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.
Incremental Sheet Metal Forming (ISMF) is a modern sheet metal forming technology which offers the possibility of manufacturing 3D complex parts of thin sheet metals using the CNC milling machine. The surface quality is a very important aspect in any manufacturing process. Therefore, this study focuses on the resultant residual stresses by forming parameters, namely; (tool shape, step over, feed rate, and slope angle) using Taguchi method for the products formed by single point incremental forming process (SPIF). For evaluating the surface quality, practical experiments to produce pyramid like shape have been implemented on aluminum sheets (AA1050) for thickness (0.9) mm. Three types of tool shape used in this work, the spherical tool ga
... Show MoreIn this paper, the proposed phase fitted and amplification fitted of the Runge-Kutta-Fehlberg method were derived on the basis of existing method of 4(5) order to solve ordinary differential equations with oscillatory solutions. The recent method has null phase-lag and zero dissipation properties. The phase-lag or dispersion error is the angle between the real solution and the approximate solution. While the dissipation is the distance of the numerical solution from the basic periodic solution. Many of problems are tested over a long interval, and the numerical results have shown that the present method is more precise than the 4(5) Runge-Kutta-Fehlberg method.
The efforts embedded in this paper have been devoted to designing, preparing, and testing warm mix asphalt (WMA) mixtures and comparing their behavior against traditional hot mix asphalt mixtures. For WMA preparation, the Sasobit wax additive has been added to a 40/50 asphalt binder with a concentration of 3%. An experimental evaluation has been performed by conducting the Marshall together with volumetric properties, indirect tensile strength, and wheel tracking tests to acquire the tensile strength ratio (TSR), retained stability index (RSI), and rut depth. It was found that the gained benefit of reduction in mixing and compaction temperatures was reversely associated with a noticeable decline in Marshall properties and moisture s
... Show MoreAny design subject to a set of forces contributing to the establishment of relations working to strengthen the internal elements of the design; any imbalance in these elements can make a fragmented and weak design, thus preventing it from achieving the goal or performance. Poor performance can be attributed to various factors: the extent and function of the elements and principles in the design, realization of the idea, especially in fashion design.
Moreover, there are many aspects of a design that go into achieving the realization of the designer’s idea. The design utilizes a lot of stimulants by drawing attention to its design, which is consistent with the need for psychological and material individuals. In this research, we will
In this paper, we present multiple bit error correction coding scheme based on extended Hamming product code combined with type II HARQ using shared resources for on chip interconnect. The shared resources reduce the hardware complexity of the encoder and decoder compared to the existing three stages iterative decoding method for on chip interconnects. The proposed method of decoding achieves 20% and 28% reduction in area and power consumption respectively, with only small increase in decoder delay compared to the existing three stage iterative decoding scheme for multiple bit error correction. The proposed code also achieves excellent improvement in residual flit error rate and up to 58% of total power consumption compared to the other err
... Show MoreBy- products of corn starch industry were used to prepare media for propagation the lactic acid bacteria as a natural auxotroph. The by- products used were the corn steep water (S) and gluten extract (G) after a proper treatment to get them ready for media preparation. The results showed that it was possible to replace the peptone and meat extract by gluten extract in MRS medium. The growth was approximately similar to that obtained in standard MRS media. Corn steep water (S) was used as well and the growth enhanced by including Tween – 80 at 1% level. The later media named MZ, which was superior for growing standard and local strains and starters. The MZ medium modified by adding acetate and glacial acetic acid similarly to
... Show MoreThis work aims to enhance acoustic and thermal insulation properties for polymeric composite by adding nanoclay and rock wool as reinforcement materials with different rations. A polymer blend of (epoxy+ polyester) as matrix materials was used. The Hand lay-up technique was used to manufacture the castings. Epoxy and polyester were mixed at different weight ratios involving (50:50, 60:40, 70:30, 80:20, and 90:10) wt. % of (epoxy: polyester) wt. % respectively. Impact tests for optimum sample (OMR), caustic and thermal insulation tests were performed. Nano clay (Kaolinite) with ratios ( 5 and 7.5% ) wt.% , also hybrid reinforcement materials involving (Kaolite 5 & 7.5 % wt.% + 10% volume fraction of rockwool ) were added as reinforcem
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