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 Messengers and the Imam of the God-fearing, Muhammad is God, his family, and all of his companions. As for what comes after... Fainting is one of the involuntary symptoms and states that occur to a person when carrying out his life’s tasks suddenly due to his loss of sense and movement, so he loses consciousness for a period of time that is short or may be long, and the person is held accountable and responsible for every moment of his life. He is required to perform duties specified by Sharia law, such as prayer, fasting, and Hajj...and fainting prevents him from performing these actions. We must consider the opinions of jurists and know the legal implications resulting from it. It was said that a person has a capacity that enable
... Show MoreIt sheds light on the cultural dimension in the decentralized administration experience in Iraq as evaluation tool by adding a new dimension in studying decentralization in addition to the administrative, political and legal dimensions .The proposal of study is that without the civil political culture ,the administrative decentralization in Iraq which remains weak and it may be imposed to a set of problems. - The study includes an introduction, conclusion and a set of political and cultural issues , its components and it may have the political analysis of this culture and its role in determining the movement of the administrative decentralized movement in Iraq post 2003.
Teresa Fitzpatrick presents a connection between oppressed women and the plant of Wisteria in gothic fiction in her article “Wisteria: A Female Eco-Gothic Metaphor in American Fiction Through the Ages.” The connection between women and nature is common in literature as women are usually compared to the beauty or ferocity of flowers, rivers, or natural phenomena in general. The connection extends to the architecture and sort of plants that appear in gothic literature. Gothic novels have routinely been connected to the secrets and life stories of women who cannot have the liberty to live or share them outside their homes. A fearful house with a prisoned person, ghost, or a secret is mostly normally found in gothic writing. Women have exce
... Show MoreTrickle irrigation is one of the most conservative irrigation techniques since it implies supplying water directly on the soil through emitters. Emitters dissipate energy of water at the end of the trickle irrigation system and provide water at emission points. The area wetted by an emitter depends upon the discharge of emitter, soil texture, initial soil water content, and soil permeability. The objectives of this research were to predict water distribution profiles through different soils for different conditions and quantify the distribution profiles in terms of main characteristics of soil and emitter. The wetting patterns were simulated at the end of each hour for a total time of application of 12 hrs, emitter disch
... Show MoreObjectives: The demand for orthodontic treatment is nowadays increasing significantly for aesthetic improvement and to correct various kinds of malocclusion, yet the prolonged treatment time remains the main obstacle. This review aimed to demonstrate various orthodontic techniques and highlight the evidence-based successful approaches used for acceleration of orthodontic tooth movement. Materials and Methods: Data and sources of information pertaining to accelerated orthodontic tooth movement premised on English-written articles were searched using electronic databases including Google Scholar, Scopus, PubMed and MEDLINE. Results: This review demonstrated the availability of different surgical and non-surgical methods to enhance tooth movem
... Show MoreHollow core photonic bandgap fibers provide a new geometry for the realization and enhancement of many nonlinear optical effects. Such fibers offer novel guidance and dispersion properties that provide an advantage over conventional fibers for various applications. Dispersion, which expresses the variation with wavelength of the guided-mode group velocity, is one of the most important properties of optical fibers. Photonic crystal fibers (PCFs) offer much larger flexibility than conventional fibers with respect to tailoring of the dispersion curve. This is partly due to the large refractive-index contrast available in the silica/air microstructures, and partly due to the possibility of making complex refractive-index structure over the fibe
... Show MoreIn recent years, Wireless Sensor Networks (WSNs) are attracting more attention in many fields as they are extensively used in a wide range of applications, such as environment monitoring, the Internet of Things, industrial operation control, electric distribution, and the oil industry. One of the major concerns in these networks is the limited energy sources. Clustering and routing algorithms represent one of the critical issues that directly contribute to power consumption in WSNs. Therefore, optimization techniques and routing protocols for such networks have to be studied and developed. This paper focuses on the most recent studies and algorithms that handle energy-efficiency clustering and routing in WSNs. In addition, the prime
... Show MoreFish are regarded as a crucial indicator of alterations in the aquatic environment due to their position at the apex of the food chain. Monitoring these alterations is crucial for identifying modifications in the aquatic ecosystem. The principal elements influencing fish health are temperature, pH, dissolved oxygen, salinity, pesticide contamination, microplastics, and algal presence. These elements substantially influence fish health regarding development, reproduction, respiration, oxygen stress, and the internal enzymes associated with digesting and other metabolic functions. Alterations in global environmental conditions and anthropogenic pollutants result in modifications to fish populations, their lives, and their behavior and
... Show MoreDeveloping an efficient algorithm for automated Magnetic Resonance Imaging (MRI) segmentation to characterize tumor abnormalities in an accurate and reproducible manner is ever demanding. This paper presents an overview of the recent development and challenges of the energy minimizing active contour segmentation model called snake for the MRI. This model is successfully used in contour detection for object recognition, computer vision and graphics as well as biomedical image processing including X-ray, MRI and Ultrasound images. Snakes being deformable well-defined curves in the image domain can move under the influence of internal forces and external forces are subsequently derived from the image data. We underscore a critical appraisal
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