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.
This systematic review aimed to analyse available evidence to answer two focused questions about the efficacy of erythritol powder air‐polishing (EPAP) (i) as an adjunctive during active periodontal therapy (APT) and (ii) as an alternative to hand/ultrasonic instrumentation during supportive periodontal therapy (SPT). Additionally, microbiological outcomes and patient's comfort/perceptions were assessed as secondary outcomes.
PubMed, Cochrane and Medline were searched for relevant articles published before February 2021 following PRISMA guidelines. The search was conducted by three indep
The personality characteristics of the Leader are considered one of the main elements to reach into business organizations entrepreneurship; and because of the development of the organizations of the continuous transformations as result of huge Competition in private High Education sector, there is a great need for Leaders characterized of certain personality capable of managing their organizations and can positively effect on them. Also these organizations' success to reach into entrepreneurship requires a main significant element that is (strategic flexibility) which is considered one of the important elements for success.
Accordingly, this research is trying to fin
... Show MoreSpiritual is one of modern subjects gained importance of their role in the meaning imparted to work and to promote a sense of belonging to the group and the community, including support personnel positive attitudes towards their work. The research aims to highlight the impact of the relationship between workplace spiritual and variable working attitudes to sample variant of the hospitals, health department BAGHDAD / Rusafa, and in order to achieve this, the researcher is based on the descriptive and analytical approach adopted for the analysis of the questionnaire and to test relations research and its variables. The research community (4) of hospitals in Sadr City, included've targeted 106 doctors and 222 nurses formed a whole (
... Show MoreNumerical investigation has been carried out on heat transfer and friction factor characteristics of copper-water nanofluid flow in a constant heat-fluxed tube with the existence of new configuration of vortex generator using Computational Fluid Dynamics (CFD) simulation. Two types of swirl flow generator: Classical twisted tape (CTT) and Parabolic-cut twisted tape (PCT) with a different twist ratio (= 2.93, 3.91 and 4.89) and different cut depth (= 0.5, 1.0 and 1.5 cm) with 2% and 4% volume concentration
... Show MoreThe solidification process in a multi-tube latent heat energy system is affected by the natural convection and the arrangement of heat exchanger tubes, which changes the buoyancy effect as well. In the current work, the effect of the arrangement of the tubes in a multi-tube heat exchanger was examined during the solidification process with the focus on the natural convection effects inside the phase change material (PCM). The behavior of the system was numerically analyzed using liquid fraction and energy released, as well as temperature, velocity and streamline profiles for different studied cases. The arrangement of the tubes, considering seven pipes in the symmetrical condition, are assumed at different positions in the system, i
... Show MoreA field experiment was carried out in the College of Agricultural Engineering Sciences - University of Baghdad, during the fall season of 2021 to find out which cultivated cultivars of maize are efficient under nitrogen fertilization. The experiment was applied according to an RCBD (split-plot design with three replications). The cultivars of the experiment (Baghdad, 5018, Sarah) supply three levels of nitrogen fertilizer, which are N1 (100 kg.N/ha), N2 (200 kg.N/ha) and N3 (300 kg.N/ha). The statistical analysis results showed the superiority of the Sarah genotype, which gave the highest value of SOD and CAT enzymes, reaching 11.59 units mg-1 and 10.76 units mg-1 . Protein sequentially, while cultivar5018 outperformed as it gave th
... Show Moreالغرض من هذا العمل هو دراسة الفضاء الإسقاطي ثلاثي الأبعاد PG (3، P) حيث p = 4 باستخدام المعادلات الجبرية وجدنا النقاط والخطوط والمستويات وفي هذا الفضاء نبني (k، ℓ) -span وهي مجموعة من خطوط k لا يتقاطع اثنان منها. نثبت أن الحد الأقصى للكمال (k، ℓ) -span في PG (3،4) هو (17، ℓ) -span ، وهو ما يساوي جميع نقاط المساحة التي تسمى السبريد.