indonesia, Vietnam, Philippines, Lao PDR) met inclusion criteria. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Evidence reveals a sharp divergence in policy performance. Synergistic strategic purchasing—exemplified by Thailand's integrated capitation, global budgets, and central procurement—achieved significant pro-poor equity (27–30% of subsidies concentrated in the poorest quintile) and 25% savings in pharmaceutical expenditures. Conversely, fragmented instruments in other settings triggered adverse provider behaviors, including cost-shifting to patients, induced utilization, and potential quality concerns. Even in relatively high-performing schemes, persistent inequities related to geography, gender, and chronic disease management remain unresolved. Cost-containment effectiveness depends fundamentally on governance maturity and policy integration, not technical design alone. To safeguard UHC sustainability, Southeast Asian policymakers should transition from fragmented cost-cutting toward data-driven, quality-linked strategic purchasing frameworks that actively monitor equity and outcomes.

By 2020, lung, breast, and colorectal cancers were expected to be the top three cancers in Asia 1 .Geographical factors are one of the determinants of a high number of patients with cancer.For example, prostate cancer is among the top three cancers in North America and Oceania, and it ranks eighth in Asia.Most cancer-related deaths in Asia are caused by digestive cancers (liver and stomach cancers) 2 .The prevalence of Helicobacter pylori is generally higher in Asian countries/regions than in Western countries, which may explain the higher burden of digestive cancers, such as colon cancer, in Asia.Other aspects, including ethnic differences, smoking, alcohol consumption, diet, and sanitation measures, may also contribute to the wide geographical variation in the cancer burden 3 .Regional estimates show that among half of the new cases, deaths and 5-year prevalent cases were found in Asia 4 .Almost 90% of patients with cancer can be cured by

This study investigated the chemical and physical stability of extemporaneously prepared fortified cefazolin ophthalmic solutions (50 mg/mL) stored in low-density polyethylene containers under freezer conditions (−18 ± 2 °C) for up to 45 days. Formulations were compounded using cefazolin sodium for injection and five preservative-free vehicles: sterile water for injection, normal saline solution, balanced salt solution, and two commercially available lubricant eye drops—Lubric-Eyes® and VISLUBE®. Cefazolin concentrations were quantified using a validated stability-indicating high-performance liquid chromatographic method with photodiode array detection, employing a C18 column and a mobile phase composed of acetonitrile and 0.1% (v/v) acetic acid in water (22:78, v/v). All formulations retained 94.36%–99.89% of their initial cefazolin concentration throughout the 45-day frozen storage, with no significant changes in pH (5.37–6.70), color, odor, or visible particulates. To simulate outpatient post-dispensing conditions, samples stored frozen for 14 days were thawed at 30 ± 2 °C for 1 hr, then stored under refrigeration (5 ± 3 °C) for an additional 14 days. Cefazolin concentrations during this 28-day period remained within 97.53%–100.38% of initial values, although slight discoloration and mild odor changes were observed from Day 21 onward. In conclusion, the present study demonstrates that frozen storage provides superior stability for cefazolin ophthalmic solutions compared to the studies at refrigeration alone that were previously reported in the literature. Importantly, this study provides the first evidence of the compatibility between cefazolin sodium and preservative-free lubricant-based vehicles, highlighting their potential as patient-friendly alternatives in extemporaneous ophthalmic compounding.

Amorphous solid dispersions (ASDs) represent a promising approach to enhancing the oral bioavailability of poorly water-soluble drugs by forming stable, highly soluble amorphous states. Despite their advantages, significant challenges remain due to the metastable nature of ASDs, which often requires the incorporation of additives to inhibit crystallisation. This article explores the intricate interactions between drugs and polymers within ASDs, focusing on hydrogen bonding, ionic interactions, van der Waals forces, and hydrophobic interactions, and their roles in maintaining drug solubility and stability. It highlights that the drug release mechanism is complex and varies with drug loading, transitioning from polymer-controlled to drug-controlled release. Characterisation techniques such as thermal analysis, spectroscopy, and microscopy provide insights into the interactions and stability of ASDs. Despite advances, challenges remain regarding the complexity of interactions and the long-term stability of ASDs, necessitating further research into optimal polymer selection, drug-polymer ratios, and processing techniques. This study emphasises the need for a deeper understanding of drug-polymer interplay and its implications for the rational design of effective ASD formulations to improve drug delivery systems.

