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 theme of love has been and still is the interest of authors and writers for it is closely related to people’s lives. That great passion has helped them express genuine thoughts pertinent to that theme that has given rise to many debates, some are vague and others controversial. In his (strait is the gate), (La Porte étroite), André Gide has sought to shed light on his characters perspective of love and its relationship with sacredness and divine happiness. Indeed these characters have found often themselves restrained, chained and exhausted, by tough religious commands that have imposed on them spiritual commitments and duties too hard to break.
André Gide has revealed a protestant deviation from the perfection theme tha
... Show MoreRehabilitation robots are widely recognized as vital for restoring motor function in patients with lower-limb impairments. A Modified Fractional-Order Proportional-Integral-Derivative (MFOPID) controller is proposed to improve trajectory tracking of a 2-DoF Lower Limb Rehabilitation Exoskeleton Robot (LLRER). The classical FOPID is augmented with a modified control formulation by which steady-state error is reduced and the transient response is sharpened. Controller gains and fractional orders were tuned offline using a hybrid metaheuristic Improved Elk Herd Optimization hybridized with Grey Wolf and Multi-Verse Optimization algorithms (IElk-GM) so that exploration and exploitation are balanced. Superiority over the classical FOPID
... Show MoreThe reaction of methyldopa with o-vanillin in refluxing ethanol afforded Schiff base and characterized through physical analysis with a number of spectra also the study of biological activity. The geometry of the Schiff base was identified through using (C.H.N) analysis, Mass, 1H-NMR, FT-IR, UV-Vis spectroscopy. Metal complexes of Cr3+, Mn2+, Co2+, Ni2+, Cu2+, Zn2+, Cd2+ and Hg2+ with Schiff base have been prepared in the molar ratio 2:1 (Metal:L), (L = Schiff base ligand) except Hg2+ at molar ratio 1:1 (Hg:L). The prepared complexes were characterized by using Mass, FT-IR and UV-Vis spectral studies, on other than magnetic properties and flame atomic absorption, conductivity measurements. According to the results a dinuclear octahedral geo
... Show Moreرافقت القسوة الانسان منذ القدم وكثيرا ما تم الخلط بينها وبين العنف لشدة التقارب بينهما , وهنا يحاول البحث ان يفصل بين كلا المفهومين ويتفرد بمفهوم القسوة, الذي سلط عليه الضوء في المسرح لأول مرة على يد الفرنسي(انطوان ارتو) في محاولة للكشف عن المعالجة الاخراجية التي قدمها المخرج العراقي(صميم حسب الله) لمفهوم القسوة في مسرحيته الموسومة (خريف) ويتضمن البحث نبذه (مفهوم القسوة في الفكر الانساني) وكذلك (الق
... Show MoreJohn Updike’s use of setting in his fiction has elicited different and even conflicting reactions from critics, varying from symbolic interpretations of setting to a sense of confusion at his use of time and place in his stories. The present study is an attempt at examining John Updike’s treatment of binary settings in Pigeon Feathers and Other Stories (1962) to reveal theme, characters’ motives and conflicts. Analyzing Updike’s stories from a structuralist’s perspective reveals his employment of two different places and times in the individual stories as a means of reflecting the psychological state of the characters, as in “The Persistence of Desire”, or expressing conflicting views on social and political is
... Show MoreStatistical methods of forecasting have applied with the intention of constructing a model to predict the number of the old aged people in retirement homes in Iraq. They were based on the monthly data of old aged people in Baghdad and the governorates except for the Kurdistan region from 2016 to 2019. Using Box-Jenkins methodology, the stationarity of the series was examined. The appropriate model order was determined, the parameters were estimated, the significance was tested, adequacy of the model was checked, and then the best model of prediction was used. The best model for forecasting according to criteria of (Normalized BIC, MAPE, RMSE) is ARIMA (0, 1, 2).
In this numerical study a detailed evaluation of the heat transfer characteristics and flow structure in a laminar and turbulent flow through a rectangular channel containing built-in of different type vortex generator has been a accomplished in a range of Reynolds number between 500 and 100,000.A modified version of ESCEAT code has been used to solve Navier-Stokes and energy equations. The purpose of this paper is to present numerical comparisons in terms of temperature, Nusselt number and flow patterns on several configurations of longitudinal vortex generator including new five cases. The structures of heat and flow were studied, using iso-contours of velocity components, vortices, temperature and Nusselt n
... Show MoreIn this work, a single pile is physically modeled and embedded in an upper liquefiable loose sand layer overlying a non-liquefiable dense layer. A laminar soil container is adopted to simulate the coupled static-dynamic loading pile response during earthquake motions: Ali Algharbi, Halabjah, El-Centro, and Kobe earthquakes. During seismic events with combined loading, the rotation along the pile, the lateral and vertical displacements at the pile head as well as the pore pressure ratio in loose sandy soil were assessed. According to the experimental findings, combined loading that ranged from 50 to 100% of axial load would alter the pile reaction by reducing the pile head peak ground acceleration, rotation of the pile, and lateral displacem
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