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.
A simulation study is used to examine the robustness of some estimators on a multiple linear regression model with problems of multicollinearity and non-normal errors, the Ordinary least Squares (LS) ,Ridge Regression, Ridge Least Absolute Value (RLAV), Weighted Ridge (WRID), MM and a robust ridge regression estimator MM estimator, which denoted as RMM this is the modification of the Ridge regression by incorporating robust MM estimator . finialy, we show that RMM is the best among the other estimators
Survival analysis is widely applied in data describing for the life time of item until the occurrence of an event of interest such as death or another event of understudy . The purpose of this paper is to use the dynamic approach in the deep learning neural network method, where in this method a dynamic neural network that suits the nature of discrete survival data and time varying effect. This neural network is based on the Levenberg-Marquardt (L-M) algorithm in training, and the method is called Proposed Dynamic Artificial Neural Network (PDANN). Then a comparison was made with another method that depends entirely on the Bayes methodology is called Maximum A Posterior (MAP) method. This method was carried out using numerical algorithms re
... Show MoreObjectives: To determine the impact of an educational program on nurses’ knowledge
and practices concerning neurogenic bladder rehabilitation for spinal cord injured persons
through a follow-up approach each two months post program implementation for six
months.
Methodology: "Follow-up" longitudinal design by using time series approach of data
analysis and the application of pre-post tests approach for the study and the control
groups. The study was carried out at Ibn Al-Kuff hospital for (SCI) in Baghdad governorate
from 5th of July 2010 to 15th of October 2011. To achieve the objectives of the study, a
non-probability (purposive) sample of (60) nurses (males and females) were working in SCI
units were selec
A thin film of AgInSe2 and Ag1-xCuxInSe2 as well as n-Ag1-xCuxInSe2 /p-Si heterojunction with different Cu ratios (0, 0.1, 0.2) has been successfully fabricated by thermal evaporation method as absorbent layer with thickness about 700 nm and ZnTe as window layer with thickness about 100 nm. We made a multi-layer of p-ZnTe/n-AgCuInSe2/p-Si structures, In the present work, the conversion efficiency (η) increased when added the Cu and when used p-ZnTe as a window layer (WL) the bandgap energy of the direct transition decreases from 1.75 eV (Cu=0.0) to 1.48 eV (Cu=0.2 nm) and the bandgap energy for ZnTe=2.35 eV. The measurements of the electrical properties for prepared films showed that the D.C electrical conductivity (σd.c) increase
... Show MoreIn this study, the zinc oxide NPs have been synthesized from the fresh pomegranate peels extract using the precipitation method. The ZnO nanoparticles were produced from the reaction of fresh peels extract with zinc acetate salt which was used as zinc source in the presence of 2 M NaOH. The green synthesized nanoparticles were characterized through X-ray diffraction (XRD), UV-Vis diffuse reflection spectroscopy, Fourier transform infrared spectroscopy (FTIR), and Atomic force microscopy (AFM). The XRD patterns confirm the formation of hexagonal wurtzite phase structure for ZnO synthesized using pomegranate peels extract with average crystalline size of 28 nm. FTIR spectra identify the presence of many active functional groups for the pom
... Show MoreComposite steel-concrete sections have a broad benefit through increasing structural strength as well as minimizing the self-loads. All past researches were concerned with pre-installed shear connectors (PRSC) in the manufacturing of composite sections. A new fabrication technique for steel-concrete-steel composite sections were presented in the current study by the post-installation shear connectors (POSC) passed-through an embedded polymerizing vinyl chloride (PVC) pipes. The performance of normal strength concrete prisms with a specified strength of 32 MPa connected to square steel tubes (SST) was investigated. Six specimens were fabricated in both methodologies, PRSC and POSC were experimentally tested by Push-out test. The spac
... Show MoreThe problem of rebellion is considered one of the features of rapid changes that a society undergoes in all spheres and directions of life, especially in the realm of social relations, customs, traditions, values, and principles. Rebellion may manifest itself in rebellion against oneself, against values or traditions, or against social or governmental authority. One may find that submission plays a vital role in all of these interactions. This study deals with the problem of rebellion in the works of two renowned authors: The French Gustave Flaubert and the Israeli Amos Oz, through two main characters who share similar qualities and traits. Emma Bovary and Henna Konin demonstrate this through their rebellion against themselves, their relati
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