Ethosomes, a kind of vesicle, are microscopic structures that aid in the efficient delivery of drugs over the epidermal barrier by focusing their action on certain cells. Due to their unique composition and structural properties, ethosomes, which are innovative phospholipid vesicular carriers containing elevated concentrations of ethanol, provide efficient absorption and enhanced permeability through the skin. Pharmacosomes, which are drug-lipid complexes with improved drug dispersion and administration, are new drug delivery technologies being developed. Improved drug permeability and targeting are provided by sophisticated systems including aquasomes, cubosomes, and ethosomes, which increase the efficacy of drug delivery. Different techniques, including as the hot method, cold method, and dispersion approach, can be used to manufacture ethosomes, and each has an impact on the end product's properties. Ethosomes are a kind of lipid vesicle that show promise for drug delivery applications because they are flexible and enhance medication penetration into the circulation and deep skin layers. A comprehensive overview of drug delivery ethosomes, including their types, compositions, preparation methods, characterizations, marketed formulations, applications, and ultimately, future prospects, is also included in this article.

Every human being has been designed to have a natural immune system in their body.The immune system is the main barrier to entering foreign objects or substances into the body.Many factors cause the decrease and increase in the body's ability to work.In addition, Indonesia, one of the countries with a tropical climate, is very suitable for the growth of various bacteria, viruses, and other disease agents 1 .

Boesenbergia rotunda (L.) extract is characterized by the presence of pinostrobin (PNS) as its major active component. PNS expresses several pharmacological activities such as antioxidant, anti-inflammatory, antiviral, anticancer, and anti-aromatase activities. Similar to other flavonoids, PNS has poor water solubility, resulting in low bioavailability and limiting its clinical application. These physicochemical constraints pose significant challenges for effective transdermal delivery, particularly in achieving sufficient drug penetration across the stratum corneum. To address these limitations, the development of an effective drug delivery system that can improve both the solubility and transdermal permeation of PNS is warranted. This study aimed to develop an optimized microemulsion (ME) formulation for the transdermal delivery of B. rotunda extract, focusing on PNS. Various oils, surfactants, and co-surfactants were screened, and different surfactant to co-surfactant ratios were evaluated through pseudo-ternary phase diagrams and optimized using Design Expert software. The developed ME was characterized for physical appearance, droplet size, polydispersity index (PDI), zeta potential, pH, entrapment efficiency, in vitro release and ex vivo skin permeation. For the result, the optimized formulation was with a fixed surfactant to co-surfactant ratio of 3:1. The optimized ME consisted of 63.34% Labrasol® and Transcutol®, 18.33% limonene, and 18.33% water, which the mean droplet size, PDI, zeta potential and entrapment efficiency were discovered as 156.00.80 nm, 0.210.02, 0.050.03 mV, and 99.79%, respectively. In vitro drug release studies demonstrated that the ME exhibited a higher release rate than the oil solution but a lower release rate than the extract in ethanol solution over a 24-hour period. Ex vivo skin permeation studies revealed that the optimized ME demonstrated significantly higher skin permeation than the control formulations. In conclusion, these findings suggest that the developed ME is a promising carrier system for enhancing the transdermal delivery of PNS.

