Abstract Background: The novel coronavirus 2 (SARS?CoV?2) pandemic is a pulmonary disease, which leads to cardiac, hematologic, and renal complications. Anticoagulants are used for COVID-19 infected patients because the infection increases the risk of thrombosis. The world health organization (WHO), recommend prophylaxis dose of anticoagulants: (Enoxaparin or unfractionated Heparin for hospitalized patients with COVID-19 disease. This has created an urgent need to identify effective medications for COVID-19 prevention and treatment. The value of COVID-19 treatments is affected by cost-effectiveness analysis (CEA) to inform relative value and how to best maximize social welfare through evidence-based pricing decisions. Objective: compare the clinical outcome and the costs of two anticoagulants (heparin and (enoxaparin)) used to treat hospitalized patients with COVID-19 infection. Patients and method: The study was a retrospective review of medical records of adult, non-pregnant, COVID-19 infected hospitalized patients who had baseline and last outcome measurements at Alamal Epidemiology Center, Al-Najaf city from (Augast 2020 to June 2021). The outcome measures included D-dimer, length of stay (LOS), and mortality rate. Only the cost of the medical treatment was considered in the analysis. The pharmacoeconomics analysis was done in three different cost-effectiveness analysis methods. Microsoft Excel spreadsheet and Statistical Package for the Social Sciences software (SPSS), was used to conduct statistical analysis. Kaplan Meier test was used to compare the mortality rate. T-TEST was used to compare the outcomes of the two groups. Results and discussion: two groups were compared, the first group consists of 72 patients who received heparin, and the second group consists of 72 patients who received enoxaparin. COVID-19 infected patients had a higher abnormal average D-dimer (2534.675 ng/dl). No significant differences between both genders with regards to the basal average D-dimer (males= 2649.95 ng/dl, females= 2374.1mg/dl, P-value>0.05). There was a significant difference between patient's ages 60 years and patients <60. (3177.33 ng/dl, 1763.06 ng/dl, P-value <0.05). It seems that, higher D-dimer levels were associated with a higher mortality rate (died=3166.263 ng/dl, survived= 1729.94 ng/dl, P-value <0.05). Heparin was more effective in decreasing D-dimer levels than enoxaparin which inversely increased the D-dimer levels (-24.4 ng/dl/day, +154.701 ng/dl/day, P-value <0.05). Additionally, heparin was more effective in increasing the survival rate compared to enoxaparin (55% vs, 35%, P-value<0.05). Heparin was associated with a longer duration of stay in hospital than enoxaparin but with no significant difference (13.7 days, 12.3 days, P-value >0.05). Concerning the cost, treatment with heparin cost less than enoxaparin (2.08 U.S $, 9.44 U.S $)/per patient/per day. Conclusion: Originator heparin was a more cost-effective anticoagulant therapy compared to originator enoxaparin, it was associated with a lower cost and better effect, treatment with Heparin resulted in positive INB= 11.3, where a positive result means that heparin is more cost-effective than Enoxaparin. All three methods of pharmacoeconomic analysis decide that heparin was more cost-effective than enoxaparin in treating COVID-19 infected patients.
