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.
An anal fissure which does not heal with conservative measures as sits baths and laxatives is a chronic anal fissure. Physiologically, it is the high resting tone of the internal anal sphincter that chiefly interferes with the healing process of these fissures. Until now, the gold standard treatment modality is surgery, either digital anal dilatation or lateral sphincterotomy. However, concerns have been raised about the incidence of faecal incontinence after surgery. Therefore, pharmacological means to treat chronic anal fissures have been explored.A Medline and pub med database search from 1986-2012 was conducted to perform a literature search for articles relating to the non-surgical treatment of chronic anal fissure.Pharmacological s
... Show MoreA shocking third species emerged from a family of coronaviruses (CoV) in late 2019 following viruses causing SARS (Severe Acute Respiratory Syndrome-CoV) in 2003 and MERS (Middle East Respiratory Syndrome-CoV) in 2012; it’s a novel coronavirus now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly called 2019-nCoV). First emerging in China, it has spread rapidly across the globe, giving rise to significant social and economic costs and imposing severe strain on healthcare systems. Since many attempts to control viral spread has been futile, the only old practice of containment including city lockdown and social distancing are working to some extent. Unfortunately, specific antiviral drugs and vaccines remain u
... Show MoreWellbore instability is a significant problem faced during drilling operations and causes loss of circulation, caving, stuck pipe, and well kick or blowout. These problems take extra time to treat and increase the Nonproductive Time (NPT). This paper aims to review the factors that influence the stability of wellbores and know the methods that have been reached to reduce them. Based on a current survey, the factors that affect the stability of the wellbore are far-field stress, rock mechanical properties, natural fractures, pore pressure, wellbore trajectory, drilling fluid chemicals, mobile formations, naturally over-pressured shale collapse, mud weight, temperature, and time. Also, the most suitable ways to reduce well
... Show MoreAbstract [email protected] Background: Acute Traumatic Stress Disorder (ATSD) might be complicated by Post Traumatic Stress Disorder (PTSD). Psychological First Aid (PFA) said to be helpful to reduce the possibility of reduction of ASD and PTSD symptoms. PFA is simple procedure to deliver help & support to victims, may be by some one close to him, quietly and professionally. Iraq has and is still experiencing, continuous traumatic stresses. ATSD is especially seen in war such as during the Gulf War, Embargo and nowadays under the current American occupation. With the extreme shortage of recourses and the given late priority to psychological problems and intervention have disastrous consequences on the psycho-social wellbeing of peop
... Show MoreThe occurrences of invasive candidiasis has increased over the previous few decades. Although Candida albicans considers as one of the most common species of organisms, that cause acquired fungal infections. Candida albicans is an opportunistic fungal pathogen and inherent in as a lifelong, the yeast is present in healthy individuals as a commensal, and can reside harmlessly in human body. However, in immuno-compromised individuals, the fungus can invade tissues, producing superficial infections and, in severe cases, life-threatening systemic infections. This review wills emphasis on virulence factor of C. albicans including (adhesion, invasion, candida proteinase, and phenotypic switching and biofilm formation. I
... Show MoreConventional dosage forms for topical and transdermal drug delivery have several disadvantages related mainly to its poor skin permeation and patient compliance. Many approaches have been developed to improve these dosage forms. Film forming drug delivery systems represents a recent advancement in this field. It provides improved patient compliance with enhanced skin permeation of drugs. In its simplest form, these consist of a polymeric solution, usually in a supersaturated state, in a suitable solvent. A plasticizer is usually added to improve the flexibility and enhance the tensile strength to the film. It is also possible to control and sustain the drug release from the films by controlling the polymeric content, concentration o
... Show MoreWorldwide, enormous amounts of waste cause major environmental issues, including scrap tires and plastic, and large waste, a consequence of the demolition of buildings, including crushed concrete, crushed clay bricks, and crushed thermo-stone. From that point, it’s possible to consider that the recycling processes for these materials and using them in the manufacturing field will reduce the adverse effects on the environment of these wastes and the consumption of natural resources. Sustainable concrete blocks can be considered as one of the products produced by using these materials as partial volume replacement of the coarse, fine aggregate, or cement content, considering their dry density, workability, absorption, co
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Praise be to God, and prayers and peace be upon our master Muhammad, the Messenger of God, and upon his family, companions, and those who are guided by his guidance.
Then:
Our Islamic jurisprudence and its basic principles are fixed, namely: the Noble Qur’an, then the Prophet’s Sunnah, then consensus, then analogy. However, it is characteristic of what makes it developed to meet the requirements of renewed life, including: sent interests, custom, approval, blocking pretexts, changing times. That is why it went through different stages, growth, brilliance, stagnation and endowment; Therefore, many scholars of Islamic jurisprudence divided its stages into four sections: the stage of inf
... Show MoreThe maximization of the net present value of the investment in oil field improvements is greatly aided by the optimization of well location, which plays a significant role in the production of oil. However, using of optimization methods in well placement developments is exceedingly difficult since the well placement optimization scenario involves a large number of choice variables, objective functions, and restrictions. In addition, a wide variety of computational approaches, both traditional and unconventional, have been applied in order to maximize the efficiency of well installation operations. This research demonstrates how optimization approaches used in well placement have progressed since the last time they were examined. Fol
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