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.
Hyperprolactinemia is a common endocrine abnormality caused by physiological factors like pregnancy and lactation, drug-induced factors like antipsychotics, pituitary adenomas that secrete prolactin, or stalk compression or section that reduces dopamine inhibition. Dopamine agonists cure most prolactinomas.
To assess response to treatment in micro versus macroprolactinoma.
One of the most important features of American foreign activity during the second half of the 19th century was the encouragement of sending Protestant missionary missions to all countries around the world. The mission of these missions was facilitated by the weakened state of the Ottoman Empire, the increasing influence of European countries, and their interference in its internal affairs. Despite the Ottoman efforts to counter the activities of these missions, the American missionary missions adopted a well-planned strategy that suited the conditions of the region, aimed at achieving their goals through direct and indirect methods, including intervention in the field of education. These missions gave great importance to educational aspects
... Show MoreCovalent modification of protein by drugs may disrupt self-tolerance, leading to lymphocyte activation. Until now, determination of the threshold required for this process has not been possible. Therefore, we performed quantitative mass spectrometric analyses to define the epitopes formed in tolerant and hypersensitive patients taking the β-lactam antibiotic piperacillin and the threshold required for T cell activation. A hydrolyzed piperacillin hapten was detected on four lysine residues of human serum albumin (HSA) isolated from tolerant patients. The level of modified Lys541 ranged from 2.6 to 4.8%. Analysis of plasma from hypersensitive patients revealed the same pattern and leve
We define L-contraction mapping in the setting of D-metric spaces analogous to L-contraction mappings [1] in complete metric spaces. Also, give a definition for general D- matric spaces.And then prove the existence of fixed point for more general class of mappings in generalized D-metric spaces.
The Jeribe Formation, the Jambour oil field, is the major carbonate reservoir from the tertiary reservoirs of the Jambour field in northern Iraq, including faults. Engineers have difficulty organizing carbonate reserves since they are commonly tight and heterogeneous. This research presents a geological model of the Jeribe reservoir based on its facies and reservoir characterization data (Permeability, Porosity, Water Saturation, and Net to Gross). This research studied four wells. The geological model was constructed with the Petrel 2020.3 software. The structural maps were developed using a structural contour map of the top of the Jeribe Formation. A pillar grid model with horizons and layering was designed for each zone. Followin
... Show MoreIn the years recently city planning projects have been confirmed sustainable high concentration on planning streets and pedestrian paths being the most prominent component of the urban structure in the city and these me and diverse departments link the city’s sectors and serve as a space for economic, service, and social activities. On the other hand, pedestrian traffic is an essential component of the various means of transportation within the city. Suffer cities in the Middle East and Arab cities in particular are neglecting pedestrian paths in the vital urban environment. Vehicle control mechanisms on roads, and changing the uses of pedestrian paths as result of encroaching on the sidewalks designated for pedestrians. Which leads to a
... Show MoreWe propose a new method for detecting the abnormality in cerebral tissues present within Magnetic Resonance Images (MRI). Present classifier is comprised of cerebral tissue extraction, image division into angular and distance span vectors, acquirement of four features for each portion and classification to ascertain the abnormality location. The threshold value and region of interest are discerned using operator input and Otsu algorithm. Novel brain slices image division is introduced via angular and distance span vectors of sizes 24˚ with 15 pixels. Rotation invariance of the angular span vector is determined. An automatic image categorization into normal and abnormal brain tissues is performed using Support Vector Machine (SVM). St
... Show MoreSub-threshold operation has received a lot of attention in limited performance applications.However, energy optimization of sub-threshold circuits should be performed with the concern of the performance limitation of such circuit. In this paper, a dual size design is proposed for energy minimization of sub-threshold CMOS circuits. The optimal downsizing factor is determined and assigned for some gates on the off-critical paths to minimize the energy at the maximum allowable performance. This assignment is performed using the proposed slack based genetic algorithm which is a heuristic-mixed evolutionary algorithm. Some gates are heuristically assigned to the original and the downsized design based on their slack time determined by static tim
... Show MoreIn recent years, there has been a rise in interest in the study of antibiotic occurrence in the aquatic environment due to the negative consequences of prolonged exposure and the potential for bacterial antibiotic resistance. Most antibiotic residues from treated wastewater end up in the aquatic environment as they are not eliminated in facilities that treat wastewater. Antibiotics must be identified in influent and effluent wastewater using reliable analytical techniques for several reasons. Firstly, monitoring antibiotic presence in aquatic environments. Secondly, assessing environmental risks, computing wastewater treatment plant removal efficiencies, and estimating antibiotic consumption. Therefore, this work aims to provide an overview
... Show MoreIn the last few years, the Internet of Things (IoT) is gaining remarkable attention in both academic and industrial worlds. The main goal of the IoT is laying on describing everyday objects with different capabilities in an interconnected fashion to the Internet to share resources and to carry out the assigned tasks. Most of the IoT objects are heterogeneous in terms of the amount of energy, processing ability, memory storage, etc. However, one of the most important challenges facing the IoT networks is the energy-efficient task allocation. An efficient task allocation protocol in the IoT network should ensure the fair and efficient distribution of resources for all objects to collaborate dynamically with limited energy. The canonic
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