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.
The accounting system of government is considered an important tool to follow up the financial transactions that reflect the activities of governmental units and by which the useful information for estimating governmental annual revenues and expenditures are provided through the state public budget because it is an information system that provides detailed past performance, as well as measures the efficiency of the governmental agencies performance in implementing the budget, and the of success governmental units is measured through the type of services and programs offered, their size and the possibility of achieving the objectives assigned to them. The medical evacuation program is one of the medical and curative health services provid
... Show MoreThe research deals with the problem of visual pollution, as it is one of the most important urban problems that cities suffer from. The concept of visual pollution has recently emerged to describe the deformation and degradation of the urban environment. Visual pollution is defined as any component of the surrounding environment that is inconsistent and not homogeneous with its natural and human components. The volume of visual pollution has doubled due to the non-compliance with the laws, regulations and controls set by the Municipality of Baghdad by the citizens, and to the weak municipal role that the municipality plays in implementing these laws. Therefore, it has become necessary to know the manifestations of visual pollution and th
... Show MoreThe current research aims to measure the level of entrepreneurial orientation and its dimensions (creativity, independence, proactivity, risk tolerance, and achievement) in the National Security Chancellery, as its importance and role in guiding senior leaders of the chancellery to make strategic decisions with high quality in various Iraqi concerns, more specifically the security aspect. The data was collected from 94 individuals (the research sample) from the research community (120) individuals at different administrative levels and intentionally where the questionnaire was adopted as a main tool for data collection and the primary data was analyzed through descriptive and inferential statistical methods (arithmetic mean, standard dev
... Show MoreThe formal integration of the interior spaces in general and the commercial spaces of the watch shops in the large commercial centers in particular is the goal that the designers aim to reach in order for the interior space to become successful in terms of the design idea and its characteristics. Implementation mechanism. One of the reasons for achieving formal integration in the interior spaces of watch shops is the requirements of the design that must be available in these spaces to reach a state of formal integration between the interior and the exterior so that the space becomes fully integrated in all respects. Because of the aforementioned reasons for dealing with the research, through four chapters: The first chapter included the
... Show MoreThe city suffers from the weakness of the civil defense to provide services where there are clusters of residential Guy covered services for that requires the study of the geographic distribution of the civil defense centers in Baghdad care great because they take care of Protect the population and their own property and protect state institutions. Through a review of the problems faced it is expected that this study will help decision-makers to take appropriate steps to develop this service core
Purpose: Despite the high clinical accuracy of dynamic navigation, inherent sources of error exist. The purpose of this study was to improve the accuracy of dynamic navigated surgical procedures in the edentulous maxilla by identifying the optimal configuration of intra-oral points that results in the lowest possible registration error for direct clinical implementation. Materials and methods: Six different 4-area configurations were tested by 3 operators against positive and negative controls (8-areas and 3-areas, respectively) using a skull model. The two dynamic navigation systems (X-Guide® and NaviDent®) and the two registration methods (bone surface tracing and fiducial markers) produced four registration groups. The accuracy of the
... Show MoreThe current study was designed to investigate the histological structure of the cerebellum in the Iraqi frog
In his masterpiece ’The Prophet’, Kahlil Gibran presents his unwavering faith and passionate belief in the healing power of universal love that brings humans to sublime ideas and elevates their souls and behavior. The current study aims to find out the stylistic devices utilized to represent the concept of love based on the hypothesis that Gibran tends to use certain stylistic effects to convey his meaning. The study adopts Leech and Short’s (2007) framework of stylistic analysis to analyze the lexical items and figures of speech in selected extracts from the book. The findings reveal that Gibran prefers concrete nouns, dynamic verbs, and physical adjectives over abstract nouns, stative verbs, and psychological adjectives to s
... Show More