Nimodipine (NMD) is a dihydropyridine calcium channel blocker useful for the prevention and treatment of delayed ischemic effects. It belongs to class ? drugs, which is characterized by low solubility and high permeability. This research aimed to prepare Nimodipine nanoparticles (NMD NPs) for the enhancement of solubility and dissolution rate. The formulation of nanoparticles was done by the solvent anti-solvent technique using either magnetic stirrer or bath sonicator for maintaining the motion of the antisolvent phase. Five different stabilizers were used to prepare NMD NPs( TPGS, Soluplus®, HPMC E5, PVP K90, and poloxamer 407). The selected formula F2, in which Soluplus
has been utilized as a stabilizer, has a par
... Show MoreWettability of CO2-brine-mineral systems plays a vital role during geological CO2-storage. Residual trapping is lower in deep saline aquifers where the CO2 is migrating through quartz rich reservoirs but CO2 accumulation within a three-way structural closure would have a high storage volume due to higher CO2 saturation in hydrophobic quartz rich reservoir rock. However, such wettability is only poorly understood at realistic subsurface conditions, which are anoxic or reducing. As a consequence of the reducing environment, the geological formations (i.e. deep saline aquifers) contain appreciable concentrations of various organic acids. We thus demonstrate here what impact traces of organic acids exposed to storage rock have on their wettabil
... Show MoreThe primary components of successful engineering projects are time, cost, and quality. The use of the ring footing ensures the presence of these elements. This investigation aims to find the optimum number of geogrid reinforcement layers under ring footing subjected to inclined loading. For this purpose, experimental models were used. The parameters were studied to find the optimum geogrid layers number, including the optimum geogrid layers spacing and the optimum geogrid layers number. The optimum geogrid layers spacing value is 0.5B. And as the load inclination angle increased, the tilting and the tilting improvement percent for the load inclination angles (5°,10°,15°) are (40%,28%, and 5%) respectively. The reduction percent of the
... Show MoreCatalytic reduction is considered an effective approach for the reduction of toxic organic pollutants from the environment, but finding an active catalyst is still a big challenge. Herein, Ag decorated CeO2 catalyst was synthesized through polyol reduction method and applied for catalytic reduction (conversion) of 4-nitrophenol (4-NP) to 4-aminophenol (4-AP). The Ag decorated CeO2 catalyst displayed an outstanding reduction activity with 99% conversion of 4-NP in 5 min with a 0.61 min−1 reaction rate (k). A number of structural characterization techniques were executed to investigate the influence of Ag on CeO2 and its effect on the catalytic conversion of 4-NP. The outstanding catalytic performances of the Ag-CeO2 catalyst can be assigne
... Show MoreDue to severe scouring, many bridges failed worldwide. Therefore, the safety of the existing bridge (after contrition) mainly depends on the continuous monitoring of local scour at the substructure. However, the bridge's safety before construction mainly depends on the consideration of local scour estimation at the bridge substructure. Estimating the local scour at the bridge piers is usually done using the available formulae. Almost all the formulae used in estimating local scour at the bridge piers were derived from laboratory data. It is essential to test the performance of proposed local scour formulae using field data. In this study, the performance of selected bridge scours estimation formulae was validated and sta
... Show MorePMMA (Poly methyl methacrylate) is considered one of the most commonly used materials in denture base fabrication due to its ideal properties. Although, a major problem with this resin is the frequent fractures due to heavy chewing forces which lead to early crack and fracture in clinical use. The addition of nanoparticles as filler performed in this study to enhance its selected mechanical properties. The Nano-additive effect investigated in normal circumstances and under a different temperature during water exposure. First, tests applied on the prepared samples at room temperature and then after exposure to water bath at (20, 40, 60) C° respectively. SEM, PSD, EDX were utilized for samples evaluation in this study. Flexural
... Show MoreUnderwater Wireless Sensor Networks (UWSNs) play a vital role in ocean monitoring and exploration. However, harsh underwater conditions and frequent topology changes caused by node and sink mobility pose significant challenges for reliable routing. Conventional routing protocols that depend on global route reconstruction and static paths generate excessive control overhead and degrade performance in large-scale underwater environments. In this paper, we propose an energy-efficient virtual cell-based mobile-sink adaptive routing (VC-MAR) protocol for UWSNs. The sensing field is logically partitioned into a three-dimensional grid of virtual cells, where a cell-gateway is elected in each cell to construct a low-overhead routing backbon
... Show MoreIslamic law has relied on a number of sources in order to denote the rulings issued by them, including what is original and what is sub, and it is known to all scholars, that the Prophet's Sunnah is the second major source after the Koran, which separated the overall and devoted its year and restricted absolute. God Almighty obeyed the owner and his followers, and that his obedience of obedience to God Almighty said: (Who obeys the messenger has obeyed God) (women: 80), and then between the peasant who believes in him and his victory and follow him, he said: (and he said: And the one who was revealed with them were the successful ones (al-A'raf: 157).
It is known that the Sunnah commanded to follow is the