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.
Abstract
The study aims to know the degree of secondary school managers' practice of servant leadership in Gaza from their teachers’ perspective. It further aims to examine whether there are any statistically significant differences at (α 0.05≥) between the means of the study sample’s members attributed to variables such as (gender, educational qualification, and years of experience). To achieve the objectives of the study, the study adopted the descriptive survey method, using a questionnaire consisting of (30) items distributed to four domains: (workers service, ethical dealing, motivation & influence, and building an organized, integrated society). Then, the questionnaire was distributed to t
... Show MoreThe study aims to set an image to the mechanisms of the skills of the 21st century in the educational competencies of the basic education stage. To achieve this aim, a qualitative research design has been adopted in its analytical content analysis way. The study has arrived to the following conclusions: the availability of: the communicative and team work skills with a percentage of 25.9%, linguistic competency with a percentage of 24.6%, the skills of local and global citizenship, creativity, and problem solving with a percentage of 13.6%, critical thinking with a percentage of 10.38%, technological culture with a percentage of 5.8%, pioneerism and initiativeness with a percentage of 10.38%, technological culture with a percentage of
... Show MoreThis study included isolation and characterization of extremely halophilic bacteria from Al-Massab Al-Aam region in South of Iraq Fifty isolates were identified by using numerical taxonomy 40 strains belonged to the genus Halobacterium which inclucted Hb. halobium Hb. cutirubrum Hb. salinarium Hb. saccharovorum Hb. valismortis and Hb. volcanii. Ten strains belonged to the genus Halococcus which included Hc. morrhuae Hc. saccharolyticus. Growth curves were sensitive mutants determined for wild type and salt Generation time in logarthmic phase was measured and found to be (10.37 2hr 7 0.59) for Hb. salinarium / 18 (6.490 hr 0.24) for Hb. cutirubrum / 32, (6.700 hr + 0.488) for Hb. valismortis / 20, (11.243 hr + 0.96) for Hb. volcanii / 7. (7
... Show MoreThis research deals with one scene from the movie Romeo and Juliet, which is the balcony scene, due to the importance of this scene in the formation of the construction of the subsequent events of the movie.
The first chapter contained the methodological framework of the research, where the research problem was identified in how Zeffirelli dealt with the balcony scene in the play Romeo and Juliet and enriched it in the cinematic language with a comparison with the original text of the scene. In the balcony scene with comparative parts between the film and the text and the limits of the research that was limited to the film Zeffirelli and the translated text by Munis Taha Hussein.
The second chapter contained the theoretic
... Show MoreObjective(s): The present study aims at assessing the prevalence of smoking among health workers in Baghdad Teaching Hospital and to find out the effectiveness of instructional booklet concerning risk of smoking on health workers′ knowledge in hospital.
Methodology: A pre-experimental design study was conducted from 1st of October 2019 to 17th of March 2020. A non-probability sample consists of (500) participant (343 non-smokers and 157 smokers) from (1500) health workers in Baghdad Teaching Hospital, they included the physicians, nurses, pharmacists, physiotherapists, Laboratory Technicians, Medical Assistants. A questionnaire is constructed to evaluate the effectiveness of instructional booklet on health workers’ knowledge
The interactive websites are the interaction between the product and the user, and interactive design is based on the user interface for communication and how the interface responds to the user and how to help him to achieve his goals and enjoy the use of the interface. The interactive design is based on the design of interactive programs, i.e., programs that directly interact with the user, taking into account the different culture of the audience, the age group and many other factors. An example for the use of the user interface: Web designs, smartphone application designs and it even includes computer operating systems and electronic game interface. The interaction is the communication between the source and the receiver. The we
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This study aims to identify the level of patients’ satisfaction among a sample of hospitalized patients in the targeted hospital (Al-Kindy Teaching Hospital, and Al-Yarmook Teaching Hospital). Moreover, this study highlights the reality of services for patients, especially in the targeted governmental teaching hospitals. The Patient Satisfaction with Nursing Care (PSNCS) has been measured in these hospitals through the revised scale by Tang et al, (2013).This scale includes four major domains; Health Information (5 items), Influencing Support (4 items), Decision Control (4 items), Specialized Technical Competence (7 items). The method of surveying patients’ opinions about the degree
... Show MoreThere is a global shortage of health care providers needed to address all levels of primary and specialty care. The recent COVID-19 pandemic also highlights the importance and added value of health professionals with specialty training in infectious diseases. In the United States, advanced practice providers (APPs) are being engaged to meet the expanding demand for generalist and specialist patient care. The history and development of advanced practice registered nurses (APRNs) and physician assistants (PAs), are discussed as collaborative healthcare providers to promote better understanding of the ways they can be incorporated into a healthcare system. An example of how APPs are utilized to provide both inpatient and outpatient
... Show MoreThe fast evolution of cyberattacks in the Internet of Things (IoT) area, presents new security challenges concerning Zero Day (ZD) attacks, due to the growth of both numbers and the diversity of new cyberattacks. Furthermore, Intrusion Detection System (IDSs) relying on a dataset of historical or signature‐based datasets often perform poorly in ZD detection. A new technique for detecting zero‐day (ZD) attacks in IoT‐based Conventional Spiking Neural Networks (CSNN), termed ZD‐CSNN, is proposed. The model comprises three key levels: (1) Data Pre‐processing, in this level a thorough cleaning process is applied to the CIC IoT Dataset 2023, which contains both malicious and t