Clopidogrel is a prodrug that must be transformed into an active metabolite by hepatic cytochrome P450 (CYP) isoenzymes to prevent platelet clotting. Polymorphisms of the CYP2C19 gene can cause a reduction or complete loss of CYP2C19 enzyme activity resulting in inhibiting clopidogrel metabolism, effectiveness and increase stroke recurrence risk in ischemic stroke patients. This study aims to investigate the correlation between genetic polymorphisms in CYP2C19*2 and*3 and recurrent risk in patients with ischemic stroke taking clopidogrel 75mg in Kurdistan region –Iraq. This retrospective case-control study was carried out at Kurdistan, Erbil, Medicina medical center, and Rizgary general hospital from January 2021 to August 2021. The blood sample was taken from the participants and tested for genotyping. The collection of data was taken from patients' medical charts in the hospital and patients’ electronic medical records from the neurology clinic. Sixty patients participated, (34) were male and (26) were female, with age range (38-96) years, diagnosed from not more than two years with ischemic stroke and taking 75 mg clopidogrel maintenance dose. Genotyping analysis showed 61.7 % were homozygotes for wild allele *1, the heterozygotes divided into 26.7% (*1/*2) and 6.7 % (*1/*3) genotype, while the homozygotes for mutant alleles CYP2C19*2,*3 distributed in 3.3 %(*2/*2) and 1.7 %(*3/*3). The (*2/*3) was not detected in the study population. A significant relation was found between risk of stroke recurrence with carrying the variant allele CYP2C19 *2, reduced CYP2C19 enzyme metabolic activity, and ACEIs/ARBs usage (P = 0.024, P = 0.039, P=0.24 respectively). On the other hand, there was no significant relationship between the risk of stroke recurrence and carrying the variant allele CYP2C19 *3 (P = 1.000). Ischemic stroke patients treated with clopidogrel and carrying a CYP2C19*2 allele had a higher risk of recurrent stroke as it is associated with reduced the metabolic activity of CYP2C19 enzyme leading to reduction of clopidogrel effect.
Mechanism of Arbitration in the Stock Exchange Disputes
This research tackles the play of Synge "Rider to the Sea" to find out whether the
theories of Leech (1983) and Brown and Levinson (1987) can be applied or not to this study.
The model of Leech (1983) consists of seven principles and for Brown and Levinson
(1987),it consists of two principles of politeness where one of them is positive and the other is
negative politeness.
It is hypothesed that:
1. There is a relation between the two theories.
2. Synge deals with these theories in such a way to depict his characters.
3. It is also hypothesed that every character deals with these principles in such a way to show
the events of the play.
The study concludes that there is a relation between the two theories in d
The aim of the research is to clarify the role of service quality through its dimensions represented by (tangibility, reliability, safety, response, empathy) in tax compliance with taxpayers, i.e. performance of the duties and obligations of the taxpayer through its dimensions (registration, accounting, payment of the amount of tax), and to know For this role, a sample was taken from the taxpayers of the branches of the General Authority for Taxes spread in the governorate of Baghdad and its affiliated districts, which amount to (15) tax branches, as (215) questionnaires were distributed to know the impressions and reactions of the taxpayers regarding the level of service quality through the aforementioned dimensions. Using the statistic
... Show MoreThe Sacrament of Marriage in the Christian Religion
Abstract
The cultural contrast is considered of the essential subjects in the field of administration of international businesses which have great and effective role for representation in one social system for the individuals have various belongings, and the nursing performance is considered an essential basic for health care, thus a discussion for two variables have done to formulate the intellectual frame for this research which are( the cultural contrast and the nursing performance). depended a questionnaire as a research tool by(90) he/ she nurses of the Iraqis and the arrivals( the
... Show MoreAbstract: The term extremism refers to the distance from moderation, excess and hyperbole, and it is a relative term that varies from one society to another, according to the prevailing traditions, values and culture, as the problem of extremism is one of the main issues that contemporary societies are concerned with is a phenomenon that has its roots in the intellectual formation of societies. By knowing the concept of extremism, we can identify the reasons that contributed to the existence of extremism as a phenomenon, on the one hand; on the other hand, to clarify the role of women in combating extremism and developing effective solutions to reduce this phenomenon. As women play a major role in society, starting from the family to educa
... Show MoreAbstract: In accordance with contemporary Western thinking, power is an organized force with a high ability to achieve stability and social security because it possesses tools based on rational organization, which helps it to control the behavior of the individual and society and prevent them from practicing the processes of exclusion and discrimination against others in pursuit of their interests and needs. Vision The philosophers and thinkers of the theory of social contract can consolidate it, which changed the form and nature of power from the traditional heritage to the constructionWhich has contributed to the development and development of civil society - Western political, and despite the success of this experiment, especially aft
... Show More<p>There is an Increasing demand for the education in the field of E-learning specially the higher education, and to keep contiuity between the user and the course director in any place and time. This research presents a proposed and simulation multimedia network design for distance learning utilizing ATM technique. The propsed framework determines the principle of ATM technology and shows how multimedia can be integrated within E- learning conteext. The first part of this research presents a theoretical design for the Electricity Department, university of technology. The purpose is to illustrate the usage of the ATM and Multimedia in distance learning process. In addition, this research composes two entities: Software entity
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