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.
Each organization has values and objectives, tangible and intangible properties of its products. The reflection of properties on the brand constitutes the identity of the brand that contributes to building the customer's convictions about the products or services provided by any organization and its brand in a positive or negative way. This is reflected in purchasing behavior, which may push forward the progress towards marketing goals or deviation from them. Therefore, the current research came to identify the brand identity, its types and the factors affecting them and how they affect to achieve each of the marketing goals. At a time when
... Show MoreRecently, all over the world mechanism of cloud computing is widely acceptable and used by most of the enterprise businesses in order increase their productivity. However there are still some concerns about the security provided by the cloud environment are raises. Thus in this our research project, we are discussing over the cloud computing paradigm evolvement for the large business applications like CRM as well as introducing the new framework for the secure cloud computing using the method of IT auditing. In this case our approach is basically directed towards the establishment of the cloud computing framework for the CRM applications with the use of checklists by following the data flow of the CRM application and its lifecycle. Those ch
... Show MoreThis paper proposes a self organizing fuzzy controller as an enhancement level of the fuzzy controller. The adjustment mechanism provides explicit adaptation to tune and update the position of the output membership functions of the fuzzy controller. Simulation results show that this controller is capable of controlling a non-linear time varying system so that the performance of the system improves so as to reach the desired state in a less number of samples.
Background: Nursing interventions tailored to the smoking triggers in patients with non-communicable chronic diseases are essential. However, these interventions are scant due to the nature of factors associated with smoking cessation and the poor understanding of the effect of nurse-led intervention in Iraq.Purpose: This study aimed to determine the dominant smoking triggers and examine the effects of a tailored nursing intervention on smoking behavior in patients with non-communicable chronic diseases.Methods: Convenience samples of 128 patients with non-communicable chronic diseases, male and female patients, who were 18-70 years old, were recruited in this quasi-experimental, randomized comparative trial in the outpatient clinic
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The research aims to build a training program to develop some executive functions for kindergarten children. To achieve this goal, the two researchers built the program according to the following steps:
1. Determining the general objective of the program.
2. Determining the behavioral objectives of the program.
3. Determining the included content in the program.
4. Implementing the content of the activities of the program.
5. Evaluating the Program.
The program included (12) training activities, the training activities included several items: the title of the activity, the time of implementation of the activity, the general objective of the activity, the procedural behavioral objective, the means and tools u
In this article, we aim to define a universal set consisting of the subscripts of the fuzzy differential equation (5) except the two elements and , subsets of that universal set are defined according to certain conditions. Then, we use the constructed universal set with its subsets for suggesting an analytical method which facilitates solving fuzzy initial value problems of any order by using the strongly generalized H-differentiability. Also, valid sets with graphs for solutions of fuzzy initial value problems of higher orders are found.
This paper deals with defining Burr-XII, and how to obtain its p.d.f., and CDF, since this distribution is one of failure distribution which is compound distribution from two failure models which are Gamma model and weibull model. Some equipment may have many important parts and the probability distributions representing which may be of different types, so found that Burr by its different compound formulas is the best model to be studied, and estimated its parameter to compute the mean time to failure rate. Here Burr-XII rather than other models is consider because it is used to model a wide variety of phenomena including crop prices, household income, option market price distributions, risk and travel time. It has two shape-parame
... Show MoreIn this investigation, water-soluble N-Acetyl Cysteine Capped-Cadmium Telluride QDs (NAC/CdTe nanocrystals), utilizing N-acetyl cysteine as a stabilizer, were prepared to assess their potential in differentiating between DNA extracted from pathogenic bacteria (e.g. Escherichia coli isolated from urine specimen) and intact DNA (extracted from blood of healthy individuals) for biomedical sensing prospective. Following the optical characterization of the synthesized QDs, the XRD analysis illustrated the construction of NAC-CdTe-QDs with a grain size of 7.1 nm. The prepared NAC-CdTe-QDs exhibited higher PL emission features at of 550 nm and UV-Vis absorption peak at 300 nm. Additionally, the energy gap quantified via PL and UV–Vis were 2.2 eV
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