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 principle of citizenship has international dimensions that affect the application of the principle, such as the structure of the international system, and the control of the concepts of globalization, international organizations which played an important role in the consolidation of this principle.
The problem of the study revolves around the effects of international variables on the principle of citizenship in Kuwait during the period 1991-2018.
The study used several indicators, such as: the rule of law, achieving the principle of separation of powers, the right to form parties, the application of the law of nationality, and racial discrimination, women's rights, and freedom of expression.
The heat transfer and flow resistance characteristics for air flow cross over circular finned tube heat exchanger has been studied numerically and experimentally. The purpose of the study was to improve the heat transfer characteristics of an annular finned-tube heat exchanger for better performance. The study has concentrated on the effect of the number of perforations and perforations shapes on the heat transfer and pressure drop across a staggered finned tube heat exchanger. The Numerical part of present study has been performed using ANSYS Fluent 14.5 using SST Turbulent model, while the experimental study consist from a test rig with different models of heat exchangers and all required measurement devices were build
... Show MoreAlice Walker's novel The Color Purple1983, whose events take place in the rural Georgia and addresses the most important issues in the early 20thcentury; like male dominant society and women submission to men, weaves a mosaic picture of male-female relationships. Black men like Alphonso, Albert and Harpo are portrayed as oppressors, cruel and they exercise power and violence over their wives and daughters. Through the negative portrayal of black male characters, Walker is accused to be a men hating writer because she ''Views oppression as an essentially masculine activity which springs from the male's aggressive need to dominate. In the novel, man is the premium mobile, the one by whom and t
... Show MoreThis study deals with the time property in the cinema through two films: (The Knife) directed by Khalid Hamada and (The Deceived) directed by Tawfiq Saleh. These two films were excerpted by the cinema from two novels of the Palestinian writer Ghassan Kanafani, the first is from the novel (What is Left for You) and the second is from the novel (Men in the Sun). If the Palestinian novel has imposed its presence on the Arab creative scene through a group of novelists who took it upon themselves to communicate their cause to the world, the Palestinian cinema has been far from being a purely Palestinian, because many of the cinematic works have been provided by Arab countries on the issue, while this cinema is still seeking
... Show MoreIn this study, a bioadhesive dosage form of eoconazole nitrate for vaginal delivery was designed using a combination of bioadhesive polymers: Carbopol 941 p and sodium carboxymethylcellulose or methylcellulose in different ratios. The bioadhesive strength was evaluated by measuring the force required to detach the tablet from sheep vaginal mucosal membrane. It was found that the bioadhesive force was directly proportional to Carbopol 941 p content in the different formulae. The formulae were tested for their swelling behavior using agar gel plate method. The results showed that formulae containing a combination of Carbopol 941 p and sodium carboxymethylcellulose had greater swelling index
... Show MoreThis paper is devoted to an inverse problem of determining discontinuous space-wise dependent heat source in a linear parabolic equation from the measurements at the final moment. In the existing literature, a considerably accurate solution to the inverse problems with an unknown space-wise dependent heat source is impossible without introducing any type of regularization method but here we have to determine the unknown discontinuous space-wise dependent heat source accurately using the Haar wavelet collocation method (HWCM) without applying the regularization technique. This HWCM is based on finite-difference and Haar wavelets approximation to the inverse problem. In contrast to othe
Aim: The present study aims to improve the poor water solubility of zaltoprofen which is a non-steroidal anti-inflammatory drug (NSAIDs) with a potent analgesic effect using solid dispersion then formulate it as a hollow type suppository to be more convenient for geriatric patients. Materials and Method: Zaltoprofen solid dispersions were prepared by solvent evaporation technique in different zaltoprofen: Soluplus® ratios. Results: Among the formulations tested, zaltoprofen solid dispersion preparation using 1:5 (zaltoprofen: Soluplus®) ratio showed the highest solubility and selected for further investigation. Solid dispersion characterization was evaluated by differential scanning calorimetry (DSC), X-ray diffraction study (XRD) and Fou
... Show MoreThis study investigates the performance of granular dead anaerobic sludge (GDAS) bio-sorbent as permeable reactive barrier in removing phenol from a simulated contaminated shallow groundwater. Batch tests have been performed to characterize the equilibrium sorption properties of the GDAS and sandy soil in phenol-containing aqueous solutions. The results of GDAS tests proved that the best values of operating parameters, which achieve the maximum removal efficiency of phenol (=85%), at equilibrium contact time (=3 hr), initial pH of the solution (=5), initial phenol concentration (=50 mg/l), GDAS dosage (=0.5 g/100 ml), and agitation speed (=250 rpm). Fourier transform infrared (FTIR) analysis proved that the carboxylic acid, aromatic, alk
... Show MoreThe objective of the conventional well testing technique is to evaluate well- reservoir interaction through determining the flow capacity and well potential on a short-term basis by relying on the transient pressure response methodology. The well testing analysis is a major input to the reservoir simulation model to validate the near wellbore characteristics and update the variables that are normally function of time such as skin, permeability and productivity multipliers.
Well test analysis models are normally built on analytical approaches with fundamental physical of homogenous media with line source solution. Many developments in the last decade were made to increase the resolution of transient response derivation to meet the
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