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.
In order to promote sustainable steel-concrete composite structures, special shear connectors that can facilitate deconstruction are needed. A lockbolt demountable shear connector (LB-DSC), including a grout-filled steel tube embedded in the concrete slab and fastened to a geometrically compatible partial-thread bolt, which is bolted on the steel section's top flange of a composite beam, was proposed. The main drawback of previous similar demountable bolts is the sudden slip of the bolt inside its hole. This bolt has a locked conical seat lug that is secured inside a predrilled compatible counter-sunk hole in the steel section's flange to provide a non-slip bolt-flange connection. Deconstruction is achieved by demounting the tube from the t
... Show MoreThe preparation of the phenanthridine derivative compound was achieved by adopting an efficient one-pot synthetic approach. The condensation of an ethanolic mixture of benzaldehyde, cyclohexanone and ammonium acetate in a 2:1:1 mole ratio resulted in the formation of the title compound. Analytical and spectroscopic techniques were used to confirm the nature of the new compound. A mechanism for the formation of the phenanthridine moiety that is based on three steps has been suggested
In this study, the use of non-thermal plasma theory to remove toxic gases emitted from a vehicle was experimentally investigated. A non-thermal plasma reactor was constructed in the form of a cylindrical tube made of Pyrex glass. Two stainless steel rods were placed inside the tube to generate electric discharge and plasma condition, by connecting with a high voltage power supply (up to 40 kV). The reactor was used to remove the contaminants of a 1.25-liter 4-cylinder engine at ambient conditions. Several tests have been carried out for a ranging speed from 750 to 4,500 rpm of the engine and varying voltages from 0 to 32 kV. The gases entering the reactor were examined by a gas analyzer and the gases concentration ratio
... Show MoreIn this study, condensation polymerization was used to synthesize a number of novel liquid crystal polymers with 1,3,4-oxadiazole rings based on melamine. The new synthesized polymers were characterized by Fourier transform infrared (FTIR) and proton nuclear magnetic resonance (1HNMR) spectroscopy. Differential scanning calorimetry (DSC) and optical polarization microscopy (OPM) were used to investigate their liquid crystalline properties. The results demonstrated that throughout a wide temperature range, most of the polymers exhibited columnar (CohX) and nematic (N) liquid crystalline phases.
The effective application of the method of measuring and evaluating performance according to the Balanced Scorecard the need for an information system a comprehensive and integrated for internal and external environment, Which requires the need to develop accounting information system in general and cost management information systems to suit the particular requirements of the environment in terms of the development of modern methods of measurement to include the use of some methods that have proven effective in measuring and evaluating performance.
The research problem in need of management to develop methods of measuring and evaluating performance through the use of both financial measures and non
... Show MoreCurrent search aims to identify the creative thinking of the kindergarten teachers and
solving professional problems among kindergarten teachers skills, and whether the level of
creative thinking in solving professional problems, according on marital status years of
service academic achievement of teachers as well as to identify the correlation between the
two variables the current sample consisted of (300) teachers to achieve the objectives of the
stndy , the researcher used two measures, one to measure creative thinking and the other to
measure the solution to the problems of professional kindergarten teachers skills. It has been
shown. validity and reliability of the two measures. The present stndy aims to identif
This paper introduces the Multistep Modified Reduced Differential Transform Method (MMRDTM). It is applied to approximate the solution for Nonlinear Schrodinger Equations (NLSEs) of power law nonlinearity. The proposed method has some advantages. An analytical approximation can be generated in a fast converging series by applying the proposed approach. On top of that, the number of computed terms is also significantly reduced. Compared to the RDTM, the nonlinear term in this method is replaced by related Adomian polynomials prior to the implementation of a multistep approach. As a consequence, only a smaller number of NLSE computed terms are required in the attained approximation. Moreover, the approximation also converges rapidly over a
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