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.
Systemic lupus erythematosus (SLE) is an autoimmune disease with polymorphic expression. B cells have an essential contribution in immune system activation via the production of different cytokines and functioning as potent antigen-presenting cells. Therefore, a drug that particularly targets B cells may represent an ideal therapeutic approach for SLE. Rituximab (RTX), an anti-CD20 monoclonal antibody causing transient B-cell depletion, has been used to manage SLE. This study aims to assess Rituximab effects on lupus nephritis (LN) patients when added to conventional immunosuppressants. Twenty four patients, 15-32 years old, with class III/IV/V LN were involved in this study. All were on steroids before lupus nephritis occurrence. They were
... Show MoreThis work presents an experimental study of heat transfer and flow of distilled water and metal oxide nanofluid Fe3O4-distilled water at concentrations of (φ = 0.3, 0.6, 0.9 %) by volume in a horizontal pipe with constant magnetic field. All the tests are carried out with Reynolds number range (2900-9820) and uniform heat flux (11262-19562 W/m2). The results show that, the nanofluid concentration and magnetic intensity increase, the Nusselt number increases. The maximum enhancement in Nusselt number with magnetic nanofluid is (5.4 %, 26.4 %, 42.7 %) for volume concentration (0.3, 0.6, 0.9 %) respectively. The enhancement is maximized with magnetic intensity (0.1, 0.2, 0.3 tesla) respectively to (43.9, 44
... Show MoreThis paper deals with a central issue in the field of human communication and reveals the roaming monitoring of the incitement and hatred speech and violence in media, its language and its methods. In this paper, the researcher seeks to provide a scientific framework for the nature of the discourse of incitement, hatred speech, violence, and the role that media can play in solving conflicts with their different dimensions and in building community peace and preventing the emergence of conflicts among different parties and in different environments. In this paper, the following themes are discussed:
The root of the discourse of hatred and incitement
The nature and dimensions of the discourse of incitement and hatred speech
The n
Although the axial aptitude and pile load transfer under static loading have been extensively documented, the dynamic axial reaction, on the other hand, requires further investigation. During a seismic event, the pile load applied may increase, while the soil load carrying capacity may decrease due to the shaking, resulting in additional settlement. The researchers concentrated their efforts on determining the cause of extensive damage to the piles after the seismic event. Such failures were linked to discontinuities in the subsoil due to abrupt differences in soil stiffness, and so actions were called kinematic impact of the earthquake on piles depending on the outcomes of laboratory
Background: 37% phosphoric acid (PA) is the traditional enamel etching technique prior to bracket adhesion, yet it has been implicated in numerous enamel injuries. The purpose of the current study was to create a calcium phosphate (CaP) etching paste in a simplified capsule formula that can underpin clinically adequate bracket bond strength without jeopardizing the integrity of enamel upon the debracketing procedure. Materials and Methods: micro-sized hydroxyapatite (HA) powder was mixed with 40% PA solution to prepare experimental acidic CaP paste. Sixty human premolars were assigned into two groups of 30 each. Enamel conditioning was accomplished using 37% PA-gel for control group and CaP paste for e
... Show MoreThis study applies a discourse analysis framework to explore the portrayal of women in Maysloon Hadi’s novel (The Black Eyes) (2011), using Critical Discourse Analysis (CDA) and Norman Fairclough’s tri-dimensional model (1989) as the analytical foundation. It investigates the roles and challenges women face in the novel. While there is growing interest in the portrayal of women in literature, Iraqi literature—especially from the perspective of Iraqi women writers remains underexplored. Hadi’s *The Black Eyes* provides a unique case to examine this intersection. Despite the novel’s rich narrative, which offers insight into Iraqi women’s lives, there is a lack of comprehensive CDA to understand how its language constructs
... Show More<p>In combinatorial testing development, the fabrication of covering arrays is the key challenge by the multiple aspects that influence it. A wide range of combinatorial problems can be solved using metaheuristic and greedy techniques. Combining the greedy technique utilizing a metaheuristic search technique like hill climbing (HC), can produce feasible results for combinatorial tests. Methods based on metaheuristics are used to deal with tuples that may be left after redundancy using greedy strategies; then the result utilization is assured to be near-optimal using a metaheuristic algorithm. As a result, the use of both greedy and HC algorithms in a single test generation system is a good candidate if constructed correctly. T
... Show MoreA new efficient Two Derivative Runge-Kutta method (TDRK) of order five is developed for the numerical solution of the special first order ordinary differential equations (ODEs). The new method is derived using the property of First Same As Last (FSAL). We analyzed the stability of our method. The numerical results are presented to illustrate the efficiency of the new method in comparison with some well-known RK methods.