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.
ملخص البحث
تبحث الدراسھ عن تنفیذ افضل لمفھوم التعلم مدى الحیاة كھیكل موجھ للسیاسة التربویة في العراق بشكل عام وفي
التعلیم العالي بشكل خاص. تحدد الدراسة استراتجیات التعلم مدى الحیاة وتناقش اھمیتھ وسماتھ الرئیسیة لتسھیل
الوصول الى فرص تعلم متمیز و ملائم لحاجات الطلبة مدى الحیاة، كما تناقش دور الجامعة في تحقیق ھذا الھدف.
The present analysis targets to recognize the influence of the separate teaching approach on the accomplishment of grammar for scholars of the College of Islamic Sciences. The target of attaining this target led the investigations developing the subsequent null theories: 1. No statistically substantial variance is happened at the consequence level of 0.05 between the mean scores of the scholars in the investigational category who learnt consistent with the separate learning approach and the mean scores of the scholars in the control category who learnt in the conventional method in the accomplishment test. 2. No statistically substantial variance has been observed at the consequence level of 0.05 in the mean differences between the
... Show MoreThis research discusses one of the largest and most important issues of a doctrinal and philosophical dimension at the same time, which is the issue of man’s freedom to choose his actions, and thus his responsibility for those actions, by looking at the nature of these acts, their being and the origin of their creation. He showed that they were created in man by force, and that he was their original creator, and that they were among the creatures of the God Almighty God like others, but they are attributed to man through acquisition. So to the first saying went Jahmiyya or Jabariyya, and to the second saying went to fatalism in the past, and the existentialists shared with them in the modern era, and to the third saying went to the Sun
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The purpose of this research work is to synthesize conjugates of some NSAIDs with sulfamethoxazole as possible mutual prodrugs to overcome the local gastric irritation of NSAID with free carboxyl group by formation of ester linkage that supposed to remain intact in stomach and may hydrolyze in intestine chemically or enzymatically; in addition to that attempting to target the synthesized derivative to the colon by formation of azo group that undergo reduction only by colonic bacterial azo reductaze enzyme to liberate the parent compound to act locally (treatment of inflammation and infections in colon)
The aim of this study is to construct a Mathematical model connecting the variation between the ambient temperatures and the level of consumption of kerosene in Iraq during the period (1985-1995), and use it to predict the level of this consumption during the years (2005-2015) based on the estimation of the ambient temperatures.
The reactions of ozone with 2,3-Dimethyl-2-Butene (CH3)2C=C(CH3)2 and 1,3-Butadiene CH2=CHCH=CH2 have been investigated under atmospheric conditions at 298±3K in air using both relative and absolute rate techniques, and the measured rate coefficients are found to be in good agreement in both techniques used. The obtained results show the addition of ozone to the double bond in these compounds and how it acts as function of the methyl group substituent situated on the double bond. The yields of all the main products have been determined using FTIR and GC-FID and the product studies of these reactions establish a very good idea for the decomposition pathways for the primary formed compounds (ozonides) and give a good information for the effe
... Show MoreAbstract The purpose of this study, teach the art of performing Olympic lifts (snatch and, clean and jerk) using the two methods are instructional (self-learning associated with the model) and (reverse style of partial way). Identify the effectiveness of these methods in learning the art of performance and style of the best Olympic lifting in the learning and retention of novice for Olympic lifts. The research sample consisted of 16 lifters were selected purposively representing specialist center for the care of athletic talent to weightlifting for ages 14 years. The sample was divided into two experimental, Each group (8) eight weightlifters. The experimental group used the style of the first self-learning associated with the m
... Show MoreThe insurance Sector of important vessels saving that work on the accumulation of capitals which contribute to the financing of economic and social development plans of countries, in order to achieve of marketing superiority in presenting the insurance services it would require insurance companies focus their marketing efforts and increased interest in internal customer to recruitment new customers and keep of current customers, so the research aims to release the impact of the dimensions of the internal marketing of (the company's vision, training and development, incentive and, motivation, internal communication) in the dimensions of the marketing superiority (to keep the customer, service quality, customer satisfaction, customer, valu
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