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.
The inflammatory response is a crucial aspect of the tissues’ responses to deleterious inflammogens. This complex response involves leukocytes cells such as macrophages, neutrophils, and lymphocytes, also known as inflammatory cells. In response to the inflammatory process, these cells release specialized substances which include vasoactive amines and peptides, eicosanoids, proinflammatory cytokines, and acute-phase proteins, which mediate the inflammatory process by preventing further tissue damage and ultimately resulting in healing and restoration of tissue function. This review discusses the role of the inflammatory cells as well as their by-products in the mediation of inflammatory process. A brief insight into the role of natural an
... Show MoreAccording to the importance of the subject of research, and the importance of the surveyed organization as a dynamic sector of the country in general , The research attempts to suggest to service organizations in general reconsidering the currently adopted mechanisms in the redesign of its functions , and in the services provided industry . The data was collected from (98) Director Mangers , head of department and head of division . The research tool is the questionnaire , which included (50) items . The results show Significant Effect & Correlation relationship between the two variables due to their dimensions . These lead to he application of job enrichment technology will increase the organization's ability to possess efficient hu
... Show MoreThis research aims to clarify the advantages of statistical sampling method and provided the scientific basis of the auditor was able to defend the future of any objection to the validity of his opinion on the financial statements of the restrictions of personal rule as much as possible during the stages of the general Company for Cotton industries.Aresearc An applied study in the Board of supreme Audit (the accounts of the cotton industry), have been used, a researcher at the theoretical side to achieve the objectives of the research methodology descriptive inference in the collection and analysis of financial statements of the circle (sample) for the financial year (2008). To achieve the objectives of the field study was designed
... Show MoreThe stratigraphic sequence of Cenomanian-Early Turonian is composed of Ahmadi, Rumaila, and Mishrif formations in the Rifai, Noor and Halfaya Oil Fields within the Mesopotamian Zone of Iraq, which is bounded at top and bottom by unconformity surfaces. The microfacies analysis of the study wells assisted the recognition of five main environments (open marine, basinal, shallow open marine, Rudist biostrome, and lagoon); these microfacies were indicative of a normal lateral change facies from shallow water facies to deeper water and open marine sediments.
Ahmadi Formation (Early Cenomanian) is characterized by open marine sediments during the transgressive conditions, and would be
... Show MoreWhen the guard honey bees, Apis mellifera L., form a clump at the hive entrance or on the flight board, the oriental hornet, Vespa orientails L., either creeps toward the clump or hovers over it in order to take a bee. Once the hornet creeps, only few bees facing the hornet become alert, rock their heads and antennae, open their wings, and take a posture of defense. The rest of the clump stays listless without any signal of concern. However, the clump stays dense and the defending bees do not detach themselves neither from the rest of the clump nor from each other. For this reason, it is very difficult for the hornet to grab a bee unless the latter makes a “mistake” by detaching herself from other adjacent bees. If the hornet grabs s
... Show MoreRegression Discontinuity (RD) means a study that exposes a definite group to the effect of a treatment. The uniqueness of this design lies in classifying the study population into two groups based on a specific threshold limit or regression point, and this point is determined in advance according to the terms of the study and its requirements. Thus , thinking was focused on finding a solution to the issue of workers retirement and trying to propose a scenario to attract the idea of granting an end-of-service reward to fill the gap ( discontinuity point) if it had not been granted. The regression discontinuity method has been used to study and to estimate the effect of the end -service reward on the cutoff of insured workers as well as t
... Show MoreIn this research we been estimated the survival function for data suffer from the disturbances and confusion of Iraq Household Socio-Economic Survey: IHSES II 2012 , to data from a five-year age groups follow the distribution of the Generalized Gamma: GG. It had been used two methods for the purposes of estimating and fitting which is the way the Principle of Maximizing Entropy: POME, and method of booting to nonparametric smoothing function for Kernel, to overcome the mathematical problems plaguing integrals contained in this distribution in particular of the integration of the incomplete gamma function, along with the use of traditional way in which is the Maximum Likelihood: ML. Where the comparison on the basis of the method of the Cen
... Show MoreThe toxicological risks and lifetime cancer risks associated with exposure to disinfection by-products (DBPs) including Halloacetic acids (HAAs) and trihalomethanes (THMs) compounds by drinking water in several districts in Wassit Province were estimated. The seasonal variation of HAAs and THMs compounds in drinking water have indicated that the mean values for total HAAs (THAAs) and total THMs (TTHMs) ranged from 43.2 to 72.4 mg/l and from 40 to 115.5 mg/l, respectively. The World health organization index for additive toxicity approach was non-compliant with the WHO guideline value in summer and autumn seasons and this means that THMs concentration has adverse toxic health effects. The multi-pathway of lifetime hu
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