A simple LC-MS/MS method was developed for the determination of irbesartan in human plasma with high sensitivity and specificity. The extraction process utilized a liquid-liquid extraction technique with a mixture of ethyl acetate and hexane (90:10, v/v), achieving highly efficient recovery of irbesartan. Chromatographic separation was performed on a Luna? HST C18 column (50 mm x 3 mm, 2.5 ?m), using a mobile phase consisting of 0.1% aqueous formic acid and acetonitrile (33: 67, v/v) at flow rate of 0.2 mL/min, with a total runtime of 4.0 minutes. Irbesartan was detected by tandem mass spectrometer with positive ionization mode using the multiple reaction monitoring (MRM). The mass transition ion-pairs were m/z 428.95>206.96 and 428.95>195.01 amu for [Irbesartan+H]+ and m/z 435.98>234.97 and 435.98>291 amu for [Valsartan +H]+ (internal standard, IS), with, retention times of 1.44 and 2.24 minutes respectively. Key parameters of full validation were evaluated, and all consistently met the acceptance criteria. The limit of detection (LOD) and lower limit of quantification (LLOQ) for irbesartan were determined to be 60 pg/mL and 5.00 ng/mL, respectively. The method demonstrated linearity over concentration ranges of 5.00 - 6012.62 ng/mL with a correlation coefficient (r) consistently greater than 0.997(n = 3) using 1/X2 weighting. The within-run precision ranged from 2.43% to 7.61% and with accuracy from 92.42 to 106.20%. The between-run precision ranged from 4.73% to 8.66% with accuracy from 98.56%to 101.20%. Additionally, we investigated the effects of different plasma conditions, including hemolysed and hyperlipidemic plasma, on accuracy and precision. The results demonstrated that all measured values fell within acceptable tolerance limits. The relative recovery of irbesartan was determine to be 80.34%, 75.32%, and 74.26% for the LQC, MQC and HQC levels, respectively, while the IS demonstrated a relative recovery of 76.93%. The matrix effect exhibited no significant interference, as evidenced by the comparison of peak responses from six determinations at LQC and HQC levels, prepared in extracted drug-free human plasma obtained from six individual normal plasma sources, with those of neat standards at the corresponding concentrations. This ensures the reliability of the quantification. The calculated matrix factor values were 0.91 for LQC and 1.00 for HQC for irbesartan, while the matrix factor for valsartan was 0.92. Moreover, the IS-normalized matrix factor values were 0.99 for LQC and 1.09 for HQC for irbesartan. In addition, no significant matrix effect was observed when hemolysed and hyperlipidemic plasma samples were analyzed. Stability studies confirmed that irbesartan remained stable in human plasma under various conditions. It was stable for up to 29 days at -80?C for long term storage, up to 24 hours at 4?C and up to 6 hours at room temperature (25?C). The new LC-MS/MS method exhibit high sensitivity, specificity, and a broad wide linearity range, (5 to 6000 ng/mL) with a short run time of 4.0 minutes using valsartan as an internal standard. The method was developed and validated using a single-step liquid – liquid extraction requiring only 100 ?L of plasma. This positive ESI-LC-MS/MS method is simple, reproducible and robust, allowing high-throughput analysis with a large sample capacity per batch. It was successfully applied to the quantification of irbesartan in human plasma for bioequivalence studies of higher strength of irbesartan tablet (300 mg) in Thai volunteers.

Vancomycin is a glycopeptide antibiotic commonly used as the first-line therapy for severe infections caused by methicillin-resistant Staphylococcus aureus (MRSA).Therapeutic drug monitoring during vancomycin treatment is essential to optimize clinical efficacy and minimize the risk of nephrotoxicity.The first 2009 vancomycin therapeutic drug monitoring guideline recommended using a trough concentration (C trough ) value of 15-20 mg/L as a surrogate pharmacokinetic/pharmacodynamic parameter for a 24-hour area under the concentration-time curve (AUC 24 ) in clinical practice 1 .However, this approach has been criticized, as C trough tends to underestimate AUC 24 by approximately 25% 2The 2020 revised consensus guideline has favored AUC-guided monitoring to optimize vancomycin dosing instead of C trough target because recently updated data found that C trough was not well correlated with efficacy and particularly nephrotoxicity 3 .Additionally, in vitro and in vivo assessments of pharmacokinetic/pharmacodynamic

Liver injury occurs due to continuous exposure to chemical or biological hazards. Eugenol (EUG), a phenolic compound derived from red betel (Piper crocatum) leaves, has multivalent effects, primarily on antioxidant and antibacterial applications. The conducted research sought to investigate the safeguarding activities of EUG on hydrogen peroxide (H2O2)-induced toxicity of human liver HepG2 cells by examining homeostasis, interleukin 10 (IL-10), malondialdehyde (MDA) levels, reactive oxygen species (ROS) level and cytochrome P450 family 1 subfamily B member 1 (CYP1B1) gene expression. The H2O2-induced hepatotoxic cells, which served as a positive control, were treated with EUG. The measurements for IL-10 and MDA levels were made using enzyme-linked immunosorbent assay (ELISA), flow cytometry was employed for ROS level, and reverse transcription-quantitative real-time PCR (RT-qPCR) was used for CYP1B1 gene expression assay. EUG 6.25; 25 μg/mL increased IL-10 levels at 55.33 and 47.52 pg/mL compared to the positive control at 21.66 pg/mL. EUG 6.25; 25 μg/mL lowered MDA levels at 679.07 and 651.60 ng/mL compared to the positive control at 845.33 μg/mL. EUG 6.25; 25 μg/mL suppressed ROS level at 15.83 and 19.40% compared to the positive control at 24.10%. EUG 6.25; 25 μg/mL also up-regulated CYP1B1 gene expression. In conclusion, EUG exhibited excellent hepatoprotective effects in hepatotoxic cells model by maintaining ROS homeostasis, increasing IL-10, decreasing MDA levels, and upregulating CYP1B1 gene expression.